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Non-covered ICD-10-CM Codes for Labs


This section lists codes that are never covered by Medicare for a diagnostic lab testing service. If a code from this section is given as the reason for the test, the test may be billed to the Medicare beneficiary without billing Medicare first because the service is not covered by statute, in most instances because it is performed for screening purposes and is not within an exception. The beneficiary, however, does have a right to have the claim submitted to Medicare, upon request.

R99 Ill-defined and unknown cause of mortality
Z00.00 Encounter for general adult medical examination without abnormal findings
Z00.01 Encounter for general adult medical examination with abnormal findings
Z00.110 Health examination for newborn under 8 days old
Z00.111 Health examination for newborn 8 to 28 days old
Z00.121 Encounter for routine child health examination with abnormal findings
Z00.129 Encounter for routine child health examination without abnormal findings
Z00.5 Encounter for examination of potential donor of organ and tissue
Z00.6 Encounter for examination for normal comparison and control in clinical research program
Z00.70 Encounter for examination for period of delayed growth in childhood without abnormal findings
Z00.71 Encounter for examination for period of delayed growth in childhood with abnormal findings
Z00.8 Encounter for other general examination
Z02.0 Encounter for examination for admission to educational institution
Z02.1 Encounter for pre-employment examination
Z02.2 Encounter for examination for admission to residential institution
Z02.3 Encounter for examination for recruitment to armed forces
Z02.4 Encounter for examination for driving license
Z02.5 Encounter for examination for participation in sport
Z02.6 Encounter for examination for insurance purposes
Z02.71 Encounter for disability determination
Z02.79 Encounter for issue of other medical certificate
Z02.81 Encounter for paternity testing
Z02.82 Encounter for adoption services
Z02.83 Encounter for blood-alcohol and blood-drug test
Z02.89 Encounter for other administrative examinations
Z02.9 Encounter for administrative examinations, unspecified
Z04.6 Encounter for general psychiatric examination, requested by authority
Z04.8 Encounter for examination and observation for other specified reasons
Z04.9 Encounter for examination and observation for unspecified reason
Z11.0 Encounter for screening for intestinal infectious diseases
Z11.1 Encounter for screening for respiratory tuberculosis
Z11.2 Encounter for screening for other bacterial diseases
Z11.3 Encounter for screening for infections with a predominantly sexual mode of transmission
Z11.4 Encounter for screening for human immunodeficiency virus [HIV]
Z11.51 Encounter for screening for human papillomavirus (HPV)
Z11.59 Encounter for screening for other viral diseases
Z11.6 Encounter for screening for other protozoal diseases and helminthiases
Z11.8 Encounter for screening for other infectious and parasitic diseases
Z11.9 Encounter for screening for infectious and parasitic diseases, unspecified
Z12.0 Encounter for screening for malignant neoplasm of stomach
Z12.10 Encounter for screening for malignant neoplasm of intestinal tract, unspecified
Z12.13 Encounter for screening for malignant neoplasm of small intestine
Z12.2 Encounter for screening for malignant neoplasm of respiratory organs
Z12.6 Encounter for screening for malignant neoplasm of bladder
Z12.71 Encounter for screening for malignant neoplasm of testis
Z12.72 Encounter for screening for malignant neoplasm of vagina
Z12.73 Encounter for screening for malignant neoplasm of ovary
