Shruthi Posted Fri 12th of June, 2020 09:17:29 AM
If the indication is GI Bleed, Blood in stool, Anemia and also Personal history of Colon polyp or Screening Colonoscopy, would this visit be considered as screening colonoscopy or diagnostic? (polyp was removed during the exam). If diagnostic what will the ICD order?
SuperCoder Answered Mon 15th of June, 2020 06:41:54 AM
As per the provided documentation, this visit will be considered diagnostic.
Screening colonoscopy: “A screening colonoscopy is a service performed on an asymptomatic person for the purpose of testing for the presence of colorectal cancer or colorectal polyps,” according to the American Gastroenterological Society (AGA). Even if the provider identifies a polyp during the process, the basic intent of the procedure would still be counted as screening.
Diagnostic colonoscopy: The provider performs this procedure when a patient presents with a history and/or symptoms that require investigation. This might include issues like chronic diarrhea, significant hematochezia, or a questionable abnormality noted on an imaging study. Assuming an office note or pre-procedure note is created detailing the patient’s complaint history then the subsequent procedure will be a diagnostic colonoscopy.
For screening colonoscopy with no abnormal findings — patient is eligible for next follow-up screening colonoscopy after 119 months or 10 years. However, if screening colonoscopy leads to therapeutic colonoscopy, i.e. finding and removal of a polyp then the patient would never be considered eligible for screening colonoscopy, (even after ten years of no findings), but instead would be eligible for a covered surveillance colonoscopy.
For diagnostic colonoscopy primary ICD code will be polyp and then afterwards sign and symptoms like GI bleed, blood in stool, anemia will be coded. Also, code Z86.010 (Personal history of colonic polyps) for patient history.
Note: If surgeon documented definitive diagnosis in his operative note and sign/symptoms are parts of that diagnosis then sign or symptoms codes will not be coded separately.
Please also check the below links:
Hope this helps!
Shruthi Posted Tue 16th of June, 2020 14:01:54 PM
Thanks for the detailed note. So the conclusion is - if symptoms are present along with screening diagnosis (Z86.010 or Z12.11 or Z80.0), the study would be considered as diagnostic. As we consider the case as diagnostic, patient deductible would be applied. Please confirm.
SuperCoder Answered Wed 17th of June, 2020 09:48:37 AM
Shruthi Posted Fri 19th of June, 2020 13:03:03 PM
Thank you. We have billed cases where in indication stated Symptoms and had Screening diagnosis (Z12.11, Z86.010, Z80.0), such scenarios were billed with PT/33 modifier with Z code as primary. What corrective measures can we take to fix this issue from payer end.
SuperCoder Answered Mon 22nd of June, 2020 07:48:12 AM
Please provide EOB document of the claim, so that we can identify the reason of denial. Please send EOB document on firstname.lastname@example.org