Medicare National Coverage Decision: Culture, Bacterial, Urine
Other
Names/Abbreviations: Urine culture
87086 Culture, bacterial; quantitative, colony count, urine.
87088 Culture, bacterial; with isolation and presumptive identification of isolates, urine
87184 Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents).
87186 Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration (MIC) or breakpoint), each multiantimicrobial, per plate.
003.1 Salmonella septicemia
038.0-038.9 Septicemia
276.2 Acidosis
276.4 Metabolic acidosis/alkalosis
286.6 Defibrination syndrome/disseminated intravascular coagulation
288.0 Agranulocytosis/neutropenia
288.8 Other specified disease of white blood cells including leukemoid reaction/leukocytosis
306.53 Psychogenic dysuria
306.59 Other psychogenic genitourinary malfunction
518.82 Other pulmonary insufficiency, not elsewhere classified
570 Acute and subacute necrosis of liver
580.0-580.9
Acute glomerulonephritis
583.0-583.9 Nephritis and Nephropathy, not specified as acute or chronic
584.5 Acute renal failure, with lesion of tubular necrosis
584.9 Acute renal failure, unspecified
585 Chronic renal failure
586 Renal failure, unspecified
590.00-590.9 Infections of kidney/pyelonephritis acute and chronic
592.0-592.9 Calculus of kidney and ureter
593.0-593.9 Other disorders of kidney and ureter (cyst, stricture, obstruction, reflux, etc.)
594.0-594.9 Calculus of lower urinary tract
595.0-595.9 Cystitis
597.0 Urethritis, not sexually transmitted and urethral syndrome
597.80-597.89 Other urethritis
598.00-598.01 Urethral stricture due to infection
599.0 Urinary tract infection, site not specified
599.7 Hematuria
600.0-600.9 Hyperplasia of prostate
601.0-601.9 Inflammatory diseases of prostate
602.0-602.9 Other disorders of prostate (calculus, congestion, atrophy, etc.)
604.0-604.99 Orchitis and epididymitis
608.0-608.9 Other disorders of male genital organs (seminal vesiculitis, spermatocele, etc.)
614.0-614.9 Inflammatory disease of ovary, fallopian tube, pelvic cellular tissue, and peritoneum
615.0-615.9 Inflammatory disease of uterus, except cervix
616.0 Cervicitis and endocervicitis
616.10-616.11 Vaginitis and vulvovaginitis
616.2-616.9 Other inflammatory conditions of cervix, vagina and vulva
619.0-619.9
Fistula involving female genital tract
625.6 Stress incontinence, female
639.0 Genital tract and pelvic infection complicating abortion, ectopic or molar pregnancies
639.5 Shock complicating abortion, ectopic or molar pregnancies
646.60-646.64 Infections of genitourinary tract in pregnancy
670.00-670.04 Major puerperal infection
672.00-672.04 Pyrexia of unknown origin during the puerperium
724.5 Backache, unspecified
780.2 Syncope and collapse
780.6 Fever (Hyperthermia)
780.79 Other malaise and fatigue
780.9 Other general symptoms (altered mental status, chills, generalized pains)
785.0 Tachycardia, unspecified
785.50-785.59 Shock without mention of trauma
788.0-788.9 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 pain
789.60-789.69 Abdominal tenderness
790.7 Bacteremia
791.0-791.9 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 urethra
939.3 Foreign body in genitourinary tract, penis
V55.5-V55.6 Attention to cystostomy or other artificial opening of urinary tract
V72.84 Pre-operative examination, unspecified
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0
- V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydia diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
Other Names/Abbreviations: HIV, HIV-1, HIV-2, HIV1/2, HTLV III, Human T-cell lymphotropic virus, AIDS, Acquired immune deficiency syndrome
86689 Qualitative or semiquantitative immunoassays performed by multiple step methods; HTLV or HIV antibody, confirmatory test (for example, Western Blot)
86701 Qualitative or semiquantitative immunoassays performed by multiple step methods; HIV-1
86702 Qualitative or semiquantitative immunoassays performed by multiple step methods; HIV-2
86703 Qualitative or semiquantitative immunoassays performed by multiple step methods; HIV-1 and HIV-2, single assay
87390 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; HIV-1
87391 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; HIV-2
87534 Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, direct probe technique
87535 Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, amplified probe technique
87537 Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, direct probe technique
87538 Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, amplified probe technique
ICD-9-CM Codes Covered by Medicare Program
for 86689, 86701, 86702, 86703, 87390, 87391, 87534, 87535, 87537, 87538
003.1 Salmonella septicemia
007.2 Coccidiosis (Isoporiasis)
007.4 Cryptosporidiosis
007.8 Other specified protozoal intestinal diseases
010.00-010.96 Primary tuberculous infection
011.00-011.96 Pulmonary tuberculosis
012.00-012.86 Other respiratory tuberculosis
013.00-013.96 Tuberculosis of meninges and central nervous system
014.00-014.86 Tuberculosis of intestines, peritoneum and mesenteric glands
015.00-015.96 Tuberculosis of bones and joints
016.00-016.96 Tuberculosis of genitourinary system
017.00-017.96 Tuberculosis of other organs
018.00-018.96 Miliary tuberculosis
027.0 Listeriosis
031.0-031.9 Diseases due to other mycobacteria
038.2 Pneumococcal septicemia
038.43 Septicemia (Pseudomonas)
039.0-039.9 Actinomycotic infections (includes Nocardia)
041.7 Pseudomonas infection
042 HIV disease (Acute retroviral syndrome, AIDS-related complex)
046.3 Progressive multifocal leukoencephalopathy
049.0-049.9 Other non-arthropod-borne viral diseases of central nervous system
052.0-052.8 Chickenpox (with complication)
053.0-053.9 Herpes zoster
054.0-054.9 Herpes simplex
055.0-055.8 Measles (with complication)
070.20-070.23 Viral hepatitis B with hepatic coma
070.30-070.33 Viral hepatitis B without mention of hepatic coma
070.41 Acute or unspecified hepatitis C with hepatic coma
070.42 Hepatitis delta without mention of active hepatitis B disease with hepatic coma
070.44 Chronic hepatitis C with hepatic coma
070.49 Other specified viral hepatitis with hepatic coma
070.51 Acute or unspecified hepatitis C without hepatic coma
070.52 Hepatitis delta without mention of active hepatitis B disease without hepatic coma
070.54 Chronic hepatitis C without hepatic coma
070.59 Other specified viral hepatitis without hepatic coma
070.6 Unspecified viral hepatitis with hepatic coma
070.9 Unspecified viral hepatitis without hepatic coma
078.0 Molluscum contagiosum
078.10-078.19 Viral warts
078.3 Cat-scratch disease
078.5 Cytomegaloviral disease
078.88 Other specified diseases due to Chlamydiae
079.50 Retrovirus unspecified
079.51 HTLV-I
079.52 HTLV-II
079.53 Human immunodeficiency virus, type 2
079.59 Other specified Retrovirus
079.88 Other specified chlamydial infection
079.98 Unspecified chlamydial infection
085.0-085.9 Leishmaniasis
088.0 Bartonellosis
090.0-090.9 Congenital syphilis
091.0-091.9 Early syphilis symptomatic
092.0-092.9 Early syphilis, latent
093.0-093.9 Cardiovascular syphilis
094.0-094.9 Neurosyphilis
095.0-095.9 Other forms of late syphilis, with symptoms
096 Late syphilis, latent
097.0-097.9 Other and unspecified syphilis
098.0-098.89 Gonococcal infections
099.0 Chancroid
099.1 Lymphogranuloma venereum
099.2 Granuloma inguinale
099.3 Reiter’s disease
099.40-099.49 Other nongonococcal urethritis
099.50-099.59 Other venereal diseases due to Chlamydia trachomatis
99.8 Other specified venereal disease
99.9 Veneral Disease unspecified
110.1 Dermatophytosis of nail
111.0 ityriasis versicolor
112.0-112.9 Candidiasis
114.0-114.9 Coccidioidomycosis
115.00-115.99 Histoplasmosis
116.0-116.2 Blastomycotic infection
117.3 Aspergillosis
117.5 Cryptococcosis
118 Opportunistic mycoses
127.2 Strongyloidiasis
130.0-130.9 Toxoplasmosis
131.01 Trichomonal vulvovaginitis
132.2 Phthirus pubis
133.0 Scabies
136.2 Specific infections by free living amebae
136.3 Pneumocystosis
136.8 Other specified infectious and parasitic disease (for example, microsporidiosis)
176.0-176.9 Kaposi’s sarcoma
180.0-180.9 Malignant neoplasm of cervix uteri
200.20-200.28 Burkitt’s tumor or lymphoma
200.80-200.88 Lymphosarcoma, other named variants
201.00-201.98 Hodgkin’s disease
263.0 Malnutrition of moderate degree
263.1 Malnutrition of mild degree
263.9 Unspecified protein-calorie malnutrition
280.0-280.9 Iron deficiency anemias
285.9 Anemia, unspecified
287.3 Primary thrombocytopenia
288.0 Agranulocytosis
288.8 Other specified disease of white blood cells
294.8 Other specified organic brain syndromes (chronic)
310.1 Organic personality syndrome
322.2 Chronic meningitis
336.9 Unspecified disease of spinal cord
348.3 Encephalopathy unspecified
354.0-354.9 Mononeuritis of upper limbs and mononeuritis multiplex
356.8 Other specified idiopathic peripheral neuropathy
363.20 Chorioretinitis, unspecified
425.4 Other primary cardiomyopathies
473.0-473.9 Chronic sinusitis
481-482.9 Pneumococcal pneumonia
484.1 Pneumonia in cytomegalic inclusion disease
486 Pneumonia, organism unspecified
512.8 Other spontaneous pneumothorax
516.8 Other specified alveolar and parietoalveolar pneumonopathies
528.2 Oral aphthae
528.6 Leukoplakia of oral mucosa
530.2 Ulcer of esophagus
583.9 Nephropathy with unspecified pathological lesion in kidney
588.8 Other specified disorders resulting from impaired renal function
647.60-647.64 Other viral diseases complicating pregnancy (use for HIV I and II)
682.0-682.9 Other cellulitis and abscess
690.10-690.18 Seborrheic dermatitis
696.1 Other psoriasis
698.3 Lichenification and lichen simplex chronicus
704.8 Other specified diseases of hair and hair follicles
706.0-706.9 Diseases of sebaceous glands
780.6 Fever
780.79 Other malaise and fatigue
783.21 Abnormal loss of weight
783.40 Lack of expected normal physiological development
785.6 Enlargement of lymph nodes
786.00 Respiratory abnormality, unspecified
786.05 Shortness of breath
786.2 Cough
786.3 Hemoptysis
786.4 Abnormal sputum
787.91 Diarrhea
795.71 Nonspecific serologic evidence of human immunodeficiency virus
799.4 Wasting disease
V01.7 Contact with or exposure to communicable diseases, other viral diseases
V71.5
Rape
ICD-9-CM Codes Denied for 86689, 86701,
86702, 86703, 87390, 87391, 87534, 87535, 87537, 87538: Use GY modifier to
indicate a non-covered service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7
Family history of malignant neoplasm, other lymphatic and hematopoietic
neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydia diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0
- V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That Do Not
Support Medical Necessity for 86689, 86701, 86702, 86703, 87390, 87391, 87534,
87535, 87537, 87538: Use GA modifier if
ABN signed OR GZ modifier if ABN is not signed
Any
ICD-9-CM code not listed in either of the ICD-9-CM 86689, 86701, 86702, 87390,
87391, 87534, 87535, 87537, 87538 sections.
