tci Medicare Compliance & Reimbursement - 2008 Issue 2

Coding Coach: Cure Colonoscopy Denials With CMS' Advice

You may be surprised by Medicare's guidance on diagnosis codes If you're confused about what constitutes a screening versus a therapeutic colonoscopy and how to order your ICD-9 codes, you're not alone. Four scenarios break down the Centers for Medicare & Medicaid Services' (CMS) stance on this tricky subject and help lead to picture-perfect colonoscopy claims.Secure What a Screening Procedure Entails Scenario 1: A Medicare patient with no gastrointestinal symptoms reports for a screening colonoscopy (or flexible sigmoidoscopy). The gastroenterologist performs the procedure and sees nothing out of the ordinary.Solution: This is a screening procedure. CMS waives...

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