1. M

    Wiki Z34.XX vs Z36

    When should Z36, encounter for antenatal screening of mother, codes be used? I'm not understanding the difference between Z34.XX and Z36 codes. In what situation would both be used vs just Z34XX. A lot of our OB providers with code both Z36.89 and Z34.XX. It seems like Z34.XX covers most...
  2. A

    Depression and Anxiety Screenings (96127)

    Do you charge for screenings for anxiety and depression (96127X2) if they are done during every psych visit (99202-99205 or 99212-99215)? I feel that these would be part of the E/M since they are done on every patient in the psych clinic, but I was wondering what views others had.
  3. N

    Using Z12.11 for both polyp removals for colonoscopies

    Has anyone seen if there's been a coding change regarding colonoscopies? When a patient has a screening colonoscopy, I of course use Z12.11 as the primary code, followed by polyp codes (if found). I've had a couple remits come back where they paid for 45385, but are putting 45384 towards their...
  4. A

    Wiki Denial dexa claims

    I have a 72 male patient with United healthcare Medicare plan coming iN did screening dexa. The insurance first denied the screening code, then denied it shin when we tried to bill as diagnostics dexa. Really don’t know what’s wrong with it....
  5. E

    Screening or Diagnostic?

    The patient presents for a visit stating that two weeks ago, she experienced vaginal burning and discharge. She treated herself with OTC Monistat, and her symptoms resolved. She would like to have a test run to see if she has a lingering infection. The provider runs a NuSwab, which returns...
  6. T

    History of Colon Polyps

    Working for a physician who does not dictate/indicate whether colon polyps are hyperplastic or adenomatous when the patient is seen for a screening colonoscopy. Understanding that the patients don't really know if they were precancerous or not, how do you handle this situation? If the patient...
  7. K

    Modifier with screening

    UHC started denying screening codes G0444, G0443 with mod 25. I tried 59, 51 and only XU works with Medicare plans. Did anyone bypass this denial with UHC? Thank you
  8. L

    Low Dose Lung CT Certification

    I had a client in IL ask me today where were are able to upload the Certification once certified for this screening. They weren't for sure if it would be in PECOS or not. I checked today and I do not see the option for these as you do Mammo Certification. For those of you who have been...
  9. M

    Billing E/M code for new pt STD screening only

    Our provider sometimes sees new patients at our walk-in clinic who only want STD screening and have no symptoms. An ROS and brief exam are always done. Can I bill an E/M code for these cases or just the lab draw?
  10. M

    Depression Screening

    I was wondering if anyone knows if you can bill the G0444 Depression Screening if the patient already has an existing diagnosis of depression? I have been researching this, however, I cannot find anything that says you cannot bill the G0444 for this situation. Thank you in advance!
  11. E

    Wiki Coding Clinic States use Z12.11 on High Risk Screening Colonoscopy???

    I reviewed documentation from a recent AskMueller seminar of GI coding and billing and it states to assign Z12.11 screening for malignant neoplasm as the primary diagnosis code for high risk screening colonoscopy, stating a surveillance colonoscopy is a screening colonoscopy. I had never heard...
  12. A

    T1023 - mental health screening

    Does anyone know what the requirements are for this code? Does it have to be face-to-face/ in-person or over the phone? I've been asked if this code can be used when a provider reviews documentation from a referral for a potential client. Thanks in advance.
  13. J

    Office Visit Before Colonoscopy (medicare)

    Medicare patient here for Office Visit before setting up a Colonoscopy, due to Personal History of Colon Polyps. Sent for EKG - will possibly need clearance before procedure, am I correct that I cannot charge for this visit as it is included in the Medicare global fee for Colonoscopy?
  14. E

    Z80.0 clinical edit error BCBS Michigan

    Anyone experiencing denials for Z80.0 with BCBS? I've run into several plans that are denying Z80.0 (family hx colon cancer) as an invalid ICD10 code for high risk screening colonoscopy. I've talked with provider services, reported the issue and believe since Oct 1st they have an error in their...
  15. J

