tci Part B Insider - 2012 Issue 29

Reader Question: Payers May Disagree About Colon Biopsy Diagnosis Code

Question: When our pathologist examines a colon biopsy from a screening colonoscopy (turned diagnostic), should we report the screening ICD-9 code or the pathology report findings as the diagnosis?Answer: The answer to your question may depend on the payer. Generally, you should report the diagnosis to the highest degree of certainty known at the time of billing, which would mean using the pathology report findings such as 211.3 (Benign neoplasm of other parts of digestive system; colon).Payers may differ: Depending on your Medicare contractor or other payer rules, you may need to list first the screening...

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