tci Outpatient Facility Coding Alert - 2018 Issue 2

Reader Question: Distinguish Between Screening vs. Diagnostic Colonoscopy

Question: Can you explain the difference between a screening colonoscopy versus a diagnostic colonoscopy? California Subscriber Answer: Physicians order screening colonoscopies in the absence of signs or symptoms of disease to identify colorectal cancer (CRC) or polyps. Insurers define who is eligible for a covered screening based on risk groups. Medicare typically covers screening colonoscopies once every 10 years beginning at age 50 for asymptomatic beneficiaries at "normal risk" of developing CRC. Medicare covers screening colonoscopy once every two years, regardless of age, for "high risk" patients demonstrating one of the following situations: A close relative (sibling, parent, or...

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