Wiki Primary Dagnosis for Endoscopy?

[MedCoder0911]

My co-worker and I have a question.

I code the findings of an endoscopy as primary, followed by the reason the procedure was ordered. (For example 211.1 primary because gastric polyps were found and biopsied, then dx 280.9 as secondary because that was the reason the procedure was ordered.)
My co-worker thinks 280.9 should be primary and the findings should be secondary.

I seem to remember reading somewhere that findings should be coded primary (unless it's a screening procedure). Am I remembering incorrectly? Should I be coding the reason for the procedure as primary?

Any help is appreciated.

 

[chewri]

This is a great question. I have been taught that with Medicare claims you bill the finding 1st and with Commercial you bill what they came in for 1st. I would like opinion on this as well.
tx

 

[mitchellde]

If the patient presents with symptoms that the procedure is ordered for and the procedure is performed with findings that explain the symptoms then you code only the findings for all payers. The finding is what the provider was looking for. This is well covered in the coding guidelines.

 

[MedCoder0911]

If the patient presents with symptoms that the procedure is ordered for and the procedure is performed with findings that explain the symptoms then you code only the findings for all payers. The finding is what the provider was looking for. This is well covered in the coding guidelines.

Yes, I certainly understand that guideline. But what if the findings do not explain the symptoms? In that case, should the symptom be coded as primary or secondary?

 

[mitchellde]

If the findings are not what is expected for the presenting symptoms, and therefore the symptoms still indicate a problem not yet defined, then the finding is an incidental, unexpected finding and is listed secondary to the presenting symptoms.

 

[MedCoder0911]

thank you! Is there a guideline somewhere that I missed stating such?