Hello, this is what there referencing. Personally, you both right. Colonoscopy are a little tricky because you have the SCREENING VS DIAGNOSTIC element to the coding. Some payors just need Z86.010 alone to get paid on HIGH RISK. Even though I think coding instructs that it can't be billed alone. I don't add Z12.11 with Z86.010 unless it's the insurance is requesting it.
Screening, Surveillance, and Follow-up Colonoscopy
The AHA Central Office on ICD-10 has received several requests whether previously published advice about screening colonoscopy still applies. The previous advice is still relevant, and the following questions and answers are intended to help further clarify the correct coding of these outpatient encounters.
Question: A 55-year-old male underwent screening colonoscopy and a large polyp was found. Due to its size, and the inability of the gastroenterologist to visualize the base of the polyp, it was only partially removed. The pathology confirmed tubulovillous adenoma and the provider recommended a follow-up colonoscopy in three months. How would this encounter be coded?
Answer: Assign code Z12.11, Encounter for screening for malignant neoplasm of colon, as the first-listed diagnosis for the screening colonoscopy. Assign code D12.6, Benign neoplasm of colon, unspecified, as an additional diagnosis.
Whenever a screening examination is performed, the screening code is the first-listed code. The fact that the test is a screening examination remains, regardless of the findings or any additional procedure that is performed as a result of the findings.
Question: The above patient returns to the gastrointestinal (GI) lab for repeat colonoscopy since the entire polyp could not be removed during the initial encounter. A polypectomy is carried out in which the entire polyp is excised. The provider recommends a surveillance colonoscopy in three years. What are the appropriate diagnosis code(s) for this encounter?
Answer: Assign code D12.6, Benign neoplasm of colon, unspecified, as the first-listed diagnosis. The reason for the encounter is for removal of the remaining polyp.
Question: A patient, who is status post removal of adenomatous colon polyps five years ago, presents to the GI lab for surveillance colonoscopy. The colonoscopy is completely normal and the provider recommends surveillance colonoscopy in ten years. What is the correct diagnosis code assignment?
Answer: Assign code Z12.11, Encounter for screening for malignant neoplasm of colon, as the first-listed diagnosis for the surveillance colonoscopy. Code Z86.010, Personal history of colonic polyps, should be assigned as an additional diagnosis.
A surveillance colonoscopy is still a screening, and patients are being screened for malignancy; however, it is considered a high-risk screening exam due to the history of previous polyps.
Question: A patient is status post colon polypectomy for an adenomatous polyp. Because of the suspicious nature of the polyp and potential for malignant transformation, the patient is being seen for a follow-up examination six months after excision
of the polyp. The colonoscopy is negative for any recurrence of the polyp. What is the correct code assignment for this encounter?
Answer: Assign code Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm. Code Z86.010, Personal history of colonic polyps, should be assigned as an additional diagnosis.