Local Coverage Article Billing and Coding

Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization

A56389

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General Information

Article ID
A56389
Article Title
Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization
Article Type
Billing and Coding
Original Effective Date
03/21/2019
Revision Effective Date
01/01/2023
Revision Ending Date
N/A
Retirement Date
N/A
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Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Upper Gastrointestinal Endoscopy and Visualization L34434.

All unlisted procedure codes billed for services are subject to development and medical review.

Coding Information

CPT/HCPCS Codes

Group 1

(68 Codes)
Group 1 Paragraph

Covered

Group 1 Codes
CodeDescription
43191 Esophagoscopy rigid trnso dx
43192 Esophagoscp rig trnso inject
43193 Esophagoscp rig trnso biopsy
43194 Esophagoscp rig trnso rem fb
43195 Esophagoscopy rigid balloon
43196 Esophagoscp guide wire dilat
43197 Esophagoscopy flex dx brush
43198 Esophagosc flex trnsn biopsy
43200 Esophagoscopy flexible brush
43201 Esoph scope w/submucous inj
43202 Esophagoscopy flex biopsy
43204 Esoph scope w/sclerosis inj
43205 Esophagus endoscopy/ligation
43206 Esoph optical endomicroscopy
43210 Egd esophagogastrc fndoplsty
43211 Esophagoscop mucosal resect
43212 Esophagoscop stent placement
43213 Esophagoscopy retro balloon
43214 Esophagosc dilate balloon 30
43215 Esophagoscopy flex remove fb
43216 Esophagoscopy lesion removal
43217 Esophagoscopy snare les remv
43220 Esophagoscopy balloon <30mm
43226 Esoph endoscopy dilation
43227 Esophagoscopy control bleed
43229 Esophagoscopy lesion ablate
43231 Esophagoscop ultrasound exam
43232 Esophagoscopy w/us needle bx
43233 Egd balloon dil esoph30 mm/>
43235 Egd diagnostic brush wash
43236 Uppr gi scope w/submuc inj
43237 Endoscopic us exam esoph
43238 Egd us fine needle bx/aspir
43239 Egd biopsy single/multiple
43240 Egd w/transmural drain cyst
43241 Egd tube/cath insertion
43242 Egd us fine needle bx/aspir
43243 Egd injection varices
43244 Egd varices ligation
43245 Egd dilate stricture
43246 Egd place gastrostomy tube
43247 Egd remove foreign body
43248 Egd guide wire insertion
43249 Esoph egd dilation <30 mm
43250 Egd cautery tumor polyp
43251 Egd remove lesion snare
43252 Egd optical endomicroscopy
43253 Egd us transmural injxn/mark
43254 Egd endo mucosal resection
43255 Egd control bleeding any
43259 Egd us exam duodenum/jejunum
43260 Ercp w/specimen collection
43261 Endo cholangiopancreatograph
43262 Endo cholangiopancreatograph
43263 Ercp sphincter pressure meas
43264 Ercp remove duct calculi
43265 Ercp lithotripsy calculi
43266 Egd endoscopic stent place
43270 Egd lesion ablation
43274 Ercp duct stent placement
43275 Ercp remove forgn body duct
43276 Ercp stent exchange w/dilate
43277 Ercp ea duct/ampulla dilate
43278 Ercp lesion ablate w/dilate
74235 Remove esophagus obstruction
0652T Egd flx transnasal dx br/wa
0653T Egd flx transnasal bx 1/mlt
0654T Egd flx transnasal tube/cath

Group 2

(1 Code)
Group 2 Paragraph

The following CPT® code is noncovered when performed as adjunct procedure in the treatment of GERD when performed in conjunction with procedures listed in section C. Noncovered Transesophageal Endoscopic Procedures for the Treatment of GERD of the Upper Gastrointestinal Endoscopy and Visualization L34434 LCD.

Group 2 Codes
CodeDescription
43499 Unlisted procedure esophagus

Group 3

(1 Code)
Group 3 Paragraph

N/A

Group 3 Codes
CodeDescription
J0585 Injection,onabotulinumtoxina

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(609 Codes)
Group 1 Paragraph

Covered

 

