Local Coverage Article Billing and Coding

Billing and Coding: Lab: Controlled Substance Monitoring and Drugs of Abuse Testing

A54799

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Article ID
A54799
Article Title
Billing and Coding: Lab: Controlled Substance Monitoring and Drugs of Abuse Testing
Article Type
Billing and Coding
Original Effective Date
12/24/2015
Revision Effective Date
10/01/2021
Revision Ending Date
N/A
Retirement Date
N/A
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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.1.2 - A/B MAC (B) Contacts with Independent Clinical Laboratories

Article Guidance

Article Text

The information in this article contains billing, coding, or other guidelines that complement the Local Coverage Determination (LCD) for Lab: Controlled Substance Monitoring and Drugs of Abuse Testing L35724.

Effective January 1, 2017, controlled substance testing providers should apply the following coding and billing guidelines for L35724 – Lab: Controlled Substance Monitoring and Drugs of Abuse.

  • To receive reimbursement for controlled substance and drugs of abuse testing, the service reported on the claim MUST match the service ordered by the physician.
  • Incidental findings not ordered by the physician are not a covered service and will be denied.
  • A maximum of one presumptive urine drug test may be submitted and paid per patient DOS.
  • A maximum of one definitive urine drug test may be submitted and paid per patient DOS.

Reminder - DOS refers to the date of the sample collection, not the date the test was run.

Presumptive Urine Drug Testing (UDT)

Providers may ONLY perform and report one of the following three types of presumptive UDT available per patient DOS:

    1. 80305: Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g. immunoassay) capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service.
    2. 80306: Drug test(s), presumptive, any number of drug classes, qualitative, any number of devices or procedures, (e.g., immunoassay) read by instrument assisted direct optical observation (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service.
    3. 80307: Drug test(s), presumptive, any number of drug classes, qualitative, any number of devices or procedures by instrument chemistry analyzers (e.g., utilizing immunoassay [e.g., EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (e.g., GC, HPLC), and mass spectrometry either with or without chromatography, (e.g., DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service.

Definitive (Qualitative or Quantitative) UDT Testing

Based on the number of drug classes indicated for the patient’s needs, providers may ONLY perform and report one of the following five UDT services per patient DOS:

    1. G0480: Drug test(s) definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS ( any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day, 1-7 drug class(es), including metabolite(s) if performed.
    2. G0481: Drug test(s) definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day, 8-14 drug class(es), including metabolites(s) if performed.
    3. G0482: Drug test(s) definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS ( any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day, 15-21 drug classes, including metabolites(s) if performed.
    4. G0483: Drug test(s) definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day, 22 or more drug classes, including metabolites(s) if performed.
    5. G0659: Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem), excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes.

Coding/Billing Clarification of Non-Covered Services

  • Reflex testing for IA presumptive positives may only be performed by laboratories other than physician office labs (POL). Physicians in POL are expected to determine the medical necessity for definitive testing for a presumptive positive result and document the necessity in the medical record because they have specific patient information and may not need definitive testing.
  • When a presumptive test is negative for a patient on a prescribed medication, a definitive drug test may be performed.
  • Only one presumptive service may be billed per patient, per DOS, regardless of the provider.
  • Medicare will process the first presumptive service received per patient, per DOS. All subsequent claims for a presumptive service for the same patient and same DOS will be denied.
  • Only one definitive service may be billed per patient, per DOS, regardless of the provider.
  • Medicare will process the first definitive service received per patient, per DOS. All subsequent claims for a definitive service for the same patient and same DOS will be denied.

 To report a Controlled Substance Monitoring and Drugs of Abuse Testing service, please submit the following claim information:

  • Select the appropriate CPT® code
  • Enter 1 unit of service (UOS)
  • Select the appropriate ICD-10-CM code

Coding Information

CPT/HCPCS Codes

Group 1

Group 1 Paragraph

The following codes are new and effective 01/01/2017: G0659, 80305, 80306 and 80307.

