shepherddl
Networker
- Messages
- 30
- Best answers
- 0
Not sure when to use screening dx code and when to use symptoms--for Medicare. Does intent of service matter?
For example: Patient, over 65 comes in for what they believe is a 100% Medicare covered screening colonoscopy. The doc may have asked them, “hey, have you ever had your colonoscopy?” They say no. Doc asks if they have any bleeding or pain, etc. And pt. says, yay, sometimes I have a little blood on my toilet paper. The intent of that was not a true, diagnostic colonoscopy, which is only covered at 80%. The doc was just doing the screening, which is covered at 100%. Code as z12.11? Doc has diagnosed on h&p and op note as screening colonoscopy and blood in stool.
Versus—patient comes in and says, “hey doc I’m having a little pain in my side and some blood.” Doc says we need to do a colonoscopy—in that case, it’s a diagnostic and not coded as a screening?
I know about modifiers PT-33, etc. but those are only applied to ones with a dx code as a screening, correct?
If doc has noted "screening colonoscopy" anywhere, do you code that and then symptoms as secondary?
Any coding rules you can point to for your answer?
For example: Patient, over 65 comes in for what they believe is a 100% Medicare covered screening colonoscopy. The doc may have asked them, “hey, have you ever had your colonoscopy?” They say no. Doc asks if they have any bleeding or pain, etc. And pt. says, yay, sometimes I have a little blood on my toilet paper. The intent of that was not a true, diagnostic colonoscopy, which is only covered at 80%. The doc was just doing the screening, which is covered at 100%. Code as z12.11? Doc has diagnosed on h&p and op note as screening colonoscopy and blood in stool.
Versus—patient comes in and says, “hey doc I’m having a little pain in my side and some blood.” Doc says we need to do a colonoscopy—in that case, it’s a diagnostic and not coded as a screening?
I know about modifiers PT-33, etc. but those are only applied to ones with a dx code as a screening, correct?
If doc has noted "screening colonoscopy" anywhere, do you code that and then symptoms as secondary?
Any coding rules you can point to for your answer?