Question Follow-up Colonoscopy

Stefanie

Networker
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83
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0
Medicare Patient:

My GI doc has recently (this year) been recommending 1 year and sometimes 3-6 month colonoscopy follow-ups due to polyp pathology of high grade/low grade dysplasia. His operative report states "polypectomy" or "resection was complete." I feel like he knows something I don't, as far as new guidelines for surveillance. I wouldn't normally bill this follow-up colonoscopy as diagnostic, I'm not finding any new guidelines with USPSTF, or CMS' Colorectal Cancer Screening NCD changes. This follow-up isn't diagnostic because of the pathology result, is it? My fear is I'm going to advise to get an ABN because as of right now I will be coding it as surveillance, and the patient may choose not to get the follow-up due to cost. I guess I'm asking what would you do in this scenario?

Thank you!!
 

clarkmegan

Networker
Local Chapter Officer
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49
Location
Newport News
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This will be a surveillance colonoscopy, but not screening. I would code the polyp that he is following up on as the diagnosis and 45378 or other appropriate CPT code if additional polyps are found. No modifiers since it is not a screening. You can also use Z09-encounter for follow up exam after completed treatment for conditions other than malignant neoplasm. As long as you don't use G0105, you should be fine. CMS does not impose limits on 45378 as long as it meets medical necessity, which it does in your case.
 
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