Wiki Colonscopy- Surveillance vs Preventative

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kcaskey03

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Hello,
I have a colonoscopy scenario that i have questions on how to bill. patient is NOT medicare.

Patient is returning for 2nd colonoscopy at 5 yr mark- because polpys were found on first one. (also has fmhx of polpys) Does this 2nd colonoscopy count as a surveillance/diagnostic colonoscopy or is it preventative. Also to note- at this 2nd colonscopy-more polyps found and removed (needs to return again 5 yrs)

Ive read numerous things online and it seems to be a hot topic of debate if this is preventative or diagnostic.. since preventative allows 1 in every 10 years and now that they have to return in shorter time intervals d/t high risk- it should be diagnostic?

How does this scenario code out (diagnosis wise)? Primary dx- personal hx of polpys? Does modifier 33 need to be added or left off?


Thanks for any input.
 
If there were polyps found and patient is returning before the 10 yr mark and not Medicare, only use Z86.010, this will not be a screening colon.
 
It depends on the payer guidelines. If the insurance company recognizes Z86.010 as preventive, I would use -33, if its surveillance, then I would leave off -33. Most of the commercial insurance companies I work with do not recognize Z86.010 as preventive only surveillance, with Humana being an exception. If you try adding Z12.10 before Z86.010, that could result in improper payment if it goes against the insurance policy guidelines. Also, even though the patient has family history, personal history trumps the family history so I would not use that code unless it was placed as a last diagnosis. Even then, you could have insurance companies tell the patient, "If they had listed another diagnosis first, then we would have paid as preventive." I would stick with Z86.010 first, followed by any findings.
 
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