Respected Contributor
Posts: 3,033
Registered: ‎09-30-2010

Re: Who Do I File Complaint for Medical Coding Issue?

@Still Raining You obviously have worked in the medical billing field.  


No wonder the average person doesn't understand medical bills when they are received.  Most especially during a lengthy hospital stay with multiple attendants, tests, procedures, surgery, physical therapy, etc.


I doff my hat to you. Is CPT something related to co-pay?  Is TC total cost?  I didn't cheat by going off on a search to see what these codes mean.

Respected Contributor
Posts: 4,754
Registered: ‎10-26-2010

Re: Who Do I File Complaint for Medical Coding Issue?

The colonoscopy was performed as a screening.  The tissue sample was taken as a screening.  Upon pathology review a benign polyp was discovered.  Pathology should have used a primary diagnosis code as screening with an incidental finding of a benign polyp.  


Yes, the Pathology supervisor should provide you with a written denial refusing to amend their code.  Of course, they will refuse to put anything in writing!!!!  They will refuse to amend anything;  they "never" make mistakes.


I would put everything in writing, include copies of all EOBs, and send to your insurance company.  In addition, call the insurance company and speak with a manager.  Explain everything in detail.  Hopefully your appeal will be fully reviewed.


Good luck!!!!