Medicare Code Editor. Definitions of Medicare Code Edits

Transcription

1 Medicare Code Editor Definitions of Medicare Code Edits v31.0 October 2013

2 PBL-011 October 2013

3 Table of Contents About this document... v Chapter 1: Edit code lists Invalid diagnosis or procedure code E-code as principal diagnosis Duplicate of PDX Age conflict... 8 Newborn diagnoses... 8 Pediatric diagnoses (age 0 through 17) Maternity diagnoses (age 12 through 55) Adult diagnoses (age 15 through 124) Sex conflict Diagnoses for females only Procedures for females only Diagnoses for males only Procedures for males only Manifestation code as principal diagnosis Manifestations not allowed as principal diagnosis Non-specific principal diagnosis Questionable admission Questionable admission - principal diagnosis only Unacceptable principal diagnosis Unacceptable principal diagnoses Non-specific O.R. procedure Non-covered procedure Non-covered procedures Open biopsy check Bilateral procedure Bilateral procedure codes Invalid age Invalid sex Invalid discharge status Limited coverage Limited coverage Wrong procedure performed Wrong procedure performed Procedure inconsistent with length of stay Procedure inconsistent with length of stay Chapter 2: Code list changes Changes to existing edits Page iii

4 Table of Contents Index Page iv

5 About this document The Medicare Code Editor (MCE) detects and reports errors in the coding claims data. This manual contains a description of each coding edit with corresponding ICD-9-CM code lists. The coding edit information in this manual is effective from 10/01/2013 to 09/30/2014. Page v

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7 Chapter 1: Edit code lists Following is a list of current edits described in this chapter. 1. Invalid diagnosis or procedure code 2. E-code as principal diagnosis 3. Duplicate of PDX 4. Age conflict 5. Sex conflict 6. Manifestation code as principal diagnosis 7. Non-specific principal diagnosis (Discontinued as of 10/01/07) 8. Questionable admission 9. Unacceptable principal diagnosis 10. Non-specific O.R. procedure (Discontinued as of 10/01/07) 11. Non-covered procedure 12. Open biopsy check (Discontinued as of 10/01/10) 13. Bilateral procedure 14. Invalid age 15. Invalid sex 16. Invalid discharge status 17. Limited coverage 18. Wrong procedure performed 19. Procedure inconsistent with length of stay 1. Invalid diagnosis or procedure code The Medicare Code Editor checks each diagnosis including the admitting diagnosis and each procedure against a table of valid ICD-9-CM codes. If an entered code does not agree with any code on the internal list, it is assumed to be invalid or that the 4th or 5th digit of the code is invalid or missing. 2. E-code as principal diagnosis For a list of all valid ICD-9-CM codes, see volumes 2 (diseases) and 3 (procedures) of the International Classification of Diseases, 9th Revision, Fourth Edition, Clinical Modification (ICD-9- CM). E-codes are ICD-9-CM codes beginning with the letter E. They describe the circumstance causing an injury, not the nature of the injury, and therefore should not be used as a principal diagnosis. For a list of all E-codes, see volume 2 (diseases) of the International Classification of Diseases, 9th Revision, Fourth Edition, Clinical Modification (ICD-9-CM). Page 7

8 3. Duplicate of PDX Whenever a secondary diagnosis is coded the same as the principal diagnosis, the secondary diagnosis is identified as a duplicate of the principal diagnosis. 4. Age conflict The Medicare Code Editor detects inconsistencies between a patient s age and any diagnosis on the patient s record. For example, a five-year-old patient with benign prostatic hypertrophy or a 78-year-old patient coded with a delivery. In the above cases, the diagnosis is clinically and virtually impossible in a patient of the stated age. Therefore, either the diagnosis or the age is presumed to be incorrect. There are four age categories for diagnoses in the program: Newborn. Age of 0 years; a subset of diagnoses intended only for newborns and neonates (e.g., fetal distress, perinatal jaundice). Pediatric. Age range is 0 17 years inclusive (e.g., Reye s syndrome, routine child health exam). Maternity. Age range is years inclusive (e.g., diabetes in pregnancy, antepartum pulmonary complication). Adult. Age range is years inclusive (e.g., senile delirium, mature cataract). The following pages contain lists of ICD-9-CM diagnosis codes with corresponding English descriptions for each of the age categories described above. Newborn diagnoses Cystic fibrosis w ileus Persistent fetal circ Mat anticonv aff NB/fet Mat antimetabol aff NB 7620 Placenta previa aff NB 7621 Placenta hem NEC aff NB 7622 Abn plac NEC/NOS aff NB 7623 Placent transfusion syn 7624 Prolapsed cord aff NB 7625 Oth umbil cord compress 7626 Umbil cond NEC aff NB 7627 Chorioamnionitis aff NB 7628 Abn amnion NEC aff NB 7629 Abn amnion NOS aff NB 7630 Breech del/extrac aff NB 7631 Malpos/dispro NEC aff NB 7632 Forceps delivery aff NB 7633 Vacuum extrac del aff NB 7634 Cesarean delivery aff NB Page 8

9 7635 Mat anesth/analg aff NB 7636 Precipitate del aff NB 7637 Abn uterine contr aff NB Ab ftl hrt rt/rh b/f lab Ab ftl hrt rt/rh dur lab Ab ftl hrt rt/rhy NOS Meconium dur del aff NB Compl del NEC aff NB 7639 Compl deliv NOS aff NB Light-for-dates wtnos Light-for-dates <500g Lt-for-dates g Lt-for-dates g Lt-for-dates g Lt-for-dates g Lt-for-dates g Lt-for-dates g Lt-for-dates g Lt-for-dates 2500+g Lt-for-date w/mal wtnos Lt-for-date w/mal <500g Lt-date w/mal g Lt-date w/mal g Lt-date w/mal g Lt-date w/mal g Lt-date w/mal g Lt-date w/mal g Lt-date w/mal g Lt-for-date w/mal 2500+g Fetal malnutrition wtnos Fetal malnutrition <500g Fetal malnutr g Fetal mal g Fetal mal g Fetal mal g Fetal mal g Fetal malnutr g Fetal malnutr g Fetal malnutr 2500+g Fet growth retard wtnos Fet growth retard <500g Fet growth ret g Fet growth ret g Fet grwth ret g Fet grwth ret g Fet grwth ret g Fet grwth ret g Fet grwth ret g Fet growth ret 2500+g Extreme immatur wtnos Extreme immatur <500g Extreme immatur g Extreme immatur g Extreme immat g Extreme immat g Extreme immat g Extreme immat g Extreme immat g Extreme immat 2500+g Page 9

10 76510 Preterm infant NEC wtnos Preterm NEC <500g Preterm NEC g Preterm NEC g Preterm NEC g Preterm NEC g Preterm NEC g Preterm NEC g Preterm NEC g Preterm NEC 2500+g Weeks of gestation NOS <24 comp wks gestation comp weeks gestation comp wks gestation comp wks gestation comp wks gestation comp wks gestation comp wks gestation comp wks gestation comp wks gestation 7660 Exceptionally large baby 7661 Heavy-for-date infan NEC Post-term infant Prolong gestation-infant 7670 Cerebral hem at birth Epicranial subapo hemorr Injuries to scalp NEC 7672 Clavicle fx at birth 7673 Bone injury NEC at birth 7674 Spinal cord inj at birth 7675 Facial nerve inj-birth 7676 Brach plexus inj-birth 7677 Nerve inj NEC at birth 7678 Birth trauma NEC 7679 Birth trauma NOS 7680 Fetal death-anoxia NOS 7681 Fet death-anoxia dur lab 7682 Fet distress befor labor 7683 Fetal distrs dur lab/del 7684 Fetal distress NOS 7685 Severe birth asphyxia 7686 Mild/mod birth asphyxia Hypoxc-ischem enceph NOS Mild hypox-ischem enceph Mod hypox-ischem enceph Sev hypox-ischem enceph 7689 Birth asphyxia NOS 769 Respiratory distress syn 7700 Congenital pneumonia Fetal & newborn asp NOS Meconium asp wo resp sym Meconium asp w resp symp Amniotc asp w/o resp sym Amniotic asp w resp sym Blood asp w/o resp sympt Blood asp w resp sympt NB asp w/o resp symp NEC NB asp w resp symp NEC 7702 NB interstit emphysema Page 10

11 7703 NB pulmonary hemorrhage 7704 Primary atelectasis 7705 NB atelectasis NEC/NOS 7706 NB transitory tachypnea Primary apnea of newborn Other apnea of newborn Cyanotic attack, newborn Resp failure of newborn Stomch cont asp w/o resp Stomach cont asp w resp NB respiratory arrest NB hypoxia Resp prob after brth NEC 7709 NB respiratory cond NOS 7710 Congenital rubella 7711 Cong cytomegalovirus inf 7712 Congenital infec NEC 7713 Tetanus neonatorum 7714 Omphalitis of newborn 7715 Neonatal infec mastitis 7716 Neonatal conjunctivitis 7717 Neonatal candida infect NB septicemia [sepsis] NB urinary tract infectn Bacteremia of newborn Perinatal infection NEC 7720 NB fetal blood loss NEC NB intraven hem NOS NB intraven hem,grade i NB intraven hem,grade ii NB intravn hem,grade iii NB intraven hem,grade iv 7722 NB subarachnoid hemorr 7723 Post-birth umbil hemorr 7724 NB GI hemorrhage 7725 NB adrenal hemorrhage 7726 NB cutaneous hemorrhage 7728 Neonatal hemorrhage NEC 7729 Neonatal hemorrhage NOS 7730 NB hemolyt dis:rh isoimm 7731 NB hemolyt dis-abo isoim 7732 NB hemolyt dis-isoim NEC 7733 Hydrops fetalis:isoimm 7734 NB kernicterus:isoimmun 7735 NB late anemia:isoimmun 7740 Perinat jaund-hered anem 7741 Perinat jaund:hemolysis 7742 Neonat jaund preterm del Delay conjugat jaund NOS Neonat jaund in oth dis Delay conjugat jaund NEC 7744 Fetal/neonatal hepatitis 7745 Perinatal jaundice NEC 7746 Fetal/neonatal jaund NOS 7747 NB kernicterus 7750 Infant diabet mother syn 7751 Neonat diabetes mellitus 7752 Neonat myasthenia gravis 7753 Neonatal thyrotoxicosis Page 11

12 7754 Hypocalcem/hypomagnes NB 7755 Neonatal dehydration 7756 Neonatal hypoglycemia 7757 Late metab acidosis NB NB acidosis NEC Neonat endo/met dis NEC 7759 Transient met dis NB NOS 7760 NB hemorrhagic disease 7761 Neonatal thrombocytopen 7762 Dissem intravasc coag NB 7763 Oth neonatal coag dis 7764 Polycythemia neonatorum 7765 Congenital anemia 7766 Anemia of prematurity 7767 Neonatal neutropenia 7768 Transient hemat dis NEC 7769 NB hematological dis NOS 7771 Meconium obstruction 7772 Intest obst-inspiss milk 7773 Swallowed blood syndrome 7774 Transitory ileus of NB Nec enterocoltis NB NOS Stg I nec enterocol NB Stg II nec enterocol NB Stg III nec enterocol NB 7776 Perinatal intest perfor 7778 Perinat GI sys dis NEC 7779 Perinat GI sys dis NOS 7780 Hydrops fetalis no isoim 7781 Sclerema neonatorum 7782 NB cold injury syndrome 7783 NB hypothermia NEC 7784 NB temp regulat dis NEC 7785 Edema of newborn NEC/NOS 7787 NB breast engorgement 7788 NB integument cond NEC 7789 NB integument cond NOS 7790 Convulsions in newborn 7791 NB cereb irrit NEC/NOS 7792 Cns dysfunction syn NB NB feeding problems NB bilious vomiting NB other vomiting NB failure to thrive 7794 NB drug reaction/intoxic 7795 NB drug withdrawal syndr 7796 Termination of pregnancy Neonatal bradycardia Neonatal tachycardia Delay separate umbl cord Meconium staining NB cardiac arrest Perinatal condition NEC 7799 Perinatal condition NOS Excess cry infant/baby 7966 Abnorm neonate screening V2031 Health supvsn nb <8 days V2032 Health supv nb 8-28 days V290 NB obsrv suspct infect Page 12

13 V291 V292 V293 V298 V299 V3000 V3001 V301 V3100 V3101 V311 V3200 V3201 V321 V3300 V3301 V331 V3400 V3401 V341 V3500 V3501 V351 V3600 V3601 V361 V3700 V3701 V371 V3900 V3901 V391 NB obsrv suspct neurlgcl Obsrv NB suspc resp cond NB obs genetc/metabl cnd NB obsrv oth suspct cond NB obsrv unsp suspct cnd Single lb in-hosp w/o cs Single lb in-hosp w cs Singl livebrn-before adm Twin-mate lb-hosp w/o cs Twin-mate lb-in hos w cs Twin, mate lb-before adm Twin-mate sb-hosp w/o cs Twin-mate sb-hosp w cs Twin, mate sb-before adm Twin-NOS-in hosp w/o cs Twin-NOS-in hosp w cs Twin NOS-before admissn Oth mult lb-hosp w/o cs Oth mult lb-in hosp w cs Oth mult nb-before adm Oth mult sb-hosp w/o cs Oth mult sb-in hosp w cs Oth mult sb-before adm Mult lb/sb-in hos w/o cs Mult lb/sb-in hosp w cs Mult nb/sb-before adm Mult brth NOS-hos w/o cs Mult birth NOS-hosp w cs Mult brth NOS-before adm Liveborn NOS-hosp w/o cs Liveborn NOS-hosp w cs Liveborn NOS-before adm Pediatric diagnoses (age 0 through 17) Infant botulism Roseola infantum NOS Roseola infant d/t HHV Roseola infant d/t HHV Sexual precocity NEC Emotional dis child NEC 3139 Emotional dis child NOS Reye's syndrome Seborrhea capitis Sbrheic infantl drmtitis Fussy infant/baby Failure to thrive-child Delayed milestones Ac idio pul hemrg infant 7897 Colic 7980 Sudden infant death synd Appar life threat-infant Child abuse NOS Child emotnl/psych abuse Child neglect-nutrition Child sexual abuse Child physical abuse Page 13

14 99555 Shaken infant syndrome Child abuse/neglect NEC V200 Foundling health care V201 Care of healthy chld NEC V202 Routin child health exam V695 Behav insomnia-childhood V8551 BMI,pediatric <5% V8552 BMI,pediatric 5% - <85% V8553 BMI,pediatric 85% - <95% V8554 BMI,pediatric >= 95% Maternity diagnoses (age 12 through 55) 630 Hydatidiform mole 6310 Inapp chg hcg early preg 6318 Oth abn prod conception 632 Missed abortion Abd preg w/o intrau preg Abd preg w intraut preg Tubal preg w/o intra prg Tubal preg w intra preg Ovarn preg w/o intra prg Ovarian preg w intra prg Ect preg NEC w/o int prg Ectpc prg NEC w int preg Ect preg NOS w/o int prg Ectp preg NOS w int preg Spon abor w pel inf-unsp Spon abor w pelv inf-inc Spon abor w pel inf-comp Spon abort w hemorr-unsp Spon abort w hemorr-inc Spon abort w hemorr-comp Spon ab w pel damag-unsp Spon ab w pelv damag-inc Spon ab w pel damag-comp Spon ab w ren fail-unsp Spon ab w ren fail-inc Spon ab w ren fail-comp Spon ab w metab dis-unsp Spon ab w metab dis-inc Spon ab w metab dis-comp Spon abort w shock-unsp Spon abort w shock-inc Spon abort w shock-comp Spon abort w embol-unsp Spon abort w embol-inc Spon abort w embol-comp Spon ab w compl NEC-unsp Spon ab w compl NEC-inc Spon ab w compl NEC-comp Spon ab w compl NOS-unsp Spon ab w compl NOS-inc Spon ab w compl NOS-comp Spon abort uncompl-unsp Spon abort uncompl-inc Spon abort uncompl-comp Page 14

15 63500 Leg abor w pelv inf-unsp Leg abor w pelv inf-inc Leg abor w pelv inf-comp Legal abor w hemorr-unsp Legal abort w hemorr-inc Legal abor w hemorr-comp Leg ab w pelv damag-unsp Leg ab w pelv damag-inc Leg ab w pelv damag-comp Leg abor w ren fail-unsp Leg abor w ren fail-inc Leg abor w ren fail-comp Leg ab w metab dis-unsp Leg ab w metab dis-inc Leg ab w metab dis-comp Legal abort w shock-unsp Legal abort w shock-inc Legal abort w shock-comp Legal abort w embol-unsp Legal abort w embol-inc Legal abort w embol-comp Leg ab w compl NEC-unsp Leg ab w compl NEC-inc Leg ab w compl NEC-comp Leg ab w compl NOS-unsp Leg ab w compl NOS-inc Leg ab w compl NOS-comp Legal abort uncompl-unsp Legal abort uncompl-inc Legal abort uncompl-comp Illeg ab w pelv inf-unsp Illeg ab w pelv inf-inc Illeg ab w pelv inf-comp Illeg ab w hemorr-unspec Illeg ab w hemorr-inc Illeg ab w hemorr-comp Illeg ab w pel damg-unsp Illeg ab w pel damag-inc Illeg ab w pel damg-comp Illeg ab w ren fail-unsp Illeg ab w ren fail-inc Illeg ab w ren fail-comp Illeg ab w met dis-unsp Illeg ab w metab dis-inc Illeg ab w met dis-comp Illeg abort w shock-unsp Illeg abort w shock-inc Illeg abort w shock-comp Illeg ab w embolism-unsp Illeg ab w embolism-inc Illeg ab w embolism-comp Illg ab w compl NEC-unsp Illeg ab w compl NEC-inc Illg ab w compl NEC-comp Illg ab w compl NOS-unsp Illeg ab w compl NOS-inc Illg ab w compl NOS-comp Illeg abort uncompl-unsp Illeg abort uncompl-inc Page 15

16 63692 Illeg abort uncompl-comp Abort NOS w pel inf-unsp Abort NOS w pel inf-inc Abort NOS w pel inf-comp Abort NOS w hemorr-unsp Abort NOS w hemorr-inc Abort NOS w hemorr-comp Ab NOS w pelv damag-unsp Ab NOS w pelv damag-inc Ab NOS w pelv damag-comp Ab NOS w renal fail-unsp Ab NOS w renal fail-inc Ab NOS w renal fail-comp Ab NOS w metab dis-unsp Ab NOS w metab dis-inc Ab NOS w metab dis-comp Abort NOS w shock-unsp Abort NOS w shock-inc Abort NOS w shock-comp Ab NOS w embolism-unsp Ab NOS w embolism-inc Ab NOS w embolism-comp Ab NOS w compl NEC-unsp Ab NOS w compl NEC-inc Ab NOS w compl NEC-comp Ab NOS w compl NOS-unsp Ab NOS w compl NOS-inc Ab NOS w compl NOS-comp Ab NOS uncomplicat-unsp Ab NOS uncomplicat-inc Ab NOS uncomplicat-comp 6380 Attem abort w pelvic inf 6381 Attem abort w hemorrhage 6382 Attem abort w pelv damag 6383 Attem abort w renal fail 6384 Attem abor w metabol dis 6385 Attem abortion w shock 6386 Attemp abort w embolism 6387 Attemp abort w compl NEC 6388 Attemp abort w compl NOS 6389 Attempted abort uncompl 6390 Postabortion gu infect 6391 Postabortion hemorrhage 6392 Postabort pelvic damage 6393 Postabort kidney failure 6394 Postabort metabolic dis 6395 Postabortion shock 6396 Postabortion embolism 6398 Postabortion compl NEC 6399 Postabortion compl NOS Threatened abort-unspec Threatened abort-deliver Threaten abort-antepart Hem early preg NEC-unsp Hem early preg NEC-deliv Hem early pg NEC-antepar Hemorr early preg-unspec Hem early preg-delivered Hem early preg-antepart Page 16

17 64100 Placenta previa-unspec Placenta previa-deliver Placenta previa-antepart Placenta prev hem-unspec Placenta prev hem-deliv Placen prev hem-antepart Prem separ placen-unspec Prem separ placen-deliv Prem separ plac-antepart Coag def hemorr-unspec Coag def hemorr-deliver Coag def hemorr-antepart Antepart hem NEC-unspec Antepartum hem NEC-deliv Antepart hem NEC-antepar Antepart hem NOS-unspec Antepartum hem NOS-deliv Antepart hem NOS-antepar Essen hyperten preg-unsp Essen hyperten-delivered Essen hyperten-del w p/p Essen hyperten-antepart Essen hyperten-postpart Renal hyperten preg-unsp Renal hyperten pg-deliv Renal hyperten-del p/p Renal hyperten-antepart Renal hyperten-postpart Old hyperten preg-unspec Old hyperten NEC-deliver Old hyperten-deliv w p/p Old hyperten NEC-antepar Old hyperten NEC-postpar Trans hyperten preg-unsp Trans hyperten-delivered Trans hyperten-del w p/p Trans hyperten-antepart Trans hyperten-postpart Mild/NOS preeclamp-unsp Mild/NOS preeclamp-deliv Mild preeclamp-del w p/p Mild/NOS preeclamp-antep Mild/NOS preeclamp-p/p Severe preeclamp-unspec Severe preeclamp-deliver Sev preeclamp-del w p/p Sev preeclamp-antepartum Sev preeclamp-postpartum Eclampsia-unspecified Eclampsia-delivered Eclampsia-deliv w p/p Eclampsia-antepartum Eclampsia-postpartum Tox w old hyperten-unsp Tox w old hyperten-deliv Tox w old hyp-del w p/p Tox w old hyper-antepart Tox w old hyper-postpart Hyperten preg NOS-unspec Page 17

