Okay, yeah, scratching your head. I think sometimes that is exactly how we feel on this. All right, so this is, there's quite a few things involved with screening versus diagnostic. We're going to look at the Affordable Care Act. We're going to look at the loophole. We're going to look at what actually is average risk screening versus high risk versus diagnostic. Looking at the colon cancer screening options, screening codes, and you know, what happens with IBD patients, and the modifiers appropriate to screening, and billing the visit before screening colonoscopy, and last but not least, the False Claims Act. So let's talk about the Affordable Care Act guidelines. And this actually, this is quite a few years old. So back on May 18th of 2021, the U.S. Preventive Task Force posted the final recommendation to begin screening at age 45 through age 75. And there are three grades associated with this. Grade A is 50 to 75. Grade B included 45 to 49, and grade C is anything after age 75, so from 76 to 85. And your payer policies do differ on some of this, specifically on grade C. Most of the policies for your commercial payers, as well as Medicare now, include both grade A and grade B. And at one time, and for the most part, Medicare does not follow the Affordable Care Act word for word, but they are starting to follow some parts of it. So Medicare also began coverage at age 45 on January 1st of 2023. Back on January 1st of 2023, Medicare also allowed for a follow-up colonoscopy, and they actually call it follow-on colonoscopy, after a positive stool-based screening finding. For the commercial payers that follow the Preventive Task Force guidelines, that actually also started on May 31st of 2022. How you bill this, remember that this is an average risk screening, so it would be G0121, and that is the code the majority of payers, with the exception of Medicaid, cover. The diagnosis code will be Z1211, and then R19.5, which is the code for the positive stool studies. So this is actually the Affordable Care Act. They have not really revised the age on that in this paragraph, but remember, this pretty well states, applies to asymptomatic adults, you might as well say 45 years and older, who are at average risk of colorectal cancer, and who do not have a family history of known genetic disorders that predispose them to a high lifetime risk of colorectal cancer, such as Lynch syndrome or FAP, a personal history of IBD, a previous adenomous polyp, or previous colorectal cancer. So when screening results in the diagnosis of colorectal adenomas or cancer, patients are followed up with a surveillance regimen, and recommendations for screening no longer apply. All right. The reason I have this highlighted is because a good percentage of your commercial payers follow the Affordable Care Act guidelines. Remember when I was talking about the legislation acts, and with Illinois, it says that they, you know, they're not necessarily following this per se, because in Illinois, you're eligible now for a preventive colonoscopy, even for surveillance issues. All right. But that's a state issue. Most of your commercial payers out there follow this to the T. It's kind of the loophole in the Affordable Care Act. If they find something, guess what? They only have to cover one every 10 years. So Medicare screening colonoscopy loophole. This actually passed and was put into law on December 27th of 2020. When a screening colonoscopy becomes a diagnostic procedure for Medicare, the patient is responsible for a percentage, because it's treated as a surgical procedure. Remember, like I said, Medicare does not follow the Affordable Care Act guidelines. For the Affordable Care Act, if a screening colonoscopy converts into a surgical technique, or what they consider therapeutic technique, that technique is covered at 100%, as well as pathology, as well as anesthesia, et cetera. There's no out-of-pocket responsibility for the patient. But for Medicare, it's not the same thing. So when it converts from a screening to a therapeutic, we apply what's called a modifier PT, which means preventive, and that waives the patient's deductible. But the patient is still responsible for the percentage that Medicare does not cover. And since 2023 and through 2026, instead of the standard 20% out-of-pocket for Medicare, it's normally 80-20, for the screening converted to therapeutic, it's an 85-15. So the patient is responsible for the 15% out-of-pocket. And then in 2027, it goes down to 10. And finally, in 2030, the patient has no out-of-pocket responsibility. Now a lot of you go, oh my gosh, they're still responsible for 15%. Most of your patients out there have a Medicare secondary plan, what will cover what Medicare approves, but it'll cover the out-of-pocket for the patient. And if the patient has a Medicare Advantage plan, that will also cover that percentage as well. So there really aren't a lot of Medicare patients out there that are really left with the 15%, but there still will be some. So let's talk about screening versus surveillance versus diagnostic. I