Gastroenterology Coding Alert

CMS recently issued a memo (AB-01-144) clarifying its diagnostic coding guidelines for reporting diagnostic tests. The memo, effective Jan. 1, 2002, reaffirms the agency's commitment to the Official ICD-9-CM Guidelines for Coding and Reporting. It also restates the ICD-9's longstanding principal that physicians billing for the interpretation of a diagnostic test must report their diagnoses based on the results of the test, not the signs and symptoms that lead to the ordering of the test. Only if the diagnostic test did not provide a diagnosis or was normal, should the interpreting physician code the sign(s) or symptom(s) that prompted the ordering of the test.
 
Although most of the examples cited in the memo were directed at radiologists and pathologists, two sections will interest gastroenterologists. The first is an example of a patient seen in the emergency room for chest pain. An EKG is normal, and the final diagnosis is chest pain due to suspected gastroesophageal reflux disease (GERD) (530.81). The patient is told to follow-up with another physician for further evaluation of the suspected GERD. The CMS memo says the primary diagnosis code for the EKG should be chest pain (786.50). Although the EKG was normal, a definitive cause for the chest pain was not determined.
 
The other section relates to screenings, diagnostic tests ordered in the absence of signs or symptoms. The memo states that when a screening is ordered, the physician interpreting the test should report the reason for the test (e.g., screening) as the primary diagnosis code. The test results, if reported, may be recorded as additional diagnosis. This seems to contradict Medicare's policy that if during a screening flexible sigmoidoscopy (G0104) or colonoscopy (G0105 or G0121) a lesion or growth is biopsied or removed, the appropriate diagnostic results should be noted and a diagnostic procedure billed instead.
 
The memo can be downloaded at www.hcfa.gov/ pubforms/transmit/AB01144.pdf. Adobe Acrobat Reader is required to view the memo and is available at no charge at The Coding Institute Web site at www.medville.com.