APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL

Lists are in alphabetical order. To quickly find what you’re looking for, type Ctrl+F and enter your term in the “Find” field. APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Abnormal electrocardiogram [ECG] [EKG] (R94.31) 3 3 Abnormal findings on diagnostic imaging of lung (R91) 1 1 Abnormal findings on diagnostic imaging of other abdominal regions, including retroperitoneum (R93.5) 1 1 Abnormal findings on diagnostic imaging of other parts of digestive tract (R93.3) 1 1 Abnormal findings on diagnostic imaging of other specified body structures (r93.8) 1 1 Abnormal posture (R29.3) 2 1 3 Abnormal result of other cardiovascular function study (R94.39) 3 3 Abnormal uterine and vaginal bleeding, unspecified (n93.9) 1 1 Abnormal weight loss (R63.4) 1 1 Achilles tendinitis, right leg (M76.61) 5 3 8 Acidosis (E87.2) 1 1

Acquired absence of bilateral breasts and nipples (Z90.13) 5 5 Acquired absence of left breast and nipple (Z90.12) 2 2 Acquired absence of right leg below (Z89.511) 1 1 Acquired absence of unspecified breast and nipple (Z90.10) 1 1 Actinomycotic sepsis (A42.7) 1 1

Acute and subacute hepatic failure without coma (K72.00) 1 1 Acute appendicitis with localized peritonitis (K35.3) 3 3 Acute bronchiolitis due to respiratory syncytial virus (J21.0) 2 2 Acute bronchiolitis, unspecified (J21.9) 3 3 Acute embolism and thrombosis of unspecified femoral vein (i82.419) 1 1 Acute ischemic heart disease, unspecified (I24.9) 1 1 Acute kidney failure with tubular necrosis (N17.0) 1 1 Acute kidney failure, unspecified (N17.9) 4 4 Acute lymphoblastic leukemia not having achieved remission (C91.00) 3 3 Acute lymphoblastic leukemia, in relapse (C91.02) 1 1 Acute lymphoblastic leukemia, in remission (C91.01) 3 3 Acute myeloblastic leukemia, not having achieved remission (C92.00) 1 1 Acute obstructive laryngitis [croup] (J05.0) 1 1

January 1, 2018 - December 31, 2018 1 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Acute on chronic combined systolic and diastolic hrt fail (I50.43) 1 1 Acute pancreatitis without necrosis or infection, unspecified (K85.90) 2 2 Acute pyelonephritis (N10) 1 1 Acute respiratory failure with hypercapnia (J96.02) 1 1 Adhesive capsulitis of left (M75.02) 4 11 15 Adhesive capsulitis of right shoulder (M75.01) 2 3 5 Adjustment disorder with anxiety (F43.22) 1 1 2 Adjustment disorder with mixed anxiety and depressed mood (F43.23) 2 2 Adjustment disorder with mixed disturbance of emotions and conduct (F43.25) 4 4

Adolescent idiopathic scoliosis, thoracic region (M41.124) 1 1 Aftercare following explantation of prosthesis (Z47.32) 1 1 Aftercare following joint replacement surgery (Z47.1) 5 10 15 Age-related osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture (M80.011A) 1 1 Age-related osteoporosis without current pathological fracture (M81.0) 23 8 31 Agranulocytosis secondary to cancer chemotherapy (D70.1) 3 3 Alcohol abuse, uncomplicated (F10.10) 1 1 Alcohol dependence uncomplicated (F10.20) 2 2 Alcohol dependence with withdrawal, unspecified (F10.239) 2 2 Alcohol dependence, uncomplicated (F10.20 Alcohol Use Disorder) 1 1 Alcoholic cirrhosis of liver with ascites (K70.31) 1 1 Algoneurodystrophy, unspecified site (M89.00) 1 1 Alpha-1-antitrypsin deficiency (E88.01) 1 1 Altered mental status, unspecified (R41.82) 1 1 Anaplastic large cell lymphoma, ALK-negative, lymph nodes of multiple sites (C84.78) 1 1 Anemia, unspecified (D64.9) 8 8 Anesthesia of skin (R20.0) 1 1 Angina pectoris unspecified (I20.9) 1 1 (Q38.1) 1 1 Ankylosing spondylitis of cervical region (M45.2) 1 1 Anxiety disorder, unspecified (F41.9) 1 1 Aplastic anemia, unspecified (D61.9) 3 3

January 1, 2018 - December 31, 2018 2 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Apraxia (R48.2) 2 2 Arthrodesis status (Z98.1) 1 1 Arthropathic psoriasis, unspecified (L40.50) 4 4 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) (27447) 1 1 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris (I25.110) 1 1 Atherosclerotic heart disease of native coronary artery without angina pectoris (I25.10) 5 5 Attention-deficit hyperactivity disorder, combined type (F90.2) 4 2 6 Attention-deficit hyperactivity disorder, predominantly hyperactive type (F90.1) 2 2 Attention-deficit hyperactivity disorder, predominantly inattentive type (F90.0) 1 2 3 Attention-deficit hyperactivity disorder, unspecified type (F90.9) 7 2 9 Autistic disorder (F84.0) 17 2 1 20 Autoimmune hepatitis (K75.4) 1 1 Bacteremia (R78.81) 2 2 Basal cell carcinoma of skin of left ear and external auricular canal (C44.219) 1 1 Basal cell carcinoma of skin of nose (C44.311) 1 1 Basal cell carcinoma of skin of right eyelid, including canthus (C44.112) 1 1 Bell's palsy (G51.0) 1 1 Benign lipomatous neoplasm of skin and subcutaneous tissue of head, face and (D17.0) 1 1 Benign neoplasm of heart (D15.1) 1 1 Benign neoplasm of pituitary gland (D35.2) 1 1 Benign neoplasm of unspecified breast (D24.9) 1 1 Benign paroxysmal vertigo, unspecified ear (H81.10) 1 1 Bicipital tendinitis, left shoulder (M75.22) 1 1 2 Bilateral primary osteoarthritis of knee (M17.0) 43 10 54 Bipolar disorder, current episode depressed, severe, without psychotic features (F31.4) 1 1 Bipolar disorder, current episode manic severe with psychotic features (F31.2) 1 1 Bipolar disorder, in full remission, most recent episode depressed (F31.76) 1 1 Bitten by dog, subsequent encounter (W54.0XXD) 1 1 Blepharospasm (G24.5) 3 3 Boutonniere deformity of right finger(s) (M20.021) 1 1 2

January 1, 2018 - December 31, 2018 3 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Bradycardia, unspecified (r00.1) 2 2 Breakdown (mechanical) of cranial or spinal infusion catheter, initial encounter (T85.610A) 1 1 Breakdown (mechanical) of internal fixation device of vertebrae, subsequent encounter (T84.216D) 1 1 Bucket-handle tear of medial meniscus, current injury, right knee, initial encounter (S83.211A) 1 1 Bullous keratopathy, right eye (H18.11) 1 1 Bursitis of right shoulder (M75.51) 1 1 Calculus of gallbladder without cholecystitis without obstruction (K80.20) 1 1 Calculus of kidney (N20.0) 1 1 Calculus of ureter (N20.1) 4 4 Carcinoid syndrome (E34.0) 5 5 Carcinoma in situ of cervix, unspecified (D06.9) 1 1 Cardiac arrhythmia, unspecified (I49.9) 2 2 Cardiac murmur, unspecified (R01.1) 1 1 Cardiomyopathy, unspecified (I42.9) 2 2 Cellulitis of left lower limb (L03.116) 2 2 Cellulitis of unspecified part of limb (L03.119) 1 1 Cellulitis, unspecified (L03.90) 1 1 Central corneal opacity left eye (h17.12) 2 2 Central perforation of tympanic membrane, right ear (H72.01) 1 1 Central retinal vein occlusion, bilateral, with macular edema (H34.8130) 2 2 Central retinal vein occlusion, left eye, with retinal neovascularization (H34.8121) 2 2 Central serous chorioretinopathy, bilateral (H35.713) 1 1 Central serous chorioretinopathy, left eye (H35.712) 2 2 Cerebral infarction, unspecified (I63.9) 3 3 Cerebral palsy, unspecified (G80.9) 3 1 4 Cervical disc disorder at C4-C5 level with myelopathy (M50.021) 3 3 Cervical disc disorder at C4-C5 level with radiculopathy (M50.121) 26 2 28 Cervical disc disorder at C5-C6 level with myelopathy (M50.022) 1 1 Cervical disc disorder at C5-C6 level with radiculopathy (M50.122) 26 26 Cervical disc disorder at C6-C7 level with myelopathy (M50.023) 1 1 Cervical disc disorder at C6-C7 level with radiculopathy (M50.123) 13 13

