decisionhealth Newsletters, Part B News - 2002 Issue 9 (September)
Findings in GI screenings still can be billed primary, CMS says
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Article Overview
This article covers CMS guidance on how to bill gastrointestinal screening procedures under Medicare, with emphasis on screening colonoscopy and sigmoidoscopy when findings are discovered during the exam versus when nothing is found. It also summarizes related ICD-9-CM carrier transmittal guidance on how to report diagnostic test results when a physician interpretation is unclear, unavailable, or pending. The piece is aimed at coders, billing staff, and gastroenterology practices that need to understand how the guidance affects claim submission and diagnosis reporting.
Why This Topic Matters
The article addresses a common source of billing confusion in GI screening claims and explains why certain Medicare practices remain payable under existing guidance. It also highlights how carriers may expect diagnostic testing records to be handled when the interpreting physician’s final read is not yet available.
What You Will Learn
- How CMS guidance distinguishes GI screening colonoscopy and sigmoidoscopy billing from other screening services
- How diagnostic test reporting is addressed when the physician interpretation is unclear or unavailable
- How the article frames Medicare carrier guidance for coding and claim timing
- What general types of circumstances may affect the reported diagnosis for a screening or diagnostic test claim
Who Should Read This
- Medical coders
- Billing staff
- Gastroenterology practices
- Compliance staff
- Revenue cycle professionals
Codes Discussed
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