2013 Billing Guide - paclab

Page

Introduction ��..�1

Key Points for Diagnosis Coding ��.. 2

Medicare Billing �� 3-13

Successful Laboratory Requisitions

Documentation Requests

Advance Beneficiary Notices

Medicare Secondary Payor

Regence Vitamin D Limitations ��14-17

Premera Vitamin D Limitations ��18-22

United Healthcare Hepatitis Screening Limitations��...�. 23-28

Washington DSHS Guidelines ��29-30

Medicare Coverage Limitation Resources ��31-38

NCD-LCD Test Code & Price List

Investigation Test Code & Price List

Frequency Test List

Always Non-Covered ICD9-CM Codes

Medicare NCD & LCD Table of Contents ��..��39-40

Medicare NCD & LCD Listings ��.��41-127

Common ICD-9 Codes ��...��.��128-130

PACLAB A 2013 BILLING GUIDE: TABLE OF CONTENTS

The Importance of Diagnosis Codes

INTRODUCTION

In today's regulated healthcare climate, diagnosis codes are mandatory. When

requisitions arrive without a valid and covered code or a signed waiver (if

necessary), the Lab might not be reimbursed for our services. Please assist us

by providing this required information at the time you order the test. if you have

any questions regarding this issue, please contact your service representative

or your billing coordinator.

The Balanced Budget Act of 1997 requires physicians to provide diagnostic or

other medical information when ordering services furnished by another entity in

order for payment to be made to the entity furnishing the service. PACLAB is

not allowed to determine what code should be used for the laboratory services.

Only the ordering physician/authorized provider is authorized to determine the

reason that the test is ordered. PACLAB is also not allowed to routinely accept

orders where Advance Beneficiary Notices (ABNs) are not collected when

necessary, or routinely write off tests where an ABN is not obtained. This may

be considered "inducement" under government regulations. However, to assist

the physician's office in determining whether an ABN may be needed, PACLAB

provides ABN assistance through our website www.paclab.com which will help

the physician's staff to determine whether an ABN is required. In addition,

PACLAB provides electronic access to National and Local Coverage Decision

(NCD and LCD) information.

We are pleased to provide various tools designed to help you. These include

staff training, waiver (ABN) forms, waiting room signs, etc.

1 April 2013

� When ordering Medication Levels it is still necessary to provide a medically

necessary diagnosis, symptom or “med monitoring” code (V58.61, V58.69�).

Although it may be obvious that the patient is on medication, Medicare does not allow

turning a test order into an ICD-9 code.

Key Points for Diagnosis Coding

� All requisitions must provide proof of “medical necessity” for each test ordered in the

form of ICD-9 codes, narrative diagnoses or symptoms.

� If the alpha-numeric “ICD-9” code is not known, a narrative diagnosis (full

description or abbreviation) may be written on the requisition.

Example: If the patient's chart indicates atrial fibrillation, but the ICD-9 (427.31) is not known, writing“A-

Fib” on the requisition is acceptable.

**IMPORTANT NOTE: If the patient has Medicare coverage and a Limited Coverage Test is ordered,

the patient will have to sign an Advance Beneficiary Notice (ABN) if only a narrative is provided.

� Diagnosis codes can either be actual diagnoses, current symptoms or abnormal test

results.

Example: The patient has been diagnosed w/ hypothyroidism and the provider orders a TSH,

hypothyroidism (244.9) would be the appropriate diagnosis (ICD-9) assigned.

Example: The patient has been experiencing fatigue and weight gain. The provider wants to run a TSH

to see if the patient is hypothyroid. In this case, fatigue (780.79) and weight gain (783.1) would be the

appropriate narratives or codes to assign.

Example: The patient’s lab results come back w/ an elevated glucose (790.29), a low HCT (285.9) and

an abnormality of their UA (791.9). As a result, the provider adds on a Glycohemoglobin (HgbA1C), an

Iron or Ferritin and a Urine Culture. Therefore the “medical necessity” is proven in the abnormal labs (be

specific), not the original diagnosis. This, again, can be given as either a narrative diagnosis or an ICD-

9 code.

� “RULE OUT”, “POSSIBLE” or “SUSPECTED” are not codeable descriptions.

In the above example, rather than considering "ruling out" hypothyroidism, the symptoms which are

causing the provider to believe that this might be the problem, i.e. fatigue and weight gain, should be

provided.

� V58.61 is for anticoagulant monitoring and V58.69 is for monitoring of other

medications. These codes are acceptable by Medicare, but they cannot be

interchanged.

2 April 2013

Medicare

Billing

3 April 2013

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

Patient's date of birth

Successful Laboratory Requisitions, Medicare Billing

The following Medicare billing requirements will assist you to

accurately complete laboratory requisitions. The objective is to

minimize recurring phone calls to our valued clients and service

center employees. Thank you for your attention to detail.

When billing Medicare, the following italicized information is always

required on the laboratory requisition. The additional information is

essential for accurate billing.

Patient's full name

Patient's sex

Patient's Social Security Number (optional)

Insurance ID number (Medicare HIC # + Prefix or suffix

character(s))

Marked Test(s) being ordered with appropriate and valid ICD-

9 for every test ordered

When indicated, a signed and dated ABN-with test(s) listed,

reason(s) specified for possible denial and estimated cost of

test(s) with the patient checking the option desired and the

patient signing and dating the ABN.

Patient's phone number

Patient's full address

Ordering provider full name

Ordering provider signature

Date and time of collection and fasting status

Who is to be billed (circle Medicare)

4 April 2013

Successful Laboratory Requisitions, Medicare Billing

5 April 2013

Documentation Guidelines for Medicare Services

This article is being revised and reprinted from "Medicare B News," Issue 236 dated

April 17, 2007, to ensure that the Noridian Adminstrative Services (NAS) provider and

supplier community has access to recent publications that contain the most current,

accurate and effective information available.

Medical records should be complete, legible, and include the following information:

• Reason for encounter, relevant history, findings, test results, and date of service.

• Assessment and impression of diagnosis.

• Plan of care with date and legible identity of the observer.

• Documentation that supports that the rendering/billing provider indicated on the claim

is the healthcare professional providing the service. (*Note)

• Records should not only substantiate the service performed, but also the required

level of care.

If the physician uses a scribe (an individual taking notes), the scribe needs to fully sign

the note, with their own credentials, followed by the physician’s signature and

credentials.

We, as the Laboratory, perform tests requested for your patients who have Medicare.

We are required, by law, to provide documentation if requested by the Comprehensive

Error Rate Testing (CERT) program by CMS. CERT reviews claims, on a post-

payment review of claims, submitted by our laboratory. These claims could be audited

for documentation to support the rendering/billing provider indicated on the claim.

During the audit process, if documentation is needed, the physician or supplier (lab)

must provide the required documentation within the deadlines stipulated in the written

request from CERT.

The lab receives these CERT requests and must request patient records, progress

notes, etc. from the physician’s office and/or clinic. Therefore, it is critical for each

office/clinic to understand that we have time limits to receive this information and must

respond to Medicare within the timeframe given to the laboratory. Upon receipt of

documentation, CERT reviews the claims and medical records from the

providers/suppliers who submitted the claims, reviewing the claims for compliance

with Medicare coverage, coding, and billing rules.

Below are the guidelines from Medicare to assist in documentation and provide

guidance to follow when ordering Laboratory tests.

Documentation Requests, Medicare Billing

6 April 2013

Documentation Requests, Medicare Billing

By law, Medicare contractors [Medicare Administrative Contractors (MAC) Part B

Carriers and Medicare Administrative Contractors (MAC) Part A Fiscal Intermediaries]

can review any information, including medical records, pertaining to a Medicare claim.

Providers billing Medicare for their services must act in accordance with the following

conditions:

• Document in appropriate office records and/or hospital records each time a covered

Medicare service is provided or ordered. In the case of laboratory test orders, the

exact name of the test(s) being ordered needs to be in the patient's medical record.

When providing concurrent care for hospital or custodial care facility patients,

physicians should identify their specialty in order to help support the necessity. Write

medical information legibly and sign each entry with a legible signature, or ensure that

the provider’s/author’s/observer’s identity is present and legible.

Medical information should be clear, concise, and reflect the patient's condition.

Sign progress notes for hospital and custodial care facility patients with all entries

dated and signed by the healthcare provider who actually examined the patient.

Provide sufficient detail to support diagnostic tests that were furnished and the level of

care billed.

Do not use statements such as “same as above” or ditto marks (“). This is not

acceptable documentation that the service was provided on that date. The “burden of

proof” remains with the provider to substantiate services and/or supplies billed to

Medicare. During the audit process, if documentation is needed, the physician or

supplier must provide the required documentation within the deadlines stipulated in

* Note: Medicare needs to identify primary physicians/practitioners of a service not

only for use in standard claims transactions, but also for review, fraud detection, and

planning policies. In order to accomplish this, NAS (Noridian Administration Services)

must be able to determine and verify the rendering physician/practitioner for each

outpatient service billed to Medicare. It is very important that the individual(s)

performing a billed service is/are identified.

7 April 2013

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Advance Beneficiary Notice, Medicare Billing

An Advance Beneficiary Notice (ABN) should be obtained

whenever a provider has reason to believe a procedure could

be denied as not reasonable and necessary. Generally,

services necessitating a signed ABN are those that are

payable in some instances, but not payable in others. These

can include:

The Omnibus Budget Reconciliation Act of 1986 (OBRA)

included a limitation of liability (or waiver of liability) provision

that provided beneficiaries with protection from liability when

they, in good faith, receive services from a Medicare provider

for which Medicare payment is subsequently denied as not

"reasonable and necessary."

Screening Tests

Tests that might be ordered as part of a routine exam (when

the patient does not exhibit evidence of a particular disease)

are not covered.

Please provide an ICD-9

code for each test

ordered for Medicare

patients.

Tests Not Medically Necessary

Tests that are not medically necessary for a diagnosis or

condition - in Medicare's opinion - are not covered.

Laboratory tests that are specifically excluded by the Medicare

program. (e.g., General Health Panels)

Experimental ("Investigational") Tests

Tests designated by the manufacturer as "for research or

investigational use," and thus considered experimental or

investigational, are also not covered by Medicare.

Tests Performed Too Frequently

Tests that are performed more frequently than is

recommended by Medicare are not covered.

Laboratory tests for which Medicare has established either a

National Coverage Decision (NCD) or for which a Medicare

Administrative Contractor (MAC) has established a Local

Coverage Decision (LCD).

8 April 2013

1.

2.

3.

4.

5.

6.

7.

8. Patient must date the ABN.


Please provide the laboratory with a valid Advance

Beneficiary Notice when you have reason to believe

Medicare may deny a procedure as 'medically

unnecessary.'

The procedure for obtaining a Medicare waiver (ABN) is based

on the current list of tests for which Medicare requires an

ICD9 code to consider payment. Please refer to the "Current

Lab Services That Require Proof of Medical Necessity" list. Do

not obtain a Medicare waiver (ABN) for every Medicare

patient, but only for those who may be held liable for the

service.

Medicare is very specific about what elements are required on

an ABN for it to be considered valid. Absence of any of the

required elements invalidates that ABN and is the same as no

ABN at all. Medicare is also very specific about format and

appearance of the ABN. Please take a moment to review the

ABN that follows. The following must be completed on each

ABN obtained:

Patient Name

Date of Birth or other unique identifier as Identification

Number. Must not use Medicare numbers (HICNs) or SSN.

Specific tests the patient was advised could be denied must

be listed in the appropriate column.

The reason these tests may be denied must be listed in the

appropriate column.

The estimated cost of the test(s), to the best of your

knowledge, must be provided in the appropriate column.

Once the information is recorded, ask the patient to read, and

then check Option 1, Option 2, and or Option 3. The patient

must do this.

Patient must sign the ABN.

9 April 2013


10 April 2013

1.

2.

3.

4.

5.

6.

7.

8.

9. Have the patient check Option 1, 2 or 3, and then the patient

must date and sign the form.

The ABN Request Program

Please provide the laboratory with a valid Advance

Beneficiary Notice when you have reason to believe

Medicare may deny a procedure as 'medically

unnecessary.'

PACLAB provides ABN assistance through our website

www.paclab.com. This program will determine if an ABN is

necessary without the need to look through a book or manual.

How to use it:

Go to our website and click on ABN Request.

Select the entity where the testing will be performed. The Bill

Class field should automatically populate with the appropriate

code for that entity.

Enter our workpar (or ?test name, if unknown) for each and

every test the provider has ordered in the first box. Separate

the workpars with a comma or vertical bar leaving no spaces

between characters.

Specific tests the patient was advised could be denied must

be listed in the appropriate column.

In the second box, enter the ICD-9 codes provided on the

requisition, using the same separators with no spaces

between characters.

Click on the Medical Necessity button. The program will

inform you if the test/s require an ABN. If required, an ABN

must be printed out.

Enter the patient’s name and date of birth into the appropriate

fields and click on the Generate Printable ABN button. The

ABN will have the patient’s name, date of birth, and the cost of

the testing listed.

Print out the ABN and explain it to the patient.

11 April 2013

References

Medicare Part B 1999 Basic Billing Manual

Medicare Secondary Payer

Medicare Secondary Payer (MSP) refers to those instances in

which Medicare does not have the primary responsibility for

paying the medical expenses for a Medicare beneficiary.

All Providers should screen Medicare patients to obtain

correct and current health insurance information before

submitting a primary claim to Medicare.

By completing the MSP Questionnaire to initially screen your

Medicare patients, you will help reduce costs to the Medicare

Program as well as administrative costs to your practice.

Requisitions provided to the laboratory should reflect accurate

patient insurance information, including screening for

Medicare Secondary Payer. Laboratory Patient Service Center

employees will provide Medicare Secondary Payer screening

when performing phlebotomy on Medicare beneficiaries.

Physician offices that are unable to provide Medicare

Secondary Payer screening are encouraged to direct their

patients to our Patient Service Centers for this vital

requirement of the Medicare Program.

www.cms.gov/MedicareSecondPayerandYou/

www.noridianmedicare.com/

www.noridianmedicare.com/p-medb/news/faq/msp.html

Medicare B New, Issue 167 "Medicare Secondary Payer"

Hospital Manual-Section 295.1, 301-301.2 January 1999

12 April 2013

DISABILITYProceed only to #9-10

Date of injury/illness: ________/______/_________

Name/Address of WC plan:

Policy or ID #:

Date of accident: ________/______/_________

Type of accident: Automobile or Non-Auto?

Name/Address of no-fault or liability insurer?

Insurance claim number: _______________

Was another party responsible for the accident?

Name/address of any liability insurer?

9. DISABILITY: Are you currently

employed?

Date dialysis began: ________/______/_________

Name/Address of Spouse's Employer

Do you have Group Health Plan coverage based on

your own or a spouse's current employment?

Does employer who has GHP employ 20 or more?

Name/Address of GHP

Policy ID Number

Group ID Number

Name of Policy Holder

Relationship to patient

ESRD (End Stage Renal Dis)Proceed to #11-14

Name/Address of Employer

Date of transplant: ________/______/_________

10. DISABILITY: Is a family

member currently employed?

11. ESRD: Do you have group

health plan coverage

12. ESRD: Have you received a

kidney transplant?

13. ESRD: Have you received

maintenance dialysis treatment?

14. ESRD: Are you within the 30

month coordination period?

NO YES

NO YES

NO YES

NO YES

NO YES

NO YES

5. Is this lab procedure being

done due to a non-work related

accident?

6. Are you entitled to Medicare

based on: circle field(s) to R

7. AGE: Are you currently

employed?

8. AGE: Is your spouse currently

employed?

AGEProceed only to #7-8

NO YES

NO YES

NO YES

NO YES

NO YES

NO YES

4. Is this lab procedure being

done due to a work related

accident/condition?

NO YES

Medicare Secondary Payer (MSP) Questionnaire

Part II

1. Are you receiving Black Lung

Benefits?

2. Are you receiving any gov't

funded research program that

would pay for this service?

3. Has the Dept of Veteran's

Affairs (DVA) agreed to pay for

these procedures?

Medicare Secondary Payor (MSP) Questionnaire (LAB)

Medicare requires the questions below in Part I to be answered by each patient, before Medicare is billed

for medical services. If the answer to any of these questions is "yes," please complete the appropriate

follow-up information in Part II.

Patient Name:

Medicare #: Date of Service:

Part I Circle NO or YES

Date benefits began: ________/______/_________

Which government program and research grant will

pay primary benefits for this lab test(s)?

13 April 2013

Regence

Billing

14 April 2013

252.00-252.08

252.1

263.9

268.2

275.41

275.42

276.3

278.4

268.0, 268.1

275.40, 275.49

571.9

579.0

579.2

579.4

579.9

585.6

585.9

592.0

Rickets

Disorder of calcium metabolism

Chronic liver disease without alcohol

Celiac disease

Blind loop syndrome

Pancreatic Steatorrhea

Intestinal malabsorption

End stage renal disease

Chronic kidney disease

Calculus of kidney

Hypervitaminosis D

REGENCE SUMMARY OF ALLOWED DX CODES FOR VITAMIN D TESTING:

CPT 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed

APPENDIX I - ALLOWED FOR CPT 82306 AS OF 9/1/11

Conditions Specifically Associated with Vitamin D Deficiency

Hyperparathyroidism

Hypoparathyroidism

Protein-calorie malnutrition

Osteomalacia

Hypocalcemia

Hypercalcemia

Disorders of phosphorus metabolism

A list of Regence approved codes for VITAMIN D testing is provided below.

Vitamin D Limitations, Regence Billing

Regence has implemented a VITAMIN D testing policy and has greatly reduced the

number of ICD9 codes that they will now cover. This is effective September 1, 2011.

It is the provider’s responsibility to select diagnosis codes carried out to the highest level

of specificity and selected from the ICD-9-CM code book appropriate to the year in which

the service is rendered for the claim(s) submitted.

Regence's VITAMIN D policy should be retained as a reference, but remember that every

code provided on the lab order must be substantiated in the patient’s chart.

If a VITAMIN D test is ordered for a reason that is not considered “medically necessary”

by Regence, the “Non-covered Services Waiver Form” must be provided to and signed by

the patient.

15 April 2013


592.1

733.00

775.4

786.2

780

V70-V77.1

V77.3-V77.8

V77.91

V78-V82.9

135*

252.00-252.08

252.1

268.0

268.1

268.2

270.0*

275.3*

275.40

275.41

275.42

275.49

592.0

592.1

592.9

775.4

Other disorders of calcium metabolism

Calculus of kidney

Calculus of ureter

Urinary calculus, unspecified

Hypocalcemia and hypomagnesemia of newborn

Hypocalcemia

ICD 9-CM and Description - ALLOWED FOR 82652 AS OF 10/1/11

Sarcoidosis* New code added October 1.

Hyperparathyroidism, range

Hypoparathyroidism

Rickets, active

Rickets, late effect

Osteomalacia, unspecified

Fanconi syndrome* New code added October 1.

Familial hypophosphatemia* New code added October 1.

Unspecified disorder of calcium metabolism

Hypocalcemia

Based upon recent additional feedback received from clinicians related to CPT 82652

Vitamin D; 1, 25-dihydroxy, includes fraction(s), if performed, we have expanded the

medical conditions list where we will consider serum testing for calcitriol (1,25[OH]2D)

medically necessary for diagnosis or direct treatment. Effective October 1, the covered

medical conditions include:


Osteopetrosis

As a reminder, effective September 1, the following International Classification of

Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes are considered not

medically necessary and denied as a provider write-off when billed with CPT 82306:

ICD 9-CM and Description - NOT ALLOWED FOR 82306 or 82652 AS OF 9/1/11

General Symptoms

Persons without reported diagnosis encountered during examination and

Same as above

Same as above

Same as above

CPT 82652 Vitamin D; 1,25 dihydroxy, includes fraction(s), if performed

Vitamin D policy diagnoses expanded for CPT 82652 (1,25[OH]2D)

Osteoporosis

Calculus of ureter

16 April 2013


17 April 2013

Premera

Billing

18 April 2013

010.00 –018.96

135

200.00 –200.08

200.10 –200.18

200.20 –200.28

200.30 –200.38

200.40 –200.48

200.50 –200.58

200.60 –200.68

200.70 –200.78

200.80 –200.88

201.00 –201.08

201.10 –201.18

201.20 –201.28

201.40 –201.48

201.50 –201.58

201.60 –201.68

Lymphocytic-histiocytic predominance

Nodular sclerosis

Mixed cellularity

Anaplastic large cell lymphoma

Large cell lymphoma

Other lymphoma variants

Hodgkin’s paragranuloma

Hodgkin’s granuloma

Hodgkin’s sarcoma

Reticulosarcoma

Lymphosarcoma

Burkitt’s tumor or lymphoma

Marginal zone lymphoma

Mantel cell lymphoma

Primary central nervous system lymphoma

PREMERA SUMMARY OF ALLOWED DX CODES FOR VITAMIN D TESTING:

CPT 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed

ICD9-CM ALLOWED FOR CPT 82306 AS OF 11/12/12

Tuberculous infection, code range

Sarcoidosis

Vitamin D Limitations, Premera Billing

Premera has implemented a VITAMIN D testing policy and has greatly reduced the

number of ICD9 codes that they will now cover. This is effective November 12, 2012.




Premera's VITAMIN D policy should be retained as a reference, but remember that every

code provided on the lab order must be substantiated in the patient’s chart. Premera’s

policy can be reviewed in its entirety at:

https://www.premera.com/stellent/groups/public/documents/medicalpolicy/cmi_134366.ht

m#P34_328

If a VITAMIN D test is ordered for a reason that is not considered “medically necessary”

by Regence, the “Non-covered Services Waiver Form” must be provided to and signed by

the patient.

A list of Premera approved codes for VITAMIN D testing is provided below.

19 April 2013


201.70 –201.78

201.90 –201.98

202.00 –202.08

202.10 –202.18

202.20 –202.28

202.30–202.38

202.40 –202.48

202.50 –202.58

202.60 –202.68

202.70 –202.78

202.80 –202.88

202.90 –202.98

252.00 – 252.08

252.1

262

263.0

263.1

263.9

268.0

268.1

268.2

268.9

270.0 –270.9

275.3

275.40

275.41

275.42

278.4

278.8

278.8

359.5

414.00

414.01

414.05

414.06

414.3

555.0-555.9

571.2

571.5

571.6

576.8

Biliary cirrhosis

Other specified disorders of biliary tract

Coronary atherosclerosis of unspec. type of bypass graft

Coronary atherosclerosis of native coronary artery of transplanted heart

Coronary atherosclerosis due to lipid rich plaque

Regional enteritis, code range

Alcoholic cirrhosis of liver

Cirrhosis of liver without mention of alcohol

Hypervitaminosis D

Hyperalimentation

Other hyperalimentation

Myopathy in endocrine diseases

Coronary atherosclerosis of unspec type of vessel, native or graft

Coronary atherosclerosis of native coronary artery

Unspecified vitamin D deficiency

Disorders of amino-acid transport and metabolism, code range


Disorder of calcium metabolism, unspecified

Hypocalcemia

Hypercalcemia

Malnutrition of moderate degree

Malnutrition of mild degree

Unspecified protein-calorie malnutrition

Rickets, active

Ricketts, late effect


Peripheral T-cell lymphoma

Other lymphomas

Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue

Hyperparathyroidism, code range

Hypoparathyroidism

Other severe, protein-calorie malnutrition

Mycosis Fungoides

Sezary’s disease

Malignant histiocytosis

Leukemic reticuloendotheliosis

Letterer-Siwe disease

Malignant mast cell tumors

Lymphocytic depletion

Hodgkin’s disease, unspecified

Nodular lymphoma

20 April 2013


579.0-579.9

585.3–585.6

585.9

588.0

592.0

592.1

592.9

594.0

594.1

594.2

594.8

594.9

696.1

710.0

710.3

729.1

733.00

733.01

733.02

733.03

733.09

733.90

756.51

756.52

775.4

* V58.65

* V58.69

010.00 –018.96

135

252.00 – 252.08

252.1

268.0

268.1

268.2

270.0

275.3

275.40

Rickets, active

Ricketts, late effect


Fanconi syndrome


Disorder of calcium metabolism, unspec

CPT 82652 Vitamin D; 1,25 dihydroxy, includes fraction(s), if performed

ICD9-CM ALLOWED FOR CPT 82652 AS OF 11/12/12

Tuberculous infection, code range

Sarcoidosis

Hyperparathyroidism, code range

Hypoparathyroidism

Osteogenesis imperfecta

Osteopetrosis


Long-term (current) use of steroids

Long-term (current) use of other medications

* NOTE: Report with 268.2, Osteomalacia, unspecified

Osteoporosis, unspecified

Senile osteoporosis

Idiopathic osteoporosis

Disuse osteoporosis

Other osteoporosis

Disorder of bone and cartilage unspecified

Other lower urinary tract calculus

Calculus of lower urinary tract, unspecified

Other psoriasis

Systemic lupus erythematosus

Dermatomyositis

Myalgia and myositis unspecified

Calculus of kidney

Calculus of ureter

Urinary calculus unspecified

Calculus in diverticulum of bladder

Other calculus in bladder

Calculus in urethra

Intestinal malabsorption

Chronic kidney disease, code range

Chronic kidney disease, unspecified

Renal osteodystrophy

21 April 2013


275.41

278.8

585.3–585.6

592.0

592.1

592.9

756.51

756.52

775.4

Osteogenesis imperfecta

Osteopetrosis

Hypocalcemia & hypomagnesemia of newborn

Hypocalcemia

Hyperalimentation



Calculus of ureter

Urinary calculus unspecified

22 April 2013

United Healthcare (UHC)

Billing

23 April 2013

Hepatitis Screening Limitations, United Healthcare (UHC)

CPT 86803 Hepatitis C antibody

CPT 86804 Hepatitis C antibody; confirmatory test (eg, immunoblot)

CPT 87340 Infectious agent antigen detection by enzyme immunoassay technique,

qualitative or semiquantitative, multiple step method; hepatitis B surface antigen (HBsAG)


qualitative or semiquantitative, multiple step method; hepatitis B surface antigen (HBsAG)

neutralization


qualitative or semiquantitative, multiple step method; hepatitis Be antigen (HBeAG)

CPT 86709 Hepatitis A antibody (HAAb); IgM antibody

UHC has implemented a Hepatitis Screening testing policy and has greatly reduced the

number of ICD9 codes that they will now cover. This is effective April 1, 2012.




UHC's Hepatitis Screening policy should be retained as a reference, but remember that

every code provided on the lab order must be substantiated in the patient’s chart.

United’s policy can be reviewed in its entirety at:

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-

US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Polici

es%20and%20Protocols/Medical%20Policies/Medical%20Policies/Hepatitis_Screening.p

df

A list of UHC approved codes for Hepatis Screening testing is provided below.

UHC SUMMARY OF "PROVEN" DX CODES FOR HEPATITIS SCREENING TESTING:

APPLICABLE CODES: "The codes listed in this policy are for reference purposes only.

Listing of a service or device code in this policy does not imply that the service described

by this code is a covered or non-covered health service. Coverage is determined by the

benefit document. This list of codes may not be all inclusive."

