Superseded Local Coverage Article Billing and Coding

Billing and Coding: Serum Phosphorus

A57650

Expand All | Collapse All
Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
Superseded
To see the currently-in-effect version of this document, go to the section.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57650
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Serum Phosphorus
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
04/12/2023
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

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

Current Dental Terminology © 2022 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. 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

Social Security Act (Title XVIII) Standard References:

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

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L34022, Serum Phosphorus. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

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

Documentation Requirements

1.  All documentation must be maintained in the patient's medical record and made available to the contractor upon request.

2.  Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.

3.  The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

4.  If the provider of the service is other than the ordering/referring physician, that provider must maintain hard copy documentation of test results and interpretation, along with copies of the ordering/referring physician’s order for the studies. The physician must state the clinical indication/medical necessity for the study in his order for the test. 

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
999x Not Applicable
N/A

Revenue Codes

Code Description
99999 Not Applicable
N/A

CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph

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

Group 1 Codes
Code Description
84100 Assay of phosphorus
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(498 Codes)
Group 1 Paragraph

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

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 84100.

Note: Renal dialysis facilities should report a diagnosis code of N18.6 for submission of claims.

Group 1 Codes
Code Description
B52.0 Plasmodium malariae malaria with nephropathy
C40.00 Malignant neoplasm of scapula and long bones of unspecified upper limb
C40.01 Malignant neoplasm of scapula and long bones of right upper limb
C40.02 Malignant neoplasm of scapula and long bones of left upper limb
C40.10 Malignant neoplasm of short bones of unspecified upper limb
C40.11 Malignant neoplasm of short bones of right upper limb
C40.12 Malignant neoplasm of short bones of left upper limb
C40.20 Malignant neoplasm of long bones of unspecified lower limb
C40.21 Malignant neoplasm of long bones of right lower limb
C40.22 Malignant neoplasm of long bones of left lower limb
C40.30 Malignant neoplasm of short bones of unspecified lower limb
C40.31 Malignant neoplasm of short bones of right lower limb
C40.32 Malignant neoplasm of short bones of left lower limb
C40.80 Malignant neoplasm of overlapping sites of bone and articular cartilage of unspecified limb
C40.81 Malignant neoplasm of overlapping sites of bone and articular cartilage of right limb
C40.82 Malignant neoplasm of overlapping sites of bone and articular cartilage of left limb
C40.90 Malignant neoplasm of unspecified bones and articular cartilage of unspecified limb
C40.91 Malignant neoplasm of unspecified bones and articular cartilage of right limb
C40.92 Malignant neoplasm of unspecified bones and articular cartilage of left limb
C41.0 Malignant neoplasm of bones of skull and face
C41.1 Malignant neoplasm of mandible
C41.2 Malignant neoplasm of vertebral column
C41.3 Malignant neoplasm of ribs, sternum and clavicle
C41.4 Malignant neoplasm of pelvic bones, sacrum and coccyx
C41.9 Malignant neoplasm of bone and articular cartilage, unspecified
C79.51 Secondary malignant neoplasm of bone
C79.52 Secondary malignant neoplasm of bone marrow
C90.00 Multiple myeloma not having achieved remission
C90.01 Multiple myeloma in remission
C90.02 Multiple myeloma in relapse
D47.3 Essential (hemorrhagic) thrombocythemia
D47.Z9 Other specified neoplasms of uncertain behavior of lymphoid, hematopoietic and related tissue
D59.9 Acquired hemolytic anemia, unspecified
D69.0 Allergic purpura
D69.1 Qualitative platelet defects
