2024 ICD-10-CM Diagnosis Code Z12.11
Encounter for screening for malignant neoplasm of colon
- ICD-10-CM Code:
- Z12.11
- ICD-10 Code for:
- Encounter for screening for malignant neoplasm of colon
- Is Billable?
- Yes - Valid for Submission
- Code Navigator:
Z12.11 is a billable diagnosis code used to specify a medical diagnosis of encounter for screening for malignant neoplasm of colon. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.
This code describes a circumstance which influences the patient's health status but not a current illness or injury. The code is unacceptable as a principal diagnosis.
The code is linked to some Quality Measures as part of Medicare's Quality Payment Program (QPP). When this code is used as part of a patient's medical record the following Quality Measures might apply: Appropriate Follow-up Interval For Normal Colonoscopy In Average Risk Patients.
Approximate Synonyms
The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:
- Screening for malignant neoplasm done
- Screening for malignant neoplasm of colon done
- Screening for neoplasm done
Clinical Classification
Clinical Category is Neoplasm-related encounters
- CCSR Category Code: FAC008
- Inpatient Default CCSR: X - Not applicable.
- Outpatient Default CCSR: Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.
Tabular List of Diseases and Injuries
The following annotation back-references are applicable to this diagnosis code. The Tabular List of Diseases and Injuries is a list of ICD-10-CM codes, organized "head to toe" into chapters and sections with coding notes and guidance for inclusions, exclusions, descriptions and more.
Inclusion Terms
Inclusion TermsThese terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
- Encounter for screening colonoscopy NOS
Index to Diseases and Injuries References
The following annotation back-references for this diagnosis code are found in the injuries and diseases index. The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10-CM code(s).
- - Encounter (with health service) (for) - Z76.89
- - colonoscopy, screening - Z12.11
- - Screening (for) - Z13.9
- - colonoscopy - Z12.11
- - neoplasm (malignant) (of) - Z12.9
- - colon - Z12.11
- - intestinal tract - Z12.10
- - colon - Z12.11
Code Edits
The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10-CM Code Edits are applicable to this code:
- Unacceptable principal diagnosis - There are selected codes that describe a circumstance which influences an individual's health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis.
Present on Admission (POA)
Z12.11 is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here.
CMS POA Indicator Options and Definitions
POA Indicator | Reason for Code | CMS will pay the CC/MCC DRG? |
---|---|---|
Y | Diagnosis was present at time of inpatient admission. | YES |
N | Diagnosis was not present at time of inpatient admission. | NO |
U | Documentation insufficient to determine if the condition was present at the time of inpatient admission. | NO |
W | Clinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission. | YES |
1 | Unreported/Not used - Exempt from POA reporting. | NO |
Convert Z12.11 to ICD-9-CM
- ICD-9-CM Code: V76.51 - Screen malig neop-colon
Quality Payment Program Measures
When code Z12.11 is part of the patient's diagnoses the following Quality Measures apply and affect reimbursement. The objective of Medicare's Quality Measures is to improve patient care by making it more: effective, safe, efficient, patient-centered and equitable.
Quality Measure | Description | Quality Domain | Measure Type | High Priority | Submission Methods |
---|---|---|---|---|---|
Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients | Percentage of patients aged 50 to 75 years of age receiving a screening colonoscopy without biopsy or polypectomy who had a recommended follow-up interval of at least 10 years for repeat colonoscopy documented in their colonoscopy report. | Communication and Care Coordination | Process | YES | Claims, Registry |
Patient Education
Health Screening
Screenings are tests that look for diseases before you have symptoms. Screening tests can find diseases early, when they're easier to treat. You can get some screenings in your doctor's office. Others need special equipment, so you may need to go to a different office or clinic.
Some conditions that doctors commonly screen for include:
- Breast cancer and cervical cancer in women
- Colorectal cancer
- Diabetes
- High blood pressure
- High cholesterol
- Osteoporosis
- Overweight and obesity
- Prostate cancer in men
Which tests you need depends on your age, your sex, your family history, and whether you have risk factors for certain diseases. After a screening test, ask when you will get the results and whom to talk to about them.
Agency for Healthcare Research and Quality
[Learn More in MedlinePlus]
Colorectal Cancer Screening (PDQ®)
Learn about colorectal cancer screening tests used to find changes in the colon or rectum before cancer develops.[Learn More in MedlinePlus]
Screening Tests to Detect Colorectal Cancer and Polyps
Learn about the methods used to screen for colorectal cancer. This fact sheet also discusses the advantages and disadvantages of several colorectal cancer screening tests.[Learn More in MedlinePlus]
Tests to Detect Colorectal Cancer and Polyps
Learn about the methods used to screen for colorectal cancer. This fact sheet also discusses the advantages and disadvantages of several colorectal cancer screening tests.[Learn More in MedlinePlus]
Code History
- FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
- FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
- FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
- FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
- FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
- FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
- FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
- FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
- FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.