January 1, 2018 - December 31, 2018 4 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Cervical disc disorder with radiculopathy, high cervical region (M50.11) 2 2 Cervical disc disorder with radiculopathy, cervicothoracic region (M50.13) 4 4 Cervical disc disorder with radiculopathy, unspecified cervical region (M50.10) 7 7 Cervicalgia (M54.2) 21 17 38 Charcot's joint, left and (M14.672) 1 1 Chest pain, unspecified (R07.9) 23 23 Cholecystitis, unspecified (K81.9) 2 2 Chondromalacia patellae, right knee (M22.41) 1 1 Chondromalacia, left knee (M94.262) 1 1 3 Chondromalacia, right knee (M94.261) 1 3 4 Chronic frontal sinusitis (J32.1) 2 2

Chronic inflammatory demyelinating polyneuritis (G61.81) 1 1 Chronic instability of knee right knee (M23.51) 1 1 Chronic kidney disease, stage 4 (severe) (N18.4) 2 2 Chronic kidney disease, stage 5 (N18.5) 1 1 Chronic kidney disease, unspecified (N18.9) 1 1 Chronic migraine without aura, intractable, without status migrainosus (G43.719) 20 20 Chronic migraine without aura, not intractable, with status migrainosus (G43.701) 4 4 Chronic migraine without aura, not intractable, without status migrainosus (G43.709) 9 9 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission (C92.10) 1 1 Chronic obstructive pulmonary disease w (acute) exacerbatio (j44.1) 3 3 Chronic pain syndrome (G89.4) 48 5 54 Chronic persistent hepatitis, not elsewhere classified (K73.0) 2 2 Chronic pulmonary embolism (I27.82) 1 1 Chronic sinusitis, unspecified (J32.9) 2 2 Chronic sphenoidal sinusitis (J32.3) 1 1 Chronic systolic (congestive) heart failure (I50.22) 1 1 Chronic venous hypertension (idiopathic) with ulcer of left lower extremity (I87.312) 1 1

Cleft hard and soft palate with unilateral cleft lip (Q37.5) 1 1 Cleft lip, unilateral (Q36.9) 1 1 Clonic hemifacial spasm (G51.3) 3 3

January 1, 2018 - December 31, 2018 5 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Collapsed vertebra, not elsewhere classified, lumbar region, initial encounter for fracture (M48.56XA) 2 2 Colles' fracture of left radius, subsequent encounter for closed fracture with routine healing (S52.532D) 1 1 2 Combined arterial insufficiency and corporo-venous occlusive erectile dysfunction (N52.03) 1 1 Complete or rupture of left shoulder, not specified as traumatic (M75.122) 7 7 Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic (M75.121) 14 2 16 Complex regional pain syndrome I of unspecified lower limb (G90.529) 2 2 Complex regional pain syndrome I, unspecified (G90.50) 1 1 Complex tear of medial meniscus, current injury, left knee, initial encounter (S83.232A) 6 1 7 Complex tear of medial meniscus, current injury, right knee, initial encounter (S83.231A) 2 2 Complications of other reattached body part (T87.2) 1 1 Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side (H90.11) 3 3 Congenital agranulocytosis (D70.0) 1 1 Congenital kyphosis, thoracolumbar region (Q76.415) 1 1 Congenital malformation of peripheral vascular system, unspecified (Q27.9) 1 1 Congenital spondylolisthesis (Q76.2) 1 1 Constipation, unspecified (K59.00) 2 2 continuous positive airway pressure (cpap) device (e0601) 1 1 Contracture of muscle, right shoulder (M62.411) 1 1 Contracture, left hand (M24.542) 1 1 Contusion of left , initial encounter (S50.02XA) 1 1 Contusion of left shoulder, subsequent encounter (S40.012D) 1 1 Cortical age-related cataract, bilateral (H25.013) 1 1 Counseling related to patient's sexual behavior and orientation (Z70.1) 1 1 Cramp and spasm (R25.2) 1 1 2 Craniosynostosis (Q75.0) 1 1 Crohn's disease of both small and large intestine with unspecified complications (K50.819) 1 1 Crohn's disease of large intestine with rectal bleeding (K50.111) 1 Crohn's disease of small intestine with unspecified complications (K50.019) 2 2

January 1, 2018 - December 31, 2018 6 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Crohn's disease of small intestine without complications (K50.00) 2 1 3 Crohn's disease, unspecified, without complications (K50.90) 2 2 Crossing vessel and stricture of ureter w/o hydronephrosis (N13.5) 1 1 Cystic disease of liver (Q44.6) 2 2 Cystocele, unspecified (N81.10) 1 1 Cysts of right upper eyelid (H02.821) 1 1 Defects in the complement system (D84.1) 3 3 Degenerative disease of nervous system, unspecified (G31.9) 1 1 Dehydration (E86.0) 4 4 Delayed milestone in childhood (R62.0) 3 1 4 Dental caries, unspecified (K02.9) 1 1 Derangement of unspecified lateral meniscus due to old tear or injury, right knee (M23.200) 1 1 Derangement of unspecified medial meniscus due to old tear or injury, left knee (M23.204) 1 1 Dermatitis, unspecified (L30.9) 1 1 Dermatochalasis of right upper eyelid (H02.831) 5 1 6 Dermatochalasis of unspecified eye, unspecified eyelid (H02.839) 1 1 Developmental disorder of speech and language, unspecified (F80.9) 2 2 Deviated nasal septum (J34.2) 41 1 42 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, bilateral (E08.3413) 1 1 Difficulty in walking not elsewhere classified (R26.2) 2 2

Diffuse cystic mastopathy of unspecified breast (N60.19) 1 1 Diffuse large B-cell lymph nodes of axilla and upper limb (C83.34) 1 1 Diffuse large B-cell lymphoma nodes of head face and neck D (C83.31) 4 4 Diffuse large B-cell lymphoma, extranodal and solid organ sites (C83.39) 1 1 Diffuse large B-cell lymphoma, lymph nodes of multiple sites (C83.38) 1 1 Diffuse traumatic brain injury without loss of consciousness, initial encounter (S06.2X0A) 1 1 Disease of intestine, unspecified (K63.9) 3 3 Disease of spinal cord, unspecified (G95.9) 3 3

January 1, 2018 - December 31, 2018 7 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Disease of stomach and duodenum, unspecified (K31.9) 1 1 Dislocation and of and at ankle, foot and toe level (S93) 2 2 Dislocation of jaw, unspecified side, initial encounter (S03.00XA) 1 1 Disorder of adrenal gland, unspecified (E27.9) 1 1 Disorder of breast, unspecified (N64.9) 1 1 Disorder of kidney and ureter unspecified (N28.9) 1 1 Displaced avulsion fracture of right ischium, subsequent encounter for fracture with routine healing (S32.611D) 2 2 Displaced bicondylar fracture of left tibia, subsequent encounter for closed fracture with routine healing (S82.142D) 1 1 Displaced fracture of first metatarsal bone, right foot, subsequent encounter for fracture with routine healing (S92.311D) 1 1 Displaced fracture of head of left radius, initial encounter for closed fracture (S52.122A) 1 1 Displaced fracture of head of right radius, subsequent encounter for closed fracture with routine healing (S52.121D) 1 1 Displaced fracture of medial malleolus of left tibia, subsequent encounter for closed fracture with routine healing (S82.52XD) 1 2 3 Displaced fracture of middle third of navicular [scaphoid] bone of left wrist, subsequent encounter for fracture with nonunion (S62.022K) 1 1 Displaced fracture of right radial styloid process, subsequent encounter for closed fracture with routine healing (S52.511D) 1 1 Displaced transverse fracture of shaft of left fibula, subsequent encounter for closed fracture with routine healing (S82.422D) 1 1 Disturbances of salivary secretion (K11.7) 1 1 Diverticulitis of intestine, part unspecified, with perforation and abscess without bleeding (K57.80) 1 1 Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding (K57.92) 2 2 Diverticulitis of large intestine with perforation and abscess without bleeding (k57.20) 1 1 Dorsalgia, unspecified (M54.9) 2 1 3 Dvtrcli of lg int w/o perforation or abscess w bleeding (K57.33) 1 1 Dyspareunia (N94.1) 1 1

January 1, 2018 - December 31, 2018 8 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Dysphagia, unspecified (R13.10) 3 3 Dysthymic disorder (F34.1) 1 1 Dystonia, unspecified (G24.9) 1 1 Edema, unspecified (r60.9) 1 1 Elevated white blood cell count, unspecified (D72.829) 1 1 Embolism and thrombosis of superficial veins of right lower extremities (I82.811) 2 2 Emphysema, unspecified (J43.9) 1 1 Encephalopathy, unspecified (g93.40) 1 1 Encounter for antineoplastic chemotherapy (Z51.11) 3 3 Encounter for fitting and adjustment of unspecified left artificial leg (Z44.102) 1 1 2 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm (Z09) 1 1 Encounter for other orthopedic aftercare (Z47.89) 37 37 74

