Wiki Colonoscopy dx history of multiple cancers

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debemrxs4@aol.com

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Hello, I have a patient who is not due for a screening colonoscopy until 11/2026, however her pulmonologist is referring her for an earlier screening because she has had 2 cancers ( lung cancer and endometrial cancer). How would I code this-Should I use the Z12.11,C54.1,Z85.118
(currently has the endometrial cancer)----Or should I use the CANCER CODE as primary, that's the primary reason for the referral?
Thanks for your help!
 
I changed my response because now that I'm thinking about it this does sound like it could be considered a screening colonoscopy because the patient isn't having any signs/symptoms. The colonoscopy is being performed to see if any polyps or cancer is present because of their history of lung and endometrial cancers. I would just make sure that your GI provider clearly documents that this is a screening colonoscopy.
 
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I agree with the post above but would just add that the definition of a covered screening varies from payer to payer. 'Early' screenings such as this are covered by some payers for patients who are considered high risk, and the criteria for what qualifies as high risk may vary. I don't believe this would meet Medicare's definition of a high risk screening. You may want to review the payer policies of this patient's insurance plan to see if this cancer history qualifies them for high risk screening. If it does not, then the payer will likely consider this a diagostic procedure and may require you to bill it that way.
 
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