Monday, July 12, 2010

How to file the claim with screening examination on CMS 1500

CMS advises that, whether or not an abnormality is found, if a service to a Medicare beneficiary starts out as a screening examination (colonoscopy or sigmoidoscopy), then the primary diagnosis should be indicated on the form CMS-1500 (or its electronic equivalent) using the ICD-9 code for the screening examination.

As an example, the above scenario should be billed as follows using claim form CMS-1500 (or its electronic equivalent):

• Item 21 (Diagnosis or Nature of Illness or Injury)

• Indicate the Primary Diagnosis using the International Classification of Diseases, Ninth Revision, Clinical Modification, (ICD-9-CM) code for the screening examination (colonoscopy or sigmoidoscopy), and
• Indicate the Secondary Diagnosis using the ICD-9-CM code for the abnormal finding (polyp, etc.).
• For example, V76.51 (Special screening for malignant neoplasms, Colon) would be used as the first listed code, while the secondary code might be 211.3 (Benign neoplasm of other parts of digestive system, Colon).



• Item 24D (Procedures, Services, or Supplies)

• Indicate the procedure performed using the CMS Healthcare Common Procedure Coding System/Common Procedure Terminology (HCPCS/CPT) code for the procedure (biopsy or polypectomy), and


  • Item 24E (Diagnosis Pointer)
• Enter only "2" (to link the procedure (polypectomy or biopsy) with the abnormal finding (polyp, etc.)

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