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Colonoscopy screening; Z12.11

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I recently coded a pathology report for a colonoscopy specimen (CPT 88305-26, DX Z12.11) which was denied payment by BCBS.

Pre-operative dx is: Screening for malignant neoplasm of colon.

In the report Gross description states:Specimen labeled, "colon polyp at 54cm." The specimen consist of tiny flecks of white material less than 1 mm. Collected in a tissue sack. All submitted.

Microscopic Description; Sample is crushed hemorrhagic colonic glands and stroma. There is no specific histological abnormality.

Final Pathological Diagnosis Large intestine, 54 cm, biopsy: No diagnostic alteration.

I've been asked by management to change the dx to D12.4 (Benign neoplasm of descending colon) and rebill the claim.

I don't feel the diagnosis D12.4 is supported by the dictation in the report and am looking for some outside opinions.

Any input is welcome, thank you.
 

mitchellde

True Blue
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You cannot code it a benign neoplasm since the path report does not support that diagnosis. You could code the K63.5 code for colon polyp since that is what the specimen is described as.
 
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Thanks! I really appreciate the input. After reviewing report, I did end up coding the polyp, not the neoplasm and re-billing the claim. Glad to hear a consensus.
 
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