D69.2 Other nonthrombocytopenic purpura
D69.3 Immune thrombocytopenic purpura
D69.41 Evans syndrome
D69.42 Congenital and hereditary thrombocytopenia purpura
D69.49 Other primary thrombocytopenia
D69.51 Posttransfusion purpura
D69.59 Other secondary thrombocytopenia
D69.6 Thrombocytopenia, unspecified
D69.8 Other specified hemorrhagic conditions
D69.9 Hemorrhagic condition, unspecified
D86.0 Sarcoidosis of lung
D86.1 Sarcoidosis of lymph nodes
D86.2 Sarcoidosis of lung with sarcoidosis of lymph nodes
D86.3 Sarcoidosis of skin
D86.81 Sarcoid meningitis
D86.82 Multiple cranial nerve palsies in sarcoidosis
D86.83 Sarcoid iridocyclitis
D86.84 Sarcoid pyelonephritis
D86.85 Sarcoid myocarditis
D86.86 Sarcoid arthropathy
D86.87 Sarcoid myositis
D86.89 Sarcoidosis of other sites
D86.9 Sarcoidosis, unspecified
E08.21 Diabetes mellitus due to underlying condition with diabetic nephropathy
E08.22 Diabetes mellitus due to underlying condition with diabetic chronic kidney disease
E08.29 Diabetes mellitus due to underlying condition with other diabetic kidney complication
E09.21 Drug or chemical induced diabetes mellitus with diabetic nephropathy
E09.22 Drug or chemical induced diabetes mellitus with diabetic chronic kidney disease
E09.29 Drug or chemical induced diabetes mellitus with other diabetic kidney complication
E20.1 Pseudohypoparathyroidism
E21.0 Primary hyperparathyroidism
E21.1 Secondary hyperparathyroidism, not elsewhere classified
E21.2 Other hyperparathyroidism
E21.3 Hyperparathyroidism, unspecified
E40 Kwashiorkor
E41 Nutritional marasmus
E42 Marasmic kwashiorkor
E43 Unspecified severe protein-calorie malnutrition
E44.0 Moderate protein-calorie malnutrition
E44.1 Mild protein-calorie malnutrition
E45 Retarded development following protein-calorie malnutrition
E46 Unspecified protein-calorie malnutrition
E55.0 Rickets, active
E55.9 Vitamin D deficiency, unspecified
E64.0 Sequelae of protein-calorie malnutrition
E64.3 Sequelae of rickets
E67.2 Megavitamin-B6 syndrome
E67.3 Hypervitaminosis D
E67.8 Other specified hyperalimentation
E68 Sequelae of hyperalimentation
E79.0 Hyperuricemia without signs of inflammatory arthritis and tophaceous disease
E83.30 Disorder of phosphorus metabolism, unspecified
E83.31 Familial hypophosphatemia
E83.32 Hereditary vitamin D-dependent rickets (type 1) (type 2)
E83.39 Other disorders of phosphorus metabolism
E83.42 Hypomagnesemia
E83.50 Unspecified disorder of calcium metabolism
E83.51 Hypocalcemia
E83.52 Hypercalcemia
E83.59 Other disorders of calcium metabolism
E86.0 Dehydration
E86.1 Hypovolemia
E86.9 Volume depletion, unspecified
E87.0 Hyperosmolality and hypernatremia
E87.1 Hypo-osmolality and hyponatremia
E87.21 Acute metabolic acidosis
E87.22 Chronic metabolic acidosis
E87.29 Other acidosis
E87.3 Alkalosis
E87.4 Mixed disorder of acid-base balance
E87.5 Hyperkalemia
E87.6 Hypokalemia
E87.70 Fluid overload, unspecified
E87.71 Transfusion associated circulatory overload
E87.79 Other fluid overload
E87.8 Other disorders of electrolyte and fluid balance, not elsewhere classified
F05 Delirium due to known physiological condition
F28 Other psychotic disorder not due to a substance or known physiological condition
F29 Unspecified psychosis not due to a substance or known physiological condition
G93.40 Encephalopathy, unspecified
G93.41 Metabolic encephalopathy
G93.49 Other encephalopathy
I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal 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
I67.83 Posterior reversible encephalopathy syndrome
K90.0 Celiac disease
K90.1 Tropical sprue
K90.2 Blind loop syndrome, not elsewhere classified
K90.3 Pancreatic steatorrhea
K90.41 Non-celiac gluten sensitivity
K90.49 Malabsorption due to intolerance, not elsewhere classified
K90.89 Other intestinal malabsorption
K90.9 Intestinal malabsorption, unspecified
K91.2 Postsurgical malabsorption, not elsewhere classified
M32.14 Glomerular disease in systemic lupus erythematosus
M32.15 Tubulo-interstitial nephropathy in systemic lupus erythematosus
M35.04 Sjogren syndrome with tubulo-interstitial nephropathy
M35.4 Diffuse (eosinophilic) fasciitis
M60.80 Other myositis, unspecified site
M60.811 Other myositis, right shoulder
M60.812 Other myositis, left shoulder
M60.819 Other myositis, unspecified shoulder
M60.821 Other myositis, right upper arm
M60.822 Other myositis, left upper arm
M60.829 Other myositis, unspecified upper arm
M60.831 Other myositis, right forearm
M60.832 Other myositis, left forearm
M60.839 Other myositis, unspecified forearm
M60.841 Other myositis, right hand
M60.842 Other myositis, left hand
M60.849 Other myositis, unspecified hand
M60.851 Other myositis, right thigh
M60.852 Other myositis, left thigh
M60.859 Other myositis, unspecified thigh
M60.861 Other myositis, right lower leg
M60.862 Other myositis, left lower leg
M60.869 Other myositis, unspecified lower leg
M60.871 Other myositis, right ankle and foot
M60.872 Other myositis, left ankle and foot
M60.879 Other myositis, unspecified ankle and foot
M60.88 Other myositis, other site
M60.89 Other myositis, multiple sites
M60.9 Myositis, unspecified
M62.20 Nontraumatic ischemic infarction of muscle, unspecified site
M62.211 Nontraumatic ischemic infarction of muscle, right shoulder
M62.212 Nontraumatic ischemic infarction of muscle, left shoulder
M62.219 Nontraumatic ischemic infarction of muscle, unspecified shoulder
M62.221 Nontraumatic ischemic infarction of muscle, right upper arm
M62.222 Nontraumatic ischemic infarction of muscle, left upper arm
M62.229 Nontraumatic ischemic infarction of muscle, unspecified upper arm
M62.231 Nontraumatic ischemic infarction of muscle, right forearm
M62.232 Nontraumatic ischemic infarction of muscle, left forearm
M62.239 Nontraumatic ischemic infarction of muscle, unspecified forearm
M62.241 Nontraumatic ischemic infarction of muscle, right hand
M62.242 Nontraumatic ischemic infarction of muscle, left hand
M62.249 Nontraumatic ischemic infarction of muscle, unspecified hand
M62.251 Nontraumatic ischemic infarction of muscle, right thigh
M62.252 Nontraumatic ischemic infarction of muscle, left thigh
M62.259 Nontraumatic ischemic infarction of muscle, unspecified thigh
M62.261 Nontraumatic ischemic infarction of muscle, right lower leg
M62.262 Nontraumatic ischemic infarction of muscle, left lower leg
M62.269 Nontraumatic ischemic infarction of muscle, unspecified lower leg
M62.271 Nontraumatic ischemic infarction of muscle, right ankle and foot
M62.272 Nontraumatic ischemic infarction of muscle, left ankle and foot
M62.279 Nontraumatic ischemic infarction of muscle, unspecified ankle and foot
M62.28 Nontraumatic ischemic infarction of muscle, other site
M62.81 Muscle weakness (generalized)
M62.82 Rhabdomyolysis
M62.84 Sarcopenia
M62.89 Other specified disorders of muscle
M62.9 Disorder of muscle, unspecified
M63.80 Disorders of muscle in diseases classified elsewhere, unspecified site
M63.811 Disorders of muscle in diseases classified elsewhere, right shoulder
M63.812 Disorders of muscle in diseases classified elsewhere, left shoulder
M63.819 Disorders of muscle in diseases classified elsewhere, unspecified shoulder
M63.821 Disorders of muscle in diseases classified elsewhere, right upper arm
M63.822 Disorders of muscle in diseases classified elsewhere, left upper arm
M63.829 Disorders of muscle in diseases classified elsewhere, unspecified upper arm
M63.831 Disorders of muscle in diseases classified elsewhere, right forearm
M63.832 Disorders of muscle in diseases classified elsewhere, left forearm
M63.839 Disorders of muscle in diseases classified elsewhere, unspecified forearm
M63.841 Disorders of muscle in diseases classified elsewhere, right hand
M63.842 Disorders of muscle in diseases classified elsewhere, left hand
M63.849 Disorders of muscle in diseases classified elsewhere, unspecified hand
M63.851 Disorders of muscle in diseases classified elsewhere, right thigh
M63.852 Disorders of muscle in diseases classified elsewhere, left thigh
M63.859 Disorders of muscle in diseases classified elsewhere, unspecified thigh
M63.861 Disorders of muscle in diseases classified elsewhere, right lower leg
M63.862 Disorders of muscle in diseases classified elsewhere, left lower leg
M63.869 Disorders of muscle in diseases classified elsewhere, unspecified lower leg
M63.871 Disorders of muscle in diseases classified elsewhere, right ankle and foot
M63.872 Disorders of muscle in diseases classified elsewhere, left ankle and foot
M63.879 Disorders of muscle in diseases classified elsewhere, unspecified ankle and foot
M63.88 Disorders of muscle in diseases classified elsewhere, other site
M63.89 Disorders of muscle in diseases classified elsewhere, multiple sites
M72.8 Other fibroblastic disorders
M79.11 Myalgia of mastication muscle
M79.12 Myalgia of auxiliary muscles, head and neck
M79.18 Myalgia, other site
