2013 billing guide - tri-cities laboratories

2013Billing Guide

For questions or more information, please contact your Billing Coordinator

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 ��.��41-129

Common ICD-9 Codes ��...��.��130-132

TCL 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. Tri-Cities

Laboratory (TCL) 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. TCL 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, TCL provides ABN assistance through our website

www.tricitieslab.com which will help the physician's staff to determine whether

an ABN is required. In addition, TCL 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 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)

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

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

�

�

�

�

�

�

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).

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.

8 April 2013

1.

2.

3.

4.

5.

6.

7.

8.

Specific tests the patient was advised could be denied must

be listed in the appropriate column.


Please provide the laboratory with a valid Advance

Beneficiary Notice when you have reason to believe

Medicare may deny a procedure as 'medically

unnecessary.'

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.

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.

Patient must date the ABN.

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.'

TCL provides ABN assistance through our website

www.tricitieslab.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

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

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.

12 April 2013

DISABILITYProceed only to #9-10

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)?

NO YES

NO YES

NO YES

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

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

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

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.

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

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

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

Osteoporosis

Calculus of ureter

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:

Hypocalcemia and hypomagnesemia of newborn

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)

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

Other disorders of calcium metabolism

Calculus of kidney

Calculus of ureter

Urinary calculus, unspecified


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

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.

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

Lymphocytic-histiocytic predominance

Nodular sclerosis

Mixed cellularity

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

579.0-579.9

585.3–585.6

Mycosis Fungoides

Sezary’s disease

Malignant histiocytosis

Leukemic reticuloendotheliosis

Letterer-Siwe disease

Malignant mast cell tumors

Lymphocytic depletion

Hodgkin’s disease, unspecified

Nodular lymphoma

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

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

Biliary cirrhosis

Other specified disorders of biliary tract

Intestinal malabsorption

Chronic kidney disease, code range

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

20 April 2013

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

275.41

278.8

585.3–585.6

592.0

Chronic kidney disease, unspecified

Renal osteodystrophy

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

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

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

Hypocalcemia

Hyperalimentation



21 April 2013

592.1

592.9

756.51

756.52

775.4

Osteogenesis imperfecta

Osteopetrosis

Hypocalcemia & hypomagnesemia of newborn

Calculus of ureter

Urinary calculus unspecified

22 April 2013

United Healthcare (UHC)

Billing

23 April 2013

Hepatitis Screening Limitations, United Healthcare (UHC)

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

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)

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

Washington Public Assistance/DSHS

Billing

29 April 2013

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.

Guidelines, Washington Public Assistance/DSHS

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.

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.

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

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

Multiple Cytogenetics Studies, All 88230-88299

(LCD)

4/1/1999 Client Services

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 Multiple Genetic Testing 81201, 81202,

81203, 81211,

81212, 81213,

81214, 81215,

81216, 81217,

81270, 81275,

81292 ,81293,

81294, 81295,

81296, 81297,

81298, 81299,

81317, 81318,

81319, 81381,

81401 ,81403,

81405, 81406,

88363

12/1/2006;

1/1/2013

Client Services

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

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

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

Multiple IPHEN Flow Cytometry 88180, 88182

(LCD)

4/10/1997 Client Services

IRON.BIND Iron Binding Capacity 83550 (NCD) 11/25/2002 $ 40.00 IRN Iron, Total 83540 (NCD) 11/25/2002 $ 40.00 LIPID Lipid Profile 80061 (NCD) 11/25/2002 $ 44.00 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 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


IMMCFA, NEUOXB,

TICFA

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

�

�

�

�

�

�

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

times the first year.

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 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.

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

generally not be indicated more than twice per year.

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

Sudden death, cause unknown

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

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

Description

Family history of malignant neoplasm, unspecified malignant

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

Family history of malignant neoplasm, urinary organs

Family history of malignant neoplasm, kidney

Family history of malignant neoplasm, bladder

Family history of malignant neoplasm, other

Family history of malignant neoplasm, leukemia

Family history of malignant neoplasm, other lymphatic and

Family history of malignant neoplasm, other specified 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 of infant or child

Health supervision for newborn under 8 days old

37 April 2013

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

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

Health supervision for newborn 8 to 28 days old

Other person consulting on behalf of another person

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

Healthy persons accompanying sick persons

Pediatric pre-birth visit for expectant parent(s)

Special screening for endocrine, nutrition, metabolic, and immunity

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 malignant neoplasms, bladder

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

cervix, and rectum)

Special screening for cardiovascular, respiratory, and genitourinary

diseases

Special screening for other conditions

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

Special screening for other neurological conditions

Special screening for glaucoma and other eye conditions; ear

38 April 2013

NCD & LCD WASHINGTON B

2013

NCD & LCD

Washington

Medicare B

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

Cytogenetics �� LCD 55-70

Digoxin Therapeutic Drug Assay(Any Source) �� NCD 71-73

Genetic Testing �� LCD 74-80

Gamma Glutamyltransferase (GGT) �� NCD 81-84

Glycated Hemoglobin & Glycated Protein �� NCD 85-86

Glucose Testing (Blood) �� NCD 87-90

HCG Quantitative �� NCD 91

Hepatitis Panel, Acute �� NCD 92

Human Immunodeficiency Virus (HIV)

Viral Load Diagnosis �� NCD 93-96

Human Immunodeficiency Virus (HIV) Prognosis �� NCD 97

Iron Studies, Serum �� NCD 98-101

Lipid Profile & Cholesterol Testing �� NCD 102-104

Occult Blood, Feces Screening �� NCD 105-107

Prostate Specific Antigen (PSA) �� NCD 108

Prothrombin Time (PT) �� NCD 109-116

Partial Thromboplastin Time (PTT) �� NCD 117-122

Thyroid Testing �� NCD 123-126

Urine Culture �� NCD 127-128

Vitamin D�� LCD 129-130

NCD & LCD WASHINGTON B

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 B Medical Policy July 25, 2011

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 B Medical Policy July 25, 2011

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)

Medicare B Medical Policy February 1999; Effective May 1, 2006

CPT: 88120 Cytp urine 3-5 probes each specimenCPT: 88121 Cytp urine 3-5 probes cmptrCPT: 88230 Tissue culture for non-neoplastic disorders; lymphocyteCPT: 88233 Skin or other solid tissue biopsyCPT: 88235 Amniotic fluid or chronic villus cellsCPT: 88237 Bone marrow, blood cellsCPT: 88239 Solid tumorCPT: 88240 Cryopreservation, freezing and storage of cells, each cell lineCPT: 88241 Thawing and expansion of frozen cells, each aliquotCPT: 88245 Chromosome analysis for breakage syndromes; baseline Sister Chromatid

Exchange (SCE), 20-25 cellsCPT: 88248 Baseline breakage, score 50-100 cells, count 20 cells, 2 karyotypes (e.g. for

ataxia telagiectasia, Fanconi anemia, fragile X)CPT: 88249 Chromosome analysis for breakage syndromes; score 100 cells, clastogen

stress (e.g., diepoxbutane, mitomycin C, ionizing radiation, UV radiation)

CPT: 88261 Chromosome analysis; count 5 cells, 1 karyotype, with bandingCPT: 88262 Count 15-20 cells, 2 karyotypes, with bandingCPT: 88263 Count 45 cells for mosaicism, 2 karyotypes, with bandingCPT: 88264 Analyze 20-25 cellsCPT: 88267 Chromosome analysis, amniotic fluid or chronic villus, count 15 cells, 1

karyotype, with bandingCPT: 88269 Chromosome analysis, in situ for amniotic fluid cells, count cells from 6-12

colonies, 1 karyotype, with bandingCPT: 88271 Molecular cytogenetics; DNA probe, each (e.g., FISH)CPT: 88272 Chromosomal in situ hybridization, analyze 3-5 cells (e.g. for derivatives and

markers)CPT: 88273 Chromosomal in situ hybridization, analyze 10-30 cells (e.g., for

microdeletions)CPT: 88274 Interface in situ hybridization, analyze 25-99 cellsCPT: 88275 Interphase in situ hybridization, analyze 100-300 cellsCPT: 88280 Chromosome analysis; additional karyotypes, each studyCPT: 88283 Additional specialized banding technique (e.g., NOR, C-banding)CPT: 88285 Additional cells counted, each studyCPT: 88289 Additional high resolution studyCPT: 88291 Cytogenetics and molecular cytogenetics, interpretation and reportCPT: 88299 Unlisted cytogenetic study

171.9* Malignant neoplasm of connective and other soft tissue site unspecified

188.0-188.8 Malignant neoplasm of the bladder189.0 Malignant neoplasm of kidney except pelvis200.00 Reticulosarcoma unspecified site200.01 Reticulosarcoma involving lymph nodes of head face and neck200.02 Reticulosarcoma involving intrathoracic lymph nodes200.03 Reticulosarcoma involving intra-abdominal lymph nodes200.04 Reticulosarcoma involving lymph nodes of axilla and upper limb200.05 Reticulosarcoma involving lymph nodes of inguinal region and lower limb

