Wiki Z12.5

[lansford87]

Hi,
I wanted to know if anyone uses Z12.5 on a commercial physical? I only use it on Medicare with the G0102. I don't believe it is wrong if it is on there or not, but I believe that it would be inclusive to the Z00.00 along with any other screenings done with a physical. I am having a friendly debate with my fellow coders, in which they believe it might get denied if missing. What does everyone else think?

 

[thomas7331]

Well, to start with, I'd make a friendly reminder to your fellow coders that whether or not to assign a diagnosis code is based on what is documented in the record, not on whether or not the claim might get denied.

Regarding Z12.5, that is for an encounter for screening so is only appropriate if a screening service is being done at that visit. If the provider is just doing a routine physical exam but referring the patient for a colonoscopy, then Z12.5 is likely not appropriate for the encounter.