Notification



Notification Issue Date:



Policy Attachment


Attachment to Policy # 07.03.18o


Attachment:C

Policy #:07.03.18o

Description:ICD-10 Codes

Title:Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies


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 FOLLOWING CODES REPRESENT INDICATIONS THAT SUPPORT MEDICAL NECESSITY
ICD-10 Code Narrative
G62.0Drug-induced polyneuropathy
G62.1Alcoholic polyneuropathy
G62.2Polyneuropathy due to other toxic agents
G62.81Critical illness polyneuropathy
G62.82Radiation-induced polyneuropathy
G62.89Other specified polyneuropathies
G63Polyneuropathy in diseases classified elsewhere
G64Other disorders of peripheral nervous system
G65.0Sequelae of Guillain-Barre syndrome
G65.1Sequelae of other inflammatory polyneuropathy
G65.2Sequelae of toxic polyneuropathy
G70.00Myasthenia gravis without (acute) exacerbation
G70.01Myasthenia gravis with (acute) exacerbation
G70.1Toxic myoneural disorders
G70.2Congenital and developmental myasthenia
G70.80Lambert-Eaton syndrome, unspecified
G70.81Lambert-Eaton syndrome in disease classified elsewhere
G70.89Other specified myoneural disorders
G70.9Myoneural disorder, unspecified
G71.00Muscular dystrophy, unspecified
G71.01Duchenne or Becker muscular dystrophy
G71.02Facioscapulohumeral muscular dystrophy
G71.09Other specified muscular dystrophies
G71.11Myotonic muscular dystrophy
G71.12Myotonia congenita
G71.13Myotonic chondrodystrophy
G71.14Drug induced myotonia
G71.19Other specified myotonic disorders
G71.2Congenital myopathies
G71.3Mitochondrial myopathy, not elsewhere classified
G71.8Other primary disorders of muscles
G71.9Primary disorder of muscle, unspecified
G72.0Drug-induced myopathy
G72.1Alcoholic myopathy
G72.2Myopathy due to other toxic agents
G72.3Periodic paralysis
G72.41Inclusion body myositis [IBM]
G72.49Other inflammatory and immune myopathies, not elsewhere classified
G72.81Critical illness myopathy
G72.89Other specified myopathies
G72.9Myopathy, unspecified
G73.1Lambert-Eaton syndrome in neoplastic disease
G73.3Myasthenic syndromes in other diseases classified elsewhere
G73.7Myopathy in diseases classified elsewhere
G80.0Spastic quadriplegic cerebral palsy
G80.1Spastic diplegic cerebral palsy
G80.2Spastic hemiplegic cerebral palsy
G80.3Athetoid cerebral palsy
G80.4Ataxic cerebral palsy
G80.8Other cerebral palsy
G80.9Cerebral palsy, unspecified
G81.00Flaccid hemiplegia affecting unspecified side
G81.01Flaccid hemiplegia affecting right dominant side
G81.02Flaccid hemiplegia affecting left dominant side
G81.03Flaccid hemiplegia affecting right nondominant side
G81.04Flaccid hemiplegia affecting left nondominant side
G81.10Spastic hemiplegia affecting unspecified side
G81.11Spastic hemiplegia affecting right dominant side
G81.12Spastic hemiplegia affecting left dominant side
G81.13Spastic hemiplegia affecting right nondominant side
G81.14Spastic hemiplegia affecting left nondominant side
G81.90Hemiplegia, unspecified affecting unspecified side
G81.91Hemiplegia, unspecified affecting right dominant side
G81.92Hemiplegia, unspecified affecting left dominant side
G81.93Hemiplegia, unspecified affecting right nondominant side
G81.94Hemiplegia, unspecified affecting left nondominant side
G82.20Paraplegia, unspecified
G82.21Paraplegia, complete
G82.22Paraplegia, incomplete
G82.50Quadriplegia, unspecified
G82.51Quadriplegia, C1-C4 complete
G82.52Quadriplegia, C1-C4 incomplete
G82.53Quadriplegia, C5-C7 complete
G82.54Quadriplegia, C5-C7 incomplete
G83.0Diplegia of upper limbs
G83.10Monoplegia of lower limb affecting unspecified side
G83.11Monoplegia of lower limb affecting right dominant side
G83.12Monoplegia of lower limb affecting left dominant side
G83.13Monoplegia of lower limb affecting right nondominant side
G83.14Monoplegia of lower limb affecting left nondominant side
G83.20Monoplegia of upper limb affecting unspecified side
G83.21Monoplegia of upper limb affecting right dominant side
G83.22Monoplegia of upper limb affecting left dominant side
G83.23Monoplegia of upper limb affecting right nondominant side
G83.24Monoplegia of upper limb affecting left nondominant side
G83.30Monoplegia, unspecified affecting unspecified side
