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Gastroenterology Coding Alert

Reader Question:

Clear Documentation Helps in Defusing Denial Scenarios

Published on Thu Apr 05, 2012

Question: Of late, we have been getting several calls from our patients saying that their insurance is not covering office visits prior to colonoscopy procedures. Their contention is that the office visit is included as part of the procedure. These are not routine colon pre visits. We have been informing that these procedures do not have global days and we are reporting these procedures as is specified in AMA guidelines. But when insurance companies are saying that we have been billing wrong, it is hard to convince them otherwise. Please suggest apt guidelines to help us in situations like this so that our claims do not get rejected by insurance companies and patients get paid for these procedures.Kentucky SubscriberAnswer: If the office visit was for a screening colonoscopy, then you cannot bill for the office visit as this visit becomes part of the screening procedure. But if your patient presents [...]
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