SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Heavy Metal Testing

A56767

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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Source Article ID
N/A
Article ID
A56767
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Heavy Metal Testing
Article Type
Billing and Coding
Original Effective Date
11/07/2019
Revision Effective Date
10/01/2021
Revision Ending Date
N/A
Retirement Date
N/A

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Current Dental Terminology © 2023 American Dental Association. All rights reserved.

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CMS National Coverage Policy

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Article Guidance

Article Text

This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Heavy Metal Testing.

Coding Information:

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare.

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act.

The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported.

 

Response To Comments

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1
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Coding Information

Bill Type Codes

Code Description

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Revenue Codes

Code Description

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(129 Codes)
Group 1 Paragraph

The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the related determination.

Aluminum

Group 1 Codes
Code Description
F06.8 Other specified mental disorders due to known physiological condition
F11.121 Opioid abuse with intoxication delirium
F11.122 Opioid abuse with intoxication with perceptual disturbance
F11.14 Opioid abuse with opioid-induced mood disorder
F11.188 Opioid abuse with other opioid-induced disorder
F11.221 Opioid dependence with intoxication delirium
F11.24 Opioid dependence with opioid-induced mood disorder
F11.288 Opioid dependence with other opioid-induced disorder
F11.921 Opioid use, unspecified with intoxication delirium
F11.929 Opioid use, unspecified with intoxication, unspecified
F11.94 Opioid use, unspecified with opioid-induced mood disorder
F11.988 Opioid use, unspecified with other opioid-induced disorder
F12.121 Cannabis abuse with intoxication delirium
F12.129 Cannabis abuse with intoxication, unspecified
F12.159 Cannabis abuse with psychotic disorder, unspecified
F12.188 Cannabis abuse with other cannabis-induced disorder
F12.221 Cannabis dependence with intoxication delirium
F12.229 Cannabis dependence with intoxication, unspecified
F12.288 Cannabis dependence with other cannabis-induced disorder
F12.921 Cannabis use, unspecified with intoxication delirium
F12.929 Cannabis use, unspecified with intoxication, unspecified
F12.988 Cannabis use, unspecified with other cannabis-induced disorder
F13.121 Sedative, hypnotic or anxiolytic abuse with intoxication delirium
F13.129 Sedative, hypnotic or anxiolytic abuse with intoxication, unspecified
F13.14 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced mood disorder
F13.159 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified
F13.188 Sedative, hypnotic or anxiolytic abuse with other sedative, hypnotic or anxiolytic-induced disorder
F13.221 Sedative, hypnotic or anxiolytic dependence with intoxication delirium
F13.229 Sedative, hypnotic or anxiolytic dependence with intoxication, unspecified
F13.24 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced mood disorder
F13.259 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified
F13.26 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder
F13.27 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting dementia
F13.921 Sedative, hypnotic or anxiolytic use, unspecified with intoxication delirium
F13.929 Sedative, hypnotic or anxiolytic use, unspecified with intoxication, unspecified
F13.94 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced mood disorder
F13.96 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder
F13.97 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting dementia
F13.988 Sedative, hypnotic or anxiolytic use, unspecified with other sedative, hypnotic or anxiolytic-induced disorder
F14.121 Cocaine abuse with intoxication with delirium
F14.129 Cocaine abuse with intoxication, unspecified
F14.14 Cocaine abuse with cocaine-induced mood disorder
F14.188 Cocaine abuse with other cocaine-induced disorder
F14.221 Cocaine dependence with intoxication delirium
F14.229 Cocaine dependence with intoxication, unspecified
F14.24 Cocaine dependence with cocaine-induced mood disorder
F14.288 Cocaine dependence with other cocaine-induced disorder
F14.921 Cocaine use, unspecified with intoxication delirium
F14.929 Cocaine use, unspecified with intoxication, unspecified
F14.94 Cocaine use, unspecified with cocaine-induced mood disorder
F14.988 Cocaine use, unspecified with other cocaine-induced disorder
F15.121 Other stimulant abuse with intoxication delirium
F15.129 Other stimulant abuse with intoxication, unspecified
F15.14 Other stimulant abuse with stimulant-induced mood disorder
F15.188 Other stimulant abuse with other stimulant-induced disorder
F15.221 Other stimulant dependence with intoxication delirium