Encounter for other preprocedural examination (Z01.818) 1 1 Encounter for other specified aftercare (Z51.89) 2 2 Encounter for preprocedural cardiovascular examination (Z01.810) 1 1 Encounter for prophylactic removal of breast (Z40.01) 4 4 Encounter for supervision of normal pregnancy, unspecified, third trimester (Z34.93) 1 1 End stage renal disease (N18.6) 14 14 Endocarditis, valve unspecified (I38) 1 1 Endometriosis unspecified (N80.9) 1 1 Enthesopathy unspecified (M77.9) 1 1 Esophageal obstruction (K22.2) 1 1 Essential (primary) hypertension (I10) 1 1 Evans syndrome (D69.41) 1 1 Excessive and frequent menstruation with regular cycle (N92.0) 2 2 Expressive language disorder (F80.1) 2 2 Extranodal marginal zone B-cell lymphoma of mucosa- associated lymphoid tissue [MALT-lymphoma] (C88.4) 4 4 Exudative age-related macular degeneration, left eye, stage unspecified (H35.3220) 2 2 Exudative age-related macular degeneration, left eye, with active choroidal neovascularization (H35.3221) 9 9 Exudative age-related macular degeneration, right eye, with active choroidal neovascularization (H35.3211) 8 8 Fabry (-Anderson) disease (E75.21) 2 2 Failure to thrive (child) (R62.51) 1 1

January 1, 2018 - December 31, 2018 9 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Failure to thrive in newborn (P92.6) 1 1 Family history of malignant neoplasm of breast (Z80.3) 3 3 6 Family history of malignant neoplasm of digestive organs (Z80.0) 1 1 Family history of malignant neoplasm of other organs or systems (Z80.8) 1 1 Fecal urgency (R15.2) 1 1 Feeding difficulties (R63.3) 2 1 3 Felty's syndrome, multiple sites (M05.09) 1 1 Fetal alcohol syndrome (dysmorphic) (Q86.0) 1 Fever, unspecified (r50.9) 1 1 Fistula of vagina to large intestine (N82.3) 2 2 Flaccid hemiplegia affecting unspecified side (G81.00) 1 1 Flu due to unidentified flu virus w unsp type of pneumonia (J11.00) 1 1 Follicular lymphoma grade II, lymph nodes of multiple sites (C82.18) 2 2 Follicular lymphoma grade IIIa, lymph nodes of multiple sites (C82.38) 4 4 Follicular lymphoma, unspecified, unspecified site (C82.90) 3 3 Foot drop, right foot (M21.371) 1 1 Fracture of mandible, unspecified, initial encounter for closed fracture (S02.609A) 1 1 Fracture of unspecified part of neck of left femur, initial encounter for closed fracture (S72.002A) 1 1 Frequency of micturition (R35.0) 2 2 4 Functional urinary incontinence (R39.81) 1 1 Fusion of spine, cervical region (M43.22) 1 1 Fx unsp part of neck of r femur subs for clos fx w nonunion (S72.001K) 1 1 Ganglion, other site (M67.48) 1 1 Gangrene, not elsewhere classified (I96) 1 1

Gastroduodenitis, unspecified, without bleeding (K29.90) 1 1 Gastro-esophageal reflux disease without esophagitis (K21.9) 1 1 2 Gastrointestinal hemorrhage, unspecified (k92.2) 3 3 Gaucher disease (E75.22) 3 3 Generalized anxiety disorder (F41.1) 4 1 5 Genetic susceptibility to malignant neoplasm of breast (Z15.01) 4 4 Gross hematuria (R31.0) 2 2 Headache (R51) 1 1

January 1, 2018 - December 31, 2018 10 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Heart failure, unspecified (i50.9) 4 4 Hemangioma of intra-abdominal structures (D18.03) 1 1 Hematuria, unspecified (R31.9) 1 1 Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side (I69.354) 1 1 Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side (I69.351) 1 1 Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage affecting left dominant side (I69.052) 1 1 Hemolytic-uremic syndrome (D59.3) 1 1 Hepatic failure unspecified without coma (K72.90) 1 1 Hepatic fibrosis (K74.0) 1 1 Hereditary hypogammaglobulinemia (D80.0) 1 1 Hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck (C81.91) 2 1 3

Hodgkin lymphoma, unspecified, unspecified site (C81.90) 4 4 Hyperkalemia (E87.5) 1 1 Hypermobility syndrome (M35.7) 2 2 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease (I12.0) 1 1 Hypertensive encephalopathy (I67.4) 1 1 Hypertensive heart disease with heart failure (I11.0) 1 1 Hypertensive urgency (i16.0) 2 2 Hypertrophy of breast (N62) 18 1 19 Hypertrophy of nasal turbinates (J34.3) 37 37 Hypertrophy of tonsils (J35.1) 1 1 Hypertrophy of tonsils with hypertrophy of adenoids (J35.3) 1 1 Hypokalemia (E87.6) 2 2 Hypo-osmolality and hyponatremia (e87.1) 4 4 Hypotension, unspecified (I95.9) 2 2 Hypoxemia (r09.02) 4 4

Idiopathic aseptic necrosis of unspecified bone (M87.00) 2 2 Idiopathic urticaria (L50.1) 2 2 Ileus unspecified (K56.7) 1 1 Iliotibial band syndrome, left leg (M76.32) 1 1 Immune thrombocytopenic purpura (D69.3) 1 1 Impingement syndrome of left shoulder (M75.42) 2 1 3 Impingement syndrome of right shoulder (M75.41) 8 4 12

Incisional hernia without obstruction or gangrene (K43.2) 2 2

January 1, 2018 - December 31, 2018 11 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Incomplete rotator cuff tear or rupture of left shoulder, not specified as traumatic (M75.112) 2 1 3 Incomplete uterovaginal prolapse (N81.2) 2 2 Inconclusive mammogram (R92.2) 1 1 Indeterminate sex, unspecified (Q56.4) 1 1 Infection and inflammatory reaction due to other internal joint prosthesis, initial encounter (T84.59XA) 1 1 Infection following a procedure, initial encounter (T81.4XXA) 2 2 Influenza due to other identified influenza virus with other respiratory manifestations (J10.1) 2 2 Influenza due to unidentified influenza virus with other respiratory manifestations (j11.1) 1 1 Influenza due to unidentified influenza virus with unspecified type of pneumonia (J11.0) 1 1 Interstitial cystitis (chronic) without hematuria (N30.10) 1 1 Interstitial pulmonary disease, unspecified (J84.9) 4 4 Intervertebral disc disorders with radiculopathy, lumbar region (M51.16) 40 2 42 Intervertebral disc disorders with radiculopathy, lumbosacral region (M51.17) 16 16 Intra-abdominal and pelvic swelling, mass and lump, unspecified site (R19.00) 5 5 Intraductal carcinoma in situ of left breast (D05.12) 3 3 Intramural leiomyoma of uterus (D25.1) 1 1 Iron deficiency anemia, unspecified (D50.9) 5 1 6 Irregular menstruation, unspecified (N92.6) 1 1 Ischemic cardiomyopathy (I25.5) 2 2 Joint disorder, unspecified (M25.9) 5 5 Juvenile idiopathic scoliosis, thoracolumbar region (M41.115) 1 1 2 Juvenile osteochondrosis of tibia and fibula, right leg (M92.51) 1 1 Keratoconus, unspecified, right eye (H18.601) 1 1 Keratoconus, unstable, left eye (H18.622) 1 1 Keratoconus, unstable, right eye (H18.621) 1 1 Kidney transplant rejection (T86.11) 1 1 Laceration of left quadriceps muscle, fascia and tendon, subsequent encounter (S76.122D) 3 3 Laceration of muscle, fascia and tendon of other parts of biceps, left , initial encounter (S46.222A) 2 2 Laceration without foreign body of left thumb with damage to nail, initial encounter (S61.112A) 1 1

January 1, 2018 - December 31, 2018 12 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Laceration without foreign body, right knee, subsequent encounter (S81.011D) 1 1 Lateral dislocation of left patella, subsequent encounter (S83.015D) 1 1 Lateral epicondylitis, left elbow (M77.12) 3 5 8 Lateral epicondylitis, right elbow (M77.11) 1 3 4 Left lower quadrant pain (R10.32) 1 1 Lipodystrophy, not elsewhere classified (E88.1) 1 1 Liver disease, unspecified (K76.9) 1 1 Lobar pneumonia, unspecified organism (J18.1) 1 1 Local infection of the skin and subcutaneous tissue, unspecified (L08.9) 2 2 Localized edema (R60.0) 5 1 6 Loose body in knee, left knee (M23.42) 1 1 Loose body in knee, right knee (M23.41) 2 2 Low back pain (M54.5) 61 19 80 Lumbago with sciatica unspecified side (M54.40) 1 1 Lumbago with sciatica, right side (M54.41) 3 3 Lumbago with sciatica, unspecified side (M54.4) 1 1 Lyme disease, unspecified (A69.20) 1 1 Lymphocytopenia (D72.810) 1 1 Major depressive disorder, recurrent severe without psychotic features (F33.2) 2 2 Major depressive disorder, recurrent, mild (F33.0) 1 1 Major depressive disorder, recurrent, severe with psychotic symptoms (F33.3) 1 1

