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Screening vs medical

  1. #1
    Default Screening vs medical
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    Fellow coders, i have a question, i was asked by a patient today, he has 100% coverage for a "screening of colon" but what if the surgeon finds a polyp? Doesnt this turn from diagnostic to medical? The patient is now conerned because the physicans office will bill screening (V76.51) as the primary code, even if something was found. I always assumed if somethng was found, you bill that as primary to V76.51--making this code your 2nd diagnosis code. Am i wrong??

    Thanks
    Julie S., CPC
    Anesthesia Coder
    Education Officer, Cleveland Area Chapter 2016
    Email: medcoder05@gmail.com

  2. Thumbs up Screening vs. Medical
    Hi,

    Since there was no way for the doc to know that there was a polyp or might have been a polyp, it is considered to have been found as a direct result of the study. Since this patient presented for a screening, it should be coded as V76.51 and can be followed by 211.3 (for the polyp if indeed that is what they found).

    In all fairness to the patient, he should not be penalized (by the insurance company) for a positive findings on a screening study. Indeed, the carrier should be grateful that the patient took the time to have this done because screening studies do save lives.

    Have a great day,

    Joyce

  3. #3
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    Joyce is correct and if you read the coding guidelines for ICD-9 they state that the screening V code will remain the primary dx regardless of the finds or any subsequent procedure performed at that time as a result of the findings.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Default
    thanks guys for your information, i always thought that it was the opposite, but thanks, i hope this easies the patients mind and he will continue to schedule his colonscopy.

    thanks again!
    Julie S., CPC
    Anesthesia Coder
    Education Officer, Cleveland Area Chapter 2016
    Email: medcoder05@gmail.com

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