Diagnostic vs Screening Colonoscopy..help!

[amh@yahoo.com]

How would you bill?
49 yr old Patient came in for routine checkup, and revealed issue with constipation..I recommened billing as diagnostic not screening,due to pat having constipation, an xray was done and then referred for colonoscopy.

Dr noted:
HPI-I have a pat. present for routine physical also has occassional abdominal discomfort and cramping suspicious for constipation. x-ray revealed stool, (she is a candidate for colonoscopy and will be scheduled as part of todays visit).

Assessment-routine health maintenance exam, no notable findings of long-term healthcare issures. The pat. scheduled for colonoscopy given her recent persistence of constipation, has longstanding constipation and x-ray confrims presence of obstipation today.

Billing codes included the 99214/564.1 irritable bowel, V70 mammagram and other xray screening...the colonoscopy billed as 45378-icd-9...787.99 involvement of digestive.., 569.89 disorder of intestine..

 

[btadlock1]

How would you bill?
49 yr old Patient came in for routine checkup, and revealed issue with constipation..I recommened billing as diagnostic not screening,due to pat having constipation, an xray was done and then referred for colonoscopy.

Dr noted:
HPI-I have a pat. present for routine physical also has occassional abdominal discomfort and cramping suspicious for constipation. x-ray revealed stool, (she is a candidate for colonoscopy and will be scheduled as part of todays visit).

Assessment-routine health maintenance exam, no notable findings of long-term healthcare issures. The pat. scheduled for colonoscopy given her recent persistence of constipation, has longstanding constipation and x-ray confrims presence of obstipation today.

Billing codes included the 99214/564.1 irritable bowel, V70 mammagram and other xray screening...the colonoscopy billed as 45378-icd-9...787.99 involvement of digestive.., 569.89 disorder of intestine..

If that's all there was to the note, I don't see enough here to meet the criteria for a 99214 - most notably, there's no actual exam documented there.

Also, I don't see where you're getting irritable bowel from - The doctor documented abdominal cramps & severe constipation; although those are sometimes indicative of IBS, they could just as easily indicate that the patient has poor dieting habits, and needs to get more fiber. The point is, when the doctor doesn't mention a condition like IBS in the note, you can't make that conclusion when you code, based off of similar symptoms.

You should get clarificaation from the provider as to the purpose of the exam; was it prescheduled as a routine colonoscopy? And why would it be medically necessary to perform an invasive diagnostic procedure, when an xray has already identified the problem? Routine = Screening; Diagnostic = to gather evidence to make a diagnosis; Surgical = to fix a known problem

Without seeing the colonoscopy note, I can't tell you which of those best applies, or whether your CPT selection is correct.

Assuming the doctor did document the comprehensive health exam mentioned in your post, then you should bill out the appropriate routine health exam code for her plan (CPT preventive codes for Commercial & Medicaid, HCPCS for Medicare). The mammogram billing will probably also vary based on payer type, so I can't offer much advise on it, either, at the moment.

Since a problem was discovered during the routine exam, you likely have enough documentation to allow for an additional P-O E/M (99212-99215), with a 25 modifier (if it's on the same DOS as a routine exam). You'll also need a 57 modifier, if the decision for surgery was made at that time; meaning, it wasn't prescheduled. I think you should check with your payers resources and with the CPT guidelines for further assistance - (not to be rude, but...) your initial code choices are pretty off-base, right now, from what I can see. If you can offer more information, I'll be glad to offer you better help...Sorry...

 

[scorrado]

The assessment states constipation (564.00) so why are you not using that as your diagnosis for the visit? As far as the colonoscopy you would need to post that operative note before I could comment on the codes for that.

 

[amh@yahoo.com]

Op report had indicated melonosis coli. I did not do the coding but was asked to review, by biller, because patient did not want to pay for colonoscopy. This was all the information I was given..clearly more documentation is needed. I appreciate your in-depth comments and quick response.

 

[btadlock1]

Op report had indicated melonosis coli. I did not do the coding but was asked to review, by biller, because patient did not want to pay for colonoscopy. This was all the information I was given..clearly more documentation is needed. I appreciate your in-depth comments and quick response.

"Melanosis of the colon" is listed as 569.89 - if that's what the op note lists as the conclusive diagnosis, you code it in that manner.

If that is the final diagnosis, then you may have justification to bill the colonoscopy as diagnostic, but once again, without seeing the note, or what was listed as the indication for the scope on the op note, I can't offer you a clear answer.

One other point worth making, is that 569.89 includes terms such as pericolitis & perisigmoiditis, which indicate inflammation of the connective tissue or of the peritoneum surrounding the colon, or sigmoid. (http://medical-dictionary.thefreedictionary.com/pericolitis)

However, obstruction of intestine (such as fecal impaction - 560.32), is coded from the 560 - 560.9 range.

Depending on the information contained in the op note, it may be necessary to first code something such as 560.32 (or whichever obstruction code is best supported by the documentation), and then list 569.89 as a secondary diagnosis, due to the etiology/manifestation rule in the ICD-9 conventions (Section I, A, 6).

Again, it's just something to think about - I'm not sure that any of this advice would be able to prove useful, without seeing the note. Good luck!