Major depressive disorder, recurrent, unspecified (F33.9) 1 1 Malignant (primary) neoplasm, unspecified (C80.1) 3 3 Malignant melanoma of other part of trunk (C43.59) 4 4

Malignant melanoma of overlapping sites of skin (C43.8) 1 1 Malignant neoplasm of base of tongue (C01) 3 3 Malignant neoplasm of bladder, unspecified (C67.9) 1 1 Malignant neoplasm of brain, unspecified (C71.9) 1 1 Malignant neoplasm of central portion of left female breast (C50.112) 3 3 Malignant neoplasm of central portion of right female breast (C50.111) 7 7 Malignant neoplasm of cervix uteri, unspecified (C53.9) 12 1 13 Malignant neoplasm of cheek mucosa (C06) 2 2 Malignant neoplasm of colon, unspecified (C18.9) 8 8 Malignant neoplasm of connective and soft tissue of right lower limb, including hip (C49.21) 2 1 3

January 1, 2018 - December 31, 2018 13 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Malignant neoplasm of connective and soft tissue, unspecified (C49.9) 4 4 Malignant neoplasm of descending colon (C18.6) 2 2 Malignant neoplasm of endometrium (c54.1) 4 4 Malignant neoplasm of frontal lobe (C71.1) 3 3 Malignant neoplasm of glottis (C32.0) 1 1 Malignant neoplasm of hard palate (C05.0) 1 1 Malignant neoplasm of head of pancreas (C25.0) 3 3 Malignant neoplasm of head, face and neck (C76.0) 1 1 Malignant neoplasm of laryngeal cartilage (C32.3) 1 1 Malignant neoplasm of larynx, unspecified (C32.9) 1 1 Malignant neoplasm of lateral wall of bladder (C67.2) 1 1

Malignant neoplasm of lateral wall of nasopharynx (C11.2) 4 4 Malignant neoplasm of left choroid (C69.32) 1 1 Malignant neoplasm of left kidney except renal pelvis (C64.2) 1 1 Malignant neoplasm of left ovary (C56.2) 1 1 Malignant neoplasm of lower gum (C03.1) 1 1 Malignant neoplasm of lower lobe left bronchus or lung (C34.32) 1 1 Malignant neoplasm of lower lobe, right bronchus or lung (C34.31) 1 1

Malignant neoplasm of lower third of esophagus (C15.5) 1 1 Malignant neoplasm of lower-inner quadrant of right female breast (C50.311) 1 1 Malignant neoplasm of lower-outer quadrant of left female breast (C50.512) 6 6

Malignant neoplasm of middle third of esophagus (C15.4) 2 2 Malignant neoplasm of myometrium (C54.2) 1 1

Malignant neoplasm of nasopharynx, unspecified (C11.9) 3 3 Malignant neoplasm of oropharynx, unspecified (C10.9) 1 1 Malignant neoplasm of overlapping sites of bladder (C67.8) 1 1

Malignant neoplasm of overlapping sites of colon (C18.8) 1 1 Malignant neoplasm of overlapping sites of left female breast (C50.812) 1 1 Malignant neoplasm of ovrlp sites of right female breast (C50.811) 4 4 Malignant neoplasm of pancreas, unspecified (C25.9) 3 3

January 1, 2018 - December 31, 2018 14 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Malignant neoplasm of parietal lobe (C71.3) 2 2 Malignant neoplasm of peritoneum, unspecified (C48.2) 3 3 Malignant neoplasm of posterior wall of nasopharynx (C11.1) 2 2 Malignant neoplasm of prostate (C61) 17 17 Malignant neoplasm of pyloric antrum (C16.3) 1 1 Malignant neoplasm of rectosigmoid junction (C19) 11 11 Malignant neoplasm of rectum (C20) 14 14 Malignant neoplasm of right ovary (C56.1) 4 4 Malignant neoplasm of sigmoid colon (C18.7) 11 11 Malignant neoplasm of stomach unspecified (C16.9) 2 2 Malignant neoplasm of temporal lobe (C71.2) 1 1 Malignant neoplasm of thyroid gland (C73) 1 1 Malignant neoplasm of tongue, unspecified (C02.9) 1 1 Malignant neoplasm of tonsil, unspecified (C09.9) 6 6 Malignant neoplasm of tonsillar fossa (C09.0) 2 2 Malignant neoplasm of transverse colon (c18.4) 2 2 Malignant neoplasm of unspecified ovary (C56.9) 3 3 Malignant neoplasm of unspecified part of left bronchus or lung (C34.92) 1 1 Malignant neoplasm of unspecified part of right bronchus or lung (c34.91) 1 1 Malignant neoplasm of unspecified part of unspecified bronchus or lung (C34.90) 11 11 Malignant neoplasm of unspecified site of left female breast (C50.912) 16 16 Malignant neoplasm of unspecified site of right female breast (C50.911) 13 13 Malignant neoplasm of unspecified site of unspecified female breast (C50.919) 15 15 Malignant neoplasm of upper lobe, left bronchus or lung (C34.12) 1 1 Malignant neoplasm of upper lobe, right bronchus or lung (C34.11) 4 4 Malignant neoplasm of upper-inner quadrant of left female breast (C50.212) 7 7 Malignant neoplasm of upper-inner quadrant of right female breast (C50.211) 1 1 Malignant neoplasm of upper-outer quadrant of left female breast (C50.412) 8 8 Malignant neoplasm of upper-outer quadrant of right female breast (C50.411) 16 16 Malignant neoplasm of upper-outer quadrant of unspecified female breast (C50.419) 4 4

January 1, 2018 - December 31, 2018 15 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN

Malignant neoplasm of urinary organ, unspecified (C68.9) 1 1 Malignant neoplasm of vulva unspecified (C51.9) 1 1 Malignant pleural effusion (J91.0) 1 1 Mandibulofacial dysostosis (Q75.4) 1 1 Mastitis without abscess (N61.0) 2 2 Mastodynia (N64.4) 1 1 Mechanical ptosis of left eyelid (H02.412) 1 1 Medial epicondylitis, left elbow (M77.02) 2 2 4 Medial epicondylitis, right elbow (M77.01) 2 1 3 Melanoma in situ of left upper limb, including shoulder (D03.62) 1 1 Microcephaly (Q02) 1 1 Mid-cervical disc disorder, unspecified level (M50.120) 1 1 Migraine w/o aura not intractable w/o status migrainosus (G43.009) 1 1 Migraine with aura, intractable, with status migrainosus (G43.111) 1 1 Migraine with aura, intractable, without status migrainosus (G43.119) 4 4 Migraine with aura, not intractable, with status migrainosus (G43.101) 1 1 Migraine with aura, not intractable, without status migrainosus (G43.109) 3 3 Migraine without aura, intractable, without status migrainosus (G43.019) 3 3 Migraine, unspecified, not intractable, without status migrainosus (G43.909) 2 2 Mild cognitive impairment, so stated (G31.84) 1 1 Missed abortion (O02.1) 1 1 Mixed incontinence (N39.46) 5 5 Mixed receptive-expressive language disorder (F80.2) 5 1 6 Moderate persistent asthma, uncomplicated (J45.40) 1 1 Morbid (severe) obesity due to excess calories (E66.01) 2 2

Multiple myeloma not having achieved remission (C90.00) 15 15 Multiple sclerosis (G35) 9 10 Muscle wasting and atrophy, not elsewhere classified, unspecified site (M62.50) 1 1 Muscle weakness (generalized) (M62.81) 8 1 9 Muscular dystrophy (G71.0) 3 1 4 Myalgia (M79.1) 2 2 4

Myasthenia gravis without (acute) exacerbation (G70.00) 1 1

January 1, 2018 - December 31, 2018 16 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Myogenic ptosis of bilateral eyelids (H02.423) 2 2 Nasal congestion (R09.81) 5 5 Nasal polyp, unspecified (J33.9) 2 2 Nausea with vomiting, unspecified (R11.2) 1 1 Neoplasm of uncertain behavior of bone and articular cartilage (D48.0) 1 1 Neoplasm of uncertain behavior of left kidney (D41.02) 1 1 Neoplasm of uncertain behavior of right breast (D48.61) 1 1 Neoplasm of unspecified behavior of breast (D49.3) 1 1 Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system (D49.7) 2 2 Nephrotic syndrome with unspecified morphologic changes (N04.9) 2 2 Neuralgia and neuritis, unspecified (M79.2) 1 1 Neuromuscular dysfunction of bladder, unspecified (N31.9) 1 1 Neuromuscular scoliosis, occipito-atlanto-axial region (M41.41) 1 1 Neurosyphilis unspecified (A52.3) 2 2 Nipple discharge (N64.52) 1 1 Nodular sclerosis classical Hodgkin lymphoma, unspecified site (C81.10) 1 1 Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck (C81.11) 4 1 5 Nonalcoholic steatohepatitis (NASH) (K75.81) 2 2 Nondisp fx of head of l rad, subs for clos fx w routn heal (S52.125D) 1 1

