ICD-10 Codes covered under Medical Nutrition Therapy services – Effective February 1, 2021* ICD-10 Diagnosis Code Description ICD-10 Diagnosis Code Description A56.01 Chlamydial cystitis and urethritis E24.0 Pituitary-dependent Cushing's disease Congenital adrenogenital disorders associated B20. HIV E25.0 with enzyme deficiency B52.0 Plasmodium malariae malaria with nephropathy E20.1 Pseudohypoparathyroidism B25.1 Cytomegaloviral hepatitis E28.2 Polycystic Ovarian Syndrome B25.2 Cytomegaloviral pancreatitis E34.0 Carcinoid syndrome B52.0 Plasmodium malariae malaria with nephropathy E41 Nutritional marasmus C00.0 – C96.9 All types of Cancer code (range) E42 Marasmic kwashiorkor C96.A Histiocytic sarcoma E43 Unspecified severe protein-calorie malnutrition Other specified malignant neoplasms of C96.Z lymphoid, hematopoietic and related tissue E44.0 – E46 Moderate protein-calorie malnutrition (range) D00.00 – D09.9 Carcinoma code (range) E50 – E50.9 Vitamin A deficiency (range) D63.0 Anemia in neoplastic disease E51 – E51.9 Thiamine deficiency (range) D64.81 Anemia due to antineoplastic chemotherapy E52 Niacin deficiency [pellagra] Agranulocytosis secondary to cancer D70.1 E53.0 – E53.9 Deficiency of other B group vitamins (range) chemotherapy E54 Ascorbic acid deficiency D70.2 Other drug-induced agranulocytosis E55.0 – E55.9 Vitamin D deficiency Iron deficiency anemia secondary to blood loss D50.0 – D50.1 (range) E56.0 – E56.9 Other vitamin deficiencies D50.8 – D50.9 Other iron Deficiency Anemia (range) E58 Dietary calcium deficiency D51.0 – D51.9 B12 deficiency anemia (range) E59 Dietary selenium deficiency D52.0 – D52.9 Dietary folate anemia (range) E60 Dietary zinc deficiency D53.0 – D53.9 Other anemia (range) E61.0 – E61.9 Deficiency of other nutrient elements D55.0 – D55.9 Anemia due to enzyme disorders (range) E63.0 – E63.9 Other nutritional deficiencies D64.81 Anemia due to antineoplastic chemotherapy E64.0 – E64.9 Sequelae of protein-calorie malnutrition (range) D64.89 Other specified anemias E65 Localized adiposity D64.9 Anemia US E66.0 – E66.9 Obesity (code range) Other disorders involving the immune mechanism, D89.0-D89.2 E67.0 – E67.8 Other hyperalimentation (code range) not elsewhere classified (code range) E68 Sequelae of hyperalimentation E03.9 Hypothyroidism Disorders of aromatic amino acid metabolism/ E70.0 – E70.9 E05.90 Thyrotoxicosis PKU (code range) Disorders of branched chain amino acid E08 – E13.9 All Diabetes code range E71.0 – E71.39 metabolism (code range) E08.00 – E08.9 Diabetes due to underlying conditions (range) E71.40 – E71.43 Disorders of carnitine metabolism E09.00 – E09.9 Drug induced diabetes mellitus (range) E71.440 Ruvalcaba-Myhre-Smith syndrome E10.10 – E10.9 Type 1 Diabetes (range) E71.448 Other secondary carnitine deficiency E11.00 – E11.9 Type 2 Diabetes (range) Disorders of amino acid transport/ E72.00 – E72.9 E13.00 – E13.9 Other specified diabetes(range) homocystinuria (code range) E16.0 – E16.2 Hypoglycemia (range) E73.0 – E73.9 Lactose intolerance (code range) Other disorders of carbohydrate metabolism E20.1 Pseudohypoparathyroidism E74.00 – E74.9 (code range) E22.0 Acromegaly and pituitary gigantism *This list of diagnoses is subject to change. PRV20473-2101 ICD-10 Codes covered under Medical Nutrition Therapy services – Effective February 1, 2021* ICD-10 Diagnosis Code Description ICD-10 Diagnosis Code Description E75.21 – E75.249 Other sphingolipidosis (code range) Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex G40.201 E75.3 Sphingolipidosis, unspecified partial seizures, not intractable, with status E75.5 – E75.6 Other lipid storage disorders (code range) epilepticus Localization-related (focal) (partial) symptomatic E77.0 – E77.9 Disorders of glycoprotein metabolism (code range) epilepsy and epileptic syndromes with complex G40.209 Disorders of lipoprotein metabolism and other partial seizures, not intractable, without status E78.7 – E78.9 lipidemias (code range) epilepticus Disorders of porphyrin and bilirubin metabolism Localization-related (focal) (partial) symptomatic E80.0 – E80.29 (code range) epilepsy and epileptic syndromes with complex G40.211 partial seizures, intractable, with status E83.00 – E83.19, Disorders of mineral metabolism (code range) epilepticus E83.30 – E83.9 Localization-related (focal) (partial) symptomatic E84.0 – E84.9 Cystic fibrosis (range) epilepsy and epileptic syndromes with complex G40.219 E86.0 – E86.9 Volume depletion (code range) partial seizures, intractable, without status epilepticus Other disorders of fluid electrolyte and acid- E87.0 – E87.8 base balance (code range) Generalized idiopathic epilepsy and epileptic G40.301 – G40.309 syndromes, not intractable, with status E88.01 – E88.2, Other and