Okay, so our next topic is kind of never ending, screening versus diagnostic colonoscopy. So I think we still have a problem with the complete definition of screening. So definition of average risk screening is a lack of symptoms, are symptoms, abnormalities, no personal history of any GI disease or malignancy. And this past May, actually it was May 18th, we did get the Affordable Care Act revised to begin average risk screening at age 45. It took three years in order to do it, but it's there. Medicare covers at 100% for screening with no patient financial responsibility since January 1st of 2011. Now remember that Medicare does not follow the Affordable Care Act. So it's allowed every 10 years by Medicare for average risk screening and also for those payer policies that follow the Affordable Care Act. So that's where Medicare and ACA are exactly the same. Now the frequency for commercial payers is dependent upon the patient coverage and plan. There are still some payers out there, our patient policies that don't allow our covered screening benefits. And those are usually self-funded plans. So there's another issue with this, because some of the payers out there also allow screenings at increased frequency. You know, there's one plan out there that will allow screening colonoscopy every year, but doesn't necessarily mean that the patient's eligible for that. So just because the insurance company says, yeah, go ahead, do it, you know, you got to worry about the abuse situation with that. So your physician, your provider and your physician is responsible to determine what the patient's medical necessity is for any tests or any procedures out there. So screening means no symptoms with your boss, no GI symptoms, no findings during the endoscopy. You cannot have screening and symptoms as indications, it's contradictory. And I think that's the most common thing we see when we do reviews and we do questions, we get questions raised, we also have our own support clients as well. And I mean, that's the still most common indication is our doctors are still putting screening with a symptom. All right. So if you're looking at the endoscopy report, which a lot of you, I think listening in, a lot of the practices look at the endo reports before coding and claims are submitted. If the indications are not clear or further contradictory, this should be clarified. So if pulled for review, just remember this, if a payer pulls your claim for review, they're going to pick the most common, let's put it this way, the indication which costs them less money. So if they have to pay complete screening benefits without any patient responsibility, what do you think they're going to look for? They're going to look for a symptom, anything that would not be necessarily screening. Also guys, and just, this is also food for thought. Remember that when a payer looks at a claim or decides to pull a claim, it often is because of the patient's claim history. So if you don't have a lot of sometimes accurate information from the patient or maybe from the provider, the referring provider as well, remember that if you don't have that information, you don't know what's been submitted on a previous claim. And if the patient has had any GI symptoms submitted on a PCP claim, that often is the reason why a payer can pull your claim for review. Because all of a sudden, maybe there's been GI bleed, positive stool for a colt, iron deficiency, anything that's been submitted on a previous claim. And then here comes a screening colonoscopy that doesn't make sense to the payer. And often that is why they pull the claim for review. Now when they pull a claim for review, it doesn't mean that it's the time it's being paid. Sometimes these claims get pulled after payment has been received, and then it's potential possible recoupment. So again, be very clear. Your staff should ask questions if there's something that's contradictory or they just need clarification. When a polyp or lesion is found, the colonoscopy is no longer considered screening but a surgical endoscopy. Now the Affordable Care Act allows for no out-of-pocket patient responsibility when average risk screening is the indication and a lesion is found that must be treated. When you go on the payer's site, UnitedHealthcare, Aetna, Humana, Cigna, all of them have screening colonoscopy guidelines. And most all of them say they follow the ACA guidelines. And as long as it is an average risk screening that is converted to a surgical polyp is found, there is no out-of-pocket fee for the procedure, the facility, any lab, any anesthesia charge, as long as it's coded correctly. All right. For Medicare, the patient is responsible for the 20% that Medicare does not pay. The screening colonoscopy loophole will actually close in 2030, and everybody got really excited because this actually got signed into law on December 27th last year. And everybody thought, oh, good, it'll immediately start where the patient has no out-of-pocket. No. The phase out of cost sharing begins in 2023. So in 2022, the patient is still responsible for the 20% that Medicare does not cover when a screening converts to a diagnostic or surgical endoscopy. From 2023 to 2026, the patient's responsible for 15%. From 2027 to 2029, it's 8%. And then from 2030 and beyond, that is 100%. So if your patients don't quite understand it, which a lot of them don't, so if they do have Medicare and a secondary plan, they still usually don't have an out-of-pocket. If you put the PT modifier on it, which we do, then that should waive the patient's deductible. And