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ICD-10 Support

ICD-10 Support

The ICD-10 Diagnosis Codes for Providers

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. This content and the information and assistance provided by Janssen CarePath are presented for informational purposes only. They do not constitute reimbursement or legal advice. Janssen CarePath does not promise or guarantee coverage, levels of reimbursement, or payment.

Similarly, codes are supplied for informational purposes only and represent no statement, promise, or guarantee, expressed or implied, by Janssen or its third-party service providers that these codes will be appropriate or that reimbursement will be made.

Laws, regulations, and policies concerning reimbursement are complex and are updated frequently. Accordingly, the information may not be current or comprehensive. Janssen and its third-party service providers strongly recommend you consult your payer for its most current coverage, reimbursement, and coding policies. Janssen and its third-party service providers make no representations or warranties, expressed or implied, as to the accuracy of the information provided. In no event shall the third-party service providers or Janssen, or their employees or agents, be liable for any damages resulting from or relating to any information provided by, or accessed to or through, Janssen CarePath. All HCPs and other users of this information agree that they accept responsibility for the use of this program.

Click below for ICD-10 Codes.

ATRIAL FIBRILLATION

ICD-10 Indication ICD-10 Code
Paroxysmal atrial fibrillation I48.0
Persistent atrial fibrillation I48.1X
Longstanding persistent atrial fibrillation I48.11
Other persistent atrial fibrillation I48.19
Chronic atrial fibrillation I48.2X
Chronic atrial fibrillation, unspecified I48.20
Permanent atrial fibrillation I48.21
Unspecified atrial fibrillation and flutter I48.9X
Unspecified atrial fibrillation I48.91

DEEP VEIN THROMBOSIS

ICD-10 Indication ICD-10 Code
Other venous embolism and thrombosis I82*
*Code first venous embolism and thrombosis complicating:
    abortion, ectopic or molar pregnancy (O00-O007, O08.7)
    pregnancy, childbirth and the puerperium (O22.-, O87.-)
Acute embolism and thrombosis of deep veins of lower extremity I82.4XX
Acute embolism and thrombosis of unspecified deep veins of lower extremity I82.40X
Deep vein thrombosis NOS  
DVT NOS  
... unspecified deep veins of right lower extremity I82.401
... unspecified deep veins of left lower extremity I82.402
... unspecified deep veins of lower extremity, bilateral I82.403
... unspecified deep veins of unspecified lower extremity I82.409
Acute embolism and thrombosis of unspecified femoral vein I82.419
... right femoral vein I82.411
... left femoral vein I82.412
... femoral vein, bilateral I82.413
Acute embolism and thrombosis of unspecified iliac vein I82.429
... right iliac vein I82.421
... left iliac vein I82.422
... iliac vein, bilateral I82.423
Acute embolism and thrombosis of unspecified popliteal vein I82.439
... right popliteal vein I82.431
... left popliteal vein I82.432
... popliteal vein, bilateral I82.433
Acute embolism and thrombosis of unspecified tibial vein I82.449
... right tibial vein I82.441
... left tibial vein I82.442
... tibial vein, bilateral I82.443
Acute embolism and thrombosis of other specified deep vein of unspecified lower extremity I82.499
... other specified deep vein of right lower extremity I82.491
... other specified deep vein of left lower extremity I82.492
... other specified deep vein of lower extremity, bilateral I82.493
Acute embolism and thrombosis of unspecified deep veins of unspecified proximal lower extremity I82.4Y9
... unspecified deep veins of right proximal lower extremity I82.4Y1
... unspecified deep veins of left proximal lower extremity I82.4Y2
... unspecified deep veins of proximal lower extremity, bilateral I82.4Y3
Acute embolism and thrombosis of unspecified deep veins of unspecified distal lower extremity I82.4Z9
... unspecified deep veins of right distal lower extremity I82.4Z1
... unspecified deep veins of left distal lower extremity I82.4Z2
... unspecified deep veins of distal lower extremity, bilateral I82.4Z3
Chronic embolism and thrombosis of deep veins of lower extremity I82.5XX*
*Use additional code, if applicable, for associated long-term (current) use of anticoagulants (Z79.01)
... unspecified deep veins of right lower extremity I82.501
... unspecified deep veins of left lower extremity I82.502
... unspecified deep veins of lower extremity, bilateral I82.503
... unspecified deep veins of unspecified lower extremity I82.509
Chronic embolism and thrombosis of femoral vein I82.51X
... right femoral vein I82.511
... left femoral vein I82.512
... femoral vein, bilateral I82.513
... unspecified femoral vein I82.519
Chronic embolism and thrombosis of iliac vein I82.52X
... right iliac vein I82.521
... left iliac vein I82.522
... iliac vein, bilateral I82.523
... unspecified iliac vein I82.529
Chronic embolism and thrombosis of popliteal vein I82.53X
... right popliteal vein I82.531
... left popliteal vein I82.532
... popliteal vein, bilateral I82.533
... unspecified popliteal vein I82.539
Chronic embolism and thrombosis of tibial vein I82.54X
... right tibial vein I82.541
... left tibial vein I82.542
... tibial vein, bilateral I82.543
... unspecified tibial vein I82.549
Chronic embolism and thrombosis of peroneal vein I82.55X
... right peroneal vein I82.551
... left peroneal vein I82.552
... peroneal vein, bilateral I82.553
... unspecified peroneal vein I82.559
Chronic embolism and thrombosis of calf muscular vein I82.56X
... right calf muscular vein I82.561
... left calf muscular vein I82.562
... calf muscular vein, bilateral I82.563
... unspecified calf muscular vein I82.569
Chronic embolism and thrombosis of other specified deep vein of lower extremity I82.59X
... other specified deep vein of right lower extremity I82.591
... other specified deep vein of left lower extremity I82.592
... other specified deep vein of lower extremity, bilateral I82.593
... other specified deep vein of unspecified lower extremity I82.599
Chronic embolism and thrombosis of unspecified deep veins of proximal lower extremity I82.5YX
... unspecified deep veins of right proximal lower extremity I82.5Y1
... unspecified deep veins of left proximal lower extremity I82.5Y2
... unspecified deep veins of proximal lower extremity, bilateral I82.5Y3
... unspecified deep veins of unspecified proximal lower extremity I82.5Y9
Chronic embolism and thrombosis of unspecified deep veins of distal lower extremity I82.5ZX
... unspecified deep veins of right distal lower extremity I82.5Z1
... unspecified deep veins of left distal lower extremity I82.5Z2
... unspecified deep veins of distal lower extremity, bilateral I82.5Z3
... unspecified deep veins of unspecified distal lower extremity I82.5Z9
Acute embolism and thrombosis of deep veins of upper extremity I82.62X
... Brachial vein  
... Radial vein  
... Ulnar vein  
... deep veins of right upper extremity I82.621
... deep veins of left upper extremity I82.622
... deep veins of upper extremity, bilateral I82.623
... unspecified upper extremity I82.629
Chronic embolism and thrombosis of deep veins of upper extremity I82.72X*
... Brachial vein  
... Radial vein  
... Ulnar vein  
*Use additional code, if applicable, for associated long-term (current) use of anticoagulants (Z79.01)
... deep veins of right upper extremity I82.721
... deep veins of left upper extremity I82.722
... deep veins of upper extremity, bilateral I82.723
... unspecified upper extremity I82.729

