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L.2.04.420
Blood counts are used to evaluate and diagnose diseases relating to abnormalities of the blood or bone marrow. These include primary disorders such as anemia, leukemia, polycythemia, thrombocytosis and thrombocytopenia. Many other conditions secondarily affect the blood or bone marrow, including reaction to inflammation and infections, coagulopathies, neoplasms and exposure to toxic substances. Many treatments and therapies affect the blood or bone marrow, and blood counts may be used to monitor treatment effects.
The complete blood count (CBC) includes a hemogram and differential white blood count (WBC). The hemogram includes enumeration of red blood cells, white blood cells, and platelets, as well as the determination of hemoglobin, hematocrit, and indices.
The symptoms of hematological disorders are often nonspecific, and are commonly encountered in patients who may or may not prove to have a disorder of the blood or bone marrow. Furthermore, many medical conditions that are not primarily due to abnormalities of blood or bone marrow may have hematological manifestations that result from the disease or its treatment. As a result, the CBC is one of the most commonly indicated laboratory tests.
In patients with possible hematological abnormalities, it may be necessary to determine the hemoglobin and hematocrit, to calculate the red cell indices, and to measure the concentration of white blood cells and platelets. These measurements are usually performed on a multichannel analyzer that measures all of the parameters on every sample. Therefore, laboratory assessments routinely include these measurements.
A hemoglobin (Hgb), hematocrit (Hct), red blood cell count (RBC), or complete blood count (CBC) may be considered medically necessary for the following indications:
I. Evaluation of Bone Marrow Dysfunction Associated With:
1. Neoplasms2. Therapeutic agents3. Exposure to toxic substances4. Pregnancy5. Peripheral destruction of blood cells6. Suspected bone marrow failure or bone marrow infiltrate7. Suspected myeloproliferative8. Myelodysplastic9. Lymphoproliferative processes10. Immune disorders
II. Evaluation of Signs, Symptoms, Test Results, Illness or Disease that can be Associated with Red Blood Cells:
A. Red Blood Cell Disorders
1. Anemia2. Pallor3. Weakness4. Fatigue5. Weight Loss6. Bleeding7. Acute injury associated with blood loss or suspected blood loss8. Abnormal menstrual bleeding9. Hematuria10. Hematemesis11. Hematochezia12. Positive fecal occult blood test13. Malnutrition14. Vitamin deficiency15. Malabsorption16. Neuropathy17. Known malignancy18. Presence of acute or chronic disease that may have associated anemia19. Coagulation or hemostatic disorders20. Postural dizziness21. Syncope22. Abdominal pain23. Change in bowel habits24. Chronic marrow hypoplasia or decreased RBC production25. Tachycardia26. Systolic heart murmur27. Congestive heart failure dyspnea28. Angina29. Nailbed deformitites30. Growth retardation31. Jaundice32. Hepatomegaly33. Splenomegaly34. Imphadenopathy35. Ulcers on the lower extremities
B. Polycythemia
1. Fever2. Chills3. Ruddy skin4. Conjunctival redness5. Cough6. Wheezing7. Cyanosis8. Clubbing of the fingers9. Orthopnea10. Heart murmur11. Headache12. Vague cognitive changes including memory changes13. Sleep apnea14. Weakness15. Pruritus16. Dizziness17. Excessive sweating18. Visual symptoms19. Weight loss20. Massive obesity21. Gastrointestinal bleeding22. Paresthesias23. Dyspnea24. Joint symptoms25. Epigastric distress26. Pain and erythema of the fingers or toes27. Venous or arterial thrombosis28. Thromboembolism29. Myocardial infarction30. Stroke31. Transient ischemic attacks32. Congenital heart disease33. Chronic obstructive pulmonary disease34. Increased erythropoietin production associated with neoplastic35. Renal or hepatic disorders36. Androgen or diuretic use37. Splenomegaly38. Hepatomegaly39. Diastolic hypertension
C. Other Indications
1. Thalassemia2. Suspected hemoglobinopathy3. Lead poisoning4. Arsenic poisoning5. Spherocytosis
A complete blood count (CBC) may be considered medically necessary for the following indications:
I. Evaluation of Signs, Symptoms, Test Results, Illness or Disease Associated with White Blood Count:
A. Leukemia
B. Infections or inflammatory processes
C. Suspected bone marrow failure or bone marrow infiltrate
D. Suspected myeloproliferative
E. Myelodysplastic or lymphoproliferative disorder
F. Use of drugs that may cause leucopenia
G. Immune disorders
1. Fever2. Chills3. Sweats4. Shock5. Fatigue6. Malaise7. Tachycardia8. Tachypnea9. Heart murmur10. Seizures11. Alterations of consciousness12. Meningismus13. Pain such as headache14. Abdominal pain15. Arthralgia16. Odynophagia17. Dysuria18. Redness or swelling of skin19. Soft tissue bone20. Joint, ulcers, or the skin or mucous membranes21. Gangrene22. Mucous membrane discharge23. Bleeding24. Thrombosis25. Respiratory failure26. Pulmonary infiltrate27. Jaundice28. Diarrhea29. Vomiting30. Hepatomegaly31. Splenomegaly32. Lymphadenopathy33. Opportunistic infection such as oral candidiasis
H. Other Indications
1. Storage diseases2. Mucopolysaccharidoses3. Use of drugs that cause leukocytosis such as G-CSF or CM-CSF
II. Evaluation of Signs, Symptoms, Test Results, Illness, or Disease Associated with Platelets:
A. Increased or decreased platelet production and destruction
B. Platelet dysfunction
1. Gastrointestinal bleeding2. Genitourinary tract bleeding3. Bilateral epistaxis4. Thrombosis5. Ecchymosis6. Purpura7. Jaundice8. Petechiae9. Fever10. Heparin therapy11. Suspected DIC12. Shock13. Pre-eclampsia14. Neonate with maternal ITP15. Massive transfusions16. Recent platelet transfusion17. Cardiopulmonary bypass18. Hemolytic uremic syndrome19. Renal diseases20. Lymphadenopathy21. Hepatomegaly22. Splenomegaly23. Hypersplenism24. Neurologic abnormalities25. Viral or other infection26. Myeloproliferative27. Myelodysplastic28. Lymphoproliferative disorder29. Thrombosis30. Exposure to toxic agents31. Excessive alcohol ingestion32. Autoimmune disorders (SLE, RA, and other)
C. Other Indications
1. May-Hegglin syndrome2. Wiskott-Aldrich syndrome
A hemoglobin, hematocrit, RBC, or CBC is considered not medically necessary for all other indications.
None
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
Medically Necessary is defined as those services, treatments, procedures, equipment, drugs, devices, items or supplies furnished by a covered Provider that are required to identify or treat a Member's illness, injury or Mental Health Disorders, and which Company determines are covered under this Benefit Plan based on the criteria as follows in A through D:
A. consistent with the symptoms or diagnosis and treatment of the Member's condition, illness, or injury; and
B. appropriate with regard to standards of good medical practice; and
C. not solely for the convenience of the Member, his or her Provider; and
D. the most appropriate supply or level of care which can safely be provided to Member. When applied to the care of an Inpatient, it further means that services for the Member's medical symptoms or conditions require that the services cannot be safely provided to the Member as an Outpatient.
For the definition of medical necessity, “standards of good medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary.
Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.
05/23/2016: New policy added. Approved by Medical Policy Advisory Committee. Effective 07/01/2016. Policy number L.2.04.420.
06/22/2016: Code Reference section updated to add the following ICD-10 Diagnosis codes: B18.2, E83.110, F32.9, J01.00, J01.10, J01.90, J02.0, J02.9, J03.00, J03.90, J06.9, J10.1, J11.1, J15.9, J18.9, J20.9, J21.9, J32.9, K62.5, K80.20, L03.115, L03.116, L03.90, L70.0, N39.0, N93.8, N93.9, R00.2, R07.2, R10.2, R21, R59.9, Z79.899, Z94.0, and Z94.4. Corrected ICD-10 diagnosis code range: Z13.21 - E13.29 should be Z13.21 - Z13.29.
07/15/2016: Code Reference section updated to make the following corrections: I10.0 should be I10, C48.21 should be C4A.21, and P61 should be P61.0.
09/30/2016: Code Reference section updated to add the following ICD-10 diagnosis codes: D49.0 - D49.9, D50.9, D64.9, D69.6, D72.819, D72.829, L03.011 - L03.91, L04.0 - L04.9, R50.9, Z01.811, Z01.812, Z01.818, and Z39.2. Extended code ranges for the following diagnoses: C00.0 - C96.9, D00.00 - D09.9, D10.0 - D36.9, D37.01 - D48.9, and D3A.00 - D3A.8. Added new ICD-10 diagnoses: E10.3211, E13.3211, F50.89, G56.03, G56.13, G56.23, G56.33, G56.43, G56.83, G57.03, G57.13, G57.23, G57.33, G57.43, G57.53, G57.63, G57.63, G57.73, G57.83, I16.0, I16.1, I16.9, I63.013, I16.313, I63.323, I63.333, I63.343, I63.413, I63.423, I63.433, I63.443, K55.011, K59.31, K59.39, K85.00 - K85.82, K86.89, M26.621 - M26.629, N13.0, N93.1, O00.00 - O00.81, O09.A1 - O09.A3, O33.7XX0 - O33.7XX9, O34.211 - O34.219, O44.21 - O44.33, O44.41 - O44.53, R31.29, Z33.3, and Z83.42. Revised code description for ICD-10 code N10.
12/09/2016: Code Reference section updated to add ICD-10 diagnosis codes J15.0, J15.1, J15.20, J15.211, J15.212, J15.29, J15.3, J15.4, J15.5, J15.6, and J15.7.
01/25/2017: Code Reference section updated to add ICD-10 diagnosis code R20.2.
08/25/2017: Code Reference section updated to add the following ICD-10 diagnosis codes: D81.9, F98.3, H66.92, J01.01, J05.0, Q27.33, R19.7, R26.89, T81.4XXA, Z79.01, and Z94.1.
09/29/2017: Code Reference section updated to add the following new codes: ICD-10 diagnosis codes A04.71, A04.72, C96.20, C96.21, C96.22, C96.29, E11.10, E11.11, F50.82, G12.25, H54.0X33, H54.0X34, H54.0X35, H54.0X43, H54.0X44, H54.0X45, H54.0X53, H54.0X54, H54.0X55, H54.1131, H54.1132, H54.1141, H54.1142, H54.1151, H54.1152, H54.1213, H54.1214, H54.1215, H54.1223, H54.1224, H54.1225, H54.2X11, H54.2X12, H54.2X21, H54.2X22, H54.413A, H54.414A, H54.415A, H54.42A3, H54.42A4, H54.42A5, H54.511A, H54.512A, H54.52A1, H54.52A2, I27.20, I27.21, I27.22, I27.23, I27.24, I27.29, I27.83, K56.50, K56.51, K56.52, K56.690, K56.691, K56.699, K91.30, K91.31, K91.32, P78.84, and Z40.03. Removed deleted diagnosis codes E09.321, E09.329, E09.331, E09.339, E09.341, E09.349, E09.351, E13.321, E13.329, E13.331, E13.339, E13.341, E13.349, E13.351, E13.359, F50.8, K55.0, K59.3, K85.0, K85.1, K85.2, K85.3, K85.8, K86.8, K90.4, M26.62, O00.0, O00.1, O00.2, O00.8, O33.7, O34.21, and R31.2.
11/29/2017: Code Reference section updated to add ICD-10 diagnosis code Z36.89.
09/27/2018: Code Reference section updated to add new ICD-10 diagnosis codes K35.20, K35.21, K35.30, K35.31, K35.32, K35.33, K35.890, K35.891, K61.31, K61.39, K61.5, O30.131, O30.132, O30.133, O30.231, O30.232, O30.233, O30.831, O30.832, O30.833, O30.839, O86.00, O86.01, O86.02, O86.03, O86.04, O86.09, P35.4, T81.40XA, T81.40XD, T81.40XS, T81.41XA, T81.41XD, T81.41XS, T81.42XA, T81.42XD, T81.42XS, T81.43XA, T81.43XD, T81.43XS, T81.44XA, T81.44CD, T81.44XS, T81.49XA, T81.49XD, T81.49XS, Z83.430, and Z83.438, effective 10/01/2018.
09/20/2019: Code Reference section updated to add new ICD-10 diagnosis codes D75.A, I26.93, I26.94, I82.451, I82.452, I82.453, I82.459, I82.461, I82.462, I82.463, I82.469, I82.551, I82.552, I82.553, I82.559, I82.561, I82.562, I82.563, I82.569, L89.006, L89.016, L89.026, L89.106, L89.116, L89.126, L89.136, L89.146, L89.156, L89.206, L89.216, L89.226, L89.306, L89.316, L89.326, L89.46, L89.506, L89.516, L89.526, L89.606, L89.616, L89.626, L89.816, L89.896, L89.96, and R11.15. Removed deleted ICD-10 diagnosis codes A04.7, H54.0, H54.11, H54.12, H54.41, H54.42, H54.51, H54.52, K56.5, K56.69, K91.3, and Z36. Revised code descriptions for ICD-10 diagnosis codes G43.A0 and G43.A1. Effective 10/01/2019.
10/18/2019: Code Reference section updated to add ICD-10 diagnosis codes H66.90, H66.91, and H66.93. Removed deleted ICD-10 diagnosis codes K35.2, K35.3, K35.89, O86.0, and T81.4XXA.
04/29/2020: Code Reference section updated to add ICD-10 diagnosis codes E83.111, E83.118, and E83.119.
09/24/2020: Code Reference section updated to add new ICD-10 diagnosis codes A84.81, A84.89, 60.00, B60.01, B60.02, B60.03, B60.09, D57.03, D57.09, D57.213, D57.218, D57.413, D57.418, D57.42, D57.431, D57.432, D57.433, D57.438, D57.439, D57.44, D57.451, D57.452, D57.453, D57.458, D57.459, D57.813, D57.818, D59.10, D59.11, D59.12, D59.13, D59.19, D72.10, D72.110, D72.111, D72.118, D72.119, D72.12, D72.18, D72.19, D84.81, D84.821, D84.822, D84.89, D89.831, D89.832, D89.833, D89.834, D89.835, D89.839, F10.130, F10.131, F10.132, F10.139, F10.930, F10.931, F10.932, F10.939, G40.42, K20.80, K20.81, K20.90, K20.91, K21.00, K21.01, K59.81, K59.89, K74.00, K74.01, K74.02, M06.0A, M06.8A, M08.2A, N18.30, N18.31, N18.32, O34.218, O34.22, O99.891, O99.892, O99.893, R51.0 and R51.9, effective 10/01/2020.
11/06/2020: Code Reference section updated to add ICD-10 diagnosis code U07.1.
