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 Code | Description | Category |
|---|---|---|
| E11.9 | Type 2 diabetes mellitus without complications | Type 2 diabetes mellitus (E11) |
| E13.9 | Other specified diabetes mellitus without complications | Other specified diabetes mellitus (E13) |
| E66.09 | Other obesity due to excess calories | Overweight and obesity (E66) |
| E66.1 | Drug-induced obesity | Overweight and obesity (E66) |
| E66.8 | Other obesity | Overweight and obesity (E66) |
| E66.9 | Obesity, unspecified | Overweight and obesity (E66) |
| H61.20 | Impacted cerumen, unspecified ear | Other disorders of external ear (H61) |
| H61.21 | Impacted cerumen, right ear | Other disorders of external ear (H61) |
| H61.22 | Impacted cerumen, left ear | Other disorders of external ear (H61) |
| H61.23 | Impacted cerumen, bilateral | Other disorders of external ear (H61) |
| I10 | Essential (primary) hypertension | Essential (primary) hypertension (I10) |
| I44.4 | Left anterior fascicular block | Atrioventricular and left bundle-branch block (I44) |
| I44.5 | Left posterior fascicular block | Atrioventricular and left bundle-branch block (I44) |
| I44.60 | Unspecified fascicular block | Atrioventricular and left bundle-branch block (I44) |
| I44.69 | Other fascicular block | Atrioventricular and left bundle-branch block (I44) |
| I44.7 | Left bundle-branch block, unspecified | Atrioventricular and left bundle-branch block (I44) |
| I45.0 | Right fascicular block | Other conduction disorders (I45) |
| I45.10 | Unspecified right bundle-branch block | Other conduction disorders (I45) |
| I45.19 | Other right bundle-branch block | Other conduction disorders (I45) |
| R03.0 | Elevated blood-pressure reading, without diagnosis of hypertension | Abnormal blood-pressure reading, without diagnosis (R03) |
| R97.20 | Elevated prostate specific antigen [PSA] | Abnormal tumor markers (R97) |
| R97.21 | Rising PSA following treatment for malignant neoplasm of prostate | Abnormal tumor markers (R97) |
| Z21 | Asymptomatic human immunodeficiency virus [HIV] infection status | Asymptomatic human immunodeficiency virus infection status (Z21) |
| Z45.010 | Encounter for checking and testing of cardiac pacemaker pulse generator [battery] | Encounter for adjustment and management of implanted device (Z45) |
| Z45.018 | Encounter for adjustment and management of other part of cardiac pacemaker | Encounter for adjustment and management of implanted device (Z45) |
| Z45.02 | Encounter for adjustment and management of automatic implantable cardiac defibrillator | Encounter for adjustment and management of implanted device (Z45) |
| Z45.09 | Encounter for adjustment and management of other cardiac device | Encounter for adjustment and management of implanted device (Z45) |
