LCD Reference Article Billing and Coding Article

Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

A57063

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Draft Article
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
A57063
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
10/01/2023
Revision Ending Date
N/A
Retirement Date
N/A

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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) L33583 Diagnostic and Therapeutic Esophagogastroduodenoscopy. 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.
  4. The patient’s medical record (e.g., history and physical, office/progress notes, procedure report) maintained by the ordering/referring physician must clearly indicate the reason for the Esophagogastroduodenoscopy (EGD). Also, the results of the EGD must be included in the patient’s medical record. 

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(795 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: 43233, 43235, 43236, 43237, 43238, 43239, 43241, 43243, 43244, 43245, 43246, 43247, 43248, 43249, 43250, 43251, 43253, 43254, 43255, 43266, and 43270.

Group 1 Codes
Code Description
B25.2 Cytomegaloviral pancreatitis
B37.81 Candidal esophagitis
C15.3 Malignant neoplasm of upper third of esophagus
C15.4 Malignant neoplasm of middle third of esophagus
C15.5 Malignant neoplasm of lower third of esophagus
C15.8 Malignant neoplasm of overlapping sites of esophagus
C15.9 Malignant neoplasm of esophagus, unspecified
C16.0 Malignant neoplasm of cardia
C16.1 Malignant neoplasm of fundus of stomach
C16.2 Malignant neoplasm of body of stomach
C16.3 Malignant neoplasm of pyloric antrum
C16.4 Malignant neoplasm of pylorus
C16.5 Malignant neoplasm of lesser curvature of stomach, unspecified
C16.6 Malignant neoplasm of greater curvature of stomach, unspecified
C16.8 Malignant neoplasm of overlapping sites of stomach
C16.9 Malignant neoplasm of stomach, unspecified
C17.0 Malignant neoplasm of duodenum
C17.1 Malignant neoplasm of jejunum
C17.2 Malignant neoplasm of ileum
C17.3 Meckel's diverticulum, malignant
C17.8 Malignant neoplasm of overlapping sites of small intestine
C17.9 Malignant neoplasm of small intestine, unspecified
C22.0 Liver cell carcinoma
C22.2 Hepatoblastoma
C22.3 Angiosarcoma of liver
C22.4 Other sarcomas of liver
C22.7 Other specified carcinomas of liver
C22.8 Malignant neoplasm of liver, primary, unspecified as to type
C23 Malignant neoplasm of gallbladder
C24.0 Malignant neoplasm of extrahepatic bile duct
C24.1 Malignant neoplasm of ampulla of Vater
C24.8 Malignant neoplasm of overlapping sites of biliary tract
C24.9 Malignant neoplasm of biliary tract, unspecified
C25.0 Malignant neoplasm of head of pancreas
C25.1 Malignant neoplasm of body of pancreas
C25.2 Malignant neoplasm of tail of pancreas
C25.3 Malignant neoplasm of pancreatic duct
C25.4 Malignant neoplasm of endocrine pancreas
C25.7 Malignant neoplasm of other parts of pancreas
C25.8 Malignant neoplasm of overlapping sites of pancreas
C25.9 Malignant neoplasm of pancreas, unspecified
C26.9 Malignant neoplasm of ill-defined sites within the digestive system
C46.4 Kaposi's sarcoma of gastrointestinal sites
C49.A0 Gastrointestinal stromal tumor, unspecified site
C49.A1 Gastrointestinal stromal tumor of esophagus
C49.A2 Gastrointestinal stromal tumor of stomach
C49.A3 Gastrointestinal stromal tumor of small intestine
C49.A9 Gastrointestinal stromal tumor of other sites
C7A.092 Malignant carcinoid tumor of the stomach
C78.4 Secondary malignant neoplasm of small intestine
C78.6 Secondary malignant neoplasm of retroperitoneum and peritoneum
C79.89 Secondary malignant neoplasm of other specified sites
C79.9 Secondary malignant neoplasm of unspecified site
C82.50 Diffuse follicle center lymphoma, unspecified site
C82.59 Diffuse follicle center lymphoma, extranodal and solid organ sites
C84.A0 Cutaneous T-cell lymphoma, unspecified, unspecified site
C84.A9 Cutaneous T-cell lymphoma, unspecified, extranodal and solid organ sites
C84.Z0 Other mature T/NK-cell lymphomas, unspecified site
C84.Z9 Other mature T/NK-cell lymphomas, extranodal and solid organ sites
C84.90 Mature T/NK-cell lymphomas, unspecified, unspecified site
C84.99 Mature T/NK-cell lymphomas, unspecified, extranodal and solid organ sites
C85.10 Unspecified B-cell lymphoma, unspecified site
C85.19 Unspecified B-cell lymphoma, extranodal and solid organ sites
C85.20 Mediastinal (thymic) large B-cell lymphoma, unspecified site
C85.29 Mediastinal (thymic) large B-cell lymphoma, extranodal and solid organ sites
C85.80 Other specified types of non-Hodgkin lymphoma, unspecified site
C85.89 Other specified types of non-Hodgkin lymphoma, extranodal and solid organ sites
C85.90 Non-Hodgkin lymphoma, unspecified, unspecified site
C85.99 Non-Hodgkin lymphoma, unspecified, extranodal and solid organ sites
C86.4 Blastic NK-cell lymphoma
C88.4 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma]
D00.1 Carcinoma in situ of esophagus
D00.2 Carcinoma in situ of stomach
D01.0 Carcinoma in situ of colon
D01.1 Carcinoma in situ of rectosigmoid junction
D01.2 Carcinoma in situ of rectum
D01.3 Carcinoma in situ of anus and anal canal
D01.40 Carcinoma in situ of unspecified part of intestine
D01.49 Carcinoma in situ of other parts of intestine
D01.5 Carcinoma in situ of liver, gallbladder and bile ducts
D12.0 Benign neoplasm of cecum
D12.1 Benign neoplasm of appendix
D12.2 Benign neoplasm of ascending colon
D12.3 Benign neoplasm of transverse colon
D12.4 Benign neoplasm of descending colon
D12.5 Benign neoplasm of sigmoid colon
D12.6 Benign neoplasm of colon, unspecified
D12.7 Benign neoplasm of rectosigmoid junction
D12.8 Benign neoplasm of rectum
D12.9 Benign neoplasm of anus and anal canal
D13.0 Benign neoplasm of esophagus
D13.1 Benign neoplasm of stomach
D13.2 Benign neoplasm of duodenum
D13.30 Benign neoplasm of unspecified part of small intestine
D13.39 Benign neoplasm of other parts of small intestine
D13.4 Benign neoplasm of liver
D13.5 Benign neoplasm of extrahepatic bile ducts
D13.6 Benign neoplasm of pancreas
D13.7 Benign neoplasm of endocrine pancreas
D13.91 Familial adenomatous polyposis
D13.99 Benign neoplasm of ill-defined sites within the digestive system
D17.5 Benign lipomatous neoplasm of intra-abdominal organs
D17.71 Benign lipomatous neoplasm of kidney
D17.9 Benign lipomatous neoplasm, unspecified
D18.03 Hemangioma of intra-abdominal structures
D19.1 Benign neoplasm of mesothelial tissue of peritoneum
D20.0 Benign neoplasm of soft tissue of retroperitoneum
D20.1 Benign neoplasm of soft tissue of peritoneum
D37.1 Neoplasm of uncertain behavior of stomach