Group 1 Codes
CodeDescription
80305 DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; CAPABLE OF BEING READ BY DIRECT OPTICAL OBSERVATION ONLY (EG, UTILIZING IMMUNOASSAY [EG, DIPSTICKS, CUPS, CARDS, OR CARTRIDGES]), INCLUDES SAMPLE VALIDATION WHEN PERFORMED, PER DATE OF SERVICE
80306 DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; READ BY INSTRUMENT ASSISTED DIRECT OPTICAL OBSERVATION (EG, UTILIZING IMMUNOASSAY [EG, DIPSTICKS, CUPS, CARDS, OR CARTRIDGES]), INCLUDES SAMPLE VALIDATION WHEN PERFORMED, PER DATE OF SERVICE
80307 DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; BY INSTRUMENT CHEMISTRY ANALYZERS (EG, UTILIZING IMMUNOASSAY [EG, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), CHROMATOGRAPHY (EG, GC, HPLC), AND MASS SPECTROMETRY EITHER WITH OR WITHOUT CHROMATOGRAPHY, (EG, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) INCLUDES SAMPLE VALIDATION WHEN PERFORMED, PER DATE OF SERVICE
G0480 DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT LIMITED TO GC/MS (ANY TYPE, SINGLE OR TANDEM) AND LC/MS (ANY TYPE, SINGLE OR TANDEM AND EXCLUDING IMMUNOASSAYS (E.G., IA, EIA, ELISA, EMIT, FPIA) AND ENZYMATIC METHODS (E.G., ALCOHOL DEHYDROGENASE)), (2) STABLE ISOTOPE OR OTHER UNIVERSALLY RECOGNIZED INTERNAL STANDARDS IN ALL SAMPLES (E.G., TO CONTROL FOR MATRIX EFFECTS, INTERFERENCES AND VARIATIONS IN SIGNAL STRENGTH), AND (3) METHOD OR DRUG-SPECIFIC CALIBRATION AND MATRIX-MATCHED QUALITY CONTROL MATERIAL (E.G., TO CONTROL FOR INSTRUMENT VARIATIONS AND MASS SPECTRAL DRIFT); QUALITATIVE OR QUANTITATIVE, ALL SOURCES, INCLUDES SPECIMEN VALIDITY TESTING, PER DAY; 1-7 DRUG CLASS(ES), INCLUDING METABOLITE(S) IF PERFORMED
G0481 DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT LIMITED TO GC/MS (ANY TYPE, SINGLE OR TANDEM) AND LC/MS (ANY TYPE, SINGLE OR TANDEM AND EXCLUDING IMMUNOASSAYS (E.G., IA, EIA, ELISA, EMIT, FPIA) AND ENZYMATIC METHODS (E.G., ALCOHOL DEHYDROGENASE)), (2) STABLE ISOTOPE OR OTHER UNIVERSALLY RECOGNIZED INTERNAL STANDARDS IN ALL SAMPLES (E.G., TO CONTROL FOR MATRIX EFFECTS, INTERFERENCES AND VARIATIONS IN SIGNAL STRENGTH), AND (3) METHOD OR DRUG-SPECIFIC CALIBRATION AND MATRIX-MATCHED QUALITY CONTROL MATERIAL (E.G., TO CONTROL FOR INSTRUMENT VARIATIONS AND MASS SPECTRAL DRIFT); QUALITATIVE OR QUANTITATIVE, ALL SOURCES, INCLUDES SPECIMEN VALIDITY TESTING, PER DAY; 8-14 DRUG CLASS(ES), INCLUDING METABOLITE(S) IF PERFORMED
G0482 DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT LIMITED TO GC/MS (ANY TYPE, SINGLE OR TANDEM) AND LC/MS (ANY TYPE, SINGLE OR TANDEM AND EXCLUDING IMMUNOASSAYS (E.G., IA, EIA, ELISA, EMIT, FPIA) AND ENZYMATIC METHODS (E.G., ALCOHOL DEHYDROGENASE)), (2) STABLE ISOTOPE OR OTHER UNIVERSALLY RECOGNIZED INTERNAL STANDARDS IN ALL SAMPLES (E.G., TO CONTROL FOR MATRIX EFFECTS, INTERFERENCES AND VARIATIONS IN SIGNAL STRENGTH), AND (3) METHOD OR DRUG-SPECIFIC CALIBRATION AND MATRIX-MATCHED QUALITY CONTROL MATERIAL (E.G., TO CONTROL FOR INSTRUMENT VARIATIONS AND MASS SPECTRAL DRIFT); QUALITATIVE OR QUANTITATIVE, ALL SOURCES, INCLUDES SPECIMEN VALIDITY TESTING, PER DAY; 15-21 DRUG CLASS(ES), INCLUDING METABOLITE(S) IF PERFORMED
G0483 DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT LIMITED TO GC/MS (ANY TYPE, SINGLE OR TANDEM) AND LC/MS (ANY TYPE, SINGLE OR TANDEM AND EXCLUDING IMMUNOASSAYS (E.G., IA, EIA, ELISA, EMIT, FPIA) AND ENZYMATIC METHODS (E.G., ALCOHOL DEHYDROGENASE)), (2) STABLE ISOTOPE OR OTHER UNIVERSALLY RECOGNIZED INTERNAL STANDARDS IN ALL SAMPLES (E.G., TO CONTROL FOR MATRIX EFFECTS, INTERFERENCES AND VARIATIONS IN SIGNAL STRENGTH), AND (3) METHOD OR DRUG-SPECIFIC CALIBRATION AND MATRIX-MATCHED QUALITY CONTROL MATERIAL (E.G., TO CONTROL FOR INSTRUMENT VARIATIONS AND MASS SPECTRAL DRIFT); QUALITATIVE OR QUANTITATIVE, ALL SOURCES, INCLUDES SPECIMEN VALIDITY TESTING, PER DAY; 22 OR MORE DRUG CLASS(ES), INCLUDING METABOLITE(S) IF PERFORMED
G0659 DRUG TEST(S), DEFINITIVE, UTILIZING DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING BUT NOT LIMITED TO GC/MS (ANY TYPE, SINGLE OR TANDEM) AND LC/MS (ANY TYPE, SINGLE OR TANDEM), EXCLUDING IMMUNOASSAYS (E.G., IA, EIA, ELISA, EMIT, FPIA) AND ENZYMATIC METHODS (E.G., ALCOHOL DEHYDROGENASE), PERFORMED WITHOUT METHOD OR DRUG-SPECIFIC CALIBRATION, WITHOUT MATRIX-MATCHED QUALITY CONTROL MATERIAL, OR WITHOUT USE OF STABLE ISOTOPE OR OTHER UNIVERSALLY RECOGNIZED INTERNAL STANDARD(S) FOR EACH DRUG, DRUG METABOLITE OR DRUG CLASS PER SPECIMEN; QUALITATIVE OR QUANTITATIVE, ALL SOURCES, INCLUDES SPECIMEN VALIDITY TESTING, PER DAY, ANY NUMBER OF DRUG CLASSES
0143U DRUG ASSAY, DEFINITIVE, 120 OR MORE DRUGS OR METABOLITES, URINE, QUANTITATIVE LIQUID CHROMATOGRAPHY WITH TANDEM MASS SPECTROMETRY (LC-MS/MS) USING MULTIPLE REACTION MONITORING (MRM), WITH DRUG OR METABOLITE DESCRIPTION, COMMENTS INCLUDING SAMPLE VALIDATION, PER DATE OF SERVICE
0144U DRUG ASSAY, DEFINITIVE, 160 OR MORE DRUGS OR METABOLITES, URINE, QUANTITATIVE LIQUID CHROMATOGRAPHY WITH TANDEM MASS SPECTROMETRY (LC-MS/MS) USING MULTIPLE REACTION MONITORING (MRM), WITH DRUG OR METABOLITE DESCRIPTION, COMMENTS INCLUDING SAMPLE VALIDATION, PER DATE OF SERVICE
0145U DRUG ASSAY, DEFINITIVE, 65 OR MORE DRUGS OR METABOLITES, URINE, QUANTITATIVE LIQUID CHROMATOGRAPHY WITH TANDEM MASS SPECTROMETRY (LC-MS/MS) USING MULTIPLE REACTION MONITORING (MRM), WITH DRUG OR METABOLITE DESCRIPTION, COMMENTS INCLUDING SAMPLE VALIDATION, PER DATE OF SERVICE
0146U DRUG ASSAY, DEFINITIVE, 80 OR MORE DRUGS OR METABOLITES, URINE, BY QUANTITATIVE LIQUID CHROMATOGRAPHY WITH TANDEM MASS SPECTROMETRY (LC-MS/MS) USING MULTIPLE REACTION MONITORING (MRM), WITH DRUG OR METABOLITE DESCRIPTION, COMMENTS INCLUDING SAMPLE VALIDATION, PER DATE OF SERVICE
0147U DRUG ASSAY, DEFINITIVE, 85 OR MORE DRUGS OR METABOLITES, URINE, QUANTITATIVE LIQUID CHROMATOGRAPHY WITH TANDEM MASS SPECTROMETRY (LC-MS/MS) USING MULTIPLE REACTION MONITORING (MRM), WITH DRUG OR METABOLITE DESCRIPTION, COMMENTS INCLUDING SAMPLE VALIDATION, PER DATE OF SERVICE
0148U DRUG ASSAY, DEFINITIVE, 100 OR MORE DRUGS OR METABOLITES, URINE, QUANTITATIVE LIQUID CHROMATOGRAPHY WITH TANDEM MASS SPECTROMETRY (LC-MS/MS) USING MULTIPLE REACTION MONITORING (MRM), WITH DRUG OR METABOLITE DESCRIPTION, COMMENTS INCLUDING SAMPLE VALIDATION, PER DATE OF SERVICE
0149U DRUG ASSAY, DEFINITIVE, 60 OR MORE DRUGS OR METABOLITES, URINE, QUANTITATIVE LIQUID CHROMATOGRAPHY WITH TANDEM MASS SPECTROMETRY (LC-MS/MS) USING MULTIPLE REACTION MONITORING (MRM), WITH DRUG OR METABOLITE DESCRIPTION, COMMENTS INCLUDING SAMPLE VALIDATION, PER DATE OF SERVICE
0150U DRUG ASSAY, DEFINITIVE, 120 OR MORE DRUGS OR METABOLITES, URINE, QUANTITATIVE LIQUID CHROMATOGRAPHY WITH TANDEM MASS SPECTROMETRY (LC-MS/MS) USING MULTIPLE REACTION MONITORING (MRM), WITH DRUG OR METABOLITE DESCRIPTION, COMMENTS INCLUDING SAMPLE VALIDATION, PER DATE OF SERVICE
0227U DRUG ASSAY, PRESUMPTIVE, 30 OR MORE DRUGS OR METABOLITES, URINE, LIQUID CHROMATOGRAPHY WITH TANDEM MASS SPECTROMETRY (LC-MS/MS) USING MULTIPLE REACTION MONITORING (MRM), WITH DRUG OR METABOLITE DESCRIPTION, INCLUDES SAMPLE VALIDATION