Group 1 Codes
CodeDescription
B37.81 Candidal esophagitis
C01 Malignant neoplasm of base of tongue
C02.0 Malignant neoplasm of dorsal surface of tongue
C02.1 Malignant neoplasm of border of tongue
C02.2 Malignant neoplasm of ventral surface of tongue
C02.3 Malignant neoplasm of anterior two-thirds of tongue, part unspecified
C02.4 Malignant neoplasm of lingual tonsil
C02.8 Malignant neoplasm of overlapping sites of tongue
C09.0 Malignant neoplasm of tonsillar fossa
C09.1 Malignant neoplasm of tonsillar pillar (anterior) (posterior)
C09.8 Malignant neoplasm of overlapping sites of tonsil
C12 Malignant neoplasm of pyriform sinus
C13.0 Malignant neoplasm of postcricoid region
C13.1 Malignant neoplasm of aryepiglottic fold, hypopharyngeal aspect
C13.2 Malignant neoplasm of posterior wall of hypopharynx
C13.8 Malignant neoplasm of overlapping sites of hypopharynx
C13.9 Malignant neoplasm of hypopharynx, unspecified
C15.3 Malignant neoplasm of upper third of esophagus
C15.4 Malignant neoplasm of middle third of esophagus
C15.5 Malignant neoplasm of lower third of esophagus
C15.8 Malignant neoplasm of overlapping sites of esophagus
C15.9 Malignant neoplasm of esophagus, unspecified
C16.0 Malignant neoplasm of cardia
C16.1 Malignant neoplasm of fundus of stomach
C16.2 Malignant neoplasm of body of stomach
C16.3 Malignant neoplasm of pyloric antrum
C16.4 Malignant neoplasm of pylorus
C16.5 Malignant neoplasm of lesser curvature of stomach, unspecified
C16.6 Malignant neoplasm of greater curvature of stomach, unspecified
C16.8 Malignant neoplasm of overlapping sites of stomach
C16.9 Malignant neoplasm of stomach, unspecified
C17.0 Malignant neoplasm of duodenum
C17.1 Malignant neoplasm of jejunum
C17.2 Malignant neoplasm of ileum
C17.3 Meckel's diverticulum, malignant
C17.8 Malignant neoplasm of overlapping sites of small intestine
C17.9 Malignant neoplasm of small intestine, unspecified
C24.1 Malignant neoplasm of ampulla of Vater
C25.0 Malignant neoplasm of head of pancreas
C25.1 Malignant neoplasm of body of pancreas
C25.2 Malignant neoplasm of tail of pancreas
C25.3 Malignant neoplasm of pancreatic duct
C25.4 Malignant neoplasm of endocrine pancreas
C25.7 Malignant neoplasm of other parts of pancreas
C25.8 Malignant neoplasm of overlapping sites of pancreas
C25.9 Malignant neoplasm of pancreas, unspecified
C32.0 Malignant neoplasm of glottis
C32.1 Malignant neoplasm of supraglottis
C32.2 Malignant neoplasm of subglottis
C32.3 Malignant neoplasm of laryngeal cartilage
C32.8 Malignant neoplasm of overlapping sites of larynx
C33 Malignant neoplasm of trachea
C7A.010 Malignant carcinoid tumor of the duodenum
C7A.092 Malignant carcinoid tumor of the stomach
C81.01 Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.02 Nodular lymphocyte predominant Hodgkin lymphoma, intrathoracic lymph nodes
C81.03 Nodular lymphocyte predominant Hodgkin lymphoma, intra-abdominal lymph nodes
C81.11 Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.12 Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes
C81.13 Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes
C81.21 Mixed cellularity Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.22 Mixed cellularity Hodgkin lymphoma, intrathoracic lymph nodes
C81.23 Mixed cellularity Hodgkin lymphoma, intra-abdominal lymph nodes
C81.31 Lymphocyte depleted Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.32 Lymphocyte depleted Hodgkin lymphoma, intrathoracic lymph nodes
C81.33 Lymphocyte depleted Hodgkin lymphoma, intra-abdominal lymph nodes
C81.41 Lymphocyte-rich Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.42 Lymphocyte-rich Hodgkin lymphoma, intrathoracic lymph nodes
C81.43 Lymphocyte-rich Hodgkin lymphoma, intra-abdominal lymph nodes
C81.71 Other Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.72 Other Hodgkin lymphoma, intrathoracic lymph nodes
C81.73 Other Hodgkin lymphoma, intra-abdominal lymph nodes
C81.91 Hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck
C81.92 Hodgkin lymphoma, unspecified, intrathoracic lymph nodes
C81.93 Hodgkin lymphoma, unspecified, intra-abdominal lymph nodes
C82.51 Diffuse follicle center lymphoma, lymph nodes of head, face, and neck
C82.52 Diffuse follicle center lymphoma, intrathoracic lymph nodes
C82.53 Diffuse follicle center lymphoma, intra-abdominal lymph nodes
C82.61 Cutaneous follicle center lymphoma, lymph nodes of head, face, and neck
C82.62 Cutaneous follicle center lymphoma, intrathoracic lymph nodes
C82.63 Cutaneous follicle center lymphoma, intra-abdominal lymph nodes
C82.81 Other types of follicular lymphoma, lymph nodes of head, face, and neck
C82.82 Other types of follicular lymphoma, intrathoracic lymph nodes
C82.83 Other types of follicular lymphoma, intra-abdominal lymph nodes
C83.01 Small cell B-cell lymphoma, lymph nodes of head, face, and neck
C83.02 Small cell B-cell lymphoma, intrathoracic lymph nodes
C83.03 Small cell B-cell lymphoma, intra-abdominal lymph nodes
C83.11 Mantle cell lymphoma, lymph nodes of head, face, and neck
C83.12 Mantle cell lymphoma, intrathoracic lymph nodes
C83.13 Mantle cell lymphoma, intra-abdominal lymph nodes
C83.31 Diffuse large B-cell lymphoma, lymph nodes of head, face, and neck
C83.32 Diffuse large B-cell lymphoma, intrathoracic lymph nodes
C83.33 Diffuse large B-cell lymphoma, intra-abdominal lymph nodes
C83.51 Lymphoblastic (diffuse) lymphoma, lymph nodes of head, face, and neck
C83.52 Lymphoblastic (diffuse) lymphoma, intrathoracic lymph nodes
C83.53 Lymphoblastic (diffuse) lymphoma, intra-abdominal lymph nodes
C83.71 Burkitt lymphoma, lymph nodes of head, face, and neck
C83.72 Burkitt lymphoma, intrathoracic lymph nodes
C83.73 Burkitt lymphoma, intra-abdominal lymph nodes
C83.81 Other non-follicular lymphoma, lymph nodes of head, face, and neck
C83.82 Other non-follicular lymphoma, intrathoracic lymph nodes
