Colorectal cancer screening plays a critical role in preventive care, but accurate coding and billing remain complex due to evolving payer policies, frequency limitations, and preventive service regulations. This comprehensive webinar will break down the Medicare coverage, coding and billing guidelines for colorectal cancer screening and how to submit claims. Participants will gain clarity on procedure coding (including Colonoscopy, CT Colonography, FOBT and flexible sigmoidoscopy), appropriate ICD-10-CM diagnosis selection, screening versus diagnostic distinctions, modifier usage, and handling high-risk patient criteria. We will also explore Medicare cost-sharing rules, frequency limitations, and common denial/rejection scenarios to reduce compliance risk and improve reimbursement. This session will cover:

• Understand screening vs. diagnostic colonoscopy billing distinctions
• Understand Medicare coverage for colorectal cancer screening and how to submit claims
• Apply correct CPT®, HCPCS, and ICD-10-CM codes for colorectal cancer screening services
• Navigate Medicare preventive coverage rules and cost-sharing updates
• Identify high-risk patient coding requirements
• Correctly use modifiers (e.g. KX and PT) when applicable
• Avoid common documentation and billing errors that lead to denials and recoupments
• Reveal reasons for common rejections and denials for this specialty based on data

Session Agenda:

• Overview of Colorectal Cancer Screening
  – Definition and Statistics
  – Controllable and Uncontrollable Risk Factors
  – Lists of Colorectal Cancer Screening Services (Colonoscopy, Flexible Sigmoidoscopy, Computed Tomography (CT) Colonography, Blood-based Biomarker test and FOBT)
• Coverage for Colonoscopy, Flexible Sigmoidoscopy, Computed Tomography (CT) Colonography and FOBT
• High-Risk Individuals
• Frequency for Normal and High-Risk Patients
• Billing/Coding for Colorectal Cancer Screening
  – Coding Changes
  – ICD-10 Codes
  – CPT/HCPCS Codes
  – Revenue Code and Type of Bill
• Modifiers for Colorectal Cancer Screening (Modifier KX and PT)
• Hospital Inpatient
• Patient’s Eligibility
• Rejections vs. Denials
• Potential Actions to Choose for Rejections and Denials
• Appeals Process
• Common Rejection Reasons for Specialty 28/Claim Lines (Invalid or Missing Modifiers or Procedures)
• Specialty 28 Rejection by CPT/HCPCS Codes (G0121, 45378)
• Common Denial Reasons for Specialty 28/Claim Lines
• Specialty 28 Denial by CPT/HCPCS Codes (99024,99232, 99213, 45385)
• Time-Limit for Filling Claim
• How to fix or avoid denials/rejections?
  – Modifier Issue Fixes
  – Place of Services Fixes
  – Patient Eligibility Fixes
  – Provider Number Fixes
  – Avoid Duplicate Denials
  – Avoid E/M Denials
  – Avoid Timely Filing Denials
• Questions and Answers

Who Should Attend:

• Physicians
• Non-Physicians Providers
• Surgeons
• Medical Billing Specialists and Managers
• Medical Coding Specialists and Managers
• Medical Auditors
• Revenue Cycle Manager and Staff
• Practice Managers
• Claim Reviewers
• Office Managers and Administrators
• Clinical Operations Staff
• Compliance Officers
• FQHC/RHCs
• Critical Care Providers
• Qualified Healthcare Practitioners
• Healthcare Executives, Directors and Supervisors

Don’t miss this opportunity to master Medicare coverage for colorectal cancer screening, current coding/billing practices and how to submit claims to avoid common billing mistakes to prevent denials and recoupments.