I believe you are referring to guidelines for physicians.The coding guidelines actually set this for us and they are not Medicare guidelines they are the official guidelines for coding and reporting. They state that if the reason for he visit is screening then screening remains the first-listed dx code regardless of the findings or subsequent procedure performed at that setting. So the first-listed code is screening then polyps. Also the coding clinics have addressed this many time. This does not depend on payer, it has to do with why was the patient there, and they were there for screening. The polyps are an incidental finding.
Thank you this confirms what I have been doing based on my knowledge. We have read the Ambulatory Coding & Payment Report Vol 13 No. 1 pg 1-3 which dicusses this same topic giving warnings if you do or don't code screening primary. In the end the issue remains unrelolved since AMA, AHA and CMS don't even agree.I believe you are referring to guidelines for physicians.
ASC's have different guidelines than physicians/surgeons offices. I stated in my previous post above specifically where you can find them in the ICD-9 Book which are the "official guidelines".
The guidelines for ASC's state:
"For ambulatory surgery, code the diagnosis for which the surgery was performed. If the post-operative diagnosis is known to be different from the pre-operative diagnosis at the time the diagnois is confirmed, select the POST-OPERATIVE diagnosis for coding since it is the most definitive."
straight from the ICD-9 book-Section IV Letter O (page 25 of my book)
Hope this helps,
Mary, CPC, COSC
I am not sure which guidelines you are referring to but there is only one set of official guidelines. The following is an excerpt from these guidelines:
From Section I under screening it says:
Should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis.
Not to get into the middle of this one, because I do believe that each opinion is validated, but doesn't the "may be" in that quote from the guidelines constitute a decision by the coder to do so? It doesn't seem like it is mandated in that statement. For us here, we use the V code for Medicare and BX but for everyone else, we use the 211.3 code. I am not trying to make waves, I am legitamitely confused by all of this. Do you follow the "surgery" guidelines or do you follow the "screening" guidelines? We are also CAH so our case proably doesn't apply to all.
In the end, I guess I also agree with Gloria that since even the "big wigs" can't agree, we do what we have to, individually, to code what we believe to be "to the best of our ability".