Medicare
National Coverage Decision: Blood Counts
Other Names/Abbreviations: CBC
85007 Blood count; manual differential WBC count (includes RBC morphology and platelet estimation)
85008 Blood counts, manual blood smear examination without differential parameters
85013 Blood counts, Spun microhematocrit
85014 Blood counts, Other than spun hematocrit
85018 Blood counts, Hemoglobin
85021 Blood counts, Hemogram, automated (RBC, WBC, Hgb, Hct, and indices only)
85022 Blood counts, Hemogram, automated, and manual differential WBC count (CBC)
85023 Blood counts, Hemogram and platelet count, automated, and manual differential WBC count (CBC)
85024 Blood counts, Hemogram and platelet count, automated, and automated partial differential WBC count (CBC)
85025 Hemogram and platelet count, automated and automated complete differential WBC count (CBC)
85027 Blood counts, Hemogram and platelet count, automated
85031 Blood count; hemogram, manual, complete CBC (RBC, WBC, Hgb, Hct, differential and indices
85048 Blood counts, White blood cell (WBC)
85590 Platelet; manual count
85595 Platelet, automated count
Any ICD-9-CM code not listed in either of the ICD-9-CM 85007, 85008, 85013, 85014, 85018, 85021, 85022, 85023, 85024, 85025, 85027, 85031, 85048, 85590, 85595 sections.
ICD-9-CM Codes Denied
for 85007, 85008, 85013, 85014, 85018, 85021, 85022, 85023, 85024, 85025,
85027, 85031, 85048, 85590, 85595: Use GY modifier to indicate a non-covered
service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9
Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydia diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That Do Not
Support Medical Necessity for 85007, 85008, 85013, 85014, 85018, 85021, 85022,
85023, 85024, 85025, 85027, 85031, 85048, 85590, 85595: Use GA modifier if ABN signed OR GZ modifier
if ABN is not signed
078.10-078.19 Viral warts
210.0-210.9 Benign neoplasm of lip, oral cavity, and pharynx
214.0 Benign neoplasm of skin
217 Benign neoplasm of breast
222.0-222.9 Benign neoplasm of male genital organs
224.0 Benign neoplasm of eyeball, except conjunctiva, cornea, retina, and choroid
230.0 Carcinoma in situ of lip, oral cavity and pharynx
232.0-232.9 Carcinoma in situ of skin
300.00-300.09 Neurotic disorders
301.0-301.9 Personality disorders
302.0-302.9 Sexual deviations and disorders
307.0 Stammering and stuttering
307.20-307.23 Tics
307.3 Stereotyped repetitive movements
307.80-307.89 Psychalgia
312.00-312.9 Disturbance of conduct, not elsewhere classified
313.0-313.9 Disturbance of emotions specific to childhood and adolescence
314.00-314.9 Hyperkinetic syndrome of childhood
363.30-363.35 Chorioretinal scars
363.40-363.43 Choroidal degeneration
363.50-363.57 Hereditary choroidal dystrophies
363.70-363.9 Choroidal detachment
366.00-366.9 Cataract
367.0-367.9 Disorders of refraction and accommodation
371.00-371.9 Corneal opacity and oother disorders of cornea
373.00-373.9 Inflammation of eyelids
375.00-375.9 Disorders of lacrimal system
376.21-376.9
Disorders of the orbit, except 376.3 Other exophthalmic conditions
377.10-377.16 Optic atrophy
377.21-377.24 Other disorders of optic disc
384.20-384.25 Perforation of tympanic membrane
384.81-384.82 Other specified disorders of tympanic membrane
385.00-385.9 Other disorders of middle ear and mastoid
387.0-387.9 Otosclerosis
388.00-388.5
Other disorders of ear
389.00-389.9 Hearing loss
440.0-440.1 Atherosclerosis of aorta and renal artery
443.81-443.9 Other and unspecified peripheral vascular disease
448.1 Capillary nevus, non neoplastic
457.0 Postmastectomy lymphedema syndrome
470 Deviated nasal septum
471.0-471.9 Nasal polyps
478.0 Hypertrophy of nasal turbinates
478.4 Polyp of vocal cord or larynx
520.0-520.9 Disorders of tooth development and eruption
521.0-521.9 Diseases of hard tissues of teeth
524.00-524.9 Dentofacial anomalies, including malocclusion
525.0-525.9 Other diseases and conditions of teeth and supporting structures
526.0-526.3 Diseases of the jaws
527.6-527.9 Diseases of salivary glands
575.6 Cholesterolosis of gallbladder
600.0-600.9 Hyperplasia of prostate
603.0 Encysted hydrocele
603.8 Other specified types of hydrocele
603.9 Hydrocele, unspecified
605 Redundant prepuce and phimosis
606.0-606.1 Infertility, male azoospermia and oligospremia
608.1 Spermatocele
608.3 Atrophy of testis
610.0-610.9 Benign mammary dysplasia
611.1-611.6 Other disorders of breast
611.9 Unspecified breast disorder
616.2 Cyst of Bartholin's gland
618.0-618.9 Genital prolapse
620.0-620.3 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 disorders
628.0-628.9 Infertility, female
676.00-676.94 Other disorders of breast associated with childbirth and disorders of lactation
691.0-691.8 Atopic dermatitis and related disorders
692.0-692.9 Contact dermatitis and other eczema
700 Corns and callosities
701.0-701.9
Other hypertrophic and atrophic conditions of skin
702.0-702.8 Other dermatoses
703.9 Unspecified disease of nail
706.0-706.9 Diseases of sebaceous glands
709.00-709.4 Other disorders of skin and subcutaneous tissue
715.00-715.98 Osteoarthrosis
716.00-716.99 Other and unspecified arthropathies
718.00-718.99 Other derangement of joint
726.0-726.91 Peripheral enthesopathies and allied syndromes
727.00-727.9 Other disorders of synovium, tendon, and bursa
728.10-728.85 Disorders of muscle ligament and fascia
732.0-732.9 Osteochondropathies
733.00-733.09 Osteoporosis
734 Flat foot
735.0-735.9 Acquired deformities of toe
736.00-736.9 Other acquired deformities of limb
737.0-737.9 Curvature of spine
738.0-738.9 Other acquired deformity
739.0-739.9 Nonallopathic lesions, not elsewhere classified
830.0-839.9 Dislocations
840.0-848.9 Sprains and strains of joints and adjacent muscles
905.0-909.9 Late effects of musculoskeletal and connective tissue injuries
910.0-919.9 Superficial injuries
930.0-932 Foreign body on external eye, in ear, in nose
955.0-957.9 Injury to peripheral nerve
V03.0-V06.9 Need for prophylactic vaccination
V11.0-V11.9 Personal history of mental disorder
V14.0-V14.8 Personal history of allergy to medicinal agents
V16.0 Family history of malignant neoplasm, gastrointestinal tract
V16.3 Family history of malignant neoplasm, breast
V21.0-V21.9 Constitutional states in development
V25.01-V25.9 Encounter for contraceptive management
V26.0-V26.9 Procreative management
V40.0-V40.9 Mental and behavioral problems
V41.0-V41.9
Problems with special senses and other special functions
V43.0-V43.1 Organ or tissue replaced by other means, eye globe or lens
V44.0-V44.9 Artificial opening status
V45.00-V45.89 Other post surgical states
V48.0-V48.9 Problems with head, neck, and trunk
V49.0-V49.9 Other conditions influencing health status
V51 Aftercare involving the use of plastic surgery
V52.0-V52.9 Fitting and adjustment of prosthetic device and implant
V53.01-V53.09 Fitting and adjustment of devices related to nervous system and special senses
V53.1 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
V53.5 Fitting and adjustment of other intestinal appliance
V53.6 Fitting and adjustment of urinary devices
V53.7 Fitting and adjustment of orthopedic devices
V53.8 Fitting and adjustment of wheelchair
V53.9 Fitting and adjustment of other and unspecified device
V54.0-V54.9 Other orthopedic aftercare
V55.0-V55.9 Attention to artificial openings
V57.0-V57.9 Care involving use of rehabilitation procedures
V58.5 Orthodontics
V59.0-V59.9 Donors
V61.0-V61.9 Other family circumstances
V62.2-V62.9 Other psychosocial circumstances
V65.2 Person feigning illness
V65.3 Dietary surveillance and counseling
V65.40-V65.49 Other counseling, not elsewhere classified
V65.5 Person with feared complaint in whom no diagnosis was made
V65.8 Other reasons for seeking consultation
V65.9 Unspecified reason for consultation
V66.0-V66.9 Convalescence and palliative care
V67.3 Follow-up examination following psychotherapy
V67.4 Follow-up examination following treatment of healed fracture
V69.3 Problems related to lifestyle, gambling and betting
V71.01-V71.09 Observation and evaluation for suspected conditions not found, mental
V72.0-V72.2 Special investigations, examination of eyes and vision, ears and hearing, dental
V72.4-V72.7 Special investigations, preganancy exam, radiologic exam, laboratory exam, diagnostic skin and sensitization tests
V72.9 Special investigation, unspecified
V76.10-V76.19 Special screening for malignant neoplasms, breast
V76.2 Special screening for malignant neoplasms, cervix
Medicare National
Coverage Decision: Partial Thromboplastin Time
Other Names/Abbreviations: PTT
85730 Thromboplastin
time, partial (PTT); plasma or whole blood
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 Clonorchiasis
121.3 Fascioliasis
124 Trichinosis
135 Sarcoidosis
155.0-155.2 Malignant neoplasm of liver and intrahepatic bile ducts
197.7 Malignant neoplasm of liver, specified as secondary
238.4 Polycythemia vera
238.7 Other lymphatic and hemapoietic tissues
239.9 Neoplasm of unspecified nature, site unspecified
246.3 Hemorrhage and infarction of thyroid
250.40-250.43 Diabetic with renal manifestations
269.0 Deficiency of Vitamin K
273.0-273.9 Disorders of plasma protein metabolism
275.0-275.9 Disorders of iron metabolism
277.1 Disorders of porphyrin metabolism
277.3 Amyloidosis
285.1 Acute posthemorrhagic anemia
286.0 Congenital factor VIII disorder - Hemophilia A
286.1 Congenital factor IX disorder - Hemophilia B
286.2-286.3 Other congenital factor deficiencies
286.4 von Willebrand's disease
286.5 Hemorrhagic disorder due to circulating anticoagulants
286.6 Defibrination syndrome
286.7 Acquired coagulation factor deficiency
286.9 Other and unspecified coagulation defects
287.0-287.9 Purpura and other hemorrhagic conditions
289.0 Polycythemia, secondary
325 Phlebitis and thrombophlebitis of intracranial venous sinuses
360.43 Hemophthalmos, except current injury
362.30-362.37 Retinal vascular occlusion
362.43 Hemorrhagic detachment of retinal pigment epithelium
362.81 Retinal hemorrhage
363.61-363.63 Choroidal hemorrhage
363.72 Choroidal detachment
368.9 Unspecified Visual Disturbances
372.72 Conjunctive hemorrhage
374.81 Hemorrhage of eyelid
376.32 Orbital hemorrhage
377.42 Hemorrhage in optic nerve sheaths
379.23 Vitreous hemorrhage
380.31 Hematoma of auricle or pinna
403.01, 403.11, 403.91 Hypertensive Renal Disease with renal failure
404.02, 404.12, 404.92 Hypertensive Heart and Renal Disease with renal failure
410.00-410.92 Acute myocardial infarction
423.0 Hemopericardium
427.31 Atrial fibrillation
427.9 Cardiac dysrhythmias, unspecified
428.0 Congestive heart failure
429.79 Mural thrombus
430-432.9 Cerebral hemorrhage
433.00-433.91 Occlusion and stenosis of precerebral arteries
434.00-434.91 Occlusion of cerebral arteries
435.9 Focal neurologic deficit
444.0-444.9 Arterial embolism and thrombosis
446.6 Thrombotic microangiopathy
447.2 Rupture of artery
448.0 Hereditary Hemorrhagic telangiectasia
451.0-451.9 Phlebitis and thrombophlebitis
453.0-453.9 Other Venous emboli and thrombosis
456.0 Esophageal varices with bleeding
456.1 Esophageal varices without bleeding
456.8 Varices of other sites
459.89 Ecchymosis
530.7 Gastroesophageal laceration – hemorrhage syndrome
530.82 Esophageal hemorrhage
531.00-535.61 Gastric-Duodenal ulcer disease
537.83 Angiodysplasia of stomach and duodenum with hemorrhage
556.0-557.9 Hemorrhagic bowel disease
562.02-562.03 Diverticulosis of small intestine with hemorrhage
562.12 Diverticulosis of colon with hemorrhage
562.13 Diverticulitis of colon with hemorrhage
568.81 Hemoperitoneum (nontraumatic)
569.3 Hemorrhage of rectum and anus
570 Acute and subacute necrosis of liver
571.0-573.9 Liver disease (in place of specific codes listed)
576.0-576.9 Biliary tract disorders
577.0 Acute pancreatitis
578.0-578.9 Gastrointestinal Hemorrhage
579.0-579.9 Malabsorption
581.0-581.9 Nephrotic Syndrome
583.9 Nephritis, with unspecified pathological lesion in kidney
584.5-584.9 Acute Renal Failure
585 Chronic Renal Failure
586 Renal failure
593.81-593.89 Other disorders of kidney and ureter, with hemorrhage
596.7 Hemorrhage into bladder wall
