Non-covered ICD-10-CM Codes for All Lab NCDs Jan2020 - Quest Diagnostics

[Pages:8]Non-covered ICD-10-CM Codes for All Lab NCDs

This section lists codes that are never covered by Medicare for a diagnostic lab testing service. If a code from this section is given as the reason for the test, the test may be billed to the Medicare beneficiary without billing Medicare first because the service is not covered by statute, in most instances because it is performed for screening purposes and is not within an exception. The beneficiary, however, does have a right to have the claim submitted to Medicare, upon request.

The ICD-10-CM codes in the table below can be viewed on CMS' website as part of Downloads: Lab Code List, at



Code R99 Z00.00 Z00.01 Z00.110 Z00.111 Z00.121 Z00.129 Z00.5 Z00.6 Z00.70

Z00.71 Z00.8 Z02.0 Z02.1 Z02.2 Z02.3 Z02.4 Z02.5 Z02.6 Z02.71 Z02.79 Z02.81 Z02.82

Description Ill-defined and unknown cause of mortality Encounter for general adult medical examination without abnormal findings Encounter for general adult medical examination with abnormal findings Health examination for newborn under 8 days old Health examination for newborn 8 to 28 days old Encounter for routine child health examination with abnormal findings Encounter for routine child health examination without abnormal findings Encounter for examination of potential donor of organ and tissue Encounter for examination for normal comparison and control in clinical research program Encounter for examination for period of delayed growth in childhood without abnormal findings Encounter for examination for period of delayed growth in childhood with abnormal findings Encounter for other general examination Encounter for examination for admission to educational institution Encounter for pre-employment examination Encounter for examination for admission to residential institution Encounter for examination for recruitment to armed forces Encounter for examination for driving license Encounter for examination for participation in sport Encounter for examination for insurance purposes Encounter for disability determination Encounter for issue of other medical certificate Encounter for paternity testing Encounter for adoption services

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Code Z02.83 Z02.89 Z02.9 Z04.6 Z04.81 Z04.82 Z04.89 Z04.9 Z11.0 Z11.1 Z11.2 Z11.3 Z11.4 Z11.51 Z11.59 Z11.6 *Z11.7 Z11.8 Z11.9 Z12.0 Z12.10 Z12.13 Z12.2 Z12.6 Z12.71 Z12.72 Z12.73 Z12.79 Z12.81 Z12.82 Z12.83 Z12.89 Z12.9 Z13.0

Description Encounter for blood-alcohol and blood-drug test Encounter for other administrative examinations Encounter for administrative examinations, unspecified Encounter for general psychiatric examination, requested by authority Encounter for examination and observation of victim following forced sexual exploitation Encounter for examination and observation of victim following forced labor exploitation Encounter for examination and observation for other specified reasons Encounter for examination and observation for unspecified reason Encounter for screening for intestinal infectious diseases Encounter for screening for respiratory tuberculosis Encounter for screening for other bacterial diseases Encounter for screening for infections with a predominantly sexual mode of transmission Encounter for screening for human immunodeficiency virus [HIV] Encounter for screening for human papillomavirus (HPV) Encounter for screening for other viral diseases Encounter for screening for other protozoal diseases and helminthiases *Encounter for testing for latent tuberculosis infection Encounter for screening for other infectious and parasitic diseases Encounter for screening for infectious and parasitic diseases, unspecified Encounter for screening for malignant neoplasm of stomach Encounter for screening for malignant neoplasm of intestinal tract, unspecified Encounter for screening for malignant neoplasm of small intestine Encounter for screening for malignant neoplasm of respiratory organs Encounter for screening for malignant neoplasm of bladder Encounter for screening for malignant neoplasm of testis Encounter for screening for malignant neoplasm of vagina Encounter for screening for malignant neoplasm of ovary Encounter for screening for malignant neoplasm of other genitourinary organs Encounter for screening for malignant neoplasm of oral cavity Encounter for screening for malignant neoplasm of nervous system Encounter for screening for malignant neoplasm of skin Encounter for screening for malignant neoplasm of other sites Encounter for screening for malignant neoplasm, site unspecified Encounter for screening for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism

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Code Z13.21 Z13.220 Z13.228 Z13.29 Z13.30 Z13.31 Z13.32 Z13.39 Z13.40 Z13.41 Z13.42 Z13.49 Z13.5 Z13.71 Z13.79 Z13.810 Z13.811 Z13.818 Z13.820 Z13.828 Z13.83 Z13.84 Z13.850 Z13.858 Z13.88 Z13.89 Z13.9 Z36.0 Z36.1 Z36.2 Z36.3 Z36.4 Z36.5 Z36.81 Z36.82

