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SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Routine Foot Care

A57957

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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Superseded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.

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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57957
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Routine Foot Care
Article Type
Billing and Coding
Original Effective Date
06/29/2020
Revision Effective Date
10/01/2022
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 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 © 2023 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

CMS Internet Only Manual, Benefit Policy Manual, Pub 100-02 Chapter 15, Section 290 - Foot Care

Title XVIII of the Social Security Act, Section 1833(e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

 

Article Guidance

Article Text

Below is a summary of the expected coding and billing to be used when billing for routine foot care that meets the criteria as established in the CMS Internet Only Manual, Benefit Policy Manual, Pub 100-02 Chapter 15, Section 290 linked in the Associated Documents section below.

Please note the clinical documentation must clearly show that the patient’s condition warrants a provider rendering these services in accordance with the above instruction and failure to provide such professional services would be hazardous to the beneficiary due to their underlying medical condition(s). Failure to properly document the reasoning for the care rendered may result in denial of the claim.

In addition, the beneficiary may have complicating diagnosis(es) that require them to be under the care of a primary physician for the disease that is causing the beneficiary to seek provider based routine foot care. For the asterisked conditions, the name of the primary physician (must be a D.O. or M.D.) who made the diagnosis, and the approximate date of the last visit should be included in the record and entered on the appropriate claim forms or electronic equivalent when billing Medicare per the Benefit Policy Manual noted above. Please refer to the CMS website for instructions for billing Part A and Part B claims. There is also information on Noridian’s website for JF Part B claims.

Routine foot care services are not restricted to podiatrists. These services may be used by any certified physician or non-physician (NPP) specialty, in keeping with State licensure, if applicable, to provide proper care in either a Part A facility or physician’s office.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
013x Hospital Outpatient
071x Clinic - Rural Health
077x Clinic - Federally Qualified Health Center (FQHC)
085x Critical Access Hospital
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

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Group 1

(7 Codes)
Group 1 Paragraph

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

 Group 1 Codes
Code Description
11055 PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); SINGLE LESION
11056 PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); 2 TO 4 LESIONS
11057 PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); MORE THAN 4 LESIONS
11719 TRIMMING OF NONDYSTROPHIC NAILS, ANY NUMBER
11720 DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); 1 TO 5
11721 DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); 6 OR MORE
G0127 TRIMMING OF DYSTROPHIC NAILS, ANY NUMBER
N/A

CPT/HCPCS Modifiers

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Group 1

(3 Codes)
Group 1 Paragraph

For purposes of applying presumption of coverage, when the evidence available discloses certain physical and/or clinical findings consistent with the diagnosis and indicative of severe peripheral involvement, the following findings are pertinent:

  • Class A Findings:
    • Nontraumatic amputation of foot or integral skeletal portion thereof.
  • Class B Findings:
    • Absent posterior tibial pulse;
    • Advanced trophic changes as: hair growth (decrease or absence) nail changes  (thickening) pigmentary changes (discoloration) skin texture (thin, shiny) skin color (rubor  or redness) (three required); and
    • Absent dorsalis pedis pulse.
  • Class C Findings:
    • Claudication;
    • Temperature changes (e.g., cold feet);
    • Edema;
    • Paresthesias (abnormal spontaneous sensations in the feet); and
    • Burning.

The presumption of coverage may be applied when the physician rendering the routine foot care has identified the following by using the modifiers below:

  1. A Class A finding (Q7);
  2. Two of the Class B findings (Q8); or
  3. One Class B and two Class C findings (Q9).

 

 Group 1 Codes
Code Description
Q7 ONE CLASS A FINDING
Q8 TWO CLASS B FINDINGS
Q9 ONE CLASS B AND TWO CLASS C FINDINGS
N/A

ICD-10-CM Codes that Support Medical Necessity

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Group 1

(19 Codes)
Group 1 Paragraph

The ICD-10-CM codes below represent the PRIMARY diagnoses for all Group 2, and Group 3 and Group 4 SECONDARY diagnoses.

(For treatment of painful mycotic nails, or onychogryphosis, or onychauxis, see Groups 5 and 6).

For the treatment of painful callouses, please see the Wound and Ulcer Care LCD and associated Billing and Coding article L38904/A58367 effective 11/28/21.

 Group 1 Codes
Code Description
B35.1 Tinea unguium
L11.0 Acquired keratosis follicularis
L60.1 Onycholysis
L60.2 Onychogryphosis
L60.3 Nail dystrophy
L60.8* Other nail disorders
L84* Corns and callosities
L85.0 Acquired ichthyosis
L85.1 Acquired keratosis [keratoderma] palmaris et plantaris
L85.2 Keratosis punctata (palmaris et plantaris)
L86 Keratoderma in diseases classified elsewhere
L87.0 Keratosis follicularis et parafollicularis in cutem penetrans
L87.2 Elastosis perforans serpiginosa
L98.7* Excessive and redundant skin and subcutaneous tissue
Q81.0 Epidermolysis bullosa simplex
Q81.1 Epidermolysis bullosa letalis
Q81.2 Epidermolysis bullosa dystrophica
Q81.8 Other epidermolysis bullosa
Q82.8 Other specified congenital malformations of skin
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Effective 06/19/2022, L60.8 is to be billed with 11719 - trimming of non-dystrophic nails - only if one of the systemic conditions from Group 2, 3 or 4 below is present AND the patient does NOT have dystrophic nails. G0127 is the appropriate code for the trimming of dystrophic nails.

*Effective 06/19/2022, G0127 is to be billed for dystrophic nails only. It is inappropriate to bill L60.8, L84 and L98.7 with G0127.

 

Group 2

(167 Codes)
Group 2 Paragraph

The ICD-10-CM codes below represent the diagnoses where the patient has evidence of neuropathy, as demonstrated by methods such as the Semmes-Weinstein filament, but no vascular impairment, for which no class findings modifiers are required.

One of the Group 1 ICD-10-CM codes above MUST be billed as the primary diagnosis to ensure payment.

