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Medicare eligibility

Messages
2
Location
Charlottesville, VA
Best answers
0
We have a patient who had procedure done 11/02/12 a colonoscopy, patient had 5 adenomatous polyps but also had a poor preparation and the physician was unable to see well. They want the patient back in one year but per guidelines of Medicare they can be eligible with in two-five years unless they develop signs or symptoms then it's based on medical necessity. So our question is, have any of you dealt with that? is there a code or do we have to get the patient to sign an ABN?
 

Walker22

True Blue
Messages
695
Location
Atlanta, Ga.
Best answers
0
Based on the situation you have described, I would recommend an ABN form. If the patient had prepared better, that wouldn't be necessary.
 

thotaling

New
Messages
5
Best answers
0
If the prep was not adequate, you need to look at your report to see how far the doctor was able to pass the scope. If he did not scope all the way, then you would use modifier -52. Then next year you would not need an ABN because your modifier would show that a "complete" procedure was not performed.
 
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