C83.83 Other non-follicular lymphoma, intra-abdominal lymph nodes
C83.91 Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of head, face, and neck
C83.92 Non-follicular (diffuse) lymphoma, unspecified, intrathoracic lymph nodes
C83.93 Non-follicular (diffuse) lymphoma, unspecified, intra-abdominal lymph nodes
C84.01 Mycosis fungoides, lymph nodes of head, face, and neck
C84.02 Mycosis fungoides, intrathoracic lymph nodes
C84.03 Mycosis fungoides, intra-abdominal lymph nodes
C84.11 Sezary disease, lymph nodes of head, face, and neck
C84.12 Sezary disease, intrathoracic lymph nodes
C84.13 Sezary disease, intra-abdominal lymph nodes
C84.41 Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of head, face, and neck
C84.42 Peripheral T-cell lymphoma, not elsewhere classified, intrathoracic lymph nodes
C84.43 Peripheral T-cell lymphoma, not elsewhere classified, intra-abdominal lymph nodes
C84.61 Anaplastic large cell lymphoma, ALK-positive, lymph nodes of head, face, and neck
C84.62 Anaplastic large cell lymphoma, ALK-positive, intrathoracic lymph nodes
C84.63 Anaplastic large cell lymphoma, ALK-positive, intra-abdominal lymph nodes
C84.71 Anaplastic large cell lymphoma, ALK-negative, lymph nodes of head, face, and neck
C84.72 Anaplastic large cell lymphoma, ALK-negative, intrathoracic lymph nodes
C84.73 Anaplastic large cell lymphoma, ALK-negative, intra-abdominal lymph nodes
C84.A1 Cutaneous T-cell lymphoma, unspecified lymph nodes of head, face, and neck
C84.A2 Cutaneous T-cell lymphoma, unspecified, intrathoracic lymph nodes
C84.A3 Cutaneous T-cell lymphoma, unspecified, intra-abdominal lymph nodes
C84.Z1 Other mature T/NK-cell lymphomas, lymph nodes of head, face, and neck
C84.Z2 Other mature T/NK-cell lymphomas, intrathoracic lymph nodes
C84.Z3 Other mature T/NK-cell lymphomas, intra-abdominal lymph nodes
C84.91 Mature T/NK-cell lymphomas, unspecified, lymph nodes of head, face, and neck
C84.92 Mature T/NK-cell lymphomas, unspecified, intrathoracic lymph nodes
C84.93 Mature T/NK-cell lymphomas, unspecified, intra-abdominal lymph nodes
C85.11 Unspecified B-cell lymphoma, lymph nodes of head, face, and neck
C85.12 Unspecified B-cell lymphoma, intrathoracic lymph nodes
C85.13 Unspecified B-cell lymphoma, intra-abdominal lymph nodes
C85.21 Mediastinal (thymic) large B-cell lymphoma, lymph nodes of head, face, and neck
C85.22 Mediastinal (thymic) large B-cell lymphoma, intrathoracic lymph nodes
C85.23 Mediastinal (thymic) large B-cell lymphoma, intra-abdominal lymph nodes
C85.81 Other specified types of non-Hodgkin lymphoma, lymph nodes of head, face, and neck
C85.82 Other specified types of non-Hodgkin lymphoma, intrathoracic lymph nodes
C85.83 Other specified types of non-Hodgkin lymphoma, intra-abdominal lymph nodes
C85.91 Non-Hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck
C85.92 Non-Hodgkin lymphoma, unspecified, intrathoracic lymph nodes
C85.93 Non-Hodgkin lymphoma, unspecified, intra-abdominal lymph nodes
C86.0 Extranodal NK/T-cell lymphoma, nasal type
C86.1 Hepatosplenic T-cell lymphoma
C86.2 Enteropathy-type (intestinal) T-cell lymphoma
C86.3 Subcutaneous panniculitis-like T-cell lymphoma
C86.4 Blastic NK-cell lymphoma
C88.4 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma]
D00.1 Carcinoma in situ of esophagus
D00.2 Carcinoma in situ of stomach
D01.7 Carcinoma in situ of other specified digestive organs
D13.0 Benign neoplasm of esophagus
D13.1 Benign neoplasm of stomach
D13.2 Benign neoplasm of duodenum
D13.39 Benign neoplasm of other parts of small intestine
D13.4 Benign neoplasm of liver
D13.5 Benign neoplasm of extrahepatic bile ducts
D13.6 Benign neoplasm of pancreas
D13.7 Benign neoplasm of endocrine pancreas
D17.5 Benign lipomatous neoplasm of intra-abdominal organs
D3A.010 Benign carcinoid tumor of the duodenum
D3A.092 Benign carcinoid tumor of the stomach
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
D37.6 Neoplasm of uncertain behavior of liver, gallbladder and bile ducts
D37.8 Neoplasm of uncertain behavior of other specified digestive organs
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
D51.0 Vitamin B12 deficiency anemia due to intrinsic factor deficiency
D62 Acute posthemorrhagic anemia
E41 Nutritional marasmus
E43 Unspecified severe protein-calorie malnutrition
E44.0 Moderate protein-calorie malnutrition
E46 Unspecified protein-calorie malnutrition
E64.0 Sequelae of protein-calorie malnutrition
I69.091 Dysphagia following nontraumatic subarachnoid hemorrhage
I69.191 Dysphagia following nontraumatic intracerebral hemorrhage
I69.291 Dysphagia following other nontraumatic intracranial hemorrhage
I69.391 Dysphagia following cerebral infarction
I69.891 Dysphagia following other cerebrovascular disease
I69.991 Dysphagia following unspecified cerebrovascular disease
I77.2 Rupture of artery
I78.0 Hereditary hemorrhagic telangiectasia
I85.00 Esophageal varices without bleeding
I85.01 Esophageal varices with bleeding
I85.10 Secondary esophageal varices without bleeding
I85.11 Secondary esophageal varices with bleeding
J86.0 Pyothorax with fistula
K20.0 Eosinophilic esophagitis
K20.80 Other esophagitis without bleeding
K20.81 Other esophagitis with bleeding
K20.90 Esophagitis, unspecified without bleeding
K20.91 Esophagitis, unspecified with bleeding
K21.00 Gastro-esophageal reflux disease with esophagitis, without bleeding
K21.01 Gastro-esophageal reflux disease with esophagitis, with bleeding
K21.9 Gastro-esophageal reflux disease without esophagitis
K22.0* Achalasia of cardia
K22.10 Ulcer of esophagus without bleeding
K22.11 Ulcer of esophagus with bleeding
K22.2 Esophageal obstruction
K22.3 Perforation of esophagus
K22.4 Dyskinesia of esophagus
K22.5 Diverticulum of esophagus, acquired
K22.6 Gastro-esophageal laceration-hemorrhage syndrome
K22.70 Barrett's esophagus without dysplasia
K22.710 Barrett's esophagus with low grade dysplasia
