ICD-10 CM Codes that support Medical Necessity for CPT Code 86003 Part 03

T41.45XS Adverse effect of unspecified anesthetic, sequela
T41.45XD Adverse effect of unspecified anesthetic, subsequent encounter
T43.205A Adverse effect of unspecified antidepressants, initial encounter
T43.205S Adverse effect of unspecified antidepressants, sequela
T43.205D Adverse effect of unspecified antidepressants, subsequent encounter
T42.75XA Adverse effect of unspecified antiepileptic and sedative-hypnotic drugs, initial encounter
T42.75XS Adverse effect of unspecified antiepileptic and sedative-hypnotic drugs, sequela
T42.75XD Adverse effect of unspecified antiepileptic and sedative-hypnotic drugs, subsequent encounter
T43.505A Adverse effect of unspecified antipsychotics and neuroleptics, initial encounter
T43.505S Adverse effect of unspecified antipsychotics and neuroleptics, sequela
T43.505D Adverse effect of unspecified antipsychotics and neuroleptics, subsequent encounter
T48.205A Adverse effect of unspecified drugs acting on muscles, initial encounter
T48.205S Adverse effect of unspecified drugs acting on muscles, sequela
T48.205D Adverse effect of unspecified drugs acting on muscles, subsequent encounter
T44.905A Adverse effect of unspecified drugs primarily affecting the autonomic nervous system, initial encounter
T44.905S Adverse effect of unspecified drugs primarily affecting the autonomic nervous system, sequela
T44.905D Adverse effect of unspecified drugs primarily affecting the autonomic nervous system, subsequent encounter
T50.905A Adverse effect of unspecified drugs, medicaments and biological substances, initial encounter
T50.905S Adverse effect of unspecified drugs, medicaments and biological substances, sequela
T50.905D Adverse effect of unspecified drugs, medicaments and biological substances, subsequent encounter
T45.605A Adverse effect of unspecified fibrinolysis-affecting drugs, initial encounter
T45.605S Adverse effect of unspecified fibrinolysis-affecting drugs, sequela
T45.605D Adverse effect of unspecified fibrinolysis-affecting drugs, subsequent encounter
T41.205A Adverse effect of unspecified general anesthetics, initial encounter
T41.205S Adverse effect of unspecified general anesthetics, sequela
T41.205D Adverse effect of unspecified general anesthetics, subsequent encounter
T38.905A Adverse effect of unspecified hormone antagonists, initial encounter
T38.905S Adverse effect of unspecified hormone antagonists, sequela
T38.905D Adverse effect of unspecified hormone antagonists, subsequent encounter
T38.805A Adverse effect of unspecified hormones and synthetic substitutes, initial encounter
T38.805S Adverse effect of unspecified hormones and synthetic substitutes, sequela
T38.805D Adverse effect of unspecified hormones and synthetic substitutes, subsequent encounter
T40.605A Adverse effect of unspecified narcotics, initial encounter
T40.605S Adverse effect of unspecified narcotics, sequela
T40.605D Adverse effect of unspecified narcotics, subsequent encounter
T39.95XA Adverse effect of unspecified nonopioid analgesic, antipyretic and antirheumatic, initial encounter
T39.95XS Adverse effect of unspecified nonopioid analgesic, antipyretic and antirheumatic, sequela
T39.95XD Adverse effect of unspecified nonopioid analgesic, antipyretic and antirheumatic, subsequent encounter
T45.95XA Adverse effect of unspecified primarily systemic and hematological agent, initial encounter
T45.95XS Adverse effect of unspecified primarily systemic and hematological agent, sequela
T45.95XD Adverse effect of unspe
T40.905A Adverse effect of unspecified psychodysleptics [hallucinogens], initial encounter
T40.905S Adverse effect of unspecified psychodysleptics [hallucinogens], sequela
T40.905D Adverse effect of unspecified psychodysleptics [hallucinogens], subsequent encounter
T43.605A Adverse effect of unspecified psychostimulants, initial encounter
T43.605S Adverse effect of unspecified psychostimulants, sequela
T43.605D Adverse effect of unspecified psychostimulants, subsequent encounter
T43.95XA Adverse effect of unspecified psychotropic drug, initial encounter
T43.95XS Adverse effect of unspecified psychotropic drug, sequela
T43.95XD Adverse effect of unspecified psychotropic drug, subsequent encounter
T36.95XA Adverse effect of unspecified systemic antibiotic, initial encounter
T36.95XS Adverse effect of unspecified systemic antibiotic, sequela
T36.95XD Adverse effect of unspecified systemic antibiotic, subsequent encounter
T37.95XA Adverse effect of unspecified systemic anti-infective and antiparasitic, initial encounter
T37.95XS Adverse effect of unspecified systemic anti-infective and antiparasitic, sequela
T37.95XD Adverse effect of unspecified systemic anti-infective and antiparasitic, subsequent encounter
T49.95XA Adverse effect of unspecified topical agent, initial encounter
T49.95XS Adverse effect of unspecified topical agent, sequela
T49.95XD Adverse effect of unspecified topical agent, subsequent encounter
T45.2X5A Adverse effect of vitamins, initial encounter
T45.2X5S Adverse effect of vitamins, sequela
T45.2X5D Adverse effect of vitamins, subsequent encounter
B44.81 Allergic bronchopulmonary aspergillosis
L23.9 Allergic contact dermatitis, unspecified cause
J30.81 Allergic rhinitis due to animal (cat) (dog) hair and dander
J30.5 Allergic rhinitis due to food
J30.1 Allergic rhinitis due to pollen
L50.0 Allergic urticaria
Z88.6 Allergy status to analgesic agent status
Z88.4 Allergy status to anesthetic agent status
Z88.5 Allergy status to narcotic agent status
Z88.1 Allergy status to other antibiotic agents status
Z88.3 Allergy status to other anti-infective agents status
Z88.8 Allergy status to other drugs, medicaments and biological substances status
Z88.0 Allergy status to penicillin
Z88.7 Allergy status to serum and vaccine status
Z88.2 Allergy status to sulfonamides status
Z91.012 Allergy to eggs
Z91.011 Allergy to milk products
Z91.018 Allergy to other foods
Z91.010 Allergy to peanuts
Z91.013 Allergy to seafood
T78.40XA Allergy, unspecified, initial encounter
T80.51XA Anaphylactic reaction due to administration of blood and blood products, initial encounter
T88.6XXA Anaphylactic reaction due to adverse effect of correct drug or medicament
properly administered, initial encounter
T78.08XA Anaphylactic reaction due to eggs, initial encounter
T78.06XA Anaphylactic reaction due to food additives, initial encounter
T78.04XA Anaphylactic reaction due to fruits and vegetables, initial encounter
T78.07XA Anaphylactic reaction due to milk and dairy products, initial encounter
T78.03XA Anaphylactic reaction due to other fish, initial encounter
T78.09XA Anaphylactic reaction due to other food products, initial encounter
T80.59XA Anaphylactic reaction due to other serum, initial encounter
T78.01XA Anaphylactic reaction due to peanuts, initial encounter
T78.02XA Anaphylactic reaction due to shellfish (crustaceans), initial encounter
T78.05XA Anaphylactic reaction due to tree nuts and seeds, initial encounter
T78.00XA Anaphylactic reaction due to unspecified food, initial encounter
T80.52XA Anaphylactic reaction due to vaccination, initial encounter
T78.2XXA Anaphylactic shock, unspecified, initial encounter
T78.3XXA Angioneurotic edema, initial encounter
R43.0 Anosmia
L20.81 Atopic neurodermatitis
L20.0 Besnier’s prurigo
J35.02 Chronic adenoiditis
H65.413 Chronic allergic otitis media, bilateral
H65.412 Chronic allergic otitis media, left ear
H65.411 Chronic allergic otitis media, right ear
J32.2 Chronic ethmoidal sinusitis
H68.023 Chronic Eustachian salpingitis, bilateral
H68.022 Chronic Eustachian salpingitis, left ear
H68.021 Chronic Eustachian salpingitis, right ear
J32.1 Chronic frontal sinusitis
H10.413 Chronic giant papillary conjunctivitis, bilateral
H10.412 Chronic giant papillary conjunctivitis, left eye
H10.411 Chronic giant papillary conjunctivitis, right eye
J32.0 Chronic maxillary sinusitis
J31.1 Chronic nasopharyngitis
J31.2 Chronic pharyngitis
J31.0 Chronic rhinitis
H65.23 Chronic serous otitis media, bilateral
H65.22 Chronic serous otitis media, left ear
H65.21 Chronic serous otitis media, right ear
J32.3 Chronic sphenoidal sinusitis
K29.30 Chronic superficial gastritis without bleeding
J35.01 Chronic tonsillitis
J35.03 Chronic tonsillitis and adenoiditis
L50.6 Contact urticaria
R05 Cough
J45.991 Cough variant asthma
L30.2 Cutaneous autosensitization
L27.2 Dermatitis due to ingested food
L27.8 Dermatitis due to other substances taken internally
L27.9 Dermatitis due to unspecified substance taken internally
L50.3 Dermatographic urticaria
L20.82 Flexural eczema
L27.0 Generalized skin eruption due to drugs and medicaments taken internally
J35.2 Hypertrophy of adenoids
J34.3 Hypertrophy of nasal turbinates
