SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Transthoracic Echocardiography (TTE)

A57306

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Source Article ID
N/A
Article ID
A57306
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Transthoracic Echocardiography (TTE)
Article Type
Billing and Coding
Original Effective Date
09/26/2019
Revision Effective Date
11/16/2023
Revision Ending Date
N/A
Retirement Date
N/A

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

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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. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

Title XVIII of the Social Security Act (SSA):

Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Section 1862(a)(7) of Title XVIII of the Social Security Act excludes routine physical examination, unless otherwise covered by statute.

Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Code of Federal Regulations:

42 CFR, Section 410.32, indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) and the results must be used in the management of the patient.

42 CFR 410.33 provides credentialing requirements for testing performed in an IDTF by technicians.

CMS Publications:

CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 9:

    100 General Billing Requirements

CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 12:

    30.4 Cardiovascular System (Codes 92950-93799)

Article Guidance

Article Text

This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy DL34338-Transthoracic Echocardiography (TTE).

 

General Guidelines for Claims submitted to Part A or Part B MAC:

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.

 

Advance Beneficiary Notice of Non-coverage (ABN) Modifier Guidelines

An ABN may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.

Effective from April 1, 2010, non-covered services should be billed with modifier –GA, -GX, -GY, or –GZ, as appropriate.

The –GA modifier (“Waiver of Liability Statement Issued as Required by Payer Policy”) should be used when physicians, practitioners, or suppliers want to indicate that they anticipate that Medicare will deny a specific service as not reasonable and necessary, and they do have an ABN signed by the beneficiary on file. Modifier GA applies only when services will be denied under reasonable and necessary provisions, sections 1862(a)(1), 1862(a)(9), 1879(e), or 1879(g) of the Social Security Act. Effective April 1, 2010, Part A MAC systems will automatically deny services billed with modifier GA. An ABN, Form CMS-R-131, should be signed by the beneficiary to indicate that ‎he/she accepts responsibility for payment.‎ The -GA modifier may also be used on assigned claims when a patient refuses to sign the ABN and the latter is properly witnessed. For claims submitted to the Part A MAC, occurrence code 32 and the date of the ABN is required.

 

Modifier GX (“Notice of Liability Issued, Voluntary Under Payer Policy”) should be used when the beneficiary has signed an ABN, and a denial is anticipated based on provisions other than medical necessity, such as statutory exclusions of coverage or technical issues. An ABN is not required for these denials, but if non-covered services are reported with modifier GX, will automatically be denied services.

 

The –GZ modifier should be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary and they have not had an ABN signed by the beneficiary. ‎If the service is statutorily non-covered, or without a benefit category, submit the ‎appropriate CPT/HCPCS code with the -GY modifier. An ABN is not required for these denials, and the limitation of liability does not apply for beneficiaries. Services with modifier GY will automatically deny.

CAMZYOS REMS program

Echocardiograms done as part of the CAMZYOS REMS program must be billed with a KX modifier and meet all requirements of the REMS program. This program is limited to patients with NYHA Class II-III Obstructive Hypertrophic Cardiomyopathy (I42.1).

Documentation Requirements

The patient’s medical record should include but is not limited to:

  • The assessment of the patient by the ordering provider as it relates to the complaint of the patient for that visit,
  • Relevant medical history
  • Results of pertinent tests/procedures
  • Signed and dated office visit record/operative report (Please note that all services ordered or rendered to Medicare beneficiaries must be signed.)

Response To Comments

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Coding Information

Bill Type Codes

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Revenue Codes

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(1,086 Codes)
Group 1 Paragraph

It is the responsibility of the provider to code to the highest level specified in the ICD-10-CM. The correct use of an ICD-10-CM code does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.

Applicable to codes: 93306, 93307, 93308, 93320, 93321, 93325, C8923, C8924, and C8929.

