Notification Issue Date:

Policy Attachment

Attachment to Policy # 07.03.21k


Policy #:07.03.21k

Description:ICD-10-CM codes

Title:Electromyography (EMG) (Needle and Non-Needle) of the Anal or Urethral Sphincter

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-CM codes

C61 Malignant neoplasm of prostate

G04.1 Tropical spastic paraplegia

G12.20 Motor neuron disease, unspecified

G12.21 Amyotrophic lateral sclerosis

G12.22 Progressive bulbar palsy

G12.23 Primary lateral sclerosis

G12.24 Familial motor neuron disease

G12.25 Progressive spinal muscle atrophy

G12.29 Other motor neuron disease

G12.8 Other spinal muscular atrophies and related syndromes

G35 Multiple sclerosis

G81.01 Flaccid hemiplegia affecting right dominant side

G81.02 Flaccid hemiplegia affecting left dominant side

G81.03 Flaccid hemiplegia affecting right nondominant side

G81.04 Flaccid hemiplegia affecting left nondominant side

G81.11 Spastic hemiplegia affecting right dominant side

G81.12 Spastic hemiplegia affecting left dominant side

G81.13 Spastic hemiplegia affecting right nondominant side

G81.14 Spastic hemiplegia affecting left nondominant side

G81.91 Hemiplegia, unspecified affecting right dominant side

G81.92 Hemiplegia, unspecified affecting left dominant side

G81.93 Hemiplegia, unspecified affecting right nondominant side

G81.94 Hemiplegia, unspecified affecting left nondominant side

G82.20 Paraplegia, unspecified

G82.21 Paraplegia, complete

G82.22 Paraplegia, incomplete

G82.50 Quadriplegia, unspecified

G82.51 Quadriplegia, C1-C4 complete

G82.52 Quadriplegia, C1-C4 incomplete

G82.53 Quadriplegia, C5-C7 complete

G82.54 Quadriplegia, C5-C7 incomplete

G83.11 Monoplegia of lower limb affecting right dominant side

G83.12 Monoplegia of lower limb affecting left dominant side

G83.13 Monoplegia of lower limb affecting right nondominant side

G83.14 Monoplegia of lower limb affecting left nondominant side

G83.4 Cauda equina syndrome

G83.9 Paralytic syndrome, unspecified

K59.00 Constipation, unspecified

K59.01 Slow transit constipation

K59.02 Outlet dysfunction constipation

K59.09 Other constipation

K59.4 Anal spasm

K62.2 Anal prolapse

K62.3 Rectal prolapse

N31.0 Uninhibited neuropathic bladder, not elsewhere classified

N31.1 Reflex neuropathic bladder, not elsewhere classified

N31.8 Other neuromuscular dysfunction of bladder

N31.9 Neuromuscular dysfunction of bladder, unspecified

N32.0 Bladder-neck obstruction

N31.2 Flaccid neuropathic bladder, not elsewhere classified

N32.81 Overactive bladder

N35.016 Post-traumatic urethral stricture, male, overlapping sites

N35.116 Postinfective urethral stricture, not elsewhere classified, male, overlapping sites

N35.811 Other urethral stricture, male, meatal

N35.812 Other urethral bulbous stricture, male

N35.813 Other membranous urethral stricture, male

N35.814 Other anterior urethral stricture, male

N35.816 Other urethral stricture, male, overlapping sites

N35.819 Other urethral stricture, male, unspecified site

N35.82 Other urethral stricture, female

N35.911 Unspecified urethral stricture, male, meatal

N35.912 Unspecified bulbous urethral stricture, male

N35.913 Unspecified membranous urethral stricture, male

N35.914 Unspecified anterior urethral stricture, male

N35.916 Unspecified urethral stricture, male, overlapping sites

N35.919 Unspecified urethral stricture, male, unspecified site

N35.92 Unspecified urethral stricture, female

N36.41 Hypermobility of urethra

N36.42 Intrinsic sphincter deficiency (ISD)

N36.43 Combined hypermobility of urethra and intrinsic sphincter deficiency

N36.44 Muscular disorders of urethra

N36.8 Other specified disorders of urethra

N39.3 Stress incontinence (female) (male)

N39.41 Urge incontinence

N39.42 Incontinence without sensory awareness

N39.43 Post-void dribbling

N39.44 Nocturnal enuresis

N39.45 Continuous leakage

N39.46 Mixed incontinence

N39.490 Overflow incontinence

N39.498 Other specified urinary incontinence

N40.1 Benign prostatic hyperplasia with lower urinary tract symptoms

N40.3 Nodular prostate with lower urinary tract symptoms

N42.83 Cyst of prostate

N81.0 Urethrocele

N81.10 Cystocele, unspecified

N81.11 Cystocele, midline

N81.12 Cystocele, lateral

N81.2 Incomplete uterovaginal prolapse

N81.3 Complete uterovaginal prolapse

N81.4 Uterovaginal prolapse, unspecified

N81.5 Vaginal enterocele

N81.6 Rectocele

N81.81 Perineocele

N81.82 Incompetence or weakening of pubocervical tissue

N81.83 Incompetence or weakening of rectovaginal tissue

N81.84 Pelvic muscle wasting

N81.85 Cervical stump prolapse

N81.89 Other female genital prolapse

N81.9 Female genital prolapse, unspecified

N99.116 Postprocedural urethral stricture, male, overlapping site

R15.0 Incomplete defecation

R15.1 Fecal smearing

R15.2 Fecal urgency

R15.9 Full incontinence of feces

R30.0 Dysuria

R30.9 Painful micturition, unspecified

R32 Unspecified urinary incontinence

R33.8 Other retention of urine

R33.9 Retention of urine, unspecified

R35.0 Frequency of micturition

R35.1 Nocturia

R35.8 Other polyuria

R39.0 Extravasation of urine

R39.11 Hesitancy of micturition

R39.12 Poor urinary stream

R39.13 Splitting of urinary stream

R39.14 Feeling of incomplete bladder emptying

R39.15 Urgency of urination

R39.16 Straining to void

R39.191 Need to immediately re-void

R39.192 Position dependent micturition

R39.198 Other difficulties with micturition

R39.82 Chronic bladder pain

Version Effective Date: 10/01/2019
Version Issued Date: 10/02/2019
Version Reissued Date: 11/20/2019

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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.