Nondisp fx of lateral malleolus of left fibula init (S82.65XA) 2 2 Nondisplaced fracture of lateral malleolus of right fibula, subsequent encounter for closed fracture with routine healing (S82.64XD) 1 1 Nondisplaced Zone I fracture of sacrum, initial encounter for closed fracture (s32.110A) 1 1 Nonfamilial hypogammaglobulinemia (D80.1) 1 1 Non-follicular (diffuse) lymphoma, unspecified, extranodal and solid organ sites (C83.99) 1 1 Non-Hodgkin lymphoma, unspecified, unspecified site (C85.90) 1 1 Noninfective gastroenteritis and colitis, unspecified (K52.9) 2 2 Nonspec elev of levels of transamns & lactic acid dehydrgns (R74.0) 1 1

January 1, 2018 - December 31, 2018 17 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN

Non-ST elevation (NSTEMI) myocardial infarction (I21.4) 7 7 Obstruction of bile duct (K83.1) 1 1 Obstructive sleep apnea (adult) (pediatric) (G47.33) 84 2 86 Occipital neuralgia (M54.81) 1 1

Occlusion and stenosis of bilateral carotid arteries (i65.23) 2 2 Occup of sp off-rd mv injured in nontraffic accident init (V86.99XA) 1 1 Ocular pain, right eye (h57.11) 1 1 Opioid dependence with withdrawal (F11.23) 1 1 Osseous and sublux stenosis of intvrt foramin of cerv regio (M99.61) 2 2 Osseous and stenosis of intervertebral foramina of lumbar region (M99.63) 1 1 Osteoarthritis of knee, unspecified (M17.9) 1 1 Osteochondritis dissecans, right knee (M93.261) 1 1 Osteomyelitis of vertebra, lumbar region (M46.26) 1 1 Oth disrd of the skin and subcutaneous tissue (L98.8) 1 1 Oth fx second lum vertebra subs for fx w routn heal (S32.028D) 1 1 Oth nondisp fx of upr end r humer subs for fx w routn heal (S42.294D) 2 2 Oth non-follic lymphoma lymph nodes of head face and neck O (C83.81) 1 1 Oth tear of medial meniscus, current injury, left knee, subs (S83.242D) 1 1 Other acute appendicitis (K35.89) 1 1 Other acute nonsuppurative otitis media, recurrent, left ear (H65.195) 1 1 Other acute postprocedural pain (G89.18) 1 1 Other benign mammary dysplasias of unspecified breast (N60.89) 1 1 Other biomechanical lesions of cervical region (M99.81) 3 3 Other biomechanical lesions of lumbar region (M99.83) 4 4 Other bursitis of knee, left knee (M70.52) 1 1

Other cervical disc degeneration at C4-C5 level (M50.321) 2 2

Other cervical disc degeneration at C5-C6 level (M50.322) 1 1 Other cervical disc degeneration, high cervical region (M50.31) 1 1 Other cervical disc degeneration, cervicothoracic region (M50.33) 1 1

January 1, 2018 - December 31, 2018 18 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Other cervical disc degeneration, unspecified cervical region (M50.30) 1 1

Other cervical disc displacement at C4-C5 level (M50.221) 1 1

Other cervical disc displacement at C5-C6 level (M50.222) 1 1

Other cervical disc displacement at C6-C7 level (M50.223) 1 1 Other cervical disc displacement unsp cervical region (M50.20) 1 1 Other chest pain (R07.89) 3 3 Other chronic pain (G89.29) 6 6 Other chronic postprocedural pain (G89.28) 1 1 Other chronic sinusitis (J32.8) 4 4 Other cirrhosis of liver (K74.69) 1 1 Other diseases of salivary glands (K11.8) 1 1 Other disorder of circulatory system (I99.8) 1 1 Other displaced fracture of lower end of right humerus, subsequent encounter for fracture with routine healing (S42.491D) 1 1 Other displaced fracture of upper end of left humerus, subsequent encounter for fracture with routine healing (S42.292D) 1 1 Other drug-induced agranulocytosis (D70.2) 5 5 Other dystonia (G24.8) 1 1 Other encephalopathy (G93.49) 1 1 Other enthesopathies, not elsewhere classified (M77.8) 2 2 Other enthesopathy of right foot (M77.51) 1 1 Other forms of angina pectoris (I20.8) 2 2 Other forms of dyspnea (R06.09) 1 1

Other forms of scoliosis, thoracolumbar region (M41.85) 1 1 Other fracture of lower end of left tibia, subsequent encounter for closed fracture with routine healing (S82.392D) 1 1 Other fracture of upper and lower end of left fibula, initial encounter for closed fracture (S82.832A) 1 1 Other fracture of upper and lower end of right fibula, initial encounter for closed fracture (S82.831A) 1 1 Other fracture of upper end of left tibia, subsequent encounter for closed fracture with routine healing (S82.192D) 3 1 4 Other hemorrhage in early pregnancy (O20.8) 1 1 Other hypertrophic disorders of the skin (L91.8) 1 1

January 1, 2018 - December 31, 2018 19 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Other idiopathic scoliosis, lumbar region (M41.26) 1 1 Other injury of other muscle(s) and tendon(s) at lower leg level, right leg, subsequent encounter (S86.891D) 1 1 Other instability, left knee (M25.362) 2 1 3 Other instability, left shoulder (M25.312) 2 2 Other instability, right ankle (M25.371) 1 1 Other instability, right knee (M25.361) 4 4 Other instability, right shoulder (M25.311) 1 1 Other internal derangements of right knee (M23.8X1) 1 1 Other intervertebral disc degeneration lumbosacral region (M51.37) 4 4 Other intervertebral disc degeneration, lumbar region (M51.36) 28 28 Other intervertebral disc degeneration, thoracic region (M51.34) 2 2 Other intervertebral disc disorders, thoracic region (M51.84) 1 1 Other intervertebral disc displacement, lumbar region (M51.26) 184 6 190 Other intervertebral disc displacement, lumbosacral region (M51.27) 2 2 Other intervertebral disc displacement, thoracic region (M51.24) 3 3 Other iron deficiency anemias (D50.8) 5 5 Other lack of coordination (R27.8) 3 3 Other localized visual field defect, bilateral (H53.453) 1 1 Other long term (current) drug therapy (Z79.899) 1 1 Other malignant neoplasm without specification of site. (C80.01) 1 1 Other malignant neuroendocrine tumors (C7A.8) 1 1 Other mechanical complication of breast prosthesis and implant, initial encounter (T85.49XA) 1 1 Other mechanical complication of other specified internal prosthetic devices, implants and grafts, initial encounter (T85.698A) 1 1 Other muscle spasm (M62.838) 1 1 Other nondisplaced fracture of third cervical vertebra, subsequent encounter for fracture with delayed healing (S12.291G) 1 1 Other nonspecific abnormal finding of lung field (R91.8) 2 2 Other osteomyelitis, ankle and foot (M86.8X7) 1 1 Other osteomyelitis, other site (M86.8X8) 1 1 Other pancytopenia (D61.818) 1 1 Other pneumonia, unspecified organism (J18.8) 1 1

January 1, 2018 - December 31, 2018 20 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Other psoriatic arthropathy (L40.59) 1 1 Other pulmonary embolism without acute cor pulmonale (I26.99) 1 1 Other rheumatoid arthritis with rheumatoid factor of multiple sites (M05.89) 2 2 Other shoulder lesions, right shoulder (M75.81) 2 2 Other signs and symptoms in breast (N64.59) 1 1 Other somatoform disorders (F45.8) 1 1 Other specified acquired deformities of musculoskeletal system (M95.8) 1 1 Other specified complication of internal orthopedic prosthetic devices, implants and grafts, initial encounter (T84.89XA) 1 1 Other specified complication of internal orthopedic prosthetic devices, implants and grafts, subsequent encounter (T84.89XD) 1 1 Other specified conditions associated with female genital organs and menstrual cycle (N94.89) 1 1 Other specified congenital malformations of spinal cord (Q06.8) 1 1 Other specified depressive episodes (F32.89) 1 1 Other specified diabetes mellitus with ketoacidosis without coma (E13.10) 2 2 Other specified disorders of bladder (N32.8) 1 1 Other specified disorders of bone density and structure, unspecified site (M85.80) 5 1 6 Other specified disorders of brain (G93.89) 2 2 Other specified disorders of breast (N64.89) 3 3 Other specified disorders of nose and nasal sinuses (J34.89) 2 2 Other specified dorsopathies, lumbosacral region (M53.87) 1 1 Other specified dorsopathies, thoracic region (M53.84) 1 1 Other specified mononeuropathies (G58.8) 1 1 Other specified myoneural disorders (G70.89) 1 1 Other specified peripheral vascular diseases (I73.89) 1 1 Other specified postprocedural states (Z98.890) 2 2 4 Other specified rheumatoid arthritis, multiple sites (M06.89) 3 3 Other specified symptoms and signs involving the digestive system and abdomen (R19.8) 1 1 Other speech disturbances (R47.89) 1 1 Other spondylosis lumbar region (M47.896) 53 3 56

