ICD-10-CM Browser Tool
What is the ICD-10-CM Browser Tool
The National Center for Health Statistics ICD-10-CM Browser tool is here https://icd10cmtool.cdc.gov/ This user-friendly web-based query application allows users to search for codes from the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) and provides instructional information needed to understand the usage of ICD-10-CM codes. The application provides access to multiple fiscal year version sets that are available with real-time comprehensive results via the search capabilities.
The National Center for Health Statistics updates ICD-10-CM on an annual basis. In addition to the new browser tool, ICD-10-CM and all approved updates to the classification are still available on this webpage for public use.
ICD-10-CM Browser Tool https://icd10cmtool.cdc.gov/
Online user’s guide
- The Official ICD–10–CM Coding Guidelines
- ICD–10–CM Tabular List of Diseases and Injuries
- ICD–10–CM Index to Diseases and Injuries
- ICD–10–CM External Cause of Injuries Index
- ICD–10–CM Table of Neoplasms
- ICD–10–CM Table of Drugs and Chemicals
Functionality features include:
- Search Index for main term or subterms
- Search by ICD–10–CM code
- Pop-up instructional notes
- Ability to toggle from the Index to the Tabular list
To receive email updates about this page, enter your email address:
- Centers for Medicare and Medicaid Services external icon
- World Health Organization external icon
Exit Notification / Disclaimer Policy
- The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
- Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
- CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.
- Type 2 Diabetes
- Heart Disease
- Digestive Health
- Multiple Sclerosis
- COVID-19 Vaccines
- Occupational Therapy
- Healthy Aging
- Health Insurance
- Public Health
- Patient Rights
- Caregivers & Loved Ones
- End of Life Concerns
- Health News
- Thyroid Test Analyzer
- Doctor Discussion Guides
- Hemoglobin A1c Test Analyzer
- Lipid Test Analyzer
- Complete Blood Count (CBC) Analyzer
- What to Buy
- Editorial Process
- Meet Our Medical Expert Board
ICD 10 Codes and How to Look Them Up
The right code ensures you're correctly treated and billed
International Classification of Diseases (ICD) codes are a set of designations used by healthcare staff to communicate diseases, symptoms, abnormal findings, and other elements of a patient's diagnosis in a way that is universally accepted by those in the medical and insurance fields. The tenth and most recent edition is known as ICD-10.
ICD-10 codes are passed to insurance companies to establish the medical necessity of the services a provider is asking to be paid for. There are more than 70,000 of them, and their highly specific definitions are understood by all who use them.
While ICD-10 codes often appear on patient paperwork and bills, they don't always. Looking up these codes can become quite important if you're trying to sort out a medical pre-approval or billing issue with your insurance provider. An incorrect code can mean that coverage of practitioner visits and treatments gets denied.
This article explains how medical professionals use ICD codes, why they matter to you, and how you can find an ICD-10 when you need it.
SDI Productions / Getty Images
How to Look Up ICD-10 Codes
You may want to look up an ICD code because:
- Your insurance claim is being disputed
- Your insurance claim has not been paid
- You have submitted for pre-approval for a certain treatment or specialist visit and were denied
This sometimes happens when an ICD code does not align with a CPT code, which is similar designation that identifies the services rendered or being requested.
You may be able to find ICD-10 codes for a recent visit by checking out the summary given to you by your healthcare provider or hospital. ICD codes should be listed under "diagnosis" or "Dx."
Explanation of benefits (EOB) statements from your insurance company, Medicare, or another payer may also contain ICD codes.
If you need to look up the ICD code for a particular diagnosis or confirm what an ICD code stands for, visit the Centers for Disease Control and Prevention (CDC) website to use their free searchable database of current ICD-10 codes.
Having ICD-10 codes on-hand—both the correct ones for your situation and those that were filed in your case, if different—can help you have a more productive conversation with your provider, their billing department, and your insurance company.
How ICD Codes Are Used
ICD codes are used in billing, treatments, and statistics collection. Having the right code is important to ensure that standardized treatment for a medical issue is delivered and that medical expenses are reimbursed.
In the United States, ICD codes are overseen by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS).
The ICD receives annual updates in between revisions, which is sometimes reflected in the code title. For example, the 2020 updated version was the ICD-10-CM. The ICD-11 was approved by the WHO in 2019 so it can go into effect in 2022.
The ICD is maintained by the World Health Organization (WHO) and used across the globe, with some country-specific modifications.
When your healthcare provider submits a bill to an insurance company for reimbursement , each service is described by a common procedural technology (CPT) code . It is matched to an ICD code. If the two codes don't align correctly with each other, the company may deny payment.
In other words, if the service isn't one that would typically be provided for someone with that diagnosis, an insurance company will not pay.
For example, your healthcare provider should not submit a bill for an X-ray if you come in complaining of a rash since imaging is not indicated for that concern.
An ICD code is assigned to every disease. If you have a chronic illness, such as diabetes or heart disease, your ICD code will typically follow your medical records.
In a hospital setting, this can be lifesaving. But for patients with chronic conditions who come to the hospital for an unrelated issue, this can cause frustration.
When you meet a new healthcare provider, they may ask questions about the chronic illness first instead of focusing on your reason for being in the hospital. However, while a condition may seem unrelated to you, there may be a connection known only to the physician.
This process makes sense when you consider that about 80% of "older adults" have at least one chronic health condition while 50% have two or more.