M79.7 Fibromyalgia
M83.0 Puerperal osteomalacia
M83.1 Senile osteomalacia
M83.2 Adult osteomalacia due to malabsorption
M83.3 Adult osteomalacia due to malnutrition
M83.4 Aluminum bone disease
M83.5 Other drug-induced osteomalacia in adults
M83.8 Other adult osteomalacia
M83.9 Adult osteomalacia, unspecified
M85.9 Disorder of bone density and structure, unspecified
M88.0 Osteitis deformans of skull
M88.1 Osteitis deformans of vertebrae
M88.811 Osteitis deformans of right shoulder
M88.812 Osteitis deformans of left shoulder
M88.819 Osteitis deformans of unspecified shoulder
M88.821 Osteitis deformans of right upper arm
M88.822 Osteitis deformans of left upper arm
M88.829 Osteitis deformans of unspecified upper arm
M88.831 Osteitis deformans of right forearm
M88.832 Osteitis deformans of left forearm
M88.839 Osteitis deformans of unspecified forearm
M88.841 Osteitis deformans of right hand
M88.842 Osteitis deformans of left hand
M88.849 Osteitis deformans of unspecified hand
M88.851 Osteitis deformans of right thigh
M88.852 Osteitis deformans of left thigh
M88.859 Osteitis deformans of unspecified thigh
M88.861 Osteitis deformans of right lower leg
M88.862 Osteitis deformans of left lower leg
M88.869 Osteitis deformans of unspecified lower leg
M88.871 Osteitis deformans of right ankle and foot
M88.872 Osteitis deformans of left ankle and foot
M88.879 Osteitis deformans of unspecified ankle and foot
M88.88 Osteitis deformans of other bones
M88.89 Osteitis deformans of multiple sites
M88.9 Osteitis deformans of unspecified bone
M89.9 Disorder of bone, unspecified
M94.9 Disorder of cartilage, unspecified
N00.0 Acute nephritic syndrome with minor glomerular abnormality
N00.1 Acute nephritic syndrome with focal and segmental glomerular lesions
N00.2 Acute nephritic syndrome with diffuse membranous glomerulonephritis
N00.3 Acute nephritic syndrome with diffuse mesangial proliferative glomerulonephritis
N00.4 Acute nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis
N00.5 Acute nephritic syndrome with diffuse mesangiocapillary glomerulonephritis
N00.6 Acute nephritic syndrome with dense deposit disease
N00.7 Acute nephritic syndrome with diffuse crescentic glomerulonephritis
N00.8 Acute nephritic syndrome with other morphologic changes
N00.9 Acute nephritic syndrome with unspecified morphologic changes
N00.A Acute nephritic syndrome with C3 glomerulonephritis
N01.0 Rapidly progressive nephritic syndrome with minor glomerular abnormality
N01.1 Rapidly progressive nephritic syndrome with focal and segmental glomerular lesions
N01.2 Rapidly progressive nephritic syndrome with diffuse membranous glomerulonephritis
N01.3 Rapidly progressive nephritic syndrome with diffuse mesangial proliferative glomerulonephritis
N01.4 Rapidly progressive nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis
N01.5 Rapidly progressive nephritic syndrome with diffuse mesangiocapillary glomerulonephritis
N01.6 Rapidly progressive nephritic syndrome with dense deposit disease
N01.7 Rapidly progressive nephritic syndrome with diffuse crescentic glomerulonephritis
N01.8 Rapidly progressive nephritic syndrome with other morphologic changes
N01.9 Rapidly progressive nephritic syndrome with unspecified morphologic changes
N01.A Rapidly progressive nephritic syndrome with C3 glomerulonephritis
N02.0 Recurrent and persistent hematuria with minor glomerular abnormality
N02.1 Recurrent and persistent hematuria with focal and segmental glomerular lesions
N02.2 Recurrent and persistent hematuria with diffuse membranous glomerulonephritis
N02.3 Recurrent and persistent hematuria with diffuse mesangial proliferative glomerulonephritis
N02.4 Recurrent and persistent hematuria with diffuse endocapillary proliferative glomerulonephritis
N02.5 Recurrent and persistent hematuria with diffuse mesangiocapillary glomerulonephritis
N02.6 Recurrent and persistent hematuria with dense deposit disease
N02.7 Recurrent and persistent hematuria with diffuse crescentic glomerulonephritis
N02.8 Recurrent and persistent hematuria with other morphologic changes
N02.9 Recurrent and persistent hematuria with unspecified morphologic changes
N02.A Recurrent and persistent hematuria with C3 glomerulonephritis
N03.0 Chronic nephritic syndrome with minor glomerular abnormality
N03.1 Chronic nephritic syndrome with focal and segmental glomerular lesions
N03.2 Chronic nephritic syndrome with diffuse membranous glomerulonephritis
