cms limitations guide - cardiovascular services limitations guide/cms...cms limitations guide -...
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CMS Limitations Guide - Cardiovascular Services
Starting July 1, 2008, CMS has placed numerous medi-
cal necessity limits on tests and procedures. This refer-
ence guide provides you with all of the latest changes.
This guide is not an all-inclusive list of National Coverage
Documents (NCD) and Local Coverage Documents (LCD).
Please consult the CMS website for additional information
at cms.hhs.gov/mcd/search.asp?clickon=search. You can
search by LCD or NCD or keyword and region.
CMS will deny payment if the correct diagnosis codes are
not entered on the order form, and your patient’s test or
procedure will not be covered. We compiled this informa-
tion in one location to make it easier for you to find the
proper codes for medically necessary diagnoses.
It is the responsibility of the provider to code to the high-
est level specified in the ICD-9-CM (e.g. to the fourth or
fifth digit). The correct use of an ICD-9-CM code listed
below does not assure coverage of a service. The service
must be reasonable and necessary in the specific case and
must meet the criteria specified in this determination.
We will continue to update this list as new CMS limitations
are announced. You can always find the most current list
on mymunson.org.
If you have any questions, please contact Kari Smith,
Office Coordinator, at (231) 935-2296, or Karen Popa,
Director, Patient Access Services, at (231) 935-7493.
CMS LimitationsCardiolite Stress TestingLCD # L2611, Effective date: 09/30/2008
CPT/HCPCS Codes: CPT 78460, CPT 78461, CPT 78464, CPT 78465, CPT 78472, CPT 78478, CPT 78481, CPT 78483,
CPT 93015, CPT 93016, CPT 93017, CPT 93018
ICD-9 codes that SUPPORT medical necessity for perfusion with or without functional studies (CPT codes 78460,
78461, 78464, 78465, 78472, 78473, 78478, 78480, 78481, 78483, 93015, 93016, 93017, and 93018):
410.00 acute myocardial infarction of anterolateral wall episode of care unspecified
410.01 acute myocardial infarction of anterolateral wall initial episode of care
410.02 acute myocardial infarction of anterolateral wall subsequent episode of care
410.10 acute myocardial infarction of other anterior wall episode of care unspecified
410.11 acute myocardial infarction of other anterior wall initial episode of care
410.12 acute myocardial infarction of other anterior wall subsequent episode of care
410.20 acute myocardial infarction of inferolateral wall episode of care unspecified
410.21 acute myocardial infarction of inferolateral wall initial episode of care
410.22 acute myocardial infarction of inferolateral wall subsequent episode of care
410.30 acute myocardial infarction of inferoposterior wall episode of care unspecified
410.31 acute myocardial infarction of inferoposterior wall initial episode of care
410.32 acute myocardial infarction of inferoposterior wall subsequent episode of care
410.40 acute myocardial infarction of other inferior wall episode of care unspecified
410.41 acute myocardial infarction of other inferior wall initial episode of care
410.42 acute myocardial infarction of other inferior wall subsequent episode of care
410.50 acute myocardial infarction of other lateral wall episode of care unspecified
410.51 acute myocardial infarction of other lateral wall initial episode of care
410.52 acute myocardial infarction of other lateral wall subsequent episode of care
410.60 true posterior wall infarction episode of care unspecified
410.61 true posterior wall infarction initial episode of care
410.62 true posterior wall infarction subsequent episode of care
410.70 subendocardial infarction episode of care unspecified
410.71 subendocardial infarction initial episode of care
410.72 subendocardial infarction subsequent episode of care
410.80 acute myocardial infarction of other specified sites episode of care unspecified
410.81 acute myocardial infarction of other specified sites initial episode of care
410.82 acute myocardial infarction of other specified sites subsequent episode of care
410.90 acute myocardial infarction of unspecified site episode of care unspecified
410.91 acute myocardial infarction of unspecified site initial episode of care
410.92 acute myocardial infarction of unspecified site subsequent episode of care
411.0 postmyocardial infarction syndrome
411.1 intermediate coronary syndrome
411.81 acute coronary occlusion without myocardial infarction
411.89 other acute and subacute forms of ischemic heart disease other
412 old myocardial infarction
413.0 angina decubitus
413.1 prinzmetal angina
413.9 other and unspecified angina pectoris
414.00 coronary atherosclerosis of unspecified type of vessel native or graft
414.01 coronary atherosclerosis of native coronary artery
414.02 coronary atherosclerosis of autologous vein bypass graft
414.03 coronary atherosclerosis of nonautologous biological bypass graft
CMS LimitationsCardiolite Stress Testing (con’t)
414.04 coronary atherosclerosis of artery bypass graft
414.06 coronary atherosclerosis of native coronary artery of transplanted heart
414.07 coronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart
414.10 aneurysm of heart (wall)
414.11 aneurysm of coronary vessels
414.12 dissection of coronary artery
414.19 other aneurysm of heart
414.2 chronic total occlusion of coronary artery
414.8 other specified forms of chronic ischemic heart disease
414.9 chronic ischemic heart disease unspecified
427.41 ventricular fibrillation
427.42 ventricular flutter
427.5 cardiac arrest
428.0 congestive heart failure unspecified
428.1 left heart failure
428.20 unspecified systolic heart failure
428.21 acute systolic heart failure
428.22 chronic systolic heart failure
428.23 acute on chronic systolic heart failure
428.40 unspecified combined systolic and diastolic heart failure
428.41 acute combined systolic and diastolic heart failure
428.42 chronic combined systolic and diastolic heart failure
428.43 acute on chronic combined systolic and diastolic heart failure
429.79 certain sequelae of myocardial infarction not elsewhere classified other
429.83 takotsubo syndrome
429.89 other ill-defined heart diseases
746.85 coronary artery anomaly congenital
786.05 shortness of breath
786.50 unspecified chest pain
786.51 precordial pain
786.59 other chest pain
794.31 nonspecific abnormal electrocardiogram (ecg) (ekg)
996.72 other complications due to other cardiac device implant and graft
996.83 complications of transplanted heart
V42.1 heart replaced by transplant
V45.81 postsurgical aortocoronary bypass status
V45.82 percutaneous transluminal coronary angioplasty status
CMS LimitationsDobutamine Stress Echocardiograms LCD # L14293, L23620, L26409, Effective date: 01/01/2009
ICD-9 Codes that SUPPORT medical necessity for Dobutamine Stress Echocardiograms:
410.02 acute myocardial infarction of anterolateral wall subsequent episode of care
410.12 acute myocardial infarction of other anterior wall subsequent episode of care
410.22 acute myocardial infarction of inferolateral wall subsequent episode of care
410.32 acute myocardial infarction of inferoposterior wall subsequent episode of care
410.42 acute myocardial infarction of other inferior wall subsequent episode of care
410.52 acute myocardial infarction of other lateral wall subsequent episode of care
410.62 true posterior wall infarction subsequent episode of care
410.72 subendocardial infarction subsequent episode of care
411.0 postmyocardial infarction syndrome
411.1 intermediate coronary syndrome
411.81 acute coronary occlusion without myocardial infarction
411.89 other acute and subacute forms of ischemic heart disease other
413.0 angina decubitus
413.1 prinzmetal angina
413.9 other and unspecified angina pectoris
414.00 coronary atherosclerosis of unspecified type of vessel native or graft
414.01 coronary atherosclerosis of native coronary artery
414.02 coronary atherosclerosis of autologous vein bypass graft
414.03 coronary atherosclerosis of nonautologous biological bypass graft
414.04 coronary atherosclerosis of artery bypass graft
414.05 coronary atherosclerosis of unspecified bypass graft
414.06 coronary atherosclerosis of native coronary artery of transplanted heart
414.07 coronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart
414.2 chronic total occlusion of coronary artery
414.8 other specified forms of chronic ischemic heart disease
424. mitral valve disorders
424.1 aortic valve disorders
424.2 tricuspid valve disorders specified as nonrheumatic
424.3 pulmonary valve disorders
425.1 hypertrophic obstructive cardiomyopathy
425.2 obscure cardiomyopathy of africa
425.3 endocardial fibroelastosis
425.4 other primary cardiomyopathies
425.5 alcoholic cardiomyopathy
425.7 nutritional and metabolic cardiomyopathy
425.8 cardiomyopathy in other diseases classified elsewhere
425.9 secondary cardiomyopathy unspecified
426.2 left bundle branch hemiblock
426.3 other left bundle branch block
426.4 right bundle branch block
426.82 long qt syndrome
428.0 congestive heart failure unspecified
428.1 left heart failure
428.20 unspecified systolic heart failure
428.21 acute systolic heart failure
428.22 chronic systolic heart failure
CMS LimitationsDobutamine Stress Echocardiograms (con’t)
428.23 acute on chronic systolic heart failure
428.30 unspecified diastolic heart failure
428.31 acute diastolic heart failure
428.32 chronic diastolic heart failure
428.33 acute on chronic diastolic heart failure
428.40 unspecified combined systolic and diastolic heart failure
428.41 acute combined systolic and diastolic heart failure
428.42 chronic combined systolic and diastolic heart failure
428.43 acute on chronic combined systolic and diastolic heart failure
428.9 heart failure unspecified
429.0 myocarditis unspecified
429.1 myocardial degeneration
429.2 cardiovascular disease unspecified
429.3 cardiomegaly
429.4 functional disturbances following cardiac surgery
780.2 syncope and collapse
786.02 orthopnea
786.05 shortness of breath
786.09 respiratory abnormality other
786.50 unspecified chest pain
786.51 precordial pain
794.31 nonspecific abnormal electrocardiogram (ecg) (ekg)
996.1 mechanical complication of other vascular device implant and graft
996.72 other complications due to other cardiac device implant and graft
996.83 complications of transplanted heart
v58.69 long-term (current) use of other medications
CMS LimitationsElectrocardiography (ECG or EKG)LCD # L27427; Effective Date: 06/05/2009
CPT/HCPCS Codes: CPT 93005, CPT 93010
ICD-9 codes that SUPPORT medical necessity for electrocardiogram, routine ecg with at least 12 leads; tracing only,
without interpretation and report (CPT 93005); and electrocardiogram, routine ecg with at least 12 leads; interpretation
and report only (CPT 93010):
002.0 typhoid fever
002.1 paratyphoid fever a
002.2 paratyphoid fever b
002.3 paratyphoid fever c
005.1 botulism food poisoning
017.90 tuberculosis of other specified organs unspecified examination
017.91 tuberculosis of other specified organs bacteriological or histological examination not done
017.92 tuberculosis of other specified organs bacteriological or histological examination results unknown (at
present)
017.93 tuberculosis of other specified organs tubercle bacilli found (in sputum) by microscopy
017.94 tuberculosis of other specified organs tubercle bacilli not found (in sputum) by microscopy but found
by bacterial culture
017.95 tuberculosis of other specified organs tubercle bacilli not found by bacteriological examination but
tuberculosis confirmed histologically
