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Per Medicare guidelines, the procedure should be codes as a colonoscopy with a 53 modifier, which will pay a partial fee and allow you to repeat the procedure within the restricted time period and get full payment for the second procedure. Even if the scope was advanced beyond the splenic flexure, but the visualization
For patients in their late 70s with significant comorbidities, colonoscopies provide minimal, if any, benefit and are not recommended by guidelines. Physicians He told Mr. Eckler that, for people of his age and with his prior colonoscopy results, the advantages of repeating the procedure did not seem to outweigh the risks.
26 Sep 2013 An area of particular confusion is screening colonoscopies converted to a diagnostic or therapeutic colonoscopy. To complicate the issue, Medicare uses different procedure codes than other payers. This article from CodingIntel dedicated to colonoscopy coding guidelines will help surgeons and their office
With Medicare, you must be 50 or older to be eligible for coverage of most colon cancer screenings. The exception to this is a colonoscopy, for which there is no minimum age requirement. Medicare covers the following screenings: Fecal occult blood test – once a year (every 12 months) for persons age 50 or older; Flexible
Screening colonoscopy: Medicare covers this test once every 24 months if you're at high risk for colorectal cancer. Screening fecal occult blood test: Medicare covers this lab test once every 12 months if you're 50 or older.

3 Jul 2012 US guidelines place emphasis on performing a high-quality baseline examination. In 2008, the MSTF published screening guidelines for CRC, which included recommendations for the interval for repeat colonoscopy after negative findings on baseline examination. (5). New issues have emerged since the
21 Jun 2010 You say that Medicare will cover colonoscopies at no cost to the patient as of January 2011. However, it is not clear whether the 120-month limitation for a repeat asymptomatic colonoscopy will remain, or whether (as many physicians advise) a colonoscopy will be covered after only seven or eight years
5 Nov 2015 According to Medicare Learning Network Matters Medicare Coverage and Billing for Colorectal Cancer Screening, Medicare beneficiaries without high risk factors are eligible for screening colonoscopy every ten years. Beneficiaries at high risk for developing colorectal cancer are eligible once every 24
1 Oct 2012 Medicare coverage for a screening colonoscopy is based on beneficiary risk. For beneficiaries 50 and older not considered to be at high risk for developing colorectal cancer, Medicare covers one screening colonoscopy every 10 years, but not within 47 months of a previous screening flexible sigmoidoscopy.

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February 2018