ND Committee Review
Internal Medical Policy Committee 9-21-20 Revised policy
Internal Medical Policy Committee 1-19-2021 Coding update:
- Removed
Procedure codes 92585; and 92586;
and
- Added
Procedure codes 92650; 92651; 92652; and 92653.
Internal Medical Policy Committee 9-21-2021 Coding update.
- Added
Diagnosis codes H81.41; H81.42; H81.43; H81.49; and H83.19
Internal Medical Policy Committee 9-28-2022 Revision of Policy
- Removed
Procedure code 95941 and 95942.
- Updated
language throughout policy
Internal Medical Policy Committee 5-23-2023 -
Effective July 03, 2023
o
Added
criteria.
o
Added
procedure code 95941.
Internal Medical Policy Committee 11-15-2023 -
Effective October 01, 2023
- Added
Diagnosis codes G93.42, G93.43 and G93.44
- Removed
Diagnosis codes G20.
- AddedDiagnosis codes C75.0, D345, D35.1, D44.0, D44.2, E04.0, E04.1, E04.2, E04.8, E04.9, E21.0, E21.1, E21.2, E21.3, E21.4, E21.5, and H81.4
- Removed
Diagnosis codes H81.41, H81.42, H81.43, H81.49, H83.19, I63.8, S06.2X7D and S06.2X7S
Internal Medical Policy Committee 3-19-2024 Revision -
Effective May 06, 2024
- Removed
Diagnosis codes: C72.20; C72.30; C72.40; D33.9; D42.9; D49.6; G52.9; G95.20; G95.9; H71.00; H71.10; H71.20; H71.30; H71.90; H74.40; H81.09; I63.00; I63.019; I63.039; I63.10; I63.119; I63.139; I63.20; I63.219; I63.319; I63.329; I63.339; I63.349; I63.40; I63.419; I63.429; I63.439; I63.449; I63.50; I63.519; I63.529; I63.539; I63.549; I65.09; I66.09; I66.19; I66.29; I66.9; I71.00; M21.759; M21.769; M40.00; M40.10; M40.209; M40.299; M40.30; M40.40; M40.50; M41.00; M41.119; M41.129; M41.20; M41.30; M41.40; M41.50; M41.80; M41.9; M43.8X9; M47.019; M47.029; M47.10; M48.00; M50.00; M50.10; M50.120; M50.20; M50.220; M50.30; M50.91; M50.920; M50.93; M54.30; P11.2; P11.9; P14.9; Q05.4; Q05.9; Q77.9; Q85.00; S06.9X0A; S06.9X0D; S06.9X0S; S06.9X1A; S06.9X1D; ; S06.9X1S; ; S06.9X2A; S06.9X2D; S06.9X2S; S06.9X3A; S06.9X3D; S06.9X3S; S06.9X4A; S06.9X4D; S06.9X4S; S06.9X5A; S06.9X5D; S06.9X5S; S06.9X6A; S06.9X6D; S06.9X6S; S06.9X7A; S06.9X8A; S06.9X9A; S06.9X9D; S06.9X9S; S12.000A; S12.000B; S12.000S; S12.001A; S12.001B; S12.001S; S12.100A; S12.100B; S12.100S; S12.101A; S12.101B; S12.101S; S12.130A; S12.130B; S12.130S; S12.131A; S12.131B; S12.131S; S12.200A; S12.200B; S12.231A; S12.231B; S12.231S; S12.291S; S12.300A; S12.300B; S12.300S; S12.301A; S12.301B; S12.301S; S12.330A; S12.330B; S12.330S; S12.331A; S12.331B; S12.331S; S12.400A; S12.400B; S12.400S; S12.401A; S12.401B; S12.401S; S12.430A; S12.430B; S12.430S; S12.431A; S12.431B; S12.431S; S12.500A; S12.500B; S12.500S; S12.501A; S12.501B; S12.501S; S12.530A; S12.530B; S12.530S; S12.531A; S12.531B; S