IN Health Coverage Programs Annual Update of ICD-10 Codes
October 2017 ~
Indiana Health Coverage Programs (IHCP) has released their annual update of the ICD-10 diagnosis and procedure codes. The following changes became effective as of October 1, 2017:
Behavioral and Primary Healthcare Coordination (BPHC)
- Qualifying ICD-10 diagnosis codes for BPHC added, effective for date of service (DOS) on or after October 1, 2017
- F5028 – Avoidant/restrictive food intake disorder
Chiropractic Diagnosis Codes
- ICD-10 primary diagnosis codes added for chiropractic services, effective for DOS on or after October 1, 2017
- M48061 – Spinal stenosis, lumbar region without neurogenic claudication
- M48062 – Spinal stenosis, lumbar region with neurogenic claudication
Family Planning Services
- Additional ICD-10 procedure codes that require a valid sterilization consent form, effective for DOS on or after October 1, 2017
- 0V5F8ZZ – Destruction of right spermatic cord, via natural or artificial opening endoscopic
- 0V5G8ZZ – Destruction of left spermatic cord, via natural or artificial opening endoscopic
- 0V5H8ZZ – Destruction of bilateral spermatic cords, via natural or artificial opening endoscopic
- 0V5N8ZZ – Destruction of right vas deferens, via natural or artificial opening endoscopic
- 0V5P8ZZ – Destruction of left vas deferens, via natural or artificial opening endoscopic
- 0V5Q8ZZ – Destruction of bilateral vas deferens, via natural or artificial opening endoscopic
- 0VBF8ZZ – Excision of right spermatic cord, via natural or artificial opening endoscopic
- 0VBG8ZZ – Excision of left spermatic cord, via natural or artificial opening endoscopic
- 0VBH8ZZ – Excision of bilateral spermatic cords, via natural or artificial opening endoscopic
- 0VBN8ZZ – Excision of right vas deferens, via natural or artificial opening endoscopic
- 0VBP8ZZ – Excision of left vas deferens, via natural or artificial opening endoscopic
- 0VBQ8ZZ – Excision of bilateral vas deferens, via natural or artificial opening endoscopic
- 0VLF8CZ – Occlusion of right spermatic cord with extraluminal device, via natural or artificial opening endoscopic
- 0VLF8DZ – Occlusion of right spermatic cord with intraluminal device, via natural or artificial opening endoscopic
- 0VLF8ZZ – Occlusion of right spermatic cord, via natural or artificial opening endoscopic
- 0VLG8CZ – Occlusion of left spermatic cord with extraluminal device, via natural or artificial opening endoscopic
- 0VLG8DZ – Occlusion of left spermatic cord with intraluminal device, via natural or artificial opening endoscopic
- 0VLG8ZZ – Occlusion of left spermatic cord, via natural or artificial opening endoscopic
- 0VLH8CZ – Occlusion of bilateral spermatic cords with extraluminal device, via natural or artificial opening endoscopic
- 0VLH8DZ – Occlusion of bilateral spermatic cords with intraluminal device, via natural or artificial opening endoscopic
- 0VLH8ZZ – Occlusion of bilateral spermatic cords, via natural or artificial opening endoscopic
- 0VLN8CZ – Occlusion of right vas deferens with extraluminal device, via natural or artificial opening endoscopic
- 0VLN8DZ – Occlusion of right vas deferens with intraluminal device, via natural or artificial opening endoscopic
- 0VLN8ZZ – Occlusion of right vas deferens, via natural or artificial opening endoscopic
- 0VLP8CZ – Occlusion of left vas deferens with extraluminal device, via natural or artificial opening endoscopic
- 0VLP8DZ – Occlusion of left vas deferens with intraluminal device, via natural or artificial opening endoscopic
- 0VLP8ZZ – Occlusion of left vas deferens, via natural or artificial opening endoscopic
- 0VLQ8CZ – Occlusion of bilateral vas deferens with extraluminal device, via natural or artificial opening endoscopic
- 0VLQ8DZ – Occlusion of bilateral vas deferens with intraluminal device, via natural or artificial opening endoscopic
- 0VLQ8ZZ – Occlusion of bilateral vas deferens, via natural or artificial opening endoscopic
Hospital-Acquired Conditions (HACs) and Present on Admission (POA) Codes
- IHCP follows the CMS determinations for ICD-10 Hospital Acquired Condition Diagnoses and ICD-10 Diagnosis Codes Exempt from POA for diagnosis codes exempted from POA reporting. Effective October 1, 2017, HACs will not be considered for payment if the diagnoses were not POA.
