Attachment A ICD-10-CM Mental Disorders Diagnosis Codes and s Subject to Certification of Admission/Concurrent/Continued Stay Review Based on the Admitting Diagnosis Code This list contains principal diagnosis codes for psychiatric services Category of Service 21. If a code from this list is used as the principal diagnosis code, general care hospitals that are not enrolled for COS 21 may only bill for a maximum of three days of emergency psychiatric care using COS 20. F07.0 10/01/2015 Personality change due to known physiological condition F20.0 10/01/2015 Paranoid schizophrenia F20.1 10/01/2015 Disorganized schizophrenia F20.2 10/01/2015 Catatonic schizophrenia F20.5 10/01/2015 Residual schizophrenia F20.81 10/01/2015 Schizophreniform disorder F20.89 10/01/2015 Other schizophrenia F20.9 10/01/2015 Schizophrenia, unspecified F21 10/01/2015 Schizotypal disorder F22 10/01/2015 Delusional disorders F23 10/01/2015 Brief psychotic disorder F24 10/01/2015 Shared psychotic disorder F25.9 10/01/2015 Schizoaffective disorder, unspecified F28 10/01/2015 Other psychotic disorder not due to a substance or known physiological condition F29 10/01/2015 Unspecified psychosis not due to a substance or known physiological condition F30.10 10/01/2015 Manic episode without psychotic symptoms, unspecified F30.11 10/01/2015 Manic episode without psychotic symptoms, mild F30.12 10/01/2015 Manic episode without psychotic symptoms, moderate F30.13 10/01/2015 Manic episode, severe, without psychotic symptoms F30.2 10/01/2015 Manic episode, severe with psychotic symptoms F30.3 10/01/2015 Manic episode in partial remission F30.4 10/01/2015 Manic episode in full remission F30.8 10/01/2015 Other manic episodes F30.9 10/01/2015 Manic episode, unspecified F31.10 10/01/2015 Bipolar disorder, current episode manic without psychotic features, unspecified F31.11 10/01/2015 Bipolar disorder, current episode manic without psychotic features, mild F31.12 10/01/2015 Bipolar disorder, current episode manic without psychotic features, moderate 1
Attachment A F31.13 10/01/2015 Bipolar disorder, current episode manic without psychotic features, severe F31.2 10/01/2015 Bipolar disorder, current episode manic severe with psychotic features F31.30 10/01/2015 Bipolar disorder, current episode depressed, mild or moderate severity, unspecified F31.31 10/01/2015 Bipolar disorder, current episode depressed, mild F31.32 10/01/2015 Bipolar disorder, current episode depressed, moderate F31.4 10/01/2015 Bipolar disorder, current episode depressed, severe, without psychotic features F31.5 10/01/2015 Bipolar disorder, current episode depressed, severe, with psychotic features F31.60 10/01/2015 Bipolar disorder, current episode mixed, unspecified F31.61 10/01/2015 Bipolar disorder, current episode mixed, mild F31.62 10/01/2015 Bipolar disorder, current episode mixed, moderate F31.63 10/01/2015 Bipolar disorder, current episode mixed, severe, without psychotic features F31.64 10/01/2015 Bipolar disorder, current episode mixed, severe, with psychotic features F31.73 10/01/2015 Bipolar disorder, in partial remission, most recent episode manic F31.74 10/01/2015 Bipolar disorder, in full remission, most recent episode manic F31.75 10/01/2015 Bipolar disorder, in partial remission, most recent episode depressed F31.76 10/01/2015 Bipolar disorder, in full remission, most recent episode depressed F31.77 10/01/2015 Bipolar disorder, in partial remission, most recent episode mixed F31.78 10/01/2015 Bipolar disorder, in full remission, most recent episode mixed F31.89 10/01/2015 Other bipolar disorder F31.9 10/01/2015 Bipolar disorder, unspecified F32.0 10/01/2015 Major depressive disorder, single episode, mild F32.1 10/01/2015 Major depressive disorder, single episode, moderate F32.2 10/01/2015 Major depressive disorder, single episode, severe without psychotic features F32.3 10/01/2015 Major depressive disorder, single episode, severe with psychotic features F32.4 10/01/2015 Major depressive disorder, single episode, in partial remission F32.5 10/01/2015 Major depressive disorder, single episode, in full remission F32.8 10/01/2015 Other depressive episodes F32.9 10/01/2015 Major depressive disorder, single episode, unspecified 2
