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Thread: 564.00 and Wellmark BCBS

  1. #1
    Join Date
    Apr 2007
    Des Moines

    Question 564.00 and Wellmark BCBS

    AAPC: Back to School
    I was wondering if anyone knew if Wellmark BCBS considers unspecified constipation, 564.00, a medically necessary diagnosis for a colonoscopy (45378)? Since they usually follow Medicare, and our LCD here in Iowa doesn't have 564.00 as a payable diagnosis, I was wondering if anybody has any idea if BCBS would cover this? I did go onto their website but could not find any policy regarding colonoscopies. Thanks!


  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    If the physician documented constipation as the patient's compaint and the reason for the colonsocopy then that is what you use, and you may need an ABN.

    Debra A. Mitchell, MSPH, CPC-H

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