Notification



Notification Issue Date:



Policy Attachment



Attachment to Policy # 07.00.02i


Attachment:A

Policy #:07.00.02i

Description:ICD-10 Codes

Title:Intravenous Chelation Therapy


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.



E83.00 Disorder of copper metabolism, unspecified

E83.01 Wilson's disease

E83.09 Other disorders of copper metabolism

E83.10 Disorder of iron metabolism, unspecified

E83.110 Hereditary hemochromatosis

E83.111 Hemochromatosis due to repeated red blood cell transfusions

E83.118 Other hemochromatosis

E83.119 Hemochromatosis, unspecified

E83.19 Other disorders of iron metabolism

E83.52 Hypercalcemia

E83.59 Other disorders of calcium metabolism

R78.71 Abnormal lead level in blood

R78.79 Finding of abnormal level of heavy metals in blood

R79.0 Abnormal level of blood mineral

T37.8x1A Poisoning by other specified systemic anti-infectives and antiparasitics, accidental (unintentional), initial encounter

T37.8x1D Poisoning by other specified systemic anti-infectives and antiparasitics, accidental (unintentional), subsequent encounter

T37.8x1S Poisoning by other specified systemic anti-infectives and antiparasitics, accidental (unintentional), sequela

T45.4x1A Poisoning by iron and its compounds, accidental (unintentional), initial encounter

T45.4x1D Poisoning by iron and its compounds, accidental (unintentional), subsequent encounter

T45.4x1S Poisoning by iron and its compounds, accidental (unintentional), sequela

T45.4x2A Poisoning by iron and its compounds, intentional self-harm, initial encounter

T45.4x2D Poisoning by iron and its compounds, intentional self-harm, subsequent encounter

T45.4x2S Poisoning by iron and its compounds, intentional self-harm, sequela

T45.4x3A Poisoning by iron and its compounds, assault, initial encounter

T45.4x3D Poisoning by iron and its compounds, assault, subsequent encounter

T45.4x3S Poisoning by iron and its compounds, assault, sequela

T45.4x4A Poisoning by iron and its compounds, undetermined, initial encounter

T45.4x4D Poisoning by iron and its compounds, undetermined, subsequent encounter

T45.4x4S Poisoning by iron and its compounds, undetermined, sequela

T46.0x1A Poisoning by cardiac-stimulant glycosides and drugs of similar action, accidental (unintentional), initial encounter

T46.0x1D Poisoning by cardiac-stimulant glycosides and drugs of similar action, accidental (unintentional), subsequent encounter

T46.0x1S Poisoning by cardiac-stimulant glycosides and drugs of similar action, accidental (unintentional), sequela

T46.0x2A Poisoning by cardiac-stimulant glycosides and drugs of similar action, intentional self-harm, initial encounter

T46.0x2D Poisoning by cardiac-stimulant glycosides and drugs of similar action, intentional self-harm, subsequent encounter

T46.0x2S Poisoning by cardiac-stimulant glycosides and drugs of similar action, intentional self-harm, sequela

T46.0x3A Poisoning by cardiac-stimulant glycosides and drugs of similar action, assault, initial encounter

T46.0x3D Poisoning by cardiac-stimulant glycosides and drugs of similar action, assault, subsequent encounter

T46.0x3S Poisoning by cardiac-stimulant glycosides and drugs of similar action, assault, sequela

T46.0x4A Poisoning by cardiac-stimulant glycosides and drugs of similar action, undetermined, initial encounter

T46.0x4D Poisoning by cardiac-stimulant glycosides and drugs of similar action, undetermined, subsequent encounter

T46.0x4S Poisoning by cardiac-stimulant glycosides and drugs of similar action, undetermined, sequela

T56.0x1A Toxic effect of lead and its compounds, accidental (unintentional), initial encounter

T56.0x1D Toxic effect of lead and its compounds, accidental (unintentional), subsequent encounter

T56.0x1S Toxic effect of lead and its compounds, accidental (unintentional), sequela

T56.0x2A Toxic effect of lead and its compounds, intentional self-harm, initial encounter

T56.0x2D Toxic effect of lead and its compounds, intentional self-harm, subsequent encounter

T56.0x2S Toxic effect of lead and its compounds, intentional self-harm, sequela

T56.0x3A Toxic effect of lead and its compounds, assault, initial encounter

T56.0x3D Toxic effect of lead and its compounds, assault, subsequent encounter

T56.0x3S Toxic effect of lead and its compounds, assault, sequela

T56.0x4A Toxic effect of lead and its compounds, undetermined, initial encounter

T56.0x4D Toxic effect of lead and its compounds, undetermined, subsequent encounter

T56.0x4S Toxic effect of lead and its compounds, undetermined, sequela

T56.1x1A Toxic effect of mercury and its compounds, accidental (unintentional), initial encounter

T56.1x1D Toxic effect of mercury and its compounds, accidental (unintentional), subsequent encounter

