Wiki + Cologuard = ? screening

[kimberliterpstra]

Good morning,

I have a provider who routinely uses the phrase "xx-year-old woman presenting for first time screening colonoscopy, prompted by a positive Cologuard test. Diagnosis: 1.Colorectal screening, average risk and 2. positive Cologuard." In my mind, the two diagnoses contradict each other.

The patient undergoes the procedure and ends up having a polyp removed.

My thought process is to charge 45380-45385 for the polyp removal, but in my opinion, this is not a screening... the patient would not have come in for a colonoscopy IF the Cologuard test had been negative. The provider and patient want it coded as screening (with modifier 33 or PT) and diagnosis Z12.11 to allow the patient's best benefit (no copay, no deductible).

Is my thought process correct or am I missing something?

 

[CodingKing]

You are right Positive cologuard is a sign or symptom so its no longer screening. It would be a false claim to use a screening DX or modifier 33. R19.5 would be the diagnosis that is the reason for ordering the colonoscopy

 

[clarkmegan]

You are correct. The patient is now diagnositc because they are presenting with an abnormal finding. The cologuard test was the screening and would have been billed as such, utilizing that preventive benefit. Even if you tried to bill as a screening, it should get denied because screening benefits have been used within that time frame.