How to Code Colonoscopy Under Obamacare

October 31, 2013

AGA is hearing reports of patients incorrectly charged cost sharing for screening colonoscopy due to incorrect coding by physicians. There is significant confusion about how the Affordable Care Act covers preventive screenings. In response, AGA has developed a Q&A to guide you through the process. 

Important items to note: 

  • Medicare and private payors must cover screening colonoscopy without a co-pay or deductible. 
  • If a polyp is found and removed during a screening colonoscopy, then a private insurer cannot impose cost sharing since it is an integral part of a colonoscopy. (More Details
  • Medicare CAN impose cost sharing when a screening colonoscopy turns therapeutic. AGA is fighting to have this policy corrected. 

In the meantime, use this Q&A from the AGA to help ensure you are using the correct modifiers and diagnosis codes. This document includes tips how to order diagnosis codes to avoid payment denials.

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