G83.31Monoplegia, unspecified affecting right dominant side
G83.32Monoplegia, unspecified affecting left dominant side
G83.33Monoplegia, unspecified affecting right nondominant side
G83.34Monoplegia, unspecified affecting left nondominant side
G83.4Cauda equina syndrome
G83.5Locked-in state
G83.81Brown-Sequard syndrome
G83.82Anterior cord syndrome
G83.83Posterior cord syndrome
G83.84Todd's paralysis (postepileptic)
G83.89Other specified paralytic syndromes
G83.9Paralytic syndrome, unspecified
G90.01Carotid sinus syncope
G90.09Other idiopathic peripheral autonomic neuropathy
G90.2Horner's syndrome
G90.4Autonomic dysreflexia
G90.50Complex regional pain syndrome I, unspecified
G90.511Complex regional pain syndrome I of right upper limb
G90.512Complex regional pain syndrome I of left upper limb
G90.513Complex regional pain syndrome I of upper limb, bilateral
G90.519Complex regional pain syndrome I of unspecified upper limb
G90.521Complex regional pain syndrome I of right lower limb
G90.522Complex regional pain syndrome I of left lower limb
G90.523Complex regional pain syndrome I of lower limb, bilateral
G90.529Complex regional pain syndrome I of unspecified lower limb
G90.59Complex regional pain syndrome I of other specified site
G90.8Other disorders of autonomic nervous system
G90.9Disorder of the autonomic nervous system, unspecified
G93.3Postviral fatigue syndrome
G93.5Compression of brain
G95.0Syringomyelia and syringobulbia
G95.11Acute infarction of spinal cord (embolic) (nonembolic)
G95.19Other vascular myelopathies
G95.20Unspecified cord compression
G95.29Other cord compression
G95.81Conus medullaris syndrome
G95.89Other specified diseases of spinal cord
G95.9Disease of spinal cord, unspecified
G99.0Autonomic neuropathy in diseases classified elsewhere
G99.2Myelopathy in diseases classified elsewhere
H02.141Spastic ectropion of right upper eyelid
H02.142Spastic ectropion of right lower eyelid
H02.143Spastic ectropion of right eye, unspecified eyelid
H02.144Spastic ectropion of left upper eyelid
H02.145Spastic ectropion of left lower eyelid
H02.146Spastic ectropion of left eye, unspecified eyelid
H02.149Spastic ectropion of unspecified eye, unspecified eyelid
H02.151Paralytic ectropion of right upper eyelid
H02.152Paralytic ectropion of right lower eyelid
H02.153Paralytic ectropion of right eye, unspecified eyelid
H02.154Paralytic ectropion of left upper eyelid
H02.155Paralytic ectropion of left eye lower eyelid
H02.156Paralytic ectropion of left eye, unspecified eyelid
H02.159Paralytic ectropion of unspecified eye, unspecified eyelid
H49.00Third [oculomotor] nerve palsy, unspecified eye
H49.01Third [oculomotor] nerve palsy, right eye
H49.02Third [oculomotor] nerve palsy, left eye
H49.03Third [oculomotor] nerve palsy, bilateral
H49.10Fourth [trochlear] nerve palsy, unspecified eye
H49.11Fourth [trochlear] nerve palsy, right eye
H49.12Fourth [trochlear] nerve palsy, left eye
H49.13Fourth [trochlear] nerve palsy, bilateral
H49.20Sixth [abducent] nerve palsy, unspecified eye
H49.21Sixth [abducent] nerve palsy, right eye
H49.22Sixth [abducent] nerve palsy, left eye
H49.23Sixth [abducent] nerve palsy, bilateral
H49.30Total (external) ophthalmoplegia, unspecified eye
H49.31Total (external) ophthalmoplegia, right eye
H49.32Total (external) ophthalmoplegia, left eye
H49.33Total (external) ophthalmoplegia, bilateral
H49.40Progressive external ophthalmoplegia, unspecified eye
H49.41Progressive external ophthalmoplegia, right eye
H49.42Progressive external ophthalmoplegia, left eye
H49.43Progressive external ophthalmoplegia, bilateral
H49.881Other paralytic strabismus, right eye
H49.882Other paralytic strabismus, left eye
H49.883Other paralytic strabismus, bilateral
H49.889Other paralytic strabismus, unspecified eye
H49.9Unspecified paralytic strabismus
H50.00Unspecified esotropia
H50.011Monocular esotropia, right eye
H50.012Monocular esotropia, left eye
H50.021Monocular esotropia with A pattern, right eye
H50.022Monocular esotropia with A pattern, left eye
H50.031Monocular esotropia with V pattern, right eye
H50.032Monocular esotropia with V pattern, left eye
H50.041Monocular esotropia with other noncomitancies, right eye
