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Colonoscopy Screening and when to use ICD-10 Z12.11

Camille Posted Sat 02nd of November, 2019 14:23:54 PM
Qu#1) Should I code Z12.11 (Encounter for screening for Malignant Neoplasm of Colon) as the first listed ICD-10 for ALL planned Medicare AND Commercial payer screening colonoscopies? For example G0105 / Z12.11, Z86.010 or 45378 / Z12.11, Z86.010. Qu#2) Should I code Z12.11 for a screening colonoscopy that turns into a therapeutic colonoscopy? For example: if a polyp was found and removed by snare technique during a screening colonoscopy for Personal Hx of colonic polyps, would i code 45385-33 (modifier PT if Medicare) / Z12.11, K65.5, Z86.010 (commercial payer) and 45385-PT Z12.11? Thank you very much!
SuperCoder Answered Mon 04th of November, 2019 10:17:39 AM

Hi Camille,

Yes, correct, screening code should be a first-listed code if the reason for the visit is specifically the screening exam

You should use the Z12.11 as first listed ICD-10 for all the payers.

On the other hand, once the physician indicates that the screening procedure has turned diagnostic, you’ll bill only the diagnostic colonoscopy code, and not the screening code (G0104-G0106, G0120-G0121). Not only is this correct coding, but it’s also the only way you can use modifier PT.

For diagnosis pattern, when procedure is scheduled as a screening (colonoscopy) and a polyp is found, guidelines states that whenever a screening examination is performed, the screening code is the first-listed coded. The fact that the test is a screening remains, regardless of the findings or any additional procedure that is performed as a result of the findings. Hence, with screening procedure code, first listed diagnosis will be of screening (Z12.11), then other findings (like, polyps).

Remember that once the polyp is removed the patient follow up visits should not be code with polyp of colon. Then, use code Z86.010, personal history of colonic polyps.

For modifier PT, according to Medicare:

  • Modifier PT should only be appended when a service began as a colorectal cancer screening test and then was moved to therapeutic test due to findings during the screening
  • Practitioners should append the modifier to the therapeutic procedure code that is reported instead of the screening colonoscopy or screening sigmoidoscopy HCPCS code
  • Append to surgical procedure codes in the range: 10000 to 69999 or G6018-G6028

Therefore, you should not append modifier PT to G codes such as G0104-G0121.

According to Medicare rules, you should not use the Modifier PT when the service began as a diagnostic procedure.

Hope this helps!

Camille Posted Mon 04th of November, 2019 12:05:45 PM
Will you please clarify: On a prior "Ask the Expert" question I titled "High Risk Colon Screening Colonoscopy," dated 10/26/19 and answered by SuperCoder on 10/29/19, I was advised to code G0105-PT /Z12.11, K57.30, Z86.010, Z80.0 because it was a high risk screening colonoscopy with the indication of Personal Hx of Colon Polyps and Family Hx of Colon Ca. During the colonoscopy there was a new finding of Diverticulosis with a recommendation of high fiber diet., but no therapeutic treatment performed. Is this an example of one time where I would code modifier -PT with a screening HCPCS code (G0105)? Thank you kindly!
SuperCoder Answered Tue 05th of November, 2019 05:06:32 AM

Hi Camille,

We are working on this, will get back to you soon.


SuperCoder Answered Wed 06th of November, 2019 06:54:20 AM

Hi Camille,

Hope you are keeping well.

We discussed with the Newsletter Editor, as per our Editor, modifier PT should not be used with the G codes when converted to diagnostic/therapeutic services.
In such cases, appropriate CPT code can be used with PT modifier for Medicare patients and 33 modifier for Non-Medicare patients.

Hope this helps!

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