LCD Reference Article Billing and Coding Article

Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

A56632

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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General Information

Source Article ID
N/A
Article ID
A56632
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
Article Type
Billing and Coding
Original Effective Date
06/20/2019
Revision Effective Date
01/01/2024
Revision Ending Date
N/A
Retirement Date
N/A
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CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy L34454.

Covered Indications:

For surveillance of colonic neoplasia (when the patient has a history of colorectal cancer or polyps and is being followed for this indication, use the appropriate CPT/HCPCS code with the appropriate ICD-10-CM code and 1 of the following ICD-10-CM codes as the secondary diagnosis: Z85.038, Z85.048 or Z86.010):

  • For follow-up 1 year after surgery for treatment of colorectal cancer when the patient is identified as being at high-risk for colon cancer and is eligible for continued screenings at 24-month intervals (HCPCS code G0105 should be reported).

Limitations:

**Marking of a neoplasm for localization (tattooing) is covered, but is not separately payable.

Infectious colitis is an acceptable indication in its general form. Specificity in ICD-10 coding is not needed but should be maintained in the patient's chart.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
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Revenue Codes

Code Description
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CPT/HCPCS Codes

Group 1

(51 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
44388 Colonoscopy thru stoma spx
44389 Colonoscopy with biopsy
44390 Colonoscopy for foreign body
44391 Colonoscopy for bleeding
44392 Colonoscopy & polypectomy
44394 Colonoscopy w/snare
44401 Colonoscopy with ablation
44402 Colonoscopy w/stent plcmt
45300 Proctosigmoidoscopy dx
45303 Proctosigmoidoscopy dilate
45305 Proctosigmoidoscopy w/bx
45307 Proctosigmoidoscopy fb
45308 Proctosigmoidoscopy removal
45309 Proctosigmoidoscopy removal
45315 Proctosigmoidoscopy removal
45317 Proctosigmoidoscopy bleed
45320 Proctosigmoidoscopy ablate
45321 Proctosigmoidoscopy volvul
45327 Proctosigmoidoscopy w/stent
45330 Diagnostic sigmoidoscopy
45331 Sigmoidoscopy and biopsy
45332 Sigmoidoscopy w/fb removal
45333 Sigmoidoscopy & polypectomy
45334 Sigmoidoscopy for bleeding
45335 Sigmoidoscopy w/submuc inj
45337 Sigmoidoscopy & decompress
45338 Sigmoidoscopy w/tumr remove
45340 Sig w/tndsc balloon dilation
45341 Sigmoidoscopy w/ultrasound
45342 Sigmoidoscopy w/us guide bx
45346 Sigmoidoscopy w/ablation
45347 Sigmoidoscopy w/plcmt stent
45349 Sigmoidoscopy w/resection
45378 Diagnostic colonoscopy
45379 Colonoscopy w/fb removal
45380 Colonoscopy and biopsy
45381 Colonoscopy submucous njx
45382 Colonoscopy w/control bleed
45384 Colonoscopy w/lesion removal
45385 Colonoscopy w/lesion removal
45386 Colonoscopy w/balloon dilat
45388 Colonoscopy w/ablation
45389 Colonoscopy w/stent plcmt
45390 Colonoscopy w/resection
45391 Colonoscopy w/endoscope us
45392 Colonoscopy w/endoscopic fnb
45393 Colonoscopy w/decompression
45398 Colonoscopy w/band ligation
G0105 Colorectal scrn; hi risk ind
G9998 Doc med rsn <3 colon
G9999 Doc sys rsn <3 colon
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(515 Codes)
Group 1 Paragraph

The correct use of an ICD-10 code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy L34454 LCD.

Please note: For the purposes of this Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy A56632 article, each ICD-10 code listed in this paragraph represents only the condition as noted during colonoscopy/sigmoidoscopy/proctosigmoidoscopy and should only be reported when that condition exists in the colon, rectum, anus or ileum: A03.9, Shigellosis, unspecified; A07.3, Isoporiasis; A09, Infectious gastroenteritis and colitis, unspecified; A54.6, Gonococcal infections of anus and rectum; B65.1, Schistosomiasis due to Schistosoma mansoni; B68.0, Taenia solium taeniasis; B68.1, Taenia saginata taemiasis; B71.8, Other specified cestode infections; D17.79, Benign Lipomatous neoplasm of other sites; D18.03, Hemangioma of intra-abdominal structures; D18.1, Lymphangioma, any site; D49.0, Neoplasm of unspecified behavior of digestive system; I86.4, Gastric varices; K55.031, Focal (segmental) acute (reversible) ischemia of large intestine; K55.032, Diffuse acute (reversible) ischemia of large intestine; K55.039, Acute (reversible) ischemia of large intestine, extent unspecified; K55.041, Focal (segmental) acute infarction of large intestine; K55.042, Diffuse acute infarction of large intestine; K55.049, Acute infarction of large intestine; extent unspecified K55.051, Focal (segmental) acute (reversible) ischemia of intestine, part unspecified; K55.052, Diffuse acute (reversible) ischemia of intestine, part unspecified; K55.059, Acute (reversible) ischemia of intestine, part and extent unspecified; K56.49, Other impaction of intestine; K56.3, Gallstone ileus; K57.10, Diverticulosis of small intestine without perforation or abscess without bleeding; K57.11, Diverticulosis of small intestine without perforation or abscess with bleeding; Q43.3, Congenital malformation of intestinal fixation. 

