International Classification of Disease, 9th Revision. Diagnostic Codes Related to Family Infant Toddler (FIT) Program. Eligibility Criteria

Transcription

1 International Classification of Disease, 9th Revision Diagnostic Codes Related to Family Infant Toddler (FIT) Program Eligibility Criteria Revised January 2015 The following relevant diagnosis codes under the four Family Infant Toddler Program eligibility categories are taken directly from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). 1 Page ICD-9 Codes Revised January 2015

2 Introduction: The following is a guide for Family Infant Toddler (FIT) Program providers to determine the whether the child s medical diagnosis meets eligibility under the Established Condition or Medical / Biological Risk, in accordance with the Requirements for Family Infant Toddler Early Intervention Services (NMAC ). This guide is also to be used to determine the diagnostic billing codes (ICD-9 International Classification of Diseases) to be entered into FIT-KIDS (Key Information Data System) for any the FIT eligibility criteria. This guide is organized into the FIT eligibility categories of Developmental Delay, Established Condition, Medical/Biological Risk Condition, and Environmental Risk Factors. The categories of Established Condition, and Medical/Biological Risk Condition have their own subcategories of the following: Genetic Disorders; Mental/Psychosocial Disorders (DC: 0-3 diagnosis are indicated in bold); Neurologic/Musculoskeletal; Perinatal Factors; Physical Impairments; and Sensory Abnormalities. Reminder: Eligibility determination in the categories of Medical/Biological Risk Condition and Established Condition must be made by a license Medical Practitioner. The category of Environmental Risk has subcategories of the following: Other personal history presenting hazards to health; Family history of certain chronic disabling diseases; family history of certain other specific conditions; family history of other conditions; health supervision of a child; housing, household, and economic circumstances; other family circumstances; and other psychosocial circumstances. Reminder: Eligibility determination in the category of Environmental Risk must be made using the Environmental Risk Assessment (ERA) tool. Any questions regarding conditions not on this guide must be directed to your FIT Manager who will work with a New Mexico Department of Health Physician to determine whether a proposed condition will be recognized. Periodically such conditions will be added to the list. The electronic version has the option to move between sections by clicking the table of contents (hyperlinks). Additionally, diagnoses and ICD-9 Codes can also be found by clicking CTRL+F. Note: for billing purposes through FIT-KIDS all codes that are not listed may be entered in the Field/Box of Other ICD-9 Code. Please contact your FIT Program Manager if you have any questions. Special thanks to: Dr. Janis Gonzales; Dr. Andy Hsi, Joanne Corwin, and Cindy Faris for their work on this document. 2 Page ICD-9 Codes Revised January 2015

3 Table of Contents DEVELOPMENTAL DELAY... 5 ESTABLISHED CONDITION: GENETIC DISORDERS... 6 ESTABLISHED CONDITION: NEUROLOGIC/MUSCULOSKELETAL... 8 ESTABLISHED CONDITION: PERINATAL FACTORS ESTABLISHED CONDITION: PHYSICAL IMPAIRMENTS ESTABLISHED CONDITION: SENSORY ABNORMALITIES MEDICAL/BIOLOGICAL RISK CONDITION: GENETIC DISORDERS MEDICAL/BIOLOGICAL RISK CONDITION: MENTAL/PSYCHOSOCIAL DISORDERS MEDICAL/BIOLOGICAL RISK CONDITION: NEUROLOGIC/MUSCULOSKELETAL MEDICAL/BIOLOGICAL RISK CONDITION: PERINATAL FACTORS MEDICAL/BIOLOGICAL RISK CONDITION: PERINATAL FACTORS (CONTINUED) MEDICAL/BIOLOGICAL RISK CONDITION: PHYSICAL IMPAIRMENTS MEDICAL/BIOLOGICAL RISK CONDITION: SENSORY ABNORMALITIES ENVIRONMENTAL RISK FACTORS: PERSONAL HISTORY PRESENTING HAZARD TO HEALTH Page ICD-9 Codes Revised January 2015

4 ENVIRONMENTAL RISK FACTORS: FAMILY HISTORY OF CERTAIN CHRONIC DISABLING DISEASES ENVIRONMENTAL RISK FACTORS: FAMILY HISTORY OF OTHER CONDITIONS ENVIRONMENTAL RISK FACTORS: HEALTH SUPERVISION OF INFANT OR CHILD ENVIRONMENTAL RISK FACTORS: HOUSING, HOUSEHOLD, AND ECONOMIC CIRCUMSTANCES ENVIRONMENTAL RISK FACTORS: OTHER FAMILY CIRCUMSTANCES ENVIRONMENTAL RISK FACTORS: OTHER PSYCHOSOCIAL CIRCUMSTANCES Page ICD-9 Codes Revised January 2015

5 Developmental Delay A delay of 25% or more, after correction for prematurity, in one or more of the following areas of development: cognitive; communication; physical/motor; social or emotional; or adaptive of the following: (NMAC Requirements for Family Infant Toddler Early Intervention Services.) Condition Type ICD-9 Code Development Condition/Diagnosis Autistic Disorder, Current or Active State (DC 0-3 R: 710 Multisystem Development Disorder) Development Pervasive Development Disorder (PDD), Unspecified Development Expressive Language Disorder Development Mixed Receptive-Expressive Language Disorder Development Other Developmental Speech Disorder Development Developmental Coordination Disorder Development Mixed Development Disorder Development Other Specified Delays in Development Development Unspecified Delay In Development Development 317 Mild Intellectual Disabilities Development Moderate Intellectual Disabilities Development Severe Intellectual Disabilities Development Profound Intellectual Disabilities Development 319 Unspecified Intellectual Disabilities Development Childhood Onset Fluency Disorder 5 Page ICD-9 Codes Revised January 2015