18 64291 Hypertens NOS-delivered Hypertens NOS-del w p/p Hypertens NOS-antepartum Hypertens NOS-postpartum Mild hyperem grav-unspec Mild hyperem grav-deliv Mild hyperemesis-antepar Hyperem w metab dis-unsp Hyperem w metab dis-del Hyperem w metab-antepart Late vomit of preg-unsp Late vomit of preg-deliv Late vomit preg-antepart Vomit compl preg-unspec Vomit compl preg-deliver Vomit compl preg-antepar Vomit of preg NOS-unspec Vomit of preg NOS-deliv Vomit of pg NOS-antepart Threat prem labor-unspec Thrt prem labor-antepart Threat labor NEC-unspec Threat labor NEC-antepar Early onset deliv-unspec Early onset delivery-del Post term preg-unsp Post term preg-del Post term preg-antepar Prolonged preg-unsp Prolonged preg-del Prolonged preg-antepar Papyraceous fetus-unspec Papyraceous fetus-deliv Papyraceous fet-antepar Edema in preg-unspec Edema in preg-delivered Edema in preg-del w p/p Edema in preg-antepartum Edema in preg-postpartum Renal dis preg NOS-unsp Renal dis NOS-delivered Renal dis NOS-del w p/p Renal dis NOS-antepartum Renal dis NOS-postpartum Recur preg loss-unspec Recurnt preg loss-deliv Recurnt preg loss-antep Neuritis of preg-unspec Neuritis-delivered Neuritis-delivered w p/p Neuritis of preg-antepar Neuritis of preg-postpar Bacteriuria preg-unspec Asym bacteriuria-deliver Asy bacteruria-del w p/p Asy bacteriuria-antepart Asy bacteriuria-postpart Gu infect in preg-unspec Gu infection-delivered Page 18

19 64662 Gu infection-deliv w p/p Gu infection-antepartum Gu infection-postpartum Liver/bil trct disr-unsp Liver/bil trct disr-del Liver/bil trct disr-ante Preg compl NEC-unspec Preg compl NEC-delivered Preg compl NEC-del w p/p Preg compl NEC-antepart Preg compl NEC-postpart Preg compl NOS-unspec Preg compl NOS-delivered Preg compl NOS-antepart Syphilis in preg-unspec Syphilis-delivered Syphilis-delivered w p/p Syphilis-antepartum Syphilis-postpartum Gonorrhea in preg-unspec Gonorrhea-delivered Gonorrhea-deliver w p/p Gonorrhea-antepartum Gonorrhea-postpartum Other VD in preg-unspec Other vd-delivered Other vd-delivered w p/p Other vd-antepartum Other vd-postpartum TB in preg-unspecified Tuberculosis-delivered Tuberculosis-deliv w p/p Tuberculosis-antepartum Tuberculosis-postpartum Malaria in preg-unspec Malaria-delivered Malaria-delivered w p/p Malaria-antepartum Malaria-postpartum Rubella in preg-unspec Rubella-delivered Rubella-delivered w p/p Rubella-antepartum Rubella-postpartum Oth virus in preg-unspec Oth viral dis-delivered Oth viral dis-del w p/p Oth viral dis-antepartum Oth viral dis-postpartum Inf dis in preg NEC-unsp Infect dis NEC-delivered Infect dis NEC-del w p/p Infect dis NEC-antepart Infect dis NEC-postpart Infect in preg NOS-unsp Infect NOS-delivered Infect NOS-deliver w p/p Infect NOS-antepartum Infect NOS-postpartum Page 19

20 64800 Diabetes in preg-unspec Diabetes-delivered Diabetes-delivered w p/p Diabetes-antepartum Diabetes-postpartum Thyroid dysfun preg-unsp Thyroid dysfunc-deliver Thyroid dysfun-del w p/p Thyroid dysfunc-antepart Thyroid dysfunc-postpart Anemia in preg-unspec Anemia-delivered Anemia-delivered w p/p Anemia-antepartum Anemia-postpartum Drug depend preg-unspec Drug dependence-deliver Drug dependen-del w p/p Drug dependence-antepart Drug dependence-postpart Mental dis preg-unspec Mental disorder-deliver Mental dis-deliv w p/p Mental disorder-antepart Mental disorder-postpart Congen CV dis preg-unsp Congen CV dis-delivered Congen CV dis-del w p/p Congen CV dis-antepartum Congen CV dis-postpartum CV dis NEC preg-unspec CV dis NEC preg-deliver CV dis NEC-deliver w p/p CV dis NEC-antepartum CV dis NEC-postpartum Bone disord in preg-unsp Bone disorder-delivered Bone disorder-del w p/p Bone disorder-antepartum Bone disorder-postpartum Abn glucose in preg-unsp Abn glucose toler-deliv Abn glucose-deliv w p/p Abn glucose-antepartum Abn glucose-postpartum Oth curr cond preg-unsp Oth curr cond-delivered Oth curr cond-del w p/p Oth curr cond-antepartum Oth curr cond-postpartum Tobacco use disord-unsp Tobacco use disor-delliv Tobacco use dis-del-p/p Tobacco use dis-antepart Tobacco use dis-postpart Obesity-unspecified Obesity-delivered Obesity-delivered w p/p Obesity-antepartum Page 20

21 64914 Obesity-postpartum Bariatric surg stat-unsp Bariatric surg stat-del Bariatric surg-del w p/p Bariatrc surg stat-antep Bariatrc surg stat w p/p Coagulation def-unspec Coagulation def-deliv Coagulatn def-del w p/p Coagulation def-antepart Coagulation def-postpart Epilepsy-unspecified Epilepsy-delivered Epilepsy-delivered w p/p Epilepsy-antepartum Epilepsy-postpartum Spotting-unspecified Spotting-delivered Spotting-antepartum Uterine size descrp-unsp Uterine size descrep-del Uterine size-del w p/p Uterine size des-antepar Uterine size descrep-p/p Cervical shortening-unsp Cervical shortening-del Cervical shortening-ante Spon labr w plan C/S-del Lbr w plan C/S-del w p/p 650 Normal delivery Twin pregnancy-unspec Twin pregnancy-delivered Twin pregnancy-antepart Triplet pregnancy-unspec Triplet pregnancy-deliv Triplet preg-antepartum Quadruplet preg-unspec Quadruplet preg-deliver Quadruplet preg-antepart Twins w fetal loss-unsp Twins w fetal loss-del Twins w fetal loss-ante Triplets w fet loss-unsp Triplets w fet loss-del Triplets w fet loss-ante Quads w fetal loss-unsp Quads w fetal loss-del Quads w fetal loss-ante Mult ges w fet loss-unsp Mult ges w fet loss-del Mult ges w fet loss-ante Mul gest-fet reduct unsp Mult gest-fet reduct del Mul gest-fet reduct ante Multi gestat NEC-unspec Multi gestat NEC-deliver Multi gest NEC-antepart Multi gestat NOS-unspec Mult gestation NOS-deliv Page 21

22 65193 Multi gest NOS-antepart Unstable lie-unspecified Unstable lie-delivered Unstable lie-antepartum Cephalic vers NOS-unspec Cephalic vers NOS-deliv Cephal vers NOS-antepart Breech presentat-unspec Breech presentat-deliver Breech present-antepart Transv/obliq lie-unspec Transver/obliq lie-deliv Transv/obliq lie-antepar Face/brow present-unspec Face/brow present-deliv Face/brow pres-antepart High head at term-unspec High head at term-deliv High head term-antepart Mult gest malpresen-unsp Mult gest malpres-deliv Mult ges malpres-antepar Prolapsed arm-unspec Prolapsed arm-delivered Prolapsed arm-antepart Malposition NEC-unspec Malposition NEC-deliver Malposition NEC-antepart Malposition NOS-unspec Malposition NOS-deliver Malposition NOS-antepart Pelvic deform NOS-unspec Pelvic deform NOS-deliv Pelv deform NOS-antepart Contract pelv NOS-unspec Contract pelv NOS-deliv Contrac pelv NOS-antepar Inlet contraction-unspec Inlet contraction-deliv Inlet contract-antepart Outlet contraction-unsp Outlet contraction-deliv Outlet contract-antepart Fetopelv disprop-unspec Fetopelv dispropor-deliv Fetopel disprop-antepart Fetal disprop NOS-unspec Fetal disprop NOS-deliv Fetal dispro NOS-antepar Hydrocephal fetus-unspec Hydroceph fetus-deliver Hydroceph fetus-antepart Oth abn fet disprop-unsp Oth abn fet dispro-deliv Oth abn fet dispro-antep Disproportion NEC-unspec Disproportion NEC-deliv Dispropor NEC-antepartum Disproportion NOS-unspec Page 22

23 65391 Disproportion NOS-deliv Dispropor NOS-antepartum Cong abn uter preg-unsp Congen abn uterus-deliv Cong abn uter-del w p/p Congen abn uter-antepart Congen abn uter-postpart Uter tumor in preg-unsp Uterine tumor-delivered Uterine tumor-del w p/p Uterine tumor-antepartum Uterine tumor-postpartum Prev c-delivery unspec Prev c-delivery-delivrd Prev c-delivery-antepart Retrovert uterus-unspec Retrovert uterus-deliver Retrovert uter-del w p/p Retrovert uter-antepart Retrovert uter-postpart Abn grav uterus NEC-unsp Abn uterus NEC-delivered Abn uterus NEC-del w p/p Abn uterus NEC-antepart Abn uterus NEC-postpart Cerv incompet preg-unsp Cervical incompet-deliv Cerv incompet-del w p/p Cerv incompet-antepartum Cerv incompet-postpartum Abn cervix NEC preg-unsp Abn cervix NEC-delivered Abn cervix NEC-del w p/p Abn cervix NEC-antepart Abn cervix NEC-postpart Abn vagina in preg-unsp Abnorm vagina-delivered Abnorm vagina-del w p/p Abnorm vagina-antepartum Abnorm vagina-postpartum Abn vulva in preg-unspec Abnormal vulva-delivered Abnormal vulva-del w p/p Abnormal vulva-antepart Abnormal vulva-postpart Abn pel NEC in preg-unsp Abn pelv org NEC-deliver Abn pelv NEC-deliv w p/p Abn pelv org NEC-antepar Abn pelv org NEC-postpar Fetal cns malform-unspec Fetal cns malform-deliv Fetal cns malfor-antepar Fetal chromos abn-unspec Fetal chromoso abn-deliv Fet chromo abn-antepart Famil heredit dis-unspec Famil heredit dis-deliv Famil hered dis-antepart Page 23

24 65530 Fet damg d/t virus-unsp Fet damg d/t virus-deliv Fet damg d/t virus-antep Fet damg d/t dis-unspec Fet damg d/t dis-deliver Fet damg d/t dis-antepar Fetal damg d/t drug-unsp Fet damag d/t drug-deliv Fet damg d/t drug-antepa Radiat fetal damag-unsp Radiat fetal damag-deliv Radiat fet damag-antepar Decrease fetl movmt unsp Decrease fetal movmt del Dec fetal movmt antepart Fetal abnorm NEC-unspec Fetal abnorm NEC-deliver Fetal abnorm NEC-antepar Fetal abnorm NOS-unspec Fetal abnorm NOS-deliver Fetal abnorm NOS-antepar Fetal-maternal hem-unsp Fetal-maternal hem-deliv Fetal-matern hem-antepar Rh isoimmunization-unsp Rh isoimmunizat-deliver Rh isoimmunizat-antepart Abo isoimmunization-unsp Abo isoimmunizat-deliver Abo isoimmunizat-antepar Fetal distress-unspec Fetal distress-delivered Fetal distress-antepart Intrauterine death-unsp Intrauter death-deliver Intrauter death-antepart Poor fetal growth-unspec Poor fetal growth-deliv Poor fetal grth-antepart Excess fetal grth-unspec Excess fetal grth-deliv Excess fet grth-antepart Oth placent cond-unspec Oth placent cond-deliver Oth placent cond-antepar Fet/plac prob NEC-unspec Fet/plac prob NEC-deliv Fet/plac prob NEC-antepa Fet/plac prob NOS-unspec Fet/plac prob NOS-deliv Fet/plac prob NOS-antepa Polyhydramnios-unspec Polyhydramnios-delivered Polyhydramnios-antepart Oligohydramnios-unspec Oligohydramnios-deliver Oligohydramnios-antepar Prem rupt membran-unspec Prem rupt membran-deliv Page 24

25 65813 Prem rupt memb-antepart Prolong rupt memb-unspec Prolong rupt memb-deliv Prolong rup memb-antepar Artific rupt membr-unsp Artific rupt membr-deliv Artif rupt memb-antepart Amniotic infection-unsp Amniotic infection-deliv Amniotic infect-antepart Amniotic prob NEC-unspec Amniotic prob NEC-deliv Amnion prob NEC-antepart Amniotic prob NOS-unspec Amniotic prob NOS-deliv Amnion prob NOS-antepart Fail mechan induct-unsp Fail mech induct-deliver Fail mech induct-antepar Fail induction NOS-unsp Fail induction NOS-deliv Fail induct NOS-antepart Pyrexia in labor-unspec Pyrexia in labor-deliver Pyrexia in labor-antepar Septicemia in labor-unsp Septicem in labor-deliv Septicem in labor-antepa Grand multiparity-unspec Grand multiparity-deliv Grand multiparity-antepa Elderly primigravid-unsp Elderly primigravida-del Elder primigravid-antepa Elderly multigravida-uns Elderly multigravida-del Elderly multigravd-antep Abn ftl hrt rate/rhy-uns Abn ftl hrt rate/rhy-del Abn ftl hrt rate/rhy-ant Complic labor NEC-unsp Complic labor NEC-deliv Compl labor NEC-antepart Complic labor NOS-unsp Complic labor NOS-deliv Compl labor NOS-antepart Obstruct/fet malpos-unsp Obstruc/fet malpos-deliv Obstruc/fet malpos-antep Bony pelv obstruc-unspec Bony pelv obstruct-deliv Bony pelv obstruc-antepa Abn pelv tiss obstr-unsp Abn pelv tis obstr-deliv Abn pelv tis obstr-antep Persist occipitpost-unsp Persist occiptpost-deliv Persist occiptpost-antep Shoulder dystocia-unspec Page 25

26 66041 Shoulder dystocia-deliv Shoulder dystocia-antepa Locked twins-unspecified Locked twins-delivered Locked twins-antepartum Fail trial lab NOS-unsp Fail trial lab NOS-deliv Fail trial lab NOS-antep Failed forcep NOS-unspec Failed forceps NOS-deliv Fail forceps NOS-antepar Obstruc labor NEC-unspec Obstruct labor NEC-deliv Obstruc labor NEC-antepa Obstruc labor NOS-unspec Obstruct labor NOS-deliv Obstruc labor NOS-antepa Prim uterine inert-unsp Prim uterine inert-deliv Prim uter inert-antepart Sec uterine inert-unspec Sec uterine inert-deliv Sec uterine inert-antepa Uterine inertia NEC-unsp Uterine inert NEC-deliv Uterine inert NEC-antepa Precipitate labor-unspec Precipitate labor-deliv Precipitate labor-antepa Uter dystocia NOS-unspec Uter dystocia NOS-deliv Uter dystocia NOS-antepa Abnormal labor NOS-unsp Abnormal labor NOS-deliv Abnorm labor NOS-antepar Prolonged 1st stage-unsp Prolong 1st stage-deliv Prolong 1st stage-antepa Prolonged labor NOS-unsp Prolong labor NOS-deliv Prolong labor NOS-antepa Prolonged 2nd stage-unsp Prolong 2nd stage-deliv Prolong 2nd stage-antepa Delay del 2nd twin-unsp Delay del 2nd twin-deliv Delay del 2 twin-antepar Cord prolapse-unspec Cord prolapse-delivered Cord prolapse-antepartum Cord around neck-unspec Cord around neck-deliver Cord around neck-antepar Cord compress NEC-unspec Cord compress NEC-deliv Cord compres NEC-antepar Cord entangle NEC-unspec Cord entangle NEC-deliv Cord entangl NEC-antepar Page 26

27 66340 Short cord-unspecified Short cord-delivered Short cord-antepartum Vasa previa-unspecified Vasa previa-delivered Vasa previa-antepartum Vasc lesion cord-unspec Vasc lesion cord-deliver Vasc lesion cord-antepar Cord complicat NEC-unsp Cord complicat NEC-deliv Cord compl NEC-antepart Cord complicat NOS-unsp Cord complicat NOS-deliv Cord compl NOS-antepart Del w 1 deg lacerat-unsp Del w 1 deg lacerat-del Del w 1 deg lac-postpart Del w 2 deg lacerat-unsp Del w 2 deg lacerat-del Del w 2 deg lac-postpart Del w 3 deg lacerat-unsp Del w 3 deg lacerat-del Del w 3 deg lac-postpart Del w 4 deg lacerat-unsp Del w 4 deg lacerat-del Del w 4 deg lac-postpart Ob perineal lac NOS-unsp Ob perineal lac NOS-del Perineal lac NOS-postpar Ob perineal hematom-unsp Ob perineal hematoma-del Perin hematoma-postpart Anal sphincter tear NOS Anal sphincter tear-del Anal sphinctr tear w p/p Ob perin traum NEC-unsp Ob perineal trau NEC-del Perin traum NEC-postpart Ob perin traum NOS-unsp Ob perineal trau NOS-del Perin traum NOS-postpart Prelabor rupt uter-unsp Prelabor rupt uterus-del Prelab rupt uter-antepar Rupture uterus NOS-unsp Rupture uterus NOS-deliv Inversion of uterus-unsp Invers uterus-del w p/p Invers uterus-postpart Lacerat of cervix-unspec Lacerat of cervix-deliv Lacer of cervix-postpart High vaginal lacer-unsp High vaginal lacer-deliv High vaginal lac-postpar Ob inj pelv org NEC-unsp Ob inj pelv org NEC-del Inj pelv org NEC-postpar Page 27

28 66560 Damage to pelvic jt-unsp Damage to pelvic jt-del Damage pelvic jt-postpar Ob pelvic hematoma-unsp Ob pelvic hematoma-deliv Pelvic hematom-del w pp Pelvic hematoma-postpart Ob trauma NEC-unspec Ob trauma NEC-delivered Ob trauma NEC-del w p/p Ob trauma NEC-antepartum Ob trauma NEC-postpartum Ob trauma NOS-unspec Ob trauma NOS-delivered Ob trauma NOS-del w p/p Ob trauma NOS-antepartum Ob trauma NOS-postpartum Third-stage hem-unspec Thrd-stage hem-del w p/p Third-stage hem-postpart Postpartum hem NEC-unsp Postpa hem NEC-del w p/p Postpart hem NEC-postpar Delay p/part hem-unspec Delay p/p hem-del w p/p Delay p/part hem-postpar Postpart coagul def-unsp P/p coag def-del w p/p Postpart coag def-postpa Retain placenta NOS-unsp Retnd plac NOS-del w p/p Retain plac NOS-postpart Retain prod concept-unsp Ret prod conc-del w p/p Ret prod concept-postpar Pulm compl in del-unspec Pulm compl in del-deliv Pulm complic-del w p/p Pulm complicat-antepart Pulm complicat-postpart Heart compl in del-unsp Heart compl in del-deliv Heart compl-del w p/p Heart complic-antepart Heart complic-postpart Cns compl labor/del-unsp Cns compl lab/del-deliv Cns complic-del w p/p Cns compl in del-antepar Cns compl in del-postpar Anesth comp del NEC-unsp Anesth compl NEC-deliver Anesth compl NEC-del p/p Anesth compl antepartum Anesth compl-postpartum Anesth comp del NOS-unsp Anesth compl NOS-deliver Anesth compl NOS-del p/p Anesth compl-antepartum Page 28

29 66894 Anesth compl-postpartum Maternal distress-unspec Maternal distress-deliv Matern distres-del w p/p Matern distress-antepar Matern distress-postpart Obstetric shock-unspec Obstetric shock-deliver Obstet shock-deliv w p/p Obstetric shock-antepar Obstetric shock-postpart Matern hypotens syn-unsp Matern hypoten syn-deliv Matern hypoten-del w p/p Matern hypotens-antepar Matern hypotens-postpart Ac kidny fail w del-unsp Ac kidney fail-del w p/p Ac kidney fail-postpart Oth ob surg compl-unspec Oth ob compl-delivered Oth ob compl-deliv w p/p Complc ob surg anteprtm Oth ob surg compl-postpa Forcep deliv NOS-unspec Forcep deliv NOS-deliver Breech extr NOS-unspec Breech extr NOS-deliver Cesarean deliv NOS-unsp Cesarean delivery NOS Compl lab/deliv NEC-unsp Comp lab/deliv NEC-deliv Compl del NEC-del w p/p Compl deliv NEC-antepar Compl deliv NEC-postpart Compl lab/deliv NOS-unsp Comp lab/deliv NOS-deliv Compl del NOS-del w p/p Compl deliv NOS-antepar Compl deliv NOS-postpart Maj puerp inf NOS-unsp Maj puer inf NOS-del p/p Major puerp inf NOS-p/p Puerp endometritis-unsp Puerp endomet del w p/p Puerp endomet-postpart Puerperal sepsis-unsp Puerprl sepsis-del w p/p Puerperl sepsis-postpart Puerp septc thromb-unsp Prp sptc thrmb-del w p/p Prp septc thrmb-postpart Maj prp infec NEC-unspec Maj prp inf NEC-dl w p/p Maj puerp infec NEC-p/p Varic vein leg preg-unsp Varicose vein leg-deliv Varic vein leg-del w p/p Varic vein leg-antepart Page 29

30 67104 Varic vein leg-postpart Varic vulva preg-unspec Varicose vulva-delivered Varicose vulva-del w p/p Varicose vulva-antepart Varicose vulva-postpart Thrombophleb preg-unspec Thrombophlebitis-deliver Thrombophleb-deliv w p/p Thrombophlebit-antepart Thrombophlebit-postpart Deep thromb antepar-unsp Deep throm antepar-deliv Deep vein thromb-antepar Deep thromb postpar-unsp Thromb postpar-del w p/p Deep vein thromb-postpar Thrombosis NEC preg-unsp Thrombosis NEC-delivered Thromb NEC-deliv w p/p Thrombosis NEC-antepart Thrombosis NEC-postpart Ven compl preg NEC-unsp Venous compl NEC-deliver Ven comp NEC-deliv w p/p Venous compl NEC-antepar Venous compl NEC-postpar Ven compl preg NOS-unsp Venous compl NOS-deliver Ven comp NOS-deliv w p/p Venous compl NOS-antepar Venous compl NOS-postpar Puerperal pyrexia-unspec Puerp pyrexia-del w p/p Puerp pyrexia-postpartum Ob air embolism-unspec Ob air embolism-deliver Ob air embol-deliv w p/p Ob air embolism-antepart Ob air embolism-postpart Amniotic embolism-unspec Amniotic embolism-deliv Amniot embol-deliv w p/p Amniotic embol-antepart Amniotic embol-postpart Ob pulm embol NOS-unspec Pulm embol NOS-delivered Pulm embol NOS-del w p/p Pulm embol NOS-antepart Pulm embol NOS-postpart Ob pyemic embol-unspec Ob pyemic embol-deliver Ob pyem embol-del w p/p Ob pyemic embol-antepart Ob pyemic embol-postpart Ob pulmon embol NEC-unsp Pulmon embol NEC-deliver Pulm embol NEC-del w p/p Pulmon embol NEC-antepar Page 30

