Monday, July 19, 2010

Colonoscopy and Sigmoidoscopy- Diagnostic Comments




Request to add the following codes that had been in the previous contractors LCD:
ICD-9 Code Long Descriptor

008.04 Intestinal infection due to enterohemorrhagic e. Coli
008.43 Intestinal infection due to campylobacter
008.45 Intestinal infection due to clostridium difficile
195.3 Malignant neoplasm of pelvis
197.6 Secondary malignant neoplasm of retroperitoneum and peritoneum
421.0 Acute and subacute bacterial endocarditis
569.41 Ulcer of anus and rectum
569.49 Other specified disorders of rectum and anus
701.2 Acquired acanthosis nigricans

The following ICD-9 codes have been added to the LCD:

008.04 Intestinal infection due to enterohemorrhagic e. Coli
008.43 Intestinal infection due to campylobacter
008.45 Intestinal infection due to clostridium difficile
195.3 Malignant neoplasm of pelvis
197.6 Secondary malignant neoplasm of retroperitoneum and peritoneum
421.0 Acute and subacute endocarditis
701.2 Acquired acanthosis nigricans

These ICD-9 codes were not added as they were indications for a proctoscopy which is not
included in this LCD:
569.41 Ulcer of anus and rectum
569.49 Other specified disorders of rectum and anus

Comment: A provider disagrees with the V personal history ICD-9 codes being in our
diagnostic LCD. She stated that a diagnostic procedure must have a symptom present and a
history of polyps isn’t a present symptom. She also expressed concern since Personal history of
cancer /polyps is also in the screening benefit as payable and therefore makes it confusing to have
the codes allowed for both a diagnostic and screening colonoscopy. She asked that we clarify our
LCD.

Response:
The personal history ICD-9 codes are listed to allow for a repeat colonoscopy following the
removal of an adenoma or colon cancer. The patient may not have symptoms but it is appropriate
to perform a follow up colonoscopy as recommended by national guidelines. The personal
history of colonic polyps ICD-9 code would be used to indicate that a colonoscopy is being
performed to evaluate the patient after the removal of sessile polyps to determine and document
total excision. This is usually performed within 6 months of the removal of the sessile polyp.
The guidelines also recommend that patients undergoing curative resection for colon or rectal
cancer should undergo a colonoscopy 1 year after the resection.

Medicare allows a beneficiary to receive a Screening colonoscopy every 2 years if they are at
high risk. By including personal history codes in the diagnostic LCD it allows the physician to
follow national guidelines for the re-evaluation/follow up of the patient after treatment. The
follow up colonoscopy

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