6 ESTABLISHED CONDITION: Genetic Disorders A diagnosed physical, mental, or neurobiological condition that has a high probability of resulting in developmental delay. The established condition shall be diagnosed by a health care provider and documentation shall be kept on file. Established conditions include the following: (NMAC Requirements for Family Infant Toddler Early Intervention Services.) Genetic Disorders Cerebellar Astrocytoma Genetic Disorders Tyrosinemia, Type I (Tyrosinosis) and Type II (Richner-Hanhart Syndrome) Genetic Disorders Waardenburg's Syndrome, Type I Genetic Disorders Oculocerebrorenal Syndrome (Lowe's Syndrome) Genetic Disorders Mannosidosis Genetic Disorders Wilson's Disease Genetic Disorders Lesch-Nyhan Syndrome Genetic Disorders Mucopolysaccharidosis Genetic Disorders Canavan Disease Genetic Disorders Krabbe's Disease Genetic Disorders Alper's Disease (Poliodystrophy) Genetic Disorders Leigh Disease Genetic Disorders Rett Syndrome Genetic Disorders Hydrocephalus, Obstructive (Acquired Hydrocephalus, NOS) Genetic Disorders Myasthenia Gravis, Familial Infantile Genetic Disorders Nemaline Rod Myopathy Genetic Disorders Clubfoot, Congenital Genetic Disorders Paralytic Clubbed Foot Genetic Disorders Agenesis of the Corpus Collosum Genetic Disorders Polymicrogyria Genetic Disorders Dandy Walker Syndrome Genetic Disorders Hydrancephaly (Congenital Hydrocephalus) Genetic Disorders Phocomelia, Unspecified 6 Page ICD-9 Codes Revised January 2015

7 ESTABLISHED CONDITION: Genetic Disorders (Continued) Genetic Disorders Amelia, Unspecified as to Site Genetic Disorders Congenital Anomalies of Skull and Face Bone Goldenhar Genetic Disorders Osteogenesis Imperfecta Syndromes Genetic Disorders Sjogren-Larsson Syndrome Genetic Disorders Chromosomal Anomalies - Trisomy 21 (Down Syndrome) Genetic Disorders Chromosomal Anomalies - Trisomy 13 (Patau's, D1) Genetic Disorders Chromosomal Anomalies - Trisomy 18 (Edward's, E3) Genetic Disorders Chromosomal Anomalies - 5p- (Cri Du Chat or Cat's Cry) Genetic Disorders Tuberous Sclerosis Genetic Disorders Sturge-Weber Syndrome Genetic Disorders Prader-Willi Syndrome Genetic Disorders Prader-Willis Sydrome Genetic Disorders Fragile X Syndrome For Boys Genetic Disorders Angelman's Syndrome Genetic Disorders Caudal Regression Syndrome (Sirenomelia) Genetic Disorders Cerebrohepatorenal Syndrome Genetic Disorders DeLange s Syndrome Genetic Disorders Dubowitz Syndrome Genetic Disorders Dyggve-Melchior-Clausen Syndrome (D-M-C Dwarfism) Genetic Disorders Menkes' Syndrome (Kinky Hair Disease) Genetic Disorders Rubinstein-Taybi Syndrome Genetic Disorders Smith-Lemli-Opitz Syndrome Genetic Disorders Williams Syndrome Genetic Disorders Aphasia (Acquired) Genetic Disorders Subacute Sclerosing Panencephalitis 7 Page ICD-9 Codes Revised January 2015

8 ESTABLISHED CONDITION: Neurologic/Musculoskeletal A diagnosed physical, mental, or neurobiological condition that has a high probability of resulting in developmental delay. The established condition shall be diagnosed by a health care provider and documentation shall be kept on file. Established conditions include the following: (NMAC Requirements for Family Infant Toddler Early Intervention Services.) Neurologic/Musculoskeletal Myoclonus Neurologic/Musculoskeletal Spinocerebella Disorders Neurologic/Musculoskeletal Unspecified Idiopathic Perpheral Neuropathy Neurologic/Musculoskeletal Microcephaly Neurologic/Musculoskeletal Hemiplegia (Hemiparesis), Unspecified Neurologic/Musculoskeletal Cerebral Ataxia, Congenital Neurologic/Musculoskeletal Dystonia Musculorum Deformans (Torsion Dystonia) Neurologic/Musculoskeletal Cerebral Palsy, Infantile, Diplegic (Congenital Diplegia, Paraplegia) Neurologic/Musculoskeletal Cerebral Palsy, Infantile, Hemiplegic (Congenital Hemiplegia) Neurologic/Musculoskeletal Hemiplegia, Congenital (Spastic Infantile Paralysis) Neurologic/Musculoskeletal Cerebral Palsy, Infantile, Quadriplegic Neurologic/Musculoskeletal Cerebral Palsy, Infantile, Monoplegic Neurologic/Musculoskeletal Hemiplegia, Infantile (Postnatal), NOS Neurologic/Musculoskeletal Cerebral Palsy, Infantile, Other Specified Neurologic/Musculoskeletal Cerebral Palsy, Infantile, Unspecified Neurologic/Musculoskeletal Paralysis of All Four Limbs (Quadriplegia, Quadriparesis,) Neurologic/Musculoskeletal Paralysis of Both Lower Limbs (Paraplegia) Neurologic/Musculoskeletal Paralysis of Both Upper Limbs (Diplegia) Neurologic/Musculoskeletal Paralysis of One Lower Limb (Monoplegia) Neurologic/Musculoskeletal Paralysis of One Upper Limb (Monoplegia) Neurologic/Musculoskeletal Paralysis, Unspecified Neurologic/Musculoskeletal Porencephaly 8 Page ICD-9 Codes Revised January 2015

