Wiki advice on billing visit w/dx of lynch syndrom

[cgarciamck87@gmail.com]

Our office had a patient come in for an ultrasound to check for any pelvic abnormalities. She has a dx of lynch syndrome and was recommended to have yearly ultrasounds. There was nothing abnormal that came from this and was advised to follow up in a year. Prior to this, she had just come in for her annual wellness visits. Doctor only used dx z15.09. I know I can't use this as primary dx but based on documentation, I'm finding it difficult to find a primary dx.

 

[TThivierge]

Hi Cgarcia,
Try Dx codes R93.41 or N81.84, M99.05, N94.9 according to documentation. dx Z15 is not the best dx to sue as first dx. Does the patient have any chronic conditions to add ?
Common symptoms of Lynch syndrome can be Blood in your stool. Constipation. Abdominal pain or cramps. Diarrhea or stool smaller than normal Fatigue or feeling full or bloated. But should use the History of Lynch Syndrome Z86
I hope helped you
Lady T

 

[nielynco]

Our office had a patient come in for an ultrasound to check for any pelvic abnormalities. She has a dx of lynch syndrome and was recommended to have yearly ultrasounds. There was nothing abnormal that came from this and was advised to follow up in a year. Prior to this, she had just come in for her annual wellness visits. Doctor only used dx z15.09. I know I can't use this as primary dx but based on documentation, I'm finding it difficult to find a primary dx.

Z15.09 is the only correct diagnosis for Lynch syndrome. But as we know a Z15 code is not to be listed as the primary diagnosis. If he is doing a transvaginal ultrasound to check for ovarian or endometrial cancer, you can use a screening code for this condition followed by the Z15.09. If ovary use Z12.73, if endometrial Z12.79. But keep in mind that ultrasound is not a recommended tool for female patients with lynch syndrome (which puts her at increased risk of developing cancer, not pelvic abnormalities) per ACOG. Instead they recommend an endometrial biopsy) so you may get a denial for the ultrasound.

 

[csperoni]

I agree those lynch syndrome and BRCA+ patients can get tricky with diagnoses. If documented and appropriate, family history is often a possible solution. Not appropriate for sonograms/teting, but for visits, the generic other counseling Z71.89 is also sometimes a solution.