J35.1 Hypertrophy of tonsils
J35.3 Hypertrophy of tonsils with hypertrophy of adenoids
L50.1 Idiopathic urticaria
L20.84 Intrinsic (allergic) eczema
L24.9 Irritant contact dermatitis, unspecified cause
L27.1 Localized skin eruption due to drugs and medicaments taken internally
J45.21 Mild intermittent asthma with (acute) exacerbation
J45.22 Mild intermittent asthma with status asthmaticus
J45.20 Mild intermittent asthma, uncomplicated
J45.31 Mild persistent asthma with (acute) exacerbation
J45.32 Mild persistent asthma with status asthmaticus
J45.30 Mild persistent asthma, uncomplicated
J45.41 Moderate persistent asthma with (acute) exacerbation
J45.42 Moderate persistent asthma with status asthmaticus
J45.40 Moderate persistent asthma, uncomplicated
R09.81 Nasal congestion
J34.81 Nasal mucositis (ulcerative)
L30.0 Nummular dermatitis
J01.81 Other acute recurrent sinusitis
J01.80 Other acute sinusitis
T78.1XXA Other adverse food reactions, not elsewhere classified, initial encounter
J30.89 Other allergic rhinitis
Z91.09 Other allergy status, other than to drugs and biological substances
T78.49XA Other allergy, initial encounter
J45.998 Other asthma
L20.89 Other atopic dermatitis
H10.45 Other chronic allergic conjunctivitis
H65.493 Other chronic nonsuppurative otitis media, bilateral
H65.492 Other chronic nonsuppurative otitis media, left ear
H65.491 Other chronic nonsuppurative otitis media, right ear
R43.8 Other disturbances of smell and taste
R06.09 Other forms of dyspnea
K29.60 Other gastritis without bleeding
Z91.048 Other nonmedicinal substance allergy status
J33.8 Other polyp of sinus
J30.2 Other seasonal allergic rhinitis
T80.61XA Other serum reaction due to administration of blood and blood products, initial encounter
T80.69XA Other serum reaction due to other serum, initial encounter
T80.62XA Other serum reaction due to vaccination, initial encounter
L30.8 Other specified dermatitis
J34.89 Other specified disorders of nose and nasal sinuses
L50.8 Other urticaria
H66.93 Otitis media, unspecified, bilateral
H66.92 Otitis media, unspecified, left ear
H66.91 Otitis media, unspecified, right ear
R43.2 Parageusia
R43.1 Parosmia
T39.1X1A Poisoning by 4-Aminophenol derivatives, accidental (unintentional), initial encounter
T39.1X1S Poisoning by 4-Aminophenol derivatives, accidental (unintentional), sequela
T39.1X1D Poisoning by 4-Aminophenol derivatives, accidental (unintentional), subsequent encounter
T39.1X3A Poisoning by 4-Aminophenol derivatives, assault, initial encounter
T39.1X3S Poisoning by 4-Aminophenol derivatives, assault, sequela
T39.1X3D Poisoning by 4-Aminophenol derivatives, assault, subsequent encounter
T39.1X2A Poisoning by 4-Aminophenol derivatives, intentional self-harm, initial encounter
T39.1X2S Poisoning by 4-Aminophenol derivatives, intentional self-harm, sequela
T39.1X2D Poisoning by 4-Aminophenol derivatives, intentional self-harm, subsequent encounter
T39.1X4A Poisoning by 4-Aminophenol derivatives, undetermined, initial encounter
T39.1X4S Poisoning by 4-Aminophenol derivatives, undetermined, sequela
T39.1X4D Poisoning by 4-Aminophenol derivatives, undetermined, subsequent encounter
T44.6X1A Poisoning by alpha-adrenoreceptor antagonists, accidental (unintentional), initial encounter
T44.6X1S Poisoning by alpha-adrenoreceptor antagonists, accidental (unintentional), sequela
T44.6X1D Poisoning by alpha-adrenoreceptor antagonists, accidental (unintentional), subsequent encounter
T44.6X3A Poisoning by alpha-adrenoreceptor antagonists, assault, initial encounter
T44.6X3S Poisoning by alpha-adrenoreceptor antagonists, assault, sequela
T44.6X3D Poisoning by alpha-adrenoreceptor antagonists, assault, subsequent encounter
T44.6X2A Poisoning by alpha-adrenoreceptor antagonists, intentional self-harm, initial encounter
T44.6X2S Poisoning by alpha-adrenoreceptor antagonists, intentional self-harm, sequela
T44.6X2D Poisoning by alpha-adrenoreceptor antagonists, intentional self-harm, subsequent encounter
T44.6X4A Poisoning by alpha-adrenoreceptor antagonists, undetermined, initial encounter
T44.6X4S Poisoning by alpha-adrenoreceptor antagonists, undetermined, sequela
T44.6X4D Poisoning by alpha-adrenoreceptor antagonists, undetermined, subsequent encounter
T36.5X1A Poisoning by aminoglycosides, accidental (unintentional), initial encounter
T36.5X1S Poisoning by aminoglycosides, accidental (unintentional), sequela
T36.5X1D Poisoning by aminoglycosides, accidental (unintentional), subsequent encounter
T36.5X3A Poisoning by aminoglycosides, assault, initial encounter
T36.5X3S Poisoning by aminoglycosides, assault, sequela
T36.5X3D Poisoning by aminoglycosides, assault, subsequent encounter
T36.5X2A Poisoning by aminoglycosides, intentional self-harm, initial encounter
T36.5X2S Poisoning by aminoglycosides, intentional self-harm, sequela
T36.5X2D Poisoning by aminoglycosides, intentional self-harm, subsequent encounter
T36.5X4A Poisoning by aminoglycosides, undetermined, initial encounter
T36.5X4S Poisoning by aminoglycosides, undetermined, sequela
T36.5X4D Poisoning by aminoglycosides, undetermined, subsequent encounter
T43.621A Poisoning by amphetamines, accidental (unintentional), initial encounter
T43.621S Poisoning by amphetamines, accidental (unintentional), sequela
T43.621D Poisoning by amphetamines, accidental (unintentional), subsequent encounter
T43.623A Poisoning by amphetamines, assault, initial encounter
T43.623S Poisoning by amphetamines, assault, sequela
T43.623D Poisoning by amphetamines, assault, subsequent encounter
T43.622A Poisoning by amphetamines, intentional self-harm, initial encounter
T43.622S Poisoning by amphetamines, intentional self-harm, sequela
T43.622D Poisoning by amphetamines, intentional self-harm, subsequent encounter
T43.624A Poisoning by amphetamines, undetermined, initial encounter
T43.624S Poisoning by amphetamines, undetermined, sequela
T43.624D Poisoning by amphetamines, undetermined, subsequent encounter
T50.7X1A Poisoning by analeptics and opioid receptor antagonists, accidental (unintentional), initial encounter
T50.7X1S Poisoning by analeptics and opioid receptor antagonists, accidental (unintentional), sequela
T50.7X1D Poisoning by analeptics and opioid receptor antagonists, accidental (unintentional), subsequent encounter
T50.7X3A Poisoning by analeptics and opioid receptor antagonists, assault, initial encounter
T50.7X3S Poisoning by analeptics and opioid receptor antagonists, assault, sequela
T50.7X3D Poisoning by analeptics and opioid receptor antagonists, assault, subsequent encounter
T50.7X2A Poisoning by analeptics and opioid receptor antagonists, intentional self-harm, initial encounter
T50.7X2S Poisoning by analeptics and opioid receptor antagonists, intentional self-harm, sequela
T50.7X2D Poisoning by analeptics and opioid receptor antagonists, intentional self-harm, subsequent encounter
T50.7X4A Poisoning by analeptics and opioid receptor antagonists, undetermined, initial encounter
T50.7X4S Poisoning by analeptics and opioid receptor antagonists, undetermined, sequela
T50.7X4D Poisoning by analeptics and opioid receptor antagonists, undetermined, subsequent encounter
T38.7X1A Poisoning by androgens and anabolic congeners, accidental (unintentional), initial encounter
T38.7X1S Poisoning by androgens and anabolic congeners, accidental (unintentional), sequela
T38.7X1D Poisoning by androgens and anabolic congeners, accidental (unintentional), subsequent encounter
T38.7X3A Poisoning by androgens and anabolic congeners, assault, initial encounter
T38.7X3S Poisoning by androgens and anabolic congeners, assault, sequela
T38.7X3D Poisoning by androgens and anabolic congeners, assault, subsequent encounter
T38.7X2A Poisoning by androgens and anabolic congeners, intentional self-harm, initial encounter
T38.7X2S Poisoning by androgens and anabolic congeners, intentional self-harm, sequela
T38.7X2D Poisoning by androgens and anabolic congeners, intentional self-harm, subsequent encounter
T38.7X4A Poisoning by androgens and anabolic congeners, undetermined, initial encounter
T38.7X4S Poisoning by androgens and anabolic congeners, undetermined, sequela
T38.7X4D Poisoning by androgens and anabolic congeners, undetermined, subsequent encounter
T46.4X1A Poisoning by angiotensin-converting-enzyme inhibitors, accidental (unintentional), initial encounter
T46.4X1S Poisoning by angiotensin-converting-enzyme inhibitors, accidental (unintentional), sequela
T46.4X1D Poisoning by angiotensin-converting-enzyme inhibitors, accidental (unintentional), subsequent encounter
T46.4X3A Poisoning by angiotensin-converting-enzyme inhibitors, assault, initial encounter
T46.4X3S Poisoning by angiotensin-converting-enzyme inhibitors, assault, sequela
