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
Rheumatoid arthritis 714.0 Rheumatoid myopathy with rheumatoid arthritis of unspecified site M05.40
   

More codes

... of unspecified shoulder M05.419*
... of unspecified elbow M05.429*
... of unspecified wrist M05.439*
... of unspecified hand M05.449*
... of unspecified hip M05.459*
... of unspecified knee M05.469*
... of unspecified ankle and foot M05.479*
... of multiple sites M05.49
    Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified site M05.50
   

More codes

... of unspecified shoulder M05.519*
... of unspecified elbow M05.529*
... of unspecified wrist M05.539*
... of unspecified hand M05.549*
... of unspecified hip M05.559*
... of unspecified knee M05.569*
... of unspecified ankle and foot M05.579*
... of multiple sites M05.59
    Rheumatoid arthritis with rheumatoid factor of unspecified site without organ or systems involvement M05.70
   

More codes

... of unspecified shoulder ... M05.719*
... of unspecified elbow ... M05.729*
... of unspecified wrist ... M05.739*
... of unspecified hand ... M05.749*
... of unspecified hip ... M05.759*
... of unspecified knee ... M05.769*
... of unspecified ankle and foot ... M05.779*
... of multiple sites ... M05.79
    Other rheumatoid arthritis with rheumatoid factor of unspecified site M05.80
   

More codes

... of unspecified shoulder M05.819*
... of unspecified elbow M05.829*
... of unspecified wrist M05.839*
... of unspecified hand M05.849*
... of unspecified hip M05.859*
... of unspecified knee M05.869*
... of unspecified ankle and foot M05.879*
... of multiple sites M05.89
    Rheumatoid arthritis with rheumatoid factor, unspecified M05.9
    Rheumatoid arthritis without rheumatoid factor, unspecified site M06.00
   

More codes

..., unspecified shoulder M06.019*
..., unspecified elbow M06.029*
..., unspecified wrist M06.039*
..., unspecified hand M06.049*
..., unspecified hip M06.059*
..., unspecified knee M06.069*
..., unspecified ankle and foot M06.079*
..., vertebrae M06.08
..., multiple sites M06.09
    Other specified rheumatoid arthritis, unspecified site M06.80
   

More codes

..., unspecified shoulder M06.819*
..., unspecified elbow M06.829*
..., unspecified wrist M06.839*
..., unspecified hand M06.849*
..., unspecified hip M06.859*
..., unspecified knee M06.869*
..., unspecified ankle and foot M06.879*
..., vertebrae M06.88
..., multiple sites M06.89
    Rheumatoid arthritis, unspecified M06.9
Other rheumatoid arthritis with visceral or systemic involvement 714.2 Rheumatoid vasculitis with rheumatoid arthritis of unspecified site M05.20
   

More codes

... of unspecified shoulder M05.219*
... of unspecified elbow M05.229*
... of unspecified wrist M05.239*
... of unspecified hand M05.249*
... of unspecified hip M05.259*
... of unspecified knee M05.269*
... of unspecified ankle and foot M05.279*
... of multiple sites M05.29
    Rheumatoid heart disease with rheumatoid arthritis of unspecified site M05.30
   

More codes

... of unspecified shoulder M05.319*
... of unspecified elbow M05.329*
... of unspecified wrist M05.339*
... of unspecified hand M05.349*
... of unspecified hip M05.359*
... of unspecified knee M05.369*
... of unspecified ankle and foot M05.379*
... of multiple sites M05.39
    Rheumatoid arthritis of unspecified site with involvement of other organs and systems M05.60
   

More codes

... of unspecified shoulder ... M05.619*
... of unspecified elbow ... M05.629*
... of unspecified wrist ... M05.639*
... of unspecified hand ... M05.649*
... of unspecified hip ... M05.659*
... of unspecified knee ... M05.669*
... of unspecified ankle and foot ... M05.679*
... of multiple sites ... M05.69
    Adult-onset Still's disease M06.1

* Please refer to the ICD-10 book for the lateral codes.

