Wednesday, July 6, 2016

CPT code 43235, 43236, 43237, 43238, 43239 - EGD codes

LCD for Diagnostic and Therapeutic Esophagogastroduodenoscopy (L29167)


Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service.Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.


Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.




43235
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF
SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)

43236

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY
SUBSTANCE

43237

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION LIMITED
TO THE ESOPHAGUS

43238
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH TRANSENDOSCOPIC ULTRASOUND-GUIDED
INTRAMURAL OR TRANSMURAL FINE NEEDLE ASPIRATION/BIOPSY(S),
ESOPHAGUS (INCLUDES ENDOSCOPIC ULTRASOUND EXAMINATION
LIMITED TO THE ESOPHAGUS)

43239

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH BIOPSY, SINGLE OR MULTIPLE - Fee amount $350 -$450

43241

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH TRANSENDOSCOPIC INTRALUMINAL TUBE OR
CATHETER PLACEMENT


43243

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH INJECTION SCLEROSIS OF ESOPHAGEAL AND/OR
GASTRIC VARICES

43244

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH BAND LIGATION OF ESOPHAGEAL AND/OR GASTRIC
VARICES


43245 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,

STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH DILATION OF GASTRIC OUTLET FOR OBSTRUCTION
(EG, BALLOON, GUIDE WIRE, BOUGIE)

43246
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH DIRECTED PLACEMENT OF PERCUTANEOUS
GASTROSTOMY TUBE

43247
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH REMOVAL OF FOREIGN BODY

43248
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH INSERTION OF GUIDE WIRE FOLLOWED BY DILATION
OF ESOPHAGUS OVER GUIDE WIRE

43249
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH BALLOON DILATION OF ESOPHAGUS (LESS THAN 30
MM DIAMETER)

43250

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER
LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY

43251

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER
LESION(S) BY SNARE TECHNIQUE

43255

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH CONTROL OF BLEEDING, ANY METHOD

43258

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER
LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS,
BIPOLAR CAUTERY OR SNARE TECHNIQUE


Indications and Limitations of Coverage and/or Medical Necessity

The following conditions are generally accepted as indications for the performance of EGD(s).


Indications that support EGD(s) for diagnostic purpose(s) are:


Upper abdominal distress that persists despite an appropriate trial of therapy. 

Upper abdominal distress associated with symptoms and/or signs suggesting 
serious organic disease (e.g., anorexia and weight loss). 

Dysphagia or odynophagia. 

Esophageal reflux symptoms that are persistent or recurrent despite appropriate therapy. 

Persistent vomiting of unknown cause. 

Other system disease in which the presence of upper GI pathology might modify other planned management. Examples include patients with a history of GI bleeding who are scheduled for organ transplantation, long-term anticoagulation, and chronic non-steroidal therapy for arthritis. Please note that this Indication does not provide coverage for routine pre-operative EGD for patients in whom bariatric surgical procedures are contemplated or planned


X-ray findings of: 

A suspected neoplastic lesion for confirmation and specific histologic diagnosis. 

Gastric or esophageal ulcer. 
Or, 
Evidence of upper gastrointestinal tract stricture or obstruction. 


Gastrointestinal bleeding: 

In most actively bleeding patients. 
When surgical therapy is contemplated. 
When rebleeding occurs after acute self-limited blood loss. 
When portal hypertension or aorto-enteric fistula is suspected. 
Or, 
For presumed chronic blood loss and for iron deficiency anemia when colonoscopy is negative. 


When sampling of duodenal or jejunal tissue or fluid is indicated. 
To assess acute injury after caustic agent ingestion. 
Or, 
Intraoperative EGD when necessary to clarify location or pathology of a lesion. 


Indications that support EGD(s) for therapeutic purpose(s) are:

Treatment of bleeding from lesions such as ulcers, tumors, vascular malformations (e.g., electrocoagulation, heater probe, laser photocoagulation or injection therapy). 
Sclerotherapy and/or band ligation for bleeding from esophageal or proximal gastric varices. 
Foreign body removal. 
Removal of selected polypoid lesions. 
Placement of feeding tubes (per oral, percutaneous endoscopic gastrostomy, percutaneous endoscopic jejunostomy). 
Dilation of stenotic lesions (e.g., with transendoscopic balloon dilators or dilating systems employing guide wires). 
Or, 
Palliative therapy of stenosing neoplasms (e.g., laser, bipolar electrocoagulation, stent placement). 



