Wiki Hx of Polyps

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44
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Sterling Heights, MI
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I'm in Michigan and billing Blue Cross for patient's having a hx of polyps. I am using the new diagnosis codes and am getting rejected stating its not a benefit when you perform it for the reported dx. Michigan Blue Cross and Blue Care Network are rejecting claims for these new codes.
Is anyone else having trouble?
 
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Encounter
Are you using secondary Z dx as first dx on claim? If so that will cause a denial. Put a dx of symptoms or digestive problem first dx then use Z13.820 or Z12.11 or Z86.010 as last dx. Follow provider documentation on patient s problem first.
I hope helped you
Lady T
 
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These patient's are only coming in because they have a history of colon polyps (tubular adenomas) They had a colon say 3-5 years ago and polyps were found and now they're back due to increased risk for colon ca. The report finds nothing on the current procedure and they have no other issues. I used the new icd10 code Z86.0101. This is saying that these patient's that are high risk for colon cancer, BX won't pay for their colonoscopy? only 1 every 10 years? Something doesn't seem right
 
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I am sort of having this same issue. I was always under the understanding 1 every 10 years was for Medicare. Was just about to come here and ask if anyone knew or thought of it billing as dx of polyp primary and Z86.010 secondary with modifier 33 on procedure code?
 
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