Gastroenterology Coding Alert

When did Medicare start to allow gastroenterologists to bill for asymptomatic colorectal screenings (flexible sigmoidoscopies and colonoscopies)?

Michael T. Foley, MD
Arlongtin, Mass.

Answer: Medicare initiated coverage of various colorectal cancer screening examinations with the passage of the Balanced Budget Act of 1997, which went into effect on Jan. 1, 1998. Coverage of colorectal screening tests for asymptomatic patients includes the following procedures furnished to an individual for the early detection of cancer:

Screening fecal-occult blood tests are covered at a frequency of once every 12 months for beneficiaries who have attained age 50.
Screening flexible sigmoidoscopies are covered at a frequency of once every 48 months for beneficiaries who have attained age 50.
Screening colonoscopies are covered at a frequency of once every 24 months for beneficiaries at high risk for colorectal cancer.
Screening barium enema examinations are covered as an alternative to either a screening sigmoidoscopy or screening colonoscopy examination. The same frequency parameters specified in the screening sigmoidoscopies or colonoscopies apply.

Because coverage requirements for these cancer screenings vary from state to state, you should contact your local Medicare carrier for more information. (Also, see the January 2000 Gastroenterology Coding Alert Choosing Correct ICD-9 Codes for Colorectal Cancer Screenings on page 5.)