Frequently Used Tests & ICD9 Codes
Medicare limited coverage policies outline indications for which testing is considered reasonable and medically necessary. Monitoring of treatment or therapy may be reasonable and medically
necessary at frequencies outlined in Medicare's Limited Coverage Policies and indicated below as Q--. Test(s) ordered in addition to Medicare's recognized frequencies for monitoring and in
response to changes in patient treatment or condition, the diagnosis must support medical nenessity and should be accompanied by a diagnosis code (ICD9) specific to that medical condition. If
testing is requested which is not covered by Medicare the patient or responsible party may sign an Advanced beneficiary Notice (ABN) and be fully responsible for payment. Please refer to
your Medical Necessity policies and ICD9 Code book for additional information.
Albumin, Prealbumin (NDS)	Comprehensive Metabolic Panel (NDS)
263.0-Malnutrition of moderate degree	042-HIV Disease
263.9-Malnutrition, Protein-Calorie NOS	250.10-250.43-Diabetes Mellitus
269.9-Unspecified nutritional deficiency	250.80-250.83-Diabetes with other specified manifestations
280.9-Anemia, iron deficiency unspecified	263.0-Malnutrition of moderate degree
281.0-Anemia, pernicious	263.1-Malnutrition of mild degree
285.0-Sideroblastic anemia	263.9-Malnutrition, Protein-Calorie NOS
285.9-Anemia, unspecified	275.09-Disorders of iron metabolism (Hemochromatosis)
356.0-Hereditary peripheral neuropathy	276.50-Volume Depletion, unspecified
401.9-Hypertension, unspecified	290.0-Senile Dementia, Uncomplicated
586-Renal failure unspecified	290.3-Senile Dementia with Delirium
707.00-Pressure ulcer unspecified site	298.9-Unspecified psychosis
783.21-Abnormal loss of weight	401.9-Hypertension, unspecified
V58.69-Long-term (current) use of other (high risk) medications	536.2-Persistent Vomiting
CBCD, CBC, H&H (LC)	593.9-Unspecified Disorder of Kidney and Ureter
008.45-Infectious, Clostridium difficile	780.71-Fatigue syndrome, chronic
009.3-Diarrhea of presumed infectious origin	780.79-Other malaise and fatigue
041.11-Infectious, staphyloccus aureus	782.3-Edema
042-HIV Disease	782.4-Jaundice unspecified
250.00-250.93 Diabetes Mellitus	995.20-Unspecified adverse effect of drug, medical and biological susbstance
263.0-Malnutrition of moderate degree	V58.69-Long-term (current) use of other (high risk) medications
263.1-Malnutrition of mild degree	V67.51-Following completed treatment with high risk medicine, NEC
263.9-Malnutrition, Protein-Calorie NOS	B-type Natriuretic Peptide (BNP) (LC)
278.00-Obesity, unspecified	402.91-Unspecified Hypertensive Heart Disease with Heart Failure
280.0-Anemia, secondary to blood loss	428.0-Congestive Heart Failure Unspecified
280.1-Anemia, secondary to inadequat dietary intake	428.9-Heart Failure Unspecified
281.0-Anemia, pernicious	786.00-Respiratory Abnormality Unspecified
281.2-Anemia, folate deficiency	786.02-Orthopnea (difficulty breathing except in upright position)
286.5-Coagulation defects, Hemorragic disorder due to intrinsic circulating anticoagulants	786.05-Shortness of Breath
401.9-Hypertension, unspecified	786.06-Tachypnea (hyperventilation)
428.0-Congestive Heart Failure Unspecified	786.07-Wheezing
465.9-Infection, acute upper respiratory of unspecified site	Digoxin (LC) Q yearly after steady state is achieved
536.2-Persistent Vomiting	427.31-Atrial fibrillation
586-Renal failure unspecified	428.0-Congestive heart failure
780.60-Fever NOS	972.0-Cardiac rhythm regulators
780.79-Malaise and Fatigue	972.1-Poisioning by cardiotonic glycosides and drugs of similar action
782.3-Edema	995.20-Unspecified adverse effect of drug, medical and biological susbstance
783.1-Abnormal weight gain	V58.69-Long-term (current) use of other (high risk) medications
783.21-Abnormal loss of weight	Dilantin (Phenytoin) (NDS)
785.4-Gangrene	350.1-Trigeminal neuralgia
786.05-Shortness of Breath	427.9-Cardiac arrhythmia unspecified
