Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Jurisdiction Oregon. Retirement Date N/A

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1 Local Coverage Determination (LCD): Urinalysis Policy (L34060) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information Contractor Name Noridian Healthcare Solutions, LLC Back to Top Contract Number Contract Type A and B MAC Jurisdiction J - F LCD Information Document Information LCD ID L34060 Original ICD-9 LCD ID L24431 LCD Title Urinalysis Policy AMA CPT / ADA CDT / AHA NUBC Copyright Statement CPT only copyright American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright American Dental Association. All rights reserved. CDT and CDT-2010 are trademarks of the American Dental Association. Jurisdiction Oregon Original Effective Date For services performed on or after 10/01/2015 Revision Effective Date For services performed on or after 10/01/2015 Revision Ending Date N/A Retirement Date N/A Notice Period Start Date N/A UB-04 Manual. OFFICIAL UB-04 DATA SPECIFICATIONS MANUAL, 2014, is copyrighted by American Hospital Association ( AHA ), Chicago, Illinois. No portion of OFFICIAL UB-04 MANUAL may be reproduced, sorted in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior express, written consent of AHA. Health Forum reserves the right to change the copyright notice from time to time upon written notice to Company. Notice Period End Date N/A CMS National Coverage Policy Title XVIII of the Social Security Act, 1862(a)(7). This section excludes routine physical examinations. Printed on 10/2/2015. Page 1 of 71

2 Title XVIII of the Social Security Act, Section 1862(a)(1)(A) section allows coverage and payment for only those services that are considered to be reasonable and necessary. Title XVIII of the Social Security Act; Section 1833(e). This section prohibits Medicare payment for any claim, which lacks the necessary information to process the claim. Coverage Guidance Coverage Indications, Limitations, and/or Medical Necessity Note: Providers should seek information related to National Coverage Determinations (NCD) and other Centers for Medicare & Medicaid Services (CMS) instructions in CMS Manuals. This LCD only pertains to the contractor's discretionary coverage related to this service. Urinalysis is a commonly used physical, chemical and/or microscopic examination of the urine used to detect renal or urinary tract disease or systemic disorders manifested by or through the urinary system. In order for Medicare coverage to be provided for urinalysis, the patient must have signs or symptoms of a kidney/urinary tract disorder or a condition, which is known to affect the kidney/urinary tract. The following is a list of conditions in which urinalysis may be considered medically reasonable and necessary. The patient has symptoms suggestive of possible kidney/urinary tract disorder, e.g., dysuria, frequency, hesitancy, nocturia, urgency, flank pain, pelvic pain, abdominal pain, etc. The patient exhibits signs of kidney/urinary tract disorder such as hematuria, discoloration of urine, edema and malodorous urine. The patient has been recently treated or is under treatment for urinary tract disorder and follow-up urinalysis is necessary to evaluate the patient. The patient has a condition known to affect the kidneys or urinary tract, e.g., hypertension, diabetes mellitus, known renal disease, collagen vascular disease and a urinalysis is necessary to evaluate the patient. The patient is undergoing treatment with medication known to potentially adversely affect the kidneys, e.g., gold therapy. The patient has sustained trauma suggestive of possible kidney/urinary tract injury. The patient has unexplained fever. The patient is pregnant and urinalysis is being done as part of standard prenatal care. The patient is pregnant and urinalysis is being done to screen for diabetic pre-eclampsia. Urinalysis can be covered as part of the evaluation of a dehydrated patient. Back to Top Coding Information Bill Type : Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims. 012x Hospital Inpatient (Medicare Part B only) 013x Hospital Outpatient 014x Hospital - Laboratory Services Provided to Non-patients 022x Skilled Nursing - Inpatient (Medicare Part B only) 023x Skilled Nursing - Outpatient 085x Critical Access Hospital Printed on 10/2/2015. Page 2 of 71

3 Revenue : Contractors may specify Revenue to help providers identify those Revenue typically used to report this service. In most instances Revenue are purely advisory; unless specified in the policy services reported under other Revenue are equally subject to this coverage determination. Complete absence of all Revenue indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue. 030X Laboratory - General Classification 031X Laboratory Pathology - General Classification CPT/HCPCS Group 1 Paragraph: The "30% Coding Rule" comes from the AMA (American Medical Association), the organization that holds the copyrights for all CPT codes. The rule states that if, in a given section (e.g., surgery) or subsection (e.g., surgery, integumentary) of the CPT Manual, more than 30% of the codes are listed in the LMRP, then the short descriptors must be used rather than the long descriptors found in the CPT Manual. In this LCD, it does not apply, due to the fact that codes utilized in this policy do not exceed 30% of any CPT section or subsection. Group 1 : Urinalysis nonauto w/scope Urinalysis auto w/scope Urinalysis nonauto w/o scope Urinalysis auto w/o scope Urinalysis Urine screen for bacteria Microscopic exam of urine Urinalysis glass test ICD-10 that Support Medical Necessity Group 1 Paragraph: N/A Group 1 : ICD-10 A18.11 Tuberculosis of kidney and ureter A18.12 Tuberculosis of bladder A18.13 Tuberculosis of other urinary organs A18.14 Tuberculosis of prostate A18.15 Tuberculosis of other male genital organs A18.16 Tuberculosis of cervix A18.17 Tuberculous female pelvic inflammatory disease A18.18 Tuberculosis of other female genital organs A27.0 Leptospirosis icterohemorrhagica A34 Obstetrical tetanus A40.0 Sepsis due to streptococcus, group A A40.1 Sepsis due to streptococcus, group B A40.3 Sepsis due to Streptococcus pneumoniae A40.8 Other streptococcal sepsis A41.01 Sepsis due to Methicillin susceptible Staphylococcus aureus A41.02 Sepsis due to Methicillin resistant Staphylococcus aureus A41.1 Sepsis due to other specified staphylococcus A41.3 Sepsis due to Hemophilus influenzae A41.4 Sepsis due to anaerobes A41.51 Sepsis due to Escherichia coli [E. coli] A41.52 Sepsis due to Pseudomonas Printed on 10/2/2015. Page 3 of 71

