ATTACHMENT A ICD-9-CM MENTAL DISORDERS DIAGNOSIS CODES AND DESCRIPTIONS Subject to Certification of Admission/Concurrent/Continued Stay Review This list contains principal diagnosis codes for psychiatric services Category of Service 21. General care hospitals that are not enrolled for COS 21 will continue to bill for a maximum of three days of emergency psychiatric care using COS 20. The description of codes noted in bold has changed based on ICD-9-CM coding guidelines effective 10-01-04. Schizophrenic disorders 295.00 Unspecified 295.01 Subchronic 295.02 Chronic 295.03 Subchronic with acute exacerbation 295.04 Chronic with acute exacerbation 295.05 In remission 295.10 Disorganized type unspecified 295.11 Disorganized type subchronic 295.12 Disorganized type chronic 295.13 Disorganized type subchronic with acute exacerbation 295.14 Disorganized type chronic with acute exacerbation 295.15 Disorganized type in remission 295.20 Catatonic type unspecified 295.21 Catatonic type subchronic 295.22 Catatonic type chronic 295.23 Catatonic type subchronic with acute exacerbation 295.24 Catatonic type chronic with acute exacerbation 295.25 Catatonic type in remission 295.30 Paranoid type unspecified 295.31 Paranoid type subchronic 295.32 Paranoid type chronic 295.33 Paranoid type subchronic with acute exacerbation 295.34 Paranoid type chronic with acute exacerbation 295.35 Paranoid type in remission 295.40 Schizophreniform disorder, unspecified 295.41 Schizophreniform disorder, subchronic 295.42 Schizophreniform disorder, chronic 295.43 Schizophreniform disorder, subchronic with acute exacerbation 295.44 Schizophreniform disorder, chronic with acute exacerbation 295.45 Schizophreniform disorder, in remission 295.50 Latent schizophrenia unspecified Attachment A - Page 1
295.51 Latent schizophrenia subchronic 295.52 Latent schizophrenia chronic 295.53 Latent schizophrenia subchronic with acute exacerbation 295.54 Latent schizophrenia chronic with acute exacerbation 295.55 Latent schizophrenia in remission 295.60 Schizophrenic disorders, residual type, unspecified 295.61 Schizophrenic disorders, residual type, subchronic 295.62 Schizophrenic disorders, residual type, chronic 295.63 Schizophrenic disorders, residual type, subchronic with acute exacerbation 295.64 Schizophrenic disorders, residual type, chronic with acute exacerbation 295.65 Schizophrenic disorders, residual type, in remission 295.70 Schizoaffective disorder,unspecified 295.71 Schizoaffective disorder, subchronic 295.72 Schizoaffective disorder, chronic 295.73 Schizoaffective disorder, subchronic with acute exacerbation 295.74 Schizoaffective disorder, chronic with acute exacerbation 295.75 Schizoaffective disorder, in remission 295.80 Other specified types of schizophrenia unspecified 295.81 Other specified types of schizophrenia subchronic 295.82 Other specified types of schizophrenia chronic 295.83 Other specified types of schizophrenia subchronic with acute exacerbation 295.84 Other specified types of schizophrenia chronic with acute exacerbation 295.85 Other specified types of schizophrenia in remission 295.90 Unspecified 295.91 Subchronic 295.92 Chronic 295.93 Subchronic with acute exacerbation 295.94 Chronic with acute exacerbation 295.95 In remission 296.00 Bipolar I disorder, single manic episode, unspecified 296.01 Bipolar I disorder, single manic episode, mild 296.02 Bipolar I disorder, single manic episode, moderate 296.03 Bipolar I disorder, single manic episode, severe, without mention of psychotic behavior 296.04 Bipolar I disorder, single manic episode, severe, specified as with psychotic behavior 296.05 Bipolar I disorder, single manic episode, in partial or unspecified remission 296.06 Bipolar I disorder, single manic episode, in full remission Attachment A - Page 2
