Local Coverage Article Billing and Coding

Billing and Coding: Susceptibility Studies

A57176

Expand All | Collapse All

Contractor Information

Article Information

General Information

Article ID
A57176
Article Title
Billing and Coding: Susceptibility Studies
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
N/A
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2021 American Dental Association. All rights reserved.

Copyright © 2013 - 2022, the American Hospital Association, Chicago, Illinois. Reproduced by CMS with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816. Making copies or utilizing the content of the UB-04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. To license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816. You may also contact us at ub04@aha.org.

CMS National Coverage Policy

N/A

Article Guidance

Article Text

This First Coast Billing and Coding Article for Local Coverage Determination (LCD) L33755 Susceptibility Studies provides billing and coding guidance for frequency limitations as well as diagnosis limitations that support diagnosis to procedure code automated denials. However, services performed for any given diagnosis must meet all of the indications and limitations stated in the LCD, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.

Refer to the LCD for reasonable and necessary requirements and limitations.

The redetermination process may be utilized for consideration of services performed outside of the reasonable and necessary requirements in the LCD.

Coding Guidelines

The National Coverage Determination (NCD) 190.12 for “Urine Culture, Bacterial,” is for CPT codes 87086 and 87088. The diagnosis codes listed for CPT codes 87086 and 87088 in the NCD are also allowed for susceptibility studies (CPT codes 87181-87190).

CMS change request 2383, dated October 4, 2002, gives questions and answers related to implementation of NCDs for clinical diagnostic laboratory services. Regarding the question that CPT codes 87184 and 87186 are for sensitivity studies and are not specific to urine, there was concern with editing these CPT codes with diagnoses listed in the covered list. CMS gave the following response: “It is true that CPT codes for sensitivity testing are not specific to urine. Editing of these CPT codes with the list of covered diagnosis is likely to result in inappropriate denial of these services when they are performed on specimen other than urine. The edit module will not edit for these CPT codes. Rather, they will return a “not applicable” response from the edit module. Contractors are free to edit these codes locally either on a pre-payment or post-payment basis.”

The ICD-10-CM codes in Group 1 provide additional diagnosis codes for specimens other than urine.

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
  4. If the provider of the service is other than the ordering/referring physician/nonphysician practitioner, that provider must maintain hard copy documentation of test results and interpretation, along with copies of the ordering/referring physician/nonphysician provider’s order for the studies. The physician/nonphysician provider must state the clinical indication/medical necessity for the study in his order for the test.
  5. An order from the treating physician/nonphysician practitioner as required by CFR, Title 42, Volume 2, Chapter IV, Part 410.32(a) Ordering diagnostic tests.

Utilization Guidelines

In accordance with CMS Ruling 95-1 (V), utilization of these services should be consistent with locally acceptable standards of practice. 

Compliance with the provisions in LCD L33755, Susceptibility Studies may be monitored and addressed through post payment data analysis and subsequent medical review audits.

Coding Information

CPT/HCPCS Codes

Group 1

(7 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
87181 SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; AGAR DILUTION METHOD, PER AGENT (EG, ANTIBIOTIC GRADIENT STRIP)
87184 SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; DISK METHOD, PER PLATE (12 OR FEWER AGENTS)
87185 SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; ENZYME DETECTION (EG, BETA LACTAMASE), PER ENZYME
87186 SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION (MINIMUM INHIBITORY CONCENTRATION [MIC] OR BREAKPOINT), EACH MULTI-ANTIMICROBIAL, PER PLATE
87187 SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION, MINIMUM LETHAL CONCENTRATION (MLC), EACH PLATE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
87188 SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MACROBROTH DILUTION METHOD, EACH AGENT
87190 SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MYCOBACTERIA, PROPORTION METHOD, EACH AGENT

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(688 Codes)
Group 1 Paragraph

The following ICD-10-CM codes support medical necessity and provide limited coverage for CPT codes: 87181, 87184, 87185, 87186, 87187, 87188, 87190

This is not an all-inclusive list of covered ICD-10-CM codes for Susceptibility Studies. For additional covered diagnoses, reference the Medicare National Coverage Determination (NCD) 190.12 – Urine Culture, Bacterial ICD-10-CM Codes Covered by Medicare Program.

