ICD Body System
Date amended:
Statements of Principles
Current RMA Instruments
Reasonable Hypothesis SOP
15 of 2022
Balance of Probabilities SOP
16 of 2022
Changes from previous Instruments


ICD Coding
  • ICD-9-CM Codes: 211.30, 211.40
  • ICD-10-AM Codes: D12.0-D12.5, D12.7, D12.8
Brief description

This SOP covers benign adenomatous polyps of the large intestine (colon and rectum).  An intestinal polyp is a protuberance of the mucosa (lining) of the intestine into the lumen. There are other types of intestinal polyps that are not covered. See the lists below.

Confirming the diagnosis

Diagnosis is based on histology of removed polyps excised via colonoscopy, sigmoidoscopy or surgery.

The relevant medical specialist is a gastroenterologist, or a general or colorectal surgeon.

Additional diagnoses covered by SOP
  • Colorectal adenomatous polyp
  • Colorectal serrated adenoma
  • Colorectal polypoid adenoma
  • Colorectal villous or tubulovillous adenoma
  • Colorectal mixed polypoid and villous adenoma
Conditions not covered by SOP
  • Adenomatous polyps of other sites, ie. anal canal, anus, stomach, duodenum, jejunum or ileum#
  • Benign neoplasms including polyps of the anus or anal canal#
  • Familial Adenomatous Polyposis*
  • Hyperplastic polyps of the colon or rectum#
  • Malignant neoplasm of the colon*
  • Malignant neoplasm of the rectum*
  • Non-epithelial benign neoplasms of the colon or rectum#
  • Non-neoplastic polyps of the colon or rectum#
  • Non-polypoid dysplasia of the colon or rectum#
  • Polyps of the colon or rectum which are not adenomatous#

* another SOP applies

# non-SOP condition

Clinical onset

In most cases the condition will be asymptomatic and clinical onset will be the same as date of diagnosis. 

Clinical worsening

The only SOP worsening factor is for inability to obtain appropriate clinical management.  Appropriate management includes removal of polyps and ongoing surveillance.