Questionable Admission ICD-10-CM Codes
ICD-10-CM diagnoses usually not sufficient for hospital admission.
30 codes
Grouped by ICD-10 chapterThese codes represent conditions that typically do not justify admission to an acute care hospital. Claims with these codes as principal diagnosis may be flagged for medical necessity review.
E00-E89
Endocrine, Nutritional and Metabolic Diseases9
E11.9Type 2 diabetes mellitus without complications
E11.AType 2 diabetes mellitus without complications in remission
E13.9Other specified diabetes mellitus without complications
E66.09Other obesity due to excess calories
E66.1Drug-induced obesity
E66.811Obesity, class 1
E66.812Obesity, class 2
E66.89Other obesity not elsewhere classified
E66.9Obesity, unspecified
H60-H95
Ear and Mastoid Process Diseases4
I00-I99
Circulatory System Diseases9
I10Essential (primary) hypertension
I44.4Left anterior fascicular block
I44.5Left posterior fascicular block
I44.60Unspecified fascicular block
I44.69Other fascicular block
I44.7Left bundle-branch block, unspecified
I45.0Right fascicular block
I45.10Unspecified right bundle-branch block
I45.19Other right bundle-branch block
R00-R99
Symptoms and Abnormal Findings3
Z00-Z99
Factors Influencing Health Status5
Z21Asymptomatic human immunodeficiency virus [HIV] infection status
Z45.010Encounter for checking and testing of cardiac pacemaker pulse generator [battery]
Z45.018Encounter for adjustment and management of other part of cardiac pacemaker
Z45.02Encounter for adjustment and management of automatic implantable cardiac defibrillator
Z45.09Encounter for adjustment and management of other cardiac device
Source: CMS Definitions of Medicare Code Edits v43.0 (FY 2026)