should highlight this, I should triple underline it. Screening is the lack of symptoms and abnormalities. Not incidental diarrhea, not incidental abdominal pain. If you're putting that in your indication, it's not incidental. So it's completely lack of symptoms and abnormalities. And the patient's eligible for screening at age 45. Medicare covers it 100% since January 1st of 2011. We know it's allowed 10 years by Medicare and most of the commercial payers as well. We had a question in support this past week that said, well, what happens if the patient's eligible for a screening colonoscopy every year for this payer? That's great. If we start doing them every year, now that's a whole different ballgame. Just because the patient's eligible for a colonoscopy every year, are we going to do one every year? Then we get into a potential abuse situation. So this is all based on medical necessity. Remember we just talked about this before. During the screening procedure, polyps or lesions can be found, which are often removed. This is considered a surgical or therapeutic colonoscopy. And most payers follow the Affordable Care Act, the patient should still be allowed complete preventive benefits for this. All right, so surveillance colonoscopy. And why do some payers not cover this as preventive? Well, it's an endoscopic exam to identify recurrent neoplasia in an asymptomatic individual with previously identified precancerous lesions. All right, so adenomatous polyps or adenomas are polyps that grow in the lining of the colon and they carry a high risk of cancer if they are left, all right, if they're not treated. And they're considered premalignant. The other types of polyps that can occur in the colon are hyperplastic and inflammatory. Remember we got those new codes, Kristen's going to go into more detail on those, between the hyperplastic and inflammatory polyps. Now hyperplastic obviously don't require surveillance. Inflammatory polyps, and this is what causes a problem when you look in the ICD-10 book. When you look for a diagnosis code for an inflammatory polyp, it leads you to K51.40 area, which is ulcerative colitis, right? If the patient does not have ulcerative colitis, you are not going to assign that code. Be very careful when you do a lookup in the ICD-10 book or in the index, and often in our software, if you type in inflammatory polyps, it's going to lead you to that. That would be assigning a diagnosis to a patient who does not have this disorder and cause a problem, major problem. So inflammatory polyps are usually considered a K63.5 code, which is just a colon polyp for patients that do not have IBD. So surveillance colonoscopy, this is patient that's asymptomatic, again, has a personal history of colorectal cancer, anonymous polyps, or inflammatory bowel disease. And remember, we were just talking about this, many commercial payers, Medicare replacements do not cover this as a screening benefit. We're going to bill G0105 for this code. This is a high-risk screening, but also it's considered a surveillance to most payers. And most of your payers do accept the G code, again, back to the exception of Medicaid. So screening versus diagnostic. So patients with IBD, do they qualify for high-risk screening? So if the provider proceeds under the same guidelines as a routine screening, which means all we're going to do is look, and only biopsy those areas that are abnormal, then yes, the colon could be billed as screening, and that would be a G0105 situation. And if biopsies are taken because there is a nodular area or because a polyp is removed, et cetera, and no random biopsies are taken, then we could actually bill this as a screening converted into a therapeutic. But most oftentimes, the intent prior to proceeding with the procedure is to randomly biopsy the colon to assess how the medication is keeping disease under control. This is diagnostic. It's not considered screening because random biopsies are never taken during a screening colonoscopy. But we'll talk about that in a little bit for something else. Random biopsies indicate the provider's intent for the procedure is diagnostic. So if your patient questions whether a colon will be screening, then you need to really check with your provider determining intent. Are you just going to look, and you're not going to go ahead and touch and biopsy this patient? Then technically, it could be considered a screening. But again, we need to check with the provider to determine what the intent is. So diagnostic colonoscopy, back to symptoms, patient has diarrhea, hematochesia, abdominal pain, change in bowel habits, weight loss, anemia, abnormal X-ray of the GI tract, et cetera. There is a symptom or an abnormality which prompts the evaluation of the GI tract. All right, colorectal screening we just talked about, asymptomatic, code is G0121. The only diagnosis code you're going to submit on this claim is Z12.11. I see hemorrhoids, I see diverticulosis also added to this code. Those are usually incidental findings. If they're incidental, you do not have a treatment plan