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Wiki Screening colonoscopies with Incidental symptoms

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bethh05

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The physician dictated screening colonoscopy and incidental constipation as a pre op diagnosis. I queried the physician's office, the physician responded to bill as a screening, incidental findings should not keep us from billing a screening. Every article I have found states that any symptom indicated in the medical record will change the screening to a diagnostic exam. I cannot find anything related to an incidental symptom. Any help is greatly appreciated! Thank you
 
I agree with the physician, unless any type of removal of waste was performed, a preventive screening code is correct. If a polyp was found and removed during the colonoscopy, then for a Medicare patient a PT modifier is required for a screening that turns into a procedure. Not sure that constipation requires a procedure and the screening code is correct.
 
The question is about pre op diagnosis, I am trying to determine whether an incidental pre op diagnosis should be considered a symptom? The physician is stating that because it is incidental, I guess it should not be considered, but it is still indicated in the medical record. Constipation is not a payable diagnosis, but it is still a symptom. If you see the 4th paragraph in the article, it states this.
http://digestivecarephysicians.com/client_files/file/scrngvsdiagcolon.pdf

Once a symptom has been dictated it is not considered a screening. Here is another article regarding coding colonoscopies, if you are billing screenings when symptoms are dictated that is incorrect.
http://www.beckersasc.com/asc-codin...rs-guide-to-surgery-center-colonoscopies.html
 
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I would not consider the constipation as a symptom unless it is documented that the patient specifically presented to the office with constipation as the complaint. Just because the patient responded affirmative to a question have you had constipation does make it incidental and not rooted. So it really depends on the note and how the issue was brought up.
 
I agree that is depends on the context of the constipation. Patient could be on chronic pain meds and have chronic constipation but still qualify just like if they have a component of diarrhea contributed to a med like Metformin and it is not a new change for them.
 
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