Please note: For the purposes of this Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy A56632 article, ICD-10 code K92.2 also represents portal hypertensive colopathy.

ICD-10 code Z09 requires a secondary diagnosis, for example, Z85.038, Z85.048 or Z86.010.

Group 1 Codes
Code Description
A03.9 Shigellosis, unspecified
A04.3 Enterohemorrhagic Escherichia coli infection
A04.5 Campylobacter enteritis
A04.6 Enteritis due to Yersinia enterocolitica
A04.71 Enterocolitis due to Clostridium difficile, recurrent
A04.72 Enterocolitis due to Clostridium difficile, not specified as recurrent
A04.8 Other specified bacterial intestinal infections
A04.9 Bacterial intestinal infection, unspecified
A06.1 Chronic intestinal amebiasis
A06.2 Amebic nondysenteric colitis
A06.9 Amebiasis, unspecified
A07.0 Balantidiasis
A07.3 Isosporiasis
A07.8 Other specified protozoal intestinal diseases
A08.0 Rotaviral enteritis
A08.11 Acute gastroenteropathy due to Norwalk agent
A08.19 Acute gastroenteropathy due to other small round viruses
A08.2 Adenoviral enteritis
A08.31 Calicivirus enteritis
A08.32 Astrovirus enteritis
A08.39 Other viral enteritis
A09 Infectious gastroenteritis and colitis, unspecified
A18.31 Tuberculous peritonitis
A18.32 Tuberculous enteritis
A18.39 Retroperitoneal tuberculosis
A18.83 Tuberculosis of digestive tract organs, not elsewhere classified
A54.6 Gonococcal infection of anus and rectum
A55 Chlamydial lymphogranuloma (venereum)
B20 Human immunodeficiency virus [HIV] disease
B37.82 Candidal enteritis
B65.1 Schistosomiasis due to Schistosoma mansoni [intestinal schistosomiasis]
B68.0 Taenia solium taeniasis
B68.1 Taenia saginata taeniasis
B68.9 Taeniasis, unspecified
B70.0 Diphyllobothriasis
B71.0 Hymenolepiasis
B71.1 Dipylidiasis
B71.8 Other specified cestode infections
B76.8 Other hookworm diseases
B76.9 Hookworm disease, unspecified
B77.0 Ascariasis with intestinal complications
B77.89 Ascariasis with other complications
B77.9 Ascariasis, unspecified
B78.0 Intestinal strongyloidiasis
B78.7 Disseminated strongyloidiasis
B78.9 Strongyloidiasis, unspecified
B79 Trichuriasis
B80 Enterobiasis
B82.0 Intestinal helminthiasis, unspecified
B82.9 Intestinal parasitism, unspecified
B83.9 Helminthiasis, unspecified
C17.2 Malignant neoplasm of ileum
C18.0 Malignant neoplasm of cecum
C18.1 Malignant neoplasm of appendix
C18.2 Malignant neoplasm of ascending colon
C18.3 Malignant neoplasm of hepatic flexure
C18.4 Malignant neoplasm of transverse colon
C18.5 Malignant neoplasm of splenic flexure
C18.6 Malignant neoplasm of descending colon
C18.7 Malignant neoplasm of sigmoid colon
C18.8 Malignant neoplasm of overlapping sites of colon
C18.9 Malignant neoplasm of colon, unspecified
C19 Malignant neoplasm of rectosigmoid junction
C20 Malignant neoplasm of rectum
C21.0 Malignant neoplasm of anus, unspecified
C21.1 Malignant neoplasm of anal canal
C21.2 Malignant neoplasm of cloacogenic zone
C21.8 Malignant neoplasm of overlapping sites of rectum, anus and anal canal
C49.A4 Gastrointestinal stromal tumor of large intestine
C49.A5 Gastrointestinal stromal tumor of rectum
C49.A9 Gastrointestinal stromal tumor of other sites
C7A.00 Malignant carcinoid tumor of unspecified site
C7A.020 Malignant carcinoid tumor of the appendix
C7A.021 Malignant carcinoid tumor of the cecum
C7A.022 Malignant carcinoid tumor of the ascending colon
C7A.023 Malignant carcinoid tumor of the transverse colon
C7A.024 Malignant carcinoid tumor of the descending colon
C7A.025 Malignant carcinoid tumor of the sigmoid colon
C7A.026 Malignant carcinoid tumor of the rectum
C7A.029 Malignant carcinoid tumor of the large intestine, unspecified portion
C7A.096 Malignant carcinoid tumor of the hindgut, unspecified
C7A.098 Malignant carcinoid tumors of other sites
C7A.1 Malignant poorly differentiated neuroendocrine tumors
C7A.8 Other malignant neuroendocrine tumors
C7B.04 Secondary carcinoid tumors of peritoneum
C7B.09 Secondary carcinoid tumors of other sites
C7B.1 Secondary Merkel cell carcinoma
C7B.8 Other secondary neuroendocrine tumors
C77.2 Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes
C78.4 Secondary malignant neoplasm of small intestine
C78.5 Secondary malignant neoplasm of large intestine and rectum
C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct
D01.0 Carcinoma in situ of colon
D01.1 Carcinoma in situ of rectosigmoid junction
D01.2 Carcinoma in situ of rectum
D01.3 Carcinoma in situ of anus and anal canal
D12.0 Benign neoplasm of cecum
D12.1 Benign neoplasm of appendix
D12.2 Benign neoplasm of ascending colon
D12.3 Benign neoplasm of transverse colon
D12.4 Benign neoplasm of descending colon