Still, this reality sometimes results in a provider ordering unnecessary tests and treatments that are indicated for the chronic condition rather than focusing on the concern that caused you to seek treatment.
ICD codes are used globally to track health statistics and causes of death. This is helpful for gathering data on chronic illnesses as well as new ones. For example, a new code was added to the ICD-10 in 2020 to track vaping-related illnesses .
ICD codes are also used in clinical trials to recruit and track subjects and are sometimes, though not always, included on death certificates.
Elements of ICD-10 Codes
The ICD-10 update in 2015 completely overhauled the coding system. The new codes are broken down into chapters and subchapters. They include a letter plus two digits to the left of the decimal point, then one or two digits to the right.
The letters group diseases together and describe a specific condition, organ system, or characteristic of a condition. The numbers further refine that definition.
For example, E10.9 stands for type 1 diabetes and E11.9 is type 2 diabetes.
The letter is determined by the nature of the diagnosis:
- A: Infectious and parasitic diseases
- B: Infectious and parasitic diseases
- D: Neoplasms, blood, and blood-forming organs
- E: Endocrine, nutritional, or metabolic
- F: Mental and behavioral disorders
- G: Nervous system
- H: Eyes, ears, nose, and throat
- I: Circulatory system
- J: Respiratory system
- K: Digestive system
- M: Musculoskeletal system
- N: Genitourinary system
- O: Pregnancy and childbirth
- P: Perinatal conditions
- Q: Congenital and chromosomal abnormalities
- R: Abnormal clinical and lab findings
- S: Injury, poisoning, and other external causes
- T: Injury, poisoning, and other external causes
- U: Used for emergency designation
- V: External causes of morbidity
- W: External causes of morbidity
- X: External causes of morbidity
- Y: External causes of morbidity
- Z: Factors influencing health status and contact with health services
Updating ICD-10 Codes
In 2022, the ICD codes will change again with the addition of two numbers—one that precedes the letter and one that comes at the end. For example, X98.6 (ICD-10 code) will become 0X98.60.
The updated code also does not use letters "I" or "O" to avoid confusion with 1 and 0.
This new edition will be called ICD-11.
The International Classification of Diseases (ICD) is a tool that assigns codes—a kind of medical shorthand—for diseases, signs and symptoms, abnormal findings, circumstances, and external causes of diseases or injury. Insurance companies expect the codes to be consistent between a condition and the treatment rendered. Otherwise, they may balk at paying. This is reason enough to learn how to look them up for yourself.
Centers for Disease Control and Prevention. International classification of diseases, tenth revision, clinical modification (ICD-10-CM) .
Centers for Disease Control and Prevention. Depression is not a normal part of growing older.
Centers for Disease Control and Prevention. New ICD-10-CM code for vaping-related disorder to be implemented April 1, 2020 .
Cartwright DJ. ICD-9-CM to ICD-10-CM codes: What? why? how? Adv Wound Care (New Rochelle) . 2013;2(10):588–592. doi:10.1089/wound.2013.0478
World Health Organization. ICD-11 reference guide .
By Trisha Torrey Trisha Torrey is a patient empowerment and advocacy consultant. She has written several books about patient advocacy and how to best navigate the healthcare system.
By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.
Made by our clinical team and practitioner community. Try new resources in-app, download a PDF, or share your own
Discover growth and healing through Therapy and Development resources.
Navigate the path to recovery with Healthcare and Rehabilitation focused resources.
Explore Community and Educational resources for better well-being and empowerment.
Access our resources to elevate client care.
Lab Review ICD-10-CM Codes
Discover commonly used ICD-10 codes for lab review. Ensure accurate billing with these lab review diagnosis codes.
What ICD-10 Codes are Used for Lab Review
Regarding lab review in the medical field, several ICD-10 codes are commonly used to describe various clinical scenarios and conditions that may require laboratory tests and analysis. These codes help healthcare professionals accurately document and bill for the services provided during lab reviews. Here are the commonly used Lab Review ICD-10 codes , along with clinical descriptions for each code:
- R73.01 - Abnormal glucose: This code is used when a patient's blood glucose levels are outside the normal range, indicating potential issues such as diabetes or prediabetes, which often require further lab review and diagnostic testing.
- R74.0 - Abnormal serum enzyme levels: When lab results show elevated or abnormal levels of serum enzymes, it can be a sign of various medical conditions, such as liver disease or muscle injury, necessitating further lab review for a precise diagnosis.
- R82.5 - Proteinuria: Proteinuria indicates an abnormal amount of protein in the urine, which can be a sign of kidney disease, among other conditions. Lab reviews are essential for determining the underlying cause.
- D49.9 - Neoplasm of unspecified behavior of the endocrine glands: This code is used when lab results suggest the presence of an endocrine gland tumor, but further testing is required to determine whether it is benign, malignant, or uncertain.
- E03.9 - Hypothyroidism, unspecified: Hypothyroidism affecting the thyroid gland may require a lab review to diagnose the condition's severity and guide treatment decisions.
- R07.9 - Chest pain, unspecified: Lab tests may be conducted in chest pain cases to rule out severe cardiac conditions or to identify other causes, such as muscle strain or anxiety.
- N18.9 - Chronic kidney disease, unspecified: Lab review is crucial for diagnosing and staging chronic kidney disease, which can have various causes and complications.
