you work for a third party payer performning medical records review. your job is to match codes that were submitted on the claim to documentation in the medical record. you notice that a code has been input for a colonoscopy procedure, but you don't see the procedure report anywhere in the record. as the third party payer representative what will your action be regarding the code that was submitted on the claim form?

Question

you work for a third party payer performning medical records review. your job is to match codes that were submitted on the claim to documentation in the medical record.  you notice that a code has been input for a colonoscopy procedure, but you don't see the procedure report anywhere in the record.  as the third party payer representative what will your action be regarding the code that was submitted on the claim form?