Article Detail - JF Part A
Screening Colonoscopies versus Diagnostic Colonoscopies
Medicare covers screening colonoscopies once every 24 months for high-risk patients and for patients not at high risk, once every ten years (120 months), or four years (48 months) after a previous flexible sigmoidoscopy.
Screening colonoscopy indicated for patients:
- Aged 50-85 years
- Asymptomatic
- Average colorectal cancer risk
When a screening colonoscopy transitions to a diagnostic colonoscopy, medical records must indicate:
- Medical reasonableness, necessity, and frequency of each diagnostic service supplied
- Colonoscopy report must describe maximum depth of penetration, description of abnormal findings and any procedures performed from the findings (e.g., biopsy).
- Append -PT modifier to CPT indicating screening colonoscopy switched to diagnostic colonoscopy.
Diagnostic colonoscopy indicated for patients:
- Abnormality determined by radiology exam consistent with colonic lesion
- Abnormal oncology colorectal screening or stool-based DNA test
- Unexplained gastrointestinal bleeding:
- Hematochezia not from rectum or perianal source
- Melena of unknown origin
- Presence of fecal occult blood
- Unexplained iron deficiency anemia
- Clinically significant diarrhea of unexplained origin
- Needs evaluation of acute colonic ischemia or ischemic bowel disease
- Needs evaluation due to streptococcus bovis endocarditis when source determined to be colonic origin
- Clinical suspicion of inflammatory bowel disease
- Known chronic inflammatory bowel disease of the colon when a more precise extent of disease determination will influence treatment
- Surveillance of Crohn’s colitis or chronic ulcerative colitis to rule out colorectal cancer
- Surveillance of colonic neoplasia
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