Oregon Health Authority Division of Medical Assistance Programs Diagnosis codes that do not require a POA indicator

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1 1370 Late effects of respiratory or unspecified tuberculosis 1371 Late effects of central nervous system tuberculosis 1372 Late effects of genitourinary tuberculosis 1373 Late effects of tuberculosis of bones and joints 1374 Late effects of tuberculosis of other specified organs 138 Late effects of acute poliomyelitis 1390 Late effects of viral encephalitis 1391 Late effects of trachoma 1398 Late effects of other and unspecified infectious and parasitic diseases 2681 Rickets, late effect 326 Late effects of intracranial abscess or pyogenic infection 412 Old myocardial infarction 4380 Late effects of cerebrovascular disease, cognitive deficits Late effects of cerebrovascular disease, speech and language deficit, unspecified Late effects of cerebrovascular disease, aphasia Late effects of cerebrovascular disease, dysphasia Late effects of cerebrovascular disease, dysarthria Late effects of cerebrovascular disease, fluency disorder Late effects of cerebrovascular disease, other speech and language deficits Late effects of cerebrovascular disease, hemiplegia affecting unspecified side Late effects of cerebrovascular disease, hemiplegia affecting dominant side Late effects of cerebrovascular disease, hemiplegia affecting nondominant side Late effects of cerebrovascular disease, monoplegia of upper limb affecting unspecified side Late effects of cerebrovascular disease, monoplegia of upper limb affecting dominant side Late effects of cerebrovascular disease, monoplegia of upper limb affecting nondominant side Late effects of cerebrovascular disease, monoplegia of lower limb affecting unspecified side Late effects of cerebrovascular disease, monoplegia of lower limb affecting dominant side Late effects of cerebrovascular disease, monoplegia of lower limb affecting nondominant side Late effects of cerebrovascular disease, other paralytic syndrome affecting unspecified side Late effects of cerebrovascular disease, other paralytic syndrome affecting dominant side Late effects of cerebrovascular disease, other paralytic syndrome affecting nondominant side Late effects of cerebrovascular disease, other paralytic syndrome, bilateral 4386 Late effects of cerebrovascular disease, alterations of sensations 4387 Late effects of cerebrovascular disease, disturbances of vision Other late effects of cerebrovascular disease, apraxia Other late effects of cerebrovascular disease, dysphagia Other late effects of cerebrovascular disease, facial weakness Other late effects of cerebrovascular disease, ataxia Other late effects of cerebrovascular disease, vertigo Other late effects of cerebrovascular disease 4389 Unspecified late effects of cerebrovascular disease 650 Normal delivery Failed forceps or vacuum extractor, unspecified, unspecified as to episode of care or not applicable Page 1 of 54 Effective 10/1/2014

2 66071 Failed forceps or vacuum extractor, unspecified, delivered, with or without mention of antepartum condition Failed forceps or vacuum extractor, unspecified, antepartum condition or complication 677 Late effect of complication of pregnancy, childbirth, and the puerperium 7400 Anencephalus 7401 Craniorachischisis 7402 Iniencephaly Spina bifida with hydrocephalus, unspecified region Spina bifida with hydrocephalus, cervical region Spina bifida with hydrocephalus, dorsal (thoracic) region Spina bifida with hydrocephalus, lumbar region Spina bifida without mention of hydrocephalus, unspecified region Spina bifida without mention of hydrocephalus, cervical region Spina bifida without mention of hydrocephalus, dorsal (thoracic) region Spina bifida without mention of hydrocephalus, lumbar region 7420 Encephalocele 7421 Microcephalus 7422 Congenital reduction deformities of brain 7423 Congenital hydrocephalus 7424 Other specified congenital anomalies of brain Diastematomyelia Hydromyelia Other specified congenital anomalies of spinal cord 7428 Other specified congenital anomalies of nervous system 7429 Unspecified congenital anomaly of brain, spinal cord, and nervous system Clinical anophthalmos, unspecified Cystic eyeball, congenital Cryptophthalmos Microphthalmos, unspecified Simple microphthalmos Microphthalmos associated with other anomalies of eye and adnexa Buphthalmos, unspecified Simple buphthalmos Buphthalmos associated with other ocular anomalies Congenital cataract, unspecified Congenital capsular and subcapsular cataract Congenital cortical and zonular cataract Congenital nuclear cataract Total and subtotal cataract, congenital Congenital aphakia Congenital anomalies of lens shape Congenital ectopic lens Other congenital cataract and lens anomalies Congenital anomalies of corneal size and shape Page 2 of 54 Effective 10/1/2014

3 74342 Corneal opacities, interfering with vision, congenital Other corneal opacities, congenital Specified congenital anomalies of anterior chamber, chamber angle, and related structures Aniridia Other specified congenital anomalies of iris and ciliary body Specified congenital anomalies of sclera Multiple and combined congenital anomalies of anterior segment Other congenital anomalies of anterior segment Vitreous anomalies Fundus coloboma Chorioretinal degeneration, congenital Congenital folds and cysts of posterior segment Congenital macular changes Other retinal changes, congenital Specified congenital anomalies of optic disc Vascular anomalies Other congenital anomalies of posterior segment Congenital ptosis Congenital deformities of eyelids Other specified congenital anomalies of eyelid Specified congenital anomalies of lacrimal gland Specified congenital anomalies of lacrimal passages Specified congenital anomalies of orbit Other congenital anomalies of eyelids, lacrimal system, and orbit 7438 Other specified anomalies of eye 7439 Unspecified anomaly of eye Unspecified anomaly of ear with impairment of hearing Absence of external ear Other anomalies of external ear with impairment of hearing Anomaly of middle ear, except ossicles Anomalies of ear ossicles Anomalies of inner ear Other anomalies of ear causing impairment of hearing 7441 Accessory auricle Absence of ear lobe, congenital Macrotia Microtia Specified anomalies of Eustachian tube Other specified anomalies of ear 7443 Unspecified anomaly of ear Branchial cleft sinus or fistula Branchial cleft cyst Cervical auricle Preauricular sinus or fistula Page 3 of 54 Effective 10/1/2014

