Notification



Notification Issue Date:



Policy Attachment

Attachment to Policy # MA07.009g


Attachment:C

Policy #:MA07.009g

Description:ICD-10 CM Codes Eligible to be Reported for Routine Foot Care for Certain Medical Conditions (E13.3513 - I87.093), Continued

Title:Routine Foot Care for Certain Medical Conditions


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.


INTERNATIONAL CLASSIFICATION OF DISEASES (ICD-10) DIAGNOSIS CODES ASSOCIATED WITH ROUTINE FOOT CARE (continued)
E13.3513Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral
E13.3519Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye
E13.3521Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye
E13.3522Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye
E13.3523Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral
E13.3529Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye
E13.3531Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye
E13.3532Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye
E13.3533Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral
E13.3539Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye
E13.3541Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye
E13.3542Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye
E13.3543Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral
E13.3549Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye
E13.3551Other specified diabetes mellitus with stable proliferative diabetic retinopathy, right eye
E13.3552Other specified diabetes mellitus with stable proliferative diabetic retinopathy, left eye
E13.3553Other specified diabetes mellitus with stable proliferative diabetic retinopathy, bilateral
E13.3559Other specified diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye
E13.3591Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye
E13.3592Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye
E13.3593Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral
E13.3599Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye
E13.36Other specified diabetes mellitus with diabetic cataract
E13.37X1Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, right eye
E13.37X2Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, left eye
E13.37X3Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral
E13.37X9Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye
E13.39Other specified diabetes mellitus with other diabetic ophthalmic complication
E13.40Other specified diabetes mellitus with diabetic neuropathy, unspecified
E13.41Other specified diabetes mellitus with diabetic mononeuropathy
E13.42Other specified diabetes mellitus with diabetic polyneuropathy
E13.43Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy
E13.44Other specified diabetes mellitus with diabetic amyotrophy
E13.49Other specified diabetes mellitus with other diabetic neurological complication
E13.51Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene
E13.52Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene
E13.59Other specified diabetes mellitus with other circulatory complications
E13.610Other specified diabetes mellitus with diabetic neuropathic arthropathy
E13.618Other specified diabetes mellitus with other diabetic arthropathy
E13.620Other specified diabetes mellitus with diabetic dermatitis
E13.621Other specified diabetes mellitus with foot ulcer
E13.622Other specified diabetes mellitus with other skin ulcer
E13.628Other specified diabetes mellitus with other skin complications
E13.630Other specified diabetes mellitus with periodontal disease
E13.638Other specified diabetes mellitus with other oral complications
E13.641Other specified diabetes mellitus with hypoglycemia with coma
E13.649Other specified diabetes mellitus with hypoglycemia without coma
E13.65Other specified diabetes mellitus with hyperglycemia
E13.69Other specified diabetes mellitus with other specified complication
E13.8Other specified diabetes mellitus with unspecified complications
E13.9Other specified diabetes mellitus without complications
E52Niacin deficiency [pellagra]
E53.0Riboflavin deficiency
E53.1Pyridoxine deficiency
E53.8Deficiency of other specified B group vitamins
E53.9Vitamin B deficiency, unspecified
E75.21Fabry (-Anderson) disease
E75.22Gaucher disease
E75.240Niemann-Pick disease type A
E75.241Niemann-Pick disease type B
E75.242Niemann-Pick disease type C
E75.243Niemann-Pick disease type D
E75.248Other Niemann-Pick disease
E75.249Niemann-Pick disease, unspecified
E75.3Sphingolipidosis, unspecified
E77.0Defects in post-translational modification of lysosomal enzymes
E77.1Defects in glycoprotein degradation
E77.8Other disorders of glycoprotein metabolism