JOINT REPLACEMENT

ICD-10 Indication ICD-10 Code
Presence of unspecified artificial hip joint Z96.649
... right artificial hip joint Z96.641
... left artificial hip joint Z96.642
... artificial hip joint, bilateral Z96.643
Presence of unspecified artificial knee joint Z96.659
... right artificial knee joint Z96.651
... left artificial knee joint Z96.652
... artificial knee joint, bilateral Z96.653

PULMONARY EMBOLISM

ICD-10 Indication ICD-10 Code
Septic pulmonary embolism with acute cor pulmonale I26.01*
*Code first underlying infection
Saddle embolus of pulmonary artery with acute cor pulmonale I26.02
Other pulmonary embolism with acute cor pulmonale I26.09
Septic pulmonary embolism without acute cor pulmonale I26.90*
*Code first underlying infection
Saddle embolus of pulmonary artery without acute cor pulmonale I26.92
Single subsegmental pulmonary embolism without acute cor pulmonale I26.93
Multiple subsegmental pulmonary emboli without acute cor pulmonale I26.94
Other pulmonary embolism without acute cor pulmonale I26.99

CORONARY ARTERY DISEASE (CAD)

ICD-10 Indication ICD-10 Code
Ischemic heart disease I20-I25*
*Use additional code to identify presence of hypertension (I10-I16)
Angina pectoris I20.X*
*Use additional code to identify:
    exposure to environmental tobacco smoke (Z77.22)
    history of tobacco dependence (Z87.891)
    occupational exposure to environmental tobacco smoke (Z57.31)
    tobacco dependence (F17.-)
    tobacco use (Z72.0)
Other forms of angina pectoris I20.8
Angina pectoris, unspecified I20.9
Chronic ischemic heart disease I25.XXX*
*Use additional code to identify:
    chronic total occlusion of coronary artery (I25.82)
    exposure to environmental tobacco smoke (Z77.22)
    history of tobacco dependence (Z87.891)
    occupational exposure to environmental tobacco smoke (Z57.31)
    tobacco dependence (F17.-)
    tobacco use (Z72.0)
Atherosclerotic heart disease of native coronary artery I25.1X*
*Use additional code, if applicable, to identify:
    coronary atherosclerosis due to calcified coronary lesion (I25.84)
    coronary atherosclerosis due to lipid rich plaque (I25.83)
Atherosclerotic heart disease of native coronary artery without angina pectoris I25.10
Atherosclerotic heart disease of native coronary artery with angina pectoris I25.11X
Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris I25.118
Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris I25.119
Ischemic cardiomyopathy I25.5
Silent myocardial ischemia I25.6
Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris I25.70X
Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris I25.700
Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris I25.708
Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectoris I25.709
Chronic total occlusion of coronary artery I25.82*
*Code first coronary atherosclerosis (I25.1-, I25.7-, I25.81-)
Presence of aortocoronary bypass graft Z95.1