4 74447 Preauricular cyst Oregon Health Authority Other branchial cleft cyst or fistula; preauricular sinus 7445 Webbing of neck Macrocheilia Microcheilia Macrostomia Microstomia Other specified congenital anomalies of face and neck 7449 Unspecified congenital anomalies of face and neck 7450 Common truncus Complete transposition of great vessels Double outlet right ventricle Corrected transposition of great vessels Other transposition of great vessels 7452 Tetralogy of fallot 7453 Common ventricle 7454 Ventricular septal defect 7455 Ostium secundum type atrial septal defect Endocardial cushion defect, unspecified type Ostium primum defect Other endocardial cushion defects 7457 Cor biloculare 7458 Other bulbus cordis anomalies and anomalies of cardiac septal closure 7459 Unspecified defect of septal closure Congenital pulmonary valve anomaly, unspecified Atresia of pulmonary valve, congenital Stenosis of pulmonary valve, congenital Other congenital anomalies of pulmonary valve 7461 Tricuspid atresia and stenosis, congenital 7462 Ebstein's anomaly 7463 Congenital stenosis of aortic valve 7464 Congenital insufficiency of aortic valve 7465 Congenital mitral stenosis 7466 Congenital mitral insufficiency 7467 Hypoplastic left heart syndrome Subaortic stenosis Cor triatriatum Infundibular pulmonic stenosis Obstructive anomalies of heart, not elsewhere classified Coronary artery anomaly Congenital heart block Malposition of heart and cardiac apex Other specified congenital anomalies of heart 7469 Unspecified congenital anomaly of heart Page 4 of 54 Effective 10/1/2014

5 7470 Patent ductus arteriosus Coarctation of aorta (preductal) (postductal) Interruption of aortic arch Anomaly of aorta, unspecified Anomalies of aortic arch Atresia and stenosis of aorta Other anomalies of aorta Pulmonary artery coarctation and atresia Pulmonary arteriovenous malformation Oregon Health Authority Other anomalies of pulmonary artery and pulmonary circulation Anomaly of great veins, unspecified Total anomalous pulmonary venous connection Partial anomalous pulmonary venous connection Other anomalies of great veins 7475 Absence or hypoplasia of umbilical artery Anomaly of the peripheral vascular system, unspecified site Gastrointestinal vessel anomaly Renal vessel anomaly Upper limb vessel anomaly Lower limb vessel anomaly Anomalies of other specified sites of peripheral vascular system Anomalies of cerebrovascular system Spinal vessel anomaly Persistent fetal circulation Other specified anomalies of circulatory system 7479 Unspecified anomaly of circulatory system 7480 Choanal atresia 7481 Other anomalies of nose 7482 Web of larynx 7483 Other anomalies of larynx, trachea, and bronchus 7484 Congenital cystic lung 7485 Agenesis, hypoplasia, and dysplasia of lung Anomaly of lung, unspecified Congenital bronchiectasis Other congenital anomalies of lung 7488 Other specified anomalies of respiratory system 7489 Unspecified anomaly of respiratory system Cleft palate, unspecified Cleft palate, unilateral, complete Cleft palate, unilateral, incomplete Cleft palate, bilateral, complete Cleft palate, bilateral, incomplete Cleft lip, unspecified Cleft lip, unilateral, complete Page 5 of 54 Effective 10/1/2014

6 74912 Cleft lip, unilateral, incomplete Cleft lip, bilateral, complete Cleft lip, bilateral, incomplete Cleft palate with cleft lip, unspecified Oregon Health Authority Cleft palate with cleft lip, unilateral, complete Cleft palate with cleft lip, unilateral, incomplete Cleft palate with cleft lip, bilateral, complete Cleft palate with cleft lip, bilateral, incomplete Other combinations of cleft palate with cleft lip 7500 Tongue tie Congenital anomaly of tongue, unspecified Aglossia Congenital adhesions of tongue Fissure of tongue Macroglossia Microglossia Other congenital anomalies of tongue Absence of salivary gland Accessory salivary gland Atresia, salivary duct Congenital fistula of salivary gland Congenital fistula of lip Other specified anomalies of mouth Diverticulum of pharynx Other specified anomalies of pharynx 7503 Tracheoesophageal fistula, esophageal atresia and stenosis 7504 Other specified anomalies of esophagus 7505 Congenital hypertrophic pyloric stenosis 7506 Congenital hiatus hernia 7507 Other specified anomalies of stomach 7508 Other specified anomalies of upper alimentary tract 7509 Unspecified anomaly of upper alimentary tract 7510 Meckel's diverticulum 7511 Atresia and stenosis of small intestine 7512 Atresia and stenosis of large intestine, rectum, and anal canal 7513 Hirschsprung's disease and other congenital functional disorders of colon 7514 Anomalies of intestinal fixation 7515 Other anomalies of intestine Unspecified anomaly of gallbladder, bile ducts, and liver Biliary atresia Congenital cystic disease of liver Other anomalies of gallbladder, bile ducts, and liver 7517 Anomalies of pancreas 7518 Other specified anomalies of digestive system Page 6 of 54 Effective 10/1/2014