- D72.829 - Eosinophilia, unspecified: Elevated eosinophil levels in blood tests can indicate various underlying conditions, including allergies, infections, or autoimmune diseases, requiring further investigation.
- R55 - Syncope and collapse: Lab work may be necessary to identify the underlying causes of syncope (fainting) and collapses resulting from heart issues, neurological problems, or other conditions.
- Z13.6 - Encounter for screening for cardiovascular disorders: This code is used when patients undergo lab reviews as part of routine cardiovascular screening, such as lipid profile testing, to assess their risk of heart disease.
Which Lab Review ICD codes are Billable
Determining whether specific lab review ICD-10 codes are billable depends on various factors, including the healthcare provider's documentation, the patient's insurance, and the particular circumstances of the lab review.
However, here is a general indication of whether commonly used lab review ICD-10 codes are typically billable:
- R73.01 - Abnormal glucose: Yes
- R74.0 - Abnormal serum enzyme levels: Yes
- R82.5 - Proteinuria: Yes
- D49.9 - Neoplasm of unspecified behavior of the endocrine glands: Yes
- E03.9 - Hypothyroidism, unspecified: Yes
- R07.9 - Chest pain, unspecified: Yes
- N18.9 - Chronic kidney disease, unspecified: Yes
- D72.829 - Eosinophilia, unspecified: Yes
- R55 - Syncope and collapse: Yes
- Z13.6 - Encounter for screening for cardiovascular disorders: Yes
These ICD-10 codes are commonly used for billing, but the necessity, visit context, and insurance coverage affects billability. Accurate documentation is crucial to support billing, and insurance policies and patient coverage also impact the process.
- ICD-10 codes are crucial in accurately documenting and billing for various medical conditions requiring laboratory reviews and diagnostic testing.
- These codes provide a standardized way to describe clinical scenarios, ensuring proper classification and billing for the services offered during lab reviews.
- ICD-10 codes are essential for medical professionals to track and monitor patients' health conditions, aiding diagnosis and treatment decisions.
- Lab reviews are often initiated when clinical symptoms or other findings indicate the need for further investigation and assessment.
- Accurate and detailed documentation by healthcare providers is fundamental to support the medical necessity of lab reviews for billing purposes.
- The specific context of the patient's visit, the medical necessity of the lab review, and the patient's insurance coverage all influence whether a lab review is billable.
- Commonly used ICD-10 codes for lab review encompass a range of conditions, from abnormal glucose levels to chest pain, proteinuria, and chronic diseases.
- Billing for lab reviews also depends on whether the review is part of routine screenings, diagnostic evaluations, or monitoring of chronic conditions.
- Insurance policies and the extent of patient coverage further impact the billing process and reimbursement for lab review services.
- Accurate coding and billing procedures ensure that healthcare providers can deliver quality care while efficiently managing their finances.
- Laboratory Examination
- Diagnostic Analysis
- Clinical Testing
- Medical Assessment
- Pathology Evaluation
Commonly asked questions
Use a Lab Review ICD code when documenting a medical condition that requires laboratory testing for diagnosis or monitoring.
Lab Review diagnoses can be billable, but it depends on factors such as medical necessity, context, and insurance coverage.
Lab Review Diagnosis Codes are not treatments; they indicate the need for laboratory testing. Treatments depend on the specific condition diagnosed.
History of covid 19 icd-10-cm codes | 2023.
Read this short guide to learn about History of COVID-19 ICD codes you can use!
Lisinopril Allergy ICD-10-CM Codes | 2023
Discover the specific ICD-10 codes for Lisinopril allergy. Navigate accurate documentation and categorization of allergic reactions to this ACE inhibitor.
Post Op ICD-10-CM Codes | 2023
Explore comprehensive ICD-10 codes for post-operative care. Ensure accurate billing and patient management with standardized Post Op diagnosis codes.
Night Sweats ICD-10-CM Codes | 2023
Read this short guide to learn about Night Sweats ICD codes you can use!
Left Hip Replacement ICD-10-CM Codes | 2023
Read this short guide to learn about Left Hip Replacement ICD codes you can use!
Status Post Pci ICD-10-CM Codes | 2023
Explore the comprehensive guide on ICD-10 codes for Status Post PCI. Stay updated with the latest coding standards for coronary angioplasty procedures.
Kidney Transplant ICD-10-CM Codes | 2023
Explore the comprehensive guide on ICD-10 codes specific to kidney transplant procedures, complications, and post-operative care. Stay informed and updated.
Agitation ICD-10-CM Codes | 2023
Explore the key ICD-10 codes for diagnosing agitation. Navigate precise clinical documentation and billing with our comprehensive guide on agitation.
Poor Oral Intake ICD-10-CM Codes | 2023
Looking for ICD-10 codes used for poor oral intake? Check out this guide to learn about codes’ clinical information, billability, synonyms, etc.
Surgical Aftercare ICD-10-CM Codes | 2023
Check out this guide to learn about the ICD-10 codes used for surgical aftercare, whether they’re billable, and some clinical information.
TB Screening ICD-10-CM Codes | 2023
Learn more about the ICD-10 codes used for TB screening, their billability, synonyms, and FAQ answers. Feel free to use our guide to code more accurately.
Gastric Bypass ICD-10-CM Codes | 2023
Read this short guide to learn about Gastric Bypass ICD codes you can use!
