Wiki G0105 Billed with dx Z12.11

[tconstable]

I am sure that this has been hashed out over and over with little clarity on the internet and in posts.

Case in point:

Medicare patient with Crohn's. No Crohn's symptoms for over a year. Obviously high risk, G0105. Patient comes in for a screening colonoscopy. The question.. Is using Z12.11 appropriate as the primary diagnosis and the Crohn's as secondary?

Any weblinks for support would help as well..

 

[tpdmcoding]

yes z12.11 is your primary code, along with if the person has a personal history z86.010 and or family history z80.0 those also can be added.

 

[LMJONES24]

It has always been my understanding that in order to use the Z12.11 as the prim dx that it needs to be the patients 1st colonoscopy or it has been 10 yrs? Please correct me if I am wrong and direct me to where it states otherwise.

 

[danskangel313]

See page 5:
https://www.cms.gov/Medicare/Preven...wnloads/MPS-QuickReferenceChart-1TextOnly.pdf

 

[crusecmt]

9 yrs coding digestive health

The ICD-10 diagnosis code for a Preventative Screening Colonoscopy is Z12.11 and Z12.12. The diagnosis code for a patient with a History of Polyps is Z86.010. As per the Official ICD-10-CM Guidelines for Coding and Reporting, these two codes cannot be reported together.

There are two types of history “Z” codes, personal and family. Personal history codes explain a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring. Family history codes are for use when a patient has a family member(s) who has had a particular disease that causes the patient to be at higher risk of also contracting the disease.

Personal history codes may be used in conjunction with follow-up codes. Family history codes may be used in conjunction with screening codes to explain the need for a test or procedure. A history of an illness, even if no longer present, is important information that may alter the type of treatment ordered.

G0105 with Z87.19, Personal history of other diseases of the digestive system w/ K50.--- (patient's previous dx of Crohn's), would be most accurate for this case.