12.531S; S12.600A; S12.600B; S12.600S; S12.601A; S12.601B; S12.601S; S12.630A; S12.630B; S12.630S; S12.631A; S12.631B; S12.631S; S12.9XXA; S12.9XXD; S12.9XXS; S14.101A; S14.101D; S14.101S; S14.102A; S14.102D; S14.102S; S14.103A; S14.103D; S14.103S; S14.104A; S14.104D; S14.104S; S14.105A; S14.105D; S14.105S; S14.106A; S14.106D; S14.106S; S14.107A; S14.107D; S14.107S; S14.108D; S14.108S; S14.109A; S14.109D; S14.109S; S22.019A; S22.019B; S22.019S; S22.029A; S22.029B; S22.029S; S22.039A; S22.039B; S22.039S; S22.049A; S22.049B; S22.049S; S22.059A; S22.059B; S22.059S; S22.069A; S22.069B; S22.069S; S22.079A; S22.079B; S22.079S; S22.089A; S22.089B; S22.089S; S24.102A; S24.102S; S24.103A; S24.103S; S24.104A; S24.104S; S24.109A; S24.109S; S32.009A; S32.009B; S32.009S; S32.019A; S32.019B; S32.019S; S32.029A; S32.029B; S32.029S; S32.039A; S32.039B; S32.039S; S32.049A; S32.049B; S32.049S; S32.059A; S32.059B; S32.059S; S32.10XA; S32.10XB; S32.10XS; S34.101A; S34.101S; S34.102A; S34.102S; S34.103A; S34.103S; S34.104A; S34.104S; S34.105A; S34.105S; S34.109A; S34.109S; S34.119A; S34.119S; S34.129A; S34.129S; S34.139A; S34.139S; S44.00XA; S44.00XS; S44.10XA; S44.10XS; S44.20XA; S44.20XS; S44.30XA; S44.30XS; S44.40XA; S44.40XS; S44.50XA; S44.50XS; S44.8X9A; S44.8X9S; S44.90XA; S44.90XS; S54.10XA; S54.10XS; S54.20XA; S54.20XS; S54.30XA; S54.30XS; S54.8X9A; S54.8X9S; S54.90XA; S64.00XA; S64.00XS; S64.10XA; S64.10XS; S64.20XA; S64.20XS; S64.30XA; S64.30XS; S64.40XA; S64.40XS; S64.498A; S64.498S; S64.8X9A; S64.8X9S; S64.90XA; S64.90XS; S74.00XA; S74.00XS; S74.01XA; S74.01XS; S74.20XA; S74.20XS; S84.00XA; S84.00XS; S84.10XA; S84.10XS; S84.20XA; S84.20XS; S84.809A; S84.809S; S84.90XA; S84.90XS; S94.00XA; S94.00XS; S94.10XA; S94.10XS; S94.20XA; S94.20XS; S94.30XA; S94.30XS; S94.8X9A; S94.8X9S; S94.90XA; S94.90XS;
and
- Added
Diagnosis codes: G40.A01; G40.A09; G40.A11; G40.A19; G40.B01; G40.B09; G40.B11; G40.B19; G40.C01; G40.C09; G40.C11; G40.C19; G40.001; G40.009; G40.011; G40.019; G40.101; G40.109; G40.201; G40.209; G40.301; G40.309; G40.401; G40.409; G40.501; G40.509; G40.801; G40.802; G10.811; G40.812; G40.813; G40.814; G40.821; G40.822; G40.823; G40.824; G40.833; G40.834; G40.89; G40.901; G40.909; G40.911; G40.919; G40.A01; G40.A09; G40.A11; G40.A19; G40.B01; G40.B09; G40.B11; G40.B19; G40.C01; G40.C09; G40.C11; G40.C19; G80.3; and Z98.890.
Internal Medical Policy Committee 9-17-2024 Coding update -
Effective October 01, 2024
- Corrected
procedure code from 95886 to 95868;
and
- Added
diagnosis codes G40.841; G40.842; G40.843; G40.844; M51.360; M51.361; M51.362; M51.369; M51.370; M51.371; M51.372; and M51.379;
and
- Added
Policy Application
