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Diverticulosis patient wants screening colonoscopy

lchasteen

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This happens a lot :

An asymptomatic patient comes in and has a previous diagnosis of diverticulosis. She has no signs or symptoms. Wants to have a screening colonoscopy.
Is this patient eligible for a screening or does the fact that she has a gastrointestinal disease disqualify her from getting a screening?

We have found several conflicting articles. Any info would be appreciated!!!!!!
 
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San Diego, CA
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In reading charts, I have seen physicians order a colonoscopy to see the extent of the diverticulosis and where the pockets are.

Per this web page, other testing includes:
"Gastroenterologists can directly visualize the diverticula (more than one pouch, or diverticulum) in the colon during a procedure that uses a small camera attached to a lighted, flexible tube inserted through the rectum. One of these procedures is a sigmoidoscopy, which uses a short tube to examine only the rectum and lower part of the colon. A colonoscopy uses a longer tube to examine the entire colon. Diverticulosis can also be seen by other imaging tests, for example, computed tomography (CT) scan or barium x-rays." http://www.asge.org/patients/patients.aspx?id=6818

I don't know that she is disqualified from a screening. Maybe have patient consult gastroenterologist.

It would be the physician's decision.
Hope that helps!
 
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agibb1022

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Loveland
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If is was my patient, I would look at how recent her diagnosis was. If it was less than 10 years ago, she wouldn't qualify for a screening because that diagnosis alone does not put her in a high-risk category that would justify another screening, and most payer guidelines state that once the diagnosis is established, all subsequent average risk colonoscopies before 10 years are diagnostic. However, if it has been 10 years since she has been diagnosed and she has not had any signs or symptoms for 10 years, and she is simply coming back for another colonoscopy because it's been 10 years, I would say she might qualify for a screening.

Another thing to consider is her insurance coverage. Some companies cover colons earlier than 10 years as preventive, even if you don't use the screening diagnosis. Maybe her plan will cover it no matter how it's billed??? The plan may also have specific guidelines related to when they "re-qualify" for a screening.

Hope that's helpful. I sure wish this screening/surveillance colonoscopy stuff could just be black and white!! :confused:
 

lchasteen

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This particular patient has Medicare and her last colonoscopy was 5 years ago.

Pre-op Diagnosis: History of polyps Post-op Diagnosis : Same
Diverticulosis


Normally if she didn't have Diverticulosis , we would bill for a high risk screening colonoscopy (G0105), but she has diverticulosis so I am thinking that because of her gastrointestinal disease we would not be able to use G0105.

I am reading that she can't have any sign, symptom, and/or relevant diagnosis to get a high risk colonoscopy.

I agree its not black and white.
 

agibb1022

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Loveland
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This particular patient has Medicare and her last colonoscopy was 5 years ago.

Pre-op Diagnosis: History of polyps Post-op Diagnosis : Same
Diverticulosis


Normally if she didn't have Diverticulosis , we would bill for a high risk screening colonoscopy (G0105), but she has diverticulosis so I am thinking that because of her gastrointestinal disease we would not be able to use G0105.

I am reading that she can't have any sign, symptom, and/or relevant diagnosis to get a high risk colonoscopy.

I agree its not black and white.
Hmmm...tough one.

Were they adenomatous polyps? If so, you could probably do screening since Medicare considers those as high-risk individuals and have that as your indication and primary dx with the diverticulosis second. If they weren't, I think you are safe saying that the two diagnoses together add up to a diagnostic procedure.

It does read like you said though, if they have GI disease then it diagnostic. Would the adenomatous polyps (if applicable) override that to make it high risk??? I'm not sure...
 
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