Wiki EGD/Colonoscopies

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Colonoscopy denials

Which carrier are you having problems with? Some carriers won't pay for anesthesia for Upper/Lower endos without certain criteria being met. Morbid obesity, airway issues, other chronic conditions that would make doing the procedure without an anesthesiologist unsafe.
 
We are specifically having problems with the surgeon diagnosising with screening V76.51, then say they find hemorroids. We code with what they find or post op dx and not with the pre-op diagnosis. It affects if the patient has to pay a copay or actually pay there deductible or coinsurance. I have insurances, especially Anthem BCBS tell me I am supposed to be billing with G0105 as the CPT code. I have never billed a G code for anesthesia but I was self taught. I have been trying to research this and cannot find anything. Thank you for your help.
 
If you look at the ICD-9 coding guidelines they state that when the purpose is screening the screening V code remains first-listed regardless of the findings. The CPT code must change from the screening G code to the diagnostic CPT code when a bx or polypectomy is done. However if the findings state hemorrhoids and no other diagnostic procedure is performed, then the hemorrhoids are and incidental finding and the first-listed dx code must be the V code for screening, the hemorrhoids may be listed as a secondary dx and the procedure would be the G code for Medicare and any other commercial carrier that prefers the G code for screening colonoscopy.
 
A great big YES!! We have found that pretty much all of our payers accross the board in 5 different states want the V code first. So, my advice is, if the screening dx is given, regardless what they find in the course of the procedure, code it first, code second any findings.
 
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