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screening colonoscopy - diagnosis is diverticulitis

  1. #1
    Default screening colonoscopy - diagnosis is diverticulitis
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    If a patient comes in for a screening colonoscopy with a pre-op diagnosis of screening and family history of colon cancer- and the post-op diagnosis is diverticulitis- do I code this as 45378 with diagnosis 562.10 and V16.0 or do I use the screening diagnosis V76.51 and V16.0?

    Thanks for your help!

  2. Default
    It's not a screening if something is found. Now that you've got a dx it turned into a Diagnostic scope not a screening. You would only use the screening codes to indicate that nothing was found and your ICD-9's of history would/should justify screening. Now you got a DX which justifies a DX scope. Sorry if I'm not explaining this well.

    Patient won't be happy but at least they know what's going on and can take care of it.

    Good Luck!

  3. #3
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    The patient already had the screening done which is V76.51. Now you just code Diverticulitis 562.10 and the family history V16.0 with your CPT.

  4. #4
    Location
    Fayetteville, NC
    Posts
    300
    Default
    It depends on the insurance. Most of the major carriers in my area are now advising us that if it started as a screening the primary diagnosis code on the procedure (45378, 45380, 45384, 45385, etc) should be the screening V code regardless of what is found. I guess since most of the carriers are not/were not accepting the screening modifier they had to give us some way to show what was actually going on.
    According to Blue Cross of North Carolina now it is coded with the procedure code for what was found but the primary diagnosis code is the screening code V76.51. And in the event that they have a history of polyps or cancer but are currently exhibiting no signs or symptoms that would warrant a colonoscopy (such as rectal bleeding, diarrhea, abdominal pain, melena) it is still considered a screening.They faxed out an instruction sheet over the summer that stated if it started as a screening the primary diagnosis on the procedure regardless of the results would be the screening V code. And they are paying at 100% even though there are results. Now this is only if the patient has NO signs or symptoms what so ever when they come in to schedule the procedure regardless of their history.
    I was a little confused by this so I called BCNC and spoke with the person in charge of this and she said that if the patient exhibited NO CURRENT symptoms that it is a screening. If during the procedure polyps or diverticulosis or whatever was found that the primary code should still be the screening V code followed by the diagnosis codes for what was found.
    A. McCormick, CPC, CGSC
    Walters Surgical Associates

  5. #5
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    Oh ok that helps a ton! I am in Iowa but I went ahead with the screening code, then the diverticulosis, then the family history. No one in the report that I have does it say she has any symptoms for the screening. Thank you all for the info! It really helped me!

  6. #6
    Location
    Columbia, MO
    Posts
    12,570
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    Quote Originally Posted by bbierman81 View Post
    Oh ok that helps a ton! I am in Iowa but I went ahead with the screening code, then the diverticulosis, then the family history. No one in the report that I have does it say she has any symptoms for the screening. Thank you all for the info! It really helped me!
    The coding guidelines are very clear on this it does not depend on the payer. The diagnosis is the patien's not the payers and not the physician's and not the coder's. If the patient came in for screening and was asymptomatic then it is screening first listed, findings are secondary dx codes as they incidental to what the expectation was given the patient presentation of asymptomatic status. Incidental findings are always secondary. If the patient were symptomatic and the findings are diverticulosis then you replace the symptom with the finding as it is not incidental when you are looking for the cause of the symptoms.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Default
    Well I'm not trying to split hairs here, just understand.

    562.10 is diverticulosis

    562.11 is diverticulitis

  8. #8
    Default
    Sorry that was my error- I meant the patient had diverticulosis- 562.10.All in all- this information is very helpful. Thanks everyone for your feed back! Much appreciated

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