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Thread: Colonoscopy ?screening

  1. #11
    Join Date
    Apr 2007
    Bangor, Maine


    AAPC: Back to School
    [QUOTE=mitchellde;61070]I am not sure which guidelines you are referring to but there is only one set of official guidelines. The following is an excerpt from these guidelines:

    From Section I under screening it says:
    Should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis.

    Not to get into the middle of this one, because I do believe that each opinion is validated, but doesn't the "may be" in that quote from the guidelines constitute a decision by the coder to do so? It doesn't seem like it is mandated in that statement. For us here, we use the V code for Medicare and BX but for everyone else, we use the 211.3 code. I am not trying to make waves, I am legitamitely confused by all of this. Do you follow the "surgery" guidelines or do you follow the "screening" guidelines? We are also CAH so our case proably doesn't apply to all.

    In the end, I guess I also agree with Gloria that since even the "big wigs" can't agree, we do what we have to, individually, to code what we believe to be "to the best of our ability".

  2. #12
    Join Date
    Apr 2007
    Columbia, MO


    I disagree, I feel the guidelines are very clear on the subject of screening. My question is why code it different for different payers? This says you are coding for reimbursement then. The scenario did not change just becuse the payer changed. The guidelines state:
    The testing of a person to rule out or confirm a suspected diagnosis because the patient has some sign or symptom is a diagnostic examination, not a screening. In these cases, the sign or symptom is used to explain the reason for the test.
    A screening code may be a first listed code if the reason for the visit is specifically the screening exam. It may also be used as an additional code if the screening is done during an office visit for other health problems. A screening code is not necessary if the screening is inherent to a routine examination, such as a pap smear done during a routine pelvic examination.

    Also Coding clinics state:
    Whne the reason for the encounter is screening, then screening remains the first-listed code regardless of the findings or any additional procedure performed due to the findings.

    If a patient does not have screening as a benefit then they are responsible for the payment. However if they do have screening benefits and you code it as a diagnostic exam, then they will most likely have out of pocket expenses like deductible that would not have incurred. I have seen this happen numerous times and then try to unravel it on the back end (no pun intended) is very time consuming.

    So my point being if it is screening for a Medicaid patient then with the same scenario it is screening for everyone.

  3. #13
    Join Date
    Apr 2007
    Bangor, Maine


    I definitely see your point! As far as coding differently for different payers, I couldn't agree more. I am walking a very fine line here by doing that. Trying to explain that to my supervisors, however, is another issue completely. But anyway, thanks for the clarification, Deb. Maybe I can use it as ammo with management here. Have a good day

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