9 ESTABLISHED CONDITION: Neurologic/Musculoskeletal (Continued) Neurologic/Musculoskeletal Encephalopathy, Static Neurologic/Musculoskeletal Muscular Dystrophy, Congenital Neurologic/Musculoskeletal Duchenne Muscular Dystrophy Neurologic/Musculoskeletal Myotonic Dystrophy Neurologic/Musculoskeletal Myotonia Congenita (Thomsen's Disease) Neurologic/Musculoskeletal Menigomyelocele Neurologic/Musculoskeletal Spina Bifida with Hydrocephalus (Arnold Chiari / Chiari II ) Neurologic/Musculoskeletal Spina Bifida without Hydrocephalus (Meningomyelocele, Meningocele) Neurologic/Musculoskeletal Encephalocele Neurologic/Musculoskeletal Holoprosencephaly Neurologic/Musculoskeletal Lissencephaly Neurologic/Musculoskeletal Cerebral Dysplasia Neurologic/Musculoskeletal Encephalopathy, Congenital Neurologic/Musculoskeletal Lumbosacral Agenesis Neurologic/Musculoskeletal Anencephaly Neurologic/Musculoskeletal Encephalopathy, Hypoxic Ischemic Neurologic/Musculoskeletal Convulsions in newborn Neurologic/Musculoskeletal Hypotonia, Congenital, Non-Benign Form Neurologic/Musculoskeletal Fracture of Vertebral Column with Spinal Cord Injury Neurologic/Musculoskeletal Traumatic Brain Injury Neurologic/Musculoskeletal Paralysis, Other Specified 9 Page ICD-9 Codes Revised January 2015

10 ESTABLISHED CONDITION: Perinatal Factors A diagnosed physical, mental, or neurobiological condition that has a high probability of resulting in developmental delay. The established condition shall be diagnosed by a health care provider and documentation shall be kept on file. Established conditions include the following: (NMAC Requirements for Family Infant Toddler Early Intervention Services.) Perinatal Factors Less Than 24 Weeks of Gestation Perinatal Factors Completed Weeks of Gestation Perinatal Factors Completed Weeks of Gestation Perinatal Factors Completed Weeks of Gestation Perinatal Factors Birth asphyxia, severe Perinatal Factors Congenital rubella Perinatal Factors Congenital Rubella Perinatal Factors Congenital Cytomegalvirus Infection Toxoplasmosis Perinatal Factors Cerebral depression coma and other abnormal cerebral signs in fetus or newborn Perinatal Factors Drug withdrawal syndrome in newborn Perinatal Factors Preventricular leukomalacia Perinatal Factors Sever Birth Asphyxia Perinatal Factors Other Congenital Infections Specific to the Perinatal Period 10 Page ICD-9 Codes Revised January 2015

11 ESTABLISHED CONDITION: Physical Impairments A diagnosed physical, mental, or neurobiological condition that has a high probability of resulting in developmental delay. The established condition shall be diagnosed by a health care provider and documentation shall be kept on file. Established conditions include the following: (NMAC Requirements for Family Infant Toddler Early Intervention Services.) Physical Impairments Retinoblastoma Physical Impairments Anophthalmos Physical Impairments Microphthalmia Physical Impairments Aniridia Physical Impairments Coloboma Physical Impairments Anomalies of external ear with impairment of hearing Atresia or stenosis Physical Impairments Microtia Physical Impairments Other specified congenital anomalies of ear Physical Impairments Other Specified Nonteratogenic Anomalies Physical Impairments Unspecified Anomaly of Upper Limb Congenital Physical Impairments Periventricular Leukomalacia 11 Page ICD-9 Codes Revised January 2015