D12.5 Benign neoplasm of sigmoid colon
D12.6 Benign neoplasm of colon, unspecified
D12.7 Benign neoplasm of rectosigmoid junction
D12.8 Benign neoplasm of rectum
D12.9 Benign neoplasm of anus and anal canal
D17.5 Benign lipomatous neoplasm of intra-abdominal organs
D17.79 Benign lipomatous neoplasm of other sites
D18.03 Hemangioma of intra-abdominal structures
D18.1 Lymphangioma, any site
D3A.00 Benign carcinoid tumor of unspecified site
D3A.020 Benign carcinoid tumor of the appendix
D3A.021 Benign carcinoid tumor of the cecum
D3A.022 Benign carcinoid tumor of the ascending colon
D3A.023 Benign carcinoid tumor of the transverse colon
D3A.024 Benign carcinoid tumor of the descending colon
D3A.025 Benign carcinoid tumor of the sigmoid colon
D3A.026 Benign carcinoid tumor of the rectum
D3A.029 Benign carcinoid tumor of the large intestine, unspecified portion
D3A.8 Other benign neuroendocrine tumors
D37.1 Neoplasm of uncertain behavior of stomach
D37.2 Neoplasm of uncertain behavior of small intestine
D37.3 Neoplasm of uncertain behavior of appendix
D37.4 Neoplasm of uncertain behavior of colon
D37.5 Neoplasm of uncertain behavior of rectum
D37.8 Neoplasm of uncertain behavior of other specified digestive organs
D37.9 Neoplasm of uncertain behavior of digestive organ, unspecified
D49.0 Neoplasm of unspecified behavior of digestive system
D50.0 Iron deficiency anemia secondary to blood loss (chronic)
D50.9 Iron deficiency anemia, unspecified
I77.2 Rupture of artery
I78.0 Hereditary hemorrhagic telangiectasia
I86.4 Gastric varices
K35.80 Unspecified acute appendicitis
K38.0 Hyperplasia of appendix
K38.1 Appendicular concretions
K38.2 Diverticulum of appendix
K38.3 Fistula of appendix
K38.8 Other specified diseases of appendix
K38.9 Disease of appendix, unspecified
K50.10 Crohn's disease of large intestine without complications
K50.111 Crohn's disease of large intestine with rectal bleeding
K50.112 Crohn's disease of large intestine with intestinal obstruction
K50.113 Crohn's disease of large intestine with fistula
K50.114 Crohn's disease of large intestine with abscess
K50.118 Crohn's disease of large intestine with other complication
K50.119 Crohn's disease of large intestine with unspecified complications
K50.80 Crohn's disease of both small and large intestine without complications
K50.811 Crohn's disease of both small and large intestine with rectal bleeding
K50.812 Crohn's disease of both small and large intestine with intestinal obstruction
K50.813 Crohn's disease of both small and large intestine with fistula
K50.814 Crohn's disease of both small and large intestine with abscess
K50.818 Crohn's disease of both small and large intestine with other complication
K50.819 Crohn's disease of both small and large intestine with unspecified complications
K50.90 Crohn's disease, unspecified, without complications
K50.911 Crohn's disease, unspecified, with rectal bleeding
K50.912 Crohn's disease, unspecified, with intestinal obstruction
K50.913 Crohn's disease, unspecified, with fistula
K50.914 Crohn's disease, unspecified, with abscess
K50.918 Crohn's disease, unspecified, with other complication
K50.919 Crohn's disease, unspecified, with unspecified complications
K51.00 Ulcerative (chronic) pancolitis without complications
K51.011 Ulcerative (chronic) pancolitis with rectal bleeding
K51.012 Ulcerative (chronic) pancolitis with intestinal obstruction
K51.013 Ulcerative (chronic) pancolitis with fistula
K51.014 Ulcerative (chronic) pancolitis with abscess
K51.018 Ulcerative (chronic) pancolitis with other complication
K51.019 Ulcerative (chronic) pancolitis with unspecified complications
K51.20 Ulcerative (chronic) proctitis without complications
K51.211 Ulcerative (chronic) proctitis with rectal bleeding
K51.212 Ulcerative (chronic) proctitis with intestinal obstruction
K51.213 Ulcerative (chronic) proctitis with fistula
K51.214 Ulcerative (chronic) proctitis with abscess
K51.218 Ulcerative (chronic) proctitis with other complication
K51.219 Ulcerative (chronic) proctitis with unspecified complications
K51.30 Ulcerative (chronic) rectosigmoiditis without complications
K51.311 Ulcerative (chronic) rectosigmoiditis with rectal bleeding
K51.312 Ulcerative (chronic) rectosigmoiditis with intestinal obstruction
K51.313 Ulcerative (chronic) rectosigmoiditis with fistula
K51.314 Ulcerative (chronic) rectosigmoiditis with abscess
K51.318 Ulcerative (chronic) rectosigmoiditis with other complication
K51.319 Ulcerative (chronic) rectosigmoiditis with unspecified complications
K51.40 Inflammatory polyps of colon without complications
K51.411 Inflammatory polyps of colon with rectal bleeding
