Treetoad
Expert
Hi all. I'm wondering if I could get an opinion with a problem that I find myself up against.
My doc took a Medicare patient to endoscopy for a screening colonoscopy. While in the suite, the patient mentioned that she was having a problem with "flat stools". My doc performed the colonoscopy and while there took ramdom biopsies. The pathology report came back negative. I charged procedure code 45380 with diagnosis V76.51 (screening, malignant neoplasm, colon) and 787.99 (symptoms, digestive system, NEC). I knew at the time that this was going to be a denied service, but I didn't see an alternative. When the denial finally came in, it was suggested to me (by a non-coder, but someone in the fiscal department) that I should have used diagnosis 564.9 (disorder, intestine, functional, NEC) and the claim would be paid. I don't want to label a person as having a functional intestinal problem when it doesn't appear they have one. The patient didn't sign an ABN. Also, did I mention the facility portion of the claim paid with the diagnosis that I gave it? Because of this, I'm being encouraged to use the functional diagnosis to get the provider portion paid. Does anyone out there know of anything that I could have done differently? I appreciate any thoughts.
My doc took a Medicare patient to endoscopy for a screening colonoscopy. While in the suite, the patient mentioned that she was having a problem with "flat stools". My doc performed the colonoscopy and while there took ramdom biopsies. The pathology report came back negative. I charged procedure code 45380 with diagnosis V76.51 (screening, malignant neoplasm, colon) and 787.99 (symptoms, digestive system, NEC). I knew at the time that this was going to be a denied service, but I didn't see an alternative. When the denial finally came in, it was suggested to me (by a non-coder, but someone in the fiscal department) that I should have used diagnosis 564.9 (disorder, intestine, functional, NEC) and the claim would be paid. I don't want to label a person as having a functional intestinal problem when it doesn't appear they have one. The patient didn't sign an ABN. Also, did I mention the facility portion of the claim paid with the diagnosis that I gave it? Because of this, I'm being encouraged to use the functional diagnosis to get the provider portion paid. Does anyone out there know of anything that I could have done differently? I appreciate any thoughts.
Last edited: