Notification



Notification Issue Date:



Medical Policy Bulletin


Title:Testing Serum Vitamin D Levels

Policy #:06.02.51c

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.


The Company makes decisions on coverage based on Policy Bulletins, benefit plan documents, and the member’s medical history and condition. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable.

When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's benefit contract.

Testing serum Vitamin D, 25 hydroxy or 1, 25 dihydroxy, levels is considered medically necessary and, therefore, covered for individuals with the following indications per the frequency limits listed in this policy section:

MEDICALLY NECESSARY INDICATIONS
  • Chronic kidney disease stage III or greater†
  • Cirrhosis/chronic liver disease †
  • Fibromyalgia
  • Granulomatous diseases
  • Hypocalcemia†
  • Hypercalcemia†
  • Hypovitaminosis D†
  • Hypervitaminosis D†
  • Chronic use of anticonvulsants, corticosteroids, or diuretics
  • Obstructive jaundice/biliary tract disease †
  • Osteomalacia†
  • Osteoporosis†
  • Osteogenesis imperfecta†
  • Osteosclerosis/osteopetrosis†
  • Psoriasis
  • Rickets†
  • Vitamin D deficiency on replacement therapy; to monitor the efficacy of treatment
  • Parathyroid disorders
  • Osteopenia
  • Unexplained abnormality in serum calcium
  • Unexplained abnormality in serum phosphorous
  • Unexplained abnormality in serum alkaline phosphatase
  • Unexplained abnormality in serum parathyroid hormone
  • Individuals who have been institutionalized (i.e. who reside at long-term facilities, (e.g., long-term hospital stays, nursing homes, assisted living facilities, and similar environments), where some degree of medical care is provided.
  • Newborns and children who fail to thrive
  • Exclusively breast-fed or premature infants who are not reliably taking supplements of vitamin D (400 international units daily)
  • Infants and young children with nonspecific symptoms such as poor growth, gross motor delays, and unusual irritability
  • Dark-skinned infants and children who live at higher latitudes in the winter and spring months, particularly infants with a history of prematurity
  • Chronic diseases that are associated with malabsorption, (e.g., cystic fibrosis and inflammatory bowel disease, short gut syndrome, cholestasis
  • Children with low dietary intake of vitamin D, who are not taking supplements

MEDICALLY NECESSARY FREQUENCIES

Testing of 25 hydroxy Vitamin D (CPT Code 82306), including fraction(s) is considered medically necessary and, therefore, covered for up to three (3) times per year for the ICD-10-CM codes listed under the CPT Code 82306 in the coding table of this policy.

Testing of 1, 25 dihydroxy Vitamin D (CPT Code 82652), including fraction(s) is considered medically necessary and, therefore, covered for up to two (2) times per year for the ICD-10-CM codes listed under the CPT Code 82652 in the coding table of this policy.

Only one 25 hydroxy Vitamin D or only one 1,25 hydroxy Vitamin D level level will be reimbursed in any 24 hour period, if medically necessary. Storage and supplement components will not be reimbursed separately.†

NOT MEDICALLY NECESSARY

All other uses, including routine screening, for testing serum Vitamin D levels are considered not medically necessary and, therefore, not covered.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.
Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, Testing Serum Vitamin D Levels is covered under the medical benefits of the Company’s products when the medical necessity criteria listed in this medical policy are met.

However, services that are identified in this policy as not medically necessary are not eligible for coverage or reimbursement by the Company.

Description

Vitamin D, also known as calciferol, is a fat-soluble vitamin that has a variety of physiologic effects, most prominently in calcium homeostasis and bone metabolism. In addition to the role it plays in bone metabolism, other physiologic effects include inhibition of smooth muscle proliferation, regulation of the renin-angiotensin system, decrease in coagulation, and decrease in inflammatory markers.

Vitamin D is a prohormone that is not active until it is converted to 25-hydroxyvitamin D (25[OH]D; 25- hydroxycholecalciferol), in the liver, and then to the active form of the vitamin, 1,25-dihydroxyvitamin D (1,25(OH)2D; 1,25-dihydroxycholecalciferol) in the kidney. The current accepted “best measure” for assessing vitamin D status is total serum 25(OH)D (expressed in ng/mL or nmol/L). The Institute of Medicine lists the following cutoffs:
  • Deficiency—serum 25-hydroxyvitamin D values ≤12 ng/mL (30 nmol/L)
  • Insufficiency—serum 25-hydroxyvitamin D values of 12-19 ng/mL (30-49 nmol/L)
  • Sufficiency—serum 25-hydroxyvitamin D values of 20-50 ng/mL (50-125 nmol/L)

Although these cutoff values are widely accepted, no firm agreement has been accepted as to what concentration of 25(OH)D is “optimal” for health.

The evidence on testing vitamin D levels for skeletal health and overall mortality includes many randomized controlled trials (RCTs) and systematic reviews of vitamin D supplementation. Relevant outcomes are overall survival, disease-specific survival, test accuracy and validity, symptoms, morbid events, and treatment-related morbidity. Despite the large quantity of evidence, considerable uncertainty remains regarding the beneficial health effects of vitamin D. For skeletal health, there may be a small effect of vitamin D supplementation on falls, but there does not appear to be an impact on reducing fractures for the general population. The effect on fracture reduction may be significant in elderly women, in institutionalized individuals, and with higher doses of vitamin D. For overall mortality, there is also no benefit for the general population. Evidence from a systematic review that included trials of patients with vitamin D deficiency reported a small reduction in overall mortality for institutionalized patients. The evidence is sufficient to determine qualitatively that the technology results in a meaningful improvement in the net health outcome.

The evidence on the impact of vitamin D on extraskeletal health benefits, including cardiovascular disease, hypertension, diabetes, and cancer, includes many RCTs. Relevant outcomes are overall survival, disease-specific survival, test accuracy and validity, symptoms, morbid events, and treatmentrelated morbidity. RCTs evaluating extraskeletal outcomes have not reported a benefit for vitamin D supplementation. In the available RCTs, extraskeletal outcomes were mostly secondary and occurred uncommonly. Therefore, the studies may not have had adequate power to detect a benefit, and ascertainment of outcomes may not have been optimal. The evidence is insufficient to determine the effects of the technology on health outcomes.

