Are there age restrictions for ICD-10-CM code R54?

Yes, this code is restricted to patients between the ages of 15 and 124 years.

Is R54 an acceptable principal diagnosis?

No, code R54 is identified as an unacceptable principal diagnosis (Edit 113) due to OPPS coding requirements. However, this exclusion is ignored for specific bill types (12x, 22x, 81x, 82x).

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Medical Coding
ICD-10-CM
Chapter 18
R54

R54 Billable Code

Age-related physical debility

Effective From: 10/01/2016

Chapter Classification

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

Section Detail

R50-R69 General symptoms and signs (R50-R69)

Coding Guidelines & Notes

excludes1

age-related cognitive decline (R41.81)
sarcopenia (M62.84)
senile psychosis (F03.-)
senility NOS (R41.81)

OPPS Editing Flags

Age Restrictions Ages 15 to 124

External Cause No

Mental Health No

Manifestation (Edit 89) No

Code First Applicable ?This code represents a manifestation of an underlying disease. The underlying condition must be coded first as the principal diagnosis. No

Unacceptable PDX (Edit 113) Yes

PDX Exclusion Logic

OPPS Required: Yes
Bill Type Override: Yes

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