Billing and Coding: Computed Tomographic (CT) Colonography for Diagnostic Uses

This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Computed Tomographic (CT) Colonography for Diagnostic Uses. Coding Information: Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act. The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported. Documentation Requirements:The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.Utilization Guidelines:CT colonography is reimbursable only when performed following an instrument colonoscopy which was incomplete or when a board certified or board eligible gastroenterologist or surgeon trained in endoscopy determined from an evaluation of the patient that optical colonoscopy can not be safely attempted. Tests performed without a prior incomplete instrument colonoscopy in history or documentation by a board certified or eligible gastroenterologist, a surgeon trained in endoscopy or a physician with equivalent endoscopic training indicating why an optical colonoscopy cannot be safely attempted will be denied.