There are published systematic reviews, which describe relationships between low vitamin D and conditions such as fibromyalgia, gestational diabetes and pre-eclampsia, bone health, and adverse outcomes such as falls or infection. However, the general consensus expressed in these reviews on the clinical utility of vitamin D testing is the available evidence is inconsistent for conditions that are not related to bone health. Screening in the general population reportedly lacks evidence and is not recommended.

Signs and symptoms of vitamin D deficiency are largely manifested by changes in bone health and biochemical markers associated with bone production and resorption. In most cases, a clinical diagnosis of an abnormality in bone health (eg, rickets, osteomalacia, osteoporosis) will lead to a decision to test vitamin D levels. Symptoms related to the clinical condition may be present, such as pain or low-impact fractures, but these symptoms are usually not indications for testing prior to a specific diagnosis. Some biochemical markers of bone health may indicate an increased risk for vitamin D deficiency, and testing of vitamin D levels may therefore be appropriate. These biochemical markers include unexplained abnormalities in serum calcium, phosphorous, alkaline phosphatase, and/or parathyroid hormone.

Signs and symptoms of vitamin D toxicity (hypervitaminosis D) generally result from induced hypercalcemia. Acute intoxication can cause symptoms of confusion, anorexia, vomiting, weakness, polydipsia, and polyuria. Chronic intoxication can cause bone demineralization, kidney stones, and bone pain.

There are no standardized lists of factors denoting high risk for vitamin D deficiency, and published lists of high-risk factors differ considerably. Certain factors tend to be present on most lists, however, and they may constitute a core set of factors for which there is general agreement that testing is indicated.

“Institutionalized” as used herein refers to patients who reside at long-term facilities where some degree of medical care is provided. These circumstances and facilities can include long-term hospital stays, nursing homes, assisted living facilities, and similar environments.

All assays of vitamin D and its metabolites need not be performed for each of the clinically warranted indications. Often, one type is more appropriate for a certain disease state than another. The most common type of vitamin D deficiency is that of 25 hydroxy vitamin D. A much smaller percentage of 1, 25 dihydroxy vitamin D deficiency exists; mostly in those with renal disease.

The need for repeat testing may vary by condition. A single test may be indicated for diagnostic purposes; a repeat test may be appropriate to determine whether supplementation has been successful in restoring normal serum levels. More than 1 repeat test may be indicated occasionally, such as in cases where, eg, supplementation has not been successful in restoring levels, continued or recurrent signs and symptoms may indicate ongoing deficiency, and/or inadequate absorption or noncompliance with replacement therapy is suspected.

PRACTICE GUIDELINES AND POSITION STATEMENTS

A search of the National Guideline Clearinghouse, the Healthcare Standards database, and other web-based resources identified more than a dozen relevant guidelines. In general, no guideline recommends screening for vitamin D deficiency in the general population of adults or children.

ENDOCRINE SOCIETY
In 2011, the Endocrine Society published clinical practice guidelines for the evaluation, treatment and prevention of vitamin D deficiency. The following recommendations were made regarding testing vitamin D levels:
  • 25(OH)D [25-hydroxyvitamin D] serum level testing is recommended to evaluate vitamin D status only in patients who are at risk of deficiency. The guideline does not recommend screening of individuals who are not at risk of vitamin D deficiency.
  • 1,25(OH)2D [1,25-dihydroxyvitamin D] testing is not recommended to evaluate vitamin D status. However, the guideline does recommend monitoring calcitriol levels in certain conditions.


AMERICAN COLLEGE OF OBSTETRICS AND GYNECOLOGY (ACOG)
The American College of Obstetrics and Gynecology issued guidelines on the testing of vitamin D levels and vitamin D supplementation in pregnant women. The following recommendation was made about testing vitamin D levels:
  • At this time there is insufficient evidence to support a recommendation for screening all pregnant women for vitamin D deficiency. For pregnant women thought to be at increased risk of vitamin D deficiency, maternal 25-OH-D levels can be considered and should be interpreted in the context of the individual clinical circumstance. When vitamin D deficiency is identified during pregnancy, most experts agree that 1,000-2,000 international units per day of vitamin D is safe.

U.S. PREVENTIVE SERVICES TASK FORCE RECOMMENDATIONS
The U.S. Preventive Services Task Force (USPSTF) published a recommendation in 2014 on vitamin D screening. USPSTF concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic individuals (grade I [insufficient evidence]).
References


Agency for Healthcare Research and Quality. Effectiveness and Safety of Vitamin D in Relation to Bone Health. 2011; http://www.ahrq.gov/clinic/tp/vitadtp.htm. Accessed March 10th, 2016.

American College of Obstetrics and Gynecology Committee on Obstetric Practice. ACOG Committee Opinion No. 495: Vitamin D: Screening and supplementation during pregnancy. Obstet Gynecol. 2011;118(1):197- 98.

Avenell A, Gillespie WJ, Gillespie LD, et al. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev. 2009(2):CD000227.

Bischoff-Ferrari HA, Willett WC, Wong JB, et al. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA. 2005;293(18):2257-2264.

Bischoff-Ferrari HA, Willett WC, Wong JB, et al. Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med. 2009;169(6):551-561.

Bjelakovic G, Gluud LL, Nikolova D, et al. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev. 2011(7):CD007470.

Blue Cross Blue Shield of Kansas. Testing for Vitamin D deficiency. 2014;
http://www.bcbsks.com/CustomerService/Providers/MedicalPolicies/policies/policies/Testing_VitaminDDeficiency_2014-02-05.pdf. Accessed March 10th, 2016.

Blue Cross Blue Shield of Mississipi. Vitamin D testing. 2015; http://www.bcbsms.com/index.php?q=medicalpolicy-search-page.html&action=viewPolicy&path=%2Fpolicy%2Femed%2FVitamin+D+Testing.html.
Accessed August 10th, 2016.

Bolland MJ, Avenell A, Baron JA, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010;341:c3691. PMID 20671013

Cauley JA, Lacroix AZ, Wu L, et al. Serum 25-hydroxyvitamin D concentrations and risk for hip fractures. Ann Intern Med. 2008;149(4):242-250.

Cauley JA, Parimi N, Ensrud KE, et al. Serum 25-hydroxyvitamin D and the risk of hip and nonspine fractures in older men. J Bone Miner Res. 2010;25(3):545-553.

Chowdhury R, Kunutsor S, Vitezova A, et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ. 2014;348:g1903.

