National Coverage Determination: Collagen Crosslinks, Any Method National Coverage Determination
CPT Code: 82523
Collagen Crosslinks, Any Method
CMS Policy Number: 190.19

82523 Collagen cross links, any method



Description: Collagen crosslinks, part of the matrix of bone upon which bone mineral is deposited, are biochemical markers the excretion of which provides a quantitative measurement of bone resorption. Elevated levels of urinary collagen crosslinks indicate elevated bone resorption. Elevated bone resorption contributes to age-related and postmenopausal loss of bone leading to osteoporosis and increased risk of fracture. The collagen crosslinks assay can be performed by immunoassay or by high performance liquid chromatography (HPLC). Collagen crosslink immunoassays measure the pyridinoline crosslinks and associated telopeptides in urine.

Bone is constantly undergoing a metabolic process called turnover or remodeling. This includes a degradation process, bone resorption, mediated by the action of osteoclasts, and a building process, bone formation, mediated by the action of osteoblasts. Remodeling is required for the maintenance and overall health of bone and is tightly coupled; that is, resorption and formation must be in balance. In abnormal states of bone remodeling, when resorption exceeds formation, it results in a net loss of bone. The measurement of specific, bone-derived resorption products provides analytical data about the rate of bone resorption.

Osteoporosis is a condition characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures of the hip, spine, and wrist. The term primary osteoporosis is applied where the causal factor in the disease is menopause or aging. The term secondary osteoporosis is applied where the causal factor is something other than menopause or aging, such as long-term administration of glucocorticosteroids, endocrine-related disorders (other than loss of estrogen due to menopause), and certain bone diseases such as cancer of the bone.

With respect to quantifying bone resorption, collagen crosslink tests can provide adjunct diagnostic information in concert with bone mass measurements. Bone mass measurements and biochemical markers may have complementary roles to play in assessing effectiveness of osteoporosis treatment. Proper management of osteoporosis patients, who are on long-term therapeutic regimens, may include laboratory testing of biochemical markers of bone turnover, such as collagen crosslinks, that provide a profile of bone turnover responses within weeks of therapy. Changes in collagen crosslinks are determined following commencement of antiresorptive therapy. These can be measured over a shorter time interval when compared to bone mass density. If bone resorption is not elevated, repeat testing is not medically necessary.

Indications:
Generally speaking, collagen crosslink testing is useful mostly in “fast losers” of bone. The age when these bone markers can help direct therapy is often pre-Medicare. By the time a fast loser of bone reaches age 65, she will most likely have been stabilized by appropriate therapy or have lost so much bone mass that further testing is useless. Coverage for bone marker assays may be established, however, for younger Medicare beneficiaries and for those men and women who might become fast losers because of some other therapy such as glucocorticoids. Safeguards should be incorporated to prevent excessive use of tests in patients for whom they have no clinical relevance.

Collagen crosslinks testing is used to:

  • Identify individuals with elevated bone resorption, who have osteoporosis in whom response to treatment is being monitored.
  • Predict response (as assessed by bone mass measurements) to FDA approved antiresorptive therapy in postmenopausal women.
  • Assess response to treatment of patients with osteoporosis, Paget’s disease of the bone, or risk for osteoporosis where treatment may include FDA approved antiresorptive agents, anti- estrogens or selective estrogen receptor moderators.

    Limitations:
    Because of significant specimen to specimen collagen crosslink physiologic variability (15-20%), current recommendations for appropriate utilization include: one or two base-line assays from specified urine collections on separate days; followed by a repeat assay about 3 months after starting anti-resorptive therapy; followed by a repeat assay in 12 months after the 3-month assay; and thereafter not more than annually, unless there is a change in therapy in which circumstance an additional test may be indicated 3 months after the initiation of new therapy.

    Some collagen crosslink assays may not be appropriate for use in some disorders, according to FDA labeling restrictions.

