Wiki Surveillance Colonoscopies

Create Wiki
C

clp5775@icloud.com

Guest
Messages
3
Location
Titusville, FL
Best answers
0
Just wanted to get clarification on the new Tip added to Z12.11 Encounter for screening for malignant neoplasm of colon. It states, "Surveillance colonoscopies area a type of screening exam used to screen for malignancies in those patients with history or polyps and/or cancer (previously removed)." Is it now correct to bill Z12.11 + Z86.010 and/or Z85.038? I know prior to this we could not bill them together. Any clarification would be greatly appreciated. :)
 
Last edited:
I think it’s based on payer specific. I code GI and don’t use the Z12.11 as primary. If it’s for Z86.010 I just use that code as primary. I haven’t had any issues.
 
I had a colleague tell me that the local BCBS office told her to code Z12.11 AND Z08 if it's a patient with a history of cancer or Z09 if it's a history of polyps and to append modifier 33. Are you using modifier 33 on the surveillance colonoscopies?
 
I am a coder and Practice Manager but the coders in our office all code Z12.11 and then the findings on our surveillance scopes and we receive a lot of denials on our surveillance scopes due to being performed too soon for screening, so I am trying to find out if there is a better way to code the follow-ups when they need to be done before the 5 or 10 year mark.
 
If the patient needs to come in before the 5 or 10 year mark why would you be using the screening or surveillance codes? Wouldn’t this be for a problem then? If not and you know it’s too soon why are you scheduling the visit for their screening colonoscopy?
 
We code both

At our center, if a patient presents with a personal history of cancer or a personal history of colon polyps and is presenting for a screening, we code both diagnoses if the provider gives them to us. We list it in the order he or she provides it on the Operative Report. I haven't seen anything stating that if both diagnoses are present and one does not exclude the other, they can't be coded together. Occasionally we will have a case returned to us from billing and they indicate that insurance prefers a preference for one diagnosis listed prior to the other. If both are documented by the physician in the original report and the physician issues an addendum to reorder the diagnoses on the claim, we do. If Insurance "A" says they want the diagnoses presented in a different order than what passes fine for Insurance "B" and the physician agrees that the diagnoses are of equal importance and can be swapped, I'm fine with swapping them. We have been in contact with our providers' offices to help them understand that insurance preference on the order of these diagnoses can cause denials.
 
You must log in or register to reply here.
Top