January 1, 2018 - December 31, 2018 21 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Other spondylosis with myelopathy, cervical region (M47.12) 10 10 Other spondylosis with myelopathy, lumbar region (M47.16) 1 1 Other spondylosis with radiculopathy, cervical region (M47.22) 41 1 42 Other spondylosis with radiculopathy, lumbar region (M47.26) 23 23 Other spondylosis with radiculopathy, lumbosacral region (M47.27) 44 5 49 Other spondylosis with radiculopathy, thoracic region (M47.24) 2 2 Other spondylosis, cervical region (M47.892) 44 1 45 Other spondylosis, lumbosacral region (M47.897) 52 2 54

Other spondylosis, occipito-atlanto-axial region (M47.891) 2 2 Other spondylosis, thoracic region (M47.894) 9 9 Other spondylosis, thoracolumbar region (M47.895) 3 3 Other spontaneous disruption of anterior cruciate of left knee (M23.612) 2 1 3 Other spontaneous disruption of anterior cruciate ligament of right knee (M23.611) 6 1 7 Other sprain of right , initial encounter (S43.491A) 1 1 Other stimulant dependence, uncomplicated (F15.20) 1 1 2 Other symptoms and signs involving general sensations and perceptions (R44.8) 1 1 Other tear of lateral meniscus, current injury, right knee, initial encounter (S83.281A) 1 1 Other tear of lateral meniscus, current injury, right knee, subsequent encounter (S83.281D) 3 1 4 Other tear of medial meniscus, current injury, left knee, initial encounter (S83.242A) 2 1 3 Other tear of medial meniscus, current injury, right knee, initial encounter (S83.241A) 3 3 Other tear of medial meniscus, current injury, unspecified knee, initial encounter (S83.249A) 2 2

Other unilateral secondary osteoarthritis of knee (M17.5) 1 2 3 Overactive bladder (N32.81) 1 1 Pain due to internal orthopedic prosthetic devices, implants and grafts, subsequent encounter (T84.84XD) 1 1

January 1, 2018 - December 31, 2018 22 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Pain due to internal prosthetic devices, implants and grafts, not elsewhere classified, initial encounter (T85.84XA) 1 1 Pain in joint (M25.5) 1 1 Pain in knee (M25.56) 1 1 Pain in left ankle and joints of left foot (M25.572) 4 9 13 Pain in left elbow (M25.522) 1 1 Pain in left foot (M79.672) 3 3 Pain in left hand (M79.642) 1 1 Pain in left hip (M25.552) 2 3 5 Pain in left knee (M25.562) 28 16 45 Pain in left lower leg (M79.662) 1 1 Pain in left shoulder (M25.512) 9 19 28 Pain in leg, unspecified (M79.606) 2 2 Pain in right ankle and joints of right foot (M25.571) 5 8 13 Pain in right elbow (M25.521) 7 2 9 Pain in right foot (M79.671) 2 2 4 Pain in right (M79.631) 1 1 Pain in right hip (M25.551) 6 13 19 Pain in right knee (M25.561) 19 17 37 Pain in right leg (M79.604) 1 4 5 Pain in right shoulder (M25.511) 24 16 40 Pain in right wrist (M25.531) 5 1 6 Pain in thoracic spine (M54.6) 6 2 8 Pain in unspecified knee (M25.569) 2 2 Pain in unspecified shoulder (M25.519) 1 1 Palmar fascial fibromatosis [Dupuytren] (M72.0) 2 2 Palpitations (R00.2) 10 10 Pancreas transplant status (Z94.83) 1 1 Panic disorder [episodic paroxysmal anxiety] (FF41.0) 1 1 Panniculitis affecting regions of neck and back, lumbar region (M54.06) 1 1 Panniculitis affecting regions of neck and back, site unspecified (M54.) 1 1 Paralysis of vocal cords and larynx, unilateral (J38.01) 1 1 Paresthesia of skin (R20.2) 2 2 Parkinson's disease (G20) 1 1 Paroxysmal atrial fibrillation (I48.0) 3 3 Patellofemoral disorders, right knee (M22.2X1) 1 1 Pelvic and perineal pain (R10.2) 4 1 5 unspecified (K05.6) 1 1 Peripheral T-cell lymphoma, not classified, unspecified site (C84.40) 3 3 Peripheral vascular disease, unspecified (I73.9) 1 1

January 1, 2018 - December 31, 2018 23 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Periprosth fracture around other internal prosth joint init (M97.8XXA) 1 1 Periumbilical pain (R10.33) 1 1 Personal history of in-situ neoplasm of breast (z86.000) 1 1

Personal history of malignant neoplasm of breast (Z85.3) 4 4

Personal history of malignant neoplasm of larynx (Z85.21) 1 1

Personal history of malignant neoplasm of ovary (Z85.43) 2 2 Personal history of malignant neoplasm of unspecified site of lip, oral cavity, and pharynx (Z85.819) 1 1 Personal history of other malignant neoplasms of lymphoid, hematopoietic and related tissues (Z85.79) 1 1 Pervasive developmental disorder, unspecified (F84.9) 1 1 Phonological disorder (F80.0) 8 3 11 Plantar fascial fibromatosis (M72.2) 4 5 Pneumonia due to Streptococcus pneumoniae (J13) 1 1 Pneumonia, unspecified organism (J18.9) 6 6 Pneumothorax, unspecified (j93.9) 1 1 Poisoning by unspecified drugs, medicaments and biological substances, accidental (unintentional), initial encounter (T50.901A) 1 1 Polycystic kidney, adult type (Q61.2) 1 1 Polycythemia vera (d45.1) 1 1 Polyosteoarthritis, unspecified (M15.9) 1 1 Polyp of nasal cavity (J33.0) 1 1 Postlaminectomy syndrome, not elsewhere classified (M96.1) 4 1 5

Postprocedural seroma of a musculoskeletal structure following a musculoskeletal system procedure (M96.842) 1 1 Post-traumatic osteoarthritis left ankle and foot (M19.172) 1 1 Post-traumatic stress disorder, acute (F43.11) 1 1 Post-traumatic stress disorder, unspecified (F43.10) 1 1 Post-traumatic urethral stricture (N35.0) 1 1 Precordial pain (R07.2) 2 2 Pregnant state, incidental (Z33.1) 1 1 Premature rupture of membranes, unspecified as to length of time between rupture and onset of labor, unspecified weeks of gestation (O42.90) 1 1 Presence of artificial hip joint, bilateral (Z96.643) 1 1 Presence of artificial knee joint, bilateral (Z96.653) 1 1

January 1, 2018 - December 31, 2018 24 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Presence of left artificial knee joint (Z96.652) 1 1 Presence of right artificial hip joint (Z96.641) 3 3 Presence of right artificial knee joint (Z96.651) 3 2 5 Presence of unspecified artificial knee joint (Z96.659) 2 2 4 Preterm labor second tri w preterm delivery second tri unsp (O60.12X0) 1 1 Primary biliary cirrhosis (K74.3) 1 1 Primary open-angle glaucoma, left eye, indeterminate stage (H40.1124) 1 1 Primary open-angle glaucoma, right eye, indeterminate stage (H40.1114) 1 1 Primary open-angle glaucoma, right eye, mild stage (H40.1111) 1 1 Primary osteoarthritis, left shoulder (M19.012) 1 1 Primary osteoarthritis, right elbow (M19.021) 1 1 Primary osteoarthritis, right shoulder (m19.011) 2 4 6 Pseudarthrosis after fusion or arthrodesis (M96.0) 2 2 Psoas tendinitis, unspecified hip (M76.1) 1 1 Quadriplegia, unspecified (G82.50) 2 2 Radial collateral ligament sprain of right elbow, subsequent encounter (S53.431D) 1 1 Radiation sickness, unspecified, sequela (T66.XXXS) 1 1 Radiculopathy, cervical region (M54.12) 88 5 93 Radiculopathy, lumbar region (M54.16) 188 5 195 Radiculopathy, lumbosacral region (M54.17) 77 2 79 Radiculopathy, site unspecified (M54.10) 5 5 Radiculopathy, thoracic region (M54.14) 12 12 Radiculopathy, thoracolumbar region (M54.15) 1 1 Raynaud's syndrome without gangrene (I73.0) 1 1 Rectal fistula (K60.4) 1 1 Recurrent and persistent hematuria with other morphologic changes (N02.8) 1 1 Recurrent dislocation of patella, left knee (M22.02) 5 5 Recurrent dislocation, right shoulder (M24.411) 1 1 Recurrent pregnancy loss (N96) 2 2 Renal and perinephric abscess (N15.1) 1 1 Retention of urine, unspecified (R33.9) 1 1 Retinal edema (H35.81) 1 1 Retinal hemorrhage, unspecified eye (H35.60) 1 1

