Wiki Z15.09 as reason for colon biopsy specimen

[Lcubed]

Hello all.

With the ICD guideline change for Z15.09 as primary we are seeing denials. We have always coded the Ordering reason as our pathological diagnosis if no abnormalities are seen.
Should we now code as a screen, i.e. Z12.11 etc. and then add the Z15.09 as secondary?
I would think we would want the endoscopy team order as a screen as well so that code is on our order?

Thinking out loud and wondering what our options could be.

Thank you in advance!

Laura

 

[TThivierge]

Hi Lcubed
You must have provider give a reason for doing colonoscopy. Those Z codes are not first listed and give no definitive illness info to the payer, too generic. Was the colonoscopy done for any reason such as dx codes of R15, K21.9,R19. K59 or K92? Or just searching for digestive lower gastro problem? I d always use a definite dx related to cause from provider s data. Maybe you could try as dx K63.8 Other disease of intestines first dx then add dx Z12.11. This might be a better choice in conjunction with situation.
I hope I helped you.
Lady T