Local Coverage Article Billing and Coding

Billing and Coding: Duplex Scanning

A57636

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Article Information

General Information

Article ID
A57636
Article Title
Billing and Coding: Duplex Scanning
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
05/20/2022
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

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33674 Duplex Scanning. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

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 duplex scan study(ies) is other than the ordering/referring physician, the provider of the service must maintain hard copy documentation of test results and interpretation, along with copies of the ordering/referring physician’s order for the studies.
  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. 

Coding Information

CPT/HCPCS Codes

Group 1

(2 Codes)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
CodeDescription
93975 Vascular study
93976 Vascular study

Group 2

(2 Codes)
Group 2 Paragraph

N/A

Group 2 Codes
CodeDescription
93978 Vascular study
93979 Vascular study

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(255 Codes)
Group 1 Paragraph

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.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 93975 and 93976.

Group 1 Codes
CodeDescription
D72.829 Elevated white blood cell count, unspecified
D72.89 Other specified disorders of white blood cells
G93.3 Postviral fatigue syndrome
I10 Essential (primary) hypertension
I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I70.1 Atherosclerosis of renal artery
I72.2 Aneurysm of renal artery
I72.8 Aneurysm of other specified arteries
I74.11 Embolism and thrombosis of thoracic aorta
I81 Portal vein thrombosis
I82.3 Embolism and thrombosis of renal vein
I85.00 Esophageal varices without bleeding
I85.01 Esophageal varices with bleeding
I85.10 Secondary esophageal varices without bleeding
I85.11 Secondary esophageal varices with bleeding
I86.1 Scrotal varices
K55.011 Focal (segmental) acute (reversible) ischemia of small intestine
K55.012 Diffuse acute (reversible) ischemia of small intestine
K55.019 Acute (reversible) ischemia of small intestine, extent unspecified
K55.021 Focal (segmental) acute infarction of small intestine
K55.022 Diffuse acute infarction of small intestine
K55.029 Acute infarction of small intestine, extent unspecified
K55.031 Focal (segmental) acute (reversible) ischemia of large intestine
K55.032 Diffuse acute (reversible) ischemia of large intestine
K55.039 Acute (reversible) ischemia of large intestine, extent unspecified
K55.041 Focal (segmental) acute infarction of large intestine
K55.042 Diffuse acute infarction of large intestine
K55.049 Acute infarction of large intestine, extent unspecified
K55.051 Focal (segmental) acute (reversible) ischemia of intestine, part unspecified
K55.052 Diffuse acute (reversible) ischemia of intestine, part unspecified
K55.059 Acute (reversible) ischemia of intestine, part and extent unspecified
K55.061 Focal (segmental) acute infarction of intestine, part unspecified
K55.062 Diffuse acute infarction of intestine, part unspecified
K55.069 Acute infarction of intestine, part and extent unspecified
K55.1 Chronic vascular disorders of intestine
K76.6 Portal hypertension
N18.1 Chronic kidney disease, stage 1
N18.2 Chronic kidney disease, stage 2 (mild)
N18.31 Chronic kidney disease, stage 3a
N18.32 Chronic kidney disease, stage 3b
N18.4 Chronic kidney disease, stage 4 (severe)
N18.5 Chronic kidney disease, stage 5
N28.0 Ischemia and infarction of kidney
N28.82 Megaloureter
N28.89 Other specified disorders of kidney and ureter
N44.00 Torsion of testis, unspecified
N44.1 Cyst of tunica albuginea testis
N44.2 Benign cyst of testis
N44.8 Other noninflammatory disorders of the testis
N50.1 Vascular disorders of male genital organs
N50.3 Cyst of epididymis
N50.811 Right testicular pain
N50.812 Left testicular pain
N50.819 Testicular pain, unspecified
N50.82 Scrotal pain
N50.89 Other specified disorders of the male genital organs
N50.9 Disorder of male genital organs, unspecified
N53.12 Painful ejaculation
