ICD↔CPT crosswalk
CPT 91111: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 91111 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 91111 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 |
|---|---|
| A18.32 | 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 |
| C7A.010 | Malignant carcinoid tumor of the duodenum |
| C7A.011 | Malignant carcinoid tumor of the jejunum |
| C7A.012 | Malignant carcinoid tumor of the ileum |
| C7A.019 | Malignant carcinoid tumor of the small intestine, unspecified portion |
| D01.40 | Carcinoma in situ of unspecified part of intestine |
| D01.49 | Carcinoma in situ of other parts of intestine |
| D12.0 | Benign neoplasm of cecum |
| D12.1 | Benign neoplasm of appendix |
| D12.2 | Benign neoplasm of ascending colon |
| D12.3 | Benign neoplasm of transverse colon |
| D12.4 | Benign neoplasm of descending colon |
| D12.5 | Benign neoplasm of sigmoid colon |
| 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 |
| D37.1 | 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 |
| D3A.010 | Benign carcinoid tumor of the duodenum |
| D3A.011 | Benign carcinoid tumor of the jejunum |
| D3A.012 | Benign carcinoid tumor of the ileum |
| D3A.019 | Benign carcinoid tumor of the small intestine, unspecified portion |
| D50.0 | Iron deficiency anemia secondary to blood loss (chronic) |
| D50.9 | Iron deficiency anemia, unspecified |
| D62 | Acute posthemorrhagic anemia |
| D72.89 | Other specified disorders of white blood cells |
| E16.4 | Increased secretion of gastrin |
| I77.6 | Arteritis, unspecified |
| I85.00 | Esophageal varices without bleeding |
| I85.01 | Esophageal varices with bleeding |
| I85.10 | Secondary esophageal varices without bleeding |
| I85.11 | Secondary esophageal varices with bleeding |
| I89.0 | Lymphedema, not elsewhere classified |
| 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 |
| K50.012 | Crohn's disease of small intestine with intestinal obstruction |
| K50.013 | Crohn's disease of small intestine with fistula |
| K50.014 | Crohn's disease of small intestine with abscess |
| 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 |
| K50.112 | Crohn's disease of large intestine with intestinal obstruction |
| K50.113 | Crohn's disease of large intestine with fistula |
| K50.114 | Crohn's disease of large intestine with abscess |
| 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 |
| K50.812 | Crohn's disease of both small and large intestine with intestinal obstruction |
| K50.813 | Crohn's disease of both small and large intestine with fistula |
| K50.814 | Crohn's disease of both small and large intestine with abscess |
| 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 |
| K50.912 | Crohn's disease, unspecified, with intestinal obstruction |
| K50.913 | Crohn's disease, unspecified, with fistula |
| K50.914 | Crohn's disease, unspecified, with abscess |
| 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 |
| K52.1 | Toxic gastroenteritis and colitis |
| K52.21 | Food protein-induced enterocolitis syndrome |
| K52.22 | Food protein-induced enteropathy |
| K52.29 | Other allergic and dietetic gastroenteritis and colitis |
| K52.3 | Indeterminate colitis |
| K52.81 | Eosinophilic gastritis or gastroenteritis |
| K52.82 | Eosinophilic colitis |
| K52.89 | Other specified noninfective gastroenteritis and colitis |
| K52.9 | Noninfective gastroenteritis and colitis, unspecified |
| K55.011 | Focal (segmental) acute (reversible) ischemia of small intestine |
| K55.012 | Diffuse acute (reversible) ischemia of small intestine |
| K55.019 | Acute (reversible) ischemia of small intestine, extent unspecified |
| K55.021 | Focal (segmental) acute infarction of small intestine |
| K55.022 | Diffuse acute infarction of small intestine |
| K55.029 | Acute infarction of small intestine, extent unspecified |
| K55.051 | Focal (segmental) acute (reversible) ischemia of intestine, part unspecified |
| K55.052 | Diffuse acute (reversible) ischemia of intestine, part unspecified |
| K55.059 | Acute (reversible) ischemia of intestine, part and extent unspecified |