CPT 86704 Hepatitis B core antibody (HBcAB); total

CPT 86705 Hepatitis B core antibody (HBcAB); IgM antibody

CPT 86706 Hepatitis B surface antibody (HBsAB)

CPT 86707 Hepatitis Be antibody (HBeAB)

CPT 86708 Hepatitis A antibody (HAAb); total

24 April 2013


Proven

Diagnosis Code

Description

042 Human immunodeficiency virus [HIV] disease

054.10-054.19 Herpes zoster with other nervous system complications

070.0-070.9 Viral hepatitis

078.10 Viral warts, unspecified

078.11 Condyloma acuminatum

078.19 Other specified viral warts

079.4 Human papillomavirus in conditions classified elsewhere and of unspecified site

090.0-090.9 Congenital syphilis

091.0-091.9 Early syphilis, symptomatic

092.0 Early syphilis, latent, serological relapse after treatment

092.9 Early syphilis, latent, unspecified

093.0-093.9 Cardiovascular syphilis

094.0-094.9 Neurosyphilis

095.0-095.9 Other specified forms of late symptomatic syphilis

096 Late syphilis, latent

097.0 Late syphilis, unspecified

097.1 Latent syphilis, unspecified

097.9 Syphilis, unspecified

098.0-098.89 Gonococcal infections

099.0-099.9 Other venereal disease

131.00-131.9 Trichomoniasis

135 Sarcoidosis

286.0-286.4,

286.6-286.9

Coagulation defects

304.00-304.93 Drug dependence

456.0 Esophageal varices with bleeding

456.1 Esophageal varices without mention of bleeding

555.0-555.9 Regional enteritis

556.0-556.5,

556.8, 556.9

Ulcerative colitis

571.0 Alcoholic fatty liver

571.1 Acute alcoholic hepatitis

571.2 Alcoholic cirrhosis of liver

571.3 Unspecified alcoholic liver damage

571.5 Cirrhosis of liver without mention of alcohol

571.6 Biliary cirrhosis

571.8 Other chronic nonalcoholic liver disease

25 April 2013


571.9 Unspecified chronic liver disease without mention of alcohol

585.3 Chronic kidney disease, Stage III (moderate)

585.4 Chronic kidney disease, Stage IV (severe)

585.5 Chronic kidney disease, Stage V

585.6 End stage renal disease

608.4 Other inflammatory disorder of male genital organs

614.9 Unspecified inflammatory disease of female pelvic organs and tissues

616.10 Vaginitis and vulvovaginitis, unspecified

616.11 Vaginitis and vulvovaginitis in diseases classified elsewhere

631 Other abnormal product of conception

632 Missed abortion

633.00-633.91 Ectopic pregnancy

634.00-634.92 Spontaneous abortion

635.00-635.92 Legally induced abortion

636.00-636.92 Illegally induced abortion

637.00-637.92 Unspecified abortion

638.0-638.9 Failed attempted abortion

639.0-639.9 Complications following abortion and ectopic and molar pregnancies

640.00-640.93 Hemorrhage in early pregnancy

641.00-641.93 Antepartum hemorrhage, abruptio placentae and placenta previa

642.00-642.94 Hypertension complicating pregnancy, childbirth and the puerperium

643.00-643.93 Excessive vomiting in pregnancy

644.00-644.21 Early or threatened labor

645.10-645.23 Late pregnancy

646.00-646.93 Other complications of pregnancy, not elsewhere classified

647.00-647.94 Infectious and parasitic conditions in the mother classifiable elsewhere, but

complicating pregnancy, childbirth or the puerperium

648.00-648.94 Other current conditions in the mother classifiable elsewhere, but complicating

pregnancy, childbirth or the puerperium

649.00-649.73 Other conditions or status of the mother classifiable elsewhere, but

complicating pregnancy, childbirth or the puerperium

650 Normal delivery

651.00-651.93 Multiple gestation

652.00-652.93 Malposition and malpresentation of fetus

653.00-653.93 Disproportion

654.00-654.94 Abnormality of organs and soft tissues of pelvis

655.00-655.93 Known or suspected fetal abnormality affecting management of mother

656.00-656.93 Other known or suspected fetal and placental problems affecting management

of mother

657.00-657.03 Polyhydramnios

658.00-658.93 Other problems associated with amniotic cavity and membranes

26 April 2013


659.00-659.93 Other indications for care or intervention related to labor and delivery, not

elsewhere classified

660.00-660.93 Obstructed labor

661.00-661.93 Abnormality of forces of labor

662.00-662.33 Long labor

663.00-663.93 Umbilical cord complications

664.00-664.94 Trauma to perineum and vulva during delivery

665.00-665.94 Other obstetrical trauma

666.00-666.34 Postpartum hemorrhage

667.00-667.14 Retained placenta or membranes, without hemorrhage

668.00-668.94 Complications of the administration of anesthetic or other sedation in labor and

delivery

669.00-669.94 Other complications of labor and delivery, not elsewhere classified

670.00-670.84 Major puerperal infection

672.00-672.04 Pyrexia of unknown origin during the puerperium

673.00-673.84 Obstetrical pulmonary embolism

674.00-674.04 Cerebrovascular disorders in the puerperium

674.80-674.94 Other and unspecified complications of puerperium, not elsewhere classified

696.0 Psoriatic arthropathy

696.1 Other psoriasis and similar disorders

714.0 Rheumatoid arthritis

714.1 Felty's syndrome

714.2 Other rheumatoid arthritis with visceral or systemic involvement

714.81 Rheumatoid lung

714.89 Other specified inflammatory polyarthropathies:other

714.9 Unspecified inflammatory polyarthropathy

720.0 Ankylosing spondylitis

720.9 Unspecified inflammatory spondylopathy

790.4 Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase

794.8 Nonspecific abnormal results of function study of liver

959.14 Other injury of external genitals

996.82 Complications of transplanted liver

V01.6 Contact with or exposure to venereal diseases

V01.79 Contact with or exposure to other viral diseases

V02.60-V02.69 Viral hepatitis carrier

V02.7 Carrier or suspected carrier of gonorrhea

V02.8 Carrier or suspected carrier of other venereal diseases

V08 Asymptomatic human immunodeficiency virus [HIV] infection status

V22.0-V22.2 Normal pregnancy

V23.0-V23.3 Supervision of high-risk pregnancy

27 April 2013


V23.41 Supervision of pregnancy with history of pre-term labor

V23.49 Supervision of pregnancy with other poor obstetric history

V23.5 Pregnancy with other poor reproductive history

V23.7 Insufficient prenatal care

V23.81-V23.86,

V23.89

Supervision of high-risk pregnancy

V23.9 Unspecified high-risk pregnancy

V24.0-V24.2 Postpartum care and examination

V26.29 Other investigation and testing

V28.2 Other antenatal screening based on amniocentesis

V28.81-V28.89 Other specified antenatal screening

V28.9 Unspecified antenatal screening

V42.0-V42.9 Organ or tissue replaced by transplant

V45.11 Renal dialysis status

V56.0 Encounter for extracorporeal dialysis

V56.8 Encounter other dialysis

V58.11 Encounter for antineoplastic chemotherapy

V58.2 Blood transfusion, without reported diagnosis

V59.01-V59.6,

V59.8-V59.9

Donors of other or unspecified organ or tissue

V69.2 High-risk sexual behavior

V71.5 Observation following alleged rape or seduction

V72.42 Pregnancy examination or test, positive result

V74.5 Screening examination for venereal disease

V83.01-V83.02 Hemophilia A carrier

V87.41 Personal history of antineoplastic chemotherapy

V87.46 Personal history of immunosuppressive therapy

V91.00 -V91.99 Multiple gestation placenta status

28 April 2013

Billing

Washington Public Assistance/DSHS

29 April 2013

Guidelines, Washington Public Assistance/DSHS

HIV tests: DSHS only covers following ICD-9 codes:

042 - Human immunodeficiency virus (HIV)

079.53 - Human immunodeficiency virus, type 2 (HIV-2)

V01.79 - Contact or exposure to other viral diseases

V08 - Asymptomatic HIV infection status

V22.0, V22.1- Pregnancy

V28.89-Other Specified Antenatal Screening

References

All of the above information can be found in the Billing Instructions for Physician-Related

Services. This is available online at:

http://hrsa.dshs.wa.gov/billing/documents/provideroneguide/providerone_billing_and_resource_gui

de.pdf

Preventative Physicals: DSHS only covers preventative physicals for children up to

the age of 18. DSHS does not cover preventative physicals for adults.

Family Planning Only Coverage: DSHS will only cover services associated with

contraception (ICD-9 codes V25.0-V25.9, except V25.3).

Pap Smears: DSHS will cover one routine Pap smear per patient, per calendar year.

DSHS considers routine Pap smears to be those billed with an ICD-9 code of V76.2,

V72.31, V76.47, or V25.40 - V25.49.

“Screening” Testing: DSHS does not cover screening lab work. Therefore, an actual

diagnosis or symptom ICD-9 code must be provided for all lab work to prove medical

necessity.

Monitoring Patient Medications: If monitoring the patient’s medication, the “med

monitoring” ICD-9 codes (V58.61 - V58.69) are to be used as secondary diagnosis

codes only. Per DSHS, the reason for the medication use must be given as the

primary ICD-9 code.

Prenatal Care: If a patient is being seen for prenatal care , and lab work is ordered,

the diagnosis codes V22.0 (patient’s 1st

pregnancy) & V22.1 (any subsequent

pregnancy) are acceptable per DSHS, but V22.2 is not.

30 April 2013

Medicare Coverage Limitation Resources

31 April 2013

Workpar Description CPT4 Eff Date Est Fee

AFP Alpha Feto-protein 82105 (NCD) 11/25/2002 $ 60.00 BTNP B-Type Natriuretic

Peptide

83880 (LCD) 7/25/2011 $ 153.00

CA125 CA125 86304 (NCD) 11/25/2002 $ 62.00 CA15-3 CA15-3 86300 (NCD) 11/25/2002 $ 85.00 CA19-9 CA19-9 86301 (NCD) 11/25/2002 $ 75.00 CA27.29 CA27-29 86300 (NCD) 11/25/2002 $ 66.00 CBC CBC (All complete Blood

Counts)

85021-85028

(NCD)

11/25/2002 $ 44.00

CEA CEA 82378 (NCD) 11/25/2002 $ 54.00 PAP SMEARS Cervical Smears 88150 (LCD) 1996 Client Services CHO Cholesterol 82465 (NCD) 11/25/2002 $ 11.00 UA.ID Culture, Organism ID 87088 (NCD) 11/25/2002 $ 81.00 CURNNS Culture Urine Colony

Count

87086 (NCD) 11/25/2002 $ 58.00

DIF Differential (Blood

Counts), Manual

85007-85008

(NCD)

11/25/2002 $ 62.00

DIG Digoxin 80162 (NCD) 11/25/2002 $ 47.00 DLDL Direct LDL 83721 (NCD) 11/25/2002 $ 58.00 FERR Ferritin 82728 (NCD) 11/25/2002 $ 46.00 FREE T4 Free T4 84439 (NCD) 11/25/2002 $ 44.00 FRUCTO Fructosamine 82985 (NCD) 11/25/2002 $ 53.00 GGT Gamma

Glutamyltransferase

82977 (NCD) 11/25/2002 $ 11.00

GLU Glucose 82947-82948,

82962 (NCD)

11/25/2002 $ 11.00

GLHGB Glycohemoglobin 83036 (NCD) 11/25/2002 $ 45.00 HCG-QUANT HCG Quantitative 84702 / 84703

(NCD)

11/25/2002 $ 52.00

HDL HDL 83718 (NCD) 11/25/2002 $ 41.00 HCT Hematocrit (Including

Spun)

85013-85014

(NCD)

11/25/2002 $ 42.00

HGB Hemoglobin 85018 (NCD) 11/25/2002 $ 42.00 AUT Hemogram, Automated 85021, 85027

(NCD)

11/25/2002 $ 42.00

HEPACU Hepatitis Panel, Acute 80074 (NCD) 11/25/2002 $ 138.00 12HIVR HIV (Virology Serology) 86703 (NCD) 11/25/2002 $ 55.00

HIVQBD HIV-1 Ultrasensitive RNA 87536 (NCD) 11/25/2002 $ 355.00

HIVUS HIV-1, Ultrasensitive

Quant by PCR

87536 (NCD) 11/25/2002 $ 372.00

HIV2AB HIV-2 Antibody, Elisa 86702 (NCD) 11/25/2002 $ 389.00 1HIVWB HIV-1 Western Blot 86689 (NCD) 11/25/2002 $ 245.00 Multiple HIV-2, Amplified Probe 87538 (NCD) 11/25/2002 Client Services Multiple HIV-2, Direct Probe 87538 (NCD) 11/25/2002 Client Services Multiple HIV-2, Quant 87539 (NCD) 11/25/2002 Client Services HYPOA Hypothyroid Profile 84479,84436,

84443 (NCD)

11/25/2002 $ 133.00

IRON.BIND Iron Binding Capacity 83550 (NCD) 11/25/2002 $ 40.00 IRN Iron, Total 83540 (NCD) 11/25/2002 $ 40.00

NATIONAL COVERAGE DECISION AND LOCAL COVERAGE DECISION TEST LIST AND PRICES

32 April 2013


NATIONAL COVERAGE DECISION AND LOCAL COVERAGE DECISION TEST LIST AND PRICES

LIPID Lipid Profile 80061 (NCD) 11/25/2002 $ 44.00 MAG Magnesium 82735 (LCD) 4/16/2006 $ 40.00 B.NTX N-Telopeptides (NTX) 82523 (NCD) 11/25/2002 $ 116.00 OC.BLD Occult Blood 82270 (NCD) 11/25/2002 $ 55.00 PTT Partial Thromboplastin

Time

85730 (NCD) 11/25/2002 $ 41.00

PLT Platelet Count 85595 (NCD) 11/25/2002 $ 42.00 PT Prothrombin Time 85610 (NCD) 11/25/2002 $ 41.00 PSA PSA 84153 (NCD) 11/25/2002 $ 54.00 T3UP T3 Uptake 84479 (NCD) 11/25/2002 $ 45.00 T4 T4 by Icma 84436 (NCD) 11/25/2002 $ 44.00 BTB Thyroid Profile 84479, 84436

(NCD)

11/25/2002 $ 89.00

TRANSFERRIN Transferrin 84466 (NCD) 11/25/2002 $ 62.00 TRIG Triglycerides 84478 (NCD) 11/25/2002 $ 11.00 TSH TSH 84443 (NCD) 11/25/2002 $ 45.00 UA Urinalysis 81003 (LCD) 10/1/2005 $ 39.00 VDOH Vitam D, 25-Hydroxy 82306 (LCD) 11/14/2011 $ 88.00 VITD23 Vitamin D2/D3, 25-

Hydroxy

82306 (LCD) 11/14/2011 $ 186.00

VIDD Vitamin D (1, 25-

DiHydroxy

82652 (LCD) 11/14/2011 $ 128.00

WBC White Cell Count 85048 (NCD) 11/25/2002 $ 42.00

Reviewed: April 2013

33 April 2013


21HYAB 21 Hydroxylase

Antibodies

83519 Investigational $ 222.00

APOLA, APOLB Apolipoprotein A & B 82172 Never Covered $ 115.00

ADH Arginine Vasopressing

Hormone


ADIPA Adiponectin 83520 Investigational $ 621.00 C2 C2 Complement

Component


C3AL C3AL 86160 Investigational $ 297.00 C7SP Complement Component

C7


C9CSP Complement Component

C9


CAMPAB Campylobacter Jejuni

Antibody


multiple Cellular Function Assay

Involving Stimulation

86352 Never Covered Client Services

CHROMA Chromogranin A 86316 Investigational $ 178.00 CYSTICERCUS.AB Cysticercus AB 86682 Investigational $ 209.00

DENGUE Dengue Fever Virus AB,

IGG & IGM

86790 x 2 Investigational $ 197.00

EPIP4A Human Epididymis

Protein

86305 Never Covered $ 634.00

FTABGA Francisella Tularensis AB

Igg


FTABMA Francisella Tularensis AB

Igm


FTAGMA Francisella Tularensis

ABS Igg & Igm

86668 x2 Investigational $ 227.00

FCORTS Cortisol, Serum Free 82530 Investigational $ 374.00 GM1.AB GM 1 Anitbody Panel 83516 x 4 Investigational $ 620.00 GM1ABS Ganglioside (GM1) ABS,

IGG & IGM

83516 x 2 Investigational $ 254.00

GM1COM Ganglioside Asialo GM1

GM2


HEPDAB Hepatitis D Virus

Antibody, Total EIA


HIST Histamine 83088 Investigational $ 153.00 HISTP Histamine, Plasma 83088 Investigational $ 153.00 HIST-U Histamine, Urine 83088 Investigational $ 153.00 HIV2WB HIV-2 Antibody, IB 86689 Investigational $ 292.00 INHB Inhibin B 83520 Investigational $ 388.00 LPA.MAYO Lipoprotein (A) 82172 Never Covered $ 62.00

LEPTNA Lysozyme 83520 Investigational $ 322.00 MUR Myelin Basic Protein 85549 Investigational $ 111.00 MBP Maternal Screen,

Integrated Spec #1


INVESTIGATIONAL TEST LIST AND PRICES: REQUIRE ABN EVERY TIME THEY ARE ORDERED

34 April 2013


INVESTIGATIONAL TEST LIST AND PRICES: REQUIRE ABN EVERY TIME THEY ARE ORDERED

MSSIS2 Maternal Screen,

Sequential Spec #2

82105, 84702,

82677, 86336

Investigational $ 475.00

MSSS2 Maternal Screen,

Sequential Spec #2

82105, 84702,

82677, 86336


MYAJO1 Phospholipids, serum or

Plasma

83516 x 7, 86235

x3


NEUIGG Neuronal Antibodies Igg

by


NMRLP NMR Lipoprofile 83704 Never Covered $ 159.00

NMR630 NMR Lipoprofile Test

(LDL-P Only)


NSECA Neuron Specific Enolase,

CSF


NSEN Plasminogen Act Inhib-1,

4G/5G


PCALTA Procalcitonin 84145 Never Covered $ 633.00

PHOSPHO T-3 Reverse 84311 Investigational $ 147.00 T3REV Vascular Endothelial

Growth Factor


TRYPTS Tryptase 83520 Investigational $ 478.00 B.VAPCT1 Lipo, Frac 83701 Never Covered $ 92.00

B.ASAWK1 Thromboxane

Metabolites


VEGF Vascular Endothelial

Growth Factor


VGCCAB Voltage Gated Calcium

Chanel Ab



35 April 2013

Description CPT4 Frequency Covered Covered Diagnosis

Glycated Hemoglobin 83036 1 every 3 months See NCD detail

Glucose 82947 1 per year V77.1 Special screening for endocrine,

nutritional, metabolic, and immunity

disorders; diabetes mellitus

Occult Blood (Fecal) 82270, 82274 1 per year V76.51 Special screening for malignant

neoplasms of colon

Pap Smear 1 every 2 years V76.2 Special screening for malignant

neoplasms of the cervix

V15.89 Other specified personal history

presenting hazards to health

V76.47 Special Screening for malignant

neoplasms of the vagina

PSA 84153 1 per year for men

over 50 years of age

V76.44 Special screening for malignant

neoplasms of prostate

LIPID 80061 1 every 5 years V81.0 Special screening for ischemic

heart disease

V81.1 Special screening for

hypertension

V81.2 Special screening for other &

unspecified cardiovascular conditions

�

�

�

�

�

�

FREQUENCY TEST LIST: IF ANY OF THESE TEST(S) ARE REQUIRED TO BE RUN MORE OFTEN

THAN THE ALLOWABLE FREQUENCIES LISTED, THEY MUST BE DIAGNOSTIC OR HAVE AN ABN

FOR FREQUENCY.

***LIPID PANEL FREQUENCY LIMITATION*** NCD 190.23 Summary for Lipid Testing

Routine screening is generally not covered by Medicare

Borderline high total or LDL cholesterol levels: Lipid panel is reasonable on an

annual basis.

First year of anti-lipid dietary or pharmacologic therapy.

When evaluating non-specific chronic abnormalities of the liver, lipid panel would

generally not be indicated more than twice per year.

* One component of the panel or a measured LDL may be reasonable up to 6

times the first year.

* When documentation supports marked elevations or changes in anti-lipid

therapy due to inadequate initial patient response to dietary or pharmacologic

therapy, more frequent total cholesterol, HDL cholesterol, LDL cholesterol and

triglyceride testing may be indicated.

* After treatment goals are established: LDL cholesterol or total cholesterol may

be measured three times yearly.

Long-term anti-lipid dietary or pharmacologic therapy: Lipid panel is reasonable

on an annual basis.

If no dietary or pharmacologic therapy is advised, monitoring is not necessary.

36 April 2013

Code

798.0-798.9

V15.85

V16.1

V16.2

V16.40

V16.50

V16.51

V16.52

V16.59

V16.6

V16.7

V16.8

V16.9

V17.0-V17.3

V17.41

V17.49

V17.5-V17.89

V18.0

V18.11

V18.19

V18.2-V18.4, V18.51,

V18.59,V18.61, V18.69,

V18.7-V18.9

V19.0-V19.8

V20.0-V20.2

V20.31

Family history of malignant neoplasm, other

Family history of malignant neoplasm, leukemia

Family history of malignant neoplasm, other lymphatic and

Non-covered ICD-9-CM Codes for All NCD Edits, Medicare Billing

Per Medicare: This section lists codes that are never covered. 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 individual ICD-9-CM codes included in code ranges in the table below can be viewed

on CMS’ website under Downloads: Lab Code List. The link is:

http://www.cms.hhs.gov/CoverageGenInfo

Family history of malignant neoplasm, urinary organs

Family history of malignant neoplasm, kidney

Non-covered ICD-9-CM Codes for All NCD Edits:

Sudden death, cause unknown

Family history of malignant neoplasm, bladder

Description

Personal history of contact with and (suspected) exposure to potentially

hazardous body fluidsFamily history of malignant neoplasm, trachea, bronchus, and lung

Family history of malignant neoplasm, other respiratory and

Family history of malignant neoplasm, genital organs

Health supervision of infant or child

Family history of malignant neoplasm, other specified malignant

Family history of malignant neoplasm, unspecified malignant

Family history of certain chronic disabling diseases

Family history of sudden cardiac death (SCD)

Family history of other cardiovascular diseases

Family history of asthma; other chronic respiratory conditions

arthritis;other musculoskeletal diseases

Family history of diabetes mellitus

Family history of multiple endocrine neoplasia (MEN) syndrome

Family history of other endocrine and metabolic diseases

Family history of anemia; other blood disorders; mental retardation;

colonic polyps; other digestive disorders; polycystic kidney; other

kidney diseases; other genitourinary diseases; infectious and parasitic

diseases; genetic disease carrier

Family history of other conditions

Health supervision for newborn under 8 days old

37 April 2013

V20.32

V28.0-V28.9

V50.0-V50.9

V53.2

V60.0-V60.6

V60.81

V60.89

V60.9

V62.0

V62.1

V65.0

V65.11

V65.19

V68.0-V68.9

V70.0-V70.9

V73.0-V73.6

V73.81

V73.88-V73.89

V73.98-V73.99

V74.0-V74.9

V75.0-V75.9

V76.0

V76.3

V76.42-V76.43, V76.45-

V76.47, V76.49, V76.50,

V76.52, V76.81, V76.89,

V76.9V77.0

V77.2-V77.99

V78.0-V78.9

V79.0-V79.9

V80.01

V80.09

V80.1-V80.3

V81.3-V81.6

V82.0-V82.6, V82.71,

V82.79, V82.81, V82.89,

V82.9

Healthy persons accompanying sick persons

Health supervision for newborn 8 to 28 days old

Encounter for antenatal screening of mother

Elective surgery for purposes other than remedying health states

Hearing aid

Lack of housing; inadequate housing; lack of material resources;

person living alone; no other household person able to render care;

holiday relief care; and person living in residential institutionFoster care (status)

Other specified housing or economic circumstances

Unspecified housing or economic circumstances

Unemployment

Adverse effects of work environment

Special screening for malignant neoplasms, bladder

Pediatric pre-birth visit for expectant parent(s)

Other person consulting on behalf of another person

Encounters for administrative purposes

General medical examinations

Special screening examinations for viral and chlamydia diseases

Special screening examinations for Human papillomavirus (HPV)

Other specified chlamydial and viral diseases

Unspecified chlamydial and viral disease

Special screening examinations for bacterial and spirochetal diseases

Special screening examination for other infectious diseases

Special screening for malignant neoplasms, respiratory organs

Special screening for other neurological conditions

Special screening for glaucoma and other eye conditions; ear

Special screening for cardiovascular, respiratory, and genitourinary

diseases

Special screening for other conditions

Special screening for malignant neoplasms,(sites other than breast,

cervix, and rectum)

Special screening for endocrine, nutrition, metabolic, and immunity

Special screening for endocrine, nutrition, metabolic, and immunity

Special screening for disorders of blood and blood-forming organs

Special screening for mental disorders

Special screening for traumatic brain injury

38 April 2013

NCD & LCD WASHINGTON A

2013

NCD & LCD

Washington

Medicare A

39 April 2013

Page

Alpha Fetoprotein; Serum �� NCD 41-42

Blood Counts �� NCD 43-47

B-Type Natriuretic Peptide (BNP) �� LCD 48-49

CA125 �� NCD 50

CA 15-3/CA 27.29 �� NCD 51

CA 19-9 �� NCD 52

CEA �� NCD 53

Collagen Cross Links (NTX) �� NCD 54

Digoxin Therapeutic Drug Assay(Any Source) �� NCD 55-57

Gamma Glutamyltransferase (GGT) �� NCD 58-61

Glycated Hemoglobin & Glycated Protein �� NCD 62-63

Glucose Testing (Blood) �� NCD 64-67

HCG Quantitative �� NCD 68

Hepatitis Panel, Acute �� NCD 69

Human Immunodeficiency Virus (HIV)

Viral Load Diagnosis �� NCD 70-73

Human Immunodeficiency Virus (HIV) Prognosis �� NCD 74

Iron Studies, Serum �� NCD 75-78

Lipid Profile & Cholesterol Testing �� NCD 79-81

Magnesium �� LCD 82-87

Occult Blood, Feces Screening �� NCD 88-90

Prostate Specific Antigen (PSA) �� NCD 91

Prothrombin Time (PT) �� NCD 92-99

Partial Thromboplastin Time (PTT) �� NCD 100-105

Thyroid Testing �� NCD 106-109

Urinalysis �� LCD 110-123

Urine Culture �� NCD 124-125

Vitamin D�� LCD 126-127

NCD & LCD WASHINGTON A

40 April 2013

National Coverage Decision November 25, 2002

CPT: 82105 Alpha Fetoprotein; serum

070.22-070.23 Chronic viral hepatitis B with hepatic coma, with or without mention of

hepatitis delta070.32-070.33 Chronic viral Hep B w/out mention of hepatic coma, with or w/out mention of

hepatitis delta070.44 Chronic hepatitis C with hepatic coma

070.54 Chronic hepatitis C without mention of hepatic coma

095.3 Syphilis of liver

121.1 Clonorchiasis

121.3 Fascioliasis

155.0-155.2 Malignant neoplasm of the liver and intrahepatic bile ducts

164.2-164.9 Malignant neoplasm of the mediastinum

183.0 Malignant neoplasm, ovary

186.0 Malignant neoplasm of undescended testis

186.9 Malignant neoplasm, other and unspecific testis

197.1 Secondary malignant neoplasm of mediastinum

197.7 Secondary malignant neoplasm of liver

198.6 Secondary malignant neoplasm of ovary

198.82 Secondary malignant neoplasm, genital organs

209.20-209.29 Malignant carcinoid tumors of other and unspecified sites

209.70 Secondary neuroendocrine tumor, unspecified site

209.71 Secondary neuroendocrine tumor of distant lymph nodes

209.72 Secondary neuroendocrine tumor of liver

209.73 Secondary neuroendocrine tumor of bone

209.74 Secondary neuroendocrine tumor of peritoneum

209.75 Secondary Merkel cell carcinoma

209.79 Secondary neuroendocrine tumor of other sites

211.5 Benign neoplasm of liver and biliary passages

235.3 Neoplasm of uncertain behavior of liver and biliary passages

272.2 Mixed hyperlipidemia

273.4 Alpha 1 antitrypsin deficiency

275.01 Hereditary hemochromatosis

275.02 Hemochromatosis due to repeated red blood cell transfusions

275.03 Other hemochromatosis

275.09 Other disorders of iron metabolism

275.1 Disorder of copper metabolism

277.00 Cystic Fibrosis without mention of meconium ileus

277.03 Cystic Fibrosis with gastrointestinal manifestations

277.6 Other deficiencies of circulating enzymes

285.0 Sideroblastic Anemia

338.3 Neoplasm related pain (acute) (chronic)

414.4 Coronary atherosclerosis due to calcified coronary lesion

444.01 Saddle embolus of abdominal aorta

444.09 Other arterial embolism and thrombosis of abdominal aorta

571.2 Alcoholic cirrhosis of liver

ALPHA FETO PROTEIN; SERUM

41 AFP (NCD)


ALPHA FETO PROTEIN; SERUM

571.40 Chronic hepatitis, unspecified

571.41 Chronic persistent hepatitis

571.42 Autoimmune hepatitis

571.49 Other chronic hepatitis


573.5 Hepatopulmonary syndrome

608.89 Other specified disorders of male genital organs

793.11 Solitary pulmonary nodule

793.19 Other nonspecific abnormal finding of lung field

793.1 Non-specific abnormal findings of lung field

793.2 Non-specific abnormal findings of other intrathoracic organs

793.3 Non-specific abnormal findings of biliary tract

793.6 Non-specific abnormal findings of abdominal area, including retro peritoneum

795.89 Other abnormal tumor markers

V10.07 Personal history of malignant neoplasm, liver

V10.43 Personal history of malignant neoplasm, ovary

V10.47 Personal history of malignant neoplasm, testis

V86.0-V86.1 Estrogen receptor positive status [ER+]


42 AFP (NCD)

National Coverage Decision November 25, 2002*THIS SECTION ONLY****ALL OTHER DIAGNOSIS WILL BE COVERED***

***LISTED BELOW ARE THE DIAGNOSES THAT ARE NOT COVERED***

CPT: 85004 Blood count automated differential white blood cell (WBC count

CPT: 85007 Blood count; manual differential WBC count (includes RBC morphology and

platelet estimation)CPT: 85008 Blood counts, manual blood smear examination without differential

parameters

CPT: 85013 Blood counts, Spun microhematocrit

CPT: 85014 Blood counts, Other than spun hematocrit

CPT: 85018 Blood counts, Hemoglobin

CPT: 85025 Hemogram and platelet count, automated and automated complete

differential WBC count (CBC)CPT: 85027 Blood counts, Hemogram and platelet count, automated

CPT: 85032 Manual cell count (erythrocyte, leukocyte, or platelet) each

CPT: 85048 Blood counts, White blood cell (WBC)

CPT: 85049 Platelet, automated

078.10-078.19 Viral Warts210.0-210.9 Benign neoplasm of lip, oral cavity, and pharynx214.0 Benign neoplasm of skin216.0-216.9 Benign neoplasm of skin 217 Benign neoplasm of breast222.0-222.9 Benign neoplasm of male genital organs224.0 Benign neoplasm of eyeball, except conjunctiva, cornea, retina, and choroid

230.0 Carcinoma in situ of lip, oral cavity and pharynx232.0-232.9 Carcinoma in situ of skin300.00-300.09 Neurotic disorders301.0-301.9 Personality disorders302.0-302.9 Sexual deviations and disorders307.0 Stammering 307.20-307.23 Tics307.3 Stereotyped movements disorder307.80-307.89 Pain disorders related to psychological factors312.00-312.9 Disturbance of conduct, not elsewhere classified313.0-313.9 Disturbance of emotions specific to childhood and adolescence314.00-314.9 Hyperkinetic syndrome of childhood338.0-338.4 Central pain syndrome363.30-363.35 Chorioretinal scars363.40-363.43 Choroidal degeneration363.50-363.57 Hereditary choroidal dystrophies363.70-363.9 Choroidal detachment366.00-366.9 Cataract367.0-367.9 Disorders of refraction and accommodation371.00-371.9 Corneal opacity and other disorders of cornea373.00-373.9 Inflammation of eyelids375.00-375.9 Disorders of lacrimal system376.21-376.9 Disorders of the orbit, except 376.3, other exophthalmic conditions377.10-377.16 Optic atrophy377.21-377.24 Other disorders of optic disc

BLOOD COUNTS

43 CBC (NCD)



BLOOD COUNTS

384.20-384.25 Perforation of tympanic membrane384.81-384.82 Other specified disorders of tympanic membrane385.00-385.9 Other disorders of middle ear and mastoid387.0-387.9 Otosclerosis388.00-388.5 Other disorders of ear389.00-389.9 Hearing Loss440.0-440.1 Atherosclerosis of aorta and renal artery443.81-443.9 Other and unspecified peripheral vascular disease

