icd-10 code for surveillance colonoscopy

What ICD 10 cm code(s) are reported?

Apr 11, 2020 · 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. Z80.

What is the ICD 10 diagnosis code for?

Mar 01, 2013 · Colonoscopy for these patients would not be a “surveillance,” but a screening, reported with HCPCS Level II code G0105 Colorectal cancer screening; colonoscopy on individual at high risk. Surveillance colonoscopy (CPT® 45378, G0105) Patient does not have any gastrointestinal sign, symptom (s), and/or relevant diagnosis.

How do you code a screening colonoscopy?

Jul 21, 2016 · ICD-10 code: Stomach: Z12.0: Intestinal tract, unspecified: Z12.10: Colon: Z12.11: Rectum: Z12.12: Small intestine: Z12.13: Other sites: Z12.89: Site unspecified: Z12.9: Non cancerous disorders: ICD-10 code: Screening for upper GI disorder: Z13.810: Screening for lower GI disorder: Z13.811: Screening for other digestive disorders: Z13.818

How to code screening and diagnostic colonoscopy?

Oct 01, 2015 · Explanation of Revision: Based on CR 10153 (Annual 2018 ICD-10-CM Update) the LCD was revised. Added ICD-10-CM diagnosis codes K56.50 – K56.52, K56.600 – K56.699. Deleted ICD-10-CM diagnosis codes K56.5, K56.60, K56.69. The effective date of this revision is based on date of service.

How do you code a surveillance colonoscopy?

What's the right code to use for screening colonoscopy? For commercial and Medicaid patients, use CPT code 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression [separate procedure]).

Do you use Z12 11 on surveillance colonoscopy?

In this case, since the word SURVEILLANCE colonoscopy is documented, I would recommend coding this as a screening (Z12. 11), followed by any findings, as well as the personal history of colonic polyps (Z86. 010) – sequenced in that order.Dec 16, 2021

What is the difference between a screening colonoscopy and a surveillance colonoscopy?

Medicare and most insurance carriers will pay for screening colonoscopies once every 10 years. Surveillance colonoscopies are performed on patients who have a prior personal history of colon polyps or colon cancer. Medicare will pay for these exams once every 24 months.

What is considered a surveillance colonoscopy?

Surveillance colonoscopy is any colonoscopic examination performed to identify recurrent or metachronous neoplasia in an asymptomatic individual with previously identified precan- cerous lesions (the term surveillance is also applied to patients with previous cancer but that group is not covered here).

What is the ICD 10 code for screening mammogram?

Z12. 31, Encounter for screening mammogram for malignant neoplasm of breast, is the primary diagnosis code assigned for a screening mammogram. If the mammogram is diagnostic, the ICD-10-CM code assigned is the reason the diagnostic mammogram was performed.Mar 13, 2019

What is CPT code for screening colonoscopy?

Article GuidanceCOLORECTAL CANCER SCREENING GUIDELINESColorectal Cancer Screening Test/ProcedureCPT/HCPCS CodeScreening Fecal-Occult Blood Test82270 G0328Screening Flexible SigmoidoscopyG0104Screening Colonoscopy - individual at high riskG01055 more rows

Is a colonoscopy considered a diagnostic test?

Colonoscopies are either diagnostic or preventive. The difference between the two is sometimes hard to distinguish, but there is big difference on how insurance companies cover either procedure.Jan 12, 2018

What is the difference between surveillance and screening?

The fundamental purpose of screening is early diagnosis and treatment of the individual and thus has a clinical focus. The fundamental purpose of surveillance is to detect and eliminate the underlying causes such as hazards or exposures of any discovered trends and thus has a prevention focus.

Is Z86 010 a preventive code?

Z80. 0 (family history of malignant neoplasm of digestive organs) Z86. 010 (personal history of colonic polyps)....Two Sets of Procedure Codes Used for Screening Colonoscopy:Common colorectal screening diagnosis codesICD-10-CMDescriptionZ86.010Personal history of colonic polyps2 more rows•Dec 16, 2021

Step 1: Define Screening vs. Surveillance Colonoscopy, Determine Patient Need

Physicians and coders must be able to distinguish between a screening and surveillance colonoscopy. As defined by The U.S. Preventive Services Task...

