Printer Friendly Version
Printer Friendly Version
Printer Friendly Version
L.1.01.404
Parenteral nutritional support (PEN), also known as parenteral hyperalimentation, is used for patients with medical conditions that impair gastrointestinal absorption to a degree incompatible with life. It is also used for variable periods of time to bolster the nutritional status of severely malnourished patients with medical or surgical conditions. PEN involves percutaneous transvenous implantation of a central venous catheter into the vena cava or right atrium. A nutritionally adequate hypertonic solution consisting of glucose (sugar), amino acids (protein), electrolytes (sodium, potassium), vitamins and minerals, and sometimes fats is administered daily. An infusion pump is generally used to assure a steady flow of the solution either on a continuous (24-hour) or intermittent schedule. If intermittent, a heparin lock device and diluted heparin are used to prevent clotting inside the catheter.
Enteral nutrition (EN) is used for patients with a functioning intestinal tract who have disorders that prevent nutrients from being successfully transported to and/or absorbed in the small intestine or who have life threatening disorders of body chemistry and require formulas specially formulated to prevent toxicity. Enteral nutrition consists of nutritional support given orally or through any of a variety of enteral tubes used in specific medical circumstances. Feedings may be intermittent or continuous and may be administered using an infusion pump.
Participating providers are required to follow the American Dietetic Association Medical Nutrition Therapy Protocols for Parenteral and Enteral Feeding Support.
Parenteral Nutrition
1. Nutrients and their method of administration for parenteral nutrition must be specifically ordered by a physician.
2. Parenteral feeding support (PEN) in the home is considered medically necessary in the treatment of inanition associated with conditions resulting in impaired intestinal absorption, including the following conditions, but not limited to, any of the conditions listed in the "Code Reference" section.
Crohn's disease;
Obstruction secondary to stricture or neoplasm of the esophagus, stomach, or small intestine;
Loss of the swallowing mechanism due to a central nervous system disorder, where the risk of aspiration is great;
Short bowel syndrome secondary to massive small bowel resection;
Malabsorption due to enterocolic, enterovesical or enterocutaneous fistulas (PEN being temporary until the fistula is repaired);
Motility disorder (pseudo-obstruction);
Newborn infants with catastrophic gastrointestinal anomalies such as tracheoesophageal fistula, gastroschisis, omphalocele, or massive intestinal atresia;
Infants and young children who fail to thrive due to systemic disease or secondarily to intestinal insufficiency associated with short bowel syndrome, malabsorption, or chronic idiopathic diarrhea;
Patients with prolonged paralytic ileus following major surgery or multiple injuries;
Other conditions such as hyperemesis gravidarum and pancreatitis.
3. The following criteria must be met prior to the initial implementation of PEN:
The patient can receive no more than 30% of his/her caloric needs orally or the patient cannot benefit from enteral feedings.
The patient may be in a stage of wasting as indicated by the following:
1. Unintentional weight loss greater than 5% over 1 month or 10% over 6 months from usual body weight; adjust for body part amputation;2. Serum albumin is less than 3.4 gm;3. BUN is below 10 mg (this is not a good marker in patients receiving dialysis due to protein catabolism);4. Phosphorus level is less than 2.5 mg (normal phosphorus is 3 - 4.5 mg)
Enteral Nutrition
1. Nutrients and their method of administration for enteral nutrition must be specifically ordered by a physician.
2. Enteral nutrition that meets the definition of Medical Food (see Policy Guidelines) when administered through enteral feeding tubes (e.g. NG tubes, NE tubes, G-tubes, J-tubes) is considered medically necessary for the following functional impairments:
A. Central nervous system disorders in which the patient is unable to swallow because a damaged brain or spinal cord can no longer communicate with the muscles of the alimentary tract. This leads to interference with the neuromuscular coordination of chewing and swallowing and risk for aspiration. The paralysis may be a result of, but not limited to:
1. Cerebral vascular accident2. Trauma/accident3. Spinal cord injury4. Birth defects/cerebral palsy5. Parkinson’s disease6. Amyotrophic lateral sclerosis7. Multiple sclerosis8. Myasthenia gravis9. Huntington’s chorea
B. An anatomic or mechanical functional impairment that results in a specific inability to swallow or may prevent food from reaching the stomach (e.g. esophageal obstruction or stricture, cancer of the neck, larynx, or tongue).
C. Hyper metabolic conditions or disease leading to an inability to maintain weight and strength commensurate with his or her general condition. Examples include: extensive burns, congenital heart defects, and end stage renal disease.