K22.711 Barrett's esophagus with high grade dysplasia
K22.719 Barrett's esophagus with dysplasia, unspecified
K22.81 Esophageal polyp
K22.82 Esophagogastric junction polyp
K22.89 Other specified disease of esophagus
K25.0 Acute gastric ulcer with hemorrhage
K25.1 Acute gastric ulcer with perforation
K25.2 Acute gastric ulcer with both hemorrhage and perforation
K25.3 Acute gastric ulcer without hemorrhage or perforation
K25.4 Chronic or unspecified gastric ulcer with hemorrhage
K25.7 Chronic gastric ulcer without hemorrhage or perforation
K25.9 Gastric ulcer, unspecified as acute or chronic, without hemorrhage or perforation
K26.0 Acute duodenal ulcer with hemorrhage
K26.3 Acute duodenal ulcer without hemorrhage or perforation
K26.4 Chronic or unspecified duodenal ulcer with hemorrhage
K26.7 Chronic duodenal ulcer without hemorrhage or perforation
K26.9 Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation
K27.0 Acute peptic ulcer, site unspecified, with hemorrhage
K27.3 Acute peptic ulcer, site unspecified, without hemorrhage or perforation
K27.4 Chronic or unspecified peptic ulcer, site unspecified, with hemorrhage
K27.7 Chronic peptic ulcer, site unspecified, without hemorrhage or perforation
K27.9 Peptic ulcer, site unspecified, unspecified as acute or chronic, without hemorrhage or perforation
K28.0 Acute gastrojejunal ulcer with hemorrhage
K28.3 Acute gastrojejunal ulcer without hemorrhage or perforation
K28.4 Chronic or unspecified gastrojejunal ulcer with hemorrhage
K28.7 Chronic gastrojejunal ulcer without hemorrhage or perforation
K28.9 Gastrojejunal ulcer, unspecified as acute or chronic, without hemorrhage or perforation
K29.00 Acute gastritis without bleeding
K29.01 Acute gastritis with bleeding
K29.20 Alcoholic gastritis without bleeding
K29.21 Alcoholic gastritis with bleeding
K29.30 Chronic superficial gastritis without bleeding
K29.31 Chronic superficial gastritis with bleeding
K29.40 Chronic atrophic gastritis without bleeding
K29.41 Chronic atrophic gastritis with bleeding
K29.50 Unspecified chronic gastritis without bleeding
K29.51 Unspecified chronic gastritis with bleeding
K29.60 Other gastritis without bleeding
K29.61 Other gastritis with bleeding
K29.70 Gastritis, unspecified, without bleeding
K29.71 Gastritis, unspecified, with bleeding
K29.80 Duodenitis without bleeding
K29.81 Duodenitis with bleeding
K29.90 Gastroduodenitis, unspecified, without bleeding
K29.91 Gastroduodenitis, unspecified, with bleeding
K30 Functional dyspepsia
K31.0 Acute dilatation of stomach
K31.1 Adult hypertrophic pyloric stenosis
K31.2 Hourglass stricture and stenosis of stomach
K31.3 Pylorospasm, not elsewhere classified
K31.4 Gastric diverticulum
K31.5 Obstruction of duodenum
K31.6 Fistula of stomach and duodenum
K31.7 Polyp of stomach and duodenum
K31.811 Angiodysplasia of stomach and duodenum with bleeding
K31.819 Angiodysplasia of stomach and duodenum without bleeding
K31.82 Dieulafoy lesion (hemorrhagic) of stomach and duodenum
K31.89 Other diseases of stomach and duodenum
K31.A11 Gastric intestinal metaplasia without dysplasia, involving the antrum
K31.A12 Gastric intestinal metaplasia without dysplasia, involving the body (corpus)
K31.A13 Gastric intestinal metaplasia without dysplasia, involving the fundus
K31.A14 Gastric intestinal metaplasia without dysplasia, involving the cardia
K31.A15 Gastric intestinal metaplasia without dysplasia, involving multiple sites
K31.A21 Gastric intestinal metaplasia with low grade dysplasia
K31.A22 Gastric intestinal metaplasia with high grade dysplasia
K44.0 Diaphragmatic hernia with obstruction, without gangrene
K50.00 Crohn's disease of small intestine without complications
K50.011 Crohn's disease of small intestine with rectal bleeding
K50.014 Crohn's disease of small intestine with abscess
K50.018 Crohn's disease of small intestine with other complication
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
K50.813 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
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
K52.831 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
K55.011 Focal (segmental) acute (reversible) ischemia of small intestine
K55.012 Diffuse acute (reversible) ischemia of small intestine
K55.019 Acute (reversible) ischemia of small intestine, extent unspecified
K55.021 Focal (segmental) acute infarction of small intestine
K55.022 Diffuse acute infarction of small intestine
K55.029 Acute infarction of small 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
K63.3 Ulcer of intestine
K70.0 Alcoholic fatty liver
K74.60 Unspecified cirrhosis of liver
K76.6 Portal hypertension
K76.81 Hepatopulmonary syndrome
K76.82 Hepatic encephalopathy
K76.89 Other specified diseases of liver
K80.00 Calculus of gallbladder with acute cholecystitis without obstruction
K80.01 Calculus of gallbladder with acute cholecystitis with obstruction
K80.10 Calculus of gallbladder with chronic cholecystitis without obstruction
K80.11 Calculus of gallbladder with chronic cholecystitis with obstruction
K80.18 Calculus of gallbladder with other cholecystitis without obstruction
K80.19 Calculus of gallbladder with other cholecystitis with obstruction
K80.20 Calculus of gallbladder without cholecystitis without obstruction
K80.21 Calculus of gallbladder without cholecystitis with obstruction
K80.30 Calculus of bile duct with cholangitis, unspecified, without obstruction
K80.31 Calculus of bile duct with cholangitis, unspecified, with obstruction
K80.32 Calculus of bile duct with acute cholangitis without obstruction
K80.33 Calculus of bile duct with acute cholangitis with obstruction
K80.34 Calculus of bile duct with chronic cholangitis without obstruction
K80.35 Calculus of bile duct with chronic cholangitis with obstruction
K80.40 Calculus of bile duct with cholecystitis, unspecified, without obstruction
