My primary care physician referred me to your office for a screening colonoscopy. Why wasn’t it billed as a screening or preventative colonoscopy?
To bill for a screening colonoscopy the patient must be without gastrointestinal symptoms, 50 years of age or older, have no personal history of gastrointestinal disease, colon polyps and/or colon cancer. In most cases patients are limited to one screening colonoscopy per ten year increment.
It is a common occurrence for insurance providers/carriers to recommend contacting physicians’ offices to change claim coding to pay claims at 100%. Should a claim meet all of the criteria listed above, our office will certainly review records and submit changes if appropriate. However, in most cases, screening benefits will be denied due to age, symptoms, or time interval restrictions.
Our billing office is available at (402) 397-7057 or (402) 504-3880 during regular business hours to answer questions regarding your claim and Medicare and American Medical Association (AMA) coding policies.