D. Disorders of the gastrointestinaltract leading to dysfunction of absorption, digestion, utilization,secretion, and storage of nutrients, such as cystic fibrosis, Crohn’s disease, ulcerative colitis, and short gut syndrome.
E. Inborn errors of metabolism which require special formulas to prevent development of serious physical or mental disabilities.
3. Nutritional formulas that meet the definition of Medical Food (see Policy Guidelines) when administered orallyare considered medically necessary for patients where the formula is the sole source of nutrition (greater than 75% of daily caloric intake) and the formula is a specialized elemental formula that is labeled and used for the dietary management of a specified disease/disorder/condition for which there are distinctive nutritional requirements to avert the development of serious physical or mental disabilities or to promote normal development. Examples of such conditions include end stage renal disease and inborn errors of metabolism. The physician's order and medical records must clearly document the specific medical disorder, disease, or condition.
4. Enteral feeding (per tube or orally) is not medically necessary if 25% of estimated calories needed per day or less are being administered. This is considered supplemental and will be denied as not medically necessary, except when transitioning off of total parenteral nutrition (TPN).
Approved PEN or EN services (those that require a physician's prescription) may include, but are not limited to, the following:
cost of nutrients and solutions;
cost of rental or purchase of an infusion pump and heparin lock;
supplies and equipment necessary for the proper functioning and effective use of a PEN or EN system (e.g., catheters, dressings, IV stand, needles, filters, extension tubing, bags and concentrated nutrients);
home visits by a physician;
home visits by a registered nurse (RN) or licensed practical nurse (LPN) under the order and supervision of a physician, which meet guidelines for home care benefits. Skilled nursing services may include injection of drugs (IV or IM) and drawing of blood.
home visits by a licensed, registered dietitian according to the American Dietetic Association Medical Nutrition Therapy Protocols for Parenteral and Enteral Feeding Support.
Benefits will not be provided for the following:
Special formulas consumed due to food allergies (such as soy formulas)
Conventional food items that are naturally low in protein, even if consumed by patients with inherited metabolic disease. These are considered grocery items.
Probiotics dietary supplements and foods
Formula and nutritional substances/supplements usedto increase the protein or calorie intake in addition to the patient's daily diet. This is considered supplementation.
Infant formulas used as a substitute for breastfeeding
In patients with stable nutritional status in whom only short-term enteral or parenteral nutrition might be required (e.g., less than 2 weeks)
For routine pre- and/or postoperative care
Over-the-counter enteral nutrition that can be purchased in a retail supermarket, wholesale club, pharmacy, or over the internet unless it meets the definition of Medical Food (See Policy Guidelines).
Food thickener, blenderized food, baby food, and regular shelf food used in enteral feeding
Digestive enzymes added to enteral formula via a cartridge device attached to the tubing used for enteral feeding (Relizorb)
None
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
Medical Food is defined in Section 5(b) of the Orphan Drug Act (21 U.S.C. 360ee (b) (3)) as “a food which is formulated to be consumed or administered enterally under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation.” In general, to be considered a medical food, a product must, at a minimum, meet the following criteria: the product must be a food for oral or tube feeding; the product must be labeled for the dietary management of a specific medical disorder, disease, or condition for which there are distinctive nutritional requirements; and the product must be intended to be used under medical supervision.
Coverage of PEN and EN feeding support is intended for patients who cannot eat, not for those who will not eat.
Global allowances for PEN and EN feeding support in the home include nursing services, cost of supplies, clinical pharmacy service, dietitian monitoring, supply delivery and administrative overhead.
Benefits may be provided for placement of central venous catheters and nasogastric, nasojejunostomy, gastrostomy or jejunostomy feeding tubes when policy guidelines have been met for PEN or EN.
The total cost of renting equipment should not exceed the purchase cost of the equipment.
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.
6/1994: Approved by Medical Policy Advisory Committee (MPAC) as Home Hyperalimentation.
5/1999: MPAC reviewed, updated and renamed policy, HCPCS T0015, T0030, T0045, T0060 added.
3/5/2002: Prior authorization deleted.
3/12/2002: New 2002 HCPCS B4164, B4168, B4172, B4176, B4178, B4180, B4184, B4186, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, B5200, B9000, B9002, B9004, B9006, B9998, B9999 added.
3/19/2002: Fifth digit required for 643.0X, review on an "Individual basis" for 577.0 and 643.0X has been deleted.