Hospice Diagnosis Codes
- ICD-10 hospice diagnosis codes added, effective for DOS on or after October 1, 2017
- G1223 – Primary lateral sclerosis
- G1224 – Familial motor neuron disease
- G1225 – Progressive spinal muscle atrophy
- I2720 – Pulmonary hypertension, unspecified
- I2721 – Secondary pulmonary arterial hypertension
- I2722 – Pulmonary hypertension due to left heart disease
- I2723 – Pulmonary hypertension due to lung diseases and hypoxia
- I2724 – Chronic thromboembolic pulmonary hypertension
- I2729 – Other secondary pulmonary hypertension
- I2783 – Eisenmenger’s syndrome
- I50810 – Right heart failure, unspecified
- I50811 – Acute right heart failure
- I50813 – Acute on chronic right heart failure
- I50814 – Right heart failure due to left heart failure
- I5082 – Biventricular heart failure
- I5083 – High output heart failure
- I5084 – End stage heart failure
- I5089 – Other heart failure
Mental Health and Addiction Diagnosis Codes for MRO Eligibility
- Qualifying ICD-10 diagnosis codes MRO services added, effective for DOS on or after October 1, 2017
- F5082 – Avoidant/restrictive food intake disorder
- ANSA: Ye
- CANS: Yes
- F5082 – Avoidant/restrictive food intake disorder
Obstetrical and Gynecological Services
- Additional ICD-10 procedure codes requiring documentation of medical necessity with the claim, effective for DOS on or after October 1, 2017
- 0UT90ZL – Resection of Uterus, Supracervical, Open Approach
- 0UT94ZL – Resection of Uterus, Supracervical, Percutaneous Endoscopic Approach
- 0UT97ZL – Resection of Uterus, Supracervical, Via Natural or Artificial Opening
- 0UT98ZL – Resection of Uterus, Supracervical, Via Natural or Artificial Opening Endoscopic
PET Scan Diagnosis Codes
- ICD-10 diagnosis codes for PET scan coverage added, effective for DOS on or after October 1, 2017
- C9620 – Malignant mast cell neoplasm, unspecified
- C9621 – Aggressive systemic mastocytosis
- C9622 – Mast cell sarcoma
- C9629 – Other malignant mast cell neoplasm
- D4702 – Systemic mastocytosis
- D4709 – Other mast cell neoplasms of uncertain behavior
Presumptive Eligibility for Pregnant Women
- ICD-10 diagnosis codes added for Presumptive Eligibility for Pregnant Women, effective for DOS on or after October 1, 2017
- O00101 – Right tubal pregnancy without intrauterine pregnancy
- O00102 – Left tubal pregnancy without intrauterine pregnancy
- O00109 – Unspecified tubal pregnancy without intrauterine pregnancy
- O00111 – Right tubal pregnancy with intrauterine pregnancy
- O00112 – Left tubal pregnancy with intrauterine pregnancy
- O00119 – Unspecified tubal pregnancy with intrauterine pregnancy
- O00201 – Right ovarian pregnancy without intrauterine pregnancy
- O00202 – Left ovarian pregnancy without intrauterine pregnancy
- O00209 – Unspecified ovarian pregnancy without intrauterine pregnancy
- O00211 – Right ovarian pregnancy with intrauterine pregnancy
- O00212 – Left ovarian pregnancy with intrauterine pregnancy
- O00219 – Unspecified ovarian pregnancy with intrauterine pregnancy
- O368310 – Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, not applicable or unspecified
- O368311 – Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, fetus 1
- O368312 – Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, fetus 2
- O368313 – Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, fetus 3
- O368314 – Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, fetus 4
- O368315 – Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, fetus 5
- O368319 – Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, other fetus
- O368320 – Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, not applicable or unspecified
- O368321 – Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, fetus 1
- O368322 – Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, fetus 2
- O368323 – Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, fetus 3
- O368324 – Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, fetus 4
- O368325 – Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, fetus 5
- O368329 – Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, other fetus
- O368330 – Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, not applicable or unspecified
- O368331 – Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, fetus 1
- O368332 – Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, fetus 2
- O368333 – Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, fetus 3
- O368334 – Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, fetus 4
- O368335 – Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, fetus 5
- O368339 – Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, other fetus
- O368390 – Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, not applicable or unspecified
- O368391 – Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, fetus 1
- O368392 – Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, fetus 2
- O368393 – Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, fetus 3
- O368394 – Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, fetus 4
- O368395 – Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, fetus 5
- O368399 – Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, other fetus
- Z360 – Encounter for antenatal screening for chromosomal anomalies