N53.8 Other male sexual dysfunction
N53.9 Unspecified male sexual dysfunction
R09.89 Other specified symptoms and signs involving the circulatory and respiratory systems
R10.0 Acute abdomen
R10.10 Upper abdominal pain, unspecified
R10.11 Right upper quadrant pain
R10.12 Left upper quadrant pain
R10.13 Epigastric pain
R10.2 Pelvic and perineal pain
R10.30 Lower abdominal pain, unspecified
R10.31 Right lower quadrant pain
R10.32 Left lower quadrant pain
R10.33 Periumbilical pain
R10.84 Generalized abdominal pain
R10.9 Unspecified abdominal pain
R16.0 Hepatomegaly, not elsewhere classified
R16.1 Splenomegaly, not elsewhere classified
R16.2 Hepatomegaly with splenomegaly, not elsewhere classified
R18.0 Malignant ascites
R18.8 Other ascites
R19.00 Intra-abdominal and pelvic swelling, mass and lump, unspecified site
R19.01 Right upper quadrant abdominal swelling, mass and lump
R19.02 Left upper quadrant abdominal swelling, mass and lump
R19.03 Right lower quadrant abdominal swelling, mass and lump
R19.04 Left lower quadrant abdominal swelling, mass and lump
R19.05 Periumbilic swelling, mass or lump
R19.06 Epigastric swelling, mass or lump
R19.07 Generalized intra-abdominal and pelvic swelling, mass and lump
R19.09 Other intra-abdominal and pelvic swelling, mass and lump
R31.0 Gross hematuria
R31.1 Benign essential microscopic hematuria
R31.21 Asymptomatic microscopic hematuria
R31.29 Other microscopic hematuria
R31.9 Hematuria, unspecified
R53.0 Neoplastic (malignant) related fatigue
R53.1 Weakness
R53.81 Other malaise
R53.83 Other fatigue
R63.4 Abnormal weight loss
R93.5 Abnormal findings on diagnostic imaging of other abdominal regions, including retroperitoneum
S35.211A Minor laceration of celiac artery, initial encounter
S35.211D Minor laceration of celiac artery, subsequent encounter
S35.211S Minor laceration of celiac artery, sequela
S35.212A Major laceration of celiac artery, initial encounter
S35.212D Major laceration of celiac artery, subsequent encounter
S35.212S Major laceration of celiac artery, sequela
S35.218A Other injury of celiac artery, initial encounter
S35.218D Other injury of celiac artery, subsequent encounter
S35.218S Other injury of celiac artery, sequela
S35.219A Unspecified injury of celiac artery, initial encounter
S35.219D Unspecified injury of celiac artery, subsequent encounter
S35.219S Unspecified injury of celiac artery, sequela
S35.221A Minor laceration of superior mesenteric artery, initial encounter
S35.221D Minor laceration of superior mesenteric artery, subsequent encounter
S35.221S Minor laceration of superior mesenteric artery, sequela
S35.222A Major laceration of superior mesenteric artery, initial encounter
S35.222D Major laceration of superior mesenteric artery, subsequent encounter
S35.222S Major laceration of superior mesenteric artery, sequela
S35.228A Other injury of superior mesenteric artery, initial encounter
S35.228D Other injury of superior mesenteric artery, subsequent encounter
S35.228S Other injury of superior mesenteric artery, sequela
S35.229A Unspecified injury of superior mesenteric artery, initial encounter
S35.229D Unspecified injury of superior mesenteric artery, subsequent encounter
S35.229S Unspecified injury of superior mesenteric artery, sequela
S35.231A Minor laceration of inferior mesenteric artery, initial encounter
S35.231D Minor laceration of inferior mesenteric artery, subsequent encounter
S35.231S Minor laceration of inferior mesenteric artery, sequela
S35.232A Major laceration of inferior mesenteric artery, initial encounter
S35.232D Major laceration of inferior mesenteric artery, subsequent encounter
S35.232S Major laceration of inferior mesenteric artery, sequela
S35.238A Other injury of inferior mesenteric artery, initial encounter
S35.238D Other injury of inferior mesenteric artery, subsequent encounter
S35.238S Other injury of inferior mesenteric artery, sequela
S35.239A Unspecified injury of inferior mesenteric artery, initial encounter
S35.239D Unspecified injury of inferior mesenteric artery, subsequent encounter
S35.239S Unspecified injury of inferior mesenteric artery, sequela
S35.291A Minor laceration of branches of celiac and mesenteric artery, initial encounter