F15.229 Other stimulant dependence with intoxication, unspecified
F15.24 Other stimulant dependence with stimulant-induced mood disorder
F15.288 Other stimulant dependence with other stimulant-induced disorder
F15.921 Other stimulant use, unspecified with intoxication delirium
F15.929 Other stimulant use, unspecified with intoxication, unspecified
F15.94 Other stimulant use, unspecified with stimulant-induced mood disorder
F15.988 Other stimulant use, unspecified with other stimulant-induced disorder
F16.121 Hallucinogen abuse with intoxication with delirium
F16.129 Hallucinogen abuse with intoxication, unspecified
F16.14 Hallucinogen abuse with hallucinogen-induced mood disorder
F16.188 Hallucinogen abuse with other hallucinogen-induced disorder
F16.221 Hallucinogen dependence with intoxication with delirium
F16.229 Hallucinogen dependence with intoxication, unspecified
F16.24 Hallucinogen dependence with hallucinogen-induced mood disorder
F16.288 Hallucinogen dependence with other hallucinogen-induced disorder
F16.921 Hallucinogen use, unspecified with intoxication with delirium
F16.929 Hallucinogen use, unspecified with intoxication, unspecified
F16.94 Hallucinogen use, unspecified with hallucinogen-induced mood disorder
F16.988 Hallucinogen use, unspecified with other hallucinogen-induced disorder
F18.121 Inhalant abuse with intoxication delirium
F18.129 Inhalant abuse with intoxication, unspecified
F18.14 Inhalant abuse with inhalant-induced mood disorder
F18.17 Inhalant abuse with inhalant-induced dementia
F18.188 Inhalant abuse with other inhalant-induced disorder
F18.221 Inhalant dependence with intoxication delirium
F18.229 Inhalant dependence with intoxication, unspecified
F18.24 Inhalant dependence with inhalant-induced mood disorder
F18.27 Inhalant dependence with inhalant-induced dementia
F18.288 Inhalant dependence with other inhalant-induced disorder
F18.921 Inhalant use, unspecified with intoxication with delirium
F18.929 Inhalant use, unspecified with intoxication, unspecified
F18.94 Inhalant use, unspecified with inhalant-induced mood disorder
F18.97 Inhalant use, unspecified with inhalant-induced persisting dementia
F18.988 Inhalant use, unspecified with other inhalant-induced disorder
F19.121 Other psychoactive substance abuse with intoxication delirium
F19.129 Other psychoactive substance abuse with intoxication, unspecified
F19.14 Other psychoactive substance abuse with psychoactive substance-induced mood disorder
F19.16 Other psychoactive substance abuse with psychoactive substance-induced persisting amnestic disorder
F19.17 Other psychoactive substance abuse with psychoactive substance-induced persisting dementia
F19.188 Other psychoactive substance abuse with other psychoactive substance-induced disorder
F19.221 Other psychoactive substance dependence with intoxication delirium
F19.229 Other psychoactive substance dependence with intoxication, unspecified
F19.24 Other psychoactive substance dependence with psychoactive substance-induced mood disorder
F19.26 Other psychoactive substance dependence with psychoactive substance-induced persisting amnestic disorder
F19.27 Other psychoactive substance dependence with psychoactive substance-induced persisting dementia
F19.288 Other psychoactive substance dependence with other psychoactive substance-induced disorder
F19.921 Other psychoactive substance use, unspecified with intoxication with delirium
F19.929 Other psychoactive substance use, unspecified with intoxication, unspecified
F19.94 Other psychoactive substance use, unspecified with psychoactive substance-induced mood disorder
F19.96 Other psychoactive substance use, unspecified with psychoactive substance-induced persisting amnestic disorder
F19.97 Other psychoactive substance use, unspecified with psychoactive substance-induced persisting dementia
F19.988 Other psychoactive substance use, unspecified with other psychoactive substance-induced disorder
N18.1 Chronic kidney disease, stage 1
N18.2 Chronic kidney disease, stage 2 (mild)
N18.30 Chronic kidney disease, stage 3 unspecified
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
N18.6 End stage renal disease
N18.9 Chronic kidney disease, unspecified
T47.0X4A Poisoning by histamine H2-receptor blockers, undetermined, initial encounter
T47.0X4D Poisoning by histamine H2-receptor blockers, undetermined, subsequent encounter
T47.0X4S Poisoning by histamine H2-receptor blockers, undetermined, sequela
T47.1X4A Poisoning by other antacids and anti-gastric-secretion drugs, undetermined, initial encounter
T47.1X4D Poisoning by other antacids and anti-gastric-secretion drugs, undetermined, subsequent encounter
T47.1X4S Poisoning by other antacids and anti-gastric-secretion drugs, undetermined, sequela
T56.894A Toxic effect of other metals, undetermined, initial encounter
T56.894D Toxic effect of other metals, undetermined, subsequent encounter
T56.894S Toxic effect of other metals, undetermined, sequela
T82.898A Other specified complication of vascular prosthetic devices, implants and grafts, initial encounter
T82.898D Other specified complication of vascular prosthetic devices, implants and grafts, subsequent encounter
T82.898S Other specified complication of vascular prosthetic devices, implants and grafts, sequela

