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Screening Cscope vs UHC

  1. #11
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    Medical Coding Books
    Quote Originally Posted by mitchellde View Post
    I agree coding for payment is unethical, it is something I would never even suggest. I still see this as a screening for a patient with a hx of polyps. It is the way we did it at the cancer center always. If a patient had breast cancer and has a screening mam for the surviving breast then it is a screening V code with a hx of breast cancer. I see this no different. So I guess it is an interpretation issue. The problem is the patient is at the heart of our interpretations.
    But the surviving breast is not the one that had the cancer...
    It does seem to be an interpretation issue. While I agree that the patient is the priority, the real issue in our job is the correct coding. And, as we all know, coding is quite often open to interpretation and can be subjective.

    coachlang3 - as far as what the insurance "wants" doesn't mean that it is correct coding. How often do the insurance companies tell patients that the doctors office coded the visit "wrong" when we really coded it right?
    Lisa Bledsoe, CPC, CPMA

  2. #12
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    I disagree with the comment that this is the way that the insurance wants it. Coding screening (v7651) is the way to code a colonoscopy so that it will get paid and there is no conflict with them or the patient. When I code V1272 as primary I do not get denials. I get deductible issues or 80/20 payment. But they are not denials. But as a coder I cannot in good faith code a patient who has a history of colon polyps or colon cancer as screening. I have to code the reason they are having the procedure and that reason is history. What do you do when a patient has Medicare and they have a hx of colon polyps and it has been two years since their colo? If you code V7651 with G0121 it will get denied for frequency because that can only be used every 10 years. The proper way to code it is V1272 with G0105.
    Obviously we should all just agree to disagree on this one! LOL! The life of a coder. Now my big question -what are we going to do when we have a patient who has Medicare secondary and their primary payer recognizes consult codes next year? Do we bill the consult code or not?
    Susie Corrado, CPC
    __________________
    ENT Coding/Billing

  3. #13
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    I agree Susie - we may have to agree to disagree.
    As for the consultation issue...man - I for one wanted them gone, but not just by CMS. If they can't be completely gone, then leave it alone and we'll just keep working with the providers on the documentation requirements! Now it's opened this whole new can of worms!
    Lisa Bledsoe, CPC, CPMA

  4. #14
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    Quote Originally Posted by scorrado View Post
    I disagree with the comment that this is the way that the insurance wants it. Coding screening (v7651) is the way to code a colonoscopy so that it will get paid and there is no conflict with them or the patient. When I code V1272 as primary I do not get denials. I get deductible issues or 80/20 payment. But they are not denials. But as a coder I cannot in good faith code a patient who has a history of colon polyps or colon cancer as screening. I have to code the reason they are having the procedure and that reason is history. What do you do when a patient has Medicare and they have a hx of colon polyps and it has been two years since their colo? If you code V7651 with G0121 it will get denied for frequency because that can only be used every 10 years. The proper way to code it is V1272 with G0105.
    Obviously we should all just agree to disagree on this one! LOL! The life of a coder. Now my big question -what are we going to do when we have a patient who has Medicare secondary and their primary payer recognizes consult codes next year? Do we bill the consult code or not?
    I NEVER let coverage issues cloud my coding. I think that is the problem with some of the issues in a lot of offices I have been in. I am sorry to be the big thorn here but I still firmly feel this is by definition a screening. Irregarless of the frequency there is no diagnostic purpose for this exam it is for the purpose of screening. So no matter if the patient has screening benefits or has to pay a deductible, my concern is always correct coding. I go back to the patient is here for screening due to a hx of polyps. Sorry ladies I go on record as big disagreement.

    Debra A. Mitchell, MSPH, CPC-H

  5. #15
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    Debra - I admire your stance and appreciate your input. I feel strongly about my opinion/interpretation as well. We have to stand up for what we believe in life and in our work. Shows passion!
    Lisa Bledsoe, CPC, CPMA

  6. Default
    The valuable piece of information that was given to me by the insurance company is that the rule of thumb is that in a patient with no history of any colon problems may have a screening colonoscopy every 10 years. In a patient that has or had a polyp (or any other condition pertinent to the colon), may have a screening colonoscopy perhaps every 2-3 or every 5 years BECAUSE they are at higher risk. If they are returning for the study at their physician's urging and not because they have pain or bleeding or any other symptom, it is a screening study.

    Much of the coding heirarchy is very ambiguous and it puts us in a very confusing position (most times).

    Sometimes, we not only have to change or hats daily but we have to change glasses to see things in different lights.

    Good luck all

  7. #17
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    Thanks AuntJoyce - very good point to put it all in perspective.
    Lisa Bledsoe, CPC, CPMA

  8. #18
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    Debra,

    Out of curiosity I would like to know how you code a Medicare pt who has a history of colon polyps and their last colo was 5 years ago? As previously stated in my earlier post you can't code that with v7651 and G0121. It will be denied. It has to be coded v1272 and G0105.
    Susie Corrado, CPC
    __________________
    ENT Coding/Billing

  9. #19
    Location
    Columbia, MO
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    I code it with the V76.51
    V12.72
    and the G0121

    Debra A. Mitchell, MSPH, CPC-H

  10. #20
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    Quote Originally Posted by AuntJoyce View Post
    The valuable piece of information that was given to me by the insurance company is that the rule of thumb is that in a patient with no history of any colon problems may have a screening colonoscopy every 10 years. In a patient that has or had a polyp (or any other condition pertinent to the colon), may have a screening colonoscopy perhaps every 2-3 or every 5 years BECAUSE they are at higher risk. If they are returning for the study at their physician's urging and not because they have pain or bleeding or any other symptom, it is a screening study.

    Much of the coding heirarchy is very ambiguous and it puts us in a very confusing position (most times).

    Sometimes, we not only have to change or hats daily but we have to change glasses to see things in different lights.

    Good luck all
    EXACTLY it is screening not diagnostic.

    Debra A. Mitchell, MSPH, CPC-H

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