Chung M, Balk EM, Brendel M, et al. Vitamin D and calcium: a systematic review of health outcomes. Evid Rep Technol Assess (Full Rep). 2009(183):1-420.

Elamin MB, Abu Elnour NO, Elamin KB, et al. Vitamin D and cardiovascular outcomes: a systematic review and meta-analysis. J Clin Endocrinol Metab. Jul 2011;96(7):1931-1942.

Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911-1930.

Holvik K, Ahmed LA, Forsmo S, et al. Low serum levels of 25-hydroxyvitamin D predict hip fracture in the elderly: a NOREPOS study. J Clin Endocrinol Metab. 2013;98(8):3341-3350.

Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. 2010. Available at:
http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx. Accessed July 20, 2015.

Jackson RD, LaCroix AZ, Gass M, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006;354(7):669-683.

Jia X, Aucott LS, McNeill G. Nutritional status and subsequent all-cause mortality in men and women aged 75 years or over living in the community. Br J Nutr. 2007;98(3):593-599.

LeBlanc ES, Chou R, Pappas M. Screening for vitamin D deficiency. Ann Intern Med. 2015;162(10):738.

LeBlanc ES, Zakher B, Daeges M, et al. Screening for vitamin D deficiency: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2015;162(2):109-122.

Local Coverage Determination (LCD):†Vitamin D Assay Testing (L34888). Available at:https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=34888&ContrId=323&ver=6&ContrVer=1&Date=10%2f29%2f2015&DocID=L34888&bc=iAAAAAgAAAAAAA%3d%3d& Accessed March 10th, 2016.

Looker AC, Mussolino ME. Serum 25-hydroxyvitamin D and hip fracture risk in older U.S. white adults. J Bone Miner Res. 2008;23(1):143-150.

Margolis KL, Ray RM, Van Horn L, et al. Effect of calcium and vitamin D supplementation on blood pressure: the Women's Health Initiative Randomized Trial. Hypertension. 2008;52(5):847-855.

Mithal A, Wahl DA, Bonjour JP, et al. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int. 2009;20(11):1807-1820.

Noridian Administrative Services LCD. Vitamin D Assay Testing. 2015. Available at:
http://www.sonoraquest.com/uploads/docs/Vitamin_D_Assay_Testing.pdf?AspxAutoDetectCookieSupport=1. Accessed March 10th, 2016.

Palmer SC, McGregor DO, Craig JC, et al. Vitamin D compounds for people with chronic kidney disease requiring dialysis. Cochrane Database Syst Rev. 2009(4):CD005633.

Palmer SC, McGregor DO, Craig JC, et al. Vitamin D compounds for people with chronic kidney disease not requiring dialysis. Cochrane Database Syst Rev. 2009(4):CD008175.

Pittas AG, Chung M, Trikalinos T, et al. Systematic review: Vitamin D and cardiometabolic outcomes. Ann Intern Med. 2010;152(5):307-314.

Quality AfHRa. Vitamin D and Calcium: A Systematic Review of Health Outcomes (Update). 2014. Available at:http://www.effectivehealthcare.ahrq.gov/ehc/products/537/1953/vitamin-d-calcium-report-140902.pdf. Accessed March 10th, 2016.

Regence BlueCross BlueShield. Policy No. 52: Vitamin D Testing. Regency Medical Policy Manual 2015. Available at:
http://blue.regence.com/trgmedpol/lab/lab52.pdf. Accessed March 10th, 2016.

Sanders KM, Stuart AL, Williamson EJ, et al. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA. 2010;303(18):1815-1822.

Shapses SA, Manson JE. Vitamin D and prevention of cardiovascular disease and diabetes: why the evidence falls short. JAMA. 2011;305(24):2565-2566.

Theodoratou E, Tzoulaki I, Zgaga L, et al. Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials. BMJ. 2014;348:g2035.

United States Preventive Services Task Force (USPSTF). Vitamin D Deficiency: Screening 2014. Available at:
http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/vitamin-d-deficiencyscreening. Accessed March 10th, 2016.

UpToDate: Vitamin D insufficiency and deficiency in children and adolescents. AuthorMadhusmita Misra, MD, MPH. Available at (subscription required): http://www.uptodate.com/contents/vitamin-d-insufficiency-and-deficiency-in-children-and-adolescents?source=search_result&search=vitamin+d+testing+pediatrics&selectedTitle=1~150. Accessed March 10th, 2016.

Visser M, Deeg DJ, Puts MT, et al. Low serum concentrations of 25-hydroxyvitamin D in older persons and the risk of nursing home admission. Am J Clin Nutr. 2006;84(3):616-622; quiz 671-612.

Wang TJ, Pencina MJ, Booth SL, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation. 2008;117(4):503-511.

Wellmark Blue Cross and Blue Shield. Vitamin D testing. 2015. Available at:
https://bluepriority.wellmark.com/Provider/MedPoliciesAndAuthorizations/MedicalPolicies/policies/Vitamin_D_Testing.aspx. Accessed March 10th, 2016.

Wisconsin Physicians Service Insurance Corporation. Medicare LCD: Vitamin D Assay Testing (L31076). 2015. Available at:
https://www.cms.gov/medicare-coverage-database/details/lcddetails.aspx?LCDId=31076&ContrId=143&ver=21&ContrVer=1&Date=&DocID=L31076&bc=iAAAAAgAAAAAAA
%3d%3d&. Accessed March 10th, 2016.

Yetley EA. Assessing the vitamin D status of the US population. Am J Clin Nutr. 2008;88(2):558S-564S.





Coding

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.