448.1 Capillary nevus, non neoplastic457.0 Postmastectomy lymphedema syndrome470 Deviated nasal septum

471.0-471.9 Nasal polyps478.0 Hypertrophy of nasal turbinates478.4 Polyp of vocal cord or larynx478.11, 478.19 Nasal mucositis (ulcerative)478.19 Other disease of nasal cavity and sinuses520.0-520.9 Disorders of tooth development and eruption521.00-521.9 Diseases of hard tissues of teeth524.00-524.9 Dentofacial anomalies, including malocculsion525.0-525.9 Other diseases and conditions of teeth and supporting structures526.0-526.3 Diseases of the jaws527.6-527.9 Disease of salivary glands575.6 Cholesterolosis of gallbladder600.00-600.91 Hyperplasia of prostate603.0 Encysted hydrocele603.8 Other specified types of hydrocele603.9 Hydrocele, unspecified

605 Redundant prepuce and phimosis606.0-606.1 Infertility, male azoospermia and oligospremia

608.1 Spermatocoele608.3 Atrophy of testis608.20-608.24 Torsion of testis610.0-610.9 Benign mammary dysplasia611.1-611.6 Other disorders of breast611.9 Unspecified breast disorder616.2 Cyst of Bartholin's gland618.00-618.9 Genital prolapse620.0-620.3 Noninflammatory disorders of ovary, fallopian tube, and broad ligament

621.6-621.7 Malposition or chronic inversion of uterus

627.2-627.9 Menopausal and post menopausal disorders628.0-628.9 Infertility, female676.00-676.94 Other disorders of breast associated with childbirth and disorders of lactation

691.0-691.8 Atopic dermatitis and related disorders692.0-692.9 Contact dermatitis and other eczema700 Corns and callosities701.0-701.9 Other hypertrophic and atrophic conditions of skin702.0-702.8 Other dermatoses703.9 Unspecified disease of nail706.0-706.9 Diseases of sebaceous glands

44 CBC (NCD)



BLOOD COUNTS

709.00-709.4 Other disorders of skin and subcutaneous tissue715.00-715.98 Osteoarthrosis716.00-716.99 Other and unspecified arthropathies718.00-718.99 Other derangement of joint726.0-726.91 Peripheral esthesiopathies and allied syndromes727.00-727.9 Other disorders of synovium, tendon, and bursa728.10-728.85 Disorders of muscle ligament and fascia732.0-732.9 Osteochondropathies733.00-733.09 Osteoporosis734 Flat foot

735.0-735.9 Acquired deformities of toe

736.00-736.9 Other acquired deformities of limb737.0-737.9 Curvature of spine738.0-738.9 Other acquired deformity739.0-739.9 Nonallopathic lesions, not elsewhere classified

799.81 Decreased libido830.0-832.19 Dislocation of jaw, shoulder, and elbow832.2 Nursemaid's elbow833.00-833.19 Dislocation of wrist834.00-834.12 Dislocation of finger835.00-835.13 Dislocation of hip836.0-836.69 Dislocation of knee837.0-837.1 Dislocation of ankle838.00-838.19 Dislocation of foot839.00-839.9 Other, multiple and ill-defined dislocations840.0-848.9 Sprains and strains of joints and adjacent muscles905.0-909.9 Late effects of musculoskeletal and connective tissue injuries910.0-919.9 Superficial injuries930.0-932 Foreign body on external eye, in ear, in nose955.0-957.9 Injury to peripheral nerveV03.0-V06.9 Need for prophylactic vaccinationV11.0-V11.3 Personal history of mental disorder; schizophrenia, affective disorders,

neurosis, and alcoholismV11.4 Personal history of combat and operational stress reactionV11.8-V11.9 Personal history of other and unspecified mental disordersV14.0-V14.8 Personal history of allergy to medicinal agentsV16.0 Family history of malignant neoplasm, gastrointestinal tractV16.3 Family history of malignant neoplasm, breastV16.52 Family history of malignant neoplasm, bladderV21.0-V21.9 Consitutional states in developmentV25.01-V25.04, V25.9 Encounter for contraceptive management

V25.11 Encounter for insertion of intrauterine contraceptive deviceV25.12 Encounter for removal of intrauterine contraceptive deviceV25.13 Encounter for removal and reinsertion of intrauterine contraceptive device

V25.2-V25.3, V25.40-

V25.43, V25.49, V25.5,

V25.8, V25.9

Encounter for sterilization; menstrual extraction; surveillance of previously

prescribed contraceptive methods; and insertion of implantable subdermal

contraceptive; other specified and unspecified contraceptive management

V26.0-V26.9 Procreative management

45 CBC (NCD)



BLOOD COUNTS

V40.0-V40.9 Mental and behavioral problemsV41.0-V41.9 Problems with special senses and other special functionsV43.0-V43.1 Organ or tissue replaced by other means, eye globe or lensV44.0-V44.9 Artificial opening statusV45.00-V45.89 Other post surgical statesV48.0-V48.9 Problems with head, neck and trunkV49.0-V49.85 Other conditions influencing health statusV49.86 Do not resuscitate statusV49.87 Physical restraints statusV49.89-V49.9 Other specified and unspecified conditions influencing health statusV51.0 Encounter for breast reconstruction following mastectomyV51.8 Other aftercare involving the use of plastic surgeryV52.0-V52.9 Fitting and adjustment of prosthetic device and implantV53.01-V53.09 Fitting and adjustment of devices related to nervous system and special

sensesV53.1 Fitting and adjustment of spectacles and contact lenses

V53.31-V53.39 Fitting and adjustment of cardiac device

V53.4 Fitting and adjustment of orthodontic devices

V53.50 Fitting and adjustment of intestinal appliance or deviceV53.51 Fitting and adjustment of gastric lap bandV53.59 Fitting and adjustment of other gastrointestinal appliance and deviceV53.5 Fitting and adjustment of other intestinal appliance

V53.6 Fitting and adjustment of urinary devicesV53.7 Fitting and adjustment of orthopedic devicesV53.8 Fitting and adjustment of wheelchairV53.90-V53.99 Fitting and adjustment of other and unspecified deviceV54.01-V54.9 Other orthopedic aftercareV55.0-V55.9 Attention to artificial openingsV57.0-V57.9 Care involving use of rehabilitation proceduresV58.5 OrthodonticsV59.01-V59.9 DonorsV61.0-V61.09 Other family circumstancesV61.09 Other family disruption V61.10 Counseling for marital and partner problems, unspecifiedV61.12 Counseling for perpetrator of spousal and partner abuse V61.20 Counseling for parent-child problem V61.21 Counseling for victim of child abuseV61.22 Counseling for perpetrator of parental child abuse

V61.23 Counseling for parent-biological child problemV61.24 Counseling for parent-adopted child problemV61.25 Counseling for parent (guardian)-foster child problemV61.29 Other parent-child problems (Description Revised 10/09)V61.3 Problems with aged parents or in-lawsV61.41 Alcoholism in familyV61.42 Substance abuse in familyV61.49, V61.5-V61.9 Other specified and unspecified family problemsV62.21 Personal current military deployment status

V62.22 Personal history of return from military deploymentV62.29 Other occupational circumstances or maladjustment

46 CBC (NCD)



BLOOD COUNTS

V62.3-V62.84 Educational circumstances; other psychological or physical stress, not

elsewhere classified; suicidal ideation

V62.85 Homicidal ideation

V62.89-V62.9 Other psychological or physical stress, not elsewhere classified; and

unspecified psychosocial circumstances

V65.2 Person feigning illness

V65.3 Dietary surveillance and counseling

V65.40-V65.49 Other counseling, not elsewhere classifiedV65.5 Person with feared complaint in whom no diagnosis was madeV65.8 Other reasons for seeking consultationV65.9 Unspecified reason for consultationV66.0-V66.9 Convalescence and palliative careV67.3 Follow-up examination following psychotherapyV67.4 Follow-up examination following treatment of healed fractureV69.3 Problems related to lifestyle, gambling and betting

V70.0 Routine general examinationV71.01-V71.09 Observation and evaluation for suspected conditions not found, mentalV72.0-V72.2 Special investigations, examination of eyes and vision, ears and hearing,

dentalV72.40-V72.7 Special investigations, pregnancy exam, radiologic exam, laboratory exam,

diagnostic skin and sensitization testsV72.9 Special investigation, unspecifiedV73.81 Special screening exam for Human papillomavirus (HPV)V76.10-V76.19 Special screening for malignant neoplasms, breastV76.2 Special screening for malignant neoplasms, cervixV76.44 Special screening for malignant neoplasms, prostateV76.51 Special screening for malignant neoplasms. Intestine, colonV77.1 Special screening for diabetes mellitusV81.0-V81.2 Special screening for cardiovascular disease


47 CBC (NCD)

Medicare A Medical Policy September 21, 2010

CPT: 83880 Natriuretic peptide

402.01 Malignant hypertensive heart disease with heart failure

402.11 Benign hypertensive heart disease with heart failure

402.91 Unspecified hypertensive heart disease with heart failure

404.01 Hypertensive heart and chronic kidney disease, malignant, with heart failure

and with chronic kidney disease stage I-IV, or unspecified404.03 Hypertensive heart and chronic kidney disease, malignant, with heart failure

and with chronic kidney disease stage V or End Stage Renal Disease

404.11 Hypertensive heart and chronic kidney disease, benign, with heart failure and

with chronic kidney disease stage I-IV, or unspecified404.13 Hypertensive heart and chronic kidney disease, benign, with heart failure and

with chronic kidney disease stage V or End Stage Renal Disease

404.91 Hypertensive heart and chronic kidney disease, unspecified, with heart failure

and with chronic kidney disease stage I-IV, or unspecified


and with chronic kidney disease stage V or End Stage Renal Disease

410.62 True posterior wall infarction subsequent episode of care

410.72 Subendocardial infarction subsequent episode of care

410.82 Acute myocardial infarction of other specified sites subsequent episode of

care410.92 Acute myocardial infarction of unspecified site subsequent episode of care

423.2 Constrictive pericarditis

425.4 Other primary cardiomyopathies

428.0 Congestive heart failure unspecified

428.1 Left heart failure

428.20 Unspecified systolic heart failure

428.21 Acute systolic heart failure

428.22 Chronic systolic heart failure

428.23 Acute on Chronic systolic heart failure

428.30 Unspecified diastolic heart failure

428.31 Acute diastolic heart failure

428.32 Chronic diastolic heart failure

428.33 Acute on Chronic diastolic heart failure

428.40 Unspecified combined systolic and diastolic heart failure

428.41 Acute combined systolic and diastolic heart failure

428.42 Chronic combined systolic and diastolic heart failure

428.43 Acute on chronic combined systolic and diastolic heart failure

428.9 Heart failure unspecified

491.21 Obstructive chronic bronchitis with (acute) exacerbation

491.22 Obstructive chronic bronchitis with acute bronchitis

493.22 Chronic obstructive asthma with (acute) exacerbation

493.92 Asthma unspecified with (acute) exacerbation

519.11 Acute bronchospasm

786.00 Respiratory abnormality unspecified

786.02 Orthopnea

786.05 Shortness of breath

B-TYPE NATRIURETIC PEPTIDE (BNP)

48 BNP (LCD)

Medicare A Medical Policy September 21, 2010

B-TYPE NATRIURETIC PEPTIDE (BNP)

786.06 Tachypnea

786.07 Wheezing

786.09 Respiratory abnormality other


49 BNP (LCD)


CPT: 86304 Immunoassay for tumor antigen, quantitative, CA125

158.8-158.9 Malignant neoplasms, peritoneum, unspecified

180.0 Malignant neoplasm, endocervix

182.0 Malignant neoplasm of corpus uteri, except isthmus

183.0 Malignant neoplasm, ovary

183.2 Malignant neoplasm, fallopian tube

183.8 Malignant neoplasm, other specified sites of uterine adnexa

184.8 Malignant neoplasm, other specified sites of female genital organs

198.6 Secondary malignant neoplasm, ovary

198.82 Secondary malignancy of genital organs

236.0-236.3 Neoplasm of uncertain behavior of female genital organs

338.3 Neoplasm related pain (acute)(chronic)

789.39 Abdominal or pelvic swelling, mass, or lump, other specified site

795.82 Elevated cancer antigen 125 (CA 125)


V10.41-V10.42 Personal history of malignant neoplasm, other parts of uterus

V10.43-V10.44 Personal history of malignant neoplasm of female genital organs


CA125

50 CA 125 (NCD)


CPT: 86300 Immunoassay for tumor antigen, quantitative, CA15-3 / CA 27.29

174.0-174.9 Breast, primary (female) - malignant neoplasm of female breast

175.0-175.9 Breast, primary (male) - malignant neoplasm of male breast

198.2 Secondary malignant neoplasm (breast)

198.81 Secondary malignant neoplasm (breast)



V10.3 Personal history of malignant neoplasm, breast


CA 15-3 / CA 27.29

51 CA 15-3 / CA 27.29 (NCD)


CPT: 86301 Immunoassay for tumor antigen, quantitative, CA19-9

155.1 Malignant neoplasm, intrahepatic bile ducts

156.0 Malignant neoplasm, gallbladder

156.1 Malignant neoplasm, extrahepatic bile ducts

156.2 Malignant neoplasm, ampulla of Vater

156.8 Malignant neoplasm, other specified sites of gallbladder and extrahepatic bile

ducts

156.9 Malignant neoplasm, unspecified part of biliary tract

157.0-157.9 Malignant neoplasm, pancreas

197.8 Secondary malignant neoplasm, other digestive organs and spleen

235.3 Neoplasm of uncertain behavior, liver and biliary passages

235.5 Neoplasm of uncertain behavior, other and unspecified digestive organs



V10.09 Other personal history of cancer


CA 19-9

52 CA 19-9 (NCD)


CPT: 82378 Carcinoembryonic Antigen

150.0-150.9 Malignant neoplasm of the esophagus

151.0-151.9 Malignant neoplasm of stomach

152.0-154.8 Malignant neoplasm of small intestine, including duodenum, rectum,

157.0-157.9 Primary malignancy of pancreas

159.0 Malignant neoplasm of intestinal tract, part unspecified

162.0-162.9 Malignant neoplasm of trachea, bronchus, lung

174.0-174.9 Malignant neoplasm of female breast

175.0-175.9 Malignant neoplasm of male breast

183.0 Malignant neoplasm of ovary

197.0 Secondary malignant neoplasm of lung

197.4 Secondary malignant neoplasm of small intestine

197.5 Secondary malignant neoplasm of large intestine and rectum

209.00-209.03 Malignant carcinoid tumors of the small intestine

209.10-209.17 Malignant carcinoid tumors of the appendix, large intestine and rectum

209.20-209.29 Malignant carcinoid tumors of other and unspecified sites

209.70 Secondary neuroendocrine tumor, unspecified site

209.71 Secondary neuroendocrine tumor of distant lymph nodes

209.72 Secondary neuroendocrine tumor of liver

209.73 Secondary neuroendocrine tumor of bone

209.74 Secondary neuroendocrine tumor of peritoneum

209.75 Secondary Merkel cell carcinoma


230.3 Carcinoma in situ of colon

230.4 Carcinoma in situ of rectum

230.7 Carcinoma in situ of other/unspecified parts of intestine

230.9 Carcinoma in situ other and unspecified digestive organs

235.2 Neoplasm of uncertain behavior of stomach, intestines, rectum

338.3 Neoplasm related pain (acute) (chronic)

790.99 Other nonspecific findings on examination of blood

795.81 Elevated Carcinoembryonic Antigen (CEA)


V10.00 Personal history of malignant neoplasm of gastro-intestinal tract, unspecified

V10.05 Personal history of malignant neoplasm, large intestine

V10.06 Personal history of malignant neoplasm, rectum, rectosigmoid junction, anus

V10.11 Personal history of malignant neoplasm, bronchus, and lung

V10.3 Personal history of malignant neoplasm, breast

V10.43 Personal history of malignant neoplasm, ovary

V67.2 Follow-up examination following chemotherapy


CARCINOEMBRYONIC ANTIGEN (CEA)

53 CEA (NCD)


CPT: 82523 Collagen cross links, any method

242.00-242.91 Thyrotoxicosis

245.2 Chronic lymphocytic thyroiditis (only if thyrotoxic)

246.9 Unspecified disorder of thyroid

252.00-252.02 Hyperparathyroidism

252.08 Hyperparathyroidism

256.2 Postablative ovarian failure

256.31-256.39 Other ovarian failure

256.8 Other ovarian dysfunction

256.9 Unspecified ovarian dysfunction

268.9 Unspecified vitamin D deficiency

269.3 Mineral deficiency, not elsewhere classified

627.0 Premenopausal menorrhagia

627.1 Postmenopausal bleeding

627.2 Menopausal or female climacteric state

627.4 States associated with artificial menopause

627.8 Other specified menopausal and postmenopausal disorders

627.9 Unspecified menopausal & postmenopausal disorder

731.0 Osteitis deformans without mention of bone tumor (Paget's disease of bone)

733.00-733.09 Osteoporosis

733.10-733.19 Pathological fracture

733.90 Disorder of bone and cartilage, unspecified

805.8 Fracture of vertebral column without mention of spiral cord injury,

unspecified, closed V58.65 Long-term (current) use of steroids

V58.69 Long-term (current) use of other medications


COLLAGEN CROSS LINKS (NTX)

54

COLLAGEN CROSS LINKS

NTX (NCD)


CPT: 80162 Digoxin

242.00-242.91 Thyrotoxicosis with or without goiter

243 Congenital hypothyroidism

244.0-244.9 Acquired hypothyroidism

245.0-245.9 Thyroiditis

275.2 Disorders of magnesium metabolism

275.40-275.49 Disorders of calcium metabolism

275.5 Hungry bone syndrome

276.0 Hyperosmolality

276.1 Hyposmolality

276.2 Acidosis

276.3 Alkalosis

276.4 Mixed acid-base balance disorder

276.50-276.52 Volume depletion

276.61 Transfusion associated circulatory overload

276.69 Other fluid overload

276.7 Hyperpotassemia

276.8 Hypopotassemia

276.9 Electrolyte and fluid Disorder (not elsewhere classified)

293.0 Acute delirium

293.1 Subacute delirium

307.47 Other dysfunctions of sleep stages or arousal from sleep

339.3 Drug induced headache, not elsewhere classified

368.16 Psychopysical visual disturbances

368.8 Other specified visual disturbances

368.9 Unspecified visual disturbances

397.9 Rheumatic diseases of endocardium

398.0 Rheumatic Myocarditis

398.91 Rheumatic Hearth Failure

402.01 Hypertensive heart disease, malignant with CHF

402.11 Hypertensive heart disease, benign with CHF

402.91 Hypertensive heart disease, unspecified with CHF

403.00-403.91 Hypertensive renal disease

404.00-404.93 Hypertensive heart and renal disease

410.00-410.92 Acute myocardial infarction

411.0-411.89 Other acute and subacute forms of ischemic heart disease

413.0-413.9 Angina pectoris

414.4 Coronary atherosclerosis due to calcified coronary lesion

422.0-422.99 Acute myocarditis

425.0, 425.11, 425.18

425.2-425.9Cardiomyopathy

DIGOXIN THERAPEUTIC DRUG ASSAY (ANY SOURCE)

55 DIGOXIN (NCD)



426.0-426.9 Conduction disorders

427.0-427.9 Cardiac dysrhythmias

428.0-428.9 Heart failure

429.2 Cardiovascular disease, unspecified

429.4 Heart Disturbances Postcardiac Surgery

429.5 Rupture chordae tenineae

429.6 Rupture papillary muscle

429.71 Acquired cardiac septal defect

444.01 Saddle embolus of abdominal aorta

444.09 Other arterial embolism and thrombosis of abdominal aorta

514 Pulmonary congestion and hypostasis


579.9 Unspecified intestinal malabsorption

584.5-584.9 Acute renal failure

585.1-585.9 Chronic renal failure

586 Renal Failure, unspecified

587 Renal sclerosis, unspecified

588.0 Renal osteodystrophy

588.1 Nephrogenic Diabetes Insipidus

588.81, 588.89 Impaired renal function (not elsewhere classified)

588.9 Unspecified disorder resulting from impaired renal function

780.01 Coma

780.02 Transient alteration of awareness

780.09 Other ill-defined general symptoms (drowsiness, semicoma, somnolence,

stupor, unconsciousness)

780.1 Hallucinations

780.2 Syncope & collapse

780.4 Dizziness and giddiness

780.71-780.79 Malaise and fatigue

783.0 Anorexia

784.0 Headache

787.01-787.03 Nausea and vomiting

787.04 Bilious emesis

787.91 Diarrhea

794.31 Abnormal electrocardiogram

799.21 Nervousness

799.22 Irritability

799.23 Impulsiveness

799.24 Emotional lability

799.25 Demoralization and apathy

799.29 Other signs and symptoms involving emotional state

56 DIGOXIN (NCD)



972.0 Poisoning by cardiac rhythm regulators

972.1 Poisoning by cardiotonic glycosides and drugs of similar action

995.20 Unspecified adverse effect of unspecified drug, medicinal and biological

995.21 Arthus phenomenon

995.24 Failed moderate sedation during procedure

995.27 Other drug allergy

995.29 Unspecified adverse effect of other drug, medicinal and biological substance

**E942.1 Adverse effect of cardiotonic glycosides and drugs of similar action

V58.69 Encounter long term medication use (not elsewhere classified)

** Code may not be reported as a stand-alone or first-listed code on the claim.


57 DIGOXIN (NCD)


CPT: 82977 Glutamyltransferase, gamma (GGT)

003.1 Salmonella septicemia

006.0-006.9 Amebiasis

014.00-014.86 Tuberculosis of intestines, peritoneum, and mesenteric glands

017.90-017.96 Tuberculosis of other organs

018.90-018.96 Miliary tuberculosis, unspecified

020.0-020.9 Plague

022.3 Anthrax septicemia

027.0 Listeriosis

027.1 Erysipelothrix infection

030.1 Tuberculoid leprosy (Type T)

032.83 Diptheritic peritonitis

036.1 Meningococcal encephalitis036.2 Meningococcemia038.0-038.9 Septicemia039.2 Actinomycotic infections, abdominal040.0 Gas gangrene042 Human immunodeficiency virus (HIV) disease054.0 Eczema herpeticum054.5 Herpetic septicemia060.0-060.1 Yellow fever070.0-070.9 Viral hepatitis072.71 Mumps073.0 Ornithosis, with pneumonia074.8 Specific diseases due to Coxsackie virus075 Infectious mononucleosis078.5 Other diseases due to viruses and Chlamydiae079.99 Unspecified viral infection082.0-082.9 Tick-borne rickettsioses, stet084.9 Malaria086.1 Chagas disease with organ involvement other than heart088.81 Lyme disease091.62 Secondary syphilitic hepatitis095.3 Syphilis of liver100.0 Leptospirosis icterohemorrhagica112.5 Candidiasis, disseminated115.00 Infection by Histoplasm capsulatum without mention of manifestation120.9 Schistosomiasis, unspecified121.1 Clonorchiasis121.3 Fascioliasis122.0 Echinococcus granulosus infection of liver122.5 Echinococcus multilocularis infection of liver122.8 Echinococcosis, unspecified, of liver122.9 Echinococcus, other and unspecified130.5 Hepatitis due to toxoplasmosis 135 Sarcoidosis150.0-159.9 Malignant neoplasm of digestive organs and peritoneum160.0-165.9 Malignant neoplasm of respiratory and intrathoracic organs170.0-176.9 Malignant neoplasm of bone, connective tissue, skin, and breast

GAMMA GLUTAMYLTRANSFERASE (GGT)

58 GGT (NCD)



179-189.9 Malignant neoplasm of genitourinary organs200.00-208.92 Malignant neoplasm of lymphatic and hematopoietic tissue209.20-209.29 Malignant carcinoid tumors of other and unspecified sites209.70 Secondary neuroendocrine tumor, unspecified site209.71 Secondary neuroendocrine tumor of distant lymph nodes209.72 Secondary neuroendocrine tumor of liver209.73 Secondary neuroendocrine tumor of bone209.74 Secondary neuroendocrine tumor of peritoneum209.75 Secondary Merkel cell carcinoma209.79 Secondary neuroendocrine tumor of other sites211.5 Benign neoplasm of liver and biliary passages211.6 Benign neoplasm of pancreas, except islets of Langerhans211.7 Benign neoplasm of islets of Langerhans228.04 Hemangioma of intrac-abdominal structures230.7 Carcinoma in situ of other and unspecified parts of intestine 230.8 Carcinoma in situ of liver and biliary system230.9 Carcinoma in situ other and unspecified digestive organs235.0-235.9 Neoplasms of uncertain behavior of digestive and respiratory systems236.0-236.99 Neoplasms of uncertain behavior of genitourinary organs237.73 Schwannomatosis237.79 Other neurofibromatosis237.9 Neoplasms of uncertain behavior of other and uncertain parts of the nervous

system

238.0-238.6 Neoplasms of uncertain behavior of other and unspecified sites and tissues

238.71-238.76 Neoplasms of other lymphatic and hematopoietic tissues238.77 Post-transplant lymphoproliferative disorder (PTLD)238.79 Neoplasm of uncertain behavior 238.8 Neoplasms of uncertain behavior of other specified sites238.9 Neoplasms of uncertain behavior of unspecified sites239.0 Neoplasm of unspecified nature of digestive system250.00-250.93 Diabetes mellitus252.00-252.02, 252.08 Hyperparathyroidism

263.1 Malnutrition of mild degree263.9 Unspecified protein-calorie malnutrition268.0 Rickets, active268.2 Osteomalacia, unspecified269.0 Deficiency of vitamin K270.2 Other disturbances of aromatic amino acid metabolism270.9 Unspecified disorder of amino acid metabolism271.0 Glycogenosis272.0 Pure hypercholesterolemia272.1 Pure hyperglyceridemia272.2 Mixed hyperlipidemia272.4 Other and unspecified hyperlipidemia272.7 Lipidoses272.9 Unspecified disorder of lipoid metabolism273.4 Alpha 1 antitrypsin deficiency275.01 Hereditary hemochromatosis275.02 Hemochromatosis due to repeated red blood cell transfusions275.03 Other hemochromatosis275.09 Other disorders of iron metabolism275.1 Disorders of copper metabolism

59 GGT (NCD)



275.2 Disorders of magnesium metabolism275.3 Disorders of phosphorus metabolism275.40-275.49 Disorders of calcium metabolism275.5 Hungry bone syndrome277.1 Disorders of porphyrin metabolism277.30-277.31, 277.39 Amyloidosis

277.4 Disorders of bilirubin excretion277.6 Other deficiencies of circulating enzymes282.60-282.69 Sickle cell anemia286.6 Defibrination syndrome286.7 Acquired coagulation factor deficiency

289.4 Hypersplenism289.52 Splenic sequestration291.0-291.9 Alcoholic psychoses303.00-303.03 Acute alcoholic intoxication303.90-303.93 Other and unspecified alcohol dependence304.00-304.93 Drug dependence305.00-305.93 Non-dependent abuse of drugs357.5 Alcoholic polyneuropathy359.21-359.29 Myotonic disorders452 Portal vein thrombosis453.0-453.9 Other vein embolism and thrombosis456.0-456.21 Esophageal varices555.0-555.9 Regional enteritis556.0-556.9 Ulcerative colitis557.0 Acute vascular insufficiency of intestine

558.1-558.9 Other noninfectious gastroenteritis and colitis560.0-560.2 Intestinal obstruction: intussusceptions, paralytic ileus, volvulus560.3 Impaction of intestine, unspecified560.31 Gallstone ileus560.32 Fecal impaction560.39 Other impaction of intestine560.81-560.89, 560.9 Other and unspecified intestinal obstruction562.01 Diverticulitis of small intestine (without mention of hemorrhage)562.03 Diverticulitis of small intestine with hemorrhage562.11 Diverticulitis of colon (without mention of hemorrhage)562.13 Diverticulitis of colon with hemorrhage567.0-567.9 Peritonitis569.83 Perforation of intestine569.87 Vomiting of fecal matter570 Acute and subacute necrosis of liver571.0-571.9 Chronic liver disease and cirrhosis572.0-572.8 Liver abscess and sequelae of chronic liver disease573.0-573.9 Other disorders of liver574.00-574.91 Cholelithiasis575.0-575.9 Other disorders of gallbladder576.0-576.9 Other disorders of biliary tract581.0-581.9 Nephrotic syndrome

582.0-582.9 Chronic glomerulonephritis583.0-583.9 Nephritis and nephropathy not specified as acute or chronic584.5-584.9 Acute renal failure585.6 Chronic renal failure

60 GGT (NCD)



586 Renal failure, unspecified587 Renal sclerosis, unspecified588.0-588.9 Disorders resulting from impaired renal function590.00-590.9 Infections of kidney642.50-642.54 Severe pre-eclampsia646.70,646.71,646.73 Liver disorders in pregnancy782.4 Jaundice, unspecified, not of newborn789.1 Hepatomegaly790.4 Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase

790.5 Other nonspecific abnormal serum enzyme levels

960.00-969.09 Poisoning by antidepressants969.70-969.79 Poisoning by psychostimulants969.8, 969.9 Poisoning by other specified and unspecified psychotropic agents970.0-970.1 Poisoning by analeptics and opiate antagonists

970.81 Poisoning by cocaine970.89 Poisoning by other central nervous system stimulants970.9 Poisoning by unspecified central nervous system stimulants971.0-971.3, 971.9 Poisoning by drugs primarily affecting the autonomic nervous system972.0-972.9 Poisoning by agents primarily affecting the cardiovascular system973.0-973.6, 973.8,

973.9

Poisoning by agents primarily affecting the GI system

974.0-974.7 Poisoning by water, mineral, and uric acid metabolism drugs975.0-975.8 Poisoning by agents primarily acting on the smooth and skeletal muscles and

respiratory system976.0-976.9 Poisoning by agents primarily affecting skin and mucous membrane,

ophthalmological, otorhinolaryngological, and dental drugs977.0-977.4, 977.8,

977.9

Poisoning by other and unspecified drugs, and medicinal substances

978.0-978.6, 978.8,

978.9

Poisoning by bacterial vaccines

979.0-979.7 Poisoning by other vaccines and biological substances979.9 Poisoning by drugs, medicinal, and biological substances980.0-989.89 Toxic effects of substances chiefly nonmedicinal as to sourceV42.7 Organ replaced by transplant, liverV58.61-V58.69 Long Term (current) drug useV67.1 Follow up examination, radiotherapyV67.2 Follow up examination, chemotherapyV67.51 Follow up examination after completed treatment with high-risk medications,

not elsewhere classified


61 GGT (NCD)


CPT: 82985 Glycated protein

CPT: 83036 Hemoglobin; Glycated

211.7 Benign neoplasm of islets of Langerhans

249.00-249.91 Secondary Diabetes Mellitus, with or without various manifestations

250.00-250.93* Diabetes mellitus & various related codes

251.0 Hypoglycemic coma

251.1 Other specified hypoglycemia

251.2 Hypoglycemia unspecified

251.3 Post-surgical hypoinsulinemia

251.4 Abnormality of secretion of glucagon

251.8 Other specified disorders of pancreatic internal secretion

251.9 Unspecified disorder of pancreatic internal secretion

258.0-258.9 Polyglandular dysfunction271.4 Renal glycosuria275.01 Hereditary hemochromatosis275.02 Hemochromatosis due to repeated red blood cell transfusions275.03 Other hemochromatosis275.09 Other disorders of iron metabolism

577.1 Chronic pancreatitis579.3 Other and unspecified postsurgical nonabsorption648.00* Diabetes mellitus complicating pregnancy, childbirth or the puerperium,

unspecified as to episode of care or not applicable

648.03* Diabetes mellitus complicating pregnancy, Childbirth or the puerperium,

antepartum condition or complication

648.04* Diabetes mellitus complicating pregnancy, childbirth or the puerperium,

postpartum condition or complication

648.80 Abnormal glucose tolerance complicating pregnancy, childbirth or the

puerperium, unspecified as to episode of care or not applicable648.83 Abnormal glucose tolerance complicating pregnancy, childbirth or the

puerperium, antepartum condition or complication648.84 Abnormal glucose tolerance complicating pregnancy, childbirth or the

puerperium, postpartum condition or complication790.21 Impaired fasting glucose

790.22 Impaired glucose tolerance test790.29 Other abnormal glucose (hyperglycemia)790.6 Other abnormal blood chemistry962.3 Poisoning by insulin and antidiabetic agentsV12.21 Personal history of gestational diabetesV12.29 Personal history of other endocrine, metabolic, and immunity disordersV58.67 Long-term use of insulinV58.69 Long-term use of other medication

GLYCATED HEMOGLOBIN AND GLYCATED PROTEIN

Frequency Limitation: This test is only deemed medically necessary every 3 months.

