L31530 HOME HEALTH - OCCUPATIONAL THERAPY

 

1 J11HH-11-001-L Region IV

 

2/20/2012

 

Indications and Limitations of Coverage and/or Medical Necessity

 

• Although rehabilitative services are provided by occupational therapy, speech therapy and physical therapy, this policy only addresses occupational therapy.

• Occupational therapy (OT) is an integral component of rehabilitative services in the areas of physical, cognitive and psychosocial impairment.

o Occupational therapy is based on purposeful, goal directed activity (occupation).

o The goal of occupational therapy is to prevent, improve or restore physical and or cognitive impairment following disease or injury.

• Occupational therapists utilize clinical history, observation, interview, standardized testing and assessment of activities of daily living skills, work skills, and leisure skills to characterize individuals with impairments, functional limitations and disabilities.

o The results of these assessments are used to identify structural impairments and functional limitations and to design an individualized plan of treatment to assist in improving or restoring function.

o All occupational therapy services must be performed by or under the supervision of a qualified occupational therapist.

o The treatment approach includes:

 Evaluation.

 Basic activities of daily living (BADLs) training.

 Instrumental activities of daily living (IADLs) training.

 Muscle reeducation.

 Cognitive training.

 Perceptual motor training.

 Fine motor coordination/strengthening/coordination.

 Orthotics (splinting).

 Adaptive equipment fabrication and training.

 Environment modification recommendations/training.

 Patient/caregiver education/training.

 Transfer training.

 Functional mobility training.

 Manual therapy.

 Physical agent modalities.

 Neurodevelopment training.

o Occupational therapy services are covered services provided the services are of a level of complexity and sophistication, or the patient's condition is such that the services can be safely and effectively performed only by a licensed occupational therapist or under his/her supervision.

 Services normally considered a routine part of nursing care are not covered as occupational therapy

• (i.e., provide ADLs training for a patient with no rehabilitation potential).

o In order for the plan of treatment to be covered, it must address a condition for which occupational therapy is an accepted method of treatment as defined by standards of medical practice.

 Also, the plan of treatment must be for a condition that is expected to improve significantly within a reasonable and generally predictable period of time or establishes a safe and effective maintenance program.

 If at any point in the treatment of an illness or injury it is determined that the expectations will not materialize, the services are no longer considered reasonable and necessary and are excluded from coverage.

o Occupational therapy is only covered when it is rendered under a written plan of treatment established by the physician and the qualified occupational therapist, and signed and dated by the physician.

 The plan of treatment should address specific therapeutic goals for which modalities and procedures are planned out specifically in terms of type, frequency and duration.

 The physician should review the plan of treatment every 60 days.

o The physician and/or therapist must document the patient's functional limitations in terms that are objective and measurable.

o Rehabilitation services for vision impairment:

 The coverage criteria and definition of rehabilitation services for vision impairment (Low Vision) are found in the Transmittal AB-02-078, dated May 29, 2002, Change Request 2083.

 

 

• SPECIFIC PROCEDURE AND MODALITY GUIDELINES

 

o Fabrication/Application of Casts, Splints and Strapping (CPT 29065-29550)

 Fabrication and application of casts, splints, and strapping will be considered reasonable and necessary if used to support weak, post-surgical or ineffective joints/muscles, facilitate increased motor response, to assist in compensation in a permanent loss of motor function, reduce/correct joint limitations/deformities and/or protect body parts from injury, thus enhancing the performance of tasks or movements.

 The casts, splints and strapping are often used in conjunction with therapeutic exercise, functional training, other interventions, and should be selected in the context of patients' needs, social/culture environments, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL).

 Note: When identifying orthotics fitting and training see CPT code 97504.

 

 

• BODY AND UPPER EXTREMITY CASTS:

 

o Application of long arm (CPT code 29065)

 May be indicated for the shoulder and/or elbow in the treatment of

• Fractures.

• Dislocations.

• Sprains/strains.

• Tendinitis.

• Post-op reconstruction.

• Treatment of spasticity.

• Contractures.

• Other deformities involving soft tissue.

o Application of short arm (CPT code 29075)

 May be indicated for the:

• Forearm.

• Wrist.

• Elbow.

• In the treatment of:

o Fractures.

o Dislocations.

o Sprains/strains.

o Tendinitis.

o Post-op reconstruction.

o Treatment of spasticity.

o Contractures.

o Other deformities involving soft tissue.

o Application of hand and lower forearm (CPT code 29085)

 May be indicated for the:

• Forearm.

• Wrist.

• Hand.

• In the treatment of:

o Fractures.

o Dislocations.

o Sprains/strains.

o Tendinitis.

o Post-op reconstruction.

o Treatment of spasticity.

o Contractures.

o Deformities involving soft tissue.

o Application of finger cast (CPT code 29086)

 May be indicated for the finger in the treatment of:

• Fractures.

• Dislocations.

• Sprains/strains tendinitis.

• Post-op reconstruction.

• Treatment of spasticity.

• Contractures.

• Other deformities involving soft tissue.

 

• SPLINTS:

 

o Application of long arm splint (CPT code 29105);

 May be indicated for the shoulder and/or elbow in the treatment of:

• Fractures.

• Dislocations.

• Sprains/strains.

• Tendinitis.

• Post-op reconstruction.

• Treatment of spasticity.

• Contractures.

• Other deformities involving soft tissue.

o Application of short arm splint (CPT code 29125 & 29126)

 May be indicated for the:

• Forearm.

• Wrist.

• Hand.

• In the treatment of:

o Fractures.

o Dislocations.

o Sprain/strains.

o Tendinitis.

o Post-op reconstruction.

o Treatment of spasticity.

o Contractures.

o Other deformities involving soft tissue.

o Application of finger splint (CPT code 29130 & 29131)

 May be indicated for the finger in the treatment of:

• Fractures.

• Dislocations.

• Sprains/strains tendinitis.

• Post-op reconstruction.

• Treatment of spasticity.

• Contractures.

• Other deformities involving soft tissue.

 

 

• STRAPPING

 

o Strapping of thorax (CPT code 29200)

 May be indicated for the thoracic spine, lumbar spine, rib cage or abdominal musculature in the treatment of contusions, dislocations, fractures, sprains/strains, post-op conditions, neuro-muscular conditions, contractures, or other deformities involving soft tissue.

o Strapping of low back (CPT code 29799)

 May be indicated for the lumbar spine rib cage or abdominal musculature in the treatment of contusions, dislocations, fractures, sprain/strains, post-op conditions, neuro-muscular conditions, contractures or other deformities involving soft tissue.

o Strapping of shoulder (CPT code 29240)

 May be indicated for any portion of the shoulder girdle complex, or rib cage in the treatment of contusions, dislocations, fractures, sprains/strains, post-op conditions, neuro-muscular conditions, contractures or other deformities involving soft tissue.

o Strapping of elbow or wrist (CPT code 29260)

 May be indicated for the elbow or wrist when there is involvement of the humerus, forearm, wrist, or hand in the treatment of contusions, dislocations, fractures, sprains/strains, post-op conditions, neuro-muscular conditions, edema, scar management, contractures or other deformities involving soft tissue.

o Strapping of hand or finger (CPT code 29280)

 May be indicated where there is involvement of the hand or fingers in the treatment of contusions, dislocations, fractures, sprains/strains, post-op conditions, neuro-muscular conditions, edema, scar management, contractures or other deformities involving soft tissue.

 

 

• LOWER EXTREMITY CASTS:

 

o Application of long leg cast (CPT code 29345 and 39365)

 May be indicated when there is involvement of the femur, patella, tibia, fibula, ankle or foot in the treatment of contusions, dislocations, fractures, sprains/strains, post-op conditions, contractures or other deformities involving soft tissue.

o Application of short leg cast (CPT codes 29405)

 May be indicated when there is involvement of the tibia, fibula, ankle or foot in the treatment of contusions, dislocations, fractures, sprains/strains, post-op conditions, contractures or other deformities involving soft tissue.

 

 

• SPLINTS

o Applications of long leg splint (CPT code 29505)

 May be indicated when there is involvement of the:

• Femur.

• Patella.

• Tibia.

• Fibula.

• Ankle or foot.

• in the treatment of:

o Contusions.

o Dislocations.

o Fractures.

o Sprains/strains.

o Post-op conditions.

o Contractures.

o Other deformities involving soft tissue.

o Applications of short leg splint (CPT code 29515)

 May be indicated when there is involvement of the:

• Tibia.

• Fibula.

• Ankle or foot.

• in the treatment of:

o Contusions.

o Contractures.

o Other deformities involving soft tissue.

 

• STRAPPING

o Strapping of hip (CPT code 29520)

 May be indicated when there is:

• Involvement of the lower back.

• Abdomen or hip in the treatment of contusions.

• Dislocations.

• Fractures.

• Sprains/strains.

• Post-op contusions.

• Neuro-muscular conditions.

• Contractures.

• Other deformities involving soft tissue.

o Strapping of knee (CPT code 29530)

 May be indicated when there is:

• involvement of the lower leg

• ankle and /or foot

• in the treatment of:

o Contusions.

o Dislocations.

o Fractures.

o Sprains/strains.

o Post-op contusions.

o Neuro-muscular conditions.

o Contractures.

o Other deformities involving soft tissue.

o Strapping of ankle (CPT code 29540)

 May be indicated when there is involvement of the lower leg, ankle and/or foot in the treatment of contusions, dislocations, fractures, sprains/strains, post-op conditions, neuro-muscular conditions, contractures or other deformities involving soft tissue.

o Strapping of toes (CPT code 29550)

 May be indicated when there is involvement of any of the toes in the treatment of contusions, dislocations, fractures, sprains/strains, post-op conditions, neuro-muscular conditions, contractures or other deformities involving soft tissue.

 

 

• Biofeedback Training by any Modality (CPT code 90901)and Biofeedback Training, Perineal Muscles, anorectal or urethral sphincter, including EMG and/or manometry (CPT code 90911)

o The coverage criteria and definition of biofeedback is found in the CMS Manual System, Pub. 100-03, Medicare National Coverage Determinations Ch 1, Part 1, §§30.1 and 30.11.

 

 

• Evaluation of oral and pharyngeal swallowing function CPT 92610)

o The evaluation of oropharyngeal swallowing dysfunction including the phases of oral preparatory, oral/voluntary and pharyngeal in reference to oral and motility problems in the oral cavity and pharynx.

o The clinical examination may include:

 History of patient's disorder and awareness of swallowing disorder, and indications of localization and nature of disorder.

 Medical status including nutritional and respiratory status.

 Oral anatomy/physiology.

• (labial control, lingual control, palatal function)

 Pharyngeal function.

 Laryngeal function.

 Ability to follow directions.

• Alertness.

 Efforts and interventions used to facilitate normal swallow. (compensatory strategies such as chin tuck, dietary changes, etc.).

 Identifying symptoms during attempts to swallow.

o The clinical examination can be divided into two phases:

 The preparatory examination with no swallow

 The initial swallow examination with actual swallow while physiology is observed

o Note: Based on the findings, an instrumental exam may be recommended.

 

• Treatment of swallowing and dysfunctional or oral function for feeding (CPT 92526)

o This involves the treatment for impairments/functional limitations of mastication, the preparatory phase, oral phase, pharyngeal stage, and esophageal phase of swallowing.

o Make appropriate recommendations regarding diet and compensatory techniques and instruct in direct/indirect therapies to facilitate oral motor control for feeding.

 

• Muscle testing, manual (CPT codes 95831-95834)

o The series of codes 95831-95834 are intended to report manual test of muscles or muscle groups for strength based on grading scales.

o Muscle testing, manual (separate procedure); extremity (excluding hand) or trunk, with report (CPT code 95831)

 To use this code for extremity manual muscle testing, every muscle of at least one extremity would need to be tested, with documentation of why such a thorough assessment was warranted.

o Muscle testing, manual (separate procedure) with report.

 Hand, with or without comparison with normal side. (CPT code 95832).

o Muscle testing, manual (separate procedure) with report,

 Total evaluation of body, excluding hands. (CPT code 95833 and 95834).

o The measurement of muscle performance using manual muscle testing only.

 

 

• Range of Motion Measurements (CPT code 95851 and 95852)

o This is the determination of range of motion using a tape measure, ruler, electronic device or goniometer.

o To use CPT code 95851 for extremity range of motion testing, every joint of an extremity would need to be tested, with documentation of why such a thorough assessment was warranted.

 

 

• Standardized Cognitive Performance Testing (CPT code 96125)

o Neuropsychological testing (e.g., Ross Information Processing Assessment, LOTCA- Loewenstein Occupational Therapy Cognitive Assessment, MVPT - Motor-Free Visual Perception Test, ACL - Allen Cognitive Test), (per hour of the Occupational Therapist's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report.) This is usually done outside the Occupational Therapy’s initial evaluation/re-evaluation.

 

 

• Occupational Therapy Evaluation (CPT code 97003) and Occupational Therapy Re-evaluation (CPT code 97004):

o Evaluation is a comprehensive service that requires professional skills to make clinical judgments about conditions for which services are indicated based on objective measurements and subjective evaluations of patient performance and functional abilities.

o Evaluation is warranted e.g., for a new diagnosis or when a condition is treated in a new setting. These evaluative judgments are essential to development of the plan of care, including goals and the selection of interventions.

o The time spent in evaluation does not count as treatment time.

o The initial examination has the following components:

 The patient history to include prior level of function

 Relevant systems review

 Tests and measures

 Current functional status (abilities and deficits)

 Evaluation of patient's, physician's and as appropriate the caregiver's goals

o Factors that influence the complexity of the examination and evaluation process include the clinical findings, extent and duration of loss of function, prior functional level, social/environmental considerations, educational level, the patient's overall physical and cognitive health status, social/cultural supports, psychosocial factors and use of adaptive equipment.

