Some payers will request recoupments for colonoscopy claims when billed and paid as screening procedures that included a symptom of the indication, in addition to screening. Sometimes they even change the procedure to diagnostic after auditing the history and physicals and finding that the patient has a symptom. If the physician has both screening and a symptom listed on the indications on the colonoscopy report, this should be clarified and amended since a symptom and screening is considered contradictory.
Gastroenterology billing is complex and requires a high level of experience and knowledge for appropriate coding, modifier application, and general medical billing procedures. Billing specifics such as medical necessity verification, component coding, etc., require ever increasing levels of billing expertise and efficiency.
TriumpHealth is well-versed in gastroenterology billing and will collaborate with your practice to ensure you receive maximum reimbursement for services provided.