for diverticulosis or hemorrhoids in your plan of care on your endoscopy report, don't submit them. All right, hemorrhoids are usually not an indication for colonoscopy, all right, as well, and diverticulosis maybe, all right, again, if it's something you are actually treating. So best practices, only submit the code that applies to your treatment plan if you have one. G0105, colorectal cancer on an individual at high risk. This is covered once every two years, which means at least 23 months from the last screening. And that's the key, from the last screening colonoscopy. All right, so the only code submitted that starts at time clock is a G code. If you do a polypectomy, that is not a G code. You're going to bill 45385 if you did a snare, we're going to add a PT modifier, which waives the copayment, and we're going to use, and this is dependent upon payer. You're going to use either screening for primary or the finding for primary on this, but the diagnosis codes do not trigger the time clock, only the G code. So if you did a polypectomy and it came back with, say, an area that needs to be monitored, like in six months, there could be margins. What you might've taken out is a piecemeal, and you want to look again in that in six months to a year. You're not going to bill, you're not going to worry about billing G0105 because that's what you should bill. G0105 in a year, it'll be covered because you did not start the time clock with the 45385. All right, so this is kind of where we're standing with some of our payers, and this is one of probably the major payer out there. UnitedHealthcare has frequently asked questions. All you have to do is type in UHC screening colonoscopy policy, and you'll get right to their site, and they've got a Q&A session on every preventive benefit in there. So it says, if a polyp is encountered during a preventive screening colonoscopy, are future colonoscopies considered under the preventive care services benefit? It says no. If a polyp is removed during a preventive screening, future colonoscopies would normally be considered to be diagnostic because the time intervals between future colonoscopies would be shortened. All right, that's their national policy. That doesn't mean that it's going to apply to every patient. Remember what I said earlier about preauthorization? Every one of your procedures should be preauthorized, and most of the time, you get the response. As long as it's done as an outpatient, no preauthorization is required, but the next statement is, this is not a guarantee of payment. Verification of eligibility should be done. That's another step, and that is where you're going to find out whether or not, what is the patient's policy regarding this? Remember, this could be state-driven, and it could be employer-driven. Let's talk about the modifiers that apply to screenings. KX, this is a follow-up screening after a positive stool, positive result from a stool-based test. Yes, doctors, you have got to say positive screening Cologuard, positive screening FIT, positive screening GYAC. Most of you are thinking, well, Cologuard, that's only done for average risk screening. Well, that's what it should be done, but how many of you are seeing primary care providers not following the guidelines, and are you doing off-label use of Cologuard? When you go and look at the Cologuard website and the commercials, it specifically says it is only for average risk patients. If you are seeing a positive Cologuard on somebody with a personal history of polyps, that's not screening. That's diagnostic. All right, so please, if this is truly a screening, all right, make sure it's a positive screening stool test. PT, colorectal cancer screening turned diagnostic. We talked about that already. 33 is a preventive service. Now, PT is usually allowed by Medicare and some of the Blue Cross and Blue Shield payers and Anthem. 33 is a preventative service, 52 is reduced, 53 is a discontinued procedure for the doctor, 74 is a discontinued procedure for the ASC. So KX was published on February 27th of 2023, went into effect on January 1st of 23, and this is, again, this is that follow-on or follow-up colonoscopy after a Medicare-covered, non-invasive stool colorectal cancer screening test returns as positive. You attach the KX modifier to G0121, and the link for this is at the bottom of the slide. Modifier PT, this is converted to diagnostic specific to use on Medicare. It waives the patient's deductible, but their patient is still responsible for 15%. This also can be used on Medicare Advantage plans and some of the commercial Blue Cross and Blue Shield plans. For the commercial benefits, it's just going to trigger all the preventive benefits and eliminates the out-of-pocket responsibility for the patient. Modifier 33, you would put this on a service that is not or does not have the term preventive in the definition, right? So you're not going to ever add it to G0121 or G0105 because screening's contained in the description. But for those payers that do not accept the G codes, you would put 45378 with a 