12/15/2020: Code Reference section updated to add new ICD-10 diagnosis codes J12.82, M35.81, M35.89, Z11.52, Z20.822, and Z86.16, effective 01/01/2021.
02/22/2021: Code Reference section updated to add ICD-10 diagnosis codes A08.4, A09, A31.9, A41.9, D53.9, D61.9, D70.9, E03.9, E11.8, E29.1, E55.9, E83.19, G40.909, G43.909, I88.9, J12.89, J40, K50.90 - K50.918, K51.90 - K51.918, K52.9, K57.92, K74.60, K92.2, L08.9, L40.9, L50.9, L65.9, M06.9, M10.9, M13.0, M25.50, M32.9, M35.9, M79.10, M79.641, M79.642, M79.671, M79.672, M86.9, N18.9, N92.6, N95.0, R00.0, R06.00, R07.89, R07.9, R10.10, R10.30, R10.9, R11.10, R11.2, R31.9, R35.0, R53.81, R53.82, R58, R60.0, R60.9, R71.0, R71.8, R76.8, R94.5, T84.50XA - T84.59XS, Z22.7, Z79.1, and Z79.2. Extended the range for the following diagnosis codes: K29.00 - K29.91.
10/01/2021: Code Reference section updated to add new ICD-10 diagnosis codes R05.1 - R05.9, R63.30 - R63.39, and U09.9, effective 10/01/2021.
09/20/2022: Policy reviewed. Policy statements unchanged. Policy Guidelines updated to change "Nervous/Mental Conditions" to "Mental Health Disorders" and "Medically Necessary" to "medical necessity." Code Reference section updated to add new ICD-10 diagnosis codes B37.31, B37.32, D68.00, D68.01, D68.020, D68.021, D68.022, D68.023, D68.029, D68.03, D68.04, D68.09, D75.821, D75.822, D75.828, D75.829, D75.84, D81.82, I20.2, I25.112, I25.712, I25.722, I25.732, I25.752, I25.762, I25.792, I47.20, I47.21, I47.29, N14.11, N14.19, N76.82, O35.00X1, O35.00X2, O35.00X3, O35.00X4, O35.00X5, O35.00X9, O35.01X1, O35.01X2, O35.01X3, O35.01X4, O35.01X5, O35.01X9, O35.02X1, O35.02X2, O35.02X3, O35.02X4, O35.02X5, O35.02X9, O35.03X1, O35.03X2, O35.03X3, O35.03X4, O35.03X5, O35.03X9, O35.04X1, O35.04X2, O35.04X3, O35.04X4, O35.04X5, O35.04X9, O35.05X1, O35.05X2, O35.05X3, O35.05X4, O35.05X5, O35.05X9, O35.06X1, O35.06X2, O35.06X3, O35.06X4, O35.06X5, O35.06X9, O35.07X1, O35.07X2, O35.07X3, O35.07X4, O35.07X5, O35.07X9, O35.08X1, O35.08X2, O35.08X3, O35.08X4, O35.08X5, O35.08X9, O35.09X1, O35.09X2, O35.09X3, O35.09X4, O35.09X5, O35.09X9, O35.10X1, O35.10X2, O35.10X3, O35.10X4, O35.10X5, O35.10X9, O35.11X1, O35.11X2, O35.11X3, O35.11X4, O35.11X5, O35.11X9, O35.12X1, O35.12X2, O35.12X3, O35.12X4, O35.12X5, O35.12X9, O35.13X1, O35.13X2, O35.13X3, O35.13X4, O35.13X5, O35.13X9, O35.14X1, O35.14X2, O35.14X3, O35.14X4, O35.14X5, O35.14X9, O35.15X1, O35.15X2, O35.15X3, O35.15X4, O35.15X5, O35.15X9, O35.19X1, O35.19X2, O35.19X3, O35.19X4, O35.19X5, O35.19X9, O35.AXX1, O35.AXX2, O35.AXX3, O35.AXX4, O35.AXX5, O35.AXX9, O35.BXX1, O35.BXX2, O35.BXX3, O35.BXX4, O35.BXX5, O35.BXX9, O35.CXX1, O35.CXX2, O35.CXX3, O35.CXX4, O35.CXX5, O35.CXX9, O35.DXX1, O35.DXX2, O35.DXX3, O35.DXX4, O35.DXX5, O35.DXX9, O35.EXX1, O35.EXX2, O35.EXX3, O35.EXX4, O35.EXX5, O35.EXX9, O35.FXX1, O35.FXX2, O35.FXX3, O35.FXX4, O35.FXX5, O35.FXX9, O35.GXX1, O35.GXX2, O35.GXX3, O35.GXX4, O35.GXX5, O35.GXX9, O35.HXX1, O35.HXX2, O35.HXX3, O35.HXX4, O35.HXX5, O35.HXX9, P28.30, P28.31, P28.32, P28.33, and P28.39, effective 10/01/2022. Removed deleted ICD-10 diagnosis codes B60.0, D84.8, K21.0, K59.8, K74.0, O99.89, and R51.
09/29/2023: Code Reference section updated to add new ICD-10 diagnosis codes A41.54, B96.83, D57.04, D57.214, D57.414, D57.434, D57.454, D57.814, D61.02, D89.84, G40.C01, G40.C09, G40.C11, G40.C19, G43.E01, G43.E09, G43.E11, G43.E19, I1A.0, I20.89, I24.81, I24.89, I25.85, I47.10, I47.11, I47.19, J15.61, J15.69, K35.200, K35.201, K35.209, K35.210, K35.211, K35.219, K35.20, K35.21, K63.8211, K63.8212, K63.8219, K63.822, K63.829, K68.2, K68.3, K90.821, K90.822, K90.829, K90.83, N02.B1, N02.B2, N02.B3, N02.B4, N02.B5, N02.B6, N02.B9, N04.20, N04.21, N04.22, N04.29, N06.20, N06.21, N06.22, N06.29, O26.641, O26.642, O26.643, O90.41, O90.49, Q44.70, Q44.71, Q44.79, T56.821A, T56.821D, T56.821S, T56.822A, T56.822D, T56.822S, T56.823A, T56.823D, T56.823S, T56.824A, T56.824D, T56.824S, Z16.13, Z22.340, Z22.341, Z22.349, Z22.350, Z22.358, and Z22.359, effective 10/01/2023. Removed deleted ICD-10 diagnosis codes R05 and R63.3.
10/17/2023: Policy reviewed. Policy statements unchanged. Code Reference section updated to remove deleted ICD-10 diagnosis codes D68.0, G93.3, I47.2, O35.0XX1, O35.0XX2, O35.0XX3, O35.0XX4, O35.0XX5, O35.0XX9, O35.1XX1, O35.1XX2, O35.1XX3, O35.1XX4, O35.1XX5, O35.1XX9, and P28.3.
08/29/2024: Policy reviewed; no changes.
10/01/2024: Code Reference section updated to add new ICD-10 diagnosis codes L29.81 and L29.89. Removed deleted ICD-10 diagnosis codes I20.8, I24.8, J15.6, K35.20, K35.201, and Q44.7.
10/01/2025: Code Reference section updated to add new ICD-10 diagnosis codes B88.01, D71.1, D71.8, D71.9, E11.A, G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, G35.D, L98.431, L98.432, L98.433, L98.434, L98.435, L98.436, L98.438, L98.439, L98.441, L98.442, L98.443, L98.444, L98.445, L98.446, L98.448, L98.449, L98.451, L98.452, L98.453, L98.454, L98.455, L98.456, L98.458, L98.459, L98.461, L98.462, L98.463, L98.464, L98.465, L98.466, L98.468, L98.469, L98.471, L98.472, L98.473, L98.474, L98.475, L98.476, L98.478, L98.479, L98.A111, L98.A112, L98.A113, L98.A114, L98.A115, L98.A116, L98.A118, L98.A119, L98.A121, L98.A122, L98.A123, L98.A124, L98.A125, L98.A126, L98.A128, L98.A129, L98.A191, L98.A192, L98.A193, L98.A194, L98.A195, L98.A196, L98.A198, L98.A199, L98.A211, L98.A212, L98.A213, L98.A214, L98.A215, L98.A216, L98.A218, L98.A219, L98.A221, L98.A222, L98.A223, L98.A224, L98.A225, L98.A226, L98.A228, L98.A229, L98.A291, L98.A292, L98.A293, L98.A294, L98.A295, L98.A296, L98.A298, L98.A299, L98.A311, L98.A312, L98.A313, L98.A314, L98.A315, L98.A316, L98.A318, L98.A319, L98.A321, L98.A322, L98.A323, L98.A324, L98.A325, L98.A326, L98.A328, L98.A391, L98.A392, L98.A393, L98.A394, L98.A395, L98.A396, L98.A398, L98.A399, N00.B1, N00.B2, N04.B1, N04.B2, N07.B, R10.20, R10.21, R10.22, R10.23, R10.24, R10.85, R10.8A1, R10.8A2, R10.8A3, R10.8A9, R10.A0, R10.A1, R10.A2, R10.A3, R11.16, R76.81, R76.89, Z84.11, and Z84.19.
CMS.gov, National Coverage Determination (NCD)
Medical Policy Advisory Committee
Code Number | Description |
CPT-4 | |
85013 | Blood count; spun microhematocrit |
85014 | Blood count; hematocrit (Hct) |
85018 | Blood count; hemoglobin (Hgb) |
85025 | Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count |
85027 | Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) |
85032 | Blood count; manual cell count (erythrocyte, leukocyte, or platelet) each |
85041 | Blood count; red blood cell (RBC), automated |
HCPCS | |
G0306 | Complete CBC, automated (HgB, HCT, RBC, WBC, without platelet count) and automated WBC differential count |
G0307 | Complete CBC, automated (HgB, Hct, RBC, WBC; without platelet count) |
ICD-10 Procedure | |
ICD-10 Diagnosis | |
A00.0, A00.1 | Cholera |
A01.01 - A01.3 | Typhoid and paratyphoid fevers |
A02.0, A02.1, A02.21 - A02.29, A02.8 | Other salmonella infections |
A03.0 - A03.8 | Shigellosis |
A04.0 - A04.72 | Other bacterial intestinal infections |
A05.0 - A05.8 | Other bacterial foodborne intoxications, not elsewhere classified |
A06.0 - A06.89 | Amebiasis |
A07.0 - A07.8 | Other protozoal intestinal diseases |
A08.0 - A08.39, A08.4, A08.8 | Viral and other specified intestinal infections |
A09 | Infectious gastroenteritis and colitis, unspecified |
A15.0 - A15.8, A17.0 - A17.89, A18.01 - A18.09, A18.11 - A18.4, A18.51 - A18.89, A19.0, A19.1, A19.8 | Tuberculosis |
A20.0 - A20.8 | Plague |
A21.0 - A21.8, A22.0 - A22.8, A23.0 - A23.8, A24.0 - A24.3, A25.0, A25.1, A26.0 - A26.8, A27.0 - A27.89, A28.0 - A28.8 | Certain zoonotic bacterial diseases |
A30.0 - A30.8 | Leprosy [Hansen's disease] |
A31.0 - A31.9 | Infection due to other mycobacteria |
A32.0 - A32.89 | Listeriosis |
A33 | Tetanus neonatorum |
A34 | Obstetrical tetanus |
A35 | Other tetanus |
A36.0 - A36.89 | Diphtheria |
A37.00 - A37.81 | Whooping cough |
A38.0 - A38.9 | Scarlet Fever |
A39.0 - A39.3, A39.51 - A39.89 | Meningococcal infection |
A40.0 - A40.8 | Streptococcal sepsis |
A41.01 - A41.1, A41.3, A41.4, A41.51 - A41.9 | Other sepsis |
A42.0 - A42.89 | Actinomycosis |
A43.0 - A43.8 | Nocardiosis |
A44.0 - A44.8 | Bartonellosis |
A46 | Erysipelas |
A48.0 - A48.8 | Other bacterial diseases, not elsewhere classified |
A50.01 - A50.1, A50.31 - A50.39, A50.41 - A50.6, A51.0 - A51.5, A52.01 - A52.09, A52.11 - A52.2, A52.71 - A52.8, A54.09 - A54.29, A54.31 - A54.39, A54.41 - A54.89, A55, A56.01 - A56.19, A56.3 - A56.8, A57, A58,A59.01 - A59.8, A60.01 - A60.1, A63.0, A63.8 | Infections with a predominantly sexual mode of transmission |
A65, A66.0 - A66.8, A67.0 - A67.3, A68.0, A68.1, A69.0, A69.1, A69.21 - A69.8 | Other spirochetal diseases |
A70, A71.0,A71.1, A74.0,A74.81, A74.89 | Other diseases caused by chlamydiae |
A75.0 - A75.3, A77.0 - A77.3, A77.41 - A77.8, A78, A79.0 - A79.89 | Rickettsioses |
A80.0 - A80.2, A80.39, A80.4, A81.01 - A81.89, A82.0, A82.1, A83.0 - A83.8, A84.0 - A84.8, A84.81, A84.89,A85.0, A85.1, A85.8, A86, A87.0 - A87.8, A88.0 - A88.8 | Viral and prion infections of the central nervous system |
A90, A91, A92.0 - A92.2, A92.31 - A92.8, A93.0 - A93.8, A95.0, A95.1, A96.0 - A96.8, A98.0 - A98.8 | Arthropod-borne viral fevers and viral hemorrhagic fevers |
B00.0 - B00.4, B00.51 - B00.89, B01.0 - B01.9, B02.0 - B02.29, B02.31 - B02.9, B03, B04, B05.0 - B05.9, B06.01 - B06.9, B07.0, B07.8, B08.010 - B08.03, B08.09, B08.1, B08.21 - B08.8, B08.61 - B08.69, B08.71 - B08.8 | Viral infections characterized by skin and mucous membrane lesions |
B10.01 - B10.89 | Other human herpes viruses |
B15.0 - B15.9 | Acute Hepatitis A |
B16.0 - B16.9 | Acute hepatitis B |
B17.0 | Acute delta-(super) infection of hepatitis B carrier |
B17.10 | Acute hepatitis C without hepatic coma |
B18.2 | Chronic viral hepatitis C |
B20 | Human immunodeficiency virus [HIV] disease |
B25.0 - B25.8, B26.0 - B26.9, B27.0 - B27.99, B30.0 - B30.8, B33.0, B33.1, B33.21 - B33.8 | Other viral diseases |
B37.31, B37.32 | Candidiasis of vulva and vagina |
B35.0 - B35.8, B36.0 - B36.8, B37.0 - B37.89, B38.0 - B38.89, B39.0, B39.1, B39.3, B39.5, B40.0, B40.1, B40.3 - B40.89, B41.0 - B41.8, B42.0 - B42.89, B43.0 - B43.8, B44.0 - B44.89, B45.0 - B45.8, B46.0 - B46.4, B46.8, B47.0, B47.1, B48.0 - B48.8 | Mycoses |
B50.0, B50.8, B51.0 - B51.9, B52.0 - B52.9, B53.0 - B53.8, B55.0 - B55.2, B56.0, B56.1, B57.0 - B57.2, B57.31 - B57.39, B57.41 - B57.5, B58.01 - B58.89, B59, B60.00, B60.01,B60.02, B60.03,B60.09,B60.11 - B60.8 | Protoxoal diseases |
B65.0 - B65.8, B66.0 - B66.8, B67.0 - B67.39, B67.5 - B67.69, B67.99, B68.0, B68.1, B69.0 - B69.89, B70.0, B70.1, B71.0 - B71.8, B72, B73.01 - B73.1, B74.0 - B74.8, B75, B76.0 - B76.8, B77.0 - B77.89, B78.0 - B78.7, B79, B80, B81.0 - B81.8, B83.0 - B83.8 | Heminthiases |
B85.0, B85.1, B85.3, B85.4, B86, B87.0 - B87.89, B88.0,B88.01 - B88.8 | Pediculosis, acariasis, and other infestations (B88.01 New 10/01/2025) (B88.0 Deleted 09/30/2025) |
B90.0 - B90.8, B91, B92, B94.0 - B94.8 | Sequelae of infectious and parasitic diseases |
B95.0 - B95.4, B95.61 - B95.7, B96.0, B96.1, B96.21, B96.22, B96.29 - B96.89,B97.0, B97.11 - B97.29, B97.31 - B97.89 | Bacterial and viral infectious agents |
B99.8 | Other infectious diseases |
C00.0 - C96.9 | Malignant neoplasms |
D00.00- D09.9 | In situ neoplasms |
D10.0 - D36.9 | Benign neoplasms, except benign neuroendocrine tumors |