200.06 Reticulosarcoma involving intrapelvic lymph nodes200.07 Reticulosarcoma involving spleen200.08 Reticulosarcoma involving lymph nodes of multiple sites200.10 Lymphosarcoma unspecified site200.11 Lymphosarcoma involving lymph nodes of head face and neck

CYTOGENETICS

55 CYTOGENETICS (LCD)


CYTOGENETICS

200.12 Lymphosarcoma involving intrathoracic lymph nodes200.13 Lymphosarcoma involving intra-abdominal lymph nodes200.14 Lymphosarcoma involving lymph nodes of axilla and upper limb200.15 Lymphosarcoma involving lymph nodes of inguinal region and lower limb

200.16 Lymphosarcoma involving intrapelvic lymph nodes200.17 Lymphosarcoma involving spleen200.18 Lymphosarcoma involving lymph nodes of multiple sites200.20 Burkitt's tumor or lymphoma unspecified site200.21 Burkitt's tumor or lymphoma involving lymph nodes of head face and neck

200.22 Burkitt's tumor or lymphoma involving intrathoracic lymph nodes200.23 Burkitt's tumor or lymphoma involving intra-abdominal lymph nodes200.24 Burkitt's tumor or lymphoma involving lymph nodes of axilla and upper limb

200.25 Burkitt's tumor or lymphoma involving lymph nodes of inguinal region and

lower limb200.26 Burkitt's tumor or lymphoma involving intrapelvic lymph nodes200.27 Burkitt's tumor or lymphoma involving spleen200.28 Burkitt's tumor or lymphoma involving lymph nodes of multiple sites200.80 Other named variants of lymphosarcoma and reticulosarcoma unspecified

200.81 Other named variants of lymphosarcoma and reticulosarcoma involving

lymph nodes of head face and neck200.82 Other named variants of lymphosarcoma and reticulosarcoma involving

intrathoracic lymph nodes200.83 Other named variants of lymphosarcoma and reticulosarcoma involving intra-

abdominal lymph nodes200.84 Other named variants of lymphosarcoma and reticulosarcoma involving

lymph nodes of axilla and upper limb200.85 Other named variants of lymphosarcoma and reticulosarcoma involving

lymph nodes of inguinal region and lower limb200.86 Other named variants of lymphosarcoma and reticulosarcoma involving

intrapelvic lymph nodes200.87 Other named variants of lymphosarcoma and reticulosarcoma involving

200.88 Other named variants of lymphosarcoma and reticulosarcoma involving

lymph nodes of multiple sites201.00 Hodgkin's paragranuloma unspecified site201.01 Hodgkin's paragranuloma involving lymph nodes of head face and neck

201.02 Hodgkin's paragranuloma involving intrathoracic lymph nodes201.03 Hodgkin's paragranuloma involving intra-abdominal lymph nodes201.04 Hodgkin's paragranuloma involving lymph nodes of axilla and upper limb

201.05 Hodgkin's paragranuloma involving lymph nodes of inguinal region and lower

limb201.06 Hodgkin's paragranuloma involving intrapelvic lymph nodes201.07 Hodgkin's paragranuloma involving spleen201.08 Hodgkin's paragranuloma involving lymph nodes of multiple sites201.10 Hodgkin's granuloma unspecified site201.11 Hodgkin's granuloma involving lymph nodes of head face and neck201.12 Hodgkin's granuloma involving intrathoracic lymph nodes201.13 Hodgkin's granuloma involving intra-abdominal lymph nodes201.14 Hodgkin's granuloma involving lymph nodes of axilla and upper limb201.15 Hodgkin's granuloma involving lymph nodes of inguinal region and lower 201.16 Hodgkin's granuloma involving intrapelvic lymph nodes201.17 Hodgkin's granuloma involving spleen



CYTOGENETICS

201.18 Hodgkin's granuloma involving lymph nodes of multiple sites201.20 Hodgkin's sarcoma unspecified site201.21 Hodgkin's sarcoma involving lymph nodes of head face and neck201.22 Hodgkin's sarcoma involving intrathoracic lymph nodes201.23 Hodgkin's sarcoma involving intra-abdominal lymph nodes201.24 Hodgkin's sarcoma involving lymph nodes of axilla and upper limb201.25 Hodgkin's sarcoma involving lymph nodes of inguinal region and lower limb

201.26 Hodgkin's sarcoma involving intrapelvic lymph nodes201.27 Hodgkin's sarcoma involving spleen201.28 Hodgkin's sarcoma involving lymph nodes of multiple sites201.40 Hodgkin's disease lymphocytic-histiocytic predominance unspecified site

201.41 Hodgkin's disease lymphocytic-histiocytic predominance involving lymph

nodes of head face and neck201.42 Hodgkin's disease lymphocytic-histiocytic predominance involving

intrathoracic lymph nodes201.43 Hodgkin's disease lymphocytic-histiocytic predominance involving intra-

abdominal lymph nodes201.44 Hodgkin's disease lymphocytic-histiocytic predominance involving lymph

nodes of axilla and upper limb201.45 Hodgkin's disease lymphocytic-histiocytic predominance involving lymph

nodes of inguinal region and lower limb201.46 Hodgkin's disease lymphocytic-histiocytic predominance involving

intrapelvic lymph nodes201.47 Hodgkin's disease lymphocytic-histiocytic predominance involving spleen

201.48 Hodgkin's disease lymphocytic-histiocytic predominance involving lymph

nodes of multiple sites201.50 Hodgkin's disease nodular sclerosis unspecified site201.51 Hodgkin's disease nodular sclerosis involving lymph nodes of head face and

201.52 Hodgkin's disease nodular sclerosis involving intrathoracic lymph nodes

201.53 Hodgkin's disease nodular sclerosis involving intra-abdominal lymph nodes

201.54 Hodgkin's disease nodular sclerosis involving lymph nodes of axilla and

upper limb201.55 Hodgkin's disease nodular sclerosis involving lymph nodes of inguinal region

and lower limb201.56 Hodgkin's disease nodular sclerosis involving intrapelvic lymph nodes201.57 Hodgkin's disease nodular sclerosis involving spleen201.58 Hodgkin's disease nodular sclerosis involving lymph nodes of multiple sites

201.60 Hodgkin's disease mixed cellularity unspecified site201.61 Hodgkin's disease mixed cellularity involving lymph nodes of head face and

201.62 Hodgkin's disease mixed cellularity involving intrathoracic lymph nodes

201.63 Hodgkin's disease mixed cellularity involving intra-abdominal lymph nodes

201.64 Hodgkin's disease mixed cellularity involving lymph nodes of axilla and upper

limb201.65 Hodgkin's disease mixed cellularity involving lymph nodes of inguinal region

and lower limb201.66 Hodgkin's disease mixed cellularity involving intrapelvic lymph nodes201.67 Hodgkin's disease mixed cellularity involving spleen201.68 Hodgkin's disease mixed cellularity involving lymph nodes of multiple sites

201.70 Hodgkin's disease lymphocytic depletion unspecified site201.71 Hodgkin's disease lymphocytic depletion involving lymph nodes of head face

and neck



CYTOGENETICS

201.72 Hodgkin's disease lymphocytic depletion involving intrathoracic lymph nodes

201.73 Hodgkin's disease lymphocytic depletion involving intra-abdominal lymph

201.74 Hodgkin's disease lymphocytic depletion involving lymph nodes of axilla and

upper limb201.75 Hodgkin's disease lymphocytic depletion involving lymph nodes of inguinal

region and lower limb

201.76 Hodgkin's disease lymphocytic depletion involving intrapelvic lymph nodes

201.77 Hodgkin's disease lymphocytic depletion involving spleen201.78 Hodgkin's disease lymphocytic depletion involving lymph nodes of multiple

201.90 Hodgkin's disease unspecified type unspecified site201.91 Hodgkin's disease unspecified type involving lymph nodes of head face and

neck201.92 Hodgkin's disease unspecified type involving intrathoracic lymph nodes

201.93 Hodgkin's disease unspecified type involving intra-abdominal lymph nodes

201.94 Hodgkin's disease unspecified type involving lymph nodes of axilla and

upper limb201.95 Hodgkin's disease unspecified type involving lymph nodes of inguinal region

and lower limb201.96 Hodgkin's disease unspecified type involving intrapelvic lymph nodes201.97 Hodgkin's disease unspecified type involving spleen201.98 Hodgkin's disease unspecified type involving lymph nodes of multiple sites

202.00 Nodular lymphoma unspecified site202.01 Nodular lymphoma involving lymph nodes of head face and neck202.02 Nodular lymphoma involving intrathoracic lymph nodes202.03 Nodular lymphoma involving intra-abdominal lymph nodes202.04 Nodular lymphoma involving lymph nodes of axilla and upper limb202.05 Nodular lymphoma involving lymph nodes of inguinal region and lower limb

202.06 Nodular lymphoma involving intrapelvic lymph nodes202.07 Nodular lymphoma involving spleen202.08 Nodular lymphoma involving lymph nodes of multiple sites202.80 Other malignant lymphomas unspecified site202.81 Other malignant lymphomas involving lymph nodes of head face and neck

202.82 Other malignant lymphomas involving intrathoracic lymph nodes202.83 Other malignant lymphomas involving intra-abdominal lymph nodes202.84 Other malignant lymphomas involving lymph nodes of axilla and upper limb

