Question Survelliance Colonoscopy

lamiller

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Murfreesboro, TN
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Scenerio.....Patient has commercial insurance and comes in for surveillance colonoscopy at 5 years, another polyp is found. Physician takes a cold forcep biopsy. I use Z86.010 and code it as 45380-33? What I seemed to be getting confused about is when I should add the modifier to bill as screening?
 

Pam Brooks

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Surveillance (without symptoms) for previously excised polyps is screening. This seems to be a point of confusion. Unless there is a symptom like bleeding, and as long as the previous polyp was removed, further colonoscopies are screenings. They are high-risk, but screenings just the same. Your coding is correct.
 

suchang78

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Scenerio.....Patient has commercial insurance and comes in for surveillance colonoscopy at 5 years, another polyp is found. Physician takes a cold forcep biopsy. I use Z86.010 and code it as 45380-33? What I seemed to be getting confused about is when I should add the modifier to bill as screening?
You miss the dx for polyp.
 
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Are adenomatous polyps D12._ are the same as regular polyp K63.5? If the person has the D12 type, you would not use Z12.11 correct?
 

suchang78

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Are adenomatous polyps D12._ are the same as regular polyp K63.5? If the person has the D12 type, you would not use Z12.11 correct?
Adenomatous polyp usually is indicated in the pathology report. If the pathology is ready at the time of coding, I would like to code it instead of polyp. If not, code it as K63.5. When patient was for screening colonoscopy but also had polypectomy at the same encounter. The final diagnoses should be Z12.11 ( as primary), secondary is whatever the finding + history code if indicated. CPT from screening colonoscopy changed to whatever diagnostic procedure was done with modifier " PT" for medicare or " 33" for Commerical insurances to indicated that patient was originally encountered for screening colonoscopy, but turned out diagnostic procedure.
 
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Adenomatous polyp usually is indicated in the pathology report. If the pathology is ready at the time of coding, I would like to code it instead of polyp. If not, code it as K63.5. When patient was for screening colonoscopy but also had polypectomy at the same encounter. The final diagnoses should be Z12.11 ( as primary), secondary is whatever the finding + history code if indicated. CPT from screening colonoscopy changed to whatever diagnostic procedure was done with modifier " PT" for medicare or " 33" for Commerical insurances to indicated that patient was originally encountered for screening colonoscopy, but turned out diagnostic procedure.
Thank you for your response! I am still not clear on when Z12.11 is indicated as the Dx on a person with history of adenomatous polyps and they are doing a surveillance colonoscopy again less than 1 year later. The modifiers are the indicator to the insurance company that this is not a "screening"? If no longer a screening why is a screening Dx code to be primary? This instance the colonoscopy is diagnostic, right?
 
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