if they have a secondary insurance, there will be no out-of-pocket for that patient. So, all right, remember, this reflects not just the physician side, but also the facility side as well. So if Bill was screening as a principal diagnosis and the finding as a secondary diagnosis, most payers will continue to pay preventive services. All right, so for Medicare, we're going to put modifier PT to the surgical claim. And for commercial payers, modifier 33 is added. Some of our commercial payers, like Anthem and some of the Blue Cross Blue Shield payers as well, will accept the PT as well. So high-risk screening, all right, this is where we got screening versus diagnostic on high-risk screening. And this also can be considered surveillance by commercial payers. Patients who have had a personal history of colon polyps, personal history of colon cancer, family history of colon polyps, family history of colon cancer, and patients with IBD. So since May of 2018, when the American Cancer Society revised the guidelines, they also added patients that have a history of radiation therapy to the abdomen as higher than average risk. Now, for Medicare purposes, family history includes only first-degree relatives, which are siblings, parents, or children. Now we do have some commercial payers out there that have their own plans, and it may include two or more second-degree relatives. Some of the payers follow Medicare on those, and some have their own policies. Colon polyps are adenomatous, not hyperplastic. Repeat screening is covered by Medicare after a minimum of two years, and it's covered at 100%. But this is where the commercial payers come into play on this one. It may not be considered screening, but surveillance, it may not be covered under preventive benefits. And unfortunately, this is probably one of the number one calls that your practice gets from the patients, because they call the insurance company, and they can't understand why they have to pay. And of course, the insurance company or the rep that they talk to tells them if the doctor had coded it correctly as screening, it would be covered at 100%. And then the patient goes, okay, it's the doctor's fault. So they call us. All right. But they don't also understand that the commercial payer didn't ask the appropriate question, or they didn't ask it either. You know, often if this causes an issue, we ask our patients to initiate a three-way call between our practice and the claims rep and the patient where this all can be discussed. And often the most common issue is the rep or whoever the patient talked to didn't ask if the patient had a history of polyps or history of cancer. When they find that out, they go, oh, well, then that's not average risk screening. All right. So again, average risk screening is considered no personal history. All right. It's somebody that's completely asymptomatic. Now family history falls under high risk screening, if you've seen there as well, but most commercial payers do cover family history at 100%. It's personal history that is considered surveillance issues, and it's considered a medical, not a preventive benefit. So diagnostic, patient has past or present GI symptoms, residual polyps, GI disease, iron deficiency, anemia, any abnormal tests, abnormal CTs, et cetera. Verified benefits and eligibility of medical necessity for diagnostic colonoscopy. I mentioned that earlier when we were talking about the breaking news that we should be checking preauthorization issues. You know, we've gotten some feedback by some clients and some stating that, well, we don't preauthorize. I mean, that's a patient's responsibility, and I'm like, hmm, well, if you make the patient responsible, then technically, if they don't do it, you're the one left holding the bag on this. All right. I recommend that there's two things that you all do. All right. First of all, you check for preauthorization. All right. And most of the time, like I said earlier, that they will tell you, as long as it's done as an outpatient, no preauthorization is needed. Then the last thing they tell you is this is not a guarantee of payment. Did you verify eligibility? So, excuse me, eligibility is the next step that you need to do, and that's when you're going to find out, is personal history cover as a preventive benefit or not? It's always a good idea that you find this out at the time of scheduling, give the patient information so that they can make an appropriate decision. You also want to check your LCDs, and I talked about this earlier, to make sure that your appropriate diagnosis and indications are covered. Now, before, surveillance versus screening, there's no difference for Medicare. Medicare will cover it 100% from commercial payers. You know, we recommend following the same as CMS, though. Remember that a lot of the screening issues we see are benefit-driven. So, you know, I just covered this before. One thing I want to make sure that you be a little bit wary of is the utilization of Z1211, which is average for screening, as the primary, with personal history of polyps as the secondary. Remember that the primary diagnosis code is usually the one that triggers the payer to pay the payer claim, all right? Modifiers that you put on a claim are informational only. It tells the computer, oh, like a 33 or a PT, for instance, that, oh, this might be a preventive service, but ultimately what they look at is the primary diagnosis code that is submitted on the claim. And to utilize a Z1211 in front of personal history, this can be considered an incorrect claim or potentially a