D37.2 Neoplasm of uncertain behavior of small intestine
D37.3 Neoplasm of uncertain behavior of appendix
D37.4 Neoplasm of uncertain behavior of colon
D37.5 Neoplasm of uncertain behavior of rectum
D37.6 Neoplasm of uncertain behavior of liver, gallbladder and bile ducts
D48.3 Neoplasm of uncertain behavior of retroperitoneum
D48.4 Neoplasm of uncertain behavior of peritoneum
D49.0 Neoplasm of unspecified behavior of digestive system
D50.0 Iron deficiency anemia secondary to blood loss (chronic)
D50.1 Sideropenic dysphagia
D50.8 Other iron deficiency anemias
D50.9 Iron deficiency anemia, unspecified
D62 Acute posthemorrhagic anemia
E10.43 Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy
E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy
E13.43 Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy
E16.4 Increased secretion of gastrin
E16.9 Disorder of pancreatic internal secretion, unspecified
E41 Nutritional marasmus
E44.0 Moderate protein-calorie malnutrition
E44.1 Mild protein-calorie malnutrition
E45 Retarded development following protein-calorie malnutrition
E46 Unspecified protein-calorie malnutrition
E64.0 Sequelae of protein-calorie malnutrition
F44.4 Conversion disorder with motor symptom or deficit
F44.5 Conversion disorder with seizures or convulsions
F44.6 Conversion disorder with sensory symptom or deficit
F44.7 Conversion disorder with mixed symptom presentation
F45.8 Other somatoform disorders
F50.00 Anorexia nervosa, unspecified
F50.01 Anorexia nervosa, restricting type
F50.02 Anorexia nervosa, binge eating/purging type
F50.2 Bulimia nervosa
F50.81 Binge eating disorder
F50.82 Avoidant/restrictive food intake disorder
F50.89 Other specified eating disorder
F50.9 Eating disorder, unspecified
F98.21 Rumination disorder of infancy
F98.3 Pica of infancy and childhood
I69.091 Dysphagia following nontraumatic subarachnoid hemorrhage
I69.191 Dysphagia following nontraumatic intracerebral hemorrhage
I69.291 Dysphagia following other nontraumatic intracranial hemorrhage
I69.391 Dysphagia following cerebral infarction
I69.891 Dysphagia following other cerebrovascular disease
I69.991 Dysphagia following unspecified cerebrovascular disease
I77.2 Rupture of artery
I78.0 Hereditary hemorrhagic telangiectasia
I85.00 Esophageal varices without bleeding
I85.01 Esophageal varices with bleeding
I85.10 Secondary esophageal varices without bleeding
I85.11 Secondary esophageal varices with bleeding
J69.0 Pneumonitis due to inhalation of food and vomit
J86.0 Pyothorax with fistula
K20.0 Eosinophilic esophagitis
K20.80 Other esophagitis without bleeding
K20.81 Other esophagitis with bleeding
K20.90 Esophagitis, unspecified without bleeding
K20.91 Esophagitis, unspecified with bleeding
K21.00 Gastro-esophageal reflux disease with esophagitis, without bleeding
K21.01 Gastro-esophageal reflux disease with esophagitis, with bleeding
K21.9 Gastro-esophageal reflux disease without esophagitis
K22.0 Achalasia of cardia
K22.10 Ulcer of esophagus without bleeding
K22.11 Ulcer of esophagus with bleeding
K22.2 Esophageal obstruction
K22.3 Perforation of esophagus
K22.4 Dyskinesia of esophagus
K22.5 Diverticulum of esophagus, acquired
K22.6 Gastro-esophageal laceration-hemorrhage syndrome
K22.70 Barrett's esophagus without dysplasia
K22.710 Barrett's esophagus with low grade dysplasia
K22.711 Barrett's esophagus with high grade dysplasia
K22.719 Barrett's esophagus with dysplasia, unspecified
K22.81 Esophageal polyp
K22.82 Esophagogastric junction polyp
K22.89 Other specified disease of esophagus
K23 Disorders of esophagus in diseases classified elsewhere
K25.0 Acute gastric ulcer with hemorrhage
K25.1 Acute gastric ulcer with perforation
K25.2 Acute gastric ulcer with both hemorrhage and perforation
K25.3 Acute gastric ulcer without hemorrhage or perforation
K25.4 Chronic or unspecified gastric ulcer with hemorrhage
K25.5 Chronic or unspecified gastric ulcer with perforation
K25.6 Chronic or unspecified gastric ulcer with both hemorrhage and perforation
K25.7 Chronic gastric ulcer without hemorrhage or perforation
K25.9 Gastric ulcer, unspecified as acute or chronic, without hemorrhage or perforation
K26.0 Acute duodenal ulcer with hemorrhage
K26.1 Acute duodenal ulcer with perforation
K26.2 Acute duodenal ulcer with both hemorrhage and perforation
K26.3 Acute duodenal ulcer without hemorrhage or perforation
K26.4 Chronic or unspecified duodenal ulcer with hemorrhage
K26.5 Chronic or unspecified duodenal ulcer with perforation
K26.6 Chronic or unspecified duodenal ulcer with both hemorrhage and perforation
K26.7 Chronic duodenal ulcer without hemorrhage or perforation
K26.9 Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation
K27.0 Acute peptic ulcer, site unspecified, with hemorrhage
K27.1 Acute peptic ulcer, site unspecified, with perforation
K27.2 Acute peptic ulcer, site unspecified, with both hemorrhage and perforation
K27.3 Acute peptic ulcer, site unspecified, without hemorrhage or perforation
K27.4 Chronic or unspecified peptic ulcer, site unspecified, with hemorrhage
K27.5 Chronic or unspecified peptic ulcer, site unspecified, with perforation
K27.6 Chronic or unspecified peptic ulcer, site unspecified, with both hemorrhage and perforation
K27.7 Chronic peptic ulcer, site unspecified, without hemorrhage or perforation
K27.9 Peptic ulcer, site unspecified, unspecified as acute or chronic, without hemorrhage or perforation
K28.0 Acute gastrojejunal ulcer with hemorrhage
K28.1 Acute gastrojejunal ulcer with perforation
K28.2 Acute gastrojejunal ulcer with both hemorrhage and perforation
K28.3 Acute gastrojejunal ulcer without hemorrhage or perforation
K28.4 Chronic or unspecified gastrojejunal ulcer with hemorrhage
K28.5 Chronic or unspecified gastrojejunal ulcer with perforation
K28.6 Chronic or unspecified gastrojejunal ulcer with both hemorrhage and perforation
K28.7 Chronic gastrojejunal ulcer without hemorrhage or perforation
K28.9 Gastrojejunal ulcer, unspecified as acute or chronic, without hemorrhage or perforation
K29.00 Acute gastritis without bleeding
K29.01 Acute gastritis with bleeding
K29.20 Alcoholic gastritis without bleeding
K29.21 Alcoholic gastritis with bleeding
K29.30 Chronic superficial gastritis without bleeding
K29.31 Chronic superficial gastritis with bleeding
K29.40 Chronic atrophic gastritis without bleeding
K29.41 Chronic atrophic gastritis with bleeding
K29.50 Unspecified chronic gastritis without bleeding
K29.51 Unspecified chronic gastritis with bleeding
K29.60 Other gastritis without bleeding
K29.61 Other gastritis with bleeding
K29.70 Gastritis, unspecified, without bleeding
K29.71 Gastritis, unspecified, with bleeding
K29.80 Duodenitis without bleeding
