Clinic wants me to change ICD-10 code

bbooks

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A patient and clinic want me to change the diagnosis code to a screening code as primary. I've stated how I am unable to do so with the information I have. I would like to share and see if you all would validate me. This is the path report:

Clinical Information: Screening, dysphagia, diverticulosis
Final Diagnosis: Gastric antral mucosa with no significant pathologic findings. Minimal Chronic inflammation is present. Negative for H. Pylori organisms.
Specimen: Biopsy of gastric antrum, erythema​

I can include the gross and micro if needed. No stains were done.

I coded this 88305, K29.50

Here's what I think might have happened. The patient might have had an upper endoscopy and a colonoscopy done at the same time. The clinic may have includes the clinical information for both procedures. But my point is that because "dysphagia" is mentioned, I cannot consider that the gastric specimen was from a screening procedure - that the inclusion of "dysphagia" requires that I code this as a diagnostic procedure.

I have requested a copy of the requisition, H&P, and op note to clarify.

I would appreciate your thoughts and expertise! Thanks.
 

agibb1022

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A patient and clinic want me to change the diagnosis code to a screening code as primary. I've stated how I am unable to do so with the information I have. I would like to share and see if you all would validate me. This is the path report:

Clinical Information: Screening, dysphagia, diverticulosis
Final Diagnosis: Gastric antral mucosa with no significant pathologic findings. Minimal Chronic inflammation is present. Negative for H. Pylori organisms.
Specimen: Biopsy of gastric antrum, erythema​

I can include the gross and micro if needed. No stains were done.

I coded this 88305, K29.50

Here's what I think might have happened. The patient might have had an upper endoscopy and a colonoscopy done at the same time. The clinic may have includes the clinical information for both procedures. But my point is that because "dysphagia" is mentioned, I cannot consider that the gastric specimen was from a screening procedure - that the inclusion of "dysphagia" requires that I code this as a diagnostic procedure.

I have requested a copy of the requisition, H&P, and op note to clarify.

I would appreciate your thoughts and expertise! Thanks.


It sounds like this biopsy was obtained via upper endoscopy and those aren't ever done for screening purposes (I am surprised the clinic itself is pushing that too). So, even if they also happened to have had a screening colonoscopy done at the same time, they are billed as separate procedures and the screening indication is only for the lower procedure. I think you are correct the way you are doing it.

I actually get this type of argument from patients a lot. I do billing and coding for an ASC that does both procedures and patients often think that since their colonoscopy is a screening and paid in full, then their EGD should be as well. I have to explain that, even if they are done at the same time, it doesn't work that way! :)

Good luck!
 
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