Billing and Coding: Colon Capsule Endoscopy (CCE)

The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the related LCD L38837 Colon Capsule Endoscopy (CCE). Coding Guidance Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier. For the purposes of this Billing and Coding Article, ICD-10-CM diagnosis code Z53.8 indicates that the instrument colonoscopy has been attempted and was incomplete and ICD-10-CM diagnosis code Z53.09 indicates the procedure is contraindicated when a board certified or board eligible gastroenterologist, a surgeon trained in endoscopy, or a physician with equivalent endoscopic training determined from an evaluation of the patient that optical colonoscopy cannot be safely attempted. Documentation Requirements All documentation must be maintained in the patient's medical record and made available to the contractor upon request. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.