Patients who come in for an annual physical exam often expect that all the labs ordered for the visit, or at the visit, will be considered preventive and paid in full by their insurer. Some patients are surprised to later receive a bill for a diagnostic service. Show Some diagnostic tests are considered preventive services, such as a screening colonoscopy or mammogram. But lab tests ordered to monitor a patient’s existing condition are not considered screenings. The correct diagnosis code for a test for monitoring or assessing a known condition is the code for the condition being monitored. The ICD-10 definition of a screening is “the testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease (e.g., screening mammogram).” Some screenings, such as screening for lipoid disorders, have a specific ICD-10 code. Many of these are found in category Z13, "Encounter for screening for other diseases and disorders." There are also specific codes for screening for malignant neoplasms in category Z12 and for infectious diseases in category Z11. Let’s use hyperlipidemia as an example. For a patient with no known history of hyperlipidemia who is being screened for the disease, you would use diagnosis code Z13.220, "Encounter for screening for lipoid disorders." For a patient already diagnosed with hyperlipidemia who is undergoing a lab test and
being monitored or treated, you would use a code from category E78, "Disorders of lipoprotein metabolism and other lipidemias." It isn’t easy to explain to a patient that not all labs done at the time of an annual physical exam are part of a preventive service. But you should feel confident that, according to ICD-10 rules, monitoring a known condition is not considered a screening. – Betsy Nicoletti, a Massachusetts-based coding and billing consultant Posted on Oct 31, 2018 by Betsy Nicoletti This Coding Tip was updated on 7/26/2022 Coding colonoscopy records has always been a challenge when it comes to reporting the primary diagnosis for the account. All colonoscopy procedures are performed to look for potential malignancy and some coders think that all of these should be coded as screenings, code Z12.11. The coding advice for reporting screening vs. follow-up did not change with the implementation of ICD-10-CM. If the patient presents for a screening colonoscopy and a polyp or any other lesion/diagnosis is found, the primary diagnosis is still going to be Z12.11, Encounter for screening for malignant neoplasm of colon. The coder should also report the polyp or findings as additional diagnosis codes. When a screening colonoscopy is performed, the screening code would be reported regardless of the findings during the exam or other procedures performed due to the findings. Surveillance is often used to describe the visit for the 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. Surveillance colonoscopies are still screenings. However, the coder must be cautious as sometimes the physician will document “surveillance” colonoscopy when in fact what he is performing is a follow-up colonoscopy. Read and be guided by all the information within the medical record. Follow-up examination is typically performed when a patient has been found on previous exam to have a potentially malignant neoplasm or lesion that is suspicious for malignant transformation. A patient that had colonoscopy a few months ago with polypectomy, for adenomatous polyp, returns for follow-up examination to look for recurrence would be coded as a follow-up examination with Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm. If the follow-up is being performed after removal of malignancy, then Z08, Encounter for follow-up examination after completed treatment for malignant neoplasm would be reported as the first listed code. When a patient presents for outpatient colonoscopy due to symptoms that they are having, then the symptom or finding would be the primary diagnosis. If a cause is found/identified by the physician to be the culprit of the symptoms, then this would be the primary diagnosis. If the patient presents with changes in bowel habits and during the colonoscopy the patient is found to have severe sigmoid diverticulosis, the primary diagnosis would be the symptom unless the physician specifies that the symptom is due to the finding of diverticulosis. If the physician does state that the diverticulosis is the postoperative diagnosis or the etiology of the symptoms, then the diverticulosis is the primary diagnosis. As always, be sure to reference any facility specific coding guidelines to determine if there is any specific guidance to follow. References: AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS, First Quarter 2018 Pages: 6-7 The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly. Is malignant neoplasm the same as cancer?Neoplasms may be benign (not cancer) or malignant (cancer). Benign neoplasms may grow large but do not spread into, or invade, nearby tissues or other parts of the body. Malignant neoplasms can spread into, or invade, nearby tissues.
What does encounter for screening for malignant neoplasm of breast?31 (Encounter for screening mammogram for malignant neoplasm of breast) is the correct code to use when you are ordering a routine mammogram for a patient. However, coders are coming across many routine mammogram orders that use Z12. 39 (Encounter for other screening for malignant neoplasm of breast).
How serious is a malignant neoplasm?A cancerous tumor (malignant neoplasm) can grow unchecked, invade healthy tissue and metastasize (spread), or spread from the place where it starts to other parts of the body. If it goes untreated and continues to spread, a malignant neoplasm can interfere with organ function and become life threatening.
What does it mean encounter for screening?“Codes from categories Z11-Z13, Encounter for screening, are assigned to encounters for tests performed to identify a disease or disease precursors for the purpose of early detection and treatment for patients who test positive.
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What does encounter for screening for malignant neoplasm mean
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