# Screening dexa problem



## barber (Oct 11, 2010)

Iam having a problem at work concerning the interpretation of Pg 51 in the 2010 professional edition Chapter 18 number 5 concerning the word may when applied to bone density screenings. I interpreted this section with the assistance of other coders on the ListManager to mean that if the physician writes screening on the script then the screening code must be listed 1st and the diagnosis code 2nd. The other coder, billing manager and collector state that the diagnosis code is 1st and the screening code 2nd. Please cite reputable  literature to back up your interpretation either way. They do not consider blogs or list serves reliable and we do not subscribe to Radiology Coding Alert or any other coding publications. Thank you for your time.


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## mitchellde (Oct 11, 2010)

Per the coding guidelines, the screening dx code is always listed first regardless of the findings.
Pg 70 of the coding guidelines for 2011:
A screening code may be a first listed code if the reason for the visit is specifically the screening exam..........
Should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis.
The V code indicates that a screening exam is planned. A procedure code is required to confirm that the screening was performed.


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## Nora (Dec 6, 2010)

The term "screening" seems to be over-used.  How can I tell when a dexa is truly a screening, as opposed to a diagnostic dexa?  Sometimes the prescription says screening (often on a pre-printed, generic form), but the patient's report is full of symptoms/reasons why she needs a dexa.  It seems many people mistakenly use the word "screening" when they don't really mean "screening" -- they mean "scan".  What makes a "screening" a screening?


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## mitchellde (Dec 6, 2010)

screening is a patient that is asymptomatic, but meets a predetermined criteria for which screening is prudent for preventive and early detection.  If the patient has signs or symptoms that require investigation then these are diagnostic tests not screening.


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## Nora (Dec 6, 2010)

Even if the doctor orders a "screening"?  Or do I HAVE to code it as a screening?  Say, for example, the patient has been undergoing osteoporosis treatment for 3 years and I KNOW it is not a screening, but the prescription says screening.  Can I code it as a diagnostic, or must it be coded as a screening because that's what it says?


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## mitchellde (Dec 6, 2010)

If we know the patient has osteoporosis and is undergoing treatment then the test is being ordered to check the effectivness of the treatment.  The AHA coding clinics have several issues that cover this, it is then coded as V58.83 encounter for therapeutic drug monitoring with V58.69 as the secondary dx.  This is not screening it is monitoring.  As long as you verify with the documentation in the medical record then you may change the dx.  The doctor is probably ordering screening as he does not see it as diagnostic since he already knows the diagnosis.  Ask him to change to order in the future to monitoring.


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## Nora (Dec 6, 2010)

Thank you so much, Debra!  You have been a great help!!


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## Lisa Bledsoe (Dec 7, 2010)

Check out page 3 of this link.  It uses lab tests as an example, but also applies to any screening:
http://www.trailblazerhealth.com/Publications/Job Aid/BillingTipsE-MPrevScreenSvcs.pdf

Also see the ICD-9 guidelines for screening:
"Should a condition be discovered during the screening the the code for the condition may be assigned as an additional diagnosis."


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