Hospital Follow Up ICD-10-CM Codes | 2023
Read this short guide to learn about Hospital Follow Up ICD codes you can use!
SIRS ICD-10-CM Codes | 2023
Read this short guide to learn about SIRS ICD codes you can use!
Neck Mass ICD-10-CM Codes | 2023
Read this short guide to learn about Neck Mass ICD codes you can use!
Learn about the ICD-10 code Z02.89 – Encounter for other administrative examinations.
Read this short guide to learn about the ICD-10 code R68.89 – Other general symptoms and signs.
Read this short guide to learn about the ICD-10 code Z78.0 – Asymptomatic menopausal state.
Read this short guide to learn about the ICD-10 code Z79.4 – Long term (current) use of insulin.
Explore the intricacies of ICD-10-CM codes F41.9 and Z23, related to encounters for immunization. Stay updated with Carepatron on coding guidelines.
Cardiac Stent ICD-10-CM Codes
Read this short guide to learn about Cardiac Stent ICD codes you can use!
Fever ICD-10-CM Codes
Read this short guide to learn about Fever ICD codes you can use!
Chronic Anticoagulation ICD-10-CM Codes
Read this short guide to learn about Chronic Anticoagulation ICD codes you can use!
Elevated Lipase ICD-10-CM Codes
Read this short guide to learn about Elevated Lipase ICD codes you can use!
Adult Failure To Thrive ICD-10-CM Codes
Discover commonly used ICD-10 codes for Adult Failure To Thrive, aiding accurate diagnosis and treatment of this condition in adults.
Facial Swelling ICD-10-CM Codes
Discover ICD-10 codes for facial swelling. Ensure accurate diagnosis and billing for treatment. Understand the codes for precise medical records.
AAA Screening (Abdominal Aortic Aneurysm Screening) ICD-10-CM Codes
Dive into the 2023 ICD codes for AAA Screening. Grasp the codes, billability, and clinical relevance for this vital cardiovascular screening procedure.
Elevated Blood Pressure ICD-10-CM Codes
Explore the 2023 ICD codes for Elevated Blood Pressure. Understand this common cardiovascular concern's codes, billability, and clinical relevance.
Leg Edema ICD-10-CM Codes
Uncover the 2023 ICD codes for Leg Edema. Delve into this common swelling condition's codes, billability, and clinical relevance.
Z45.2 – Encounter for adjustment and management of vascular access device | ICD-10-CM
Explore Z45.2 ICD codes for vascular access device management. Learn about billable codes, clinical information, and more.
Bowel Incontinence ICD-10-CM Codes
Read this short guide to learn about Bowel Incontinence ICD codes you can use.
Burning with Urination ICD-10-CM Codes
Read this short guide to learn about Burning with Urination ICD codes you can use.
Incomplete Bladder Emptying ICD-10-CM Codes
Know more about the ICD-10 code used for incomplete bladder emptying and its clinical description, symptoms, billability, etc.
Ambulatory Dysfunction ICD-10-CM Codes
Explore the essential ICD-10 codes for Ambulatory Dysfunction, including R26.0, R26.1, R26.81, and more. Learn about their clinical applications today.
Fatigue And Malaise ICD-10-CM Codes
Explore the specific ICD-10 codes for diagnosing fatigue and malaise. Understand their clinical significance & applications in today's healthcare industry.
Anticoagulation ICD-10-CM Codes
Dive into the comprehensive guide on Anticoagulation ICD codes for 2023. Understand the codes, their billability, and their clinical relevance.
Bilateral Lower Extremity Edema ICD-10-CM Codes
Dive into the comprehensive guide on Bilateral Lower Extremity Edema ICD codes for 2023. Understand the codes, their billability, and their clinical relevance.
Edema Lower Extremity ICD-10-CM Codes
Delve into the detailed guide on Edema Lower Extremity ICD codes for 2023. Learn about the codes, their billability, and their clinical implications.
Leg Swelling ICD-10-CM Codes
Delve into the comprehensive guide on Leg Swelling ICD codes for 2023. Discover the codes, their billability, and their clinical significance.
Unsteadiness On Feet ICD-10-CM Codes
Explore ICD-10-CM codes for unsteadiness on feet in 2023. Learn about common codes, billable statuses, and gain clinical insights in this comprehensive guide.
Failure To Thrive ICD-10-CM Codes
Explore ICD-10-CM codes for failure to thrive in 2023. Learn about common codes and billable statuses, and gain clinical insights in this comprehensive guide.
History of Falls ICD-10-CM Codes
Read this short guide to learn about the lone History of Falls ICD code you can use.
Fall Risk ICD-10-CM Codes
Explore the comprehensive guide on Fall Risk ICD codes for 2023. Understand the codes, their billability, and their clinical relevance in depth.
Falls ICD-10-CM Codes
Dive into the detailed guide on Falls ICD codes for 2023. Grasp the codes, their billability, and their clinical significance.
Trip And Fall ICD-10-CM Codes
Delve into the comprehensive guide on Trip And Fall ICD codes for 2023. Understand the codes, their billability, and their clinical significance in depth.
Ascites ICD-10-CM Codes
Navigate through the detailed guide on Ascites ICD codes for 2023. Uncover the codes, their billability, and their clinical significance.
