Saturday, June 19, 2010

Covered Diagnosis - Colon Cancer Screening preventive service

PREVENTIVE SERVICES PAYMENT POLICIES

Colon Cancer Screening

Requirements

HMO/POS
 Referrals are required from Primary Care Physician to a Contracting Provider.
 Services subject to benefit limitations.
PPO/PBA
 Services are subject to benefit limitations.

Limitations and Exclusions
Limitations:
Colorectal cancer screening, which includes:
 Fecal occult blood (age 50 or older) annually if not part of the annual well-woman exam; and
 Barium enema or Sigmoidoscopy (age 50 or older) once every five (5) years; or
 Colonoscopy (age 50 or older) once every ten(10) years.

Provider Billing Guidelines and Documentation
In order for Claims to be processed to the Preventive Service Benefit, the provider must submit with the following diagnosis and service codes:


Code Description
V12.72 Personal History of Colonic  Polyps
V16.0 Family History of Malignant Neoplasms of Gastrointestinal Tract
V70.0 Routine General Medical Examination at a HealthCare Facility
V70.9 Unspecified General Medical Examination
V72.85 Other Specified Examination
V72.9 Unspecified Examination
V76.49 Special Screening for Malignant Neoplasms, Other Sites
V76.50 Special Screening for Malignant Neoplasms, Unspecified Intestine
V76.51 Special Screening for Malignant Neoplasms, Colon
V76.52 Special Screening for Malignant Neoplasms, Small Intestine
V76.89 Special Screening for Malignant Neoplasm
V76.9 Screening for Unspecified Malignant Neoplasms

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