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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.
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.
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.