CPT Procedure Code Number(s)

0038U, 82306, 82652


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

MEDICALLY NECESSARY FOR 82306

D71 Functional disorders of polymorphonuclear neutrophils

E20.0 Idiopathic hypoparathyroidism

E20.1 Pseudohypoparathyroidism

E20.8 Other hypoparathyroidism

E20.9 Hypoparathyroidism, unspecified

E21.0 Primary hyperparathyroidism

E21.1 Secondary hyperparathyroidism, not elsewhere classified

E21.2 Other hyperparathyroidism

E21.3 Hyperparathyroidism, unspecified

E21.4 Other specified disorders of parathyroid gland

E21.5 Disorder of parathyroid gland, unspecified

E55.0 Rickets, active

E55.9 Vitamin D deficiency, unspecified

E58 Dietary calcium deficiency

E67.2 Megavitamin-b6 syndrome

E67.3 Hypervitaminosis D

E67.8 Other specified hyperalimentation

E68 Sequelae of hyperalimentation

E83.30 Disorder of phosphorus metabolism, unspecified

E83.31 Familial hypophosphatemia

E83.32 Hereditary vitamin D-dependent rickets (type 1) (type 2)

E83.39 Other disorders of phosphorus metabolism

E83.50 Unspecified disorder of calcium metabolism

E83.51 Hypocalcemia

E83.52 Hypercalcemia

E83.59 Other disorders of calcium metabolism

E84.0 Cystic fibrosis with pulmonary manifestations

E84.11 Meconium ileus in cystic fibrosis

E84.19 Cystic fibrosis with other intestinal manifestations

E84.8 Cystic fibrosis with other manifestations

E84.9 Cystic fibrosis, unspecified

G73.7 Myopathy in diseases classified elsewhere

K50.00 Crohn's disease of small intestine without complications

K50.011 Crohn's disease of small intestine with rectal bleeding

K50.012 Crohn's disease of small intestine with intestinal obstruction

K50.013 Crohn's disease of small intestine with fistula

K50.014 Crohn's disease of small intestine with abscess

K50.018 Crohn's disease of small intestine with other complication

K50.019 Crohn's disease of small intestine with unspecified complications

K50.10 Crohn's disease of large intestine without complications

K50.111 Crohn's disease of large intestine with rectal bleeding

K50.112 Crohn's disease of large intestine with intestinal obstruction

K50.113 Crohn's disease of large intestine with fistula

K50.114 Crohn's disease of large intestine with abscess

K50.118 Crohn's disease of large intestine with other complication

K50.119 Crohn's disease of large intestine with unspecified complications

K50.80 Crohn's disease of both small and large intestine without complications

K50.811 Crohn's disease of both small and large intestine with rectal bleeding

K50.812 Crohn's disease of both small and large intestine with intestinal obstruction

K50.813 Crohn's disease of both small and large intestine with fistula

K50.814 Crohn's disease of both small and large intestine with abscess

K50.818 Crohn's disease of both small and large intestine with other complication

K50.819 Crohn's disease of both small and large intestine with unspecified complications