33 modifier. And it actually should be added also to the commercial payers when a screening colonoscopy is converted to surgical therapeutic, so you want to trigger preventive benefits. And for any of you that are billing for conscious sedation services or also known as moderate, which I'll talk about a little bit later, you're going to add the 33 modifier to that as well. Modifier 52 is reduced service. And really guys, when you look at modifier 52, it says where the physician completes the procedure but elects to reduce a portion of a service or procedure. In the CPT book, it instructs us to report 52 if a therapeutic colonoscopy is performed and does not reach the cecum or small intestine anastomosis. All right, hmm, all right. Not, we're talking therapeutic. We're not talking about just the base codes. The procedure codes should document why the service was reduced, all right, and document the reason on the claim. You know, the best practice, and we'll talk about modifier 53 in just a little bit, is all the physicians should be documenting how far you got, why you couldn't get to the end of the line, and when you're bringing the patient back. And sometimes with modifier 52, if there's an obstruction due to a malignant tumor, you're not going to end up bringing this patient back, all right? You're going to send them to usually colorectal surgery, general surgery for the potential resection on that. But if you're going to bring the patient back at some point because of the fact the patient's prep is poor, and you only got to the transverse colon, you did a polypectomy, and there was so much stool anterior to that, well, you know what? Again, this 52 goes on your surgical claim. All right, so question, what modifier is used to identify a screening colonoscopy is converted to a therapeutic surgical colonoscopy on a Medicare patient? Is it modifier 59? Is it modifier 33? Is it modifier PT? Modifier is no modifier necessary. PT, 78%, you are correct. All right, the 59 is to report on a bundled procedure, and so that's not appropriate. The 33, because this is Medicare, does not apply to Medicare. For a commercial payer, that would be appropriate, but for Medicare, the PT is the correct answer. Modifier 53, when performing a diagnostic or screening on a patient who is scheduled and prepared for colonoscopy, this is in your CPT book. If the physician is unable to advance the colonoscope to the cecum, or colon, small intestine, and anastomosis due to unforeseen circumstances, report 45378 or 4438, which is colonoscopy through stoma, with modifier 53, and provide appropriate documentation. So it doesn't matter if it's screening or diagnostic. Now the G code isn't in here because the G code is not in the CPT book, but it is still appropriate for G0105 or G0121 as well. I'm going to talk about this transmittal that actually goes back to 2003, and then again it was dated October 1st of 2015, instructs us to use, and this is Medicare only, guys, but to the 53 modifier, when the scope does not go to the cecum, goes beyond the splenic flexure in the tent of the procedure, is a screening or diagnostic colonoscopy. So remember what I said earlier. Most auditors are looking for three things in the endoscopy report. How far the scope went, why the procedure was incomplete, and when the patient is going to be brought back for repeat examination. Now there is nothing written in stone about how soon you should bring the patient back, but when you're trying to stop the time clock on a patient to allow them to get that completion colonoscopy done without an out-of-pocket responsibility, you pretty well should be bringing them back within a year, and a lot of times you're bringing them back the next day, or within a month, or two months, or three months, or whatever, but the sooner the better on this. If it ends up being five years because the patient really didn't follow through on this, good luck on getting this one covered. All right, so payers are looking for three things. How far did the scope go, why couldn't you complete it, and when the patient is going to be brought back for the repeat exam. If that's not crystal clear in there, they'll probably just ignore the 53 modifier and pay you, and if the patient comes back tomorrow, or if the patient comes back in three months, the patient will not get the freebie, they'll be responsible for an out-of-pocket responsibility. Medicare for the most part stops the time clock if everything's dated, but Medicare replacement plans may not, and some of the commercials do not as well, because their guidelines are, guess what, you're allowed once every 10 years, that's it, one, even if it's a poor prep, one, that's it, so I can't stress enough that your staff, whoever does instructions with the patient, really just make sure the patient is aware that they need to follow through with the prep, because if they don't, and we have to bring them back again, that insurance plan may not cover this as free. It's so important that there's stress on the importance of completion of the prep, and if the