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.
|