Sequential or periodic diagnostic EGD may be indicated:

For follow up of selected esophageal, gastric or stomal ulcers to demonstrate healing (frequency of follow-up EGD is variable, but every two to four months until healing is demonstrated is reasonable). 

For follow up in patients with prior adenomatous gastric polyps (approximate frequency of follow-up EGDs would be every one to four years depending on the clinical circumstances, with occasional patients with sessile polyps requiring every six months surveillance initially), and similarly with surveillance of confirmed high-grade gastric dysplasia. 

For follow up for adequacy of prior sclerotherapy and/or band ligation of esophageal varices (approximate frequency of follow-up EGDs is variable depending on the state of the patient but every six to 24 months is reasonable after the initial sclerotherapy sessions are completed). 

For follow-up of Barrett’s esophagus (approximate frequency of follow-up EGDs is one to two years with biopsies, unless dysplasia is demonstrated, in which case, a repeat biopsy in two to three months might be indicated). 

Or, 
For follow-up in patients with familial adenomatous polyposis (approximate frequency of follow-up EGDs would be every two to four years, but might be more frequent, such as every six to 12 months, if gastric adenomas or adenomas of the duodenum were demonstrated).

For follow-up of patients with severe, refractory gastroesophageal reflux disease where the concern of malignant degeneration exists (approximate frequency of every ten years)

Billing and Coding Tips

Beginning with dates of service on or after April 1, 2015, ClaimsXten removed their incidental edit on Current Procedural Terminology (CPT®) code 43235  esophagogastroduodenoscopy (EGD), flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)) when reported with CPT codes 43770-43775 (laparoscopy, surgical, gastric restrictive procedures). However, when an EGD is performed following a gastric restrictive  procedure to confirm there is no leakage, we consider the EGD to be an integral part of the primary procedure and not eligible for separate reimbursement. Therefore, beginning with claims processed on or after August 17, 2015, we will again apply the bundled services incidental edit on CPT code 43235 (EGD) when reported with CPT codes 43770-43775 (gastric restrictive procedures). This information will be documented in Section 2 of our policy. 

Unbundling occurs when multiple procedure codes are submitted for a group of procedures that are described by a single comprehensive code. An example of Unbundling would be fragmenting one service into component parts and coding each component as if it were a separate service. For example, the correct CPT comprehensive code to use for upper gastrointestinal endoscopy with biopsy of stomach is CPT code 43239. Separating the service into two component parts,
using CPT code 43235 for upper gastrointestinal endoscopy and CPT code 43600 for biopsy of stomach is inappropriate

CPT Codes: 45378, 43239, 43235, 45385, 45380 Reminder: In accordance with Oxford’s policies and procedures, an office facility fee (code OFAC2) will be paid for these five codes if the provider chooses to perform them in his or her office


If an EGD is performed with a biopsy, and then the physician removes the scope and performs an Esophageal Dilation by unguided sound, it should be billed using two CPT codes – CPT code 43239 for the EGD with a biopsy and code 43450 for the Esophageal Dilation.

If an EGD is performed with a biopsy, and then the physician performs an Esophageal Dilation using the scope instrument itself, only the 43239 EGD with Biopsy code is billable. If no Biopsy is performed and the only procedure performed is an Esophageal Dilation using the scope instrument itself, only the 43235 Diagnostic EGD code is billable.

Use code 43243 for an EGD with injection sclerosis of esophageal and/or gastric varices. Use code 45381 for a Colonscopy in which Saline is injected to raise a polyp, ink is injected or Tattooing of a lesion is performed. This code is not usually Unbundled from the Biopsy or Polypectomy codes.

If the physician attempts – but fails – to remove a polyp by one (example, Snare) technique, but is successful at removing the polyp via another technique (such as Hot Biopsy Forceps) only bill the CPT code for the procedure that was successful (45384).

If an EGD with a Polypectomy by Cold Biopsy Forceps is performed, use the 43258 Ablationcode – not the 43239 Biopsy code.

Use code 45380 for Colonoscopy procedures performed with Biopsies and/or the Removal of all or portions of Polyps using Cold Biopsy Forceps.

