Gastroenterology Coding Alert

Question: A patient came to our gastroenterologist for a screening colonoscopy. During the visit, she said that she has been having abdominal pain for the past one year. Our gastroenterologist in the note says that the pain might be due to ovarian cysts. He recommended a fiber regimen and notes the screening colonoscopy. The patient underwent the colonoscopy. I would like to know whether to bill the colonoscopy as screening or diagnostic.

Minnesota Subscriber

Answer: To be clear about whether to bill the procedure as a diagnostic colonoscopy or a screening colonoscopy, you need to be clear about why your gastroenterologist asked for the procedure.

If your gastroenterologist asked for the colonoscopy to ascertain and evaluate what the reason for the abdominal pain was, then you cannot bill the colonoscopy as screening. This is so because your gastroenterologist is checking the cause for the symptoms that the patient has been experiencing. This cannot be coded as a screening procedure and is definitely diagnostic.

However, if your gastroenterologist is performing the colonoscopy because the patient presented for the screening, then it is right to bill the colonoscopy as a screening procedure. Since your gastroenterologist notes screening in the documentation, it is more likely that your gastroenterologist opted for screening colonoscopy.

It is best to go through the documentation more thoroughly to check the intent of your gastroenterologist for conducting the procedure to ascertain if the procedure was diagnostic or for screening. If you are still not sure about what the purpose of the colonoscopy was, then it is best to check back with your gastroenterologist before you code for the procedure. This will help clarify things and prevent mistakes that might lead to denial.