K50.90 Crohn's disease, unspecified, without complications

K50.911 Crohn's disease, unspecified, with rectal bleeding

K50.912 Crohn's disease, unspecified, with intestinal obstruction

K50.913 Crohn's disease, unspecified, with fistula

K50.914 Crohn's disease, unspecified, with abscess

K50.918 Crohn's disease, unspecified, with other complication

K50.919 Crohn's disease, unspecified, with unspecified complications

K51.00 Ulcerative (chronic) pancolitis without complications

K51.011 Ulcerative (chronic) pancolitis with rectal bleeding

K51.012 Ulcerative (chronic) pancolitis with intestinal obstruction

K51.013 Ulcerative (chronic) pancolitis with fistula

K51.014 Ulcerative (chronic) pancolitis with abscess

K51.018 Ulcerative (chronic) pancolitis with other complication

K51.019 Ulcerative (chronic) pancolitis with unspecified complications

K51.20 Ulcerative (chronic) proctitis without complications

K51.211 Ulcerative (chronic) proctitis with rectal bleeding

K51.212 Ulcerative (chronic) proctitis with intestinal obstruction

K51.213 Ulcerative (chronic) proctitis with fistula

K51.214 Ulcerative (chronic) proctitis with abscess

K51.218 Ulcerative (chronic) proctitis with other complication

K51.219 Ulcerative (chronic) proctitis with unspecified complications

K51.30 Ulcerative (chronic) rectosigmoiditis without complications

K51.311 Ulcerative (chronic) rectosigmoiditis with rectal bleeding

K51.312 Ulcerative (chronic) rectosigmoiditis with intestinal obstruction

K51.313 Ulcerative (chronic) rectosigmoiditis with fistula

K51.314 Ulcerative (chronic) rectosigmoiditis with abscess

K51.318 Ulcerative (chronic) rectosigmoiditis with other complication

K51.319 Ulcerative (chronic) rectosigmoiditis with unspecified complications

K51.50 Left sided colitis without complications

K51.511 Left sided colitis with rectal bleeding

K51.512 Left sided colitis with intestinal obstruction

K51.513 Left sided colitis with fistula

K51.514 Left sided colitis with abscess

K51.518 Left sided colitis with other complication

K51.519 Left sided colitis with unspecified complications

K51.80 Other ulcerative colitis without complications

K51.811 Other ulcerative colitis with rectal bleeding

K51.812 Other ulcerative colitis with intestinal obstruction

K51.813 Other ulcerative colitis with fistula

K51.814 Other ulcerative colitis with abscess

K51.818 Other ulcerative colitis with other complication

K51.819 Other ulcerative colitis with unspecified complications

K51.90 Ulcerative colitis, unspecified, without complications

K51.911 Ulcerative colitis, unspecified with rectal bleeding

K51.912 Ulcerative colitis, unspecified with intestinal obstruction

K51.913 Ulcerative colitis, unspecified with fistula

K51.914 Ulcerative colitis, unspecified with abscess

K51.918 Ulcerative colitis, unspecified with other complication

K51.919 Ulcerative colitis, unspecified with unspecified complications

K70.0 Alcoholic fatty liver

K70.10 Alcoholic hepatitis without ascites

K70.11 Alcoholic hepatitis with ascites

K70.2 Alcoholic fibrosis and sclerosis of liver

K70.30 Alcoholic cirrhosis of liver without ascites

K70.31 Alcoholic cirrhosis of liver with ascites

K70.40 Alcoholic hepatic failure without coma

K70.9 Alcoholic liver disease, unspecified

K71.0 Toxic liver disease with cholestasis

K71.10 Toxic liver disease with hepatic necrosis, without coma

K71.2 Toxic liver disease with acute hepatitis

K71.3 Toxic liver disease with chronic persistent hepatitis

K71.4 Toxic liver disease with chronic lobular hepatitis

K71.50 Toxic liver disease with chronic active hepatitis without ascites

K71.51 Toxic liver disease with chronic active hepatitis with ascites

K71.6 Toxic liver disease with hepatitis, not elsewhere classified

K71.7 Toxic liver disease with fibrosis and cirrhosis of liver

K71.8 Toxic liver disease with other disorders of liver

K71.9 Toxic liver disease, unspecified

K72.00 Acute and subacute hepatic failure without coma

K72.10 Chronic hepatic failure without coma

K72.90 Hepatic failure, unspecified without coma

K73.0 Chronic persistent hepatitis, not elsewhere classified

K73.1 Chronic lobular hepatitis, not elsewhere classified

K73.2 Chronic active hepatitis, not elsewhere classified

K73.8 Other chronic hepatitis, not elsewhere classified

K73.9 Chronic hepatitis, unspecified

K74.0 Hepatic fibrosis

K74.1 Hepatic sclerosis

K74.2 Hepatic fibrosis with hepatic sclerosis

K74.3 Primary biliary cirrhosis

K74.4 Secondary biliary cirrhosis

K74.5 Biliary cirrhosis, unspecified

K74.60 Unspecified cirrhosis of liver

K74.69 Other cirrhosis of liver

K75.0 Abscess of liver

K75.1 Phlebitis of portal vein

K75.2 Nonspecific reactive hepatitis

K75.3 Granulomatous hepatitis, not elsewhere classified

K75.4 Autoimmune hepatitis

K75.81 Nonalcoholic steatohepatitis (NASH)

K75.89 Other specified inflammatory liver diseases

K75.9 Inflammatory liver disease, unspecified

K76.0 Fatty (change of) liver, not elsewhere classified

K76.1 Chronic passive congestion of liver

K76.2 Central hemorrhagic necrosis of liver

K76.3 Infarction of liver

K76.4 Peliosis hepatis

K76.5 Hepatic veno-occlusive disease

K76.6 Portal hypertension

K76.7 Hepatorenal syndrome

K76.81 Hepatopulmonary syndrome

K76.89 Other specified diseases of liver

K76.9 Liver disease, unspecified

K77 Liver disorders in diseases classified elsewhere

K83.01 Primary sclerosing cholangitis

K83..09 Other cholangitis

K83.1 Obstruction of bile duct

K83.2 Perforation of bile duct

K83.3 Fistula of bile duct

K83.4 Spasm of sphincter of oddi

K83.5 Biliary cyst

K83.8 Other specified diseases of biliary tract

K83.9 Disease of biliary tract, unspecified

K87 Disorders of gallbladder, biliary tract and pancreas in diseases classified elsewhere

K90.0 Celiac disease

K90.1 Tropical sprue

K90.2 Blind loop syndrome, not elsewhere classified

K90.3 Pancreatic steatorrhea

K90.4 Malabsorption due to intolerance, not elsewhere classified

K90.81 Whipple's disease

K90.89 Other intestinal malabsorption

K90.9 Intestinal malabsorption, unspecified

K91.2 Postsurgical malabsorption, not elsewhere classified

L40.0 Psoriasis vulgaris

L40.1 Generalized pustular psoriasis

L40.2 Acrodermatitis continua

L40.3 Pustulosis palmaris et plantaris

L40.4 Guttate psoriasis

L40.50 Arthropathic psoriasis, unspecified

L40.51 Distal interphalangeal psoriatic arthropathy

L40.52 Psoriatic arthritis mutilans

L40.53 Psoriatic spondylitis

L40.54 Psoriatic juvenile arthropathy

L40.59 Other psoriatic arthropathy

L40.8 Other psoriasis

L40.9 Psoriasis, unspecified

M32.0 Drug-induced systemic lupus erythematosus

M32.10 Systemic lupus erythematosus, organ or system involvement unspecified

M32.11 Endocarditis in systemic lupus erythematosus

M32.12 Pericarditis in systemic lupus erythematosus

M32.13 Lung involvement in systemic lupus erythematosus

M32.14 Glomerular disease in systemic lupus erythematosus

M32.15 Tubulo-interstitial nephropathy in systemic lupus erythematosus

M32.19 Other organ or system involvement in systemic lupus erythematosus

M32.8 Other forms of systemic lupus erythematosus

M32.9 Systemic lupus erythematosus, unspecified

M33.00 Juvenile dermatomyositis, organ involvement unspecified

M33.01 Juvenile dermatomyositis with respiratory involvement

M33.02 Juvenile dermatomyositis with myopathy

M33.03 Juvenile dermatomyositis without myopathy

M33.09 Juvenile dermatomyositis with other organ involvement

M33.10 Other dermatomyositis, organ involvement unspecified

M33.11 Other dermatomyositis with respiratory involvement

M33.12 Other dermatomyositis with myopathy

M33.13 Other dermatomyositis without myopathy

M33.19 Other dermatomyositis with other organ involvement

M33.20 Polymyositis, organ involvement unspecified

M33.21 Polymyositis with respiratory involvement

M33.22 Polymyositis with myopathy

M33.29 Polymyositis with other organ involvement

M33.90 Dermatopolymyositis, unspecified, organ involvement unspecified

M33.91 Dermatopolymyositis, unspecified with respiratory involvement

M33.92 Dermatopolymyositis, unspecified with myopathy

M33.93 Dermatopolymyositis, unspecified without myopathy

M33.99 Dermatopolymyositis, unspecified with other organ involvement

M36.0 Dermato(poly)myositis in neoplastic disease

M60.80 Other myositis, unspecified site

M60.811 Other myositis, right shoulder

M60.812 Other myositis, left shoulder

M60.819 Other myositis, unspecified shoulder

M60.821 Other myositis, right upper arm

M60.822 Other myositis, left upper arm

M60.829 Other myositis, unspecified upper arm

M60.831 Other myositis, right forearm

M60.832 Other myositis, left forearm

M60.839 Other myositis, unspecified forearm

M60.841 Other myositis, right hand

M60.842 Other myositis, left hand

M60.849 Other myositis, unspecified hand

M60.851 Other myositis, right thigh

M60.852 Other myositis, left thigh

M60.859 Other myositis, unspecified thigh

M60.861 Other myositis, right lower leg

M60.862 Other myositis, left lower leg

M60.869 Other myositis, unspecified lower leg

M60.871 Other myositis, right ankle and foot

M60.872 Other myositis, left ankle and foot

M60.879 Other myositis, unspecified ankle and foot

M60.88 Other myositis, other site

M60.89 Other myositis, multiple sites

M60.9 Myositis, unspecified

M79.10 Myalgia, unspecified site

M79.11 Myalgia of mastication muscle

M79.12 Myalgia of auxiliary muscles, head and neck

M79.18 Myalgia, other site

M79.7 Fibromyalgia

M80.00XA Age-related osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture

M80.00XD Age-related osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with routine healing

