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CHC LABS INC.

 

PROTHROMBIN TIME

(85610)

002.0-002.9

Typhoid fever

003.0-003.9

Salmonella gastroenteritis

038.9

Unspecified septicemia

042

Human immunodeficiency virus(HIV) disease

060.0-060.9

Sylvatic yellow fever

065.0-065.9

Crimean hemorrhagic fever (CHF congo virus)

070.0-070.9

Viral hepatitis A with hepatic coma

075

Infectious monoucleosis

078.6

Hemorrhagic nephrosonephritis

078.7

Arenaviral hemorrhagic fever

084.8

Blackwater fever

120.0

Schistosomiasis due to schistosoma haematobium

121.1

Clonorchiasis

121.3

Fascioliasis

124

Trichinosis

134.2

Hirudiniasis

135

Sarcoidosis

152.0-152.9

Malignant neoplasm of duodenum

155.0-155.2

Malignant neoplasm of liver primary

156.0-156.9

Malignant neoplasm of gallbladder

157.0-157.9

Malignant neoplasm of head of pancreas

188.0-189.9

Malignant neoplasm of trigone of urinary bladder

198.0

Secondary malignant neoplasm of kidney

198.1

Secondary malignant neoplasm of other urinary organs

200.00-200.88

Reticulosarcoma unspecified site

202.00-202.98

Nodular lymphoma unspecified site

223.0-223.9

Benign neoplasm of kidney except pelvis

238.4

Polycythemia vera

238.5

Neoplasm of uncertain behavior of histiocytic and mast cells

238.6

Neoplasm of uncertain behavior of plasma cells

238.7

Neoplasm of uncertain behavior of other lymphatic and hematopoietic tissues

239.4

Neoplasm of unspecified nature of bladder

239.5

Neoplasm of unspecified nature of other genitourinary organs

239.9

Neoplasm of unspecified nature site unspecified

246.3

Hemorrhage and infarction of thyroid

250.40-250.43

Diabetes mellitus with renal manifestations type II or unspecified type not stated as uncontrolled

263.0-263.9

Malnutrition of moderate degree

269.0

Deficiency of vitamin K

269.2

Unspecified vitamin deficinecy

273.0-273.9

Polyclonal hypergammaglobulinemia

275.0

Disorder of iron metabolism

277.1

Disorders of porphyrin metabolism

277.3

Amyloidosis

280.0

Iron deficiency anemia secondary to blood loss (chronic)

280.9

Iron deficiency anemia unspecified

281.0

Pernicious anemia

281.1

Other vitamin B12 deficiency anemia

281.9

Unspecified deficiency anemia

 