T46.4X3D Poisoning by angiotensin-converting-enzyme inhibitors, assault, subsequent encounter
T46.4X2A Poisoning by angiotensin-converting-enzyme inhibitors, intentional self-harm, initial encounter
T46.4X2S Poisoning by angiotensin-converting-enzyme inhibitors, intentional self-harm, sequela
T46.4X2D Poisoning by angiotensin-converting-enzyme inhibitors, intentional self-harm, subsequent encounter
T46.4X4A Poisoning by angiotensin-converting-enzyme inhibitors, undetermined, initial encounter
T46.4X4S Poisoning by angiotensin-converting-enzyme inhibitors, undetermined, sequela
T46.4X4D Poisoning by angiotensin-converting-enzyme inhibitors, undetermined, subsequent encounter
T38.811A Poisoning by anterior pituitary [adenohypophyseal] hormones, accidental (unintentional), initial encounter
T38.811S Poisoning by anterior pituitary [adenohypophyseal] hormones, accidental (unintentional), sequela
T38.811D Poisoning by anterior pituitary [adenohypophyseal] hormones, accidental (unintentional), subsequent encounter
T38.813A Poisoning by anterior pituitary [adenohypophyseal] hormones, assault, initial encounter
T38.813S Poisoning by anterior pituitary [adenohypophyseal] hormones, assault, sequela
T38.813D Poisoning by anterior pituitary [adenohypophyseal] hormones, assault, subsequent encounter
T38.812A Poisoning by anterior pituitary [adenohypophyseal] hormones, intentional selfharm, initial encounter
T38.812S Poisoning by anterior pituitary [adenohypophyseal] hormones, intentional selfharm, sequela
T38.812D Poisoning by anterior pituitary [adenohypophyseal] hormones, intentional selfharm, subsequent encounter
T38.814A Poisoning by anterior pituitary [adenohypophyseal] hormones, undetermined, initial encounter
T38.814S Poisoning by anterior pituitary [adenohypophyseal] hormones, undetermined, sequela
T38.814D Poisoning by anterior pituitary [adenohypophyseal] hormones, undetermined, subsequent encounter
T37.4X1A Poisoning by anthelminthics, accidental (unintentional), initial encounter
T37.4X1S Poisoning by anthelminthics, accidental (unintentional), sequela
T37.4X1D Poisoning by anthelminthics, accidental (unintentional), subsequent encounter
T37.4X3A Poisoning by anthelminthics, assault, initial encounter
T37.4X3S Poisoning by anthelminthics, assault, sequela
T37.4X3D Poisoning by anthelminthics, assault, subsequent encounter
T37.4X2A Poisoning by anthelminthics, intentional self-harm, initial encounter
T37.4X2S Poisoning by anthelminthics, intentional self-harm, sequela
T37.4X2D Poisoning by anthelminthics, intentional self-harm, subsequent encounter
T37.4X4A Poisoning by anthelminthics, undetermined, initial encounter
T37.4X4S Poisoning by anthelminthics, undetermined, sequela
T37.4X4D Poisoning by anthelminthics, undetermined, subsequent encounter
T45.0X1A Poisoning by antiallergic and antiemetic drugs, accidental (unintentional), initial encounter
T45.0X1S Poisoning by antiallergic and antiemetic drugs, accidental (unintentional), sequela
T45.0X1D Poisoning by antiallergic and antiemetic drugs, accidental (unintentional), subsequent encounter
T45.0X3A Poisoning by antiallergic and antiemetic drugs, assault, initial encounter
T45.0X3S Poisoning by antiallergic and antiemetic drugs, assault, sequela
T45.0X3D Poisoning by antiallergic and antiemetic drugs, assault, subsequent encounter
T45.0X2A Poisoning by antiallergic and antiemetic drugs, intentional self-harm, initial encounter
T45.0X2S Poisoning by antiallergic and antiemetic drugs, intentional self-harm, sequela
T45.0X2D Poisoning by antiallergic and antiemetic drugs, intentional self-harm, subsequent encounter
T45.0X4A Poisoning by antiallergic and antiemetic drugs, undetermined, initial encounter
T45.0X4S Poisoning by antiallergic and antiemetic drugs, undetermined, sequela
T45.0X4D Poisoning by antiallergic and antiemetic drugs, undetermined, subsequent encounter
T48.6X1A Poisoning by antiasthmatics, accidental (unintentional), initial encounter
T48.6X1S Poisoning by antiasthmatics, accidental (unintentional), sequela
T48.6X1D Poisoning by antiasthmatics, accidental (unintentional), subsequent encounter
T48.6X3A Poisoning by antiasthmatics, assault, initial encounter
T48.6X3S Poisoning by antiasthmatics, assault, sequela
T48.6X3D Poisoning by antiasthmatics, assault, subsequent encounter
T48.6X2A Poisoning by antiasthmatics, intentional self-harm, initial encounter
T48.6X2S Poisoning by antiasthmatics, intentional self-harm, sequela
T48.6X2D Poisoning by antiasthmatics, intentional self-harm, subsequent encounter
T48.6X4A Poisoning by antiasthmatics, undetermined, initial encounter
T48.6X4S Poisoning by antiasthmatics, undetermined, sequela
T48.6X4D Poisoning by antiasthmatics, undetermined, subsequent encounter
T44.0X1A Poisoning by anticholinesterase agents, accidental (unintentional), initial encounter
T44.0X1S Poisoning by anticholinesterase agents, accidental (unintentional), sequela
T44.0X1D Poisoning by anticholinesterase agents, accidental (unintentional), subsequent encounter
T44.0X3A Poisoning by anticholinesterase agents, assault, initial encounter
T44.0X3S Poisoning by anticholinesterase agents, assault, sequela
T44.0X3D Poisoning by anticholinesterase agents, assault, subsequent encounter
T44.0X2A Poisoning by anticholinesterase agents, intentional self-harm, initial encounter
T44.0X2S Poisoning by anticholinesterase agents, intentional self-harm, sequela
T44.0X2D Poisoning by anticholinesterase agents, intentional self-harm, subsequent
encounter
T44.0X4A Poisoning by anticholinesterase agents, undetermined, initial encounter
T44.0X4S Poisoning by anticholinesterase agents, undetermined, sequela
T44.0X4D Poisoning by anticholinesterase agents, undetermined, subsequent encounter
T45.7X1A Poisoning by anticoagulant antagonists, vitamin K and other coagulants, accidental (unintentional), initial encounter
T45.7X1S Poisoning by anticoagulant antagonists, vitamin K and other coagulants, accidental (unintentional), sequela
T45.7X1D Poisoning by anticoagulant antagonists, vitamin K and other coagulants, accidental (unintentional), subsequent encounter
T45.7X3A Poisoning by anticoagulant antagonists, vitamin K and other coagulants, assault, initial encounter
T45.7X3S Poisoning by anticoagulant antagonists, vitamin K and other coagulants, assault, sequela
T45.7X3D Poisoning by anticoagulant antagonists, vitamin K and other coagulants, assault, subsequent encounter
T45.7X2A Poisoning by anticoagulant antagonists, vitamin K and other coagulants, intentional self-harm, initial encounter
T45.7X2S Poisoning by anticoagulant antagonists, vitamin K and other coagulants, intentional self-harm, sequela
T45.7X2D Poisoning by anticoagulant antagonists, vitamin K and other coagulants, intentional self-harm, subsequent encounter
T45.7X4A Poisoning by anticoagulant antagonists, vitamin K and other coagulants, undetermined, initial encounter
T45.7X4S Poisoning by anticoagulant antagonists, vitamin K and other coagulants, undetermined, sequela
T45.7X4D Poisoning by anticoagulant antagonists, vitamin K and other coagulants, undetermined, subsequent encounter
T45.511A Poisoning by anticoagulants, accidental (unintentional), initial encounter
T45.511S Poisoning by anticoagulants, accidental (unintentional), sequela
T45.511D Poisoning by anticoagulants, accidental (unintentional), subsequent encounter
T45.513A Poisoning by anticoagulants, assault, initial encounter
T45.513S Poisoning by anticoagulants, assault, sequela
T45.513D Poisoning by anticoagulants, assault, subsequent encounter
T45.512A Poisoning by anticoagulants, intentional self-harm, initial encounter
T45.512S Poisoning by anticoagulants, intentional self-harm, sequela
T45.512D Poisoning by anticoagulants, intentional self-harm, subsequent encounter
T45.514A Poisoning by anticoagulants, undetermined, initial encounter
T45.514S Poisoning by anticoagulants, undetermined, sequela
T45.514D Poisoning by anticoagulants, undetermined, subsequent encounter
T47.6X1A Poisoning by antidiarrheal drugs, accidental (unintentional), initial encounter
T47.6X1S Poisoning by antidiarrheal drugs, accidental (unintentional), sequela
T47.6X1D Poisoning by antidiarrheal drugs, accidental (unintentional), subsequent encounter
T47.6X3A Poisoning by antidiarrheal drugs, assault, initial encounter
T47.6X3S Poisoning by antidiarrheal drugs, assault, sequela
T47.6X3D Poisoning by antidiarrheal drugs, assault, subsequent encounter
T47.6X2A Poisoning by antidiarrheal drugs, intentional self-harm, initial encounter
T47.6X2S Poisoning by antidiarrheal drugs, intentional self-harm, sequela
T47.6X2D Poisoning by antidiarrheal drugs, intentional self-harm, subsequent encounter
T47.6X4A Poisoning by antidiarrheal drugs, undetermined, initial encounter

