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Screening Colonoscopy w/HX of Chronic Constipation

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    Medical Coding Books
    Well, if the documentation states it is a screening then you can use V76.51. If screening is not mentioned then you have to use 564.00. You cannot decide if this is a screening or not it has to be documented. Just because the physician is doing a colonoscopy does automatically mean they are screening for cancer. No, Medicare will not cover constipation, your provider will have to get a signed ABN beforehad in order to do the colonoscopy. Physician's think that constipation is an important reason to do a colonoscopy.....Medicare does not....the physicians cannot comprehend why they cannot do a colonoscopy on a Medicare patient for constipation. It just is not payable. If you have no ABN...you have to write it off.

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    You're absolutely correct in regards to the documentation supporting the screening colonoscopy. I thought, by reading the first item in this thread, that we were referring to a screening colonoscopy.

    ~L
    CPC, CGSC, COSC

  3. #13
    Default
    I agree with MKJ. It is how the doctor documented it on the op note. If he documented on the op note that he is doing the colo for chronic constipation that is what needs to be coded. If he says screening - you code screening. If your doctor states both on the op note then symptoms trump screening. Fortunately, constipation is a paid diagnosis for Trailblazer here so we do not have the ABN issue. It is my quote that Lisa copied in her previous reply and I stand by that. The doctors need to be very clear on the op note why they are doing it. There is no issue with doing a screening on a patient who has chronic constipation. The doctor just cant mention constipation on the op note.
    Susie Corrado, CPC
    __________________
    ENT Coding/Billing

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    The doctor was clear in the op note that this was a screening colonoscopy and documented in history part of the note that the patient had chronic constipation. Are you saying that by simply mentioning chronic constipation anywhere in the op note that the colonoscopy becomes diagnostic? If you have any guidelines that you are using from Medicare regarding this issue, where can I locate them? Thanks.

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    I'd be curious to see that myself.

    ~L
    CPC, CGSC, COSC

  6. #16
    Default
    The information I was given regarding all of this came from a seminar I went to in March that was put on by McVey. Many of us in the seminar brought up the issue of our doctors documenting the reason for the colo on the operative note as "colo for screening in a patient with intermittent rectal bleeding" (or any other problem the patient might be having). She told us that we needed to get with out doctors and they needed to amend the op notes to state either just screening or rectal bleeding. That if they leave both screening and rectal bleeding that you have no choice but to code the rectal bleeding but their true intent may be that they know the rectal bleeding is from hemorrhoids and they are doing the colo for screening purposes. By leaving both as the "reason" it is not very clear what the doctors true reason for doing the colo is. Because of this information I was given at this seminar - I (and many others) have been coding this way every since. I think it makes sense and my doctors have gotten very good about putting either screening as the reason for the colo or a problem the patient is having. I dont have the issue of two reasons anymore on the op note. Makes my life easier! I am sure if you got in touch with someone at McVey they could send you all the documentation they have on this.
    Susie Corrado, CPC
    __________________
    ENT Coding/Billing

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    Thanks for all of the information. I appreciate it.

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