ASGE members may submit coding inquiries electronically to codingquestions@ASGE.org. Each month, ASGE gets dozens of questions from members. When submitting a question, please allow at least three business days for a response. When submitting inquiries, please include the ASGE member’s name and ID number. Only questions will be accepted and not reports. Below are two questions that could be beneficial to your practice.
Question #1
I have a patient who had a screening colonoscopy in December that showed adenomatous polyps in the cecum, which were removed in piecemeal fashion. Per pathology, margins from the polyp removal were not clear. The provider wants to bill the follow-up colonoscopy to remove the residual tissue as a personal history of colon polyps ICD-10-CM Diagnosis Code (Z86.010). Would this be correct, or should it be ICD-10-CM Diagnosis Code D12.0 (adenoma of cecum)? Please advise.
Answer
Since there is still residual polyp tissue, ICD-10-CM Diagnosis Code D12.0 would be correct.
Question #2
Can you please give some direction on Medicare's new modifier KX (when the patient presents for a positive stool screening, Cologuard, that results in a colonoscopy)?
Answer
Modifier KX was published in Medicare's Med-Learn Matters Article, MM13017, addressing modifier KX. Medicare indicates the following: "Attach the KX modifier to a screening colonoscopy code to indicate such service was performed as a follow-up screening after a positive result from a stool-based test.”
We have not received any clinical examples on appropriate use, so we have recommended the following: When a patient has a positive Cologuard that results in a normal screening colonoscopy, report G-code G0121-KX with ICD-10-CM Diagnosis Codes Z12.11 and R19.5. When a patient has a positive Cologuard that results in a therapeutic colonoscopy, such as a cold forceps biopsy of a polyp, report CPT code 45380-PT/KX with ICD-10-CM Diagnosis Codes Z12.11, R19.5 and the appropriate polyp code.