North Carolina Health Insurance Plans | Blue Cross NC

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Effective: December 1, 2015

ICD-10 Diagnosis Codes Associated With Revenue Code 0360 and Requiring Medical Records Submissions

The following is a list identifying the ICD-10 Diagnosis Codes associated with Revenue Code 0360, which are known to typically require additional information to document medical necessity. When reporting one of the following codes on a claim, medical records should be submitted to BCBSNC in advance of the claim being filed.

Please note this code listing is not to be considered all inclusive and is subject to revision by BCBSNC at any time.

ICD-9 |ICD-10 | |ICD-9 |ICD-10 | |ICD-9 |ICD-10 | |721.1 |M47.011 | |722.11 |M51.24 | |723.0 |M48.01 | | |M47.012 | | |M51.25 | | |M48.02 | | |M47.013 | |722.2 |M50.90 | | |M48.03 | | |M47.014 | | |M50.91 | | |M99.20 | | |M47.015 | | |M50.92 | | |M99.21 | | |M47.016 | | |M50.93 | | |M99.30 | | |M47.017 | | |M51.9 | | |M99.31 | | |M47.019 | |722.30 |M51.9 | | |M99.40 | | |M47.021 | |722.31 |M51.44 | | |M99.41 | | |M47.022 | | |M51.45 | | |M99.50 | | |M47.029 | |722.32 |M51.46 | | |M99.51 | | |M47.11 | | |M51.47 | | |M99.60 | | |M47.12 | |722.39 |M51.9 | | |M99.61 | | |M47.13 | |722.4 |M50.30 | | |M99.70 | |721.2 |M47.24 | | |M50.31 | | |M99.71 | | |M47.25 | | |M50.32 | |723.1 |M54.2 | | |M47.814 | | |M50.33 | |723.2 |M53.0 | | |M47.815 | |722.51 |M51.34 | |723.3 |M53.1 | | |M47.894 | | |M51.35 | |723.4 |M54.11 | | |M47.895 | |722.52 |M51.36 | | |M54.12 | |721.3 |M47.26 | | |M51.37 | | |M54.13 | | |M47.27 | |722.6 |M51.34 | | | | | |M47.28 | | |M51.35 | | | | | |M47.816 | | |M51.36 | | | | | |M47.817 | | |M51.37 | | | | | |M47.818 | |722.70 |M51.9 | | | | | |M47.896 | |722.71 |M50.00 | | | | | |M47.897 | | |M50.01 | | | | | |M47.898 | | |M50.02 | | | | |721.41 |M47.14 | | |M50.03 | | | | | |M47.15 | |722.72 |M50.04 | | | | |721.42 |M47.16 | | |M50.05 | | | | |721.5 |M48.20 | |722.73 |M50.06 | | | | | |M48.21 | |722.80 |M96.1 | | | | | |M48.22 | |722.81 |M96.1 | | | | | |M48.23 | |722.82 |M96.1 | | | | | |M48.24 | |722.83 |M96.1 | | | | | |M48.25 | |722.90 |M46.40 | | | | | |M48.26 | | |M46.48 | | | | | |M48.27 | | |M46.49 | | | | |721.6 |M48.10 | | |M51.9 | | | | | |M48.11 | |722.91 |M46.41 | | | | | |M48.12 | | |M46.42 | | | | | |M48.13 | | |M46.43 | | | | | |M48.14 | | |M50.10 | | | | | |M48.15 | | |M50.11 | | | | | |M48.16 | | |M50.12 | | | | | |M48.17 | | |M50.13 | | | | | |M48.18 | | |M50.80 | | | | | |M48.19 | | |M50.81 | | | | |721.7 |M48.30 | | |M50.82 | | | | | |M48.31 | | |M50.83 | | | | | |M48.32 | | |M50.90 | | | | | |M48.33 | | |M50.91 | | | | | |M48.34 | | |M50.92 | | | | | |M48.35 | | |M50.93 | | | | | |M48.36 | |722.92 |M46.44 | | | | | |M48.37 | | |M46.45 | | | | | |M48.38 | | |M51.14 | | | | |721.8 |M25.78 | | |M51.15 | | | | | |M48.9 | | |M51.84 | | | | |721.9 |M47.20 | | |M51.85 | | | | | |M47.819 | |722.93 |M46.46 | | | | | |M47.899 | | |M46.47 | | | | | |M47.9 | | |M51.16 | | | | |721.91 |M47.10 | | |M51.17 | | | | |722.0 |M50.20 | | |M51.86 | | | | | |M50.21 | | |M51.87 | | | | | |M50.22 | | | | | | | | |M50.23 | | | | | | | |722.10 |M51.26 | | | | | | | | |M51.27 | | | | | | | |

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