Use code 45383 for colon polyps treated by the Ablation technique, where a polyp is removed using the APC, laser, heat probe, or other device to cauterize it or the remnants of a polyp previously removed during a colonoscopy procedure. Use this code also when polyps are Fulgurated.


Colonoscopy procedures performed through Stomas (Ileostomy and Colostomy patients) are coded from section 44388-44397 codes. 


New Codes

Balloon Dilation of Esophagus

EGD code 43233 (out of sequence) has been established to report balloon dilation of 30 mm in diameter or larger. This dilation procedure includes fluoroscopic guidance, when used. 


Endoscopic Mucosal Resection

Code 43254 has been established to report endoscopic mucosal resection (EMR) with EGD. Code 43254 includes removal of tumor(s), polyp(s) or other lesion(s) by snare technique (43251); directed submucosal injection(s) (43236); and band ligation (43254), so these services are not separately reportable when performed on the same lesion during the same session. Biopsy (43239) performed on the same lesion as EMR is not separately reportable. Code 43254 includes moderate sedation, as indicated by the moderate sedation symbol.

Ultrasound-Guided Injections / Placement of Fiducial Markers

Code 43253 has been established to describe ultrasound-guided transmural injection of substances (e.g., celiac axis injection) or fiducial markers. This code includes endoscopic ultrasound (EUS) of the esophagus, stomach, and either the duodenum or a surgically-altered stomach where the jejunum is examined distal to the anastomosis.  


43239 Esophagogastroduodenoscopy, flexible, transoral; biopsy, single or multiple Parent code revised 



43254 Esophagogastroduodenoscopy, flexible, transoral; EMR (endoscopic mucosal resection) New Code for 2014 Do not report biopsy 43239, submucosal injection 43236, band ligation 43244 or snare removal 43251 separately for same lesion



Key Documentation Terms

Within this area of procedures it is important to make sure that the  documentation clearly identifies what was examined and the procedure(s) performed. Codes with in this section are further classified by the procedures performed (e.g., biopsy, injection, removal of foreign body, and removal of tumor).

When reporting procedures within this family of codes, each procedure must be clearly documented. For instance when performing code 43250 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery, at the minimum the documentation should include what was removed and the key terms “hot biopsy forceps” or “bipolar cautery.” Code 43251 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique, should include what was removed and the key terms “removal of” and “snare technique” in the documentation for the procedure. 

Bundling CPT 43239

Unbundling Unbundling occurs when multiple procedure codes are submitted for a group of procedures that are described by a single comprehensive code. An example of Unbundling would be fragmenting one service into component parts and coding each component as if it were a separate service. For example, the correct CPT comprehensive code to use for upper gastrointestinal endoscopy with biopsy of stomach is CPT code 43239. Separating the service into two component parts, using CPT code 43235 for upper gastrointestinal endoscopy and CPT code 43600 for biopsy of stomach is inappropriate

Unbundling


 Unbundling occurs when multiple procedure codes are submitted for a group of procedures that are described by a single comprehensive code. An example of Unbundling would be fragmenting one service into component parts and coding each component as if it were a separate service. For example, the correct CPT comprehensive code to use for upper gastrointestinal endoscopy with biopsy of stomach is CPT code 43239.  Separating the service into two component parts, using CPT code 43235 for upper gastrointestinal endoscopy and CPT code 43600 for biopsy of stomach is inappropriate (per CMS National Correct Coding Policy Manual).


Esophagogastroduodenoscopy (EGD) CPT CODES

Revised Codes

• 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) b brushing or washing, when performed (separate procedure) $670.47

• 43236; with directed submucosal injection(s) any substance $670.47

• 43237; with endoscopic ultrasound examination limited to the esophagus stomach or duodenum, and adjacent structures $1,013.05

• 43238; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), esophagus (includes endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures) $1,013.05

