Colonoscopy Coding Inconsistencies Create Confusion

Tags: Affordable Care Act | billing | coding | colonoscopy | copay | deductible

Under the Affordable Care Act, colonoscopies are to be provided without a copay or deductible, but differential billing codes make patient cost more complex, according to Medpage Today.

The Kaiser Family Foundation, American Cancer Society and National Colorectal Cancer Roundtable identified three situations in which patients encountered unexpected cost sharing for colonoscopies. The situations are when a polyp is detected and removed during screening, when a screening is done following a positive stool blood test and when the patient is at increased risk for colon cancer.

Billing codes and classifications vary greatly among providers and payors. This variation could leave patients with between a $1,000 and $2,000 bill to foot.

The sponsors recommend the federal government clarify coding and coverage to eliminate confusion and improve consistency.

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