SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Computed Tomographic (CT) Colonography for Diagnostic Uses

A57026

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Draft Article
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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Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57026
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Computed Tomographic (CT) Colonography for Diagnostic Uses
Article Type
Billing and Coding
Original Effective Date
09/12/2019
Revision Effective Date
10/01/2022
Revision Ending Date
09/30/2023
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

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.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Language quoted from CMS National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the LCD Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See §1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

Title XVIII of the Social Security Act (SSA):

Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Code of Federal Regulations

42 CFR Section 410.32 indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary's specific medical problem. Tests not ordered by the physician (or other qualified non-physician provider) who is treating the beneficiary are not reasonable and necessary (see Sec. 411.15(k)(1) of this chapter).

42 CFR Section 410.38, subpart B indicates the tests approved for coverage of colorectal cancer screening

CMS Publications:

CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1:

    220.1 Computed Tomography

CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15:

    80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests

CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 13:

    10 ICD-9-CM Coding for Diagnostic Tests
    20 Payment Conditions for Radiology Services
    80 Supervision and Interpretation (S & I) Codes and Interventional Radiology

 

Article Guidance

Article Text

This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Computed Tomographic (CT) Colonography for Diagnostic Uses.

Coding Information:

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare.

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act.

The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported.

Documentation Requirements:

The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Utilization Guidelines:

CT colonography is reimbursable only when performed following an instrument colonoscopy which was incomplete or when a board certified or board eligible gastroenterologist or surgeon trained in endoscopy determined from an evaluation of the patient that optical colonoscopy can not be safely attempted. Tests performed without a prior incomplete instrument colonoscopy in history or documentation by a board certified or eligible gastroenterologist, a surgeon trained in endoscopy or a physician with equivalent endoscopic training indicating why an optical colonoscopy cannot be safely attempted will be denied.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

Group 1

(2 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
74261 COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC, INCLUDING IMAGE POSTPROCESSING; WITHOUT CONTRAST MATERIAL
74262 COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC, INCLUDING IMAGE POSTPROCESSING; WITH CONTRAST MATERIAL(S) INCLUDING NON-CONTRAST IMAGES, IF PERFORMED
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

(1 Code)
Group 1 Paragraph

The correct use of an ICD-10-CM 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 this determination.

For the purposes of this LCD, ICD-10-CM code Z53.8 indicates that the instrument colonoscopy has been attempted and was incomplete or when a board certified or board eligible gastroenterologist, a surgeon trained in endoscopy, or a physician with equivalent endoscopic training determined from an evaluation of the patient that optical colonoscopy cannot be safely attempted.

Group 1 Codes
Code Description
Z53.8 Procedure and treatment not carried out for other reasons

Group 2

(516 Codes)
Group 2 Paragraph

In addition to reporting ICD-10-CM code Z53.8, one (or more) of the ICD-10-CM codes below MUST be reported in order to support medical necessity.

