Gastroenterology Coding Alert

Reader Question ~ Avoid 799.9 When Patient Has Identifiable Symptom

Question: When an asymptomatic patient comes to the office for his checkup prior to a screening colonoscopy, and the physician provides a level-two E/M service before sending the patient home, what diagnosis and CPT codes would we use? A co-worker told me to use 799.9, but I don't believe that's correct.

Ohio Subscriber
 
Answer: Code 799.9 (Other ill-defined and unknown causes of morbidity and mortality; other unknown and unspecified cause) implies that there is a symptom present, but the gastroenterologist cannot pinpoint it. So if the patient was truly asymptomatic, you should not use 799.9.

For a new patient, you should:

- report 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and straightforward medical decision-making)

- attach ICD-9 code V72.83 (Special investigations and examinations; other specified preoperative examination) to 99202 to show that the patient was asymptomatic.
 
For an established patient, you should:

- report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history; a problem-focused examination; straightforward medical decision-making)

- attach ICD-9 code V72.83 to 99212 to show that the patient was asymptomatic. Note: Medicare considers a preoperative visit for an asymptomatic patient included in the procedure code for screening colonoscopy. Therefore, Medicare will deny payment for the E/M service.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Gastroenterology Coding Alert

View All

Which Codify by AAPC tool is right for you?

Call 844-334-2816 to speak with a Codify by AAPC specialist now.