"Colon scrn" with long term diarrhea and fecal incontenence

---

I am a relatively new coder for an outpatient facility.

YESTERDAY, I had a note returned to me stating that I should have left v76.51 as the primary dx for a patient that presented with multiple digestive symptoms, including long-standing diarrhea and abdominal pain. I was corrected by a more senior (and much more highly educated) coder within the organization and told that because the patient had a previous dx of IBS years back, the diarrhea and abdominal pain should be overlooked as the norm for this patient and that the primary dx in this case should have been v76.51. I initially didn't see the IBS dx in the patients chart...and I suppose that I understand that in this case. (However, everything I can find online and in print is telling me that chronic diarrhea automatically excludes you from using v76.51..?)

TODAY I have the following op note to code and I have no clue now what to do:

Preop dx- need for screening colonoscopy, mild to moderate anal incontenence

post-op dx-same as above plus diverticulosis

procedure- screening colon. w/ mucosal biopsies to rule out microscopic colitis

path- came back benign colononic mucosa with no sig. histopathologic change, neg for acute and chronic colitis

indications- pt has a long history of loose stool, 1 to 3 a day and is now having at least 1 or more accidents or stool per week. (MD never says the word "chronic" only long history)

Procedure-Colonoscopy is performed, including noting during an included digital rectal exam that the patient demonstrated "very minimal extremely lax sphincter muscle tone". "As the scope was being withdrawn, I did cold biopsies from both the right side of the colon in the left side of the colon." There were no growths or abnormalities detected.

Pt indicated to return in 10 years for another screening. Pt will also be referred to an incontenence clinic for further eval and treatment. "Of course, this would include treatment of microscopic colitis should it be discovered on biopsy." (It was not.)

This patient has no mentioned known diagnoses like IBS or any other reason I can see in the limited history dictation from the office that I should look the other way from this diarrhea and incontence. On one hand, I don't feel that the dr would have done this exam and biopsies without the earlier dx of the diarrhea and incontenence because other than the finding of the lax sphincter, there were no other abnormalities reported. On the other hand, I don't have any documentation of why the patient presented to the appointment...I don't know if she normally tolerates these symptoms and got a colon screening reminder or if the development of the fecal incontence brought her in and then then it was noticed she qualified for a screening. (PT is 76, on Medicare and hasn't had one since 2003.)

I don't want to cause a problem with my supervisor but I also want to do the job as I should be, without causing undue billing issues for a patient. I do know that the office believes they are sending the pt for a screening and I'm sure the told the patient that it would be a covered screening so if I go against that I will need backup for my logic.

ANY help or perspective on this issue would be greatly appreciated!!

"Colon scrn" with long term diarrhea and fecal incontenence