false claim, and it can cause payers to recoup money from practices, and it has been already done this way. So unless the payer has written policy, and there are some payers out there that do, that allow for the Z1211 to be in the primary position in front of Z86.10 in front of personal history of polyps, I would not do it that way. And most of this is dependent upon the patient's plan. It can be an employer plan or the private plan. And we are seeing some of the payers and employers covering this, all right? But again, just because it gets the patient off your back, you know, doesn't mean it's absolutely correct. So the preventive task force guidelines, and this is the statement. The recommendation applies to asymptomatic adults 45 years and older who are at average risk of colorectal cancer and who do not have a family history of known genetic disorders such as Lynch syndrome or FAP, a personal history of IBD, a previous adenomatous polyp or previous colorectal cancer. When screening results in the diagnosis of colorectal adenomas are cancer, patients are followed up with a surveillance regimen and recommendations for screening no longer apply. So this is the preventive task force guideline. This is the ACA. And like I said, a lot of the commercial payers follow this guideline. All right, so the American Cancer Society recommendations. I think you're all aware it started screening at age 45 on May 18th. The last payer to revise policy was Cigna on October 15th of 21. So there has been a hesitancy of the policies to be updated on the commercial payer site. Now there's some that actually do state that they'll follow the CMS guidelines. So if the follow the CMS guidelines are the AMA guidelines on this, then they should cover it at age 45. But it's always nice to see it in writing. And again, verify eligibility at the time of scheduling. Now this is a Medicare screening colonoscopy memorandum that goes into effect and went into effect back in 2003. And remember that this affects Medicare, not necessarily Medicare replacement plans. When a screening colonoscopy is attempted on a Medicare patient and the provider does reach the cecum and or terminal ilium, but due to decreased visualization, usually due to a poor prep, is going to bring the Medicare patient back sooner than the allotted time for screening, two years for high risk and 10 years for low, Medicare requires the 53 modifier in this case so that the beneficiary can receive another screening colonoscopy in the future in accordance with the Medicare screening colonoscopy regulations. So this transmittal AB03114 is still in effect. So what happened in 2015 when we had the changes to modifier 53 and the changes to colonoscopy? So the new colonoscopy guidelines state that it has to, the cecum has to be visualized or a modifier 53 has to be added to this, right? So this policy says, well, if you do reach the cecum, but you didn't get a good picture, you didn't get to see the entire colon, so we're going to bring the patient back sooner. We can still put a 53 on this, Medicare allows this, all right, but the commercial payers may not because if you've got to the cecum, then 53 is not valid, all right? So again, when you document your colonoscopies, there's three key things, especially if we're wanting to add a 53 modifier to a claim. You got to indicate how far you got, why you were not able to visualize, get to the end of the line in other words, and when are you going to bring the patient back? Those are three key items that have to be documented in the endoscopy report and colonoscopy report. All right, so for Medicare, if you did reach the CECM but the prep was terrible and you're going to bring the patient back in three weeks or tomorrow or in three months, et cetera for another one, right? With maybe a different prep or anything like that. Then we put a 53 modifier on our claim. And again, anytime we put a 53 on it, it will get pulled for review. We'll have to send a copy of the report and they are looking for those three things. How far you got, why you couldn't get any further and when are you going to bring the patient back? All right, so they all have to be documented. So if you're dealing with a commercial payer and you put a 53 on it and you reach the CECM, they make a question when you got to the CECM so therefore the 53 is not valid. It does not stop the time clock. And even if you bring the patient back again in six months or three weeks or tomorrow, that next one may not be free, all right? Depends upon what their policy is. Some of their policies say they're only going to pay for one screening benefit, regardless if you added a 53 to it or not. So it's so vital guys that whoever is doing your instructions with the patient on the prep, make sure that the patient understands that they got really one shot at their free colonoscopy. No, so follow the prep. If they're not getting cleaned out, call, reschedule it, all right? We don't want to have you pay for that second one just because the prep was poor. And the importance of following the guidelines. So we've got some choices for screening colonoscopy. 