ICD-10 CM Codes that support Medical Necessity for CPT Code 86003 Part 02

T36.3X5A Adverse effect of macrolides, initial encounter
T36.3X5S Adverse effect of macrolides, sequela
T36.3X5D Adverse effect of macrolides, subsequent encounter
T40.3X5A Adverse effect of methadone, initial encounter
T40.3X5S Adverse effect of methadone, sequela
T40.3X5D Adverse effect of methadone, subsequent encounter
T43.635A Adverse effect of methylphenidate, initial encounter
T43.635S Adverse effect of methylphenidate, sequela
T43.635D Adverse effect of methylphenidate, subsequent encounter
T50.0X5A Adverse effect of mineralocorticoids and their antagonists, initial encounter
T50.0X5S Adverse effect of mineralocorticoids and their antagonists, sequela
T50.0X5D Adverse effect of mineralocorticoids and their antagonists, subsequent encounter
T42.5X5A Adverse effect of mixed antiepileptics, initial encounter
T42.5X5S Adverse effect of mixed antiepileptics, sequela
T42.5X5D Adverse effect of mixed antiepileptics, subsequent encounter
T50.A25A Adverse effect of mixed bacterial vaccines without a pertussis component, initial encounter
T50.A25S Adverse effect of mixed bacterial vaccines without a pertussis component, sequela
T50.A25D Adverse effect of mixed bacterial vaccines without a pertussis component, subsequent encounter
T43.1X5A Adverse effect of monoamine-oxidase-inhibitor antidepressants, initial encounter
T43.1X5S Adverse effect of monoamine-oxidase-inhibitor antidepressants, sequela
T43.1X5D Adverse effect of monoamine-oxidase-inhibitor antidepressants, subsequent encounter
T49.5X5A Adverse effect of ophthalmological drugs and preparations, initial encounter
T49.5X5S Adverse effect of ophthalmological drugs and preparations, sequela
T49.5X5D Adverse effect of ophthalmological drugs and preparations, subsequent encounter
T40.0X5A Adverse effect of opium, initial encounter
T40.0X5S Adverse effect of opium, sequela
T40.0X5D Adverse effect of opium, subsequent encounter
T38.4X5A Adverse effect of oral contraceptives, initial encounter
T38.4X5S Adverse effect of oral contraceptives, sequela
T38.4X5D Adverse effect of oral contraceptives, subsequent encounter
T48.995A Adverse effect of other agents primarily acting on the respiratory system, initial encounter
T48.995S Adverse effect of other agents primarily acting on the respiratory system, sequela
T48.995D Adverse effect of other agents primarily acting on the respiratory system, subsequent encounter
T47.8X5A Adverse effect of other agents primarily affecting gastrointestinal system, initial encounter
T47.8X5S Adverse effect of other agents primarily affecting gastrointestinal system, sequela
T47.8X5D Adverse effect of other agents primarily affecting gastrointestinal system, subsequent encounter
T46.995A Adverse effect of other agents primarily affecting the cardiovascular system, initial encounter
T46.995S Adverse effect of other agents primarily affecting the cardiovascular system, sequela
T46.995D Adverse effect of other agents primarily affecting the cardiovascular system, subsequent encounter
T47.1X5A Adverse effect of other antacids and anti-gastric-secretion drugs, initial encounter
T47.1X5S Adverse effect of other antacids and anti-gastric-secretion drugs, sequela
T47.1X5D Adverse effect of other antacids and anti-gastric-secretion drugs, subsequent encounter
T48.5X5A Adverse effect of other anti-common-cold drugs, initial encounter
T48.5X5S Adverse effect of other anti-common-cold drugs, sequela
T48.5X5D Adverse effect of other anti-common-cold drugs, subsequent encounter
T43.295A Adverse effect of other antidepressants, initial encounter
T43.295S Adverse effect of other antidepressants, sequela
T43.295D Adverse effect of other antidepressants, subsequent encounter
T46.2X5A Adverse effect of other antidysrhythmic drugs, initial encounter
T46.2X5S Adverse effect of other antidysrhythmic drugs, sequela
T46.2X5D Adverse effect of other antidysrhythmic drugs, subsequent encounter
T42.6X5A Adverse effect of other antiepileptic and sedative-hypnotic drugs, initial encounter
T42.6X5S Adverse effect of other antiepileptic and sedative-hypnotic drugs, sequela
T42.6X5D Adverse effect of other antiepileptic and sedative-hypnotic drugs, subsequent encounter
T46.5X5A Adverse effect of other antihypertensive drugs, initial encounter
T46.5X5S Adverse effect of other antihypertensive drugs, sequela
T46.5X5D Adverse effect of other antihypertensive drugs, subsequent encounter
T37.3X5A Adverse effect of other antiprotozoal drugs, initial encounter
T37.3X5S Adverse effect of other antiprotozoal drugs, sequela
T37.3X5D Adverse effect of other antiprotozoal drugs, subsequent encounter
T43.595A Adverse effect of other antipsychotics and neuroleptics, initial encounter
T43.595S Adverse effect of other antipsychotics and neuroleptics, sequela
T43.595D Adverse effect of other antipsychotics and neuroleptics, subsequent encounter
T50.A95A Adverse effect of other bacterial vaccines, initial encounter
T50.A95S Adverse effect of other bacterial vaccines, sequela
T50.A95D Adverse effect of other bacterial vaccines, subsequent encounter
T44.995A Adverse effect of other drug primarily affecting the autonomic nervous system, initial encounter
T44.995S Adverse effect of other drug primarily affecting the autonomic nervous system, sequela
T44.995D Adverse effect of other drug primarily affecting the autonomic nervous system, subsequent encounter
T48.295A Adverse effect of other drugs acting on muscles, initial encounter
T48.295S Adverse effect of other drugs acting on muscles, sequela
T48.295D Adverse effect of other drugs acting on muscles, subsequent encounter
T50.995A Adverse effect of other drugs, medicaments and biological substances, initial encounter
T50.995S Adverse effect of other drugs, medicaments and biological substances, sequela
T50.995D Adverse effect of other drugs, medicaments and biological substances, subsequent encounter
T38.5X5A Adverse effect of other estrogens and progestogens, initial encounter
T38.5X5S Adverse effect of other estrogens and progestogens, sequela
T38.5X5D Adverse effect of other estrogens and progestogens, subsequent encounter
T45.695A Adverse effect of other fibrinolysis-affecting drugs, initial encounter
T45.695S Adverse effect of other fibrinolysis-affecting drugs, sequela
T45.695D Adverse effect of other fibrinolysis-affecting drugs, subsequent encounter
T41.295A Adverse effect of other general anesthetics, initial encounter
T41.295S Adverse effect of other general anesthetics, sequela
T41.295D Adverse effect of other general anesthetics, subsequent encounter
T38.995A Adverse effect of other hormone antagonists, initial encounter
T38.995S Adverse effect of other hormone antagonists, sequela
T38.995D Adverse effect of other hormone antagonists, subsequent encounter
T38.895A Adverse effect of other hormones and synthetic substitutes, initial encounter
T38.895S Adverse effect of other hormones and synthetic substitutes, sequela
T38.895D Adverse effect of other hormones and synthetic substitutes, subsequent encounter
T47.4X5A Adverse effect of other laxatives, initial encounter
T47.4X5S Adverse effect of other laxatives, sequela
T47.4X5D Adverse effect of other laxatives, subsequent encounter
T40.695A Adverse effect of other narcotics, initial encounter
T40.695S Adverse effect of other narcotics, sequela
T40.695D Adverse effect of other narcotics, subsequent encounter
T39.8X5A Adverse effect of other nonopioid analgesics and antipyretics, not elsewhere classified, initial encounter
T39.8X5S Adverse effect of other nonopioid analgesics and antipyretics, not elsewhere classified, sequela
T39.8X5D Adverse effect of other nonopioid analgesics and antipyretics, not elsewhere classified, subsequent encounter
T39.395A Adverse effect of other nonsteroidal anti-inflammatory drugs [NSAID], initial encounter
T39.395S Adverse effect of other nonsteroidal anti-inflammatory drugs [NSAID], sequela
T39.395D Adverse effect of other nonsteroidal anti-inflammatory drugs [NSAID], subsequent encounter
T40.2X5A Adverse effect of other opioids, initial encounter
T40.2X5S Adverse effect of other opioids, sequela
T40.2X5D Adverse effect of other opioids, subsequent encounter
T44.3X5A Adverse effect of other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, initial encounter
T44.3X5S Adverse effect of other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, sequela
T44.3X5D Adverse effect of other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, subsequent encounter
T44.1X5A Adverse effect of other parasympathomimetics [cholinergics], initial encounter
T44.1X5S Adverse effect of other parasympathomimetics [cholinergics], sequela
T44.1X5D Adverse effect of other parasympathomimetics [cholinergics], subsequent encounter
T45.8X5A Adverse effect of other primarily systemic and hematological agents, initial encounter
T45.8X5S Adverse effect of other primarily systemic and hematological agents, sequela