285.0

Sideroblastic anemia

285.1

Acute posthemorrhagic anemia

286.0-286.9

Congenital factor VIII disorder

287.0-287.2

Allergic purpura

287.30-287.39

Primary thrombocytopenia

290.40-290.43

Arteriosclerotic dementia uncomplicated

325

Phlebitis and thrombophlebitis of intracranial venous sinuses

342.90-342.92

Unspecified hemiplegia and hemiparesis affecting unspecified side

360.43

Hemophthalmos except current injury

362.18

Retinal vasculitis

362.30-362.37

Retinal vascular occlusion unspecified

362.43

Hemorrhagic detach of retinal pigment epithelium

362.81

Retinal hemorrhage

363.61-363.72

Choroidal hemorrhage unspecified

368.9

Unspecified visual disturbance

372.72

Conjunctival hemorrhage

374.81

Hemorrhage of eyelid

376.32

Orbital hemorrhage

377.42

Hemorrhage in optic nerve sheaths

377.53

Disorders of optic chiasm associated with vascular disorders

377.62

Disorders of other visual pathways associated with vascular disorders

377.72

Disorders of visual cortex associated with vascular disorders

379.23

Vitreous hemorrhage

380.31

Hematoma of auricle or pinna

386.2

Vertigo of central origin

386.50

Labyrinthine dysfunction unspecified

394.0-394.9

Mitral stenosis

395.0

Rheumatic aortic stenosis

395.2

Rheumatic aortic stenosis with insufficiency

396.0-396.9

Mitral valve stenosis and aortic valve stenosis

397.0-397.9

Diseases of tricuspid valve

398.0-398.99

Rheumatic myocarditis

403.01

Malignant hypertensive renal disease with renal failure

403.11

Benign hypertensive renal disease with renal failure

403.91

Unspecified hypertensive renal disease with renal failure

404.02

Malignant hypertensive heart and renal disease with renal failure

404.12

Benign hypertensive heart and renal disease with renal failure

404.92

Unspecified hypertensive heart and renal disease with renal failure

410.00-410.92

Acute myocardial infraction of anterolateral wall episode of care unspecified

411.1

Intermediate coronary syndrome

411.81

Acute coronary occlusion without myocardial infarction

411.89

Other acute and subacute forms of ischemic heart disease other

413.0-413.9

Angina decubitus

414.00-414.06

Coronary atherosclerosis of unspecified type of vessel, native or graft

414.8

Other specified forms of chronic ischemic heart disease

414.9

Chronic ischemic heart disease, unspecified

415.0-415.19

Acute cor pulmonale

416.9

Chronic pulmonary heart disease, unspecified

423.0

Hemopericardium

424.0

Mitral valve disorders

424.1

Aortic valve disorders

424.90

Endocarditis valve unspecified, unspecified cause

425.0-425.9

Endomyocardial fibrosis

427.0-427.9

Paroxysmal supreventricular tachycardia

428.0-428.9

Congestive heart failure, unspecified

429.0-429.4

Myocarditis unspecified

429.79

Certain sequelae of myocardial infarction not elsewhere classified, other

430

Subarachnoid hemorrhage

431

Intracerebral hemorrhage

432.0-432.9

Nontraumatic extradural hemorrhage

433.00-433.91

Occlusion and stenosis of basilar artery without cerebral infarction

434.00-434.91

Cerebral thrombosis without cerebral infarction

436

Acute but ill-defined cerebrovascular disease

437.0

Cerebral atherosclerosis

437.1

Other generalized ischemic cerebrovascular disease

437.6

Nonpyogenic thrombosis of intracranial venous sinus

440.0-440.9

Atherosclerosis of aorta

441.0-441.9

Dissection of aorta

443.0-443.9

Raynaud’s syndrome

444.0-444.9

Embolism and thrombosis of abdominal aorta

447.1

Stricture of artery

447.2

Rupture of artery

447.6

Arteritis unspecified

448.0

Hereditary hemorrhagic telangiectasia

448.9

Other and unspecified capillary diseases

451.0-451.9

Phlebitis and thrombophlebitis of superficial vessels lower extremities

452

Portal vein thrombosis

453.0-453.9

Budd-Chiari syndrome

455.2

Internal hemorrhoids with other complication

455.5

External hemorrhoids with other complication

455.8

Unspecified hemorrhoids with other complication

456.0-456.1

Esophageal varices with bleeding

456.8

Varices of other sites

459.0

Hemorrhage, unspecified

459.10

Postphlebitic syndrome without complications

459.11

Postphlebitic syndrome with ulcer

459.12

Postphlebitic syndrome with inflammation

459.13

Postphlebitic syndrome with ulcer and inflammation

459.19

Postphlebitic syndrome with other complication

459.2

Compression of vein

459.81

Venous (peripheral) insufficiency, unspecified

459.89

Other specified circulatory system disorders

511.8

Other specified forms of pleural effusion except tuberculous

514

Pulmonary congestion and hypostasis

530.7

Gastroesophageal laceration-hemorrhage syndrome

530.82

Esophageal hemorrhage

530.86

Infection of esophagostomy

530.87

Mechanical complication of esophagostomy

531.00-535.61

Acute gastric ulcer with hemorrhage without obstruction

555.0-555.9

Regional enteritis of small intestine

556.0-556.9

Ulcerative (chronic) enterocolitis

557.0-557.9

Acute vascular insufficiency of intestine

562.02-562.03

Diverticulosis of small intestine with hemorrhage

562.10

Diverticulosis of colon (without hemorrhage)

562.11

Diverticulitis of colon (without hemorrhage)

562.12

Diverticulosis of colon with hemorrhage

562.13

Diverticulitis of colon with hemorrhage

568.81

Hemoperitoneum (nontraumatic)

569.3

Hemorrhage of rectum and anus

571.0-571.9

Alcoholic fatty liver

572.2

Hepatic coma

 

572.4

Hepatorenal syndrome

572.8

Other sequelae of chronic liver disease

573.1-573.9

Hepatitis in viral diseases classified elsewhere

576.0-576.9

Postcholecystectomy syndrome

577.0

Acute pancreatitis

578.0-578.9

Hematemesis

579.0-579.9

Celiac disease

581.0-581.9

Nephrotic syndrome with lesion of proliferative glomerulonephritis

583.9

Nephritis and nephropathy not specified as acute or chronic with unspecified pathological lesion in kidney