D37.01 - D48.9 | Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes |
D3A.00 - D3A.8 | Benign neuroendocrine tumors |
D45 | Polycythemia vera |
D49.0 - D49.9 | Neoplasms of uncertain behavior |
D50.0 - D50.9, D51.0 - D51.8, D52.0 - D52.8, D53.0 - D53.9 | Nutritional anemias |
D55.0 - D55.8, D56.0 - D56.8, D57.01 - D57.212,D57.03, D57.09, D57.213, D57.214, D57.218,D57.3 - D57.412, D57.413, D57.414, D57.418,D57.42, D57.431,D57.432, D57.433, D57.434, D57.438, D57.439,D57.44, D57.451,D57.452, D57.453, D57.454, D57.458, D57.459,D57.80 - D57.812,D57.813, D57.814, D57.818,D58.0 - D58.8, D59.0 - D59.8,D59.10, D59.11,D59.12, D59.13, D59.19 | Hemolytic anemias |
D60.0 - D60.8, D61.01 - D61.9, D62, D63.0 - D63.8, D64.0 - D64.9 | Aplastic and other anemias and other bone marrow failure syndromes |
D68.00, D68.01, D68.020, D68.021, D68.022, D68.023, D68.029, D68.03, D68.04, D68.09 | Von Willebrand disease |
D65, D66, D67, D68.00 - D68.8, D69.0 - D69.6, D69.8 | Coagulation defects, purpura and other hemorrhagic conditions |
D70.0 - D70.9, D71, D71.1, D71.8, D71.9,D72.0 - D72.819,D72.10, D72.110, D72.111, D72.118, D72.119, D72.12, D72.18, D72.19, D72.820 - D72.829, D72.89, D73.0 - D73.89, D74.0, D74.8, D75.0 - D75.89, D75.AD76.1 - D76.3, D77 | Other disorders of blood and blood-forming organs (D71.1, D71.8, D71.9 New 10/01/2025) (D71 Deleted 09/30/2025) |
D75.821, D75.822, D75.828, D75.829 | Heparin induced thrombocytopenia |
D75.84 | Other platelet-activating anti-PF4 disorders |
D78.01 - D78.89 | Intraoperative and postprocedural complications of the spleen |
D81.82 | Activated Phosphoinositide 3-kinase Delta Syndrome [APDS] |
D80.0 - D80.8, D81.0 - D81.818, D81.89, D81.9D82.0 - D82.8, D83.0 - D83.8, D84.0 - D84.81,D84.821, D84.822, D84.89, D86.0 - D86.89, D89.0, D89.1, D89.3 - D89.812, D89.82, D89.831,D89.832, D89.833,D89.834, D89.835,D89.839, D89.84, D89.89 | Certain disorders involving the immune mechanism |
E03.9 | Hypothyroidism, unspecified |
E07.89 | Other specified disorders of thyroid |
E08.00 - E08.39, E08.41 - E08.69, E08.9 | Diabetes mellitus due to underlying condition |
E09.00 - E09.29, E09.3211 - E09.39, E09.41 - E09.69, E09.9 | Drug or chemical induced diabetes mellitus |
E10.10 - E10.29, E10.3211- E10.39, E10.41 - E10.69, E10.9 | Type 1 diabetes mellitus |
E11.00 - E11.39, E11.41 - E11.69, E11.8, E11.9, E11.A | Type 2 diabetes mellitus (E11.A New 10/01/2025) |
E13.00 - E13.29, E13.3211 - E13.39, E13.41 - E13.69, E13.9 | Other specified diabetes mellitus |
E29.1 | Testicular hypofunction |
E41 | Nutritional marasmus |
E42 | Marasmic kwashiorkor |
E44.0 - E44.1 | Protein-calorie malnutrition of moderate and mild degree |
E45 | Retarded development following protein-calorie malnutrition |
E50.0 - E50.8 | Vitamin A deficiency |
E51.11 - E51.8 | Thiamine deficiency |
E52 | Niacin deficiency [pellagra] |
E53.0 - E53.8 | Deficiency of other B groups vitamins |
E54 | Ascorbic acid deficiency |
E55.0 | Rickets, active |
E55.9 | Vitamin D deficiency, unspecified |
E56.0 - E56.8 | Other vitamin deficiencies |
E58 | Dietary calcium deficiency |
E59 | Dietary selenium deficiency |
E60 | Dietary zinc deficiency |
E61.0 - E61.8 | Deficiency of other nutrient elements |
E63.0 - E63.8 | Other nutritional deficiencies |
E64.0 | Sequelae of protein-calorie malnutrition |
E64.1 | Sequelae of vitamin A deficiency |
E64.2 | Sequelae of vitamin C deficiency |
E64.3 | Sequelae of rickets |
E64.8 | Sequelae of other nutritional deficiencies |
E64.9 | Sequelae of unspecified nutritional deficiency |
E66.01 | Morbid (severe) obesity due to excess calories |
E66.09 | Other obesity due to excess calories |
E66.2 | Morbid (severe) obesity with alveolar hypoventilation |
E74.00 - E74.09 | Glycogen storage disease |
E74.39 | Other disorders of intestinal carbohydrate absorption |
E75.01 - E75.09 | GM2 gangliosidosis |
E75.11, E75.19 | Other and unspecified gangliosidosis |
E75.21 - E75.23 | Other sphingolipidosis |
E75.240 - E75.248 | Niemann-Pick disease |
E75.25 | Metachromatic leukodystrophy |
E75.29 | Other sphingolipidosis |
E75.4 | Neuronal ceroid lipofuscinosis |
E75.5 | Other lipid storage disorders |
E76.01 - E76.03 | Mucopolysaccharidosis, type I |
E76.1 | Mucopolysaccharidosis, type II |
E76.210, E76.211 | Morquio mucopolysaccharidoses |
E76.22 | Sanfilippo mucopolysaccharidoses |
E76.29 | Other mucopolysaccharidoses |
E76.8 | Other disorders of glucosaminoglycan metabolism |
E80.4 | Gilbert syndrome |
E80.5 | Crigler-Najjar syndrome |
E83.110 | Hereditary hemochromatosis |
E83.111 | Hemochromatosis due to repeated red blood cell transfusions |
E83.118 | Other hemochromatosis |
E83.119 | Hemochromatosis, unspecified |
E83.19 | Other disorders of iron metabolism |
E86.0 | Dehydration |
F10.10 - F10.121,F10.130, F10.131,F10.132, F10.139,F10.14 - F10.151, F10.180 - F10.188, F10.20 - F10.221, F10.230 - F10.232, F10.24 - F10.251, F10.26 - F10.288,F10.930, F10.931,F10.932, F10.939 | Alcohol related disorders |
F32.9 | Major depressive disorder, single episode, unspecified |
F44.5 | Conversion disorder with seizures or convulsions |
F45.8 | Psychogenic diarrhea |
F50.01 - F50.89 | Eating Disorders |
F98.3 | Pica of infancy and childhood |
G00.0 - G00.8 | Bacterial meningitis, not elsewhere classified |
G01 | Meningitis in bacterial diseases classified elsewhere |
G02 | Meningitis in other infectious and parasitic diseases classified elsewhere |
G03.0 - G03.8 | Meningitis due to other and unspecified causes |
G04.01 -G04.2, G04.31 - G04.89 | Encephalitis, myelitis and encephalomyelitis |
G05.3 - G05.4 | Encephalitis, myelitis and encephalomyelitis in diseases classified elsewhere |
G06.0, G06.1 | Intracranial and intraspinal abscess and granuloma |
G07 | Intracranial and intraspinal abscess and granuloma in diseases classified elsewhere |
G08 | Intracranial and intraspinal phlebitis and thrombophlebitis |
G09 | Sequelae of inflammatory diseases of central nervous system |
G12.21 | Amyotrophic lateral sclerosis |
G12.25 | Progressive spinal muscle atrophy |
G30.0 - G30.8 | Alzheimer's disease |
G35, G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, G35.D | Multiple sclerosis (G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, G35.D New 10/01/2025) (G35 Deleted 09/30/2025) |
G37.0 | Diffuse sclerosis of central nervous system |
G37.5 | Concentric sclerosis [Balo] of central nervous system |
G40.001 - G40.019 | Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset |
G40.101 - G40.119 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures |
G40.201 - G40.219 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures |
G40.301 - G40.319 | Generalized idiopathic epilepsy and epileptic syndromes |
G40.C01, G40.C09 | Lafora progressive myoclonus epilepsy, not intractable |
G40.C11, G40.C19 | Lafora progressive myoclonus epilepsy, intractable |
G40.401 - G40.419 | Other generalized epilepsy and epileptic syndromes |
G40.42 | Cyclin-Dependent Kinase-Like 5 Deficiency Disorder |
G40.501, G40.509 | Epileptic seizures related to external causes |
G40.801 - G40.89 | Other epilepsy and recurrent seizures |
G40.909 | Epilepsy, unspecified, not intractable, without status epilepticus |
G40.A01 - G40.A19 | Absence epileptic syndrome |
G40.B01 - G40.B19 | Juvenile myoclonic epilepsy [impulsive petit mal] |
G43.A0 | Cyclical vomiting, in migraine, not intractable |
G43.A1 | Cyclical vomiting, in migraine, intractable |
G43.C0 - G43.C1 | Periodic headache syndromes in child or adult |
G43.001 - G43.839 | Migraine |
G43.909 | Migraine, unspecified, not intractable, without status migrainosus |
G43.E01, G43.E09 | Chronic migraine with aura, not intractable |
G43.E11, G43.E19 | Chronic migraine with aura, intractable |
G44.011 - G44.099 | Cluster headaches and other trigeminal autonomic cephalgias (TAC) |
G44.1 | Vascular headache, not elsewhere classified |
G44.211 - G44.229 | Tension-type headache |
G44.311 - G44.329 | Post-traumatic headache |
G44.40 - G44.41 | Drug-induced headache, not elsewhere classified |
G44.51 - G44.59 | Complicated headache syndromes |
G44.81 - G44.89 | Other specified headache syndromes |
G45.0 - G45.8 | Transient cerebral ischemic attacks and related syndromes |
G47.31 - G47.39 | Sleep apnea |
G54.0 - G54.8 | Nerve root and plexus disorders |
G56.01 - G56.03, G56.11 - G56.13, G56.21 - G56.23,G56.31 - G56.33,G56.41 - G56.43,G56.81 - G56.83 | Mononeuropathies of upper limb |
G57.01 - G57.03,G57.11 - G57.13,G57.21 - G57.23, G57.31 - G57.33, G57.41 - G57.43,G57.51 - G57.53,G57.61 - G57.63, G57.71 - G57.73, G57.81 - G57.83 | Mononeuropathies of lower limb |
G58.0 - G58.8 | Other mononeuropathies |
G59 | Mononeuropathy in diseases classified elsewhere |
G60.0 - G60.8 | Hereditary and idiopathic neuropathy |
G61.0 - G61.89 | Inflammatory polyneuropathy |
G62.0 - G62.89 | Other and unspecified polyneuropathies |
G63 | Polyneuropathy in diseases classified elsewhere |
G65.0 - G65.2 | Sequelae of inflammatory and toxic polyneuropathies |
G70.00 - G70.2, G70.81, G70.89 | Myasthenia gravis |
G72.41 - G72.49 | Inflammatory and immune myopathies, not elsewhere classified |
G90.01 | Carotid sinus syncope |
G93.81 | Temporal sclerosis |
H53.011 - H53.013, H53.021 - H53.023, H53.031 - H53.033, H53.11 - H53.123, H53.131 - H53.133, H53.141 - H53.143, H53.15 - H53.2, H53.31 - H53.34,H53.411 - H53.413, H53.421 - H53.423, H53.431 - H53.433, H53.451 - H53.453, H53.461, H53.462, H53.47 - H53.483, H53.51 - H53.59, H53.61 - H53.8 | Visual disturbances |
H54.0X33 - H54.0X55, H54.1131 - H54.3, H54.413A - H54.42A5, H54.511A - H54.52A2,H54.61, H54.62, H54.8 | Blindness and low vision |
H66.90 - H66.93 | Otitis media, unspecified |
I01.0 - I01.8 | Rheumatic fever with heart involvement |
I05.0 - I05.8 | Rheumatic mitral valve diseases |
I06.0 - I06.8 | Rheumatic aortic valve diseases |
I07.0 - I07.8 | Rheumatic tricuspid valve diseases |
I08 - I08.8 | Multiple valve diseases |
I09.0, I09.2 - I09.89 | Other rheumatic heart diseases |
I10 | Essential (primary) hypertension |
I11.0, I11.9 | Hypertensive heart disease |
I12.0, I12.9 | Hypertensive chronic kidney disease |
I13.0 - I13.2 | Hypertensive heart and chronic kidney disease |
I15.0 | Renovascular hypertension |
I15.1 | Hypertension secondary to other renal disorders |
I15.2 | Hypertension secondary to endocrine disorders |
I15.8 | Other secondary hypertension |
I1A.0 | Resistant hypertension |
I16.0, I16.1, I16.9 | Hypertensive crisis |
I20.0 - I20.2, I20.89 | Angina pectoris |
I21.01 - I21.29, I21.4 | ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction |
I22.0 - I22.8 | Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction |
I23.0 - I23.8 | Certain current complications following ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction (within the 28 day period) |
I24.0 - I24.89 | Other acute ischemic heart diseases |
I25.10 - I25.118, I25.2 - I25.6, I25.710 - I25.718, I25.720 - I25.728, I25.730 - I25.738, I25.750 - I25.758, I25.760 - I25.768, I25.790 - I25.798, I25.810 - I25.89 | Chronic ischemic heart disease |
I26.01 - I26.99 | Pulmonary embolism |
I27.0 - I27.89 | Other pulmonary heart diseases |
I28.0 - I28.8 | Other diseases of pulmonary vessels |
I45.89 | Other specified conduction disorders (Nonparoxysmal AV nodal tachycardia) |
I47.0 - I47.29 | Paroxysmal tachycardia |
I49.5 | Sick sinus syndrome |
I50.1, I50.21 - I50.23, I50.31 - I50.33, I50.41 - I50.43 | Heart failure |
