Part B Insider - 2022 Issue 3
Medicare Coverage: Correctly File Screening Colonoscopy Claims with These Tips
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Article Overview
This premium article covers Medicare billing guidance for colorectal cancer screening procedures, including how CMS is phasing out beneficiary coinsurance when a screening scope leads to additional services. It is aimed at coders, billers, and gastroenterology practices that need a practical overview of the 2022 MPFS final rule, diagnosis code placement, procedure code choices, and modifier use for preventive colorectal screening claims. The article also discusses how these topics affect claim reporting for Medicare and, in general terms, other payers.
Why This Topic Matters
Accurate coding for screening colonoscopy and flexible sigmoidoscopy claims affects patient cost-sharing, claim acceptance, and proper preventive-service reporting. This guidance is relevant because CMS policy changes altered how certain screening procedures are treated when additional services occur during the same encounter.
Article Sections
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Look to MPFS Final Rule
Explains the CMS policy update addressed in the Medicare Physician Fee Schedule final rule and how it affects colorectal cancer screening scope procedures over time. The section provides background on the change and its effective time frame.
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Tip 1: Get the Diagnosis Right
Reviews diagnosis coding considerations for colorectal cancer screening colonoscopy and flexible sigmoidoscopy claims. The section focuses on sequencing and reporting concepts for screening-related encounters.
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Tip 2: Skip ‘G’ Codes With Lesion Removal
Covers procedure code selection for Medicare screening scope claims when additional services are performed during the same encounter. The section also addresses preventive-service modifier reporting for Medicare and mentions alternate payer handling.
What You Will Learn
- How CMS policy changes affect colorectal cancer screening scope claims
- How to think about diagnosis coding for screening colonoscopy and flexible sigmoidoscopy encounters
- How procedure code selection differs between routine screening and encounters with additional services
- How preventive-service modifiers are discussed in the context of Medicare and other payers
Who Should Read This
- Medical coders
- Medical billers
- Gastroenterology practices
- Revenue cycle staff
- Compliance staff
Codes Discussed
Modifiers Discussed
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