Billing and Coding: Colon Capsule Endoscopy (CCE)

Colon Capsule Endoscopy (CCE) is billable when optical colonoscopy was attempted and incomplete (ICD-10-CM Z53.8) or when colonoscopy is contraindicated as determined by a qualified endoscopist (ICD-10-CM Z53.09), subject to the reasonable and necessary requirements of LCD L38571. Claims must include a valid ICD-10 code, supporting medical record documentation (history, exam, diagnostic results), and the referring/ordering physician name and NPI when required; non-covered services must be billed with the appropriate modifier. CPT/HCPCS coding must accurately describe the service and comply with NCCI and OPPS edits.

"Colon capsule endoscopy (CCE) may be billed when an instrument (optical) colonoscopy was attempted but was incomplete, documented by ICD-10-CM code Z53."

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