Group 1 Codes
Code Description
A18.84 Tuberculosis of heart
A36.81 Diphtheritic cardiomyopathy
A39.53 Meningococcal pericarditis
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 - A41.4 Sepsis due to other specified staphylococcus - Sepsis due to anaerobes
A41.50 - A41.53 Gram-negative sepsis, unspecified - 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
A42.7 Actinomycotic sepsis
A52.01 - A52.03 Syphilitic aneurysm of aorta - Syphilitic endocarditis
A52.06 Other syphilitic heart involvement
A54.83 Gonococcal heart infection
A69.21 - A69.23 Meningitis due to Lyme disease - Arthritis due to Lyme disease
A69.29 Other conditions associated with Lyme disease
B33.20 - B33.23 Viral carditis, unspecified - Viral pericarditis
B37.6 Candidal endocarditis
B39.4* Histoplasmosis capsulati, unspecified
B39.5* Histoplasmosis duboisii
B57.0 Acute Chagas' disease with heart involvement
B57.2 Chagas' disease (chronic) with heart involvement
B58.81 Toxoplasma myocarditis
C38.0 Malignant neoplasm of heart
C45.2 Mesothelioma of pericardium
C79.89 Secondary malignant neoplasm of other specified sites
D15.1 Benign neoplasm of heart
D48.7 Neoplasm of uncertain behavior of other specified sites
D49.89 Neoplasm of unspecified behavior of other specified sites
D86.0 - D86.3 Sarcoidosis of lung - Sarcoidosis of skin
D86.81 - D86.87 Sarcoid meningitis - Sarcoid myositis
D86.89 Sarcoidosis of other sites
E03.5 Myxedema coma
E83.110 Hereditary hemochromatosis
E83.111 Hemochromatosis due to repeated red blood cell transfusions
E83.118 Other hemochromatosis
E83.19 Other disorders of iron metabolism
E85.0 - E85.4 Non-neuropathic heredofamilial amyloidosis - Organ-limited amyloidosis
E85.81 Light chain (AL) amyloidosis
E85.82 Wild-type transthyretin-related (ATTR) amyloidosis
E85.89 Other amyloidosis
E85.9 Amyloidosis, unspecified
G06.0 Intracranial abscess and granuloma
G06.1 Intraspinal abscess and granuloma
G45.0 - G45.3 Vertebro-basilar artery syndrome - Amaurosis fugax
G45.8 Other transient cerebral ischemic attacks and related syndromes
G45.9 Transient cerebral ischemic attack, unspecified
G46.0 - G46.2 Middle cerebral artery syndrome - Posterior cerebral artery syndrome
G47.30 - G47.33 Sleep apnea, unspecified - Obstructive sleep apnea (adult) (pediatric)
H34.01 - H34.03 Transient retinal artery occlusion, right eye - Transient retinal artery occlusion, bilateral
I01.0 - I01.2 Acute rheumatic pericarditis - Acute rheumatic myocarditis
I01.8 Other acute rheumatic heart disease
I01.9 Acute rheumatic heart disease, unspecified
I02.0 Rheumatic chorea with heart involvement
I02.9 Rheumatic chorea without heart involvement
I05.0 - I05.2 Rheumatic mitral stenosis - Rheumatic mitral stenosis with insufficiency
I05.8 Other rheumatic mitral valve diseases
I06.0 - I06.2 Rheumatic aortic stenosis - Rheumatic aortic stenosis with insufficiency
I06.8 Other rheumatic aortic valve diseases
I07.0 - I07.2 Rheumatic tricuspid stenosis - Rheumatic tricuspid stenosis and insufficiency
I07.8 Other rheumatic tricuspid valve diseases
I08.0 - I08.3 Rheumatic disorders of both mitral and aortic valves - Combined rheumatic disorders of mitral, aortic and tricuspid valves
I08.8 Other rheumatic multiple valve diseases
I08.9 Rheumatic multiple valve disease, unspecified
I09.0 - I09.2 Rheumatic myocarditis - Chronic rheumatic pericarditis
I09.81 Rheumatic heart failure
I09.89 Other specified rheumatic heart diseases
I11.0 Hypertensive heart disease with heart failure
I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
I15.0 Renovascular hypertension
I15.1 Hypertension secondary to other renal disorders
I20.0 Unstable angina
I20.1 Angina pectoris with documented spasm
I20.81 Angina pectoris with coronary microvascular dysfunction
I20.89 Other forms of angina pectoris
I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery
I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery
I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery
I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery
I21.29 ST elevation (STEMI) myocardial infarction involving other sites
I21.3 ST elevation (STEMI) myocardial infarction of unspecified site
I21.4 Non-ST elevation (NSTEMI) myocardial infarction
I21.A1 Myocardial infarction type 2
I21.A9 Other myocardial infarction type
I22.0 - I22.2 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall - Subsequent non-ST elevation (NSTEMI) myocardial infarction
I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites
I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site
I23.0 - I23.8 Hemopericardium as current complication following acute myocardial infarction - Other current complications following acute myocardial infarction
I24.0 Acute coronary thrombosis not resulting in myocardial infarction
I24.1 Dressler's syndrome
I24.81 Acute coronary microvascular dysfunction
I24.89 Other forms of acute ischemic heart disease
I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
I25.112 Atherosclerotic heart disease of native coronary artery with refractory angina pectoris
I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
I25.2 Old myocardial infarction
I25.3 Aneurysm of heart
I25.41 Coronary artery aneurysm
I25.42 Coronary artery dissection
I25.5 Ischemic cardiomyopathy
I25.6 Silent myocardial ischemia
I25.702 Atherosclerosis of coronary artery bypass graft(s), unspecified, with refractory angina pectoris
I25.710 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris
I25.711 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.712 Atherosclerosis of autologous vein coronary artery bypass graft(s) with refractory angina pectoris
I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris
I25.720 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris
I25.721 Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.722 Atherosclerosis of autologous artery coronary artery bypass graft(s) with refractory angina pectoris
I25.728 Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris
I25.730 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris
I25.731 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.732 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with refractory angina pectoris
I25.738 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris
I25.750 Atherosclerosis of native coronary artery of transplanted heart with unstable angina
I25.751 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm
I25.752 Atherosclerosis of native coronary artery of transplanted heart with refractory angina pectoris
I25.758 Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris
I25.760 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina
I25.761 Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm
I25.762 Atherosclerosis of bypass graft of coronary artery of transplanted heart with refractory angina pectoris
I25.768 Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris
I25.790 Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris
I25.791 Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.792 Atherosclerosis of other coronary artery bypass graft(s) with refractory angina pectoris
I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris
I25.810 - I25.812 Atherosclerosis of coronary artery bypass graft(s) without angina pectoris - Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris
I25.82 Chronic total occlusion of coronary artery
I25.84 Coronary atherosclerosis due to calcified coronary lesion
I25.89 Other forms of chronic ischemic heart disease
I26.01 Septic pulmonary embolism with acute cor pulmonale
I26.02 Saddle embolus of pulmonary artery with acute cor pulmonale
I26.09 Other pulmonary embolism with acute cor pulmonale
I26.90 Septic pulmonary embolism without acute cor pulmonale
I26.92 Saddle embolus of pulmonary artery without acute cor pulmonale
I26.93 Single subsegmental pulmonary embolism without acute cor pulmonale
I26.94 Multiple subsegmental pulmonary emboli without acute cor pulmonale
I26.99 Other pulmonary embolism without acute cor pulmonale
I27.0 - I27.1 Primary pulmonary hypertension - Kyphoscoliotic heart disease
I27.20 Pulmonary hypertension, unspecified
I27.21 Secondary pulmonary arterial hypertension
I27.22 Pulmonary hypertension due to left heart disease
I27.23 Pulmonary hypertension due to lung diseases and hypoxia
I27.24 Chronic thromboembolic pulmonary hypertension
I27.29 Other secondary pulmonary hypertension
I27.82 Chronic pulmonary embolism
I27.83 Eisenmenger's syndrome
I27.89 Other specified pulmonary heart diseases
I28.0 Arteriovenous fistula of pulmonary vessels
I28.1 Aneurysm of pulmonary artery
I30.0 Acute nonspecific idiopathic pericarditis
I30.1 Infective pericarditis
I30.8 Other forms of acute pericarditis
I31.0 - I31.4 Chronic adhesive pericarditis - Cardiac tamponade
I31.8 Other specified diseases of pericardium
I32 Pericarditis in diseases classified elsewhere
I33.0 Acute and subacute infective endocarditis
I33.9 Acute and subacute endocarditis, unspecified
I34.0 - I34.2 Nonrheumatic mitral (valve) insufficiency - Nonrheumatic mitral (valve) stenosis
I34.81 Nonrheumatic mitral (valve) annulus calcification
I34.89 Other nonrheumatic mitral valve disorders
I35.0 - I35.2 Nonrheumatic aortic (valve) stenosis - Nonrheumatic aortic (valve) stenosis with insufficiency
I35.8 Other nonrheumatic aortic valve disorders
I36.0 - I36.2 Nonrheumatic tricuspid (valve) stenosis - Nonrheumatic tricuspid (valve) stenosis with insufficiency
I36.8 Other nonrheumatic tricuspid valve disorders
I37.0 - I37.2 Nonrheumatic pulmonary valve stenosis - Nonrheumatic pulmonary valve stenosis with insufficiency
I37.8 Other nonrheumatic pulmonary valve disorders
I38 Endocarditis, valve unspecified
I39 Endocarditis and heart valve disorders in diseases classified elsewhere
I40.0 Infective myocarditis
I40.1 Isolated myocarditis
I40.8 Other acute myocarditis
I40.9 Acute myocarditis, unspecified
I41 Myocarditis in diseases classified elsewhere
I42.0 - I42.8 Dilated cardiomyopathy - Other cardiomyopathies
I43 Cardiomyopathy in diseases classified elsewhere
I44.1 Atrioventricular block, second degree
I44.2 Atrioventricular block, complete
I44.30 Unspecified atrioventricular block
I44.39 Other atrioventricular block
I44.7 Left bundle-branch block, unspecified
I45.2 - I45.6 Bifascicular block - Pre-excitation syndrome
I45.9 Conduction disorder, unspecified
I46.2 Cardiac arrest due to underlying cardiac condition
I46.8 Cardiac arrest due to other underlying condition
I46.9 Cardiac arrest, cause unspecified
I47.11 Inappropriate sinus tachycardia, so stated
I47.19 Other supraventricular tachycardia
I47.21 Torsades de pointes
I47.29 Other ventricular tachycardia
I47.9 Paroxysmal tachycardia, unspecified
I48.0 - I48.4 Paroxysmal atrial fibrillation - Atypical atrial flutter
I49.01 Ventricular fibrillation
I49.02 Ventricular flutter
I49.1 - I49.3 Atrial premature depolarization - Ventricular premature depolarization
I49.40 Unspecified premature depolarization
I49.49 Other premature depolarization
I50.1 Left ventricular failure, unspecified
I50.21 - I50.23 Acute systolic (congestive) heart failure - Acute on chronic systolic (congestive) heart failure
I50.31 - I50.33 Acute diastolic (congestive) heart failure - Acute on chronic diastolic (congestive) heart failure
I50.41 - I50.43 Acute combined systolic (congestive) and diastolic (congestive) heart failure - Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I51.0 - I51.5 Cardiac septal defect, acquired - Myocardial degeneration
I51.7 Cardiomegaly
I51.81 Takotsubo syndrome
I51.89 Other ill-defined heart diseases
I51.9 Heart disease, unspecified
I52 Other heart disorders in diseases classified elsewhere
I60.01 Nontraumatic subarachnoid hemorrhage from right carotid siphon and bifurcation
I60.02 Nontraumatic subarachnoid hemorrhage from left carotid siphon and bifurcation
I60.11 Nontraumatic subarachnoid hemorrhage from right middle cerebral artery
I60.12 Nontraumatic subarachnoid hemorrhage from left middle cerebral artery
I60.31 Nontraumatic subarachnoid hemorrhage from right posterior communicating artery
I60.32 Nontraumatic subarachnoid hemorrhage from left posterior communicating artery