786.07-Wheezing	780.39-Convulsions NOS
786.50-Chest pain, unspecified	V58.69-Long-term (current) use of other (high risk) medications
789.00-Abdominal pain unspecified site	Iron, IBC, Ferritin, Transferrin (LC)
V58.69-Long-term (current) use of other (high risk) medications	042-HIV Disease
V67.51-Following completed treatment with high risk medicine, NEC	250.00-Diabetes/Mellitus Type II
Basic Metabolic Panel (NDS)	263.0-Malnutrition of moderate degree
042-HIV Disease	263.1-Malnutrition of mild degree
250.20-Diabetes w/hyperosmolarity Type II or unspecified	263.9-Malnutrition, Protein-Calorie NOS
250.22-Diabetes w/hyperosmolarity Type II or unspecified, controlled	275.09-Disorders of iron metabolism
263.0-Malnutrition of moderate degree	280.9-Anemia, iron deficiency unspecified
263.1-Malnutrition of mild degree	281.0-Anemia, pernicious
263.9-Malnutrition, Protein-Calorie NOS	281.2-Anemia, folate deficiency
290.0-Senile Dementia, Uncomplicated	282.60-Sickle-cell disease, unspecified
290.3-Senile Dementia with Delirium	285.9-Anemia, unspecified
401.9-Hypertension, unspecified	286.9-Coagulation defects, other and unspecified
416.9-Chronic Pulmonary Heart Disease, Unspecified	428.0-Congestive Heart Failure Unspecified
536.2-Persistent Vomiting	428.9-Heart Failure Unspecified
593.9-Unspecified Disorder of Kidney and Ureter	586-Renal failure unspecified
780.39-Convulsions NOS	719.40-Pain in unspecified joint
780.71-Fatigue syndrome, chronic	719.49-Pain in multiple joints
782.3-Edema	790.6-Other abnormal blood chemistry
995.20-Unspecified Adverse Effect of Unspecified Drug, Medicinal & Biological Substance	V12.1-Personal history of nutritional deficiency
V58.69-Long-term (current) use of other (high risk) medications
LC=Limited Coverage Test. These procedures are covered by Medicare for a specific group of dignosis determined & identified in Medicare Limited Coverage Policies.
NDS=Non Diagnosis Specific. There are no specific diagnostic restrictions, however Medicare will pay for these procedures as determined to be reasonable and medically necessary.
Frequently Used Tests & ICD9 Codes
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Glucose (LC) Frequent strip tests Q 3	Platelet Counts (LC)
038.12-Methicillin resistant Staphylococcus aureus septicemia	285.9-Anemia, unspecified
250.00-Diabetes mellitus without mention of complication (non insulin type II)	V58.61-Long term (current) use of anticoagulants
250.02-Diabetes mellitus without mention of complication (non insulin type II uncontrolled)	V58.69-Long-term (current) use of other (high risk) medications
250.90-Diabetes mellitus with unspecified complications (type II or unspecified type)	Potassium and Electrolytes (NDS)
250.92-Diabetes mellitus with unspecified complications (non insulin type II) uncontrolled	250.00-250.93 Diabetes Mellitus
263.0-Malnutrition of moderate degree	276.50-Volume Depletion, unspecified
263.1-Malnutrition of mild degree	401.9-Hypertension, unspecified
263.9-Malnutrition, Protein-Calorie NOS	V58.69-Long-term (current) use of other (high risk) medications
298.9-Unspecified psychosis	V67.51-Following completed treatment with high risk medicine, NEC
482.9-Bacterial pneumonia, unspecified	Protime with INR (LC) Q2 to 3 weeks after patient stable
599.0-Urinary Tract infection, site not specified	042-HIV disease
707.00-Pressure ulcer unspecified site	286.0-286.9 - Coagulation defects
780.4-Dizziness and giddiness	428.0-428.9 Heart Failure
780.71-Fatigue syndrome, chronic	586-Renal failure unspecified
781.0-Abnormal involuntary movements	729.5-Pain in limb
783.1-Abnormal weight gain	964.2-Poisoning by anticoagulants
783.21-Abnormal loss of weight	995.20-Unspecified adverse effect of drug
785.4-Gangrene	V58.61-Long term (current) use of anticoagulants
786.50-Chest pain, unspecified	PTT (LC)
V58.69-Long-term (current) use of other (high risk) medications	038.9-Unspecified septicemia
V67.51-Following completed treatment with high risk medicine, NEC	042-HIV disease
