aguerrero14
Guest
Good Morning All!
I am curious if anyone has recently had to code an office visit or colonoscopy for a positive Cologuard Test. I am the biller and coder in a Gastroenterology office.
Scenario:
Patient sees Primary MD, and is given the Cologuard Test Kit, Test is positive and Patient is referred to our office for a Colonoscopy. Patient's 2 previous colonoscopies were normal. Patient is referred to our office as the Primary has deferred the decision to our Doc. If a patient has a positive Test result, wouldn't the colonoscopy be considered diagnostic? What if the patient had never had a colonoscopy before? How do we justify a screening when a test has shown a possibility of polyp or cancer?
I have not been able to find any documentation supporting a screening code. If the patient is 50 and due for a screening colonoscopy anyhow, why would the Primary Physician order a cologuard? The Patient should just be referred to Gastroenterology for 1st Screening in order for the patient to receive insurance benefits under their preventative care.
I have been battling with patients about their screening benefits because they think everything is at no cost to them even if polyps are removed. Some insurance plans (UHC, specifically) do not recognize screening or high risk screening IF a polyp was removed. Now, add this cologuard test into the mix and I'm feeling like I will really be at odds with my patients and doctors, since they have made the decision for a screening test. Will my office have to "warn every patient with a + Cologuard that the subsequent Colonoscopy will be processed as a diagnostic exam, even if the patient was due for a screening, high risk screening, or "surveillance" Colonoscopy?
Sorry for the long post. I want to be sure that my explanation is clear.
Thank you in advance for your opinions and suggestions!!
I am curious if anyone has recently had to code an office visit or colonoscopy for a positive Cologuard Test. I am the biller and coder in a Gastroenterology office.
Scenario:
Patient sees Primary MD, and is given the Cologuard Test Kit, Test is positive and Patient is referred to our office for a Colonoscopy. Patient's 2 previous colonoscopies were normal. Patient is referred to our office as the Primary has deferred the decision to our Doc. If a patient has a positive Test result, wouldn't the colonoscopy be considered diagnostic? What if the patient had never had a colonoscopy before? How do we justify a screening when a test has shown a possibility of polyp or cancer?
I have not been able to find any documentation supporting a screening code. If the patient is 50 and due for a screening colonoscopy anyhow, why would the Primary Physician order a cologuard? The Patient should just be referred to Gastroenterology for 1st Screening in order for the patient to receive insurance benefits under their preventative care.
I have been battling with patients about their screening benefits because they think everything is at no cost to them even if polyps are removed. Some insurance plans (UHC, specifically) do not recognize screening or high risk screening IF a polyp was removed. Now, add this cologuard test into the mix and I'm feeling like I will really be at odds with my patients and doctors, since they have made the decision for a screening test. Will my office have to "warn every patient with a + Cologuard that the subsequent Colonoscopy will be processed as a diagnostic exam, even if the patient was due for a screening, high risk screening, or "surveillance" Colonoscopy?
Sorry for the long post. I want to be sure that my explanation is clear.
Thank you in advance for your opinions and suggestions!!