ICD↔CPT crosswalk
CPT 76872: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 76872 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 76872 with a diagnosis that isn't covered typically denies as CARC 50 — not medically necessary.
National approximation. Coverage varies by MAC and state — confirm against the specific LCD/NCD and article that applies to your jurisdiction and date of service.
| ICD-10 | Description |
|---|---|
| A18.14 | Tuberculosis of prostate |
| C19 | Malignant neoplasm of rectosigmoid junction |
| C20 | Malignant neoplasm of rectum |
| C21.1 | Malignant neoplasm of anal canal |
| C21.2 | Malignant neoplasm of cloacogenic zone |
| C21.8 | Malignant neoplasm of overlapping sites of rectum, anus and anal canal |
| C45.1 | Mesothelioma of peritoneum |
| C48.0 | Malignant neoplasm of retroperitoneum |
| C48.1 | Malignant neoplasm of specified parts of peritoneum |
| C48.8 | Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum |
| C61 | Malignant neoplasm of prostate |
| C67.0 | Malignant neoplasm of trigone of bladder |
| C67.1 | Malignant neoplasm of dome of bladder |
| C67.2 | Malignant neoplasm of lateral wall of bladder |
| C67.3 | Malignant neoplasm of anterior wall of bladder |
| C67.4 | Malignant neoplasm of posterior wall of bladder |
| C67.5 | Malignant neoplasm of bladder neck |
| C67.8 | Malignant neoplasm of overlapping sites of bladder |
| C78.5 | Secondary malignant neoplasm of large intestine and rectum |
| C79.51 | Secondary malignant neoplasm of bone |
| C79.52 | Secondary malignant neoplasm of bone marrow |
| C79.82 | Secondary malignant neoplasm of genital organs |
| D01.1 | Carcinoma in situ of rectosigmoid junction |
| D01.2 | Carcinoma in situ of rectum |
| D01.3 | Carcinoma in situ of anus and anal canal |
| D07.5 | Carcinoma in situ of prostate |
| D12.7 | Benign neoplasm of rectosigmoid junction |
| D12.8 | Benign neoplasm of rectum |
| D12.9 | Benign neoplasm of anus and anal canal |
| D29.1 | Benign neoplasm of prostate |
| D37.1 | Neoplasm of uncertain behavior of stomach |
| D37.2 | Neoplasm of uncertain behavior of small intestine |
| D37.3 | Neoplasm of uncertain behavior of appendix |
| D37.4 | Neoplasm of uncertain behavior of colon |
| D37.5 | Neoplasm of uncertain behavior of rectum |
| D40.0 | Neoplasm of uncertain behavior of prostate |
| K50.014 | Crohn's disease of small intestine with abscess |
| K50.114 | Crohn's disease of large intestine with abscess |
| K50.814 | Crohn's disease of both small and large intestine with abscess |
| K60.311 | Anal fistula, simple, initial |
| K60.312 | Anal fistula, simple, persistent |
| K60.313 | Anal fistula, simple, recurrent |
| K60.321 | Anal fistula, complex, initial |
| K60.322 | Anal fistula, complex, persistent |
| K60.323 | Anal fistula, complex, recurrent |
| K60.411 | Rectal fistula, simple, initial |
| K60.412 | Rectal fistula, simple, persistent |
| K60.413 | Rectal fistula, simple, recurrent |
| K60.421 | Rectal fistula, complex, initial |
| K60.422 | Rectal fistula, complex, persistent |
| K60.423 | Rectal fistula, complex, recurrent |
| K60.511 | Anorectal fistula, simple, initial |
| K60.512 | Anorectal fistula, simple, persistent |
| K60.513 | Anorectal fistula, simple, recurrent |
| K60.521 | Anorectal fistula, complex, initial |
| K60.522 | Anorectal fistula, complex, persistent |
| K60.523 | Anorectal fistula, complex, recurrent |
| K61.0 | Anal abscess |
| K61.1 | Rectal abscess |
| K61.2 | Anorectal abscess |
| K61.31 | Horseshoe abscess |
| K61.39 | Other ischiorectal abscess |
| K61.4 | Intrasphincteric abscess |
| K62.0 | Anal polyp |