PSORIATIC ARTHRITIS

ICD-9 Indication ICD-9 Code ICD-10 Indication ICD-10 Code
Psoriatic arthropathy 696.0 Arthropathic psoriasis, unspecified L40.50
    Distal interphalangeal psoriatic arthropathy L40.51
    Psoriatic arthritis mutilans L40.52
    Psoriatic spondylitis L40.53
    Other psoriatic arthropathy L40.59

ANKYLOSING SPONDYLITIS

ICD-9 Indication ICD-9 Code ICD-10 Indication ICD-10 Code
Ankylosing spondylitis 720.0 Ankylosing spondylitis of multiple sites in spine M45.0
    ... occipito-atlanto-axial region M45.1
    ... cervical region M45.2
    ... cervicothoracic region M45.3
    ... thoracic region M45.4
    ... thoracolumbar region M45.5
    ... lumbar region M45.6
    ... lumbosacral region M45.7
    ... sacral and sacrococcygeal region M45.8
    ... unspecified sites in spine M45.9

ULCERATIVE COLITIS

ICD-9 Indication ICD-9 Code ICD-10 Indication ICD-10 Code
    Use additional code to identify manifestations, such as: pyoderma gangrenosum (L88)
Ulcerative (chronic) enterocolitis 556.0 Other ulcerative colitis without complications K51.80
   

More codes

... with rectal bleeding K51.811
... with intestinal obstruction K51.812
... with fistula K51.813
... with abscess K51.814
... with other complication K51.818
... with unspecified complications K51.819
Ulcerative (chronic ) ileocolitis 556.1 Other ulcerative colitis without complications K51.80
   

More codes

... with rectal bleeding K51.811
... with intestinal obstruction K51.812
... with fistula K51.813
... with abscess K51.814
... with other complication K51.818
... with unspecified complications K51.819
Ulcerative (chronic) proctitis 556.2 Ulcerative (chronic) proctitis without complications K51.20
   

More codes

... with rectal bleeding K51.211
... with intestinal obstruction K51.212
... with fistula K51.213
... with abscess K51.214
... with other complication K51.218
... with unspecified complications K51.219
Ulcerative (chronic) proctosigmoiditis 556.3 Ulcerative (chronic) rectosigmoiditis without complications K51.30
   

More codes

... with rectal bleeding K51.311
... with intestinal obstruction K51.312
... with fistula K51.313
... with abscess K51.314
... with other complication K51.318
... with unspecified complications K31.319
Left-sided ulcerative (chronic) colitis 556.5 Left sided colitis without complications K51.50
   

More codes

... with rectal bleeding K51.511
... with intestinal obstruction K51.512
... with fistula K51.513
... with abscess K51.514
... with other complication K51.518
... with unspecified complications K51.519
Universal ulcerative (chronic) colitis 556.6 Ulcerative (chronic) pancolitis without complications K51.00
   

More codes

... with rectal bleeding K51.011
... with intestinal obstruction K51.012
... with fistula K51.013
... with abscess K51.014
... with other complication K51.018
... with unspecified complications K51.019
Other ulcerative colitis 556.8 Other ulcerative colitis without complications K51.80
   

More codes

... with rectal bleeding K51.811
... with intestinal obstruction K51.812
... with fistula K51.813
... with abscess K51.814
... with other complication K51.818
... with unspecified complications K51.819
Ulcerative colitis, unspecified 556.9 Ulcerative colitis, unspecified, without complications K51.90
   

More codes

..., with rectal bleeding K51.911
..., with intestinal obstruction K51.912
..., with fistula K51.913
..., with abscess K51.914
..., with other complication K51.918
..., with unspecified complications K51.919

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

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

What is SIMPONI® (golimumab)?

SIMPONI® 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
  • Active psoriatic arthritis (PsA) alone, or in combination with methotrexate
  • Active ankylosing spondylitis (AS)
  • Moderately to severely active ulcerative colitis (UC) for inducing and maintaining clinical response, improving endoscopic appearance of the mucosa during induction, inducing clinical remission, and achieving and sustaining clinical remission in induction responders who have demonstrated corticosteroid dependence or who have had an inadequate response to or failed to tolerate oral aminosalicylates, oral corticosteroids, azathioprine, or 6‑mercaptopurine
Important Safety Information For SIMPONI®

SERIOUS INFECTIONS

Patients treated with SIMPONI® (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® if a patient develops a serious infection.

