Z12.11 coding help needed

ShobihaaS

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Hi All,

I have a case where the patient has a history of diverticulosis and the doctor performed a screening colonoscopy. During the procedure, polyps were identified and removed, and first-degree hemorrhoids were also noted. The doctor instructed us to code the following:
  • Primary Dx: Z12.11 – Encounter for screening for malignant neoplasm of colon
  • Secondary Dx: K63.5 – Polyp of colon, K57.30 – Diverticulosis of large intestine without perforation or abscess, K64.0 – First degree hemorrhoids

My concern is regarding the choice of Z12.11 as the primary diagnosis. Since the patient has a history of diverticulosis, shouldn’t the primary diagnosis reflect that condition instead? However, the visit note mentions that the patient had a diverticulosis attack 10 years ago, and the consulting doctor at that time documented a normal colon with benign tissue.

Could you please confirm if coding Z12.11 as the primary diagnosis is correct, considering the procedure was performed primarily as a screening?
 
If the patient is symptom free, I would code Z12.11 primary. You could add Z87.19 for history of diverticulosis, but it's my opinion it wouldn't be relevant if that last attack was 10 yrs ago with no finding.
 
If the patient is symptom free, I would code Z12.11 primary. You could add Z87.19 for history of diverticulosis, but it's my opinion it wouldn't be relevant if that last attack was 10 yrs ago with no finding.
With the visit note i do not see any stuffs discussed regarding the malignancy. So my concern is can we report this code as default?
 
With the visit note i do not see any stuffs discussed regarding the malignancy. So my concern is can we report this code as default?

Which malignancy are you referring to?

Diverticulosis is not a malignancy - is there a different history of a malignancy that you didn't mention in your original post?
 
Which malignancy are you referring to?

Diverticulosis is not a malignancy - is there a different history of a malignancy that you didn't mention in your original post?
Clinic is using this code as Primary
  • Primary Dx: Z12.11 – Encounter for screening for malignant neoplasm of colon. But in the visit note, I don't see anything related to malignancy. Thats my concern.
 
Clinic is using this code as Primary
  • Primary Dx: Z12.11 – Encounter for screening for malignant neoplasm of colon. But in the visit note, I don't see anything related to malignancy. Thats my concern.

Correct - it's a screening colonoscopy. The patient shouldn't have a diagnosis related to a malignancy.

Screenings are preventative tests. The patient is being screened to make sure they don't have colon cancer.

 
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