DIABETES MELLITUS WITH PERIPHERAL ARTERY DISEASE (PAD)

ICD-10 Indication ICD-10 Code
Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy without gangrene E09.51
Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene E09.52
Type 1 diabetes mellitus with circulatory complications E10.5X
Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene E10.51
Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene E10.52
Type 2 diabetes mellitus with circulatory complications E11.5X*
*Use additional code to identify control using:
    insulin (Z79.4)
    oral antidiabetic drugs (Z79.84)
    oral hypoglycemic drugs (Z79.84)
Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene E11.51
Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene E11.52
Other specified diabetes mellitus with circulatory complications E13.5X*
*Use additional code to identify control using:
    insulin (Z79.4)
    oral antidiabetic drugs (Z79.84)
    oral hypoglycemic drugs (Z79.84)
Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene E13.51
Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene E13.52

PERIPHERAL ARTERY DISEASE (PAD) - Part 1

ICD-10 Indication ICD-10 Code
Atherosclerosis I70*
*Use additional code to identify:
    exposure to environmental tobacco smoke (Z77.22)
    history of tobacco dependence (Z87.891)
    occupational exposure to environmental tobacco smoke (Z57.31)
    tobacco dependence (F17.-)
    tobacco use (Z72.0)
Atherosclerosis of renal artery I70.1
Atherosclerosis of native arteries of the extremities I70.2*
*Use additional code, if applicable, to identify chronic total occlusion of artery of extremity (I70.92)
Unspecified atherosclerosis of native arteries of extremities I70.20
... right leg I70.201
... left leg I70.202
... bilateral legs I70.203
... other extremity I70.208
... unspecified extremity I70.209
Atherosclerosis of native arteries of extremities with intermittent claudication I70.21
... right leg I70.211
... left leg I70.212
... bilateral legs I70.213
... other extremity I70.218
... unspecified extremity I70.219
Atherosclerosis of native arteries of extremities with rest pain I70.22
... right leg I70.221
... left leg I70.222
... bilateral legs I70.223
... other extremity I70.228
... unspecified extremity I70.229
Atherosclerosis of native arteries of right leg with ulceration I70.23*
*Use additional code to identify severity of ulcer (L97.-)
... of thigh I70.231
... of calf I70.232
... of ankle I70.233
... of heel and midfoot I70.234
... of other part of foot I70.235
... of other part of lower right leg I70.238
... of unspecified site I70.239
Atherosclerosis of native arteries of left leg with ulceration I70.24
Use additional code to identify severity of ulcer (L97.-)
... of thigh I70.241
... of calf I70.242
... of ankle I70.243
... of heel and midfoot I70.244
... of other part of foot I70.245
... of other part of lower left leg I70.248
... of unspecified site I70.249
Atherosclerosis of native arteries of other extremities with ulceration I70.25*
*Use additional code to identify the severity of the ulcer (L98.49-)
Atherosclerosis of native arteries of extremities with gangrene I70.26*
*Use additional code to identify the severity of any ulcer (L97.-, L98.49-), if applicable
... right leg I70.261
... left leg I70.262
... bilateral legs I70.263
... other extremity I70.268
... unspecified extremity I70.269
Other atherosclerosis of native arteries of extremities I70.29
... right leg I70.291
... left leg I70.292
... bilateral legs I70.293
... other extremity I70.298
... unspecified extremity I70.299
Atherosclerosis of unspecified type of bypass graft(s) of the extremities I70.3*
*Use additional code, if applicable, to identify chronic total occlusion of artery of extremity (I70.92)
Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities I70.30
... right leg I70.301
... left leg I70.302
... bilateral legs I70.303
... other extremity I70.308
... unspecified extremity I70.309
Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication I70.31
... right leg I70.311
... left leg I70.312
... bilateral legs I70.313
... other extremity I70.318
... unspecified extremity I70.319
Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain I70.32
... right leg I70.321
... left leg I70.322
... bilateral legs I70.323
... other extremity I70.328
... unspecified extremity I70.329
Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration I70.33*
*Use additional code to identify severity of ulcer (L97.-)
... of thigh I70.331
... of calf I70.332
... of ankle I70.333
... of heel and midfoot I70.334
... of other part of foot I70.335
... of other part of lower leg I70.338
... of unspecified site I70.339
Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration I70.34*
*Use additional code to identify severity of ulcer (L97.-)
... of thigh I70.341
... of calf I70.342
... of ankle I70.343
... of heel and midfoot I70.344
... of other part of foot I70.345
... of other part of lower leg I70.348
... of unspecified site I70.349
Atherosclerosis of unspecified type of bypass graft(s) of other extremity with ulceration I70.35*
*Use additional code to identify severity of ulcer (L98.49-)
Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene I70.36*
*Use additional code to identify the severity of any ulcer (L97.-, L98.49-), if applicable
... right leg I70.361
... left leg I70.362
... bilateral legs I70.363
... other extremity I70.368
... unspecified extremity I70.369
Other atherosclerosis of unspecified type of bypass graft(s) of the extremities I70.39
... right leg I70.391
... left leg I70.392
... bilateral legs I70.393
... other extremity I70.398
... unspecified extremity I70.399
Atherosclerosis of autologous vein bypass graft(s) of the extremities I70.4*
*Use additional code, if applicable, to identify chronic total occlusion of artery of extremity (I70.92)
Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities I70.40
... right leg I70.401
... left leg I70.402
... bilateral legs I70.403
... other extremity I70.408
... unspecified extremity I70.409
Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication I70.41
... right leg I70.411
... left leg I70.412
... bilateral legs I70.413
... other extremity I70.418
... unspecified extremity I70.419
Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain I70.42
... right leg I70.421
... left leg I70.422
... bilateral legs I70.423
... other extremity I70.428
... unspecified extremity I70.429
Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration I70.43*
*Use additional code to identify severity of ulcer (L97.-)
... of thigh I70.431
... of calf I70.432
... of ankle I70.433
... of heel and midfoot I70.434
... of other part of foot I70.435
... of other part of lower leg I70.438
... of unspecified site I70.439
Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration I70.44*
*Use additional code to identify severity of ulcer (L97.-)
... of thigh I70.441
... of calf I70.442
... of ankle I70.443
... of heel and midfoot I70.444
... of other part of foot I70.445
... of other part of lower leg I70.448
... of unspecified site I70.449
Atherosclerosis of autologous vein bypass graft(s) of other extremity with ulceration I70.45*
*Use additional code to identify severity of ulcer (L98.49-)
Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene I70.46*
*Use additional code to identify the severity of any ulcer (L97.-, L98.49-), if applicable
... right leg I70.461
... left leg I70.462
... bilateral legs I70.463
... other extremity I70.468
... unspecified extremity I70.469
Other atherosclerosis of autologous vein bypass graft(s) of the extremities I70.49
... right leg I70.491
... left leg I70.492
... bilateral legs I70.493
... other extremity I70.498
... unspecified extremity I70.499
Atherosclerosis of nonautologous biological bypass graft(s) of the extremities I70.5*
*Use additional code, if applicable, to identify chronic total occlusion of artery of extremity (I70.92)
Unspecified atherosclerosis of nonautologous biological bypass graft(s) of the extremities I70.50
... right leg I70.501
... left leg I70.502
... bilateral legs I70.503
... other extremity I70.508
... unspecified extremity I70.509
Atherosclerosis of nonautologous biological bypass graft(s) of the extremities intermittent claudication I70.51
... right leg I70.511
... left leg I70.512
... bilateral legs I70.513
... other extremity I70.518
... unspecified extremity I70.519
Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain I70.52
... right leg I70.521
... left leg I70.522
... bilateral legs I70.523
... other extremity I70.528
... unspecified extremity I70.529
Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration I70.53*
*Use additional code to identify severity of ulcer (L97.-)
... of thigh I70.531
... of calf I70.532
... of ankle I70.533
... of heel and midfoot I70.534
... of other part of foot I70.535
... of other part of lower leg I70.538
... of unspecified site I70.539
Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration I70.54*
*Use additional code to identify severity of ulcer (L97.-)
... of thigh I70.541
... of calf I70.542
... of ankle I70.543
... of heel and midfoot I70.544
... of other part of foot I70.545
... of other part of lower leg I70.548
... of unspecified site I70.549
Atherosclerosis of nonautologous biological bypass graft(s) of other extremity with ulceration I70.55*
*Use additional code to identify severity of ulcer (L98.49-)
Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene I70.56*
*Use additional code to identify the severity of any ulcer (L97.-, L98.49-), if applicable
... right leg I70.561
... left leg I70.562
... bilateral legs I70.563
... other extremity I70.568
... unspecified extremity I70.569
Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities I70.59
... right leg I70.591
... left leg I70.592
... bilateral legs I70.593
... other extremity I70.598
... unspecified extremity I70.599

