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L.6.01.409
Magnetic resonance imaging (MRI) is a multiplanar imaging method based on an interaction between radiofrequency (RF) electromagnetic fields and certain nuclei in the body (usually hydrogen nuclei) after the body has been placed in a strong magnetic field. MRI differentiates between normal and abnormal tissues, providing a sensitive examination to detect disease. This sensitivity is based on the high degree of inherent contrast due to variations in the magnetic relaxation properties of different tissues, both normal and diseased, and the dependence of the MRI signal on these tissue properties.
MRI is a radiology technique that uses magnetism, radio waves, and a computer to produce images of body structures. The MRI scanner is a tube surrounded by a giant circular magnet. The patient is placed on a moveable bed that is inserted into the magnet. The magnet creates a strong magnetic field that aligns the protons of hydrogen atoms, which are then exposed to a beam of radio waves. This spins the various protons of the body, and they produce a faint signal that is detected by the receiver portion of the MRI scanner. The receiver information is processed by a computer, and an image is produced. The image and resolution produced by MRI is quite detailed and can detect tiny changes of structures within the body. For some procedures, contrast agents, such as gadolinium, are used to increase the accuracy of the images.
Magnetic resonance imaging (MRI) is a proven imaging modality for the detection, evaluation, assessment, staging, and follow-up of diseases of the head and neck. Properly performed and interpreted, MRI not only contributes to diagnosis but also can guide treatment planning, help predict outcome, and increase diagnostic confidence. However, MRI should be performed only for a valid medical reason, and only after careful consideration of alternative imaging modalities. The strengths of MRI and other modalities should be weighed as to their suitability in particular patients and in particular clinical conditions.
Related medical policies are -
Provider Accreditation for MRI – Network Providers
All Network Providers billing the technical component of the MRI must be accredited in MRI by the Intersocietal Accreditation Commission (IAC) or a MRI module by the American College of Radiology (ACR) or RadSite. The professional component of the MRI will be reimbursed based upon the accreditation of the facility as the ACR, IAC or RadSite facility accreditations require that interpreting professional physicians also be accredited.
MRI of the Orbit
Magnetic resonance imaging (MRI) of the orbit is considered medically necessary for the following indications:
Decrease range of motion of eyes
Hyperthyroidism (e.g., Graves disease)
Infection (orbital cellulitis, abscess)
Nystagmus
Optic neuritis
Progressive vision loss
Proptosis (exophthalmos)
Orbital Pseudotumor
Strabismus
Trauma to the eye
Ocular tumor (e.g., melanoma)
Visual loss unexplained by ophthalmic evaluation
Unilateral visual deficit
Tumors or malignancy (known or suspected)
Diagnosis or staging;
Evaluation or response to treatment;
Preoperative evaluation.
MRI of the Face
Magnetic resonance imaging (MRI) of the face is considered medically necessary for the following indications:
Osteomyelitis
Parotid tumors
Trauma
Evaluation of facial nerve disorders of the 7th cranial nerve
Tumor (sinonasal, facial)
Tumors or malignancy (known or suspected)
Diagnosis or staging;
Evaluation or response to treatment;
Preoperative evaluation.
MRI of the Neck
Magnetic resonance imaging (MRI) of the neck is considered medically necessary for the following indications:
Brachial plexus dysfunction (brachial plexopathy, thoracic outlet syndrome)
Neck lymphadenopathy
Obstructive thyroid nodule
Palpable lesion in mouth or throat
Palpable neck mass
Persistent hoarseness
Skull base tumors
Suspected or known tumor of: larynx, pharynx, nasopharynx, thyroid, parathyroid, salivary glands
Tracheal stenosis
Vocal cord lesion
Vocal cord paralysis
Non-thyroid mass in neck
Neck trauma
Tumors or malignancy (known or suspected)
Diagnosis or staging
Evaluation or response to treatment;
Preoperative evaluation.
MRI of the TMJ
Magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) is considered medically necessary for the following indications:
Suspected TMJ joint disease/TMJ dysfunction (difficulty in the ability to open mouth, pain with chewing, etc)
Frozen or locked jaw
Preoperative evaluation of dysfunctional TMJ.
Other Indications for MRI
Magnetic resonance imaging (MRI) is considered medically necessary for the following other indications:
Evidence of tumor from a physical exam, plain sinus x-ray or CT or MRI
Cerebrospinal fluid (CSF) leak
Sinusitis (rhinosinusitis) unresponsive to 3 documented courses of 4 weeks of medical management (each documented course of treatment must be 4 weeks long) (e.g., antibiotics, nasal steroids, decongestants, anti-histamines)
Magnetic resonance imaging (MRI) of the orbit, face, TMJ, and neck is considered not medically necessary for all other indications, including when performed for screening purposes in asymptomatic patients (absence of signs, symptoms, or disease).