I60.4 Nontraumatic subarachnoid hemorrhage from basilar artery
I60.51 Nontraumatic subarachnoid hemorrhage from right vertebral artery
I60.52 Nontraumatic subarachnoid hemorrhage from left vertebral artery
I60.6 Nontraumatic subarachnoid hemorrhage from other intracranial arteries
I60.7 Nontraumatic subarachnoid hemorrhage from unspecified intracranial artery
I60.8 Other nontraumatic subarachnoid hemorrhage
I63.311 Cerebral infarction due to thrombosis of right middle cerebral artery
I63.312 Cerebral infarction due to thrombosis of left middle cerebral artery
I63.321 Cerebral infarction due to thrombosis of right anterior cerebral artery
I63.322 Cerebral infarction due to thrombosis of left anterior cerebral artery
I63.331 Cerebral infarction due to thrombosis of right posterior cerebral artery
I63.332 Cerebral infarction due to thrombosis of left posterior cerebral artery
I63.341 Cerebral infarction due to thrombosis of right cerebellar artery
I63.342 Cerebral infarction due to thrombosis of left cerebellar artery
I63.39 Cerebral infarction due to thrombosis of other cerebral artery
I63.411 Cerebral infarction due to embolism of right middle cerebral artery
I63.412 Cerebral infarction due to embolism of left middle cerebral artery
I63.421 Cerebral infarction due to embolism of right anterior cerebral artery
I63.422 Cerebral infarction due to embolism of left anterior cerebral artery
I63.431 Cerebral infarction due to embolism of right posterior cerebral artery
I63.432 Cerebral infarction due to embolism of left posterior cerebral artery
I63.441 Cerebral infarction due to embolism of right cerebellar artery
I63.442 Cerebral infarction due to embolism of left cerebellar artery
I63.49 Cerebral infarction due to embolism of other cerebral artery
I63.511 Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery
I63.512 Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery
I63.521 Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery
I63.522 Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery
I63.531 Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery
I63.532 Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery
I63.541 Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery
I63.542 Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery
I63.59 Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery
I63.6 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic
I63.81 Other cerebral infarction due to occlusion or stenosis of small artery
I63.89 Other cerebral infarction
I66.01 - I66.03 Occlusion and stenosis of right middle cerebral artery - Occlusion and stenosis of bilateral middle cerebral arteries
I66.11 - I66.13 Occlusion and stenosis of right anterior cerebral artery - Occlusion and stenosis of bilateral anterior cerebral arteries
I66.21 - I66.23 Occlusion and stenosis of right posterior cerebral artery - Occlusion and stenosis of bilateral posterior cerebral arteries
I66.3 Occlusion and stenosis of cerebellar arteries
I66.8 Occlusion and stenosis of other cerebral arteries
I67.841 Reversible cerebrovascular vasoconstriction syndrome
I67.848 Other cerebrovascular vasospasm and vasoconstriction
I67.850 Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
I67.858 Other hereditary cerebrovascular disease
I67.89 Other cerebrovascular disease
I70.0 Atherosclerosis of aorta
I71.00 - I71.03 Dissection of unspecified site of aorta - Dissection of thoracoabdominal aorta
I71.11 Aneurysm of the ascending aorta, ruptured
I71.12 Aneurysm of the aortic arch, ruptured
I71.13 Aneurysm of the descending thoracic aorta, ruptured
I71.21 Aneurysm of the ascending aorta, without rupture
I71.22 Aneurysm of the aortic arch, without rupture
I71.23 Aneurysm of the descending thoracic aorta, without rupture
I71.31 Pararenal abdominal aortic aneurysm, ruptured
I71.32 Juxtarenal abdominal aortic aneurysm, ruptured
I71.33 Infrarenal abdominal aortic aneurysm, ruptured
I71.41 Pararenal abdominal aortic aneurysm, without rupture
I71.42 Juxtarenal abdominal aortic aneurysm, without rupture
I71.43 Infrarenal abdominal aortic aneurysm, without rupture
I71.51 Supraceliac aneurysm of the thoracoabdominal aorta, ruptured
I71.52 Paravisceral aneurysm of the thoracoabdominal aorta, ruptured
I71.61 Supraceliac aneurysm of the thoracoabdominal aorta, without rupture
I71.62 Paravisceral aneurysm of the thoracoabdominal aorta, without rupture
I71.8 Aortic aneurysm of unspecified site, ruptured
I74.11 Embolism and thrombosis of thoracic aorta
I74.2 - I74.5 Embolism and thrombosis of arteries of the upper extremities - Embolism and thrombosis of iliac artery
I74.8 Embolism and thrombosis of other arteries
I74.9 Embolism and thrombosis of unspecified artery
I76 Septic arterial embolism
I79.0 Aneurysm of aorta in diseases classified elsewhere
I95.1 Orthostatic hypotension
I95.2 Hypotension due to drugs
I95.81 Postprocedural hypotension
I95.89 Other hypotension
I95.9 Hypotension, unspecified
I97.0 Postcardiotomy syndrome
I97.110 Postprocedural cardiac insufficiency following cardiac surgery
I97.111 Postprocedural cardiac insufficiency following other surgery
I97.120 Postprocedural cardiac arrest following cardiac surgery
I97.121 Postprocedural cardiac arrest following other surgery
I97.130 Postprocedural heart failure following cardiac surgery
I97.131 Postprocedural heart failure following other surgery
I97.190 Other postprocedural cardiac functional disturbances following cardiac surgery
I97.191 Other postprocedural cardiac functional disturbances following other surgery
I97.710 Intraoperative cardiac arrest during cardiac surgery
I97.711 Intraoperative cardiac arrest during other surgery
I97.790 Other intraoperative cardiac functional disturbances during cardiac surgery
I97.791 Other intraoperative cardiac functional disturbances during other surgery
I97.88 Other intraoperative complications of the circulatory system, not elsewhere classified
I97.89 Other postprocedural complications and disorders of the circulatory system, not elsewhere classified
J80 Acute respiratory distress syndrome
J81.0 Acute pulmonary edema
J95.1 - J95.3 Acute pulmonary insufficiency following thoracic surgery - Chronic pulmonary insufficiency following surgery
J95.821 Acute postprocedural respiratory failure
J95.822 Acute and chronic postprocedural respiratory failure
J95.84 Transfusion-related acute lung injury (TRALI)
J96.01 Acute respiratory failure with hypoxia
J96.02 Acute respiratory failure with hypercapnia
J96.21 Acute and chronic respiratory failure with hypoxia
J96.22 Acute and chronic respiratory failure with hypercapnia
K68.11 Postprocedural retroperitoneal abscess
M30.3 Mucocutaneous lymph node syndrome [Kawasaki]
M31.4 Aortic arch syndrome [Takayasu]
M32.0 Drug-induced systemic lupus erythematosus
M32.11 - M32.15 Endocarditis in systemic lupus erythematosus - Tubulo-interstitial nephropathy in systemic lupus erythematosus
M32.19 Other organ or system involvement in systemic lupus erythematosus
M32.8 Other forms of systemic lupus erythematosus
M32.9 Systemic lupus erythematosus, unspecified
N26.2 Page kidney
N98.0 Infection associated with artificial insemination
O90.3 Peripartum cardiomyopathy
O90.89 Other complications of the puerperium, not elsewhere classified
Q20.2 Double outlet left ventricle
Q20.3 Discordant ventriculoarterial connection
Q20.5 Discordant atrioventricular connection
Q20.8 Other congenital malformations of cardiac chambers and connections
Q21.0 Ventricular septal defect
Q21.11 - Q21.15 Secundum atrial septal defect - Inferior sinus venosus atrial septal defect
Q21.19 Other specified atrial septal defect
Q21.20 - Q21.4 Atrioventricular septal defect, unspecified as to partial or complete - Aortopulmonary septal defect
Q21.9 Congenital malformation of cardiac septum, unspecified
Q22.1 - Q22.6 Congenital pulmonary valve stenosis - Hypoplastic right heart syndrome
Q22.8 Other congenital malformations of tricuspid valve
Q23.0 - Q23.3 Congenital stenosis of aortic valve - Congenital mitral insufficiency
Q23.8 Other congenital malformations of aortic and mitral valves
Q24.0 - Q24.4 Dextrocardia - Congenital subaortic stenosis
Q24.6 Congenital heart block
Q24.8 Other specified congenital malformations of heart
Q25.0 Patent ductus arteriosus
Q25.1 Coarctation of aorta
Q25.21 Interruption of aortic arch
Q25.29 Other atresia of aorta
Q25.3 Supravalvular aortic stenosis
Q25.41 Absence and aplasia of aorta
Q25.42 Hypoplasia of aorta
Q25.43 Congenital aneurysm of aorta
Q25.44 Congenital dilation of aorta
Q25.45 Double aortic arch
Q25.46 Tortuous aortic arch
Q25.47 Right aortic arch
Q25.48 Anomalous origin of subclavian artery
Q25.49 Other congenital malformations of aorta
Q25.5 Atresia of pulmonary artery
Q25.6 Stenosis of pulmonary artery
Q25.71 Coarctation of pulmonary artery
Q25.72 Congenital pulmonary arteriovenous malformation
Q25.79 Other congenital malformations of pulmonary artery
Q25.8 Other congenital malformations of other great arteries
Q26.0 - Q26.4 Congenital stenosis of vena cava - Anomalous pulmonary venous connection, unspecified
Q26.8 Other congenital malformations of great veins
Q26.9 Congenital malformation of great vein, unspecified
Q27.9 Congenital malformation of peripheral vascular system, unspecified
Q28.2 Arteriovenous malformation of cerebral vessels
Q28.3 Other malformations of cerebral vessels
Q87.410 Marfan syndrome with aortic dilation
Q87.418 Marfan syndrome with other cardiovascular manifestations
Q87.42 Marfan syndrome with ocular manifestations
Q87.43 Marfan syndrome with skeletal manifestation
Q89.01 Asplenia (congenital)
Q89.09 Congenital malformations of spleen
Q89.3 Situs inversus
Q89.9 Congenital malformation, unspecified
Q90.0 - Q90.2 Trisomy 21, nonmosaicism (meiotic nondisjunction) - Trisomy 21, translocation
Q96.0 - Q96.4 Karyotype 45, X - Mosaicism, 45, X/other cell line(s) with abnormal sex chromosome
Q96.8 Other variants of Turner's syndrome
R00.2 Palpitations
R00.8 Other abnormalities of heart beat
R01.0 - R01.2 Benign and innocent cardiac murmurs - Other cardiac sounds
R06.00 Dyspnea, unspecified
R06.02 Shortness of breath
R06.09 Other forms of dyspnea
R06.2 Wheezing
R06.3 Periodic breathing
R06.81 - R06.83 Apnea, not elsewhere classified - Snoring
R06.89 Other abnormalities of breathing
R07.2 Precordial pain
R07.82 Intercostal pain
R07.89 Other chest pain
R07.9 Chest pain, unspecified
R09.2 Respiratory arrest
R22.2 Localized swelling, mass and lump, trunk
R23.0 Cyanosis
R40.20 Unspecified coma
R40.2111 - R40.2114 Coma scale, eyes open, never, in the field [EMT or ambulance] - Coma scale, eyes open, never, 24 hours or more after hospital admission
R40.2121 - R40.2124 Coma scale, eyes open, to pain, in the field [EMT or ambulance] - Coma scale, eyes open, to pain, 24 hours or more after hospital admission
R40.2211 - R40.2214 Coma scale, best verbal response, none, in the field [EMT or ambulance] - Coma scale, best verbal response, none, 24 hours or more after hospital admission
R40.2221 - R40.2224 Coma scale, best verbal response, incomprehensible words, in the field [EMT or ambulance] - Coma scale, best verbal response, incomprehensible words, 24 hours or more after hospital admission
R40.2311 - R40.2314 Coma scale, best motor response, none, in the field [EMT or ambulance] - Coma scale, best motor response, none, 24 hours or more after hospital admission
R40.2321 - R40.2324 Coma scale, best motor response, extension, in the field [EMT or ambulance] - Coma scale, best motor response, extension, 24 hours or more after hospital admission
R40.2341 - R40.2344 Coma scale, best motor response, flexion withdrawal, in the field [EMT or ambulance] - Coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission
R40.4 Transient alteration of awareness
R47.01 Aphasia
R50.2 Drug induced fever
R50.81 Fever presenting with conditions classified elsewhere
R50.82 Postprocedural fever
R50.9 Fever, unspecified
R55 Syncope and collapse
R57.0 Cardiogenic shock
R57.1 Hypovolemic shock
R57.8 Other shock
R57.9 Shock, unspecified
R60.0 Localized edema
R60.1 Generalized edema
R65.21 Severe sepsis with septic shock
R68.89 Other general symptoms and signs
R78.81 Bacteremia
R94.31 Abnormal electrocardiogram [ECG] [EKG]
