Why Colonoscopy Prep Isn’t So Bad Anymore
Preparing for your colonoscopy
Here are some things you can do to help it go as smoothly and comfortably as possible:
If the procedure is interrupted or shortened due to the poor bowel preparation the procedure should be coded to the extent to which it was performed. If the procedure was cancelled due to poor bowel preparation, and the admission meets criteria for reporting, then a code from Z53.
Poor bowel preparation has been shown to be associated with lower quality indicators of colonoscopy performance, such as reduced cecal intubation rates, increased patient discomfort and lower adenoma detection.
Failed or “incomplete” colonoscopies should be coded using CPT 45378 with the right G-code modifier for a failed procedure.
Article - Billing and Coding: Incomplete Colonoscopy/Failed Colonoscopy (A55227)
If you have waited more than 3 hours without a response, then it may not be working well. Be sure you are drinking enough fluid. If that doesn't work, drink the second part of your prep and continue to drink fluids. It should work eventually.
Suboptimal bowel preparation inhibits the endoscopist's ability to visualize the mucosal lining for polyps and cancers; this lack of visualization influences recommended follow-up intervals for repeat screening or surveillance colonoscopy[7,8].
Nearly 4% of all patients may receive inconclusive test results at the beginning. If this is your case, you do not necessarily have colorectal cancer. It only means you have to have a repeat exam.
Z12. 11: Encounter for screening for malignant neoplasm of the colon.
Reasons for incomplete colonoscopy included poor preparation (11%), pain or inadequate sedation (16%), tortuous colon (30%), diverticular disease (6%), obstructing mass (6%) and stricturing disease (10%). Reasons for incomplete procedures in the remaining 21% of patients were not reported by the referring physician.
To report screening colonoscopy on a patient not considered high risk for colorectal cancer, use HCPCS code G0121 and diagnosis code V76. 51 (Special screening for malignant neoplasm of the colon).
For modifier 52, CPT® Appendix A explains: "Under certain circumstances a service or procedure is partially reduced or eliminated at the physician's discretion.
--Pay for screening colonoscopies (code G0105) when performed by a doctor of medicine or osteopathy at a frequency of once every 24 months for beneficiaries at high risk for developing colorectal cancer (i.e., at least 23 months have passed following the month in which the last covered G0105 screening colonoscopy was ...
To report screening colonoscopy on a patient not considered high risk for colorectal cancer, use HCPCS code G0121 and diagnosis code Z12.11 ( encounter for screening for malignant neoplasm of the colon ).
As such, “screening” describes a colonoscopy that is routinely performed on an asymptomatic person for the purpose of testing for the presence of colorectal cancer or colorectal polyps. Whether a polyp or cancer is ultimately found does not ...
Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen (s) by brushing or washing, with or without colon decompression (separate procedure) G0121 ( colorectal cancer screening; colonoscopy on individual not meeting the criteria for high risk.
Typically, procedure codes with 0, 10 or 90-day global periods include pre-work, intraoperative work, and post-operative work in the Relative Value Units (RVUs) assigned . As a result, CMS’ policy does not allow for payment of an Evaluation and Management (E/M) service prior to a screening colonoscopy. In 2005, the Medicare carrier in Rhode Island explained the policy this way:
Diagnosis Code Ordering is Important for a Screening Procedure turned Diagnostic. When the intent of a visit is screening, and findings result in a diagnostic or therapeutic service, the ordering of the diagnosis codes can affect how payers process the claim.
Screening colonoscopy is a service with first dollar coverage. A screening test with an A or B rating from the US Preventive Services Task Force, should have no patient due amount, since the Affordable Care Act (ACA) was passed.
The patient has never had a screening colonoscopy. The patient has no history of polyps and none of the patient’s siblings, parents or children has a history of polyps or colon cancer. The patient is eligible for a screening colonoscopy. Reportable procedure and diagnoses include:
During the colonoscopy a doctor can biopsy and remove pre – cancerous polyps and some early stage cancers and also diagnose other conditions or diseases. General definitions of procedure indications from various specialty societies , including the ACA: * A screening colonoscopy is done to look for disease, such as cancer, ...
Definition of Terms Colonoscopy: A colonoscopy is a procedure that permits the direct examination of the mucosa of the entire colon by using a flexible lighted tube. The procedure is done with sedation in a hospital outpatient department, in a clinic , or an office facility. During the colonoscopy a doctor can biopsy and remove pre – cancerous ...
