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Colonoscopy w/ a pt that has symptoms

burgmeit

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IF THE PATIENT COMES IN WITH A PROBLEM/SYMPTOM SUCH AS WEIGHT LOSS, WHICH IS NOT A COVERED DX WITH MEDICARE, I WAS RECENTLY TOLD TO ALWAYS ADD V76.51 FOR A SCREENING. I AM UNABLE TO FIND ANY DOCUMENTATION TO EITHER SUPPORT OR DISPUTE THIS. I PERSONALLY DO NOT FEEL COMFORTABLE ADDIING THE SCREENING ONLY FOR PT'S THAT HAVE A NON-COVERED DX. PLEASE HELP.:confused:
 

ehanna

Guru
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Colonoscopy billing

I am not sure if this helps you but a screening colonoscopy turns into a diagnostic colonoscopy if a problem is found.

In essence, yes the patient has experienced weight loss, but the procedure itself is for screening purposes. This is only my opinion and others may feel differently.

Good luck!

Emily
 

coachlang3

True Blue
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534
Location
Charlotte, NC
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Why did the doctor do the procedure and what did he/she document and what did the pt come in for?

If the doctor did the colon due to concerning weight loss, your office should have had the pt sign an ABN.

A colon cancer screening is for pt's with no active symptoms (asymptomatic).

You cannot just add the screening code if they did not come in for a screening or if the doctor did the procedure due to the weight loss.

If the indications for the procedure (should be dictated on the procedure note) mention anything other than colon cancer screening, personal hx of polyps or colon cancer or 1st degree family (or mulitple second degree) history of polyps or colon cancer, then it is not a screening.

However, if the pt truly came in for a screening, the doctor saw the pt has been treated for unwanted weight loss and it is under control by another doctor or even your doctor, then it could be a screening, as long as it's not the reason your doctor did the colon.
 

mitchellde

True Blue
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13,538
Location
Columbia, MO
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I agree if the procedure is being performed due to symptoms or complaint then it is not by definition a screening procedure. You cannot just add a dx code for payment purposes. The dx code is reflective of the PATIENT's dx at the time of the encounter/reason for procedure as documented by the provider. So it comes down to what does the documentation say is the reason for the procedure.
 

burgmeit

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I agree and I am not comfortable tacking on a screening code if it is NOT truly a screening.
 
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