ICD-10 Coding for Personal History of Colon Polyps(Z86.010, K63.5, Z12.11)
Complete ICD-10-CM coding and documentation guide for Personal History of Colon Polyps. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Personal History of Colon Polyps
Z86.010Primary Range
Personal history of colonic polyps
This range is used for documenting a patient's history of benign colonic polyps, specifically adenomatous or serrated types.
Encounter for screening for malignant neoplasm of colon
Used for screening colonoscopies, including surveillance after polyp removal.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Z86.010 | Personal history of colonic polyps | Use for patients with a documented history of adenomatous or serrated colonic polyps. |
|
| K63.5 | Polyp of colon | Use for active hyperplastic polyps found during the current encounter. |
|
| Z12.11 | Encounter for screening for malignant neoplasm of colon | Use for screening colonoscopies, including surveillance. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for personal history of colon polyps
Essential facts and insights about Personal History of Colon Polyps
Primary ICD-10-CM Codes for personal history of colon polyps
Decision Criteria
clinical Criteria
- Patient has a history of adenomatous or serrated polyps.
documentation Criteria
- Pathology report confirms polyp type.
Applicable To
- History of adenomatous polyps
- History of serrated polyps
Excludes
- Current polyps (K63.5)
Clinical Validation Requirements
- Pathology report confirming adenomatous or serrated polyps
Code-Specific Risks
- Incorrectly coding current polyps as history
Coding Notes
- Ensure documentation specifies the type of polyp for accurate coding.
K63.5 - Polyp of colon
Use for active hyperplastic polyps found during the current encounter.
Applicable To
- Current hyperplastic polyps
Excludes
- History of polyps (Z86.010)
Clinical Validation Requirements
- Current pathology report confirming hyperplastic polyp
Coding Notes
Ensure current polyps are not coded as history.
Z12.11 - Encounter for screening for malignant neoplasm of colon
Use for screening colonoscopies, including surveillance.
Applicable To
- Screening colonoscopy
Excludes
- Diagnostic colonoscopy
Clinical Validation Requirements
- Documentation indicating screening purpose
Coding Notes
Ensure the procedure is truly screening and not diagnostic.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Personal History of Colon Polyps to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z86.010.
Impact
Clinical: Inaccurate patient history and follow-up care., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Review pathology reports, Train staff on documentation standards
Impact
Reimbursement: Incorrect reimbursement due to misclassification., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient history records.
Mitigation Strategy
Ensure current polyps are coded with K63.5, not Z86.010.
Impact
Reimbursement: Denials due to incorrect coding., Compliance: Violation of screening vs. diagnostic coding rules., Data Quality: Misleading data on screening practices.
Mitigation Strategy
Only use Z12.11 for true screening procedures.
Impact
Incorrect use of screening codes for diagnostic procedures.
Mitigation Strategy
Regular audits and staff training on coding guidelines.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Personal History of Colon Polyps, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Personal History of Colon Polyps
Use these documentation templates to ensure complete and accurate documentation for Personal History of Colon Polyps. These templates include all required elements for proper coding and billing.
Surveillance Colonoscopy
Specialty: GastroenterologyRequired Elements
- Indication for procedure
- History of polyps
- Pathology report
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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