Wiki Screening bumping against a Diagnostic

[KarylB]

I have a differnece of training on my team. I was trained that only Screenings or Survailance colonoscopies bump against each other. Another memeber of my team said she was told that if the patient had a diagnostic colonoscopy within the 10 year period that this would kick it out of being a true 10 Screening and back to a diagnostic.
We have a patient that has had rectal bleeding issues but their last Screening was 10 years ago. The report two years ago states that the bleeding was from hemorrhoids, and the sympstoms have since resolved.
Should he still be eligible for a Screening?
Thank you for your help!
Karyl B

 

[elaine.pulsepoint@icloud.com]

Check The Payer's Guidelines

Hi -

If the patient has Medicare, you can use CSnap to check for their next eligible date for a routine or high risk screening colonoscopy. CSnap "Preventive" tab will list for you the month and year that the patient is eligible for G0121 and G0105 (and it lists other preventive services like mammogram, etc).

Medicare does not change the eligibility dates if the patient had a diagnostic service within their screening period, it doesn't "bump up" against their edits.

However, if the finding diagnosis during that time period changes the patient's medical status, let's say the rectal bleeding wasn't resolved and polyps were found, then the patient now has a history of polyps and would be considered high risk or if symptoms are still present, they'd be considered diagnostic.

We would assume that the diagnostic colonoscopy to evaluate the bleeding also performed a screening for colorectal cancer, but assumptions are not always correct. The medical decision making of the physician should be the driving force to determine if the need for a screening colonoscopy is medically necessary in this scenario.

Good luck!
-Elaine