K29.81 Duodenitis with bleeding
K29.90 Gastroduodenitis, unspecified, without bleeding
K29.91 Gastroduodenitis, unspecified, with bleeding
K30 Functional dyspepsia
K31.0 Acute dilatation of stomach
K31.1 Adult hypertrophic pyloric stenosis
K31.2 Hourglass stricture and stenosis of stomach
K31.3 Pylorospasm, not elsewhere classified
K31.4 Gastric diverticulum
K31.5 Obstruction of duodenum
K31.6 Fistula of stomach and duodenum
K31.7 Polyp of stomach and duodenum
K31.811 Angiodysplasia of stomach and duodenum with bleeding
K31.819 Angiodysplasia of stomach and duodenum without bleeding
K31.82 Dieulafoy lesion (hemorrhagic) of stomach and duodenum
K31.84 Gastroparesis
K31.89 Other diseases of stomach and duodenum
K31.A11 Gastric intestinal metaplasia without dysplasia, involving the antrum
K31.A12 Gastric intestinal metaplasia without dysplasia, involving the body (corpus)
K31.A13 Gastric intestinal metaplasia without dysplasia, involving the fundus
K31.A14 Gastric intestinal metaplasia without dysplasia, involving the cardia
K31.A15 Gastric intestinal metaplasia without dysplasia, involving multiple sites
K31.A19 Gastric intestinal metaplasia without dysplasia, unspecified site
K31.A21 Gastric intestinal metaplasia with low grade dysplasia
K31.A22 Gastric intestinal metaplasia with high grade dysplasia
K44.0 Diaphragmatic hernia with obstruction, without gangrene
K44.1 Diaphragmatic hernia with gangrene
K44.9 Diaphragmatic hernia without obstruction or gangrene
K45.0 Other specified abdominal hernia with obstruction, without gangrene
K50.00 Crohn's disease of small intestine without complications
K50.011 Crohn's disease of small intestine with rectal bleeding
K50.012 Crohn's disease of small intestine with intestinal obstruction
K50.013 Crohn's disease of small intestine with fistula
K50.014 Crohn's disease of small intestine with abscess
K50.018 Crohn's disease of small intestine with other complication
K50.019 Crohn's disease of small intestine with unspecified complications
K50.10 Crohn's disease of large intestine without complications
K50.111 Crohn's disease of large intestine with rectal bleeding
K50.112 Crohn's disease of large intestine with intestinal obstruction
K50.113 Crohn's disease of large intestine with fistula
K50.114 Crohn's disease of large intestine with abscess
K50.118 Crohn's disease of large intestine with other complication
K50.119 Crohn's disease of large intestine with unspecified complications
K50.80 Crohn's disease of both small and large intestine without complications
K50.811 Crohn's disease of both small and large intestine with rectal bleeding
K50.812 Crohn's disease of both small and large intestine with intestinal obstruction
K50.813 Crohn's disease of both small and large intestine with fistula
K50.814 Crohn's disease of both small and large intestine with abscess
K50.818 Crohn's disease of both small and large intestine with other complication
K50.819 Crohn's disease of both small and large intestine with unspecified complications
K50.90 Crohn's disease, unspecified, without complications
K50.911 Crohn's disease, unspecified, with rectal bleeding
K50.912 Crohn's disease, unspecified, with intestinal obstruction
K50.913 Crohn's disease, unspecified, with fistula
K50.914 Crohn's disease, unspecified, with abscess
K50.918 Crohn's disease, unspecified, with other complication
K50.919 Crohn's disease, unspecified, with unspecified complications
K52.21 Food protein-induced enterocolitis syndrome
K52.22 Food protein-induced enteropathy
K52.29 Other allergic and dietetic gastroenteritis and colitis
K52.3 Indeterminate colitis
K52.81 Eosinophilic gastritis or gastroenteritis
K52.831 Collagenous colitis
K52.832 Lymphocytic colitis
K52.838 Other microscopic colitis
K52.839 Microscopic colitis, unspecified
K52.89 Other specified noninfective gastroenteritis and colitis
K55.30 Necrotizing enterocolitis, unspecified
K55.31 Stage 1 necrotizing enterocolitis
K55.32 Stage 2 necrotizing enterocolitis
K55.33 Stage 3 necrotizing enterocolitis
K56.600 Partial intestinal obstruction, unspecified as to cause
K56.601 Complete intestinal obstruction, unspecified as to cause
K56.609 Unspecified intestinal obstruction, unspecified as to partial versus complete obstruction
K57.00 Diverticulitis of small intestine with perforation and abscess without bleeding
K57.01 Diverticulitis of small intestine with perforation and abscess with bleeding
K57.11 Diverticulosis of small intestine without perforation or abscess with bleeding
K57.12 Diverticulitis of small intestine without perforation or abscess without bleeding
K57.13 Diverticulitis of small intestine without perforation or abscess with bleeding
K57.40 Diverticulitis of both small and large intestine with perforation and abscess without bleeding
K57.41 Diverticulitis of both small and large intestine with perforation and abscess with bleeding
K57.51 Diverticulosis of both small and large intestine without perforation or abscess with bleeding
K57.52 Diverticulitis of both small and large intestine without perforation or abscess without bleeding
K57.53 Diverticulitis of both small and large intestine without perforation or abscess with bleeding
K63.3 Ulcer of intestine
K63.5 Polyp of colon
K70.10 Alcoholic hepatitis without ascites
K70.11 Alcoholic hepatitis with ascites
K70.2 Alcoholic fibrosis and sclerosis of liver
K70.30 Alcoholic cirrhosis of liver without ascites
K70.31 Alcoholic cirrhosis of liver with ascites
K70.40 Alcoholic hepatic failure without coma
K70.41 Alcoholic hepatic failure with coma
K70.9 Alcoholic liver disease, unspecified
K73.0 Chronic persistent hepatitis, not elsewhere classified
K73.1 Chronic lobular hepatitis, not elsewhere classified
K73.2 Chronic active hepatitis, not elsewhere classified
K73.8 Other chronic hepatitis, not elsewhere classified
K73.9 Chronic hepatitis, unspecified
K74.01 Hepatic fibrosis, early fibrosis
K74.02 Hepatic fibrosis, advanced fibrosis
K74.3 Primary biliary cirrhosis
K74.4 Secondary biliary cirrhosis
K74.5 Biliary cirrhosis, unspecified
K74.60 Unspecified cirrhosis of liver
K74.69 Other cirrhosis of liver
K75.4 Autoimmune hepatitis
K76.6 Portal hypertension
K80.00 Calculus of gallbladder with acute cholecystitis without obstruction
K80.01 Calculus of gallbladder with acute cholecystitis with obstruction
K80.10 Calculus of gallbladder with chronic cholecystitis without obstruction
K80.11 Calculus of gallbladder with chronic cholecystitis with obstruction
K80.12 Calculus of gallbladder with acute and chronic cholecystitis without obstruction
K80.13 Calculus of gallbladder with acute and chronic cholecystitis with obstruction
K80.18 Calculus of gallbladder with other cholecystitis without obstruction
