Colonoscopy Preventative vs. Diagnostic ; Screening vs Surveillance – Blue Cross Blue Shield of Illinois vs Provider and I am in the Middle

I had a colonoscopy this year and was charged $3000+ because BCBS says the provider coded it as diagnostic vs preventative. I have had colonoscopies before, and a polyp was found in a previous scope. I am now on a 5-year cycle because of this.

After I received the bill, I first talked to BCBS and they said it was the provider who charged it as a diagnostic code (which is subject to deductibles) vs a preventative code (which is covered 100%). I then called the provider who states that is interpreted by BCBS as diagnostic and they claim they have not done anything wrong. The code the provider used was Z86.010. with no modifier.

After doing some research of my own I found that since I have colonoscopies every 5 years they are no longer considered screening but are surveillance. This distinction apparently allows for different coding that can be interpreted as diagnostic. I have read that the provider could use both a screening code and a surveillance code which I believe BCBS would then see it as preventative. Or a modifier could be added that could change the procedure from appearing strictly diagnostic vs preventative. Modifier 33 is a code that when added maintains the preventative focus of the procedure.

So my question is what leverage do I have with the provider to get them to add/change their code? BCBS seems unwilling or unable to help. Does my primary care physician have any leverage?

I really don’t want to pay this bill which IMHO should be covered by my insurance, but I do understand that they need the correct coding to administer benefits. HELP!!!