| K55.061 | Focal (segmental) acute infarction of intestine, part unspecified |
| K55.062 | Diffuse acute infarction of intestine, part unspecified |
| K55.069 | Acute infarction of intestine, part and extent unspecified |
| K55.1 | Chronic vascular disorders of intestine |
| K55.20 | Angiodysplasia of colon without hemorrhage |
| K55.21 | Angiodysplasia of colon with hemorrhage |
| K55.30 | Necrotizing enterocolitis, unspecified |
| K55.31 | Stage 1 necrotizing enterocolitis |
| K55.32 | Stage 2 necrotizing enterocolitis |
| K55.33 | Stage 3 necrotizing enterocolitis |
| K56.1 | Intussusception |
| K56.51 | Intestinal adhesions [bands], with partial obstruction |
| K56.600 | Partial intestinal obstruction, unspecified as to cause |
| K56.601 | Complete intestinal obstruction, unspecified as to cause |
| K56.609 | Unspecified intestinal obstruction, unspecified as to partial versus complete obstruction |
| K56.690 | Other partial intestinal obstruction |
| K57.01 | Diverticulitis of small intestine with perforation and abscess with bleeding |
| K57.11 | Diverticulosis of small intestine without perforation or abscess with bleeding |
| K57.13 | Diverticulitis of small intestine without perforation or abscess with bleeding |
| K57.41 | Diverticulitis of both small and large intestine with perforation and abscess with bleeding |
| K57.51 | Diverticulosis of both small and large intestine without perforation or abscess with bleeding |
| K57.53 | Diverticulitis of both small and large intestine without perforation or abscess with bleeding |
| K58.0 | Irritable bowel syndrome with diarrhea |
| K58.9 | Irritable bowel syndrome, unspecified |
| K63.3 | Ulcer of intestine |
| K63.5 | Polyp of colon |
| K63.81 | Dieulafoy lesion of intestine |
| K70.2 | Alcoholic fibrosis and sclerosis of liver |
| K70.30 | Alcoholic cirrhosis of liver without ascites |
| K70.31 | Alcoholic cirrhosis of liver with ascites |
| K74.00 | Hepatic fibrosis, unspecified |
| K74.01 | Hepatic fibrosis, early fibrosis |
| K74.02 | Hepatic fibrosis, advanced fibrosis |
| K74.3 | Primary biliary cirrhosis |
| K74.4 | Secondary biliary cirrhosis |
| K74.5 | Biliary cirrhosis, unspecified |
| K74.60 | Unspecified cirrhosis of liver |
| K74.69 | Other cirrhosis of liver |
| K76.6 | Portal hypertension |
| K90.0 | Celiac disease |
| K90.41 | Non-celiac gluten sensitivity |
| K90.49 | Malabsorption due to intolerance, not elsewhere classified |
| K90.89 | Other intestinal malabsorption |
| K91.31 | Postprocedural partial intestinal obstruction |
| K92.0 | Hematemesis |
| K92.1 | Melena |
| K92.2 | Gastrointestinal hemorrhage, unspecified |
| Q85.81 | PTEN hamartoma tumor syndrome |
| Q85.82 | Other Cowden syndrome |
| Q85.83 | Von Hippel-Lindau syndrome |
| Q85.89 | Other phakomatoses, not elsewhere classified |
| Q85.9 | Phakomatosis, unspecified |
| R10.10 | Upper abdominal pain, unspecified |
| R10.11 | Right upper quadrant pain |
| R10.12 | Left upper quadrant pain |
| R10.13 | Epigastric pain |
| R10.21 | Pelvic and perineal pain right side |
| R10.22 | Pelvic and perineal pain left side |
| R10.23 | Pelvic and perineal pain bilateral |
| R10.30 | Lower abdominal pain, unspecified |
| R10.31 | Right lower quadrant pain |
| R10.32 | Left lower quadrant pain |
| R10.33 | Periumbilical pain |
| R10.84 | Generalized abdominal pain |
| R10.85 | Abdominal pain of multiple sites |
| R10.9 | Unspecified abdominal pain |
| R19.5 | Other fecal abnormalities |
| R19.7 | Diarrhea, unspecified |
| R93.3 | Abnormal findings on diagnostic imaging of other parts of digestive tract |
| Z98.890 | Other specified postprocedural states |
| Z98.891 | History of uterine scar from previous surgery |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 91111?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 167 ICD-10 diagnosis codes that support medical necessity for CPT 91111. 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 91111 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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