K80.41 Calculus of bile duct with cholecystitis, unspecified, with obstruction
K80.42 Calculus of bile duct with acute cholecystitis without obstruction
K80.43 Calculus of bile duct with acute cholecystitis with obstruction
K80.44 Calculus of bile duct with chronic cholecystitis without obstruction
K80.45 Calculus of bile duct with chronic cholecystitis with obstruction
K80.50 Calculus of bile duct without cholangitis or cholecystitis without obstruction
K80.51 Calculus of bile duct without cholangitis or cholecystitis with obstruction
K80.60 Calculus of gallbladder and bile duct with cholecystitis, unspecified, without obstruction
K80.61 Calculus of gallbladder and bile duct with cholecystitis, unspecified, with obstruction
K80.62 Calculus of gallbladder and bile duct with acute cholecystitis without obstruction
K80.63 Calculus of gallbladder and bile duct with acute cholecystitis with obstruction
K80.64 Calculus of gallbladder and bile duct with chronic cholecystitis without obstruction
K80.65 Calculus of gallbladder and bile duct with chronic cholecystitis with obstruction
K80.66 Calculus of gallbladder and bile duct with acute and chronic cholecystitis without obstruction
K80.67 Calculus of gallbladder and bile duct with acute and chronic cholecystitis with obstruction
K80.70 Calculus of gallbladder and bile duct without cholecystitis without obstruction
K80.71 Calculus of gallbladder and bile duct without cholecystitis with obstruction
K80.80 Other cholelithiasis without obstruction
K80.81 Other cholelithiasis with obstruction
K83.01 Primary sclerosing cholangitis
K83.09 Other cholangitis
K83.1 Obstruction of bile duct
K83.2 Perforation of bile duct
K83.3 Fistula of bile duct
K83.4 Spasm of sphincter of Oddi
K83.5 Biliary cyst
K83.8 Other specified diseases of biliary tract
K83.9 Disease of biliary tract, unspecified
K85.00 Idiopathic acute pancreatitis without necrosis or infection
K85.01 Idiopathic acute pancreatitis with uninfected necrosis
K85.02 Idiopathic acute pancreatitis with infected necrosis
K85.10 Biliary acute pancreatitis without necrosis or infection
K85.11 Biliary acute pancreatitis with uninfected necrosis
K85.12 Biliary acute pancreatitis with infected necrosis
K85.20 Alcohol induced acute pancreatitis without necrosis or infection
K85.21 Alcohol induced acute pancreatitis with uninfected necrosis
K85.22 Alcohol induced acute pancreatitis with infected necrosis
K85.30 Drug induced acute pancreatitis without necrosis or infection
K85.31 Drug induced acute pancreatitis with uninfected necrosis
K85.32 Drug induced acute pancreatitis with infected necrosis
K85.80 Other acute pancreatitis without necrosis or infection
K85.81 Other acute pancreatitis with uninfected necrosis
K85.82 Other acute pancreatitis with infected necrosis
K85.90 Acute pancreatitis without necrosis or infection, unspecified
K85.91 Acute pancreatitis with uninfected necrosis, unspecified
K85.92 Acute pancreatitis with infected necrosis, unspecified
K86.0 Alcohol-induced chronic pancreatitis
K86.1 Other chronic pancreatitis
K86.2 Cyst of pancreas
K86.3 Pseudocyst of pancreas
K86.81 Exocrine pancreatic insufficiency
K86.89 Other specified diseases of pancreas
K86.9 Disease of pancreas, unspecified
K87 Disorders of gallbladder, biliary tract and pancreas in diseases classified elsewhere
K90.0 Celiac disease
K90.1 Tropical sprue
K90.41 Non-celiac gluten sensitivity
K90.49 Malabsorption due to intolerance, not elsewhere classified
K90.81 Whipple's disease
K90.89 Other intestinal malabsorption
K90.9 Intestinal malabsorption, unspecified
K91.30 Postprocedural intestinal obstruction, unspecified as to partial versus complete
K91.31 Postprocedural partial intestinal obstruction
K91.32 Postprocedural complete intestinal obstruction
K91.5 Postcholecystectomy syndrome
K91.81 Other intraoperative complications of digestive system
K91.82 Postprocedural hepatic failure
K91.83 Postprocedural hepatorenal syndrome
K91.86 Retained cholelithiasis following cholecystectomy
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
K92.0 Hematemesis
K92.1 Melena
K92.2 Gastrointestinal hemorrhage, unspecified
K92.81 Gastrointestinal mucositis (ulcerative)
K94.20 Gastrostomy complication, unspecified
K94.23 Gastrostomy malfunction
K94.30 Esophagostomy complications, unspecified
K94.31 Esophagostomy hemorrhage
K94.33 Esophagostomy malfunction
K94.39 Other complications of esophagostomy
Q26.5 Anomalous portal venous connection
Q26.6 Portal vein-hepatic artery fistula
Q27.33 Arteriovenous malformation of digestive system vessel
Q39.0 Atresia of esophagus without fistula
Q39.1 Atresia of esophagus with tracheo-esophageal fistula
Q39.2 Congenital tracheo-esophageal fistula without atresia
Q39.3 Congenital stenosis and stricture of esophagus
Q39.4 Esophageal web
Q39.5 Congenital dilatation of esophagus
Q39.6 Congenital diverticulum of esophagus
Q39.8 Other congenital malformations of esophagus
Q39.9 Congenital malformation of esophagus, unspecified
Q40.1 Congenital hiatus hernia
Q40.2 Other specified congenital malformations of stomach
Q40.3 Congenital malformation of stomach, unspecified
Q44.0 Agenesis, aplasia and hypoplasia of gallbladder
Q44.1 Other congenital malformations of gallbladder
Q44.4 Choledochal cyst
R07.9 Chest pain, unspecified
R10.11 Right upper quadrant pain
R10.12 Left upper quadrant pain
R10.13 Epigastric pain
R10.33 Periumbilical pain
R11.0 Nausea
R11.10 Vomiting, unspecified
R11.11 Vomiting without nausea
R11.12 Projectile vomiting
R11.15 Cyclical vomiting syndrome unrelated to migraine
R11.2 Nausea with vomiting, unspecified
R12 Heartburn
R13.0 Aphagia
R13.10 Dysphagia, unspecified
R13.11 Dysphagia, oral phase
R13.12 Dysphagia, oropharyngeal phase
R13.13 Dysphagia, pharyngeal phase
R13.14 Dysphagia, pharyngoesophageal phase
R13.19 Other dysphagia
R17 Unspecified jaundice
