question. my insurance covers "colonoscopies" 100% after the age of 50. How can our pouchoscopies fall in the same category to be covered? do we ask the doctors to code the pouchoscopy as a colonoscopy?? how does this work?
Replies sorted oldest to newest
I am also looking into this as well since my insurance is changing. I believe others have said it is coded as a sigmoidoscopy. If that is what my surgeon does, I will be covered.
When I spoke with my insurer (Tricare), she mentioned CPT coding so I looked it up and there is separate coding for Colonoscopy, Sigmoidoscopy and Pouchoscopy as well as with biopsy as of 2015. I guess it depends on what code is used and what your insurer will pay.
It's just wrong if I have to pay for an annual pouchoscopy if colonoscopy is covered 100% after age 50. How is that fair?
You're absolutely right! Especially because it should be considered preventative, in my case I had dysplasia prior to my surgeries.
So here is my experience, and my husband's, and my son's (we all have UC). The 100% covered colonoscopy is for routine preventative care (and at the same frequency, like every 5-10 years). Once the procedure is for monitoring a known condition or for diagnosing symptoms, it is not routine preventative and is not coded as such, even though there is a preventative component.
That said, at least my premium rates are not based on my diagnoses, but only age and zip code (at least for now).
Jan 