• 43239; with biopsy, single or multiple $670.47


ICD-9 Codes that Support Medical Necessity

040.2 WHIPPLE'S DISEASE
112.84 CANDIDAL ESOPHAGITIS
150.0 -
152.9 opens in
new window
MALIGNANT NEOPLASM OF CERVICAL ESOPHAGUS -
MALIGNANT NEOPLASM OF SMALL INTESTINE UNSPECIFIED
SITE
155.0 MALIGNANT NEOPLASM OF LIVER PRIMARY
156.0 -
156.9 opens in
new window
MALIGNANT NEOPLASM OF GALLBLADDER - MALIGNANT
NEOPLASM OF BILIARY TRACT PART UNSPECIFIED SITE
157.0 -
157.9 opens in new window
MALIGNANT NEOPLASM OF HEAD OF PANCREAS - MALIGNANT
NEOPLASM OF PANCREAS PART UNSPECIFIED
159.8 MALIGNANT NEOPLASM OF OTHER SITES OF DIGESTIVE
SYSTEM AND INTRA-ABDOMINAL ORGANS
176.3 KAPOSI'S SARCOMA GASTROINTESTINAL SITES
197.4 SECONDARY MALIGNANT NEOPLASM OF SMALL INTESTINE
INCLUDING DUODENUM
197.6 SECONDARY MALIGNANT NEOPLASM OF RETROPERITONEUM
AND PERITONEUM

