Gastroenterology Coding Alert

Medical necessity is pivotal for preventive service.

With the implementation date of Oct. 1, 2015 looming, you can’t afford to go slow on changing your mindset from the ICD-9 system to ICD-10. Let us help you prepare with this snapshot of the new way you’ll report screening colonoscopies under ICD-10.

Direct crosswalk: The current code that payers want when your surgeon performs a screening colonoscopy is V76.51 (Special screening for malignant neoplasms colon). Once ICD-10 goes into effect, you’ll substitute V76.51 with the ICD-10 equivalent: Z12.11 (Encounter for screening for malignant neoplasm of colon).

ICD-10 adds a note under Z12.11 stating that you should use the code for “encounter for screening colonoscopy not otherwise specified (NOS).”

Coding scenario: A 62-year-old established Medicare patient with average risk for colorectal cancer presents for a screening colonoscopy. He had his last screening 11 years ago. On the claim, you should report G0121 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk). Ensure beforehand that the patient can tolerate the scope and there are no indications for any therapeutic intervention during the colonoscopy.

You have been attaching ICD-9 diagnosis code V76.51 (Special screening for malignant neoplasms; colon). In ICD-10, you will add Z12.11 to the claim.