T45.8X5D Adverse effect of other primarily systemic and hematological agents, subsequent encounter
T40.995A Adverse effect of other psychodysleptics [hallucinogens], initial encounter
T40.995S Adverse effect of other psychodysleptics [hallucinogens], sequela
T40.995D Adverse effect of other psychodysleptics [hallucinogens], subsequent encounter
T43.695A Adverse effect of other psychostimulants, initial encounter
T43.695S Adverse effect of other psychostimulants, sequela
T43.695D Adverse effect of other psychostimulants, subsequent encounter
T43.8X5A Adverse effect of other psychotropic drugs, initial encounter
T43.8X5S Adverse effect of other psychotropic drugs, sequela
T43.8X5D Adverse effect of other psychotropic drugs, subsequent encounter
T37.8X5A Adverse effect of other specified systemic anti-infectives and antiparasitics, initial encounter
T37.8X5S Adverse effect of other specified systemic anti-infectives and antiparasitics, sequela
T37.8X5D Adverse effect of other specified systemic anti-infectives and antiparasitics, subsequent encounter
T40.4X5A Adverse effect of other synthetic narcotics, initial encounter
T40.4X5S Adverse effect of other synthetic narcotics, sequela
T40.4X5D Adverse effect of other synthetic narcotics, subsequent encounter
T36.8X5A Adverse effect of other systemic antibiotics, initial encounter
T36.8X5S Adverse effect of other systemic antibiotics, sequela
T36.8X5D Adverse effect of other systemic antibiotics, subsequent encounter
T49.8X5A Adverse effect of other topical agents, initial encounter
T49.8X5S Adverse effect of other topical agents, sequela
T49.8X5D Adverse effect of other topical agents, subsequent encounter
T50.Z95A Adverse effect of other vaccines and biological substances, initial encounter
T50.Z95S Adverse effect of other vaccines and biological substances, sequela
T50.Z95D Adverse effect of other vaccines and biological substances, subsequent encounter
T50.B95A Adverse effect of other viral vaccines, initial encounter
T50.B95S Adverse effect of other viral vaccines, sequela
T50.B95D Adverse effect of other viral vaccines, subsequent encounter
T49.6X5A Adverse effect of otorhinolaryngological drugs and preparations, initial encounter
T49.6X5S Adverse effect of otorhinolaryngological drugs and preparations, sequela
T49.6X5D Adverse effect of otorhinolaryngological drugs and preparations, subsequent encounter
T48.0X5A Adverse effect of oxytocic drugs, initial encounter
T48.0X5S Adverse effect of oxytocic drugs, sequela
T48.0X5D Adverse effect of oxytocic drugs, subsequent encounter
T36.0X5A Adverse effect of penicillins, initial encounter
T36.0X5S Adverse effect of penicillins, sequela
T36.0X5D Adverse effect of penicillins, subsequent encounter
T46.7X5A Adverse effect of peripheral vasodilators, initial encounter
T46.7X5S Adverse effect of peripheral vasodilators, sequela
T46.7X5D Adverse effect of peripheral vasodilators, subsequent encounter
T50.A15A Adverse effect of pertussis vaccine, including combinations with a pertussis component, initial encounter
T50.A15S Adverse effect of pertussis vaccine, including combinations with a pertussis component, sequela
T50.A15D Adverse effect of pertussis vaccine, including combinations with a pertussis component, subsequent encounter
T43.3X5A Adverse effect of phenothiazine antipsychotics and neuroleptics, initial encounter
T43.3X5S Adverse effect of phenothiazine antipsychotics and neuroleptics, sequela
T43.3X5D Adverse effect of phenothiazine antipsychotics and neuroleptics, subsequent encounter
T44.4X5A Adverse effect of predominantly alpha-adrenoreceptor agonists, initial encounter
T44.4X5S Adverse effect of predominantly alpha-adrenoreceptor agonists, sequela
T44.4X5D Adverse effect of predominantly alpha-adrenoreceptor agonists, subsequent encounter
T44.5X5A Adverse effect of predominantly beta-adrenoreceptor agonists, initial encounter
T44.5X5S Adverse effect of predominantly beta-adrenoreceptor agonists, sequela
T44.5X5D Adverse effect of predominantly beta-adrenoreceptor agonists, subsequent encounter
T39.315A Adverse effect of propionic acid derivatives, initial encounter
T39.315S Adverse effect of propionic acid derivatives, sequela
T39.315D Adverse effect of propionic acid derivatives, subsequent encounter
T39.2X5A Adverse effect of pyrazolone derivatives, initial encounter
T39.2X5S Adverse effect of pyrazolone derivatives, sequela
T39.2X5D Adverse effect of pyrazolone derivatives, subsequent encounter
T36.6X5A Adverse effect of rifampicins, initial encounter
T36.6X5S Adverse effect of rifampicins, sequela
T36.6X5D Adverse effect of rifampicins, subsequent encounter
T39.095A Adverse effect of salicylates, initial encounter
T39.095S Adverse effect of salicylates, sequela
T39.095D Adverse effect of salicylates, subsequent encounter
T47.3X5A Adverse effect of saline and osmotic laxatives, initial encounter
T47.3X5S Adverse effect of saline and osmotic laxatives, sequela
T47.3X5D Adverse effect of saline and osmotic laxatives, subsequent encounter
T43.215A Adverse effect of selective serotonin and norepinephrine reuptake inhibitors, initial encounter
T43.215S Adverse effect of selective serotonin and norepinephrine reuptake inhibitors, sequela
T43.215D Adverse effect of selective serotonin and norepinephrine reuptake inhibitors, subsequent encounter
T43.225A Adverse effect of selective serotonin reuptake inhibitors, initial encounter
T43.225S Adverse effect of selective serotonin reuptake inhibitors, sequela
T43.225D Adverse effect of selective serotonin reuptake inhibitors, subsequent encounter
T48.1X5A Adverse effect of skeletal muscle relaxants [neuromuscular blocking agents], initial encounter
T48.1X5S Adverse effect of skeletal muscle relaxants [neuromuscular blocking agents], sequela
T48.1X5D Adverse effect of skeletal muscle relaxants [neuromuscular blocking agents], subsequent encounter
T50.B15A Adverse effect of smallpox vaccines, initial encounter
T50.B15S Adverse effect of smallpox vaccines, sequela
T50.B15D Adverse effect of smallpox vaccines, subsequent encounter
T47.2X5A Adverse effect of stimulant laxatives, initial encounter
T47.2X5S Adverse effect of stimulant laxatives, sequela
T47.2X5D Adverse effect of stimulant laxatives, subsequent encounter
T42.2X5A Adverse effect of succinimides and oxazolidinediones, initial encounter
T42.2X5S Adverse effect of succinimides and oxazolidinediones, sequela
T42.2X5D Adverse effect of succinimides and oxazolidinediones, subsequent encounter
T37.0X5A Adverse effect of sulfonamides, initial encounter
T37.0X5S Adverse effect of sulfonamides, sequela
T37.0X5D Adverse effect of sulfonamides, subsequent encounter
T43.025A Adverse effect of tetracyclic antidepressants, initial encounter
T43.025S Adverse effect of tetracyclic antidepressants, sequela
T43.025D Adverse effect of tetracyclic antidepressants, subsequent encounter
T36.4X5A Adverse effect of tetracyclines, initial encounter
T36.4X5S Adverse effect of tetracyclines, sequela
T36.4X5D Adverse effect of tetracyclines, subsequent encounter
T41.5X5A Adverse effect of therapeutic gases, initial encounter
T41.5X5S Adverse effect of therapeutic gases, sequela
T41.5X5D Adverse effect of therapeutic gases, subsequent encounter
T45.615A Adverse effect of thrombolytic drugs, initial encounter
T45.615S Adverse effect of thrombolytic drugs, sequela
T45.615D Adverse effect of thrombolytic drugs, subsequent encounter
T38.1X5A Adverse effect of thyroid hormones and substitutes, initial encounter
T38.1X5S Adverse effect of thyroid hormones and substitutes, sequela
T38.1X5D Adverse effect of thyroid hormones and substitutes, subsequent encounter
T43.015A Adverse effect of tricyclic antidepressants, initial encounter
T43.015S Adverse effect of tricyclic antidepressants, sequela
T43.015D Adverse effect of tricyclic antidepressants, subsequent encounter
T48.905A Adverse effect of unspecified agents primarily acting on the respiratory system, initial encounter
T48.905S Adverse effect of unspecified agents primarily acting on the respiratory system, sequela
T48.905D Adverse effect of unspecified agents primarily acting on the respiratory system, subsequent encounter
T46.905A Adverse effect of unspecified agents primarily affecting the cardiovascular system, initial encounter
T46.905S Adverse effect of unspecified agents primarily affecting the cardiovascular system, sequela
T46.905D Adverse effect of unspecified agents primarily affecting the cardiovascular system, subsequent encounter
T47.95XA Adverse effect of unspecified agents primarily affecting the gastrointestinal system, initial encounter
T47.95XS Adverse effect of unspecified agents primarily affecting the gastrointestinal system, sequela
T47.95XD Adverse effect of unspecified agents primarily affecting the gastrointestinal system, subsequent encounter
T41.45XA Adverse effect of unspecified anesthetic, initial encounter

