Questionable admission codes - ICD-10-CM Medicare Code Edits

Some diagnoses are not usually sufficient justification for admission to an acute care hospital. For example, if a patient is given code R030 for elevated blood pressure reading, without diagnosis of hypertension, then the patient would have a questionable admission, since elevated blood pressure reading is not normally sufficient justification for admission to a hospital. The following list contains diagnosis codes identified as questionable admission when used.

The following 27 ICD-10-CM codes are intended for questionable admission codes

ICD CodeDescriptionCategory
E11.9Type 2 diabetes mellitus without complicationsType 2 diabetes mellitus (E11)
E13.9Other specified diabetes mellitus without complicationsOther specified diabetes mellitus (E13)
E66.09Other obesity due to excess caloriesOverweight and obesity (E66)
E66.1Drug-induced obesityOverweight and obesity (E66)
E66.8Other obesityOverweight and obesity (E66)
E66.9Obesity, unspecifiedOverweight and obesity (E66)
H61.20Impacted cerumen, unspecified earOther disorders of external ear (H61)
H61.21Impacted cerumen, right earOther disorders of external ear (H61)
H61.22Impacted cerumen, left earOther disorders of external ear (H61)
H61.23Impacted cerumen, bilateralOther disorders of external ear (H61)
I10Essential (primary) hypertensionEssential (primary) hypertension (I10)
I44.4Left anterior fascicular blockAtrioventricular and left bundle-branch block (I44)
I44.5Left posterior fascicular blockAtrioventricular and left bundle-branch block (I44)
I44.60Unspecified fascicular blockAtrioventricular and left bundle-branch block (I44)
I44.69Other fascicular blockAtrioventricular and left bundle-branch block (I44)
I44.7Left bundle-branch block, unspecifiedAtrioventricular and left bundle-branch block (I44)
I45.0Right fascicular blockOther conduction disorders (I45)
I45.10Unspecified right bundle-branch blockOther conduction disorders (I45)
I45.19Other right bundle-branch blockOther conduction disorders (I45)
R03.0Elevated blood-pressure reading, without diagnosis of hypertensionAbnormal blood-pressure reading, without diagnosis (R03)
R97.20Elevated prostate specific antigen [PSA]Abnormal tumor markers (R97)
R97.21Rising PSA following treatment for malignant neoplasm of prostateAbnormal tumor markers (R97)
Z21Asymptomatic human immunodeficiency virus [HIV] infection statusAsymptomatic human immunodeficiency virus infection status (Z21)
Z45.010Encounter for checking and testing of cardiac pacemaker pulse generator [battery]Encounter for adjustment and management of implanted device (Z45)
Z45.018Encounter for adjustment and management of other part of cardiac pacemakerEncounter for adjustment and management of implanted device (Z45)
Z45.02Encounter for adjustment and management of automatic implantable cardiac defibrillatorEncounter for adjustment and management of implanted device (Z45)
Z45.09Encounter for adjustment and management of other cardiac deviceEncounter for adjustment and management of implanted device (Z45)