7 7519 Unspecified anomaly of digestive system 7520 Anomalies of ovaries Oregon Health Authority Unspecified anomaly of fallopian tubes and broad ligaments Embryonic cyst of fallopian tubes and broad ligaments Other anomalies of fallopian tubes and broad ligaments 7522 Doubling of uterus Agenesis of uterus Hypoplasia of uterus Unicornuate uterus Bicornuate uterus Septate uterus Arcuate uterus Other anomalies of uterus Unspecified anomaly of cervix, vagina, and external female genitalia Embryonic cyst of cervix, vagina, and external female genitalia Imperforate hymen Cervical agenesis Cervical duplication Vaginal agenesis Transverse vaginal septum Longitudinal vaginal septum Other anomalies of cervix, vagina, and external female genitalia Undescended testis Retractile testis Hypospadias Epispadias Congenital chordee Micropenis Hidden penis Other penile anomalies 7527 Indeterminate sex and pseudohermaphroditism Scrotal transposition Other specified anomalies of genital organs 7529 Unspecified anomaly of genital organs 7530 Renal agenesis and dysgenesis Cystic kidney disease, unspecified Congenital single renal cyst Polycystic kidney, unspecified type Polycystic kidney, autosomal dominant Polycystic kidney, autosomal recessive Renal dysplasia Medullary cystic kidney Medullary sponge kidney Other specified cystic kidney disease Page 7 of 54 Effective 10/1/2014

8 75320 Unspecified obstructive defect of renal pelvis and ureter Congenital obstruction of ureteropelvic junction Congenital obstruction of ureterovesical junction Congenital ureterocele Other obstructive defects of renal pelvis and ureter 7533 Other specified anomalies of kidney 7534 Other specified anomalies of ureter 7535 Exstrophy of urinary bladder 7536 Atresia and stenosis of urethra and bladder neck 7537 Anomalies of urachus 7538 Other specified anomalies of bladder and urethra 7539 Unspecified anomaly of urinary system 7540 Congenital musculoskeletal deformities of skull, face, and jaw 7541 Congenital musculoskeletal deformities of sternocleidomastoid muscle 7542 Congenital musculoskeletal deformities of spine Congenital dislocation of hip, unilateral Congenital dislocation of hip, bilateral Congenital subluxation of hip, unilateral Congenital subluxation of hip, bilateral Congenital dislocation of one hip with subluxation of other hip Genu recurvatum Congenital dislocation of knee (with genu recurvatum) Congenital bowing of femur Congenital bowing of tibia and fibula Congenital bowing of unspecified long bones of leg Talipes varus Talipes equinovarus Metatarsus primus varus Metatarsus varus Other varus deformities of feet Talipes valgus Congenital pes planus Talipes calcaneovalgus Other valgus deformities of feet Talipes, unspecified Talipes cavus Other deformities of feet Pectus excavatum Pectus carinatum Other specified nonteratogenic anomalies Polydactyly, unspecified digits Polydactyly of fingers Polydactyly of toes Syndactyly of multiple and unspecified sites Page 8 of 54 Effective 10/1/2014

9 75511 Syndactyly of fingers without fusion of bone Syndactyly of fingers with fusion of bone Syndactyly of toes without fusion of bone Syndactyly of toes with fusion of bone Oregon Health Authority Unspecified reduction deformity of upper limb Transverse deficiency of upper limb Longitudinal deficiency of upper limb, not elsewhere classified Longitudinal deficiency, combined, involving humerus, radius, and ulna (complete or incomplete) Longitudinal deficiency, humeral, complete or partial (with or without distal deficiencies, incomplete) Longitudinal deficiency, radioulnar, complete or partial (with or without distal deficiencies, incomplete) Longitudinal deficiency, radial, complete or partial (with or without distal deficiencies, incomplete) Longitudinal deficiency, ulnar, complete or partial (with or without distal deficiencies, incomplete) Longitudinal deficiency, carpals or metacarpals, complete or partial (with or without incomplete phalangeal deficiency) Longitudinal deficiency, phalanges, complete or partial Unspecified reduction deformity of lower limb, Transverse deficiency of lower limb Longitudinal deficiency of lower limb, not elsewhere classified Longitudinal deficiency, combined, involving femur, tibia, and fibula (complete or incomplete) Longitudinal deficiency, femoral, complete or partial (with or without distal deficiencies, incomplete) Longitudinal deficiency, tibiofibular, complete or partial (with or without distal deficiencies, incomplete) Longitudinal deficiency, tibia, complete or partial (with or without distal deficiencies, incomplete) Longitudinal deficiency, fibular, complete or partial (with or without distal deficiencies, incomplete) Longitudinal deficiency, tarsals or metatarsals, complete or partial (with or without incomplete phalangeal deficiency) Longitudinal deficiency, phalanges, complete or partial 7554 Reduction deformities, unspecified limb Unspecified anomaly of upper limb Congenital deformity of clavicle Congenital elevation of scapula Radioulnar synostosis Madelung's deformity Acrocephalosyndactyly Accessory carpal bones Macrodactylia (fingers) Cleft hand, congenital Other anomalies of upper limb, including shoulder girdle Unspecified anomaly of lower limb Page 9 of 54 Effective 10/1/2014

