A47550 Bone Mass Measurements
Description
ICD 9 Codes
CPT/HCPCS Codes
Italicized and/or quoted material is excerpted from the American Medical Association, Current Procedural
Terminology (CPT) codes.
The following CPT codes are used to describe the type of bone density measurement tests that are currently
available and covered.
76977
ULTRASOUND BONE DENSITY MEASUREMENT AND INTERPRETATION, PERIPHERAL SITE(S),
ANY METHOD
77078
COMPUTED TOMOGRAPHY, BONE MINERAL DENSITY STUDY, 1 OR MORE SITES; AXIAL
SKELETON (EG, HIPS, PELVIS, SPINE)
77079
COMPUTED TOMOGRAPHY, BONE MINERAL DENSITY STUDY, 1 OR MORE SITES;
APPENDICULAR SKELETON (PERIPHERAL) (EG, RADIUS, WRIST, HEEL)
77080
DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES;
AXIAL SKELETON (EG, HIPS, PELVIS, SPINE)
77081
DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES;
APPENDICULAR SKELETON (PERIPHERAL) (EG, RADIUS, WRIST, HEEL)
77083
G0130
RADIOGRAPHIC ABSORPTIOMETRY (EG, PHOTODENSITOMETRY, RADIOGRAMMETRY), 1 OR
MORE SITES
SINGLE ENERGY X-RAY ABSORPTIOMETRY (SEXA) BONE DENSITY STUDY, ONE OR MORE
SITES; APPENDICULAR SKELETON (PERIPHERAL) (EG, RADIUS, WRIST, HEEL)
ICD-9 Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from
the ICD-9-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.
Patients who qualify by statute for osteoporosis screening may be evaluated by studies that are characterized
by CPT codes 77078 , 77079 , 77080 , 77081 , 77083 , 76977 , and G0130. The following is a list of ICD-9-CM
codes that support the medical necessity of osteoporosis screening.
241.0
NONTOXIC UNINODULAR GOITER
246.9
UNSPECIFIED DISORDER OF THYROID
252.00 - 252.08
HYPERPARATHYROIDISM, UNSPECIFIED - OTHER HYPERPARATHYROIDISM
255.0
CUSHING'S SYNDROME
256.2
POSTABLATIVE OVARIAN FAILURE
256.31
PREMATURE MENOPAUSE
256.39
OTHER OVARIAN FAILURE
259.3
ECTOPIC HORMONE SECRETION NOT ELSEWHERE CLASSIFIED
627.2
SYMPTOMATIC MENOPAUSAL OR FEMALE CLIMACTERIC STATES
627.4
SYMPTOMATIC STATES ASSOCIATED WITH ARTIFICIAL MENOPAUSE
733.00
OSTEOPOROSIS UNSPECIFIED
733.01
SENILE OSTEOPOROSIS
733.02
IDIOPATHIC OSTEOPOROSIS
733.03
DISUSE OSTEOPOROSIS
733.09
OTHER OSTEOPOROSIS
733.11 - 733.16
PATHOLOGICAL FRACTURE OF HUMERUS - PATHOLOGICAL FRACTURE OF TIBIA OR FIBULA
733.19
PATHOLOGICAL FRACTURE OF OTHER SPECIFIED SITE
733.90
DISORDER OF BONE AND CARTILAGE UNSPECIFIED
733.93
STRESS FRACTURE OF TIBIA OR FIBULA
733.94
STRESS FRACTURE OF THE METATARSALS
733.95
STRESS FRACTURE OF OTHER BONE
733.96
STRESS FRACTURE OF FEMORAL NECK
733.97
STRESS FRACTURE OF SHAFT OF FEMUR
733.98
STRESS FRACTURE OF PELVIS
781.91
LOSS OF HEIGHT
V49.81
ASYMPTOMATIC POSTMENOPAUSAL STATUS (AGE-RELATED) (NATURAL)
V58.65
LONG-TERM (CURRENT) USE OF STEROIDS
A47550 Bone Mass Measurements
Description
ICD 9 Codes
Once the diagnosis of osteoporosis has been established, the effectiveness of treatment can ONLY be
monitored using a dual energy x-ray absorptiometry (CPT code 77080 ). The valid ICD-9-CM codes for the
established diagnosis of osteoporosis are:
255.0
CUSHING'S SYNDROME
733.00
OSTEOPOROSIS UNSPECIFIED
733.01
SENILE OSTEOPOROSIS
733.02
IDIOPATHIC OSTEOPOROSIS
733.03
DISUSE OSTEOPOROSIS
733.09
OTHER OSTEOPOROSIS
733.90
DISORDER OF BONE AND CARTILAGE UNSPECIFIED
ICD-9 Codes that DO NOT Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from
the ICD-9-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.
Peripheral scans are characterized by CPT codes 77078 , 77079 , 77081 , 77083 , 76977 , G0130. These scans
are NOT covered for the monitoring of the effectiveness of osteoporosis therapy. Therefore, if any of the
following codes are the only codes submitted on the claim, the claim will NOT be covered
255.0
CUSHING'S SYNDROME
733.00
OSTEOPOROSIS UNSPECIFIED
733.01
SENILE OSTEOPOROSIS
733.02
IDIOPATHIC OSTEOPOROSIS
733.03
DISUSE OSTEOPOROSIS
733.09
OTHER OSTEOPOROSIS
733.90
DISORDER OF BONE AND CARTILAGE UNSPECIFIED
ICD 9 Codes
Non-Invasive Cerebrovascular Arterial Studies L27504
Description
93875
NONINVASIVE PHYSIOLOGIC STUDIES OF EXTRACRANIAL ARTERIES, COMPLETE BILATERAL STUDY
(EG, PERIORBITAL FLOW DIRECTION WITH ARTERIAL COMPRESSION, OCULAR
PNEUMOPLETHYSMOGRAPHY, DOPPLER ULTRASOUND SPECTRAL ANALYSIS)
93880
DUPLEX SCAN OF EXTRACRANIAL ARTERIES; COMPLETE BILATERAL STUDY
93882
DUPLEX SCAN OF EXTRACRANIAL ARTERIES; UNILATERAL OR LIMITED STUDY
93886
TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; COMPLETE STUDY
93888
TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; LIMITED STUDY
93890
TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; VASOREACTIVITY STUDY
93892
TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; EMBOLI DETECTION WITHOUT
INTRAVENOUS MICROBUBBLE INJECTION
TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; EMBOLI DETECTION WITH
INTRAVENOUS MICROBUBBLE INJECTION
93893
ICD-9 Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD9-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.
Please see revision history for ICD-9-CM code updates effective 10/01/2009.
