Improvement in Colonoscopy Value Reporting Using ICD 10 Using Colon Polyp Segments

Abstract

Introduction: One of the demonstrations of value in colonoscopy involves the reporting of the number of polyps removed as well as the segments of the colon from which they were removed. Payers, limited by the contents of claims data, have been unable to assess the number of polyps removed under ICD-9. On October 1st, 2015; the CMS required all medical providers to convert from ICD-9 to ICD-10. Unlike reporting under ICD-9, ICD-10 requires polypectomies to be reported by segment. This study demonstrates the value of polyp reporting by segment under ICD-10 using a large claims database. Methods: The data for this study is derived from all colonoscopies performed between October 1, 2015 and December 31, 2015 reported to Health Care Service Corporation (HCSC), a Blue Cross Blue Shield member covering Illinois, Montana, New Mexico, Texas and Montana. The only cases included were those that were reported as screening using ICD-10 code Z12.11. They were then analyzed as to polyp segment reported. Results: A total of 107,704 screening cases composed the study group. In 32,311 cases (30%) polyps were removed. Of these, 12,960 cases were eliminated as they were reported only using the generic K635 code or the Unspecified code D126. The remaining 94,744 cases compose the study cases and were all profiled by polyps removed by polyp segment. This is shown below: Cecum: 19% Ascending: 31% Transverse: 33% Descending: 19% Sigmoid: 31% Rectosigmoid: 3% Rectum: 13% In addition, the data reveal the actual number of polyps removed by colonoscopy as shown below: One Segment: 28.01% Two Segments: 9.37% Three Segments: 3.01% Four Segments: 0.40% Five Segments: 0.04% Total: 40.82% Under ICD-9 the number of polyps reported per colonoscopy would have been 0.3 whereas under ICD-10 it is 0.41, thus more accurately demonstrating the value of colonoscopy. Conclusion: Polypectomy reporting under ICD-10 more accurately reflects the actual number of polyps removed increasing the number of reported polyps from 30% to 41%. The value of colonoscopy is therefore more accurately reported using polyp segment reporting with ICD-10. Also, the number of pathology specimens will be easier to justify using segment reporting. It is essential for Gastroenterologists to report polypectomy using segment reporting as opposed to the generic or unspecified ICD-10 codes.