Nancy Posted Tue 07th of February, 2012 18:37:28 PM
Patient states she is coming in for a routine bone density. But the radiologist coded it as diagnostic how is it billed. Can it go from screening to diagnostic?
SuperCoder Answered Tue 07th of February, 2012 22:36:44 PM
It starts out as a screening test, it MUST remain a screening test. If you are doing it for screening, you are talking about an asymptomatic patient who is not having any problems and then you do a screening and then find something. It is still a screening. It would be fraud to report the test with the final diagnosis in this situation.
ICD-9 Code Must Reflect Reason for the Visit
The key here is whether the test was a screening test or a diagnostic test. For screening tests, the physician orders the test as a routine, to make sure the patient is healthy. He or she is not expecting to find a problem. However, if the test is ordered as a result of a sign, symptom or presenting complaint, then the test is not a screening test but a diagnostic test.
Generally, the diagnostic test gets paid with ICD code 733.00, but screening test not paid easily being mapped to a V code.
Note: Osteoporosis is sometimes caused by prolonged use of certain medications, and a physician may order routine screening bone density studies annually for patients on such drugs
The diagnosis code in this case would be the appropriate V code to show that the test was ordered in the absence of signs or symptoms for screening purposes only. Make sure to obtain a waiver from the patient and bill the service with a -GA modifier (waiver of liability statement on file) so the provider is not responsible for the fee, and the patient may be charged.