Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

This billing and coding guidance requires valid ICD-10-CM diagnosis codes, appropriate reporting of referring/ordering provider name and NPI when applicable, and adherence to NCCI/OPPS edits. Advance Beneficiary Notice rules apply (GA, GX, GZ, GY modifiers) and may trigger automatic denials; required documentation includes the provider assessment, relevant history, test results or symptoms, signed visit/operative records, and CMS-R-131 when an ABN is used.

"A claim submitted without a valid ICD-10-CM diagnosis code will be returned as an incomplete claim under Section 1833(e) of the Social Security Act."

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