icd 10 procedure code for colonoscopy

Common colorectal screening diagnosis codes

ICD-10-CM	Description
Z12.11	Encounter for screening for malignant ne ...
Z80.0	Family history of malignant neoplasm of ...
Z86.010	Personal history of colonic polyps

May 26 2022

Full Answer

How do you code a screening colonoscopy?

• Z12. 11: Encounter for screening for malignant neoplasm of the colon.
• Z80. 0: Family history of malignant neoplasm of digestive organs.
• Z86. 010: Personal history of colonic polyps.

What is the procedure code for a colonoscopy?

non-Medicare payors, use the CPT conventions. Colonoscopy codes are listed in the digestive section of CPT, codes 45378–45398 (or codes 44388–44408, if performed through a stoma rather than the anus). CPT code 45378 is the base code for a colonoscopy without biopsy or other interventions. It includes brushings or washings, if performed.

How to code screening and diagnostic colonoscopy?

• G0121 – Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
• G0105 – Colorectal cancer screening; colonoscopy on individual at high risk
• G0104 – Colorectal cancer screening; flexible sigmoidoscopy

How do you code an incomplete colonoscopy?

The CPT® codebook, in contrast to CMS rules, instructs, "For an incomplete colonoscopy, with full preparation for a colonoscopy, use a colonoscopy code with the modifier 52 and provide documentation." Some non-Medicare payers may follow CMS guidelines for an incomplete colonoscopy, while others may adhere to CPT®

What is the ICD-10-PCS code for colonoscopy?

2022 ICD-10-PCS Procedure Code 0DBN4ZX: Excision of Sigmoid Colon, Percutaneous Endoscopic Approach, Diagnostic.

What is the procedure code for a 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]).

What is the diagnosis code for preventive colonoscopy?

When reporting a screening colonoscopy on a non-Medicare patient, report CPT® code 45378 and use the appropriate screening diagnosis code.

What procedure code is 45380?

Diagnostic / Therapeutic Colonoscopy – Patient has gastrointestinal symptoms, colon polyps, or gastrointestinal disease requiring evaluation or treatment by colonoscopy (CPT Code: 45380 – See # 1 below).

Why is a colonoscopy considered a diagnostic procedure?

Diagnostic colonoscopies are used when a patient exhibits specific symptoms that may indicate colon cancer or other issues. This procedure helps the physician further diagnose the patient's condition. Diagnostic colonoscopies may also involve biopsies, lesion removals, and the like.

What is the CPT code for colonoscopy with clip placement?

There are no specific CPT® Codes for endoscopic tissue marking with a clip; the procedure defaults to an unlisted procedure code for the area in which the clip is being placed (e.g., unlisted procedure code for the intestine: 44799).

What is the ICD-10 code for colon polyps?

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 .

When does a screening colonoscopy become a diagnostic?

A colonoscopy is considered diagnostic when you've had:Signs or symptoms in the lower gastrointestinal tract noted in your medical record before the procedure, including: ... Polyps within the past 10 years.A positive stool-based test or CT colonography and require a follow-up colonoscopy.

Does Medicare cover colonoscopy procedure?

Medicare covers screening colonoscopies once every 24 months if you're at high risk for colorectal cancer. If you aren't at high risk, Medicare covers the test once every 120 months, or 48 months after a previous flexible sigmoidoscopy. There's no minimum age requirement.

What is the difference between 45380 and 45385?

45380—Colonoscopy, with biopsy, single or multiple. Hint: The physician may use the words “biopsy forceps,” or “Jumbo forceps.” Fee amount $468.96. 45385—Colonoscopy, with removal of tumor(s), polyp(s), lesion(s) by snare technique.

What is the difference between CPT 45380 and 45378?

A family of CPT codes applies to colonoscopy. For example, code 45378 applies to a colonoscopy in which no polyp is detected, while codes 45380-45385 apply to colonoscopy that involves an intervention (e.g., 45385 is the code for colonoscopy with polypectomy.)

What is procedure code 00811?

When a screening colonoscopy becomes a diagnostic colonoscopy, anesthesia services are reported with CPT code 00811 (Anesthesia for lower intestinal endoscopic procedures, endoscopy introduced distal to duodenum; not otherwise specified) and with the PT modifier.

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:

Why is diagnosis code ordering important?

Diagnosis Code Ordering is Important for a Screening Procedure turned Diagnostic. When the intent of a visit is screening, and findings result in a diagnostic or therapeutic service, the ordering of the diagnosis codes can affect how payers process the claim.

Is colonoscopy a first dollar service?

Screening colonoscopy is a service with first dollar coverage. A screening test with an A or B rating from the US Preventive Services Task Force, should have no patient due amount, since the Affordable Care Act (ACA) was passed.

Can a patient have a colonoscopy?

The patient has never had a screening colonoscopy. The patient has no history of polyps and none of the patient’s siblings, parents or children has a history of polyps or colon cancer. The patient is eligible for a screening colonoscopy. Reportable procedure and diagnoses include:

Does Medicare waive co-pay for 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.

General 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.”

Article Guidance

The following billing and coding guidance is to be used with its associated Local Coverage Determination. Coding Guidelines Do not report a colonoscopy procedure code for an endoscopy performed with a sigmoidoscope on a patient with a normal length colon, even if the sigmoidoscope reaches proximal to the splenic flexure.

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.