Medical Policy Medical Policy
Policy Num: 02.002.006
Policy Name: Prueba de Esfuerzo con Perfusion del Miocardio (Stress Test)
Policy ID: [02.002.006] [Ar / L / M+ / P+] [0.00.00]
Last Review: September 11, 2024
Next Review: Policy Archived
Related Policies: None
En la prueba de esfuerzo (Cardiovascular “Stress Test”) se induce una angina cardiaca mediante el aumento gradual del ejercicio. En esta prueba se realiza inicialmente una prueba de esfuerzo, al descontinuar ésta por la razón que fuere, se inyecta un material radiactivo (Thallium 201, Sestamibe, Tegnecio). Estos materiales se concentran en el músculo cardíaco y emiten radiaciones que permiten visualizar el miocardio. Las áreas no visualizadas se interpretan como deficientes en circulación o isquémicas.
Si el cardiólogo sólo supervisa una prueba de esfuerzo cardiovascular, debe usar el código 93016.
Si el cardiólogo sólo hace interpretación e informe utilizará código 93018.
Si el cardiólogo sólo realiza el trazado, utilizará el código 93017. De igual forma, si el equipo utilizado pertenece a una instalación, se usará el código 93017.
Para facturar el procedimiento completo, incluso la interpretación de imágenes trazadas y si es dueño del equipo, usará el código 93015. De ser necesario utilizará el código radiológico (78453 ó 78454).
Este es un servicio global.
Los Cardiólogos Nucleólogos pueden reportar pruebas de esfuerzo cardiovascular
Si un cardiólogo y un radiólogo hacen el procedimiento en conjunto, el radiólogo debe usar los códigos de Medicina Nuclear.
Benefits are determined by the group contract, member benefit booklet, and/or individual subscriber certificate in effect at the time services were rendered. Benefit products or negotiated coverages may have all or some of the services discussed in this medical policy excluded from their coverage.
| CPT | DESCRIPCION |
| 93015 | Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report |
| 93016 | physician supervision only, without interpretation and report |
| 93017 | tracing only, without interpretation and report |
| 93018 | interpretation and report only |
| 78453 | Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic) |
| 78454 | multiple studies, at rest and/or stress (exercise and/or pharmacologic), and/or rest reinjection |
| 78481 | Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification |
| 78483 | multiple studies, at rest and with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification |
| ICD-10-CM (effective date 10/01/2015) | Description |
| F45.0 | Somatization disorder |
| F45.8 | Other somatoform disorders |
| I00 | Rheumatic fever without heart involvement |
| I01.0 - I01.9 | Rheumatic fever with heart involvement range code |
| I02.0 - I02.9 |
|
| I05.0 - I05.9 |
|
| I06.0 - I06.9 | Rheumatic aortic valve diseases |
| I07.0 - I07.9 | Rheumatic tricuspid valve diseases |
| I08.0 - I08.9 | Multiple valve diseases |
| I09.0 - I09.2 | Other rheumatic heart diseases |
| I09.81 - I09.9 | Other specified rheumatic heart diseases |
| I10 | Essential (primary) hypertension |
| I11.0 | Hypertensive heart disease with heart failure |
| I11.9 | Hypertensive heart disease without heart failure |
| I12.0 | Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease |
| I12.9 | Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease |
| I13.0 | Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease |
| I13.10 | Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease |
| I13.11 | Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease |
| I13.2 | Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease |
| I15.0 | Renovascular hypertension |
| I15.1 | Hypertension secondary to other renal disorders |
