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L.2.04.403
Colonoscopy is a visual examination of the lining of the colon (large intestine, large bowel) with a fiberoptic endoscope. It is inserted through the anus and rectum and advanced through the large intestine under direct vision, using the scope's optical system. Instruments and tools can be passed through the scope, for taking samples (biopsies). This procedure may be performed in the outpatient setting.
Flexible sigmoidoscopy is a visual examination of the rectum and lower colon called the sigmoid colon. A sigmoidoscope, long flexible tube with fiber optics, is passed through the anus and rectum into the sigmoid colon. Instruments and tools can be passed through the scope, for taking samples (biopsies). This procedure may be performed in the outpatient setting.
Virtual colonoscopy, also known as computed tomography (CT) colonography, is an imaging technique of the colon involving thin-section helical CT to generate high-resolution 2-dimensional axial images of the colon. Three-dimensional images, which resemble the endoluminal images obtained with conventional endoscopic colonoscopy, are then reconstructed off line. Virtual colonoscopy has been investigated as an alternative to conventional endoscopic colonoscopy, specifically as an alternative screening technique for colon cancer. While virtual colonoscopy requires a full bowel preparation, similar to conventional colonoscopy, no sedation is required, and the examination is less time consuming. However, gas insufflation of the intestine, which may be uncomfortable to the patient, and interpretation of the images is described as difficult and time consuming
For Coding Guidelines see the Monitored Anesthesia Care during Gastrointestinal Endoscopy Policy.
Screening (asymptomatic individuals) colonoscopy and sigmoidoscopy will be allowed under the following guidelines:
Effective 01/01/2022, screening (asymptomatic individuals) colonoscopy and sigmoidoscopy will be allowed under the following guidelines:
Beginning at age 45, both men and women should follow ONE of the screening options below:
Flexible sigmoidoscopy every 5 years, OR
Colonoscopy every 10 years
A digital rectal examination (DRE) should be performed at the time of EACH screening sigmoidoscopy or colonoscopy.
High Risk
People should begin colorectal cancer screening earlier and/or undergo screening more often if they have any of the following colorectal cancer risk factors. Frequency should be determined by the ordering physician:
Familial syndromes that have a high incidence of developing neoplasia (such as familial adenomatous polyposis and hereditary non-polyposis colon cancer), as well as any patient age >35 with 2 first degree relatives (parents, siblings, and children) with colon cancer at any age OR 1 first degree relative with colon cancer at age <60. Note: A first degree relative is defined as a parent, sibling, or child.
A personal history of colorectal cancer or adenomatous polyps, or
A personal history of chronic inflammatory bowel disease or irritable bowel syndrome.
Inflammatory Bowel Disease
Most patients do not require colonoscopy for initial diagnosis, unless clinical sigmoidoscopy and radiological studies fail to secure diagnosis. Multiple biopsies are helpful when it is clinically necessary to distinguish between ulcerative colitis and Crohn's. Screening colonoscopy for follow-up of inflammatory bowel disease is usually not covered except for cancer surveillance in chronic ulcerative colitis.
Abnormal Exam (Symptomatic individuals)
Colonoscopy is considered medically necessary under the following circumstances:
Unexplained bleeding
Hematochezia (bright red bloody stool) NOT thought to be from a rectal or perianal source. Please note the following:
Scant hematochezia: Chronic intermittent visible bright red blood most often represents an anal lesion. Spots or drops post defecation suggest an anal lesion, while streaks of blood on formed stools suggests rectal or digital colonic origin. Diagnostic evaluation should have included inspection of the anus, digital exam, anoscopy, and sigmoidoscopy.
Colonoscopy is not medically necessary for bright red rectal bleeding in patients with anorectal source on sigmoidoscopy, and no other symptoms suggestive of a source higher in the colon.)
Melena of unknown origin
Presence of fecal occult blood (heme, guaiac+) in age >40
Diarrhea
That is clinically significant and of unexplained origin.