K80.19 Calculus of gallbladder with other cholecystitis with obstruction
K80.20 Calculus of gallbladder without cholecystitis without obstruction
K80.21 Calculus of gallbladder without cholecystitis with obstruction
K80.40 Calculus of bile duct with cholecystitis, unspecified, without obstruction
K80.41 Calculus of bile duct with cholecystitis, unspecified, with obstruction
K80.42 Calculus of bile duct with acute cholecystitis without obstruction
K80.43 Calculus of bile duct with acute cholecystitis with obstruction
K80.44 Calculus of bile duct with chronic cholecystitis without obstruction
K80.45 Calculus of bile duct with chronic cholecystitis with obstruction
K80.46 Calculus of bile duct with acute and chronic cholecystitis without obstruction
K80.47 Calculus of bile duct with acute and chronic cholecystitis with obstruction
K80.80 Other cholelithiasis without obstruction
K80.81 Other cholelithiasis with obstruction
K81.0 Acute cholecystitis
K82.3 Fistula of gallbladder
K83.3 Fistula of bile duct
K85.00 Idiopathic acute pancreatitis without necrosis or infection
K85.01 Idiopathic acute pancreatitis with uninfected necrosis
K85.02 Idiopathic acute pancreatitis with infected necrosis
K85.10 Biliary acute pancreatitis without necrosis or infection
K85.11 Biliary acute pancreatitis with uninfected necrosis
K85.12 Biliary acute pancreatitis with infected necrosis
K85.20 Alcohol induced acute pancreatitis without necrosis or infection
K85.21 Alcohol induced acute pancreatitis with uninfected necrosis
K85.22 Alcohol induced acute pancreatitis with infected necrosis
K85.30 Drug induced acute pancreatitis without necrosis or infection
K85.31 Drug induced acute pancreatitis with uninfected necrosis
K85.32 Drug induced acute pancreatitis with infected necrosis
K85.80 Other acute pancreatitis without necrosis or infection
K85.81 Other acute pancreatitis with uninfected necrosis
K85.82 Other acute pancreatitis with infected necrosis
K85.90 Acute pancreatitis without necrosis or infection, unspecified
K85.91 Acute pancreatitis with uninfected necrosis, unspecified
K85.92 Acute pancreatitis with infected necrosis, unspecified
K86.0 Alcohol-induced chronic pancreatitis
K86.1 Other chronic pancreatitis
K86.2 Cyst of pancreas
K86.3 Pseudocyst of pancreas
K90.0 Celiac disease
K90.1 Tropical sprue
K90.2 Blind loop syndrome, not elsewhere classified
K90.3 Pancreatic steatorrhea
K90.41 Non-celiac gluten sensitivity
K90.49 Malabsorption due to intolerance, not elsewhere classified
K90.81 Whipple's disease
K90.89 Other intestinal malabsorption
K90.9 Intestinal malabsorption, unspecified
K91.2 Postsurgical malabsorption, not elsewhere classified
K91.30 Postprocedural intestinal obstruction, unspecified as to partial versus complete
K91.31 Postprocedural partial intestinal obstruction
K91.32 Postprocedural complete intestinal obstruction
K91.5 Postcholecystectomy syndrome
K91.81 Other intraoperative complications of digestive system
K91.82 Postprocedural hepatic failure
K91.83 Postprocedural hepatorenal syndrome
K91.850 Pouchitis
K91.858 Other complications of intestinal pouch
K91.86 Retained cholelithiasis following cholecystectomy
K91.870 Postprocedural hematoma of a digestive system organ or structure following a digestive system procedure
K91.871 Postprocedural hematoma of a digestive system organ or structure following other procedure
K91.872 Postprocedural seroma of a digestive system organ or structure following a digestive system procedure
K91.873 Postprocedural seroma of a digestive system organ or structure following other procedure
K91.89 Other postprocedural complications and disorders of digestive system
K92.0 Hematemesis
K92.1 Melena
K92.2 Gastrointestinal hemorrhage, unspecified
K92.81 Gastrointestinal mucositis (ulcerative)
K94.03 Colostomy malfunction
K94.13 Enterostomy malfunction
K94.20 Gastrostomy complication, unspecified
K94.21 Gastrostomy hemorrhage
K94.22 Gastrostomy infection
K94.23 Gastrostomy malfunction
K94.29 Other complications of gastrostomy
K94.30 Esophagostomy complications, unspecified
K94.31 Esophagostomy hemorrhage
K94.32 Esophagostomy infection
K94.33 Esophagostomy malfunction
K94.39 Other complications of esophagostomy
L13.0 Dermatitis herpetiformis
M34.0 Progressive systemic sclerosis
M34.1 CR(E)ST syndrome
M34.2 Systemic sclerosis induced by drug and chemical
M34.81 Systemic sclerosis with lung involvement
M34.82 Systemic sclerosis with myopathy
M34.83 Systemic sclerosis with polyneuropathy
M34.89 Other systemic sclerosis
M34.9 Systemic sclerosis, unspecified
Q26.5 Anomalous portal venous connection
Q26.6 Portal vein-hepatic artery fistula
Q27.33 Arteriovenous malformation of digestive system vessel
Q39.0 Atresia of esophagus without fistula
Q39.1 Atresia of esophagus with tracheo-esophageal fistula
Q39.2 Congenital tracheo-esophageal fistula without atresia
Q39.3 Congenital stenosis and stricture of esophagus
Q39.4 Esophageal web
Q39.5 Congenital dilatation of esophagus
Q39.6 Congenital diverticulum of esophagus
Q39.8 Other congenital malformations of esophagus
Q39.9 Congenital malformation of esophagus, unspecified
Q40.0 Congenital hypertrophic pyloric stenosis
Q40.1 Congenital hiatus hernia
Q40.2 Other specified congenital malformations of stomach
Q40.3 Congenital malformation of stomach, unspecified
R05.2 Subacute cough
R05.3 Chronic cough
R06.5 Mouth breathing
R06.7 Sneezing
R06.89 Other abnormalities of breathing
R07.1 Chest pain on breathing
R07.2 Precordial pain
R07.81 Pleurodynia
R07.82 Intercostal pain
R07.89 Other chest pain
R07.9 Chest pain, unspecified
R09.82 Postnasal drip
R10.0 Acute abdomen
R10.10 Upper abdominal pain, unspecified
R10.11 Right upper quadrant pain
R10.12 Left upper quadrant pain
R10.13 Epigastric pain
R10.2 Pelvic and perineal pain
R10.30 Lower abdominal pain, unspecified
R10.31 Right lower quadrant pain
R10.32 Left lower quadrant pain
R10.33 Periumbilical pain
R10.811 Right upper quadrant abdominal tenderness
R10.812 Left upper quadrant abdominal tenderness
R10.813 Right lower quadrant abdominal tenderness
R10.814 Left lower quadrant abdominal tenderness
R10.815 Periumbilic abdominal tenderness
R10.816 Epigastric abdominal tenderness
R10.817 Generalized abdominal tenderness
R10.819 Abdominal tenderness, unspecified site
R10.821 Right upper quadrant rebound abdominal tenderness
R10.822 Left upper quadrant rebound abdominal tenderness
R10.823 Right lower quadrant rebound abdominal tenderness
R10.824 Left lower quadrant rebound abdominal tenderness
R10.825 Periumbilic rebound abdominal tenderness
R10.826 Epigastric rebound abdominal tenderness
R10.827 Generalized rebound abdominal tenderness