PERIPHERAL ARTERY DISEASE (PAD) - Part 2

ICD-10 Indication ICD-10 Code
Atherosclerosis I70*
*Use additional code to identify:
    exposure to environmental tobacco smoke (Z77.22)
    history of tobacco dependence (Z87.891)
    occupational exposure to environmental tobacco smoke (Z57.31)
    tobacco dependence (F17.-)
    tobacco use (Z72.0)
Atherosclerosis of nonbiological bypass graft(s) of the extremities I70.6*
*Use additional code, if applicable, to identify chronic total occlusion of artery of extremity (I70.92)
Unspecified atherosclerosis of nonbiological bypass graft(s) of the extremities I70.60
... right leg I70.601
... left leg I70.602
... bilateral legs I70.603
... other extremity I70.608
... unspecified extremity I70.609
Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication I70.61
... right leg I70.611
... left leg I70.612
... bilateral legs I70.613
... other extremity I70.618
... unspecified extremity I70.619
Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain I70.62
... right leg I70.621
... left leg I70.622
... bilateral legs I70.623
... other extremity I70.628
... unspecified extremity I70.629
Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration I70.63*
*Use additional code to identify severity of ulcer (L97.-)
... of thigh I70.631
... of calf I70.632
... of ankle I70.633
... of heel and midfoot I70.634
... of other part of foot I70.635
... of other part of lower leg I70.638
... of unspecified site I70.639
Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration I70.64*
*Use additional code to identify severity of ulcer (L97.-)
... of thigh I70.641
... of calf I70.642
... of ankle I70.643
... of heel and midfoot I70.644
... of other part of foot I70.645
... of other part of lower leg I70.648
... of unspecified site I70.649
Atherosclerosis of nonbiological bypass graft(s) of other extremity with ulceration I70.65*
*Use additional code to identify severity of ulcer (L98.49-)
Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene I70.66*
*Use additional code to identify the severity of any ulcer (L97.-, L98.49-), if applicable
... right leg I70.661
... left leg I70.662
... bilateral legs I70.663
... other extremity I70.668
... unspecified extremity I70.669
Other atherosclerosis of nonbiological bypass graft(s) of the extremities I70.69
... right leg I70.691
... left leg I70.692
... bilateral legs I70.693
... other extremity I70.698
... unspecified extremity I70.699
Atherosclerosis of other type of bypass graft(s) of the extremities I70.7*
*Use additional code, if applicable, to identify chronic total occlusion of artery of extremity (I70.92)
Unspecified atherosclerosis of other type of bypass graft(s) of the extremities I70.70
... right leg I70.701
... left leg I70.702
... bilateral legs I70.703
... other extremity I70.708
... unspecified extremity I70.709
Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication I70.71
... right leg I70.711
... left leg I70.712
... bilateral legs I70.713
... other extremity I70.718
... unspecified extremity I70.719
Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain I70.72
... right leg I70.721
... left leg I70.722
... bilateral legs I70.723
... other extremity I70.728
... unspecified extremity I70.729
Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration I70.73*
*Use additional code to identify severity of ulcer (L97.-)
... of thigh I70.731
... of calf I70.732
... of ankle I70.733
... of heel and midfoot I70.734
... of other part of foot I70.735
... of other part of lower leg I70.738
... of unspecified site I70.739
Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration I70.74*
*Use additional code to identify severity of ulcer (L97.-)
... of thigh I70.741
... of calf I70.742
... of ankle I70.743
... of heel and midfoot I70.744
... of other part of foot I70.745
... of other part of lower leg I70.748
... of unspecified site I70.749
Atherosclerosis of other type of bypass graft(s) of other extremity with ulceration I70.75*
*Use additional code to identify severity of ulcer (L98.49-)
Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene I70.76*
*Use additional code to identify the severity of any ulcer (L97.-, L98.49-), if applicable
... right leg I70.761
... left leg I70.762
... bilateral legs I70.763
... other extremity I70.768
... unspecified extremity I70.769
Other atherosclerosis of other type of bypass graft(s) of the extremities I70.79
... right leg I70.791
... left leg I70.792
... bilateral legs I70.793
... other extremity I70.798
... unspecified extremity I70.799
Other and unspecified atherosclerosis I70.9
Unspecified atherosclerosis I70.90
Generalized atherosclerosis I70.91
Chronic total occlusion of artery of the extremities I70.92*
*Code first atherosclerosis of arteries of the extremities (I70.2-, I70.3-, I70.4-, I70.5-, I70.6-, I70.7-)
Other specified peripheral vascular diseases I73.89

For more information on the transition to ICD-10, visit the CMS website.

SOURCE
ICD-10-CM 2020: The Official Codebook. American Medical Association, 2019.

INDICATIONS

XARELTO® (rivaroxaban) is indicated to reduce the risk of stroke and systemic embolism in adult patients with nonvalvular atrial fibrillation (AF).

There are limited data on the relative effectiveness of XARELTO® and warfarin in reducing the risk of stroke and systemic embolism when warfarin therapy is well controlled.

XARELTO® is indicated for the treatment of deep vein thrombosis (DVT). XARELTO® is indicated for the treatment of pulmonary embolism (PE). XARELTO® is indicated for the reduction in the risk of recurrence of DVT and/or PE in adult patients at continued risk for recurrent DVT and/or PE after completion of initial treatment lasting at least 6 months.

XARELTO® is indicated for the prophylaxis of DVT, which may lead to PE in adult patients undergoing knee or hip replacement surgery.

XARELTO® is indicated for the prophylaxis of venous thromboembolism (VTE) and VTE-related death during hospitalization and post hospital discharge in adult patients admitted for an acute medical illness who are at risk for thromboembolic complications due to moderate or severe restricted mobility and other risk factors for VTE, and not at high risk of bleeding.

XARELTO®, in combination with aspirin, is indicated to reduce the risk of major cardiovascular events (cardiovascular death, myocardial infarction, and stroke) in adult patients with  coronary artery disease (CAD).

