ICD-10 Support

ICD-10 Support

The ICD-10 Diagnosis Codes For Providers

Easy access to the information you may need

If you’re a provider, you’ll want to get familiar with billing codes that went into effect October 1, 2015. While sample ICD-9-CM codes have been mapped to the latest ICD-10-CM codes so that coders can become familiar with the new codes, the ultimate responsibility for correct coding lies with the provider of services. The codes included in the charts below are not intended to be promotional, or to encourage or suggest a use of any drug that is inconsistent with FDA-approved use.

Please refer to the current policy for the latest codes since these codes are subject to change. The codes provided are not intended to be exhaustive. Please consult your ICD-10 code book for additional information.

Third-party reimbursement is affected by many factors. The content provided is for informational purposes only and is not intended to provide reimbursement or legal advice and does not promise or guarantee coverage, levels of reimbursement, payment, or charge. Similarly, all CPT®* and HCPCS codes are supplied for informational purposes only and represent no promise or guarantee that these codes will be appropriate or that reimbursement will be made. It is not intended to increase or maximize reimbursement by any payer. Laws, regulations, and policies concerning reimbursement are complex and are updated frequently. While we have made an effort to be current as of the issue date of this document, the information may not be as current or comprehensive when you view it. We strongly recommend that you consult with your payer organization(s) for local or actual coverage and reimbursement policies and with your internal reimbursement specialist for any reimbursement or billing questions.

*CPT® copyright 2016 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.

Click below for an ICD-10 Crosswalk Sample.

RHEUMATOID ARTHRITIS AND OTHER INFLAMMATORY POLYARTHROPATHIES / OTHER RHEUMATOID ARTHRITIS

ICD-9 Indication ICD-9 Code ICD-10 Indication ICD-10 Code
Rheumatoid arthritis and other inflammatory polyarthropathies 714 Rheumatoid arthritis with rheumatoid factor M05
    Other rheumatoid arthritis M06
    Juvenile rheumatoid arthritis M08
Rheumatoid arthritis 714.0 Rheumatoid arthritis without rheumatoid factor, unspecified site M06.00
Use additional code to identify manifestation, as:
  myopathy (359.6)
  polyneuropathy (357.1)

More codes

..., right shoulder M06.011
..., left shoulder M06.012
..., unspecified shoulder M06.019
..., right elbow M06.021
..., left elbow M06.022
..., unspecified elbow M06.029
..., right wrist M06.031
..., left wrist M06.032
..., unspecified wrist M06.039
..., right hand M06.041
..., left hand M06.042
..., unspecified hand M06.049
..., right hip M06.051
..., left hip M06.052
..., unspecified hip M06.059
..., right knee M06.061
..., left knee M06.062
..., unspecified knee M06.069
..., right ankle and foot M06.071
..., left ankle and foot M06.072
..., unspecified ankle and foot M06.079
..., vertebrae M06.08
..., multiple sites M06.09

 

    Rheumatoid bursitis, unspecified site M06.20
   

More codes

..., right shoulder M06.211
..., left shoulder M06.212
..., unspecified shoulder M06.219
..., right elbow M06.221
..., left elbow M06.222
..., unspecified elbow M06.229
..., right wrist M06.231
..., left wrist M06.232
..., unspecified wrist M06.239
..., right hand M06.241
..., left hand M06.242
..., unspecified hand M06.249
..., right hip M06.251
..., left hip M06.252
..., unspecified hip M06.259
..., right knee M06.261
..., left knee M06.262
..., unspecified knee M06.269
..., right ankle and foot M06.271
..., left ankle and foot M06.272
..., unspecified ankle and foot M06.279
..., vertebrae M06.28
..., multiple sites M06.29

 

    Rheumatoid nodule, unspecified site M06.30
   

More codes

..., right shoulder M06.311
..., left shoulder M06.312
..., unspecified shoulder M06.319
..., right elbow M06.321
..., left elbow M06.322
..., unspecified elbow M06.329
..., right wrist M06.331
..., left wrist M06.332
..., unspecified wrist M06.339
..., right hand M06.341
..., left hand M06.342
..., unspecified hand M06.349
..., right hip M06.351
..., left hip M06.352
..., unspecified hip M06.359
..., right knee M06.361
..., left knee M06.362
..., unspecified knee M06.369
..., right ankle and foot M06.371
..., left ankle and foot M06.372
..., unspecified ankle and foot M06.379
..., vertebrae M06.38
..., multiple sites M06.39
    Other specified rheumatoid arthritis, unspecified site M06.80
   

