Gastroenterology Coding Alert

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 emergency and the best way to make sure that the physician is paid for the service is to get phone verification of benefits. Moreover, regulation doesn't require insurance coverage for high-risk screening colonoscopy.Although some insurance would accept G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) instead of 45378 (Colonoscopy, flexible, proximal to splenic [...]