E77.9Disorder of glycoprotein metabolism, unspecified
E85.1Neuropathic heredofamilial amyloidosis
E85.2Heredofamilial amyloidosis, unspecified
E85.3Secondary systemic amyloidosis
E85.4Organ-limited amyloidosis
E85.81 Light chain (AL) amyloidosis
E85.82 Wild-type transthyretin-related (ATTR) amyloidosis
E85.89Other amyloidosis
E85.9Amyloidosis, unspecified
G12.21Amyotrophic lateral sclerosis
G12.25 Progressive spinal muscle atrophy
G13.0Paraneoplastic neuromyopathy and neuropathy
G13.1Other systemic atrophy primarily affecting central nervous system in neoplastic disease
G35Multiple sclerosis
G60.0Hereditary motor and sensory neuropathy
G60.1Refsum's disease
G60.2Neuropathy in association with hereditary ataxia
G60.3Idiopathic progressive neuropathy
G60.8Other hereditary and idiopathic neuropathies
G60.9Hereditary and idiopathic neuropathy, unspecified
G61.0Guillain-Barre syndrome
G61.1Serum neuropathy
G61.81Chronic inflammatory demyelinating polyneuritis
G61.89Other inflammatory polyneuropathies
G61.9Inflammatory polyneuropathy, unspecified
G62.0Drug-induced polyneuropathy
G62.1Alcoholic polyneuropathy
G62.2Polyneuropathy due to other toxic agents
G62.81Critical illness polyneuropathy
G62.82Radiation-induced polyneuropathy
G62.89Other specified polyneuropathies
G62.9Polyneuropathy, unspecified
G63Polyneuropathy in diseases classified elsewhere
G64Other disorders of peripheral nervous system
G65.0Sequelae of Guillain-Barre syndrome
G65.1Sequelae of other inflammatory polyneuropathy
G65.2Sequelae of toxic polyneuropathy
G90.09Other idiopathic peripheral autonomic neuropathy
G99.0Autonomic neuropathy in diseases classified elsewhere
I70.201Unspecified atherosclerosis of native arteries of extremities, right leg
I70.202Unspecified atherosclerosis of native arteries of extremities, left leg
I70.203Unspecified atherosclerosis of native arteries of extremities, bilateral legs
I70.208Unspecified atherosclerosis of native arteries of extremities, other extremity
I70.209Unspecified atherosclerosis of native arteries of extremities, unspecified extremity
I70.211Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.218Atherosclerosis of native arteries of extremities with intermittent claudication, other extremity
I70.219Atherosclerosis of native arteries of extremities with intermittent claudication, unspecified extremity
I70.221Atherosclerosis of native arteries of extremities with rest pain, right leg
I70.222Atherosclerosis of native arteries of extremities with rest pain, left leg
I70.223Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.228Atherosclerosis of native arteries of extremities with rest pain, other extremity
I70.229Atherosclerosis of native arteries of extremities with rest pain, unspecified extremity
I70.231Atherosclerosis of native arteries of right leg with ulceration of thigh
I70.232Atherosclerosis of native arteries of right leg with ulceration of calf
I70.233Atherosclerosis of native arteries of right leg with ulceration of ankle
I70.234Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot
I70.235Atherosclerosis of native arteries of right leg with ulceration of other part of foot
I70.238Atherosclerosis of native arteries of right leg with ulceration of other part of lower leg
I70.239Atherosclerosis of native arteries of right leg with ulceration of unspecified site
I70.241Atherosclerosis of native arteries of left leg with ulceration of thigh
I70.242Atherosclerosis of native arteries of left leg with ulceration of calf
I70.243Atherosclerosis of native arteries of left leg with ulceration of ankle
I70.244Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot
I70.245Atherosclerosis of native arteries of left leg with ulceration of other part of foot
I70.248Atherosclerosis of native arteries of left leg with ulceration of other part of lower left leg
I70.249Atherosclerosis of native arteries of left leg with ulceration of unspecified site
I70.25Atherosclerosis of native arteries of other extremities with ulceration
I70.261Atherosclerosis of native arteries of extremities with gangrene, right leg
I70.262Atherosclerosis of native arteries of extremities with gangrene, left leg
I70.263Atherosclerosis of native arteries of extremities with gangrene, bilateral legs
I70.268Atherosclerosis of native arteries of extremities with gangrene, other extremity
I70.269Atherosclerosis of native arteries of extremities with gangrene, unspecified extremity
I70.291Other atherosclerosis of native arteries of extremities, right leg
I70.292Other atherosclerosis of native arteries of extremities, left leg
I70.293Other atherosclerosis of native arteries of extremities, bilateral legs
I70.298Other atherosclerosis of native arteries of extremities, other extremity
