Page 1 of 10 - Clinical Laboratory Services

Frequently Used Tests & ICD-10 Codes

revised 9/18/2015

Medicare limited coverage policies outline indications for which testing is considered reasonable and necessary. Monitoring of treatment or therapy may be reasonable and medically necessary at frequencies outlined in Medicare's Limited Coverage Policies and indicated below as Q. Test(s) ordered in addition to Medicare's recognized frequencies for monitoring and in response to changes in patient treatment or condition, the diagnosis must support medical necessity and should be and accompanied by a diagnosis code (ICD10) specific to that medical condition. If testing is requested which is not covered by Medicare the patient or responsible party may sign an Advanced Beneficiary Notice (ABN) and be fully responsible for payment. Please refer to your Medical Necessity policies and ICD10 Code book for additional information.

The below list is intended to assist in providing ICD-10 diagnosis codes as required by Medicare and other insurers. This list includes examples of

diagnoses based on CLS' historical ordering data, but does not represent a complete list of lab related diagnoses. Some ICD-10 codes as noted require an Test Name

additional code (see notes in red). Please refer to Medicare Regulations and Manuals issued and authorized by CMS for a complete list of ICD-10 codes

that meet medical necessity. The ultimate responsibility for correct coding lies with the ordering physician.

Albumin, Prealbumin (NDS)

D50.9

Iron deficiency anemia, unspecified

D51.0 D64.0 D64.9

Vitamin B12 defic anemia due to intinsic factor deficiency Hereditary sideroblastic anemia Anemia, unspecified

E44.0 E46 E63.9

Moderate protein-calorie malnutrition Unspecified protein-calorie malnutrition (Malnutrition NOS & Protein-calorie imbalance NOS) Nutritional deficiency, unspecified

I10 L89.90 L89.91

Essential (primary) hypertension Pressure ulcer of unspecified site, unspecified stage Pressure ulcer of unspecified site, stage 1

L89.92 L89.93 L89.94

Pressure ulcer of unspecified site, stage 2 Pressure ulcer of unspecified site, stage 3 Pressure ulcer of unspecified site, stage 4

L89.95 N19 R63.4

Pressure ulcer of unspecified site, unstageable Unspecified kidney failure Abnormal weight loss

Z79.899 Other long term (current) drug therapy

BMP Basic Metabolic Panel (NDS)

B20

Human immunodeficiency virus (HIV) disease Use additional code (s) to identify all manifestations of HIV infection

F03.90 I10 I27.9

Unspecified dementia without behavioral disturbance Essential (primary) hypertension Pulmonary heart disease, unspecified

N28.9 R53.82 R56.9

Disorder of kidney and ureter, unspecified (Nephropathy NOS, renal disease acute NOS, renal insuffucuency acute) Chronic fatigue, unspecified Unspecified convulsions

R60.0 R60.1 R60.9

Localized edema Generalized edema Edema, unspecified (Fluid retention NOS)

Z79.899 Other long term (current) drug therapy

BNP B-type Natriuretic Peptide (LC)

I11.0

Hypertensive heart disease with heart failure Use additional code to identify type of heart failure (I150.-)

I50.20 I50.21 I50.22

Unspecified systolic (congestive) heart failure Acute systolic (congestive) heart failure Chronic systolic (congestive) heart failure

I50.23

Acute on chronic systolic (congestive) heart failure

I50.30 I50.31

Unspecified diastolic (congestive) heart failure Acute diastolic (congestive) heart failure

I50.32

Chronic diastolic (congestive) heart failure

I50.33 I50.40

Acute on chronic diastolic (congestive) heart failure Unspecified combined systolic and diastolic (congestive) heart failure

I50.41

Acute combined systolic and diastolic (congestive) heart failure

I50.42 I50.43 I50.20-

Chronic combined systolic and diastolic (congestive) heart failure Acute on chronic combined systolic and diastolic (congestive) heart failure Code first: heart failure following surgery (I97.13-), heart failure due to hypertension (I11.0), heart failure due to hypertension with chronic kidney disease

