ND Committee Review
Internal Medical Policy Committee 11-14-2019 no change to criteria, some diagnosis updates; updated to v. 19.
Internal Medical Policy Committee 11-19-2020 Removed the following diagnosis codes:
M84.30XK, M84.311K, M84.312K, M84.321K, M84.322K, M84.331K, M84.332K, M84.333K, M84.334K, M84.341K, M84.342K, M84.344K, M84.345K, M84350K, M84.351K, M84.352K, M84.359K, M84.361K, M84.362K, M84.363K, M84.364K, M84.371K, M84.372K, M84.374K, M84.375K, M84.377K, M84.378K, M84.38XK, M84.50XK, M84.511K, M84.512K, M84.521K, M84.522K, M84.531K, M84.532K, M84.533K, M84.534K, M84.541K, M84.542K, M84.550K, M84.551K, M84.552K, M84.559K, M84.561K, M84.562K, M84.563K, M84.564K, M84.571K, M84.572K, M84.574K, M84.575K, M84.58XK, M84.68XK
Internal Medical Policy Committee 11-23-2021 Updated clarifying language
Internal Medical Policy Committee 7-21-2022 Coding update - Effective September 05, 2022
- Removed Procedure code: A4559
- Removed Diagnosis codes: S22.32XK; S2.39XK; S22.41XK; S22.42XK; S22.43XK; S22.49XK; S22.5XXK; S22.9XXK; S32.301K; S32.302K; S32.311K; S32.312K; S32.314K; S32.315K; S32.391K; S32.392K; S32.401K; S32.411K; S32.412K; S32.414K; S32.415K; S32.421K; S32.422K; S32.424K; S32.425K; S32.431K; S32.432K