5/2/2002: Type of Service and Place of Service deleted.
5/28/2002: Code Reference section updated, CPT 99560, 99561, 99562 added, HCPCS B4081, B4082, B4083, B4086, S5520, S5522, S9123, S9124, S9340, S9341, S9342, S9343, S9364-S9368, S9374-S9379, S9524 added.
8/26/2003: Code Reference section updated, CPT code 97802, 99341-99350, 99601, 99602 added, CPT code 99560, 99561, 99562 deletion dated of 6/30/2003 added, ICD-9 procedure code 99.15 added, ICD-9 diagnosis codes 530.3, 537.89, 560.9, 577.0, 643.0X, 750.3, 751.2, 756.79 listed separately, 643.0X fifth digit added, ICD-9 diagnosis code 141.0-141.9, 150.0-150.9, 151.0-151.9, 195.0, 197.8, 198.89, 210.0-210.9, 211.0, 211.1. 230.0-230.2, 232.4, 234.8, 235.0-235.2, 235.5, 238.8, 239.0, 239.8, 261, 783.21 added, HCPCS B4034, B4035, B4036, B4081, B4082, B4083, B4086, B4164, B4168, B4172, B4176, B4178, B4180, B4184, B4186, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, B5200, B9000, B9002, B9004, B9006, B9998, B9999, S9123, S9124, S9374-S9379, S9524 deleted, HCPCS S9364-S9368 listed separately, HCPCS G0108, G0109, S5517, S5518 added, HCPCS H0201, H0300, H0301, H0600 BCBSMS deletion date of 9/30/2003 added, HCPCS S5520, S5522 description revised, HCPCS T0015, T0030, T0045, T0060 “BCBSMS deletion date of 9/30/2003, see codes G0108-G0109 and 97802” added, Notes “**B4150 is the code used for all categories. Processors will recode any codes from B4151-B4156 to B4150” and “B4081-B4086 are included in the global service H0300 or H0301. B4081-B4086 will be bundled with either H0300 or H0301 on the claim” deleted, conditions moved from "Code Reference" section to "Policy" section
3/23/2005: Code Reference section reviewed, CPT code 97803, 97804 added covered codes, CPT 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350 description revised, CPT 99560, 99561, 99562 deleted, HCPCS B4102, B4103, B4104, B4157, B4158, B4159, B4160, B4161, B4162, B4164, B4168, B4172, B4176, B4178, B4180, B4184, B4186, B4189, B4193, B4197, B4199, B4216, B5000, B5100, B5200 added covered codes, HCPCS B4151, B4156 description revised and deletion date of 12/31/2004 added, HCPCS B4152, B4153, B4154, B4155 description revised, HCPCS T0015, T0030, T0045, T0060 deleted, non-covered codes table added, HCPCS B4149 added non-covered codes.
3/9/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy.
10/23/2006: Policy reviewed, no changes.
9/20/2007: Code Reference section updated. ICD-9 2007 revisions added to policy.
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008.
9/28/2009: Code reference section updated. New ICD-9 diagnosis codes 239.81, 239.89, 756.72 and 756.73 added to covered table. Deleted statement added to ICD9 diagnosis code 239.8.
4/29/2010: Policy statement clarified that benefits will not be provided for over-the-counter nutritional supplements or enteral nutrition.
3/26/2012: Further policy clarification about nutritionals.
08/31/2015: Medical policy revised to add ICD-10 codes. Removed ICD-9 procedure code 99.15, ICD-9 diagnosis code 239.8, and HCPCS codes B4151, B4156, B4184, and B4186 from the Code Reference section.
01/01/2016: Policy statement updated to revise criteria for coverage of enteral nutrition by tube or orally. The definition of Medical Food added to the Policy Guidelines. Code Reference section updated to add the following ICD-10 diagnosis codes to the Covered Codes table: E70.0, E70.21, E70.41, E71.0, E71.110, E71.111, E71.120, E71.121, E72.11, E72.21, E72.22, E72.23, E84.11, E84.19, I69.091, I69.191, I69.291, I69.391, I69.891, K90.4, K90.89, N18.4, N18.5, N18.6, Q20.1, Q20.2, Q20.3, Q20.4, Q20.5, Q20.8, Q22.6, Q23.4, and T31.20 - T31.99. Code description revised for HCPCS codes B5000, B5100, and B5200.
05/31/2016: Policy number L.1.01.404 added.
07/25/2016: Code Reference section updated to make the following correction: ICD-10 diagnosis code K891.2 should be K91.2.