017.96 tuberculosis of other specified organs tubercle bacilli not found by bacteriological or histological ex-
amination but tuberculosis confirmed by other methods (inoculation of animals)
018.00 acute miliary tuberculosis unspecified examination
018.01 acute miliary tuberculosis bacteriological or histological examination not done
018.02 acute miliary tuberculosis bacteriological or histological examination results unknown (at present)
018.03 acute miliary tuberculosis tubercle bacilli found (in sputum) by microscopy
018.04 acute miliary tuberculosis tubercle bacilli not found (in sputum) by microscopy but found by bacterial
culture
018.05 acute miliary tuberculosis tubercle bacilli not found by bacteriological examination but tuberculosis
confirmed histologically
018.06 acute miliary tuberculosis tubercle bacilli not found by bacteriological or histological examination but
tuberculosis confirmed by other methods (inoculation of animals)
018.80 other specified miliary tuberculosis unspecified examination
018.81 other specified miliary tuberculosis bacteriological or histological examination not done
018.82 other specified miliary tuberculosis bacteriological or histological examination results unknown (at
present)
018.83 other specified miliary tuberculosis tubercle bacilli found (in sputum) by microscopy
018.84 other specified miliary tuberculosis tubercle bacilli not found (in sputum) by microscopy but found by
bacterial culture
018.85 other specified miliary tuberculosis tubercle bacilli not found by bacteriological examination but tuber-
culosis confirmed histologically
018.86 other specified miliary tuberculosis tubercle bacilli not found by bacteriological or histological exami-
nation but tuberculosis confirmed by other methods (inoculation of animals)
020.2 septicemic plague
022.3 anthrax septicemia
032.0 faucial diphtheria
032.82 diphtheritic myocarditis
034.1 scarlet fever
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
036.2 meningococcemia
036.40 meningococcal carditis unspecified
036.41 meningococcal pericarditis
036.42 meningococcal endocarditis
036.43 meningococcal myocarditis
038.0 streptococcal septicemia
038.10 staphylococcal septicemia unspecified
038.11 methicillin susceptible staphylococcus aureus septicemia
038.12 methicillin resistant staphylococcus aureus septicemia
038.19 other staphylococcal septicemia
038.2 pneumococcal septicemia
038.3 septicemia due to anaerobes
038.40 septicemia due to gram-negative organism unspecified
038.41 septicemia due to hemophilus influenzae (h. influenzae)
038.42 septicemia due to escherichia coli (e. coli)
038.43 septicemia due to pseudomonas
038.44 septicemia due to serratia
038.49 other septicemia due to gram-negative organisms
038.8 other specified septicemias
038.9 unspecified septicemia
040.0 gas gangrene
040.82 toxic shock syndrome
042 human immunodeficiency virus (hiv) disease
054.5 herpetic septicemia
066.40 west nile fever, unspecified
066.41 west nile fever with encephalitis
066.42 west nile fever with other neurologic manifestation
066.49 west nile fever with other complications
074.1 epidemic pleurodynia
074.20 coxsackie carditis unspecified
074.21 coxsackie pericarditis
074.22 coxsackie endocarditis
074.23 coxsackie myocarditis
075 infectious mononucleosis
086.0 chagas’ disease with heart involvement
088.81 lyme disease
093.0 aneurysm of aorta specified as syphilitic
093.1 syphilitic aortitis
093.20 syphilitic endocarditis of valve unspecified
093.21 syphilitic endocarditis of mitral valve
093.22 syphilitic endocarditis of aortic valve
093.23 syphilitic endocarditis of tricuspid valve
093.24 syphilitic endocarditis of pulmonary valve
093.81 syphilitic pericarditis
093.82 syphilitic myocarditis
093.89 other specified cardiovascular syphilis
093.9 cardiovascular syphilis unspecified
098.83 gonococcal pericarditis
098.84 gonococcal endocarditis
098.85 other gonococcal heart disease
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
112.5 disseminated candidiasis
112.81 candidal endocarditis
115.03 histoplasma capsulatum pericarditis
115.04 histoplasma capsulatum endocarditis
115.13 histoplasma duboisii pericarditis
115.14 histoplasma duboisii endocarditis
115.93 histoplasmosis pericarditis unspecified
115.94 histoplasmosis endocarditis
130.3 myocarditis due to toxoplasmosis
130.8 multisystemic disseminated toxoplasmosis
135 sarcoidosis
153.0 malignant neoplasm of hepatic flexure
153.1 malignant neoplasm of transverse colon
153.2 malignant neoplasm of descending colon
153.3 malignant neoplasm of sigmoid colon
153.4 malignant neoplasm of cecum
153.5 malignant neoplasm of appendix vermiformis
153.6 malignant neoplasm of ascending colon
153.7 malignant neoplasm of splenic flexure
153.8 malignant neoplasm of other specified sites of large intestine
153.9 malignant neoplasm of colon unspecified site
162.9 malignant neoplasm of bronchus and lung unspecified
163.0 malignant neoplasm of parietal pleura
163.1 malignant neoplasm of visceral pleura
163.8 malignant neoplasm of other specified sites of pleura
163.9 malignant neoplasm of pleura unspecified
164.0 malignant neoplasm of thymus
164.1 malignant neoplasm of heart
164.2 malignant neoplasm of anterior mediastinum
164.3 malignant neoplasm of posterior mediastinum
164.8 malignant neoplasm of other parts of mediastinum
164.9 malignant neoplasm of mediastinum part unspecified
174.0 malignant neoplasm of nipple and areola of female breast
174.1 malignant neoplasm of central portion of female breast
174.2 malignant neoplasm of upper-inner quadrant of female breast
174.3 malignant neoplasm of lower-inner quadrant of female breast
174.4 malignant neoplasm of upper-outer quadrant of female breast
174.5 malignant neoplasm of lower-outer quadrant of female breast
174.6 malignant neoplasm of axillary tail of female breast
174.8 malignant neoplasm of other specified sites of female breast
174.9 malignant neoplasm of breast (female) unspecified site
197.1 secondary malignant neoplasm of mediastinum
212.4 benign neoplasm of pleura
212.5 benign neoplasm of mediastinum
212.7 benign neoplasm of heart
238.4 polycythemia vera
240.0 goiter specified as simple
240.9 goiter unspecified
241.0 nontoxic uninodular goiter
241.1 nontoxic multinodular goiter
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
241.9 unspecified nontoxic nodular goiter
242.00 toxic diffuse goiter without thyrotoxic crisis or storm
242.01 toxic diffuse goiter with thyrotoxic crisis or storm
242.10 toxic uninodular goiter without thyrotoxic crisis or storm
242.11 toxic uninodular goiter with thyrotoxic crisis or storm
242.20 toxic multinodular goiter without thyrotoxic crisis or storm
242.21 toxic multinodular goiter with thyrotoxic crisis or storm
242.30 toxic nodular goiter unspecified type without thyrotoxic crisis or storm
242.31 toxic nodular goiter unspecified type with thyrotoxic crisis or storm
242.40 thyrotoxicosis from ectopic thyroid nodule without thyrotoxic crisis or storm
242.41 thyrotoxicosis from ectopic thyroid nodule with thyrotoxic crisis or storm
242.80 thyrotoxicosis of other specified origin without thyrotoxic crisis or storm
242.81 thyrotoxicosis of other specified origin with thyrotoxic crisis or storm
242.90 thyrotoxicosis without goiter or other cause and without thyrotoxic crisis or storm
242.91 thyrotoxicosis without goiter or other cause with thyrotoxic crisis or storm
243 congenital hypothyroidism
244.0 postsurgical hypothyroidism
244.1 other postablative hypothyroidism
244.2 iodine hypothyroidism
244.3 other iatrogenic hypothyroidism
244.8 other specified acquired hypothyroidism
244.9 unspecified acquired hypothyroidism
245.0 acute thyroiditis
245.1 subacute thyroiditis
245.2 chronic lymphocytic thyroiditis
249.00 secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspeci-
fied
249.01 secondary diabetes mellitus without mention of complication, uncontrolled
249.10 secondary diabetes mellitus with ketoacidosis, not stated as uncontrolled, or unspecified
249.11 secondary diabetes mellitus with ketoacidosis, uncontrolled
249.20 secondary diabetes mellitus with hyperosmolarity, not stated as uncontrolled, or unspecified
249.21 secondary diabetes mellitus with hyperosmolarity, uncontrolled
249.30 secondary diabetes mellitus with other coma, not stated as uncontrolled, or unspecified
249.31 secondary diabetes mellitus with other coma, uncontrolled
249.80 secondary diabetes mellitus with other specified manifestations, not stated as uncontrolled, or unspec-
ified
249.81 secondary diabetes mellitus with other specified manifestations, uncontrolled
250.00 diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncon-
trolled
250.01 diabetes mellitus without mention of complication, type i [juvenile type], not stated as uncontrolled
250.02 diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled
250.03 diabetes mellitus without mention of complication, type i [juvenile type], uncontrolled
250.10 diabetes with ketoacidosis, type ii or unspecified type, not stated as uncontrolled
250.11 diabetes with ketoacidosis, type i [juvenile type], not stated as uncontrolled
250.12 diabetes with ketoacidosis, type ii or unspecified type, uncontrolled
250.13 diabetes with ketoacidosis, type i [juvenile type], uncontrolled
250.20 diabetes with hyperosmolarity, type ii or unspecified type, not stated as uncontrolled
250.21 diabetes with hyperosmolarity, type i [juvenile type], not stated as uncontrolled
250.22 diabetes with hyperosmolarity, type ii or unspecified type, uncontrolled
250.23 diabetes with hyperosmolarity, type i [juvenile type], uncontrolled
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
250.30 diabetes with other coma, type ii or unspecified type, not stated as uncontrolled
250.31 diabetes with other coma, type i [juvenile type], not stated as uncontrolled
250.32 diabetes with other coma, type ii or unspecified type, uncontrolled
250.33 diabetes with other coma, type i [juvenile type], uncontrolled
250.40 diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled
250.41 diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled
250.42 diabetes with renal manifestations, type ii or unspecified type, uncontrolled
250.43 diabetes with renal manifestations, type i [juvenile type], uncontrolled
250.50 diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled
250.51 diabetes with ophthalmic manifestations, type i [juvenile type], not stated as uncontrolled
250.52 diabetes with ophthalmic manifestations, type ii or unspecified type, uncontrolled
250.53 diabetes with ophthalmic manifestations, type i [juvenile type], uncontrolled
250.60 diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled
250.61 diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled
250.62 diabetes with neurological manifestations, type ii or unspecified type, uncontrolled
250.63 diabetes with neurological manifestations, type i [juvenile type], uncontrolled
250.70 diabetes with peripheral circulatory disorders, type ii or unspecified type, not stated as uncontrolled
250.71 diabetes with peripheral circulatory disorders, type i [juvenile type], not stated as uncontrolled
250.72 diabetes with peripheral circulatory disorders, type ii or unspecified type, uncontrolled
250.73 diabetes with peripheral circulatory disorders, type i [juvenile type], uncontrolled
250.80 diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled
250.81 diabetes with other specified manifestations, type i [juvenile type], not stated as uncontrolled
250.82 diabetes with other specified manifestations, type ii or unspecified type, uncontrolled
250.83 diabetes with other specified manifestations, type i [juvenile type], uncontrolled
250.90 diabetes with unspecified complication, type ii or unspecified type, not stated as uncontrolled
