Wiki Surveillance colonoscopy

[ENDOCODER]

Need some help please. We had a patient boarded for a colonoscopy/ hx of polyps in 2013, tubular adenoma. Patient had procedure and nothing was found. The patient has United Healthcare and their policy states once a patient has a polyp after a screening all future colonoscopies are considered diagnostic because the time frame between future colonoscopies would be shortened. We billed for a screening colon that they found a polyp in 2013. The patient has no other issues only that she had a polyp in 2013. Do we bill this procedure using G0105 or do we bill 45378 with dx Z86.010. Also, surveillance colonoscopies could be billed as a screening?

 

[DFUGET]

I would check UHC's fee schedule to see if G0105 is on it. If it is not I would bill 45378 dx Z86.010. Otherwise G0105, Z86.010 is correct.

 

[tlsonnier]

I am having a debate with colleges regarding when to bill a screening colonoscopy. My physicians did a screening colonoscopy on a patient and found polyps in 2007, 10 years ago. We coded it 45380PT , V76.51, 211.3. Pt came back 3 years later, 2010, for screening/surveillance and nothing was found, g0121, v12.72. Patient had another colon 3 years after the last one ,2013, and nothing found again, g0121,v12.72. Pt is now coming back in for screening colon. My question is, the pt had a screening 10 years ago and has personal history of polyps but nothing has been found for 10 years, can we bill a true screening, G0105, Z12.11 or do we still need to use the personal history code Z86.010?

 

[DFUGET]

I am having a debate with colleges regarding when to bill a screening colonoscopy. My physicians did a screening colonoscopy on a patient and found polyps in 2007, 10 years ago. We coded it 45380PT , V76.51, 211.3. Pt came back 3 years later, 2010, for screening/surveillance and nothing was found, g0121, v12.72. Patient had another colon 3 years after the last one ,2013, and nothing found again, g0121,v12.72. Pt is now coming back in for screening colon. My question is, the pt had a screening 10 years ago and has personal history of polyps but nothing has been found for 10 years, can we bill a true screening, G0105, Z12.11 or do we still need to use the personal history code Z86.010?

Once a patient is found to have polyps it will always be billed as Z86.010 because they have a personal history. It should be billed as a high risk screening G0105, Z86.010.