More codes

..., right shoulder M06.811
..., left shoulder M06.812
..., unspecified shoulder M06.819
..., right elbow M06.821
..., left elbow M06.822
..., unspecified elbow M06.829
..., right wrist M06.831
..., left wrist M06.832
..., unspecified wrist M06.839
..., right hand M06.841
..., left hand M06.842
..., unspecified hand M06.849
..., right hip M06.851
..., left hip M06.852
..., unspecified hip M06.859
..., right knee M06.861
..., left knee M06.862
..., unspecified knee M06.869
..., right ankle and foot M06.871
..., left ankle and foot M06.872
..., unspecified ankle and foot M06.879
..., vertebrae M06.88
..., multiple sites M06.89
    Rheumatoid arthritis, unspecified M06.9
    Rheumatoid myopathy with rheumatoid arthritis of unspecified site M05.40
   

More codes

... right shoulder M05.411
... left shoulder M05.412
... unspecified shoulder M05.419
... right elbow M05.421
... left elbow M05.422
... unspecified elbow M05.429
... right wrist M05.431
... left wrist M05.432
... unspecified wrist M05.439
... right hand M05.441
... left hand M05.442
... unspecified hand M05.449
... right hip M05.451
... left hip M05.452
... unspecified hip M05.459
... right knee M05.461
... left knee M05.462
... unspecified knee M05.469
... right ankle and foot M05.471
... left ankle and foot M05.472
... unspecified ankle and foot M05.479
... multiple sites M05.49
    Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified site M05.50
   

More codes

... right shoulder M05.511
... left shoulder M05.512
... unspecified shoulder M05.519
... right elbow M05.521
... left elbow M05.522
... unspecified elbow M05.529
... right wrist M05.531
... left wrist M05.532
... unspecified wrist M05.539
... right hand M05.541
... left hand M05.542
... unspecified hand M05.549
... right hip M05.551
... left hip M05.552
... unspecified hip M05.559
... right knee M05.561
... left knee M05.562
... unspecified knee M05.569
... right ankle and foot M05.571
... left ankle and foot M05.572
... unspecified ankle and foot M05.579
... multiple sites M05.59
    Rheumatoid arthritis with rheumatoid factor of unspecified site without organ or systems involvement M05.70
   

More codes

... right shoulder ... M05.711
... left shoulder ... M05.712
... unspecified shoulder ... M05.719
... right elbow ... M05.721
... left elbow ... M05.722
... unspecified elbow ... M05.729
... right wrist ... M05.731
... left wrist ... M05.732
... unspecified wrist ... M05.739
... right hand ... M05.741
... left hand ... M05.742
... unspecified hand ... M05.749
... right hip ... M05.751
... left hip ... M05.752
... unspecified hip ... M05.759
... right knee ... M05.761
... left knee ... M05.762
... unspecified knee ... M05.769
... right ankle and foot ... M05.771
... left ankle and foot ... M05.772
... unspecified ankle and foot ... M05.779
... multiple sites ... M05.79
    Other rheumatoid arthritis with rheumatoid factor of unspecified site M05.80
   

More codes

... right shoulder M05.811
... left shoulder M05.812
... unspecified shoulder M05.819
... right elbow M05.821
... left elbow M05.822
... unspecified elbow M05.829
... right wrist M05.831
... left wrist M05.832
... unspecified wrist M05.839
... right hand M05.841
... left hand M05.842
... unspecified hand M05.849
... right hip M05.851
... left hip M05.852
... unspecified hip M05.859
... right knee M05.861
... left knee M05.862
... unspecified knee M05.869
... right ankle and foot M05.871
... left ankle and foot M05.872
... unspecified ankle and foot M05.879
... multiple sites M05.89
    Rheumatoid arthritis with rheumatoid factor, unspecified M05.9
Other rheumatoid arthritis with visceral or systemic involvement 714.2 Rheumatoid vasculitis with rheumatoid arthritis of unspecified site M05.20
   

