Outpatient colonoscopy

sspeer

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Wasilla, AK
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Hello everyone. I am a coder but do not code for facilities and I am having a personal issue with the hospital coding.
5 years ago I had 1 polyp that turned out to be tubular adenoma. resection fof 12 in of my intestine. Had a repeat colonoscopy 2 years later.
I went in again recently for a high risk screening. No problems just screening. Blue Cross approved it as long as that is how it was billed.
Dr. billed accordingly and was covered 100%. The hospital is leaving me with about $1000.00 balance. I have called and found out that they are submitting the claim as a follow up procedure along with other dx ie. colon polyps, intestinal anastamosis, Asthma and osteoarthritis in knees. they are listing everything from my preop H & P but not the reason for the procedure. This is what I'm told they do as a facility. I have had my insurance working with them trying to figure this out and the most I can get is that the hospital will discount 50%. Not good enough. It doesn't make any sense to me.
Can someone please help me with the arguement to get this paid? I think it should have Z12.11, Z86.010 and that's it.
HELP!!
Not to mention they biopsied the anastamosis site and sent it to a non PPO without my knowledge.

Thanks to everyone in advance
 
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