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Family History of Colon Cancer

Stefanie

Networker
Messages
82
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0
Patient is young, started having surveillance colonoscopies, q. 5 years, at age 25 , due to a brother diagnosed with colon cancer and passing at a young age. Currently I am using the diagnosis of Z80.0 (Fx hx) as primary as the patient has not had any findings in his past scopes. Patient is now requesting we use the "screening" diagnosis as he states his insurance will pay 100% for a screening vs. deductible/copay for surveillance. I understand q. 5 years makes this definitely a surveillance scope, I'm wondering would it be inappropriate to use the screening diagnosis (Z12.11) in intervals, q. 10 years, as long as the scopes remain clear? Just trying to compromise with the patient. Thoughts?
 

thomas7331

True Blue
Messages
2,052
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0
I would recommend reviewing the policies and benefits of the patient's particular insurance on this for guidance because they vary quite a bit. The USPSTF recommendation on screening colonoscopies does not encompass patients in the high risk groups, and because of this, payers are not required to cover this situation as a preventive service benefit, so I would be hesitant to submit it to a payer as a screening if their policy specifically excludes it. I know for a fact that UHC policy states that they do not consider this situation a screening, but they, and other payers, may offer a 'high risk screening' as a benefit under a particular patient's or group's plan. But if the payer does not offer a screening benefit for high risk patients, then it would be inappropriate to code this as a screening simply to obtain a higher level of payment.
 
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DFUGET

Contributor
Messages
21
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0
It depends on the payor. Some you would bill that with just Z80.0, others will accept Z12.11 and Z80.0.
 
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