09/30/2016: Code Reference section updated to add the following new ICD-10 diagnoses: K85.00 - K85.02, K85.10 - K85.12, K85.20 - K85.22, K85.30 - K85.32, K85.80 - K85.82, K85.90 - K85.92, and K90.49.
09/29/2017: Code Reference section updated to add new ICD-10 diagnosis codes K56.601 and K91.32, effective 10/01/2017. Removed deleted ICD-10 diagnosis codes K85.0, K85.1, K85.2, K85.3, K85.8, K85.9 and K90.4.
06/18/2018: Code Reference section updated to add new HCPCS code Q9994, effective 07/01/2018.
12/19/2018: Code Reference section updated to add new HCPCS code B4105, effective 01/01/2019. Removed deleted ICD-10 diagnosis codes K56.60 and K91.3.
04/29/2020: Policy statement outlining when Benefits will not be provided updated as follows: Added Digestive enzymes added to enteral formula via a cartridge device attached to the tubing used for enteral feeding (Relizorb). Changed "Food thickener, blenderized food, baby food, and regular shelf food used with an enteral feeding system" to "Food thickener, blenderized food, baby food, and regular shelf food used in enteral feeding."
09/28/2020: Code Reference section updated to add new ICD-10 diagnosis codes K59.81 and K59.89, effective 10/01/2020. Removed deleted HCPCS code Q9994.
12/21/2022: Code Reference section updated to revise the description for CPT codes 99341, 99342, 99344, 99345, 99347, 99348, 99349, and 99350, effective 01/01/2023. Removed deleted ICD-10 diagnosis code K59.8.
01/18/2023: Policy reviewed. Policy statements unchanged. Policy Guidelines updated to change "Nervous/Mental Conditions" to "Mental Health Disorders" and "Medically Necessary" to "medical necessity."
09/29/2023: Code Reference section updated to add new ICD-10 diagnosis codes K90.821, K90.822, K90.829, and K90.83, effective 10/01/2023.
02/14/2024: Policy reviewed. Policy statements unchanged. Code Reference section updated to remove deleted CPT code 99343.
03/13/2025: Policy reviewed; no changes.
Blue Cross Blue Shield Association policy #1.02.01
Hayes Medical Technology Directory
Highmark Blue Cross Blue Shield Enteral Nutrition policy
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.
Code Number | Description | ||
CPT-4 | |||
97802 | Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes | ||
97803 | Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient; each 15 minutes | ||
97804 | Medical nutrition therapy; group (2 or more individual(s), each 30 minutes | ||
99341, 99342, 99344, 99345 | Home or residence visit for the evaluation and management of a new patient, code range | ||
99347, 99348, 99349, 99350 | Home or residence visit for the evaluation and management of an established patient, code range | ||
99601 | Home infusion/specialty drug administration, per visit (up to 2 hours) | ||
99602 | Home infusion/specialty drug administration, per visit, each additional hour (List separately in addition to primary procedure) (Use 99602 in conjunction with code 99601) | ||
HCPCS | |||
B4102 | Enteral formula for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit | ||
B4103 | Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit | ||
B4104 | Additive for enteral formula (e.g., fiber) | ||
B4150 | Enteral formula nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit | ||
B4152, B4153, B4154, B4155 | Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals. May include fiber, administered through an enteral feeding tube, 100 calories = 1 unit | ||
B4157 | Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fates, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit | ||
B4158, B4159, B4160, B4161, B4162 | Enteral formula, for pediatrics code range | ||
B4164, B4168, B4172, B4176, B4178, B4180, B4185, B4189, B4193, B4197, B4199 | Parenteral nutrition solution | ||
B4216 | Parenteral nutrition; additives (vitamins, trace elements, heparin, electrolytes) - home mix, per day | ||
B5000, B5100, B5200 | Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes code range | ||
G0108 | Diabetes outpatient self-management training services, individual, per 30 minutes | ||
G0109 | Diabetes self-management training services, group session (2 or more), per 30 minutes | ||
All S-codes below include administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem. | |||
S5517 | Home infusion therapy, all supplies necessary for restoration of catheter patency or declotting | ||
