krenatesmith
Contributor
I am looking for clarification on how to code this screening colonoscopy scenario correctly. The patient came in for a high risk screening (history of polyps) c-scope with no symptoms. During the procedure, no polyps were found, however, a skin tag was identified. No removal or biopsy performed
I code the professional portion of the claim. We coded the procedure with personal history of polyps as primary and skin tags as the secondary. We did not the attach the skin tag dx to the claim. We reported it as an incidental finding during the scope. Insurance processed our claim and the Pt's screening benefits covered the scope with no patient balance. The facility coded the skin tags as primary and the personal history of polyps as the secondary. Insurance processed the facility claim and left the patient a balance instead of applying to the Pt's screening benefits.
I am trying to make sure I am following the correct guidelines.
I am aware that insurance payors have different guidelines.
Any insight would be appreciated.
Thank you!
Kirsten White-CPC
I code the professional portion of the claim. We coded the procedure with personal history of polyps as primary and skin tags as the secondary. We did not the attach the skin tag dx to the claim. We reported it as an incidental finding during the scope. Insurance processed our claim and the Pt's screening benefits covered the scope with no patient balance. The facility coded the skin tags as primary and the personal history of polyps as the secondary. Insurance processed the facility claim and left the patient a balance instead of applying to the Pt's screening benefits.
I am trying to make sure I am following the correct guidelines.
I am aware that insurance payors have different guidelines.
Any insight would be appreciated.
Thank you!
Kirsten White-CPC