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Colon Cancer Screen

  1. #1
    Charlotte, NC
    Default Colon Cancer Screen
    Medical Coding Books
    OK, I know we have this discussion every week (sometimes everyday) but I need a clarification on something.

    Pt is referred/sent to a GI doc for a CCS. Doc magically transforms it to a consult with symptoms (this is due to the pt actually filling out a screening form and it has constipation, diarrhea and other GI syptoms on it). And then schedules the pt for a future date for a CCS (not on same day as "consult").

    I know it is not a good thing to do the whole consult thing but the patient did put down symptoms, and it's also not a good thing really to have a consult with symptoms and then try to do a screening at a later date.

    However, can the doctor d/c the patient from care for the symptoms presented and then at the later date do the CCS?

    Thanks for all hep and opinions (and if you can have some documentation, I need as much as possible to show my Board of Directors since I have to present to them my findings and opinions.

    And my opinions are as follows:

    I find it disturbing that doctors charge a consult when the patient was referred for a CCS, I find it horrible that the doctor then goes and does a CCS and charges it as such when we all know if the pt was just seen for the consult w/symptoms and we have to code it as such and then the pt turns around and screams because they had a diagnostic exam instead of a screening and now their deductibles and co-ins are being hit when they were told they were having a screening and as such when they called their ins' that is the benefit they asked about (as did our pre-cert dept).

  2. #2
    Columbia, MO
    You need to have the questionair clarify that these "symptoms" are actually current complaints, or is this something they have had at some point. You should begin with having the patient document at the top of questionair why they are here. ie, are you currently having problems , if so list, or did your physician suggest a sreening. I have experienced many times where the GI doc just asksthe patient if have ever had any issues with constipation or diarrhea which of course the patient will say yes.
    Also since the pcp did not request that your physician see the patient for symptoms, then I fail to see how this can be a consult at all.
    I think your patients have every right to be angry especially the ones that have screening as a covered benefit.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Charlotte, NC
    Default Debra,
    Thanks, I feel the same way. But unfortunately, this is a common occurence across the country. A doctor can always find a problem and thereby make it a consult. It's a nice little loophole they have. It's something I'll be bringing up at my roast, er, meeting....

  4. #4
    Are they actually charging consult codes (99241-99245) or is that just the lay term for a problem visit and they are using new or established codes as appropriate (99212-99215, 99201-99205)?

    Just having symptoms doesn't qualify for a consult. You are right consults are billed incorrectly all over the country. This is why they are high on the OIG hit list and there is talk of doing away with the code set.

    Laura, CPC, CEMC

  5. #5
    Unfortunately everyone is right. We see this all the time. I think everyone has valid points. You do need to have a questionarre (like mitchell said)that explicitly states are you "currently" experiencing any of the following symptoms. We have an open access program in place where a dr can refer a patient over for thier screening and if there is no significant risk that must be medically evaluated (based on a pre scheduling questionarre) then they come to us just for the colonoscopy screening and thats it. This alleviates a lot of problems for billing as well as unnecessary and non chargable visits prior to the procedure. It is also easier on the patient because for most insurances the screening benefit is a one time shot and if they use it on an office visit then the procedure won't be covered. If the consults are not being billed appropriately with the reason that the PCP is sending them to the practice for (for which you must have documentaion) then your doctors will pay a hefty price for it later on.

    PS Even if they "find" a problem it cannot be a consult if it is not documented in the PCP's request.

    Be firm with your instincts and what you know to be true and roast away
    Kimm Hall CPC, CMSCS, CGCS

    If you live to regret then you have not learned lifes lessons.

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