Summary & Overview
HCPCS M1379: 10-Year Colonoscopy Follow-Up Not Recommended, NOS
HCPCS Level II code M1379 documents that a standard 10-year colonoscopy follow-up interval is not recommended for a patient for reasons not otherwise specified. This code captures an important clinical decision point in colorectal cancer screening management: when routine long-interval surveillance is inappropriate. Nationally, clear documentation of surveillance recommendations affects continuity of care, appropriate scheduling, and quality measurement for colorectal cancer screening programs.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code's clinical context, typical settings where the code is used, and what to expect in terms of documentation requirements. The publication outlines benchmarks and policy-relevant considerations for payers and providers, including coding purpose, implications for screening intervals, and areas where additional payer-specific guidance may be required.
This summary provides a concise reference for clinicians, coding professionals, and policy analysts seeking to understand the role of M1379 in documenting deviations from a 10-year surveillance interval after colonoscopy, and what national payers commonly consider when reviewing such documentation. Data not available in the input for payer-specific coverage rules, related taxonomies, and ICD-10 mappings.
Billing Code Overview
HCPCS Level II code M1379 indicates that a 10 year follow-up interval for colonoscopy is not recommended, with the reason specified as not otherwise specified. The service type reflected by this description is colorectal cancer screening follow-up decision documentation, documenting that a standard 10-year surveillance interval after colonoscopy is not appropriate for the patient for unspecified reasons.
Typical site of service for documentation related to colonoscopy follow-up intervals is outpatient gastroenterology clinics or ambulatory surgical centers where colonoscopy results and follow-up plans are reviewed and recorded.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a prior colonoscopy performed five years earlier presents for routine colorectal surveillance. During a recent clinical visit the gastroenterologist documents that a standard 10-year follow-up interval for colonoscopy is not recommended; the reason is not otherwise specified in the record. The patient is referred to endoscopy scheduling for reconsideration of timing and possible alternative surveillance strategies (e.g., shorter interval colonoscopy, fecal immunochemical testing, or symptom-driven evaluation). Typical workflow: pre-procedure evaluation in clinic or by phone, informed consent, review of prior pathology and colonoscopy findings, determination of surveillance interval, and documentation of the justification for deviating from standard 10-year screening intervals. Procedure-related billing uses the HCPCS Level II code M1379 to indicate that a 10-year interval is not recommended for colonoscopy for this patient.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for colonoscopy and supported by documentation. |
23 |