4 A41.53 Sepsis due to Serratia A41.59 Other Gram-negative sepsis A41.81 Sepsis due to Enterococcus A41.89 Other specified sepsis A42.7 Actinomycotic sepsis A52.75 Syphilis of kidney and ureter A54.09 Other gonococcal infection of lower genitourinary tract A54.1 Gonococcal infection of lower genitourinary tract with periurethral and accessory gland abscess A54.21 Gonococcal infection of kidney and ureter A54.22 Gonococcal prostatitis A54.23 Gonococcal infection of other male genital organs A54.24 Gonococcal female pelvic inflammatory disease A54.29 Other gonococcal genitourinary infections A54.82 Gonococcal brain abscess A54.84 Gonococcal pneumonia A54.86 Gonococcal sepsis A54.89 Other gonococcal infections A56.01 Chlamydial cystitis and urethritis A56.02 Chlamydial vulvovaginitis A56.09 Other chlamydial infection of lower genitourinary tract A56.11 Chlamydial female pelvic inflammatory disease A56.19 Other chlamydial genitourinary infection A59.01 Trichomonal vulvovaginitis A59.02 Trichomonal prostatitis A59.03 Trichomonal cystitis and urethritis A60.01 Herpesviral infection of penis A60.02 Herpesviral infection of other male genital organs A60.03 Herpesviral cervicitis A60.04 Herpesviral vulvovaginitis A60.09 Herpesviral infection of other urogenital tract A60.1 Herpesviral infection of perianal skin and rectum A63.0 Anogenital (venereal) warts A66.0 Initial lesions of yaws A66.1 Multiple papillomata and wet crab yaws A66.2 Other early skin lesions of yaws A66.3 Hyperkeratosis of yaws A66.4 Gummata and ulcers of yaws A66.5 Gangosa A66.6 Bone and joint lesions of yaws A66.7 Other manifestations of yaws A66.8 Latent yaws A68.0 Louse-borne relapsing fever A68.1 Tick-borne relapsing fever A74.81 Chlamydial peritonitis A74.89 Other chlamydial diseases B15.0 Hepatitis A with hepatic coma B15.9 Hepatitis A without hepatic coma B16.0 Acute hepatitis B with delta-agent with hepatic coma B16.1 Acute hepatitis B with delta-agent without hepatic coma B16.2 Acute hepatitis B without delta-agent with hepatic coma B16.9 Acute hepatitis B without delta-agent and without hepatic coma B17.0 Acute delta-(super) infection of hepatitis B carrier B17.10 Acute hepatitis C without hepatic coma B17.11 Acute hepatitis C with hepatic coma B17.2 Acute hepatitis E B17.8 Other specified acute viral hepatitis B18.0 Chronic viral hepatitis B with delta-agent Printed on 10/2/2015. Page 4 of 71

5 B18.1 Chronic viral hepatitis B without delta-agent B18.2 Chronic viral hepatitis C B18.8 Other chronic viral hepatitis B25.1 Cytomegaloviral hepatitis B26.0 Mumps orchitis B33.4 Hantavirus (cardio)-pulmonary syndrome [HPS] [HCPS] B33.8 Other specified viral diseases B37.3 Candidiasis of vulva and vagina B37.41 Candidal cystitis and urethritis B37.42 Candidal balanitis B37.49 Other urogenital candidiasis B52.0 Plasmodium malariae malaria with nephropathy B74.0 Filariasis due to Wuchereria bancrofti B74.1 Filariasis due to Brugia malayi B95.0 Streptococcus, group A, as the cause of diseases classified elsewhere B95.1 Streptococcus, group B, as the cause of diseases classified elsewhere B95.2 Enterococcus as the cause of diseases classified elsewhere B95.3 Streptococcus pneumoniae as the cause of diseases classified elsewhere B95.4 Other streptococcus as the cause of diseases classified elsewhere B95.61 Methicillin susceptible Staphylococcus aureus infection as the cause of diseases classified elsewhere B95.62 Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere B95.7 Other staphylococcus as the cause of diseases classified elsewhere B96.0 Mycoplasma pneumoniae [M. pneumoniae] as the cause of diseases classified elsewhere B96.1 Klebsiella pneumoniae [K. pneumoniae] as the cause of diseases classified elsewhere B96.21 Shiga toxin-producing Escherichia coli [E. coli] (STEC) O157 as the cause of diseases classified elsewhere B96.22 Other specified Shiga toxin-producing Escherichia coli [E. coli] (STEC) as the cause of diseases classified elsewhere B96.29 Other Escherichia coli [E. coli] as the cause of diseases classified elsewhere B96.3 Hemophilus influenzae [H. influenzae] as the cause of diseases classified elsewhere B96.4 Proteus (mirabilis) (morganii) as the cause of diseases classified elsewhere B96.5 Pseudomonas (aeruginosa) (mallei) (pseudomallei) as the cause of diseases classified elsewhere B96.6 Bacteroides fragilis [B. fragilis] as the cause of diseases classified elsewhere B96.7 Clostridium perfringens [C. perfringens] as the cause of diseases classified elsewhere B96.81 Helicobacter pylori [H. pylori] as the cause of diseases classified elsewhere B96.82 Vibrio vulnificus as the cause of diseases classified elsewhere B96.89 Other specified bacterial agents as the cause of diseases classified elsewhere B97.19 Other enterovirus as the cause of diseases classified elsewhere B97.21 SARS-associated coronavirus as the cause of diseases classified elsewhere B97.29 Other coronavirus as the cause of diseases classified elsewhere B97.5 Reovirus as the cause of diseases classified elsewhere B97.6 Parvovirus as the cause of diseases classified elsewhere B97.81 Human metapneumovirus as the cause of diseases classified elsewhere B97.89 Other viral agents as the cause of diseases classified elsewhere C60.0 Malignant neoplasm of prepuce C60.1 Malignant neoplasm of glans penis C60.2 Malignant neoplasm of body of penis C60.8 Malignant neoplasm of overlapping sites of penis C61 Malignant neoplasm of prostate C62.01 Malignant neoplasm of undescended right testis C62.02 Malignant neoplasm of undescended left testis C62.11 Malignant neoplasm of descended right testis C62.12 Malignant neoplasm of descended left testis C63.01 Malignant neoplasm of right epididymis C63.02 Malignant neoplasm of left epididymis C63.11 Malignant neoplasm of right spermatic cord C63.12 Malignant neoplasm of left spermatic cord C63.2 Malignant neoplasm of scrotum Printed on 10/2/2015. Page 5 of 71