202.85 Other malignant lymphomas involving lymph nodes of inguinal region and

lower limb202.86 Other malignant lymphomas involving intrapelvic lymph nodes202.87 Other malignant lymphomas involving spleen202.88 Other malignant lymphomas involving lymph nodes of multiple sites202.90 Other and unspecified malignant neoplasms of lymphoid and histiocytic

tissue unspecified site202.91 Other and unspecified malignant neoplasms of lymphoid and histiocytic

tissue involving lymph nodes of head face and neck202.92 Other and unspecified malignant neoplasms of lymphoid and histiocytic

tissue involving intrathoracic lymph nodes202.93 Other and unspecified malignant neoplasms of lymphoid and histiocytic

tissue involving intra-abdominal lymph nodes

202.94 Other and unspecified malignant neoplasms of lymphoid and histiocytic

tissue involving lymph nodes of axilla and upper limb



CYTOGENETICS


tissue involving lymph nodes of inguinal region and lower limb


tissue involving intrapelvic lymph nodes202.97 Other and unspecified malignant neoplasms of lymphoid and histiocytic

tissue involving spleen202.98 Other and unspecified malignant neoplasms of lymphoid and histiocytic

tissue involving lymph nodes of multiple sites203.00 Multiple myeloma without mention of having achieved remission203.01 Multiple myeloma in remission203.10 Plasma cell leukemia without remission203.11 Plasma cell leukemia in remission203.12 Plasma cell leukemia in relapse203.82 Other immunoproliferative neoplasms in relapse204.00 Lymphoid leukemia acute without mention of having achieved remission

204.01 Lymphoid leukemia acute in remission

204.02 Lymphoid leukemia acute in relapse204.10 Chronic lymphoid leukemia, without mention of having achiever remission

204.12 Lymphoid leukemia chronic in relapse

204.22 Lymphoid leukemia subacute in relapse204.80 Other lymphoid leukemia without mention of having achieved remission

204.81 Other lymphoid leukemia in remission

204.82 Other lymphoid leukemia in relapse205.00 Myeloid leukemia acute without mention of having achieved remission

205.01 Myeloid leukemia acute in remission

205.02 Myeloid leukemia subacute in relapse205.10 Myeloid leukemia chronic without mention of having achieved remission

205.11 Myeloid leukemia chronic in remission

205.12 Myeloid leukemia chronic in relapse205.20 Myeloid leukemia subacute without mention of having achieved remission

205.21 Myeloid leukemia subacute in remission

205.22 Myeloid leukemia subacute in relapse

205.30 Myeloid sarcoma without mention of having achieved remission

205.31 Myeloid sarcoma in remission

205.32 Myeloid sarcoma in relapse

205.80 Other myeloid leukemia without mention of having achieved remission

205.81 Other myeloid leukemia in remission

205.82 Other myeloid leukemia in relapse

205.90 Unspecified myeloid leukemia without mention of having achieved remission

205.91 Unspecified myeloid leukemia in remission

206.00 Monocytic leukemia acute without mention of having achieved remission

206.01 Monocytic leukemia acute in remission

206.02 Monocytic leukemia subacute in relapse

206.82 Other monocytic leukemia in relapse

206.90 Unspecified monocytic leukemia without mention of having achieved

206.91 Unspecified monocytic leukemia in remission207.20 Megakaryocytic leukemia without remission207.21 Megakaryocytic leukemia in remission

207.22 Megakaryocytic leukemia in relapse207.82 Other specified leukemia in relapse



CYTOGENETICS

208.00 Leukemia of unspecified cell type acute without mention of having achieved

remission208.01 Leukemia of unspecified cell type acute in remission208.02 Leukemia of unspecified cell type acute in relapse225.2 Benign neoplasm of cerebral meninges238.4 Polycythemia vera238.6 Neoplasm of uncertain behavior of plasma cells238.71 Essential thrombocythemia238.72 Low grade myelodysplastic syndrome lesions238.73 High grade myelodysplastic syndrome lesions238.74 Myelodysplastic syndrome with 5q deletion238.75 Myelodysplastic syndrome, unspecified238.77 Post-transplant lymphoproliferative disorder (PTLD)238.79 Other lymphatic and hematopoietic tissues259.0 Delay in sexual development and puberty not elsewhere classified273.1 Monoclonal paraproteinemia273.3 Macroglobulinemia284.01 Constitutional red blood cell aplasia284.09 Other constitutional aplastic anemia284.19 Other pancytopenia284.2 Myelophthisis284.81 Red cell aplasia (acquired) (adult) (with thymoma)284.89 Other specified aplastic anemias284.9 Aplastic anemia unspecified285.0 Sideroblastic anemia285.1 Acute posthemorrhagic anemia285.21 Anemia in chronic kidney disease285.22 Anemia in neoplastic disease285.29 Anemia of other chronic illness285.8 Other specified anemias285.9 Anemia unspecified287.30 Primary thrombocytopenia, unspecified287.31 Immune thrombocytopenic purpura287.32 Evans’ syndrome287.33 Congenital and hereditary thrombocytopenic purpura287.39 Other primary thrombocytopenia287.41 Posttransfusion purpura287.49 Other secondary thrombocytopenia288.01* Congenital neutropenia288.02 Cyclic neutropenia288.1 Functional disorders of polymorphonuclear neutrophils288.2 Genetic anomalies of leukocytes288.3 Eosinophilia288.4 Hemophagocytic syndromes288.61 Lymphocytosis (symptomatic)288.63 Monocytosis (symptomatic)288.64 Plasmacytosis288.65 Basophilia288.8 Other specified disease of white blood cells289.6 Familial polycythemia289.7 Methemoglobinemia289.81 Primary hypercoagulable state



CYTOGENETICS

289.82 Secondary hypercoagulable state289.83 Myelofibrosis289.89 Other specified diseases of blood and blood-forming organs334.8 Other spinocerebellar diseases388.5 Disorders of acoustic nerve389.10 Sensorineural hearing loss unspecified629.9 Unspecified disorder of female genital organs630 Hydatidiform mole631.0 Other abnormal product of conception632 Missed abortion646.33 Habitual aborter antepartum condition or complication655.00 Central nervous system malformation in fetus unspecified as to episode of

care in pregnancy

655.01 Central nervous system malformation in fetus with delivery655.03 Central nervous system malformation in fetus antepartum655.10 Chromosomal abnormality in fetus affecting management of mother

unspecified as to episode of care in pregnancy655.11 Chromosomal abnormality in fetus affecting management of mother with

delivery655.13 Chromosomal abnormality in fetus affecting management of mother

antepartum655.20 Hereditary disease in family possibly affecting fetus affecting management of

mother unspecified as to episode of care in pregnancy

655.21 Hereditary disease in family possibly affecting fetus affecting management of

mother with delivery655.23 Hereditary disease in family possibly affecting fetus affecting management of

mother antepartum condition or complication656.40 Intrauterine death affecting management of mother unspecified as to episode

of care656.41 Intrauterine death affecting management of mother delivered656.43 Intrauterine death affecting management of mother antepartum656.50 Poor fetal growth affecting management of mother unspecified as to episode

of care656.51 Poor fetal growth affecting management of mother delivered656.53 Poor fetal growth affecting management of mother antepartum condition or

complication656.60 Excessive fetal growth affecting management of mother unspecified as to

episode of care656.61 Excessive fetal growth affecting management of mother delivered656.63 Excessive fetal growth affecting management of mother antepartum657.00 Polyhydramnios unspecified as to episode of care657.01 Polyhydramnios with delivery657.03 Polyhydramnios antepartum complication658.00 Oligohydramnios unspecified as to episode of care658.01 Oligohydramnios delivered

658.03 Oligohydramnios antepartum659.50 Elderly primigravida unspecified as to episode of care659.51 Elderly primigravida delivered659.53 Elderly primigravida antepartum659.60 Other advanced maternal age unspecified as to episode of care or not

applicable



CYTOGENETICS

659.61 Other advanced maternal age delivered with or without antepartum condition

659.63 Other advanced maternal age antepartum condition or complication740.0 Anencephalus740.1 Craniorachischisis740.2 Iniencephaly742.0 Encephalocele742.1 Microcephalus742.2 Congenital reduction deformities of brain742.3 Congenital hydrocephalus742.4 Other specified congenital anomalies of brain742.51 Diastematomyelia742.53 Hydromyelia742.59 Other specified congenital anomalies of spinal cord742.8 Other specified congenital anomalies of nervous system743.00 Clinical anophthalmos unspecified743.03 Cystic eyeball congenital743.06 Cryptophthalmos743.10 Microphthalmos unspecified743.11 Simple microphthalmos743.12 Microphthalmos associated with other anomalies of eye and adnexa743.20 Buphthalmos unspecified743.21 Simple buphthalmos743.22 Buphthalmos associated with other ocular anomalies743.30 Congenital cataract unspecified743.31 Congenital capsular and subcapsular cataract743.32 Congenital cortical and zonular cataract743.33 Congenital nuclear cataract743.34 Congenital total and subtotal cataract743.35 Congenital aphakia743.36 Congenital anomalies of lens shape743.37 Congenital ectopic lens743.39 Other congenital cataract and lens anomalies743.41 Congenital anomalies of corneal size and shape743.42 Congenital corneal opacities interfering with vision743.43 Other congenital corneal opacities743.44 Specified congenital anomalies of anterior chamber , chamber angle and

related structures743.45 Aniridia743.46 Other specified congenital anomalies of iris and ciliary body743.47 Specified congenital anomalies of sclera743.48 Multiple and combined congenital anomalies of anterior segment743.49 Other congenital anomalies of anterior segment743.51 Vitreous anomalies congenital743.52 Fundus coloboma743.53 Chorioretinal degeneration congenital743.54 Congenital folds and cysts of posterior segment743.55 Congenital macular changes743.56 Other retinal changes congenital743.57 Specified congenital anomalies of optic disc743.58 Vascular anomalies congenital743.59 Other congenital anomalies of posterior segment743.61 Congenital ptosis of eyelid