State Health Plan (SHP) Members: This policy applies to MRI of the orbit, face, TMJ, and/or neck when performed in the emergency room and in non-emergency room settings.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
Reimbursement for MRI imaging of the same anatomical area is generally limited to one (1) MRI imaging within a 6-month period. MRI imaging in excess of one (1) within a 6-month period will be subject to medical necessity review. Documentation should include radiology reason for study, radiology comparison study-date and time, radiology comparison study observation, radiology impression, and radiology study recommendation.
Additional MRI imaging of the same anatomical area may be appropriate for the following, including, but not limited to: diagnosis, staging or follow-up of cancer, follow-up assessment during or after therapy for known metastases, follow-up of member who have had an operative, interventional or therapeutic procedure (e.g., surgery, embolization), reevaluation due to change in clinical status (e.g., deterioration), new or worsening clinical findings, (e.g., neurologic signs, symptoms), medical intervention which warrants reassessment, reevaluation for treatment planning, follow-up during and after completion of therapy or treatment to assess effectiveness, and evaluation after intervention or surgery.
Re-imaging or additional imaging due to poor contrast enhanced exam or technically limited exam is the responsibility of the imaging provider.
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.
05/19/2014: New policy added. Approved by Radiology Physician Advisory Committee and Medical Policy Advisory Committee. Effective 08/15/2014.
06/30/2014: Policy Exceptions section updated regarding SHP members to state that this policy applies to MRI of the orbit, face, TMJ, and/or neck when performed in the emergency room and in non-emergency room settings. Added the following ICD-9 diagnosis codes to the Code Reference section: 242.80-242.81 and 242.90-242.91.
09/01/2015: Medical policy revised to add ICD-10 codes.
02/09/2016: Policy guidelines updated to add medically necessary and investigative definitions. Code Reference section updated to make corrections to the following diagnosis codes: T40.411S, T40.412S, T40.419S, T40.42XS, and T40.43XS should be T20.411S, T20.412S, T20.419S, T20.42XS, and T20.43XS.
06/08/2016: Policy number L.6.01.409 added.
07/25/2016: Code Reference section updated to make the following correction: ICD-10 diagnosis code E45.8 should be F45.8 and ICD-10 code E48.8 should be F48.8.
09/30/2016: Code Reference section updated to add the following new ICD-10 diagnosis codes: M26.601 - M26.639, S03.00XA - S03.03XS, S03.40XA - S03.43XS, S02.11AS, S02.11BS, S02.11CS, S02.11DS, S02.11ES, S02.11FS, S02.11GS, S02.11HS, S02.30XS, S02.40AS, S02.40BS, S02.40CS, S02.40DS, S02.40ES, S02.40FS, S02.601S, S02.602S, S02.610S, S02.611S, S02.612S, S02.620S, S02.621S, S02.622S, S02.630S, S02.631S, S02.632S, S02.640S, S02.641S, S02.642S, S02.650S, S02.651S, S02.652S, S02.670S, S02.671S, S02.672S, S02.80XS, S02.81XS, and S02.82XS. Revised code descriptions for ICD-10 diagnosis codes S02.110S, S02.11S, S02.112S, S02.118S, S02.401S, S02.402S, and S02.600S.
09/29/2017: Code Reference section updated to add new ICD-10 diagnosis codes 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, and H54.52A2, effective 10/01/2017. Removed deleted ICD-10 diagnosis codes M26.60, M26.61, M26.62, M26.63, S03.0XXA - S03.0XXS, S03.4XXA - S03.4XXS, S02.10XS, S02.3XXS, S02.61XS, S02.62XS, S02.63XS, S02.64XS, S02.65XS, S02.67XS, and S02.8XXS.
09/24/2018: Code Reference section updated to add new ICD-10 diagnosis codes C43.111, C43.112, C43.121, C43.122, D03.121, D03.122, C44.1021, C44.1022, C44.1091, C44.1092, C44.1121, C44.1122, C44.1191, C44.1192, C44.1221, C44.1222, C44.1291, C44.1292, C44.131, C44.1321, C44.1322, C44.1391, C44.1392, C44.1921, C44.1922, C44.1991, and C44.1992, effective 10/01/2018.
09/23/2019: Code Reference section updated to add new ICD-10 diagnosis codes H81.4, S02.121A, S02.121B, S02.121D, S02.121G, S02.121K, S02.121S, S02.122A, S02.122B, S02.122D, S02.122G, S02.122K, S02.122S, S02.129A, S02.129B, S02.129D, S02.129G, S02.129K, S02.129S, S02.831A, S02.831B, S02.831D, S02.831G, S02.831K, S02.831S, S02.832A, S02.832B, S02.832D, S02.832G, S02.832K, S02.832S, S02.839A, S02.839B, S02.839D, S02.839G, S02.839K, S02.839S, S02.841A, S02.841B, S02.841D, S02.841G, S02.841K, S02.841S, S02.842A, S02.842B, S02.842D, S02.842G, S02.842K, S02.842S, S02.849A, S02.849B, S02.849D, S02.849G, S02.849K, S02.849S, S02.85XA, S02.85XB, S02.85XD, S02.85XG, S02.85XK, and S02.85XS, effective 10/01/2019. Removed deleted ICD-10 diagnosis code H54.0.
