Here's an ICD coding scenario that'll help you in your work when you start using 2012 ICD-9 codes from October 1, 2011.
ICD-9 2012 changes will go into effect in a week's time. So are you geared up to tackle a diagnostic test that comes back minus a definitive diagnosis? You'll overcome these challenges when you make it a point to convey to payers exactly what you found.
Scenario: A patient who is schedule to undergo a gall bladder surgery presents for a pre-op evaluation. The GI lists the condition talking about the surgery as acute cholecystitis (575.0) and the underlying medical condition as diabetes (250.xx).
How would you handle this situation? Should you report the screening code here?
Many a time, a physician would order a diagnostic test without any signs and symptoms or perform a preop evaluation for the patient. If the main reason for the encounter is preop evaluation, you should first list a code from category V72.8 (Other specified examinations) to describe the preop evaluation. After this, you need to report a code for the condition prompting the surgery as an additional diagnosis (here 575.0). If you find out any condition during the screening, it should be reported as additional diagnosis.
V codes take center stage too
When a patient has no signs or symptoms and the gastroenterologist carries out a test solely for screening purposes, V codes will take the limelight. In this situation, you should ignore typical diagnosis codes and locate an appropriate “V" code to describe the test to the payer.
Note of caution: You should tread carefully while using V codes because there are many payers out there who will not pay for claims with only a V code as a diagnosis, with the exception of physicals or covered preventative health services; even then they'll only shell out money for one adult physical each year.
Screening codes: If the reason for the visit is specifically the screening exam, you should list the screening code first. However, you need to report the screening code as an additional code if the physician carries out the screening during an office visit for other health woes. Moreover, if the screening returns an abnormal result, then you should code those results as an additional diagnosis.
ICD-9 2012 changes will go into effect in a week's time. So are you geared up to tackle a diagnostic test that comes back minus a definitive diagnosis? You'll overcome these challenges when you make it a point to convey to payers exactly what you found.
Scenario: A patient who is schedule to undergo a gall bladder surgery presents for a pre-op evaluation. The GI lists the condition talking about the surgery as acute cholecystitis (575.0) and the underlying medical condition as diabetes (250.xx).
How would you handle this situation? Should you report the screening code here?
Many a time, a physician would order a diagnostic test without any signs and symptoms or perform a preop evaluation for the patient. If the main reason for the encounter is preop evaluation, you should first list a code from category V72.8 (Other specified examinations) to describe the preop evaluation. After this, you need to report a code for the condition prompting the surgery as an additional diagnosis (here 575.0). If you find out any condition during the screening, it should be reported as additional diagnosis.
V codes take center stage too
When a patient has no signs or symptoms and the gastroenterologist carries out a test solely for screening purposes, V codes will take the limelight. In this situation, you should ignore typical diagnosis codes and locate an appropriate “V" code to describe the test to the payer.
Note of caution: You should tread carefully while using V codes because there are many payers out there who will not pay for claims with only a V code as a diagnosis, with the exception of physicals or covered preventative health services; even then they'll only shell out money for one adult physical each year.
Screening codes: If the reason for the visit is specifically the screening exam, you should list the screening code first. However, you need to report the screening code as an additional code if the physician carries out the screening during an office visit for other health woes. Moreover, if the screening returns an abnormal result, then you should code those results as an additional diagnosis.
