PART B CODING COACH: Cure Your Colonoscopy Denials by Following CMS' Advice

Why This Topic Matters

Colonoscopy claims are frequently denied or delayed when the reported procedure type, diagnosis category, or visit purpose is not aligned with Medicare expectations. Understanding the general scenario-based guidance can help billing and coding staff recognize which claims need closer review before submission.

Article Sections

1. Secure What a Screening Procedure Entails

   Introduces the screening colonoscopy and screening flexible sigmoidoscopy scenario for Medicare patients without gastrointestinal symptoms. The section discusses the broad coding and diagnosis categories involved in an uncomplicated screening exam.

2. Know How to Code Contrast Screening

   Covers a screening exam that reveals an abnormal finding and becomes therapeutic during the same encounter. The section addresses the general shift in procedure and diagnosis reporting when findings are addressed during the exam.

3. Solve This Incidental Diagnosis Challenge

   Expands the prior scenario to include additional incidental findings identified during the same screening encounter. The section outlines how multiple diagnosis categories may be presented in sequence.

4. Watch Out for Screening, Surveillance Differences

   Discusses the distinction between repeat colorectal cancer screening and later surveillance after a prior finding. The section explains the broader claim-processing issue raised by timing and purpose of the follow-up visit.