10/21/2019: Code Reference section updated to add ICD-10 diagnosis code C30.0. Removed deleted ICD-10 diagnosis codes C43.11, C43.12, D03.12, C44.102, C44.109, C44.112, C44.119, C44.122, C44.129, C44.192, and C44.199.
09/25/2020: Code Reference section updated to add new ICD-10 diagnosis codes G96.00, G96.01, G96.02, D96.08, G96.09, H55.82, M26.641, M26.642, M26.643, M26.649, M26.651, M26.652, M26.653, and M26.659, effective 10/01/2020.
11/08/2022: 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 remove deleted ICD-10 diagnosis codes H81.41, H81.42, H81.43, and H81.49.
09/27/2023: Code Reference section updated to add new ICD-10 diagnosis codes D48.110, H50.621, H50.622, H50.629, H50.631, H50.632, H50.639, H50.641, H50.642, H50.649, H50.651, H50.652, H50.659, H50.661, H50.662, H50.669, H50.671, H50.672, H50.679, H50.681, H50.682, and H50.689, effective 10/01/2023.
12/04/2023: Policy reviewed; no changes.
12/01/2024: Code Reference section updated to add ICD-10 diagnosis codes H53.9 and R93.0. Removed deleted ICD-10 diagnosis code D48.1.
12/16/2024: Policy reviewed; no changes.
11/01/2025: Added RadSite as an imaging accreditation body.
08/13/2026: Policy reviewed. Policy statements unchanged. Code Reference section updated to remove ICD-9 diagnosis codes.
American College of Radiology. ACR-ASNR-SPR Practice Guideline for the Performance of Magnetic Resonance Imaging (MRI) of the Head and Neck, 2012.
American College of Radiology. ACR Practice Guideline for Performing and Interpreting Magnetic Resonance Imaging (MRI), 2011.
Magnetic Resonance Imaging (MRI) Orbit, Face, Temporomandibular Joint (TMJ) and Neck medical policy, Blue Cross and Blue Shield of Florida
Medical Policy Advisory Committee
Radiology Physician Advisory Committee
This may not be a comprehensive list of procedure codes applicable to this policy.
The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.
Covered Codes
Code Number | Description |
CPT-4 | |
70336 | Magnetic resonance (eg, proton) imaging, temporomandibular joint(s) |
70540 | Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) |
70542 | Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) |
70543 | Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast material(s) and further sequences |
HCPCS | |
ICD-10 Procedure | |
ICD-10 Diagnosis | |
A39.82 | Meningococcal retrobulbar neuritis |
A35 | Other tetanus |
C07 | Malignant neoplasm of parotid gland |
C08.0 - C08.9 | Malignant neoplasm of other and unspecified major salivary glands |
C09.0 - C09.9 | Malignant neoplasm of tonsil |
C10.0 - C10.9 | Malignant neoplasm of oropharynx |
C11.0 - C11.9 | Malignant neoplasm of nasopharynx |
C12 | Malignant neoplasm of pyriform sinus |
C13.0 - C13.9 | Malignant neoplasm of hypopharynx |
C14.0 | Malignant neoplasm of pharynx, unspecified |
C30.0 | Malignant neoplasm of nasal cavity |
C30.1 | Malignant neoplasm of middle ear |
C31.8 | Malignant neoplasm of overlapping sites of accessory sinuses |
C32.0 - C32.9 | Malignant neoplasm of larynx |
C41.0 | Malignant neoplasm of bones of skull and face |
C47.0 | Malignant neoplasm of peripheral nerves of head, face and neck |
C49.0 | Malignant neoplasm of connective and soft tissue of head, face and neck |
C43.10 - C43.122 | Malignant melanoma of eyelid, including canthus |
D03.10 - D03.122 | Melanoma in situ of eyelid, including canthus |
C44.101 - C44.1992 | Other and unspecified malignant neoplasm of skin of eyelid, including canthus |
C69.00 - C69.92 | Malignant neoplasm of eye and adnexa |
C71.0 | Malignant neoplasm of cerebrum, except lobes and ventricles |
C71.1 | Malignant neoplasm of frontal lobe |
C71.2 | Malignant neoplasm of temporal lobe |
C71.3 | Malignant neoplasm of parietal lobe |
C71.5 | Malignant neoplasm of cerebral ventricle |
C71.6 | Malignant neoplasm of cerebellum |
C71.7 | Malignant neoplasm of brain stem |
C71.8 | Malignant neoplasm of overlapping sites of brain |
C71.9 | Malignant neoplasm of brain, unspecified |
C72.20 - C72.22 | Malignant neoplasm of olfactory nerve |
