![]() Whether a polyp or cancer is ultimately found does not change the screening intent of that procedure. A patient with rectal bleeding and anemia who is has a colonscopy is having a diagnostic colonoscopy.Īs such, “screening” describes a colonoscopy that is routinely performed on an asymptomatic person for the purpose of testing for the presence of colorectal cancer or colorectal polyps. A diagnostic test is done in response to a sign or symptom, to investigate and diagnosis a condition. It is defined by the population on which the test is performed, not the results or findings of the test. What is the Difference between a Screening Test and a Diagnostic Colonoscopy?Ī screening test is a test provided to a patient in the absence of signs or symptoms based on the patient’s age, gender, medical history and family history according to medical guidelines. Not a member? Learn more about membership. Members can watch this brief overview, and download the slides for reference.Members, login to watch the video. This article from CodingIntel about colonoscopy coding guidelines, will help physicians, coders and billers select accurate procedure and diagnosis codes for colonoscopy services. To complicate the issue, Medicare uses different procedure codes than other payers for screening and a different modifier for screening procedures that become diagnostic or therapeutic. An area of particular confusion is screening colonoscopies converted to a diagnostic or therapeutic colonoscopy. How to code for screening colonoscopies, what modifiers are needed and what diagnosis codes to assign can be challenging for physicians. But, what if the surgeon or gastroenterologist takes a biopsy or removes a polyp? How is that billed, and with what modifiers and diagnoses? CodingIntel provides detailed medical coding resources to physicians and their staff to help them accurately code for their services, including colonoscopy coding guidelines with using CPT codes, modifiers PT and 33, and diagnosis coding. A screening test with an A or B rating from the US Preventive Services Task Force, should have no patient due amount, since the Affordable Care Act (ACA) was passed. Screening colonoscopy is a service with first dollar coverage. Medicare charges co-insurance in that case, the amount of which will very gradually decrease to zero by 2030.In that case, using the correct modifiers and sequencing the diagnosis codes correctly can increase the likelihood that the payer will still process the service as a screening, but there are no guarantees.A screening colonoscopy should have no patient due amount for an insured patient, but if the physician does a diagnostic procedure (biopsy) or therapeutic procedure (removal of polyp), the procedure is no longer considered a screening.An Overview of Colonoscopy Coding Guidelines
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