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

Group 1 Codes
CodeDescription
A00.0 Cholera due to Vibrio cholerae 01, biovar cholerae
A00.1 Cholera due to Vibrio cholerae 01, biovar eltor
A00.9 Cholera, unspecified
A01.00 Typhoid fever, unspecified
A01.01 Typhoid meningitis
A01.02 Typhoid fever with heart involvement
A01.03 Typhoid pneumonia
A01.04 Typhoid arthritis
A01.05 Typhoid osteomyelitis
A01.09 Typhoid fever with other complications
A01.1 Paratyphoid fever A
A01.2 Paratyphoid fever B
A01.3 Paratyphoid fever C
A01.4 Paratyphoid fever, unspecified
A02.0 Salmonella enteritis
A02.1 Salmonella sepsis
A02.20 Localized salmonella infection, unspecified
A02.21 Salmonella meningitis
A02.22 Salmonella pneumonia
A02.23 Salmonella arthritis
A02.24 Salmonella osteomyelitis
A02.25 Salmonella pyelonephritis
A02.29 Salmonella with other localized infection
A02.8 Other specified salmonella infections
A02.9 Salmonella infection, unspecified
A03.0 Shigellosis due to Shigella dysenteriae
A03.1 Shigellosis due to Shigella flexneri
A03.2 Shigellosis due to Shigella boydii
A03.3 Shigellosis due to Shigella sonnei
A03.8 Other shigellosis
A03.9 Shigellosis, unspecified
A04.0 Enteropathogenic Escherichia coli infection
A04.1 Enterotoxigenic Escherichia coli infection
A04.2 Enteroinvasive Escherichia coli infection
A04.3 Enterohemorrhagic Escherichia coli infection
A04.4 Other intestinal Escherichia coli infections
A04.5 Campylobacter enteritis
A04.6 Enteritis due to Yersinia enterocolitica
A04.71 Enterocolitis due to Clostridium difficile, recurrent
A04.72 Enterocolitis due to Clostridium difficile, not specified as recurrent
A04.8 Other specified bacterial intestinal infections
A04.9 Bacterial intestinal infection, unspecified
A05.0 Foodborne staphylococcal intoxication
A05.1 Botulism food poisoning
A05.2 Foodborne Clostridium perfringens [Clostridium welchii] intoxication
A05.3 Foodborne Vibrio parahaemolyticus intoxication
A05.4 Foodborne Bacillus cereus intoxication
A05.5 Foodborne Vibrio vulnificus intoxication
A05.8 Other specified bacterial foodborne intoxications
A05.9 Bacterial foodborne intoxication, unspecified
A06.0 Acute amebic dysentery
A06.1 Chronic intestinal amebiasis
A06.2 Amebic nondysenteric colitis
A06.3 Ameboma of intestine
A06.4 Amebic liver abscess
A06.5 Amebic lung abscess
A06.6 Amebic brain abscess
A06.7 Cutaneous amebiasis
A06.81 Amebic cystitis
A06.82 Other amebic genitourinary infections
A06.89 Other amebic infections
A06.9 Amebiasis, unspecified
A07.0 Balantidiasis
A07.1 Giardiasis [lambliasis]
A07.2 Cryptosporidiosis
A07.3 Isosporiasis
A07.4 Cyclosporiasis
A07.8 Other specified protozoal intestinal diseases
A07.9 Protozoal intestinal disease, unspecified
A08.0 Rotaviral enteritis
A08.11 Acute gastroenteropathy due to Norwalk agent
A08.19 Acute gastroenteropathy due to other small round viruses
A08.2 Adenoviral enteritis
A08.31 Calicivirus enteritis
A08.32 Astrovirus enteritis
A08.39 Other viral enteritis
A08.4 Viral intestinal infection, unspecified
A08.8 Other specified intestinal infections
A09 Infectious gastroenteritis and colitis, unspecified
A15.0 Tuberculosis of lung
A15.4 Tuberculosis of intrathoracic lymph nodes
A15.5 Tuberculosis of larynx, trachea and bronchus
A15.6 Tuberculous pleurisy
A15.7 Primary respiratory tuberculosis
A15.8 Other respiratory tuberculosis
A15.9 Respiratory tuberculosis unspecified
A17.0 Tuberculous meningitis
A17.1 Meningeal tuberculoma
A17.81 Tuberculoma of brain and spinal cord
A17.82 Tuberculous meningoencephalitis
A17.83 Tuberculous neuritis
A17.89 Other tuberculosis of nervous system
A17.9 Tuberculosis of nervous system, unspecified
A18.01 Tuberculosis of spine
A18.02 Tuberculous arthritis of other joints
A18.03 Tuberculosis of other bones
A18.09 Other musculoskeletal tuberculosis
A18.10 Tuberculosis of genitourinary system, unspecified
A18.11 Tuberculosis of kidney and ureter
A18.12 Tuberculosis of bladder
A18.13 Tuberculosis of other urinary organs
A18.14 Tuberculosis of prostate
A18.15 Tuberculosis of other male genital organs
A18.16 Tuberculosis of cervix
A18.17 Tuberculous female pelvic inflammatory disease
A18.18 Tuberculosis of other female genital organs
A18.2 Tuberculous peripheral lymphadenopathy
