Monday, June 21, 2010

Endoscopy CPT and covered diagnosis - CPT 43200,43235,43251

ICD-9-CM Codes That Support Medical Necessity

The CPT/HCPCS codes included in this LCD will be subjected to ?procedure to diagnosis? editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.

Medicare is establishing the following limited coverage for CPT/HCPCS codes 43200, 43201, 43202, 43204, 43205, 43215, 43216, 43217, 43219, 43220, 43226, 43227, 43228, 43231, 43232, 43234, 43235, 43236, 43237, 43238, 43239, 43240, 43241, 43242, 43243, 43244, 43245, 43246, 43247, 43248, 43249, 43250, 43251, 43255, 43256, 43258, 43259, 43260, 76975:
Covered for:
008.00? 008.04 E. coli
008.1? 008.3 Intestinal infection due to other organisms
008.41?008.44 Other specified bacteria
008.5 Bacterial enteritis unspecified
041.86 Helicobacter pylori (h. pylori) infection
112.84 Candidal esophagitis
146.0?146.9 Malignant neoplasm of oropharynx
150.0?150.5 Malignant neoplasm of esophagus
150.8?150.9 Malignant neoplasm of esophagus
151.0?151.6 Malignant neoplasm of stomach
151.8?151.9 Malignant neoplasm of stomach
152.0 ? 152.1 Malignant neoplasm of small intestine, including duodenum
152.8 Malignant neoplasm of other specified sites of small intestine
156.0?156.2 Malignant neoplasm of gallbladder and extrahepatic bile ducts
156.8?156.9 Malignant neoplasm of gallbladder and extrahepatic bile ducts
157.0?157.4 Malignant neoplasm of pancreas
157.8?157.9 Malignant neoplasm of pancreas
161.0?161.3 Malignant neoplasm of larynx
161.8?161.9 Malignant neoplasm of larynx
162.0 Malignant neoplasm of trachea
162.2?162.5 Malignant neoplasm of trachea, bronchus, and lung
162.8?162.9 Malignant neoplasm of trachea, bronchus, and lung
176.3 Kaposi?s sarcoma gastrointestinal sites
196.2 Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes
197.4 Secondary malignant neoplasm of small intestine including duodenum
197.8 Secondary malignant neoplasm of other digestive organs and spleen
198.89 Secondary malignant neoplasm of other specified sites
199.1?199.2 Other malignant neoplasm of unspecified site
200.03 Reticulosarcoma involving intra-abdominal lymph nodes
200.13 Lymphosarcoma involving intra-abdominal lymph nodes
211.0?211.2 Benign neoplasm of other parts of digestive system
211.5?211.7 Benign neoplasm of other parts of digestive system
214.3 Lipoma of intra-abdominal organs
230.0?230.2 Carcinoma in situ of digestive organs
230.7?230.9 Carcinoma in situ of digestive organs
235.2?235.5 Neoplasm of uncertain behavior of digestive and respiratory systems
235.7?235.8 Neoplasm of uncertain behavior of digestive and respiratory systems
239.0 Neoplasm of unspecified nature of digestive system
261 Nutritional marasmus
262 Other severe protein-calorie malnutrition
263.0 Malnutrition of moderate degree
263.8?263.9 Other and unspecified protein calorie malnutrition
280.0?280.1 Iron deficiency anemias
280.8?280.9 Iron deficiency anemias
285.1 Acute posthemorrhagic anemia
285.9 Anemia unspecified
300.11 Conversion disorder
306.4 Gastrointestinal malfunction arising from mental factors
307.1 Anorexia nervosa
438.82 Dysphagia cerebrovascular disease
447.2 Rupture of artery
448.0 Hereditary hemorrhagic telangiectasia
456.0?456.1 Esophageal varices
456.20?456.21 Esophageal varices in diseases classified elsewhere
456.8 Varices of other sites
507.0 Pneumonitis due to inhalation of food or vomitus
518.1 Interstitial emphysema
530.0 Achalasia and cardiospasm
530.10?530.13 Esophagitis
530.19 Other esophagitis
530.20?530.21 Ulcer of esophagus
530.3?530.7 Diseases of esophagus
530.81?530.87 Other specified disorders of esophagus
530.89 Other diseases of esophagus
530.9 Unspecified disorder of esophagus
531.00?531.01 Gastric ulcer (Acute with hemorrhage)
531.10?531.11 Gastric ulcer (Acute with perforation)
531.20?531.21 Gastric ulcer (Acute with hemorrhage and perforation)
531.30?531.31 Gastric ulcer (Acute without mention of hemorrhage or perforation)
531.40?531.41 Gastric ulcer (Chronic or unspecified with hemorrhage)
531.50?531.51 Gastric ulcer (Chronic or unspecified with perforation)
531.60?561.61 Gastric ulcer (Chronic or unspecified with hemorrhage and perforation)
531.70?531.71 Gastric ulcer (Chronic without mention of hemorrhage or perforation)
