2024 Gastroenterology Reimbursement and Coding Update | November 2023-04 - Screening vs Diagnostic Colonoscopy

04 - Screening vs Diagnostic Colonoscopy_Mueller

Pdf Summary

This document discusses various aspects of screening and diagnostic colonoscopies, particularly in relation to the Affordable Care Act (ACA). The document begins with an update on the ACA policy, which now recommends that colorectal cancer screening should begin at age 45. Medicare is set to begin coverage for screening colonoscopies at age 45 starting from January 1, 2023. The document also highlights the Medicare Screening Colonoscopy Loophole and the recently passed Removing Barriers to Colorectal Cancer Screening Act, which aims to close the loophole that requires patients to pay for a diagnostic colonoscopy if polyps are found during a screening colonoscopy. The document then explains the differences between screening, surveillance, and diagnostic colonoscopies, as well as the eligibility criteria and coverage for each. It also addresses the specific considerations and challenges for inflammatory bowel disease (IBD) patients undergoing colonoscopies. The document provides information on screening modifiers and guidelines for billing a visit prior to a screening colonoscopy. It also offers insights on ICD-10 codes and their proper usage for screening and personal history of cancer or polyps. The document concludes with practice pearls, emphasizing the importance of clear documentation, proper verification of insurance coverage and preauthorization, and patient education on the differences between screening and diagnostic procedures.

Keywords

screening colonoscopies

diagnostic colonoscopies

Affordable Care Act

colorectal cancer screening

Medicare coverage

Medicare Screening Colonoscopy Loophole

Removing Barriers to Colorectal Cancer Screening Act

surveillance colonoscopies

inflammatory bowel disease patients

billing guidelines