S5518 | Home infusion therapy, all supplies necessary for catheter repair | ||
S5520 | Home infusion therapy, all supplies (including catheter) necessary for a peripherally inserted central venous catheter (picc) line insertion | ||
S5522 | Home infusion therapy, insertion of peripherally inserted central venous catheter (picc), nursing services only (no supplies or catheter included) | ||
All S-codes below include administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment for home enteral feeding, including tubing, swabs, gauze, alcohol wipes, betadine, etc. Enteral formula and nursing visits are coded separately. | |||
S9340 | Home therapy; enteral nutrition; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem | ||
S9341 | Home therapy; enteral nutrition via gravity; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem | ||
S9342 | Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem | ||
S9343 | Home therapy; enteral nutrition via bolus; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem | ||
All S-codes below include administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (includes standard TPN formula - lipids, specialty amino acid formulas). Drugs and nursing visits coded separately. | |||
S9364 | Home infusion therapy, total parenteral nutrition (TPN); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem (do not use with home infusion codes S9365-S9368 using daily volume scales) | ||
S9365 | Home infusion therapy, total parenteral nutrition (TPN); one liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem | ||
S9366 | Home infusion therapy, total parenteral nutrition (TPN); more than one liter but no more than two liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem | ||
S9367 | Home infusion therapy, total parenteral nutrition (TPN); more than two liters but no more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem | ||
S9368 | Home infusion therapy, total parenteral nutrition (TPN); more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem | ||
ICD-9 Procedure | ICD-10 Procedure | ||
ICD-9 Diagnosis | ICD-10 Diagnosis | ||
141.0, 141.1, 141.2, 141.3, 141.4, 141.5, 141.6, 141.8, 141.9 | Malignant neoplasm of base of tongue code range | C01 - C02.9 | Malignant neoplasm of tongue (code range) |
150.0, 150.1, 150.2, 150.3, 150.4, 150.5, 150.8, 150.9 | Malignant neoplasm of cervical esophagus code range | C15.3 - C15.9 | Malignant neoplasm of esophagus (code range) |
151.0, 151.1, 151.2, 151.3, 151.4, 151.6, 151.8, 151.9 | Malignant neoplasm of stomach code range | C16.0 - C16.9 | Malignant neoplasm of stomach (code range) |
195.0 | Malignant neoplasm of head, face, and neck | C76.0 | Malignant neoplasm of head, face, and neck |
197.8 | Secondary malignant neoplasm of other digestive organs and spleen | C78.7 - C78.89 | Secondary malignant neoplasm of liver, intrahepatic bile duct and other and unspecified digestive organs (code range) |
198.89 | Secondary malignant neoplasm of other specified sites | C79.89 - C79.9 | Secondary malignant neoplasm of other specified sites |
209.63 | Benign carcinoid tumor of the stomach | D3A.092 | Benign carcinoid tumor of the stomach |
210.0, 210.1, 210.2, 210.3, 210.4, 210.5, 210.6, 210.7, 210.8, 210.9 | Benign neoplasm of lip, oral cavity, and pharynx code range | D10.0 - D10.9 | Benign neoplasm of lip, oral cavity, and pharynx (code range) |
211.0 | Benign neoplasm of esophagus | D13.0 | Benign neoplasm of esophagus |
211.1 | Benign neoplasm of stomach | D13.1 | Benign neoplasm of stomach |
230.0, 230.1, 230.2 | Carcinoma in situ of digestive organs code range | D00.00 - D00.2 | Carcinoma in situ of lip, oral cavity and pharynx (code range) |
232.4 | Carcinoma in situ of scalp and skin of neck | D04.4 | Carcinoma in situ of scalp and skin of neck |
234.8 | Carcinoma in situ of other specified sites | D09.8 | Carcinoma in situ of other specified sites |
235.0, 235.1, 235.2, 235.5 | Neoplasm of uncertain behavior of the digestive system code range | D37.01 - D37.9 | Neoplasm of uncertain behavior of oral cavity and digestive system (code range) |
238.8 | Neoplasm of uncertain behavior of other specified sites | D48.7 | Neoplasm of uncertain behavior of other specified sites |
239.0 | Neoplasm of unspecified nature of digestive system | D49.0 | Neoplasm of unspecified behavior of digestive system |
