Here is a list of CPT codes and Diagnoses that are medically necessary for those CPT codes from the Medicare website, Hope you can use one of those DX's.
CPT/HCPCS Codes back to top
Italicized and/or quoted material is excerpted from the American Medical Association, Current Procedural Terminology (CPT) codes.
See revision history for code updates effective 01/01/2009.
11000 DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE
11001 DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; EACH ADDITIONAL 10% OF THE BODY SURFACE, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
11040 DEBRIDEMENT; SKIN, PARTIAL THICKNESS
11041 DEBRIDEMENT; SKIN, FULL THICKNESS
11042 DEBRIDEMENT; SKIN, AND SUBCUTANEOUS TISSUE
11043 DEBRIDEMENT; SKIN, SUBCUTANEOUS TISSUE, AND MUSCLE
11044 DEBRIDEMENT; SKIN, SUBCUTANEOUS TISSUE, MUSCLE, AND BONE
29580 STRAPPING; UNNA BOOT
97022 APPLICATION OF A MODALITY TO 1 OR MORE AREAS; WHIRLPOOL
97597 REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), SELECTIVE DEBRIDEMENT, WITHOUT ANESTHESIA (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), WITH OR WITHOUT TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, MAY INCLUDE USE OF A WHIRLPOOL, PER SESSION; TOTAL WOUND(S) SURFACE AREA LESS THAN OR EQUAL TO 20 SQUARE CENTIMETERS
97598 REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), SELECTIVE DEBRIDEMENT, WITHOUT ANESTHESIA (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), WITH OR WITHOUT TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, MAY INCLUDE USE OF A WHIRLPOOL, PER SESSION; TOTAL WOUND(S) SURFACE AREA GREATER THAN 20 SQUARE CENTIMETERS
97602 REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), NON-SELECTIVE DEBRIDEMENT, WITHOUT ANESTHESIA (EG, WET-TO-MOIST DRESSINGS, ENZYMATIC, ABRASION), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION
97605 NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA LESS THAN OR EQUAL TO 50 SQUARE CENTIMETERS
97606 NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA GREATER THAN 50 SQUARE CENTIMETERS
ICD-9 Codes that Support Medical Necessity back to top
It is the provider's responsibility to select codes carried out to the highest level of specificity and selected from the ICD-9-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.
017.00 - 017.06 TUBERCULOSIS OF SKIN AND SUBCUTANEOUS CELLULAR TISSUE UNSPECIFIED EXAMINATION - TUBERCULOSIS OF SKIN AND SUBCUTANEOUS CELLULAR TISSUE TUBERCLE BACILLI NOT FOUND BY BACTERIOLOGICAL OR HISTOLOGICAL EXAMINATION BUT TUBERCULOSIS CONFIRMED BY OTHER METHODS (INOCULATION OF ANIMALS)
021.0 ULCEROGLANDULAR TULAREMIA
022.0 CUTANEOUS ANTHRAX
024 GLANDERS