12 ESTABLISHED CONDITION: Sensory Abnormalities A diagnosed physical, mental, or neurobiological condition that has a high probability of resulting in developmental delay. The established condition shall be diagnosed by a health care provider and documentation shall be kept on file. Established conditions include the following: (NMAC Requirements for Family Infant Toddler Early Intervention Services.) Sensory Abnormalities Retinal detachment with retinal defect Unspecified Sensory Abnormalities Retinopathy of Prematurity (ROP) Sensory Abnormalities Retinitis Pigmentosa (RP) Sensory Abnormalities Leber s Congenital Amaurosis Sensory Abnormalities Glaucoma of Childhood Sensory Abnormalities Cataracts Sensory Abnormalities Visual Field Defects, unspecified Sensory Abnormalities Homonomymous Bilateral Sensory Abnormalities Hemianopsia/Hemianopia: Heteronymous Sensory Abnormalities Achromatopsia Sensory Abnormalities Blindness Sensory Abnormalities Cortical Visual Impairment (CVI) (unspecified visual disturbance) Sensory Abnormalities Optic Nerve Atrophy Sensory Abnormalities Optic nerve Hypoplasia Sensory Abnormalities Cortical blindness (Disorders of visual cortex) Sensory Abnormalities Aphakia Sensory Abnormalities Nystagmus Unspecified Sensory Abnormalities Neural hearing loss, bilateral Sensory Abnormalities Central hearing loss, bilateral 12 Page ICD-9 Codes Revised January 2015

13 ESTABLISHED CONDITION: Sensory Abnormalities (continued) Sensory Abnormalities Sensorineural hearing loss, unilateral Sensory Abnormalities Sensorineural hearing loss, asymmetrical Sensory Abnormalities Sensorineural hearing loss of combined types, bilateral Sensory Abnormalities Mixed conductive and sensorineural hearing loss Unspecified Sensory Abnormalities Unspecified hearing loss Sensory Abnormalities Anomalies of ear causing impairment of hearing Sensory Abnormalities Other Specified congenital anomalies 13 Page ICD-9 Codes Revised January 2015

14 MEDICAL/BIOLOGICAL RISK CONDITION: Genetic Disorders A diagnosed physical, mental, or neurobiological condition. The biological or medical risk condition shall be diagnosed by a health care provider and documentation shall be kept on file. Biological and medical risk conditions include the following: (NMAC Requirements for Family Infant Toddler Early Intervention Services.) *Questions Regarding conditions not on this list shall be directed to your FIT Manager who will work with a Department of Health Physician to determine whether a proposed condition will be recognized. Genetic Disorders Neurofibromatosis Genetic Disorders 243 Hypothyroidism (Untreated), Congenital Genetic Disorders Fanconi (-de Toni) (-Debre) Syndrome Genetic Disorders Phenylketonuria (PKU) Genetic Disorders Other Disturbances of Aromatic Amino-Acid Metabolism (Waardenberg's/Albinism) Genetic Disorders Isovaleric Acidemia Genetic Disorders Maple Syrup Urine Disease Genetic Disorders Methylmalonic Aciduria Genetic Disorders Homocystinuria Genetic Disorders Argininosuccinic Aciduria Genetic Disorders Glycinemia Genetic Disorders Pompe's Disease (Glycogen Storage Disease) Genetic Disorders Galactosemia Genetic Disorders Gaucher s Disease Genetic Disorders Mucolipidosis Genetic Disorders Niemann-Pick Disease, Classic Infantile and Juvenile Genetic Disorders Adrenoleukodystrophy Genetic Disorders DiGeorge's Syndrome 14 Page ICD-9 Codes Revised January 2015

15 MEDICAL/BIOLOGICAL RISK CONDITION: Genetic Disorders (continued) Genetic Disorders Drug Withdrawal Syndrome Genetic Disorders Metachromatic Leukodystrophy Genetic Disorders GM1 Gangliosidosis Genetic Disorders GM2 Gangliosidosis (Tay-Sachs or Sandhoff Disease) Genetic Disorders Neuronal Ceroid Lipofuscinoses Genetic Disorders Ataxia Telanglectasia Genetic Disorders Werdnig-Hoffman Disease Genetic Disorders Periventricular Leukomalacia (PVL), Other than Perinatal Origin Genetic Disorders Hypertrophic Interstitial Neuritis (Dejerine-Sottas or Gombault's) Genetic Disorders Anoxic Insult to Brain Genetic Disorders Diastematomyelia Genetic Disorders Familial Dysautonomia (Riley-Day Syndrome, HSAN III) Genetic Disorders Holt-Oram (Cardiac-Limb) Syndrome (Atriodigital Dysplasia) Genetic Disorders Apert's Syndrome (Acrocephalosyndactyly I, ACS I) Genetic Disorders Saethre-Chotzen Syndrome (Chotzen's, Acrocephalosyndactyly III) Genetic Disorders Larsen's Syndrome Genetic Disorders Robin s Syndrome Genetic Disorders Achondrogenesis I (Parenti-Fraccaro Syndrome) Genetic Disorders Achondrogenesis II (Langer-Saldino Syndrome) Genetic Disorders Achondroplasia Genetic Disorders Diastrophic Dysplasia Genetic Disorders Osteodystrophy, Congenital 15 Page ICD-9 Codes Revised January 2015