I51.89 | Other ill-defined heart diseases |
I63.011 - I63.013, I63.02 - I63.032, I63.09 | Cerebral infarction due to thrombosis of precerebral arteries |
I63.111, I63.112, I63.12 - I63.132, I63.19 | Cerebral infarction due to embolism of precerebral arteries |
I63.311 - I63.313, I63.321 - I63.323, I63.331 - I63.333,I63.341 - I63.343, I63.39 | Cerebral infarction due to thrombosis of cerebral arteries |
I63.411 - I63.413,I63.421 - I63.423, I63.431 - I63.433,I63.441 - I63.443, I63.49 | Cerebral infarction due to embolism of cerebral arteries |
I63.6 | Cerebral infarction due to cerebral venous thrombosis, nonpyogenic |
I70.261 - I70.268 | Atherosclerosis of native arteries of extremities with gangrene |
I70.361 - I70.368 | Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene |
I70.461 - I70.468 | Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene |
I70.561 - I70.568 | Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene |
I70.661 - I70.668 | Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene |
I70.762 - I70.768 | Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene |
I74.01, I74.09 | Embolism and thrombosis of abdominal aorta |
I74.11, I74.19 | Embolism and thrombosis of other and unspecified parts of aorta |
I74.2 | Embolism and thrombosis of arteries of the upper extremities |
I74.3 | Embolism and thrombosis of arteries of the lower extremities |
I74.5 | Embolism and thrombosis of iliac artery |
I74.8 | Embolism and thrombosis of other arteries |
I82.0 | Budd-Chiari syndrome |
I82.1 | Thrombophlebitis migrans |
I82.210 - I82.291 | Embolism and thrombosis of vena cava and other thoracic veins |
I82.3 | Embolism and thrombosis of renal vein |
I82.401 - I82.403, I82.411 - I82.413, I82.421 - I82.423, I82.431 - I82.433, I82.441 - I82.443, I82.451, I82.452, I82.453, I82.459, I82.461, I82.462, I82.463, I82.469,I82.491 - I82.493, I82.4Y1 - I82.4Y3, I82.4Z1 - I82.4Z9 | Acute embolism and thrombosis of deep veins of lower extremity |
I82.501 - I82.509, I82.511 - I82.513, I82.521 - I82.523, I82.531 - I82.533, I82.541 - I82.543, I82.551, I82.552, I82.553, I82.559, I82.561, I82.562, I82.563, I82.569,I82.591 - I82.593, I82.5Y1 - I82.5Y3, I82.5Z1 - I82.5Z3 | Chronic embolism and thrombosis of deep veins of lower extremity |
I82.601 - I82.603, I82.611 - I82.613, I82.621 - I82.623 | Acute embolism and thrombosis of veins of upper extremity |
I82.701 - I82.703, I82.711 - I82.713, I82.721 - I82.723 | Chronic embolism and thrombosis of veins of upper extremity |
I82.811 - I82.813, I82.890, I82.891 | Embolism and thrombosis of other specified veins |
I82.A11 - I82.A13, I82.A21 - I82.A23 | Embolism and thrombosis of axillary vein |
I82.B11 - I82.B13, I82.B21 - I82.B23 | Embolism and thrombosis of subclavian vein |
I82.C11 - I82.C13, I82.C21 - I82.C23 | Embolism and thrombosis of internal jugular vein |
I87.301 - I87.303, I87.311 - I87.313, I87.321 - I87.323, I87.331 - I87.333, I87.391 - I87.393 | Chronic venous hypertension (idiopathic) |
I88.9 | Nonspecific lymphadenitis, unspecified |
I96 | Gangrene, not elsewhere classified |
J01.00, J01.01 | Acute maxillary sinusitis |
J01.10 | Acute frontal sinusitis, unspecified |
J01.90 | Acute sinusitis, unspecified |
J02.0 | Streptococcal pharyngitis |
J02.9 | Acute pharyngitis, unspecified |
J03.00 | Acute streptococcal tonsillitis, unspecified |
J03.90 | Acute tonsillitis, unspecified |
J05.0 | Acute obstructive laryngitis [croup] |
J06.9 | Acute upper respiratory infection, unspecified |
J10.1 | Influenza due to other identified influenza virus with other respiratory manifestations |
J11.1 | Influenza due to unidentified influenza virus with other respiratory manifestations |
J12.82 | Pneumonia due to coronavirus disease 2019 |
J12.89 | Other viral pneumonia |
J15.0 | Pneumonia due to Klebsiella pneumoniae |
J15.1 | Pneumonia due to Pseudomonas |
J15.20, J15.211, J15.212, J15.29 | Pneumonia due to staphylococcus code range |
J15.3 | Pneumonia due to streptococcus, group B |
J15.4 | Pneumonia due to other streptococci |
J15.5 | Pneumonia due to Escherichia coli |
J15.61 | Pneumonia due to Acinetobacter baumannii |
J15.69 | Pneumonia due to other Gram-negative bacteria |
J15.7 | Pneumonia due to Mycoplasma pneumoniae |
J15.9 | Unspecified bacterial pneumonia |
J18.9 | Pneumonia, unspecified organism |
J20.9 | Acute bronchitis, unspecified |
J21.9 | Acute bronchiolitis, unspecified |
J32.9 | Chronic sinusitis, unspecified |
J40 | Bronchitis, not specified as acute or chronic |
J44.0, J44.1 | Other chronic obstructive pulmonary disease |
J96.01, J96.02 | Acute respiratory failure |
J96.11, J96.12 | Chronic respiratory failure |
J96.21, J96.22 | Acute and chronic respiratory failure |
J98.11, J98.19 | Pulmonary collapse |
K20.80, K20.81,K20.90, K20.91 | Esophagitis |
K21.00, K21.01, K21.9 | Gastro-esophageal reflux disease |
K25.0 - K25.3, K25.7 | Gastric ulcer |
K26.0 - K26.3, K26.7 | Duodenal ulcer |
K28.0 - K28.3, K28.7 | Gastrojejunal ulcer |
K29.00 - K29.91 | Gastritis and duodenitis |
K30 | Functional dyspepsia |
K31.0 - K31.89 | Other diseases of stomach and duodenum |
K35.200, K35.201, K35.209, K35.210, K35.211, K35.219 | Acute appendicitis with generalized peritonitis |
K35.30 - K35.33, K35.890, K35.891 | Acute appendicitis |
K36 | Other appendicitis |
K37 | Unspecified appendicitis |
K38.0 - K38.8 | Other diseases of appendix |
K40.00 - K40.91 | Inguinal hernia |
K41.00 - K41.91 | Femoral hernia |
K42.0 - K42.9 | Umbilical hernia |
K43.0 - K43.6, K43.9 | Ventral hernia |
K44.0 - K44.9 | Diaphragmatic hernia |
K45.0 - K45.8 | Other abdominal hernia |
K50.00 - K50.018, K50.10 - K50.118, K50.80 - K50.818, K50.90 - K50.918 | Crohn's disease [regional enteritis] |
K51.00 - K51.018, K51.20 - K51.218, K51.30 - K51.318, K51.40 - K51.418, K51.50 - K51.518, K51.80 - K51.818, K51.90 - K51.918 | Ulcerative colitis |
K52.0 - K52.9 | Other and unspecified noninfective gastroenteritis and colitis |
K55.011 - K55.8 | Vascular disorders of intestine |
K56.0 - K56.52, K56.690 - K56.699 | Paralytic ileus and intestinal obstruction without hernia |
K57.00 - K57.53 | Diverticular disease of intestine |
K57.92 | Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding |
K58.0, K58.9 | Irritable bowel syndrome |
K59.00 - K59.09 | Constipation |
K59.1 | Functional diarrhea |
K59.2 | Neurogenic bowel, not elsewhere classified |
K59.31, K59.39 | Megacolon, not elsewhere classified |
K59.81, K59.89 | Other specified functional intestinal disorders |
K61.31 | Horseshoe abscess |
K61.39 | Other ischiorectal abscess |
K61.5 | Supralevator abscess |
K62.5 | Hemorrhage of anus and rectum |
K63.8211, K63.8212, K63.8219 | Small intestinal bacterial overgrowth |
K63.822 | Small intestinal fungal overgrowth |
K63.829 | Intestinal methanogen overgrowth, unspecified |
K65.0 - K65.8 | Peritonitis |
K66.0 - K66.8 | Other disorders of the peritoneum |
K67 | Disorders of peritoneum in infectious diseases classified elsewhere |
K68.11 - K68.9 | Disorders of the retroperitoneum |
K70.0 - K70.41 | Alcoholic liver disease |
K71.0 - K71.8 | Toxic liver disease |
K72.00 - K72.11 | Hepatic failure, not elsewhere classified |
K73.0 - K73.8 | Chronic hepatitis, not elsewhere classified |
K74.00 - K74.4, K74.60, K74.69 | Fibrosis and cirrhosis of liver |
K75.1 - K75.89 | Other inflammatory liver diseases |
K76.0 - K76.89 | Other diseases of liver |
K77 | Liver disorders in diseases classified elsewhere |
K80.20 | Calculus of gallbladder without cholecystitis without obstruction |
K85.00 - K85.82 | Acute pancreatitis |
K86.0 - K86.3 | Other diseases of pancreas |
K86.89 | Other specified diseases of pancreas |
K87 | Disorders of gallbladder, biliary tract and pancreas in diseases classified elsewhere |
K90.0 - K90.89 | Intestinal malabsorption |
K91.0 | Vomiting following gastrointestinal surgery |
K91.2 | Postsurgical malabsorption, not elsewhere classified |
K91.30, K91.31, K91.32 | Postprocedural intestinal obstruction |
K91.61, K91.62 | Intraoperative hemorrhage and hematoma of a digestive system organ or structure complicating a procedure |
K92.0 | Hematemesis |
K92.1 | Melena |
K92.2 | Gastrointestinal hemorrhage, unspecified |
K92.81 | Gastrointestinal mucositis (ulcerative) |
K92.89 | Other specified diseases of the digestive system |
L00 | Staphylococcal scalded skin syndrome |
L03.011 - L03.91 | Cellulitis and lymphangitis |
L03.115 | Cellulitis of right lower limb |
L03.116 | Cellulitis of left lower limb |
L03.90 | Cellulitis, unspecified |
L04.0 - L04.9 | Acute lymphadenitis |
L08.9 | Local infection of the skin and subcutaneous tissue, unspecified |
L10.0 - L10.89 | Pemphigus |
L12.0 - L12.8 | Pemphigoid |
L20.0 - L20.89, L21.0 - L21.8, L22, L23.0 - L23.89, L24.0 - L24.89, L26, L27.0 - L27.8, L28.0 - L28.2, L29.0 - L29.2, L29.8, L29.81, L29.89,L30.0 - L30.8 | Dermatitis and eczema |
L40.0 - L40.4, L40.51 - L40.9 | Psoriasis |
L41.0 - L41.8 | Parapsoriasis |
L49.0 - L49.9 | Exfoliation due to erythematous conditions according to extent of body surface involved |
L50.0 - L50.9 | Urticaria |
L51.0 - L51.8 | Erythema multiforme |
L52 | Erythema nodosum |
L53.0 - L53.8 | Other erythematous conditions |
L54 | Erythema in diseases classified elsewhere |
L59.0 | Erythema ab igne [dermatitis ab igne] |
L60.0 - L60.8 | Nail disorders |
L62 | Nail disorders in diseases classified elsewhere |
L63.0 - L63.8 | Alopecia areata |
L65.9 | Nonscarring hair loss, unspecified |
L70.0 | Acne vulgaris |
L73.2 | Hidradenitis suppurativa |
L74.0 - L74.2, L74.4 - L74.513, L74.52, L74.8 | Eccrine sweat disorders |
L75.0 - L75.8 | Apocrine sweat disorders |
L80 | Vitiligo |
L81.0 - L81.8 | Other disorders of pigmentation |
L82.0 - L82.1 | Seborrheic keratosis |
L83 | Acanthosis nigricans |
L86 | Keratoderma in diseases classified elsewhere |
L87.0 - L87.8 | Transepidermal elimination disorders |
L88 | Pyoderma gangrenosum |
L89.006 | Pressure-induced deep tissue damage of unspecified elbow |
L89.010 - L89.014, L89.016L89.020 - L89.024, L89.026 | Pressure ulcer of elbow |
L89.106,L89.110 - L89.114, L89.116,L89.120 - L89.124, L89.126,L89.130 - L89.134,L89.136,L89.140 - L89.144, L89.146,L89.150 - L89.154,L89.156 | Pressure ulcer of back |
L89.206,L89.210 - L89.214, L89.216,L89.220 - L89.224, L89.226 | Pressure ulcer of hip |
L89.306,L89.310 - L89.314,L89.316, L89.320 - L89.324, L89.326 | Pressure ulcer of buttock |
L89.41 - L89.46 | Pressure ulcer of contiguous site of back, buttock and hip |
L89.506,L89.510 - L89.514, L89.516,L89.520 - L89.524, L89.526 | Pressure ulcer of ankle |
L89.606,L89.610 - L89.614, L89.616,L89.620 - L89.624, L89.626 | Pressure ulcer of heel |
L89.810 - L89.814, L89.816,L89.890 - L89.894, L89.896, L89.96 | Pressure ulcer of other site |
L90.0 - L90.8 | Atrophic disorders of skin |
L92.0 - L92.8 | Granulomatous disorders of skin and subcutaneous tissue |
L93.0 - L93.2 | Lupus erythematosus |
L95.0 - L95.8 | Vasculitis limited to skin, not elsewhere classified |
L97.111 - L97.114,L97.121 - L97.124 | Non-pressure chronic ulcer of thigh |
L97.211 - L97.214, L97.221 - L97.224 | Non-pressure chronic ulcer of calf |
L97.311 - L97.314, L97.321 - L97.324 | Non-pressure chronic ulcer of ankle |
L97.411 - L97.414, L97.421 - L97.424 | Non-pressure chronic ulcer of heel and midfoot |
L97.511 - L97.514, L97.521 - L97.524 | Non-pressure chronic ulcer of other part of foot |
