Diagnostic Vs Screening In Colonoscopy


If we have a high risk person and again these are looking at Medicare guidelines, every two years or as the languages that we frequently see, at least 23 months have passed.

Now, why do they say it that way? Well, it is based on not a date of service but rather a month of service. So that if you have a colonoscopy done in January, 23 months need to pass. So that means January two years later.

So even though you could have had it done January 31st, the next time January rolls around that you're eligible, you could have it done on the first couple of months. So that is clear.

And also they talk about the last coverage screening colonoscopy – not just a colonoscopy but a covered screening colonoscopy.

Now, for those that are not at high risk for the screening colonoscopy, it's every 10 years or we have 119 months or if there's - if the patient has had a flexible sig, they have to wait four years before they do have a covered colonoscopy.

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So as we look at that diagnostic versus screening, it's the - all in the technicality of the documentation of the patient's risk and based on either their personal risk or their family risk. That's all a bunch of diagnostic codes.

And now we're going to go into the rest of the lecture which we want to talk about the actual colonoscopy. What are we going to do with these colonoscopies? How are we going to code them? We see information from both principles with CPT coding and national CPT book about what is a colonoscopy. You know, where does it have to go to?

We see the words “proximal of the splenic flexure”. And the splenic flexure is the curve in the GI system, if you will. It is very difficult to get a flexible sigmoidos - sigmoidoscope around that corner, if you will. And so that's why the preferred method is to have a colonoscopy.

Now you can see why you'd have a colon prep because there is a special long area that has to be clean enough for them so look at the mucosa.

But if mucosa as - mucosa is the same kind of texture as the inside of your mouth, the inside cheek of your mouth. That's what it looks like when it's cleaned out. It's nice and pink and moist. So that's what they're looking at.

So the first colonoscopy codes that we look at is the diagnostic code. And it's a code that is a stand-alone code. It should not be reported with any other colonoscopy code. We know that CPT tells us that if a diagnostic endoscopy is cover – it is followed by a surgical endoscopy, the diagnostic is always considered part of that and not to be separately reported.

In more real terms, if this code is where a scope is inserted and if it's here for any of our endos – endoscopy whether it's a bronchoscopy or a colonoscopy or upper endoscopy, the scope is inserted and they take a look around.

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