Z12.79 Encounter for screening for malignant neoplasm of other genitourinary organs
Z12.81 Encounter for screening for malignant neoplasm of oral cavity
Z12.82 Encounter for screening for malignant neoplasm of nervous system
Z12.83 Encounter for screening for malignant neoplasm of skin
Z12.89 Encounter for screening for malignant neoplasm of other sites
Z12.9 Encounter for screening for malignant neoplasm, site unspecified
Z13.0 Encounter for screening for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
Z13.21 Encounter for screening for nutritional disorder
Z13.220 Encounter for screening for lipoid disorders
Z13.228 Encounter for screening for other metabolic disorders
Z13.29 Encounter for screening for other suspected endocrine disorder
Z13.4 Encounter for screening for certain developmental disorders in childhood
Z13.5 Encounter for screening for eye and ear disorders
Z13.71 Encounter for nonprocreative screening for genetic disease carrier status
Z13.79 Encounter for other screening for genetic and chromosomal anomalies
Z13.810 Encounter for screening for upper gastrointestinal disorder
Z13.811 Encounter for screening for lower gastrointestinal disorder
Z13.818 Encounter for screening for other digestive system disorders
Z13.820 Encounter for screening for osteoporosis
Z13.828 Encounter for screening for other musculoskeletal disorder
Z13.83 Encounter for screening for respiratory disorder NEC
Z13.84 Encounter for screening for dental disorders
Z13.850 Encounter for screening for traumatic brain injury
Z13.858 Encounter for screening for other nervous system disorders
Z13.88 Encounter for screening for disorder due to exposure to contaminants
Z13.89 Encounter for screening for other disorder
Z13.9 Encounter for screening, unspecified
Z40.00 Encounter for prophylactic removal of unspecified organ
Z40.01 Encounter for prophylactic removal of breast
Z40.02 Encounter for prophylactic removal of ovary(s)
Z40.09 Encounter for prophylactic removal of other organ
Z40.8 Encounter for other prophylactic surgery
Z40.9 Encounter for prophylactic surgery, unspecified
Z41.1 Encounter for cosmetic surgery
Z41.2 Encounter for routine and ritual male circumcision
Z41.3 Encounter for ear piercing
Z41.8 Encounter for other procedures for purposes other than remedying health state
Z41.9 Encounter for procedure for purposes other than remedying health state, unspecified
Z46.1 Encounter for fitting and adjustment of hearing aid
Z56.0 Unemployment, unspecified
Z56.2 Threat of job loss
Z56.3 Stressful work schedule
Z56.4 Discord with boss and workmates
Z56.5 Uncongenial work environment
Z56.6 Other physical and mental strain related to work
Z56.81 Sexual harassment on the job
Z56.82 Military deployment status
Z56.89 Other problems related to employment
Z56.9 Unspecified problems related to employment
Z57.0 Occupational exposure to noise
Z57.1 Occupational exposure to radiation
Z57.2 Occupational exposure to dust
Z57.31 Occupational exposure to environmental tobacco smoke
Z57.39 Occupational exposure to other air contaminants
Z57.4 Occupational exposure to toxic agents in agriculture
Z57.5 Occupational exposure to toxic agents in other industries
Z57.6 Occupational exposure to extreme temperature
Z57.7 Occupational exposure to vibration
Z57.8 Occupational exposure to other risk factors
Z57.9 Occupational exposure to unspecified risk factor
Z59.0 Homelessness
Z59.1 Inadequate housing
Z59.2 Discord with neighbors, lodgers and landlord
Z59.3 Problems related to living in residential institution
Z59.4 Lack of adequate food and safe drinking water
Z59.5 Extreme poverty
Z59.6 Low income
Z59.7 Insufficient social insurance and welfare support
Z59.8 Other problems related to housing and economic circumstances