K51.412 Inflammatory polyps of colon with intestinal obstruction
K51.413 Inflammatory polyps of colon with fistula
K51.414 Inflammatory polyps of colon with abscess
K51.418 Inflammatory polyps of colon with other complication
K51.419 Inflammatory polyps of colon with unspecified complications
K51.50 Left sided colitis without complications
K51.511 Left sided colitis with rectal bleeding
K51.512 Left sided colitis with intestinal obstruction
K51.513 Left sided colitis with fistula
K51.514 Left sided colitis with abscess
K51.518 Left sided colitis with other complication
K51.519 Left sided colitis with unspecified complications
K51.80 Other ulcerative colitis without complications
K51.811 Other ulcerative colitis with rectal bleeding
K51.812 Other ulcerative colitis with intestinal obstruction
K51.813 Other ulcerative colitis with fistula
K51.814 Other ulcerative colitis with abscess
K51.818 Other ulcerative colitis with other complication
K51.819 Other ulcerative colitis with unspecified complications
K51.90 Ulcerative colitis, unspecified, without complications
K51.911 Ulcerative colitis, unspecified with rectal bleeding
K51.912 Ulcerative colitis, unspecified with intestinal obstruction
K51.913 Ulcerative colitis, unspecified with fistula
K51.914 Ulcerative colitis, unspecified with abscess
K51.918 Ulcerative colitis, unspecified with other complication
K51.919 Ulcerative colitis, unspecified with unspecified complications
K52.0 Gastroenteritis and colitis due to radiation
K52.1 Toxic gastroenteritis and colitis
K52.21 Food protein-induced enterocolitis syndrome
K52.22 Food protein-induced enteropathy
K52.29 Other allergic and dietetic gastroenteritis and colitis
K52.3 Indeterminate colitis
K52.81 Eosinophilic gastritis or gastroenteritis
K52.82 Eosinophilic colitis
K52.831 Collagenous colitis
K52.832 Lymphocytic colitis
K52.838 Other microscopic colitis
K52.839 Microscopic colitis, unspecified
K52.89 Other specified noninfective gastroenteritis and colitis
K52.9 Noninfective gastroenteritis and colitis, unspecified
K55.031 Focal (segmental) acute (reversible) ischemia of large intestine
K55.032 Diffuse acute (reversible) ischemia of large intestine
K55.039 Acute (reversible) ischemia of large intestine, extent unspecified
K55.041 Focal (segmental) acute infarction of large intestine
K55.042 Diffuse acute infarction of large intestine
K55.049 Acute infarction of large intestine, extent unspecified
K55.051 Focal (segmental) acute (reversible) ischemia of intestine, part unspecified
K55.052 Diffuse acute (reversible) ischemia of intestine, part unspecified
K55.059 Acute (reversible) ischemia of intestine, part and extent unspecified
K55.061 Focal (segmental) acute infarction of intestine, part unspecified
K55.062 Diffuse acute infarction of intestine, part unspecified
K55.069 Acute infarction of intestine, part and extent unspecified
K55.1 Chronic vascular disorders of intestine
K55.20 Angiodysplasia of colon without hemorrhage
K55.21 Angiodysplasia of colon with hemorrhage
K55.30 Necrotizing enterocolitis, unspecified
K55.31 Stage 1 necrotizing enterocolitis
K55.32 Stage 2 necrotizing enterocolitis
K55.33 Stage 3 necrotizing enterocolitis
K55.8 Other vascular disorders of intestine
K55.9 Vascular disorder of intestine, unspecified
K56.0 Paralytic ileus
K56.2 Volvulus
K56.3 Gallstone ileus
K56.49 Other impaction of intestine
K56.50 Intestinal adhesions [bands], unspecified as to partial versus complete obstruction
K56.51 Intestinal adhesions [bands], with partial obstruction
K56.52 Intestinal adhesions [bands] with complete obstruction
K56.600 Partial intestinal obstruction, unspecified as to cause
K56.601 Complete intestinal obstruction, unspecified as to cause
K56.609 Unspecified intestinal obstruction, unspecified as to partial versus complete obstruction
K56.690 Other partial intestinal obstruction
K56.691 Other complete intestinal obstruction
K56.699 Other intestinal obstruction unspecified as to partial versus complete obstruction
K56.7 Ileus, unspecified
K57.00 Diverticulitis of small intestine with perforation and abscess without bleeding
K57.01 Diverticulitis of small intestine with perforation and abscess with bleeding
K57.10 Diverticulosis of small intestine without perforation or abscess without bleeding
K57.11 Diverticulosis of small intestine without perforation or abscess with bleeding
K57.20 Diverticulitis of large intestine with perforation and abscess without bleeding
K57.21 Diverticulitis of large intestine with perforation and abscess with bleeding
K57.30 Diverticulosis of large intestine without perforation or abscess without bleeding
