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
- Abnormal blood-pressure reading, without diagnosis (R03)
- Abnormal tumor markers (R97)
- Asymptomatic human immunodeficiency virus [HIV] infection st
- Atrioventricular and left bundle-branch block (I44)
- Encounter for adjustment and management of implanted device
- Essential (primary) hypertension (I10)
- Other conduction disorders (I45)
- Other disorders of external ear (H61)
- Other specified diabetes mellitus (E13)
- Overweight and obesity (E66)
- Type 2 diabetes mellitus (E11)
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Type 2 diabetes mellitus (E11)
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E11.9 - Type 2 diabetes mellitus without complications
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Other specified diabetes mellitus (E13)
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E13.9 - Other specified diabetes mellitus without complications
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Overweight and obesity (E66)
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Other disorders of external ear (H61)
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Essential (primary) hypertension (I10)
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I10 - Essential (primary) hypertension
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Atrioventricular and left bundle-branch block (I44)
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Other conduction disorders (I45)
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Abnormal blood-pressure reading, without diagnosis (R03)
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R03.0 - Elevated blood-pressure reading, without diagnosis of hypertension
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Abnormal tumor markers (R97)
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Asymptomatic human immunodeficiency virus [HIV] infection status (Z21)
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Z21 - Asymptomatic human immunodeficiency virus [HIV] infection status
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Encounter for adjustment and management of implanted device (Z45)
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Z45.010 - Encounter for checking and testing of cardiac pacemaker pulse generator [battery]
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Z45.018 - Encounter for adjustment and management of other part of cardiac pacemaker
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Z45.02 - Encounter for adjustment and management of automatic implantable cardiac defibrillator
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Z45.09 - Encounter for adjustment and management of other cardiac device
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