31 67384 Pulmon embol NEC-postpar Puerp cerebvasc dis-unsp Puerp cerebvas dis-deliv Cerebvas dis-deliv w p/p Cerebrovasc dis-antepart Cerebrovasc dis-postpart Disrupt c-sect wnd-unsp Disrupt c-sect-del w p/p Disrupt c-sect-postpart Disrupt perineum-unspec Disrupt perin-del w p/p Disrupt perineum-postpar Ob surg compl NEC-unspec Ob surg compl-del w p/p Ob surg comp NEC-postpar Placental polyp-unspec Placent polyp-del w p/p Placental polyp-postpart Peripart cardiomy-unspec Peripartum cardiomy-del Peripart card del w p/p Peripartum card-antepart Peripartum card-postpart Puerp compl NEC-unspec Puerp comp NEC-del w p/p Puerp compl NEC-postpart Puerp compl NOS-unspec Puerp comp NOS-del w p/p Puerp compl NOS-postpart Infect nipple preg-unsp Infect nipple-delivered Infect nipple-del w p/p Infect nipple-antepartum Infect nipple-postpartum Breast abscess preg-unsp Breast abscess-delivered Breast abscess-del w p/p Breast abscess-antepart Breast abscess-postpart Mastitis in preg-unspec Mastitis-delivered Mastitis-deliv w p/p Mastitis-antepartum Mastitis-postpartum Breast inf preg NEC-unsp Breast infect NEC-deliv Breast inf NEC-del w p/p Breast inf NEC-antepart Breast inf NEC-postpart Breast inf preg NOS-unsp Breast infect NOS-deliv Breast inf NOS-del w p/p Breast inf NOS-antepart Breast inf NOS-postpart Retract nipple preg-unsp Retracted nipple-deliver Retract nipple-del w p/p Retract nipple-antepart Retract nipple-postpart Page 31

32 67610 Cracked nipple preg-unsp Cracked nipple-delivered Cracked nipple-del w p/p Cracked nipple-antepart Cracked nipple-postpart Breast engorge-unspec Breast engorge-delivered Breast engorge-del w p/p Breast engorge-antepart Breast engorge-postpart Breast dis preg NEC-unsp Breast dis NEC-delivered Breast dis NEC-del w p/p Breast dis NEC-antepart Breast dis NEC-postpart Lactation fail-unspec Lactation fail-delivered Lactation fail-del w p/p Lactation fail-antepart Lactation fail-postpart Suppr lactation-unspec Suppr lactation-deliver Suppr lactat-del w p/p Suppr lactation-antepar Suppr lactation-postpart Galactorrhea preg-unspec Galactorrhea-delivered Galactorrhea-del w p/p Galactorrhea-antepartum Galactorrhea-postpartum Lactation dis NEC-unspec Lactation dis NEC-deliv Lactat dis NEC-del w p/p Lactat dis NEC-antepart Lactat dis NEC-postpart Lactation dis NOS-unspec Lactation dis NOS-deliv Lactat dis NOS-del w p/p Lactat dis NOS-antepart Lactat dis NOS-postpart Fetal hematologic-unspec Fetal hematologic-deliv Fetal hematologic-ante Fetal conjoin twins-unsp Fetal conjoin twins-del Fetal conjoin twins-ante Mat comp in utero-unsp Mat comp in utero-del Mat comp in utro-del-p/p Mat comp in utero-ante Mat comp in utero-p/p Fetal comp in utero-unsp Fetal comp in utero-del Ftl cmp in utro-del-p/p Fetal comp in utero-ante Fetal comp in utero-p/p 7923 Abn find-amniotic fluid 7965 Abn find antenatl screen V230 Preg w hx of infertility Page 32

33 V231 V232 V233 V2341 V2342 V2349 V235 V237 V2381 V2382 V2383 V2384 V2385 V2386 V2387 V2389 V239 V240 V270 V271 V272 V273 V274 V275 V276 V277 V279 V280 V281 V282 V286 V2881 V2882 V2889 V616 V617 V7242 V8901 V8902 V8903 V8904 V8905 V8909 V9100 V9101 V9102 V9103 V9109 V9110 V9111 V9112 V9119 V9120 V9121 V9122 V9129 V9190 V9191 V9192 Preg w hx-trophoblas dis Preg w hx of abortion Grand multiparity Preg w hx pre-term labor Preg w hx ectopic preg Preg w poor obs hx NEC Preg w poor reproduct hx Insufficnt prenatal care Suprv elderly primigrav Suprv elderly multigrav Suprv young primigravida Suprv young multigravida Pregnt-assist repro tech Preg-hx in utro prev prg Preg w incon fetl viabil Suprv high-risk preg NEC Suprv high-risk preg NOS Postpart care after del Deliver-single liveborn Deliver-single stillborn Deliver-twins, both live Del-twins, 1 nb, 1 sb Deliver-twins, both sb Del-mult birth, all live Del-mult brth, some live Del-mult birth, all sb Outcome of delivery NOS Screening-chromosom anom Screen-alphafetoprotein Screen by amniocent NEC Antenatal screen strep b Scrn fetal anatmc survey Scrn risk preterm labor Antenatal screening NEC Illegitimate pregnancy Unwanted pregnancy NEC Pregnancy test-positive Sus amntc cav/mem nt fnd Sus placentl prob nt fnd Sus fetal anomaly nt fnd Sus fetal growth not fnd Sus cervcl shortn nt fnd Oth sus mat/ftl nt fnd Twin gest-plac/sac NOS Twin gest-monochr/monoam Twin gest-monochr/diamni Twin gest-dich/diamniotc Twin gest-plac/sac undet Tripl gest-plac/sac NOS Triplet gest 2+ monochor Triplet gest 2+ monoamn Tripl gest-plac/sac und Quad gest-plac/sac NOS Quad gest 2+ monochorion Quad gest 2+ monoamniotc Quad gest-plac/sac undet Mult gest-plac/sac NOS Mult gest 2+ monochr NEC Mult gest 2+ monoamn NEC Page 33

34 V9199 Mult gest-plac/sac undet Adult diagnoses (age 15 through 124) Premature menopause 2900 Senile dementia uncomp Presenile dementia Presenile delirium Presenile delusion Presenile depression Senile delusion Senile depressive 2903 Senile delirium Vascular dementia,uncomp Vasc dementia w delirium Vasc dementia w delusion Vasc dementia w depressn 2909 Senile psychot cond NOS Amyotrophic sclerosis Senile cataract NOS Pseudoexfol lens capsule Incipient cataract Ant subcaps senile catar Post subcap senile catar Cortical senile cataract Senile nuclear cataract Mature cataract Hypermature cataract Senile cataract NEC Senile entropion Senile ectropion Vitreomacular adhesion Cor ath unsp vsl ntv/gft Crnry athrscl natve vssl Crn ath atlg vn bps grft Crn ath nonatlg blg grft Cor ath artry bypas grft Cor ath bypass graft NOS Cor ath bps graft tp hrt 4143 Cor ath d/t lpd rch plaq Acq cardiac septl defect Other sequelae of MI NEC 4370 Cerebral atherosclerosis 4400 Aortic atherosclerosis 4401 Renal artery atheroscler Athscl extrm ntv art NOS Ath ext ntv at w claudct Ath ext ntv at w rst pn Ath ext ntv art ulcrtion Athrsc extrm ntv art oth Athscl extrm bps gft NOS Ath ext autologs bps gft Ath ext nonautlg bps gft 4408 Atherosclerosis NEC 4409 Atherosclerosis NOS 4540 Leg varicosity w ulcer 4541 Leg varicosity w inflam Page 34

35 4542 Varicos leg ulcer/inflam 4549 Asympt varicose veins 4570 Postmastect lymphedema 500 Coal workers' pneumocon 501 Asbestosis 5165 Adlt pul Langs cell hist 5710 Alcoholic fatty liver 5711 Ac alcoholic hepatitis 5712 Alcohol cirrhosis liver 5713 Alcohol liver damage NOS BPH w/o urinary obs/luts BPH w urinary obs/luts Nod prostate w/o ur obst Nod prostate w ur obst BPH loc w/o ur obs/luts BPH loc w urin obs/luts 6003 Cyst of prostate BPH NOS w/o ur obs/luts BPH NOS w ur obs/luts 6010 Acute prostatitis 6011 Chronic prostatitis 6012 Abscess of prostate 6013 Prostatocystitis 6014 Prostatitis in oth dis 6018 Prostatic inflam dis NEC 6019 Prostatitis NOS 6020 Calculus of prostate 6021 Prostatic congest/hemorr 6022 Atrophy of prostate 6028 Prostatic disorders NEC 6029 Prostatic disorder NOS 6060 Azoospermia 6061 Oligospermia 6068 Male infertility NEC 6069 Male infertility NOS Impotence, organic orign 6101 Diffus cystic mastopathy Ptosis of breast Hypoplasia of breast Capslr contrctr brst imp 6120 Deformity reconst breast 6121 Disproportn reconst brst 7286 Contracted palmar fascia 7837 Failure to thrive-adult Elvtd prstate spcf antgn Decreased libido Adult maltreatment NOS Adult physical abuse Adult emotnl/psych abuse Adult sexual abuse Adult neglect-nutrition Oth adult abuse/neglect V114 Hx combat/stress reactn V2385 Pregnt-assist repro tech V4981 Asympt postmeno status V510 Brst reconst fol mastect V6221 Hx military deployment V6222 Hx retrn military deploy V6229 Occupationl circumst NEC Page 35

36 V7101 V850 V851 V8521 V8522 V8523 V8524 V8525 V8530 V8531 V8532 V8533 V8534 V8535 V8536 V8537 V8538 V8539 V8541 V8542 V8543 V8544 V8545 Obsv-adult antisoc behav BMI less than 19,adult BMI between 19-24,adult BMI ,adult BMI ,adult BMI ,adult BMI ,adult BMI ,adult BMI ,adult BMI ,adult BMI ,adult BMI ,adult BMI ,adult BMI ,adult BMI ,adult BMI ,adult BMI ,adult BMI ,adult BMI , adult BMI , adult BMI , adult BMI , adult BMI 70 and over, adult 5. Sex conflict Medicare Code Editor detects inconsistencies between a patient s sex and any diagnosis or procedure on the patient s record. For example, a male patient with cervical cancer (diagnosis) or a female patient with a prostatectomy (procedure). In both instances, the indicated diagnosis or the procedure conflicts with the stated sex of the patient. Therefore, either the patient s diagnosis, procedure or sex is presumed to be incorrect. The following pages contain lists of male and female related ICD-9-CM diagnosis and procedure codes with corresponding English descriptions. Diagnoses for females only TB ovary & tube-unspec TB ovary & tube-no exam TB ovary/tube-exam unkn TB ovary & tube-micro dx TB ovary & tube-cult dx TB ovary & tube-histo dx TB ovary & tube-oth test TB female gen NEC-unspec TB fem gen NEC-no exam TB fem gen NEC-exam unkn TB fem gen NEC-micro dx TB fem gen NEC-cult dx TB fem gen NEC-histo dx TB fem gen NEC-oth test Page 36

37 05411 Herpetic vulvovaginitis Herpetic ulcer of vulva Gc cervicitis (acute) Gc endometritis (acute) Acute gc salpingitis Gc cervicitis, chronic Gc endometritis, chronic Gc salpingitis (chronic) 1121 Candidal vulvovaginitis Trichomonal vaginitis 1740 Malig neo nipple 1741 Mal neo breast-central 1742 Mal neo breast up-inner 1743 Mal neo breast low-inner 1744 Mal neo breast up-outer 1745 Mal neo breast low-outer 1746 Mal neo breast-axillary 1748 Malign neopl breast NEC 1749 Malign neopl breast NOS 179 Malig neopl uterus NOS 1800 Malig neo endocervix 1801 Malig neo exocervix 1808 Malig neo cervix NEC 1809 Mal neo cervix uteri NOS 181 Malignant neopl placenta 1820 Malig neo corpus uteri 1821 Mal neo uterine isthmus 1828 Mal neo body uterus NEC 1830 Malign neopl ovary 1832 Mal neo fallopian tube 1833 Mal neo broad ligament 1834 Malig neo parametrium 1835 Mal neo round ligament 1838 Mal neo adnexa NEC 1839 Mal neo adnexa NOS 1840 Malign neopl vagina 1841 Mal neo labia majora 1842 Mal neo labia minora 1843 Malign neopl clitoris 1844 Malign neopl vulva NOS 1848 Mal neo female genit NEC 1849 Mal neo female genit NOS 1986 Second malig neo ovary 2180 Submucous leiomyoma 2181 Intramural leiomyoma 2182 Subserous leiomyoma 2189 Uterine leiomyoma NOS 2190 Benign neo cervix uteri 2191 Benign neo corpus uteri 2198 Benign neo uterus NEC 2199 Benign neo uterus NOS 220 Benign neoplasm ovary 2210 Ben neo fallopian tube 2211 Benign neoplasm vagina 2212 Benign neoplasm vulva 2218 Ben neo fem genital NEC 2219 Ben neo fem genital NOS 2331 Ca in situ cervix uteri 2332 Ca in situ uterus NEC Page 37

38 23330 Ca in situ fem gen NOS Carcinoma in situ vagina Carcinoma in situ vulva Ca in situ fem gen NEC 2360 Uncert behav neo uterus 2361 Unc behav neo placenta 2362 Unc behav neo ovary 2363 Unc behav neo female NEC 2560 Hyperestrogenism 2561 Ovarian hyperfunc NEC 2562 Postablativ ovarian fail Premature menopause Ovarian failure NEC 2564 Polycystic ovaries 2568 Ovarian dysfunction NEC 2569 Ovarian dysfunction NOS Female orgasmic disorder Dyspareunia,psychogenic Psychogenic vaginismus Psychogenic dysmenorrhea Menst mgr wo ntrc wo st Menstl mgrn w ntrc wo st Menstl mgr wo ntrc w st Menstl mgrn w ntrc w st 4566 Vulval varices 5164 Lymphangioleiomyomatosis 6140 Ac salpingo-oophoritis 6141 Chr salpingo-oophoritis 6142 Salpingo-oophoritis NOS 6143 Acute parametritis 6144 Chronic parametritis 6145 Ac pelv peritonitis-fem 6146 Fem pelvic periton adhes 6147 Chr pelv periton NEC-fem 6148 Fem pelv inflam dis NEC 6149 Fem pelv inflam dis NOS 6150 Ac uterine inflammation 6151 Chr uterine inflammation 6159 Uterine inflam dis NOS 6160 Cervicitis Vaginitis NOS Vaginitis in oth disease 6162 Bartholin's gland cyst 6163 Bartholin's glnd abscess 6164 Abscess of vulva NEC Ulceration of vulva NOS Vulvar ulcer in oth dis Mucositis cerv,vag,vulva Inflm cerv,vag,vulva NEC 6169 Female gen inflam NOS 6170 Uterine endometriosis 6171 Ovarian endometriosis 6172 Tubal endometriosis 6173 Pelv perit endometriosis 6174 Vaginal endometriosis 6175 Intestinal endometriosis 6176 Endometriosis in scar 6178 Endometriosis NEC 6179 Endometriosis NOS Page 38

39 61800 Vaginal wall prolpse NOS Cystocele, midline Cystocele, lateral Urethrocele Rectocele Perineocele Cystourethrocele 6181 Uterine prolapse 6182 Uterovag prolaps-incompl 6183 Uterovag prolaps-complet 6184 Utervaginal prolapse NOS 6185 Postop vaginal prolapse 6186 Vaginal enterocele 6187 Old lacer pelvic muscle Incomptnce pubocerv tiss Incomptnce rectovag tiss Pelvic muscle wasting Cervical stump prolapse Genital prolapse NEC 6189 Genital prolapse NOS 6190 Urin-genital fistul, fem 6191 Digest-genit fistul, fem 6192 Genital-skin fistul, fem 6198 Fem genital fistula NEC 6199 Fem genital fistula NOS 6200 Follicular cyst of ovary 6201 Corpus luteum cyst 6202 Ovarian cyst NEC/NOS 6203 Acq atrophy ovary & tube 6204 Prolapse of ovary & tube 6205 Torsion of ovary or tube 6206 Broad ligament lacer syn 6207 Broad ligament hematoma 6208 Noninfl dis ova/adnx NEC 6209 Noninfl dis ova/adnx NOS 6210 Polyp of corpus uteri 6211 Chr uterine subinvolutn 6212 Hypertrophy of uterus Endometrial hyperpla NOS Simp endo hyper w/o atyp Comp endo hyper w/o atyp Endomet hyperpla w atyp Ben endomet hyperplasia Endomet intraepithl neop 6214 Hematometra 6215 Intrauterine synechiae 6216 Malposition of uterus 6217 Chr inversion of uterus 6218 Disorders of uterus NEC 6219 Disorder of uterus NOS 6220 Erosion/ectropion cervix Dysplasia of cervix NOS Mild dysplasia of cervix Mod dysplasia of cervix 6222 Leukoplakia of cervix 6223 Old laceration of cervix 6224 Stricture of cervix 6225 Incompetence of cervix 6226 Hypertrophic elong cervx Page 39

40 6227 Mucous polyp of cervix 6228 Noninflam dis cervix NEC 6229 Noninflam dis cervix NOS 6230 Dysplasia of vagina 6231 Leukoplakia of vagina 6232 Stricture of vagina 6233 Tight hymenal ring 6234 Old vaginal laceration 6235 Noninfect vag leukorrhea 6236 Vaginal hematoma 6237 Polyp of vagina 6238 Noninflam dis vagina NEC 6239 Noninflam dis vagina NOS Vulvar intraeph neopl I Vulvr intraepth neopl II Dystrophy of vulva NEC 6241 Atrophy of vulva 6242 Hypertrophy of clitoris 6243 Hypertrophy of labia 6244 Old laceration of vulva 6245 Hematoma of vulva 6246 Polyp of labia and vulva 6248 Noninflam dis vulva NEC 6249 Noninflam dis vulva NOS 6250 Dyspareunia 6251 Vaginismus 6252 Mittelschmerz 6253 Dysmenorrhea 6254 Premenstrual tension 6255 Pelvic congestion synd 6256 Fem stress incontinence Vulvodynia NOS Vulvar vestibulitis Other vulvodynia 6258 Fem genital symptoms NEC 6259 Fem genital symptoms NOS 6260 Absence of menstruation 6261 Scanty menstruation 6262 Excessive menstruation 6263 Pubertal menorrhagia 6264 Irregular menstruation 6265 Ovulation bleeding 6266 Metrorrhagia 6267 Postcoital bleeding 6268 Menstrual disorder NEC 6269 Menstrual disorder NOS 6270 Premenopause menorrhagia 6271 Postmenopausal bleeding 6272 Sympt fem climact state 6273 Atrophic vaginitis 6274 Sympt state w artif meno 6278 Menopausal disorder NEC 6279 Menopausal disorder NOS 6280 Infertility-anovulation 6281 Infertil-pituitary orig 6282 Infertility-tubal origin 6283 Infertility-uterine orig 6284 Infertil-cervical orig 6288 Female infertility NEC Page 40

41 6289 Female infertility NOS 6290 Hematocele, female NEC 6291 Hydrocele canal nuck-fem Genital mutilation NOS Genital mutilatn type I Genital mutilatn type II Genital muilatn type III Fem genital mutilate NEC Eros imp vag mesh in tis Exp imp vag mesh-vagina Rec preg loss wo cur prg Female genital disor NEC 6299 Female genital dis NOS 630 Hydatidiform mole 6310 Inapp chg hcg early preg 6318 Oth abn prod conception 632 Missed abortion Abd preg w/o intrau preg Abd preg w intraut preg Tubal preg w/o intra prg Tubal preg w intra preg Ovarn preg w/o intra prg Ovarian preg w intra prg Ect preg NEC w/o int prg Ectpc prg NEC w int preg Ect preg NOS w/o int prg Ectp preg NOS w int preg Spon abor w pel inf-unsp Spon abor w pelv inf-inc Spon abor w pel inf-comp Spon abort w hemorr-unsp Spon abort w hemorr-inc Spon abort w hemorr-comp Spon ab w pel damag-unsp Spon ab w pelv damag-inc Spon ab w pel damag-comp Spon ab w ren fail-unsp Spon ab w ren fail-inc Spon ab w ren fail-comp Spon ab w metab dis-unsp Spon ab w metab dis-inc Spon ab w metab dis-comp Spon abort w shock-unsp Spon abort w shock-inc Spon abort w shock-comp Spon abort w embol-unsp Spon abort w embol-inc Spon abort w embol-comp Spon ab w compl NEC-unsp Spon ab w compl NEC-inc Spon ab w compl NEC-comp Spon ab w compl NOS-unsp Spon ab w compl NOS-inc Spon ab w compl NOS-comp Spon abort uncompl-unsp Spon abort uncompl-inc Spon abort uncompl-comp Leg abor w pelv inf-unsp Leg abor w pelv inf-inc Page 41

42 63502 Leg abor w pelv inf-comp Legal abor w hemorr-unsp Legal abort w hemorr-inc Legal abor w hemorr-comp Leg ab w pelv damag-unsp Leg ab w pelv damag-inc Leg ab w pelv damag-comp Leg abor w ren fail-unsp Leg abor w ren fail-inc Leg abor w ren fail-comp Leg ab w metab dis-unsp Leg ab w metab dis-inc Leg ab w metab dis-comp Legal abort w shock-unsp Legal abort w shock-inc Legal abort w shock-comp Legal abort w embol-unsp Legal abort w embol-inc Legal abort w embol-comp Leg ab w compl NEC-unsp Leg ab w compl NEC-inc Leg ab w compl NEC-comp Leg ab w compl NOS-unsp Leg ab w compl NOS-inc Leg ab w compl NOS-comp Legal abort uncompl-unsp Legal abort uncompl-inc Legal abort uncompl-comp Illeg ab w pelv inf-unsp Illeg ab w pelv inf-inc Illeg ab w pelv inf-comp Illeg ab w hemorr-unspec Illeg ab w hemorr-inc Illeg ab w hemorr-comp Illeg ab w pel damg-unsp Illeg ab w pel damag-inc Illeg ab w pel damg-comp Illeg ab w ren fail-unsp Illeg ab w ren fail-inc Illeg ab w ren fail-comp Illeg ab w met dis-unsp Illeg ab w metab dis-inc Illeg ab w met dis-comp Illeg abort w shock-unsp Illeg abort w shock-inc Illeg abort w shock-comp Illeg ab w embolism-unsp Illeg ab w embolism-inc Illeg ab w embolism-comp Illg ab w compl NEC-unsp Illeg ab w compl NEC-inc Illg ab w compl NEC-comp Illg ab w compl NOS-unsp Illeg ab w compl NOS-inc Illg ab w compl NOS-comp Illeg abort uncompl-unsp Illeg abort uncompl-inc Illeg abort uncompl-comp Abort NOS w pel inf-unsp Page 42

