LCD Reference Article Billing and Coding Article

Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)

A56796

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Source Article ID
N/A
Article ID
A56796
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article Type
Billing and Coding
Original Effective Date
08/08/2019
Revision Effective Date
05/02/2022
Revision Ending Date
N/A
Retirement Date
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CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References: 

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L36007, Lower Extremity Major Joint Replacement (Hip and Knee). Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Documentation Requirements

    1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
    2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
    3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

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Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(1,210 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 27130, 27132, 27134, 27137, and 27138.

Note
: ICD-10-CM codes Z89.621, Z89.622, Z96.641, Z96.642, Z96.643, and Z96.649 are considered status codes and should not be used with a diagnosis code from one of the body system chapters, if the diagnosis code includes the information provided by the status code.

Group 1 Codes
Code Description
C40.20 Malignant neoplasm of long bones of unspecified lower limb
C40.21 Malignant neoplasm of long bones of right lower limb
C40.22 Malignant neoplasm of long bones of left lower limb
C49.20 Malignant neoplasm of connective and soft tissue of unspecified lower limb, including hip
C49.21 Malignant neoplasm of connective and soft tissue of right lower limb, including hip
C49.22 Malignant neoplasm of connective and soft tissue of left lower limb, including hip
D16.21 Benign neoplasm of long bones of right lower limb
D16.22 Benign neoplasm of long bones of left lower limb
D21.21 Benign neoplasm of connective and other soft tissue of right lower limb, including hip
D21.22 Benign neoplasm of connective and other soft tissue of left lower limb, including hip
L40.50 Arthropathic psoriasis, unspecified
L40.54 Psoriatic juvenile arthropathy
L40.59 Other psoriatic arthropathy
M05.051 Felty's syndrome, right hip
M05.052 Felty's syndrome, left hip
M05.451 Rheumatoid myopathy with rheumatoid arthritis of right hip
M05.452 Rheumatoid myopathy with rheumatoid arthritis of left hip
M05.751 Rheumatoid arthritis with rheumatoid factor of right hip without organ or systems involvement
M05.752 Rheumatoid arthritis with rheumatoid factor of left hip without organ or systems involvement
M05.851 Other rheumatoid arthritis with rheumatoid factor of right hip
M05.852 Other rheumatoid arthritis with rheumatoid factor of left hip
M06.051 Rheumatoid arthritis without rheumatoid factor, right hip
M06.052 Rheumatoid arthritis without rheumatoid factor, left hip
M07.651 Enteropathic arthropathies, right hip
M07.652 Enteropathic arthropathies, left hip
M08.051 Unspecified juvenile rheumatoid arthritis, right hip
M08.052 Unspecified juvenile rheumatoid arthritis, left hip
M08.251 Juvenile rheumatoid arthritis with systemic onset, right hip
M08.252 Juvenile rheumatoid arthritis with systemic onset, left hip
M08.3 Juvenile rheumatoid polyarthritis (seronegative)
M08.451 Pauciarticular juvenile rheumatoid arthritis, right hip
M08.452 Pauciarticular juvenile rheumatoid arthritis, left hip
M08.851 Other juvenile arthritis, right hip
M08.852 Other juvenile arthritis, left hip
M08.951 Juvenile arthritis, unspecified, right hip
M08.952 Juvenile arthritis, unspecified, left hip
M12.051 Chronic postrheumatic arthropathy [Jaccoud], right hip
M12.052 Chronic postrheumatic arthropathy [Jaccoud], left hip
M12.351 Palindromic rheumatism, right hip
M12.352 Palindromic rheumatism, left hip
M12.551 Traumatic arthropathy, right hip
M12.552 Traumatic arthropathy, left hip
M12.851 Other specific arthropathies, not elsewhere classified, right hip
M12.852 Other specific arthropathies, not elsewhere classified, left hip
M12.9 Arthropathy, unspecified
M13.0 Polyarthritis, unspecified
M13.151 Monoarthritis, not elsewhere classified, right hip
M13.152 Monoarthritis, not elsewhere classified, left hip
M16.0 Bilateral primary osteoarthritis of hip
M16.11 Unilateral primary osteoarthritis, right hip
M16.12 Unilateral primary osteoarthritis, left hip
M16.2 Bilateral osteoarthritis resulting from hip dysplasia
M16.31 Unilateral osteoarthritis resulting from hip dysplasia, right hip
M16.32 Unilateral osteoarthritis resulting from hip dysplasia, left hip
M16.4 Bilateral post-traumatic osteoarthritis of hip
M16.51 Unilateral post-traumatic osteoarthritis, right hip
M16.52 Unilateral post-traumatic osteoarthritis, left hip
M16.9 Osteoarthritis of hip, unspecified
M24.651 Ankylosis, right hip
M24.652 Ankylosis, left hip
M24.851 Other specific joint derangements of right hip, not elsewhere classified
M24.852 Other specific joint derangements of left hip, not elsewhere classified
M24.9 Joint derangement, unspecified
M25.251 Flail joint, right hip
M25.252 Flail joint, left hip
M25.351 Other instability, right hip
M25.352 Other instability, left hip
M25.551 Pain in right hip
M25.552 Pain in left hip
M25.559 Pain in unspecified hip
M80.051A - M80.051S Age-related osteoporosis with current pathological fracture, right femur, initial encounter for fracture - Age-related osteoporosis with current pathological fracture, right femur, sequela
M80.052A - M80.052S Age-related osteoporosis with current pathological fracture, left femur, initial encounter for fracture - Age-related osteoporosis with current pathological fracture, left femur, sequela
M80.061A - M80.061S Age-related osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture - Age-related osteoporosis with current pathological fracture, right lower leg, sequela
M80.062A - M80.062S Age-related osteoporosis with current pathological fracture, left lower leg, initial encounter for fracture - Age-related osteoporosis with current pathological fracture, left lower leg, sequela
M80.851A - M80.851S Other osteoporosis with current pathological fracture, right femur, initial encounter for fracture - Other osteoporosis with current pathological fracture, right femur, sequela
M80.852A - M80.852S Other osteoporosis with current pathological fracture, left femur, initial encounter for fracture - Other osteoporosis with current pathological fracture, left femur, sequela
M80.861A - M80.861S Other osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture - Other osteoporosis with current pathological fracture, right lower leg, sequela
M80.862A - M80.862S Other osteoporosis with current pathological fracture, left lower leg, initial encounter for fracture - Other osteoporosis with current pathological fracture, left lower leg, sequela
M84.351A - M84.351S Stress fracture, right femur, initial encounter for fracture - Stress fracture, right femur, sequela
M84.352A - M84.352S Stress fracture, left femur, initial encounter for fracture - Stress fracture, left femur, sequela
M84.359A - M84.359S Stress fracture, hip, unspecified, initial encounter for fracture - Stress fracture, hip, unspecified, sequela
M84.451A - M84.451S Pathological fracture, right femur, initial encounter for fracture - Pathological fracture, right femur, sequela
M84.452A - M84.452S Pathological fracture, left femur, initial encounter for fracture - Pathological fracture, left femur, sequela
M84.459A - M84.459S Pathological fracture, hip, unspecified, initial encounter for fracture - Pathological fracture, hip, unspecified, sequela
M84.551A - M84.551S Pathological fracture in neoplastic disease, right femur, initial encounter for fracture - Pathological fracture in neoplastic disease, right femur, sequela
M84.552A - M84.552S Pathological fracture in neoplastic disease, left femur, initial encounter for fracture - Pathological fracture in neoplastic disease, left femur, sequela
M84.559A - M84.559S Pathological fracture in neoplastic disease, hip, unspecified, initial encounter for fracture - Pathological fracture in neoplastic disease, hip, unspecified, sequela
M87.051 Idiopathic aseptic necrosis of right femur
M87.052 Idiopathic aseptic necrosis of left femur
M87.10 Osteonecrosis due to drugs, unspecified bone
M87.151 Osteonecrosis due to drugs, right femur
M87.152 Osteonecrosis due to drugs, left femur
M87.20 Osteonecrosis due to previous trauma, unspecified bone
M87.251 Osteonecrosis due to previous trauma, right femur
M87.252 Osteonecrosis due to previous trauma, left femur
M87.351 Other secondary osteonecrosis, right femur
M87.352 Other secondary osteonecrosis, left femur
M88.861 Osteitis deformans of right lower leg