T56.1x1S Toxic effect of mercury and its compounds, accidental (unintentional), sequela

T56.1x2A Toxic effect of mercury and its compounds, intentional self-harm, initial encounter

T56.1x2D Toxic effect of mercury and its compounds, intentional self-harm, subsequent encounter

T56.1x2S Toxic effect of mercury and its compounds, intentional self-harm, sequela

T56.1x3A Toxic effect of mercury and its compounds, assault, initial encounter

T56.1x3D Toxic effect of mercury and its compounds, assault, subsequent encounter

T56.1x3S Toxic effect of mercury and its compounds, assault, sequela

T56.1x4A Toxic effect of mercury and its compounds, undetermined, initial encounter

T56.1x4D Toxic effect of mercury and its compounds, undetermined, subsequent encounter

T56.1x4S Toxic effect of mercury and its compounds, undetermined, sequela

T56.2X1A Toxic effect of chromium and its compounds, accidental (unintentional), initial encounter

T56.2X1D Toxic effect of chromium and its compounds, accidental (unintentional), subsequent encounter

T56.2X1S Toxic effect of chromium and its compounds, accidental (unintentional), sequela

T56.2X2A Toxic effect of chromium and its compounds, intentional self-harm, initial encounter

T56.2X2D Toxic effect of chromium and its compounds, intentional self-harm, subsequent encounter

T56.2X2S Toxic effect of chromium and its compounds, intentional self-harm, sequela

T56.2X3A Toxic effect of chromium and its compounds, assault, initial encounter

T56.2X3D Toxic effect of chromium and its compounds, assault, subsequent encounter

T56.2X3S Toxic effect of chromium and its compounds, assault, sequela

T56.2X4A Toxic effect of chromium and its compounds, undetermined, initial encounter

T56.2X4D Toxic effect of chromium and its compounds, undetermined, subsequent encounter

T56.2X4S Toxic effect of chromium and its compounds, undetermined, sequela

T56.3x1A Toxic effect of cadmium and its compounds, accidental (unintentional), initial encounter

T56.3x1D Toxic effect of cadmium and its compounds, accidental (unintentional), subsequent encounter

T56.3x1S Toxic effect of cadmium and its compounds, accidental (unintentional), sequela

T56.3x2A Toxic effect of cadmium and its compounds, intentional self-harm, initial encounter

T56.3x2D Toxic effect of cadmium and its compounds, intentional self-harm, subsequent encounter

T56.3x2S Toxic effect of cadmium and its compounds, intentional self-harm, sequela

T56.3x3A Toxic effect of cadmium and its compounds, assault, initial encounter

T56.3x3D Toxic effect of cadmium and its compounds, assault, subsequent encounter

T56.3x3S Toxic effect of cadmium and its compounds, assault, sequela

T56.3x4A Toxic effect of cadmium and its compounds, undetermined, initial encounter

T56.3x4D Toxic effect of cadmium and its compounds, undetermined, subsequent encounter

T56.3x4S Toxic effect of cadmium and its compounds, 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

T56.4x2A Toxic effect of copper and its compounds, intentional self-harm, initial encounter

T56.4x2D Toxic effect of copper and its compounds, intentional self-harm, subsequent encounter

T56.4x2S Toxic effect of copper and its compounds, intentional self-harm, sequela

T56.4x3A Toxic effect of copper and its compounds, assault, initial encounter

T56.4x3D Toxic effect of copper and its compounds, assault, subsequent encounter

T56.4x3S Toxic effect of copper and its compounds, assault, sequela

T56.4x4A Toxic effect of copper and its compounds, undetermined, initial encounter

T56.4x4D Toxic effect of copper and its compounds, undetermined, subsequent encounter

T56.4x4S Toxic effect of copper and its compounds, undetermined, sequela

T56.5x1A Toxic effect of zinc and its compounds, accidental (unintentional), initial encounter

T56.5x1D Toxic effect of zinc and its compounds, accidental (unintentional), subsequent encounter

T56.5x1S Toxic effect of zinc and its compounds, accidental (unintentional), sequela

T56.5x2A Toxic effect of zinc and its compounds, intentional self-harm, initial encounter

T56.5x2D Toxic effect of zinc and its compounds, intentional self-harm, subsequent encounter

T56.5x2S Toxic effect of zinc and its compounds, intentional self-harm, sequela

T56.5x3A Toxic effect of zinc and its compounds, assault, initial encounter

T56.5x3D Toxic effect of zinc and its compounds, assault, subsequent encounter

T56.5x3S Toxic effect of zinc and its compounds, assault, sequela

T56.5x4A Toxic effect of zinc and its compounds, undetermined, initial encounter

T56.5x4D Toxic effect of zinc and its compounds, undetermined, subsequent encounter

T56.5x4S Toxic effect of zinc and its compounds, undetermined, sequela

T56.6x1A Toxic effect of tin and its compounds, accidental (unintentional), initial encounter