198.89 SECONDARY MALIGNANT NEOPLASM OF OTHER SPECIFIED
SITES
202.80 OTHER MALIGNANT LYMPHOMAS UNSPECIFIED SITE
211.0 -
211.9 opens in
new window
BENIGN NEOPLASM OF ESOPHAGUS - BENIGN NEOPLASM OF
OTHER AND UNSPECIFIED SITE IN THE DIGESTIVE SYSTEM
214.3 LIPOMA OF INTRA-ABDOMINAL ORGANS
214.9 LIPOMA UNSPECIFIED SITE
215.9 OTHER BENIGN NEOPLASM OF CONNECTIVE AND OTHER SOFT
TISSUE SITE UNSPECIFIED
228.04 HEMANGIOMA OF INTRA-ABDOMINAL STRUCTURES
230.1 -
230.8 opens in
new window
CARCINOMA IN SITU OF ESOPHAGUS - CARCINOMA IN SITU OF
LIVER AND BILIARY SYSTEM
235.2 -
235.4 opens in
new window
NEOPLASM OF UNCERTAIN BEHAVIOR OF STOMACH
INTESTINES AND RECTUM - NEOPLASM OF UNCERTAIN
BEHAVIOR OF RETROPERITONEUM AND PERITONEUM
239.0 NEOPLASM OF UNSPECIFIED NATURE OF DIGESTIVE SYSTEM
251.5 ABNORMALITY OF SECRETION OF GASTRIN
261 NUTRITIONAL MARASMUS
263.0 -
263.9 opens in
new window
MALNUTRITION OF MODERATE DEGREE - UNSPECIFIED
PROTEIN-CALORIE MALNUTRITION
280.0 -
280.9 opens in
new window
IRON DEFICIENCY ANEMIA SECONDARY TO BLOOD LOSS
(CHRONIC) - IRON DEFICIENCY ANEMIA UNSPECIFIED
285.1 ACUTE POSTHEMORRHAGIC ANEMIA
300.11 CONVERSION DISORDER
306.4 GASTROINTESTINAL MALFUNCTION ARISING FROM MENTAL
FACTORS
307.1 ANOREXIA NERVOSA
307.50 EATING DISORDER UNSPECIFIED
307.51 BULIMIA NERVOSA
307.52 PICA
307.53 RUMINATION DISORDER
307.54 PSYCHOGENIC VOMITING
438.82 DYSPHAGIA CEREBROVASCULAR DISEASE
447.2 RUPTURE OF ARTERY
448.0 HEREDITARY HEMORRHAGIC TELANGIECTASIA
456.0 ESOPHAGEAL VARICES WITH BLEEDING
456.1 ESOPHAGEAL VARICES WITHOUT BLEEDING
456.20 -
456.21 opens in
new window
ESOPHAGEAL VARICES IN DISEASES CLASSIFIED ELSEWHERE
WITH BLEEDING - ESOPHAGEAL VARICES IN DISEASES
CLASSIFIED ELSEWHERE WITHOUT BLEEDING
507.0 PNEUMONITIS DUE TO INHALATION OF FOOD OR VOMITUS
530.0 -
530.89 opens in
new window
ACHALASIA AND CARDIOSPASM - OTHER DISEASES OF
ESOPHAGUS
531.00 -
531.91 opens in
new window
ACUTE GASTRIC ULCER WITH HEMORRHAGE WITHOUT
OBSTRUCTION - GASTRIC ULCER UNSPECIFIED AS ACUTE OR
CHRONIC WITHOUT HEMORRHAGE OR PERFORATION WITH
OBSTRUCTION
532.00 -
532.91 opens in
new window
ACUTE DUODENAL ULCER WITH HEMORRHAGE WITHOUT
OBSTRUCTION - DUODENAL ULCER UNSPECIFIED AS ACUTE OR
CHRONIC WITHOUT HEMORRHAGE OR PERFORATION WITH
OBSTRUCTION
533.00 -
533.91 opens in
new window
ACUTE PEPTIC ULCER OF UNSPECIFIED SITE WITH
HEMORRHAGE WITHOUT OBSTRUCTION - PEPTIC ULCER OF
UNSPECIFIED SITE UNSPECIFIED AS ACUTE OR CHRONIC
WITHOUT HEMORRHAGE OR PERFORATION WITH
OBSTRUCTION
534.00 -
534.91 opens in
new window
ACUTE GASTROJEJUNAL ULCER WITH HEMORRHAGE WITHOUT
OBSTRUCTION - GASTROJEJUNAL ULCER UNSPECIFIED AS
ACUTE OR CHRONIC WITHOUT HEMORRHAGE OR
PERFORATION WITH OBSTRUCTION
535.00 -
535.71 opens in
new window
ACUTE GASTRITIS (WITHOUT HEMORRHAGE) - EOSINOPHILIC
GASTRITIS, WITH HEMORRHAGE
536.1 ACUTE DILATATION OF STOMACH
536.2 PERSISTENT VOMITING
536.3 GASTROPARESIS
536.40 -
536.49 opens in
new window
GASTROSTOMY COMPLICATION UNSPECIFIED - OTHER
GASTROSTOMY COMPLICATIONS
536.8 DYSPEPSIA AND OTHER SPECIFIED DISORDERS OF FUNCTION
OF STOMACH
537.0 -
537.89 opens in
new window
ACQUIRED HYPERTROPHIC PYLORIC STENOSIS - OTHER
SPECIFIED DISORDERS OF STOMACH AND DUODENUM
538 GASTROINTESTINAL MUCOSITIS (ULCERATIVE)
551.3 DIAPHRAGMATIC HERNIA WITH GANGRENE
552.3 -
552.8 opens in
new window
DIAPHRAGMATIC HERNIA WITH OBSTRUCTION - HERNIA OF