 Group 2 Codes
Code Description
A30.4 Borderline lepromatous leprosy
A30.5 Lepromatous leprosy
A50.43 Late congenital syphilitic polyneuropathy
A52.15 Late syphilitic neuropathy
A52.16 Charcot's arthropathy (tabetic)
A52.17 General paresis
A52.19 Other symptomatic neurosyphilis
A52.2 Asymptomatic neurosyphilis
A52.3 Neurosyphilis, unspecified
D51.0* Vitamin B12 deficiency anemia due to intrinsic factor deficiency
D81.1* Severe combined immunodeficiency [SCID] with low T- and B-cell numbers
D81.2* Severe combined immunodeficiency [SCID] with low or normal B-cell numbers
D81.31* Severe combined immunodeficiency due to adenosine deaminase deficiency
D81.32* Adenosine deaminase 2 deficiency
D81.39* Other adenosine deaminase deficiency
E08.00* Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
E08.10* Diabetes mellitus due to underlying condition with ketoacidosis without coma
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
E08.40* Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified
E08.41* Diabetes mellitus due to underlying condition with diabetic mononeuropathy
E08.42* Diabetes mellitus due to underlying condition with diabetic polyneuropathy
E08.43* Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathy
E08.44* Diabetes mellitus due to underlying condition with diabetic amyotrophy
E08.49* Diabetes mellitus due to underlying condition with other diabetic neurological complication
E08.610* Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy
E08.618* Diabetes mellitus due to underlying condition with other diabetic arthropathy
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
E09.39* Drug or chemical induced diabetes mellitus with other diabetic ophthalmic complication
E09.40* Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified
E09.41* Drug or chemical induced diabetes mellitus with neurological complications with diabetic mononeuropathy
E09.42* Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy
E09.43* Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy
E09.44* Drug or chemical induced diabetes mellitus with neurological complications with diabetic amyotrophy
E09.49* Drug or chemical induced diabetes mellitus with neurological complications with other diabetic neurological complication
E09.610* Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy
E09.618* Drug or chemical induced diabetes mellitus with other diabetic arthropathy
E09.620* Drug or chemical induced diabetes mellitus with diabetic dermatitis
E09.628* Drug or chemical induced diabetes mellitus with other skin complications
E09.649* Drug or chemical induced diabetes mellitus with hypoglycemia without coma
E09.65* Drug or chemical induced diabetes mellitus with hyperglycemia
E09.69* Drug or chemical induced diabetes mellitus with other specified complication
E09.9* Drug or chemical induced diabetes mellitus without complications
E10.10* Type 1 diabetes mellitus with ketoacidosis without coma
E10.21* Type 1 diabetes mellitus with diabetic nephropathy
E10.22* Type 1 diabetes mellitus with diabetic chronic kidney disease
E10.29* Type 1 diabetes mellitus with other diabetic kidney complication
E10.40* Type 1 diabetes mellitus with diabetic neuropathy, unspecified
E10.41* Type 1 diabetes mellitus with diabetic mononeuropathy
E10.42* Type 1 diabetes mellitus with diabetic polyneuropathy
E10.43* Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy
E10.44* Type 1 diabetes mellitus with diabetic amyotrophy
E10.49* Type 1 diabetes mellitus with other diabetic neurological complication
E10.610* Type 1 diabetes mellitus with diabetic neuropathic arthropathy
E10.618* Type 1 diabetes mellitus with other diabetic arthropathy
E10.620* Type 1 diabetes mellitus with diabetic dermatitis
E10.628* Type 1 diabetes mellitus with other skin complications
E10.649* Type 1 diabetes mellitus with hypoglycemia without coma
E10.65* Type 1 diabetes mellitus with hyperglycemia
E10.69* Type 1 diabetes mellitus with other specified complication
E10.9* Type 1 diabetes mellitus without complications
E11.00* Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
E11.10* Type 2 diabetes mellitus with ketoacidosis without coma
E11.21* Type 2 diabetes mellitus with diabetic nephropathy
E11.22* Type 2 diabetes mellitus with diabetic chronic kidney disease
E11.29* Type 2 diabetes mellitus with other diabetic kidney complication
E11.40* Type 2 diabetes mellitus with diabetic neuropathy, unspecified
E11.41* Type 2 diabetes mellitus with diabetic mononeuropathy
E11.42* Type 2 diabetes mellitus with diabetic polyneuropathy
E11.43* Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy
E11.44* Type 2 diabetes mellitus with diabetic amyotrophy
E11.49* Type 2 diabetes mellitus with other diabetic neurological complication
E11.610* Type 2 diabetes mellitus with diabetic neuropathic arthropathy
E11.618* Type 2 diabetes mellitus with other diabetic arthropathy
E11.620* Type 2 diabetes mellitus with diabetic dermatitis
E11.628* Type 2 diabetes mellitus with other skin complications
E11.649* Type 2 diabetes mellitus with hypoglycemia without coma
E11.65* Type 2 diabetes mellitus with hyperglycemia
E11.69* Type 2 diabetes mellitus with other specified complication
E13.00* Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
E13.10* Other specified diabetes mellitus with ketoacidosis without coma
E13.21* Other specified diabetes mellitus with diabetic nephropathy
E13.22* Other specified diabetes mellitus with diabetic chronic kidney disease
E13.29* Other specified diabetes mellitus with other diabetic kidney complication
E13.40* Other specified diabetes mellitus with diabetic neuropathy, unspecified
E13.41* Other specified diabetes mellitus with diabetic mononeuropathy
E13.42* Other specified diabetes mellitus with diabetic polyneuropathy
E13.43* Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy
E13.44* Other specified diabetes mellitus with diabetic amyotrophy
E13.49* Other specified diabetes mellitus with other diabetic neurological complication
E13.610* Other specified diabetes mellitus with diabetic neuropathic arthropathy
E13.620* Other specified diabetes mellitus with diabetic dermatitis
E13.628* Other specified diabetes mellitus with other skin complications
E13.649* Other specified diabetes mellitus with hypoglycemia without coma
E13.65* Other specified diabetes mellitus with hyperglycemia
E13.69* Other specified diabetes mellitus with other specified complication
E52* Niacin deficiency [pellagra]
E53.0* Riboflavin deficiency
E53.1* Pyridoxine deficiency
E53.8* Deficiency of other specified B group vitamins
E53.9* Vitamin B deficiency, unspecified
E75.21 Fabry (-Anderson) disease
E75.244 Niemann-Pick disease type A/B
E85.1 Neuropathic heredofamilial amyloidosis
E85.2 Heredofamilial amyloidosis, unspecified
E85.3 Secondary systemic amyloidosis
E85.4 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
G12.21 Amyotrophic lateral sclerosis
G12.25 Progressive spinal muscle atrophy
G13.0* Paraneoplastic neuromyopathy and neuropathy
G13.1* Other systemic atrophy primarily affecting central nervous system in neoplastic disease
G35* Multiple sclerosis
G60.0 Hereditary motor and sensory neuropathy
G60.1 Refsum's disease
G60.2 Neuropathy in association with hereditary ataxia
G60.3 Idiopathic progressive neuropathy
G60.8 Other hereditary and idiopathic neuropathies
G60.9 Hereditary and idiopathic neuropathy, unspecified
G61.0 Guillain-Barre syndrome
G61.1* Serum neuropathy
G61.81 Chronic inflammatory demyelinating polyneuritis
G61.89 Other inflammatory polyneuropathies
G61.9 Inflammatory polyneuropathy, unspecified
G62.0* Drug-induced polyneuropathy
G62.1* Alcoholic polyneuropathy
G62.2* Polyneuropathy due to other toxic agents
G62.81 Critical illness polyneuropathy
G62.82* Radiation-induced polyneuropathy
G62.89 Other specified polyneuropathies
G62.9 Polyneuropathy, unspecified
G63* Polyneuropathy in diseases classified elsewhere
G64 Other disorders of peripheral nervous system
G65.0* Sequelae of Guillain-Barre syndrome
G65.1* Sequelae of other inflammatory polyneuropathy
G65.2* Sequelae of toxic polyneuropathy
G90.09 Other idiopathic peripheral autonomic neuropathy
G99.0 Autonomic neuropathy in diseases classified elsewhere
M05.511 Rheumatoid polyneuropathy with rheumatoid arthritis of right shoulder
M05.512 Rheumatoid polyneuropathy with rheumatoid arthritis of left shoulder
M05.521 Rheumatoid polyneuropathy with rheumatoid arthritis of right elbow
M05.522 Rheumatoid polyneuropathy with rheumatoid arthritis of left elbow
M05.531 Rheumatoid polyneuropathy with rheumatoid arthritis of right wrist
M05.532 Rheumatoid polyneuropathy with rheumatoid arthritis of left wrist
M05.541 Rheumatoid polyneuropathy with rheumatoid arthritis of right hand
M05.542 Rheumatoid polyneuropathy with rheumatoid arthritis of left hand
M05.551 Rheumatoid polyneuropathy with rheumatoid arthritis of right hip
M05.552 Rheumatoid polyneuropathy with rheumatoid arthritis of left hip
M05.561 Rheumatoid polyneuropathy with rheumatoid arthritis of right knee
M05.562 Rheumatoid polyneuropathy with rheumatoid arthritis of left knee
M05.571 Rheumatoid polyneuropathy with rheumatoid arthritis of right ankle and foot
M05.572 Rheumatoid polyneuropathy with rheumatoid arthritis of left ankle and foot
M05.59 Rheumatoid polyneuropathy with rheumatoid arthritis of multiple sites
M34.83 Systemic sclerosis with polyneuropathy
M35.06 Sjogren syndrome with peripheral nervous system involvement
N18.30* Chronic kidney disease, stage 3 unspecified
N18.31* Chronic kidney disease, stage 3a
N18.32* Chronic kidney disease, stage 3b
N18.4* Chronic kidney disease, stage 4 (severe)
N18.5* Chronic kidney disease, stage 5
N18.6* End stage renal disease
Group 2 Medical Necessity ICD-10-CM Codes Asterisk Explanation