Note:The Introduction section is for your general knowledge and is not to be takenas policy coverage criteria. The rest of the policy uses specific words and concepts familiar to medical professionals. It is intended for providers.A provider can be a person, such as a doctor, nurse, psychologist, or dentist.
It can also be doneas a diagnostic procedure when symptoms or lab tests suggest there might be a problem in the rectum or colon.In some cases, minor procedures may be done during a colonoscopy,such as taking a biopsy or destroying an area of unhealthy tissue (a lesion).
This guideline applies only to people of average risk. Colonoscopy is only one of the screening tests that can be used. This benefit coverage guideline provides general information about how the health plan decides whether a colonoscopy is covered under the preventive or diagnostic (medical) benefits.
Point to note: Code 45378 is the base code for a colonoscopy without biopsy or other interventions. It includes brushings or washings if performed. Report 45378 with ICD-10 code Z86.010 on the first line of the CMS 1500 form.
For Medicare beneficiaries, screening colonoscopy is reported using the following HCPCS codes: - G0105 (Colorectal cancer screening; colonoscopy on individual at high risk), for a Medicare beneficiary at high risk for colorectal cancer, and the appropriate diagnosis code that necessitates the more frequent screening.
Medicare beneficiaries without high-risk factors are eligible for a screening colonoscopy every ten years. Beneficiaries at higher risk for developing colorectal cancer are eligible for screening once every 24 months. Medicare considers an individual who is at high risk of developing colorectal cancer as one who has one or more of the following:
According to a study by the American Cancer Society, 90% colorectal cancer (CRC) cases are detected in individuals with over 50 years in the U.S and colonoscopy is the most effective and the most commonly adopted procedure for the diagnosis and screening of CRC in older adults.
A Diagnostic colonoscopy is performed when an abnormal finding, sign, or symptom is found such as diarrhea, anemia, abdominal pain, or rectal bleeding. A Screening colonoscopy is performed on person without symptoms in order to test for the presence of colorectal cancer or colorectal polyps. Even if a polyp or cancer is found during ...
53 - Medicare guidelines state that if a patient is scheduled for a screening colonoscopy, but because of poor prep the scope cannot be advanced beyond the splenic fixture, the procedure should be coded as a colonoscopy with modifier 53 (discontinued procedure).
CPT defines a colonoscopy examination as "the examination of the entire colon, from the rectum to the cecum or colon-small intestine anastomosis, and may include an examination of the terminal ileum or small intestine proximal to an anastomosis" as well.
ICD-10 coding can be tricky. There are payors that accept the Z12.11 (encounter for screening for malignant neoplasm of colon) in the first coding position, while other payors either require this diagnosis in a subsequent position behind family history codes or prefer to see the Z12 .11 left off the claim entirely. Please check with your Fiscal Intermediaries for coding guidelines.
A screening colonoscopy is typically performed once every 10 years on asymptomatic individuals within the age range of 50-75. These patients would not be considered high-risk and have no personal or family history of colon cancer, high-risk gastrointestinal disease or a personal history of pre-cancerous polyps.
A screening colonoscopy is performed once every 10 years on healthy individuals while a surveillance colonoscopy is usually performed every two to five years and is based on the outcome of an individual’s previous colonoscopy.
There are several reasons why a patient may be asked to return for a follow-up colonoscopy. Many of these reasons may involve a non-high-risk factor such as poor bowel prep or the inability to excise an entire polyp during the last colonoscopy. Individuals may also return for a colonoscopy within 24 months due to a personal history of colon cancer to check for recurrence. Patients may also present within a 24-month time frame when their last colonoscopy yielded polyps that were serrated or sessile in nature. This is based potentially on the look of the polyp and could be a pre-cursor to colon cancer.
Coding colonoscopies can be one of the more difficult procedures to code in the ASC setting if you don’t have a firm understanding of rules and regulations surrounding these types of cases. Let’s take a look at some of the more common scenarios and how to apply proper coding.
Surveillance Colonoscopies: The term surveillance has caused quite a bit of confusion since surveillance really is still a screening. Patients with a history of colon polyps are not recommend for a screening colonoscopy, but for a surveillance.