43 63701 Abort NOS w pel inf-inc Abort NOS w pel inf-comp Abort NOS w hemorr-unsp Abort NOS w hemorr-inc Abort NOS w hemorr-comp Ab NOS w pelv damag-unsp Ab NOS w pelv damag-inc Ab NOS w pelv damag-comp Ab NOS w renal fail-unsp Ab NOS w renal fail-inc Ab NOS w renal fail-comp Ab NOS w metab dis-unsp Ab NOS w metab dis-inc Ab NOS w metab dis-comp Abort NOS w shock-unsp Abort NOS w shock-inc Abort NOS w shock-comp Ab NOS w embolism-unsp Ab NOS w embolism-inc Ab NOS w embolism-comp Ab NOS w compl NEC-unsp Ab NOS w compl NEC-inc Ab NOS w compl NEC-comp Ab NOS w compl NOS-unsp Ab NOS w compl NOS-inc Ab NOS w compl NOS-comp Ab NOS uncomplicat-unsp Ab NOS uncomplicat-inc Ab NOS uncomplicat-comp 6380 Attem abort w pelvic inf 6381 Attem abort w hemorrhage 6382 Attem abort w pelv damag 6383 Attem abort w renal fail 6384 Attem abor w metabol dis 6385 Attem abortion w shock 6386 Attemp abort w embolism 6387 Attemp abort w compl NEC 6388 Attemp abort w compl NOS 6389 Attempted abort uncompl 6390 Postabortion gu infect 6391 Postabortion hemorrhage 6392 Postabort pelvic damage 6393 Postabort kidney failure 6394 Postabort metabolic dis 6395 Postabortion shock 6396 Postabortion embolism 6398 Postabortion compl NEC 6399 Postabortion compl NOS Threatened abort-unspec Threatened abort-deliver Threaten abort-antepart Hem early preg NEC-unsp Hem early preg NEC-deliv Hem early pg NEC-antepar Hemorr early preg-unspec Hem early preg-delivered Hem early preg-antepart Placenta previa-unspec Placenta previa-deliver Page 43

44 64103 Placenta previa-antepart Placenta prev hem-unspec Placenta prev hem-deliv Placen prev hem-antepart Prem separ placen-unspec Prem separ placen-deliv Prem separ plac-antepart Coag def hemorr-unspec Coag def hemorr-deliver Coag def hemorr-antepart Antepart hem NEC-unspec Antepartum hem NEC-deliv Antepart hem NEC-antepar Antepart hem NOS-unspec Antepartum hem NOS-deliv Antepart hem NOS-antepar Essen hyperten preg-unsp Essen hyperten-delivered Essen hyperten-del w p/p Essen hyperten-antepart Essen hyperten-postpart Renal hyperten preg-unsp Renal hyperten pg-deliv Renal hyperten-del p/p Renal hyperten-antepart Renal hyperten-postpart Old hyperten preg-unspec Old hyperten NEC-deliver Old hyperten-deliv w p/p Old hyperten NEC-antepar Old hyperten NEC-postpar Trans hyperten preg-unsp Trans hyperten-delivered Trans hyperten-del w p/p Trans hyperten-antepart Trans hyperten-postpart Mild/NOS preeclamp-unsp Mild/NOS preeclamp-deliv Mild preeclamp-del w p/p Mild/NOS preeclamp-antep Mild/NOS preeclamp-p/p Severe preeclamp-unspec Severe preeclamp-deliver Sev preeclamp-del w p/p Sev preeclamp-antepartum Sev preeclamp-postpartum Eclampsia-unspecified Eclampsia-delivered Eclampsia-deliv w p/p Eclampsia-antepartum Eclampsia-postpartum Tox w old hyperten-unsp Tox w old hyperten-deliv Tox w old hyp-del w p/p Tox w old hyper-antepart Tox w old hyper-postpart Hyperten preg NOS-unspec Hypertens NOS-delivered Hypertens NOS-del w p/p Page 44

45 64293 Hypertens NOS-antepartum Hypertens NOS-postpartum Mild hyperem grav-unspec Mild hyperem grav-deliv Mild hyperemesis-antepar Hyperem w metab dis-unsp Hyperem w metab dis-del Hyperem w metab-antepart Late vomit of preg-unsp Late vomit of preg-deliv Late vomit preg-antepart Vomit compl preg-unspec Vomit compl preg-deliver Vomit compl preg-antepar Vomit of preg NOS-unspec Vomit of preg NOS-deliv Vomit of pg NOS-antepart Threat prem labor-unspec Thrt prem labor-antepart Threat labor NEC-unspec Threat labor NEC-antepar Early onset deliv-unspec Early onset delivery-del Post term preg-unsp Post term preg-del Post term preg-antepar Prolonged preg-unsp Prolonged preg-del Prolonged preg-antepar Papyraceous fetus-unspec Papyraceous fetus-deliv Papyraceous fet-antepar Edema in preg-unspec Edema in preg-delivered Edema in preg-del w p/p Edema in preg-antepartum Edema in preg-postpartum Renal dis preg NOS-unsp Renal dis NOS-delivered Renal dis NOS-del w p/p Renal dis NOS-antepartum Renal dis NOS-postpartum Recur preg loss-unspec Recurnt preg loss-deliv Recurnt preg loss-antep Neuritis of preg-unspec Neuritis-delivered Neuritis-delivered w p/p Neuritis of preg-antepar Neuritis of preg-postpar Bacteriuria preg-unspec Asym bacteriuria-deliver Asy bacteruria-del w p/p Asy bacteriuria-antepart Asy bacteriuria-postpart Gu infect in preg-unspec Gu infection-delivered Gu infection-deliv w p/p Gu infection-antepartum Page 45

46 64664 Gu infection-postpartum Liver/bil trct disr-unsp Liver/bil trct disr-del Liver/bil trct disr-ante Preg compl NEC-unspec Preg compl NEC-delivered Preg compl NEC-del w p/p Preg compl NEC-antepart Preg compl NEC-postpart Preg compl NOS-unspec Preg compl NOS-delivered Preg compl NOS-antepart Syphilis in preg-unspec Syphilis-delivered Syphilis-delivered w p/p Syphilis-antepartum Syphilis-postpartum Gonorrhea in preg-unspec Gonorrhea-delivered Gonorrhea-deliver w p/p Gonorrhea-antepartum Gonorrhea-postpartum Other VD in preg-unspec Other vd-delivered Other vd-delivered w p/p Other vd-antepartum Other vd-postpartum TB in preg-unspecified Tuberculosis-delivered Tuberculosis-deliv w p/p Tuberculosis-antepartum Tuberculosis-postpartum Malaria in preg-unspec Malaria-delivered Malaria-delivered w p/p Malaria-antepartum Malaria-postpartum Rubella in preg-unspec Rubella-delivered Rubella-delivered w p/p Rubella-antepartum Rubella-postpartum Oth virus in preg-unspec Oth viral dis-delivered Oth viral dis-del w p/p Oth viral dis-antepartum Oth viral dis-postpartum Inf dis in preg NEC-unsp Infect dis NEC-delivered Infect dis NEC-del w p/p Infect dis NEC-antepart Infect dis NEC-postpart Infect in preg NOS-unsp Infect NOS-delivered Infect NOS-deliver w p/p Infect NOS-antepartum Infect NOS-postpartum Diabetes in preg-unspec Diabetes-delivered Page 46

47 64802 Diabetes-delivered w p/p Diabetes-antepartum Diabetes-postpartum Thyroid dysfun preg-unsp Thyroid dysfunc-deliver Thyroid dysfun-del w p/p Thyroid dysfunc-antepart Thyroid dysfunc-postpart Anemia in preg-unspec Anemia-delivered Anemia-delivered w p/p Anemia-antepartum Anemia-postpartum Drug depend preg-unspec Drug dependence-deliver Drug dependen-del w p/p Drug dependence-antepart Drug dependence-postpart Mental dis preg-unspec Mental disorder-deliver Mental dis-deliv w p/p Mental disorder-antepart Mental disorder-postpart Congen CV dis preg-unsp Congen CV dis-delivered Congen CV dis-del w p/p Congen CV dis-antepartum Congen CV dis-postpartum CV dis NEC preg-unspec CV dis NEC preg-deliver CV dis NEC-deliver w p/p CV dis NEC-antepartum CV dis NEC-postpartum Bone disord in preg-unsp Bone disorder-delivered Bone disorder-del w p/p Bone disorder-antepartum Bone disorder-postpartum Abn glucose in preg-unsp Abn glucose toler-deliv Abn glucose-deliv w p/p Abn glucose-antepartum Abn glucose-postpartum Oth curr cond preg-unsp Oth curr cond-delivered Oth curr cond-del w p/p Oth curr cond-antepartum Oth curr cond-postpartum Tobacco use disord-unsp Tobacco use disor-delliv Tobacco use dis-del-p/p Tobacco use dis-antepart Tobacco use dis-postpart Obesity-unspecified Obesity-delivered Obesity-delivered w p/p Obesity-antepartum Obesity-postpartum Bariatric surg stat-unsp Page 47

48 64921 Bariatric surg stat-del Bariatric surg-del w p/p Bariatrc surg stat-antep Bariatrc surg stat w p/p Coagulation def-unspec Coagulation def-deliv Coagulatn def-del w p/p Coagulation def-antepart Coagulation def-postpart Epilepsy-unspecified Epilepsy-delivered Epilepsy-delivered w p/p Epilepsy-antepartum Epilepsy-postpartum Spotting-unspecified Spotting-delivered Spotting-antepartum Uterine size descrp-unsp Uterine size descrep-del Uterine size-del w p/p Uterine size des-antepar Uterine size descrep-p/p Cervical shortening-unsp Cervical shortening-del Cervical shortening-ante Spon labr w plan C/S-del Lbr w plan C/S-del w p/p 650 Normal delivery Twin pregnancy-unspec Twin pregnancy-delivered Twin pregnancy-antepart Triplet pregnancy-unspec Triplet pregnancy-deliv Triplet preg-antepartum Quadruplet preg-unspec Quadruplet preg-deliver Quadruplet preg-antepart Twins w fetal loss-unsp Twins w fetal loss-del Twins w fetal loss-ante Triplets w fet loss-unsp Triplets w fet loss-del Triplets w fet loss-ante Quads w fetal loss-unsp Quads w fetal loss-del Quads w fetal loss-ante Mult ges w fet loss-unsp Mult ges w fet loss-del Mult ges w fet loss-ante Mul gest-fet reduct unsp Mult gest-fet reduct del Mul gest-fet reduct ante Multi gestat NEC-unspec Multi gestat NEC-deliver Multi gest NEC-antepart Multi gestat NOS-unspec Mult gestation NOS-deliv Multi gest NOS-antepart Unstable lie-unspecified Page 48

49 65201 Unstable lie-delivered Unstable lie-antepartum Cephalic vers NOS-unspec Cephalic vers NOS-deliv Cephal vers NOS-antepart Breech presentat-unspec Breech presentat-deliver Breech present-antepart Transv/obliq lie-unspec Transver/obliq lie-deliv Transv/obliq lie-antepar Face/brow present-unspec Face/brow present-deliv Face/brow pres-antepart High head at term-unspec High head at term-deliv High head term-antepart Mult gest malpresen-unsp Mult gest malpres-deliv Mult ges malpres-antepar Prolapsed arm-unspec Prolapsed arm-delivered Prolapsed arm-antepart Malposition NEC-unspec Malposition NEC-deliver Malposition NEC-antepart Malposition NOS-unspec Malposition NOS-deliver Malposition NOS-antepart Pelvic deform NOS-unspec Pelvic deform NOS-deliv Pelv deform NOS-antepart Contract pelv NOS-unspec Contract pelv NOS-deliv Contrac pelv NOS-antepar Inlet contraction-unspec Inlet contraction-deliv Inlet contract-antepart Outlet contraction-unsp Outlet contraction-deliv Outlet contract-antepart Fetopelv disprop-unspec Fetopelv dispropor-deliv Fetopel disprop-antepart Fetal disprop NOS-unspec Fetal disprop NOS-deliv Fetal dispro NOS-antepar Hydrocephal fetus-unspec Hydroceph fetus-deliver Hydroceph fetus-antepart Oth abn fet disprop-unsp Oth abn fet dispro-deliv Oth abn fet dispro-antep Disproportion NEC-unspec Disproportion NEC-deliv Dispropor NEC-antepartum Disproportion NOS-unspec Disproportion NOS-deliv Dispropor NOS-antepartum Page 49

50 65400 Cong abn uter preg-unsp Congen abn uterus-deliv Cong abn uter-del w p/p Congen abn uter-antepart Congen abn uter-postpart Uter tumor in preg-unsp Uterine tumor-delivered Uterine tumor-del w p/p Uterine tumor-antepartum Uterine tumor-postpartum Prev c-delivery unspec Prev c-delivery-delivrd Prev c-delivery-antepart Retrovert uterus-unspec Retrovert uterus-deliver Retrovert uter-del w p/p Retrovert uter-antepart Retrovert uter-postpart Abn grav uterus NEC-unsp Abn uterus NEC-delivered Abn uterus NEC-del w p/p Abn uterus NEC-antepart Abn uterus NEC-postpart Cerv incompet preg-unsp Cervical incompet-deliv Cerv incompet-del w p/p Cerv incompet-antepartum Cerv incompet-postpartum Abn cervix NEC preg-unsp Abn cervix NEC-delivered Abn cervix NEC-del w p/p Abn cervix NEC-antepart Abn cervix NEC-postpart Abn vagina in preg-unsp Abnorm vagina-delivered Abnorm vagina-del w p/p Abnorm vagina-antepartum Abnorm vagina-postpartum Abn vulva in preg-unspec Abnormal vulva-delivered Abnormal vulva-del w p/p Abnormal vulva-antepart Abnormal vulva-postpart Abn pel NEC in preg-unsp Abn pelv org NEC-deliver Abn pelv NEC-deliv w p/p Abn pelv org NEC-antepar Abn pelv org NEC-postpar Fetal cns malform-unspec Fetal cns malform-deliv Fetal cns malfor-antepar Fetal chromos abn-unspec Fetal chromoso abn-deliv Fet chromo abn-antepart Famil heredit dis-unspec Famil heredit dis-deliv Famil hered dis-antepart Fet damg d/t virus-unsp Fet damg d/t virus-deliv Page 50

51 65533 Fet damg d/t virus-antep Fet damg d/t dis-unspec Fet damg d/t dis-deliver Fet damg d/t dis-antepar Fetal damg d/t drug-unsp Fet damag d/t drug-deliv Fet damg d/t drug-antepa Radiat fetal damag-unsp Radiat fetal damag-deliv Radiat fet damag-antepar Decrease fetl movmt unsp Decrease fetal movmt del Dec fetal movmt antepart Fetal abnorm NEC-unspec Fetal abnorm NEC-deliver Fetal abnorm NEC-antepar Fetal abnorm NOS-unspec Fetal abnorm NOS-deliver Fetal abnorm NOS-antepar Fetal-maternal hem-unsp Fetal-maternal hem-deliv Fetal-matern hem-antepar Rh isoimmunization-unsp Rh isoimmunizat-deliver Rh isoimmunizat-antepart Abo isoimmunization-unsp Abo isoimmunizat-deliver Abo isoimmunizat-antepar Fetal distress-unspec Fetal distress-delivered Fetal distress-antepart Intrauterine death-unsp Intrauter death-deliver Intrauter death-antepart Poor fetal growth-unspec Poor fetal growth-deliv Poor fetal grth-antepart Excess fetal grth-unspec Excess fetal grth-deliv Excess fet grth-antepart Oth placent cond-unspec Oth placent cond-deliver Oth placent cond-antepar Fet/plac prob NEC-unspec Fet/plac prob NEC-deliv Fet/plac prob NEC-antepa Fet/plac prob NOS-unspec Fet/plac prob NOS-deliv Fet/plac prob NOS-antepa Polyhydramnios-unspec Polyhydramnios-delivered Polyhydramnios-antepart Oligohydramnios-unspec Oligohydramnios-deliver Oligohydramnios-antepar Prem rupt membran-unspec Prem rupt membran-deliv Prem rupt memb-antepart Prolong rupt memb-unspec Page 51

52 65821 Prolong rupt memb-deliv Prolong rup memb-antepar Artific rupt membr-unsp Artific rupt membr-deliv Artif rupt memb-antepart Amniotic infection-unsp Amniotic infection-deliv Amniotic infect-antepart Amniotic prob NEC-unspec Amniotic prob NEC-deliv Amnion prob NEC-antepart Amniotic prob NOS-unspec Amniotic prob NOS-deliv Amnion prob NOS-antepart Fail mechan induct-unsp Fail mech induct-deliver Fail mech induct-antepar Fail induction NOS-unsp Fail induction NOS-deliv Fail induct NOS-antepart Pyrexia in labor-unspec Pyrexia in labor-deliver Pyrexia in labor-antepar Septicemia in labor-unsp Septicem in labor-deliv Septicem in labor-antepa Grand multiparity-unspec Grand multiparity-deliv Grand multiparity-antepa Elderly primigravid-unsp Elderly primigravida-del Elder primigravid-antepa Elderly multigravida-uns Elderly multigravida-del Elderly multigravd-antep Abn ftl hrt rate/rhy-uns Abn ftl hrt rate/rhy-del Abn ftl hrt rate/rhy-ant Complic labor NEC-unsp Complic labor NEC-deliv Compl labor NEC-antepart Complic labor NOS-unsp Complic labor NOS-deliv Compl labor NOS-antepart Obstruct/fet malpos-unsp Obstruc/fet malpos-deliv Obstruc/fet malpos-antep Bony pelv obstruc-unspec Bony pelv obstruct-deliv Bony pelv obstruc-antepa Abn pelv tiss obstr-unsp Abn pelv tis obstr-deliv Abn pelv tis obstr-antep Persist occipitpost-unsp Persist occiptpost-deliv Persist occiptpost-antep Shoulder dystocia-unspec Shoulder dystocia-deliv Shoulder dystocia-antepa Page 52

53 66050 Locked twins-unspecified Locked twins-delivered Locked twins-antepartum Fail trial lab NOS-unsp Fail trial lab NOS-deliv Fail trial lab NOS-antep Failed forcep NOS-unspec Failed forceps NOS-deliv Fail forceps NOS-antepar Obstruc labor NEC-unspec Obstruct labor NEC-deliv Obstruc labor NEC-antepa Obstruc labor NOS-unspec Obstruct labor NOS-deliv Obstruc labor NOS-antepa Prim uterine inert-unsp Prim uterine inert-deliv Prim uter inert-antepart Sec uterine inert-unspec Sec uterine inert-deliv Sec uterine inert-antepa Uterine inertia NEC-unsp Uterine inert NEC-deliv Uterine inert NEC-antepa Precipitate labor-unspec Precipitate labor-deliv Precipitate labor-antepa Uter dystocia NOS-unspec Uter dystocia NOS-deliv Uter dystocia NOS-antepa Abnormal labor NOS-unsp Abnormal labor NOS-deliv Abnorm labor NOS-antepar Prolonged 1st stage-unsp Prolong 1st stage-deliv Prolong 1st stage-antepa Prolonged labor NOS-unsp Prolong labor NOS-deliv Prolong labor NOS-antepa Prolonged 2nd stage-unsp Prolong 2nd stage-deliv Prolong 2nd stage-antepa Delay del 2nd twin-unsp Delay del 2nd twin-deliv Delay del 2 twin-antepar Cord prolapse-unspec Cord prolapse-delivered Cord prolapse-antepartum Cord around neck-unspec Cord around neck-deliver Cord around neck-antepar Cord compress NEC-unspec Cord compress NEC-deliv Cord compres NEC-antepar Cord entangle NEC-unspec Cord entangle NEC-deliv Cord entangl NEC-antepar Short cord-unspecified Short cord-delivered Page 53

54 66343 Short cord-antepartum Vasa previa-unspecified Vasa previa-delivered Vasa previa-antepartum Vasc lesion cord-unspec Vasc lesion cord-deliver Vasc lesion cord-antepar Cord complicat NEC-unsp Cord complicat NEC-deliv Cord compl NEC-antepart Cord complicat NOS-unsp Cord complicat NOS-deliv Cord compl NOS-antepart Del w 1 deg lacerat-unsp Del w 1 deg lacerat-del Del w 1 deg lac-postpart Del w 2 deg lacerat-unsp Del w 2 deg lacerat-del Del w 2 deg lac-postpart Del w 3 deg lacerat-unsp Del w 3 deg lacerat-del Del w 3 deg lac-postpart Del w 4 deg lacerat-unsp Del w 4 deg lacerat-del Del w 4 deg lac-postpart Ob perineal lac NOS-unsp Ob perineal lac NOS-del Perineal lac NOS-postpar Ob perineal hematom-unsp Ob perineal hematoma-del Perin hematoma-postpart Anal sphincter tear NOS Anal sphincter tear-del Anal sphinctr tear w p/p Ob perin traum NEC-unsp Ob perineal trau NEC-del Perin traum NEC-postpart Ob perin traum NOS-unsp Ob perineal trau NOS-del Perin traum NOS-postpart Prelabor rupt uter-unsp Prelabor rupt uterus-del Prelab rupt uter-antepar Rupture uterus NOS-unsp Rupture uterus NOS-deliv Inversion of uterus-unsp Invers uterus-del w p/p Invers uterus-postpart Lacerat of cervix-unspec Lacerat of cervix-deliv Lacer of cervix-postpart High vaginal lacer-unsp High vaginal lacer-deliv High vaginal lac-postpar Ob inj pelv org NEC-unsp Ob inj pelv org NEC-del Inj pelv org NEC-postpar Damage to pelvic jt-unsp Damage to pelvic jt-del Page 54

