Medicare covers screening Colonoscopy once every 24 months for high-risk patients and for patients not at high risk, once every ten years (120 months), or four years (48 months) after a previous flexible sigmoidoscopy.
Screening colonoscopy recommended for patients
Aged 50-85 years
Asymptomatic
Average colorectal cancer risk
When a screening colonoscopy transitions to a diagnostic colonoscopy, medical records must indicate:
Medical reasonableness, necessity, and frequency of each diagnostic service supplied
Colonoscopy report must describe maximum depth of penetration, description of abnormal findings and any procedures performed from the findings (e.g., biopsy).
Append -PT modifier to CPT indicating screening colonoscopy switched to diagnostic colonoscopy.
Diagnostic colonoscopy recommended for patients
Abnormality determined by radiology exam consistent with colonic lesion
Abnormal oncology colorectal screening or stool-based DNA test
Unexplained gastrointestinal bleeding:
Hematochezia not from rectum or perianal source
Melena of unknown origin
Presence of fecal occult blood
Unexplained iron deficiency anemia
Clinically significant diarrhea of unexplained origin
Needs evaluation of acute colonic ischemia or ischemic bowel disease
Needs evaluation due to streptococcus bovis endocarditis when source determined to be colonic origin
Clinical suspicion of inflammatory bowel disease
Known chronic inflammatory bowel disease of the colon when a more precise extent of disease determination will influence treatment
Surveillance of Crohn’s colitis or chronic ulcerative colitis to rule out colorectal cancer
Surveillance of colonic neoplasia
Sources: Noridianmedicare
Source Links:
Comments