Medicare Advantage ICD-10-CM Quick Reference Code Guide ...

Medicare Advantage ICD-10-CM Quick Reference Code Guide 2023 Update

Obesity, unspecified (use addt'l code for BMI)

E66.9

- diabetic autonomic neuropathy (gastroparesis)

E11.43

This Quick Reference Code Guide is intended to replace any previous version prior to August 2022.

Additional codes indicated by {italics}. Codes with _ or .- require additional characters to complete; explanatory notes in (parentheses). Please note these ICD-10-CM and CPT II examples are not all-inclusive.

Morbid / Severe obesity due to calories (use addt'l code for BMI)

E66.01

Abnormal BMI requires underlying diagnosis

- other diabetic neurological complications {addt'l} - diabetic peripheral angiopathy w/o gangrene - diabetic peripheral angiopathy with gangrene

E11.49 E11.51 E11.52

RESPIRATORY Obstructive sleep apnea {for CPAP-Z99.89} Interstitial lung disease Pneumonia, unspecified organism {Flu 1st if applicable} Pneumonia, viral {Flu 1st if applicable} Bronchitis, acute, unspecified Bronchitis, chronic (specify type) Bronchitis, chronic, unspecified Chronic respiratory failure (specify type) Dependence on supplemental oxygen

ICD-10 Abdominal aortic aneurysm w/o rupture

G47.33 Old MI - > 4 weeks from acute episode

J84.9 Angina, post-infarction - < 4 weeks from AMI

J18.9 Unstable angina / Intermed coronary synd

J12.9 CAD, native artery w/o angina {type, if known}

J20.9 CAD, native artery with angina {type, if known}

J41.- CAD, bypass graft {identify type, if known}

J42

Ischemic cardiomyopathy

J96.- Cardiomyopathy, idiopathic / familial / unspecified

Z99.81 Atrial fibrillation, unspecified

171.4 I25.2 I23.7 I20.0 I25.10 I25.11I25.7I25.5 I42.9 I48.91

BMI 19 or less BMI 20 - 29 (5th character needed) BMI 30 - 39 (5th character needed) BMI 40.0 - 44.9 BMI 45.0 - 49.9

RENAL/GENITOURINARY Anemia in chronic kidney disease CKD Stage 1 GFR >90 : w/ proteinuria and/or clinically relevant kidney abnormality CKD Stage 2 Mild GFR 60 - 89 : w/ proteinuria and/or clinically relevant kidney abnormality

Z68.1 Z68.2Z68.3Z68.41 Z68.42 ICD-10 D63.1 N18.1

N18.2

- other circulatory complications {use addt'l code} - diabetic neuropathic arthropathy / Charcot's joint - other diabetic arthropathy {use addt'l code} - diabetic dermatitis - foot ulcer {use addt'l code for site, L97 - L98} - other skin ulcer {use addt'l code for site, L97 - L98} - other skin complications {use addt'l code} - hypoglycemia, w/o coma - hyperglycemia - unspecified complications

E11.59 E11.610 E11.618 E11.620 E11.621 E11.622 E11.628 E11.649 E11.65 E11.8

Emphysema (specify type)

J43.- Paroxysmal atrial fibrillation

I48.0 CKD Stage 3a (GFR 45 - 59)

N18.31 - no complications

E11.9

COPD, unspecified

J44.9 Persistent atrial fibrillation

I48.1- CKD Stage 3b (GFR 30 - 44)

N18.32 Prediabetes

R73.03

COPD with exacerbation

J44.1 Long-standing persistent atrial fibrillation

I48.11 CKD Stage 4 Severe GFR (15 - 29)

N18.4 Long-term use of insulin

Z79.4

COPD with acute bronchitis / LRI {type B96 - B97}

J44.0 Permanent atrial fibrillation

I48.21 CKD Stage 5 GFR < 15

N18.5 Long-term use of oral antidiabetic drugs

Z79.84

NOTE: For COPD with Emphysema use J43.9; for other COPD

Heart failure unspecified / Congestive heart disease

I50.9 ESRD / Chronic Dialysis {use also Z99.2}

N18.6 Insulin pump, presence of, internal or external

Z96.41

combinations use J44.- {Also asthma type PRN}

Heart failure, systolic, unspecified

I50.20 Renal dialysis, dependence on

Z99.2 NEUROLOGICAL

ICD-10

Asthma, unspecified, uncomplicated

J45.909 Heart failure, diastolic, unspecified

I50.30 Noncompliance with renal dialysis

Z91.15 Parkinson's disease

G20

Asthma, unspecified with acute exacerbation

J45.901 Heart failure, comb systolic / diastolic, unspecified

I50.40 CKD, Stage unspecified / CRF / CRI

N18.9 Dementia with Lewy bodies {also code type}

G31.83

Asthma, mild intermittent (5th character below) Asthma, mild persistent (5th character below)

