I apologize I had the deductible part wrong. I was trying to show that Medicare stated that the screening code should be the primary dx, even when a polyp is found, this came out in Dec 07:

" Polypectomy Performed During Screening Colonoscopy or Flexible Sigmoidoscopy,
• A patient presents for a screening colonoscopy (or flexible sigmoidoscopy), and
the patient has no gastrointestinal symptoms.
• During the subsequent screening colonoscopy (or flexible sigmoidoscopy), an
abnormality is identified (such as a polyp, etc.), and it is biopsied or removed.
CMS advises that, whether or not an abnormality is found, if a service to a Medicare
beneficiary starts out as a screening examination (colonoscopy or sigmoidoscopy), then
the primary diagnosis should be indicated on the form CMS-1500 (or its electronic
equivalent) using the ICD-9 code for the screening examination.

As an example, the above scenario should be billed as follows using claim form CMS-
1500 (or its electronic equivalent):

• Item 21 (Diagnosis or Nature of Illness or Injury)
• Indicate the Primary Diagnosis using the International Classification of Diseases,
Ninth Revision, Clinical Modification, (ICD-9-CM) code for the screening
examination (colonoscopy or sigmoidoscopy), and
• Indicate the Secondary Diagnosis using the ICD-9-CM code for the abnormal
finding (polyp, etc.).
For example, V76.51 (Special screening for malignant neoplasms, Colon) would be used
as the first listed code, while the secondary code might be 211.3 (Benign neoplasm of
other parts of digestive system, Colon).
• Item 24D (Procedures, Services, or Supplies)
• Indicate the procedure performed using the CMS Healthcare Common Procedure
Coding System/Common Procedure Terminology (HCPCS/CPT) code for the
procedure (biopsy or polypectomy), and
• Item 24E (Diagnosis Pointer)
• Enter only "2" (to link the procedure (polypectomy or biopsy) with the abnormal
finding (polyp, etc.)
A Medicare beneficiary undergoing a screening colonoscopy (no symptoms and no
abnormal findings prior to the procedure) will be responsible for the deductible if a polyp
is identified and either biopsied or removed.
When there is no need for a therapeutic procedure"

Hope this helps, sorry for any confusion

Quote Originally Posted by NELENAZ View Post
Starting January 1, 2007 Medicare deductible is not waived IF the colorectal cancer screening test BECOMES a DIAGNOSTIC colorectal test, that is the service actually results in a biopsy or removal of a lesion or growth. You may find this information under the MLN Matters Number:SE0710 of the Medicare Website

Hope this helps!!!