| I15.8 | Other secondary hypertension |
| I15.9 | Secondary hypertension, unspecified |
| I20.0 | Unstable angina |
| I20.1 | Angina pectoris with documented spasm |
| I20.8 | Other forms of angina pectoris, (Delete Effective Date 09/30/2023) |
| I20.81 | Acute coronary microvascular dysfunction, (Effective Date 10/01/2023) |
| I20.89 | Other forms of angina pectoris, (Effective Date 10/01/2023) |
| I20.9 | Angina pectoris, unspecified |
| I21.01 | ST elevation (STEMI) myocardial infarction involving left main coronary artery |
| I21.02 | ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery |
| I21.09 | ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall |
| I21.11 | ST elevation (STEMI) myocardial infarction involving right coronary artery |
| I21.19 | ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall |
| I21.21 | ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery |
| I21.29 | ST elevation (STEMI) myocardial infarction involving other sites |
| I21.3 | ST elevation (STEMI) myocardial infarction of unspecified site |
| I21.4 | Non-ST elevation (NSTEMI) myocardial infarction |
| I22.0 | Subsequent ST elevation (STEMI) myocardial infarction of anterior wall |
| I22.1 | Subsequent ST elevation (STEMI) myocardial infarction of inferior wall |
| I22.2 | Subsequent non-ST elevation (NSTEMI) myocardial infarction |
| I22.8 | Subsequent ST elevation (STEMI) myocardial infarction of other sites |
| I22.9 | Subsequent ST elevation (STEMI) myocardial infarction of unspecified site |
| I23.0 | Hemopericardium as current complication following acute myocardial infarction |
| I23.1 | Atrial septal defect as current complication following acute myocardial infarction |
| I23.2 | Ventricular septal defect as current complication following acute myocardial infarction |
| I23.3 | Rupture of cardiac wall without hemopericardium as current complication following acute myocardial infarction |
| I23.4 | Rupture of chordae tendineae as current complication following acute myocardial infarction |
| I23.5 | Rupture of papillary muscle as current complication following acute myocardial infarction |
| I23.6 | Thrombosis of atrium, auricular appendage, and ventricle as current complications following acute myocardial infarction |
| I23.8 | Other current complications following acute myocardial infarction |
| I24.0 | Acute coronary thrombosis not resulting in myocardial infarction |
| I24.1 | Dressler's syndrome |
| I24.8 | Other forms of acute ischemic heart disease, (Delete Effective Date 09/30/2023) |
| I24.81 | Acute coronary microvascular dysfunction, (Effective Date 10/01/2023) |
| I24.89 | Other forms of acute ischemic heart disease, (Effective Date 10/01/2023) |
| I24.9 | Acute ischemic heart disease, unspecified |
| I25.10 | Atherosclerotic heart disease of native coronary artery without angina pectoris |
| I25.2 | Old myocardial infarction |
| I25.3 | Aneurysm of heart |
| I25.41 | Coronary artery aneurysm |
| I25.5 | Ischemic cardiomyopathy |
| I25.6 | Silent myocardial ischemia |
| I25.810 | Atherosclerosis of coronary artery bypass graft(s) without angina pectoris |
| I25.89 | Other forms of chronic ischemic heart disease |
| I25.9 | Chronic ischemic heart disease, unspecified |
| I26.01 | Septic pulmonary embolism with acute cor pulmonale |
| I26.02 | Saddle embolus of pulmonary artery with acute cor pulmonale |
| I26.09 | Other pulmonary embolism with acute cor pulmonale |
| I26.90 | Septic pulmonary embolism without acute cor pulmonale |
| I26.92 | Saddle embolus of pulmonary artery without acute cor pulmonale |
| I26.99 | Other pulmonary embolism without acute cor pulmonale |
