I have a question for those of you that bill for Medicare of colorado, I have an example a pt had a colonoscopy (00810) and we billed with DX Code V16.0, V12.72 and 562.10, clm denied for rountine not covered. I called and spoke with a rep. who directed me to their website trailblazer health.com LCD for anesthesia (mac), and it listed procedure usually that do not require general, regional or Mac anesthesia, in which 00740 and 00810 is one of them.it also listed ICD-9 code that support medical necessity e.g 038.0, spticemia codes, 25000-255.9, 276.0-276.9, 278.01, 278.03, 290.0-290.9, 291.0-291.9, 300.00-300.02, 300.9, 300.10 etc, to cut the long story short , there is no GI diagnosis included in the list, the main reason for the procedure.
Could someone advise how you code and bill, we bill for different states and will like to know if it is also same with FL, TX, VI, GA, TN, I am new in this specialty.
Do I have to list the GI diagnosis primary and medical necessity codes if documented as secondary with Dx pointer to the Medical necessity code.
thanks
Could someone advise how you code and bill, we bill for different states and will like to know if it is also same with FL, TX, VI, GA, TN, I am new in this specialty.
Do I have to list the GI diagnosis primary and medical necessity codes if documented as secondary with Dx pointer to the Medical necessity code.
thanks