CYTOGENETICS

743.62 Congenital deformities of eyelids743.63 Other specified congenital anomalies of eyelid743.64 Specified congenital anomalies of lacrimal gland743.65 Specified congenital anomalies of lacrimal passages743.66 Specified congenital anomalies of orbit

743.69 Other congenital anomalies of eyelids lacrimal system and orbit743.8 Other specified anomalies of eye congenital743.9 Unspecified anomaly of eye congenital744.00 Unspecified congenital anomaly of ear with impairment of hearing744.01 Congenital absence of external ear744.02 Other congenital anomalies of external ear with impairment of hearing

744.03 Congenital anomaly of middle ear except ossicles744.04 Congenital anomalies of ear ossicles744.05 Congenital anomalies of inner ear744.09 Other congenital anomalies of ear causing impairment of hearing744.1 Accessory auricle744.21 Absence of ear lobe congenital744.22 Macrotia744.23 Microtia744.24 Specified congenital anomalies of eustachian tube744.29 Other congenital anomalies of ear744.3 Unspecified congenital anomaly of ear744.41 Branchial cleft sinus or fistula744.42 Branchial cleft cyst744.43 Cervical auricle744.46 Preauricular sinus or fistula744.47 Preauricular cyst744.49 Other branchial cleft cyst or fistula; preauricular sinus744.5 Webbing of neck744.81 Macrocheilia744.82 Microcheilia744.83 Macrostomia744.84 Microstomia744.89 Other specified congenital anomalies of face and neck744.9 Unspecified congenital anomalies of face and neck745.0 Common truncus745.10 Complete transposition of great vessels745.11 Double outlet right ventricle745.12 Corrected transposition of great vessels745.19 Other transposition of great vessels745.2 Tetralogy of fallot745.3 Common ventricle745.4 Ventricular septal defect

745.5 Ostium secundum type atrial septal defect745.60 Endocardial cushion defect unspecified type745.61 Estium primum defect745.69 Other endocardial cushion defects745.7 Cor biloculare745.8 Other bulbus cordis anomalies and anomalies of cardiac septal closure

745.9 Unspecified defect of septal closure746.00 Congenital pulmonary valve anomaly unspecified746.01 Atresia of pulmonary valve congenital



CYTOGENETICS

746.02 Stenosis of pulmonary valve congenital746.09 Other congenital anomalies of pulmonary valve746.1 Tricuspid atresia and stenosis congenital746.2 Ebstein's anomaly746.3 Congenital stenosis of aortic valve746.4 Congenital insufficiency of aortic valve746.5 Congenital mitral stenosis746.6 Congenital mitral insufficiency746.7 Hypoplastic left heart syndrome746.81 Subaortic stenosis congenital746.82 Cor triatriatum746.83 Infundibular pulmonic stenosis congenital746.84 Congenital obstructive anomalies of heart not elsewhere classified746.85 Coronary artery anomaly congenital746.86 Congenital heart block746.87 Malposition of heart and cardiac apex746.89 Other specified congenital anomalies of heart746.9 Unspecified congenital anomaly of heart747.0 Patent ductus arteriosus747.10 Coarctation of aorta (preductal) (postductal)747.11 Interruption of aortic arch747.20 Congenital anomaly of aorta unspecified747.21 Congenital anomalies of aortic arch747.22 Congenital atresia and stenosis of aorta747.29 Other congenital anomalies of aorta747.31 Pulmonary artery coarctation and atresia747.32 Pulmonary arteriovenous malformation747.39 Congenital anomalies of pulmonary artery747.40 Congenital anomaly of great veins unspecified747.41 Total anomalous pulmonary venous connection747.42 Partial anomalous pulmonary venous connection747.49 Other anomalies of great veins747.5 Absence or hypoplasia of umbilical artery747.60 Anomaly of the peripheral vascular system unspecified site747.61 Gastrointestinal vessel anomaly747.62 Renal vessel anomaly747.63 Upper limb vessel anomaly747.64 Lower limb vessel anomaly747.69 Anomalies of other specified sites of peripheral vascular system747.81 Congenital anomalies of cerebrovascular system747.82 Spinal vessel anomaly747.83 Persistent fetal circulation747.89 Other specified congenital anomalies of circulatory system747.9 Unspecified congenital anomaly of circulatory system748.0 Choanal atresia748.1 Other congenital anomalies of nose748.2 Web of larynx748.3 Other congenital anomalies of larynx trachea and bronchus748.4 Congenital cystic lung748.5 Congenital agenesis hypoplasia and dysplasia of lung748.60 Congenital anomaly of lung unspecified748.61 Congenital bronchiectasis



CYTOGENETICS

748.69 Other congenital anomalies of lung748.8 Other specified congenital anomalies of respiratory system748.9 Unspecified congenital anomaly of respiratory system749.00 Cleft palate unspecified749.01 Cleft palate unilateral complete749.02 Cleft palate unilateral incomplete749.03 Cleft palate bilateral complete749.04 Cleft palate bilateral incomplete749.10 Cleft lip unspecified749.11 Cleft lip unilateral complete749.12 Cleft lip unilateral incomplete749.13 Cleft lip bilateral complete749.14 Cleft lip bilateral incomplete749.20 Cleft palate with Cleft lip unspecified749.21 Cleft palate with Cleft lip unilateral complete

749.22 Cleft palate with Cleft lip unilateral incomplete

749.23 Cleft palate with Cleft lip bilateral complete749.24 Cleft palate with Cleft lip bilateral incomplete749.25 Other combinations of cleft palate with cleft lip750.0 Tongue tie750.10 Congenital anomaly of tongue unspecified750.11 Aglossia750.12 Congenital adhesions of tongue750.13 Congenital fissure of tongue750.15 Macroglossia750.16 Microglossia750.19 Other congenital anomalies of tongue750.21 Congenital absence of salivary gland750.22 Accessory salivary gland750.23 Congenital atresia salivary duct750.24 Congenital fistula of salivary gland750.25 Congenital fistula of lip750.26 Other specified congenital anomalies of mouth750.27 Congenital diverticulum of pharynx750.29 Other specified congenital anomalies of pharynx750.3 Congenital tracheoesophageal fistula esophageal atresia and stenosis750.4 Other specified congenital anomalies of esophagus

750.5 Congenital hypertrophic pyloric stenosis

750.6 Congenital hiatus hernia

750.7 Other specified congenital anomalies of stomach

750.8 Other specified congenital anomalies of upper alimentary tract

750.9 Unspecified congenital anomaly of upper alimentary tract

751.0 Meckel's diverticulum

751.1 Congenital atresia and stenosis of small intestine

751.2 Congenital atresia and stenosis of large intestine rectum and anal canal

751.3 Hirschsprung's disease and other congenital functional disorders of colon

751.4 Congenital anomalies of intestinal fixation

751.5 Other congenital anomalies of intestine

751.60 Unspecified congenital anomaly of gallbladder bile ducts and liver

751.61 Biliary atresia congenital

751.62 Congenital cystic disease of liver751.69 Other congenital anomalies of gallbladder bile ducts and liver



CYTOGENETICS

751.7 Congenital anomalies of pancreas751.8 Other specified congenital anomalies of digestive system751.9 Unspecified congenital anomaly of digestive system752.0 Congenital anomalies of ovaries752.10 Unspecified congenital anomaly of fallopian tubes and broad ligaments

752.11 Embryonic cyst of fallopian tubes and broad ligaments752.19 Other congenital anomalies of fallopian tubes and broad ligaments752.2 Doubling of uterus

752.31 Agenesis of uterus

752.32 Hypoplasia of uterus

752.33 Unicornuate uterus

752.34 Bicornuate uterus

752.35 Septate uterus

752.36 Arcuate uterus

752.39 Other anomalies of uterus

752.40 Unspecified congenital anomaly of cervix vagina and external female genitalia

752.41 Embryonic cyst of cervix vagina and external female genitalia

752.42 Imperforate hymen752.43 Cervical agenesis752.44 Vaginal duplication752.45 Vaginal agenesis752.46 Transverse vaginal septum752.47 Longitudinal vaginal septum752.49 Other congenital anomalies of cervix vagina and external female genitalia

