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Otolaryngology Coding Alert

Reader Question:

Esophagoscopy Requires Payable Diagnosis

Published on Thu Dec 27, 2012

Question: My physician performed a laryngoscopy, with operating microscope, excision of tumor, on a patient with a diagnosis of 478.4 (polyp of vocal cord of larynx). The patient smokes (two packs a day) and has chewed tobacco in the past. Therefore, the physician also felt it necessary to perform an esophagoscopy (43200, esophagoscopy, rigid or flexible; diagnostic with or without collection of specimen[s] by brushing or washing [separate procedure]). Medicare denied the 43200, and referred to a December 1997 bulletin that stated Medicare will not pay for screening procedures performed in the absence of signs or symptoms. A vocal cord polyp is not a covered diagnosis for an esophagoscopy, and when the carrier reviewed the office notes and dictation to determine whether the service was reasonable and necessary, it decided against the claim. Do you have any suggestions?

New Mexico Subscriber
 
Answer: Most Medicare [...]
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