Results 1 to 5 of 5

Anesthesia for Colonoscopy denial

  1. #1
    Question Anesthesia for Colonoscopy denial
    Exam Training Packages
    Hello All,
    I have an anesthesia provider based in Arkansas. We billed a colonoscopy with DX code V160 and anes code 00810. We received a denial from Medicare stating: "These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam." The anesthesia type was MAC, but I checked and Pinnacle Medicare does not have a MAC LCD.

    I have only seen this denial for the actual colonoscopy not the anesthesia for the colonoscopy. Is there a way to appeal this? Or is this a denial that others have seen for the anesthesia for colonoscopy?

    Any help or insight would be appreciated! Thanks!
    Missy Heuer CPC, CIRCC, CANPC

  2. #2
    Question Denial for 00180 Anesthesia
    Was the place of service in the office? We have seen several codes denied because the procedure was performed in the office, not in an ASC. I have been trying to find something to clarify why the CRNA isn't being paid and the only clue I have found is where the procedure was considered to be a consious or moderate sedation level and that the payment to the surgeon was inclusive for the sedation. Apparently, there was no need for a separate person to administer or monitor the patient and could have been done by the performing surgeon.

    The issue we are having is due to the use of deep sedation for procedures done in the office (POS 11) setting.

    Can someone point me to a resource where this can be clarified?

  3. Default colonoscopy
    Did they use Profavol? if so use dx code v58.83 and rebill. this will get paid. Yes, there are medical necessities for this code.

  4. Default Colonoscopy
    I would be very careful with that V58.83 - bear in mind that the patient presented for a colonoscopy and not for the monitoring of any therapeutic medication - this would be considered misleading the insurance carrier. Sure, they will go ahead any pay it while they build their case against the provider.

    The use of Propofol or any other medication for the purposes of sedating a patient in no way constitutes the reason for the encounter.

    I think you need to rethink the application of this "V" code.

  5. #5
    for our pennsylvania state centers, we append the V58.83 only if MAC was done on a medicare patient. This is not the primary diag of course but if we do not have this diag pa medicare will deny stating not medically necessary.

    hope this helps!
    Julie S., CPC
    Anesthesia Coder
    Education Officer, Cleveland Area Chapter 2016

Similar Threads

  1. Denial for Medicare screening colonoscopy
    By JDV7980 in forum Gastroenterology
    Replies: 2
    Last Post: 08-19-2015, 06:10 PM
  2. Pain Block/Ultrasound Guidance Denial for Anesthesia
    By marielad10 in forum Billing/Reimbursement
    Replies: 0
    Last Post: 07-14-2015, 11:17 AM
  3. Medicare Denial on modifier 78--Anesthesia Billing
    By Janisa41 in forum Medical Coding General Discussion
    Replies: 4
    Last Post: 09-11-2014, 01:19 PM
  4. colonoscopy w/ anesthesia
    By LORA CRAWFORD in forum Outpatient Facilities
    Replies: 0
    Last Post: 04-10-2009, 11:37 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.