296.10 Manic disorder, recurrent episode unspecified 296.11 Manic disorder, recurrent episode mild 296.12 Manic disorder, recurrent episode moderate 296.13 Manic disorder, recurrent episode severe, without mention of psychotic behavior 296.14 Manic disorder, recurrent episode severe, specified as with psychotic behavior 296.15 Manic disorder, recurrent episode in partial or unspecified remission 296.16 Manic disorder, recurrent episode in full remission 296.20 Major depressive disorder, single episode unspecified 296.21 Major depressive disorder, single episode mild 296.22 Major depressive disorder, single episode moderate 296.23 Major depressive disorder, single episode severe, without mention of psychotic behavior 296.24 Major depressive disorder, single episode severe, specified as with psychotic behavior 296.25 Major depressive disorder, single episode in partial or unspecified remission 296.26 Major depressive disorder, single episode in full remission 296.30 Major depressive disorder, recurrent episode unspecified 296.31 Major depressive disorder, recurrent episode mild 296.32 Major depressive disorder, recurrent episode moderate 296.33 Major depressive disorder, recurrent episode severe, without mention of psychotic behavior 296.34 Major depressive disorder, recurrent episode severe, specified as with psychotic behavior 296.35 Major depressive disorder, recurrent episode in partial or unspecified remission 296.36 Major depressive disorder, recurrent episode in full remission 296.40 Bipolar I disorder, most recent episode (or current) manic, unspecified 296.41 Bipolar I disorder, most recent episode (or current) manic, mild 296.42 Bipolar I disorder, most recent episode (or current) manic, moderate 296.43 Bipolar I disorder, most recent episode (or current) manic, severe, without mention of psychotic behavior 296.44 Bipolar I disorder, most recent episode (or current) manic, severe, specified as with psychotic behavior 296.45 Bipolar I disorder, most recent episode (or current) manic, in partial or unspecified remission 296.46 Bipolar I disorder, most recent episode (or current) manic, in full remission 296.50 Bipolar I disorder, most recent episode (or current) depressed, unspecified 296.51 Bipolar I disorder, most recent episode (or current) depressed, mild 296.52 Bipolar I disorder, most recent episode (or current) depressed, moderate 296.53 Bipolar I disorder, most recent episode (or current) depressed, severe, without mention of psychotic behavior 296.54 Bipolar I disorder, most recent episode (or current) depressed, severe, specified as Attachment A - Page 3
with psychotic behavior 296.55 Bipolar I disorder, most recent episode (or current) depressed, in partial or unspecified remission 296.56 Bipolar I disorder, most recent episode (or current) depressed, in full remission 296.60 Bipolar I disorder, most recent episode (or current) mixed, unspecified 296.61 Bipolar I disorder, most recent episode (or current) mixed, mild 296.62 Bipolar I disorder, most recent episode (or current) mixed, moderate 296.63 Bipolar I disorder, most recent episode (or current) mixed, severe, without mention of psychotic behavior 296.64 Bipolar I disorder, most recent episode (or current) mixed, severe, specified as with psychotic behavior 296.65 Bipolar I disorder, most recent episode (or current) mixed, in partial or unspecified remission 296.66 Bipolar I disorder, most recent episode (or current), mixed, in full remission 296.7 Bipolar I disorder, most recent episode (or current), unspecified 296.80 Bipolar disorder, unspecified 296.81 Atypical manic disorder 296.82 Atypical depressive disorder 296.89 Other and unspecified bipolar disorders, other 296.90 Unspecified episode mood disorder 296.99 Other specified episodic mood disorder 297.0 Paranoid state, simple 297.1 Delusional disorder 297.2 Paraphrenia 297.3 Shared psychotic disorder 297.8 Other specified paranoid states 297.9 Unspecified paranoid state 298.0 Depressive type psychoses 298.1 Excitative type psychoses 298.2 Reactive confusion 298.3 Acute paranoid reaction 298.4 Psychogenic paranoid psychosis 298.8 Other and unspecified reactive psychosis 298.9 Unspecified psychosis 299.00 Autistic disorder, current or active state 299.01 Autistic disorder, residual state 299.10 Childhood disintegrative disorder, current or active state 299.11 Childhood disintegrative disorder, residual state 299.80 Other specified pervasive developmental disorders, current or active state 299.81 Other specified pervasive developmental disorders, residual state Attachment A - Page 4