6 C63.7 Malignant neoplasm of other specified male genital organs C63.8 Malignant neoplasm of overlapping sites of male genital organs C64.1 Malignant neoplasm of right kidney, except renal pelvis C64.2 Malignant neoplasm of left kidney, except renal pelvis C65.1 Malignant neoplasm of right renal pelvis C65.2 Malignant neoplasm of left renal pelvis C66.1 Malignant neoplasm of right ureter C66.2 Malignant neoplasm of left ureter C67.0 Malignant neoplasm of trigone of bladder C67.1 Malignant neoplasm of dome of bladder C67.2 Malignant neoplasm of lateral wall of bladder C67.3 Malignant neoplasm of anterior wall of bladder C67.4 Malignant neoplasm of posterior wall of bladder C67.5 Malignant neoplasm of bladder neck C67.6 Malignant neoplasm of ureteric orifice C67.7 Malignant neoplasm of urachus C67.8 Malignant neoplasm of overlapping sites of bladder C68.0 Malignant neoplasm of urethra C68.1 Malignant neoplasm of paraurethral glands C68.8 Malignant neoplasm of overlapping sites of urinary organs C79.01 Secondary malignant neoplasm of right kidney and renal pelvis C79.02 Secondary malignant neoplasm of left kidney and renal pelvis C79.11 Secondary malignant neoplasm of bladder C79.19 Secondary malignant neoplasm of other urinary organs C88.0 Waldenstrom macroglobulinemia C90.00 Multiple myeloma not having achieved remission C90.01 Multiple myeloma in remission C90.02 Multiple myeloma in relapse D07.5 Carcinoma in situ of prostate D09.0 Carcinoma in situ of bladder D09.19 Carcinoma in situ of other urinary organs D29.1 Benign neoplasm of prostate D30.01 Benign neoplasm of right kidney D30.02 Benign neoplasm of left kidney D30.11 Benign neoplasm of right renal pelvis D30.12 Benign neoplasm of left renal pelvis D30.21 Benign neoplasm of right ureter D30.22 Benign neoplasm of left ureter D30.3 Benign neoplasm of bladder D30.4 Benign neoplasm of urethra D30.8 Benign neoplasm of other specified urinary organs D40.0 Neoplasm of uncertain behavior of prostate D41.01 Neoplasm of uncertain behavior of right kidney D41.02 Neoplasm of uncertain behavior of left kidney D41.11 Neoplasm of uncertain behavior of right renal pelvis D41.12 Neoplasm of uncertain behavior of left renal pelvis D41.21 Neoplasm of uncertain behavior of right ureter D41.22 Neoplasm of uncertain behavior of left ureter D41.3 Neoplasm of uncertain behavior of urethra D41.4 Neoplasm of uncertain behavior of bladder D47.2 Monoclonal gammopathy D57.01 Hb-SS disease with acute chest syndrome D57.02 Hb-SS disease with splenic sequestration D57.1 Sickle-cell disease without crisis D57.20 Sickle-cell/Hb-C disease without crisis D Sickle-cell/Hb-C disease with acute chest syndrome D Sickle-cell/Hb-C disease with splenic sequestration D57.80 Other sickle-cell disorders without crisis Printed on 10/2/2015. Page 6 of 71