K57.31 Diverticulosis of large intestine without perforation or abscess with bleeding
K57.32 Diverticulitis of large intestine without perforation or abscess without bleeding
K57.33 Diverticulitis of large intestine without perforation or abscess with bleeding
K57.40 Diverticulitis of both small and large intestine with perforation and abscess without bleeding
K57.41 Diverticulitis of both small and large intestine with perforation and abscess with bleeding
K57.50 Diverticulosis of both small and large intestine without perforation or abscess without bleeding
K57.51 Diverticulosis of both small and large intestine without perforation or abscess with bleeding
K57.52 Diverticulitis of both small and large intestine without perforation or abscess without bleeding
K57.53 Diverticulitis of both small and large intestine without perforation or abscess with bleeding
K57.80 Diverticulitis of intestine, part unspecified, with perforation and abscess without bleeding
K57.81 Diverticulitis of intestine, part unspecified, with perforation and abscess with bleeding
K57.90 Diverticulosis of intestine, part unspecified, without perforation or abscess without bleeding
K57.91 Diverticulosis of intestine, part unspecified, without perforation or abscess with bleeding
K57.92 Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding
K57.93 Diverticulitis of intestine, part unspecified, without perforation or abscess with bleeding
K58.0 Irritable bowel syndrome with diarrhea
K58.1 Irritable bowel syndrome with constipation
K58.2 Mixed irritable bowel syndrome
K58.8 Other irritable bowel syndrome
K58.9 Irritable bowel syndrome without diarrhea
K59.00 Constipation, unspecified
K59.01 Slow transit constipation
K59.02 Outlet dysfunction constipation
K59.03 Drug induced constipation
K59.04 Chronic idiopathic constipation
K59.09 Other constipation
K59.1 Functional diarrhea
K59.2 Neurogenic bowel, not elsewhere classified
K59.31 Toxic megacolon
K59.39 Other megacolon
K59.81 Ogilvie syndrome
K59.89 Other specified functional intestinal disorders
K62.0 Anal polyp
K62.1 Rectal polyp
K62.4 Stenosis of anus and rectum
K62.5 Hemorrhage of anus and rectum
K62.6 Ulcer of anus and rectum
K62.81 Anal sphincter tear (healed) (nontraumatic) (old)
K62.82 Dysplasia of anus
K63.0 Abscess of intestine
K63.1 Perforation of intestine (nontraumatic)
K63.2 Fistula of intestine
K63.3 Ulcer of intestine
K63.4 Enteroptosis
K63.5 Polyp of colon
K63.81 Dieulafoy lesion of intestine
K63.8211 Small intestinal bacterial overgrowth, hydrogen-subtype
K63.8212 Small intestinal bacterial overgrowth, hydrogen sulfide-subtype
K63.8219 Small intestinal bacterial overgrowth, unspecified
K63.822 Small intestinal fungal overgrowth
K63.829 Intestinal methanogen overgrowth, unspecified
K63.89 Other specified diseases of intestine
K64.0 First degree hemorrhoids
K64.1 Second degree hemorrhoids
K64.2 Third degree hemorrhoids
K64.3 Fourth degree hemorrhoids
K64.8 Other hemorrhoids
K90.49 Malabsorption due to intolerance, not elsewhere classified
K90.821 Short bowel syndrome with colon in continuity
K90.822 Short bowel syndrome without colon in continuity
K90.829 Short bowel syndrome, unspecified
K90.83 Intestinal failure
K90.89 Other intestinal malabsorption
K91.30 Postprocedural intestinal obstruction, unspecified as to partial versus complete
K91.31 Postprocedural partial intestinal obstruction
K91.32 Postprocedural complete intestinal obstruction
K91.850 Pouchitis
K91.858 Other complications of intestinal pouch
K91.870 Postprocedural hematoma of a digestive system organ or structure following a digestive system procedure
K91.871 Postprocedural hematoma of a digestive system organ or structure following other procedure
K91.872 Postprocedural seroma of a digestive system organ or structure following a digestive system procedure
K91.873 Postprocedural seroma of a digestive system organ or structure following other procedure
K91.89 Other postprocedural complications and disorders of digestive system
K92.1 Melena
K92.2 Gastrointestinal hemorrhage, unspecified
K92.89 Other specified diseases of the digestive system
K94.00 Colostomy complication, unspecified
K94.01 Colostomy hemorrhage
K94.03 Colostomy malfunction
K94.09 Other complications of colostomy
K94.10 Enterostomy complication, unspecified
K94.11 Enterostomy hemorrhage
K94.13 Enterostomy malfunction
K94.19 Other complications of enterostomy
N28.89 Other specified disorders of kidney and ureter
N32.1 Vesicointestinal fistula
N80.50 Endometriosis of intestine, unspecified
N80.512 Deep endometriosis of the rectum
N80.519 Endometriosis of the rectum, unspecified depth
