cms limitations guide - cardiovascular services limitations guide/cms...cms limitations guide -...

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.hhs.gov/mcd/search.asp?clickon=search

http://www.mymunson.org

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:





















414.05 coronary atherosclerosis of unspecified bypass graft





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






CMS LimitationsDobutamine Stress Echocardiograms (con’t)


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





428.9 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


786.09 respiratory abnormality other




996.1 mechanical complication of other vascular device implant and graft



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


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


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


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


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


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


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


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


404.91 hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney


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



































412 old myocardial infarction










414.05 coronary atherosclerosis of unspecified bypass graft








414.3 coronary atherosclerosis due to lipid rich plaque



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


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


426.89 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




427.60 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








428.30 unspecified diastolic heart failure

428.31 acute diastolic heart failure

428.32 chronic diastolic heart failure

428.33 acute on chronic diastolic heart failure





428.9 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


429.81 other disorders of papillary muscle

429.82 hyperkinetic heart disease



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


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


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


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


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


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


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


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


746.86 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


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



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


786.09 respiratory abnormality other

786.1 stridor



786.52 painful respiration


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


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


794.39 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


no loss of consciousness


brief (less than one hour) loss of consciousness


moderate (1-24 hours) loss of consciousness


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


loss of consciousness of unspecified duration



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


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


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)


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


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


996.81 complications of transplanted kidney

996.82 complications of transplanted liver


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


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








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)


426.89 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


427.60* 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


780.4 dizziness and giddiness

785.0 tachycardia unspecified

785.1 palpitations





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):




































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):





































CMS LimitationsNuclear Medicine: Myocardial Perfusion with or without Functional Studies (con’t)






























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