Need help! Not sure what to do about this situation. My supervisor wants me to bill a sigmoidoscopy for an incomplete colonscopy. I have given her information in the Medicare manual about using 45378-53 for this procedure. She say's it is "the physician's decision if he wants to bill for a sig or a colonoscopy". I say we need to follow Medicare guidelines and she wants me to prove it to her that we can't bill a sig. I don't think I should have to, I have already given her the Medicare manual. Also, most of these patients are coming back for a repeat. Does this sound like fraud or abuse? Any help greatly appreciated!
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Wiki Supervisor refuses to follow Medicare guidelines
- Thread starter JJOHN0312
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LMBENHOFF
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Incomplete colonoscopies and Medicare
Your supervisor is incorrect by wishing to bill for a sigmoidoscopy instead of an incomplete colonoscopy on a Medicare patient. Not only is the reimbursement the same for both (no additional $ for sig), she will be using that patients screening benefit for that time period if that was the intent of the procedure-putting the patients health at risk.
Your supervisor is incorrect by wishing to bill for a sigmoidoscopy instead of an incomplete colonoscopy on a Medicare patient. Not only is the reimbursement the same for both (no additional $ for sig), she will be using that patients screening benefit for that time period if that was the intent of the procedure-putting the patients health at risk.
colonoscopy vs sig
Thank you! I agree and know exactly what you are saying. How would I convince her that is a no no and we should bill for an incomplete? This is all coming from some consultant (who by the way is not a coder or an auditor). She says that only applies to screenings, but if it is a diagnostic he should bill the code he wants?
Thank you! I agree and know exactly what you are saying. How would I convince her that is a no no and we should bill for an incomplete? This is all coming from some consultant (who by the way is not a coder or an auditor). She says that only applies to screenings, but if it is a diagnostic he should bill the code he wants?
cynthiabrown
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it is right in the guidelines for cpt for colonoscopy