Wiki Surveillance Colonoscopies with current polyps

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meghanb413

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Trying to get a little bit of clarification when it comes to "surveillance" colonoscopies.

Situation: patient has a personal history of polyps [Z86.010] and new polyps [K63.5] are also found during this current procedure.

What diagnosis codes should be used/in what order?
 
meghanb413 said:
Trying to get a little bit of clarification when it comes to "surveillance" colonoscopies.

Situation: patient has a personal history of polyps [Z86.010] and new polyps [K63.5] are also found during this current procedure.

What diagnosis codes should be used/in what order?
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Z12.11, then history and founding.

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.
 
meghanb413 said:
In this specific instance it's a United Healthcare plan that is handled by Harvard Pilgrim.
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If it's UHC, you need to use Z86.010 followed by the polyp code (ie, K63.5, D12.0, D12.2, D12.3, etc). UHC does not consider a colonoscopy for patients with a history of polyps or colon cancer to be a screening. Although it goes against the coding guidelines to code a history of polyps with a finding of a new polyp, we may do so if the insurance has a policy. Please know this is very new.
 
LisaAlonso23 said:
If it's UHC, you need to use Z86.010 followed by the polyp code (ie, K63.5, D12.0, D12.2, D12.3, etc). UHC does not consider a colonoscopy for patients with a history of polyps or colon cancer to be a screening. Although it goes against the coding guidelines to code a history of polyps with a finding of a new polyp, we may do so if the insurance has a policy. Please know this is very new.
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I don't know the billing and insurance part. I code for hospital, we use coding clinic for our guidelines. So far, I don't get any denied case back from billing department.
 
I am also confused as what to be billing. BCBS insurance. Patient has history of polyps Z86.010 comes back in for surveillance dr. doesn't find anything.
Would Z12.11 with Z86.010 and an asa code of 00811?
 
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