596.8 Other disorders of bladder, with hemorrhage
599.7 Hematuria
607.82 Penile hemorrhage
608.83 Vascular disorders of male genital organs
611.8 Hematoma of breast
620.7 Hemorrhage of broad ligament
621.4 Hematometra
622.8 Other specified disorders of cervix, with hemorrhage
623.6 Vaginal hematoma
623.8 Other specified diseases of the vagina, with hemorrhage
624.5 Hematoma of vulva
626.6 Metrorrhagia
626.7 Postcoital bleeding
627.0 Premenopausal bleeding
627.1 Postmenopausal bleeding
629.0 Hematocele female not elsewhere classified
632 Missed abortion
634.00-634.92 Spontaneous abortion
635.10-635.12 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
639.1 Delayed or excessive hemorrhage following abortion and ectopic and molar pregnancies
639.6 Complications following abortion and ectopic and molar pregnancies, embolism
640.00-640.93 Hemorrhage in early pregnancy 641.00-641.93 Antepartum hemorrhage
642.00-642.94 Hypertension complicating pregnancy, childbirth, and the puerperium
646.70-646.73 Liver disorders in pregnancy
656.00-656.03 Fetal maternal hemorrhage
658.40-658.43 Infection of amniotic cavity
666.00-666.34 Postpartum hemorrhage
671.20-671.54 Phlebitis in pregnancy
673.00-673.84 Obstetrical pulmonary embolus
674.30-674.34 Other complications of surgical wounds, with hemorrhage
710.0 Systemic Lupus erythematosus
713.2 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 Hemarthrosis
729.5 Leg pain/calf pain
733.10-733.19 Pathologic fracture associated with fat embolism
762.1 Other forms of placental separation with hemorrhage (affecting newborn code – do not assign to mother’s record)
764.90-764.99 Fetal intrauterine growth retardation
767.0-767.1 Subdural and cerebral hemorrhage
767.8 Other specified birth trauma, with hemorrhage
770.3 Fetal and newborn pulmonary hemorrhage
772.0-772.9 Fetal and neonatal hemorrhage
774.0-774.7 Other perinatal jaundice
776.0-776.9 Hemorrhagic disease of the newborn
780.2 Syncope
782.4 Jaundice, unspecified, not of newborn
782.7 Spontaneous ecchymoses Petechiae
784.7 Epistaxis
784.8 Hemorrhage from throat
785.4 Gangrene
785.50 Shock
786.05 Shortness of breath
786.3 Hemoptysis
786.50 Chest pain, unspecified
786.59 Chest pain
789.00-789.09 Abdominal pain
790.92 Abnormal coagulation profile
800.00-800.99 Fracture of vault of skull
801.00-801.99 Fracture of base of skull
802.20-802.9 Fracture of face bones
803.00-803.99 Other fracture, skull
804.00-804.99 Multiple fractures, skull
805.00- 806.9 Fracture, vertebral column
807.00-807.09 Fractures of rib(s), closed
807.10-807.19 Fracture of rib(s), open
808.8-808.9 Fracture of pelvis
809.0-809.1 Fracture of trunk
810.00-810.13 Fracture of clavicle
811.00-811.19 Fracture of scapula
812.00-812.59 Fracture of humerus
813.10-813.18 Fracture of radius and ulna, upper end, open
813.30-813.33 Fracture of radius and ulna, shaft, open
813.50-813.54 Fracture of radius and ulna, lower end, open
813.90-813.93 Fracture of radius and ulna, unspecified part, open
819.0-819.1 Multiple fractures
820.00–821.39 Femur
823.00-823.92 Tibia and fibula
827.0–829.1 Other multiple lower limb
852.00–853.19 Subarachnoid subdural, and extradural hemorrhage, following injury, Other and specified intracranial hemorrhage following injury
860.0-860.5 Traumatic pneumothorax and hemothorax
861.00-861.32 Injury to heart and lung
862.0-862.9 Injury to other and unspecified intrathoracic organs
863.0-863.99 Injury to gastrointestinal tract
864.00-864.19 Injury to liver
865.00-865.19 Injury to spleen
866.00-866.13 Injury to kidney
867.0-867.9 Injury to pelvic organs
868.00-868.19 Injury to other intra-abdominal organs
869.0-869.1 Internal injury to unspecified or ill defined organs
900.00-900.9 Injury to blood vessels of head and neck
901.0-901.9 Injury to blood vessels of the thorax
902.0-902.9 Injury to blood vessels of the abdomen and pelvis
903.00-903.9 Injury to blood vessels of upper extremity
904.0-904.9 Injury to blood vessels of lower extremity and unspecified sites
920 - 924.9 Contusion with intact skin surface
925.1-929.9 Crushing injury
958.2 Secondary and recurrent hemorrhage
959.9 Injury, unspecified site
964.2 Poisoning by anticoagulants
964.5 Poisoning by anticoagulant antagonists
964.7 Poisoning by natural blood and blood products
980.0 Toxic effects of alcohol
989.5 Snake venom
995.2 Unspecified adverse effect of drug, medicinal and biological substance (due to correct medicinal substance properly administered)
996.70-996.79 Other complications of internal prosthetic device
997.02 Iatrogenic cerebrovascular infarction or hemorrhage
998.11 Hemorrhage or hematoma complicating a procedure
999.2 Other vascular complications of medical care
V12.3 Personal history of diseases of blood and blood forming organs
V58.2 Admission for Transfusion of blood products
V58.61 Long term (current use) of anticoagulants
V72.81 Pre-operative cardiovascular examination
V72.83 Other specified pre-operative examination
V72.84 Pre-operative examination, unspecified
ICD-9-CM Codes Denied for 85730: Use GY
modifier to indicate a non-covered service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydia diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That Do Not Support Medical Necessity
for 85730: Use GA modifier if ABN
signed OR GZ modifier if ABN is not signed
Any ICD-9-CM code not listed in either of the ICD-9-CM 85730 sections.
Medicare National
Coverage Decision: Prothrombin Time
Other Names/Abbreviations: PT
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
070.0-070.9 Viral hepatitis
075 Infectious mononucleosis
078.6 Hemorrhagic nephrosonephritis
078.7 Arenaviral hemorrhagic fever
084.8 Blackwater fever
120.0 Schistosomiasis
121.1 Clonorchiasis
121.3 Fascioliasis
124 Trichinosis
134.2 Hirudiniasis
135 Sarcoidosis
152.0-152.9 Malignant neoplasm of small intestine, including duodenum
155.0-155.2 Malignant neoplasm of liver and intrahepatic bile ducts
156.0-156.9 Malignant neoplasm of gallbladder and extrahepatic bile ducts
157.0-157.9 Malignant neoplasm of pancreas
188.0-189.9 Malignant neoplasm of bladder, kidney, and other and unspecified urinary organs
198.0 Secondary malignant neoplasm, kidney
198.1 Secondary malignant neoplasm, other urinary organs
200.00-200.88 Lymphosarcoma and reticulosarcoma
202.00-202.98 Other malignant neoplasms of lymphoid and histiocytic tissue
223.0-223.9 Benign neoplasm of kidney and other urinary organs
238.4 Polycythemia vera
238.5 Histocytic and mast cells – neoplasm of uncertain behavior
238.6 Plasma cells – neoplasm of uncertain behavior
238.7 Other lymphatic and hematopoietic tissues
239.4 Neoplasm of unspecified nature, bladder
239.5 Neoplasm of unspecified nature, other genitourinary organs
239.9 Neoplasm of unspecified nature, site unspecified
246.3 Hemorrhage and infarction of thyroid
250.40-250.43 Diabetic with renal manifestations
263.0-263.9 Other and unspecified protein/calorie malnutrition
269.0 Deficiency of Vitamin K
269.2 Unspecified vitamin deficiency
273.0-273.9 Disorders of plasma protein metabolism
275.0 Disorders of iron metabolism
277.1 Disorders of porphyrin metabolism
277.3 Amyloidosis
280.0 Iron deficiency anemia, secondary to blood loss - chronic
280.9 Iron deficiency anemia, unspecified
281.0 Pernicious anemia
281.1 Other Vitamin B12 Deficiency Anemia, NEC
281.9 Unspecified Deficiency Anemia, NOS
285.0 Sideroblastic anemia
285.1 Acute posthemorrhagic anemia
286.0-286.9 Coagulation defects
287.0-287.9 Purpura and other hemorrhagic conditions
290.40-290.43 Arteriosclerotic dementia
325 Phlebitis and thrombophlebitis of intracranial venous sinuses
342.90-342.92 Hemiplegia NOS
360.43 Hemophthalmos, except current injury
362.18 Retinal vasculitis
362.30-362.37 Retinal vascular occlusion
362.43 Hemorrhagic detachment of retinal pigment epithelium
362.81 Retinal hemorrhage
363.61-363.72 Choroidal hemorrhage and rupture, detachment
368.9 Unspecified Visual Disturbances
372.72 Conjunctival hemorrhage
374.81 Hemorrhage of eyelid
376.32 Orbital hemorrhage
377.42 Hemorrhage in optic nerve sheaths
377.53 Disorders of optic chiasm associated with vascular disorders
377.62 Disorders of visual pathways associated with vascular disorders
377.72 Disorders of visual cortex associated with vascular disorders
379.23 Vitreous hemorrhage
380.31 Hematoma of auricle or pinna
386.2 Vertigo of central origin
386.50 Labyrinthine dysfunction, unspecified
394.0-394.9 Diseases of the mitral valve
395.0 Rheumatic aortic stenosis
395.2 Rheumatic aortic stenosis with insufficiency
396.0-396.9 Diseases of mitral and aortic valves
397.0-397.9 Diseases of other endocardial structures
398.0-398.99 Other rheumatic heart disease
403.01, 403.11, 403.91 Hypertensive Renal Disease with renal failure
404.02, 404.12, 404.92 Hypertensive Heart and Renal Disease with renal failure
410.00-410.92 Acute myocardial infarction
411.1 Intermediate coronary syndrome
411.81 Coronary occlusion without myocardial infarction
411.89 Other acute and subacute forms of ischemic heart disease
413.0-413.9 Angina pectoris
414.00-414.05 Coronary atherosclerosis
414.8 Other specified forms of chronic ischemic heart disease
414.9 Chronic ischemic heart disease, unspecified
415.0-415.19 Acute pulmonary heart disease
416.9 Chronic pulmonary heart disease, unspecified
423.0 Hemopericardium
424.0 Mitral valve disorders
424.1 Aortic valve disorder
424.90 Endocarditis, valve unspecified, unspecified cause
425.0-425.9 Cardiomyopathy
427.0-427.9 Cardiac dysrhythmias
428.0-428.9 Heart failure
429.0-429.4 Ill-defined descriptions and complications of heart disease
429.79 Other certain sequelae of myocardial infarction, not elsewhere classified
430 Subarachnoid hemorrhage
431 Intracerebral hemorrhage
432.0-432.9 Other and unspecified intracranial hemorrhage
433.00-433.91 Occlusion and stenosis of precerebral arteries
434.00-434.91 Occlusion of cerebral arteries
435.0-435.9 Transient cerebral ischemia
436 Acute, but ill-defined cerebrovascular disease
437.0 Cerebral atherosclerosis
437.1 Other generalized ischemic cerebrovascular disease
437.6 Nonpyogenic thrombosis of intracranial venous sinus
440.0-440.9 Atherosclerosis
441.0-441.9 Aortic aneurysm and dissection
443.0-443.9 Other peripheral vascular disease
444.0-444.9 Arterial embolism and thrombosis
447.1 Stricture of artery
447.2 Rupture of artery
447.6 Arteritis, unspecified
448.0 Hereditary hemorrhagic telangiectasia
448.9 Other and unspecified capillary diseases
451.0-451.9 Phlebitis and thrombophlebitis
452 Portal vein thrombosis
453.0-453.9 Other venous embolism and thrombosis
455.2 Internal hemorrhoids with other complication
455.5 External hemorrhoids with other complication
455.8 Unspecified hemorrhoids with other complication
456.0-456.1 Esophageal varices
456.8 Varices of other sites
459.0 Hemorrhage, unspecified
459.1 Postphlebitis syndrome
459.2 Compression of vein
459.81 Venous (peripheral) insufficiency, unspecified
459.89 Other, other specified disorders of circulatory system
511.8 Other specified forms of effusion, except tuberculosis
514 Pulmonary congestion and hypostasis
530.7 Gastroesophageal laceration – hemorrhage syndrome
530.82 Esophageal hemorrhage
531.00-535.61 Gastric ulcer, duodenal ulcer, peptic ulcer, gastrojejunal ulcer, gastritis and duodenitis
555.0-555.9 Regional enteritis
556.0-556.9 Ulcerative colitis
557.0-557.9 Vascular insufficiency of intestine
562.02 - 562.03 Diverticulosis of small intestine with hemorrhage
562.10 Diverticulosis of colon w/o hemorrhage
562.11 Diverticulitis of colon w/o hemorrhage
562.12 Diverticulosis of colon with hemorrhage
562.13 Diverticulitis of colon with hemorrhage
568.81 Hemoperitoneum (nontraumatic)
569.3 Hemorrhage of rectum and anus
571.0-571.9 Chronic liver disease and cirrhosis
572.2 Hepatic coma
572.4 Hepatorenal syndrome
572.8 Other sequelae of chronic liver disease
573.1-573.9 Hepatitis in viral diseases, other and unspecified disorder of liver
576.0-576.9 Other disorders of Biliary tract
577.0 Acute pancreatitis
578.0-578.9 Gastrointestinal hemorrhage
579.0-579.9 Intestinal Malabsorption
