by Jared Staheli
July 5th, 2015
A. Characteristics of the High Risk Individual
An individual at high risk for developing colorectal cancer has one or more of the following:
• A close relative (sibling, parent, or child) who has had colorectal cancer or an adenomatous polyp;
• A family history of familial adenomatous polyposis;
• A family history of hereditary nonpolyposis colorectal cancer;
• A personal history of adenomatous polyps;
• A personal history of colorectal cancer; or
• Inflammatory bowel disease, including Crohn’s Disease, and ulcerative colitis.
B. Partial List of ICD-9-CM Codes Indicating High Risk
Listed below are some examples of diagnoses that meet the high-risk criteria for colorectal cancer. This is not an all-inclusive list. There may be more instances of conditions, which may be coded and could be considered high risk at the medical directors’ discretion.
Personal History
V10.05 | Personal history of malignant neoplasm of large intestine |
V10.06 | Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus |
Chronic Digestive Disease Condition:
555.0 | Regional enteritis of small intestine |
555.1 | Regional enteritis of large intestine |
555.2 | Regional enteritis of small intestine with large intestine |
555.9 | Regional enteritis of unspecified site |
556.0 | Ulcerative (chronic) enterocolitis |
556.1 | Ulcerative (chronic) ileocolitis |
556.2 | Ulcerative (chronic) proctitis |
556.3 | Ulcerative (chronic) proctosigmoiditis |
556.8 | Other ulcerative colitis |
556.9 | Ulcerative colitis, unspecified (non-specific PDX on the MCE) |
Inflammatory Bowel:
558.2 | Toxic gastroenteritis and colitis |
558.9 | Other and unspecified non-infectious gastroenteritis and colitis |
References: