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Susan Posted Thu 12th of October, 2017 15:29:21 PM
Patient is a 50 year old female with positive Generic testing results show her to be a carrier for Peutz-Jeghers Syndrome which may be associated with colon cancer the same as Lynch syndrome. The code for Lynch is Z05.09( Genetic susceptibility to other malignant neoplasms) which the Peutz-Jeghers could fall into also.Since the patient is 50 I coding her colonoscopy as a screening Z12.11 and using z15.09 as another dx code. The Daughter is just nineteen and wants a colonoscopy due to the mother being a carrier. She is not eligible for screening so in this situation how would I code her procedure?
SuperCoder Answered Fri 13th of October, 2017 06:16:06 AM

It is highly recommended to do a full gene sequence analysis on daughter whose mother/father is a carrier of Lynch Syndrome. You can use ICD-10 CM Code Z84.81 (Family history of carrier of genetic disease) with the pathology CPT code and also report the finding or confirmed diagnosis code.

Coverage age for screening colonoscopy for patient with Lynch Syndrome, may vary from Insurance to Insurance company. Some payers, allow screening colonoscopy to 20 years of old patient with Lynch Syndrome where as some private payer (Blue Cross PREMERA) covers screening colonoscopy on patient under 50 yrs. of age with Family history of Lynch Syndrome mother having. Please get in touch with your respective payer for coverage age criteria.

Susan Posted Fri 13th of October, 2017 12:06:49 PM
Thank you for your reply
SuperCoder Answered Mon 16th of October, 2017 00:14:15 AM

Your welcome!

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