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Diagnostic Service only

mcdream

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Diagnostic Service only- Dexa (Bone Mass Measurement)

Question: Is my thought process of the coding sequence correct for the following scenarios:

Dexa order states: Screening for Osteoporosis.
Interpretation (findings): Osteopenia
Code Sequence
1st (reason)- Screening (Z13.820)
2nd (findings)- Osteopenia (M85.:cool:

Dexa order states: The diagnosis, condition, or problem (ex: Postmenopausal).
Interpretation (findings): Osteopenia
Code Sequence
1st (findings)- Osteopenia (M85.:cool:
2nd (codes for other diagnoses)- Indication/reason on order (ex: Postmenopausal-asymptomatic (Z78.0) or symptomatic (N95.1))
*Codes for other diagnoses (e.g., chronic conditions) may be sequenced as additional diagnoses.

Dexa order states: Long term (current) drug therapy (ex: systemic steroids, bisphosphonates).
Interpretation (findings): Osteopenia
Code Sequence
1st (findings)- Osteopenia (M85.:cool:
2nd (reason)- Encounter for therapeutic drug level monitoring (Z51.81)
3rd (drug)- Long-term (current) drug therapy (Z79.:cool:
*Codes for other diagnoses (e.g., chronic conditions) may be sequenced as additional diagnoses.

TIA for your support!


Reference: ICD-10-CM Official Guidelines for Coding & Reporting

Screening exam- Is the testing for disease or disease precursors in seemingly well individuals. A screening code may be first-listed if the reason for the visit is specifically the screening exam. Should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis.

Diagnostic exam- Is the testing of a person to rule out or confirm a suspected diagnosis because the patient has some sign or symptom.

Section IV-K: "Patients receiving diagnostic services only" states:
"For patients receiving diagnostic services only during an encounter/visit, sequence first the diagnosis, condition, problem, or other reason for encounter/visit shown to be chiefly responsible for the outpatient service provided during the encounter/visit. Codes for other diagnoses (e.g., chronic conditions) may be sequenced as additional diagnoses."
 
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I agree - code first the reason for the encounter followed by findings as confirmed on interpretation.
 

mcdream

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Coding for DEXA

Hi all!
How are you coding for dexa when the reason for the dexa is: "screening for osteoporosis"? Are you using the screening code first (z13.830) followed by the findings code (osteopenia m85.8- or osteoporosis m81.-)?

What about when the reason for the dexa is something other than "screening" for example "postmenopausal". Are you using the findings code first (m85.8- or m81.-) followed by postmenopausal (z78.0)?

*The reason I'm seeking your input is because DGs state different coding order for "screening" verses "diagnostic". Reference original post.

Thanks in advance for your time & input on this topic.
 

mitchellde

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My 2.5 cents worth:
screening implies that you are not looking for abnormalities, you are trying to verify a healthy person. Abnormalities would be incidental findings which would be listed secondary, and screening listed first
A diagnostic study is being performed due to the presence of signs and symptoms or known abnormalities. If the study confirms a diagnosis you do not code the symptoms that are a part of the diagnosis, code only the diagnosis. (this is stated in coding guidelines)
If a condition is known to exist and the patient is receiving treatment, the study then is performed to make certain the treatment is performing as expected. Therefore the drug monitoring code goes first as that is the reason for the study followed by the Z79 code for the type of drug and last the condition that exists to need the drug.
 

mcdream

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Debra,
Thank you for your reply. So if a dexa is ordered as:

Screening=asymptomatic patient
Z13.820 for screen is first listed, followed by the findings?

Diagnostic=symptomatic patient
M85.8- or M81.- for the findings is the only code listed? Don't add a second code for the symptomatic issue (ex: Z78.0 for postmenopausal)?

Thank you in advance for your continued input on this topic. Much appreciated!
 

mcdream

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Debra- Thank you. I read an earlier post you commented on regarding when a Dexa is ordered as a screening then screening MUST be the first listed dx code regardless of the findings- ordered as a screening MUST code as a screening.
Question: what if the dexa is ordered as a screening but the order ALSO states a known medical condition for example postmenopausal? Isn't postmenopausal considered a qualifying circumstance (known condition) which would result in coding as a diagnostic exam (code findings first) rather than a screening exam?
Thank you for your continued support on this topic.
 

mitchellde

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Debra- Thank you. I read an earlier post you commented on regarding when a Dexa is ordered as a screening then screening MUST be the first listed dx code regardless of the findings- ordered as a screening MUST code as a screening.
Question: what if the dexa is ordered as a screening but the order ALSO states a known medical condition for example postmenopausal? Isn't postmenopausal considered a qualifying circumstance (known condition) which would result in coding as a diagnostic exam (code findings first) rather than a screening exam?
Thank you for your continued support on this topic.
If the provider documents the dexa is being ordered for the post menopausal status then yes it is Diagnostic and not screening
 

mcdream

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If the provider documents the dexa is being ordered for the post menopausal status then yes it is Diagnostic and not screening
Debra- what if the dexa is being ordered for "screening for osteoporosis" & does not state postmenopausal on the order, BUT the indication on the interpretation report states "postmenopausal; being evaluated for osteoporosis" would this be diagnostic not screening based on the postmenopausal status documented on the interpretation report or must this be coded as a screening dexa because that is how it was ordered?
*Medicare covers dexa for postmenopausal BUT does not cover dexa for screening (ABN required).
 

mitchellde

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I would need to query the ordering provider to obtain a copy of the chart note for the day the screening was ordered to see how he wrote the note. Sometimes the person in the office does not mark the order exactly as it should b. If the chart note indicates screening but does not state postmenopausal then you would need to codes as a screening.
 

mcdream

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I would need to query the ordering provider to obtain a copy of the chart note for the day the screening was ordered to see how he wrote the note. Sometimes the person in the office does not mark the order exactly as it should b. If the chart note indicates screening but does not state postmenopausal then you would need to codes as a screening.
Debra- so you can only determine the nature of the dexa as diagnostic or screening based on the Dexa order &/or the ordering provider's chart note referencing the reason for the dexa?
You CANNOT code an indication (e.g: postmenopausal- pulled from patient dexa questionnaire form) that is stated on the interpretation report that is NOT also stated on the order &/or chart note?
 
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