Wiki Pre-Op coding

[damiankelley3@gmail.com]

I am having a lot of trouble with some of my providers not stating the indication for surgery for pre-op exams. Here is the situation:
Pt presents for pre-op exam by clinic provider (not the surgery/procedure provider)
The scheduled procedure is a colonoscopy
No indication for the colonoscopy is stated anywhere in the chart (or previous visits that I can see)
Provider documents Z01.818 and no other dx codes

I am a pretty new coder but from my understanding of Z01.818 this would be the primary code with the reason for surgery reported 2nd followed by any other dx.
Adding Z12.11 - encounter for screening colonoscopy doesn't seem right to me.

Any advice on how to proceed here? I have queried the provider and have not received a response.

Can Z01.818 be reported on its own?

Thanks.

 

[LisaAlonso23]

If the patient is scheduled to have a procedure following the colonoscopy and that's the reason for the colonoscopy, Z12.11 is not applicable. I see patients have EGDs prior to bariatric surgery. In this case the EGD diagnosis is the same for the bariatric surgery.

You need to encourage your doctors to write out the diagnoses necessitating procedures and not provide you with ICD-10 codes, because they may not always be correct. In this case, Z01.818 is not correct.

 

[OpenClaims]

Z01.818 cannot be coded on it's own, insurance payors will likely deny the claim. I've seen this happen many times in my edits and denials. Z12.11 would not be applicable in this case, unless the person above and I are misunderstanding your question. You did the right thing by querying. If you haven't heard back, then follow your facilities guidelines on follow-up queries. I'd encourage you to talk to your manager and/or provider education team to see if they can be educated on this documentation. At this point, without a response, I would not code the encounter, pending query response.

Is this patient considered high risk and needing the colonoscopy for that, or is it a normal screening that will be done?