- Bleeding and blood in stool
- Unexplained weight loss
- Anemia / low blood counts
- Abdominal pain
- History of diverticulitis / polyps
- Cancer (personal or family)
- Stool change or change in bowel movements
- Constipation / diarrhea
- Rectal pain
- Abdominal symptoms (Describe: __________________________)
Diagnostic/therapeutic colonoscopy: Patient has any of the above past and/or present gastrointestinal symptoms, polyps, or gastrointestinal disease.
Preventative colonoscopy screening: Patient is asymptomatic (no gastrointestinal symptoms either past or present), over the age of 50, has no personal or family history of gastrointestinal disease, colon polyps, and/or cancer. The patient has not undergone a colonoscopy within the last 10 years.
Surveillance/high-risk screening colonoscopy: Patient is asymptomatic (no gastrointestinal symptoms either past or present), and has a personal history or family history of gastrointestinal disease, colon polyps, and/or cancer. Patients in this category are required to undergo colonoscopy surveillance at shortened intervals (e.g. every 2-5 years).
Insurance: Screening Colonoscopy vs. Diagnostic Colonoscopy
If you’re here today because you were sent to one of our providers for a “Screening Colonoscopy” or you have seen a physician and he/she recommends a colonoscopy, please read this page in its entirety. You will need to be fully educated on the state and federal guidelines for reimbursement services.
The CMS “Screening Initiatives” passed in January, 2011 dictates that patients undergoing a “screening colonoscopy” will not be held to their coinsurance or deductible responsibilities. The definition of a screening colonoscopy per CMS guidelines is as follows:
“A colonoscopy being performed on a patient who does NOT have any signs or symptoms in the lower GI anatomy PRIOR to the scheduled test.”
Please note: If you’ve had a colonoscopy within the last 10 years and the result indicated you had colon polyps, you may NOT be eligible for “screening initiative” benefits. You have a prior history of polyps your colonoscopy is now considered a “surveillance of the colon” and may be considered diagnostic. You may have been healthy and have had no symptoms since your last colonoscopy, but you have what is considered a pre-existing nature of polyps and therefore, are not eligible for a “screening”. If your colonoscopy has been over 10 years, you are eligible for a “screening colonoscopy” regardless of your history. It is your responsibility to know your insurance benefit. Please contact your insurance company with benefit questions prior to your procedure.
Please be advised that if you are a true “screening colonoscopy” and during the procedure your doctor finds a polyp or tissue that has to be removed for pathological testing or you are diagnosed with a GI problem, the procedure is no longer a “screening” but becomes “diagnostic”. Please be aware that any polyp that is found may be pre-cancerous and must be removed. Your insurance benefits may change. We make every effort to code correctly for your procedure with the correct modifiers and diagnoses. We make every effort to work with the facility to have the billing coded correctly as well. The correct coding of a procedure is driven by the physician and your medical history. It is not dictated by your benefit or the insurance company.