Wiki DX is inconsistent with the procedure

[fcctn-2008@yahoo.com]

Screening colonoscopy and when it was done the procedure 45380 was used with the DX Z1211, K5730, D122, K635, the INS denied for the DX is inconsistent with the procedure? do we need to add 45378 ? please advise

 

[sls314]

Screening colonoscopy and when it was done the procedure 45380 was used with the DX Z1211, K5730, D122, K635, the INS denied for the DX is inconsistent with the procedure? do we need to add 45378 ? please advise

What was the date of service?

D12.2 and K63.5 had an Excludes1 note in ICD-10-CM for 2023. If the DOS was prior to 10/1, you may be getting it kicked back for that Excludes1 note.

 

[sls314]

I should add that I didn't address the CPT code selection either way, because I don't code/bill for colonoscopies.

The diagnosis codes jumped out at me, because I knew there were modifications made to Excludes notes from FY 2023 to FY 2024.

If the payer is a stickler about coding edits, that could cause an issue if your DOS was prior to 10/1.

 

[fcctn-2008@yahoo.com]

thank you , the DOS was September 2023