Wiki Re-mapping

[kristilm]

Lets say I have a patient with BCBS insurance and she is scheduled for a screening colonoscopy. During the procedure they find a polyp and remove it with a snare. I coded it with V76.51 as the primary diagnosis and then 211.3 as the secondary. This particular patients insurance does not cover screening colonoscopies. I wanted to rebill with 211.3 as the primary and V76.51 as the secondary, but someone told me that it was illegal. Can anyone give me any insight into this? Thanks!

Kristi

 

[coachlang3]

Curious-Is the hypothetical patient under the age of 50? If so, is there a personal or family history? If not, why is a screening being done?

 

[mitchellde]

You cannot change the dx codes and the sequencing due to a coverage issue. Correct and compliant coding states to code the screening V code first and any findings secondary. You can then code the polypectomy with the 33 modifier, but if screening is not covered then the patient knew this or was responsible for knowing this prior to having the procedure performed.

 

[Karen8084]

Agree with Debra regarding the addition of modifier "33" for the polypectomy code.
Are you absolutely sure that the patient's insurance (BCBS) does not cover screenings?
Because of the "Affordable Care Act" many more insurance companies are covering colonoscopy screenings now (and in my experience that includes BCBS too).