N80.522 Deep endometriosis of the sigmoid colon
N80.529 Endometriosis of the sigmoid colon, unspecified depth
N80.532 Deep endometriosis of the cecum
N80.539 Endometriosis of the cecum, unspecified depth
N80.542 Deep endometriosis of the appendix
N80.549 Endometriosis of the appendix, unspecified depth
N80.552 Deep endometriosis of other parts of the colon
N80.559 Endometriosis of other parts of the colon, unspecified depth
N80.562 Deep endometriosis of the small intestine
N80.569 Endometriosis of the small intestine, unspecified depth
N82.2 Fistula of vagina to small intestine
N82.3 Fistula of vagina to large intestine
N82.4 Other female intestinal-genital tract fistulae
Q42.0 Congenital absence, atresia and stenosis of rectum with fistula
Q42.1 Congenital absence, atresia and stenosis of rectum without fistula
Q42.2 Congenital absence, atresia and stenosis of anus with fistula
Q42.3 Congenital absence, atresia and stenosis of anus without fistula
Q42.8 Congenital absence, atresia and stenosis of other parts of large intestine
Q42.9 Congenital absence, atresia and stenosis of large intestine, part unspecified
Q43.1 Hirschsprung's disease
Q43.2 Other congenital functional disorders of colon
Q43.3 Congenital malformations of intestinal fixation
Q43.4 Duplication of intestine
Q43.5 Ectopic anus
Q43.6 Congenital fistula of rectum and anus
Q43.7 Persistent cloaca
Q43.8 Other specified congenital malformations of intestine
Q43.9 Congenital malformation of intestine, unspecified
R10.0 Acute abdomen
R10.10 Upper abdominal pain, unspecified
R10.11 Right upper quadrant pain
R10.12 Left upper quadrant pain
R10.13 Epigastric pain
R10.2 Pelvic and perineal pain
R10.30 Lower abdominal pain, unspecified
R10.31 Right lower quadrant pain
R10.32 Left lower quadrant pain
R10.33 Periumbilical pain
R10.83 Colic
R10.84 Generalized abdominal pain
R10.9 Unspecified abdominal pain
R11.13 Vomiting of fecal matter
R19.03 Right lower quadrant abdominal swelling, mass and lump
R19.04 Left lower quadrant abdominal swelling, mass and lump
R19.05 Periumbilic swelling, mass or lump
R19.07 Generalized intra-abdominal and pelvic swelling, mass and lump
R19.09 Other intra-abdominal and pelvic swelling, mass and lump
R19.4 Change in bowel habit
R19.5 Other fecal abnormalities
R19.7 Diarrhea, unspecified
R19.8 Other specified symptoms and signs involving the digestive system and abdomen
R93.3 Abnormal findings on diagnostic imaging of other parts of digestive tract
S36.500A Unspecified injury of ascending [right] colon, initial encounter
S36.500D Unspecified injury of ascending [right] colon, subsequent encounter
S36.500S Unspecified injury of ascending [right] colon, sequela
S36.501A Unspecified injury of transverse colon, initial encounter
S36.501D Unspecified injury of transverse colon, subsequent encounter
S36.501S Unspecified injury of transverse colon, sequela
S36.502A Unspecified injury of descending [left] colon, initial encounter
S36.502D Unspecified injury of descending [left] colon, subsequent encounter
S36.502S Unspecified injury of descending [left] colon, sequela
S36.503A Unspecified injury of sigmoid colon, initial encounter
S36.503D Unspecified injury of sigmoid colon, subsequent encounter
S36.503S Unspecified injury of sigmoid colon, sequela
S36.508A Unspecified injury of other part of colon, initial encounter
S36.508D Unspecified injury of other part of colon, subsequent encounter
S36.508S Unspecified injury of other part of colon, sequela
S36.510A Primary blast injury of ascending [right] colon, initial encounter
S36.510D Primary blast injury of ascending [right] colon, subsequent encounter
S36.510S Primary blast injury of ascending [right] colon, sequela
S36.511A Primary blast injury of transverse colon, initial encounter
S36.511D Primary blast injury of transverse colon, subsequent encounter
S36.511S Primary blast injury of transverse colon, sequela
S36.512A Primary blast injury of descending [left] colon, initial encounter
S36.512D Primary blast injury of descending [left] colon, subsequent encounter
S36.512S Primary blast injury of descending [left] colon, sequela
S36.513A Primary blast injury of sigmoid colon, initial encounter
S36.513D Primary blast injury of sigmoid colon, subsequent encounter
S36.513S Primary blast injury of sigmoid colon, sequela
S36.518A Primary blast injury of other part of colon, initial encounter
S36.518D Primary blast injury of other part of colon, subsequent encounter
S36.518S Primary blast injury of other part of colon, sequela
S36.519A Primary blast injury of unspecified part of colon, initial encounter
S36.519D Primary blast injury of unspecified part of colon, subsequent encounter
