Alert 10002 (CPT ICD-10-CM Crosswalk)

Owned by Roman Konovalov
Last updated: Sept 13, 2020Version comment
4 min read

Description:

  1. CPT code must be used with at least one ICD-10-CM code referenced in the CPT ICD-10-CM Crosswalk.
  2. If CPT code has at least one referenced ICD-10-CM code in NCD Crosswalk, this edit returns no alert.
  3. If CPT code has all referenced ICD-10-CM codes in LCD Crosswalk only, this edit returns warnings.
  4. Otherwise, Greenrain MNC generates one error for this CPT code.

Edit ID: 10002

Error type: ERROR or WARNING

Error message example 1:

This example is provided for the following codes:

  1. CPT code = 0110T.
  2. Principal ICD-10-CM code = Z99.81.
  3. The error message does not refer to Administration CPT Codes.

Error Alert Example

CPT code 0110T may not be used with principal diagnosis code Z99.81.

DESCRIPTION

CPT code 0110T = Quantitative Sensory Testing (Qst), Testing And Interpretation Per Extremity; Using Other Stimuli To Assess Sensation

Principal diagnosis code Z99.81 = Dependence On Supplemental Oxygen

Error message example 2:

This example is provided for the following codes:

  1. CPT code = 00910.
  2. Principal ICD-10-CM code = B95.3.
  3. Secondary ICD-10-CM code = M87.250.
  4. The error message does not refer to Administration CPT Codes.

Error Alert Example

CPT code 00910 may not be used with diagnosis codes B95.3 and M87.250.

DESCRIPTION

CPT code 00910 = Anesthesia For Transurethral Procedures (Including Urethrocystoscopy); Not Otherwise Specified

Principal diagnosis code B95.3 = Streptococcus Pneumoniae As The Cause Of Diseases Classified Elsewhere

Secondary diagnosis code M87.250 = Osteonecrosis Due To Previous Trauma, Pelvis

Error message example 3:

This example is provided for the following codes:

  1. CPT code = 9007F.
  2. Principal ICD-10-CM code = A02.22.
  3. Secondary ICD-10-CM codes = K71.51 and Y35.213D.
  4. The error message does not refer to Administration CPT Codes.

Error Alert Example

CPT code 9007F may not be used with diagnosis codes A02.22, K71.51 and Y35.213D.

DESCRIPTION

CPT code 9007F = Other Carotid Stenosis: Ipsilateral Tia Or Stroke 120 Days Or Greater Prior To Procedure Or Any Prior Contralateral Carotid Territory Or Vertebrobasilar Tia Or Stroke (Nma-No Measure Associated)

Principal diagnosis code A02.22 = Salmonella Pneumonia

Secondary diagnosis code K71.51 = Toxic Liver Disease With Chronic Active Hepatitis With Ascites

Secondary diagnosis code Y35.213D = Legal Intervention Involving Injury By Tear Gas, Suspect Injured, Subsequent Encounter

Error message example 4:

This example is provided for the following codes:

  1. CPT code = 27006.
  2. Principal ICD-10-CM code = I69.969.
  3. Secondary ICD-10-CM codes = G45.9, Z11.4, T50.8X2D, R93.9 and Z85.230.
  4. The error message shows the description of a maximum of 5 ICD-10-CM codes to save the size of the message.
  5. The last sentence contains a note regarding the 6th ICD-10-CM code.
  6. The error message does not refer to Administration CPT Codes.

Error Alert Example

CPT code 27006 may not be used with diagnosis codes I69.969, G45.9, Z11.4, T50.8X2D, R93.9 and Z85.230.

DESCRIPTION

CPT code 27006 = Tenotomy, Abductors And/Or Extensor(S) Of Hip, Open (Separate Procedure)

Principal diagnosis code I69.969 = Other Paralytic Syndrome Following Unspecified Cerebrovascular Disease Affecting Unspecified Side

Secondary diagnosis code G45.9 = Transient Cerebral Ischemic Attack, Unspecified

Secondary diagnosis code Z11.4 = Encounter For Screening For Human Immunodeficiency Virus [Hiv]

Secondary diagnosis code T50.8X2D = Poisoning By Diagnostic Agents, Intentional Self-Harm, Subsequent Encounter

Secondary diagnosis code R93.9 = Diagnostic Imaging Inconclusive Due To Excess Body Fat Of Patient

Note: refer to the coding documentation for a description of secondary diagnosis code Z85.230.

