ICD-10 Guide

Z13.811

Encounter for screening for lower gastrointestinal disorder

BILLABLE STATUSYes

IMPLEMENTATION DATEOctober 1, 2015

LAST UPDATED09/12/2025

Code Description

ICD-10 Z13.811 is a billable code used to indicate a diagnosis of encounter for screening for lower gastrointestinal disorder.

Key Diagnostic Point:

Z13.811 is utilized during encounters specifically aimed at screening for lower gastrointestinal disorders, which may include conditions such as colorectal cancer, inflammatory bowel disease, and other gastrointestinal pathologies. This code emphasizes the importance of preventive care and early detection, which can significantly improve patient outcomes. Factors influencing health status, such as socioeconomic status, access to healthcare, and lifestyle choices, play a crucial role in the effectiveness of screening programs. Social determinants of health, including education, income, and community resources, can affect an individual's likelihood of participating in screening. Preventive care through regular screenings is vital in identifying asymptomatic conditions early, thereby reducing morbidity and mortality associated with lower gastrointestinal disorders. Proper documentation of the patient's risk factors, screening history, and any relevant social determinants is essential for accurate coding and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Need for comprehensive patient history including risk factors
Documentation of screening results and follow-up plans
Understanding of preventive care guidelines and recommendations
Variability in payer requirements for preventive services

Audit Risk Factors

Inadequate documentation of screening rationale
Failure to document patient consent for screening
Lack of follow-up plans for abnormal screening results
Incorrect sequencing of codes related to screening

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Documentation must include patient history, risk factors, and screening results. Follow-up plans should be clearly outlined.

Common Clinical Scenarios

Routine checkups where screening for lower gastrointestinal disorders is performed, including discussions about family history and lifestyle factors.

Billing Considerations

Consideration of social determinants such as access to healthcare, education level, and socioeconomic status that may influence screening participation.

Public Health

Documentation Requirements

Population-level data collection and surveillance documentation are necessary to track screening rates and outcomes.

Common Clinical Scenarios

Community health initiatives aimed at increasing awareness and participation in lower gastrointestinal screenings.

Billing Considerations

Focus on health disparities and barriers to access that affect screening rates in different populations.

Coding Guidelines

Inclusion Criteria

Use Z13.811 When

Z codes should be used when the encounter is specifically for screening purposes
They should be sequenced appropriately, typically as secondary codes following any primary diagnosis
Payer requirements may vary, so it is essential to verify coverage for preventive screenings

Exclusion Criteria

Do NOT use Z13.811 When

No specific exclusions found.

Related CPT Codes

45378CPT Code

Colonoscopy, flexible, diagnostic

Clinical Scenario

Used during an encounter coded with Z13.811 for screening purposes.

Documentation Requirements

Documentation must include indication for the procedure and results.

Specialty Considerations

Primary care providers should ensure that screening guidelines are followed.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding preventive encounters, enhancing the ability to track and manage population health effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding preventive encounters, enhancing the ability to track and manage population health effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding preventive encounters, enhancing the ability to track and manage population health effectively.

Resources

Clinical References

•
Colorectal Cancer Screening Guidelines

Coding & Billing References

•
Colorectal Cancer Screening Guidelines

Frequently Asked Questions

What documentation is required for Z13.811?

Documentation must include the reason for the screening, patient history, risk factors, and any follow-up plans based on the screening results.

ICD-10 Z13.811 is a billable code used to indicate a diagnosis of encounter for screening for lower gastrointestinal disorder.