Wiki 91110 ANTHEM MEDICAID DENIALS

sboroughs

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Columbus, IN
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WE GOT A DENIAL ON 91110 FOR - NOT COVERED WHEN PERFORMED FOR THE REPORTED DIAGNOSIS. DOES ANYONE KNOW IF THERE IS A POLICY FOR ANTHEM MEDICAID? I HAVE NOT BEEN ABLE TO LOCATE ONE.
 
This is from Anthem's Medical Policies & Clinical UM Guidelines - I searched for Indiana, since it looks like where you are located.


CPT
91110Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with interpretation and report
91111Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus, with interpretation and report
Note: This procedure is considered Not Medically Necessary for all indications
91299Unlisted diagnostic gastroenterology procedure [when specified as use of patency capsule]
Note: This procedure is considered Not Medically Necessary for all indications
0355TGastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), colon, with interpretation and report
Note: This procedure is considered Not Medically Necessary for all indications
ICD-10 Diagnosis
C17.0-C17.9Malignant neoplasm of small intestine
C18.0-C18.9Malignant neoplasm of colon
C19Malignant neoplasm of rectosigmoid junction
C20Malignant neoplasm of rectum
C7A.010-C7A.019Malignant carcinoid tumors of the small intestine
D13.2Benign neoplasm of duodenum
D13.30-D13.39Benign neoplasm of other and unspecified parts of small intestine
D37.2Neoplasm of uncertain behavior of small intestine
D50.0-D50.9Iron deficiency anemia
K50.00-K50.919Crohn’s disease (regional enteritis)
K90.0-K90.9Intestinal malabsorption
K92.0Hematemesis
K92.1Melena
K92.2Gastrointestinal hemorrhage, unspecified
Z86.010Personal history of colonic polyps
 
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