299.90 Unspecified pervasive developmental disorders, current or active state 299.91 Unspecified pervasive developmental disorders, residual state 300.00 Anxiety state, unspecified 300.01 Panic disorder without agoraphobia 300.02 Generalized anxiety disorder 300.09 Neurotic disorders other 300.10 Hysteria, unspecified 300.11 Conversion disorder 300.12 Dissociative amnesia 300.13 Dissociative fugue 300.14 Dissociative identity disorder 300.15 Dissociative disorder or reaction, unspecified 300.16 Factitious disorder with predominantly psychological signs and symptoms 300.19 Other and unspecified factitious illness 300.20 Phobia, unspecified 300.21 Agoraphobia with panic disorder 300.22 Agoraphobia without mention of panic attacks 300.23 Social phobia 300.29 Other isolated or specific phobias 300.3 Obsessive-compulsive disorders 300.4 Dysthymic disorder 300.5 Neurasthenia 300.6 Depersonalization disorder 300.7 Hypochondriasis 300.81 Somatization disorder 300.82 Undifferentiated somatoform disorder 300.89 Other somatoform disorders 300.9 Unspecified nonpsychotic mental disorder 301.0 Paranoid personality disorder 301.10 Affective personality disorder, unspecified 301.11 Chronic hypomanic personality disorder 301.12 Chronic depressive personality disorder 301.13 Cyclothymic disorder 301.20 Schizoid personality disorder, unspecified 301.21 Introverted personality 301.22 Schizotypal personality disorder 301.3 Explosive personality disorder 301.4 Obsessive-compulsive personality disorder 301.50 Histrionic personality disorder, unspecified 301.51 Chronic factitious illness with physical symptoms Attachment A - Page 5
301.59 Other histrionic personality disorder 301.6 Dependent personality disorder 301.7 Antisocial personality disorder 301.81 Narcissistic personality disorder 301.82 Avoidant personality disorder 301.83 Borderline personality disorder 301.84 Passive-aggressive personality 301.89 Other personality disorder 301.9 Unspecified personality disorder 302.0 Ego-dystonic sexual orientation 302.1 Zoophilia 302.2 Pedophilia 302.3 Transvestic fetishism 302.4 Exhibitionism 302.50 Trans-sexualism with unspecified sexual history 302.51 Trans-sexualism with asexual history 302.52 Trans-sexualism with homosexual history 302.53 Trans-sexualism with heterosexual history 302.6 Gender identity disorder in children 302.70 Psychosexual dysfunction, unspecified 302.71 Hypoactive sexual desire disorder 302.72 Psychosexual dysfunction with inhibited sexual excitement 302.73 Female orgasmic disorder 302.74 Male orgasmic disorder 302.75 Premature ejaculation 302.76 Dyspareunia, psychogenic 302.79 Psychosexual dysfunction with other specified psychosexual dysfunctions 302.81 Fetishism 302.82 Voyeurism 302.83 Sexual masochism 302.84 Sexual sadism 302.85 Gender identity disorder in adolescent or adults 302.89 Other specified psychosexual disorder 302.9 Unspecified psychosexual disorder 307.0 Stuttering 307.20 Tic disorder, unspecified 307.21 Transient tic disorder 307.22 Chronic motor or vocal tic disorder 307.23 Tourette s disorder 307.3 Stereotyped movement disorder Attachment A - Page 6
307.40 Nonorganic sleep disorder, unspecified 307.41 Transient disorder of initiating or maintaining sleep 307.42 Persistent disorder of initiating or maintaining sleep 307.43 Transient disorder of initiating or maintaining wakefulness 307.44 Persistent disorder of initiating or maintaining wakefulness 307.45 Circadian rhythm sleep disorder 307.46 Sleep arousal disorder 307.47 Other dysfunctions of sleep stages or arousal from sleep 307.49 Other 307.50 Eating disorder, unspecified 307.6 Enuresis 307.7 Encopresis 307.80 Psychogenic pain, site unspecified 307.9 Psychalgia Other and unspecified special symptoms or syndromes, not