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564.00 and Wellmark BCBS

  1. #1
    Question 564.00 and Wellmark BCBS
    Exam Training Packages
    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
    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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