237.3
342.00 - 342.92
344.00 - 344.9
346.01
346.20 - 346.21
346.80 - 346.81
For CPT codes 93875, 93880, and 93882:
NEOPLASM OF UNCERTAIN BEHAVIOR OF PARAGANGLIA
FLACCID HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - UNSPECIFIED
HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE
QUADRIPLEGIA UNSPECIFIED - PARALYSIS UNSPECIFIED
MIGRAINE WITH AURA, WITH INTRACTABLE MIGRAINE, SO STATED, WITHOUT MENTION OF
STATUS MIGRAINOSUS
VARIANTS OF MIGRAINE, NOT ELSEWHERE CLASSIFIED, WITHOUT MENTION OF INTRACTABLE
MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS - VARIANTS OF MIGRAINE, NOT
ELSEWHERE CLASSIFIED, WITH INTRACTABLE MIGRAINE, SO STATED, WITHOUT MENTION OF
STATUS MIGRAINOSUS
OTHER FORMS OF MIGRAINE, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION
OF STATUS MIGRAINOSUS - OTHER FORMS OF MIGRAINE, WITH INTRACTABLE MIGRAINE, SO
STATED, WITHOUT MENTION OF STATUS MIGRAINOSUS
348.81
TEMPORAL SCLEROSIS
348.89*
OTHER CONDITIONS OF BRAIN
362.30 - 362.37
RETINAL VASCULAR OCCLUSION UNSPECIFIED - VENOUS ENGORGEMENT OF RETINA
362.84
RETINAL ISCHEMIA
364.42
RUBEOSIS IRIDIS
368.10 - 368.12
SUBJECTIVE VISUAL DISTURBANCE UNSPECIFIED - TRANSIENT VISUAL LOSS
368.2
DIPLOPIA
368.40 - 368.47
VISUAL FIELD DEFECT UNSPECIFIED - HETERONYMOUS BILATERAL FIELD DEFECTS
431
INTRACEREBRAL HEMORRHAGE
433.00 - 433.91
OCCLUSION AND STENOSIS OF BASILAR ARTERY WITHOUT CEREBRAL INFARCTION - OCCLUSION
AND STENOSIS OF UNSPECIFIED PRECEREBRAL ARTERY WITH CEREBRAL INFARCTION
434.00 - 434.91
435.0 - 435.9
CEREBRAL THROMBOSIS WITHOUT CEREBRAL INFARCTION - CEREBRAL ARTERY OCCLUSION
UNSPECIFIED WITH CEREBRAL INFARCTION
BASILAR ARTERY SYNDROME - UNSPECIFIED TRANSIENT CEREBRAL ISCHEMIA
436
ACUTE BUT ILL-DEFINED CEREBROVASCULAR DISEASE
437.0 - 437.1
CEREBRAL ATHEROSCLEROSIS - OTHER GENERALIZED ISCHEMIC CEREBROVASCULAR DISEASE
437.3 - 437.5
CEREBRAL ANEURYSM NONRUPTURED - MOYAMOYA DISEASE
437.7
TRANSIENT GLOBAL AMNESIA
437.9
UNSPECIFIED CEREBROVASCULAR DISEASE
442.81 - 442.82
ANEURYSM OF ARTERY OF NECK - ANEURYSM OF SUBCLAVIAN ARTERY
443.21
DISSECTION OF CAROTID ARTERY
444.9*
EMBOLISM AND THROMBOSIS OF UNSPECIFIED ARTERY
446.0 - 446.7
POLYARTERITIS NODOSA - TAKAYASU'S DISEASE
ICD 9 Codes
Non-Invasive Cerebrovascular Arterial Studies L27504
Description
447.0 - 447.2
ARTERIOVENOUS FISTULA ACQUIRED - RUPTURE OF ARTERY
447.6
ARTERITIS UNSPECIFIED
447.8 - 447.9
449
OTHER SPECIFIED DISORDERS OF ARTERIES AND ARTERIOLES - UNSPECIFIED DISORDERS OF
ARTERIES AND ARTERIOLES
SEPTIC ARTERIAL EMBOLISM
780.2*
SYNCOPE AND COLLAPSE
781.2 - 781.4
ABNORMALITY OF GAIT - TRANSIENT PARALYSIS OF LIMB
781.94
FACIAL WEAKNESS
782.0
DISTURBANCE OF SKIN SENSATION
784.2*
SWELLING MASS OR LUMP IN HEAD AND NECK
784.3
APHASIA
784.51
DYSARTHRIA
784.59
OTHER SPEECH DISTURBANCE
785.9*
OTHER SYMPTOMS INVOLVING CARDIOVASCULAR SYSTEM
787.20 - 787.29
DYSPHAGIA, UNSPECIFIED - OTHER DYSPHAGIA
900.00 - 900.9
901.1
INJURY TO CAROTID ARTERY UNSPECIFIED - INJURY TO UNSPECIFIED BLOOD VESSEL OF HEAD
AND NECK
INJURY TO INNOMINATE AND SUBCLAVIAN ARTERIES
958.4
TRAUMATIC SHOCK
996.1
MECHANICAL COMPLICATION OF OTHER VASCULAR DEVICE IMPLANT AND GRAFT
996.70 - 996.79
OTHER COMPLICATIONS DUE TO UNSPECIFIED DEVICE IMPLANT AND GRAFT - OTHER
COMPLICATIONS DUE TO OTHER INTERNAL PROSTHETIC DEVICE IMPLANT AND GRAFT
998.0 - 998.9
V43.4
POSTOPERATIVE SHOCK NOT ELSEWHERE CLASSIFIED - UNSPECIFIED COMPLICATION OF
PROCEDURE NOT ELSEWHERE CLASSIFIED
BLOOD VESSEL REPLACED BY OTHER MEANS
V45.89
OTHER POSTSURGICAL STATUS
V58.49
OTHER SPECIFIED AFTERCARE FOLLOWING SURGERY
V67.00
FOLLOW-UP EXAMINATION FOLLOWING UNSPECIFIED SURGERY
V67.09
FOLLOW-UP EXAMINATION FOLLOWING OTHER SURGERY
*Note: Use code 348.89 to identify assessment of Suspected Brain Death; use code 444.9 to report Paradoxical Cerebral
Embolism; use code 780.2 when symptomatology indicates a strong clinical suspicion of vertebrobasilar insufficiency;
use code 784.2 to report Pulsatile Neck Mass; use code 785.9 to report Carotid Bruit.
282.60 - 282.69
For CPT codes 93886, 93888, 93890, 93892, and 93893:
SICKLE-CELL DISEASE UNSPECIFIED - OTHER SICKLE-CELL DISEASE WITH CRISIS
348.81
TEMPORAL SCLEROSIS
348.89*
OTHER CONDITIONS OF BRAIN
362.30 - 362.37
RETINAL VASCULAR OCCLUSION UNSPECIFIED - VENOUS ENGORGEMENT OF RETINA
362.84
RETINAL ISCHEMIA
364.42
RUBEOSIS IRIDIS
368.10 - 368.12
SUBJECTIVE VISUAL DISTURBANCE UNSPECIFIED - TRANSIENT VISUAL LOSS
368.2
DIPLOPIA
368.40 - 368.47
VISUAL FIELD DEFECT UNSPECIFIED - HETERONYMOUS BILATERAL FIELD DEFECTS
430
SUBARACHNOID HEMORRHAGE
431
INTRACEREBRAL HEMORRHAGE
433.00 - 433.21
435.0 - 435.9
OCCLUSION AND STENOSIS OF BASILAR ARTERY WITHOUT CEREBRAL INFARCTION - OCCLUSION
AND STENOSIS OF VERTEBRAL ARTERY WITH CEREBRAL INFARCTION
OCCLUSION AND STENOSIS OF OTHER SPECIFIED PRECEREBRAL ARTERY WITHOUT CEREBRAL
INFARCTION - OCCLUSION AND STENOSIS OF UNSPECIFIED PRECEREBRAL ARTERY WITH
CEREBRAL INFARCTION
CEREBRAL THROMBOSIS WITHOUT CEREBRAL INFARCTION - CEREBRAL ARTERY OCCLUSION
UNSPECIFIED WITH CEREBRAL INFARCTION
BASILAR ARTERY SYNDROME - UNSPECIFIED TRANSIENT CEREBRAL ISCHEMIA
436
ACUTE BUT ILL-DEFINED CEREBROVASCULAR DISEASE
437.0 - 437.1
CEREBRAL ATHEROSCLEROSIS - OTHER GENERALIZED ISCHEMIC CEREBROVASCULAR DISEASE
437.3 - 437.5
CEREBRAL ANEURYSM NONRUPTURED - MOYAMOYA DISEASE
433.80 - 433.91
434.00 - 434.91
ICD 9 Codes
Non-Invasive Cerebrovascular Arterial Studies L27504
Description
437.7
TRANSIENT GLOBAL AMNESIA
437.9
UNSPECIFIED CEREBROVASCULAR DISEASE
442.81 - 442.82
ANEURYSM OF ARTERY OF NECK - ANEURYSM OF SUBCLAVIAN ARTERY
444.9*
EMBOLISM AND THROMBOSIS OF UNSPECIFIED ARTERY
446.0 - 446.29
POLYARTERITIS NODOSA - OTHER SPECIFIED HYPERSENSITIVITY ANGIITIS
447.0 - 447.2
ARTERIOVENOUS FISTULA ACQUIRED - RUPTURE OF ARTERY
447.6
ARTERITIS UNSPECIFIED
447.8 - 447.9
449
OTHER SPECIFIED DISORDERS OF ARTERIES AND ARTERIOLES - UNSPECIFIED DISORDERS OF
ARTERIES AND ARTERIOLES
