Wiki claim rejected for diagnostic colonoscopy

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lindam@caricures.com

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We had a patient that had a colonoscopy in March of this year and had several large polyps removed, including with EMR. Provider rescoped in October to make sure completely removed. I submitted the claim as a diagnostic 45378 since it was only 6 months, I didn't think screening codes were appropriate. DX code I used was Z86.0101. She did not have an residual so that was all there was to code. per clearinghouse - claim rejected by UHC/Medicare Advantage stating missing or invalid information. They point me to LBI Smartedit - reject per LCD OR NCD guidelines, that procedure code 45378 has not met associated diagnosis code relationship criteria for CMS ID(S) L38812. When I look that up, I looks like what I am using is fine,under Covered indications #17. Unless I am reading this wrong. Can someone help me out please. I am in Pennsylvania
 
lindam@caricures.com said:
We had a patient that had a colonoscopy in March of this year and had several large polyps removed, including with EMR. Provider rescoped in October to make sure completely removed. I submitted the claim as a diagnostic 45378 since it was only 6 months, I didn't think screening codes were appropriate. DX code I used was Z86.0101. She did not have an residual so that was all there was to code. per clearinghouse - claim rejected by UHC/Medicare Advantage stating missing or invalid information. They point me to LBI Smartedit - reject per LCD OR NCD guidelines, that procedure code 45378 has not met associated diagnosis code relationship criteria for CMS ID(S) L38812. When I look that up, I looks like what I am using is fine,under Covered indications #17. Unless I am reading this wrong. Can someone help me out please. I am in Pennsylvania
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Try using Z09 as the primary diagnosis. This is what I use in WI.
 
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