H50.042Monocular esotropia with other noncomitancies, left eye
H50.05Alternating esotropia
H50.06Alternating esotropia with A pattern
H50.07Alternating esotropia with V pattern
H50.08Alternating esotropia with other noncomitancies
H50.10Unspecified exotropia
H50.111Monocular exotropia, right eye
H50.112Monocular exotropia, left eye
H50.121Monocular exotropia with A pattern, right eye
H50.122Monocular exotropia with A pattern, left eye
H50.131Monocular exotropia with V pattern, right eye
H50.132Monocular exotropia with V pattern, left eye
H50.141Monocular exotropia with other noncomitancies, right eye
H50.142Monocular exotropia with other noncomitancies, left eye
H50.15Alternating exotropia
H50.16Alternating exotropia with A pattern
H50.17Alternating exotropia with V pattern
H50.18Alternating exotropia with other noncomitancies
H50.21Vertical strabismus, right eye
H50.22Vertical strabismus, left eye
H50.30Unspecified intermittent heterotropia
H50.311Intermittent monocular esotropia, right eye
H50.312Intermittent monocular esotropia, left eye
H50.32Intermittent alternating esotropia
H50.331Intermittent monocular exotropia, right eye
H50.332Intermittent monocular exotropia, left eye
H50.34Intermittent alternating exotropia
H50.40Unspecified heterotropia
H50.411Cyclotropia, right eye
H50.412Cyclotropia, left eye
H50.42Monofixation syndrome
H50.43Accommodative component in esotropia
H50.50Unspecified heterophoria
H50.51Esophoria
H50.52Exophoria
H50.53Vertical heterophoria
H50.54Cyclophoria
H50.55Alternating heterophoria
H50.60Mechanical strabismus, unspecified
H50.611Brown's sheath syndrome, right eye
H50.612Brown's sheath syndrome, left eye
H50.69Other mechanical strabismus
H50.811Duane's syndrome, right eye
H50.812Duane's syndrome, left eye
H50.89Other specified strabismus
H50.9Unspecified strabismus
H51.0Palsy (spasm) of conjugate gaze
H51.11Convergence insufficiency
H51.12Convergence excess
H51.20Internuclear ophthalmoplegia, unspecified eye
H51.21Internuclear ophthalmoplegia, right eye
H51.22Internuclear ophthalmoplegia, left eye
H51.23Internuclear ophthalmoplegia, bilateral
H51.8Other specified disorders of binocular movement
H51.9Unspecified disorder of binocular movement
I60.00Nontraumatic subarachnoid hemorrhage from unspecified carotid siphon and bifurcation
I60.01Nontraumatic subarachnoid hemorrhage from right carotid siphon and bifurcation
I60.02Nontraumatic subarachnoid hemorrhage from left carotid siphon and bifurcation
I60.10Nontraumatic subarachnoid hemorrhage from unspecified middle cerebral artery
I60.11Nontraumatic subarachnoid hemorrhage from right middle cerebral artery
I60.12Nontraumatic subarachnoid hemorrhage from left middle cerebral artery
I60.30Nontraumatic subarachnoid hemorrhage from unspecified posterior communicating artery
I60.31Nontraumatic subarachnoid hemorrhage from right posterior communicating artery
I60.32Nontraumatic subarachnoid hemorrhage from left posterior communicating artery
I60.4Nontraumatic subarachnoid hemorrhage from basilar artery
I60.50Nontraumatic subarachnoid hemorrhage from unspecified vertebral artery
I60.51Nontraumatic subarachnoid hemorrhage from right vertebral artery
I60.52Nontraumatic subarachnoid hemorrhage from left vertebral artery
I60.6Nontraumatic subarachnoid hemorrhage from other intracranial arteries
I60.7Nontraumatic subarachnoid hemorrhage from unspecified intracranial artery
I60.8Other nontraumatic subarachnoid hemorrhage
I60.9Nontraumatic subarachnoid hemorrhage, unspecified
I65.21Occlusion and stenosis of right carotid artery
I65.22Occlusion and stenosis of left carotid artery
I65.23Occlusion and stenosis of bilateral carotid arteries
I65.29Occlusion and stenosis of unspecified carotid artery
I67.1Cerebral aneurysm, nonruptured
I69.033Monoplegia of upper limb following nontraumatic subarachnoid hemorrhage affecting right non-dominant side
I69.034Monoplegia of upper limb following nontraumatic subarachnoid hemorrhage affecting left non-dominant side
I69.041Monoplegia of lower limb following nontraumatic subarachnoid hemorrhage affecting right dominant side


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

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