SEPTIC ARTERIAL EMBOLISM
747.81
CONGENITAL ANOMALIES OF CEREBROVASCULAR SYSTEM
780.2*
SYNCOPE AND COLLAPSE
781.2 - 781.5
ABNORMALITY OF GAIT - CLUBBING OF FINGERS
781.94
FACIAL WEAKNESS
782.0
DISTURBANCE OF SKIN SENSATION
784.3
APHASIA
784.51
DYSARTHRIA
784.59
OTHER SPEECH DISTURBANCE
785.9*
OTHER SYMPTOMS INVOLVING CARDIOVASCULAR SYSTEM
787.20 - 787.29
DYSPHAGIA, UNSPECIFIED - OTHER DYSPHAGIA
900.00 - 900.9
901.1
INJURY TO CAROTID ARTERY UNSPECIFIED - INJURY TO UNSPECIFIED BLOOD VESSEL OF HEAD
AND NECK
INJURY TO INNOMINATE AND SUBCLAVIAN ARTERIES
958.4
TRAUMATIC SHOCK
996.1
MECHANICAL COMPLICATION OF OTHER VASCULAR DEVICE IMPLANT AND GRAFT
996.74
OTHER COMPLICATIONS DUE TO OTHER VASCULAR DEVICE IMPLANT AND GRAFT
998.11 - 998.4
HEMORRHAGE COMPLICATING A PROCEDURE - FOREIGN BODY ACCIDENTALLY LEFT DURING A
PROCEDURE NOT ELSEWHERE CLASSIFIED
PERSISTENT POSTOPERATIVE FISTULA NOT ELSEWHERE CLASSIFIED - ACUTE REACTION TO
FOREIGN SUBSTANCE ACCIDENTALLY LEFT DURING A PROCEDURE NOT ELSEWHERE CLASSIFIED
998.6 - 998.7
V43.4
BLOOD VESSEL REPLACED BY OTHER MEANS
V67.00
FOLLOW-UP EXAMINATION FOLLOWING UNSPECIFIED SURGERY
V67.09
FOLLOW-UP EXAMINATION FOLLOWING OTHER SURGERY
*Note: Use code 348.89 to identify assessment of Suspected Brain Death; use code 444.9 to report Paradoxical Cerebral
Embolism; use code 780.2 when symptomatology indicates a strong clinical suspicion of vertebrobasilar insufficiency;
use code 785.9 to report Carotid Bruit.
L-27506 Non-Invasive Peripheral Venous Studies
Description
ICD 9 Codes
CPT/HCPCS Codes
Italicized and/or quoted material is excerpted from the American Medical Association, Current Procedural
Terminology (CPT) codes.
93965
NONINVASIVE PHYSIOLOGIC STUDIES OF EXTREMITY VEINS, COMPLETE BILATERAL STUDY
(EG, DOPPLER WAVEFORM ANALYSIS WITH RESPONSES TO COMPRESSION AND OTHER
MANEUVERS, PHLEBORHEOGRAPHY, IMPEDANCE PLETHYSMOGRAPHY)
93970
93971
G0365
DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND
OTHER MANEUVERS; COMPLETE BILATERAL STUDY
DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND
OTHER MANEUVERS; UNILATERAL OR LIMITED STUDY
VESSEL MAPPING OF VESSELS FOR HEMODIALYSIS ACCESS (SERVICES FOR
PREOPERATIVE VESSEL MAPPING PRIOR TO CREATION OF HEMODIALYSIS ACCESS USING
AN AUTOGENOUS HEMODIALYSIS CONDUIT, INCLUDING ARTERIAL INFLOW AND VENOUS
OUTFLOW)
ICD-9 Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from
the ICD-9-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.
415.11 - 415.19
IATROGENIC PULMONARY EMBOLISM AND INFARCTION - OTHER PULMONARY EMBOLISM
AND INFARCTION
444.9*
EMBOLISM AND THROMBOSIS OF UNSPECIFIED ARTERY
451.0 - 451.9
452
453.1 - 453.2
453.40 - 453.74
453.79 - 453.84
453.89 - 453.9
454.0 - 454.8
459.10 - 459.39
585.4 - 585.6*
671.00 - 671.94
PHLEBITIS AND THROMBOPHLEBITIS OF SUPERFICIAL VESSELS OF LOWER EXTREMITIES PHLEBITIS AND THROMBOPHLEBITIS OF UNSPECIFIED SITE
PORTAL VEIN THROMBOSIS
THROMBOPHLEBITIS MIGRANS - OTHER VENOUS EMBOLISM AND THROMBOSIS OF
INFERIOR VENA CAVA
ACUTE VENOUS EMBOLISM AND THROMBOSIS OF UNSPECIFIED DEEP VESSELS OF LOWER
EXTREMITY - CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF AXILLARY VEINS
CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF OTHER SPECIFIED VEINS - ACUTE
VENOUS EMBOLISM AND THROMBOSIS OF AXILLARY VEINS
ACUTE VENOUS EMBOLISM AND THROMBOSIS OF OTHER SPECIFIED VEINS - EMBOLISM
AND THROMBOSIS OF UNSPECIFIED SITE
VARICOSE VEINS OF LOWER EXTREMITIES WITH ULCER - VARICOSE VEINS OF LOWER
EXTREMITIES WITH OTHER COMPLICATIONS
POSTPHLEBETIC SYNDROME WITHOUT COMPLICATIONS - CHRONIC VENOUS
HYPERTENSION WITH OTHER COMPLICATION
CHRONIC KIDNEY DISEASE, STAGE IV (SEVERE) - END STAGE RENAL DISEASE
695.9
VARICOSE VEINS OF LEGS COMPLICATING PREGNANCY AND THE PUERPERIUM
UNSPECIFIED AS TO EPISODE OF CARE - UNSPECIFIED POSTPARTUM VENOUS
COMPLICATION
OBSTETRICAL BLOOD-CLOT EMBOLISM UNSPECIFIED AS TO EPISODE OF CARE OBSTETRICAL BLOOD-CLOT EMBOLISM POSTPARTUM
UNSPECIFIED ERYTHEMATOUS CONDITION
707.10 - 707.19
UNSPECIFIED ULCER OF LOWER LIMB - ULCER OF OTHER PART OF LOWER LIMB
729.5
PAIN IN LIMB
729.81
SWELLING OF LIMB
747.60 - 747.69
782.2 - 782.3
ANOMALY OF THE PERIPHERAL VASCULAR SYSTEM UNSPECIFIED SITE - ANOMALIES OF
OTHER SPECIFIED SITES OF PERIPHERAL VASCULAR SYSTEM
LOCALIZED SUPERFICIAL SWELLING MASS OR LUMP - EDEMA
785.4
GANGRENE
786.00
RESPIRATORY ABNORMALITY UNSPECIFIED
786.03
APNEA
786.05
SHORTNESS OF BREATH
786.06
TACHYPNEA
673.20 - 673.24
786.09
RESPIRATORY ABNORMALITY OTHER
786.3
HEMOPTYSIS
786.50
UNSPECIFIED CHEST PAIN
786.52
PAINFUL RESPIRATION
L-27506 Non-Invasive Peripheral Venous Studies
Description
ICD 9 Codes
786.59
OTHER CHEST PAIN
794.2
NONSPECIFIC ABNORMAL RESULTS OF FUNCTION STUDY OF PULMONARY SYSTEM
903.00 - 903.9
INJURY TO AXILLARY VESSEL(S) UNSPECIFIED - INJURY TO UNSPECIFIED BLOOD VESSEL
OF UPPER EXTREMITY
INJURY TO COMMON FEMORAL ARTERY - INJURY TO BLOOD VESSELS OF UNSPECIFIED
SITE
MECHANICAL COMPLICATION OF OTHER VASCULAR DEVICE IMPLANT AND GRAFT
904.0 - 904.9
996.1
996.70 - 996.79
OTHER COMPLICATIONS DUE TO UNSPECIFIED DEVICE IMPLANT AND GRAFT - OTHER
COMPLICATIONS DUE TO OTHER INTERNAL PROSTHETIC DEVICE IMPLANT AND GRAFT
997.2
PERIPHERAL VASCULAR COMPLICATIONS NOT ELSEWHERE CLASSIFIED
997.79
VASCULAR COMPLICATIONS OF OTHER VESSELS
998.2
ACCIDENTAL PUNCTURE OR LACERATION DURING A PROCEDURE NOT ELSEWHERE
CLASSIFIED
OTHER VASCULAR COMPLICATIONS OF MEDICAL CARE NOT ELSEWHERE CLASSIFIED
999.2
V12.51 - V12.52
V42.0
PERSONAL HISTORY OF VENOUS THROMBOSIS AND EMBOLISM - PERSONAL HISTORY OF
THROMBOPHLEBITIS
KIDNEY REPLACED BY TRANSPLANT
V45.81
POSTSURGICAL AORTOCORONARY BYPASS STATUS
V67.00
FOLLOW-UP EXAMINATION FOLLOWING UNSPECIFIED SURGERY
V72.83*
OTHER SPECIFIED PRE-OPERATIVE EXAMINATION
*NOTE: Use code 444.9 for paradoxical embolism; use codes 585.4, 585.5 or 585.6 (secondary diagnosis) with
code V72.83 for G0365; code V72.83 is covered only for CPT/HCPCS codes 93971 and G0365.
