Determining High Risk for Developing Colorectal Cancer (Rev. 1, 10-01-03)

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

Chronic Digestive Disease Condition:

Inflammatory Bowel:

References:

• Pub 100-04 Medicare Claims Processing Manual - Chapter 18