Group 2

(4 Codes)
Group 2 Paragraph

Antimony

Group 2 Codes
Code Description
B55.9 Leishmaniasis, unspecified
T56.891A Toxic effect of other metals, accidental (unintentional), initial encounter
T56.891D Toxic effect of other metals, accidental (unintentional), subsequent encounter
T56.891S Toxic effect of other metals, accidental (unintentional), sequela

Group 3

(33 Codes)
Group 3 Paragraph

Arsenic

Group 3 Codes
Code Description
D61.1 Drug-induced aplastic anemia
D61.2 Aplastic anemia due to other external agents
D61.3 Idiopathic aplastic anemia
D61.89 Other specified aplastic anemias and other bone marrow failure syndromes
G60.0 Hereditary motor and sensory neuropathy
G60.2 Neuropathy in association with hereditary ataxia
G60.9 Hereditary and idiopathic neuropathy, unspecified
G61.1 Serum neuropathy
G62.2 Polyneuropathy due to other toxic agents
G62.82 Radiation-induced polyneuropathy
G93.40 Encephalopathy, unspecified
G93.41 Metabolic encephalopathy
G93.49 Other encephalopathy
I67.83 Posterior reversible encephalopathy syndrome
K52.21 Food protein-induced enterocolitis syndrome
K52.22 Food protein-induced enteropathy
K52.29 Other allergic and dietetic gastroenteritis and colitis
K52.89 Other specified noninfective gastroenteritis and colitis
K63.4 Enteroptosis
K63.89 Other specified diseases of intestine
K92.89 Other specified diseases of the digestive system
L23.1 Allergic contact dermatitis due to adhesives
L23.5 Allergic contact dermatitis due to other chemical products
L24.5 Irritant contact dermatitis due to other chemical products
L25.3 Unspecified contact dermatitis due to other chemical products
N03.9 Chronic nephritic syndrome with unspecified morphologic changes
R11.15 Cyclical vomiting syndrome unrelated to migraine
R11.2 Nausea with vomiting, unspecified
R19.7 Diarrhea, unspecified
R63.4 Abnormal weight loss
T57.0X4A Toxic effect of arsenic and its compounds, undetermined, initial encounter
T57.0X4D Toxic effect of arsenic and its compounds, undetermined, subsequent encounter
T57.0X4S Toxic effect of arsenic and its compounds, undetermined, sequela

Group 4

(4 Codes)
Group 4 Paragraph

Barium

Group 4 Codes
Code Description
J98.4 Other disorders of lung
T56.894A Toxic effect of other metals, undetermined, initial encounter
T56.894D Toxic effect of other metals, undetermined, subsequent encounter
T56.894S Toxic effect of other metals, undetermined, sequela

