ICD-9 Codes that Support Medical Necessity for Pulmonary Rehabilitation
It is the responsibility of the provider to code to the highest level specified in the ICD-9-CM (e.g., to the fourth or fifth digit). The correct use of an ICD-9-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the policy.
The following are acceptable medical diagnoses for patients receiving PR services:
135 SARCOIDOSIS
277.00 CYSTIC FIBROSIS WITHOUT MECONIUM ILEUS
491.0 SIMPLE CHRONIC BRONCHITIS
491.1 MUCOPURULENT CHRONIC BRONCHITIS
491.20 OBSTRUCTIVE CHRONIC BRONCHITIS WITHOUT EXACERBATION
491.8 OTHER CHRONIC BRONCHITIS
492.8 OTHER EMPHYSEMA
493.20 CHRONIC OBSTRUCTIVE ASTHMA UNSPECIFIED
493.82 COUGH VARIANT ASTHMA
494.0 BRONCHIECTASIS WITHOUT ACUTE EXACERBATION
494.1 BRONCHIECTASIS WITH ACUTE EXACERBATION
496 CHRONIC AIRWAY OBSTRUCTION NOT ELSEWHERE CLASSIFIED
500 COAL WORKERS' PNEUMOCONIOSIS
501 ASBESTOSIS
502 PNEUMOCONIOSIS DUE TO OTHER SILICA OR SILICATES
503 PNEUMOCONIOSIS DUE TO OTHER INORGANIC DUST
504 PNEUMONOPATHY DUE TO INHALATION OF OTHER DUST
505 PNEUMOCONIOSIS UNSPECIFIED
506.4 CHRONIC RESPIRATORY CONDITIONS DUE TO FUMES AND VAPORS
506.9 UNSPECIFIED RESPIRATORY CONDITIONS DUE TO FUMES AND VAPORS
508.1 CHRONIC AND OTHER PULMONARY MANIFESTATIONS DUE TO RADIATION
515 POSTINFLAMMATORY PULMONARY FIBROSIS
516.0 PULMONARY ALVEOLAR PROTEINOSIS
516.2 PULMONARY ALVEOLAR MICROLITHIASIS
516.3 IDIOPATHIC FIBROSING ALVEOLITIS
516.8 OTHER SPECIFIED ALVEOLAR AND PARIETOALVEOLAR PNEUMONOPATHIES
518.89 OTHER DISEASES OF LUNG NOT ELSEWHERE CLASSIFIED