M88.862 Osteitis deformans of left lower leg
M96.0 Pseudarthrosis after fusion or arthrodesis
M97.01XA - M97.01XS Periprosthetic fracture around internal prosthetic right hip joint, initial encounter - Periprosthetic fracture around internal prosthetic right hip joint, sequela
M97.02XA - M97.02XS Periprosthetic fracture around internal prosthetic left hip joint, initial encounter - Periprosthetic fracture around internal prosthetic left hip joint, sequela
M97.9XXA - M97.9XXS Periprosthetic fracture around unspecified internal prosthetic joint, initial encounter - Periprosthetic fracture around unspecified internal prosthetic joint, sequela
Q65.00 Congenital dislocation of unspecified hip, unilateral
Q65.01 Congenital dislocation of right hip, unilateral
Q65.02 Congenital dislocation of left hip, unilateral
Q65.1 Congenital dislocation of hip, bilateral
S32.401A - S32.401S Unspecified fracture of right acetabulum, initial encounter for closed fracture - Unspecified fracture of right acetabulum, sequela
S32.402A - S32.402S Unspecified fracture of left acetabulum, initial encounter for closed fracture - Unspecified fracture of left acetabulum, sequela
S32.411A - S32.411S Displaced fracture of anterior wall of right acetabulum, initial encounter for closed fracture - Displaced fracture of anterior wall of right acetabulum, sequela
S32.412A - S32.412S Displaced fracture of anterior wall of left acetabulum, initial encounter for closed fracture - Displaced fracture of anterior wall of left acetabulum, sequela
S32.414A - S32.414S Nondisplaced fracture of anterior wall of right acetabulum, initial encounter for closed fracture - Nondisplaced fracture of anterior wall of right acetabulum, sequela
S32.415A - S32.415S Nondisplaced fracture of anterior wall of left acetabulum, initial encounter for closed fracture - Nondisplaced fracture of anterior wall of left acetabulum, sequela
S32.421A - S32.421S Displaced fracture of posterior wall of right acetabulum, initial encounter for closed fracture - Displaced fracture of posterior wall of right acetabulum, sequela
S32.422A - S32.422S Displaced fracture of posterior wall of left acetabulum, initial encounter for closed fracture - Displaced fracture of posterior wall of left acetabulum, sequela
S32.424A - S32.424S Nondisplaced fracture of posterior wall of right acetabulum, initial encounter for closed fracture - Nondisplaced fracture of posterior wall of right acetabulum, sequela
S32.425A - S32.425S Nondisplaced fracture of posterior wall of left acetabulum, initial encounter for closed fracture - Nondisplaced fracture of posterior wall of left acetabulum, sequela
S32.431A - S32.431S Displaced fracture of anterior column [iliopubic] of right acetabulum, initial encounter for closed fracture - Displaced fracture of anterior column [iliopubic] of right acetabulum, sequela
S32.432A - S32.432S Displaced fracture of anterior column [iliopubic] of left acetabulum, initial encounter for closed fracture - Displaced fracture of anterior column [iliopubic] of left acetabulum, sequela
S32.434A - S32.434S Nondisplaced fracture of anterior column [iliopubic] of right acetabulum, initial encounter for closed fracture - Nondisplaced fracture of anterior column [iliopubic] of right acetabulum, sequela
S32.435A - S32.435S Nondisplaced fracture of anterior column [iliopubic] of left acetabulum, initial encounter for closed fracture - Nondisplaced fracture of anterior column [iliopubic] of left acetabulum, sequela
S32.441A - S32.441S Displaced fracture of posterior column [ilioischial] of right acetabulum, initial encounter for closed fracture - Displaced fracture of posterior column [ilioischial] of right acetabulum, sequela
S32.442A - S32.442S Displaced fracture of posterior column [ilioischial] of left acetabulum, initial encounter for closed fracture - Displaced fracture of posterior column [ilioischial] of left acetabulum, sequela
S32.444A - S32.444S Nondisplaced fracture of posterior column [ilioischial] of right acetabulum, initial encounter for closed fracture - Nondisplaced fracture of posterior column [ilioischial] of right acetabulum, sequela
S32.445A - S32.445S Nondisplaced fracture of posterior column [ilioischial] of left acetabulum, initial encounter for closed fracture - Nondisplaced fracture of posterior column [ilioischial] of left acetabulum, sequela
S32.451A - S32.451S Displaced transverse fracture of right acetabulum, initial encounter for closed fracture - Displaced transverse fracture of right acetabulum, sequela
S32.452A - S32.452S Displaced transverse fracture of left acetabulum, initial encounter for closed fracture - Displaced transverse fracture of left acetabulum, sequela
S32.454A - S32.454S Nondisplaced transverse fracture of right acetabulum, initial encounter for closed fracture - Nondisplaced transverse fracture of right acetabulum, sequela
S32.455A - S32.455S Nondisplaced transverse fracture of left acetabulum, initial encounter for closed fracture - Nondisplaced transverse fracture of left acetabulum, sequela
S32.461A - S32.461S Displaced associated transverse-posterior fracture of right acetabulum, initial encounter for closed fracture - Displaced associated transverse-posterior fracture of right acetabulum, sequela
S32.462A - S32.462S Displaced associated transverse-posterior fracture of left acetabulum, initial encounter for closed fracture - Displaced associated transverse-posterior fracture of left acetabulum, sequela
S32.464A - S32.464S Nondisplaced associated transverse-posterior fracture of right acetabulum, initial encounter for closed fracture - Nondisplaced associated transverse-posterior fracture of right acetabulum, sequela
S32.465A - S32.465S Nondisplaced associated transverse-posterior fracture of left acetabulum, initial encounter for closed fracture - Nondisplaced associated transverse-posterior fracture of left acetabulum, sequela
S32.471A - S32.471S Displaced fracture of medial wall of right acetabulum, initial encounter for closed fracture - Displaced fracture of medial wall of right acetabulum, sequela
S32.472A - S32.472S Displaced fracture of medial wall of left acetabulum, initial encounter for closed fracture - Displaced fracture of medial wall of left acetabulum, sequela
S32.474A - S32.474S Nondisplaced fracture of medial wall of right acetabulum, initial encounter for closed fracture - Nondisplaced fracture of medial wall of right acetabulum, sequela
S32.475A - S32.475S Nondisplaced fracture of medial wall of left acetabulum, initial encounter for closed fracture - Nondisplaced fracture of medial wall of left acetabulum, sequela
S32.481A - S32.481S Displaced dome fracture of right acetabulum, initial encounter for closed fracture - Displaced dome fracture of right acetabulum, sequela
S32.482A - S32.482S Displaced dome fracture of left acetabulum, initial encounter for closed fracture - Displaced dome fracture of left acetabulum, sequela
S32.484A - S32.484S Nondisplaced dome fracture of right acetabulum, initial encounter for closed fracture - Nondisplaced dome fracture of right acetabulum, sequela
S32.485A - S32.485S Nondisplaced dome fracture of left acetabulum, initial encounter for closed fracture - Nondisplaced dome fracture of left acetabulum, sequela
S32.491A - S32.491S Other specified fracture of right acetabulum, initial encounter for closed fracture - Other specified fracture of right acetabulum, sequela
S32.492A - S32.492S Other specified fracture of left acetabulum, initial encounter for closed fracture - Other specified fracture of left acetabulum, sequela
S72.001A Fracture of unspecified part of neck of right femur, initial encounter for closed fracture
S72.001C Fracture of unspecified part of neck of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.001D Fracture of unspecified part of neck of right femur, subsequent encounter for closed fracture with routine healing
S72.001E Fracture of unspecified part of neck of right femur, subsequent encounter for open fracture type I or II with routine healing
S72.001F Fracture of unspecified part of neck of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.001G Fracture of unspecified part of neck of right femur, subsequent encounter for closed fracture with delayed healing
S72.001H Fracture of unspecified part of neck of right femur, subsequent encounter for open fracture type I or II with delayed healing
S72.001J Fracture of unspecified part of neck of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.001K Fracture of unspecified part of neck of right femur, subsequent encounter for closed fracture with nonunion
S72.001M Fracture of unspecified part of neck of right femur, subsequent encounter for open fracture type I or II with nonunion