L97.811 - L97.814, L97.821 - L97.824 | Non-pressure chronic ulcer of other part of lower leg |
L98.0 - L98.3,L98.5 - L98.8 | Other disorders of skin and subcutaneous tissue, not elsewhere classified |
L98.411 - L98.414 | Non-pressure chronic ulcer of buttock |
L98.421 - L98.424 | Non-pressure chronic ulcer of back |
L98.431, L98.432, L98.433, L98.434, L98.435, L98.436, L98.438, L98.439 | Non-pressure chronic ulcer of abdomen (New 10/01/2025) |
L98.441, L98.442, L98.443, L98.444, L98.445, L98.446, L98.448, L98.449 | Non-pressure chronic ulcer of chest (New 10/01/2025) |
L98.451, L98.452, L98.453, L98.454, L98.455, L98.456, L98.458, L98.459 | Non-pressure chronic ulcer of neck (New 10/01/2025) |
L98.461, L98.462, L98.463, L98.464, L98.465, L98.466, L98.468, L98.469 | Non-pressure chronic ulcer of face (New 10/01/2025) |
L98.471, L98.472, L98.473, L98.474, L98.475, L98.476, L98.478, L98.479 | Non-pressure chronic ulcer of groin (New 10/01/2025) |
L98.491 - L98.494 | Non-pressure chronic ulcer of skin of other sites |
L98.A111, L98.A112, L98.A113, L98.A114, L98.A115, L98.A116, L98.A118, L98.A119, L98.A121, L98.A122, L98.A123, L98.A124, L98.A125, L98.A126, L98.A128, L98.A129, L98.A191, L98.A192, L98.A193, L98.A194, L98.A195, L98.A196, L98.A198, L98.A199 | Non-pressure chronic ulcer of upper arm (New 10/01/2025) |
L98.A211, L98.A212, L98.A213, L98.A214, L98.A215, L98.A216, L98.A218, L98.A219, L98.A221, L98.A222, L98.A223, L98.A224, L98.A225, L98.A226, L98.A228, L98.A229, L98.A291, L98.A292, L98.A293, L98.A294, L98.A295, L98.A296, L98.A298, L98.A299 | Non-pressure chronic ulcer of forearm (New 10/01/2025) |
L98.A311, L98.A312, L98.A313, L98.A314, L98.A315, L98.A316, L98.A318, L98.A319, L98.A321, L98.A322, L98.A323, L98.A324, L98.A325, L98.A326, L98.A328, L98.A391, L98.A392, L98.A393, L98.A394, L98.A395, L98.A396, L98.A398, L98.A399 | Non-pressure chronic ulcer of hand (New 10/01/2025) |
L99 | Other disorders of skin and subcutaneous tissue in diseases classified elsewhere |
M00.011, M00.012, M00.021, M00.022, M00.031, M00.032, M00.041, M00.042, M00.051, M00.052, M00.061, M00.062, M00.071, M00.072, M00.08, M00.09, M00.111, M00.112, M00.121, M00.122, M00.131, M00.132, M00.141, M00.142, M00.151, M00.152, M00.161, M00.162, M00.171, M00.172, M00.18, M00.19, M00.211, M00.212, M00.221, M00.222, M00.231, M00.232, M00.241, M00.242, M00.251, M00.252, M00.261, M00.262, M00.271, M00.272, M00.28, M00.29, M00.811, M00.812, M00.821, M00.822, M00.831, M00.832, M00.841, M00.842, M00.851, M00.852, M00.861, M00.862, M00.871, M00.872, M00.88, M00.89 | Pyogenic arthritis |
M01.X11, M01.X12, M01.X21, M01.X22, M01.X31, M01.X32, M01.X41, M01.X42, M01.X51, M01.X52, M01.X61, M01.X62, M01.X71, M01.X72, M01.X8, M01.X9 | Direct infections of joint in infectious and parasitic diseases classified elsewhere |
M02.011, M02.012, M02.021, M02.022, M02.031, M02.032, M02.041, M02.042, M02.051, M02.052, M02.061, M02.062, M02.071, M02.072, M02.08, M02.09, M02.111, M02.112, M02.121, M02.122, M02.131, M02.132, M02.141, M02.142, M02.151, M02.152, M02.161, M02.162, M02.171, M02.172, M02.18, M02.19, M02.211, M02.212, M02.221, M02.222, M02.231, M02.232, M02.241, M02.242, M02.251, M02.252, M02.261, M02.262, M02.271, M02.272, M02.28, M02.29, M02.311, M02.312, M02.321, M02.322, M02.331, M02.332, M02.341, M02.342, M02.351, M02.352, M02.361, M02.362, M02.371, M02.372, M02.38, M02.39, M02.811, M02.812, M02.821, M02.822, M02.831, M02.832, M02.841, M02.842, M02.851, M02.852, M02.861, M02.862, M02.871, M02.872, M02.88, M02.89 | Postinfective and reactive arthropathies |
M05.011, M05.012, M05.021, M05.022, M05.031, M05.032, M05.041, M05.042, M05.051, M05.052, M05.061, M05.062, M05.071, M05.072, M05.09, M05.111, M05.112, M05.121, M05.122, M05.131, M05.132, M05.141, M05.142, M05.151, M05.152, M05.161, M05.162, M05.171, M05.172, M05.19, M05.211, M05.212, M05.221, M05.222, M05.231, M05.232, M05.241, M05.242, M05.251, M05.252, M05.261, M05.262, M05.271, M05.272, M05.29, M05.311, M05.312, M05.321, M05.322, M05.331, M05.332, M05.341, M05.342, M05.351, M05.352, M05.361, M05.362, M05.371, M05.372, M05.39, M05.411, M05.412, M05.421, M05.422, M05.431, M05.432, M05.441, M05.442, M05.451, M05.452, M05.461, M05.462, M05.471, M05.472, M05.49, M05.511, M05.512, M05.521, M05.522, M05.531, M05.532, M05.541, M05.542, M05.551, M05.552, M05.561, M05.562, M05.571, M05.572, M05.59, M05.611, M05.612, M05.621, M05.622, M05.631, M05.632, M05.641, M05.642, M05.651, M05.652, M05.661, M05.662, M05.671, M05.672, M05.69, M05.711, M05.712, M05.721, M05.722, M05.731, M05.732, M05.741, M05.742, M05.751, M05.752, M05.761, M05.762, M05.771, M05.772, M05.79, M05.811, M05.812, M05.821, M05.822, M05.831, M05.832, M05.841, M05.842, M05.851, M05.852, M05.861, M05.862, M05.871, M05.872, M05.89 | Rheumatoid arthritis with rheumatoid factor |
M06.0A, M06.011, M06.012, M06.021, M06.022, M06.031, M06.032, M06.041, M06.042, M06.051, M06.052, M06.061, M06.062, M06.071, M06.072, M06.08, M06.09, M06.1, M06.211, M06.212, M06.221, M06.222, M06.231, M06.232, M06.241, M06.242, M06.251, M06.252, M06.261, M06.262, M06.271, M06.272, M06.28, M06.29, M06.311, M06.312, M06.321, M06.322, M06.331, M06.332, M06.341, M06.342, M06.351,M06.352, M06.361, M06.362, M06.371, M06.372, M06.38, M06.39, M06.4, M06.811, M06.812, M06.821, M06.822, M06.831, M06.832, M06.841, M06.842, M06.851, M06.852, M06.861, M06.862, M06.871, M06.872, M06.88, M06.89, M06.8A, M06.9 | Other rheumatoid arthritis |
M07.611, M07.612, M07.621, M07.622, M07.631, M07.632, M07.641, M07.642, M07.651, M07.652, M07.661, M07.662, M07.671, M07.672, M07.68, M07.69 | Enteropathic arthropathies |
M08.1, M08.211, M08.212, M08.221, M08.222, M08.231, M08.232, M08.241, M08.242, M08.251, M08.252, M08.261, M08.262, M08.271, M08.272, M08.28, M08.29, M08.2A, M08.3, M08.411, M08.412, M08.421, M08.422, M08.431, M08.432, M08.441, M08.442, M08.451, M08.452, M08.461, M08.462, M08.471, M08.472, M08.48, M08.811, M08.812, M08.821, M08.822, M08.831, M08.832, M08.841, M08.842, M08.851, M08.852, M08.861, M08.862, M08.871, M08.872, M08.88, M08.89 | Juvenile arthritis |
M10.011, M10.012, M10.021, M10.022, M10.031, M10.032, M10.041, M10.042, M10.051, M10.052, M10.061, M10.062, M10.071, M10.072, M10.08, M10.09, M10.111, M10.112, M10.121, M10.122, M10.131, M10.132, M10.141, M10.142, M10.151, M10.152, M10.161, M10.162, M10.171, M10.172, M10.18, M10.19, M10.211, M10.212, M10.221, M10.222, M10.231, M10.232, M10.241, M10.242, M10.251, M10.252, M10.261, M10.262, M10.271, M10.272, M10.28, M10.29, M10.311, M10.312, M10.321, M10.322, M10.331, M10.332, M10.341, M10.342, M10.351, M10.352, M10.361, M10.362, M10.371, M10.372, M10.38, M10.39, M10.411, M10.412, M10.421, M10.422, M10.431, M10.432, M10.441, M10.442, M10.451, M10.452, M10.461, M10.462, M10.471, M10.472, M10.48, M10.49, M10.9 | Gout |
M11.011, M11.012, M11.021, M11.022, M11.031, M11.032, M11.041, M11.042, M11.051, M11.052, M11.061, M11.062, M11.071, M11.072, M11.08, M11.09, M11.111, M11.112, M11.121, M11.122, M11.131, M11.132, M11.141, M11.142, M11.151, M11.152, M11.161, M11.162, M11.171, M11.172, M11.18, M11.19, M11.211, M11.212, M11.221, M11.222, M11.231, M11.232, M11.241, M11.242, M11.251, M11.252, M11.261, M11.262, M11.271, M11.272, M11.28, M11.29, M11.811, M11.812, M11.821, M11.822, M11.831, M11.832, M11.841, M11.842, M11.851, M11.852, M11.861, M11.862, M11.871, M11.872, M11.88, M11.89 | Other crystal arthropathies |
M12.011, M12.012, M12.021, M12.022,M12.031, M12.032, M12.041, M12.042,M12.051, M12.052,M12.061, M12.062, M12.071, M12.072,M12.08, M12.09, M12.111, M12.112, M12.121, M12.122, M12.131, M12.132, M12.141, M12.142, M12.151, M12.152,M12.161, M12.162, M12.171, M12.172, M12.18, M12.19, M12.211, M12.212, M12.221, M12.222, M12.231, M12.232, M12.241, M12.242, M12.251, M12.252, M12.261, M12.262, M12.271, M12.272,M12.371, M12.372, M12.28, M12.29,M12.311, M12.312, M12.321, M12.322,M12.331, M12.332, M12.341, M12.342, M12.351, M12.352, M12.361, M12.362, M12.38, M12.39,M12.411, M12.412, M12.421, M12.422, M12.431, M12.432, M12.441, M12.442, M12.451, M12.452, M12.461, M12.462, M12.471, M12.472, M12.48, M12.49, M12.511, M12.512, M12.521, M12.522, M12.531, M12.532, M12.541, M12.542, M12.551, M12.552, M12.561, M12.562, M12.571, M12.572,M12.58, M12.59, M12.811, M12.812, M12.821, M12.822, M12.831, M12.832, M12.841, M12.842, M12.851, M12.852, M12.861, M12.862, M12.871, M12.872, M12.88, M12.89 | Other and unspecified arthropathy |
M13.0,M13.111, M13.112, M13.121, M13.122, M13.131, M13.132, M13.141, M13.142, M13.151, M13.152, M13.161, M13.162, M13.171, M13.172, M13.811, M13.812, M13.821, M13.822, M13.831, M13.832, M13.841, M13.842, M13.851, M13.852, M13.861, M13.862, M13.871, M13.872, M13.88, M13.89 | Other arthritis |
M14.611, M14.612, M14.621, M14.622, M14.631, M14.632, M14.641, M14.642, M14.651, M14.652, M14.661, M14.662, M14.671, M14.672, M14.68, M14.69, M14.811, M14.812, M14.821, M14.822, M14.831, M14.832, M14.841, M14.842, M14.851, M14.852, M14.861, M14.862, M14.871, M14.872, M14.88, M14.89 | Arthropathies in other diseases classified elsewhere |
M15.0 - M15.8 | Polyosteoarthritis |
M16.0, M16.11 - M16.2, M16.31 - M16.4, M16.51 - M16.7 | Osteoarthritis of hip |
M17.0, M17.11 - M17.2, M17.31 - M17.5 | Osteoarthritis of knee |
M18.0, M18.11 - M18.2, M18.31 - M18.4, M18.51, M18.52 | Osteoarthritis of first carpometacarpal joint |
M19.011, M19.012, M19.021, M19.022, M19.031, M19.032, M19.041, M19.042, M19.071, M19.072, M19.111, M19.112, M19.121, M19.122, M19.131, M19.132, M19.141, M19.142, M19.171, M19.172, M19.211, M19.212, M19.221, M19.222, M19.231, M19.232, M19.241, M19.242, M19.271, M19.272 | Other and unspecified osteoarthritis |
M1A.0110 - M1A.0121, M1A.0210 - M1A.0221, M1A.0310 - M1A.0321, M1A.0410 - M1A.0421,M1A.0510 - M1A.0521, M1A.0610 - M1A.0621, M1A.0710 - M1A.0721, M1A.08X0 - M1A.09X1, M1A.1110 - M1A.1121, M1A.1210 - M1A.1221, M1A.1310 - M1A.1321, M1A.1410 - M1A.1421, M1A.1510 - M1A.1521, M1A.1610 - M1A.1621, M1A.1710 - M1A.1721, M1A.18X0 - M1A.19X1, M1A.2110 - M1A.2121, M1A.2210 - M1A.2221, M1A.2310 - M1A.2321, M1A.2410 - M1A.2421, M1A.2510 - M1A.2521, M1A.2610 - M1A.2621, M1A.2710 - M1A.2721, M1A.28X0 - M1A.29X1, M1A.3110 - M1A.3121, M1A.3210 - M1A.3221, M1A.3310 - M1A.3321, M1A.3410 - M1A.3421, M1A.3510 - M1A.3521, M1A.3610 - M1A.3621, M1A.3710 - M1A.3721, M1A.38X0 - M1A.39X1, M1A.4110 - M1A.4121, M1A.4210 - M1A.4221, M1A.4310 - M1A.4321, M1A.4410 - M1A.4421, M1A.4510 - M1A.4521, M1A.4610 - M1A.4621, M1A.4710 - M1A.4721, M1A.48X0 - M1A.49X1 | Chronic gout |
M24.511, M24.512, M24.521, M24.522, M24.531, M24.532, M24.541, M24.542, M24.551, M24.552, M24.561, M24.562, M24.571, M24.572, M24.574, M24.575 | Contracture of joint |
M24.611, M24.612, M24.621, M24.622, M24.631, M24.632, M24.641, M24.642, M24.651, M24.652, M24.661, M24.662, M24.671, M24.672, M24.674, M24.675 | Ankylosis of joint |
M24.7 | Protrusio acetabuli |
M24.811, M24.812, M24.821, M24.822, M24.831, M24.832, M24.841, M24.842, M24.851, M24.852, M24.871, M24.872, M24.874, M24.875 | Other specific joint derangements, not elsewhere classified |