16 MEDICAL/BIOLOGICAL RISK CONDITION: Genetic Disorders (Continued) Genetic Disorders Acrodysostosis (Acrodysplasia I) Genetic Disorders Cutis Laxa Syndromes, Recessive Form Genetic Disorders Ehlers-Danlos Syndromes Genetic Disorders Kniest's Syndrome (Metatrophic Dwarfism II) Genetic Disorders Ichthyosis Congenita (Harlequin Fetus) Genetic Disorders Xeroderma Pigmentosum Genetic Disorders Velo-cardio-facial Syndrome Genetic Disorders Chromosomal Deletions (11p-,13q-, 12p-, etc.) Genetic Disorders Chromosomal Insertions (10p+, 13q+, 3q+, etc.) Genetic Disorders Chromosomal Anomalies - XO (Turner's Syndrome) Genetic Disorders Chromosomal Anomalies - XXY (Klinefelter's Syndrome) Genetic Disorders Chromosomal Anomalies- Other Trisomy or Mosaics Genetic Disorders Chromosomal Anomalies-Other Sex Chromosome Anomalies Genetic Disorders Coffin-Lowry Syndrome Genetic Disorders Beals' Syndrome (Beals-Hecht Syndrome) Genetic Disorders Marfan's Syndrome Genetic Disorders Fragile X Syndrome For Girls Genetic Disorders Beckwith-Wiedemann Syndrome Genetic Disorders Biedl-Bardet Syndrome Genetic Disorders Cerebral Gigantism (Soto's Syndrome) Genetic Disorders CHARGE Syndrome (CHARGE Association) Genetic Disorders Klippel-Trenaunay-Weber Syndrome 16 Page ICD-9 Codes Revised January 2015

17 MEDICAL/BIOLOGICAL RISK CONDITION: Genetic Disorders (Continued) Genetic Disorders Langer-Giedion Syndrome (Acrodysplasia V, Klingmuller's) Genetic Disorders Linear Nevus Sebaceous Syndrome Genetic Disorders Noonan's Syndrome Genetic Disorders Oral-Facial-Digital Syndrome Genetic Disorders Otopalatodigital Syndrome Genetic Disorders Russell (-Silver) Syndrome Genetic Disorders VATER Syndrome Genetic Disorders Amniotic Band (affecting fetus or newborn) Genetic Disorders Cytomegalic Inclusion Disease, Congenital Genetic Disorders Periventricular Leukomalacia (PVL), Perinatal Origin Genetic Disorders Failure to Thrive 17 Page ICD-9 Codes Revised January 2015

18 MEDICAL/BIOLOGICAL RISK CONDITION: Mental/Psychosocial Disorders A diagnosed physical, mental, or neurobiological condition. The biological or medical risk condition shall be diagnosed by a health care provider and documentation shall be kept on file. Biological and medical risk conditions include the following: (NMAC Requirements for Family Infant Toddler Early Intervention Services.) *Questions Regarding conditions not on this list shall be directed to your FIT Manager who will work with a Department of Health Physician to determine whether a proposed condition will be recognized. Condition Type ICD-9 Code Mental/Psychosocial Disorders Condition/Diagnosis Major Depressive Affective Disorder Single Episode Unspecified (DC 0-3 R: 231 Type I Major Depression) Mental/Psychosocial Disorders Episodic Mood Disorder Unspecified (DC 0-3 R: 231 Type II Depressive Disorder) Other Specified Pervasive Developmental Disorder, Current or Active State (DC 0-3 Mental/Psychosocial Disorders R: 710 Multisystem Development Disorder) Mental/Psychosocial Disorders Anxiety state, unspecified (DC 0-3 R: 225 Anxiety Disorder NOS) Mental/Psychosocial Disorders Generalized Anxiety Disorder (DC 0-3 R: 220's Anxiety Disorder Disorder) Mental/Psychosocial Disorders Social Phobia (DC 0-3 R: 220's Anxiety Disorder Disorder) Mental/Psychosocial Disorders Other Isolated or Specific Phobias (DC 0-3 R: 220's Anxiety Disorder Disorder) Mental/Psychosocial Disorders Anorexia Nervosa (DC 0-3 R: 600's Feeding Behavior Disorder) Mental/Psychosocial Disorders Transient Disorder of Initiating or Maintaining Sleep (DC 0-3 R: 500's Sleep Behavior Disorder) Mental/Psychosocial Disorders Persistent Disorder of Initiating or Maintaining Sleep (DC 0-3 R: 500's Sleep Behavior Disorder) Mental/Psychosocial Disorders Eating disorder, unspecified (DC 0-3 R: 600's Feeding Behavior Disorder) 18 Page ICD-9 Codes Revised January 2015

19 MEDICAL/BIOLOGICAL RISK CONDITION: Mental/Psychosocial Disorders (Continued) Condition Type ICD-9 Code Condition/Diagnosis Mental/Psychosocial Disorders Bulimia (DC 0-3 R: 600's Feeding Behavior Disorder) Mental/Psychosocial Disorders PICA (DC 0-3 R: 600's Feeding Behavior Disorder) Mental/Psychosocial Disorders Rumination Disorder (DC 0-3 R: 600's Feeding Behavior Disorder) Mental/Psychosocial Disorders Psychogenic vomiting (DC 0-3 R: 600's Feeding Behavior Disorder) Mental/Psychosocial Disorders Adj. reaction w/ prolonged depressive reaction (DC 0-3 R: 210 Prolonged Bereavement/Grief Reaction) Mental/Psychosocial Disorders Adj. reaction w/ separation anxiety disorder (DC 0-3 R: 220's Anxiety Disorder Disorder) Mental/Psychosocial Disorders Adj. reaction w/anxious mood (DC 0-3 R: 300 Adjustment Disorder) Mental/Psychosocial Disorders Adj. reaction w/ mixed anxiety & depressed mood (DC 0-3 R: 300 Adjustment Disorder) Mental/Psychosocial Disorders Other Adjustment Reaction with Predominate Disturbance of Other Emotions (DC 0-3 R: 300 Adjustment Disorder) Mental/Psychosocial Disorders Adjustment Disorder with Disturbance of Conduct (DC 0-3 R: 400's Regulation Disorder of Sensory Processing) Mental/Psychosocial Disorders Adj. reaction w/ mixed dist. of emotions and conduct (DC 0-3 R: 150 Deprivation /Maltreatment Disorder or DC 0-3 R: 900 Relationship Disorder If PIR-GAS of 40 or below) Mental/Psychosocial Disorders Posttraumatic Stress Disorder (DC 0-3 R: 100 Post Traumatic Stress Disorder) Mental/Psychosocial Disorders Adj. reaction, unspecified (DC 0-3 R: 300 Adjustment Disorder) Emotional Disturbance of Childhood Unspecified (DC 0-3 R: 240 Mixed Disorder of Mental/Psychosocial Disorders Emotional Expressiveness) 19 Page ICD-9 Codes Revised January 2015