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
E87.2 Acidosis
F10.11 Alcohol abuse, in remission
F10.130 Alcohol abuse with withdrawal, uncomplicated
F10.131 Alcohol abuse with withdrawal delirium
F10.132 Alcohol abuse with withdrawal with perceptual disturbance
F10.20 Alcohol dependence, uncomplicated
F11.11 Opioid abuse, in remission
F11.13 Opioid abuse with withdrawal
F11.20 Opioid dependence, uncomplicated
F11.220 Opioid dependence with intoxication, uncomplicated
F11.221 Opioid dependence with intoxication delirium
F11.222 Opioid dependence with intoxication with perceptual disturbance
F11.23 Opioid dependence with withdrawal
F11.24 Opioid dependence with opioid-induced mood disorder
F11.250 Opioid dependence with opioid-induced psychotic disorder with delusions
F11.251 Opioid dependence with opioid-induced psychotic disorder with hallucinations
F11.281 Opioid dependence with opioid-induced sexual dysfunction
F11.282 Opioid dependence with opioid-induced sleep disorder
F11.288 Opioid dependence with other opioid-induced disorder
F12.11 Cannabis abuse, in remission
F12.13 Cannabis abuse with withdrawal
F12.23 Cannabis dependence with withdrawal
F12.93 Cannabis use, unspecified with withdrawal
F13.11 Sedative, hypnotic or anxiolytic abuse, in remission
F13.130 Sedative, hypnotic or anxiolytic abuse with withdrawal, uncomplicated
F13.131 Sedative, hypnotic or anxiolytic abuse with withdrawal delirium
F13.132 Sedative, hypnotic or anxiolytic abuse with withdrawal with perceptual disturbance
F14.11 Cocaine abuse, in remission
F14.13 Cocaine abuse, unspecified with withdrawal
F14.93 Cocaine use, unspecified with withdrawal
F15.11 Other stimulant abuse, in remission
F15.13 Other stimulant abuse with withdrawal
F16.11 Hallucinogen abuse, in remission
F18.10 Inhalant abuse, uncomplicated
F18.11 Inhalant abuse, in remission
F18.120 Inhalant abuse with intoxication, uncomplicated
F18.90 Inhalant use, unspecified, uncomplicated
F19.11 Other psychoactive substance abuse, in remission
F19.130 Other psychoactive substance abuse with withdrawal, uncomplicated
F19.131 Other psychoactive substance abuse with withdrawal delirium
F19.132 Other psychoactive substance abuse with withdrawal with perceptual disturbance
F19.20 Other psychoactive substance dependence, uncomplicated
F20.0 Paranoid schizophrenia
F20.1 Disorganized schizophrenia
F20.2 Catatonic schizophrenia
F20.89 Other schizophrenia
F55.0 Abuse of antacids
F55.1 Abuse of herbal or folk remedies
F55.2 Abuse of laxatives
F55.3 Abuse of steroids or hormones
F55.4 Abuse of vitamins
F55.8 Abuse of other non-psychoactive substances
G40.301 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, with status epilepticus
G40.309 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus
G40.311 Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus
G40.319 Generalized idiopathic epilepsy and epileptic syndromes, intractable, without status epilepticus
G40.401 Other generalized epilepsy and epileptic syndromes, not intractable, with status epilepticus
G40.409 Other generalized epilepsy and epileptic syndromes, not intractable, without status epilepticus
G40.411 Other generalized epilepsy and epileptic syndromes, intractable, with status epilepticus
G40.419 Other generalized epilepsy and epileptic syndromes, intractable, without status epilepticus
G40.42 Cyclin-Dependent Kinase-Like 5 Deficiency Disorder
G89.29 Other chronic pain
G89.4 Chronic pain syndrome
I44.0 Atrioventricular block, first degree
I44.1 Atrioventricular block, second degree
I44.30 Unspecified atrioventricular block
I45.81 Long QT syndrome
I47.0 Re-entry ventricular arrhythmia
I47.1 Supraventricular tachycardia
I47.2 Ventricular tachycardia
I49.2 Junctional premature depolarization
M25.511 Pain in right shoulder
M25.512 Pain in left shoulder
M47.21 Other spondylosis with radiculopathy, occipito-atlanto-axial region
M47.22 Other spondylosis with radiculopathy, cervical region
M47.23 Other spondylosis with radiculopathy, cervicothoracic region
M47.26 Other spondylosis with radiculopathy, lumbar region
M47.27 Other spondylosis with radiculopathy, lumbosacral region
M47.28 Other spondylosis with radiculopathy, sacral and sacrococcygeal region
M47.811 Spondylosis without myelopathy or radiculopathy, occipito-atlanto-axial region
M47.812 Spondylosis without myelopathy or radiculopathy, cervical region
M47.813 Spondylosis without myelopathy or radiculopathy, cervicothoracic region
M47.816 Spondylosis without myelopathy or radiculopathy, lumbar region
M47.817 Spondylosis without myelopathy or radiculopathy, lumbosacral region
M47.818 Spondylosis without myelopathy or radiculopathy, sacral and sacrococcygeal region
M47.891 Other spondylosis, occipito-atlanto-axial region
M47.892 Other spondylosis, cervical region
M47.893 Other spondylosis, cervicothoracic region
M47.896 Other spondylosis, lumbar region
M47.897 Other spondylosis, lumbosacral region
M47.898 Other spondylosis, sacral and sacrococcygeal region
M51.14 Intervertebral disc disorders with radiculopathy, thoracic region
M51.15 Intervertebral disc disorders with radiculopathy, thoracolumbar region
M51.16 Intervertebral disc disorders with radiculopathy, lumbar region
M51.17 Intervertebral disc disorders with radiculopathy, lumbosacral region
M51.36 Other intervertebral disc degeneration, lumbar region
M51.37 Other intervertebral disc degeneration, lumbosacral region
M54.10 Radiculopathy, site unspecified
M54.12 Radiculopathy, cervical region
M54.14 Radiculopathy, thoracic region
M54.15 Radiculopathy, thoracolumbar region
M54.16 Radiculopathy, lumbar region
M54.17 Radiculopathy, lumbosacral region
M54.18 Radiculopathy, sacral and sacrococcygeal region
M54.2 Cervicalgia
M60.811 Other myositis, right shoulder
M60.812 Other myositis, left shoulder
M60.821 Other myositis, right upper arm
M60.822 Other myositis, left upper arm
M60.831 Other myositis, right forearm
M60.832 Other myositis, left forearm
