Not all 70,000+ ICD-10 codes — the ones each specialty actually bills, with the specificity rules and medical-necessity pairings that keep claims clean.
| Code | Diagnosis (Plain English) | Coding & Medical Necessity Notes |
|---|---|---|
| Behavioral Health | ||
| F32.9 / F32.1 | Major depressive disorder, single episode (unspecified / moderate) | Payers increasingly push back on F32.9 — code severity when documented. Severity supports visit level and treatment intensity. |
| F33.1 | Major depressive disorder, recurrent, moderate | Recurrent vs single episode matters for treatment authorization; document episode history. |
| F41.1 | Generalized anxiety disorder | The highest-volume BH code. Pairs with 90837 time documentation for extended sessions. |
| F43.23 | Adjustment disorder with mixed anxiety and depressed mood | Time-limited by definition — long treatment courses under adjustment codes draw reviews. |
| F84.0 | Autism spectrum disorder | The ABA-therapy anchor dx. Authorizations tie units (97153 et al.) to this code; comprehensive diagnostic eval must be on file. |
| F90.2 | ADHD, combined type | Type specification expected; stimulant PA requests reference it. |
| F10.20 | Alcohol use disorder, moderate/severe, uncomplicated | SUD codes drive IOP/residential auth levels; severity coding must match ASAM documentation. |
| Primary Care / Internal Medicine | ||
| E11.9 | Type 2 diabetes without complications | Audit magnet when complications exist but aren't coded — E11.9 with an insulin pump claim contradicts itself. Code complications (E11.40, E11.65, etc.) when documented; add Z79.4 for insulin use. |
| I10 | Essential hypertension | Clean standalone; combine codes (I11.x, I13.x) when heart/kidney involvement documented — required, not optional, under ICD-10 combination rules. |
| E78.5 | Dyslipidemia, unspecified | Supports lipid panels and statin management visits; E78.00–E78.2 when type documented. |
| Z00.00 | Adult wellness exam without abnormal findings | The AWV/preventive anchor. If a problem is addressed too, code Z00.01 + the problem — and the E/M splits with modifier 25. |
| J06.9 | Acute upper respiratory infection | High-volume urgent visit code; fine as-is when no more specific site documented. |
| K21.9 | GERD without esophagitis | K21.0 (with esophagitis) when scoped and documented — affects PPI prior auths. |
| Pain Management | ||
| M54.50 / M54.51 | Low back pain, unspecified / vertebrogenic | M54.5 was expanded — unspecified M54.50 weakens interventional PA requests. Code the documented source (M54.51 vertebrogenic, M54.16 radiculopathy) for procedure support. |
| M54.16 / M54.17 | Radiculopathy, lumbar / lumbosacral | The workhorse for epidural steroid injection (62323) necessity; imaging correlation documented. |
| M47.816 | Spondylosis without myelopathy, lumbar | Facet-syndrome pathway: supports MBB (64493) and RFA (64635) sequences payers require in order. |
| M25.551 / M25.552 | Hip pain, right / left | Laterality mandatory — M25.55 alone is invalid. Same family for knee (M25.56-) and shoulder (M25.51-). |
| G89.29 | Chronic pain, other | Supports chronic pain management plans; sequencing rules — code the underlying cause first when known. |
| Orthopedics | ||
| M17.11 / M17.12 | Primary knee osteoarthritis, right / left | The TKA (27447) necessity anchor. Laterality required; conservative-treatment history documented for surgical PA. |
| M75.101–M75.102 | Rotator cuff syndrome/tear, right / left (family) | Full-thickness vs partial (M75.11x vs M75.10x) changes surgical authorization; MRI correlation. |
| S72.001A | Femoral neck fracture, right, initial encounter | 7th character discipline: A while in active treatment, D during healing follow-up, S for late effects. Wrong character = global period chaos. |
| S83.511A | ACL sprain/tear, right knee, initial | Injury codes need the encounter character every claim. External cause codes (W/V) help workers' comp and liability claims route. |
| M23.221 | Meniscus derangement, medial, right knee | Supports arthroscopy (29881); document acuity vs degenerative — payer policies differ on degenerative tears. |
| DME-Supporting Diagnoses | ||
| G47.33 | Obstructive sleep apnea | The CPAP (E0601) anchor — with sleep study AHI documented. Without it, no PAP coverage exists. |
| J44.1 / J44.9 | COPD with exacerbation / uncomplicated | Oxygen (E1390) qualification pairs with blood gas results; exacerbation coding supports nebulizer and increased supplies. |
| E11.40 | Type 2 diabetes with neuropathy | Diabetic shoe (A5500) and supply justifications; the complication code, not E11.9, does the work. |
| I50.9 / I50.32 | Heart failure (unspecified / chronic diastolic) | Hospital bed and oxygen requests reference NYHA class in notes; specific HF type strengthens files. |
| L89.312 | Pressure ulcer, right buttock, stage 2 (family) | Support-surface (E0277) coverage is staged-ulcer driven — site + stage coding is the entire case. |
| M62.81 | Generalized muscle weakness | Common mobility-equipment support code — but payers want the underlying condition coded first. |
| Dental / Medical Cross-Coding | ||
| K02.9 / K02.53 | Dental caries (unspecified / pit and fissure into dentin) | Medical plans processing dental-origin claims want K-codes; specificity helps accident and surgical cases. |
| K04.7 | Periapical abscess without sinus | Supports emergency extraction/RCT claims to medical plans when dental benefits are exhausted. |
| M26.60- | Temporomandibular joint disorders (family) | TMD appliance (D9944) medical cross-coding anchor; laterality characters apply. |
| S02.5XXA | Tooth fracture, initial encounter | Trauma cases open medical benefits; external cause codes route liability/accident coverage. |
No codes match your filter.
ICD-10-CM is maintained by CMS/NCHS and is public domain; descriptions here are plain-English summaries, and the official code set (updated every October 1) controls. Medical-necessity pairings reflect common payer policy patterns — the payer's coverage policy for your contract is authoritative. This is a curated high-volume list, not a complete code set. Updated July 2026.