Question Screening colonoscopy diagnosis coding for pathology procedure code 88305

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Hello,
I have a question that our group has been going back and forth over for screening colonoscopies. We receive colonoscopy cases from Hospitals that bill out the technical portion of the charge and we bill out the professional portion of the 88305's - what diagnosis code would you use as the primary diagnosis code for our Pathology group??

1) the screening diagnosis code & then the finding diagnosis ?
2) the finding diagnosis & no screening code?
3) the findings diagnosis, with modifier 33?
4 the screening diagnosis, the finding diagnosis & modifier 33?

Thanks for any help :)
 

thomas7331

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I believe #2 is the most correct answer. A pathology service is never a screening in this context. A tissue sample would only be taken if there was an abnormality found during the colonoscopy, so it is only related to the findings, not to the screening. I don't know of any payer that would classify pathology services as part of a member's preventive care benefits.
 
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Bangor, Maine
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I believe #2 is the most correct answer. A pathology service is never a screening in this context. A tissue sample would only be taken if there was an abnormality found during the colonoscopy, so it is only related to the findings, not to the screening. I don't know of any payer that would classify pathology services as part of a member's preventive care benefits.
Thank You, That is what we have been doing but had some questions from staff who answer the phones and have to relay this answer to patients calling as to why. I was having a hard time to find written guidelines on diag. coding placement for pathology so we might have something to send if the patient wanted/asked for it as they have in the past.
Thanks again!
 

lcolborn

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With my experience with other commercial payers, for instance BCBS( MS ) , If the patient came in for a screening colonoscopy, the Z12.11( 33 modifier) is your primary dx and D12.__ . And in this order is the same way filing their pathology 88305.
 
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With my experience with other commercial payers, for instance BCBS( MS ) , If the patient came in for a screening colonoscopy, the Z12.11( 33 modifier) is your primary dx and D12.__ . And in this order is the same way filing their pathology 88305.

I'm thinking what you are saying applies to "non-outpatient" settings?

There are three specific sections for ICD 10 Coding Guidelines that specify what to code as primary.

Section II is for non-outpatient settings

Section III is for additional dx in non-outpatient settings

Section IV is for outpatient coding and reporting . <<<< Clinical Pathology Lab would fit here.
Under Section IV. A. Selection of first-listed conditions. "In the outpatient setting, the term first-listed diagnosis is used in lieu of principal diagnosis. "

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In the above scenario the pathologist is the physician & his/her findings should be reported as the first listed diagnosis.

I saw a previous post from 2018 in this forum that I think is still appropriate to this thread.
Copied and Pasted:
"A pathologist is a physician, and therefore their final diagnosis and findings should be reported as the first-listed diagnosis. Although the intent of the colonoscopy was a screening, that code should be appended to the screening colonoscopy, not the pathologists' claim, since his tissue analysis shows a confirmation of a polyp. See AHA Coding Clinic 1Q2017.

The insurance company is telling the patient this because 1.) they aren't coders, and 2). their insured is upset because they are going to have deductible/co-insurance responsibility for the pathologist's bill, instead of a screening visit, which has no patient responsiblity. The payer is telling the patient that it was 'coded wrong', so that the payer won't have to take the heat for the patient being upset.

If I had a dollar for everyone of these scenarios that has crossed my desk since the ACA was implemented, I would be on a beach in Tahiti right now, sipping margaritas. It's a pain that the payers throw coders under the bus, when they don't even understand the rules.

We should not code for payment/coverage reasons."
 
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