patient's having trouble, then they need to contact and potentially reschedule. We want to make sure they get this for free. That's the whole purpose of this. The next area is modifier 74. The physician bill 53, and then modifier 74 is for the facility, so that's pretty well cut and dry. You were supposed to bill a screening. Remember, I kind of talked about this earlier. Patient meets the minimum age for a screening procedure, so we're looking at 45 for the majority of insurance carriers, including Medicare, and sometimes when the patients call in and say, I called the insurance company and they said that you billed it wrong, don't actually assume that that patient's incorrect. We need to investigate this a little further. Sometimes we've got some payers out there that allow the screening diagnosis in the first position, so make sure that before you say, oh, absolutely not, we billed it right, make sure that you investigate this a little bit further. Make sure also that you have the policy in writing, if it's truly a payers policy and not that just Joan told me to add C1211 as primary. We all make mistakes, and let the patient know you'll have the chart reviewed, just like I said, and what happens if the patient had a family history of polyps, but actually personal history was entered, and we haven't seen that before, and family history seems to be covered. That does not trigger the denial. It seems that the personal history is the issue. What happens if the patient goes, well, I want a call between you and the insurance company because the insurance company said that you did it wrong? That's fine, go ahead and do it, because a lot of times the patient did not talk to the claims rep, they're at the insurance company. They just talked to the first person, they answered the phone, who said, it's the doctor's fault. They didn't get to the right person, and oftentimes when we get to that right person, and we get on a call with them, the patient gets told, oh, they billed it correctly, you didn't say you had polyps, so again, always a good idea to do that call with the patient. They may not be happy with the end result, but at least you've proved that you have done it correctly. What about the patient who is symptomatic, but that isn't why we are doing the colonoscopy? It is up to your physician to identify the medical necessity for any procedure. If the symptom patient is a symptom, but that's not why the colonoscopy is being ordered, document that in the visit note. Oftentimes you are seeing this patient first. What happens if the patient has chronic constipation that's being managed by Muralex and Diet, and they do not require an endoscopic exam? That's what you need to say. Patient's eligible for screening, and this will be scheduled. Intermittent abdominal pain due to known history of IBS. No endoscopic evaluation is indicated. However, the patient is scheduled for screening, will be scheduled for screening colonoscopy at their convenience. You have to be crystal clear. Well, we know the patient has symptoms, but that is not why we're doing the procedure. This needs to be documented. If you don't state that, guess what ends up being on that indication on the endoscopy report? Chronic constipation or intermittent abdominal pain, because your schedulers often take it from your visit notes. There should be some type of kind of a stopgap in here, because if you're scheduling the patient for screening, and the scheduler in your office or whoever does preauthorization pulls the note and goes, huh, I don't see screening on here. It should stop right there, and it should go back to the provider that ordered it, whether it be a physician, whether it be an advanced provider, et cetera. It should stop at that point. If it gets past that point and it goes to the ASC, and the ASC looks at the indication and they go, oh, whoa, whoa, whoa, it's not, wait a minute, it says screening, but there's a symptom, it should go, it still goes back to the provider that orders it, and you all should have that type of policy. We want to get this taken care of at the front end, because by the time this goes to the back end and the procedure's been done, we don't have a good, let's put it this way, a good solution. Why were biopsies done on normal mucosa to rule out microscopic colitis during screening? Oh, wow. Kristen can comment on this. We see this all of the time. This is one of the major questions that we get on the support line. Remember again that screening means no symptoms, so why are biopsies done on normal mucosa? So medical necessity for biopsies is based upon findings, symptoms, abnormality, disease surveillance. If this is not documented, this is considered a potential abuse situation. And then we've got another problem. What about the pathologist? They need a reason for the specimen. All right, if they put on screening and no history whatsoever, and most of the time I think you all know that the pathology comes back normal. It's very rare that we see some type of colitis, but every once in a while we do. But what happens if we