20 MEDICAL/BIOLOGICAL RISK CONDITION: Neurologic/Musculoskeletal A diagnosed physical, mental, or neurobiological condition. The biological or medical risk condition shall be diagnosed by a health care provider and documentation shall be kept on file. Biological and medical risk conditions include the following: (NMAC Requirements for Family Infant Toddler Early Intervention Services.) *Questions Regarding conditions not on this list shall be directed to your FIT Manager who will work with a Department of Health Physician to determine whether a proposed condition will be recognized. Neurologic/Musculoskeletal 431 Intracerebral Hemorrhage Neurologic/Musculoskeletal Malignant Neoplasm of Nervous System Part Unspecified Neurologic/Musculoskeletal Meningitis Unspecified Neurologic/Musculoskeletal Syringomyelia Neurologic/Musculoskeletal Epilepsy, Generalized Nonconvulsive Neurologic/Musculoskeletal Epilepsy, Generalized Convulsive Neurologic/Musculoskeletal Lennox-Gastaut Syndrome (Gastaut's Syndrome) Neurologic/Musculoskeletal Myoclonic Encephalopathy of Childhood (Kinsbourne Syndrome) Neurologic/Musculoskeletal Epilepsy, Partial, with Impairment of Consciousness Neurologic/Musculoskeletal Epilepsy, Partial, without Impairment of Consciousness Neurologic/Musculoskeletal Infantile Spasms, Epilepsy (Infantile Myoclonic Seizures) Neurologic/Musculoskeletal Epilepsy, Unspecified Neurologic/Musculoskeletal Cerebral Cysts, Congenital Neurologic/Musculoskeletal Myopathy Unspecified Neurologic/Musculoskeletal Tethered Cord Neurologic/Musculoskeletal Reduction Deformity of Brain Neurologic/Musculoskeletal Congenital Hydrocephalus 20 Page ICD-9 Codes Revised January 2015

21 MEDICAL/BIOLOGICAL RISK CONDITION: Neurologic/Musculoskeletal (continued) Neurologic/Musculoskeletal Other Specified Congenital Anomalies of Brain Neurologic/Musculoskeletal Brachial Plexus Injury, Perinatal Origin (Erb's Palsy) Neurologic/Musculoskeletal Seizures (Convulsions), Isolated and Nonrecurrent Neurologic/Musculoskeletal Toxic Effects of Unspecified Lead Compound Neurologic/Musculoskeletal Shaken Baby Syndrome Neurologic/Musculoskeletal Unspecified Viral Meningitis 21 Page ICD-9 Codes Revised January 2015

22 MEDICAL/BIOLOGICAL RISK CONDITION: Perinatal Factors A diagnosed physical, mental, or neurobiological condition. The biological or medical risk condition shall be diagnosed by a health care provider and documentation shall be kept on file. Biological and medical risk conditions include the following: (NMAC Requirements for Family Infant Toddler Early Intervention Services.) *Questions Regarding conditions not on this list shall be directed to your FIT Manager who will work with a Department of Health Physician to determine whether a proposed condition will be recognized. Perinatal Factors Hyperbilirubinemia Perinatal Factors Triplets, unspecified Fetus or newborn affected by material conditions which may be unrelated to present Perinatal Factors pregnancy Perinatal Factors Noxious influences affecting fetus or newborn via placenta or breast milk, Unspecified Perinatal Factors Noxious influences affecting fetus or newborn via placenta or breast milk, Alcohol Perinatal Factors Noxious influences affecting fetus or newborn via placenta or breast milk, Narcotics Perinatal Factors Noxious influences affecting fetus or newborn via placenta or breast milk, Cocaine Perinatal Factors Fetal Hydantoin Syndrome Perinatal Factors Disorders Relating to Other Preterm Infant Less Than 500 Grams Perinatal Factors Disorders Relating to Other Preterm Infant Grams Perinatal Factors Disorders Relating to Other Preterm Infant Grams Perinatal Factors Disorders Relating to Other Preterm Infant Grams Perinatal Factors Disorders Relating to Other Preterm Infant Grams Perinatal Factors Disorders Relating to Other Preterm Infant 1500 Grams 22 Page ICD-9 Codes Revised January 2015

