Forum - Questions & Answers

Mar 1st, 2016 - rphelps 615  1 

Colon screening

Getting a denial on a G0105 for a history of crohns. I used diagnosis code K50.00. Does anyone have any idea why I am getting denied?

Mar 1st, 2016 - codinqueen 57 

re: Colon screening

If you are billing a colon screening HCPCS code G0105 or G0121 you MUST have Z12.11 as P dx. Was the Dr screening for colon cancer because pt is at high risk d/t Crohn's disease? If that is the case, your P Dx is Z12.11, followed by the Crohns dx code and use HCPCS G0105 because she is high risk. ANYtime you are billing a HCPCS code that indicates screening for colon cancer, your P dx MUST be Z12.11 or it will be denied. Screening colonoscopies were addressed by the Affordable Care Act a few yrs ago and since they are preventive, there is no pt co-pay for screening exams that don't find anything. In order to evaluate the claim, CMS & the insurance companies are requiring Z12.11 as the P dx for screening colonoscopies.

Mar 2nd, 2016 - mbrigham 1 

re: Colon screening

Our Medicare carrier does not want the Z12.11 as the primary code on the G0105. They require the reason they are high risk, example they would want Z86.010 for personal history of polyps as primary and we do not have to use the Z12.11 on this either. I do agree with the G0121 you need Z12.11 as primary. You need to check with your Medicare carrier to be sure.

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