S35.291D Minor laceration of branches of celiac and mesenteric artery, subsequent encounter
S35.291S Minor laceration of branches of celiac and mesenteric artery, sequela
S35.292A Major laceration of branches of celiac and mesenteric artery, initial encounter
S35.292D Major laceration of branches of celiac and mesenteric artery, subsequent encounter
S35.292S Major laceration of branches of celiac and mesenteric artery, sequela
S35.298A Other injury of branches of celiac and mesenteric artery, initial encounter
S35.298D Other injury of branches of celiac and mesenteric artery, subsequent encounter
S35.298S Other injury of branches of celiac and mesenteric artery, sequela
S35.299A Unspecified injury of branches of celiac and mesenteric artery, initial encounter
S35.299D Unspecified injury of branches of celiac and mesenteric artery, subsequent encounter
S35.299S Unspecified injury of branches of celiac and mesenteric artery, sequela
S35.311A Laceration of portal vein, initial encounter
S35.311D Laceration of portal vein, subsequent encounter
S35.311S Laceration of portal vein, sequela
S35.318A Other specified injury of portal vein, initial encounter
S35.318D Other specified injury of portal vein, subsequent encounter
S35.318S Other specified injury of portal vein, sequela
S35.319A Unspecified injury of portal vein, initial encounter
S35.319D Unspecified injury of portal vein, subsequent encounter
S35.319S Unspecified injury of portal vein, sequela
S35.321A Laceration of splenic vein, initial encounter
S35.321D Laceration of splenic vein, subsequent encounter
S35.321S Laceration of splenic vein, sequela
S35.328A Other specified injury of splenic vein, initial encounter
S35.328D Other specified injury of splenic vein, subsequent encounter
S35.328S Other specified injury of splenic vein, sequela
S35.329A Unspecified injury of splenic vein, initial encounter
S35.329D Unspecified injury of splenic vein, subsequent encounter
S35.329S Unspecified injury of splenic vein, sequela
S35.331A Laceration of superior mesenteric vein, initial encounter
S35.331D Laceration of superior mesenteric vein, subsequent encounter
S35.331S Laceration of superior mesenteric vein, sequela
S35.338A Other specified injury of superior mesenteric vein, initial encounter
S35.338D Other specified injury of superior mesenteric vein, subsequent encounter
S35.338S Other specified injury of superior mesenteric vein, sequela
S35.339A Unspecified injury of superior mesenteric vein, initial encounter
S35.339D Unspecified injury of superior mesenteric vein, subsequent encounter
S35.339S Unspecified injury of superior mesenteric vein, sequela
S35.341A Laceration of inferior mesenteric vein, initial encounter
S35.341D Laceration of inferior mesenteric vein, subsequent encounter
S35.341S Laceration of inferior mesenteric vein, sequela
S35.348A Other specified injury of inferior mesenteric vein, initial encounter
S35.348D Other specified injury of inferior mesenteric vein, subsequent encounter
S35.348S Other specified injury of inferior mesenteric vein, sequela
S35.349A Unspecified injury of inferior mesenteric vein, initial encounter
S35.349D Unspecified injury of inferior mesenteric vein, subsequent encounter
S35.349S Unspecified injury of inferior mesenteric vein, sequela
S35.401A Unspecified injury of right renal artery, initial encounter
S35.401D Unspecified injury of right renal artery, subsequent encounter
S35.401S Unspecified injury of right renal artery, sequela
S35.402A Unspecified injury of left renal artery, initial encounter
S35.402D Unspecified injury of left renal artery, subsequent encounter
S35.402S Unspecified injury of left renal artery, sequela
S35.403A Unspecified injury of unspecified renal artery, initial encounter
S35.403D Unspecified injury of unspecified renal artery, subsequent encounter
S35.403S Unspecified injury of unspecified renal artery, sequela
S35.404A Unspecified injury of right renal vein, initial encounter
S35.404D Unspecified injury of right renal vein, subsequent encounter
S35.404S Unspecified injury of right renal vein, sequela
S35.405A Unspecified injury of left renal vein, initial encounter
S35.405D Unspecified injury of left renal vein, subsequent encounter
