This guideline clarifies billing instructions for colonoscopy procedures. Even when a routine screening results in detection of suspicious tissue or removal of a polyp, you should assign the screening diagnosis code as the primary diagnosis. This is because the intent of the procedure was preventive. Then, list the diagnosis code related to any additional findings or procedures you perform during the colonoscopy as secondary diagnoses.
If you schedule a colonoscopy as a diagnostic procedure in response to symptoms indicating disease or as surveillance for prior documented disease, you should document the procedure as such. For a diagnostic colonoscopy, however, applicable copayment, coinsurance and deductibles will apply depending on the member’s plan of coverage. For members who have a preventive benefit plan, we cover a screening colonoscopy at 100 percent. Please note that these claims must have the appropriate routine primary diagnosis code and CPT code. See the Current Procedural Terminology (CPT) Manual for details.
As you discuss colonoscopy with your patients who are BlueCross members, please keep these coverage distinctions in mind. We want your patients to make well-informed health care decisions and understand how much they will have to pay.
If you have questions, please e-mail us at Provider.Education@bcbssc.com.