M80.00XG Age-related osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with delayed healing

M80.00XK Age-related osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with nonunion

M80.00XP Age-related osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with malunion

M80.00XS Age-related osteoporosis with current pathological fracture, unspecified site, sequela

M80.011A Age-related osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture

M80.011D Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with routine healing

M80.011G Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with delayed healing

M80.011K Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with nonunion

M80.011P Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with malunion

M80.011S Age-related osteoporosis with current pathological fracture, right shoulder, sequela

M80.012A Age-related osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture

M80.012D Age-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with routine healing

M80.012G Age-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with delayed healing

M80.012K Age-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with nonunion

M80.012P Age-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with malunion

M80.012S Age-related osteoporosis with current pathological fracture, left shoulder, sequela

M80.019A Age-related osteoporosis with current pathological fracture, unspecified shoulder, initial encounter for fracture

M80.019D Age-related osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with routine healing

M80.019G Age-related osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with delayed healing

M80.019K Age-related osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with nonunion

M80.019P Age-related osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with malunion

M80.019S Age-related osteoporosis with current pathological fracture, unspecified shoulder, sequela

M80.021A Age-related osteoporosis with current pathological fracture, right humerus, initial encounter for fracture

M80.021D Age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with routine healing

M80.021G Age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with delayed healing

M80.021K Age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with nonunion

M80.021P Age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with malunion

M80.021S Age-related osteoporosis with current pathological fracture, right humerus, sequela

M80.022A Age-related osteoporosis with current pathological fracture, left humerus, initial encounter for fracture

M80.022D Age-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with routine healing

M80.022G Age-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with delayed healing

M80.022K Age-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with nonunion

M80.022P Age-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with malunion

M80.022S Age-related osteoporosis with current pathological fracture, left humerus, sequela

M80.029A Age-related osteoporosis with current pathological fracture, unspecified humerus, initial encounter for fracture

M80.029D Age-related osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with routine healing

M80.029G Age-related osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with delayed healing

M80.029K Age-related osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with nonunion

M80.029P Age-related osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with malunion

M80.029S Age-related osteoporosis with current pathological fracture, unspecified humerus, sequela

M80.031A Age-related osteoporosis with current pathological fracture, right forearm, initial encounter for fracture

M80.031D Age-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with routine healing

M80.031G Age-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with delayed healing

M80.031K Age-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with nonunion

M80.031P Age-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with malunion

M80.031S Age-related osteoporosis with current pathological fracture, right forearm, sequela

M80.032A Age-related osteoporosis with current pathological fracture, left forearm, initial encounter for fracture

M80.032D Age-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with routine healing

M80.032G Age-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with delayed healing

M80.032K Age-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with nonunion

M80.032P Age-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with malunion

M80.032S Age-related osteoporosis with current pathological fracture, left forearm, sequela

M80.039A Age-related osteoporosis with current pathological fracture, unspecified forearm, initial encounter for fracture

M80.039D Age-related osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with routine healing

M80.039G Age-related osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with delayed healing

M80.039K Age-related osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with nonunion

M80.039P Age-related osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with malunion

M80.039S Age-related osteoporosis with current pathological fracture, unspecified forearm, sequela

M80.041A Age-related osteoporosis with current pathological fracture, right hand, initial encounter for fracture

M80.041D Age-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with routine healing

M80.041G Age-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with delayed healing

M80.041K Age-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with nonunion

M80.041P Age-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with malunion

M80.041S Age-related osteoporosis with current pathological fracture, right hand, sequela

M80.042A Age-related osteoporosis with current pathological fracture, left hand, initial encounter for fracture

M80.042D Age-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with routine healing

M80.042G Age-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with delayed healing

M80.042K Age-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with nonunion

M80.042P Age-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with malunion

M80.042S Age-related osteoporosis with current pathological fracture, left hand, sequela

M80.049A Age-related osteoporosis with current pathological fracture, unspecified hand, initial encounter for fracture

M80.049D Age-related osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with routine healing

M80.049G Age-related osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with delayed healing

M80.049K Age-related osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with nonunion

M80.049P Age-related osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with malunion

M80.049S Age-related osteoporosis with current pathological fracture, unspecified hand, sequela

M80.051A Age-related osteoporosis with current pathological fracture, right femur, initial encounter for fracture

M80.051D Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with routine healing

M80.051G Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with delayed healing

M80.051K Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with nonunion

M80.051P Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with malunion

M80.051S Age-related osteoporosis with current pathological fracture, right femur, sequela

M80.052A Age-related osteoporosis with current pathological fracture, left femur, initial encounter for fracture

M80.052D Age-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with routine healing

M80.052G Age-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with delayed healing

M80.052K Age-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with nonunion

M80.052P Age-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with malunion

M80.052S Age-related osteoporosis with current pathological fracture, left femur, sequela

M80.059A Age-related osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture

M80.059D Age-related osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with routine healing

M80.059G Age-related osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with delayed healing

M80.059K Age-related osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with nonunion

M80.059P Age-related osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with malunion

M80.059S Age-related osteoporosis with current pathological fracture, unspecified femur, sequela

M80.061A Age-related osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture

M80.061D Age-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with routine healing

M80.061G Age-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with delayed healing

M80.061K Age-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with nonunion

M80.061P Age-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with malunion

M80.061S Age-related osteoporosis with current pathological fracture, right lower leg, sequela

M80.062A Age-related osteoporosis with current pathological fracture, left lower leg, initial encounter for fracture

M80.062D Age-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with routine healing

M80.062G Age-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with delayed healing

M80.062K Age-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with nonunion

M80.062P Age-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with malunion

M80.062S Age-related osteoporosis with current pathological fracture, left lower leg, sequela

M80.069A Age-related osteoporosis with current pathological fracture, unspecified lower leg, initial encounter for fracture

M80.069D Age-related osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with routine healing

M80.069G Age-related osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with delayed healing

M80.069K Age-related osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with nonunion

M80.069P Age-related osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with malunion

M80.069S Age-related osteoporosis with current pathological fracture, unspecified lower leg, sequela

M80.071A Age-related osteoporosis with current pathological fracture, right ankle and foot, initial encounter for fracture

M80.071D Age-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with routine healing

M80.071G Age-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with delayed healing

M80.071K Age-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with nonunion

M80.071P Age-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with malunion

M80.071S Age-related osteoporosis with current pathological fracture, right ankle and foot, sequela