LCD L27536 - Transthoracic Echocardiography (TTE)
Description
ICD 9 Codes
CPT/HCPCS Codes
Italicized and/or quoted material is excerpted from the American Medical Association, Current Procedural Terminology
(CPT) codes.
Hospitals should use guidelines and descriptors associated with the applicable Level I CPT code(s) to bill for
echocardiograms without contrast.
93303
TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; COMPLETE
93304
93306
93307
93308
93320
TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; FOLLOW-UP OR
LIMITED STUDY
ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES
M-MODE RECORDING, WHEN PERFORMED, COMPLETE, WITH SPECTRAL DOPPLER
ECHOCARDIOGRAPHY, AND WITH COLOR FLOW DOPPLER ECHOCARDIOGRAPHY
ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES
M-MODE RECORDING, WHEN PERFORMED, COMPLETE, WITHOUT SPECTRAL OR COLOR DOPPLER
ECHOCARDIOGRAPHY
ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES
M-MODE RECORDING, WHEN PERFORMED, FOLLOW-UP OR LIMITED STUDY
A9700
DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL
DISPLAY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING);
COMPLETE
DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL
DISPLAY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING); FOLLOWUP OR LIMITED STUDY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC
IMAGING)
DOPPLER ECHOCARDIOGRAPHY COLOR FLOW VELOCITY MAPPING (LIST SEPARATELY IN ADDITION
TO CODES FOR ECHOCARDIOGRAPHY)
SUPPLY OF INJECTABLE CONTRAST MATERIAL FOR USE IN ECHOCARDIOGRAPHY, PER STUDY
Q9955
INJECTION, PERFLEXANE LIPID MICROSPHERES, PER ML
Q9956
INJECTION, OCTAFLUOROPROPANE MICROSPHERES, PER ML
93321
93325
Q9957
INJECTION, PERFLUTREN LIPID MICROSPHERES, PER ML
Hospitals billing under OPPS are instructed to bill for echocardiograms with contrast or without contrast, followed by
contrast studies using the applicable HCPCS code(s) below. They should also report the appropriate units of HCPCS codes
for the contrast agents used in the performance of the echocardiograms.
Please see revision history for code description update retroactive to 01/01/2010.
C8921
TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY
WITH CONTRAST, FOR CONGENITAL CARDIAC ANOMALIES; COMPLETE
C8922
TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY
WITH CONTRAST, FOR CONGENITAL CARDIAC ANOMALIES; FOLLOW-UP OR LIMITED STUDY
C8923
TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY
WITH CONTRAST, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING,
WHEN PERFORMED, COMPLETE, WITHOUT SPECTRAL OR COLOR DOPPLER ECHOCARDIOGRAPHY
C8924
TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY
WITH CONTRAST, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING,
WHEN PERFORMED, FOLLOW-UP OR LIMITED STUDY
TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY
WITH CONTRAST, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING,
WHEN PERFORMED, COMPLETE, WITH SPECTRAL DOPPLER ECHOCARDIOGRAPHY, AND WITH COLOR
FLOW DOPPLER ECHOCARDIOGRAPHY
C8929
ICD-9 Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-9CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.
032.82
DIPHTHERITIC MYOCARDITIS
074.21
COXSACKIE PERICARDITIS
074.22
COXSACKIE ENDOCARDITIS
074.23
COXSACKIE MYOCARDITIS
086.0
CHAGAS' DISEASE WITH HEART INVOLVEMENT
LCD L27536 - Transthoracic Echocardiography (TTE)
Description
ICD 9 Codes
088.81
LYME DISEASE
093.0
ANEURYSM OF AORTA SPECIFIED AS SYPHILITIC
093.1
SYPHILITIC AORTITIS
093.21
SYPHILITIC ENDOCARDITIS OF MITRAL VALVE
093.22
SYPHILITIC ENDOCARDITIS OF AORTIC VALVE
093.23
SYPHILITIC ENDOCARDITIS OF TRICUSPID VALVE
093.24
SYPHILITIC ENDOCARDITIS OF PULMONARY VALVE
093.81
SYPHILITIC PERICARDITIS
093.82
SYPHILITIC MYOCARDITIS
098.83
GONOCOCCAL PERICARDITIS
098.84
GONOCOCCAL ENDOCARDITIS
112.81
CANDIDAL ENDOCARDITIS
115.03
HISTOPLASMA CAPSULATUM PERICARDITIS
115.04
HISTOPLASMA CAPSULATUM ENDOCARDITIS
115.13
HISTOPLASMA DUBOISII PERICARDITIS
115.14
HISTOPLASMA DUBOISII ENDOCARDITIS
130.3
MYOCARDITIS DUE TO TOXOPLASMOSIS
135
SARCOIDOSIS
164.1
MALIGNANT NEOPLASM OF HEART
198.89
SECONDARY MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES
212.7
BENIGN NEOPLASM OF HEART
238.8
NEOPLASM OF UNCERTAIN BEHAVIOR OF OTHER SPECIFIED SITES
239.81
NEOPLASMS OF UNSPECIFIED NATURE, RETINA AND CHOROID
239.89
NEOPLASMS OF UNSPECIFIED NATURE, OTHER SPECIFIED SITES
275.0
DISORDERS OF IRON METABOLISM
276.50 - 276.52
VOLUME DEPLETION, UNSPECIFIED - HYPOVOLEMIA
277.30
AMYLOIDOSIS, UNSPECIFIED
277.31
FAMILIAL MEDITERRANEAN FEVER
277.39
OTHER AMYLOIDOSIS
391.0
ACUTE RHEUMATIC PERICARDITIS
391.1
ACUTE RHEUMATIC ENDOCARDITIS
391.2
ACUTE RHEUMATIC MYOCARDITIS
391.8
OTHER ACUTE RHEUMATIC HEART DISEASE
391.9
ACUTE RHEUMATIC HEART DISEASE UNSPECIFIED
392.0
RHEUMATIC CHOREA WITH HEART INVOLVEMENT
393
CHRONIC RHEUMATIC PERICARDITIS
394.0 - 394.2
MITRAL STENOSIS - MITRAL STENOSIS WITH INSUFFICIENCY
394.9
OTHER AND UNSPECIFIED MITRAL VALVE DISEASES
395.0
RHEUMATIC AORTIC STENOSIS
395.1
RHEUMATIC AORTIC INSUFFICIENCY
395.2
RHEUMATIC AORTIC STENOSIS WITH INSUFFICIENCY
396.0 - 396.3
397.0 - 397.1
MITRAL VALVE STENOSIS AND AORTIC VALVE STENOSIS - MITRAL VALVE INSUFFICIENCY AND