581.0-581.9 Nephrotic Syndrome
583.9 Nephritis, with unspecified pathological lesion in kidney
584.5-584.9 Acute Renal Failure
585 Chronic Renal Failure
586 Renal failure, unspecified
593.81-593.89 Other specified disorders of kidney and ureter
596.7 Hemorrhage into bladder wall
596.8 Other specified disorders of bladder
599.7 Hematuria
607.82 Vascular disorders of penis
608.83 Vascular disorders of male genital organs
611.8 Other specified disorders of breast - hematoma
620.7 Hematoma of broad ligament
621.4 Hematometra
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 tract
627.0 Premenopausal menorrhagia
627.1 Postmenopausal bleeding
629.0 Hematocele female, not classified elsewhere
632 Missed abortion
634.10-634.12 Spontaneous abortion, complicated by excessive hemorrhage
635.10-635.12 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 pregnancies
639.6 Complications following abortion and ectopic and molar pregnancies with embolism
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
646.70-646.73 Liver disorders in pregnancy
656.00-656.03 Fetal maternal hemorrhage
658.40-658.43 Infection of amniotic cavity
666.00-666.34 Postpartum hemorrhage
671.20-671.94 Venous complications in pregnancy and the puerperium except legs, vulva and perineum
673.00-673.84 Obstetrical pulmonary embolism
674.30-674.34 Other complications of obstetrical surgical wounds
713.2 Arthropathy associated with hematological disorders
713.6 Arthropathy associated with hypersensitivity reaction
719.15 Hemarthrosis pelvic region and thigh
719.16 Lower leg
719.19 Multiple sites
729.5 Pain in limb
733.1 Pathologic fracture, unspecified site
746.00-746.9 Other Congenital anomalies of heart
762.1 Other forms of placental separation and hemorrhage
767.0-767.1 Birth trauma, subdural and cerebral hemorrhage and injury to scalp
767.8 Other specified birth trauma
770.3 Pulmonary hemorrhage
772.0-772.9 Fetal and neonatal hemorrhage
774.6 Unspecified fetal and neonatal jaundice
776.0-776.9 Hemorrhagic disease of the newborn
780.2 Syncope and collapse
782.3 Edema
782.4 Jaundice, unspecified, not of newborn
782.7 Spontaneous ecchymosis
784.7 Epistaxis
784.8 Hemorrhage from throat
785.4 Gangrene
785.50 Shock without mention of trauma
786.05 Shortness of breath
786.3 Hemoptysis
786.59 Chest pain, other
789.00-789.09 Abdominal pain
789.1 Hepatomegaly
789.5 Ascites
790.92 Abnormal coagulation profile
790.94 Euthyroid sick syndrome
791.2 Hemoglobinuria
794.8 Abnormal Liver Function Study
800.00-800.99 Fracture of vault of skull
801.00-801.99 Fracture of base of skull
802.20-802.9 Fracture of face bones
803.00-803.99 Other and unqualified skull fractures
804.00-804.99 Multiple fractures involving skull or face with other bones
805.00-806.9 Fracture, vertebral column
807.00-807.09 Fractures of rib(s), closed
807.10-807.19 Fracture of rib(s), open
808.8-808.9 Unspecified fracture of pelvis
809.0-809.1 Ill-defined fractures of bones of trunk
810.00-810.13 Fracture of clavicle
811.00-811.19 Fracture of scapula
812.00-812.59 Fracture of humerus
813.10-813.18 Fracture of radius and ulna, upper end, open
813.30-813.38 Shaft, open
813.50-813.54 Lower end, open
813.90-813.93 Fracture unspecified part, open
819.0-819.1 Multiple fractures involving both upper limbs, closed and open
820.00-821.39 Fracture of neck of femur
823.00-823.92 Fracture of tibia and fibula
827.0-829.1 Other multiple lower limb
852.00-853.19 Subarachnoid subdural, and extradural hemorrhage, following injury, Other and secified intracranial hemorrhage following injury
860.0-860.5 Traumatic pneumothorax and hemothorax
861.00-861.32 Injury to heart and lung
862.0-862.9 Injury to other and unspecified intrathoracic organs
863.0-863.9 Injury to gastrointestinal tract
864.00-864.19 Injury to liver
865.00-865.19 Injury to spleen
866.00-866.13 Injury to kidney
867.0-867.9 Injury to pelvic organs
868.00-868.19 Injury to other intra-abdominal organs
869.0-869.1 Internal injury to unspecified or ill defined organs
900.00-900.9 Injury to blood vessels of head and neck
901.0-901.9 Injury to blood vessels of the thorax
902.0-902.9 Injury to blood vessels of the abdomen and pelvis
903.00-903.9 Injury to blood vessels of upper extremity
904.0-904.9 Injury to blood vessels of lower extremity and unspecified sites
920-924.9 Contusion with intact skin surface
925.1-929.9 Crushing injury
958.2 Secondary and recurrent hemorrhage
959.9 Injury, unspecified site
964.0-964.9 Poisoning by agents primarily affecting blood constituents
980.0-980.9 Toxic effect of alcohol
981 Toxic effect of petroleum products
982.0-982.8 Toxic effects of solvents other than petroleum-based
987.0-987.9 Toxic effect of other gases, fumes or vapors
989.0-989.9 Toxic effect of other substances chiefly non-medicinal as to source
995.2 Unspecified adverse effect of drug, medicinal and biological substance (due to correct medicinal substance properly administered)
996.82 Complication of transplanted liver
997.02 Iatrogenic cerebrovascular infarction or hemorrhage
997.4 Digestive system complications
998.11-998.12 Hemorrhage or hematoma complicating a procedure
999.2 Other vascular complications
999.8 Other transfusion reactions
V08 Asymptomatic HIV infection
V12.1 History of nutritional deficiency
V12.3 Personal history of diseases of blood and blood-forming organs
V12.50-V12.59 Diseases of circulatory system
V15.1 Personal history of surgery to heart and great vessels
V15.2 Personal history of surgery of other major organs
V42.0 Kidney replaced by transplant
V42.1 Heart replaced by transplant
V42.2 Heart valve replaced by transplant
V42.6 Lung replaced by transplant
V42.7 Liver replaced by transplant
V42.81-V42.89 Other specified organ or tissue replaced by transplant
V43.2 Heart replaced by other means
V43.3 Heart valve replaced by other means
V43.4 Blood vessel replaced by other means
V43.60 Unspecified joint replaced by other means
V58.2 Transfusion of blood products
V58.61 Long-term (current) use of anticoagulants
V72.84 Pre-operative examination, unspecified
ICD-9-CM Codes Denied for 85610: Use GY
modifier to indicate a non-covered service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydia diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That Do Not Support Medical Necessity
for 85610: Use GA modifier if ABN
signed OR GZ modifier if ABN is not signed
Any ICD-9-CM code not listed in either of the ICD-9-CM 85610 sections.
Medicare National
Coverage Decision: Serum Iron Studies
82728 Ferritin
83540 Iron
83550 Iron
Binding capacity
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 joints
016.00-016.06 Tuberculosis of kidney
016.10-016.16 Tuberculosis of bladder
016.20-016.26 Tuberculosis of ureter
016.30-016.36 Tuberculosis of other urinary organs
042 Human Immunodeficiency virus (HIV) disease
070.0-070.9 Viral hepatitis
140.0-149.9 Malignant neoplasm of lip oral cavity and pharynx
150.0-159.9 Malignant neoplasm of digestive organs and peritoneum
160.0-165.9 Malignant neoplasm of respiratory and intrathoracic organs
170.0-176.9 Malignant neoplasm of bone, connective tissue, skin and breast
179-189.9 Malignant neoplasm of genitourinary organs
190.0-199.1 Malignant neoplasm of other and unspecified sites
200.0-208.91 Malignant neoplasm of lymphatic and hematopoietic tissue
210.0-229.9 Benign neoplasms
230.0-234.9 Carcinoma in situ
235.0-238.9 Neoplasms of uncertain behavior
239.0-239.9 Neoplasms of unspecified nature
250.00-250.93 Diabetes mellitus
253.2 Panhypopituitarism
253.7 Iatrogenic pituitary disorders
253.8 Other disorders of the pituitary and other syndromes of diencephalohypophysial origin
256.31-256.39 Other ovarian failure
257.2 Other testicular hypofunction
260 Kwashiorkor
261 Nutritional marasmus
262 Other severe protein-calorie malnutrition
263.0-263.9 Other and unspecified protein-calorie malnutrition
275.0 Disorders of iron metabolism
277.1 Disorders of porphyrin metabolism
280.0-280.9 Iron deficiency anemias
281.0-281.9 Other deficiency anemias
282.4 Thalassemias
285.0 Sideroblastic anemia (includes hemochromatosis with refractory anemia)
285.1 Acute post-hemorrhagic anemia
285.9 Anemia, unspecified
286.0-286.9 Coagulation defects (congenital factor disorders)
287.0-287.9 Purpura and other hemorrhagic conditions
306.4 Physiological malfunction arising from mental factors, gastrointestinal
307.1 Anorexia nervosa
307.50-307.59 Other and unspecified disorders of eating
425.4 Other primary cardiomyopathies
425.5 Alcoholic cardiomyopathy
425.7 Nutritional and metabolic cardiomyopathy
425.8 Cardiomyopathy in other diseases classified elsewhere
425.9 Secondary cardiomyopathy, unspecified
426.0-426.9 Conduction disorders
427.0-427.9 Cardiac dysrhythmias
428.0-428.9 Heart Failure
530.7 Gastroesophageal laceration-hemorrhage syndrome
530.82 Esophageal hemorrhage
531.00-531.91 Gastric ulcer
532.00-532.91 Duodenal ulcer
533.00-533.91 Peptic ulcer, site unspecified
534.00-534.91 Gastrojejunal ulcer
535.00-535.61 Gastritis and duodenitis
536.0-536.9 Disorders of function of stomach
537.83 Angiodysplasia of stomach and duodenum with hemorrhage
555.0-555.9 Regional enteritis
556.0-556.9 Ulcerative colitis
557.0 Acute vascular insufficiency of intestine
557.1 Chronic vascular insufficiency of intestine
562.02 Diverticulosis of small intestine without hemorrhage
562.03 Diverticulitis of small intestine without hemorrhage
562.12 Diverticulosis of colon with hemorrhage
562.13 Diverticulitis of colon with hemorrhage
569.3 Hemorrhage of rectum and anus
569.85 Angiodysplasia of intestine with hemorrhage
570 Acute and subacute necrosis of liver
571.0-571.9 Chronic liver disease and cirrhosis
572.0-572.8 Liver abscess and sequelae of chronic liver disease
573.0-573.9 Other disorders of liver
578.0-578.9 Gastrointestinal hemorrhage
579.0-579.3 Intestinal malabsorption
579.8-579.9 Other specified and unspecified intestinal malabsorption
581.0-581.9 Nephrotic syndrome
585 Chronic renal failure
586 Renal failure, unspecified
608.3 Atrophy of testis
626.0-626.9 Disorders of menstruation and other abnormal bleeding from female genital tract
627.0 Premenopausal menorrhagia
627.1 Postmenopausal bleeding
648.20-648.24 Other current conditions in the mother classifiable elsewhere, but complicating pregnancy, childbirth, or the puerperium: Anemia
698.0-698.9 Pruritus and related conditions
704.00-704.09 Alopecia
709.00-709.09 Dyschromia
713.0 Arthropathy associated with other endocrine and metabolic disorders
716.40-716.99 Other and unspecified arthropathies
719.40-719.49 Pain in joint
773.2 Hemolytic disease due to other and unspecified isoimmunization
773.3 Hydrops fetalis due to isoimmunization
773.4 Kernicterus due to isoimmunization
773.5 Late anemia due to isoimmunization
783.9 Other symptoms concerning nutrition, metabolism and development
790.0 Abnormality of red blood cells
790.4 Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]
790.5 Other nonspecific abnormal serum enzyme levels
790.6 Other abnormal blood chemistry
799.4 Cachexia
964.0 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 marrow
999.8 Other transfusion reaction
V08 Asymptomatic HIV infection
V12.1 Personal history of nutritional deficiency
V12.3 Personal history of diseases of blood and blood forming organs
V15.1 Personal history of surgery to heart and great vessels
V15.2 Personal history of surgery to other major organs
V43.2 Heart replaced by other means
V43.3 Heart valve replaced by other means
V43.4 Blood vessel replaced by other means
V43.60 Unspecified joint replaced by other means
V56.0 Extracorporeal dialysis
V56.8 Other dialysis
V72.84 Pre-operative examination, unspecified
ICD-9-CM Codes Denied for 82728, 83540, 83550, 84466: Use GY modifier to indicate a non-covered service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydia diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That Do Not Support Medical Necessity
for 82728, 83540, 83550, 84466: Use GA
modifier if ABN signed OR GZ modifier if ABN is not signed
Any ICD-9-CM code not listed in either of the ICD-9-CM 82728, 83540, 83550, 84466 sections.