R10.829 Rebound abdominal tenderness, unspecified site
R10.84 Generalized abdominal pain
R10.9 Unspecified abdominal pain
R11.0 Nausea
R11.10 Vomiting, unspecified
R11.11 Vomiting without nausea
R11.12 Projectile vomiting
R11.13 Vomiting of fecal matter
R11.14 Bilious vomiting
R11.15 Cyclical vomiting syndrome unrelated to migraine
R11.2 Nausea with vomiting, unspecified
R12 Heartburn
R13.0 Aphagia
R13.10 Dysphagia, unspecified
R13.11 Dysphagia, oral phase
R13.12 Dysphagia, oropharyngeal phase
R13.13 Dysphagia, pharyngeal phase
R13.14 Dysphagia, pharyngoesophageal phase
R13.19 Other dysphagia
R14.0 Abdominal distension (gaseous)
R14.1 Gas pain
R14.2 Eructation
R14.3 Flatulence
R15.0 Incomplete defecation
R15.1 Fecal smearing
R15.2 Fecal urgency
R15.9 Full incontinence of feces
R18.0 Malignant ascites
R18.8 Other ascites
R19.00 Intra-abdominal and pelvic swelling, mass and lump, unspecified site
R19.01 Right upper quadrant abdominal swelling, mass and lump
R19.02 Left upper quadrant abdominal swelling, mass and lump
R19.03 Right lower quadrant abdominal swelling, mass and lump
R19.04 Left lower quadrant abdominal swelling, mass and lump
R19.05 Periumbilic swelling, mass or lump
R19.06 Epigastric swelling, mass or lump
R19.07 Generalized intra-abdominal and pelvic swelling, mass and lump
R19.09 Other intra-abdominal and pelvic swelling, mass and lump
R19.11 Absent bowel sounds
R19.12 Hyperactive bowel sounds
R19.15 Other abnormal bowel sounds
R19.2 Visible peristalsis
R19.5 Other fecal abnormalities
R19.6 Halitosis
R19.7 Diarrhea, unspecified
R22.2 Localized swelling, mass and lump, trunk
R47.82 Fluency disorder in conditions classified elsewhere
R49.0 Dysphonia
R49.21 Hypernasality
R49.22 Hyponasality
R49.8 Other voice and resonance disorders
R63.0 Anorexia
R63.39 Other feeding difficulties
R63.4 Abnormal weight loss
R63.6 Underweight
R64 Cachexia
R68.84 Jaw pain
R70.1 Abnormal plasma viscosity
R74.8 Abnormal levels of other serum enzymes
R74.9 Abnormal serum enzyme level, unspecified
R77.0 Abnormality of albumin
R77.1 Abnormality of globulin
R77.2 Abnormality of alphafetoprotein
R77.8 Other specified abnormalities of plasma proteins
R77.9 Abnormality of plasma protein, unspecified
R78.1 Finding of opiate drug in blood
R78.2 Finding of cocaine in blood
R78.3 Finding of hallucinogen in blood
R78.4 Finding of other drugs of addictive potential in blood
R78.5 Finding of other psychotropic drug in blood
R78.6 Finding of steroid agent in blood
R78.89 Finding of other specified substances, not normally found in blood
R78.9 Finding of unspecified substance, not normally found in blood
R79.89 Other specified abnormal findings of blood chemistry
R93.2 Abnormal findings on diagnostic imaging of liver and biliary tract
R93.3 Abnormal findings on diagnostic imaging of other parts of digestive tract
R93.5 Abnormal findings on diagnostic imaging of other abdominal regions, including retroperitoneum
S09.10XA Unspecified injury of muscle and tendon of head, initial encounter
S09.10XD Unspecified injury of muscle and tendon of head, subsequent encounter
S09.10XS Unspecified injury of muscle and tendon of head, sequela
S09.11XA Strain of muscle and tendon of head, initial encounter
S09.11XD Strain of muscle and tendon of head, subsequent encounter
S09.11XS Strain of muscle and tendon of head, sequela
S09.19XA Other specified injury of muscle and tendon of head, initial encounter
S09.19XD Other specified injury of muscle and tendon of head, subsequent encounter
S09.19XS Other specified injury of muscle and tendon of head, sequela
S09.8XXA Other specified injuries of head, initial encounter
S09.8XXD Other specified injuries of head, subsequent encounter
S09.8XXS Other specified injuries of head, sequela
S09.90XA Unspecified injury of head, initial encounter
S09.90XD Unspecified injury of head, subsequent encounter
S09.90XS Unspecified injury of head, sequela
S09.92XA Unspecified injury of nose, initial encounter
S09.92XD Unspecified injury of nose, subsequent encounter
S09.92XS Unspecified injury of nose, sequela
S09.93XA Unspecified injury of face, initial encounter
S09.93XD Unspecified injury of face, subsequent encounter
S09.93XS Unspecified injury of face, sequela
S11.20XA Unspecified open wound of pharynx and cervical esophagus, initial encounter
S11.20XD Unspecified open wound of pharynx and cervical esophagus, subsequent encounter
S11.20XS Unspecified open wound of pharynx and cervical esophagus, sequela
S11.21XA Laceration without foreign body of pharynx and cervical esophagus, initial encounter
S11.21XD Laceration without foreign body of pharynx and cervical esophagus, subsequent encounter
S11.21XS Laceration without foreign body of pharynx and cervical esophagus, sequela
S11.22XA Laceration with foreign body of pharynx and cervical esophagus, initial encounter
S11.22XD Laceration with foreign body of pharynx and cervical esophagus, subsequent encounter
S11.22XS Laceration with foreign body of pharynx and cervical esophagus, sequela
S11.23XA Puncture wound without foreign body of pharynx and cervical esophagus, initial encounter
S11.23XD Puncture wound without foreign body of pharynx and cervical esophagus, subsequent encounter
S11.23XS Puncture wound without foreign body of pharynx and cervical esophagus, sequela
S11.24XA Puncture wound with foreign body of pharynx and cervical esophagus, initial encounter
S11.24XD Puncture wound with foreign body of pharynx and cervical esophagus, subsequent encounter
S11.24XS Puncture wound with foreign body of pharynx and cervical esophagus, sequela
S11.25XA Open bite of pharynx and cervical esophagus, initial encounter
S11.25XD Open bite of pharynx and cervical esophagus, subsequent encounter
S11.25XS Open bite of pharynx and cervical esophagus, sequela
S16.8XXA Other specified injury of muscle, fascia and tendon at neck level, initial encounter
S16.8XXD Other specified injury of muscle, fascia and tendon at neck level, subsequent encounter
S16.8XXS Other specified injury of muscle, fascia and tendon at neck level, sequela
S16.9XXA Unspecified injury of muscle, fascia and tendon at neck level, initial encounter
S16.9XXD Unspecified injury of muscle, fascia and tendon at neck level, subsequent encounter
S16.9XXS Unspecified injury of muscle, fascia and tendon at neck level, sequela
S19.80XA Other specified injuries of unspecified part of neck, initial encounter
S19.80XD Other specified injuries of unspecified part of neck, subsequent encounter
S19.80XS Other specified injuries of unspecified part of neck, sequela
S19.81XA Other specified injuries of larynx, initial encounter
S19.81XD Other specified injuries of larynx, subsequent encounter
S19.81XS Other specified injuries of larynx, sequela