55 66564 Damage pelvic jt-postpar Ob pelvic hematoma-unsp Ob pelvic hematoma-deliv Pelvic hematom-del w pp Pelvic hematoma-postpart Ob trauma NEC-unspec Ob trauma NEC-delivered Ob trauma NEC-del w p/p Ob trauma NEC-antepartum Ob trauma NEC-postpartum Ob trauma NOS-unspec Ob trauma NOS-delivered Ob trauma NOS-del w p/p Ob trauma NOS-antepartum Ob trauma NOS-postpartum Third-stage hem-unspec Thrd-stage hem-del w p/p Third-stage hem-postpart Postpartum hem NEC-unsp Postpa hem NEC-del w p/p Postpart hem NEC-postpar Delay p/part hem-unspec Delay p/p hem-del w p/p Delay p/part hem-postpar Postpart coagul def-unsp P/p coag def-del w p/p Postpart coag def-postpa Retain placenta NOS-unsp Retnd plac NOS-del w p/p Retain plac NOS-postpart Retain prod concept-unsp Ret prod conc-del w p/p Ret prod concept-postpar Pulm compl in del-unspec Pulm compl in del-deliv Pulm complic-del w p/p Pulm complicat-antepart Pulm complicat-postpart Heart compl in del-unsp Heart compl in del-deliv Heart compl-del w p/p Heart complic-antepart Heart complic-postpart Cns compl labor/del-unsp Cns compl lab/del-deliv Cns complic-del w p/p Cns compl in del-antepar Cns compl in del-postpar Anesth comp del NEC-unsp Anesth compl NEC-deliver Anesth compl NEC-del p/p Anesth compl antepartum Anesth compl-postpartum Anesth comp del NOS-unsp Anesth compl NOS-deliver Anesth compl NOS-del p/p Anesth compl-antepartum Anesth compl-postpartum Maternal distress-unspec Page 55

56 66901 Maternal distress-deliv Matern distres-del w p/p Matern distress-antepar Matern distress-postpart Obstetric shock-unspec Obstetric shock-deliver Obstet shock-deliv w p/p Obstetric shock-antepar Obstetric shock-postpart Matern hypotens syn-unsp Matern hypoten syn-deliv Matern hypoten-del w p/p Matern hypotens-antepar Matern hypotens-postpart Ac kidny fail w del-unsp Ac kidney fail-del w p/p Ac kidney fail-postpart Oth ob surg compl-unspec Oth ob compl-delivered Oth ob compl-deliv w p/p Complc ob surg anteprtm Oth ob surg compl-postpa Forcep deliv NOS-unspec Forcep deliv NOS-deliver Breech extr NOS-unspec Breech extr NOS-deliver Cesarean deliv NOS-unsp Cesarean delivery NOS Compl lab/deliv NEC-unsp Comp lab/deliv NEC-deliv Compl del NEC-del w p/p Compl deliv NEC-antepar Compl deliv NEC-postpart Compl lab/deliv NOS-unsp Comp lab/deliv NOS-deliv Compl del NOS-del w p/p Compl deliv NOS-antepar Compl deliv NOS-postpart Maj puerp inf NOS-unsp Maj puer inf NOS-del p/p Major puerp inf NOS-p/p Puerp endometritis-unsp Puerp endomet del w p/p Puerp endomet-postpart Puerperal sepsis-unsp Puerprl sepsis-del w p/p Puerperl sepsis-postpart Puerp septc thromb-unsp Prp sptc thrmb-del w p/p Prp septc thrmb-postpart Maj prp infec NEC-unspec Maj prp inf NEC-dl w p/p Maj puerp infec NEC-p/p Varic vein leg preg-unsp Varicose vein leg-deliv Varic vein leg-del w p/p Varic vein leg-antepart Varic vein leg-postpart Varic vulva preg-unspec Page 56

57 67111 Varicose vulva-delivered Varicose vulva-del w p/p Varicose vulva-antepart Varicose vulva-postpart Thrombophleb preg-unspec Thrombophlebitis-deliver Thrombophleb-deliv w p/p Thrombophlebit-antepart Thrombophlebit-postpart Deep thromb antepar-unsp Deep throm antepar-deliv Deep vein thromb-antepar Deep thromb postpar-unsp Thromb postpar-del w p/p Deep vein thromb-postpar Thrombosis NEC preg-unsp Thrombosis NEC-delivered Thromb NEC-deliv w p/p Thrombosis NEC-antepart Thrombosis NEC-postpart Ven compl preg NEC-unsp Venous compl NEC-deliver Ven comp NEC-deliv w p/p Venous compl NEC-antepar Venous compl NEC-postpar Ven compl preg NOS-unsp Venous compl NOS-deliver Ven comp NOS-deliv w p/p Venous compl NOS-antepar Venous compl NOS-postpar Puerperal pyrexia-unspec Puerp pyrexia-del w p/p Puerp pyrexia-postpartum Ob air embolism-unspec Ob air embolism-deliver Ob air embol-deliv w p/p Ob air embolism-antepart Ob air embolism-postpart Amniotic embolism-unspec Amniotic embolism-deliv Amniot embol-deliv w p/p Amniotic embol-antepart Amniotic embol-postpart Ob pulm embol NOS-unspec Pulm embol NOS-delivered Pulm embol NOS-del w p/p Pulm embol NOS-antepart Pulm embol NOS-postpart Ob pyemic embol-unspec Ob pyemic embol-deliver Ob pyem embol-del w p/p Ob pyemic embol-antepart Ob pyemic embol-postpart Ob pulmon embol NEC-unsp Pulmon embol NEC-deliver Pulm embol NEC-del w p/p Pulmon embol NEC-antepar Pulmon embol NEC-postpar Puerp cerebvasc dis-unsp Page 57

58 67401 Puerp cerebvas dis-deliv Cerebvas dis-deliv w p/p Cerebrovasc dis-antepart Cerebrovasc dis-postpart Disrupt c-sect wnd-unsp Disrupt c-sect-del w p/p Disrupt c-sect-postpart Disrupt perineum-unspec Disrupt perin-del w p/p Disrupt perineum-postpar Ob surg compl NEC-unspec Ob surg compl-del w p/p Ob surg comp NEC-postpar Placental polyp-unspec Placent polyp-del w p/p Placental polyp-postpart Peripart cardiomy-unspec Peripartum cardiomy-del Peripart card del w p/p Peripartum card-antepart Peripartum card-postpart Puerp compl NEC-unspec Puerp comp NEC-del w p/p Puerp compl NEC-postpart Puerp compl NOS-unspec Puerp comp NOS-del w p/p Puerp compl NOS-postpart Infect nipple preg-unsp Infect nipple-delivered Infect nipple-del w p/p Infect nipple-antepartum Infect nipple-postpartum Breast abscess preg-unsp Breast abscess-delivered Breast abscess-del w p/p Breast abscess-antepart Breast abscess-postpart Mastitis in preg-unspec Mastitis-delivered Mastitis-deliv w p/p Mastitis-antepartum Mastitis-postpartum Breast inf preg NEC-unsp Breast infect NEC-deliv Breast inf NEC-del w p/p Breast inf NEC-antepart Breast inf NEC-postpart Breast inf preg NOS-unsp Breast infect NOS-deliv Breast inf NOS-del w p/p Breast inf NOS-antepart Breast inf NOS-postpart Retract nipple preg-unsp Retracted nipple-deliver Retract nipple-del w p/p Retract nipple-antepart Retract nipple-postpart Cracked nipple preg-unsp Cracked nipple-delivered Page 58

59 67612 Cracked nipple-del w p/p Cracked nipple-antepart Cracked nipple-postpart Breast engorge-unspec Breast engorge-delivered Breast engorge-del w p/p Breast engorge-antepart Breast engorge-postpart Breast dis preg NEC-unsp Breast dis NEC-delivered Breast dis NEC-del w p/p Breast dis NEC-antepart Breast dis NEC-postpart Lactation fail-unspec Lactation fail-delivered Lactation fail-del w p/p Lactation fail-antepart Lactation fail-postpart Suppr lactation-unspec Suppr lactation-deliver Suppr lactat-del w p/p Suppr lactation-antepar Suppr lactation-postpart Galactorrhea preg-unspec Galactorrhea-delivered Galactorrhea-del w p/p Galactorrhea-antepartum Galactorrhea-postpartum Lactation dis NEC-unspec Lactation dis NEC-deliv Lactat dis NEC-del w p/p Lactat dis NEC-antepart Lactat dis NEC-postpart Lactation dis NOS-unspec Lactation dis NOS-deliv Lactat dis NOS-del w p/p Lactat dis NOS-antepart Lactat dis NOS-postpart 677 Late effct cmplcatn preg Fetal hematologic-unspec Fetal hematologic-deliv Fetal hematologic-ante Fetal conjoin twins-unsp Fetal conjoin twins-del Fetal conjoin twins-ante Mat comp in utero-unsp Mat comp in utero-del Mat comp in utro-del-p/p Mat comp in utero-ante Mat comp in utero-p/p Fetal comp in utero-unsp Fetal comp in utero-del Ftl cmp in utro-del-p/p Fetal comp in utero-ante Fetal comp in utero-p/p Climact arthritis-unspec Climact arthritis-shlder Climact arthritis-up/arm Climact arthrit-forearm Page 59

60 71634 Climact arthritis-hand Climact arthritis-pelvis Climact arthritis-l/leg Climact arthritis-ankle Climact arthritis NEC Climact arthritis-mult 7520 Anomalies of ovaries Tubal/broad lig anom NOS Embryonic cyst of adnexa Tubal/broad lig anom NEC 7522 Doubling of uterus Agenesis of uterus Hypoplasia of uterus Unicornuate uterus Bicornuate uterus Septate uterus Arcuate uterus Anomalies of uterus NEC Cervix/fem gen anom NOS Embryon cyst fem gen NEC Imperforate hymen Cervical agenesis Cervical duplication Vaginal agenesis Transv vaginal septum Longitud vaginal septum Cervix/fem gen anom NEC 7923 Abn find-amniotic fluid Abn glandular pap smear Pap smear (ASC-US) Pap smear (ASC-H) Pap smear cervix w LGSIL Pap smear cervix w HGSIL Cervical (HPV) DNA pos Pap smr cytol evid malig Sat cerv smr-no trnsfrm Unsat cerv cytlogy smear Abn pap cervix HPV NEC Abn gland pap smr vagina Pap smear vag w ASC-US Pap smear vagina w ASC-H Pap smear vagina w LGSIL Pap smear vagina w HGSIL Vag hi risk HPV-DNA pos Pap smr vag-cytol malig Vaginl cytol smr unsatis Oth abn Pap smr vag/hpv Elev ca antigen Abn find antenatl screen 8674 Uterus injury-closed 8675 Uterus injury-open 8784 Open wound of vulva 8785 Open wound vulva-compl 8786 Open wound of vagina 8787 Open wound vagina-compl Injury uterine artery Injury uterine vein Injury ovarian artery Injury ovarian vein Page 60

61 9391 Foreign body uterus 9392 Foreign bdy vulva/vagina 9474 Burn of vagina & uterus Malfunction iud V074 Hormone replace postmeno V1040 Hx-female genit malg NOS V1041 Hx-cervical malignancy V1042 Hx-uterus malignancy NEC V1043 Hx of ovarian malignancy V1044 Hx-female genit malg NEC V1221 Hx gestational diabetes V131 Hx-trophoblastic disease V1321 History-pre-term labor V1322 Hx of cervical dysplasia V1323 Hx vaginal dysplasia V1324 Hx vulvar dysplasia V1329 Hx-genital/obs dis NEC V1521 Hx in utero proc in preg V220 Supervis normal 1st preg V221 Supervis oth normal preg V222 Preg state, incidental V230 Preg w hx of infertility V231 Preg w hx-trophoblas dis V232 Preg w hx of abortion V233 Grand multiparity V2341 Preg w hx pre-term labor V2342 Preg w hx ectopic preg V2349 Preg w poor obs hx NEC V235 Preg w poor reproduct hx V237 Insufficnt prenatal care V2381 Suprv elderly primigrav V2382 Suprv elderly multigrav V2383 Suprv young primigravida V2384 Suprv young multigravida V2385 Pregnt-assist repro tech V2386 Preg-hx in utro prev prg V2387 Preg w incon fetl viabil V2389 Suprv high-risk preg NEC V239 Suprv high-risk preg NOS V240 Postpart care after del V241 Postpart care-lactation V242 Rout postpart follow-up V2501 Prescrip-oral contracept V2511 Insertion of iud V2512 Removal of iud V2513 Remove/insert iud V253 Menstrual extraction V2541 Contracept pill surveill V2542 Iud surveillance V2543 Srvl mplnt sbdrm cntrcep V255 Nsrt mplnt sbdrm cntrcep V261 Artificial insemination V2631 Fem genetic test dis car V2632 Female genetic test NEC V2651 Tubal ligation status V2681 Assist repro fertility V270 Deliver-single liveborn V271 Deliver-single stillborn V272 Deliver-twins, both live Page 61

62 V273 V274 V275 V276 V277 V279 V280 V281 V282 V283 V284 V285 V286 V2881 V2882 V2889 V289 V4551 V4981 V5042 V524 V5970 V5971 V5972 V5973 V5974 V616 V617 V6701 V7231 V7232 V7240 V7241 V7242 V7611 V762 V7646 V7647 V824 V8402 V8404 V8801 V8802 V8803 V8901 V8902 V8903 V8904 V8905 V8909 V9100 V9101 V9102 V9103 V9109 V9110 V9111 V9112 V9119 Del-twins, 1 nb, 1 sb Deliver-twins, both sb Del-mult birth, all live Del-mult brth, some live Del-mult birth, all sb Outcome of delivery NOS Screening-chromosom anom Screen-alphafetoprotein Screen by amniocent NEC Scr fetl malfrm-ultrasnd Screen-fetal retardation Screen-isoimmunization Antenatal screen strep b Scrn fetal anatmc survey Scrn risk preterm labor Antenatal screening NEC Antenatal screening NOS Prsc ntrutr cntrcptv dvc Asympt postmeno status Prphylct orgn rmvl ovary Fit/adj breast pros/impl Egg donor NEC Egg donor age <35 anon Egg donor age <35 desig Egg donor age 35+ anon Egg donor age 35+ desig Illegitimate pregnancy Unwanted pregnancy NEC Follow-up vag pap smear Routine gyn examination Pap smear confirmation Pregnancy test unconfirm Pregnancy test negative Pregnancy test-positive Screen mammogram hi risk Screen mal neop-cervix Screen malig neop-ovary Screen malig neop-vagina Mat pstntl scr-chrm anom Genetc sus mal neo ovary Genetc susc mal neo endo Acq absnce cervix/uterus Acq ab ut remn cerv stmp Acq absnc cerv/remain ut Sus amntc cav/mem nt fnd Sus placentl prob nt fnd Sus fetal anomaly nt fnd Sus fetal growth not fnd Sus cervcl shortn nt fnd Oth sus mat/ftl nt fnd Twin gest-plac/sac NOS Twin gest-monochr/monoam Twin gest-monochr/diamni Twin gest-dich/diamniotc Twin gest-plac/sac undet Tripl gest-plac/sac NOS Triplet gest 2+ monochor Triplet gest 2+ monoamn Tripl gest-plac/sac und Page 62

63 V9120 V9121 V9122 V9129 V9190 V9191 V9192 V9199 Quad gest-plac/sac NOS Quad gest 2+ monochorion Quad gest 2+ monoamniotc Quad gest-plac/sac undet Mult gest-plac/sac NOS Mult gest 2+ monochr NEC Mult gest 2+ monoamn NEC Mult gest-plac/sac undet Procedures for females only 6501 Laparoscopic oophorotomy 6509 Other oophorotomy 6511 Ovarian aspirat biopsy 6512 Ovarian biopsy NEC 6513 Lap biopsy of ovary 6514 Oth lap dx proc ovaries 6519 Ovarian dx procedure NEC 6521 Ovarian cyst marsupializ 6522 Ovarian wedge resection 6523 Lap marsup ovarian cyst 6524 Lap wedge resect ovary 6525 Oth lap loc exc dest ova 6529 Local destr ova les NEC 6531 Lap unilat oophorectomy 6539 Oth unilat oophorectomy 6541 Lap uni salpingo-oophor 6549 Oth uni salpingo-oophor 6551 Oth remove both ovaries 6552 Oth remove remain ovary 6553 Lap remove both ovaries 6554 Lap remove remain ovary 6561 Oth remove ovaries/tubes 6562 Oth remove rem ova/tube 6563 Lap remove ovaries/tubes 6564 Lap remove rem ova/tube 6571 Oth simple suture ovary 6572 Oth reimplant of ovary 6573 Oth salpingo-oophoroplas 6574 Lap simple suture ovary 6575 Lap reimplant of ovary 6576 Lap salpingo-oophoroplas 6579 Repair of ovary NEC 6581 Lap adhesiolys ova/tube 6589 Adhesiolysis ovary/tube 6591 Aspiration of ovary 6592 Transplantation of ovary 6593 Manual rupt ovarian cyst 6594 Ovarian denervation 6595 Ovarian torsion release 6599 Ovarian operation NEC 6601 Salpingotomy 6602 Salpingostomy 6611 Fallopian tube biopsy 6619 Fallop tube dx proc NEC 6621 Bilat endosc crush tube 6622 Bilat endosc divis tube Page 63

64 6629 Bilat endos occ tube NEC 6631 Bilat tubal crushing NEC 6632 Bilat tubal division NEC 6639 Bilat tubal destruct NEC 664 Total unilat salpingect 6651 Remove both fallop tubes 6652 Remove solitary fal tube 6661 Destroy fallop tube les 6662 Remov tube & ectop preg 6663 Bilat part salpingec NOS 6669 Partial salpingectom NEC 6671 Simpl suture fallop tube 6672 Salpingo-oophorostomy 6673 Salpingo-salpingostomy 6674 Salpingo-uterostomy 6679 Fallop tube repair NEC 668 Fallopian tube insufflat 6691 Fallopian tube aspirat 6692 Unilat fallop tube destr 6693 Impl fallop tube prosth 6694 Remov fallop tube prosth 6695 Blow therapeut into tube 6696 Fallopian tube dilation 6697 Bury fimbriae in uterus 6699 Fallopian tube op NEC 670 Cervical canal dilation 6711 Endocervical biopsy 6712 Cervical biopsy NEC 6719 Cervical dx procedur NEC 672 Conization of cervix 6731 Cervical cyst marsupial 6732 Cervical les cauterizat 6733 Cervical les cryotherapy 6739 Cervical les destruc NEC 674 Amputation of cervix 6751 Transab cerclage cervix 6759 Oth rep int cervical os 6761 Suture cervical lacerat 6762 Cervical fistula repair 6769 Cervical repair NEC 680 Hysterotomy 6811 Digital exam of uterus 6812 Hysteroscopy 6813 Open uterine biopsy 6814 Open uterine ligament bx 6815 Clos uterine ligament bx 6816 Closed uterine biopsy 6819 Uterus/adnex dx proc NEC 6821 Endomet synechiae divis 6822 Incision uterine septum 6823 Endometrial ablation 6824 Uterine art emb w coils 6825 Uterine art emb w/o coil 6829 Uterine les destruct NEC 6831 Lap scervic hysterectomy 6839 Subtotl abd hyst NEC/NOS 6841 Lap total abdominal hyst 6849 Total abd hyst NEC/NOS 6851 Lap ast vag hysterectomy Page 64

65 6859 Vag hysterectomy NEC/NOS 6861 Lap radical abdomnl hyst 6869 Radical abd hyst NEC/NOS 6871 Lap radical vaginal hyst 6879 Radical vag hyst NEC/NOS 688 Pelvic evisceration 689 Hysterectomy NEC/NOS 6901 D & C for preg terminat 6902 D & C post delivery 6909 D & C NEC 6919 Destruc uter support NEC 6921 Interposit op uterin lig 6922 Uterine suspension NEC 6923 Vag repair invers uterus 6929 Uterus/adnexa repair NEC 693 Paracerv uterine denerv 6941 Suture uterine lacerat 6942 Closure uterine fistula 6949 Uterine repair NEC 6951 Aspirat curet-preg termi 6952 Aspirat curet-post deliv 6959 Aspir curett uterus NEC 696 Menstrual extraction 697 Insertion of iud 6991 Insert uterine device 6992 Artificial insemination 6993 Insertion of laminaria 6994 Man replace invert uter 6995 Incision of cervix 6996 Remove cervical cerclage 6997 Remove penetrat cerv FB 6998 Uterine support op NEC 6999 Uterine operation NEC 700 Culdocentesis 7011 Hymenotomy 7012 Culdotomy 7013 Intralum vag adhesiolys 7014 Vaginotomy NEC 7021 Vaginoscopy 7022 Culdoscopy 7023 Cul-de-sac biopsy 7024 Vaginal biopsy 7029 Vagin/cul-de-sac dx NEC 7031 Hymenectomy 7032 Excis cul-de-sac lesion 7033 Excision vaginal lesion 704 Vaginal obliteration 7050 Cystocel/rectocel repair 7051 Cystocele repair 7052 Rectocele repair 7053 Cysto & recto w grf/pros 7054 Rep cystocel w grft/pros 7055 Rep rectocele w grf/pros 7061 Vaginal construction 7062 Vaginal reconstruction 7071 Suture vagina laceration 7072 Repair colovagin fistula 7073 Repair rectovag fistula 7074 Rep vaginoent fistul NEC Page 65

66 7075 Repair vag fistula NEC 7076 Hymenorrhaphy 7077 Vaginal suspens & fixat 7078 Vag susp/fix w grft/pros 7079 Vaginal repair NEC 708 Vaginal vault obliterat 7091 Vaginal operation NEC 7092 Cul-de-sac operation NEC 7093 Cul-de-sac grf/pros NEC 7094 Insert biological graft 7095 Insert synth graft/prost 7101 Vulvar adhesiolysis 7109 Incis vulva/perineum NEC 7111 Vulvar biopsy 7119 Vulvar diagnos proc NEC 7121 Percutan bartholin aspir 7122 Incise bartholin's gland 7123 Bartholin gland marsup 7124 Destruc bartholin gland 7129 Bartholin's gland op NEC 713 Local vulvar excis NEC 714 Operations on clitoris 715 Radical vulvectomy 7161 Unilateral vulvectomy 7162 Bilateral vulvectomy 7171 Suture vulvar laceration 7172 Repair vulvar fistula 7179 Vulvar/perin repair NEC 718 Other vulvar operations 719 Other female genital ops 720 Low forceps operation 721 Low forceps w episiotomy 7221 Mid forceps w episiotomy 7229 Mid forceps op NEC 7231 High forceps w episiot 7239 High forceps op NEC 724 Forceps rotat fetal head 7251 Part brch extrac w forcp 7252 Part breech extract NEC 7253 Tot brch extrac w forcep 7254 Tot breech extrac NEC 726 Forceps-aftercoming head 7271 Vacuum ext del w episiot 7279 Vacuum extract del NEC 728 Instrument delivery NEC 729 Instrument delivery NOS 7301 Induct labor-rupt memb 7309 Artif rupt membranes NEC 731 Surg induct labor NEC 7321 Int/comb version no extr 7322 Int/comb version w extr 733 Failed forceps 734 Medical induction labor 7351 Manual rotat fetal head 7359 Manual assist deliv NEC 736 Episiotomy 738 Fetal ops-facilitate del 7391 Ext version-assist deliv 7392 Replace prolapsed cord Page 66

