Tuesday, July 10, 2012

When to use Colonoscopy DX V70.5, V70.9

We can use the following scenario.

Individuals at average risk for colon cancer:
Colonoscopy covered once every 10 years beginning at age 50.

Individuals at increased risk for colon cancer:
Colonoscopy once every five years for individuals with a first-degree relative diagnosed with a colorectal cancer or an adenomatous polyp before age 60, or in two or more first-degree relatives at any age. Optical colonoscopy should be performed beginning at either 40 or 10 years younger than the earliest affected relative, whichever is earlier.

Colonoscopy once every 10 years, beginning at age 40, for individuals with a first-degree relative diagnosed with colorectal cancer or an adenomatous polyp at age 60 or older, or colorectal cancer diagnosed in two second- degree relatives.

Individuals at high risk for colon cancer:

Colonoscopy once every one to two years for individuals with a genetic or clinical diagnosis of hereditary non-polyposis colorectal cancer (HNPCC) or individuals at increased risk for HNPCC. Optical colonoscopy should be performed beginning at age 20 to 25 or 10 years younger than the earliest age of diagnosis, whichever is earlier.

For individuals diagnosed with inflammatory bowel disease, chronic ulcerative colitis, or Crohn’s disease, cancer risk begins to be significant eight years after the onset of pancolitis or 10 to 12 years after the onset of left-sided colitis. For individuals meeting these risk parameters, optical
colonoscopy should be performed every one to two years with biopsies for dysplasia.

 There are no copayments or cost-shares required for TRICARE Prime or TRICARE Standard and TRICARE Extra beneficiaries. Note: Computed tomographic colonography (CTC) is covered as a colorectal cancer screening only when an optical colonoscopy is medically contraindicated or cannot be completed due to a known colonic lesion or structural abnormality, or when other technical difficulty is encountered that prevents adequate visualization of the entire colon. CTC is not covered as a colorectal cancer screening for any other indication or reason.

Mammograms V70.5 V70.9

Performed annually for women beginning at age 40 (baseline at age 35 for high risk, then annually).

There are no copayments or cost-shares for TRICARE Prime or TRICARE Standard and TRICARE Extra beneficiaries.

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