S12.000B* Unspecified displaced fracture of first cervical vertebra, initial encounter for open fracture
S12.001B* Unspecified nondisplaced fracture of first cervical vertebra, initial encounter for open fracture
S12.100B* Unspecified displaced fracture of second cervical vertebra, initial encounter for open fracture
S12.101B* Unspecified nondisplaced fracture of second cervical vertebra, initial encounter for open fracture
S12.200B* Unspecified displaced fracture of third cervical vertebra, initial encounter for open fracture
S12.201B* Unspecified nondisplaced fracture of third cervical vertebra, initial encounter for open fracture
S12.300B* Unspecified displaced fracture of fourth cervical vertebra, initial encounter for open fracture
S12.301B* Unspecified nondisplaced fracture of fourth cervical vertebra, initial encounter for open fracture
S14.111A* Complete lesion at C1 level of cervical spinal cord, initial encounter
S14.112A* Complete lesion at C2 level of cervical spinal cord, initial encounter
S14.113A* Complete lesion at C3 level of cervical spinal cord, initial encounter
S14.114A* Complete lesion at C4 level of cervical spinal cord, initial encounter
S14.121A* Central cord syndrome at C1 level of cervical spinal cord, initial encounter
S14.122A* Central cord syndrome at C2 level of cervical spinal cord, initial encounter
S14.123A* Central cord syndrome at C3 level of cervical spinal cord, initial encounter
S14.124A* Central cord syndrome at C4 level of cervical spinal cord, initial encounter
S21.309A* Unspecified open wound of unspecified front wall of thorax with penetration into thoracic cavity, initial encounter
S22.5XXA Flail chest, initial encounter for closed fracture
S22.5XXB Flail chest, initial encounter for open fracture
S25.01XA Minor laceration of thoracic aorta, initial encounter
S25.02XA Major laceration of thoracic aorta, initial encounter
S25.09XA Other specified injury of thoracic aorta, initial encounter
S25.21XA Minor laceration of superior vena cava, initial encounter
S25.22XA Major laceration of superior vena cava, initial encounter
S25.29XA Other specified injury of superior vena cava, initial encounter
S25.401A Unspecified injury of right pulmonary blood vessels, initial encounter
S25.402A Unspecified injury of left pulmonary blood vessels, initial encounter
S25.411A Minor laceration of right pulmonary blood vessels, initial encounter
S25.412A Minor laceration of left pulmonary blood vessels, initial encounter
S25.421A Major laceration of right pulmonary blood vessels, initial encounter
S25.422A Major laceration of left pulmonary blood vessels, initial encounter
S25.491A Other specified injury of right pulmonary blood vessels, initial encounter
S25.492A Other specified injury of left pulmonary blood vessels, initial encounter
S26.00XA Unspecified injury of heart with hemopericardium, initial encounter
S26.01XA Contusion of heart with hemopericardium, initial encounter
S26.020A Mild laceration of heart with hemopericardium, initial encounter
S26.021A Moderate laceration of heart with hemopericardium, initial encounter
S26.022A Major laceration of heart with hemopericardium, initial encounter
S26.09XA Other injury of heart with hemopericardium, initial encounter
S26.10XA Unspecified injury of heart without hemopericardium, initial encounter
S26.11XA Contusion of heart without hemopericardium, initial encounter
S26.12XA Laceration of heart without hemopericardium, initial encounter
S26.19XA Other injury of heart without hemopericardium, initial encounter
S26.90XA* Unspecified injury of heart, unspecified with or without hemopericardium, initial encounter
S26.92XA* Laceration of heart, unspecified with or without hemopericardium, initial encounter
S29.091A Other injury of muscle and tendon of front wall of thorax, initial encounter
S29.092A Other injury of muscle and tendon of back wall of thorax, initial encounter
S29.8XXA Other specified injuries of thorax, initial encounter
T36.0X5A Adverse effect of penicillins, initial encounter
T36.1X5A Adverse effect of cephalosporins and other beta-lactam antibiotics, initial encounter
T36.2X5A Adverse effect of chloramphenicol group, initial encounter
T36.3X5A Adverse effect of macrolides, initial encounter
T36.4X5A Adverse effect of tetracyclines, initial encounter
T36.5X5A Adverse effect of aminoglycosides, initial encounter
T36.6X5A Adverse effect of rifampicins, initial encounter
T36.7X5A Adverse effect of antifungal antibiotics, systemically used, initial encounter
T36.8X5A Adverse effect of other systemic antibiotics, initial encounter
T37.0X5A Adverse effect of sulfonamides, initial encounter
T37.1X5A Adverse effect of antimycobacterial drugs, initial encounter
T37.2X5A Adverse effect of antimalarials and drugs acting on other blood protozoa, initial encounter
T37.3X5A Adverse effect of other antiprotozoal drugs, initial encounter
T37.4X5A Adverse effect of anthelminthics, initial encounter
T37.5X5A Adverse effect of antiviral drugs, initial encounter
T37.8X5A Adverse effect of other specified systemic anti-infectives and antiparasitics, initial encounter
T38.0X1A Poisoning by glucocorticoids and synthetic analogues, accidental (unintentional), initial encounter
T38.0X2A Poisoning by glucocorticoids and synthetic analogues, intentional self-harm, initial encounter
T38.0X3A Poisoning by glucocorticoids and synthetic analogues, assault, initial encounter
T38.0X5A Adverse effect of glucocorticoids and synthetic analogues, initial encounter
T38.1X5A Adverse effect of thyroid hormones and substitutes, initial encounter
T38.2X5A Adverse effect of antithyroid drugs, initial encounter
T38.4X5A Adverse effect of oral contraceptives, initial encounter
T38.5X5A Adverse effect of other estrogens and progestogens, initial encounter
T38.6X5A Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, initial encounter
T38.7X5A Adverse effect of androgens and anabolic congeners, initial encounter
T38.815A Adverse effect of anterior pituitary [adenohypophyseal] hormones, initial encounter
T38.895A Adverse effect of other hormones and synthetic substitutes, initial encounter
T38.995A Adverse effect of other hormone antagonists, initial encounter
T39.015A Adverse effect of aspirin, initial encounter
T39.095A Adverse effect of salicylates, initial encounter
T39.1X5A Adverse effect of 4-Aminophenol derivatives, initial encounter
T39.2X5A Adverse effect of pyrazolone derivatives, initial encounter
T39.315A Adverse effect of propionic acid derivatives, initial encounter
T39.395A Adverse effect of other nonsteroidal anti-inflammatory drugs [NSAID], initial encounter
T39.4X5A Adverse effect of antirheumatics, not elsewhere classified, initial encounter
T39.8X5A Adverse effect of other nonopioid analgesics and antipyretics, not elsewhere classified, initial encounter
T40.0X5A Adverse effect of opium, initial encounter
T40.2X1A Poisoning by other opioids, accidental (unintentional), initial encounter
T40.2X3A Poisoning by other opioids, assault, initial encounter
T40.2X4A Poisoning by other opioids, undetermined, initial encounter
T40.2X5A Adverse effect of other opioids, initial encounter
T40.3X5A Adverse effect of methadone, initial encounter
T40.491A Poisoning by other synthetic narcotics, accidental (unintentional), initial encounter
T40.492A Poisoning by other synthetic narcotics, intentional self-harm, initial encounter
T40.493A Poisoning by other synthetic narcotics, assault, initial encounter
T40.495A Adverse effect of other synthetic narcotics, initial encounter
T40.5X5A Adverse effect of cocaine, initial encounter
T40.691A Poisoning by other narcotics, accidental (unintentional), initial encounter
T40.692A Poisoning by other narcotics, intentional self-harm, initial encounter
T40.693A Poisoning by other narcotics, assault, initial encounter
T40.695A Adverse effect of other narcotics, initial encounter
T40.715A Adverse effect of cannabis, initial encounter
T40.725A Adverse effect of synthetic cannabinoids, initial encounter
T40.995A Adverse effect of other psychodysleptics [hallucinogens], initial encounter
T41.0X5A Adverse effect of inhaled anesthetics, initial encounter
T41.1X5A Adverse effect of intravenous anesthetics, initial encounter
T41.295A Adverse effect of other general anesthetics, initial encounter
T41.3X5A Adverse effect of local anesthetics, initial encounter
T41.5X5A Adverse effect of therapeutic gases, initial encounter
T42.0X5A Adverse effect of hydantoin derivatives, initial encounter
T42.1X5A Adverse effect of iminostilbenes, initial encounter
T42.2X5A Adverse effect of succinimides and oxazolidinediones, initial encounter
T42.3X5A Adverse effect of barbiturates, initial encounter
T42.4X5A Adverse effect of benzodiazepines, initial encounter
T42.5X5A Adverse effect of mixed antiepileptics, initial encounter
T42.6X5A Adverse effect of other antiepileptic and sedative-hypnotic drugs, initial encounter
T42.8X5A Adverse effect of antiparkinsonism drugs and other central muscle-tone depressants, initial encounter
T43.015A Adverse effect of tricyclic antidepressants, initial encounter
T43.025A Adverse effect of tetracyclic antidepressants, initial encounter
T43.1X5A Adverse effect of monoamine-oxidase-inhibitor antidepressants, initial encounter
T43.215A Adverse effect of selective serotonin and norepinephrine reuptake inhibitors, initial encounter
T43.225A Adverse effect of selective serotonin reuptake inhibitors, initial encounter
T43.295A Adverse effect of other antidepressants, initial encounter
T43.3X5A Adverse effect of phenothiazine antipsychotics and neuroleptics, initial encounter
T43.4X5A Adverse effect of butyrophenone and thiothixene neuroleptics, initial encounter
T43.595A Adverse effect of other antipsychotics and neuroleptics, initial encounter
T43.615A Adverse effect of caffeine, initial encounter
T43.625A Adverse effect of amphetamines, initial encounter
T43.635A Adverse effect of methylphenidate, initial encounter
T43.641A Poisoning by ecstasy, accidental (unintentional), initial encounter
T43.641D Poisoning by ecstasy, accidental (unintentional), subsequent encounter
T43.641S Poisoning by ecstasy, accidental (unintentional), sequela
T43.642A Poisoning by ecstasy, intentional self-harm, initial encounter
T43.642D Poisoning by ecstasy, intentional self-harm, subsequent encounter
T43.642S Poisoning by ecstasy, intentional self-harm, sequela
T43.643A Poisoning by ecstasy, assault, initial encounter
T43.643D Poisoning by ecstasy, assault, subsequent encounter
T43.643S Poisoning by ecstasy, assault, sequela
T43.644A Poisoning by ecstasy, undetermined, initial encounter
T43.644D Poisoning by ecstasy, undetermined, subsequent encounter
T43.644S Poisoning by ecstasy, undetermined, sequela
T43.651A Poisoning by methamphetamines accidental (unintentional), initial encounter
T43.651D Poisoning by methamphetamines accidental (unintentional), subsequent encounter
T43.651S Poisoning by methamphetamines accidental (unintentional), sequela
T43.652A Poisoning by methamphetamines intentional self-harm, initial encounter
T43.652D Poisoning by methamphetamines intentional self-harm, subsequent encounter
T43.652S Poisoning by methamphetamines intentional self-harm, sequela
T43.653A Poisoning by methamphetamines, assault, initial encounter
T43.653D Poisoning by methamphetamines, assault, subsequent encounter
T43.653S Poisoning by methamphetamines, assault, sequela
T43.654A Poisoning by methamphetamines, undetermined, initial encounter
T43.654D Poisoning by methamphetamines, undetermined, subsequent encounter
T43.654S Poisoning by methamphetamines, undetermined, sequela
T43.655A Adverse effect of methamphetamines, initial encounter
T43.655D Adverse effect of methamphetamines, subsequent encounter
T43.655S Adverse effect of methamphetamines, sequela
T43.656A Underdosing of methamphetamines, initial encounter
T43.656D Underdosing of methamphetamines, subsequent encounter
T43.656S Underdosing of methamphetamines, sequela
T43.695A Adverse effect of other psychostimulants, initial encounter
T43.8X5A Adverse effect of other psychotropic drugs, initial encounter