Group 2 Codes
Code Description
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
B77.81 Ascariasis pneumonia
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
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
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
D12.7 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
D17.71 Benign lipomatous neoplasm of kidney
D18.03 Hemangioma of intra-abdominal structures
D18.1 Lymphangioma, any 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
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
I33.0 Acute and subacute infective endocarditis
I77.2 Rupture of artery
I78.0 Hereditary hemorrhagic telangiectasia
I86.4 Gastric varices
I86.8 Varicose veins of other specified sites
K35.80 Unspecified acute appendicitis
K35.890 Other acute appendicitis without perforation or gangrene
K35.891 Other acute appendicitis without perforation, with gangrene
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
K50.00 Crohn's disease of small intestine without complications
K50.011 Crohn's disease of small intestine with rectal bleeding
K50.012 Crohn's disease of small intestine with intestinal obstruction
K50.013 Crohn's disease of small intestine with fistula
K50.014 Crohn's disease of small intestine with abscess
K50.018 Crohn's disease of small intestine with other complication
K50.019 Crohn's disease of small intestine with unspecified complications
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
K51.50 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
K52.82 Eosinophilic colitis
K52.89 Other specified noninfective gastroenteritis and colitis
K52.9 Noninfective gastroenteritis and colitis, unspecified
K55.1 Chronic vascular disorders of intestine
K55.20 Angiodysplasia of colon without hemorrhage
K55.21 Angiodysplasia of colon with hemorrhage
K55.8 Other vascular disorders of intestine
K55.9 Vascular disorder of intestine, unspecified
K56.0 Paralytic ileus
K56.1 Intussusception
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
K56.690 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
K58.9 Irritable bowel syndrome without diarrhea
K59.00 Constipation, unspecified
K59.01 Slow transit constipation
K59.02 Outlet dysfunction 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)
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
K63.89 Other specified diseases of intestine
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
K80.36 Calculus of bile duct with acute and chronic cholangitis without obstruction
K80.37 Calculus of bile duct with acute and chronic cholangitis with obstruction
K83.01 Primary sclerosing cholangitis
K83.09 Other cholangitis
K90.89 Other intestinal malabsorption
K91.89 Other postprocedural complications and disorders of digestive system
K92.1 Melena
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
N82.2 Fistula of vagina to small intestine
N82.3 Fistula of vagina to large intestine
N82.4 Other female intestinal-genital tract fistulae
P77.1 Stage 1 necrotizing enterocolitis in newborn
P77.2 Stage 2 necrotizing enterocolitis in newborn
P77.3 Stage 3 necrotizing enterocolitis in newborn
P77.9 Necrotizing enterocolitis in newborn, unspecified
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
Q85.81 PTEN tumor syndrome
Q85.82 Other Cowden syndrome
Q85.83 Von Hippel-Lindau syndrome
Q85.89 Other phakomatoses, not elsewhere classified
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
R10.84 Generalized abdominal pain
R10.9 Unspecified abdominal pain
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 - S36.503S Unspecified injury of ascending [right] colon, initial encounter - Unspecified injury of sigmoid colon, sequela
S36.508A - S36.513S Unspecified injury of other part of colon, initial encounter - Primary blast injury of sigmoid colon, sequela
S36.518A - S36.523S Primary blast injury of other part of colon, initial encounter - Contusion of sigmoid colon, sequela
S36.528A - S36.533S Contusion of other part of colon, initial encounter - Laceration of sigmoid colon, sequela
S36.538A - S36.539S Laceration of other part of colon, initial encounter - Laceration of unspecified part of colon, sequela
S36.590A - S36.593S Other injury of ascending [right] colon, initial encounter - Other injury of sigmoid colon, sequela
S36.598A - S36.599S Other injury of other part of colon, initial encounter - Other injury of unspecified part of colon, sequela
S36.60XA - S36.63XS Unspecified injury of rectum, initial encounter - Laceration of rectum, sequela
S36.69XA - S36.69XS Other injury of rectum, initial encounter - Other injury of rectum, 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
T18.4XXA Foreign body in colon, initial encounter
T18.4XXD Foreign body in colon, subsequent encounter
T18.4XXS Foreign body in colon, sequela
T18.5XXA Foreign body in anus and rectum, initial encounter
T18.5XXD Foreign body in anus and rectum, subsequent encounter
T18.5XXS Foreign body in anus and rectum, 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
T18.9XXA Foreign body of alimentary tract, part unspecified, initial encounter