239.81 | Neoplasm of unspecified nature, retina and choroid | D49.81 | Neoplasm of unspecified behavior of retina and choroid |
239.89 | Neoplasm of unspecified nature of other specified sites | D49.89 | Neoplasm of unspecified behavior of other specified sites |
261 | Nutritional marasmus | E41 | Nutritional marasmus |
530.3 | Stricture and stenosis of esophagus | K22.2 | Esophageal obstruction |
537.89 | Other specified disorder of stomach and duodenum (stricture of the stomach) | K31.89 | Other diseases of stomach and duodenum |
555.9 | Regional enteritis of unspecified site (Crohn's disease ) | K50.90 - K50.919 | Crohn's disease (code range) |
560.9 | Unspecified intestinal obstruction | K56.601 | Unspecified intestinal obstruction |
564.89 | Other functional disorders of intestine | K59.81, K59.89 | Other specified functional intestinal disorders |
577.0 | Acute pancreatitis | K85.00 - K85.02, K85.10 - K85.12, K85.20 - K85.22, K85.30 - K85.32, K85.80 - K85.82, K85.90 - K85.92 | Acute pancreatitis |
579.3 | Other and unspecified postsurgical nonabsorption | K91.2 | Postsurgical malabsorption, not elsewhere classified |
579.9 | Unspecified intestinal malabsorption | K90.9 | Intestinal malabsorption, unspecified |
643.00 643.01643.03 | Mild hyperemesis gravidarum, unspecified as to episode of careMild hyperemesis gravidarum, deliveredMild hyperemesis gravidarum, antepartum | O21.0 | Mild hyperemesis gravidarum |
750.3 | Congenital tracheoesophageal fistula, esophageal atresia and stenosis | Q39.0 - Q39.4 | Congenital malformation of esophagus (code range) |
751.2 | Congenital atresia and stenosis of large intestine, rectum, and anal canal | Q42.0 - Q42.9 | Congenital absence, atresia and stenosis of large intestines |
756.72 | Omphalocele | Q79.2 | Exomphalos (omphalocele) |
756.73 | Gastroschisis | Q79.3 | Gastroschisis |
756.79 | Other congenital anomalies of abdominal wall | Q79.59 | Other congenital malformations of abdominal wall |
783.21 | Loss of weight | R63.4 | Abnormal weight loss |
787.20, 787.21, 787.22, 787.23, 787.24, 787.29 | Dysphagia code range | R13.0 - R13.19 | Dysphagia (code range) |
787.91 | Diarrhea | R19.7 | Diarrhea, unspecified |
997.4 | Digestive system complication | K91.32 K91.81 - K91.89 | Intraoperative and postoperative complications (digestive system) |
E70.0 | Classical phenylketonuria | ||
E70.21 | Tyrosinemia | ||
E70.41 | Histidinemia | ||
E71.0 | Maple-syrup-urine disease | ||
E71.110 | Isovaleric acidemia | ||
E71.111 | 3-methylglutaconic aciduria | ||
E71.120 | Methylmalonic acidemia | ||
E71.121 | Propionic acidemia | ||
E72.11 | Homocystinuria | ||
E72.21 | Argininemia | ||
E72.22 | Arginosuccinic aciduria | ||
E72.23 | Citrullinemia | ||
E84.11 | Meconium ileus in cystic fibrosis | ||
E84.19 | Cystic fibrosis with other intestinal manifestations | ||
I69.091 | Dysphagia following nontraumatic subarachnoid hemorrhage | ||
I69.191 | Dysphagia following nontraumatic intracerebral hemorrhage | ||
I69.291 | Dysphagia following other nontraumatic intracranial hemorrhage | ||
I69.391 | Dysphagia following cerebral infarction | ||
I69.891 | Dysphagia following other cerebrovascular disease | ||
K90.49 | Malabsorption due to intolerance, not elsewhere classified | ||
K90.821, K90.822, K90.829 | Short bowel syndrome | ||
K90.83 | Intestinal failure | ||
K90.89 | Other intestinal malabsorption | ||
N18.4 | Chronic kidney disease, stage 4 (severe) | ||
N18.5 | Chronic kidney disease, stage 5 | ||
N18.6 | End stage renal disease | ||
Q20.1 | Double outlet right ventricle | ||
Q20.2 | Double outlet left ventricle | ||
Q20.3 | Discordant ventriculoarterial connection | ||
Q20.4 | Double inlet ventricle | ||
Q20.5 | Discordant atrioventricular connection | ||
Q20.8 | Other congenital malformations of cardiac chambers and connections | ||
Q22.6 | Hypoplastic right heart syndrome | ||
Q23.4 | Hypoplastic left heart syndrome | ||
T31.20 - T31.99 | Burns involving 20% - 90% or more of body surface |
Code Number | Description |
CPT-4 | |
HCPCS | |
B4105 | In-line cartridge containing digestive enzyme(s) for enteral feeding, each |
B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins, and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
ICD-10 Procedure | |
ICD-10 Diagnosis |
CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.