Wiki Opinions Please!

[coder25]

I have a situation occurring with colonoscopies and my docs that I do not know what I should do.

They insist that their patients need to have colonoscopies which are medically necessary. Apparently, the surgery scheduler is asking docs to write letters to Medicare about the medical necessity of these procedures with the hopes they will not get paid. I tried to explain this to both the scheduler and docs about their rules.

I understand about the two-year rule for high risk patients, but am I to bill these to Medicare knowing full well that they will be denied?? I don't want to lose my certification and I am not sure how to handle this situation.

Any advice you can give will be greatly appreciated!

 

[kbarron]

Have the pt sign the ABN

 

[tpontillo]

Medicare covers colonoscopy screenings once every 10 years for pts not at high risk, and high risk is done every two years. I dont know what the situation is that you are having. Is the doctors doing colons every year? Are you a GI group and all patients are having a colon? I need more info

 

[tpontillo]

There is a link that you can look at the requirements for screenings

http://www.cms.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf

 

[coder25]

I found my answer. I need to either use GA or GZ modifier to the claims. My docs feel that if the patient has diverticulitis or hx of colon polyps/colon cancer, that the patient should have a colonoscopy every year, despite all the documentation that I gave them about the frequency.

Thanks for the responses!