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Let's code a colonoscopy dilemma! - JM

Posted: Apr 22, 2010

Op report reason: Screening and Diarrhea. Colonoscopy done, polyp found and removed. The reason for the colonoscopy is both Screening and Diarrhea. In fact, doc documents prime reason for colonoscopy is screening and second reason diarrhea. What is the diagnosis code for this? If a coder has to code by the documentation and the doctor's final answer is that it is for both a screening and for diarrhea, what is a coder to do?

What is he screening for? - Redpen

[ In Reply To ..]
What is he screening for, and does he think the diarrhea is a symptom of it?

Colonoscopy - JM

[ In Reply To ..]
This pt has never had a screening for colon cancer. By age, pt is just due for one. A screening by definition/guidelines - V76.51 is for/in a person with no symptoms, right? So, using V76.51 and also listing diarrhea would get you in trouble, yes? IS it diarrhea or is it a screening. This is the bind, doc wants it for both. You can't have your cake...

Ah ha! - sm

[ In Reply To ..]
Well, no, you can't have both a screening and diagnostic colonoscopy at the same time. You're correct . . . it's not a screening if there are symptoms.

The issue is whether the diarrhea warranted the colonoscopy. If the diarrhea was significant enough to warrant colonoscopy, and if your payer considers a colonoscopy to be medically necessary for it, then this is not a screening.

Does he tell you what caused the diarrhea and is it something other than the polyp? If so, that something is the first-listed diagnosis. The polyp is second, with no mention of V76.51.

If he feels the polyp caused the diarrhea, then list the polyp first. You could list the diarrhea after.

If it had been a screening AND the diarrhea was incidental and not enough to warrant a colonoscopy, you would use V76.51 first, the polyps, and then the diarrhea.

I'm not sure what his issue is, but he can't get paid for this twice. What's the point in insisting on calling it a screening?? Does the payer pay more for screenings? (??)

I'd check the payer's instructions, too, like the Medicare website for your state. Look at the LCD.

You can use V76.51 and diarrhea, if you were truly screening for a malignant neoplasm and you did not feel the diarrhea was a worrisome symptom and if it was not significant enough to warrant a colonoscopy.

I think I got that straight. :)

Colonoscopy. This is the world of coding, folks! - JM

[ In Reply To ..]
Not sure what the issue is with this doctor, it doesn't matter. The fact is that this is just how he documents. Where does it say I can use diarrhea or a symptom with a V76.51? I need that in writing! I feel I cannot code the diarrhea with a screening V76.51 because that is a symptom; therefore, that would cancel out the screening because it is showing the pt has a symptom! Chicken or the egg? I code for the facility side and follow Coding Clinic and Medicare guidelines which define a screening as done on a pt with no symptoms. No, they don't know what caused the diarrhea, no the polyp did not cause the diarrhea, not from the documentation. Therefore, diarrhea is the primary diagnosis. All opinions welcome!

Well, maybe . . . - Redpen

[ In Reply To ..]
I think you're on the right track.

Just for the sake of argument, what would you code if it was a screening that found a polyp? V76.51, polyp, or would you use polyp, V76.51?

Your answer should be V76.51, polyp. So, you see, you CAN use another diagnosis with V76.51. You code hemorrhoids, fissures, and diverticuli found on a screening, don't you? The sky doesn't fall.

You have an awkward situation with this kind of documentation. Sometimes it's easier to find documentation telling you what you CAN'T do than it is to find documentation telling you what you CAN do. The list of what you CAN do would be impossibly long, after all.

Another consideration . . . you'll need to use a code which includes removal of the polyp. That's going to have to be linked to the polyp, because diarrhea isn't going to do it.

colo - JM

[ In Reply To ..]
If it was a screening, it would be V76.51 and whatever is found during this screening is a secondary diagnosis, but primary remains a screening. Simple! Lovely! Yes, of course I code what is found during the screening and, yes, I would code the procedure. The diarrhea was not found during the procedure, it was a symptom coming in.

I am talking about the INDICATION for the colonoscopy. Screening and diarrhea.

In my scenario, the REASON for the colonoscopy was diarrhea and screening. This patient is coming in with a symptom that is one of the reasons the colonoscopy is being done. I am saying that you cannot have both. It is either a screening or a diagnostic. See? And if there is a symptom, it cannot be called a screening.

Yup, I see that! - Redpen

[ In Reply To ..]
Yes, I do see that. However, I felt obligated to raise all possiblities just so everyone could see how much fun coding is! (Thankfully, it's usually not this much fun.)

So, if you fear that coding is just copying the codes a doctor uses, here's evidence to the contrary. Coders can't just parrot the language the doctor uses, either. They have to make rational decisions about what really happened.

If he did that looking for the cause of the diarrhea, then that was his motive. At that point, there is no screening going on--he has a reason for that colonoscopy.

Yes, fun - JM

[ In Reply To ..]

Yes. A challenge. I'll post more. I have a lot of "fun" ones. I like hearing everyone else's take. Am I too rigid? Both of you responded that you would have posted the screening and also the diarrhea. I like Redpenâ��s answer about finding documentation telling you what you can't do and finding documentation telling you what you can do. In many situations there are not hard-fast rules to guide you to be found. If it does not say you can't, maybe you can. I find the rule/guideline and strictly follow, but they are not black and white.

This was fun to watch! Do more please. - nm

[ In Reply To ..]
nm

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