Medicare National
Coverage Decision: Collagen Crosslinks, Any
Method
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
252.0 Hyperparathyroidism
256.2 Postablative ovarian failure
256.3 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
V58.69 Long-term (current) use of other medications
ICD-9-CM Codes Denied for 82523: Use GY modifier to indicate a non-covered service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea,bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydia diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That Do Not Support Medical Necessity
for 82523: Use GA modifier if ABN
signed OR GZ modifier if ABN is not signed
Any ICD-9-CM code not listed in either of the ICD-9-CM 82523 sections.
Medicare National
Coverage Decision: Collagen Crosslinks, Any
Method
82947 Glucose;
quantitative, blood (except reagent strip)
82948 Glucose;
blood, reagent strip
82962 Glucose,
blood by glucose monitoring device(s) cleared by the FDA specifically for home
use.
011.00-011.96 Tuberculosis
038.0-038.9 Septicemia
112.1 Recurrent vaginal candidiasis
112.3 Interdigital candidiasis
118 Opportunistic mycoses
157.4 Malignant neoplasm of Islets of Langerhans
158.0 Malignant neoplasm of retroperitoneum
211.7 Benign neoplasm of Islets of Langerhans
242.00-242.91 Thyrotoxicosis
250.00-250.93 Diabetes mellitus
251.0-251.9 Disorders of pancreatic internal secretion
253.0-253.9 Disorders of the pituitary gland
255.0 Cushing syndrome
263.0-263.9 Malnutrition
271.0-271.9 Disorders of carbohydrate transport and metabolism
272.0-272-4 Disorders of lipoid metabolism
275.0 Hemochromatosis
276.0-276.9 Disorders of fluid, electrolyte and acid-base balance
278.3 Hypercarotinemia
293.0 Acute delirium
294.9 Unspecified organic brain syndrome
298.9 Unspecified psychosis
300.9 Unspecified neurotic disorder
310.1 Organic personality syndrome
337.9 Autonomic nervous system neuropathy
345.10-345.11 Generalized convulsive epilepsy
348.3 Encephalopathy, unspecified
355.9 Neuropathy, not otherwise specified
356.9 Unspecified hereditary and idiopathic peripheral neuropathy
357.9 Unspecified inflammatory and toxic neuropathy
362.10 Background retinopathy
362.18 Retinal vasculitis
362.29 Nondiabetic proliferative retinopathy
362.50-362.57 Degeneration of macular posterior pole
362.60-362.66 Peripheral retinal degeneration
362.81-362.89 Other retinal disorders
362.9 Unspecified retinal disorders
365.04 Borderline glaucoma, ocular hypertension
365.32 Corticosteroid-induced glaucoma residual
366.00-366.09 Presenile cataract
366.10-366.19 Senile cataract
367.1 Acute myopia
368.8 Other specified visual disturbance
373.00 Blepharitis
377.24 Pseudopapilledema
377.9 Unspecified disorder of optic nerve and visual pathways
378.50-378.55 Paralytic strabismus
379.45 Argyll-Robertson pupils
410.00-410.92 Acute myocardial infarctions
414.00-414.19 Coronary atherosclerosis and aneurysm of heart
425.9 Secondary cardiomyopathy, unspecified
440.23 Arteriosclerosis of extremities with ulceration
440.24 Arteriosclerosis of extremities with gangrene
440.9 Arteriosclerosis, not otherwise specified
458.0 Postural hypotension
462 Acute pharyngitis
466.0 Acute bronchitis
480.0-486 Pneumonia
490 Recurrent bronchitis, not specified as acute or chronic
491.0-491.9 Chronic bronchitis
527.7 Disturbance of salivary secretion (drymouth)
528.0 Stomatitis
535.50-535.51 Gastritis
536.8 Dyspepsia
571.8 Other chronic nonalcoholic liver disease
572.0-572.8 Liver abscess and sequelae of chronic liver disease
574.50-574.51 Choledocholithiasis
575.0-575.12 Cholecystitis
576.1 Cholangitis
577.0 Acute pancreatitis
577.1 Chronic pancreatitis
577.8 Pancreatic multiple calculi
590.00-590.9 Infections of the kidney
595.9 Recurrent cystitis
596.4 Bladder atony
596.53 Bladder paresis
599.0 Urinary tract infection, recurrent
607.84 Impotence of organic origin
608.89 Other disorders male genital organs
616.10 Vulvovaginitis
626.0 Amenorrhea
626.4 Irregular menses
628.9 Infertility - female
648.00 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, antipartum 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 applicable
648.83 Abnormal glucose tolerance complicating pregnancy, childbirth or the puerperium, antepartum condition or complication
648.84 Abnormal glucose tolerance complicating pregnancy, childbirth or the puerperium, postpartum condition or complication
656.60-656.63 Fetal problems affecting management of mother - large for-date of fetus
657.00-657.03 Polyhydramnios
680.0-680.9 Carbuncle and furuncle
686.00-686.9 Infections of skin and subcutaneous tissue
698.0 Pruritus ani
698.1 Pruritus of genital organs
704.1 Hirsutism
705.0 Anhidrosis
707.0-707.9 Chronic ulcer of skin
709.3 Degenerative skin disorders
729.1 Myalgia
730.07-730.27 Osteomyelitis of tarsal bones
780.01 Coma
780.02 Transient alteration of awareness
780.09 Alteration of consciousness, other
780.2 Syncope and collapse
780.31 Febrile convulsions
780.39 Seizures, not otherwise specified
780.4 Dizziness and giddiness
780.71-780.79 Malaise and fatigue
780.8 Hyperhidrosis
781.0 Abnormal involuntary movements
782.0 Loss of vibratory sensation
783.1 Abnormal weight gain
783.21 Abnormal loss of weight
783.5 Polydipsia
783.6 Polyphagia
785.0 Tachycardia
785.4 Gangrene
786.01 Hyperventilation
786.09 Dyspnea,
786.50 Chest pain, unspecified
787.6 Fecal incontinence
787.91 Diarrhea
788.41-788.43 Frequency of urination and polyuria
789.1 Hepatomegaly
790.2 Abnormal glucose tolerance test
790.6 Other abnormal blood chemistry (hyperglycemia)
791.0 Proteinuria
791.5 Glycosuria
796.1 Abnormal reflex
799.4 Cachexia
V23.0-V23.9 Supervision of high risk pregnancy
V58.69 Long term current use of other medication
V67.2 Follow-up examination, following chemotherapy
V67.51
Follow up examination with high-risk medication not elsewhere classified
ICD-9-CM Codes Denied for 82947, 82948,
82962: Use GY modifier to indicate a non-covered service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydia diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3
Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
ICD-9-CM Codes That Do Not Support Medical Necessity
for 82947, 82948, 82962: Use GA
modifier if ABN signed OR GZ modifier if ABN is not signed
Any ICD-9-CM code not listed in either of the ICD-9-CM 82947, 82948, 82962 sections.
Medicare National
Coverage Decision: Glycated
Hemoglobin/Glycated Protein
82985 Glycated
protein
83036 Hemoglobin;
glycated
211.7 Benign neoplasm of islets of Langerhans
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 dysfunction
271.4 Renal glycosuria
275.0 Hemochromatosis
577.1 Chronic pancreatitis
579.3 Other and unspecified postsurgical nonabsorption
648.00 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 applicable
648.83 Abnormal glucose tolerance complicating pregnancy, childbirth or the puerperium, antepartum condition or complication
648.84 Abnormal glucose tolerance complicating pregnancy, childbirth or the puerperium, postpartum condition or complication
790.2 Abnormal glucose tolerance test
790.6 Other abnormal blood
chemistry (hyperglycemia)
962.3 Poisoning by insulin and antidiabetic agents
V12.2 Personal history of endocrine, metabolic, and immunity disorders
V58.69 Long-term use of other medication
ICD-9-CM Codes Denied for 82985, 83036: Use
GY modifier to indicate a non-covered service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0
- V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydia diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That Do Not Support Medical Necessity
for 82985, 83036: Use GA modifier if
ABN signed OR GZ modifier if ABN is not signed
Any ICD-9-CM code not listed in either of the ICD-9-CM 82985, 83036 sections.