N03.3 Chronic nephritic syndrome with diffuse mesangial proliferative glomerulonephritis
N03.4 Chronic nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis
N03.5 Chronic nephritic syndrome with diffuse mesangiocapillary glomerulonephritis
N03.6 Chronic nephritic syndrome with dense deposit disease
N03.7 Chronic nephritic syndrome with diffuse crescentic glomerulonephritis
N03.8 Chronic nephritic syndrome with other morphologic changes
N03.9 Chronic nephritic syndrome with unspecified morphologic changes
N03.A Chronic nephritic syndrome with C3 glomerulonephritis
N04.0 Nephrotic syndrome with minor glomerular abnormality
N04.1 Nephrotic syndrome with focal and segmental glomerular lesions
N04.2 Nephrotic syndrome with diffuse membranous glomerulonephritis
N04.3 Nephrotic syndrome with diffuse mesangial proliferative glomerulonephritis
N04.4 Nephrotic syndrome with diffuse endocapillary proliferative glomerulonephritis
N04.5 Nephrotic syndrome with diffuse mesangiocapillary glomerulonephritis
N04.6 Nephrotic syndrome with dense deposit disease
N04.7 Nephrotic syndrome with diffuse crescentic glomerulonephritis
N04.8 Nephrotic syndrome with other morphologic changes
N04.9 Nephrotic syndrome with unspecified morphologic changes
N04.A Nephrotic syndrome with C3 glomerulonephritis
N05.0 Unspecified nephritic syndrome with minor glomerular abnormality
N05.1 Unspecified nephritic syndrome with focal and segmental glomerular lesions
N05.2 Unspecified nephritic syndrome with diffuse membranous glomerulonephritis
N05.3 Unspecified nephritic syndrome with diffuse mesangial proliferative glomerulonephritis
N05.4 Unspecified nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis
N05.5 Unspecified nephritic syndrome with diffuse mesangiocapillary glomerulonephritis
N05.6 Unspecified nephritic syndrome with dense deposit disease
N05.7 Unspecified nephritic syndrome with diffuse crescentic glomerulonephritis
N05.8 Unspecified nephritic syndrome with other morphologic changes
N05.9 Unspecified nephritic syndrome with unspecified morphologic changes
N05.A Unspecified nephritic syndrome with C3 glomerulonephritis
N06.0 Isolated proteinuria with minor glomerular abnormality
N06.1 Isolated proteinuria with focal and segmental glomerular lesions
N06.2 Isolated proteinuria with diffuse membranous glomerulonephritis
N06.3 Isolated proteinuria with diffuse mesangial proliferative glomerulonephritis
N06.4 Isolated proteinuria with diffuse endocapillary proliferative glomerulonephritis
N06.5 Isolated proteinuria with diffuse mesangiocapillary glomerulonephritis
N06.6 Isolated proteinuria with dense deposit disease
N06.7 Isolated proteinuria with diffuse crescentic glomerulonephritis
N06.8 Isolated proteinuria with other morphologic lesion
N06.9 Isolated proteinuria with unspecified morphologic lesion
N06.A Isolated proteinuria with C3 glomerulonephritis
N07.0 Hereditary nephropathy, not elsewhere classified with minor glomerular abnormality
N07.1 Hereditary nephropathy, not elsewhere classified with focal and segmental glomerular lesions
N07.2 Hereditary nephropathy, not elsewhere classified with diffuse membranous glomerulonephritis
N07.3 Hereditary nephropathy, not elsewhere classified with diffuse mesangial proliferative glomerulonephritis
N07.4 Hereditary nephropathy, not elsewhere classified with diffuse endocapillary proliferative glomerulonephritis
N07.5 Hereditary nephropathy, not elsewhere classified with diffuse mesangiocapillary glomerulonephritis
N07.6 Hereditary nephropathy, not elsewhere classified with dense deposit disease
N07.7 Hereditary nephropathy, not elsewhere classified with diffuse crescentic glomerulonephritis
N07.8 Hereditary nephropathy, not elsewhere classified with other morphologic lesions
N07.9 Hereditary nephropathy, not elsewhere classified with unspecified morphologic lesions
N07.A Hereditary nephropathy, not elsewhere classified with C3 glomerulonephritis
N08 Glomerular disorders in diseases classified elsewhere
N14.0 Analgesic nephropathy
N14.11 Contrast-induced nephropathy
N14.19 Nephropathy induced by other drugs, medicaments and biological substances
N14.2 Nephropathy induced by unspecified drug, medicament or biological substance
N14.3 Nephropathy induced by heavy metals
N14.4 Toxic nephropathy, not elsewhere classified
N15.0 Balkan nephropathy
N15.8 Other specified renal tubulo-interstitial diseases
N15.9 Renal tubulo-interstitial disease, unspecified