67 7393 Incis cx to assist deliv 7394 Pubiotomy to assist del 7399 Ops assisting deliv NEC 740 Classical c-section 741 Low cervical c-section 742 Extraperitoneal c-sect 743 Rem extratub ectop preg 744 Cesarean section NEC 7491 Hysterotomy to termin pg 7499 Cesarean section NOS 750 Intra-amnion inj for ab 751 Diagnostic amniocentesis 752 Intrauterine transfusion 7531 Amnioscopy 7532 Fetal ekg 7533 Fetal blood sample/bx 7534 Other fetal monitoring 7535 Dx proc fetus/amnion NEC 7536 Correction fetal defect 7537 Amnioinfusion 7538 Fetal pulse oximetry 754 Manual removal-placenta 7550 Repair ob lac uterus NOS 7551 Repair ob lacerat cervix 7552 Repair ob lac corp uteri 7561 Repair ob lac blad/ureth 7562 Repair ob lac rect/anus 7569 Repair ob laceration NEC 757 Manual explor uterus p/p 758 Ob tamponade uterus/vag 7591 Evac ob inc hemat perin 7592 Evac ob hemat vulva/vag 7593 Surg corr invert uterus 7594 Man replac invert uterus 7599 Obstetric operation NEC 8781 X-ray of gravid uterus 8782 Gas hysterosalpingogram 8783 Dye hysterosalpingogram 8784 Percutaneous hysterogram 8785 Tube & uterus x-ray NEC 8789 Female genital x-ray NEC 8846 Contrast placentogram 8878 Dx ultrasound-grav uter 8926 Gynecologic examination 9141 Bact smear-female genit 9142 Culture-female genital 9143 C & s-female genital 9144 Parasitology-female gen 9145 Toxicology-female genit 9146 Cell blk/pap-female gen 9149 Micro exam-femal gen NEC 9217 Placental scan 9614 Vaginal packing 9615 Vaginal mold insertion 9616 Other vaginal dilation 9617 Vag diaphragm insertion 9618 Oth vagin pessary insert 9644 Vaginal douche 9724 Replace vag diaphragm Page 67

68 9725 Replace vaginal pessary 9726 Replace vag/vulv packing 9771 Removal iud 9772 Remov intrauterine pack 9773 Remov vaginal diaphragm 9774 Removal oth vag pessary 9775 Remov vag/vulv packing 9816 Remov intralum uter FB 9817 Remov intralum vag FB 9823 Removal vulvar FB 9998 Milk extraction Diagnoses for males only TB epididymis-unspec TB epididymis-no exam TB epididymis-exam unkn TB epididymis-micro dx TB epididymis-cult dx TB epididymis-histo dx TB epididymis-oth test TB male genit NEC-unspec TB male gen NEC-no exam TB male gen NEC-ex unkn TB male gen NEC-micro dx TB male gen NEC-cult dx TB male gen NEC-histo dx TB male gen NEC-oth test Herpetic infect of penis 0720 Mumps orchitis Gc prostatitis (acute) Gc orchitis (acute) Gc sem vesiculit (acute) Gc prostatitis, chronic Gc orchitis, chronic Gc sem vesiculitis, chr Trichomonal prostatitis 1750 Mal neo male nipple 1759 Mal neo male breast NEC 185 Malign neopl prostate 1860 Mal neo undescend testis 1869 Malig neo testis NEC 1871 Malign neopl prepuce 1872 Malig neo glans penis 1873 Malig neo penis body 1874 Malig neo penis NOS 1875 Malig neo epididymis 1876 Mal neo spermatic cord 1877 Malign neopl scrotum 1878 Mal neo male genital NEC 1879 Mal neo male genital NOS 2144 Lipoma spermatic cord 2220 Benign neoplasm testis 2221 Benign neoplasm penis 2222 Benign neoplasm prostate 2223 Benign neo epididymis 2224 Benign neoplasm scrotum Page 68

69 2228 Ben neo male genital NEC 2229 Ben neo male genital NOS 2334 Ca in situ prostate 2335 Ca in situ penis 2336 Ca in situ male gen NEC 2364 Unc behav neo testis 2365 Unc behav neo prostate 2366 Unc behav neo male NEC 2570 Testicular hyperfunction 2571 Postablat testic hypofun 2579 Testicular dysfunct NOS Male orgasmic disorder Premature ejaculation 4564 Scrotal varices BPH w/o urinary obs/luts BPH w urinary obs/luts Nod prostate w/o ur obst Nod prostate w ur obst BPH loc w/o ur obs/luts BPH loc w urin obs/luts 6003 Cyst of prostate BPH NOS w/o ur obs/luts BPH NOS w ur obs/luts 6010 Acute prostatitis 6011 Chronic prostatitis 6012 Abscess of prostate 6013 Prostatocystitis 6014 Prostatitis in oth dis 6018 Prostatic inflam dis NEC 6019 Prostatitis NOS 6020 Calculus of prostate 6021 Prostatic congest/hemorr 6022 Atrophy of prostate 6023 Dysplasia of prostate 6028 Prostatic disorders NEC 6029 Prostatic disorder NOS 6030 Encysted hydrocele 6031 Infected hydrocele 6038 Hydrocele NEC 6039 Hydrocele NOS 6040 Orchitis with abscess Orchitis/epididymit NOS Orchitis in oth disease Orchitis/epididymit NEC 605 Redun prepuce & phimosis 6060 Azoospermia 6061 Oligospermia 6068 Male infertility NEC 6069 Male infertility NOS 6070 Leukoplakia of penis 6071 Balanoposthitis 6072 Inflam dis, penis NEC 6073 Priapism Balanitis xerotica oblit Vascular disorder, penis Edema of penis Impotence, organic orign Peyronie's disease Disorder of penis NEC Page 69

70 6079 Disorder of penis NOS 6080 Seminal vesiculitis 6081 Spermatocele Torsion of testis NOS Extravag tors sperm cord Intravag tors sperm cord Torsion appendix testis Torsion appy epididymis 6083 Atrophy of testis 6084 Male gen inflam dis NEC Male gen dis in oth dis Hematospermia Male gen vascul dis NEC Chylocele, tunic vaginal Stricture, male gen orgn Edema, male genital orgn Retrograde ejaculation Male genital dis NEC 6089 Male genital dis NOS Undescended testis Retractile testis Hypospadias Epispadias Congenital chordee Micropenis Hidden penis Penile anomalies NEC Scrotal transposition 7587 Klinefelter's syndrome Stress incontinence male Elvtd prstate spcf antgn 7922 Abn findings-semen 8780 Open wound of penis 8781 Open wound penis-compl 8782 Opn wound scrotum/testes 8783 Opn wnd scrot/test-compl 9393 Foreign body penis Fx corpus cavrnosm penis V1045 Hx-male genit malig NOS V1046 Hx-prostatic malignancy V1047 Hx-testicular malignancy V1048 Hx-epididymis malignancy V1049 Hx-male genit malig NEC V1361 Hx-hypospadias V2634 Male genetc test dis car V2635 Test male/fem preg loss V2639 Male genetic test NEC V2652 Vasectomy status V502 Routine circumcision V7644 Scrn malig neop-prostate V7645 Screen malig neop-testis V8403 Genetc sus mal neo prost Page 70

71 Procedures for males only 600 Incision of prostate 6011 Closed prostatic biopsy 6012 Open prostatic biopsy 6013 Clos seminal vesicles bx 6014 Open seminal vesicles bx 6015 Periprostatic biopsy 6018 Prostatic dx proced NEC 6019 Semin ves dx proced NEC 6021 Transureth prostatectomy 6029 Oth transureth prostatec 603 Suprapubic prostatectomy 604 Retropubic prostatectomy 605 Radical prostatectomy 6061 Los excis prostatic les 6062 Perineal prostatectomy 6069 Prostatectomy NEC 6071 Percut semin ves aspirat 6072 Seminal vesicle incision 6073 Seminal vesicle excision 6079 Seminal vesicle op NEC 6081 Periprostatic incision 6082 Periprostatic excision 6091 Percut prostatic aspirat 6092 Injection into prostate 6093 Repair of prostate 6094 Control prostate hemorr 6095 Trans bal dil pros ureth 6096 Tu destr prostate by mt 6097 Oth tu destr pros - rt 6099 Prostatic operation NEC 610 Scrotum & tunica i & d 6111 Scrotum & tunica biopsy 6119 Scrot/tunica dx proc NEC 612 Excision of hydrocele 613 Scrotal les destruction 6141 Suture scrotal lacerat 6142 Scrotal fistula repair 6149 Scrotum/tunic repair NEC 6191 Percut tunica aspiration 6192 Excision tunica les NEC 6199 Scrotum & tunica op NEC 620 Incision of testes 6211 Closed testicular biopsy 6212 Open testicular biopsy 6219 Testes dx procedure NEC 622 Testicular les destruct 623 Unilateral orchiectomy 6241 Remove both testes 6242 Remove solitary testis 625 Orchiopexy 6261 Suture testicular lacer 6269 Testicular repair NEC 627 Insert testicular prosth 6291 Aspiration of testes Page 71

72 6292 Injection into testes 6299 Testicular operation NEC 6301 Spermatic cord/vas biops 6309 Spermat cord/vas dx NEC 631 Exc spermatic varicocele 632 Excise epididymis cyst 633 Excise cord/epid les NEC 634 Epididymectomy 6351 Suture cord & epid lacer 6352 Reduction torsion testes 6353 Transplant spermat cord 6359 Cord & epidid repair NEC 636 Vasotomy 6370 Male sterilization NOS 6371 Ligation of vas deferens 6372 Spermatic cord ligation 6373 Vasectomy 6381 Suture vas & epidid lac 6382 Postop vas reconstruct 6383 Epididymovasostomy 6384 Removal vas ligature 6385 Remov vas deferens valve 6389 Vas & epididy repair NEC 6391 Spermatocele aspiration 6392 Epididymotomy 6393 Spermatic cord incision 6394 Sperm cord adhesiolysis 6395 Insert valve in vas def 6399 Cord/epid/vas ops NEC 640 Circumcision 6411 Penile biopsy 6419 Penile diagnost proc NEC 642 Local excis penile les 643 Amputation of penis 6441 Suture penile laceration 6442 Release of chordee 6443 Construction of penis 6444 Reconstruction of penis 6445 Replantation of penis 6449 Penile repair NEC 645 Sex transformat op NEC 6491 Dorsal/lat slit prepuce 6492 Incision of penis 6493 Division of penile adhes 6494 Fit ext penile prosthes 6495 Ins noninfl penis prosth 6496 Remove int penile prosth 6497 Ins inflate penis prosth 6498 Penile operation NEC 6499 Male genital op NEC 8791 Contr semin vesiculogram 8792 Prostat/sem ves xray NEC 8793 Contrast epididymogram 8794 Contrast vasogram 8795 Epididymis/vas x-ray NEC 8799 Male genital x-ray NEC 9824 Removal scrotal/penis FB 9994 Prostatic massage 9995 Stretching of foreskin Page 72

73 9996 Sperm collection 6. Manifestation code as principal diagnosis Manifestation codes describe the manifestation of an underlying disease, not the disease itself, and therefore should not be used as a principal diagnosis. The following list contains ICD-9-CM diagnoses with corresponding English descriptions identified as manifestation codes. Manifestations not allowed as principal diagnosis 2842 Myelophthisis Splenic sequestration Myelofibrosis Dementia w/o behav dist Dementia w behavior dist 3207 Mening in oth bact dis 3210 Cryptococcal meningitis 3211 Mening in oth fungal dis 3212 Mening in oth viral dis 3213 Trypanosomiasis meningit 3214 Meningit d/t sarcoidosis 3218 Mening in oth nonbac dis Enceph/encephmye oth dis Myelitis-oth viral dis 3231 Rickettsial encephalitis 3232 Protozoal encephalitis Ot encph/mye ot inf else Oth myelitis ot inf else Inf ac dis encephalomyel Postinf encephalitis NEC Postinfectious myelitis Toxic encph & encephlomy Toxic myelitis Insomnia in other dis Insomnia dt mental disor Hypersomnia in other dis Hypersom dt mental disor Sleep hypovent oth dis Cntrl sleep apnea ot dis Circadian rhym oth dis Parasomnia oth diseases 3302 Cereb degen in lipidosis 3303 Cerb deg chld in oth dis 3317 Cereb degen in oth dis 3344 Cerebel atax in oth dis 3362 Comb deg cord in oth dis 3363 Myelopathy in oth dis 3371 Aut neuropthy in oth dis Acute myelitis oth cond Narclpsy w/o cat oth dis Narcolepsy w cat oth dis Page 73

74 3571 Neurpthy in col vasc dis 3572 Neuropathy in diabetes 3573 Neuropathy in malig dis 3574 Neuropathy in other dis 3581 Myasthenia in oth dis Lambert-Eaton syn ot dis 3595 Myopathy in endocrin dis 3596 Infl myopathy in oth dis Diabetic retinopathy NOS Prolif diab retinopathy Nonprolf db retnoph NOS Mild nonprolf db retnoph Mod nonprolf db retinoph Sev nonprolf db retinoph Diabetic macular edema Ret dystrph in lipidoses Ret dystrph in syst dis Chr iridocyl in oth dis Glaucoma w systemic synd Diabetic cataract Tetanic cataract Myotonic cataract Cataract w syndrome NEC Keratitis in exanthema Phthisical cornea Parasitic conjunctivitis Rosacea conjunctivitis Mucocutan dis conjunctiv 3734 Infect derm lid w deform 3735 Infec dermatitis lid NEC 3736 Parasitic infest eyelid Xanthelasma Parasite infest, orbit Thyrotoxic exophthalmos Exophthalm ophthalmopleg Ac infect extern ear NEC Chr mycot otitis externa Ac supp OM in oth dis 4200 Ac pericardit in oth dis 4211 Ac endocardit in oth dis 4220 Ac myocardit in oth dis Endocarditis in oth dis 4257 Metabolic cardiomyopathy 4258 Cardiomyopath in oth dis Angiopathy in other dis Bleed esoph var oth dis Esoph varice oth dis NOS 4841 Pneum w cytomeg incl dis 4843 Pneumonia in whoop cough 4845 Pneumonia in anthrax 4846 Pneum in aspergillosis 4847 Pneum in oth sys mycoses 4848 Pneum in infect dis NEC 5161 Idio pulm hemosiderosis 5171 Rheumatic pneumonia 5172 Syst sclerosis lung dis 5173 Acute chest syndrome 5178 Lung involv in oth dis Acq absence of teeth NOS Page 74

75 52511 Loss of teeth d/t trauma Loss teeth d/t peri dis Loss of teeth d/t caries Loss of teeth NEC 5670 Peritonitis in infec dis 5731 Hepatitis in viral dis 5732 Hepatitis in oth inf dis Ac nephritis in oth dis Nephrotic syn in oth dis Chr nephritis in oth dis Nephritis NOS in oth dis Pyelonephrit in oth dis 5954 Cystitis in oth dis Ureth strict:oth infect 6014 Prostatitis in oth dis Orchitis in oth disease Male gen dis in oth dis Vaginitis in oth disease Vulvar ulcer in oth dis 6281 Infertil-pituitary orig Reiter arthritis-unspec Reiter arthritis-shlder Reiter arthritis-up/arm Reiter arthritis-forearm Reiter arthritis-hand Reiter arthritis-pelvis Reiter arthritis-l/leg Reiter arthritis-ankle Reiter arthritis NEC Reiter arthritis-mult Behcet arthritis-unspec Behcet arthritis-shlder Behcet arthritis-up/arm Behcet arthritis-forearm Behcet arthritis-hand Behcet arthritis-pelvis Behcet arthritis-l/leg Behcet arthritis-ankle Behcet arthritis NEC Behcet arthritis-mult Dysenter arthrit-unspec Dysenter arthrit-shlder Dysenter arthrit-up/arm Dysenter arthrit-forearm Dysenter arthrit-hand Dysenter arthrit-pelvis Dysenter arthrit-l/leg Dysenter arthrit-ankle Dysenter arthrit NEC Dysenter arthrit-mult Bact arthritis-unspec Bact arthritis-shlder Bact arthritis-up/arm Bact arthritis-forearm Bact arthritis-hand Bact arthritis-pelvis Bact arthritis-l/leg Bact arthritis-ankle Bact arthritis NEC Page 75

76 71149 Bact arthritis-mult Viral arthritis-unspec Viral arthritis-shlder Viral arthritis-up/arm Viral arthritis-forearm Viral arthritis-hand Viral arthritis-pelvis Viral arthritis-l/leg Viral arthritis-ankle Viral arthritis NEC Viral arthritis-mult Mycotic arthritis-unspec Mycotic arthritis-shlder Mycotic arthritis-up/arm Mycotic arthrit-forearm Mycotic arthritis-hand Mycotic arthritis-pelvis Mycotic arthritis-l/leg Mycotic arthritis-ankle Mycotic arthritis NEC Mycotic arthritis-mult Helminth arthrit-unspec Helminth arthrit-shlder Helminth arthrit-up/arm Helminth arthrit-forearm Helminth arthrit-hand Helminth arthrit-pelvis Helminth arthrit-l/leg Helminth arthrit-ankle Helminth arthrit NEC Helminth arthrit-mult Inf arthritis NEC-unspec Inf arthritis NEC-shlder Inf arthritis NEC-up/arm Inf arthrit NEC-forearm Inf arthritis NEC-hand Inf arthritis NEC-pelvis Inf arthritis NEC-l/leg Inf arthritis NEC-ankle Inf arthrit NEC-oth site Inf arthritis NEC-mult Dicalc phos cryst-unspec Dicalc phos cryst-shlder Dicalc phos cryst-up/arm Dicalc phos crys-forearm Dicalc phos cryst-hand Dicalc phos cryst-pelvis Dicalc phos cryst-l/leg Dicalc phos cryst-ankle Dicalc phos cry-site NEC Dicalc phos cryst-mult Pyrophosph cryst-unspec Pyrophosph cryst-shlder Pyrophosph cryst-up/arm Pyrophosph cryst-forearm Pyrophosph cryst-hand Pyrophosph cryst-pelvis Pyrophosph cryst-l/leg Pyrophosph cryst-ankle Page 76

77 71228 Pyrophos cryst-site NEC Pyrophos cryst-mult Chondrocalcin NOS-unspec Chondrocalcin NOS-shlder Chondrocalcin NOS-up/arm Chondrocalc NOS-forearm Chondrocalcin NOS-hand Chondrocalcin NOS-pelvis Chondrocalcin NOS-l/leg Chondrocalcin NOS-ankle Chondrocalc NOS-oth site Chondrocalcin NOS-mult 7130 Arthrop w endocr/met dis 7131 Arthrop w noninf GI dis 7132 Arthropath w hematol dis 7133 Arthropathy w skin dis 7134 Arthropathy w resp dis 7135 Arthropathy w nerve dis 7136 Arthrop w hypersen react 7137 Arthrop w system dis NEC 7138 Arthrop w oth dis NEC Spondylopathy in oth dis Synovitis in oth dis Polio osteopathy-unspec Polio osteopathy-shlder Polio osteopathy-up/arm Polio osteopathy-forearm Polio osteopathy-hand Polio osteopathy-pelvis Polio osteopathy-l/leg Polio osteopathy-ankle Polio osteopathy NEC Polio osteopathy-mult Bone infect NEC-unspec Bone infect NEC-shlder Bone infect NEC-up/arm Bone infect NEC-forearm Bone infect NEC-hand Bone infect NEC-pelvis Bone infect NEC-l/leg Bone infect NEC-ankle Bone infect NEC-oth site Bone infect NEC-mult 7311 Osteitis def in oth dis 7318 Bone involv in oth dis Spin curv NOS in oth dis Kyphosis in oth dis Lordosis in oth dis Scoliosis in oth dis 7740 Perinat jaund-hered anem Neonat jaund in oth dis 7745 Perinatal jaundice NEC Fever in other diseases Flncy dsord cond elsewhr Septic shock V4031 Wandering-dis elsewhere Page 77

78 7. Non-specific principal diagnosis Effective 10/01/07, the non-specific principal diagnosis edit was discontinued and will appear for claims processed using MCE version only. 8. Questionable admission Some diagnoses are not usually sufficient justification for admission to an acute care hospital. For example, if a patient is given code 4011 for benign hypertension, then the patient would have a questionable admission, since benign hypertension is not normally sufficient justification for admission to a hospital. The following list contains diagnosis codes with corresponding English descriptions identified as questionable admission when used as a principal diagnosis. Questionable admission - principal diagnosis only DMII wo cmp nt st uncntr Obesity NOS 3804 Impacted cerumen 4011 Benign hypertension 4262 Left bb hemiblock 4263 Left bb block NEC 4264 Rt bundle branch block Elvtd prstate spcf antgn 7962 Elev bl pres w/o hypertn 9999 Complic med care NEC/NOS V08 Asymp hiv infectn status V5331 Ftng cardiac pacemaker V5332 Ftng autmtc dfibrillator V5339 Ftng oth cardiac device 9. Unacceptable principal diagnosis There are selected codes that describe a circumstance which influences an individual s health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis. There are a few usually unacceptable principal diagnosis codes that are considered "acceptable" when a secondary diagnosis is also coded on the record. If no secondary diagnosis is present for this subset of codes, the message REQUIRES SECONDARY DX will appear. The following pages contain a list of codes with corresponding English descriptions identified as unacceptable when entered as principal diagnosis. Page 78