Medicare National
Coverage Decision: Thyroid Testing
84436 Thyroxine;
total
84439 Thyroxine;
free
84443 Thyroid
stimulating hormone (TSH)
84479 Thyroid
hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR)
017.50-017.56 Tuberculosis of the thyroid gland
183.0 Malignant neoplasm of ovary
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 sites
237.4 Neoplasm of uncertain behavior of other and unspecified endocrine glands
239.7 Neoplasm of unspecified nature, thyroid gland
240.0-240.9 Goiter specified and unspecified
241.0-241.9 Nontoxic nodular goiter
242.00-242.91 Thyrotoxicosis with or without goiter
243 Congenital hypothyroidism
244.0-244.9 Acquired hypothyroidism
245.0-245.9 Thyroiditis
246.0-246.9 Other disorders of thyroid
250.00-250.93 Diabetes mellitus
252.1 Hypoparathyroidism
253.1 Other and unspecified anterior pituitary hyper function
253.2 Panhypopituitarism
253.3 Pituitary dwarfism
253.4 Other anterior pituitary disorders
253.7 Iatrogenic pituitary disorders
255.2 Adrenogenital disorders
255.4 Corticoadrenal insufficiency
256.3 Ovarian failure
257.2 Testicular hypofunction
258.0-258.9 Polyglandular dysfunction
262 Malnutrition, severe
263.0-263.9 Malnutrition, other and unspecified
266.0 Ariboflavinosis
272.0 Pure hypercholesterolemia
272.2 Mixed hyperlipidemia
272.4 Other and unspecified hyperlipidemia
275.40-275.49 Calcium disorders
276.0 Hyposmolality and/or hypernatremia
276.1 Hyposmolality and/or hyponatremia
278.3 Hypercarotenemia
279.4 Autoimmune disorder, not classified elsewhere
281.0 Pernicious anemia
281.9 Unspecified deficiency anemia
283.0 Autoimmune hemolytic anemia
285.9 Anemia, unspecified
290.0
Senile dementia, uncomplicated
290.10-290.13 Presenile dementia
290.20-290.21 Senile dementia with delusional or depressive features
290.3 Senile dementia with delirium
293.0-293.1 Delirium
293.81-293.89 Transient organic mental disorders
294.8 Other specified organic brain syndromes
296.00-296.99 Affective psychoses
297.0 Paranoid state, simple
297.1 Paranoia
297.9 Unspecified paranoid state
298.3 Acute paranoid reaction
300.00-300.09 Anxiety states
307.9 Agitation - other and unspecified special symptoms or syndromes, not elsewhere classified
310.1 Organic personality syndrome
311 Depressive disorder, not elsewhere classified
331.0-331.2 Alzheimer’s, pick’s disease, Senile degeneration of brain
333.1 Essential and other specified forms of tremor
333.99 Other extrapyramidal diseases and abnormal movement disorders
354.0 Carpal Tunnel syndrome
356.9 Idiopathic peripheral neuropathy, unspecified polyneuropathy
358.1 Myasthenic syndromes in diseases classified elsewhere
359.5 Myopathy in endocrine diseases classified elsewhere
359.9 Myopathy, unspecified
368.2 Diplopia
372.71 Conjunctival hyperemia
372.73 Conjunctival edema
374.41 Lid retraction or lag
374.82 Eyelid edema
376.21 Thyrotoxic exophthalmos
376.22 Exophthalmic ophthalmoplegia
376.30-376.31 Exophthalmic conditions, unspecified and constant
376.33-376.34 Orbital edema or congestion, intermittent exophthalmos
378.50-378.55
Paralytic strabismus
401.0-401.9 Essential hypertension
403.00-403.91 Hypertensive renal disease
404.00-404.93 Hypertensive heart and renal disease
423.9 Unspecified disease of pericardium
425.7 Nutritional and metabolic cardiomyopathy
427.0 Paroxysmal supraventricular tachycardia
427.2 Paroxysmal tachycardia, unspecified
427.31 Atrial fibrillation
427.89 Other specified cardiac dysrhythmia
427.9 Cardiac dysrhythmia, unspecified
428.0 Congestive heart failure
428.1 Left heart failure
429.3 Cardiomegaly
511.9 Unspecified pleural effusion
518.81 Acute respiratory failure
529.8 Other specified conditions of the tongue
560.1 Paralytic ileus
564.0 Constipation
564.7 Megacolon, other than Hirschsprung’s
568.82 Peritoneal effusion (chronic)
625.3 Dysmenorrhea
626.0-626.2 Disorders of menstruation
626.4 Irregular menstrual cycle
648.10-648.14 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 Alopecia
709.01 Vitiligo
710.0-710.9 Diffuse disease of connective tissue
728.2 Muscle wasting
728.9 Unspecified disorder of muscle, ligament, and fascia
729.1 Myalgia and myositis, unspecified
729.82 Musculoskeletal cramp
730.30-730.39 Periostitis without osteomyelitis
733.09 Osteoporosis, drug induced
750.15 Macroglossia, congenital
759.2
Anomaly of other endocrine glands
780.01 Coma
780.02 Transient alteration of awareness
780.09 Alteration of consciousness, other
780.50-780.52 Insomnia
780.6 Fever
780.71-780.79 Malaise and fatigue
780.8 Hyperhidrosis
780.9 Other general symptoms (hyperthermia)
781.0 Abnormal involuntary movements
781.3 Lack of coordination, ataxia
782.0 Disturbance of skin sensation
782.3 Localized edema
782.8 Changes in skin texture
782.9 Other symptoms involving skin and integumentary tissues
783.1 Abnormal weight gain
783.21 Abnormal loss of weight
783.6 Polyphagia
784.1 Throat pain
784.49 Voice disturbance
784.5 Other speech disturbance
785.0 Tachycardia, unspecified
785.1 Palpitations
785.9 Other symptoms involving cardiovascular system
786.09 Other symptoms involving respiratory system
786.1 Stridor
787.2 Dysphagia
787.91-787.99 Other symptoms involving digestive system
789.5 Ascites
793.9 Nonspecific abnormal findings on radiological and other examination, other (neck)
794.5 Thyroid, abnormal scan or uptake
796.1 Other nonspecific abnormal findings, abnormal reflex
799.2 Nervousness
990 Effects of radiation, unspecified
V10.87 Personal history of malignant neoplasm of the thyroid
V10.88 Personal history of malignant neoplasm of other endocrine gland
V12.2
Personal history of endocrine, metabolic and immunity disorders
V58.69 Long term (current) use of other medications
V67.00-V67.9 Follow-up examination
ICD-9-CM Codes Denied for 84436, 84439, 84443, 84479: Use GY modifier to indicate a non-covered service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0
Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydia diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That Do Not Support Medical Necessity
for 84436, 84439, 84443, 84479: Use GA
modifier if ABN signed OR GZ modifier if ABN is not signed
Any ICD-9-CM code not listed in either of the ICD-9-CM 84436, 84439, 84443, 84479 sections.
Medicare National
Coverage Decision: Lipids
80061 Lipid
panel
82465 Cholesterol,
serum or whole blood, total
83715 Lipoprotein,
blood; electrophoretic separation and quantitation
83716 Lipoprotein, blood: high
resolution fractionation and quantitation of lipoprotein cholesterol (for
example, electrophoretic, nuclear magnetic resonance, ultracentrifugation)
83718 Lipoprotein,
direct measurement; high density cholesterol (HDL cholesterol)
83721 Lipoprotein,
direct measurement, LDL cholesterol
84478 Triglycerides
242.00-245.9 Disorders of the thyroid gland with hormonal dysfunction
250.00-250.93 Diabetes mellitus
255.0 Cushing's syndrome
260 Kwashiorkor
261 Nutritional marasmas
262 Other severe, protein-calorie malnutrition
263.0 Malnutrition of moderate degree
263.1 Malnutrition of mild degree
263.8 Other protein-calorie malnutrition
263.9 Unspecified protein-calorie malnutrition
270.0 Disturbances of amino-acid transport
271.1 Galactosemia
272.0 Pure hypercholesterolemia
272.1 Hyperglyceridemia
272.2 Mixed hyperlipidemia (tuberous xanthoma)
272.3 Hyperchylomicronemia
272.4 Other and unspecified hyperlipidemia (unspecified xanthoma)
272.5 Lipoprotein deficiencies
272.6 Lipodystrophy
272.7 Lipidoses
272.8 Other disorders of lipoid metabolism
272.9 Unspecified disorders of lipoid metabolism
277.3 Amyloidosis
278.00 Obesity
278.01 Morbid obesity
303.90-303.92 Alcoholism
362.10-362.16 Other background retinopathy and retinal vascular change
362.30-362.34 Retinal vascular occlusion
362.82 Retinal exudates and deposits
371.41 Senile corneal changes
374.51 Xanthelasma
379.22 Crystalline deposits in vitreous
388.00 Degenerative & vascular disorder of ear, unspecified
388.02 Transient ischemic deafness
401.1, 401.9 Essential hypertension
402.00-402.91 Hypertensive heart disease
403.00-403.91 Hypertensive renal disease
404.00-404.93 Hypertensive heart and renal disease
405.01-405.99 Secondary hypertension
410.00-410.92 Acute myocardial infarction
411.0-411.1 Other acute & subacute forms of ischemic heart disease
411.81 Coronary occlusion without myocardial infarction
411.89 Other acute and subacute ischemic heart disease
412 Old myocardial infarction
413.0-413.1 Angina pectoris
413.9 Other and unspecified angina pectoris
414.00-414.03
Coronary atherosclerosis
414.04 Coronary atherosclerosis of artery bypass graft
414.05 Coronary athrscl-unspec graft
414.10 Aneurysm, heart (wall)
414.11 Coronary vessel aneurysm
414.19 Other aneurysm of heart
414.8 Other specified forms of chronic ischemic heart disease
414.9 Chronic ischemic heart disease, unspecified
428.0-428.9 Heart failure
429.2 Heart disease, unspecified
429.9 Heart disease NOS
431 Intracerebral hemorrhage
433.00-433.91 Occlusion & stenosis of precerebral arteries
434.00-434.91 Occlusion of cerebral arteries
435.0-435.9 Transient cerebral ischemia
437.0 Cerebral atherosclerosis
437.1 Other generalized ischemic cerebrovascular disease
437.5 Moyamoya disease
438.0-438.9 Late effects of cerebrovascular disease
440.0-440.9 Arteriosclerosis
441.00-441.9 Aortic aneurysms
442.0 Upper extremity aneurysm
442.1 Renal artery aneurysm
442.2 Iliac artery aneurysm
444.0-444.9 Arterial embolism & thrombosis
557.1 Chronic vascular insufficiency of intestine
571.8 Other chronic non-alcoholic liver disease
571.9 Unspecified chronic liver disease without mention of alcohol
573.8 Other specified disorders of liver
573.9 Unspecified disorders of liver
577.0-577.9 Pancreatic disease
579.3 Other & unspecified postsurgical nonabsorption
579.8 Other specified intestinal malabsorption
581.0-581.9 Nephrotic syndrome
584.5
Acute renal failure with lesion of tubular necrosis
585 Chronic renal failure
588.0 Renal osteodystrophy
588.1 Nephrogenic diabetes insipidus
588.8 Other specified disorders resulting from impaired renal function
588.9 Unspecified disorder resulting from impaired renal function
607.84 Impotence of organic origin, penis disorder
646.70-646.71 Liver disorders in pregnancy
646.73 Liver disorder antepartum
648.10-648.14 Thyroid disfunction in pregnancy and the puerperium
696.0 Psoriatic arthropathy
696.1 Other psoriasis
751.61 Biliary atresia
764.10-764.19 "Light for dates" with signs of fetal malnutrition
786.50 Chest pain unspecified
786.51 Precordial pain
786.59 Chest pain, other
789.1 Hepatomegaly
790.4 Abnormal transaminase
790.5 Abnormal alkaline phosphatase
790.6 Other abnormal blood chemistry
793.4 Abnormal imaging study
987.9 Toxic effect of unspecified gas or vapor
996.81 Complication of transplanted organ, kidney
V42.0 Transplanted organ, kidney
V42.7 Organ Replacement by transplant,liver
V58.69 Long term (current) use of other medications
ICD-9-CM Codes Denied for 80061, 82465,
83715, 83716, 83718, 83721, 84478: Use GY modifier to indicate a non-covered
service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydia diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That Do Not Support Medical Necessity
for 80061, 82465, 83715, 83716, 83718, 83721, 84478: Use GA modifier if ABN signed OR GZ modifier if ABN is not signed
Any ICD-9-CM code not listed in either of the ICD-9-CM 80061, 82465, 83715, 83716, 83718, 83721, 84478 sections.