23 MEDICAL/BIOLOGICAL RISK CONDITION: Perinatal Factors (continued) Perinatal Factors Completed Weeks of Gestation Perinatal Factors Completed Weeks of Gestation Perinatal Factors Completed Weeks of Gestation Perinatal Factors Intrauterine hypoxia and birth asphyxia Perinatal Factors Birth asphyxia, unspecified Perinatal Factors Congenital cytomegalovirus infection Perinatal Factors Tetanus neonatorum Perinatal Factors Intraventricular hemorrhage unspecified grade Perinatal Factors Intraventricular hemorrhage grade I Perinatal Factors Intraventricular hemorrhage grade II Perinatal Factors Intraventricular hemorrhage grade III Perinatal Factors Intraventricular hemorrhage grade IV Perinatal Factors Subarachnoid hemorrhage of newborn Perinatal Factors Hypoglycemia, neonatal Perinatal Factors Unspecified hematological disorder specific to newborn Perinatal Factors Feeding problems in newborn Perinatal Factors Failure to thrive in newborn Perinatal Factors Drug reactions and intoxications specific to newborn Perinatal Factors Cardiac arrest of newborn Perinatal Factors Nonspecific Abnormal findings on neonatal screening 23 Page ICD-9 Codes Revised January 2015

24 MEDICAL/BIOLOGICAL RISK CONDITION: Physical Impairments A diagnosed physical, mental, or neurobiological condition. The biological or medical risk condition shall be diagnosed by a health care provider and documentation shall be kept on file. Biological and medical risk conditions include the following: (NMAC Requirements for Family Infant Toddler Early Intervention Services.) *Questions Regarding conditions not on this list shall be directed to your FIT Manager who will work with a Department of Health Physician to determine whether a proposed condition will be recognized. Physical Impairments Severe Arthritis Physical Impairments Torticollis Unspecified Physical Impairments Scoliosis Physical Impairments Cleft Palate Physical Impairments Cleft Lip Physical Impairments Cleft Palate with Cleft Lip Physical Impairments Arthrogryposis Physical Impairments Reduction Deformity of Limbs Physical Impairments Cleft Hand, Congenital Physical Impairments Limb Deformity Physical Impairments Craniosynostosis Physical Impairments Goldenhar's Syndrome (Oculoauriculovertebral Dysplasia) Physical Impairments Mandibulofacial Dysostosis (Franschetti-Klein Syndrome) Physical Impairments Diaphragmatic Hernia Physical Impairments Prune Belly Syndrome Physical Impairments Gastroschisis, Congenital Physical Impairments Poland's Syndrome (Pectoralis Muscle Deficiency-Syndactyly) 24 Page ICD-9 Codes Revised January 2015

25 MEDICAL/BIOLOGICAL RISK CONDITION: Sensory Abnormalities A diagnosed physical, mental, or neurobiological condition. The biological or medical risk condition shall be diagnosed by a health care provider and documentation shall be kept on file. Biological and medical risk conditions include the following: (NMAC Requirements for Family Infant Toddler Early Intervention Services.) *Questions Regarding conditions not on this list shall be directed to your FIT Manager who will work with a Department of Health Physician to determine whether a proposed condition will be recognized. Sensory Abnormalities Spasmus Nutans Sensory Abnormalities Hypermetropia Sensory Abnormalities Myopia Sensory Abnormalities Amblyopia Sensory Abnormalities Heterotopia Sensory Abnormalities Visual Disturbance Sensory Abnormalities Unspecified Visual Disturbance Sensory Abnormalities Delayed Visual Maturation (DVM)* (unspecified visual disturbance) Sensory Abnormalities Ptosis of eyelid Unspecified Sensory Abnormalities Esotropia Unspecified Sensory Abnormalities Exotropia Unspecified Sensory Abnormalities Duane s Syndrome Sensory Abnormalities Strabismus Sensory Abnormalities Unspecified Disorder of Eye Movement Sensory Abnormalities Chronic Serous Otitis Media Simple or Unspecified Sensory Abnormalities Conductive hearing loss, unspecified Sensory Abnormalities Unspecified congenital anomaly of ear 25 Page ICD-9 Codes Revised January 2015

26 ENVIRONMENTAL RISK FACTORS: Personal History Presenting Hazard to Health A presence of adverse family factors in the child s environment that increases the risk for developmental delay in children. Eligibility determination shall be made using the Environmental Risk Assessment (ERA) tool approved by the FIT program. (NMAC Requirements for Family Infant Toddler Early Intervention Services.) ICD-9 Condition Type Code Personal History Presenting Hazard to Health V15.41 Personal History Presenting Hazard to Health V15.42 Personal History Presenting Hazard to Health V15.49 Personal History Presenting Hazard to Health V15.86 Personal History Presenting Hazard to Health V15.89 Personal History Presenting Hazard to Health V15.9 Condition/Diagnosis History of physical abuse (e.g., sexual abuse or rape) History of emotional abuse (e.g., neglect) Psychological trauma Exposure to lead Other specified personal history presenting hazards to health Unspecified personal history presenting hazards to health ENVIRONMENTAL RISK FACTORS: Family History of Certain Chronic Disabling Diseases A presence of adverse family factors in the child s environment that increases the risk for developmental delay in children. Eligibility determination shall be made using the Environmental Risk Assessment (ERA) tool approved by the FIT program. (NMAC Requirements for Family Infant Toddler Early Intervention Services.) Family History of Certain Chronic Disabling Diseases V17.0 Psychiatric condition Family History of Certain Chronic Disabling Diseases V17.2 Other neurological diseases (e.g., Epilepsy, Huntington's chorea) Family History of Certain Chronic Disabling Diseases V17.89 Other musculoskeletal diseases 26 Page ICD-9 Codes Revised January 2015