| I27.0 | Primary pulmonary hypertension |
| I27.1 | Kyphoscoliotic heart disease |
| I27.81 | Cor pulmonale (chronic) |
| I27.82 | Chronic pulmonary embolism |
| I27.89 | Other specified pulmonary heart diseases |
| I27.9 | Pulmonary heart disease, unspecified |
| I30.0 | Acute nonspecific idiopathic pericarditis |
| I30.8 | Other forms of acute pericarditis |
| I30.9 | Acute pericarditis, unspecified |
| I31.0 | Chronic adhesive pericarditis |
| I31.1 | Chronic constrictive pericarditis |
| I31.2 | Hemopericardium, not elsewhere classified |
| I31.4 | Cardiac tamponade |
| I31.8 | Other specified diseases of pericardium |
| I31.9 | Disease of pericardium, unspecified |
| I32 | Pericarditis in diseases classified elsewhere |
| I33.0 | Acute and subacute infective endocarditis |
| I33.9 | Acute and subacute endocarditis, unspecified |
| I34.0 | Nonrheumatic mitral (valve) insufficiency |
| I34.81 | Nonrheumatic mitral (valve) annulus calcification |
| I34.89 | Other nonrheumatic mitral valve disorders |
| I35.0 | Nonrheumatic aortic (valve) stenosis |
| I35.1 | Nonrheumatic aortic (valve) insufficiency |
| I35.2 | Nonrheumatic aortic (valve) stenosis with insufficiency |
| I35.8 | Other nonrheumatic aortic valve disorders |
| I35.9 | Nonrheumatic aortic valve disorder, unspecified |
| I36.0 | Nonrheumatic tricuspid (valve) stenosis |
| I36.8 | Other nonrheumatic tricuspid valve disorders |
| I37.0 | Nonrheumatic pulmonary valve stenosis |
| I37.8 | Other nonrheumatic pulmonary valve disorders |
| I38 | Endocarditis, valve unspecified |
| I39 | Endocarditis and heart valve disorders in diseases classified elsewhere |
| I40.0 | Infective myocarditis |
| I40.1 | Isolated myocarditis |
| I40.8 | Other acute myocarditis |
| I41 | Myocarditis in diseases classified elsewhere |
| I42.0 | Dilated cardiomyopathy |
| I42.1 | Obstructive hypertrophic cardiomyopathy |
| I42.2 | Other hypertrophic cardiomyopathy |
| I42.3 | Endomyocardial (eosinophilic) disease |
| I42.4 | Endocardial fibroelastosis |
| I42.5 | Other restrictive cardiomyopathy |
| I42.6 | Alcoholic cardiomyopathy |
| I42.7 | Cardiomyopathy due to drug and external agent |
| I42.8 | Other cardiomyopathies |
| I42.9 | Cardiomyopathy, unspecified |
| I43 | Cardiomyopathy in diseases classified elsewhere |
| I44.0 | Atrioventricular block, first degree |
| I44.1 | Atrioventricular block, second degree |
| I44.2 | Atrioventricular block, complete |
| I44.30 | Unspecified atrioventricular block |
| I44.39 | Other atrioventricular block |
| I44.4 | Left anterior fascicular block |
| I44.5 | Left posterior fascicular block |
| I44.60 | Unspecified fascicular block |
| I44.69 | Other fascicular block |
| I44.7 | Left bundle-branch block, unspecified |
| I45.0 | Right fascicular block |
| I45.10 | Unspecified right bundle-branch block |
| I45.19 | Other right bundle-branch block |
| I45.2 | Bifascicular block |
| I45.3 | Trifascicular block |
| I45.4 | Nonspecific intraventricular block |
| I45.5 | Other specified heart block |
| I45.6 | Pre-excitation syndrome |
| I45.81 | Long QT syndrome |
| I45.89 | Other specified conduction disorders |
| I45.9 | Conduction disorder, unspecified |
| I46.2 | Cardiac arrest due to underlying cardiac condition |
| I46.8 | Cardiac arrest due to other underlying condition |
| I46.9 | Cardiac arrest, cause unspecified |
| I47.0 | Re-entry ventricular arrhythmia |
| I47.1 | Supraventricular tachycardia, (Delete Effective date 09/30/2023) |
| I47.10 | Supraventricular tachycardia, unspecified, (Effective date 10/01/2023) |
| I47.11 | Supraventricular tachycardia, (Effective date 10/01/2023) |
| I47.19 | Supraventricular tachycardia, (Effective date 10/01/2023) |