elsewhere classified 308.0 Predominant disturbance of emotions 308.1 Predominant disturbance of consciousness 308.2 Predominant psychomotor disturbance 308.3 Other acute reactions to stress 308.4 Mixed disorders as reaction to stress 308.9 Unspecified acute reaction to stress 309.0 Adjustment disorder with depressed mood 309.1 Prolonged depressive reaction 309.21 Separation anxiety disorder 309.22 Emancipation disorder of adolescence and early adult life 309.23 Specific academic or work inhibition 309.24 Adjustment disorder with anxiety 309.28 Adjustment disorder with mixed anxiety and depressed mood 309.29 Other predominant disturbance of other emotions 309.3 Adjustment disorder with disturbance of conduct 309.4 Adjustment disorder with disturbance of emotions and conduct 309.81 Posttraumatic stress disorder 309.82 Adjustment reaction with physical symptoms 309.83 Adjustment reaction with withdrawal 309.89 Other specified adjustment reaction 309.9 Unspecified adjustment reaction 310.0 Frontal lobe syndrome 311 Depressive disorder, not elsewhere classified 312.00 Undersocialized conduct disorder, aggressive type, unspecified 312.01 Undersocialized conduct disorder, aggressive type, mild Attachment A - Page 7
312.02 Undersocialized conduct disorder, aggressive type, moderate 312.03 Undersocialized conduct disorder, aggressive type, severe 312.10 Undersocialized conduct disorder, unaggressive type, unspecified 312.11 Undersocialized conduct disorder, unaggressive type, mild 312.12 Undersocialized conduct disorder, unaggressive type, moderate 312.13 Undersocialized conduct disorder, unaggressive type, severe 312.20 Socialized conduct disorder, unspecified 312.21 Socialized conduct disorder, mild 312.22 Socialized conduct disorder, moderate 312.23 Socialized conduct disorder, severe 312.30 Impulse control disorder, unspecified 312.31 Pathological gambling 312.32 Kleptomania 312.33 Pyromania 312.34 Intermittent explosive disorder 312.35 Isolated explosive disorder 312.39 Other 312.4 Mixed disturbance of conduct and emotions 312.81 Conduct disorder, childhood onset type 312.82 Conduct disorder, adolescent onset type 312.89 Other conduct disorder 312.9 Unspecified disturbance of conduct 313.0 Overanxious disorder 313.1 Misery and unhappiness disorder 313.21 Shyness disorder of childhood 313.22 Introverted disorder of childhood 313.23 Selective mutism 313.3 Relationship problems 313.81 Oppositional defiant disorder 313.82 Identity disorder 313.83 Academic underachievement disorder 313.89 Other 313.9 Unspecified emotional disturbance of childhood or adolescence 314.00 Attention deficit disorder Without mention of hyperactivity 314.01 Attention deficit disorder With hyperactivity 314.1 Hyperkinesis with developmental delay 314.2 Hyperkinetic conduct disorder 314.8 Other specified manifestations of hyperkinetic syndrome 314.9 Unspecified hyperkinetic syndrome 315.00 Reading disorder, unspecified Attachment A - Page 8
315.01 Alexia 315.02 Developmental dyslexia 315.09 Other 315.1 Mathematics disorder 315.2 Other specific learning difficulties 315.31 Expressive language disorder 315.32 Mixed receptive-expressive language disorder 315.39 Other 315.4 Developmental coordination disorder 315.5 Mixed development disorder 315.8 Other specified delays in development 315.9 Unspecified delay in development 317 Mild mental retardation 318.0 Moderate mental retardation 318.1 Severe mental retardation 318.2 Profound mental retardation 319 Unspecified mental retardation Attachment A - Page 9