Attachment A F33.0 10/01/2015 Major depressive disorder, recurrent, mild F33.1 10/01/2015 Major depressive disorder, recurrent, moderate F33.2 10/01/2015 Major depressive disorder, recurrent, severe without psychotic features F33.3 10/01/2015 Major depressive disorder, recurrent, severe with psychotic symptoms F33.40 10/01/2015 Major depressive disorder, recurrent, in remission, unspecified F33.41 10/01/2015 Major depressive disorder, recurrent, in partial remission F33.42 10/01/2015 Major depressive disorder, recurrent, in full remission F33.9 10/01/2015 Major depressive disorder, recurrent, unspecified F34.0 10/01/2015 Cyclothymic disorder F34.1 10/01/2015 Dysthymic disorder F34.8 10/01/2015 Other persistent mood [affective] disorders F39 10/01/2015 Unspecified mood [affective] disorder F40.00 10/01/2015 Agoraphobia, unspecified F40.01 10/01/2015 Agoraphobia w/ panic disorder F40.02 10/01/2015 Agoraphobia w/o panic disorder F40.10 10/01/2015 Social phobia, unspecified F40.11 10/01/2015 Social phobia, generalized F40.210 10/01/2015 Arachnophobia F40.218 10/01/2015 Other animal type phobia F40220 10/01/2015 Fear of thunderstorms F40.228 10/01/2015 Other natural environment type phobia F40.230 10/01/2015 Fear of blood F40.231 10/01/2015 Fear of injections and transfusions F40.232 10/01/2015 Fear of other medical care F40.233 10/01/2015 Fear of injury F40.240 10/01/2015 Claustrophobia F40.241 10/01/2015 Acrophobia F40.242 10/01/2015 Fear of bridges F40.243 10/01/2015 Fear of flying F40.248 10/01/2015 Other situational type phobia F40.290 10/01/2015 Androphobia F40.291 10/01/2015 Gynephobia F40.298 10/01/2015 Other specified phobia F40.8 10/01/2015 Other phobic anxiety disorders F40.9 10/01/2015 Phobic anxiety disorder, unspecified F41.0 10/01/2015 Panic disorder [episodic paroxysmal anxiety] w/o agoraphobia F41.1 10/01/2015 Generalized anxiety disorder F41.3 10/01/2015 Other mixed anxiety disorders F41.8 10/01/2015 Other spcified anxiety disorders 3
Attachment A F41.9 10/01/2015 Anxiety disorder, unspecified F42 10/01/2015 Obsessive-compulsive disorder F43.0 10/01/2015 Acute stress reaction F43.10 10/01/2015 Post-traumatic stress disorder, unspecified F43.11 10/01/2015 Post-traumatic stress disorder, acute F43.12 10/01/2015 Post-traumatic stress disorder, chronic F43.20 10/01/2015 Adjustment disorder, unspecified F43.21 10/01/2015 Adjustment disorder w/ depressed mood F43.22 10/01/2015 Adjustment disorder w/ anxiety F43.23 10/01/2015 Adjustment disorder with mixed anxiety and depressed mood F43.24 10/01/2015 Adjustment disorder w/ disturbance of conduct F43.25 10/01/2015 Adjustment disorder w/ mixed disturbance of emotions and conduct F43.29 10/01/2015 Adjustment disorder w/ other symptoms F43.8 10/01/2015 Other reactions to severe stress F43.9 10/01/2015 Reaction to severe stress, unspecified F44.0 10/01/2015 Dissociative amnesia F44.1 10/01/2015 Dissociative fugue F44.2 10/01/2015 Dissociative stupor F44.4 10/01/2015 Conversion disorder w/ motor symptom or deficit F44.5 10/01/2015 Conversion disorder w/ seizures or convulsions F44.6 10/01/2015 Conversion disorder w/ sensory symptom or deficit F44.7 10/01/2015 Conversion disorder w/ mixed symptom presentation F44.81 10/01/2015 Dissociative identity disorder F44.89 10/01/2015 Other