Test Code Test Name CPT HCYS Homocysteine Level 83090
Page 1 of 4 Narrative Description ICD9 Acute Coronary Occlusion without Myocardial Infarction 411.81 Acute Myocardial Infarction of Anterolateral Wall episode of care unspecified 410.20 410.22 Acute Myocardial Infarction of Inferolateral Wall subsequent episode of care Acute Myocardial Infarction of Inferoposterior Wall episode of care unspecified 410.30 410.32 Acute Myocardial Infarction of Inferoposterior Wall subsequent episode of care Acute Myocardial Infarction of Other Inferior Wall episode of care unspecified 410.40 410.42 Acute Myocardial Infarction of Other Inferior Wall subsequent episode of care Acute Myocardial Infarction of Other Lateral Wall episode of care unspecified 410.50 410.52 Acute Myocardial Infarction of Other Lateral Wall subsequent episode of care Acute Myocardial Infarction of other specified sites episode of care unspecified 410.80 410.82 Acute Myocardial Infarction of other specified sites subsequent episode of care Acute Myocardial Infarction of unspecified site episode of care unspecified Acute 410.90 410.92 Myocardial Infarction of unspecified site subsequent episode of care Aneurysm of Heart (Wall) Dissection of Coronary Artery 414.10 414.12 Angina Decubitus 413.0 Atherosclerosis of Aorta 440.0 Atherosclerosis of Native Arteries of the extremities unspecified Atherosclerosis 440.20 440.24 of Native Arteries of the extremities with Gangrene Atherosclerosis of other specified arteries 440.8 Atherosclerosis of Renal Artery 440.1 Atherosclerosis of unspecified bypass graft of the extremities Atherosclerosis of 440.30 440.32 Nonautologous Biological bypass graft of the extremities Benign Essential Hypertension 401.1 Benign Hypertensive Heart Disease without Heart Failure Benign Hypertensive 402.10 402.11 Heart Disease with Heart Failure Benign Renovascular Hypertension 405.11 Budd-Chiari Syndrome 453.0 Cerebral Artery Occlusion unspecified without Cerebral Infarction Cerebral 434.90 434.91 Artery Occlusion unspecified with Cerebral Infarction Cerebral Atherosclerosis 437.0 Cerebral Embolism without Cerebral Infarction Cerebral Embolism with Cerebral 434.10 434.11 Infarction Cerebral Thrombosis without Cerebral Infarction Cerebral Thrombosis with 434.00 434.01 Cerebral Infarction Chronic Ischemic Heart Disease Unspecified 414.9 Coronary Atherosclerosis of Unspecified Type of Vessel Native or Graft Coronary Atherosclerosis of bypass graft (Artery)(Vein) of transplanted Heart Diabetes Mellitus without mention of complication, Type II or Unspecified Type, not stated as uncontrolled Diabetes Mellitus without mention of complication, Type I [Juvenile Type], 414.00 414.07 250.00 250.03
Page 2 of 4 Diabetes with Hyperosmolarity, Type II or Unspecified Type, not stated 250.20 250.23 uncontrolled Diabetes with Hyperosmolarity, Type I [Juvenile Type], Diabetes with Ketoacidosis, Type II or Unspecified Type, not stated as 250.10 250.13 uncontrolled Diabetes with Ketoacidosis, Type I [Juvenile Type], Diabetes with Neurological Manifestations, Type II or Unspecified Type, not stated 250.60 250.63 uncontrolled Diabetes with Neurological Manifestations, Type I [Juvenile Type], Diabetes with Ophthalmic Manifestations, Type II or Unspecified Type, not stated 250.50 250.53 uncontrolled Diabetes with Ophthalmic Manifestations, Type I [Juvenile Type], Diabetes with Other Coma, Type II or Unspecified Type, not stated uncontrolled 250.30 250.33 Diabetes with Other Coma, Type I [Juvenile Type], Diabetes with Other Specified Manifestations, Type II or Unspecified Type, not 250.80 250.83 stated as Diabetes with Other Specified Manifestations, Type I [Juvenile Type], Diabetes with Peripheral Circulatory Disorders, Type II or Unspecified Type, not 250.70 250.73 stated uncontrolled Diabetes with Peripheral Circulatory Disorders, Type I [Juvenile Type], Diabetes with Renal Manifestations, Type II or Unspecified Type, not stated 250.40 250.43 uncontrolled Diabetes with Renal Manifestations, Type I [Juvenile Type], Diabetes with Unspecified Complication, Type II or Unspecified Type, not stated 250.90 250.93 uncontrolled Diabetes with Unspecified Complication, Type I [Juvenile Type], Embolism and Thrombosis of Renal Vein 453.3 Embolism and Thrombosis of Vena Cava 453.2 Folate-Deficiency Anemia 281.2 Generalized and unspecified Atherosclerosis 440.9 Hyperchylomicronemia 272.3 Hypertensive Chronic Kidney Disease, Benign, with Chronic Kidney Disease Stage I through Stage IV, or Unspecified Hypertensive Chronic Kidney Disease, Benign, with Chronic Kidney Disease State V or End Stage Renal Disease Hypertensive Chronic Kidney Disease, Malignant, with Chronic Kidney Disease Stage I through Stage IV, or Unspecified Hypertensive Chronic Kidney Disease, Malignant, with Chronic Kidney Disease State V or End Stage