More codes

... right shoulder M05.211
... left shoulder M05.212
... unspecified shoulder M05.219
... right elbow M05.221
... left elbow M05.222
... unspecified elbow M05.229
... right wrist M05.231
... left wrist M05.232
... unspecified wrist M05.239
... right hand M05.241
... left hand M05.242
... unspecified hand M05.249
... right hip M05.251
... left hip M05.252
... unspecified hip M05.259
... right knee M05.261
... left knee M05.262
... unspecified knee M05.269
... right ankle and foot M05.271
... left ankle and foot M05.272
... unspecified ankle and foot M05.279
... multiple sites M05.29
    Rheumatoid heart disease with rheumatoid arthritis of unspecified site M05.30
   

More codes

... right shoulder M05.311
... left shoulder M05.312
... unspecified shoulder M05.319
... right elbow M05.321
... left elbow M05.322
... unspecified elbow M05.329
... right wrist M05.331
... left wrist M05.332
... unspecified wrist M05.339
... right hand M05.341
... left hand M05.342
... unspecified hand M05.349
... right hip M05.351
... left hip M05.352
... unspecified hip M05.359
... right knee M05.361
... left knee M05.362
... unspecified knee M05.369
... right ankle and foot M05.371
... left ankle and foot M05.372
... unspecified ankle and foot M05.379
... multiple sites M05.39
    Rheumatoid arthritis of unspecified site with involvement of other organs and systems M05.60
   

More codes

... right shoulder ... M05.611
... left shoulder ... M05.612
... unspecified shoulder ... M05.619
... right elbow ... M05.621
... left elbow ... M05.622
... unspecified elbow ... M05.629
... right wrist ... M05.631
... left wrist ... M05.632
... unspecified wrist ... M05.639
... right hand ... M05.641
... left hand ... M05.642
... unspecified hand ... M05.649
... right hip ... M05.651
... left hip ... M05.652
... unspecified hip ... M05.659
... right knee ... M05.661
... left knee ... M05.662
... unspecified knee ... M05.669
... right ankle and foot ... M05.671
... left ankle and foot ... M05.672
... unspecified ankle and foot ... M05.679
... multiple sites ... M05.69
    Adult-onset Still's disease M06.1
Felty's syndrome 714.1 Felty's syndrome, unspecified site M05.00
   

More codes

..., right shoulder M05.011
..., left shoulder M05.012
..., unspecified shoulder M05.019
..., right elbow M05.021
..., left elbow M05.022
..., unspecified elbow M05.029
..., right wrist M05.031
..., left wrist M05.032
..., unspecified wrist M05.039
..., right hand M05.041
..., left hand M05.042
..., unspecified hand M05.049
..., right hip M05.051
..., left hip M05.052
..., unspecified hip M05.059
..., right knee M05.061
..., left knee M05.062
..., unspecified knee M05.069
..., right ankle and foot M05.071
..., left ankle and foot M05.072
..., unspecified ankle and foot M05.079
..., multiple sites M05.09
Rheumatoid lung 714.81 Rheumatoid lung disease with rheumatoid arthritis of unspecified site M05.10
   

More codes

..., right shoulder M05.111
..., left shoulder M05.112
..., unspecified shoulder M05.119
..., right elbow M05.121
..., left elbow M05.122
..., unspecified elbow M05.129
..., right wrist M05.131
..., left wrist M05.132
..., unspecified wrist M05.139
..., right hand M05.141
..., left hand M05.142
..., unspecified hand M05.149
..., right hip M05.151
..., left hip M05.152
..., unspecified hip M05.159
..., right knee M05.161
..., left knee M05.162
..., unspecified knee M05.169
..., right ankle and foot M05.171
..., left ankle and foot M05.172
..., unspecified ankle and foot M05.179
..., multiple sites M05.19
Other specified inflammatory polyarthropathies 714.89 Inflammatory polyarthropathy M06.4
Unspecified inflammatory polyarthropathy 714.9 Inflammatory polyarthropathy M06.4

For more information on ICD-10, visit the CMS Web site.

SOURCES
American Medical Association, “2017 The Complete Official Codebook ICD10-CM”

INDICATION

SIMPONI ARIA® is a tumor necrosis factor (TNF) blocker indicated for the treatment of adult patients with moderately to severely active Rheumatoid Arthritis (RA) in combination with methotrexate.

