tci Part B Insider - 2004 Issue 3

Screening or Diagnostic? Medicare Has Huge Gray Area

Certain conditions can call for either type of colonoscopyA patient comes in with a pre-existing diagnosis, and your physician performs a colonoscopy. Should you bill it as a diagnostic or as a screening colonoscopy? There's no clear answer. "It's a very tough subject that's been plaguing a lot of people," says Carol Pohlig, a coder with the department of medicine at the Hospital of the University of Pennsylvania.  And many providers have been billing incorrectly recently, according to Part B carrier Cahaba GBA. In an October 2003 notice, Cahaba warns that "providers are incorrectly billing for...

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