ND Committee Review
Internal Medical Policy Committee 9-21-2020
- ANCA/ASCA updated from E/I to medically necessary;
- added procedure codes 86255; 86256 and 86671;
- added diagnosis code of K52.3
Internal Medical Policy Committee 9-21-2021 Coding update -
Effective October 01, 2021
Removed
procedure codes 86255; 86256; 86671 and 89240.
Added
Diagnosis codes:
| K50.00 | K50.011 | K50.012 | K50.013 | K50.014 | K50.018 | K50.019 |
| K50.10 | K50.111 | K50.112 | K50.113 | K50.114 | K50.118 | K50.119 |
| K50.80 | K50.811 | K50.812 | K50.813 | K50.814 | K50.818 | K50.819 |
| K50.90 | K50.911 | K50.912 | K50.913 | K50.914 | K50.918 | K50.919 |
| K51.00 | K51.011 | K51.012 | K51.013 | K51.014 | K51.018 | K51.019 |
| K51.20 | K51.211 | K51.212 | K51.213 | K51.214 | K51.218 | K51.219 |
| K51.30 | K51.311 | K51.312 | K51.313 | K51.314 | K51.318 | K51.319 |
| K51.50 | K51.511 | K51.512 | K51.513 | K51.514 | K51.518 | K51.519 |
| K51.80 | K51.811 | K51.812 | K51.813 | K51.814 | K51.818 | K51.819 |
| K51.90 | K51.911 | K51.912 | K51.913 | K51.914 | K51.918 | K51.919 |
| K52.3 | K52.81 | K52.82 | K52.831 | K52.832 | K52.838 | K52.839 |
| K58.0 | K58.1 | K58.2 | K58.8 | K58.9 | K59.1 | R10.10 |
| R10.11 | R10.12 | R10.30 | R10.31 | R10.32 | R10.33 | R10.811 |
| R10.813 | R10.814 | R10.816 | R10.817 | R10.819 | R10.84 | R10.9 |
| R19.5 | R19.7 | R19.8 | Z79.899 |
Internal Medical Policy Committee 5-24-2022 Revision
- Updated
with clarifying language
Internal Medical Policy Committee 5-23-2023 Annual Review - no changes in criteria
Internal Medical Policy Committee 1-16-2024-Revision-
Effective March 04, 2024
- Removed
section ANCA/ASCA;
and
- Removed
procedure code 81401.
Internal Medical Policy Committee 11-19-2024 Annual Review -no changes in criteria
