Colonoscopies for patients with history of polyps

Messages
3
Location
Clemmons, NC
Best answers
0
We are having an issue with billing for colonoscopies, especially when the patient returns after having polyps. Is it a true statement that once a patient has polyps, they will not be eligible for a "screening" colonoscopy 10 years later, which means they will not receive the 100% coverage benefit provided by their insurance company? Here's one scenario: •6/2006-1st colonoscopy: "Screening" (age 50)-had polyps (put on 5 year recall) (Diagnosis used: Z12.11 Screening for colon malignancy and #K63.5 Colon Polyp) •6/2011-2nd colonoscopy: "Surveillance" normal no polyps (put on 5 year recall) (Diagnosis used: Z86.010 Personal History of Colon Polyp) •9/2016-3rd colonoscopy: Is this a surveillance colon with diagnosis (Z86.010 Personal History of Colon Polyp) or Screening colon (10 years after 1st screening) with diagnosis (Z12.11 Screening for colon malignancy). There seems to be a major difference of opinion in this type of situation. I have not been able to obtain any solid documentation reflecting guidelines for these types of issues, especially since the Affordable Care Act.
 
Top