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MA10.002f
A
MA10.002f
Medically Necessary ICD-10 Codes
Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs


​Medically Necessary 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
I20.2         Refractory angina pectoris
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
I25.112     Atherosclerosic heart disease of native coronary artery with refractory angina pectoris
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
I25.702     Atherosclerosis of coronary artery bypass graft(s), unspecified, with refractory angina pectoris
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
I25.712     Atherosclerosis of autologous vein coronary artery bypass graft(s) with refractory angina pectoris
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
I25.722     Atherosclerosis of autologous artery coronary artery bypass graft(s) with refractory angina pectoris
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
I25.732     Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with refractory angina pectoris
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
I25.752     Atherosclerosis of native coronary artery of transplanted heart with refractory angina pectoris
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
I25.762     Atherosclerosis of bypass graft of coronary artery of transplanted heart with refractory angina pectoris
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
I25.792     Atherosclerosis of other coronary artery bypass graft(s) with refractory angina pectoris
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
I34.81       Nonrheumatic mitral (valve) annulus calcification
I34.89       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
Z95.818    Presence of other cardiac implants and grafts
Z98.61      Coronary angioplasty status
Z98.890    Other specified postprocedural states

03/11/2024
03/11/2024
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Medical Policy Bulletin
Medicare Advantage
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