A18.31 Tuberculous peritonitis
A18.32 Tuberculous enteritis
A18.39 Retroperitoneal tuberculosis
A18.4 Tuberculosis of skin and subcutaneous tissue
A18.50 Tuberculosis of eye, unspecified
A18.51 Tuberculous episcleritis
A18.52 Tuberculous keratitis
A18.53 Tuberculous chorioretinitis
A18.54 Tuberculous iridocyclitis
A18.59 Other tuberculosis of eye
A18.6 Tuberculosis of (inner) (middle) ear
A18.7 Tuberculosis of adrenal glands
A18.81 Tuberculosis of thyroid gland
A18.82 Tuberculosis of other endocrine glands
A18.83 Tuberculosis of digestive tract organs, not elsewhere classified
A18.84 Tuberculosis of heart
A18.85 Tuberculosis of spleen
A18.89 Tuberculosis of other sites
A19.0 Acute miliary tuberculosis of a single specified site
A19.1 Acute miliary tuberculosis of multiple sites
A19.2 Acute miliary tuberculosis, unspecified
A19.8 Other miliary tuberculosis
A19.9 Miliary tuberculosis, unspecified
A20.0 Bubonic plague
A20.1 Cellulocutaneous plague
A20.2 Pneumonic plague
A20.3 Plague meningitis
A20.7 Septicemic plague
A20.8 Other forms of plague
A20.9 Plague, unspecified
A21.0 Ulceroglandular tularemia
A21.1 Oculoglandular tularemia
A21.2 Pulmonary tularemia
A21.3 Gastrointestinal tularemia
A21.7 Generalized tularemia
A21.8 Other forms of tularemia
A21.9 Tularemia, unspecified
A22.0 Cutaneous anthrax
A22.1 Pulmonary anthrax
A22.2 Gastrointestinal anthrax
A22.7 Anthrax sepsis
A22.8 Other forms of anthrax
A22.9 Anthrax, unspecified
A23.0 Brucellosis due to Brucella melitensis
A23.1 Brucellosis due to Brucella abortus
A23.2 Brucellosis due to Brucella suis
A23.3 Brucellosis due to Brucella canis
A23.8 Other brucellosis
A23.9 Brucellosis, unspecified
A24.0 Glanders
A24.1 Acute and fulminating melioidosis
A24.2 Subacute and chronic melioidosis
A24.3 Other melioidosis
A24.9 Melioidosis, unspecified
A25.0 Spirillosis
A25.1 Streptobacillosis
A25.9 Rat-bite fever, unspecified
A26.0 Cutaneous erysipeloid
A26.7 Erysipelothrix sepsis
A26.8 Other forms of erysipeloid
A26.9 Erysipeloid, unspecified
A27.0 Leptospirosis icterohemorrhagica
A27.81 Aseptic meningitis in leptospirosis
A27.89 Other forms of leptospirosis
A27.9 Leptospirosis, unspecified
A28.0 Pasteurellosis
A28.2 Extraintestinal yersiniosis
A28.8 Other specified zoonotic bacterial diseases, not elsewhere classified
A28.9 Zoonotic bacterial disease, unspecified
A30.0 Indeterminate leprosy
A30.1 Tuberculoid leprosy
A30.2 Borderline tuberculoid leprosy
A30.3 Borderline leprosy
A30.4 Borderline lepromatous leprosy
A30.5 Lepromatous leprosy
A30.8 Other forms of leprosy
A30.9 Leprosy, unspecified
A31.0 Pulmonary mycobacterial infection
A31.1 Cutaneous mycobacterial infection
A31.2 Disseminated mycobacterium avium-intracellulare complex (DMAC)
A31.8 Other mycobacterial infections
A31.9 Mycobacterial infection, unspecified
A32.0 Cutaneous listeriosis
A32.11 Listerial meningitis
A32.12 Listerial meningoencephalitis
A32.7 Listerial sepsis
A32.81 Oculoglandular listeriosis
A32.82 Listerial endocarditis
A32.89 Other forms of listeriosis
A32.9 Listeriosis, unspecified
A35 Other tetanus
A36.0 Pharyngeal diphtheria
A36.1 Nasopharyngeal diphtheria
A36.2 Laryngeal diphtheria
A36.3 Cutaneous diphtheria
A36.81 Diphtheritic cardiomyopathy
A36.82 Diphtheritic radiculomyelitis
A36.83 Diphtheritic polyneuritis
A36.84 Diphtheritic tubulo-interstitial nephropathy
A36.85 Diphtheritic cystitis
A36.86 Diphtheritic conjunctivitis
A36.89 Other diphtheritic complications
A36.9 Diphtheria, unspecified
A37.00 Whooping cough due to Bordetella pertussis without pneumonia
A37.01 Whooping cough due to Bordetella pertussis with pneumonia
A37.10 Whooping cough due to Bordetella parapertussis without pneumonia
A37.11 Whooping cough due to Bordetella parapertussis with pneumonia
A37.80 Whooping cough due to other Bordetella species without pneumonia
A37.81 Whooping cough due to other Bordetella species with pneumonia
A37.90 Whooping cough, unspecified species without pneumonia
A37.91 Whooping cough, unspecified species with pneumonia
A38.0 Scarlet fever with otitis media
A38.1 Scarlet fever with myocarditis
A38.8 Scarlet fever with other complications
A38.9 Scarlet fever, uncomplicated
A39.0 Meningococcal meningitis
A39.1 Waterhouse-Friderichsen syndrome
