2023 Changes to Colorectal Screening Tests
Published on
Wednesday, March 22, 2023
Did You Know?
The Code of Federal Regulations defines colorectal cancer screening tests as being any of the following procedures furnished to an individual for the purpose of early detection of colorectal cancer:
- Screening fecal-occult blood tests.
- Screening flexible sigmoidoscopies.
- Screening colonoscopies, including anesthesia furnished in conjunction with the service.
- Screening barium enemas.
- Other tests or procedures established by a national coverage determination, and modifications to tests under this paragraph, with such frequency and payment limits as CMS determines appropriate, in consultation with appropriate organizations.
Why It Matters?
Effective January 1, 2023: If you code outpatient colonoscopy procedures, be aware of new Medicare guidelines where a positive stool-based colorectal cancer-screening test can, in some cases, constitute a screening colonoscopy.
The excerpt below is from the Code of Federal Regulations and can be seen in section K at this link: eCFR :: 42 CFR 410.37 -- Colorectal cancer screening tests: Conditions for and limitations on coverage.
“A complete colorectal cancer screening. Effective January 1, 2023, colorectal cancer screening tests include a follow-on screening colonoscopy after a Medicare covered non-invasive stool-based colorectal cancer screening test returns a positive result.”
Also refer to Coding Clinic for HCPCS 4th quarter 2022, page 17 for additional information.
What Can I Do?
Share this information with your outpatient coding professionals. For non-Medicare payers, it may be necessary to contact them directly for guidance.
Article Author: Jeffery Gordon, RN, MSN, CCA, COC
Jeffery Gordon, RN, MSN, CCA, COC, is the Manager of Outpatient Medical Review at Medical Management Plus, Inc. Jeff has over thirty-five years of experience in healthcare including Critical Care, Infection Control, Quality Assurance, Medical Necessity, Outpatient Coding, Medicare Claims data analysis and Medical Record review.