dissociative and conversion disorders F44.9 10/01/2015 Dissociative and conversion disorder, unspecified F45.0 10/01/2015 Somatization disorder F45.1 10/01/2015 Undifferentiated somatoform disorder F45.20 10/01/2015 Hypochondriacal disorder, unspecified F45.21 10/01/2015 Hypochondriasis F45.22 10/01/2015 Body dysmorphic disorder F45.29 10/01/2015 Other hypochondriacal disorders F45.41 10/01/2015 Pain disorder exlusively relatd to psychological factors F45.8 10/01/2015 Other somatoform disorders F45.9 10/01/2015 Somatoform disorder, unspecified F48.1 10/01/2015 Depersonalization-derealization syndrome F48.8 10/01/2015 Other specified nonpsychotic mental disorders F48.9 10/01/2015 Nonpsychotic mental disorder, unspecified F50.9 10/01/2015 Eating disorder, unspecified F51.01 10/01/2015 Primary insomnia F51.02 10/01/2015 Adjustment insomnia 4
Attachment A F51.03 10/01/2015 Paradoxical insomnia F51.09 10/01/2015 Other insomnia not due to a substance or known physiological condition F51.11 10/01/2015 Primary hypersomnia F51.12 10/01/2015 Insufficient sleep syndrome F51.19 10/01/2015 Other hypersomnia not due to a substance or known physiological condition F51.3 10/01/2015 Sleepwalking F51.4 10/01/2015 Sleep terrors F51.5 10/01/2015 Nightmare disorder F51.8 10/01/2015 Other sleep disorders not due to a substance or known physiological condition F51.9 10/01/2015 Sleep disorder not due to a substance or known physiological condition, unspecified F52.0 10/01/2015 Hypoactive sexual desire disorder F52.1 10/01/2015 Sexual aversion disorder F52.21 10/01/2015 Male erectile disorder F52.22 10/01/2015 Female sexual arousal disorder F52.31 10/01/2015 Female orgasmic disorder F52.32 10/01/2015 Male orgasmic disorder F52.4 10/01/2015 Premature ejaculation F52.6 10/01/2015 Dyspareunia not due to a substance or known physiological condition F52.8 10/01/2015 Other sexual dysfunction not due to a substance or known physiological condition F52.9 10/01/2015 Unspecified sexual dysfunction not due to a substance or know physiological condition F60.0 10/01/2015 Paranoid personality disorder F60.1 10/01/2015 Schizoid personality disorder F60.2 10/01/2015 Antisocial personality disorder F60.3 10/01/2015 Borderline personality disorder F60.4 10/01/2015 Histrionic personality disorder F60.5 10/01/2015 Obsessive-compulsive personality disorder F60.6 10/01/2015 Avoidant personality disorder F60.7 10/01/2015 Dependent personality disorder F60.81 10/01/2015 Narcissistic personality disorder F60.89 10/01/2015 Other specific personality disorders F60.9 10/01/2015 Personality disorder, unspecified F63.0 10/01/2015 Pathological gambling F63.1 10/01/2015 Pyromania F63.2 10/01/2015 Kleptomania 5
Attachment A F63.3 10/01/2015 Trichotillomania F63.81 10/01/2015 Intermittent explosive disorder F63.89 10/01/2015 Other impulse disorders F63.9 10/01/2015 Impulse disorder, unspecified F64.1 10/01/2015 Gender identity disorder in adolescence and adulthood F64.2 10/01/2015 Gender identity disorder in childhood F64.8 10/01/2015 Other gender identity disorders F65.0 10/01/2015 Fetishism F65.1 10/01/2015 Transvestic fetishism F65.2 10/01/2015 Exhibitionism F65.3 10/01/2015 Voyeurism F65.4 10/01/2015 Pedophilia F65.50 10/01/2015 Sadomasochism, unspecified F65.51 10/01/2015 Sexual masochism F65.52 10/01/2015 Sexual sadism F65.81 10/01/2015 Frotteurism F65.89 10/01/2015 Other paraphilias F65.9 10/01/2015 Parahilia, unspecified F66 10/01/2015 Other sexual disorders F68.10 10/01/2015 Factitious disorder, unspecified F68.11 10/01/2015 Factitious disorder w/ predominantly psychological signs and symptoms F68.12 10/01/2015 Fatitious disorder w/ predominantly physical signs and symptoms F68.8 10/01/2015 Other specified disorders of adult personality and behavior