Assault ICD-10-CM Codes
Delve into the comprehensive guide on Assault ICD codes for 2023. Understand this severe and concerning issue's codes, billability, and clinical significance.
Recurrent Falls ICD-10-CM Codes
Read this short guide to learn about Recurrent Falls ICD codes you can use. Explore clinical and billing information here.
Mitral Valve Repair ICD-10-CM Codes
Read this short guide and learn about mitral valve repair ICD codes you can use. Learn clinical and billing information here.
Cardiac Murmur ICD-10-CM Codes
Read this short guide to learn about Cardiac Murmur ICD codes you can use.
Bedbound ICD-10-CM Codes
Read this short guide to learn about Bedbound ICD codes you can use.
Transaminitis ICD-10-CM Codes
Read this short guide and learn about transaminitis ICD codes you can use. Learn about clinical and coding information here.
Elevated Lactic Acid ICD-10-CM Codes
Read this short guide and learn about elevated lactic acid ICD codes you can use. Explore clinical and billing information here.
Hysterectomy ICD-10-CM Codes
Read this short guide to learn about Hysterectomy ICD codes you can use!
R41.0 Disorientation ICD-10-CM Codes
Dive into the 2023 ICD codes for R41.0 Disorientation. Understand the codes, billability, and clinical relevance of this cognitive disturbance.
Confusion ICD-10-CM Codes
Explore the 2023 ICD codes for Confusion. Understand the codes, billability, and clinical relevance for this cognitive disturbance often seen in clinical settings.
Total Knee Arthroplasty ICD-10-CM Codes
Read this short guide to learn about Total Knee Arthroplasty ICD codes you can use.
Colostomy ICD-10-CM Codes
Navigate through the comprehensive guide on Colostomy ICD codes for 2023. Understand the codes, their billability, and their clinical relevance in depth.
Screening Osteoporosis ICD-10-CM Codes
Read this short guide and learn about screening osteoporosis ICD codes you can use.
MSSA Bacteremia ICD-10-CM Codes
Read this short guide and learn about MSAA Bacteremia ICD codes you can use.
Pre Op ICD-10-CM Codes
Learn about ICD-10 Codes Used for Pre Op clearances. Explore commonly used codes for cardiovascular, respiratory, and laboratory assessments before surgery.
BMI ICD-10-CM Codes
Learn about the essential role of ICD-10 Codes Used for BMI classification. These codes are a crucial metric for assessing weight-related health.
HX Breast Cancer ICD-10-CM Codes
Find the ICD-10-CM codes for breast cancer history. Indispensable for accurate medical billing, documentation, and comprehension of patient medical history.
Elevated PSA ICD-10-CM Codes
Discover the ICD-10-CM codes related to elevated PSA levels, vital for precise medical documentation, insurance billing, & targeted diagnostic procedures.
History of Stroke ICD-10-CM Codes
Read this short guide and learn about history of stroke ICD codes you can use. Explore billing and clinical information.
History of Appendectomy ICD-10-CM Codes
Read this short guide and learn about history of appendectomy ICD codes you can use. Learn about billing and clinical information.
Carotid Bruit CVA ICD-10-CM Codes
Familiarize yourself with the ICD-10 codes used for carotid bruit CVA and learn more about their synonyms, clinical descriptions, billability, etc.
Mouth Pain CVA ICD-10-CM Codes
Discover the ICD-10 Codes used for mouth pain CVA and their clinical description, synonyms, billability, etc.
History Of Migraine ICD-10-CM Codes
Explore the ICD-10-CM codes for a history of migraines in 2023. Understand the coding system for past migraine episodes and gain insights into this condition's documentation.
Expressive Aphasia ICD-10-CM Codes
Discover ICD-10-CM codes for Expressive Aphasia in 2023. Find out which codes are billable and gain clinical insights in this comprehensive guide.
History Of Abnormal Pap ICD-10-CM Codes
Explore ICD-10-CM codes for a history of abnormal Pap smears. Learn about standard codes, and billable statuses, and gain clinical insights in this comprehensive guide.
Peritoneal Dialysis ICD-10-CM Codes
Read this short guide and learn about peritoneal dialysis ICD codes you can use.
History of Brain Aneurysm ICD-10-CM Codes
Read this short guide and learn about the history of brain aneurysm ICD codes you can use.
BKA ICD-10-CM Codes
Learn about valid BKA ICD-10 codes related to Below-Knee Amputation (BKA) and when to use them.
Flank Pain ICD-10-CM Codes
Discover the 2023 guide on Flank Pain ICD-10-CM codes. Gain insights into the specific codes, clinical descriptions, and billing implications.
Edema ICD-10-CM Codes
Read this short guide and learn about edema ICD codes you can use.
Fibromyalgia ICD-10-CM Codes
Read this short guide and learn about fibromyalgia ICD codes you can use.
Nausea And Vomiting ICD-10-CM Codes
Read this short guide and learn about nausea and vomiting ICD codes you can use.
PCOS ICD-10-CM Codes
Read this short guide and learn about PCOS ICD codes you can use.
Food Allergy ICD-10-CM Codes
Navigate the guide on Food Allergy ICD-10-CM codes. Learn about the specific codes, clinical descriptions, and billing implications.
Nausea ICD-10-CM Codes
Read this short guide and learn about nausea ICD codes you can use.