Retinal neovascularization, unspecified, left eye (H35.052) 2 2 Retinal neovascularization, unspecified, right eye (H35.051) 2 2

January 1, 2018 - December 31, 2018 25 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement (M05.79) 2 2 Rheumatoid arthritis with rheumatoid factor, unspecified (M05.9) 1 1 Rheumatoid arthritis without rheumatoid factor, multiple sites (M06.09) 3 3 Rheumatoid arthritis, unspecified (M06.9) 2 2 Right lower quadrant pain (R10.31) 1 1 Right upper quadrant pain (R10.11) 1 1 Sacrococcygeal disorders, not elsewhere classified (M53.3) 2 2 Sacroiliitis, not elsewhere classified (M46.1) 22 2 24 Sciatica, left side (M54.32) 1 1 Sciatica, right side (M54.31) 3 3 6 Scoliosis, unspecified (M41.9) 4 4 Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck (C77.0) 1 1 Secondary carcinoid tumors, unspecified site (C7B.00) 2 2 Secondary malignant neoplasm of bone (C79.51) 8 8 Secondary malignant neoplasm of brain (C79.31) 1 1 Secondary malignant neoplasm of liver and intrahepatic bile duct (C78.7) 1 1 Secondary malignant neoplasm of unspecified lung (C78.00) 1 1 Sedative, hypnotic or anxiolytic dependence, uncomplicated (F13.20) 1 1 Segmental and somatic dysfunction of lumbar region (M99.03) 2 2 Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side (H90.42) 1 1 Severe persistent asthma with (acute) exacerbation (J45.51) 2 2 Severe persistent asthma, uncomplicated (J45.50) 7 7 Sezary disease, lymph nodes of multiple sites (C84.18) 1 1 Shortness of breath (R06.02) 5 5 Simple febrile convulsions (R56.00) 1 1 Sleep apnea (G47.3) 1 1 Slow transit constipation (K59.01) 1 1 Snoring (R06.83) 1 1 Social pragmatic communication disorder (F80.82) 1 1 Solitary pulmonary nodule (R91.1) 2 2 Spasmodic torticollis (G24.3) 3 1 4 Spastic diplegic cerebral palsy (G80.1) 2 2 Spastic hemiplegic cerebral palsy (G80.2) 2 2

January 1, 2018 - December 31, 2018 26 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Spastic quadriplegic cerebral palsy (G80.0) 3 2 5 Specific developmental disorder of motor function (F82) 2 1 3 Speech and language development delay due to hearing loss (F80.4) 2 2 Spinal instabilities, cervical region (M53.2X2) 1 1 Spinal instabilities, lumbosacral region (M53.2X7) 3 3 Spinal stenosis cervicothoracic region (M48.03) 2 2 Spinal stenosis, cervical region (M48.02) 18 2 20 Spinal stenosis, lumbar region (M48.06) 9 9 Spinal stenosis, lumbar region with neurogenic claudication (M48.062) 43 43 Spinal stenosis, lumbar region without neurogenic claudication (M48.061) 15 15 Spinal stenosis, lumbosacral region (M48.07) 9 9 Spinal stenosis, occipito-atlanto-axial region (M48.01) 1 1 Spinal stenosis, site unspecified (M48.00) 2 2 Spinal stenosis, thoracic region (M48.04) 2 2 Spondylolisthesis, cervical region (M43.12) 2 1 3 Spondylolisthesis, cervicothoracic region (M43.13) 1 1 Spondylolisthesis, lumbar region (M43.16) 10 1 11 Spondylolisthesis, lumbosacral region (M43.17) 7 7 Spondylolisthesis, multiple sites in spine (M43.19) 1 1 Spondylolisthesis, site unspecified (M43.10) 4 4 Spondylolysis, lumbar region (M43.06) 4 4 Spondylosis without myelopathy or radiculopathy, cervical region (M47.812) 35 1 36 Spondylosis without myelopathy or radiculopathy, cervicothoracic region (M47.813) 1 1 Spondylosis without myelopathy or radiculopathy, lumbar region (M47.816) 35 1 36 Spondylosis without myelopathy or radiculopathy, lumbosacral region (M47.817) 26 26 Spontaneous rupture of extensor tendons, right hand (M66.241) 1 1 Spontaneous rupture of flexor tendons, left upper arm (M66.322) 1 1 Sprain of anterior cruciate ligament of left knee, initial encounter (S83.512A) 2 2 Sprain of anterior cruciate ligament of left knee, subsequent encounter (S83.512D) 7 2 9 Sprain of anterior cruciate ligament of right knee, initial encounter (S83.511A) 1 1 Sprain of anterior cruciate ligament of right knee, subsequent encounter (S83.511D) 7 7

January 1, 2018 - December 31, 2018 27 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Sprain of ligaments of cervical spine, initial encounter (S13.4XXA) 2 2 Sprain of ligaments of lumbar spine, initial encounter (S33.5XXA) 1 1 Sprain of medial collateral ligament of left knee, subsequent encounter (S83.412D) 2 2 Sprain of medial collateral ligament of right knee, subsequent encounter (S83.411D) 2 2 Sprain of other part of right wrist and hand, subsequent encounter (S63.8X1D) 1 1 Sprain of unspecified ligament of right ankle, subsequent encounter (S93.401D) 2 1 3 ST elevation (STEMI) myocardial infarction of unspecified site (I21.3) 2 2 Stiffness of left shoulder, not elsewhere classified (M25.612) 1 1

Stiffness of right knee, not elsewhere classified (M25.661) 1 1 Stiffness of right shoulder, not elsewhere classified (M25.611) 1 1 Stiffness of unspecified knee, not elsewhere classified (M25.669) 1 1 of muscle(s) and tendon(s) of the rotator cuff of right shoulder, subsequent encounter (S46.011D) 1 1 Strain of muscle, fascia and tendon at neck level, subsequent encounter (S16.1XXD) 1 1 Strain of muscle, fascia and tendon of left hip, initial encounter (S76.012A) 1 1

Strain of muscle, fascia and tendon of long head of biceps, unspecified arm, subsequent encounter (S46.119D) 2 2 Strain of other muscles, fascia and tendons at shoulder and upper arm level, left arm, subsequent encounter (S46.812D) 1 1 Strain of other specified muscles and tendons at ankle and foot level, right foot, initial encounter (S96.811A) 1 1 Strain of unspecified muscle, fascia and tendon at shoulder and upper arm level, right arm, initial encounter (S46.911A) 1 1 Strain of unspecified muscle, fascia and tendon at shoulder and upper arm level, right arm, subsequent encounter (S46.911D) 2 2 Stress fracture, left tibia, subsequent encounter for fracture with routine healing (M84.362D) 1 1

January 1, 2018 - December 31, 2018 28 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Stress fracture, right tibia, initial encounter for fracture (M84.361A) 1 1 Stress fracture, unspecified tibia and fibula, initial encounter for fracture (M84.369A) 1 1 2 Stress incontinence (female) (male) (N39.3) 3 3 10 Superior glenoid labrum lesion of left shoulder, initial encounter (S43.432A) 2 1 3 Superior glenoid labrum lesion of left shoulder, subsequent encounter (S43.432D) 1 2 3 Superior glenoid labrum lesion of right shoulder, initial encounter (S43.431A) 1 1 Superior glenoid labrum lesion of right shoulder, subsequent encounter (S43.431D) 2 3 5 Superior glenoid labrum lesion of unspecified shoulder, subsequent encounter (S43.439D) 1 1 2 Supraventricular tachycardia (I47.1) 1 1 Syncope and collapse (R55) 4 4 Systemic involvement of connective tissue, unspecified (M35.9) 1 1 Systemic lupus erythematosus, unspecified (M32.9) 7 7 Tachycardia, unspecified (R00.0) 2 2 Tear of articular cartilage of left knee, current, subsequent encounter (S83.32XD) 1 1 Tear of articular cartilage of right knee, current, subsequent encounter (S83.31XD) 2 2 Threatened abortion (O20.0) 1 1 Toxic effect of unspecified snake venom, accidental (unintentional), initial encounter (T63.001A) 1 1 Tracheostomy status (Z93.0) 1 1 Transient alteration of awareness (R40.4) 1 1 Transient cerebral ischemic attack, unspecified (G45.9) 1 1 Traumatic subdural hemorrhage (S06.5) 1 1 Tremor, unspecified (R25.1) 1 1 2 Tributary (branch) retinal vein occlusion, left eye, with macular edema (H34.8320) 2 2 Tributary (branch) retinal vein occlusion, right eye, with macular edema (H34.8310) 4 4 Trigeminal neuralgia (G50.0) 1 1 Trigger finger, right middle finger (M65.331) 1 1 Trochanteric bursitis, right hip (M70.61) 1 1 2 Type 1 diabetes mellitus with diabetic polyneuropathy (e10.42) 1 1 Type 1 diabetes mellitus with hyperglycemia (E10.65) 17 17

