ICD↔CPT crosswalk
CPT 78816: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 78816 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 78816 with a diagnosis that isn't covered typically denies as CARC 50 — not medically necessary.
National approximation. Coverage varies by MAC and state — confirm against the specific LCD/NCD and article that applies to your jurisdiction and date of service.
| ICD-10 | Description |
|---|---|
| D86.85 | Sarcoid myocarditis |
| M31.4 | Aortic arch syndrome [Takayasu] |
| M31.5 | Giant cell arteritis with polymyalgia rheumatica |
| M31.6 | Other giant cell arteritis |
| M46.40 | Discitis, unspecified, site unspecified |
| M46.41 | Discitis, unspecified, occipito-atlanto-axial region |
| M46.42 | Discitis, unspecified, cervical region |
| M46.43 | Discitis, unspecified, cervicothoracic region |
| M46.44 | Discitis, unspecified, thoracic region |
| M46.45 | Discitis, unspecified, thoracolumbar region |
| M46.46 | Discitis, unspecified, lumbar region |
| M46.47 | Discitis, unspecified, lumbosacral region |
| M46.48 | Discitis, unspecified, sacral and sacrococcygeal region |
| M46.49 | Discitis, unspecified, multiple sites in spine |
| M86.311 | Chronic multifocal osteomyelitis, right shoulder |
| M86.312 | Chronic multifocal osteomyelitis, left shoulder |
| M86.321 | Chronic multifocal osteomyelitis, right humerus |
| M86.322 | Chronic multifocal osteomyelitis, left humerus |
| M86.331 | Chronic multifocal osteomyelitis, right radius and ulna |
| M86.332 | Chronic multifocal osteomyelitis, left radius and ulna |
| M86.341 | Chronic multifocal osteomyelitis, right hand |
| M86.342 | Chronic multifocal osteomyelitis, left hand |
| M86.351 | Chronic multifocal osteomyelitis, right femur |
| M86.352 | Chronic multifocal osteomyelitis, left femur |
| M86.361 | Chronic multifocal osteomyelitis, right tibia and fibula |
| M86.362 | Chronic multifocal osteomyelitis, left tibia and fibula |
| M86.371 | Chronic multifocal osteomyelitis, right ankle and foot |
| M86.372 | Chronic multifocal osteomyelitis, left ankle and foot |
| M86.38 | Chronic multifocal osteomyelitis, other site |
| M86.39 | Chronic multifocal osteomyelitis, multiple sites |
| M86.411 | Chronic osteomyelitis with draining sinus, right shoulder |
| M86.412 | Chronic osteomyelitis with draining sinus, left shoulder |
| M86.421 | Chronic osteomyelitis with draining sinus, right humerus |
| M86.422 | Chronic osteomyelitis with draining sinus, left humerus |
| M86.431 | Chronic osteomyelitis with draining sinus, right radius and ulna |
| M86.432 | Chronic osteomyelitis with draining sinus, left radius and ulna |
| M86.441 | Chronic osteomyelitis with draining sinus, right hand |
| M86.442 | Chronic osteomyelitis with draining sinus, left hand |
| M86.451 | Chronic osteomyelitis with draining sinus, right femur |
| M86.452 | Chronic osteomyelitis with draining sinus, left femur |
| M86.461 | Chronic osteomyelitis with draining sinus, right tibia and fibula |
| M86.462 | Chronic osteomyelitis with draining sinus, left tibia and fibula |
| M86.471 | Chronic osteomyelitis with draining sinus, right ankle and foot |
| M86.472 | Chronic osteomyelitis with draining sinus, left ankle and foot |
| M86.48 | Chronic osteomyelitis with draining sinus, other site |
| M86.49 | Chronic osteomyelitis with draining sinus, multiple sites |
| M86.511 | Other chronic hematogenous osteomyelitis, right shoulder |
| M86.512 | Other chronic hematogenous osteomyelitis, left shoulder |
| M86.521 | Other chronic hematogenous osteomyelitis, right humerus |
| M86.522 | Other chronic hematogenous osteomyelitis, left humerus |
| M86.531 | Other chronic hematogenous osteomyelitis, right radius and ulna |
| M86.532 | Other chronic hematogenous osteomyelitis, left radius and ulna |
| M86.541 | Other chronic hematogenous osteomyelitis, right hand |
| M86.542 | Other chronic hematogenous osteomyelitis, left hand |
| M86.551 | Other chronic hematogenous osteomyelitis, right femur |
| M86.552 | Other chronic hematogenous osteomyelitis, left femur |
| M86.561 | Other chronic hematogenous osteomyelitis, right tibia and fibula |
| M86.562 | Other chronic hematogenous osteomyelitis, left tibia and fibula |
| M86.571 | Other chronic hematogenous osteomyelitis, right ankle and foot |
| M86.572 | Other chronic hematogenous osteomyelitis, left ankle and foot |
| M86.58 | Other chronic hematogenous osteomyelitis, other site |
| M86.59 | Other chronic hematogenous osteomyelitis, multiple sites |
| M86.611 | Other chronic osteomyelitis, right shoulder |
| M86.612 | Other chronic osteomyelitis, left shoulder |
| M86.621 | Other chronic osteomyelitis, right humerus |
| M86.622 | Other chronic osteomyelitis, left humerus |
| M86.631 | Other chronic osteomyelitis, right radius and ulna |
| M86.632 | Other chronic osteomyelitis, left radius and ulna |
| M86.641 | Other chronic osteomyelitis, right hand |
| M86.642 | Other chronic osteomyelitis, left hand |
| M86.651 | Other chronic osteomyelitis, right thigh |
| M86.652 | Other chronic osteomyelitis, left thigh |
| M86.661 | Other chronic osteomyelitis, right tibia and fibula |
| M86.662 | Other chronic osteomyelitis, left tibia and fibula |
| M86.671 | Other chronic osteomyelitis, right ankle and foot |
| M86.672 | Other chronic osteomyelitis, left ankle and foot |
| M86.68 | Other chronic osteomyelitis, other site |
| M86.69 | Other chronic osteomyelitis, multiple sites |
| R50.9 | Fever, unspecified |
| T82.6XXA | Infection and inflammatory reaction due to cardiac valve prosthesis, initial encounter |
| T82.6XXD | Infection and inflammatory reaction due to cardiac valve prosthesis, subsequent encounter |
| T82.6XXS | Infection and inflammatory reaction due to cardiac valve prosthesis, sequela |
| T82.7XXA | Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter |
| T82.7XXD | Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, subsequent encounter |
| T82.7XXS | Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, sequela |
| XX0.00 |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 78816?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 86 ICD-10 diagnosis codes that support medical necessity for CPT 78816. The covered codes are listed on this page. Coverage varies by MAC/state — always confirm against the policy that applies to you.
What is a medical-necessity (LCD/NCD) crosswalk?
A claim whose procedure isn't supported by a covered diagnosis denies as "not medically necessary" (CARC 50). CMS coverage policies define which diagnoses justify a procedure; this page is the ICD-10 → CPT 78816 view of that relationship.
Catch medical-necessity denials before you bill. CareNiva scrubs claims against LCD/NCD coverage and flags unsupported diagnoses — in the same platform you run visits and billing.
More free billing tools: all crosswalks · NCCI edits · Medicare fees · denial codes
Informational only, not coding, billing, or legal advice. Based on CMS Medicare Coverage Database data; verify the current LCD/NCD for your MAC before billing.
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