79 Note: Codes that require a secondary diagnosis are indicated with an asterisk (*). Unacceptable principal diagnoses 1992 Malig neopl-transp organ Post tp lymphprolif dis Graft-versus-host NOS Ac graft-versus-host dis Chronc graft-vs-host dis Ac on chrn grft-vs-host 3051 Tobacco use disorder 3533 Thoracic root lesion NEC Lambert-Eaton synd neopl Glaucoma stage NOS Mild stage glaucoma Moderate stage glaucoma Severe stage glaucoma Indeterm stage glaucoma 3708 Keratitis NEC 4142 Chr tot occlus cor artry 4143 Cor ath d/t lpd rch plaq 4144 Cor ath d/t calc cor lsn Septic pulmonary embolsm 4233 Cardiac tamponade 4404 Chr tot occl art extrem 449 Septic arterial embolism Sec spont pneumothorax 5735 Hepatopulmonary syndrome 6113 Fat necrosis of breast Exfol d/t eryth <10% bdy Exfl d/t eryth bdy Exfl d/t eryth bdy Exfl d/t eryth bdy Exfl d/t eryth bdy Exfl d/t eryth bdy Exfl d/t eryth bdy Exfl d/t eryth bdy Exfl d/t eryth bdy Exfl d/t eryth >=90% bdy Malignant ascites 7981 Instantaneous death 7982 Death within 24 hr sympt 7989 Unattended death Postop shock, septic V010 Cholera contact V011 Tuberculosis contact V012 Poliomyelitis contact V013 Smallpox contact V014 Rubella contact V015 Rabies contact V016 Venereal dis contact V0181 Contact/exposure-anthrax V0189 Communic dis contact NEC V019 Communic dis contact NOS V020 Cholera carrier V021 Typhoid carrier V022 Amebiasis carrier Page 79

80 V023 V024 V0251 V0252 V0253 V0254 V0259 V0260 V0261 V0262 V0269 V027 V028 V029 V030 V031 V032 V033 V034 V035 V036 V037 V0381 V0382 V0389 V039 V040 V041 V042 V043 V044 V045 V046 V047 V0481 V0482 V0489 V050 V051 V052 V053 V054 V058 V059 V060 V061 V062 V063 V064 V065 V066 V068 V069 V071 V072 V0731 V074 V0751 V0752 GI pathogen carrier NEC Diphtheria carrier Group b streptoc carrier Streptococus carrier NEC Meth susc Staph carrier Meth resis Staph carrier Bacteria dis carrier NEC Viral hep carrier NOS Hepatitis B carrier Hepatitis C carrier Viral hep carrier NEC Gonorrhea carrier Venereal dis carrier NEC Carrier NEC Vaccin for cholera Vacc-typhoid-paratyphoid Vaccin for tuberculosis Vaccin for plague Vaccin for tularemia Vaccin for diphtheria Vaccin for pertussis Tetanus toxoid inoculat Nd vac hmophlus inflnz b Nd vac strptcs pneumni b Nd other specf vacnation Vaccin for bact dis NOS Vaccin for poliomyelitis Vaccin for smallpox Vaccin for measles Vaccin for rubella Vaccin for yellow fever Vaccin for rabies Vaccin for mumps Vaccin for common cold Vaccin for influenza Vaccination for RSV Vaccn/inoc viral dis NEC Arbovirus enceph vaccin Vacc arboviral dis NEC Vaccin for leishmaniasis Need prphyl vc vrl hepat Need prphyl vc varicella Vaccin for disease NEC Vaccin for singl dis NOS Vaccin for cholera + tab Vaccination for DTP-DTaP Vaccin for dtp + tab Vaccin for dtp + polio Vac-measle-mumps-rubella Vaccination for Td-DT Nd vac strp pnumn/inflnz Vac-dis combinations NEC Vac-dis combinations NOS Desensitiza to allergens Prophylact immunotherapy Prophylac fluoride admin Hormone replace postmeno Use of SERMs Use aromatase inhibitors Page 80

81 V0759 V079 V090 V091 V092 V093 V094 V0950 V0951 V096 V0970 V0971 V0980 V0981 V0990 V0991 V1000 V1001 V1002 V1003 V1004 V1005 V1006 V1007 V1009 V1011 V1012 V1020 V1021 V1022 V1029 V103 V1040 V1041 V1042 V1043 V1044 V1045 V1046 V1047 V1048 V1049 V1050 V1051 V1052 V1053 V1059 V1060 V1061 V1062 V1063 V1069 V1071 V1072 V1079 V1081 V1082 V1083 V1084 Use oth agnt af estrogen Prophyl or tx meas NOS Inf mcrg rstn pncllins Inf mcrg rstn b-lactam Inf mcrg rstn macrolides Inf mcrg rstn ttrcycln Inf mcrg rstn amnglcsds Inf mcr rst qn flr nt ml Inf mcrg rstn qn flrq ml Inf mcrg rstn sulfnmides Inf mcr rst oth ag nt ml Inf mcrg rstn oth ag mlt Inf mcr rst ot drg nt ml Inf mcrg rstn oth drg ml Infc mcrg drgrst nt mult Infc mcrg drgrst mult Hx of GI malignancy NOS Hx of tongue malignancy Hx-oral/pharynx malg NEC Hx-esophageal malignancy Hx of gastric malignancy Hx of colonic malignancy Hx-rectal & anal malign Hx of liver malignancy Hx of GI malignancy NEC Hx-bronchogenic malignan Hx-tracheal malignancy Hx-resp org malignan NOS Hx-laryngeal malignancy Hx-nose/ear/sinus malig Hx-intrathoracic mal NEC Hx of breast malignancy Hx-female genit malg NOS Hx-cervical malignancy Hx-uterus malignancy NEC Hx of ovarian malignancy Hx-female genit malg NEC Hx-male genit malig NOS Hx-prostatic malignancy Hx-testicular malignancy Hx-epididymis malignancy Hx-male genit malig NEC Hx-urinary malignan NOS Hx of bladder malignancy Hx of kidney malignancy Hx malig renal pelvis Hx-urinary malignan NEC Hx of leukemia NOS Hx of lymphoid leukemia Hx of myeloid leukemia Hx of monocytic leukemia Hx of leukemia NEC Hx-lymphosarcoma Hx-hodgkin's disease Hx-lymphatic malign NEC Hx of bone malignancy Hx-malig skin melanoma Hx-skin malignancy NEC Hx of eye malignancy Page 81

82 V1085 V1086 V1087 V1088 V1089 V1090 V1091 V110 V111 V112 V113 V114 V118 V119 V1200 V1201 V1202 V1203 V1204 V1209 V121 V1221 V1229 V123 V1240 V1241 V1242 V1249 V1250 V1251 V1252 V1253 V1254 V1255 V1259 V1260 V1261 V1269 V1270 V1271 V1272 V1279 V1300 V1301 V1302 V1303 V1309 V131 V1321 V1322 V1323 V1324 V1329 V133 V134 V1351 V1352 V1359 V1361 Hx of brain malignancy Hx-malign nerve syst NEC Hx of thyroid malignancy Hx-endocrine malign NEC Hx of malignancy NEC Hx malig neoplasm NOS Hx malig neuroendo tumor Hx of schizophrenia Hx of affective disorder Hx of neurosis Hx of alcoholism Hx combat/stress reactn Hx-mental disorder NEC Hx-mental disorder NOS Prsnl hst unsp nfct prst Prsnl hst tuberculosis Prsnl hst poliomyelitis Personal histry malaria Hx Methicln resist Staph Prsnl hst oth nfct parst Hx-nutrition deficiency Hx gestational diabetes Hx-endocr/meta/immun dis Hx-blood diseases Hx nerv sys/snse org NOS Hx benign neoplasm brain Personl hx infection CNS Hx nerv sys/snse org NEC Hx-circulatory dis NOS Hx-ven thrombosis/embols Hx-thrombophlebitis Hx sudden cardiac arrest Hx TIA/stroke w/o resid Hx pulmonary embolism Hx-circulatory dis NEC Hx resp system dis NOS Prsnl hx recur pneumonia Hx resp system dis NEC Prsnl hst unspc dgstv ds Prsnl hst peptic ulcr ds Prsnl hst colonic polyps Prsnl hst ot spf dgst ds Prsnl hst urnr dsrd unsp Prsnl hst urnr dsrd calc Personal history UTI Personl hx nephrotic syn Prsn hst ot spf urn dsrd Hx-trophoblastic disease History-pre-term labor Hx of cervical dysplasia Hx vaginal dysplasia Hx vulvar dysplasia Hx-genital/obs dis NEC Hx-skin/subcutan tis dis Hx of arthritis Hx pathological fracture Hx stress fracture Hx musculoskletl dis NEC Hx-hypospadias Page 82

83 V1362 V1363 V1364 V1365 V1366 V1367 V1368 V1369 V137 V1381 V1389 V139 V140 V141 V142 V143 V144 V145 V146 V147 V148 V149 V1501 V1502 V1503 V1504 V1505 V1506 V1507 V1508 V1509 V151 V1521 V1522 V1529 V153 V1541 V1542 V1549 V1551 V1552 V1553 V1559 V156 V157 V1580 V1581 V1582 V1583 V1584 V1585 V1586 V1587 V1588 V1589 V159 V160 V161 V162 Hx-cong malform-gu Hx-cong malform-nervous Hx-cong malform-eye,face Hx-cong malform-heart Hx-cong malform-resp sys Hx-cong malform-digest Hx-cong malform-skin,ms Hx-congenital malfor NEC Hx-perinatal problems Hx of anaphylaxis Hx diseases NEC Hx of disease NOS Hx-penicillin allergy Hx-antibiot allergy NEC Hx-sulfonamides allergy Hx-anti-infect allergy Hx-anesthetic allergy Hx-narcotic allergy Hx-analgesic allergy Hx-vaccine allergy Hx-drug allergy NEC Hx-drug allergy NOS Hx-peanut allergy Hx-milk prod allergy Hx-eggs allergy Hx-seafood allergy Hx-other food allergy Hx-allergy insct/arachnd Hx-latex allergy Hx-radiogrphc dye allrgy Hx-allergy NEC Hx-major cardiovasc surg Hx in utero proc in preg Hx in utero proc fetus Hx surgery to organs NEC Hx of irradiation Hx of physical abuse Hx of emotional abuse Psychological trauma NEC Hx traumatic fracture Hx traumatc brain injury Hx retained FB, rem Hx injury NEC Hx of poisoning Hx of contraception Hx failed mod sedation Hx of past noncompliance History of tobacco use Hx underimmunizn status Hx-contct/expos asbestos Hx-cont/exps haz bdy fld Hx-contact/exposure lead Hx of ECMO Personal history of fall Hx-health hazards NEC Hx-health hazard NOS Family hx-gi malignancy Fm hx-trach/bronchog mal Fam hx-intrathoracic mal Page 83

84 V163 Family hx-breast malig V1640 Fm hx genital malig NOS V1641 Fm hx ovary malignancy V1642 Fm hx prostate malig V1643 Fm hx testis malig V1649 Fm hx genital malig NEC V1651 Family hx-kidney malig V1652 Fam hx-bladder malig V1659 Fam hx-urinry malig NEC V166 Family hx-leukemia V167 Fam hx-lymph neoplas NEC V168 Family hx-malignancy NEC V169 Family hx-malignancy NOS V170 Fam hx-psychiatric cond V171 Family hx-stroke V172 Fam hx-neurolog dis NEC V173 Fam hx-ischem heart dis V1741 Fam hx sudden card death V1749 Fam hx-cardiovas dis NEC V175 Family hx-asthma V176 Fam hx-chr resp cond NEC V177 Family hx-arthritis V1781 Family hx osteoporosis V1789 Fam hx musculosk dis NEC V180 Fam hx-diabetes mellitus V1811 Fam hx MEN syndrome V1819 Fm hx endo/metab dis NEC V182 Family hx-anemia V183 Fam hx-blood disord NEC V184 Fm hx-intellect disablty V1851 Family hx colonic polyps V1859 Fam hx digest disord NEC V1861 Fam hx-polycystic kidney V1869 Fam hx-kidney dis NEC V187 Family hx-gu disease NEC V188 Fm hx-infect/parasit dis V189 Fam hx genet dis carrier V190 Family hx-blindness V1911 Family history glaucoma V1919 Family hx-eye disord NEC V192 Family hx-deafness V193 Family hx-ear disord NEC V194 Family hx-skin condition V195 Fam hx-congen anomalies V196 Family hx-allergic dis V197 Consanguinity V198 Family hx-condition NEC V201 Care of healthy chld NEC V202 Routin child health exam V2031 Health supvsn nb <8 days V2032 Health supv nb 8-28 days V210 Rapid childhood growth V211 Puberty V212 Adolescence growth NEC V2130 Low birthwt status NOS V2131 Low birthwt status <500g V2132 Low birthwt g V2133 Low birthwt g V2134 Low birthwt g Page 84

85 V2135 Low birthwt g V218 Constit state in dev NEC V219 Constit state in dev NOS V220 Supervis normal 1st preg V221 Supervis oth normal preg V222 Preg state, incidental V230 Preg w hx of infertility V231 Preg w hx-trophoblas dis V232 Preg w hx of abortion V233 Grand multiparity V2341 Preg w hx pre-term labor V2342 Preg w hx ectopic preg V2349 Preg w poor obs hx NEC V235 Preg w poor reproduct hx V237 Insufficnt prenatal care V2381 Suprv elderly primigrav V2382 Suprv elderly multigrav V2383 Suprv young primigravida V2384 Suprv young multigravida V2385 Pregnt-assist repro tech V2386 Preg-hx in utro prev prg V2387 Preg w incon fetl viabil V2389 Suprv high-risk preg NEC V239 Suprv high-risk preg NOS V241 Postpart care-lactation V242 Rout postpart follow-up V2501 Prescrip-oral contracept V2502 Initiate contracept NEC V2503 Contracept mgmt-emergncy V2504 Natrl fam pln-avoid preg V2509 Contraceptive mangmt NEC V2511 Insertion of iud V2512 Removal of iud V2513 Remove/insert iud V2540 Contracept surveill NOS V2541 Contracept pill surveill V2542 Iud surveillance V2543 Srvl mplnt sbdrm cntrcep V2549 Contracept surveill NEC V255 Nsrt mplnt sbdrm cntrcep V258 Contraceptive mangmt NEC V259 Contraceptive mangmt NOS V261 Artificial insemination V2621 Fertility testing V2622 Sterilzation rev aftcare V2629 Investigate & test NEC V2631 Fem genetic test dis car V2632 Female genetic test NEC V2633 Genetic counseling V2634 Male genetc test dis car V2635 Test male/fem preg loss V2639 Male genetic test NEC V2641 Natrl family plan counsl V2642 Fertlity preserv counsel V2649 Procr mgmt cnsl/adv NEC V2651 Tubal ligation status V2652 Vasectomy status V2681 Assist repro fertility V2682 Fertility preserv proc Page 85

86 V2689 V269 V270 V271 V272 V273 V274 V275 V276 V277 V279 V280 V281 V282 V283 V284 V285 V286 V2881 V2882 V2889 V289 V293 V299 V302 V312 V322 V332 V342 V352 V362 V372 V391 V392 V400 V401 V402 V4039 V409 V410 V411 V412 V413 V414 V415 V416 V417 V418 V419 V420 V421 V422 V423 V424 V425 V426 V427 V4281 V4282 Procreative managemt NEC Procreative mangmt NOS Deliver-single liveborn Deliver-single stillborn Deliver-twins, both live Del-twins, 1 nb, 1 sb Deliver-twins, both sb Del-mult birth, all live Del-mult brth, some live Del-mult birth, all sb Outcome of delivery NOS Screening-chromosom anom Screen-alphafetoprotein Screen by amniocent NEC Scr fetl malfrm-ultrasnd Screen-fetal retardation Screen-isoimmunization Antenatal screen strep b Scrn fetal anatmc survey Scrn risk preterm labor Antenatal screening NEC Antenatal screening NOS NB obs genetc/metabl cnd NB obsrv unsp suspct cnd Single liveborn-nonhosp Twin, mate lb-nonhosp Twin, mate sb-nonhosp Twin NOS-nonhosp Oth multiple nb-nonhosp Oth multiple sb-nonhosp Multiple nb/sb-nonhosp Mult birth NOS-nonhosp Liveborn NOS-before adm Liveborn NOS-nonhosp Problems with learning Prob with communication Mental problems NEC Oth spc behavior problem Mental/behavior prob NOS Problems with sight Eye problems NEC Problems with hearing Ear problems NEC Voice production problem Smell and taste problem Problem w swallowing Sexual function problem Probl w special func NEC Probl w special func NOS Kidney transplant status Heart transplant status Heart valve transplant Skin transplant status Bone transplant status Cornea transplant status Lung transplant status Liver transplant status Trnspl status-bne marrow Trspl sts-perip stm cell Page 86

87 V4283 V4284 V4289 V429 V430 V431 V4321 V4322 V433 V434 V435 V4360 V4361 V4362 V4363 V4364 V4365 V4366 V4369 V437 V4381 V4382 V4383 V4389 V440 V441 V442 V443 V444 V4450 V4451 V4452 V4459 V446 V447 V448 V449 V4500 V4501 V4502 V4509 V4511 V4512 V452 V453 V454 V4551 V4552 V4559 V4561 V4569 V4572 V4573 V4574 V4575 V4576 V4577 V4578 V4579 Trnspl status-pancreas Trnspl status-intestines Trnspl status organ NEC Transplant status NOS Eye replacement NEC Lens replacement NEC Heart assist dev replace Artficial heart replace Heart valve replac NEC Blood vessel replac NEC Bladder replacement NEC Joint replaced unspcf Joint replaced shoulder Joint replaced elbow Joint replaced wrist Joint replaced hip Joint replaced knee Joint replaced ankle Oth spcf joint replaced Limb replacement NEC Larynx replacement Breast replacement Artific skin repl status Organ/tiss replacmnt NEC Tracheostomy status Gastrostomy status Ileostomy status Colostomy status Enterostomy status NEC Cystostomy status NOS Cutaneous-vesicos status Appendico-vesicos status Cystostomy status NEC Urinostomy status NEC Artificial vagina status Artif open status NEC Artif open status NOS Status cardc dvce unspcf Status cardiac pacemaker Status autm crd dfbrltr Status oth spcf crdc dvc Renal dialysis status Noncmplnt w renal dialys Ventricular shunt status Intestinal bypass status Arthrodesis status Prsc ntrutr cntrcptv dvc Prsc sbdrml cntrcp mplnt Prsc other cntrcptv dvc Cataract extract status Post-proc st eye/adn NEC Acquire absnce intestine Acquired absence kidney Acq absence urinary trct Acq absence of stomach Acq absence of lung Acq absnce genital organ Acquired absence of eye Acq absence of organ NEC Page 87

88 V4581 V4582 V4583 V4584 V4585 V4586 V4587 V4588 V4589 V460 V462 V463 V468 V469 V470 V471 V472 V473 V474 V475 V479 V480 V481 V482 V483 V484 V485 V486 V487 V488 V489 V490 V491 V492 V493 V494 V495 V4960 V4961 V4962 V4963 V4964 V4965 V4966 V4967 V4970 V4971 V4972 V4973 V4974 V4975 V4976 V4977 V4981 V4982 V4983 V4984 V4985 V4986 Aortocoronary bypass Status-post ptca Breast impl remov status Dental restoratn status Insulin pump status Bariatric surgery status Trnsplnt orgn rem status TPA adm status 24 hr pta Post-proc states NEC Dependence on aspirator Depend-supplement oxygen Wheelchair dependence Machine dependence NEC Machine dependence NOS Intern organ deficiency Mech prob w internal org Cardiorespirat probl NEC Digestive problems NEC Urinary problems NEC Genital problems NEC Probl w internal org NOS Deficiencies of head Deficiencies neck/trunk Mechanical prob w head Mech prob w neck & trunk Sensory problem w head Sensor prob w neck/trunk Disfigurements of head Disfigurement neck/trunk Prob-head/neck/trunk NEC Prob-head/neck/trunk NOS Deficiencies of limbs Mechanical prob w limbs Motor problems w limbs Sensory problems w limbs Disfigurements of limbs Limb problems NEC Status amput up lmb NOS Status amput thumb Status amput oth fingers Status amput hand Status amput wrist Status amput below elbow Status amput above elbow Status amput shoulder Status amput lwr lmb NOS Status amput great toe Status amput othr toe(s) Status amput foot Status amput ankle Status amput below knee Status amput above knee Status amput hip Asympt postmeno status Dental sealant status Await organ transplnt st Bed confinement status Dual sensory impairment Do not resusctate status Page 88

89 V4987 Physical restrain status V4989 Conditn influ health NEC V499 Probl influ health NOS V503 Ear piercing V508 Elective surgery NEC V509 Elective surgery NOS V529 Fitting prosthesis NOS V531 Fit contact lens/glasses V532 Adjustment hearing aid V534 Fit orthodontic device V5350 Fit/adjust intestinl dev V5351 Fit/adj gastric lap band V5359 Fit/adjust gi app-device V536 Fitting urinary devices V537 Fit orthopedic devices V538 Adjustment of wheelchair V5390 Fit/adjust device NOS V5391 Fit/adjust insulin pump V5399 Fit/adjust device NEC V549 Orthopedic aftercare NOS V559 Attn to artif open NOS V562 Fit/adj perit dial cath V5631 Hemodialysis testing V5632 Peritoneal dialysis test V570 Breathing exercises *V571 Physical therapy NEC *V5721 Encntr occupatnal thrpy *V5722 Encntr vocational thrpy *V573 Speech-language therapy V574 Orthoptic training V5781 Orthotic training *V5789 Rehabilitation proc NEC *V579 Rehabilitation proc NOS V582 Blood transfusion, no dx V5830 Attn rem nonsurg dressng V5831 Attn rem surg dressing V5832 Attn removal of sutures V5862 Long-term use antibiotic V5863 Lng use antiplte/thrmbtc V5864 Long-term anti-inflamtry V5865 Long-term use steroids V5868 Lng term bisphosphonates V589 Aftercare NOS V5901 Blood donor-whole blood V5902 Blood donor-stem cells V5909 Blood donor NEC V5970 Egg donor NEC V5971 Egg donor age <35 anon V5972 Egg donor age <35 desig V5973 Egg donor age 35+ anon V5974 Egg donor age 35+ desig V600 Lack of housing V601 Inadequate housing V602 Economic problem V603 Person living alone V604 No family able to care V605 Holiday relief care V606 Person in resident inst V6081 Foster care (status) Page 89

