Gastroenterology Coding Alert

Question: I billed 45332 for sigmoidoscopy with foreign-body removal with diagnosis code 936 for foreign body in the sigmoid colon. Medicare denied the claim for "not deemed medical necessity." The operative report states, "Stent found in sigmoid colon, grasped with forceps and removed without any tension or difficulty." What is the right ICD-9 code? Illinois Subscriber Answer: "According to our medical policy, this is a payable diagnosis," says Staci Jordan, CPC, CCS-P, reimbursement analyst for the University of Oklahoma Health Sciences Center in Oklahoma City. "I believe this was coded correctly."

Look at your local medical review policies (LMRP) and make sure Medicare did not deny this in error. Check if there is another ICD-9 code that should also be reported with the service for a symptom or underlying diagnosis. Otherwise, the claim should be appealed. If 936 (Foreign body in intestine and colon) is not on the LMRP, your gastroenterologist needs to get involved in having it added to the policy. A simple letter from your doctor requesting to have the code added and the reason can do this. Contact your local Medicare office for more information.