R63.0 Anorexia
R63.39 Other feeding difficulties
R63.4 Abnormal weight loss
R93.2* Abnormal findings on diagnostic imaging of liver and biliary tract
R93.3 Abnormal findings on diagnostic imaging of other parts of digestive tract
R93.5 Abnormal findings on diagnostic imaging of other abdominal regions, including retroperitoneum
S11.20XA Unspecified open wound of pharynx and cervical esophagus, initial encounter
S11.20XD Unspecified open wound of pharynx and cervical esophagus, subsequent encounter
S11.20XS Unspecified open wound of pharynx and cervical esophagus, sequela
S11.21XA Laceration without foreign body of pharynx and cervical esophagus, initial encounter
S11.21XD Laceration without foreign body of pharynx and cervical esophagus, subsequent encounter
S11.21XS Laceration without foreign body of pharynx and cervical esophagus, sequela
S11.22XA Laceration with foreign body of pharynx and cervical esophagus, initial encounter
S11.22XD Laceration with foreign body of pharynx and cervical esophagus, subsequent encounter
S11.22XS Laceration with foreign body of pharynx and cervical esophagus, sequela
S11.23XA Puncture wound without foreign body of pharynx and cervical esophagus, initial encounter
S11.23XD Puncture wound without foreign body of pharynx and cervical esophagus, subsequent encounter
S11.23XS Puncture wound without foreign body of pharynx and cervical esophagus, sequela
S11.24XA Puncture wound with foreign body of pharynx and cervical esophagus, initial encounter
S11.24XD Puncture wound with foreign body of pharynx and cervical esophagus, subsequent encounter
S11.24XS Puncture wound with foreign body of pharynx and cervical esophagus, sequela
S11.25XA Open bite of pharynx and cervical esophagus, initial encounter
S11.25XD Open bite of pharynx and cervical esophagus, subsequent encounter
S11.25XS Open bite of pharynx and cervical esophagus, sequela
S27.812A Contusion of esophagus (thoracic part), initial encounter
S27.812D Contusion of esophagus (thoracic part), subsequent encounter
S27.812S Contusion of esophagus (thoracic part), sequela
S27.813A Laceration of esophagus (thoracic part), initial encounter
S27.813D Laceration of esophagus (thoracic part), subsequent encounter
S27.813S Laceration of esophagus (thoracic part), sequela
S27.818A Other injury of esophagus (thoracic part), initial encounter
S27.818D Other injury of esophagus (thoracic part), subsequent encounter
S27.818S Other injury of esophagus (thoracic part), sequela
S27.819A Unspecified injury of esophagus (thoracic part), initial encounter
S27.819D Unspecified injury of esophagus (thoracic part), subsequent encounter
S27.819S Unspecified injury of esophagus (thoracic part), sequela
T18.100A Unspecified foreign body in esophagus causing compression of trachea, initial encounter
T18.100D Unspecified foreign body in esophagus causing compression of trachea, subsequent encounter
T18.100S Unspecified foreign body in esophagus causing compression of trachea, sequela
T18.108A Unspecified foreign body in esophagus causing other injury, initial encounter
T18.108D Unspecified foreign body in esophagus causing other injury, subsequent encounter
T18.108S Unspecified foreign body in esophagus causing other injury, sequela
T18.110A Gastric contents in esophagus causing compression of trachea, initial encounter
T18.110D Gastric contents in esophagus causing compression of trachea, subsequent encounter
T18.110S Gastric contents in esophagus causing compression of trachea, sequela
T18.118A Gastric contents in esophagus causing other injury, initial encounter
T18.118D Gastric contents in esophagus causing other injury, subsequent encounter
T18.118S Gastric contents in esophagus causing other injury, sequela
T18.120A Food in esophagus causing compression of trachea, initial encounter
T18.120D Food in esophagus causing compression of trachea, subsequent encounter
T18.120S Food in esophagus causing compression of trachea, sequela
T18.128A Food in esophagus causing other injury, initial encounter
T18.128D Food in esophagus causing other injury, subsequent encounter
T18.128S Food in esophagus causing other injury, sequela
T18.190A Other foreign object in esophagus causing compression of trachea, initial encounter
T18.190D Other foreign object in esophagus causing compression of trachea, subsequent encounter
T18.190S Other foreign object in esophagus causing compression of trachea, sequela
T18.198A Other foreign object in esophagus causing other injury, initial encounter
T18.198D Other foreign object in esophagus causing other injury, subsequent encounter
T18.198S Other foreign object in esophagus causing other injury, sequela
T18.2XXA Foreign body in stomach, initial encounter
T18.2XXD Foreign body in stomach, subsequent encounter
T18.2XXS Foreign body in stomach, sequela
T18.3XXA Foreign body in small intestine, initial encounter
T18.3XXD Foreign body in small intestine, subsequent encounter
T18.3XXS Foreign body in small intestine, sequela
T18.8XXA Foreign body in other parts of alimentary tract, initial encounter
T18.8XXD Foreign body in other parts of alimentary tract, subsequent encounter
T18.8XXS Foreign body in other parts of alimentary tract, sequela
T28.0XXA Burn of mouth and pharynx, initial encounter
T28.0XXD Burn of mouth and pharynx, subsequent encounter
T28.0XXS Burn of mouth and pharynx, sequela
T28.1XXA Burn of esophagus, initial encounter
T28.1XXD Burn of esophagus, subsequent encounter
T28.1XXS Burn of esophagus, sequela
T28.2XXA Burn of other parts of alimentary tract, initial encounter
T28.2XXD Burn of other parts of alimentary tract, subsequent encounter
T28.2XXS Burn of other parts of alimentary tract, sequela
T28.5XXA Corrosion of mouth and pharynx, initial encounter
T28.5XXD Corrosion of mouth and pharynx, subsequent encounter
T28.5XXS Corrosion of mouth and pharynx, sequela
