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Oklahoma Gastroenterology

Thomas Posted Mon 16th of November, 2015 19:15:17 PM

Filed a Medicare claim for a patient who had a colonoscopy with BICAP and epinephrine injection ablation of AVM's. Patient had reddish-colored stools and AVM's in cecum. Billed Medicare with CPT 45388 and Diagnosis code 578.1 and 747.61. Medicare denies stating procedure code billed is not correct/valid for services billed. CPT is listed in AMA CPT coding book and I am not understanding why Medicare denied claim.
Also, checked with hospital how they billed claim and they used CPT primary 45384 and secondary CPT 45381. But those codes are for removal of tumor? Confused as to how to filed Medicare.
Thanks so much for all your help.

SuperCoder Answered Tue 17th of November, 2015 01:57:10 AM

Thanks for your query,

For Medicare Claim, you should prefer G6024; Colonoscopy, flexible; proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique for reporting 45388.

Since you are billing for the professional services, you should refer to the G code; G6024.

Thomas Posted Tue 17th of November, 2015 14:33:20 PM

Thank you for your quick response, however I am unsure if I have to use a V Diagnosis code ICD-9 (before ICD-10 date) with G6024 or can I use
diagnosis codes 578.1 primary and 747.61 secondary. Again, this is for Medicare claim filing.
THANK YOU FOR YOUR HELP!

SuperCoder Answered Wed 18th of November, 2015 00:24:43 AM

Hi,

You can use 578.1 as a primary and 747.61 as a secondary code with CPT G6024. Please find below LCD link for G0624 for more assistance

http://mediquant.com/policy/L33521_20150219.pdf

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