ATTACHMENT B ICD-9-CM MENTAL DISORDERS DIAGNOSIS CODES AND DESCRIPTIONS Subject to Certification of Admission/Concurrent/Continued Stay Review This list contains principal diagnosis codes for medical services Category of Service 20 or psychiatric services Category of Service 21. General care hospitals that are not enrolled for COS 21 will continue to bill for a maximum of three days of emergency psychiatric care using COS 20. The description of codes noted in bold has changed based on ICD-9-CM coding guidelines effective 10-01-04. 290.0 Senile dementia, uncomplicated 290.10 Presenile dementia, uncomplicated 290.11 Presenile dementia with delirium 290.12 Presenile dementia with delusional features 290.13 Presenile dementia with depressive features 290.20 Senile dementia with delusional features 290.21 Senile dementia with depressive features 290.3 Senile dementia with delirium 290.40 Vascular dementia, uncomplicated 290.41 Vascular dementia, with delirium 290.42 Vascular dementia, with delusions 290.43 Vascular dementia, with depressed mood 290.8 Other specified senile psychotic conditions 290.9 Unspecified senile psychotic condition 291.0 Alcohol withdrawal delirium 291.1 Alcohol-induced persisting amnestic disorder 291.2 Alcohol-induced persisting dementia 291.3 Alcohol-induced psychotic disorder with hallucinations 291.4 Idiosyncratic alcohol intoxication 291.5 Alcohol-induced psychotic disorder with delusions 291.81 Alcohol withdrawal 291.89 Other specified alcohol-induced mental disorders 291.9 Unspecified alcohol-induced mental disorders 292.0 Drug withdrawal 292.11 Drug-induced psychotic disorder with delusions 292.12 Drug-induced psychotic disorder with hallucinations 292.2 Pathological drug intoxication 292.81 Drug-induced delirium 292.82 Drug-induced persisting dementia 292.83 Drug-induced persisting amnestic disorder 292.84 Drug-induced mood disorder Attachment B - Page 1
ATTACHMENT B - continued 292.89 Other 292.9 Unspecified drug-induced mental disorder 293.1 Subacute delirium 306.0 Physiological malfunction arising from mental factors Musculoskeletal 306.1 Physiological malfunction arising from mental factors Respiratory 306.2 Physiological malfunction arising from mental factors Cardiovascular 306.3 Physiological malfunction arising from mental factors Skin 306.4 Physiological malfunction arising from mental factors Gastrointestinal 306.50 Psychogenic genitourinary malfunction, unspecified 306.51 Psychogenic vaginismus 306.52 Psychogenic dysmenorrhea 306.53 Psychogenic dysuria 306.59 Other 306.6 Endocrine 306.7 Organs of special sense 306.8 Other specified psychophysiological malfunction 306.9 Unspecified psychophysiological malfunction 307.1 Anorexia nervosa 307.48 Repetitive intrusions of sleep 307.51 Bulimia nervosa 307.52 Pica 307.53 Rumination disorder 307.54 Psychogenic vomiting 307.59 Other 307.81 Tension headache 307.89 Other, pain disorder related to psychological factors 310.2 Postconcussion syndrome 310.8 Other specified nonpsychotic mental disorders following organic brain damage 310.9 Unspecified nonpsychotic mental disorder following organic brain damage 316 Psychic factors associated with diseases classified elsewhere Attachment B - Page 2
ATTACHMENT C ICD-9-CM DIAGNOSIS CODES Subject to Certification and Concurrent/Continued Stay Review Note: Several codes have been added based on the ICD-9-CM coding guidelines. Descriptions of some codes have also changed based on ICD-9-CM coding guidelines effective 10/01/04. New codes are denoted by an asterisk (*). Description changes are noted in bold. Category Description of Diagnosis 038.0 Streptococcal Septicemia 038.10 Staphylococcal Septicemia, unspecified 038.11 Staphylococcus aureus septicemia 038.19 Other Staphylococcal septicemia 038.40 Gram-negative organism, unspecified 038.42 Escherichia coli (E. Coli) 038.43 Pseudomonas 038.49 Septicemia due to other gram-negative organisms Other 038.8 Other specified septicemias 038.9 Unspecified septicemia 250.00 Diabetes mellitus without (w/o) mention of complication, type II or unspecified type, not stated as uncontrolled 250.01 Diabetes mellitus w/o mention of complication type I [juvenile type], not stated as uncontrolled 250.02 Diabetes mellitus w/o mention of complication, type II or unspecified type, uncontrolled 250.03 Diabetes mellitus w/o mention of complication, type I [juvenile type], uncontrolled 250.80 Diabetes with other specified manifestations, type II or unspecified type, not stated as controlled *250.81 Diabetes with other specified manifestations, type I [juvenile type], not stated as uncontrolled 250.82 Diabetes with other specified manifestations, type II or unspecified type, uncontrolled 250.83 Diabetes with other specified manifestations type I [juvenile type], uncontrolled 276.5 Disorders of fluid, electrolyte, and acid- base balance, Volume Depletion 280.0 Iron Deficiency anemia Secondary to blood loss (chronic) 280.9 Iron Deficiency anemia, unspecified 282.62 Hb-S disease with mention of crisis 401.0 Essential hypertension, malignant 401.9 Essential hypertension, unspecified Attachment C - Page 1
