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Patient furious about screening turned diagnostic colonoscopy

  1. #21
    Medical Coding Books
    Great forms Anna! I am going to print a couple of them and show my manager. Thanks for sharing.
    Susie Corrado, CPC
    ENT Coding/Billing

  2. Default
    It's good to read everyones thoughts about this; hours are spent dealing with these issues with patients, surgeons and payers. Can anyone tell me where to find (from CMS or the AMA) documentation that delineates their guidelines for "screeening" versus "surveillance" colonoscopies, if they have any such documentation? CMS in the past still used the "screening" codes ("G" codes) for both but split it into no-risk screening (for no history) and high-risk screening (for personal history of polyps of fam hx of colon cancer).

    There is a lot of information available relating to 'screening' versus 'diagnostic or therapeutic' but is their anything specifically addressing "screening' versus 'surveillance'?

    Thank you for the help.

  3. Default
    I guess I should have clarified about the screening versus surveillance.

    This was in reference to some recent 3rd party insurance company medical policies and the physician medical language; not Medicare and Medicaid. To my knowledge Medicare does not recognize the difference in writing. You are correct in that Medicare uses the "G" codes to differinate between high risk (G0105) and average risk (G0121). the Medicare Colon Screening policy can be found at and the policy manual at As you know, what CMS sets as standard does not always follow for the 3rd party carriers.

    Anna Barnes, CPC, CEMC, CGSCS

  4. #24
    I think if the pt was there for a recall LE I would have billed the screening code. Our doctors often have the pts state at time of the colonoscopy that they are having this problem or that problem but if you recalled the pt for a screening and there was no office visit documenting/diagnosing the problems it should have remained a screening.

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