Several months ago our office got a fax from Blue Cross of North Carolina stating that if the patient had a history of colon polyps (or any other history that would lead to needing a colon check) as the main reason for a colonoscopy that we should be billing those with the screening diagnosis code primary.
For further clarification I actually spoke with someone in their main office who is in charge of this change. She told me that if there was not a current sign or symptom that all colonoscopies would be considered screenings.
I even used a couple of examples that seemed far-fetched to me like a history of colon polyps, history of colon cancer, history of breast cancer (for a patient to be screened earlier than the currently accepted age), family history of colon polyps, family history of colon cancer, etc. And she said screening, all of those reasons and any others that are not current symptoms, are screenings from now on.
This has been a big debate in our office and obviously many others for quite some time. I actually like knowing how they want it. This has also helped cut down on angry patient calls when they get their bills because many family practice doctors will send them over for screenings because they have a history of polyps or colon cancer and they had no current symptoms and they were having to pay alot out of pocket for having a colonoscopy done.
Since late August I have been coding my Medicare and Medicaid claims this way as well. So far they all seem to be paying the way they should.
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