Medicare National
Coverage Decision: Digoxin Therapeutic Drug
Assay
80162 Digoxin
(Therapeutic Drug Assay)
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
276.0 Hyperosmolality
276.1 Hyposmolality
276.2 Acidosis
276.3 Alkalosis
276.4 Mixed acid-base balance disorder
276.5 Volume depletion
276.6 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
368.16 Psychophysical 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 Heart 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 & renal disease
410.00-410.92 Acute myocardial infarction
411.0-411.89 Other acute & subacute forms of ischemic heart disease
413.0-413.9 Angina pectoris
422.0-422.99 Acute myocarditis
425.0-425.9 Cardiomyopathy
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 tendineae
429.6 Rupture papillary muscle
429.71 Acquired cardiac septal defect
514 Pulmonary congestion & hypostasis
579.9 Unspecified Intestinal malabsorption
584.5-584.9 Acute renal failure
585 Chronic renal failure
586 Renal Failure, unspecified
587 Renal sclerosis, unspecified
588.0 Renal osteodystrophy
588.1
Nephrogenic Diabetes Insipidus
588.8 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 & fatigue
783.0 Anorexia
784.0 Headache
787.01-787.03 Nausea & vomiting
787.91 Diarrhea
794.31 Abnormal electrocardiogram
799.2 Nervousness
972.0 Poisoning by cardiac rhythm regulators
972.1 Poisoning by cardiotonic glycosides & drugs of similar action
995.2 Unspecified adverse effect of 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.
ICD-9-CM Codes Denied for 80162: Use GY modifier to indicate a non-covered service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydia diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0
Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That Do Not Support Medical Necessity
for 80162: Use GA modifier if ABN
signed OR GZ modifier if ABN is not signed
Any ICD-9-CM code not listed in either of the ICD-9-CM 80162 sections.
Medicare National
Coverage Decision: Alpha-fetoprotein
82105 Alpha-fetoprotein;
serum
070.22-070.23 Chronic viral hepatitis B with hepatic coma, with or without mention of hepatitis delta
070.32-070.33 Chronic viral hepatitis B without mention of hepatic coma, with or without mention of hepatitis delta
070.44 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
211.5 Benign neoplasm of liver and biliary passages
235.3 Neoplasm of uncertain behavior of liver and biliary passages
272.2 Mixed hyperlipidemia
275.0 Disorder of iron metabolites
275.1 Disorder of copper metabolism
277.00 Cystic Fibrosis without mention of meconium ileus
277.6 Other deficiencies of circulating enzymes
285.0 Sideroblastic Anemia
571.2 Alcoholic cirrhosis of liver
571.40 Chronic hepatitis, unspecified
571.41 Chronic persistent hepatitis
571.49 Other chronic hepatitis
571.5 Cirrhosis of liver without mention of alcohol
608.89 Other specified disorders of male genital organs
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
V10.07
Personal history of malignant neoplasm, liver
V10.43 Personal history of malignant neoplasm, ovary
V10.47 Personal history of malignant neoplasm, testis
ICD-9-CM Codes Denied for 82105: Use GY modifier to indicate a non-covered service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2
Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydia diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That Do Not Support Medical Necessity:
ICD-9-CM Codes That Do Not Support Medical
Necessity for 82105: Use GA modifier if
ABN signed OR GZ modifier if ABN is not signed
Any ICD-9-CM code not listed in either of the ICD-9-CM 82105 sections.
Medicare National Coverage Decision: Carcinoembryonic
Antigen
82378 Carcinoembryonic antigen (CEA)
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, rectosigmoid junction and anus.
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 neoplasm of lung
197.4 Secondary malignant neoplasm of small intestine
197.5 Secondary malignant neoplasm of large intestine and rectum
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
790.99 Other nonspecific findings on examination of blood
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
ICD-9-CM Codes Denied for 82378: Use GY modifier to indicate a non-covered service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6
Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydia diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0
- V77.99 Special screening for endocrine, nutrition, metabolic, and immunity
disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That Do Not Support Medical
Necessity for 82378: Use GA modifier if
ABN signed OR GZ modifier if ABN is not signed
Any ICD-9-CM code not listed in either of the ICD-9-CM 82378 sections.
Medicare National Coverage Decision: Human Chorionic Gonadotropin
84702 Gonadotropin, chorionic (hCG); quantitative
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 determined
164.9 Malignant neoplasm of mediastinum, part specified
181 Malignant neoplasm of placenta
183.0 Malignant neoplasm of ovary
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
197.6 Secondary malignant neoplasm of retroperitoneum and peritoneum
198.6 Secondary malignant neoplasm of ovary
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 Pregnancy, molar
632 Missed abortion
633.9 Unspecified ectopic pregnancy
640.00-640.03 Threatened abortion
V10.09 Personal history of malignant neoplasm, other gastrointestinal sites
V10.29 Personal history of malignant neoplasm of other respiratory and intrathoracic organs
V10.43 Personal history of malignant neoplasm, ovary
V10.47 Personal history of malignant neoplasm, testis
V22.0-V22.1 Normal pregnancy
ICD-9-CM Codes Denied
for 84702: Use GY modifier to indicate a non-covered service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85
Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydia diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0
- V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That Do Not Support Medical
Necessity for 84702: Use GA modifier if
ABN signed OR GZ modifier if ABN is not signed
Any ICD-9-CM code not listed in either of the ICD-9-CM 84702 sections.
Medicare National Coverage Decision: Tumor Antigen by Immunoassay - CA125
86304 Immunoassay for tumor antigen, quantitative, CA 125
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
V10.43-V10.44 Personal history of malignant neoplasm of female genital organs
ICD-9-CM Codes Denied for 86304: Use GY modifier to indicate a non-covered service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1
Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydia diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0
Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That Do Not Support Medical
Necessity for 86304: Use GA modifier if
ABN signed OR GZ modifier if ABN is not signed
Any ICD-9-CM code not listed in either of the ICD-9-CM 86304 sections.
Medicare National Coverage Decision: Tumor Antigen by Immunoassay CA 15-3/CA 27.29
86300 Immunoassay for tumor antigen, quantitative; CA 15-3 (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
ICD-9-CM Codes Denied
for 86300: Use GY modifier to indicate a non-covered service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0
- V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydia diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That Do Not Support Medical
Necessity for 86300: Use GA modifier if
ABN signed OR GZ modifier if ABN is not signed
Any ICD-9-CM code not listed in either of the ICD-9-CM 86300 sections.
Medicare National Coverage Decision: Tumor Antigen by Immunoassay CA 19-9
86301 Immunoassay for tumor antigen, quantitative; CA 19-9
155.1
Malignant neoplasm, intrahepatic bile ducts
156.1 Malignant neoplasm, extrahepatic bile ducts
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
ICD-9-CM Codes Denied for 86301: Use GY modifier to indicate a non-covered service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0
- V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydia diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That
Do Not Support Medical Necessity for 86301:
Use GA modifier if ABN signed OR GZ modifier if ABN is not signed
Any ICD-9-CM code not listed in either of the ICD-9-CM 86301 sections.
Medicare National Coverage Decision: Prostate Specific Antigen
Other Names/Abbreviations: Total PSA
84153 Prostate Specific Antigen (PSA), total
185 Malignant neoplasm of prostate
188.5 Malignant neoplasm of bladder neck
196.5 Secondary malignant neoplasm, lymph nodes inguinal region and lower limb
196.6 Secondary malignant neoplasm, intrapelvic lymph nodes
196.8 Secondary malignant neoplasm, lymph nodes of multiple sites
198.5 Secondary malignant neoplasm, bone and bone marrow
198.82 Secondary malignant neoplasm, genital organs
233.4 Carcinoma in situ, prostate
236.5 Neoplasm of uncertain behavior of prostate
239.5 Neoplasm of unspecified nature, other genitourinary organs
596.0 Bladder neck obstruction
599.6 Urinary obstruction, unspecified
599.7 Hematuria
601.9 Unspecified prostatitis
602.9 Unspecified disorder of prostate
788.20 Retention of urine, unspecified
788.21 Incomplete bladder emptying
788.30 Urinary incontinence, unspecified
788.41 Urinary frequency
788.43 Nocturia
788.62 Slowing of urinary stream
790.93 Elevated prostate specific antigen
793.6/793.7 Non-specific abnormal result of radiologic examination, evidence of malignancy
794.9 Bone scan evidence of malignancy
V10.46 Personal history of malignant neoplasm; prostate
ICD-9-CM Codes Denied for 84153: Use GY modifier to indicate a non-covered service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0
Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydial diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That
Do Not Support Medical Necessity for 84153:
Use GA modifier if ABN signed OR GZ modifier if ABN is not signed
Any ICD-9-CM code not listed in either of the ICD-9-CM 84153 sections.
Medicare National Coverage Decision: Gamma Glutamyl Transferase
Other Names/Abbreviations: GGT
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 specified 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 Diphtheritic peritonitis
036.1 Meningococcal encephalitis
036.2 Meningococcemia
038.0-038.9 Septicemia
039.2 Actinomycotic infections, abdominal
040.0 Gas gangrene
042 Human immunodeficiency virus (HIV) disease
054.0 Eczema herpeticum
054.5 Herpetic septicemia
060.0-060.1 Yellow fever
070.0-070.9 Viral hepatitis
072.71 Mumps hepatitis
073.0 Ornithosis, with pneumonia
074.8 Other specified diseases due to Coxsackie virus
075 Infectious mononucleosis
078.5 Cytomegaloviral disease
079.99 Unspecified viral infection
082.0-082.9
Tick-borne rickettsioses, stet
084.9 Other pernicious complications of malaria
086.1 Chagas disease with organ involvement other than heart
088.81 Lyme disease
091.62 Secondary syphilitic hepatitis
095.3 Syphilis of liver
100.0 Leptospirosis icterohemorrhagica
112.5 Candidiasis, disseminated
115.00 Infection by Histoplasma capsulatum without mention of manifestation
120.9 Schistosomiasis, unspecified
121.1 Clonorchiasis
121.3 Fascioliasis
122.0 Echinococcus granulosus infection of liver
122.5 Echinococcus multilocularis infection of liver
122.8 Echinococcosis, unspecified, of liver
122.9 Echinococcus, other and unspecified
130.5 Hepatitis due to toxoplasmosis
135 Sarcoidosis
150.0-159.9 Malignant neoplasm of digestive organs and peritoneum
160.0-165.9 Malignant neoplasm of respiratory and intrathoracic organs
170.0-176.9 Malignant neoplasm of bone, connective tissue, skin, and breast
179-189.9 Malignant neoplasm of genitourinary organs
200.00-208.91 Malignant neoplasm of lymphatic and hematopoietic tissue
211.5 Benign neoplasm of liver and biliary passages
211.6 Benign neoplasm of pancreas, except islets of Langerhans
211.7 Benign neoplasm of islets of Langerhans
228.04 Hemangioma of intra-abdominal structures
230.7 Carcinoma in situ of other and unspecified parts of intestine
230.8
Carcinoma in situ of liver and biliary system
230.9 Carcinoma in situ other and unspecified digestive organs
235.0-238.9 Neoplasms of uncertain behavior
239.0 Neoplasm of unspecified nature of digestive system
250.00-250.93 Diabetes mellitus
252.0 Hyperparathyroidism
263.1 Malnutrition of mild degree
263.9 Unspecified protein-calorie malnutrition
268.0 Rickets, active
268.2 Osteomalacia, unspecified
269.0 Deficiency of vitamin K
270.2 Other disturbances of aromatic amino acid metabolism
270.9 Unspecified disorder of amino acid metabolism
271.0 Glycogenosis
272.0 Pure hypercholesterolemia
272.1 Pure hyperglyceridemia
272.2 Mixed hyperlipidemia
272.4 Other and unspecified hyperlipidemia
272.7 Lipidoses
272.9 Unspecified disorder of lipoid metabolism
275.0 Disorders of iron metabolism
275.1 Disorders of copper metabolism
275.3 Disorders of phosphorus metabolism
275.40-275.49 Disorders of calcium metabolism
277.1 Disorders of porphyrin metabolism
277.3 Amyloidosis
277.4 Disorders of bilirubin excretion
277.6 Other deficiencies of circulating enzymes
282.60-282.69 Sickle cell anemia
286.6 Defibrination syndrome
286.7 Acquired coagulation factor deficiency
289.4 Hypersplenism
291.0-291.9 Alcoholic psychoses
303.00-303.03 Acute alcoholic intoxication
303.90-303.93 Other and unspecified alcohol dependence
304.00-304.93
Drug dependence
305.00-305.93 Non-dependent abuse of drugs
357.5 Alcoholic polyneuropathy
359.2 Myotonic disorders
452 Portal vein thrombosis
453.0-453.9 Other vein embolism and thrombosis
456.0-456.21 Esophageal varices
555.0-555.9 Regional enteritis
556.0-556.9 Ulcerative colitis
557.0 Acute vascular insufficiency of intestine
558.1-558.9 Other noninfectious gastroenteritis and colitis
560.0-560.9 Intestinal obstruction without mention of hernia
562.01 Diverticulitis of small intestine (without mention of hemorrhage)
562.03 Diverticulitis of small intestine with hemorrhage
562.11 Diverticulitis of colon (without mention of hemorrhage)
562.13 Diverticulitis of colon with hemorrhage
567.0-567.9 Peritonitis
569.83 Perforation of intestine
570 Acute and subacute necrosis of liver
571.0-571.9 Chronic liver disease and cirrhosis
572.0-572.8 Liver abscess and sequelae of chronic liver disease
573.0-573.9 Other disorders of liver
574.00-574.91 Cholelithiasis
575.0-575.9 Other disorders of gallbladder
576.0-576.9 Other disorders of biliary tract
581.0-581.9 Nephrotic syndrome
582.0-582.9 Chronic glomerulonephritis
583.0-583.9 Nephritis and nephropathy not specified as acute or chronic
584.5-584.9 Acute renal failure
585 Chronic renal failure
586 Renal failure, unspecified
587 Renal sclerosis, unspecified
588.0-588.9 Disorders resulting from impaired renal function
590.00-590.9 Infections of kidney
642.50-642.54
Severe pre-eclampsia
646.70, 646.71, 646.73 Liver disorders in pregnancy
782.4 Jaundice, unspecified, not of newborn
789.1 Hepatomegaly
790.4 Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase
790.5 Other nonspecific abnormal serum enzyme levels
960.0-979.9 Poisoning by drugs, medicinal, and biological substances
980.0-989.89 Toxic effects of substances chiefly nonmedicinal as to source
V42.7 Organ replaced by transplant, liver
V58.61-V58.69 Long term (current) drug use
V67.1 Follow-up examination, radiotherapy
V67.2 Follow-up examination, chemotherapy
V67.51 Follow-up examination after completed treatment with high-risk medications, not elsewhere classified
ICD-9-CM Codes Denied for 82977: Use GY
modifier to indicate a non-covered service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6
Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydial diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42
- V76.9 Special screening for malignant neoplasms,(sites other than breast,
cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That
Do Not Support Medical Necessity for 82977:
Use GA modifier if ABN signed OR GZ modifier if ABN is not signed
Any ICD-9-CM code not listed in either of the ICD-9-CM 82977 sections.
