Start with the surgeon's diagnosis
The main diagnosis on your claim is usually the reason for the surgery. Use the post-op diagnosis from the operative note when it's more specific than the pre-op one, for example a biopsy that confirms what was suspected.
Add what supports your care
Some payers decide whether MAC was necessary based on the patient's other conditions. Add the conditions that justify your care, like severe lung disease or sleep apnea, when they're documented.
Common problems
- Diagnosis copied from the schedule, which is often vague
- Screening colonoscopy that found a polyp, coded the wrong way. See GI endoscopy billing.
- Your diagnosis doesn't match the surgeon's claim, which can trigger review
This article is general information, not billing, legal or tax advice. Payer rules change; always check current guidance.
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