 Thus, the evaluation reflects the chronicity or severity of the current problem, the possibility of multi-site or multi-system involvement, the presence of preexisting systemic conditions or diseases, and the stability of the condition.

 Occupational therapists also consider the level of the current impairments and the probability of prolonged impairment, functional limitation, the living environment, prior level of function, the social/cultural supports, psychosocial factors, and use of adaptive equipment.

o Initial evaluations or reevaluations may be determined reasonable and necessary even when the evaluation determines that skilled rehabilitation is not required if the patient's condition showed a need for an evaluation, or even if the goals established by the plan of treatment are not realized.

o Reevaluation is periodically indicated during an episode of care when the professional assessment indicates a significant improvement or decline in the patient’s condition or functional status that was not anticipated in the plan of care.

 Some regulations and state practice acts require reevaluation at specific intervals.

 A reevaluation is focused on evaluation of progress toward current goals and making a professional judgment about continued care, modifying goals, and/or treatment or terminating services.

o Reevaluations are appropriate periodically to assess progress toward goals established in the plan of treatment, or to identify and establish interventions for newly developed impairments at least once every 30 days, for each therapy discipline.

 A reevaluation may be appropriate prior to a planned discharge for the purposes of determining whether goals have been met, or for the use of the physician or the treatment setting at which treatment will be continued.

 

• Designing and Implementing a Maintenance Program:

o If the patient's clinical condition requires the specialized skill, knowledge and judgment of a qualified therapist to design or establish a maintenance program related to the patient's illness or injury, in order to ensure the safety of the patient and the effectiveness of the program, such services are covered.

o During the last visit(s) for restorative treatment, the qualified therapist may develop a maintenance program.

 The goals of a maintenance program would be, for example, to maintain functional status or to prevent decline in function.

o Periodic evaluations of the patient and adjustments to a maintenance program may be covered if such require the specified skills of a qualified occupational therapist.

o Where a maintenance program is not established until after the rehabilitative therapy program has been completed, or where there was no rehabilitative therapy program, a qualified therapist's development of a maintenance program would be considered reasonable and necessary for the treatment of the patient's condition only when an identified danger to the patient exists.

o When designing or establishing a maintenance program, the qualified therapist must teach the patient or the patient's family or caregiver's necessary techniques, exercises or precautions as necessary to treat the illness or injury.

o The skills of a qualified therapist are needed to perform maintenance therapy:

 Where the clinical condition of the patient is such that the complexity of the therapy services required to maintain function involved the use of complex and sophisticated therapy procedures to be delivered by the therapist himself/herself (and not an assistant) or the clinical condition of the patient is such that the complexity of the therapy series required to maintain function must be delivered by the therapist himself/herself (and not an assistant) in order to ensure the patient's safety and to provide an effective maintenance program, then those reasonable and necessary services should be covered.

o The amount, frequency, and duration of the services must be reasonable.

 

 

• Skilled Maintenance Therapy for Safety

o The development, implementation, management, and evaluation of a patient care plan based on the physician's orders constitute skilled therapy services when, because the patient's condition, those activities require the skills of a qualified therapist to ensure the effectiveness of the treatment goals and ensure medical safety.

o Where the skills of a therapist are needed to manage and periodically reevaluate the appropriateness of a maintenance program because of an identified danger to the patient, such services would be covered, even if the skills of a therapist were not needed to carry out the activities performed as part of the maintenance program.

 

 

• Vasopneumatic Devices (CPT code 97016):

o The use of Vasopneumatic Devices may be considered reasonable and necessary for the application of pressure to an extremity for the purpose of reducing edema.

o Specific indications for the use of vasopneumatic devices include:

 Reduction of edema after acute injury

 Lymphedema

 Education and training on the use of vasopneumatic devices for home use.

 

 

• Paraffin Bath (CPT code 97018):

o Paraffin Bath, also known as hot wax treatment, is primarily used for pain to increase flexibility of soft tissue, and relief in chronic joint problems of the wrists, hands, and feet.

o Heat treatments of this type do not ordinarily require the skills of a qualified occupational therapist.

 However, in a particular case, the skills, knowledge and judgment of a qualified occupational therapist might be required in such treatments or baths.

• e.g., where the patient's condition is complicated by circulatory deficiency, areas of desensitization, open wounds or other complications.

 Also, if such treatments are given prior to but as an integral part of a skilled occupational therapy procedure, the treatments would be considered part of the occupational therapy service.

 

• Infrared Therapy (CPT code 97026):

o Noncoverage of Infrared Therapy Devices is described in CMS Manual System, Pub 100-03, Medicare National Coverage Determinations, Chapter 1, Part 4, §240.3

 

 

• Electrical Stimulation Therapy (CPT code 97032)

o Application of a modality to one or more areas, electrical stimulation, manual, each 15 minutes

o CPT code 97032 requires "visual, verbal and/or manual contact" (i.e. constant attendance.)

o The coverage criteria and definition of Neuromuscular Electrical Stimulator (NMES) and Electrical Nerve Stimulator (TENS) are found in the CMS Manual System, Pub. 100-03, Medicare National Coverage Determinations, Chapter 1, Part 1, §10.2 and Part 2, §§160.7, 160.12, 160.13.

o Effective for claims with dates of service on or after June 8, 2012, CMS no longer allows coverage under any circumstance except in the setting of an approved clinical study under coverage with evidence development (CED) for TENS used for treatment of chronic low back pain (CLBP) which has persisted for more than three months and is not a manifestation of a clearly defined and generally recognizable primary disease entity.

 

 

• Iontophoresis Application (CPT code 97033)

o Iontophoresis is a process in which electrically charged molecules or atoms (i. e., ions) are driven into tissue with an electrical field.

o Voltage provides the driving force.

 Parameters such as drug polarity and electrophoretic mobility must be known in order to be able to assess whether iontophoresis can deliver therapeutic concentrations of a medication at sites below the skin.

o The application of iontophoresis is considered reasonable and necessary for the topical delivery of medications into a specific area of the body.

o Specific indications for the use of iontophoresis application may include but are not limited to:

 Tendonitis or calcific tendonitis.

 Bursitis.

 Adhesive capsulitis.

 Hyperhidrosis.

 Thick adhesive scare.

 

 

• Contrast Baths (CPT code 97034)

o Contrast baths are a special form of therapeutic heat and cold that can be applied to distal extremities.

 The effectiveness of contrast baths is thought to be due to reflex hyperemia produced by the alternating exposure to heat and cold.

 Although a variety of applications are possible, contrast baths often are used in treatment to decrease edema and inflammation.

o The use of contrast baths is considered reasonable and necessary to desensitize patients to pain by reflex hyperemia produced by the alternating exposure to heat and cold.

o Specific indications for the use of contrast baths include:

 The patient having rheumatoid arthritis or other inflammatory arthritis.

 The patient having reflex sympathetic dystrophy.

 The patient having a sprain or strain resulting from an acute injury.

o Heat treatments of this type and whirlpool baths do not ordinarily require the skills of a qualified occupational therapist.

 However, in a particular case, the skills, knowledge and judgment of a qualified occupational therapist might be required in such treatments or baths.

• e.g., where the patient's condition is complicated by circulatory deficiency, areas of desensitization, open wounds or other complications.

 If such treatments were given prior to but as an integral part of a skilled occupational therapy procedure, the treatment would be considered part of the skilled occupational therapy service.

 

 

• Ultrasound (CPT code 97035)

o Therapeutic Ultrasound is a deep heating modality that produces a sound wave of 0.8 to 3.0 MHz.

 In the human body, ultrasound has several pronounced effects on biologic tissues.

 It is attenuated by certain tissues and reflected by bone.

 Thus, tissues lying immediately next to bone can receive an even greater dosage of ultrasound, as much as 30% more.

 Because of the increased extensibility ultrasound produces in tissues of high collagen content, combined with the close proximity of joint capsules, tendons, and ligaments to cortical bone where they receive a more intense irradiation, it is an ideal modality for increasing mobility in those tissues with restricted range of motion.

o The application of ultrasound is considered reasonable and necessary for patients requiring deep heat to a specific area for reduction of pain, spasm, and joint stiffness, and the increase of muscle, tendon and ligament flexibility.

o Specific indications for the use of ultrasound application include:

 The patient having tightened structures limiting joint motion that requires an increase in extensibility.

 The patient having symptomatic soft tissue calcification.

 The patient having neuromas.

o Note: Ultrasound is not considered to be reasonable and necessary for the treatment of asthma, bronchitis or any other pulmonary condition.

 

 

• GENERAL GUIDELINES FOR THERAPEUTIC PROCEDURES:

o Therapeutic procedures are procedures that attempt to reduce impairments and improve function through the application of clinical skills and/or services.

o Use of these procedures requires that these services be rendered under the supervision of an occupational therapist.

o Therapeutic exercises and neuromuscular reeducation are examples of therapeutic interventions.

 The expected goals documented in the written plan of treatment, affected by the use of each of these procedures, will help define whether these procedures are reasonable and necessary.

 Therefore, since any one or a combination of more than one of these procedures may be used in a written plan of treatment, documentation must support the use of each procedure as it relates to a specific therapeutic goal.

o Services provided concurrently by an occupational therapist, physical therapist and speech therapist may be covered, if separate and distinct goals are documented in the written plan of treatment.

o Requires (one on one) direct patient contact.

 

 

• Therapeutic Exercise (CPT code 97110)

o Therapeutic Exercise is performed with a patient either actively, active-assisted, or passively participating (e.g., isokinetic exercise, stretching, strengthening and gross and fine motor movement).

o An occupational therapist may use this code when addressing impairments of exercise tolerance due to cardiopulmonary impairments.

 Therapeutic exercise with an individualized physical conditioning and exercise program using proper breathing techniques can be considered for a patient with activity limitations secondary to cardiopulmonary impairments.

o Therapeutic Exercise is considered reasonable and necessary if at least one of the following conditions is present and documented:

 The patient having weakness, contracture, stiffness secondary to spasm, spasticity, decreased joint range of motion, functional mobility deficits, balance and/or coordination deficits, abnormal posture, muscle imbalance.

 The patient needing to improve mobility, flexibility, strengthening, coordination, control of extremities, dexterity, range of motion, or endurance as part of activities of daily living training, or reeducation

o Documentation supporting Therapeutic Exercise must document objective loss of joint motion, strength, coordination and /or mobility (e.g., degrees of motion, strength grades, and levels of assistance).

 

 

• Neuromuscular Reeducation (CPT code 97112)

o This therapeutic procedure is provided to improve balance, coordination, kinesthetic sense, posture, motor planning, body awareness, and proprioception (e.g., proprioceptive neuromuscular facilitation, Feldenkreis, and Bobath).

o Neuromuscular Reeducation may be considered reasonable and necessary for impairments, which affect the body’s neuromuscular system.

 (e.g., poor static or dynamic sitting/standing balance, loss of gross and fine motor coordination, desensitization, proprioception, hypo/hypersensitivity, hypo/hypertonicity, and neglect.).

 

 

• Massage Therapy (CPT code 97124)

o Massage is the application of systemic manipulation to the soft tissues of the body for therapeutic purposes.

 Although various assistive devices and electrical equipment are available for the purpose of delivering massage, use of the hands is considered the most effective method of application, because palpation can be used as an assessment as well as a treatment tool.

o Massage Therapy, including effleurage, petrissage, and/or tapotement (stroking, compression, percussion) may be considered reasonable and necessary if at least one of the following conditions is present and documented:

 The patient having paralyzed musculature contributing to impaired circulation.

 The patient having sensitivity of tissues to pressure.

 The patient having tight muscles resulting in shortening and/or spasticity of affective muscles.

 The patient having abnormal adherence of tissue to surrounding tissue.

 The patient having relaxation in preparation for neuromuscular reeducation or therapeutic exercise.

 The patient having contractures and decreased range of motion.

 

• Manual Therapy Techniques (CPT code 97140)

o Joint Mobilization (Peripheral or Spinal)

 This procedure may be considered reasonable and necessary if restricted joint motion is present and documented.

 It may be reasonable and necessary as an adjunct to therapeutic exercises when loss of articular motion and flexibility impedes the therapeutic procedure.

o Soft Tissue Mobilization

 This procedure involves the application of skilled manual therapy techniques (active or passive) to soft tissues in order to effect changes in the soft tissues, articular structures, neural or vascular systems.

• Examples are facilitation of fluid exchange, restoration of movement in acutely edematous muscles, or stretching of shortened muscular or connective tissue.

 Myofascial release/soft tissue mobilization can be considered reasonable and necessary if at least one of the following conditions is present and documented:

• The patient having restricted joint or soft tissue motion in an extremity, neck or trunk.

• Treatment being a necessary adjunct to other occupational therapy interventions such as 97110, 97112 or 97530.

o Manual Lymphatic Drainage/Complex Decongestive Physiotherapy

 The goal of this type of therapy is to reduce lymphedema by routing the fluid to functional pathways, preventing backflow as the new routes become established, and to use the most appropriate methods to maintain the reduction after therapy is complete.

 This therapy involves intensive treatment to reduce the size of the extremity by a combination of manual decongestive therapy and serial compression bandaging, followed by an exercise program.

• It is expected that during these sessions, education is being provided to the patient and/or caregiver on the correct application of the compression bandage.