Step 2: Properly Report Personal/Family History With Screening/Follow-Up

According to ICD-9-CM Official Guidelines for Coding and Reporting, section 18.d.4:There are two types of history V codes, personal and family. Per...

Step 3: Understand Government and Carrier Screening Definitions

Following USPSTF recommendations, the ACA preventative guidelines state patients with a personal history of adenomatous polyps and/or colon cancer...

Step 4: Educate The Patient

Under the ACA, payers must offer first-dollar coverage for screening colonoscopy but are not obliged to do so for a surveillance or diagnostic colo...

Step 5: correctly Apply The Principles

Scenario 1: An asymptomatic patient is scheduled for a colonoscopy. The patient had an adenomatous polyp removed from the descending colon two year...

What are the two types of ICD-9 codes?

According to ICD-9-CM Official Guidelines for Coding and Reporting, section 18.d.4:#N#There are two types of history V codes, personal and family . Personal history codes explain a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring. Personal history codes may be used in conjunction with follow-up codes and family history codes may be used in conjunction with screening codes to explain the need for a test or procedure.#N#Common personal history codes used with colonoscopy are V12.72 and V10.0x Personal history of malignant neoplasm of the gastrointestinal tract. The family history codes include V16.0 Family history of malignant neoplasm of the gastrointestinal tract; V18.51 Family history of colonic polyps; and V18.59 Family history of other digestive disorders. Lastly, V76.51 describes screening of the colon.#N#Per the ICD-9-CM official guidelines, you would be able to report V76.51 (screening) primary to V16.0 (family history of colon polyps). In contrast, you would not use V76.51 (screening) with V12.72 (personal history of colon polyps) because family history codes, not personal history codes, should be paired with screening codes. Personal history would be paired with a follow-up code.#N#Just because you get paid doesn’t mean the coding is correct: Most carriers will pay V76.51 with V12.72 because their edits are flawed and allow it. The patient’s claim will process under a patient’s preventative benefits with no out-of-pocket; however, an audit of the record with the carrier guidance will reveal that the claim incorrectly paid under preventative services when, in fact, the procedure should have paid as surveillance. The best strategy is to contact your payer to be sure you are coding correctly based on that payer’s “screening vs. surveillance” guidelines.

How often should a colonoscopy be performed?

Preventive Services Task Force (USPSTF):#N#A screening colonoscopy is performed once every 10 years for asymptomatic patients aged 50-75 with no history of colon cancer, polyps, and/or gastrointestinal disease.#N#A surveillance colonoscopy can be performed at varying ages and intervals based on the patient’s personal history of colon cancer, polyps, and/or gastrointestinal disease. Patients with a history of colon polyp (s) are not recommended for a screening colonoscopy, but for a surveillance colonoscopy. Per the USPSTF, “When the screening test results in the diagnosis of clinically significant colorectal adenomas or cancer, the patient will be followed by a surveillance regimen and recommendations for screening are no longer applicable.”#N#The USPSTF does not recommend a particular surveillance regime for patients who have a personal history of polyps and/or cancer; however, surveillance colonoscopies generally are performed in shortened intervals of two to five years. Medical societies, such as the American Society of Colon and Rectal Surgeons and the American Society of Gastrointestinal Endoscopy, regularly publish recommendations for colonoscopy surveillance.#N#The type of colonoscopy will fall into one of three categories, depending on why the patient is undergoing the procedure.#N#Diagnostic/Therapeutic colonoscopy (CPT® 45378 Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen (s) by brushing or washing, with or without colon decompression (separate procedure))#N#Patient has a gastrointestinal sign, symptom (s), and/or diagnosis.#N#Preventive colonoscopy screening (CPT® 45378, G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk)#N#Patient is 50 years of age or older#N#Patient does not have any gastrointestinal sign, symptom (s), and/or relevant diagnosis#N#Patient does not have any personal history of colon cancer, polyps, and/or gastrointestinal disease#N#Patient may have a family history of gastrointestinal sign, symptom (s), and/or relevant diagnosis#N#Exception: Medicare patients with a family history (first degree relative with colorectal and/or adenomatous cancer) may qualify as “high risk.” Colonoscopy for these patients would not be a “surveillance,” but a screening, reported with HCPCS Level II code G0105 Colorectal cancer screening; colonoscopy on individual at high risk.#N#Surveillance colonoscopy (CPT® 45378, G0105)#N#Patient does not have any gastrointestinal sign, symptom (s), and/or relevant diagnosis.#N#Patient has a personal history of colon cancer, polyps, and/or gastrointestinal disease.