| K62.1 | Rectal polyp |
| K62.5 | Hemorrhage of anus and rectum |
| K62.7 | Radiation proctitis |
| K62.82 | Dysplasia of anus |
| K62.89 | Other specified diseases of anus and rectum |
| N40.0 | Benign prostatic hyperplasia without lower urinary tract symptoms |
| N40.1 | Benign prostatic hyperplasia with lower urinary tract symptoms |
| N40.2 | Nodular prostate without lower urinary tract symptoms |
| N40.3 | Nodular prostate with lower urinary tract symptoms |
| N41.0 | Acute prostatitis |
| N41.1 | Chronic prostatitis |
| N41.2 | Abscess of prostate |
| N41.3 | Prostatocystitis |
| N41.4 | Granulomatous prostatitis |
| N41.8 | Other inflammatory diseases of prostate |
| N42.30 | Unspecified dysplasia of prostate |
| N42.31 | Prostatic intraepithelial neoplasia |
| N42.32 | Atypical small acinar proliferation of prostate |
| N42.39 | Other dysplasia of prostate |
| N42.81 | Prostatodynia syndrome |
| N42.82 | Prostatosis syndrome |
| N42.83 | Cyst of prostate |
| N42.89 | Other specified disorders of prostate |
| N46.01 | Organic azoospermia |
| N46.021 | Azoospermia due to drug therapy |
| N46.022 | Azoospermia due to infection |
| N46.023 | Azoospermia due to obstruction of efferent ducts |
| N46.024 | Azoospermia due to radiation |
| N46.025 | Azoospermia due to systemic disease |
| N46.029 | Azoospermia due to other extratesticular causes |
| N46.11 | Organic oligospermia |
| N46.121 | Oligospermia due to drug therapy |
| N46.122 | Oligospermia due to infection |
| N46.123 | Oligospermia due to obstruction of efferent ducts |
| N46.124 | Oligospermia due to radiation |
| N46.125 | Oligospermia due to systemic disease |
| N46.129 | Oligospermia due to other extratesticular causes |
| N46.8 | Other male infertility |
| N50.1 | Vascular disorders of male genital organs |
| N53.11 | Retarded ejaculation |
| N53.13 | Anejaculatory orgasm |
| N53.14 | Retrograde ejaculation |
| N53.19 | Other ejaculatory dysfunction |
| R15.0 | Incomplete defecation |
| R15.1 | Fecal smearing |
| R15.2 | Fecal urgency |
| R15.9 | Full incontinence of feces |
| R36.1 | Hematospermia |
| R97.20 | Elevated prostate specific antigen [PSA] |
| R97.21 | Rising PSA following treatment for malignant neoplasm of prostate |
| Z03.89 | Encounter for observation for other suspected diseases and conditions ruled out |
| Z12.12 | Encounter for screening for malignant neoplasm of rectum |
| Z85.048 | Personal history of other malignant neoplasm of rectum, rectosigmoid junction, and anus |
| Z85.46 | Personal history of malignant neoplasm of prostate |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 76872?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 118 ICD-10 diagnosis codes that support medical necessity for CPT 76872. The covered codes are listed on this page. Coverage varies by MAC/state — always confirm against the policy that applies to you.
What is a medical-necessity (LCD/NCD) crosswalk?
A claim whose procedure isn't supported by a covered diagnosis denies as "not medically necessary" (CARC 50). CMS coverage policies define which diagnoses justify a procedure; this page is the ICD-10 → CPT 76872 view of that relationship.
Catch medical-necessity denials before you bill. CareNiva scrubs claims against LCD/NCD coverage and flags unsupported diagnoses — in the same platform you run visits and billing.
More free billing tools: all crosswalks · NCCI edits · Medicare fees · denial codes
Informational only, not coding, billing, or legal advice. Based on CMS Medicare Coverage Database data; verify the current LCD/NCD for your MAC before billing.
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