S72.001N Fracture of unspecified part of neck of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.001P Fracture of unspecified part of neck of right femur, subsequent encounter for closed fracture with malunion
S72.001Q Fracture of unspecified part of neck of right femur, subsequent encounter for open fracture type I or II with malunion
S72.001R Fracture of unspecified part of neck of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.001S Fracture of unspecified part of neck of right femur, sequela
S72.002A Fracture of unspecified part of neck of left femur, initial encounter for closed fracture
S72.002C Fracture of unspecified part of neck of left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.002D Fracture of unspecified part of neck of left femur, subsequent encounter for closed fracture with routine healing
S72.002E Fracture of unspecified part of neck of left femur, subsequent encounter for open fracture type I or II with routine healing
S72.002F Fracture of unspecified part of neck of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.002G Fracture of unspecified part of neck of left femur, subsequent encounter for closed fracture with delayed healing
S72.002H Fracture of unspecified part of neck of left femur, subsequent encounter for open fracture type I or II with delayed healing
S72.002J Fracture of unspecified part of neck of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.002K Fracture of unspecified part of neck of left femur, subsequent encounter for closed fracture with nonunion
S72.002M Fracture of unspecified part of neck of left femur, subsequent encounter for open fracture type I or II with nonunion
S72.002N Fracture of unspecified part of neck of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.002P Fracture of unspecified part of neck of left femur, subsequent encounter for closed fracture with malunion
S72.002Q Fracture of unspecified part of neck of left femur, subsequent encounter for open fracture type I or II with malunion
S72.002R Fracture of unspecified part of neck of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.002S Fracture of unspecified part of neck of left femur, sequela
S72.011A Unspecified intracapsular fracture of right femur, initial encounter for closed fracture
S72.011C Unspecified intracapsular fracture of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.011D Unspecified intracapsular fracture of right femur, subsequent encounter for closed fracture with routine healing
S72.011E Unspecified intracapsular fracture of right femur, subsequent encounter for open fracture type I or II with routine healing
S72.011F Unspecified intracapsular fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.011G Unspecified intracapsular fracture of right femur, subsequent encounter for closed fracture with delayed healing
S72.011H Unspecified intracapsular fracture of right femur, subsequent encounter for open fracture type I or II with delayed healing
S72.011J Unspecified intracapsular fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.011K Unspecified intracapsular fracture of right femur, subsequent encounter for closed fracture with nonunion
S72.011M Unspecified intracapsular fracture of right femur, subsequent encounter for open fracture type I or II with nonunion
S72.011N Unspecified intracapsular fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.011P Unspecified intracapsular fracture of right femur, subsequent encounter for closed fracture with malunion
S72.011Q Unspecified intracapsular fracture of right femur, subsequent encounter for open fracture type I or II with malunion
S72.011R Unspecified intracapsular fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.011S Unspecified intracapsular fracture of right femur, sequela
S72.012A Unspecified intracapsular fracture of left femur, initial encounter for closed fracture
S72.012C Unspecified intracapsular fracture of left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.012D Unspecified intracapsular fracture of left femur, subsequent encounter for closed fracture with routine healing
S72.012E Unspecified intracapsular fracture of left femur, subsequent encounter for open fracture type I or II with routine healing
S72.012F Unspecified intracapsular fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.012G Unspecified intracapsular fracture of left femur, subsequent encounter for closed fracture with delayed healing
S72.012H Unspecified intracapsular fracture of left femur, subsequent encounter for open fracture type I or II with delayed healing
S72.012J Unspecified intracapsular fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.012K Unspecified intracapsular fracture of left femur, subsequent encounter for closed fracture with nonunion
S72.012M Unspecified intracapsular fracture of left femur, subsequent encounter for open fracture type I or II with nonunion
S72.012N Unspecified intracapsular fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.012P Unspecified intracapsular fracture of left femur, subsequent encounter for closed fracture with malunion
S72.012Q Unspecified intracapsular fracture of left femur, subsequent encounter for open fracture type I or II with malunion
S72.012R Unspecified intracapsular fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.012S Unspecified intracapsular fracture of left femur, sequela
S72.021A Displaced fracture of epiphysis (separation) (upper) of right femur, initial encounter for closed fracture
S72.021C Displaced fracture of epiphysis (separation) (upper) of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.021D Displaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for closed fracture with routine healing
S72.021E Displaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for open fracture type I or II with routine healing
S72.021F Displaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.021G Displaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for closed fracture with delayed healing
S72.021H Displaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for open fracture type I or II with delayed healing
S72.021J Displaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.021K Displaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for closed fracture with nonunion
S72.021M Displaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for open fracture type I or II with nonunion
S72.021N Displaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.021P Displaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for closed fracture with malunion
S72.021Q Displaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for open fracture type I or II with malunion
S72.021R Displaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.021S Displaced fracture of epiphysis (separation) (upper) of right femur, sequela
S72.022A Displaced fracture of epiphysis (separation) (upper) of left femur, initial encounter for closed fracture
S72.022C Displaced fracture of epiphysis (separation) (upper) of left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.022D Displaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for closed fracture with routine healing
S72.022E Displaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for open fracture type I or II with routine healing
S72.022F Displaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.022G Displaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for closed fracture with delayed healing
S72.022H Displaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for open fracture type I or II with delayed healing
S72.022J Displaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.022K Displaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for closed fracture with nonunion
S72.022M Displaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for open fracture type I or II with nonunion
S72.022N Displaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.022P Displaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for closed fracture with malunion
S72.022Q Displaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for open fracture type I or II with malunion
S72.022R Displaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.022S Displaced fracture of epiphysis (separation) (upper) of left femur, sequela
S72.024A Nondisplaced fracture of epiphysis (separation) (upper) of right femur, initial encounter for closed fracture
S72.024C Nondisplaced fracture of epiphysis (separation) (upper) of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.024D Nondisplaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for closed fracture with routine healing
S72.024E Nondisplaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for open fracture type I or II with routine healing
