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boozaarn

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Patient is having a breast u/s because of abn. findings on mammo screen.
She is asked to pay deductibles..:confused:

Can it be d/t hospital's routine of not converting screening to diagnostic (GG) on same visit but on another day..?

Thanks
Boozaarn, CPC-H,CCS
 
What was the diagnosis code for the screening? If it was coded with abnormal findings they are not going to pay for the u/s. The rule of thumb is all screenings get a screening code no matter what the findings. V76.12 Normal findings;V76.11 High-risk history of cancer, family history,etc. Hope this helps.
 
I am not understanding. The day of the screening mamm it should be coded as the V code for screening first and any abnormality second if a diagnostic ultrasound is performed the same day, the diagnosis codes remain the same and you add the procedure code for the ultrasound. If the diagnostic ultrasound is performed on a different due to the abnormality then diagnosis code is the abnormality and it is a diagnostic study
 
okay

First visit - mammogram with assymetry
v76.12 -
611.89

second visit - u/s - 611.89 - deductibles on this visit

Could it be because they didn't convert it from screening to diagnostic on same visit? GG

Thanks
 
Since it's a second visit due to abnormal findings, it is no longer considered a screening. Only the original mammo will be paid as preventive, not the ultrasound.
 
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