Looking for help with preventative colonoscopy screening

[u/Subject_Narwhal_6072]

So I visited my PCP looking for a referral due to an extensive family history of Colon Cancer (both of my parents were screened and had polyps removed, my Paternal aunt was diagnosed with stage 3 colon cancer at age 40 and died shortly after. Other paternal aunt had polyps removed too. So I pushed my doctor with this information to give a referral for a preventative screening colonoscopy at an earlier age. Was referred to the GI place and did a consultation there. I was able to get a pre auth from insurance but it was mis-coded as a Diagnostic. I was hoping that due to my family history that I could get this as a preventative screening so I could have peace of mind. A friend of my girlfriend's had recently passed away from surprise colon cancer too in her early 40s so I was extremely on edge. I could use any advice or help with writing a letter to my PCP and the GI Doc to help get this coded as a preventative screen even though I am only 36, I feel like I am a high-risk individual due to my familiy history.

Any help would be appreciated with how I can write a letter or what I can say to help my case in getting this coded correctly for insurance. Thanks!

[u/twisted_german]

Did they remove any polyps or find anything else they had to biopsy? I would go to the GI and ask them why they coded it it as diagnostic and see if it could be resubmitted. I have a family history, and had one at 49 which was under the recommended age at that time, and I got preauthorization and it was covered.  But it was completely normal and I didn't have any biopsies or anything like that.

If you don't doesn’t have any gastrointestinal symptoms and they didn't find any polyps or other abnormality, colonoscopy is considered preventive screening.  That's literally the definition of screening. It doesn't matter if you are at increased risk, as long as you yourself haven't been diagnosed with anything yet and don't have any symptoms.  However, insurance companies have to pay for screening that follows USPSTF recommendations, and they really don't address people under age 45. So even if it is coded like a screening, they may not pay for it, but it's worth a shot.