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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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.