tci Part B Insider - 2019 Issue Q4

Reader Question: Find Out About Medicare’s Colonoscopy Criteria

Question: What documentation do we have to provide for a Medicare patient to justify a screening colonoscopy? SuperCoder Subscriber Answer: The key to determining patient eligibility for a screening colonoscopy lies in your ability to demonstrate whether the patient is at a high risk for developing colorectal cancer or not. According to the Centers for Medicare & Medicaid Services (CMS), “Medicare covers one screening colonoscopy every 10 years, but not within 47 months of a previous screening flexible sigmoidoscopy … for beneficiaries 50 and older not considered to be at high risk for developing colorectal cancer. For beneficiaries...

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