Wiki History of Colon Polyps

[tammyross]

Working for a physician who does not dictate/indicate whether colon polyps are hyperplastic or adenomatous when the patient is seen for a screening colonoscopy. Understanding that the patients don't really know if they were precancerous or not, how do you handle this situation? If the patient has a history of adenomatous polyps, the ICD 10 code Z86.010 is used and Z87.19 if the polyps are hyperplastic. We are finding this to be extremely challenging due to the 2 year or 10 year frequency on high/low patients. I can't find information on how this should be handled. I would very much appreciate any feedback/suggestions on the best way to handle this. Thank you in advance!!

 

[dobsonphillips]

Are you not reviewing the path report? Because at the time of the physician dictation he may not know until the information is reviewed by the pathologist.

 

[maurich]

Z87.19-Personal history of other diseases of the digestive system would not be the appropriate code use for hyperplastic polyps, I am a coding and compliance auditor for a very large GI practice. The code K63.5-Polyp of colon is used when there are no pathologic findings such as adenomas. Always be sure to check CGS Medicare Local Coverage Policies for your Medicare patients, and third party payors as well.

 

[thomas7331]

Z87.19-Personal history of other diseases of the digestive system would not be the appropriate code use for hyperplastic polyps, I am a coding and compliance auditor for a very large GI practice. The code K63.5-Polyp of colon is used when there are no pathologic findings such as adenomas. Always be sure to check CGS Medicare Local Coverage Policies for your Medicare patients, and third party payors as well.

The guidance to use Z87.19 for a history of hyperplastic polyps comes from the AHA ICD-10-CM/PCS Coding Clinic, First Quarter 2017, which states that since a hyperplastic polyp is not neoplastic, that Z86.010 is incorrect since that code category is only for classifying a history of benign neoplasms. While I understand this reasoning, I personally disagree with this guidance since the ICD-10 alphabetic index directs to Z86.010 for any personal history of polyps, regardless of type, and I also feel that Z87.19 is not appropriate since it is less specific and also goes against both coding conventions as well as most payer guidelines for the reporting of screening services.

To the original post, assuming you are referring to the type of polyp in the patient's history and not in the current encounter, if the specific type of polyp in the patient's history is not documented (which I've found it usually is not), then I code Z86.010 since that is correct per the coding conventions.