ICD-10 CM Codes that support Medical Necessity for CPT Code 86003 Part 01

H10.13 Acute atopic conjunctivitis, bilateral
H10.12 Acute atopic conjunctivitis, left eye
H10.11 Acute atopic conjunctivitis, right eye
J01.20 Acute ethmoidal sinusitis, unspecified
H68.013 Acute Eustachian salpingitis, bilateral
H68.012 Acute Eustachian salpingitis, left ear
H68.011 Acute Eustachian salpingitis, right ear
J01.10 Acute frontal sinusitis, unspecified
J04.0 Acute laryngitis
J01.00 Acute maxillary sinusitis, unspecified
J05.0 Acute obstructive laryngitis [croup]
J01.40 Acute pansinusitis, unspecified
J01.21 Acute recurrent ethmoidal sinusitis
J01.11 Acute recurrent frontal sinusitis
J01.01 Acute recurrent maxillary sinusitis
J01.41 Acute recurrent pansinusitis
J01.91 Acute recurrent sinusitis, unspecified
J01.31 Acute recurrent sphenoidal sinusitis
H65.03 Acute serous otitis media, bilateral
H65.02 Acute serous otitis media, left ear
H65.06 Acute serous otitis media, recurrent, bilateral
H65.05 Acute serous otitis media, recurrent, left ear
H65.04 Acute serous otitis media, recurrent, right ear
H65.01 Acute serous otitis media, right ear
J01.90 Acute sinusitis, unspecified
J01.30 Acute sphenoidal sinusitis, unspecified
T39.1X5A Adverse effect of 4-Aminophenol derivatives, initial encounter
T39.1X5S Adverse effect of 4-Aminophenol derivatives, sequela
T39.1X5D Adverse effect of 4-Aminophenol derivatives, subsequent encounter
T44.6X5A Adverse effect of alpha-adrenoreceptor antagonists, initial encounter
T44.6X5S Adverse effect of alpha-adrenoreceptor antagonists, sequela
T44.6X5D Adverse effect of alpha-adrenoreceptor antagonists, subsequent encounter
T36.5X5A Adverse effect of aminoglycosides, initial encounter
T36.5X5S Adverse effect of aminoglycosides, sequela
T36.5X5D Adverse effect of aminoglycosides, subsequent encounter
T43.625A Adverse effect of amphetamines, initial encounter
T43.625S Adverse effect of amphetamines, sequela
T43.625D Adverse effect of amphetamines, subsequent encounter
T50.7X5A Adverse effect of analeptics and opioid receptor antagonists, initial encounter
T50.7X5S Adverse effect of analeptics and opioid receptor antagonists, sequela
T50.7X5D Adverse effect of analeptics and opioid receptor antagonists, subsequent encounter
T38.7X5A Adverse effect of androgens and anabolic congeners, initial encounter
T38.7X5S Adverse effect of androgens and anabolic congeners, sequela
T38.7X5D Adverse effect of androgens and anabolic congeners, subsequent encounter
T46.4X5A Adverse effect of angiotensin-converting-enzyme inhibitors, initial encounter
T46.4X5S Adverse effect of angiotensin-converting-enzyme inhibitors, sequela
T46.4X5D Adverse effect of angiotensin-converting-enzyme inhibitors, subsequent encounter
T38.815A Adverse effect of anterior pituitary [adenohypophyseal] hormones, initial encounter
T38.815S Adverse effect of anterior pituitary [adenohypophyseal] hormones, sequela
T38.815D Adverse effect of anterior pituitary [adenohypophyseal] hormones, subsequent encounter
T37.4X5A Adverse effect of anthelminthics, initial encounter
T37.4X5S Adverse effect of anthelminthics, sequela
T37.4X5D Adverse effect of anthelminthics, subsequent encounter
T45.0X5A Adverse effect of antiallergic and antiemetic drugs, initial encounter
T45.0X5S Adverse effect of antiallergic and antiemetic drugs, sequela
T45.0X5D Adverse effect of antiallergic and antiemetic drugs, subsequent encounter
T48.6X5A Adverse effect of antiasthmatics, initial encounter
T48.6X5S Adverse effect of antiasthmatics, sequela
T48.6X5D Adverse effect of antiasthmatics, subsequent encounter
T44.0X5A Adverse effect of anticholinesterase agents, initial encounter
T44.0X5S Adverse effect of anticholinesterase agents, sequela
T44.0X5D Adverse effect of anticholinesterase agents, subsequent encounter
T45.7X5A Adverse effect of anticoagulant antagonists, vitamin K and other coagulants, initial encounter
T45.7X5S Adverse effect of anticoagulant antagonists, vitamin K and other coagulants, sequela
T45.7X5D Adverse effect of anticoagulant antagonists, vitamin K and other coagulants, subsequent encounter
T45.515A Adverse effect of anticoagulants, initial encounter
T45.515S Adverse effect of anticoagulants, sequela
T45.515D Adverse effect of anticoagulants, subsequent encounter
T47.6X5A Adverse effect of antidiarrheal drugs, initial encounter
T47.6X5S Adverse effect of antidiarrheal drugs, sequela
T47.6X5D Adverse effect of antidiarrheal drugs, subsequent encounter
T50.6X5A Adverse effect of antidotes and chelating agents, initial encounter
T50.6X5S Adverse effect of antidotes and chelating agents, sequela
T50.6X5D Adverse effect of antidotes and chelating agents, subsequent encounter
T36.7X5A Adverse effect of antifungal antibiotics, systemically used, initial encounter
T36.7X5S Adverse effect of antifungal antibiotics, systemically used, sequela
T36.7X5D Adverse effect of antifungal antibiotics, systemically used, subsequent encounter
T38.6X5A Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, initial encounter
T38.6X5S Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, sequela
T38.6X5D Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, subsequent encounter
T46.6X5A Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, initial encounter
T46.6X5S Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, sequela
T46.6X5D Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, subsequent encounter
T37.2X5A Adverse effect of antimalarials and drugs acting on other blood protozoa, initial encounter
T37.2X5S Adverse effect of antimalarials and drugs acting on other blood protozoa, sequela
T37.2X5D Adverse effect of antimalarials and drugs acting on other blood protozoa, subsequent encounter
T37.1X5A Adverse effect of antimycobacterial drugs, initial encounter
T37.1X5S Adverse effect of antimycobacterial drugs, sequela
T37.1X5D Adverse effect of antimycobacterial drugs, subsequent encounter
T45.1X5A Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter
T45.1X5S Adverse effect of antineoplastic and immunosuppressive drugs, sequela
T45.1X5D Adverse effect of antineoplastic and immunosuppressive drugs, subsequent encounter
T42.8X5A Adverse effect of antiparkinsonism drugs and other central muscle-tone depressants, initial encounter
42.8X5S Adverse effect of antiparkinsonism drugs and other central muscle-tone depressants, sequela
T42.8X5D Adverse effect of antiparkinsonism drugs and other central muscle-tonedepressants, subsequent encounter
T49.1X5A Adverse effect of antipruritics, initial encounter
T49.1X5S Adverse effect of antipruritics, sequela
T49.1X5D Adverse effect of antipruritics, subsequent encounter
T39.4X5A Adverse effect of antirheumatics, not elsewhere classified, initial encounter
T39.4X5S Adverse effect of antirheumatics, not elsewhere classified, sequela
T39.4X5D Adverse effect of antirheumatics, not elsewhere classified, subsequent encounter
T45.525A Adverse effect of antithrombotic drugs, initial encounter
T45.525S Adverse effect of antithrombotic drugs, sequela
T45.525D Adverse effect of antithrombotic drugs, subsequent encounter
T38.2X5A Adverse effect of antithyroid drugs, initial encounter
T38.2X5S Adverse effect of antithyroid drugs, sequela
T38.2X5D Adverse effect of antithyroid drugs, subsequent encounter
T48.3X5A Adverse effect of antitussives, initial encounter
T48.3X5S Adverse effect of antitussives, sequela
T48.3X5D Adverse effect of antitussives, subsequent encounter
T46.8X5A Adverse effect of antivaricose drugs, including sclerosing agents, initial encounter
T46.8X5S Adverse effect of antivaricose drugs, including sclerosing agents, sequela
T46.8X5D Adverse effect of antivaricose drugs, including sclerosing agents, subsequent encounter
T37.5X5A Adverse effect of antiviral drugs, initial encounter
T37.5X5S Adverse effect of antiviral drugs, sequela
T37.5X5D Adverse effect of antiviral drugs, subsequent encounter
T50.5X5A Adverse effect of appetite depressants, initial encounter
T50.5X5S Adverse effect of appetite depressants, sequela
T50.5X5D Adverse effect of appetite depressants, subsequent encounter
T39.015A Adverse effect of aspirin, initial encounter
T39.015S Adverse effect of aspirin, sequela
T39.015D Adverse effect of aspirin, subsequent encounter
T42.3X5A Adverse effect of barbiturates, initial encounter
T42.3X5S Adverse effect of barbiturates, sequela
T42.3X5D Adverse effect of barbiturates, subsequent encounter
T42.4X5A Adverse effect of benzodiazepines, initial encounter
T42.4X5S Adverse effect of benzodiazepines, sequela
T42.4X5D Adverse effect of benzodiazepines, subsequent encounter
T44.7X5A Adverse effect of beta-adrenoreceptor antagonists, initial encounter
T44.7X5S Adverse effect of beta-adrenoreceptor antagonists, sequela
T44.7X5D Adverse effect of beta-adrenoreceptor antagonists, subsequent encounter
T43.4X5A Adverse effect of butyrophenone and thiothixene neuroleptics, initial encounter
T43.4X5S Adverse effect of butyrophenone and thiothixene neuroleptics, sequela
T43.4X5D Adverse effect of butyrophenone and thiothixene neuroleptics, subsequent encounter
T43.615A Adverse effect of caffeine, initial encounter
T43.615S Adverse effect of caffeine, sequela
T43.615D Adverse effect of caffeine, subsequent encounter
T46.1X5A Adverse effect of calcium-channel blockers, initial encounter
T46.1X5S Adverse effect of calcium-channel blockers, sequela
T46.1X5D Adverse effect of calcium-channel blockers, subsequent encounter
T40.7X5A Adverse effect of cannabis (derivatives), initial encounter
T40.7X5S Adverse effect of cannabis (derivatives), sequela
T40.7X5D Adverse effect of cannabis (derivatives), subsequent encounter
T50.2X5A Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, initial encounter
T50.2X5S Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and otherdiuretics, sequela
T50.2X5D Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, subsequent encounter
T46.0X5A Adverse effect of cardiac-stimulant glycosides and drugs of similar action, initial encounter
T46.0X5S Adverse effect of cardiac-stimulant glycosides and drugs of similar action, sequela
T46.0X5D Adverse effect of cardiac-stimulant glycosides and drugs of similar action, subsequent encounter
T44.8X5A Adverse effect of centrally-acting and adrenergic-neuron-blocking agents, initial encounter
T44.8X5S Adverse effect of centrally-acting and adrenergic-neuron-blocking agents, sequela
T44.8X5D Adverse effect of centrally-acting and adrenergic-neuron-blocking agents, subsequent encounter
T36.1X5A Adverse effect of cephalosporins and other beta-lactam antibiotics, initial encounter
T36.1X5S Adverse effect of cephalosporins and other beta-lactam antibiotics, sequela
T36.1X5D Adverse effect of cephalosporins and other beta-lactam antibiotics, subsequent encounter
T36.2X5A Adverse effect of chloramphenicol group, initial encounter
T36.2X5S Adverse effect of chloramphenicol group, sequela
T36.2X5D Adverse effect of chloramphenicol group, subsequent encounter
T40.5X5A Adverse effect of cocaine, initial encounter
T40.5X5S Adverse effect of cocaine, sequela
T40.5X5D Adverse effect of cocaine, subsequent encounter
T46.3X5A Adverse effect of coronary vasodilators, initial encounter
T46.3X5S Adverse effect of coronary vasodilators, sequela
T46.3X5D Adverse effect of coronary vasodilators, subsequent encounter
T49.7X5A Adverse effect of dental drugs, topically applied, initial encounter
T49.7X5S Adverse effect of dental drugs, topically applied, sequela
T49.7X5D Adverse effect of dental drugs, topically applied, subsequent encounter
T50.8X5A Adverse effect of diagnostic agents, initial encounter
T50.8X5S Adverse effect of diagnostic agents, sequela
T50.8X5D Adverse effect of diagnostic agents, subsequent encounter
T47.5X5A Adverse effect of digestants, initial encounter
T47.5X5S Adverse effect of digestants, sequela
T47.5X5D Adverse effect of digestants, subsequent encounter
T50.4X5A Adverse effect of drugs affecting uric acid metabolism, initial encounter
T50.4X5S Adverse effect of drugs affecting uric acid metabolism, sequela
T50.4X5D Adverse effect of drugs affecting uric acid metabolism, subsequent encounter
T50.3X5A Adverse effect of electrolytic, caloric and water-balance agents, initial encounter
T50.3X5S Adverse effect of electrolytic, caloric and water-balance agents, sequela
T50.3X5D Adverse effect of electrolytic, caloric and water-balance agents, subsequent encounter
T47.7X5A Adverse effect of emetics, initial encounter
T47.7X5S Adverse effect of emetics, sequela
T47.7X5D Adverse effect of emetics, subsequent encounter
T49.3X5A Adverse effect of emollients, demulcents and protectants, initial encounter
T49.3X5S Adverse effect of emollients, demulcents and protectants, sequela
T49.3X5D Adverse effect of emollients, demulcents and protectants, subsequent encounter
T45.3X5A Adverse effect of enzymes, initial encounter
T45.3X5S Adverse effect of enzymes, sequela
T45.3X5D Adverse effect of enzymes, subsequent encounter
T48.4X5A Adverse effect of expectorants, initial encounter
T48.4X5S Adverse effect of expectorants, sequela
T48.4X5D Adverse effect of expectorants, subsequent encounter

