Endoscopy Center of Washington DC

January 18, 2017Revdex.comID- ***The Endoscopy Center Of Washington, DC strives to provide quality clinical care and follows all AAPC Medical Coding guidelines.This patient provided the physician with information that they had a personal and family history of colon polypsA
screening is commonly done for first time patients who have not had any history of polyps and is normally covered under the Preventive Benefit at 100% on most policies.In this situation the procedure was done and a polyp was removed which under medical guidelines is considered a diagnostic procedure and different benefit levels are applied, per the patient's insurance policy.The information below was provided by this patient's home plan of BCBS of MassO routine Colonoscopy is covered 100% at no cost to the membero if the procedure becomes medical - $copay appliesThe balance of the claim will be processed at 10% O subject to a $deductible.We contacted the physician and he agreed to amend the operative report and we submitted a corrected claim on the patient's behalf and are still awaiting adjudicationPart of submitting the corrected claim with coding, we must provide the operative report as medical documentation and it specifically states her personal history and what was done during the procedure which made it diagnostic, not preventative.Our policy is to not to bill to get paid, but to bill according to the medical procedure documented or record and the insurance company will adjudicate according the patient's medical policy.If you should have any questions, please do not hesitate to contact me.Regards,Ken T***Manager, Business Operations ###-###-####

I just received notice today that BCBS MA processed the claim they resubmitted so I am satisfied.  Thanks so much for all of your help.