62 GLHGB (NCD)


GLYCATED HEMOGLOBIN AND GLYCATED PROTEIN


* Per Medicare, www.cms.gov, it is not considered reasonable and necessary to perform glycated

hemoglobin tests more often than every three months on a controlled diabetic patient to determine

whether the patient's metabolic control has been on average within the target range. It is not

considered reasonable and necessary for these tests to be performed more frequently than once a

month for diabetic pregnant women. Testing for uncontrolled type one or two diabetes mellitus may

require testing more than four times a year. Refer to CMS guidelines for the clinical basis for those

situations in which testing more frequently than four times per annum is indicated. Medical

necessity documentation must support such testing in excess of the above guidelines.

63 GLHGB (NCD)


CPT: 82947 Glucose; quantitative, blood (except reagent strip)CPT: 82948 Glucose; blood, reagent stripCPT: 82962 Glucose, blood by glucose monitoring device(s) cleared by the FDA

specifically for home use

011.00-011.96 Tuberculosis038.0-038.9 Septicemia112.1 Recurrent vaginal candidiasis112.3 Interdigital candidiasis118 Opportunistic mycoses157.4 Malignant neoplasm of Islets of Langerhans158.0 Malignant neoplasm of retroperitoneum211.7 Benign neoplasm of Islets of Langerhans242.00-242.91 Thyrotoxicosis249.00-249.91 Secondary Diabetes Mellitus, with or without various manifestations250.00-250.93 Diabetes mellitus251.0-251.9 Disorders of pancreatic internal secretion253.0-253.9 Disorders of the pituitary gland 255.0 Cushing syndrome263.0-263.9 Malnutrition271.0-271.9 Disorders of carbohyrdate transport and metabolism272.0-272.4 Disorders of lipoid metabolism275.01 Hereditary hemochromatosis275.02 Hemochromatosis due to repeated red blood cell transfusions275.03 Other hemochromatosis275.09 Other disorders of iron metabolism276.0 Hyperosmolality and/or hypernatremia276.1 Hyposmolality and/or hyponatremia276.2 Acidosis276.3 Alkalosis276.4 Mixed Aacid-base balance disorder276.50 Volume depletion, unspecified276.51 Dehydration276.52 Hypovolemia276.61 Transfusion associated circulatory overload276.69 Other fluid overload276.7 Hyperpotassemia276.8 Hypopotassemia276.9 Electrolyte and fluid disorders not elsewhere classified278.3 Hypercarotinemia293.0 Acute delirium294.9 Unspecified organic brain syndrome298.9 Unspecified psychosis300.9 Unspecified neurotic disorder310.1 Organic personality syndrome331.83 Mild cognitive impairment, so stated337.9 Autonomic nervous system neuropathy345.10-345.11 Generalized convulsive epilepsy 348.31 Encephalopathy, unspecified355.9 Neuropathy, not otherwise specified

GLUCOSE TESTING (BLOOD)

Frequency Limitation: See "Frequency Test List" for specifics.

64 GLUCOSE (NCD)



356.9 Unspecified hereditary and idiopathic peripheral neuropathy357.9 Unspecified inflammatory and toxic neuropathy362.10 Background retinopathy362.18 Retinal vasculitis362.29 Nondiabetic proliferative retinopathy362.50-362.57 Degeneration of macular posterior pole362.60-362.66 Peripheral retinal degeneration362.81-382.89 Other retinal disorders362.9 Unspecified retinal disorders365.04 Borderline glaucoma, ocular hypertension365.32 Corticosteroid-induced glaucoma residual366.00-366.09 Presenile cataract366.10-366.19 Senile cataract367.1 Acute myopia368.8 Other specified visual disturbance373.00 Blepharitis377.24 Pseudopapilledema377.9 Unspecified disorder of optic nerve and visual pathways378.50-378.55 Paralytic strabismus379.45 Argyll-Robertson pupils410.00-410.92 Acute myocardial infarctions414.00-414.19 Coronary atherosclerosis and aneurysm of heart414.3 Coronary atherosclerosis due to lipid rich plaque414.4 Coronary atherosclerosis due to calcified coronary lesion425.9 Secondary cardiomyopathy, unspecified440.23 Arteriosclerosis of extremities with ulceration440.24 Arteriosclerosis of extremities with gangrene440.9 Arteriosclerosis, not otherwise specified458.0 Postural hypotension462 Acute pharyngitis466.0 Acute bronchitis480.0-486 Pneumonia490 Recurrent bronchitis, not specified as acute or chronic491.0-491.9 Chronic bronchitis527.7 Disturbance of slaivary secretion (drymouth)528.00, 528.09 Stomatitis535.50-535.51 Gastritis536.8 Dyspepsia571.8 Other chronic nonalcoholic liver disease572.0-572.8 Liver abscess and sequelae of chronic liver disease574.50-574.51 Choledocholithiasis575.0-575.12 Cholecystitis576.1 Cholangitis577.0 Acute pancreatitis577.1 Chronic pancreatitis577.8 Pancreatic multiple calculi590.00-590.9 Infections of the kidney

595.9 Recurrent cystitis596.4 Bladder atony596.53 Bladder paresis

599.0 Urinary tract infection, recurrent

607.84 Impotence of organic origin

65 GLUCOSE (NCD)



608.89 Other disorders male genital organs616.10 Vulvovaginitis626.0 Amenorrhea626.4 Irregular menses628.9 Infertility - female648.00 Diabetes mellitus complicating pregnancy, childbirth or the puerperium,

unspecified as to episode of care or not applicable648.03 Diabetes mellitus complicating pregnancy, childbirth or the puerperium,

antipartum condition or complication648.04 Diabetes mellitus complicating pregnancy, childbirth or the puerperium,

postpartum condition or complication648.80 Abnormal glucose tolerance complicating pregnancy, childbirth or the

puerperium, unspecified as to episode of care or not applicable648.83 Abnormal glucose tolerance complicating pregnancy, childbirth or the

puerperium, antepartum condition or complication648.84 Abnormal glucose tolerance complicating pregnancy, childbirth or the

puerperium, postpartum condition or complication649.20-649.24 Bariatric surgery status complicating pregnancy, childbirth, or the

puerperium, unspecified as to episode of care or not applicable656.60-656.63 Fetal problems affecting management of mother - large for-date of fetus

657.00-657.03 Polyhydramnios680.0-680.9 Carbunde and furuncle686.00-686.9 Infections of skin and subcutaneous tissue698.0 Pruritus ani698.1 Pruritus of genital organs704.1 Hirsutism705.0 Anhidrosis707.00-707.9 Chronic ulcer of skin709.3 Degenerative skin disorders729.1 Myalgia730.07 Acute osteomyelitis of the ankle and foot730.17 Chronic osteomyelitis of ankle and foot730.27 Unspecified osteomyelitis of ankle and foot780.01 Coma780.02 Transient alteration of awareness780.09 Alteration of consciousness, other780.2 Syncope and collapse780.31 Febrile convulsions780.32 Complex febrile convulsions780.39 Seizures, not otherwise specified780.4 Dizziness and giddiness780.71-780.79 Malaise and fatigue780.8 Hyperhidrosis781.0 Abnormal involuntary movements782.0 Loss of vibratory sensation783.1 Abnormal weight gain783.21 Abnormal loss of weight783.5 Polydipsia783.6 Polyphagia785.0 Tachycardia785.4 Gangrene786.01 Hyperventilation

66 GLUCOSE (NCD)



786.09 Dyspnea786.50 Chest pain, unspecified787.6 Full incontinence of feces787.61 Incomplete defecation787.62 Fecal smearing787.63 Fecal urgency787.91 Diarrhea788.41-788.43 Frequency of urination and polyuria789.1 Hepatomegaly790.21-790.29 Abnormal glucose tolerance test790.6 Other abnormal blood chemistry (hyperglycemia)791.0 Proteinuria791.5 Glycosuria796.1 Abnormal reflex799.4 Cachexia* V23.0-V23.9 Supervison of high risk pregnancyV58.63-V58.65 Long-term (current) use of antiplatelet/antithrombotic

V58.67 Long-term use of insulin

V58.69 Long term current use of other medicationV67.2 Follow-up examination, following chemotherapyV67.51 Follow up examination with high-risk medication not elsewhere classified

V77.1 ** Screening for diabetes mellitus. **This screening allowed once a year with

this code. If additional Glucose tests are performed, they must be diagnostic

or must have an ABN for frequency. Covered for CPT code 82947 only.

* V22.0-V23.9 OB Patients Only


67 GLUCOSE (NCD)


CPT: 84702 HCG Quantitative; (Human Chorionic Gonadotropin)

158.0 Malignant neoplasm of retroperitoneum

158.8 Malignant neoplasm of specified parts of peritoneum

164.2 Malignant neoplasm of anterior mediastinum

164.3 Malignant neoplasm of posterior mediastinum

164.8 Malignant neoplasm, other (includes malignant neoplasm of contiguous

overlapping sites of thymus, heart, and mediastinum whose point of origin

cannot be determined164.9 Malignant neoplasm of mediastinum, part specified

181 Malignant neoplasm of placenta


183.8 Other specified sites of uterine adnexa

186.0 Malignant neoplasm of undescended testis

186.9 Malignant neoplasm of other and unspecified testis

194.4 Malignant neoplasm of pineal gland

197.1 Secondary malignant neoplasm of mediastinum



198.82 Secondary malignant neoplasm of other genital organs

236.1 Neoplasm of uncertain behavior, placenta


623.8 Vaginal bleeding

625.9 Pelvic pain

630 Hydatidiform mole

631.0 Inappropriate change in quantitative human chorionic gonadotropin (hCG) in

early pregnancy

631.8 Other abnormal products of conception

632 Missed abortion

633.90-633.91 Unspecified ectopic pregnancy

634.00-634.02 Spontaneous abortion, unspecified, complicated by genital tract and pelvic

infection640.00-640.03 Threatened abortion, unspecified as to episode of care

642.30-642.34 Transient hypertension of pregnancy, unspecified as to episode of care

642.40-642.74 Mild or unspecified pre-eclampsia, unspecified as to episode of care

642.90-642.94 Unspecified hypertension complicating pregnancy, childbirth, or the

puerperium, unspecified as to episode of care795.89 Other abnormal tumor markers

V10.09 Personal history of malignant neoplasm, other gastrointestinal sites

V10.29 Personal history of malignant neoplasm of other respiratory and intrathoracic

organsV10.43 Personal history of malignant neoplasm, ovary

V10.47 Personal history of malignant neoplasm, testis

V22.0-V22.1 Normal pregnancy


HCG QUANTITATIVE

68 HCG QUANT (NCD)


CPT: 80074 Hepatitis Panel, Acute


456.0-456.21 Esophageal varices with or without mention of bleeding

570 Acute and subacute necrosis of liver


572.0-572.8 Liver abscess and sequelae of chronic liver disease

573.3 Hepatitis, unspecified


780.31-780.32 Febrile convulsions

780.33 Post traumatic seizures

780.71 Chronic fatigue syndrome

780.72 Functional quadriplegia

780.79 Other malaise and fatigue782.4 Jaundice, unspecified, not of newborn783.0-783.6 Symptoms concerning nutrition, metabolism, and development784.69 Other symbolic dysfunction787.01-787.03 Nausea and vomiting787.04 Bilious emesis789.00-789.09 Abdominal pain789.1 Hepatomegaly789.61 Localized abdominal tenderness (RUQ)789.7 Colic

790.4 Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase794.8 Non-specific abnormal results of function 996.82 Complication of transplanted organ, liverV72.85 Liver transplant recipient evaluation


HEPATITIS PANEL, ACUTE

69 HEPATITIS PANEL, ACUTE (NCD)


CPT: 86689 Qualitative or semiquantitative immunoassays performed by multiple step

methods; HTLV or HIV antibody, confirmatory test (for example, Western Blot)CPT: 86701 Qualitative or semiquantitative immunoassays performed by multiple step

methods; HIV-1CPT: 86702 Qualitative or semiquantitative immunoassays performed by multiple step

methods; HIV-2CPT: 86703 Qualitative or semiquantitative immunoassays performed by multiple step

methods; HIV-1 and HIV-2, single assayCPT: 87390 Infectious agent antigen detection by enzyme immunoassay technique,

qualitative or semiquantitative, multiple step method; HIV-1CPT: 87391 Infectious agent antigen detection by enzyme immunoassay technique,

qualitative or semiquantitative, multiple step method; HIV-2CPT: 87534 Infectious agent antigen by nucleic acid (DNA or RNA); HIV-1, direct probe

techniqueCPT: 87535 Infectious agent antigen by nucleic acid (DNA or RNA); HIV-1, amplified probe

techniqueCPT: 87537 Infectious agent antigen by nucleic acid (DNA or RNA); HIV-2, direct probe

techniqueCPT: 87538 Infectious agent antigen by nucleic acid (DNA or RNA); HIV-2, amplified probe

technique


007.2 Coccidiosis (Isoporiasis)

007.4 Cryptosporidiosis007.8 Other specified protozoal intestinal diseases010.00-010.96 Primary tuberculous infection011.00-011.96 Pulmonary tuberculosis012.00-012.86 Other respiratory tuberculosis013.00-013.96 Tuberculosis of meninges and central nervous system014.00-014.86 Tuberculosis of intestines, peritoneum and mesenteric glands015.00-015.96 Tuberculosis of bones and joints016.00-016.96 Tuberculosis of genitourinary system017.00-017.96 Tuberculosis of other organs018.00-018.96 Miliary tuberculosis027.0 Listeriosis031.0-031.9 Diseases due to other mycobacteria038.2 Pneumococcal septicemia038.43 Septicemia (Pseudomonas)039.0-039.9 Actinomycotic infections (includes Nocardia)041.7 Pseudomonas infection042 HIV disease (Acute retroviral syndrome, AIDS-related complex)046.3 Progressive multifocal leukoencephalopathy049.0-049.9 Other non-arthropod-borne viral diseases of central nervous system052.0-052.8 Chickenpox (with complication)053.0-053.9 Herpes zoster054.0-054.9 Herpes simplex055.0-055.8 Measles (with complication)070.20-070.23 Viral hepatitis B with hepatic coma070.30-070.33 Viral hepatitis B without mention of hepatic coma070.41 Acute or unspecified hepatitis C with hepatic coma070.42 Hepatitis delta without mention of active hepatitis B disease with hepatic

070.44 Chronic hepatitis C with hepatic coma

HUMAN IMMUNODEFICIENCY VIRUS TESTING (Diagnosis)

70 HIV DIAGNOSIS (NCD)



070.49 Other specified viral hepatitis with hepatic coma070.51 Acute or unspecified hepatitis C without hepatic coma070.52 Hepatitis delta without mention of active hepatitis B disease without hepatic

coma070.54 Chronic hepatitis C without hepatic coma070.59 Other specified viral hepatitis without hepatic coma070.6 Unspecified viral hepatitis with hepatic coma070.70 Viral hepatitis070.71 Viral hepatitis070.9 Unspecified viral hepatitis without hepatic coma078.0 Molluscum contagiosum078.10-078.19 Viral warts078.3 Cat-scratch disease078.5 Cytomegaloviral disease078.88 Other specified diseases due to Chlamydiae079.50 Retrovirus unspecified079.51 HTLV-I079.52 HTLV-II079.53 Human immunodeficiency virus, type 2079.59 Other specified Retrovirus079.88 Other specified chlamydial infection079.98 Unspecified chlamydial infection085.0-085.9 Leishmaniasis088.0 Bartonellosis090.0-090.9 Congenital syphilis091.0-091.9 Early syphilis symptomatic092.0-092.9 Early syphilis, latent093.0-093.9 Cardiovascular syphilis094.0-094.9 Neurosyphilis095.0-095.9 Other forms of late syphilis, with symptoms096 Late syphilis, latent097.0-097.9 Other and unspecified syphilis098.0-098.89 Gonococcal infections099.0 Chancroid099.1 Lymphogranuloma venereum099.2 Granuloma inguinale099.3 Reiter's disease099.40-099.49 Other nongonococcal urethritis099.50-099.59 Other venereal diseases due to Chlamydia trachomatis099.8 Other specified venereal disease099.9 Venereal Disease unspecified110.1 Dermatophytosis of nail111.0 Ityriasis versicolor112.0-112.9 Candidiasis114.0-114.9 Coccidioidmycosis115.00-115.99 Histoplasmosis116.0-116.2 Blastomycotic infection117.3 Aspergillosis117.5 Cryptococcosis118 Opportunistic mycoses127.2 Strongyloidiasis130.0-130.9 Toxoplasmosis




131.01 Trichomonal vulvovaginitis132.2 Phthirus pubis133.0 Scabies136.21-136.29 Specific infections by free living amebae136.3 Pneumocystosis136.8 Other specified infectious and parasitic disease (for example,

microsporidiosis)176.0-176.9 Kaposi's sarcoma

180.0-180.9 Malignant neoplasm of cervix uteri200.20-200.28 Burkitt's tumor or lymphoma200.80-200.88 Lymphosarcoma, other named variants201.00-201.98 Hodgkin's disease263.0 Malnutrition of moderate degree263.1 Malnutrition of mild degree263.9 Unspecified protein-calorie malnutrition280.0-280.9 Iron deficiency anemias285.9 Anemia, unspecified287.30-278.39 Primary thrombocytopenia288.00-288.09 Agranulocytosis288.4 Hemophagocytic syndromes288.50-288.69 Leukocytopenia288.8 Other specified disease of white blood cells289.53 Neutropenic splenomegaly294.8 Other persistent mental disorders due to conditions classified elsewhere

310.1 Personality change due to conditions classified elsewhere

322.2 Chronic meningitis331.19 Other frontotemporal dementia331.83 Mild cognitive impairment, so stated336.9 Unspecified disease of spinal cord348.30 Encephalopathy unspecified348.39 Other encephalopathy354.0-354.9 Mononeuritis of upper limbs and mononeuritis multiplex356.8 Other specified idiopathic peripheral neuropathy363.20 Chorioretinitis, unspecified425.4 Other primary cardiomyopathies473.0-473.9 Chronic sinusitis481-482.9 Pneumococcal pneumonia484.1 Pneumonia in cytomegalic inclusion disease486 Pneumonia, organism unspecified512.81 Primary spontaneous pneumothorax512.82 Secondary spontaneous pneumothorax512.83 Chronic pneumothorax516.8 Other specified alveolar and parietoalveolar pneumonopathies528.2 Oral aphthae528.6 Leukoplakia of oral mucosa530.20 Ulcer of esophagus530.21 Ulcer of esophagus with bleeding530.85 Barrett's esophagus583.9 Nephropathy with unspecified pathological lesion in kidney588.81, 588.89 Other specified disorders resulting from impaired renal function647.60-647.64 Other viral diseases complicating pregnancy (use for HIV I and II)682.0-682.9 Other cellulitis and abscess




690.10-690.18 Seborrheic dermatitis696.1 Other psoriasis698.3 Lichenification and lichen simplex chronicus704.8 Other specified diseases of hair and hair follicles706.0-706.9 Diseases of sebaceous glands780.60-780.65 Fever and other physiologic disturbances of temperature regulation780.66 Febrile nonhemolytic transfusion reaction780.79 Other malaise and fatigue783.21 Abnormal loss of weight783.40 Lack of expected normal physiological development785.6 Enlargement of lymph nodes786.00 Respiratory abnormality, unspecified786.05 Shortness of breath786.2 Cough786.30 Hemoptysis, unspecified786.31 Acute idiopathic pulmonary hemorrhage in infants (AIPHI)786.39 Other hemoptysis

786.4 Abnormal sputum787.91 Diarrhea795.71 Nonspecific serologic evidence of human immunodeficiency virus

799.4 Wasting diseaseV01.71, V01.79 Contact with or exposure to communicable diseases, other viral diseases

V71.5 Rape




CPT: 87536 Infectious agent detection by nucleic acid (DNA or RNA); HIV-1 quantification

CPT: 87539 Infectious agent detection by nucleic acid (DNA or RNA); HIV-2 quantification

042 Human immunodeficiency virus (HIV) disease

079.53 Human immunodeficiency virus, type 2 [HIV-2]

647.60-647.64 Other viral diseases complicating pregnancy (including HIV-I and II)

795.71 Non-specific serologic evidence of human immunodeficiency virus (HIV)

V08 Asymptomatic human immunodeficiency virus (HIV) infection status


HUMAN IMMUNODEFICIENCY VIRUS TESTING (Prognosis Including Monitoring)

74 HIV (NCD)


CPT: 82728 Ferritin

CPT: 83540 Iron

CPT: 83550 Iron Binding capacity

CPT: 84466 Transferrin

002.0-002.9 Typhoid and paratyphoid fevers

003.0-003.9 Other salmonella infections

006.0-006.9 Amebiasis

007.0-007.9 Other protozoal intestinal diseases

008.00-008.8 Intestinal infections due to other organisms

009.0-009.3 Ill-defined intestinal infections

011.50-011.56 Tuberculous bronchiectasis

014.00-014.86 Tuberculosis of intestines, peritoneum, and mesenteric glands

015.00-015.96 Tuberculosis of bones and joints016.00-016.06 Tuberculosis of kidney016.10-016.16 Tuberculosis of bladder016.20-016.26 Tuberculosis of ureter016.30-016.36 Tuberculosis of other urinary organs042 Human Immunodeficiency virus (HIV) disease070.0-070.9 Viral hepatitis140.0-149.9 Malignant neoplasm of lip oral cavity and pharynx150.0-159.9 Malignant neoplasm of digestive organs and peritoneum160.0-165.9 Malignant neoplasm of respiratory and intrathoracic organs170.0-176.9 Malignant neoplasm of bone, connective tissue, skin and breast179-189.9 Malignant neoplasm of genitourinary organs190.0-199.2 Malignant neoplasm without specification of site200.00-208.92 Malignant neoplasm of lymphatic and hematopoietic tissue209.00-209.03 Benign carcinoid tumors of the small intestine209.10-209.17 Benign carcinoid tumors of the appendix, large intestine and rectum209.20-209.29 Benign carcinoid tumors of other and unspecified sites209.30 Malignant poorly differentiated neuroendocrine carcinoma, any site209.31-209.36 Merkel cell carcinoma209.40-209.43 Malignant carcinoid tumors of the small intestine209.50-209.57 Malignant carcinoid tumors of the appendix, large intestine and rectum

209.60-209.69 Malignant carcinoid tumors of other and unspecified sites209.70 Secondary neuroendocrine tumor, unspecified site209.71 Secondary neuroendocrine tumor of distant lymph nodes209.72 Secondary neuroendocrine tumor of liver209.73 Secondary neuroendocrine tumor of bone209.74 Secondary neuroendocrine tumor of peritoneum209.75 Secondary Merkel cell carcinoma209.79 Secondary neuroendocrine tumor of other sites210.0-229.9 Benign neoplasms230.0-234.9 Carcinoma in situ235.0-235.9 Neoplasms of uncertain behavior of digestive and respiratory systems236.0-236.99 Neoplasms of uncertain behavior of genitourinary organs237.0-237.72 Neoplasms of uncertain behavior of endocrine glands and nervous system

237.73 Schwannomatosis237.79 Other neurofibromatosis237.9 Other and uncertain parts of the nervous system

IRON STUDIES; SERUM

75 IRON STUDIES (NCD)


IRON STUDIES; SERUM

238.0-238.6 Neoplasms of uncertain behavior of other and unspecified sites and tissues

238.71-238.76 Neoplasms of other lymphatic and hematopoietic tissues238.77 Post-transplant lymphoproliferative disorder (PTLD)238.79, 238.8, 238.9 Neoplasms of uncertain behavior239.0-239.7 Neoplasms of unspecified nature239.81 Neoplasms of unspecified nature, retina and choroid239.89 Neoplasms of unspecified nature, other specified sites239.9 Neoplasms of unspecified nature, site unspecified249.00-249.91 Secondary Diabetes Mellitus, with or without various manifestations250.00-250.93 Diabetes mellitus253.2 Panhypopituitarism253.7 Iatrogenic pituitary disorders253.8 Other disorders of the pituitary and other syndromes of

diencephalohypophysial origin256.31-256.39 Other ovarian failure257.2 Other testicular hypofunction260 Kwashiorkor261 Nutritional marasmus262 Other severe protein-calorie malnutrition263.0-263.9 Other and unspecified protein-calorie malnutrition275.01 Hereditary hemochromatosis275.02 Hemochromatosis due to repeated red blood cell transfusions275.03 Other hemochromatosis275.09 Other disorders of iron metabolism277.1 Disorders of porphyrin metabolism280.0-280.9 Iron deficiency anemias281.0-281.9 Other deficiency anemias282.40-282.49 Thalassemias282.60-282.63 Sickle cell anemia282.64 Sickle-cell/Hb-C disease with crisis282.68 Other sickle-cell disease without crisis282.69 Sickle cell anemia, other285.0 Sideroblastic anemia (includes hemochromatosis with refractory anemia)

285.1 Acute post-hemorrhagic anemia

285.21 Anemia in end-stage renal disease285.3 Antineoplastic chemotherapy induced anemia285.9 Anemia, unspecified286.0-286.9 Coagulation defects ( congenital factor disorders)287.0-287.39 Allergic purpura; qualitative platelet defects; other non-thrombocytopenic

purpuras; primary thrombocytopenia287.41 Posttransfusion purpura287.49 Other secondary thrombocytopenia287.5-287.9 Thrombocytopenia, unspecified; other specified and unspecified hemorrhagic

conditions289.52 Splenic sequestration306.4 Physiological malfunction arising from mental factors, gastrointestinal307.1 Anorexia nervosa307.50-307.59 Other and unspecified disorders of eating403.01 Hypertensive chronic kidney disease, malignant, with chronic kidney disease

stage V or end stage renal disease403.11 Hypertensive chronic kidney disease, benign with chronic kidney disease

stage V or end stage renal disease



IRON STUDIES; SERUM

403.91 Hypertensive chronic kidney disease, unspecified, with chronic kidney

disease stage V or end stage renal disease404.02 Hypertensive chronic kidney disease, malignant, without heart failure and

with chronic kidney disease stage V or end stage renal disease404.03 Hypertensive heart and chronic kidney disease, with heart failure and with

chronic kidney disease stage V or end stage renal disease404.12 Hypertensive heart and chronic kidney disease, benign, without heart failure

and with chronic kidney disease stage V or end stage renal disease

404.13 Hypertensive heart and chronic kidney disease, benign, with heart failure and

chronic kidney disease stage V or end stage renal disease404.92 Hypertensive heart and chronic kidney disease, unspecified, without heart

failure and with chronic kidney disease stage V or end stage renal disease


and chronic kidney disease stage V or end stage renal disease

425.4 Other primary cardiomyopathies425.5 Alcoholic cardiomyopathy425.7 Nutritional and metabolic cardiomyopathy425.8 Cardiomyopathy in other diseases classified elsewhere425.9 Secondary cardiomyopathy, unspecified426.0-426.9 Conduction disorders427.0-427.9 Cardiac dysrhythmias428.0-428.9 Heart Failure530.7 Gastroesophageal laceration-hemorrhage syndrome

530.82 Esophageal hemorrhage531.00-531.91 Gastric ulcer532.00-532.91 Duodenal ulcer533.00-533.91 Peptic ulcer, site unspecified