A39.2 Acute meningococcemia
A39.3 Chronic meningococcemia
A39.4 Meningococcemia, unspecified
A39.50 Meningococcal carditis, unspecified
A39.51 Meningococcal endocarditis
A39.52 Meningococcal myocarditis
A39.53 Meningococcal pericarditis
A39.81 Meningococcal encephalitis
A39.82 Meningococcal retrobulbar neuritis
A39.83 Meningococcal arthritis
A39.84 Postmeningococcal arthritis
A39.89 Other meningococcal infections
A39.9 Meningococcal infection, unspecified
A40.0 Sepsis due to streptococcus, group A
A40.1 Sepsis due to streptococcus, group B
A40.3 Sepsis due to Streptococcus pneumoniae
A40.8 Other streptococcal sepsis
A40.9 Streptococcal sepsis, unspecified
A41.01 Sepsis due to Methicillin susceptible Staphylococcus aureus
A41.02 Sepsis due to Methicillin resistant Staphylococcus aureus
A41.1 Sepsis due to other specified staphylococcus
A41.2 Sepsis due to unspecified staphylococcus
A41.3 Sepsis due to Hemophilus influenzae
A41.4 Sepsis due to anaerobes
A41.50 Gram-negative sepsis, unspecified
A41.51 Sepsis due to Escherichia coli [E. coli]
A41.52 Sepsis due to Pseudomonas
A41.53 Sepsis due to Serratia
A41.59 Other Gram-negative sepsis
A41.81 Sepsis due to Enterococcus
A41.89 Other specified sepsis
A41.9 Sepsis, unspecified organism
A42.0 Pulmonary actinomycosis
A42.1 Abdominal actinomycosis
A42.2 Cervicofacial actinomycosis
A42.7 Actinomycotic sepsis
A42.81 Actinomycotic meningitis
A42.82 Actinomycotic encephalitis
A42.89 Other forms of actinomycosis
A42.9 Actinomycosis, unspecified
A43.0 Pulmonary nocardiosis
A43.1 Cutaneous nocardiosis
A43.8 Other forms of nocardiosis
A43.9 Nocardiosis, unspecified
A46 Erysipelas
A48.0 Gas gangrene
A48.2 Nonpneumonic Legionnaires' disease [Pontiac fever]
A48.3 Toxic shock syndrome
A48.4 Brazilian purpuric fever
A48.51 Infant botulism
A48.52 Wound botulism
A48.8 Other specified bacterial diseases
A49.01 Methicillin susceptible Staphylococcus aureus infection, unspecified site
A49.02 Methicillin resistant Staphylococcus aureus infection, unspecified site
A49.1 Streptococcal infection, unspecified site
A49.2 Hemophilus influenzae infection, unspecified site
A49.3 Mycoplasma infection, unspecified site
A49.8 Other bacterial infections of unspecified site
A49.9 Bacterial infection, unspecified
A50.01 Early congenital syphilitic oculopathy
A50.02 Early congenital syphilitic osteochondropathy
A50.03 Early congenital syphilitic pharyngitis
A50.04 Early congenital syphilitic pneumonia
A50.05 Early congenital syphilitic rhinitis
A50.06 Early cutaneous congenital syphilis
A50.07 Early mucocutaneous congenital syphilis
A50.08 Early visceral congenital syphilis
A50.09 Other early congenital syphilis, symptomatic
A50.1 Early congenital syphilis, latent
A50.2 Early congenital syphilis, unspecified
A50.30 Late congenital syphilitic oculopathy, unspecified
A50.31 Late congenital syphilitic interstitial keratitis
A50.32 Late congenital syphilitic chorioretinitis
A50.39 Other late congenital syphilitic oculopathy
A50.40 Late congenital neurosyphilis, unspecified
A50.41 Late congenital syphilitic meningitis
A50.42 Late congenital syphilitic encephalitis
A50.43 Late congenital syphilitic polyneuropathy
A50.44 Late congenital syphilitic optic nerve atrophy
A50.45 Juvenile general paresis
A50.49 Other late congenital neurosyphilis
A50.51 Clutton's joints
A50.52 Hutchinson's teeth
A50.53 Hutchinson's triad
A50.54 Late congenital cardiovascular syphilis
A50.55 Late congenital syphilitic arthropathy
A50.56 Late congenital syphilitic osteochondropathy
A50.57 Syphilitic saddle nose
A50.59 Other late congenital syphilis, symptomatic
A50.6 Late congenital syphilis, latent
A50.7 Late congenital syphilis, unspecified
A50.9 Congenital syphilis, unspecified
A51.0 Primary genital syphilis
A51.1 Primary anal syphilis
A51.2 Primary syphilis of other sites
A51.31 Condyloma latum
A51.32 Syphilitic alopecia
A51.39 Other secondary syphilis of skin
A51.41 Secondary syphilitic meningitis
A51.42 Secondary syphilitic female pelvic disease
A51.43 Secondary syphilitic oculopathy
A51.44 Secondary syphilitic nephritis
A51.45 Secondary syphilitic hepatitis
A51.46 Secondary syphilitic osteopathy
A51.49 Other secondary syphilitic conditions
A51.5 Early syphilis, latent