unspecified metabolic disorders epilepticus (range) E88.89 (code range) E88.3 Tumor lysis syndrome Generalized idiopathic epilepsy and epileptic G40.311 – G40.319 syndromes, intractable, with status epilepticus Absence epileptic syndrome, not intractable, (range) G40.A01 – G40.A09 with status epilepticus (range) Other generalized epilepsy and epileptic Absence epileptic syndrome, intractable, with G40.A11 – G40.A19 G40.401 – G40.409 syndromes, not intractable, with status status epilepticus (range) epilepticus (range) Juvenile myoclonic epilepsy, not intractable, Other generalized epilepsy and epileptic G40.B01 – G40.B09 G40.411 with status epilepticus (range) syndromes, intractable, with status epilepticus Juvenile myoclonic epilepsy, intractable, with G40.B11 Other generalized epilepsy and epileptic status epilepticus G40.419 syndromes, intractable, without status Juvenile myoclonic epilepsy, intractable, without epilepticus G40.B19 status epilepticus Epileptic seizures related to external causes, not G40.501 Localization-related (focal) (partial) idiopathic intractable, with status epilepticus epilepsy and epileptic syndromes with seizures G40.001 Epileptic seizures related to external causes, not of localized onset, not intractable, with status G40.509 intractable, without status epilepticus epilepticus Other epilepsy, not intractable, with status Localization-related (focal) (partial) idiopathic G40.801 – G40.804 epilepticus (range) epilepsy and epileptic syndromes with seizures G40.009 Lennox-Gastaut syndrome, not intractable, with of localized onset, not intractable, without status G40.811 – G40.814 epilepticus status epilepticus Epileptic spasms, not intractable, with status Localization-related (focal) (partial) idiopathic G40.821 – G40.89 epilepsy and epileptic syndromes with seizures epilepticus (range) G40.011 – G40.019 of localized onset, intractable, with status Epilepsy, unspecified, not intractable, with status G40.901 epilepticus (range) epilepticus Localization-related (focal) (partial) symptomatic Epilepsy, unspecified, not intractable, without epilepsy and epileptic syndromes with simple G40.909 G40.101 – G40.109 status epilepticus partial seizures, not intractable, with status epilepticus (range) G40.911 – G40.919 Epilepsy Localization-related (focal) (partial) symptomatic G47.30 Sleep apnea, unspecified epilepsy and epileptic syndromes with simple G40.111 – G40.119 partial seizures, intractable, with status G47.33 Obstructive sleep apnea (adult) (pediatric) epilepticus (range) I09.81 Rheumatic heart failure I10 – I16.9 Hypertension/ HTN kidney disease/Crisis (range) PRV20473-2101 ICD-10 Codes covered under Medical Nutrition Therapy services – Effective February 1, 2021* ICD-10 Diagnosis Code Description ICD-10 Diagnosis Code Description Acute coronary thrombosis not resulting in I24.0 – I25.9 K29.80 – K29.81 Duodenitis without bleeding myocardial infarction (range) K29.90 Gastroduodenitis, unspecified, without bleeding Atherosclerotic heart disease of native coronary I25.10 artery without angina pectoris K29.91 Gastroduodenitis, unspecified, with bleeding I27.0 – I 27.2 Primary pulmonary hypertension (range) K30.0 Functional dyspepsia I27.81 Cor pulmonale (chronic) K31.0 Acute dilatation of stomach I27.82 Chronic pulmonary embolism K31.1 Adult hypertrophic pyloric stenosis I27.83 Eisenmenger's syndrome K31.2 Hourglass stricture and stenosis of stomach I27.89 Other specified pulmonary heart diseases K31.3 Pylorospasm, not elsewhere classified I27.9 Pulmonary heart disease, unspecified K31.4 Gastric diverticulum I42.2 – I43 Other hypertrophic cardiomyopathy (range) K31.5 Obstruction of duodenum I50.1 – I50.9 Heart failure (range) K31.6 Fistula of stomach and duodenum Angiodysplasia of stomach and duodenum with I51.4 Myocarditis, unspecified K31.811 – K31.9 bleeding I51.5 – I51.7 Cardiomegaly K44.0 – K44.9 Diaphragmatic hernia (range) I51.9 Heart disease, unspecified Crohn's disease of small intestine without Other heart disorders in diseases classified K50.00 I52 complications elsewhere Crohn's disease of large intestine without Other specified noninfective disorders of K50.10 I89.8 complications lymphatic vessels and lymph nodes (chylous) Crohn's disease of small intestine with rectal K50.011 – K50.019 I97.3 Postprocedural hypertension bleeding Crohn's disease of large intestine with rectal J94.0 Chylous effusion K50.111 – K50.119 bleeding Oral mucositis (ulcerative) due to antineoplastic K12.31 Crohn's disease of both small and large therapy K50.80 intestine without complications K12.33 Oral mucositis (ulcerative) due to radiation Crohn's disease of both small and large K50.811 – K50.819 K20.0 Eosinophilic esophagitis intestine with rectal bleeding Crohn's disease, unspecified,