10 75561 Coxa valga, congenital Coxa vara, congenital Other congenital deformity of hip (joint) Congenital deformity of knee (joint) Macrodactylia of toes Other anomalies of toes Anomalies of foot, not elsewhere classified Oregon Health Authority Other anomalies of lower limb, including pelvic girdle 7558 Other specified anomalies of unspecified limb 7559 Unspecified anomaly of unspecified limb 7560 Anomalies of skull and face bones Anomaly of spine, unspecified Spondylolysis, lumbosacral region Spondylolisthesis Absence of vertebra, congenital Hemivertebra Fusion of spine (vertebra), congenital Klippel-Feil syndrome Spina bifida occulta Other anomalies of spine 7562 Cervical rib 7563 Other anomalies of ribs and sternum 7564 Chondrodystrophy Congenital osteodystrophy, unspecified Osteogenesis imperfecta Osteopetrosis Osteopoikilosis Polyostotic fibrous dysplasia of bone Chondroectodermal dysplasia Multiple epiphyseal dysplasia Other osteodystrophies 7566 Anomalies of diaphragm Anomaly of abdominal wall, unspecified Prune belly syndrome Omphalocele Gastroschisis Other congenital anomalies of abdominal wall Absence of muscle and tendon Accessory muscle Ehlers-Danlos syndrome Other specified anomalies of muscle, tendon, fascia, and connective tissue 7569 Other and unspecified anomalies of musculoskeletal system 7570 Hereditary edema of legs 7571 Ichthyosis congenita Page 10 of 54 Effective 10/1/2014

11 7572 Dermatoglyphic anomalies Congenital ectodermal dysplasia Vascular hamartomas Congenital pigmentary anomalies of skin Other specified anomalies of skin 7574 Specified anomalies of hair 7575 Specified anomalies of nails 7576 Specified congenital anomalies of breast Oregon Health Authority 7578 Other specified anomalies of the integument 7579 Unspecified congenital anomaly of the integument 7580 Down's syndrome 7581 Patau's syndrome 7582 Edwards' syndrome Cri-du-chat syndrome Velo-cardio-facial syndrome Other microdeletions Other autosomal deletions 7584 Balanced autosomal translocation in normal individual 7585 Other conditions due to autosomal anomalies 7586 Gonadal dysgenesis 7587 Klinefelter's syndrome Other conditions due to sex chromosome anomalies Other conditions due to chromosome anomalies 7589 Conditions due to anomaly of unspecified chromosome 7590 Anomalies of spleen 7591 Anomalies of adrenal gland 7592 Anomalies of other endocrine glands 7593 Situs inversus 7594 Conjoined twins 7595 Tuberous sclerosis 7596 Other hamartoses, not elsewhere classified 7597 Multiple congenital anomalies, so described Prader-Willi syndrome Marfan syndrome Fragile X syndrome Other specified congenital anomalies 7599 Congenital anomaly, unspecified 9050 Late effect of fracture of skull and face bones 9051 Late effect of fracture of spine and trunk without mention of spinal cord lesion 9052 Late effect of fracture of upper extremities 9053 Late effect of fracture of neck of femur 9054 Late effect of fracture of lower extremities 9055 Late effect of fracture of multiple and unspecified bones 9056 Late effect of dislocation Page 11 of 54 Effective 10/1/2014

12 9057 Late effect of sprain and strain without mention of tendon injury 9058 Late effect of tendon injury 9059 Late effect of traumatic amputation 9060 Late effect of open wound of head, neck, and trunk 9061 Late effect of open wound of extremities without mention of tendon injury 9062 Late effect of superficial injury 9063 Late effect of contusion 9064 Late effect of crushing 9065 Late effect of burn of eye, face, head, and neck 9066 Late effect of burn of wrist and hand 9067 Late effect of burn of other extremities 9068 Late effect of burns of other specified sites 9069 Late effect of burn of unspecified site 9070 Late effect of intracranial injury without mention of skull fracture 9071 Late effect of injury to cranial nerve 9072 Late effect of spinal cord injury 9073 Late effect of injury to nerve root(s), spinal plexus(es), and other nerves of trunk 9074 Late effect of injury to peripheral nerve of shoulder girdle and upper limb 9075 Late effect of injury to peripheral nerve of pelvic girdle and lower limb 9079 Late effect of injury to other and unspecified nerve 9080 Late effect of internal injury to chest 9081 Late effect of internal injury to intra-abdominal organs 9082 Late effect of internal injury to other internal organs 9083 Late effect of injury to blood vessel of head, neck, and extremities 9084 Late effect of injury to blood vessel of thorax, abdomen, and pelvis 9085 Late effect of foreign body in orifice 9086 Late effect of certain complications of trauma 9089 Late effect of unspecified injury 9090 Late effect of poisoning due to drug, medicinal or biological substance 9091 Late effect of toxic effects of nonmedical substances 9092 Late effect of radiation 9093 Late effect of complications of surgical and medical care 9094 Late effect of certain other external causes 9095 Late effect of adverse effect of drug, medicinal or biological substance 9099 Late effect of other and unspecified external causes E0000 E0001 E0002 E0008 E0009 E0010 E0011 E0020 E0021 Civilian activity done for income or pay Military activity Volunteer activity Other external cause status Unspecified external cause status Activities involving walking, marching and hiking Activities involving running Activities involving swimming Activities involving springboard and platform diving Page 12 of 54 Effective 10/1/2014