A51.9 Early syphilis, unspecified
A52.00 Cardiovascular syphilis, unspecified
A52.01 Syphilitic aneurysm of aorta
A52.02 Syphilitic aortitis
A52.03 Syphilitic endocarditis
A52.04 Syphilitic cerebral arteritis
A52.05 Other cerebrovascular syphilis
A52.06 Other syphilitic heart involvement
A52.09 Other cardiovascular syphilis
A52.10 Symptomatic neurosyphilis, unspecified
A52.11 Tabes dorsalis
A52.12 Other cerebrospinal syphilis
A52.13 Late syphilitic meningitis
A52.14 Late syphilitic encephalitis
A52.15 Late syphilitic neuropathy
A52.16 Charcot's arthropathy (tabetic)
A52.17 General paresis
A52.19 Other symptomatic neurosyphilis
A52.2 Asymptomatic neurosyphilis
A52.3 Neurosyphilis, unspecified
A52.71 Late syphilitic oculopathy
A52.72 Syphilis of lung and bronchus
A52.73 Symptomatic late syphilis of other respiratory organs
A52.74 Syphilis of liver and other viscera
A52.75 Syphilis of kidney and ureter
A52.76 Other genitourinary symptomatic late syphilis
A52.77 Syphilis of bone and joint
A52.78 Syphilis of other musculoskeletal tissue
A52.79 Other symptomatic late syphilis
A52.8 Late syphilis, latent
A52.9 Late syphilis, unspecified
A53.0 Latent syphilis, unspecified as early or late
A53.9 Syphilis, unspecified
A54.00 Gonococcal infection of lower genitourinary tract, unspecified
A54.01 Gonococcal cystitis and urethritis, unspecified
A54.02 Gonococcal vulvovaginitis, unspecified
A54.03 Gonococcal cervicitis, unspecified
A54.09 Other gonococcal infection of lower genitourinary tract
A54.1 Gonococcal infection of lower genitourinary tract with periurethral and accessory gland abscess
A54.21 Gonococcal infection of kidney and ureter
A54.22 Gonococcal prostatitis
A54.23 Gonococcal infection of other male genital organs
A54.24 Gonococcal female pelvic inflammatory disease
A54.29 Other gonococcal genitourinary infections
A54.30 Gonococcal infection of eye, unspecified
A54.31 Gonococcal conjunctivitis
A54.32 Gonococcal iridocyclitis
A54.33 Gonococcal keratitis
A54.39 Other gonococcal eye infection
A54.40 Gonococcal infection of musculoskeletal system, unspecified
A54.41 Gonococcal spondylopathy
A54.42 Gonococcal arthritis
A54.43 Gonococcal osteomyelitis
A54.49 Gonococcal infection of other musculoskeletal tissue
A54.5 Gonococcal pharyngitis
A54.6 Gonococcal infection of anus and rectum
A54.81 Gonococcal meningitis
A54.82 Gonococcal brain abscess
A54.83 Gonococcal heart infection
A54.84 Gonococcal pneumonia
A54.85 Gonococcal peritonitis
A54.86 Gonococcal sepsis
A54.89 Other gonococcal infections
A54.9 Gonococcal infection, unspecified
A55 Chlamydial lymphogranuloma (venereum)
A56.00 Chlamydial infection of lower genitourinary tract, unspecified
A56.01 Chlamydial cystitis and urethritis
A56.02 Chlamydial vulvovaginitis
A56.09 Other chlamydial infection of lower genitourinary tract
A56.11 Chlamydial female pelvic inflammatory disease
A56.19 Other chlamydial genitourinary infection
A56.2 Chlamydial infection of genitourinary tract, unspecified
A56.3 Chlamydial infection of anus and rectum
A56.4 Chlamydial infection of pharynx
A56.8 Sexually transmitted chlamydial infection of other sites
A57 Chancroid
A58 Granuloma inguinale
A63.8 Other specified predominantly sexually transmitted diseases
A64 Unspecified sexually transmitted disease
A65 Nonvenereal syphilis
A66.0 Initial lesions of yaws
A66.1 Multiple papillomata and wet crab yaws
A66.2 Other early skin lesions of yaws
A66.3 Hyperkeratosis of yaws
A66.4 Gummata and ulcers of yaws
A66.5 Gangosa
A66.6 Bone and joint lesions of yaws
A66.7 Other manifestations of yaws
A66.8 Latent yaws
A66.9 Yaws, unspecified
A67.0 Primary lesions of pinta
A67.1 Intermediate lesions of pinta
A67.2 Late lesions of pinta
A67.3 Mixed lesions of pinta
A67.9 Pinta, unspecified
A68.0 Louse-borne relapsing fever
A68.1 Tick-borne relapsing fever
A68.9 Relapsing fever, unspecified
A69.0 Necrotizing ulcerative stomatitis
A69.1 Other Vincent's infections
A69.8 Other specified spirochetal infections
A69.9 Spirochetal infection, unspecified
B35.0 Tinea barbae and tinea capitis
B35.1 Tinea unguium
B35.2 Tinea manuum
B35.3 Tinea pedis
B35.4 Tinea corporis
B35.5 Tinea imbricata
B35.6 Tinea cruris
B35.8 Other dermatophytoses
B35.9 Dermatophytosis, unspecified