Other
Evaluation of an abnormality on barium enema that is likely to be clinically significant, such as a stricture or a filling defect
Evaluation of acute colonic ischemia or ischemic bowel disease
Intraoperative identification of the site of a lesion that cannot be detected by palpation or gross inspection at surgery (such as polypectomy site or location of a bleeding source)
Treatment of colonic volvulus or pseudo-obstruction
Evaluation of patient with strep bovis endocarditis
Unexplained iron deficiency anemia
Removal of a foreign body
Colonoscopy is NOT medically necessary for the following circumstances: Unexplained bleeding
Upper GI bleeding or melena with a known upper GI source. For intermittent melena, since an upper tract source is most likely, patients should begin with upper endoscopy.
Bright red rectal bleeding in patients with anorectal source on sigmoidoscopy, and no other symptoms suggestive of a source higher in the colon. Please note the following:
Scant hematochezia: Chronic intermittent visible bright red blood most often represents an anal lesion. Spots or drops post defecation suggest an anal lesion, while streaks of blood on formed stools suggests rectal or digital colonic origin. Diagnostic evaluation should have included inspection of the anus, digital exam, anoscopy, and sigmoidoscopy.
Neoplasia/Cancer
Metastatic adenocarcinoma of unknown primary, in the absence of colonic symptoms, when colonoscopy results will not influence management.
Diarrhea that is acute, limited.
Other routine examination of the colon in patients about to undergo elective abdominal surgery for colonic disease.
Contraindications to colonoscopy:
Severe active colitis or toxic megacolon
Peritonitis
Possible perforated viscus
Acute severe diverticulitis
Flexible sigmoidoscopy in the ambulatory or office-setting is considered medically necessary under the following circumstances:
Follow-up for recurrent neoplasia
Surveillance for neoplasia in patient with subtotal colectomy for cancer or ileoproctostomy for familial polyposis
Evaluation of lower GI symptoms in conjunction with barium enema x-rays
Evaluation of a rectosigmoid stricture demonstrated on barium x-ray
Acute colitis
Anorectal symptoms: bleeding, pain, itching
Familial syndromes with high incidence of developing neoplasia
Computed tomography (CT) colonography, commonly referred to as virtual colonoscopy, may be considered medically necessary in patients for whom a conventional colonoscopy is indicated but who are unable to undergo conventional colonoscopy for medical reasons or in patients with an incomplete conventional colonoscopy because of colonic stenosis or obstruction.
Except as noted in the policy statement above, CT colonography is considered not medically necessary for the purposes of colon cancer screening because the clinical outcomes with this screening strategy have not been shown to be superior to other approaches including optical colonoscopy.
None
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
Medically Necessary is defined as those services, treatments, procedures, equipment, drugs, devices, items or supplies furnished by a covered Provider that are required to identify or treat a Member's illness, injury or Mental Health Disorders, and which Company determines are covered under this Benefit Plan based on the criteria as follows in A through D:
A. consistent with the symptoms or diagnosis and treatment of the Member's condition, illness, or injury; and
B. appropriate with regard to standards of good medical practice; and
C. not solely for the convenience of the Member, his or her Provider; and
D. the most appropriate supply or level of care which can safely be provided to Member. When applied to the care of an Inpatient, it further means that services for the Member's medical symptoms or conditions require that the services cannot be safely provided to the Member as an Outpatient.
For the definition of medical necessity, “standards of good medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary.
Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.
Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner.
Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk.
2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection.
5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted.
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section.
2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06.
04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. Code Reference Section updated revised to identify deleted codes S0605, 0066T and 0067T. Added new CPT Code 74261 and 74262 to the Covered Codes Table and CPT Code 74263 to Non-Covered Codes Table.
07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted.
05/08/2013: Policy reviewed; no changes.
12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025.
08/25/2015: Code Reference section updated for ICD-10.
12/31/2015: Policy guidelines updated to add medically necessary and investigative definitions. Code Reference section updated to remove deleted CPT codes 44393, 45339, 45355, and 45383.
04/01/2016: Policy statement for screening asymptomatic individuals revised to remove "fecal occult blood test (FOBT)" to align with the Healthy You! Wellness benefit change effective 01/01/2016. Code Reference section updated to remove the following CPT codes: 82270, 82271, 82272, and 82274.