534.00-534.91 Gastrojejunal ulcer535.00-535.71 Gastritis and duodenitis536.0-536.9 Disorders of function of stomach537.83 Angiodysplasia of stomach and duodenum with hemorrhage537.84 Dielulafoy Lesion (Hemorrhagic) of stomach and duodenum

555.0-555.9 Regional enteritis556.0-556.9 Ulcerative colitis557.0 Acute vascular insufficiency of intestine557.1 Chronic vascular insufficiency of intestine562.02 Diverticulosis of small intestine with hemorrhage562.03 Diverticulitis of small intestine with hemorrhage562.12 Diverticulosis of colon with hemorrhage562.13 Diverticulitis of colon with hemorrhage569.3 Hemorrhage of rectum an anus569.85 Angiodysplasia of intestine with hemorrhage569.86 Dieulafoy lesion (Hemorrhagic) of intestine569.87 Vomiting of fecal matter570 Acute and subacute necrosis of liver571.0-571.9 Chronic liver disease and cirrhosis572.0-572.8 Liver abscess and sequelae of chronic liver disease573.0-573.9 Other disorders of liver

578.0-578.9 Gastrointestinal hemorrhage579.0-579.3 Intestinal malabsorption

579.8-579.9 Other specified and unspecified intestinal malabsorption



IRON STUDIES; SERUM

581.0-581.9 Nephrotic syndrome585.4-585.9 Chronic renal failure586 Renal failure, unspecified608.3 Atrophy of testis626.0-626.9 Disorders of menstruation and other abnormal bleeding from female genital

tract627.0 Premenopausal menorrhagia627.1 Postmenopausal bleeding648.20-648.24 Other current conditions in the mother classifiable elsewhere, but

complicating pregnancy, childbirth , or puerperium: Anemia698.0-698.9 Pruritus and related conditions704.00-704.09 Alopecia709.00-709.09 Dyschromia713.0 Arthropathy associated with other endocrine and metabolic disorders716.40-716.99 Other and unspecified arthropathies719.40-719.49 Pain in joint773.2 Hemolytic disease due to other and unspecified isoimmunization773.3 Hydrops fetalis due to isoimmunization773.4 Kernicterus due to isoimmunization773.5 Late anemia due to isoimmunization783.9 Other symptoms concerning nutrition, metabolism and development790.01-790.09 Abnormality of red blood cells790.4 Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase

790.5 Other nonspecific abnormal serum enzyme levels790.6 Other abnormal blood chemistry799.4 Cachexia964.0 Poisoning by agents primarily affecting blood constituents, iron compounds

984.0-984.9 Toxic effect of lead and its compounds (including fumes)996.85 Complications of transplanted organ, bone marrow999.80 Transfusion reaction, unspecified999.83 Hemolytic transfusion reaction, incompatibility unspecified999.84 Acute hemolytic transfusion reaction, incompatibility unspecified999.85 Delayed hemolytic transfusion reaction, incompatibility unspecified999.89 Other transfusion reactionV08 Asymptomatic HIV infectionV12.1 Personal history of nutritional deficiencyV12.3 Personal history of diseases of blood and blood forming organsV15.1 Personal history of surgery to heart and great vesselsV15.21 Personal history of undergoing in utero procedure during pregnancyV15.22 Personal history of undergoing in utero procedure while a fetusV15.29 Personal history of surgery of other major organsV43.21-V43.22 Heart replaced by other meansV43.3 Heart valve replaces by other meansV43.4 Blood vessel replaced by other meansV43.60 Unspecified joint replaced by other meansV56.0 Extracorporeal dialysisV56.8 Other dialysis




CPT: 80061 Lipid PanelCPT: 82465 Cholesterol, serum or whole blood, totalCPT: 83700 Lipoprotein, blood; electophorectic CPT: 83701 Lipoprotein, blood: high fractionation CPT: 83704 Lipoprotein blood: quantitation of lipoprotein particle numbers and

lipoprotein particles subclassesCPT: 83718 Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)

CPT: 83721 Lipoprotein, direct measurement, LDL cholesterolCPT: 84478 Triglycerides

242.00-245.9 Disorders of the thyroid gland with hormonal dysfunction249.00-249.91 Secondary diabetes mellitus with renal manifestations250.00-250.93 Diabetes mellitus255.0 Cushing's syndrome260 Kwashiorkor261 Nutritional marasmus262 Other severe, protein-calorie malnutrition263.0 Malnutrition of moderate degree263.1 Malnutrition of mild degree263.8 Other protein-calorie malnutrition263.9 Unspecified protein-calorie malnutrition270.0 Disturbances of amino-acid transport271.1 Galactosemia272.0 Pure hypercholesterolemia272.1 Hyperglyceridemia272.2 Mixed hyperlipidemia (tuberous xanthoma)272.3 Hyperchylomicronemia272.4 Other and unspecified hyperlipidemia (unspecified xanthoma)272.5 Lipoprotein deficiencies272.6 Lipodystrophy272.7 Lipidoses272.8 Other disorders of lipoid metabolism272.9 Unspecified disorders of lipoid metabolism277.30-277.39 Amyloidosis278.00 Obesity278.01 Morbid obesity278.02 Overweight278.03 Obesity hypoventilation syndrome303.90-303.92 Alcoholism362.10-362.16 Other background retinopathy and retinal vascular change362.30-362.34 Retinal vascular occlusion362.82 Retinal exudates and deposits371.41 Senile corneal changes374.51 Xanthelasma379.22 Crystalline deposits in vitreous388.00 Degenerative and vascular disorder of ear, unspecified388.02 Transient ischemic deafness401.0, 401.1,401.9 Essential hypertension402.00-402.91 Hypertensive heart disease403.00-403.91 Hypertensive renal disease

LIPID PROFILE AND CHOLESTEROL TESTING


79 LIPID (NCD)



404.00-404.93 Hypertensive heart and renal disease405.01-405.99 Secondary hypertension410.00-410.92 Acute myocardial infarction411.0-411.1 Other acute and subacute forms of ischemic heart disease411.81 Coronary occlusion without myocardial infarction411.89 Other acute and subacute ischemic heart disease412 Old myocardial infarction413.0-413.1 Angina pectoris413.9 Other and unspecified angina pectoris414.00-414.03 Coronary atherosclerosis414.04 Coronary atherosclerosis of artery bypass graft414.05 Coronary athrscl-unspec graft414.06 Coronary atherosclerosis of coronary artery of transplanted heart414.07 Coronary atherosclerosis, of bypass graft (artery)(vein) of transplanted heart

414.10 Aneurysm, heart (wall)414.11 Coronary vessel aneurysm414.12 Dissection of coronary artery414.19 Other aneurysm of heart

414.3 Coronary atherosclerosis due to lipid rich plaque

414.4 Coronary atherosclerosis due to calcified coronary lesion414.8 Other specified forms of chronic ischemic heart disease414.9 Chronic ischemic heart disease, unspecified428.0-428.9 Heart failure429.2 Heart disease, unspecified429.9 Heart disease NOS431 Intracerebral hemorrhage433.00-433.91 Occlusion and stenosis of precerebral arteries434.00-434.91 Occlusion of cerebral arteries435.0-435.9 Transient cerebral ischemia437.0 Cerebral atherosclerosis437.1 Other generalized ischemic cerebrovascular disease437.5 Moyamoya disease438.0 Late effects of cerebrovascular disease438.13 Late effects of cerebrovascular disease, dysarthria438.14 Late effects of cerebrovascular disease, fluency disorder438.9 Unspecified late effects of cerebrovascular disease440.0-440.9 Arteriosclerosis441.00-441.9 Aortic aneurysms442.0 Upper extremity aneurysm442.1 Renal artery aneurysm442.2 Iliac artery aneurysm444.01, 444.09,

444.1-444.9

Arterial embolism and thrombosis

557.1 Chronic vascular insufficiency of intestine571.8 Other chronic non-alcoholic liver disease571.9 Unspecified chronic liver disease without mention of alcohol573.5 Hepatopulmonary syndrome573.8 Other specified disorders of liver573.9 Unspecified disorders of liver577.0-577.9 Pancreatic disease579.3 Other and unspecified postsurgical nonabsorption579.8 Other specified intestinal malabsorption

80 LIPID (NCD)



581.0-581.9 Nephrotic syndrome584.5 Acute renal failure with lesion of tubular necrosis585.4-585.9 Chronic renal failure588.0 Renal osteodystrophy588.1 Nephrogenic diabetes insipidus588.81, 588.89 Other specified disorders resulting from impaired renal function588.9 Unspecified disorder resulting from impaired renal function607.84 Impotence of organic origin, penis disorder646.70-646.71 Liver disorders in pregnancy 646.73 Liver and biliary tract disorders in pregnancy, antepartum condition or

complication648.10-648.14 Thyroid dysfunction in pregnancy and the puerperium696.0 Psoriatic Arthropathy696.1 Other psoriasis751.61 Biliary atresia764.10-764.19 "Light-For-Dates" with signs of fetal malnutrition786.50 Chest pain unspecified786.51 Precordial pain786.59 Chest pain, other789.1 Hepatomegaly790.4 Abnormal transaminase790.5 Abnormal alkaline phosphatase790.6 Other abnormal blood chemistry793.4 Abnormal imaging study987.9 Toxic effect of unspecified gas or vapor996.81 Complication of transplanted organ, kidneyV42.0 Transplanted organ, kidneyV42.7 Organ Replacement by transplant, liverV58.63-V58.64 Long-term (current) use of antiplatelet/antithromboticV58.69 Long-term (current) use of other medicationsV81.0, V81.1, V81.2 ** Screening for other unspecified Cardiovascular conditions. ** This screening

is only allowed 1 every 5 years with these codes. If additional Lipids tests are

performed, they must be diagnostic or must have an ABN for frequency.

Covered for CPT codes 80061, 82465, 83718 and 84478 only.


81 LIPID (NCD)

Medicare A Medical Policy April 16, 2006

CPT: 83735 Magnesium

249.00-249.91 Secondary Diabetes Mellitus, with or without various manifestations250.00-250.03 Diabetes mellitus without mention of complication, type II or unspecified type,

not stated as uncontrolled250.10-250.13 Diabetes with ketoacidosis250.20-250.23 Diabetes with hyperosmolarity250.30-250.33 Diabetes with other coma250.40-250.43 Diabetes with renal manifestations250.50-250.53 Diabetes with ophthalmic manifestations250.60-250.63 Diabetes with neurological manifestations250.70-250.73 Diabetes with peripheral circulatory disorders250.80-250.83 Diabetes with other specified manifestations250.90-250.93 Diabetes with unspecified complication252.00-252.08 Hyperparathyroidism252.1 Hypoparathyroidism252.8 Other specified disorders of the parathyroid gland252.9 Unspecified disorders of parathyroid gland255.10-255.14 Hyperaldosteronism259.3 Ectopic hormone secretion, not elsewhere classified260 Kwashiorkor261 Nutritional marasmus262 Other severe, protein-calorie malnutrition263.0 Malnutrition of moderate degree263.8 Other protein-calorie malnutrition263.9 Unspecified protein-calorie malnutrition275.2-275.3 Disorders of magnesium metabolism275.5 Hungry bone syndrome275.40-275.49 Disorders of calcium metabolism276.0 Hyperosmolality and/or hypernatremia276.1 Hyposmolality and/or hyponatremia276.2 Acidosis276.4 Mixed acid-base balance disorder276.50-276.52 Volume depletion276.7 Hyperpotassemia276.8 Hypopotassemia276.9 Electrolyte and fluid disorders not elsewhere classified278.8 Other hyperalimentation286.9 Other and unspecified coagulation defects289.51 Chronic congestive splenomegaly289.52 Splenic sequestration289.53 Neutropenic splenomegaly289.59 Other diseases of spleen293.0-293.1 Transient acute and subacute delirium298.9 Unspecified psychosis303.00 - 303.03 Acute alcoholic intoxication in alcoholism303.90-303.93 Other and unspecified alcohol dependence, chronic alcoholism307.1 Anorexia nervosa307.20 Tic disorder, unspecified307.22 Chronic motor tic disorder307.50-307.54 Eating disorder, unspecified307.59 Other disorders of eating

MAGNESIUM

82 MAGNESIUM (LCD)


MAGNESIUM

333.2 Myoclonus333.3 Tics of organic origin336.1 Vascular myelopathies345.60-345.61 Infantile spasms357.4 Polyneuropathy in other diseases classified elsewhere359.5 Myopathy in endocrine diseases classified elsewhere359.81 Critical illness myopathy359.89 Other myopathies359.9 Myopathy, unspecified

401.0 Malignant essential hypertension

401.1 Benign essential hypertension401.9 Unspecified essential hypertension402 Malignant hypertensive heart disease without heart failure402.01 Malignant hypertensive heart disease with heart failure402.1 Benign hypertensive heart disease without heart failure402.11 Benign hypertensive heart disease with heart failure402.9 Unspecified hypertensive heart disease without heart failure402.91 Unspecified hypertensive heart disease with heart failure403.00 Hypertensive kidney disease, malignant, without chronic kidney disease

403.01 Malignant hypertensive renal disease with renal failure403.10-403.11 Benign hypertensive renal disease with renal failure403.90-403.91 Unspecified hypertensive renal disease with renal failure404.00 Hypertensive heart and kidney disease, malignant, without hearth failure or

chronic kidney disease404.01 Hypertensive heart and kidney disease, malignant, with heart failure404.02 Malignant hypertensive heart and renal disease with renal failure404.03 Malignant hypertensive heart and renal disease with heart failure and renal

failure404.10-404.11 Hypertensive heart and kidney disease, benign with heart failure404.12 Benign hypertensive heart and renal disease with renal failure404.13 Benign hypertensive heart and renal disease with heart failure and renal

failure404.90-404.91 Hypertensive heart and kidney disease, unspecified, with heart failure404.92 Unspecified hypertensive heart and renal disease with renal failure404.93 Unspecified hypertensive heart and renal disease with heart failure and renal

failure405.01 Malignant renovascular hypertension405.09 Other malignant secondary hypertension405.11 Benign renovascular hypertension405.19 Other benign secondary hypertension405.91 Unspecified renovascular hypertension405.99 Other unspecified secondary hypertension410.00-410.02 Acute myocardial infarction of anterolateral wall410.10-410.12 Acute myocardial infarction of other anterior wall410.20-410.22 Acute myocardial infarction of inferolateral wall410.30-410.32 Acute myocardial infarction of inferoposterior wall410.40-410.42 Acute myocardial infarction of other inferior wall410.50-410.52 Acute myocardial infarction of other lateral wall410.60-410.62 Acute myocardial infarction, true posterior wall410.70-410.72 Acute myocardial infarction, subendocardial410.80-410.82 Acute myocardial infarction of other specified site410.90-410.92 Acute myocardial infarction of unspecified site

83 MAGNESIUM (LCD)


MAGNESIUM

411.81 Coronary occlusion without myocardial infarction414.8 Other specified forms of chronic ischemic heart disease415.11 Latrogenic pulmonary embolism and infarction415.19 Other pulmonary embolism and infarction425.4 Other primary cardiomyopathies427.0-427.2 Paroxysmal supraventricular, ventricular, and unspecified tachycardia

427.31-427.32 Atrial fibrillation and flutter427.41-427.42 Ventricular fibrillation and flutter427.5 Cardiac arrest427.60-427.61 Premature beats427.69 Premature beats, other427.81 Sinoatrial node dysfunction427.89 Sinoatrial node dysfunction, other427.9 Cardiac dysrhythmia428.0 Congestive Heart Failure, Unspecified429.79 Certain sequelae of myocardial infarction not elsewhere classified, other

429.83 Takotsubo syndrome429.89 Other ill-defined heart disease458.0-458.29 Hypotension458.9 Hypotension, unspecified536.2 Persistent vomiting558.41 Eosinophilic gastroenteritis558.9 Other and unspecified noninfectious gastroenteritis and colitis560.81 Intestinal or peritoneal adhesions with obstruction (postoperative)

569.60 Colostomy and enterostomy complication unspecified569.81 fistula of intestine excluding rectum and anus579.0 Celiac disease579.2 Blind loop syndrome579.3 Other and unspecified postsurgical nonabsorption579.8 Other specified intestinal malabsorption579.9 Unspecified intestinal malabsorption580.0 - 580.9 Acute glomerulonephritis581.0 - 581.9 Nephrotic syndrome582.0 - 582.9 Chronic glomerulonephritis583.0 - 583.9 Nephritis and nephropathy, not specified as acute of chronic584.5-584.9 Acute kidney failure585.1 - 585.9 Chronic renal failure586 Renal failure, unspecified587 Renal sclerosis, unspecified588.0 Renal osteodystrophy588.1 Nephrogeni diabetes insipidus588.81, 588.89 Other specified disorder resulting from impaired renal function593.81 Vascular disorders of kidney593.9 Disorder of the kidney and ureter, unspecified632 Missed abortion634.10-634.12 Spontaneous abortion; complicated by delay or excessive hemorrhage

634.20-634.22 Spontaneous abortion; unspecified complicated by damage to pelvic organs

or tissues634.30-634.32 Spontaneous abortion; complicated by renal failure634.40-634.42 Spontaneous abortion; complicated by metabolic disorder634.60-635.62 Spontaneous abortion; complicated by embolism

84 MAGNESIUM (LCD)


MAGNESIUM

634.70-634.72 Spontaneous abortion; with other specified complications634.80-634.82 Spontaneous abortion; with unspecified complications635.10-635.12 Legally induced abortion; complicated by delay or excessive hemorrhage

635.30-635.32 Legally induced abortion; complicated by renal failure635.40-635.42 Legally induced abortion; complicated by metabolic disorder635.50-635.52 Legally induced abortion; complicated by shock635.60-635.62 Legally induced abortion; complicated by embolism635.70-635.72 Legally induced abortion; with other specified complications635.80-635.82 Legally induced abortion; with unspecified complications636.10-636.12 Illegally induced abortion; complicated by delay or excessive hemorrhage

636.30-636.32 Illegally induced abortion; complicated by renal failure636.40-636.42 Illegally induced abortion; complicated by metabolic disorder636.50-636.52 Illegally induced abortion; complicated by shock636.60-636.62 Illegally induced abortion; complicated by embolism636.70-636.72 Illegally induced abortion; with other specified complications636.80-636.82 Illegally induced abortion; with unspecified complications637.10-637.12 Unspecified abortion; complicated by delay or excessive hemorrhage637.20-637.22 Unspecified abortion; complicated by damage to pelvic organs or tissues637.30-637.32 Unspecified abortion; complicated by renal failure637.40-637.42 Unspecified abortion; complicated by metabolic disorder637.50-637.52 Unspecified abortion; complicated by shock637.60-637.62 Unspecified abortion; complicated by embolism637.70-637.72 Unspecified abortion; with other specified complications637.80-637.82 Unspecified abortion; with unspecified complications638.1-638.9 Failed attempted abortion; complicated by delay or excessive hemorrhage

639.1 - 639.9 Complications following abortion and ectopic and molar pregnancies640.00,640.01,640.03 Threatened abortion640.80,640.81,640.83 Other specified hemorrhage in early pregnancy640.90,640.91,640.93 Unspecified hemorrhage in early pregnancy641.00,641.01,641.03 Placenta previa without hemorrhage641.10,641.11,641.13 Hemorrhage from placenta previa641.20,641.21,641.23 Premature separation of placenta641.30,641.31,641.33 Antepartum hemorrhage associated with coagulation defects641.80,641.81,641.83 Other antepartum hemorrhage641.90-641.93 Unspecified antepartum hemorrhage642.00-642.04 Hypertension complicating pregnancy, childbirth and the pueperium642.10-642.14 Hypertension secondary to renal disease, complicating pregnancy, childbirth,

and the puerperium642.20-642.24 Other pre-existing hypertension complicating pregnancy, childbirth and the

puerperium642.30-642.34 Transient hypertension of pregnancy642.40-642.44 Mild or unspecified pre-eclampsia642.50-642.54 Severe pre-eclampsia642.60-642.64 Eclampsia642.70-642.74 Pre-eclampsia or eclampsia superimposed on pre-existing hypertension

642.90-642.94 Unspecified hypertension complicating pregnancy, childbirth or the

puerperium643.00,643.01,643.03 Mild hyperemesis gravidarum643.10,643.11,643.13 Hyperemesis gravidarum with metabolic disturbance643.20,643.21,643.23 Late vomiting of pregnancy643.80,643.81,643.83 Other vomiting complicating pregnancy643.90,643.91,643.93 Unspecified vomiting of pregnancy

85 MAGNESIUM (LCD)


MAGNESIUM

646.20-646.24 Unspecified renal disease in pregnancy without mention of hypertension

646.80-646.84 Other specified complications of pregnancy646.90-646.91 Unspecified complication of pregnancy646.93 Antepartum condition or complication648.00-648.04 Diabetes mellitus, pregnancy648.90-648.94 Other current conditions of pregnancy, classified elsewhere655.70,655.71,655.73 Decreased fetal movements affecting management of mother unspecified as

to episode of care655.80,655.81,655.83 Other known or suspected fetal abnormality655.90,655.91,655.93 Unspecified fetal abnormality656.00,656.01,656.03 Fetal-maternal hemorrhage656.30,656.31,656.33 Fetal distress656.40,656.41,656.43 Intrauterine death666.00 Postpartum hemorrhage, third-stage, unspecified as to episode of care or not

applicable666.02 Postpartum hemorrhage, third-stage, delivered with mention of postpartum

complication666.04 Postpartum hemorrhage, third-stage, postpartum condition or complication

666.10 Other immediate postpartum hemorrhage, unspecified as to episode of care

or not applicable 666.12 Other immediate postpartum hemorrhage, delivered with mention of

postpartum complication666.14 Other immediate postpartum hemorrhage, postpartum condition or

complication666.20 Delayed and secondary postpartum hemorrhage666.22 Delayed and secondary postpartum hemorrhage delivered with mention of

postpartum complication666.24 Delayed and secondary postpartum hemorrhage postpartum condition or

complication668.10-668.14 Cardiac complications668.80-668.84 Other complications of anesthesia or other sedation in labor and delivery

668.90-668.94 Unspecified complication of anesthesia or other sedation in labor and

delivery

669.10-669.14 Shock during or following labor and delivery669.20-669.24 Maternal hypotension syndrome669.30-669.32 Acute renal failure following labor and delivery669.34 postpartum condition or complication669.40-669.44 Other complications of obstetrical surgery and procedures669.80-669.84 Other complications of delivery669.90-669.94 Unspecified complication of labor and delivery673.20-673.24 Obstetrical blood-clot embolism728.9 Unspecified disorders of muscle, ligament, and fascia729.82 Cramp of limb 729.89 Other musculoskeletal symptoms referable to limbs753.12 Polycystic kidney unspecified type753.13 Polycystic kidney autosomal dominant760.0 Maternal hypertensive disorders760.1 Maternal renal and urinary tract diseases 760.4 Maternal nutrition disorders760.71 Influences affecting fetus; alcohol760.8 Other specified maternal conditions affecting fetus or newborn

86 MAGNESIUM (LCD)


MAGNESIUM

763.81-763.84 Other specified complications of labor and delivery affecting fetus or

newborn, abnormality in fetal heart rate or rhythm763.89 Unspecified complication of labor and delivery affecting fetus or newborn

763.9 Unspecified complication of labor and delivery affecting fetus or newborn

779.32 Bilious vomiting in newborn779.33 Other vomiting in newborn780.01-780.02 Coma780.09 Other alterations of consciousness780.2 Syncope and collapse780.31 Febrile convulsions (simple), unspecified780.32 Complex febrile convulsions780.39 Convulsions780.71 Chronic fatigue syndrome780.79 Malaise and fatigue781.0 Abnormal involuntary movements781.7 Tetany783.0 Anorexia783.21-783.22 Abnormal loss of weight783.3 Feeding difficulties and mismanagement783.9 Other symptoms concerning nutrition, metabolism, and development785.0 Tachycardia, unspecified785.50-785.51 Cardiogenic shock; shock unspecified785.59 Shock, other787.04 Bilious emesis787.91 Diarrhea790.6 Other abnormal blood chemistry794.31 Abnormal electrocardiogram794.4 Abnormal kidney test796.2 Elevated blood pressure reading without diagnosis of hypertension799.4 Cachexia958.4 Traumatic shock995.23 Unspecified adverse effect of insulin995.29 Unspecified adverse effect of other drug, medicinal and biological substance

996.81 Complications of transplanted kidney996.86 Complications of transplanted pancreas997.1 Cardiac complications998.0 Postoperative shock998.9 Unspecified complication of procedure, not elsewhere classified999.9 Other and unspecified complications of medical care, not elsewhere

classified, dialysisV23.0-V23.9 Supervision of high-risk pregnancy V42.0 Kidney replaced by transplantV42.1 Heart replaced by transplantV42.7 Liver replaced by transplantV42.83 Pancreas replaced by transplantV56.0 Extracorporeal dialysisV56.8 Other dialysisV58.11-V58.12 Chemotherapy, (cis-platinum)V58.69 Long term (current) use of other medications (high risk)


87 MAGNESIUM (LCD)


CPT: 82272 Blood occult peroxidaseCPT: G0394 Blood Occult Test (e.g., guaiac), feces, for single determination for colorectal

neoplasm (e.g., patient was provided three cards or single triple card for

consecutive collection)

003.0 Salmonella gastroenteritis003.1 Salmonella septicemia004.0-004.9 Shigellosis005.0-005.9 Other food poisoning (bacterial)006.0-006.9 Amebiasis 007.0-007.9 Other protozoal intestinal diseases008.41-008.49 Intestinal infections due to other specified bacteria009.0-009.3 Ill-defined intestinal infections014.00-014.86 Tuberculosis of intestines, peritoneum, and mesenteric glands

040.2 Whipple's disease095.2 Syphilitic peritonitis095.3 Syphilis of liver098.0 Gonococcal infection, acute, lower genitourinary tract098.7 Gonococcal Infection anus and rectum 098.84 Gonococcal endocarditis123.0-123.9 Other cestode infection124 Trichinosis127.0-127.9 Other intestinal helminthiases139.8 Late effects of other and unspecified infectious and parasitic diseases

150.0-157.9 Malignant neoplasm of digestive organisms159.0-159.9 Malignant neoplasm of other and ill-defined sites within the digestive organs

and peritoneum 176.3 Kaposi's sarcoma, gastrointestinal sites197.4-197.5 Secondary malignant neoplasm of intestines197.8 Secondary malignant neoplasm of other digestive organs and spleen199.0 Disseminated malignant neoplasm204.00-204.92 Lymphoid leukemia205.00-208.92 Leukemia (Myeloid, Monocytic, Other or Unspecified type)209.00-209.03 Benign carcinoid tumors of the small intestine209.10-209.17 Benign carcinoid tumors of the appendix, large intestine and rectum209.40-209.43 Malignant carcinoid tumors of the small intestine209.50-209.57 Malignant carcinoid tumors of the appendix, large intestine and rectum

209.70 Secondary neuroendocrine tumor, unspecified site209.71 Secondary neuroendocrine tumor of distant lymph nodes209.72 Secondary neuroendocrine tumor of liver209.73 Secondary neuroendocrine tumor of bone209.74 Secondary neuroendocrine tumor of peritoneum209.75 Secondary Merkel cell carcinoma


211.0-211.9 Benign neoplasm of other parts of digestive system

228.04 Hemangioma of intra-abdominal structures

230.2-230.9 Carcinoma in situ of digestive organs235.2 Neoplasm of uncertain behavior of stomach, intestines and rectum235.5 Neoplasm of uncertain behavior of other and unspecified digestive organs

BLOOD, OCCULT; FECES SCREENING


88 OCCULT BLOOD (NCD)



239.0 Neoplasm of unspecified nature, digestive system280.0-280.9 Iron deficiency anemias284.2 Myelophthisis285.0-285.9 Other and unspecified anemias286.0-286.9 Coagulation defects287.0-287.39 Allergic purpura; qualitative platelet defects; other non-thrombocytopenic


conditions338.3 Neoplasm related pain (acute)(chronic)448.0 Hereditary hemorrhagic telangiectasia 455.0-455.8 Hemorrhoids456.0-456.21 Esophageal varices with or without mention of bleeding530.10-535.71 Diseases of esophagus, stomach, and duodenum536.2 Persistent vomiting536.8-536.9 Dyspepsia and other specified and unspecified functional disorders of the

stomach537.0-537.4 Other disorders of stomach and duodenum537.82-537.83 Angiodysplasia of stomach and duodenum537.84 Dieulatoy lesion (hemorrhagic) of stomach and duodenum537.89 Other specified disorders of the stomach and duodenum555.0-558.9 Non-infectious enteritis and colitis560.0-560.2 Intestinal obstruction: intussusceptions, paralytic ileus, volvulus560.3 Impaction of intestine, unspecified560.31 Gallstone ileus560.32 Fecal impaction560.39 Other impaction of intestine560.81-560.89, 560.9 Other and unspecified intestinal obstruction562.10-562.13 Diverticulosis/diverticulitis of colon564.00-564.9 Functional digestive disorders, not elsewhere classified565.0-565.1 Anal fissure 569.0 Anal and rectal polyp569.1 Rectal prolapse569.3 Hemorrhage of rectum and anus569.41-569.49 Other specified disorders of rectum and anus569.82-569.83 Ulceration and perforation of intestine 569.84-569.85 Angiodysplasia of intestine with or without mention of hemorrhage569.86 Dieulafoy lesion (hemorrhagic) of intestine569.87 Vomiting of fecal matter571.0-571.9 Chronic liver disease and cirrhosis577.0-577.9 Diseases of the pancreas578.0-578.9 Gastrointestinal hemorrhage579.0 Celiac disease579.8 Other specified intestinal malabsorption596.1 Intestinovesical fistula617.5 Endometriosis of intestine780.71 Chronic fatigue syndrome780.72 Functional quadriplegia780.79 Other malaise and fatigue783.0 Anorexia




783.21 Abnormal loss of weight787.01-787.03 Nausea and vomiting787.04 Bilious emesis787.1 Heartburn787.20-787.29 Dysphagia787.7 Abnormal feces787.91 Diarrhea

787.99 Other symptoms involving digestive system789.00-789.09 Abdominal pain789.30-789.39 Abdominal or pelvic swelling, mass, or lump789.40-789.49 Abdominal rigidity789.51 Malignant Ascites789.59 Other Ascites789.60-789.69 Abdominal tenderness789.7 Colic790.92 Abdominal coagulation profile

792.1 Nonspecific abnormal findings in stool contents793.6 Nonspecific abnormal findings on radiological and other794.8 Nonspecific abnormal results of function studies, liver863.0-863.90 Injury to gastrointestinal tract863.91-863.95, 863.99 Injury to pancreas

864.00-864.09 Injury to liver without mention of open wound into cavity864.11-864.19 Injury to liver with open wound into cavity866.00-866.03 Injury to kidney without mention of open wound into cavity

866.10-866.13 Injury to kidney with open wound into cavity902.0-902.9 Injury to blood vessels of abdomen and pelvis926.11-926.19 Crushing injury of trunk, other specified sites926.8 Crushing injury of trunk, multiple sites926.9 Crushing injury of trunk, unspecified site995.20 Unspecified adverse effect of unspecified drug, medicinal and biological

substance995.24 Failed moderate sedation during procedure964.2 Poisoning by agents primarily affecting blood constituents, anticoagulants

V10.00-V10.09 Personal history of malignant neoplasm, gastrointestinal tractV12.00 Personal history of unspecified infectious and parasitic diseaseV12.72 Personal history of colonic polypsV58.61 Long term (current) use of anticoagulantsV58.63-V58.66 Long-term (current) drug useV58.69 Long term (current) use of other medicationsV67.51 Following treatment with high risk medication, not elsewhere specifiedV76.51 ** Screening for malignant neoplasm of the colon. **This screening is only

allowed once every 365 days with this code. If additional Occult Blood tests

are performed they must be diagnostic or must have an ABN for frequency.