752.51 Undescended testis752.52 Retractile testis752.61 Hypospadias752.62 Epispadias752.63 Congenital chordee752.64 Micropenis752.65 Hidden penis752.69 Other penile anomalies752.7 Indeterminate sex and pseudohermaphroditism752.81 Scrotal transposition752.89 Other specified anomalies of genital organs752.9 Unspecified congenital anomaly of genital organs753.0 Renal agenesis and dysgenesis753.10 Cystic kidney disease unspecified753.11 Congenital single renal cyst753.12 Polycystic kidney unspecified type753.13 Polycystic kidney autosomal dominant753.14 Polycystic kidney autosomal recessive753.15 Renal dysplasia753.16 Medullary cystic kidney753.17 Medullary sponge kidney753.19 Other specified cystic kidney disease753.20 Unspecified obstructive defect of renal pelvis and ureter753.21 Congenital obstruction of ureteropelvic junction753.22 Congenital obstruction of ureterovesical junction753.23 Congenital ureterocele753.29 Other obstructive defect of renal pelvis and ureter753.3 Other specified anomalies of kidney



CYTOGENETICS

753.4 Other specified anomalies of ureter753.5 Exstrophy of urinary bladder753.6 Congenital atresia and stenosis of urethra and bladder neck753.7 Congenital anomalies of urachus753.8 Other specified congenital anomalies of bladder and urethra753.9 Unspecified congenital anomaly of urinary system754.0 Congenital musculoskeletal deformities of skull face and jaw754.1 Congenital musculoskeletal deformities of sternocleidomastoid muscle

754.2 Congenital musculoskeletal deformities of spine754.30 Congenital dislocation of hip unilateral754.31 Congenital dislocation of hip bilateral754.32 Congenital subluxation of hip unilateral754.33 Congenital subluxation of hip bilateral754.35 Congenital dislocation of one hip with subluxation of other hip754.40 Genu recurvatum754.41 Congenital dislocation of knee (with genu recurvatum)754.42 Congenital bowing of femur754.43 Congenital bowing of tibia and fibula754.44 Congenital bowing of unspecified long bones of leg754.50 Congenital talipes varus754.51 Congenital talipes equinovarus754.52 Congenital metatarsus primus varus754.53 Congenital metatarsus varus754.59 Other congenital varus deformities of feet754.60 Congenital talipes valgus754.61 Congenital pes planus754.62 Talipes calcaneovalgus754.69 Other congenital valgus deformities of feet754.70 Talipes unspecified754.71 Talipes cavus754.79 Other congenital deformities of feet754.81 Pectus excavatum754.82 Pectus carinatum754.89 Other specified nonteratogenic anomalies755.00 Polydactyly unspecified digits755.01 Polydactyly of fingers755.02 Polydactyly of toes755.10 Syndactyly of multiple and unspecified sites755.11 Syndactyly of fingers without fusion of bone755.12 Syndactyly of fingers with fusion of bone755.13 Syndactyly of toes without fusion of bone755.14 Syndactyly of toes with fusion of bone755.20 Unspecified reduction deformity of upper limb congenital755.21 Transverse deficiency of upper limb755.22 Longitudinal deficiency of upper limb not elsewhere classified755.23 Longitudinal deficiency combined involving humerus radius and ulna

(complete or incomplete)755.24 Longitudinal deficiency humeral complete or partial (with or without distal

deficiencies incomplete)755.25 Longitudinal deficiency radioulnar complete or partial (with or without distal

deficiencies incomplete)



CYTOGENETICS

755.26 Longitudinal deficiency radial complete or partial (with or without distal

deficiencies incomplete)755.27 Longitudinal deficiency ulnar complete or partial (with or without distal


755.28 Longitudinal deficiency carpals or metacarpals complete or partial (with or

without incomplete phalangeal deficiency)

755.29 Longitudinal deficiency phalanges complete or partial

755.30 Unspecified reduction deformity of lower limb congenital

755.31 Transverse deficiency of lower limb

755.32 Longitudinal deficiency of lower limb not elsewhere classified

755.33 Longitudinal deficiency combined involving femur tibia and fibula (complete or

incomplete)

755.34 Longitudinal deficiency femoral complete or partial (with or without distal


755.35 Longitudinal deficiency tibiofibular complete or partial (with or without distal


755.36 Longitudinal deficiency tibia complete or partial (with or without distal


755.37 Longitudinal deficiency fibular complete or partial (with or without distal


755.38 Longitudinal deficiency tarsals or metatarsals complete or partial (with or

without incomplete phalangeal deficiency)

755.39 Longitudinal deficiency phalanges complete or partial

755.4 Congenital reduction deformities unspecified limb

755.5 Unspecified anomaly of upper limb congenital

755.51 Congenital deformity of clavicle

755.52 Congenital elevation of scapula

755.53 Radioulnar synostosis

755.54 Madelung's deformity

755.55 Acrocephalosyndactyly

755.56 Accessory carpal bones

755.57 Macrodactylia (fingers)

755.58 Cleft hand congenital

755.59 Other congenital anomalies of upper limb including shoulder girdle

755.60 Unspecified congenital anomaly of lower limb

755.61 Coxa valga congenital

755.62 Coxa vara congenital

755.63 Other congenital deformity of hip (joint)

755.64 Congenital deformity of knee (joint)

755.65 Macrodactylia of toes

755.66 Other congenital anomalies of toes

755.67 Congenital anomalies of foot not elsewhere classified

755.69 Other congenital anomalies of lower limb including pelvic girdle

755.8 Other specified congenital anomalies of unspecified limb



CYTOGENETICS

755.9 Unspecified congenital anomaly of unspecified limb

756.0 Congenital anomalies of skull and face bones

756.10 Congenital anomaly of spine unspecified

756.11 Congenital spondylolysis lumbosacral region

756.12 Spondylolisthesis congenital

756.13 Absence of vertebra congenital

756.14 Hemivertebra

756.15 Fusion of spine (vertebra) congenital

756.16 Klippel-feil syndrome

756.17 Spina bifida occulta

756.19 Other congenital anomalies of spine

756.2 Cervical rib

756.3 Other congenital anomalies of ribs and sternum

756.4 Chondrodystrophy

756.50 Congenital osteodystrophy unspecified

756.51 Osteogenesis imperfecta

756.52 Osteopetrosis

756.53 Osteopoikilosis

756.54 Polyostotic fibrous dysplasia of bone

756.55 Chondroectodermal dysplasia

756.56 Multiple epiphyseal dysplasia

756.59 Other congenital osteodystrophies

756.6 Congenital anomalies of diaphragm

756.70 Anomaly of abdominal wall unspecified

756.71 Prune belly syndrome

756.72 Omphalocele

756.73 Gastroschisis

756.81 Congenital absence of muscle and tendon

756.82 Accessory muscle

756.83 Ehlers-danlos syndrome

756.89 Other specified congenital anomalies of muscle tendon fascia and connective

tissue

757.0 Hereditary edema of legs

757.1 Ichthyosis congenita

757.2 Dermatoglyphic anomalies

757.31 Congenital ectodermal dysplasia

757.32 Vascular hamartomas

757.33 Congenital pigmentary anomalies of skin

757.39 Other specified congenital anomalies of skin

758.0 Down's syndrome

758.1 Patau's syndrome

758.2 Edwards' syndrome

758.31 Cri-du-chat syndrome

758.32 Velo-cardio-facial syndrome



CYTOGENETICS

758.33 Other microdeletions

758.39 Other autosomal deletions

758.4 Balanced autosomal translocation in normal individual

758.5 Other conditions due to autosomal anomalies

758.6 Gonadal dysgenesis

758.7 Klinefelter's syndrome

758.81 Other conditions due to sex chromosome anomalies

758.89 Other conditions due to chromosome anomalies

758.9 Conditions due to anomaly of unspecified chromosome

759.83 Fragile x syndrome

783.22 Underweight

783.40 Unspecified lack of normal physiological development

783.41 Failure to thrive

783.42 Delayed milestones

783.43 Short stature

796.5 Abnormal finding on antenatal screening

796.6 Nonspecific abnormal findings on neonatal screening

V13.61 Personal history of (corrected) hypospadias

V13.62 Personal history of other (corrected) congenital malformations of

genitourinary systemV13.63 Personal history of (corrected) congenital malformations of nervous system

V13.64 Personal history of (corrected) congenital malformations of eye, ear, face and

neckV13.65 Personal history of (corrected) congenital malformations of heart and

circulatory systemV13.66 Personal history of (corrected) congenital malformations of respiratory

systemV13.67 Personal history of (corrected) congenital malformations of digestive system

V13.68 Personal history of (corrected) congenital malformations of integument, limbs

and musculoskeletal systems

V13.69 Personal history of other (corrected) congenital malformations

V18.4 Family history of mental retardation

V19.5 Family history of congenital anomalies

V49.89* Other specified conditions influencing health status

*171.9 Medical record must contain documentation of either: alveolar soft part

sarcoma, alveolar rhabdomyosarcoma, clear cell sarcoma, desmoplastic

small sound cell tumor, Ewing sarcoma, myxoid liposarcoma, low grade

fibromyxoid sarcoma, extra skeletal myxoid chondrosarcoma, inflammatory

myofibroblastic tumor or synovial sarcoma in order to use these diagnosis

codes

*288.01 Limited to infantile genetic agranulocytosis only

*V49.89 To be used only when repeat testing is believed to be medically reasonable

and necessary




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)

71 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

72 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.