Peripheral Edema ICD-10-CM Codes
Dive into the 2023 guide on Peripheral Edema ICD-10-CM codes. Learn about the specific codes, clinical descriptions, and billing implications.
Lower Urinary Tract Symptoms ICD-10-CM Codes
Explore the 2023 Lower Urinary Tract Symptoms ICD-10-CM codes guide. Delve into the specific codes, clinical descriptions, and billing implications.
Stroke-Like Symptoms ICD-10-CM Codes
Discover essential ICD-10 Codes Used for Stroke-Like Symptoms. Ensure accurate diagnosis and treatment with our comprehensive list.
Mammogram Screening ICD-10-CM Codes
Discover the ICD-10-CM codes vital for documenting mammogram screenings in 2023. Stay updated with the latest coding specifics.
Abnormal Pap Smear ICD-10-CM Codes
ICD-10 Codes for Abnormal Pap Smear: Dive into the ICD-10-CM codes essential for diagnosing and documenting abnormal Pap smear results in 2023.
Wound Care ICD-10-CM Codes
Discover the ICD-10 codes used for wound care and the codes’ clinical descriptions, billability, synonyms, and more.
History of Breast Cancer (Hx Breast Ca) ICD-10-CM Codes
Access this guide on the History of Breast Cancer (Hx Breast Ca) ICD-10-CM codes. Learn about the specific codes, descriptions, and billing implications.
Medical Clearance ICD-10-CM Codes
Read this short guide and learn about medical clearance ICD codes you can use!
Hospice ICD-10-CM Codes | 2023
Explore ICD-10-CM codes for Hospice in 2023. Learn about billable codes, clinical descriptions, synonyms, and more in this comprehensive guide for accurate diagnosis and documentation in hospice care.
Abnormal Weight Loss ICD-10-CM Codes
Explore ICD-10-CM codes for Abnormal Weight Loss in 2023, including diagnoses, documentation, and clinical descriptions. Learn more with this comprehensive guide!
Weight Loss ICD-10-CM Codes
Discover the 2023 ICD-10-CM codes for weight loss. This thorough manual covers billable codes, clinical descriptions, synonyms, and more to help with correct diagnosis and reporting.
Lymphadenopathy ICD-10-CM Codes
Explore this short guide to ICD-10 codes for lymphadenopathy. Learn more about the codes’ billability, synonyms, and clinical descriptions.
Nephrostomy Tube ICD-10-CM Codes
ICD-10 Codes Used for Nephrostomy Tube diagnoses in 2023 to streamline medical coding and billing with our practitioner-focused resource.
Loop Recorder ICD-10-CM Codes
Simplify coding with our ICD-10 Codes Used for Loop Recorder guide. Enhance your practice's efficiency with our practitioner-friendly ICD-10 code reference.
Statin Intolerance ICD-10-CM Codes
Discover the ICD-10-CM codes for Statin Intolerance. In this thorough reference, you will find thorough information about the ICD Codes for Statin Intolerance.
Discover the ICD-10-CM codes for Lung Nodul. Learn about billable codes, clinical descriptions, synonyms, and more.
Elevated Hematocrit ICD-10-CM Codes
Explore the comprehensive guide to ICD-10 codes for diagnosing elevated hematocrit, including R71.8, D58.2, and R79.89. Stay updated with 2023 codes.
Abnormal Lab Results ICD-10-CM Codes
Discover 2023 ICD-10 codes for diagnosing abnormal lab results, including R79.9, to enhance healthcare accuracy and patient outcomes.
Loss Of Consciousness ICD-10-CM Codes
ICD-10 Codes Used for Loss of Consciousness: Navigate the essential ICD-10-CM codes utilized for diagnosing and documenting instances of loss of consciousness in 2023.
Join 10,000+ teams using Carepatron to be more productive
Website maintenance is planned from midnight CT Wednesday, Nov. 8, to 8:00 a.m. CT Thursday, Nov. 9, and again from midnight CT Thursday, Nov. 9, to 8:00 a.m. CT Friday, Nov. 10. Brief disruptions will occur during this time.
How to properly code for a pre-op examination
Family physicians are frequently asked to perform pre-surgical evaluations, both in the office and at the hospital. The Centers for Medicare & Medicaid Services recently proposed no longer requiring a comprehensive medical history and physical assessment prior to surgery, but many patients will still need an evaluation and many surgeons will still request one.
Physicians must select a CPT code and a diagnosis code for the evaluation. This is typically done in the office for scheduled procedures and in the hospital for urgent or emergency surgery.
CPT codes. If the evaluation meets the requirements for a consultation, and if the patient’s insurance company still recognizes consultation codes (many commercial payers still do), you can bill a consult. Consult codes most accurately describe the service performed and are reimbursed at a higher rate than new and established patient visit codes. According to CPT, “A consultation is a type of evaluation and management service provided at the request of another physician or appropriate source to either recommend care for a specific condition or problem or to determine whether to accept responsibility for ongoing management of the patient’s entire care or for the care of a specific condition or problem.” Use outpatient codes 99241-99245 or inpatient codes 99251-99255 for new or established patients.
Like most evaluation and management codes, consultation codes have different levels that require performance and documentation of a certain level of history, exam, and medical decision-making as part of the encounter. If you perform and document the key components, and if the medical record reflects the request for evaluation and that you returned a report to the requesting physician, you should have no difficulty reporting a consultation code for the encounter, as long as the payer accepts consultation codes.
