Billing and Coding: Colon Capsule Endoscopy (CCE)

Colon capsule endoscopy is covered when optical colonoscopy was attempted and incomplete (ICD-10 Z53.8) or when optical colonoscopy is contraindicated as determined by qualified endoscopy-trained physicians (ICD-10 Z53.09), subject to the LCD L38807 reasonable and necessary requirements. Claims must be supported by complete, legible medical records with provider signature and documentation that justifies the selected ICD-10 and CPT/HCPCS codes; non-covered services must be billed with the appropriate modifier.

"Colon capsule endoscopy (CCE) is covered when instrument (optical) colonoscopy has been attempted and was incomplete, documented using ICD-10-CM code Z53."

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