250.91 diabetes with unspecified complication, type i [juvenile type], not stated as uncontrolled
250.92 diabetes with unspecified complication, type ii or unspecified type, uncontrolled
250.93 diabetes with unspecified complication, type i [juvenile type], uncontrolled
251.0 hypoglycemic coma
251.1 other specified hypoglycemia
251.2 hypoglycemia unspecified
251.3 postsurgical hypoinsulinemia
252.00 hyperparathyroidism, unspecified
252.01 primary hyperparathyroidism
252.02 secondary hyperparathyroidism, non-renal
252.08 other hyperparathyroidism
252.1 hypoparathyroidism
252.8 other specified disorders of parathyroid gland
252.9 unspecified disorder of parathyroid gland
253.0 acromegaly and gigantism
253.2 panhypopituitarism
253.5 diabetes insipidus
255.0 cushing’s syndrome
255.10 hyperaldosteronism, unspecified
255.11 glucocorticoid-remediable aldosteronism
255.12 conn’s syndrome
255.13 bartter’s syndrome
255.14 other secondary aldosteronism
255.2 adrenogenital disorders
255.3 other corticoadrenal overactivity
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
255.41 glucocorticoid deficiency
255.42 mineralocorticoid deficiency
255.5 other adrenal hypofunction
255.6 medulloadrenal hyperfunction
255.8 other specified disorders of adrenal glands
265.0 beriberi
265.1 other and unspecified manifestations of thiamine deficiency
265.2 pellagra
272.0 pure hypercholesterolemia
272.1 pure hyperglyceridemia
272.2 mixed hyperlipidemia
272.3 hyperchylomicronemia
272.4 other and unspecified hyperlipidemia
272.5 lipoprotein deficiencies
272.6 lipodystrophy
272.7 lipidoses
272.8 other disorders of lipoid metabolism
272.9 unspecified disorder of lipoid metabolism
275.0 disorders of iron metabolism
275.1 disorders of copper metabolism
275.2 disorders of magnesium metabolism
275.3 disorders of phosphorus metabolism
275.40 unspecified disorder of calcium metabolism
275.41 hypocalcemia
275.42 hypercalcemia
275.49 other disorders of calcium metabolism
275.9 unspecified disorder of mineral metabolism
276.0 hyperosmolality and/or hypernatremia
276.1 hyposmolality and/or hyponatremia
276.2 acidosis
276.3 alkalosis
276.4 mixed acid-base balance disorder
276.50 volume depletion, unspecified
276.51 dehydration
276.52 hypovolemia
276.6 fluid overload disorder
276.7 hyperpotassemia
276.8 hypopotassemia
276.9 electrolyte and fluid disorders not elsewhere classified
277.30 amyloidosis, unspecified
277.31 familial mediterranean fever
277.39 other amyloidosis
277.5 mucopolysaccharidosis
282.41 sickle-cell thalassemia without crisis
282.42 sickle-cell thalassemia with crisis
282.49 other thalassemia
282.5 sickle-cell trait
282.60 sickle-cell disease unspecified
282.61 hb-ss disease without crisis
282.62 hb-ss disease with crisis
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
282.63 sickle-cell/hb-c disease without crisis
282.64 sickle-cell/hb c disease with crisis
282.68 other sickle-cell disease without crisis
282.69 other sickle-cell disease with crisis
285.9 anemia unspecified
289.0 polycythemia secondary
289.7 methemoglobinemia
304.01 opioid type dependence continuous use
304.02 opioid type dependence episodic use
304.21 cocaine dependence continuous use
304.22 cocaine dependence episodic use
304.41 amphetamine and other psychostimulant dependence continuous use
304.51 hallucinogen dependence continuous use
304.71 combinations of opioid type drug with any other drug dependence continuous use
304.72 combinations of opioid type drug with any other drug dependence episodic use
306.2 cardiovascular malfunction arising from mental factors
327.20 organic sleep apnea, unspecified
327.21 primary central sleep apnea
327.22 high altitude periodic breathing
327.23 obstructive sleep apnea (adult) (pediatric)
327.24 idiopathic sleep related non obstructive alveolar hypoventilation
327.25 congenital central alveolar hypoventilation syndrome
327.26 sleep related hypoventilation/hypoxemia in conditions classifiable elsewhere
327.27 central sleep apnea in conditions classified elsewhere
327.29 other organic sleep apnea
333.4 huntington’s chorea
334.0 friedreich’s ataxia
337.00 idiopathic peripheral autonomic neuropathy, unspecified
337.01 carotid sinus syndrome
337.09 other idiopathic peripheral autonomic neuropathy
359.21 myotonic muscular dystrophy
390 rheumatic fever without heart involvement
391.0 acute rheumatic pericarditis
391.1 acute rheumatic endocarditis
391.2 acute rheumatic myocarditis
391.8 other acute rheumatic heart disease
391.9 acute rheumatic heart disease unspecified
392.0 rheumatic chorea with heart involvement
392.9 rheumatic chorea without heart involvement
393 chronic rheumatic pericarditis
394.0 mitral stenosis
394.1 rheumatic mitral insufficiency
394.2 mitral stenosis with insufficiency
394.9 other and unspecified mitral valve diseases
395.0 rheumatic aortic stenosis
395.1 rheumatic aortic insufficiency
395.2 rheumatic aortic stenosis with insufficiency
395.9 other and unspecified rheumatic aortic diseases
396.0 mitral valve stenosis and aortic valve stenosis
396.1 mitral valve stenosis and aortic valve insufficiency
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
396.2 mitral valve insufficiency and aortic valve stenosis
396.3 mitral valve insufficiency and aortic valve insufficiency
396.8 multiple involvement of mitral and aortic valves
396.9 mitral and aortic valve diseases unspecified
397.0 diseases of tricuspid valve
397.1 rheumatic diseases of pulmonary valve
397.9 rheumatic diseases of endocardium valve unspecified
398.0 rheumatic myocarditis
398.90 rheumatic heart disease unspecified
398.91 rheumatic heart failure (congestive)
398.99 other rheumatic heart diseases
401.0 malignant essential hypertension
401.1 benign essential hypertension
401.9 unspecified essential hypertension
402.00 malignant hypertensive heart disease without heart failure
402.01 malignant hypertensive heart disease with heart failure
402.10 benign hypertensive heart disease without heart failure
402.11 benign hypertensive heart disease with heart failure
402.90 unspecified hypertensive heart disease without heart failure
402.91 unspecified hypertensive heart disease with heart failure
403.00 hypertensive chronic kidney disease, malignant, with chronic kidney disease stage i through stage iv,
or unspecified
403.01 hypertensive chronic kidney disease, malignant, with chronic kidney disease stage v or end stage renal
disease
403.10 hypertensive chronic kidney disease, benign, with chronic kidney disease stage i through stage iv, or
unspecified
403.11 hypertensive chronic kidney disease, benign, with chronic kidney disease stage v or end stage renal
disease
403.90 hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv,
or unspecified
403.91 hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage
renal disease
404.00 hypertensive heart and chronic kidney disease, malignant, without heart failure and with chronic kid-
ney disease stage i through stage iv, or unspecified
404.01 hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney
disease stage i through stage iv, or unspecified
404.02 hypertensive heart and chronic kidney disease, malignant, without heart failure and with chronic kid-
ney disease stage v or end stage renal disease
404.03 hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney
disease stage v or end stage renal disease
404.10 hypertensive heart and chronic kidney disease, benign, without heart failure and with chronic kidney
disease stage i through stage iv, or unspecified
404.11 hypertensive heart and chronic kidney disease, benign, with heart failure and with chronic kidney dis-
ease stage i through stage iv, or unspecified
404.12 hypertensive heart and chronic kidney disease, benign, without heart failure and with chronic kidney
disease stage v or end stage renal disease
404.13 hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease
stage v or end stage renal disease
404.90 hypertensive heart and chronic kidney disease, unspecified, without heart failure and with chronic kid-
ney disease stage i through stage iv, or unspecified
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
404.91 hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney
disease stage i through stage iv, or unspecified
404.92 hypertensive heart and chronic kidney disease, unspecified, without heart failure and with chronic kid-
ney disease stage v or end stage renal disease
404.93 hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney dis-
ease stage v or end stage renal disease
405.01 malignant renovascular hypertension
405.09 other malignant secondary hypertension
405.11 benign renovascular hypertension
405.19 other benign secondary hypertension
405.91 unspecified renovascular hypertension
405.99 other unspecified secondary hypertension
410.00 acute myocardial infarction of anterolateral wall episode of care unspecified
410.01 acute myocardial infarction of anterolateral wall initial episode of care
410.02 acute myocardial infarction of anterolateral wall subsequent episode of care
410.10 acute myocardial infarction of other anterior wall episode of care unspecified
410.11 acute myocardial infarction of other anterior wall initial episode of care
410.12 acute myocardial infarction of other anterior wall subsequent episode of care
410.20 acute myocardial infarction of inferolateral wall episode of care unspecified
410.21 acute myocardial infarction of inferolateral wall initial episode of care
410.22 acute myocardial infarction of inferolateral wall subsequent episode of care
410.30 acute myocardial infarction of inferoposterior wall episode of care unspecified
410.31 acute myocardial infarction of inferoposterior wall initial episode of care
410.32 acute myocardial infarction of inferoposterior wall subsequent episode of care
410.40 acute myocardial infarction of other inferior wall episode of care unspecified
410.41 acute myocardial infarction of other inferior wall initial episode of care
410.42 acute myocardial infarction of other inferior wall subsequent episode of care
410.50 acute myocardial infarction of other lateral wall episode of care unspecified
410.51 acute myocardial infarction of other lateral wall initial episode of care
410.52 acute myocardial infarction of other lateral wall subsequent episode of care
410.60 true posterior wall infarction episode of care unspecified
410.61 true posterior wall infarction initial episode of care
410.62 true posterior wall infarction subsequent episode of care
410.70 subendocardial infarction episode of care unspecified
410.71 subendocardial infarction initial episode of care
410.72 subendocardial infarction subsequent episode of care
410.80 acute myocardial infarction of other specified sites episode of care unspecified
410.81 acute myocardial infarction of other specified sites initial episode of care
410.82 acute myocardial infarction of other specified sites subsequent episode of care
410.90 acute myocardial infarction of unspecified site episode of care unspecified
410.91 acute myocardial infarction of unspecified site initial episode of care
410.92 acute myocardial infarction of unspecified site subsequent episode of care
411.0 postmyocardial infarction syndrome
411.1 intermediate coronary syndrome
411.81 acute coronary occlusion without myocardial infarction
411.89 other acute and subacute forms of ischemic heart disease other
412 old myocardial infarction
413.0 angina decubitus
413.1 prinzmetal angina
413.9 other and unspecified angina pectoris
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
414.00 coronary atherosclerosis of unspecified type of vessel native or graft