XARELTO®, in combination with aspirin, is indicated to reduce the risk of major thrombotic vascular events (myocardial infarction, ischemic stroke, acute limb ischemia, and major amputation of a vascular etiology) in adult patients with peripheral artery disease (PAD), including patients who have recently undergone a lower extremity revascularization procedure due to symptomatic PAD.

XARELTO® is indicated for the treatment of venous thromboembolism (VTE) and reduction in the risk of recurrent VTE in pediatric patients from birth to less than 18 years after at least 5 days of initial parenteral anticoagulant treatment.

XARELTO® is indicated for thromboprophylaxis in pediatric patients aged 2 years and older with congenital heart disease who have undergone the Fontan procedure.

IMPORTANT SAFETY INFORMATION

WARNING: (A) PREMATURE DISCONTINUATION OF XARELTO® INCREASES THE RISK OF THROMBOTIC EVENTS,
(B) SPINAL/EPIDURAL HEMATOMA

A. Premature discontinuation of XARELTO® increases the risk of thrombotic events

Premature discontinuation of any oral anticoagulant, including XARELTO®, increases the risk of thrombotic events. If anticoagulation with XARELTO® is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant.

B. Spinal/epidural hematoma

Epidural or spinal hematomas have occurred in patients treated with XARELTO® who are receiving neuraxial anesthesia or undergoing spinal puncture. These hematomas may result in long-term or permanent paralysis. Consider these risks when scheduling patients for spinal procedures. Factors that can increase the risk of developing epidural or spinal hematomas in these patients include:

  • Use of indwelling epidural catheters
  • Concomitant use of other drugs that affect hemostasis, such as non-steroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, other anticoagulants, see Drug Interactions
  • A history of traumatic or repeated epidural or spinal punctures
  • A history of spinal deformity or spinal surgery
  • Optimal timing between the administration of XARELTO® and neuraxial procedures is not known

Monitor patients frequently for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent treatment is necessary.

Consider the benefits and risks before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis.

CONTRAINDICATIONS

  • Active pathological bleeding
  • Severe hypersensitivity reaction to XARELTO® (eg, anaphylactic reactions)