T18.9XXD Foreign body of alimentary tract, part unspecified, subsequent encounter
T18.9XXS Foreign body of alimentary tract, part unspecified, sequela
T82.7XXA Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter
T82.7XXD Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, subsequent encounter
T82.7XXS Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, sequela
T82.818A Embolism due to vascular prosthetic devices, implants and grafts, initial encounter
T82.818D Embolism due to vascular prosthetic devices, implants and grafts, subsequent encounter
T82.818S Embolism due to vascular prosthetic devices, implants and grafts, sequela
T82.828A Fibrosis due to vascular prosthetic devices, implants and grafts, initial encounter
T82.828D Fibrosis due to vascular prosthetic devices, implants and grafts, subsequent encounter
T82.828S Fibrosis due to vascular prosthetic devices, implants and grafts, sequela
T82.838A Hemorrhage due to vascular prosthetic devices, implants and grafts, initial encounter
T82.838D Hemorrhage due to vascular prosthetic devices, implants and grafts, subsequent encounter
T82.838S Hemorrhage due to vascular prosthetic devices, implants and grafts, sequela
T82.848A Pain due to vascular prosthetic devices, implants and grafts, initial encounter
T82.848D Pain due to vascular prosthetic devices, implants and grafts, subsequent encounter
T82.848S Pain due to vascular prosthetic devices, implants and grafts, sequela
T82.858A Stenosis of other vascular prosthetic devices, implants and grafts, initial encounter
T82.858D Stenosis of other vascular prosthetic devices, implants and grafts, subsequent encounter
T82.858S Stenosis of other vascular prosthetic devices, implants and grafts, sequela
T82.868A Thrombosis due to vascular prosthetic devices, implants and grafts, initial encounter
T82.868D Thrombosis due to vascular prosthetic devices, implants and grafts, subsequent encounter
T82.868S Thrombosis due to vascular prosthetic devices, implants and grafts, sequela
T82.898A Other specified complication of vascular prosthetic devices, implants and grafts, initial encounter
T82.898D Other specified complication of vascular prosthetic devices, implants and grafts, subsequent encounter
T82.898S Other specified complication of vascular prosthetic devices, implants and grafts, sequela
T82.9XXA Unspecified complication of cardiac and vascular prosthetic device, implant and graft, initial encounter
T82.9XXD Unspecified complication of cardiac and vascular prosthetic device, implant and graft, subsequent encounter
T82.9XXS Unspecified complication of cardiac and vascular prosthetic device, implant and graft, sequela
T85.611A Breakdown (mechanical) of intraperitoneal dialysis catheter, initial encounter
T85.611D Breakdown (mechanical) of intraperitoneal dialysis catheter, subsequent encounter
T85.611S Breakdown (mechanical) of intraperitoneal dialysis catheter, sequela
T85.621A Displacement of intraperitoneal dialysis catheter, initial encounter
T85.621D Displacement of intraperitoneal dialysis catheter, subsequent encounter
T85.621S Displacement of intraperitoneal dialysis catheter, sequela
T85.631A Leakage of intraperitoneal dialysis catheter, initial encounter
T85.631D Leakage of intraperitoneal dialysis catheter, subsequent encounter
T85.631S Leakage of intraperitoneal dialysis catheter, sequela
T85.691A Other mechanical complication of intraperitoneal dialysis catheter, initial encounter
T85.691D Other mechanical complication of intraperitoneal dialysis catheter, subsequent encounter
T85.691S Other mechanical complication of intraperitoneal dialysis catheter, sequela
Z03.89 Encounter for observation for other suspected diseases and conditions ruled out
Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
Z85.00 Personal history of malignant neoplasm of unspecified digestive organ
Z85.01 Personal history of malignant neoplasm of esophagus
Z85.028 Personal history of other malignant neoplasm of stomach
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
Z86.010 Personal history of colonic polyps
Z87.19 Personal history of other diseases of the digestive system
Z98.0 Intestinal bypass and anastomosis status
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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

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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
10/01/2022 R2

Due to the annual ICD-10 code updates, Q85.8 has been deleted from ICD-10 Codes that support Medical Necessity Group 2 and the following codes have been added: Q85.81, Q85.82, Q85.83 and Q85.89.

10/01/2020 R1

Due to the annual ICD-10 updates, K59.8 has been deleted, and new codes K59.81 and K59.89 have been added.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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
09/21/2023 10/01/2023 - N/A Currently in Effect View
09/21/2022 10/01/2022 - 09/30/2023 Superseded You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • CT Colonography
  • Virtual Colonoscopy