ICD-10 Code for Screening Colonoscopy
For a routine screening colonoscopy in an asymptomatic average-risk patient with no personal or family history of colorectal cancer or polyps, use ICD-10 code Z12.11 (Encounter for screening for malignant neoplasm of colon).
Primary Screening Code
- Z12.11 is the appropriate ICD-10 code for ordering a screening colonoscopy for colorectal cancer in average-risk individuals aged 45 years and older with no symptoms or significant risk factors 1, 2.
When to Use Alternative Codes
High-Risk Family History
- If the patient has a first-degree relative with colorectal cancer or advanced adenoma diagnosed before age 60, or two first-degree relatives at any age, use Z80.0 (Family history of malignant neoplasm of digestive organs) instead of Z12.11 3, 4.
- These patients require colonoscopy every 5 years starting at age 40 or 10 years before the youngest affected relative's diagnosis 3, 4.
Personal History of Polyps or Cancer
- For patients with a personal history of colorectal polyps, use Z86.010 (Personal history of colonic polyps) 3.
- For patients with a personal history of colorectal cancer, use Z85.038 (Personal history of other malignant neoplasm of large intestine) 3.
Follow-up After Positive Screening Test
- If ordering colonoscopy as follow-up to a positive FIT, gFOBT, or stool DNA test, this becomes a diagnostic rather than screening procedure—use the appropriate symptom code (e.g., R19.5 for abnormal fecal test) rather than Z12.11 3.
Common Pitfalls to Avoid
- Do not use Z12.11 for symptomatic patients: If the patient has rectal bleeding, change in bowel habits, abdominal pain, or other gastrointestinal symptoms, this is a diagnostic colonoscopy, not screening—use the appropriate symptom code instead 1.
- Insurance coverage depends on correct coding: Using Z12.11 ensures the procedure is billed as preventive screening with no patient cost-sharing under most insurance plans, whereas diagnostic codes may trigger copays and deductibles 3.
- Age matters for coverage: While guidelines now recommend screening starting at age 45, some payers may still require age 50 for coverage under screening benefits—verify individual payer policies 3, 1, 2.