Understanding the difference between screening and medical colonoscopies

Many times our patients are concerned about whether their insurance will pay for their procedure as a screening or a medical colonoscopy. Each patient should be aware that the benefits provided by his or her plan may differ from other plans offered by the same insurance company which prohibits us from understanding each patient’s individual benefits. Therefore, it is the patient’s responsibility to understand their plan benefits.

Our coding team works hand in hand with your physician in conjunction with the American Medical Association Coding Guidelines to ensure that your claim is coded correctly.

The following information will be helpful for you in determining how your benefits may pay.

Your colonoscopy will fall into one of the following categories:

Diagnostic/Therapeutic Colonoscopy

Patient has past and/or present gastrointestinal symptoms, colon polyps, or a gastrointestinal disease. Patients in this category typically have colonoscopies more frequently than 10 years.

Most carriers will process this under your medical benefits.

Preventative/Screening Colonoscopy

Patient has no gastrointestinal symptoms either past or present, is over the age of 50, no personal history of gastrointestinal disease, colon polyps and/or colon cancer. The patient has not undergone a colonoscopy within the last 10 years.

Most carriers will process this under screening benefits if your plan allows.

Surveillance/High Risk Colonoscopy

Patient has no gastrointestinal symptoms either past or present, has a personal history of gastrointestinal disease, colon polyps, and or colon cancer. Patients in this category are required to undergo colonoscopy surveillance at shortened intervals perhaps every 2-5 years.

Most carriers will process this under your medical benefits however Medicare will process this under your screening benefits every 24 months.

If you have any questions please call us at (402) 504-3846.