AGA is hearing reports of patients incorrectly charged cost-sharing fees 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 payers 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.
• Medicare CAN impose cost-sharing when a screening colonoscopy turns therapeutic. AGA is fighting to have this policy corrected.
In the meantime, use the AGA Q&A at http://www.gastro.org/journals-publications/aga-edigest/archive/aga_edigest_oct_31_2013 to help ensure you are using the correct modifiers and diagnosis codes. This document includes tips on how to order diagnosis codes to avoid payment denials.
