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Gastroenterology Coding Alert

Reader Question:

Beware: Hiding Medical Information For Higher Reimbursement Is Fraud

Published on Fri Jun 10, 2011

Question: We have a patient that came in 2002 for a screening (referred by his primary care physician [PCP]), and we found adenomas polyps. The patient came back for a follow-up in 2005; this time we found hyperplastic polyps. For his 2011 follow-up visit, we didn't find any polyps. We coded with V12.72 as primary diagnosis. The procedure report stated follow-up for history of adenomas polyps. However, when I checked the patient's chart, I learned that he changed primary care physicians just before he came back for his first follow-up. Now his new PCP wants us to change the ICD-9 code to V76.51 so that the insurance will cover 100 percent. What would be your advice?Florida SubscriberAnswer: If a patient has a documented history of polyps, then the PCP has that history, and hiding that fact could be considered fraud. The recent healthcare legislation provided patients with certain preventative healthcare [...]
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