06/07/2016: Policy number L.2.04.403 added.
09/30/2016: Code Reference section updated to add the following new ICD-10 diagnoses: K52.3, K52.831 - K52.839, K55.031 - K55.039, K55.041 - K55.049, K55.30 - K55.33, and K58.1 - K58.8.
09/29/2017: Code Reference section updated to add new ICD-10 procedure codes 0DDE4ZX, 0DDE8ZX, 0DDF4ZX, 0DDF8ZX, 0DDG4ZX, 0DDG8ZX, 0DDH4ZX, 0DDH8ZX, 0DDK4ZX, 0DDK8ZX, 0DDL4ZX, 0DDL8ZX, 0DDM4ZX, 0DDM8ZX, 0DDN4ZX, 0DDN8ZX, 0DDP4ZX, 0DDP8ZX and new ICD-10 diagnosis codes K56.600 - K56.699, effective 10/01/2017. Removed deleted HCPCS code G6019, G6020, G6022, G6023, G6024, and G6025 and ICD-10 diagnosis code K55.0.
09/28/2020: Code Reference section updated to add new ICD-10 diagnosis codes K59.81 and K59.89, effective 10/01/2020. Removed deleted ICD-10 diagnosis codes K56.69 and K56.60 and ICD-9 diagnosis code 560.9.
12/09/2021: Policy updated to state that effective 01/01/2022, screening colonoscopy and sigmoidoscopy will be covered beginning at age 45.
10/10/2022: Policy reviewed. Policy statements unchanged. Policy Guidelines updated to change "Nervous/Mental Conditions" to "Mental Health Disorders" and "Medically Necessary" to "medical necessity."
09/29/2023: Code Reference section updated to add new ICD-10 diagnosis codes D13.91, Z83.710, Z83.711, Z83.718, and Z83.719, effective 10/01/2023.
10/17/2023: Policy reviewed; no changes.
10/01/2024: Policy updated to remove language regarding screening beginning at age 50. Code Reference section updated to add new ICD-10 diagnosis codes Z83.72, Z86.0100, Z86.0101, Z86.0102, and Z86.0109.
10/01/2025: Code Reference section updated to add new ICD-10 diagnosis code Z15.060. Revised code description for ICD-10 diagnosis code Z83.718. Removed deleted ICD-10 diagnosis code Z86.010.
American Cancer Society, Colon and Rectum Cancer Resource Center recommendations for early colorectal cancer detection
American Society of Gastroendoscopy (ASGE) consensus statement, "The Appropriate Use of Gastrointestinal Endoscopy"
Blue Cross Blue Shield association policy #6.01.32
Guidelines for Clinical Applications by the ASGE; Publication Nos. 1009 and 1013 1986.
Hayes Medical Technology Directory
TEC Assessment Program, Volume 19, No. 6, July 2004
United States Preventive Services Task Force (USPSTF) 1996 recommendation
This is not intended to be a comprehensive list of codes. Note that some codes may be variable and coverage will be based on the clinical indication for the service.
For Coding Guidelines see the Anesthesia Coding Policy.
The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.
