SUPD-ICD-10 Exclusions Statin Chart - Network Health

SUPD-ICD-10 Exclusions Statin Chart

CONDITION RHABDOMYOLYSIS_MYOPATHY RHABDOMYOLYSIS_MYOPATHY RHABDOMYOLYSIS_MYOPATHY RHABDOMYOLYSIS_MYOPATHY RHABDOMYOLYSIS_MYOPATHY RHABDOMYOLYSIS_MYOPATHY RHABDOMYOLYSIS_MYOPATHY

ICD-10 G72.0 G72.89 G72.9 M60.80 M60.9 M62.82 T46.6X5A

ESRD

I12.0

ESRD

I13.11

ESRD

ESRD ESRD ESRD ESRD ESRD LACTATION LACTATION LACTATION LACTATION LACTATION LACTATION LACTATION

I13.2

N18.5 N18.6 N19 Z91.15 Z99.2 O91.03 O91.13 O91.23 O92.03 O92.13 O92.5 O92.70

DESCRIPTION Drug-induced myopathy Other specified myopathies Myopathy, unspecified Other myositis, unspecified site Myositis, unspecified Rhabdomyolysis Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, initial encounter Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease Chronic kidney disease, stage 5 End stage renal disease Renal failure, unspecified Patient's noncompliance with renal dialysis Dependence on renal dialysis Infection of nipple associated with lactation Abscess of breast associated with lactation Nonpurulent mastitis associated with lactation Retracted nipple associated with lactation Cracked nipple associated with lactation Suppressed lactation Unspecified disorders of lactation

Y0108_3724-02-0622_C

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CONDITION LACTATION LACTATION CIRRHOSIS CIRRHOSIS CIRRHOSIS CIRRHOSIS CIRRHOSIS CIRRHOSIS CIRRHOSIS CIRRHOSIS PCOS PREDIABETES PREDIABETES PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY

ICD-10 O92.79 Z39.1 K70.30 K70.31 K71.7 K74.3 K74.4 K74.5 K74.60 K74.69 E28.2 R73.03 R73.09 O00.101 O00.102 O00.109 O00.111 O00.112 O00.119 O00.201 O00.202 O00.209 O00.211 O00.212 O00.219 O00.80 O00.81

DESCRIPTION Other disorders of lactation Encounter for care and examination of lactating mother Alcoholic cirrhosis of liver without ascites Alcoholic cirrhosis of liver with ascites Toxic liver disease with fibrosis and cirrhosis of liver Primary biliary cirrhosis Secondary biliary cirrhosis Biliary cirrhosis, unspecified Unspecified cirrhosis of liver Other cirrhosis of liver Polycystic ovarian syndrome Prediabetes Other abnormal blood glucose Right tubal pregnancy without intrauterine pregnancy Left tubal pregnancy without intrauterine pregnancy Unspecified tubal pregnancy without intrauterine pregnancy Right tubal pregnancy with intrauterine pregnancy Left tubal pregnancy with intrauterine pregnancy Unspecified tubal pregnancy with intrauterine pregnancy Right ovarian pregnancy without intrauterine pregnancy Left ovarian pregnancy without intrauterine pregnancy Unspecified ovarian pregnancy without intrauterine pregnancy Right ovarian pregnancy with intrauterine pregnancy Left ovarian pregnancy with intrauterine pregnancy Unspecified ovarian pregnancy with intrauterine pregnancy Other ectopic pregnancy without intrauterine pregnancy Other ectopic pregnancy with intrauterine pregnancy

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CONDITION PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY

PREGNANCY

PREGNANCY

PREGNANCY

PREGNANCY

PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY

ICD-10 O00.90 O00.91 O09.00 O09.01 O09.02 O09.03 O09.10 O09.11 O09.12 O09.13 O09.211 O09.212 O09.213 O09.219

O09.291

O09.292

O09.293

O09.299

O09.30 O09.31 O09.32 O09.33 O09.40 O09.41

DESCRIPTION Unspecified ectopic pregnancy without intrauterine pregnancy Unspecified ectopic pregnancy with intrauterine pregnancy Supervision of pregnancy with history of infertility, unspecified trimester Supervision of pregnancy with history of infertility, first trimester Supervision of pregnancy with history of infertility, second trimester Supervision of pregnancy with history of infertility, third trimester Supervision of pregnancy with history of ectopic pregnancy, unspecified trimester Supervision of pregnancy with history of ectopic pregnancy, first trimester Supervision of pregnancy with history of ectopic pregnancy, second trimester Supervision of pregnancy with history of ectopic pregnancy, third trimester Supervision of pregnancy with history of pre-term labor, first trimester Supervision of pregnancy with history of pre-term labor, second trimester Supervision of pregnancy with history of pre-term labor, third trimester Supervision of pregnancy with history of pre-term labor, unspecified trimester Supervision of pregnancy with other poor reproductive or obstetric history, first trimester Supervision of pregnancy with other poor reproductive or obstetric history, second trimester Supervision of pregnancy with other poor reproductive or obstetric history, third trimester Supervision of pregnancy with other poor reproductive or obstetric history, unspecified trimester Supervision of pregnancy with insufficient antenatal care, unspecified trimester Supervision of pregnancy with insufficient antenatal care, first trimester Supervision of pregnancy with insufficient antenatal care, second trimester Supervision of pregnancy with insufficient antenatal care, third trimester Supervision of pregnancy with grand multiparity, unspecified trimester Supervision of pregnancy with grand multiparity, first trimester

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CONDITION PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY

PREGNANCY

PREGNANCY

PREGNANCY

ICD-10 O09.42 O09.43 O09.511 O09.512 O09.513 O09.519 O09.521 O09.522 O09.523 O09.529 O09.611 O09.612 O09.613 O09.619 O09.621 O09.622 O09.623 O09.629 O09.70 O09.71 O09.72 O09.73

O09.811

O09.812

O09.813

DESCRIPTION Supervision of pregnancy with grand multiparity, second trimester Supervision of pregnancy with grand multiparity, third trimester Supervision of elderly primigravida, first trimester Supervision of elderly primigravida, second trimester Supervision of elderly primigravida, third trimester Supervision of elderly primigravida, unspecified trimester Supervision of elderly multigravida, first trimester Supervision of elderly multigravida, second trimester Supervision of elderly multigravida, third trimester Supervision of elderly multigravida, unspecified trimester Supervision of young primigravida, first trimester Supervision of young primigravida, second trimester Supervision of young primigravida, third trimester Supervision of young primigravida, unspecified trimester Supervision of young multigravida, first trimester Supervision of young multigravida, second trimester Supervision of young multigravida, third trimester Supervision of young multigravida, unspecified trimester Supervision of high risk pregnancy due to social problems, unspecified trimester Supervision of high risk pregnancy due to social problems, first trimester Supervision of high risk pregnancy due to social problems, second trimester Supervision of high risk pregnancy due to social problems, third trimester Supervision of pregnancy resulting from assisted reproductive technology, first trimester Supervision of pregnancy resulting from assisted reproductive technology, second trimester Supervision of pregnancy resulting from assisted reproductive technology, third trimester

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CONDITION

PREGNANCY

PREGNANCY

PREGNANCY

PREGNANCY

PREGNANCY

PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY PREGNANCY

ICD-10 O09.819

O09.821

O09.822

O09.823

O09.829

O09.891 O09.892 O09.893 O09.899 O09.90 O09.91 O09.92 O09.93 O09.A0 O09.A1 O09.A2 O09.A3 O10.011 O10.012 O10.013 O10.019 O10.111 O10.112

DESCRIPTION Supervision of pregnancy resulting from assisted reproductive technology, unspecified trimester Supervision of pregnancy with history of in utero procedure during previous pregnancy, first trimester Supervision of pregnancy with history of in utero procedure during previous pregnancy, second trimester Supervision of pregnancy with history of in utero procedure during previous pregnancy, third trimester Supervision of pregnancy with history of in utero procedure during previous pregnancy, unspecified trimester Supervision of other high risk pregnancies, first trimester Supervision of other high risk pregnancies, second trimester Supervision of other high risk pregnancies, third trimester Supervision of other high risk pregnancies, unspecified trimester Supervision of high risk pregnancy, unspecified, unspecified trimester Supervision of high risk pregnancy, unspecified, first trimester Supervision of high risk pregnancy, unspecified, second trimester Supervision of high risk pregnancy, unspecified, third trimester Supervision of pregnancy with history of molar pregnancy, unspecified trimester Supervision of pregnancy with history of molar pregnancy, first trimester Supervision of pregnancy with history of molar pregnancy, second trimester Supervision of pregnancy with history of molar pregnancy, third trimester Pre-existing essential hypertension complicating pregnancy, first trimester Pre-existing essential hypertension complicating pregnancy, second trimester Pre-existing essential hypertension complicating pregnancy, third trimester Pre-existing essential hypertension complicating pregnancy, unspecified trimester Pre-existing hypertensive heart disease complicating pregnancy, first trimester Pre-existing hypertensive heart disease complicating pregnancy, second trimester

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