Gastroenterology Coding Alert

Question: Which ICD-9 codes prove medical necessity for Medicare's high-risk colorectal cancer screening exam?


Missouri Subscriber


Answer: When you report 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 remember which patients meet Medicare's requirements for payment, save this list of common 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 condition (for instance, report 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.

--Clinical and coding expertise for You Be the Coder and Reader Questions provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and a former member of the CPT advisory panel; and Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Lawrenceville, Ga.