Covered Codes
Code Number | Description | ||
CPT-4 | |||
44388, 44389 | Colonoscopy through stoma code range | ||
44390 | Colonoscopy through stoma; with removal of foreign body(s) | ||
44392, 44394 | Colonoscopy through stoma with removal/ablation of polyp(s) or other lesions(s) code range | ||
44401 | Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed) | ||
44402 | Colonoscopy through stoma; with endoscopic stent placement (including pre- and post-dilation and guide wire passage, when performed) | ||
44403 | Colonoscopy through stoma; with endoscopic mucosal resection | ||
44404 | Colonoscopy through stoma; with directed submucosal injection(s), any substance | ||
44405 | Colonoscopy through stoma; with transendoscopic balloon dilation | ||
44406 | Colonoscopy through stoma; with endoscopic ultrasound examination, limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures | ||
44407 | Colonoscopy through stoma; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures | ||
44408 | Colonoscopy through stoma; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed | ||
45307 | Proctosigmoidoscopy, rigid; with removal of foreign body | ||
45330, 45331 | Sigmoidoscopy, flexible code range | ||
45332 | Sigmoidoscopy, flexible; with removal of foreign body(s) | ||
45333, 45338 | Sigmoidoscopy, flexible with removal/ablation of polyp(s) or other lesions(s) code range | ||
45346 | Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) | ||
45347 | Sigmoidoscopy, flexible; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed) | ||
45349 | Sigmoidoscopy, flexible; with endoscopic mucosal resection | ||
45350 | Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids) | ||
45378, 45379, 45380 | Colonoscopy, flexible, proximal to splenic flexure code range | ||
45384, 45385 | Colonoscopy, flexible with removal/ablation of polyp(s) or other lesions(s) code range | ||
45388 | Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) | ||
45389 | Colonoscopy, flexible; with endoscopic stent placement (includes pre- and post-dilation and guide wire passage, when performed) | ||
45390 | Colonoscopy, flexible; with endoscopic mucosal resection | ||
45393 | Colonoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed | ||
45398 | Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids) | ||
45399 | Unlisted procedure, colon | ||
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 | ||
HCPCS | |||
G0104 | Colorectal cancer screening; flexible sigmoidoscopy | ||
G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | ||
G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk *Covered only if the age and sex parameters under the "Policy" section are met. Otherwise, this is not covered. | ||
G0328 | Colorectal cancer screening; fecal-occult blood test, immunoassay, 1-3 simultaneous determinations. | ||
G0394 | Blood occult test (e.g., guaiac), feces, for single determination for colorectal neoplasm (i.e., patient was provided three cards or single triple card for consecutive collection) | ||
ICD-9 Procedure | ICD-10 Procedure | ||
45.21 | Transabdominal endoscopy of large intestine | 0DJD4ZZ | Inspection of lower intestinal tract, percutaneous endoscopic approach |
48.21 | Transabdominal proctosigmoidoscopy | ||
45.22 | Endoscopy of large intestine through artificial stoma | 0DJD8ZZ | Inspection of lower intestinal tract, via natural or artificial opening endoscopic |
45.23 | Colonoscopy | ||
45.24 | Flexible sigmoidoscopy | ||
48.22 | Proctosigmoidoscopy through artificial stoma | ||
48.23 | Rigid proctosigmoidoscopy | ||
45.25 | Closed [endoscopic] biopsy of large intestine | 0DBE4ZX | Excision of large intestine, percutaneous endoscopic approach, diagnostic |
0DDE4ZX | Extraction of large intestine, percutaneous endoscopic approach, diagnostic | ||
0DBE8ZX | Excision of large intestine, via natural or artificial opening endoscopic, diagnostic | ||
0DDE8ZX | Extraction of large intestine, via natural or artificial opening endoscopic, diagnostic | ||
