Wiki Medicare denying Z80.0-Considered routine??

[Hayley_Sutton]

I am getting a ton of denials from Medicare for colonoscopies performed with the indication Z80.0-Family history of colon cancer. The remark code is: 49- These are non covered services because this is a routine exam or screening procedure done in conjunction with a routine exam. It denies patients that we have not billed an office exam with any routine indications. I called Medicare and the rep just kept saying it was not on their list to support medical necessity. I haven't had this issue until recently. They deny any claim with the code; polyp removal or no polyp removal.

Anyone else having this issue or know the fix?

 

[mitchellde]

You should use the code Z12.11 for screening first listed and family history secondary.

 

[ssmith955]

Z12.11 vs Z80.0

If the patient is 50 or older and is having first time screening I will use V12.11 as primary then the Z80.0. If the patient is under the age of 50
they are not eligible for a screening and the V12.11 in the primary slot will be denied because pt not eligible, so in that case I use the Z80.0
in the primary slot. What are your thoughts on this?