7 D Other sickle-cell disorders with acute chest syndrome D Other sickle-cell disorders with splenic sequestration D59.3 Hemolytic-uremic syndrome D59.5 Paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli] D59.6 Hemoglobinuria due to hemolysis from other external causes D59.8 Other acquired hemolytic anemias D69.51 Posttransfusion purpura D69.59 Other secondary thrombocytopenia D78.11 Accidental puncture and laceration of the spleen during a procedure on the spleen D78.12 Accidental puncture and laceration of the spleen during other procedure D81.3 Adenosine deaminase [ADA] deficiency D81.5 Purine nucleoside phosphorylase [PNP] deficiency D86.0 Sarcoidosis of lung D86.1 Sarcoidosis of lymph nodes D86.2 Sarcoidosis of lung with sarcoidosis of lymph nodes D86.3 Sarcoidosis of skin D86.81 Sarcoid meningitis D86.82 Multiple cranial nerve palsies in sarcoidosis D86.83 Sarcoid iridocyclitis D86.84 Sarcoid pyelonephritis D86.85 Sarcoid myocarditis D86.86 Sarcoid arthropathy D86.87 Sarcoid myositis D86.89 Sarcoidosis of other sites D89.0 Polyclonal hypergammaglobulinemia D89.1 Cryoglobulinemia E08.00 Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) E08.01 Diabetes mellitus due to underlying condition with hyperosmolarity with coma E08.10 Diabetes mellitus due to underlying condition with ketoacidosis without coma E08.11 Diabetes mellitus due to underlying condition with ketoacidosis with coma E08.21 Diabetes mellitus due to underlying condition with diabetic nephropathy E08.22 Diabetes mellitus due to underlying condition with diabetic chronic kidney disease E08.29 Diabetes mellitus due to underlying condition with other diabetic kidney complication E Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema E Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema E Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema E Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema E Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema E Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema E Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema E Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema E08.36 Diabetes mellitus due to underlying condition with diabetic cataract E08.39 Diabetes mellitus due to underlying condition with other diabetic ophthalmic complication E08.41 Diabetes mellitus due to underlying condition with diabetic mononeuropathy E08.42 Diabetes mellitus due to underlying condition with diabetic polyneuropathy E08.43 Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathy E08.44 Diabetes mellitus due to underlying condition with diabetic amyotrophy E08.49 Diabetes mellitus due to underlying condition with other diabetic neurological complication E08.51 Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene Printed on 10/2/2015. Page 7 of 71

8 E08.52 Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene E08.59 Diabetes mellitus due to underlying condition with other circulatory complications E Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy E Diabetes mellitus due to underlying condition with other diabetic arthropathy E Diabetes mellitus due to underlying condition with diabetic dermatitis E Diabetes mellitus due to underlying condition with foot ulcer E Diabetes mellitus due to underlying condition with other skin ulcer E Diabetes mellitus due to underlying condition with other skin complications E Diabetes mellitus due to underlying condition with periodontal disease E Diabetes mellitus due to underlying condition with other oral complications E Diabetes mellitus due to underlying condition with hypoglycemia with coma E Diabetes mellitus due to underlying condition with hypoglycemia without coma E08.65 Diabetes mellitus due to underlying condition with hyperglycemia E08.69 Diabetes mellitus due to underlying condition with other specified complication E08.9 Diabetes mellitus due to underlying condition without complications E09.00 Drug or chemical induced diabetes mellitus with hyperosmolarity without nonketotic hyperglycemichyperosmolar coma (NKHHC) E09.01 Drug or chemical induced diabetes mellitus with hyperosmolarity with coma E09.10 Drug or chemical induced diabetes mellitus with ketoacidosis without coma E09.11 Drug or chemical induced diabetes mellitus with ketoacidosis with coma E09.21 Drug or chemical induced diabetes mellitus with diabetic nephropathy E09.22 Drug or chemical induced diabetes mellitus with diabetic chronic kidney disease E09.29 Drug or chemical induced diabetes mellitus with other diabetic kidney complication E Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema E Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema E Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema E Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema E Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema E Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema E Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema E Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema E09.36 Drug or chemical induced diabetes mellitus with diabetic cataract E09.39 Drug or chemical induced diabetes mellitus with other diabetic ophthalmic complication E09.41 Drug or chemical induced diabetes mellitus with neurological complications with diabetic mononeuropathy E09.42 Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy E09.43 Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy E09.44 Drug or chemical induced diabetes mellitus with neurological complications with diabetic amyotrophy E09.49 Drug or chemical induced diabetes mellitus with neurological complications with other diabetic neurological complication E09.51 Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy without gangrene E09.52 Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene E09.59 Drug or chemical induced diabetes mellitus with other circulatory complications E Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy E Drug or chemical induced diabetes mellitus with other diabetic arthropathy E Drug or chemical induced diabetes mellitus with diabetic dermatitis E Drug or chemical induced diabetes mellitus with foot ulcer E Drug or chemical induced diabetes mellitus with other skin ulcer Printed on 10/2/2015. Page 8 of 71

