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screening vs diagnostic

  1. Default Screening vs Colonoscopy...
    Medical Coding Books
    I too have a similar situation where a 51 yr old female PT was referred to my Dr by her physician for bloating, cramps and abdominal pain relieved by bm or flatus. My Dr performed the colonoscopy to check for potential problems and the PT having a family Hx. findings were unremarkable other than some hemmoroids. She uses a commercial payer which does Preventative Care Svcs and PT believes to be entitled to 100%. ( they only paid for the colonoscopy)

    I know The Payer lists the procedure, And so I take it that it wouldn't be preventative but a diagnostic screening, but as a new coder I am somewhat confused, as to which is what after reading policies and protocols which I'm not sure about. Is there (1) an actual source that I can access? (2) how should this be coded? (what is the real deal?)

    Imput would be appreciated as PT is Rather upset!

  2. #12
    Location
    Charlotte, NC
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    534
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    Depends on why your doctor actually did the procedure.

    Did he do the procedure because of the abd pain and cramping or did he do the procedure ebcause the pt needed a CCS?

    If the pt was being seen for the abd pain it is not even a diagnostic screening it is just a diagnostic colonoscopy.

    The way you wrote it I would code it as a 45378 for the cpt and 789.00 and 787.3 for dx.

    What did the doctors procedure note state for the indication?

  3. Default
    Quote Originally Posted by coachlang3 View Post
    Depends on why your doctor actually did the procedure.

    Did he do the procedure because of the abd pain and cramping or did he do the procedure ebcause the pt needed a CCS?

    If the pt was being seen for the abd pain it is not even a diagnostic screening it is just a diagnostic colonoscopy.

    The way you wrote it I would code it as a 45378 for the cpt and 789.00 and 787.3 for dx.

    What did the doctors procedure note state for the indication?
    The colonoscopy was done because of the abd pain and cramping also that the PT has a family Hx for colonrectal cancer.

  4. #14
    Location
    White Plains, NY
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    123
    Default Gratuitous commment
    Quote Originally Posted by syllingk View Post
    I say we send all questions like this straight to ObamaCare
    The guidelines are not part of PPACA; they are part of appropriate screening procedures for cancer. Their adoption pre-dates PPACA.

    Please keep politics out of this Forum.

    Lin

  5. #15
    Location
    Columbia, MO
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    12,844
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    Quote Originally Posted by Coder_Rick View Post
    I too have a similar situation where a 51 yr old female PT was referred to my Dr by her physician for bloating, cramps and abdominal pain relieved by bm or flatus. My Dr performed the colonoscopy to check for potential problems and the PT having a family Hx. findings were unremarkable other than some hemmoroids. She uses a commercial payer which does Preventative Care Svcs and PT believes to be entitled to 100%. ( they only paid for the colonoscopy)

    I know The Payer lists the procedure, And so I take it that it wouldn't be preventative but a diagnostic screening, but as a new coder I am somewhat confused, as to which is what after reading policies and protocols which I'm not sure about. Is there (1) an actual source that I can access? (2) how should this be coded? (what is the real deal?)

    Imput would be appreciated as PT is Rather upset!
    The guidelines for screening are clear, the patient must be asymptomatic for a test to be a screening. The phrase diagnostic screening is incorrect, there is no such thing, a procedure is either diagnostic due to a diagnosis or presenting symptoms, or it is screening due to a pre determined criteria such as age, and the patient is asymptomatic.

    Debra A. Mitchell, MSPH, CPC-H

  6. Default
    Thanks for clearing things up!

  7. #17
    Location
    Columbia, SC
    Posts
    11
    Default
    Here's another question. We have situation where the doctor's order says "low hemoglobin" and in the Op Note he also refers to anemia. Would you consider this a diagnostic colonoscopy since there may be some other cause of anemia?

  8. #18
    Location
    Charlotte, NC
    Posts
    534
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    Quote Originally Posted by njwanucha View Post
    Here's another question. We have situation where the doctor's order says "low hemoglobin" and in the Op Note he also refers to anemia. Would you consider this a diagnostic colonoscopy since there may be some other cause of anemia?

    What is the actual indication for the procedure itself? Anemia?

    Many times the doctor might do an EGD due to upper gi symptoms such as anemia but they have no reason to suspect lower gi symptoms so the colon is a screening and they do an EGD for the upper GI symptoms.

    Tough call.

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