Wiki Normal Colonoscopy


Best answers
Does anyone know how what dx code to use for normal colonoscopy.
I was wondering if the pt. had gas and bloating if this would fall underneath
change in bowel habits. I don't know as there is no other symtpoms other than abd.pain and medicare wont pay for that dx code. Thanks
Please check Medicare's LCD's they will pay for procedure 45378 with a dx
of abdominal pain or gas or bloating, all of these diagnosis are approved by Medicare and support medical necessity. Hope this helps...Sandra
You can't use change in bowel habits, unless the physician says that in his documentation. Medicare will not pay for abdominal pain, gas or bloating as someone else stated for a least not where I am (WI). I wouldn't use 569.89 because you stated the colonoscopy was normal, so what would be the other specified disorder? I think your going to have to put the GZ modifier on this, unless there was a waiver signed. You'll also havt to do some provider education and let let know what the payable Dx's are for a colonoscopy and if they do not have one they need a waiver. If they do not want to do free colonoscopies, they'll make sure they have a waiver next time. (My opinion)
In FL Medicare will pay for a normal colonoscopy with a 789.00; I would not use the 569.89 if no biopsy was obtained and there is not path report to support that dx. I would go with the patient's symptoms.
When the findings are normal, i use the complaints as the dx. Like someone else said, make sure you check your LCD or it won't matter what dx you use. If it isn't listed the ins isn't going to pay.