How do you bill a colonoscopy surveillance?
Asked by: Emory Simonis | Last update: March 8, 2025Score: 4.6/5 (43 votes)
Is surveillance colonoscopy coded as screening?
A: Words that physicians may use for screening colonoscopies include screening, surveillance, preventive, high risk screening, average risk screening, need for screening, etc. In this case, since the word SURVEILLANCE colonoscopy is documented, I would recommend coding this as a screening (Z12.
Is surveillance colonoscopy covered by insurance?
The Affordable Care Act requires recommended preventative services, such as colonoscopies, be covered at no cost to the patient.
Do you use Z12-11 on surveillance colonoscopy?
If a patient has had previous removal of colon polyps a few years ago and is now presenting for surveillance colonoscopy to look for any additional polyps or recurrence of the polyp this is coded with Z12. 11, Encounter for screening for malignant neoplasm of colon as the first listed code.
What is the ICD-10 code for colonoscopy surveillance?
Encounter for screening for malignant neoplasm of colon
Z12. 11 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2025 edition of ICD-10-CM Z12. 11 became effective on October 1, 2024.
AGA Clinical Practice: Strategies to Improve Quality of Screening and Surveillance Colonoscopy
How to bill surveillance colonoscopy?
What's the right code to use for screening colonoscopy? For commercial and Medicaid patients, use CPT code 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression [separate procedure]).
Is a surveillance colonoscopy considered preventive care?
Even though surveillance colonoscopy is for asymptomatic patients, commercial insurers classify it as a 'diagnostic' rather than preventive service. This unjustly subjects the very patients who need this screening the most to additional cost-sharing.
Is a surveillance colonoscopy the same as a colonoscopy?
Diagnostic colonoscopies, also referred to as follow-up or surveillance colonoscopies, are different from screening colonoscopies since such procedures are provided when there is a greater probability of cancer development or if there is evidence that colorectal cancer might be present.
What is the difference between Z12 31 and Z12 39?
The Z12. 31 is specific to screening mammograms and the Z12. 39 is any screening of the breast other than mammograms.
What are the guidelines for colonoscopy screening and surveillance?
- Colonoscopy every 10 years.
- CT colonography (virtual colonoscopy) every 5 years.
- Sigmoidoscopy every 5 years.
How much is a surveillance colonoscopy?
Without insurance, a colonoscopy in the U.S. can range from $1,250 to $4,800 or more with an average cost of $2,750. If you have insurance, you typically pay nothing for a screening colonoscopy.
Why won't insurance cover colonoscopy?
Soon after the ACA became law, some insurance companies considered a colonoscopy to no longer be just a “screening” test if a polyp was removed during the procedure. It would then be a “diagnostic” test, and would therefore be subject to co-pays and deductibles.
What is the KX modifier for colonoscopy?
Modifier KX was published in Medicare's Med-Learn Matters Article, MM13017, addressing modifier KX. Medicare indicates the following: "Attach the KX modifier to a screening colonoscopy code to indicate such service was performed as a follow-up screening after a positive result from a stool-based test.”
Are surveillance colonoscopies covered by insurance?
Depending upon on your insurance carrier, surveillance colonoscopy could be processed under your screening benefits or diagnostic benefit and may have some cost share.
Are surveillance and screening the same?
Surveillance is not screening, but concerns identified during surveillance should trigger additional developmental screening. Surveillance may also occur at acute care visits if a child has missed a routine health supervision visit or if concerns arise between health supervision visits.
What are the nice guidelines for surveillance colonoscopy?
Surveillance can be stratified by risk: • low: consider colonoscopy at 5 years, • intermediate: offer colonoscopy at 3 years, • high: offer colonoscopy at 1 year. Other tests, e.g. computed tomographic colonography (CTC) or double contrast barium enema, should be offered if indicated.
Is Z12-31 a preventive code?
For example, the screening mammogram ICD-10 code is Z12. 31, indicating a routine screening where no disease is presumed. This code is essential for preventative health measures, emphasizing the importance of regular screenings in the early detection of breast cancer.
What is the Z code for screening colonoscopy?
To report a screening colonoscopy on a patient not considered high risk for colorectal cancer, use HCPCS code G0121 and diagnosis code Z12. 11 (encounter for screening for malignant neoplasm of the colon).
What is the difference between Z12 4 and Z01 419?
Z12. 4 - Screening pap smear of cervix in the absence of sign, symptom or history. Z01. 419 - Screening pap smear of cervix in the absence of sign, symptom or history, smear collected as part of gynecological examination.
What is a camera colonoscopy?
During a colonoscopy, your doctor uses a flexible tube with a small camera to look inside your large bowel (colon). In some hospitals, people with symptoms of bowel cancer may have a capsule endoscopy instead of having a colonoscopy straight away. The capsule endoscopy can help to rule out bowel cancer.
When can you stop colonoscopy surveillance?
The American College of Physicians, e.g., recommends that average-risk CRC screening be discontinued in patients with a life expectancy of <10 years (the average life expectancy for a 75-year-old in the United States) (11).
What type of screening is a colonoscopy?
Colonoscopy. Colonoscopy is a procedure to look inside the rectum and colon for polyps, abnormal areas, or cancer. A colonoscope is inserted through the rectum into the colon. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing.
Can colonoscopy be billed as preventative?
If a procedure is billed as a screening, colonoscopy benefits will be applied as preventive based on the intent of the test and not on the findings.
Why isn't my colonoscopy covered by insurance?
Your insurance should cover 100% of the costs, so you will not need to pay. If your doctor removes a polyp during the test, it becomes a DIAGNOSTIC COLONOSCOPY. This means your insurance may not cover the cost. Your care team will let you know after if they find any polyps.