Our anesthesiologist performed anesthesia for a patient who had a screening colonoscopy and at the same time – an EGD for abdominal pain. We billed the patient’s insurance with 00740 dx code – R10.9 and the insurance processed the claim and left the patient with a copay/deductible. He called complaining that his account was coded wrong and we should have billed the screening colonoscopy so that his insurance will cover at 100%. Isn’t that insurance fraud?? He claims to be a coder for this insurance company also…and says "just change it".

I have been scouring the internet, trying to find clear documentation that we coded this correctly (the facility and the surgeon’s office also JUST billed the colonoscopy so their claims were paid 100% by insurance.) Is there anything else we should have done? From our end it seems we are doing it all correctly??!