Wiki Diverticulosis

[donnar]

I could use some help with a documentation issue please. I have a physician that uses diverticulosis for dx when performing a colooscopy. Diverticulosis, 562.10, is nonpayable. I often will use signs/symp instead. He says to "default" to diverticulitis, 562.11, payable, which he never actually states in dictation. He always uses diverticulosis. Anyone feel that this is correct?
Thank you for your comments

 

[coderguy1939]

I would not code anything not documented by the surgeon during the procedure. IN this instance, you would be giving the patient an illness they don't have.

 

[AuntJoyce]

I fully agree that if you default to diverticulitis just because the physician thinks that that will get the claim paid...you are giving the patient a diagnosis that they truly may not have. Your comment about coding the signs and symptoms is always the best way to go. A lot of physicians just don't get it that if it is not documented, they did not do it nor does the patient necessarily have it. I have coded many MANY colonoscopies where I had to resort to coding signs and symptoms and every one was paid based on that. Encourage your docs to frown upon using something that is not quite "kosher" jsut to get that claim out the door and turned into a check.

Go with your gut instincts - they will never lead you astray

Joyce