The whole definition here as it comes down is that if you are fine then it is preventive healthcare, find a poly and now it is diagnostic care, and that’s kind of the way the coding works.  Wait until ICD10 charges in on this one as this could get very complicated with the type of polyp, etc.  image

Medicare and private insurers ask for money and the fees can be as high as $3000, so many patient thinking the screenings are free are surprised.  Again, touching on codding is is preventive or diagnostic?  If nothing is found that part is pretty easy to code but when a polyp is found all coding hell breaks loose.  No wonder Ozzie Osbourne is running  a contest for a colonoscopy, I guess we do need prizes for these:)  If you happened to read this recent article, then you know it’s part of hospital marketing to get you in there too if you have good insurance for screenings as they need revenue as hospitals are cutting budgets and laying off, and a couple in Hawaii at Christmas time closed down as they ran out of money. 

At A Time When Medicare is Looking to Cut Down on Re-Admissions Hospitals are Marketing to Find New Admissions As A Source of Revenue

Some doctors say it is so complicated now with coding that there’s really no way to be 100% sure you have coded correctly and are pushing for screenings to be free, polyps or no polyps.  It’s to the point that a representative of the California Association of Underwriters advises patients to not discuss any other health concerns while you are there for your screening! 

Well folks, we are back to the Killer Algorithms here that do the formulas for the coding as stated in the title above.  The healthcare law made many of the “screenings” free, but if they are codes diagnostic, then it’s no longer a screening..had to be a good bunch of analytics guys who wrote this up as this is math and formulas even over the heads of attorneys.  BD 

Patients are getting charged as much as $3,000 for screenings they thought would be free under a federal health care reform mandate that promises free preventive care.

The year-old provision compels new insurance policies to cover colonoscopies, mammograms, blood pressure screenings, HIV tests and many other procedures aimed at early detection of health problems, with no co-pays or deductibles. But doctors say the requirement — designed to make it easier to get care — may morph into a roadblock because some patients are getting billed when certain preventive procedures reveal growths that could become cancer.

"I think it stinks. The ludicrous thing is the reason you do screening is to find something," said Dr. Jack Rotenberg, a digestive system specialist in Oxnard, Calif., suggesting that charging people when problems are diagnosed is the definition of bait and switch.


  1. There’s a good point here in that many preventive services are advertised as free, and when they are promoted this way, they should be free of charge to patients. The colonoscopy is just one example: the cost of the procedure should not depend on the outcome, but apparently, some of these charges are hitting patients who did not have prior knowledge that their chosen “preventative services” might result in a medical bill of up to several thousand dollars. Patients can educate themselves by asking doctors before the preventive screening what situations can prompt a fee and estimated charges.


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