Notification



Notification Issue Date:



Policy Attachment


Attachment to Policy # 10.01.01n


Attachment:A

Policy #:10.01.01n

Description:ICD-10 Codes

Title:Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs


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.



ICD-10 Codes

I05.0 Rheumatic mitral stenosis

I06.0 Rheumatic aortic stenosis

I07.0 Rheumatic tricuspid stenosis

I07.1 Rheumatic tricuspid insufficiency

I07.2 Rheumatic tricuspid stenosis and insufficiency

I07.8 Other rheumatic tricuspid valve diseases

I07.9 Rheumatic tricuspid valve disease, unspecified

I09.81 Rheumatic heart failure

I09.89 Other specified rheumatic heart diseases

I11.0 Hypertensive heart disease with heart failure

I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease

I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease

I20.1 Angina pectoris with documented spasm

I20.8 Other forms of angina pectoris

I20.9 Angina pectoris, unspecified

I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery

I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery

I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall

I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery

I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall

I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery

I21.29 ST elevation (STEMI) myocardial infarction involving other sites

I21.A1 Myocardial infarction type 2

I21.A9 Other myocardial infarction type

I21.3 ST elevation (STEMI) myocardial infarction of unspecified site

I21.4 Non-ST elevation (NSTEMI) myocardial infarction

I21.9 Acute myocardial infarction, unspecified

I22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall

I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall

I22.2 Subsequent non-ST elevation (NSTEMI) myocardial infarction

I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites

I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site

I23.7 Postinfarction angina

I23.8 Other current complications following acute myocardial infarction

I24.8 Other forms of acute ischemic heart disease

I24.9 Acute ischemic heart disease, unspecified

I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris

I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm

I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris

I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris

I25.2 Old myocardial infarction

I25.5 Ischemic cardiomyopathy

I25.6 Silent myocardial ischemia

I25.701 Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasm

I25.708 Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris

I25.709 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectoris

I25.711 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm

I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris

I25.719 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris

I25.721 Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm

I25.728 Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris

I25.729 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectoris

I25.731 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm

I25.738 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris

I25.739 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectoris

I25.751 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm

I25.758 Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris

I25.759 Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris

I25.761 Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm

I25.768 Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris

I25.769 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectoris

I25.791 Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm

I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris

I25.799 Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectoris

I25.810 Atherosclerosis of coronary artery bypass graft(s) without angina pectoris

I25.811 Atherosclerosis of native coronary artery of transplanted heart without angina pectoris

I25.812 Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris

I25.83 Coronary atherosclerosis due to lipid rich plaque

I25.84 Coronary atherosclerosis due to calcified coronary lesion

I25.89 Other forms of chronic ischemic heart disease

I25.9 Chronic ischemic heart disease, unspecified

I34.0 Nonrheumatic mitral (valve) insufficiency

I34.1 Nonrheumatic mitral (valve) prolapse

I34.2 Nonrheumatic mitral (valve) stenosis

I34.8 Other nonrheumatic mitral valve disorders

I34.9 Nonrheumatic mitral valve disorder, unspecified

I35.0 Nonrheumatic aortic (valve) stenosis

I35.1 Nonrheumatic aortic (valve) insufficiency

I35.2 Nonrheumatic aortic (valve) stenosis with insufficiency

I35.8 Other nonrheumatic aortic valve disorders

I35.9 Nonrheumatic aortic valve disorder, unspecified

I36.0 Nonrheumatic tricuspid (valve) stenosis

I36.1 Nonrheumatic tricuspid (valve) insufficiency

I36.2 Nonrheumatic tricuspid (valve) stenosis with insufficiency

I36.8 Other nonrheumatic tricuspid valve disorders

I36.9 Nonrheumatic tricuspid valve disorder, unspecified

I37.0 Nonrheumatic pulmonary valve stenosis

I37.1 Nonrheumatic pulmonary valve insufficiency

I37.2 Nonrheumatic pulmonary valve stenosis with insufficiency

I37.8 Other nonrheumatic pulmonary valve disorders

I37.9 Nonrheumatic pulmonary valve disorder, unspecified

I42.0 Dilated cardiomyopathy

I42.2 Other hypertrophic cardiomyopathy

I42.5 Other restrictive cardiomyopathy

I42.8 Other cardiomyopathies

I42.9 Cardiomyopathy, unspecified

I50.1 Left ventricular failure, unspecified

I50.20 Unspecified systolic (congestive) heart failure

I50.21 Acute systolic (congestive) heart failure

I50.22 Chronic systolic (congestive) heart failure

I50.23 Acute on chronic systolic (congestive) heart failure

I50.30 Unspecified diastolic (congestive) heart failure

I50.31 Acute diastolic (congestive) heart failure

I50.32 Chronic diastolic (congestive) heart failure

I50.33 Acute on chronic diastolic (congestive) heart failure

I50.40 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure

I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure

I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure

I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure

I50.810 Right heart failure, unspecified

I50.811 Acute right heart failure

I50.812 Chronic right heart failure

I50.813 Acute on chronic right heart failure

I50.814 Right heart failure due to left heart failure

I50.82 Biventricular heart failure

I50.83 High output heart failure

I50.84 End stage heart failure

I50.89 Other heart failure

I50.9 Heart failure, unspecified

I51.89 Other ill-defined heart diseases

I51.9 Heart disease, unspecified

I52 Other heart disorders in diseases classified elsewhere

I97.110 Postprocedural cardiac insufficiency following cardiac surgery

I97.111 Postprocedural cardiac insufficiency following other surgery

I97.130 Postprocedural heart failure following cardiac surgery

I97.131 Postprocedural heart failure following other surgery

I97.190 Other postprocedural cardiac functional disturbances following cardiac surgery

I97.191 Other postprocedural cardiac functional disturbances following other surgery

Q20.3 Discordant ventriculoarterial connection

Q20.5 Discordant atrioventricular connection

Q20.9 Congenital malformation of cardiac chambers and connections, unspecified

Q21.3 Tetralogy of Fallot

Q24.5 Malformation of coronary vessels

Q24.9 Congenital malformation of heart, unspecified

Z48.21 Encounter for aftercare following heart transplant

Z48.280 Encounter for aftercare following heart-lung transplant

Z94.1 Heart transplant status

Z94.3 Heart and lungs transplant status

Z95.1 Presence of aortocoronary bypass graft

Z95.2 Presence of prosthetic heart valve

Z95.3 Presence of xenogenic heart valve

Z95.4 Presence of other heart-valve replacement

Z95.5 Presence of coronary angioplasty implant and graft

Z95.811 Presence of heart assist device

Z95.812 Presence of fully implantable artificial heart

Z98.61 Coronary angioplasty status

Z98.890 Other specified postprocedural states


Version Effective Date: 10/01/2017
Version Issued Date: 09/29/2017
Version Reissued Date: 09/26/2019

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