I70.299Other atherosclerosis of native arteries of extremities, unspecified extremity
I70.90Unspecified atherosclerosis
I70.91Generalized atherosclerosis
I73.00Raynaud's syndrome without gangrene
I73.01Raynaud's syndrome with gangrene
I73.1Thromboangiitis obliterans [Buerger's disease]
I73.81Erythromelalgia
I73.89Other specified peripheral vascular diseases
I73.9Peripheral vascular disease, unspecified
I77.1Stricture of artery
I77.6Arteritis, unspecified
I79.1Aortitis in diseases classified elsewhere
I79.8Other disorders of arteries, arterioles and capillaries in diseases classified elsewhere
I80.00Phlebitis and thrombophlebitis of superficial vessels of unspecified lower extremity
I80.01Phlebitis and thrombophlebitis of superficial vessels of right lower extremity
I80.02Phlebitis and thrombophlebitis of superficial vessels of left lower extremity
I80.03Phlebitis and thrombophlebitis of superficial vessels of lower extremities, bilateral
I80.10Phlebitis and thrombophlebitis of unspecified femoral vein
I80.11Phlebitis and thrombophlebitis of right femoral vein
I80.12Phlebitis and thrombophlebitis of left femoral vein
I80.13Phlebitis and thrombophlebitis of femoral vein, bilateral
I80.201Phlebitis and thrombophlebitis of unspecified deep vessels of right lower extremity
I80.202Phlebitis and thrombophlebitis of unspecified deep vessels of left lower extremity
I80.203Phlebitis and thrombophlebitis of unspecified deep vessels of lower extremities, bilateral
I80.209Phlebitis and thrombophlebitis of unspecified deep vessels of unspecified lower extremity
I80.221Phlebitis and thrombophlebitis of right popliteal vein
I80.222Phlebitis and thrombophlebitis of left popliteal vein
I80.223Phlebitis and thrombophlebitis of popliteal vein, bilateral
I80.229Phlebitis and thrombophlebitis of unspecified popliteal vein
I80.231Phlebitis and thrombophlebitis of right tibial vein
I80.232Phlebitis and thrombophlebitis of left tibial vein
I80.233Phlebitis and thrombophlebitis of tibial vein, bilateral
I80.239Phlebitis and thrombophlebitis of unspecified tibial vein
I80.241Phlebitis and thrombophlebitis of right peroneal vein
I80.242Phlebitis and thrombophlebitis of left peroneal vein
I80.243Phlebitis and thrombophlebitis of peroneal vein, bilateral
I80.249Phlebitis and thrombophlebitis of unspecified peroneal vein
I80.251Phlebitis and thrombophlebitis of right calf muscular vein
I80.252Phlebitis and thrombophlebitis of left calf muscular vein
I80.253Phlebitis and thrombophlebitis of calf muscular vein, bilateral
I80.259Phlebitis and thrombophlebitis of unspecified calf muscular vein
I80.291Phlebitis and thrombophlebitis of other deep vessels of right lower extremity
I80.292Phlebitis and thrombophlebitis of other deep vessels of left lower extremity
I80.293Phlebitis and thrombophlebitis of other deep vessels of lower extremity, bilateral
I80.299Phlebitis and thrombophlebitis of other deep vessels of unspecified lower extremity
I80.3Phlebitis and thrombophlebitis of lower extremities, unspecified
I87.001Postthrombotic syndrome without complications of right lower extremity
I87.002Postthrombotic syndrome without complications of left lower extremity
I87.003Postthrombotic syndrome without complications of bilateral lower extremity
I87.009Postthrombotic syndrome without complications of unspecified extremity
I87.011Postthrombotic syndrome with ulcer of right lower extremity
I87.012Postthrombotic syndrome with ulcer of left lower extremity
I87.013Postthrombotic syndrome with ulcer of bilateral lower extremity
I87.019Postthrombotic syndrome with ulcer of unspecified lower extremity
I87.021Postthrombotic syndrome with inflammation of right lower extremity
I87.022Postthrombotic syndrome with inflammation of left lower extremity
I87.023Postthrombotic syndrome with inflammation of bilateral lower extremity
I87.029Postthrombotic syndrome with inflammation of unspecified lower extremity
I87.031Postthrombotic syndrome with ulcer and inflammation of right lower extremity
I87.032Postthrombotic syndrome with ulcer and inflammation of left lower extremity
I87.033Postthrombotic syndrome with ulcer and inflammation of bilateral lower extremity
I87.039Postthrombotic syndrome with ulcer and inflammation of unspecified lower extremity
I87.091Postthrombotic syndrome with other complications of right lower extremity
I87.092Postthrombotic syndrome with other complications of left lower extremity
I87.093Postthrombotic syndrome with other complications of bilateral lower extremity



Version Effective Date: 10/01/2019
Version Issued Date: 10/01/2019
Version Reissued Date: N/A

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