Medicare Compliance & Reimbursement - 2020 Issue 1
You Be the Coder: Code to Capture Screening Intent
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Article Overview
This article discusses a colorectal screening scenario in which a flexible sigmoidoscopy changes from screening to diagnostic after a polyp is removed. It is aimed at coders and billing staff who need to understand the general reporting approach, payer-specific distinctions, and the related diagnosis and modifier concepts that may apply. The article also references Medicare and commercial payer handling, as well as the interaction between screening intent, diagnostic findings, and claim processing.
Why This Topic Matters
Accurate reporting in this type of encounter affects whether the claim is processed as preventive or diagnostic and whether cost-sharing applies. The article is relevant for coders who need to recognize when the original screening intent must be supported alongside the final procedure reporting.
What You Will Learn
- How a screening colorectal endoscopy scenario may change when a lesion is removed
- Why payer type can affect coding and claim handling
- How diagnosis reporting relates to screening intent in a converted procedure encounter
- How modifiers may be used in preventive versus converted screening situations
- How claim edits can affect whether screening and diagnostic procedures are billed together
Who Should Read This
- Medical coders
- Coding auditors
- Billing staff
- Revenue cycle specialists
- Compliance staff
Codes Discussed
Modifiers Discussed
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