tci Part B Insider - 2011 Issue 5

Reader Questions: Check Payer Guidelines for Colonoscopy Pay

Question: My gastroenterologist performed a colonoscopy on a patient who is less than 50 years old with a V16.0 diagnosis. He doesn't have coverage for screening colonoscopy because of his age, but his insurance considers V16.0 a medical diagnosis and could have paid for the service. The colonoscopy revealed no findings. Why did the insurance deny my claim when I billed V16.0 with 45378?Answer: You should have determined the benefits for the procedure and verified the payment before performing it on the patient. Colonoscopy procedures in patients without active symptoms do not qualify as an...

To read the full article, sign in and subscribe to tci Part B Insider.


Keep pace with evolving Medicare regulations with timely analysis of critical updates interpreted in an easy-to-follow, easy-to-apply format. Your subscription to TCI’s Part B Insider will equip you to navigate code and guideline changes, CCI edits, and revisions to modifiers, the fee schedule, OIG target areas, and more.

  • Current newsletters added each month
  • Fully searchable archives - over 4800 articles
  • ALL years/issues back to 2003 organized by year and issue
  • Codes mentioned in articles are linked to Code Information pages
  • Code Information pages link back to related articles

This feature is currently unavailable for online purchase. For more information, please call 801-770-4203 or Contact Us.

demo
request yours today
 subscribe
start today
 newsletter
free subscription

Thank you for choosing Find-A-Code, please Sign In to remove ads.