2017-10-04 21:06:45 UTC

Closing the Colonoscopy Loophole

Oct. 4, 2017

AGA committee member Shazia Mehmood Siddique’s Philadelphia Inquirer op-ed explains how current legislation is hurting patients.

AGA applauds Shazia Mehmood Siddique, MD, for her recent op-ed in Philadelphia Inquirer that sheds light on the “colonoscopy loophole.”

What is the Colonoscopy Loophole?
The Affordable Care Act covers screening colonoscopies at no cost to patients as long as no polyps are found. As Dr. Siddique explains in her article, finding a polyp changes the billing code to a therapeutic colonoscopy, a reclassification that changes the procedure from a diagnostic screening to an intervention. And this means a bill is generated. This reclassification directly affects those covered by Medicare and not commercial insurers.

AGA Leaders Urge Congress to Correct this Problem
Dr. Siddique — a member of the AGA Trainee and Early Career Committee and AGA Clinical Guidelines Committee — joined other AGA leaders for AGA Advocacy Day in late September where they spoke directly to lawmakers about patients who are blindsided by this regulation. AGA supports closing this loophole to ensure patients continue to have access to quality care and preventative screenings. We encourage all members to continue to share their patient stories, like Dr. Siddique has, to help raise awareness of this issue.

AGA Can Help You Advocate for GI
Watch an AGA webinar (login required) to learn more about how to set up congressional meetings in your district, or contact Navneet Buttar, AGA government and political affairs manager, at nbuttar@gastro.org or 240-482-3221.  

More on Colonoscopy

Important Opportunity to Advise CMS on Colonoscopy Episode

Oct. 26, 2017

It is critical that you share your feedback with CMS by Wednesday, Nov. 15.

Tips to Avoid a 2019 Payment Penalty

Oct. 19, 2017

Report on one measure for one patient for the 2017 Quality Payment Program Performance Year.

Colonoscopy Cost Measure to be Tested for MIPS

Oct. 4, 2017

Prepare now to share your thoughts on the value of the measure with CMS.