Gastroenterology Coding Alert
Dx Codes and High-Risk Patients
Question: What are some of the common ICD-9 codes that prove medical necessity for Medicare's high-risk colorectal cancer screening? Note: For more information on reporting high-risk colorectal cancer screenings to Medicare, see "Manage Risk Requirements Before Filing G0105" on page 44).
Missouri Subscriber
Answer: When you are reporting a high-risk colorectal cancer screening to Medicare (G0105, Colorectal cancer screening; colonoscopy on individual at high risk), the first step in proving medical necessity is strong diagnosis coding based on the patient's high-risk characteristics.
To help you remember which patients meet Medicare's requirements for payment, save this list of ICD-9 codes that indicate a patient may be at high risk for colorectal cancer:
V10.05 - Personal history of malignant neoplasm of large intestine
V10.06 - Personal history of malignant neoplasm of rectum, rectosigmoid junction and anus
V12.72 - Personal history of colonic polyps
V16.0 - Family history of malignant neoplasm, gastrointestinal tract
V18.5 - Family history of colon polyps
V19.8 - Family history of other conditions (Use V19.8 for family history of polyposis)
555.0 - Regional enteritis of small intestine
555.1 - Regional enteritis of large intestine
555.2 - Regional enteritis of small intestine with large intestine
555.9 - Regional enteritis of unspecified site
556.0 - Ulcerative (chronic) enterocolitis
556.1 - Ulcerative (chronic) ileocolitis
556.2 - Ulcerative (chronic) proctitis
556.3 - Ulcerative (chronic) proctosigmoiditis
556.8 - Other ulcerative colitis
556.9 - Ulcerative colitis, unspecified
558.2 - Toxic gastroenteritis and colitis
558.9 - Other and unspecified noninfectious gastroenteritis and colitis.
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Presented by Trish Bukauskas-Vollmer, CMM, CPC, CMSCS The following supplement to Gastroenterology Coding Alert is [...]