T44.0X5A Adverse effect of anticholinesterase agents, initial encounter
T44.1X5A Adverse effect of other parasympathomimetics [cholinergics], initial encounter
T44.2X1A Poisoning by ganglionic blocking drugs, accidental (unintentional), initial encounter
T44.2X2A Poisoning by ganglionic blocking drugs, intentional self-harm, initial encounter
T44.2X3A Poisoning by ganglionic blocking drugs, assault, initial encounter
T44.2X5A Adverse effect of ganglionic blocking drugs, initial encounter
T44.3X5A Adverse effect of other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, initial encounter
T44.4X5A Adverse effect of predominantly alpha-adrenoreceptor agonists, initial encounter
T44.5X5A Adverse effect of predominantly beta-adrenoreceptor agonists, initial encounter
T44.6X5A Adverse effect of alpha-adrenoreceptor antagonists, initial encounter
T44.7X5A Adverse effect of beta-adrenoreceptor antagonists, initial encounter
T44.8X5A Adverse effect of centrally-acting and adrenergic-neuron-blocking agents, initial encounter
T44.995A Adverse effect of other drug primarily affecting the autonomic nervous system, initial encounter
T45.0X1A Poisoning by antiallergic and antiemetic drugs, accidental (unintentional), initial encounter
T45.0X2A Poisoning by antiallergic and antiemetic drugs, intentional self-harm, initial encounter
T45.0X3A Poisoning by antiallergic and antiemetic drugs, assault, initial encounter
T45.0X5A Adverse effect of antiallergic and antiemetic drugs, initial encounter
T45.1X1A Poisoning by antineoplastic and immunosuppressive drugs, accidental (unintentional), initial encounter
T45.1X2A Poisoning by antineoplastic and immunosuppressive drugs, intentional self-harm, initial encounter
T45.1X3A Poisoning by antineoplastic and immunosuppressive drugs, assault, initial encounter
T45.1X5A Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter
T45.1X5S Adverse effect of antineoplastic and immunosuppressive drugs, sequela
T45.2X5A Adverse effect of vitamins, initial encounter
T45.3X5A Adverse effect of enzymes, initial encounter
T45.4X5A Adverse effect of iron and its compounds, initial encounter
T45.515A Adverse effect of anticoagulants, initial encounter
T45.525A Adverse effect of antithrombotic drugs, initial encounter
T45.615A Adverse effect of thrombolytic drugs, initial encounter
T45.625A Adverse effect of hemostatic drug, initial encounter
T45.695A Adverse effect of other fibrinolysis-affecting drugs, initial encounter
T45.7X5A Adverse effect of anticoagulant antagonists, vitamin K and other coagulants, initial encounter
T45.8X5A Adverse effect of other primarily systemic and hematological agents, initial encounter
T46.0X1A Poisoning by cardiac-stimulant glycosides and drugs of similar action, accidental (unintentional), initial encounter
T46.0X2A Poisoning by cardiac-stimulant glycosides and drugs of similar action, intentional self-harm, initial encounter
T46.0X3A Poisoning by cardiac-stimulant glycosides and drugs of similar action, assault, initial encounter
T46.0X5A Adverse effect of cardiac-stimulant glycosides and drugs of similar action, initial encounter
T46.1X1A Poisoning by calcium-channel blockers, accidental (unintentional), initial encounter
T46.1X2A Poisoning by calcium-channel blockers, intentional self-harm, initial encounter
T46.1X3A Poisoning by calcium-channel blockers, assault, initial encounter
T46.1X5A Adverse effect of calcium-channel blockers, initial encounter
T46.2X1A Poisoning by other antidysrhythmic drugs, accidental (unintentional), initial encounter
T46.2X2A Poisoning by other antidysrhythmic drugs, intentional self-harm, initial encounter
T46.2X3A Poisoning by other antidysrhythmic drugs, assault, initial encounter
T46.2X5A Adverse effect of other antidysrhythmic drugs, initial encounter
T46.3X1A Poisoning by coronary vasodilators, accidental (unintentional), initial encounter
T46.3X2A Poisoning by coronary vasodilators, intentional self-harm, initial encounter
T46.3X3A Poisoning by coronary vasodilators, assault, initial encounter
T46.3X5A Adverse effect of coronary vasodilators, initial encounter
T46.4X1A Poisoning by angiotensin-converting-enzyme inhibitors, accidental (unintentional), initial encounter
T46.4X2A Poisoning by angiotensin-converting-enzyme inhibitors, intentional self-harm, initial encounter
T46.4X3A Poisoning by angiotensin-converting-enzyme inhibitors, assault, initial encounter
T46.4X5A Adverse effect of angiotensin-converting-enzyme inhibitors, initial encounter
T46.5X1A Poisoning by other antihypertensive drugs, accidental (unintentional), initial encounter
T46.5X2A Poisoning by other antihypertensive drugs, intentional self-harm, initial encounter
T46.5X3A Poisoning by other antihypertensive drugs, assault, initial encounter
T46.5X5A Adverse effect of other antihypertensive drugs, initial encounter
T46.6X1A Poisoning by antihyperlipidemic and antiarteriosclerotic drugs, accidental (unintentional), initial encounter
T46.6X2A Poisoning by antihyperlipidemic and antiarteriosclerotic drugs, intentional self-harm, initial encounter
T46.6X3A Poisoning by antihyperlipidemic and antiarteriosclerotic drugs, assault, initial encounter
T46.6X5A Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, initial encounter
T46.7X1A Poisoning by peripheral vasodilators, accidental (unintentional), initial encounter
T46.7X2A Poisoning by peripheral vasodilators, intentional self-harm, initial encounter
T46.7X3A Poisoning by peripheral vasodilators, assault, initial encounter
T46.7X5A Adverse effect of peripheral vasodilators, initial encounter
T46.8X1A Poisoning by antivaricose drugs, including sclerosing agents, accidental (unintentional), initial encounter
T46.8X2A Poisoning by antivaricose drugs, including sclerosing agents, intentional self-harm, initial encounter
T46.8X3A Poisoning by antivaricose drugs, including sclerosing agents, assault, initial encounter
T46.8X5A Adverse effect of antivaricose drugs, including sclerosing agents, initial encounter
T46.901A Poisoning by unspecified agents primarily affecting the cardiovascular system, accidental (unintentional), initial encounter
T46.902A Poisoning by unspecified agents primarily affecting the cardiovascular system, intentional self-harm, initial encounter
T46.903A Poisoning by unspecified agents primarily affecting the cardiovascular system, assault, initial encounter
T46.905A Adverse effect of unspecified agents primarily affecting the cardiovascular system, initial encounter
T46.991A Poisoning by other agents primarily affecting the cardiovascular system, accidental (unintentional), initial encounter
T46.992A Poisoning by other agents primarily affecting the cardiovascular system, intentional self-harm, initial encounter
T46.993A Poisoning by other agents primarily affecting the cardiovascular system, assault, initial encounter
T46.995A Adverse effect of other agents primarily affecting the cardiovascular system, initial encounter
T47.0X5A Adverse effect of histamine H2-receptor blockers, initial encounter
T47.1X5A Adverse effect of other antacids and anti-gastric-secretion drugs, initial encounter
T47.2X5A Adverse effect of stimulant laxatives, initial encounter
T47.3X5A Adverse effect of saline and osmotic laxatives, initial encounter
T47.4X5A Adverse effect of other laxatives, initial encounter
T47.5X5A Adverse effect of digestants, initial encounter
T47.6X5A Adverse effect of antidiarrheal drugs, initial encounter
T47.7X5A Adverse effect of emetics, initial encounter
T47.8X5A Adverse effect of other agents primarily affecting gastrointestinal system, initial encounter
T48.0X5A Adverse effect of oxytocic drugs, initial encounter
T48.1X5A Adverse effect of skeletal muscle relaxants [neuromuscular blocking agents], initial encounter
T48.295A Adverse effect of other drugs acting on muscles, initial encounter
T48.3X5A Adverse effect of antitussives, initial encounter
T48.4X5A Adverse effect of expectorants, initial encounter
T48.5X5A Adverse effect of other anti-common-cold drugs, initial encounter
T48.6X5A Adverse effect of antiasthmatics, initial encounter
T48.995A Adverse effect of other agents primarily acting on the respiratory system, initial encounter
T49.0X5A Adverse effect of local antifungal, anti-infective and anti-inflammatory drugs, initial encounter
T49.1X5A Adverse effect of antipruritics, initial encounter
T49.2X5A Adverse effect of local astringents and local detergents, initial encounter
T49.3X5A Adverse effect of emollients, demulcents and protectants, initial encounter
T49.4X5A Adverse effect of keratolytics, keratoplastics, and other hair treatment drugs and preparations, initial encounter
T49.5X5A Adverse effect of ophthalmological drugs and preparations, initial encounter
T49.6X5A Adverse effect of otorhinolaryngological drugs and preparations, initial encounter
T49.7X5A Adverse effect of dental drugs, topically applied, initial encounter
T49.8X5A Adverse effect of other topical agents, initial encounter
T50.0X1A Poisoning by mineralocorticoids and their antagonists, accidental (unintentional), initial encounter
T50.0X2A Poisoning by mineralocorticoids and their antagonists, intentional self-harm, initial encounter
T50.0X3A Poisoning by mineralocorticoids and their antagonists, assault, initial encounter
T50.0X5A Adverse effect of mineralocorticoids and their antagonists, initial encounter
T50.1X5A Adverse effect of loop [high-ceiling] diuretics, initial encounter
T50.2X5A Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, initial encounter
T50.3X5A Adverse effect of electrolytic, caloric and water-balance agents, initial encounter
T50.4X5A Adverse effect of drugs affecting uric acid metabolism, initial encounter
T50.5X5A Adverse effect of appetite depressants, initial encounter
T50.6X5A Adverse effect of antidotes and chelating agents, initial encounter
T50.7X5A Adverse effect of analeptics and opioid receptor antagonists, initial encounter
T50.8X5A Adverse effect of diagnostic agents, initial encounter
T50.A15A Adverse effect of pertussis vaccine, including combinations with a pertussis component, initial encounter
T50.A25A Adverse effect of mixed bacterial vaccines without a pertussis component, initial encounter
T50.A95A Adverse effect of other bacterial vaccines, initial encounter
T50.B15A Adverse effect of smallpox vaccines, initial encounter
T50.B95A Adverse effect of other viral vaccines, initial encounter
T50.Z15A Adverse effect of immunoglobulin, initial encounter
T50.Z95A Adverse effect of other vaccines and biological substances, initial encounter
T50.905A Adverse effect of unspecified drugs, medicaments and biological substances, initial encounter
T50.995A Adverse effect of other drugs, medicaments and biological substances, initial encounter
T51.3X1A Toxic effect of fusel oil, accidental (unintentional), initial encounter
T51.3X2A Toxic effect of fusel oil, intentional self-harm, initial encounter
T51.3X3A Toxic effect of fusel oil, assault, initial encounter
T58.01XA Toxic effect of carbon monoxide from motor vehicle exhaust, accidental (unintentional), initial encounter
T58.02XA Toxic effect of carbon monoxide from motor vehicle exhaust, intentional self-harm, initial encounter
T58.03XA Toxic effect of carbon monoxide from motor vehicle exhaust, assault, initial encounter
T58.11XA Toxic effect of carbon monoxide from utility gas, accidental (unintentional), initial encounter
T58.12XA Toxic effect of carbon monoxide from utility gas, intentional self-harm, initial encounter
T58.13XA Toxic effect of carbon monoxide from utility gas, assault, initial encounter
T58.2X1A Toxic effect of carbon monoxide from incomplete combustion of other domestic fuels, accidental (unintentional), initial encounter
T58.2X2A Toxic effect of carbon monoxide from incomplete combustion of other domestic fuels, intentional self-harm, initial encounter
T58.2X3A Toxic effect of carbon monoxide from incomplete combustion of other domestic fuels, assault, initial encounter
T58.8X1A Toxic effect of carbon monoxide from other source, accidental (unintentional), initial encounter
T58.8X2A Toxic effect of carbon monoxide from other source, intentional self-harm, initial encounter