ATTACHMENT C - continued 403.91 Hypertensive renal disease, with renal failure *453.40 Venous embolism and thrombosis of unspecified deep vessels of lower extremity *453.41 Venous embolism and thrombosis of proximal lower extremity *453.42 Venous embolism and thrombosis of deep vessels of distal lower extremity 453.8 Other venous embolism and thrombosis of other specified veins. 486 Pneumonia, organism unspecified 490 Bronchitis, not specified as acute or chronic 491.20 Obstructive Chronic bronchitis without mention of acute exacerbation. 491.21 Obstructive Chronic bronchitis with acute exacerbation *491.22 Obstructive Chronic bronchitis with acute bronchitis 518.81 Acute respiratory failure 518.82 Other pulmonary insufficiency, not elsewhere classified 530.81 Esophageal reflux 535.00 Acute gastritis without mention of hemorrhage 535.40 Other specified gastritis without mention of hemorrhage 535.50 Unspecified gastritis and gastroduodenitis without mention of hemorrhage 558.9 Other and unspecified noninfectious gastroenteritis and colitis 571.2 Alcoholic cirrhosis of liver 571.3 Alcoholic liver damage, unspecified 585 Chronic renal failure 599.0 Urinary tract infection, site not specified *707.00 Decubitus ulcer, unspecified site *707.01 Decubitus ulcer, elbow *707.02 Decubitus ulcer, upper back *707.03 Decubitus ulcer, lower back *707.04 Decubitus ulcer, hip *707.05 Decubitus ulcer, buttock *707.06 Decubitus ulcer, ankle *707.07 Decubitus ulcer, heel *707.09 Decubitus ulcer, other site 707.10 Unspecified ulcer of lower limb 707.11 Ulcer of thigh 707.12 Ulcer of calf 707.13 Ulcer of ankle 707.14 Ulcer of heel and midfoot 707.15 Ulcer of other part of foot 707.16 Ulcer of other part of lower limb 724.2 Lumbago Attachment C Page 2
ATTACHMENT C - continued 780.2 Syncope and collapse 780.39 Other convulsions 780.4 Dizziness and giddiness 783.0 Anorexia 786.09 Symptoms involving respiratory system and other chest symptoms, other 786.50 Chest pain unspecified 786.59 Chest pain other 789.00 Abdominal pain unspecified site 789.03 Abdominal pain right lower quadrant 789.04 Abdominal pain left lower quadrant 810.00 Fracture of clavicle closed unspecified part 821.01 Fracture of femur shaft, closed 825.25 Fracture of one or more metatarsal bone(s) Attachment C Page 3
ATTACHMENT D DRG Codes Subject to Prepayment Review DRG DESCRIPTION 386* Extreme Immaturity or Respiratory Distress Syndrome 986* Extreme Immaturity or Respiratory Distress Syndrome 468 Extensive OR Procedure Unrelated to Principal Diagnosis 477 Non-Extensive OR Procedure Unrelated to Principal Diagnosis 025 Seizure & Headache, Age > 17 years, Without Complications and Comorbidities 098 Bronchitis and Asthma, Age 0-17 years 134 Hypertension 143 Chest Pain 182 Esophagitis, Gastroenteritis, & Miscellaneous Digestive Disorders, Age > 17 years, With Complications and Comorbidities 183 Esophagitis, Gastroenteritis, & Miscellaneous Digestive Disorders, Age > 17 years, Without Complications and Comorbidities 184 Esophagitis, Gastroenteritis, & Miscellaneous Digestive Disorders, Age 0-17 years 243 Medical Back Problems 369 Menstrual and Other Female Reproductive System Disorders 381 Abortion with Dilation and Curettage, Aspiration Curettage or Hysterotomy 410 Chemotherapy Without Acute Leukemia as Secondary Diagnosis 435 Alcohol/Drug Abuse or Dependence, Detoxification or Other Symptomatic Treatment, Without Complications and Comorbidities * Code Added Effective 08/01/04 Attachment D Page 1