Z59.9 Problem related to housing and economic circumstances, unspecified
Z60.2 Problems related to living alone
Z62.21 Child in welfare custody
Z71.0 Person encountering health services to consult on behalf of another person
Z74.1 Need for assistance with personal care
Z74.2 Need for assistance at home and no other household member able to render care
Z74.3 Need for continuous supervision
Z74.8 Other problems related to care provider dependency
Z74.9 Problem related to care provider dependency, unspecified
Z75.5 Holiday relief care
Z76.0 Encounter for issue of repeat prescription
Z76.1 Encounter for health supervision and care of foundling
Z76.2 Encounter for health supervision and care of other healthy infant and child
Z76.3 Healthy person accompanying sick person
Z76.4 Other boarder to healthcare facility
Z76.81 Expectant parent(s) prebirth pediatrician visit
Z80.1 Family history of malignant neoplasm of trachea, bronchus and lung
Z80.2 Family history of malignant neoplasm of other respiratory and intrathoracic organs
Z80.49 Family history of malignant neoplasm of other genital organs
Z80.51 Family history of malignant neoplasm of kidney
Z80.52 Family history of malignant neoplasm of bladder
Z80.59 Family history of malignant neoplasm of other urinary tract organ
Z80.6 Family history of leukemia
Z80.7 Family history of other malignant neoplasms of lymphoid, hematopoietic and related tissues
Z80.8 Family history of malignant neoplasm of other organs or systems
Z80.9 Family history of malignant neoplasm, unspecified
Z81.0 Family history of intellectual disabilities
Z81.1 Family history of alcohol abuse and dependence
Z81.2 Family history of tobacco abuse and dependence
Z81.3 Family history of other psychoactive substance abuse and dependence
Z81.4 Family history of other substance abuse and dependence
Z81.8 Family history of other mental and behavioral disorders
Z82.0 Family history of epilepsy and other diseases of the nervous system
Z82.1 Family history of blindness and visual loss
Z82.2 Family history of deafness and hearing loss
Z82.3 Family history of stroke
Z82.41 Family history of sudden cardiac death
Z82.49 Family history of ischemic heart disease and other diseases of the circulatory system
Z82.5 Family history of asthma and other chronic lower respiratory diseases
Z82.61 Family history of arthritis
Z82.62 Family history of osteoporosis
Z82.69 Family history of other diseases of the musculoskeletal system and connective tissue
Z82.71 Family history of polycystic kidney
Z82.79 Family history of other congenital malformations, deformations and chromosomal abnormalities
Z82.8 Family history of other disabilities and chronic diseases leading to disablement, not elsewhere classified
Z83.0 Family history of human immunodeficiency virus [HIV] disease
Z83.1 Family history of other infectious and parasitic diseases
Z83.2 Family history of diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
Z83.3 Family history of diabetes mellitus
Z83.41 Family history of multiple endocrine neoplasia [MEN] syndrome
Z83.49 Family history of other endocrine, nutritional and metabolic diseases
Z83.511 Family history of glaucoma
Z83.518 Family history of other specified eye disorder
Z83.52 Family history of ear disorders
Z83.6 Family history of other diseases of the respiratory system
Z83.71 Family history of colonic polyps
Z83.79 Family history of other diseases of the digestive system
Z84.0 Family history of diseases of the skin and subcutaneous tissue
Z84.1 Family history of disorders of kidney and ureter
Z84.2 Family history of other diseases of the genitourinary system
Z84.3 Family history of consanguinity
Z84.81 Family history of carrier of genetic disease
Z84.89 Family history of other specified conditions