Is colonoscopy a screening?

Colonoscopy for these patients would not be a “ surveillance,” but a screening, reported with HCPCS Level II code G0105 Colorectal cancer screening; colonoscopy on individual at high risk. Patient does not have any gastrointestinal sign, symptom (s), and/or relevant diagnosis.

Who is Anna Barnes?

Anna Barnes, CPC, CEMC, CGSCS, is the director of operations for Atlanta Colon and Rectal Surgery.

Document Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for diagnostic colonoscopy. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy.

Coverage Guidance

Compliance with the provisions in this policy may be monitored and addressed through post payment data analysis and subsequent medical review audits.#N#History/Background and/or General Information#N#Colonoscopy allows direct visual examination of the intestinal tract with a flexible tube containing light transmitting glass fibers that return a magnified image.

What is the code for colonoscopy?

To report screening colonoscopy on a patient not considered high risk for colorectal cancer, use HCPCS code G0121 and diagnosis code Z12.11 ( encounter for screening for malignant neoplasm of the colon ).

What is a colonoscopy screening?

As such, “screening” describes a colonoscopy that is routinely performed on an asymptomatic person for the purpose of testing for the presence of colorectal cancer or colorectal polyps. Whether a polyp or cancer is ultimately found does not ...

What are the global periods for colonoscopy?

Typically, procedure codes with 0, 10 or 90-day global periods include pre-work, intraoperative work, and post-operative work in the Relative Value Units (RVUs) assigned . As a result, CMS’ policy does not allow for payment of an Evaluation and Management (E/M) service prior to a screening colonoscopy. In 2005, the Medicare carrier in Rhode Island explained the policy this way:

Does Medicare cover colonoscopy?

However, diagnostic colonoscopy is a test performed as a result of an abnormal finding, sign or symptom. Medicare does not waive the co-pay and deductible when the intent of the visit is to perform a diagnostic colonoscopy. Medicare waives the deductible but not the co-pay when a procedure scheduled as a screening is converted to a diagnostic ...

Is E/M covered by Medicare?

Medicare defines an E/M prior to a screening colonoscopy as routine, and thus non-covered. However, when the intent of the visit is a diagnostic colonoscopy an E/M prior to the procedure ordered for a finding, sign or symptom is a covered service.

What does PT mean in CPT?

The PT modifier ( colorectal cancer screening test, converted to diagnostic test or other procedure) is appended to the CPT ® code.

Can you remove polyps at screening colonoscopy?

It is not uncommon to remove one or more polyps at the time of a screening colonoscopy. Because the procedure was initiated as a screening the screening diagnosis is primary and the polyp (s) is secondary. Additionally, the surgeon does not report the screening colonoscopy HCPCS code, but reports the appropriate code for the diagnostic or therapeutic procedure performed, CPT ® code 45379—45392.

Document Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

Title XVIII of the Social Security Act (SSA), §1862 (a) (1) (A) states that no Medicare payment shall be made for items or services that “are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.”#N#Title XVIII of the Social Security Act, §1862 (a) (7) and 42 Code of Federal Regulations, §411.15 et seq.

Coverage Guidance

Colonoscopy is a visual examination of the lining of the large intestine using a rigid or flexible video or fiberoptic endoscope. The procedure includes inspection of the entire colon, from the rectum to the cecum, and may include the examination of the terminal ileum.