Podiatry: Diagnosis Codes

1 Podiatry: Diagnosis Codes Page 1 of 107 UnitedHealthcare Medicare Advantage Policy Appendix: Applicable Code List Approval 12/08/2021 Proprietary Information of UnitedHealthcare. Copyright 2021 United HealthCare Services, Inc. UnitedHealthcare Medicare Advantage Policy Appendix: Applica ble Code List Podiatry: Diagnosis Codes This list of Codes applies to the Medicare Advantage Policy Guideline titled Podiatry. Approval Date: December 8, 2021 Applicable Codes The following list(s) of procedure and/or Diagnosis Codes is provided for reference purposes only and may not be all inclusive.

2 The listing of a code does not imply that the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. Other Policies and guidelines may apply. Coding Clarification: The following Diagnosis code lists pertains to the following CPT/HCPCS Codes : 11055, 11056, and 11057 11719, 11720, 11721, and HCPCS Code G0127 Diagnosis Code Description For CPT Codes 11055, 11056, and 11057 Indeterminate leprosy Tuberculoid leprosy Borderline tuberculoid leprosy Borderline leprosy Borderline lepromatous leprosy Lepromatous leprosy Other forms of leprosy Leprosy, unspecified Early congenital syphilis, latent Late congenital neurosyphilis.

3 Unspecified Late congenital syphilitic meningitis Late congenital syphilitic encephalitis Late congenital syphilitic polyneuropathy Juvenile general paresis Symptomatic neurosyphilis, unspecified Tabes dorsalis Other cerebrospinal syphilis Late syphilitic meningitis Late syphilitic encephalitis Late syphilitic neuropathy Charcot's arthropathy (tabetic) Podiatry: Diagnosis Codes Page 2 of 107 UnitedHealthcare Medicare Advantage Policy Appendix: Applicable Code List Approval 12/08/2021 Proprietary Information of UnitedHealthcare.

4 Copyright 2021 United HealthCare Services, Inc. Diagnosis Code Description For CPT Codes 11055, 11056, and 11057 General paresis Other symptomatic neurosyphilis Asymptomatic neurosyphilis Neurosyphilis, unspecified B20 Human immunodeficiency virus [HIV] disease Tinea unguium Vitamin B12 deficiency anemia due to intrinsic factor deficiency Other megaloblastic anemias, not elsewhere classified Other specified coagulation defects Coagulation defect, unspecified Other biotin-dependent carboxylase deficiency Biotin-dependent carboxylase deficiency, unspecified Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)

5 Diabetes mellitus due to underlying condition with hyperosmolarity with coma Diabetes mellitus due to underlying condition with ketoacidosis without coma Diabetes mellitus due to underlying condition with ketoacidosis with coma Diabetes mellitus due to underlying condition with diabetic nephropathy Diabetes mellitus due to underlying condition with diabetic chronic kidney disease Diabetes mellitus due to underlying condition with other diabetic kidney complication Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema.

6 Bilateral Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye Podiatry: Diagnosis Codes Page 3 of 107 UnitedHealthcare Medicare Advantage Policy Appendix.

7 Applicable Code List Approval 12/08/2021 Proprietary Information of UnitedHealthcare. Copyright 2021 United HealthCare Services, Inc. Diagnosis Code Description For CPT Codes 11055, 11056, and 11057 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema.

8 Right eye Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, left eye Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, bilateral Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, right eye Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, left eye Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, bilateral Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema.

9 Right eye Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, left eye Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, bilateral Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, right eye Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, left eye Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, bilateral Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, unspecified eye Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula.

10 Right eye Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye Diabetes mellit