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. 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.

2 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, 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.

3 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) 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.

4 Left eye Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, 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: Applicable Code List Approval 12/08/2021 Proprietary Information of UnitedHealthcare.

5 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, 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, 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.

6 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, 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 mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye Podiatry: Diagnosis Codes Page 4 of 107 UnitedHealthcare Medicare Advantage Policy Appendix: Applicable Code List Approval 12/08/2021 Proprietary Information of UnitedHealthcare.

7 Copyright 2021 United HealthCare Services, Inc. Diagnosis Code Description For CPT Codes 11055, 11056, and 11057 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, right eye Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, left eye Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, unspecified eye Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema.

8 Right eye Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, left eye Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, bilateral Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, unspecified eye Diabetes mellitus due to underlying condition with diabetic cataract Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, right eye Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, left eye Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, bilateral Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, unspecified eye Diabetes mellitus due to underlying condition with other diabetic ophthalmic complication Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified Diabetes mellitus due to underlying condition with diabetic mononeuropathy Diabetes mellitus due to underlying condition with diabetic polyneuropathy Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathy Diabetes mellitus due to underlying condition with diabetic amyotrophy Diabetes mellitus due to underlying condition with other diabetic neurological complication Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene Podiatry: Diagnosis Codes Page 5 of 107 UnitedHealthcare Medicare Advantage Policy Appendix: Applicable Code List Approval 12/08/2021 Proprietary Information of UnitedHealthcare.

9 Copyright 2021 United HealthCare Services, Inc. Diagnosis Code Description For CPT Codes 11055, 11056, and 11057 Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene Diabetes mellitus due to underlying condition with other circulatory complications Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy Diabetes mellitus due to underlying condition with other diabetic arthropathy Diabetes mellitus due to underlying condition with diabetic dermatitis Diabetes mellitus due to underlying condition with foot ulcer Diabetes mellitus due to underlying condition with other skin ulcer Diabetes mellitus due to underlying condition with other skin complications Diabetes mellitus due to underlying condition with periodontal disease Diabetes mellitus due to underlying condition with other oral complications Diabetes mellitus due to underlying condition with hypoglycemia with coma Diabetes mellitus due to underlying condition with hypoglycemia without coma

10 Diabetes mellitus due to underlying condition with hyperglycemia Diabetes mellitus due to underlying condition with other specified complication Diabetes mellitus due to underlying condition with unspecified complications Diabetes mellitus due to underlying condition without complications Drug or chemical induced diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) Drug or chemical induced diabetes mellitus with hyperosmolarity with coma Drug or chemical induced diabetes mellitus with ketoacidosis without coma Drug or chemical induced diabetes mellitus with ketoacidosis with coma Drug or chemical induced diabetes mellitus with diabetic nephropathy Drug or chemical induced diabetes mellitus with diabetic chronic kidney disease Drug or chemical induced diabetes mellitus with other diabetic kidney complication Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic r