Wiki New ICD 10's for Colonoscopies. Denial issue.

[krenatesmith]

Recent updates to C-scope Diagnosis have resulted in several denials with our claims, particularly with Medicare & Humana. Dx Z86.0101, Z86.0102, Z86.0109.

Per guidelines we are to use the Z codes that refer to "any follow-up examination after treatment" as primary, however both payors are denying our claims.

Please let me know if this is happening due to the "update" & it will hopefully "correct itself"

Thank you

 

[chames]

I am noticing the same thing with Medicare, unfortunately I have not figured out what the issue is yet.

 

[TThivierge]

Chames and Krenata,
The ICD10 manual states those Z dx codes ARE NOT primary dx codes to use dx Z86. The provider needs to tell you why or symptoms or digestive reason patient having colonoscopies. Also try to use K92.8 as first with Z86 as 2nd dx if no symptoms.
I hope this option helps you
Lady T