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g0105 screening colonoscopy

Terri Posted Fri 16th of May, 2014 18:00:32 PM

Our physician did a screening colonoscopy on a high risk patient who has a personal history of colon cancer (medistatic disease). We did the screening with 1 year (364 days) and the patient has Medicare Insurance. Medicare denied this claim due to benefit maximum for the time period. Is there any other way for Medicare to pay our claim. We did not have the patient sign an ABN form.

SuperCoder Answered Mon 19th of May, 2014 07:55:51 AM

This is tough to get.Medicare beneficiaries without high risk factors are eligible for screening colonoscopy every 10 years. Those with high risk are eligible once every 24 months. With G0105 use if patients want one more than once every 2 years and they are with risk factors, have them sign an Advanced Beneficiary Notice [ABN]. And bill the patient.

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