C72.30 - C72.32 | Malignant neoplasm of optic nerve |
C72.40 - C72.42 | Malignant neoplasm of acoustic nerve |
C72.50 - C72.59 | Malignant neoplasm of other and unspecified cranial nerves |
C70.0 | Malignant neoplasm of cerebral meninges |
C70.9 | Malignant neoplasm of meninges, unspecified |
C72.9 | Malignant neoplasm of central nervous system, unspecified |
C73 | Malignant neoplasm of thyroid gland |
C75.0 | Malignant neoplasm of parathyroid gland |
C75.1 | Malignant neoplasm of pituitary gland |
C75.2 | Malignant neoplasm of craniopharyngeal duct |
C76.0 | Malignant neoplasm of head, face and neck |
C77.0 | Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck |
C78.30 | Secondary malignant neoplasm of unspecified respiratory organ |
C78.39 | Secondary malignant neoplasm of other respiratory organs |
C79.31 | Secondary malignant neoplasm of brain |
C79.32 | Secondary malignant neoplasm of cerebral meninges |
C79.40 | Secondary malignant neoplasm of unspecified part of nervous system |
C79.49 | Secondary malignant neoplasm of other parts of nervous system |
C79.51 | Secondary malignant neoplasm of bone |
C79.52 | Secondary malignant neoplasm of bone marrow |
C79.89 | Secondary malignant neoplasm of other specified sites |
C79.9 | Secondary malignant neoplasm of unspecified site |
D11.0 | Benign neoplasm of parotid gland |
D11.7 | Benign neoplasm of other major salivary glands |
D11.9 | Benign neoplasm of major salivary gland, unspecified |
D10.5 | Benign neoplasm of other parts of oropharynx |
D10.6 | Benign neoplasm of nasopharynx |
D10.7 | Benign neoplasm of hypopharynx |
D10.9 | Benign neoplasm of pharynx, unspecified |
D14.0 | Benign neoplasm of middle ear, nasal cavity and accessory sinuses |
D14.1 | Benign neoplasm of larynx |
D16.4 | Benign neoplasm of bones of skull and face |
D21.0 | Benign neoplasm of connective and other soft tissue of head, face and neck |
D31.00 - D31.92 | Benign neoplasm of eye and adnexa |
D33.0 | Benign neoplasm of brain, supratentorial |
D33.1 | Benign neoplasm of brain, infratentorial |
D33.2 | Benign neoplasm of brain, unspecified |
D33.3 | Benign neoplasm of cranial nerves |
D32.0 | Benign neoplasm of cerebral meninges |
D32.9 | Benign neoplasm of meninges, unspecified |
D33.7 | Benign neoplasm of other specified parts of central nervous system |
D35.1 | Benign neoplasm of parathyroid gland |
D18.02 | Hemangioma of intracranial structures |
D19.7 | Benign neoplasm of mesothelial tissue of other sites |
D36.7 | Benign neoplasm of other specified sites |
D00.00 - D00.08 | Carcinoma in situ of lip, oral cavity and pharynx |
D09.20 - D09.22 | Carcinoma in situ of eye |
D09.3 | Carcinoma in situ of thyroid and other endocrine glands |
D09.8 | Carcinoma in situ of other specified sites |
D37.030 - D37.039 | Neoplasm of uncertain behavior of the major salivary glands |
D37.01 | Neoplasm of uncertain behavior of lip |
D37.02 | Neoplasm of uncertain behavior of tongue |
D37.04 | Neoplasm of uncertain behavior of the minor salivary glands |
D37.05 | Neoplasm of uncertain behavior of pharynx |
D37.09 | Neoplasm of uncertain behavior of other specified sites of the oral cavity |
D38.0 | Neoplasm of uncertain behavior of larynx |
D44.3 | Neoplasm of uncertain behavior of pituitary gland |
D44.4 | Neoplasm of uncertain behavior of craniopharyngeal duct |
D44.6 | Neoplasm of uncertain behavior of carotid body |
D44.7 | Neoplasm of uncertain behavior of aortic body and other paraganglia |
D44.0 | Neoplasm of uncertain behavior of thyroid gland |
D44.2 | Neoplasm of uncertain behavior of parathyroid gland |
D44.9 | Neoplasm of uncertain behavior of unspecified endocrine gland |
D43.0 | Neoplasm of uncertain behavior of brain, supratentorial |
D43.1 | Neoplasm of uncertain behavior of brain, infratentorial |
D43.2 | Neoplasm of uncertain behavior of brain, unspecified |
D43.4 | Neoplasm of uncertain behavior of spinal cord |
D42.0 - D42.9 | Neoplasm of uncertain behavior of meninges |
D48.0 | Neoplasm of uncertain behavior of bone and articular cartilage |
D48.110 | Desmoid tumor of head and neck |
D48.2 | Neoplasm of uncertain behavior of peripheral nerves and autonomic nervous system |
D48.7 | Neoplasm of uncertain behavior of other specified sites |
D49.1 | Neoplasm of unspecified behavior of respiratory system |
D49.2 | Neoplasm of unspecified behavior of bone, soft tissue, and skin |
D49.6 | Neoplasm of unspecified behavior of brain |
D49.7 | Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system |
D49.81 | Neoplasm of unspecified behavior of retina and choroid |
E05.00 - E05.01 | Thyrotoxicosis with diffuse goiter |
E05.10 - E05.11 | Thyrotoxicosis with toxic single thyroid nodule |
E05.20 - E05.21 | Thyrotoxicosis with toxic multinodular goiter |
E05.30 - E05.31 | Thyrotoxicosis from ectopic thyroid tissue |
E05.40 - E05.41 | Thyrotoxicosis factitia |
E05.80 - E05.81 | Other thyrotoxicosis |
E05.90 - E05.91 | Thyrotoxicosis, unspecified |
E07.1 | Dyshormogenetic goiter |
F45.8 | Other somatoform disorders |
F48.8 | Other specified nonpsychotic mental disorders |
G36.0 | Neuromyelitis optica [Devic] |
G97.41 | Accidental puncture or laceration of dura during a procedure |
G96.11 | Dural tear |
G96.0, G96.00, G96.01, G96.02, G96.08, G96.09 | Cerebrospinal fluid leak |
G51.0 - G51.9 | Facial nerve disorders |
G54.0 | Brachial plexus disorders |
H53.131 - H53.139 | Sudden visual loss |
H53.121 - H53.129 | Transient visual loss |
H53.9 | Unspecified visual disturbance |
H54.0X33 - H54.8 | Blindness and low vision |
H05.00 - H05.049 | Acute inflammation of orbit |
H05.10 - H05.129 | Chronic inflammatory disorders of orbit |
H05.20 - H05.269 | Exophthalmic conditions |
H05.89 | Other disorders of orbit |
H46.00 - H46.9 | Optic neuritis |
H49.00 - H49.9 | Paralytic strabismus |
H50.00 - H50.9 | Other strabismus |
H51.0 - H51.9 | Other disorders of binocular movement |
H50.621, H50.622, H50.629 | Inferior oblique muscle entrapment |
H50.631, H50.632, H50.639 | Inferior rectus muscle entrapment |
H50.641, H50.642, H50.649 | Lateral rectus muscle entrapment |
H50.651, H50.652, H50.659 | Medial rectus muscle entrapment |
H50.661, H50.662, H50.669 | Superior oblique muscle entrapment |
H50.671, H50.672, H50.679 | Superior rectus muscle entrapment |
H50.681, H50.682, H50.689 | Extraocular muscle entrapment, unspecified |
H55.00 - H55.89 | Nystagmus and other irregular eye movements |
H81.10 - H81.13 | Benign paroxysmal vertigo |
H81.4 | Vertigo of central origin |
G96.0 | Cerebrospinal fluid leak |
J01.00 - J01.91 | Acute Sinusitis |
J32.0 - J32.9 | Chronic sinusitis |
J39.2 | Other diseases of pharynx |
J38.00 - J38.02 | Paralysis of vocal cords or larynx |
J38.1 | Polyp of vocal cord and larynx |
J38.2 | Nodules of vocal cords |
J38.3 | Other diseases of vocal cords |
J39.8 | Other specified diseases of upper respiratory tract |
J98.09 | Other diseases of bronchus, not elsewhere classified |
K04.6 | Periapical abscess with sinus |
E08.630 | Diabetes mellitus due to underlying condition with periodontal disease |
E09.630 | Drug or chemical induced diabetes mellitus with periodontal disease |
E10.630 | Type 1 diabetes mellitus with periodontal disease |
E11.630 | Type 2 diabetes mellitus with periodontal disease |
E13.630 | Other specified diabetes mellitus with periodontal disease |
K05.5 | Other periodontal diseases |
K06.1 | Gingival enlargement |
K06.2 | Gingival and edentulous alveolar ridge lesions associated with trauma |
K06.8 | Other specified disorders of gingiva and edentulous alveolar ridge |
M26.601 - M26.69 | Temporomandibular joint disorders |
K11.3 | Abscess of salivary gland |
K11.6 | Mucocele of salivary gland |
K11.8 | Other diseases of salivary glands |
K12.2 | Cellulitis and abscess of mouth |
K09.8 | Other cysts of oral region, not elsewhere classified |
K09.9 | Cyst of oral region, unspecified |
O90.5 | Postpartum thyroiditis |
O99.280 - O99.285 | Other endocrine, nutritional and metabolic diseases complicating pregnancy, childbirth and the puerperium |
L02.12 | Furuncle of neck |
L02.13 | Carbuncle of neck |
M86.08 | Acute hematogenous osteomyelitis, other sites |
