National Coverage Determination: Collagen Crosslinks, Any Method

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-10 Descriptor

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