S72.024F Nondisplaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.024G Nondisplaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for closed fracture with delayed healing
S72.024H Nondisplaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for open fracture type I or II with delayed healing
S72.024J Nondisplaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.024K Nondisplaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for closed fracture with nonunion
S72.024M Nondisplaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for open fracture type I or II with nonunion
S72.024N Nondisplaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.024P Nondisplaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for closed fracture with malunion
S72.024Q Nondisplaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for open fracture type I or II with malunion
S72.024R Nondisplaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.024S Nondisplaced fracture of epiphysis (separation) (upper) of right femur, sequela
S72.025A Nondisplaced fracture of epiphysis (separation) (upper) of left femur, initial encounter for closed fracture
S72.025C Nondisplaced fracture of epiphysis (separation) (upper) of left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.025D Nondisplaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for closed fracture with routine healing
S72.025E Nondisplaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for open fracture type I or II with routine healing
S72.025F Nondisplaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.025G Nondisplaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for closed fracture with delayed healing
S72.025H Nondisplaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for open fracture type I or II with delayed healing
S72.025J Nondisplaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.025K Nondisplaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for closed fracture with nonunion
S72.025M Nondisplaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for open fracture type I or II with nonunion
S72.025N Nondisplaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.025P Nondisplaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for closed fracture with malunion
S72.025Q Nondisplaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for open fracture type I or II with malunion
S72.025R Nondisplaced fracture of epiphysis (separation) (upper) of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.025S Nondisplaced fracture of epiphysis (separation) (upper) of left femur, sequela
S72.031A Displaced midcervical fracture of right femur, initial encounter for closed fracture
S72.031C Displaced midcervical fracture of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.031D Displaced midcervical fracture of right femur, subsequent encounter for closed fracture with routine healing
S72.031E Displaced midcervical fracture of right femur, subsequent encounter for open fracture type I or II with routine healing
S72.031F Displaced midcervical fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.031G Displaced midcervical fracture of right femur, subsequent encounter for closed fracture with delayed healing
S72.031H Displaced midcervical fracture of right femur, subsequent encounter for open fracture type I or II with delayed healing
S72.031J Displaced midcervical fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.031K Displaced midcervical fracture of right femur, subsequent encounter for closed fracture with nonunion
S72.031M Displaced midcervical fracture of right femur, subsequent encounter for open fracture type I or II with nonunion
S72.031N Displaced midcervical fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.031P Displaced midcervical fracture of right femur, subsequent encounter for closed fracture with malunion
S72.031Q Displaced midcervical fracture of right femur, subsequent encounter for open fracture type I or II with malunion
S72.031R Displaced midcervical fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.031S Displaced midcervical fracture of right femur, sequela
S72.032A Displaced midcervical fracture of left femur, initial encounter for closed fracture
S72.032C Displaced midcervical fracture of left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.032D Displaced midcervical fracture of left femur, subsequent encounter for closed fracture with routine healing
S72.032E Displaced midcervical fracture of left femur, subsequent encounter for open fracture type I or II with routine healing
S72.032F Displaced midcervical fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.032G Displaced midcervical fracture of left femur, subsequent encounter for closed fracture with delayed healing
S72.032H Displaced midcervical fracture of left femur, subsequent encounter for open fracture type I or II with delayed healing
S72.032J Displaced midcervical fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.032K Displaced midcervical fracture of left femur, subsequent encounter for closed fracture with nonunion
S72.032M Displaced midcervical fracture of left femur, subsequent encounter for open fracture type I or II with nonunion
S72.032N Displaced midcervical fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.032P Displaced midcervical fracture of left femur, subsequent encounter for closed fracture with malunion
S72.032Q Displaced midcervical fracture of left femur, subsequent encounter for open fracture type I or II with malunion
S72.032R Displaced midcervical fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.032S Displaced midcervical fracture of left femur, sequela
S72.034A Nondisplaced midcervical fracture of right femur, initial encounter for closed fracture
S72.034C Nondisplaced midcervical fracture of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.034D Nondisplaced midcervical fracture of right femur, subsequent encounter for closed fracture with routine healing
S72.034E Nondisplaced midcervical fracture of right femur, subsequent encounter for open fracture type I or II with routine healing
S72.034F Nondisplaced midcervical fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.034G Nondisplaced midcervical fracture of right femur, subsequent encounter for closed fracture with delayed healing
S72.034H Nondisplaced midcervical fracture of right femur, subsequent encounter for open fracture type I or II with delayed healing
S72.034J Nondisplaced midcervical fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.034K Nondisplaced midcervical fracture of right femur, subsequent encounter for closed fracture with nonunion
S72.034M Nondisplaced midcervical fracture of right femur, subsequent encounter for open fracture type I or II with nonunion
S72.034N Nondisplaced midcervical fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.034P Nondisplaced midcervical fracture of right femur, subsequent encounter for closed fracture with malunion
S72.034Q Nondisplaced midcervical fracture of right femur, subsequent encounter for open fracture type I or II with malunion
S72.034R Nondisplaced midcervical fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.034S Nondisplaced midcervical fracture of right femur, sequela
S72.035A Nondisplaced midcervical fracture of left femur, initial encounter for closed fracture
S72.035C Nondisplaced midcervical fracture of left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.035D Nondisplaced midcervical fracture of left femur, subsequent encounter for closed fracture with routine healing
S72.035E Nondisplaced midcervical fracture of left femur, subsequent encounter for open fracture type I or II with routine healing
S72.035F Nondisplaced midcervical fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.035G Nondisplaced midcervical fracture of left femur, subsequent encounter for closed fracture with delayed healing
S72.035H Nondisplaced midcervical fracture of left femur, subsequent encounter for open fracture type I or II with delayed healing
S72.035J Nondisplaced midcervical fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.035K Nondisplaced midcervical fracture of left femur, subsequent encounter for closed fracture with nonunion
S72.035M Nondisplaced midcervical fracture of left femur, subsequent encounter for open fracture type I or II with nonunion
S72.035N Nondisplaced midcervical fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.035P Nondisplaced midcervical fracture of left femur, subsequent encounter for closed fracture with malunion
S72.035Q Nondisplaced midcervical fracture of left femur, subsequent encounter for open fracture type I or II with malunion
S72.035R Nondisplaced midcervical fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.035S Nondisplaced midcervical fracture of left femur, sequela