WARNINGS AND PRECAUTIONS

  • Increased Risk of Thrombotic Events after Premature Discontinuation: Premature discontinuation of any oral anticoagulant, including XARELTO®, in the absence of adequate alternative anticoagulation increases the risk of thrombotic events. An increased rate of stroke was observed during the transition from XARELTO® to warfarin in clinical trials in atrial fibrillation patients. If XARELTO® is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant.
  • Risk of Bleeding: XARELTO® increases the risk of bleeding and can cause serious or fatal bleeding. Promptly evaluate any signs or symptoms of blood loss and consider the need for blood replacement. Discontinue in patients with active pathological hemorrhage.
    • An agent to reverse the anti-factor Xa activity of rivaroxaban is available. Because of high plasma protein binding, rivaroxaban is not dialyzable.
    • Concomitant use of other drugs that impair hemostasis increases risk of bleeding. These include aspirin, P2Y12 platelet inhibitors, dual antiplatelet therapy, other antithrombotic agents, fibrinolytic therapy, NSAIDs, selective serotonin reuptake inhibitors (SSRIs), and serotonin norepinephrine reuptake inhibitors (SNRIs).
    • Risk of Hemorrhage in Acutely Ill Medical Patients at High Risk of Bleeding: Acutely ill medical patients with the following conditions are at increased risk of bleeding with the use of XARELTO® for primary VTE prophylaxis: history of bronchiectasis, pulmonary cavitation, or pulmonary hemorrhage; active cancer (ie, undergoing acute, in-hospital cancer treatment); active gastroduodenal ulcer or history of bleeding in the three months prior to treatment; or dual antiplatelet therapy. XARELTO® is not for use for primary VTE prophylaxis in these hospitalized, acutely ill medical patients at high risk of bleeding. 
  • Spinal/Epidural Anesthesia or Puncture: When neuraxial anesthesia (spinal/epidural anesthesia) or spinal puncture is employed, patients treated with anticoagulant agents for prevention of thromboembolic complications are at risk of developing an epidural or spinal hematoma, which can result in long-term or permanent paralysis. To reduce the potential risk of bleeding associated with concurrent use of XARELTO® and epidural or spinal anesthesia/analgesia or spinal puncture, consider the pharmacokinetic profile of XARELTO®. Placement or removal of an epidural catheter or lumbar puncture is best performed when the anticoagulant effect of XARELTO® is low; however, the exact timing to reach a sufficiently low anticoagulant effect in each patient is not known. An indwelling epidural or intrathecal catheter should not be removed before at least 2 half-lives have elapsed (ie, 18 hours in young patients aged 20 to 45 years and 26 hours in elderly patients aged 60 to 76 years), after the last administration of XARELTO®. The next dose should not be administered earlier than 6 hours after the removal of the catheter. If traumatic puncture occurs, delay the administration of XARELTO® for 24 hours. Monitor frequently to detect signs or symptoms of neurological impairment, such as midline back pain, sensory and motor deficits (numbness, tingling, or weakness in lower limbs), or bowel and/or bladder dysfunction. Instruct patients to immediately report any of the above signs or symptoms. If signs or symptoms of spinal hematoma are suspected, initiate urgent diagnosis and treatment including consideration for spinal cord decompression even though such treatment may not prevent or reverse neurological sequelae.
  • Use in Patients with Renal Impairment:
    • Nonvalvular Atrial Fibrillation: Periodically assess renal function as clinically indicated (ie, more frequently in situations in which renal function may decline) and adjust therapy accordingly. Consider dose adjustment or discontinuation in patients who develop acute renal failure while on XARELTO®. Clinical efficacy and safety studies with XARELTO® did not enroll patients with CrCl <30 mL/min or end-stage renal disease (ESRD) on dialysis.
    • Treatment of Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), and Reduction in the Risk of Recurrence of DVT and of PE: In patients with CrCl <30 mL/min, rivaroxaban exposure and pharmacodynamic effects are increased compared to patients with normal renal function. There are limited clinical data in patients with CrCl 15 to <30 mL/min; therefore, observe closely and promptly evaluate any signs or symptoms of blood loss in these patients. There are no clinical data in patients with CrCl <15 mL/min (including patients on dialysis); therefore, avoid the use of XARELTO® in these patients. Discontinue XARELTO® in patients who develop acute renal failure while on treatment.