Medicare National Coverage Decision: Hepatitis Panel/ Acute Hepatitis Panel
80074 Acute Hepatitis Panel
This panel consists of the following tests:
Hepatitis B surface antigen (HBsAg) (CPT 87340)
Hepatitis C antibody (CPT 86803)
Hepatitis B core antibody (HBcAb), IgM Antibody (CPT 86705)
Hepatitis A antibody (HAAb), IgM Antibody (CPT 86709)
070.0-070.9 Viral hepatitis
456.0-456.21 Esophageal varices with or without mention of bleeding
570 Acute and subacute necrosis of liver
571.5 Cirrhosis of liver without mention of alcohol
572.0-572.8 Liver abscess and sequelae of chronic liver disease
573.3 Hepatitis, unspecified
780.31 Febrile convulsions
780.71 Chronic fatigue syndrome
780.79 Other malaise and fatigue
782.4 Jaundice, unspecified, not of newborn
783.0-783.6 Symptoms concerning nutrition, metabolism, and development
784.69 Other symbolic dysfunction
787.01-787.03 Nausea and vomiting
789.00-789.09 Abdominal pain
789.1
Hepatomegaly
789.61 Localized abdominal tenderness (RUQ)
794.8 Nonspecific abnormal results of function
996.82 Complications of transplanted organ, liver
999.3 Other infection following infusion, injection, transfusion, or vaccination
V72.85 Liver transplant recipient evaluation
ICD-9-CM Codes Denied for 80074: Use GY modifier to indicate a non-covered service (Do not sign ABN)
798.0 - 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0
- V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0 - V73.99 Special screening examinations for viral and chlamydial diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That
Do Not Support Medical Necessity for 80074:
Use GA modifier if ABN signed OR GZ modifier if ABN is not signed
Any ICD-9-CM code not listed in either of the ICD-9-CM 80074 sections.
Medicare National Coverage Decision: Fecal Occult Blood
82270 Blood, occult, by peroxidase activity (eg guaiac); feces, 1-3 simultaneous determinations
003.1 Salmonella septicemia
004.0-004.9 Shigellosis
005.0-005.9 Other food poisoning (bacterial)
006.0-006.9 Amebiasis
007.0-007.9 Other protozoal intestinal diseases
008.41-008.49 Intestinal infections due to other specified bacteria
009.0-009.3 Ill-defined intestinal infections
014.00-014.86 Tuberculosis of intestines, peritoneum, and mesenteric glands
040.2 Whipple’s disease
095.2 Syphilitic peritonitis
095.3 Syphilis of liver
098.0 Gonococcal infection, acute, lower genitourinary tract
098.7 Gonococcal Infection anus and rectum
098.84 Gonococcal endocaritis
123.0-123.9 Other cestode infection
124 Trichinosis
127.0-127.9 Other intestinal helminthiases
139.8 Late effects of other and unspecified infectious and parasitic diseases
150.0-157.9 Malignant neoplasm of digestive organisms
159.0-159.9 Malignant neoplasm of other and illdefined sites within the digestive organs and peritoneum
176.3
Kaposi’s sarcoma, gastrointestinal sites
197.4-197.5 Secondary malignant neoplasm of intestines
197.8 Secondary malignant neoplasm of other digestive organs and spleen
199.0 Disseminated malignant neoplasm
204.00-204.91 Lymphoid leukemia
205.00-208.91 Leukemia
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 organs
235.2 Neoplasm of uncertain behavior of stomach, intestines, and rectum
235.5 Neoplasm of uncertain behavior of other and unspecified digestive organs
239.0 Neoplasm of unspecified nature, digestive system
280.0-280.9 Iron deficiency anemias
285.0-285.9 Other and unspecified anemias
286.0-286.9 Coagulation defects
287.0-287.9 Purpura and other hemorrhagic conditions
448.0 Hereditary hemorrhagic telangiectasia
455.0-455.8 Hemorrhoids
456.0-456.21 Esophageal varices with or without mention of bleeding
530.10-535.61 Diseases of the esophagus, stomach, and duodenum
536.2 Persistent vomiting
536.8-536.9 Dyspepsia and other specified and unspecified functional disorders of the stomach
537.0-537.4 Other disorders of stomach and duodenum
537.82-537.83 Angiodysplasia of stomach and duodenum
537.89 Other specified disorders of stomach and duodenum
555.0-558.9 Non-infectious enteritis and colitis
560.0-560.39 Intestinal obstruction/impaction without mention of hernia
562.10-562.13 Diverticulosis/diverticulitis of colon
564.0-564.9
Functional digestive disorders, not elsewhere classified
565.0-565.1 Anal fissure and fistula
569.0 Anal and rectal polyp
569.1 Rectal prolapse
569.3 Hemorrhage of rectum and anus
569.41-569.49 Other specified disorders of rectum and anus
569.82-569.83 Ulceration and perforation of intestine
569.84-569.85 Angiodysplasia of intestine with or without mention of hemorrhage
571.0-571.9 Chronic liver disease and cirrhosis
577.0-577.9 Diseases of the pancreas
578.0-578.9 Gastrointestinal hemorrhage
579.0 Celiac disease
579.8 Other specified intestinal malabsorption
596.1 Intestinovesical fistula
617.5 Endometriosis of intestine
780.71 Chronic fatigue syndrome
780.79 Other malaise and fatigue
783.0 Anorexia
783.21 Abnormal loss of weight
787.01-787.03 Nausea and vomiting
787.1 Heartburn
787.2 Dysphagia
787.7 Abnormal feces
787.91 Diarrhea
787.99 Other symptoms involving digestive system
789.00-789.09 Abdominal pain
789.30-789.39 Abdominal or pelvic swelling, mass, or lump
789.40-789.49 Abdominal rigidity
789.5 Ascites
789.60-789.69 Abdominal tenderness
790.92 Abnormal coagulation profile
792.1 Nonspecific abnormal findings in stool contents
793.6 Nonspecific abnormal findings on radiological and other
794.8 Nonspecific abnormal results of function studies, liver
863.0-863.90
Injury to gastrointestinal tract
864.00-864.09 Injury to liver without mention of open wound into cavity
864.11-864.19 Injury to liver with open wound into cavity
866.00-866.03 Injury to kidney without mention of open wound into cavity
866.10-866.13 Injury to kidney with open wound into cavity
902.0 -902.9 Injury to blood vessels of abdomen and pelvis
926.11-926.19 Crushing injury of trunk, other specified sites
926.8 Crushing injury of trunk, multiple sites
926.9 Crushing injury of trunk, unspecified site
964.2 Poisoning by agents primarily affecting blood constituents, anticoagulants
995.2 Unspecified adverse effect of drug, medicinal, and biological substance
V10.00-V10.09 Personal history of malignant neoplasm, gastrointestinal tract
V12.00 Personal history of unspecified infectious and parasitic disease
V12.72 Personal history of colonic polyps
V58.61 Long term (current) use of anticoagulants
V58.69 Long term (current) use of other medications
V67.51 Following treatment with high risk medication, not elsewhere specified
ICD-9-CM Codes Denied
for 82270: Use GY modifier to indicate a non-covered service (Do not sign ABN)
798.0
- 798.9 Sudden death, cause unknown
V15.85 Exposure to potentially hazardous body fluids
V16.1 Family history of malignant neoplasm, trachea, bronchus, and lung
V16.2 Family history of malignant neoplasm, other respiratory and intrathoracic organs
V16.40 Family history of malignant neoplasm, genital organs
V16.51-V16.59 Family history of malignant neoplasm, urinary organs
V16.6 Family history of malignant neoplasm, leukemia
V16.7 Family history of malignant neoplasm, other lymphatic and hematopoietic neoplasms
V16.8 Family history of malignant neoplasm, other specified malignant neoplasm
V16.9 Family history of malignant neoplasm, unspecified malignant neoplasm
V17.0 - V17.8 Family history of certain chronic disabling diseases
V18.0 - V18.8 Family history of certain other specific conditions
V19.0 - V19.8 Family history of other conditions
V20.0 - V20.2 Health supervision of infant or child
V28.0 - V28.9 Antenatal screenings
V50.0 - V50.9 Elective surgery for purposes other than remedying health states
V53.2 Fitting and adjustment of hearing aid
V60.0 - V60.9 Housing, household, and economic circumstances
V62.0 Unemployment
V62.1 Adverse effects of work environment
V65.0 Healthy persons accompanying sick persons
V65.1 Persons consulting on behalf of another person
V68.0 - V68.9 Encounters for administrative purposes
V70.0 - V70.9 General medical examinations
V73.0
- V73.99 Special screening examinations for viral and chlamydial diseases
V74.0 - V74.9 Special screening examinations for bacterial and spirochetal diseases
V75.0 - V75.9 Special screening examination for other infectious diseases
V76.0 Special screening for malignant neoplasms, respiratory organs
V76.3 Special screening for malignant neoplasms, bladder
V76.42 - V76.9 Special screening for malignant neoplasms,(sites other than breast, cervix, and rectum)
V77.0 - V77.99 Special screening for endocrine, nutrition, metabolic, and immunity disorders
V78.0 - V78.9 Special Screening for disorders of blood and blood-forming organs
V79.0 - V79.9 Special screening for mental disorders
V80.0 - V80.3 Special screening for neurological, eye, and ear diseases
V81.0 - V81.6 Special screening for cardiovascular, respiratory, and genitourinary diseases
V82.0 - V82.9 Special screening for other conditions
ICD-9-CM Codes That
Do Not Support Medical Necessity for 82270:
Use GA modifier if ABN signed OR GZ modifier if ABN is not signed
Any ICD-9-CM code not listed in either of the ICD-9-CM 82270 sections.