M60.841 Other myositis, right hand
M60.842 Other myositis, left hand
M60.851 Other myositis, right thigh
M60.852 Other myositis, left thigh
M60.861 Other myositis, right lower leg
M60.862 Other myositis, left lower leg
M60.871 Other myositis, right ankle and foot
M60.872 Other myositis, left ankle and foot
M60.88 Other myositis, other site
M60.89 Other myositis, multiple sites
M79.2 Neuralgia and neuritis, unspecified
M79.7 Fibromyalgia
R40.0 Somnolence
R40.1 Stupor
R40.2110 Coma scale, eyes open, never, unspecified time
R40.2111 Coma scale, eyes open, never, in the field [EMT or ambulance]
R40.2112 Coma scale, eyes open, never, at arrival to emergency department
R40.2113 Coma scale, eyes open, never, at hospital admission
R40.2114 Coma scale, eyes open, never, 24 hours or more after hospital admission
R40.2120 Coma scale, eyes open, to pain, unspecified time
R40.2121 Coma scale, eyes open, to pain, in the field [EMT or ambulance]
R40.2122 Coma scale, eyes open, to pain, at arrival to emergency department
R40.2123 Coma scale, eyes open, to pain, at hospital admission
R40.2124 Coma scale, eyes open, to pain, 24 hours or more after hospital admission
R40.2210 Coma scale, best verbal response, none, unspecified time
R40.2211 Coma scale, best verbal response, none, in the field [EMT or ambulance]
R40.2212 Coma scale, best verbal response, none, at arrival to emergency department
R40.2213 Coma scale, best verbal response, none, at hospital admission
R40.2214 Coma scale, best verbal response, none, 24 hours or more after hospital admission
R40.2220 Coma scale, best verbal response, incomprehensible words, unspecified time
R40.2221 Coma scale, best verbal response, incomprehensible words, in the field [EMT or ambulance]
R40.2222 Coma scale, best verbal response, incomprehensible words, at arrival to emergency department
R40.2223 Coma scale, best verbal response, incomprehensible words, at hospital admission
R40.2224 Coma scale, best verbal response, incomprehensible words, 24 hours or more after hospital admission
R40.2310 Coma scale, best motor response, none, unspecified time
R40.2311 Coma scale, best motor response, none, in the field [EMT or ambulance]
R40.2312 Coma scale, best motor response, none, at arrival to emergency department
R40.2313 Coma scale, best motor response, none, at hospital admission
R40.2314 Coma scale, best motor response, none, 24 hours or more after hospital admission
R40.2320 Coma scale, best motor response, extension, unspecified time
R40.2321 Coma scale, best motor response, extension, in the field [EMT or ambulance]
R40.2322 Coma scale, best motor response, extension, at arrival to emergency department
R40.2323 Coma scale, best motor response, extension, at hospital admission
R40.2324 Coma scale, best motor response, extension, 24 hours or more after hospital admission
R40.2340 Coma scale, best motor response, flexion withdrawal, unspecified time
R40.2341 Coma scale, best motor response, flexion withdrawal, in the field [EMT or ambulance]
R40.2342 Coma scale, best motor response, flexion withdrawal, at arrival to emergency department
R40.2343 Coma scale, best motor response, flexion withdrawal, at hospital admission
R40.2344 Coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission
R41.82 Altered mental status, unspecified
R44.0 Auditory hallucinations
R44.2 Other hallucinations
R44.3 Hallucinations, unspecified
R45.850 Homicidal ideations
R45.851 Suicidal ideations
R45.88 Nonsuicidal self-harm
R56.9 Unspecified convulsions
T39.011A Poisoning by aspirin, accidental (unintentional), initial encounter
T39.012A Poisoning by aspirin, intentional self-harm, initial encounter
T39.013A Poisoning by aspirin, assault, initial encounter
T39.014A Poisoning by aspirin, undetermined, initial encounter
T39.091A Poisoning by salicylates, accidental (unintentional), initial encounter
T39.092A Poisoning by salicylates, intentional self-harm, initial encounter
T39.093A Poisoning by salicylates, assault, initial encounter
T39.094A Poisoning by salicylates, undetermined, initial encounter
T39.1X1A Poisoning by 4-Aminophenol derivatives, accidental (unintentional), initial encounter
T39.1X2A Poisoning by 4-Aminophenol derivatives, intentional self-harm, initial encounter
T39.1X3A Poisoning by 4-Aminophenol derivatives, assault, initial encounter
T39.1X4A Poisoning by 4-Aminophenol derivatives, undetermined, initial encounter
T39.2X1A Poisoning by pyrazolone derivatives, accidental (unintentional), initial encounter
T39.2X2A Poisoning by pyrazolone derivatives, intentional self-harm, initial encounter
T39.2X3A Poisoning by pyrazolone derivatives, assault, initial encounter
T39.2X4A Poisoning by pyrazolone derivatives, undetermined, initial encounter
T39.311A Poisoning by propionic acid derivatives, accidental (unintentional), initial encounter
T39.312A Poisoning by propionic acid derivatives, intentional self-harm, initial encounter
T39.313A Poisoning by propionic acid derivatives, assault, initial encounter
T39.314A Poisoning by propionic acid derivatives, undetermined, initial encounter
T39.391A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], accidental (unintentional), initial encounter
T39.392A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], intentional self-harm, initial encounter
T39.393A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], assault, initial encounter
T39.394A Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], undetermined, initial encounter
T40.0X1A Poisoning by opium, accidental (unintentional), initial encounter
T40.0X2A Poisoning by opium, intentional self-harm, initial encounter
T40.0X3A Poisoning by opium, assault, initial encounter
T40.0X4A Poisoning by opium, undetermined, initial encounter
T40.1X1A Poisoning by heroin, accidental (unintentional), initial encounter
T40.1X2A Poisoning by heroin, intentional self-harm, initial encounter
T40.1X3A Poisoning by heroin, assault, initial encounter
T40.1X4A Poisoning by heroin, undetermined, initial encounter
