tci Part B Insider - 2016 Issue 13

Reader Question: Colonoscopy Won't Be Payable for Acute Diarrhea

Question: Our patient had diarrhea and the physician ordered a colonoscopy. Now the payer is denying the charge. Can you advise? Supercoder.com subscriber Answer: If your physician performs or orders a colonoscopy for the following conditions, keep in mind that they aren’t typically payable. You should have additional documentation that indicates the medical necessity of the procedure when you submit your records for review by the payer. These conditions are as follows: Chronic, stable, irritable bowel syndrome or chronic abdominal pain. There are unusual exceptions in which the colonoscopy may be done once to rule out organic...

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