Examine These FAQ to Sort Your Medicare Cancer Screen Codes

Posted on 26. May, 2010 by Editor.

Remember frequency rules differ for average, high risk.

Getting Medicare to pony up for colorectal cancer screenings is not difficult provided you follow its frequency guidelines and eligibility requirements to the letter. A coding slip up on one of these items will knock you out of the saddle, and Medicare won’t accept the claim at all.

Rope in all the coding info you’ll need via this Medicare colorectal cancer screening FAQ.

Who’s Eligible for Average-Risk Test?

If the Medicare patient is 50-plus years old, he is eligible for a covered Medicare screening, confirms Dena Rumisek, CPC, biller at Michigan’s Grand River Gastroenterology PC.

However:

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Gastro Coders: Be Aware of Medicare Screening Reqs Or Risk Payment Denial

Posted on 12. Apr, 2010 by Editor.

Following 10-year-rule eliminates G0121 rejection.

If you slip up on screening colonoscopy claims’ frequency guidelines and eligibility requirements, Medicare will pay you zilch.

Use this guidance to capture every screening dollar your gastroenterologist deserves.

Home in on Eligibility Requirements for Average-Risk Test

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Colorectal Cancer Screening: A Medicare Coding & Billing FAQ

Posted on 04. Sep, 2009 by .

Steer clear of G0121 denials with these tips.

If you slip up on screening colonoscopy claims’ frequency guidelines and eligibility requirements, Medicare will pay you zilch. But our colorectal cancer screening FAQ provides you the coding the know-how you need to soar through your coding duties with the greatest of ease.

Q: Who’s Eligible for Average-Risk Test?

Any Medicare patient 50 years or older is eligible for a covered Medicare screening, confirms Dena Rumisek, CPC, biller at Michigan’s Grand River Gastroenterology PC.

Catch: These patients can have a colorectal cancer screening only once every 10 years, says Cheryl Ray, CCS, CPMA, of Atlantic Gastroenterology in Greenville, N.C. You’d be wise to pay attention to the frequency guidelines, as “Medicare is very stringent on the date … it has to be 10 years or longer — it can’t be 9 years and 360 days” between covered screening colonoscopies, assures Rumisek.

AUDIO: Things You Shouldn’t Have to Swallow in Gastroenterology Billing. With Jill Young.

Example: A 73-year-old established Medicare patient reports for a screening colonoscopy on Aug. 11, 2009. The patient’s records indicate that he last had a covered screening on July 31, 1995. On the claim, you should report G0121 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk).

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