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Unknown history due to adoption

  1. #1
    Default Unknown history due to adoption
    Medical Coding Books
    If a patient comes in for a screening colonoscopy and has an unknown history due to being adopted can a high risk be assumed or is it still an average risk colonoscopy?

  2. #2
    Charlotte, NC
    I don't have any guidelines to give you but since there is no "history" known and you shouldn't assume, I would see it as average risk.

  3. #3
    This brings up the point of "not making the patient sicker than what they are" when assigning diagnosis codes that we all learn when becoming certified. I definitely would not assume high risk unless you know for sure. You would not be able to support that if you were ever audited.
    Susie Corrado, CPC
    ENT Coding/Billing

  4. #4
    Charlotte, NC
    As a follow-up I just had a scheduler call me from one of our offices and told me one of her doctors just gave her a ccs to schedule and said due to unknown family history the pt is high risk and she said he considers all of these pt's the same way.

    What are the odds this happens to me today?

    I just scoured the internet and the CMS and ACS and Cleveland Clinic sites trying to determine this. I found nothing.

    I understand from a medical standpoint why they have to consider it this way. But as Susie said, you can't "prove" it or show it so it's not high risk.

    I didn't find a single document or entry backing up adopted patients being considered high risk due to unknown family history.

  5. #5
    Charlotte, NC
    Okay, I found something thanks to Google and some different wording.

    Link doesn't work but if you google "interpretation of family health history + medscape"

    it should bring you right to the page if not here's the copy and paste:

    Interpretation of Family Health History
    Red flags are indications that there may be an increased genetic risk and the need for more in-depth probing. The primary red flag for most common diseases is a large number of affected relatives with the same or related condition. Premature onset of disease is also a genetic risk factor and varies depending on the disease ( Table 3 ).

    A number of methods have been proposed for assessing and stratifying risk in the presence of red flags. Scheuner and colleagues[19] stratify risk based on family history into 3 groups: high, moderate, and average.

    High Risk
    Premature disease in a first-degree relative;

    Premature disease in a second-degree relative (coronary artery disease only);

    Two affected first-degree relatives;

    One first-degree relative with late or unknown disease onset and an affected second-degree relative with premature disease from the same lineage;

    Two second-degree maternal or paternal relatives with at least 1 having premature onset of disease;

    Three or more affected maternal or paternal relatives; or

    Presence of a "moderate-risk" family history on both sides of the pedigree.

    Moderate Risk
    One first-degree relative with late or unknown onset of disease; or

    Two second-degree relatives from the same lineage with late or unknown disease onset.

    Average Risk

    No affected relatives;

    Only 1 affected second-degree relative from one or both sides of the family;

    No known family history; or

    Adopted person with unknown family history.

    Authors and Disclosures
    Lorie M. Vandenbusche, MSN, FNP, Kent State University, College of Nursing, Kent, Ohio

    Disclosure: Lorie M. Vandenbusche, MSN, FNP, has disclosed no relevant financial relationships.
    Last edited by coachlang3; 12-07-2011 at 01:57 PM.

  6. #6
    I agree that the correct answer is average risk

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