S35.405S Unspecified injury of left renal vein, sequela
S35.406A Unspecified injury of unspecified renal vein, initial encounter
S35.406D Unspecified injury of unspecified renal vein, subsequent encounter
S35.406S Unspecified injury of unspecified renal vein, sequela
S35.411A Laceration of right renal artery, initial encounter
S35.411D Laceration of right renal artery, subsequent encounter
S35.411S Laceration of right renal artery, sequela
S35.412A Laceration of left renal artery, initial encounter
S35.412D Laceration of left renal artery, subsequent encounter
S35.412S Laceration of left renal artery, sequela
S35.413A Laceration of unspecified renal artery, initial encounter
S35.413D Laceration of unspecified renal artery, subsequent encounter
S35.413S Laceration of unspecified renal artery, sequela
S35.414A Laceration of right renal vein, initial encounter
S35.414D Laceration of right renal vein, subsequent encounter
S35.414S Laceration of right renal vein, sequela
S35.415A Laceration of left renal vein, initial encounter
S35.415D Laceration of left renal vein, subsequent encounter
S35.415S Laceration of left renal vein, sequela
S35.416A Laceration of unspecified renal vein, initial encounter
S35.416D Laceration of unspecified renal vein, subsequent encounter
S35.416S Laceration of unspecified renal vein, sequela
S35.491A Other specified injury of right renal artery, initial encounter
S35.491D Other specified injury of right renal artery, subsequent encounter
S35.491S Other specified injury of right renal artery, sequela
S35.492A Other specified injury of left renal artery, initial encounter
S35.492D Other specified injury of left renal artery, subsequent encounter
S35.492S Other specified injury of left renal artery, sequela
S35.493A Other specified injury of unspecified renal artery, initial encounter
S35.493D Other specified injury of unspecified renal artery, subsequent encounter
S35.493S Other specified injury of unspecified renal artery, sequela
S35.494A Other specified injury of right renal vein, initial encounter
S35.494D Other specified injury of right renal vein, subsequent encounter
S35.494S Other specified injury of right renal vein, sequela
S35.495A Other specified injury of left renal vein, initial encounter
S35.495D Other specified injury of left renal vein, subsequent encounter
S35.495S Other specified injury of left renal vein, sequela
S35.496A Other specified injury of unspecified renal vein, initial encounter
S35.496D Other specified injury of unspecified renal vein, subsequent encounter
S35.496S Other specified injury of unspecified renal vein, sequela
S35.8X9A Unspecified injury of other blood vessels at abdomen, lower back and pelvis level, initial encounter
S35.8X9D Unspecified injury of other blood vessels at abdomen, lower back and pelvis level, subsequent encounter
S35.8X9S Unspecified injury of other blood vessels at abdomen, lower back and pelvis level, sequela
S35.90XA Unspecified injury of unspecified blood vessel at abdomen, lower back and pelvis level, initial encounter
S35.90XD Unspecified injury of unspecified blood vessel at abdomen, lower back and pelvis level, subsequent encounter
S35.90XS Unspecified injury of unspecified blood vessel at abdomen, lower back and pelvis level, sequela
S35.91XA Laceration of unspecified blood vessel at abdomen, lower back and pelvis level, initial encounter
S35.91XD Laceration of unspecified blood vessel at abdomen, lower back and pelvis level, subsequent encounter
S35.91XS Laceration of unspecified blood vessel at abdomen, lower back and pelvis level, sequela
S35.99XA Other specified injury of unspecified blood vessel at abdomen, lower back and pelvis level, initial encounter
S35.99XD Other specified injury of unspecified blood vessel at abdomen, lower back and pelvis level, subsequent encounter
S35.99XS Other specified injury of unspecified blood vessel at abdomen, lower back and pelvis level, sequela
Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
Z48.22 Encounter for aftercare following kidney transplant
Z48.23 Encounter for aftercare following liver transplant
Z94.0 Kidney transplant status
Z94.4 Liver transplant status
Z94.83 Pancreas transplant status

