Wiki Adding Screens to surveillance exams?

[enad1011]

Several patients have contacted our office after being told by their insurance that we should be adding a screening code of Z12.11 for full payment of a SURVEILLANCE exam for personal hx of polyps (Z86.010). This is clearly not a screening. We have been informed that a very large practice has been billing with the screening code in the primary position resulting in full payment and no transfers to patients' deductibles/co-insurances. We have always believed that we only code for the indication, as screens are only performed every 10 years and surveillance exams are more often based on doctor recommendation. Does anyone else charge for both screening(Z12.11) and hx of polyps(Z86.010) together? Any help would be appreciated.

Thanks!!!!

 

[enad1011]

Input anyone?

Does anyone have any input on this? Are there any AAPC staff members who can point me in the right direction as to where I can find some information on this topic? It would be appreciated.


Thanks a lot!

 

[Tine]

This is what my office came up with when this issue arose. It took quite a few months, and a lot of back and forth. I am not sure if this will help but it is what we have. Remember this is specific to our clinic here, so disregard anything that seems that specific (such as mentioning the codes at the back of the report).

"So, after much debate and research this week regarding Screening Colonoscopies I believe we have come to a final decision. It is imperative that both the professional and facility coding match because we have some very disgruntled patients.

MCR’s rule is that if a patient came in for a screening colonoscopy the 1st list DX needs to be Z12.11 regardless if they find a polyp or any other disease.

I think there may be some confusion due to the wording, some of the providers indicates “screening” and some indicate “surveillance”, what I think they mean when they state “surveillance” is that the patient has either a history of prior polyps and/or colitis therefore this indicates the patient is have a high risk colonoscopy.

I would discourage using only the codes at the back of the report because the codes are generated from the documentation. Please make sure you are adding Z12.11 if the provider states screening or surveillance as your 1st listed DX with the appropriate modifiers. If the patient has a history of polyps then code Z86.010 and any other DX from the report."

 

[Mayzoo]

"Most coders use an encoder today; if the word “surveillance” is entered in the encoder it leads the coder down the path to a follow-up code. The coding guidelines state that “the follow-up codes are used to explain continuing surveillance following completed treatment of a disease, condition or injury.” Without looking any further it would seem that a follow-up code would be most appropriate. That is incorrect, however, when it comes to coding a surveillance colonoscopy, specifically. The Bulletin of the American College of Surgeons describes a surveillance colonoscopy as a subset of screening. 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."

"It can be very difficult for a coder to see a surveillance or screening exam documented by a physician but make the determination that the exam does not meet the definition of screening based on documentation of active symptoms such as rectal bleeding, abdominal pain, anemia, or diarrhea. Coders should work with their coding leadership to determine the best approach to handle situations in which the medical record documentation doesn’t support the type of exam documented."


http://journal.ahima.org/2017/10/12/coding-surveillance-colonoscopy/

Also:

https://www.aapc.com/blog/22483-colonoscopy-screening-or-surveillance/

 

[enad1011]

The responses have been helpful. We are considering our options and we will likely add a screening code based on payer guidelines and not use this for all surveillance exams at this point.

Thank you to all who responded.

 

[Cruzc0710]

colonoscopy surveillance and z09

Hi all,
I'm new to this posting thing, and I know I saw this subject somewhere but couldn't pull it up, so I'm starting a new one in hopes of getting some input.

I just started coding Endoscopies for a hospital and this subject comes up so many times. I still don't have a correct answer. I wish organizations would come up with a solid guideline. So many patients are being caught in the middle.

I was taught to code z12.11 as Primary Diagnosis with z86.010 or and findings a secondary diagnosos for surveillance colonoscopy if the patient had previous polyps and was was seen in less than 5 yr intervals.

My question is:
If the patient is seen in less than a year ( 6 months) and the provider states Screening, and there are polyps found. how should it be coded? Is it appropriate to use the Z09 code or still code with z12.11 as primary? I would love any input.