tci General Surgery Coding Alert - 2004 Issue 4

Reader Question: Diagnosis Matters for Screening Colonoscopy

Question: We recently filed a claim for a screening colonoscopy for a Medicare patient, but Medicare denied the claim. I thought Medicare was covering these screenings. Was I wrong?Massachusetts Subscriber Answer: Medicare will pay for a screening colonoscopy under certain well-defined circumstances:For patients at average risk, Medicare will approve a screening colonoscopy once every 10 years for Medicare Part B beneficiaries over age 50 without signs or symptoms. The appropriate code for this service is HCPCS G0121 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk).For patients at high risk, Medicare will approve screenings...

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