T40.2X1A Poisoning by other opioids, accidental (unintentional), initial encounter
T40.2X2A Poisoning by other opioids, intentional self-harm, initial encounter
T40.2X3A Poisoning by other opioids, assault, initial encounter
T40.2X4A Poisoning by other opioids, undetermined, initial encounter
T40.3X1A Poisoning by methadone, accidental (unintentional), initial encounter
T40.3X2A Poisoning by methadone, intentional self-harm, initial encounter
T40.3X3A Poisoning by methadone, assault, initial encounter
T40.3X4A Poisoning by methadone, undetermined, initial encounter
T40.411A Poisoning by fentanyl or fentanyl analogs, accidental (unintentional), initial encounter
T40.411D Poisoning by fentanyl or fentanyl analogs, accidental (unintentional), subsequent encounter
T40.411S Poisoning by fentanyl or fentanyl analogs, accidental (unintentional), sequela
T40.412A Poisoning by fentanyl or fentanyl analogs, intentional self-harm, initial encounter
T40.412D Poisoning by fentanyl or fentanyl analogs, intentional self-harm, subsequent encounter
T40.412S Poisoning by fentanyl or fentanyl analogs, intentional self-harm, sequela
T40.413A Poisoning by fentanyl or fentanyl analogs, assault, initial encounter
T40.413D Poisoning by fentanyl or fentanyl analogs, assault, subsequent encounter
T40.413S Poisoning by fentanyl or fentanyl analogs, assault, sequela
T40.414A Poisoning by fentanyl or fentanyl analogs, undetermined, initial encounter
T40.414D Poisoning by fentanyl or fentanyl analogs, undetermined, subsequent encounter
T40.414S Poisoning by fentanyl or fentanyl analogs, undetermined, sequela
T40.421A Poisoning by tramadol, accidental (unintentional), initial encounter
T40.421D Poisoning by tramadol, accidental (unintentional), subsequent encounter
T40.421S Poisoning by tramadol, accidental (unintentional), sequela
T40.422A Poisoning by tramadol, intentional self-harm, initial encounter
T40.422D Poisoning by tramadol, intentional self-harm, subsequent encounter
T40.422S Poisoning by tramadol, intentional self-harm, sequela
T40.423A Poisoning by tramadol, assault, initial encounter
T40.423D Poisoning by tramadol, assault, subsequent encounter
T40.423S Poisoning by tramadol, assault, sequela
T40.424A Poisoning by tramadol, undetermined, initial encounter
T40.424D Poisoning by tramadol, undetermined, subsequent encounter
T40.424S Poisoning by tramadol, undetermined, sequela
T40.491A Poisoning by other synthetic narcotics, accidental (unintentional), initial encounter
T40.491D Poisoning by other synthetic narcotics, accidental (unintentional), subsequent encounter
T40.491S Poisoning by other synthetic narcotics, accidental (unintentional), sequela
T40.492A Poisoning by other synthetic narcotics, intentional self-harm, initial encounter
T40.492D Poisoning by other synthetic narcotics, intentional self-harm, subsequent encounter
T40.492S Poisoning by other synthetic narcotics, intentional self-harm, sequela
T40.493A Poisoning by other synthetic narcotics, assault, initial encounter
T40.493D Poisoning by other synthetic narcotics, assault, subsequent encounter
T40.493S Poisoning by other synthetic narcotics, assault, sequela
T40.494A Poisoning by other synthetic narcotics, undetermined, initial encounter
T40.494D Poisoning by other synthetic narcotics, undetermined, subsequent encounter
T40.494S Poisoning by other synthetic narcotics, undetermined, sequela
T40.601A Poisoning by unspecified narcotics, accidental (unintentional), initial encounter
T40.602A Poisoning by unspecified narcotics, intentional self-harm, initial encounter
T40.603A Poisoning by unspecified narcotics, assault, initial encounter
T40.604A Poisoning by unspecified narcotics, undetermined, initial encounter
T40.691A Poisoning by other narcotics, accidental (unintentional), initial encounter
T40.692A Poisoning by other narcotics, intentional self-harm, initial encounter
T40.693A Poisoning by other narcotics, assault, initial encounter
T40.694A Poisoning by other narcotics, undetermined, initial encounter
T40.711A Poisoning by cannabis, accidental (unintentional), initial encounter
T40.711D Poisoning by cannabis, accidental (unintentional), subsequent encounter
T40.711S Poisoning by cannabis, accidental (unintentional), sequela
T40.712A Poisoning by cannabis, intentional self-harm, initial encounter
T40.712D Poisoning by cannabis, intentional self-harm, subsequent encounter
T40.712S Poisoning by cannabis, intentional self-harm, sequela
T40.713A Poisoning by cannabis, assault, initial encounter
T40.713D Poisoning by cannabis, assault, subsequent encounter
T40.713S Poisoning by cannabis, assault, sequela
T40.714A Poisoning by cannabis, undetermined, initial encounter
T40.714D Poisoning by cannabis, undetermined, subsequent encounter
T40.714S Poisoning by cannabis, undetermined, sequela
T40.721A Poisoning by synthetic cannabinoids, accidental (unintentional), initial encounter
T40.721D Poisoning by synthetic cannabinoids, accidental (unintentional), subsequent encounter
T40.721S Poisoning by synthetic cannabinoids, accidental (unintentional), sequela
T40.722A Poisoning by synthetic cannabinoids, intentional self-harm, initial encounter
T40.722D Poisoning by synthetic cannabinoids, intentional self-harm, subsequent encounter
T40.722S Poisoning by synthetic cannabinoids, intentional self-harm, sequela
T40.723A Poisoning by synthetic cannabinoids, assault, initial encounter
T40.723D Poisoning by synthetic cannabinoids, assault, subsequent encounter
T40.723S Poisoning by synthetic cannabinoids, assault, sequela
T40.724A Poisoning by synthetic cannabinoids, undetermined, initial encounter
T40.724D Poisoning by synthetic cannabinoids, undetermined, subsequent encounter
T40.724S Poisoning by synthetic cannabinoids, undetermined, sequela
T40.8X1A Poisoning by lysergide [LSD], accidental (unintentional), initial encounter
T40.8X2A Poisoning by lysergide [LSD], intentional self-harm, initial encounter