T58.8X3A Toxic effect of carbon monoxide from other source, assault, initial encounter
T66.XXXA Radiation sickness, unspecified, initial encounter
T75.01XA Shock due to being struck by lightning, initial encounter
T75.09XA Other effects of lightning, initial encounter
T75.4XXA Electrocution, initial encounter
T79.0XXA Air embolism (traumatic), initial encounter
T79.1XXA Fat embolism (traumatic), initial encounter
T79.4XXA Traumatic shock, initial encounter
T80.0XXA Air embolism following infusion, transfusion and therapeutic injection, initial encounter
T80.211A Bloodstream infection due to central venous catheter, initial encounter
T80.212A Local infection due to central venous catheter, initial encounter
T80.218A Other infection due to central venous catheter, initial encounter
T80.22XA Acute infection following transfusion, infusion, or injection of blood and blood products, initial encounter
T80.29XA Infection following other infusion, transfusion and therapeutic injection, initial encounter
T80.51XA Anaphylactic reaction due to administration of blood and blood products, initial encounter
T80.52XA Anaphylactic reaction due to vaccination, initial encounter
T80.59XA Anaphylactic reaction due to other serum, initial encounter
T81.10XA Postprocedural shock unspecified, initial encounter
T81.11XA Postprocedural cardiogenic shock, initial encounter
T81.12XA Postprocedural septic shock, initial encounter
T81.19XA Other postprocedural shock, initial encounter
T81.40XA Infection following a procedure, unspecified, initial encounter
T81.40XD Infection following a procedure, unspecified, subsequent encounter
T81.40XS Infection following a procedure, unspecified, sequela
T81.41XA Infection following a procedure, superficial incisional surgical site, initial encounter
T81.41XD Infection following a procedure, superficial incisional surgical site, subsequent encounter
T81.41XS Infection following a procedure, superficial incisional surgical site, sequela
T81.42XA Infection following a procedure, deep incisional surgical site, initial encounter
T81.42XD Infection following a procedure, deep incisional surgical site, subsequent encounter
T81.42XS Infection following a procedure, deep incisional surgical site, sequela
T81.43XA Infection following a procedure, organ and space surgical site, initial encounter
T81.43XD Infection following a procedure, organ and space surgical site, subsequent encounter
T81.43XS Infection following a procedure, organ and space surgical site, sequela
T81.44XA Sepsis following a procedure, initial encounter
T81.44XD Sepsis following a procedure, subsequent encounter
T81.44XS Sepsis following a procedure, sequela
T81.49XA Infection following a procedure, other surgical site, initial encounter
T81.49XD Infection following a procedure, other surgical site, subsequent encounter
T81.49XS Infection following a procedure, other surgical site, sequela
T81.718A Complication of other artery following a procedure, not elsewhere classified, initial encounter
T81.72XA Complication of vein following a procedure, not elsewhere classified, initial encounter
T82.01XA Breakdown (mechanical) of heart valve prosthesis, initial encounter
T82.02XA Displacement of heart valve prosthesis, initial encounter
T82.03XA Leakage of heart valve prosthesis, initial encounter
T82.110A Breakdown (mechanical) of cardiac electrode, initial encounter
T82.111A Breakdown (mechanical) of cardiac pulse generator (battery), initial encounter
T82.118A Breakdown (mechanical) of other cardiac electronic device, initial encounter
T82.120A Displacement of cardiac electrode, initial encounter
T82.121A Displacement of cardiac pulse generator (battery), initial encounter
T82.128A Displacement of other cardiac electronic device, initial encounter
T82.190A Other mechanical complication of cardiac electrode, initial encounter
T82.191A Other mechanical complication of cardiac pulse generator (battery), initial encounter
T82.198A Other mechanical complication of other cardiac electronic device, initial encounter
T82.211A Breakdown (mechanical) of coronary artery bypass graft, initial encounter
T82.212A Displacement of coronary artery bypass graft, initial encounter
T82.213A Leakage of coronary artery bypass graft, initial encounter
T82.221A Breakdown (mechanical) of biological heart valve graft, initial encounter
T82.222A Displacement of biological heart valve graft, initial encounter
T82.223A Leakage of biological heart valve graft, initial encounter
T82.228A Other mechanical complication of biological heart valve graft, initial encounter
T82.310A Breakdown (mechanical) of aortic (bifurcation) graft (replacement), initial encounter
T82.311A Breakdown (mechanical) of carotid arterial graft (bypass), initial encounter
T82.312A Breakdown (mechanical) of femoral arterial graft (bypass), initial encounter
T82.318A Breakdown (mechanical) of other vascular grafts, initial encounter
T82.320A Displacement of aortic (bifurcation) graft (replacement), initial encounter
T82.321A Displacement of carotid arterial graft (bypass), initial encounter
T82.322A Displacement of femoral arterial graft (bypass), initial encounter
T82.328A Displacement of other vascular grafts, initial encounter
T82.330A Leakage of aortic (bifurcation) graft (replacement), initial encounter
T82.331A Leakage of carotid arterial graft (bypass), initial encounter
T82.332A Leakage of femoral arterial graft (bypass), initial encounter
T82.338A Leakage of other vascular grafts, initial encounter
T82.390A Other mechanical complication of aortic (bifurcation) graft (replacement), initial encounter
T82.391A Other mechanical complication of carotid arterial graft (bypass), initial encounter
T82.392A Other mechanical complication of femoral arterial graft (bypass), initial encounter
T82.398A Other mechanical complication of other vascular grafts, initial encounter
T82.41XA Breakdown (mechanical) of vascular dialysis catheter, initial encounter
T82.42XA Displacement of vascular dialysis catheter, initial encounter
T82.43XA Leakage of vascular dialysis catheter, initial encounter
T82.510A Breakdown (mechanical) of surgically created arteriovenous fistula, initial encounter
T82.511A Breakdown (mechanical) of surgically created arteriovenous shunt, initial encounter
T82.512A Breakdown (mechanical) of artificial heart, initial encounter
T82.513A Breakdown (mechanical) of balloon (counterpulsation) device, initial encounter
T82.514A Breakdown (mechanical) of infusion catheter, initial encounter
T82.515A Breakdown (mechanical) of umbrella device, initial encounter
T82.518A Breakdown (mechanical) of other cardiac and vascular devices and implants, initial encounter
T82.520A Displacement of surgically created arteriovenous fistula, initial encounter
T82.521A Displacement of surgically created arteriovenous shunt, initial encounter
T82.522A Displacement of artificial heart, initial encounter
T82.523A Displacement of balloon (counterpulsation) device, initial encounter
T82.524A Displacement of infusion catheter, initial encounter
T82.525A Displacement of umbrella device, initial encounter
T82.528A Displacement of other cardiac and vascular devices and implants, initial encounter
T82.530A Leakage of surgically created arteriovenous fistula, initial encounter
T82.531A Leakage of surgically created arteriovenous shunt, initial encounter
T82.532A Leakage of artificial heart, initial encounter
T82.533A Leakage of balloon (counterpulsation) device, initial encounter
T82.534A Leakage of infusion catheter, initial encounter
T82.535A Leakage of umbrella device, initial encounter
T82.538A Leakage of other cardiac and vascular devices and implants, initial encounter
T82.590A Other mechanical complication of surgically created arteriovenous fistula, initial encounter
T82.591A Other mechanical complication of surgically created arteriovenous shunt, initial encounter
T82.592A Other mechanical complication of artificial heart, initial encounter
T82.593A Other mechanical complication of balloon (counterpulsation) device, initial encounter
T82.594A Other mechanical complication of infusion catheter, initial encounter
T82.595A Other mechanical complication of umbrella device, initial encounter
T82.598A Other mechanical complication of other cardiac and vascular devices and implants, initial encounter
T82.6XXA Infection and inflammatory reaction due to cardiac valve prosthesis, initial encounter
T82.7XXA Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter
T82.817A Embolism due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.818A Embolism due to vascular prosthetic devices, implants and grafts, initial encounter
T82.827A Fibrosis due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.837A Hemorrhage due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.847A Pain due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.857A Stenosis of other cardiac prosthetic devices, implants and grafts, initial encounter
T82.867A Thrombosis due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.897A Other specified complication of cardiac prosthetic devices, implants and grafts, initial encounter
T84.51XA Infection and inflammatory reaction due to internal right hip prosthesis, initial encounter
T84.52XA Infection and inflammatory reaction due to internal left hip prosthesis, initial encounter
T84.53XA Infection and inflammatory reaction due to internal right knee prosthesis, initial encounter
T84.54XA Infection and inflammatory reaction due to internal left knee prosthesis, initial encounter
T84.59XA Infection and inflammatory reaction due to other internal joint prosthesis, initial encounter
T85.79XA Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, initial encounter
T86.21 - T86.23 Heart transplant rejection - Heart transplant infection
T86.290 Cardiac allograft vasculopathy
T86.298 Other complications of heart transplant
T86.31 - T86.33 Heart-lung transplant rejection - Heart-lung transplant infection
T86.39 Other complications of heart-lung transplant
T88.0XXA Infection following immunization, initial encounter
T88.59XA Other complications of anesthesia, initial encounter
Z01.30 Encounter for examination of blood pressure without abnormal findings
Z01.31 Encounter for examination of blood pressure with abnormal findings
Z01.810 Encounter for preprocedural cardiovascular examination
Z01.818 Encounter for other preprocedural examination
Z01.82 Encounter for allergy testing
Z01.89 Encounter for other specified special examinations
Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
Z12.11 Encounter for screening for malignant neoplasm of colon
Z13.6 Encounter for screening for cardiovascular disorders
Z48.21 - Z48.24 Encounter for aftercare following heart transplant - Encounter for aftercare following lung transplant
Z48.280 Encounter for aftercare following heart-lung transplant
Z48.288 Encounter for aftercare following multiple organ transplant
Z48.290 Encounter for aftercare following bone marrow transplant
Z48.298 Encounter for aftercare following other organ transplant
Z51.11 Encounter for antineoplastic chemotherapy
Z52.4 Kidney donor
Z52.89 Donor of other specified organs or tissues
Z79.3 Long term (current) use of hormonal contraceptives
Z79.85 Long-term (current) use of injectable non-insulin antidiabetic drugs
Z79.891 Long term (current) use of opiate analgesic
Z79.899 Other long term (current) drug therapy
Z86.711 Personal history of pulmonary embolism
Z86.73 Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits
Z86.74 Personal history of sudden cardiac arrest
Z87.731 Personal history of (corrected) tracheoesophageal fistula or atresia
Z87.760 Personal history of (corrected) congenital diaphragmatic hernia or other congenital diaphragm malformations
Z94.1 - Z94.3 Heart transplant status - Heart and lungs transplant status
Z95.2 - Z95.4 Presence of prosthetic heart valve - Presence of other heart-valve replacement
Z95.811 Presence of heart assist device
Z95.812 Presence of fully implantable artificial heart
Z98.890 Other specified postprocedural states
Z98.891 History of uterine scar from previous surgery
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

