Revenue Cycle Insider

Question: I noticed that Medicare made multiple updates to the local coverage determination (LCD) billing and coding article A56394 in 2026, but I can’t figure out what the changes are. Could you please explain what revisions were made?

Revenue Cycle Insider Subscriber

Answer: Certainly! The Centers for Medicare & Medicaid Services (CMS) did publish multiple public versions of the LCD reference article “Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic” this year.

The first revision took effect on June 25, 2026, and the agency added the following codes as qualifying secondary ICD-10-CM codes for Z08 (Encounter for follow-up examination after completed treatment for malignant neoplasm):

• Z85.030 (Personal history of malignant carcinoid tumor of large intestine)
• Z85.040 (Personal history of malignant carcinoid tumor of rectum)
• Z85.05 (Personal history of malignant neoplasm of liver)
• Z85.060 (Personal history of malignant carcinoid tumor of small intestine)
• Z85.068 (Personal history of other malignant neoplasm of small intestine)

These codes join Z85.038 (Personal history of other malignant neoplasm of large intestine) and Z85.048 (Personal history of other malignant neoplasm of rectum, rectosigmoid junction, and anus) as secondary diagnosis codes for surveillance of colonic neoplasia.

This revision indicated that the change was effective for services that occurred on or after Aug. 24, 2024.

Then, on July 16, CMS stated that the previous revision included “the incorrect effective date.” The new effective dates of service are on or after Aug. 29, 2024.

This means that if your gastroenterologist performed a surveillance colonoscopy on or after Aug. 29, 2024, you may bill primary diagnosis code Z08 with any of the secondary diagnosis codes listed above.

The effective date also applies to Z09 (Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm) as the primary code with the following secondary diagnosis codes:

• Z86.0100 (Personal history of colon polyps, unspecified)
• Z86.0101 (Personal history of adenomatous and serrated colon polyps)
• Z86.0102 (Personal history of hyperplastic colon polyps)
• Z86.0109 (Personal history of other colon polyps).

Mike Shaughnessy, BA, CPC, Production Editor, AAPC