Wiki Humana Mcr Diagnosis code issue

[macyoverstreet]

When billing colonscopies/egds for our practice-physician orders colonoscopy for positive cologard (r19.5) pathology comes back nothing found. We obviously leave r19.5. Humana pays procedure but denies pathology for dx code issue. Why? We have never had issues with this. Physician orders egd for r10.9, R19.4 , and gerd k21.9- nothing is found on pathology report- we leave these codes- Humana again pays procedure but not pathology- why? Just confused on what to do in these situations when we cannot code anything else other than symptom codes.

 

[TThivierge]

Well the provider is checking for disease of gastro area...try these listed digestive ds. below and then dx Z12.11 or dx Z13.811. Look at dx Z12.10-Z12.13 However if provider gives you a pt has detailed problem or symptom list that as first dx when checking the colon or stomach area
Here are some gastro dx codes for colon area....
Digestive DO K92.89
Intestine DO K63.89 or K59.89
Rectum &Anus Dx K62.89
If doing EGD treatment and does not give some, R dx code symptoms can possible use dx K31.89 DO of Stomach or K22.89 DO of Esophagus area and dx Z13.810
I hope helped you a bit more
Lady T

 

[macyoverstreet]

Well the provider is checking for disease of gastro area...try these listed digestive ds. below and then dx Z12.11 or dx Z13.811. Look at dx Z12.10-Z12.13 However if provider gives you a pt has detailed problem or symptom list that as first dx when checking the colon or stomach area
Here are some gastro dx codes for colon area....
Digestive DO K92.89
Intestine DO K63.89 or K59.89
Rectum &Anus Dx K62.89
If doing EGD treatment and does not give some, R dx code symptoms can possible use dx K31.89 DO of Stomach or K22.89 DO of Esophagus area and dx Z13.810
I hope helped you a bit more
Lady T

So with z12.11 you can only use when doing a colonoscopy screening but they are being scoped for actual symptoms. When billing this we leave the symptoms (reason for being scoped) and it still denies even though the dx codes are covered for that procedure per Medicare LCD's. As far as k31.89 how would that stand when we don't know what the "disease" is because pathology report is unremarkable. It seems in auditing sense that would be incorrect as well. It seems they don't pay on symptoms codes on path when nothing is found but will pay procedure but I just cannot figure out why.

 

[macyoverstreet]

Well the provider is checking for disease of gastro area...try these listed digestive ds. below and then dx Z12.11 or dx Z13.811. Look at dx Z12.10-Z12.13 However if provider gives you a pt has detailed problem or symptom list that as first dx when checking the colon or stomach area
Here are some gastro dx codes for colon area....
Digestive DO K92.89
Intestine DO K63.89 or K59.89
Rectum &Anus Dx K62.89
If doing EGD treatment and does not give some, R dx code symptoms can possible use dx K31.89 DO of Stomach or K22.89 DO of Esophagus area and dx Z13.810
I hope helped you a bit more
Lady T

I just filed and EGD with symptom codes and the z13.811 and will follow! Fingers crossed it will pay.

 

[TThivierge]

Macyoverstreet
If provider is checking stomach problems and not give symptom or just checking I d use dx K31.89 DO of stomach and proper Z code. Whereas if provider checking Esophagus but found nothing Id put K22.89 linked with EGD procedure. Hopefully the provider is giving a symptom to go along with the K31 or K22 but I put that first then symptom code then Z dx code last. I believe just using Z dx code does not give enough details for payers.
I hope helped you
Lady T