Group 2

(185 Codes)
Group 2 Paragraph

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.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 93978 and 93979.

Group 2 Codes
CodeDescription
I35.0 Nonrheumatic aortic (valve) stenosis
I35.1 Nonrheumatic aortic (valve) insufficiency
I35.2 Nonrheumatic aortic (valve) stenosis with insufficiency
I35.8 Other nonrheumatic aortic valve disorders
I35.9 Nonrheumatic aortic valve disorder, unspecified
I70.201 Unspecified atherosclerosis of native arteries of extremities, right leg
I70.202 Unspecified atherosclerosis of native arteries of extremities, left leg
I70.203 Unspecified atherosclerosis of native arteries of extremities, bilateral legs
I70.208 Unspecified atherosclerosis of native arteries of extremities, other extremity
I70.209 Unspecified atherosclerosis of native arteries of extremities, unspecified extremity
I70.211 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212 Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.218 Atherosclerosis of native arteries of extremities with intermittent claudication, other extremity
I70.219 Atherosclerosis of native arteries of extremities with intermittent claudication, unspecified extremity
I70.221 Atherosclerosis of native arteries of extremities with rest pain, right leg
I70.222 Atherosclerosis of native arteries of extremities with rest pain, left leg
I70.223 Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.228 Atherosclerosis of native arteries of extremities with rest pain, other extremity
I70.229 Atherosclerosis of native arteries of extremities with rest pain, unspecified extremity
I70.231 Atherosclerosis of native arteries of right leg with ulceration of thigh
I70.232 Atherosclerosis of native arteries of right leg with ulceration of calf
I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle
I70.234 Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot
I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot
I70.238 Atherosclerosis of native arteries of right leg with ulceration of other part of lower leg
I70.239 Atherosclerosis of native arteries of right leg with ulceration of unspecified site
I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh
I70.242 Atherosclerosis of native arteries of left leg with ulceration of calf
I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle
I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot
I70.245 Atherosclerosis of native arteries of left leg with ulceration of other part of foot
I70.248 Atherosclerosis of native arteries of left leg with ulceration of other part of lower leg
I70.249 Atherosclerosis of native arteries of left leg with ulceration of unspecified site
I70.25 Atherosclerosis of native arteries of other extremities with ulceration
I70.261 Atherosclerosis of native arteries of extremities with gangrene, right leg
I70.262 Atherosclerosis of native arteries of extremities with gangrene, left leg
I70.263 Atherosclerosis of native arteries of extremities with gangrene, bilateral legs
I70.268 Atherosclerosis of native arteries of extremities with gangrene, other extremity
I70.269 Atherosclerosis of native arteries of extremities with gangrene, unspecified extremity
I70.291 Other atherosclerosis of native arteries of extremities, right leg
I70.292 Other atherosclerosis of native arteries of extremities, left leg
I70.293 Other atherosclerosis of native arteries of extremities, bilateral legs
I70.298 Other atherosclerosis of native arteries of extremities, other extremity
I70.299 Other atherosclerosis of native arteries of extremities, unspecified extremity
I71.00 Dissection of unspecified site of aorta
I71.01 Dissection of thoracic aorta
I71.02 Dissection of abdominal aorta
I71.03 Dissection of thoracoabdominal aorta
I71.2 Thoracic aortic aneurysm, without rupture
I71.4 Abdominal aortic aneurysm, without rupture
I71.6 Thoracoabdominal aortic aneurysm, without rupture
I71.9 Aortic aneurysm of unspecified site, without rupture
I72.3 Aneurysm of iliac artery
I73.9 Peripheral vascular disease, unspecified
I74.11 Embolism and thrombosis of thoracic aorta
I74.5 Embolism and thrombosis of iliac artery
I79.0 Aneurysm of aorta in diseases classified elsewhere
I80.211 Phlebitis and thrombophlebitis of right iliac vein
I80.212 Phlebitis and thrombophlebitis of left iliac vein
I80.213 Phlebitis and thrombophlebitis of iliac vein, bilateral
I80.219 Phlebitis and thrombophlebitis of unspecified iliac vein
I82.220 Acute embolism and thrombosis of inferior vena cava
I82.221 Chronic embolism and thrombosis of inferior vena cava
I95.9 Hypotension, unspecified
M54.2 Cervicalgia
M54.50 Low back pain, unspecified
M54.51 Vertebrogenic low back pain
M54.59 Other low back pain
