whitney1802
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When coding GI pathology reports if the patient was seen for a screening (Z12.11) but there were adenomas or polyps found do you bill the screening first or last?
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Wiki GI Screening
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mitchellde
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when I code for pathology I code only from the pathology findings. if all is normal and there are no findings then I look to see why the procedure was performed. If it was screening I use the screening code , if it was looking for a specific disease and nothing is found then I use Z03.89
When coding pathology, code the pathological diagnosis first and the screening code second. For example, D12.3, Z12.11. My experience is that most insurers will insist on having the screening code present if their plan pays the cost of the biopsy in a screening procedure. Without the screening code, they will assume the procedure was done for diagnostic reasons. To make things confusing, some insurers require the screening code first and the diagnosis code second. These seem to be in minority, though.
whitney1802
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That is the way I have always coded as well. Recently I have had insurance companies ask me to resubmit with only that code or to make it primary diagnosis!
But if you read Paget's, it states not to use the screening code but to either use the diagnosis or if no diagnosis report the signs and symptoms (but then of course if they don't report signs or symptoms, just a screening, then you would have to use the screening code) - what are everyone's thoughts?
Including Biopsies & Polyps from Screening Colonoscopy: Biopsies and polyps extracted during screening colonoscopy surgical procedures sometimes create confusion for pathology
coders: Should the primary diagnosis (first listed) reported for the pathology examination be a screening Z-code, or should it be the code that describes the pathologic finding (e.g., D12.6
for adenomatous polyp)? Some people think that, because the surgical procedure started out as a screening examination, the primary diagnosis reported by the pathologist should be a Zcode;
however, that’s not in accordance with either the official ICD guide or Medicare policy. While the guidance states that the attending physician (i.e., the one performing the
screening colonoscopy) should report the applicable Z-code as the primary diagnosis, that direction doesn’t carry through to a pathologist when examining tissue extracted during the
screening colonoscopy. In fact, the ICD guide declares the “testing of a person to rule out or confirm a suspected diagnosis [for example, cancerous colon polyp] because the patient has
some sign or symptom [for example, polyp] is a diagnostic examination, not a screening.”{ICD-10-CM Official Guidelines for Coding and Reporting} Hence, the pathologist is to
report the code that corresponds to his/her examination findings as the primary diagnosis on the claim, even though the tissue was obtained during a screening procedure; however,
should the pathologic exam fail to yield a definitive diagnosis, the pathologist should report the sign or symptom (e.g., K63.5) as the primary diagnosis on his/her claim.
Including Biopsies & Polyps from Screening Colonoscopy: Biopsies and polyps extracted during screening colonoscopy surgical procedures sometimes create confusion for pathology
coders: Should the primary diagnosis (first listed) reported for the pathology examination be a screening Z-code, or should it be the code that describes the pathologic finding (e.g., D12.6
for adenomatous polyp)? Some people think that, because the surgical procedure started out as a screening examination, the primary diagnosis reported by the pathologist should be a Zcode;
however, that’s not in accordance with either the official ICD guide or Medicare policy. While the guidance states that the attending physician (i.e., the one performing the
screening colonoscopy) should report the applicable Z-code as the primary diagnosis, that direction doesn’t carry through to a pathologist when examining tissue extracted during the
screening colonoscopy. In fact, the ICD guide declares the “testing of a person to rule out or confirm a suspected diagnosis [for example, cancerous colon polyp] because the patient has
some sign or symptom [for example, polyp] is a diagnostic examination, not a screening.”{ICD-10-CM Official Guidelines for Coding and Reporting} Hence, the pathologist is to
report the code that corresponds to his/her examination findings as the primary diagnosis on the claim, even though the tissue was obtained during a screening procedure; however,
should the pathologic exam fail to yield a definitive diagnosis, the pathologist should report the sign or symptom (e.g., K63.5) as the primary diagnosis on his/her claim.
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whitney1802
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I think that it all just comes down to the insurance provider. Some specifically call for the screening first and some even request that only the screening be reported. I actually never code signs and symptoms if a screening was done. I wonder in my lab's case what the rules (according to Paget's) would be because we bill for the prof component and the referring physician bills for tech as they have a lean lab there to cut and stain slides. I guess that the physician could only bill with screening for the biopsy itself!? Which makes no sense to me since the screening isn't complete unless the tissue is diagnosed and the pathology is a requirement for everything taken from the body and just because a polyp is taken during a screening doesn't mean that there is suspected cancer unless the doctor specifically said he suspected cancer, right!? Am I making sense? I may need sleep lol.
I agree that sometimes the coding procedure depends upon what the insurance provider wants.
In regard to Padget, he doesn't say to never use the screening code, he says that it should never be the the primary code if there is a pathological diagnosis. That's my routine, but as mentioned earlier, some insurance companies still want the screening code as primary. Sometimes you won't know that until it comes back as a denial with a request to reverse the coding.
In regard to Padget, he doesn't say to never use the screening code, he says that it should never be the the primary code if there is a pathological diagnosis. That's my routine, but as mentioned earlier, some insurance companies still want the screening code as primary. Sometimes you won't know that until it comes back as a denial with a request to reverse the coding.