M80.072A Age-related osteoporosis with current pathological fracture, left ankle and foot, initial encounter for fracture

M80.072D Age-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with routine healing

M80.072G Age-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with delayed healing

M80.072K Age-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with nonunion

M80.072P Age-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with malunion

M80.072S Age-related osteoporosis with current pathological fracture, left ankle and foot, sequela

M80.079A Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, initial encounter for fracture

M80.079D Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with routine healing

M80.079G Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with delayed healing

M80.079K Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with nonunion

M80.079P Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with malunion

M80.079S Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, sequela

M80.08XA Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture

M80.08XD Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with routine healing

M80.08XG Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with delayed healing

M80.08XK Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with nonunion

M80.08XP Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with malunion

M80.08XS Age-related osteoporosis with current pathological fracture, vertebra(e), sequela

M80.80XA Other osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture

M80.80XD Other osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with routine healing

M80.80XG Other osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with delayed healing

M80.80XK Other osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with nonunion

M80.80XP Other osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with malunion

M80.80XS Other osteoporosis with current pathological fracture, unspecified site, sequela

M80.811A Other osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture

M80.811D Other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with routine healing

M80.811G Other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with delayed healing

M80.811K Other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with nonunion

M80.811P Other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with malunion

M80.811S Other osteoporosis with current pathological fracture, right shoulder, sequela

M80.812A Other osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture

M80.812D Other osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with routine healing

M80.812G Other osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with delayed healing

M80.812K Other osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with nonunion

M80.812P Other osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with malunion

M80.812S Other osteoporosis with current pathological fracture, left shoulder, sequela

M80.819A Other osteoporosis with current pathological fracture, unspecified shoulder, initial encounter for fracture

M80.819D Other osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with routine healing

M80.819G Other osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with delayed healing

M80.819K Other osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with nonunion

M80.819P Other osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with malunion

M80.819S Other osteoporosis with current pathological fracture, unspecified shoulder, sequela

M80.821A Other osteoporosis with current pathological fracture, right humerus, initial encounter for fracture

M80.821D Other osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with routine healing

M80.821G Other osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with delayed healing

M80.821K Other osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with nonunion

M80.821P Other osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with malunion

M80.821S Other osteoporosis with current pathological fracture, right humerus, sequela

M80.822A Other osteoporosis with current pathological fracture, left humerus, initial encounter for fracture

M80.822D Other osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with routine healing

M80.822G Other osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with delayed healing

M80.822K Other osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with nonunion

M80.822P Other osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with malunion

M80.822S Other osteoporosis with current pathological fracture, left humerus, sequela

M80.829A Other osteoporosis with current pathological fracture, unspecified humerus, initial encounter for fracture

M80.829D Other osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with routine healing

M80.829G Other osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with delayed healing

M80.829K Other osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with nonunion

M80.829P Other osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with malunion

M80.829S Other osteoporosis with current pathological fracture, unspecified humerus, sequela

M80.831A Other osteoporosis with current pathological fracture, right forearm, initial encounter for fracture

M80.831D Other osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with routine healing

M80.831G Other osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with delayed healing

M80.831K Other osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with nonunion

M80.831P Other osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with malunion

M80.831S Other osteoporosis with current pathological fracture, right forearm, sequela

M80.832A Other osteoporosis with current pathological fracture, left forearm, initial encounter for fracture

M80.832D Other osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with routine healing

M80.832G Other osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with delayed healing

M80.832K Other osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with nonunion

M80.832P Other osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with malunion

M80.832S Other osteoporosis with current pathological fracture, left forearm, sequela

M80.839A Other osteoporosis with current pathological fracture, unspecified forearm, initial encounter for fracture

M80.839D Other osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with routine healing

M80.839G Other osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with delayed healing

M80.839K Other osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with nonunion

M80.839P Other osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with malunion

M80.839S Other osteoporosis with current pathological fracture, unspecified forearm, sequela

M80.841A Other osteoporosis with current pathological fracture, right hand, initial encounter for fracture

M80.841D Other osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with routine healing

M80.841G Other osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with delayed healing

M80.841K Other osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with nonunion

M80.841P Other osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with malunion

M80.841S Other osteoporosis with current pathological fracture, right hand, sequela

M80.842A Other osteoporosis with current pathological fracture, left hand, initial encounter for fracture

M80.842D Other osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with routine healing

M80.842G Other osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with delayed healing

M80.842K Other osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with nonunion

M80.842P Other osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with malunion

M80.842S Other osteoporosis with current pathological fracture, left hand, sequela

M80.849A Other osteoporosis with current pathological fracture, unspecified hand, initial encounter for fracture

M80.849D Other osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with routine healing

M80.849G Other osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with delayed healing

M80.849K Other osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with nonunion

M80.849P Other osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with malunion

M80.849S Other osteoporosis with current pathological fracture, unspecified hand, sequela

M80.851A Other osteoporosis with current pathological fracture, right femur, initial encounter for fracture

M80.851D Other osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with routine healing

M80.851G Other osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with delayed healing

M80.851K Other osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with nonunion

M80.851P Other osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with malunion

M80.851S Other osteoporosis with current pathological fracture, right femur, sequela

M80.852A Other osteoporosis with current pathological fracture, left femur, initial encounter for fracture

M80.852D Other osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with routine healing

M80.852G Other osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with delayed healing

M80.852K Other osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with nonunion

M80.852P Other osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with malunion

M80.852S Other osteoporosis with current pathological fracture, left femur, sequela

M80.859A Other osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture

M80.859D Other osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with routine healing

M80.859G Other osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with delayed healing

M80.859K Other osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with nonunion

M80.859P Other osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with malunion

M80.859S Other osteoporosis with current pathological fracture, unspecified femur, sequela

M80.861A Other osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture

M80.861D Other osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with routine healing

M80.861G Other osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with delayed healing

M80.861K Other osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with nonunion

M80.861P Other osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with malunion

M80.861S Other osteoporosis with current pathological fracture, right lower leg, sequela

M80.862A Other osteoporosis with current pathological fracture, left lower leg, initial encounter for fracture

M80.862D Other osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with routine healing

M80.862G Other osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with delayed healing

M80.862K Other osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with nonunion

M80.862P Other osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with malunion

M80.862S Other osteoporosis with current pathological fracture, left lower leg, sequela