    ICD-10-CM Codes Covered by Medicare Program

    289 Covered ICD-10 Codes:

    ICD-10Descriptor
    C44.1321 Sebaceous cell carcinoma of skin of right upper eyelid, including canthus
    C44.1322 Sebaceous cell carcinoma of skin of right lower eyelid, including canthus
    C44.1391 Sebaceous cell carcinoma of skin of left upper eyelid, including canthus
    C44.1392 Sebaceous cell carcinoma of skin of left lower eyelid, including canthus
    E05.00 Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or storm
    E05.01 Thyrotoxicosis with diffuse goiter with thyrotoxic crisis or storm
    E05.10 Thyrotoxicosis with toxic single thyroid nodule without thyrotoxic crisis or storm
    E05.11 Thyrotoxicosis with toxic single thyroid nodule with thyrotoxic crisis or storm
    E05.20 Thyrotoxicosis with toxic multinodular goiter without thyrotoxic crisis or storm
    E05.21 Thyrotoxicosis with toxic multinodular goiter with thyrotoxic crisis or storm
    E05.30 Thyrotoxicosis from ectopic thyroid tissue without thyrotoxic crisis or storm
    E05.31 Thyrotoxicosis from ectopic thyroid tissue with thyrotoxic crisis or storm
    E05.40 Thyrotoxicosis factitia without thyrotoxic crisis or storm
    E05.41 Thyrotoxicosis factitia with thyrotoxic crisis or storm
    E05.80 Other thyrotoxicosis without thyrotoxic crisis or storm
    E05.81 Other thyrotoxicosis with thyrotoxic crisis or storm
    E05.90 Thyrotoxicosis, unspecified without thyrotoxic crisis or storm
    E05.91 Thyrotoxicosis, unspecified with thyrotoxic crisis or storm
    E06.3 Autoimmune thyroiditis
    E07.9 Disorder of thyroid, unspecified
    E21.0 Primary hyperparathyroidism
    E21.1 Secondary hyperparathyroidism, not elsewhere classified
    E21.2 Other hyperparathyroidism
    E21.3 Hyperparathyroidism, unspecified
    E28.310 Symptomatic premature menopause
    E28.319 Asymptomatic premature menopause
    E28.39 Other primary ovarian failure
    E28.8 Other ovarian dysfunction
    E28.9 Ovarian dysfunction, unspecified
    E55.9 Vitamin D deficiency, unspecified
    E58 Dietary calcium deficiency
    E59 Dietary selenium deficiency
    E60 Dietary zinc deficiency
    E61.0 Copper deficiency
    E61.1 Iron deficiency
    E61.2 Magnesium deficiency
    E61.3 Manganese deficiency
    E61.4 Chromium deficiency
    E61.5 Molybdenum deficiency
    E61.6 Vanadium deficiency
    E88.02 Plasminogen deficiency
    E89.40 Asymptomatic postprocedural ovarian failure
    E89.41 Symptomatic postprocedural ovarian failure
    M48.50XA Collapsed vertebra, not elsewhere classified, site unspecified, initial encounter for fracture
    M48.51XA Collapsed vertebra, not elsewhere classified, occipito-atlanto-axial region, initial encounter for fracture
    M48.52XA Collapsed vertebra, not elsewhere classified, cervical region, initial encounter for fracture
    M48.53XA Collapsed vertebra, not elsewhere classified, cervicothoracic region, initial encounter for fracture
    M48.54XA Collapsed vertebra, not elsewhere classified, thoracic region, initial encounter for fracture
    M48.55XA Collapsed vertebra, not elsewhere classified, thoracolumbar region, initial encounter for fracture
    M48.56XA Collapsed vertebra, not elsewhere classified, lumbar region, initial encounter for fracture
    M48.57XA Collapsed vertebra, not elsewhere classified, lumbosacral region, initial encounter for fracture
    M48.58XA Collapsed vertebra, not elsewhere classified, sacral and sacrococcygeal region, initial encounter for fracture
    M80.00XA Age-related osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture
    M80.011A Age-related osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture
    M80.012A Age-related osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture
    M80.019A Age-related osteoporosis with current pathological fracture, unspecified shoulder, initial encounter for fracture
    M80.021A Age-related osteoporosis with current pathological fracture, right humerus, initial encounter for fracture
    M80.022A Age-related osteoporosis with current pathological fracture, left humerus, initial encounter for fracture
    M80.029A Age-related osteoporosis with current pathological fracture, unspecified humerus, initial encounter for fracture
    M80.031A Age-related osteoporosis with current pathological fracture, right forearm, initial encounter for fracture
    M80.032A Age-related osteoporosis with current pathological fracture, left forearm, initial encounter for fracture
    M80.039A Age-related osteoporosis with current pathological fracture, unspecified forearm, initial encounter for fracture
    M80.041A Age-related osteoporosis with current pathological fracture, right hand, initial encounter for fracture
    M80.042A Age-related osteoporosis with current pathological fracture, left hand, initial encounter for fracture
