A screening colonoscopy is performed on an individual without symptoms, who has not been diagnosed with colorectal cancer or has no additional risk factors for colorectal cancer, such as polyps or inflammatory bowel disease, prior to the start of the screening exam. A diagnostic colonoscopy is performed on an individual who has symptoms, or has a previous history of colorectal cancer, polyps or other gastrointestinal disease or disorders. Please be aware that the insurance companies must process claims based on the provider’s billing. Members who have a preventive screening colonoscopy billed as a diagnostic exam instead should contact the provider’s office to discuss the services received and ask if the claim can be resubmitted with the correct preventive coding. If the provider’s office does not agree to resubmit the claim, members should contact the insurance carrier to request a review of the claim. It’s possible that claims originally billed as diagnostic may be reprocessed or adjusted to pay as preventive, but only if it can be verified through the provider’s office that the exam was scheduled as a preventive screening.
What is the difference between a screening and diagnostic colonoscopy?
