Question SURVEILLENCE COLONOSCOPIES

stogsmom3

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How would you code a surveillence colonoscopy that a patient was found to have hyperplastic polyps found on a previous colonoscopy?

Would this be billed with Z09 & Z86.010 or Z12.11 & Z86.010. I normally wouldn't bill Z12.11 with Z86.010. Some providers treat this with reverting back to screening after so many clears. I didn't think that was a thing with history of colon polyps. I've always thought screening to be asymptomatic and no personal history.

I've found so much contradicting information. Looking for advise from an experienced coder.
 

clarkmegan

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Local Chapter Officer
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Newport News
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I would not code Z86.010 for hyperplastic polyps because they are not considered neoplasms. Z86.010 is for personal history of benign neoplasm. I would code Z12.11 instead.
 

katemae84

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The discovery of polyps on a previous screening colonoscopy does not preclude a patient from receiving screening colonoscopies in the future. If that were the case, there would be no such thing as high-risk screening colonoscopies and the G0105 could be deleted right out of the HCPCS book! ;)
Hyperplastic polyps are not colon cancer, so a screening diagnosis of Z12.11 is still appropriate for subsequent screening colonoscopies with any personal or family histories listed as secondary diagnoses. I list Z12.11 as the primary diagnosis, then add Z87.19, Personal history of other diseases of the digestive system, for the history of hyperplastic polyps.
 

thomas7331

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You will actually need to look at your payer policies on this - this is an area that is more determined by payers than it is be coding guidelines. For example, Medicare does consider a patient with a history of polyps to be eligible for a screening service, which is paid at the preventive services benefit level. UnitedHealthcare, on the other hand, per their medical policy, considers a patient with a personal or family history of polyps to be ineligible for a screening and any further colonoscopies are treated as diagnostic for payment purposes (unless the particular plan they are administering has opted not to follow the policy).

The USPSTF, quoted in part above, has indicated that they have not included patients who are considered 'high risk' as part of their studies and recommendations, which means that payers are not required under the Affordable Care Act to recognize colonoscopies as screenings for these types of patients, which would otherwise be covered as preventive benefits.
 

ReignRuby

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Thank you thomas7331. Are you able to provide where I can find the payer policies for Medicare regarding screening colonoscopies? I have been looking for quite some time with no luck.[/QUOTE]
 

thomas7331

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Thank you thomas7331. Are you able to provide where I can find the payer policies for Medicare regarding screening colonoscopies? I have been looking for quite some time with no luck.
Medicare coverage is detailed in NCD 210.3 which you can find here:

You can also find the information on Medicare preventive services chart:
 
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