Group 5

(4 Codes)
Group 5 Paragraph

Beryllium

Group 5 Codes
Code Description
J98.4 Other disorders of lung
T56.7X4A Toxic effect of beryllium and its compounds, undetermined, initial encounter
T56.7X4D Toxic effect of beryllium and its compounds, undetermined, subsequent encounter
T56.7X4S Toxic effect of beryllium and its compounds, undetermined, sequela

Group 6

(9 Codes)
Group 6 Paragraph

Bismuth

Group 6 Codes
Code Description
D74.8 Other methemoglobinemias
D74.9 Methemoglobinemia, unspecified
K05.5 Other periodontal diseases
M84.40XA Pathological fracture, unspecified site, initial encounter for fracture
M84.40XD Pathological fracture, unspecified site, subsequent encounter for fracture with routine healing
M84.40XS Pathological fracture, unspecified site, sequela
T56.894A Toxic effect of other metals, undetermined, initial encounter
T56.894D Toxic effect of other metals, undetermined, subsequent encounter
T56.894S Toxic effect of other metals, undetermined, sequela

Group 7

(5 Codes)
Group 7 Paragraph

Cadmium

Group 7 Codes
Code Description
J98.4 Other disorders of lung
N19 Unspecified kidney failure
T56.3X4A Toxic effect of cadmium and its compounds, undetermined, initial encounter
T56.3X4D Toxic effect of cadmium and its compounds, undetermined, subsequent encounter
T56.3X4S Toxic effect of cadmium and its compounds, undetermined, sequela

Group 8

(4 Codes)
Group 8 Paragraph

Chromium

Group 8 Codes
Code Description
J98.4 Other disorders of lung
T56.2X4A Toxic effect of chromium and its compounds, undetermined, initial encounter
T56.2X4D Toxic effect of chromium and its compounds, undetermined, subsequent encounter
T56.2X4S Toxic effect of chromium and its compounds, undetermined, sequela

Group 9

(4 Codes)
Group 9 Paragraph

Cobalt

Group 9 Codes
Code Description
J98.4 Other disorders of lung
T56.894A Toxic effect of other metals, undetermined, initial encounter
T56.894D Toxic effect of other metals, undetermined, subsequent encounter
T56.894S Toxic effect of other metals, undetermined, sequela

Group 10

(31 Codes)
Group 10 Paragraph

Copper

Group 10 Codes
Code Description
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.20 Refractory anemia with excess of blasts, unspecified
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.4 Refractory anemia, unspecified
D46.Z Other myelodysplastic syndromes
D46.9 Myelodysplastic syndrome, unspecified
E83.00 Disorder of copper metabolism, unspecified
E83.09 Other disorders of copper metabolism
I42.9 Cardiomyopathy, unspecified
J98.4 Other disorders of lung
K73.0 Chronic persistent hepatitis, not elsewhere classified
K73.9 Chronic hepatitis, unspecified
K74.60 Unspecified cirrhosis of liver
K74.69 Other cirrhosis of liver
K76.9 Liver disease, unspecified
N19 Unspecified kidney failure
Q89.8 Other specified congenital malformations
R63.30 Feeding difficulties, unspecified
R63.31 Pediatric feeding disorder, acute
R63.32 Pediatric feeding disorder, chronic
R63.39 Other feeding difficulties
R74.8 Abnormal levels of other serum enzymes
R74.9 Abnormal serum enzyme level, unspecified
T56.894A Toxic effect of other metals, undetermined, initial encounter
T56.894D Toxic effect of other metals, undetermined, subsequent encounter
T56.894S Toxic effect of other metals, undetermined, sequela

