Casco Bay Surgery

Colonoscopy Insurance Billing Procedures

Insurance companies often break down colonoscopies into two categories:  

If any abnormality is found during a screening colonoscopy (this is common), it becomes a medically necessary colonoscopy. For example, a 50-year-old man with no known symptoms is referred for a screening colonoscopy. During the colonoscopy, the surgeon finds a polyp. Standard medical treatment of a polyp is to remove it, and the surgeon will do that during the colonoscopy (to prevent the polyp from turning into a colon cancer). The colonoscopy, however, is then no longer a screening colonoscopy and will no longer be billed with a screening diagnosis or a screening procedure code. It will be billed with a diagnosis of colon polyp and a procedure code of colonoscopy with polypectomy (removal of polyp). If this patient’s insurance policy is different for screening versus medically necessary colonoscopy, the bill the patient receives may be very different from the one he expected for a screening colonoscopy.

Your insurance company decides whether benefits are different for a screening colonoscopy versus a medically necessary colonoscopy. When checking with your insurance company for benefits, please be aware that a screening colonoscopy can turn into a medically necessary type of colonoscopy during the procedure, and this is simply practicing standard, "best-practice" medical care.

If you have any questions or problems, please don't hesitate to call us.