How to code surveillance colonoscopy?
Asked by: Dr. Durward Jakubowski V | Last update: April 18, 2025Score: 4.2/5 (4 votes)
What is the ICD-10 code for surveillance colonoscopy?
Z12. 11 (encounter for screening for malignant neoplasm of colon)
What is the CPT code for surveillance 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]).
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.
Is surveillance colonoscopy considered screening?
Diagnostic colonoscopies, also known as follow-up or surveillance colonoscopies, are different from screening colonoscopies, as they are performed when there is a greater chance that cancer might develop or in the event there are indications that colon or rectal cancer may exist.
Colonoscopy - Screening, Diagnosis, and Surveillance for Colon Cancer
What is the difference between surveillance and screening?
The fundamental purpose of screening is early diagnosis and treatment of the individual and thus has a clinical focus. The fundamental purpose of surveillance is to detect and eliminate the underlying causes such as hazards or exposures of any discovered trends and thus has a prevention focus.
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.
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 is the difference between a colonoscopy and a screening colonoscopy?
While screening colonoscopies are key to catching problems in their earliest stages before symptoms arise, a diagnostic colonoscopy is necessary when symptoms are already present. Screening or diagnostic approaches are even more important if you have a personal risk of colorectal cancer or certain medical conditions.
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.
What is diagnosis code Z12 12?
ICD-10 code Z12. 12 for Encounter for screening for malignant neoplasm of rectum is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
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.”
When to use Z09?
ICD-10 code: Z09 Follow-up examination after treatment for conditions other than malignant neoplasms.
Why isn't a diagnostic colonoscopy covered by insurance?
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 a surveillance colonoscopy?
A colonoscopy allows specialists to look for early changes in the large bowel (colon) before cancer develops. This is called a surveillance colonoscopy. It detects changes at a very early stage when they are more likely to be treated and cured.
What is the difference between a surveillance colonoscopy and a diagnostic 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.
How to code a colonoscopy?
What is the ICD-10 code for screening colonoscopy?
ICD-10 code Z12. 11 for Encounter for screening for malignant neoplasm of colon is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
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 diagnosis code Z12 13?
Encounter for screening for malignant neoplasm of small intestine. Z12. 13 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
Does Medicare pay for surveillance colonoscopy?
Colonoscopies. Medicare covers screening colonoscopies once every 24 months if you're at high risk for colorectal cancer. If you aren't at high risk, Medicare covers the test once every 120 months, or 48 months after a previous flexible sigmoidoscopy. There's no minimum age requirement.
What does repeat colonoscopy for surveillance mean?
Surveillance refers to the process of evaluating patients with a personal history of polyps or cancer. People who have precancerous polyps completely removed should have a colonoscopy every 3-5 years, depending on the size and number of polyps found.
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.