T56.6x1D Toxic effect of tin and its compounds, accidental (unintentional), subsequent encounter

T56.6x1S Toxic effect of tin and its compounds, accidental (unintentional), sequela

T56.6x2A Toxic effect of tin and its compounds, intentional self-harm, initial encounter

T56.6x2D Toxic effect of tin and its compounds, intentional self-harm, subsequent encounter

T56.6x2S Toxic effect of tin and its compounds, intentional self-harm, sequela

T56.6x3A Toxic effect of tin and its compounds, assault, initial encounter

T56.6x3D Toxic effect of tin and its compounds, assault, subsequent encounter

T56.6x3S Toxic effect of tin and its compounds, assault, sequela

T56.6x4A Toxic effect of tin and its compounds, undetermined, initial encounter

T56.6x4D Toxic effect of tin and its compounds, undetermined, subsequent encounter

T56.6x4S Toxic effect of tin and its compounds, undetermined, sequela

T56.811A Toxic effect of thallium, accidental (unintentional), initial encounter

T56.811D Toxic effect of thallium, accidental (unintentional), subsequent encounter

T56.811S Toxic effect of thallium, accidental (unintentional), sequela

T56.812A Toxic effect of thallium, intentional self-harm, initial encounter

T56.812D Toxic effect of thallium, intentional self-harm, subsequent encounter

T56.812S Toxic effect of thallium, intentional self-harm, sequela

T56.813A Toxic effect of thallium, assault, initial encounter

T56.813D Toxic effect of thallium, assault, subsequent encounter

T56.813S Toxic effect of thallium, assault, sequela

T56.814A Toxic effect of thallium, undetermined, initial encounter

T56.814D Toxic effect of thallium, undetermined, subsequent encounter

T56.814S Toxic effect of thallium, undetermined, sequela

T56.891A Toxic effect of other metals, accidental (unintentional), initial encounter

T56.891D Toxic effect of other metals, accidental (unintentional), subsequent encounter

T56.891S Toxic effect of other metals, accidental (unintentional), sequela

T56.892A Toxic effect of other metals, intentional self-harm, initial encounter

T56.892D Toxic effect of other metals, intentional self-harm, subsequent encounter

T56.892S Toxic effect of other metals, intentional self-harm, sequela

T56.893A Toxic effect of other metals, assault, initial encounter

T56.893D Toxic effect of other metals, assault, subsequent encounter

T56.893S Toxic effect of other metals, assault, sequela

T56.894A Toxic effect of other metals, undetermined, initial encounter

T56.894D Toxic effect of other metals, undetermined, subsequent encounter

T56.894S Toxic effect of other metals, undetermined, sequela

T56.91XA Toxic effect of unspecified metal, accidental (unintentional), initial encounter

T56.91XD Toxic effect of unspecified metal, accidental (unintentional), subsequent encounter

T56.91XS Toxic effect of unspecified metal, accidental (unintentional), sequela

T56.92XA Toxic effect of unspecified metal, intentional self-harm, initial encounter

T56.92XD Toxic effect of unspecified metal, intentional self-harm, subsequent encounter

T56.92XS Toxic effect of unspecified metal, intentional self-harm, sequela

T56.93XA Toxic effect of unspecified metal, assault, initial encounter

T56.93XD Toxic effect of unspecified metal, assault, subsequent encounter

T56.93XS Toxic effect of unspecified metal, assault, sequela

T56.94XA Toxic effect of unspecified metal, undetermined, initial encounter

T56.94XD Toxic effect of unspecified metal, undetermined, subsequent encounter

T56.94XS Toxic effect of unspecified metal, undetermined, sequela

T57.0x1A Toxic effect of arsenic and its compounds, accidental (unintentional), initial encounter

T57.0x1D Toxic effect of arsenic and its compounds, accidental (unintentional), subsequent encounter

T57.0x1S Toxic effect of arsenic and its compounds, accidental (unintentional), sequela

T57.0x2A Toxic effect of arsenic and its compounds, intentional self-harm, initial encounter

T57.0x2D Toxic effect of arsenic and its compounds, intentional self-harm, subsequent encounter

T57.0x2S Toxic effect of arsenic and its compounds, intentional self-harm, sequela

T57.0x3A Toxic effect of arsenic and its compounds, assault, initial encounter

T57.0x3D Toxic effect of arsenic and its compounds, assault, subsequent encounter

T57.0x3S Toxic effect of arsenic and its compounds, assault, sequela

T57.0x4A Toxic effect of arsenic and its compounds, undetermined, initial encounter

T57.0x4D Toxic effect of arsenic and its compounds, undetermined, subsequent encounter

T57.0x4S Toxic effect of arsenic and its compounds, undetermined, sequela

Version Effective Date: 03/04/2019
Version Issued Date: 03/04/2019
Version Reissued Date: N/A



2017 AmeriHealth.