AORTIC VALVE INSUFFICIENCY
MULTIPLE INVOLVEMENT OF MITRAL AND AORTIC VALVES - MITRAL AND AORTIC VALVE DISEASES
UNSPECIFIED
DISEASES OF TRICUSPID VALVE - RHEUMATIC DISEASES OF PULMONARY VALVE
397.9
RHEUMATIC DISEASES OF ENDOCARDIUM VALVE UNSPECIFIED
398.0
RHEUMATIC MYOCARDITIS
398.91
RHEUMATIC HEART FAILURE (CONGESTIVE)
396.8 - 396.9
398.99
OTHER RHEUMATIC HEART DISEASES
401.0
MALIGNANT ESSENTIAL HYPERTENSION
402.00
MALIGNANT HYPERTENSIVE HEART DISEASE WITHOUT HEART FAILURE
402.10
BENIGN HYPERTENSIVE HEART DISEASE WITHOUT HEART FAILURE
402.90
UNSPECIFIED HYPERTENSIVE HEART DISEASE WITHOUT HEART FAILURE
LCD L27536 - Transthoracic Echocardiography (TTE)
Description
ICD 9 Codes
404.00 - 404.03
HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, MALIGNANT, WITHOUT HEART FAILURE AND
WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED - HYPERTENSIVE
HEART AND CHRONIC KIDNEY DISEASE, MALIGNANT, WITH HEART FAILURE AND WITH CHRONIC
KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE
404.10
HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, BENIGN, WITHOUT HEART FAILURE AND
WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED
404.90 - 404.93
HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, UNSPECIFIED, WITHOUT HEART FAILURE
AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, UNSPECIFIED, WITH HEART FAILURE AND
CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE
405.11
BENIGN RENOVASCULAR HYPERTENSION
405.19
OTHER BENIGN SECONDARY HYPERTENSION
410.00 - 410.02
ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL EPISODE OF CARE UNSPECIFIED ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL SUBSEQUENT EPISODE OF CARE
410.10 - 410.12
ACUTE MYOCARDIAL INFARCTION OF OTHER ANTERIOR WALL EPISODE OF CARE UNSPECIFIED ACUTE MYOCARDIAL INFARCTION OF OTHER ANTERIOR WALL SUBSEQUENT EPISODE OF CARE
410.20 - 410.22
ACUTE MYOCARDIAL INFARCTION OF INFEROLATERAL WALL EPISODE OF CARE UNSPECIFIED ACUTE MYOCARDIAL INFARCTION OF INFEROLATERAL WALL SUBSEQUENT EPISODE OF CARE
410.30 - 410.32
ACUTE MYOCARDIAL INFARCTION OF INFEROPOSTERIOR WALL EPISODE OF CARE UNSPECIFIED ACUTE MYOCARDIAL INFARCTION OF INFEROPOSTERIOR WALL SUBSEQUENT EPISODE OF CARE
410.40 - 410.42
ACUTE MYOCARDIAL INFARCTION OF OTHER INFERIOR WALL EPISODE OF CARE UNSPECIFIED ACUTE MYOCARDIAL INFARCTION OF OTHER INFERIOR WALL SUBSEQUENT EPISODE OF CARE
410.50 - 410.52
ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL EPISODE OF CARE UNSPECIFIED ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL SUBSEQUENT EPISODE OF CARE
410.60 - 410.62
TRUE POSTERIOR WALL INFARCTION EPISODE OF CARE UNSPECIFIED - TRUE POSTERIOR WALL
INFARCTION SUBSEQUENT EPISODE OF CARE
SUBENDOCARDIAL INFARCTION EPISODE OF CARE UNSPECIFIED - SUBENDOCARDIAL INFARCTION
SUBSEQUENT EPISODE OF CARE
ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES EPISODE OF CARE UNSPECIFIED ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES SUBSEQUENT EPISODE OF CARE
410.70 - 410.72
410.80 - 410.82
411.0 - 411.1
POSTMYOCARDIAL INFARCTION SYNDROME - INTERMEDIATE CORONARY SYNDROME
411.81
ACUTE CORONARY OCCLUSION WITHOUT MYOCARDIAL INFARCTION
411.89
OTHER ACUTE AND SUBACUTE FORMS OF ISCHEMIC HEART DISEASE OTHER
412
OLD MYOCARDIAL INFARCTION
413.0 - 413.1
ANGINA DECUBITUS - PRINZMETAL ANGINA
413.9
OTHER AND UNSPECIFIED ANGINA PECTORIS
414.00 - 414.07
CORONARY ATHEROSCLEROSIS OF UNSPECIFIED TYPE OF VESSEL NATIVE OR GRAFT - CORONARY
ATHEROSCLEROSIS OF BYPASS GRAFT (ARTERY) (VEIN) OF TRANSPLANTED HEART
414.10 - 414.12
ANEURYSM OF HEART (WALL) - DISSECTION OF CORONARY ARTERY
414.19
OTHER ANEURYSM OF HEART
414.2
CHRONIC TOTAL OCCLUSION OF CORONARY ARTERY
414.8
OTHER SPECIFIED FORMS OF CHRONIC ISCHEMIC HEART DISEASE
415.0
ACUTE COR PULMONALE
415.11
IATROGENIC PULMONARY EMBOLISM AND INFARCTION
416.0
PRIMARY PULMONARY HYPERTENSION
416.2
CHRONIC PULMONARY EMBOLISM
416.8
OTHER CHRONIC PULMONARY HEART DISEASES
416.9
CHRONIC PULMONARY HEART DISEASE UNSPECIFIED
420.0
ACUTE PERICARDITIS IN DISEASES CLASSIFIED ELSEWHERE
420.90 - 420.91
ACUTE PERICARDITIS UNSPECIFIED - ACUTE IDIOPATHIC PERICARDITIS
420.99
OTHER ACUTE PERICARDITIS
LCD L27536 - Transthoracic Echocardiography (TTE)
Description
ICD 9 Codes
421.0 - 421.1
421.9
ACUTE AND SUBACUTE BACTERIAL ENDOCARDITIS - ACUTE AND SUBACUTE INFECTIVE
ENDOCARDITIS IN DISEASES CLASSIFIED ELSEWHERE
ACUTE ENDOCARDITIS UNSPECIFIED
422.0
ACUTE MYOCARDITIS IN DISEASES CLASSIFIED ELSEWHERE
422.91
IDIOPATHIC MYOCARDITIS
422.92
SEPTIC MYOCARDITIS
422.93
TOXIC MYOCARDITIS
423.0 - 423.2
HEMOPERICARDIUM - CONSTRICTIVE PERICARDITIS
423.8 - 423.9
OTHER SPECIFIED DISEASES OF PERICARDIUM - UNSPECIFIED DISEASE OF PERICARDIUM
424.0 - 424.3
MITRAL VALVE DISORDERS - PULMONARY VALVE DISORDERS
424.90 - 424.99
425.0 - 425.9
ENDOCARDITIS VALVE UNSPECIFIED UNSPECIFIED CAUSE - OTHER ENDOCARDITIS VALVE
UNSPECIFIED
ENDOMYOCARDIAL FIBROSIS - SECONDARY CARDIOMYOPATHY UNSPECIFIED
426.0
ATRIOVENTRICULAR BLOCK COMPLETE
426.12
MOBITZ (TYPE) II ATRIOVENTRICULAR BLOCK
426.3
OTHER LEFT BUNDLE BRANCH BLOCK
426.50 - 426.54
BUNDLE BRANCH BLOCK UNSPECIFIED - TRIFASCICULAR BLOCK
426.6
OTHER HEART BLOCK
426.7
ANOMALOUS ATRIOVENTRICULAR EXCITATION
