100% coverage for colonoscopy screenings

Hi all,
We have been having receiving a lot of payments lately on our screening claims that are NOT paying at 100% (these are not Medicare claims). We are coding as always, using the -33 & -PT when applicable. Has something changed that I am not aware of? Some of the claims are reprocessing as we appeal, others are standing their ground and stating the claims were processed correctly. (Many of these claims I am referencing are BCBS HMO.)
Any advice from anyone? Thank you for your help! Chris

Comments

  • What CPT and ICD10 are you billing?



    Dena Rumisek
    Grand River Gastroenterology PC
    Grand River Endoscopy Center
    616-752-6529
  • For example.....

    45378 / Z12.11 or
    G0121 / Z12.11 or
    45385 -33 / Z12.11, D12.6
  • Odd. Have you contacted the carriers?

    Dena Rumisek
    Grand River Gastroenterology PC
    Grand River Endoscopy Center
    616-752-6529
  • We are not getting paid the way it states either and it's not one specific
    carrier. Even with the appropriate modifiers and correct line links. We
    have a full billing department that deals with this but always trying to be
    one step ahead so that it does not come down to outright denials or
    fighting for correct payment. Does not always work and I use the same
    combo that you do of ICD/CPT codes. The only time I don't is when they
    take biopsies for histology during a screening, then it's a little
    trickier.
  • Yes, sometimes they reprocess and pay 100% and other times they do not. Sometimes they stand by their original decision. We are seeing some copays being applied at times also.
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