Once a Screening, Always a Screening, CMS Says

Why This Topic Matters

Accurate reporting for screening colonoscopy claims affects claim acceptance, diagnosis sequencing, and compliance with Medicare and payer rules. The topic is especially relevant because the article addresses a long-standing area of confusion for coding teams.

Article Sections

1. Medicare Requires G Codes for Screening Exam

   This section covers Medicare screening colonoscopy reporting and the general diagnosis framework used for average-risk and high-risk patients. It also mentions examples of conditions that may support a high-risk screening designation.

2. A Polyp Transforms Procedure Coding

   This section discusses how the procedure code may change when an abnormality is found during a screening exam and a diagnostic service is performed. It presents a coding example involving colonoscopy and biopsy.

3. Polyps Won't Affect Dx Coding

   This section explains the CMS clarification about diagnosis sequencing when a screening exam leads to additional findings. It also references official coding guidance and comments from coding professionals.