S36.519S Primary blast injury of unspecified part of colon, sequela
S36.520A Contusion of ascending [right] colon, initial encounter
S36.520D Contusion of ascending [right] colon, subsequent encounter
S36.520S Contusion of ascending [right] colon, sequela
S36.521A Contusion of transverse colon, initial encounter
S36.521D Contusion of transverse colon, subsequent encounter
S36.521S Contusion of transverse colon, sequela
S36.522A Contusion of descending [left] colon, initial encounter
S36.522D Contusion of descending [left] colon, subsequent encounter
S36.522S Contusion of descending [left] colon, sequela
S36.523A Contusion of sigmoid colon, initial encounter
S36.523D Contusion of sigmoid colon, subsequent encounter
S36.523S Contusion of sigmoid colon, sequela
S36.528A Contusion of other part of colon, initial encounter
S36.528D Contusion of other part of colon, subsequent encounter
S36.528S Contusion of other part of colon, sequela
S36.530A Laceration of ascending [right] colon, initial encounter
S36.530D Laceration of ascending [right] colon, subsequent encounter
S36.530S Laceration of ascending [right] colon, sequela
S36.531A Laceration of transverse colon, initial encounter
S36.531D Laceration of transverse colon, subsequent encounter
S36.531S Laceration of transverse colon, sequela
S36.532A Laceration of descending [left] colon, initial encounter
S36.532D Laceration of descending [left] colon, subsequent encounter
S36.532S Laceration of descending [left] colon, sequela
S36.533A Laceration of sigmoid colon, initial encounter
S36.533D Laceration of sigmoid colon, subsequent encounter
S36.533S Laceration of sigmoid colon, sequela
S36.538A Laceration of other part of colon, initial encounter
S36.538D Laceration of other part of colon, subsequent encounter
S36.538S Laceration of other part of colon, sequela
S36.590A Other injury of ascending [right] colon, initial encounter
S36.590D Other injury of ascending [right] colon, subsequent encounter
S36.590S Other injury of ascending [right] colon, sequela
S36.591A Other injury of transverse colon, initial encounter
S36.591D Other injury of transverse colon, subsequent encounter
S36.591S Other injury of transverse colon, sequela
S36.592A Other injury of descending [left] colon, initial encounter
S36.592D Other injury of descending [left] colon, subsequent encounter
S36.592S Other injury of descending [left] colon, sequela
S36.593A Other injury of sigmoid colon, initial encounter
S36.593D Other injury of sigmoid colon, subsequent encounter
S36.593S Other injury of sigmoid colon, sequela
S36.598A Other injury of other part of colon, initial encounter
S36.598D Other injury of other part of colon, subsequent encounter
S36.598S Other injury of other part of colon, sequela
S36.599A Other injury of unspecified part of colon, initial encounter
S36.599D Other injury of unspecified part of colon, subsequent encounter
S36.599S Other injury of unspecified part of colon, sequela
S36.60XA Unspecified injury of rectum, initial encounter
S36.60XD Unspecified injury of rectum, subsequent encounter
S36.60XS Unspecified injury of rectum, sequela
S36.61XA Primary blast injury of rectum, initial encounter
S36.61XD Primary blast injury of rectum, subsequent encounter
S36.61XS Primary blast injury of rectum, sequela
S36.62XA Contusion of rectum, initial encounter
S36.62XD Contusion of rectum, subsequent encounter
S36.62XS Contusion of rectum, sequela
S36.63XA Laceration of rectum, initial encounter
S36.63XD Laceration of rectum, subsequent encounter
S36.63XS Laceration of rectum, sequela
S36.69XA Other injury of rectum, initial encounter
S36.69XD Other injury of rectum, subsequent encounter
S36.69XS Other injury of rectum, sequela
T18.8XXS Foreign body in other parts of alimentary tract, sequela
Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
Z12.11 Encounter for screening for malignant neoplasm of colon
Z80.0 Family history of malignant neoplasm of digestive organs
Z85.00 Personal history of malignant neoplasm of unspecified digestive organ
Z85.038 Personal history of other malignant neoplasm of large intestine
Z85.048 Personal history of other malignant neoplasm of rectum, rectosigmoid junction, and anus
Z85.05 Personal history of malignant neoplasm of liver
Z86.003 Personal history of in-situ neoplasm of oral cavity, esophagus and stomach
Z86.004 Personal history of in-situ neoplasm of other and unspecified digestive organs
Z86.010 Personal history of colonic polyps
Z87.19 Personal history of other diseases of the digestive system
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/01/2024 R10

