K31.9 — Disease of stomach and duodenum, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
- Providers must follow the billing, coding, and documentation requirements referenced in LCD L33455; this article provides supplementary coding guidance only.
- Documentation that the test is ordered and interpreted by a gastroenterologist trained to use and interpret the Wireless Motility Capsule.
- Documentation that basic clinical investigations, including endoscopy, were performed and failed to elucidate a diagnosis prior to WMC use.
Key Coverage Criteria
- Coverage and medical necessity for wireless gastrointestinal motility monitoring systems are determined according to Local Coverage Determination L33455.
- Coverage when used to evaluate patients with suspected delayed gastric emptying or gastroparesis of any etiology.
- Coverage when used to evaluate colonic transit in patients with chronic idiopathic constipation lasting more than 6 months.
- Coverage when used to determine gastrointestinal motility measures (gastric emptying, small bowel transit, colonic transit, whole gut transit, or intraluminal pressure patterns) in patients after basic clinical investigations, including endoscopy, have failed to elucidate a diagnosis.
- CT abdomen is medically necessary to evaluate abdominal pain.
- CT abdomen is medically necessary to evaluate known or suspected abdominal masses or fluid collections.
6 Active Policies
AETNA-CPB-0396 — Gastrointestinal Function: Selected Tests
ANTHEM-CG-LAB-21 — CG-LAB-21 Serum Iron Testing
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
A56724 — Billing and Coding: Wireless Gastrointestinal Motility Monitoring Systems
L33455 — Wireless Gastrointestinal Motility Monitoring Systems
Related Codes
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