S72.041A Displaced fracture of base of neck of right femur, initial encounter for closed fracture
S72.041C Displaced fracture of base of neck of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.041D Displaced fracture of base of neck of right femur, subsequent encounter for closed fracture with routine healing
S72.041E Displaced fracture of base of neck of right femur, subsequent encounter for open fracture type I or II with routine healing
S72.041F Displaced fracture of base of neck of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.041G Displaced fracture of base of neck of right femur, subsequent encounter for closed fracture with delayed healing
S72.041H Displaced fracture of base of neck of right femur, subsequent encounter for open fracture type I or II with delayed healing
S72.041J Displaced fracture of base of neck of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.041K Displaced fracture of base of neck of right femur, subsequent encounter for closed fracture with nonunion
S72.041M Displaced fracture of base of neck of right femur, subsequent encounter for open fracture type I or II with nonunion
S72.041N Displaced fracture of base of neck of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.041P Displaced fracture of base of neck of right femur, subsequent encounter for closed fracture with malunion
S72.041Q Displaced fracture of base of neck of right femur, subsequent encounter for open fracture type I or II with malunion
S72.041R Displaced fracture of base of neck of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.041S Displaced fracture of base of neck of right femur, sequela
S72.042A Displaced fracture of base of neck of left femur, initial encounter for closed fracture
S72.042C Displaced fracture of base of neck of left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.042D Displaced fracture of base of neck of left femur, subsequent encounter for closed fracture with routine healing
S72.042E Displaced fracture of base of neck of left femur, subsequent encounter for open fracture type I or II with routine healing
S72.042F Displaced fracture of base of neck of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.042G Displaced fracture of base of neck of left femur, subsequent encounter for closed fracture with delayed healing
S72.042H Displaced fracture of base of neck of left femur, subsequent encounter for open fracture type I or II with delayed healing
S72.042J Displaced fracture of base of neck of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.042K Displaced fracture of base of neck of left femur, subsequent encounter for closed fracture with nonunion
S72.042M Displaced fracture of base of neck of left femur, subsequent encounter for open fracture type I or II with nonunion
S72.042N Displaced fracture of base of neck of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.042P Displaced fracture of base of neck of left femur, subsequent encounter for closed fracture with malunion
S72.042Q Displaced fracture of base of neck of left femur, subsequent encounter for open fracture type I or II with malunion
S72.042R Displaced fracture of base of neck of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.042S Displaced fracture of base of neck of left femur, sequela
S72.044A Nondisplaced fracture of base of neck of right femur, initial encounter for closed fracture
S72.044C Nondisplaced fracture of base of neck of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.044D Nondisplaced fracture of base of neck of right femur, subsequent encounter for closed fracture with routine healing
S72.044E Nondisplaced fracture of base of neck of right femur, subsequent encounter for open fracture type I or II with routine healing
S72.044F Nondisplaced fracture of base of neck of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.044G Nondisplaced fracture of base of neck of right femur, subsequent encounter for closed fracture with delayed healing
S72.044H Nondisplaced fracture of base of neck of right femur, subsequent encounter for open fracture type I or II with delayed healing
S72.044J Nondisplaced fracture of base of neck of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.044K Nondisplaced fracture of base of neck of right femur, subsequent encounter for closed fracture with nonunion
S72.044M Nondisplaced fracture of base of neck of right femur, subsequent encounter for open fracture type I or II with nonunion
S72.044N Nondisplaced fracture of base of neck of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.044P Nondisplaced fracture of base of neck of right femur, subsequent encounter for closed fracture with malunion
S72.044Q Nondisplaced fracture of base of neck of right femur, subsequent encounter for open fracture type I or II with malunion
S72.044R Nondisplaced fracture of base of neck of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.044S Nondisplaced fracture of base of neck of right femur, sequela
S72.045A Nondisplaced fracture of base of neck of left femur, initial encounter for closed fracture
S72.045C Nondisplaced fracture of base of neck of left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.045D Nondisplaced fracture of base of neck of left femur, subsequent encounter for closed fracture with routine healing
S72.045E Nondisplaced fracture of base of neck of left femur, subsequent encounter for open fracture type I or II with routine healing
S72.045F Nondisplaced fracture of base of neck of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.045G Nondisplaced fracture of base of neck of left femur, subsequent encounter for closed fracture with delayed healing
S72.045H Nondisplaced fracture of base of neck of left femur, subsequent encounter for open fracture type I or II with delayed healing
S72.045J Nondisplaced fracture of base of neck of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.045K Nondisplaced fracture of base of neck of left femur, subsequent encounter for closed fracture with nonunion
S72.045M Nondisplaced fracture of base of neck of left femur, subsequent encounter for open fracture type I or II with nonunion
S72.045N Nondisplaced fracture of base of neck of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.045P Nondisplaced fracture of base of neck of left femur, subsequent encounter for closed fracture with malunion
S72.045Q Nondisplaced fracture of base of neck of left femur, subsequent encounter for open fracture type I or II with malunion
S72.045R Nondisplaced fracture of base of neck of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.045S Nondisplaced fracture of base of neck of left femur, sequela
S72.051A Unspecified fracture of head of right femur, initial encounter for closed fracture
S72.051C Unspecified fracture of head of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.051D Unspecified fracture of head of right femur, subsequent encounter for closed fracture with routine healing
S72.051E Unspecified fracture of head of right femur, subsequent encounter for open fracture type I or II with routine healing
S72.051F Unspecified fracture of head of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.051G Unspecified fracture of head of right femur, subsequent encounter for closed fracture with delayed healing
S72.051H Unspecified fracture of head of right femur, subsequent encounter for open fracture type I or II with delayed healing
S72.051J Unspecified fracture of head of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.051K Unspecified fracture of head of right femur, subsequent encounter for closed fracture with nonunion
S72.051M Unspecified fracture of head of right femur, subsequent encounter for open fracture type I or II with nonunion
S72.051N Unspecified fracture of head of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.051P Unspecified fracture of head of right femur, subsequent encounter for closed fracture with malunion
S72.051Q Unspecified fracture of head of right femur, subsequent encounter for open fracture type I or II with malunion
S72.051R Unspecified fracture of head of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.051S Unspecified fracture of head of right femur, sequela
S72.052A Unspecified fracture of head of left femur, initial encounter for closed fracture
S72.052C Unspecified fracture of head of left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.052D Unspecified fracture of head of left femur, subsequent encounter for closed fracture with routine healing
S72.052E Unspecified fracture of head of left femur, subsequent encounter for open fracture type I or II with routine healing
S72.052F Unspecified fracture of head of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.052G Unspecified fracture of head of left femur, subsequent encounter for closed fracture with delayed healing