Renal Disease Hypertensive Chronic Kidney Disease, Unspecified, with Chronic Kidney Disease Stage I through Stage IV, or Unspecified Hypertensive Chronic Kidney Disease, Unspecified, with Chronic Kidney Disease State V or End Stage Renal Disease Hypertensive Heart and Chronic Kidney Disease, Benign, without Heart Failure and with Chronic Kidney Disease Stage I through Stage IV, or Unspecified hypertensive Heart and Chronic Kidney Disease, Benign, with Heart Failure and Chronic Kidney Disease Stage V or End Stage Renal Disease Hypertensive Heart and Chronic Kidney Disease, Malignant, without Heart Failure and with Chronic Kidney Disease State I through Stage IV, or unspecified - Hypertensive Heart and Chronic Kidney Disease, Malignant, with Heart Failure and with Chronic Kidney Disease State V or End Stage Renal Disease 403.10 403.11 403.00 403.01 403.90 403.91 404.10 404.13 404.00 404.03
Page 3 of 4 Hypertensive Heart and Chronic Kidney Disease, Unspecified, without Heart 404.90 404.93 Failure and with Chronic Kidney Disease Stage I through Stage IV, or Unspecified Hypertensive Heart and Chronic Kidney Disease, Unspecified, with Heart Failure and Chronic Kidney Disease Stage V or End Stage Renal Disease Intermediate Coronary Syndrome 411.1 Malignant Essential Hypertension 401.0 Malignant Hypertensive Heart Disease without Heart Failure Malignant 402.00 402.01 Hypertensive Heart Disease with Heart Failure Malignant Renovascular Hypertension 405.01 Mixed Hyperlipidemia 272.2 Nopyogenic Thrombosis of Intracranial Venous Sinus 437.6 Occlusion and Stenosis of Basilar Artery without Cerebral Infarction Occlusion 433.00 433.01 and Stenosis of Basilar Artery with Cerebral Infarction Occlusion and Stenosis of Carotid Artery without Cerebral Infarction Occlusion 433.10 433.11 and Stenosis of Carotid Artery with Cerebral Infarction Occlusion and Stenosis of Multiple and Bilateral Precerebral Arteries without 433.30 433.31 Cerebral Infarction Occlusion and Stenosis of Other Specified Precerebral Artery with Cerebral Infarction Occlusion and Stenosis of Other Specified Precerebral Artery without Cerebral 433.80 433.81 Infarction Occlusion and Stenosis of Unspecified Precerebral Artery with Cerebral Infarction Occlusion and Stenosis of Unspecified Precerebral Artery without Cerebral 433.90 433.91 Infarction Occlusion and Stenosis of Unspecified Precerebral Artery with Cerebral Infarction Occlusion and Stenosis of Vertebral Artery without Cerebral Infarction Occlusion 433.20 433.21 and Stenosis of Vertebral Artery with Cerebral Infarction Old Myocardial Infarction 412 Other Acute and Subacute forms of Ischemic Heart Disease Other 411.89 Other and Unspecified Angina Pectoris 413.9 Other and Unspecified Hyperlipidemia 272.4 Other Aneurysm of Heart 414.19 Other Atherosclerosis of Native Arteries of the extremities 440.29 Other Benign Secondary Hypertension 405.19 Other Malignant Secondary Hypertension 405.09 Other specified forms of chronic Ischemic Heart Disease 414.8 Other Specified Megaloblastic Anemias not elsewhere classified 281.3 Other Unspecified Secondary Hypertension 405.99 Other Vitamin B12 Deficiency Anemia 281.1 Pernicious Anemia 281.0
Page 4 of 4 Postmyocardial Infarction Syndrome 411.0 Prinzmetal Angia 413.1 Pure Hypercholesterolemia 272.0 Pure Hyperglyceridemia 272.1 Subendocardial Infarction Episode of care unspecified Subendocardial Infarction 410.70 410.72 Episode of care Thrombophlebitis Migrans 453.1 True Posterior Wall Infarction episode of care unspecified True Posterior Wall 410.60 410.62 Infarction subsequent episode of care Unspecified Essential Hypertension 401.9 Unspecified Hypertensive Heart Disease without Heart Failure - Unspecified 402.90 402.91 Hypertensive Heart Disease with Heart Failure Unspecified Renovascular Hypertension 405.91 Venous Embolism and Thrombosis of unspecified deep vessels of lower extremity Venous Embolism and Thrombosis of deep vessels of Distal lower extremity 453.40 453.42
MEDICARE POLICY # L25650 Page 1 of 1 250.00 250.03 250.10 250.13 250.20 250.23 250.30 250.33 250.40 250.43 250.50 250.53 250.60 250.63 250.70 250.73 250.80 250.83 250.90 250.93 272.0 272.1 272.2 272.3 272.4 281.0 281.1 281.2 281.3 401.0 401.1 401.9 402.00 402.01 402.10 402.11 402.90 402.91 403.00 403.01 403.10 403.11 403.90 403.91 404.00 404.03 404.10 404.13 404.90 404.93 405.01 405.09 405.11 405.19 405.91 405.99 410.20 410.22 410.30 410.32 410.40 410.42 410.50 410.52 410.60 410.62 410.70 410.72 410.80 410.82 410.90 410.92 411.0 411.1 411.81 411.89 412 413.0 413.1 413.9 414.00 414.07 414.10 414.12 414.19 414.8 414.9 433.00 433.01 433.10 433.11 433.20 433.21 433.30 433.31 433.80 433.81 433.90 433.91 434.00 434.01 434.10 434.11 434.90 434.91 437.0 437.6 440.0 440.1 440.20 440.24 440.29 440.30 440.32 440.8 440.9 453.0 453.1 453.2 453.3 453.40 453.42