Guidelines for billing the Capsule to Medicare will vary between jurisdictions and as a medical biller, you need to look up the LCD that governs your state. But here are some of the basics of billing Capsule to Medicare.

Capsule is indicated when:

1.       Patient has Dx of occult gastrointestinal bleeding of an undetermined site.
2.       Patient has already undergone an upper and lower endoscopy and tests have not revealed source of bleeding.

Check with your local MAC, but payable DX(es) may include:

A18.32: Tuberculous enteritis
A18.39: Retroperitoneal tuberculosis
A18.83: Tuberculosis of digestive tract organs, not elsewhere classified
C17.0: Malignant neoplasm of duodenum
C17.1: Malignant neoplasm of jejunum
C17.2: Malignant neoplasm of ileum
C17.3: Meckel’s diverticulum, malignant
C17.8: Malignant neoplasm of overlapping sites of small intestine
C17.9: Malignant neoplasm of small intestine, unspecified
C49.A3: Gastrointestinal stromal tumor of small intestine
C49.A4: Gastrointestinal stromal tumor of large intestine
C78.4: Secondary malignant neoplasm of small intestine
D01.40: Carcinoma in situ of unspecified part of intestine
D01.49: Carcinoma in situ of other parts of intestine
D13.2: Benign neoplasm of duodenum
D13.30: Benign neoplasm of unspecified part of small intestine
D13.39: Benign neoplasm of other parts of small intestine
D37.2: Neoplasm of uncertain behavior of small intestine
D50.0 I: Iron deficiency anemia secondary to blood loss (chronic)
D50.9: Iron deficiency anemia, unspecified
E16.4: Increased secretion of gastrin
I77.6: Arteritis, unspecified
K31.811: Angiodysplasia of stomach and duodenum with bleeding
K31.82: Dieulafoy lesion (hemorrhagic) of stomach and duodenum
K50.00: Crohn’s disease of small intestine without complications
K50.011: Crohn’s disease of small intestine with rectal bleeding
K50.018: Crohn’s disease of small intestine with other complication
K50.019: Crohn’s disease of small intestine with unspecified complications
K50.10: Crohn’s disease of large intestine without complications
K50.111: Crohn’s disease of large intestine with rectal bleeding
K50.118: Crohn’s disease of large intestine with other complication
K50.119: Crohn’s disease of large intestine with unspecified complications
K50.80: Crohn’s disease of both small and large intestine without complications
K50.811: Crohn’s disease of both small and large intestine with rectal bleeding
K50.818: Crohn’s disease of both small and large intestine with other complication
K50.819: Crohn’s disease of both small and large intestine with unspecified complications
K50.90: Crohn’s disease, unspecified, without complications
K50.911: Crohn’s disease, unspecified, with rectal bleeding
K50.918: Crohn’s disease, unspecified, with other complication
K50.919: Crohn’s disease, unspecified, with unspecified complications
K52.0: Gastroenteritis and colitis due to radiation
K55.1: Chronic vascular disorders of intestine
K55.21: Angiodysplasia of colon with hemorrhage
K57.11: Diverticulosis of small intestine without perforation or abscess with bleeding
K57.13: Diverticulitis of small intestine without perforation or abscess with bleeding
K57.51: Diverticulosis of small and large intestine w/o perforation or abscess with bleeding
K57.53: Diverticulitis of small and large intestine w/o perforation or abscess with bleeding
K90.0: Celiac disease
K92.1: Melena