2019 icd 10 code for positive cologuard test

Full Answer

What does a positive result mean in a ColoGuard test?

If you receive a positive result on your Cologuard test, it is likely that you already have colorectal cancer or pre-cancerous colon polyps that are causing bleeding. False positive results are common with non-colonoscopy screening tests.

How accurate is ColoGuard test?

• The test results for detecting precancerous polyps aren’t very accurate compared to those of colonoscopy.
• High chances of false positives can make you anxious while waiting for further testing.
• The test may also miss the presence of polyps or colon cancer (false negative).
• One of the main drawbacks of Cologuard is the associated cost. ...

What is the ICD 10 diagnosis code for?

The ICD-10-CM is a catalog of diagnosis codes used by medical professionals for medical coding and reporting in health care settings. The Centers for Medicare and Medicaid Services (CMS) maintain the catalog in the U.S. releasing yearly updates.

What does a positive or negative Cologuard result mean?

Understanding a Cologuard result Cologuard is a screening test that looks for altered DNA and/or blood that could be signs of precancerous growths or colorectal cancer. A negative result means Cologuard did not detect these potential signs A positive result means these potential signs were detected

What is the ICD-10 code for positive cologuard?

What ICD-10/diagnosis code(s) should be used for Cologuard? To process claims for Medicare/Medicare Advantage patients, claims must include either ICD-10 diagnosis code Z12. 11 (encounter for screening for malignant neoplasm of colon) or Z12. 12 (encounter for screening for malignant neoplasm of rectum).

What is the ICD-10 code for colorectal cancer screening?

A screening colonoscopy should be reported with the following International Classification of Diseases, 10th edition (ICD-10) codes: Z12. 11: Encounter for screening for malignant neoplasm of the colon.

What does it mean if you get a positive result from cologuard?

Abnormal result (positive result) suggests that the test found some pre-cancer or cancer cells in your stool sample. However, the Cologuard test does not diagnose cancer. You will need further tests to make a diagnosis of cancer. Your provider will likely suggest a colonoscopy.

Is Z12 11 a preventive code?

The colonoscopy or sigmoidoscopy is still classified as a preventive service eligible for coverage at the no-member-cost-share benefit level. a. Submit the claim with Z12. 11 (Encounter for screening for malignant neoplasm of colon) as the first-listed diagnosis code; this is the reason for the service or encounter.

How do you code colonoscopy after positive cologuard?

If the patient undergoes a colonoscopy for a positive Cologuard and a polyp is found, the coder would select K63. 5 (polyp of colon) as the first-listed diagnosis for the colonoscopy.

What is the ICD-10 code for colon polyp?

ICD-10 code K63. 5 for Polyp of colon is a medical classification as listed by WHO under the range - Diseases of the digestive system .

Does Medicare cover colonoscopy after positive cologuard?

But agreeing to that cheaper, easier DNA screening for colorectal cancer can cost consumers much more in the end. Because if that test comes back positive, as mine did, some insurers and Medicare will no longer cover as a preventive service the colonoscopy that your doctor will inevitably order next.

How often is cologuard false positive?

Cologuard has a 14% false-positive rate. While 14% isn't awful, these false-positive tests do tend to generate quite a bit of unnecessary angst in the affected patients until they can eventually undergo a diagnostic colonoscopy.

Why are colonoscopies not recommended after age 75?

“There are risks involved with colonoscopy, such as bleeding and perforation of the colon, and also risks involved with the preparation, especially in older people,” Dr.

What does code Z12 31 mean?

For example, Z12. 31 (Encounter for screening mammogram for malignant neoplasm of breast) is the correct code to use when you are ordering a routine mammogram for a patient. However, coders are coming across many routine mammogram orders that use Z12. 39 (Encounter for other screening for malignant neoplasm of breast).

When should Z12 11 be used?

If the patient presents for a screening colonoscopy and a polyp or any other lesion/diagnosis is found, the primary diagnosis is still going to be Z12. 11, Encounter for screening for malignant neoplasm of colon. The coder should also report the polyp or findings as additional diagnosis codes.

What is the diagnosis code for preventive colonoscopy?

Procedure code: G0121 (Average risk screening) or 45378-33 (Diagnostic colonoscopy with modifier 33 indicating this is a preventive service).