Commonly Used ICD-10 Codes Medical Necessity Effective October
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Commonly Used ICD-10 Codes Medical Necessity Effective October 1, 2015, appropriate ICD-10 code(s) are required with each requisition. ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT) (CPT 85730, 85732) ICD-10 Description ICD-10 ICD-9 Abnormal Coagulation Profile Chest Pain, Unspecified Coagulation Defect, Unspecified Encounter for Therapeutic Drug Level Monitoring Heart Failure, Unspecified Long-Term (Current) Use of Anticoagulants Shortness of Breath Unspecified Atrial Fibrillation R79.1 R07.9 D68.9 Z51.81 I50.9 Z79.01 R06.02 I48.91 790.92 786.5 286.9 V58.83 428 V58.61 786.05 427.31 ICD-10 Description ICD-10 ICD-9 Abnormal Weight Gain Abnormal Weight Loss Age-related Cognitive Decline Anemia, Unspecified Chest Pain, Unspecified Chronic Obstructive Pulmonary Disease, Unspecified Cough Encounter for Antineoplastic Chemotherapy Encounter for Antineoplastic Radiation Therapy Encounter for Other Preprocedural Examination Fever, Unspecified Heart Failure, Unspecified Iron Deficiency Anemia, Unspecified Long-Term (Current) Use Of Anticoagulants Other Long-Term (Current) Drug Therapy Other Malaise Other Fatigue Pallor Rash and Other Nonspecific Skin Eruption Streptococcal Pharyngitis Unspecified Abdominal Pain Unspecified Jaundice Unspecified Protein-Calorie Malnutrition R63.5 R63.4 R41.81 D64.9 R07.9 J44.9 R05 Z51.11 Z51.0 Z01.818 R50.9 I50.9 D50.9 Z79.01 Z79.899 R53.81 R53.83 R23.1 R21 J02.0 R10.9 R17 E46 783.1 783.2 797 285.9 786.50 496 786.2 V58.1 V58.0 V72.84 780.6 428 280.9 V58.61 V58.69 780.79 780.79 782.61 782 34 789.00 782.4 263.9 BLOOD COUNTS (CPT 85004-85049) Note: This is a partial listing of ICD-10 Codes and is no way indicative of all available codes. For complete list of codes, refer to www.cms.gov/medicare-coverage-database Medical Necessity guidelines. Page 1 of 7 Commonly Used ICD-10 Codes Medical Necessity Effective October 1, 2015, appropriate ICD-10 code(s) are required with each requisition. BLOOD GLUCOSE (CPT 82945-82952) ICD-10 Description ICD-10 ICD-9 Abnormal Finding of Blood Chemistry, Unspecified Abnormal Weight Gain Atherosclerotic Heart Disease of Native Coronary Artery without Angina Pectoris R79.9 R63.5 I25.10 790.6 783.1 414 R19.7 R35.0 E16.1 Z79.899 R53.81 R53.83 E78.0 A41.9 E11.9 F29 787.91 788.41 251.1 V58.69 780.79 780.79 272 38.9 250 298.9 ICD-10 Description ICD-10 ICD-9 Atherosclerotic Heart Disease of Native Coronary Artery without Angina Pectoris I25.10 414.01 Hyperchylomironemia Hyperlipidemia, Unspecified Mixed Hyeperglyceridemia Other Hyperlipidemia Pure Hypercholesteremia Pure Hyperglyceridemia E78.3 E78.5 E78.2 E78.4 E78.0 E78.1 272.3 272.4 272.2 272.4 272 272.1 ICD-10 ICD-9 I49.9 I50.9 R45.0 Z79.899 T46.0X1A 427.9 428 799.2 V58.69 972.1 Diarrhea, Unspecified Frequency of Micturition Other Hypoglycemia Other Long-Term (Current) Drug Therapy Other Malaise Other Fatigue Pure Hypercholesterolemia Sepsis, Unspecified Organism Type 2 Diabetes Mellitus without Complications Unspecified Psychosis Not Due to a Substance or Known Physiological Condition C-REACTIVE PROTEIN TESTING (CPT 86141) DIGOXIN (CPT 80162) ICD-10 Description Cardiac Arrhythmia, Unspecified Heart Failure, Unspecified Nervousness Other Long-Term (Current) Drug Therapy Poisoning by Cardiac-Stimulant Glycosides and Drugs of Similar Action, Accidental (Unintentional), Initial Encounter Note: This is a partial listing of ICD-10 Codes and is no way indicative of all available codes. For complete list of codes, refer to www.cms.gov/medicare-coverage-database