Fast Coder vs. Physician Coder vs. Multispecialty Coder  |  Compare & SaveLearn More!

Regular Price: $24.95

Ask an Expert Starting at $24.95

Have a medical coding question? Get definitive answers from TCI SuperCoder's Ask an Expert.

Browse Past Questions By Specialty

+View all
Priyanka Posted 6 month(s) ago
my providers does a screening colonoscopy and finds hemorrhoid, nothing else was done scope was removed. its a medicare advantage plan as per the lcd determination z12.11 and k64.8 is not a covered dx. I coded this a 45378-PT. the claim is being denied how would I tackle this issue. The patient had previous colonscopy done 10 years ago. this was a follow up colonscopy, pt is 57 age male.
SuperCoder Posted 6 month(s) ago

hi,

 

As per the LCD provided by medicare ICD 10 Cm code Z12.11 is billable appropriate code. or try to bill with ICD code K92.89.

>https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33671&ver=16&SearchType=Advanced&CoverageSelection=Local&ArticleType=SAD|Ed&PolicyType=Both&s=All&CptHcpcsCode=45378&kq=true&bc=IAAAACAAAAAAAA==&

Hope this helps!

Priyanka Posted 6 month(s) ago
I went and looked at the lcd info is it just for state of florida or for all the states in general? we are in Tennessee.
SuperCoder Posted 6 month(s) ago

Hi,

 

As per the LCD provided by CMS for Tennessee state ICD 10 CM code Z12.11 and k64.8 is not payable. Please try to bill with ICD 10 CM K92.89 Other specified diseases of the digestive system as there is no other payable code for this cpt for state of Tennessee.

>https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=34614&ver=29&SearchType=Advanced&CoverageSelection=Local&ArticleType=SAD|Ed&PolicyType=Both&s=50&CptHcpcsCode=45378&kq=true&bc=IAAAACAAAAAAAA==&

 

 

Hope this helps!

Priyanka Posted 5 month(s) ago
I should bill the screening as k92.89 with 45378-PT. It's ok to not bill the Z code?
SuperCoder Posted 5 month(s) ago

Hi,

As there is no specific billable ICD 10 CM code for 45378. Hence try to bill with K92.89 or check your medical record for any documented symptom that is billable with 45378 as per LCD.

 

Hope this helps! 

Posted by Priyanka, 6 month(s). There are 6 posts. The latest reply is from SuperCoder.

Related Topics