ASGE members may submit coding inquiries electronically to codingquestions@asge.org. Each month ASGE gets dozens of questions from members. When submitting a question, please allow at least three business days for a response. When submitting inquiries, please include the ASGE member’s name and ID number. Only questions will be accepted and not reports. Below are two questions that could be beneficial to your practice.
Question #1
We have patients who frequently come in for colonoscopies for chronic diarrhea, which according to the ICD 10 book is K52.9, which is defined as noninfective gastroenteritis and colitis. Now we have a patient who called back upset because her biopsies came back normal with no colitis, but we billed her as having colitis, but that was the indication for the procedure, so I'm not sure if there is something else I am supposed to be billing if they have a normal biopsy?
Answer
This is a MAJOR issue in the ICD-10 world. You should be coding R19.7 for diarrhea. Yes, if biopsies taken show colitis, then K52.9 would be appropriate.
Question #2
Several insurance carriers have been denying some of our claims due to diagnoses that are similar. For example, billing a 45385/45380 with diagnosis code K63.5 primary and D12.5. They are saying they only want the K63.5. Is this something new with the insurances not wanting to know both?
Answer
This is not new since more and more payers are following ICD-10 parenthetical advice. D12.X codes and K63.5 can't be submitted together since they are Excludes-1 ICD-10 edits.
K63.5 Polyp of colon
EXCLUDES-1 adenomatous polyp of colon (D12.-) (D12-D12.9)
Since not all polyps are adenomatous, best practice would be to submit K63.5 when more than one polyp is removed and not all are neoplastic. Additionally, best practice is to utilize Box 19 and enter the location of the polyp(s) to support a separate lesion when billing more than one endoscopic technique.