Wiki GI screening colonoscopy for MCR advantage

[kmbrowning]

I billed a low risk screening colonoscopy (G0121) with V76.51 as I generally do. The carrier, AARP- United Health Care Medicare Adavantage, denied citing NCD 210.3, diagnosis does not meet medical necessity criteria, does not correspond with CPT. I have no idea where to turn. I 've searched the CMS website, UHC website, have made numerous phone calls and I have received no help or advice on this one. Can anyone help, please??

 

[patriciapeaslee]

You did not mention your patient's age. You may want to refer to the USPSTF's age recommendations for 'routine" screenings and see if that was the reason they denied the claim.


http://www.uspreventiveservicestaskforce.org/uspstf08/colocancer/colors.htm

 

[sheardmd]

I'm having this same problem. I have reached out to my UHC rep, but I still don't have an answer. I have searched far and wide looking for answers too. Glad to know that I am not alone at least.

 

[pineapplelvr]

I may be way off on this but 210.3 "benign neoplasm of floor of mouth" is not relevant to the colonoscopy-- do you have to have that code on there?

 

[mitchellde]

I may be way off on this but 210.3 "benign neoplasm of floor of mouth" is not relevant to the colonoscopy-- do you have to have that code on there?

I think the poster means NCD 210.3 as in that is the number assigned to that NCD, not an ICD-9 Code.