Put the Right ICD-9 Codes on Your GI Endoscopy Claims
Check with insurer for a complete list
Your lower gastrointestinal endoscopy claims will stand a greater chance of acceptance if you include the appropriate ICD-9 code to prove medical necessity.
Medicare carriers publish their own lists of medical-necessity codes for GI procedures on their Web sites. Insurers consider many symptoms justification for a lower GI endoscopy. Take a look at this list of often used ICD-9 codes that insurers commonly accept for lower GI endoscopy claims, courtesy of Jan Rasmussen, CPC, AGS-GI, ACS-OB, president of Professional Coding Solutions in Eau Claire, Wis.:
280.0 - Iron deficiency anemias; secondary to blood loss (chronic)
280.9 - Iron deficiency anemia, unspecified
285.9 - Anemia, unspecified
555.0 - Regional enteritis; small intestine
562.10 - Diverticulosis of colon (without mention of hemorrhage)
562.11 - Diverticulitis of colon (without mention of hemorrhage)
562.12 - Diverticulosis of colon with hemorrhage
562.13 - Diverticulitis of colon with hemorrhage
787.91 - Diarrhea
787.99 - Other symptoms involving digestive system; change in bowel habits
V10.05 - Personal history of malignant neoplasm; gastrointestinal tract; large intestine
V12.72 - Personal history of certain other diseases; diseases of digestive system; colonic polyps
V16.0 - Family history of malignant neoplasm; gastrointestinal tract
V18.5 - Family history of certain other specific conditions; digestive disorders.
Example: The gastroenterologist performs a proctosigmoidoscopy on a patient with persistent diarrhea and bleeding. During the procedure, he has to control bleeding via heater probe.
On the claim, you should:
report 45317 (Proctosigmoidoscopy, rigid; with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]) for the proctosigmoidoscopy.
attach 787.91 to 45317 to account for the diarrhea.
Note: While the listed ICD-9 codes commonly prove medical necessity on lower GI endoscopy claims, you should check with your individual carrier before using these, or any other, diagnosis codes on a claim.
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