9 E Drug or chemical induced diabetes mellitus with other skin complications E Drug or chemical induced diabetes mellitus with periodontal disease E Drug or chemical induced diabetes mellitus with other oral complications E Drug or chemical induced diabetes mellitus with hypoglycemia with coma E Drug or chemical induced diabetes mellitus with hypoglycemia without coma E09.65 Drug or chemical induced diabetes mellitus with hyperglycemia E09.69 Drug or chemical induced diabetes mellitus with other specified complication E09.9 Drug or chemical induced diabetes mellitus without complications E10.10 Type 1 diabetes mellitus with ketoacidosis without coma E10.11 Type 1 diabetes mellitus with ketoacidosis with coma E10.21 Type 1 diabetes mellitus with diabetic nephropathy E10.22 Type 1 diabetes mellitus with diabetic chronic kidney disease E10.29 Type 1 diabetes mellitus with other diabetic kidney complication E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema E Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema E Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema E10.36 Type 1 diabetes mellitus with diabetic cataract E10.39 Type 1 diabetes mellitus with other diabetic ophthalmic complication E10.41 Type 1 diabetes mellitus with diabetic mononeuropathy E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy E10.43 Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy E10.44 Type 1 diabetes mellitus with diabetic amyotrophy E10.49 Type 1 diabetes mellitus with other diabetic neurological complication E10.51 Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene E10.52 Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene E10.59 Type 1 diabetes mellitus with other circulatory complications E Type 1 diabetes mellitus with diabetic neuropathic arthropathy E Type 1 diabetes mellitus with other diabetic arthropathy E Type 1 diabetes mellitus with diabetic dermatitis E Type 1 diabetes mellitus with foot ulcer E Type 1 diabetes mellitus with other skin ulcer E Type 1 diabetes mellitus with other skin complications E Type 1 diabetes mellitus with periodontal disease E Type 1 diabetes mellitus with other oral complications E Type 1 diabetes mellitus with hypoglycemia with coma E Type 1 diabetes mellitus with hypoglycemia without coma E10.65 Type 1 diabetes mellitus with hyperglycemia E10.69 Type 1 diabetes mellitus with other specified complication E10.9 Type 1 diabetes mellitus without complications E11.00 Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) E11.01 Type 2 diabetes mellitus with hyperosmolarity with coma E11.21 Type 2 diabetes mellitus with diabetic nephropathy E11.22 Type 2 diabetes mellitus with diabetic chronic kidney disease E11.29 Type 2 diabetes mellitus with other diabetic kidney complication E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema Printed on 10/2/2015. Page 9 of 71

10 E Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema E Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema E11.36 Type 2 diabetes mellitus with diabetic cataract E11.39 Type 2 diabetes mellitus with other diabetic ophthalmic complication E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy E11.44 Type 2 diabetes mellitus with diabetic amyotrophy E11.49 Type 2 diabetes mellitus with other diabetic neurological complication E11.51 Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene E11.52 Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene E11.59 Type 2 diabetes mellitus with other circulatory complications E Type 2 diabetes mellitus with diabetic neuropathic arthropathy E Type 2 diabetes mellitus with other diabetic arthropathy E Type 2 diabetes mellitus with diabetic dermatitis E Type 2 diabetes mellitus with foot ulcer E Type 2 diabetes mellitus with other skin ulcer E Type 2 diabetes mellitus with other skin complications E Type 2 diabetes mellitus with periodontal disease E Type 2 diabetes mellitus with other oral complications E Type 2 diabetes mellitus with hypoglycemia with coma E Type 2 diabetes mellitus with hypoglycemia without coma E11.65 Type 2 diabetes mellitus with hyperglycemia E11.69 Type 2 diabetes mellitus with other specified complication E11.9 Type 2 diabetes mellitus without complications E13.00 Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemichyperosmolar coma (NKHHC) E13.01 Other specified diabetes mellitus with hyperosmolarity with coma E13.10 Other specified diabetes mellitus with ketoacidosis without coma E13.11 Other specified diabetes mellitus with ketoacidosis with coma E13.21 Other specified diabetes mellitus with diabetic nephropathy E13.22 Other specified diabetes mellitus with diabetic chronic kidney disease E13.29 Other specified diabetes mellitus with other diabetic kidney complication E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema E Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema E Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema E Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema E Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema E13.36 Other specified diabetes mellitus with diabetic cataract E13.39 Other specified diabetes mellitus with other diabetic ophthalmic complication E13.41 Other specified diabetes mellitus with diabetic mononeuropathy E13.42 Other specified diabetes mellitus with diabetic polyneuropathy E13.43 Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy E13.44 Other specified diabetes mellitus with diabetic amyotrophy E13.49 Other specified diabetes mellitus with other diabetic neurological complication E13.51 Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene E13.52 Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene E13.59 Other specified diabetes mellitus with other circulatory complications E Other specified diabetes mellitus with diabetic neuropathic arthropathy E Other specified diabetes mellitus with other diabetic arthropathy Printed on 10/2/2015. Page 10 of 71

11 E Other specified diabetes mellitus with diabetic dermatitis E Other specified diabetes mellitus with foot ulcer E Other specified diabetes mellitus with other skin ulcer E Other specified diabetes mellitus with other skin complications E Other specified diabetes mellitus with periodontal disease E Other specified diabetes mellitus with other oral complications E Other specified diabetes mellitus with hypoglycemia with coma E Other specified diabetes mellitus with hypoglycemia without coma E13.65 Other specified diabetes mellitus with hyperglycemia E13.69 Other specified diabetes mellitus with other specified complication E13.9 Other specified diabetes mellitus without complications E22.2 Syndrome of inappropriate secretion of antidiuretic hormone E23.2 Diabetes insipidus E36.11 Accidental puncture and laceration of an endocrine system organ or structure during an endocrine system procedure E36.12 Accidental puncture and laceration of an endocrine system organ or structure during other procedure E74.8 Other specified disorders of carbohydrate metabolism E76.01 Hurler's syndrome E76.02 Hurler-Scheie syndrome E76.03 Scheie's syndrome E76.1 Mucopolysaccharidosis, type II E Morquio A mucopolysaccharidoses E Morquio B mucopolysaccharidoses E76.22 Sanfilippo mucopolysaccharidoses E76.29 Other mucopolysaccharidoses E76.8 Other disorders of glucosaminoglycan metabolism E78.2 Mixed hyperlipidemia E78.3 Hyperchylomicronemia E78.4 Other hyperlipidemia E79.1 Lesch-Nyhan syndrome E79.2 Myoadenylate deaminase deficiency E79.8 Other disorders of purine and pyrimidine metabolism E80.0 Hereditary erythropoietic porphyria E80.1 Porphyria cutanea tarda E80.21 Acute intermittent (hepatic) porphyria E80.29 Other porphyria E80.4 Gilbert syndrome E80.5 Crigler-Najjar syndrome E80.6 Other disorders of bilirubin metabolism E Hereditary hemochromatosis E Hemochromatosis due to repeated red blood cell transfusions E Other hemochromatosis E83.19 Other disorders of iron metabolism E83.52 Hypercalcemia E84.0 Cystic fibrosis with pulmonary manifestations E84.11 Meconium ileus in cystic fibrosis E84.19 Cystic fibrosis with other intestinal manifestations E84.8 Cystic fibrosis with other manifestations E85.0 Non-neuropathic heredofamilial amyloidosis E85.1 Neuropathic heredofamilial amyloidosis E85.3 Secondary systemic amyloidosis E85.4 Organ-limited amyloidosis E85.8 Other amyloidosis E86.0 Dehydration E86.1 Hypovolemia E87.0 Hyperosmolality and hypernatremia E87.1 Hypo-osmolality and hyponatremia Printed on 10/2/2015. Page 11 of 71

