Wiki Colon Cancer Screening Evaluation - 84 yr. old Medicare patient was referred

[numberslil@aol.com]

84 yr. old Medicare patient was referred to our GI doc for a colon cancer screening - no personal or family history - timing for colon screen is appropriate/patient does have chronic kidney disease. In the HPI patient mentions diarrhea/doc notes due to diet not an indication for the "screening". Due to renal issues the doc needed to adjust medications and prep for the procedure (an intervention).

Questions:

Is this a billable visit? Coded as follows: Primary dx: ICD I12.9 (Kidney Disease) and is there a code I can use for the medication intervention?

When billing for the Colonoscopy can I use the screening code: Z12.11 since the only indication for the colonoscopy is a preventive service?

Thank you,

Lillian Greco
Practice Administrator
Woodbridge Medical Assoc., PA

 

[mitchellde]

I12.9 is a code for hypertensive chronic kidney disease which you did not indicate. If the reason for the encounter was to evaluate the patients chronic kidney disease the you would use the N18.- code. You would use the Z code for screening for the colonoscopy encounter.

 

[numberslil@aol.com]

Colon Cancer Screening Evaluation

1. Is the visit billable since the doc had to "touch" the patient - bring him in to change his medications due to his rental dx he is 84?

2. Since the patient was referred and mentioned a symptom "diarrhea" would this colon screening be "medical" as oppose to 100% preventive? Billed as follows: R19.7, Z12.11.

Thank you for your response.

 

[agibb1022]

1. If the patient requires some intervention on the part of the physician prior to the procedure, then yes, you can bill an OV. See link to AGA website. And I agree with mitchellede on the kidney disease thing...need to clarify if hypertensive or not, and then use that CKD diagnosis followed by Z12.11.

http://www.gastro.org/practice-management/coding/screening-colonoscopy-faq#Diagnosis code ordering is important

2. You said that in the note the doc indicated that the diarrhea was due to diet. With that limited information, I would think that the diarrhea is not the reason for the procedure, therefore the patient is eligible for a 10-year screening.

Hope that helps!