Wiki Medicare diagnostic colonoscopy issue


Redding, CA
Best answers
Hey everyone, if you have any resources I can use, I'd sure appreciate it! I have 5 claims from 2009 that Medicare went back and reprocessed, all for diagnostic (not screening) colonoscopies. They said that the reason for reprocessing and denial was because there was a frequency issue on all of them. I wasn't aware that there was a frequency requirement on DIAGNOSTIC colonoscopies. I know about the screening limits. So if anyone has any info on this, it would be greatly appreciated! Thanks!

I dont have any specific information for you and I too am unaware of any frequency limitations of diagnostic colonoscopies. However I would certainly appeal the decision of the reprocessing, you never know who is conducting this audit. Be sure to include all of the notes warranting the diagnostic procedure. Also, as a part of the appeal request discolsure of the coverage determination or frequency limitations that triggered the reporcessing.