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Facility disagreement

Romika Posted Thu 22nd of September, 2016 14:23:59 PM
51 year old female presented in the office for first colon screening. Pt mentioned she has external hemorrhoids and recently noticed red blood which prompted the appt. Indication for colonoscopy was screening. Findings were diverticulosis. Professional claim was billed as screening but the ASC billed the claim with diverticulosis (K57.30) and fecal abnormalities (R19.5) no screening code attached. How should the ASC have billed this procedure?
SuperCoder Answered Fri 23rd of September, 2016 03:16:13 AM

As per guidelines, the testing of a person to rule out or confirm a suspected diagnosis for some sign or symptom is a diagnostic examination, not a screening. For these cases, the sign or symptom is used to explain the reason for the test. In this case, as the patient had symptoms in the form of red blood which prompted the appointment, the ASC has billed it correctly. Thank you.

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