T44.2X5A Adverse effect of ganglionic blocking drugs, initial encounter
T44.2X5S Adverse effect of ganglionic blocking drugs, sequela
T44.2X5D Adverse effect of ganglionic blocking drugs, subsequent encounter
T38.0X5A Adverse effect of glucocorticoids and synthetic analogues, initial encounter
T38.0X5S Adverse effect of glucocorticoids and synthetic analogues, sequela
T38.0X5D Adverse effect of glucocorticoids and synthetic analogues, subsequent encounter
T45.625A Adverse effect of hemostatic drug, initial encounter
T45.625S Adverse effect of hemostatic drug, sequela
T45.625D Adverse effect of hemostatic drug, subsequent encounter
T47.0X5A Adverse effect of histamine H2-receptor blockers, initial encounter
T47.0X5S Adverse effect of histamine H2-receptor blockers, sequela
T47.0X5D Adverse effect of histamine H2-receptor blockers, subsequent encounter
T42.0X5A Adverse effect of hydantoin derivatives, initial encounter
T42.0X5S Adverse effect of hydantoin derivatives, sequela
T42.0X5D Adverse effect of hydantoin derivatives, subsequent encounter
T42.1X5A Adverse effect of iminostilbenes, initial encounter
T42.1X5S Adverse effect of iminostilbenes, sequela
T42.1X5D Adverse effect of iminostilbenes, subsequent encounter
T50.Z15A Adverse effect of immunoglobulin, initial encounter
T50.Z15S Adverse effect of immunoglobulin, sequela
T50.Z15D Adverse effect of immunoglobulin, subsequent encounter
T41.0X5A Adverse effect of inhaled anesthetics, initial encounter
T41.0X5S Adverse effect of inhaled anesthetics, sequela
T41.0X5D Adverse effect of inhaled anesthetics, subsequent encounter
T38.3X5A Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter
T38.3X5S Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, sequela
T38.3X5D Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, subsequent encounter
T41.1X5A Adverse effect of intravenous anesthetics, initial encounter
T41.1X5S Adverse effect of intravenous anesthetics, sequela
T41.1X5D Adverse effect of intravenous anesthetics, subsequent encounter
T45.4X5A Adverse effect of iron and its compounds, initial encounter
T45.4X5S Adverse effect of iron and its compounds, sequela
T45.4X5D Adverse effect of iron and its compounds, subsequent encounter
T49.4X5A Adverse effect of keratolytics, keratoplastics, and other hair treatment drugs and preparations, initial encounter
T49.4X5S Adverse effect of keratolytics, keratoplastics, and other hair treatment drugs and preparations, sequela
T49.4X5D Adverse effect of keratolytics, keratoplastics, and other hair treatment drugs and preparations, subsequent encounter
T41.3X5A Adverse effect of local anesthetics, initial encounter
T41.3X5S Adverse effect of local anesthetics, sequela
T41.3X5D Adverse effect of local anesthetics, subsequent encounter
T49.0X5A Adverse effect of local antifungal, anti-infective and anti-inflammatory drugs, initial encounter
T49.0X5S Adverse effect of local antifungal, anti-infective and anti-inflammatory drugs, sequela
T49.0X5D Adverse effect of local antifungal, anti-infective and anti-inflammatory drugs, subsequent encounter
T49.2X5A Adverse effect of local astringents and local detergents, initial encounter
T49.2X5S Adverse effect of local astringents and local detergents, sequela
T49.2X5D Adverse effect of local astringents and local detergents, subsequent encounter
T50.1X5A Adverse effect of loop [high-ceiling] diuretics, initial encounter
T50.1X5S Adverse effect of loop [high-ceiling] diuretics, sequela
T50.1X5D Adverse effect of loop [high-ceiling] diuretics, subsequent encounter

Allergy Testing - 82785, 86001, 86003, 86005 Part 02

Limitations:

The following tests are considered not medically reasonable and necessary:

• Ingestion (Oral) Challenge Food Testing performed by the patient in the home, and not in the office setting, will not be covered.

• Provocative Testing for which there is limited or no evidence of validity include the cytotoxic test, the provocation-neutralization procedure, electrodermal diagnosis, applied kinesiology, the “reaginic” pulse test, and chemical analysis of body tissues. Controlled studies for the cytotoxic and provocation-neutralization tests demonstrated that the results are not reproducible and do not correlate with clinical evidence of allergy. 

Electrodermal diagnosis and applied kinesiology have not been evaluated for efficacy. Similarly, the “reaginic” pulse test and chemical analysis of body tissues for various exogenous chemicals have not been substantiated as valid tests for allergy. Provocative and neutralization testing and neutralization therapy (Rinkel test) of food allergies (sublingual, intracutaneous and subcutaneous) are excluded from Medicare coverage because available evidence does not show these tests and therapies are effective.

• IgG and IgG Subclass Antibody Tests measure allergen-specific IgG and IgG subclasses by using immunoabsorption assays and IgG and IgG subclass antibody tests for food allergy/ delayed food allergic symptoms or intolerance to specific foods. These tests are considered experimental and investigational since there is insufficient evidence in the published peerreviewed scientific literature to support the diagnostic value of these tests.

• Antigens for which no clinical efficacy is documented in peer reviewed literature include the following: newsprint, tobacco smoke and leaf, dandelion, orris root, phenol, alcohol, sugar, yeast, grain mill dust, soybean dust (except when the patient has a known exposure to soybean dust such as a food processing plant), honeysuckle, marigold, goldenrod, fiberglass, wool, green tea, or chalk.

• Radioallergosorbent test (RAST), fluoroallergosorbent test (FAST), and multiple antigen simultaneous test (MAST) are in vitro techniques for determining whether a patient’s serum contains IgE antibodies against specific allergens of clinical importance. As with any allergy testing, the need for such tests is based on the findings during a complete history and physical examination of the patient. These tests are not appropriate in most general allergy testing. Instead, individual IgE tests should be performed against a specific antigen.

• ELISA (enzyme-linked immunoaorbent assay) test is another in vitro method of allergy testing for specific IgE antibodies against allergens. It is used to determine in vitro reaction to various foods and relies on lymphocyte blastogenesis in response to certain food antigens.

• Quantitative multi-allergen screen is a non-specific screen that does not identify a specific antigen. It is does not have sufficient literature demonstrating clear cut clinical implication. It is a screening tool and therefore not covered by Medicare.

• Effective August 5, 1985, cytotoxic leukocyte tests for food allergies are excluded from Medicare coverage because available evidence does not show that these tests are safe and effective. (CMS Pub. 100-03 Medicare National Coverage Determination (NCD) Manual, Chapter 1- Coverage Determinations, Part 2 Section 110.13-Cytotoxic Food Tests).

• Effective October 31, 1988, sublingual intracutaneous and subcutaneous provocative and neutralization testing and neutralization therapy for food allergies are excluded from Medicare coverage because available evidence does not show that these tests and therapies are effective. (CMS Pub 100-03 Medicare National Coverage Determinations Manual, Chapter

1- Coverage Determinations, Part 2, Section 110.11 – Food Allergy Testing and Treatment).

• The following tests are considered experimental and investigational for allergy testing as these have not been proven to be effective or appropriate for the evaluation and/ or management of IgE-mediated allergic reactions. This list is not all inclusive:

• Antigen leukocyte cellular antibody (ALCAT) automated food allergy testing

• Applied kinesiology or Nambudripad’s allergy elimination test (NAET (i.e., muscle strength testing or measurement after allergen ingestion)

• Anti-Fc epsilon receptor antibodies testing

• Anti-IgE receptor antibody testing

• Blood, urine, or stool micro-nutrient assessments

• Candidiasis test

• Chemical analysis of body tissues (e.g., hair)

• Chlorinated pesticides (serum)

• Chronic urticarial index testing

• Clifford materials reactivity testing

• Complement (total or components)

• Complement antigen testing

• C-reactive protein

•Cytokine and cytokine receptor assay

• Cytotoxic testing for environmental or clinical ecological allergy testing (Bryans Test, ACT)

• Electrodermal testing or electro-acupuncture

•Electromagnetic sensitivity syndrome/disorder (allergy to electricity, electrosensitivity, electrohypersensitivity, and hypersensitivity to electricity).

• Environmental cultures and chemicals

• Eosinophil cationic protein (ECP) test

• Food immune complex assay (FICA) or food allergenic extract immunotherapy

• General immune system assessments

• Immune complex assay

• Immunoglobulin G (IgG) testing for allergy

• Iridology

• Leukocyte antibodies testing

• Leukocyte histamine release test (LHRT)/basophil histamine release test

• Lymphocytes (B or T subsets)

• Lymphocyte function assay

• Mediator release test (MRT) or the LEAP program

• Metabolic assessments 

• Multiple chemical sensitivity syndrome (a.k.a., idiopathic environmental intolerance (IEI), clinical ecological illness, clinical ecology, environmental illness, chemical AIDS, environmental/chemical hypersensitivity disease, total allergy syndrome, cerebral allergy, 20th century disease)

• Prausnitz-Kustner or P-K testing - passive cutaneous transfer test

• Pulse response test

• Qualification of nutritional assessments

• Rebuck skin window test

• Secretory IgA (salvia)

• Sage Complement Antigen Test

• Specific Immunoglobulin (IgG) (e.g., by Radioallergosorbent (RAST) or Enzyme-linked immunosorbent assay (ELISA)

• Sublingual provocative neutralization testing and treatment with hormones.

• Total serum IgG, immunoglobulin A (IgA) and immunoglobulin M (IgM)

• Venom blocking antibodies

• Volatile chemical panels (blood testing for chemicals)

• Live Cell Analysis

• Passive Transfer

• Cytotoxic Food Testing

Routine allergy re-testing does not meet the definition of medically necessity according to the practice parameters and recommendations from the American College of Allergy, Asthma, and Immunology (ACAAI), the American Academy of Allergy, Asthma, and Immunology (AAAAI), and the Joint Council of Allergy, Asthma, and Immunology (JCAAI).

Utilization Guidelines

It is expected that these services would be performed as indicated by current medical literature and/or standards of practice. When services are performed in excess of established parameters, they may be subject to review for medical necessity.

It would not be expected that all patients would receive the same tests or the same number of sensitivity tests. The number of tests performed must be judicious and related to the history, physical findings and clinical judgment specific to each individual patient. The selection of antigens should be individualized, based on the history and physical examination.

Retesting with the same antigen(s) should rarely be necessary within a three-year period. Exceptions include young children with negative skin tests or older children and adults with negative skin tests, but persistent symptoms suggestive of allergic disease where skin tests may be repeated one year later. Claims for retesting within a three-year period should be submitted with documentation of the medical necessity.

Testing done on separate days for different antigens is acceptable as long as the total number of tests done within any three-year period is not excessive.

In vitro testing is covered when medically reasonable and necessary as a substitute for skin testing; it is not usually necessary in addition to skin testing. If in vitro testing is inconclusive, and contraindications for skin testing have been resolved, then skin testing may be done and is covered. 

The medical record must document this rationale. In vitro IgE testing will be limited to 30 allergens/beneficiary over a 12 month period. If more tests are performed, medical records may be requested. 

A maximum of 55 allergy patch tests for diagnose of allergic contact dermatitis per beneficiary per year is allowed without the submission of documentation with the claim to support medical necessity. Greater than 55 patch tests per patient per year may result in a request of medical records.

It would not be expected that more than forty (40) units be reported for intracutaneous (intradermal) testing per year for a patient. If more than 40 units are reported, medical records may be requested.

Allergy Testing - 82785, 86001, 86003, 86005 Part 01

Coverage Indications, Limitations, and/or Medical Necessity

Overview:

Allergy testing is performed to determine a patient’s immunologic sensitivity or reaction to particular allergens for the purpose of identifying the cause of the allergic state. It is based on findings during a complete medical and immunologic history, and appropriate physical exam obtained by face-to-face contact with the patient.