CPT: 84153 Prostate Specific Antigen; Total

185 Malignant neoplasm of prostate188.5 Malignant neoplasm of bladder neck196.5 Secondary malignant neoplasm, lymph nodes inguinal region and lower limb

196.6 Secondary malignant neoplasm, intrapelvic lymph nodes196.8 Secondary malignant neoplasm, lymph nodes of multiple sites198.5 Secondary malignant neoplasm, bone and bone marrow198.82 Secondary malignant neoplasm, genital organs233.4 Carcinoma in situ, prostate236.5 Neoplasm of uncertain behavior of prostate239.5 Neoplasm of unspecified nature, other genitourinary organs596.0 Bladder neck obstruction599.60 Urinary obstruction, unspecified599.69 Urinary obstruction, not elsewhere classified599.70-599.72 Hematuria600.00 Hypertrophy (benign) of prostate without urinary obstruction and other lower

urinary tract (LUTS)600.01 Benign prostate hypertrophy with urinary obstruction600.10 Nodular prostate without urinary obstruction600.11 Nodular prostate with urinary obstruction600.21 Benign localized hyperplasia of prostate with urinary obstruction and other

lower urinary tract symptoms (LUTS)601.9 Unspecified prostatitis602.9 Unspecified disorder of prostate788.20 Retention of urine, unspecified788.21 Incomplete bladder emptying788.30 Urinary incontinence, unspecified788.41 Urinary frequency788.43 Nocturia788.62 Slowing of urinary stream788.63-788.65 Urgency of urination790.93 Elevated prostate specific antigen793.6, 793.7 Non-specific abnormal result of radiologic examination, evidence of

malignancy794.9 Bone scan evidence of malignancyV10.46 Personal history of malignant neoplasm; prostateV76.44 ** Screening for malignant neoplasm of the prostate. **This screening is only

covered for men over 50 years of age once every 365 days with this code. If

additional PSA tests are performed they must be diagnostic or must have an

ABN for frequency.


PROSTATE SPECIFIC ANTIGEN (PSA)


91 PSA (NCD)


CPT: 85610 Prothrombin Time

002.0-002.9 Typhoid and paratyphoid

003.0-003.9 Other Salmonella infections

038.9 Unspecified Septicemia

042 Human Immunodeficiency virus (HIV) disease

060.0-060.9 Yellow fever

065.0-065.9 Arthropod-borne hemorrhagic fever


075 Infectious mononucleosis

078.6 Hemorrhagic nephrosonephritis

078.7 Arenaviral hemorrhagic fever

084.8 Blackwater fever

120.0 Schistosomiasis121.1 Clonorchiasis121.3 Fascioliasis124 Trichinosis134.2 Hirudiniasis135 Sarcoidosis152.0-152.9 Malignant neoplasm of small intestine, including duodenum155.0-155.2 Malignant neoplasm of liver and intrahepatic bile ducts156.0-156.9 Malignant neoplasm of gallbladder and extrahepatic bile ducts157.0-157.9 Malignant neoplasm of pancreas188.0-189.9 Malignant neoplasm of bladder, kidney, and other and unspecified urinary

organs

197.7 Secondary malignant neoplasm, liver198.0 Secondary malignant neoplasm, kidney198.1 Secondary malignant neoplasm, other urinary organs200.00-200.88 Lymphosarcoma and reticulosarcoma202.00-202.98 Other malignant neoplasms of lymphoid and histiocytic tissue209.20-209.29 Malignant carcinoid tumors of other and unspecified sites209.70 Secondary neuroendocrine tumor, unspecified site209.71 Secondary neuroendocrine tumor of distant lymph nodes209.72 Secondary neuroendocrine tumor of liver209.73 Secondary neuroendocrine tumor of bone209.74 Secondary neuroendocrine tumor of peritoneum209.75 Secondary Merkel cell carcinoma209.79 Secondary neuroendocrine tumor of other sites223.0-223.9 Benign neoplasm of kidney and other urinary organs238.4 Polycythemia vera238.5 Histocytic and mast cells - neoplasm of uncertain behavior238.6 Plasma cells - neoplasm of uncertain behavior238.71-238.79 Other lymphatic and hematopoietic tissues239.4 Neoplasm of unspecified nature, bladder239.5 Neoplasm of unspecified nature, other genitourinary organs239.9 Neoplasm of unspecified nature, site unspecified246.3 Hemorrhage and infarction of thyroid249.40-249.41 Secondary diabetes mellitus with renal manifestations250.40-250.43 Diabetic with renal manifestations263.0-263.9 Other and unspecified protein/calorie malnutrition

PROTHROMBIN TIME

92 PT (NCD)


PROTHROMBIN TIME

269.0 Deficiency of Vitamin K269.2 Unspecified vitamin deficiency273.0-273.9 Disorders of plasma protein metabolism275.01 Hereditary hemochromatosis275.02 Hemochromatosis due to repeated red blood cell transfusions275.03 Other hemochromatosis275.09 Other disorders of iron metabolism277.1 Disorders of porphyrin metabolism277.30-277.39 Amyloidosis280.0 Iron deficiency anemia, secondary to blood loss - chronic280.9 Iron deficiency anemia, unspecified281.0 Pernicious anemia281.1 Other Vitamin B12 Deficiency Anemia, NEC281.9 Unspecified Deficiency Anemia, NOS285.0 Sideroblastic anemia285.1 Acute posthemorrhagic anemia286.0-286.9 Coagulation defects287.0-287.39 Allergic purpura; qualitative platelet defects; other non-thrombocytopenic


conditions289.81 Primary hypercoagulable state290.40-290.43 Vascular dementia325 Phlebitis and thrombophlebitis of intracranial venous sinuses342.90-342.92 Hemiplegia NOS360.43 Hemophthalmos, except current injury362.18 Retinal vasculitis362.30-362.37 Retinal vascular occlusion362.43 Hemorrhagic detachment of retinal pigment epithelium362.81 Retinal hemorrhage363.61-363.72 Choroidal hemorrhage and rupture, detachment368.9 Unspecified Visual Disturbances372.72 Conjunctival hemorrhage374.81 Hemorrhage of eyelid376.32 Orbital hemorrhage377.42 Hemorrhage in optic nerve sheaths377.53 Disorders of optic chiasm associated with vascular disorders377.62 Disorders of visual pathways associated with vascular disorders377.72 Disorders of visual cortex associated with vascular disorders379.23 Vitreous hemorrhage380.31 Hematoma of auricle or pinna

386.2 Vertigo of central origin

386.50 Labyrinthine dysfunction, unspecified394.0-394.9 Diseases of the mitral valve395.0 Rheumatic aortic stenosis 395.2 Rheumatic aortic stenosis with insufficiency396.0-396.9 Diseases of mitral and aortic valves397.0-397.9 Diseases of other endocardial structures398.0-398.99 Other rheumatic heart disease

93 PT (NCD)


PROTHROMBIN TIME

403.01, 403.11 403.91 Hypertensive chronic kidney disease, with chronic kidney disease stage V or

end stage renal disease404.02, 404.12 404.92 Hypertensive heart and chronic kidney disease without heart failure and with

chronic kidney disease stage V or end stage renal disease410.00-410.92 Acute myocardial infarction 411.1 Intermediate coronary syndrome411.81 Coronary occlusion without myocardial infarction411.89 Other acute and subacute forms of ischemic heart disease413.0-413.9 Angina pectoris414.00-414.07 Coronary atherosclerosis414.3 Coronary atherosclerosis due to lipid rich plaque414.4 Coronary atherosclerosis due to calcified coronary lesion414.8 Other specified forms of chronic ischemic heart disease414.9 Chronic ischemic heart disease, unspecified415.0-415.19 Acute pulmonary heart disease

416.9 Chronic pulmonary heart disease, unspecified423.0 Hemopericardium424.0 Mitral valve disorders424.1 Aortic valve disorder424.90 Endocarditis, valve unspecified, unspecified cause425.0, 425.11, 425.18

425.2 - 425.9-425.9

Cardiomyopathy

427.0-427.9 Cardiac dysrhythmias428.0-428.9 Heart failure429.0-429.4 Ill-defined descriptions and complications of heart disease429.79 Other certain sequelae of myocardial infarction, not elsewhere classified

430 Subarachnoid hemorrhage 431 Intracerebral hemorrhage432.0-432.9 Other and unspecified intracranial hemorrhage433.00-433.91 Occlusion and stenosis of precerebral arteries434.00-434.91 Occlusion of cerebral arteries435.0-435.9 Transient cerebral ischemia436 Acute, but ill-defined cerebrovascular disease437.0 Cerebral atherosclerosis437.1 Other generalized ischemic cerebrovascular disease437.6 Nonpyogenic thrombosis of intracranial venous sinus440.0-440.9 Atherosclerosis441.0-441.9 Aortic aneurysm and dissection443.0-443.9 Other peripheral vascular disease444.01, 444.09,

444.1 - 444.9


447.1 Stricture of artery447.2 Rupture of artery447.6 Arteritis, unspecified448.0 Hereditary hemorrhagic telangiectasia448.9 Other and unspecified capillary diseases451.0-451.9 Phlebitis and thrombophlebitis 452 Portal vein thrombosis453.0-453.9 Other venous embolism and thrombosis455.2 Internal hemorrhoids with other complication455.5 External hemorrhoids with other complication455.8 Unspecified hemorrhoids with other complication

94 PT (NCD)


PROTHROMBIN TIME

456.0-456.1 Esophageal varices456.8 Varices of other sites459.0 Hemorrhage, unspecified459.10-459.19 Postphlebitis syndrome459.2 Compression of vein459.81 Venous (peripheral) insufficiency, unspecified459.89 Other, other specified disorders of circulatory system511.81 Malignant pleural effusion511.89 Other specified forms of effusion except tuberculous514 Pulmonary congestion and hypostasis530.7 Gastroesophageal laceration - hemorrhage syndrome530.82 Esophageal hemorrhage530.86 Infection of esophagostomy530.87 Mechanical complication of esophagostomy531.00-535.71 Gastric ulcer, duodenal ulcer, peptic ulcer, gastrojejunal ulcer, gastritis and

duodenitis555.0-555.9 Regional enteritis556.0-556.9 Ulcerative colitis557.0-557.9 Vascular insufficiency of intestine562.02-562.03 Diverticulosis of small intestine with hemorrhage562.10 Diverticulosis of colon w/o hemorrhage562.11 Diverticulitis of colon w/o hemorrhage562.12 Diverticulitis of colon with hemorrhage562.13 Diverticulitis of colon with hemorrhage568.81 Hemoperitoneum (nontraumatic)569.3 Hemorrhage of rectum and anus571.0-571.9 Chronic liver disease and cirrhosis572.2 Hepatic Coma572.4 Hepatorenal syndrome572.8 Other sequelae of chronic liver disease573.1-573.9 Hepatitis in viral diseases, other and unspecified disorder of liver576.0-576.9 Other disorders of Biliary tract577.0 Acute pancreatitis578.0-578.9 Gastrointestinal hemorrhage579.0-579.9 Intestinal Malabsorption581.0-581.9 Nephrotic Syndrome583.9 Nephritis, with unspecified pathological lesion in kidney584.5-584.9 Acute Renal Failure585.4-585.9 Chronic kidney disease586 Renal failure, unspecified593.81-593.89 Other specified disorders of kidney and ureter596.7 Hemorrhage into bladder wall596.81 Infection of cystostomy596.82 Mechanical complication of cystostomy596.83 Other complication of cystostomy596.89 Other specified disorders of bladder599.70-599.72 Hematuria607.82 Vascular disorders of penis608.83 Vascular disorders of male genital organs611.89 Other specified disorders of breast 620.7 Hematoma of broad ligament621.4 Hematometra

95 PT (NCD)


PROTHROMBIN TIME

622.8 Other specified noninflammatory disorders of cervix

623.6 Vaginal hematoma

623.8 Other specified noninflammatory disorders of the vagina

624.5 Hematoma of vulva

626.2-626.9 Abnormal bleeding from female genital tract627.0 Premenopausal menorrhagia627.1 Postmenopausal bleeding629.0 Hematocele female, not classified elsewhere632 Missed abortion634.10-634.12 Spontaneous abortion, complicated by excessive hemorrhage635.10-635.12 Legally induced abortion, complicated by delayed or excessive hemorrhage

636.10-636.12 Illegally induced abortion, complicated by delayed or excessive hemorrhage

637.10-637.12 Abortion unspecified, complicated by delayed or excessive hemorrhage

638.1 Failed attempted abortion, complicated by delayed or excessive hemorrhage

639.1 Delayed or excessive hemorrhage following abortion and ectopic and molar

pregnancies639.6 Complications following abortion and ectopic and molar pregnancies with

embolism640.00-640.93 Hemorrhage in early pregnancy641.00-641.93 Antepartum hemorrhage, abruptio placentae, and placenta previa642.00-642.94 Hypertension complicating pregnancy, childbirth, and the puerperium646.70-646.73 Liver disorders in pregnancy649.30-649.34 Coagulation defects complicating pregnancy, childbirth, or the puerperium,

unspecified as to episode of care or not applicable649.50-649.53 Spotting complicating pregnancy, unspecified as to episode of care or not

applicable656.00-656.03 Fetal maternal hemorrhage658.40-658.43 Infection of amniotic cavity666.00-666.34 Postpartum hemorrhage671.20-671.94 Venous complications in pregnancy and the puerperium except legs, vulva

and perineum673.00-673.84 Obstetrical pulmonary embolism674.30-674.34 Other complications of obstetrical surgical wounds713.2 Arthropathy associated with hematological disorders713.6 Arthropathy associated with hypersensitivity reaction719.15 Hemarthrosis pelvic region and thigh719.16 Lower Leg719.19 Multiple sites729.5 Pain in limb729.81 Swelling of limb733.10 Pathologic fracture, unspecified site746.00-746.9 Other Congenital anomalies of heart762.1 Other forms of placental separation and hemorrhage767.0,767.11 Birth trauma, subdural and cerebral hemorrhage and injury to scalp767.8 Other specified birth trauma770.3 Pulmonary hemorrhage772.0-772.9 Fetal and neonatal hemorrhage774.6 Unspecified fetal and neonatal jaundice776.0-776.9 Hemorrhagic disease of the newborn780.2 Syncope and collapse782.3 Edema

96 PT (NCD)


PROTHROMBIN TIME

782.4 Jaundice, unspecified, not of newborn782.7 Spontaneous ecchymosis784.7 Epistaxis784.8 Hemorrhage from throat785.4 Gangrene785.50 Shock without mention of trauma786.05 Shortness of breath786.30 Hemoptysis, unspecified786.31 Acute idiopathic pulmonary hemorrhage in infants (AIPHI)786.39 Other hemoptysis786.50 Chest pain, unspecified786.51 Precordial pain786.59 Chest pain, other789.00-789.09 Abdominal pain789.7 Colic789.1 Hepatomegaly789.51 Malignant Ascites789.59 Other Ascites790.92 Abnormal coagulation profile790.94 Euthyroid sick syndrome791.2 Hemoglobinuria794.8 Abnormal Liver Function Study800.00-800.99 Fracture of vault of skull801.00-801.99 Fracture of base of skull802.20-802.9 Fracture of face bones803.00-803.99 Other and unqualified skull fractures804.00-804.99 Multiple fractures involving skull or face with other bones805.00-806.9 Fracture, vertebral column807.00-807.09 Fractures of rib(s), closed807.10-807.19 Fracture of rib(s), open808.8-808.9 Unspecified fracture of pelvis809.0-809.1 Ill-defined fractures of bones of trunk810.00-810.13 Fracture of clavicle811.00-811.19 Fracture of scapula812.00-812.59 Fracture of humerus813.10-813.18 Fracture of radius and ulna, upper end, open813.30-813.33 Shaft, open813.50-813.54 Lower end, open813.90-813.93 Fracture unspecified part, open819.0-819.1 Multiple fractures involving upper both upper limbs, closed and open820.00-821.39 Fracture of neck of femur823.00-823.92 Fracture of tibia and fibula827.0-829.1 Other multiple lower limb852.00-853.19 Subarachnoid subdural, and extradural hemorrhage, following injury, Other

and specified intracranial hemorrhage following injury860.0-860.5 Traumatic pneumothorax and hemothorax861.00-861.32 Injury to heart and lung862.0-862.9 Injury to other and unspecified intrathoracic organs863.0-863.90 Injury to gastrointestinal tract863.91-863.95 &

863.99

Injury to Pancreas

864.00-864.19 Injury to liver

97 PT (NCD)


PROTHROMBIN TIME

865.00-865.19 Injury to spleen866.00-866.13 Injury to kidney867.0-867.9 Injury to pelvic organs868.00-868.19 Injury to other intra-abdominal organs869.0-869.1 Internal injury to unspecified or ill defined organs900.00-900.9 Injury to blood vessels of head and neck901.0-901.9 Injury to blood vessels of the thorax902.0-902.9 Injury to blood vessels of the abdomen and pelvis903.00-903.9 Injury to blood vessels of upper extremity904.0-904.9 Injury to blood vessels of lower extremity and unspecified sites920-924.9 Contusion with intact skin surface925.1-929.9 Crushing injury

958.2 Secondary and recurrent hemorrhage959.9 Injury, unspecified site964.0-964.9 Poisoning by agents primarily affecting blood constituents980.0-980.9 Toxic effect of alcohol981 Toxic effect of petroleum products982.0-982.8 Toxic effects of solvents other than petroleum-based987.0-987.9 Toxic effect of other gases, fumes or vapors989.0-989.9 Toxic effect of other substances chiefly non-medicinal as to source995.20 Unspecified adverse effect of unspecified drug, medicinal and biological

substance995.21 Arthus phenomenon995.24 Failed moderate sedation during procedure995.27 Other drug allergy995.29 Unspecified adverse effect of other drug, medicinal and biological substance

996.82 Complication of transplanted liver997.02 Iatrogenic cerebrovascular infarction or hemorrhage997.41 Retained cholelithiasis following cholecystectomy997.49 Other digestive system complications998.11-998.12 Hemorrhage or hematoma complicating a procedure999.2 Other vascular complications999.80 Transfusion reaction, unspecified999.83 Hemolytic transfusion reaction, incompatibility unspecified999.84 Acute hemolytic transfusion reaction, incompatibility unspecified999.85 Delayed hemolytic transfusion reaction, incompatibility unspecified999.89 Other transfusion reactionV08 Asymptomatic HIV infectionV12.1 History of nutritional deficiencyV12.3 Personal history of diseases of blood and blood-forming organsV12.50-V12.55, V12.59 Personal history of transient ischemic attack, cerebral infarction, or

pulmonary embolism without residual deficitsV15.1 Personal history of surgery to heart and great vesselsV15.21 Personal history of undergoing in utero procedure during pregnancyV15.22 Personal history of undergoing in utero procedure while a fetusV15.29 Personal history of surgery of other major organsV42.0 Kidney replaced by transplantV42.1 Heart replaced by transplantV42.2 Heart valve replaced by transplantV42.6 Lung replaced by transplantV42.7 Liver replaced by transplantV42.81-V42.89 Other specified organ or tissue replaced by transplant

98 PT (NCD)


PROTHROMBIN TIME

V43.21, V43.22 Heart replaced by other meansV43.3 Heart valve replaced by other meansV43.4 Blood vessel replaced by other meansV58.2 Transfusion of blood productsV58.61 Long term (current) use of anticoagulantsV58.83 Encounter for therapeutic drug monitoring


99 PT (NCD)


CPT: 85730 Partial Thromboplastin Time (PTT)

002.0-002.9 Typhoid and paratyphoid

003.0-003.9 Other Salmonella infections

038.9 Unspecified Septicemia

042 Human immunodeficiency virus (HIV) disease

060.0-060.9 Yellow fever

065.0-065.9 Arthropod borne hemorrhagic fever

070.0-070.9 Viral Hepatitis

075 Infectious mononucleosis

078.6 Hemorrhagic nephrosonephritis

078.7 Arenaviral hemorrhagic fever

120.0 Schistosomiasis haematobium

121.1 Clonorchiasis121.3 Fascioliasis124 Trichinosis135 Sarcoidosis155.0-155.2 Malignant neoplasm of liver and intrahepatic bile ducts197.7 Malignant neoplasm of liver, specified as secondary238.4 Polycythemia vera238.71-238.79 Other lymphatic and hemapoietic tissues239.9 Neoplasm of unspecified nature, site unspecified246.3 Hemorrhage and infarction of thyroid249.40-249.41 Secondary diabetes mellitus with renal manifestations250.40-250.43 Diabetic with renal manifestations269.0 Deficiency of Vitamin K273.0-273.9 Disorders of plasma protein metabolism275.01 Hereditary hemochromatosis275.02 Hemochromatosis due to repeated red blood cell transfusions275.03 Other hemochromatosis275.09 Other disorders of iron metabolism275.1 Disorders of copper metabolism275.2 Disorders of magnesium metabolism275.3 Disorders of phosphorus metabolism275.40-275.49 Disorders of calcium metabolism275.5 Hungry bone syndrome275.8-275.9 Other specified disorders of mineral metabolism, and unspecified disorder of

mineral metabolism277.1 Disorders of porphyrin metabolism277.30-277.39 Amyloisodosis285.1 Acute posthemorrhagic anemia286.0 Congenital factor VIII disorder - Hemophilia A286.1 Congenital factor IX disorder - Hemophilia B286.2-286.3 Other congenital factor deficiencies286.4 von Willebrand's disease286.52 Acquired hemophilia286.53 Antiphospholipid antibody with hemorrhagic disorder286.59 Other hemorrhagic disorder due to intrinsic circulating anticoagulants,

antibodies, or inhibitors286.6 Defibrination syndrome

PARTIAL THROMBOPLASTIN TIME

100 PTT (NCD)



286.7 Acquired coagulation factor deficiency286.9 Other and unspecified coagulation defects287.0-287.39 Allergic purpura; qualitative platelet defects; other non-thrombocytopenic


conditions289.0 Polycythemia, secondary289.81 Primary hypercoagulable state325 Phlebitis and thrombophlebitis of intracranial venous sinuses360.43 Hemophthalmos, except current injury362.30-362.37 Retinal vascular occlusion362.43 Hemorrhagic detachment of retinal pigment epithelium362.81 Retinal hemorrhage363.61-363.63 Choroidal hemorrhage363.72 Choroidal detachment368.9 Unspecified Visual Disturbances372.72 Conjunctive hemorrhage374.81 Hemorrhage of eyelid376.32 Orbital hemorrhage377.42 Hemorrhage in optic nerve sheaths379.23 Vitreous hemorrhage380.31 Hematoma of auricle or pinna403.01, 403.11,

03.91

Hypertensive chronic kidney disease, with chronic kidney disease stage V or

end stage renal disease404.02, 404.12,

404.92

Hypertensive heart and chronic kidney disease without heart failure and with

chronic kidney disease stage V or end stage renal disease410.00-410.92 Acute myocardial infarction423.0 Hemopericardium427.31 Atrial fibrillation427.9 Cardiac dysrhythmias, unspecified428.0 Congestive heart failure, unspecified429.79 Mural thrombus430-432.9 Cerebral hemorrhage433.00-433.91 Occlusion and stenosis of precerebral arteries434.00-434.91 Occlusion of cerebral arteries435.9 Focal neurologic deficit444.01, 444.09,

444.1 - 444.9


446.6 Thrombotic microangiopathy447.2 Rupture of artery448.0 Hereditary Hemorrhagic telangiectasia451.0-451.9 Phlebitis and thrombophlebitis453.0-453.9 Other Venous emboli and thrombosis456.0 Esophageal varices with bleeding456.1 Esophageal varices without bleeding456.8 Varices of other sites459.89 Ecchymosis530.7 Gastroesophageal laceration - hemorrhage syndrome530.82 Esophageal hemorrhage

101 PTT (NCD)



531.00-535.71 Gastric ulcer, duodenal ulcer, peptic ulcer, gastrojejunal ulcer, gastritis and

duodenitis537.83 Angiodysplasia of stomach and duodenum with hemorrhage537.84 Dielulafoy lesion (Hemorrhagic) of stomach and duodenum556.0-557.9 Hemorrhagic bowel disease562.02-562.03 Diverticulosis of small intestine with hemorrhage562.12 Diverticulosis of colon with hemorrhage562.13 Diverticulitis of colon with hemorrhage568.81 Hemoperitoneum (nontraumatic)569.3 Hemorrhage of rectum and anus570 Acute and subacute necrosis of liver571.0-573.9 Liver disease (in place of specific codes listed)576.0-576.9 Biliary tract disorders577.0 Acute pancreatitis578.0-578.9 Gastrointestinal Hemorrhage579.0-579.9 Malabsorption581.0-581.9 Nephrotic Syndrome583.9 Nephritis, with unspecified pathological lesion in kidney584.5-584.9 Acute Renal Failure585.4 Chronic kidney disease, Stage IV (severe)585.5 Chronic kidney disease, Stage V585.6 End stage renal disease585.9 Chronic kidney disease, unspecified586 Renal failure593.81-593.89 Other disorders of kidney and ureter, with hemorrhage596.7 Hemorrhage into bladder wall596.81 Infection of cystostomy596.82 Mechanical complication of cystostomy596.83 Other complication of cystostomy596.89 Other specified disorders of bladder

599.70-599.72 Hematuria

607.82 Penile hemorrhage

608.83 Vascular disorders of male genital organs

611.89 Other specified disorders of Breast

620.7 Hemorrhage of broad ligament621.4 Hematometra622.8 Other specified disorders of cervix, with hemorrhage623.6 Vaginal hematoma623.8 Other specified diseases of the vagina, with hemorrhage624.5 Hematoma of vulva626.6 Metrorrhagia626.7 Postcoital bleeding627.0 Premenopausal bleeding627.1 Postmenopausal bleeding629.0 Hematocele female not elsewhere classified632 Missed abortion634.00-634.92 Spontaneous abortion635.10-635.12 Legally induced abortion, complicated by delayed or excessive hemorrhage

636.10-636.12 Illegally induced abortion, complicated by delayed or excessive hemorrhage

637.10-637.12 Abortion unspecified, complicated by delayed or excessive hemorrhage

638.1 Failed attempt abortion, complicated by delayed or excessive hemorrhage

102 PTT (NCD)



639.1 Delayed or excessive hemorrhage following abortion and ectopic and molar

pregnancies639.6 Complications following abortion and ectopic and molar pregnancies,

embolism640.00-640.93 Hemorrhage in early pregnancy641.00-641.93 Antepartum hemorrhage642.00-642.94 Hypertension complicating pregnancy, childbirth, and the puerperium646.70-646.73 Liver disorders in pregnancy649.30-649.34 Coagulation defects complicating pregnancy, childbirth, or the puerperium,

unspecified as to episode of care or not applicable649.50-649.53 Spotting complicating pregnancy, unspecified as to episode of care or not

applicable656.00-656.03 Fetal maternal hemorrhage658.40-658.43 Infection of amniotic cavity666.00-666.34 Postpartum hemorrhage671.20-671.54 Phlebitis in pregnancy673.00-673.84 Obstetrical pulmonary embolus674.30-674.34 Other complications of surgical wounds, with hemorrhage710.0 Systemic Lupus erythematosus713.2 Arthropathy associated with hematologic disorders (note: may not be used

without indicating associated condition first)713.6 Arthropathy associated with Henoch Schonlein (note: may not be used

without indicating associated condition first)719.10-719.19 Hemarthrosis729.5 Leg pain/calf pain729.81 Swelling of limb733.10-733.19 Pathologic fracture associated with fat embolism762.1 Other forms of placental separation with hemorrhage (affecting newborn code-

do not assign to mother's record)764.90-764.99 Fetal intrauterine growth retardation767.0,767.11 Subdural and cerebral hemorrhage767.8 Other specified birth trauma, with hemorrhage770.3 Fetal and newborn pulmonary hemorrhage772.0-772.9 Fetal and neonatal hemorrhage774.0-774.7 Other perinatal jaundice776.0-776.9 Hemorrhagic disease of the newborn780.2 Syncope782.4 Jaundice, unspecified, not of newborn782.7 Spontaneous ecchymoses Petechiae784.7 Epistaxis784.8 Hemorrhage from throat785.4 Gangrene785.50 Shock786.05 Shortness of breath786.30 Hemoptysis, unspecified786.31 Acute idiopathic pulmonary hemorrhage in infants (AIPHI)786.39 Other hemoptysis786.50 Chest pain, unspecified786.59 Chest pain 789.00-789.09 Abdominal pain789.7 Colic790.92 Abnormal coagulation profile