031.1 CUTANEOUS DISEASES DUE TO OTHER MYCOBACTERIA
039.0 - 039.9 CUTANEOUS ACTINOMYCOTIC INFECTION - ACTINOMYCOTIC INFECTION OF UNSPECIFIED SITE
040.0 GAS GANGRENE
085.1 - 085.5 CUTANEOUS LEISHMANIASIS URBAN - MUCOCUTANEOUS LEISHMANIASIS (AMERICAN)
110.0 DERMATOPHYTOSIS OF SCALP AND BEARD
110.2 - 110.9 DERMATOPHYTOSIS OF HAND - DERMATOPHYTOSIS OF UNSPECIFIED SITE
116.0 - 116.2 BLASTOMYCOSIS - LOBOMYCOSIS
172.0 - 172.8 MALIGNANT MELANOMA OF SKIN OF LIP - MALIGNANT MELANOMA OF OTHER SPECIFIED SITES OF SKIN
173.0 - 173.8 OTHER MALIGNANT NEOPLASM OF SKIN OF LIP - OTHER MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF SKIN
174.0 - 174.9 MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF FEMALE BREAST - MALIGNANT NEOPLASM OF BREAST (FEMALE) UNSPECIFIED SITE
175.0 MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF MALE BREAST
176.0 KAPOSI'S SARCOMA SKIN
198.2 SECONDARY MALIGNANT NEOPLASM OF SKIN
216.0 - 216.8 BENIGN NEOPLASM OF SKIN OF LIP - BENIGN NEOPLASM OF OTHER SPECIFIED SITES OF SKIN
232.0 - 232.8 CARCINOMA IN SITU OF SKIN OF LIP - CARCINOMA IN SITU OF OTHER SPECIFIED SITES OF SKIN
233.0 CARCINOMA IN SITU OF BREAST
249.70 - 249.71 SECONDARY DIABETES MELLITUS WITH PERIPHERAL CIRCULATORY DISORDERS, NOT STATED AS UNCONTROLLED, OR UNSPECIFIED - SECONDARY DIABETES MELLITUS WITH PERIPHERAL CIRCULATORY DISORDERS, UNCONTROLLED
250.80 - 250.83 DIABETES WITH OTHER SPECIFIED MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED - DIABETES WITH OTHER SPECIFIED MANIFESTATIONS, TYPE I [JUVENILE TYPE], UNCONTROLLED
440.23 ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES WITH ULCERATION
440.24 ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES WITH GANGRENE
443.1 THROMBOANGIITIS OBLITERANS (BUERGER'S DISEASE)
454.0 VARICOSE VEINS OF LOWER EXTREMITIES WITH ULCER
454.2 VARICOSE VEINS OF LOWER EXTREMITIES WITH ULCER AND INFLAMMATION
459.11 POSTPHLEBETIC SYNDROME WITH ULCER
459.13 POSTPHLEBETIC SYNDROME WITH ULCER AND INFLAMMATION
459.31 CHRONIC VENOUS HYPERTENSION WITH ULCER
459.33 CHRONIC VENOUS HYPERTENSION WITH ULCER AND INFLAMMATION
565.0 - 565.1 ANAL FISSURE - ANAL FISTULA
566 ABSCESS OF ANAL AND RECTAL REGIONS
608.4 OTHER INFLAMMATORY DISORDERS OF MALE GENITAL ORGANS
608.83 VASCULAR DISORDERS OF MALE GENITAL ORGANS
611.0 INFLAMMATORY DISEASE OF BREAST
616.4 OTHER ABSCESS OF VULVA
616.50 - 616.51 ULCERATION OF VULVA UNSPECIFIED - ULCERATION OF VULVA IN DISEASES CLASSIFIED ELSEWHERE
619.2 GENITAL TRACT-SKIN FISTULA FEMALE
619.8 OTHER SPECIFIED FISTULAS INVOLVING FEMALE GENITAL TRACT
664.00 - 664.44 FIRST-DEGREE PERINEAL LACERATION UNSPECIFIED AS TO EPISODE OF CARE IN PREGNANCY - UNSPECIFIED PERINEAL LACERATION POSTPARTUM
