Wiki Colonoscopy denied due to ICD-10

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patdow

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I’m needing help on how to bill correctly for a colonoscopy. Patient had colonoscopy due to personal history of colon polyps. Previous colonoscopy was 2 years prior with colon polyps found. No colon polyps found on this recent colonoscopy. So we billed using Z86.010 Personal History of Colonic Polyps and G0105 Colonoscopy High Risk Screening. Patient insurance is Cigna primary and Medicare secondary. Claim denied due to “ICD-10 is unacceptable principal diagnosis”. I don’t know what other icd 10 code to use. Insurance rep is not helping. And we already sent them medical records but they still denied.
 
Hi Patdow
Id use the gastro or digestive problem from the patient if provider gives you this information such as K21.9 K59, R19, R15,K92 ,K64 , K57 Etc. I'd use the Z86.010 last dx code. You can always use Z12.11, Z13.818, Z13.810 or Z13.811 which should be last listed dx code. I'd try K63.89 Other ds of intestines or Z01.89 , then dx Z86.010. Or a first listed Z code of Z01.89 might work. This will explain to payer checking on if other gastro diseases in colon due to pt s past history. Hopefully the physician is describing this in reason for medical necessity of colonoscopy again.
I hope this helps you
Lady T
 
Here in Georgia the Local Coverage Article has been updated indicate the following:

For surveillance of colonic neoplasia (when the patient has a history of colorectal cancer or polyps and is being followed for this indication, use the appropriate CPT/HCPCS code with the appropriate ICD-10-CM code and one of the following ICD-10-CM codes as the secondary diagnosis: Z85.038, Z85.048 or Z86.010):

ICD-10 code Z09 requires a secondary diagnosis, for example, Z85.038, Z85.048 or Z86.010.

Hope this helps!
 
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