Your gastroenterologist performs a high resolution anoscopy (HRA) for screening high risk patients for anal cancers and dysplasia. How would you report the services?
Read on to know how you can apply Category III codes to get HRA reimbursement.
Support Necessity With Risk Factors
Patients may be at high risk for forms of anal dysplasia and cancer, even though they do not have any presenting signs and symptoms. For this purpose, some gastroenterologists use high resolution anoscopy to screen high risk patients for early detection of any anal lesions such as dysplasia or cancer.
High risk patients can need special screening for neoplasms due to a personal history or family history, HIV (042, Human immunodeficiency virus (HIV) disease), women or men with human papilloma virus (HPV) related conditions (079.4, Human papillomavirus in conditions classified elsewhere and of unspecified site), and other immune compromised patients.
ICD-9 connection: Your ICD-9 diagnosis code choices for patients that fall into the high risk category, thereby increasing the need for high resolution anoscopy screening, include V76.41 (Screening for malignant neoplasms of the rectum), V76.49 (Special screening for malignant neoplasms other sites) and V76.89 (Special screening for other malignant neoplasms).
Example: You may read that a 69-year-old male patient presents to your gastroenterologist’s office with a prior history of neoplasm of the rectum. Although there are no presenting symptoms, your gastroenterologist decides upon screening with HRA to rule out any new lesions.
As your gastroenterologist is only performing this procedure for screening purposes, you can report the procedure with the Category III code 0226T (Anoscopy, high resolution [HRA] [with magnification and chemical agent enhancement]; diagnostic, including collection of specimen[s] by brushing or washing when performed) along with V76.41 to support the need for screening.
Tip: You will need to carefully look through the documentation to check if...
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