414.01 coronary atherosclerosis of native coronary artery
414.02 coronary atherosclerosis of autologous vein bypass graft
414.03 coronary atherosclerosis of nonautologous biological bypass graft
414.04 coronary atherosclerosis of artery bypass graft
414.05 coronary atherosclerosis of unspecified bypass graft
414.06 coronary atherosclerosis of native coronary artery of transplanted heart
414.07 coronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart
414.10 aneurysm of heart (wall)
414.11 aneurysm of coronary vessels
414.12 dissection of coronary artery
414.19 other aneurysm of heart
414.2 chronic total occlusion of coronary artery
414.3 coronary atherosclerosis due to lipid rich plaque
414.8 other specified forms of chronic ischemic heart disease
414.9 chronic ischemic heart disease unspecified
415.0 acute cor pulmonale
415.11 iatrogenic pulmonary embolism and infarction
415.12 septic pulmonary embolism
415.19 other pulmonary embolism and infarction
416.0 primary pulmonary hypertension
416.1 kyphoscoliotic heart disease
416.8 other chronic pulmonary heart diseases
416.9 chronic pulmonary heart disease unspecified
417.0 arteriovenous fistula of pulmonary vessels
417.1 aneurysm of pulmonary artery
417.8 other specified diseases of pulmonary circulation
417.9 unspecified disease of pulmonary circulation
420.0 acute pericarditis in diseases classified elsewhere
420.90 acute pericarditis unspecified
420.91 acute idiopathic pericarditis
420.99 other acute pericarditis
421.0 acute and subacute bacterial endocarditis
421.1 acute and subacute infective endocarditis in diseases classified elsewhere
421.9 acute endocarditis unspecified
422.0 acute myocarditis in diseases classified elsewhere
422.90 acute myocarditis unspecified
422.91 idiopathic myocarditis
422.92 septic myocarditis
422.93 toxic myocarditis
422.99 other acute myocarditis
423.0 hemopericardium
423.1 adhesive pericarditis
423.2 constrictive pericarditis
423.3 cardiac tamponade
423.8 other specified diseases of pericardium
423.9 unspecified disease of pericardium
424.0 mitral valve disorders
424.1 aortic valve disorders
424.2 tricuspid valve disorders specified as nonrheumatic
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
424.3 pulmonary valve disorders
424.90 endocarditis valve unspecified unspecified cause
424.91 endocarditis in diseases classified elsewhere
424.99 other endocarditis valve unspecified
425.0 endomyocardial fibrosis
425.1 hypertrophic obstructive cardiomyopathy
425.2 obscure cardiomyopathy of africa
425.3 endocardial fibroelastosis
425.4 other primary cardiomyopathies
425.5 alcoholic cardiomyopathy
425.7 nutritional and metabolic cardiomyopathy
425.8 cardiomyopathy in other diseases classified elsewhere
425.9 secondary cardiomyopathy unspecified
426.0 atrioventricular block complete
426.10 atrioventricular block unspecified
426.11 first degree atrioventricular block
426.12 mobitz (type) ii atrioventricular block
426.13 other second degree atrioventricular block
426.2 left bundle branch hemiblock
426.3 other left bundle branch block
426.4 right bundle branch block
426.50 bundle branch block unspecified
426.51 right bundle branch block and left posterior fascicular block
426.52 right bundle branch block and left anterior fascicular block
426.53 other bilateral bundle branch block
426.54 trifascicular block
426.6 other heart block
426.7 anomalous atrioventricular excitation
426.81 lown-ganong-levine syndrome
426.82 long qt syndrome
426.89 other specified conduction disorders
426.9 conduction disorder unspecified
427.0 paroxysmal supraventricular tachycardia
427.1 paroxysmal ventricular tachycardia
427.2 paroxysmal tachycardia unspecified
427.31 atrial fibrillation
427.32 atrial flutter
427.41 ventricular fibrillation
427.42 ventricular flutter
427.5 cardiac arrest
427.60 premature beats unspecified
427.61 supraventricular premature beats
427.69 other premature beats
427.81 sinoatrial node dysfunction
427.89 other specified cardiac dysrhythmias
427.9 cardiac dysrhythmia unspecified
428.0 congestive heart failure unspecified
428.1 left heart failure
428.20 unspecified systolic heart failure
428.21 acute systolic heart failure
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
428.22 chronic systolic heart failure
428.23 acute on chronic systolic heart failure
428.30 unspecified diastolic heart failure
428.31 acute diastolic heart failure
428.32 chronic diastolic heart failure
428.33 acute on chronic diastolic heart failure
428.40 unspecified combined systolic and diastolic heart failure
428.41 acute combined systolic and diastolic heart failure
428.42 chronic combined systolic and diastolic heart failure
428.43 acute on chronic combined systolic and diastolic heart failure
428.9 heart failure unspecified
429.0 myocarditis unspecified
429.1 myocardial degeneration
429.2 cardiovascular disease unspecified
429.3 cardiomegaly
429.4 functional disturbances following cardiac surgery
429.5 rupture of chordae tendineae
429.6 rupture of papillary muscle
429.71 certain sequelae of myocardial infarction not elsewhere classified acquired cardiac septal defect
429.79 certain sequelae of myocardial infarction not elsewhere classified other
429.81 other disorders of papillary muscle
429.82 hyperkinetic heart disease
429.83 takotsubo syndrome
429.89 other ill-defined heart diseases
429.9 heart disease unspecified
430 subarachnoid hemorrhage
431 intracerebral hemorrhage
432.0 nontraumatic extradural hemorrhage
432.1 subdural hemorrhage
432.9 unspecified intracranial hemorrhage
433.00 occlusion and stenosis of basilar artery without cerebral infarction
433.01 occlusion and stenosis of basilar artery with cerebral infarction
433.10 occlusion and stenosis of carotid artery without cerebral infarction
433.11 occlusion and stenosis of carotid artery with cerebral infarction
433.20 occlusion and stenosis of vertebral artery without cerebral infarction
433.21 occlusion and stenosis of vertebral artery with cerebral infarction
433.30 occlusion and stenosis of multiple and bilateral precerebral arteries without cerebral infarction
433.31 occlusion and stenosis of multiple and bilateral precerebral arteries with cerebral infarction
433.80 occlusion and stenosis of other specified precerebral artery without cerebral infarction
433.81 occlusion and stenosis of other specified precerebral artery with cerebral infarction
434.00 cerebral thrombosis without cerebral infarction
434.01 cerebral thrombosis with cerebral infarction
434.10 cerebral embolism without cerebral infarction
434.11 cerebral embolism with cerebral infarction
434.90 cerebral artery occlusion unspecified without cerebral infarction
434.91 cerebral artery occlusion unspecified with cerebral infarction
435.0 basilar artery syndrome
435.1 vertebral artery syndrome
435.2 subclavian steal syndrome
435.3 vertebrobasilar artery syndrome
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
435.8 other specified transient cerebral ischemias
435.9 unspecified transient cerebral ischemia
436 acute but ill-defined cerebrovascular disease
437.0 cerebral atherosclerosis
437.1 other generalized ischemic cerebrovascular disease
437.2 hypertensive encephalopathy
437.3 cerebral aneurysm nonruptured
437.4 cerebral arteritis
437.5 moyamoya disease
437.6 nonpyogenic thrombosis of intracranial venous sinus
437.7 transient global amnesia
437.8 other ill-defined cerebrovascular disease
437.9 unspecified cerebrovascular disease
440.0 atherosclerosis of aorta
440.1 atherosclerosis of renal artery
440.20 atherosclerosis of native arteries of the extremities unspecified
440.21 atherosclerosis of native arteries of the extremities with intermittent claudication
440.22 atherosclerosis of native arteries of the extremities with rest pain
440.23 atherosclerosis of native arteries of the extremities with ulceration
440.24 atherosclerosis of native arteries of the extremities with gangrene
440.29 other atherosclerosis of native arteries of the extremities
440.4 chronic total occlusion of artery of the extremities
441.00 dissection of aorta aneurysm unspecified site
441.01 dissection of aorta thoracic
441.02 dissection of aorta abdominal
441.03 dissection of aorta thoracoabdominal
441.1 thoracic aneurysm ruptured
441.2 thoracic aneurysm without rupture
441.3 abdominal aneurysm ruptured
441.4 abdominal aneurysm without rupture
441.5 aortic aneurysm of unspecified site ruptured
441.6 thoracoabdominal aneurysm ruptured
441.7 thoracoabdominal aneurysm without rupture
441.9 aortic aneurysm of unspecified site without rupture
442.0 aneurysm of artery of upper extremity
442.1 aneurysm of renal artery
442.2 aneurysm of iliac artery
442.3 aneurysm of artery of lower extremity
442.81 aneurysm of artery of neck
442.82 aneurysm of subclavian artery
442.83 aneurysm of splenic artery
442.84 aneurysm of other visceral artery
442.89 aneurysm of other specified site
442.9 other aneurysm of unspecified site
443.0 raynaud’s syndrome
443.1 thromboangiitis obliterans (buerger’s disease)
443.21 dissection of carotid artery
443.22 dissection of iliac artery
443.23 dissection of renal artery
443.24 dissection of vertebral artery
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
443.29 dissection of other artery
443.81 peripheral angiopathy in diseases classified elsewhere
443.89 other peripheral vascular disease
443.9 peripheral vascular disease unspecified
444.0 embolism and thrombosis of abdominal aorta
444.1 embolism and thrombosis of thoracic aorta
444.21 arterial embolism and thrombosis of upper extremity
444.22 arterial embolism and thrombosis of lower extremity
444.81 embolism and thrombosis of iliac artery
444.89 embolism and thrombosis of other artery
444.9 embolism and thrombosis of unspecified artery
445.01 atheroembolism of upper extremity
445.02 atheroembolism of lower extremity
445.81 atheroembolism of kidney
445.89 atheroembolism of other site
446.0 polyarteritis nodosa
446.1 acute febrile mucocutaneous lymph node syndrome (mcls)
446.20 hypersensitivity angiitis unspecified
446.21 goodpasture’s syndrome
446.29 other specified hypersensitivity angiitis
446.3 lethal midline granuloma
446.4 wegener’s granulomatosis
446.5 giant cell arteritis
446.6 thrombotic microangiopathy
446.7 takayasu’s disease
447.0 arteriovenous fistula acquired
447.1 stricture of artery
447.2 rupture of artery
447.3 hyperplasia of renal artery
447.4 celiac artery compression syndrome
447.5 necrosis of artery
447.6 arteritis unspecified
447.8 other specified disorders of arteries and arterioles
447.9 unspecified disorders of arteries and arterioles
449 septic arterial embolism
458.0 orthostatic hypotension
458.1 chronic hypotension
458.21 hypotension of hemodialysis
458.29 other iatrogenic hypotension
458.8 other specified hypotension
458.9 hypotension unspecified
459.2 compression of vein
466.11 acute bronchiolitis due to respiratory syncytial virus (rsv)
466.19 acute bronciolitis due to other infectious organisms
483.1 pneumonia due to chlamydia
488 influenza due to identified avian influenza virus
491.20 obstructive chronic bronchitis without exacerbation
491.21 obstructive chronic bronchitis with (acute) exacerbation
493.01 extrinsic asthma with status asthmaticus
493.02 extrinsic asthma with (acute) exacerbation
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
493.10 intrinsic asthma unspecified
493.11 intrinsic asthma with status asthmaticus
493.12 intrinsic asthma with (acute) exacerbation
493.20 chronic obstructive asthma unspecified
493.21 chronic obstructive asthma with status asthmaticus
493.22 chronic obstructive asthma with (acute) exacerbation
493.81 exercise-induced bronchospasm
493.82 cough variant asthma
493.91 asthma unspecified type with status asthmaticus