12 E87.2 Acidosis E87.3 Alkalosis E87.4 Mixed disorder of acid-base balance E87.6 Hypokalemia E87.71 Transfusion associated circulatory overload E87.79 Other fluid overload E87.8 Other disorders of electrolyte and fluid balance, not elsewhere classified E88.01 Alpha-1-antitrypsin deficiency E88.09 Other disorders of plasma-protein metabolism, not elsewhere classified E88.3 Tumor lysis syndrome F07.0 Personality change due to known physiological condition F45.8 Other somatoform disorders G83.4 Cauda equina syndrome G93.3 Postviral fatigue syndrome G97.48 Accidental puncture and laceration of other nervous system organ or structure during a nervous system procedure G97.49 Accidental puncture and laceration of other nervous system organ or structure during other procedure H Accidental puncture and laceration of right eye and adnexa during an ophthalmic procedure H Accidental puncture and laceration of left eye and adnexa during an ophthalmic procedure H Accidental puncture and laceration of eye and adnexa during an ophthalmic procedure, bilateral H Accidental puncture and laceration of right eye and adnexa during other procedure H Accidental puncture and laceration of left eye and adnexa during other procedure H Accidental puncture and laceration of eye and adnexa during other procedure, bilateral H95.31 Accidental puncture and laceration of the ear and mastoid process during a procedure on the ear and mastoid process H95.32 Accidental puncture and laceration of the ear and mastoid process during other procedure I10 Essential (primary) hypertension I11.0 Hypertensive heart disease with heart failure I11.9 Hypertensive heart disease without heart failure I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease I13.10 Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease I15.0 Renovascular hypertension I15.1 Hypertension secondary to other renal disorders I15.2 Hypertension secondary to endocrine disorders I15.8 Other secondary hypertension I33.0 Acute and subacute infective endocarditis I39 Endocarditis and heart valve disorders in diseases classified elsewhere I50.21 Acute systolic (congestive) heart failure I50.22 Chronic systolic (congestive) heart failure I50.23 Acute on chronic systolic (congestive) heart failure I50.31 Acute diastolic (congestive) heart failure I50.32 Chronic diastolic (congestive) heart failure I50.33 Acute on chronic diastolic (congestive) heart failure I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure I77.3 Arterial fibromuscular dysplasia I77.4 Celiac artery compression syndrome Printed on 10/2/2015. Page 12 of 71

13 I77.5 Necrosis of artery I86.1 Scrotal varices I89.0 Lymphedema, not elsewhere classified I97.2 Postmastectomy lymphedema syndrome I97.51 Accidental puncture and laceration of a circulatory system organ or structure during a circulatory system procedure I97.52 Accidental puncture and laceration of a circulatory system organ or structure during other procedure J20.0 Acute bronchitis due to Mycoplasma pneumoniae J20.1 Acute bronchitis due to Hemophilus influenzae J20.2 Acute bronchitis due to streptococcus J20.4 Acute bronchitis due to parainfluenza virus J95.71 Accidental puncture and laceration of a respiratory system organ or structure during a respiratory system procedure J95.72 Accidental puncture and laceration of a respiratory system organ or structure during other procedure K52.2 Allergic and dietetic gastroenteritis and colitis K52.89 Other specified noninfective gastroenteritis and colitis K70.41 Alcoholic hepatic failure with coma K71.0 Toxic liver disease with cholestasis K71.10 Toxic liver disease with hepatic necrosis, without coma K71.11 Toxic liver disease with hepatic necrosis, with coma K71.2 Toxic liver disease with acute hepatitis K71.3 Toxic liver disease with chronic persistent hepatitis K71.4 Toxic liver disease with chronic lobular hepatitis K71.50 Toxic liver disease with chronic active hepatitis without ascites K71.51 Toxic liver disease with chronic active hepatitis with ascites K71.6 Toxic liver disease with hepatitis, not elsewhere classified K71.7 Toxic liver disease with fibrosis and cirrhosis of liver K71.8 Toxic liver disease with other disorders of liver K72.00 Acute and subacute hepatic failure without coma K72.01 Acute and subacute hepatic failure with coma K72.11 Chronic hepatic failure with coma K73.0 Chronic persistent hepatitis, not elsewhere classified K73.1 Chronic lobular hepatitis, not elsewhere classified K73.2 Chronic active hepatitis, not elsewhere classified K73.8 Other chronic hepatitis, not elsewhere classified K74.0 Hepatic fibrosis K74.3 Primary biliary cirrhosis K74.4 Secondary biliary cirrhosis K74.69 Other cirrhosis of liver K75.2 Nonspecific reactive hepatitis K75.3 Granulomatous hepatitis, not elsewhere classified K75.4 Autoimmune hepatitis K75.81 Nonalcoholic steatohepatitis (NASH) K75.89 Other specified inflammatory liver diseases K76.0 Fatty (change of) liver, not elsewhere classified K76.1 Chronic passive congestion of liver K76.2 Central hemorrhagic necrosis of liver K76.4 Peliosis hepatis K76.89 Other specified diseases of liver K77 Liver disorders in diseases classified elsewhere K91.71 Accidental puncture and laceration of a digestive system organ or structure during a digestive system procedure K91.72 Accidental puncture and laceration of a digestive system organ or structure during other procedure L76.11 Accidental puncture and laceration of skin and subcutaneous tissue during a dermatologic procedure L76.12 Accidental puncture and laceration of skin and subcutaneous tissue during other procedure M Staphylococcal arthritis, right shoulder M Staphylococcal arthritis, left shoulder Printed on 10/2/2015. Page 13 of 71