When the patient's condition is one of those designated by an asterisk (*), routine procedures are covered only if the patient is under the active care of a Doctor of Medicine or Osteopathy, who documents he/she has seen the patient for treatment and/or evaluation of the complicating disease process during the 6-month period prior to the rendition of the routine-type services per the Benefit Policy Manual, Publication 100-02, Chapter 15, Section 290F-Presumption of Coverage.

 

Group 3

(392 Codes)
Group 3 Paragraph

The ICD-10-CM codes below represent those diagnoses where the patient has evidence of vascular impairment, for which the class findings modifiers are required.

For purposes of applying presumption of coverage, when the evidence available discloses certain physical and/or clinical findings consistent with the diagnosis and indicative of severe peripheral involvement, the following findings are pertinent:

  • Class A Findings:
    • Nontraumatic amputation of foot or integral skeletal portion thereof.
  • Class B Findings:
    • Absent posterior tibial pulse;
    • Advanced trophic changes as: hair growth (decrease or absence) nail changes (thickening) pigmentary changes (discoloration) skin texture (thin, shiny) skin color (rubor or redness) (three required); and
    • Absent dorsalis pedis pulse.
  • Class C Findings:
    • Claudication;
    • Temperature changes (e.g., cold feet);
    • Edema;
    • Paresthesias (abnormal spontaneous sensations in the feet); and
    • Burning.

The presumption of coverage may be applied when the physician rendering the routine foot care has identified the following by using the modifiers below:

  1. A Class A finding (Q7);
  2. Two of the Class B findings (Q8); or
  3. One Class B and two Class C findings (Q9).

 

One of the Group 1 ICD-10-CM codes above MUST be billed as the primary diagnosis to ensure payment.

 

