mkees
Contributor
I need help from someone on guideance for the following problem:
I have a patient that has been in twice for a screening colonoscopy, the first time the report states the scope advanced only 10 cm. I coded it per Medicare's instruction for incomplete colons 45378-53 w/dx of V76.51. The 2nd one was incomplete also but I coded it as a Sigmoidoscopy 45330 w/dx V76.51 as the scope went 10 cm.
Both are denied for medical necessity for the dx per the LCD. I have tried to appeal these in the past with no luck due to the diagnosis, I can't change the diagnosis since it was ordered as a screen and the patient had no symptoms or history of anything.
Should I be billing these at all?? Should both be 45330?? There will be a 3rd attempt as long as the prep is adequate.
Help!!
Thanks!
Michelle Kees CPC
I have a patient that has been in twice for a screening colonoscopy, the first time the report states the scope advanced only 10 cm. I coded it per Medicare's instruction for incomplete colons 45378-53 w/dx of V76.51. The 2nd one was incomplete also but I coded it as a Sigmoidoscopy 45330 w/dx V76.51 as the scope went 10 cm.
Both are denied for medical necessity for the dx per the LCD. I have tried to appeal these in the past with no luck due to the diagnosis, I can't change the diagnosis since it was ordered as a screen and the patient had no symptoms or history of anything.
Should I be billing these at all?? Should both be 45330?? There will be a 3rd attempt as long as the prep is adequate.
Help!!
Thanks!
Michelle Kees CPC