Surveillance Colonoscopy vs Screening

thomas7331

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I think it's confusing in the way it's been worded in that article, but I think the point is that surveillance in documentation can mean different things in different contexts. She's talking initially about surveillance after a previously removed polyp, which is not a malignancy, and I agree - that would be a screening (high-risk due to the history of polyp and done more frequently, but still a screening). In my experience, providers more often use the term 'surveillance' when looking for a recurrence of a malignancy or tumor that required treatment beyond just the removal that occurs during a routine colonoscopy - that kind of surveillance would be coded as follow-up care, not screening, which I'd also agree with if I'm following correctly.
 

JanRebecca

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She is saying you CAN use code Z12.11 and Z86.010 as secondary coding to get a colonoscopy paid under screening benefits - however from what I've read on this site most feel that is not correct coding. That Z12.11 and Z86.010 cannot be used together ?? This is where my confusion is!
 

jfolz

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She is saying you CAN use code Z12.11 and Z86.010 as secondary coding to get a colonoscopy paid under screening benefits - however from what I've read on this site most feel that is not correct coding. That Z12.11 and Z86.010 cannot be used together ?? This is where my confusion is!
I felt the same way about using the 2 dx codes together when the hospital I work for instructed us to code them together. I had been under the impression that you would drop the screening Z12.11 if ANY other symptom was presented and Z86.10 could be considered a symptom. I looked everywhere and was never able to find anything official about not using the 2 dx codes together. I have been coding them together since instructed by my employer and using the rationale that Z86.010 is not an ACTIVE symptom, only a history of a condition that may warrant more often SCREENING an individual.

I am following this thread, as I am very interested to hear other takes on the subject:D
 
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JanRebecca

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I felt the same way about using the 2 dx codes together when the hospital I work for instructed us to code them together. I had been under the impression that you would drop the screening Z12.11 if ANY other symptom was presented and Z86.10 could be considered a symptom. I looked everywhere and was never able to find anything official about not using the 2 dx codes together. I have been coding them together since instructed by my employer and using the rationale that Z86.010 is not an ACTIVE symptom, only a history of a condition that may warrant more often SCREENING an individual.

I am following this thread, as I am very interested to hear other takes on the subject:D
Yes! and everything I read just makes me more confused!!!
 

AGambino

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Adding to this...

I have had some many questions about this.

Say I have a patient come in with a personal history of cancerous polyps I was under the assumption to code as Z08 and Z86.010 the more I read says I should be using Z09 and Z86.010.But when I read the above article and this thread I see to bill as Z12.11 and Z86.010. How do I determine if I should code Z09 and Z86.010 or Z12.11 and Z86.010???
 
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marandee

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Surveillance Colonoscopies

I am researching the use of modifier -33 which represents to insurance that patient is not responsible for coinsurance or copay on this preventative service.
Ex: - initial colonoscopy screening: Z12.11 and findings of polyps (removed / benign).
Three years later and as instructed for 'surveillance', the patient schedules another colonoscopy. This colonoscopy is with Z86.010 as main reason for surveillance colonoscopy, not deemed a screening due to history of polyps.
With modifier -33 appended to this colonoscopy, I believe insurance will cover the colonoscopy, though not a screening and within ten years of initial screening because it is in fact a preventative service and listed on the USPSTF A and B recommendations (and the service is not a separately reported service specifically identified as preventive).

IS anyone using modifier -33 and can offer additional advice? (Medicare is modifier PT).

Thanks.
 

thomas7331

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Actually the USPSTF recommendations do not apply to patients with a personal history of polyps or cancer, so I believe that commercial payers are not required to cover this at the preventive care benefit level: "This recommendation applies to asymptomatic adults 50 years and older who are at average risk of colorectal cancer and who do not have a family history of known genetic disorders that predispose them to a high lifetime risk of colorectal cancer (such as Lynch syndrome or familial adenomatous polyposis), a personal history of inflammatory bowel disease, a previous adenomatous polyp, or previous colorectal cancer. When screening results in the diagnosis of colorectal adenomas or cancer, patients are followed up with a surveillance regimen, and recommendations for screening no longer apply. The USPSTF did not review or consider the evidence on the effectiveness of any particular surveillance regimen after diagnosis and removal of adenomatous polyps or colorectal cancer."

I think you would need to look at individual payer policies to see what their criteria are in order for the colonoscopy to be considered a screening and to get a definitive answer on how they expect it to be billed. Medicare does still consider it a preventive service - a 'high risk' screening, but UHC, for example, in their commercial policy states that they consider it to be a diagnostic procedure once the patient has a history of polyps.
 

navila0508

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ask mueller consulting

you will add a modifier 33 to CPT code bill z86.010 with whatever else was found and they will cover as screening
-PT modier is used for Medicare Replacement Plans and is the same thing

I attend AskMueller COnsultings workshop every year. Great tool
 
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