Wiki Billing Screening vs Family History Colon ca

[amathis]

When billing for a screening colonoscopy(first colonoscopy), and the patient mentions their is a family history colon cancer, would you add the family history diagnosis to the claim?

 

[Michael0630]

When billing for a screening colonoscopy(first colonoscopy), and the patient mentions their is a family history colon cancer, would you add the family history diagnosis to the claim?

Yes because that shows they are at a higher risk of getting colon cancer as well.

 

[amathis]

Yes because that shows they are at a higher risk of getting colon cancer as well.

Doesn't that change how it would be billed and follow up? Example, Z12.11/G0121 is screening, follow up is 10 years and Z80.0/G0105 is high risk, usually follow up every 3-5 years. I thought screening means there are no symptoms, no personal or family history.

 

[Michael0630]

Doesn't that change how it would be billed and follow up? Example, Z12.11/G0121 is screening, follow up is 10 years and Z80.0/G0105 is high risk, usually follow up every 3-5 years. I thought screening means there are no symptoms, no personal or family history.

Well yes technically but you said that the patient mentioned they have a family history of colon cancer so if a coder/or even biller was to see that in the documentation there is no harm in adding that to the claim. You are telling the insurance company a story within the ICD 10 codes -

Z12.11 (Encounter for screening for malignant neoplasm of colon) due to Z80.0 (Family history of malignant neoplasm of digestive organs).

But also you never know what the Dr. may find when they are scoping. My mother had went for her "screening colonoscopy" and she went into the procedure thinking she would have a free surgery since she was of age to receive one however, her GI removed a TINY polyp so that ultimately changed her whole procedure and she ended up having to pay OOP over 2k.

Anyways I guess the choice is yours if you want to add Z80.0 to your claim or not.

 

[amathis]

Well yes technically but you said that the patient mentioned they have a family history of colon cancer so if a coder/or even biller was to see that in the documentation there is no harm in adding that to the claim. You are telling the insurance company a story within the ICD 10 codes -

Z12.11 (Encounter for screening for malignant neoplasm of colon) due to Z80.0 (Family history of malignant neoplasm of digestive organs).

But also you never know what the Dr. may find when they are scoping. My mother had went for her "screening colonoscopy" and she went into the procedure thinking she would have a free surgery since she was of age to receive one however, her GI removed a TINY polyp so that ultimately changed her whole procedure and she ended up having to pay OOP over 2k.

Anyways I guess the choice is yours if you want to add Z80.0 to your claim or not.

They should put modifier PT on the claim letting the insurance company know it starting out as a screening.

 

[xXxPARAGONxXx]

When billing for a screening colonoscopy(first colonoscopy), and the patient mentions their is a family history colon cancer, would you add the family history diagnosis to the claim?

Yes.

Family history is not a symptom.
Family history of colon cancer is relevant history and should be included on the claim.
Being asymptomatic and having a positive family history of colon cancer does not convert a screening colonoscopy into a diagnostic colonoscopy. Unless the provider encounters a finding during the colonoscopy (e.g., polyp), the colonoscopy will remain a screening colonoscopy.

Also, just because someone has a positive family history of colon cancer does not necessarily mean they will need more frequent colonoscopies [if the initial screening colonoscopy is negative] than someone who has a negative family history of colon cancer.

https://www.aafp.org/pubs/afp/issues/2015/0115/p93/jcr:content/root/aafp-article-primary-content-container/aafp_article_main_par/aafp_tables_content2.enlarge.html

 

[DebbyLove84]

Thank you for sharing that link, but it doesn't look like it is the most recent Colorectal Cancer Screening guidelines. They have changed in the last few years. The start age for the initial screening has dropped to 45, and most people who have a first degree relative with colon cancer are on a 5 year repeat interval.