T40.8X3A Poisoning by lysergide [LSD], assault, initial encounter
T40.8X4A Poisoning by lysergide [LSD], undetermined, initial encounter
T40.901A Poisoning by unspecified psychodysleptics [hallucinogens], accidental (unintentional), initial encounter
T40.902A Poisoning by unspecified psychodysleptics [hallucinogens], intentional self-harm, initial encounter
T40.903A Poisoning by unspecified psychodysleptics [hallucinogens], assault, initial encounter
T40.904A Poisoning by unspecified psychodysleptics [hallucinogens], undetermined, initial encounter
T40.991A Poisoning by other psychodysleptics [hallucinogens], accidental (unintentional), initial encounter
T40.992A Poisoning by other psychodysleptics [hallucinogens], intentional self-harm, initial encounter
T40.993A Poisoning by other psychodysleptics [hallucinogens], assault, initial encounter
T40.994A Poisoning by other psychodysleptics [hallucinogens], undetermined, initial encounter
T42.0X1A Poisoning by hydantoin derivatives, accidental (unintentional), initial encounter
T42.0X2A Poisoning by hydantoin derivatives, intentional self-harm, initial encounter
T42.0X3A Poisoning by hydantoin derivatives, assault, initial encounter
T42.0X4A Poisoning by hydantoin derivatives, undetermined, initial encounter
T42.3X1A Poisoning by barbiturates, accidental (unintentional), initial encounter
T42.3X2A Poisoning by barbiturates, intentional self-harm, initial encounter
T42.3X3A Poisoning by barbiturates, assault, initial encounter
T42.3X4A Poisoning by barbiturates, undetermined, initial encounter
T42.4X1A Poisoning by benzodiazepines, accidental (unintentional), initial encounter
T42.4X2A Poisoning by benzodiazepines, intentional self-harm, initial encounter
T42.4X3A Poisoning by benzodiazepines, assault, initial encounter
T42.4X4A Poisoning by benzodiazepines, undetermined, initial encounter
T42.6X1A Poisoning by other antiepileptic and sedative-hypnotic drugs, accidental (unintentional), initial encounter
T42.6X2A Poisoning by other antiepileptic and sedative-hypnotic drugs, intentional self-harm, initial encounter
T42.6X3A Poisoning by other antiepileptic and sedative-hypnotic drugs, assault, initial encounter
T42.6X4A Poisoning by other antiepileptic and sedative-hypnotic drugs, undetermined, initial encounter
T42.71XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, accidental (unintentional), initial encounter
T42.72XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, intentional self-harm, initial encounter
T42.73XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, assault, initial encounter
T42.74XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, undetermined, initial encounter
T43.011A Poisoning by tricyclic antidepressants, accidental (unintentional), initial encounter
T43.012A Poisoning by tricyclic antidepressants, intentional self-harm, initial encounter
T43.013A Poisoning by tricyclic antidepressants, assault, initial encounter
T43.014A Poisoning by tricyclic antidepressants, undetermined, initial encounter
T43.021A Poisoning by tetracyclic antidepressants, accidental (unintentional), initial encounter
T43.022A Poisoning by tetracyclic antidepressants, intentional self-harm, initial encounter
T43.023A Poisoning by tetracyclic antidepressants, assault, initial encounter
T43.024A Poisoning by tetracyclic antidepressants, undetermined, initial encounter
T43.1X1A Poisoning by monoamine-oxidase-inhibitor antidepressants, accidental (unintentional), initial encounter
T43.1X2A Poisoning by monoamine-oxidase-inhibitor antidepressants, intentional self-harm, initial encounter
T43.1X3A Poisoning by monoamine-oxidase-inhibitor antidepressants, assault, initial encounter
T43.1X4A Poisoning by monoamine-oxidase-inhibitor antidepressants, undetermined, initial encounter
T43.201A Poisoning by unspecified antidepressants, accidental (unintentional), initial encounter
T43.202A Poisoning by unspecified antidepressants, intentional self-harm, initial encounter
T43.203A Poisoning by unspecified antidepressants, assault, initial encounter
T43.204A Poisoning by unspecified antidepressants, undetermined, initial encounter
T43.211A Poisoning by selective serotonin and norepinephrine reuptake inhibitors, accidental (unintentional), initial encounter
T43.212A Poisoning by selective serotonin and norepinephrine reuptake inhibitors, intentional self-harm, initial encounter
T43.213A Poisoning by selective serotonin and norepinephrine reuptake inhibitors, assault, initial encounter
T43.214A Poisoning by selective serotonin and norepinephrine reuptake inhibitors, undetermined, initial encounter
T43.221A Poisoning by selective serotonin reuptake inhibitors, accidental (unintentional), initial encounter
T43.222A Poisoning by selective serotonin reuptake inhibitors, intentional self-harm, initial encounter
T43.223A Poisoning by selective serotonin reuptake inhibitors, assault, initial encounter
T43.224A Poisoning by selective serotonin reuptake inhibitors, undetermined, initial encounter
T43.291A Poisoning by other antidepressants, accidental (unintentional), initial encounter
T43.292A Poisoning by other antidepressants, intentional self-harm, initial encounter
T43.293A Poisoning by other antidepressants, assault, initial encounter
T43.294A Poisoning by other antidepressants, undetermined, initial encounter
T43.3X1A Poisoning by phenothiazine antipsychotics and neuroleptics, accidental (unintentional), initial encounter
T43.3X2A Poisoning by phenothiazine antipsychotics and neuroleptics, intentional self-harm, initial encounter
T43.3X3A Poisoning by phenothiazine antipsychotics and neuroleptics, assault, initial encounter
T43.3X4A Poisoning by phenothiazine antipsychotics and neuroleptics, undetermined, initial encounter
T43.4X1A Poisoning by butyrophenone and thiothixene neuroleptics, accidental (unintentional), initial encounter
T43.4X2A Poisoning by butyrophenone and thiothixene neuroleptics, intentional self-harm, initial encounter
