Billing and Coding: Colon Capsule Endoscopy

Colon capsule endoscopy may be billed when instrument colonoscopy was attempted and incomplete (Z53.8) or when optical colonoscopy is contraindicated as determined by a qualified endoscopist (Z53.09). All medical records must be legible, include patient identifiers, dates of service, and the responsible clinician's signature, and must support the ICD-10-CM and CPT/HCPCS codes billed. Coverage is subject to the reasonable and necessary requirements in LCD L38777; non-covered services must not be billed as covered and should use the appropriate modifier.

"Colon capsule endoscopy (CCE) may be billed when an instrument colonoscopy has been attempted and was incomplete, documented with ICD-10-CM code Z53."

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