Yet another question about screening colonoscopy

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We are experiencing so many issues with screen versus diagnostic versus surveillance colonoscopies. I understand that every single situation is different, but here is the current one.

Patient was scheduled for colonoscopy (yes, scheduled by another physician with our office) for "abnormal weight loss, no previous colonoscopy, screen."

Patient signed the colonoscopy permit by initialing the "preventive colonoscopy screening" line of our permit.

In checking into our office, when asked by our staff about any current issues, he stated he had some weight loss (30-40 pounds in 3 months) but he was not concerned about it.

From what I understand, from the documentation available to the hospital, they will have to code it as abnormal weight loss. None of the documentation available to them says "screening." It all says "abnormal weight loss."

We are actually experiencing this with another patient. We billed as V76.51 with 569.3 (no symptoms by patient but slightly positive occult--from another forum post, this was the code to use), but hospital billed as 569.3 without V76.51 code. Our part was paid, but the hospital's part was not because they didn't use the V76.51.

In any case, my concern at the moment is the first patient mentioned, the one with the drastic weight loss that he said, in his own words, he is not worried about.

These colonoscopy screens/nonscreens are about to drive me crazy. They are not as cut-and-dry as I'd like them to be.

Thanks for any help!!
 

mitchellde

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slightly positive occult is definitely NOT 569.3, that code is for hemorrhage from rectum and anus.. these are 2 entirely different things. In fact if the provider documented slightly positive occult blood there is nothing there for the coder to code .
As far as your current patient, the patient is in charge here, if the patient is stating they have no problems and they want a screening procedure then that is what it is, the provider that scheduled the patient needs to be more clear and certainly the person obtaining the permit should have asked some questions. Our permits have a blank that we fill in with the reason for the test it is not a blank the patient checks, perhaps your consents are not all that clear. See if you can obtain a copy of the office note from the provider that ordered the test in the first place this should tell you what was discussed and the reason for the test.
 
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You are always so helpful!!

Unfortunately, the requesting physician's notes say, "abnormal weight loss, no previous colonoscopy, screen," and this is what the hospital will be coding by, as this is what my physician will document, also, unless I completely miss my guess.

The patient is seemingly honestly not concerned about the weight loss. The requesting physician's office did actually code their note using that diagnosis code, so that diagnosis is "out there," so to speak, for this patient with their insurance company.

As far as our consent, we have taken a consent referred to on here and tweaked it a little bit, in an attempt to clarify for the patient, but it is still confusing.

Again, thank you for your help!

Trina
 

mitchellde

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can you get a copy of the entire note not just the impression or referring dx. Sometimes what they discuss and what they order are 2 different things. However if the notes states the patient had concerns regarding weight loss, and the colonoscopy is a diagnostic tool being used to investigate then it is diagnostic, on the otherhand perhaps the patient intended to lose weight and this is not abnormal and the colonoscopy was suggested as a screening given the patient age. See there should be an expectation on the part of the ordering provider if it is being performed as an investigational test. I have observed some providers document the word screen when they do not mean preventive, they use it to mean we will screen to see what is going on, and used in that context then it is not screening but diagnostic. I would btain the entire not and see what the CC and HPI tell you as well as the exam and the MDM and plan.
 
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they use it to mean we will screen to see what is going on
I think this is it in a nutshell. What the provider intends as a "screen" is not how we are interpreting "screen"...two different definitions.

I do have the whole note, and no, the original exam by PCP was not being done to investigate the cause of the weight loss...routine physical...it was more of a, "Oh-by-the-way-I-have-lost-some-weight," type response.

The single sentence above really clarifies a lot.

Thanks! This helps a lot!
 
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