• It is also expected that after the completion of the therapy, the patient and/or caregiver can perform these activities without supervision.

 

 

• Orthotics Fitting (CPT code 97760

o This procedure may be considered reasonable and necessary, if there is an indication for education for the application of orthotics, and the functional use of the orthotic is present and documented.

o Generally, orthotic training can be completed in three visits; however for modification of the orthotic due to healing of tissue, change in edema, or impairment in skin integrity additional visits may be required.

o The medical record should document the distinct treatments rendered when orthotic training for upper and lower extremity is done.

o The patient is capable of being trained to use the particular device prescribed in an appropriate manner.

 In some cases, the patient may not be able to perform this function, but a responsible individual can be trained to apply the device.

 

 

• Prosthetic Training (CPT code 97761)

o This procedure and training may be considered reasonable and necessary, if there is an indication for education in the application of the prosthesis, and the functional use of the prosthesis is present and documented.

o The medical record should document the distinct goals and service rendered when prosthetic training for upper and lower extremity is done.

o Periodic revisits beyond the third month would require documentation to support medical necessity.

 

 

• Orthotic/Prosthetic Checkout (CPT Code 97762)

o These assessments are reasonable and necessary when there is a modification or reissue of a recently issued device or a reassessment of a newly issued device.

o These assessments may be reasonable and necessary when patients experience a loss of function directly related to the device (e.g., pain, skin breakdown, and falls).

o These assessments may be reasonable and necessary for determining "the patients response to wearing the device, determining whether the patient is donning/doffing the device correctly, determining the patient's need for padding, underwrap, or socks and determining the patient's tolerance to any dynamic forces being applied."

 

 

• Therapeutic Activities (CPT code 97530)

o Therapeutic activities are considered reasonable and necessary for patients needing a broad range of rehabilitative techniques.

 Activities can be for a specific body part or could involve the entire body.

 This procedure involves the use of functional activities to improve performance in a progressive manner.

 The activities are usually directed at a loss or impairment of mobility, strength, balance, coordination or cognition.

 They require the skills of occupational therapists and are designed to address a specific functional need of the patient.

 These dynamic activities must be part of an active written plan of treatment and be directed at a specific outcome.

o In order for therapeutic activities to be covered, the following requirements must be met:

 The patient having a condition for which therapeutic activities can reasonably be expected to restore or improve functioning.

 The patient’s condition being such that he/she is unable to perform therapeutic activities except under the supervision of an occupational therapist.

 There being a clear correlation between the type of exercise performed and the patient’s underlying medical condition for which the therapeutic activities were prescribed.

 

 

• Cognitive Skills Development (CPT code 97532)

o This procedure is reasonable and necessary for patients who have a disease or injury in which impairment of cognitive functioning is documented.

 Impaired functions may include but are not limited to ability to follow simple commands, attention to tasks, problem solving skills, memory, ability to follow numerous steps in a process, perform in a logical sequence and ability to compute.

o This procedure is reasonable and necessary only when it requires the skills of an occupational therapist and is designed to address specific needs of the patient and is part of the written plan of care.

o Treatment techniques utilized include but are not limited to recall of information, tabletop graded activities focusing on attentional skills (e.g. cancellation tasks, mazes), and graded processes in steps, which patient must follow to complete task, computer programs that focus on the above.

o Development of cognitive skills must be reasonable and necessary to restore and improve functioning of the patient.

 Documentation must relate the training to expected functional goals that are attainable by the patient.

o Services provided concurrently by physicians, occupational therapists and speech therapists may be covered, if separate and distinct goals are documented in the written plan of treatment.

 

 

• Sensory Integration (CPT code 97533)

o The use of sensory integrative techniques is considered reasonable and necessary when patients must develop adaptive skills for sensory processing.

o When there has been a disruption of the auditory, vestibular, proprioceptive, tactile and/or visual system.

 Interventions are required to assist the patient in remaining functional in their environment.

o The loss of sensory systems often compromises the safety of the patient; therefore therapy should provide adaptations that allow the patient to interact with their environment that promotes well-being.

 

 

• Self-Care/Home Management Training (CPT code 97535)

o The coverage criteria and definition of self-care/home management training is found in the CMS Manual System, Pub 100-03, Medicare National Coverage Determinations, Chapter 1, Part 3, §170.1

o "Self-care/home management training (97535) describes a group of interventions that focuses on activities of daily living skills and compensatory activities needed to achieve independence.

 These include activities such as dressing, bathing, food preparation, and cooking.

 The patient/client may require adaptive equipment and/or assistive technology in the home environment.

 This code includes training the patient/client and/or caregiver in the use of the equipment."

o This code should not be used globally for all home instructions.

 When instructing the patient in a self-management program, use the code that best describes the focus of the self-management activity.

 

 

• Community/Work Reintegration Training (CPT code 97537)

o Services that are related solely to specific employment opportunities, work skills, or work settings are not reasonable and necessary for the diagnosis and treatment of an illness or injury and are excluded from coverage by section 1862(a)(1) of the Social Security Act.

o Services that are covered include complex IADL’s a person must do to maintain independence in the community.

 These tasks involve interaction with the physical and social environment.

 Examples of these activities may include telephone skills, written communication, handling mail, use of money, shopping from home, emergency procedure use/skills, and use of assistive technology device/adaptive equipment.

 This service is only covered when the skilled intervention of occupational therapy is required to achieve established goals.

 

 

• Wheelchair Management Training (CPT code 97542)

o Wheelchair management "includes assessing if the patient/client needs a wheelchair, determining what kind of wheelchair is appropriate, including its size and components, measuring the patient/client to ensure proper fit, and fitting the patient/client into the chair once it is received.

 This code is also used for reporting the time associated with training the patient/client and/or caregiver in transfers in and out of the chair as well as propulsion on all surfaces.

 It is important for the therapist to provide instructions for safety so as not to risk skin breakdown or a fall."

o This service trains the patient in functional activities that promote optimal safety, mobility and transfers.

 Patients who are wheelchair bound may occasionally need skilled input on positioning to avoid pressure points, contractures, and other medical complications.

o This procedure is reasonable and necessary only when it requires the skills of an occupational therapist is designed to address specific needs of the patient, and must be part of an active written plan of treatment directed at a specific goal.

o The patient and/or caregiver must have the capacity to learn from instructions.

o Typically, three to four sessions should be sufficient to teach the patient and/or caregiver these skills.

o When billing CPT code 97542 for wheelchair propulsion training, documentation must relate the training to expected functional goals that are attainable by the patient.

 

 

• Physical Performance Test or Measurement (CPT code 97750)

o This testing may be reasonable and necessary for patients with neurological or musculoskeletal conditions when such tests are needed:

 To formulate or evaluate a specific written plan of treatment.

 To determine a patients’ functional capacity.

 

 

• Assistive Technology Assessment (CPT code 97755)

o This assessment requires professional skill to gather data by observation and patient inquiry and may include limited objective testing and measurement to make clinical judgments regarding the patient’s condition(s).

o Assessment determines, e.g., changes in the patient’s status since the last visit and whether the planned procedure or service should be modified.

o Based on these assessment data, the professional may make judgment about progress toward goals and/or determine that a more complete evaluation or reevaluation is indicated.

 

Coding Information

Bill Type Codes:

• Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service.

• Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type.

• Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

 

032x Home Health - Inpatient (plan of treatment under Part B only)

033x Home Health - Outpatient (plan of treatment under Part A, including DME under Part A)

 

Revenue Codes:

• Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service.

• In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination.

• Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

 

0430  Occupational Therapy - General Classification

0431  Occupational Therapy - Visit

0432  Occupational Therapy - Hourly

0434  Occupational Therapy - Evaluation or Reevaluation

 

 

CPT/HCPCS Codes

 

29065 Application of long arm cast

29075 Application of forearm cast

29085 Apply hand/wrist cast

29086 Apply finger cast

29105 Apply long arm splint

29125 Apply forearm splint

29126 Apply forearm splint

29130 Application of finger splint

29131 Application of finger splint

29200 Strapping of chest

29240 Strapping of shoulder

29260 Strapping of elbow or wrist

29280 Strapping of hand or finger

29345 Application of long leg cast

29365 Application of long leg cast

29405 Apply short leg cast

29505 Application long leg splint

29515 Application lower leg splint

29520 Strapping of hip

29530 Strapping of knee

29540 Strapping of ankle and/or ft

29550 Strapping of toes

29799 Casting/strapping procedure

90901 Biofeedback train any meth

90911 Biofeedback peri/uro/rectal

92526 Oral function therapy

92610 Evaluate swallowing function

95831 Limb muscle testing manual

95832 Hand muscle testing manual

95833 Body muscle testing manual

95834 Body muscle testing manual

95851 Range of motion measurements

95852 Range of motion measurements

96125 Cognitive test by hc pro

97003 Ot evaluation

97004 Ot re-evaluation

97016 Vasopneumatic device therapy

97018 Paraffin bath therapy

97026 Infrared therapy

97032 Electrical stimulation

97033 Electric current therapy

97034 Contrast bath therapy

97035 Ultrasound therapy

97110 Therapeutic exercises

97112 Neuromuscular reeducation

97124 Massage therapy

97140 Manual therapy 1/> regions

97530 Therapeutic activities

97532 Cognitive skills development

97533 Sensory integration

97535 Self-care management training

97537 Community/work reintegration

97542 Wheelchair management training

97750 Physical performance test

97755 Assistive technology assess

97760 Orthotic mgmt and training

97761 Prosthetic training

97762 C/o for orthotic/prosth use

G0152 HHCP-serv of ot,ea 15 min

 

 

ICD-9 Codes that Support Medical Necessity

 

 

138 LATE EFFECTS OF ACUTE POLIOMYELITIS

294.11 DEMENTIA IN CONDITIONS CLASSIFIED ELSEWHERE WITH BEHAVIORAL DISTURBANCE

294.21 DEMENTIA, UNSPECIFIED, WITH BEHAVIORAL DISTURBANCE

307.59 OTHER DISORDERS OF EATING

310.1 PERSONALITY CHANGE DUE TO CONDITIONS CLASSIFIED ELSEWHERE

315.1 MATHEMATICS DISORDER

331.0 ALZHEIMER'S DISEASE

331.6 CORTICOBASAL DEGENERATION

333.71 - 333.79 ATHETOID CEREBRAL PALSY - OTHER ACQUIRED TORSION DYSTONIA

333.83 SPASMODIC TORTICOLLIS

333.84 ORGANIC WRITERS' CRAMP

333.85 SUBACUTE DYSKINESIA DUE TO DRUGS

333.91 STIFF-MAN SYNDROME

334.0 - 336.9 FRIEDREICH'S ATAXIA - UNSPECIFIED DISEASE OF SPINAL CORD

337.21 - 337.29 REFLEX SYMPATHETIC DYSTROPHY OF THE UPPER LIMB - REFLEX SYMPATHETIC DYSTROPHY OF OTHER SPECIFIED SITE

342.00 FLACCID HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE

342.01 FLACCID HEMIPLEGIA AND HEMIPARESIS AFFECTING DOMINANT SIDE

342.02 FLACCID HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE

342.10 SPASTIC HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE

342.11 SPASTIC HEMIPLEGIA AND HEMIPARESIS AFFECTING DOMINANT SIDE

342.12 SPASTIC HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE

342.80 OTHER SPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE

342.81 OTHER SPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING DOMINANT SIDE

342.82 OTHER SPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE

342.90 UNSPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE

342.91 UNSPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING DOMINANT SIDE

342.92 UNSPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE

343.0 - 343.4 CONGENITAL DIPLEGIA - INFANTILE HEMIPLEGIA

343.8 - 343.9 OTHER SPECIFIED INFANTILE CEREBRAL PALSY - INFANTILE CEREBRAL PALSY UNSPECIFIED

344.00 QUADRIPLEGIA UNSPECIFIED

344.01 QUADRIPLEGIA C1-C4 COMPLETE

344.02 QUADRIPLEGIA C1-C4 INCOMPLETE

344.03 QUADRIPLEGIA C5-C7 COMPLETE

344.04 QUADRIPLEGIA C5-C7 INCOMPLETE

344.09 OTHER QUADRIPLEGIA

344.1 PARAPLEGIA

344.2 DIPLEGIA OF UPPER LIMBS

344.30 - 344.32

MONOPLEGIA OF LOWER LIMB AFFECTING UNSPECIFIED SIDE - MONOPLEGIA OF LOWER LIMB AFFECTING NONDOMINANT SIDE

344.40 - 344.42

MONOPLEGIA OF UPPER LIMB AFFECTING UNSPECIFIED SIDE - MONOPLEGIA OF UPPER LIMB AFFECTING NONDOMINANT SDE

344.5 UNSPECIFIED MONOPLEGIA

344.60 - 344.61

CAUDA EQUINA SYNDROME WITHOUT NEUROGENIC BLADDER - CAUDA EQUINA SYNDROME WITH NEUROGENIC BLADDER

344.81 - 344.89

LOCKED-IN STATE - OTHER SPECIFIED PARALYTIC SYNDROME

344.9 PARALYSIS UNSPECIFIED

346.00 MIGRAINE WITH AURA, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS

346.01 MIGRAINE WITH AURA, WITH INTRACTABLE MIGRAINE, SO STATED, WITHOUT MENTION OF STATUS MIGRAINOSUS

346.02 MIGRAINE WITH AURA, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITH STATUS MIGRAINOSUS

346.03 MIGRAINE WITH AURA, WITH INTRACTABLE MIGRAINE, SO STATED, WITH STATUS MIGRAINOSUS

346.10 MIGRAINE WITHOUT AURA, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS

346.11 MIGRAINE WITHOUT AURA, WITH INTRACTABLE MIGRAINE, SO STATED, WITHOUT MENTION OF STATUS MIGRAINOSUS

346.12 MIGRAINE WITHOUT AURA, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITH STATUS MIGRAINOSUS

346.13 MIGRAINE WITHOUT AURA, WITH INTRACTABLE MIGRAINE, SO STATED, WITH STATUS MIGRAINOSUS

346.20 VARIANTS OF MIGRAINE, NOT ELSEWHERE CLASSIFIED, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS

346.21 VARIANTS OF MIGRAINE, NOT ELSEWHERE CLASSIFIED, WITH INTRACTABLE MIGRAINE, SO STATED, WITHOUT MENTION OF STATUS MIGRAINOSUS