M25.011, M25.012, M25.021, M25.022, M25.031, M25.032, M25.041, M25.042, M25.051, M25.052, M25.061, M25.062, M25.071, M25.072, M25.074, M25.075, M25.08, M25.111, M25.112, M25.121, M25.122, M25.131, M25.132, M25.141, M25.142, M25.151, M25.152, M25.161, M25.162, M25.171, M25.172, M25.174, M25.175, M25.18, M25.211, M25.212, M25.221, M25.222, M25.231, M25.232, M25.241, M25.242, M25.251, M25.252, M25.261, M25.262,M25.271, M25.272, M25.28, M25.311, M25.312, M25.321, M25.322, M25.331, M25.332, M25.341, M25.342, M25.351, M25.352, M25.361, M25.362, M25.371, M25.372, M25.374, M25.375, M25.411, M25.412, M25.421, M25.422, M25.431, M25.432, M25.441, M25.442, M25.451, M25.452, M25.461, M25.462, M25.471, M25.472, M25.474, M25.475, M25.48,M25.50, M25.511, M25.512, M25.521, M25.522, M25.531, M25.532, M25.551, M25.552, M25.561, M25.562, M25.571, M25.572, M25.611, M25.612, M25.621, M25.622, M25.631, M25.632, M25.641, M25.642, M25.651, M25.652, M25.661, M25.662, M25.671, M25.672, M25.674, M25.675, M25.711, M25.712, M25.721, M25.722, M25.731, M25.732, M25.741, M25.742, M25.751, M25.752, M25.761, M25.762, M25.771, M25.772, M25.774, M25.775, M25.78, M25.811, M25.812, M25.821, M25.822, M25.831, M25.832, M25.841, M25.842, M25.851, M25.852, M25.861, M25.862, M25.871, M25.872 | Other joint disorder, not elsewhere classified |
M26.621 - M26.629 | Arthralgia of temporomandibular joint |
M30.0 - M30.8 | Polyarteritis nodosa and related conditions |
M31.0 - M31.8 | Other necrotizing vasculopathies |
M32.0, M32.11 - M32.9 | Systemic lupus erythematosus (SLE) |
M33.01 - M33.09, M33.11 - M33.19, M33.21 - M33.29 | Dermatopolymyositis |
M34.0 - M34.89 | Systemic sclerosis [scleroderma] |
M35.01 -M35.8, M35.9 | Other systemic involvement of connective tissue |
M35.81 | Multisystem inflammatory syndrome |
M35.89 | Other specified systemic involvement of connective tissue |
M36.0 - M36.8 | Systemic disorders of connective tissue in diseases classified elsewhere |
M46.01 - M46.1M46.21 - M46.28, M46.31 - M46.39, M46.51 - M46.59, M46.81 - M46.89 | Other inflammatory spondylopathies |
M47.011 - M47.016, M47.021, M47.022, M47.11 - M47.16, M47.21 - M47.818, M47.891 - M47.898 | Spondylosis |
M48.01 - M48.08, M48.11 - M48.19, M48.21 - M48.27, M48.31 - M48.38 | Other spondylopathies |
M49.81 - M49.89 | Spondylopathies in diseases classified elsewhere |
M60.011, M60.012, M60.021, M60.022, M60.031, M60.032, M60.041, M60.042, M60.044, M60.045, M60.051, M60.052, M60.061, M60.062, M60.070, M60.071, M60.073, M60.074, M60.076, M60.077, M60.08, M60.09, M60.111, M60.112, M60.121, M60.122, M60.131, M60.132, M60.141, M60.142, M60.151, M60.152, M60.161, M60.162, M60.171, M60.172, M60.18, M60.19, M60.211, M60.212, M60.221, M60.222, M60.231, M60.232, M60.241, M60.242, M60.251, M60.252, M60.261, M60.262, M60.271, M60.272, M60.28, M60.811, M60.812, M60.821, M60.822, M60.831, M60.832, M60.841, M60.842, M60.851, M60.852, M60.861, M60.862, M60.871, M60.872, M60.88, M60.89 | Infective myositis |
M62.81 | Muscle weakness (generalized) |
M79.10 | Myalgia, unspecified site |
M79.641, M79.642, M79.644, M79.645 | Pain in hand and fingers |
M79.671, M79.672M79.674, M79.675 | Pain in foot and toes |
M83.2 | Adult osteomalacia due to malabsorption |
M83.3 | Adult osteomalacia due to malnutrition |
M86.9 | Osteomyelitis, unspecified |
N00.0 - N00.8, N00.B1, N00.B2 | Acute nephritic syndrome (N00.B1, N00.B2 New 10/01/2025) |
N01.0 - N01.8 | Rapidly progressive nephritic syndrome |
N02.0 - N02.8 | Recurrent and persistent hematuria |
N02.B1, N02.B2, N02.B3, N02.B4, N02.B5, N02.B6, N02.B9 | Recurrent and persistent immunoglobulin A nephropathy |
N03.0 - N03.8 | Chronic nephritic syndrome |
N04.0 - N04.9, N04.B1, N04.B2 | Nephrotic syndrome (N04.B1, N04.B2 New 10/01/2025) |
N06.0 - N06.8 | Isolated proteinuria with specified morphological lesion |
N07.0 - N07.8, N07.B | Hereditary nephropathy, not elsewhere classified (N07.B New 10/01/2025) |
N08 | Glomerular disorders in diseases classified elsewhere |
N10 | Acute pyelonephritis |
N11.0 - N11.8 | Chronic tubulo-interstitial nephritis |
N12 | Tubulo-interstitial nephritis, not specified as acute or chronic |
N13.0 - N13.2, N13.39 - N13.6, N13.71 - N13.722, N13.731, N13.732, N13.8 | Obstructive and reflux uropathy |
N14.0 - N14.4 | Drug- and heavy-metal-induced tubulo-interstitial and tubular conditions |
N15.0 - N15.8 | Other renal tubulo-interstitial diseases |
N16 | Renal tubulo-interstitial disorders in diseases classified elsewhere |
N17.0 - N17.8 | Acute kidney failure |
N18.1 - N18.6, N18.30, N18.31, N18.32, N18.9 | Chronic kidney disease (CKD) |
N20.0 - N20.2 | Calculus of kidney and ureter |
N22 | Calculus of urinary tract in diseases classified elsewhere |
N25.0 - N25.89 | Disorders resulting from impaired renal tubular function |
N26.1, N26.2 | Unspecified contracted kidney |
N27.0, N27.1 | Small kidney of unknown cause |
N28.0 - N28.89 | Other disorders of kidney and ureter, not elsewhere classified |
N29 | Other disorders of kidney and ureter in diseases classified elsewhere |
N30.00 -N30.81 | Cystitis |
N39.0 | Urinary tract infection, site not specified |
N49.3 | Fournier gangrene |
N76.82 | Fournier disease of vagina and vulva |
N92.0 - N92.6 | Excessive, frequent and irregular menstruation |
N93.1 | Pre-pubertal vaginal bleeding |
N93.8 | Other specified abnormal uterine and vaginal bleeding |
N93.9 | Abnormal uterine and vaginal bleeding, unspecified |
N95.0 | Postmenopausal bleeding |
O00.00 - O00.81 | Ectopic pregnancy |
O01.0, O01.1 | Hydatidiform mole |
O02.0 - O02.89 | Other abnormal products of conception |
O03.0 - O03.2, O03.31 - O03.4 | Spontaneous abortion |
O04.5 - O04.7, O04.81 - O04.89 | Complications following (induced) termination of pregnancy |
O07.0 - O07.2, O07.31 - O07.4 | Failed attempted termination of pregnancy |
O08.0 - O08.89 | Complications following ectopic and molar pregnancy |
O09.01 -O09.03, O09.11 - O09.213, O09.291 - O09.293, O09.31 - O09.33, O09.41 - O09.513, O09.521 - O09.523, O09.611 - O09.613, O09.621 - O09.623, O09.71 - O09.813, O09.821 - O09.823, O09.891 - O09.893, O09.A1 - O09.A3 | Supervision of high risk pregnancy |
O10.011 - O10.013, O10.02 - O10.113, O10.12 - O10.213, O10.22 - O10.313, O10.32 - O10.413, O10.42, O10.43 | Pre-existing hypertension complicating pregnancy, childbirth, and the puerperium |
O11.1 - O11.3 | Pre-existing hypertension with pre-eclampsia |
O12.01 - O12.03, O12.11 - O12.13, O12.21 - O12.23 | Gestational [pregnancy-induced] edema and proteinuria without hypertension |
O13.1 - O13.3 | Gestational [pregnancy-induced] hypertension without significant proteinuria |
O14.02, O14.03, O14.12, O14.13, O14.22, O14.23 | Pre-eclampsia |
O15.02 - O15.2 | Eclampsia |
O20.0, O20.8 | Hemorrhage in early pregnancy |
O21.0 - O21.8 | Excessive vomiting in pregnancy |
O22.01 - O22.03, O22.11 - O22.13, O22.21 - O22.23, O22.31 - O22.33, O22.41 - O22.43, O22.51 - O22.53, O22.8X1 - O22.8X3 | Venous complications and hemorrhoids in pregnancy |
O23.01 - O23.03, O23.11 - O23.13, O23.21 - O23.23, O23.31 - O23.33, O23.511 - O23.513, O23.521 - O23.523, O23.591 - O23.593 | Infections of genitourinary tract in pregnancy |
O24.011 - O24.013, O24.02 - O24.113, O24.12, O24.13, O24.410, O24.414, O24.420, O24.424, O24.430, O24.434, O24.811 - O24.813, O24.82, O24.83 | Diabetes mellitus in pregnancy, childbirth, and the puerperium |
O25.11 - O25.3 | Malnutrition in pregnancy, childbirth and the puerperium |
O26.01 - O26.03, O26.11 - O26.13, O26.21 - O26.23, O26.31 - O26.33, O26.41 - O26.43, O26.51 - O26.53, O26.611 - O26.613, O26.62, O26.63,O26.711 - O26.713, O26.72, O26.73, O26.811 - O26.813, O26.821 - O26.823, O26.831 - O26.833, O26.841 - O26.843, O26.851 - O26.853, O26.86, O26.872, O26.873, O26.891 - O26.893 | Maternal care for other conditions predominantly related to pregnancy |
O26.641, O26.642, O26.643 | Intrahepatic cholestasis of pregnancy |
O28.0 - O28.8 | Abnormal findings on antenatal screening of mother |
O29.011 - O29.013, O29.021 - O29.023, O29.091 - O29.093, O29.111 - O29.113, O29.121 - O29.123, O29.191 - O29.193, O29.211 - O29.213, O29.291 - O29.293, O29.3X1 - O29.3X3, O29.41 - O29.43, O29.5X1 - O29.5X9, O29.61 - O29.63, O29.8X1 - O29.8X3 | Complications of anesthesia during pregnancy |
O30.001 - O30.003, O30.011 - O30.013, O30.021 - O30.023, O30.031 - O30.033, O30.041 - O30.043, O30.091 - O30.093, O30.101 - O30.103, O30.111 - O30.113, O30.121 - O30.123, O30.131, O30.132, O30.133, O30.191 - O30.193, O30.201 - O30.203, O30.211 - O30.213, O30.221 - O30.223, O30.231, O30.232, O30.233, O30.291 - O30.293, O30.811 - O30.813, O30.821 - O30.823, O30.831, O30.832, O30.833, O30.839,O30.891 - O30.893 | Multiple gestation |
O31.00X1 - O31.00X9, O31.01X1 - O31.01X9, O31.02X1 - O31.02X9, O31.03X1 - O31.03X9, O31.11X1 - O31.11X9, O31.12X1 - O31.12X9, O31.13X1 - O31.13X9, O31.21X1 - O31.21X9, O31.22X1 - O31.22X9, O31.23X1 - O31.23X9, O31.31X1 - O31.31X9, O31.32X1 - O31.32X9, O31.33X1 - O31.33X9, O31.8X11 - O31.8X19, O31.8X21 - O31.8X29, O31.8X31 - O31.8X39 | Complications specific to multiple gestation |
O32.0XX1 - O32.9XX9 | Maternal care for malpresentation of fetus |
O33.0 - O33.2, O33.3XX1 - O33.3XX9, O33.4XX1 - O33.4XX9, O33.5XX1 - O33.5XX9, O33.6XX1 - O33.6XX9, O33.7XX0 - O33.7XX9, O33.8 | Maternal care for disproportion |
O34.01 - O34.03, O34.11 - O34.13, O34.211 - O34.219, O34.218, O34.22,O34.29, O34.31 - O34.33, O34.41 - O34.43, O34.511 - O34.513, O34.521 - O34.523, O34.531 - O34.533, O34.591 - O34.593, O34.61 - O34.63, O34.71 - O34.73, O34.81 - O34.83 | Maternal care for abnormality of pelvic organs |
O35.00X1, O35.00X2, O35.00X3, O35.00X4, O35.00X5, O35.00X9 | Maternal care for (suspected) central nervous system malformation or damage in fetus, unspecified |
O35.01X1, O35.01X2, O35.01X3, O35.01X4, O35.01X5, O35.01X9 | Maternal care for (suspected) central nervous system malformation or damage in fetus, agenesis of the corpus callosum |
O35.02X1, O35.02X2, O35.02X3, O35.02X4, O35.02X5, O35.02X9 | Maternal care for (suspected) central nervous system malformation or damage in fetus, anencephaly |
O35.03X1, O35.03X2, O35.03X3, O35.03X4, O35.03X5, O35.03X9 | Maternal care for (suspected) central nervous system malformation or damage in fetus, choroid plexus cysts |
O35.04X1, O35.04X2, O35.04X3, O35.04X4, O35.04X5, O35.04X9 | Maternal care for (suspected) central nervous system malformation or damage in fetus, encephalocele |
O35.05X1, O35.05X2, O35.05X3, O35.05X4, O35.05X5, O35.05X9 | Maternal care for (suspected) central nervous system malformation or damage in fetus, holoprosencephaly |
O35.06X1, O35.06X2, O35.06X3, O35.06X4, O35.06X5, O35.06X9 | Maternal care for (suspected) central nervous system malformation or damage in fetus, hydrocephaly |
O35.07X1, O35.07X2, O35.07X3, O35.07X4, O35.07X5, O35.07X9 | Maternal care for (suspected) central nervous system malformation or damage in fetus, microcephaly |
O35.08X1, O35.08X2, O35.08X3, O35.08X4, O35.08X5, O35.08X9 | Maternal care for (suspected) central nervous system malformation or damage in fetus, spina bifida |
O35.09X1, O35.09X2, O35.09X3, O35.09X4, O35.09X5, O35.09X9 | Maternal care for (suspected) other central nervous system malformation or damage in fetus |
O35.10X1, O35.10X2, O35.10X3, O35.10X4, O35.10X5, O35.10X9 | Maternal care for (suspected) chromosomal abnormality in fetus, unspecified |
O35.11X1, O35.11X2, O35.11X3, O35.11X4, O35.11X5, O35.11X9 | Maternal care for (suspected) chromosomal abnormality in fetus, Trisomy 13 |
O35.12X1, O35.12X2, O35.12X3, O35.12X4, O35.12X5, O35.12X9 | Maternal care for (suspected) chromosomal abnormality in fetus, Trisomy 18 |
O35.13X1, O35.13X2, O35.13X3, O35.13X4, O35.13X5, O35.13X9 | Maternal care for (suspected) chromosomal abnormality in fetus, Trisomy 21 |