13 E0022 E0023 E0024 E0025 E0026 E0027 E0028 E0029 E0030 E0031 E0032 E0033 E0039 E0040 E0041 E0042 E0043 E0044 E0049 E0050 E0051 E0052 E0053 E0054 E0059 E0060 E0061 E0062 E0063 E0064 E0065 E0066 E0069 E0070 E0071 E0072 E0073 E0074 E0075 E0076 E0077 E0078 Activities involving water polo Activities involving water aerobics and water exercise Activities involving underwater diving and snorkeling Activities involving rowing, canoeing, kayaking, rafting and tubing Activities involving water skiing and wake boarding Activities involving surfing, windsurfing and boogie boarding Activities involving water sliding Other activity involving water and watercraft Activities involving ice skating Activities involving ice hockey Activities involving snow (alpine) (downhill) skiing, snow boarding, sledding, tobogganing and snow tubing Activities involving cross country skiing Other activity involving ice and snow Activities involving mountain climbing, rock climbing and wall climbing Activities involving rappelling Activities involving BASE jumping Activities involving bungee jumping Activities involving hang gliding Other activity involving climbing, rappelling and jumping off Activities involving dancing Activities involving yoga Activities involving gymnastics Activities involving trampoline Activities involving cheerleading Other activity involving dancing and other rhythmic movements Activities involving roller skating (inline) and skateboarding Activities involving horseback riding Activities involving golf Activities involving bowling Activities involving bike riding Activities involving jumping rope Activities involving non-running track and field events Other activity involving other sports and athletics played individually Activities involving american tackle football Activities involving american flag or touch football Activities involving rugby Activities involving baseball Activities involving lacrosse and field hockey Activities involving soccer Activities involving basketball Activities involving volleyball (beach) (court) Activities involving physical games generally associated with school recess, summer camp and children Page 13 of 54 Effective 10/1/2014

14 E0079 E0080 E0081 E0082 E0083 E0084 E0089 E0090 E0091 E0092 E0093 E0094 E0095 E0099 E0100 E0101 E0102 E0103 E0109 E0110 E0111 E0119 E0120 E0121 E0122 E0129 E0130 E0131 E0132 E0133 E0134 E0135 E0138 E0139 E0140 E0141 E0149 E0150 E0151 E0152 E0159 E0160 E0161 E0162 Other activity involving other sports and athletes played as a team or group Activities involving boxing Activities involving wrestling Activities involving racquet and hand sports Activities involving frisbee Activities involving martial arts Other specified sports and athletics activity Activity involving exercise machines primarily for cardiorespiratory conditioning Activity involving calisthenics Activity involving aerobic and step exercise Activity involving circuit training Activity involving obstacle course Activity involving grass drills Other activity involving cardiorespiratory exercise Activity involving exercise machines primarily for muscle strengthening Activity involving push-ups, pull-ups, sit-ups Activity involving free weights Activity involving pilates Other activity involving other muscle strengthening exercises Activities involving computer keyboarding Activities involving hand held interactive electronic device Other activity involving computer technology and electronic devices Activities involving knitting and crocheting Activities involving sewing Activities involving furniture building and finishing Activity involving other arts and handcrafts Activities involving personal bathing and showering Activities involving laundry Activities involving vacuuming Activities involving ironing Activities involving floor mopping and cleaning Activities involving residential relocation Other personal hygiene activity Other household maintenance Caregiving involving bathing Caregiving involving lifting Other activity involving person providing caregiving Activities involving food preparation and clean up Activities involving grilling and smoking food Activities involving cooking and baking Other activity involving cooking and grilling Activities involving digging, shoveling and raking Activities involving gardening and landscaping Activities involving building and construction Page 14 of 54 Effective 10/1/2014

15 E0169 E0170 E0179 E0180 E0181 E0182 E0183 E0190 E0191 E0192 E0199 E0290 E0291 E0292 E0299 E030 E8000 E8001 E8002 E8003 E8008 E8009 E8010 E8011 E8012 E8013 E8018 E8019 E8020 E8021 E8022 E8023 E8028 E8029 E8030 E8031 E8032 E8033 E8038 E8039 E8040 E8041 Other activity involving property and land maintenance, building and construction Roller coaster riding Other activity involving external motion Activities involving piano playing Activities involving drum and other percussion instrument playing Activities involving string instrument playing Activities involving winds and brass instrument playing Activities involving walking an animal Activities involving milking an animal Activities involving grooming and shearing an animal Other activity involving animal care Refereeing a sports activity Spectator at an event Rough housing and horseplay Other activity Unspecified activity Railway accident involving collision with rolling stock and injuring railway employee Railway accident involving collision with rolling stock and injuring passenger on railway Railway accident involving collision with rolling stock and injuring pedestrian Railway accident involving collision with rolling stock and injuring pedal cyclist Railway accident involving collision with rolling stock and injuring other specified person Railway accident involving collision with rolling stock and injuring unspecified person Railway accident involving collision with other object and injuring railway employee Railway accident involving collision with other object and injuring passenger on railway Railway accident involving collision with other object and injuring pedestrian Railway accident involving collision with other object and injuring pedal cyclist Railway accident involving collision with other object and injuring other specified person Railway accident involving collision with other object and injuring unspecified person Railway accident involving derailment without antecedent collision injuring railway employee Railway accident involving derailment without antecedent collision injuring passenger on railway Railway accident involving derailment without antecedent collision injuring pedestrian Railway accident involving derailment without antecedent collision injuring pedal cyclist Railway accident involving derailment without antecedent collision injuring other specified person Railway accident involving derailment without antecedent collision injuring unspecified person Railway accident involving explosion, fire, or burning injuring railway employee Railway accident involving explosion, fire, or burning injuring passenger on railway Railway accident involving explosion, fire, or burning injuring pedestrian Railway accident involving explosion, fire, or burning injuring pedal cyclist Railway accident involving explosion, fire, or burning injuring other specified person Railway accident involving explosion, fire, or burning injuring unspecified person Fall in, on, or from railway train injuring railway employee Fall in, on, or from railway train injuring passenger on railway Page 15 of 54 Effective 10/1/2014