S19.82XA Other specified injuries of cervical trachea, initial encounter
S19.82XD Other specified injuries of cervical trachea, subsequent encounter
S19.82XS Other specified injuries of cervical trachea, sequela
S19.83XA Other specified injuries of vocal cord, initial encounter
S19.83XD Other specified injuries of vocal cord, subsequent encounter
S19.83XS Other specified injuries of vocal cord, sequela
S19.84XA Other specified injuries of thyroid gland, initial encounter
S19.84XD Other specified injuries of thyroid gland, subsequent encounter
S19.84XS Other specified injuries of thyroid gland, sequela
S19.85XA Other specified injuries of pharynx and cervical esophagus, initial encounter
S19.85XD Other specified injuries of pharynx and cervical esophagus, subsequent encounter
S19.85XS Other specified injuries of pharynx and cervical esophagus, sequela
S19.89XA Other specified injuries of other specified part of neck, initial encounter
S19.89XD Other specified injuries of other specified part of neck, subsequent encounter
S19.89XS Other specified injuries of other specified part of neck, sequela
S19.9XXA Unspecified injury of neck, initial encounter
S19.9XXD Unspecified injury of neck, subsequent encounter
S19.9XXS Unspecified injury of neck, sequela
S27.812A Contusion of esophagus (thoracic part), initial encounter
S27.812D Contusion of esophagus (thoracic part), subsequent encounter
S27.812S Contusion of esophagus (thoracic part), sequela
S27.813A Laceration of esophagus (thoracic part), initial encounter
S27.813D Laceration of esophagus (thoracic part), subsequent encounter
S27.813S Laceration of esophagus (thoracic part), sequela
S27.818A Other injury of esophagus (thoracic part), initial encounter
S27.818D Other injury of esophagus (thoracic part), subsequent encounter
S27.818S Other injury of esophagus (thoracic part), sequela
S27.819A Unspecified injury of esophagus (thoracic part), initial encounter
S27.819D Unspecified injury of esophagus (thoracic part), subsequent encounter
S27.819S Unspecified injury of esophagus (thoracic part), sequela
T18.100A Unspecified foreign body in esophagus causing compression of trachea, initial encounter
T18.100D Unspecified foreign body in esophagus causing compression of trachea, subsequent encounter
T18.100S Unspecified foreign body in esophagus causing compression of trachea, sequela
T18.108A Unspecified foreign body in esophagus causing other injury, initial encounter
T18.108D Unspecified foreign body in esophagus causing other injury, subsequent encounter
T18.108S Unspecified foreign body in esophagus causing other injury, sequela
T18.110A Gastric contents in esophagus causing compression of trachea, initial encounter
T18.110D Gastric contents in esophagus causing compression of trachea, subsequent encounter
T18.110S Gastric contents in esophagus causing compression of trachea, sequela
T18.118A Gastric contents in esophagus causing other injury, initial encounter
T18.118D Gastric contents in esophagus causing other injury, subsequent encounter
T18.118S Gastric contents in esophagus causing other injury, sequela
T18.120A Food in esophagus causing compression of trachea, initial encounter
T18.120D Food in esophagus causing compression of trachea, subsequent encounter
T18.120S Food in esophagus causing compression of trachea, sequela
T18.128A Food in esophagus causing other injury, initial encounter
T18.128D Food in esophagus causing other injury, subsequent encounter
T18.128S Food in esophagus causing other injury, sequela
T18.190A Other foreign object in esophagus causing compression of trachea, initial encounter
T18.190D Other foreign object in esophagus causing compression of trachea, subsequent encounter
T18.190S Other foreign object in esophagus causing compression of trachea, sequela
T18.198A Other foreign object in esophagus causing other injury, initial encounter
T18.198D Other foreign object in esophagus causing other injury, subsequent encounter
T18.198S Other foreign object in esophagus causing other injury, sequela
T18.2XXA Foreign body in stomach, initial encounter
T18.2XXD Foreign body in stomach, subsequent encounter
T18.2XXS Foreign body in stomach, sequela
T18.3XXA Foreign body in small intestine, initial encounter
T18.3XXD Foreign body in small intestine, subsequent encounter
T18.3XXS Foreign body in small intestine, sequela
T18.4XXA Foreign body in colon, initial encounter
T18.4XXD Foreign body in colon, subsequent encounter
T18.4XXS Foreign body in colon, sequela
T18.8XXA Foreign body in other parts of alimentary tract, initial encounter
T18.8XXD Foreign body in other parts of alimentary tract, subsequent encounter
T18.8XXS Foreign body in other parts of alimentary tract, sequela
T18.9XXA Foreign body of alimentary tract, part unspecified, initial encounter
T18.9XXD Foreign body of alimentary tract, part unspecified, subsequent encounter
T18.9XXS Foreign body of alimentary tract, part unspecified, sequela
T28.0XXA Burn of mouth and pharynx, initial encounter
T28.0XXD Burn of mouth and pharynx, subsequent encounter
T28.0XXS Burn of mouth and pharynx, sequela
T28.1XXA Burn of esophagus, initial encounter
T28.1XXD Burn of esophagus, subsequent encounter
T28.1XXS Burn of esophagus, sequela
T28.2XXA Burn of other parts of alimentary tract, initial encounter
T28.2XXD Burn of other parts of alimentary tract, subsequent encounter
T28.2XXS Burn of other parts of alimentary tract, sequela
T28.5XXA Corrosion of mouth and pharynx, initial encounter
T28.5XXD Corrosion of mouth and pharynx, subsequent encounter
T28.5XXS Corrosion of mouth and pharynx, sequela
T28.6XXA Corrosion of esophagus, initial encounter
T28.6XXD Corrosion of esophagus, subsequent encounter
T28.6XXS Corrosion of esophagus, sequela
T28.7XXA Corrosion of other parts of alimentary tract, initial encounter
T28.7XXD Corrosion of other parts of alimentary tract, subsequent encounter
T28.7XXS Corrosion of other parts of alimentary tract, sequela
T54.0X3A Toxic effect of phenol and phenol homologues, assault, initial encounter
T54.0X3D Toxic effect of phenol and phenol homologues, assault, subsequent encounter
T54.0X3S Toxic effect of phenol and phenol homologues, assault, sequela
T54.1X1A Toxic effect of other corrosive organic compounds, accidental (unintentional), initial encounter
T54.1X1D Toxic effect of other corrosive organic compounds, accidental (unintentional), subsequent encounter
T54.1X1S Toxic effect of other corrosive organic compounds, accidental (unintentional), sequela
T54.1X2A Toxic effect of other corrosive organic compounds, intentional self-harm, initial encounter
T54.1X2D Toxic effect of other corrosive organic compounds, intentional self-harm, subsequent encounter
