Wiki Screening/Diagnostic

[NESmith]

I have a provider that did a screening colonoscopy on a patient and found the prep to be very poor. He continued with the colonoscopy and all he found were hemmorroids. He brought the patient back in the next day to do another colonoscopy because of the poor prep and found two polyps, one that was removed and the other bx. He billed this as a screening even though he had done the screening the day before. The patient's insurance is denying because he is billing two screenings. Would the second colonoscopy not be a diagnostic colonoscopy because of the hemmorroids? Thanks for your help

 

[L4uniki]

Poor Prepped Colonoscopy

My experience would tell me that the first screening should have been aborted by the physician if he detected the prep was so poor that the results could be jeopardized. Some responsibility lies with the caregivers in assuring those holding positions for prepping and other assistance should be amply oriented with their duties. If the patient had not followed instructions, the screening probably should have been postponed altogether until proper prep could be realized. The index clearly states that medical necessity has to be proven for additional procedures, same day procedures, and aborted procedures, along with modifiers applied for additional procedures within certain time lines.