J45.2J45.3-

End-stage heart failure {HF type, if known} Non-ischemic myocardial injury {non-traumatic}

I50.84 DIABETES MELLITUS TYPES

I5A

AND COMPLICATIONS

Alzheimer's disease {also code type} ICD-10 - dementia w/o behavioral disturbance

G30.9 F02.80

Asthma, moderate persistent (5th character below) Asthma, severe persistent (5th character below)

(5th character) - uncomplicated

J45.4J45.5J45._0

HYPERTENSION please specify type with all associated conditions {note additional codes}

Hypertension, benign / essential / primary

NOTE: for the following highlighted DM code: First 3 characters ICD-10 [E_ _.] indicate type, per list below. Listed complications indicated by

characters after decimal [._ -] are the same for all DM types.

I10

{Some conditions require additional codes}

- dementia with behavioral disturbance - for example, Wandering in diseases

Unspecified dementia w/o behavioral disturbance

F02.81 Z91.83 F03.90

(5th character) - with acute exacerbation

J45._1 - with heart disease / LVH / diastolic dysfunction

I11.9

DM due to underlying condition

E08.- Unspecified dementia with behavioral disturbance

F03.91

(5th character) - with status asthmaticus

J45._2 - with heart failure {also code CHF type}

I11.0

DM due to drugs or chemicals

E09.- Complete immobility due to frailty/severe disability

R53.2

Use additional code to indicate smoking status

- with CKD {also code stage - N18.-}

I12.-

DM - Type 1

E10.- Tremors (specify type)

G25.-

Cigarette dependence (6th character for status)

F17.21- - with heart disease and CKD {also code CKD stage}

I13.1- DM - Type 2 or unspecified type

E11.- Myoclonus {also adverse effect, drug T36 - T50}

G25.3

Other type nicotine dependence / e-cig / vaping

F17.-

- with CHF and CKD1-4 {also CHF and CKD stages}

I13.0 Other specified DM / Post-procedural diabetes

E13.- Epilepsy, unspecified w/o status epileticus

G40.909

Tobacco use (non-dependent)

Z72.0

- with CHF and 5-ESRD {also CHF and CKD stages}

I13.2 DM 2 with - (document all that currently apply to patient)

Myopathy, unspecified

G72.9

History of nicotine / tobacco dependence

Z87.891 Hypertensive urgency {also code HTN type}

I16.0

- diabetic nephropathy

E11.21 Multiple sclerosis

G35

Occupational exposure to tobacco smoke

Z57.31 Pulmonary hypertension {also underlying}

I27.2

- diabetic CKD {use addt'l code for stage - N18}

E11.22 Chronic pain syndrome

G89.4

CARDIAC/CEREBRO- & CARDIOVASCULAR ICD-10 ENDOCRINE

ICD-10 - other diabetic kidney complication {use addt'l code} E11.29 Note: Neuropathy in presence of diabetes (see DM section) E11.4-

Atherosclerosis of extremities Specify native artery or bypass graft. Specify with intermittent claudication, rest pain, or grangrene.

Aortic aneurysm

Late effect - cerebrovascular disease - (not CVA)

Cerebrovascular disease, other

Carotid artery stenosis (specify laterality)

Hyperthyroidism w/o crisis / storm I70.--- Post-procedural hypothyroidism

Autoimmune thyroiditis / Hashimoto's

A71.-- Goiter, unspecified

I69.8 or 9-

I67.89 NUTRITIONAL STATUS

I65.2-

Malnutrition, protein calorie / unspecified (use addt'l code for BMI)

