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National Colorectal Awareness Month

Coding Educator, March 15, 2010

By: Jennifer Avery, CCS, CPC, CPC-H, CCDS

February was National Cancer Prevention Month, and we looked at ways to prevent various forms of cancer during that time. However March is National Colorectal Cancer Awareness Month, so we will take a look at ways to reduce risk and look for symptoms of this specific type of cancer.
 
Colorectal cancer is a cancer of the colon or rectum. It is equally common in men and women. In 2009, an estimated 146,970 people were diagnosed with the disease and 49,920 people died from it, according to the Prevent Cancer Foundation. However, some forms of cancer, like this one, can often be prevented or detected.
 
Individuals should determine whether they are at a higher risk for the disease. Risk factors for colorectal cancer include:
  • Tobacco use
  • Obesity
  • A family history of inflammatory bowel disease
  • A history of colorectal polyps or colorectal cancer itself
  • Age (i.e., persons aged 50 years or older are at a higher risk)
Colorectal cancer prevention and detection
 
People at a higher risk should take steps to reduce that risk when possible. The Prevent Cancer Foundation suggests the following to help reduce risk:
  • Be physically active and exercise regularly
  • Maintain a healthy weight
  • Eat a high-fiber diet rich in fruits, vegetables, nuts, beans and whole grains
  • Consume calcium-rich foods like low-fat or skim milk
  • Limit red meat consumption and avoid processed meats
  • Avoid smoking and limit excessive alcohol consumption
In addition to following these guidelines, individuals at greater risk should also undergo regular screenings for the cancer. Screening procedures can include:
  • Colonoscopies (every 10 years)
  • Virtual colonoscopies (every five years)
  • Flexible sigmoidoscopies and double-constant barium enemas (every five years)
Coding for colorectal cancer and related procedures
 
ICD-9 has created category V76.xx to identify the purpose of the screening exam for malignant neoplasms. For colorectal screening the ICD-9 code is V7.51.
 
The American Hospital Association Coding Clinic, volume 21 number 1,first quarter, 2004 addresses proper code sequencing.It says that whenever a physician performs a screening examination, coders should report the screening code first. The screening exams remains the indicator regardless of the findings or any additional procedures that the physician may need to perform (e.g., polypectomy, biopsy, etc.).
 
Screening intervals for tests that can find cancer include fecal occult blood and fecal immunochemical tests, which should be undergone annually, and stool DNA tests, the timing of which should be dictated by a physician.  
 
CPT Assistant discusses colorectal screening in the January 2004 issue, “Coding Communication: Colonoscopy Coding Made Simple.”
 
However, there is some confusion because Coding Clinic and CPT Assistant advice seems to conflict regarding proper code sequencing.
 
CPT Assistant states that the ICD-9 code should reflect the finding that required the therapeutic procedure. For example, when a physician performs a polypectomy then the first-listed diagnosis should be for the colon or rectal polyp. It then states that the code reflecting the indication (V76.51) should also be listed along with any high-risk indications.
 
Payers also have thoughts on the subject. For many insurance companies coders report the diagnostic colonoscopy code 45378 to identify the screening colonoscopy the physician performed along with diagnosis code V76.51, which identifies it was done for screening purposes.
 
However, Medicare has its own set of codes for screening exams to help with payer-specific issues. When a patient receives a screening colonoscopy and has a family history or colorectal cancer (e.g., polyps) then coders should report HCPCS II code G0105 (Colorectal cancer screening; colonoscopy on individual at high risk). If the patient has reached the indicated age to begin screening exams but has none of the identified high risk factors then coders should report HCPCS II code G0121 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk).
 
There are times when physicians begin screening exams but are not able to complete them (e.g., due to poor preparations). If coders reporting CPT code 45378, they should append modifier -52 to identify the physician discontinued the procedure. However, for Medicare, coders should report an interrupted colonoscopy screening with codes G0105 or G0121 along with modifier -53 (indicating a cancelled procedure) for the professional side and either modifier -73 or -74 (identifying the discontinuation of the procedure) for the facility side.
 
CPT Assistant also says that if a physician performs a therapeutic procedure during a screening exam then coders should report the appropriate CPT code for the therapeutic procedure. This could include the codes for a simple biopsy (code 45380), snare polypectomy (code 45385), etc. The diagnosis code should reflect the reason for the therapeutic procedure the physician performs. 
 
Check with your individual payers on how to appropriately report these services. As you can see, there is conflicting advice from coding authorities as well as from various payers.
 
Cancer is not an entirely preventable disease, but patients can take certain measures to decrease their risk. In the case of colorectal cancer, recommended screenings coupled with healthy lifestyle choices, can go a long way towards prevention and early detection. If you may be at a high risk for colorectal cancer, talk with your healthcare professional today.  
 
Editor’s note: Visit the Prevent Cancer Foundation by clicking here:

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