103 PTT (NCD)



800.00-800.99 Fracture of vault of skull801.00-801.99 Fracture of base of skull802.20-802.9 Fracture of face bones803.00-803.99 Other fracture, skull804.00-804.99 Multiple fractures, skull805.00-806.9 Fracture, vertebral column807.00-807.09 Fractures of rib(s), closed807.10-807.19 Fractures of rib(s), open808.8-808.9 Fracture of pelvis809.0-809.1 Fracture of trunk810.00-810.13 Fracture of clavicle811.00-811.19 Fracture of scapula812.00-812.59 Fracture of humerus813.10-813.18 Fracture of radius and ulna, upper end, open813.30-813.33 Fracture of radius and ulna, shaft, open813.50-813.54 Fracture of radius and ulna, lower end, open813.90-813.93 Fracture of radius and ulna, unspecified part, open819.0-819.1 Multiple fractures 820.00-821.39 Femur823.00-823.92 Tibia and fibula827.0-829.1 Other multiple lower limb852.00-853.19 Subarachnoid subdural, and extradural hemorrhage, following injury, Other

and specified intracranial hemorrhage following injury860.0-860.5 Traumatic pneumothorax and hemothorax861.00-861.32 Injury to heart and lung862.0-862.9 Injury to other and unspecified intrathoracic organs863.0-863.99 Injury to gastrointestinal tract864.00-864.19 Injury to liver865.00-865.19 Injury to spleen866.00-866.13 Injury to kidney867.0-867.9 Injury to pelvic organs868.00-868.19 Injury to other intra-abdominal organs

869.0-869.1 Internal injury to unspecified or ill defined organs900.00-900.9 Injury to blood vessels of head and neck901.0-901.9 Injury to blood vessels of the thorax902.0-902.9 Injury to blood vessels of the abdomen and pelvis903.00-903.9 Injury to blood vessels of upper extremity904.0-904.9 Injury to blood vessels of lower extremity and unspecified sites920-924.9 Contusion with intact skin surface925.1-929.9 Crushing injury958.2 Secondary and recurrent hemorrhage959.9 Injury, unspecified site964.2 Poisoning by anticoagulants964.5 Poisoning by anticoagulant antagonists964.7 Poisoning by natural blood and blood products980.0 Toxic effects of alcohol989.5 Snake venom995.20 Unspecified adverse effect of unspecified drug, medicinal and biological

substance995.21 Arthus phenomenon995.24 Failed moderate sedation during procedure995.27 Other drug allergy

104 PTT (NCD)



995.29 Unspecified adverse effect of other drug, medicinal and biological substance

996.70-996.79 Other complications of internal prosthetic device997.02 Iatrogenic cerebrovascular infarction or hemorrhage998.11 Hemorrhage or hematoma complicating a procedure998.12 Hematoma complicating a procedure999.2 Other vascular complications of medical careV12.3 Personal history of diseases of blood and blood forming organsV58.2 Admission for Transfusion of blood productsV58.61 Long term (current use) of anticoagulantsV58.83 Encounter for therapeutic drug monitoring


105 PTT (NCD)


CPT: 84436 Thyroxine; total

CPT: 84439 Thyroxine; free

CPT: 84443 Thyroid stimulating hormone (TSH)

CPT: 84479 Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR)

017.50-017.56 Tuberculosis of the thyroid gland


193 Malignant neoplasm of thyroid gland

194.8 Malignant neoplasm of other endocrine glands and related structures, other

198.89 Secondary malignant neoplasm of the thyroid

220 Benign neoplasm of ovary

226 Benign neoplasm of thyroid gland

227.3 Benign neoplasm of pituitary gland and craniopharyngeal duct

234.8 Carcinoma in situ of other and unspecified sites237.4 Neoplasm of uncertain behavior of other and unspecified endocrine glands

239.7 Neoplasm of unspecified nature, thyroid gland240.0-240.9 Goiter specified and unspecified241.0-241.9 Nontoxic nodular goiter242.00-242.91 Thyrotoxicosis with or without goiter243 Congenital hypothyroidism244.0-244.9 Acquired hypothyroidism245.0-245.9 Thyroiditis246.0-246.9 Other disorders of thyroid249.40-249.41 Secondary diabetes mellitus with renal manifestations250.00-250.93 Diabetes mellitus252.1 Hypoparathyroidism253.1 Other and unspecified anterior pituitary hyper function253.2 Panhypopituitarism253.3 Pituitary dwarfism253.4 Other anterior pituitary disorders253.7 Iatrogenic pituitary disorders255.2 Adrenogenital disorders255.41 Glucocorticoid deficiency255.42 Mineralocorticoid deficiency256.31-256.39 Ovarian failure257.2 Testicular hypofunction258.0-258.9 Polyglandular dysfunction262 Malnutrition, severe263.0-263.9 Malnutrition, other and unspecified266.0 Ariboflavinosis272.0 Pure hypercholesterolemia272.2 Mixed hyperlipidemia272.4 Other and unspecified hyperlipidemia275.40-275.49 Calcium disorders275.5 Hungry bone syndrome276.0 Hyposmolality and/or hypernatremia276.1 Hyposmolality and/or hyponatremia278.3 Hypercarotenemia279.41-279.49 Autoimmune disorder, not classified elsewhere

THYROID TESTING

106 THYROID (NCD)


THYROID TESTING

281.0 Pernicious anemia281.9 Unspecified deficiency anemia283.0 Autoimmune hemolytic anemia285.9 Anemia, unspecified290.0 Senile dementia, uncomplicated290.10-290.13 Presenile dementia290.20-290.21 Senile dementia with delusional or depressive features290.3 Senile dementia with delirium293.0-293.1 Delirium293.81-293.89 Transient organic mental disorders294.8 Other specified organic brain syndromes296.00-296.99 Affective psychoses297.0 Paranoid state, simple297.1 Paranoia297.9 Unspecified paranoid state298.3 Acute paranoid reaction300.00-300.09 Anxiety states307.9 Agitation-other and unspecified special symptoms or syndromes, not

elsewhere classified310.1 Organic personality syndrome311 Depressive disorder, not elsewhere classified327.00-327.8 Other organic sleep disorders331.0, 331.11,

331.19, 331.2

Alzheimer's, pick's disease, Senile degeneration of brain

331.83 Mild cognitive impairment, so stated333.1 Essential and other specified forms of tremor333.99 Other extrapyramidal diseases and abnormal movement disorders354.0 Carpal Tunnel syndrome356.9 Idiopathic peripheral neuropathy, unspecified polyneuropathy358.1 Myasthenic syndromes in diseases classified elsewhere359.5 Myopathy in endocrine diseases classified elsewhere359.9 Myopathy, unspecified368.2 Diplopia372.71 Conjunctival hyperemia372.73 Conjunctival edema374.41 Lid retraction or lag374.82 Eyelid edema376.21 Thyrotoxic exophthalmos376.22 Exophthalmic ophthalmoplegia376.30-376.31 Exophthalmic conditions, unspecified and constant376.33-376.34 Orbital edema or congestion, intermittent exophthalmos378.50-378.55 Paralytic strabismus401.0-401.9 Essential hypertension403.00-403.91 Hypertensive renal disease404.00-404.93 Hypertensive heart and renal disease423.9 Unspecified disease of pericardium425.7 Nutritional and metabolic cardiomyopathy427.0 Paroxysmal supraventricular tachycardia427.2 Paroxysmal tachycardia, unspecified427.31 Atrial fibrillation427.89 Other specified cardiac dysrhythmia427.9 Cardiac dysrhythmia, unspecified

107 THYROID (NCD)


THYROID TESTING

428.0 Congestive heart failure428.1 Left heart failure429.3 Cardiomegaly511.9 Unspecified pleural effusion518.81 Acute respiratory failure529.8 Other specified conditions of the tongue560.1 Paralytic ileus564.00-564.09 Constipation564.7 Megacolon, other than Hirschsprung's568.82 Peritoneal effusion (chronic)625.3 Dysmenorrhea626.0-626.2 Disorders of menstruation626.4 Irregular menstrual cycle648.10-648.14 Other current conditions in the mother, classifiable elsewhere, but

complicating pregnancy, childbirth, or the puerperium, thyroid dysfunction

676.20-676.24 Engorgement of breast associated with childbirth and disorders of lactation

698.9 Unspecified pruritic disorder

701.1 Keratoderma, acquired (dry skin)703.8 Other specified diseases of nail (Brittle nails)704.00-704.09 Alopecia709.01 Vitiligo710.0-710.9 Diffuse disease of connective tissue728.2 Muscle wasting728.87 Muscle weakness728.9 Unspecified disorder of muscle, ligament, and fascia729.1 Myalgia and myositis, unspecified729.82 Musculoskeletal cramp730.30-730.39 Periostitis without osteomyelitis733.02 Idiopathic osteoporosis733.09 Osteoporosis, drug induced750.15 Macroglossia, congenital759.2 Anomaly of other endocrine glands780.01 Coma780.02 Transient alteration of awareness780.09 Alteration of consciousness, other 780.50-780.52 Insomnia780.60-780.66 Fever and other physiologic disturbances of temperature regulation780.71-780.79 Malaise and fatigue780.8 Hyperhidrosis780.93 Memory Loss780.94 Early satiety780.96 Generalized pain780.97 Altered mental status780.99 Other general symptoms (hyperthermia)781.0 Abnormal involuntary movements781.3 Lack of coordination, ataxia782.0 Disturbance of skin sensation782.3 Localized edema782.8 Changes in skin texture782.9 Other symptoms involving skin and integumentary tissues783.0 Anorexia783.1 Abnormal weight gain

108 THYROID (NCD)


THYROID TESTING

783.21 Abnormal loss of weight783.6 Polyphagia784.1 Throat pain784.42 Dysphonia784.43 Hypernasality784.44 Hyponasality784.49 Voice disturbance784.51 Dysarthria784.59 Other speech disturbance785.0 Tachycardia, unspecified785.1 Palpitations785.9 Other symptoms involving cardiovascular system786.09 Other symptoms involving respiratory system786.1 Stridor787.20-787.29 Dysphagia787.91-787.99 Other symptoms involving digestive system789.51 Malignant Ascites789.59 Other Ascites793.99 Other nonspecific abnormal findings on radiological and other examinations

of body structure794.5 Thyroid, abnormal scan or uptake796.1 Other nonspecific abnormal findings, abnormal reflex799.21 Nervousness799.22 Irritability799.23 Impulsiveness799.24 Emotional lability799.25 Demoralization and apathy799.29 Other signs and symptoms involving emotional state990 Effects of radiation, unspecifiedV10.87 Personal history of malignant neoplasm of the thyroidV10.88 Personal history of malignant neoplasm of other endocrine glandV10.91 Personal history of malignant neuroendocrine tumorV12.21 Personal history of gestational diabetesV12.29 Personal history of other endocrine, metabolic, and immunity disorders

V58.69 Long tern (current) use of other medicationsV67.00-V67.9 Follow-up examination


109 THYROID (NCD)

Medicare A Medical Policy October 1, 2005

CPT: 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin,

ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any

number of these constituents; with microscopyCPT: 81001 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin,

ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any

number of these constituents; with microscopyCPT: 81002 Urinalysis without microscopy, non-automated

CPT: 81003 Urinalysis without microscopy, automated

CPT: 81005 Urinalysis; qualitative or semiquantitative, except immunoassays

CPT: 81007 Urinalysis; bacteria screen, by non-culture technique, commercial kit (specify

type)CPT: 81015 Urinalysis; microscopic only

CPT: 81020 Urinalysis; two or three glass test

016.00-016.96 Tuberculosis of the genitourinary system

038.0 - 038.9 Septicemia

041.00 Streptococcus infection in conditions classified elsewhere & of unspecified

site, Streptococcus unspecified041.01 Streptococcus infection in conditions classified elsewhere & of unspecified

site, Streptococcus GROUP A041.02 Streptococcus infection in conditions classified elsewhere & of unspecified

site, Streptococcus GROUP B041.03 Streptococcus infection in conditions classified elsewhere & of unspecified

site, Streptococcus GROUP C041.04 Streptococcus infection in conditions classified elsewhere & of unspecified

site, Streptococcus GROUP D [Enterococcus]041.05 Streptococcus infection in conditions classified elsewhere & of unspecified

site, Streptococcus GROUP G041.09 Streptococcus infection in conditions classified elsewhere & of unspecified

site, other Streptococcus041.10 Staphylococcus infection in conditions classified elsewhere & of unspecified

site, Unspecified041.11 Staphylococcus infection - Methicillin susceptible Staphylococcus aureus

(MSSA)041.12 Staphylococcus infection - Methicillin Resistant Staphylococcus aureus

(MRSA)041.19 Staphylococcus infection in conditions classified elsewhere & of unspecified

site, other Staphylococcus041.2 Pneumococcus infection in conditions classified elsewhere & of unspecified

site041.3 Klebsiella Pneumoniae041.41 Shiga toxin-producing Escherichia Coli [E. Coli] (STEC)041.42 Other specified Shiga toxin-producing Escherichia Coli [E. Coli] (STEC)

041.43 Shiga toxin-producing Escherichia Coli [E. Coli] (STEC), unspecified041.49 Other and unspecified Shiga toxin-producing Escherichia Coli [E. Coli] 041.5 Hemophilus Influenzae (H. Influenzae) infection in conditions classified

041.6 Proteus (Mirabilis) (Morganii) infection in conditions classified elsewhere & of

unspecified site041.7 Pseudomonas infection in conditions classified elsewhere & of unspecified

site

URINALYSIS (UA)

110 URINALYSIS (LCD)


URINALYSIS (UA)

041.81 Other specified bacterial infections in conditions classified elsewhere & of

unspecified site, Mycoplasma041.82 Other specified bacterial infections in conditions classified elsewhere & of

unspecified site, Bacteroides Fragilis041.83 Other specified bacterial infections in conditions classified elsewhere & of

unspecified site, Clostridium Perfringens041.84 Other specified bacterial infections in conditions classified elsewhere & of

unspecified site, other anaerobes041.85 Other specified bacterial infections in conditions classified elsewhere & of

unspecified site, other gram-negative organisms041.86 Helicobacter Pylori (H. Pylori)041.89 Bacterial infection unspecified in conditions classified elsewhere & of

unspecified site, other specified bacteria041.9 Bacterial infection unspecified in conditions classified elsewhere & of

unspecified site054.10-054.19 Genital herpes070.0 - 070.59 Viral hepatitis 070.70 Unspecified viral hepatitis C without hepatic coma070.71 Unspecified viral hepatitis C with hepatic coma072.0 Mumps orchitis 078.11 Condyloma acuminatum 078.88 Other specified diseases due to chlamydia 079.81-079.89 Other specified viral and chlamydial infection 079.98 Unspecified chlamydial infection 087.0 - 087.1 Relapsing fever 095.4 Syphilis of kidney098.0 Gonococcal infection, acute, lower genitourinary tract 098.10-098.19 Gonococcal infection, acute, upper genitourinary tract 098.2 Gonococcal infection, chronic, of lower genitourinary tract098.30-098.39 Gonococcal infection, chronic, of upper genitourinary tract

098.89 Other Gonococcal infection of other specified sites 099.3 Reiter's disease 099.40 - 099.49 Nonspecified urethritis 099.53 - 099.54 Other venereal diseases due to Chlamydia trachomatis 100.0 Leptospiral icterohemorrhagica 102.0 - 102.9 Yaws 112.1 Candidasis of vulva and vagina 112.2 Candidasis of other urogenital sites125.0 - 125.1 Filarial infection and dracontiasis131.00 - 131.03 Urogenital trichomoniasis 135 Sarcoidosis185 Malignant neoplasm of prostate 186.0, 186.9 Malignant neoplasm of testis 187.1 Malignant neoplasm of prepuce 187.1 Malignant neoplasm of penis and other male genital organs

187.2 Malignant neoplasm of glans penis 187.3 Malignant neoplasm of body of penis187.5 Malignant neoplasm of epididymis187.6 Malignant neoplasm of spermatic cord 187.7 Malignant neoplasm of scrotum187.8 Malignant neoplasm of other specified sites of male genital organs 188.0 - 188.9 Malignant neoplasm of bladder



URINALYSIS (UA)

189.0 - 189.9 Malignant neoplasm of kidney and other and unspecified urinary organs

198.0, 198.1 Secondary malignant neoplasm of kidney and other urinary organs 203.00 Multiple Myeloma without mention of having achieved remission203.01 Multiple Myeloma in remission203.02 Multiple Myeloma in relapse222.2 Benign neoplasm of prostate 223.0 - 223.3 Benign neoplasm of kidney and other urinary organs 223.81 - 223.89 Benign neoplasm of urethra and other urinary organs233.4 Carcinoma in situ of prostate233.7 Carcinoma in situ of bladder 233.9 Carcinoma in situ and other unspecified urinary organs 236.5 Neoplasm of uncertain behavior of prostate 236.7 Neoplasm of uncertain behavior of bladder236.90 - 236.99 Neoplasm of uncertain behavior of other and unspecified urinary organs

249.00-249.91 Secondary Diabetes Mellitus, with or without various manifestations250.00 - 250.93 Diabetes mellitus 253.5 - 253.6 Diabetes insipidus and other disorders of neurohypophysis 271.4 Renal glycosuria 272.2 - 272.4 Mixed and other unspecified hyperlipidemia 273.0 - 273.8 Disorders of plasma protein metabolism274.00-274.03 Gouty arthropathy274.10 - 274.19 Gouty nephropathy 275.01 Hereditary hemochromatosis275.02 Hemochromatosis due to repeated red blood cell transfusions275.03 Other hemochromatosis275.09 Other disorders of iron metabolism275.42 Hypercalcemia 276.0 Hyperosmolality and/or hypernatremia276.1 Hyposmolality and/or hyponatremia276.2 Acidosis276.3 Alkalosis276.4 Mixed acid-base balance disorder276.50 Volume depletion, unspecified276.51 Dehydration276.52 Hypovolemia276.61 Transfusion associated circulatory overload276.69 Other fluid overload276.8 Hypopotassemia276.9 Electrolyte & fluid disorders not elsewhere classified277.00 - 277.09 Cystic Fibrosis (use 5th digit to specify)277.1 - 277.5 Amyloidosis/disorders of bilirubin excretion 277.88 Tumor lysis syndrome282.60 - 282.69 Sickle-cell anemia 283.11 Hemolytic-uremic syndrome283.2 Hemoglobinuria due to hemolysis from external causes287.41 Posttransfusion purpura287.49 Other secondary thrombocytopenia306.53 Psychogenic Dysuria310.1 Personality change due to conditions classified elsewhere344.61 Cauda equina syndrome with neurogenic bladder 401.0 - 405.99 Hypertensive disease421.0 - 421.9 Acute and subacute endocarditis



URINALYSIS (UA)

428.0 Congestive heart failure446.0 - 446.7 Polyarteritis nodosa and allied conditions 447.3 - 447.6 Other disorders of arteries and arterioles 456.4 Scrotal varices (varicocele) 457.0 - 457.1 Postmastectomy lymphedema and other lymphedema 570 Acute and subacute necrosis of liver 571.40 - 571.49 Chronic hepatitis 571.5 - 571.8 Chronic and other cirrhosis of the liver572.2 Hepatic encephalopathy573.0 - 573.3 Other disorders of liver 580.0 - 583.9 Nephritis, nephrotic syndrome, and nephrosis584.5 - 584.9 Acute kidney failure 585.9 Chronic renal failure 586 Renal failure, unspecified 587 Renal sclerosis588.0 Renal osteodystrophy588.1 - 588.89 Disorders resulting from impaired renal function 589.0 - 589.9 Small kidney, unknown cause590.00 - 590.9 Infection of kidney591 Hydronephrosis 592.0 - 592.9 Calculus of kidney and ureter 593.0 - 593.6 Other disorders of kidney and ureter 593.70 - 593.73 Vesicoureteral reflux593.81 - 593.89 Other specified disorders of kidney and ureter593.9 Unspecified disorder of kidney and ureter 594.0 - 594.9 Calculus of lower urinary tract595.0 - 595.9 Cystitis 596.0 - 596.4 Other disorders of bladder 596.51 - 596.59 Other functional disorders of bladder 596.6 - 596.9 Rupture of bladder, nontraumatic; hemorrhage into bladder wall; other

specified disorders of bladder597.0 Urethral abscess 597.80 - 597.89 Other and unspecified urethritis 598.00 - 598.01 Urethral stricture due to infection 598.1 - 598.9 Urethral stricture 599.0 Urinary Tract Infection, unspecified site (UTI)599.1 - 599.69 Other disorders of urethra and urinary tract599.70 Hematuria599.71 Gross hematuria599.72 Microscopic hematuria599.9 Unspecified disorders of urethra and urinary tract600.01 Hypertophy (benign) of prostate with urinary obstruction & other lower

urinary tract symptoms (LUTS)600.11 Nodular prostate with urinary obstruction600.21 Benign localized hyperplasia of prostate with urinary obstruction and other

lower urinary tract symptoms (LUTS)600.91 Hyperplasia of prostate, unspecified, with urinary obstruction & other lower

urinary symptoms (LUTS)601.0 - 601.9 Inflammatory diseases of prostate602.0 - 602.9 Other disorders of prostate603.0 - 603.9 Hydrocele604.0 Orchitis and epididymitis



URINALYSIS (UA)

604.90-604.91 Other orchitis, epididymitis and epididymoorchitis, without mention of

abscess605 Redundant prepuce and phimosis606.1 Oligospermia606.9 Male infertility, unspecified 607.1 Balanoposthitis607.81 Balanitis xerotica obliterans607.84 Impotence of organic origin607.89 Other specified disorders of penis608.0 Seminal vesiculitis608.1 Spermatocele 608.23 Torsion of appendix testis608.24 Torsion of appendix epididymis608.83 Vascular disorders of male genital organs608.89 Other disorders of male genital organs 608.9 Unspecified disorders of male genital organs616.10 - 616.11 Vaginitis and vulvovaginitis618.00 - 618.09 Genital prolapse 619.0 - 619.9 Fistula involving female genital tract625.0 Dyspareunia625.6 Stress incontinence, female 625.70 - 625.79 Vulvodynia625.9 Unspecified symptom associated with female genital organs628.9 Infertility, female of unspecified origin 629.31 Erosion of implanted vaginal mesh and other prosthetic materials to

surrounding organ or tissues629.32 Exposure of implanted vaginal mesh ant other prosthetic materials into

634.00 - 634.32 Spontaneous abortion with complications635.00 - 635.32 Legally induced abortion with complications636.00 - 636.32 Illegally induced abortion with complications637.00 - 637.32 Unspecified abortion with complications638.0 - 638.3 Failed attempted abortion with complications639.0 - 639.3 Complications following abortion and ectopic and molar pregnancies642.00 - 642.94 Benign essential hypertension complicating pregnancy, childbirth and the

puerperium646.10 Edema or excessive weight gain in pregnancy, unspecified as to episode of

care646.11 Edema or excessive weight gain in pregnancy, with delivery, with or without

mention of antepartum complication646.12 Edema or excessive weight gain in pregnancy, with delivery, with mention of

postpartum complication646.13 Antepartum edema or excessive weight gain646.14 Postpartum edema or excessive weight gain646.20 Unspecified renal disease in pregnancy, unspecified as to episode of care

646.21 Unspecified renal disease in pregnancy, with delivery646.22 Unspecified renal disease in pregnancy, with delivery, with mention of

postpartum complication646.23 Unspecified antepartum renal disease646.24 Unspecified postpartum renal disease646.50 Asymptomatic bacteriuria in pregnancy, unspecified as to episode of care

646.51 Asymptomatic bacteriuria in pregnancy, with delivery



URINALYSIS (UA)

646.52 Asymptomatic bacteriuria in pregnancy, with delivery, with mention of

postpartum complication646.53 Antepartum asymptomatic bacteriuria646.54 Postpartum asymptomatic bacteriuria646.60 - 646.64 Infection of genitourinary tract in pregnancy 647.10 - 647.14 Infections and parasitic conditions in mother, Gonorrhea 648.00 - 648.04 Other current conditions in mother, Diabetes mellitus 648.80 - 648.84 Other abnormalities in shape or position of gravid uterus and of neighboring

structures 654.40 - 654.44 Other abnormalities in shape or position of gravid uterus and of neighboring

structures

658.40 Infection of amniotic cavity unspecified as to episode of care658.41 Infection of amniotic cavity delivered658.43 Infection of amniotic cavity antepartum659.20 Unspecified type maternal pyrexia during labor unspecified as to episode of

care659.21 Unspecified type maternal pyrexia during labor delivered659.23 Unspecified type maternal pyrexia antepartum659.30 Generalized infection during labor unspecified as to episode of care659.31 Generalized infection during labor delivered659.33 Generalized infection during labor antepartum664.80 Other specified trauma to perineum and vulva unspecified as to episode of

care in pregnancy664.81 Other specified trauma to perineum and vulva with delivery664.84 Other specified trauma to perineum and vulva postpartum664.90 Unspecified trauma to perineum and vulva unspecified as to episode of care

in pregnancy664.91 Unspecified trauma to perineum and vulva with delivery664.94 Unspecified trauma to perineum and vulva postpartum665.40 High vaginal laceration unspecified as to episode of care in pregnancy

665.41 High vaginal laceration with delivery665.44 High vaginal laceration postpartum665.50 Other injury to pelvic organs unspecified as to episode of care in pregnancy

665.51 Other injury to pelvic organs with delivery665.54 Other injury to pelvic organs postpartum665.80 Other specified obstetrical trauma unspecified as to episode of care665.81 Other specified obstetrical trauma with delivery665.82 Other specified obstetrical trauma delivered with postpartum condition or

complication665.83 Other specified obstetrical trauma antepartum665.84 Other specified obstetrical trauma postpartum669.30 - 669.34 Acute kidney failure following labor and delivery 670.00 Major puerperal infection, unspecified, unspecified as to episode of care

670.02 Major puerperal infection, unspecified, delivered, with postpartum

complication670.04 Major puerperal infection, unspecified, postpartum condition or complication

670.20-670.24 Puerperal sepsis670.80-670.84 Other major puerperal infection672.00 - 672.04 Pyrexia of unknown origin during the puerperium 710.0 - 710.4 Diffuse diseases of connective tissue710.9 Unspecified diffuse connective tissue disease



URINALYSIS (UA)

711.00 - 711.09 Pyogenic arthritis 714.0 - 714.9 Rheumatoid arthritis 719.40 - 719.49 Pain in joint 724.2 Lumbago724.5 Backache, unspecified 752.51 Undescended testis 753.0 Renal agenesis and dysgenesis 753.10 - 753.19 Cystic kidney disease 753.3 - 753.9 Other anomalies of urinary system780.02 Transient Alteration of awareness780.09 Alteration of consciousness, other780.2 Syncope and collapse780.33 Post traumatic seizures780.4 Dizziness and giddiness780.60-780.65 Fever and other physiologic disturbances of temperature regulation780.66 Febrile nonhemolytic transfusion reaction780.79 Malaise and fatigue780.91 Fussy Infant (baby)780.97 Altered Mental Status782.3 Edema783.5 Polydipsia785.59 Other shock without mention of trauma 787.01 Nausea with vomiting787.03 Vomiting Alone787.91 Diarrhea788.0 - 788.1 Renal colic/dysuria 788.20 - 788.29 Retention of urine 788.30 - 788.39 Incontinence of urine788.41 - 788.43 Frequency of urination and polyuria 788.5 Oliguria and anuria 788.61 - 788.69 Other abnormality of urination788.7 Urethral discharge/extravasation of urine/ other symptoms involving urinary

system 788.8 Extravasation of urine788.91 Functional urinary incontinence788.99 Other symptoms involving urinary system789.00 - 789.09 Abdominal Pain (specify site)789.51 Ascites, Malignant790.21 Abnormal glucose tolerance test790.22 Impaired glucose tolerance test790.29 Other abnormal glucose790.7 Bacteremia 790.93 Elevated PSA 790.95 Elevated C-reactive protein791.0 - 791.9 Nonspecific findings on examination of urine 793.5 - 793.6 Abnormal findings on radiological and other examinations of genitourinary

organs, abdominal area, including retroperitoneum 794.4 Nonspecific abnormal results of function study of kidney795.79 Other and unspecified nonspecific immunological findings, e.g., abnormal

ANA test796.2 Elevated blood pressure reading without diagnosis of hypertension 799.21 Nervousness



URINALYSIS (UA)

799.22 Irritability799.23 Impulsiveness799.24 Emotional lability799.59 Other signs and symptoms involving cognition806.5 Open fracture of lumbar spine with spinal cord injury806.70 Open fracture of sacrum and coccyx with unspecified spinal cord injury

806.71 Open fracture of sacrum and coccyx with complete cauda equina lesion

808.0 Closed fracture of acetabulum808.1 Open fracture of acetabulum808.2 Closed fracture of pubis808.3 Open fracture of pubis808.41 Closed fracture of ilium808.42 Closed fracture of ischium808.43 Multiple closed pelvic fractures with disruption of pelvic circle808.44 Multiple closed pelvic fractures without disruption of pelvic circle808.49 Closed fracture of other specified part of pelvis808.51 Open fracture of ilium808.52 Open fracture of ischium808.53 Multiple open pelvic fractures with disruption of pelvic circle808.54 Multiple open pelvic fractures without disruption of pelvic circle808.59 Open fracture of other specified part of pelvis808.9 Unspecified open fracture of pelvis866.00 - 866.13 Injury to kidney 867.0 - 867.3 Injury to bladder and urethra 867.6 Injury to other specified pelvic organs, without mention of open wound into

cavity 867.7 Injury to other specified pelvic organs with open wound into cavity867.8 Injury to other specified pelvic organ without open wound into cavity867.9 Injury to unspecified pelvic organ with open wound into cavity868.00 Injury to unspecified intra-abdominal organ without open wound into cavity

