2025 Gastroenterology Reimbursement and Coding Update (Virtual) | November 2024-Screening versus Diagnostic Colonoscopy

Video Transcription

Video Summary

The transcript focuses on understanding the implementation and nuances of colorectal cancer screenings, particularly under different insurance policies, including the Affordable Care Act and Medicare. It discusses the distinction between screening, diagnostic, and surveillance colonoscopies, highlighting how coverage differs based on these categories. The guide addresses Medicare's policies as opposed to commercial insurers regarding coverage of colonoscopies, especially when a procedure transitions from screening to diagnostic. It emphasizes the necessity of correct billing codes and modifiers like G0121, G0105, and modifiers such as PT and 33, which influence patient costs. The Affordable Care Act mandates screenings starting at age 45, with grades indicating different age brackets for coverage. The transcript explores the impact of family history on screening eligibility and notes the importance of correct coding and documentation to ensure accurate billing and coverage. To avoid discrepancies, the guide emphasizes verifying pre-authorization, ensuring patients are informed about their financial responsibilities, and addressing any administrative follow-ups such as modifiers for procedures and managing patient records accurately. It also advises referencing payer-specific policies and provides guidance for practitioners on handling incomplete procedures and follow-ups.

Asset Subtitle

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

Keywords

colorectal cancer screenings

insurance policies

Affordable Care Act

Medicare coverage

billing codes

screening vs diagnostic

family history impact

payer-specific policies