T54.1X2S Toxic effect of other corrosive organic compounds, intentional self-harm, sequela
T54.1X3A Toxic effect of other corrosive organic compounds, assault, initial encounter
T54.1X3D Toxic effect of other corrosive organic compounds, assault, subsequent encounter
T54.1X3S Toxic effect of other corrosive organic compounds, assault, sequela
T54.1X4A Toxic effect of other corrosive organic compounds, undetermined, initial encounter
T54.1X4D Toxic effect of other corrosive organic compounds, undetermined, subsequent encounter
T54.1X4S Toxic effect of other corrosive organic compounds, undetermined, sequela
T54.2X3A Toxic effect of corrosive acids and acid-like substances, assault, initial encounter
T54.2X3D Toxic effect of corrosive acids and acid-like substances, assault, subsequent encounter
T54.2X3S Toxic effect of corrosive acids and acid-like substances, assault, sequela
T54.3X1A Toxic effect of corrosive alkalis and alkali-like substances, accidental (unintentional), initial encounter
T54.3X1D Toxic effect of corrosive alkalis and alkali-like substances, accidental (unintentional), subsequent encounter
T54.3X1S Toxic effect of corrosive alkalis and alkali-like substances, accidental (unintentional), sequela
T54.3X2A Toxic effect of corrosive alkalis and alkali-like substances, intentional self-harm, initial encounter
T54.3X2D Toxic effect of corrosive alkalis and alkali-like substances, intentional self-harm, subsequent encounter
T54.3X2S Toxic effect of corrosive alkalis and alkali-like substances, intentional self-harm, sequela
T54.3X3A Toxic effect of corrosive alkalis and alkali-like substances, assault, initial encounter
T54.3X3D Toxic effect of corrosive alkalis and alkali-like substances, assault, subsequent encounter
T54.3X3S Toxic effect of corrosive alkalis and alkali-like substances, assault, sequela
T54.3X4A Toxic effect of corrosive alkalis and alkali-like substances, undetermined, initial encounter
T54.3X4D Toxic effect of corrosive alkalis and alkali-like substances, undetermined, subsequent encounter
T54.3X4S Toxic effect of corrosive alkalis and alkali-like substances, undetermined, sequela
T54.91XA Toxic effect of unspecified corrosive substance, accidental (unintentional), initial encounter
T54.91XD Toxic effect of unspecified corrosive substance, accidental (unintentional), subsequent encounter
T54.91XS Toxic effect of unspecified corrosive substance, accidental (unintentional), sequela
T54.92XA Toxic effect of unspecified corrosive substance, intentional self-harm, initial encounter
T54.92XD Toxic effect of unspecified corrosive substance, intentional self-harm, subsequent encounter
T54.92XS Toxic effect of unspecified corrosive substance, intentional self-harm, sequela
T54.93XA Toxic effect of unspecified corrosive substance, assault, initial encounter
T54.93XD Toxic effect of unspecified corrosive substance, assault, subsequent encounter
T54.93XS Toxic effect of unspecified corrosive substance, assault, sequela
T54.94XA Toxic effect of unspecified corrosive substance, undetermined, initial encounter
T54.94XD Toxic effect of unspecified corrosive substance, undetermined, subsequent encounter
T54.94XS Toxic effect of unspecified corrosive substance, undetermined, sequela
T56.4X1A Toxic effect of copper and its compounds, accidental (unintentional), initial encounter
T56.4X1D Toxic effect of copper and its compounds, accidental (unintentional), subsequent encounter
T56.4X1S Toxic effect of copper and its compounds, accidental (unintentional), sequela
T57.1X1A Toxic effect of phosphorus and its compounds, accidental (unintentional), initial encounter
T57.1X1D Toxic effect of phosphorus and its compounds, accidental (unintentional), subsequent encounter
T57.1X1S Toxic effect of phosphorus and its compounds, accidental (unintentional), sequela
T57.1X2A Toxic effect of phosphorus and its compounds, intentional self-harm, initial encounter
T57.1X2D Toxic effect of phosphorus and its compounds, intentional self-harm, subsequent encounter
T57.1X2S Toxic effect of phosphorus and its compounds, intentional self-harm, sequela
T57.1X3A Toxic effect of phosphorus and its compounds, assault, initial encounter
T57.1X3D Toxic effect of phosphorus and its compounds, assault, subsequent encounter
T57.1X3S Toxic effect of phosphorus and its compounds, assault, sequela
T57.1X4A Toxic effect of phosphorus and its compounds, undetermined, initial encounter
T57.1X4D Toxic effect of phosphorus and its compounds, undetermined, subsequent encounter
T57.1X4S Toxic effect of phosphorus and its compounds, undetermined, sequela
T65.5X1A Toxic effect of nitroglycerin and other nitric acids and esters, accidental (unintentional), initial encounter
T65.5X1D Toxic effect of nitroglycerin and other nitric acids and esters, accidental (unintentional), subsequent encounter
T65.5X1S Toxic effect of nitroglycerin and other nitric acids and esters, accidental (unintentional), sequela
T66.XXXA Radiation sickness, unspecified, initial encounter
T66.XXXD Radiation sickness, unspecified, subsequent encounter
T66.XXXS Radiation sickness, unspecified, sequela
T86.40 Unspecified complication of liver transplant
T86.41 Liver transplant rejection
T86.42 Liver transplant failure
T86.43 Liver transplant infection
T86.49 Other complications of liver transplant
Z43.1 Encounter for attention to gastrostomy
Z72.4 Inappropriate diet and eating habits
Z79.01 Long term (current) use of anticoagulants
Z79.1 Long term (current) use of non-steroidal anti-inflammatories (NSAID)
Z79.3 Long term (current) use of hormonal contraceptives
Z79.84 Long term (current) use of oral hypoglycemic drugs
Z79.891 Long term (current) use of opiate analgesic
Z79.899 Other long term (current) drug therapy
Z83.710 Family history of adenomatous and serrated polyps
Z83.79 Family history of other diseases of the digestive system
Z85.00 Personal history of malignant neoplasm of unspecified digestive organ
Z85.01 Personal history of malignant neoplasm of esophagus
Z85.028 Personal history of other malignant neoplasm of stomach
Z85.068 Personal history of other malignant neoplasm of small intestine
Z85.07 Personal history of malignant neoplasm of pancreas
Z85.09 Personal history of malignant neoplasm of other digestive organs
Z86.010 Personal history of colonic polyps
Z87.11 Personal history of peptic ulcer disease
Z87.19 Personal history of other diseases of the digestive system
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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-CM Codes that Support Medical Necessity” section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 Codes