IMPORTANT SAFETY INFORMATION For SIMPONI ARIA®
SERIOUS INFECTIONS

Patients treated with SIMPONI ARIA® (golimumab) are at increased risk for developing serious infections that may lead to hospitalization or death. Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. Discontinue SIMPONI ARIA® if a patient develops a serious infection.

Reported infections with TNF blockers, of which SIMPONI ARIA® is a member, include:

  • Active tuberculosis (TB), including reactivation of latent TB. Patients frequently presented with disseminated or extrapulmonary disease. Test patients for latent TB before SIMPONI ARIA® use and during therapy. Initiate treatment for latent infection prior to SIMPONI ARIA® use.
  • Invasive fungal infections, including histoplasmosis, coccidioidomycosis, candidiasis, aspergillosis, blastomycosis, and pneumocystosis. Patients with histoplasmosis or other invasive fungal infections may present with disseminated, rather than localized, disease. Consider empiric anti-fungal therapy in patients at risk for invasive fungal infections who develop severe systemic illness.
  • Bacterial, viral, and other infections due to opportunistic pathogens, including Legionella and Listeria.

Consider the risks and benefits of treatment with SIMPONI ARIA® prior to initiating therapy in patients with chronic or recurrent infection. Do not start SIMPONI ARIA® in patients with clinically important active infections, including localized infections. Closely monitor patients for the development of signs and symptoms of infection during and after treatment with SIMPONI ARIA®, including the possible development of TB in patients who tested negative for latent TB infection prior to initiating therapy, who are on treatment for latent TB, or who were previously treated for TB infection.

Risk of infection may be higher in patients greater than 65 years of age, patients with co-morbid conditions and/or patients taking concomitant immunosuppressant therapy. Other serious infections observed in patients treated with SIMPONI ARIA® included sepsis, pneumonia, cellulitis, and abscess.

MALIGNANCIES

Lymphoma and other malignancies, some fatal, have been reported in children and adolescent patients treated with TNF blockers, of which SIMPONI ARIA® is a member. Approximately half the cases were lymphomas, including Hodgkin’s and non-Hodgkin’s lymphoma. The other cases represented a variety of malignancies, including rare malignancies usually associated with immunosuppression and malignancies not usually observed in children or adolescents. Malignancies occurred after a median of 30 months after the first dose of therapy. Most of the patients were receiving concomitant immunosuppressants.

In the controlled portions of clinical trials of TNF blockers including the subcutaneous formulation of golimumab, more cases of lymphoma have been observed among patients receiving anti-TNF treatment compared with patients in the control groups. In clinical trials, the incidence of malignancies other than lymphoma and non-melanoma skin cancer per 100 patient-years of follow-up was 0.56 (95% CI: 0.01, 3.11) in the SIMPONI ARIA® group compared with an incidence of 0 (95% CI: 0.00, 3.79) in the placebo group. Cases of acute and chronic leukemia have been reported with TNF-blocker use, including SIMPONI ARIA®. The risks and benefits of TNF-blocker therapy should be considered prior to initiating therapy in patients with a known malignancy or who develop a malignancy.

Postmarketing cases of hepatosplenic T-cell lymphoma (HSTCL), a rare type of T-cell lymphoma, have been reported in patients treated with TNF blockers. These cases have had a very aggressive disease course and have been fatal. Nearly all reported cases have occurred in patients with Crohn’s disease or ulcerative colitis, and the majority were in adolescent and young adult males. Almost all of these patients had received treatment with azathioprine or 6-mercaptopurine concomitantly with a TNF blocker at or prior to diagnosis. A risk for the development for HSTCL in patients treated with TNF blockers cannot be excluded.

Melanoma and Merkel cell carcinoma have been reported in patients treated with TNF-blocking agents, including
SIMPONI ARIA®. Periodic skin examination is recommended for all patients, particularly those with risk factors for skin cancer.

HEPATITIS B REACTIVATION

The use of TNF blockers, of which SIMPONI ARIA® is a member, has been associated with reactivation of hepatitis B virus (HBV) in patients who are chronic hepatitis B carriers. In some instances, HBV reactivation occurring in conjunction with TNF-blocker therapy has been fatal. The majority of these reports have occurred in patients who received concomitant immunosuppressants.

