Coding, Classification and Reimbursement

rectosigmoid polyp

  • 1.  rectosigmoid polyp

    Posted 03-29-2018 16:06

    I'm having a conundrum of sorts with something that should be relatively easy.  What would you code for "rectosigmoid polyp"?  If I follow the index from polyp, rectum, I arrive at K62.1 – rectal polyp.  If I follow the index from polyp, colon, sigmoid, I get D12.5 – Benign neoplasm of sigmoid colon.  Just below this is D12.7 – Benign neoplasm of rectosigmoid junction, but I cannot figure out a way to get to this code through the index.  So, which is it K62.1, D12.5, or D12.7?

    Thanks,
    Laura



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    Laura Hoot, RHIT,CCS
    AMI Senior Coding Professional
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  • 2.  RE: rectosigmoid polyp

    Posted 03-29-2018 16:14
    Hi Laura,

    Does it specify rectosigmoid?  If so when I used to work Pathology we would have put D12.7.  Our guidelines stated that if it was specified on location, we used benign neoplasm.  That was our facility though.  





  • 3.  RE: rectosigmoid polyp

    Posted 03-30-2018 08:07
    Hi Jennifer,
    Documentation specifically states "rectosigmoid".  D12.7 is what I have been using, but just a little frustrated that there are no entries in the index that will lead you there.  I was helping a friend out and couldn't give her an exact way to get there. I wanted to make sure I wasn't missing something that, like I said, should be relatively simple.

    Thanks so much,
    Laura

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    Laura Hoot, RHIT,CCS
    AMI Senior Coding Professional
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  • 4.  RE: rectosigmoid polyp

    Posted 03-30-2018 10:13
    Hi Laura,

    Yeah when I look it up it points to K63.5.  But I know in my prior Pathology job we used D12.7, I think that was in the Padgett (Path authority) handbook that if you have a specified location for polyp you use benign neoplasm.  Unfortunately I don't have their guidelines anymore but I know that's what we did.  
    I'm just not sure that's across the board though as I don't work in Path anymore. 





  • 5.  RE: rectosigmoid polyp

    Posted 03-30-2018 09:29
    Dear Laura,

    Did you try running it through the encoder?

    Jodi Miller, RHIT, CCS

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    Jodi Miller, RHIT, CCS
    Outpatient Coder/Abstractor
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  • 6.  RE: rectosigmoid polyp

    Posted 04-05-2018 08:47
    Jodi,
    Thank you for the suggestion.  Although encoders are very useful tools, the book is the ultimatum for determining the correct code.  This question was presented to me by a friend and I want to provide her with the correct path through the index of how to arrive at the correct code.  Another point to consider when relying solely on the encoder is not all encoders are the same and many coders won't use the same encoder their whole career. Knowing where to find the correct code the old fashioned way is essential in coding mastery.

    Laura

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    Laura Hoot, RHIT,CCS
    AMI Senior Coding Professional
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  • 7.  RE: rectosigmoid polyp

    Posted 04-05-2018 09:38
    I used to have access to the Padgett handbook which is the authority on Pathology. Per the Padgett handbook if it specifies location, you use D12.7.  





  • 8.  RE: rectosigmoid polyp

    Posted 04-08-2018 12:35
    Dear Laura,

    Yes. I 100% agree with you. I was just curious of the pathway that the encoder took you and it came up with.

    Jodi Miller, RHIT, CCS

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    Jodi Miller, RHIT, CCS
    Outpatient Coder/Abstractor
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  • 9.  RE: rectosigmoid polyp

    Posted 03-31-2018 08:41
    ​Did you check the result of the path report for the rectosigmoid polyp?  If it was "adenomatous" then here's the encoder logic:  polyp / adenomatous / rectosigmoid = D12.7.  Even if not adenomatous, then my encoder still gives the same result:  polyp / rectosigmoid = D12.7.  My encoder is Optum.

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    Diane M. Sherman, RHIT
    Coding Specialist and Consultant
    Sacred Heart Hospital and Amphion Medical Solutions
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  • 10.  RE: rectosigmoid polyp

    Posted 04-01-2018 11:12

    Hello,

     

    I would advise looking at Coding Clinic, First Quarter, 2017, pages 15-16.  If you do not have access to Coding Clinic, here is an excerpt.

     

    There is no requirement that coding cannot be done until all diagnostic results are available. Code to the highest degree of certainty what is known at the time of code assignment. As previously stated, code K63.5, Polyp of colon, is the default when the type of polyp is not specified as adenomatous/neoplastic regardless of the location in the colon.

    The Official Guidelines for Coding and Reporting for outpatient services state, "For outpatient encounters for diagnostic tests that have been interpreted by a physician, and the final report is available at the time of coding, code any confirmed or definitive diagnosis(es) documented in the interpretation."

    For coding purposes, facilities may develop specific policies regarding which reports must be available in order to complete code assignment."

     

    I hope you find this helpful!






  • 11.  RE: rectosigmoid polyp

    Posted 04-05-2018 08:25

    So, according to this coding clinic then, "rectosigmoid polyp" is simply assigned to K63.5, since I do not have any further description or specificity.  I feel the index is a little misleading or confusing, since adenomatous is indexed on its own, without any further indexing of sites and that the other sites of the colon are listed on their own without any further indexing to what type of polyp they are.  It would seem to make more sense to index the types and then further index the types by site. Even if "hyperplastic" and "andenomatous" were the only types indexed, coders would then be able to see that the type of polyp is necessary information to further code and if the type is not known, then the main index would be what should be turned to in the tabular.   Thank you for pointing out the Coding Clinic.

    Laura



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    Laura Hoot, RHIT,CCS
    AMI Senior Coding Professional
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  • 12.  RE: rectosigmoid polyp

    Posted 04-05-2018 08:35
    Hi Diane,
    This was more a question for just the specific documentation of "rectosigmoid polyp".  Of course, if there is further documentation with more specificity, then that would definitely be considered as well. It's interesting that Optum gets you to D12.7.  Thank you for investigating this for me.
    Laura

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    Laura Hoot, RHIT,CCS
    AMI Senior Coding Professional
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  • 13.  RE: rectosigmoid polyp

    Posted 04-03-2018 18:21
    I did a reverse search for this code D12.7 . It does not appear in the alphabetic index but is listed several places in the Neoplasm Table, Intestine, large, colon, with rectum, benign and several similar entries. This would not be the first time the Index is found to be a bit lacking. :) 

     
    Lorraine Papazian-Boyce, MS, CPC
    AHIMA-Approved ICD-10-CM/PCS Trainer
    Author, Pearson's Comprehensive Medical Coding: A Path to Success







  • 14.  RE: rectosigmoid polyp

    Posted 04-05-2018 08:29
    I'm glad to see I have company in my thought process that the index is a bit squirrely on this one.  :-)
    Laura

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    Laura Hoot, RHIT,CCS
    AMI Senior Coding Professional
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  • 15.  RE: rectosigmoid polyp

    Posted 14 days ago
    Unfortunately they did not correct this with the 2020 index and also didn't indent the Sigmoid and Transverse Colon items to be under Adenomatous.  My understanding is that with this change to the index the only time the D12.x codes can be applied is if the pathology states the polyp is an adenoma.  Documentation of Ascending colon polyp will need to be coded as K63.5 even though the colon site was specified.  Do you all agree with that?



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    Allison Evans, RHIA
    Coding Manager
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