90 V6089 V609 V6101 V6102 V6103 V6104 V6105 V6106 V6107 V6108 V6109 V6110 V6111 V6112 V6120 V6122 V6123 V6124 V6125 V6129 V613 V6141 V6142 V6149 V615 V616 V617 V618 V619 V620 V621 V6221 V6222 V6229 V623 V624 V625 V626 V6281 V6282 V6283 V6285 V6289 V629 V630 V631 V632 V638 V639 V6400 V6401 V6402 V6403 V6404 V6405 V6406 V6407 V6408 V6409 Housing/econo circum NEC Housing/econo circum NOS Fmily dsrpt-fam military Fmily dsrpt-ret military Fmily dsrpt- divorce/sep Family dsrpt-estrangmemt Famly dsrpt-chld custody Family dsrpt-foster care Family dsrpt-death membr Fmly dsrp-fam absnce NEC Family disruption NEC Consl partner prob Cnsl victm partner abuse Cnsl perp partner abuse Cnsl prnt-chld prob NOS Cnsl perp parent chld ab Cnsl prnt-biol chld prob Cnsl prnt-adpt chld prob Cnsl prnt-fstr chld prob Oth parent-child problem Problem w aged parent Alcoholism in family Substance abuse-family Family health probl NEC Multiparity Illegitimate pregnancy Unwanted pregnancy NEC Family circumstances NEC Family circumstance NOS Unemployment Adverse eff-work environ Hx military deployment Hx retrn military deploy Occupationl circumst NEC Educational circumstance Social maladjustment Legal circumstances Refusal of treatment Interpersonal probl NEC Bereavement, uncomplicat Cnsl perp phys/sex abuse Homicidal ideation Psychological stress NEC Psychosocial circum NOS Home remote from hospitl No medical serv in home Wait adm to oth facility No med facilities NEC No med facilities NOS No vaccination NOS No vaccin-acute illness No vaccin-chronc illness No vaccin-immune comp No vaccin-allergy to vac No vaccin-caregiv refuse No vaccination-pt refuse No vaccination-religion No vaccin-prev disease No vaccination NEC Page 90

91 V641 V642 V643 V6441 V6442 V6443 V6511 V6519 V653 V6540 V6541 V6542 V6543 V6544 V6545 V6546 V6549 V655 V658 V659 V665 V667 V669 V679 V6801 V6809 V681 V682 V6881 V6889 V689 V690 V691 V692 V693 V695 V698 V699 V700 V702 V703 V706 V708 V709 V719 V7211 V7212 V7219 V722 V725 V7260 V7261 V7262 V7263 V7269 V727 V7284 V7285 V7286 No proc/contraindication No proc/patient decision No proc for reasons NEC Lap surg convert to open Thoracoscop conv to open Arthroscopc conv to open Ped pre-brth vst-parent Person consult for anoth Dietary surveil/counsel Counseling NOS Exercise counseling Counslng sbstn use abuse Counseling injry prevent Hiv counseling Consln ot sex trnsmt dis Insulin pump training Other specfd counseling Persn w feared complaint Reason for consult NEC Reason for consult NOS Convalescence NEC Encountr palliative care Convalescence NOS Follow-up exam NOS Disability examination Issue of med certif NEC Issue repeat prescript Request expert evidence Referral-no exam/treat Administrtve encount NEC Administrtve encount NOS Lack of physical exercse Inapprt diet eat habits High-risk sexual behavr Gambling and betting Behav insomnia-childhood Oth prblms rltd lfstyle Prblm rltd lfstyle NOS Routine medical exam Gen psychiatric exam NEC Med exam NEC-admin purp Health exam-pop survey General medical exam NEC General medical exam NOS Observ-suspect cond NOS Hearing exam-fail screen Hearing conservatn/trtmt Exam ears & hearing NEC Dental examination Radiological exam NEC Laboratory exam NOS Antibody response exam Routine physicl lab exam Pre-procedure lab exam Laboratory exam NEC Skin/sensitization tests Preop exam unspcf Oth specified exam Blood typing encounter Page 91

92 V729 V730 V731 V732 V733 V734 V735 V736 V7381 V7388 V7389 V7398 V7399 V740 V741 V742 V743 V744 V745 V746 V748 V749 V750 V751 V752 V753 V754 V755 V756 V757 V758 V759 V760 V7610 V7611 V7612 V7619 V762 V763 V7641 V7642 V7643 V7645 V7646 V7647 V7649 V7650 V7651 V7652 V7681 V7689 V769 V770 V771 V772 V773 V774 V775 V776 Examination NOS Screening-poliomyelitis Screening for smallpox Screening for measles Screening for rubella Screening-yellow fever Screening-arbovirus dis Screening for trachoma Special screen exam HPV Scrn oth spcf chlmyd dis Scrn oth spcf viral dis Scrn unspcf chlmyd dis Scrn unspcf viral dis Screening for cholera Screening-pulmonary TB Screening for leprosy Screening for diphtheria Screen-bact conjunctivit Screen for veneral dis Screening for yaws Screen-bacterial dis NEC Screen-bacterial dis NOS Screen-rickettsial dis Screening for malaria Screen for leishmaniasis Screen-trypanosomiasis Screen-mycotic infect Screen-schistosomiasis Screen for filariasis Screen for helminthiasis Screen-parasitic dis NEC Screen for infec dis NOS Screen mal neop-resp org Scrn mal neo breast NOS Screen mammogram hi risk Screen mammogram NEC Scrn mal neo breast NEC Screen mal neop-cervix Screen mal neop-bladder Screen mal neop-rectum Screen mal neop-oral cav Screen mal neop-skin Screen malig neop-testis Screen malig neop-ovary Screen malig neop-vagina Screen mal neop oth site Scrn malig neo-intes NOS Screen malig neop-colon Scrn mal neo-small intes Screen neop-nervous syst Screen neoplasm NEC Screen-neoplasm NOS Screen-thyroid disorder Screen-diabetes mellitus Screen for malnutrition Screen-phenylketonuria Screen for galactosemia Screening for gout Screen-cystic fibrosis Page 92

93 V777 V778 V7791 V7799 V780 V781 V782 V783 V788 V789 V790 V791 V792 V793 V798 V799 V8001 V8009 V801 V802 V803 V810 V811 V812 V813 V814 V815 V816 V820 V821 V822 V823 V824 V825 V826 V8271 V8279 V8281 V8289 V829 V8301 V8302 V8381 V8389 V8401 V8402 V8403 V8404 V8409 V8481 V8489 V850 V851 V8521 V8522 V8523 V8524 V8525 V8530 Screen-inborn err metab Screening for obesity Screen lipoid disorders Screen-endoc/nut/met NEC Screen-iron defic anemia Screen-defic anemia NEC Screen-sickle cell dis Scrn-hemoglobinopath NEC Screen-blood dis NEC Screen-blood dis NOS Screening for depression Screening for alcoholism Scrn intellect disabilty Screen-development prob Screen-mental dis NEC Screen-mental dis NOS Screen-traumtc brain inj Screen-neuro condition Screening for glaucoma Screening-eye cond NEC Screening for ear dis Scrn-ischemic heart dis Screen for hypertension Screen-cardiovasc NEC Screen-bronch/emphysema Screen-respir cond NEC Screen for nephropathy Screen for gu cond NEC Screen for skin cond Screen-rheumatoid arthr Screen-rheumat dis NEC Screen-cong hip dislocat Mat pstntl scr-chrm anom Screen-contamination NEC Multiphasic screening Screen-gentc dis carrier Genetic screening NEC Screen - osteoporosis Screen for condition NEC Screen for condition NOS Asympt hemoph a carrier Sympt hemophil a carrier Cystic fibrosis gene car Genetic carrier stat NEC Genetc sus mal neo brest Genetc sus mal neo ovary Genetc sus mal neo prost Genetc susc mal neo endo Genetic susc mal neo NEC Genetc sus mult endo neo Genetic suscept dis NEC BMI less than 19,adult BMI between 19-24,adult BMI ,adult BMI ,adult BMI ,adult BMI ,adult BMI ,adult BMI ,adult Page 93

94 V8531 BMI ,adult V8532 BMI ,adult V8533 BMI ,adult V8534 BMI ,adult V8535 BMI ,adult V8536 BMI ,adult V8537 BMI ,adult V8538 BMI ,adult V8539 BMI ,adult V8541 BMI , adult V8542 BMI , adult V8543 BMI , adult V8544 BMI , adult V8545 BMI 70 and over, adult V8551 BMI,pediatric <5% V8552 BMI,pediatric 5% - <85% V8553 BMI,pediatric 85% - <95% V8554 BMI,pediatric >= 95% V860 Estrogen recep pstv stat V861 Estrogen recep neg stat V8701 Contact/exposure arsenic V8702 Cont/susp expose uranium V8709 Cntct/exp hazrd metl NEC V8711 Cntct/exp aromatc amines V8712 Contact/exposure benzene V8719 Cont/exp haz aromat NEC V872 Cont/exp hazard chem NEC V8731 Contact/exposure mold V8732 Contact/exp algae bloom V8739 Cont/exp hazard sub NEC V8741 Hx antineoplastic chemo V8742 Hx monoclonal drug thrpy V8743 Hx estrogen therapy V8744 Hx inhaled steroid thrpy V8745 Hx systemc steroid thrpy V8746 Hx immunosuppres thrpy V8749 Hx drug therapy NEC V8801 Acq absnce cervix/uterus V8802 Acq ab ut remn cerv stmp V8803 Acq absnc cerv/remain ut V8811 Acq total absnc pancreas V8812 Acq part absnce pancreas V8821 Acq absence of hip joint V8822 Acq absence knee joint V8829 Acq absence of oth joint V8901 Sus amntc cav/mem nt fnd V8902 Sus placentl prob nt fnd V8903 Sus fetal anomaly nt fnd V8904 Sus fetal growth not fnd V8905 Sus cervcl shortn nt fnd V8909 Oth sus mat/ftl nt fnd V9001 Retain deplete uran frag V9009 Retain radioac frag NEC V9010 Retained metal frag NOS V9011 Retain magnet metal frag V9012 Retain nonmag meta frag V902 Retain plastic fragments V9031 Retained quills/spines V9032 Retained tooth Page 94

95 V9033 V9039 V9081 V9083 V9089 V909 V9100 V9101 V9102 V9103 V9109 V9110 V9111 V9112 V9119 V9120 V9121 V9122 V9129 V9190 V9191 V9192 V9199 Retained wood fragments Retain organic frag NEC Retained glass fragments Retain stone/crystl frag Retain FB NEC Retain FB, mat NOS Twin gest-plac/sac NOS Twin gest-monochr/monoam Twin gest-monochr/diamni Twin gest-dich/diamniotc Twin gest-plac/sac undet Tripl gest-plac/sac NOS Triplet gest 2+ monochor Triplet gest 2+ monoamn Tripl gest-plac/sac und Quad gest-plac/sac NOS Quad gest 2+ monochorion Quad gest 2+ monoamniotc Quad gest-plac/sac undet Mult gest-plac/sac NOS Mult gest 2+ monochr NEC Mult gest 2+ monoamn NEC Mult gest-plac/sac undet 10. Non-specific O.R. procedure Effective 10/01/07, the non-specific O.R. procedure edit was discontinued and will appear for claims processed using MCE version only. 11. Non-covered procedure There are some procedures for which Medicare does not provide reimbursement. There are also procedures that would normally not be reimbursed by Medicare but due to the presence of certain diagnoses are reimbursed. The following page contains lists of non-covered procedure codes with corresponding English descriptions, and explains the circumstances in which the edit is applied. Non-covered procedures 1. The following criteria are retroactive effective November 6, The procedure shown below is identified as a non-covered procedure except when combined with non-operating room procedure code 0065 (Perc ins intracran stent). Page 95

96 Procedure 0062 Perc angio intracran ves 2. The following criteria are retroactive effective April 26, ICD-9-CM procedure codes 5280 (Pancreat transplant NOS) and 5282 (Pancreatic homotransplan) alone [without 5569 (Kidney transplant NEC)] are considered "Non-covered procedures" except for the following condition: When either 5280 or 5282 is combined with at least one principal or secondary diagnosis code from the following diagnoses list: Diagnoses list DMI wo cmp nt st uncntrl DMI wo cmp uncntrld DMI keto nt st uncntrld DMI ketoacd uncontrold DMI hprsm nt st uncntrld DMI hprosmlr uncontrold DMI o cm nt st uncntrld DMI oth coma uncontrold DMI renl nt st uncntrld DMI renal uncntrld DMI ophth nt st uncntrld DMI ophth uncntrld DMI neuro nt st uncntrld DMI neuro uncntrld DMI circ nt st uncntrld DMI circ uncntrld DMI oth nt st uncntrld DMI oth uncntrld DMI unspf nt st uncntrld DMI unspf uncntrld 2513 Postsurg hypoinsulinemia (This code is only effective for this edit from 10/01/10 forward. It is not retroactive.) 3. The following criteria are retroactive effective May 1, The procedure shown below is identified as a non-covered procedure except when combined with diagnosis code V707 (Exam-clincal trial). Procedure 3752 Imp tot int bi ht rp sys The procedures shown below are always identified as non-covered procedures Keratomileusis 1172 Keratophakia 1175 Radial keratotomy Page 96

97 1176 Epikeratophakia 3735 Partial ventriculectomy 3753 Repl/rep thr unt tot hrt 3754 Repl/rep oth tot hrt sys 3928 Extracran-intracr bypass 4493 Insert gastric bubble 5051 Auxiliary liver transpl 5283 Pancreatic heterotranspl 5796 Implant bladder stimulat 5797 Replace bladder stimulat 6370 Male sterilization NOS 6371 Ligation of vas deferens 6372 Spermatic cord ligation 6373 Vasectomy 645 Sex transformat op NEC 6621 Bilat endosc crush tube 6622 Bilat endosc divis tube 6629 Bilat endos occ tube NEC 6631 Bilat tubal crushing NEC 6632 Bilat tubal division NEC 6639 Bilat tubal destruct NEC 9852 Eswl gb/bile duct 9859 Eswl other sites The procedures shown below are identified as non-covered procedures only when any code from the diagnoses list shown below is present as either a principle or secondary diagnosis. Procedures 4101 Auto bone mt w/o purg 4104 Auto hem stem ct w/o pur 4107 Auto hem stem ct w purg 4109 Auto bone mt w purging Diagnoses Ac lym leuk wo achv rmsn Ac myl leuk wo achv rmsn Ch myl leuk wo achv rmsn Chr myl leuk w rmsion Ac mono leu wo achv rmsn Ac erth/erlk wo ach rmsn Ac leu un cl wo ach rmsn The procedures shown below are identified as non-covered procedures only when any code from the diagnoses list shown below is present as either a principle or secondary diagnosis. Procedures 4102 Alo bone marrow trnsplnt 4103 Allogrft bone marrow NOS 4105 Allo hem stem ct w/o pur 4108 Allo hem stem ct w purg Page 97

98 Diagnoses Mult mye w/o achv rmson Mult myelm w remission The procedure shown below is identified as a "Non-covered procedure" when the beneficiary is over age 60. Procedure 8465 Ins totl disc pros lumb Open biopsy check Effective 10/01/10, the open biopsy check edit was discontinued and will appear for claims processed using MCE version only. 13. Bilateral procedure Certain codes do not accurately reflect procedures performed in one admission on two or more different bilateral joints of the lower extremities. A combination of these codes shows a bilateral procedure when they could be procedures performed on a single joint (i.e., duplicate procedures). For example, if 8151 (Total hip replacement) and 8152 (Partial hip replacement) are both coded on the claim, the edit "bilateral procedure" will appear. This edit instructs the fiscal intermediary to ensure that these procedures were performed on two separate joints. However, if 8151 (Total hip replacement) is coded twice, the edit would not appear because this signifies a true bilateral procedure. The following list contains the joint replacement procedure codes with corresponding English descriptions identified as "bilateral procedure" whenever two or more different joint procedures are coded, and the principal diagnosis causes assignment to MDC 8. Bilateral procedure codes 0070 Rev hip repl-acetab/fem 0080 Rev knee replacemt-total 0085 Resrf hip,total-acet/fem 0086 Resrf hip,part-fem head 0087 Resrf hip,part-acetablum 8151 Total hip replacement 8152 Partial hip replacement 8154 Total knee replacement 8156 Total ankle replacement Page 98

99 14. Invalid age A patient s age may be necessary for appropriate DRG determination. If the age reported is not between 0 years and 124 years, the Medicare Code Editor will assume the age is in error. 15. Invalid sex A patient s sex (gender) may be necessary for appropriate DRG determination. The sex code reported must be either 1 (male) or 2 (female). 16. Invalid discharge status A patient s discharge status may be necessary for appropriate DRG determination. Discharge status must be coded according to the UB-04 conventions. Valid values are: 01 = Home or self-care 02 = Disch/trans to another short term hospital 03 = Disch/trans to SNF 04 = Disch/trans to ICF (valid until 9/30/09) 04 = Cust/supp care (added 10/01/09) 05 = Disch/trans to another type of facility (valid until 03/31/08) 05 = Disch/trans to a designated cancer center or children s hospital (added 04/01/08) 06 = Care of home health service 07 = Left against medical advice 08 = Home IV service (valid until 09/30/05) 20 = Died 21 = Court/law enfrc (added 10/1/09) 30 = Still a patient 43 = Fed hospital (added 10/01/03) 50 = Hospice-home 51 = Hospice-medical facility 61 = Swing Bed (added 10/01/2001) 62 = Rehab facility/rehab unit (added 10/01/2001) 63 = Long term care hospital (added 10/01/2001) 64 = Nursing facility Medicaid certified (added 10/01/02) Page 99

100 65 = Psych hosp/unit (added 10/01/03) 66 = Critical access hospital (added 10/01/05) 69 = Designated Disaster Alternative Care Site (added 10/01/13) 70 = Discharge/transfer to another type of health care institution not defined elsewhere in the code list (added 04/01/08) 71 = Outpatient services-other facility (10/01/01 09/30/03 only) 72 = Outpatient services-this facility (10/01/01 09/30/03 only) 81 = Home-Self care w Planned Readmission (added 10/01/13) 82 = Short Term Hospital w Planned Readmission (added 10/01/13) 83 = SNF w Planned Readmission (added 10/01/13) 84 = Cust/supp care w Planned Readmission (added 10/01/13) 85 = Canc/child hosp w Planned Readmission (added 10/01/13) 86 = Home Health Service w Planned Readmission (added 10/01/13) 87 = Court/law enfrc w Planned Readmission (added 10/01/13) 88 = Federal Hospital w Planned Readmission (added 10/01/13) 89 = Swing Bed w Planned Readmission (added 10/01/13) 90 = Rehab Facility/ Unit w Planned Readmission (added 10/01/13) 91 = LTCH w Planned Readmission (added 10/01/13) 92 = Nursg Fac-Medicaid Cert w Planned Readmission (added 10/01/13) 93 = Psych Hosp/Unit w Planned Readmission (added 10/01/13) 94 = Crit Acc Hosp w Planned Readmission (added 10/01/13) 95 = Oth Institution w Planned Readmission (added 10/01/13) 17. Limited coverage For certain procedures whose medical complexity and serious nature incur extraordinary associated costs, Medicare limits coverage to a portion of the cost. The limited coverage edit indicates the type of limited coverage. (e.g., Heart transplant-limited coverage, Lung transplant-limited coverage, etc.) Page 100

101 The following is a list of limited coverage procedure codes with corresponding English descriptions. Limited coverage 3222 Lung vol reduction surg 3350 Lung transplant NOS 3351 Unilat lung transplant 3352 Bilat lung transplant 336 Comb heart/lung transpla 3751 Heart transplantation 3766 Implantable hrt assist 4697 Transplant of intestine 5059 Liver transplant NEC 5280 Pancreat transplant NOS 5282 Pancreatic homotransplan 5569 Kidney transplant NEC The following criteria are retroactive effective May 1, The procedure shown below is identified as a limited coverage procedure when combined with diagnosis code V707 (Exam-clincal trial). Procedure 3752 Imp tot int bi ht rp sys 18. Wrong procedure performed Certain E-codes indicate that the wrong procedure was performed. The following list contains the codes, with corresponding English descriptions, that indicate the wrong procedure was performed. Wrong procedure performed E8765 E8766 E8767 Perfrm wrong op/right pt Proc-pt not sched surg Rt proc-wrong side/part Page 101

102 19. Procedure inconsistent with length of stay The following procedure code should only be coded on claims with a length of stay of four days or greater. Procedure inconsistent with length of stay 9672 Continuous invasive mechanical ventilation for 96 consecutive hours or more Page 102

103 Chapter 2: Code list changes This chapter summarizes the changes in the edit code lists from the last release of the Medicare Code Editor (MCE) software to the current one. The code lists are part of chapter 1 in this manual. Changes to existing edits Codes 7511 Atresia small intestine, 7512 Atresia large intestine, and Biliary atresia were removed from the pediatric edit effective 10/01/13. The following discharge status codes were added effective 10/01/13: 69 Designated Disaster Alternative Care Site 81 Home-Self care w Planned Readmission 82 Short Term Hospital w Planned Readmission 83 SNF w Planned Readmission 84 Cust/supp care w Planned Readmission 85 Canc/child hosp w Planned Readmission 86 Home Health Service w Planned Readmission 87 Court/law enfrc w Planned Readmission 88 Federal Hospital w Planned Readmission 89 Swing Bed w Planned Readmission 90 Rehab Facility/ Unit w Planned Readmission 91 LTCH w Planned Readmission 92 Nursg Fac-Medicaid Cert w Planned Readmiss 93 Psych Hosp/Unit w Planned Readmission 94 Crit Acc Hosp w Planned Readmission 95 Oth Institution w Planned Readmission Page 103

104

105 Index A Adult age categories... 8 diagnosis codes Manifestation code as principal diagnosis Age categories... 8 adult maternity newborn... 8 pediatric Age conflict... 8 adult diagnosis codes maternity diagnosis codes newborn diagnsis codes... 8 pediatric diagnosis codes B Bilateral procedure C Code lists... 7 Codes adult diagnoses age conflict... 8, 13, 14, 34 diagnoses allowed for females only maternity diagnoses newborn diagnoses... 8 non-covered procedure pediatric diagnoses valid discharge status D Diagnoses allowed for females only codes 36 Duplicate of PDX... 8 example... 8 E E-code as principal diagnosis... 7 E-codes... 7 Edit list... 7 Edits age conflict... 8 bilateral procedure I duplicate of PDX... 8 E-code as principal diagnoses... 7 invalid age invalid discharge status invalid sex limited coverage manifestation code as principal diagnosis non-covered procedure non-specific O.R. procedure non-specific principal diagnosis open biopsy check procedure inconsistent with LOS questionable admission requires secondary diagnosis sex conflict unacceptable principal diagnosis wrong procedure performed Invalid age Invalid discharge status Invalid sex L Limited coverage List of edits... 7 M Manifestation code as principal diagnosis 73 Maternity age categories... 8 diagnosis codes N Newborn age categories... 8 diagnosis codes... 8 Non-covered procedure codes Non-specific O.R. procedure Non-specific principal diagnosis O Open biopsy check P Pediatric age categories... 8 Page 105

106 Index diagnosis codes Procedure inconsistent with LOS Q Questionable admission Requires secondary diagnosis S Sex conflict diagnosis allowed for females only. 36, 68 U UB-04 discharge status code list Unacceptable principal diagnosis V Valid discharge status codes W Wrong procedure performed Page 106