S72.052H Unspecified fracture of head of left femur, subsequent encounter for open fracture type I or II with delayed healing
S72.052J Unspecified fracture of head of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.052K Unspecified fracture of head of left femur, subsequent encounter for closed fracture with nonunion
S72.052M Unspecified fracture of head of left femur, subsequent encounter for open fracture type I or II with nonunion
S72.052N Unspecified fracture of head of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.052P Unspecified fracture of head of left femur, subsequent encounter for closed fracture with malunion
S72.052Q Unspecified fracture of head of left femur, subsequent encounter for open fracture type I or II with malunion
S72.052R Unspecified fracture of head of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.052S Unspecified fracture of head of left femur, sequela
S72.061A Displaced articular fracture of head of right femur, initial encounter for closed fracture
S72.061C Displaced articular fracture of head of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.061D Displaced articular fracture of head of right femur, subsequent encounter for closed fracture with routine healing
S72.061E Displaced articular fracture of head of right femur, subsequent encounter for open fracture type I or II with routine healing
S72.061F Displaced articular fracture of head of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.061G Displaced articular fracture of head of right femur, subsequent encounter for closed fracture with delayed healing
S72.061H Displaced articular fracture of head of right femur, subsequent encounter for open fracture type I or II with delayed healing
S72.061J Displaced articular fracture of head of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.061K Displaced articular fracture of head of right femur, subsequent encounter for closed fracture with nonunion
S72.061M Displaced articular fracture of head of right femur, subsequent encounter for open fracture type I or II with nonunion
S72.061N Displaced articular fracture of head of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.061P Displaced articular fracture of head of right femur, subsequent encounter for closed fracture with malunion
S72.061Q Displaced articular fracture of head of right femur, subsequent encounter for open fracture type I or II with malunion
S72.061R Displaced articular fracture of head of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.061S Displaced articular fracture of head of right femur, sequela
S72.062A Displaced articular fracture of head of left femur, initial encounter for closed fracture
S72.062C Displaced articular fracture of head of left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.062D Displaced articular fracture of head of left femur, subsequent encounter for closed fracture with routine healing
S72.062E Displaced articular fracture of head of left femur, subsequent encounter for open fracture type I or II with routine healing
S72.062F Displaced articular fracture of head of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.062G Displaced articular fracture of head of left femur, subsequent encounter for closed fracture with delayed healing
S72.062H Displaced articular fracture of head of left femur, subsequent encounter for open fracture type I or II with delayed healing
S72.062J Displaced articular fracture of head of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.062K Displaced articular fracture of head of left femur, subsequent encounter for closed fracture with nonunion
S72.062M Displaced articular fracture of head of left femur, subsequent encounter for open fracture type I or II with nonunion
S72.062N Displaced articular fracture of head of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.062P Displaced articular fracture of head of left femur, subsequent encounter for closed fracture with malunion
S72.062Q Displaced articular fracture of head of left femur, subsequent encounter for open fracture type I or II with malunion
S72.062R Displaced articular fracture of head of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.062S Displaced articular fracture of head of left femur, sequela
S72.064A Nondisplaced articular fracture of head of right femur, initial encounter for closed fracture
S72.064C Nondisplaced articular fracture of head of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.064D Nondisplaced articular fracture of head of right femur, subsequent encounter for closed fracture with routine healing
S72.064E Nondisplaced articular fracture of head of right femur, subsequent encounter for open fracture type I or II with routine healing
S72.064F Nondisplaced articular fracture of head of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.064G Nondisplaced articular fracture of head of right femur, subsequent encounter for closed fracture with delayed healing
S72.064H Nondisplaced articular fracture of head of right femur, subsequent encounter for open fracture type I or II with delayed healing
S72.064J Nondisplaced articular fracture of head of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.064K Nondisplaced articular fracture of head of right femur, subsequent encounter for closed fracture with nonunion
S72.064M Nondisplaced articular fracture of head of right femur, subsequent encounter for open fracture type I or II with nonunion
S72.064N Nondisplaced articular fracture of head of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.064P Nondisplaced articular fracture of head of right femur, subsequent encounter for closed fracture with malunion
S72.064Q Nondisplaced articular fracture of head of right femur, subsequent encounter for open fracture type I or II with malunion
S72.064R Nondisplaced articular fracture of head of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.064S Nondisplaced articular fracture of head of right femur, sequela
S72.065A Nondisplaced articular fracture of head of left femur, initial encounter for closed fracture
S72.065C Nondisplaced articular fracture of head of left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.065D Nondisplaced articular fracture of head of left femur, subsequent encounter for closed fracture with routine healing
S72.065E Nondisplaced articular fracture of head of left femur, subsequent encounter for open fracture type I or II with routine healing
S72.065F Nondisplaced articular fracture of head of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.065G Nondisplaced articular fracture of head of left femur, subsequent encounter for closed fracture with delayed healing
S72.065H Nondisplaced articular fracture of head of left femur, subsequent encounter for open fracture type I or II with delayed healing
S72.065J Nondisplaced articular fracture of head of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.065K Nondisplaced articular fracture of head of left femur, subsequent encounter for closed fracture with nonunion
S72.065M Nondisplaced articular fracture of head of left femur, subsequent encounter for open fracture type I or II with nonunion
S72.065N Nondisplaced articular fracture of head of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.065P Nondisplaced articular fracture of head of left femur, subsequent encounter for closed fracture with malunion
S72.065Q Nondisplaced articular fracture of head of left femur, subsequent encounter for open fracture type I or II with malunion
S72.065R Nondisplaced articular fracture of head of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.065S Nondisplaced articular fracture of head of left femur, sequela
S72.091A Other fracture of head and neck of right femur, initial encounter for closed fracture
S72.091B Other fracture of head and neck of right femur, initial encounter for open fracture type I or II
S72.091C Other fracture of head and neck of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.091D Other fracture of head and neck of right femur, subsequent encounter for closed fracture with routine healing
S72.091E Other fracture of head and neck of right femur, subsequent encounter for open fracture type I or II with routine healing
S72.091F Other fracture of head and neck of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.091G Other fracture of head and neck of right femur, subsequent encounter for closed fracture with delayed healing
S72.091H Other fracture of head and neck of right femur, subsequent encounter for open fracture type I or II with delayed healing
S72.091J Other fracture of head and neck of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.091K Other fracture of head and neck of right femur, subsequent encounter for closed fracture with nonunion
