Wiki Screening Colonoscopy vs Diagnostic Colonoscopy

[bonnieaustin1978@gmail.com]

If a Humana Medicare advantage patient comes in for a colonoscopy for a personal history of colon polyps would it still be considered screening? If so would we bill a HCPCS code instead of the 45380 CPT code? Also would we use a PT modifier when billng?

 

[LisaAlonso23]

Yes, they follow Medicare guidelines as a Medicare Advantage Plan.

 

[AmandaBriggs]

Once the patient carries a diagnosis of polyps, any future colonoscopies are no longer screening colonoscopies and are instead surveillance colonoscopies. Screening colonoscopies are for asymptomatic patients with no history of polyps or other intestinal disorders.

 

[LisaAlonso23]

The above comment is not accurate. It actually depends on the insurance.

The following consider a history of polyps to be a screening:

Medicare (including Medicare Advantage Plans and any plan that follows Medicare guidelines)
All commercial plans except Aetna, Cigna, UHC, BCBS TX, BCBS SC

Aetna, Cigna, UHC, BCBS TX, BCBS SC all consider surveillance to be diagnostic.