M86.18 | Other acute osteomyelitis, other site |
M86.28 | Subacute osteomyelitis, other site |
M86.09 | Acute hematogenous osteomyelitis, multiple sites |
M86.19 | Other acute osteomyelitis, multiple sites |
M86.29 | Subacute osteomyelitis, multiple sites |
M86.38 | Chronic multifocal osteomyelitis, other site |
M86.48 | Chronic osteomyelitis with draining sinus, other site |
M86.58 | Other chronic hematogenous osteomyelitis, other site |
M86.68 | Other chronic osteomyelitis, other site |
M86.8X8 | Other osteomyelitis, other site |
M86.39 | Chronic multifocal osteomyelitis, multiple sites |
M86.49 | Chronic osteomyelitis with draining sinus, multiple sites |
M86.59 | Other chronic hematogenous osteomyelitis, multiple sites |
M86.69 | Other chronic osteomyelitis, multiple sites |
M86.8X0 | Other osteomyelitis, multiple sites |
M46.20 - M46.28 | Osteomyelitis of vertebra |
M86.9 | Osteomyelitis, unspecified |
Q11.3 | Macrophthalmos |
Q15.8 | Other specified congenital malformations of eye |
Q31.1- Q31.9 | Congenital malformations of larynx |
Q39.0 | Atresia of esophagus without fistula |
Q39.1 | Atresia of esophagus with tracheo-esophageal fistula |
Q39.2 | Congenital tracheo-esophageal fistula without atresia |
Q39.3 | Congenital stenosis and stricture of esophagus |
Q39.4 | Esophageal web |
P11.3 | Birth injury to facial nerve |
P14.0 | Erb's paralysis due to birth injury |
P14.1 | Klumpke's paralysis due to birth injury |
P14.3 | Other brachial plexus birth injuries |
P35.2 | Congenital herpesviral [herpes simplex] infection |
P35.3 | Congenital viral hepatitis |
P35.8 | Other congenital viral diseases |
P35.9 | Congenital viral disease, unspecified |
P37.0, P37.1, P37.2, P37.3, P37.4, P37.8, P37.9 | Other congenital infectious and parasitic diseases |
P72.1 | Transitory neonatal hyperthyroidism |
R22.0 | Localized swelling, mass and lump, head |
R22.1 | Localized swelling, mass and lump, neck |
R90.0 | Intracranial space-occupying lesion found on diagnostic imaging of central nervous system |
R49.0 | Dysphonia |
R68.84 | Jaw pain |
R59.0 - R59.9 | Enlarged lymph nodes |
R93.0 | Abnormal findings on diagnostic imaging of skull and head, not elsewhere classified |
S02.121A, S02.121B, S02.121D, S02.121G, S02.121K, S02.121S | Fracture of orbital roof, right side |
S02.122A, S02.122B, S02.122D, S02.122G, S02.122K, S02.122S | Fracture of orbital roof, left side |
S02.129A, S02.129B, S02.129D, S02.129G, S02.129K, S02.129S | Fracture of orbital roof, unspecified site |
S02.831A, S02.831B, S02.831D, S02.831G, S02.831K, S02.831S | Fracture of medial orbital wall, right side |
S02.832A, S02.832B, S02.832D, S02.832G, S02.832K, S02.832S | Fracture of medial orbital wall, left side |
S02.839A, S02.839B, S02.839D, S02.839G, S02.839K, S02.839S | Fracture of medial orbital wall, unspecified site |
S02.841A, S02.841B, S02.841D, S02.841G, S02.841K, S02.841S | Fracture of lateral orbital wall, right side |
S02.842A, S02.842B, S02.842D, S02.842G, S02.842K, S02.842S | Fracture of lateral orbital wall, left side |
S02.849A, S02.849B, S02.849D, S02.849G, S02.849K, S02.849S | Fracture of lateral orbital wall, unspecified side |
S02.85XA, S02.85XB, S02.85XD, S02.85XG, S02.85XK, S02.85XS | Fracture of orbit, unspecified |
S02.91XA - S02.91XS | Unspecified fracture of skull |
S03.00XA - S03.03XS | Dislocation of jaw |
S13.4XXA - S13.4XXS | Sprain of ligaments of cervical spine |
S13.8XXA - S13.8XXS | Sprain of joints and ligaments of other parts of neck |
S13.9XXA - S13.9XXS | Sprain of joints and ligaments of unspecified parts of neck |
S16.1XXA - S16.1XXS | Strain of muscle, fascia and tendon at neck level |
S03.40XA - S03.43XS | Sprain of jaw |
S02.11AS, S02.11BS | Type I occipital condyle fracture, sequela |
S02.11CS, S02.11DS | Type II occipital condyle fracture, sequela |
S02.11ES, S02.11FS | Type III occipital condyle fracture, sequela |
S02.11GS, S02.11HS | Other fracture or occiput, sequela |
S02.30XS | Fracture of orbital floor, unspecified side, sequela |
S02.40AS, S02.40BS | Malar fracture, sequela |