0DBF4ZX | Excision of right large intestine, percutaneous endoscopic approach, diagnostic | ||
0DDF4ZX | Extraction of right large intestine, percutaneous endoscopic approach, diagnostic | ||
0DBF8ZX | Excision of right large intestine, via natural or artificial opening endoscopic, diagnostic | ||
0DDF8ZX | Extraction of right large intestine, via natural or artificial opening endoscopic, diagnostic | ||
0DBG4ZX | Excision of left large intestine, percutaneous endoscopic approach, diagnostic | ||
0DDG4ZX | Extraction of left large intestine, percutaneous endoscopic approach, diagnostic | ||
0DBG8ZX | Excision of left large intestine, via natural or artificial opening endoscopic, diagnostic | ||
0DDG8ZX | Extraction of left large intestine, via natural or artificial opening endoscopic, diagnostic | ||
0DBH4ZX | Excision of cecum, percutaneous endoscopic approach, diagnostic | ||
0DDH4ZX | Extraction of cecum, percutaneous endoscopic approach, diagnostic | ||
0DBH8ZX | Excision of cecum, via natural or artificial opening endoscopic, diagnostic | ||
0DDH8ZX | Extraction of cecum, via natural or artificial opening endoscopic, diagnostic | ||
0DBK4ZX | Excision of ascending colon, percutaneous endoscopic approach, diagnostic | ||
0DDK4ZX | Extraction of ascending colon, percutaneous endoscopic approach, diagnostic | ||
0DBK8ZX | Excision of ascending colon, via natural or artificial opening endoscopic, diagnostic | ||
0DDK8ZX | Extraction of ascending colon, via natural or artificial opening endoscopic, diagnostic | ||
0DBL4ZX | Excision of transverse colon, percutaneous endoscopic approach, diagnostic | ||
0DDL4ZX | Extraction of transverse colon, percutaneous endoscopic approach, diagnostic | ||
0DBL8ZX | Excision of transverse colon, via natural or artificial opening endoscopic, diagnostic | ||
0DDL8ZX | Extraction of transverse colon, via natural or artificial opening endoscopic, diagnostic | ||
0DBM4ZX | Excision of descending colon, percutaneous endoscopic approach, diagnostic | ||
0DDM4ZX | Extraction of descending colon, percutaneous endoscopic approach, diagnostic | ||
0DBM8ZX | Excision of descending colon, via natural or artificial opening endoscopic, diagnostic | ||
0DDM8ZX | Extraction of descending colon, via natural or artificial opening endoscopic, diagnostic | ||
0DBN4ZX | Excision of sigmoid colon, percutaneous endoscopic approach, diagnostic | ||
0DDN4ZX | Extraction of sigmoid colon, percutaneous endoscopic approach, diagnostic | ||
0DBN8ZX | Excision of sigmoid colon, via natural or artificial opening endoscopic, diagnostic | ||
0DDN8ZX | Extraction of sigmoid colon, via natural or artificial opening endoscopic, diagnostic | ||
45.42 | Endoscopic polypectomy of large intestine | 0DBE4ZZ | Excision of large intestine, percutaneous endoscopic approach |
0DBE8ZZ | Excision of large intestine, via natural or artificial opening endoscopic | ||
0DBF8ZZ | Excision of right large intestine, via natural or artificial opening endoscopic | ||
0DBG8ZZ | Excision of left large intestine, via natural or artificial opening endoscopic | ||
0DBH8ZZ | Excision of cecum, via natural or artificial opening endoscopic | ||
0DBK8ZZ | Excision of ascending colon, via natural or artificial opening endoscopic | ||
0DBL8ZZ | Excision of transverse colon, via natural or artificial opening endoscopic | ||
0DBM8ZZ | Excision of descending colon, via natural or artificial opening endoscopic | ||
0DBN8ZZ | Excision of sigmoid colon, via natural or artificial opening endoscopic | ||
45.43 | Endoscopic destruction of other lesion or tissue of large intestine | 0D5E4ZZ | Destruction of large intestine, percutaneous endoscopic approach |
0D5E8ZZ | Destruction of large intestine, via natural or artificial opening endoscopic | ||
0D5F4ZZ | Destruction of right large intestine, percutaneous endoscopic approach | ||
0D5F8ZZ | Destruction of right large intestine, via natural or artificial opening endoscopic | ||