T28.6XXA Corrosion of esophagus, initial encounter
T28.6XXD Corrosion of esophagus, subsequent encounter
T28.6XXS Corrosion of esophagus, sequela
T28.7XXA Corrosion of other parts of alimentary tract, initial encounter
T28.7XXD Corrosion of other parts of alimentary tract, subsequent encounter
T28.7XXS Corrosion of other parts of alimentary tract, sequela
T54.1X1A Toxic effect of other corrosive organic compounds, accidental (unintentional), initial encounter
T54.1X1D Toxic effect of other corrosive organic compounds, accidental (unintentional), subsequent encounter
T54.1X1S Toxic effect of other corrosive organic compounds, accidental (unintentional), sequela
T54.1X2A Toxic effect of other corrosive organic compounds, intentional self-harm, initial encounter
T54.1X2D Toxic effect of other corrosive organic compounds, intentional self-harm, subsequent encounter
T54.1X2S Toxic effect of other corrosive organic compounds, intentional self-harm, sequela
T54.1X3A Toxic effect of other corrosive organic compounds, assault, initial encounter
T54.1X3D Toxic effect of other corrosive organic compounds, assault, subsequent encounter
T54.1X3S Toxic effect of other corrosive organic compounds, assault, sequela
T54.1X4A Toxic effect of other corrosive organic compounds, undetermined, initial encounter
T54.1X4D Toxic effect of other corrosive organic compounds, undetermined, subsequent encounter
T54.1X4S Toxic effect of other corrosive organic compounds, undetermined, sequela
T54.3X1A Toxic effect of corrosive alkalis and alkali-like substances, accidental (unintentional), initial encounter
T54.3X1D Toxic effect of corrosive alkalis and alkali-like substances, accidental (unintentional), subsequent encounter
T54.3X1S Toxic effect of corrosive alkalis and alkali-like substances, accidental (unintentional), sequela
T54.3X2A Toxic effect of corrosive alkalis and alkali-like substances, intentional self-harm, initial encounter
T54.3X2D Toxic effect of corrosive alkalis and alkali-like substances, intentional self-harm, subsequent encounter
T54.3X2S Toxic effect of corrosive alkalis and alkali-like substances, intentional self-harm, sequela
T54.3X3A Toxic effect of corrosive alkalis and alkali-like substances, assault, initial encounter
T54.3X3D Toxic effect of corrosive alkalis and alkali-like substances, assault, subsequent encounter
T54.3X3S Toxic effect of corrosive alkalis and alkali-like substances, assault, sequela
T54.3X4A Toxic effect of corrosive alkalis and alkali-like substances, undetermined, initial encounter
T54.3X4D Toxic effect of corrosive alkalis and alkali-like substances, undetermined, subsequent encounter
T54.3X4S Toxic effect of corrosive alkalis and alkali-like substances, undetermined, sequela
T54.91XA Toxic effect of unspecified corrosive substance, accidental (unintentional), initial encounter
T54.91XD Toxic effect of unspecified corrosive substance, accidental (unintentional), subsequent encounter
T54.91XS Toxic effect of unspecified corrosive substance, accidental (unintentional), sequela
T54.92XA Toxic effect of unspecified corrosive substance, intentional self-harm, initial encounter
T54.92XD Toxic effect of unspecified corrosive substance, intentional self-harm, subsequent encounter
T54.92XS Toxic effect of unspecified corrosive substance, intentional self-harm, sequela
T54.93XA Toxic effect of unspecified corrosive substance, assault, initial encounter
T54.93XD Toxic effect of unspecified corrosive substance, assault, subsequent encounter
T54.93XS Toxic effect of unspecified corrosive substance, assault, sequela
T54.94XA Toxic effect of unspecified corrosive substance, undetermined, initial encounter
T54.94XD Toxic effect of unspecified corrosive substance, undetermined, subsequent encounter
T54.94XS Toxic effect of unspecified corrosive substance, undetermined, sequela
T57.1X1A Toxic effect of phosphorus and its compounds, accidental (unintentional), initial encounter
T57.1X1D Toxic effect of phosphorus and its compounds, accidental (unintentional), subsequent encounter
T57.1X1S Toxic effect of phosphorus and its compounds, accidental (unintentional), sequela
T57.1X2A Toxic effect of phosphorus and its compounds, intentional self-harm, initial encounter
T57.1X2D Toxic effect of phosphorus and its compounds, intentional self-harm, subsequent encounter
T57.1X2S Toxic effect of phosphorus and its compounds, intentional self-harm, sequela
T57.1X3A Toxic effect of phosphorus and its compounds, assault, initial encounter
T57.1X3D Toxic effect of phosphorus and its compounds, assault, subsequent encounter
T57.1X3S Toxic effect of phosphorus and its compounds, assault, sequela
T57.1X4A Toxic effect of phosphorus and its compounds, undetermined, initial encounter
T57.1X4D Toxic effect of phosphorus and its compounds, undetermined, subsequent encounter
T57.1X4S Toxic effect of phosphorus and its compounds, undetermined, sequela
Z08 Encounter for follow-up examination after completed treatment for malignant neoplasm
Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
Z43.1 Encounter for attention to gastrostomy
Z46.59* Encounter for fitting and adjustment of other gastrointestinal appliance and device
Z79.01 Long term (current) use of anticoagulants
Z79.82 Long term (current) use of aspirin
Z79.83 Long term (current) use of bisphosphonates
Z79.891 Long term (current) use of opiate analgesic
Z79.899 Other long term (current) drug therapy
Z85.01 Personal history of malignant neoplasm of esophagus
Z85.028 Personal history of other malignant neoplasm of stomach
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: ICD-10 Code Z46.59 (Encounter for fitting and adjustment of other gastrointestinal appliance and device) is allowed only for CPT® Codes 43275 (ERCP removal foreign body- duct), and 43276 (ERCP stent exchange w/dilatation) for the removal of a biliary stent.