do have a finding? Then that means the patient had symptoms and it shouldn't have been done for screening. All right, so any time when you are looking at the note before submitting a charge, and here I'm talking to the coders, and you see biopsies are done to rule out microscopic colitis, congingenous colitis, lymphocytic colitis, et cetera, whatever's in there, and your indication is screening, and there are no abnormalities found, you should stop right there and do a little research, pull the patient's history. A lot of times that information is in the nursing HMP, in the ASC. If you have actually seen that patient in the office, will there be a visit note? And if you see that there are, and a lot of times I've seen where the visit note patients come in for diarrhea, and it says, screening colonoscopy to rule out microscopic colitis. Biopsies will be taken. Oh my gosh, it's in the note. It is not screening. It is actually indication it should be diarrhea, right? So I can go on and on on this, I think you can kind of hear me on this, but this is something we see so many times. And I know doctors, you wanna give that patient that screening benefit, but it's not screening. Visit prior to screening colonoscopy. So this actually comes from the Department of Labor, actually back in 2017. The planner issuer may not impose cost sharing with respect to a required consult prior to the screening procedure if the attending determines that the pre-procedure consult would be medically appropriate for the individual. So the medical provider examines the patient to determine if the patient is healthy enough for the procedure, explains the process, including the required prep for the procedure, all of which are necessary to protect the health of the patient. So on July 1st of 2017, actually, sorry, I said 2017, but it's actually 2016, HICPIC code S0285 was established, right? I hope some of you have been using this. This code is good. Only problem with this is Medicare won't cover this visit, they will not accept the S code. And the only time you can build a visit to Medicare is when you address something completely unrelated, and that problem will be billed as the primary diagnosis and the level of service then would be based upon decision-making for that encounter. And I know a lot of times when you have a triage system, especially for those of you that do open access screenings, that if the patient is at high risk due to COPD or meds or whatever, and it could affect how the procedure is performed with the patient's risk, you'll have the patient come in to be seen by a provider. And a lot of these patients are Medicare, but Medicare won't cover that unless you are actually managing their condition. So just because the patient has risk factors does not mean that you can bill a visit unless you're managing it. And Dr. Sun said earlier, what if you are actually stopping the Eloquist two to three days before the procedure because the patient has AFib? Then you are managing that patient's anticoagulant status even for two or three days. You are then assuming responsibility if the patient throws a clot. That is management of a patient's condition even for a short period of time, but you would not bill screening as your primary diagnosis. You would be billing the Z79.01 for anticoagulant management, and you will also be billing AFib. You have to have two components, what you are managing. So we know that the visit prior to screening for Medicare is not payable. Medicare replacement's the same. For the commercial side, yeah. So UnitedHealthcare, Cigna, Atena, Anthem, Humanum, most of the blues, not all of them, most of the blues recognize S0285, and they cover this with a screening benefit, and these are usually the appropriate ICD-10 codes, the Z12.10, 11, and 12, Z80.0, Z83.71, Z83.79. So this is screening and family history. Okay, that's great. That's about equal to 99202. Some of the payers that don't recognize S0285 will pay you based on 99202, and it is pretty well going to be a 99202 based upon your decision making. Patient has no symptoms, so that means a minimal risk, a minimal complexity, and there's no data, so that's minimal on the data. Those are two equal minimal or straightforward decision making, which is a level two. Even though you're doing a colonoscopy, which is considered a minor procedure, which is potentially a level three, you're not going to have two components match that. There is another diagnosis code that is accepted by some Blue Cross and Blue Shield payers, and that is Z01.818, which is just a pre-procedure visit, but most payers don't want that code. There's just some that do. Okay, so here's some hints for ICD-10 for screening. Z1211, ICD-10 instructs us that screening and diagnostic is contradictory. So you're going to use Z1211 on the absence of symptoms. It says excludes one. For those of you who are not familiar with what parenthetical advice excludes one in the ICD-10 book means, you can't bill these together. That's what excludes one. So if the patient has a sign or symptom, that is considered