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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 30 ICD-10-CM codes are intended for questionable admission codes

  • Type 2 diabetes mellitus (E11)

    • E11.9 - Type 2 diabetes mellitus without complications

  • Other specified diabetes mellitus (E13)

    • E13.9 - Other specified diabetes mellitus without complications

  • Overweight and obesity (E66)

    • E66.09 - Other obesity due to excess calories

    • E66.1 - Drug-induced obesity

    • E66.811 - Obesity, class 1

    • E66.812 - Obesity, class 2

    • E66.813 - Obesity, class 3

    • E66.89 - Other obesity not elsewhere classified

    • E66.9 - Obesity, unspecified

  • Other disorders of external ear (H61)

    • H61.20 - Impacted cerumen, unspecified ear

    • H61.21 - Impacted cerumen, right ear

    • H61.22 - Impacted cerumen, left ear

    • H61.23 - Impacted cerumen, bilateral

  • Essential (primary) hypertension (I10)

    • I10 - Essential (primary) hypertension

  • Atrioventricular and left bundle-branch block (I44)

    • 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

  • Other conduction disorders (I45)

    • I45.0 - Right fascicular block

    • I45.10 - Unspecified right bundle-branch block

    • I45.19 - Other right bundle-branch block

  • Abnormal blood-pressure reading, without diagnosis (R03)

    • R03.0 - Elevated blood-pressure reading, without diagnosis of hypertension

  • Abnormal tumor markers (R97)

    • R97.20 - Elevated prostate specific antigen [PSA]

    • R97.21 - Rising PSA following treatment for malignant neoplasm of prostate

  • Asymptomatic human immunodeficiency virus [HIV] infection status (Z21)

    • Z21 - Asymptomatic human immunodeficiency virus [HIV] infection status

  • Encounter for adjustment and management of implanted device (Z45)

    • Z45.010 - Encounter for checking and testing of cardiac pacemaker pulse generator [battery]

    • Z45.018 - Encounter for adjustment and management of other part of cardiac pacemaker

    • Z45.02 - Encounter for adjustment and management of automatic implantable cardiac defibrillator

    • Z45.09 - Encounter for adjustment and management of other cardiac device