Group 11

(18 Codes)
Group 11 Paragraph

Lead

Group 11 Codes
Code Description
G58.8 Other specified mononeuropathies
G58.9 Mononeuropathy, unspecified
G60.0 Hereditary motor and sensory neuropathy
G60.1 Refsum's disease
G60.2 Neuropathy in association with hereditary ataxia
G60.3 Idiopathic progressive neuropathy
G60.8 Other hereditary and idiopathic neuropathies
G60.9 Hereditary and idiopathic neuropathy, unspecified
G93.40 Encephalopathy, unspecified
G93.41 Metabolic encephalopathy
G93.49 Other encephalopathy
R71.0 Precipitous drop in hematocrit
R71.8 Other abnormality of red blood cells
R93.6 Abnormal findings on diagnostic imaging of limbs
R93.7 Abnormal findings on diagnostic imaging of other parts of musculoskeletal system
T56.0X4A Toxic effect of lead and its compounds, undetermined, initial encounter
T56.0X4D Toxic effect of lead and its compounds, undetermined, subsequent encounter
T56.0X4S Toxic effect of lead and its compounds, undetermined, sequela

Group 12

(13 Codes)
Group 12 Paragraph

Manganese

Group 12 Codes
Code Description
G25.70 Drug induced movement disorder, unspecified
G25.71 Drug induced akathisia
G25.79 Other drug induced movement disorders
G25.89 Other specified extrapyramidal and movement disorders
G25.9 Extrapyramidal and movement disorder, unspecified
G26 Extrapyramidal and movement disorders in diseases classified elsewhere
R63.30 Feeding difficulties, unspecified
R63.31 Pediatric feeding disorder, acute
R63.32 Pediatric feeding disorder, chronic
R63.39 Other feeding difficulties
T57.2X4A Toxic effect of manganese and its compounds, undetermined, initial encounter
T57.2X4D Toxic effect of manganese and its compounds, undetermined, subsequent encounter
T57.2X4S Toxic effect of manganese and its compounds, undetermined, sequela

Group 13

(32 Codes)
Group 13 Paragraph

Mercury

Group 13 Codes
Code Description
G11.10 Early-onset cerebellar ataxia, unspecified
G11.11 Friedreich ataxia
G11.19 Other early-onset cerebellar ataxia
G25.70 Drug induced movement disorder, unspecified
G25.71 Drug induced akathisia
G25.79 Other drug induced movement disorders
G25.89 Other specified extrapyramidal and movement disorders
G25.9 Extrapyramidal and movement disorder, unspecified
G26 Extrapyramidal and movement disorders in diseases classified elsewhere
G32.81 Cerebellar ataxia in diseases classified elsewhere
I69.093 Ataxia following nontraumatic subarachnoid hemorrhage
I69.193 Ataxia following nontraumatic intracerebral hemorrhage
I69.293 Ataxia following other nontraumatic intracranial hemorrhage
I69.393 Ataxia following cerebral infarction
I69.893 Ataxia following other cerebrovascular disease
I69.993 Ataxia following unspecified cerebrovascular disease
N19 Unspecified kidney failure
R27.0 Ataxia, unspecified
R27.8 Other lack of coordination
R27.9 Unspecified lack of coordination
T37.8X1A Poisoning by other specified systemic anti-infectives and antiparasitics, accidental (unintentional), initial encounter
T37.8X1D Poisoning by other specified systemic anti-infectives and antiparasitics, accidental (unintentional), subsequent encounter
T37.8X1S Poisoning by other specified systemic anti-infectives and antiparasitics, accidental (unintentional), sequela
T47.4X4A Poisoning by other laxatives, undetermined, initial encounter
T47.4X4D Poisoning by other laxatives, undetermined, subsequent encounter
T47.4X4S Poisoning by other laxatives, undetermined, sequela
T49.8X4A Poisoning by other topical agents, undetermined, initial encounter
T49.8X4D Poisoning by other topical agents, undetermined, subsequent encounter
T49.8X4S Poisoning by other topical agents, undetermined, sequela
T56.1X4A Toxic effect of mercury and its compounds, undetermined, initial encounter
T56.1X4D Toxic effect of mercury and its compounds, undetermined, subsequent encounter
T56.1X4S Toxic effect of mercury and its compounds, undetermined, sequela