346.22 VARIANTS OF MIGRAINE, NOT ELSEWHERE CLASSIFIED, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITH STATUS MIGRAINOSUS

346.23 VARIANTS OF MIGRAINE, NOT ELSEWHERE CLASSIFIED, WITH INTRACTABLE MIGRAINE, SO STATED, WITH STATUS MIGRAINOSUS

346.30 HEMIPLEGIC MIGRAINE, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS

346.31 HEMIPLEGIC MIGRAINE, WITH INTRACTABLE MIGRAINE, SO STATED, WITHOUT MENTION OF STATUS MIGRAINOSUS

346.32 HEMIPLEGIC MIGRAINE, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITH STATUS MIGRAINOSUS

346.33 HEMIPLEGIC MIGRAINE, WITH INTRACTABLE MIGRAINE, SO STATED, WITH STATUS MIGRAINOSUS

346.40 MENSTRUAL MIGRAINE, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS

346.41 MENSTRUAL MIGRAINE, WITH INTRACTABLE MIGRAINE, SO STATED, WITHOUT MENTION OF STATUS MIGRAINOSUS

346.42 MENSTRUAL MIGRAINE, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITH STATUS MIGRAINOSUS

346.43 MENSTRUAL MIGRAINE, WITH INTRACTABLE MIGRAINE, SO STATED, WITH STATUS MIGRAINOSUS

346.50 PERSISTENT MIGRAINE AURA WITHOUT CEREBRAL INFARCTION, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS

346.51 PERSISTENT MIGRAINE AURA WITHOUT CEREBRAL INFARCTION, WITH INTRACTABLE MIGRAINE, SO STATED, WITHOUT MENTION OF STATUS MIGRAINOSUS

346.52 PERSISTENT MIGRAINE AURA WITHOUT CEREBRAL INFARCTION, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITH STATUS MIGRAINOSUS

346.53 PERSISTENT MIGRAINE AURA WITHOUT CEREBRAL INFARCTION, WITH INTRACTABLE MIGRAINE, SO STATED, WITH STATUS MIGRAINOSUS

346.60 PERSISTENT MIGRAINE AURA WITH CEREBRAL INFARCTION, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS

346.61 PERSISTENT MIGRAINE AURA WITH CEREBRAL INFARCTION, WITH INTRACTABLE MIGRAINE, SO STATED, WITHOUT MENTION OF STATUS MIGRAINOSUS

346.62 PERSISTENT MIGRAINE AURA WITH CEREBRAL INFARCTION, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITH STATUS MIGRAINOSUS

346.63 PERSISTENT MIGRAINE AURA WITH CEREBRAL INFARCTION, WITH INTRACTABLE MIGRAINE, SO STATED, WITH STATUS MIGRAINOSUS

346.70 CHRONIC MIGRAINE WITHOUT AURA, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS

346.71 CHRONIC MIGRAINE WITHOUT AURA, WITH INTRACTABLE MIGRAINE, SO STATED, WITHOUT MENTION OF STATUS MIGRAINOSUS

346.72 CHRONIC MIGRAINE WITHOUT AURA, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITH STATUS MIGRAINOSUS

346.73 CHRONIC MIGRAINE WITHOUT AURA, WITH INTRACTABLE MIGRAINE, SO STATED, WITH STATUS MIGRAINOSUS

346.80 OTHER FORMS OF MIGRAINE, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS

346.81 OTHER FORMS OF MIGRAINE, WITH INTRACTABLE MIGRAINE, SO STATED, WITHOUT MENTION OF STATUS MIGRAINOSUS

346.82 OTHER FORMS OF MIGRAINE, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITH STATUS MIGRAINOSUS

346.83 OTHER FORMS OF MIGRAINE, WITH INTRACTABLE MIGRAINE, SO STATED, WITH STATUS MIGRAINOSUS

346.90 MIGRAINE, UNSPECIFIED, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS

346.91 MIGRAINE, UNSPECIFIED, WITH INTRACTABLE MIGRAINE, SO STATED, WITHOUT MENTION OF STATUS MIGRAINOSUS

346.92 MIGRAINE, UNSPECIFIED, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITH STATUS MIGRAINOSUS

346.93 MIGRAINE, UNSPECIFIED, WITH INTRACTABLE MIGRAINE, SO STATED, WITH STATUS MIGRAINOSUS

351.0 BELL'S PALSY

353.0 - 353.8

BRACHIAL PLEXUS LESIONS - OTHER NERVE ROOT AND PLEXUS DISORDERS

353.9 UNSPECIFIED NERVE ROOT AND PLEXUS DISORDER

354.0 - 354.8

CARPAL TUNNEL SYNDROME - OTHER MONONEURITIS OF UPPER LIMB

354.9 MONONEURITIS OF UPPER LIMB UNSPECIFIED

355.1 MERALGIA PARESTHETICA

355.71 CAUSALGIA OF LOWER LIMB

355.79 OTHER MONONEURITIS OF LOWER LIMB

356.0 - 356.8 HEREDITARY PERIPHERAL NEUROPATHY - OTHER SPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY

356.9 UNSPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY

357.2 POLYNEUROPATHY IN DIABETES

358.30 LAMBERT-EATON SYNDROME, UNSPECIFIED

358.31 LAMBERT-EATON SYNDROME IN NEOPLASTIC DISEASE

358.39 LAMBERT-EATON SYNDROME IN OTHER DISEASES CLASSIFIED ELSEWHERE

359.0 - 359.1 CONGENITAL HEREDITARY MUSCULAR DYSTROPHY - HEREDITARY PROGRESSIVE MUSCULAR DYSTROPHY

359.21 MYOTONIC MUSCULAR DYSTROPHY

359.22 MYOTONIA CONGENITAL

359.23 MYOTONIC CHONDRODYSTROPHY

359.24 DRUG INDUCED MYOTONIA

359.29 OTHER SPECIFIED MYOTONIC DISORDER

359.71 INCLUSION BODY MYOSITIS

359.79 OTHER INFLAMMATORY AND IMMUNE MYOPATHIES, NEC

368.41 SCOTOMA INVOLVING CENTRAL AREA

368.45 GENERALIZED VISUAL FIELD CONTRACTION OR CONSTRICTION

368.46 HOMONYMOUS BILATERAL FIELD DEFECTS

368.47 HETERONYMOUS BILATERAL FIELD DEFECTS

369.01 BETTER EYE: TOTAL VISION IMPAIRMENT; LESSER EYE: TOTAL VISION IMPAIRMENT

369.02 BETTER EYE: NEAR-TOTAL VISION IMPAIRMENT; LESSER EYE: NOT FURTHER SPECIFIED

369.03 BETTER EYE: NEAR-TOTAL VISION IMPAIRMENT; LESSER EYE: TOTAL VISION IMPAIRMENT

369.04 BETTER EYE: NEAR-TOTAL VISION IMPAIRMENT; LESSER EYE: NEAR-TOTAL VISION IMPAIRMENT

369.06 BETTER EYE: PROFOUND VISION IMPAIRMENT; LESSER EYE: TOTAL VISION IMPAIRMENT

369.07 BETTER EYE: PROFOUND VISION IMPAIRMENT; LESSER EYE: NEAR-TOTAL VISION IMPAIRMENT

369.08 BETTER EYE: PROFOUND VISION IMPAIRMENT; LESSER EYE: PROFOUND VISION IMPAIRMENT

369.12 BETTER EYE: SEVERE VISION IMPAIRMENT; LESSER EYE: TOTAL VISION IMPAIRMENT

369.13 BETTER EYE: SEVERE VISION IMPAIRMENT; LESSER EYE: NEAR-TOTAL VISION IMPAIRMENT

369.14 BETTER EYE: SEVERE VISION IMPAIRMENT; LESSER EYE: PROFOUND VISION IMPAIRMENT

369.16 BETTER EYE: MODERATE VISION IMPAIRMENT; LESSER EYE: TOTAL VISION IMPAIRMENT

369.17 BETTER EYE: MODERATE VISION IMPAIRMENT; LESSER EYE: NEAR-TOTAL VISION IMPAIRMENT

369.18 BETTER EYE: MODERATE VISION IMPAIRMENT; LESSER EYE: PROFOUND VISION IMPAIRMENT

369.22 BETTER EYE: SEVERE VISION IMPAIRMENT; LESSER EYE: SEVERE VISION IMPAIRMENT

369.24 BETTER EYE: MODERATE VISION IMPAIRMENT; LESSER EYE: SEVERE VISION IMPAIRMENT

369.25 BETTER EYE: MODERATE VISION IMPAIRMENT; LESSER EYE: MODERATE VISION IMPAIRMENT

386.11 BENIGN PAROXYSMAL POSITIONAL VERTIGO

438.0 COGNITIVE DEFICITS

438.21 HEMIPLEGIA AFFECTING DOMINANT SIDE

438.22 HEMIPLEGIA AFFECTING NONDOMINANT SIDE

438.30 MONOPLEGIA OF UPPER LIMB AFFECTING UNSPECIFIED SIDE

438.31 MONOPLEGIA OF UPPER LIMB AFFECTING DOMINANT SIDE

438.32 MONOPLEGIA OF UPPER LIMB AFFECTING NONDOMINANT SIDE

438.40 MONOPLEGIA OF LOWER LIMB AFFECTING UNSPECIFIED SIDE

438.41 MONOPLEGIA OF LOWER LIMB AFFECTING DOMINANT SIDE

438.42 MONOPLEGIA OF LOWER LIMB AFFECTING NONDOMINANT SIDE

438.50 OTHER PARALYTIC SYNDROME AFFECTING UNSPECIFIED SIDE

438.51 OTHER PARALYTIC SYNDROME AFFECTING DOMINANT SIDE

438.52 OTHER PARALYTIC SYNDROME AFFECTING NONDOMINANT SIDE

438.53 OTHER PARALYTIC SYNDROME BILATERAL

438.6 ALTERATIONS OF SENSATIONS

438.81 APRAXIA CEREBROVASCULAR DISEASE

438.82 DYSPHAGIA CEREBROVASCULAR DISEASE

438.83 FACIAL WEAKNESS

438.84 ATAXIA

438.85 VERTIGO

438.89 OTHER LATE EFFECTS OF CEREBROVASCULAR DISEASE

438.9 UNSPECIFIED LATE EFFECTS OF CEREBROVASCULAR DISEASE

440.23 ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES WITH ULCERATION

440.24 ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES WITH GANGRENE

443.0 RAYNAUD'S SYNDROME

457.0 POSTMASTECTOMY LYMPHEDEMA SYNDROME

457.1 OTHER LYMPHEDEMA

459.11 POSTPHLEBETIC SYNDROME WITH ULCER

459.13 POSTPHLEBETIC SYNDROME WITH ULCER AND INFLAMMATION

459.31 CHRONIC VENOUS HYPERTENSION WITH ULCER

459.33 CHRONIC VENOUS HYPERTENSION WITH ULCER AND INFLAMMATION

490 BRONCHITIS NOT SPECIFIED AS ACUTE OR CHRONIC

491.0 SIMPLE CHRONIC BRONCHITIS

491.1 MUCOPURULENT CHRONIC BRONCHITIS

491.20 OBSTRUCTIVE CHRONIC BRONCHITIS WITHOUT EXACERBATION

491.21 OBSTRUCTIVE CHRONIC BRONCHITIS WITH (ACUTE) EXACERBATION

491.22 OBSTRUCTIVE CHRONIC BRONCHITIS WITH ACUTE BRONCHITIS

491.8 OTHER CHRONIC BRONCHITIS

491.9 UNSPECIFIED CHRONIC BRONCHITIS

492.0 EMPHYSEMATOUS BLEB

492.8 OTHER EMPHYSEMA

493.00 - 493.02 EXTRINSIC ASTHMA UNSPECIFIED - EXTRINSIC ASTHMA WITH (ACUTE) EXACERBATION

493.10 - 493.12 INTRINSIC ASTHMA UNSPECIFIED - INTRINSIC ASTHMA WITH (ACUTE) EXACERBATION

493.20 - 493.22 CHRONIC OBSTRUCTIVE ASTHMA UNSPECIFIED - CHRONIC OBSTRUCTIVE ASTHMA WITH (ACUTE) EXACERBATION

493.81 EXERCISE-INDUCED BRONCHOSPASM

493.82 COUGH VARIANT ASTHMA

493.90 - 493.92 ASTHMA UNSPECIFIED - ASTHMA UNSPECIFIED WITH (ACUTE) EXACERBATION

494.0 - 494.1

BRONCHIECTASIS WITHOUT ACUTE EXACERBATION - BRONCHIECTASIS WITH ACUTE EXACERBATION

496 CHRONIC AIRWAY OBSTRUCTION NOT ELSEWHERE CLASSIFIED

524.60 - 524.69

TEMPOROMANDIBULAR JOINT DISORDERS UNSPECIFIED - TEMPOROMANDIBULAR JOINT DISORDERS OTHER SPECIFIED TEMPOROMANDIBULAR JOINT DISORDERS