Description Encounter for screening for nutritional disorder Encounter for screening for lipoid disorders Encounter for screening for other metabolic disorders Encounter for screening for other suspected endocrine disorder Encounter for screening examination for mental health and behavioral disorders, unspecified Encounter for screening for depression Encounter for screening for maternal depression Encounter for screening examination for other mental health and behavioral disorders Encounter for screening for unspecified developmental delays Encounter for autism screening Encounter for screening for global developmental delays (milestones) Encounter for screening for other developmental delays Encounter for screening for eye and ear disorders Encounter for nonprocreative screening for genetic disease carrier status Encounter for other screening for genetic and chromosomal anomalies Encounter for screening for upper gastrointestinal disorder Encounter for screening for lower gastrointestinal disorder Encounter for screening for other digestive system disorders Encounter for screening for osteoporosis Encounter for screening for other musculoskeletal disorder Encounter for screening for respiratory disorder NEC Encounter for screening for dental disorders Encounter for screening for traumatic brain injury Encounter for screening for other nervous system disorders Encounter for screening for disorder due to exposure to contaminants Encounter for screening for other disorder Encounter for screening, unspecified Encounter for antenatal screening for chromosomal anomalies Encounter for antenatal screening for raised alphafetoprotein level Encounter for other antenatal screening follow-up Encounter for antenatal screening for malformations Encounter for antenatal screening for fetal growth retardation Encounter for antenatal screening for isoimmunization Encounter for antenatal screening for hydrops fetalis Encounter for antenatal screening for nuchal translucency

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Code Z36.83 Z36.84 Z36.85 Z36.86 Z36.87 Z36.88 Z36.89 Z36.8A Z36.9 Z40.00 Z40.01 Z40.02 Z40.09 Z40.8 Z40.9 Z41.1 Z41.2 Z41.3 Z41.8 Z41.9 Z46.1 Z56.0 Z56.2 Z56.3 Z56.4 Z56.5 Z56.6 Z56.81 Z56.82 Z56.89 Z56.9 Z57.0 Z57.1 Z57.2 Z57.31

Description Encounter for fetal screening for congenital cardiac abnormalities Encounter for antenatal screening for fetal lung maturity Encounter for antenatal screening for Streptococcus B Encounter for antenatal screening for cervical length Encounter for antenatal screening for uncertain dates Encounter for antenatal screening for fetal macrosomia Encounter for other specified antenatal screening Encounter for antenatal screening for other genetic defects Encounter for antenatal screening, unspecified Encounter for prophylactic removal of unspecified organ Encounter for prophylactic removal of breast Encounter for prophylactic removal of ovary(s) Encounter for prophylactic removal of other organ Encounter for other prophylactic surgery Encounter for prophylactic surgery, unspecified Encounter for cosmetic surgery Encounter for routine and ritual male circumcision Encounter for ear piercing Encounter for other procedures for purposes other than remedying health state Encounter for procedure for purposes other than remedying health state, unspecified Encounter for fitting and adjustment of hearing aid Unemployment, unspecified Threat of job loss Stressful work schedule Discord with boss and workmates Uncongenial work environment Other physical and mental strain related to work Sexual harassment on the job Military deployment status Other problems related to employment Unspecified problems related to employment Occupational exposure to noise Occupational exposure to radiation Occupational exposure to dust Occupational exposure to environmental tobacco smoke

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*January 2020 Changes ICD-10-CM Version ? Red

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Code Z57.39 Z57.4 Z57.5 Z57.6 Z57.7 Z57.8 Z57.9 Z59.0 Z59.1 Z59.2 Z59.3 Z59.4 Z59.5 Z59.6 Z59.7 Z59.8 Z59.9 Z60.2 Z62.21 Z71.0 Z74.1 Z74.2 Z74.3 Z74.8 Z74.9 Z75.5 Z76.0 Z76.1 Z76.2 Z76.3 Z76.4 Z76.81 Z80.1 Z80.2 Z80.49

Description Occupational exposure to other air contaminants Occupational exposure to toxic agents in agriculture Occupational exposure to toxic agents in other industries Occupational exposure to extreme temperature Occupational exposure to vibration Occupational exposure to other risk factors Occupational exposure to unspecified risk factor Homelessness Inadequate housing Discord with neighbors, lodgers and landlord Problems related to living in residential institution Lack of adequate food and safe drinking water Extreme poverty Low income Insufficient social insurance and welfare support Other problems related to housing and economic circumstances Problem related to housing and economic circumstances, unspecified Problems related to living alone Child in welfare custody Person encountering health services to consult on behalf of another person Need for assistance with personal care Need for assistance at home and no other household member able to render care Need for continuous supervision Other problems related to care provider dependency Problem related to care provider dependency, unspecified Holiday relief care Encounter for issue of repeat prescription Encounter for health supervision and care of foundling Encounter for health supervision and care of other healthy infant and child Healthy person accompanying sick person Other boarder to healthcare facility Expectant parent(s) prebirth pediatrician visit Family history of malignant neoplasm of trachea, bronchus and lung Family history of malignant neoplasm of other respiratory and intrathoracic organs Family history of malignant neoplasm of other genital organs