45378, which actually the definition of 45378 is flexible diagnostic and it doesn't have the term screening. And so we would need the 33 modifier in order to trigger preventive benefits, you know? So there's no differentiation between average and high-risk screening in this 45378. And some payers will pander to my claim indicating that there is a code for screening. And what would that code be? G0121, which is colonoscopy on an individual not meeting criteria for high risk. Most of our commercial payers, Medicare replacement plans, accept the G codes. It's not accepted by Medicaid. And also some of the, I call them more the mom and pop carriers, not the national policy. The patient has no out-of-pocket responsibility. And the only diagnosis code for G0121 should be Z1211. G0105 is another choice. And this is an individual on high risk. So it specifies high risk screening in the description. So it could be personal history of anonymous pals, family history, history of IBD. It is accepted by Medicare again and most of the commercial payers at all. Now, doesn't necessarily mean that all the commercial payers will pay this at 100% because again, based upon your diagnosis code with G0105, it can be considered surveillance. But for Medicare purposes, as long as G0105 is submitted, we can, you know, the payer will usually accept it. It may not be subject to preventive benefits. So again, this is entirely up to each individual payer plan. All right, so what modifier should be assigned on a 75-year-old Medicare patient when a screening colonoscopy is converted to a therapeutic or surgical colonoscopy? Is it XS? Is it modifier 51? Is it PT? Or is it modifier 33? All right, so none of you picked XS, which is correct. All right. And overwhelmingly, 84% of you picked PT and actually that is the correct modifier. All right, so PT means preventive and actually is a modifier that makes some sense. All right, so preventive for Medicare, this waives the patient's deductible. The 33 for Medicare is not appropriate. There are instances where you can use the 33 modifier, but that is not in this situation. So it would be modifier PT. So let's talk about modifier 33 in a little bit more detail. So when the primary purpose of the service is to deliver an evidence-based service in accordance with the preventive task force, all right, the service may be added, identified by adding the 33 modifier. There are some already have that description in, in the CPT or the HCPCS code, so then the 33 would not be added, such like G0121 or G0105 or 00812, which is the screening code for anesthesia. So it should be added to 45378 for those payers that do not accept the G codes. It could be added to G0500 when conscious sedation is done by the endoscopy provider, and it should be added to commercial payers when a screening colonoscopy is converted to surgical to trigger preventive benefits. So where the PT versus the 33 is on a surgical, a colonoscopy converted from screening to surgical, most of the commercial payers require the 33. The PT is for Medicare, but again, like I said, Anthem also does allow for the PT modifier as well, and some Blue Cross Blue Shield providers as well. Okay, so modifier PT, again, waives the patient's Medicare deductible, but the patient is still responsible for that 20% that Medicare does not cover. Currently it's 20% through 2022, it's also 20%. It also is used on Medicare Advantage plans, all right? And that triggers preventive benefits on commercials and eliminates any out-of-pocket responsibility for the patient. So these little modifiers are pretty important. So modifier 53, I mentioned this before. So under certain circumstances, the physician or other qualified healthcare professional may elect to terminate a surgical or diagnostic procedure, all right? And it says this modifier is not to be used to report elective cancellation, right? So if an outpatient or ambulatory surgery center reporting of a previously scheduled procedure is canceled after anesthesia is given, then we would use a 74. So the physician reports a discontinued procedure or terminated procedure with 53, the facility reports with a 74. So example for 53, a 70-year-old male undergoing high-risk screening due to personal history of transverse colon cancer. The scope was advanced to the ascending colon, but unable to complete the screening due to a PrEP. Plan for reevaluation tomorrow. Medicare patients under Medicare Part B. G0105 with the 53 modifier with the diagnosis of the personal history of colon cancer. And actually Z53.8 is a procedure discontinued to patient condition. So that's actually a code that you can use for poor PrEP. Now there are some payers that may require the Z08 as a primary diagnosis in front of the personal history of cancer, but not all do. What the 53 does is stops the time clock, allows the patient to return with the fully covered screening benefit. And Medicare will pin the claim and want to review the endoscopy report, right? So like I said, most auditors look for three things, how far the scope went, why the procedure was incomplete, and when the patient is going to be brought back for repeat examination. It's usually within six months to a year. And if modifier 53 is accepted, payment will be 50% of the approved amount. And that was revised in 2015. Prior to that, you got the same amount as a flexible sigmoidoscopy. So this is a 65 year old undergoing screening, scope advanced to the cecum, but PrEP is incomplete and patient returning in six months. So that's a similar diagnosis. It's not a, this is G0121 with the 53 modifier. All right. Because the PrEP was incomplete, even though the scope got to the cecum, the 53 is allowed per the Medicare memorandum. So 55 year old undergoing screening colonoscopy, scope is advanced to the ascending, but PrEP was poor. Patient has commercial insurance. So G0121 with the 53 modifier, or 45378 with the 33 and the 53 modifier. Again, most payers will request the endoscopy report and stops time clock should allow the patient to