S02.40CS, S02.40DS | Maxillary fracture, sequela |
S02.40ES, S02.40FS | Zygomatic fracture, sequela |
S02.601S, S02.602S | Fracture of unspecified part of body of right/left mandible, sequela |
S02.610S, S02.611S, S02.612S | Fracture of condylar process of mandible, sequela |
S02.620S, S02.621S, S02.622S | Fracture of subcondylar process of mandible, sequela |
S02.630S, S02.631S, S02.632S | Fracture of coronoid process of mandible, sequela |
S02.640S, S02.641S, S02.642S | Fracture of ramus of mandible, sequela |
S02.650S, S02.651S, S02.652S | Fracture of angle of mandible, sequela |
S02.670S, S02.671S, S02.672S | Fracture of alveolus of mandible, sequela |
S02.80XS, S02.81XS, S02.82XS | Fracture of other specified skull and facial bones, sequela |
S05.20XA - S05.22XS | Ocular laceration and rupture with prolapse or loss of intraocular tissue |
S05.30XA - S05.32XS | Ocular laceration without prolapse or loss of intraocular tissue |
S05.40XA - S05.42XS | Penetrating wound of orbit with or without foreign body |
S05.50XA - S05.52XS | Penetrating wound with foreign body of eyeball |
S05.60XA - S05.62XS | Penetrating wound without foreign body of eyeball |
S05.70XA - S05.72XS | Avulsion of eye |
S05.8X1A - S05.8X9S | Other injuries of eye and orbit |
S05.90XA - S05.92XS | Unspecified injury of eye and orbit |
S01.00XA - S01.00XS | Open wound of scalp |
S01.20XA - S01.25XS | Open wound of nose |
S01.401A - S01.459S | Open wound of cheek and temporomandibular area |
S01.451A - S01.552S | Open wound of lip and oral cavity |
S01.80XA - S01.85XS | Open wound of other parts of head |
S01.90XA - S01.95XS | Open wound of unspecified part of head |
S02.5XXA - S02.5XXS | Fracture of tooth (traumatic) |
S03.2XXA - S03.2XXS | Dislocation of tooth |
S08.0XXA - S08.0XXS | Avulsion of scalp |
S08.811A - S08.89XS | Traumatic amputation of other parts of head |
S09.12XA - S09.12XS | Laceration of muscle and tendon of head |
S09.8XXA - S09.8XXS | Other specified injuries of head |
S09.90XA - S09.90XS | Unspecified injury of face and head |
S09.93XA - S09.93XS | Unspecified injury of face |
S02.0XXS | Fracture of vault of skull, sequela |
S02.110S | Type I occipital condyle fracture, unspecified side, sequela |
S02.111S | Type II occipital condyle fracture, unspecified side, sequela |
S02.112S | Type III occipital condyle fracture, unspecified side, sequela |
S02.113S | Unspecified occipital condyle fracture, sequela |
S02.118S | Other fracture of occiput, unspecified side, sequela |
S02.119S | Unspecified fracture of occiput, sequela |
S02.19XS | Other fracture of base of skull, sequela |
S02.2XXS | Fracture of nasal bones, sequela |
S02.400S | Malar fracture unspecified, sequela |
S02.401S | Maxillary fracture, unspecified side, sequela |
S02.402S | Zygomatic fracture, unspecified side, sequela |
S02.411S | LeFort I fracture, sequela |
S02.412S | LeFort II fracture, sequela |
S02.413S | LeFort III fracture, sequela |
S02.42XS | Fracture of alveolus of maxilla, sequela |
S02.5XXS | Fracture of tooth (traumatic), sequela |
S02.600S | Fracture of unspecified part of body of mandible, unspecified side, sequela |
S02.609S | Fracture of mandible, unspecified, sequela |
S02.66XS | Fracture of symphysis of mandible, sequela |
S02.69XS | Fracture of mandible of other specified site, sequela |
S02.91XS | Unspecified fracture of skull, sequela |
S02.92XS | Unspecified fracture of facial bones, sequela |
T20.00XS, T20.011S, T20.012S, T20.019S, T20.02XS, T20.03XS, T20.04XS, T20.05XS, T20.06XS, T20.07XS, T20.09XS, T20.10XS, T20.111S, T20.112S, T20.119S, T20.12XS, T20.13XS, T20.14XS, T20.15XS, T20.16XS, T20.17XS, T20.19XS, T20.20XS, T20.211S, T20.212S, T20.219S, T20.22XS, T20.23XS, T20.24XS, T20.25XS, T20.26XS, T20.27XS, T20.29XS, T20.30XS, T20.311S, T20.312S, T20.319S, T20.32XS, T20.33XS, T20.34XS, T20.35XS, T20.36XS, T20.37XS, T20.39XS, T20.40XS, T20.411S, T20.412S, T20.419S, T20.42XS, T20.43XS, T20.44XS, T20.45XS, T20.46XS, T20.47XS, T20.49XS, T20.50XS, T20.511S, T20.512S, T20.519S, T20.52XS, T20.53XS, T20.54XS, T20.55XS, T20.56XS, T20.57XS, T20.59XS, T20.60XS, T20.611S, T20.612S, T20.619S, T20.62XS, T20.63XS, T20.64XS, T20.65XS, T20.66XS, T20.67XS, T20.69XS, T20.70XS, T20.711S, T20.712S, T20.719S, T20.72XS, T20.73XS, T20.74XS, T20.75XS, T20.76XS, T20.77XS, T20.79XS | Burn and corrosion of head, face, and neck, sequela |