January 1, 2018 - December 31, 2018 29 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Type 1 diabetes mellitus with ketoacidosis without coma (E10.10) 4 4 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral (E10.3513) 4 4 Type 1 diabetes mellitus without complications (E10.9) 9 9 Type 2 diab w hyprosm w/o nonket hyprgly-hypros coma (NKHHC (E11.00) 1 1 Type 2 diab with severe nonp rtnop with macular edema r eye (E11.3411) 2 2 Type 2 diabetes mellitus with diabetic chronic kidney disease (E11.22) 1 1 Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene (E11.52) 1 1 Type 2 diabetes mellitus with foot ulcer (E11.621) 1 1 Type 2 diabetes mellitus with hyperglycemia (E11.65) 3 3 Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) Y (E11.0) 1 1 Type 2 diabetes mellitus with hypoglycemia without coma (E11.649) 1 1 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral (E11.3213) 2 2 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye (E11.3211) 1 1 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral (E11.3313) 9 9 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye (E11.3311) 1 1 Type 2 diabetes mellitus with other specified complication (E11.69) 2 2 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral (E11.3513) 37 37 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye (E11.3511) 4 4 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye (E11.3531) 1 1 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral (E11.3413) 18 18

January 1, 2018 - December 31, 2018 30 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye (E11.3412) 1 1 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral (E11.3493) 1 1 Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, right eye (E11.3551) 1 1 Type 2 diabetes mellitus without complications (E11.9) 1 1 Ulcerative (chronic) pancolitis without complications (K51.00) 1 1 Ulcerative colitis unspecified with other complication (K51.918) 1 1 Ulcerative colitis, unspecified, without complications (K51.90) 3 3 Ulnar collateral ligament sprain of right elbow, subsequent encounter (S53.441D) 1 1 Unilateral post-traumatic osteoarthritis, right knee (M17.31) 2 2 Unilateral post-traumatic osteoarthritis, unspecified knee (M17.30) 1 1 Unilateral primary osteoarthritis of first carpometacarpal joint, left hand (M18.12) 2 2 Unilateral primary osteoarthritis of knee (M17.1) 1 1 2 Unilateral primary osteoarthritis, left hip (M16.12) 9 2 11 Unilateral primary osteoarthritis, left knee (M17.12) 58 11 69 Unilateral primary osteoarthritis, right hip (M16.11) 7 7 Unilateral primary osteoarthritis, right knee (M17.11) 84 13 97 Unilateral primary osteoarthritis, unspecified knee (M17.10) 4 4 Unsp dislocation of right acromioclavicular joint, subs (S43.101D) 2 2 Unsp fracture of unsp lum vertebra subs for fx w nonunion (S32.009K) 2 2 Unsp intestnl obst unsp as to partial versus complete obst (K56.609) 5 5 Unspecified abdominal pain (r10.9) 6 6 Unspecified abnormal involuntary movements (R25.9) 1 1 Unspecified acute appendicitis (K35.80) 1 1 Unspecified asthma with (acute) exacerbation (J45.901) 1 1 Unspecified asthma, uncomplicated (J45.909) 1 1 Unspecified atrial fibrillation (i48.91) 11 11 Unspecified atrial flutter (I48.92) 3 3

January 1, 2018 - December 31, 2018 31 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Unspecified benign mammary dysplasia of left breast (N60.92) 1 1 Unspecified cirrhosis of liver (K74.60) 1 1 Unspecified complication of internal prosthetic device, implant and graft, initial encounter (T85.9XXA) 1 1 Unspecified complication of procedure, initial encounter (T81.9XXA) 1 1 Unspecified convulsions (R56.9) 3 3 Unspecified cord compression (G95.20) 2 2 Unspecified dislocation of left patella, initial encounter (S83.005A) 1 1 Unspecified dislocation of left patella, subsequent encounter (S83.005D) 1 1 Unspecified dislocation of right patella, initial encounter (S83.004A) 1 1 Unspecified dislocation of right patella, subsequent encounter (S83.004D) 1 1

Unspecified disorder of psychological development (F89) 1 1 Unspecified dyspareunia (N94.10) 1 1 Unspecified ectropion of right eye, unspecified eyelid (H02.103) 1 1 Unspecified fall, initial encounter (W19.XXXA) 1 1 Unspecified fracture of right femur, initial encounter for closed fracture (S72.91XA) 1 1 Unspecified fracture of right patella, initial encounter for closed fracture (S82.001A) 1 1 Unspecified fracture of unspecified lumbar vertebra, initial encounter for closed fracture (S32.009A) 1 1 Unspecified fracture of upper end of left humerus, subsequent encounter for fracture with routine healing (S42.202D) 2 2 4 Unspecified hydronephrosis (N13.30) 1 1 Unspecified inflammatory spondylopathy, cervical region (M46.92) 1 1 Unspecified injury of muscle(s) and tendon(s) of the rotator cuff of left shoulder, subsequent encounter (S46.002D) 1 1

Unspecified injury of muscle, fascia and tendon of the posterior muscle group at level, left thigh (S76.302) 1 1 Unspecified injury of muscle, fascia and tendon of the posterior muscle group at thigh level, left thigh, subsequent encounter (S76.302D) 1 1

January 1, 2018 - December 31, 2018 32 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Unspecified injury of muscle, fascia and tendon of the posterior muscle group at thigh level, right thigh, initial encounter (S76.301A) 2 2 Unspecified injury of muscle, fascia and tendon of the posterior muscle group at thigh level, right thigh, subsequent encounter (S76.301D) 1 1 Unspecified injury of right Achilles tendon, subsequent encounter (S86.001D) 2 3 5 Unspecified injury of unspecified wrist, hand and finger(s), initial encounter (S69.90XA) 1 1 Unspecified internal derangement of left knee (M23.92) 1 1 Unspecified lack of coordination (R27.9) 2 2 Unspecified lack of expected normal physiological development in childhood (R62.50) 1 1 Unspecified lump in the left breast, lower outer quadrant (N63.23) 1 1 Unspecified lump in the right breast, upper outer quadrant (N63.11) 1 1 2 Unspecified lump in unspecified breast (N63.0) 1 1 Unspecified mononeuropathy of unspecified lower limb (G57.90) 1 1 Unspecified mood [affective] disorder (F39) 1 1 Unspecified open wound of nose, initial encounter (S01.20XA) 1 1 Unspecified osteoarthritis, unspecified site (M19.90) 2 2 Unspecified otosclerosis, unspecified ear (H80.90) 1 1 Unspecified pre-existing hypertension complicating childbirth (010.92) 1 1 Unspecified renal colic (N23) 1 1 Unspecified rotator cuff tear or rupture of left shoulder, not specified as traumatic (M75.102) 3 5 8 Unspecified rotator cuff tear or rupture of right shoulder, not specified as traumatic (M75.101) 4 4 Unspecified rotator cuff tear or rupture of unspecified shoulder, not specified as traumatic (M75.100) 1 1 Unstable angina (I20.0) 1 1 Unsteadiness on feet (R26.81) 1 1 Upper abdominal pain, unspecified (R10.10) 1 1 Urinary tract infection, site not specified (N39.0) 5 5 Urticaria, unspecified (L50.9) 2 2 Vaginismus (N94.2) 2 2 Varicose veins of bilateral lower extremities with other complications (I83.893) 2 2

January 1, 2018 - December 31, 2018 33 APPROVAL AND DENIAL RATES BY DIAGNOSIS CODE AND LABEL APPEAL DIAGNOSIS CODES AND LABELS APPROVED DENIED TOTAL OVERTURN Varicose veins of bilateral lower extremities with pain (I83.813) 4 4 Varicose veins of left lower extremities with other complications (I83.892) 2 2 Varicose veins of left lower extremity with inflammation (I83.12) 46 46

Varicose veins of left lower extremity with pain (I83.812) 4 4 Varicose veins of right lower extremities with pain (I83.811) 3 3 Varicose veins of right lower extremity with inflammation (I83.11) 30 30 Varicose veins of right lower extremity with other complications (I83.891) 19 19 Vascular disorders of male genital organs (N50.1) 1 1 Venous insufficiency (chronic) (peripheral) (I87.2) 27 27 Ventricular tachycardia (I47.2) 1 1 Vitreous hemorrhage, right eye (H43.11) 2 2 Volume depletion, unspecified (E86.9) 1 1 Vomiting unspecified (R11.10) 2 2 Vulvodynia, unspecified (N94.819) 3 3 Weakness (R53.1) 2 2 Webbed fingers, left hand (Q70.12) 1 1 Wedge compression fracture of first lumbar vertebra, initial encounter for closed fracture (S32.010A) 1 1 Wegener's granulomatosis without renal involvement (M31.3) 1 1 Zoster without complications (B02.9) 2 2 Grand Total 3860 553 3 4431

January 1, 2018 - December 31, 2018 34