Medical Necessity guidelines. Page 2 of 7 Commonly Used ICD-10 Codes Medical Necessity Effective October 1, 2015, appropriate ICD-10 code(s) are required with each requisition. FERRITIN (CPT 82728) ICD-10 Description ICD-10 ICD-9 Anemia, Unspecified Iron Deficiency Anemia, Unspecified Type 2 Diabetes Mellitus without Complications D64.9 D50.9 E11.9 285.9 280.9 250 ICD-10 Description ICD-10 ICD-9 Liver Disease, Unspecified Other Long-Term (Current) Drug Therapy Sepsis, Unspecified Organism Type 2 Diabetes Mellitus without Complications Unspecified Kidney Failure K76.9 Z79.899 A41.9 E11.9 N19 573.9 V58.69 38.9 250 586 ICD-10 Description ICD-10 ICD-9 Abnormal Finding Of Blood Chemistry, Unspecified Other Abnormal Glucose Other Long-Term (Current) Drug Therapy R79.9 R73.09 Z79.899 790.6 790.29 V58.69 GAMMA GLUTAMYL TRANSFERASE (GGT) (CPT 82977) GLYCOSYLATED HEMOGLOBIN (CPT 83036, 83037) LIPID TESTING (CPT 80061, 82465, 83695, 83698, 83700, 83704, 83718, 83719, 83721, 84478) ICD-10 Description ICD-10 ICD-9 Heart Failure, Unspecified Hyperlipidemia, Unspecified Hyperlipidemia, Unspecified Hypertensive Heart and Chronic Kidney Disease without Heart Failure, with Stage 1 through Stage 4 Chronic Kidney Disease I50.9 E78.5 E78.5 I13.10 428 272.4 272.4 404.91 Unspecified Chronic Kidney Disease Overweight Pure Hypercholesterolemia Type 2 Diabetes Mellitus without Complications N18.9 E66.3 E78.0 E11.9 585.9 278.02 272 250 Note: This is a partial listing of ICD-10 Codes and is no way indicative of all available codes. For complete list of codes, refer to www.cms.gov/medicare-coverage-database Medical Necessity guidelines. Page 3 of 7 Commonly Used ICD-10 Codes Medical Necessity Effective October 1, 2015, appropriate ICD-10 code(s) are required with each requisition. PROSTATE SPECIFIC ANTIGEN (PSA) (CPT 84153, 84154) ICD-10 Description ICD-10 ICD-9 Disorder of Prostate, Unspecified Elevated Prostate Specific Antigen [PSA] Frequency Of Micturition Hematuria, Unspecified Inflammatory Disease of Prostate, Unspecified Nocturia Poor Urinary Stream Urgency Of Urination N42.9 R97.2 R35.0 R31.9 N41.9 R35.1 R39.12 R39.15 602.9 790.83 788.41 599.7 601.9 788.43 788.62 788.63 ICD-10 Description ICD-10 ICD-9 Abnormal Coagulation Profile Atherosclerotic Heart Disease of Native Coronary Artery without Angina Pectoris R79.1 I25.10 790.92 414 Encounter for Therapeutic Drug Level Monitoring Heart Failure, Unspecified Long-Term (Current) Use of Anticoagulants Nutritional Anemia, Unspecified Unspecified Atrial Fibrillation Z51.81 I50.9 Z79.01 D53.9 I48.91 V58.83 428 V58.61 281.9 427.31 PROTHROMBIN TIME (PT) (CPT 85610) Note: This is a partial listing of ICD-10 Codes and is no way indicative of all available codes. For complete list of codes, refer to www.cms.gov/medicare-coverage-database Medical Necessity guidelines. Page 4 of 7 Commonly Used ICD-10 Codes Medical Necessity Effective October 1, 2015, appropriate ICD-10 code(s) are required with each requisition. THYROID FUNCTION STUDIES (CPT 84436, 84439, 84442, 84443, 84479, 84480, 84481, 84482) ICD-10 Description ICD-10 ICD-9 Abnormal Weight Gain Abnormal Weight Loss Anemia, Unspecified Constipation, Unspecified Disorder of Thyroid, Unspecified Fever, Unspecified Heart Failure, Unspecified Hypertensive Heart and Chronic Kidney Disease without Heart Failure, with Stage 1 through Stage 4 Chronic Kidney Disease R63.5 R63.4 D64.9 K59.00 E07.9 R50.9 I50.9 I13.10 783.1 783.2 285.9 564 246.9 780.6 428 404.00 Unspecified Chronic Kidney Disease Hypothyroidism, Unspecified Insomnia, Unspecified Nervousness Other Long-Term (Current) Drug Therapy Other Malaise