    • Prophylaxis of Deep Vein Thrombosis Following Hip or Knee Replacement Surgery: In patients with CrCl <30 mL/min, rivaroxaban exposure and pharmacodynamic effects are increased compared to patients with normal renal function. There are limited clinical data in patients with CrCl 15 to <30 mL/min; therefore, observe closely and promptly evaluate signs or symptoms of blood loss in these patients. There are no clinical data in patients with CrCl <15 mL/min (including patients on dialysis); therefore, avoid the use of XARELTO® in these patients. Discontinue XARELTO® in patients who develop acute renal failure while on treatment.
    • Prophylaxis of Venous Thromboembolism in Acutely Ill Medical Patients at Risk for Thromboembolic Complications Not at High Risk of Bleeding: In patients with CrCl <30 mL/min, rivaroxaban exposure and pharmacodynamic effects are increased compared to patients with normal renal function. There are limited clinical data in patients with CrCl 15 to <30 mL/min; therefore, observe closely and promptly evaluate any signs or symptoms of blood loss in these patients. There are no clinical data in patients with CrCl <15 mL/min (including patients on dialysis); therefore, avoid the use of XARELTO® in these patients. Discontinue XARELTO® in patients who develop acute renal failure while on treatment.
    • Reduction of Risk of Major Cardiovascular Events in Patients with CAD  and Reduction of Risk of Major Thrombotic Vascular Events in Patients with PAD, Including Patients after Recent Lower Extremity Revascularization Due to Symptomatic PAD: For patients with CrCl <15 mL/min, no data are available, and limited data are available for patients with a CrCl of 15 to 30 mL/min.  In patients with CrCl <30 mL/min, a dose of 2.5 mg XARELTO® twice daily is expected to give an exposure similar to that in patients with moderate renal impairment (CrCl 30 to <50 mL/min), whose efficacy and safety outcomes were similar to those with preserved renal function. Clinical efficacy and safety studies with XARELTO® did not enroll patients with end-stage renal disease (ESRD) on dialysis.
    • Pediatric Patients: There are limited clinical data in pediatric patients 1 year or older with moderate or severe renal impairment (eGFR <50 mL/min/1.73 m2); therefore, avoid use of XARELTO® in these patients.

      There are no clinical data in pediatric patients younger than 1 year with serum creatinine results above 97.5th percentile; therefore, avoid the use of XARELTO® in these patients.

  • Use in Patients with Hepatic Impairment: No clinical data are available for adult patients with severe hepatic impairment. Avoid use in patients with moderate (Child-Pugh B) and severe (Child-Pugh C) hepatic impairment or with any hepatic disease associated with coagulopathy, since drug exposure and bleeding risk may be increased. No clinical data are available in pediatric patients with hepatic impairment.
  • Use with P-gp and Strong CYP3A Inhibitors or Inducers: Avoid concomitant use of XARELTO® with known combined P-gp and strong CYP3A inhibitors or inducers.
  • Risk of Pregnancy-Related Hemorrhage: In pregnant women, XARELTO® should be used only if the potential benefit justifies the potential risk to the mother and fetus. XARELTO® dosing in pregnancy has not been studied. The anticoagulant effect of XARELTO® cannot be monitored with standard laboratory testing. Promptly evaluate signs or symptoms suggesting blood loss (eg, a drop in hemoglobin and/or hematocrit, hypotension, or fetal distress).
  • Patients with Prosthetic Heart Valves: Use of XARELTO® is not recommended in patients who have had transcatheter aortic valve replacement (TAVR), based on the results of the GALILEO study, which reported higher rates of death and bleeding in patients randomized to XARELTO® compared to those randomized to an antiplatelet regimen. Safety and efficacy of XARELTO® have not been studied in patients with other prosthetic heart valves or other valve procedures. Use of XARELTO® is not recommended in patients with prosthetic heart valves.
  • Acute PE in Hemodynamically Unstable Patients/Patients Who Require Thrombolysis or Pulmonary Embolectomy: Initiation of XARELTO® is not recommended acutely as an alternative to unfractionated heparin in patients with pulmonary embolism who present with hemodynamic instability or who may receive thrombolysis or pulmonary embolectomy.
  • Increased Risk of Thrombosis in Patients with Antiphospholipid Syndrome: Direct-acting oral anticoagulants (DOACs), including XARELTO®, are not recommended for use in patients with triple-positive antiphospholipid syndrome (APS).  For patients with APS (especially those who are triple positive [positive for lupus anticoagulant, anticardiolipin, and anti-beta 2-glycoprotein I antibodies]), treatment with DOACs has been associated with increased rates of recurrent thrombotic events compared with vitamin K antagonist therapy. 