E05.90 E89.0 E06.3 E04.9 ICD-10 E46

- retinopathy w/o macular edema (specify laterality) - diabetic retinopathies (specify type and laterality) - other diabetic ophthalmic complication {use addt'l code} - diabetic neuropathy, unspecified - diabetic mononeuropathy - diabetic polyneuropathy / neuralgia

E11.319E11.3E11.39

E11.40 E11.41 E11.42

Polyneuropathy, Hereditary / Idiopathic Neuropathy, Idiopathic progressive History of stroke or TIA w/o residual effect Sequlae of cerebral infarction, unspecified

- cognitive deficit (specify type) - other / e.g., vision / sensation {also type}

G60.9 G60.3 Z86.73 I69.30 I69.31I69.398

Providers must be diligent about confirming the accuracy of their diagnoses and ensure that their diagnosis and coding practices comply with all applicable legal requirements. Accurate and complete risk adjustment documentation, coding, and submission activities allow Cigna Medicare programs to provide the best benefits and

resources possible to your patients. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. ? 2023 Cigna.

PCOMM-2023-669929872d

Codes with _ or .- require additional characters to

- , bronchus and lung (specify site)

complete. Required additional codes indicated by {italic}. - , prostate

NEUROLOGICAL (continued)

ICD-10 - , skin (specifiy site) and type

- aphasia

I69.320 Malignant melanoma, skin (specifiy site)

- ataxia - dysphagia {also code type - R13.1-} - dysphasia - dysarthria

I69.393 I69.391 I69.321 I69.322

Malignant Ascites Malignant Pleural effusion HISTORY OF MALIGNANT NEOPLASM

- fluency disorder / stuttering

I69.323 Personal history, malignant neoplasm

- hemiplegia / hemiparesis (specify laterality)

I69.35- Personal history, thyroid cancer

- monoplegia, lower limb (specify laterality)

I69.34- - , small intestine non-carcinoid

- monoplegia, upper limb (specify laterality)

I69.33- - , colon cancer, non-carcinoid

PSYCHIATRIC Generalized anxiety disorder Anxiety depression, mild or not persistent

ICD-10 F41.1 F41.8

- , breast cancer - , lung cancer, unspecified - , prostate cancer

Anxiety disorder, unspecified Bipolar disorders (specify type and severity)

F41.9

- , skin cancer, NEC

F31.-

- , malignant melanoma, skin

Schizophrenia disorders (type and severity)

F20.- MUSCULOSKELATAL

Mood / affective disorder, unspecified

F39

Rheumatoid arthritis [verify DMARD]

Major depressive disorder, single episode mild, moderate, severe, w/ or w/out psychotic features

F32.- Gout, unspecified {also code manifestations} Osteomyelitis, unspecified

Major depressive disorder, recurrent mild, moderate,

F33.- Osteomyelitis, other chronic (specify site)

severe, w/ or w/out psychotic features.

Osteoporosis, age-related, no fracture

Alcohol abuse (specify stage and related disorder)

F10.1- Osteoporosis, age-related with fx (specify site)

Alcohol dependence (specify stage and related disorder)

F10.2- Osteopenia (specify site)

Opioid abuse (specify stage and related disorder)

F11.1- Systemic lupus erythematosus, unspecified

Opioid dependence (specify stage and related disorder)

F11.2- Arthropathic psoriasis, unspecified

GASTROINTESTINAL

ICD-10 Spinal / caudal stenosis (specify level)

Esophageal reflux with esophagitis

K21.0 Intervertebral disc disorders, back

Barrett's esophagus (specify type and manifest)

K22.7- Sciatica (specify laterality)

Irritable bowel syndrome (specify type)

K58.- Chronic pain - when added to any pain dx

Diverticular disease, large intestine w/o abscess

K57.3- SENSORY ORGANS

Crohn's disease, unspecified

K50.9- Macular degeneration (specify type)

Celiac disease {also associated disorders}

K90.0 Open-angle glaucoma, stage unspecified

Ulcerative colitis (specify complications)

K51.9- Cataract, unspecified

Alcoholic cirrhosis of liver (indicate ascites)

K70.3- Cataract, senile, unspecified

Unspecified cirrhosis of liver

K74.60 Hearing loss, unspecified (specify laterality)

Pancreatitis, chronic ACTIVE MALIGNANT NEOPLASM

K86.1 FACTORS INFLUENCING HEALTH STATUS ICD-10 Acquired absence of limb (specify site / laterality)

Active indicates disease currently present. Use History (right) if no evidence of disease. Primary cancer codes listed, metastases coded separately.