F69 10/01/2015 Unspecified disorder of adult personality and behavior F70 10/01/2015 Mild intellectual disabilities F71 10/01/2015 Moderate intellectual disabilities F72 10/01/2015 Severe intellectual disabilities F73 10/01/2015 Profound intellectual disabilities F78 10/01/2015 Other intellectual disabilities F79 10/01/2015 Unspecified intellectual disabilities F80.0 10/01/2015 Phonological disorder F80.1 10/01/2015 Expressive language disorder F80.2 10/01/2015 Mixed receptive-expressive language disorder F80.4 10/01/2015 Speech and language developmental delay due to hearing loss F80.89 10/01/2015 Other developmental disorders of speech and language F80.9 10/01/2015 Developmental disorder of speech and language, unspecified F81.0 10/01/2015 Specific reading disorder F81.2 10/01/2015 Mathematics disorder F81.89 10/01/2015 Other developmental disorders of scholastic skills 6
Attachment A F81.9 10/01/2015 Developmental disorder of scholastic skills, unspecified F82 10/01/2015 Specific developmental disorder of motor function F84.0 10/01/2015 Autistic disorder F84.3 10/01/2015 Other childhood disintegrative disorder F84.5 10/01/2015 Asperger's Syndrome F84.8 10/01/2015 Other pervasive developmental disorders F84.9 10/01/2015 Pervasive developmental disorder, unspecified F88 10/01/2015 Other disorders of psychological development F89 10/01/2015 Unspecified disorder of pyschological development F90.0 10/01/2015 Attention-deficit hyperactivity disorder, predominantly inattentive type F90.1 10/01/2015 Attention-deficit hyperactivity disorder, predominantly hyperactive type F90.2 10/01/2015 Attention-deficit hyperactivity disorder, combined type F90.8 10/01/2015 Attention-deficit hyperactivity disorder, other type F90.9 10/01/2015 Attention-deficit hyperactivity disorder, unspecified type F91.0 10/01/2015 Conduct disorder confined to family context F91.1 10/01/2015 Conduct disorder, childhood-onset type F91.2 10/01/2015 Conduct disorder, adolescent-onset type F91.3 10/01/2015 Oppositional defiant disorder F91.8 10/01/2015 Other conduct disorders F91.9 10/01/2015 Conduct disorder, unspecified F93.0 10/01/2015 Separation anxiety disorder of childhood F93.8 10/01/2015 Other childhood emotional disorders F93.9 10/01/2015 Childhood emotional disorder, unspecified F94.0 10/01/2015 Selective mutism F94.1 10/01/2015 Reactive attachment disorder of childhood F94.2 10/01/2015 Disinhibited attachment disorder of childhood F94.8 10/01/2015 Other childhood disorders of social functioning F94.9 10/01/2015 Childhood disorder of social functioning, unspecified F95.0 10/01/2015 Transient tic disorder F95.1 10/01/2015 Chronic motor or vocal tic disorder F95.2 10/01/2015 Tourette's disorder F95.9 10/01/2015 Tic disorder, unspecified F98.0 10/01/2015 Enuresis not due to a substance or known physiological condition F98.1 10/01/2015 Encopresis not due to a substance or known physiological condition F98.4 10/01/2015 Stereotyped movement disorder F98.5 10/01/2015 Adult onset fluency disorder F98.8 10/01/2015 Other specified behavioral and emotional disorders with onset 7
Attachment A usually occurring in childhood and adolescence F98.9 10/01/2015 Unspecified behavioral and emotional disorders w/ onset usually occurring in childhood and adolescence F99 10/01/2015 Mental disorder, not otherwise specified H93.25 10/01/2015 Central auditory processing disorder R45.1 10/01/2015 Restlessness and agitation R45.2 10/01/2015 Unhappiness R45.5 10/01/2015 Hostility R45.6 10/01/2015 Violent behavior R45.7 10/01/2015 State of emotional shock and stress, unspecified R45.81 10/01/2015 Low self-esteem R45.82 10/01/2015 Worries R48.0 10/01/2015 Dyslexia and alexia Z87.890 10/01/2015 Personal history of sex reassignment 8
