ND Committee Review
Internal Medical Policy Committee 11-14-2019 Update, no changes in criteria. Reformat diagnosis codes. Remove duplicate diagnosis codes.
Internal Medical Policy Committee 3-16-2020 Removed the indications (Angiodysplasias of the gastrointestinal tract; To investigate anemia with concomitant iron deficiency, suspected to be of small bowel origin, after appropriate evaluation (at a minimum lower and upper endoscopy) has excluded a source of anemia from the upper GI tract and colon)
Internal Medical Policy Committee 9-21-2020 Added Diagnosis Codes C17.0; C17.1; C17.2; C17.3; C17.8; C17.9; C78.4; C7A.010; C7A.011; C7A.012; C7A.019; D37.2; D3A.010; D3A.011; D3A.012; D3A.019; D50.0
Internal Medical Policy Committee 1-19-2021 Removed Diagnosis Codes D12.6, G89.29, K52.22, R10.0, R10.10, R10.11, R10.12, R10.13, R10.30, R10.31, R10.32, R10.33 and Added D50.1, D50.8, D50.9 and K52.3. Added Procedure code 91299
Internal Medical Policy Committee 7-22-2021 Added: Procedure code 0651T
Internal Medical Policy Committee 9-21-2021 Coding update- Removed Diagnosis code K22.8; Added Diagnosis codes: K22.81, K22.82, K22.89, K31.A0; K31.A11; K31.A12; K31.A13, K3.A14, K31.A15, K31.A19, K31.A21, K31.A22, K31.A29
Internal Medical Policy Committee 11-23-2021 Coding update-Effective January 01, 2022
- Added Diagnosis codes: I85.00; I85.01; I85.10; I85.11 and Procedure code 91113;
- Removed Diagnosis codes: K21.9; K22.2; K22.3; K22.70; K22.710; K22.711; K22.719 and Procedure code: 0355T