Wiki Timeframe for Screening Colonoscopy following a normal Cologuard

[lphillips409318]

If a patient a patient has a negative Cologuard, do they have to wait 10 years to be eligible for a normal screening colonoscopy? ( this is related to patients 50+ years old). I appreciate any information you all can provide. Thanks

 

[cedwards]

This is a great question! I came here searching for documentation to a similar question. I have a Medicare patient who was referred to us for a colonoscopy due to a positive ColoGuard. The patient states they were told by Medicare that as long as we code the colonoscopy as a screening/preventative service it will be covered under their screening benefits because they are entitled to a screening colonoscopy every 10 years and the colonoscopy and ColoGuard are different tests. I tried to explain to the patient that this colonoscopy would not be screening because of the + ColoGuard test and they are asking me for proof/documentation as to why this is. Medicare.gov states Medicare covers the test once every 120 months or 48 months after a previous flexible sigmoidoscopy. The patient wants me to provide them something like that with the ColoGuard and colonoscopy timeframes but I can't find anything. The patient won't take my word for it because they were told by Medicare it can be billed and covered as a screening. It wouldn't be a terrible issue if the patient had a secondary plan that covered the Medicare coinsurance, but they don't so the patient is on the hook for the 20% coinsurance.

 

[sarah3065]

When a patient has a cologuard, that is their colorectal cancer screening benefit they are using....when it is positive and they are referred for a colonoscopy, that colonoscopy is diagnostic. Check out the medicare coverage database, search colonosopy. MCD Search (cms.gov)