Patient with the personal history of polyps cannot be coded as Screening. Surveillance colonoscopies are ordered because the patient had a previous finding of cancer or polyps, but are currently asymptomatic. Screening Colonoscopy Colorectal cancer is one of the leading causes of cancer deaths in the United States. What can be done about this? Colorectal cancer screening tests and procedures can be used alone or in various combinations and include fecal blood test, barium enema, flexible sigmoidoscopy and colonoscopy. At least 47 months must have passed since the month in which the prior sigmoidoscopy was performed. And worse yet, there will be others that will not go for the procedure for fear of the cost.
Should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis. The fact that the test is a screening remains, regardless of the findings or any additional procedure that is performed as a result of the findings. Medicare will pay for this procedure every four years at least 47 completed months since the last screening barium enema or sigmoidoscopy. However, it is also relatively costly and requires a strenuous prep, moderate sedation, and — if the patient is employed — time away from work. The patient had an adenomatous polyp removed from the descending colon two years ago. Scenario 4: An asymptomatic Medicare patient is scheduled for a colonoscopy. The Bulletin of the American College of Surgeons describes a surveillance colonoscopy as a subset of screening.
What better time to refresh your know-how for colorectal cancer screening than National Colorectal Cancer Awareness month? Please refer to the following pages for how screening and surveillance codes are differentiated. 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. What is the correct answer?! Confusion also occurs when physicians use surveillance and screening as like terms. Append modifier Pt or 33 whatever is appropriate for the carrier you billed. Z08 indicates that the patient had cancer and we are now checking for its occurrence again. Here are a few guidelines for screening and surveillance colonoscopy.
Thank you very much, I feel you just helped me prove my point. During the grace period, insurances processed claims even if they were wrongly coded, just as long as the codes belonged to the broader family of correct codes. They look it as surveillance. I would code is with the personal history as the admit diagnosis v12. Specifically, the physician must establish that the estimated screening potential for a barium enema exam of the patient in question is equal to or greater than the screening potential for a screening sigmoidoscopy or colonoscopy of the same patient. The colonoscopy is completely normal and the provider recommends surveillance colonoscopy in ten years.
Codes under Z13 are also used as screening codes for other systems of the human body. I specifically asked ahead if time if I would be billed as diagnostic if they found a polyp and I was assured by the scheduler that it could not be switched from preventative to diagnostic if they did a biopsy. Physicians and patients have both benefited from this new law. If patient has family history of malignant neoplasms, codes belonging to Z80 series can be used. Code any positive findings found on the diagnostic mammogram as the first listed diagnoses. What is the correct diagnosis code assignment? The article provided a very clear determination between a screening and diagnostic colo. High risk colonoscopies every 2 years should have a primary high risk diagnosis indicating it is a high risk patient.
My father had colon cancer so I have been diligent about the recommended screenings. How should the diagnoses and procedures for this case be coded? Scenario 2: An asymptomatic patient is scheduled for a colonoscopy. The lumen of the colon and rectum is visualized. The questions I get about that article are all related to diagnosis coding. The patient's medical record should contain documentation to support an incomplete procedure. To be reimbursed for the screening, gastroenterologists must include an accepted diagnosis code denoting the high-risk status of the patient with the procedure code.
I am more educated now after V12. I am afraid this may lead consumers to not have their colonoscopies due to not having the means to pay out of pocket. It relies on the fact that colon cancers usually shed blood cells into the stool. The stool guaiac test has been available for many years, and the cost is nominal compared to other types of screening. Pt has history of colon polyps Z86010. Encounter for screening for other diseases and disorders; Z13.
For example, patients with a history of colon polyps are not recommended for a screening colonoscopy, but for a surveillance colonoscopy. Encounter for screening for other metabolic disorders. For a double-contrast barium enema, also called an air-contrast barium enema, air is also pumped into the colon to distend it and make abnormalities easier to see. The patient is classified as an average risk screening. A screening code may be a first-listed code if the reason for the visit is specifically the screening exam. Now that coding professionals are all on the same page regarding code assignment, problem solved… right? Given the fact patient has had previous episodes of disease either malignant or other than malignant, a personal history code of malignancy becomes imperative.
In addition, the second quarter 2017 issue of Coding Clinic confirmed previous guidance stating that a surveillance colonoscopy is a screening exam and therefore it must be coded utilizing screening guidelines. But with all the research I did and help from the comments here and elsewhere, I was able to gather enough information to appeal and get that decision reversed so that it was covered in full. Patient with the personal history of polyps cannot be coded as Screening. A screening code may be the first listed code if the reason for the visit is specifically the screening exam. In most case, metastatic colon cancer can spread into your bone, which causes pain and fractures, lungs, liver, which causes skin problem, lymph and even brain.
It is my understanding that high risk patients in most circumstances may receive a screening colonoscopy at 24 months. Systems like help in directing doctors to code correctly at the point of care. For patients at normal risk for colorectal cancer, a screening barium enema performed as an alternative to sigmoidoscopy G0104 is reported with code G0106. I am a patient who had polyps one time nearly 10 years ago and no polyps since then at two other screenings. In addition, the second quarter 2017 issue of Coding Clinic confirmed previous guidance stating that a surveillance colonoscopy is a screening exam and therefore it must be coded utilizing screening guidelines.