Colonscopy- Surveillance vs Preventative

kcaskey03

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Hello,
I have a colonoscopy scenario that i have questions on how to bill.

Patient is returning for 2nd colonoscopy at 5 yr mark- because polpys were found on first one. (also has fmhx of polpys) Does this 2nd colonoscopy count as a surveillance/diagnostic colonoscopy or is it preventative. Also to note- at this 2nd colonscopy-more polyps found and removed (needs to return again 5 yrs)

Ive read numerous things online and it seems to be a hot topic of debate if this is preventative or diagnostic.. since preventative allows 1 in every 10 years and now that they have to return in shorter time intervals d/t high risk- it should be diagnostic.

If the 5 yr surveillance is diagnostic- what dx codes are used? (personal hx of polpys, then results of biopsy? )

Thanks for any input.
 
Last edited:

cgaston

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was it an adenomatous polyp? If so, Medicare considers a patient with a personal history of adenomatous polyps a high risk patient, so they would qualify for a screening every 2 years:

Medicare beneficiaries without high risk factors are eligible for screening colonoscopy every 10 years.

Beneficiaries at high risk for developing colorectal cancer are eligible once every 24 months. Medicare considers an individual at high risk for developing colorectal cancer as one who has one or more of the following:

A close relative (sibling, parent or child) who has had colorectal cancer or an adenomatous polyp.
A family history of familial adenomatous polyposis.
A family history of hereditary nonpolyposis colorectal cancer.
A personal history of adenomatous polyps.
A personal history of colorectal cancer.
Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis.
 

kcaskey03

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patient does not have medicare

polyp from 1st colonoscopy- i don't have records on
polyp from 2nd one was tubular adenoma
 

cgaston

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Most carriers follow Medicare Guidelines. However, to be sure you should look up the screening guidelines for the insurance carrier the patient does have.
 
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