return with a fully covered screening benefit. And remember that not all payers will allow the patient to have more than one screening colonoscopy. Modifier 74 is a discontinued and incomplete procedure in the ASC. Okay, so payers will still require the endoscopy report for the same components. But for those of you under Palmetto with modifier 74, it's very difficult for the ASC to get reimbursement on this because they require that the op node on the endoscopy note contain the reason for termination, the description of services actually performed, description of supplies actually provided, services not performed that would have been, supplies that would have been provided if the surgery had not been terminated, time actually spent in each stage pre-op, operative and post-op, and time that would have been spent if each of these stages of the surgery had not been terminated. So your physician has to document all of that in order for your ASC to get paid and consider for payment with modifier 74. So again, Palmetto GBA is a Medicare carrier most on the East Coast, but if you have any Railroad Medicare patients, you're all under Palmetto. So if you want more information for Palmetto, here's your link, and actually you can just type in Palmetto Medicare modifier 74, it'll take you right to it. All right, so again, we're just going to go over the definition of screening versus diagnostic one more time. So Z1211 is the encounter for screening, right? If it's normal chronic mucosa, our procedure code is G0121 or 45378 with the 33. If there's a personal history of adenomatous polyps, we would use G0105 or 45378 with the 33 modifier. All right, indicating that this is a preventive service. Remember, it's still up to the commercial payer to determine benefits. The 33 modifier just alerts the computer that this may be considered a preventive service. Diagnosis codes, Z08 and Z09. And I mentioned this a little bit briefly. Z08 is the encounter for follow-up exam after completed treatment for malignant neoplasm. It has in the ICD-10 instructions to use an additional code to identify the personal history of malignant neoplasm. So the Z85s. Z09 is encounter for follow-up exam after completed treatment for conditions other than malignant neoplasm. So that would be our personal history codes, Z86, Z87. So personal history of polyps, et cetera. So, and it says actually use additional code to identify that. And then if you look at the Z85 section, it said code first any follow-up exam after treatment of malignant neoplasm. So it's like, oh my gosh, I have to use a Z08 in front of Z85. And do I have to use a Z09 in front of Z86? For the majority of payers, no. Because if they have the diagnosis codes in there that they accept as a primary indication, the Z85 and the Z86, they accept it as a primary diagnosis, then you bill it that way. If you get an explanation of benefits back that states Z85 is not a primary diagnosis, then you know that payer wants Z08 in the first position. So I would not routinely utilize Z08 or Z09 in front of your personal history codes unless your payer has an issue with that. Okay. So again, we've got family history of G0105 or 4537833. And you can utilize Z1211 with Z80.0 for family history or Z80.0 by itself. This is a payer issue as well in an ICD-10 instruction. All right. So ICD-10 states to use Z1211 in front of family history, but sometimes that doesn't make sense if you're scoping somebody that's age 27. All right. Because their father was diagnosed with colorectal cancer at age 35. All right. So to a payer with ICD-1211 on a 27-year-old patient, they're going to go, whoop, doesn't meet the criteria for screening. So in some instances, we would use Z80.0 in the first position. And you can always use your comment field, which is box 19, and put mother diagnosed or brother diagnosed with colon cancer at age such and such to explain why you're starting this at an early age. All right. So again, some payers will automatically deny Z12. And create a spreadsheet based upon payer preferences on anything related to screening issues. So normally screening begins 10 years younger than the person with colon cancer. And like I said, make sure that you utilize your comment field in box 19 to put information such as that in there. Your payers do read the comment field. All right. Whether the patient has a family history or personal history of cancer or polyps, pre-authorization has to be obtained followed by verification of eligibility. You need to make sure, you know, that what the patient's benefits is. I mentioned this earlier, the patients should be informed of any financial responsibility. Now, you know, there are staffing issues, I understand. Based upon the size of your practice, a recommendation would be that you either have part-time or full-time financial counselor to help take care of this instead of payment plans. And practices that actually have set this up have experienced less patient dissatisfaction. You know, patient getting surprised afterwards, definitely, you know what, they don't like it. They get upset, you know, and you're still going to have some upset patients even if you tell them upfront, because it's just like, oh, it's going to cover it. My insurance is going to cover everything. But you know what? We cannot code to the insurance. We have to code to the patient's condition. And the patients don't understand that. They can't understand why. We just can't change that diagnosis code. What's the big deal? It's considered a false claim, which is a felony. All right, we have to watch what we