Financial Incentives Boost the Rate of Colorectal Cancer Screenings

Financial Incentives Boost the Rate of Colorectal Cancer Screenings

New research found that a $100 cash incentive to patients eligible for a preventive colonoscopy screening has doubled the rate of screening.

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The third most commonly diagnosed cancer in both men and women, colorectal cancer can be screened in the United States with most of the recommended tests such as colonoscopies and fecal occult blood tests. According to the American Cancer Society, in 2017 an estimated 135,430 people will be diagnosed with colorectal cancer and about 50,260 people will die from the disease in the U.S. A new research from the Perelman School of Medicine at the University of Pennsylvania has found that a $100 cash incentive more than doubled the rate of colorectal cancer screenings.

Colonoscopy is a very powerful screening technique that can not only diagnose polyps that are precursors to colon cancer, but also remove them during the procedure. For providers, gastroenterology medical billing includes billing for colorectal cancer screenings. 

The research team performed a randomized controlled trial on 2,245 people between 50 and 64 years old, who were eligible for colonoscopy screening.

While some received an email asking them to opt in or opt out of a screening colonoscopy (the simple active choice group), others received an email with the same message along with an offer of $100 if they had a colonoscopy within three months and the third group (the control group) received an email with just a phone number for scheduling a colonoscopy. It was found that 3.7 percent of the group that was offered the $100 inducement received a screening colonoscopy within three months, which is higher than the 1.6 percent of the control group and 1.5 percent of the simple active choice group.

Medicare Coverage Guidelines for Colonoscopy Medicare covers several types of colorectal cancer screening tests such as fecal occult blood tests, flexible sigmoidoscopies, colonoscopies, multi-target stool DNA tests, and barium enemas (80%). Though Part B deductible does not apply, coinsurance applies to colonoscopies and sigmoidoscopies performed in ambulatory surgical centers and non-Outpatient Prospective Payment System hospitals.

Medicare covers colonoscopy once in every 120 months or every 48 months after a previous flexible sigmoidoscopy; and for beneficiaries at high risk, once every 24 months. People of any age are eligible for a colonoscopy. If a screening colonoscopy

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or screening flexible sigmoidoscopy results in the biopsy or removal of a lesion or growth during the same visit, the procedure is considered diagnostic and you may have to pay coinsurance and/or a copayment, but the Part B deductible doesn't apply. Medicare beneficiaries without high risk factors are eligible for screening colonoscopy every ten years.

Colonoscopy - Medical Coding CPT codes 

45378 Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)

When one or more polyps are removed at the time of a screening colonoscopy, the surgeon does not report the screening colonoscopy code, but uses the appropriate code for the diagnostic or therapeutic procedure performed, which include: 

45379 Colonoscopy, flexible, proximal to splenic flexure, with removal of foreign body (s)



45380 Colonoscopy ------------, with biopsy, single or multiple



45381 Colonoscopy ------------, with directed submucosal injection(s), any substance



45382 Colonoscopy ------------, with control of bleeding, any method



45383 Colonoscopy ------------, with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)



45384 Colonoscopy ------------, with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps



45385 Colonoscopy ------------, with removal of tumor(s), polyp(s), or other lesions by snare technique



45386 Colonoscopy ------------, with transendoscopic balloon dilation



45389 Colonoscopy ------------, with endoscopic stent placement (includes pre- and post-dilation and guide wire passage, when performed)



45390 Colonoscopy, flexible; with endoscopic mucosal resection

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

45391 Colonoscopy ---------, with transendoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures



45392

Colonoscopy

---------,

with

transendoscopic

ultrasound

guided

intramural or transmural fine needle aspiration/biopsy(s) includes endoscopic ultrasound

examination

limited

to

the

rectum,

sigmoid,

descending,

transverse or ascending colon and cecum, and adjacent structures 

45393 Colonoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed



45398 Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids)

HCPCS codes 

G0105 colorectal cancer screening; colonoscopy on individual at high risk)



G0121 colorectal cancer screening; colonoscopy on individual not meeting the criteria for high risk

ICD-10 codes A screening colonoscopy should be reported with the following ICD-10 codes: 

Z12.11 (encounter for screening for malignant neoplasm of colon)



Z80.0 (family history of malignant neoplasm of digestive organs)



Z86.010 (personal history of colonic polyps)

Common ICD-10 diagnosis codes indicating high risk: 

Z85.038 Personal history of other malignant neoplasm of large intestine



Z85.048

Personal

history

of

other

malignant

neoplasm

of

rectum,

rectosigmoid junction, and anus Providers in the gastroenterology specialty can ensure accurate medical coding with the support of a gastroenterology medical billing company.

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