Physician Practice

Q&A: Screening or diagnostic colonoscopy?

Physician Practice Insider, July 28, 2015


Do you have questions about physician practice coding, reimbursement, safety, EHRs, compliance, HIPAA, or other topics? Send your questions to Editor John Castelluccio and we’ll work with our experts to find you an answer.
Q: There is confusion in our office about billing for a screening versus diagnostic colonoscopy after having a positive screening of a fecal immunochemical test (FIT) or fecal occult blood test (FOBT). Since these tests are now being used for screening tools, if the test was positive and the need for a colonoscopy would be your next step, should it be billed as a screening colonoscopy or diagnostic?
A: If screening tests (FIT or FOBT) are coming back positive that would convert what may have been a screening colonoscopy into a diagnostic test for Medicare purposes. If the patient is not showing any symptoms, however, they may wish to verify with their commercial payers. Not all payers may consider FIT or FOBT screening tests but may still allow for a screening benefit for colonoscopy (which usually is a better benefit for the patient).
Editor's note: This question was answered by Jillian Harrington, MHA, CPC, CPC-I, CPC-P, CCS, CCS-P, MHP, an HCPro Boot Camp Instructor and regulatory specialist. This information does not constitute legal advice.


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