Wiki Help with 00813

[csmith90]

Hi All & Happy 2026!

Does anyone have information they can share in regard to coding 00813 correctly?
If the colonoscopy is done because the previous year the patient had a colonoscopy completed but had poor bowel prep, would you still code this new procedure with Z12.11? Her previous report from a year ago indicates that a polyp was removed at that time but findings for this procedures were grade 3 internal hemorrhoids and report does not indicate that any polyps or specimens were taken.

Thanks!

 

[LisaAlonso23]

The coding of colonoscopy cases depends on several factors:

1. Was an EGD performed in the same encounter? 00813 is coded only when an EGD is performed in the same encounter. Otherwise, 00811 or 00812 would be the codes to select.
2. What does the op note state as the reason the colonoscopy was performed? This will determine how you would code the diagnosis & the correct ASA code.
3. What is the insurance? The diagnosis & the insurance help determine whether to use ASA code 00811 or 00812.

 

[csmith90]

Hi Lisa,

I appreciate your help in navigating this CPT code. In response to your questions
1. Yes, the EGD was performed during the same encounter as the colonoscopy.
2. The op note indication is that "the patient is presenting for repeat colonoscopy due to her prior colonoscopy having poor bowel prep and noting a polyp was removed." The preop diagnosis is "history of colonic polyps and poor bowel prep."
3. Insurance is Medicare.

 

[LisaAlonso23]

Poor prep is not an acceptable diagnosis for a procedure. The provider needs to indicate the codable diagnosis.
The diagnosis for the EGD is also important. For example, if the patient is experiencing abdominal pain, Z12.11 may not be coded per the ICD-10 guidelines.

00813 is the correct ASA code in this case.