N16 Renal tubulo-interstitial disorders in diseases classified elsewhere
N17.0 Acute kidney failure with tubular necrosis
N17.1 Acute kidney failure with acute cortical necrosis
N17.2 Acute kidney failure with medullary necrosis
N17.8 Other acute kidney failure
N17.9 Acute kidney failure, unspecified
N18.1 Chronic kidney disease, stage 1
N18.2 Chronic kidney disease, stage 2 (mild)
N18.31 Chronic kidney disease, stage 3a
N18.32 Chronic kidney disease, stage 3b
N18.4 Chronic kidney disease, stage 4 (severe)
N18.5 Chronic kidney disease, stage 5
N18.6 End stage renal disease
N18.9 Chronic kidney disease, unspecified
N19 Unspecified kidney failure
N25.0 Renal osteodystrophy
N25.1 Nephrogenic diabetes insipidus
N25.81 Secondary hyperparathyroidism of renal origin
N25.89 Other disorders resulting from impaired renal tubular function
N25.9 Disorder resulting from impaired renal tubular function, unspecified
N26.1 Atrophy of kidney (terminal)
N26.9 Renal sclerosis, unspecified
O26.90 Pregnancy related conditions, unspecified, unspecified trimester
Q64.8 Other specified congenital malformations of urinary system
Q64.9 Congenital malformation of urinary system, unspecified
R11.0 Nausea
R17 Unspecified jaundice
R20.0 Anesthesia of skin
R20.1 Hypoesthesia of skin
R20.2 Paresthesia of skin
R20.3 Hyperesthesia
R20.8 Other disturbances of skin sensation
R20.9 Unspecified disturbances of skin sensation
R21 Rash and other nonspecific skin eruption
R22.0 Localized swelling, mass and lump, head
R22.1 Localized swelling, mass and lump, neck
R22.2 Localized swelling, mass and lump, trunk
R22.30 Localized swelling, mass and lump, unspecified upper limb
R22.31 Localized swelling, mass and lump, right upper limb
R22.32 Localized swelling, mass and lump, left upper limb
R22.33 Localized swelling, mass and lump, upper limb, bilateral
R22.40 Localized swelling, mass and lump, unspecified lower limb
R22.41 Localized swelling, mass and lump, right lower limb
R22.42 Localized swelling, mass and lump, left lower limb
R22.43 Localized swelling, mass and lump, lower limb, bilateral
R22.9 Localized swelling, mass and lump, unspecified
R23.0 Cyanosis
R23.1 Pallor
R23.2 Flushing
R23.3 Spontaneous ecchymoses
R23.4 Changes in skin texture
R23.8 Other skin changes
R23.9 Unspecified skin changes
R41.840 Attention and concentration deficit
R41.841 Cognitive communication deficit
R41.842 Visuospatial deficit
R41.843 Psychomotor deficit
R41.844 Frontal lobe and executive function deficit
R45.0 Nervousness
R45.4 Irritability and anger
R56.9 Unspecified convulsions
R60.0 Localized edema
R60.1 Generalized edema
R60.9 Edema, unspecified
R63.0 Anorexia
R78.71 Abnormal lead level in blood
R78.79 Finding of abnormal level of heavy metals in blood
R78.81 Bacteremia
R78.89 Finding of other specified substances, not normally found in blood
R79.0 Abnormal level of blood mineral
R79.89 Other specified abnormal findings of blood chemistry
R79.9 Abnormal finding of blood chemistry, unspecified
R90.82 White matter disease, unspecified
R93.0 Abnormal findings on diagnostic imaging of skull and head, not elsewhere classified
R93.6 Abnormal findings on diagnostic imaging of limbs
R93.7 Abnormal findings on diagnostic imaging of other parts of musculoskeletal system
T39.011A Poisoning by aspirin, accidental (unintentional), initial encounter
T39.011D Poisoning by aspirin, accidental (unintentional), subsequent encounter
T39.011S Poisoning by aspirin, accidental (unintentional), sequela
T39.012A Poisoning by aspirin, intentional self-harm, initial encounter
T39.012D Poisoning by aspirin, intentional self-harm, subsequent encounter
T39.012S Poisoning by aspirin, intentional self-harm, sequela
T39.013A Poisoning by aspirin, assault, initial encounter
T39.013D Poisoning by aspirin, assault, subsequent encounter
T39.013S Poisoning by aspirin, assault, sequela
T39.014A Poisoning by aspirin, undetermined, initial encounter
T39.014D Poisoning by aspirin, undetermined, subsequent encounter
T39.014S Poisoning by aspirin, undetermined, sequela
T39.091A Poisoning by salicylates, accidental (unintentional), initial encounter
T39.091D Poisoning by salicylates, accidental (unintentional), subsequent encounter
T39.091S Poisoning by salicylates, accidental (unintentional), sequela
T39.092A Poisoning by salicylates, intentional self-harm, initial encounter
T39.092D Poisoning by salicylates, intentional self-harm, subsequent encounter