B36.0 Pityriasis versicolor
B36.1 Tinea nigra
B36.2 White piedra
B36.3 Black piedra
B36.8 Other specified superficial mycoses
B36.9 Superficial mycosis, unspecified
B37.0 Candidal stomatitis
B37.1 Pulmonary candidiasis
B37.2 Candidiasis of skin and nail
B37.3 Candidiasis of vulva and vagina
B37.41 Candidal cystitis and urethritis
B37.42 Candidal balanitis
B37.49 Other urogenital candidiasis
B37.5 Candidal meningitis
B37.6 Candidal endocarditis
B37.7 Candidal sepsis
B37.81 Candidal esophagitis
B37.82 Candidal enteritis
B37.83 Candidal cheilitis
B37.84 Candidal otitis externa
B37.89 Other sites of candidiasis
B37.9 Candidiasis, unspecified
B38.0 Acute pulmonary coccidioidomycosis
B38.1 Chronic pulmonary coccidioidomycosis
B38.2 Pulmonary coccidioidomycosis, unspecified
B38.3 Cutaneous coccidioidomycosis
B38.4 Coccidioidomycosis meningitis
B38.7 Disseminated coccidioidomycosis
B38.81 Prostatic coccidioidomycosis
B38.89 Other forms of coccidioidomycosis
B38.9 Coccidioidomycosis, unspecified
B39.0 Acute pulmonary histoplasmosis capsulati
B39.1 Chronic pulmonary histoplasmosis capsulati
B39.2 Pulmonary histoplasmosis capsulati, unspecified
B39.3 Disseminated histoplasmosis capsulati
B39.4 Histoplasmosis capsulati, unspecified
B39.5 Histoplasmosis duboisii
B39.9 Histoplasmosis, unspecified
B40.0 Acute pulmonary blastomycosis
B40.1 Chronic pulmonary blastomycosis
B40.2 Pulmonary blastomycosis, unspecified
B40.3 Cutaneous blastomycosis
B40.7 Disseminated blastomycosis
B40.81 Blastomycotic meningoencephalitis
B40.89 Other forms of blastomycosis
B40.9 Blastomycosis, unspecified
B41.0 Pulmonary paracoccidioidomycosis
B41.7 Disseminated paracoccidioidomycosis
B41.8 Other forms of paracoccidioidomycosis
B41.9 Paracoccidioidomycosis, unspecified
B42.0 Pulmonary sporotrichosis
B42.1 Lymphocutaneous sporotrichosis
B42.7 Disseminated sporotrichosis
B42.81 Cerebral sporotrichosis
B42.82 Sporotrichosis arthritis
B42.89 Other forms of sporotrichosis
B42.9 Sporotrichosis, unspecified
B43.0 Cutaneous chromomycosis
B43.1 Pheomycotic brain abscess
B43.2 Subcutaneous pheomycotic abscess and cyst
B43.8 Other forms of chromomycosis
B43.9 Chromomycosis, unspecified
B44.0 Invasive pulmonary aspergillosis
B44.1 Other pulmonary aspergillosis
B44.2 Tonsillar aspergillosis
B44.7 Disseminated aspergillosis
B44.89 Other forms of aspergillosis
B44.9 Aspergillosis, unspecified
B45.0 Pulmonary cryptococcosis
B45.1 Cerebral cryptococcosis
B45.2 Cutaneous cryptococcosis
B45.3 Osseous cryptococcosis
B45.7 Disseminated cryptococcosis
B45.8 Other forms of cryptococcosis
B45.9 Cryptococcosis, unspecified
B46.0 Pulmonary mucormycosis
B46.1 Rhinocerebral mucormycosis
B46.2 Gastrointestinal mucormycosis
B46.3 Cutaneous mucormycosis
B46.4 Disseminated mucormycosis
B46.5 Mucormycosis, unspecified
B46.8 Other zygomycoses
B46.9 Zygomycosis, unspecified
B47.0 Eumycetoma
B47.1 Actinomycetoma
B47.9 Mycetoma, unspecified
B48.0 Lobomycosis
B48.1 Rhinosporidiosis
B48.2 Allescheriasis
B48.3 Geotrichosis
B48.4 Penicillosis
B48.8 Other specified mycoses
B49 Unspecified mycosis
B60.8 Other specified protozoal diseases
B92 Sequelae of leprosy
B94.2 Sequelae of viral hepatitis
B94.8 Sequelae of other specified infectious and parasitic diseases
B94.9 Sequelae of unspecified infectious and parasitic disease
B95.0 Streptococcus, group A, as the cause of diseases classified elsewhere
B95.1 Streptococcus, group B, as the cause of diseases classified elsewhere
B95.2 Enterococcus as the cause of diseases classified elsewhere
B95.3 Streptococcus pneumoniae as the cause of diseases classified elsewhere
B95.4 Other streptococcus as the cause of diseases classified elsewhere
B95.5 Unspecified streptococcus as the cause of diseases classified elsewhere
B95.61 Methicillin susceptible Staphylococcus aureus infection as the cause of diseases classified elsewhere
B95.62 Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere
B95.7 Other staphylococcus as the cause of diseases classified elsewhere
B95.8 Unspecified staphylococcus as the cause of diseases classified elsewhere
B96.0 Mycoplasma pneumoniae [M. pneumoniae] as the cause of diseases classified elsewhere
B96.1 Klebsiella pneumoniae [K. pneumoniae] as the cause of diseases classified elsewhere