I50.43 I50.9

(I13.-), rheumatic heart failure (I09.81) Heart failure, unspecified

Page 1 of 10

A04.7 A09 A49.01 B20 D50.0 D50.8 D51.0 D52.9 D68.318 E10.10 E10.21 E10.29 E10.59 E10.620 E10.65 E10.8 E10.9 E11.21 E11.29 E11.59 E11.620 E11.65 E11.8 E11.9 E13.10 E13.21 E13.29 E46 E66.9 I10 I50.9 I96 N19 R07.9 R10.9 R11.10 R50.9 R53.81 R53.83 R60.0 R60.1 R60.9 Z79.899

B20 E10.10 E10.21 E10.29 E10.628 E10.65 E11.21 E11.29 E11.628 E11.65 E13.10 E13.21 E13.29 E13.628 E83.10 F03.90 F28 I10 N28.9 R11.10 R53.81 R53.82 R53.83 R60.0 R60.1 R60.9 Z79.899

CBCD, CBC, H&H (LC) Entercolitis due to Clostridium difficle Infectious gastroenteritis and colitis, unspecified Methicillin susceptible Staphylococcus infection, unspecified site (MSSA infections & Staphylococcus aurues infection NOS) Human immunodeficiency virus (HIV) disease Use additional code (s) to identify all manifestations of HIV infection Iron deficiency anemia secondary to blood loss (chronic) (Posthemorrhagic anemia chronic) Other iron deficiency anemias (due to inadequate dietary intake) Vitamin B12 defic anemia due to intinsic factor deficiency Folate deficiency anemia, unspecified Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhbitors Type 1 diabetes mellitus with ketoacidosis without coma Type 1 diabetes mellitus with diabetic nephropathy Type 1 diabetes mellitus w oth diabetic kidney complication Type 1 diabetes mellitus with other circulatory complications Type 1 diabetes mellitus with diabetic dermatitis (necrosbosis lipoidica) Type 1 diabetes mellitus with hyperglycemia Type 1 diabetes mellitus with unspecified complications Type 1 diabetes mellitus without complications Type 2 diabetes mellitus with diabetic nephropathy Type 2 diabetes mellitus with other diabetic kidney complication Type 2 diabetes mellitus with other circulatory complications Type 2 diabetes mellitus with diabetic dermatitis (necrobiosis lipoidica) Type 2 diabetes mellitus with hyperglycemia Type 2 diabetes mellitus with unspecified complications Type 2 diabetes mellitus without complications Other specified diabetes mellitus with ketoacidosis without coma Other specified diabetes mellitus with diabetic nephropathy Other specified diabetes mellitus with other diabetic kidney complication Unspecified protein-calorie malnutrition (Malnutrition NOS & Protein-calorie imbalance NOS) Obesity, unspecified Essential (primary) hypertension Heart failure, unspecified Gangrene, not elsewhere classified Gangrenous cellulitis) Unspecified kidney failure Chest pain, unspecified Unspecified abdominal pain Vomiting, unspecified (Vomiting NOS) Fever, unspecified Other Malaise (Chronic Debility, Debility NOS, General physical deterioration, Malaise NOS, Nervous Debility) Other Fatigue (Fatigue NOS, Lack of energy, Lethargy, Tiredness) Localized edema Generalized edema Edema, unspecified (Fluid retention NOS) Other long term (current) drug therapy

CMP Comprehensive Metabolic Panel (NDS) Human immunodeficiency virus (HIV) disease Use additional code (s) to identify all manifestations of HIV infection Type 1 diabetes mellitus with ketoacidosis without coma Type 1 diabetes mellitus with diabetic nephropathy Type 1 diabetes mellitus w oth diabetic kidney complication Type 1 diabetes mellitus with other skin complications Type 1 diabetes mellitus with hyperglycemia Type 2 diabetes mellitus with diabetic nephropathy Type 2 diabetes mellitus with other diabetic kidney complication Type 2 diabetes mellitus with other skin complications Type 2 diabetes mellitus with hyperglycemia Other specified diabetes mellitus with ketoacidosis without coma Other specified diabetes mellitus with diabetic nephropathy Other specified diabetes mellitus with other diabetic kidney complication Other specified diabetes mellitus with other skin complications Disorder of iron metabolism, unspecified Unspecified dementia without behavioral disturbance (Dementia NOS) Other psychotic disorder not due to a substance or known physiological condition (Chronic hallucinatory psychosis) Essential (primary) hypertension Disorder of kidney and ureter, unspecified (Nephropathy NOS, renal disease acute NOS, renal insufficiency acute) Vomiting, unspecified (Vomiting NOS) Other Malaise (Chronic Debility, Debility NOS, General physical deterioration, Malaise NOS, Nervous Debility) Chronic fatigue, unspecified Other Fatigue (Fatigue NOS, Lack of energy, Lethargy, Tiredness) Localized edema Generalized edema Edema, unspecified (Fluid retention NOS) Other long term (current) drug therapy

