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colon screening verses diagnostic procedure

Joseph Posted Tue 12th of July, 2011 18:21:38 PM

If a medicare patient has had a tubular adenoma removed during a colonoscopy, could the patient have a follow up colonoscopy a year later and would that be considered a diagnostic procedure, or do they have to wait the 2 years for a high risk screening?

SuperCoder Answered Tue 12th of July, 2011 19:40:14 PM

Medicare provides coverage for 1 screening colonoscopy every 2 years for high risk beneficiaries regardless of age. Since the first one where tubular adenomal removed can not be regarded as screening colonoscopy, so the subsequent one can't be counted for two years from the present one. The patient can have a follow-up colonoscopy a year later.

Joseph Posted Tue 12th of July, 2011 20:02:21 PM

So, would we code the follow-up as a diagnostic colonoscopy using 45378 and V12.72 as the indication with medicare if there are no polyps found?

SuperCoder Answered Tue 12th of July, 2011 20:28:52 PM

As you are billing Medicare, I thinkg you should go for G0105, i.e.,Colorectal cancer screening; colonoscopy on individual at high risk.

Joseph Posted Tue 12th of July, 2011 21:28:33 PM

So, if we do a follow-up on a medicare patient that has had a polyp removed the previous year we would use the G0105 code if there are no other polyps found during the high risk screening. If we find a polyp then the screening would become diagnostic and the patient's follow-up visit the next year would then be a G0105 unless we find another polyp at that time. Is this the correct scenario? Would the indication for the colonoscopy continue be a high risk screening even though it becomes a diagnostic each time? Thank you so much for your help, I appreciate any help you can give on this subject.

SuperCoder Answered Tue 12th of July, 2011 22:07:00 PM

That's right.
But there are other criteria for High-risk Screening also.

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