 Group 3 Codes
Code Description
E08.311* Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema
E08.319* Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema
E08.3211* Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye
E08.3212* Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye
E08.3213* Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral
E08.3291* Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye
E08.3292* Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye
E08.3293* Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral
E08.3311* Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye
E08.3312* Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye
E08.3313* Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral
E08.3391* Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, right eye
E08.3392* Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, left eye
E08.3393* Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, bilateral
E08.3411* Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, right eye
E08.3412* Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, left eye
E08.3413* Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, bilateral
E08.3491* Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, right eye
E08.3492* Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, left eye
E08.3493* Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, bilateral
E08.3511* Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, right eye
E08.3512* Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, left eye
E08.3513* Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, bilateral
E08.3521* Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye
E08.3522* Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye
E08.3523* Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral
E08.3531* Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye
E08.3532* Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye
E08.3533* Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral
E08.3541* Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye
E08.3542* Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye
E08.3543* Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral
E08.3551* Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, right eye
E08.3552* Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, left eye
E08.3553* Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral
E08.3591* Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, right eye
E08.3592* Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, left eye
E08.3593* Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, bilateral
E08.36* Diabetes mellitus due to underlying condition with diabetic cataract
E08.37X1* Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, right eye
E08.37X2* Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, left eye
E08.37X3* Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, bilateral
E08.39* Diabetes mellitus due to underlying condition with other diabetic ophthalmic complication
E08.51* Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene
E08.52* Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene
E08.59* Diabetes mellitus due to underlying condition with other circulatory complications
E08.621* Diabetes mellitus due to underlying condition with foot ulcer
E08.622* Diabetes mellitus due to underlying condition with other skin ulcer
E09.311* Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema
E09.319* Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema
E09.3211* Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye
E09.3212* Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye
E09.3213* Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral
E09.3291* Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye
E09.3292* Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye
E09.3293* Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral
E09.3311* Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye
E09.3312* Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye
E09.3313* Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral
E09.3391* Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye
E09.3392* Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye
E09.3393* Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral
E09.3411* Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye
E09.3412* Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye
E09.3413* Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral
E09.3491* Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye
E09.3492* Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye
E09.3493* Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral
E09.3511* Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye
E09.3512* Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye
E09.3513* Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral
E09.3521* Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye
E09.3522* Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye
E09.3523* Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral
E09.3531* Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye
E09.3532* Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye
E09.3533* Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral
E09.3541* Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye
E09.3542* Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye
E09.3543* Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral
E09.3551* Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, right eye
E09.3552* Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, left eye
E09.3553* Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, bilateral
E09.3591* Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye
E09.3592* Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye
E09.3593* Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral
E09.36* Drug or chemical induced diabetes mellitus with diabetic cataract
E09.37X1* Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, right eye
E09.37X2* Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, left eye
E09.37X3* Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral
E09.51* Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy without gangrene
E09.52* Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene
E09.59* Drug or chemical induced diabetes mellitus with other circulatory complications
E09.621* Drug or chemical induced diabetes mellitus with foot ulcer
E09.622* Drug or chemical induced diabetes mellitus with other skin ulcer
E10.311* Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema
E10.319* Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema
E10.3211* Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye
E10.3212* Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye
E10.3213* Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral
E10.3291* Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye
E10.3292* Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye
E10.3293* Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral
E10.3311* Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye
E10.3312* Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye
E10.3313* Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral
E10.3391* Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye
E10.3392* Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye
E10.3393* Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral
E10.3411* Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye
E10.3412* Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye
E10.3413* Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral
E10.3491* Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye
E10.3492* Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye
E10.3493* Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral
E10.3511* Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye
E10.3512* Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye
E10.3513* Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral
E10.3521* Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye
E10.3522* Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye
E10.3523* Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral
E10.3531* Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye
E10.3532* Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye
E10.3533* Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral
E10.3541* Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye
E10.3542* Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye
E10.3543* Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral
E10.3551* Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, right eye
E10.3552* Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, left eye
E10.3553* Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral
E10.3591* Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye
E10.3592* Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye
E10.3593* Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral
E10.36* Type 1 diabetes mellitus with diabetic cataract
E10.39* Type 1 diabetes mellitus with other diabetic ophthalmic complication
E10.51* Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene
E10.52* Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E10.59* Type 1 diabetes mellitus with other circulatory complications
E10.621* Type 1 diabetes mellitus with foot ulcer
E10.622* Type 1 diabetes mellitus with other skin ulcer
E11.311* Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema
E11.319* Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
E11.3211* Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye
E11.3212* Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye
E11.3213* Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral
E11.3291* Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye
E11.3292* Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye
E11.3293* Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral
E11.3311* Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye
E11.3312* Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye
E11.3313* Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral
E11.3391* Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye
E11.3392* Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye
E11.3393* Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral
E11.3411* Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye
E11.3412* Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye
E11.3413* Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral
E11.3491* Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye
E11.3492* Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye
E11.3493* Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral
E11.3511* Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye
E11.3512* Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye
E11.3513* Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral
E11.3521* Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye
E11.3522* Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye
E11.3523* Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral
E11.3531* Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye
E11.3532* Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye
E11.3533* Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral
E11.3541* Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye
E11.3542* Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye
E11.3543* Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral
E11.3551* Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, right eye
E11.3552* Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye
E11.3553* Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral
E11.3591* Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye
E11.3592* Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye
E11.3593* Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral
E11.36* Type 2 diabetes mellitus with diabetic cataract
E11.37X1* Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye
E11.37X2* Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye
E11.37X3* Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral
E11.39* Type 2 diabetes mellitus with other diabetic ophthalmic complication
E11.51* Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
E11.52* Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E11.59* Type 2 diabetes mellitus with other circulatory complications
E11.621* Type 2 diabetes mellitus with foot ulcer
E11.622* Type 2 diabetes mellitus with other skin ulcer
E13.311* Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema
E13.319* Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema
E13.3211* Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye
E13.3212* Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye
E13.3213* Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral
E13.3291* Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye
E13.3292* Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye
E13.3293* Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral
E13.3311* Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye
E13.3312* Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye
E13.3313* Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral
E13.3391* Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye
E13.3392* Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye
E13.3393* Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral
E13.3411* Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye
E13.3412* Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye
E13.3413* Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral
E13.3491* Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye
