Wiki Medicare screening v surveillence

[rebelhotspur]

Does Medicare pay for a screening v surveillence colonoscopy differently? Surveillence may incur the 20% of the allowable, right? I have a physician was has coded screening but pt has history of polyps and physician is questioning why he has to change the diagnosis and how it impacts the patient.

 

[thomas7331]

A patient with a history of polyps is classified by Medicare as being 'high risk', and screenings for these patients are covered at 5-year intervals and paid at 100%. The screening (which I think is what you're calling 'surveillance', which is not a term Medicare or ICD-10 uses) colonoscopy for these patients would be coded with HCPCS code G0105 instead of the G0121 which is used for screening of patients who are not high risk. I'm not understanding what you're saying about the physician having to change the diagnosis though. There should be no need to change a diagnosis if the information in the record is clear and complete.

You can get additional information about Medicare coverage for colorectal screening services here:

https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html#COLO_CAN.