Other Fatigue Pain in Throat Palpitations Pure Hypercholesterolemia Sleep Apnea, Unspecified Unspecified Dementia without Behavioral Disturbance Unspecified Lack of Coordination N18.9 E03.9 G47.00 R45.0 Z79.899 R53.81 R53.83 R07.0 R00.2 E78.0 G47.30 F03.90 R72.9 585.9 244.9 780.52 799.2 V58.69 780.79 780.79 784.1 785.1 272 780.51 290 781.3 Note: This is a partial listing of ICD-10 Codes and is no way indicative of all available codes. For complete list of codes, refer to www.cms.gov/medicare-coverage-database Medical Necessity guidelines. Page 5 of 7 Commonly Used ICD-10 Codes Medical Necessity Effective October 1, 2015, appropriate ICD-10 code(s) are required with each requisition. URINE CULTURE (CPT 87086, 87088) ICD-10 Description ICD-10 ICD-9 Abdominal Tenderness, Unspecified Site Abdominal tenderness, Unspecified Site Acute Cystitis without Hematuria Acute Cystitis with Hematuria Cystitis, Unspecified without Hematuria Cystitis, Unspecified with Hematuria Acute Prostatitis Altered Mental Status, Unspecified Bacteremia Calculus in Bladder Calculus of Lower Urinary Tract, Unspecified Calculus of Prostate Enlarged Prostate w/o Lower Urinary Tract Symptoms R10.819 R10.819 N30.0 N30.01 N30.90 N30.91 N41.0 R41.82 R78.81 N21.0 N21.9 N42.0 N40.0 789.6 789.69 595.0 595.0 595.9 595.9 601.0 80.97 790.7 594.0 594.9 602.0 600.0 Inflammatory Disease of the Prostate, Unspecified Fever, Unspecified Functional Urinary Incontinence Hematuria, Unspecified Hesitancy of Micturition Other Amnesia Other Difficulties with Micturition Other Long-Term (Current) Drug Therapy Other Symptoms & Signs Involving Genitourinary System Pain, Unspecified Rebound Abdominal Tenderness, Unspecified Site Rebound Abdominal Tenderness, Unspecified Site Sepsis, Unspecified Organism Streptococcal Sepsis, Unspecified Tachycardia, Unspecified Unspecified Abdominal Pain N41.9 R50.9 R39.81 R31.9 R39.11 R41.3 R39.19 Z79.899 601.9 780.6 788.81 599.7 788.64 780.93 788.69 V58.69 R39.89 R52 R10.829 R10.829 A41.9 A40.9 R00.0 R10.9 788.99 780.96 789.6 789.69 38.9 38.0 785 789.00/ 789.09 Unspecified Renal Colic Urethral Discharge without Blood Urethral Discharge, Unspecified Urgency of Urination Urinary Tract Infection, Site Not Specified N23 R36.0 R36.9 R39.15 N39.0 788 788.7 788.7 788.63 599 Note: This is a partial listing of ICD-10 Codes and is no way indicative of all available codes. For complete list of codes, refer to www.cms.gov/medicare-coverage-database Medical Necessity guidelines. Page 6 of 7 Commonly Used ICD-10 Codes Medical Necessity Effective October 1, 2015, appropriate ICD-10 code(s) are required with each requisition. VITAMIN D 1, 25 DIHYDROXY (CPT 82652) ICD-10 Description ICD-10 ICD-9 Chronic Kidney Disease, Stage III (Moderate) Chronic Kidney Disease, Stage IV (Severe) Chronic Kidney Disease, Stage V End Stage Renal Disease Osteogenesis Imperfecta Osteopetrosis N18.3 N18.4 N18.5 N18.6 Q78.0 Q78.2 585.3 585.4 585.5 585.6 756.51 756.52 ICD-10 Description ICD-10 ICD-9 Age-Related Osteoporosis without Current Pathological Fracture Age-Related Osteoporosis without Current Pathological Fracture Hypercalcemia Hypocalcemia Other Osteoporosis without Current Pathological Fracture Other Osteoporosis without Current Pathological Fracture Vitamin D Deficiency, Unspecified M81.0 M81.0 E83.52 E83.51 M81.8 M81.8 E55.9 733.00 733.01 275.42 275.41 733.02 733.09 268.9 VITAMIN D 25 HYDROXY (CPT 82306) Note: This is a partial listing of ICD-10 Codes and is no way indicative of all available codes. For complete list of codes, refer to www.cms.gov/medicare-coverage-database Medical Necessity guidelines. Page 7 of 7
