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COLONOSCOPY

Mary Posted Mon 11th of August, 2014 10:16:20 AM

There was a patient seen at the office and was scheduled for a colonoscopy. She had her last colon done at another hospital and when the office received a copy of the past colon done on 2/6/06. The impression was colon to the cecum, no mass lesion and diverticulosis. I spoke with my doctor and told him I did not think that her Medicare would not pay for two more years as nothing was found on the colon. I was looking in her medical records and he son died from melanoma could I use some type of this diagnosis? I say the patient has to wait two more years for a screening colon. Thanks for your help.

SuperCoder Answered Mon 11th of August, 2014 10:33:32 AM

Thanks for your question. I agree with you that the patient should wait for their colonoscopy unless there are other indications that would suggest a need for the procedure. If there are indications such as rectal bleeding, constipation, or etc the patient can receive the procedure as a diagnostic procedure at a cost to the patient. If the patient is high risk; meaning that there is a family history colon polyps, colon cancer or if there is some type of inflammatory bowel disease present, the patient would be able to receive the procedure under the high risk benefit which is every 24 months. If the patient insists on getting the procedure, she must understand that she will be responsible for the out of pocket cost as it will not be covered under her preventative benefits.

The attached links will provide additional information on the screening benefits offered by Medicare.

http://www.medicare.gov/Pubs/pdf/10110.pdf

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE0613.pdf

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