Group 14

(3 Codes)
Group 14 Paragraph

Molybdenum

Group 14 Codes
Code Description
T56.894A Toxic effect of other metals, undetermined, initial encounter
T56.894D Toxic effect of other metals, undetermined, subsequent encounter
T56.894S Toxic effect of other metals, undetermined, sequela

Group 15

(5 Codes)
Group 15 Paragraph

Nickel

Group 15 Codes
Code Description
J98.4 Other disorders of lung
N19 Unspecified kidney failure
T56.894A Toxic effect of other metals, undetermined, initial encounter
T56.894D Toxic effect of other metals, undetermined, subsequent encounter
T56.894S Toxic effect of other metals, undetermined, sequela

Group 16

(4 Codes)
Group 16 Paragraph

Selenium

Group 16 Codes
Code Description
N19 Unspecified kidney failure
T56.894A Toxic effect of other metals, undetermined, initial encounter
T56.894D Toxic effect of other metals, undetermined, subsequent encounter
T56.894S Toxic effect of other metals, undetermined, sequela

Group 17

(7 Codes)
Group 17 Paragraph

Thallium

Group 17 Codes
Code Description
G62.2 Polyneuropathy due to other toxic agents
R27.0 Ataxia, unspecified
R27.8 Other lack of coordination
R27.9 Unspecified lack of coordination
T56.814A Toxic effect of thallium, undetermined, initial encounter
T56.814D Toxic effect of thallium, undetermined, subsequent encounter
T56.814S Toxic effect of thallium, undetermined, sequela

Group 18

(3 Codes)
Group 18 Paragraph

Tin

Group 18 Codes
Code Description
T56.6X4A Toxic effect of tin and its compounds, undetermined, initial encounter
T56.6X4D Toxic effect of tin and its compounds, undetermined, subsequent encounter
T56.6X4S Toxic effect of tin and its compounds, undetermined, sequela

Group 19

(3 Codes)
Group 19 Paragraph

Titanium

Group 19 Codes
Code Description
T56.894A Toxic effect of other metals, undetermined, initial encounter
T56.894D Toxic effect of other metals, undetermined, subsequent encounter
T56.894S Toxic effect of other metals, undetermined, sequela

Group 20

(48 Codes)
Group 20 Paragraph

Zinc

Group 20 Codes
Code Description
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.20 Refractory anemia with excess of blasts, unspecified
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.4 Refractory anemia, unspecified
D46.Z Other myelodysplastic syndromes
D46.9 Myelodysplastic syndrome, unspecified
K50.00 - K50.919 Crohn's disease of small intestine without complications - Crohn's disease, unspecified, with unspecified complications
K90.9 Intestinal malabsorption, unspecified
N19 Unspecified kidney failure
R63.30 Feeding difficulties, unspecified
R63.31 Pediatric feeding disorder, acute
R63.32 Pediatric feeding disorder, chronic
R63.39 Other feeding difficulties
T56.5X4A Toxic effect of zinc and its compounds, undetermined, initial encounter
T56.5X4D Toxic effect of zinc and its compounds, undetermined, subsequent encounter
T56.5X4S Toxic effect of zinc and its compounds, undetermined, sequela
N/A

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

Group 1

(1 Code)
Group 1 Paragraph

ICD10 codes not listed above

Group 1 Codes
Code Description
XX000 Not Applicable
N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

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.

Code Description

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N/A

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.

Code Description

Please accept the License to see the codes.

N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2021 R3

Based on the annual ICD-10 updates for 2022, R63.3 was deleted from ICD-10 Codes that Support Medical Necessity Group 10, Group 12, and Group 20 and replaced by R63.30, R63.31, R63.32, and R63.39.

10/01/2020 R2

Correct typographical error in Revision History dated 10/01/2020. G11.12 should read G11.11.

10/01/2020 R1

Based on the annual ICD-10 updates for 2021, G11.1 was deleted from ICD-10 Codes that Support Medical Necessity, Group 13 and replaced by G11.10, G11.12, and G11.19.  N18.3 was deleted from ICD-10 Codes that Support Medical Necessity, Group 1 and replaced by N18.30, N18.31, and N18.32.

N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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