0D5G4ZZ | Destruction of left large intestine, percutaneous endoscopic approach | ||
0D5G8ZZ | Destruction of left large intestine, via natural or artificial opening endoscopic | ||
0D5H4ZZ | Destruction of cecum, percutaneous endoscopic approach | ||
0D5H8ZZ | Destruction of cecum, via natural or artificial opening endoscopic | ||
0D5K4ZZ | Destruction of ascending colon, percutaneous endoscopic approach | ||
0D5K8ZZ | Destruction of ascending colon, via natural or artificial opening endoscopic | ||
0D5L4ZZ | Destruction of transverse colon, percutaneous endoscopic approach | ||
0D5L8ZZ | Destruction of transverse colon, via natural or artificial opening endoscopic | ||
0D5M4ZZ | Destruction of descending colon, percutaneous endoscopic approach | ||
0D5M8ZZ | Destruction of descending colon, via natural or artificial opening endoscopic | ||
0D5N4ZZ | Destruction of sigmoid colon, percutaneous endoscopic approach | ||
0D5N8ZZ | Destruction of sigmoid colon, via natural or artificial opening endoscopic | ||
48.24 | Closed (endoscopic) biopsy of rectum | 0DBP4ZX | Excision of rectum, percutaneous endoscopic approach, diagnostic |
0DDP4ZX | Extraction of rectum, percutaneous endoscopic approach, diagnostic | ||
0DBP8ZX | Excision of rectum, via natural or artificial opening endoscopic, diagnostic | ||
0DDP8ZX | Extraction of rectum, via natural or artificial opening endoscopic, diagnostic | ||
98.03 | Removal of intraluminal foreign body from stomach and small intestine without incision | 0DC47ZZ | Extirpation of matter from esophagogastric junction, via natural or artificial opening |
0DC48ZZ | Extirpation of matter from esophagogastric junction, via natural or artificial opening endoscopic | ||
0DC67ZZ | Extirpation of matter from stomach, via natural or artificial opening | ||
0DC68ZZ | Extirpation of matter from stomach, via natural or artificial opening endoscopic | ||
0DC77ZZ | Extirpation of matter from stomach, pylorus, via natural or artificial opening | ||
0DC78ZZ | Extirpation of matter from stomach, pylorus, via natural or artificial opening endoscopic | ||
0DC87ZZ | Extirpation of matter from small intestine, via natural or artificial opening | ||
0DC88ZZ | Extirpation of matter from small intestine, via natural or artificial opening endoscopic | ||
0DC97ZZ | Extirpation of matter from duodenum, via natural or artificial opening | ||
0DC98ZZ | Extirpation of matter from duodenum, via natural or artificial opening endoscopic | ||
0DCA7ZZ | Extirpation of matter from jejunum, via natural or artificial opening | ||
0DCA8ZZ | Extirpation of matter from jejunum, via natural or artificial opening endoscopic | ||
0DCB7ZZ | Extirpation of matter from ileum, via natural or artificial opening | ||
0DCB8ZZ | Extirpation of matter from ileum, via natural or artificial opening endoscopic | ||
98.04 | Removal of intraluminal foreign body from large intestine without incision | 0DCC7ZZ | Extirpation of matter from ileocecal valve, via natural or artificial opening |
0DCC8ZZ | Extirpation of matter from ileocecal valve, via natural or artificial opening endoscopic | ||
0DCE7ZZ | Extirpation of matter from large intestine, via natural or artificial opening | ||
0DCE8ZZ | Extirpation of matter from large intestine, via natural or artificial opening endoscopic | ||
0DCF7ZZ | Extirpation of matter from right large intestine, via natural or artificial opening | ||
0DCF8ZZ | Extirpation of matter from right large intestine, via natural or artificial opening endoscopic | ||
0DCG7ZZ | Extirpation of matter from left large intestine, via natural or artificial opening | ||
0DCG8ZZ | Extirpation of matter from left large intestine, via natural or artificial opening endoscopic | ||
0DCH7ZZ | Extirpation of matter from cecum, via natural or artificial opening | ||
0DCH8ZZ | Extirpation of matter from cecum, via natural or artificial opening endoscopic | ||
0DCK7ZZ | Extirpation of matter from ascending colon, via natural or artificial opening | ||
