Wiki Screening Colonoscopy - I have an appointment

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I have an appointment to get a screening colonoscopy done. This is my first. I do not have a history of colon issues or cancer nor does my family. The hospital called me today to pre-screen me and they told me if they find a polyp then the test is no longer screening and that I would then need to pay hundreds of dollars because I have not meet my deductible. Screening is covered at 100%. I was always taught a screening, is a screening is a screening. Is that not the case anymore? I can see my next colonoscopy being coded as diagnostic since they found polyps but not my first one.

Please let me know your thoughts on how you would diagnosis code my case.
 
If they find polyps and they remove them it is no longer SCREENING as soon at it goes from just looking to actively removing items then they need to make it a different code thus yes, you'll be paying for it.
 
I pay claims and that is how I pay, if they find a polyp during the screening it is no longer a screening becuase they remove the polyp.
 
if the colonoscopy is a screening ( which means you have no symptoms) THE SCREENING CODE V76.51 IS THE FIRST DX. you would report whatever procedure dr used to remove polyp and also modifier 33 for commercial and PT for medicare and it is still considered a screening and payable at 100 %. You have been speaking with uninformed people
 
I agree it is correct that this is still screening and coded with the screening V code first listed and the finding secondary. The procedure perfomed for the finding gets a 33 or PT modifier.
 
I also agree with it is still a screening as long as V76.51 is primary diagnosis code. Depending on the insurance you would attach modifier 33 or PT. This is from AGA coding guidelines as well. I code these on a daily basis. If you do not attach these modifiers and diagnosis codes you will be charged. Make sure facility codes correctly and the physician office as each will bill for their own services.
 
Think of it this way Ben; the patient is really the one in charge and the payient requested and qualified for a screening procedure. This is the primary reason the patient is here. In the course of performing this requested procedure an abnormality is discovered. It was not anticipated or expected. It is incidental.
First..from the patient perspective this is still screening
Second.. Incidental findings are always secondary DX codes .
So you see it is not that the guidelines are tweaked so much as it being made more clear.
 
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I have no trouble getting paid for screenings even if a polyp found. Yes, 33 modifier and V76.51 primary DX.
 
Check out this article:

http://www.asge.org/assets/0/120/122/82173/0b54425a-3ede-48ef-a174-d2db08a4954a.pdf

Only Medicare patients must pay a coinsurance when a polyp is removed. Patients with private insurance are not liable for cost-sharing when a polyp is removed.

Info on who must comply:
http://www.cms.gov/CCIIO/Resources/...on Cost-Sharing under the Affordable Care Act


Regarding Medicare and polyp removal cost sharing, legislation is working on that with the The Removing Barriers to Colorectal Cancer Screening Act of 2015:
http://tennesseeendo.com/news-artic...lonoscopy-cost-for-medicare-patients-04162015
 
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I work in a gastroenterology office in NC and code/bill for this all day every day. Yes, the code V76.51 would be listed first regardless if anything is found. The modifier 33/PT is applied when something is found. This indicates to the insurance to waive the co pay. However, if anything, and I mean anything is found, it will turn diagnostic. The V76.51 will still be listed first and then polyps, diverticulitis, hemorrhoids, etc. Your insurance will process this a diagnostic colonoscopy and apply towards your deductible.
 
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