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Callieb

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Crestwood, KY
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I don't bill labs but am trying to help a patient with his bill so I need some input. Patient was hospitalized several days about 1 month later after gallbladder surgery. She then developed diarrhea and weight loss due to not able to eat. Our doctor ordered stool culture, c diff and O&P. Her anthem is denying the c.diff 87493 due to diagnosis code of 787.91. Have talked to the lab once and am going to call them back but thought I would try this route first. The test was positive for c.diff
 
Strange; I would think having diarrhea would prove medical necessity for having a C. diff test performed. I don't have experience with that carrier (Anthem). Perhaps 008.45 -- Intestinal infections due to other organisms/Clostridium difficle....
 
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