M54.6 Pain in thoracic spine
M79.601 Pain in right arm
M79.602 Pain in left arm
M79.603 Pain in arm, unspecified
M79.604 Pain in right leg
M79.605 Pain in left leg
M79.606 Pain in leg, unspecified
M79.609 Pain in unspecified limb
M79.621 Pain in right upper arm
M79.622 Pain in left upper arm
M79.629 Pain in unspecified upper arm
M79.631 Pain in right forearm
M79.632 Pain in left forearm
M79.639 Pain in unspecified forearm
M79.641 Pain in right hand
M79.642 Pain in left hand
M79.643 Pain in unspecified hand
M79.644 Pain in right finger(s)
M79.645 Pain in left finger(s)
M79.646 Pain in unspecified finger(s)
M79.651 Pain in right thigh
M79.652 Pain in left thigh
M79.659 Pain in unspecified thigh
M79.661 Pain in right lower leg
M79.662 Pain in left lower leg
M79.669 Pain in unspecified lower leg
M79.671 Pain in right foot
M79.672 Pain in left foot
M79.673 Pain in unspecified foot
M79.674 Pain in right toe(s)
M79.675 Pain in left toe(s)
M79.676 Pain in unspecified toe(s)
R05.1 Acute cough
R05.2 Subacute cough
R05.3 Chronic cough
R05.4 Cough syncope
R05.8 Other specified cough
R05.9 Cough, unspecified
R06.02 Shortness of breath
R06.1 Stridor
R07.9 Chest pain, unspecified
R09.89 Other specified symptoms and signs involving the circulatory and respiratory systems
R10.0 Acute abdomen
R10.10 Upper abdominal pain, unspecified
R10.11 Right upper quadrant pain
R10.12 Left upper quadrant pain
R10.13 Epigastric pain
R10.2 Pelvic and perineal pain
R10.30 Lower abdominal pain, unspecified
R10.31 Right lower quadrant pain
R10.32 Left lower quadrant pain
R10.33 Periumbilical pain
R10.84 Generalized abdominal pain
R10.9 Unspecified abdominal pain
R19.00 Intra-abdominal and pelvic swelling, mass and lump, unspecified site
R19.01 Right upper quadrant abdominal swelling, mass and lump
R19.02 Left upper quadrant abdominal swelling, mass and lump
R19.03 Right lower quadrant abdominal swelling, mass and lump
R19.04 Left lower quadrant abdominal swelling, mass and lump
R19.05 Periumbilic swelling, mass or lump
R19.06 Epigastric swelling, mass or lump
R19.07 Generalized intra-abdominal and pelvic swelling, mass and lump
R19.09 Other intra-abdominal and pelvic swelling, mass and lump
R20.0 Anesthesia of skin
R20.1 Hypoesthesia of skin
R20.2 Paresthesia of skin
R20.3 Hyperesthesia
R20.8 Other disturbances of skin sensation
R20.9 Unspecified disturbances of skin sensation
R23.0 Cyanosis
R23.1 Pallor
R23.4 Changes in skin texture
R47.02 Dysphasia
R47.1 Dysarthria and anarthria
R47.81 Slurred speech
R47.89 Other speech disturbances
R47.9 Unspecified speech disturbances
R49.0 Dysphonia
R49.22 Hyponasality
R49.8 Other voice and resonance disorders
R60.0 Localized edema
R60.1 Generalized edema
R60.9 Edema, unspecified
R93.5 Abnormal findings on diagnostic imaging of other abdominal regions, including retroperitoneum
S35.00XA Unspecified injury of abdominal aorta, initial encounter
S35.00XD Unspecified injury of abdominal aorta, subsequent encounter
S35.00XS Unspecified injury of abdominal aorta, sequela
S35.01XA Minor laceration of abdominal aorta, initial encounter
S35.01XD Minor laceration of abdominal aorta, subsequent encounter
S35.01XS Minor laceration of abdominal aorta, sequela
S35.02XA Major laceration of abdominal aorta, initial encounter
S35.02XD Major laceration of abdominal aorta, subsequent encounter
S35.02XS Major laceration of abdominal aorta, sequela
S35.09XA Other injury of abdominal aorta, initial encounter
S35.09XD Other injury of abdominal aorta, subsequent encounter
S35.09XS Other injury of abdominal aorta, sequela
S35.511A Injury of right iliac artery, initial encounter
S35.511D Injury of right iliac artery, subsequent encounter
S35.511S Injury of right iliac artery, sequela
S35.512A Injury of left iliac artery, initial encounter
S35.512D Injury of left iliac artery, subsequent encounter
S35.512S Injury of left iliac artery, sequela
S35.513A Injury of unspecified iliac artery, initial encounter
S35.513D Injury of unspecified iliac artery, subsequent encounter
S35.513S Injury of unspecified iliac artery, sequela
S35.514A Injury of right iliac vein, initial encounter
S35.514D Injury of right iliac vein, subsequent encounter
S35.514S Injury of right iliac vein, sequela
S35.515A Injury of left iliac vein, initial encounter
S35.515D Injury of left iliac vein, subsequent encounter
S35.515S Injury of left iliac vein, sequela
S35.516A Injury of unspecified iliac vein, initial encounter
S35.516D Injury of unspecified iliac vein, subsequent encounter
S35.516S Injury of unspecified iliac vein, sequela
Z08 Encounter for follow-up examination after completed treatment for malignant neoplasm
Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm

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 Support Medical Necessity” section of this article.

Group 1 Codes
CodeDescription
XX000 Not Applicable

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.

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

Revision History DateRevision History NumberRevision History Explanation
05/20/2022 R3

Article revised and published on 06/30/2022 effective for dates of service on and after 05/20/2022 in response to an inquiry. ICD-10 codes Z48.23 and Z94.4 have been added to the ‘ICD-10-CM Codes that Support Medical Necessity’ section for ‘Group 1 Codes’.

10/01/2021 R2

Article revised and published on 10/14/2021 effective for dates of service on and after 10/01/2021 to reflect the Annual ICD-10-CM Code Update. The following ICD-10-CM Group 2 codes that support medical necessity have been deleted and therefore removed from the article: M54.5 and R05. The following ICD-10-CM codes have been added to the ICD-10-CM codes that support medical necessity Group 2 codes: M54.50, M54.51, M54.59, R05.1, R05.2, R05.3, R05.4, R05.8 and R05.9.

10/01/2020 R1

Revision Number: 1
Publication: September 2020 Connection
LCR A/B2020-065

Explanation of revision: Based on CR 11895 and CR 11845 (Annual 2021 ICD-10-CM Update), the “ICD-10 Codes that Support Medical Necessity/ Group 1 Codes:” section of this billing and coding article was revised to delete ICD-10-CM code N18.3 and replace it with ICD-10-CM codes N18.31 and N18.32, respectively. In addition, formatting changes have been made throughout the article. The effective date of this revision is based on date of service.

Associated Documents

Related Local Coverage Documents
LCDs
L33674 - Duplex Scanning
Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Public Versions
Updated On Effective Dates Status
06/24/2022 05/20/2022 - N/A Currently in Effect You are here
10/08/2021 10/01/2021 - 05/19/2022 Superseded View
09/25/2020 10/01/2020 - 09/30/2021 Superseded View
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Keywords

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