555.1 REGIONAL ENTERITIS OF LARGE INTESTINE

625.6 STRESS INCONTINENCE FEMALE

681.00 - 681.02

UNSPECIFIED CELLULITIS AND ABSCESS OF FINGER - ONYCHIA AND PARONYCHIA OF FINGER

682.3 CELLULITIS AND ABSCESS OF UPPER ARM AND FOREARM

682.4 CELLULITIS AND ABSCESS OF HAND EXCEPT FINGERS AND THUMB

683 ACUTE LYMPHADENITIS

701.0 CIRCUMSCRIBED SCLERODERMA

701.4 KELOID SCAR

707.00 PRESSURE ULCER, UNSPECIFIED SITE

707.01 PRESSURE ULCER, ELBOW

707.02 PRESSURE ULCER, UPPER BACK

707.03 PRESSURE ULCER, LOWER BACK

707.04 PRESSURE ULCER, HIP

707.05 PRESSURE ULCER, BUTTOCK

707.06 PRESSURE ULCER, ANKLE

707.07 PRESSURE ULCER, HEEL

707.09 PRESSURE ULCER, OTHER SITE

707.10 UNSPECIFIED ULCER OF LOWER LIMB

707.11 ULCER OF THIGH

707.12 ULCER OF CALF

707.13 ULCER OF ANKLE

707.14 ULCER OF HEEL AND MIDFOOT

707.15 ULCER OF OTHER PART OF FOOT

707.19 ULCER OF OTHER PART OF LOWER LIMB

707.20 PRESSURE ULCER, UNSPECIFIED STAGE

707.21 PRESSURE ULCER, STAGE I

707.22 PRESSURE ULCER, STAGE II

707.23 PRESSURE ULCER, STAGE III

707.24 PRESSURE ULCER, STAGE IV

707.25 PRESSURE ULCER, UNSTAGEABLE

707.8 CHRONIC ULCER OF OTHER SPECIFIED SITES

707.9 CHRONIC ULCER OF UNSPECIFIED SITE

709.2 SCAR CONDITIONS AND FIBROSIS OF SKIN

711.00 - 711.59 PYOGENIC ARTHRITIS SITE UNSPECIFIED - ARTHROPATHY INVOLVING MULTIPLE SITES ASSOCIATED WITH OTHER VIRAL DISEASES

713.5 ARTHROPATHY ASSOCIATED WITH NEUROLOGICAL DISORDERS

714.0 - 714.9 RHEUMATOID ARTHRITIS - UNSPECIFIED INFLAMMATORY POLYARTHROPATHY

715.00 - 715.89 OSTEOARTHROSIS GENERALIZED INVOLVING UNSPECIFIED SITE - OSTEOARTHROSIS INVOLVING OR WITH MULTIPLE SITES BUT NOT SPECIFIED AS GENERALIZED

715.90 - 715.98OSTEOARTHROSIS UNSPECIFIED WHETHER GENERALIZED OR LOCALIZED INVOLVING UNSPECIFIED SITE - OSTEOARTHROSIS UNSPECIFIED WHETHER GENERALIZED OR LOCALIZED INVOLVING OTHER SPECIFIED SITES

716.00 - 716.99KASCHIN-BECK DISEASE SITE UNSPECIFIED - UNSPECIFIED ARTHROPATHY INVOLVING MULTIPLE SITES

718.00 ARTICULAR CARTILAGE DISORDER SITE UNSPECIFIED

718.01 - 718.04 ARTICULAR CARTILAGE DISORDER INVOLVING SHOULDER REGION - ARTICULAR CARTILAGE DISORDER INVOLVING HAND

718.05 ARTICULAR CARTILAGE DISORDER INVOLVING PELVIC REGION AND THIGH

718.07 - 718.09 ARTICULAR CARTILAGE DISORDER INVOLVING ANKLE AND FOOT - ARTICULAR CARTILAGE DISORDER INVOLVING MULTIPLE SITES

718.10 LOOSE BODY IN JOINT SITE UNSPECIFIED

718.11 - 718.14 LOOSE BODY IN JOINT OF SHOULDER REGION - LOOSE BODY IN HAND JOINT

718.15 LOOSE BODY IN JOINT OF PELVIC REGION AND THIGH

718.17 - 718.19 LOOSE BODY IN ANKLE AND FOOT JOINT - LOOSE BODY IN JOINT OF MULTIPLE SITES

718.20 PATHOLOGICAL DISLOCATION OF JOINT SITE UNSPECIFIED

718.21 - 718.24 PATHOLOGICAL DISLOCATION OF JOINT OF SHOULDER REGION - PATHOLOGICAL DISLOCATION OF HAND JOINT

718.25 PATHOLOGICAL DISLOCATION OF JOINT OF PELVIC REGION AND THIGH

718.26 - 718.29 PATHOLOGICAL DISLOCATION OF JOINT OF LOWER LEG - PATHOLOGICAL DISLOCATION OF JOINT OF MULTIPLE SITES

718.30 RECURRENT DISLOCATION OF JOINT SITE UNSPECIFIED

718.31 - 718.34 RECURRENT DISLOCATION OF JOINT OF SHOULDER REGION - RECURRENT DISLOCATION OF HAND JOINT

718.35 RECURRENT DISLOCATION OF JOINT OF PELVIC REGION AND THIGH

718.36 - 718.39RECURRENT DISLOCATION OF LOWER LEG JOINT - RECURRENT DISLOCATION OF JOINT OF MULTIPLE SITES

718.40 CONTRACTURE OF JOINT SITE UNSPECIFIED

718.41 - 718.44 CONTRACTURE OF JOINT OF SHOULDER REGION - CONTRACTURE OF HAND JOINT

718.45 CONTRACTURE OF JOINT OF PELVIC REGION AND THIGH

718.46 - 718.49CONTRACTURE OF LOWER LEG JOINT - CONTRACTURE OF JOINT OF MULTIPLE SITES

718.50 ANKYLOSIS OF JOINT SITE UNSPECIFIED

718.51 - 718.54ANKYLOSIS OF JOINT OF SHOULDER REGION - ANKYLOSIS OF HAND JOINT

718.55 ANKYLOSIS OF JOINT OF PELVIC REGION AND THIGH

718.56 - 718.59ANKYLOSIS OF LOWER LEG JOINT - ANKYLOSIS OF JOINT OF MULTIPLE SITES

718.65 UNSPECIFIED INTRAPELVIC PROTRUSION OF ACETABULUM PELVIC REGION AND THIGH

718.70 DEVELOPMENTAL DISLOCATION OF JOINT SITE UNSPECIFIED

718.71 - 718.74 DEVELOPMENTAL DISLOCATION OF JOINT SHOULDER REGION - DEVELOPMENTAL DISLOCATION OF JOINT HAND

718.75 DEVELOPMENTAL DISLOCATION OF JOINT PELVIC REGION AND THIGH

718.76 - 718.79DEVELOPMENTAL DISLOCATION OF JOINT LOWER LEG - DEVELOPMENTAL DISLOCATION OF JOINT MULTIPLE SITES

718.80 OTHER JOINT DERANGEMENT NOT ELSEWHERE CLASSIFIED INVOLVING UNSPECIFIED SITE

718.81 - 718.84 OTHER JOINT DERANGEMENT NOT ELSEWHERE CLASSIFIED INVOLVING SHOULDER REGION - OTHER JOINT DERANGEMENT NOT ELSEWHERE CLASSIFIED INVOLVING HAND

718.85 OTHER JOINT DERANGEMENT NOT ELSEWHERE CLASSIFIED INVOLVING PELVIC REGION AND THIGH

718.86 OTHER JOINT DERANGEMENT NOT ELSEWHERE CLASSIFIED INVOLVING LOWER LEG

718.87 - 718.89 OTHER JOINT DERANGEMENT NOT ELSEWHERE CLASSIFIED INVOLVING ANKLE AND FOOT - OTHER JOINT DERANGEMENT NOT ELSEWHERE CLASSIFIED INVOLVING MULTIPLE SITES

718.91 - 718.94 UNSPECIFIED DERANGEMENT OF JOINT OF SHOULDER REGION - UNSPECIFIED DERANGEMENT OF HAND JOINT

718.95 UNSPECIFIED DERANGEMENT OF JOINT OF PELVIC REGION AND THIGH

718.97 - 718.99 UNSPECIFIED DERANGEMENT OF ANKLE AND FOOT JOINT - UNSPECIFIED DERANGEMENT OF JOINT OF MULTIPLE SITES

719.01 - 719.04 EFFUSION OF JOINT OF SHOULDER REGION - EFFUSION OF HAND JOINT

719.08 EFFUSION OF JOINT OF OTHER SPECIFIED SITES

719.41 - 719.49 PAIN IN JOINT INVOLVING SHOULDER REGION - PAIN IN JOINT INVOLVING MULTIPLE SITES

719.50 STIFFNESS OF JOINT NOT ELSEWHERE CLASSIFIED INVOLVING UNSPECIFIED SITE

719.51 - 719.59 STIFFNESS OF JOINT NOT ELSEWHERE CLASSIFIED INVOLVING SHOULDER REGION - STIFFNESS OF JOINT NOT ELSEWHERE CLASSIFIED INVOLVING MULTIPLE SITES

719.60 OTHER SYMPTOMS REFERABLE TO JOINT SITE UNSPECIFIED

719.61 - 719.69 OTHER SYMPTOMS REFERABLE TO JOINT OF SHOULDER REGION - OTHER SYMPTOMS REFERABLE TO JOINT OF MULTIPLE SITES

719.7 DIFFICULTY IN WALKING

719.80 OTHER SPECIFIED DISORDERS OF JOINT SITE UNSPECIFIED

719.81 - 719.89 OTHER SPECIFIED DISORDERS OF JOINT OF SHOULDER REGION - OTHER SPECIFIED DISORDERS OF JOINT OF MULTIPLE SITES