E13.3492* Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye
E13.3493* Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral
E13.3511* Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye
E13.3512* Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye
E13.3513* Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral
E13.3521* Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye
E13.3522* Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye
E13.3523* Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral
E13.3531* Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye
E13.3532* Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye
E13.3533* Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral
E13.3541* Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye
E13.3542* Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye
E13.3543* Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral
E13.3551* Other specified diabetes mellitus with stable proliferative diabetic retinopathy, right eye
E13.3552* Other specified diabetes mellitus with stable proliferative diabetic retinopathy, left eye
E13.3553* Other specified diabetes mellitus with stable proliferative diabetic retinopathy, bilateral
E13.3591* Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye
E13.3592* Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye
E13.3593* Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral
E13.36* Other specified diabetes mellitus with diabetic cataract
E13.37X1* Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, right eye
E13.37X2* Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, left eye
E13.37X3* Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral
E13.39* Other specified diabetes mellitus with other diabetic ophthalmic complication
E13.51* Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene
E13.52* Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene
E13.59* Other specified diabetes mellitus with other circulatory complications
E13.621* Other specified diabetes mellitus with foot ulcer
E13.622* Other specified diabetes mellitus with other skin ulcer
I70.201 Unspecified atherosclerosis of native arteries of extremities, right leg
I70.202 Unspecified atherosclerosis of native arteries of extremities, left leg
I70.203 Unspecified atherosclerosis of native arteries of extremities, bilateral legs
I70.211 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212 Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.218 Atherosclerosis of native arteries of extremities with intermittent claudication, other extremity
I70.221 Atherosclerosis of native arteries of extremities with rest pain, right leg
I70.222 Atherosclerosis of native arteries of extremities with rest pain, left leg
I70.223 Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.228 Atherosclerosis of native arteries of extremities with rest pain, other extremity
I70.229 Atherosclerosis of native arteries of extremities with rest pain, unspecified extremity
I70.231 Atherosclerosis of native arteries of right leg with ulceration of thigh
I70.232 Atherosclerosis of native arteries of right leg with ulceration of calf
I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle
I70.234 Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot
I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot
I70.238 Atherosclerosis of native arteries of right leg with ulceration of other part of lower leg
I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh
I70.242 Atherosclerosis of native arteries of left leg with ulceration of calf
I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle
I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot
I70.245 Atherosclerosis of native arteries of left leg with ulceration of other part of foot
I70.248 Atherosclerosis of native arteries of left leg with ulceration of other part of lower leg
I70.25 Atherosclerosis of native arteries of other extremities with ulceration
I70.261 Atherosclerosis of native arteries of extremities with gangrene, right leg
I70.262 Atherosclerosis of native arteries of extremities with gangrene, left leg
I70.263 Atherosclerosis of native arteries of extremities with gangrene, bilateral legs
I70.268 Atherosclerosis of native arteries of extremities with gangrene, other extremity
I70.291 Other atherosclerosis of native arteries of extremities, right leg
I70.292 Other atherosclerosis of native arteries of extremities, left leg
I70.293 Other atherosclerosis of native arteries of extremities, bilateral legs
I70.298 Other atherosclerosis of native arteries of extremities, other extremity
I70.311 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, right leg
I70.312 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, left leg
I70.313 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.321 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, right leg
I70.322 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, left leg
I70.323 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, bilateral legs
I70.333 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of ankle
I70.334 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.335 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of other part of foot
I70.343 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of ankle
I70.344 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.345 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of other part of foot
I70.361 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene, right leg
I70.362 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene, left leg
I70.363 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene, bilateral legs
I70.411 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, right leg
I70.412 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, left leg
I70.413 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.421 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, right leg
I70.422 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, left leg
I70.423 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, bilateral legs
I70.433 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of ankle
I70.434 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.435 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of other part of foot
I70.443 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of ankle
I70.444 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.445 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of other part of foot
I70.461 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, right leg
I70.462 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, left leg
I70.463 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, bilateral legs
I70.511 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, right leg
I70.512 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, left leg
I70.513 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.521 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, right leg
I70.522 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, left leg
I70.523 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, bilateral legs
I70.533 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of ankle
I70.534 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.535 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of foot
I70.543 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of ankle
I70.544 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.545 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of other part of foot
I70.561 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, right leg
I70.562 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, left leg
I70.563 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, bilateral legs
I70.91 Generalized atherosclerosis
I73.00 Raynaud's syndrome without gangrene
I73.01 Raynaud's syndrome with gangrene
I73.1 Thromboangiitis obliterans [Buerger's disease]
I73.89 Other specified peripheral vascular diseases
I73.9 Peripheral vascular disease, unspecified
I77.6 Arteritis, unspecified
I79.1 Aortitis in diseases classified elsewhere
I80.00* Phlebitis and thrombophlebitis of superficial vessels of unspecified lower extremity
I80.01* Phlebitis and thrombophlebitis of superficial vessels of right lower extremity
I80.02* Phlebitis and thrombophlebitis of superficial vessels of left lower extremity
I80.03* Phlebitis and thrombophlebitis of superficial vessels of lower extremities, bilateral
I80.11* Phlebitis and thrombophlebitis of right femoral vein
I80.12* Phlebitis and thrombophlebitis of left femoral vein
I80.13* Phlebitis and thrombophlebitis of femoral vein, bilateral
I80.201* Phlebitis and thrombophlebitis of unspecified deep vessels of right lower extremity
I80.202* Phlebitis and thrombophlebitis of unspecified deep vessels of left lower extremity
I80.203* Phlebitis and thrombophlebitis of unspecified deep vessels of lower extremities, bilateral
I80.221* Phlebitis and thrombophlebitis of right popliteal vein
I80.222* Phlebitis and thrombophlebitis of left popliteal vein
I80.223* Phlebitis and thrombophlebitis of popliteal vein, bilateral
I80.231* Phlebitis and thrombophlebitis of right tibial vein
I80.232* Phlebitis and thrombophlebitis of left tibial vein
I80.233* Phlebitis and thrombophlebitis of tibial vein, bilateral
I80.241* Phlebitis and thrombophlebitis of right peroneal vein
I80.242* Phlebitis and thrombophlebitis of left peroneal vein
I80.243* Phlebitis and thrombophlebitis of peroneal vein, bilateral
I80.251* Phlebitis and thrombophlebitis of right calf muscular vein
I80.252* Phlebitis and thrombophlebitis of left calf muscular vein
I80.253* Phlebitis and thrombophlebitis of calf muscular vein, bilateral
I80.291* Phlebitis and thrombophlebitis of other deep vessels of right lower extremity
I80.292* Phlebitis and thrombophlebitis of other deep vessels of left lower extremity
I80.293* Phlebitis and thrombophlebitis of other deep vessels of lower extremity, bilateral
I82.501* Chronic embolism and thrombosis of unspecified deep veins of right lower extremity
I82.502* Chronic embolism and thrombosis of unspecified deep veins of left lower extremity
I82.503* Chronic embolism and thrombosis of unspecified deep veins of lower extremity, bilateral
I82.531* Chronic embolism and thrombosis of right popliteal vein
I82.532* Chronic embolism and thrombosis of left popliteal vein
I82.533* Chronic embolism and thrombosis of popliteal vein, bilateral
I82.561* Chronic embolism and thrombosis of right calf muscular vein
I82.562* Chronic embolism and thrombosis of left calf muscular vein
I82.563* Chronic embolism and thrombosis of calf muscular vein, bilateral
I82.591* Chronic embolism and thrombosis of other specified deep vein of right lower extremity
I82.592* Chronic embolism and thrombosis of other specified deep vein of left lower extremity
I82.593* Chronic embolism and thrombosis of other specified deep vein of lower extremity, bilateral
I82.5Z1* Chronic embolism and thrombosis of unspecified deep veins of right distal lower extremity
I82.5Z2* Chronic embolism and thrombosis of unspecified deep veins of left distal lower extremity
I82.5Z3* Chronic embolism and thrombosis of unspecified deep veins of distal lower extremity, bilateral
I87.001 Postthrombotic syndrome without complications of right lower extremity
I87.002 Postthrombotic syndrome without complications of left lower extremity
I87.011* Postthrombotic syndrome with ulcer of right lower extremity
I87.012* Postthrombotic syndrome with ulcer of left lower extremity
I87.013* Postthrombotic syndrome with ulcer of bilateral lower extremity
I87.021* Postthrombotic syndrome with inflammation of right lower extremity
I87.022* Postthrombotic syndrome with inflammation of left lower extremity
I87.023* Postthrombotic syndrome with inflammation of bilateral lower extremity
I87.031* Postthrombotic syndrome with ulcer and inflammation of right lower extremity
I87.032* Postthrombotic syndrome with ulcer and inflammation of left lower extremity
I87.033* Postthrombotic syndrome with ulcer and inflammation of bilateral lower extremity
I87.091* Postthrombotic syndrome with other complications of right lower extremity
I87.092* Postthrombotic syndrome with other complications of left lower extremity
I87.093* Postthrombotic syndrome with other complications of bilateral lower extremity
I87.311 Chronic venous hypertension (idiopathic) with ulcer of right lower extremity
I87.312 Chronic venous hypertension (idiopathic) with ulcer of left lower extremity
I87.313 Chronic venous hypertension (idiopathic) with ulcer of bilateral lower extremity
I87.321 Chronic venous hypertension (idiopathic) with inflammation of right lower extremity
I87.322 Chronic venous hypertension (idiopathic) with inflammation of left lower extremity
I87.323 Chronic venous hypertension (idiopathic) with inflammation of bilateral lower extremity
I87.331 Chronic venous hypertension (idiopathic) with ulcer and inflammation of right lower extremity
I87.332 Chronic venous hypertension (idiopathic) with ulcer and inflammation of left lower extremity
I87.333 Chronic venous hypertension (idiopathic) with ulcer and inflammation of bilateral lower extremity
I87.391 Chronic venous hypertension (idiopathic) with other complications of right lower extremity
I87.392 Chronic venous hypertension (idiopathic) with other complications of left lower extremity
I87.393 Chronic venous hypertension (idiopathic) with other complications of bilateral lower extremity
M30.0 Polyarteritis nodosa
M30.2 Juvenile polyarteritis
M30.8 Other conditions related to polyarteritis nodosa
M35.0B Sjogren syndrome with vasculitis
Group 3 Medical Necessity ICD-10-CM Codes Asterisk Explanation

