82272

[mruiz12]

I am billing out cpt 82272, medicare keeps denying as not a covered diagnosis code. I tried to look on cms website and i can not find the covered daignosis. Does anyone happen to know were to look on the website or know the diagnosis that are covered under medicare.

[PMRNC]

That's not the way to add a diagnosis code. You get the diagnosis from the doctors documentation. If it's not covered you verify that it's not a covered diagnosis that's it. You can't create a covered diagnosis to a procedure code just to get the claim paid. Refer back to the chart documentation and make sure the proper diagnosis is entered.

[Michele]

http://www.cms.hhs.gov/mcd/search.asp?clickon=search  is the search of the NCD's for Medicare.  I would start there.  If you can't find it I would contact your local Medicare carrier and ask them to help you find documentation regarding the 82272.

Linda is right though.  You cannot just change the diagnosis to get the claim paid.  I would research it to understand why it is not paid, explain it to the dr, and ask the dr if it was coded correctly the first time.  Many dr's do not understand the importance of correctly pointing the procedures to the appropriate diagnosis and it may be a coding error. 

Michele

[oneround]

I'd be interested to know what DX code your attaching to the 82272.  The CPT code is a valid code.  The ladies are correct you can't just make up any DX code, it's fraudulent and doing so could cost you big time.  Your phyisicans documentation should contain that info.  You may just want to contact your Medicare carrier for claims instructuions.

[Pay_My_Claims]

ICD-9 318.2

[oneround]

Wow.  That truely made me laugh for the day

[PMRNC]

HA HA.. Charlene has a way of doing that.. LOL 

[kathrynm]

I have been using v76.2

[Pay_My_Claims]

if not mistaken, 82272 should be used with a diagnostic code, not a screening code. if he had rectal bleeding then you could use 82272

ask the md why he performed the fobt and if he did it as a screening, then you have to change the cpt code, if he did it because of another reason, get that dx from him and bill it out as a corrected claim