Questionable As Principal Diagnosis ICD-10-CM Codes

The following 27 ICD-10-CM codes are not usually sufficient justification for admission to an acute care hospital when used as a principal diagnosis.

  • E11.9
    Type 2 diabetes mellitus without complications
  • E13.9
    Other specified diabetes mellitus without complications
  • E66.09
    Other obesity due to excess calories
  • E66.1
    Drug-induced obesity
  • E66.8
    Other obesity
  • E66.9
    Obesity, unspecified
  • H61.20
    Impacted cerumen, unspecified ear
  • H61.21
    Impacted cerumen, right ear
  • H61.22
    Impacted cerumen, left ear
  • H61.23
    Impacted cerumen, bilateral
  • I10
    Essential (primary) hypertension
  • I44.4
    Left anterior fascicular block
  • I44.5
    Left posterior fascicular block
  • I44.60
    Unspecified fascicular block
  • I44.69
    Other fascicular block
  • I44.7
    Left bundle-branch block, unspecified
  • I45.0
    Right fascicular block
  • I45.10
    Unspecified right bundle-branch block
  • I45.19
    Other right bundle-branch block
  • R03.0
    Elevated blood-pressure reading, without diagnosis of hypertension
  • R97.20
    Elevated prostate specific antigen [PSA]
  • R97.21
    Rising PSA following treatment for malignant neoplasm of prostate
  • Z21
    Asymptomatic human immunodeficiency virus [HIV] infection status
  • Z45.010
    Encounter for checking and testing of cardiac pacemaker pulse generator [battery]
  • Z45.018
    Encounter for adjustment and management of other part of cardiac pacemaker
  • Z45.02
    Encounter for adjustment and management of automatic implantable cardiac defibrillator
  • Z45.09
    Encounter for adjustment and management of other cardiac device
ICD-10-CM Code E11.9

Type 2 diabetes mellitus without complications

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
ICD-10-CM Code E13.9

Other specified diabetes mellitus without complications

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
ICD-10-CM Code E66.09

Other obesity due to excess calories

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
ICD-10-CM Code E66.1

Drug-induced obesity

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
Use Additional
  • code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
ICD-10-CM Code E66.8

Other obesity

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
ICD-10-CM Code E66.9

Obesity, unspecified

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
Applicable To
  • Obesity NOS
ICD-10-CM Code H61.20

Impacted cerumen, unspecified ear

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
ICD-10-CM Code H61.21

Impacted cerumen, right ear

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
ICD-10-CM Code H61.22

Impacted cerumen, left ear

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
ICD-10-CM Code H61.23

Impacted cerumen, bilateral

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
ICD-10-CM Code I10

Essential (primary) hypertension

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
Includes
  • high blood pressure
  • hypertension (arterial) (benign) (essential) (malignant) (primary) (systemic)
Type 1 Excludes
  • hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-O11, O13-O16)
Type 2 Excludes
  • essential (primary) hypertension involving vessels of brain (I60-I69)
  • essential (primary) hypertension involving vessels of eye (H35.0-)
ICD-10-CM Code I44.4

Left anterior fascicular block

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
ICD-10-CM Code I44.5

Left posterior fascicular block

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
ICD-10-CM Code I44.60

Unspecified fascicular block

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
Applicable To
  • Left bundle-branch hemiblock NOS
ICD-10-CM Code I44.69

Other fascicular block

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
ICD-10-CM Code I44.7

Left bundle-branch block, unspecified

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
ICD-10-CM Code I45.0

Right fascicular block

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
ICD-10-CM Code I45.10

Unspecified right bundle-branch block

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
Applicable To
  • Right bundle-branch block NOS
ICD-10-CM Code I45.19

Other right bundle-branch block

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
ICD-10-CM Code R03.0

Elevated blood-pressure reading, without diagnosis of hypertension

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
Note
  • This category is to be used to record an episode of elevated blood pressure in a patient in whom no formal diagnosis of hypertension has been made, or as an isolated incidental finding.
ICD-10-CM Code R97.20

Elevated prostate specific antigen [PSA]

    2017 - New Code 2018 2019 Billable/Specific Code Adult Dx (15-124 years) Male Dx Questionable As Admission Dx
ICD-10-CM Code R97.21

Rising PSA following treatment for malignant neoplasm of prostate

    2017 - New Code 2018 2019 Billable/Specific Code Adult Dx (15-124 years) Male Dx Questionable As Admission Dx
ICD-10-CM Code Z21

Asymptomatic human immunodeficiency virus [HIV] infection status

    2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx
Applicable To
  • HIV positive NOS
Code First
  • Human immunodeficiency virus [HIV] disease complicating pregnancy, childbirth and the puerperium, if applicable (O98.7-)
Type 1 Excludes
  • acquired immunodeficiency syndrome (B20)
  • contact with human immunodeficiency virus [HIV] (Z20.6)
  • exposure to human immunodeficiency virus [HIV] (Z20.6)
  • human immunodeficiency virus [HIV] disease (B20)
  • inconclusive laboratory evidence of human immunodeficiency virus [HIV] (R75)
ICD-10-CM Code Z45.010

Encounter for checking and testing of cardiac pacemaker pulse generator [battery]

    2016 2017 2018 2019 Billable/Specific Code POA Exempt Questionable As Admission Dx
Applicable To
  • Encounter for replacing cardiac pacemaker pulse generator [battery]
ICD-10-CM Code Z45.018

Encounter for adjustment and management of other part of cardiac pacemaker

    2016 2017 2018 2019 Billable/Specific Code POA Exempt Questionable As Admission Dx
Type 2 Excludes
  • presence of prosthetic and other devices (Z95-Z97)
ICD-10-CM Code Z45.02

Encounter for adjustment and management of automatic implantable cardiac defibrillator

    2016 2017 2018 2019 Billable/Specific Code POA Exempt Questionable As Admission Dx
Applicable To
  • Encounter for adjustment and management of automatic implantable cardiac defibrillator with synchronous cardiac pacemaker
  • Encounter for adjustment and management of cardiac resynchronization therapy defibrillator (CRT-D)
ICD-10-CM Code Z45.09

Encounter for adjustment and management of other cardiac device

    2016 2017 2018 2019 Billable/Specific Code POA Exempt Questionable As Admission Dx