Wiki Need a quick answer/ screening colonoscopy office visit

[chembree]

I am working with a gastroenterolostist on coding a few charts. I actually code radiology/interventional radiology so this is somewhat new to me.

If you see a patient for a colonoscopy screening in the office and the patient has symptoms such as GERD, abdomen pain, noncardiac chest pain, dyslipidemia, and low back pain does a screening diagnosis need to be reported for the office visit and if it is reported does it need to be first.... or are the rules because the patient has symptoms there should not be a screening code reported and the colonoscopy would be considered diagnostic although the patient was referred for a screening?

Also- Because of the symptoms the doctor decided to perform an EGD at the same time as the colonoscopy.

Thanks in advance

 

[EricaR]

Hey, if the doctor is going to perform a scope b/c of the symptoms do not list the screening diagnosis. If for some reason he is not scoping them for these reasons but is going to be performing a screening scope you should put the screening dx on the claim last. He needs to be sure he dictates these ov notes properly if he is saying he is doing a screening colonoscopy and doing and e/m for the other reasons. Sorry the answer wasn't yesterday. BTW, this is Erica, Lori's friend. Hope all is going well for you guys! (hope you are who I think you are or I'm gonna sound crazy lol)

 

[chewri]

To me it looks like all these symptoms would be reason for the EGD not the colonoscopy.

 

[Kisalyn]

If I understand your question, you are asking how the office visit should be coded and whether the symptoms addressed during the visit will cause the screening colonoscopy to become diagnostic.

I'm not sure what your chief complaint is, but I'm going to assume it's incidental for a screening colonoscopy and really for GERD, abdominal pain, etc. The screening colonoscopy code doesn't need to be on the office claim since it doesn't provide any support for the visit, just the symptoms or conditions that the physician evaluated.

Patients having a symptom doesn't automatically mean that a colonoscopy cannot be a screening. I see epigastric pain all the time and our doctors recommend EGDs, but because it's not clinically indicated for a colonoscopy, the colonoscopy remains a screening. Additionally, a patient with intermittent diarrhea or long standing history of constipation doesn't necessarily mean your physician is performing a diagnostic colonoscopy. Unless the patient's insurance has a medical policy that states the patient's condition precludes them from a screening colonoscopy it's up to the doctor to provide you that information.

We prefer our office notes to state clearly the reason a procedure is performed under the plan of care/recommendations. So if a patient comes in and doctor recommends both an EGD and colon, it should look something like this:

Plan:
1. Schedule EGD for abdominal pain, duodentitis on CT
2. Schedule a colonoscopy for screen

We have a benefits verification department that calls patients to inform them how much they need to pay on day of service before the patient gets put on the schedule so knowing whether the procedure is screening versus diagnostic is crucial to accurately collecting pre-payments.

 

[chembree]

Thanks Erica! Hope all is well your way Do you code gastroenterology?

I am actually doing an audit for this doctor and his staff had listed the screening code as a 3rd diag out of 4 for the office visit which I felt was incorrect but the guidlines are somewhat diffierent for gastroenterology and IR/ radiology coding. So I wanted to make sure I had my information correct before bringing this to his attention.

Thanks for all the responses and great advise.

 

[EricaR]

No I work for colorectal surgeons. Are you working for Lori's co. or someplace else?

 

[teresabug]

if a referring dr or a specialist wants a pt to have a colonoscopy and he writes "screening colonoscopy", on the script, the screening V code must be listed first on the claim. If the specialist then finds an abnormality, such as polyps, etc., the polyp dx is listed second. (of course you need to wait for the path report to come back for a definitive dx on the polyp). Coding guidelines do not change whether its a gastro dr or surgeon. If it is ordered as a screening, the V code is first.
EGD are ordered b/c there is a pt. complaint that would warrent this test.
Hope this helps.