S72.091M Other fracture of head and neck of right femur, subsequent encounter for open fracture type I or II with nonunion
S72.091N Other fracture of head and neck of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.091P Other fracture of head and neck of right femur, subsequent encounter for closed fracture with malunion
S72.091Q Other fracture of head and neck of right femur, subsequent encounter for open fracture type I or II with malunion
S72.091R Other fracture of head and neck of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.091S Other fracture of head and neck of right femur, sequela
S72.092A - S72.092S Other fracture of head and neck of left femur, initial encounter for closed fracture - Other fracture of head and neck of left femur, sequela
S72.101A - S72.101S Unspecified trochanteric fracture of right femur, initial encounter for closed fracture - Unspecified trochanteric fracture of right femur, sequela
S72.102A - S72.102S Unspecified trochanteric fracture of left femur, initial encounter for closed fracture - Unspecified trochanteric fracture of left femur, sequela
S72.111A - S72.111S Displaced fracture of greater trochanter of right femur, initial encounter for closed fracture - Displaced fracture of greater trochanter of right femur, sequela
S72.112A - S72.112S Displaced fracture of greater trochanter of left femur, initial encounter for closed fracture - Displaced fracture of greater trochanter of left femur, sequela
S72.114A - S72.114S Nondisplaced fracture of greater trochanter of right femur, initial encounter for closed fracture - Nondisplaced fracture of greater trochanter of right femur, sequela
S72.115A - S72.115S Nondisplaced fracture of greater trochanter of left femur, initial encounter for closed fracture - Nondisplaced fracture of greater trochanter of left femur, sequela
S72.121A - S72.121S Displaced fracture of lesser trochanter of right femur, initial encounter for closed fracture - Displaced fracture of lesser trochanter of right femur, sequela
S72.122A - S72.122S Displaced fracture of lesser trochanter of left femur, initial encounter for closed fracture - Displaced fracture of lesser trochanter of left femur, sequela
S72.124A - S72.124S Nondisplaced fracture of lesser trochanter of right femur, initial encounter for closed fracture - Nondisplaced fracture of lesser trochanter of right femur, sequela
S72.125A - S72.125S Nondisplaced fracture of lesser trochanter of left femur, initial encounter for closed fracture - Nondisplaced fracture of lesser trochanter of left femur, sequela
S72.131A - S72.131S Displaced apophyseal fracture of right femur, initial encounter for closed fracture - Displaced apophyseal fracture of right femur, sequela
S72.132A - S72.132S Displaced apophyseal fracture of left femur, initial encounter for closed fracture - Displaced apophyseal fracture of left femur, sequela
S72.134A - S72.134S Nondisplaced apophyseal fracture of right femur, initial encounter for closed fracture - Nondisplaced apophyseal fracture of right femur, sequela
S72.135A - S72.135S Nondisplaced apophyseal fracture of left femur, initial encounter for closed fracture - Nondisplaced apophyseal fracture of left femur, sequela
S72.141A - S72.141S Displaced intertrochanteric fracture of right femur, initial encounter for closed fracture - Displaced intertrochanteric fracture of right femur, sequela
S72.142A - S72.142S Displaced intertrochanteric fracture of left femur, initial encounter for closed fracture - Displaced intertrochanteric fracture of left femur, sequela
S72.144A - S72.144S Nondisplaced intertrochanteric fracture of right femur, initial encounter for closed fracture - Nondisplaced intertrochanteric fracture of right femur, sequela
S72.145A - S72.145S Nondisplaced intertrochanteric fracture of left femur, initial encounter for closed fracture - Nondisplaced intertrochanteric fracture of left femur, sequela
S72.21XA - S72.21XS Displaced subtrochanteric fracture of right femur, initial encounter for closed fracture - Displaced subtrochanteric fracture of right femur, sequela
S72.22XA - S72.22XS Displaced subtrochanteric fracture of left femur, initial encounter for closed fracture - Displaced subtrochanteric fracture of left femur, sequela
S72.24XA - S72.24XS Nondisplaced subtrochanteric fracture of right femur, initial encounter for closed fracture - Nondisplaced subtrochanteric fracture of right femur, sequela
S72.25XA - S72.25XS Nondisplaced subtrochanteric fracture of left femur, initial encounter for closed fracture - Nondisplaced subtrochanteric fracture of left femur, sequela
S79.001A - S79.001S Unspecified physeal fracture of upper end of right femur, initial encounter for closed fracture - Unspecified physeal fracture of upper end of right femur, sequela
S79.002A - S79.002S Unspecified physeal fracture of upper end of left femur, initial encounter for closed fracture - Unspecified physeal fracture of upper end of left femur, sequela
S79.011A - S79.011S Salter-Harris Type I physeal fracture of upper end of right femur, initial encounter for closed fracture - Salter-Harris Type I physeal fracture of upper end of right femur, sequela
S79.012A - S79.012S Salter-Harris Type I physeal fracture of upper end of left femur, initial encounter for closed fracture - Salter-Harris Type I physeal fracture of upper end of left femur, sequela
T84.010A - T84.010S Broken internal right hip prosthesis, initial encounter - Broken internal right hip prosthesis, sequela
T84.011A - T84.011S Broken internal left hip prosthesis, initial encounter - Broken internal left hip prosthesis, sequela
T84.020A - T84.020S Dislocation of internal right hip prosthesis, initial encounter - Dislocation of internal right hip prosthesis, sequela
T84.021A - T84.021S Dislocation of internal left hip prosthesis, initial encounter - Dislocation of internal left hip prosthesis, sequela
T84.030A - T84.030S Mechanical loosening of internal right hip prosthetic joint, initial encounter - Mechanical loosening of internal right hip prosthetic joint, sequela
T84.031A - T84.031S Mechanical loosening of internal left hip prosthetic joint, initial encounter - Mechanical loosening of internal left hip prosthetic joint, sequela
T84.050A - T84.050S Periprosthetic osteolysis of internal prosthetic right hip joint, initial encounter - Periprosthetic osteolysis of internal prosthetic right hip joint, sequela
T84.051A - T84.051S Periprosthetic osteolysis of internal prosthetic left hip joint, initial encounter - Periprosthetic osteolysis of internal prosthetic left hip joint, sequela
T84.060A - T84.060S Wear of articular bearing surface of internal prosthetic right hip joint, initial encounter - Wear of articular bearing surface of internal prosthetic right hip joint, sequela
T84.061A - T84.061S Wear of articular bearing surface of internal prosthetic left hip joint, initial encounter - Wear of articular bearing surface of internal prosthetic left hip joint, sequela
T84.090A - T84.090S Other mechanical complication of internal right hip prosthesis, initial encounter - Other mechanical complication of internal right hip prosthesis, sequela
T84.091A - T84.091S Other mechanical complication of internal left hip prosthesis, initial encounter - Other mechanical complication of internal left hip prosthesis, sequela
T84.114A Breakdown (mechanical) of internal fixation device of right femur, initial encounter
T84.114D Breakdown (mechanical) of internal fixation device of right femur, subsequent encounter
T84.114S Breakdown (mechanical) of internal fixation device of right femur, sequela
T84.115A Breakdown (mechanical) of internal fixation device of left femur, initial encounter
T84.115D Breakdown (mechanical) of internal fixation device of left femur, subsequent encounter
T84.115S Breakdown (mechanical) of internal fixation device of left femur, sequela
T84.498A - T84.498S Other mechanical complication of other internal orthopedic devices, implants and grafts, initial encounter - Other mechanical complication of other internal orthopedic devices, implants and grafts, sequela
T84.51XA - T84.51XS Infection and inflammatory reaction due to internal right hip prosthesis, initial encounter - Infection and inflammatory reaction due to internal right hip prosthesis, sequela
T84.52XA - T84.52XS Infection and inflammatory reaction due to internal left hip prosthesis, initial encounter - Infection and inflammatory reaction due to internal left hip prosthesis, sequela
Z47.32 Aftercare following explantation of hip joint prosthesis
Z89.621 Acquired absence of right hip joint
Z89.622 Acquired absence of left hip joint
Z96.641 Presence of right artificial hip joint
Z96.642 Presence of left artificial hip joint
Z96.643 Presence of artificial hip joint, bilateral
Z96.649 Presence of unspecified artificial hip joint

