icd 10 diagnosis code for positive cologuard

Full Answer

What are the common ICD 10 codes?

ICD-10-CM CATEGORY CODE RANGE SPECIFIC CONDITION ICD-10 CODE Diseases of the Circulatory System I00 –I99 Essential hypertension I10 Unspecified atrial fibrillation I48.91 Diseases of the Respiratory System J00 –J99 Acute pharyngitis, NOS J02.9 Acute upper respiratory infection J06._ Acute bronchitis, *,unspecified J20.9 Vasomotor rhinitis J30.0

Where can one find ICD 10 diagnosis codes?

Search the full ICD-10 catalog by:

• Code
• Code Descriptions
• Clinical Terms or Synonyms

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 ColoGuard test mean?

What does a positive mean on a cologuard test? A positive result does not necessarily mean that you have cancer. It means that Cologuard detected DNA and/or hemoglobin biomarkers in the stool which are associated with colon cancer or precancer.

What does positive cologuard mean?

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.

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.

Does Medicare cover colonoscopy after positive cologuard test?

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.

What is the code for cologuard?

Effective July 1, 2018, Cologuard (CPT code 81528) has been approved for colorectal cancer screening (CRC).

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 .

How do you code a screening colonoscopy turned diagnostic?

Article - Billing and Coding: Screening Colonoscopy Converted to a Diagnostic and/or Therapeutic Colonoscopy (A55069)

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.

Is cologuard considered a colonoscopy?

Cologuard vs Colonoscopy Stool DNA (Cologuard) testing is designed to detect and not prevent cancer. A colonoscopy is the only test that both detects and prevents colon cancer. Negative stool DNA (Cologuard) tests should be repeated every 3 years.

What can cause a positive result 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.

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 many cologuard tests are positive?

Cologuard's accuracy rate for detecting colorectal cancers and precancerous polyps is touted to be 92%. While that is impressive for a stool-based test, it still means that 8% of lesions will go undetected, leaving those patients with a false sense of security. Cologuard has a 14% false-positive rate.

Is Z86 010 a preventive code?

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

What is a Cologuard test?

Cologuard is intended for the qualitative detection of colorectal neoplasia associated DNA markers and for the presence of occult hemoglobin in human stool. A positive result may indicate the presence of colorectal cancer (CRC) or advanced adenoma (AA) and should be followed by diagnostic colonoscopy.

What is a false positive colonoscopy?

A false-positive result occurs when Cologuard produces a positive result, even though a colonoscopy will not find cancer or precancerous polyps. A false-negative result occurs when Cologuard does not detect a precancerous polyp or colorectal cancer, even when a colonoscopy identifies the positive result.

What age is Cologuard used?

Cologuard is intended for use with patients, age 45 years and older , at average risk who are typical candidates for CRC screening. Cologuard was not clinically evaluated for the following types of patients: Patients with a history of colorectal cancer, adenomas, or other related cancers.

What does a positive result mean for Cologuard?

A positive result does not necessarily mean a patient has cancer. It means that Cologuard detected DNA and/or hemoglobin biomarkers in the stool that are associated with colorectal cancer or advanced adenoma. False positives and false negatives occur with Cologuard, and appropriate follow-up is important.

What is a FAP patient?

Patients who have been diagnosed with a condition that is associated with high risk for colorectal cancer. These include but are not limited to: Inflammatory bowel disease (IBD) Chronic ulcerative colitis (CUC) Crohn’s disease. Familial adenomatous polyposis (FAP) Family history of colorectal cancer.

How long after stool test can colonoscopy be done?

Under normal circumstances, a follow-up colonoscopy within 3 months of a positive stool test has been recommended. 3 However, because different parts of the country are affected in different ways, the recommendation may differ based on individual areas of the country.

What is the number to call for Cologuard?

When patients call 1-844-870-8870, our team of specialists can help them contact their insurer and ask the right questions. View details on the Cologuard patient website. *Exact Sciences estimate based on historical patient billing as of June 30, 2020. Rate of coverage varies by state and region.

What happens when a screening detects something?

Once a screening of any kind detects something, the patient is no longer in a screening status. When the primary care's office ordered the Cologuard, they billed the preventive and they used up that 1 screening service per reporting period benefit (they reported the Z12.11).

Does UHC recognize polyps?

Some insurance plans (UHC, specifically) do not recognize screening or high risk screening IF a polyp was removed. Now, add this cologuard test into the mix and I'm feeling like I will really be at odds with my patients and doctors, since they have made the decision for a screening test. Will my office have to "warn every patient ...

Can a PCP explain +cologuard?

The PCP may or may not explain this to the patient, so it's best that when a patient contacts your office with a +cologuard result, you have a policy in place that explains to them they are now a symptomatic patient and copays/deductibles/coinsurance will apply if required by their insurance policy.