B96.20 Unspecified Escherichia coli [E. coli] as the cause of diseases classified elsewhere
B96.21 Shiga toxin-producing Escherichia coli [E. coli] [STEC] O157 as the cause of diseases classified elsewhere
B96.22 Other specified Shiga toxin-producing Escherichia coli [E. coli] [STEC] as the cause of diseases classified elsewhere
B96.23 Unspecified Shiga toxin-producing Escherichia coli [E. coli] [STEC] as the cause of diseases classified elsewhere
B96.29 Other Escherichia coli [E. coli] as the cause of diseases classified elsewhere
B96.3 Hemophilus influenzae [H. influenzae] as the cause of diseases classified elsewhere
B96.4 Proteus (mirabilis) (morganii) as the cause of diseases classified elsewhere
B96.5 Pseudomonas (aeruginosa) (mallei) (pseudomallei) as the cause of diseases classified elsewhere
B96.6 Bacteroides fragilis [B. fragilis] as the cause of diseases classified elsewhere
B96.7 Clostridium perfringens [C. perfringens] as the cause of diseases classified elsewhere
B96.81 Helicobacter pylori [H. pylori] as the cause of diseases classified elsewhere
B96.82 Vibrio vulnificus as the cause of diseases classified elsewhere
B96.89 Other specified bacterial agents as the cause of diseases classified elsewhere
B99.8 Other infectious disease
G02 Meningitis in other infectious and parasitic diseases classified elsewhere
H32 Chorioretinal disorders in diseases classified elsewhere
I32 Pericarditis in diseases classified elsewhere
I39 Endocarditis and heart valve disorders in diseases classified elsewhere
J02.0 Streptococcal pharyngitis
J03.00 Acute streptococcal tonsillitis, unspecified
J03.01 Acute recurrent streptococcal tonsillitis
J17 Pneumonia in diseases classified elsewhere
J20.0 Acute bronchitis due to Mycoplasma pneumoniae
J20.1 Acute bronchitis due to Hemophilus influenzae
J20.2 Acute bronchitis due to streptococcus
K90.81 Whipple's disease
L08.1 Erythrasma
M00.00 Staphylococcal arthritis, unspecified joint
M00.011 Staphylococcal arthritis, right shoulder
M00.012 Staphylococcal arthritis, left shoulder
M00.019 Staphylococcal arthritis, unspecified shoulder
M00.021 Staphylococcal arthritis, right elbow
M00.022 Staphylococcal arthritis, left elbow
M00.029 Staphylococcal arthritis, unspecified elbow
M00.031 Staphylococcal arthritis, right wrist
M00.032 Staphylococcal arthritis, left wrist
M00.039 Staphylococcal arthritis, unspecified wrist
M00.041 Staphylococcal arthritis, right hand
M00.042 Staphylococcal arthritis, left hand
M00.049 Staphylococcal arthritis, unspecified hand
M00.051 Staphylococcal arthritis, right hip
M00.052 Staphylococcal arthritis, left hip
M00.059 Staphylococcal arthritis, unspecified hip
M00.061 Staphylococcal arthritis, right knee
M00.062 Staphylococcal arthritis, left knee
M00.069 Staphylococcal arthritis, unspecified knee
M00.071 Staphylococcal arthritis, right ankle and foot
M00.072 Staphylococcal arthritis, left ankle and foot
M00.079 Staphylococcal arthritis, unspecified ankle and foot
M00.08 Staphylococcal arthritis, vertebrae
M00.09 Staphylococcal polyarthritis
M00.10 Pneumococcal arthritis, unspecified joint
M00.111 Pneumococcal arthritis, right shoulder
M00.112 Pneumococcal arthritis, left shoulder
M00.119 Pneumococcal arthritis, unspecified shoulder
M00.121 Pneumococcal arthritis, right elbow
M00.122 Pneumococcal arthritis, left elbow
M00.129 Pneumococcal arthritis, unspecified elbow
M00.131 Pneumococcal arthritis, right wrist
M00.132 Pneumococcal arthritis, left wrist
M00.139 Pneumococcal arthritis, unspecified wrist
M00.141 Pneumococcal arthritis, right hand
M00.142 Pneumococcal arthritis, left hand
M00.149 Pneumococcal arthritis, unspecified hand
M00.151 Pneumococcal arthritis, right hip
M00.152 Pneumococcal arthritis, left hip
M00.159 Pneumococcal arthritis, unspecified hip
M00.161 Pneumococcal arthritis, right knee
M00.162 Pneumococcal arthritis, left knee
M00.169 Pneumococcal arthritis, unspecified knee
M00.171 Pneumococcal arthritis, right ankle and foot
M00.172 Pneumococcal arthritis, left ankle and foot
M00.179 Pneumococcal arthritis, unspecified ankle and foot
M00.18 Pneumococcal arthritis, vertebrae
M00.19 Pneumococcal polyarthritis
M00.20 Other streptococcal arthritis, unspecified joint