Attachment B ICD-10-CM Mental Disorders Diagnosis Codes and s Subject to Certification of Admission/Concurrent/Continued Stay Review Based on the Admitting Diagnosis Code This list contains principal diagnosis codes for medical services Category of Service 20 or psychiatric services Category of Service 21. If a code from this list is used as the principal diagnosis code, general care hospitals that are not enrolled for COS 21 may only bill for a maximum of three days of emergency psychiatric care using COS 20. All codes are subject to 60-day detox readmission review except for those identified with an asterisk. Code Beginning Review F01.50 10/01/2015 Vascular dementia w/o behavioral disturbance F01.51 10/01/2015 Vascular dementia w/ behavioral disturbance F03.90 10/01/2015 Unspecified dementia w/o behavioral disturbance F05 10/01/2015 Delirium due to known physiological condition *F07.81 10/01/2015 Postconcussional syndrome *F07.89 10/01/2015 Other personality and behavioral disorders due to known physiological condition *F07.9 10/01/2015 Unspecified personality and behavioral disorder due to known physiological condition *F09 10/01/2015 Unspecified mental disorder due to known physiological condition *F10.10 10/01/2015 Alcohol abuse, uncomplicated *F10.120 10/01/2015 Alcohol abuse with intoxication, uncomplicated F10.121 10/01/2015 Alcohol abuse with intoxication delirium *F10.129 10/01/2015 Alcohol abuse with intoxication, unspecified F10.14 10/01/2015 Alcohol abuse w/ alcohol-induced mood disorder F10.150 10/01/2015 Alcohol abuse w/ alcohol-induced psychotic disorder w/ delusions F10.151 10/01/2015 Alcohol abuse w/ alcohol-induced psychotic disorder w/ hallucinations F10.159 10/01/2015 Alcohol abuse w/ unspecified alcohol-induced disorder F10.180 10/01/2015 Alcohol abuse w/ alcohol-induced anxiety disorder F10.181 10/01/2015 Alcohol abuse w/ alcohol-induced sexual dysfunction F10.182 10/01/2015 Alcohol abuse w/ alcohol-induced sleep disorder F10.188 10/01/2015 Alcohol abuse w/ other alcohol-induced disorder F10.19 10/01/2015 Alcohol abuse w/ unspecified alcohol-induced disorder *F10.20 10/01/2015 Alcohol dependence, uncomplicated *F10.21 10/01/2015 Alcohol dependence, in remission *F10.220 10/01/2015 Alcohol dependence with intoxication, uncomplicated 1
Attachment B Code Beginning Review F10.221 10/01/2015 Alcohol dependence with intoxication delirium *F10.229 10/01/2015 Alcohol dependence w/ intoxication, unspecified F10.230 10/01/2015 Alcohol dependence w/ withdrawal, uncomplicated F10.231 10/01/2015 Alcohol dependence w/ withdrawal delirium F10.232 10/01/2015 Alcohol dependence w/ withdrawal w/ perceptual disturbance F10.239 10/01/2015 Alcohol dependence w/ withdrawal, unspecified F10.24 10/01/2015 Alcohol dependence w/ alcohol-induced mood disorder F10.250 10/01/2015 Alcohol dependence w/ alcohol-induced psychotic disorder w/ delusions F10.251 10/01/2015 Alcohol dependence w/ alcohol-induced psychotic disorder w/ hallucinations F10.259 10/01/2015 Alcohol dependence w/ alcohol-induced psychotic disorder, unspecified F10.26 10/01/2015 Alcohol dependence w/ alcohol-induced persisting amnestic disorder F10.27 10/01/2015 Alcohol dependence w/ alcohol-induced persisting dementia F10.280 10/01/2015 Alcohol dependence w/ alcohol-induced anxiety disorder F10.281 10/01/2015 Alcohol dependence w/ alcohol-induced sexual dysfunction F10.282 10/01/2015 Alcohol dependence w/ alcohol-induced sleep disorder F10.288 10/01/2015 Alcohol dependence w/ other alcohol-induced disorder F10.29 10/01/2015 Alcohol dependence w/ unspecified alcohol-induced disorder F10.920 10/01/2015 Alcohol use, unspecified with intoxication, uncomplicated F10.921 10/01/2015 Alcohol use, unspecified with intoxication delirium F10.929 10/01/2015 Alcohol