O35.14X1, O35.14X2, O35.14X3, O35.14X4, O35.14X5, O35.14X9 | Maternal care for (suspected) chromosomal abnormality in fetus, Turner Syndrome |
O35.15X1, O35.15X2, O35.15X3, O35.15X4, O35.15X5, O35.15X9 | Maternal care for (suspected) chromosomal abnormality in fetus, sex chromosome abnormality |
O35.19X1, O35.19X2, O35.19X3, O35.19X4, O35.19X5, O35.19X9 | Maternal care for (suspected) chromosomal abnormality in fetus, other chromosomal abnormality |
O35.AXX1, O35.AXX2, O35.AXX3, O35.AXX4, O35.AXX5, O35.AXX9 | Maternal care for other (suspected) fetal abnormality and damage, fetal facial anomalies |
O35.BXX1, O35.BXX2, O35.BXX3, O35.BXX4, O35.BXX5, O35.BXX9 | Maternal care for other (suspected) fetal abnormality and damage, fetal cardiac anomalies |
O35.CXX1, O35.CXX2, O35.CXX3, O35.CXX4, O35.CXX5, O35.CXX9 | Maternal care for other (suspected) fetal abnormality and damage, fetal pulmonary anomalies |
O35.DXX1, O35.DXX2, O35.DXX3, O35.DXX4, O35.DXX5, O35.DXX9 | Maternal care for other (suspected) fetal abnormality and damage, fetal gastrointestinal anomalies |
O35.EXX1, O35.EXX2, O35.EXX3, O35.EXX4, O35.EXX5, O35.EXX9 | Maternal care for other (suspected) fetal abnormality and damage, fetal genitourinary anomalies |
O35.FXX1, O35.FXX2, O35.FXX3, O35.FXX4, O35.FXX5, O35.FXX9 | Maternal care for other (suspected) fetal abnormality and damage, fetal musculoskeletal anomalies of trunk |
O35.GXX1, O35.GXX2, O35.GXX3, O35.GXX4, O35.GXX5, O35.GXX9 | Maternal care for other (suspected) fetal abnormality and damage, fetal upper extremities anomalies |
O35.HXX1, O35.HXX2, O35.HXX3, O35.HXX4, O35.HXX5, O35.HXX9 | Maternal care for other (suspected) fetal abnormality and damage, fetal lower extremities anomalies |
O35.2XX1 - O35.2XX9, O35.3XX1 - O35.3XX9, O35.4XX1 - O35.4XX9, O35.5XX1 - O35.5XX9, O35.6XX1 - O35.6XX9, O35.7XX1 - O35.7XX9, O35.8XX1 - O35.8XX9 | Maternal care for known or suspected fetal abnormality and damage |
O36.0111 - O36.0119, O36.0121 - O36.0129, O36.0131 - O36.0139, O36.0191 - O36.0195, O36.0911 - O36.0919, O36.0921 - O36.0929, O36.0931 - O36.0939, O36.1111 - O36.1119, O36.1121 - O36.1129, O36.1131 - O36.1139, O36.1911 - O36.1919, O36.1921 - O36.1929, O36.1931 - O36.1939, O36.21X1 - O36.21X9, O36.22X1 - O36.22X9, O36.23X1 - O36.23X9, O36.4XX1 - O36.4XX9, O36.5111 - O36.5119, O36.5121 - O36.5129, O36.5131 - O36.5139, O36.5911 - O36.5919, O36.5921 - O36.5929, O36.5931 - O36.5939, O36.61X1 - O36.61X9, O36.62X1 - O36.62X9, O36.63X1 - O36.63X9, O36.71X1 - O36.71X9, O36.72X1 - O36.72X9, O36.73X1 - O36.73X9, O36.80X1 - O36.80X9, O36.8121 - O36.8129, O36.8131 - O36.8139, O36.8211 - O36.8219, O36.8221 - O36.8229, O36.8231 - O36.8239, O36.8911 - O36.8919, O36.8921 - O36.8929, O36.8931 - O36.8939, | Maternal care for other fetal problems |
O40.1XX1 - O40.1XX9 O40.2XX1 - O40.2XX9, O40.3XX1 - O40.3XX9 | Polyhydramnios |
O41.01X1 - O41.01X9, O41.02X1 - O41.02X9, O41.03X1 - O41.03X9, O41.1211 - O41.1219, O41.1221 - O41.1229, O41.1231 - O41.1239, O41.1411 - O41.1419, O41.1421 - O41.1429, O41.1431 - O41.1439, O41.8X11 - O41.8X19, O41.8X21 - O41.8X29, O41.8X31 - O41.8X39, | Other disorders of amniotic fluid and membranes |
O42.011 - O42.019, O42.02, O42.111 - O42.113, O42.12, O42.911 - O42.913 | Premature rupture of membranes |
O43.011 - O43.013, O43.021 - O43.023, O43.111 - O43.113, O43.121 - O43.123, O43.191 - O43.193, O43.211 - O43.213, O43.221 - O43.223, O43.231 - O43.233, O43.811 - O43.813, O43.891 - O43.893 | Placental disorders |
O44.01 - O44.03, O44.11 - O44.13, O44.21 - O44.33, O44.41 - O44.53 | Placenta previa |
O45.011 - O45.013, O45.021 - O45.023, O45.091 - O45.093, O45.8X1 - O45.8X3, | Premature separation of placenta [abruptio placentae] |
O46.011 - O46.013, O46.021 - O46.023, O46.091 - O46.093, O46.8X1 - O46.8X3 | Antepartum hemorrhage, not elsewhere classified |
O47.02 - O47.1 | False labor |
O48.0, O48.1 | Late Pregnancy |
O60.02, O60.03, O60.12X1 - O60.12X9, O60.13X1 - O60.13X9, O60.14X1 - O60.14X9, O60.22X1 - O60.22X9, O60.23X1 - O60.23X9 | Preterm labor |
O61.0 - O61.8 | Failed induction of labor |
O62.0 - O62.8 | Abnormalities of forces of labor |
O63.0 - O63.2 | Long labor |
O64.0XX1 - O64.0XX9, O64.1XX1 - O64.1XX9, O64.2XX1 - O64.2XX9, O64.3XX1 - O64.3XX9, O64.4XX1 - O64.4XX9, O64.5XX1 - O64.5XX9, O64.8XX1 - O64.8XX9 | Obstructed labor due to malposition and malpresentation of fetus |
O65.0 - O65.3, O65.5, O65.8 | Obstructed labor due to maternal pelvic abnormality |
O66.0 - O66.3, O66.41 - O66.8 | Other obstructed labor |
O67.0, O67.8 | Labor and delivery complicated by intrapartum hemorrhage, not elsewhere classified |
O68 | Labor and delivery complicated by abnormality of fetal acid-base balance |
O69.0XX1 - O69.0XX9, O69.1XX1 - O69.1XX9, O69.2XX1 - O69.2XX9, O69.3XX1 - O69.3XX9, O69.4XX1 - O69.4XX9, O69.5XX1 - O69.5XX9, O69.81X1 - O69.81X9, O69.82X1 - O69.82X9, O69.89X1 - O69.89X9 | Labor and delivery complicated by umbilical cord complications |
O70.0 - O70.4 | Perineal laceration during delivery |
O71.02 - O71.89 | Other obstetric trauma |
O72.0 - O72.3 | Postpartum hemorrhage |
O73.0 - O73.1 | Retained placenta and membranes, without hemorrhage |
O74.0 - O74.8 | Complications of anesthesia during labor and delivery |
O75.0 - O75.89 | Other complications of labor and delivery, not elsewhere classified |
O76 | Abnormality in fetal heart rate and rhythm complicating labor and delivery |
O77.0 - O77.8 | Other fetal stress complicating labor and delivery |
O80 | Encounter for full-term uncomplicated delivery |
O82 | Encounter for cesarean delivery without indication |
O85 | Puerperal sepsis |
O86.00 - O86.19, O86.21 - O86.89 | Other puerperal infections |
O87.0 - O87.8 | Venous complications and hemorrhoids in the puerperium |
O88.011 - O88.013, O88.02, O88.03, O88.111 - O88.113, O88.12. O88.13, O88.211 - O88.213, O88.22, O88.23, O88.311 - O88.313, O88.32, O88.33, O88.811 - O88.813, O88.82, O88.83 | Obstetric embolism |
O89.01 - O89.8 | Complications of anesthesia during the puerperium |
O90.0 - O90.89 | Complications of the puerperium, not elsewhere classified |
O91.011 - O91.013, O91.02, O91.03, O91.111 - O91.113, O91.12, O91.13, O91.211 - O91.213, O91.22, O91.23 | Infections of breast associated with pregnancy, the puerperium and lactation |
O92.011 - O92.013, O92.02, O92.03, O92.111 - O92.113, O92.12, O92.13, O92.29, O92.3 - O92.6, O92.79 | Other disorders of breast and disorders of lactation associated with pregnancy and the puerperium |
O94 | Sequelae of complication of pregnancy, childbirth, and the puerperium |
O98.011 - O98.013, O98.02, O98.03, O98.111 - O98.113, O98.12, O98.13, O98.211 - O98.213, O98.22, O98.23, O98.311 - O98.313, O98.32, O98.33, O98.411 - O98.413, O98.42, O98.43, O98.511 - O98.513, O98.52, O98.53, O98.611 - O98.613, O98.62, O98.63, O98.711 - O98.713, O98.72, O98.73, O98.811 - O98.813, O98.82, O98.83, | Maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium |
O99.011 - O99.013, O99.02, O99.03, O99.111 - O99.113, O99.12, O99.13, O99.211 - O99.215, O99.281 - O99.282, O99.311 - O99.315, O99.321 - O99.325, O99.331 - O99.335, O99.341 - O99.345, O99.351 - O99.355, O99.411 - O99.413, O99.42, O99.43, O99.511 - O99.513, O99.52, O99.53, O99.611 - O99.613, O99.62, O99.63, O99.711 - O99.713, O99.72, O99.73, O99.810 - O99.835, O99.841 - O99.893 | Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium |
O9A.111 - O9A.113, O9A.12, O9A.13, O9A.211 - O9A.213, O9A.22, O9A.23, O9A.311 - O9A.313, O9A.32 - O9A.33, O9A.411 - O9A.413, O9A.42, O9A.43, O9A.511 - O9A.513, O9A.52, O9A.53 | Maternal malignant neoplasms, traumatic injuries and abuse classifiable elsewhere but complicating pregnancy, childbirth and the puerperium |
P05.01 - P05.08 | Newborn light for gestational age |
P05.11 - P05.18 | Newborn small for gestational age |
P05.2 | Newborn affected by fetal (intrauterine) malnutrition not light or small for gestational age |
P22.0 | Transient tachypnea of newborn |
P22.1 | Respiratory distress syndrome of newborn |
P28.30, P28.31, P28.32, P28.33, P28.39 | Primary sleep apnea of newborn |
P29.11 | Neonatal tachycardia |
P29.2 | Neonatal hypertension |
P29.4 | Transient myocardial ischemia in newborn |
P35.4 | Congenital Zika virus disease |
P37.1 | Congenital toxoplasmosis |
P37.5 | Neonatal candidiasis |
P53 | Vitamin K deficiency of newborn |
P54.0 | Neonatal hematemesis |
P54.1 | Neonatal melena |
P54.3 | Other neonatal gastrointestinal hemorrhage |
P54.5 | Ecchymoses of newborn |
P55.0 - P55.8 | Hemolytic disease of newborn |
P56.0, P56.99 | Hydrops fetalis due to hemolytic disease |
P57.0, P57.8 | Kernicterus |
P58.0 - P58.8 | Neonatal jaundice due to other excessive hemolysis |
P59.0, P59.1, P59.29, P59.3, P59.8 | Neonatal jaundice from other and unspecified causes |
P60 | Disseminated intravascular coagulation of newborn |
P61.0 | Transient neonatal thrombocytopenia |
P61.5 | Transient neonatal neutropenia |
P61.6 | Other transient neonatal disorders of coagulation |
P76.0 - P76.8 | Other intestinal obstruction of newborn |
P77.1 - P77.3 | Necrotizing enterocolitis of newborn |
P78.0 - P78.89 | Other perinatal digestive system disorders |
P83.1 | Neonatal erythema toxicum |
P90 | Convulsions of newborn |
P92.01 - P92.8 | Feeding problems of newborn |
Q27.33 | Arteriovenous malformation of digestive system vessel |
Q43.1 | Hirschsprung's disease |
Q44.70 | Other congenital malformation of liver, unspecified |
Q44.71 | Alagille syndrome |
Q44.79 | Other congenital malformations of liver |
Q60.0, Q60.1, Q60.3, Q60.4, Q60.6 | Renal agenesis and other reduction defects of kidney |
Q61.01 - Q61.2, Q61.4 - Q61.8 | Cystic kidney disease |
Q62.0 | Congenital hydronephrosis |
Q63.0 - Q63.8 | Other congenital malformations of kidney |
Q80.3 | Congenital bullous ichthyosiform erythroderma |
Q85.1 | Tuberous sclerosis |
Q84.0 | Congenital alopecia |
Q84.5 | Enlarged and hypertrophic nails |
Q84.6 | Other congenital malformations of nails |
Q89.09 | Congenital malformations of spleen |
R00.0 | Tachycardia, unspecified |
R00.2 | Palpitations |
R01.0, R01.2 | Cardiac murmurs and other cardiac sounds |
R04.0 | Epistaxis |
R05.1 - R05.9 | Cough code range |
R06.00 - R06.09 | Dyspnea |
R06.2 | Wheezing |
R06.82 | Tachypnea, not elsewhere classified |
R07.2 | Precordial pain |
R07.89, R07.9 | Other chest pain |
R09.2 | Respiratory arrest |
R10.0 | Acute abdomen |
R10.10 - R10.13 | Pain localized to upper abdomen |
R10.2 | Pelvic and perineal pain (Deleted 09/30/2025) |
R10.20, R10.21, R10.22R10.23, R10.24 | Pelvic and perineal pain (New 10/01/2025) |
R10.30 - R10.33 | Pain localized to other parts of lower abdomen |
R10.811 - R10.817, R10.821 - R10.827, R10.83, R10.84, R10.85, R10.8A1, R10.8A2, R10.8A3, R10.8A9, R10.9, R10.A0, R10.A1, R10.A2, R10.A3 | Other abdominal pain (R10.85, R10.8A1, R10.8A2, R10.8A3, R10.8A9, R10.A0, R10.A1, R10.A2, R10.A3 New 10/01/2025) |
R11.10 - R11.15, R11.16 | Vomiting (R11.16 New 10/01/2025) |
R11.2 | Nausea with vomiting, unspecified |
R16.0 | Hepatomegaly, not elsewhere classified |
R16.1 | Splenomegaly, not elsewhere classified |
R16.2 | Hepatomegaly with splenomegaly, not elsewhere classified |
R19.2 | Visible peristalsis |
R19.4 | Change in bowel habits |
R19.5 | Other fecal abnormalities |
R19.7 | Diarrhea, unspecified |
R20.2 | Paresthesia of skin |
R21 | Rash and other nonspecific skin eruption |