584.5-584.9

Acute renal failure with lesion of tubular necrosis

585.4

Chronic kidney disease, Stage IV (serum)

585.5

Chronic kidney disease, Stage V

585.6

End stage renal disease

585.9

Chronic kidney disease, unspecified

586

Renal failure unspecified

593.81-593.89

Vascular disorders of kidney

596.7

Hemorrhage into bladder wall

596.8

Other specified disorders of bladder

599.7

Hematuria

607.82

Vascular disorders of penis

608.83

Vascular disorders of male genital organs

611.8

Other specified disorders of breast

620.7

Hematoma of broad ligament

621.4

Hematometra

622.8

Other specified noninflammatory disorders of cervix

623.6

Vagina hematoma

623.8

Other specified noninflammatory disorders of vagina

624.5

Hematoma of vulva

626.2-626.9

Excessive or frequent menstruation

627.0

Premenopausal menorrhagia

627.1

Postmenopausal bleeding

629.0

Hematocele female not elsewhere classified

632

Missed abortion

634.10-634.12

Spontaneous abortion unspecified complicated by delayed or excessive hemorrhage

635.10-635.12

Legally induced abortion unspecified complicated by delayed or excessive hemorrhage

636.10-636.12

Illegal abortion unspecified complicated by delayed or excessive hemorrhage

637.10-637.12

Unspecified type of abortion unspecified complicated by delayed or excessive hemorrhage

638.1

Excessive hemorrhage

639.1

Delayed or excessive hemorrhage following abortion and ectopic and molar pregnancies

639.6

Embolism following abortion or ectopic and molar pregnancies

640.00-640.93

Threatened abortion unspecified as to episode of care

641.00-641.93

Placenta previa without hemorrhage unspecified as to episode of care

642.00-642.94

Benign essential hypertension complicating pregnancy childbirth and the puerperium unspecified as to episode of care

646.70-646.73

Liver disorders in pregnancy unspecified as to episode of care

656.00-656.03

Fetal-maternal hemorrhage unspecified as to episode of care in pregnancy

658.40-658.43

Infection of amniotic cavity unspecified as to episode of care

666.00-666.34

Third-stage postpartum hemorrhage unspecified as to episode of care

671.20-671.94

Superficial thrombophlebitis complicating pregnancy and the puerperium unspecified as to episode of care

 

673.00-673.84

Obstetrical air embolism unspecified as to episode of care

674.30-674.34

Other complications of obstetrical surgical wounds unspecified as to episode of care

713.2

Arthropathy associated with hematological disorders

713.6

Arthropathy associated with hypersensitivity reaction

719.15

Hemarthrosis involving pelvic region and thigh

719.16

Hemarthrosis involving lower leg

719.19

Hemarthrosis involving multiple sites

729.5

Pain in limb

729.81

Swelling of limb

733.10

Pathological fracture unspecified site

746.00-746.9

Congenital pulmonary valve anomaly unspecified

762.1

Other forms of placental separation and hemorrhage affecting fetus or newborn

767.0-767.1

Subdural and cerebral hemorrhage due to birth trauma

767.8

Other specified birth trauma

770.3

Pulmonary hemorrhage of fetus or newborn

772.0-772.9

Fetal blood loss

774.6

Unspecified fetal and neonatal jaundice

776.0-776.9

Hemorrhagic disease of newborn

780.2

Syncope and collapse

782.3

Edema

782.4

Jaundice unspecified not of newborn

782.7

Spontaneous ecchymoses

784.7

Epistaxis

784.8

Hemorrhage from throat

785.4 Gangrene 785.50 Shock 786.05 786.3 Hemoptysis 786.59 789.00-789.09 789.1 Hepatomegaly 789.5 Ascites 790.92 790.94 791.2 Hemoglobinuria 794.8 800.00-800.99 801.00-801.99 802.20-802.9 803.00-803.99 804.00-804.99 807.00-807.09 807.10-807.19 808.8-808.9 809.0-809.1 810.00-810.13 811.00-811.19 812.00-812.59 813.10-813.18 unspecified

Shortness of breath

Other chest pain

Abdominal pain unspecified site

Abnormal coagulation profile

Euthyroid sick syndrome

Nonspecific abnormal results of function study of liver

Closed fracture of vault of skull without intracranial injury with state of consciousness unspecified

Closed fracture of base of skull without intracranial injury with state of consciousness unspecified

Closed fracture of unspecified site of mandible

Other closed skull fracture without intracranial injury with state of consciousness unspecified