	427.31-Atrial Fibrilation
Hgb A1C (LC) Q 3	428.0-Congestive Heart Failure
250.00-Diabetes mellitus without mention of complication (non insulin type II)	586-Renal failure unspecified
250.02-Diabetes mellitus without mention of complication (non insulin type II uncontrolled)	729.5-Pain in limb
250.90-Diabetes mellitus with unspecified complications (type II or unspecified type)	786.05-Shortness of breath
250.92-Diabetes mellitus with unspecified complications (non insulin type II) uncontrolled	V58.61-Long term (current) use of anticoagulants
251.2-Hypoglycemia, Unspecified	RPR (NDS)
271.4-Renal glycosuria	042-HIV disease
275.09-Disorders of Iron Metabolism (Hemochromatosis)	331.0-Alzheimer's disease
577.1-Chronic pancreatitis	331.2-Senile degeneration of brain
790.29-Hyperglycemia NOS	780.4-Dizziness and giddiness
V58.67-Long-term (current) use of Insulin	TSH, T3 Uptake, T4 Total (LC) Q 6 months in clinically stable patients
V58.69-Long-term (current) use of other (high risk) medications	244.9-Hypothyroidism
	250.00-250.93 Diabetes Mellitus
Lipid Panel Q yearly, LDL & Total Cholesterol Q 2 months first year	272.2-Mixed hyperlipidemia
Q 4 months after treatment goals achieved, HDL, Triglycerides, VLDL (LC)	296.99-Mood Swings
250.00-250.93 See Diabetes Mellitus	783.1-Abnormal Weight Gain
263.0-Malnutrition of moderate degree	783.21-Abnormal Loss of Weight
263.1-Malnutrition of mild degree	V58.69-Long-term (current) use of other (high risk) medications
263.9-Malnutrition, Protein-Calorie NOS	V67.51-Following completed treatment with high risk medicine, NEC
272.0-Pure Hypercholesterolema	Urinalysis (complete) (NDS)
272.4-Hyperlipidema NOS	038.12-Methicillin resistant Staphylococcus aureus septicemia
278.00-Obesity, unspecified	428.0-Congestive Heart Failure Unspecified
401.9-Hypertension, unspecified	599.0-Urinary Tract infection, site not specified
402.11-Hypertensive heart disease benign with heart failure	599.70-Hematuria Unspecified
428.0-Congestive Heart Failure Unspecified	788.1-Dysuria
786.50-Chest pain, unspecified	788.41-Urine frequency
V58.64-Long-term (current) use of non-steroid anti-inflammatories (NSAID)	V58.64-Long-term (current) use of non-steroid anti-inflammatories (NSAID)
V58.69-Long-term (current) use of other (high risk) medications	V58.69-Long-term (current) use of other (high risk) medications
	V67.51-Following completed treatment with high risk medicine, NEC
Liver Panel and Components (NDS)	Urine Culture (LC)
042-HIV Disease	038.12-Methicillin resistant Staphylococcus aureus septicemia
275.09-Disorders of iron metabolism	288.00-Neutropenia unspecified
571.5-Cirrhosis	585.6-End stage renal disease
573.9-Unspecified liver disorder	599.0-Urinary Tract infection, site not specified
782.4-Jaundice, unspecified	599.70-Hematuria, Unspecified
789.1-Hepatomegaly	601.9-Prostatitis unspecified
794.8-Abnormal liver scans	616.10-Vaginitis and vulvovaginitis unspecified
V58.64-Long-term (current) use of non-steroid anti-inflammatories (NSAID)	780.60-Fever NOS
V58.69-Long-term (current) use of other (high risk) medications	V58.69-Long-term (current) use of other (high risk) medications
V67.51-Following completed treatment with high risk medicine, NEC	Valproic Acid (NDS)
	780.39-Convulsions NOS
Phenobarbital (NDS)	V58.62-Long-term (current) use of antibiotics
301.9-Personality disorder, unspecified	V58.69-Long-term (current) use of other (high risk) medications
780.39-Convulsions NOS	Vancomycin (NDS)
V58.69-Long-term (current) use of other (high risk) medications	V58.62-Long-term (current) use of antibiotics
	V58.69-Long-term (current) use of other (high risk) medications
LC=Limited Coverage Test. These procedures are covered by Medicare for a specific group of dignosis determined & identified in Medicare Limited Coverage Policies.
NDS=Non Diagnosis Specific. There are no specific diagnostic restrictions, however Medicare will pay for these procedures as determined to be reasonable and medically necessary.