Wiki E/M Billing For Medicare for a Personal History of Colon Polyps

[s7mich@hotmail.com]

Hello,

I need some clarification on how to bill for a Medicare patient that is coming in for a recall on a Colonoscopy that has a personal history of colon polyps. I have been told that you should always bill the Z12.11 first then the Z86.010 as the secondary code. Now this is for the E/M code. If the patient has a personal history should you not bill Z09 then Z86.010 on the claim going to Medicare instead of Z12.11 then Z86.010.

Please advise.

Thank You

 

[jamierenay]

medicare will not pay for an E/M visit prior to a colon when the visit is for screening unless they are coming in for a medical reason for the office visit.

example the doctor may need to adjust diabetes meds or stop blood thinning medications. Then you would bill the office visit with the diabetes code as primary then the Z86.010.