16 E8042 E8043 E8048 E8049 E8050 E8051 E8052 E8053 E8058 E8059 E8060 E8061 E8062 E8063 E8068 E8069 E8070 E8071 E8072 E8073 E8078 E8079 E8100 E8101 E8102 E8103 E8104 E8105 E8106 E8107 E8108 E8109 E8110 E8111 E8112 E8113 E8114 Fall in, on, or from railway train injuring pedestrian Fall in, on, or from railway train injuring pedal cyclist Fall in, on, or from railway train injuring other specified person Fall in, on, or from railway train injuring unspecified person Railway employee hit by rolling stock Passenger on railway hit by rolling stock Pedestrian hit by rolling stock Pedal cyclist hit by rolling stock Other specified person hit by rolling stock Unspecified person hit by rolling stock Other specified railway accident injuring railway employee Other specified railway accident injuring passenger on railway Other specified railway accident injuring pedestrian Other specified railway accident injuring pedal cyclist Other specified railway accident injuring other specified person Other specified railway accident injuring unspecified person Railway accident of unspecified nature injuring railway employee Railway accident of unspecified nature injuring passenger on railway Railway accident of unspecified nature injuring pedestrian Railway accident of unspecified nature injuring pedal cyclist Railway accident of unspecified nature injuring other specified person Railway accident of unspecified nature injuring unspecified person Motor vehicle traffic accident involving collision with train injuring driver of motor vehicle other than motorcycle Motor vehicle traffic accident involving collision with train injuring passenger in motor vehicle other than motorcycle Motor vehicle traffic accident involving collision with train injuring motorcyclist Motor vehicle traffic accident involving collision with train injuring passenger on motorcycle Motor vehicle traffic accident involving collision with train injuring occupant of streetcar Motor vehicle traffic accident involving collision with train injuring rider of animal; occupant of animaldrawn vehicle Motor vehicle traffic accident involving collision with train injuring pedal cyclist Motor vehicle traffic accident involving collision with train injuring pedestrian Motor vehicle traffic accident involving collision with train injuring other specified person Motor vehicle traffic accident involving collision with train injuring unspecified person Motor vehicle traffic accident involving re-entrant collision with another motor vehicle injuring driver of motor vehicle other than motorcycle Motor vehicle traffic accident involving re-entrant collision with another motor vehicle injuring passenger in motor vehicle other than motorcycle Motor vehicle traffic accident involving re-entrant collision with another motor vehicle injuring motorcyclist Motor vehicle traffic accident involving re-entrant collision with another motor vehicle injuring passenger on motorcycle Motor vehicle traffic accident involving re-entrant collision with another motor vehicle injuring occupant of streetcar Page 16 of 54 Effective 10/1/2014

17 E8115 E8116 E8117 E8118 E8119 E8120 E8121 E8122 E8123 E8124 E8125 E8126 E8127 E8128 E8129 E8130 E8131 E8132 E8133 E8134 E8135 E8136 E8137 E8138 E8139 E8140 E8141 E8142 E8143 Motor vehicle traffic accident involving re-entrant collision with another motor vehicle injuring rider of animal; occupant of animal-drawn vehicle Motor vehicle traffic accident involving re-entrant collision with another motor vehicle injuring pedal cyclist Motor vehicle traffic accident involving re-entrant collision with another motor vehicle injuring pedestrian Motor vehicle traffic accident involving re-entrant collision with another motor vehicle injuring other specified person Motor vehicle traffic accident involving re-entrant collision with another motor vehicle injuring unspecified person Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle Other motor vehicle traffic accident involving collision with motor vehicle injuring passenger in motor vehicle other than motorcycle Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist Other motor vehicle traffic accident involving collision with motor vehicle injuring passenger on motorcycle Other motor vehicle traffic accident involving collision with motor vehicle injuring occupant of streetcar Other motor vehicle traffic accident involving collision with motor vehicle injuring rider of animal; occupant of animal-drawn vehicle Other motor vehicle traffic accident involving collision with motor vehicle injuring pedal cyclist Other motor vehicle traffic accident involving collision with motor vehicle injuring pedestrian Other motor vehicle traffic accident involving collision with motor vehicle injuring other specified person Other motor vehicle traffic accident involving collision with motor vehicle injuring unspecified person Motor vehicle traffic accident involving collision with other vehicle injuring driver of motor vehicle other than motorcycle Motor vehicle traffic accident involving collision with other vehicle injuring passenger in motor vehicle other than motorcycle Motor vehicle traffic accident involving collision with other vehicle injuring motorcyclist Motor vehicle traffic accident involving collision with other vehicle injuring passenger on motorcycle Motor vehicle traffic accident involving collision with other vehicle injuring occupant of streetcar Motor vehicle traffic accident involving collision with other vehicle injuring rider of animal; occupant of animal-drawn vehicle Motor vehicle traffic accident involving collision with other vehicle injuring pedal cyclist Motor vehicle traffic accident involving collision with other vehicle injuring pedestrian Motor vehicle traffic accident involving collision with other vehicle injuring other specified person Motor vehicle traffic accident involving collision with other vehicle injuring unspecified person Motor vehicle traffic accident involving collision with pedestrian injuring driver of motor vehicle other than motorcycle Motor vehicle traffic accident involving collision with pedestrian injuring passenger in motor vehicle other than motorcycle Motor vehicle traffic accident involving collision with pedestrian injuring motorcyclist Motor vehicle traffic accident involving collision with pedestrian injuring passenger on motorcycle Page 17 of 54 Effective 10/1/2014