    M80.049A Age-related osteoporosis with current pathological fracture, unspecified hand, initial encounter for fracture
    M80.051A Age-related osteoporosis with current pathological fracture, right femur, initial encounter for fracture
    M80.052A Age-related osteoporosis with current pathological fracture, left femur, initial encounter for fracture
    M80.059A Age-related osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture
    M80.061A Age-related osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture
    M80.062A Age-related osteoporosis with current pathological fracture, left lower leg, initial encounter for fracture
    M80.069A Age-related osteoporosis with current pathological fracture, unspecified lower leg, initial encounter for fracture
    M80.071A Age-related osteoporosis with current pathological fracture, right ankle and foot, initial encounter for fracture
    M80.072A Age-related osteoporosis with current pathological fracture, left ankle and foot, initial encounter for fracture
    M80.079A Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, initial encounter for fracture
    M80.08XA Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
    M80.0AXA Age-related osteoporosis with current pathological fracture, other site, initial encounter for fracture
    M80.0AXD Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with routine healing
    M80.0AXG Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with delayed healing
    M80.0AXK Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with nonunion
    M80.0AXP Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with malunion
    M80.0AXS Age-related osteoporosis with current pathological fracture, other site, sequela
    M80.0B1A Age-related osteoporosis with current pathological fracture, right pelvis, initial encounter for fracture
    M80.0B2A Age-related osteoporosis with current pathological fracture, left pelvis, initial encounter for fracture
    M80.0B9A Age-related osteoporosis with current pathological fracture, unspecified pelvis, initial encounter for fracture
    M80.80XA Other osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture
    M80.811A Other osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture
    M80.812A Other osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture
    M80.819A Other osteoporosis with current pathological fracture, unspecified shoulder, initial encounter for fracture
    M80.821A Other osteoporosis with current pathological fracture, right humerus, initial encounter for fracture
    M80.822A Other osteoporosis with current pathological fracture, left humerus, initial encounter for fracture
    M80.829A Other osteoporosis with current pathological fracture, unspecified humerus, initial encounter for fracture
    M80.831A Other osteoporosis with current pathological fracture, right forearm, initial encounter for fracture
    M80.832A Other osteoporosis with current pathological fracture, left forearm, initial encounter for fracture
    M80.839A Other osteoporosis with current pathological fracture, unspecified forearm, initial encounter for fracture
    M80.841A Other osteoporosis with current pathological fracture, right hand, initial encounter for fracture
    M80.842A Other osteoporosis with current pathological fracture, left hand, initial encounter for fracture
    M80.849A Other osteoporosis with current pathological fracture, unspecified hand, initial encounter for fracture
    M80.851A Other osteoporosis with current pathological fracture, right femur, initial encounter for fracture
    M80.852A Other osteoporosis with current pathological fracture, left femur, initial encounter for fracture
    M80.859A Other osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture
    M80.861A Other osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture
    M80.862A Other osteoporosis with current pathological fracture, left lower leg, initial encounter for fracture
    M80.869A Other osteoporosis with current pathological fracture, unspecified lower leg, initial encounter for fracture
    M80.871A Other osteoporosis with current pathological fracture, right ankle and foot, initial encounter for fracture
    M80.872A Other osteoporosis with current pathological fracture, left ankle and foot, initial encounter for fracture
    M80.879A Other osteoporosis with current pathological fracture, unspecified ankle and foot, initial encounter for fracture
    M80.88XA Other osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
    M80.8AXA Other osteoporosis with current pathological fracture, other site, initial encounter for fracture
    M80.8AXD Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with routine healing
    M80.8AXG Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with delayed healing
    M80.8AXK Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with nonunion
