23 Miss. Code. R. 203-4.8 - Endoscopic Procedures

A. Medicaid considers the following incidental and not covered:

1. A diagnostic scope and a surgical scope in the same setting,

2. A diagnostic scope with biopsy and a surgical scope,

3. A diagnostic scope with or without biopsy done with an endoscope and an open surgical procedure in the same anatomic area, or

4. A diagnostic scope and diagnostic scope with biopsy unless the verbiage distinguishes the procedure as "with biopsy" versus "without biopsy".

B. Mutually exclusive relationships to endoscopic procedures are based on the following:

1. Complete versus partial,

2. With versus without, and

3. Extensive versus limited.

C. If endoscopic and open surgical procedures are both performed at the same surgical setting, Medicaid covers the clinically more intense procedure.

1. An endoscopic and an open surgical procedure in the same anatomic area are not covered by Medicaid for separate reimbursement.

2. Medicaid covers endoscopic-assisted, open surgical procedures performed on the same anatomic area during the same operative session when additional time, skill, and physician resources are required with the two (2) approaches, rather than a longer, more invasive open procedure, that can minimize morbidity, patient recovery, and scarring.

D. If multiple endoscopic procedures are performed during the same operative session, Medicaid covers the most complex procedure.

Notes

23 Miss. Code. R. 203-4.8

Miss. Code Ann. § 43-13-121