Medicare and Medicare Advantage plans do not recognize consult codes. State Medicaid programs and Managed Medicaid plans can also set their own rules and may not recognize consult codes. For these patients seen in the office, bill a new or established patient office visit code (99201-99205 or 99211-99215), and for inpatients bill the appropriate hospital care code. You can typically bill an initial hospital service (99221-99223). The admitting physician typically uses an AI modifier (Principal Physician of Record) on the initial hospital care code to indicate that he or she is the admitting physician, and consultants typically use the initial hospital care code with no modifier.
Diagnosis codes. For the diagnosis, use a code from subcategory Z01.81-, “Encounter for preprocedural examinations,” based on the co-morbidities you are assessing:
• Z01.810, “Encounter for preprocedural cardiovascular examination.”
• Z01.811, “Encounter for preprocedural respiratory examination.”
• Z01.812, “Encounter for preprocedural laboratory examination.”
• Z01.818, “Encounter for other preprocedural examination.”
Most pre-op exams will be coded with Z01.818. The ICD-10 instructions say to use the preprocedural diagnosis code first, and then the reason for the surgery and any additional findings.
Evaluations before surgery are reimbursable services. Select the type of service – established visit, consult, initial hospital care, etc. – and the reason for the visit in order to get paid.
– Betsy Nicoletti, a Massachusetts-based coding and billing consultant
Get "Quick Tips" in your inbox
Sign up to receive FPM 's free, weekly e-newsletter, "Quick Tips & Insights," featuring practical, peer-reviewed advice for improving practice, enhancing the patient experience, and developing a rewarding career.
- Chronic care
- Physician compensation
- Practice management
- Value-based payment
- Quick Tips from FPM journal
- AFP Community Blog
- FPs on the Front Lines
- Fresh Perspectives
- In the Trenches
- Leader Voices
- RSS ( About RSS )
Copyright © 2023 American Academy of Family Physicians. All Rights Reserved.
- FAC Articles
Working from home?
Keep your critical coding and billing tools with you no matter where you work.
Create your Find-A-Code account today!
Find-A-Code Articles, Published 2021, September 28
When is it proper to bill nurse visits using 99211.
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS Sep 28th, 2021 - Reviewed/Updated Aug 29th
When vaccines or injections are given in the office, coding can often get confusing; for example, is it correct to report a nurse visit using 99211 and an E/M office visit reporting 99202 ‑ 99215 and include injection fees with the vaccine product? In addition, the reporting of evaluation and management (E/M) during the same visit where vaccines are administered is not always understood. The answer depends on whether the provider performs a medically necessary and significant, separately identifiable E/M visit, in addition to the immunization administration.
CMS states, when a separately identifiable E/M service (which meets a higher complexity level than CPT code 99211 ) is performed, in addition to drug administration services, you should report the appropriate E/M CPT code reported with modifier -25. Documentation should support the level of E/M service billed. For an E/M service provided on the same day, a different diagnosis is not required.
It is incorrect to bill a 99211 when the provider provides an E/M service that meets a higher complexity level than CPT code 99211 , you must bill the higher complexity, and you cannot bill for two services in one day.
Charging for Nurse Visits
There are times when it is appropriate to report for a nurse visit using CPT code 99211 . The Incident-to rule applies when reporting this code, and services provided must be documented as medically necessary services, including the clinical history, clinical exam, making a clinical decision, and physician supervision.
- NOTE: A nurse visit is not paid if billed with a drug administration service such as chemotherapy or non-chemotherapy drug infusion code, including therapeutic or diagnostic injection codes. The reasoning is because diagnostic IV infusion or injection services typically require direct physician supervision, and using 99211 is reported by qualified healthcare professionals other than physicians.
08/29/2023 NOTE: (These CPT codes,90782, 90783, 90784, or 90788 were deleted in 2006, but still showing in CMS - Claims processing manual) When reporting CPT codes 90782, 90783, 90784, or 90788 , CPT code 99211 cannot be reported. In addition, it is improper billing to report a visit solely for an injection that meets the definition of the injection codes.
When the only reason for the visit is for the patient to receive an injection, payment may be made only for the injection (if it is covered). An office visit using 99211 would not be warranted where the services rendered did not constitute a regular office visit and a part of the plan of care and not at the patient's request.
Unlike other E/M codes 99202 - 99205 , and 99212 - 99215 , time alone cannot be used when reporting 99211 when selecting the appropriate code level for E/M services. Effective January 1, 2021, time was removed as an available code-selection criterion. The typical time spent on this code is five minutes.
Other visits billed with 99211
Several other visits may be reported using 99211 , and nurses are not the only staff that can report this code; medical Assistants and technicians are also included under non-physician.
According to CMS ; Physician offices can use CPT code 99211 when office clinical staff furnish assessment of symptoms and specimen collection for Covid-19 incident to the billing professionals services for both new and established patients. When the specimen collection is performed as part of another service or procedure, such as a higher-level visit furnished by the billing practitioner, that higher-level visit code should be billed. The specimen collection would not be separately payable.
Examples from CMS
The following are examples of when CPT 99211 might be used:
- Office visit for an established patient for blood pressure check and medication monitoring and advice. History, blood pressure recording, medications, and advice are documented, and the record establishes the necessity for the patient's visit.