S00.00XA - S00.02XS, S00.04XA - S00.07XS, S00.30XA - S00.32XS, S00.34XA - S00.429S, S00.441A - S00.522S, S00.541A - S00.82XS, S00.84XA - S00.92XS, S00.94XA - S00.97XS | Superficial injury of head |
S10.10XA - S10.82XS, S10.84XA - S10.92XS, S10.94XA - S10.97XS | Superficial injury of neck |
S00.201A - S00.279S | Other and unspecified superficial injuries of eyelid and periocular area |
S05.00XA - S05.02XS | Injury of conjunctiva and corneal abrasion without foreign body |
S05.90XA - S05.90XS | Unspecified injury of unspecified eye and orbit |
S00.03XA - S00.03XS | Contusion of scalp |
S00.33XA - S00.33XS | Contusion of nose |
S00.431A - S00.431S | Contusion of right ear |
S00.432A - S00.432S | Contusion of left ear |
S00.439A - S00.439S | Contusion of unspecified ear |
S00.531A - S00.531S | Contusion of lip |
S00.532A - S00.532S | Contusion of oral cavity |
S00.83XA - S00.83XS | Contusion of other part of head |
S00.93XA - S00.93XS | Contusion of unspecified part of head |
S10.0XXA - S10.0XXS | Contusion of throat |
S10.83XA - S10.83XS | Contusion of other specified part of neck |
S10.93XA - S10.93XS | Contusion of unspecified part of neck |
S05.10XA - S05.10XS | Contusion of eyeball and orbital tissues |
S05.11XA - S05.11XS | Contusion of eyeball and orbital tissues |
S05.12XA - S05.12XS | Contusion of eyeball and orbital tissues |
S05.90XA - S05.90XS | Unspecified injury of unspecified eye and orbit |
S07.0XXA - S07.0XXS | Crushing injury of face |
S07.1XXA - S07.1XXS | Crushing injury of skull |
S07.8XXA - S07.8XXS | Crushing injury of other parts of head |
S07.9XXA - S07.9XXS | Crushing injury of head, part unspecified |
T15.00XA - T15.92XS | Foreign body on external eye |
T26.00XA - T26.92XS | Burn and corrosion confined to eye and adnexa |
S04.019A - S04.019S | Injury of optic nerve, unspecified eye |
S04.50XA - S04.52XS | Injury of facial nerve |
S14.3XXA - S14.3XXS | Injury of brachial plexus, initial encounter |
S09.92XA - S09.92XS | Unspecified injury of nose |
S09.93XA - S09.93XS | Unspecified injury of face, initial encounter |
S16.8XXA - S16.8XXS | Other specified injury of muscle, fascia and tendon at neck level, initial encounter |
S16.9XXA - S16.9XXS | Unspecified injury of muscle, fascia and tendon at neck level, initial encounter |
S19.80XA - S19.9XXS | Other specified and unspecified injuries of neck |
G03.8 | Meningitis due to other specified causes |
G97.0 | Cerebrospinal fluid leak from spinal puncture |
G97.81 | Other intraoperative complications of nervous system |
G97.82 | Other postprocedural complications and disorders of nervous system |
Z85.818 | Personal history of malignant neoplasm of other sites of lip, oral cavity, and pharynx |
Z85.819 | Personal history of malignant neoplasm of unspecified site of lip, oral cavity, and pharynx |
Z85.21 | Personal history of malignant neoplasm of larynx |
Z85.840 | Personal history of malignant neoplasm of eye |
Z85.858 | Personal history of malignant neoplasm of other endocrine glands |
Z79.2 | Long term (current) use of antibiotics |
Z79.51 | Long term (current) use of inhaled steroids |
Z79.52 | Long term (current) use of systemic steroids |
Z79.3 | Long term (current) use of hormonal contraceptives |
Z79.891 | Long term (current) use of opiate analgesic |
Z79.899 | Other long term (current) drug therapy |
Z03.89 | Encounter for observation for other suspected diseases and conditions ruled out |
Z03.6 | Encounter for observation for suspected toxic effect from ingested substance ruled out |
Z03.89 | Encounter for observation for other suspected diseases and conditions ruled out |
Z01.818 | Encounter for other preprocedural examination |
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