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

  • Active tuberculosis (TB), including reactivation of latent TB. Patients frequently presented with disseminated or extrapulmonary disease. Patients should be tested for latent TB before SIMPONI® use and during therapy. Treatment for latent infection should be initiated prior to SIMPONI® 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.

The risks and benefits of treatment with SIMPONI® should be carefully considered prior to initiating therapy in patients with chronic or recurrent infection. Do not start SIMPONI® 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®, 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® included sepsis, pneumonia, cellulitis, abscess and hepatitis B infection.

MALIGNANCIES

Lymphoma and other malignancies, some fatal, have been reported in children and adolescent patients treated with TNF blockers of which SIMPONI® 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 all TNF-blocking agents including SIMPONI®, more cases of lymphoma have been observed among patients receiving TNF-blocking treatment compared with control patients. In the Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA), and Ankylosing Spondylitis (AS) clinical trials, the incidence of lymphoma per 100 patient-years of follow-up was 0.21 (95% CI: 0.03, 0.77) in the combined SIMPONI® group compared with an incidence of 0 (95% CI: 0, 0.96) in the placebo group. In clinical trials, the incidence of malignancies other than lymphoma was not increased with exposure to SIMPONI® and was similar to what would be expected in the general population. In controlled and uncontrolled portions of the Phase 2/3 studies in ulcerative colitis (UC) with a mean follow-up of approximately 1 year, there were no cases of lymphoma with SIMPONI®. Short follow-up periods, such as those of 1 year or less in the studies above, may not adequately reflect the true incidence of malignancies. Cases of acute and chronic leukemia have been reported with TNF-blocker use, including SIMPONI®. 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 UC, 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®. Periodic skin examination is recommended for all patients, particularly those with risk factors for skin cancer.

HEPATITIS B REACTIVATION

The use of TNF-blocking agents including SIMPONI® 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® for patients identified as carriers of HBV and closely monitor for active HBV infection during and following termination of therapy with SIMPONI®. Discontinue SIMPONI® in patients who develop HBV reactivation, and initiate antiviral therapy with appropriate supportive treatment. Exercise caution when considering resumption of SIMPONI®, 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®. Some cases had a fatal outcome. Exercise caution and monitor patients with heart failure. Discontinue SIMPONI® if new or worsening symptoms of heart failure appear.

DEMYELINATING DISORDERS

TNF-blocking agents, of which SIMPONI® is a member, have 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 with SIMPONI®. Exercise caution in considering the use of SIMPONI® in patients with these disorders. Consider discontinuation if these disorders develop.

AUTOIMMUNITY

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

HEMATOLOGIC CYTOPENIAS

There have been reports of pancytopenia, leukopenia, neutropenia, and thrombocytopenia in patients receiving SIMPONI® in clinical trials. Additionally, aplastic anemia has been reported in patients receiving TNF-blocking agents, of which SIMPONI® is a member. Exercise caution when using SIMPONI® in patients who have or had significant cytopenias.

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® 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® with biologics approved to treat RA, PsA, or AS is not recommended because of the possibility of an increased risk of infection.

VACCINATIONS/THERAPEUTIC INFECTIOUS AGENTS

People receiving SIMPONI® 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® in utero is not recommended for 6 months following the mother’s last SIMPONI® injection during pregnancy due to an increased risk of infection. It is recommended that therapeutic infectious agents not be given concurrently with SIMPONI® due to the possibility of clinical infections, including disseminated infections.

HYPERSENSITIVITY REACTIONS

Serious systemic hypersensitivity reactions (including anaphylactic reaction) have been reported with SIMPONI®, some occurring after the first dose. If an anaphylactic or other serious allergic reaction occurs, discontinue SIMPONI® immediately and institute appropriate therapy.

ADVERSE REACTIONS

The most serious adverse reactions were serious infections and malignancies.

Upper respiratory tract infection and nasopharyngitis were the most common adverse reactions reported in the combined Phase 3 trials through Week 16, occurring in 7% and 6% of patients treated with SIMPONI® as compared with 6% and 5% of patients in the control group, respectively. The rate of injection-site reactions was 6% with patients treated with SIMPONI® compared with 2% of patients in the control group.

In the Phase 2/3 trials in UC evaluating SIMPONI®-treated patients, no new adverse drug reactions were identified, and the frequency of adverse drug reactions was similar to the safety profile observed in patients with RA, PsA, and AS.

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

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