ICD-10 codes require a primary and secondary diagnosis.
*B39.4 or B39.5 with ICD-10 codes I32 or I39
*S26.90XA bill with ICD-10 S21.309A
*S14.111A or S14.121A bill wih ICD-10 S12.000B or S12.001B
*S14.112A or S14.122A bill with ICD-10 S12.100B or S12.101B
*S14.113A or S14.123A bill with ICD-10 S12.200B or S12.201B
*S14.114A or S14.124A bill with ICD-10 S12.300B or S12.301B
*S21.309A bill with ICD-10 S26.020A or S26.92XA

Group 2

(139 Codes)
Group 2 Paragraph

Applicable to codes 93303, and 93304, 93320, 93321, 93325, C8921, C8922:

ICD-10 code Z87.74 is covered for CPT code 93304

Group 2 Codes
Code Description
D82.1 Di George's syndrome
P22.8 Other respiratory distress of newborn
P22.9 Respiratory distress of newborn, unspecified
P28.31 Primary central sleep apnea of newborn
P28.32 Primary obstructive sleep apnea of newborn
P28.33 Primary mixed sleep apnea of newborn
P28.39 Other primary sleep apnea of newborn
P28.41 Central neonatal apnea of newborn
P28.42 Obstructive apnea of newborn
P28.43 Mixed neonatal apnea of newborn
P28.49 Other apnea of newborn
P28.89 Other specified respiratory conditions of newborn
P29.0 Neonatal cardiac failure
P29.11 Neonatal tachycardia
P29.12 Neonatal bradycardia
P29.2 - P29.4 Neonatal hypertension - Transient myocardial ischemia in newborn
P29.89 Other cardiovascular disorders originating in the perinatal period
P94.1 Congenital hypertonia
P94.2 Congenital hypotonia
P94.8 Other disorders of muscle tone of newborn
P96.0 Congenital renal failure
P96.3 Wide cranial sutures of newborn
P96.5 Complication to newborn due to (fetal) intrauterine procedure
P96.89 Other specified conditions originating in the perinatal period
Q20.0 - Q20.6 Common arterial trunk - Isomerism of atrial appendages
Q20.8 Other congenital malformations of cardiac chambers and connections
Q21.0 - Q21.16 Ventricular septal defect - Sinus venosus atrial septal defect, unspecified
Q21.19 Other specified atrial septal defect
Q21.21 - Q21.4 Partial atrioventricular septal defect - Aortopulmonary septal defect
Q21.8 Other congenital malformations of cardiac septa
Q21.9 Congenital malformation of cardiac septum, unspecified
Q22.0 - Q22.6 Pulmonary valve atresia - Hypoplastic right heart syndrome
Q22.8 Other congenital malformations of tricuspid valve
Q23.0 - Q23.4 Congenital stenosis of aortic valve - Hypoplastic left heart syndrome
Q23.8 Other congenital malformations of aortic and mitral valves
Q24.0 - Q24.6 Dextrocardia - Congenital heart block
Q24.8 Other specified congenital malformations of heart
Q25.0 Patent ductus arteriosus
Q25.1 Coarctation of aorta
Q25.21 Interruption of aortic arch
Q25.29 Other atresia of aorta
Q25.3 Supravalvular aortic stenosis
Q25.41 Absence and aplasia of aorta
Q25.42 Hypoplasia of aorta
Q25.43 Congenital aneurysm of aorta
Q25.44 Congenital dilation of aorta
Q25.45 Double aortic arch
Q25.46 Tortuous aortic arch
Q25.47 Right aortic arch
Q25.48 Anomalous origin of subclavian artery
Q25.49 Other congenital malformations of aorta
Q25.5 Atresia of pulmonary artery
Q25.6 Stenosis of pulmonary artery
Q25.71 Coarctation of pulmonary artery
Q25.72 Congenital pulmonary arteriovenous malformation
Q25.79 Other congenital malformations of pulmonary artery
Q25.8 Other congenital malformations of other great arteries
Q26.0 - Q26.4 Congenital stenosis of vena cava - Anomalous pulmonary venous connection, unspecified
Q26.8 Other congenital malformations of great veins
Q26.9 Congenital malformation of great vein, unspecified
Q27.0 Congenital absence and hypoplasia of umbilical artery
Q27.9 Congenital malformation of peripheral vascular system, unspecified
Q28.2 Arteriovenous malformation of cerebral vessels
Q28.3 Other malformations of cerebral vessels
Q28.9 Congenital malformation of circulatory system, unspecified
Q30.0 Choanal atresia
Q33.2 Sequestration of lung
Q33.3 Agenesis of lung
Q33.6 Congenital hypoplasia and dysplasia of lung
Q40.1 Congenital hiatus hernia
Q67.6 Pectus excavatum
Q67.7 Pectus carinatum
Q87.410 Marfan syndrome with aortic dilation
Q87.418 Marfan syndrome with other cardiovascular manifestations
Q87.42 Marfan syndrome with ocular manifestations
Q87.43 Marfan syndrome with skeletal manifestation
Q89.01 Asplenia (congenital)
Q89.09 Congenital malformations of spleen
Q89.3 Situs inversus
Q89.7 Multiple congenital malformations, not elsewhere classified
Q89.9 Congenital malformation, unspecified
Q90.0 - Q90.2 Trisomy 21, nonmosaicism (meiotic nondisjunction) - Trisomy 21, translocation
Q91.0 - Q91.6 Trisomy 18, nonmosaicism (meiotic nondisjunction) - Trisomy 13, translocation
Q96.0 - Q96.4 Karyotype 45, X - Mosaicism, 45, X/other cell line(s) with abnormal sex chromosome
Q96.8 Other variants of Turner's syndrome
R78.81 Bacteremia
Z87.74 Personal history of (corrected) congenital malformations of heart and circulatory system

Group 3

(5 Codes)
Group 3 Paragraph

Applicable to codes 93308, C8924:(When reporting add-on CPT codes 93320, 93321 and 93325, the same ICD-10-CM code should be used as that used for the base code to which it is attached):

Group 3 Codes
Code Description
I10 Essential (primary) hypertension
I11.9 Hypertensive heart disease without heart failure
I13.10 Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
I15.0 Renovascular hypertension

Group 4

(197 Codes)
Group 4 Paragraph

Applicable to CPT code 93350, 93351, 93352, C8928, C8930: (When reporting add-on CPT codes 93320, 93321 and 93325, the same ICD-10-CM code should be used as that used for the base code to which it is attached):

Group 4 Codes
Code Description
A18.84 Tuberculosis of heart
I20.0 Unstable angina
I20.1 Angina pectoris with documented spasm
I20.81 Angina pectoris with coronary microvascular dysfunction
I20.89 Other forms of angina pectoris
I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery
I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
I21.29 ST elevation (STEMI) myocardial infarction involving other sites
I21.4 Non-ST elevation (NSTEMI) myocardial infarction
I24.0 Acute coronary thrombosis not resulting in myocardial infarction
I24.1 Dressler's syndrome
I24.81 Acute coronary microvascular dysfunction
I24.89 Other forms of acute ischemic heart disease
I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
I25.2 Old myocardial infarction
I25.3 Aneurysm of heart
I25.41 Coronary artery aneurysm
I25.42 Coronary artery dissection
I25.5 Ischemic cardiomyopathy
I25.6 Silent myocardial ischemia
I25.710 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris
I25.711 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris
I25.720 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris
I25.721 Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.728 Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris
I25.730 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris
I25.731 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.738 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris
I25.750 Atherosclerosis of native coronary artery of transplanted heart with unstable angina
I25.751 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm
I25.758 Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris
I25.760 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina
I25.761 Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm
I25.768 Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris
I25.790 Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris
I25.791 Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris
I25.810 - I25.812 Atherosclerosis of coronary artery bypass graft(s) without angina pectoris - Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris
I25.82 Chronic total occlusion of coronary artery
I25.84 Coronary atherosclerosis due to calcified coronary lesion
I25.89 Other forms of chronic ischemic heart disease
I27.0 Primary pulmonary hypertension
I27.1 Kyphoscoliotic heart disease
I27.20 - I27.24 Pulmonary hypertension, unspecified - Chronic thromboembolic pulmonary hypertension
I27.29 Other secondary pulmonary hypertension
I27.82 Chronic pulmonary embolism
I27.83 Eisenmenger's syndrome
I27.89 Other specified pulmonary heart diseases
I34.0 - I34.2 Nonrheumatic mitral (valve) insufficiency - Nonrheumatic mitral (valve) stenosis
I34.81 Nonrheumatic mitral (valve) annulus calcification
I34.89 Other nonrheumatic mitral valve disorders
I35.0 - I35.2 Nonrheumatic aortic (valve) stenosis - Nonrheumatic aortic (valve) stenosis with insufficiency
I35.8 Other nonrheumatic aortic valve disorders
I42.0 - I42.2 Dilated cardiomyopathy - Other hypertrophic cardiomyopathy
I42.4 - I42.8 Endocardial fibroelastosis - Other cardiomyopathies
I43 Cardiomyopathy in diseases classified elsewhere
I44.4 Left anterior fascicular block
I44.5 Left posterior fascicular block
I44.69 Other fascicular block
I44.7 Left bundle-branch block, unspecified
I45.0 Right fascicular block
I45.19 Other right bundle-branch block
I49.01 Ventricular fibrillation
I49.02 Ventricular flutter
I49.1 - I49.3 Atrial premature depolarization - Ventricular premature depolarization
I49.40 Unspecified premature depolarization
I49.49 Other premature depolarization
I50.1 Left ventricular failure, unspecified
I50.20 - I50.23 Unspecified systolic (congestive) heart failure - Acute on chronic systolic (congestive) heart failure
I50.30 - I50.33 Unspecified diastolic (congestive) heart failure - Acute on chronic diastolic (congestive) heart failure
I50.40 - I50.43 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure - Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.9 Heart failure, unspecified
I51.7 Cardiomegaly
I97.0 Postcardiotomy syndrome
I97.110 Postprocedural cardiac insufficiency following cardiac surgery
I97.111 Postprocedural cardiac insufficiency following other surgery
I97.120 Postprocedural cardiac arrest following cardiac surgery
I97.121 Postprocedural cardiac arrest following other surgery
I97.130 Postprocedural heart failure following cardiac surgery
I97.131 Postprocedural heart failure following other surgery
I97.190 Other postprocedural cardiac functional disturbances following cardiac surgery
I97.191 Other postprocedural cardiac functional disturbances following other surgery
Q24.0 - Q24.4 Dextrocardia - Congenital subaortic stenosis
R06.00 - R06.02 Dyspnea, unspecified - Shortness of breath
R06.09 Other forms of dyspnea
R06.83 Snoring
R06.89 Other abnormalities of breathing
R07.2 Precordial pain
R07.82 Intercostal pain
R07.89 Other chest pain
R07.9 Chest pain, unspecified
R40.4 Transient alteration of awareness
R55 Syncope and collapse
R94.31 Abnormal electrocardiogram [ECG] [EKG]
T82.310A Breakdown (mechanical) of aortic (bifurcation) graft (replacement), initial encounter
T82.311A Breakdown (mechanical) of carotid arterial graft (bypass), initial encounter
T82.312A Breakdown (mechanical) of femoral arterial graft (bypass), initial encounter
T82.318A Breakdown (mechanical) of other vascular grafts, initial encounter
T82.320A Displacement of aortic (bifurcation) graft (replacement), initial encounter
T82.321A Displacement of carotid arterial graft (bypass), initial encounter
T82.322A Displacement of femoral arterial graft (bypass), initial encounter
T82.328A Displacement of other vascular grafts, initial encounter
T82.330A Leakage of aortic (bifurcation) graft (replacement), initial encounter
T82.331A Leakage of carotid arterial graft (bypass), initial encounter
T82.332A Leakage of femoral arterial graft (bypass), initial encounter
T82.338A Leakage of other vascular grafts, initial encounter
T82.390A Other mechanical complication of aortic (bifurcation) graft (replacement), initial encounter
T82.391A Other mechanical complication of carotid arterial graft (bypass), initial encounter
T82.392A Other mechanical complication of femoral arterial graft (bypass), initial encounter
T82.398A Other mechanical complication of other vascular grafts, initial encounter
T82.41XA Breakdown (mechanical) of vascular dialysis catheter, initial encounter
T82.42XA Displacement of vascular dialysis catheter, initial encounter
T82.43XA Leakage of vascular dialysis catheter, initial encounter
T82.510A Breakdown (mechanical) of surgically created arteriovenous fistula, initial encounter
T82.511A Breakdown (mechanical) of surgically created arteriovenous shunt, initial encounter
T82.513A Breakdown (mechanical) of balloon (counterpulsation) device, initial encounter
T82.514A Breakdown (mechanical) of infusion catheter, initial encounter
T82.515A Breakdown (mechanical) of umbrella device, initial encounter
T82.518A Breakdown (mechanical) of other cardiac and vascular devices and implants, initial encounter
T82.520A Displacement of surgically created arteriovenous fistula, initial encounter
T82.521A Displacement of surgically created arteriovenous shunt, initial encounter
T82.523A Displacement of balloon (counterpulsation) device, initial encounter
T82.524A Displacement of infusion catheter, initial encounter
T82.525A Displacement of umbrella device, initial encounter
T82.528A Displacement of other cardiac and vascular devices and implants, initial encounter
T82.530A Leakage of surgically created arteriovenous fistula, initial encounter
T82.531A Leakage of surgically created arteriovenous shunt, initial encounter
T82.533A Leakage of balloon (counterpulsation) device, initial encounter
T82.534A Leakage of infusion catheter, initial encounter
T82.535A Leakage of umbrella device, initial encounter
T82.538A Leakage of other cardiac and vascular devices and implants, initial encounter
T82.590A Other mechanical complication of surgically created arteriovenous fistula, initial encounter
T82.591A Other mechanical complication of surgically created arteriovenous shunt, initial encounter
T82.593A Other mechanical complication of balloon (counterpulsation) device, initial encounter
T82.594A Other mechanical complication of infusion catheter, initial encounter
T82.595A Other mechanical complication of umbrella device, initial encounter
T82.598A Other mechanical complication of other cardiac and vascular devices and implants, initial encounter
T82.817A Embolism due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.827A Fibrosis due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.837A Hemorrhage due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.847A Pain due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.857A Stenosis of other cardiac prosthetic devices, implants and grafts, initial encounter
T82.867A Thrombosis due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.897A Other specified complication of cardiac prosthetic devices, implants and grafts, initial encounter
T82.9XXA Unspecified complication of cardiac and vascular prosthetic device, implant and graft, initial encounter
T86.20 - T86.23 Unspecified complication of heart transplant - Heart transplant infection
T86.290 Cardiac allograft vasculopathy
T86.298 Other complications of heart transplant
T86.31 - T86.33 Heart-lung transplant rejection - Heart-lung transplant infection
T86.39 Other complications of heart-lung transplant
Z79.3 Long term (current) use of hormonal contraceptives
Z79.83 Long term (current) use of bisphosphonates
Z79.891 Long term (current) use of opiate analgesic
Z79.899 Other long term (current) drug therapy