All patients should be tested for HBV infection before initiating TNF blocker therapy. For patients who test positive for hepatitis B surface antigen, consult a physician with expertise in the treatment of hepatitis B before initiating TNF-blocker therapy. Exercise caution when prescribing SIMPONI ARIA® for patients identified as carriers of HBV and closely monitor for active HBV infection during and following termination of therapy with SIMPONI ARIA®. Discontinue SIMPONI ARIA® in patients who develop HBV reactivation, and initiate antiviral therapy with appropriate supportive treatment. Exercise caution when considering resumption of SIMPONI ARIA®, and monitor patients closely.

HEART FAILURE

Cases of worsening congestive heart failure (CHF) and new-onset CHF have been reported with TNF blockers, including SIMPONI ARIA®. Some cases had a fatal outcome. Exercise caution in CHF patients receiving SIMPONI ARIA® and monitor them closely during therapy. Discontinue SIMPONI ARIA® if new or worsening symptoms of heart failure appear.

DEMYELINATING DISORDERS

Use of TNF blockers, of which SIMPONI ARIA® is a member, has been associated with rare cases of new-onset or exacerbation of demyelinating disorders, including multiple sclerosis (MS) and Guillain-Barré syndrome. Cases of central demyelination, MS, optic neuritis, and peripheral demyelinating polyneuropathy have rarely been reported in patients treated with the subcutaneous formulation of golimumab. Exercise caution in considering the use of SIMPONI ARIA® in patients with these disorders. Consider discontinuation if these disorders develop.

AUTOIMMUNITY

Treatment with TNF blockers, including SIMPONI ARIA®, may result in the formation of antinuclear antibodies. Rarely, treatment with TNF blockers may result in a lupus-like syndrome. Discontinue treatment if symptoms of a lupus-like syndrome develop.

USE WITH OTHER DRUGS

The concomitant use of a TNF blocker and abatacept or anakinra was associated with a higher risk of serious infections, therefore the use of SIMPONI ARIA® in combination with these products is not recommended. Care should be taken when switching from one biologic to another since overlapping biological activity may further increase the risk of infection. A higher rate of serious infections has also been observed in RA patients treated with rituximab who received subsequent treatment with a TNF blocker. The concomitant use of SIMPONI ARIA® with biologics approved to treat RA is not recommended because of the possibility of an increased risk of infection.

HEMATOLOGIC CYTOPENIAS

There have been reports of pancytopenia, leukopenia, neutropenia, and thrombocytopenia in patients receiving SIMPONI ARIA® in clinical trials. Additionally, aplastic anemia has been reported in patients receiving TNF blockers. Exercise caution when using SIMPONI ARIA® in patients who have or had significant cytopenias.

VACCINATIONS/THERAPEUTIC INFECTIOUS AGENTS

People receiving SIMPONI ARIA® can receive vaccinations, except for live vaccines. Use of live vaccines could result in clinical infections, including disseminated infections. Administration of live vaccines to infants exposed to SIMPONI ARIA® in utero is not recommended for 6 months following the mother’s last SIMPONI ARIA® infusion during pregnancy due to an increased risk of infection. It is recommended that therapeutic infectious agents not be given concurrently with SIMPONI ARIA® due to the possibility of clinical infections, including disseminated infections.

HYPERSENSITIVITY REACTIONS

Serious systemic hypersensitivity reactions (including anaphylaxis) have been reported following administration of the subcutaneous formulation of golimumab and SIMPONI ARIA®, some occurring after the first dose. Hypersensitivity reactions including hives, pruritus, dyspnea, and nausea, were reported in association with infusions of SIMPONI ARIA®. If an anaphylactic or other serious allergic reaction occurs, discontinue SIMPONI ARIA® immediately and institute appropriate therapy.

ADVERSE REACTIONS

The most serious adverse reactions were serious infections and malignancies.

Upper respiratory tract infection was the most common adverse reaction reported in the Phase 3 trial through Week 24, occurring in 6.5% of patients treated with SIMPONI ARIA® as compared with 7.6% of patients in the control group. The rate of infusions associated with an infusion reaction was reported in 1.1% of SIMPONI ARIA® infusions compared with 0.2% of infusions in the control group.

Please see the full Prescribing Information and Medication Guide for SIMPONI ARIA®. Provide the Medication Guide to your patients and encourage discussion.

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