T39.092S Poisoning by salicylates, intentional self-harm, sequela
T39.093A Poisoning by salicylates, assault, initial encounter
T39.093D Poisoning by salicylates, assault, subsequent encounter
T39.093S Poisoning by salicylates, assault, sequela
T39.094A Poisoning by salicylates, undetermined, initial encounter
T39.094D Poisoning by salicylates, undetermined, subsequent encounter
T39.094S Poisoning by salicylates, undetermined, sequela
T39.314A Poisoning by propionic acid derivatives, undetermined, initial encounter
T39.314D Poisoning by propionic acid derivatives, undetermined, subsequent encounter
T39.314S Poisoning by propionic acid derivatives, undetermined, sequela
T47.0X5A Adverse effect of histamine H2-receptor blockers, initial encounter
T47.0X5D Adverse effect of histamine H2-receptor blockers, subsequent encounter
T47.0X5S Adverse effect of histamine H2-receptor blockers, sequela
T47.1X5A Adverse effect of other antacids and anti-gastric-secretion drugs, initial encounter
T47.1X5D Adverse effect of other antacids and anti-gastric-secretion drugs, subsequent encounter
T47.1X5S Adverse effect of other antacids and anti-gastric-secretion drugs, sequela
T50.1X1A Poisoning by loop [high-ceiling] diuretics, accidental (unintentional), initial encounter
T50.1X1D Poisoning by loop [high-ceiling] diuretics, accidental (unintentional), subsequent encounter
T50.1X1S Poisoning by loop [high-ceiling] diuretics, accidental (unintentional), sequela
T50.1X4A Poisoning by loop [high-ceiling] diuretics, undetermined, initial encounter
T50.1X4D Poisoning by loop [high-ceiling] diuretics, undetermined, subsequent encounter
T50.1X4S Poisoning by loop [high-ceiling] diuretics, undetermined, sequela
T50.1X5A Adverse effect of loop [high-ceiling] diuretics, initial encounter
T50.1X5D Adverse effect of loop [high-ceiling] diuretics, subsequent encounter
T50.1X5S Adverse effect of loop [high-ceiling] diuretics, sequela
T50.2X1A Poisoning by carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, accidental (unintentional), initial encounter
T50.2X1D Poisoning by carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, accidental (unintentional), subsequent encounter
T50.2X1S Poisoning by carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, accidental (unintentional), sequela
T50.2X5A Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, initial encounter
T50.2X5D Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, subsequent encounter
T50.2X5S Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, sequela
T50.3X1A Poisoning by electrolytic, caloric and water-balance agents, accidental (unintentional), initial encounter
T50.3X1D Poisoning by electrolytic, caloric and water-balance agents, accidental (unintentional), subsequent encounter
T50.3X1S Poisoning by electrolytic, caloric and water-balance agents, accidental (unintentional), sequela
T50.3X5A Adverse effect of electrolytic, caloric and water-balance agents, initial encounter
T50.3X5D Adverse effect of electrolytic, caloric and water-balance agents, subsequent encounter
T50.3X5S Adverse effect of electrolytic, caloric and water-balance agents, sequela
T50.4X1A Poisoning by drugs affecting uric acid metabolism, accidental (unintentional), initial encounter
T50.4X1D Poisoning by drugs affecting uric acid metabolism, accidental (unintentional), subsequent encounter
T50.4X1S Poisoning by drugs affecting uric acid metabolism, accidental (unintentional), sequela
T50.4X5A Adverse effect of drugs affecting uric acid metabolism, initial encounter
T50.4X5D Adverse effect of drugs affecting uric acid metabolism, subsequent encounter
T50.4X5S Adverse effect of drugs affecting uric acid metabolism, sequela
T66.XXXA Radiation sickness, unspecified, initial encounter
T66.XXXD Radiation sickness, unspecified, subsequent encounter
T66.XXXS Radiation sickness, unspecified, sequela
T74.01XA Adult neglect or abandonment, confirmed, initial encounter
T74.01XD Adult neglect or abandonment, confirmed, subsequent encounter
T74.01XS Adult neglect or abandonment, confirmed, sequela
T76.01XA Adult neglect or abandonment, suspected, initial encounter
T76.01XD Adult neglect or abandonment, suspected, subsequent encounter
T76.01XS Adult neglect or abandonment, suspected, sequela
Z48.22 Encounter for aftercare following kidney transplant
Z98.890* Other specified postprocedural states
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

