K62.3 — Rectal prolapse
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The submitted CPT/HCPCS code must accurately describe the service performed.
- All documentation must be maintained in the patient 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).
- The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
Key Coverage Criteria
- Diagnostic colonoscopy is covered when the service meets the reasonable and necessary requirements specified in Local Coverage Determination L33671.
- A colonoscopy may be billed when a sigmoidoscope is used only if the bowel is sufficiently short that the entire colon can be examined and this fact is clearly documented in the clinical record.
- An incomplete colonoscopy (inability to advance the colonoscope to the cecum or colon‑small intestine anastomosis due to unforeseen circumstances) is billed using codes 44388, 45378, G0105 or G0121 with modifier -53.
- When the colonoscopy procedure is unusual or difficult, report modifier -22 (unusual procedural services) on the claim.
- A follow-on screening colonoscopy after a Medicare-covered non-invasive stool-based CRC screening test that is positive is included in a Complete Colorectal Cancer (CRC) Screening and should be billed as such with modifier -KX to confirm clinical requirements are met.
- The most specific ICD-10-CM diagnosis code available must be selected and billed as the line diagnosis linked to the colonoscopy procedure.
13 Active Policies
L35486 — Pelvic Floor Dysfunction: Anorectal Manometry and EMG
J05
A57595 — Billing and Coding: Pelvic Floor Dysfunction: Anorectal Manometry and EMG
J05
A55937 — Billing and Coding: Diagnostic Colonoscopy
J09
L33671 — Diagnostic Colonoscopy
J09
A58428
Related Codes
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