674.10 - 674.14 DISRUPTION OF CESAREAN WOUND UNSPECIFIED AS TO EPISODE OF CARE - DISRUPTION OF CESAREAN WOUND POSTPARTUM
674.20 - 674.24 DISRUPTION OF PERINEAL WOUND UNSPECIFIED AS TO EPISODE OF CARE IN PREGNANCY - DISRUPTION OF OBSTETRICAL PERINEAL WOUND POSTPARTUM
674.30 - 674.34 OTHER COMPLICATIONS OF OBSTETRICAL SURGICAL WOUNDS UNSPECIFIED AS TO EPISODE OF CARE - OTHER COMPLICATIONS OF OBSTETRICAL SURGICAL WOUNDS POSTPARTUM CONDITION OR COMPLICATION
681.00 UNSPECIFIED CELLULITIS AND ABSCESS OF FINGER
681.10 UNSPECIFIED CELLULITIS AND ABSCESS OF TOE
682.0 - 682.9 CELLULITIS AND ABSCESS OF FACE - CELLULITIS AND ABSCESS OF UNSPECIFIED SITES
686.09 OTHER PYODERMA
686.9 UNSPECIFIED LOCAL INFECTION OF SKIN AND SUBCUTANEOUS TISSUE
705.83 HIDRADENITIS
707.00 - 707.9 PRESSURE ULCER, UNSPECIFIED SITE - CHRONIC ULCER OF UNSPECIFIED SITE
709.8 OTHER SPECIFIED DISORDERS OF SKIN
728.86 NECROTIZING FASCIITIS
730.00 - 730.20 ACUTE OSTEOMYELITIS SITE UNSPECIFIED - UNSPECIFIED OSTEOMYELITIS SITE UNSPECIFIED
785.4 GANGRENE
870.0 - 870.2 LACERATION OF SKIN OF EYELID AND PERIOCULAR AREA - LACERATION OF EYELID INVOLVING LACRIMAL PASSAGES
872.01 OPEN WOUND OF AURICLE UNCOMPLICATED
872.11 OPEN WOUND OF AURICLE COMPLICATED
873.0 OPEN WOUND OF SCALP WITHOUT COMPLICATION
873.1 OPEN WOUND OF SCALP COMPLICATED
873.20 - 873.22 OPEN WOUND OF NOSE UNSPECIFIED SITE UNCOMPLICATED - OPEN WOUND OF NASAL CAVITY UNCOMPLICATED
873.32 - 873.33 OPEN WOUND OF NASAL CAVITY COMPLICATED - OPEN WOUND OF NASAL SINUS COMPLICATED
873.41 - 873.49 OPEN WOUND OF CHEEK UNCOMPLICATED - OPEN WOUND OF OTHER AND MULTIPLE SITES UNCOMPLICATED
873.51 - 873.59 OPEN WOUND OF CHEEK COMPLICATED - OPEN WOUND OF OTHER AND MULTIPLE SITES COMPLICATED
874.8 - 874.9 OPEN WOUND OF OTHER AND UNSPECIFIED PARTS OF NECK WITHOUT COMPLICATION - OPEN WOUND OF OTHER AND UNSPECIFIED PARTS OF NECK COMPLICATED
875.0 - 875.1 OPEN WOUND OF CHEST (WALL) WITHOUT COMPLICATION - OPEN WOUND OF CHEST (WALL) COMPLICATED
876.0 - 876.1 OPEN WOUND OF BACK WITHOUT COMPLICATION - OPEN WOUND OF BACK COMPLICATED
877.0 - 877.1 OPEN WOUND OF BUTTOCK WITHOUT COMPLICATION - OPEN WOUND OF BUTTOCK COMPLICATED
878.0 - 878.9 OPEN WOUND OF PENIS WITHOUT COMPLICATION - OPEN WOUND OF OTHER AND UNSPECIFIED PARTS OF GENITAL ORGANS COMPLICATED
879.0 - 879.9 OPEN WOUND OF BREAST WITHOUT COMPLICATION - OPEN WOUND(S) (MULTIPLE) OF UNSPECIFIED SITE(S) COMPLICATED
880.00 - 880.29 OPEN WOUND OF SHOULDER REGION WITHOUT COMPLICATION - OPEN WOUND OF MULTIPLE SITES OF SHOULDER AND UPPER ARM WITH TENDON INVOLVEMENT
881.00 - 881.22 OPEN WOUND OF FOREARM WITHOUT COMPLICATION - OPEN WOUND OF WRIST WITH TENDON INVOLVEMENT
