Adhere to ICD-10 Coding Guidelines Now [avoid payment disruptions]


Adhere to ICD-10 Coding Guidelines Now [avoid payment disruptions]

October 1st, 2016 marks the end of the grace period allotted by CMS and AMA to facilitate smooth ICD-10 implementation. During the grace period, insurances processed claims even if they were wrongly coded, just as long as the codes belonged to the broader family of correct codes. However, such claims will not be paid after the grace period. It now becomes crucial for medical practices to strictly adhere to ICD-10 coding guidelines to avoid payment disruptions.

Here are a few guidelines for screening and surveillance colonoscopy.

Difference between screening and surveillance colonoscopies
Screening is a test provided to a patient in the absence of signs or symptoms. A screening colonoscopy is a service performed on an asymptomatic person for the purpose of testing the presence of colorectal cancer or colorectal polyps.
A surveillance colonoscopy can be performed at varying ages and intervals based on the patient’s personal history of colon cancer, polyps, and/or gastrointestinal disease. For example, patients with a history of colon polyps are not recommended for a screening colonoscopy, but for a surveillance colonoscopy.


Coding guidelines
ICD-10 guidelines clearly demarcate between coding for screening and surveillance.

Screening for malignant neoplasm of  ICD-10 code
Stomach Z12.0
Intestinal tract, unspecified Z12.10
Colon Z12.11
Rectum Z12.12
Small intestine Z12.13
Other sites Z12.89
Site unspecified Z12.9
Non cancerous disorders ICD-10 code
Screening for upper GI disorder Z13.810
Screening for lower GI disorder Z13.811
Screening for other digestive disorders Z13.818

 

Additional codes for family history of malignant neoplasm

Z80.0 –   Family history of malignant neoplasm of digestive organs

Z83.71 – Family history of colonic polyps

Z83.79 – Family history of other diseases of the digestive system

 

Surveillance colonoscopy codes

Z08 – Encounter for follow up examination after completed treatment of malignant neoplasm.
Use additional code for personal history of malignant neoplasm (Z85.-)

Organ Malignancy ICD-10 Code
Stomach Carcinoid tumor Z85.020
Other malignant neoplasm Z85.028
Large intestine Carcinoid tumor Z85.030
Other malignant neoplasm Z85.038
Rectum, rectosigmoid junction, anus Carcinoid tumor Z85.040
Other malignant neoplasm Z85.048
Liver Malignant neoplasm Z85.05
Small intestine Carcinoid tumor Z85.060
Other malignant neoplasm Z85.068
Pancreas Malignant neoplasm Z85.07
Other digestive organs Malignant neoplasm Z85.09

Z09 – Encounter for follow up examination after completed treatment for conditions other than malignant neoplasm.

[Read: Choosing between Modifier 53 and 52 – Gastroenterology example]

Additional codes to identify any applicable history of diseases (Z86.-, Z87.-)

Z86.010 – Personal history of colonic polyps
Z86.012 – Personal history of benign carcinoid tumor
Z86.018 – Personal history of other benign neoplasm
Z86.03 – Personal history of neoplasm of uncertain behavior
Z86.19 – Personal history of other infectious and parasitic diseases.
Z87.11 – Personal history of peptic ulcer disease
Z87.19 – Personal history of other diseases of digestive system

Colonoscopies account for majority of a gastroenterologist’s revenues. It’s important that doctors and their coders pay close attention to the specificity that ICD-10 demands. Systems like enki EHR help in directing doctors to code correctly at the point of care.

Related:

[FREE GUIDE] How to bill accurate codes for endoscopy procedures

How to code for ulcers according to ICD-10 guidelines

4 comments

  1. This article is one of the best I have seen written to include the follow up/surveillance Colonoscopy for those cases that are ordered to have more frequent follow ups due to high risk or past malignancy. It is very confusing for me as an auditor/educator because I keep hearing from the Coding supervisors that the providers do not like this Z08/Z09 codes and they are instructing their coders not to use them.

    I feel we are not following coding guidelines. Confusion also occurs when physicians use surveillance and screening as like terms. I have a coding supervisor that keeps saying they are the same. I know for fact they are not. She feels the physicians do not know the difference. Ongoing issue. Any advice. I am also wondering if you have source you used to retrieve the information in your article.

    Thank you very much, I feel you just helped me prove my point. Anymore information you have on this subject would be greatly appreciated. I do feel I need more provider information as well, hard to filter down to these items.

  2. Peggy,

    Thanks for your comments.

    It’s possible that insurances deny certain surveillance codes when given as primary – this could prompt the confusion. You could go back and examine payment trends on surveillance codes.

    Z08 indicates that the patient had cancer and we are now checking for its occurrence again. So clinically, it’s accurate to do so.

    The best source to find this information is the ICD-10-CM manual itself. Please refer to the following pages for how screening and surveillance codes are differentiated.

    Screening codes: Page 1240 of ICD-10-CM manual mentions screening codes such as Z11, Z12. The Z12 category further specifies neoplasm as per the part of digestive system. Example, Z12.11 – Encounter for screening for malignant neoplasm of colon. Codes under Z13 are also used as screening codes for other systems of the human body. Example, Z13.5 – encounter for screening for eye and ear disorders. If patient has family history of malignant neoplasms, codes belonging to Z80 series can be used. These codes have been listed on page 1255 of ICD-10-CM manual.

    Surveillance codes: Page 1239 describes Z08 (follow up examination after completing treatment of malignant neoplasm) and Z09 (other than malignant neoplasm). The description of Z08 and Z09 indicate that the patient was already suffering from either a malignant or other than malignant disease. Hence these codes form the primary code for surveillance coding. Given the fact patient has had previous episodes of disease either malignant or other than malignant, a personal history code of malignancy becomes imperative.

    Page 1256 of ICD-10-CM manual gives following guidelines:
    Z85 Personal history of malignant neoplasm

    One could use Z08 as the primary code to signify follow-up examination after treatment of malignant neoplasm. Malignant neoplasms are further classified as carcinoid tumor of an organ and other malignant neoplasm of an organ. Example, Z85.020 indicates personal history of malignant carcinoid tumor of stomach and Z85.028 indicates personal history of other malignant neoplasm of stomach.

    It is important to note that this coding requires specific documentation from the physician about carcinoid tumor or other malignant neoplasm.

    Hope this helps. Stay in touch and feel free to reach out if you have more questions.

  3. When coding a surveillance colonoscopy in a patient presenting with personal history of colon polyps – do we code it as a screening with ICD 10 code Z12.11 before the Z86.010?? I’m so confused about this!

  4. Coding for Surveillance colonoscopy differs from screening colonoscopy as in case of surveillance colonoscopy patient has previous history of polyps. Patient with the personal history of polyps cannot be coded as
    Screening. For screening, patient should not have any history and should be asymptomatic.

    Coding :
    ICD 10 codes can be Z08 – Encounter for follow-up examination after completed treatment for malignant neoplasm (as primary ICD)

    Z85.0- Personal history of malignant neoplasm codes (Please use the specific code as specified on page no 1276 of (ICD 10 CM expert 2018) (as secondary ICD)

    Z09 – Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm (as primary ICD)

    Z86.010 – Personal history of colonic polyps (as secondary ICD)

    Z87..11 – Personal history of peptic ulcer disease (as Secondary ICD)

    Z87.19 – Personal history of other diseases of digestive system (as Secondary ICD)

    Please note: Some insurances do not accept Z08 or Z09 as primary ICD code, but Z85.0 or Z86, Z87… series is accepted as primary. Please consider insurance requirements of primary ICD code before coding.

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