ABBREVIATED MEDICALLY SUPPORTED ICD-10 CODE LIST …

ABBREVIATED MEDICALLY SUPPORTED ICD-10 CODE LIST

Quick Reference to Common Diagnoses Please refer to your Medicare Bulletin for a complete listing of tests requiring Medical Necessity information.

APOLIPOPROTEIN (Lipoprotein A or B)

FDA non-approved. No payable codes. ABN always required.

ALPHA-FETOPROTEIN (AFP)

K73.0-K73.9

Chronic Hepatitis

K74.60-K74.69 Cirrhosis

E84.9

Cystic Fibrosis

E83.10

Disorder of Iron Metabolism

E83.118-E83.119 Hemochromatosis

C22.8-C62.92

Malignant Neoplasm, Various Sites

E78.2

Mixed Hyperlipidemia

C7A.00-C7B.8 Tumor, Various Sites

B-TYPE NATRIURETIC PEPTIDE (BNP)

I11.0

Heart Disease

I13.01-I13.2

Heart and Kidney Disease

I50.1-I50.9

Heart Failure

(Except I50.20, I50.30, I50.40)

R06.00-R06.82 Shortness of Breath/Respiratory Abnormality

CA 125 (Tumor Antigen by Immunoassay)

R97.8

Abnormal Tumor Markers

R97.1

Elevated Cancer Antigen 125

C48.1-C57.8

Malignant Neoplasm, Multiple Sites

G89.3

Neoplasm Related Pain

CA 15-3/CA27.29 (Tumor Antigen by Immunoassay)

R97.8

Abnormal Tumor Markers

G89.3

Neoplasm related pain

Z85.3

Personal History of Malignant Neoplasm of Breast

C50.011-C50.929 Malignant Neoplasm, Multiple Sites

CA 19-9 (Tumor Antigen by Immunoassay)

R97.8

Abnormal Tumor Markers

C23-C25.9

Malignant Neoplasm, Multiple Sites

Z85.09

Personal History of Malignant Neoplasm/Digestive Organs

CARDIOVASCULAR DISEASE SCREENING

Z13.6 Only and Once Every Five Years

CBC BLOOD COUNTS.

D64.9

Anemia Unspecified

D50.0?D50.9

Anemias

J45.20-J45.902 Asthma

J20.9, J21.8

Bronchitis, acute

R50.9

Fever, NOS

K92.0-K92.2

GI hemorrhage, including hematemesis

R31.9

Hematuria

I10-I15.8

Hypertension

M25.40-M25.9 Joint pain

Z79.891, Z79.899 Long Term (Current) Use Opiate Analgesic/Drug Therapy

R53.81-R53.83 Malaise and Fatigue

G93.3

Post viral fatigue syndrome

M06.9, M06.4

RA and Polyarthropathies

R55

Syncope & collapse

R53.1

Weakness

CEA (Carcinoembryonic Antigen)

R97.8

Abnormal Tumor Markers

R97.0

Elevated CEA

Z08-Z09

Follow up Exam after completed treatment

C15.3-C56.9

Malignant Neoplasm, Multiple Sites

DIGOXIN

I48.91 I50.9 E83.51-E83.52 N18.9 Z79.899 R53.81-R53.83 R11.0-R11.2 E06.9

Atrial Fibrillation, Unspecified Heart Failure Hypocalcemia/Hypercalcemia Kidney Disease Long term use of Medications (Drug Therapy) Malaise and Fatigue Nausea/Vomiting Thyroiditis, Unspecified

DRUG SCREENS AND CONFIRMATIONS

E87.2 or F10.20 Acidosis or Alcohol Dependence

G89.29-G89.4

Chronic Pain

Z51.81

Encounter for therapeutic drug level monitoring

R44.0-R44.3 or R56.9 Hallucinations or Convulsions

Z79.891-Z79.899 Long Term (Current) Use Opiate Analgesic/Drug Therapy

M79.2, M79.7

Neuralgia-Neuritis unspecified, Fibromyalgia

F11.20, F11.220-F11.29 Opioid Dependence

Z91.19

Patient Non-Compliance with Medical Treatment/Regimen

F20.0-F20.89

Schizophrenia

GAMMA GLUTAMYLTRANSFERASE (GGT)

E08-00-E13.9

Diabetes Mellitus

E83.10

Disorder of Iron Metabolism

B15.0-B19.9

Hepatitis

B20

HIV Disease

C81.90

Hodgkin Lymphoma

E78.00-E78.01 Hypercholesterolemia

E78.2-E78.5

Hyperlipidemia

E21.1

Hyperparathyroidism

R17

Jaundice

N19

Kidney Failure

Z79.01-Z79.899 Long term (Current) use of Medication/Drug Therapy

C15.3-C68.9

Malignant Neoplasm, Multiple Sites

A20.9

Plague, Unspecified

A41.9

Sepsis, Unspecified

GLYCOHEMOGLOBIN (HbA1C)