882.0 - 882.2 OPEN WOUND OF HAND EXCEPT FINGERS ALONE WITHOUT COMPLICATION - OPEN WOUND OF HAND EXCEPT FINGERS ALONE WITH TENDON INVOLVEMENT
883.0 - 883.2 OPEN WOUND OF FINGERS WITHOUT COMPLICATION - OPEN WOUND OF FINGERS WITH TENDON INVOLVEMENT
884.0 - 884.2 MULTIPLE AND UNSPECIFIED OPEN WOUND OF UPPER LIMB WITHOUT COMPLICATION - MULTIPLE AND UNSPECIFIED OPEN WOUND OF UPPER LIMB WITH TENDON INVOLVEMENT
885.0 - 885.1 TRAUMATIC AMPUTATION OF THUMB (COMPLETE)(PARTIAL) WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF THUMB (COMPLETE)(PARTIAL) COMPLICATED
886.0 - 886.1 TRAUMATIC AMPUTATION OF OTHER FINGER(S) (COMPLETE) (PARTIAL) WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF OTHER FINGER(S) (COMPLETE) (PARTIAL) COMPLICATED
887.0 - 887.7 TRAUMATIC AMPUTATION OF ARM AND HAND (COMPLETE) (PARTIAL) UNILATERAL BELOW ELBOW WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF ARM AND HAND (COMPLETE) (PARTIAL) BILATERAL (ANY LEVEL) COMPLICATED
890.0 - 890.2 OPEN WOUND OF HIP AND THIGH WITHOUT COMPLICATION - OPEN WOUND OF HIP AND THIGH WITH TENDON INVOLVEMENT
891.0 - 891.2 OPEN WOUND OF KNEE LEG (EXCEPT THIGH) AND ANKLE WITHOUT COMPLICATION - OPEN WOUND OF KNEE LEG (EXCEPT THIGH) AND ANKLE WITH TENDON INVOLVEMENT
892.0 - 892.2 OPEN WOUND OF FOOT EXCEPT TOE(S) ALONE WITHOUT COMPLICATION - OPEN WOUND OF FOOT EXCEPT TOE(S) ALONE WITH TENDON INVOLVEMENT
893.0 - 893.2 OPEN WOUND OF TOE(S) WITHOUT COMPLICATION - OPEN WOUND OF TOE(S) WITH TENDON INVOLVEMENT
894.0 - 894.2 MULTIPLE AND UNSPECIFIED OPEN WOUND OF LOWER LIMB WITHOUT COMPLICATION - MULTIPLE AND UNSPECIFIED OPEN WOUND OF LOWER LIMB WITH TENDON INVOLVEMENT
895.0 - 895.1 TRAUMATIC AMPUTATION OF TOE(S) (COMPLETE) (PARTIAL) WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF TOE(S) (COMPLETE) (PARTIAL) COMPLICATED
896.0 - 896.3 TRAUMATIC AMPUTATION OF FOOT (COMPLETE) (PARTIAL) UNILATERAL WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF FOOT (COMPLETE) (PARTIAL) BILATERAL COMPLICATED
897.0 - 897.7 TRAUMATIC AMPUTATION OF LEG(S) (COMPLETE) (PARTIAL) UNILATERAL BELOW KNEE WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF LEG(S) (COMPLETE) (PARTIAL) BILATERAL (ANY LEVEL) COMPLICATED
997.60 UNSPECIFIED LATE COMPLICATION OF AMPUTATION STUMP
997.62 INFECTION (CHRONIC) OF AMPUTATION STUMP
997.69 OTHER LATE AMPUTATION STUMP COMPLICATION
998.30 - 998.33 DISRUPTION OF WOUND, UNSPECIFIED - DISRUPTION OF TRAUMATIC INJURY WOUND REPAIR
998.51 - 998.59 INFECTED POSTOPERATIVE SEROMA - OTHER POSTOPERATIVE INFECTION
998.6 PERSISTENT POSTOPERATIVE FISTULA NOT ELSEWHERE CLASSIFIED
998.83 NON-HEALING SURGICAL WOUND