When the patient's condition is one of those designated by an asterisk (*), routine procedures are covered only if the patient is under the active care of a Doctor of Medicine or Osteopathy, who documents he/she has seen the patient for treatment and/or evaluation of the complicating disease process during the 6-month period prior to the rendition of the routine-type services per the Benefit Policy Manual, Publication 100-02, Chapter 15, Section 290F-Presumption of Coverage.

Group 4

(27 Codes)
Group 4 Paragraph

The ICD-10 codes below represent those diagnoses where the patient has neither a neurological nor vascular impairment yet are covered services.

One of the Group 1 ICD-10-CM codes above MUST be billed as the primary diagnosis to ensure payment.

 Group 4 Codes
Code Description
B20 Human immunodeficiency virus [HIV] disease
D68.01* Von Willebrand disease, type 1
D68.020* Von Willebrand disease, type 2A
D68.021* Von Willebrand disease, type 2B
D68.022* Von Willebrand disease, type 2M
D68.023* Von Willebrand disease, type 2N
D68.029* Von Willebrand disease, type 2, unspecified
D68.03* Von Willebrand disease, type 3
D68.04* Acquired von Willebrand disease
D68.09* Other von Willebrand disease
D68.1* Hereditary factor XI deficiency
D68.2* Hereditary deficiency of other clotting factors
D68.311* Acquired hemophilia
D68.312* Antiphospholipid antibody with hemorrhagic disorder
D68.318* Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors
D68.32* Hemorrhagic disorder due to extrinsic circulating anticoagulants
D68.4* Acquired coagulation factor deficiency
D70.1* Agranulocytosis secondary to cancer chemotherapy
D70.2* Other drug-induced agranulocytosis
D81.82 Activated Phosphoinositide 3-kinase Delta Syndrome [APDS]
D82.0 Wiskott-Aldrich syndrome
D82.1 Di George's syndrome
I89.0 Lymphedema, not elsewhere classified
Q82.0 Hereditary lymphedema
R60.0 Localized edema
R60.1 Generalized edema
Z79.01* Long term (current) use of anticoagulants
Group 4 Medical Necessity ICD-10-CM Codes Asterisk Explanation

When the patient's condition is one of those designated by an asterisk (*), routine procedures are covered only if the patient is under the active care of a Doctor of Medicine or Osteopathy, who documents he/she has seen the patient for treatment and/or evaluation of the complicating disease process during the 6-month period prior to the rendition of the routine-type services per the Benefit Policy Manual, Publication 100-02, Chapter 15, Section 290F-Presumption of Coverage.

Group 5

(5 Codes)
Group 5 Paragraph

When billing CPT® codes 11720 or 11721 for the treatment of mycotic nails, or onychogryphosis, or onychauxis, ICD-10 CM codes listed below must be reported as primary.

Note: It is inappropriate to bill the debridement of nails on the leg(s) for which a patient has a prosthetic limb(s).

 

 Group 5 Codes
Code Description
B35.1 Tinea unguium
L60.1 Onycholysis
L60.2 Onychogryphosis
L60.3 Nail dystrophy
L60.5 Yellow nail syndrome

Group 6

(25 Codes)
Group 6 Paragraph

The ICD-10 codes listed below are those diagnoses representing the patient’s symptom and reported as the secondary to the codes listed in Group 5 above.

 Group 6 Codes
Code Description
L02.611 Cutaneous abscess of right foot
L02.612 Cutaneous abscess of left foot
L03.031 Cellulitis of right toe
L03.032 Cellulitis of left toe
L03.041 Acute lymphangitis of right toe
L03.042 Acute lymphangitis of left toe
L03.115 Cellulitis of right lower limb
L03.116 Cellulitis of left lower limb
L03.119 Cellulitis of unspecified part of limb
L03.125 Acute lymphangitis of right lower limb
L03.126 Acute lymphangitis of left lower limb
L03.129 Acute lymphangitis of unspecified part of limb
L03.90 Cellulitis, unspecified
L03.91 Acute lymphangitis, unspecified
L60.0 Ingrowing nail
L98.3 Eosinophilic cellulitis [Wells]
M79.671 Pain in right foot
M79.672 Pain in left foot
M79.674 Pain in right toe(s)
M79.675 Pain in left toe(s)
R26.0 Ataxic gait
R26.1 Paralytic gait
R26.2 Difficulty in walking, not elsewhere classified
R26.81 Unsteadiness on feet
R26.89 Other abnormalities of gait and mobility
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ICD-10-CM Codes that DO NOT Support Medical Necessity

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Group 1

Group 1 Paragraph

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 Group 1 Codes

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ICD-10-PCS Codes

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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
013x Hospital Outpatient
071x Clinic - Rural Health
077x Clinic - Federally Qualified Health Center (FQHC)
085x Critical Access Hospital
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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.