Codes that have an asterisk contain additional information beyond the CPT descriptor.

Z98.890* Other specified postprocedural states (absorption by bone following parathyroidectomy)

N/A

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

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10-CM Codes that Support Medical Necessity” section of this article

Group 1 Codes
Code Description
XX000 Not Applicable
N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

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

Code Description
999x Not Applicable
N/A

Revenue Codes

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

Code Description
99999 Not Applicable
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

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

Revision History Information

Revision History Date Revision History Number Revision History Explanation
04/12/2023 R4

Article revised and published on 08/03/2023 effective for dates of service on and after 04/12/2023. This revision is in response to an inquiry. The following ICD-10-CM code has been added to ICD-10-CM Code Group 1: Z48.22. 

10/01/2022 R3

Article revised and published on 10/20/2022 effective for dates of service on and after 10/01/2022 to reflect the Annual ICD-10-CM Code Updates.

The following ICD-10-CM codes have been deleted and therefore have been removed from the article: E87.2 and N14.1 from Group 1.

The following ICD-10-CM codes have been added to the Article: E87.21, E87.22, E87.29, N14.11 and N14.19 to Group 1.

10/01/2021 R2

Article revised and published on 10/14/2021 effective for dates of service on and after 10/01/2021 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM code has undergone a descriptor change: M35.04 in Group 1.

10/01/2020 R1

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

Explanation of revision: Based on CR 11895 and CR 11845 (Annual 2021 ICD-10-CM Update) the billing and coding article was revised to remove ICD-10 code N18.3 and to add ICD-10 code N00.A, N01.A, N02.A, N03.A, N04.A, N05.A, N06.A, N07.A, N18.31, and N18.32 to the “ICD-10 Codes that Support Medical Necessity/Group 1 codes: “section of this billing and coding article. In addition, formatting changes have been made throughout the article. The effective date of this revision is based on date of service.

N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L34022 - Serum Phosphorus
Related National Coverage Documents
N/A
SAD Process URL 1
N/A
SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
08/31/2023 04/12/2023 - 08/31/2023 Retired View
07/28/2023 04/12/2023 - N/A Superseded You are here
10/14/2022 10/01/2022 - 04/11/2023 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

N/A