27 ENVIRONMENTAL RISK FACTORS: Family History of Certain Other Specific Conditions A presence of adverse family factors in the child s environment that increases the risk for developmental delay in children. Eligibility determination shall be made using the Environmental Risk Assessment (ERA) tool approved by the FIT program. (NMAC Requirements for Family Infant Toddler Early Intervention Services.) Family History of Certain Other Specific Conditions V18.4 Family History of Intellectual Disabilities ENVIRONMENTAL RISK FACTORS: Family History of Other Conditions A presence of adverse family factors in the child s environment that increases the risk for developmental delay in children. Eligibility determination shall be made using the Environmental Risk Assessment (ERA) tool approved by the FIT program. (NMAC Requirements for Family Infant Toddler Early Intervention Services.) Family History of Other Conditions V19.0 Blindness or visual loss Family History of Other Conditions V19.2 Deafness or hearing loss Family History of Other Conditions V19.5 Congenital anomalies Family History of Other Conditions V19.8 Other condition ENVIRONMENTAL RISK FACTORS: Health Supervision of Infant or Child A presence of adverse family factors in the child s environment that increases the risk for developmental delay in children. Eligibility determination shall be made using the Environmental Risk Assessment (ERA) tool approved by the FIT program. (NMAC Requirements for Family Infant Toddler Early Intervention Services.) Condition Type ICD-9 Code Health Supervision of Infant or Child V20.1 Condition/Diagnosis Other healthy infant or child receiving care (e.g., supervision of healthy infant in cases of socioeconomic adverse condition at home) 27 Page ICD-9 Codes Revised January 2015

28 ENVIRONMENTAL RISK FACTORS: Housing, Household, and Economic Circumstances A presence of adverse family factors in the child s environment that increases the risk for developmental delay in children. Eligibility determination shall be made using the Environmental Risk Assessment (ERA) tool approved by the FIT program. (NMAC Requirements for Family Infant Toddler Early Intervention Services.) Condition Type ICD-9 Code Condition/Diagnosis Housing, Household, and Economic Circumstances V60.0 Lack of housing (e.g., Social migrants, Transients) Housing, Household, and Economic Circumstances V60.1 Inadequate housing (e.g., Lack of heating, Restriction of space) Housing, Household, and Economic Circumstances V60.2 Inadequate material resources (e.g., Economic problem, Poverty) Housing, Household, and Economic Circumstances V60.4 No other household member able to render care Housing, Household, and Economic Circumstances V60.89 Other specified housing or economic circumstances Housing, Household, and Economic Circumstances V60.9 Unspecified housing or economic circumstance ENVIRONMENTAL RISK FACTORS: Other Family Circumstances A presence of adverse family factors in the child s environment that increases the risk for developmental delay in children. Eligibility determination shall be made using the Environmental Risk Assessment (ERA) tool approved by the FIT program. (NMAC Requirements for Family Infant Toddler Early Intervention Services.) Condition Type ICD-9 Code Condition/Diagnosis Other Family Circumstances V61.10 Counseling for marital and partner problems, unspecified Other Family Circumstances V61.11 Counseling for victim of spousal and partner abuse Other Family Circumstances V61.12 Counseling for perpetrator of spousal and partner abuse Other Family Circumstances V61.20 Counseling for parent-child problem, unspecified Other Family Circumstances V61.21 Counseling for victim of child abuse Other Family Circumstances V61.29 Other (e.g., Problem concerning adopted or foster child) Other Family Circumstances V61.41 Alcoholism in family Other Family Circumstances V61.49 Other Health problems within family (e.g., Care of sick or handicapped person in family or household) Other Family Circumstances V61.8 Other specified family circumstances 28 Page ICD-9 Codes Revised January 2015

29 ENVIRONMENTAL RISK FACTORS: Other Psychosocial Circumstances A presence of adverse family factors in the child s environment that increases the risk for developmental delay in children. Eligibility determination shall be made using the Environmental Risk Assessment (ERA) tool approved by the FIT program. (NMAC Requirements for Family Infant Toddler Early Intervention Services.) ICD-9 Condition Type Code Other Psychosocial Circumstances V61.9 Other Psychosocial Circumstances V62.4 Other Psychosocial Circumstances V62.5 Other Psychosocial Circumstances V62.81 Other Psychosocial Circumstances V62.89 Other Psychosocial Circumstances V62.9 Condition/Diagnosis Unspecified family circumstance Social maladjustment (e.g., Cultural deprivation, Social isolation or persecution) Legal circumstances (e.g., Imprisonment) Interpersonal problems, not elsewhere classified Other psychological or physical stress, not elsewhere classified (e.g., Life circumstance problems) Unspecified psychosocial circumstance 29 Page ICD-9 Codes Revised January 2015