M80.869A Other osteoporosis with current pathological fracture, unspecified lower leg, initial encounter for fracture

M80.869D Other osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with routine healing

M80.869G Other osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with delayed healing

M80.869K Other osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with nonunion

M80.869P Other osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with malunion

M80.869S Other osteoporosis with current pathological fracture, unspecified lower leg, sequela

M80.871A Other osteoporosis with current pathological fracture, right ankle and foot, initial encounter for fracture

M80.871D Other osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with routine healing

M80.871G Other osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with delayed healing

M80.871K Other osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with nonunion

M80.871P Other osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with malunion

M80.871S Other osteoporosis with current pathological fracture, right ankle and foot, sequela

M80.872A Other osteoporosis with current pathological fracture, left ankle and foot, initial encounter for fracture

M80.872D Other osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with routine healing

M80.872G Other osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with delayed healing

M80.872K Other osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with nonunion

M80.872P Other osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with malunion

M80.872S Other osteoporosis with current pathological fracture, left ankle and foot, sequela

M80.879A Other osteoporosis with current pathological fracture, unspecified ankle and foot, initial encounter for fracture

M80.879D Other osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with routine healing

M80.879G Other osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with delayed healing

M80.879K Other osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with nonunion

M80.879P Other osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with malunion

M80.879S Other osteoporosis with current pathological fracture, unspecified ankle and foot, sequela

M80.88XA Other osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture

M80.88XD Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with routine healing

M80.88XG Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with delayed healing

M80.88XK Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with nonunion

M80.88XP Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with malunion

M80.88XS Other osteoporosis with current pathological fracture, vertebra(e), sequela

M81.0 Age-related osteoporosis without current pathological fracture

M81.6 Localized osteoporosis żlequesne®

M81.8 Other osteoporosis without current pathological fracture

M83.0 Puerperal osteomalacia

M83.1 Senile osteomalacia

M83.2 Adult osteomalacia due to malabsorption

M83.3 Adult osteomalacia due to malnutrition

M83.4 Aluminum bone disease

M83.5 Other drug-induced osteomalacia in adults

M83.8 Other adult osteomalacia

M83.9 Adult osteomalacia, unspecified

M85.80 Other specified disorders of bone density and structure, unspecified site

M85.811 Other specified disorders of bone density and structure, right shoulder

M85.812 Other specified disorders of bone density and structure, left shoulder

M85.819 Other specified disorders of bone density and structure, unspecified shoulder

M85.821 Other specified disorders of bone density and structure, right upper arm

M85.822 Other specified disorders of bone density and structure, left upper arm

M85.829 Other specified disorders of bone density and structure, unspecified upper arm

M85.831 Other specified disorders of bone density and structure, right forearm

M85.832 Other specified disorders of bone density and structure, left forearm

M85.839 Other specified disorders of bone density and structure, unspecified forearm

M85.841 Other specified disorders of bone density and structure, right hand

M85.842 Other specified disorders of bone density and structure, left hand

M85.849 Other specified disorders of bone density and structure, unspecified hand

M85.851 Other specified disorders of bone density and structure, right thigh

M85.852 Other specified disorders of bone density and structure, left thigh

M85.859 Other specified disorders of bone density and structure, unspecified thigh

M85.861 Other specified disorders of bone density and structure, right lower leg

M85.862 Other specified disorders of bone density and structure, left lower leg

M85.869 Other specified disorders of bone density and structure, unspecified lower leg

M85.871 Other specified disorders of bone density and structure, right ankle and foot

M85.872 Other specified disorders of bone density and structure, left ankle and foot

M85.879 Other specified disorders of bone density and structure, unspecified ankle and foot

M85.88 Other specified disorders of bone density and structure, other site

M85.89 Other specified disorders of bone density and structure, multiple sites

M85.9 Disorder of bone density and structure, unspecified

M89.9 Disorder of bone, unspecified

M94.9 Disorder of cartilage, unspecified

N18.1 Chronic kidney disease, stage 1

N18.2 Chronic kidney disease, stage 2 (mild)

N18.3 Chronic kidney disease, stage 3 (moderate)

N18.4 Chronic kidney disease, stage 4 (severe)

N18.5 Chronic kidney disease, stage 5

N18.6 End stage renal disease

N18.9 Chronic kidney disease, unspecified

P92.6 Failure to thrive in newborn

Q78.0 Osteogenesis imperfecta

Q78.2 Osteopetrosis

R17 Unspecified jaundice

R45.4 Irritability and anger

R62.50 Unspecified lack of expected normal physiological development in childhood

R62.51 Failure to thrive (child)

R62.59 Other lack of expected normal physiological development in childhood

R74.8 Abnormal levels of other serum enzymes

R79.89 Other specified abnormal findings of blood chemistry

R79.0 Abnormal level of blood mineral

Z79.51 Long term (current) use of inhaled steroids

Z79.52 Long term (current) use of systemic steroids

Z79.899 Other long term (current) drug therapy

MEDICALLY NECESSARY FOR 82652

D71 Functional disorders of polymorphonuclear neutrophils

E55.0 Rickets, active

E67.2 Megavitamin-B6 syndrome

E67.3 Hypervitaminosis D

E67.8 Other specified hyperalimentation

E68 Sequelae of hyperalimentation

N18.3 Chronic kidney disease, stage 3 (moderate)

N18.4 Chronic kidney disease, stage 4 (severe)

N18.5 Chronic kidney disease, stage 5

N18.6 End stage renal disease

Q78.0 Osteogenesis imperfecta

Q78.2 Osteopetrosis




HCPCS Level II Code Number(s)

N/A


Revenue Code Number(s)

N/A

Coding and Billing Requirements



Policy History

Revisions from 06.02.51c
11/21/2018This policy has been reissued in accordance with the Company's annual review process.
10/01/2018Effective 10/01/2018, the following diagnosis codes have been deleted from this policy due to coding updates:

K83.0, M79.1

Effective 10/01/2018, the following diagnosis codes have been added to this policy due to coding updates:

K83.01, K83.09, M79.10, M79.11, M79.12, M79.18

Revisions from 06.02.51b
04/01/2018Effective 04/01/2018, the following CPT code has been added to this policy due to coding updates: 0038U


Effective 10/05/2017 this policy has been updated to the new policy template format.


Version Effective Date: 10/01/2018
Version Issued Date: 11/09/2018
Version Reissued Date: 11/27/2018

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Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.