Current Policy Statement of Health Net
Health Net, Inc. considers colonoscopy medically necessary according to the revised guidelines set forth by the American Gastroenterological Association, the American Society of Colon & Rectal Surgeons, the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, the American College of Radiology, the National Comprehensive Cancer Network, the American College of Gastroenterology, and the American Society for Gastrointestinal Endoscopy for patients who meet any of the following indications:
Diagnostic Colonoscopy
1. Evaluation of an abnormality on barium enema or other imaging study, which is likely to be clinically significant, such as a filling defect or stricture.
2. Evaluation of unexplained gastrointestinal bleeding, such as:
• Hematochezia not thought to be from rectum or perianal source, especially if the patient is > 40 years old.
• Melena of unknown origin after an upper GI source has been excluded.
• Presence of fecal occult blood.
3. Unexplained iron deficiency anemia.
4. Chronic inflammatory bowel disease of the colon if more precise diagnosis or determination of the extent of activity of disease will influence immediate management.
5. Clinically significant diarrhea of unexplained origin with additional symptoms (e.g., dehydration, weight loss).
6. Evaluation of acute colonic ischemia/ischemic bowel disease.
7. Evaluation of cytomegaloviral colitis in a patient with HIV infection
8. Evaluation of patient with Streptococcus bovis endocarditis.
9. Intraoperative identification of the site of a lesion that cannot be detected by palpation or gross inspection at surgery (e.g., polypectomy site or location of a bleeding source).
10. Marking a neoplasm for surgical localization.
Learn about Colonoscopy and Endoscopy billing procedure methodologies. GI gastrointestinal endoscopy and colonoscopy preparation, complication and what happened after the process. How to do the correct billing. EGD, GI and Screening CPT codes.
Tuesday, July 6, 2010
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CPT CODE 49082 - Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance -Average fee amount $200 CPT CODE 49083 - ...
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CPT Code Description 47562 Laparoscopy, surgical; cholecystectomy - Average fee amount - $600 - $750 47563 - Laparoscopy, surgical; c...
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Colonoscopy Billing tips - cpt 45380 45385 As a speaker at many national conferences, I find the question most frequently asked is, ...
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EGD CPT CODES COVERED ICD-10 Codes that Support Medical Necessity B25.2 Cytomegaloviral pancreatitis B37.81 Candidal esophagitis C15.3...
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Flexible Sigmoidoscopy Specific instructions for reporting flexible sigmoidoscopy have been added to the section guidelines. Report flexib...
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97010 - Application of a modality to 1 or more areas; hot or cold packs Average fee amount $5 -$10 97012 - Application of a modality to 1 ...
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Diagnostic and Therapeutic Esophagogastroduodenoscopy CPT/HCPCS Codes 43233 Egd balloon dil esoph30 mm/> 43235 Egd diagnostic br...
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Argon Plasma Coagulation Argon plasma coagulation: A non-contact thermal technique which uses ionized argon gas to deliver a high-frequenc...

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