719.91 - 719.94 UNSPECIFIED DISORDER OF JOINT OF SHOULDER REGION - UNSPECIFIED DISORDER OF HAND JOINT

719.98 UNSPECIFIED JOINT DISORDER OF OTHER SPECIFIED SITES

720.2 - 723.5 SACROILIITIS NOT ELSEWHERE CLASSIFIED - TORTICOLLIS UNSPECIFIED

724.1 PAIN IN THORACIC SPINE

724.2 LUMBAGO

724.5 BACKACHE UNSPECIFIED

724.8 OTHER SYMPTOMS REFERABLE TO BACK

725 POLYMYALGIA RHEUMATICA

726.0 ADHESIVE CAPSULITIS OF SHOULDER

726.11 - 726.19 CALCIFYING TENDINITIS OF SHOULDER - OTHER SPECIFIED DISORDERS OF BURSAE AND TENDONS IN SHOULDER REGION

726.2 OTHER AFFECTIONS OF SHOULDER REGION NOT ELSEWHERE CLASSIFIED

726.30 ENTHESOPATHY OF ELBOW UNSPECIFIED

726.31 MEDIAL EPICONDYLITIS

726.32 LATERAL EPICONDYLITIS

726.33 OLECRANON BURSITIS

726.39 OTHER ENTHESOPATHY OF ELBOW REGION

726.4 ENTHESOPATHY OF WRIST AND CARPUS

726.8 OTHER PERIPHERAL ENTHESOPATHIES

727.00 SYNOVITIS AND TENOSYNOVITIS UNSPECIFIED

727.01 SYNOVITIS AND TENOSYNOVITIS IN DISEASES CLASSIFIED ELSEWHERE

727.02 GIANT CELL TUMOR OF TENDON SHEATH

727.03 TRIGGER FINGER (ACQUIRED)

727.04 RADIAL STYLOID TENOSYNOVITIS

727.05 OTHER TENOSYNOVITIS OF HAND AND WRIST

727.2 SPECIFIC BURSITIDES OFTEN OF OCCUPATIONAL ORIGIN

727.3 OTHER BURSITIS DISORDERS

727.40 SYNOVIAL CYST UNSPECIFIED

727.41 GANGLION OF JOINT

727.42 GANGLION OF TENDON SHEATH

727.43 GANGLION UNSPECIFIED

727.49 OTHER GANGLION AND CYST OF SYNOVIUM TENDON AND BURSA

727.50 - 727.59

RUPTURE OF SYNOVIUM UNSPECIFIED - OTHER RUPTURE OF SYNOVIUM

727.60 - 727.64 NONTRAUMATIC RUPTURE OF UNSPECIFIED TENDON - NONTRAUMATIC RUPTURE OF FLEXOR TENDONS OF HAND AND WRIST

727.69 NONTRAUMATIC RUPTURE OF OTHER TENDON

727.81 CONTRACTURE OF TENDON (SHEATH)

727.82 - 727.9 CALCIUM DEPOSITS IN TENDON AND BURSA - UNSPECIFIED DISORDER OF SYNOVIUM TENDON AND BURSA

728.10 CALCIFICATION AND OSSIFICATION UNSPECIFIED

728.11 PROGRESSIVE MYOSITIS OSSIFICANS

728.12 TRAUMATIC MYOSITIS OSSIFICANS

728.13 POSTOPERATIVE HETEROTOPIC CALCIFICATION

728.19 OTHER MUSCULAR CALCIFICATION AND OSSIFICATION

728.2 MUSCULAR WASTING AND DISUSE ATROPHY NOT ELSEWHERE CLASSIFIED

728.3 OTHER SPECIFIC MUSCLE DISORDERS

728.4 LAXITY OF LIGAMENT

728.5 HYPERMOBILITY SYNDROME

728.6 CONTRACTURE OF PALMAR FASCIA

728.81 INTERSTITIAL MYOSITIS

728.82 FOREIGN BODY GRANULOMA OF MUSCLE

728.83 RUPTURE OF MUSCLE NONTRAUMATIC

728.85 SPASM OF MUSCLE

728.87 MUSCLE WEAKNESS (GENERALIZED)

728.89 OTHER DISORDERS OF MUSCLE LIGAMENT AND FASCIA

728.9 UNSPECIFIED DISORDER OF MUSCLE LIGAMENT AND FASCIA

729.0 RHEUMATISM UNSPECIFIED AND FIBROSITIS

729.1 - 729.2 MYALGIA AND MYOSITIS UNSPECIFIED - NEURALGIA NEURITIS AND RADICULITIS UNSPECIFIED

729.5 PAIN IN LIMB

729.71 NONTRAUMATIC COMPARTMENT SYNDROME OF UPPER EXTREMITY

729.81 SWELLING OF LIMB

729.82 CRAMP OF LIMB

729.89 OTHER MUSCULOSKELETAL SYMPTOMS REFERABLE TO LIMBS

729.90 DISORDERS OF SOFT TISSUE, UNSPECIFIED

729.91 POST-TRAUMATIC SEROMA

729.92 NONTRAUMATIC HEMATOMA OF SOFT TISSUE

729.99 OTHER DISORDERS OF SOFT TISSUE

731.0 OSTEITIS DEFORMANS WITHOUT BONE TUMOR

731.3 MAJOR OSSEOUS DEFECTS

732.3 JUVENILE OSTEOCHONDROSIS OF UPPER EXTREMITY

732.8 OTHER SPECIFIED FORMS OF OSTEOCHONDROPATHY

733.10 PATHOLOGICAL FRACTURE UNSPECIFIED SITE

733.11 PATHOLOGICAL FRACTURE OF HUMERUS

733.12 PATHOLOGICAL FRACTURE OF DISTAL RADIUS AND ULNA

733.19 PATHOLOGICAL FRACTURE OF OTHER SPECIFIED SITE

733.40 ASEPTIC NECROSIS OF BONE SITE UNSPECIFIED

733.41 ASEPTIC NECROSIS OF HEAD OF HUMERUS

733.81 MALUNION OF FRACTURE

733.82 NONUNION OF FRACTURE

735.0 HALLUX VALGUS (ACQUIRED)

736.00 - 736.04

UNSPECIFIED DEFORMITY OF FOREARM EXCLUDING FINGERS - VARUS DEFORMITY OF WRIST (ACQUIRED)

736.05 WRIST DROP (ACQUIRED)

736.06 CLAW HAND (ACQUIRED)

736.07 CLUB HAND ACQUIRED

736.09 OTHER ACQUIRED DEFORMITIES OF FOREARM EXCLUDING FINGERS

736.1 MALLET FINGER

736.20 UNSPECIFIED DEFORMITY OF FINGER

736.21 BOUTONNIERE DEFORMITY

736.22 SWAN-NECK DEFORMITY

736.29 OTHER ACQUIRED DEFORMITIES OF FINGER

736.30 - 736.39 UNSPECIFIED ACQUIRED DEFORMITY OF HIP - OTHER ACQUIRED DEFORMITIES OF HIP

736.41 - 736.42 GENU VALGUM (ACQUIRED) - GENU VARUM (ACQUIRED)

736.5 GENU RECURVATUM (ACQUIRED)

736.6 OTHER ACQUIRED DEFORMITIES OF KNEE

736.71 ACQUIRED EQUINOVARUS DEFORMITY

736.72 - 736.76 EQUINUS DEFORMITY OF FOOT ACQUIRED - OTHER ACQUIRED CALCANEUS DEFORMITY

736.79 OTHER ACQUIRED DEFORMITIES OF ANKLE AND FOOT

736.81 UNEQUAL LEG LENGTH (ACQUIRED)

736.89 OTHER ACQUIRED DEFORMITY OF OTHER PARTS OF LIMB

737.0 ADOLESCENT POSTURAL KYPHOSIS

737.10 KYPHOSIS (ACQUIRED) (POSTURAL)

737.11 KYPHOSIS DUE TO RADIATION

737.12 KYPHOSIS POSTLAMINECTOMY

737.19 OTHER KYPHOSIS ACQUIRED

737.20 LORDOSIS (ACQUIRED) (POSTURAL)

737.21 LORDOSIS POSTLAMINECTOMY

737.22 OTHER POSTSURGICAL LORDOSIS

737.29 OTHER LORDOSIS ACQUIRED

737.30 - 737.39 SCOLIOSIS (AND KYPHOSCOLIOSIS) IDIOPATHIC - OTHER KYPHOSCOLIOSIS AND SCOLIOSIS

737.40 UNSPECIFIED CURVATURE OF SPINE ASSOCIATED WITH OTHER CONDITIONS

737.41 KYPHOSIS ASSOCIATED WITH OTHER CONDITIONS

737.42 LORDOSIS ASSOCIATED WITH OTHER CONDITIONS

737.43 SCOLIOSIS ASSOCIATED WITH OTHER CONDITIONS

737.8 OTHER CURVATURES OF SPINE ASSOCIATED WITH OTHER CONDITIONS

737.9 UNSPECIFIED CURVATURE OF SPINE ASSOCIATED WITH OTHER CONDITIONS

738.8 - 738.9 ACQUIRED MUSCULOSKELETAL DEFORMITY OF OTHER SPECIFIED SITE - ACQUIRED MUSCULOSKELETAL DEFORMITY OF UNSPECIFIED SITE

754.1 CONGENITAL MUSCULOSKELETAL DEFORMITIES OF STERNOCLEIDOMASTOID MUSCLE

755.20 UNSPECIFIED REDUCTION DEFORMITY OF UPPER LIMB CONGENITAL

755.21 TRANSVERSE DEFICIENCY OF UPPER LIMB

755.23 LONGITUDINAL DEFICIENCY COMBINED INVOLVING HUMERUS RADIUS AND ULNA (COMPLETE OR INCOMPLETE)

755.24 LONGITUDINAL DEFICIENCY HUMERAL COMPLETE OR PARTIAL (WITH OR WITHOUT DISTAL DEFICIENCIES INCOMPLETE)

755.25 LONGITUDINAL DEFICIENCY RADIOULNAR COMPLETE OR PARTIAL (WITH OR WITHOUT DISTAL DEFICIENCIES INCOMPLETE)

755.26 LONGITUDINAL DEFICIENCY RADIAL COMPLETE OR PARTIAL (WITH OR WITHOUT DISTAL DEFICIENCIES INCOMPLETE)

755.27 LONGITUDINAL DEFICIENCY ULNAR COMPLETE OR PARTIAL (WITH OR WITHOUT DISTAL DEFICIENCIES INCOMPLETE)

755.28 LONGITUDINAL DEFICIENCY CARPALS OR METACARPALS COMPLETE OR PARTIAL (WITH OR WITHOUT INCOMPLETE PHALANGEAL DEFICIENCY)

755.29 LONGITUDINAL DEFICIENCY PHALANGES COMPLETE OR PARTIAL

755.50 - 755.53 UNSPECIFIED ANOMALY OF UPPER LIMB CONGENITAL - RADIOULNAR SYNOSTOSIS

755.54 MADELUNG'S DEFORMITY

755.55 ACROCEPHALOSYNDACTYLY

755.59 OTHER CONGENITAL ANOMALIES OF UPPER LIMB INCLUDING SHOULDER GIRDLE

756.10 CONGENITAL ANOMALY OF SPINE UNSPECIFIED

756.11 CONGENITAL SPONDYLOLYSIS LUMBOSACRAL REGION

756.12 SPONDYLOLISTHESIS CONGENITAL

756.13 ABSENCE OF VERTEBRA CONGENITAL

756.14 HEMIVERTEBRA

756.15 FUSION OF SPINE (VERTEBRA) CONGENITAL

756.16 KLIPPEL-FEIL SYNDROME

756.17 SPINA BIFIDA OCCULTA

756.19 OTHER CONGENITAL ANOMALIES OF SPINE

757.0 HEREDITARY EDEMA OF LEGS

780.4 DIZZINESS AND GIDDINESS

781.0 ABNORMAL INVOLUNTARY MOVEMENTS

781.2 ABNORMALITY OF GAIT

781.3 LACK OF COORDINATION

781.4 TRANSIENT PARALYSIS OF LIMB

781.8 NEUROLOGIC NEGLECT SYNDROME

781.92 ABNORMAL POSTURE

781.93 OCULAR TORTICOLLIS

781.94 FACIAL WEAKNESS

781.99 OTHER SYMPTOMS INVOLVING NERVOUS AND MUSCULOSKELETAL SYSTEMS

782.0 DISTURBANCE OF SKIN SENSATION

782.2 LOCALIZED SUPERFICIAL SWELLING MASS OR LUMP

782.3 EDEMA

782.8 CHANGES IN SKIN TEXTURE

783.3 FEEDING DIFFICULTIES AND MISMANAGEMENT

783.7 ADULT FAILURE TO THRIVE

784.0 HEADACHE

784.60 SYMBOLIC DYSFUNCTION UNSPECIFIED

784.61 ALEXIA AND DYSLEXIA

784.69 OTHER SYMBOLIC DYSFUNCTION

785.4 GANGRENE

787.20 DYSPHAGIA, UNSPECIFIED

787.21 DYSPHAGIA, ORAL PHASE

787.22 DYSPHAGIA, OROPHARYNGEAL PHASE

787.23 DYSPHAGIA, PHARYNGEAL PHASE

787.24 DYSPHAGIA, PHARYNGOESOPHAGEAL PHASE

787.29 OTHER DYSPHAGIA

787.60 FULL INCONTINENCE OF FECES

788.31 URGE INCONTINENCE

788.32 STRESS INCONTINENCE MALE

788.33 MIXED INCONTINENCE (MALE) (FEMALE)

788.34 INCONTINENCE WITHOUT SENSORY AWARENESS

799.51 ATTENTION OR CONCENTRATION DEFICIT

799.52 COGNITIVE COMMUNICATION DEFICIT

799.53 VISUOSPATIAL DEFICIT

799.54 PSYCHOMOTOR DEFICIT

808.44 MULTIPLE CLOSED PELVIC FRACTURES WITHOUT DISRUPTION OF PELVIC CIRCLE

808.54 MULTIPLE OPEN PELVIC FRACTURES WITHOUT DISRUPTION OF PELVIC CIRCLE

810.00 CLOSED FRACTURE OF CLAVICLE UNSPECIFIED PART

810.01 - 810.03 CLOSED FRACTURE OF STERNAL END OF CLAVICLE - CLOSED FRACTURE OF ACROMIAL END OF CLAVICLE

810.10 - 810.13 OPEN FRACTURE OF CLAVICLE UNSPECIFIED PART - OPEN FRACTURE OF ACROMIAL END OF CLAVICLE

811.00 CLOSED FRACTURE OF SCAPULA UNSPECIFIED PART

811.01 - 811.09 CLOSED FRACTURE OF ACROMIAL PROCESS OF SCAPULA - CLOSED FRACTURE OF OTHER PART OF SCAPULA

812.00 FRACTURE OF UNSPECIFIED PART OF UPPER END OF HUMERUS CLOSED

812.10 - 812.19 FRACTURE OF UNSPECIFIED PART OF UPPER END OF HUMERUS OPEN - OTHER OPEN FRACTURE OF UPPER END OF HUMERUS

812.20 - 812.21 FRACTURE OF UNSPECIFIED PART OF HUMERUS CLOSED - FRACTURE OF SHAFT OF HUMERUS CLOSED

812.30 - 812.31 FRACTURE OF UNSPECIFIED PART OF HUMERUS OPEN - FRACTURE OF SHAFT OF HUMERUS OPEN

812.40 - 812.49 FRACTURE OF UNSPECIFIED PART OF LOWER END OF HUMERUS CLOSED - OTHER CLOSED FRACTURES OF LOWER END OF HUMERUS

812.50 - 812.59 FRACTURE OF UNSPECIFIED PART OF LOWER END OF HUMERUS OPEN - OTHER FRACTURE OF LOWER END OF HUMERUS OPEN

813.00 - 813.01 CLOSED FRACTURE OF UPPER END OF FOREARM UNSPECIFIED - FRACTURE OF OLECRANON PROCESS OF ULNA CLOSED

813.10 - 813.18 OPEN FRACTURE OF UPPER END OF FOREARM UNSPECIFIED - FRACTURE OF RADIUS WITH ULNA UPPER END (ANY PART) OPEN