Page 2 of 10

I48.2 I48.91 I50.20 I50.21 I50.22 I50.23 I50.30 I50.31 I50.32 I50.33 I50.40 I50.41 I50.42 I50.43 I50.20I50.43 I50.9 T46.2X1A T46.2X2A T46.2X3A T46.2X4A T50.905A

I49.9 R56.9 Z79.899

A41.02

E08.52 E10.52 E11.52 E11.65 E11.8 E11.9 E13.52 F28 F29 I70.361

I96 L89.90 L89.91 L89.92 L89.93 L89.94 L89.95 N39.0 R07.9 R42 R53.82 R63.4 R63.5 Z79.899

Digoxin (LC) Q yearly after steady state is achieved Chronic atrial fibrillation (permanent atrial fibrillation) Unspecified atrial fibrillation Unspecified systolic (congestive) heart failure Acute systolic (congestive) heart failure Chronic systolic (congestive) heart failure Acute on chronic systolic (congestive) heart failure Unspecified diastolic (congestive) heart failure Acute diastolic (congestive) heart failure Chronic diastolic (congestive) heart failure Acute on chronic diastolic (congestive) heart failure Unspecified combined systolic and diastolic (congestive) heart failure Acute combined systolic and diastolic (congestive) heart failure Chronic combined systolic and diastolic (congestive) heart failure Acute on chronic combined systolic and diastolic (congestive) heart failure Code first: heart failure following surgery (I97.13-), heart failure due to hypertension (I11.0), heart failure due to hypertension with chronic kidney disease (I13.-), rheumatic heart failure (I09.81) Heart failure, unspecified Poisoning by other antidysrhythmic drugs, accidental (unintentional), initial encounter Poisoning by other antidysrhythmic drugs, intentional self-harm, initial encounter Poisoning by other antidysrhythmic drugs, assault, initial encounter Poisoning by other antidysrhythmic drugs, undetermined, initial encounter Adverse effect of unspecifie drugs, medicaments and biological substances, initial encounter

Dilantin (Phenytoin) (NDS) Cardiac arrhythmia, unspecified [Arrhythmia (cardiac) NOS] Unspecified Convulsions (Convulsion disorder, Fit NOS, Recurrent convulsions, Seizure (s) (convulsive) NOS) Other long term (current) drug therapy

Glucose (LC) Frequent strip tests Q 3 Sepsis due to Methicillin ressistant Staphylococcus aureus Code first: postprocedural sepsis (T81.4), sepsis following immunization (T88.0), sepsis following infusion, transfusion or therapeutic injection (T80.2-) Diabetes mellitis due to undrtlying condition with diabetic peripheral angiopathy with gangrene Type 1 diabetes mellitis with diabetic peripheral angiopathy with gangrene Type 2 diabetes mellitis with diabetic peripheral angiopathy with gangrene Type 2 diabetes mellitus with hyperglycemia Type 2 diabetes mellitus with unspecified complications Type 2 diabetes mellitus without complications Other specified diabetes mellitis with diabetic peripheral angiopathy with gangrene Other psychotic disorder not due to a substance or known physiological condition (chronic hallucinatory psychosis) Unspecified psychosis not due to a substance or known physiological condition (Psychosis NOS) Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene, right leg Use additional code to identify the severity of any ulcer (L97.-, L98.49-), if applicable Gangrene, not elsewhere classified Gangrenous cellulitis) Pressure ulcer of unspecified site, unspecified stage Pressure ulcer of unspecified site, stage 1 Pressure ulcer of unspecified site, stage 2 Pressure ulcer of unspecified site, stage 3 Pressure ulcer of unspecified site, stage 4 Pressure ulcer of unspecified site, unstageable Urinary track infections, site not specified Use additional code (B95-B97), to identify infectious agent Chest pain, unspecified Dizziness and giddiness (Light-headedness, Vertigo NOS) Chronic fatigue, unspecified Abnormal weight loss Abnormal weight gain Other long term (current) drug therapy