493.92 asthma unspecified with (acute) exacerbation
506.1 acute pulmonary edema due to fumes and vapors
512.0 spontaneous tension pneumothorax
517.3 acute chest syndrome
518.0 pulmonary collapse
518.1 interstitial emphysema
518.3 pulmonary eosinophilia
518.4 acute edema of lung unspecified
518.5 pulmonary insufficiency following trauma and surgery
518.81 acute respiratory failure
518.82 other pulmonary insufficiency not elsewhere classified
518.83 chronic respiratory failure
518.84 acute and chronic respiratory failure
518.89 other diseases of lung not elsewhere classified
519.2 mediastinitis
519.3 other diseases of mediastinum not elsewhere classified
526.9 unspecified disease of the jaws
530.0 achalasia and cardiospasm
530.10 esophagitis unspecified
530.11 reflux esophagitis
530.12 acute esophagitis
530.19 other esophagitis
530.20 ulcer of esophagus without bleeding
530.21 ulcer of esophagus with bleeding
530.3 stricture and stenosis of esophagus
530.4 perforation of esophagus
530.5 dyskinesia of esophagus
530.6 diverticulum of esophagus acquired
530.81 esophageal reflux
530.85 barrett’s esophagus
551.3 diaphragmatic hernia with gangrene
552.3 diaphragmatic hernia with obstruction
553.3 diaphragmatic hernia without obstruction or gangrene
575.0 acute cholecystitis
575.10 cholecystitis unspecified
575.11 chronic cholecystitis
575.12 acute and chronic cholecystitis
575.2 obstruction of gallbladder
575.4 perforation of gallbladder
577.0 acute pancreatitis
578.9 hemorrhage of gastrointestinal tract unspecified
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
585.3 chronic kidney disease, stage iii (moderate)
585.4 chronic kidney disease, stage iv (severe)
585.5 chronic kidney disease, stage v
585.6 end stage renal disease
611.71 mastodynia
634.50 spontaneous abortion unspecified complicated by shock
634.51 spontaneous abortion incomplete complicated by shock
634.52 spontaneous abortion complete complicated by shock
634.60 spontaneous abortion unspecified complicated by embolism
634.61 spontaneous abortion incomplete complicated by embolism
634.62 spontaneous abortion complete complicated by embolism
635.50 legally induced abortion unspecified complicated by shock
635.51 legally induced abortion incomplete complicated by shock
635.52 legally induced abortion complete complicated by shock
635.60 legally induced abortion unspecified complicated by embolism
635.61 legally induced abortion incomplete complicated by embolism
635.62 legally induced abortion complete complicated by embolism
636.50 illegal abortion unspecified complicated by shock
636.51 illegal abortion incomplete complicated by shock
636.52 illegal abortion complete complicated by shock
636.60 illegal abortion unspecified complicated by embolism
636.61 illegal abortion incomplete complicated by embolism
636.62 illegal abortion complete complicated by embolism
637.50 legally unspecified type of abortion unspecified complicated by shock
637.51 legally unspecified abortion incomplete complicated by shock
637.52 legally unspecified abortion complete complicated by shock
637.60 legally unspecified type of abortion unspecified complicated by embolism
637.61 legally unspecified abortion incomplete complicated by embolism
637.62 legally unspecified abortion complete complicated by embolism
638.5 failed attempted abortion complicated by shock
638.6 failed attempted abortion complicated by embolism
639.5 shock following abortion or ectopic and molar pregnancies
639.6 embolism following abortion or ectopic and molar pregnancies
639.8 other specified complications following abortion or ectopic and molar pregnancies
642.00 benign essential hypertension complicating pregnancy childbirth and the puerperium unspecified as to
episode of care
642.01 benign essential hypertension with delivery
642.02 benign essential hypertension with delivery with postpartum complication
642.03 antepartum benign essential hypertension
642.04 postpartum benign essential hypertension
642.10 hypertension secondary to renal disease complicating pregnancy childbirth and the puerperium un-
specified as to episode of care
642.11 hypertension secondary to renal disease with delivery
642.12 hypertension secondary to renal disease with delivery with postpartum complication
642.13 hypertension secondary to renal disease antepartum
642.14 hypertension secondary to renal disease postpartum
642.20 other pre-existing hypertension complicating pregnancy childbirth and the puerperium unspecified as
to episode of care
642.21 other pre-existing hypertension with delivery
642.22 other pre-existing hypertension with delivery with postpartum complication
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
642.23 other pre-existing hypertension antepartum
642.24 other pre-existing hypertension postpartum
642.30 transient hypertension of pregnancy unspecified as to episode of care
642.31 transient hypertension of pregnancy with delivery
642.32 transient hypertension of pregnancy with delivery with postpartum complication
642.33 antepartum transient hypertension
642.34 postpartum transient hypertension
642.40 mild or unspecified pre-eclampsia unspecified as to episode of care
642.41 mild or unspecified pre-eclampsia with delivery
642.42 mild or unspecified pre-eclampsia with delivery with postpartum complication
642.43 mild or unspecified pre-eclampsia antepartum
642.44 mild or unspecified pre-eclampsia postpartum
642.50 severe pre-eclampsia unspecified as to episode of care
642.51 severe pre-eclampsia with delivery
642.52 severe pre-eclampsia with delivery with postpartum complication
642.53 severe pre-eclampsia antepartum
642.54 severe pre-eclampsia postpartum
642.60 eclampsia complicating pregnancy childbirth or the puerperium unspecified as to episode of care
642.61 eclampsia with delivery
642.62 eclampsia with delivery with postpartum complication
642.63 eclampsia antepartum
642.64 eclampsia postpartum
642.70 pre-eclampsia or eclampsia superimposed on pre-existing hypertension complicating pregnancy child-
birth or the puerperium unspecified as to episode of care
642.71 pre-eclampsia or eclampsia superimposed on pre-existing hypertension with delivery
642.72 pre-eclampsia or eclampsia superimposed on pre-existing hypertension with delivery with postpartum
complication
642.73 pre-eclampsia or eclampsia superimposed on pre-existing hypertension antepartum
642.74 pre-eclampsia or eclampsia superimposed on pre-existing hypertension postpartum
642.90 unspecified hypertension complicating pregnancy childbirth or the puerperium unspecified as to epi-
sode of care
642.91 unspecified hypertension with delivery
642.92 unspecified hypertension with delivery with postpartum complication
642.93 unspecified antepartum hypertension
642.94 unspecified postpartum hypertension
648.50 congenital cardiovascular disorders of mother complicating pregnancy childbirth or the puerperium
unspecified as to episode of care
648.51 congenital cardiovascular disorders of mother with delivery
648.52 congenital cardiovascular disorders of mother with delivery with postpartum complication
648.53 congenital cardiovascular disorders of mother antepartum
648.54 congenital cardiovascular disorders of mother postpartum
648.60 other cardiovascular diseases of mother complicating pregnancy childbirth or the puerperium unspec-
ified as to episode of care
648.61 other cardiovascular diseases of mother with delivery
648.62 other cardiovascular diseases of mother with delivery with postpartum complication
648.63 other cardiovascular diseases of mother antepartum
648.64 other cardiovascular diseases of mother postpartum
668.10 cardiac complications of anesthesia or other sedation in labor and delivery unspecified as to episode
of care
668.11 cardiac complications of anesthesia or other sedation in labor and delivery delivered
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
668.12 cardiac complications of anesthesia or other sedation in labor and delivery delivered with postpartum
complication
668.13 cardiac complications of anesthesia or other sedation in labor and delivery antepartum
668.14 cardiac complications of anesthesia or other sedation in labor and delivery postpartum
669.10 obstetric shock unspecified as to episode of care
669.11 obstetric shock with delivery with or without antepartum condition
669.12 obstetric shock with delivery with postpartum complication
669.13 antepartum obstetric shock
669.14 postpartum obstetric shock
669.20 maternal hypotension syndrome complicating labor and delivery unspecified as to episode of care
669.21 maternal hypotension syndrome with delivery with or without antepartum condition
669.22 maternal hypotension syndrome with delivery with postpartum complication
669.23 maternal hypotension syndrome antepartum
669.24 maternal hypotension syndrome postpartum
669.40 other complications of obstetrical surgery and procedures unspecified as to episode of care
669.41 other complications of obstetrical surgery and procedures with delivery with or without antepartum
condition
669.42 other complications of obstetrical surgery and procedures with delivery with postpartum complication
669.43 other complications of obstetrical surgery and procedures antepartum condition or complication
669.44 other complications of obstetrical surgery and procedures postpartum condition or complication
673.00 obstetrical air embolism unspecified as to episode of care
673.01 obstetrical air embolism with delivery with or without antepartum condition
673.02 obstetrical air embolism with delivery with postpartum complication
673.03 obstetrical air embolism antepartum condition or complication
673.04 obstetrical air embolism postpartum condition or complication
673.10 amniotic fluid embolism unspecified as to episode of care
673.11 amniotic fluid embolism with delivery with or without antepartum condition
673.12 amniotic fluid embolism with delivery with postpartum complication
673.13 amniotic fluid embolism antepartum condition or complication
673.14 amniotic fluid embolism postpartum condition or complication
673.20 obstetrical blood-clot embolism unspecified as to episode of care
673.21 obstetrical blood-clot embolism with delivery with or without antepartum condition
673.22 obstetrical blood-clot embolism with postpartum complication
673.23 obstetrical blood-clot embolism antepartum
673.24 obstetrical blood-clot embolism postpartum
673.30 obstetrical pyemic and septic embolism unspecified as to episode of care
673.31 obstetrical pyemic and septic embolism with delivery with or without antepartum condition
673.32 obstetrical pyemic and septic embolism with delivery with postpartum complicaton
673.33 obstetrical pyemic and septic embolism antepartum
673.34 obstetrical pyemic and septic embolism postpartum
673.80 other obstetrical pulmonary embolism unspecified as to episode of care
673.81 other obstetrical pulmonary embolism with delivery with or without antepartum condition
673.82 other obstetrical pulmonary embolism with delivery with postpartum complication
673.83 other obstetrical pulmonary embolism antepartum
673.84 other obstetrical pulmonary embolism postpartum
674.50 peripart cardiomyopathy unspecified
674.51 peripartum cardiomyopathy with delivery with or without antepartum condition
674.52 peripartum cardiomyopathy with delivery with postpartum complication
674.53 peripartum cardiomyopathy with antepartum condition or complication
674.54 peripartum cardiomyopathy with postpartum condition or complication
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
710.0 systemic lupus erythematosus
710.1 systemic sclerosis
710.3 dermatomyositis
710.4 polymyositis