Code Description
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Other Coding Information

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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
10/01/2022 R11

Updated the Group 1 Asterisk Section in the ICD-10 Codes That Support Medical Necessity to read: 

  • "*Effective 06/19/2022, L60.8 is to be billed with 11719 - trimming of non-dystrophic nails - only if one of the systemic conditions from Group 2, 3 or 4 below is present AND the patient does NOT have dystrophic nails. G0127 is the appropriate code for the trimming of dystrophic nails."
  • "*Effective 06/19/2022, G0127 is to be billed for dystrophic nails only. It is inappropriate to bill L60.8, L84 and L98.7 with G0127."

In Group 4 ICD-10 Codes That Support Medical Necessity, added an asterisk (*) to the following codes: D68.01, D68.020, D68.021, D68.022, D68.023, D68.029, D68.03, D68.04, D68.09.
10/01/2022 R10

Per Annual ICD-10 Updates, the following changes were made effective 10/01/2022:

  • Deleted D68.0 and replaced this code with, D68.01, D68.020, D68.021, D68.022, D68.023, D68.029, D68.03, D68.04, D68.09 in Group 4 of the ICD-10 Codes That Support Medical Necessity.
  • Added D81.82 in Group 4 of the ICD-10 Codes That Support Medical Necessity.
06/19/2022 R9

Deleted the unspecified diagnosis codes L90.9, L91.9 & Q81.9 because there are more specific diagnosis codes to bill listed. Asterisked L84 and L98.7 and added the statement "*L84, L98.7 and L60.8 are non-covered diagnosis codes and will be denied when billed with G0127" under the Group 1: Medical Necessity ICD-10-CM Codes Asterisk Explanation.

Added D68.0, D68.1, D68.2, D68.311, D68.312, D68.318, D68.32, D68.4, D70.1 and D70.2 in Group 4 of the ICD-10 Codes That Support Medical Necessity
11/28/2021 R8

In the Medical Necessity ICD-10-CM Codes Asterisk Explanation sections for Groups 2-4, removed the reference to MLN® SE1113 and reworded the previous statement to “When the patient's condition is one of those designated by an asterisk (*), routine procedures are covered only if the patient is under the active care of a Doctor of Medicine or Osteopathy, who documents he/she has seen the patient for treatment and/or evaluation of the complicating disease process during the 6-month period prior to the rendition of the routine-type services per the Benefit Policy Manual, Publication 100-02, Chapter 15, Section 290F-Presumption of Coverage” in all 3 Groups and deleted the reference to MLN® SE1113 since it is no longer published,

Corrected the Part B link in the statement “Please refer to the CMS website for instructions for billing Part A and Part B claims.”

 
11/28/2021 R7

Changed the reference to symptomatic Hyperkeratoses coverage to For the treatment of painful callouses, please see the Wound and Ulcer Care LCD and associated Billing and Coding article L38904/A58367 effective 11/28/21 and updated the statement “For treatment of painful mycotic nails, or onychogryphosis, or onychauxis, see Group 5” to include Group 6 too in the Group 1 paragraph.

Clarified the statement regarding when to bill the asterisked diagnosis code L60.8 to read *L60.8 is to be billed with 11719 only if one of the systemic conditions from Group 2, 3 or4 below is present AND the patient does not have dystrophic nails in Group 1: Medical Necessity ICD-10-CM Codes Asterisk Explanation 
10/01/2021 R6

Asterisks added to I82.501-I82.503, I82.531-I82.533, and I82.591-I82.593 in Group 3 and E09.42 in Group 2 missed in previous updates per the Medicare Benefit Policy Manual, Chapter 15 Section 290 – Foot Care; subsection D- Systemic Conditions That Might Justify Coverage. Also moved the Primary DX codes for the treatment of mycotic nails, or onychogryphosis, or onychauxis to the Group 5 Codes section and added a Group 6 Paragraph and Codes section for the covered secondary DX.

The prior Revision History had an incorrect code. E41.0 should have been E08.41. E08.41 was already asterisked, however N18.30-N18.6 was asterisked according to Medicare Benefit Policy Manual, Chapter 15 Section 290 – Foot Care; subsection D- Systemic Conditions That Might Justify Coverage. This manual section pre-dates this Local Coverage Article.
10/01/2021 R5

Added asterisks to E41.0 & N18.30-N18.6 as these were accidentally removed with a previous version.

Add E75.244 and M35.06 to the list of Group 2 ICD -10 diagnosis codes and M35.0B to the Group 3 list of Group 3 ICD -10 diagnosis codes per the Annual ICD-10-CM Update effective 10/01/2021.
01/01/2021 R4

Added A52.17, E08.00*, E08.10*, E08.21*, E08.22*, E08.29*, E08.41*, E08.43*, E08.44*, E08.618*, E09.21*, E09.22*, E09.29*, E09.39*, E09.40*, E09.41*, E09.43*, E09.44*, E09.49*, E09.610*, E09.618*, E09.620*, E09.628*, E09.649*, E09.65*, E09.69*, E09.9*, ,E10.10*, E10.21*, E10.22*, E10.29*, E10.41*, E10.43*, E10.44*, E10.618*, E10.620*, E10.628*, E10.649*, E10.65*, E10.69*, E10.9*, E11.00*, E11.10*, E11.21*, E11.22*, E11.29*, E11.41*, E11.43*, E11.44*, E11.618*, E11.620*, E11.628*, E11.649*, E11.65*, E11.69*, E13.00*, E13.10*, E13.21*, E13.22*, E13.29*, E13.41*, E13.43*, E13.44*, E13.620*, E13.628*, E13.649*, E13.65*, E13.69*, E85.1, E85.2, E85.3, E85.4, E85.81, E85.82, E85.9, G12.21, G12.25, G13.1*, G64, G90.09, G99.0, M05.511, M05.512, M05.521, M05.522, M05.531, M05.532, M05.541, M05.542, M05.551, M05.552, M05.561, M05.562, M05.571, M05.572 and M05.59 to the Group 2 ICD-10 Codes list.