Error message example 5:

This example is provided for the following codes:

  1. CPT code = 7010F.
  2. Principal ICD-10-CM code = I77.71.
  3. Secondary ICD-10-CM codes = D3A.010, C92.10, N60.01, R92.2, H02.003, C79.52, E83.59 and G40.009.
  4. The error message shows the description of a maximum of 5 ICD-10-CM codes to save the size of the message.
  5. The last sentence contains a note regarding the 6th, 7th, 8th and 9th ICD-10-CM code.
  6. The error message does not refer to Administration CPT Codes.

Error Alert Example

CPT code 7010F may not be used with diagnosis codes I77.71, D3A.010, C92.10, N60.01, R92.2, H02.003, C79.52, E83.59 and G40.009.

DESCRIPTION

CPT code 7010F = Patient Information Entered Into A Recall System That Includes: Target Date For The Next Exam Specified And A Process To Follow Up With Patients Regarding Missed Or Unscheduled Appointments (Ml)

Principal diagnosis code I77.71 = Dissection Of Carotid Artery

Secondary diagnosis code D3A.010 = Benign Carcinoid Tumor Of The Duodenum

Secondary diagnosis code C92.10 = Chronic Myeloid Leukemia, Bcr/Abl-Positive, Not Having Achieved Remission

Secondary diagnosis code N60.01 = Solitary Cyst Of Right Breast

Secondary diagnosis code R92.2 = Inconclusive Mammogram

Note: refer to the coding documentation for a description of secondary diagnosis codes H02.003, C79.52, E83.59 and G40.009.

Warning message example 6:

This example is provided for the following codes:

  1. CPT code = 96372.
  2. Principal ICD-10-CM code = J20.9.
  3. Secondary ICD-10-CM codes = R05, J30.9.
  4. Claim also has drug code 0248-122107-1021.
  5. The warning message refers to Administration CPT Codes.

Warning Alert Example

CPT code 96372 may not be used with diagnosis codes J20.9, R05 and J30.9. However, CPT code 96372 is the administration code that might be used for drug code 0248-122107-1021.

DESCRIPTION

CPT code 96372 = Therapeutic, Prophylactic, Or Diagnostic Injection (Specify Substance Or Drug); Subcutaneous Or Intramuscular

Principal diagnosis code J20.9 = Acute Bronchitis, Unspecified

Secondary diagnosis code R05 =Cough

Secondary diagnosis code J30.9 = Allergic Rhinitis, Unspecified

Warning message example 7:

This example is provided for the following codes:

  1. CPT code = 96372.
  2. Principal ICD-10-CM code = J20.9.
  3. Claim also has drug codes 0138-163701-1161, 0070-141901-1171 and 0614-197201-1481.
  4. The warning message refers to Administration CPT Codes.

Error Alert Example

CPT code 96372 may not be used with diagnosis codes J20.9, R05 and J30.9. However, CPT code 96372 is the administration code that might be used for drug codes 0138-163701-1161, 0070-141901-1171 and 0614-197201-1481.

DESCRIPTION

CPT code 96372 = Therapeutic, Prophylactic, Or Diagnostic Injection (Specify Substance Or Drug); Subcutaneous Or Intramuscular

Principal diagnosis code J20.9 = Acute Bronchitis, Unspecified

Example 8:

This example is provided for the following codes:

  1. CPT code = 99244.
  2. Principal ICD-10-CM code = J30.9.

Result: Greenrain MNC does not raise any alert for this example because CPT code 99244 is E&M code.

Warning message example 9:

This example is provided for the following codes:

  1. CPT code = 0213T.
  2. Principal ICD-10-CM code = M46.81.
  3. The warning message is returned because this combination does not exist in the NCD Crosswalk, but it exists in the LCD Crosswalk.

Warning Alert Example

CPT code 0213T may not be used with principal diagnosis code M46.81 because this combination does not exist in the NCD Crosswalk. However, this combination exists in the LCD Crosswalk.

DESCRIPTION

CPT code 0213T = Injection(S), Diagnostic Or Therapeutic Agent, Paravertebral Facet (Zygapophyseal) Joint (Or Nerves Innervating That Joint) With Ultrasound Guidance, Cervical Or Thoracic; Single Level

Principal diagnosis code M46.81 = Other Specified Inflammatory Spondylopathies, Occipito-Atlanto-Axial Region

Owner object: Activity

Owner object property name: Code

Owner object property value: Value of Activity.Code

Reference object: Claim

Reference object property name: ID

Reference object property value: Value of Claim.ID