- Z361 – Encounter for antenatal screening for raised alphafetoprotein level
- Z362 – Encounter for other antenatal screening follow-up
- Z363 – Encounter for antenatal screening for malformations
- Z364 – Encounter for antenatal screening for fetal growth retardation
- Z365 – Encounter for antenatal screening for isoimmunization
- Z3681 – Encounter for antenatal screening for hydrops fetalis
- Z3682 – Encounter for antenatal screening for nuchal translucency
- Z3683 – Encounter for fetal screening for congenital cardiac abnormalities
- Z3684 – Encounter for antenatal screening for fetal lung maturity
- Z3685 – Encounter for antenatal screening for Streptococcus B
- Z3686 – Encounter for antenatal screening for cervical length
- Z3687 – Encounter for antenatal screening for uncertain dates
- Z3688 – Encounter for antenatal screening for fetal macrosomia
- Z3689 – Encounter for other specified antenatal screening
- Z368A – Encounter for antenatal screening for other genetic defects
- Z369 – Encounter for antenatal screening, unspecified
Surgical Services
- ICD-10 diagnosis codes added for phrenic nerve stimulator, effective for DOS on or after October 1, 2017
- G1223 – Primary lateral sclerosis
- G1224 – Familial motor neuron disease
- G1225 – Progressive spinal muscle atrophy
- ICD-10 procedure codes added for phrenic nerve stimulator services, effective for DOS on or after October 1, 2017
- 0BHT0MZ – Insertion of Diaphragmatic Pacemaker Lead into Diaphragm, Open Approach
- 0BHT3MZ – Insertion of Diaphragmatic Pacemaker Lead into Diaphragm, Percutaneous Approach
- 0BHT4MZ – Insertion of Diaphragmatic Pacemaker Lead into Diaphragm, Percutaneous Endoscopic Approach
Third-Party Liability
- Additional ICD-10 prenatal care diagnosis codes that bypass cost avoidance, effective for DOS on or after October 1, 2017
- O368310 – Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, not applicable or unspecified
- O368311 – Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, fetus 1
- O368312 – Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, fetus 2
- O368313 – Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, fetus 3
- O368314 – Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, fetus 4
- O368315 – Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, fetus 5
- O368319 – Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester, other fetus
- O368320 – Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, not applicable or unspecified
- O368321 – Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, fetus 1
- O368322 – Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, fetus 2
- O368323 – Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, fetus 3
- O368324 – Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, fetus 4
- O368325 – Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, fetus 5
- O368329 – Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester, other fetus
- O368330 – Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, not applicable or unspecified
- O368331 – Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, fetus 1
- O368332 – Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, fetus 2
- O368333 – Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, fetus 3
- O368334 – Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, fetus 4
- O368335 – Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, fetus 5
- O368339 – Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester, other fetus
- O368390 – Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, not applicable or unspecified
- O368391 – Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, fetus 1
- O368392 – Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, fetus 2
- O368393 – Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, fetus 3
- O368394 – Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, fetus 4
- O368395 – Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, fetus 5
- O368399 – Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester, other fetus
- Z360 – Encounter for antenatal screening for chromosomal anomalies
- Z361 – Encounter for antenatal screening for raised alphafetoprotein level
- Z362 – Encounter for other antenatal screening follow-up
- Z363 – Encounter for antenatal screening for malformations
- Z364 – Encounter for antenatal screening for fetal growth retardation
- Z365 – Encounter for antenatal screening for isoimmunization
- Z3681 – Encounter for antenatal screening for hydrops fetalis
- Z3682 – Encounter for antenatal screening for nuchal translucency
- Z3683 – Encounter for fetal screening for congenital cardiac abnormalities
- Z3684 – Encounter for antenatal screening for fetal lung maturity
- Z3685 – Encounter for antenatal screening for Streptococcus B
- Z3686 – Encounter for antenatal screening for cervical length
- Z3687 – Encounter for antenatal screening for uncertain dates
- Z3688 – Encounter for antenatal screening for fetal macrosomia
- Z3689 – Encounter for other specified antenatal screening
- Z368A – Encounter for antenatal screening for other genetic defects
- Z369 – Encounter for antenatal screening, unspecified
To review the full list of new, revised, and discontinued codes, refer to CMS’ diagnosis codes and procedure codes pages.
Source(s): Indiana Medicaid for Providers;