Added E08.311*, E08.319*, E08.3211*, E08.3212*, E08.3213*, E08.3291*, E08.3292*,, E08.3293*, E08.3311*, E08.3312*, E08.3313*, E08.3391*, E08.3392*, E08.3393*, E08.3411*, E08.3412*, E08.3413*, E08.3491*, E08.3492*, E08.3493*, E08.3511*, E08.3512*, E08.3513*, E08.3521*, E08.3522*, E08.3523*, E08.3531*, E08.3532*, E08.3533*, E08.3541*, E08.3542*, E08.3543*, E08.3551* , E08.3552*, E08.3553*, E08.3591*, E08.3592*, E08.3593*, E08.36*, E08.37X1*, E08.37X2*, E08.37X3*, E08.39*, E09.311*, E09.319*, E09.3211*, E09.3212*, E09.3213*, E09.3291*, E09.3292* , E09.3293*, E09.3311*, E09.3312*, E09.3313*, E09.3391*, E09.3392*, E09.3393*, E09.3411*, E09.3412*, E09.3413*, E09.3491*, E09.3492*, E09.3493*, E09.3511*, E09.3512*, E09.3513*, E09.3521*, E09.3522*, E09.3523*, E09.3531*, E09.3532*, E09.3533*, E09.3541*, E09.3542*, E09.3543*, E09.3551*, E09.3552*, E09.3553*, E09.3591*, E09.3592*, E09.3593*, E09.36*, E09.37X1*, E09.37X2*, E09.37X3*, E09.51*, E09.52*, E09.59*, E09.621*, E09.622*, E10.311*, E10.319*, E10.3211*, E10.3212*, E10.3213*, E10.3291*, E10.3292*, E10.3293*, E10.3311*, E10.3312*, E10.3313*, E10.3391*. E10.3392*, E10.3393*, E10.3411*, E10.3412*, E10.3413*, E10.3491*, E10.3492*, E10.3493*, E10.3511*, E10.3512*, E10.3513*, E10.3521*, E10.3522*, E10.3523*, E10.3531*, E10.3532*, E10.3533*, E10.3541*, E10.3542*, E10.3543*, E10.3551*, E10.3552*, E10.3553*, E10.3591*, E10.3592*, E10.3593*, E10.36*, E10.39*, E11.311*, E11.319*, E11.3211*, E11.3212*, E11.3213*, E11.3291*, E11.3292*, E11.3293*, E11.3311*, E11.3312*, E11.3313*, E11.3391*, E11.3392*, E11.3393*, E11.3411*, E11.3412*, E11.3413*, E11.3491*, E11.3492*, E11.3493*, E11.3511*, E11.3512*, E11.3513*, E11.3521*, E11.3522*, E11.3523*, E11.3531*, E11.3532*, E11.3533*, E11.3541*, E11.3542*, E11.3543*, E11.3551*, E11.3552*, E11.3553*, E11.3591*, E11.3592*, E11.3593*, E11.36*, E11.37X1*, E11.37X2*, E11.37X3*, E11.39*, E13.311*, E13.319*, E13.3211*, E13.3212*, E13.3213*, E13.3291*, E13.3292*, E13.3293*, E13.3311*, E13.3312*, E13.3313*, E13.3391*, E13.3392*, E13.3393* , E13.3411*, E13.3412*, E13.3413*, E13.3491*, E13.3492*, E13.3493*, E13.3511*, E13.3512*, E13.3513*, E13.3521*, E13.3522*, E13.3523*, E13.3531*, E13.3532*, E13.3533*, E13.3541*, E13.3542*, E13.3543*, E13.3551*, E13.3552*, E13.3553*, E13.3591*, E13.3592*, E13.3593*, E13.36*, E13.37X1*, E13.37X2*, E13.37X3*, E13.39*, I70.201, I70.202, I70.203, I70.231, I70.232, I70.238, I70.241, I70.242, I70.248, I70.25, I70.268, I70.291, I70.292, I70.293, I70.298, I70.91, I73.9, I80.11*, I80.12*, I80.13*, I80.231*, I80.232*, I80.233*, I80.241*, I80.242*, I80.243*, I87.001and I87.002 to the Group 3 ICD-10 Codes list.

Added Q82.0, R60.0 and R60.1 to the Group 4 ICD-10 Codes list.

Corrected typographical errors throughout the article.
10/01/2020 R3

Corrected link to Benefit Policy Manual Chapter 15 Section 290 in the Associated Documents below

Effective 10/01/120 added and deleted the following ICD-10 diagnosis codes per the Annual 2020ICD-10 updates.

Added to Group 2:

  • N18.30 Chronic kidney disease, stage 3 unspecified
  • N18.31 Chronic kidney disease, stage 3a
  • N18.32 Chronic kidney disease, stage 3b

Deleted from Group 2:

  • N18.3 Chronic kidney disease, stage 3 (moderate)
06/29/2020 R2

Under the ICD-10 Codes that Support Medical Necessity Group 1 Paragraph, added the word 'painful' to the following statement “(For treatment of painful mycotic nails, or onychogryphosis, or onychauxis, see Group 5)”. Clarified the timeframe the patient must have seen their treating physician for the asterisked DX code in the ICD-10 Codes that Support Medical Necessity Group 2, 3 and 4 section. Added MLN Matters® Number: SE1113 and the SSA 1833(e) to the CMS National Coverage Policy section. Added diagnosis codes I80.251-I80.252 initially missed in Group 3 to be consistent the other contracts within Noridian's Jurisdiction.
06/29/2020 R1

In the Group 1 paragraph corrected Group 4 to say Group 5 in the following statement “(For treatment of mycotic nails, or onychogryphosis, or onychauxis, see Group 4)”.
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
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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
12/19/2023 01/01/2024 - N/A Currently in Effect View
11/08/2023 10/01/2022 - 12/31/2023 Superseded View
09/11/2023 10/01/2022 - N/A Superseded View
09/20/2022 10/01/2022 - N/A Superseded You are here
09/02/2022 10/01/2022 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • presumption of coverage
  • routine foot care
  • benefit
  • podiatrist
  • podiatry
  • debridement

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