426.9
CONDUCTION DISORDER UNSPECIFIED
427.0
PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA
427.1
PAROXYSMAL VENTRICULAR TACHYCARDIA
427.31
ATRIAL FIBRILLATION
427.32
ATRIAL FLUTTER
427.41
VENTRICULAR FIBRILLATION
427.42
VENTRICULAR FLUTTER
427.5
CARDIAC ARREST
427.60 - 427.61
PREMATURE BEATS UNSPECIFIED - SUPRAVENTRICULAR PREMATURE BEATS
427.69
OTHER PREMATURE BEATS
427.81
SINOATRIAL NODE DYSFUNCTION
427.89
OTHER SPECIFIED CARDIAC DYSRHYTHMIAS
428.0
CONGESTIVE HEART FAILURE UNSPECIFIED
428.1
LEFT HEART FAILURE
428.20 - 428.23
UNSPECIFIED SYSTOLIC HEART FAILURE - ACUTE ON CHRONIC SYSTOLIC HEART FAILURE
428.30 - 428.33
UNSPECIFIED DIASTOLIC HEART FAILURE - ACUTE ON CHRONIC DIASTOLIC HEART FAILURE
428.40 - 428.43
429.0
UNSPECIFIED COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE - ACUTE ON CHRONIC
COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE
MYOCARDITIS UNSPECIFIED
429.1
MYOCARDIAL DEGENERATION
429.2
CARDIOVASCULAR DISEASE UNSPECIFIED
429.3
CARDIOMEGALY
429.4
FUNCTIONAL DISTURBANCES FOLLOWING CARDIAC SURGERY
429.5
RUPTURE OF CHORDAE TENDINEAE
429.6
RUPTURE OF PAPILLARY MUSCLE
429.71
429.79
CERTAIN SEQUELAE OF MYOCARDIAL INFARCTION NOT ELSEWHERE CLASSIFIED ACQUIRED
CARDIAC SEPTAL DEFECT
CERTAIN SEQUELAE OF MYOCARDIAL INFARCTION NOT ELSEWHERE CLASSIFIED OTHER
429.81
OTHER DISORDERS OF PAPILLARY MUSCLE
434.10 - 434.11
435.0
CEREBRAL EMBOLISM WITHOUT CEREBRAL INFARCTION - CEREBRAL EMBOLISM WITH CEREBRAL
INFARCTION
BASILAR ARTERY SYNDROME
435.8
OTHER SPECIFIED TRANSIENT CEREBRAL ISCHEMIAS
435.9
UNSPECIFIED TRANSIENT CEREBRAL ISCHEMIA
436
ACUTE BUT ILL-DEFINED CEREBROVASCULAR DISEASE
440.20
ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES UNSPECIFIED
LCD L27536 - Transthoracic Echocardiography (TTE)
Description
ICD 9 Codes
440.4
CHRONIC TOTAL OCCLUSION OF ARTERY OF THE EXTREMITIES
441.00
DISSECTION OF AORTA ANEURYSM UNSPECIFIED SITE
441.01
DISSECTION OF AORTA THORACIC
441.03
DISSECTION OF AORTA THORACOABDOMINAL
441.1
THORACIC ANEURYSM RUPTURED
441.2
THORACIC ANEURYSM WITHOUT RUPTURE
441.6
THORACOABDOMINAL ANEURYSM RUPTURED
441.7
THORACOABDOMINAL ANEURYSM WITHOUT RUPTURE
441.9
AORTIC ANEURYSM OF UNSPECIFIED SITE WITHOUT RUPTURE
444.21 - 444.22
ARTERIAL EMBOLISM AND THROMBOSIS OF UPPER EXTREMITY - ARTERIAL EMBOLISM AND
THROMBOSIS OF LOWER EXTREMITY
ACUTE FEBRILE MUCOCUTANEOUS LYMPH NODE SYNDROME (MCLS)
446.1
446.7
TAKAYASU'S DISEASE
449
SEPTIC ARTERIAL EMBOLISM
458.0
ORTHOSTATIC HYPOTENSION
518.4
ACUTE EDEMA OF LUNG UNSPECIFIED
518.5
PULMONARY INSUFFICIENCY FOLLOWING TRAUMA AND SURGERY
518.7
TRANSFUSION RELATED ACUTE LUNG INJURY (TRALI)
518.82
OTHER PULMONARY INSUFFICIENCY NOT ELSEWHERE CLASSIFIED
674.50 - 674.54
PERIPART CARDIOMYOPATHY UNSPECIFIED - PERIPARTUM CARDIOMYOPATHY WITH POSTPARTUM
CONDITION OR COMPLICATION
OTHER COMPLICATIONS OF PUERPERIUM WITH DELIVERY WITH POSTPARTUM COMPLICATION
674.82
674.84
OTHER COMPLICATIONS OF PUERPERIUM
710.0
SYSTEMIC LUPUS ERYTHEMATOSUS
745.0
COMMON TRUNCUS
745.10 - 745.12
COMPLETE TRANSPOSITION OF GREAT VESSELS - CORRECTED TRANSPOSITION OF GREAT VESSELS
745.19
OTHER TRANSPOSITION OF GREAT VESSELS
745.2 - 745.5
TETRALOGY OF FALLOT - OSTIUM SECUNDUM TYPE ATRIAL SEPTAL DEFECT
745.60 - 745.61
ENDOCARDIAL CUSHION DEFECT UNSPECIFIED TYPE - OSTIUM PRIMUM DEFECT
745.69
OTHER ENDOCARDIAL CUSHION DEFECTS
745.7 - 745.9
COR BILOCULARE - UNSPECIFIED DEFECT OF SEPTAL CLOSURE
746.00 - 746.02
746.09
CONGENITAL PULMONARY VALVE ANOMALY UNSPECIFIED - STENOSIS OF PULMONARY VALVE
CONGENITAL
OTHER CONGENITAL ANOMALIES OF PULMONARY VALVE
746.1 - 746.7
TRICUSPID ATRESIA AND STENOSIS CONGENITAL - HYPOPLASTIC LEFT HEART SYNDROME
746.81 - 746.9
SUBAORTIC STENOSIS CONGENITAL - UNSPECIFIED CONGENITAL ANOMALY OF HEART
747.0
PATENT DUCTUS ARTERIOSUS
747.10 - 747.11
COARCTATION OF AORTA (PREDUCTAL) (POSTDUCTAL) - INTERRUPTION OF AORTIC ARCH
747.20 - 747.22
CONGENITAL ANOMALY OF AORTA UNSPECIFIED - CONGENITAL ATRESIA AND STENOSIS OF AORTA
747.29
OTHER CONGENITAL ANOMALIES OF AORTA
747.3
CONGENITAL ANOMALIES OF PULMONARY ARTERY
747.40 - 747.42
747.49
CONGENITAL ANOMALY OF GREAT VEINS UNSPECIFIED - PARTIAL ANOMALOUS PULMONARY
VENOUS CONNECTION
OTHER ANOMALIES OF GREAT VEINS
759.3
SITUS INVERSUS
759.82
MARFAN SYNDROME
780.01 - 780.03
COMA - PERSISTENT VEGETATIVE STATE
780.09
ALTERATION OF CONSCIOUSNESS OTHER
780.2
SYNCOPE AND COLLAPSE
780.60 - 780.61
FEVER, UNSPECIFIED - FEVER PRESENTING WITH CONDITIONS CLASSIFIED ELSEWHERE
782.3
EDEMA
782.5
CYANOSIS
LCD L27536 - Transthoracic Echocardiography (TTE)
Description
ICD 9 Codes
784.3
APHASIA
785.1
PALPITATIONS
785.2
UNDIAGNOSED CARDIAC MURMURS
785.3
OTHER ABNORMAL HEART SOUNDS
785.50
SHOCK UNSPECIFIED
785.51
CARDIOGENIC SHOCK
785.52
SEPTIC SHOCK
785.59
OTHER SHOCK WITHOUT TRAUMA
786.05
SHORTNESS OF BREATH
786.09
RESPIRATORY ABNORMALITY OTHER
786.50
UNSPECIFIED CHEST PAIN
786.51
PRECORDIAL PAIN
786.59
OTHER CHEST PAIN
790.7
BACTEREMIA
794.31
NONSPECIFIC ABNORMAL ELECTROCARDIOGRAM (ECG) (EKG)
799.01
ASPHYXIA
799.02
HYPOXEMIA
807.4
FLAIL CHEST
861.01 - 861.03
901.0
CONTUSION OF HEART WITHOUT OPEN WOUND INTO THORAX - LACERATION OF HEART WITH
PENETRATION OF HEART CHAMBERS WITHOUT OPEN WOUND INTO THORAX
