Wiki Z12.11 not a primary dx?

[gconcienne]

I am getting denials on Z12.11 as not a primary diagnosis.

Patient is being seen by the General Surgeon with no symptoms. She has no family history either. Was referred for a screening colonoscopy. What diagnosis am I suppose to use as primary?

 

[syllingk]

need more info. Are denials for office visit before scope? All payers or just some? Not all will pay for a visit before screening. Medicare won't.

 

[mitchellde]

The coding guidelines state:
A screening code may be a first-listed code if the reason for the visit is specifically the screening exam.
The Z code indicates that a screening exam is planned. A procedure code is required to confirm that the screening was performed.

So if you are trying to use the Z12.11 code for an E&M visit it will not work.
Possibly a Z01.818 for encounter for preprocedural exam
However many payers may still deny then encountwr.

 

[pscott]

z1211

I had the same question, kind of. Our surgeons have been using z1211 for the encounter before the scope, as before they had used v76.51. I am unaware of any denials at this point, but am wondering also if thats the correct DX to use before a scope when the decision is made to do the scope. Thanks!