- feet, toes and ankle

Malignant neoplasm, colon (specify site)

C18.-

- leg below knee amputation / BKA

- , breast (specify site and laterality)

C50.-

- leg above knee amputation / AKA

Presence of artificial lower limb

C34.9- Presence, Artifical limb, complete / partial (specify site)

C61

Mastectomy (specify laterality), history of

C44.- Bilateral mastectomy, history of

C43.- Prostatectomy, history of

R18.0 Colostomy, current

J91.0 Gastrostomy, current

Ileostomy, current ICD-10

Tracheostomy, current

Z85.- Cystostomy, current (specify type)

Z85.850 Nephr- / Ureter- / Urethr- ostomy, current

Z85.068 Long-term (current) drug therapy

Z85.038 - anticoagulants

Z85.3

- antiplatelets / antithrombolitics

Z85.118 Z85.46

- aspirin - nonsteroidal anti-inflammatory drugs / NSAIDs

Z85.828 - systemic steroids

Z85.820 - bisphosphonates

ICD-10 - Long-term use of insulin

M06.9

- Long-term use of oral antidiabetic drugs

M10.9

- Insulin pump, presence of, internal or external

M86.9 Coronary angioplasty status

M86.6- Coronary artery bypass graft, presence of

M81.0 Coronary angioplasty implant / graft, presence of

M80.0- Prosthetic heart valve, presence of

M85.8- Cardiac pacemaker, excludes AICD, presence of

M32.9 Automatic implantable cardiac defibrillator / AICD

L40.50 Transplant status (specify organ)

M48.0- Pulmonary embolism, history of

M51.- Venous thrombosis / embolism, history of

M54.3- Orthopedic joint implant, presence of (specify site)

G89.29 Falls, history of / at risk of falling

ICD-10 Wheelchair, dependence on

H35.3- Noncompliance with dietary regimen

H40.10X Noncompliance with medication (specify type)

H26.9 Nonadherence to medical treatment

H25.9 COVID

H91.9- COVID-19

ICD-10 Post COVID-19 condition, unspecified

Z89.- contact (with)

Z89.4- exposure (to)

Z89.51- history of (personal)

Z89.61- long (haul)

Z97.1- pneumonia due to COVID

Z97.1- sequelae (post acute)

U09.9

Z90.1- SOCIAL DETERMINANTS OF HEALTH

ICD-10

Z90.13 Illiteracy and low level literacy

Z55.0

Z90.79 Unemployment, unspecified

Z56.0

Z93.3 Homelessness

Z59.0-

Z93.1 Food insecurity

Z59.41

Z93.2 Insufficient social insurance and welfare support

Z59.7

Z93.0 Problem related to housing and economic circumstance Z59.9

Z93.5- unspecified

Z93.6 Problems related to living alone

Z60.2

Z79.- Problems in relations with spouse or partner

Z63

Z79.01 Other absence of family member

Z63.32

Z79.02 Dependent relative needing care at home

Z63.6

Z79.82 Alcoholism and drug addiction in family

Z63.72

Z79.1 Other stressful life events affecting family and household Z63.79

Z79.52 Problems related to other legal circumstances

Z65.3

Z79.83

Other specified problems related to psychosocial circumstances

Z65.8

Z79.4 HEDIS CPT II CODES

Z79.84 BLOOD PRESSURE

CPTII

Z96.41

Systolic

Z98.61

SBP < 130 mmHg

3074F

Z95.1

SBP 130-139 mmHg

3075F

Z95.5

SBP >= 140 mmHG

3077F

Z95.2

Diastolic

Z95.0

DBP < 80 mmHg

3078F

Z95.810

DBP 80-89 mmHg

3079F

Z94.-

DBP >= 90 mmHg

3080F

Z86.711

Z86.718 COMPREHENSIVE DIABETES CARE

CPTII

Z96.6- Hemoglobin A1C Control for patients with Diabetes

Z91.81 Most recent HbA1C level less than 7.0%

3044F

Z99.3 Most recent HbA1C level >= 7.0% and < 8.0%

3051F

Z91.11 Most recent HbA1C level >= 8.0% and ................
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