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Hx of polyps vs Screening

Susan Posted Thu 05th of January, 2017 09:01:48 AM
I am referring to a post from several months ago from a question but the answer perplexes me...I have always been told that if a patient has a hx of polyps Z86.010 and comes for surveillance colonoscopy that the initial screening Z12.11 can never be used again. All the documentation I have read states use the Z86.010 as primary that if you use the Z12.11 just because the insurance carrier says they will pay with Z12.11 that is fraudulent billing. This happened with a patient insisting that I change her code to Z12.11 instead of Z86.010. I informed her that I could not change the code to Z12.11 per her insurance company.
SuperCoder Answered Fri 06th of January, 2017 01:45:00 AM

Screening is a service performed in the absence of signs or symptoms, once the patient has a diagnosis of polyps, whether a sessile serrated adenoma (SSA), adenoma or hyperplastic, follow-up colonoscopies are surveillance, not screening.

If the patient has a history of polyps, is now returning for a follow-up exam and is otherwise asymptomatic, then the exam is a surveillance colonoscopy. If the previous polyps were benign, then code Z86.010 (Personal history of colonic polyps) should be reported.

To report screening colonoscopy on a patient not considered high risk for colon cancer, use Z12.11 (Encounter for screening for malignant neoplasm of colon).

If the patient is under a commercial plan, exchange plan or Medicaid, the colonoscopy code is reported with ICD-10 code Z86.010 on the first line of the CMS1500 form.


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