excludes one, and therefore you cannot bill Z1211. And the provider must determine if the procedure will be done for screening or for diagnostic purposes. Z08 and Z09 are two codes that have really popped up in the past few years to be utilized as a primary diagnosis before patients with a history of malignant neoplasm. And Z08 says encounter for follow-up exam after completed treatment for malignant neoplasm. And it says use additional code to identify the patient's personal history of malignant neoplasm. So a lot of times what we're using is Z85.038 for colon and Z85.048 for rectal. And then there's also one in there for carcinoids. Z09 is a follow-up after completed treatment for conditions other than malignant neoplasm. And these are the Z86 and Z87 codes. Z86, personal history of polyps. We do know that Cigna and Inhumana require the Z09 in front of personal history of polyps as well as Z08 in front of personal history of malignant neoplasm. Besides Cigna and Inhumana, Palmetto also requires it. So Z85 codes and Z86 also have that advice that you have to code the Z08 or the Z09 in the first position. Now, I think most of your coders have spreadsheets for this and they know when they have to add it and when they know they don't. But this is perfect information for these Z08 codes. All right, Z12.11 and Z80.0. So this is encountered for screening again. And when your patients have a family history, it says use additional code to identify any family history of malignant neoplasm. Now some payers will automatically deny Z12.11 based upon age of the patient, if younger than age 45. So this becomes problematic if we're trying to use a Z12 code with a family history diagnosis and that patient is under the age of 45. So sometimes you're just going to use the Z80 code in the first position or you're going to use the common field. All right, doctors, they're so important. On your endoscopy report, at what age was that relative diagnosed with polyps or cancer? Because this is very important in order to get these covered. And also for pre-authorization purposes, this is very important as well. All right, so guys really be ... Docs, I can't tell you. Usually the screening begins at age 40 or 10 years younger than the person with colon cancer. So you recommend the age, mother diagnosed with colon cancer at age 48. We will put that information when we're submitting that claim in Box 19, the common field, so that payer knows exactly why we're scoping this patient at age 38. This is very important. All right, based upon this, pre-authorization and eligibility needs to be determined because you do have different guidelines for genetic eligibility and susceptibility. At what age do you start screening these patients? So all this documentation needs to be in the medical record. So it is up to your physician to be clear in their documentation whether screening is or diagnostic. And remember, if it's not clear, do not process the claim. Make them ... Have them make appropriate legal corrections if required. All right, I'm going to talk about that right now. We had a revision to CMS policy about screening versus diagnostic. Oh, I wasn't quite done with that slide yet. Okay, thank you. All right, between screening versus diagnostic, but also signature requirements. And that was in March ... May, I'm sorry, May of this year. And effective date was June 10th. And it specifically states that the provider is responsible for signing the record at the time the service is rendered. I'm going to talk about this a little bit later as well. And it also states that they are to make appropriate legal corrections, not unlocking the record. All right, do not unlock the record. That is not a legal correction. You are not to do the appropriate addendum, late entry, and correction with the date it was done. All right, you just don't go in and change it. Oh, indication should be changed. Go in and unlock the record and put a new one. No, there should be a legal addendum to show what you changed it to. Make sure that pre-authorization and eligibility are verified and the patient is fully informed of their responsibility. Even though ultimately it's the patient's responsibility to make sure that pre-authorization is obtained, you cannot rely on the patient to do this. Make sure to assign the screening and the proper ranking position. Check your Medicare Advantage plans, LCDs, payer policies for any updates. Check your EOBs for denial reasons. And then also make sure you give the patients the information verifying the difference between screening and high-risk screening and surveillance and diagnostic procedures. That's in the primer, by the way. If any of you guys have not looked at the ASG coding primer, there's a lot of very, very good information on here that you can utilize and share with your patients. And also you can put this on your website as well. All right, thank you.

colorectal cancer screenings

insurance policies

Affordable Care Act

Medicare coverage

billing codes

screening vs diagnostic

family history impact

payer-specific policies