Billing and Coding: Diagnostic Colonoscopy

This article provides billing and coding guidance for diagnostic colonoscopy and defers to Local Coverage Determination L33671 for clinical reasonable and necessary criteria. It emphasizes strict documentation requirements — legible patient identification and signatures, support for selected ICD-10 and CPT/HCPCS codes, medical necessity notes from the ordering/referring physician, procedure and pathology reports, and documentation for incomplete procedures — and instructs that non-covered services must be billed with the appropriate modifier.

"Diagnostic colonoscopy is covered when the service meets the reasonable and necessary requirements specified in Local Coverage Determination L33671."

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