Group 2

(161 Codes)
Group 2 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 27445, 27447, 27486, and 27487.

Note: ICD-10-CM codes Z89.521, Z89.522, Z96.651, Z96.652, Z96.653 and Z96.659 are considered status codes and should not be used with a diagnosis code from one of the body system chapters, if the diagnosis code includes the information provided by the status code.

Group 2 Codes
Code Description
C40.20 Malignant neoplasm of long bones of unspecified lower limb
C40.21 Malignant neoplasm of long bones of right lower limb
C40.22 Malignant neoplasm of long bones of left lower limb
D16.20 Benign neoplasm of long bones of unspecified lower limb
D16.21 Benign neoplasm of long bones of right lower limb
D16.22 Benign neoplasm of long bones of left lower limb
L40.50 Arthropathic psoriasis, unspecified
L40.54 Psoriatic juvenile arthropathy
M05.00 Felty's syndrome, unspecified site
M05.061 Felty's syndrome, right knee
M05.062 Felty's syndrome, left knee
M05.069 Felty's syndrome, unspecified knee
M05.09 Felty's syndrome, multiple sites
M05.40 Rheumatoid myopathy with rheumatoid arthritis of unspecified site
M05.461 Rheumatoid myopathy with rheumatoid arthritis of right knee
M05.462 Rheumatoid myopathy with rheumatoid arthritis of left knee
M05.469 Rheumatoid myopathy with rheumatoid arthritis of unspecified knee
M05.50 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified site
M05.561 Rheumatoid polyneuropathy with rheumatoid arthritis of right knee
M05.562 Rheumatoid polyneuropathy with rheumatoid arthritis of left knee
M05.569 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified knee
M05.70 Rheumatoid arthritis with rheumatoid factor of unspecified site without organ or systems involvement
M05.761 Rheumatoid arthritis with rheumatoid factor of right knee without organ or systems involvement
M05.762 Rheumatoid arthritis with rheumatoid factor of left knee without organ or systems involvement
M05.769 Rheumatoid arthritis with rheumatoid factor of unspecified knee without organ or systems involvement
M05.80 Other rheumatoid arthritis with rheumatoid factor of unspecified site
M05.861 Other rheumatoid arthritis with rheumatoid factor of right knee
M05.862 Other rheumatoid arthritis with rheumatoid factor of left knee
M05.869 Other rheumatoid arthritis with rheumatoid factor of unspecified knee
M05.9 Rheumatoid arthritis with rheumatoid factor, unspecified
M06.00 Rheumatoid arthritis without rheumatoid factor, unspecified site
M06.061 Rheumatoid arthritis without rheumatoid factor, right knee
M06.062 Rheumatoid arthritis without rheumatoid factor, left knee
M06.069 Rheumatoid arthritis without rheumatoid factor, unspecified knee
M06.9 Rheumatoid arthritis, unspecified
M08.261 Juvenile rheumatoid arthritis with systemic onset, right knee
M08.262 Juvenile rheumatoid arthritis with systemic onset, left knee
M08.461 Pauciarticular juvenile rheumatoid arthritis, right knee
M08.462 Pauciarticular juvenile rheumatoid arthritis, left knee
M08.861 Other juvenile arthritis, right knee
M08.862 Other juvenile arthritis, left knee
M08.961 Juvenile arthritis, unspecified, right knee
M08.962 Juvenile arthritis, unspecified, left knee
M12.00 Chronic postrheumatic arthropathy [Jaccoud], unspecified site
M12.061 Chronic postrheumatic arthropathy [Jaccoud], right knee
M12.062 Chronic postrheumatic arthropathy [Jaccoud], left knee
M12.069 Chronic postrheumatic arthropathy [Jaccoud], unspecified knee
M12.561 Traumatic arthropathy, right knee
M12.562 Traumatic arthropathy, left knee
M12.569 Traumatic arthropathy, unspecified knee
M17.0 Bilateral primary osteoarthritis of knee
M17.10 Unilateral primary osteoarthritis, unspecified knee
M17.11 Unilateral primary osteoarthritis, right knee
M17.12 Unilateral primary osteoarthritis, left knee
M17.2 Bilateral post-traumatic osteoarthritis of knee
M17.30 Unilateral post-traumatic osteoarthritis, unspecified knee
M17.31 Unilateral post-traumatic osteoarthritis, right knee
M17.32 Unilateral post-traumatic osteoarthritis, left knee
M17.9 Osteoarthritis of knee, unspecified
M23.50 Chronic instability of knee, unspecified knee
M23.51 Chronic instability of knee, right knee
M23.52 Chronic instability of knee, left knee
M24.661 Ankylosis, right knee
M24.662 Ankylosis, left knee
M24.669 Ankylosis, unspecified knee
M25.261 Flail joint, right knee
M25.262 Flail joint, left knee
M25.269 Flail joint, unspecified knee
M25.561 Pain in right knee
M25.562 Pain in left knee
M25.569 Pain in unspecified knee
M25.9 Joint disorder, unspecified
M87.051 Idiopathic aseptic necrosis of right femur
M87.052 Idiopathic aseptic necrosis of left femur
M87.059 Idiopathic aseptic necrosis of unspecified femur
M96.0 Pseudarthrosis after fusion or arthrodesis
M97.11XA - M97.11XS Periprosthetic fracture around internal prosthetic right knee joint, initial encounter - Periprosthetic fracture around internal prosthetic right knee joint, sequela
M97.12XA - M97.12XS Periprosthetic fracture around internal prosthetic left knee joint, initial encounter - Periprosthetic fracture around internal prosthetic left knee joint, sequela
M97.9XXA - M97.9XXS Periprosthetic fracture around unspecified internal prosthetic joint, initial encounter - Periprosthetic fracture around unspecified internal prosthetic joint, sequela
T84.012A - T84.012S Broken internal right knee prosthesis, initial encounter - Broken internal right knee prosthesis, sequela
T84.013A - T84.013S Broken internal left knee prosthesis, initial encounter - Broken internal left knee prosthesis, sequela
T84.019A - T84.019S Broken internal joint prosthesis, unspecified site, initial encounter - Broken internal joint prosthesis, unspecified site, sequela
T84.022A - T84.022S Instability of internal right knee prosthesis, initial encounter - Instability of internal right knee prosthesis, sequela
T84.023A - T84.023S Instability of internal left knee prosthesis, initial encounter - Instability of internal left knee prosthesis, sequela
T84.029A - T84.029S Dislocation of unspecified internal joint prosthesis, initial encounter - Dislocation of unspecified internal joint prosthesis, sequela
T84.032A - T84.032S Mechanical loosening of internal right knee prosthetic joint, initial encounter - Mechanical loosening of internal right knee prosthetic joint, sequela
T84.033A - T84.033S Mechanical loosening of internal left knee prosthetic joint, initial encounter - Mechanical loosening of internal left knee prosthetic joint, sequela
T84.039A - T84.039S Mechanical loosening of unspecified internal prosthetic joint, initial encounter - Mechanical loosening of unspecified internal prosthetic joint, sequela
T84.052A - T84.052S Periprosthetic osteolysis of internal prosthetic right knee joint, initial encounter - Periprosthetic osteolysis of internal prosthetic right knee joint, sequela
T84.053A - T84.053S Periprosthetic osteolysis of internal prosthetic left knee joint, initial encounter - Periprosthetic osteolysis of internal prosthetic left knee joint, sequela
T84.059A - T84.059S Periprosthetic osteolysis of unspecified internal prosthetic joint, initial encounter - Periprosthetic osteolysis of unspecified internal prosthetic joint, sequela
T84.062A - T84.062S Wear of articular bearing surface of internal prosthetic right knee joint, initial encounter - Wear of articular bearing surface of internal prosthetic right knee joint, sequela
T84.063A - T84.063S Wear of articular bearing surface of internal prosthetic left knee joint, initial encounter - Wear of articular bearing surface of internal prosthetic left knee joint, sequela
T84.069A - T84.069S Wear of articular bearing surface of unspecified internal prosthetic joint, initial encounter - Wear of articular bearing surface of unspecified internal prosthetic joint, sequela
T84.092A - T84.092S Other mechanical complication of internal right knee prosthesis, initial encounter - Other mechanical complication of internal right knee prosthesis, sequela
T84.093A - T84.093S Other mechanical complication of internal left knee prosthesis, initial encounter - Other mechanical complication of internal left knee prosthesis, sequela
T84.099A - T84.099S Other mechanical complication of unspecified internal joint prosthesis, initial encounter - Other mechanical complication of unspecified internal joint prosthesis, sequela
T84.428A - T84.428S Displacement of other internal orthopedic devices, implants and grafts, initial encounter - Displacement of other internal orthopedic devices, implants and grafts, sequela
T84.498A - T84.498S Other mechanical complication of other internal orthopedic devices, implants and grafts, initial encounter - Other mechanical complication of other internal orthopedic devices, implants and grafts, sequela
T84.50XA - T84.50XS Infection and inflammatory reaction due to unspecified internal joint prosthesis, initial encounter - Infection and inflammatory reaction due to unspecified internal joint prosthesis, sequela
T84.53XA - T84.53XS Infection and inflammatory reaction due to internal right knee prosthesis, initial encounter - Infection and inflammatory reaction due to internal right knee prosthesis, sequela
T84.54XA - T84.54XS Infection and inflammatory reaction due to internal left knee prosthesis, initial encounter - Infection and inflammatory reaction due to internal left knee prosthesis, sequela
Z47.33 Aftercare following explantation of knee joint prosthesis
Z89.521 Acquired absence of right knee
Z89.522 Acquired absence of left knee
Z96.651 Presence of right artificial knee joint
Z96.652 Presence of left artificial knee joint
Z96.653 Presence of artificial knee joint, bilateral
Z96.659 Presence of unspecified artificial knee joint
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the "ICD-10 Codes that Support Medical Necessity" section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

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Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

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N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
05/02/2022 R2

Article revised and published on 06/23/2022 effective for dates of service on and after 05/02/2022 in response to an inquiry. ICD-10 codes T84.114A, T84.114D, T84.114S, T84.115A, T84.115D, and T84.115S were added to ICD-10-CM Code group 1. In addition, reference to the Social Security Act has been added to ‘CMS National Coverage Policy’. Coding guidance and documentation requirements have been added to the section titled ‘Article Guidance’ and minor changes to formatting have been made throughout the article.

11/14/2019 R1

Due to system changes the order of the Coding Section has been revised and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Public Versions
Updated On Effective Dates Status
06/17/2022 05/02/2022 - N/A Currently in Effect You are here
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Keywords

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