14 M Staphylococcal arthritis, right elbow M Staphylococcal arthritis, left elbow M Staphylococcal arthritis, right wrist M Staphylococcal arthritis, left wrist M Staphylococcal arthritis, right hand M Staphylococcal arthritis, left hand M Staphylococcal arthritis, right hip M Staphylococcal arthritis, left hip M Staphylococcal arthritis, right knee M Staphylococcal arthritis, left knee M Staphylococcal arthritis, right ankle and foot M Staphylococcal arthritis, left ankle and foot M00.08 Staphylococcal arthritis, vertebrae M00.09 Staphylococcal polyarthritis M Pneumococcal arthritis, right shoulder M Pneumococcal arthritis, left shoulder M Pneumococcal arthritis, right elbow M Pneumococcal arthritis, left elbow M Pneumococcal arthritis, right wrist M Pneumococcal arthritis, left wrist M Pneumococcal arthritis, right hand M Pneumococcal arthritis, left hand M Pneumococcal arthritis, right hip M Pneumococcal arthritis, left hip M Pneumococcal arthritis, right knee M Pneumococcal arthritis, left knee M Pneumococcal arthritis, right ankle and foot M Pneumococcal arthritis, left ankle and foot M00.18 Pneumococcal arthritis, vertebrae M00.19 Pneumococcal polyarthritis M Other streptococcal arthritis, right shoulder M Other streptococcal arthritis, left shoulder M Other streptococcal arthritis, right elbow M Other streptococcal arthritis, left elbow M Other streptococcal arthritis, right wrist M Other streptococcal arthritis, left wrist M Other streptococcal arthritis, right hand M Other streptococcal arthritis, left hand M Other streptococcal arthritis, right hip M Other streptococcal arthritis, left hip M Other streptococcal arthritis, right knee M Other streptococcal arthritis, left knee M Other streptococcal arthritis, right ankle and foot M Other streptococcal arthritis, left ankle and foot M00.28 Other streptococcal arthritis, vertebrae M00.29 Other streptococcal polyarthritis M Arthritis due to other bacteria, right shoulder M Arthritis due to other bacteria, left shoulder M Arthritis due to other bacteria, right elbow M Arthritis due to other bacteria, left elbow M Arthritis due to other bacteria, right wrist M Arthritis due to other bacteria, left wrist M Arthritis due to other bacteria, right hand M Arthritis due to other bacteria, left hand M Arthritis due to other bacteria, right hip M Arthritis due to other bacteria, left hip M Arthritis due to other bacteria, right knee M Arthritis due to other bacteria, left knee Printed on 10/2/2015. Page 14 of 71

15 M Arthritis due to other bacteria, right ankle and foot M Arthritis due to other bacteria, left ankle and foot M00.88 Arthritis due to other bacteria, vertebrae M00.89 Polyarthritis due to other bacteria M Reiter's disease, right shoulder M Reiter's disease, left shoulder M Reiter's disease, right elbow M Reiter's disease, left elbow M Reiter's disease, right wrist M Reiter's disease, left wrist M Reiter's disease, right hand M Reiter's disease, left hand M Reiter's disease, right hip M Reiter's disease, left hip M Reiter's disease, right knee M Reiter's disease, left knee M Reiter's disease, right ankle and foot M Reiter's disease, left ankle and foot M02.38 Reiter's disease, vertebrae M02.39 Reiter's disease, multiple sites M Felty's syndrome, right shoulder M Felty's syndrome, left shoulder M Felty's syndrome, right elbow M Felty's syndrome, left elbow M Felty's syndrome, right wrist M Felty's syndrome, left wrist M Felty's syndrome, right hand M Felty's syndrome, left hand M Felty's syndrome, right hip M Felty's syndrome, left hip M Felty's syndrome, right knee M Felty's syndrome, left knee M Felty's syndrome, right ankle and foot M Felty's syndrome, left ankle and foot M05.09 Felty's syndrome, multiple sites M Rheumatoid lung disease with rheumatoid arthritis of right shoulder M Rheumatoid lung disease with rheumatoid arthritis of left shoulder M Rheumatoid lung disease with rheumatoid arthritis of right elbow M Rheumatoid lung disease with rheumatoid arthritis of left elbow M Rheumatoid lung disease with rheumatoid arthritis of right wrist M Rheumatoid lung disease with rheumatoid arthritis of left wrist M Rheumatoid lung disease with rheumatoid arthritis of right hand M Rheumatoid lung disease with rheumatoid arthritis of left hand M Rheumatoid lung disease with rheumatoid arthritis of right hip M Rheumatoid lung disease with rheumatoid arthritis of left hip M Rheumatoid lung disease with rheumatoid arthritis of right knee M Rheumatoid lung disease with rheumatoid arthritis of left knee M Rheumatoid lung disease with rheumatoid arthritis of right ankle and foot M Rheumatoid lung disease with rheumatoid arthritis of left ankle and foot M05.19 Rheumatoid lung disease with rheumatoid arthritis of multiple sites M Rheumatoid vasculitis with rheumatoid arthritis of right shoulder M Rheumatoid vasculitis with rheumatoid arthritis of left shoulder M Rheumatoid vasculitis with rheumatoid arthritis of right elbow M Rheumatoid vasculitis with rheumatoid arthritis of left elbow M Rheumatoid vasculitis with rheumatoid arthritis of right wrist M Rheumatoid vasculitis with rheumatoid arthritis of left wrist M Rheumatoid vasculitis with rheumatoid arthritis of right hand Printed on 10/2/2015. Page 15 of 71

