Wiki claim rejected for diagnostic colonoscopy

[lindam@caricures.com]

We had a patient that had a colonoscopy in March of this year and had several large polyps removed, including with EMR. Provider rescoped in October to make sure completely removed. I submitted the claim as a diagnostic 45378 since it was only 6 months, I didn't think screening codes were appropriate. DX code I used was Z86.0101. She did not have an residual so that was all there was to code. per clearinghouse - claim rejected by UHC/Medicare Advantage stating missing or invalid information. They point me to LBI Smartedit - reject per LCD OR NCD guidelines, that procedure code 45378 has not met associated diagnosis code relationship criteria for CMS ID(S) L38812. When I look that up, I looks like what I am using is fine,under Covered indications #17. Unless I am reading this wrong. Can someone help me out please. I am in Pennsylvania

 

[TamGIGal]

We had a patient that had a colonoscopy in March of this year and had several large polyps removed, including with EMR. Provider rescoped in October to make sure completely removed. I submitted the claim as a diagnostic 45378 since it was only 6 months, I didn't think screening codes were appropriate. DX code I used was Z86.0101. She did not have an residual so that was all there was to code. per clearinghouse - claim rejected by UHC/Medicare Advantage stating missing or invalid information. They point me to LBI Smartedit - reject per LCD OR NCD guidelines, that procedure code 45378 has not met associated diagnosis code relationship criteria for CMS ID(S) L38812. When I look that up, I looks like what I am using is fine,under Covered indications #17. Unless I am reading this wrong. Can someone help me out please. I am in Pennsylvania

Try using Z09 as the primary diagnosis. This is what I use in WI.

 

[lindam@caricures.com]

Try using Z09 as the primary diagnosis. This is what I use in WI.

I never knew there was a code like that! Thanks