18 E8144 E8145 E8146 E8147 E8148 E8149 E8150 E8151 E8152 E8153 E8154 E8155 E8156 E8157 E8158 E8159 E8160 E8161 E8162 E8163 E8164 E8165 E8166 E8167 E8168 E8169 E8170 E8171 E8172 Motor vehicle traffic accident involving collision with pedestrian injuring occupant of streetcar Motor vehicle traffic accident involving collision with pedestrian injuring rider of animal; occupant of animal drawn vehicle Motor vehicle traffic accident involving collision with pedestrian injuring pedal cyclist Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian Motor vehicle traffic accident involving collision with pedestrian injuring other specified person Motor vehicle traffic accident involving collision with pedestrian injuring unspecified person Other motor vehicle traffic accident involving collision on the highway injuring driver of motor vehicle other than motorcycle Other motor vehicle traffic accident involving collision on the highway injuring passenger in motor vehicle other than motorcycle Other motor vehicle traffic accident involving collision on the highway injuring motorcyclist Other motor vehicle traffic accident involving collision on the highway injuring passenger on motorcycle Other motor vehicle traffic accident involving collision on the highway injuring occupant of streetcar Other motor vehicle traffic accident involving collision on the highway injuring rider of animal; occupant of animal-drawn vehicle Other motor vehicle traffic accident involving collision on the highway injuring pedal cyclist Other motor vehicle traffic accident involving collision on the highway injuring pedestrian Other motor vehicle traffic accident involving collision on the highway injuring other specified person Other motor vehicle traffic accident involving collision on the highway injuring unspecified person Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring passenger in motor vehicle other than motorcycle Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring motorcyclist Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring passenger on motorcycle Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring occupant of streetcar Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring rider of animal; occupant of animal-drawn vehicle Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring pedal cyclist Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring pedestrian Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring other specified person Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring unspecified person Noncollision motor vehicle traffic accident while boarding or alighting injuring driver of motor vehicle other than motorcycle Noncollision motor vehicle traffic accident while boarding or alighting injuring passenger in motor vehicle other than motorcycle Noncollision motor vehicle traffic accident while boarding or alighting injuring motorcyclist Page 18 of 54 Effective 10/1/2014

19 E8173 E8174 E8175 E8176 E8177 E8178 E8179 E8180 E8181 E8182 E8183 E8184 E8185 E8186 E8187 E8188 E8189 E8190 E8191 E8192 E8193 E8194 E8195 E8196 E8197 E8198 E8199 E8200 E8201 E8202 E8203 E8204 E8205 E8206 Noncollision motor vehicle traffic accident while boarding or alighting injuring passenger on motorcycle Noncollision motor vehicle traffic accident while boarding or alighting injuring occupant of streetcar Noncollision motor vehicle traffic accident while boarding or alighting injuring rider of animal; occupant of animal-drawn vehicle Noncollision motor vehicle traffic accident while boarding or alighting injuring pedal cyclist Noncollision motor vehicle traffic accident while boarding or alighting injuring pedestrian Noncollision motor vehicle traffic accident while boarding or alighting injuring other specified person Noncollision motor vehicle traffic accident while boarding or alighting injuring unspecified person Other noncollision motor vehicle traffic accident injuring driver of motor vehicle other than motorcycle Other noncollision motor vehicle traffic accident injuring passenger in motor vehicle other than motorcycle Other noncollision motor vehicle traffic accident injuring motorcyclist Other noncollision motor vehicle traffic accident injuring passenger on motorcycle Other noncollision motor vehicle traffic accident injuring occupant of streetcar Other noncollision motor vehicle traffic accident injuring rider of animal; occupant of animal-drawn vehicle Other noncollision motor vehicle traffic accident injuring pedal cyclist Other noncollision motor vehicle traffic accident injuring pedestrian Other noncollision motor vehicle traffic accident injuring other specified person Other noncollision motor vehicle traffic accident injuring unspecified person Motor vehicle traffic accident of unspecified nature injuring driver of motor vehicle other than motorcycle Motor vehicle traffic accident of unspecified nature injuring passenger in motor vehicle other than motorcycle Motor vehicle traffic accident of unspecified nature injuring motorcyclist Motor vehicle traffic accident of unspecified nature injuring passenger on motorcycle Motor vehicle traffic accident of unspecified nature injuring occupant of streetcar Motor vehicle traffic accident of unspecified nature injuring rider of animal; occupant of animal-drawn vehicle Motor vehicle traffic accident of unspecified nature injuring pedal cyclist Motor vehicle traffic accident of unspecified nature injuring pedestrian Motor vehicle traffic accident of unspecified nature injuring other specified person Motor vehicle traffic accident of unspecified nature injuring unspecified person Nontraffic accident involving motor-driven snow vehicle injuring driver of motor vehicle other than motorcycle Nontraffic accident involving motor-driven snow vehicle injuring passenger in motor vehicle other than motorcycle Nontraffic accident involving motor-driven snow vehicle injuring motorcyclist Nontraffic accident involving motor-driven snow vehicle injuring passenger on motorcycle Nontraffic accident involving motor-driven snow vehicle injuring occupant of streetcar Nontraffic accident involving motor-driven snow vehicle injuring rider of animal; occupant of animaldrawn vehicle Nontraffic accident involving motor-driven snow vehicle injuring pedal cyclist Page 19 of 54 Effective 10/1/2014

