AVOID SCREENING COLONOSCOPY MISTAKES
A screening colonoscopy is only indicated
for asymptomatic patients (without symptoms). When a patient presents
for a colonoscopy they shouldn’t have any other sign or symptoms
listed as part of the indications for performing the procedure.
If a patient has any or all of the following conditions -constipation,
abdominal pain and/or rectal bleeding then the procedure would
not be a screening, it would be a diagnostic service to determine
the cause of their symptoms.
A surveillance colonoscopy doesn’t necessarily mean a screening
colonoscopy. A previous screening colonoscopy could have identified
a condition that the physician wanted to monitor or perform surveillance
on, to confirm that the condition hadn’t worsened. Since
there are coverage limitations (screenings once every 10 yrs. for
patients not meeting the high risk criteria and once every 24 months
for high risk patients) reporting another screening procedure too
soon would lead to a denial of services.
Review the CMS guidelines concerning screening colonoscopy procedures
for high risk patients. Two guidelines that are commonly misinterpreted
are “family history of colon cancer” and “personal
or family history of polyps”.
Family history of colon cancer only relates
to “close relatives” which
are defined as siblings (brothers or sisters), parent (mother or
father), or a child. Aunts, uncles and grandparents do not qualify
as close relatives.
When the term “history of polyps” is used as a diagnosis
you must determine the type of previous history. CMS guidelines
are specific in stating that with high risk there should have been “adenomatous
polyps” not hyperplastic polyps. There is very little chance
if any that a hyperplastic polyp will ever develop into a cancerous
state so a history of hyperplastic polyps would not put a patient
in the “high risk” category.