T43.4X3A Poisoning by butyrophenone and thiothixene neuroleptics, assault, initial encounter
T43.4X4A Poisoning by butyrophenone and thiothixene neuroleptics, undetermined, initial encounter
T43.501A Poisoning by unspecified antipsychotics and neuroleptics, accidental (unintentional), initial encounter
T43.502A Poisoning by unspecified antipsychotics and neuroleptics, intentional self-harm, initial encounter
T43.503A Poisoning by unspecified antipsychotics and neuroleptics, assault, initial encounter
T43.504A Poisoning by unspecified antipsychotics and neuroleptics, undetermined, initial encounter
T43.591A Poisoning by other antipsychotics and neuroleptics, accidental (unintentional), initial encounter
T43.592A Poisoning by other antipsychotics and neuroleptics, intentional self-harm, initial encounter
T43.593A Poisoning by other antipsychotics and neuroleptics, assault, initial encounter
T43.594A Poisoning by other antipsychotics and neuroleptics, undetermined, initial encounter
T43.601A Poisoning by unspecified psychostimulants, accidental (unintentional), initial encounter
T43.602A Poisoning by unspecified psychostimulants, intentional self-harm, initial encounter
T43.603A Poisoning by unspecified psychostimulants, assault, initial encounter
T43.604A Poisoning by unspecified psychostimulants, undetermined, initial encounter
T43.611A Poisoning by caffeine, accidental (unintentional), initial encounter
T43.612A Poisoning by caffeine, intentional self-harm, initial encounter
T43.613A Poisoning by caffeine, assault, initial encounter
T43.614A Poisoning by caffeine, undetermined, initial encounter
T43.621A Poisoning by amphetamines, accidental (unintentional), initial encounter
T43.622A Poisoning by amphetamines, intentional self-harm, initial encounter
T43.623A Poisoning by amphetamines, assault, initial encounter
T43.624A Poisoning by amphetamines, undetermined, initial encounter
T43.631A Poisoning by methylphenidate, accidental (unintentional), initial encounter
T43.632A Poisoning by methylphenidate, intentional self-harm, initial encounter
T43.633A Poisoning by methylphenidate, assault, initial encounter
T43.634A Poisoning by methylphenidate, undetermined, initial encounter
T43.641A Poisoning by ecstasy, accidental (unintentional), initial encounter
T43.641D Poisoning by ecstasy, accidental (unintentional), subsequent encounter
T43.641S Poisoning by ecstasy, accidental (unintentional), sequela
T43.642A Poisoning by ecstasy, intentional self-harm, initial encounter
T43.642D Poisoning by ecstasy, intentional self-harm, subsequent encounter
T43.642S Poisoning by ecstasy, intentional self-harm, sequela
T43.643A Poisoning by ecstasy, assault, initial encounter
T43.643D Poisoning by ecstasy, assault, subsequent encounter
T43.643S Poisoning by ecstasy, assault, sequela
T43.644A Poisoning by ecstasy, undetermined, initial encounter
T43.644D Poisoning by ecstasy, undetermined, subsequent encounter
T43.644S Poisoning by ecstasy, undetermined, sequela
T43.691A Poisoning by other psychostimulants, accidental (unintentional), initial encounter
T43.692A Poisoning by other psychostimulants, intentional self-harm, initial encounter
T43.693A Poisoning by other psychostimulants, assault, initial encounter
T43.694A Poisoning by other psychostimulants, undetermined, initial encounter
T43.8X1A Poisoning by other psychotropic drugs, accidental (unintentional), initial encounter
T43.8X2A Poisoning by other psychotropic drugs, intentional self-harm, initial encounter
T43.8X3A Poisoning by other psychotropic drugs, assault, initial encounter
T43.8X4A Poisoning by other psychotropic drugs, undetermined, initial encounter
T43.91XA Poisoning by unspecified psychotropic drug, accidental (unintentional), initial encounter
T43.92XA Poisoning by unspecified psychotropic drug, intentional self-harm, initial encounter
T43.93XA Poisoning by unspecified psychotropic drug, assault, initial encounter
T43.94XA Poisoning by unspecified psychotropic drug, undetermined, initial encounter
T45.0X1A Poisoning by antiallergic and antiemetic drugs, accidental (unintentional), initial encounter
T45.0X2A Poisoning by antiallergic and antiemetic drugs, intentional self-harm, initial encounter
T45.0X3A Poisoning by antiallergic and antiemetic drugs, assault, initial encounter
T45.0X4A Poisoning by antiallergic and antiemetic drugs, undetermined, initial encounter
T46.0X1A Poisoning by cardiac-stimulant glycosides and drugs of similar action, accidental (unintentional), initial encounter
T46.0X2A Poisoning by cardiac-stimulant glycosides and drugs of similar action, intentional self-harm, initial encounter
T46.0X3A Poisoning by cardiac-stimulant glycosides and drugs of similar action, assault, initial encounter
T46.0X4A Poisoning by cardiac-stimulant glycosides and drugs of similar action, undetermined, initial encounter
T50.901A Poisoning by unspecified drugs, medicaments and biological substances, accidental (unintentional), initial encounter
T50.902A Poisoning by unspecified drugs, medicaments and biological substances, intentional self-harm, initial encounter
T50.903A Poisoning by unspecified drugs, medicaments and biological substances, assault, initial encounter
T50.904A Poisoning by unspecified drugs, medicaments and biological substances, undetermined, initial encounter
Z03.821 Encounter for observation for suspected ingested foreign body ruled out
Z03.822 Encounter for observation for suspected aspirated (inhaled) foreign body ruled out
Z03.823 Encounter for observation for suspected inserted (injected) foreign body ruled out
Z03.89 Encounter for observation for other suspected diseases and conditions ruled out
Z51.81 Encounter for therapeutic drug level monitoring
Z79.3 Long term (current) use of hormonal contraceptives
Z79.891 Long term (current) use of opiate analgesic
Z79.899 Other long term (current) drug therapy
Z91.19 Patient's noncompliance with other medical treatment and regimen

