Anesthesia Coding Alert

Question: Our physician provided anesthesia during a colonoscopy for a patient with a history of colon polyps but no symptoms. Is it appropriate to bill 00182 with Z12.11 and Z86.010, or should we only use Z86.010?

Montana Subscriber

Answer: You’ve chosen the correct anesthesia code with 00812 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy). Before assigning the diagnosis, check whether the physician indicated that the procedure was for screening and when the patient last had a colonoscopy.

If no polyps were found, report diagnosis Z12.11 (Encounter for screening for malignant neoplasm of colon), followed by Z86.010 (Personal history of colonic polyps). Note that Z86.010 cannot be used as a primary diagnosis. Also note that information for Z12.11 includes the explanatory note of “Encounter for screening colonoscopy NOS.”