Under CPT/HCPCS Codes Group 1: Codes the description was revised for G9998. This revision is due to the 2024 Annual/Q1 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/24.

10/01/2023 R9

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes added K63.8211, K63.8212, K63.8219, K63.822, K63.829, K90.821, K90.822, K90.829, and K90.83. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/23.

10/01/2022 R8

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes deleted Q85.8 and added N80.50, N80.512, N80.519, N80.522, N80.529, N80.532, N80.539, N80.542, N80.549, N80.552, N80.559, N80.562 and N80.569. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/22.

01/01/2022 R7

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes added Z12.11 and Z80.0. This revision is retroactive effective for dates of service on or after 6/30/21.

01/01/2022 R6

Under CPT/HCPCS Codes Group 1: Codes added G0105. This revision is retroactive effective for dates of service on or after 4/7/21.

01/01/2022 R5

Under CPT/HCPCS Codes Group 1: Codes added G9998 and G9999. This revision is due to the 2022 Annual CPT/HCPCS Code Update and is effective on January 1, 2022.

10/01/2020 R4

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted K59.8 and added K59.81 and K59.89. This revision is due to the Annual ICD-10 Code Update and is effective on 10/1/20.

10/10/2019 R3

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy L34454 LCD and placed in this article. Under Article Text removed the subheading Documentation Requirements.

10/01/2019 R2

Under Covered ICD-10 Codes Group 1: Codes added ICD-10 codes Z86.003 and Z86.004. This revision is due to the 2019 Annual ICD-10 Code Update and is effective on October 1, 2019.

06/20/2019 R1

All coding located in the Coding Information section has been removed from the related Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy L34454 LCD and added to this article.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L34454 - Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
12/28/2023 01/01/2024 - N/A Currently in Effect You are here
08/10/2023 10/01/2023 - 12/31/2023 Superseded View
08/09/2022 10/01/2022 - 09/30/2023 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Colonoscopy
  • Sigmoidoscopy
  • Proctosigmoidoscopy