Glycated Hemoglobin or Glycated Protein

(Frequency allowed--4 times in any 12-month period)

R78.71-R78.79, R79.0, R79.89-R79.9 Abnormal Blood Chemistry

R73.01-R73.09 Abnormal Glucose

E08-00-E13.9

Diabetes Mellitus

O24.011-O24.93 Diabetes Mellitus

R73.9 or E16.1-E16.2 Hyperglycemia or Hypoglycemia

Z79.4

Insulin, long-term (current) use

Z79.891-Z79.899 Long Term (Current) Use Opiate Analgesic/Drug Therapy

H. Pylori/ C. Urea

B96.81

Heliocobacter pylori as cause of disease

C16.0-C16.9

Malignant Neoplasm

C83.30-C88.39 Lymphoma

E66.01-E66.9

Obesity

K25.0-K31.89

Ulcer/Gastritis/Disease of Stomach and Duodenum

R10.13 or Z87.11 Epigastric Pain or Personal History Peptic Ulcer Disease

HCV SCREENING

One screening per lifetime for low risk if born between 1945-1965

Z11.59

High Risk Screening= Once every 12 months

Z72.89

Problems Related to Lifestyle AND

F19.20

Unspecified Drug Dependence

Effective 10/2020

ABBREVIATED MEDICALLY SUPPORTED ICD-10 CODE LIST

Quick Reference to Common Diagnoses Please refer to your Medicare Bulletin for a complete listing of tests requiring Medical Necessity information.

HEPATITIS, ACUTE

R10.9

Abdominal Pain

R63.4-R63.5

Abnormal Weight Loss/Weight Gain

K74.60

Cirrhosis of Liver

B15.0-B19.9

Hepatitis

R17

Jaundice

K71.9

Liver Disease, Unspecified

T86.40-T86.49 Liver Transplant Complication

R53.81-R53.83 Malaise and Fatigue

R11.0-R11.11

Nausea/Vomiting

HIV RNA QUANTIFICATION

B20

HIV Disease

O98.411-O98.73 HIV, complicating pregnancy

HIV ANTIBODY QUALITATIVE (Direct Probe)

(Screen supported once per year with Z11.59

AND one of the following Z34.80, Z72.89)

Z20.828

Contact/Exposure to Viral Communicable Diseases

B16.0-B19.9

Hepatitis

B20

HIV Disease

A50.01-A89

STD Infections

A15.0-A19.9

Tuberculosis

Z01.411, Z01.419, Z12.4, Z12.72, Z12.89)

PROTIME

R10.84, R10.9 Abdominal Pain

I42.0-I49.9

Cardiac Dysrhythmias

K76.89, K76.9

Chronic Liver Disease

K70.9

Cirrhosis

D65-D69.9

Coagulation Defects

D53.9

Deficiency Anemia, NOS

E08-00-E13.9

Diabetes Mellitus

I50.1-I50.9

Heart Failure

Z79.01

Long-term (current) use of Anticoagulants

M79.601

Pain in Limb

I82.210-I82.91 Phlebitis and Thrombophlebitis

PSA

(Screening PSA once per year, for men 50+ supported with Z12.5)

N40.0-N40.3

BPH with Urinary Obstruction

R31.0-R31.9

Hematuria (gross, microscopic)

C61

Prostate CA Malignant Neoplasm

N41.9, N42.9

Prostatitis

R97.20-R97.21 PSA, Elevated

R39.15, R39.11 Urgency of Urination, Urinary Hesitancy

R35.0

Urinary Frequency

R32

Urinary Incontinence, Unspecified

IRON STUDIES (Iron, TIBC, Ferritin, Transferrin)

D52.0-D52.9

Anemia, Folate-Deficiency

D64.

Anemia, Unspecified

K76.89, K76.9

Chronic Liver Disease and Cirrhosis

E08-00-E13.9

Diabetes Mellitus

D50.8, D50.