    Surveillance Colonoscopy vs Screening

    I am beyond confused - I keep reading how to code screening vs surveillance colonoscopies and found this article which goes against everything I've been reading. Thoughts? On this site...
  16. A

    UHC Medicare Solutions denying PPD

    We are currently having an issue with UHC Medicare Solutions denying our claims for 86580 (PPD) with diagnosis code Z11.1. They are not dropping it to patient responsibility. They are telling us we must write it off. In conversations with them, they are saying we must get an ABN signed so...
  17. Lisa Griffin

    Wiki colonoscopy screening vs colonoscopy diagnostic

    Hi, Question, we seem to be having some confusion when it comes to ordering colonoscopies. For simple, asymptomatic patients who just need a screening we are using Z12.11 plus 45378. It seems that this confuses some of our patients when they see that 45378 is colonoscopy, diagnostic. If we are...
  18. A

    Bariatric Screening Lab?

    BCBS is denying our labs that we have ordered on our Bariatric patients due to not medically necessary. We order these to see if there are any comorbidities that the patient/physician isn't aware of. This really wouldn't be considered pre-operative lab work, as we haven't scheduled the surgery...
  19. C

    Medicare Denials for Screening Bone Mineral Density DEXA CPT 77080

    Hello, we are receiving denials for screening dexa scans CPT 77080 with diagnosis Z13.820 screening for osteoporosis. Per Medicare article MM5521, screenings are allowed every 2 years, but we are being denied. The denial is for NCD, as Medicare NCD 150.3 does not list the Z screening code...
  20. J

    Drug screening and confirmation

    We perform drug screen on our patients, and then repeat the screening to confirm results. Some of the codes we use are G6042, G6031, G6053. To be paid for both the screening and the confirmation, should we bill, for example, G6042 and G6058, Drug confirmation, each procedure; and G6031 and...
  21. T

    Pre-Op Visit for Screening Colonoscopy

    My director wants to bill for preop visit for patients who are coming in for screening colonoscopies. Instead of the nurse doing the H&P over the phone, the patient would come in and see the nurse practitioner. Could we bill a low level E&M code for this?
  22. C

    Screening Colonoscopy and Anestheisia

    Screening Colonoscopy and Anesthesia If a patient is having a screening colonoscopy G0121, G0105, or 45378-33. Lets say a non-medicare patient was coded with a G0121 and DX Z12.11. G0121 is accepted by most commercial insurance companies so this should be fine. When its time to bill...
  23. R

    Wiki Behavioral Health screening

    Which CPT code would I use to bill for a Behavioral/Mental health screening? 15 minutes. 96152-96152 are for assessments and that's not what I'm looking for. The code would be used by LCSW's. Thanks. Roma
  24. C

    Routine Laboratories

    Hello, I was really hoping someone can help me obtain the ICD-10 diagnosis code for routine labs? We have several Medicare patients who have had there labs denied because Medicare does not cover routine. What if the patients are healthy and the physician is screening for something that does not...
  25. K


    I have a question on this code. This code is for a metabolic disorders which is you body isn't processing food correctly causing organs to become diseases or do not function normally. I have offices giving this code to verifi prenatal test screening for chromosomes 18, 21 and 13. Am I correct in...
  26. A

    Colonoscopy coding - When coding for the physician

    When coding for the physician preforming the colonoscopy, is it ok to just code the colonoscopy from only the op note and not look back at the H & P or Pre op notes? I have heard some other coders are doing this. The reason I ask is that a Dr. may mention symptoms (rectal bleeding possible from...
  27. D

    Coding for screening exam

    I work for an ophthalmologist and I have a patient who presented for "routine" exam, but has family history of glaucoma. (VISIT WAS JULY 2015 SO ICD-9!) Patient has enlarged cup to disc ratio and as such is considered "glaucoma suspect". What is the best way to code this exam so that Aetna will...
  28. M

