Understanding the Different Types of Colonoscopies
Wording is Important
There is a great misunderstanding about the different categories under which a colonoscopy can be classified. These categories will determine your insurance benefit coverage and can make a difference in your personal out of pocket expenses. In order to avoid an unexpected charge, it is important that you educate yourself on your specific category and your insurance policy coverage.
Diagnostic/Therapeutic Colonoscopy:
Patient has past and/or present gastrointestinal symptoms, polyps, GI disease, iron deficiency anemias, and/or any other abnormal tests.
Surveillance/High Risk Screening Colonoscopy:
Patient has no current gastrointestinal symptoms BUT has a personal history of GI disease, personal and/or family history of colon polyps, and/or cancer. Patients in this category are required to undergo colonoscopy surveillance at shortened intervals (e.g., every 2-5 years)
Preventative Colonoscopy Screening Diagnosis:
Patient is asymptomatic (no present gastrointestinal symptoms), age 50 and over, has no personal or family history of GI disease, colon polyps, and/or cancer. The patient has not undergone a colonoscopy within the last 10 years.
Your primary care physician may refer you for a “screening” colonoscopy but there may be a misunderstanding of the word screening. This will be determined in the pre-operative process. Before your procedure, you can ask what category your procedure falls under and can contact your insurance company for details of coverage.
Can my GI Associates doctor or nurse change my records so that I can be considered eligible for colon screening?
Absolutely not, this would constitute insurance fraud. Your visit is documented as a medical record based on the information you or your referring physician have provided as well as what is obtained during taking our pre-procedure history and assessment. It is a binding legal document that cannot be changed in order to obtain better insurance coverage.
There are strict government and insurance company documentation and coding guidelines that prevent a physician from altering a chart or bill for the sole purpose of coverage determination.