Wiki Z80.0 clinical edit error BCBS Michigan

[elaine.pulsepoint@icloud.com]

Anyone experiencing denials for Z80.0 with BCBS? I've run into several plans that are denying Z80.0 (family hx colon cancer) as an invalid ICD10 code for high risk screening colonoscopy. I've talked with provider services, reported the issue and believe since Oct 1st they have an error in their clinical edits. Just curious if other states are encountering similar denials - it's not all the plans, just a couple to date. G0105 Z80.0 denies and per the reps at BCBS, they told me their database says Z80.0 is not valid, to use another code. I've checked Z80.0 and it did not change or get replaced with the 2018 revisions to ICD10. Interested in any input. thx!

 

[tfischer]

Are you using Z80.0 only as the diagnosis or are you also using Z12.11? Correct Coding Guidelines states to use Z12.11 as primary diagnosis and Z80.0 as secondary for family histories.

 

[AGambino]

Is this the same for personal history of polyps? so would it be Z12.11 then Z86.010? What about when the patient has a personal history of cancerous polyps, wouldn't it be coded as Z09 then Z86.010? I am very confused over this....

 

[kellibeasley]

code screening with family history, not personal history

I don't think it is the same for personal history. Coding guidelines state screening should be coded with family history codes, but not personal history codes. I would code Z09 (encounter for follow up examination after completed treatment for conditions other than malignant neoplasm) and Z86.010