Indications:

Allergy skin testing is a clinical procedure that is used to evaluate an immunologic response to allergenic material. It would not be expected that all patients would receive the same tests or the same number of sensitivity tests. The number and type of antigens used for testing must be chosen judiciously given the patient’s presentation, history, physical findings, and clinical judgment.

To be covered by Medicare, the antigens must meet all of the following criteria:

• Skin testing must be performed based on a complete history and physical exam,

• Proven efficacy as demonstrated through scientifically valid peer reviewed published medical studies, and

• Exist in the patient’s environment with a reasonable probability of exposure Allergy testing can be broadly subdivided into two methodologies:

• In vivo testing (skin tests): this testing correlates the performance and evaluation of selective cutaneous and mucous membrane tests with the patient’s history, physician examination, and other observations.

• Percutaneous Testing (scratch, puncture, prick) and is used to evaluate immunoglobulin E (IgE) mediated hypersensitivity. Percutaneous tests require medical supervision, since there is a small but significant risk of anaphylaxis. Overall, skin testing is quick, safe, and cost-effective. It remains the test of choice in most clinical situations where immediate hypersensitivity reactions are suspected.

Percutaneous testing is the usual preferred method for allergy testing. Medicare covers percutaneous (scratch, prick or puncture) testing when IgE-mediated reactions occur with any of the following:

a. Inhalants.

b. Foods. (Patients present with signs and symptoms such as urticarial, angioedema, or anaphylaxis after ingestion of specific foods. Testing for food allergies in patients who present with wheezing is occasionally required.)

c. Hymenoptera (stinging insects).

d. Specific drugs (penicillins, macromolecular agents, enzymes, and egg-containing vaccines). Skin testing is unreliable with other drugs.

• Intracutaneous/Intradermal Tests are usually performed when increased sensitivity is the main goal such as when percutaneous tests are negative and there is a strong suspicion of allergen sensitivity. Intradermal tests are injections of small amounts of antigen into the superficial layers of the skin. 

The test is interpreted after 48 hours, and typically once again at 72 or 96 hours, and the reactions are systematically scored and recorded. The patient is then informed and educated regarding specific allergies and avoidance of exposure. Avoidance of the identified allergen(s) is critical to patient improvement and resolution of the dermatitis.

Allergy patch testing is a covered procedure only when used to diagnose allergic contact dermatitis after the following exposures: dermatitis due to detergents, oils and greases, solvents, drugs and medicines in contact with skin, other chemical products, food in contact with skin, plants (except food), cosmetics, metals, rubber additives, other and unspecified. 

Patch tests may also be used and may be helpful when a distribution and persistence of dermatitis suggests a possible contact allergy, but the exact etiology of the dermatitis is unknown. 

These allergens are part of a useful, but limited series of 36 allergens. While this series of 36 allergens represents some of the most common contact allergies, there are a significant number of patients who suffer intractable contact dermatitis for which the 36 allergens are inadequate to diagnose their problem.

A supplemental series of allergens in this case can enhance accurate diagnosis, patient education, and treatment. This supplemental series is particularly critical in the diagnosis of occupationally induced dermatitis. 

If another supplemental series of allergens are clinical indicated for an accurate diagnosis, the documentation must support the medically reasonable and necessary use of the additional allergens.

• Photo Patch Testing uses two patches, with one of them being irradiated with ultraviolet light half way through the occlusive period. It is indicated to evaluate unique allergies resulting from light exposure. Some chemicals or medications produce an allergic reaction only when exposed to light (usually ultraviolet type A, UVA). Patients who are over-sensitive to light and those with a rash that appears on parts of the body normally exposed to light but that does not appear in areas shielded from the light should have a photo-patch test.

• Photo Tests is skin irradiation with a specific range of ultraviolet light. Photo tests are performed for the evaluation of photosensitivity disorders.

• Skin Endpoint Titration (SET) Testing or Intradermal Dilutional Testing (IDT) analyzes the highest dilution of a substance that produces a reaction, and may be used to determine the starting dose(s) of allergen immunotherapy.

• Delayed Hypersensitivity Skin Testing has been commonly used in three ways: anergy testing, testing for infection with intracellular pathogens, and testing for sensitivity to contact allergens. Accurate testing for contact allergy requires careful attention to technique, and limitation of testing to the specific allergens known to be associated with a contact reaction.

• Ophthalmic Mucous Membrane Tests and Direct Nasal Mucous Membrane Tests are rarely indicated. They are allowed when skin testing cannot test allergens. Ophthalmic mucous membrane tests and direct nasal mucous membrane tests are approved if levels of allergic mediators (such as histamine and tryptase) are measured and a placebo control is performed. 

This is usually performed in allergy research laboratories. It is also approved in the office setting if the physician is there to observe objective measurement of reactions which might include redness of the eyes, tearing and sneezing.

• Inhalation Bronchial Challenge Testing involves the inhalation of agents that can trigger respiratory responses and are often used to evaluate new allergens and/ or substantiate the role of allergens in patients with significant symptoms. Results of these tests are ordinarily evaluated by objective measures of pulmonary function and occasionally by characterization of bronchoalveolar lavage samples.

• Inhalation bronchial challenge tests should be performed as dose-response assays where in provocation concentration thresholds can be determined on the basis of allergen concentration required to cause a significant decrease in measured  pulmonary function.

• Inhalation bronchial challenge tests with occupational allergens need to be carefully controlled with respect to dose and duration of exposure. When industrial small molecular weight agents are assessed, tests should be performed under conditions of continuous monitoring of the specific chemical being assessed so as not to exceed the threshold limit level permitted in the workplace.

• Ingestion (Oral) Challenge Test involves the administration of sequentially or incrementally larger doses of the test item. The test items may include food or antibiotics.

The service is allowed once per patient encounter, regardless of the number of items tested, and includes evaluation of the patient’s response to the test items. Challenge ingestion food testing is a safe and effective technique in the diagnosis of food allergies. 

This procedure is covered when it is used on an outpatient basis if it is reasonable and necessary for the individual patient. (CMS Pub. 100-03 Medicare National Coverage Determination (NCD)Manual, Chapter 1- Coverage Determinations, Part 2 Section 110.12- Challenge Ingestion Food Testing).

Challenge ingestion food testing is covered for the following indications:

• Food allergy, dermatitis

• Anaphylactic shock due to adverse food reaction

• Allergy to medicinal agents

• Allergy to foods

Challenge ingestion food testing has not been proven to be effective in the diagnosis of rheumatoid arthritis, depression, or respiratory disorders. Accordingly, its use in the diagnosis of these conditions is not reasonable and necessary within the meaning of section 1862(a) (1) of the Medicare law, and no program payment is made for this procedure when it is so used. (CMS Pub. 100-03 Medicare National Coverage Determination (NCD)Manual, Chapter 1- Coverage Determinations, Part 2 Section 110.12- Challenge Ingestion Food Testing).

• Intracutaneous testing, delayed reaction - more than 6 tests, may be covered but requires additional justification and case-by-case review for the number of tests performed and the medical necessity except when the skin test is used: Prior to collagen implant therapy, a skin test for collagen sensitivity must be administered and evaluated over a 4 week period. CMS Pub 100-03 Medicare National Coverage Determinations (NCD) Manual, Chapter 1 – Coverage Determinations, Part 4, Section 230.10 – Incontinence Control Devices.

• Organ challenge test materials may be applied to the mucosae of the conjunctivae, nares, GI tract, or bronchi. Considerable experience with these methods is required for proper interpretation and analysis. All organ challenge tests should be preceded by a control test with diluent and, if possible, the procedure should be performed on a double blind or at least single-blind basis.

• In vitro testing (blood serum analysis): immediate hypersensitivity testing by measurement of allergen-specific serum IgE in the blood serum. They are useful when testing for inhalant allergens (pollens, molds, dust mites, animal danders), foods, insect stings, and other allergens such as drugs or latex, when direct skin testing is impossible due to extensive dermatitis, marked dermatographism, or in children younger than four years of age.

In vitro testing is covered when skin testing is not possible or would be unreliable; or in vitro testing is medically reasonable and necessary as determined by the physician. When in vitro testing is ordered or performed, the medical record must clearly document the indication and why it is being used instead of skin testing.

It is not covered when done in addition to a skin test for the same antigen, except in the case of suspected latex sensitivity, hymenoptera, or nut/peanut sensitivity where both the skin test and the in-vitro test may be performed. 

The number of tests done, choice of antigens,  frequency of repetition and other coverages issues are the same as skin testing. Testing must be based on a careful history/physical examination which suggests IgE medicated disease. Total Serum IgE is not appropriate in most general allergy testing. 

Instead, individual IgE tests are performed against a specific antigen. Special clinical situations in which specific IgE immunoassays are performed against a specific antigen may be appropriate in the following situations:

• Patients with extensive dermatitis, severe dermatographism, ichthyosis or generalized eczema that will not make direct skin testing possible.

• Patients needing continued use of H-1 blockers (antihistamines), or in the rare patient with persistent unexplained negative histamine control.

• Patients who cannot be safely withdrawn from medications that interfere with skin testing, such as long-acting antihistamines, tricyclic antidepressants, beta-blockers, or medications that may put the patient at undue risk if they are discontinued long enough to perform skin tests.

• Uncooperative patients with mental or physical impairments.

• For evaluation of cross-reactivity between insect venoms (e.g., fire ant, bee, wasp, yellow jacket, hornet).

• As adjunctive laboratory testing for disease activity of allergic bronchopulmonary aspergillosis and certain parasitic disease.

• To diagnose atopy in small children.

• Patients at increased risk for anaphylactic response from skin testing based on clinical history (e.g., when an unusual allergen is not available as a licensed skin test extract), or who have a history of a previous systemic reaction to skin testing.

• Patients in who skin testing were equivocal/inconclusive and in vitro testing is required as a confirmatory test.

Total IgE is reasonable and necessary for follow-up of ABPA and to diagnosis atopy in children.

Retesting with the same antigen(s) should rarely be necessary within a three-year period. Exceptions include young children with negative skin tests, or older children and adults with negative skin tests in the face of persistent symptoms. Routine repetition of skin tests is not indicated (i.e., annually) and not covered.

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