714.2 other rheumatoid arthritis with visceral or systemic involvement
724.1 pain in thoracic spine
729.1 myalgia and myositis unspecified
729.5 pain in limb
733.6 tietze’s disease
738.3 acquired deformity of chest and rib
745.0 common truncus
745.10 complete transposition of great vessels
745.11 double outlet right ventricle
745.12 corrected transposition of great vessels
745.19 other transposition of great vessels
745.2 tetralogy of fallot
745.3 common ventricle
745.4 ventricular septal defect
745.5 ostium secundum type atrial septal defect
745.60 endocardial cushion defect unspecified type
745.61 ostium primum defect
745.69 other endocardial cushion defects
745.7 cor biloculare
745.8 other bulbus cordis anomalies and anomalies of cardiac septal closure
745.9 unspecified defect of septal closure
746.00 congenital pulmonary valve anomaly unspecified
746.01 atresia of pulmonary valve congenital
746.02 stenosis of pulmonary valve congenital
746.09 other congenital anomalies of pulmonary valve
746.1 tricuspid atresia and stenosis congenital
746.2 ebstein’s anomaly
746.3 congenital stenosis of aortic valve
746.4 congenital insufficiency of aortic valve
746.5 congenital mitral stenosis
746.6 congenital mitral insufficiency
746.7 hypoplastic left heart syndrome
746.81 subaortic stenosis congenital
746.82 cor triatriatum
746.83 infundibular pulmonic stenosis congenital
746.84 congenital obstructive anomalies of heart not elsewhere classified
746.85 coronary artery anomaly congenital
746.86 congenital heart block
746.87 malposition of heart and cardiac apex
746.89 other specified congenital anomalies of heart
746.9 unspecified congenital anomaly of heart
747.0 patent ductus arteriosus
747.10 coarctation of aorta (preductal) (postductal)
747.11 interruption of aortic arch
747.20 congenital anomaly of aorta unspecified
747.21 congenital anomalies of aortic arch
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
747.22 congenital atresia and stenosis of aorta
747.29 other congenital anomalies of aorta
747.3 congenital anomalies of pulmonary artery
747.40 congenital anomaly of great veins unspecified
747.41 total anomalous pulmonary venous connection
747.42 partial anomalous pulmonary venous connection
747.49 other anomalies of great veins
747.5 absence or hypoplasia of umbilical artery
754.81 pectus excavatum
754.82 pectus carinatum
756.3 other congenital anomalies of ribs and sternum
758.0 down’s syndrome
758.1 patau’s syndrome
758.32 velo-cardio-facial syndrome
758.4 balanced autosomal translocation in normal individual
758.5 other conditions due to autosomal anomalies
758.7 klinefelter’s syndrome
758.81 other conditions due to sex chromosome anomalies
758.89 other conditions due to chromosome anomalies
759.3 situs inversus
759.4 conjoined twins
759.7 multiple congenital anomalies so described
759.81 prader-willi syndrome
759.82 marfan syndrome
759.83 fragile x syndrome
759.89 other specified congenital anomalies
768.2 fetal distress before onset of labor in liveborn infant
768.3 fetal distress first noted during labor in liveborn infant
768.4 fetal distress unspecified as to time of onset in liveborn infant
768.5 severe birth asphyxia
768.6 mild or moderate birth asphyxia
768.9 unspecified severity of birth asphyxia in liveborn infant
769 respiratory distress syndrome in newborn
770.89 other respiratory problems after birth
771.0 congenital rubella
771.1 congenital cytomegalovirus infection
771.3 tetanus neonatorum
775.3 neonatal thyrotoxicosis
775.4 hypocalcemia and hypomagnesemia of newborn
775.5 other transitory neonatal electrolyte disturbances
775.6 neonatal hypoglycemia
775.7 late metabolic acidosis of newborn
778.0 hydrops fetalis not due to isoimmunization
779.0 convulsions in newborn
779.4 drug reactions and intoxications specific to newborn
779.5 drug withdrawal syndrome in newborn
780.01 coma
780.02 transient alteration of awareness
780.03 persistent vegetative state
780.09 alteration of consciousness other
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
780.2 syncope and collapse
780.31 febrile convulsions (simple), unspecified
780.32 complex febrile convulsions
780.39 other convulsions
780.4 dizziness and giddiness
780.57 unspecified sleep apnea
780.60 fever, unspecified
780.61 fever presenting with conditions classified elsewhere
780.62 postprocedural fever
780.63 postvaccination fever
780.64 chills (without fever)
780.65 hypothermia not associated with low environmental temperature
780.71 chronic fatigue syndrome
780.79 other malaise and fatigue
781.5 clubbing of fingers
781.7 tetany
782.3 edema
782.5 cyanosis
782.61 pallor
782.62 flushing
784.1 throat pain
785.0 tachycardia unspecified
785.1 palpitations
785.2 undiagnosed cardiac murmurs
785.3 other abnormal heart sounds
785.50 shock unspecified
785.51 cardiogenic shock
785.52 septic shock
785.59 other shock without trauma
786.00 respiratory abnormality unspecified
786.01 hyperventilation
786.02 orthopnea
786.05 shortness of breath
786.09 respiratory abnormality other
786.1 stridor
786.50 unspecified chest pain
786.51 precordial pain
786.52 painful respiration
786.59 other chest pain
786.7 abnormal chest sounds
787.1 heartburn
789.00 abdominal pain unspecified site
789.01 abdominal pain right upper quadrant
789.02 abdominal pain left upper quadrant
789.03 abdominal pain right lower quadrant
789.04 abdominal pain left lower quadrant
789.05 abdominal pain periumbilic
789.06 abdominal pain epigastric
789.07 abdominal pain generalized
789.09 abdominal pain other specified site
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
790.4 nonspecific elevation of levels of transaminase or lactic acid dehydrogenase (ldh)
790.91 abnormal arterial blood gases
794.30 unspecified abnormal function study of cardiovascular system
794.31 nonspecific abnormal electrocardiogram (ecg) (ekg)
794.39 other nonspecific abnormal function study of cardiovascular system
794.4 nonspecific abnormal results of function study of kidney
794.5 nonspecific abnormal results of function study of thyroid
796.3 nonspecific low blood pressure reading
799.01 asphyxia
799.02 hypoxemia
799.1 respiratory arrest
799.2 nervousness
799.3 debility unspecified
799.4 cachexia
807.00 closed fracture of rib(s) unspecified
807.01 closed fracture of one rib
807.02 closed fracture of two ribs
807.03 closed fracture of three ribs
807.04 closed fracture of four ribs
807.05 closed fracture of five ribs
807.06 closed fracture of six ribs
807.07 closed fracture of seven ribs
807.08 closed fracture of eight or more ribs
807.10 open fracture of rib(s) unspecified
807.11 open fracture of one rib
807.12 open fracture of two ribs
807.13 open fracture of three ribs
807.14 open fracture of four ribs
807.15 open fracture of five ribs
807.16 open fracture of six ribs
807.17 open fracture of seven ribs
807.18 open fracture of eight or more ribs
807.2 closed fracture of sternum
807.3 open fracture of sternum
807.4 flail chest
853.00 other and unspecified intracranial hemorrhage following injury without open intracranial wound with
state of consciousness unspecified
853.01 other and unspecified intracranial hemorrhage following injury without open intracranial wound with
no loss of consciousness
853.02 other and unspecified intracranial hemorrhage following injury without open intracranial wound with
brief (less than one hour) loss of consciousness
853.03 other and unspecified intracranial hemorrhage following injury without open intracranial wound with
moderate (1-24 hours) loss of consciousness
853.04 other and unspecified intracranial hemorrhage following injury without open intracranial wound with
prolonged (more than 24 hours) loss of consciousness and return to pre- existing conscious level
853.05 other and unspecified intracranial hemorrhage following injury. without open intracranial wound with
prolonged (more than 24 hours) loss of consciousness without return to pre-existing conscious level
853.06 other and unspecified intracranial hemorrhage following injury without open intracranial wound with
loss of consciousness of unspecified duration
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
853.09 other and unspecified intracranial hemorrhage following injury without open intracranial wound with
concussion unspecified
853.10 other and unspecified intracranial hemorrhage following injury with open intracranial wound with state
of consciousness unspecified
853.11 other and unspecified intracranial hemorrhage following injury with open intracranial wound with no
loss of consciousness
853.12 other and unspecified intracranial hemorrhage following injury with open intracranial wound with brief
(less than one hour) loss of consciousness
853.13 other and unspecified intracranial hemorrhage following injury with open intracranial wound with
moderate (1-24 hours) loss of consciousness
853.14 other and unspecified intracranial hemorrhage following injury with open intracranial wound with pro-
longed( more than 24 hours) loss of consciousness and return to pre-existing conscious level
853.15 other and unspecified intracranial hemorrhage following injury with open intracranial wound with pro-
longed (more than 24 hours) loss of consciousness without return to pre-existing conscious level
853.16 other and unspecified intracranial hemorrhage following injury with open intracranial wound with loss
of consciousness of unspecified duration
853.19 other and unspecified intracranial hemorrhage following injury with open intracranial wound with con-
cussion unspecified
860.0 traumatic pneumothorax without open wound into thorax
860.1 traumatic pneumothorax with open wound into thorax
860.2 traumatic hemothorax without open wound into thorax
860.3 traumatic hemothorax with open wound into thorax
860.4 traumatic pneumohemothorax without open wound into thorax
860.5 traumatic pneumohemothorax with open wound into thorax
861.00 unspecified injury of heart without open wound into thorax
861.01 contusion of heart without open wound into thorax
861.02 laceration of heart without penetration of heart chambers or open wound into thorax
861.03 laceration of heart with penetration of heart chambers without open wound into thorax
861.10 unspecified injury of heart with open wound into thorax
861.11 contusion of heart with open wound into thorax
861.12 laceration of heart without penetration of heart chambers with open wound into thorax
861.13 laceration of heart with penetration of heart chambers and open wound into thorax
861.20 unspecified injury of lung without open wound into thorax
861.21 contusion of lung without open wound into thorax
861.22 laceration of lung without open wound into thorax
861.30 unspecified injury of lung with open wound into thorax
861.31 contusion of lung with open wound into thorax
861.32 laceration of lung with open wound into thorax
862.0 injury to diaphragm without open wound into cavity
862.1 injury to diaphragm with open wound into cavity
862.21 injury to bronchus without open wound into cavity
862.22 injury to esophagus without open wound into cavity
862.29 injury to other specified intrathoracic organs without open wound into cavity
862.31 injury to bronchus with open wound into cavity
862.32 injury to esophagus with open wound into cavity
862.39 injury to other specified intrathoracic organs with open wound into cavity
862.8 injury to multiple and unspecified intrathoracic organs without open wound into cavity
862.9 injury to multiple and unspecified intrathoracic organs with open wound into cavity
875.0 open wound of chest (wall) without complication
875.1 open wound of chest (wall) complicated
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
