# screening vs. diagnostic colonoscopy



## mmcneil (Jun 25, 2013)

Patient was referred from her primary physician for a screening procedure, upon questioning by my physician she revealed that she has chronic constipation. 

Procedure was coded as diagnostic due to the complaint of constipation. Patient is arguing that she was referred for screening and although she does have the constipation this was not the reason she presented for the procedure, and that neither she nor her primary physician were concerned about the constipation enough to be evaluated for it. 

Was I correct in billing as diagnostic or should it be changed to screening due to the reason for referral and patient request. I know there is much debate about this issue and I am just looking for some guidance from others as to what you would do. Thanks!


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## jmcpolin (Jun 25, 2013)

I would have coded V76.51 prime and 564.00 second.  From what I have read you only change the dx to the finding if the colonoscopy turns to treatment such as a biopsy.


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## adevine (Jun 25, 2013)

Thanks!  I'd be interested in your source(s), as this topic is troubling for our pathology practice.  We're processing & interpreting the biopsies, and have had many patients wanting the screening diagnosis listed as primary since their insurors will cover preventative care.  Does surgical pathology qualify as preventative care?  So many of our clients (surgeons) refer "random biopsies" to our facilities, but I find it hard to believe that there wasn't some endoscopic indication of disorder that prompted collection of specimens from selected sites.


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## acbarnes (Jun 25, 2013)

Watch Out! Make sure your physician's documentation states that the reason he is recommending the colonoscopy is for screening, V76.51 with no mention of constipation on the opertaive report. If the pre-operative diagnosis and indication on the colonoscopy report state constipation and screening, 564.00 would have to be listed primary since symptom/diagnosis trump V code. Remember, you must code based on the documenation, not on patient preference. 

If this secenario happens in our practice and the physician agrees that the constipation is not the indication then his original office note must state that the colonoscopy is recommended for screening purposes only and _(high fiber diet, increase water intake, OTC meds)____ is the recommendation for the complaint of constipation. The operative note will only list screening colonoscopy as the pre-operative indication. This will clear up any confusion on audit.


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## jmcpolin (Jun 25, 2013)

adevine said:


> Thanks!  I'd be interested in your source(s), as this topic is troubling for our pathology practice.  We're processing & interpreting the biopsies, and have had many patients wanting the screening diagnosis listed as primary since their insurors will cover preventative care.  Does surgical pathology qualify as preventative care?  So many of our clients (surgeons) refer "random biopsies" to our facilities, but I find it hard to believe that there wasn't some endoscopic indication of disorder that prompted collection of specimens from selected sites.



its on the CMS website


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## mmcneil (Jun 25, 2013)

acbarnes said:


> Watch Out! Make sure your physician's documentation states that the reason he is recommending the colonoscopy is for screening, V76.51 with no mention of constipation on the opertaive report. If the pre-operative diagnosis and indication on the colonoscopy report state constipation and screening, 564.00 would have to be listed primary since symptom/diagnosis trump V code. Remember, you must code based on the documenation, not on patient preference.
> 
> If this secenario happens in our practice and the physician agrees that the constipation is not the indication then his original office note must state that the colonoscopy is recommended for screening purposes only and _(high fiber diet, increase water intake, OTC meds)____ is the recommendation for the complaint of constipation. The operative note will only list screening colonoscopy as the pre-operative indication. This will clear up any confusion on audit.


My physician only documented the constipation as the indication for the procedure and in the office note he did not list a screening at all and did not give a specific reason for the colonoscopy just that one was needed.


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## mitchellde (Jun 25, 2013)

in the office documentation under the cc did the provider state the patient was presenting for complaints of constipation or was it stated as patient referred for screening?  ALso you donot change a screening V code to a finding, if the reason for the test is screening the screening V code remains primary and the find is listed secondary


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## chembree (Jul 10, 2013)

CMS advises that, whether or not an abnormality is found, if a service to a Medicare beneficiary starts out as a screening examination (colonoscopy or sigmoidoscopy), then the primary diagnosis should be indicated on the form CMS-1500 (or its electronic equivalent) using the ICD-9 code for the screening examination.


http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/SE0746.pdf


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## KImberlyann7@comcast.net (Feb 6, 2014)

*Follow up codes*

In ASC , pt is in for follow up polyps do you add a modifer 33/pt if   polyp is snared?
Which senario is correct  ????
1.  45385--33/pt. modifer on   v67.09 , v12.72,211.3 
2.   45385  211.3 v12.72   no v67.09


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