*Note: In addition to the above, ERCPs (CPT® Codes 43260, 43261, 43262, 43263, 43264, 43265, 43274, 43275, 43276, 43277, and 43278) are allowed for ICD-10 Code R93.2.

*Note: HCPCS Code J0585 is allowed only when reporting for ICD-10 Diagnosis Code K22.0 on the claim.

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

N/A

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.

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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.

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Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/01/2023 R15

Under CPT/HCPCS Codes Group 2: Codes the description was revised for 43499. This revision is due to the 2023 Annual/Q1 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/23.

10/01/2022 R14

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted Q85.8, added K76.82 and descriptors were revised for C84.41, C84.42 and C84.43. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/22.

08/14/2022 R13

The related Upper Gastrointestinal Endoscopy and Visualization L34434 LCD is being presented for notice. Under CPT/HCPCS Codes Group 1: Codes added 0652T, 0653T and 0654T.

11/01/2021 R12

Under CPT/HCPCS Codes deleted the Group 3: Codes 43284 and 43285 along with the related Group 3: Paragraph verbiage “The following CPT® codes are noncovered.” This revision is retroactive effective for dates of service on or after 1/1/21.

11/01/2021 R11

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes added C01.

10/01/2021 R10

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes deleted K22.8 and R63.3 and added K22.81, K22.82, K22.89, K31.A11, K31.A12, K31.A13, K31.A14, K31.A15, K31.A21, K31.A22, and R63.39. This revision is due to the Annual ICD-10 Update and will become effective on 10/1/21.

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes added C02.0, C02.1, C02.2, C02.3, C02.4, C02.8, C09.0, C09.1 and C09.8. This revision is effective 10/1/21.

08/19/2021 R9

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes added K80.32, K80.33, K80.34 and K80.35.

01/01/2021 R8

Under CPT/HCPCS Codes Group 4: Codes deleted C1052 as it was previously added in error with revision #7. Please disregard revision #7. This revision is retroactive effective for dates of service on or after 1/1/2021.

01/01/2021 R7

Under CPT/HCPCS Codes Group 4 Codes: added C1052. This revision is due to the Q1 2021 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/2021.

12/26/2020 R6

Under CPT/HCPCS Codes Group 2: Codes deleted 43257.

10/01/2020 R5

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted K20.8, K20.9, K21.0 and added K20.80, K20.81, K20.90, K20.91, K21.00 and K21.01. This revision is due to the Annual ICD-10 Code Update and is effective on 10/1/20.

10/17/2019 R4

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 Upper Gastrointestinal Endoscopy and Visualization L34434 LCD and placed in this article. Under CPT/HCPCS Codes Group 2: Paragraph added the verbiage “of the Upper Gastrointestinal Endoscopy and Visualization L34434 LCD”. Under ICD-10 Codes that Support Medical Necessity Group 1: Paragraph removed Group 1: Asterisk subheading and corresponding paragraphs. Under ICD-10 Codes that Support Medical Necessity Group 1: Codes placed an asterisk on ICD-10 codes K22.0, R93.2 and Z46.59. Under ICD-10 Codes that Support Medical Necessity Group 1: Medical Necessity ICD-10 Codes Asterisk Explanation added verbiage.

10/01/2019 R3

Under Covered ICD-10 Codes Group 1: Codes ICD-10 code R11.15 was added. This revision is due to the 2019 Annual ICD-10 Code Update and is effective on October 1, 2019.

05/31/2019 R2

Under Article Text added verbiage “All unlisted procedure codes billed for services are subject to development and medical review.” Under CPT/HCPCS Codes Group 4: Codes added J0585. Under Covered ICD-10 Codes Group 1: Paragraph added verbiage “*Note: HCPCS Code J0585 is allowed only when reporting for ICD-10 Diagnosis Code K22.0 on the claim.”

04/12/2019 R1

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added K80.31.

Associated Documents

Related National Coverage Documents
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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
01/11/2023 01/01/2023 - N/A Currently in Effect You are here
08/29/2022 10/01/2022 - 12/31/2022 Superseded View
06/24/2022 08/14/2022 - 09/30/2022 Superseded View
01/03/2022 11/01/2021 - 08/13/2022 Superseded View
09/22/2021 11/01/2021 - N/A Superseded View
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Keywords

  • UGE
  • Upper Gastrointestinal Endoscopy