73 DIGOXIN (NCD)

Medicare B Medical Policy December 1, 2006; updated January 1, 2013

CPT: 81201 Molecular pathology procedure, level 7 (eg, analysis of 11-25 exons by dna

sequence analysis, mutation scanning or duplication/deletion variants of 26-

50 exons, cytogenomic array analysis for neoplasia)

CPT: 81202 Examination and selection of retrieved archival (ie, previously diagnosed)

tissue(s) for molecular analysis (eg, kras mutational analysis)

CPT: 81203 Apc (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [fap],

attenuated fap) gene analysis; duplication/deletion variants

CPT: 81211 Brca1, brca2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian

cancer) gene analysis; full sequence analysis and common

duplication/deletion variants in brca1 (ie, exon 13 del 3.835kb, exon 13 dup

6kb, exon 14-20 del 26kb, exon 22 del 510bp, exon 8-9 del 7.1kb)CPT: 81212 Brca1, brca2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian

cancer) gene analysis; 185delag, 5385insc, 6174delt variants

CPT: 81213 Brca1, brca2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian

cancer) gene analysis; uncommon duplication/deletion variants

CPT: 81214 Brca1 (breast cancer 1) (eg, hereditary breast and ovarian cancer) gene

analysis; full sequence analysis and common duplication/deletion variants

(ie, exon 13 del 3.835kb, exon 13 dup 6kb, exon 14-20 del 26kb, exon 22 del

510bp, exon 8-9 del 7.1kb)CPT: 81215 Brca1 (breast cancer 1) (eg, hereditary breast and ovarian cancer) gene

analysis; known familial variant


analysis; full sequence analysis


analysis; known familial variant

CPT: 81270 Jak2 (janus kinase 2) (eg, myeloproliferative disorder) gene analysis,

p.val617phe (v617f) variant

CPT: 81275 Kras (v-ki-ras2 kirsten rat sarcoma viral oncogene) (eg, carcinoma) gene

analysis, variants in codons 12 and 13

CPT: 81292 Mlh1 (mutl homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-

polyposis colorectal cancer, lynch syndrome) gene analysis; full sequence

analysis


polyposis colorectal cancer, lynch syndrome) gene analysis; known familial

variants


polyposis colorectal cancer, lynch syndrome) gene analysis;

duplication/deletion variants

CPT: 81295 Msh2 (muts homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary

non-polyposis colorectal cancer, lynch syndrome) gene analysis; full

sequence analysis


non-polyposis colorectal cancer, lynch syndrome) gene analysis; known

familial variants


non-polyposis colorectal cancer, lynch syndrome) gene analysis;


GENETIC TESTING

74 GENETIC TESTING (LCD)


GENETIC TESTING

CPT: 81298 Msh6 (muts homolog 6 [e. coli]) (eg, hereditary non-polyposis colorectal

cancer, lynch syndrome) gene analysis; full sequence analysis

CPT: 81299 Msh6 (muts homolog 6 [e. coli]) (eg, hereditary non-polyposis colorectal

cancer, lynch syndrome) gene analysis; known familial variants

CPT: 81317 Pms2 (postmeiotic segregation increased 2 [s. cerevisiae]) (eg, hereditary non-

polyposis colorectal cancer, lynch syndrome) gene analysis; full sequence

analysis


polyposis colorectal cancer, lynch syndrome) gene analysis; known familial

variants


polyposis colorectal cancer, lynch syndrome) gene analysis;


CPT: 81381 Hla class i typing, high resolution (ie, alleles or allele groups); one allele or

allele group (eg, b*57:01p), each

CPT: 81401 Molecular pathology procedure, level 2 (eg, 2-10 snps, 1 methylated variant,

or 1 somatic variant [typically using nonsequencing target variant analysis],

or detection of a dynamic mutation disorder/triplet repeat)

CPT: 81403 Molecular pathology procedure, level 4 (eg, analysis of single exon by dna

sequence analysis, analysis of >10 amplicons using multiplex pcr in 2 or

more independent reactions, mutation scanning or duplication/deletion

variants of 2-5 exons)


sequence analysis, mutation scanning or duplication/ deletion variants of 11-

25 exons)


sequence analysis, mutation scanning or duplication/deletion variants of 26-

50 exons, cytogenomic array analysis for neoplasia)

CPT: 88363 Examination and selection of retrieved archival (ie, previously diagnosed)

tissue(s) for molecular analysis (eg, kras mutational analysis)

158.0 Malignant neoplasm of retroperitoneum

158.8 Malignant neoplasm of specified parts of peritoneum

174.0 Malignant neoplasm of nipple and areola of female breast

174.1 Malignant neoplasm of central portion of female breast

174.2 Malignant neoplasm of upper-inner quadrant of female breast

174.3 Malignant neoplasm of lower-inner quadrant of female breast

174.4 Malignant neoplasm of upper-outer quadrant of female breast

174.5 Malignant neoplasm of lower-outer quadrant of female breast

174.6 Malignant neoplasm of axillary tail of female breast

174.8 Malignant neoplasm of other specified sites of female breast

174.9 Malignant neoplasm of breast (female) unspecified site

175.0 Malignant neoplasm of nipple and areola of male breast

175.9 Malignant neoplasm of other and unspecified sites of male breast

The following Diagnosis codes billed with CPT codes 81211, 81212, 81213, 81214, 81215, 81216 and

81217 meet coverage criteria for BRCA1 and BRCA2 gene mutation testing:



GENETIC TESTING


183.2 Malignant neoplasm of fallopian tube

233.0 Carcinoma in situ of breast

V10.3 Personal history of malignant neoplasm of breast

V10.43 Personal history of malignant neoplasm of ovary

153.0 Malignant neoplasm of hepatic flexure

153.1 Malignant neoplasm of transverse colon

153.2 Malignant neoplasm of descending colon

153.3 Malignant neoplasm of sigmoid colon

153.4 Malignant neoplasm of cecum

153.5 Malignant neoplasm of appendix vermiformis

153.6 Malignant neoplasm of ascending colon

153.7 Malignant neoplasm of splenic flexure

153.8 Malignant neoplasm of other specified sites of large intestine

153.9 Malignant neoplasm of colon unspecified site

154.0 Malignant neoplasm of rectosigmoid junction

154.1 Malignant neoplasm of rectum

154.2 Malignant neoplasm of anal canal

154.3 Malignant neoplasm of anus unspecified site

154.8 Malignant neoplasm of other sites of rectum rectosigmoid junction and anus

179 Malignant neoplasm of uterus-part uns

182.8 Malignant neoplasm of other specified sites of body of uterus


183.2 Malignant neoplasm of fallopian tube

197.5 Secondary malignant neoplasm of large intestine and rectum

V10.05 Personal history of malignant neoplasm of large intestine

V10.06 Personal history of malignant neoplasm of rectum rectosigmoid junction and

anusV10.42 Personal history of malignant neoplasm of other parts of uterus

V12.72 Personal history of colonic polyps ***should be used to denote any of the

polyposis conditions as described under indications and limitations above

204.00 Acute lymphoid leukemia, without mention of having achieved remission

204.10 Chronic lymphoid leukemia, without mention of having achieved remission

204.11 Lymphoid leukemia chronic in remission

CPT codes 81201, 81202, 81203, 81275, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299,

81300, 81317, 81318, 81319, 81401, 81403, 81405, 81406 and 88363 when billed with the following

diagnosis codes meet coverage criteria for hereditary colorectal cancer (HNPCC) including

endometrial and/or ovarian cancer when the latter two are reasonably considered as part of the

Lynch syndrome, Familial Adenomatous Polyposis (FAP) testing as well as for KRAS testing, when

such testing is used to determine suitability of the use of either erbitux or panitumumab within the

limitations noted above:

The following diagnosis codes when billed with CPT codes 81270 and 81403 meet coverage criteria

for JAK2 testing:



