Colonoscopy CPT code list and covered ICD 10 code (Colorectal cancer screening)

Definition of Terms Colonoscopy:
 
A colonoscopy is a procedure that permits the direct examination of the mucosa  of the entire colon by using a flexible lighted tube. The procedure is done with sedation in a  hospital outpatient department, in a clinic , or  an  office facility. During the colonoscopy  a doctor  can  biopsy and remove pre - cancerous polyps and some early stage cancers and  also  diagnose  other  conditions or diseases.  General definitions of procedure indications from various specialty societies , including the ACA:

* A screening colonoscopy is done to look for disease, such as cancer,  and treat early  conditions, if indicated, in people without symptoms.

*A diagnostic colonoscopy is done to confirm or rule out a condition in a person who is symptomatic or who is believed to have a specific condition based on other clinical information.

*A surveillance colonoscopy is the follow-up to check for the return of a disease in a person who was previously treated for the disease and is now believed to be free of the disease.

Code Description

G0104 Colorectal cancer screening; flexible sigmoidoscopy
G0105 Colorectal cancer screening; colonoscopy on individual at high risk
G0106 Colorectal cancer screening; alternative to G0104, screening sigmoidoscopy, barium enema
G0120 Colorectal cancer screening; alternative to G0105, screening colonoscopy, barium enema
G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high
G0122 Colorectal cancer screening; barium enema
45330 Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)
45331 Sigmoidoscopy, flexible; with biopsy, single or multiple
45332 Sigmoidoscopy, flexible; with removal of foreign body
45333 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery
45334 Sigmoidoscopy, flexible; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery,
laser, heater probe, stapler, plasma coagulator)
45335 Sigmoidoscopy, flexible; with direct submucosal injection(s), any substance
45337 Sigmoidoscopy, flexible; with decompression of volvulus, any method
45338 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique
45340 Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
45341 Sigmoidoscopy, flexible; with dilation by balloon, 1 or more strictures
45342 Sigmoidoscopy, flexible; with endoscopic ultrasound examination
45346 Sigmoidoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s)
45347 Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation)
45349 Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)
45350 Colonoscopy, flexible, proximal to splenic flexure; with removal of foreign body
45378 Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple
45379 Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection(s), any substance
45380 Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)
45381 Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
45382 Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery
45384 Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique
45385 Colonoscopy, flexible, proximal to splenic flexure; with dilation by balloon, 1 or more strictures
45386 Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation)
45388 Colonoscopy, flexible, proximal to splenic flexure; with endoscopic ultrasound examination
45389 Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s)

Diagnosis Codes: ICD-10 [Effective 10/1/15]

Code Description
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
D12.6 Benign neoplasm of colon, unspecified
D12.7 Benign neoplasm of rectosigmoid junction
D12.8 Benign neoplasm of rectum
D12.9 Benign neoplasm of anus and anal canal
D13.2 Benign neoplasm of duodenum
D13.30 Benign neoplasm of unspecified part of small intestine
D13.39 Benign neoplasm of other parts of small intestine
D13.9 Benign neoplasm of ill-defined sites within the digestive system
D20.0 Benign neoplasm of soft tissue of retroperitoneum
D20.1 Benign neoplasm of soft tissue of peritoneum
D37.2 Neoplasm of uncertain behavior of small intestine
D37.4 Neoplasm of uncertain behavior of colon
D37.5 Neoplasm of uncertain behavior of rectum
D37.6 Neoplasm of uncertain behavior of liver, GB & bile duct
D37.8 Neoplasm of uncertain behavior of oth digestive organs
D37.9 Neoplasm of uncertain behavior of digestive organ, unsp
D48.3 Neoplasm of uncertain behavior of retroperitoneum
D48.4 Neoplasm of uncertain behavior of peritoneum
K50.00 Crohn's disease of small intestine without complications
K50.10 Crohn's disease of large intestine without complications
K50.80 Crohn's disease of both small and lg int w/o complications
K50.90 Crohn's disease, unspecified, without complications
K51.30 Ulcerative (chronic) rectosigmoiditis without complications
K51.40 Inflammatory polyps of colon without complications
K51.80 Other ulcerative colitis without complications
K51.90 Ulcerative colitis, unspecified, without complications
K52.0 Gastroenteritis and colitis due to radiation
K52.1 Toxic gastroenteritis and colitis
K52.2 Allergic and dietetic gastroenteritis and colitis
K52.81 Eosinophilic gastritis or gastroenteritis
K52.82 Eosinophilic colitis
K52.89 Other specified noninfective gastroenteritis and colitis
K52.9 Noninfective gastroenteritis and colitis, unspecified
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
K63.9 Disease of intestine, unspecified
Z12.10 Encounter for screening for malignant neoplasm of intestinal tract, unspecified
Z12.11 Encounter for screening for malignant neoplasm of colon
Z12.12 Encounter for screening for malignant neoplasm of rectum
Z12.13 Encounter for screening for malignant neoplasm of small intesting
Z80.0 Family history of malignant neoplasm of digestive organs
Z83.71 Family history of colonic polyps
Z85.00 Personal history of malignant neoplasm of unspecified digestive organ
Z85.030 Personal history of malignant carcinoid tumor of large intestine
Z85.038 Personal history of malignant neoplasm of large intestine
Z85.040 Personal history of malignant carcinoid tumor of rectum
Z85.048 Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus.
Z85.060 Personal history of malignant carcinoid tumor of small intestine
Z85.068 Personal history of malignant neoplasm of small intestine
Z85.09 Personal history of malignant neoplasm of digestive organs
Z86.010 Personal history of colonic polyps


Introduction

A colonoscopy  uses a flexible  lighted tube to  examine the colon and rectum .  A colonoscopy can  be used as a preventive test to screen for colon cancer or polyps. It can also be doneas a diagnostic procedure when symptoms or lab tests suggest there might be a problem in the rectum or colon.In some cases, minor procedures may be done during a colonoscopy,such as taking a biopsy or destroying an area of unhealthy tissue(a lesion). Preventive colonoscopy is done for people who are not having any symptoms or problems with the colon or rectum. The decision to do a preventive colonoscopy is usually based on age and family history. The US Preventive Services Task Force has highly recommended that all adults be screened for colon cancer between the ages of 50 and 75. This guideline applies only to people of average risk. Colonoscopy is only one of the screening tests that can be used. This benefit coverage guideline provides general information about how the health plan decides whether a colonoscopy is covered under the preventive or diagnostic (medical) benefits.

Note:The Introduction section is for your general knowledge and is not to be takenas policy coverage criteria. The rest of the policy uses specific words and concepts familiar to medical professionals. It is intended for providers.A provider can be a person, such as a doctor, nurse, psychologist, or dentist. A provider also can be a place where medical care is given, like a hospital, clinic, or lab.This policy informs them about when a service may be covered

Coding Screening Colonoscopy Services
 
Benefit coverage for a given colonoscopy procedure is based on a combination of the  procedure code (CPT, HCPCS) and the diagnosis code (ICD - 10) selected by the provider and submitted on the claim. A colonoscopy procedure may be covered as a preventive screening or a medical intervention for identified symptoms or findings. This guideline provides clinical indications for determining whether a colonoscopy is preventive or medical. Screening, diagnostic ,and surveillance indications for colonoscopy are based on guidelines from a variety of specialty societies and government organizations.

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Most read colonoscopy CPT codes