Wiki Positive Cologard Billing

selenasta

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New legislation that becomes effective 6/1 that will allow for commercial plans to allow for patients who have had a positive Cologuard test to still receive their screening benefits when a colonoscopy is performed. Will you bill a Z12.11 as the diagnosis code along with a R19.5 for the positive Cologard or have you been given any information on how this will be coded? I am concerned that the R19.5 would still trigger diagnostic benefits if used. Would a 45378-33 modifier addition work with R19.5? Also, I have has some docs use R85.89 "stool DNA based colorectal screening positive" as the coding for Positive Cologuard. Is R19.5 or R85.89 the appropriate code?
 
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R19.5 is the correct code for a positive Cologard test as of now. How we will code this is dependent of direction from CMS. I'm not finding this information anywhere. Please share the link. Thanks!
 
Last edited:
R19.5 is the correct code for a positive Cologard test as of now. How we will code this is dependent of direction from CMS. I'm not finding this information anywhere. Please share the link. Thanks!
 
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