| I47.9 | Paroxysmal tachycardia, unspecified |
| I48.0 | Paroxysmal atrial fibrillation |
| I48.1 | Persistent atrial fibrillation |
| I49.01 | Ventricular fibrillation |
| I49.02 | Ventricular flutter |
| I49.1 | Atrial premature depolarization |
| I49.40 | Unspecified premature depolarization |
| I49.49 | Other premature depolarization |
| I49.5 | Sick sinus syndrome |
| I49.8 | Other specified cardiac arrhythmias |
| I49.9 | Cardiac arrhythmia, unspecified |
| I50.1 | Left ventricular failure |
| I50.20 | Unspecified systolic (congestive) heart failure |
| I50.21 | Acute systolic (congestive) heart failure |
| I50.22 | Chronic systolic (congestive) heart failure |
| I50.23 | Acute on chronic systolic (congestive) heart failure |
| I50.33 | Acute on chronic diastolic (congestive) heart failure |
| I50.9 | Heart failure, unspecified |
| I51.0 | Cardiac septal defect, acquired |
| I51.1 | Rupture of chordae tendineae, not elsewhere classified |
| I51.2 | Rupture of papillary muscle, not elsewhere classified |
| I51.2 | Rupture of papillary muscle, not elsewhere classified |
| I51.89 | Other ill-defined heart diseases |
| I51.9 | Heart disease, unspecified |
| I52 | Other heart disorders in diseases classified elsewhere |
| I71.00 | Dissection of unspecified site of aorta |
| I71.02 | Dissection of abdominal aorta |
| I71.03 | Dissection of thoracoabdominal aorta |
| I71.8 | Aortic aneurysm of unspecified site, ruptured |
| I71.9 | Aortic aneurysm of unspecified site, without rupture |
| I79.0 | Aneurysm of aorta in diseases classified elsewhere |
| I81 | Portal vein thrombosis |
| I97.0 | Postcardiotomy syndrome |
| I97.110 | Postprocedural cardiac insufficiency following cardiac surgery |
| I97.111 | Postprocedural cardiac insufficiency following other surgery |
| I97.120 | Postprocedural cardiac arrest following cardiac surgery |
| I97.121 | Postprocedural cardiac arrest following other surgery |
| I97.130 | Postprocedural heart failure following cardiac surgery |
| I97.131 | Postprocedural heart failure following other surgery |
| I97.190 | Other postprocedural cardiac functional disturbances following cardiac surgery |
| I97.191 | Other postprocedural cardiac functional disturbances following other surgery |
| I97.710 | Intraoperative cardiac arrest during cardiac surgery |
| I97.711 | Intraoperative cardiac arrest during other surgery |
| I97.790 | Other intraoperative cardiac functional disturbances during cardiac surgery |
| I97.791 | Other intraoperative cardiac functional disturbances during other surgery |
| I97.88 | Other intraoperative complications of the circulatory system, not elsewhere classified |
| I97.89 | Other postprocedural complications and disorders of the circulatory system, not elsewhere classified |
| N26.2 | Page kidney |
| Q20.0 | Common arterial trunk |
| Q20.1 | Double outlet right ventricle |
| Q20.6 | Isomerism of atrial appendages |
| Q20.9 | Congenital malformation of cardiac chambers and connections, unspecified |
| Q21.0 | Ventricular septal defect |
| Q21.3 | Tetralogy of Fallot |
| Q21.4 | Aortopulmonary septal defect |
| Q21.8 | Other congenital malformations of cardiac septa |
| Q22.0 | Pulmonary valve atresia |
| Q22.2 | Congenital pulmonary valve insufficiency |
| Q22.3 | Other congenital malformations of pulmonary valve |
| Q22.4 | Congenital tricuspid stenosis |
| Q22.5 | Ebstein's anomaly |
| Q22.6 | Hypoplastic right heart syndrome |
| Q22.8 | Other congenital malformations of tricuspid valve |
| Q22.9 | Congenital malformation of tricuspid valve, unspecified |
| Q23.0 | Congenital stenosis of aortic valve |
| Q23.1 | Congenital insufficiency of aortic valve |