    M80.8AXP Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with malunion
    M80.8AXS Other osteoporosis with current pathological fracture, other site, sequela
    M80.8B1A Other osteoporosis with current pathological fracture, right pelvis, initial encounter for fracture
    M80.8B2A Other osteoporosis with current pathological fracture, left pelvis, initial encounter for fracture
    M80.8B9A Other osteoporosis with current pathological fracture, unspecified pelvis, initial encounter for fracture
    M81.0 Age-related osteoporosis without current pathological fracture
    M81.6 Localized osteoporosis [Lequesne]
    M81.8 Other osteoporosis without current pathological fracture
    M84.40XA Pathological fracture, unspecified site, initial encounter for fracture
    M84.411A Pathological fracture, right shoulder, initial encounter for fracture
    M84.412A Pathological fracture, left shoulder, initial encounter for fracture
    M84.419A Pathological fracture, unspecified shoulder, initial encounter for fracture
    M84.421A Pathological fracture, right humerus, initial encounter for fracture
    M84.422A Pathological fracture, left humerus, initial encounter for fracture
    M84.429A Pathological fracture, unspecified humerus, initial encounter for fracture
    M84.431A Pathological fracture, right ulna, initial encounter for fracture
    M84.432A Pathological fracture, left ulna, initial encounter for fracture
    M84.433A Pathological fracture, right radius, initial encounter for fracture
    M84.434A Pathological fracture, left radius, initial encounter for fracture
    M84.439A Pathological fracture, unspecified ulna and radius, initial encounter for fracture
    M84.441A Pathological fracture, right hand, initial encounter for fracture
    M84.442A Pathological fracture, left hand, initial encounter for fracture
    M84.443A Pathological fracture, unspecified hand, initial encounter for fracture
    M84.444A Pathological fracture, right finger(s), initial encounter for fracture
    M84.445A Pathological fracture, left finger(s), initial encounter for fracture
    M84.446A Pathological fracture, unspecified finger(s), initial encounter for fracture
    M84.451A Pathological fracture, right femur, initial encounter for fracture
    M84.452A Pathological fracture, left femur, initial encounter for fracture
    M84.453A Pathological fracture, unspecified femur, initial encounter for fracture
    M84.454A Pathological fracture, pelvis, initial encounter for fracture
    M84.459A Pathological fracture, hip, unspecified, initial encounter for fracture
    M84.461A Pathological fracture, right tibia, initial encounter for fracture
    M84.462A Pathological fracture, left tibia, initial encounter for fracture
    M84.463A Pathological fracture, right fibula, initial encounter for fracture
    M84.464A Pathological fracture, left fibula, initial encounter for fracture
    M84.469A Pathological fracture, unspecified tibia and fibula, initial encounter for fracture
    M84.471A Pathological fracture, right ankle, initial encounter for fracture
    M84.472A Pathological fracture, left ankle, initial encounter for fracture
    M84.473A Pathological fracture, unspecified ankle, initial encounter for fracture
    M84.474A Pathological fracture, right foot, initial encounter for fracture
    M84.475A Pathological fracture, left foot, initial encounter for fracture
    M84.476A Pathological fracture, unspecified foot, initial encounter for fracture
    M84.477A Pathological fracture, right toe(s), initial encounter for fracture
    M84.478A Pathological fracture, left toe(s), initial encounter for fracture
    M84.479A Pathological fracture, unspecified toe(s), initial encounter for fracture
    M84.48XA Pathological fracture, other site, initial encounter for fracture
    M84.50XA Pathological fracture in neoplastic disease, unspecified site, initial encounter for fracture
    M84.511A Pathological fracture in neoplastic disease, right shoulder, initial encounter for fracture
    M84.512A Pathological fracture in neoplastic disease, left shoulder, initial encounter for fracture
    M84.519A Pathological fracture in neoplastic disease, unspecified shoulder, initial encounter for fracture
    M84.521A Pathological fracture in neoplastic disease, right humerus, initial encounter for fracture
    M84.522A Pathological fracture in neoplastic disease, left humerus, initial encounter for fracture
    M84.529A Pathological fracture in neoplastic disease, unspecified humerus, initial encounter for fracture
    M84.531A Pathological fracture in neoplastic disease, right ulna, initial encounter for fracture
    M84.532A Pathological fracture in neoplastic disease, left ulna, initial encounter for fracture
    M84.533A Pathological fracture in neoplastic disease, right radius, initial encounter for fracture