531.90?531.91 Gastric ulcer (Unspecified as acute or chronic without mention of hemorrhage or perforation)
532.00?532.01 Duodenal ulcer (Acute with hemorrhage)
532.10?532.11 Duodenal ulcer (Acute with perforation)
532.20?532.21 Duodenal ulcer (Acute with hemorrhage and perforation)
532.30?532.31 Duodenal ulcer (Acute without mention of hemorrhage or perforation)
532.40?532.41 Duodenal ulcer (Chronic or unspecified with hemorrhage)
532.50?532.51 Duodenal ulcer (Chronic or unspecified with perforation)
532.60?532.61 Duodenal ulcer (Chronic or unspecified with hemorrhage and perforation)
532.70?532.71 Duodenal ulcer (Chronic without mention of hemorrhage or perforation)
532.90?532.91 Duodenal ulcer (Unspecified as acute or chronic without mention of hemorrhage or perforation)
533.00?533.01 Peptic ulcer of unspecified site (Acute with hemorrhage)
533.10?533.11 Peptic ulcer of unspecified site (Acute with perforation)
533.20?533.21 Peptic ulcer of unspecified site (Acute with hemorrhage and perforation)
533.30?533.31 Peptic ulcer of unspecified site (Acute without hemorrhage and perforation)
533.40?533.41 Peptic ulcer of unspecified site (Chronic or unspecified with hemorrhage)
533.50?533.51 Peptic ulcer of unspecified site (Chronic or unspecified with perforation)
533.60?533.61 Peptic ulcer of unspecified site (Chronic or unspecified with hemorrhage and perforation)
533.70?533.71 Peptic ulcer of unspecified site (Chronic without mention of hemorrhage or perforation)
533.90?533.91 Peptic ulcer of unspecified site (Unspecified as acute or chronic without mention of hemorrhage or perforation)
534.00?534.01 Gastrojejunal ulcer (Acute with hemorrhage)
534.10?534.11 Gastrojejunal ulcer (Acute with perforation)
534.20?534.21 Gastrojejunal ulcer (Acute with hemorrhage and perforation)
534.30?534.31 Gastrojejunal ulcer (Acute without hemorrhage or perforation)
534.40?534.41 Gastrojejunal ulcer (Chronic or unspecified with hemorrhage)
534.50?534.51 Gastrojejunal ulcer (Chronic or unspecified with perforation)
534.60?534.61 Gastrojejunal ulcer (Chronic or unspecified with hemorrhage and perforation)
534.70?534.71 Gastrojejunal ulcer (Chronic without mention of hemorrhage or perforation)
534.90?534.91 Gastrojejunal ulcer (Unspecified as acute or chronic without mention of hemorrhage or perforation)
535.00?535.01 Gastritis and duodenitis (Acute gastritis)
535.10?535.11 Gastritis and duodenitis (Atrophic gastritis)
535.20?535.21 Gastritis and duodenitis (Gastric mucosal hypertrophy)
535.30?535.31 Gastritis and duodenitis (Alcoholic gastritis)
535.40?535.41 Gastritis and duodenitis (Other specified gastritis)
535.50?535.51 Gastritis and duodenitis (Unspecified gastritis and gastroduodenitis)
535.60?535.61 Gastritis and duodenitis (Duodenitis)
535.70?535.71 Eosinophilic gastritis, without mention of hemorrhage
536.0?536.3 Disorders of function of stomach
536.40?536.42 Disorders of function of stomach (Gastrostomy complications)
536.49 Other gastrostomy complications
536.8?536.9 Disorders of function of stomach
537.0?537.6 Other disorders of stomach and duodenum
537.81?537.84 Other specified disorders of stomach and duodenum
537.89 Other (Other specified disorders of stomach and duodenum)
537.9 Unspecified disorder of stomach and duodenum
538 Gastrointestinal mucositis (ulcerative)
552.3 Diaphragmatic hernia with obstruction
553.3 Diaphragmatic hernia without obstruction or gangrene
555.0?555.2 Regional enteritis
555.9 Unspecified site (Regional enteritis)
556.0?556.1 Ulcerative colitis
557.0?557.1 Vascular insufficiency of intestine
557.9 Unspecified vascular insufficiency of intestine
558.1?558.3 Other and unspecified noninfectious gastroenteritis and colitis
558.41?558.42 Eosinophilic gastroenteritis
558.9 Other and unspecified noninfectious gastroenteritis and colitis
562.00?562.03 Diverticulosis of small intestine
564.2?564.4 Functional digestive disorders, not elsewhere classified
569.84 Angiodysplasia of intestine (without hemorrhage)
571.2 Alcoholic cirrhosis of liver
571.5 Cirrhosis of liver without alcohol
572.3 Portal hypertension
574.00?574.01 Calculus of gallbladder with acute cholecystitis
574.10?574.11 Calculus of gallbladder with other cholecystitis
574.20?574.21 Calculus of gallbladder without cholecystitis
574.30?574.31 Calculus of bile duct with acute cholecystitis
