ASGE members may submit coding inquiries electronically to codingquestions@asge.org. When submitting a question, please allow at least three business days for a response. When submitting inquiries, please include the 91ÊÓƵmember’s name and ID number. Only questions will be accepted and not reports. Below is our featured Coding Question of the Month that could be beneficial to your practice.
Question:
A patient had a colonoscopy in 2012, and the indication was screening; polyps were removed, and recommendations were made to return in five years for a repeat exam. The patient had a recall for 2019 but did not come in. Now in 2024, the patient has returned. Would this be done as a screening or history of colon polyps? Does a patient need to have two colonoscopies with no polyps before screening can be done, or since the last one was 10 years ago, is screening the correct diagnosis?
Answer:
If a patient has a history of adenomatous or neoplastic polyps, this will fall into the surveillance category, not screening. Closer interval surveillance may also be warranted based on the number and location of polyps and family history. If the patient had hyperplastic polyps, follow-up is usually not warranted, and the patient would be eligible for a screening benefit in 10 years as long as there is no family history of colon cancer or polyps, which would require closer surveillance.
Just because the patient did not return in five years as recommended doesn't mean this is not surveillance. It is based on the provider’s recommendations and indications. Always query your provider for their protocols on surveillance/recall intervals.