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Priyanka Posted Wed 06th of December, 2017 08:51:31 AM
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 Answered Thu 07th of December, 2017 06:08:36 AM

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 Fri 08th of December, 2017 13:13:23 PM
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 Answered Sat 09th of December, 2017 01:16:49 AM

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 Mon 11th of December, 2017 09:26:06 AM
I should bill the screening as k92.89 with 45378-PT. It's ok to not bill the Z code?
SuperCoder Answered Thu 14th of December, 2017 00:47:32 AM

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! 

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