813.20 - 813.23FRACTURE OF SHAFT OF RADIUS OR ULNA UNSPECIFIED CLOSED - FRACTURE OF SHAFT OF RADIUS WITH ULNA CLOSED

813.30 - 813.33 FRACTURE OF SHAFT OF RADIUS OR ULNA UNSPECIFIED OPEN - FRACTURE OF SHAFT OF RADIUS WITH ULNA OPEN

813.40 CLOSED FRACTURE OF LOWER END OF FOREARM UNSPECIFIED

813.41 COLLES' FRACTURE CLOSED

813.42 OTHER CLOSED FRACTURES OF DISTAL END OF RADIUS (ALONE)

813.43 FRACTURE OF DISTAL END OF ULNA (ALONE) CLOSED

813.44 FRACTURE OF LOWER END OF RADIUS WITH ULNA CLOSED

813.45 TORUS FRACTURE OF RADIUS (ALONE)

813.46 TORUS FRACTURE OF ULNA (ALONE)

813.47 TORUS FRACTURE OF RADIUS AND ULNA

813.50 - 813.54OPEN FRACTURE OF LOWER END OF FOREARM UNSPECIFIED - FRACTURE OF LOWER END OF RADIUS WITH ULNA OPEN

813.80 - 813.83 CLOSED FRACTURE OF UNSPECIFIED PART OF FOREARM - FRACTURE OF UNSPECIFIED PART OF RADIUS WITH ULNA CLOSED

813.90 - 813.93 FRACTURE OF UNSPECIFIED PART OF FOREARM OPEN - FRACTURE OF UNSPECIFIED PART OF RADIUS WITH ULNA OPEN

814.00 - 814.09 CLOSED FRACTURE OF CARPAL BONE UNSPECIFIED - CLOSED FRACTURE OF OTHER BONE OF WRIST

814.10 - 814.19 OPEN FRACTURE OF CARPAL BONE UNSPECIFIED - OPEN FRACTURE OF OTHER BONE OF WRIST

815.00 - 815.09 CLOSED FRACTURE OF METACARPAL BONE(S) SITE UNSPECIFIED - CLOSED FRACTURE OF MULTIPLE SITES OF METACARPUS

815.10 - 815.19 OPEN FRACTURE OF METACARPAL BONE(S) SITE UNSPECIFIED - OPEN FRACTURE OF MULTIPLE SITES OF METACARPUS

816.00 - 816.03 CLOSED FRACTURE OF PHALANX OR PHALANGES OF HAND UNSPECIFIED - CLOSED FRACTURE OF MULTIPLE SITES OF PHALANX OR PHALANGES OF HAND

816.10 - 816.13 OPEN FRACTURE OF PHALANX OR PHALANGES OF HAND UNSPECIFIED - OPEN FRACTURE OF MULTIPLE SITES OF PHALANX OR PHALANGES OF HAND

817.0 - 817.1 MULTIPLE CLOSED FRACTURES OF HAND BONES - MULTIPLE OPEN FRACTURES OF HAND BONES

818.0 - 818.1 ILL-DEFINED CLOSED FRACTURES OF UPPER LIMB - ILL-DEFINED OPEN FRACTURES OF UPPER LIMB

819.0 - 819.1 MULTIPLE CLOSED FRACTURES INVOLVING BOTH UPPER LIMBS AND UPPER LIMB WITH RIB(S) AND STERNUM - MULTIPLE OPEN FRACTURES INVOLVING BOTH UPPER LIMBS AND UPPER LIMB WITH RIB(S) AND STERNUM

820.00 - 820.09 FRACTURE OF UNSPECIFIED INTRACAPSULAR SECTION OF NECK OF FEMUR CLOSED - OTHER TRANSCERVICAL FRACTURE OF FEMUR CLOSED

820.10 - 820.19 FRACTURE OF UNSPECIFIED INTRACAPSULAR SECTION OF NECK OF FEMUR OPEN - OTHER TRANSCERVICAL FRACTURE OF FEMUR OPEN

820.20 - 820.22 FRACTURE OF UNSPECIFIED TROCHANTERIC SECTION OF FEMUR CLOSED - FRACTURE OF SUBTROCHANTERIC SECTION OF FEMUR CLOSED

820.30 - 820.32 FRACTURE OF UNSPECIFIED TROCHANTERIC SECTION OF FEMUR OPEN - FRACTURE OF SUBTROCHANTERIC SECTION OF FEMUR OPEN

820.8 FRACTURE OF UNSPECIFIED PART OF NECK OF FEMUR CLOSED

820.9 FRACTURE OF UNSPECIFIED PART OF NECK OF FEMUR OPEN

821.00 - 821.39 FRACTURE OF UNSPECIFIED PART OF FEMUR CLOSED - OTHER FRACTURE OF LOWER END OF FEMUR OPEN

831.00 CLOSED DISLOCATION OF SHOULDER UNSPECIFIED SITE

831.01 - 831.09 CLOSED ANTERIOR DISLOCATION OF HUMERUS - CLOSED DISLOCATION OF OTHER SITE OF SHOULDER

831.10 - 831.19 OPEN DISLOCATION OF SHOULDER UNSPECIFIED - OPEN DISLOCATION OF OTHER SITE OF SHOULDER

832.00 CLOSED DISLOCATION OF ELBOW UNSPECIFIED SITE

832.01 - 832.09 CLOSED ANTERIOR DISLOCATION OF ELBOW - CLOSED DISLOCATION OF OTHER SITE OF ELBOW

832.10 - 832.19 OPEN DISLOCATION OF ELBOW UNSPECIFIED SITE - OPEN DISLOCATION OF OTHER SITE OF ELBOW

832.2 NURSEMAID'S ELBOW

833.00 CLOSED DISLOCATION OF WRIST UNSPECIFIED PART

833.01 - 833.09 CLOSED DISLOCATION OF RADIOULNAR (JOINT) DISTAL - CLOSED DISLOCATION OF OTHER PART OF WRIST

834.00 CLOSED DISLOCATION OF FINGER UNSPECIFIED PART

834.01 - 834.12 CLOSED DISLOCATION OF METACARPOPHALANGEAL (JOINT) - OPEN DISLOCATION INTERPHALANGEAL (JOINT) HAND

836.0 - 836.3 TEAR OF MEDIAL CARTILAGE OR MENISCUS OF KNEE CURRENT - DISLOCATION OF PATELLA CLOSED

840.0 - 840.8 ACROMIOCLAVICULAR (JOINT) (LIGAMENT) SPRAIN - SPRAIN OF OTHER SPECIFIED SITES OF SHOULDER AND UPPER ARM

840.9 SPRAIN OF UNSPECIFIED SITE OF SHOULDER AND UPPER ARM

841.0 - 841.9 RADIAL COLLATERAL LIGAMENT SPRAIN - SPRAIN OF UNSPECIFIED SITE OF ELBOW AND FOREARM

842.00 SPRAIN OF UNSPECIFIED SITE OF WRIST

842.01 - 842.09 SPRAIN OF CARPAL (JOINT) OF WRIST - OTHER WRIST SPRAIN

842.10 SPRAIN OF UNSPECIFIED SITE OF HAND

842.11 - 842.19 SPRAIN OF CARPOMETACARPAL (JOINT) OF HAND - OTHER HAND SPRAIN

850.4 CONCUSSION WITH PROLONGED LOSS OF CONSCIOUSNESS WITHOUT RETURN TO PRE-EXISTING CONSCIOUS LEVEL

880.00 - 880.09 OPEN WOUND OF SHOULDER REGION WITHOUT COMPLICATION - OPEN WOUND OF MULTIPLE SITES OF SHOULDER AND UPPER ARM WITHOUT COMPLICATION

880.10 - 880.19 OPEN WOUND OF SHOULDER REGION COMPLICATED - OPEN WOUND OF MULTIPLE SITES OF SHOULDER AND UPPER ARM COMPLICATED

880.20 - 880.29 OPEN WOUND OF SHOULDER REGION WITH TENDON INVOLVEMENT - OPEN WOUND OF MULTIPLE SITES OF SHOULDER AND UPPER ARM WITH TENDON INVOLVEMENT

881.00 - 881.22 OPEN WOUND OF FOREARM WITHOUT COMPLICATION - OPEN WOUND OF WRIST WITH TENDON INVOLVEMENT

882.0 - 882.2 OPEN WOUND OF HAND EXCEPT FINGERS ALONE WITHOUT COMPLICATION - OPEN WOUND OF HAND EXCEPT FINGERS ALONE WITH TENDON INVOLVEMENT

883.0 - 883.2 OPEN WOUND OF FINGERS WITHOUT COMPLICATION - OPEN WOUND OF FINGERS WITH TENDON INVOLVEMENT

884.0 - 884.2 MULTIPLE AND UNSPECIFIED OPEN WOUND OF UPPER LIMB WITHOUT COMPLICATION - MULTIPLE AND UNSPECIFIED OPEN WOUND OF UPPER LIMB WITH TENDON INVOLVEMENT

885.0 - 885.1 TRAUMATIC AMPUTATION OF THUMB (COMPLETE)(PARTIAL) WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF THUMB (COMPLETE)(PARTIAL) COMPLICATED

886.0 - 886.1 TRAUMATIC AMPUTATION OF OTHER FINGER(S) (COMPLETE) (PARTIAL) WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF OTHER FINGER(S) (COMPLETE) (PARTIAL) COMPLICATED

887.0 - 887.7 TRAUMATIC AMPUTATION OF ARM AND HAND (COMPLETE) (PARTIAL) UNILATERAL BELOW ELBOW WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF ARM AND HAND (COMPLETE) (PARTIAL) BILATERAL (ANY LEVEL) COMPLICATED

897.0 - 897.7 TRAUMATIC AMPUTATION OF LEG(S) (COMPLETE) (PARTIAL) UNILATERAL BELOW KNEE WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF LEG(S) (COMPLETE) (PARTIAL) BILATERAL (ANY LEVEL) COMPLICATED

905.1 - 905.9 LATE EFFECT OF FRACTURE OF SPINE AND TRUNK WITHOUT SPINAL CORD LESION - LATE EFFECT OF TRAUMATIC AMPUTATION

906.0 - 906.9 LATE EFFECT OF OPEN WOUND OF HEAD NECK AND TRUNK - LATE EFFECT OF BURN OF UNSPECIFIED SITE

907.0 - 907.9 LATE EFFECT OF INTRACRANIAL INJURY WITHOUT SKULL FRACTURE - LATE EFFECT OF INJURY TO OTHER AND UNSPECIFIED NERVE

908.6 LATE EFFECT OF CERTAIN COMPLICATIONS OF TRAUMA

909.2 LATE EFFECT OF RADIATION

909.3 LATE EFFECT OF COMPLICATIONS OF SURGICAL AND MEDICAL CARE

925.1 CRUSHING INJURY OF FACE AND SCALP

925.2 CRUSHING INJURY OF NECK

927.00 - 927.8 CRUSHING INJURY OF SHOULDER REGION - CRUSHING INJURY OF MULTIPLE SITES OF UPPER LIMB

927.9 CRUSHING INJURY OF UNSPECIFIED SITE OF UPPER LIMB

929.0 CRUSHING INJURY OF MULTIPLE SITES NOT ELSEWHERE CLASSIFIED

929.9 CRUSHING INJURY OF UNSPECIFIED SITE

941.20 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF FACE AND HEAD UNSPECIFIED SITE

941.21 - 941.29 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF EAR (ANY PART) - BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF MULTIPLE SITES (EXCEPT WITH EYE) OF FACE HEAD AND NECK

941.30 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF UNSPECIFIED SITE OF FACE AND HEAD

941.31 - 941.39 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF EAR (ANY PART) - FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SITES (EXCEPT WITH EYE) OF FACE HEAD AND NECK

942.20 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF UNSPECIFIED SITE OF TRUNK

942.21 - 942.24 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF BREAST - BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF BACK (ANY PART)

942.25 - 942.29 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF GENITALIA - BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF OTHER AND MULTIPLE SITES OF TRUNK

942.30 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF UNSPECIFIED SITE OF TRUNK

942.31 - 942.34 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF BREAST - FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF BACK (ANY PART)

943.20 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF UNSPECIFIED SITE OF UPPER LIMB

943.21 - 943.29 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF FOREARM - BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF MULTIPLE SITES OF UPPER LIMB EXCEPT WRIST AND HAND

943.30 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF UNSPECIFIED SITE OF UPPER LIMB

943.31 - 943.39 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF FOREARM - FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SITES OF UPPER LIMB EXCEPT WRIST AND HAND

943.40 - 943.59 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF UNSPECIFIED SITE OF UPPER LIMB WITHOUT LOSS OF A BODY PART - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SITES OF UPPER LIMB EXCEPT WRIST AND HAND WITH LOSS OF UPPER LIMB

944.00 - 944.20 BURN OF UNSPECIFIED DEGREE OF UNSPECIFIED SITE OF HAND - BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF UNSPECIFIED SITE OF HAND

944.21 - 944.28 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF SINGLE DIGIT (FINGER (NAIL)) OTHER THAN THUMB - BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF MULTIPLE SITES OF WRIST(S) AND      HAND(S)

944.30 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF UNSPECIFIED SITE OF HAND

944.31 - 944.38

FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF SINGLE DIGIT (FINGER (NAIL)) OTHER THAN THUMB - FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SITES OF WRIST(S) AND HAND(S)

944.40 - 944.58 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF UNSPECIFIED SITE OF HAND WITHOUT LOSS OF HAND - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SITES OF WRIST(S) AND HAND(S) WITH LOSS OF A BODY PART

945.22 - 945.29 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF FOOT - BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF MULTIPLE SITES OF LOWER LIMB(S)

945.32 - 945.39 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF FOOT - FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SITES OF LOWER LIMB(S)

946.2 - 946.3BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF MULTIPLE SPECIFIED SITES - FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SPECIFIED SITES

946.4 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SPECIFIED SITES WITHOUT LOSS OF A BODY PART

946.5 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SPECIFIED SITES WITH LOSS OF A BODY PART

949.3 - 949.5 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) UNSPECIFIED SITE - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE UNSPECIFIED SITE WITH LOSS OF A BODY PART

