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.
ICD-10 guidelines clearly demarcate between coding for screening and surveillance.
|Screening for malignant neoplasm of||ICD-10 code|
|Intestinal tract, unspecified||Z12.10|
|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.-)
|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|
|Small intestine||Carcinoid tumor||Z85.060|
|Other malignant neoplasm||Z85.068|
|Other digestive organs||Malignant neoplasm||Z85.09|
Z09 – Encounter for follow up examination after completed treatment for conditions other than malignant neoplasm.
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.