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Firstcare Diagnosis Label & Code (2018)

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Firstcare Diagnosis Label & Code (2018) 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 knee (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 shoulder (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 hip joint 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 Ankyloglossia (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 neck (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 ankle and foot (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
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