ࡱ>  bjbj 4^^^^^rrrr,r)bxxxxSSS(((((((,D+- )9^SSSSS)3^^xxT)333S^^x^x(3S(33rI%T%&< %(j)0)%z/3/%&3^%&SSS))3SSS)/SSSSSSSSS $:   Your Name & Credentials  HYPERLINK "mailto:Frances@NamasteNutritionist.com" Email: Mail: Phone: % Fax: PATIENT S NAME: DATE of service: ADDRESS: DATE OF BIRTH:  ICD-10 DIAGNOSIS CODES  MEDICAL NUTRITION THERAPYDIABETESDIGESTIVE SYSTEM E10Diabetes, Type I K21.0GERD with EsophagitisE10.6Diabetes, Type I, w/ specified complicationsK21.9GERD without EsophagitisE10.64Diabetes, Type I w/ hypoglycemiaK29.7Gastritis, unspecifiedE10.65Diabetes, Type I w/ hyperglycemiaK50.0Crohns Disease of Small IntestineE10.8Diabetes, Type I w/ unspecific complicationsK50.1Crohns Disease of Large IntestineE10.9Diabetes, Type I w/o complicationsK50.8Crohns Disease of Small and Large IntestineE11Diabetes, Type IIK50.9Crohns Disease, UnspecifiedE11.64Diabetes, Type II w/ hypoglycemiaK51Colitis, UlcerativeE11.65Diabetes, Type II w/ hyperglycemiaK57.1Diverticulitis of SI w/o perforation or abscessE11.8Diabetes, Type II w/ unspecified complicationsK57.3Diverticulitis of LI w/o perforation or abscessE11.9Diabetes, Type II w/o complicationsK58Irritable Bowel SyndromeKIDNEY DISEASEK59ConstipationN18.1Chronic Kidney Disease, Stage 1K59.1Functional DiarrheaN18.2Chronic Kidney Disease, Stage 2K90.0Celiac DiseaseN18.3Chronic Kidney Disease, Stage 3K52.2Allergic and dietetic gastroenteritis & colitis N18.4Chronic Kidney Disease, Stage 4PREGNANCYN18.5Chronic Kidney Disease, Stage 5O21.0Hyperemesis gravidarum, mildWEIGHT MANAGEMENTO21.1Hyperemesis gravidarum w/ metabolic disturbanceZ68.1BMI 19 or less, adult O21.2Vomiting of pregnancy, late Z68.30BMI 30.0 30.9, adultO24.01Diabetes, Type I, pregnancy (pre-existing) Z68.31BMI 31.0 31.9, adultO24.11Diabetes, Type II, pregnancy (pre-existing)Z68.32BMI 32.0 32.9, adultO24.410Diabetes, Gestational, diet controlledZ68.33BMI 33.0 33.9, adultO24.414Diabetes, Gestational, Insulin controlled Z68.34BMI 34.0 34.9, adultO26.00Weight gain, excessive, pregnancy, unspecified trimesterZ68.35BMI 35.0 35.9, adultO26.10Weight gain, low, pregnancy, unspecified trimesterZ68.36BMI 36.0 36.9, adultO99210Obesity complicating pregnancy, unspecified trimesterZ68.37BMI 37.0 37.9, adultCLINCAL & LAB FINDINGSZ68.38BMI 38.0 38.9, adultR73.01Impaired Fasting glucoseE66.0Obesity, due to excess caloriesR73.02Impaired glucose tolerance test (oral)E66.01Obesity, morbid, due to excess caloriesR73.09Abnormal fasting GTT, other (pre diabetes)E66.9Obesity, unspecified MALNUTRITIONE66.8Obesity, other E46Malnutrition, protein/calorie, unspecifiedE66.3OverweightE44.1Malnutrition, protein/calorie, unspecified, mildR63.6UnderweightE44.0Malnutrition, protein/calorie, unspecified, moderateR63.5Abnormal Weight GainE43Malnutrition, protein calorie, unspecified, severeR63.4Abnormal Weight Loss ICD-10 DIAGNOSIS CODES MEDICAL NUTRITION THERAPY CIRCULATORY SYSTEMDISEASES OF BLOODI10Hypertension, EssentialD50.9Anemia, iron deficiency, unspecifiedI11.0Hypertensive heart disease with CHD D51.3Anemia, other dietary vitamin B12 deficiencyI11.9Hypertensive heart disease without CHD D52.0Anemia, dietary folate deficiencyI12Hypertensive chronic kidney diseaseD53.0Anemia, protein deficiency ENDOCRINE & METABOLICD53.9Anemia, nutrition, unspecified E78.0Hypercholesterolemia, pureD64.9Anemia, unspecifiedE78.1Hypertriglyceridemia, pureMUSCOSKELETALE78.4Hyperlipidemia, otherM81.0Osteoporosis, age related, without current pathological fractureE78.5Hyperlipidemia, unspecifiedM81.8Osteoporosis, other, without current pathological fractureE88.81Metabolic syndromePEDIATRICSE16.2Hypoglycemia, unspecifiedZ68.51BMI, pediatric, less than 5th percentile for ageE03.9Hypothyroidism, unspecifiedZ68.52BMI, pediatric, 5th percentile to less than 85th percentile for ageE28.2Polycystic Ovary SyndromeZ68.53BMI, pediatric, 85th percentile to less than 95th percentile for ageE05.90Thyrotoxicosis, unspecifiedZ68.54BMI, pediatric, greater than or equal to 95th percentile for ageE16.1Hypoglycemia, otherMISCELLANEOUSM1A.3Chronic gout due to renal impairmentZ71.3Dietary Counseling and Surveillance M1A.9Chronic gout, unspecifiedM10.3Gout due to renal impairmentM10.9Gout, unspecified E73.9Lactose IntoleranceMENTAL & BEHAVIORAL F50.00Anorexia nervosa, unspecifiedF50.01Anorexia nervosa, restricting typeF50.02Anorexia nervosa, binge eating/purging typeF50.2Bulimia nervosaF50.8Eating Disorder, OtherF50.9Eating Disorder, Unspecified SERVICES and CPT CODEFeeFee% 97802 -Initial Consultation and Assessment, $ UNITS (15min/unit), $% 99372  Telephone Consultation Previous Balance% 97803 -Follow-up/Reassessment Consultation, $ __UNITS (15 m.02  " $ & 6 B D ^ ` j l n z ƺujj_ShU1hv{5CJaJhU1h0[CJaJhU1huCJaJhU1h)A5CJaJhU1hQ]X5CJaJhKW5CJaJhU1h)A5CJaJhU1h9_5CJaJhU1hu5CJaJhU1hQ 5CJaJhU1h5hU1hQ 5 hKW0J5hU1h5jhU1h5UhU1h9_5 hKW5 0$ & j of $Ifgd3nkd$$Ifl(4) t0644 lap yt $Ifgd)A$a$gd$a$gdu$a$gdOj l n y$$& #$/Ifa$b$gdInkd$$Ifl(4) t0644 lap ytz , 0 J ^ ~ M 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