tci General Surgery Coding Alert - 2021 Issue Q1

Reader Questions: Look for Medicare Colonoscopy Coverage Change

Question: Is there a change this year in how Medicare pays for colorectal cancer screening colonoscopy that results in a biopsy or polyp removal? Texas Subscriber Answer: Medicare isn’t changing anything for 2021, but the Consolidated Appropriations Act, 2021 (CAA) provides a schedule for upcoming changes to coverage. At issue are cases like you’ve described, when the beneficiary presents for a screening colonoscopy (with no history or symptoms), but the surgeon finds a polyp or anomaly and takes a surgical specimen for pathological diagnosis. Look back: The problem in such a scenario has been that Medicare covers...

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