UNSPECIFIED INJURY OF HEART WITH OPEN WOUND INTO THORAX - LACERATION OF HEART WITH
PENETRATION OF HEART CHAMBERS AND OPEN WOUND INTO THORAX
INJURY TO THORACIC AORTA
901.2
INJURY TO SUPERIOR VENA CAVA
901.41
INJURY TO PULMONARY ARTERY
901.42
INJURY TO PULMONARY VEIN
958.0
AIR EMBOLISM AS AN EARLY COMPLICATION OF TRAUMA
958.1
FAT EMBOLISM AS AN EARLY COMPLICATION OF TRAUMA
958.4
TRAUMATIC SHOCK
960.7
POISONING BY ANTINEOPLASTIC ANTIBIOTICS
962.0
POISONING BY ADRENAL CORTICAL STEROIDS
963.1
POISONING BY ANTINEOPLASTIC AND IMMUNOSUPPRESSIVE DRUGS
861.10 - 861.13
965.09
POISONING BY OTHER OPIATES AND RELATED NARCOTICS
972.0
POISONING BY CARDIAC RHYTHM REGULATORS
972.1
POISONING BY CARDIOTONIC GLYCOSIDES AND DRUGS OF SIMILAR ACTION
980.3
TOXIC EFFECT OF FUSEL OIL
986
TOXIC EFFECT OF CARBON MONOXIDE
990
EFFECTS OF RADIATION UNSPECIFIED
994.0
EFFECTS OF LIGHTNING
994.8
ELECTROCUTION AND NONFATAL EFFECTS OF ELECTRIC CURRENT
995.1
ANGIONEUROTIC EDEMA NOT ELSEWHERE CLASSIFIED
995.20
UNSPECIFIED ADVERSE EFFECT OF UNSPECIFIED DRUG, MEDICINAL AND BIOLOGICAL SUBSTANCE
995.22
UNSPECIFIED ADVERSE EFFECT OF ANESTHESIA
995.29
UNSPECIFIED ADVERSE EFFECT OF OTHER DRUG, MEDICINAL AND BIOLOGICAL SUBSTANCE
996.01
MECHANICAL COMPLICATION DUE TO CARDIAC PACEMAKER (ELECTRODE)
996.02
MECHANICAL COMPLICATION DUE TO HEART VALVE PROSTHESIS
996.04
MECHANICAL COMPLICATION OF AUTOMATIC IMPLANTABLE CARDIAC DEFIBRILLATOR
996.61
INFECTION AND INFLAMMATORY REACTION DUE TO CARDIAC DEVICE IMPLANT AND GRAFT
996.71
OTHER COMPLICATIONS DUE TO HEART VALVE PROSTHESIS
996.83
COMPLICATIONS OF TRANSPLANTED HEART
997.1
CARDIAC COMPLICATIONS NOT ELSEWHERE CLASSIFIED
998.0
POSTOPERATIVE SHOCK NOT ELSEWHERE CLASSIFIED
998.51 - 998.59
INFECTED POSTOPERATIVE SEROMA - OTHER POSTOPERATIVE INFECTION
LCD L27536 - Transthoracic Echocardiography (TTE)
Description
ICD 9 Codes
999.31
INFECTION DUET CENTRAL VENOUS CATHETER
999.39
INFECTION FOLLOWING OTHER INFUSION, INJECTION, TRANSFUSION, OR VACCINATION
999.4
ANAPHYLACTIC SHOCK DUE TO SERUM NOT ELSEWHERE CLASSIFIED
V12.53
PERSONAL HISTORY OF SUDDEN CARDIAC ARREST
V12.54
V42.1
PERSONAL HISTORY OF TRANSIENT ISCHEMIC ATTACK (TIA), AND CEREBRAL INFARCTION WITHOUT
RESIDUAL DEFICITS
HEART REPLACED BY TRANSPLANT
V42.2
HEART VALVE REPLACED BY TRANSPLANT
V43.3
HEART VALVE REPLACED BY OTHER MEANS
V58.11
ENCOUNTER FOR ANTINEOPLASTIC CHEMOTHERAPY
V58.44
AFTERCARE FOLLOWING ORGAN TRANSPLANT
V58.64
LONG-TERM (CURRENT) USE OF NONSTEROIDAL ANTI-INFLAMMATORIES
V58.65
LONG-TERM (CURRENT) USE OF STEROIDS
V58.69
LONG-TERM (CURRENT) USE OF OTHER MEDICATIONS
V59.8
DONORS OF OTHER SPECIFIED ORGAN OR TISSUE
V67.51
V72.83
FOLLOW-UP EXAMINATION FOLLOWING COMPLETED TREATMENT WITH HIGH-RISK MEDICATION NOT
ELSEWHERE CLASSIFIED
OTHER SPECIFIED PRE-OPERATIVE EXAMINATION
V81.2
SCREENING FOR OTHER AND UNSPECIFIED CARDIOVASCULAR CONDITIONS
Vitamin B12 Assay
Description
ICD 9 Codes
82607
CYANOCOBALAMIN (VITAMIN B-12)
ICD-9 Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the
ICD-9-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.
040.2
WHIPPLE'S DISEASE
123.4
DIPHYLLOBOTHRIASIS INTESTINAL
151.0 - 151.9
MALIGNANT NEOPLASM OF CARDIA - MALIGNANT NEOPLASM OF STOMACH UNSPECIFIED SITE
152.0 - 152.9
MALIGNANT NEOPLASM OF DUODENUM - MALIGNANT NEOPLASM OF SMALL INTESTINE
UNSPECIFIED SITE
MALIGNANT NEOPLASM OF HEAD OF PANCREAS - MALIGNANT NEOPLASM OF PANCREAS PART
UNSPECIFIED
SECONDARY MALIGNANT NEOPLASM OF SMALL INTESTINE INCLUDING DUODENUM
157.0 - 157.9
197.4
197.8
SECONDARY MALIGNANT NEOPLASM OF OTHER DIGESTIVE ORGANS AND SPLEEN
261
NUTRITIONAL MARASMUS
262
OTHER SEVERE PROTEIN-CALORIE MALNUTRITION
263.0
MALNUTRITION OF MODERATE DEGREE
263.2
ARRESTED DEVELOPMENT FOLLOWING PROTEIN-CALORIE MALNUTRITION
263.8 - 263.9
OTHER PROTEIN-CALORIE MALNUTRITION - UNSPECIFIED PROTEIN-CALORIE MALNUTRITION
266.2
OTHER B-COMPLEX DEFICIENCIES
270.4
DISTURBANCES OF SULPHUR-BEARING AMINO-ACID METABOLISM
281.0 - 281.3
281.9
PERNICIOUS ANEMIA - OTHER SPECIFIED MEGALOBLASTIC ANEMIAS NOT ELSEWHERE
CLASSIFIED
UNSPECIFIED DEFICIENCY ANEMIA
284.1
PANCYTOPENIA
285.21
ANEMIA IN CHRONIC KIDNEY DISEASE
285.9
ANEMIA UNSPECIFIED
290.0
SENILE DEMENTIA UNCOMPLICATED
290.10
PRESENILE DEMENTIA UNCOMPLICATED
290.41
VASCULAR DEMENTIA, WITH DELIRIUM
290.42
VASCULAR DEMENTIA, WITH DELUSIONS
290.43
VASCULAR DEMENTIA, WITH DEPRESSED MOOD
291.1
ALCOHOL-INDUCED PERSISTING AMNESTIC DISORDER
291.2
ALCOHOL-INDUCED PERSISTING DEMENTIA
293.0
DELIRIUM DUE TO CONDITIONS CLASSIFIED ELSEWHERE
294.10
DEMENTIA IN CONDITIONS CLASSIFIED ELSEWHERE WITHOUT BEHAVIORAL DISTURBANCE
294.11
DEMENTIA IN CONDITIONS CLASSIFIED ELSEWHERE WITH BEHAVIORAL DISTURBANCE
294.8
OTHER PERSISTENT MENTAL DISORDERS DUE TO CONDITIONS CLASSIFIED ELSEWHERE
303.91
OTHER AND UNSPECIFIED ALCOHOL DEPENDENCE CONTINUOUS DRINKING BEHAVIOR
331.7
CEREBRAL DEGENERATION IN DISEASES CLASSIFIED ELSEWHERE
331.83
MILD COGNITIVE IMPAIRMENT, SO STATED
334.4
CEREBELLAR ATAXIA IN DISEASES CLASSIFIED ELSEWHERE
354.8 - 354.9
OTHER MONONEURITIS OF UPPER LIMB - MONONEURITIS OF UPPER LIMB UNSPECIFIED
355.8 - 355.9
MONONEURITIS OF LOWER LIMB UNSPECIFIED - MONONEURITIS OF UNSPECIFIED SITE
356.4
