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Help with Screening colonoscopy for Medicare under new LCD updates
Pathology after screening colonoscopy
Capital Blue Cross – Colonoscopy
Patient is saying that anesthesia sent him a bill – when it should have been covered 100% as screening – our part of the bill was! He called the insurance company and they are saying that because we billed as diagnostic so did anesthesia. We got paid as a preventive service – HOW WOULD the anesthesia know how we billed? THe OP report clearing says it was for a screening.
Any advice is appreciated.
Colonoscopy with Chromoendoscopy
Screening colonoscopy, multiple polyps
Are both polyp removals billable? My thought is if they are in the same anatomical location (ascending colon), even though they were two separate polyps, they are not both billable.
Any resources would be greatly appreciated!
Coding Clinic States use Z12.11 on High Risk Screening Colonoscopy???
The AGA in their GI CPT updates review states that audits have begun and take backs are happening on charges billed as routine screening colonoscopy when signs, symptoms or disease are in the medical record (personal hx of colon cancer and/or polyps is a condition). Also, I’m also thinking of the logistics of reporting screening turned diagnostic with this change (if it truly is valid). Currently a commercial high risk colon for personal hx polyps that removes a tubular adenoma by snare is reported 45385, 33 Z86.010, D12.* … it would now be reported as 45385, 33 Z12.11, Z86.010, D12.* ?? I’ve talked with many claims processors and a lot of clinical edits don’t go beyond the primary dx. It would be perceived as a routine preventive colon, not high risk.
I’m just afraid that everyone will start throwing the Z12.11 on ALL colonoscopies and payers will pay, waiving patient out of pocket, then audits will ensue and take backs will be recouped and billing departments will need to chase patients for the out of pocket expenses (and these take backs can occur years after the original billing). A personal hx of polyps, cancer, colitis, etc. allows patients to have more frequent screenings which classifies them as not routine.
Any links to literature that you’re aware of that is gold standard to support this change would be greatly appreciated. I did send a mesage to AskMueller to see if they could clarify their statement. I think payers should cover both routine and high risk colonoscopy 100% it’s ridiculous the different interpretations from payer to payer and policy to policy within the same payer. Some BCBSMi policies cover any kind of colonoscopy once a year with no patient out of pocket and then some others are grandfathered and screenings of any kind are not a benefit.
Thanks in advance for any feedback!!
Colonoscopy Aneshtesia
Thank you
Consultation for ” screening colonoscopy”
The assumption is that the HPI, Exam are adequate with the exception of the following wording…:
Referring physician "requests a consultation for: screening Consultation."
HPI starts out with "Pt. presents for evaluation"….
"Impression: Female presents for a screening colonoscopy"
"Plan: Colonoscopy…. pt. elects to proceed."
My lead coder says it is ok to bill as a Consult. I say it is not since the pt. doesn’t have a complaint or problem…
Reporting Anesthesia for Colonoscopy
The 2018 CPT® code book introduces two new codes to report anesthesia during colonoscopy, one of which is applicable specifically for a screening exam. But if a screening colonoscopy reveals diagnostic findings, proper coding for the anesthesia service may differ, depending on the payer. CPT® Sticks with Screening Code 00812, Regardless of Findings CPT® 2018 deletes […]
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