16 M Rheumatoid vasculitis with rheumatoid arthritis of left hand M Rheumatoid vasculitis with rheumatoid arthritis of right hip M Rheumatoid vasculitis with rheumatoid arthritis of left hip M Rheumatoid vasculitis with rheumatoid arthritis of right knee M Rheumatoid vasculitis with rheumatoid arthritis of left knee M Rheumatoid vasculitis with rheumatoid arthritis of right ankle and foot M Rheumatoid vasculitis with rheumatoid arthritis of left ankle and foot M05.29 Rheumatoid vasculitis with rheumatoid arthritis of multiple sites M Rheumatoid heart disease with rheumatoid arthritis of right shoulder M Rheumatoid heart disease with rheumatoid arthritis of left shoulder M Rheumatoid heart disease with rheumatoid arthritis of right elbow M Rheumatoid heart disease with rheumatoid arthritis of left elbow M Rheumatoid heart disease with rheumatoid arthritis of right wrist M Rheumatoid heart disease with rheumatoid arthritis of left wrist M Rheumatoid heart disease with rheumatoid arthritis of right hand M Rheumatoid heart disease with rheumatoid arthritis of left hand M Rheumatoid heart disease with rheumatoid arthritis of right hip M Rheumatoid heart disease with rheumatoid arthritis of left hip M Rheumatoid heart disease with rheumatoid arthritis of right knee M Rheumatoid heart disease with rheumatoid arthritis of left knee M Rheumatoid heart disease with rheumatoid arthritis of right ankle and foot M Rheumatoid heart disease with rheumatoid arthritis of left ankle and foot M05.39 Rheumatoid heart disease with rheumatoid arthritis of multiple sites M Rheumatoid myopathy with rheumatoid arthritis of right shoulder M Rheumatoid myopathy with rheumatoid arthritis of left shoulder M Rheumatoid myopathy with rheumatoid arthritis of right elbow M Rheumatoid myopathy with rheumatoid arthritis of left elbow M Rheumatoid myopathy with rheumatoid arthritis of right wrist M Rheumatoid myopathy with rheumatoid arthritis of left wrist M Rheumatoid myopathy with rheumatoid arthritis of right hand M Rheumatoid myopathy with rheumatoid arthritis of left hand M Rheumatoid myopathy with rheumatoid arthritis of right hip M Rheumatoid myopathy with rheumatoid arthritis of left hip M Rheumatoid myopathy with rheumatoid arthritis of right knee M Rheumatoid myopathy with rheumatoid arthritis of left knee M Rheumatoid myopathy with rheumatoid arthritis of right ankle and foot M Rheumatoid myopathy with rheumatoid arthritis of left ankle and foot M05.49 Rheumatoid myopathy with rheumatoid arthritis of multiple sites M Rheumatoid polyneuropathy with rheumatoid arthritis of right shoulder M Rheumatoid polyneuropathy with rheumatoid arthritis of left shoulder M Rheumatoid polyneuropathy with rheumatoid arthritis of right elbow M Rheumatoid polyneuropathy with rheumatoid arthritis of left elbow M Rheumatoid polyneuropathy with rheumatoid arthritis of right wrist M Rheumatoid polyneuropathy with rheumatoid arthritis of left wrist M Rheumatoid polyneuropathy with rheumatoid arthritis of right hand M Rheumatoid polyneuropathy with rheumatoid arthritis of left hand M Rheumatoid polyneuropathy with rheumatoid arthritis of right hip M Rheumatoid polyneuropathy with rheumatoid arthritis of left hip M Rheumatoid polyneuropathy with rheumatoid arthritis of right knee M Rheumatoid polyneuropathy with rheumatoid arthritis of left knee M Rheumatoid polyneuropathy with rheumatoid arthritis of right ankle and foot M Rheumatoid polyneuropathy with rheumatoid arthritis of left ankle and foot M05.59 Rheumatoid polyneuropathy with rheumatoid arthritis of multiple sites M Rheumatoid arthritis of right shoulder with involvement of other organs and systems M Rheumatoid arthritis of left shoulder with involvement of other organs and systems M Rheumatoid arthritis of right elbow with involvement of other organs and systems M Rheumatoid arthritis of left elbow with involvement of other organs and systems M Rheumatoid arthritis of right wrist with involvement of other organs and systems Printed on 10/2/2015. Page 16 of 71