20 E8207 E8208 E8209 E8210 E8211 E8212 E8213 E8214 E8215 E8216 E8217 E8218 E8219 E8220 E8221 E8222 E8223 E8224 E8225 E8226 E8227 E8228 E8229 E8230 E8231 E8232 E8233 E8234 E8235 E8236 Nontraffic accident involving motor-driven snow vehicle injuring pedestrian Nontraffic accident involving motor-driven snow vehicle injuring other specified person Nontraffic accident involving motor-driven snow vehicle injuring unspecified person Nontraffic accident involving other off-road motor vehicle injuring driver of motor vehicle other than motorcycle Nontraffic accident involving other off-road motor vehicle injuring passenger in motor vehicle other than motorcycle Nontraffic accident involving other off-road motor vehicle injuring motorcyclist Nontraffic accident involving other off-road motor vehicle injuring passenger on motorcycle Nontraffic accident involving other off-road motor vehicle injuring occupant of streetcar Nontraffic accident involving other off-road motor vehicle injuring rider of animal; occupant of animaldrawn vehicle Nontraffic accident involving other off-road motor vehicle injuring pedal cyclist Nontraffic accident involving other off-road motor vehicle injuring pedestrian Nontraffic accident involving other off-road motor vehicle injuring other specified person Nontraffic accident involving other off-road motor vehicle injuring unspecified person Other motor vehicle nontraffic accident involving collision with moving object injuring driver of motor vehicle other than motorcycle Other motor vehicle nontraffic accident involving collision with moving object injuring passenger in motor vehicle other than motorcycle Other motor vehicle nontraffic accident involving collision with moving object injuring motorcyclist Other motor vehicle nontraffic accident involving collision with moving object injuring passenger on motorcycle Other motor vehicle nontraffic accident involving collision with moving object injuring occupant of streetcar Other motor vehicle nontraffic accident involving collision with moving object injuring rider of animal; occupant of animal-drawn vehicle Other motor vehicle nontraffic accident involving collision with moving object injuring pedal cyclist Other motor vehicle nontraffic accident involving collision with moving object injuring pedestrian Other motor vehicle nontraffic accident involving collision with moving object injuring other specified person Other motor vehicle nontraffic accident involving collision with moving object injuring unspecified person Other motor vehicle nontraffic accident involving collision with stationary object injuring driver of motor vehicle other than motorcycle Other motor vehicle nontraffic accident involving collision with stationary object injuring passenger in motor vehicle other than motorcycle Other motor vehicle nontraffic accident involving collision with stationary object injuring motorcyclist Other motor vehicle nontraffic accident involving collision with stationary object injuring passenger on motorcycle Other motor vehicle nontraffic accident involving collision with stationary object injuring occupant of streetcar Other motor vehicle nontraffic accident involving collision with stationary object injuring rider of animal; occupant of animal-drawn vehicle Other motor vehicle nontraffic accident involving collision with stationary object injuring pedal cyclist Page 20 of 54 Effective 10/1/2014

21 E8237 E8238 E8239 E8240 E8241 E8242 E8243 E8244 E8245 E8246 E8247 E8248 E8249 E8250 E8251 E8252 E8253 E8254 E8255 E8256 E8257 E8258 E8259 E8260 E8261 E8262 E8263 E8264 E8268 E8269 E8270 E8272 Other motor vehicle nontraffic accident involving collision with stationary object injuring pedestrian Other motor vehicle nontraffic accident involving collision with stationary object injuring other specified person Other motor vehicle nontraffic accident involving collision with stationary object injuring unspecified person Other motor vehicle nontraffic accident while boarding and alighting injuring driver of motor vehicle other than motorcycle Other motor vehicle nontraffic accident while boarding and alighting injuring passenger in motor vehicle other than motorcycle Other motor vehicle nontraffic accident while boarding and alighting injuring motorcyclist Other motor vehicle nontraffic accident while boarding and alighting injuring passenger on motorcycle Other motor vehicle nontraffic accident while boarding and alighting injuring occupant of streetcar Other motor vehicle nontraffic accident while boarding and alighting injuring rider of animal; occupant of animal-drawn vehicle Other motor vehicle nontraffic accident while boarding and alighting injuring pedal cyclist Other motor vehicle nontraffic accident while boarding and alighting injuring pedestrian Other motor vehicle nontraffic accident while boarding and alighting injuring other specified person Other motor vehicle nontraffic accident while boarding and alighting injuring unspecified person Other motor vehicle nontraffic accident of other and unspecified nature injuring driver of motor vehicle other than motorcycle Other motor vehicle nontraffic accident of other and unspecified nature injuring passenger in motor vehicle other than motorcycle Other motor vehicle nontraffic accident of other and unspecified nature injuring motorcyclist Other motor vehicle nontraffic accident of other and unspecified nature injuring passenger on motorcycle Other motor vehicle nontraffic accident of other and unspecified nature injuring occupant of streetcar Other motor vehicle nontraffic accident of other and unspecified nature injuring rider of animal; occupant of animal-drawn vehicle Other motor vehicle nontraffic accident of other and unspecified nature injuring pedal cyclist Other motor vehicle nontraffic accident of other and unspecified nature injuring pedestrian Other motor vehicle nontraffic accident of other and unspecified nature injuring other specified person Other motor vehicle nontraffic accident of other and unspecified nature injuring unspecified person Pedal cycle accident injuring pedestrian Pedal cycle accident injuring pedal cyclist Pedal cycle accident injuring rider of animal Pedal cycle accident injuring occupant of animal-drawn vehicle Pedal cycle accident injuring occupant of streetcar Pedal cycle accident injuring other specified person Pedal cycle accident injuring unspecified person Animal-drawn vehicle accident injuring pedestrian Animal-drawn vehicle accident injuring rider of animal Page 21 of 54 Effective 10/1/2014

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