Page 3 of 10

E11.9 E11.65 E11.8 E13.8 E13.9 E16.2 E74.8 R73.09 R73.9 Z79.4

B20 D50.9 D51.0 D52.0 D52.8 D52.9 D64.9 D68.8 D68.9 E11.9 E13.9 E44.0 E44.1 E46 I50.20 I50.21 I50.22 I50.23 I50.30 I50.31 I50.32 I50.33 I50.40 I50.41 I50.42 I50.43 I50.20I50.43 I50.9 N19

Hgb A1C (LC) Q 3 Type 2 diabetes mellitus without complications Type 2 diabetes mellitus with hyperglycemia Type 2 diabetes mellitus with unspecified complications Other specified diabetes mellitus with unspecified complications Other specified diabetes mellitus without complications Hypoglycemia, unspecified Other specified disorders of carbohydrate metabolism (essential pentosuria, renal glycosuria) Other abnormal gluclose (Abnormal glucose NOS, Abnormal non-fasting glucose tolerance, Latent diabetes, Prediabetes) Hyperglycemia, unspecified Long term (current) use of insulin Code also any therapeutic drug level monitoring (Z51.81)

Iron, IBC, Ferritin, Transferrin (LC)

Human immunodeficiency virus (HIV) disease Use additional code (s) to identify all manifestations of HIV infection Iron deficiency anemia, unspecified Vitamin B12 defic anemia due to intinsic factor deficiency Dietary folate deficiency anemia (Nutritional megaloblastic anemia) Other folate deficiency anemias Folate deficiency anemia, unspecified Anemia, unspecified Other specified coagulation defects Coagulation defect, unspecified Type 2 diabetes mellitus without complications Other specified diabetes mellitus without complications Moderate protein-calorie malnutrition Mild protein-calorie malnutrition Unspecified protein-calorie malnutrition (Malnutrition NOS & Protein-calorie imbalance NOS) Unspecified systolic (congestive) heart failure Acute systolic (congestive) heart failure Chronic systolic (congestive) heart failure Acute on chronic systolic (congestive) heart failure Unspecified diastolic (congestive) heart failure Acute diastolic (congestive) heart failure Chronic diastolic (congestive) heart failure Acute on chronic diastolic (congestive) heart failure Unspecified combined systolic and diastolic (congestive) heart failure Acute combined systolic and diastolic (congestive) heart failure Chronic combined systolic and diastolic (congestive) heart failure Acute on chronic combined systolic and diastolic (congestive) heart failure Code first: heart failure following surgery (I97.13-), heart failure due to hypertension (I11.0), heart failure due to hypertension with chronic kidney disease (I13.-), rheumatic heart failure (I09.81) Heart failure, unspecified Unspecified kidney failure

Page 4 of 10

Lipid Panel Q yearly, LDL & Total Cholesterol Q 2 months first year Q 4 months after treatment goals achieved, HDL, Triglycerides, VLDL (LC)

E10.10

Type 1 diabetes mellitus with ketoacidosis without coma

E10.21

Type 1 diabetes mellitus with diabetic nephropathy

E10.29

Type 1 diabetes mellitus w oth diabetic kidney complication

E10.40

Type 1 diabetes mellitus with diabetic neuropathy, unspecified

E10.41

Type 1 diabetes mellitus with diabetic mononeuropathy

E10.42

Type 1 diabetes mellitus with diabetic polyneuropathy

E10.43

Type 1 diabetes with diabetic autonomic (poly)neuropathy (gastroparesis)

E10.44

Type 1 diabetes mellitus with diabetic amyotrophy

E10.49

Type 1 diabetes mellitis with other diabetic neurological complication

E10.51

Type 1 diabetes mellitis with diabeticc peripheral angiopathy without gangrene

E10.52

Type 1 diabetes mellitis with diabeticc peripheral angiopathy with gangrene

E10.59

Type 1 diabetes mellitus with other circulatory complications

E10.610 Type 1 diabetes mellitus with diabetic neuropathic arthropathy (Charcot's joints)

