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Is that Colonoscopy for "Screening" or "Diagnostic" Purposes?

Coding Corner

The information provided here applies to Medicare coding. Be sure to check with your Medicare Administrative Contractor (MAC) for additional information and clarification on these and other items. You should also contact your local insurance carriers to determine if private insurers follow Medicare's lead on all coding matters.

Is that Colonoscopy for “Screening” or “Diagnostic” Purposes?
With the finalization of the Centers for Medicare and Medicaid Services’ (CMS) payment policies for 2015 comes the potential for additional confusion.   One such area is the co-pay rules for colonoscopies.  
It is becoming more common for sedation to be provided by an anesthesiologist for screening colonoscopies.  In 2014, the patient’s financial liability for these anesthesia services is a 20 percent co-pay in addition to any unmet deductible.  Under the Social Security Act, co-pays and deductibles for screening services can be waived.   As a result of CMS’s final rule, co-pays and deductibles for anesthesia services for screening colonoscopies will be waived when billed appropriately in 2015.  However, CMS indicated that it will no longer waive the co-pays for patients when a screening colonoscopy becomes therapeutic in nature.  The policy of waiving co-pays for therapeutic colonoscopies will be discontinued January 1.  Deductibles will continue to be waived for screening colonoscopies and, beginning January 1, the associated anesthesia services.  Be prepared for lots of patient questions about this topic, especially if you referred the patient for the screening colonoscopy.