Claims & coverage

When ICD-10-CM is required

For US diagnosis claims covered by HIPAA, ICD-10-CM is required from October 1, 2015.

Use the service date for outpatient/professional claims and the discharge date for hospital inpatient claims. Earlier encounters use ICD-9-CM; each individual code must also be valid for the applicable date.

Official coding guidelines → · CMS ↗

All editions

Effective from

Code history

FY2016

2015-10-01

First observed

FY2017

2016-10-01

No tabular change

FY2018

2017-10-01

No tabular change

FY2019

2018-10-01

No tabular change

FY2020

2019-10-01

No tabular change

FY2020 · April

2020-04-01

No tabular change

FY2021

2020-10-01

No tabular change

FY2021 · 01-01

2021-01-01

No tabular change

FY2022

2021-10-01

No tabular change

FY2022 · 04-01

2022-04-01

No tabular change

FY2023

2022-10-01

No tabular change

FY2023 · 04-01

2023-04-01

No tabular change

FY2024

2023-10-01

No tabular change

FY2024 · 04-01

2024-04-01

No tabular change

FY2025

2024-10-01

No tabular change

FY2025 · 04-01

2025-04-01

No tabular change

FY2026

2025-10-01

No tabular change

FY2026 · April

2026-04-01

No tabular change

FY2027

2026-10-01

No tabular change

Inherited instructions

Chapters 18 · Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

Excludes 2

abnormal findings on antenatal screening of mother (O28.-)
certain conditions originating in the perinatal period (P04-P96)
signs and symptoms classified in the body system chapters
signs and symptoms of breast (N63, N64.5)

Note

This chapter includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill-defined conditions regarding which no diagnosis classifiable elsewhere is recorded.
Signs and symptoms that point rather definitely to a given diagnosis have been assigned to a category in other chapters of the classification. In general, categories in this chapter include the less well-defined conditions and symptoms that, without the necessary study of the case to establish a final diagnosis, point perhaps equally to two or more diseases or to two or more systems of the body. Practically all categories in the chapter could be designated 'not otherwise specified', 'unknown etiology' or 'transient'. The Alphabetical Index should be consulted to determine which symptoms and signs are to be allocated here and which to other chapters. The residual subcategories, numbered .8, are generally provided for other relevant symptoms that cannot be allocated elsewhere in the classification.
The conditions and signs or symptoms included in categories R00-R94 consist of:
(a) cases for which no more specific diagnosis can be made even after all the facts bearing on the case have been investigated;
(b) signs or symptoms existing at the time of initial encounter that proved to be transient and whose causes could not be determined;
(c) provisional diagnosis in a patient who failed to return for further investigation or care;
(d) cases referred elsewhere for investigation or treatment before the diagnosis was made;
(e) cases in which a more precise diagnosis was not available for any other reason;
(f) certain symptoms, for which supplementary information is provided, that represent important problems in medical care in their own right.

R90-R94 · Abnormal findings on diagnostic imaging and in function studies, without diagnosis (R90-R94)

Includes

nonspecific abnormal findings on diagnostic imaging by computerized axial tomography [CAT scan]
nonspecific abnormal findings on diagnostic imaging by magnetic resonance imaging [MRI][NMR]
nonspecific abnormal findings on diagnostic imaging by positron emission tomography [PET scan]
nonspecific abnormal findings on diagnostic imaging by thermography
nonspecific abnormal findings on diagnostic imaging by ultrasound [echogram]
nonspecific abnormal findings on diagnostic imaging by X-ray examination

Excludes 1

abnormal findings on antenatal screening of mother (O28.-)
diagnostic abnormal findings classified elsewhere - see Alphabetical Index

Chapters 18 · Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

Excludes 2

abnormal findings on antenatal screening of mother (O28.-)
certain conditions originating in the perinatal period (P04-P96)
signs and symptoms classified in the body system chapters
signs and symptoms of breast (N63, N64.5)

Note

This chapter includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill-defined conditions regarding which no diagnosis classifiable elsewhere is recorded.
Signs and symptoms that point rather definitely to a given diagnosis have been assigned to a category in other chapters of the classification. In general, categories in this chapter include the less well-defined conditions and symptoms that, without the necessary study of the case to establish a final diagnosis, point perhaps equally to two or more diseases or to two or more systems of the body. Practically all categories in the chapter could be designated 'not otherwise specified', 'unknown etiology' or 'transient'. The Alphabetical Index should be consulted to determine which symptoms and signs are to be allocated here and which to other chapters. The residual subcategories, numbered .8, are generally provided for other relevant symptoms that cannot be allocated elsewhere in the classification.
The conditions and signs or symptoms included in categories R00-R94 consist of:
(a) cases for which no more specific diagnosis can be made even after all the facts bearing on the case have been investigated;
(b) signs or symptoms existing at the time of initial encounter that proved to be transient and whose causes could not be determined;
(c) provisional diagnosis in a patient who failed to return for further investigation or care;
(d) cases referred elsewhere for investigation or treatment before the diagnosis was made;
(e) cases in which a more precise diagnosis was not available for any other reason;
(f) certain symptoms, for which supplementary information is provided, that represent important problems in medical care in their own right.

Abnormal findings on diagnostic imaging of other body structures

R90-R94 · Inherited instructions

Chapters 18 · Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

More specific codes

Claims & coverage

Code history

All editions (19)

Code-level instructions

Inherited instructions

Chapters 18 · Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

R90-R94 · Abnormal findings on diagnostic imaging and in function studies, without diagnosis (R90-R94)

More specific codes

Related codes

Abnormal findings on diagnostic imaging of other body structures

R90-R94 · Inherited instructions

Chapters 18 · Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

More specific codes

Claims & coverage

Code history

All editions (19)

Code-level instructions

Inherited instructions

Chapters 18 · Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

R90-R94 · Abnormal findings on diagnostic imaging and in function studies, without diagnosis (R90-R94)

More specific codes

Related codes