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Code Z80.51 Z80.52 Z80.59 Z80.6 Z80.7 Z80.8 Z80.9 Z81.0 Z81.1 Z81.2 Z81.3 Z81.4 Z81.8 Z82.0 Z82.1 Z82.2 Z82.3 Z82.41 Z82.49 Z82.5 Z82.61 Z82.62 Z82.69 Z82.71 Z82.79

Z82.8

Z83.0 Z83.1 Z83.2

Z83.3 Z83.41 Z83.49 Z83.511

Description Family history of malignant neoplasm of kidney Family history of malignant neoplasm of bladder Family history of malignant neoplasm of other urinary tract organ Family history of leukemia Family history of other malignant neoplasms of lymphoid, hematopoietic and related tissues Family history of malignant neoplasm of other organs or systems Family history of malignant neoplasm, unspecified Family history of intellectual disabilities Family history of alcohol abuse and dependence Family history of tobacco abuse and dependence Family history of other psychoactive substance abuse and dependence Family history of other substance abuse and dependence Family history of other mental and behavioral disorders Family history of epilepsy and other diseases of the nervous system Family history of blindness and visual loss Family history of deafness and hearing loss Family history of stroke Family history of sudden cardiac death Family history of ischemic heart disease and other diseases of the circulatory system Family history of asthma and other chronic lower respiratory diseases Family history of arthritis Family history of osteoporosis Family history of other diseases of the musculoskeletal system and connective tissue Family history of polycystic kidney Family history of other congenital malformations, deformations and chromosomal abnormalities Family history of other disabilities and chronic diseases leading to disablement, not elsewhere classified Family history of human immunodeficiency virus [HIV] disease Family history of other infectious and parasitic diseases Family history of diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism Family history of diabetes mellitus Family history of multiple endocrine neoplasia [MEN] syndrome Family history of other endocrine, nutritional and metabolic diseases Family history of glaucoma

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Code Z83.518 Z83.52 Z83.6 Z83.71 Z83.79 Z84.0 Z84.1 Z84.2 Z84.3 Z84.81 Z84.89

Description Family history of other specified eye disorder Family history of ear disorders Family history of other diseases of the respiratory system Family history of colonic polyps Family history of other diseases of the digestive system Family history of diseases of the skin and subcutaneous tissue Family history of disorders of kidney and ureter Family history of other diseases of the genitourinary system Family history of consanguinity Family history of carrier of genetic disease Family history of other specified conditions

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Reasons for Denial for All Lab NCDs

NOTE: This section includes CMS's interpretation of its longstanding policies pertaining to nationally covered laboratory services, and is included for informational purposes.

Tests for screening purposes that are performed in the absence of signs, symptoms, complaints, or personal history of disease or injury are not covered except as explicitly authorized by statute.

Tests for administrative purposes, including exams required by insurance companies, business establishments, government agencies, or other third parties, are not covered.

Tests that are not reasonable and necessary for the diagnosis or treatment of an illness or injury are not covered by statute.

Failure to provide documentation of the medical necessity of tests might result in denial of claims. The documentation may include notes documenting relevant signs, symptoms, or abnormal findings that substantiate the medical necessity for ordering the tests. In addition, failure to provide independent verification that the test was ordered by the treating physician (or qualified nonphysician practitioner) through documentation in the physician's office might result in denial.

A claim for a test for which there is a national coverage policy will be denied as not reasonable and necessary if the claim is submitted without an ICD-10-CM code or narrative diagnosis listed as covered in the policy unless other medical documentation justifying the necessity is submitted with the claim.

If a national coverage policy identifies a frequency expectation, a claim for a test that exceeds that expectation may be denied as not reasonable and necessary, unless it is submitted with documentation justifying increased frequency.

Tests that are not ordered by a treating physician or other qualified treating nonphysician practitioner acting within the scope of their license and in compliance with Medicare requirements will be denied as not reasonable and necessary.

Failure of the clinical laboratory performing the test to have the appropriate Clinical Laboratory Improvement Amendments of 1988 (CLIA) certificate will result in denial of claims.

NCD Error! No text of specified style in document.*January 2020 Changes ICD-10-CM Version ? Red

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