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    Wiki Sigmoidoscopy of the neovagina-looking for coding guideline resource

    I review high dollar claims for employer groups that self-fund their health plan and was asked if 340K was an acceptable case rate for two physicians to perform a sigmoidoscopy w/biopsies on patient who is trans female. If the colon is still in its original anatomical location at the time of...
  2. J

    Wiki Commercial Bill Audit Denials based on Government Payer Logic

    I am hoping this community can help. There are several bill audit vendors out there that will recommend that an ERISA plan or Stop Loss Carrier deny line items from a bill. Unbundling is a common denial reason. These recommendations are based on CMS guidelines, not the terms of the commercial...
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