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
Intestinal tract, unspecifiedZ12.10
Small intestineZ12.13
Other sitesZ12.89
Site unspecifiedZ12.9
Non cancerous disordersICD-10 code
Screening for upper GI disorderZ13.810
Screening for lower GI disorderZ13.811
Screening for other digestive disordersZ13.818

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.-)

OrganMalignancyICD-10 Code
StomachCarcinoid tumorZ85.020
Other malignant neoplasmZ85.028
Large intestineCarcinoid tumorZ85.030
Other malignant neoplasmZ85.038
Rectum, rectosigmoid junction, anusCarcinoid tumorZ85.040
Other malignant neoplasmZ85.048
LiverMalignant neoplasmZ85.05
Small intestineCarcinoid tumorZ85.060
Other malignant neoplasmZ85.068
PancreasMalignant neoplasmZ85.07
Other digestive organsMalignant neoplasmZ85.09

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.


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