Wiki diagnosis code for screening or diagnostic colonoscopy

[GRANNAN]

I have read most of the posts for screening vs diagnostic colonoscopy coding, but I don't believe I read one with the conundrum that I have. The performing physician's H&P documented the patient's symptoms. No mention in this H&P that a screening was to be performed; just the opposite: Colonoscopy & BX with Assessment of: Constipation and he gave indications on the op note as: #1-Screening; #2 change in bowel habitis. My hospital coded this with the symptoms as the primary dx and as a diagnostic colonoscopy. Now we have received a letter from the performing physician requesting this be changed to a screening colonoscopy as just the colonoscopy was done- nothing needed a biopsy and dx of screening. the physician office also supplied us with the primary care physician's H&P where the patient was seen there earlier that has a late entry stating that"Patient was sent for screening colonoscopy. She denied any symptoms at the time the colonoscopy was ordered." Can anyone give me advice on how you would handle this case? Do you accept the additional documentation and change coding or do you abide by the screening coding guidelines?

 

[jmaciulis]

I run into this a lot with our practice. We schedule a screening colonoscopy for a new patient and send them a medical history questionnaire. On the day of the procedure they present the questionnaire which now indicates a symptom they feel they are having or they verbally tell the doctor about their constipation/diarrhea/abdominal pain. The physicians have to document this, so now we have a procedure report and H&P that lists screening and symptoms.

It is a grey area and I would also appreciate feedback on it. Currently, I ask our physicians to document whether or not they believe this symptom warrants evaluation. They do not always feel comfortable giving an opinion on this since they have not seen the patient for an exam and full work up.

I have been directed to code the reason for the procedure then, which is screening. This gets even more complicated when the physician takes a serial colon biopsy due to the patient mentioning they have diarrhea sometimes. It may not even be a symptom that has been ongoing or that warrants a colonoscopy, but they figure since they are already there they might as well.

The physicians want to help and be thorough by looking into everything the patient mentions. The patient just throws out any and all symptoms they may be having because they don't know it could be the difference between a 100% covered screening and a diagnostic procedure.

 

[mitchellde]

The problem I see is that most of the time the question air states "do you have or have you ever had..." So they indicate yes to almost every everything. The patient needs to be questioned as to whether this is a current problematic issue or are they just stating this has happened in the past. One guy stated he had diarrhea the day before the procedure, which was due to the prep and totally expected! But once the performing provider indicates the procedure is being performed due to a presenting symptom then it is a diagnostic. And once the claim is submitted and supports the documentation, you cannot change it. Documentation cannot be amended after the claim is processed. So maybe you need to be clear with the physician that they must indicate CURRENT symptoms that the patient is wanting the test performed for, instead of past issues that are not a current concern.