screening colonoscopy with symptoms

smwermter

Networker
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If patient presents for colonoscopy and is due for 5 year screening and presents with symptoms (bleeding) how are you sequencing the ICD-9 codes?
 

dmaec

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Duluth, Minnesota
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if the patient is coming in with symptoms (that's why they came in, bleeding) it would be a diagnostic colonscopy -
 

smwermter

Networker
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We have been coding them diagnositic but are wondering if the screening can be coded allong with the diagnostic code. :confused:
 

Lisa Bledsoe

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Greeley, Colorado
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I get this scenario a lot mainly because patients have screening benefits to where the procedure is not applied to their deductible. They want us to change the coding because they were due for a screening colonoscopy...but if it's done for a diagnositic reason (ie bleeding) it isn't screening. It becomes an issue with the insured and the payer and the policy they have. I get so frustrated with insurance companies telling patients that if we had coded their procedure as screening it would not have gone to the deductible. What no one else takes into consideration is that if it's not screening and they ask us to change it to screening, what they are asking us to do is FRAUDULENT.
 

mbort

True Blue
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ENGLEWOOD/DENVER
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ditto Lisa!!!! I've gone as far as calling back the customer service rep at the insurance company that gave the patient that info and asked them "What are you thinking?" Were you in the operating room?"...grrrr they drive me nuts and then patients get ticked off at us.
 

scorrado

Expert
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Bridgewater, VA
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I feel your pain Lisa! The line I get all the time from the patient is "my insurance said that you coded it wrong". I get so irritated !!!!!
 

Erika95

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if the patient comes in for a screening and they find something you would list the vcode as your first dx and your findings second then on the procedure line you would show the 2nd dx first and the vcode second. showing the insurance this was set up as a screening that changed. example below

DX
1. v76.51
2. 211.3

CPT
1.45380 211.3, v76.51

hope this helps
 

LORA CRAWFORD

Networker
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East Valley, Tempe AZ
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Speaking of the insurance telling the patient that something was coded wrong. Hopefully the patient got the reps name. I would then call my provider rep and tell them that the patient reps are telling the patient to ask my provider to commit fraud so the patient does not have to bear financial responsibilty. I know it isn't easy for the patients to understand but why can't the rep say, the claim has been processed according to your contract and just leave it at that.
 

Treetoad

Expert
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Exactly Lora! The insurance reps make it sound like we don't know what we're doing and that has the patient questioning our competence.
 
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