do. All right, so obviously on this one, it's not screening. Iron deficiency anemia, it would be diagnostic, and the diagnosis code would be D50.9. All right, so I'm not going to go through the rest of these. These are just examples of if you find something. So colonoscopy with mucocecal and stigmoid palates by SNARE, we would bill 45385 with a PT modifier or a 33 modifier to the commercial payer. And then our diagnosis codes would be Z1211, D12.0, D12.5, or a K63.5, if we don't have path back to support that is a benign neoplasm. All right, so we do know that some Medicare carriers will deny if we use Z1211 in the first position with the PT modifier, because the PT modifier says it's preventive. All right, so again, make sure that you know what your payer policies are and what primary diagnosis they want in the first position. All right, so again, we have somebody that has a biopsy of a rectal polyp. We have 45380 modifier, PT modifier, or a 33. Colon screening, positive Cologuard. Post-endoscopy findings, normal colonoscopy. Procedure, colonoscopy. Procedure code, none. You can't submit charge until after re-reviewing with the provider. The indications contradict each other. All right, so Cologuard is an approved screening benefit for Medicare benefits every three years, but once the test is positive, the patient must undergo a diagnostic colonoscopy. And that's actually on the Cologuard website. It's also on their commercials. But UnitedHealthcare did change their policy beginning October 1st and states that if the patient has a positive fit or positive Cologuard, they are still eligible for preventive benefits. So it would be still considered a screening colonoscopy. They're the one payer that has made that policy. So that is new. All right, so average risk colon screening. Procedure, colonic mucosa normal. Random biopsies were obtained to rule out microscopic colitis and CIDA. So why were biopsies obtained on a normal colon? What was the medical necessity? This unfortunately is something we get questions on routinely. All right, why are you doing biopsies on something that's normal unless the patient has symptoms? So if you need to look at the HNP or visit notes to see if there was an indication, most commonly the patient has diarrhea. So if there is a symptom, the endoscopy report should be legally corrected along with path report. All right, so if there was nothing found, your physician should be consulted since there has to be, remember medical necessity for every procedure done or it's considered potentially a, let's put it this way, a false claim situation. I know Dr. Littenberg's gonna cover this a little bit later. So I'm just going, I'm giving you this information on the visit prior to screening. This actually comes from the Department of Labor. All right, and the code is S0285. All right, and I think I'll defer to him covering this a little bit more, but this slide also tells you the payers that accept it. And we just know that Medicare does not cover that visit. Okay. Now this is a question, is what about the patient who is symptomatic, but that isn't why we are doing the colonoscopy? All right, not everybody that has a symptom means that they're gonna have a colonoscopy. So it's up to your physician to identify the medical necessity for any procedure. If the patient has a symptom, but that's not where the colonoscopy is being ordered, then they need to document that in the visit notes. So chronic constipation currently being managed by Neurolaxin diet does not require endoscopic ECM. Patient is eligible for screening, and this will be scheduled. Intermittent abdominal pain due to known history of IBS, no endoscopic evaluation indicated. Patient to be scheduled for screening colonoscopy at their convenience. So you are addressing the patient as a symptom, but that is not why we're scoping it. Make sure that that's clear, especially if this is in a visit note. Okay, contradictions. Screening colonoscopy and incidental iron deficiency anemia. Patient has rectal bleeding, most likely due to hemorrhoids, but a proximal bleeding source can't be ruled out. So screening colonoscopy will be scheduled. Indication screening colonoscopy and diarrhea, and indication and history of Crohn's disease and screening. And there really is no history code of Crohn's disease. The patient has Crohn's. So just a few things. Make sure it's up to your physician to be clear in their documentation, whether screening or diagnostic. If it's not clear, discuss this with them. Make sure that you do that before you submit a charge. Make sure the pre-authorization and eligibility are verified and the patient is fully informed of their responsibility. Just don't rely on the patient to do this. You know, if you assume the patient's going to do it, you know what assume means. Make sure to assign the screening diagnosis and the proper ranking position. This can be a reason for denial. Check your local coverage determinations and payer policies for updates and coverage. Always check your EOBs for all denial reasons. You know, sometimes it's not clear as to why claims are pended. And make sure that you give patients the information verifying the differences between screening, high-risk surveillance and screening, and diagnostic procedures, and put that on your website. Actually, that's a good area of information to put on your website as well.

screening colonoscopy

diagnostic colonoscopy

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insurance coverage

average risk screening

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