2023 Gastroenterology Reimbursement and Coding Update (Virtual) | November 2022-Screening vs Diagnostic Colonoscopy

Pdf Summary

This document discusses the differences between screening and diagnostic colonoscopy and provides an update on the Affordable Care Act (ACA) recommendations for colon cancer screening. The document highlights the recommendation of the U.S. Preventive Services Task Force to start screening for colorectal cancer at age 45. It also mentions that Medicare will begin covering screening colonoscopy at age 45 starting on January 1, 2023. The document further explains the Medicare screening colonoscopy loophole, which currently charges beneficiaries for testing polyps discovered during a screening colonoscopy. It outlines the phase-out of cost-sharing for Medicare screening colonoscopy, with Medicare covering 80% of the cost in 2022 and gradually increasing coverage to 100% in 2030. <br /><br />The document provides definitions of diagnostic colonoscopy, screening colonoscopy, and surveillance colonoscopy. It explains that diagnostic colonoscopy is performed when a patient has symptoms or abnormalities prompting evaluation of the gastrointestinal tract. Screening colonoscopy is performed on patients without symptoms or abnormalities. Surveillance colonoscopy is performed on asymptomatic patients with a personal history of colorectal cancer, adenomatous polyps, or inflammatory bowel disease. The differences in coverage for these procedures by commercial payers and Medicare replacements are discussed.<br /><br />The document also discusses the use of screening modifiers, such as PT and 33, and provides an overview of the ICD-10 diagnosis codes for screening and personal history of malignant neoplasms. It emphasizes the importance of proper documentation by physicians to clearly indicate whether a procedure is for screening or diagnostic purposes. The document suggests checking payer policies and MAC LCDs for coverage updates and advises practices to have a financial counselor to assist patients with understanding their financial responsibilities.<br /><br />Overall, the document provides a comprehensive overview of the differences between screening and diagnostic colonoscopy and highlights important updates and considerations regarding coverage and billing.

Asset Subtitle

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

Keywords

screening colonoscopy

diagnostic colonoscopy

Affordable Care Act

ACA recommendations

U.S. Preventive Services Task Force

colorectal cancer screening

Medicare

Medicare screening colonoscopy loophole

cost-sharing

surveillance colonoscopy