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nsteinhauser

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I am looking for a reference from CMS/Medicare that states you cannot code a screening colonoscopy diagnosis code along with a sign or symptom diagnosis code.
The definition of 'screening' means 'the absence of signs or symptoms', so in my mind you would never code them together. And this is what has been taught for the 20+ years I've been involved; the presence of a sign or symptom means it is no longer a screening. It then becomes a diagnostic procedure.
But now someone is asking for a reference/documentation from CMS/Medicare. I've got references from every coding organization you can think of but none from CMS. The only CMS reference I can find is for cologuard, etc., tests where the Medlearn Matters states that the patient must not have a sign or symptom. I can't find anything similar for screening colonosocpies.
Thanks in advance.
 
nsteinhauser said:
I am looking for a reference from CMS/Medicare that states you cannot code a screening colonoscopy diagnosis code along with a sign or symptom diagnosis code.
The definition of 'screening' means 'the absence of signs or symptoms', so in my mind you would never code them together. And this is what has been taught for the 20+ years I've been involved; the presence of a sign or symptom means it is no longer a screening. It then becomes a diagnostic procedure.
But now someone is asking for a reference/documentation from CMS/Medicare. I've got references from every coding organization you can think of but none from CMS. The only CMS reference I can find is for cologuard, etc., tests where the Medlearn Matters states that the patient must not have a sign or symptom. I can't find anything similar for screening colonosocpies.
Thanks in advance.
Click to expand...
Hope this helps!

Screening (pages 92-93)

Screening is the testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease (e.g., screening mammogram).

The testing of a person to rule out or confirm a suspected diagnosis because the patient has some sign or symptom is a diagnostic examination, not a screening. In these cases, the sign or symptom is used to explain the reason for the test.

A screening code may be a first-listed code if the reason for the visit is specifically the screening exam. It may also be used as an additional code if the screening is done during an office visit for other health problems. A screening code is not necessary if the screening is inherent to a routine examination, such as a pap smear done during a routine pelvic examination.

Should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis.

The Z code indicates that a screening exam is planned. A procedure code is required to confirm that the screening was performed.

The screening Z codes/categories:
Z11 Encounter for screening for infectious and parasitic diseases
Z12 Encounter for screening for malignant neoplasms
Z13 Encounter for screening for other diseases and disorders
Except: Z13.9, Encounter for screening, unspecified
Z36 Encounter for antenatal screening for mother

 
Thanks for this information. Question - Surveillance colonoscopies - Some of the societies say that if more than 10 polyps are found a surveillance colonoscopy is needed in one year.
In that case would you code a D12 code instead of Z86.010? Or use the Z code but not add a 33 or PT modifier?
 
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