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Additional ICD-10 Information

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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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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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Other Coding Information

Group 1

Group 1 Paragraph

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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
10/01/2023 R5

Article revised and published on 10/26/2023 effective for dates of service on and after 10/01/2023 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM codes have been deleted and therefore have been removed from the article: D13.9 and Z83.71 in Group 1 Codes. The following ICD-10-CM codes have been added to the article: D13.91, D13.99 and Z83.710 in Group 1 Codes.

03/01/2023 R4

Article revised and published on 04/06/2023 effective for dates of service on and after 03/01/2023. The section ‘ICD-10-CM Codes that Support Medical Necessity, Group 1 Codes’ has been updated to add diagnosis code R93.2.

10/01/2021 R3

Article revised and published on 10/14/2021 effective for dates of service on and after 10/1/2021 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM codes have been added to the Article: K22.81; K22.82; K22.89; K31.A11; K31.A12; K31.A13; K31.A14; K31.A15; K31.A19; K31.A21; K31.A22; R05.2; R05.3; and R63.39 to Group 1.

The following ICD-10-CM codes have been deleted from the article: K22.8; R05; R63.3from Group 1.

03/01/2021 R2

Article revised and published on 4/22/2021 effective for dates of service on and after 03/01/2021 based on Inquiry.

The following ICD-10-CM codes: C49.A3, C7A.092, C88.4, E10.43, E11.43 and E13.43 have been added to the ICD-10 Group 1 code section of the Article.

Minor template changes made throughout the article.

10/01/2020 R1

Revision Number: 1
Publication: September 2020 Connection
LCR A/B2020-065

Explanation of Revision: Based on CR 11895 and CR 11845 (Annual 2021 ICD-10-CM Update), The following ICD-10-CM code(s) have been deleted from the “ICD-10 Codes that Support Medical Necessity/Group 1 Paragraph:” K20.8, K20.9, K21.0 and K74.0 also the following ICD-10-CM code(s) have been added to the “ICD-10 Codes that Support Medical Necessity/Group 1 Paragraph:” K20.80, K20.81, K20.90, K20.91, K21.00, K21.01, K74.01 and K74.02. Article revised and published on 10/01/2020 effective for dates of service on and after 10/01/2020 to reflect the Annual ICD-10-CM Code updates.

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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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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Updated On Effective Dates Status
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