900.00 injury to carotid artery unspecified
900.01 injury to common carotid artery
900.02 injury to external carotid artery
900.03 injury to internal carotid artery
900.1 injury to internal jugular vein
900.81 injury to external jugular vein
900.82 injury to multiple blood vessels of head and neck
900.89 injury to other specified blood vessels of head and neck
900.9 injury to unspecified blood vessel of head and neck
901.0 injury to thoracic aorta
901.1 injury to innominate and subclavian arteries
901.2 injury to superior vena cava
901.3 injury to innominate and subclavian veins
901.40 injury to pulmonary vessel(s) unspecified
901.41 injury to pulmonary artery
901.42 injury to pulmonary vein
901.81 injury to intercostal artery or vein
901.82 injury to internal mammary artery or vein
901.83 injury to multiple blood vessels of thorax
901.89 injury to other specified blood vessels of thorax
901.9 injury to unspecified blood vessel of thorax
902.0 injury to abdominal aorta
902.10 injury to inferior vena cava unspecified
902.11 injury to hepatic veins
902.19 injury to other specified branches of inferior vena cava
902.20 injury to celiac and mesenteric arteries unspecified
902.21 injury to gastric artery
902.22 injury to hepatic artery
902.23 injury to splenic artery
902.24 injury to other specified branches of celiac axis
902.25 injury to superior mesenteric artery (trunk)
902.26 injury to primary branches of superior mesenteric artery
902.27 injury to inferior mesenteric artery
902.29 injury to other celiac and mesenteric arteries
902.31 injury to superior mesenteric vein and primary subdivisions
902.32 injury to inferior mesenteric vein
902.33 injury to portal vein
902.34 injury to splenic vein
902.39 injury to other portal and splenic veins
902.40 injury to renal vessel(s) unspecified
902.41 injury to renal artery
902.42 injury to renal vein
902.49 injury to other renal blood vessels
902.50 injury to iliac vessel(s) unspecified
902.51 injury to hypogastric artery
902.52 injury to hypogastric vein
902.53 injury to iliac artery
902.54 injury to iliac vein
902.55 injury to uterine artery
902.56 injury to uterine vein
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
902.59 injury to other iliac blood vessels
902.81 injury to ovarian artery
902.82 injury to ovarian vein
902.87 injury to multiple blood vessels of abdomen and pelvis
902.89 injury to other specified blood vessels of abdomen and pelvis
908.0 late effect of internal injury to chest
909.2 late effect of radiation
922.1 contusion of chest wall
926.8 crushing injury of multiple sites of trunk
947.1 burn of larynx trachea and lung
958.0 air embolism as an early complication of trauma
958.1 fat embolism as an early complication of trauma
958.4 traumatic shock
958.7 traumatic subcutaneous emphysema
959.11 other injury of chest wall
960.7 poisoning by antineoplastic antibiotics
962.7 poisoning by thyroid and thyroid derivatives
962.8 poisoning by antithyroid agents
963.1 poisoning by antineoplastic and immunosuppressive drugs
965.1 poisoning by salicylates
966.0 poisoning by oxazolidine derivatives
966.1 poisoning by hydantoin derivatives
966.2 poisoning by succinimides
966.3 poisoning by other and unspecified anticonvulsants
966.4 poisoning by anti-parkinsonism drugs
967.0 poisoning by barbiturates
967.1 poisoning by chloral hydrate group
967.2 poisoning by paraldehyde
967.3 poisoning by bromine compounds
967.4 poisoning by methaqualone compounds
967.5 poisoning by glutethimide group
967.6 poisoning by mixed sedatives not elsewhere classified
967.8 poisoning by other sedatives and hypnotics
967.9 poisoning by unspecified sedative or hypnotic
968.0 poisoning by central nervous system muscle-tone depressants
968.1 poisoning by halothane
968.2 poisoning by other gaseous anesthetics
968.3 poisoning by intravenous anesthetics
968.4 poisoning by other and unspecified general anesthetics
968.5 poisoning by surface (topical) and infiltration anesthetics
968.6 poisoning by peripheral nerve- and plexus-blocking anesthetics
968.7 poisoning by spinal anesthetics
968.9 poisoning by other and unspecified local anesthetics
969.0 poisoning by antidepressants
969.1 poisoning by phenothiazine-based tranquilizers
969.2 poisoning by butyrophenone-based tranquilizers
969.3 poisoning by other antipsychotics neuroleptics and major tranquilizers
969.4 poisoning by benzodiazepine-based tranquilizers
969.5 poisoning by other tranquilizers
969.6 poisoning by psychodysleptics (hallucinogens)
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
969.7 poisoning by psychostimulants
969.8 poisoning by other specified psychotropic agents
969.9 poisoning by unspecified psychotropic agent
970.0 poisoning by analeptics
970.1 poisoning by opiate antagonists
970.8 poisoning by other specified central nervous system stimulants
970.9 poisoning by unspecified central nervous system stimulant
971.0 poisoning by parasympathomimetics (cholinergics)
971.1 poisoning by parasympatholytics (anticholinergics and antimuscarinics) and spasmolytics
971.2 poisoning by sympathomimetics (adrenergics)
971.3 poisoning by sympatholytics (antiadrenergics)
971.9 poisoning by unspecified drug primarily affecting autonomic nervous system
972.0 poisoning by cardiac rhythm regulators
972.1 poisoning by cardiotonic glycosides and drugs of similar action
972.2 poisoning by antilipemic and antiarteriosclerotic drugs
972.3 poisoning by ganglion-blocking agents
972.4 poisoning by coronary vasodilators
972.5 poisoning by other vasodilators
972.6 poisoning by other antihypertensive agents
972.7 poisoning by antivaricose drugs including sclerosing agents
972.8 poisoning by capillary-active drugs
972.9 poisoning by other and unspecified agents primarily affecting the cardiovascular system
974.0 poisoning by mercurial diuretics
974.1 poisoning by purine derivative diuretics
974.2 poisoning by carbonic acid anhydrase inhibitors
974.3 poisoning by saluretics
974.4 poisoning by other diuretics
974.5 poisoning by electrolytic caloric and water-balance agents
974.6 poisoning by other mineral salts not elsewhere classified
974.7 poisoning by uric acid metabolism drugs
975.1 poisoning by smooth muscle relaxants
975.7 poisoning by antiasthmatics
977.8 poisoning by other specified drugs and medicinal substances
977.9 poisoning by unspecified drug or medicinal substance
980.0 toxic effect of ethyl alcohol
980.1 toxic effect of methyl alcohol
980.2 toxic effect of isopropyl alcohol
980.3 toxic effect of fusel oil
981 toxic effect of petroleum products
982.0 toxic effect of benzene and homologues
982.1 toxic effect of carbon tetrachloride
982.2 toxic effect of carbon disulfide
982.3 toxic effect of other chlorinated hydrocarbon solvents
982.4 toxic effect of nitroglycol
982.8 toxic effect of other nonpetroleum-based solvents
986 toxic effect of carbon monoxide
989.0 toxic effect of hydrocyanic acid and cyanides
989.3 toxic effect of organophosphate and carbamate
989.4 toxic effect of other pesticides not elsewhere classified
989.5 toxic effect of venom
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
990 effects of radiation unspecified
991.6 hypothermia
992.0 heat stroke and sunstroke
992.1 heat syncope
992.3 heat exhaustion anhydrotic
993.2 other and unspecified effects of high altitude
993.3 caisson disease
994.0 effects of lightning
994.1 drowning and nonfatal submersion
994.7 asphyxiation and strangulation
994.8 electrocution and nonfatal effects of electric current
995.0 other anaphylactic shock not elsewhere classified
995.4 shock due to anesthesia not elsewhere classified
995.60 anaphylactic shock due to unspecified food
995.61 anaphylactic shock due to peanuts
995.62 anaphylactic shock due to crustaceans
995.63 anaphylactic shock due to fruits and vegetables
995.64 anaphylactic shock due to tree nuts and seeds
995.65 anaphylactic shock due to fish
995.66 anaphylactic shock due to food additives
995.67 anaphylactic shock due to milk products
995.68 anaphylactic shock due to eggs
995.69 anaphylactic shock due to other specified food
995.89 other specified adverse effects not elsewhere classified
995.90 systemic inflammatory response syndrome unspecified
995.91 sepsis
995.92 severe sepsis
995.94 systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction
996.00 mechanical complications of unspecified cardiac device implant and graft
996.01 mechanical complication due to cardiac pacemaker (electrode)
996.02 mechanical complication due to heart valve prosthesis
996.03 mechanical complication due to coronary bypass graft
996.04 mechanical complication of automatic implantable cardiac defibrillator
996.09 other mechanical complication of cardiac device implant and graft
996.1 mechanical complication of other vascular device implant and graft
996.61 infection and inflammatory reaction due to cardiac device implant and graft
996.62 infection and inflammatory reaction due to other vascular device implant and graft
996.71 other complications due to heart valve prosthesis
996.72 other complications due to other cardiac device implant and graft
996.81 complications of transplanted kidney
996.82 complications of transplanted liver
996.83 complications of transplanted heart
996.84 complications of transplanted lung
996.85 complications of transplanted bone marrow
996.86 complications of transplanted pancreas
996.87 complications of transplanted organ intestine
997.1 cardiac complications not elsewhere classified
998.0 postoperative shock not elsewhere classified
998.11 hemorrhage complicating a procedure
998.12 hematoma complicating a procedure
CMS LimitationsElectrocardiography (ECG or EKG) (con’t)
998.13 seroma complicating a procedure
998.2 accidental puncture or laceration during a procedure not elsewhere classified
998.51 infected postoperative seroma
998.59 other postoperative infection
998.7 acute reaction to foreign substance accidentally left during a procedure not elsewhere classified
998.81 emphysema (subcutaneous) (surgical) resulting from procedure
999.1 air embolism as a complication of medical care not elsewhere classified
999.4 anaphylactic shock due to serum not elsewhere classified
999.5 other serum reaction not elsewhere classified
v15.1 personal history of surgery to heart and great vessels presenting hazards to health
v42.1 heart replaced by transplant
v42.2 heart valve replaced by transplant
v42.6 lung replaced by transplant
v43.21 heart replaced by heart assist device
v43.22 heart replaced by fully implantable artificial heart
v43.3 heart valve replaced by other means
v45.00 unspecified cardiac device in situ
v45.01 cardiac pacemaker in situ
v45.02 automatic implantable cardiac defibrillator in situ
v45.09 other specified cardiac device in situ
v45.81 postsurgical aortocoronary bypass status
v45.82 percutaneous transluminal coronary angioplasty status
v47.2 other cardiorespiratory problems
v53.31 fitting and adjustment of cardiac pacemaker
v53.32 fitting and adjustment of automatic implantable cardiac defibrillator
v53.39 fitting and adjustment of other cardiac device
v58.0 radiotherapy
v58.11 encounter for antineoplastic chemotherapy
v58.12 encounter for immunotherapy for neoplastic condition
v58.69 long-term (current) use of other medications
v71.82 observation and evaluation for suspected exposure to anthrax
v71.83 observation and evaluation for suspected exposure to other biological agent
ICD-9-CM code 729.5 should be utilized when patient is experiencing left arm pain.
ICD-9-CM code 526.9 should be utilized when patient is experiencing jaw pain.
When cardiotoxicity may be involved in either radiation therapy or chemotherapy, ICD-9-CM code 990, V58.0, or V58.1
should be reported as appropriate.
