I have this problem time and time again, colonoscopies should be so easy to code...........every insurance wants it done a different way. Why can't insurance companies all get on the same page here??????
Medicare patient comes into an ASC for a screening colonoscopy. Two polyps found, one removed by snare in colon, one biopsied from rectum.
I coded as primary dx v76.51, 211.3, 211.4
CPT 45385, 45380 mod 59
Medicare pays claim except for 20%. Submitted to PA BS who does not cover screening colonoscopies. Patient gets a bill and is not happy.
To top it all off, dr's office is paid in full because they did not bill the v76.51 as primary. (which I thought you have to do since Medicare is primary and that is what/how they want it coded). So patient wants me to resubmit it without v76.51...............
I am so ready to pull my hair out and I really need some help from my coding world friends. Please help to clarify my way of thinking.
Medicare patient comes into an ASC for a screening colonoscopy. Two polyps found, one removed by snare in colon, one biopsied from rectum.
I coded as primary dx v76.51, 211.3, 211.4
CPT 45385, 45380 mod 59
Medicare pays claim except for 20%. Submitted to PA BS who does not cover screening colonoscopies. Patient gets a bill and is not happy.
To top it all off, dr's office is paid in full because they did not bill the v76.51 as primary. (which I thought you have to do since Medicare is primary and that is what/how they want it coded). So patient wants me to resubmit it without v76.51...............
I am so ready to pull my hair out and I really need some help from my coding world friends. Please help to clarify my way of thinking.