Encounter for screening for malignant neoplasm of colon. Z12.11 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2019 edition of ICD-10-CM Z12.11 became effective on October 1, 2018.
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 ).
The following services are considered colorectal cancer screening services:
The CPT code is 45378 (Colonoscopy, flexible, proximal to splenic flexure, diagnostic). For Medicare patients, coders should report V76.51 as the primary diagnosis, then check if the patient is “high risk,” based on various factors found on the CMS list.
ICD-10 code Z12. 11 for Encounter for screening for malignant neoplasm of colon is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
Personal history of colonic polyps The 2022 edition of ICD-10-CM Z86. 010 became effective on October 1, 2021.
Z12. 11 encounter for screening for malignant neoplasm of colon.
Group 1CodeDescription45378COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)45379COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODY(S)45380COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE22 more rows
“Code Z86. 010, Personal history of colonic polyps, should be assigned when 'history of colon polyps' is documented by the provider. History of colon polyp specifically indexes to code Z86. 010.” “AHA Coding Clinic, First Quarter 2017, there is not an Index entry for rectal polyps.
ICD-10 code Z12. 12 for Encounter for screening for malignant neoplasm of rectum is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
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.
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.
Definition of Terms Colonoscopy: A colonoscopy is a procedure that permits the direct examination of the mucosa of the entire colon by using a flexible lighted tube. The procedure is done with sedation in a hospital outpatient department, in a clinic , or an office facility. During the colonoscopy a doctor can biopsy and remove pre – cancerous ...
During the colonoscopy a doctor can biopsy and remove pre – cancerous polyps and some early stage cancers and also diagnose other conditions or diseases. General definitions of procedure indications from various specialty societies , including the ACA: * A screening colonoscopy is done to look for disease, such as cancer, ...
Note:The Introduction section is for your general knowledge and is not to be takenas policy coverage criteria. The rest of the policy uses specific words and concepts familiar to medical professionals. It is intended for providers.A provider can be a person, such as a doctor, nurse, psychologist, or dentist.
It can also be doneas a diagnostic procedure when symptoms or lab tests suggest there might be a problem in the rectum or colon.In some cases, minor procedures may be done during a colonoscopy,such as taking a biopsy or destroying an area of unhealthy tissue (a lesion).
This guideline applies only to people of average risk. Colonoscopy is only one of the screening tests that can be used. This benefit coverage guideline provides general information about how the health plan decides whether a colonoscopy is covered under the preventive or diagnostic (medical) benefits.
A screening code may be a first-listed code if the reason for the visit is specifically the screening exam.
A screening mammogram is an example of such a test. If a screening examination identifies pathology, the code for the reason the test (namely, the screening code from categories Z11-Z13) is assigned as the principle diagnosis or first-listed code, followed by a code for the pathology or condition found during the screening exam.”.
A screening code is not necessary if the screening is inherent to a routine examination, such as a pap smear done during a routine pelvic examination. Should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis.
Colonoscopy is a widely used endoscopic technique used to screen individuals for colorectal cancer. It is very sensitive in detecting colorectal cancers. Colonoscopy is an endoscopic procedure in which a thin tube with a camera at the tip is introduced through the anus till the start of the colon.
After the patient's bowel has been prepped, the physician inserts the colonoscope-a long, thin, flexible lighted tube-through the anus and advances the scope through the colon past the splenic flexure. The lumen of the colon and rectum is visualized. Most polyps and some cancers can be removed during this procedure.
For Medicare beneficiaries, screening colonoscopy is reported using the following HCPCS codes: - G0105 (Colorectal cancer screening; colonoscopy on individual at high risk), for a Medicare beneficiary at high risk for colorectal cancer, and the appropriate diagnosis code that necessitates the more frequent screening.
Point to note: Code 45378 is the base code for a colonoscopy without biopsy or other interventions. It includes brushings or washings if performed. Report 45378 with ICD-10 code Z86.010 on the first line of the CMS 1500 form.
Medicare beneficiaries without high-risk factors are eligible for a screening colonoscopy every ten years. Beneficiaries at higher risk for developing colorectal cancer are eligible for screening once every 24 months. Medicare considers an individual who is at high risk of developing colorectal cancer as one who has one or more of the following:
According to a study by the American Cancer Society, 90% colorectal cancer (CRC) cases are detected in individuals with over 50 years in the U.S and colonoscopy is the most effective and the most commonly adopted procedure for the diagnosis and screening of CRC in older adults.
A Diagnostic colonoscopy is performed when an abnormal finding, sign, or symptom is found such as diarrhea, anemia, abdominal pain, or rectal bleeding. A Screening colonoscopy is performed on person without symptoms in order to test for the presence of colorectal cancer or colorectal polyps. Even if a polyp or cancer is found during ...
53 - Medicare guidelines state that if a patient is scheduled for a screening colonoscopy, but because of poor prep the scope cannot be advanced beyond the splenic fixture, the procedure should be coded as a colonoscopy with modifier 53 (discontinued procedure).
CPT defines a colonoscopy examination as "the examination of the entire colon, from the rectum to the cecum or colon-small intestine anastomosis, and may include an examination of the terminal ileum or small intestine proximal to an anastomosis" as well.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Title XVIII of the Social Security Act §1833 (e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
If during a colonoscopy a pathology is encountered that necessitates an intervention which converts the screening colonoscopy to a diagnostic/therapeutic colonoscopy, the appropriate CPT ® code which includes the –PT modifier for the diagnostic/therapeutic colonoscopy must be submitted with an appropriate diagnosis to justify the procedure such as Z80.0-Family history of malignant neoplasm of digestive organs. 1) Choose the correct CPT ® code which describes the procedure that was attempted..
Note: Z80.0 does not appear as a covered ICD-10 code in the Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy A56632 article because the Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy L34454 LCD addresses ONLY procedures performed for diagnostic and/or therapeutic purposes.
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.
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.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Abstract: This article represents local instructions for CMS National Coverage Policy (CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Section 210.3).
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.
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.