Wiki coding scopes with open procedures

[apollo06]

Hello all, I would realllyyy like to be able to have a experienced ENT coder to network with or several. I have a few questions regarding when you can code a diagnostic scope with open procedures?
I understand the concept of the provider using a scope to survey to area prior to a procedure is included in the procedure. I work for pediatric ENT docs. They are constantly billing for scopes that are being denied as inclusive.
I would like to know, when do I know that they are assessing the field to determine to perform the open procedure?

Do I look for documentation such as "we determined we would go ahead with XYZ"

Thank you so much for any assistance

 

[b.cobuzzi]

When the scope and possibly a biopsy is performed for an UNKNOWN finding, you can position that the provider is saving the patient and the payer two operative sessions, one to evaluate the problem and one to treat the problem. You do this on appeal, trying to get paid for the scope. Make sure the documentation shows it is an unknown finding. Also stress that you do not want to make a child go through multiple surgeries when writing the appeal.