GENETIC TESTING

204.12 Chronic lymphoid leukemia, in relapse

205.00 Acute myeloid leukemia, without mention of having achieved remission

205.10 Chronic myeloid leukemia, without mention of having achieved remission

238.4 Polycythemia vera

238.71 Essential thrombocythemia

238.75 Myelodysplastic syndrome, unspecified

238.76 Myelofibrosis with myeloid metaplasia

238.79 Other lymphatic and hematopoietic tissues

287.5 Thrombocytopenia unspecified

288.50 Leukocytopenia, unspecified

288.51 Lymphocytopenia

288.59 Other decreased white blood cell count

288.61 Lymphocytosis (symptomatic)

288.69 Other elevated white blood cell count

288.8 Other specified disease of white blood cells

453.0 Budd-chiari syndrome

789.2 Splenomegaly

200.40 Mantle cell lymphoma, unspecified site, extranodal and solid organ sites

200.41 Mantle cell lymphoma, lymph nodes of head, face, and neck

200.42 Mantle cell lymphoma, intrathoracic lymph nodes

200.43 Mantle cell lymphoma, intra-abdominal lymph nodes

200.44 Mantle cell lymphoma, lymph nodes of axilla and upper limb

200.45 Mantle cell lymphoma, lymph nodes of inguinal region and lower limb

200.46 Mantle cell lymphoma, intrapelvic lymph nodes

200.47 Mantle cell lymphoma, spleen

200.48 Mantle cell lymphoma, lymph nodes of multiple sites

200.70 Large cell lymphoma, unspecified site, extranodal and solid organ sites

200.71 Large cell lymphoma, lymph nodes of head, face, and neck

200.72 Large cell lymphoma, intrathoracic lymph nodes

200.73 Large cell lymphoma, intra-abdominal lymph nodes

200.74 Large cell lymphoma, lymph nodes of axilla and upper limb

200.75 Large cell lymphoma, lymph nodes of inguinal region and lower limb

200.76 Large cell lymphoma, intrapelvic lymph nodes

200.77 Large cell lymphoma, spleen

200.78 Large cell lymphoma, lymph nodes of multiple sites

202.00 Nodular lymphoma unspecified site

202.01 Nodular lymphoma involving lymph nodes of head face and neck

202.02 Nodular lymphoma involving intrathoracic lymph nodes

Multiple CPT codes exist for the various molecular tests for lymphoma. The appropriate code should

be selected from the most current CPT manual. The following diagnosis codes meet coverage

criteria as indications for molecular testing of lymphoma, so long as documentation of medical

necessity for the specific test in question is present in the medical record, as noted elsewhere in this

LCD:



GENETIC TESTING

202.03 Nodular lymphoma involving intra-abdominal lymph nodes

202.04 Nodular lymphoma involving lymph nodes of axilla and upper limb

202.05 Nodular lymphoma involving lymph nodes of inguinal region and lower limb

202.06 Nodular lymphoma involving intrapelvic lymph nodes

202.07 Nodular lymphoma involving spleen

202.08 Nodular lymphoma involving lymph nodes of multiple sites

204.00 Acute lymphoid leukemia, without mention of having achieved remission

204.01 Lymphoid leukemia acute in remission

204.02 Acute lymphoid leukemia, in relapse

204.10 Chronic lymphoid leukemia, without mention of having achieved remission

204.11 Lymphoid leukemia chronic in remission

204.12 Chronic lymphoid leukemia, in relapse

204.20 Subacute lymphoid leukemia, without mention of having achieved remission

204.21 Lymphoid leukemia subacute in remission

204.22 Subacute lymphoid leukemia, in relapse

204.80 Other lymphoid leukemia, without mention of having achieved remission

204.81 Other lymphoid leukemia in remission

204.82 Other lymphoid leukemia, in relapse

204.90 Unspecified lymphoid leukemia, without mention of having achieved

remission204.91 Unspecified lymphoid leukemia in remission

204.92 Unspecified lymphoid leukemia, in relapse

205.00 Acute myeloid leukemia, without mention of having achieved remission

205.01 Myeloid leukemia acute in remission

205.02 Acute myeloid leukemia, in relapse

205.10 Chronic myeloid leukemia, without mention of having achieved remission

205.11 Myeloid leukemia chronic in remission

205.12 Chronic myeloid leukemia, in relapse

205.20 Subacute myeloid leukemia, without mention of having achieved remission

205.21 Myeloid leukemia subacute in remission

205.22 Subacute myeloid leukemia, in relapse

205.30 Myeloid sarcoma, without mention of having achieved remission

205.31 Myeloid sarcoma in remission

205.32 Myeloid sarcoma, in relapse

205.80 Other myeloid leukemia, without mention of having achieved remission

205.81 Other myeloid leukemia in remission

205.82 Other myeloid leukemia, in relapse

205.90 Unspecified myeloid leukemia, without mention of having achieved remission

205.91 Unspecified myeloid leukemia in remission

205.92 Unspecified myeloid leukemia, in relapse

206.00 Acute monocytic leukemia, without mention of having achieved remission

The following diagnosis codes when billed with CPT code 81403 meet coverage criteria as

indications for testing for BCR/ABL fusion gene so long as documentation of medical necessity for

the specific test in question is present in the medical record, as noted elsewhere in this LCD:



GENETIC TESTING

206.01 Monocytic leukemia acute in remission

206.02 Acute monocytic leukemia, in relapse

206.10 Chronic monocytic leukemia, without mention of having achieved remission

206.11 Monocytic leukemia chronic in remission

206.12 Chronic monocytic leukemia, in relapse

206.20 Subacute monocytic leukemia, without mention of having achieved remission

206.21 Monocytic leukemia subacute in remission

206.22 Subacute monocytic leukemia, in relapse

206.80 Other monocytic leukemia, without mention of having achieved remission

206.81 Other monocytic leukemia in remission

206.82 Other monocytic leukemia, in relapse

206.90 Unspecified monocytic leukemia, without mention of having achieved

remission206.91 Unspecified monocytic leukemia in remission

206.92 Unspecified monocytic leukemia, in relapse

208.00 Acute leukemia of unspecified cell type, without mention of having achieved

remission208.01 Leukemia of unspecified cell type acute in remission

208.02 Acute leukemia of unspecified cell type, in relapse

208.10 Chronic leukemia of unspecified cell type, without mention of having

achieved remission208.11 Leukemia of unspecified cell type chronic in remission

208.12 Chronic leukemia of unspecified cell type, in relapse

208.20 Subacute leukemia of unspecified cell type, without mention of having

achieved remission208.21 Leukemia of unspecified cell type subacute in remission

208.22 Subacute leukemia of unspecified cell type, in relapse

208.80 Other leukemia of unspecified cell type, without mention of having achieved

remission208.81 Other leukemia of unspecified cell type in remission

208.82 Other leukemia of unspecified cell type, in relapse

208.90 Unspecified leukemia, without mention of having achieved remission

208.91 Unspecified leukemia in remission

208.92 Unspecified leukemia, in relapse

288.61 Lymphocytosis (symptomatic)

288.69 Other elevated white blood cell count

288.8 Other specified disease of white blood cells

789.2 Splenomegaly

042 Human immunodeficiency virus (hiv) disease

V08 Asymptomatic human immunodeficiency virus (hiv) infection status


The following diagnosis codes when billed with CPT code 81381 meet coverage criteria as

indications for HLA-B*5701 testing prior to initiating abacavir therapy in patients with either Human

Immunodeficiency Virus (HIV) disease or Asymptomatic Human Immunodeficiency virus (HIV)

infection.



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)

80 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

81 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

82 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


83 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.

84 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.

85 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.

86 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

87 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

88 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


89 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

90 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

91 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)

92 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)

96 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

97 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


101 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

102 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.


103 LIPID (NCD)


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


104 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)


107 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

108 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

109 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

110 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

111 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

112 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

113 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

114 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


115 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

116 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

117 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

118 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

119 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

120 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


121 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

122 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

123 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

124 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


125 THYROID (NCD)


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

126 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


127 URINE CULTURE (NCD)

Medicare B Medical Policy November 14, 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

128 Vitamin D Assay Testing (LCD)

Medicare B Medical Policy November 14, 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


129 Vitamin D Assay Testing (LCD)

Common ICD-9 Codes

AFP - Alpha Fetoprotein CYTOGENETICS

571.5 Cirrhosis of the liver, unspecified 285.29 Anemia of other chronic illnesses

070.32 Hepatitis B, Chronic 285.9 Anemia, unspecified

070.54 Hepatitis C, Chronic 783.41 Failure to thrive in childhood

795.89 Other abnormal tumor markers 758.7 Klinefelter's syndrome

571.49 Other chronic hepatitis 203.00 Multiple myeloma, unspecified

BNP - B-type Natriuretic Peptide 202.80 Other malignant lymphomas, unspec site

519.11 Acute bronchospasm 289.89 Other specified diseases of blood

493.92 Asthma unspecified with (acute) 289.81 Primary hypercoagulable state

493.22 Chronic obstructive asthma with (acute) 287.30 Primary thrombocytopenia, unspecified

428.0 Congestive heart failure, unspec DIGOXIN

428.9 Heart failure unspecified 427.31 Atrial fibrillation

428.1 Left heart failure 429.2 Cardiovascular disease, unspecified

425.4 Orther primary cardiomyopathies 428.0 Congestive Heart Failure (CHF)

786.09 Respiratory abnormality other 244.9 Hypothyroidism, unspecified

786.05 Shortness of breath V58.69 Long term (current) use of other meds

786.07 Wheezing 780.79 Malaise and fatigue

CA125 586 Renal Failure, unspecified

V10.43 Hx malignant neoplasm, ovary 276.7 Hyperkalemia (Hyperpotassemia)