Group 5

(14 Codes)
Group 5 Paragraph

The following diagnoses are covered for CPT codes 76376 and 76377 when performed for 3-D imaging following CPT codes 93303, 93304, 93306, 93307, or 93308 (the same ICD-10-CM code should be used as that used for the base code to which it is attached):

Group 5 Codes
Code Description
I05.0 - I05.2 Rheumatic mitral stenosis - Rheumatic mitral stenosis with insufficiency
I05.8 Other rheumatic mitral valve diseases
I08.0 Rheumatic disorders of both mitral and aortic valves
I08.8 Other rheumatic multiple valve diseases
I23.4 Rupture of chordae tendineae as current complication following acute myocardial infarction
I23.5 Rupture of papillary muscle as current complication following acute myocardial infarction
I33.0 Acute and subacute infective endocarditis
I39 Endocarditis and heart valve disorders in diseases classified elsewhere
I51.1 Rupture of chordae tendineae, not elsewhere classified
I51.2 Rupture of papillary muscle, not elsewhere classified
Q23.2 Congenital mitral stenosis
Q23.3 Congenital mitral insufficiency
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 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.

Code Description

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Revenue Codes

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

Revenue codes only apply to providers who bill these services to the Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.

All revenue codes billed on the inpatient claim for the dates of service in question may be subject to review.


Code Description

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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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

Revision History Date Revision History Number Revision History Explanation
11/16/2023 R20

R19

Revision Effective: 11/16/2023

Revision Explanation: Updated LCD Reference Article section.

10/05/2023 R19

R18

Revision Effective Date: 10/05/2023

Revision Explanation: Annual review, no changes.

10/01/2023 R18

R18

Revision Effective Date: 10/01/2023

Revision Explanation: Annual ICD-10 update, Deleted I20.8, I24.8 from group 1,4. Deleted I47.1 from Group 1. Added the following I20.81, I20.89, I24.81, I24.89, I47.11, and I47.19

06/22/2023 R17

R17

Revision Effective Date: 06/22/2023

Revision Explanation: Added range I27.20-I27.24 as indicated in revision 16 for group 4.

05/28/2023 R16

R16

Revision Effective Date: 05/282023

Revision Explanation: Added C8928 to group 4 ICD-10 paragraph, this was left off in error. Added the following ICD-10 codes back to group1 under ICD-10 as these were left off in error when finalizing article: I71.21, I71.22, I71.23, I71.31, I71.32, I71.33, I71.41, I71.42, I71.43, I71.51, I71.51. Also added ICD-10 codes back to group 4: I27.0, I27.1, I27.20-I27.24, I27.29, I27.82, I27.83, I27.89, I49.01, I49.02, I49.1-I49.3, I49.40, I49.49, Q24.0-Q24.4, and R55.

05/28/2023 R15

R15

Revision Effective Date: 05/282023

Revision Explanation: Released to final to begin notice period with policy after open comment period.

03/09/2023 R14

R14

Revision Effective Date: 03/09/2023

Revision Explanation: I27.9 was left out of ICD-10 group 4 in error from revision 13.

02/09/2023 R13

R13

Revision Effective Date: 02/09/2023

Revision Explanation: Add to paragraph group 4 under ICD-10 that the diagnoses apply to stress agent used as well. Added ICD-10 codes to group 4: I27.0, I27.1, I27.20-I27.24, I27.29

I27.82, I27.83, I27.89, I49.01, I49.02, I49.1-I49.3, I49.40, I49.49, Q24.0-Q24.4, and R55. 

10/01/2022 R12

R12

Revision Effective Date: 10/01/2022

Revision Explanation: During the annual ICD-10 update the following codes were left off in error: I71.21, I71.22, I71.23, I71.31, I71.32, I71.33, I71.41, I71.42, I71.43, I71.51, I71.51.

10/01/2022 R11

R11

Revision Effective Date: 10/01/2022

Revision Explanation: During the annual ICD-10 update Q21.20 was left out of the group 1 ICD-10 codes and was include in the group 2 codes in error.

10/01/2022 R10

R10

Revision Effective Date: 10/01/2022

Revision Explanation: Deleted I34.8, I47.2, I71.1, and I71.6. Added  I34.81 I34.89   I47.21 I47.29, I71.11, I71.12, I71.13, I71.61 and  I71.62  

10/01/2022 R9

R9

Revision Effective Date: 10/01/2022

Revision Explanation: Removed p28.3 and added P28.31 P28.32 P28.33 P28.39  

10/01/2022 R8

R8

Revision Effective Date: 10/01/2022

Revision Explanation: removed P28.4 and added P28.41, P28.42, P28.43, P28.49

10/01/2022 R7

R7

Revision Effective Date: 10/01/2022

Revision Explanation: Removed the following codes I71.010, I71.011, and I71.012, already included in range. Deleted I34.8 and added I34.81 and I34.89 to Group 4.

10/01/2022 R6

R6

Revision Effective Date: 10/01/2022

Revision Explanation: Annual ICD-10 Update, Added to Group 1 I25.112, I25.702, I25.712, I25.722, I25.732, I25.752. I25.762, I25.792, Z79.85, I71.010, I71.011, I71.012,I25.112, I25.702, I25.712, I25.722, I25.732, I25.752. I25.762, I25.792, Z79.85, I71.010, I71.011, I71.012, T43.651A, T43.651D, T43.651S, T43.652A, T43.652D, T43.652S, T43.653A,, T43.653D, T43.653S, T43.654A, T43.654D, T43.654S, T43.655A, T43.655D. T43.655S, T43.656A, T43.656D, T43.656S, Z87.731, and Z87.760

10/01/2021 R5

R5

Revision Effective Date: N/A

Revision Explanation: Annual review, no changes were made.

10/01/2021 R4

R4

Revision Effective Date: 10/01/2021

Revision Explanation: Annual ICD-10 update. Under ICD-10-CM Codes that Support Medical Necessity Group 1 : T40.7X5A was deleted and  T40.715A T40.725A  were added.

10/01/2020 R3

R3
Revision Effective: 10/01/2020
Revision Explanation: During the annual ICD-10 review codes T40.4X1a, T40.4X2A, T40.4X3A, and T40.4X5A were deleted and replaced with the following codes in group 1: T40.491a, T40.492a, T40.493a, and T40.495A.

10/01/2019 R2

R2

Revision Effective: N/A

Revision Explanation: Annual review, no changes made.

10/01/2019 R1

R1

Revision Effective: 10/01/2019

Revision Explanation: During the annual ICD-10 review code I48.1 and I48.2 were end dated and replaced with I48.11, I48.19, I48.20, and I48.21 in group 1. New codes from the annual review I26.93 and I26.94 were added for ICD-10 group 1.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L34338 - Transthoracic Echocardiography (TTE)
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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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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Other URLs
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Public Versions
Updated On Effective Dates Status
09/27/2024 10/03/2024 - N/A Currently in Effect View
09/09/2024 10/01/2024 - 10/02/2024 Superseded View
07/18/2024 07/25/2024 - 09/30/2024 Superseded View
11/13/2023 11/16/2023 - 07/24/2024 Superseded View
11/07/2023 11/16/2023 - N/A Superseded You are here
09/29/2023 10/05/2023 - 11/15/2023 Superseded View
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