Medical Claims

# Navigating Colonoscopy Coding: Determining the difference between screening vs diagnostic colonoscopy coding

- August 22, 2024
- Posted by Kristen Edwards

05 Dec

Scheduling a colonoscopy appointment can be a daunting task, as there are various coding considerations to be aware of.

It is important to consider the difference between screening vs diagnostic colonoscopy coding when deciding which type of procedure you need. Screening colonoscopies are preventive measures used to detect and remove any potential cancer-causing polyps during the procedure, while diagnostic codes are for identifying an existing condition or problem. Knowing these distinctions can help you make an informed decision when scheduling an appointment with your doctor.

Additionally, it is important to understand common errors in medical billing that may occur during a procedure to be prepared for any unexpected costs that may surface. Taking the time to properly research and discuss different coding considerations with your provider can help ensure your appointment goes as smoothly as possible and that all necessary procedures are covered by insurance.

Keep reading to know the difference between screening and diagnostic coding for colonoscopies in detail.

## Screening vs Diagnostic Colonoscopy coding – The Core Difference

gastro.org

There are two primary types: diagnostic coding and preventive coding. Diagnostic codes are used to identify any pre-existing condition or problem, while preventive codes are used to detect potential risks such as polyps or cancer. Knowing this distinction can make it easier to determine which code is appropriate for your particular situation before scheduling an appointment with your doctor.

Possibly you won’t find any difference in a diagnostic colonoscopy or screening colonoscopy. They are performed using the same level of equipment with the same procedure. The difference, however, is the process of billing the facility made to your insurer. The claim will directly depend on the symptoms of the disease or the lack of symptoms that your doctor finds while the medical analysis.

It can also be understood that if a patient doesn’t show any symptoms of gastrointestinal disorder, masses, or polyps during colonoscopy screening, the colonoscopy will be considered preventive screening. According to the Affordable Care Act (ACA), preventive services are ‘essential health benefits and obligate third-party, federal, and private insurers to cover the associated costs as they need preventive coding for bills. This translates to the fact that you (as a patient) won’t be required to pay coinsurance or copay for your treatment for colonoscopy screening.

On the other hand, a diagnostic colonoscopy isn’t preventive and requires diagnostic coding to claim the services provided. According to ACA, your insurance provider may require you to pay out-of-pocket for copay and coinsurance.

## Screening Colonoscopy

A screening colonoscopy is considered a preventive procedure used to detect and remove polyps that may cause cancer. During the procedure, a thin, flexible tube with a camera attached is inserted into the rectum and passed slowly up through the colon. The camera allows your doctor to view the lining of your colon looking for any abnormal growths. Removing any polyps during the procedure can be examined in a lab to determine if they are benign or cancerous.

Colon Cancer is one of the most common types of deadly cancers and adults 45 and above should go through a colon screening to prevent the surge at early ages. The American Cancer Society suggests people with a risk of colon cancer (having a family history of cancer) should go for screening after every 9-10 years.

## Diagnostic Colonoscopy

A diagnostic colonoscopy is a procedure that can help detect early signs of colorectal cancer and other severe medical conditions. During the process, a doctor will use a lighted scope to examine the inside of your large intestine. The purpose is to identify any abnormal growths or abnormalities in the lining of the intestines. Depending on the results, a doctor may choose to perform biopsies or take tissue samples. Although it’s a painful exam, having regular colonoscopies can help catch potential health issues before they become more severe and potentially life-threatening.

A colonoscopy is said to be diagnostic when;

- You feel the change in bowel habits
- Anemia
- Abnormal pain
- Rectal bleeding
- Diarrhea
- Blood found in stool
- Constipation

### Conclusion

Understanding the different types of codes and their associated costs is essential before scheduling an appointment. Taking the right steps to ensure your procedure is covered by insurance can help you avoid any unexpected costs. By being aware of common mistakes made when coding a colonoscopy, providers can better prepare their patients for success in navigating the complexities of this procedure.

Individuals covered under Medicare are fully insured for preventive colonoscopies along with coinsurance and deductibles. If you are covered under private health insurance, ask your insurer before getting an appointment.

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