Colonoscopy, High Risk or Not

[tldixon@mokancomm.net]

I need some help sorting through this:
Dr. did a colonoscopy on 03/03 2011, discovered a benign hyperplastic rectal polyp, but did not remove it. The hospital has the 211.4 on record, but it is not in patient's medical record. Jump ahead 3 years to 12/03/2014 and same Dr. has done another colonoscopy and found no polyps...just diverticulosis. Medicare has denied this claim stating it exceeds the contracted maximum number of hours/days/units by this provider for this period. Patient has a history of diverticulitis, constipation....I sent the claim back in with the diverticulitis dx, but again it was denied for the same reason.
My question is: If the Dr. did not remove the polyp, can this still be considered a history, which would then put this patient at high risk?
I would appreciate any input on this..
Thanks,

TLD

 

[Pam Warren]

The patient's medical history is specific to the patient---not the provider. So just because your provider was not the physician who removed the orgininal polyp, that won't cause the history to not exist!

All patient history, regardless of where, when and by whom, belongs uniquely to that patient. So yes, your patient has a history of a colon polyp.

 

[tldixon@mokancomm.net]

Thank you, Pam.
Hopefully, I can get this paid for the patient.
Have a great day.

Terri L. Dixon, CPC
Ransom Memorial Hospital
Ottawa, KS. 66067
tdixon@ransom.org