    Wiki Billing 99408

    If my provider wants to bill the 99408 code for alcohol and/or substance use screening, 2 questions: 1. Does the 15-30 minutes include the time spent in the exam or is this an additional 15-30 minutes on top of the exam spent doing the screening? 2. Since this is a screening code along with...
  29. C

    Glucose screening test / help

    Glucose screening test / help code 82951 ? Is the glucose screening test included in the OB package or can the provider office bill for the actual test ?
  30. B

    Screening tests for skin cancer

    Are there any CPT or HCPCS codes specifically for the screening of skin cancers? I think I know the answer but I want to be sure.
  31. L


    We are getting denials for code G0477 which took place of G0434. This is the urine drug screening. Has anyone else experienced this? The dx is Z79.899
  32. K


    Can someone explain z36 to me. If a patient is having a prenatal test is shows in the code book z36. Can other codes be used with this code on a prenatal test? Also for carrier screening test this code would not work you would need z31.43- if I'm understanding it correctly. Thank you, April
  33. S

    Wiki Outpatient colonoscopy

    Hello everyone. I am a coder but do not code for facilities and I am having a personal issue with the hospital coding. 5 years ago I had 1 polyp that turned out to be tubular adenoma. resection fof 12 in of my intestine. Had a repeat colonoscopy 2 years later. I went in again recently for a...
  34. S

    When to bill screening codes?

    Lets say a new OB pt comes to our office and they have the routine labs drawn but also want an STD check. Is it necessary to detail each one out? Or would the correct option be to code the Z34.XX code for routine care, a Z36 for antenatal screening, and the the weeks of gestation? Or would I...
  35. T

    "screening labs" help please

    Our patients are getting bills for labs done as part of their physicals. Mostly for Vitamin D. How are you suppose to code for labs other than the Z00.00. Especially if the patient doesn't end up having any of the problems you are testing for. These tests are expensive, how do you know if...
  36. B

    Drug Screening- have been calling

    I have been calling on VOB's and a few of the insurance companies are not recognizing the G0478 drug screening code , yet they are saying the G0431 is still a billable code. It was my understanding the G0431 was a deleted code as of 2016. Anyone else running into this problem ?
  37. N

    Annual exam with screening test for sti code z11.3

    Please help i have read the guidelines in icd-10 about 10 time and i can not find the answer. Patient comes for an annual exam z00.00 or z01.419 and the provider orders sti test. In icd-9 we used v74.5 screening for sexually transmitted disease. In icd-10 i used z11.3 encounter screening for...
  38. N

    Annual exam with screening test for sti code z13.4

    Please help i have read the guidelines in icd-10 about 10 time and i can not find the answer. Patient comes for an annual exam z00.00 or z01.419 and the provider orders sti test. In icd-9 we used v74.5 screening for sexually transmitted disease. In icd-10 i used z11.3 encounter screening for...
  39. P

    Wiki NEED FAST HELP re; G0105

    Hi all, I'm hoping to get some fast help on this topic as we run into this scenario all the time at our facility and us in coding keep butting heads about the right way to go about it. There does not seem to be clear documentation out there as to when a patient is considered "high risk" allowing...
  40. A

    Wiki Help: Pom Screening

    Can someone please tell me how to bill for a Carotid Artery screening and a Peripherial Aterial Disease screening? I have never heard of these type of screening before and could really use some help.:confused: Thanks Antonniette -CPC
  41. D

    Wiki Screening Colonoscopy Coding

    I have worked at an ASC for 7 years. At a round table the other evening, a hospital coder said that if a patient is booked for a screening colonoscopy, and a polyp is found- code V76.51, followed by 211.3..... I was always taught that in this instance the procedure becomes surgical and to code...
  42. A

    Hep tidor

    I have a child that is being tested for hep antibodies after immunization due to mom being positive for virus. Do I code as a screening for virus or as tidor? What code do I use? I cannot find it anywhere. thanks