953.4 INJURY TO BRACHIAL PLEXUS

955.0 - 955.8 INJURY TO AXILLARY NERVE - INJURY TO MULTIPLE NERVES OF SHOULDER GIRDLE AND UPPER LIMB

955.9 INJURY TO UNSPECIFIED NERVE OF SHOULDER GIRDLE AND UPPER LIMB

956.0 INJURY TO SCIATIC NERVE

958.6 VOLKMANN'S ISCHEMIC CONTRACTURE

958.91 TRAUMATIC COMPARTMENT SYNDROME OF UPPER EXTREMITY

996.40 UNSPECIFIED MECHANICAL COMPLICATION OF INTERNAL ORTHOPEDIC DEVICE, IMPLANT, AND GRAFT

996.41 MECHANICAL LOOSENING OF PROSTHETIC JOINT

996.42 DISLOCATION OF PROSTHETIC JOINT

996.43 BROKEN PROSTHETIC JOINT IMPLANT

996.44 PERI-PROSTHETIC FRACTURE AROUND PROSTHETIC JOINT

996.45 PERI-PROSTHETIC OSTEOLYSIS

996.46 ARTICULAR BEARING SURFACE WEAR OF PROSTHETIC JOINT

996.47 OTHER MECHANICAL COMPLICATION OF PROSTHETIC JOINT IMPLANT

996.49 OTHER MECHANICAL COMPLICATION OF OTHER INTERNAL ORTHOPEDIC DEVICE, IMPLANT, AND GRAFT

996.66 INFECTION AND INFLAMMATORY REACTION DUE TO INTERNAL JOINT PROSTHESIS

996.67 INFECTION AND INFLAMMATORY REACTION DUE TO OTHER INTERNAL ORTHOPEDIC DEVICE IMPLANT AND GRAFT

996.77 - 996.79 OTHER COMPLICATIONS DUE TO INTERNAL JOINT PROSTHESIS - OTHER COMPLICATIONS DUE TO OTHER INTERNAL PROSTHETIC DEVICE IMPLANT AND GRAFT

996.91 - 996.94 COMPLICATIONS OF REATTACHED FOREARM - COMPLICATIONS OF REATTACHED UPPER EXTREMITY OTHER AND UNSPECIFIED

997.60 UNSPECIFIED LATE COMPLICATION OF AMPUTATION STUMP

997.61 - 997.62 NEUROMA OF AMPUTATION STUMP - INFECTION (CHRONIC) OF AMPUTATION STUMP

997.69 OTHER LATE AMPUTATION STUMP COMPLICATION

998.89 OTHER SPECIFIED COMPLICATIONS OF PROCEDURES NOT ELSEWHERE CLASSIFIED

V15.88 HISTORY OF FALL

V43.3 HEART VALVE REPLACED BY OTHER MEANS

V43.60 UNSPECIFIED JOINT REPLACEMENT

V43.61 - V43.65 SHOULDER JOINT REPLACEMENT - KNEE JOINT REPLACEMENT

V43.66 ANKLE JOINT REPLACEMENT

V43.69 OTHER JOINT REPLACEMENT

V43.7 LIMB REPLACED BY OTHER MEANS

V49.0 - V49.67 DEFICIENCIES OF LIMBS - SHOULDER AMPUTATION STATUS

V49.75 - V49.76 BELOW KNEE AMPUTATION STATUS - ABOVE KNEE AMPUTATION STATUS

V52.0 FITTING AND ADJUSTMENT OF ARTIFICIAL ARM (COMPLETE) (PARTIAL)

V52.1 FITTING AND ADJUSTMENT OF ARTIFICIAL LEG (COMPLETE) (PARTIAL)

V52.4 FITTING AND ADJUSTMENT OF BREAST PROSTHESIS AND IMPLANT

V52.8 FITTING AND ADJUSTMENT OF OTHER SPECIFIED PROSTHETIC DEVICE

V53.7 FITTING AND ADJUSTMENT OF ORTHOPEDIC DEVICES

V53.8 FITTING AND ADJUSTMENT OF WHEELCHAIR

V53.90 FITTING AND ADJUSTMENT OF UNSPECIFIED DEVICE

V53.99 FITTING AND ADJUSTMENT OF OTHER DEVICE

V54.01 - V54.02 ENCOUNTER FOR REMOVAL OF INTERNAL FIXATION DEVICE - ENCOUNTER FOR LENGTHENING/ADJUSTMENT OF GROWTH ROD

V54.09 OTHER AFTERCARE INVOLVING INTERNAL FIXATION DEVICE

V54.10 AFTERCARE FOR HEALING TRAUMATIC FRACTURE OF ARM UNSPECIFIED

V54.11 AFTERCARE FOR HEALING TRAUMATIC FRACTURE OF UPPER ARM

V54.12 AFTERCARE FOR HEALING TRAUMATIC FRACTURE OF LOWER ARM

V54.17 AFTERCARE FOR HEALING TRAUMATIC FRACTURE OF VERTEBRAE

V54.19 AFTERCARE FOR HEALING TRAUMATIC FRACTURE OF OTHER BONE

V54.20 AFTERCARE FOR HEALING PATHOLOGIC FRACTURE OF ARM UNSPECIFIED

V54.21 AFTERCARE FOR HEALING PATHOLOGIC FRACTURE OF UPPER ARM

V54.22 AFTERCARE FOR HEALING PATHOLOGIC FRACTURE OF LOWER ARM

V54.27 AFTERCARE FOR HEALING PATHOLOGIC FRACTURE OF VERTEBRAE

V54.29 AFTERCARE FOR HEALING PATHOLOGIC FRACTURE OF OTHER BONE

V54.81 AFTERCARE FOLLOWING JOINT REPLACEMENT

V54.89 OTHER ORTHOPEDIC AFTERCARE

V54.9 UNSPECIFIED ORTHOPEDIC AFTERCARE

V57.81 CARE INVOLVING ORTHOTIC TRAINING

V58.30 ENCOUNTER FOR CHANGE OR REMOVAL OF NONSURGICAL WOUND DRESSING

V58.31 ENCOUNTER FOR CHANGE OR REMOVAL OF SURGICAL WOUND DRESSING

V58.49 OTHER SPECIFIED AFTERCARE FOLLOWING SURGERY

V88.21 ACQUIRED ABSENCE OF HIP JOINT

V88.22 ACQUIRED ABSENCE OF KNEE JOINT

V88.29 ACQUIRED ABSENCE OF OTHER JOINT

 

 

Documentations Requirements

• Documentation supporting the medical necessity should be legible, maintained in the patient's medical record, and must be made available to the A/B MAC upon request.

• The plan of treatment written by the patient’s physician after any needed consultation with the qualified occupational therapist and signed by the physician.

o This must be in the patient’s medical record and made available to the A/B MAC upon request.

• When documenting family member/caregiver training and education, the documentation should include the person(s) being trained and the effectiveness of the training and education.

o The training and education should be an adjunct to the active therapy with the patient.

• OASIS data should support the medical necessity of the services documented in the medical records.

o For therapy services the OASIS MO2200 should be filled out completely and filed with the State Repository.

o An updated and completed OASIS for the billing period should be on file with the State Repository and in the patient’s medical records to be made available to the A/B MAC upon request.

• The progress note for services should reflect:

o An ongoing reassessment of the patient's response to treatment.

o Progress toward predicted goals.

o Clinical rationale for continued skilled treatment.

o Recommended changes to the plan of treatment.

o Services provided at the time of treatment.

• CORF social and/or psychological services do not include services for mental health diagnoses.

o Social and/or psychological services are covered only if the patient’s physician or the CORF physician establishes that the services directly relate to the patient’s rehabilitation plan of treatment and are needed to achieve the goals in the rehabilitation plan of treatment.

o Social and/or psychological services are those services that address the patient’s response and adjustment to the rehabilitation treatment plan:

 Rate of improvement and progress towards the rehabilitation goals.

 Other services as they directly relate to the occupational therapy plan of treatment being provided to the patient.

 

• Evaluation/Reevaluations

 

o The physician and/or occupational therapist's evaluation/re-evaluation assess the area for which occupational therapy treatment is being planned.

o It must be completed prior to beginning therapy. Evaluations must contain the following information:

 Reason for referral.

 Diagnosis/condition being treated.

 Past level of function (be specific).

 Evaluations must contain physical and cognitive baseline data necessary for assessing rehabilitation potential and measuring progress.

 Current level of function.

 Objective measurements such as strength, ROM, pain, ADL level, or edema.

 Treatment techniques/modalities selected for treating current illness or injury.

 Limitations which may influence the length of treatment.

 Short and long term goals stated in objective measurable terms, and their expected date of accomplishment.

 Frequency and duration of therapy.

 Re-assessments must be performed at least every 30 days by a qualified occupational therapist.

• The 30 day clock begins with the first therapy’s visit/assessment/measurement/documentation. (Of the occupational therapy.).

 

• Plan of Treatment

 

o Services are to be furnished according to a written plan of treatment determined by the physician after any needed consultations with the qualified occupational therapist and signed and dated by the physician after an appropriate assessment (evaluation) of the condition (illness or injury) is completed.

o The plan of treatment must be completed before active therapy begins.

o The plan of treatment must be signed by the referring or attending physician prior to billing the service to Medicare.

o The written plan of treatment may not be altered by an occupational therapist.

 *Electronic signatures are acceptable if the proper documentation is submitted to the A/B MAC.

 However, stamped dates are not allowed.

o The written plan of care must contain the following elements:

 Diagnosis being treated and the specific problems identified that are to be addressed

 Treatment techniques/modalities or procedures being used for specific problem to attain the stated goals.

 Specific functional goals for therapy in objective measurable terms. (Patient/caregiver maybe included or taken into consideration.).

 Amount, frequency, and duration of therapeutic services.

 Rehabilitation potential - therapists/physician's expectation of the patient's ability to meet the goals at initiation of treatment.

• (Patient and, when appropriate, caregiver goals may be incorporated.).

 

• Treatment Note/Progress Notes

 

o A treatment note should be written for each visit using objective measurements and functional accomplishments. It should contain the objective status of the patient, a description of the services performed, the patient's response to the services and the relation toward the treatment goals.

o The treatment note should document any treatment variations with the associated rationale.

o The treatment notes should be written using objective measurements and functional accomplishments. Use statements which demonstrate the patient's response to the therapy such as:

 "Able to perform exercises as prescribed for 15 reps."

 "Able to safely transfer from bed to toilet with standby assistance."

 "Can now abduct shoulder 120 degrees."

 "Able to don a pull over shirt with minimal assistance."

o Avoid terms such as:

 "Doing well."

 "Improving."

 "Less pain."

 "Increased range of motion."

 "Increased strength."

 "Tolerated treatment well."

 

• Certification/Re-certification

 

o The certifying physician must document that he or she or an allowed non-physician practitioner (NPP) had a face-to-face encounter with the patient.

 The encounter must occur no more than 90 days prior to the home health start of care date or within 30 days after the start of care.

o Certifications and re-certifications by the physician, must be on file and available to the A/B MAC when the request for payment is forwarded.

o Certifications are required upon initiation of therapy and at least every 60 days thereafter for Home Health.

o The referring/attending physician establishes or reviews the plan of treatment and makes the necessary certifications must sign and date all certifications/re-certifications.

o Documentation should indicate the prognosis for potential restoration of function in a reasonable and generally predictable period of time, or the need to establish a safe and effective maintenance program.

 

Utilization Guidelines

• This policy does not address services rendered to patients by occupational therapist for psychosocial impairments.

• Occupational therapy services may be furnished in the patient’s home, as CORF services, when payment for these services is not otherwise made under the Medicare home health benefit.

o However, since the CORF premise is the primary location for furnishing these services, it is expected that a clear majority of the occupational therapy services delivered will be provided on the CORF premises for all CORF patients.

 

Sources of Information and Basis for Decision

 

Applegate WB, Blass JP, Williams TF. Instruments for the functional assessment of older patients. New Engl J Med 1990; 322:1207-1214.

 

Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9:179-186.

 

Lawton MP. The functional assessment of elderly people. J Am Geriatrics Soc 1971; 39:465- 48

 

Occupational Therapy Practice Guidelines for Adults With Alzheimer’s Disease. The AOTA Practice Guidelines Series; AOTA (2001).

 

Occupational Therapy Practice Guidelines for Adults With Neurodegenerative Diseases. The AOTA Practice Guidelines Series; AOTA. (1999)

 

Occupational Therapy Practice Guidelines for Adults With Rheumatoid Arthritis. The AOTA Practice Guidelines Series; AOTA. (1999)

 

Occupational Therapy Practice Guidelines for Adults With Spinal Cord Injury. The AOTA Practice Guidelines Series; AOTA. (1999)

 

Occupational Therapy Practice Guidelines for Adults With Stroke. The AOTA Practice Guidelines Series; AOTA. (1999)

 

Occupational Therapy Practice Guidelines for Chronic Pain. The AOTA Practice Guidelines Series; AOTA. (1999)

 

Occupational Therapy Practice Guidelines for Adults With Traumatic Brain Injury. The AOTA Practice Guidelines Series; AOTA. (1999)

 

Occupational Therapy Practice Guidelines for Tendon Injuries. The AOTA Practice Guidelines Series; AOTA. (1999)

 

The Institute of Medicine’s Committee on a National Agenda for Prevention of Disabilities. Executive Summary in Disability in America: Toward a National Agenda for Prevention. National Academy Press, Washington, D. C., 1991.

 

Article(s)

A50421 - CPT Code 97755 - Assistive Technology Assessment

A50427 - Occupational Therapy for Home Health

 

Local Coverage Determination (LCD) for Home Health - Occupational Therapy (L31530)