    M84.534A Pathological fracture in neoplastic disease, left radius, initial encounter for fracture
    M84.539A Pathological fracture in neoplastic disease, unspecified ulna and radius, initial encounter for fracture
    M84.541A Pathological fracture in neoplastic disease, right hand, initial encounter for fracture
    M84.542A Pathological fracture in neoplastic disease, left hand, initial encounter for fracture
    M84.549A Pathological fracture in neoplastic disease, unspecified hand, initial encounter for fracture
    M84.550A Pathological fracture in neoplastic disease, pelvis, initial encounter for fracture
    M84.551A Pathological fracture in neoplastic disease, right femur, initial encounter for fracture
    M84.552A Pathological fracture in neoplastic disease, left femur, initial encounter for fracture
    M84.553A Pathological fracture in neoplastic disease, unspecified femur, initial encounter for fracture
    M84.559A Pathological fracture in neoplastic disease, hip, unspecified, initial encounter for fracture
    M84.561A Pathological fracture in neoplastic disease, right tibia, initial encounter for fracture
    M84.562A Pathological fracture in neoplastic disease, left tibia, initial encounter for fracture
    M84.563A Pathological fracture in neoplastic disease, right fibula, initial encounter for fracture
    M84.564A Pathological fracture in neoplastic disease, left fibula, initial encounter for fracture
    M84.569A Pathological fracture in neoplastic disease, unspecified tibia and fibula, initial encounter for fracture
    M84.571A Pathological fracture in neoplastic disease, right ankle, initial encounter for fracture
    M84.572A Pathological fracture in neoplastic disease, left ankle, initial encounter for fracture
    M84.573A Pathological fracture in neoplastic disease, unspecified ankle, initial encounter for fracture
    M84.574A Pathological fracture in neoplastic disease, right foot, initial encounter for fracture
    M84.575A Pathological fracture in neoplastic disease, left foot, initial encounter for fracture
    M84.576A Pathological fracture in neoplastic disease, unspecified foot, initial encounter for fracture
    M84.58XA Pathological fracture in neoplastic disease, other specified site, initial encounter for fracture
    M84.60XA Pathological fracture in other disease, unspecified site, initial encounter for fracture
    M84.611A Pathological fracture in other disease, right shoulder, initial encounter for fracture
    M84.612A Pathological fracture in other disease, left shoulder, initial encounter for fracture
    M84.619A Pathological fracture in other disease, unspecified shoulder, initial encounter for fracture
    M84.621A Pathological fracture in other disease, right humerus, initial encounter for fracture
    M84.622A Pathological fracture in other disease, left humerus, initial encounter for fracture
    M84.629A Pathological fracture in other disease, unspecified humerus, initial encounter for fracture
    M84.631A Pathological fracture in other disease, right ulna, initial encounter for fracture
    M84.632A Pathological fracture in other disease, left ulna, initial encounter for fracture
    M84.633A Pathological fracture in other disease, right radius, initial encounter for fracture
    M84.634A Pathological fracture in other disease, left radius, initial encounter for fracture
    M84.639A Pathological fracture in other disease, unspecified ulna and radius, initial encounter for fracture
    M84.641A Pathological fracture in other disease, right hand, initial encounter for fracture
    M84.642A Pathological fracture in other disease, left hand, initial encounter for fracture
    M84.649A Pathological fracture in other disease, unspecified hand, initial encounter for fracture
    M84.650A Pathological fracture in other disease, pelvis, initial encounter for fracture
    M84.651A Pathological fracture in other disease, right femur, initial encounter for fracture
    M84.652A Pathological fracture in other disease, left femur, initial encounter for fracture
    M84.653A Pathological fracture in other disease, unspecified femur, initial encounter for fracture
    M84.659A Pathological fracture in other disease, hip, unspecified, initial encounter for fracture
    M84.661A Pathological fracture in other disease, right tibia, initial encounter for fracture
    M84.662A Pathological fracture in other disease, left tibia, initial encounter for fracture
    M84.663A Pathological fracture in other disease, right fibula, initial encounter for fracture
    M84.664A Pathological fracture in other disease, left fibula, initial encounter for fracture
    M84.669A Pathological fracture in other disease, unspecified tibia and fibula, initial encounter for fracture
    M84.671A Pathological fracture in other disease, right ankle, initial encounter for fracture
    M84.672A Pathological fracture in other disease, left ankle, initial encounter for fracture