183.0 Malignant neoplasm of the ovary 784.0 Headache

795.89 Other abnormal tumor markers 780.2 Syncope & collapse

789.39 Pelvic swelling, mass or lump GGT - Gamma Glutamyltransferase

CA15-3/CA27.29 571.5 Cirrhosis of the liver, unspecified

174.9 CA of female breast, unspecified 250.00 Diabetes mellitus

V10.3 Hx of malignant neoplasm, breast 562.11 Diverticulitis of colon

795.89 Other abnormal tumor markers 070.30 Hepatitis B, unspecified

198.81 Secondary malignant neoplasm, breast 789.1 Hepatomegaly

CA19-9 042 HIV disease

V10.09 Hx of malig neoplasm to other GI sites 272.4 Hyperlipidemia

156.0 Malignant neoplasm , gallbladder 782.4 Jaundice, unspecified, not of newborn

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

157.9 Pancreatic CA, part unspecified V58.69 Long term (current) use of other meds

COMPLETE BLOOD COUNT 780.79 Malaise and fatigue

789.00 Abdominal pain, site unspecified 790.5 Nonspecific abn'l serum enzyme levels

783.21 Abnormal loss of weight 790.4 Nonspecific elevation of transaminase or

280.9 Anemia, Iron Deficiency 586 Renal Failure, unspecified

285.9 Anemia, unspecified 079.99 Unspecified viral infection

281.9 Anemia, unspecified deficiency GLUCOSE

136.9 Infection, unspecified 783.21 Abnormal loss of weight

V58.61 Long term (current) use of anticoags 783.1 Abnormal weight gain

V58.69 Long term (current) use of other meds 786.50 Chest pain, unspecified

041.12 MRSA 414.00 Coronary Artery Disease (CAD)

CARCINOEMBRYONIC ANTIGEN (CEA) 250.00 Diabetes mellitus

V67.2 Follow-up post chemotherapy 780.4 Dizziness and giddiness

V10.05 Hx of malignant neoplasm of colon 790.29 Hyperglycemia

153.9 Malignant neoplasm of colon 272.4 Hyperlipidemia

183.0 Malignant neoplasm of ovary 251.2 Hypoglycemia

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

790.99 Nonspecific findings on exam of blood 780.79 Malaise and fatigue

795.89 Other abnormal tumor markers 263.9 Malnutrition, unspecified

729.1 Myalgia & Fibromyalgia

791.0 Proteinuria

780.39 Seizures, not otherwise specified

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.

130 April 2013

Common ICD-9 Codes

GLYCOLATED HEMOGLOBIN (HGB A1C) IRON & FERRITIN

250.00 Diabetes Mellitis 280.9 Anemia, iron deficient, unspecified

790.29 Hyperglycemia 285.9 Anemia, unspecified

251.2 Hypoglycemia unspecified 281.9 Anemia, unspecified deficiency

V58.69 Long term (current) use of other meds 427.31 Atrial fibrillation

275.09 Other disorders of iron metabolism 428.0 Congestive Heart Failure (CHF)

577.1 Pancreatitis, chronic 250.00 Diabetes mellitus, unspecified

579.3 Unspecified surgical nonabsorption 263.9 Malnutrition, unspecified

HCG-QUANT 790.6 Other abnormal blood chemistry

V10.43 Hx malignant neoplasm, ovary 586 Renal failure, unspecified

V10.47 Hx malignant neoplasm, testis 070.9 Viral hepatitis, unspecified

186.9 Malig neoplasm of other, unspec testis 533.90 Peptic ulcer, unspecifiec

183.0 Malignant neoplasm of the ovary 570 Necrosis of the liver

632 Missed abortion 704.00 Hair loss

338.3 Neoplasm related pain V08 Asymptomatic HIV infection status

795.89 Other abnormal tumor markers V12.3 Hx of anemia

625.9 Pelvic pain, female V12.1 Hx of nutirtional deficiency

640.00 Threatened abortion 790.4 Elevated transaminase or LDH

HEPATITIS PANEL, ACUTE LIPID AND CHOLESTEROL

789.00 Abdominal pain, unspecified 585.9 Chronic renal failure, unspecified

794.8 Abnormal liver scan 428.0 Congestive Heart failure (CHF)

783.1 Abnormal weight gain 414.00 Coronary atherosclerosis (CAD)

783.21 Abnormal weight loss 250.00 Diabetes mellitus, unspecified

783.0 Anorexia 272.4 Hyperlipidemia, unspecified

571.5 Cirrhosis of liver,unspecified 401.9 Hypertension, essential, unspecified

790.4 Elevated transaminase or LDH 244.9 Hypothyroidism

573.3 Hepatitis, unspecified V58.69 Long term (current) use of other meds

789.1 Hepatomegaly 263.9 Malnutrition, unspecified

782.4 Jaundice, not of newbown 278.00 Obesity

V72.85 Liver transplant recipient evaluation V81.2

789.61 Localized tenderness (RUQ)

787.01 Nausea and vomiting NTX - Collagen Cross Links

780.79 Other malaise and fatigue 242.90 Hyperthyroidism

070.9 Viral hepatitis, unspecified V58.69 Long term(current)use of other meds

HIV 733.00 Osteoporosis

783.21 Abnormal loss of weight 621.7 Postmenopausal bleeding

786.4 Abnormal sputum 256.9 Unspecified ovarian dysfunction

285.9 Anemia, unspecified OCCULT BLOOD; FECES SCREENING

112.9 Candidiasis, site unspecified 789.00 Abdominal pain, site unspecified

682.9 Cellulitis, unspecified site 783.21 Abnormal loss of weight

786.2 Cough 280.9 Anemia, Iron Deficiency

294.8 Dementia 285.9 Anemia, unspecified

787.91 Diarrhea 787.91 Diarrhea

780.60 Fever, unspecified 578.9 GI bleed

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

486 Pneumonia, unspecified

070.9 Viral hepatitis, unspecified

HIV Viral Load

042 HIV disease

V08 Asymptomatic HIV infection status

079.53 HIV Type 2

Screening for unspec cardiovascular

condition (allowed 1x every 5years)

131 April 2013

Common ICD-9 Codes

PROSTATE SPECIFIC ANTIGEN (PSA) THYROID TESTING

600.00 BPH, Benign prostate hypertrophy 783.21 Abnormal loss of weight

790.93 Elevated prostate specific antigen 783.1 Abnormal weight gain

599.70 Hematuria 331.0 Alzheimer's disease

185 Malignant neoplasm of prostate 285.9 Anemia, unspecified

788.43 Nocturia 300.00 Anxiety, unspecified

V10.46 Personal history of prostate cancer 427.31 Atrial fibrillation

788.20 Retention of urine, unspecified 428.0 Congestive heart failure (CHF)

V76.44 Screening Code - freq limitation 564.00 Constipation, unspecified

602.9 Unspecified disorder of prostate 294.8 Dementia

601.9 Unspecified prostatitis 311 Depression

788.63 Urgency of urination 250.00 Diabetes mellitus, unspecified

788.41 Urinary frequency 780.60 Fever

788.30 Urinary incontinence, unspecified 240.9 Goiter, unspecified

599.60 Urinary obstruction, unspecified 272.4 Hyperlipidemia, unspecified

PROTHROMBIN TIME (PT) 401.9 Hypertension Essential unspecified

790.92 Abnormal coagulation profile 242.90 Hyperthyroidism, unspecified

427.31 Atrial fibrillation 244.9 Hypothyroidism, unspecified

434.91 Cerebrovascular accident (CVA) V58.69 Long term (current) use of other meds

585.9 Chronic renal failure, unspecified 780.79 Malaise and fatigue

V12.50 Circulatory Disease, unspecified 780.93 Memory Loss

286.9 Coagulation defect, unspecified 782.0 Numbness

428.0 Congestive heart failure (CHF) 785.1 Palpitations

414.00 Coronary atherosclerosis (CAD) 290.0 Senile dementia, uncomplicated

562.11 Diverticulitis of colon, w/o hemorrhage URINE CULTURE

782.3 Edema 789.00 Abdominal pain, unspecified

599.70 Hematuria 724.5 Backache, unspecified

V58.61 Long term (current) use of anticoags 790.7 Bacteremia

443.9 Peripheral vascular disease, unspec 585.9 Chronic renal failure, unspecified

586 Renal failure, unspecified 780.60 Fever

786.05 Shortness of breath 599.70 Hematuria

780.2 Syncope and collapse V58.69 Long term (current) use of other meds

453.9 Thrombosis of unspecified site 780.93 Memory loss

281.9 Unspecified Deficiency Anemia 780.97 Mental status changes

PARTIAL THROMBOPLASTIN TIME (PTT) 791.9 Nonspecific findings on exam of urine

427.31 Atrial fibrillation 780.79 Other malaise and fatigue

786.50 Chest pain, unspecified 038.9 Septicemia, unspecified

585.9 Chronic renal failure, unspecified 599.0 Urinary tract infection

571.5 Cirrhosis of the liver, unspecified VITAMIN D

286.9 Coagulation defects, unspecified 579.0 Celiac disease

428.0 Congestive heart failure (CHF) Chronic kidney disease (Stage III through

820.8 Fracture, hip

599.70 Hematuria 275.42 Hypercalcemia

V58.61 Long term (current) use of anticoags 252.00 Hyperparathyroidism, unspecified

786.05 Shortness of breath 733.00 Osteoporosis unspecified

780.2 Syncope 571.9 Unspecified chronic liver disease

268.9 Unspecified vitamin D deficiency

585.3 -

585.6

132 April 2013

2013 billing guide - tri-cities laboratories

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