| Q23.2 | Congenital mitral stenosis |
| Q23.3 | Congenital mitral insufficiency |
| Q23.4 | Hypoplastic left heart syndrome |
| Q23.8 | Other congenital malformations of aortic and mitral valves (Delete Effective date 09/30/2024) |
| Q23.81 | Other congenital malformations of aortic and mitral valves (Effective date 10/01/2024) |
| Q23.82 | Other congenital malformations of aortic and mitral valves (Effective date 10/01/2024) |
| Q23.88 | Other congenital malformations of aortic and mitral valves (Effective date 10/01/2024) |
| Q23.9 | Congenital malformation of aortic and mitral valves, unspecified |
| Q24.0 | Dextrocardia |
| Q24.1 | Levocardia |
| Q24.2 | Cor triatriatum |
| Q24.3 | Pulmonary infundibular stenosis |
| Q24.4 | Congenital subaortic stenosis |
| Q24.5 | Malformation of coronary vessels |
| Q24.6 | Congenital heart block |
| Q24.8 | Other specified congenital malformations of heart |
| Q24.9 | Congenital malformation of heart, unspecified |
| Q25.0 | Patent ductus arteriosus |
| Q25.1 | Coarctation of aorta |
| Q25.2 | Atresia of aorta |
| Q25.3 | Supravalvular aortic stenosis |
| Q25.4 | Other congenital malformations of aorta |
| Q25.5 | Atresia of pulmonary artery |
| Q25.6 | Stenosis of pulmonary artery |
| Q25.71 | Coarctation of pulmonary artery |
| Q25.72 | Congenital pulmonary arteriovenous malformation |
| Q25.79 | Other congenital malformations of pulmonary artery |
| Q25.8 | Other congenital malformations of other great arteries |
| Q25.9 | Congenital malformation of great arteries, unspecified |
| Q26.0 | Congenital stenosis of vena cava |
| Q26.1 | Persistent left superior vena cava |
| Q26.2 | Total anomalous pulmonary venous connection |
| Q26.3 | Partial anomalous pulmonary venous connection |
| Q26.4 | Anomalous pulmonary venous connection, unspecified |
| Q26.8 | Other congenital malformations of great veins |
| Q27.30 | Arteriovenous malformation, site unspecified |
| Q27.39 | Arteriovenous malformation, other site |
| Q27.9 | Congenital malformation of peripheral vascular system, unspecified |
| R00.1 | Bradycardia, unspecified |
| R00.2 | Palpitations |
| R01.0 | Benign and innocent cardiac murmurs |
| R01.1 | Cardiac murmur, unspecified |
| R06.00 | Dyspnea, unspecified |
| R06.01 | Orthopnea |
| R06.02 | Shortness of breath |
| R06.09 | Other forms of dyspnea |
| R06.2 | Wheezing |
| R06.3 | Periodic breathing |
| R06.4 | Hyperventilation |
| R06.81 | Apnea, not elsewhere classified |
| R06.82 | Tachypnea, not elsewhere classified |
| R06.83 | Snoring |
| R06.89 | Other abnormalities of breathing |
| R06.9 | Unspecified abnormalities of breathing |
| R06.9 | Unspecified abnormalities of breathing |
| R07.1 | Chest pain on breathing |
| R07.2 | Precordial pain |
| R07.81 | Pleurodynia |
| R07.82 | Intercostal pain |
| R07.89 | Other chest pain |
| R07.9 | Chest pain, unspecified |
| R42 | Dizziness and giddiness |
| R46.1 | Bizarre personal appearance |
| R46.3 | Overactivity |
| R52 | Pain, unspecified |
| R68.19 | Other nonspecific symptoms peculiar to infancy |
| R94.31 | Abnormal electrocardiogram [ECG] [EKG] |
| T80.0XXA | Air embolism following infusion, transfusion and therapeutic injection, initial encounter |
| T80.0XXD | Air embolism following infusion, transfusion and therapeutic injection, subsequent encounter |
| T80.0XXS | Air embolism following infusion, transfusion and therapeutic injection, sequela |
| T81.718A | Complication of other artery following a procedure, not elsewhere classified, initial encounter |
| T81.718D | Complication of other artery following a procedure, not elsewhere classified, subsequent encounter |