    M84.673A Pathological fracture in other disease, unspecified ankle, initial encounter for fracture
    M84.674A Pathological fracture in other disease, right foot, initial encounter for fracture
    M84.675A Pathological fracture in other disease, left foot, initial encounter for fracture
    M84.676A Pathological fracture in other disease, unspecified foot, initial encounter for fracture
    M84.68XA Pathological fracture in other disease, other site, initial encounter for fracture
    M84.751A Incomplete atypical femoral fracture, right leg, initial encounter for fracture
    M85.80 Other specified disorders of bone density and structure, unspecified site
    M85.811 Other specified disorders of bone density and structure, right shoulder
    M85.812 Other specified disorders of bone density and structure, left shoulder
    M85.819 Other specified disorders of bone density and structure, unspecified shoulder
    M85.821 Other specified disorders of bone density and structure, right upper arm
    M85.822 Other specified disorders of bone density and structure, left upper arm
    M85.829 Other specified disorders of bone density and structure, unspecified upper arm
    M85.831 Other specified disorders of bone density and structure, right forearm
    M85.832 Other specified disorders of bone density and structure, left forearm
    M85.839 Other specified disorders of bone density and structure, unspecified forearm
    M85.841 Other specified disorders of bone density and structure, right hand
    M85.842 Other specified disorders of bone density and structure, left hand
    M85.849 Other specified disorders of bone density and structure, unspecified hand
    M85.851 Other specified disorders of bone density and structure, right thigh
    M85.852 Other specified disorders of bone density and structure, left thigh
    M85.859 Other specified disorders of bone density and structure, unspecified thigh
    M85.861 Other specified disorders of bone density and structure, right lower leg
    M85.862 Other specified disorders of bone density and structure, left lower leg
    M85.869 Other specified disorders of bone density and structure, unspecified lower leg
    M85.871 Other specified disorders of bone density and structure, right ankle and foot
    M85.872 Other specified disorders of bone density and structure, left ankle and foot
    M85.879 Other specified disorders of bone density and structure, unspecified ankle and foot
    M85.88 Other specified disorders of bone density and structure, other site
    M85.89 Other specified disorders of bone density and structure, multiple sites
    M85.9 Disorder of bone density and structure, unspecified
    M88.0 Osteitis deformans of skull
    M88.1 Osteitis deformans of vertebrae
    M88.811 Osteitis deformans of right shoulder
    M88.812 Osteitis deformans of left shoulder
    M88.819 Osteitis deformans of unspecified shoulder
    M88.821 Osteitis deformans of right upper arm
    M88.822 Osteitis deformans of left upper arm
    M88.829 Osteitis deformans of unspecified upper arm
    M88.831 Osteitis deformans of right forearm
    M88.832 Osteitis deformans of left forearm
    M88.839 Osteitis deformans of unspecified forearm
    M88.841 Osteitis deformans of right hand
    M88.842 Osteitis deformans of left hand
    M88.849 Osteitis deformans of unspecified hand
    M88.851 Osteitis deformans of right thigh
    M88.852 Osteitis deformans of left thigh
    M88.859 Osteitis deformans of unspecified thigh
    M88.861 Osteitis deformans of right lower leg
    M88.862 Osteitis deformans of left lower leg
    M88.869 Osteitis deformans of unspecified lower leg
    M88.871 Osteitis deformans of right ankle and foot
    M88.872 Osteitis deformans of left ankle and foot
    M88.879 Osteitis deformans of unspecified ankle and foot
    M88.88 Osteitis deformans of other bones
    M88.89 Osteitis deformans of multiple sites
    M88.9 Osteitis deformans of unspecified bone
    M89.9 Disorder of bone, unspecified
    M94.9 Disorder of cartilage, unspecified
    N92.4 Excessive bleeding in the premenopausal period
    N95.0 Postmenopausal bleeding
    N95.1 Menopausal and female climacteric states
    N95.8 Other specified menopausal and perimenopausal disorders
    N95.9 Unspecified menopausal and perimenopausal disorder
    P78.84 Gestational alloimmune liver disease
    S12.9XXA Fracture of neck, unspecified, initial encounter
    Z79.3 Long term (current) use of hormonal contraceptives
    Z79.51 Long term (current) use of inhaled steroids
    Z79.52 Long term (current) use of systemic steroids
    Z79.84 Long term (current) use of oral hypoglycemic drugs
    Z79.85 Long-term (current) use of injectable non-insulin antidiabetic drugs
    Z79.891 Long term (current) use of opiate analgesic
    Z79.899 Other long term (current) drug therapy