Closed fractures involving skull or face with other bones without intracranial injury with state of consciousness unspecified

805.00-806.9

Closed fracture of cervical vertebra unspecified level

Closed fracture of rib(s) unspecified

Open fracture of rib(s) unspecified

Unspecified closed fracture of pelvis

Fracture of bones of trunk closed

Closed fracture of clavicle unspecified part

Closed fracture of scapula unspecified part

Fracture of unspecified part of upper end of humerus closed

Open fracture of upper end of forearm unspecified

  813.30-813.33 813.50-813.54 813.90-813.93 819.0-819.1 820.00-821.39 823.00-823.92 827.0-829.1 852.00-853.19 860.0-860.5 861.00-861.32 862.0-862.9 863.0-863.99 864.00-864.19 865.00-865.19 866.00-866.13 867.0-867.9 868.00-868.19 869.0-869.1 900.00-900.9 901.0-901.9 902.0-902.9 903.00-903.9 904.0-904.9 920-924.9 925.1-929.9 958.2 959.9 964.0-964.9 980.0-980.9 981 982.0-982.8 987.0-987.9 989.0-989.9 995.2 996.82 997.02 997.4 998.11-998.12 999.2 999.8 V08 V12.1 V12.3 V15.1

Fracture of shaft of radius or ulna unspecified, open

Open fracture of lower end of forearm unspecified

Fracture of unspecified part of forearm open

Multiple closed fractures involving both upper limbs and upper limb with rib(s) and sternum

Fracture of unspecified intracapsular section of neck of femur, closed

Closed fracture of upper end of tibia

Other multiple and ill-defined fractures of lower limb, closed

Subarachnoid hemorrhage following injury without open intracranial wound with state of consciousness unspecified

Traumatic pneumothorax without open wound into thorax

Unspecified injury of heart without open wound into thorax

Injury to diaphragm without open wound into cavity

Injury to stomach without open wound into cavity

Unspecified injury to liver without open wound into cavity

Unspecified injury to spleen without open wound into cavity

Unspecified injury to kidney without open wound into cavity

Injury to bladder and urethra without open wound into cavity

Injury to unspecified intra-abdominal organ without open wound into cavity

Internal injury to unspecified or ill-defined organs without open wound into cavity

Injury to carotid artery unspecified

Injury to thoracic aorta

Injury to abdominal aorta

Injury to axillary vessel(s) unspecified

Injury to common femoral artery

Contusion of face, scalp, and neck except eye(s)

Crushing injury of face and scalp

Secondary and recurrent hemorrhage as an early complication of trauma

Other and unspecified injury to unspecified site

Poisoning by iron and its compounds

Toxic effect of ethyl alcohol

Toxic effect of petroleum products

Toxic effect of benzene and homologues

Toxic effect of liquefied petroleum gases

Toxic effect of hydrocyanic acid and cyanides

Unspecified adverse effect of drug medicinal and biological substance not elsewhere classified

Complications of transplanted liver

Iatrogenic cerebrovascular infarction or hemorrhage

Digestive system complications not elsewhere classified

Hemorrhage complicating a procedure

Other vascular complications of medical care not elsewhere classified

Other transfusion reaction not elsewhere classified

Asymptomatic human immunodeficiency virus (HIV) infection status

Personal history of nutritional deficiency

Personal history of diseases of blood and blood-forming organs

V12.50-V12.59

Personal history of unspecified circulatory disease

Personal history of surgery to heart and great vessels presenting hazards to health

V15.2

Personal history of surgery to other major organs presenting hazards to health

V42.0

Kidney replaced by transplant

V42.1

Heart replaced by transplant

V42.2

Heart valve replaced by transplant

 

V42.6

Lung replaced by transplant

V42.7

Liver replaced by transplant

V42.81-V42.89

Bone marrow replaced by transplant

V43.2

Heart replaced by other means

V43.3

Heart valve replaced by other means

V43.4

Blood vessel replaced by other means

V58.2

Blood transfusion without reported diagnosis

V58.61

Long-term (current) use of anticoagulants

 

   This policy has been duplicated from the most current Medicare National Coverage Determination or Local Medical Review Policy available at the time this booklet was printed in October 2005. Medicare will consider this test(s) medically reasonable and necessary only if the test(s) was performed for any of the diagnoses/conditions listed on this page. This information is subject to change without notice, and Covenant Health Care Labs (CHC) is not responsible for consequences that may result from using such information. CHC is not indicating one code is more acceptable than another, and that selected codes should reflect the patients actual medical condition as noted in their medical record.

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