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billing for Medicare of Colorado

  1. #1
    Default billing for Medicare of Colorado
    Medical Coding Books
    I have a question for those of you that bill for Medicare of colorado, I have an example a pt had a colonoscopy (00810) and we billed with DX Code V16.0, V12.72 and 562.10, clm denied for rountine not covered. I called and spoke with a rep. who directed me to their website trailblazer LCD for anesthesia (mac), and it listed procedure usually that do not require general, regional or Mac anesthesia, in which 00740 and 00810 is one of also listed ICD-9 code that support medical necessity e.g 038.0, spticemia codes, 25000-255.9, 276.0-276.9, 278.01, 278.03, 290.0-290.9, 291.0-291.9, 300.00-300.02, 300.9, 300.10 etc, to cut the long story short , there is no GI diagnosis included in the list, the main reason for the procedure.
    Could someone advise how you code and bill, we bill for different states and will like to know if it is also same with FL, TX, VI, GA, TN, I am new in this specialty.
    Do I have to list the GI diagnosis primary and medical necessity codes if documented as secondary with Dx pointer to the Medical necessity code.

  2. #2
    Was MAC anesthesia used? They need a medical necessity code. If you don't have one, find out if propofol was used and bill with V58.83 as the secondary DX.
    I would bill as follows:

  3. #3
    Sarasota FL
    Default Endoscopies and MAC
    I don't see any reason to bill V58.83 which is encounter for therapeutic drug monitoring. The other Dx codes seem fine. The procedure is effectively being done for surveillance if V12.72 is used. Here in Florida we seem to get the procedures paid as there were so many complaints from patients whose bills were not being paid by MCR ( often these were just screening V76.51 codes and nothing else). MCR I think now realizes that it is appopriate to use MAC for these procedures and I know all my CRNA's use Propafol for endoscopies and they get paid. We even thought of suggesting the CRNA's get an ABN signed just in case they weren't being paid but that now seems to be unnecessary.
    Hope this helps

  4. #4
    thank you all for your responses

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