0DCK8ZZ | Extirpation of matter from ascending colon, via natural or artificial opening endoscopic | ||
0DCL7ZZ | Extirpation of matter from transverse colon, via natural or artificial opening | ||
0DCL8ZZ | Extirpation of matter from transverse colon, via natural or artificial opening endoscopic | ||
0DCM7ZZ | Extirpation of matter from descending colon, via natural or artificial opening | ||
0DCM8ZZ | Extirpation of matter from descending colon, via natural or artificial opening endoscopic | ||
0DCN7ZZ | Extirpation of matter from sigmoid colon, via natural or artificial opening | ||
0DCN8ZZ | Extirpation of matter from sigmoid colon, via natural or artificial opening endoscopic | ||
ICD-9 Diagnosis | ICD-10 Diagnosis | ||
153.0, 153.1, 153.2, 153.4, 153.5, 153.6, 153.7, 153.8, 153.9 | Malignant neoplasm of the colon code range | C18.0 - C18.9 | Malignant neoplasm of colon (code range) |
154.0 | Malignant neoplasm of rectosigmoid junction | C19 | Malignant neoplasm of rectosigmoid junction |
154.1 | Malignant neoplasm of rectosigmoid junction | C20 | Malignant neoplasm of rectum |
154.8 | Malignant neoplasm of rectum, rectosigmoid junction, and anus; rectosigmoid junction; other | C21.2 | Malignant neoplasm of cloacogenic zone |
C21.8 | Malignant neoplasm of overlapping sites of rectum, anus and anal canal | ||
197.5 | Secondary malignant neoplasm of respiratory and digestive systems; large intestine and rectum | C78.5 | Secondary malignant neoplasm of large intestine and rectum |
209.10, 209.11, 209.12, 209.13, 209.14, 209.15, 209.16, 209.17 | Malignant carcinoid tumors of the appendix, large intestine, and rectum | C7A.020 - C7A.029 | Malignant carcinoid tumors of the appendix, large intestine, and rectum (code range) |
209.50, 209.51, 209.52. 209.53, 209.54, 209.55, 209.56, 209.57 | Benign carcinoid tumors of the appendix, large intestine, and rectum | D3A.020 - D3A.029 | Benign carcinoid tumors of the appendix, large intestine, and rectum (code range) |
211.3 | Benign neoplasm of other parts of the digestive system; colon | D12.0 - D12.6 | Benign neoplasms of colon (code range) |
211.4 | Benign neoplasm of other parts of the digestive system; rectum and anal canal | D12.7 - D12.9 | Benign neoplasm of rectum, anus, and anal canal (code range) |
D13.91 | Familial adenomatous polyposis | ||
230.3 | Carcinoma in-situ of the colon | D01.0 | Carcinoma in-situ of the colon |
230.4 | Carcinoma in situ of digestive organs; rectum | D01.1 - D01.2 | Carcinoma in-situ of rectosigmoid junction and rectum (code range) |
235.2 | Neoplasm of uncertain behavior of stomach, intestines, and rectum | D37.1 | Neoplasm of uncertain behavior of stomach |
D37.2 | Neoplasm of uncertain behavior of small intestines | ||
D37.3 | Neoplasm of uncertain behavior of appendix | ||
D37.4 | Neoplasm of uncertain behavior of colon | ||
D37.5 | Neoplasm of uncertain behavior of rectum | ||
239.0 | Neoplasm of unspecified nature of digestive system | D49.0 | Neoplasm of unspecified behavior of digestive system |
280.9 | Iron deficiency anemia, unspecified | D50.9 | Iron deficiency anemia, unspecified |
421.0 | Acute and subacute bacterial endocarditis | I33.0 | Acute and subacute infective endocarditis |
538 | Gastrointestinal mucositis (ulcerative) | K92.81 | Gastrointestinal mucositis (ulcerative) |
556.5 | Left sided ulcerative (chronic) colitis | K51.50 - K51.519 | Left sided colitis (code range) |
556.6 | Universal ulcerative (chronic) colitis | K51.00 - K51.019 | Ulcerative colitis (code range) |
556.9 | Unspecified ulcerative colitis | K51.90 - K51.919 | Ulcerative colitis, unspecified (code range) |
K52.3 | Indeterminate colitis | ||
K52.831 - K52.839 | Microscopic colitis | ||
K55.031 - K55.039 | Acute (reversible) ischemia of large intestine | ||
K55.041 - K55.049 | Acute infarction of large intestine | ||
K55.30 - K55.33 | Necrotizing enterocolitis | ||