OTHER SPECIFIED SITES WITH OBSTRUCTION
553.3 DIAPHRAGMATIC HERNIA WITHOUT OBSTRUCTION OR
GANGRENE
555.0 -
555.9 opens in
new window
REGIONAL ENTERITIS OF SMALL INTESTINE - REGIONAL
ENTERITIS OF UNSPECIFIED SITE
560.9 UNSPECIFIED INTESTINAL OBSTRUCTION
562.01 DIVERTICULITIS OF SMALL INTESTINE (WITHOUT
HEMORRHAGE)
562.02 DIVERTICULOSIS OF SMALL INTESTINE WITH HEMORRHAGE
562.03 DIVERTICULITIS OF SMALL INTESTINE WITH HEMORRHAGE
569.62 MECHANICAL COMPLICATION OF COLOSTOMY AND
ENTEROSTOMY
569.71 -
569.79 opens in
new window
POUCHITIS - OTHER COMPLICATIONS OF INTESTINAL POUCH
569.82 ULCERATION OF INTESTINE
569.87 VOMITING OF FECAL MATTER
571.1 ACUTE ALCOHOLIC HEPATITIS
571.2 ALCOHOLIC CIRRHOSIS OF LIVER
571.3 ALCOHOLIC LIVER DAMAGE UNSPECIFIED
571.40 CHRONIC HEPATITIS UNSPECIFIED
571.41 CHRONIC PERSISTENT HEPATITIS
571.42 AUTOIMMUNE HEPATITIS
571.49 OTHER CHRONIC HEPATITIS
571.5 CIRRHOSIS OF LIVER WITHOUT ALCOHOL
571.6 BILIARY CIRRHOSIS
572.3 PORTAL HYPERTENSION
574.00 -
574.01 opens in
new window
CALCULUS OF GALLBLADDER WITH ACUTE CHOLECYSTITIS
WITHOUT OBSTRUCTION - CALCULUS OF GALLBLADDER WITH
ACUTE CHOLECYSTITIS WITH OBSTRUCTION
574.10 -
574.11 opens in
new window
CALCULUS OF GALLBLADDER WITH OTHER CHOLECYSTITIS
WITHOUT OBSTRUCTION - CALCULUS OF GALLBLADDER WITH
OTHER CHOLECYSTITIS WITH OBSTRUCTION
574.20 -
574.21 opens in
new window
CALCULUS OF GALLBLADDER WITHOUT CHOLECYSTITIS
WITHOUT OBSTRUCTION - CALCULUS OF GALLBLADDER
WITHOUT CHOLECYSTITIS WITH OBSTRUCTION
574.30 -
574.31 opens in
new window
CALCULUS OF BILE DUCT WITH ACUTE CHOLECYSTITIS
WITHOUT OBSTRUCTION - CALCULUS OF BILE DUCT WITH
ACUTE CHOLECYSTITIS WITH OBSTRUCTION
574.40 -
574.41 opens in
new window
CALCULUS OF BILE DUCT WITH OTHER CHOLECYSTITIS
WITHOUT OBSTRUCTION - CALCULUS OF BILE DUCT WITH
OTHER CHOLECYSTITIS WITH OBSTRUCTION
575.0 ACUTE CHOLECYSTITIS
575.5 FISTULA OF GALLBLADDER
576.0 POSTCHOLECYSTECTOMY SYNDROME
576.4 FISTULA OF BILE DUCT
577.0 ACUTE PANCREATITIS
577.1 CHRONIC PANCREATITIS
577.2 CYST AND PSEUDOCYST OF PANCREAS
578.0 -
578.9 opens in
new window
HEMATEMESIS - HEMORRHAGE OF GASTROINTESTINAL TRACT
UNSPECIFIED
579.0 -
579.9 opens in
new window
CELIAC DISEASE - UNSPECIFIED INTESTINAL MALABSORPTION
694.0 DERMATITIS HERPETIFORMIS
710.1 SYSTEMIC SCLEROSIS
747.61 GASTROINTESTINAL VESSEL ANOMALY
750.3 CONGENITAL TRACHEOESOPHAGEAL FISTULA ESOPHAGEAL
ATRESIA AND STENOSIS
750.4 OTHER SPECIFIED CONGENITAL ANOMALIES OF ESOPHAGUS
750.5 CONGENITAL HYPERTROPHIC PYLORIC STENOSIS
750.6 CONGENITAL HIATUS HERNIA
750.7 OTHER SPECIFIED CONGENITAL ANOMALIES OF STOMACH
783.0 ANOREXIA
783.21 -
783.3 opens in
new window
LOSS OF WEIGHT - FEEDING DIFFICULTIES AND
MISMANAGEMENT
784.42 DYSPHONIA
784.43 HYPERNASALITY
784.44 HYPONASALITY
784.49 OTHER VOICE AND RESONANCE DISORDERS
784.52 FLUENCY DISORDER IN CONDITIONS CLASSIFIED ELSEWHERE
784.91 -
784.99 opens in
new window
POSTNASAL DRIP - OTHER SYMPTOMS INVOLVING HEAD AND
NECK
786.2 COUGH
786.50 -
786.59 opens in
new window
UNSPECIFIED CHEST PAIN - OTHER CHEST PAIN
786.6 SWELLING MASS OR LUMP IN CHEST
787.01 -
787.91 opens in
new window
NAUSEA WITH VOMITING - DIARRHEA
789.00 -
789.09 opens in
new window
ABDOMINAL PAIN UNSPECIFIED SITE - ABDOMINAL PAIN OTHER
SPECIFIED SITE
789.30 -
789.39 opens in
new window
ABDOMINAL OR PELVIC SWELLING MASS OR LUMP
