Gastroenterology Coding Alert

A bill recently introduced in the U.S. Senate proposes to improve Medicares colorectal cancer screening benefit. The Colon Cancer Screen for Life Act of 2002 (S.1931) sponsored by Sen. Joseph Lieberman of Connecticut would increase Medicare payment rates to physicians by 30 percent for 45330, 45378, CPT 45380 , 45385, G0104, G0105, G0106, G0107, G0120 and G0121 when performed at a facility. Nonfacility payment rates for those codes would increase by 10 percent.
 
The act would also establish coverage for an outpatient office visit or consultation prior to a screening colonoscopy or in conjunction with the beneficiarys decision to obtain such a screening, regardless of whether such a screening is medically indicated with respect to the beneficiary.
 
Since a colorectal cancer screening benefit was added in 1998, the percentage of Medicare beneficiaries receiving a screening or diagnostic colonoscopy has increased only 1 percent, according to a study by the Comptroller General of the United States, which was cited in the bill. The proposed legislation blames the low rates on large reimbursement reductions by CMS and the lack of payment for consultations prior to the screening. Reimbursement under the Medicare program is not now available for these consultations, the bill states, despite the fact that reimbursement is provided under such programs for similar consultations prior to a diagnostic colonoscopy.
 
The bill, introduced into the Senate on Feb. 11, has been referred to the Senate Finance Committee for further action and would be effective July 1, 2002.