M00.211 Other streptococcal arthritis, right shoulder
M00.212 Other streptococcal arthritis, left shoulder
M00.219 Other streptococcal arthritis, unspecified shoulder
M00.221 Other streptococcal arthritis, right elbow
M00.222 Other streptococcal arthritis, left elbow
M00.229 Other streptococcal arthritis, unspecified elbow
M00.231 Other streptococcal arthritis, right wrist
M00.232 Other streptococcal arthritis, left wrist
M00.239 Other streptococcal arthritis, unspecified wrist
M00.241 Other streptococcal arthritis, right hand
M00.242 Other streptococcal arthritis, left hand
M00.249 Other streptococcal arthritis, unspecified hand
M00.251 Other streptococcal arthritis, right hip
M00.252 Other streptococcal arthritis, left hip
M00.259 Other streptococcal arthritis, unspecified hip
M00.261 Other streptococcal arthritis, right knee
M00.262 Other streptococcal arthritis, left knee
M00.269 Other streptococcal arthritis, unspecified knee
M00.271 Other streptococcal arthritis, right ankle and foot
M00.272 Other streptococcal arthritis, left ankle and foot
M00.279 Other streptococcal arthritis, unspecified ankle and foot
M00.28 Other streptococcal arthritis, vertebrae
M00.29 Other streptococcal polyarthritis
M00.80 Arthritis due to other bacteria, unspecified joint
M00.811 Arthritis due to other bacteria, right shoulder
M00.812 Arthritis due to other bacteria, left shoulder
M00.819 Arthritis due to other bacteria, unspecified shoulder
M00.821 Arthritis due to other bacteria, right elbow
M00.822 Arthritis due to other bacteria, left elbow
M00.829 Arthritis due to other bacteria, unspecified elbow
M00.831 Arthritis due to other bacteria, right wrist
M00.832 Arthritis due to other bacteria, left wrist
M00.839 Arthritis due to other bacteria, unspecified wrist
M00.841 Arthritis due to other bacteria, right hand
M00.842 Arthritis due to other bacteria, left hand
M00.849 Arthritis due to other bacteria, unspecified hand
M00.851 Arthritis due to other bacteria, right hip
M00.852 Arthritis due to other bacteria, left hip
M00.859 Arthritis due to other bacteria, unspecified hip
M00.861 Arthritis due to other bacteria, right knee
M00.862 Arthritis due to other bacteria, left knee
M00.869 Arthritis due to other bacteria, unspecified knee
M00.871 Arthritis due to other bacteria, right ankle and foot
M00.872 Arthritis due to other bacteria, left ankle and foot
M00.879 Arthritis due to other bacteria, unspecified ankle and foot
M00.88 Arthritis due to other bacteria, vertebrae
M00.89 Polyarthritis due to other bacteria
M60.009 Infective myositis, unspecified site
N34.1 Nonspecific urethritis
Z16.10* Resistance to unspecified beta lactam antibiotics
Z16.11* Resistance to penicillins
Z16.12* Extended spectrum beta lactamase (ESBL) resistance
Z16.19* Resistance to other specified beta lactam antibiotics
Z16.20* Resistance to unspecified antibiotic
Z16.21* Resistance to vancomycin
Z16.22* Resistance to vancomycin related antibiotics
Z16.31* Resistance to antiparasitic drug(s)
Z16.32* Resistance to antifungal drug(s)
Z16.33* Resistance to antiviral drug(s)
Z16.35* Resistance to multiple antimicrobial drugs
Z16.39* Resistance to other specified antimicrobial drug
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

* Diagnosis codes Z16.10, Z16.11, Z16.12, Z16.19, Z16.20, Z16.21, Z16.22, Z16.31, Z16.32, Z16.33, Z16.35 and Z16.39 should not be billed as the primary diagnosis.

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

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10 Codes that are covered” section of this article or in the NCD 190.12 Urine Culture, Bacterial ICD-10-CM Codes Covered by Medicare Program.

Group 1 Codes
CodeDescription
XX000 Not Applicable

Additional ICD-10 Information

N/A

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.

CodeDescription
999x Not Applicable

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.

CodeDescription
99999 Not Applicable

Other Coding Information

N/A

Revision History Information

N/A

Associated Documents

Related Local Coverage Documents
LCDs
L33755 - Susceptibility Studies
Related National Coverage Documents
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
10/02/2019 10/03/2018 - N/A Currently in Effect You are here

Keywords

N/A