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Inspect Coverage for HBO Therapy for Radiation Proctitis

Look at diagnosis history changes and Medicare’s national and local coverage determinations for greater insight into denied claims. Coverage determinations for hyperbaric oxygen therapy (HBOT) for radiation proctitis make getting paid for physician services tricky. A review of historical diagnosis code changes, and the effect these changes have had on Medicare coverage determinations is necessary […]

The post Inspect Coverage for HBO Therapy for Radiation Proctitis appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

GERD and Ulcerative proctitis

When a patient is having an EGD performed for an indication of GERD but the exam is normal, would you still use K21.9 or would Z87.19 (personal History of other diseases of the digestive system) be more appropriate?

Also somewhat of the same question on colonoscopy being performed with an indication of "Follow-up of chronic ulcerative proctitis, Disease activity assessment of chronic ulcerative proctitis", but the findings indicate "examination was normal, no active ulcerative colitis". Would an ICD-10 code of K51.20 still be appropriate or should Z09 & Z87.19 be more appropriate?

Thank you for any guidance.

Medical Billing and Coding Forum

Radiation Proctitis vs. Soft Tissue Radionecrosis

I have a physician that is ordering Hyperbaric Oxygen Therapy for a patient with documented radiation proctitis. He is arguing that radiation proctitis is the same thing as soft tissue radionecrosis, and he is wanting to bill with L59.8 (specified disorder of skin and subcutaneous tissues related to radiation) instead of K62.7 (radiation proctitis). I understand that L59.8 is payable for HBOT, but I’m having trouble finding anything to support whether or not this is an accurate diagnosis for what is actually happening with the patient. We are under the NGS MAC. Can anyone offer any resources or advice? Thank you.

Medical Billing and Coding Forum