DRUG INTERACTIONS

  • Combined P-gp and strong CYP3A inhibitors increase exposure to rivaroxaban and may increase risk of bleeding.
  • Combined P-gp and strong CYP3A inducers decrease exposure to rivaroxaban and may increase risk of thromboembolic events.
  • XARELTO® should not be used in patients with CrCl 15 to <80 mL/min who are receiving concomitant combined P-gp and moderate CYP3A inhibitors (eg, erythromycin) unless the potential benefit justifies the potential risk.
  • Coadministration of enoxaparin, warfarin, aspirin, clopidogrel, and chronic NSAID use may increase risk of bleeding.
  • Avoid concurrent use of XARELTO® with other anticoagulants due to increased bleeding risk, unless benefit outweighs risk. Promptly evaluate signs or symptoms of blood loss if patients are treated concomitantly with aspirin, other platelet aggregation inhibitors, or NSAIDs.

USE IN SPECIFIC POPULATIONS

  • Pregnancy: The limited available data on XARELTO® in pregnant women are insufficient to inform a drug-associated risk of adverse developmental outcomes. Use XARELTO® with caution in pregnant patients because of the potential for pregnancy-related hemorrhage and/or emergent delivery. The anticoagulant effect of XARELTO® cannot be reliably monitored with standard laboratory testing. Consider the benefits and risks of XARELTO® for the mother and possible risks to the fetus when prescribing to a pregnant woman.
    • Fetal/Neonatal adverse reactions: Based on the pharmacologic activity of Factor Xa inhibitors and the potential to cross the placenta, bleeding may occur at any site in the fetus and/or neonate.
    • Labor or delivery: The risk of bleeding should be balanced with the risk of thrombotic events when considering use in this setting.
    • There are no adequate or well-controlled studies of XARELTO® in pregnant women, and dosing for pregnant women has not been established. Post-marketing experience is currently insufficient to determine a rivaroxaban-associated risk for major birth defects or miscarriage.
  • Lactation: Rivaroxaban has been detected in human milk. There are insufficient data to determine the effects of rivaroxaban on the breastfed child or on milk production. Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for XARELTO® and any potential adverse effects on the breastfed infant from XARELTO® or from the underlying maternal condition.
  • Females and Males of Reproductive Potential: Females of reproductive potential requiring anticoagulation should discuss pregnancy planning with their physician. The risk of clinically significant uterine bleeding, potentially requiring gynecological surgical interventions, identified with oral anticoagulants, including XARELTO®, should be assessed in females of reproductive potential and those with abnormal uterine bleeding.
  • Pediatric Use: XARELTO® was not studied and therefore dosing cannot be reliably determined or recommended in children less than 6 months who were less than 37 weeks of gestation at birth, had less than 10 days of oral feeding, or had a body weight of less than 2.6 kg.

    Clinical studies that evaluated safety, efficacy, and pharmacokinetic/pharmacodynamic data support the use of XARELTO® 10-mg, 15-mg, and 20-mg tablets in pediatric patients. For the XARELTO® 2.5-mg tablets, there are no safety, efficacy, and pharmacokinetic/pharmacodynamic data to support the use in pediatric patients. Therefore, XARELTO® 2.5-mg tablets are not recommended for use in pediatric patients.

    Although not all adverse reactions identified in the adult population have been observed in clinical trials of children and adolescent patients, the same warnings and precautions for adults should be considered for children and adolescents.

  • Geriatric Use: In clinical trials the efficacy of XARELTO® in the elderly (65 years or older) was similar to that seen in patients younger than 65 years. Both thrombotic and bleeding event rates were higher in these older patients.

OVERDOSAGE

  • Overdose of XARELTO® may lead to hemorrhage. Discontinue XARELTO® and initiate appropriate therapy if bleeding complications associated with overdosage occur.  An agent to reverse the anti-factor Xa activity of rivaroxaban is available.

ADVERSE REACTIONS

  • Most common adverse reactions in adult patients with XARELTO® were bleeding complications.
  • Most common adverse reactions in pediatric patients were bleeding, cough, vomiting, and gastroenteritis.

Please read full Prescribing Information, including Boxed WARNINGS for XARELTO®.

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