E10.618 Type 1 diabetes mellitus with other diabetic arthropathy

E10.620 Type 1 diabetes mellitus with diabetic dermatitis (necrosbosis lipoidica)

E10.65

Type 1 diabetes mellitus with hyperglycemia

E10.69

Type 1 diabetes mellitus with other specified complication Use additional code to identify complication

E10.8

Type 1 diabetes mellitus with unspecified complications

E10.9

Type 1 diabetes mellitus without complications

E11.21

Type 2 diabetes mellitus with diabetic nephropathy

E11.29

Type 2 diabetes mellitus with other diabetic kidney complication

E11.40

Type 2 diabetes mellitus with diabetic neuropathys, unspecified

E11.41

Type 2 diabetes mellitus with diabetic mononeuropathy

E11.42

Type 2 diabetes mellitus with diabetic polyneuropathy

E11.43

Type 2 diabetes with diabetic autonomic (poly)neuropathy

E11.44

Type 2 diabetes mellitus with diabetic amyotrophy

E11.49

Type 2 diabetes mellitis with other diabetic neurological complication

E11.51

Type 2 diabetes mellitis with diabetic peripheral angiopath ywithout gangrene

E11.52

Type 2 diabetes mellitis with diabetic peripheral angiopathy with gangrene

E11.59

Type 2 diabetes mellitus with other circulatory complications

E11.610 Type 2 diabetes mellitus with diabetic neuropathic arthropathy

E11.618 Type 2 diabetes mellitus with other diabetic arthropathy

E11.620 Type 2 diabetes mellitus with diabetic dermatitis (necrobiosis lipoidica)

E11.65

Type 2 diabetes mellitus with hyperglycemia

E11.69

Type 2 diabetes mellitus with other specified complication Use additional code to identify complication

E11.8

Type 2 diabetes mellitus with unspecified complications

E11.9

Type 2 diabetes mellitus without complications

E13.10

Other specified diabetes mellitus with ketoacidosis without coma

E13.21

Other specified diabetes mellitus with diabetic nephropathy

E13.29

Other specified diabetes mellitus with other diabetic kidney complication

E13.9

Other specified diabetes mellitus without complications

E46

Unspecified protein-calorie malnutrition (Malnutrition NOS & Protein-calorie imbalance NOS)

E66.8

Other obesity

E66.9 E78.0

Obesity, unspecified Pure hypercholesterolemia (Familial hypercholesterolemia, Fredrickson's hyperlipoproteinemia type Iia, Hyperbetalipoproteinemia, Hyperlipidemia group A,

Low-density-lipoprotein-type [LDL] jyperlipoproteinemia)

E78.4

Other hyperlipidemia (Familial combined hyperlipidemia)

E78.5

Hyperlipidemia, unspecified

I10

Essential (primary) hypertension

I11.0

Hypertensive heart disease with heart failure Use additional code to identify type of heart failure (I150.-)

I50.20

Unspecified systolic (congestive) heart failure

I50.21

Acute systolic (congestive) heart failure

I50.22

Chronic systolic (congestive) heart failure

I50.23

Acute on chronic systolic (congestive) heart failure

I50.30

Unspecified diastolic (congestive) heart failure

I50.31

Acute diastolic (congestive) heart failure

I50.32

Chronic diastolic (congestive) heart failure

I50.33

Acute on chronic diastolic (congestive) heart failure

I50.40

Unspecified combined systolic and diastolic (congestive) heart failure

I50.41

Acute combined systolic and diastolic (congestive) heart failure

I50.42

Chronic combined systolic and diastolic (congestive) heart failure

I50.43

Acute on chronic combined systolic and diastolic (congestive) heart failure

I50.20-

Code first: heart failure following surgery (I97.13-), heart failure due to hypertension (I11.0), heart failure due to hypertension with chronic kidney disease

I50.43

(I13.-), rheumatic heart failure (I09.81)

I50.9

Heart failure, unspecified

R07.9

Chest pain, unspecified

Z79.1

Long term (current) use of non-steroidal anti-inflammatories (NSAID) Code also any therapeutic drug level monitoring (Z51.81)

Z79.899 Other long term (current) drug therapy

Page 5 of 10

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download