tci Outpatient Facility Coding Alert - 2016 Issue 5

Reader Question: Know the Limitations of Colonoscopy Coding

Question: What are the conditions when colonoscopy cannot be billed separately? New Jersey Subscriber Answer: Yes, there are conditions when a gastroenterologist performs colonoscopy but the service will not be covered. You should have additional documentation that indicates the medical necessity of the procedure when you submit your records for review by the payer. According to medical experts, a few of these conditions include: Hemorrhoids Acute limited diarrhea Chronic, stable irritable bowel syndrome (IBS) or chronic abdominal pain (though there are some exceptions with this condition in certain circumstances) Routine follow-up of inflammatory bowel disease (IBD) (except for checking...

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