2022 Gastroenterology Reimbursement and Coding Update: Concrete Solutions to Strengthen Your Foundation in GI Coding and Billing | November 2021-Screening versus Diagnostic Colonoscopy: Dealing with a Never-Ending Issue

Video Transcription

Video Summary

The video discusses the differences between screening and diagnostic colonoscopies. It explains that screening colonoscopies are done for individuals who have no symptoms, abnormalities, or personal history of GI diseases or malignancies. The Affordable Care Act covers average risk screenings starting at age 45, while Medicare covers screening at 100% with no patient financial responsibility. However, Medicare and the Affordable Care Act guidelines may differ depending on the frequency of screening covered by commercial payers. Some payers may limit coverage or allow increased frequency of screenings depending on the patient's coverage and plan. The video highlights the importance of correctly coding and documenting colonoscopy procedures and includes information on modifiers such as PT, 33, and 53 that may be used depending on the situation. It also discusses the importance of verifying eligibility, obtaining preauthorization, and informing patients about their financial responsibility. The video emphasizes the need to clearly document indications for the procedure and to ensure accurate coding to avoid claim denials. It also provides examples of different scenarios and how to correctly code and document each situation.

Asset Subtitle

Kathleen A. Mueller, RN, CPC, QMC, QGMC, CCS-P, ICD-10 Proficient

Keywords

screening colonoscopies

diagnostic colonoscopies

GI diseases

malignancies

Affordable Care Act

Medicare

commercial payers