Is surveillance colonoscopy coded as screening?
Asked by: Esperanza Konopelski PhD | Last update: March 25, 2025Score: 4.1/5 (53 votes)
Is a surveillance colonoscopy a screening?
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 do you code a surveillance colonoscopy?
In this case, since the word SURVEILLANCE colonoscopy is documented, I would recommend coding this as a screening (Z12. 11), followed by any findings, as well as the personal history of colonic polyps (Z86. 010) – sequenced in that order.
What is the ICD-10 code for surveillance colonoscopy?
Z12. 11 (encounter for screening for malignant neoplasm of colon)
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.
Colonoscopy - Screening, Diagnosis, and Surveillance for Colon Cancer
Is a follow-up colonoscopy a screening?
If you initially have a non-invasive stool-based screening test (fecal occult blood tests or multi-target stool DNA test) and receive a positive result, Medicare also covers a follow-up colonoscopy as a screening test.
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.
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 difference between screening and diagnostic 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.
Can Z09 be used as primary diagnosis?
Certain Z codes may only be used as first-listed or principal diagnosis." It would not be correct to code the problem diagnosis first if the condition no longer exists and is not being treated. Z09 would be the correct first-listed code if the follow-up after completed treatment is the primary reason for the encounter.
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.
What is the CPT code for virtual colonoscopy screening?
CPT® Code - 74263 Computed tomographic (CT) colonography (i.e., virtual colonoscopy), screening, including image postprocessing is never covered.
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]).
What is medical surveillance screening?
Medical surveillance is the analysis of health information to look for problems that may be occurring in the workplace that require targeted prevention. Thus, surveillance serves as a feedback loop to the employer.
What are the intervals for surveillance colonoscopy?
Colorectal cancer screening should begin at 50 years of age in average-risk individuals. The American College of Gastroenterology recommends that colorectal cancer screening begin at 45 years of age in black patients. Average-risk patients with normal findings on colonoscopy should have repeat colonoscopy in 10 years.
What is the ICD 10 code for screening colonoscopy?
2025 ICD-10-CM Diagnosis Code Z12. 11: Encounter for screening for malignant neoplasm of colon.
Is CPT 45380 a screening colonoscopy?
Depending on the procedure performed and the patient's insurance coverage, one of the following cpt codes may be used: 45378 or 45380. These codes specifically apply to screening colonoscopies and ensure that the procedure is properly categorized and billed.
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.
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 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.
When do you use Z12 5?
ICD-10 code Z12. 5 for Encounter for screening for malignant neoplasm of prostate is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
What age do you stop surveillance colonoscopy?
There's no upper age limit for colon cancer screening. But most medical organizations in the United States agree that the benefits of screening decline after age 75 for most people and there's little evidence to support continuing screening after age 85. Discuss colon cancer screening with your health care provider.
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.
Does Medicare cover screening colonoscopy?
Medicare Part B (Medical Insurance) covers colonoscopy screenings 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.