574.40?574.41 Calculus of bile duct with other cholecystitis
574.50?574.51 Calculus of bile duct without cholecystitis
574.60?574.61 Calculus of gallbladder and bile duct with acute cholecystitis
574.70?574.71 Calculus of gallbladder and bile duct with other cholecystitis
574.80?574.81 Calculus of gallbladder and bile duct with acute and chronic cholecystitis
574.90?574.91 Calculus of gallbladder and bile duct without cholecystitis
575.0 Acute cholecystitis
575.10?575.12 Other cholecystitis
575.2?575.9 Other disorders of gallbladder
576.0?576.5 Other disorders of biliary tract
576.8?576.9 Other disorders of biliary tract
577.0?577.2 Diseases of pancreas
577.8?577.9 Diseases of pancreas
578.0?578.1 Gastrointestinal hemorrhage
578.9?579.0 Gastrointestinal hemorrhage
579.1?579.4 Intestinal malabsorption
579.8?579.9 Intestinal malabsorption
747.20 Congenital anomaly of aorta unspecified
747.61 Gastrointestinal vessel anomaly
750.3?750.4 Other congenital anomalies of upper alimentary tract
750.6?750.9 Other congenital anomalies of upper alimentary tract
751.1 Congenital atresia and stenosis of small intestine
782.4 Jaundice unspecified not of newborn
783.0 Anorexia
783.21?783.22 Abnormal loss of weight and under weight
783.3 Feeding difficulties and mismanagement
786.50 Unspecified chest pain
786.59 Other chest pain
787.01?787.03 Nausea with vomiting
787.1 Heartburn
787.20?787.24 Dysphagia
787.29 Other dysphagia
787.3?787.7 Symptoms involving digestive system
787.91 Diarrhea
787.99 Other symptoms involving digestive system
789.00?789.07 Abdominal pain
789.09 Abdominal pain other specified site
789.1 Hepatomegaly
789.2 Splenomegaly
789.30?789.37 Abdominal or pelvic swelling mass or lump
789.39 Abdominal or pelvic swelling mass or lump other specified site
789.40?789.47 Abdominal rigidity
789.49 Abdominal rigidity other specified site
789.51 Malignant ascites
789.59 Other ascites
789.60?789.67 Abdominal tenderness
789.69 Abdominal tenderness other specified site
789.9 Other symptoms involving abdomen and pelvis
790.5 Other nonspecific abnormal serum enzyme levels
792.1 Nonspecific abnormal findings in stool contents
793.3?793.6 Nonspecific abnormal findings on radiological and other examination of body structure
794.8?794.9 Nonspecific abnormal results of function studies
862.22 Injury to esophagus without open wound into cavity
862.32 Injury to esophagus with open wound into cavity
863.0?863.1 Injury to gastrointestinal tract
863.20?863.21 Small intestine, without mention of open wound into cavity
863.29 Small intestine, without mention of open wound into cavity (Other)
863.30?863.31 Small intestine with open wound into cavity
863.39 Small intestine with open wound into cavity (Other)
874.4 Open wound of pharynx without complication
933.1 Foreign body in larynx
934.0?934.1 Foreign body in trachea, bronchus, and lung
934.8?934.9 Foreign body in trachea, bronchus, and lung
935.1?935.2 Foreign body in mouth, esophagus, and stomach
936 Foreign body in intestine and colon
938 Foreign body in digestive system unspecified
947.0 Burn of mouth and pharynx
947.2?947.3 Burn of internal organs
983.0?983.2 Toxic effect of corrosive aromatics, acids and caustic alkalis
983.9 Toxic effect of caustic unspecified
996.1 Mechanical complication of other vascular device implant and graft
996.62 Infection and inflammatory reaction due to other vascular device implant and graft
996.74 Other complications due to other vascular device implant and graft
996.87 Complications of transplanted organ intestine
997.4 Digestive system complications not elsewhere classified
V10.00?V10.07 Personal history of malignant neoplasm
V10.09 Personal history of malignant neoplasm of other sites in gastrointestinal tract
V12.70?V12.71 Diseases of digestive system
V45.75 Acquired absence of organ stomach
V47.3 Other digestive problems
V58.61?V58.67 Long-term (current) drug use
V58.69 Long-term (current) use of other medications
V67.00 Follow-up examination following unspecified surgery
V67.09 Follow-up examination following other surgery
V67.1?V67.2 Follow-up examination
Note: Providers should continue to submit ICD-9-CM diagnosis codes without decimals on their claim forms and electronic claims.

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