Wiki Physician wanting to bill screening colonoscopies regardless of presenting problem

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AT2728

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I'm looking for every bit of clear documentation to provide to my general surgeon and administration regarding when a colonoscopy is considered diagnositc and can not be billed as screening. My surgeon feels he can document positive FOBT and screening colonoscopy and then bill whichever way benefits the patient. Likewise, he recently had a patient present in Jan referred for rectal bleeding-saw him back in feb stating the issue resolved and now wants to bill the feb colonoscopy as screening. I know if they present with signs and symptoms resulting in colonoscopy that this is clearly not screening per guidelines. What can I provide to him? When I run into issue of him stating both symptom and sign and then documenting screening colonoscopy on the op report and he argues with me that I have to bill it as screening - do I document physician required billing as screening? He is impossible to get across to, literally, we agree with him so that we can remove ourselves from the situation. If not, the patient complains about paying their co-insurance-he finds out and orders a resubmission of the claim. What do I do with this?
 
see what Ingenix states in the ICD-9 CM for physicians under screening pg 23.

"The testing of a person to rule out or confirm a suspected diagnosis because the patient has some sign or symptom is a diagnostic examination, not a screening. In these cases, the sign or symptom is used to explain the reason for the test."

However, in the next paragraph it goes on to state "A screening code may be a first listed code if the reason for the visit is specifically the screening exam"

What does the order state? Was the "screening" the reason for the procedure?
If so, then V76.51 should be coded as primary code and then if anything is found during the course of the procedure that should be secondary and on... This is stated in the very next paragraph "Should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis."

This could mean that if a patient came in presenting now with signs and/or symptoms, the procedure is no longer a screening, it is a diagnostic exam...but then again if the order is stating it is specifically for screening from the referring physician then it probably should be coded as a screening. I can see it both ways. I have this same issue. Sometimes we have patients that are coming in for a screening and then when they get here the nurse or doc will talk to them and they will mention a little blood in stool or abdominal pain so the docs document it but are conflicted because the referring is referring for scrn. I think the problem more than not is the flip flopping between what is going to get you paid and be less out of pocket for the patient. Anyhow, I hope this helped a little bit and good luck.
 
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Thank for the information, it is helpful. The most common scenario we run into is a patient presenting as a referral from their pcp for a specific GI symptom. The physician sees the pt recommends a colonoscopy and then requires his nurse contact the patients insurance and query benefits for screening and diagnostic colonoscopy. She then informs him and if screening is the better benefit he believes he can then documents screening colonoscopy as the primary preop diagnisis followed by a secondary preop diag of BRBPR (for example). He then expects facility and physician coding staff to bill screening. His reasoning is that a symptom alone doesn't necessarily warrant a colonoscopy so he is screening.
 
Thanks for the feedback, and I agree. I am gathering information to present to the VP. At this point, I have tried everything I can to convince my physician on coding compliance to no avail. I refuse to put my credentials on the line.
 
Wow! Not cool... If the referring is stating a procedure is requested for a specific gi sign/symptom then that is the reason for the test.

You are on the right track. I know it can be frustrating when your pleas to the physician and/or management go nowhere. Perhaps you can even go further and speak with the compliance dept if you have one and just let them know of your concerns.

& I agree with you too Oceanlivin!
 
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