Nearly a third of patients who get colonoscopies to screen for cancer visit a gastroenterologist before having the procedure, at an average cost of $124, even though such visits may be unnecessary, a new study found.
“open access” programs, which allow providers and sometimes patients to schedule the screening test without first sitting down with a gastroenterologist for a consultation, are becoming routine.
The gastroenterologist’s office can then contact the patient to discuss how to take the bowel preparation mix to clean out the colon before the test. The patient can simply show up for the colonoscopy on the scheduled day, without taking more time off work and saving the cost of a specialist office visit.
Reference:
https://kffhealthnews.org/news/stud...ients-may-have-unneeded-pre-screening-visits/
5. You can schedule a colonoscopy without an office visit. If you’re healthy and don’t have any major medical conditions, you just need to fill out a form to schedule an Open Access Colonoscopy, so you can skip that extra appointment.
Reference:
https://www.honorhealth.com/healthy-living/top-5-reasons-schedule-a-colonoscopy
Medicare and most other insurers cover only medically necessary services. A patient is eligible for a screening colonoscopy if there are no signs or symptoms of GI trouble. It stands to reason that a pre-op clearance exam that finds no health care condition to support the medical necessity of the visit is not medically necessary...However, if there is a medically necessary reason for the visit, such as any other complicating condition that would be pertinent to the safety of the patient while undergoing the procedure (high blood pressure, diabetes, etc.), then the visit might be considered medically necessary. Medical necessity will be determined by the documentation and diagnosis coding.
Reference:
https://apps.para-hcfs.com/pde/documents/April_20_2022_Weekly_Update_For_Users.pdf