IDIOPATHIC PROGRESSIVE POLYNEUROPATHY
356.9
UNSPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY
377.33
NUTRITIONAL OPTIC NEUROPATHY
377.34
TOXIC OPTIC NEUROPATHY
529.0
GLOSSITIS
529.4
ATROPHY OF TONGUE PAPILLAE
529.6
GLOSSODYNIA
Vitamin B12 Assay
Description
ICD 9 Codes
535.10 - 535.11
ATROPHIC GASTRITIS (WITHOUT HEMORRHAGE) - ATROPHIC GASTRITIS WITH HEMORRHAGE
536.0
ACHLORHYDRIA
555.0 - 555.9
REGIONAL ENTERITIS OF SMALL INTESTINE - REGIONAL ENTERITIS OF UNSPECIFIED SITE
564.2
POSTGASTRIC SURGERY SYNDROMES
577.1
CHRONIC PANCREATITIS
579.0 - 579.9
CELIAC DISEASE - UNSPECIFIED INTESTINAL MALABSORPTION
751.1
CONGENITAL ATRESIA AND STENOSIS OF SMALL INTESTINE
780.93
MEMORY LOSS
780.97
ALTERED MENTAL STATUS
781.2
ABNORMALITY OF GAIT
781.3
LACK OF COORDINATION
782.0
DISTURBANCE OF SKIN SENSATION
V10.00
V10.04
PERSONAL HISTORY OF MALIGNANT NEOPLASM OF UNSPECIFIED SITE IN GASTROINTESTINAL
TRACT
PERSONAL HISTORY OF MALIGNANT NEOPLASM OF STOMACH
V10.09
PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER SITES IN GASTROINTESTINAL TRACT
V12.1
PERSONAL HISTORY OF NUTRITIONAL DEFICIENCY
V44.1
GASTROSTOMY STATUS
V44.2
ILEOSTOMY STATUS
V44.4
STATUS OF OTHER ARTIFICIAL OPENING OF GASTROINTESTINAL TRACT
V45.3
POSTSURGICAL INTESTINAL BYPASS OR ANASTOMOSIS STATUS
V45.72
ACQUIRED ABSENCE OF INTESTINE (LARGE) (SMALL)
V45.75
ACQUIRED ABSENCE OF ORGAN STOMACH
V45.86
BARIATRIC SURGERY STATUS
V58.69
LONG-TERM (CURRENT) USE OF OTHER MEDICATIONS
Diagnoses that Support Medical Necessity
Conditions that are listed in the "ICD-9 Codes that Support Medical Necessity" section of this policy.
ICD-9 Codes that DO NOT Support Medical Necessity
All those not listed under the "ICD-9 Codes that Support Medical Necessity" section of this policy.
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
Diagnoses that DO NOT Support Medical Necessity
Conditions that are not listed in the "ICD-9 Codes that Support Medical Necessity" section of this policy.
Vitamin D Assay
Description
ICD 9 Codes
82306
VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED
82652
DIHYDROTESTOSTERONE (DHT) 1, 25 DIHYDROXY, INCLUDES FRACTION(S), IF PERFORMED
ICD-9 Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-9-CM
code book appropriate to the year in which the service is rendered for the claim(s) submitted.
The following ICD-9-CM codes support the medical necessity of CPT code 82306.
010.00 - 018.96
135
PRIMARY TUBERCULOUS COMPLEX UNSPECIFIED EXAMINATION - UNSPECIFIED MILIARY TUBERCULOSIS
TUBERCLE BACILLI NOT FOUND BY BACTERIOLOGICAL OR HISTOLOGICAL EXAMINATION BUT
TUBERCULOSIS CONFIRMED BY OTHER METHODS (INOCULATION OF ANIMALS
SARCOIDOSIS
268.0
RICKETS ACTIVE
268.2
OSTEOMALACIA UNSPECIFIED
268.9
UNSPECIFIED VITAMIN D DEFICIENCY
275.3
DISORDERS OF PHOSPHORUS METABOLISM
275.41
HYPOCALCEMIA
275.42
HYPERCALCEMIA
278.8
OTHER HYPERALIMENTATION
359.5
MYOPATHY IN ENDOCRINE DISEASES CLASSIFIED ELSEWHERE
555.0 - 555.9
REGIONAL ENTERITIS OF SMALL INTESTINE - REGIONAL ENTERITIS OF UNSPECIFIED SITE
556.0 - 556.9
ULCERATIVE (CHRONIC) ENTEROCOLITIS - ULCERATIVE COLITIS UNSPECIFIED
571.2
ALCOHOLIC CIRRHOSIS OF LIVER
571.5
CIRRHOSIS OF LIVER WITHOUT ALCOHOL
571.6
BILIARY CIRRHOSIS
576.8
OTHER SPECIFIED DISORDERS OF BILIARY TRACT
579.0 - 579.9
CELIAC DISEASE - UNSPECIFIED INTESTINAL MALABSORPTION
585.3
CHRONIC KIDNEY DISEASE, STAGE III (MODERATE)
585.4
CHRONIC KIDNEY DISEASE, STAGE IV (SEVERE)
585.5
CHRONIC KIDNEY DISEASE, STAGE V
585.6
END STAGE RENAL DISEASE
696.1
OTHER PSORIASIS AND SIMILAR DISORDERS
710
SYSTEMIC LUPUS ERYTHEMATOSUS
710.3
DERMATOMYOSITIS
729.1
MYALGIA AND MYOSITIS UNSPECIFIED
733.00 - 733.09
OSTEOPOROSIS UNSPECIFIED - OTHER OSTEOPOROSIS
733.9
DISORDER OF BONE AND CARTILAGE UNSPECIFIED
756.51
OSTEOGENESIS IMPERFECTA
756.52
OSTEOPETROSIS
V58.65*
LONG-TERM (CURRENT) USE OF STEROIDS
V58.69*
LONG-TERM (CURRENT) USE OF OTHER MEDICATIONS
*Use V58.65 with 268.2, to describe current long term use of glucocorticoids and V58.69 with 268.2 to describe long term use
of anticonvulsants and other medication known to lower Vitamin D levels.
The following ICD-9-CM codes support the medical necessity of CPT code 82652
010.00 - 018.96
PRIMARY TUBERCULOUS COMPLEX UNSPECIFIED EXAMINATION - UNSPECIFIED MILIARY TUBERCULOSIS
TUBERCLE BACILLI NOT FOUND BY BACTERIOLOGICAL OR HISTOLOGICAL EXAMINATION BUT
TUBERCULOSIS CONFIRMED BY OTHER METHODS (INOCULATION OF ANIMALS)
135
SARCOIDOSIS
268.0
RICKETS ACTIVE
278.8
OTHER HYPERALIMENTATION
585.3
CHRONIC KIDNEY DISEASE, STAGE III (MODERATE)
585.4
CHRONIC KIDNEY DISEASE, STAGE IV (SEVERE)
585.5
CHRONIC KIDNEY DISEASE, STAGE V
585.6
END STAGE RENAL DISEASE
756.51
OSTEOGENESIS IMPERFECTA
756.52
OSTEOPETROSIS
Diagnoses that Support Medical Necessity
Conditions that are listed in the "ICD-9 Codes that Support Medical Necessity" section of this policy.
ICD-9 Codes that DO NOT Support Medical Necessity
All those not listed under the “ICD-9 Codes that Support Medical Necessity” section of this policy.
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
Diagnoses that DO NOT Support Medical Necessity
Conditions that are not listed in the “ICD-9 Codes that Support Medical Necessity" section of this policy.