Regular screening increases the chances of detecting certain cancers early, when they are most likely to be curable. However, screening strategies vary in intensity and value. Many people have a lack of understanding about the trade-offs of screening. Studies report that patients and many physicians overestimate the benefits and are unaware of and/or downplay the potential harms of cancer screening. High intensity screening strategies are not necessarily high value care.
In a paper published recently in the Annals of Internal Medicine, the American College of Physicians (ACP) issued advice for screening average risk adults without symptoms. The advice focused on five common types of cancer: breast, cervical, colorectal, ovarian, and prostate. A companion piece was also published in Annals that outlined a framework for thinking about the value of varying intensities of cancer screening. With these attempts, the organization strongly encourages clinicians to adopt a cancer screening strategy that focuses on reaching all eligible persons with these high-value screening options while reducing overly intensive, low-value screening.
Five general concepts of the paper include:
- Screening is not a single test: It is a chain of events that may lead to benefit or harm. While those with true positive results are beneficial, patients with false-positive results may experience more harm and incur more costs.
- Cancer cases are not the same: Ideal screening strategies aims at finding cancer that will respond to early treatment. Detecting slowly progressive cancer cases takes time and the patient may experience more harm than benefit. So screening is worthwhile to find cancer type with intermediate progression.
- Patients are not the same: While some patients in good general health benefit from cancer treatment and live longer, other patients may not get any benefit from cancer treatment and will not live long due to other health problems.
- Screening can benefit or harm: While screening benefits certain cancer types and patients, it can also lead to significant harms for many other patients. Over diagnosis leads to different and more persistent harms.
- Determining the value is complex, but not impossible: To determine the value of these strategies, the balance between all benefits versus all harms and costs should be assessed. Both economists and the informed public could be involved in this assessment.
Medicare covers cancer screening tests and the physician performing the test will be reimbursed for services provided to patients. Certain tests that are not included are: HPV testing as a covered screening test for cervical cancer, virtual colonoscopy for colorectal cancer, and MRI (magnetic resonance imaging) along with a mammogram for women who are at high risk for breast cancer.
Providers must make sure to provide accurate and current diagnosis codes in their medical bills submitted to insurers. Here are certain cancer screening codes relevant for 2015.
ICD-9-CM codes
- V76.51 Special screening for malignant neoplasms of colon
- V76.12 Other screening mammogram
- V76.44 screening for malignant neoplasms of prostate
- V76.46 Special screening for malignant neoplasms of ovary
- V76.43 screening for malignant neoplasms of skin
- V76.9 Special screening for unspecified malignant neoplasms
ICD-10-CM codes
- Z12.11 Encounter for screening for malignant neoplasm of colon
- Z12.31 Encounter for screening mammogram for malignant neoplasm of breast
- Z12.5 Encounter for screening for malignant neoplasm of prostate
- Z12.73 Encounter for screening for malignant neoplasm of ovary
- Z12.83 Encounter for screening for malignant neoplasm of skin
- Z12.9 Encounter for screening for malignant neoplasm, site unspecified
If the coding and billing procedure proves to be time-consuming, consider obtaining the service of AAPC-certified coders and billers working at a reliable medical billing company to complete the medical billing process on your behalf.
Meghann Drella possesses a profound understanding of ICD-10-CM and CPT requirements and procedures, actively participating in continuing education to stay abreast of any industry changes.