Iron Deficiency Anemias

E83.10-E83.19 Iron Metabolism Disorders

N18.9

Kidney/Renal Failure, Chronic

N19

Kidney/Renal Failure, Unspecified

K76.89

Liver Disease, Chronic and Nonalcoholic

LIPID STUDIES

(Cholesterol, Triglyceride, HDL, Cardiac Risk, Lipid Panel, LDL)

R07.89, R07.9 Chest Pain, Unspecified

K76.89, K76.9

Chronic Liver Disease and Cirrhosis

E08-00-E13-9

Diabetes Mellitus

I50.20-I51.9

Heart Failure/Disease

I10

Hypertension, Essential

E03.0-E03.9

Hypothyroidism

N18.9

Kidney Disease

E78.5

Hyperlipidemia

E77.0-E79.0

Lipid Metabolism Disorders

Z79.1, Z79.3,

Long Term Use NSAID/Hormonal Contraceptives

Z79.899

Long term use of Medications (Drug Therapy)

E66.1-E66.9

Obesity

E06.0-E06.9

Thyroiditis

OCCULT BLOOD

(Screening FOBT once per year with Z12.11 or Z12.12)

D64.89, D64.9 Anemias, Other and Unspecified

K92.1

Blood in Stool-Melena

R10.84, R10.9 Abdominal Pain

R11.0-R11.2

Nausea and Vomiting

R19.7

Diarrhea

N1

Z79.01, Z79.899 Long term (Current) use of Medication/Drug Therapy

PAP SCREENING TESTS (Screening Pap supported once every 24 months with the following codes only: Z77.22, Z77.9, Z91.89, Z72.89, Z72.51, Z72.52, Z72.53,

PSA, FREE R97.20-R97.21

Elevated Prostate Specific Antigen (PSA)

PTT (Partial Thromboplastin Time)

R10.0-R10.9

Abdominal Pain

I48.20, I48.91

Atrial Fibrillation

T14.90

Contusion, Unspecified State

Z79.01

Long-term (current) use of Anticoagulants

A41.9

Sepsis, Unspecified

RESPIRATORY VIRUS PANEL BY PCR

B97.29 or U07.1 Coronavirus

D80.1-D84.1

Deficiencies

J06.9 or J22

Upper Respiratory Infection/Lower Resp Infection

J12.81-J12.9

Pneumonia

R05, R06.2, R50.9 Cough or Wheezing or Fever

Z03.818 or Z03.828 Exposure other Viral Comm Diseases

Z94.0-Z94.84

Transplants

SEXUALLY TRANSMITTED INFECTION SCREEN (Chlamydia, Gonorrhea, Syphilis, Hepatitis B) (Screening supported 1x per year OR once per pregnancy) Men and Women (Non-Pregnancy) Z11.3 or Z11.59 AND Z72.89 Screening for Venereal Disease/Lifestyle Issues Women (Pregnant Condition) Z11.3 or Z11.59 AND one of the Following: Z34.00, Z34.80, Z34.90, Z33.1 ? Pregnancy

THYROID TESTS

(Includes T3, T4, TSH, all Thyroid Panels, Free T4 & Free T3, TBG, TSI,

Thyroid Microsomal Antibodies, Thyroglobulin Antibody)

D64.9

Anemia

F41.0-F41.9

Anxiety Disorders

I48.0-I48.91

Atrial Fibrillation

E08-00-E13.9

Diabetes Mellitus

I50.20-I50.9

Heart Failure

E78.00-E78.49 Hypercholesterolemia/Hyperlipidemia

E78.5

Hyperlipidemia, NOS

E03.0-E03.9

Hypothyroidism, Acquired

Effective 10/2020

ABBREVIATED MEDICALLY SUPPORTED ICD-10 CODE LIST

Quick Reference to Common Diagnoses Please refer to your Medicare Bulletin for a complete listing of tests requiring Medical Necessity information.

Z79.891, Z79.899 R53.81-R53.83 F30.10-F34.9 F06-0-F06.8, R63.5 R63.4

Long Term (Current) Use Opiate Analgesic/Drug Therapy Malaise and Fatigue Manic/Depressive Mood Disorders Mood Disorders Weight Gain, Abnormal Weight Loss, Abnormal

URINE CULTURE/URINALYSIS

R10.84

Abdominal Pain

R31.0-R31.2

Hematuria

Z79.891, Z79.899 Long Term (Current) Use Opiate Analgesic/Drug Therapy

R53.81, R53.83 Malaise and Fatigue

R82.991-998

Other nonspecific findings on exam of urine

R80.8

Proteinuria

N39.0

Urinary Tract Infection

Z13.30-Z13.39 Behavioral Disorder Screening

VITAMIN D 25-OH (Most Common)

K90.0

Celiac Disease

N18.30-N18.6

Chronic Kidney Disease

K76.9

Chronic Liver Disease without Alcohol, Unspecified

M85.80-M85.88 Disorder of Bone

M83.0-M83.9

Osteomalacia

E21.3

Hyperparathyroidism, Unspecified

E83.51-E83.52 Hypocalcemia/Hypercalcemia

M81.8

Osteoporosis, Unspecified

E55.0 or E55.9 Ricketts Active or Vitamin D Deficiency, Unspecified

Effective 10/2020

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