UNSPECIFIED SITE - ABDOMINAL OR PELVIC SWELLING MASS
OR LUMP OTHER SPECIFIED SITE
789.51 -
789.59 opens in
new window
MALIGNANT ASCITES - OTHER ASCITES
789.60 -
789.69 opens in
new window
ABDOMINAL TENDERNESS UNSPECIFIED SITE - ABDOMINAL
TENDERNESS OTHER SPECIFIED SITE
790.5 OTHER NONSPECIFIC ABNORMAL SERUM ENZYME LEVELS
790.99 OTHER ABNORMAL FINDINGS ON EXAMINATION OF BLOOD
792.1 NONSPECIFIC ABNORMAL FINDINGS IN STOOL CONTENTS
793.4 NONSPECIFIC (ABNORMAL) FINDINGS ON RADIOLOGICAL AND
OTHER EXAMINATION OF GASTROINTESTINAL TRACT
793.6
NONSPECIFIC (ABNORMAL) FINDINGS ON RADIOLOGICAL AND
OTHER EXAMINATION OF ABDOMINAL AREA, INCLUDING
RETROPERITONEUM
799.4 CACHEXIA
862.22 INJURY TO ESOPHAGUS WITHOUT OPEN WOUND INTO CAVITY
874.4 -
874.5 opens in
new window
OPEN WOUND OF PHARYNX WITHOUT COMPLICATION - OPEN
WOUND OF PHARYNX COMPLICATED
935.1 -
935.2 opens in
new window
FOREIGN BODY IN ESOPHAGUS - FOREIGN BODY IN STOMACH
936 FOREIGN BODY IN INTESTINE AND COLON
938 FOREIGN BODY IN DIGESTIVE SYSTEM UNSPECIFIED
947.0 BURN OF MOUTH AND PHARYNX
947.2 -
Diagnoses that Support Medical Necessity
N/A
ICD-9 Codes that DO NOT Support Medical Necessity
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
* According to the ICD-9-CM book, diagnosis codes E864.1, E864.2, E864.3, E864.4 and E961 are secondary diagnosis codes and should not be billed as the primary diagnosis.
947.3 opens in
new window BURN OF ESOPHAGUS - BURN OF GASTROINTESTINAL TRACT
959.01 -
959.09 opens in
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OTHER AND UNSPECIFIED INJURY TO HEAD - OTHER AND
UNSPECIFIED INJURY TO FACE AND NECK
983.2 -
983.9 opens in
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TOXIC EFFECT OF CAUSTIC ALKALIS - TOXIC EFFECT OF
CAUSTIC UNSPECIFIED
990 EFFECTS OF RADIATION UNSPECIFIED
996.82 COMPLICATIONS OF TRANSPLANTED LIVER
997.4 DIGESTIVE SYSTEM COMPLICATIONS NOT ELSEWHERE
CLASSIFIED
E864.1* ACCIDENTAL POISONING BY ACIDS NOT ELSEWHERE
CLASSIFIED
E864.2* ACCIDENTAL POISONING BY CAUSTIC ALKALIS NOT
ELSEWHERE CLASSIFIED
E864.3* ACCIDENTAL POISONING BY OTHER SPECIFIED CORROSIVES
AND CAUSTICS NOT ELSEWHERE CLASSIFIED
E864.4* ACCIDENTAL POISONING BY UNSPECIFIED CORROSIVES AND
CAUSTICS NOT ELSEWHERE CLASSIFIED
E961* ASSAULT BY CORROSIVE OR CAUSTIC SUBSTANCE EXCEPT
POISONING
V10.00 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF
UNSPECIFIED SITE IN GASTROINTESTINAL TRACT
V10.03 -
V10.04 opens in
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PERSONAL HISTORY OF MALIGNANT NEOPLASM OF
ESOPHAGUS - PERSONAL HISTORY OF MALIGNANT NEOPLASM
OF STOMACH
V10.09 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER
SITES IN GASTROINTESTINAL TRACT
V12.71 PERSONAL HISTORY OF PEPTIC ULCER DISEASE
V12.72 PERSONAL HISTORY OF COLONIC POLYPS
V12.79 PERSONAL HISTORY OF OTHER SPECIFIED DIGESTIVE SYSTEM
DISEASES
V18.51 -
V18.59 opens in
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FAMILY HISTORY, COLONIC POLYPS - FAMILY HISTORY, OTHER
DIGESTIVE DISORDERS
V55.1 ATTENTION TO GASTROSTOMY
V58.61 LONG-TERM (CURRENT) USE OF ANTICOAGULANTS
V58.64 LONG-TERM (CURRENT) USE OF NONSTEROIDAL ANTIINFLAMMATORIES
V58.69 LONG-TERM (CURRENT) USE OF OTHER MEDICATIONS
V69.1 INAPPROPRIATE DIET AND EATING HABITS
N/A
XX000 Not Applicable

Diagnoses that DO NOT Support Medical Necessity
N/A
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