Wiki What ICD 10 and CPT to use for post transplant patient for routine colonoscopy with Medicare?

[patdow]

We have a post transplant patient who had a colonoscopy in 2016. We used Z12.11 and Medicare paid. Patient did not have any other dx findings on report. Our transplant patients need to have routine colonoscopies every 5 years. Medicare denied her recent claim with Z12.11 and G0121. What ICD 10 code and CPT code should I use to get Medicare to pay?

 

[mconner001]

You don't mention the kind of transplant. Liver? Does Z85.05 apply? Have you looked at current LCDs? Noridian Medicare has an article A57343 that provides a list of appropriate diagnosis codes. Does your Medicare carrier have anything like it?

 

[patdow]

You don't mention the kind of transplant. Liver? Does Z85.05 apply? Have you looked at current LCDs? Noridian Medicare has an article A57343 that provides a list of appropriate diagnosis codes. Does your Medicare carrier have anything like it?

The patient is post liver transplant. Z85.05 does not apply. I will look into the article. Thank you for the suggestion.

 

[LisaAlonso23]

Look at Z48.23.