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

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

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;

 

 

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