Wiki using pathology report to code for Colonoscopies

[Jenannurb]

I believe that the best way to code colonoscopies with biopsies is to wait for the path report.

my physicians feel that"waiting for the path report delays claim filing, doesnt help with reimbursement and adds undue work" and that i should just go ahead with the k63.5 dx

anyone else in this dilemma?

 

[Pbhatt1]

Z codes

That's where the Z codes are their in icd book.

 

[mitchellde]

I believe that the best way to code colonoscopies with biopsies is to wait for the path report.

my physicians feel that"waiting for the path report delays claim filing, doesnt help with reimbursement and adds undue work" and that i should just go ahead with the k63.5 dx

anyone else in this dilemma?

You are not required to wait for the path report, with the exception of skin lesion excision. If this were a screening colonoscopy you will use the Z code for screening first with the polyp code or path result secondary. And a diagnostic you may code the polyp or path result. It should not affect the reimbursement either way. Having said that I code pathology and often the oath code is just K63.5.

 

[andyrobin]

waiting for path

I wait for the pathology before I send a claim. The pathology diagnosis determines when the patient needs to come back for another screening colonoscopy. Medicare covers screenings every 24 months if a patient is determined as high risk for developing colon cancer. Medicare determines that a patient is high risk if they have a;
Close relative (sibling, parent or child) who has had colorectal cancer or an adenomatous polyp.
Family history of familial adenomatous polyposis.
Family history of hereditary nonpolyposis colorectal cancer.
Personal history of colorectal cancer.
IBD, including Crohn’s disease, and ulcerative colitis
AND
Personal history of adenomatous polyps.

I hope this helps!