868.09 Injury to other and multiple intra-abdominal organs without open wound into

cavity868.10 Injury to unspecified intra-abdominal organ with open wound into cavity

868.19 Injury to other and multiple intra-abdominal organs with open wound into

cavity869.0 Internal injury to unspecified or ill-defined organs without open wound into

cavity

869.1 Internal injury to unspecified or ill-defined organs with open wound into

cavity876.1 Open wound of back complicated878.0 Open wound of genital organs (external) including traumatic amputation

879.3 Open wound of abdominal wall anterior complicated879.5 Open wound of abdominal wall lateral complicated879.7 Open wound of other and unspecified parts of trunk complicated879.8 Open wound(s) (multiple) of unspecified site(s) without complication879.9 Open wound(s) (multiple) of unspecified site(s) complicated922.1 - 922.33 Contusion of trunk (specify site)922.4 Contusion to genital organs 926.0 Crushing injury of external genitalia 926.11 Crushing injury of back926.12 Crushing injury of buttock



URINALYSIS (UA)

926.19 Crushing injury of other specified sites of trunk926.8 Crushing injury to multiple sites of trunk927.00 Crushing injury of shoulder region928.00 Crushing injury of thigh928.01 Crushing injury of hip928.10 Crushing injury of lower leg928.8 Crushing injury of multiple sites of lower limb929.0 Crushing injury of multiple sites not elsewhere classified929.9 Crushing injury of unspecified site939.0 Foreign body in genitourinary tract, bladder and urethra 939.2 Foreign body in vulva and vagina939.3 Foreign body in penis939.9 Foreign body in unspecified site in genitourinary tract941.39 Full thickness skin loss due to burn (third degree nos) of multiple sites

(except with eye) of face head and neck941.49 Deep necrosis of underlying tissues due to burn (deep third degree) of

multiple sites (except with eye) of face head and neck without loss of a body

part941.59 Deep necrosis of underlying tissues due to burn (deep third degree) of

multiple sites (except eye) of face head and neck with loss of a body part

942.20 Blisters with epidermal loss due to burn (second degree) of unspecified site

of trunk942.22 Blisters with epidermal loss due to burn (second degree) of chest wall

excluding breast and nipple942.23 Blisters with epidermal loss due to burn (second degree) of abdominal wall

942.24 Blisters with epidermal loss due to burn (second degree) of back (any part)942.29 Blisters with epidermal loss due to burn (second degree) of other and

multiple sites of trunk942.30 Full thickness skin loss due to burn (third degree nos) of unspecified site of

trunk942.32 Full thickness skin loss due to burn (third degree nos) of chest wall excluding

breast and nipple942.33 Full thickness skin loss due to burn (third degree nos) of abdominal wall942.34 Full thickness skin loss due to burn (third degree nos) of back (any part)

942.39 Full thickness skin loss due to burn (third degree nos) of other and multiple

sites of trunk942.40 Deep necrosis of underlying tissues due to burn (deep third degree) of trunk

unspecified site without loss of body part942.42 Deep necrosis of underlying tissues due to burn (deep third degree) of chest

wall excluding breast and nipple without loss of chest wall942.43 Deep necrosis of underlying tissues due to burn (deep third degree) of

abdominal wall without loss of abdominal wall942.44 Deep necrosis of underlying tissues due to burn (deep third degree) of back

(any part) without loss of back942.49 Deep necrosis of underlying tissues due to burn (deep third degree) of other

and multiple sites of trunk without loss of body part942.50 Deep necrosis of underlying tissues due to burn (deep third degree) of

unspecified site of trunk with loss of body part942.52 Deep necrosis of underlying tissues due to burn (deep third degree) of chest

wall excluding breast and nipple with loss of chest wall942.53 Deep necrosis of underlying tissues due to burn (deep third degree) of

abdominal wall with loss of abdominal wall



URINALYSIS (UA)

942.54 Deep necrosis of underlying tissues due to burn (deep third degree) of back

(any part) with loss of back942.59 Deep necrosis of underlying tissues due to burn (deep third degree) of other

and multiple sites of trunk with loss of a body part943.30 Full thickness skin loss due to burn (third degree nos) of unspecified site of

upper limb943.39 Full thickness skin loss due to burn (third degree nos) of multiple sites of

upper limb except wrist and hand943.40 Deep necrosis of underlying tissues due to burn (deep third degree) of

unspecified site of upper limb without loss of a body part943.49 Deep necrosis of underlying tissues due to burn (deep third degree) of

multiple sites of upper limb except wrist and hand without loss of upper limb

943.50 Deep necrosis of underlying tissues due to burn (deep third degree) of

unspecified site of upper limb with loss of a body part943.59 Deep necrosis of underlying tissues due to burn (deep third degree) of

multiple sites of upper limb except wrist and hand with loss of upper limb

946.2 Blisters with epidermal loss due to burn (second degree) of multiple specified

sites946.3 Full thickness skin loss due to burn (third degree burn nos) of multiple

specified sites946.4 Deep necrosis of underlying tissues due to burn (deep third degree) of

multiple specified sites without loss of a body part946.5 Deep necrosis of underlying tissues due to burn (deep third degree) of

multiple specified sites with loss of a body part947.1 Burn of larynx trachea and lung947.2 Burn of esophagus947.3 Burn of gastrointestinal tract947.4 Burn of vagina and uterus947.8 Burn of other specified sites of internal organs948.21 Burn (any degree) involving 20-29 percent of body surface with third degree

burn of 10-19%948.22 Burn (any degree) involving 20-29 percent of body surface with third degree


burn of less than 10 percent or unspecified amount948.31 Burn (any degree) involving 30-39 percent of body surface with third degree








burn of 40-49%



URINALYSIS (UA)

948.50 Burn (any degree) involving 50-59 percent of body surface with third degree


























burn of 40-49%



URINALYSIS (UA)

948.85 Burn (any degree) involving 80-89 percent of body surface with third degree




burn of 80-89%948.90 Burn (any degree) involving 90 percent of body surface with third degree burn

of less than 10 percent or unspecified amount948.91 Burn (any degree) involving 90 percent of body surface with third degree burn

of 10-19%948.92 Burn (any degree) involving 90 percent of body surface with third degree burn








of 90% or more of body surface949.3 Full thickness skin loss due to burn (third degree nos) unspecified site949.4 Deep necrosis of underlying tissue due to burn (deep third degree)

unspecified site without loss of a body part949.5 Deep necrosis of underlying tissues due to burn (deep third degree

unspecified site with loss of a body part)958.5 Traumatic anuria 959.11 Other injury of chest wall959.12 Other injury of abdomen959.13 Fracture of corpus cavernosum penis959.14 Other injury of external genitals959.19 Other and unspecified injury of other sites of trunk961.2 Poisoning by heavy metal anti-infectives 963.1 Poisoning by antineoplastic and immuno-suppressive drugs 963.3 Poisoning by alkalizing agents 965.1 Poisoning by salicylates 992.0 - 992.8 Effects of heat and light 995.20 Unspecified adverse effect of unspecified drug, medicinal and biological

substance995.21 Arthus Phenomenon995.22 Unspecified adverse effect of anesthesia995.23 Unspecified adverse effect of insulin995.27 Other drug allergy995.29 Unspecified adverse effect of other drug, medicinal and biological substance

995.53 Child sexual abuse



URINALYSIS (UA)

995.54 Child physical abuse995.59 Other child abuse and neglect996.30 - 996.39 Mechanical complication of genitourinary device, implant and g raft 996.62 Infection and inflammatory reaction due to other vascular device implant and

graft996.64 - 996.65 Infection and inflammatory reaction due to internal prosthetic device, implant

and graft996.76 Other complications due to genitourinary device implant and graft996.81 Complications of transplanted kidney 997.5 Urinary complications998.00 Postoperative shock, unspecified998.01 Postoperative shock, cardiogenic998.02 Postoperative shock, septic998.09 Postoperative shock, other998.2 Accidental puncture or laceration during a procedure 999.32 Bloodstream infection due to central venous catheter999.33 Local infection due to central venous catheter999.34 Acute infection following transfusion, infution, or injection of blood and blood

products999.60 ABO incompatibility reaction, unspecified

999.61 ABO incompatibility with hemolytic transfusion reaction not specified as

acute or delayed

999.62 ABO incompatibility with acute hemolytic transfusion reaction

999.63 ABO incompatibility with delayed hemolytic transfusion reaction

999.69 Other ABO incompatibility reaction

999.70 Rh incompatibility reaction, unspecified

999.71 Rh incompatibility with hemolytic transfusion reaction not specified as acute

or delayed

999.72 Rh incompatibility with acute hemolytic transfusion reaction

999.73 Rh incompatibility with delayed hemolytic transfusion reaction999.74 Other Rh incompatibility reaction999.75 Non-ABO incompatibility reaction, unspecified999.76 Non-ABO incompatibility with hemolytic transfusion reaction not specified as

acute or delayed999.77 Non-ABO incompatibility with acute hemolytic transfusion reaction999.78 Non-ABO incompatibility with delayed hemolytic transfusion reaction999.79 Other non-ABO incompatibility reaction999.80 Transfusion reaction, unspecified999.83 Hemolytic transfusion reaction, incompatibility unspecified999.84 Acute hemolytic transfusion reaction, incompatibility unspecified999.85 Delayed hemolytic transfusion reaction, incompatibility unspecified999.88 Complications of medical care, not elsewhere classified; other infusion

reaction 999.89 Complications of medical care, not elsewhere classified; other transfusion

reaction V10.46 Personal history of malignant neoplasm of prostate V10.50 - V10.59 Personal history of malignant neoplasm urinary organsV13.00 - V13.09 Personal history of other diseases urinary system V13.62 Personal history of other (corrected) congenital malformations of

genitourinary systemV15.51 Personal history of traumatic fractureV15.59 Personal history of other injury



URINALYSIS (UA)

V21.0 - V21.9 Constitutional states in development V22.0 - V22.2 Normal pregnancy V23.0 - V23.7 Supervision of high-risk pregnancyV23.81 - V23.89 Other high risk pregnancy V23.9 Unspecified high-risk pregnancy V42.0 Persons with organs or tissue replaced by kidney transplant V44.50 - V44.59 Persons with cystostomy V44.6 Persons with other artificial opening of urinary tract V45.11 Renal dialysis statusV58.0 Radiotherapy V58.63 Long term (current) use of antiplatelets/antithromboticsV58.64 Long term (current) use of nonsteroidal anti-inflammatoriesV58.65 Long term (current) use of other medications V58.69 Long term (current) use of other medications V59.4 Kidney DonorsV67.51 Following completed treatment with high-risk medication, NECV87.01 -V87.2 Contact with and (suspected) exposure to hazardous metals, compounds or

chemicalsV90.83 Retained stone or crystalline fragments




CPT: 87086 Culture, bacterial, quantitative, colony count, urine

CPT: 87088 Culture, bacterial; with isolation and presumptive identification of each

isolates, urineCPT: 87184 Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer

agents)CPT: 87186 Susceptibility studies, antimicrobial agent; microdilution or agar dilution

(minimum inhibitory concentration (MIC) or breakpoint), each multi-

antimicrobial, per plate


038.0-038.9 Septicemia

276.2 Acidosis

276.4 Metabolic acidosis/alkalosis

286.6 Defibrination syndrome/disseminated intravascular coagulation

288.00-288.09 Agranulocytosis/neutropenia

288.8 Other specified disease of white blood cells including leukemoid

reaction/leukocytosis306.53 Psychogenic dysuria

306.59 Other psychogenic genitourinary malfunction518.82 Other pulmonary insufficiency, not elsewhere classified570 Acute and subacute necrosis of liver580.0-580.9 Acute glomerulonephritis583.0-583.9 Nephritis and Nephropathy, not specified as acute or chronic585.6 End stage renal disease590.00-590.9 Infections of kidney/pyelonephritis acute and chronic592.0-592.9 Calculus of kidney and ureter593.0-593.9 Other disorders of kidney and ureter (cyst, stricture, obstruction, reflux, etc.)

594.0-594.9 Calculus of lower urinary tract595.0-595.9 Cystitis597.0 Urethritis, not sexually transmitted and urethral syndrome597.80-597.89 Other urethritis598.00-598.01 Urethral stricture due to infection 599.0 Urinary tract infection, site not specified599.70 Hematuria599.71 Gross hematuria599.72 Microscopic hematuria600.00-600.91 Hyperplasia of prostate601.0-601.9 Inflammatory diseases of prostate 602.0-602.9 Other disorders of prostate (calculus, congestion, atrophy, etc.)604.0-604.99 Orchitis and epididymitis608.0-608.9 Other disorders of male genital organs (seminal vesiculitis, spermatocele,

etc.)614.0-614.9 Inflammatory disease of ovary, fallopian tube, pelvic cellular tissue, and

peritoneum615.0-615.9 Inflammatory disease of uterus, except cervix616.0 Cervicitis and endocervicitis616.10-616.11 Vaginitis and vulvovaginitis616.2-616.9 Other inflammatory conditions of cervix, vagina and vulva619.0-619.9 Fistual involving female genital tract625.6 Stress incontinence, female

URINE CULTURE

124 URINE CULTURE (NCD)


URINE CULTURE

639.0 Genital tract and pelvic infection complicating abortion, ectopic or molar

pregnancies639.5 Shock complicating abortion, ectopic or molar pregnancies646.60-646.64 Infections of genitourinary tract in pregnancy670.00-670.04 Major puerperal infection

670.10-670.14 Puerperal endometritis670.20-670.24 Puerperal sepsis670.30-670.34 Puerperal septic thrombophlebitis670.80-670.84 Other major puerperal infection672.00-672.04 Pyrexia of unknown origin during the puerperium724.5 Backache, unspecified771.81-771.83 Septicemia (Sepsis) of newborn780.02 General symptoms, transient alteration of awareness780.60-780.65 Fever and other physiologic disturbances of temperature regulation780.66 Febrile nonhemolytic transfusion reaction780.79 Other malaise and fatigue780.93 Memory loss780.94 Early satiety780.96 Generalized pain780.97 Altered mental status780.99 Other general symptoms785.0 Tachycardia, unspecified785.50-785.59 Shock without mention of trauma788.0-788.99 Symptoms involving urinary system (renal colic, dysuria, retention of urine,

incontinence of urine, frequency, polyuria, nocturia, oliguria, anuria, other

abnormality of urination, urethral discharge, extravasation of urine, other

symptoms of urinary system)789.00-789.09 Abdominal pain789.60-789.69 Abdominal tenderness789.7 Colic

790.7 Bacteremia791.0-791.9 Nonspecific findings on examination of urine (proteinuria, chyluria,

hemoglobinuria, myoglobinuria, biliuria, glycosuria, acetonuria, other cells

and casts in urine, other nonspecific findings on examination of urine)799.3 Debility, unspecified (only for declining functional status)939.0 Foreign body in genitourinary tract, bladder and urethra939.3 Foreign body in genitourinary tract, penisV44.50-V44.6 Artificial cystostomy or other artificial opening of urinary tract statusV55.5-V55.6 Attention to cystostomy or other artificial opening of urinary tractV58.69 Long-term (current) use of other medications


125 URINE CULTURE (NCD)

Medicare A Medical Policy February 8, 2011

CPT: 82306 Vitamin D; 25 Hydroxy, includes fraction(s), if performed

CPT: 82652 Vitamin D; 1, 25 Hydroxy, includes fraction(s), if performed

252.00 Hyperparathyroidism, unspecified

252.01 Primary hyperparathyroidism

252.02 Secondary hyperparathyroidism, non-renal

252.08 Other hyperparathyroidism

252.1 Hypoparathyroidism

261 Nutritional marasmus

262 Other severe protein-calorie malnutrition

268.0 Rickets active268.2 Osteomalacia unspecified268.9* Unspecified vitamin D deficiency275.3 Disorders of phosphorus metabolism275.40* Unspecified disorder of calcium metabolism275.41 Hypocalcemia275.42 Hypercalcemia278.4 Hypervitaminosis D571.9 Unspecified chronic liver disease without alcohol

579.0 Celiac disease579.1 Tropical sprue579.2 Blind loop syndrome579.3 Other and unspecified postsurgical nonabsorption579.4 Pancreatic steatorrhea579.8 Other specified intestinal malabsorption579.9 Unspecified intestinal malabsorption585.3 Chronic kidney disease, Stage III (moderate)585.4 Chronic kidney disease, Stage IV (severe)585.5 Chronic kidney disease, Stage V585.6 End Stage Renal Disease588.81 Secondary hyperparathyroidism, (of renal origin)733.00 Osteoporosis unspecified733.01 Senile osteoporosis733.02 Idiopathic osteoporosis733.09 Other osteoporosis733.90 Disorder of bone and cartilage unspecified756.52 Osteopetrosis

268.9* If more than one LCD-listed condition contributes to Vit. D deficiency in a

given patient and/or is improved by Vit. D administration, coders should use:

ICD-9-CM 268.9 UNSPECIFIED VITAMIN D DEFICIENCY. This code should not

be used for any other indication.275.40* Use only for HYPERCALCINURIA

268.0 Rickets active268.2* Osteomalacia unspecified275.40* Unspecified disorder of calcium metabolism275.42* Hypercalcemia

VITAMIN D ASSAY TESTING

The following ICD-9 CM codes support the medical necessity of CPT code 82306

The following ICD-9-CM codes support the medical necessity of CPT code 82652

126 Vitamin D Assay Testing (LCD)

Medicare A Medical Policy February 8, 2011

VITAMIN D ASSAY TESTING

592.0 Calculus of kidney592.1 Calculus of ureter592.9 Urinary calculus unspecified

268.2* Use only for tumor-induced osteomalacia275.40* Use only for unexplained hypercalcinuria275.42* Use only for unexplained hypocalcemia


127 Vitamin D Assay Testing (LCD)

Common ICD-9 Codes

AFP - Alpha Fetoprotein DIGOXIN

571.5 Cirrhosis of the liver, unspecified 427.31 Atrial fibrillation

070.32 Hepatitis B, Chronic 429.2 Cardiovascular disease, unspecified

070.54 Hepatitis C, Chronic 428.0 Congestive Heart Failure (CHF)

795.89 Other abnormal tumor markers 244.9 Hypothyroidism, unspecified

571.49 Other chronic hepatitis V58.69 Long term (current) use of other meds

BNP - B-type Natriuretic Peptide 780.79 Malaise and fatigue

519.11 Acute bronchospasm 586 Renal Failure, unspecified

493.92 Asthma unspecified with (acute) 276.7 Hyperkalemia (Hyperpotassemia)

493.22 Chronic obstructive asthma with (acute) 784.0 Headache

428.0 Congestive heart failure, unspec 780.2 Syncope & collapse

428.9 Heart failure unspecified GGT - Gamma Glutamyltransferase

428.1 Left heart failure 571.5 Cirrhosis of the liver, unspecified

425.4 Orther primary cardiomyopathies 250.00 Diabetes mellitus

786.09 Respiratory abnormality other 562.11 Diverticulitis of colon

786.05 Shortness of breath 070.30 Hepatitis B, unspecified

786.07 Wheezing 789.1 Hepatomegaly

CA125 042 HIV disease

V10.43 Hx malignant neoplasm, ovary 272.4 Hyperlipidemia

183.0 Malignant neoplasm of the ovary 782.4 Jaundice, unspecified, not of newborn

795.89 Other abnormal tumor markers V58.61 Long term (current) use of anticoags

789.39 Pelvic swelling, mass or lump V58.69 Long term (current) use of other meds

CA15-3/CA27.29 780.79 Malaise and fatigue

174.9 CA of female breast, unspecified 790.5 Nonspecific abn'l serum enzyme levels

V10.3 Hx of malignant neoplasm, breast 790.4 Nonspecific elevation of transaminase or

795.89 Other abnormal tumor markers 586 Renal Failure, unspecified

198.81 Secondary malignant neoplasm, breast 079.99 Unspecified viral infection

CA19-9 GLUCOSE

V10.09 Hx of malig neoplasm to other GI sites 783.21 Abnormal loss of weight

156.0 Malignant neoplasm , gallbladder 783.1 Abnormal weight gain

795.89 Other abnormal tumor markers 786.50 Chest pain, unspecified

157.9 Pancreatic CA, part unspecified 414.00 Coronary Artery Disease (CAD)

COMPLETE BLOOD COUNT 250.00 Diabetes mellitus

789.00 Abdominal pain, site unspecified 780.4 Dizziness and giddiness

783.21 Abnormal loss of weight 790.29 Hyperglycemia

280.9 Anemia, Iron Deficiency 272.4 Hyperlipidemia

285.9 Anemia, unspecified 251.2 Hypoglycemia

281.9 Anemia, unspecified deficiency V58.69 Long term (current) use of other meds

136.9 Infection, unspecified 780.79 Malaise and fatigue

V58.61 Long term (current) use of anticoags 263.9 Malnutrition, unspecified

V58.69 Long term (current) use of other meds 729.1 Myalgia & Fibromyalgia

041.12 MRSA 791.0 Proteinuria

CARCINOEMBRYONIC ANTIGEN (CEA) 780.39 Seizures, not otherwise specified

V67.2 Follow-up post chemotherapy GLYCOLATED HEMOGLOBIN (HGB A1C)

V10.05 Hx of malignant neoplasm of colon 250.00 Diabetes Mellitis

153.9 Malignant neoplasm of colon 790.29 Hyperglycemia

183.0 Malignant neoplasm of ovary 251.2 Hypoglycemia unspecified

150.9 Malignant neoplasm of the esophagus V58.69 Long term (current) use of other meds

790.99 Nonspecific findings on exam of blood 275.09 Other disorders of iron metabolism

795.89 Other abnormal tumor markers 577.1 Pancreatitis, chronic

579.3 Unspecified surgical nonabsorption

This list comprises only the most commonly used ICD-9 codes and is not intended to be all-inclusive. It is provided as

an "at-a glance" tool to supplement the LCD & NCD Policies. ICD-9 codes must always be substantiated by patients'

medical records.

128 April 2013

Common ICD-9 Codes

HCG-QUANT IRON & FERRITIN; continued�

V10.43 Hx malignant neoplasm, ovary 533.90 Peptic ulcer, unspecifiec

V10.47 Hx malignant neoplasm, testis 570 Necrosis of the liver

186.9 Malig neoplasm of other, unspec testis 704.00 Hair loss

183.0 Malignant neoplasm of the ovary V08 Asymptomatic HIV infection status

632 Missed abortion V12.3 Hx of anemia

338.3 Neoplasm related pain V12.1 Hx of nutirtional deficiency

795.89 Other abnormal tumor markers 790.4 Elevated transaminase or LDH

625.9 Pelvic pain, female LIPID AND CHOLESTEROL

640.00 Threatened abortion 585.9 Chronic renal failure, unspecified

HEPATITIS PANEL, ACUTE 428.0 Congestive Heart failure (CHF)

789.00 Abdominal pain, unspecified 414.00 Coronary atherosclerosis (CAD)

794.8 Abnormal liver scan 250.00 Diabetes mellitus, unspecified

783.1 Abnormal weight gain 272.4 Hyperlipidemia, unspecified

783.21 Abnormal weight loss 401.9 Hypertension, essential, unspecified

783.0 Anorexia 244.9 Hypothyroidism

571.5 Cirrhosis of liver,unspecified V58.69 Long term (current) use of other meds

790.4 Elevated transaminase or LDH 263.9 Malnutrition, unspecified

573.3 Hepatitis, unspecified 278.00 Obesity

789.1 Hepatomegaly V81.2 Screening for unspec cardiovascular

782.4 Jaundice, not of newbown

V72.85 Liver transplant recipient evaluation MAGNESIUM

789.61 Localized tenderness (RUQ) 783.21 Abnormal loss of weight

787.01 Nausea and vomiting 410.90 Acute MI,unspecified site

780.79 Other malaise and fatigue 427.31 Atrial fibrillation

070.9 Viral hepatitis, unspecified 585.9 Chronic renal failure, unspecified

HIV 780.39 Convulsions

783.21 Abnormal loss of weight 252.00 Hyperparathyroidism

786.4 Abnormal sputum V58.69 Long term (current) use of meds

285.9 Anemia, unspecified V58.65 Long-term (current) use of steroids

112.9 Candidiasis, site unspecified 780.79 Malaise and fatigue

682.9 Cellulitis, unspecified site 263.9 Malnutrition, unspecified

786.2 Cough 790.6 Other abnormal blood chemistry

294.8 Dementia 415.19 Pulmonary embolism

787.91 Diarrhea 780.2 Syncope and collapse

780.60 Fever, unspecified 785.0 Tachycardia, unspecified

780.79 Malaise and fatigue NTX - Collagen Cross Links

263.9 Malnutrition, unspecified 242.90 Hyperthyroidism

486 Pneumonia, unspecified V58.69 Long term(current)use of other meds

070.9 Viral hepatitis, unspecified 733.00 Osteoporosis

HIV Viral Load 621.7 Postmenopausal bleeding

042 HIV disease 256.9 Unspecified ovarian dysfunction

V08 Asymptomatic HIV infection status OCCULT BLOOD; FECES SCREENING

079.53 HIV Type 2 789.00 Abdominal pain, site unspecified

IRON & FERRITIN; continued in next column 783.21 Abnormal loss of weight

280.9 Anemia, iron deficient, unspecified 280.9 Anemia, Iron Deficiency

285.9 Anemia, unspecified 285.9 Anemia, unspecified

281.9 Anemia, unspecified deficiency 787.91 Diarrhea

427.31 Atrial fibrillation 578.9 GI bleed

428.0 Congestive Heart Failure (CHF) V58.61 Long term (current) use of anticoags

250.00 Diabetes mellitus, unspecified V58.69 Long term (current) use of other meds

263.9 Malnutrition, unspecified

790.6 Other abnormal blood chemistry

586 Renal failure, unspecified

070.9 Viral hepatitis, unspecified

129 April 2013

Common ICD-9 Codes PROSTATE SPECIFIC ANTIGEN (PSA) THYROID TESTING; continued�

600.00 BPH, Benign prostate hypertrophy 250.00 Diabetes mellitus, unspecified

790.93 Elevated prostate specific antigen 780.60 Fever

599.70 Hematuria 240.9 Goiter, unspecified

185 Malignant neoplasm of prostate 272.4 Hyperlipidemia, unspecified

788.43 Nocturia 401.9 Hypertension Essential unspecified

V10.46 Personal history of prostate cancer 242.90 Hyperthyroidism, unspecified

788.20 Retention of urine, unspecified 244.9 Hypothyroidism, unspecified

V76.44 Screening Code - freq limitation V58.69 Long term (current) use of other meds

602.9 Unspecified disorder of prostate 780.79 Malaise and fatigue

601.9 Unspecified prostatitis 780.93 Memory Loss

788.63 Urgency of urination 782.0 Numbness

788.41 Urinary frequency 785.1 Palpitations

788.30 Urinary incontinence, unspecified 290.0 Senile dementia, uncomplicated

599.60 Urinary obstruction, unspecified URINALYSIS (UA)

PROTHROMBIN TIME (PT) 789.00 Abdominal pain, unspecified

790.92 Abnormal coagulation profile 428.0 Congestive heart failure

427.31 Atrial fibrillation 250.00 Diabetes mellitus, unspecified

434.91 Cerebrovascular accident (CVA) 788.1 Dysuria

585.9 Chronic renal failure, unspecified 780.60 Fever, unspecified

V12.50 Circulatory Disease, unspecified 599.70 Hematuria

286.9 Coagulation defect, unspecified 401.9 Hypertension, Essential, unspecified

428.0 Congestive heart failure (CHF) V58.69 Long term (current) use of other meds

414.00 Coronary atherosclerosis (CAD) 780.79 Malaise and fatigue

562.11 Diverticulitis of colon, w/o hemorrhage 780.97 Mental status changes

782.3 Edema 788.43 Nocturia

599.70 Hematuria 791.9 Nonspecific findings on exam of urine

V58.61 Long term (current) use of anticoags 593.9 Renal Insufficiency

443.9 Peripheral vascular disease, unspec 788.20 Retention of urine, unspecified

586 Renal failure, unspecified 714.0 Rheumatoid arthritis

786.05 Shortness of breath 788.41 Urinary frequency

780.2 Syncope and collapse 788.30 Urinary incontinence, unspecified

453.9 Thrombosis of unspecified site 599.0 Urinary tract infection (UTI)

281.9 Unspecified Deficiency Anemia URINE CULTURE

PARTIAL THROMBOPLASTIN TIME (PTT) 789.00 Abdominal pain, unspecified

427.31 Atrial fibrillation 724.5 Backache, unspecified

786.50 Chest pain, unspecified 790.7 Bacteremia

585.9 Chronic renal failure, unspecified 585.9 Chronic renal failure, unspecified

571.5 Cirrhosis of the liver, unspecified 780.60 Fever

286.9 Coagulation defects, unspecified 599.70 Hematuria

428.0 Congestive heart failure (CHF) V58.69 Long term (current) use of other meds

820.8 Fracture, hip 780.93 Memory loss

599.70 Hematuria 780.97 Mental status changes

V58.61 Long term (current) use of anticoags 791.9 Nonspecific findings on exam of urine

786.05 Shortness of breath 780.79 Other malaise and fatigue

780.2 Syncope 038.9 Septicemia, unspecified

THYROID TESTING; continued in next column 599.0 Urinary tract infection

783.21 Abnormal loss of weight VITAMIN D

783.1 Abnormal weight gain 579.0 Celiac disease

331.0 Alzheimer's disease Chronic kidney disease (Stage III through

285.9 Anemia, unspecified

300.00 Anxiety, unspecified 275.42 Hypercalcemia

427.31 Atrial fibrillation 252.00 Hyperparathyroidism, unspecified

428.0 Congestive heart failure (CHF) 733.00 Osteoporosis unspecified

564.00 Constipation, unspecified 571.9 Unspecified chronic liver disease

294.8 Dementia 268.9 Unspecified vitamin D deficiency

311 Depression

585.3 -

585.6

130 April 2013

Documents

2013 Billing Guide - paclab