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Policy Attachment


Attachment to Policy # 07.05.02n


Attachment:A

Policy #:07.05.02n

Description:ICD-10-CM Codes

Title:Wireless Capsule Endoscopy (WCE) as a Diagnostic Technique in Disorders of the Small Bowel, Esophagus, and Colon



ICD-10-CM Codes

A18.32 Tuberculous enteritis

A18.83 Tuberculosis of digestive tract organs, not elsewhere classified

C17.0 Malignant neoplasm of duodenum

C17.1 Malignant neoplasm of jejunum

C17.2 Malignant neoplasm of ileum

C17.3 Meckel's diverticulum, malignant

C17.8 Malignant neoplasm of overlapping sites of small intestine

C17.9 Malignant neoplasm of small intestine, unspecified

C78.4 Secondary malignant neoplasm of small intestine

C7A.010 Malignant carcinoid tumor of the duodenum

C7A.011 Malignant carcinoid tumor of the jejunum

C7A.012 Malignant carcinoid tumor of the ileum

C7A.019 Malignant carcinoid tumor of the small intestine, unspecified portion

D01.49 Carcinoma in situ of other parts of intestine

D12.6 Benign neoplasm of colon, unspecified

D13.2 Benign neoplasm of duodenum

D13.30 Benign neoplasm of unspecified part of small intestine

D13.39 Benign neoplasm of other parts of small intestine

D37.2 Neoplasm of uncertain behavior of small intestine

D3A.010 Benign carcinoid tumor of the duodenum

D3A.011 Benign carcinoid tumor of the jejunum

D3A.012 Benign carcinoid tumor of the ileum

D3A.019 Benign carcinoid tumor of the small intestine, unspecified portion

D50.0 Iron deficiency anemia secondary to blood loss (chronic)

D50.8 Other iron deficiency anemias

D50.9 Iron deficiency anemia, unspecified

E16.4 Increased secretion of gastrin

I77.6 Arteritis, unspecified

I85.00 Esophageal varices without bleeding

I85.01 Esophageal varices with bleeding

I85.10 Secondary esophageal varices without bleeding

I85.11 Secondary esophageal varices with bleeding

K31.811 Angiodysplasia of stomach and duodenum with bleeding

K31.82 Dieulafoy lesion (hemorrhagic) of stomach and duodenum

K50.00 Crohn's disease of small intestine without complications

K50.011 Crohn's disease of small intestine with rectal bleeding

K50.012 Crohn's disease of small intestine with intestinal obstruction

K50.013 Crohn's disease of small intestine with fistula

K50.014 Crohn's disease of small intestine with abscess

K50.018 Crohn's disease of small intestine with other complication

K50.019 Crohn's disease of small intestine with unspecified complications

K50.80 Crohn's disease of both small and large intestine without complications

K50.811 Crohn's disease of both small and large intestine with rectal bleeding

K50.813 Crohn's disease of both small and large intestine with fistula

K50.814 Crohn's disease of both small and large intestine with abscess

K50.818 Crohn's disease of both small and large intestine with other complication

K50.819 Crohn's disease of both small and large intestine with unspecified complications

K50.90 Crohn's disease, unspecified, without complications

K50.911 Crohn's disease, unspecified, with rectal bleeding

K50.912 Crohn's disease, unspecified, with intestinal obstruction

K50.913 Crohn's disease, unspecified, with fistula

K50.914 Crohn's disease, unspecified, with abscess

K50.918 Crohn's disease, unspecified, with other complication

K50.919 Crohn's disease, unspecified, with unspecified complications

K52.0 Gastroenteritis and colitis due to radiation

K52.21 Food protein-induced enterocolitis syndrome

K52.22 Food protein-induced enteropathy

K52.29 Other allergic and dietetic gastroenteritis and colitis

K52.3 Indeterminate colitis

K52.831 Collagenous colitis

K52.832 Lymphocytic colitis

K52.838 Other microscopic colitis

K52.839 Microscopic colitis, unspecified

K52.89 Other specified noninfective gastroenteritis and colitis

K52.9 Noninfective gastroenteritis and colitis, unspecified

K55.1 Chronic vascular disorders of intestine

K57.00 Diverticulitis of small intestine with perforation and abscess without bleeding

K57.01 Diverticulitis of small intestine with perforation and abscess with bleeding

K57.10 Diverticulosis of small intestine without perforation or abscess without bleeding

K57.11 Diverticulosis of small intestine without perforation or abscess with bleeding

K57.12 Diverticulitis of small intestine without perforation or abscess without bleeding

K57.13 Diverticulitis of small intestine without perforation or abscess with bleeding

K57.41 Diverticulitis of both small and large intestine with perforation and abscess with bleeding

K57.51 Diverticulosis of both small and large intestine without perforation or abscess with bleeding

K57.53 Diverticulitis of both small and large intestine without perforation or abscess with bleeding

K63.3 Ulcer of intestine

K63.81 Dieulafoy lesion of intestine

K74.69 Other cirrhosis of liver

K76.6 Portal hypertension

K90.0 Celiac disease

K90.1 Tropical sprue

K90.2 Blind loop syndrome, not elsewhere classified

K90.41 Non-celiac gluten sensitivity

K90.49 Malabsorption due to intolerance, not elsewhere classified

K90.81 Whipple's disease

K90.89 Other intestinal malabsorption

K90.9 Intestinal malabsorption, unspecified

K92.0 Hematemesis

K92.1 Melena

K92.2 Gastrointestinal hemorrhage, unspecified

K92.81 Gastrointestinal mucositis (ulcerative)

Q43.0 Meckel's diverticulum (displaced) (hypertrophic)

Q85.8 Other phakomatoses, not elsewhere classified

R19.5 Other fecal abnormalities

R19.7 Diarrhea, unspecified

R93.3 Abnormal findings on diagnostic imaging of other parts of digestive tract

Version Effective Date: 12/16/2016
Version Issued Date: 12/16/2016
Version Reissued Date: 01/31/2018

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