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

Video Transcription

Video Summary

In this video, the speaker discusses the difference between screening and diagnostic colonoscopy and highlights important points related to billing and insurance coverage. The speaker explains that average risk screening is recommended for individuals without symptoms and no personal history of GI diseases or malignancy. They mention that the Affordable Care Act revised the guidelines to begin average risk screening at age 45 and that Medicare covers screening at 100% with no patient financial responsibility. However, Medicare and commercial payers may have different frequency guidelines for screening, and some payers may not cover screening benefits at all. The speaker emphasizes the importance of accurately documenting the indications and findings of the colonoscopy procedure. They explain that if a polyp or lesion is found during a colonoscopy, it is considered a surgical endoscopy rather than screening. The speaker also discusses various modifiers and diagnosis codes that are used for different scenarios and payer policies. They stress the importance of pre-authorization, verifying eligibility, and informing patients of their financial responsibility. The video concludes with tips and recommendations for proper documentation and coding of colonoscopy procedures. This summary is based on the content of the video transcript and no specific credits are mentioned.

Asset Subtitle

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

Keywords

screening colonoscopy

diagnostic colonoscopy

billing

insurance coverage

average risk screening

Medicare

commercial payers