Wiki Personal / Family history of polyps/cancer and Positive Cologuard

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vickymazza

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Per the USPSTF colonoscopies after a positive stool-based test are coded as screenings, but what if the patient has a personal or family history? I can't seem to find any guidance on this, and I am starting to have problems with our physicians. Even Cologuard says their test is for Average Risk. The PCPs are ordering these tests like crazy regardless of histories. I've attended the Gastroenterology Coding, Billing and Compliance Workshop sponsored by McVey Seminars and per the consultant with AskMueller Consulting, these colonoscopies would not be screenings and in fact would be diagnostic also there is an article from Surgical Notes that states the same thing. I want to make sure I'm coding these correctly and can educated our physicians.
 
Vicky
I d use first listed Z dx code such as Z01.89 or the disease suffering with documented of course. What is the reason for colonoscopy add code to sign & symptoms ...is patient having problems such as dx K63.89, K31.89, K57 ,R19.7, K59, K64? Then use Z dx history code or personal dx code LAST. Last dx codes possible use Z13.811 or Z11.0I or Z12.11. Also know lab CPT 88305 can be linked with Z12.11 for stool feces testing If polyps located add dx D12 per intestinal site. If there is bacteria found documented add that dx too.
I hope helped you with this information
Lady T
 
A personal history of colon polyps is coded depending on the insurance. Some consider this a screening while others do not. I suggest looking into the patients' insurance first.
 
vickymazza said:
Per the USPSTF colonoscopies after a positive stool-based test are coded as screenings, but what if the patient has a personal or family history? I can't seem to find any guidance on this, and I am starting to have problems with our physicians. Even Cologuard says their test is for Average Risk. The PCPs are ordering these tests like crazy regardless of histories. I've attended the Gastroenterology Coding, Billing and Compliance Workshop sponsored by McVey Seminars and per the consultant with AskMueller Consulting, these colonoscopies would not be screenings and in fact would be diagnostic also there is an article from Surgical Notes that states the same thing. I want to make sure I'm coding these correctly and can educated our physicians.
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Did you get any clarity on this? I am running into the same issues.
 
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