557.0, 557.1, 557.9 | Acute vascular insufficiency of the intestine | K55.1, K55.8, K55.9 | Vascular disorders of intestine |
558.41, 558.42 | Eosinophilic gastroenteritis and colitis | K52.81 | Eosinophilic gastroenteritis |
K52.82 | Eosinophilic colitis | ||
558.9 | Other and unspecified noninfectious gastroenteritis and colitis | K52.89 | Other and unspecified noninfectious gastroenteritis and colitis |
K52.9 | |||
560.2 | Volvulus | K56.2 | Volvulus |
560.89 | Other specified intestinal obstruction (acute pseudo-obstruction of intestine) | K51.012, K51.212, K51.312, K51.412, K51.512, K51.812, K51.912, K56.600, K56.601, K56.609, K56.690, K56.691, K56.699 | Ulcerative colitis |
564.1 | Irritable bowel syndrome | K58.0 - K58.9 | Irritable bowel syndrome |
564.89 | Other functional disorders of the intestine (pseudo obstruction and inflammatory bowel disease) | K59.8, K59.81, K59.89 | Other specified functional intestinal disorders (pseudo obstruction and inflammatory bowel disease) |
569.2 | Stenosis of rectum and anus | K62.4 | Stenosis of anus and rectum |
569.3 | Hemorrhage of rectum and anus | K62.5 | Hemorrhage of anus and rectum |
569.42 | Anal or rectal pain | K62.89 | Other specified diseases of anus and rectum |
569.71 | Pouchitis | K91.850 | Pouchitis |
578.1 | Gastrointestinal hemorrhage; blood in stool (hematochezia) | K92.1 | Melena |
578.9 | Unspecified, hemorrhage of gastrointestinal tract | K92.2 | Gastrointestinal hemorrhage, unspecified |
698.0 | Pruritus ani | L29.0 | Pruritus ani |
787.91 | Diarrhea | R19.7 | Diarrhea, unspecified |
792.1 | Nonspecific abnormal findings in other body substances; stool content | R19.5 | Other fecal abnormalities |
936 | Foreign body in intestine and colon | T18.3XXA, T18.3XXD, T18.3XXS | Foreign body in intestine |
T18.4XXA, T18.4XXD, T18.4XXS | Foreign body in colon | ||
937 | Foreign body in anus and rectum | T18.5XXA, T18.5XXD, T18.5XXS | Foreign body in anus and rectum |
Z83.710 | Family history of adenomatous and serrated polyps | ||
Z83.711 | Family history of hyperplastic colon polyps | ||
Z83.718 | Family history of other colon polyps (Revised 10/01/2025) | ||
Z83.719 | Family history of colon polyps, unspecified | ||
Z83.72 | Family history of familial adenomatous polyposis | ||
V10.00 | Personal history of malignant neoplasm of unspecified site in gastrointestinal tract | Z85.00 | Personal history of malignant neoplasm of unspecified digestive organ |
V10.05 | Personal history of malignant neoplasm of large intestine | Z85.038 | Personal history of other malignant neoplasm of large intestine |
V10.06 | Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus | Z85.048 | Personal history of other malignant neoplasm of rectum, rectosigmoid junction, and anus |
V12.72 | Personal history of colonic polyps | Z86.0100, Z86.0101, Z86.0102, Z86.0109 | Personal history of colon polyps |
V12.79 | Personal history of other diseases of digestive disease, other (inflammatory bowel disease or irritable bowel syndrome) | Z87.19 | Personal history of other diseases of the digestive system |
V16.0 | Family history of malignant neoplasm gastrointestinal tract | Z80.0 | Family history of malignant neoplasm of digestive organs |
V76.41 | Special screening for malignant neoplasm, rectum *Covered only if the age and sex parameters under the "Policy" section are met. Otherwise, this is not covered. | Z12.12 | Encounter for screening for malignant neoplasm of rectum |
V76.51 | Special screening for malignant neoplasms, colon *Covered only if the age and sex parameters under the "Policy" section are met. Otherwise, this is not covered. | Z12.11 | Encounter for screening for malignant neoplasm of colon |
Z15.060 | Genetic susceptibility to colorectal cancer (New 10/01/2025) |
Code Number | Description |
CPT-4 | |
74263 | Computed tomographic (CT) colonography, screening, including image postprocessing |
HCPCS | |
ICD-10 Procedure | |
ICD-10 Diagnosis | |
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