Colonoscopy with history of polyps

[seslinger]

If you have a Medicare pt & all the dr. notes is "history of polyps" (Z86.010), would you code the G0105 (high risk) or G0121 (not high risk) ?
And does anyone have the current criteria for high vs. not high ?

thank you so much.
Sheila, CPC

 

[WaterJunkie]

If you have a Medicare pt & all the dr. notes is "history of polyps" (Z86.010), would you code the G0105 (high risk) or G0121 (not high risk) ?
And does anyone have the current criteria for high vs. not high ?

thank you so much.
Sheila, CPC

Hi Sheila,

For a "history of polyps" (Z86.010) you would code G0105.
Documentation to support this is below.


Medicare considers an individual who is at high risk for developing colorectal cancer as one who has one or more of the following:
Close relative (sibling, parent or child) who has had colorectal cancer or an adenomatous polyp.

Family history of familial adenomatous polyposis. (Z80.0)
Family history of hereditary nonpolyposis colorectal cancer.
Personal history of adenomatous polyps. (Z86.010)
Personal history of colorectal cancer.
IBD, including Crohn?s disease, and ulcerative colitis.

Hope this info helps.

Richard, CPC-A

 

[slphillips77]

High Risk Colonoscopies

We are having a problem with G0105 for PH of polyps (Z86.010). Most if not all insurance are dening us. We have been advised to use screening dx (Z12.110 ) before appling PH (Z86.010)

I have multiple patients as well that are UC, and we are being denied G0105 with UC (K51.00) that it is not payable.

Can anyone advise on what we may be doing wrong.

Thank you,
Stephanie