- Office visit for an established patient for return to work certificate and advice (if allowed to be by other than the physician). Exam and recommendation are noted, and the Return to Work Certificate is completed, copied, and placed in the record.
- Office visit for an established patient on regular immunotherapy who developed wheezing, rash, and swollen arm after the last injection. Possible dose adjustments are discussed with the physician, and an injection is given. History, exam, dosage, and follow-up instructions are recorded.
- Office visit for an established patient's periodic methotrexate injection. Monitoring Lab tests, query signs and symptoms, obtain vital signs, repeat testing, and injection advised. All this information is recorded and reviewed by the physician. (Note that in this circumstance, if 99211 is billed, the injection code is not separately billable). An office visit for an established patient with a new or concerning bruise is checked by the nurse (whether or not the patient is taking anticoagulants), and the patient is advised on how to care for the bruise and what to be concerned about, and, if on anticoagulants, continuing or changing current dosage is advised. History, exam, dosage, and instructions are recorded and reviewed by the physician.
- Office visit for an established patient with atrial fibrillation who is taking anticoagulants and has no complaints . The patient is queried by the nurse, vital signs are obtained, the patient is observed for bruises and other problems, the prothrombin time is obtained, the physician is advised of prothrombin time and medication dose, and medication is continued at present dose with follow up prothrombin time in one month recommended. History, vital signs, exam, prothrombin time, INR, dosage, physician's decision, and follow-up instructions are recorded.
About christine woolstenhulme, qmc qcc cmcs cpc cmrs.
Christine Woolstenhulme, CPC, QCC, CMCS, CMRS, is a Certified coder and Medical Biller currently employed with Find-A-Code. Bringing over 30 years of insight, business knowledge, and innovation to the healthcare industry. Establishing a successful Medical Billing Company from 1994 to 2015, during this time, Christine has had the opportunity to learn all aspects of revenue cycle management while working with independent practitioners and in clinic settings. Christine was a VAR for AltaPoint EHR software sales, along with management positions and medical practice consulting. Understanding the complete patient engagement cycle and developing efficient processes to coordinate teams ensuring best practice standards in healthcare. Working with payers on coding and interpreting ACA policies according to state benchmarks and insurance filings and implementing company procedures and policies to coordinate teams and payer benefits.
When is it Proper to Bill Nurse Visits using 99211. (2021, September 28). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/nurse-visits-and-injections-36866.html
Article Tags (click on a tag to see related articles)
Thank you for choosing Find-A-Code, please Sign In to remove ads.
Billing and coding
Pay a hospital or physician bill
Visit our billing site to pay your hospital or physician bill. Please have your lab code and invoice number ready.
To learn more about Excludes1 logic and how Excludes1 notes interact with Quanum, watch our video .
For additional details regarding Excludes1 rules and coding edits, click here .
We’re pleased to provide Medicare Coverage and Coding Reference Guides to help you more easily determine test coverage and find ICD-10 diagnosis codes to submit with your test order. By doing so, you can ensure your Medicare patients’ lab tests are performed without delay and prevent disruptions to your office.
Medicaid limited coverage policies
Quest’s Medicaid coverage and coding reference guides can help you understand coverage limitation—preventing potential disruptions to your practice.
Commercial coverage and coding
Quest’s Commercial Coverage and Coding Reference Guides can help you understand coverage limitations and which ICD-10 codes are most frequently ordered by physicians. Understanding these coverage limitations may help prevent administrative disruptions to your practice.
Learn how to register your lab for Z-Codes .
CPT ® Code changes for 2023
View CPT Code changes for 2023 .
Have a billing question? Contact customer service
Billing & coding
Commercial coverage & coding guidelines
Medicare coverage & coding guides
Preferred Lab Networks & Partners
Looking for patient billing?
Resources and insights from quest.
- How we operate
- Corporate responsibility
- Inclusion and diversity
- Actions and insights
- Specialty labs
- Privacy Notices
- Language assistance / non-discrimination
- Asistencia de idiomas / Aviso de no discriminación
- 語言協助 / 不歧視通知
- Your Privacy Choices
Quest® is the brand name used for services offered by Quest Diagnostics Incorporated and its affiliated companies. Quest Diagnostics Incorporated and certain affiliates are CLIA certified laboratories that provide HIPAA covered services. Other affiliates operated under the Quest® brand, such as Quest Consumer Inc., do not provide HIPAA covered services.
Quest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics. All third-party marks—® and ™—are the property of their respective owners. © 2023 Quest Diagnostics Incorporated. All rights reserved. Image content features models and is intended for illustrative purposes only.
You are now leaving the Quest Diagnostics web site. Quest Diagnostics does not control the site you are about to enter and accepts no responsibility for its content.
We'll redirect you to MyDocBill.com, the website of Quest’s billing services provider. Here, Quest patients have secure access to pay their bill, update insurance, edit their profile and view their account history.
Employer Health and Wellness
To schedule an appointment for your employer health and wellness screening (biometric screening), we need to redirect you to the Health & Wellness website.
- Your doctor must have ordered your COVID-19 antibody testing or you must have purchased a test through QuestDirect. COVID-19 is highly contagious. If you are currently experiencing COVID-19 symptoms, you must first contact your doctor for next steps..
- We can only accept patients in our Patient Service Centers who have been confirmed to be COVID-19 symptoms-free for at least 10 days.
Please visit our appointment scheduling page to make your appointment.