| T81.718S | Complication of other artery following a procedure, not elsewhere classified, sequela |
| T81.72XA | Complication of vein following a procedure, not elsewhere classified, initial encounter |
| T81.72XD | Complication of vein following a procedure, not elsewhere classified, subsequent encounter |
| T81.72XS | Complication of vein following a procedure, not elsewhere classified, sequela |
| T82.817A | Embolism of cardiac prosthetic devices, implants and grafts, initial encounter |
| T82.817D | Embolism of cardiac prosthetic devices, implants and grafts, subsequent encounter |
| T82.817S | Embolism of cardiac prosthetic devices, implants and grafts, sequela |
| T82.818A | Embolism of vascular prosthetic devices, implants and grafts, initial encounter |
| T82.818D | Embolism due to vascular prosthetic devices, implants and grafts, subsequent encounter |
| T82.818S | Embolism due to vascular prosthetic devices, implants and grafts, sequela |
| T82.827A | Fibrosis of cardiac prosthetic devices, implants and grafts, initial encounter |
| T82.827D | Fibrosis of cardiac prosthetic devices, implants and grafts, subsequent encounter |
| T82.827S | Fibrosis of cardiac prosthetic devices, implants and grafts, sequela |
| T82.837A | Hemorrhage of cardiac prosthetic devices, implants and grafts, initial encounter |
| T82.837D | Hemorrhage of cardiac prosthetic devices, implants and grafts, subsequent encounter |
| T82.837S | Hemorrhage of cardiac prosthetic devices, implants and grafts, sequela |
| T82.847A | Pain from cardiac prosthetic devices, implants and grafts, initial encounter |
| T82.847D | Pain from cardiac prosthetic devices, implants and grafts, subsequent encounter |
| T82.847S | Pain from cardiac prosthetic devices, implants and grafts, sequela |
| T82.857A | Stenosis of cardiac prosthetic devices, implants and grafts, initial encounter |
| T82.857D | Stenosis of cardiac prosthetic devices, implants and grafts, subsequent encounter |
| T82.857S | Stenosis of cardiac prosthetic devices, implants and grafts, sequela |
| T82.867A | Thrombosis of cardiac prosthetic devices, implants and grafts, initial encounter |
| T82.867D | Thrombosis of cardiac prosthetic devices, implants and grafts, subsequent encounter |
| T82.867S | Thrombosis of cardiac prosthetic devices, implants and grafts, sequela |
| T82.897A | Other specified complication of cardiac prosthetic devices, implants and grafts, initial encounter |
| T82.897D | Other specified complication of cardiac prosthetic devices, implants and grafts, subsequent encounter |
| T82.897S | Other specified complication of cardiac prosthetic devices, implants and grafts, sequela |
| T82.9XXA | Unspecified complication of cardiac and vascular prosthetic device, implant and graft, initial encounter |
| T82.9XXD | Unspecified complication of cardiac and vascular prosthetic device, implant and graft, subsequent encounter |
| T82.9XXS | Unspecified complication of cardiac and vascular prosthetic device, implant and graft, sequela |
| T86.20 | Unspecified complication of heart transplant |
| T86.21 | Heart transplant rejection |
| T86.22 | Heart transplant failure |
| T86.23 | Heart transplant infection |
| T86.290 | Cardiac allograft vasculopathy |
| T86.298 | Other complications of heart transplant |
| T86.30 | Unspecified complication of heart-lung transplant |
| T86.31 | Heart-lung transplant rejection |
| T86.32 | Heart-lung transplant failure |
| T86.33 | Heart-lung transplant infection |
| T86.39 | Other complications of heart-lung transplant |
| Z48.21 | Encounter for aftercare following heart transplant |
| Z48.24 | Encounter for aftercare following lung transplant |
| Z48.280 | Encounter for aftercare following heart-lung transplant |