CMS LimitationsHolter Monitor TestingLCD # L1241, Effective date: 09/01/2008
ICD-9 codes that SUPPORT medical necessity for Holter Monitor Testing:
410.00* acute myocardial infarction of anterolateral wall episode of care unspecified
410.01* acute myocardial infarction of anterolateral wall initial episode of care
410.02* acute myocardial infarction of anterolateral wall subsequent episode of care
410.10* acute myocardial infarction of other anterior wall episode of care unspecified
410.11* acute myocardial infarction of other anterior wall initial episode of care
410.12* acute myocardial infarction of other anterior wall subsequent episode of care
410.20* acute myocardial infarction of inferolateral wall episode of care unspecified
410.21* acute myocardial infarction of inferolateral wall initial episode of care
410.22* acute myocardial infarction of inferolateral wall subsequent episode of care
410.30* acute myocardial infarction of inferoposterior wall episode of care unspecified
410.31* acute myocardial infarction of inferoposterior wall initial episode of care
410.32* acute myocardial infarction of inferoposterior wall subsequent episode of care
410.40* acute myocardial infarction of other inferior wall episode of care unspecified
410.41* acute myocardial infarction of other inferior wall initial episode of care
410.42* acute myocardial infarction of other inferior wall subsequent episode of care
410.50* acute myocardial infarction of other lateral wall episode of care unspecified
410.51* acute myocardial infarction of other lateral wall initial episode of care
410.52* acute myocardial infarction of other lateral wall subsequent episode of care
410.60* true posterior wall infarction episode of care unspecified
410.61* true posterior wall infarction initial episode of care
410.62* true posterior wall infarction subsequent episode of care
410.70* subendocardial infarction episode of care unspecified
410.71* subendocardial infarction initial episode of care
410.72* subendocardial infarction subsequent episode of care
410.80* acute myocardial infarction of other specified sites episode of care unspecified
410.81* acute myocardial infarction of other specified sites initial episode of care
410.82* acute myocardial infarction of other specified sites subsequent episode of care
410.90* acute myocardial infarction of unspecified site episode of care unspecified
410.91* acute myocardial infarction of unspecified site initial episode of care*
410.92* acute myocardial infarction of unspecified site subsequent episode of care
411.0 postmyocardial infarction syndrome
411.1 intermediate coronary syndrome
411.81 acute coronary occlusion without myocardial infarction
411.89 other acute and subacute forms of ischemic heart disease other
413.0 angina decubitus
413.1 prinzmetal angina
413.9 other and unspecified angina pectoris
426.0 atrioventricular block complete
426.10 atrioventricular block unspecified
426.11 first degree atrioventricular block
426.12 mobitz (type) ii atrioventricular block
426.13 other second degree atrioventricular block
426.6 other heart block
426.7 anomalous atrioventricular excitation
426.81 lown-ganong-levine syndrome
CMS LimitationsHolter Monitor Testing (con’t)
426.82 long qt syndrome
426.89 other specified conduction disorders
426.9 conduction disorder unspecified
427.0* paroxysmal supraventricular tachycardia
427.1* paroxysmal ventricular tachycardia
427.2* paroxysmal tachycardia unspecified
427.31* atrial fibrillation
427.32* atrial flutter
427.41* ventricular fibrillation
427.42* ventricular flutter
427.5 cardiac arrest
427.60* premature beats unspecified
427.61* supraventricular premature beats
427.69* other premature beats
427.81* sinoatrial node dysfunction
427.89* other specified cardiac dysrhythmias
427.9 cardiac dysrhythmia unspecified
434.10 cerebral embolism without cerebral infarction
434.11 cerebral embolism with cerebral infarction
435.8 other specified transient cerebral ischemias
435.9 unspecified transient cerebral ischemia
780.2 syncope and collapse
780.4 dizziness and giddiness
785.0 tachycardia unspecified
785.1 palpitations
786.05 shortness of breath
786.50 unspecified chest pain
786.51 precordial pain
786.59 other chest pain
996.01 mechanical complication due to cardiac pacemaker (electrode)
V58.69* long-term (current) use of other medications
*Repeat long-term ECG monitoring within a six-month period will not be covered unless it is indicated for the asterisked
diagnoses.
CMS LimitationsNuclear Medicine: Cardiac Blood Pool StudiesLCD # L26859, Effective date: 01/01/2009
CPT/HCPCS Codes: CPT 78494, CPT 78496
ICD-9 codes that SUPPORT medical necessity for Cardiac Blood Pool Gated Equilibrium, SPECT Study (CPT 78494)
and Cardiac Blood Pool Gated Equilibrium, Right Ventricular, Single Study (CPT 78496):
V58.11 encounter for antineoplastic chemotherapy
V58.12 encounter for immunotherapy for neoplastic condition
V67.2 follow-up examination following chemotherapy
CMS LimitationsNuclear Medicine: Myocardial Infarct Avidity StudiesLCD # L26859, Effective date: 01/01/2009
CPT/HCPCS Codes: CPT 78466, CPT 78468, CPT 78469
ICD-9 codes that SUPPORT medical necessity for Myocardial Imaging Infarct Avid, Planar, Qualitative, or Quantitative
(CPT 78466), with Ejection Fraction by First Pass (CPT 78468) and Tomographic SPECT with or without Quantification
(CPT 78469):
410.00 acute myocardial infarction of anterolateral wall episode of care unspecified
410.01 acute myocardial infarction of anterolateral wall initial episode of care
410.02 acute myocardial infarction of anterolateral wall subsequent episode of care
410.10 acute myocardial infarction of other anterior wall episode of care unspecified
410.11 acute myocardial infarction of other anterior wall initial episode of care
410.12 acute myocardial infarction of other anterior wall subsequent episode of care
410.20 acute myocardial infarction of inferolateral wall episode of care unspecified
410.21 acute myocardial infarction of inferolateral wall initial episode of care
410.22 acute myocardial infarction of inferolateral wall subsequent episode of care
410.30 acute myocardial infarction of inferoposterior wall episode of care unspecified
410.31 acute myocardial infarction of inferoposterior wall initial episode of care
410.32 acute myocardial infarction of inferoposterior wall subsequent episode of care
410.40 acute myocardial infarction of other inferior wall episode of care unspecified
410.41 acute myocardial infarction of other inferior wall initial episode of care
410.42 acute myocardial infarction of other inferior wall subsequent episode of care
410.50 acute myocardial infarction of other lateral wall episode of care unspecified
410.51 acute myocardial infarction of other lateral wall initial episode of care
410.52 acute myocardial infarction of other lateral wall subsequent episode of care
410.60 true posterior wall infarction episode of care unspecified
410.61 true posterior wall infarction initial episode of care
410.62 true posterior wall infarction subsequent episode of care
410.70 subendocardial infarction episode of care unspecified
410.71 subendocardial infarction initial episode of care
410.72 subendocardial infarction subsequent episode of care
410.80 acute myocardial infarction of other specified sites episode of care unspecified
410.81 acute myocardial infarction of other specified sites initial episode of care
410.82 acute myocardial infarction of other specified sites subsequent episode of care
410.90 acute myocardial infarction of unspecified site episode of care unspecified
410.91 acute myocardial infarction of unspecified site initial episode of care
410.92 acute myocardial infarction of unspecified site subsequent episode of care
414.2 chronic total occlusion of coronary artery
786.50 unspecified chest pain
786.51 precordial pain
786.59 other chest pain
794.31 nonspecific abnormal electrocardiogram (ecg) (ekg)
CMS LimitationsNuclear Medicine: Myocardial Perfusion with or without Functional StudiesLCD # L26859, Effective date: 01/01/2009
CPT/HCPCS Codes: CPT 78460, CPT 78461, CPT 78464, CPT 78465, CPT 78472, CPT 78473, CPT 78478, CPT 78480,
CPT 78481, CPT 78483, CPT 93015, CPT 93016, CPT 93017, CPT 93018
ICD-9 codes that SUPPORT medical necessity for Myocardial Perfusion with or without Functional Studies, Single Pla-
nar Study (CPT 78460), Multiple Planar Studies (CPT 78461), SPECT Single Study (CPT 78464), SPECT Multiple Studies
(CPT 78465), Gated Equilibrium, Planar, Single Study** (CPT 78472), Gated Equilibrium, Planar, Multiple Studies** (CPT
78473), Myocardial Perfusion Study with Wall Motion (CPT 78478), Myocardial Perfusion Study With Ejection Fraction
(CPT 78480), Cardiac Blood Pool Imaging Planar First Pass (CPT 78481), Cardiac Blood Pool Multiple Studies (CPT
78483), Cardiovascular Stress Test with Report, Interpretation, and Physician Supervision (CPT 93015), Cardiovascular
Stress Test with Physician Supervision but without Interpretation and Report (CPT 93016), Cardiovascular Stress Test
Tracing only (CPT 93017), and Cardiovascular Stress Test Interpretation and Report only (CPT 93018):
410.00 acute myocardial infarction of anterolateral wall episode of care unspecified
410.01 acute myocardial infarction of anterolateral wall initial episode of care
410.02 acute myocardial infarction of anterolateral wall subsequent episode of care
410.10 acute myocardial infarction of other anterior wall episode of care unspecified
410.11 acute myocardial infarction of other anterior wall initial episode of care
410.12 acute myocardial infarction of other anterior wall subsequent episode of care
410.20 acute myocardial infarction of inferolateral wall episode of care unspecified
410.21 acute myocardial infarction of inferolateral wall initial episode of care
410.22 acute myocardial infarction of inferolateral wall subsequent episode of care
410.30 acute myocardial infarction of inferoposterior wall episode of care unspecified
410.31 acute myocardial infarction of inferoposterior wall initial episode of care
410.32 acute myocardial infarction of inferoposterior wall subsequent episode of care
410.40 acute myocardial infarction of other inferior wall episode of care unspecified
410.41 acute myocardial infarction of other inferior wall initial episode of care
410.42 acute myocardial infarction of other inferior wall subsequent episode of care
410.50 acute myocardial infarction of other lateral wall episode of care unspecified
410.51 acute myocardial infarction of other lateral wall initial episode of care
410.52 acute myocardial infarction of other lateral wall subsequent episode of care
410.60 true posterior wall infarction episode of care unspecified
410.61 true posterior wall infarction initial episode of care
410.62 true posterior wall infarction subsequent episode of care
410.70 subendocardial infarction episode of care unspecified
410.71 subendocardial infarction initial episode of care
410.72 subendocardial infarction subsequent episode of care
410.80 acute myocardial infarction of other specified sites episode of care unspecified
410.81 acute myocardial infarction of other specified sites initial episode of care
410.82 acute myocardial infarction of other specified sites subsequent episode of care
410.90 acute myocardial infarction of unspecified site episode of care unspecified
410.91 acute myocardial infarction of unspecified site initial episode of care
414.02 coronary atherosclerosis of autologous vein bypass graft
414.03 coronary atherosclerosis of nonautologous biological bypass graft
414.04 coronary atherosclerosis of artery bypass graft
414.06 coronary atherosclerosis of native coronary artery of transplanted heart
414.07 coronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart
414.10 aneurysm of heart (wall)
414.11 aneurysm of coronary vessels
CMS LimitationsNuclear Medicine: Myocardial Perfusion with or without Functional Studies (con’t)
414.12 dissection of coronary artery
414.19 other aneurysm of heart
414.2 chronic total occlusion of coronary artery
414.8 other specified forms of chronic ischemic heart disease
414.9 chronic ischemic heart disease unspecified
427.41 ventricular fibrillation
427.42 ventricular flutter
427.5 cardiac arrest
428.0 congestive heart failure unspecified
428.1 left heart failure
428.20 unspecified systolic heart failure
428.21 acute systolic heart failure
428.22 chronic systolic heart failure
428.23 acute on chronic systolic heart failure
428.40 unspecified combined systolic and diastolic heart failure
428.41 acute combined systolic and diastolic heart failure
428.42 chronic combined systolic and diastolic heart failure
428.43 acute on chronic combined systolic and diastolic heart failure
429.79 certain sequelae of myocardial infarction not elsewhere classified other
429.83 takotsubo syndrome
429.89 other ill-defined heart diseases
746.85 coronary artery anomaly congenital
786.05 shortness of breath
786.50 unspecified chest pain
786.51 precordial pain
786.59 other chest pain
794.31 nonspecific abnormal electrocardiogram (ecg) (ekg)
996.72 other complications due to other cardiac device implant and graft
996.83 complications of transplanted heart
V42.1 heart replaced by transplant
V45.81 postsurgical aortocoronary bypass status
V45.82 percutaneous transluminal coronary angioplasty status
**In addition to the diagnosis listed above, the following are also considered medically necessary for Cardiac Blood Pool
Studies, Gated Equilibrium, Planar, Single Study, (CPT 78472), Gated Equilibrium, Planar, Multiple Studies (CPT 78473):
V58.11 encounter for antineoplastic chemotherapy
V58.12 encounter for immunotherapy for neoplastic condition
V67.2 follow-up examination following chemotherapy