# Wrong to exclude diags for a Colonoscopy?



## SUEV (Aug 28, 2009)

Yes, another question about colonoscopies!  If a patient is sent for a screening colonoscopy and the provider finds out during the H&P that the pt had diarrhea or a change in bowel movements, do those diags have to be listed on the report?  The provider has said that it doesn't change the fact that he's doing a colorectal cancer screening, not a diagnostic colonoscopy for the incidental history.  On the other hand, he lists them on the report along with the screening diags so of course when others code it, the screening code gets dropped.  Is this just a case where I should tell him to drop the diags if they're not the reason for the colonoscopy?  This issue really plays havoc with our billing team because if it gets coded as a diagnostic, patients may not get their full benefits from their insurance company.  I don't want to manipulate my coding to get paid, but I do want to make sure we aren't unintentionally shortchanging the patients out of their benefits if these would be true screenings, even with incidental issues.  Thanks for any thoughts on this issue,
Sue


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## FTessaBartels (Aug 28, 2009)

*A related story*

Some time back I went to see a new PCP. This was for an annual exam. She was very thorough in going through my history and ROS. 

When I got the statement she had included a diagnosis of insomnia (or something like that).  I called her office and she said "well you said you were not sleeping through the night." (She didn't treat this incidental finding, by the way.)

Yes, I had said that but ONLY in response to her ROS question. I had not "complained" of that .. in fact, I had NO complaint... my visit was for a routine annual physical. 

Your doctor is doing the right thing to query the patient as part of the history, and your doctor has even said that these are "incidental history."  I think your doctor is correct - this is still a screening colonoscopy.

Just my opinion.

F Tessa Bartels, CPC, CEMC


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## mitchellde (Aug 28, 2009)

Tessa is correct it is still screening, just questioning about past issues does not change the fact that it is screening


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## coachlang3 (Aug 30, 2009)

See, I have a different thought.

The pt is being seen for a colon screening and has a current symptom (as I read it).  This is a "dangerous" line to walk.  Yes, the doctor would still want to do the screening, but the patient is no longer asymptomatic they are now symptomatic (for the purpose of a ccs) and it is no longer a screening.

I am actually speaking to my practice board tomorrow night about this very thing.  They are seeing the patient for a visit prior to the procedure (why I don't know since we do open access) and finding the diarrhea or change in habits.  And still wanting to do a CCS.  They are trying to tell me it is incidental, and I tell them it doesn't matter.

However, if during the pre-proc exam, the patient is asymptomatic, and there are no indications, fine.  But if you find anything during that pre-proc exam, ding, diagnostic.

I'm of the mind, if you are going in for a screening or well-visit, keep your mouth closed about any problems and we should be educationg patients and doctors of this.


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## mitchellde (Aug 30, 2009)

I still disagree in that to me this patient is not symptomatic.  Just because they answer yes to querys about have they HAD a change in bowel habits etc does not make them symptomatic.  The patient did not present for nor express any symptomatic or problematic concerns, therefore any querys during the history intake is exactly that, HISTORY.  I think this is the coder looking too hard for anything other than a V code for a diagnosis and I feel that is so wrong and I can make a case that the documentation truely does not support that as an acute symptomatic concern.  It is incidental, it is screening.


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## mhcpc (Aug 31, 2009)

If the change in bowel habits is not a current issue, then the colonoscopy is screening.  If it is a current issue, the colonoscopy is diagnostic.

Michele Hayes, CPC, CGIC


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## coachlang3 (Aug 31, 2009)

I think someone read what I wrote wrong, or I read something wrong.

I'm saying if the patient comes in for a proc (or the OV prior to the proc) and on our intake form we have a Current symptoms and they mention they had constipation the other day and the doctor "manages" that problem, then no V code.

I was under the impression the patient in the OP was currently having symptoms that "might" be unrelated.


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## FTessaBartels (Aug 31, 2009)

*Diagnosis vs History*

SueV
You wrote: *The provider has said that it doesn't change the fact that he's doing a colorectal cancer screening, not a diagnostic colonoscopy for the incidental history. On the other hand, he lists them on the report along with the screening diags so of course when others code it, the screening code gets dropped.*

Your doctor has told you that he considers these to be "incidental history" findings. If he truly believes they are not problematic and this is still a screening colonoscopy, then I would encourage him to *NOT* include them on his list of diagnoses. (But, still include them in his ROS.)

If he feels the symptoms are of a nature to require a diagnostic colonoscopy, then he should include them in the diagnoses, and you won't have a screening colonoscopy code. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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