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Medicare Pt has pre op dx, chr Constipation, Abd pn nos, anxiety about cancer and recent change in bowel habits. What would be the correct Procedure code? Would it be considered a screening with these diags?Thanks in advance.
The 787.99 change in bowel habits, allows this to be a diagnostic. Check the LCD for diagnostic and therapeutic colonoscopy/signmoidoscopy/proctosigmoidoscopy. chronic constipation is also listed, but you have to be careful with that code in particular. The unspecified abdominal pain is not listed.
If it's a screening only then you would use the appropriate G code. BUT if a polypectomy is performed or a biopsy obtained you MUST use 45385 or 45380, etc.
If a pt presents with symptoms and that is why the procedure is taking place, that would be diagnostic not a screening, Medicare or otherwise.
You only use the G codes when there is only a screening, if something changes during the procedure ( a polyp is found) then it becomes diagnostic but you would put the V code for a screening (V76.51-colon) in the prime dx slot.
There is a spot somewhere on CMS that shows this but I can't remember. If I find it, I will post the link.
P.S. Get out of Hampton, go up to Salisbury, it's cleaner, lol.