R22.0 - R22.2, R22.31 - R22.33, R22.41 - R22.43 | Localized swelling, mass and lump of skin and subcutaneous tissue |
R23.0 | Cyanosis |
R23.1 | Pallor |
R23.3 | Spontaneous ecchymoses |
R26.89 | Other abnormalities of gait and mobility |
R29.1 | Meningismus |
R29.810 | Facial weakness |
R30.0 | Dysuria |
R31.0 - R31.29, R31.9 | Hematuria |
R35.0 | Frequency of micturition |
R41.1 - R41.81, R41.83, R41.840 - R41.89 | Other symptoms and signs involving cognitive functions and awareness |
R42 | Dizziness and giddiness |
R50.2 | Drug induced fever |
R50.81 | Fever presenting with conditions classified elsewhere |
R50.82 | Postprocedural fever |
R50.83 | Postvaccination fever |
R50.84 | Febrile nonhemolytic transfusion reaction |
R50.9 | Fever, unspecified |
R51.0, R51.9 | Headache |
R53.0 | Neoplastic (malignant) related fatigue |
R53.1 | Weakness |
R53.81 | Other malaise |
R53.82 | Chronic fatigue, unspecified |
R53.83 | Other fatigue |
R54 | Age-related physical debility |
R55 | Syncope and collapse |
R56.00 | Simple febrile convulsions |
R56.01 | Complex febrile convulsions |
R56.1 | Post traumatic seizures |
R56.9 | Unspecified convulsions |
R57.0 | Cardiogenic shock |
R57.1 | Hypovolemic shock |
R57.8 | Other shock |
R58 | Hemorrhage, not elsewhere classified |
R59.0 | Localized enlarged lymph nodes |
R59.1 | Generalized enlarged lymph nodes |
R59.9 | Enlarged lymph nodes, unspecified |
R60.0, R60.9 | Edema, not elsewhere classified |
R61 | Generalized hyperhidrosis |
R62.51 | Failure to thrive, child |
R62.7 | Failure to thrive, adult |
R63.0 | Anorexia |
R63.30 - R63.39 | Feeding difficulties code range |
R63.4 | Abnormal weight loss |
R65.21 | Severe sepsis with septic shock |
R68.3 | Clubbing of the fingers |
R68.83 | Chills (without fever) |
R71.0 | Precipitous drop in hematocrit |
R71.8 | Other abnormality of red blood cells |
R76.8, R76.81, R76.89 | Other specified abnormal immunological findings in serum (R76.81, R76.89 New 10/01/2025) (Deleted 09/30/2025) |
R79.1 | Abnormal coagulation profile |
R94.5 | Abnormal results of liver function studies |
T38.7X1A - T38.7X6S | Poisoning by, adverse effect of and underdosing of androgens and anabolic congeners |
T50.1X1A - T50.1X6S | Poisoning by, adverse effect of and underdosing of loop [high-ceiling] diuretics |
T51.0X1A - T51.8X4S | Toxic effect of alcohol |
T52.0X1A - T52.8X4S | Toxic effect of organic solvents |
T53.0X1A - T53.74XS | Toxic effect of halogen derivatives of aliphatic and aromatic hydrocarbons |
T54.0X1A - T54.34XS | Toxic effect of corrosive substances |
T55.0X1A - T55.1X4S | Toxic effect of soaps and detergents |
T56.0X1A - T56.894S | Toxic effect of metals |
T57.0X1A - T57.8X4S | Toxic effect of other inorganic substances |
T58.01XA - T58.8X4S | Toxic effect of carbon monoxide |
T59.0X1A - T59.894S | Toxic effect of other gases, fumes, and vapors |
T60.0X1A - T60.8X4S | Toxic effect of pesticides |
T61.01XA - T61.8X4S | Toxic effect of noxious substances eaten as seafood |
T62.0X1A - T62.8X4S | Toxic effect of other noxious substances eaten as food |
T63.011A - T63.2X4S, T63.311A - T63.894S | Toxic effect of contact with venomous animals and plants |
T64.01XA - T64.84XS | Toxic effect of aflatoxin and other mycotoxin food containers |
T65.0X1A - T65.894S | Toxic effect of other and unspecified substances |
T70.3XXA - T70.3XXS | Caisson disease [decompression sickness] |
T78.00XA - T78.09XS | Anaphylactic reaction due to food |
T80.51XA - T80.59XS | Anaphylactic reaction due to serum |
T81.40XA- T81.40XS | Infection following a procedure, unspecified |
T81.41XA - T81.41XS | Infection following a procedure, superficial incisional surgical site |
T81.42XA - T81.42XS | Infection following a procedure, deep incisional surgical site |
T81.43XA - T81.43XS | Infection following a procedure, organ and space surgical site |
T81.44XA - T81.44XS | Sepsis following a procedure |
T81.49XA - T81.49XS | Infection following a procedure, other surgical site |
T84.50XA - T84.59XS | Infection and inflammatory reaction due to internal joint prosthesis |
T86.02 | Bone marrow transplant failure |
T88.2XXA - T88.2XXS | Shock due to anesthesia |
U07.1 | COVID-19 |
U09.9 | Post COVID-19 condition, unspecified |
Z00.70, Z00.71 | Encounter for examination for period of delayed growth in childhood |
Z01.00, Z01.01 | Encounter for examination of eyes and vision |
Z01.811 | Encounter for preprocedural respiratory examination |
Z01.812 | Encounter for preprocedural laboratory examination |
Z01.818 | Encounter for other preprocedural examination |
Z03.6 | Encounter for observation for suspected toxic effect from ingested substance ruled out |
Z03.71 -Z03.79 | Encounter for suspected maternal and fetal conditions ruled out |
Z08 | Encounter for follow-up examination after completed treatment for malignant neoplasm |
Z09 | Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm |
Z11.0 - Z11.8 | Encounter for screening for infectious and parasitic diseases |
Z11.52 | Encounter for screening for COVID-19 |
Z12.0, Z12.11 - Z12.89 | Encounter for screening for malignant neoplasms |
Z13.0 | Encounter for screening for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism |
Z13.1 | Encounter for screening for diabetes mellitus |
Z13.21 -Z13.29 | Encounter for screening for nutritional, metabolic and other endocrine disorders |
Z13.6 | Encounter for screening for cardiovascular disorders |
Z13.71, Z13.79 | Encounter for screening for genetic and chromosomal anomalies |
Z13.810 - Z13.818 | Encounter for screening for digestive system disorders |
Z13.820 - Z13.828 | Encounter for screening for musculoskeletal disorder |
Z13.83 | Encounter for screening for respiratory disorder NEC |
Z13.850, Z13.858 | Encounter for screening for nervous system disorders |
Z13.88 | Encounter for screening for disorder due to exposure to contaminants |
Z14.01 - Z14.8 | Genetic carrier |
Z15.01 -Z15.09 | Genetic susceptibility to malignant neoplasm |
Z15.81 | Genetic susceptibility to multiple endocrine neoplasia [MEN] |
Z16.13 | Resistance to carbapenem |
Z20.01 - Z20.89 | Contact with and (suspected) exposure to communicable diseases |
Z20.822 | Contact with and (suspected) exposure to COVID-19 |
Z21 | Asymptomatic human immunodeficiency virus [HIV] infection status |
Z22.0 - Z22.4Z22.51 - Z22.59Z22.6, Z22.7, Z22.8 | Carrier of infectious disease |
Z31.430 | Encounter of female for testing for genetic disease carrier status for procreative management |
Z31.440 | Encounter of male for testing for genetic disease carrier status for procreative management |
Z32.01 | Encounter for pregnancy test, result positive |
Z33.1, Z33.2, Z33.3 | Pregnant state |
Z34.01 - Z34.03Z34.81 - Z34.83 | Encounter for supervision of normal pregnancy |
Z36.89 | Encounter for other specified antenatal screening |
Z37.0 - Z37.4,Z37.51 - Z37.59,Z37.61 - Z37.69,Z37.7 | Outcome of delivery |
Z39.2 | Encounter for routine postpartum follow-up |
Z3A.01 - Z3A.49 | Weeks of gestation |
Z40.01 - Z40.09 | Encounter for prophylactic surgery for risk factors related to malignant neoplasms |
Z47.1 | Aftercare following joint replacement surgery |
Z48.290 | Encounter for aftercare following bone marrow transplant |
Z49.01 - Z49.32 | Encounter for care involving renal dialysis |
Z51.0 | Encounter for antineoplastic radiation therapy |
Z51.11 - Z51.12 | Encounter for antineoplastic chemotherapy and immunotherapy |
Z51.81 | Encounter for therapeutic drug level monitoring |
Z57.1 | Occupational exposure to radiation |
Z57.39 | Occupational exposure to other air contaminants |
Z57.4 | Occupational exposure to toxic agents in agriculture |
Z57.5 | Occupational exposure to toxic agents in other industries |
Z64.0 | Problems related to unwanted pregnancy |
Z68.30 - Z68.39 | Body mass index [BMI] 30-39, adult |
Z68.41 - Z68.45 | Body mass index [BMI] 40 or greater, adult |
Z71.7 | Human immunodeficiency virus [HIV] disease counseling |
Z77.010 - Z77.9 | Other contact with and (suspected) exposures hazardous to health |
Z79.01 | Long term (current) use of anticoagulants |
Z79.1 | Long term (current) use of non-steroidal anti-inflammatories (NSAID) |
Z79.2 | Long term (current) use of antibiotics |
Z79.899 | Other long term (current) drug therapy |
Z80.0 - Z80.8 | Family history of primary malignant neoplasm |
Z80.6 | Family history of leukemia |
Z81.1 | Family history of alcohol abuse and dependence |
Z82.0 | Family history of epilepsy and other diseases of the nervous system |
Z82.1 | Family history of blindness and visual loss |
Z82.3 | Family history of stroke |
Z82.41, Z82.49 | Family history of ischemic heart disease and other diseases of the circulatory system |
Z82.5 | Family history of asthma and other chronic lower respiratory diseases |
Z82.61- Z82.69 | Family history of arthritis and other diseases of the musculoskeletal system and connective tissue |
Z82.71, Z82.79 | Family history of congenital malformations, deformations and chromosomal abnormalities |
Z83.0 | Family history of human immunodeficiency virus [HIV] disease |
Z83.1 | Family history of other infectious and parasitic diseases |
Z83.2 | Family history of diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism |
Z83.3 | Family history of diabetes mellitus |
Z83.41, Z83.42, Z83.49 | Family history of other endocrine, nutritional and metabolic diseases |
Z83.430 | Family history of elevated lipoprotein(a) |
Z83.438 | Family history of other disorder of lipoprotein metabolism and other lipidemia |
Z83.511 - Z83.518 | Family history of eye disorders |
Z83.6 | Family history of other diseases of the respiratory system |
Z84.0 | Family history of diseases of the skin and subcutaneous tissue |
Z84.1, Z84.11, Z84.19 | Family history of disorders of kidney and ureter (Z84.11, Z84.19 New 10/01/2025) (Deleted 09/30/2025) |
Z84.2 | Family history of other diseases of the genitourinary system |
Z85.01 - Z85.12,Z85.21 - Z85.3,Z85.41 - Z85.44,Z85.46 - Z85.49,Z85.51 - Z85.89 | Personal history of malignant neoplasm |
Z86.000 - Z86.03 | Personal history of in-situ and benign neoplasms and neoplasms of uncertain behavior |
Z86.11 - Z86.19 | Personal history of infectious and parasitic diseases |
Z86.16 | Personal history of COVID-19 |
Z86.2 | Personal history of diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism |
Z86.31 - Z86.39 | Personal history of endocrine, nutritional and metabolic diseases |
Z86.61, Z86.69 | Personal history of diseases of the nervous system and sense organs |
Z86.711, Z86.718 | Personal history of diseases of the circulatory system |
Z86.73 | Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits |
Z86.74 | Personal history of sudden cardiac arrest |
Z86.79 | Personal history of other diseases of the circulatory system |
Z87.01, Z87.09 | Personal history of diseases of the respiratory system |
Z87.11, Z87.19 | Personal history of diseases of the digestive system |
Z87.2 | Personal history of diseases of the skin and subcutaneous tissue |
Z87.441 | Personal history of nephrotic syndrome |
Z87.74 | Personal history of (corrected) congenital malformations of heart and circulatory system |
Z92.21 | Personal history of antineoplastic chemotherapy |
Z92.3 | Personal history of irradiation |
Z94.0 | Kidney transplant status |
Z94.1 | Heart transplant status |
Z94.4 | Liver transplant status |
Z94.81 | Bone marrow transplant status |
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