See also the Exclusions


Coding Ahead

Exclusions to Non-covered ICD-10-CM Codes for Labs


The below list of codes will be covered for certain lab procedures according to CMS NCD policy.

Z36.0 – Encounter for antenatal screening for chromosomal anomalies. Applies only for NCD 190.27.
Z36.1 – Encounter for antenatal screening for raised alphafetoprotein level. Applies only for NCD 190.27, 190.32, & 190.33. 
Z36.2 – Encounter for other antenatal screening follow-up. Applies only for NCD 190.23A & 190.27. 
Z36.3 – Encounter for antenatal screening for malformations. Applies only for NCD 190.20B, 190.21, 190.25, & 190.27. 
Z36.4 – Encounter for antenatal screening for fetal growth retardation. Applies only for NCD 190.27. 
Z36.5 – Encounter for antenatal screening for isoimmunization. Applies only for NCD 190.15 & 190.27.
Z36.81 – Encounter for antenatal screening for hydrops fetalis. Applies only for NCD 190.27. 
Z36.82 – Encounter for antenatal screening for nuchal translucency. Applies only for NCD 190.27. 
Z36.83 – Encounter for fetal screening for congenital cardiac abnormalities. Applies only for NCD 190.20B, 190.21, & 190.27.
Z36.84 – Encounter for antenatal screening for fetal lung maturity. Applies only for NCD 190.27. 
Z36.85 – Encounter for antenatal screening for Streptococcus B. Applies only for NCD 190.27. 
Z36.86 – Encounter for antenatal screening for cervical length. Applies only for NCD 190.27. 
Z36.87 – Encounter for antenatal screening for uncertain dates. Applies only for NCD 190.27. 
Z36.88 – Encounter for antenatal screening for fetal macrosomia. Applies only for NCD 190.20B, 190.21, & 190.27. 
Z36.89 – Encounter for other specified antenatal screening. Applies only for NCD 190.14, 190.22, 190.23A, 190.27, & 190.33. 
Z36.8A – Encounter for antenatal screening for other genetic defects. Applies only for NCD 190.25 & 190.27. 
Z36.9 – Encounter for antenatal screening, unspecified. Applies only for NCD 190.14, 190.22, 190.23A, & 190.27. 

See also the list of Non-covered ICD-10-CM Codes for Lab procedures


Coding Ahead

Diagnoses for Baseline Labs prior to beginning bioloigics

Hello All,
I am fairly new to Dermatology coding. We do a lot of treatment and prescribing of biologics for psoriasis. These are powerful drugs that can affect the organ systems negatively; therefore baseline laboratory tests are required prior to starting the patient on these medications. AFTER the patient has been on these meds, we continue to run lab tests to monitor if/how these medications are affecting the organ systems. Z79.899 usually works for monitoring (there are a few NCD/LCDs that do not cover with this code), but I’m wondering what ICD-10 code should be used for the initial baseline lab testing? We are not monitoring the patient’s response to the medicine since they aren’t on it yet, but simply getting a baseline. Many of these lab tests have NCDs and we’re having trouble finding appropriate diagnosis codes? Thoughts anyone?

Medical Billing and Coding Forum

Denial for Labs

My claim is being rejected when I try to submit it with 80053, 80061, 84443, and 85025 for a patient who is 17 years old. It states "Procedure code is not typical for a patient whose age is 17 years. The typical age range for this procedure is 18 years – any. I have also tried using the bundled code 80050 and it also came back rejected. Insurance is UHC.

Can someone help me with this please?

Medical Billing and Coding Forum

what ICD 10 codes that can be used for preventative labs. Please help!

when patient comes for a yearly preventative care visit, my doctor order CBC with diff, CMP and TSH ( general health panel CPT 80050). I use ICD 10 codes : z13.0, Z13.29 to bill for these labs but BCBS does not pay. How should i bill for these labs? Please advise me what ICD 10 codes should i use for these labs. Thank you.

Medical Billing and Coding Forum

Ordering labs with Z00.00

Physicians are used to order labs CBC, CMP, TSH, Lipids for asymptomatic Medicare patients with Z00.00. "Z00.00" is not a valid dx for ordering labs on pts. So my question is: Can the physician order Cbc, Cmp, Tsh, Lipids as part of AWV and what diagnosis codes should he use ? What exact labs can he order during Wellness visit? Thank you!

Medical Billing and Coding Forum

Coding Labs for recurring testing on chemo patients

My physician orders a recurring Labs of CBC, CMP, TSH on his active chemo patients to monitor their blood levels. The pt usually goes for blood work 2 days before the chemo and the physician decides the next chemo session based on the lab results. Can I use Z51.81 +Z79.899 or just Z79.899 along with malignancy code on the lab orders? We are getting a lot of 84443, TSH denials? Not all the pts are diagnosed with Hypo or hyper thyroid. Thank you!

Medical Billing and Coding Forum