ICD-10-CM Codes that DO NOT Support Medical Necessity

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ICD-10-PCS Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

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Other Coding Information

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Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/01/2021 R15

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted M54.5,T40.7X1A,T40.7X2A, T40.7X3A, T40.7X4A and added R45.88, T40.711A, T40.711D, T40.711S, T40.712A, T40.712D, T40.712S, T40.713A, T40.713D, T40.713S, T40.714A, T40.714D, T40.714S, T40.721A, T40.721D, T40.721S, T40.722A, T40.722D, T40.722S, T40.723A, T40.723D, T40.723S, T40.724A, T40.724D, T40.724S. This revision is due to the Annual ICD-10 update and is effective on 10/1/21.

01/01/2021 R14

Under CMS National Coverage Policy added the regulation for CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.1.2 - A/B MAC (B) Contacts with Independent Clinical Laboratories to this section. This revision has a retroactive effective date of 1/1/21.

Under CPT/HCPCS Codes Group 1: Codes added code 0227U due to the Q1 2021 CPT/HCPCS code update and has a retroactive effective date of 1/1/21.

10/01/2020 R13

Under ICD-10 Codes that Support Medical Necessity – Group 1: Codes added codes F10.130, F10.131, F10.132, F11.13, F12.13, F13.130, F13.131, F13.132, F14.13, F14.93, F15.13, F19.130, F19.131, F19.132, G40.42, T40.411A, T40.411D, T40.411S, T40.412A, T40.412D, T40.412S, T40.413A, T40.413D, T40.413S, T40.414A, T40.414D, T40.414S, T40.421A, T40.421D, T40.421S, T40.422A, T40.422D, T40.422S, T40.423A, T40.423D, T40.423S, T40.424A, T40.424D, T40.424S, T40.491A, T40.491D, T40.491S, T40.492A, T40.492D, T40.492S, T40.493A, T40.493D, T40.493S, T40.494A, T40.494D, T40.494S, Z03.821, Z03.822, Z03.823 and deleted codes T40.4X1A, T40.4X2A, T40.4X3A, and T40.4X4A. This revision is due to the Annual ICD-10 Code Update and is effective on 10/1/20.

Under ICD-10 Codes that Support Medical Necessity – Group 1: Codes deleted codes F11.229, F11.259, F11.29, G40.901, G40.909, G40.911, G40.919, M25.50, M60.9 and R40.20. This revision is effective on 10/1/20.

01/01/2020 R12

Under CPT/HCPCS Codes Group 1: Codes added HCPCS codes 0143U, 0144U, 0145U, 0146U, 0147U, 0148U, 0149U, 0150U. This revision is due to the Annual CPT®/HCPCS Code Update and becomes effective on 1/1/20.

11/21/2019 R11

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Title XVIII of the Social Security Act, §1833(e) was removed from the CMS National Coverage Policy section of the related Lab: Controlled Substance Monitoring and Drugs of Abuse Testing L35724 LCD and placed in this article.

08/29/2019 R10

All coding located in the Coding Information section has been removed from the related Lab: Controlled Substance Monitoring and Drugs of Abuse Testing L35724 LCD and added to this article.

Under Article Title changed the title from “Controlled Substance Monitoring and Drugs of Abuse Coding and Billing Guidelines” to “Billing and Coding: Lab: Controlled Substance Monitoring and Drugs of Abuse Testing”. Under Article Text added the sentence “The information in this article contains billing, coding, or other guidelines that complement the Local Coverage Determination (LCD) for Lab: Controlled Substance Monitoring and Drugs of Abuse Testing L35724” to the first paragraph and added the last paragraph. Formatting, punctuation and typographical errors were corrected throughout the article.

04/05/2018 R9

Removed 2017 from the title.

02/26/2018 R8 The Jurisdiction "J" Part B Contracts for Alabama (10112), Georgia (10212) and Tennessee (10312) are now being serviced by Palmetto GBA. The notice period for this article begins on 12/14/17 and ends on 02/25/18. Effective 02/26/18, these three contract numbers are being added to this article. No coverage, coding or other substantive changes (beyond the addition of the 3 Part B contract numbers) have been completed in this revision.
01/29/2018 R7 The Jurisdiction "J" Part A Contracts for Alabama (10111), Georgia (10211) and Tennessee (10311) are now being serviced by Palmetto GBA. The notice period for this article begins on 12/14/17 and ends on 01/28/18. Effective 01/29/18, these three contract numbers are being added to this article. No coverage, coding or other substantive changes (beyond the addition of the 3 Part A contract numbers) have been completed in this revision.
11/23/2017 R6

Corrected bulleting issues. Content did not change.

04/06/2017 R5 Under "Presumptive Urine Drug Testing (UDT) " corrected the types of presumptive UDT available per patient DOS from four to three.

Under "Definitive (Qualitative or Quantitative) UDT Testing" corrected the number of UDT services per patient DOS from four to five.

System was updated to accept G0659: Added G0659 under Group 1 CPT codes.
01/26/2017 R4 Added the reminder sentence for DOS
01/26/2017 R3 Moved HCPCS code G0659 from Presumptive Urine Drug Testing to Definitive (Qualitive or Quantitative) UDT Testing
01/01/2017 R2 Changed the first sentence under Presumptive Urine Drug Testing (UDT); to read "...four types of presumptive UDT..." instead of three.
01/01/2017 R1 Added new 2017 CPT/HCPCS codes, replaced 2016 with 2017 and replaced “encounter” with DOS
Moved codes under subtopic CPT/HCPCS Codes, from Group 1: Paragraph to Group 1: Codes
Deleted G0477, G0478 and G0479 under Presumptive Urine Drug Testing topic
Added G0659, 80305, 80306 and 80307
Replaced the word "encounter" with DOS

Associated Documents

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Rules and Regulations URLs
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CMS Manual Explanations URLs
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