FREQUENTLY ASKED QUESTIONS REGARDING COLONOSCOPY CODING AND BILLING
WHAT IS THE DEFINITION OF PREVENTIVE COLONOSCOPY?
Preventive Colonoscopy (low risk screening diagnosis): Patient has no gastrointestinal symptoms, over the age of 50, has no personal or family history of GI disease, colon polyps, and/or cancer.
WHAT IS THE DEFINITION OF SURVEILLANCE COLONOSCOPY?
Surveillance (High Risk Screening diagnosis) Colonoscopy: Patient has personal history of GI disease, personal and/or family history of colon polyps, and/or cancer.
WHAT IS THE DEFINITION OF DIAGNOSTIC COLONOSCOPY?
Diagnostic Colonoscopy: Patient has past and/or present gastrointestinal symptoms (e.g. diarrhea, abdominal pain, rectal bleeding), polyps, GI disease, iron deficiency anemia and/or any other abnormal tests.
WILL MY INSURANCE COMPANY PAY FOR A SCREENING COLONOSCOPY?
Most insurance carriers pay for a preventive colonoscopy when a patient reaches age 50, in full, with no out of pocket cost (no deductible, co-pay or co-insurance). Premera, Kaiser, United HeathCare, Asuris, Regence and Cigna now cover a screening colonoscopy at age 45. If tissue is removed (polyps/biopsies) there may be out of pocket costs for pathology.
WILL MY INSURANCE COMPANY PAY FOR A SURVEILLANCE COLONOSCOPY?
Some insurance carriers cover surveillance colonoscopy based on diagnosis. While patients are responsible to know what their health insurance benefits include, our office will work with you to verify your plan benefits.
WILL MY INSURANCE COMPANY PAY FOR A DIAGNOSTIC COLONOSCOPY?
Insurance carriers cover a diagnostic colonoscopy after deductible, copay and coinsurance is met. While patients are responsible to know what their health insurance benefits include, our office will work with you to verify your plan benefits.
HOW WILL MY OUT OF POCKET COSTS BE DETERMINED AND COLLECTED?
Out of pocket costs are expenses for medical care that are not reimbursed by your insurance including deductible, co-pay and co-insurance. Spokane Digestive will verify your coverage and benefits to determine your out of pocket costs based on your individual plan. At the time of service, we will ask for one-half of your out of pocket cost. Payment plan options are available.
WHAT WILL MY BILL INCLUDE?
Your bill will include a facility fee, physicians professional fee, anesthesia fee, and pathology if tissue is removed (polys and/or biopsies).