Page 267 - Medicare Benefit Policy Manual

Code Description

K51.911 Ulcerative colitis, unspecified with rectal bleeding

K51.912 Ulcerative colitis, unspecified with intestinal obstruction
K51.913 Ulcerative colitis, unspecified with fistula

K51.914 Ulcerative colitis, unspecified with abscess

K51.918 Ulcerative colitis, unspecified with other complication

K51.919 Ulcerative colitis, unspecified with unspecified complications

K52.1 Toxic gastroenteritis and colitis

K52.89 Other specified noninfective gastroenteritis and colitis
K52.9 Noninfective gastroenteritis and colitis, unspecified

Z85.038 Personal history of other malignant neoplasm of large intestine

Z85.048 Personal history of other malignant neoplasm of rectum, rectosigmoid junction,
and anus
D12.6 Benign neoplasm of colon, unspecified
Z12.11 Encounter for screening for malignant neoplasm of colon

Z12.12 Encounter for screening for malignant neoplasm of rectum

Z15.09 Genetic susceptibility to other malignant neoplasm

Z80.0 Family history of malignant neoplasm of digestive organs

Z83.71 Family history of colonic polyps

280.2.4 - Determining Frequency Standards
(Rev. 1, 10-01-03)
B3-4180.4

To determine the 11, 23, 47, and 119-month periods, the count starts beginning with the
month after the month in which a previous test/procedure was performed.

EXAMPLE: The beneficiary received a fecal-occult blood test in January 2000. The
A/B MAC (B) starts its count beginning with February 2000. The beneficiary is eligible
to receive another blood test in January 2001 (the month after 11 full months have
passed).

280.2.5 - Noncovered Services
(Rev. 1, 10-01-03)
B3-4180.5