# Routine Procedure Referrals



## minoweka (May 21, 2014)

Our PCP offices add the Dx code for the routine procedure that the Provider is currently ordering for the patient. For example: Pt is here for her annual physical but she goes to ob/gyn for PAP. We add V76.2 to that DOS for the referral.  Another example is a colonoscopy. We add V76.51 to the current DOS for the referral that will actually be performed in the future. Is this correct coding? If yes, why? If no, why? I think it is not because the service is not being performed on that DOS.


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## ehanna (May 21, 2014)

If the provider is not treating the diagnosis and it is not part of an underlying condition (code first etc) then he should not be using them as a diagnosis for the visit. He should only be using the codes involved in the reason for the visit.

If he puts a pap diagnosis on the claim simply because he referred to the gyn doc he is telling the insurance company he did the pap. This is fraudulent and would quite possibly result in the procedure being denied when she did go to the gyn doc.

See what others have to say, these are my thoughts and beliefs, and I hope this helps.

E


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## MarcusM (May 21, 2014)

ICD-9-CM Diagnosis Code V76.2: Screening for malignant neoplasms of cervix.
V76.51: Special screening for malignant neoplasms of colon. 
Current Procedural Terminology is to describe the service that was provided for billing purposes, and ICD-9-CM diagnosis codes are to describe why that service was provided. If your provider is not performing those screenings, he should not make these diagnoses.


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## minoweka (May 21, 2014)

*Thank you*

Thank you both for taking the time to respond and confirming my take on the subject. I will use this as my supporting documentation for removing referral Dx's on encounters.


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## erjones147 (May 22, 2014)

At our facility, we use V68.81 for all referrals and then add the Dxs that prompted the referral in the first place. Our referrals will not be approved without the Dx codes (tribal clinic)

Our providers then write it up in our EHR as non-billable "chart reviews." No procedure code is used, and the "visit" is never sent to any insurance company


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## mitchellde (May 22, 2014)

ICD-10 CM has a guideline that states you use the screening Z codes only when the screening procedure is being performed.  I realize we are not yet using ICD-10 CM, but this guideline makes it much more clear.


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