| Z92.89 | Personal history of other medical treatment |
| Z94.1 | Heart transplant status |
| Z94.2 | Lung transplant status |
| Z94.3 | Heart and lungs transplant status |
| Z95.0 | Presence of cardiac pacemaker |
| Z95.1 | Presence of aortocoronary bypass graft |
| Z95.2 | Presence of prosthetic heart valve |
| Z95.3 | Presence of xenogenic heart valve |
| Z95.4 | Presence of other heart-valve replacement |
| Z95.5 | Presence of coronary angioplasty implant and graft |
| Z98.61 | Coronary angioplasty status |
| Z98.89 | Other specified postprocedural states |
| ICD-10 CM (effective date 10/01/2017) | Description |
| I27.21 | Secondary pulmonary arterial hypertension |
| I27.22 | Pulmonary hypertension due to left heart disease |
| I27.23 | Pulmonary hypertension due to lung diseases and hypoxia |
| I27.24 | Chronic thromboembolic pulmonary hypertension |
| I27.83 | Eisenmenger's syndrome |
| ICD-10 CM (Termination date 09/30/2017) | Description |
| I27.2 | Other secondary pulmonary hypertension |
| ICD-10 CM (effective date 3/01/2021) | Description |
| I49.3 | Ventricular premature depolarization |
| ICD-10 CM (Termination date 09/30/2022)
| |
| I34.8 | Other nonrheumatic mitral valve disorders |
| I47.2 | Ventricular tachycardia |
| I48.1 | Persistent atrial fibrillation |
| I71.01- I71.16 | Dissection of thoracic aorta |
| Q21.1 | Atrial septal defect |
| Q21.2 | Atrioventricular septal defect |
| Q25.4 | Other congenital malformations of aorta |
| ICD-10 CM (effective date 10/01/2022) | |
| I25.118 | Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris |
| I34.81-I34.9 | Other nonrheumatic mitral valve disorders Range Code |
| I47.20-I47.29 | Ventricular tachycardia Range Code |
| I48.11 | Longstanding persistent atrial fibrillation |
| I48.19 | Other persistent atrial fibrillation |
| I71.010-I71.019 | Dissection of thoracic aorta Range Code |
| I71.20-I71.62 | Aortic aneurysm Range Code |
| Q21.10-Q21.19 | Atrial septal defect Range Code |
| Q21.20-Q21.23 | Atrioventricular septal defect Range Code |
| Q25.40-Q25.49 | Other congenital malformations of aorta Range Code |
Limitación
Las establecidas en las pólizas contratadas. Requiere preautorización según póliza.
| DATE | ACTION | DESCRIPTION |
| 9/11/2024 | ICD-10-CM Codes Review | Add ICD-10-CM (Q23.81, Q23.82, Q23.88) Effective date 10/01/2024 Delete ICD-10-CM (Q23.8) Effective Date 09/30/2024 |
| 8/22/2023 | ICD-10-CM Codes Review | Add ICD-10-CM I20.81, I20.89, I24.81, I24.89, I47.10, I47.11, I47.19 Effective date 10/01/2023 Delete ICD-10-CM I20.8, I24.8, I47.1 Effective Date 09/30/2023 |
| 2/21/2023 | ICD-10-CM Codes Review | Add ICD-10-CM I25.118 Effective date 10/01/2022 Delete ICD-10-CM I48.1, Q25.4 Effective date 10/01/2022 Add ICD-10-CM I48.11-I48.19, I71.10-I71.13, I71.20-I71.62, Q25.40-Q25.49 Effective date 10/01/2022 |
| 2/03/2023 | ICD-10-CM Codes Review | DELETE ICD-10-CM I34.8, I47.2, I71.01- I71.16, Q21.1, Q21.2 EFFECTIVE 10/01/2022 ADD ICD-10-CM I34.81-I34.9, I47.20-I47.29, I71.010-I71.019, Q21.10-Q21.19, Q21.20-Q21.23 Effective date 10/01/2022 |
| 1/16/2022 | ICD 10 Codes review | DELETE ICD-10-CM I34.8 EFFECTIVE 10/01/2022 ADD ICD-10-CM I34.81, I34.89 EFFECTIVE 10/01/2022 |
| 9/16/2021 | Policy Reviewed | ICD-10 code I49.3 Added Effective 3/1/2021 |
| 8/08/2017 | ||
| 5/10/2016 | ||
| 9/23/2013 | Policy Reviewed | (ICD-10 added) |
| 2/25/2013 | ||
| 2/03/2012 | ||
| 11/02/2011 | Policy Reviewed | ICD-10 CODE ADDED |
| 3/28/2011 | Policy Reviewed | DX CODE ADDED |
| 4/03/2009 | Policy Reviewed | ICES |
| 4/18/2007 | ||
| 1/27/2005 | ||
| 2/14/1997 |
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