tci General Surgery Coding Alert - 2023 Issue Q2

Reader Questions: Don’t Forget to ‘Code First’

Question: Our surgeon performed a colonoscopy for a patient with a personal history of colon polyps. The patient had a previous colonoscopy two years ago, which did not find colon polyps, nor did the current colonoscopy. We billed the procedure using Z86.010 and G0105. The patient’s primary insurance denied the claim because the “ICD-10 is an unacceptable principal diagnosis.” Please explain what we did wrong. AAPC Forum Participant Answer: The reason for the denial in this situation is that Z86.010 (Personal history of colonic polyps) cannot be the primary diagnosis code for G0105 (Colorectal...

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