Colonoscopy Screening Coding Essentials – Expert Insights by Dr. Santosh Kumar Guptha
Screening and diagnostic colonoscopy services remains a high risk and high impact area for providers, ASCs, and billing teams. With audits increasing and payer scrutiny tightening, coders must clearly understand the distinction between average risk screening, high risk screening, and diagnostic colonoscopy. What Is Screening Colonoscopy Screening colonoscopy is performed on a patient without signs or symptoms of colorectal disease. The purpose is early detection and prevention, not diagnosis of an existing condition. According to Medicare guidelines published by the Centers for Medicare and Medicaid Services CMS, an average risk patient is defined as one who has No personal history of adenomatous polyps No family history of colorectal cancer No history of inflammatory bowel disease For average risk Medicare beneficiaries, screening colonoscopy is reported using G0121 for Medicare 45378 for commercial insurance Medicaid exchange marketplace plans and TRICARE An appropriate ICD 10 CM screening diagnosis code must be linked to […]