use, unspecified w/ intoxication, unspecified F10.94 10/01/2015 Alcohol use, unspecified with alcohol-induced mood disorder F10.950 10/01/2015 Alcohol use, unspecified w/ alcohol-induced psychotic disorder w/ delusions F10.951 10/01/2015 Alcohol use, unspecified w/ alcohol-induced psychotic disorder w/ hallucinations F10.959 10/01/2015 Alcohol use, unspecified w/ alcohol-induced psychotic disorder, unspecified F10.96 10/01/2015 Alcohol use, unspecified w/ alcohol-induced persisting amnestic disorder F10.97 10/01/2015 Alcohol use, unsp with alcohol-induced persisting dementia (Alcohol use, unspecified with alcohol-induced persisting dementia) F10.980 10/01/2015 Alcohol use, unspecified w/ alcohol-induced anxiety disorder F10.981 10/01/2015 Alcohol use, unspecified w/ alcohol-induced sexual dysfunction F10.982 10/01/2015 Alcohol use, unspecified w/ alcohol-induced sleep disorder 2
Attachment B Code Beginning Review F10.988 10/01/2015 Alcohol use, unspecified w/ other alcohol-induced disorder F10.99 10/01/2015 Alcohol use, unspecified w/ unspecified alcohol-induced disorder *F11.10 10/01/2015 Opioid abuse, uncomplicated *F11.120 10/01/2015 Opioid abuse with intoxication, uncomplicated F11.121 10/01/2015 Opioid abuse w/ intoxication delirium F11.122 10/01/2015 Opioid abuse with intoxication with perceptual disturbance *F11.129 10/01/2015 Opioid abuse with intoxication, unspecified F11.14 10/01/2015 Opioid abuse w/ opioid-induced mood disorder F11.150 10/01/2015 Opioid abuse w/ opioid-induced psychotic disorder w/ delusions F11.151 10/01/2015 Opioid abuse w/ opioid-induced psychotic disorder w/ hallucinations F11.159 10/01/2015 Opioid abuse w/ opioid-induced psychotic disorder, unspecified F11.181 10/01/2015 Opioid abuse with opioid-induced sexual dysfunction F11.182 10/01/2015 Opioid abuse w/ opioid-induced sleep disorder F11.188 10/01/2015 Opioid abuse with other opioid-induced disorder F11.19 10/01/2015 Opioid abuse with unspecified opioid-induced disorder F11.20 10/01/2015 Opioid dependence, uncomplicated *F11.21 10/01/2015 Opioid dependence, in remission F11.220 10/01/2015 Opioid dependence with intoxication, uncomplicated F11.221 10/01/2015 Opioid dependence with intoxication delirium F11.222 10/01/2015 Opioid dependence with intoxication with perceptual disturbance F11.229 10/01/2015 Opioid dependence with intoxication, unspecified F11.23 10/01/2015 Opioid dependence with withdrawal F11.24 10/01/2015 Opioid dependence with opioid-induced mood disorder F11.250 10/01/2015 Opioid dependence with opioid-induced psychotic disorder with delusions F11.251 10/01/2015 Opioid dependence with opioid-induced psychotic disorder with hallucinations F11.259 10/01/2015 Opioid dependence with opioid-induced psychotic disorder, unspecified F11.281 10/01/2015 Opioid dependence with opioid-induced sexual dysfunction F11.282 10/01/2015 Opioid dependence w/ opioid-induced sleep disorder F11.288 10/01/2015 Opioid dependence with other opioid-induced disorder F11.29 10/01/2015 Opioid dependence with unspecified opioid-induced disorder *F11.90 10/01/2015 Opioid use, unspecified, uncomplicated F11.920 10/01/2015 Opioid use, unspecified w/ intoxication, uncomplicated F11.921 10/01/2015 Opioid use, unspecified w/ intoxication delirium 3
Attachment B Code Beginning Review F11.922 10/01/2015 Opioid use, unspecified with intoxication with perceptual disturbance F11.929 10/01/2015 Opioid use, unspecified w/ intoxication, unspecified F11.93 10/01/2015 Opioid use, unspecified w/ withdrawal F11.94 10/01/2015 Opioid use, unspecified w/ opioid-induced mood disorder F11.950 10/01/2015 Opioid use, unsp w opioid-induc psych disorder w delusions (Opioid use, unspecified with opioid-induced psychotic disorder with delusions) F11.951 10/01/2015 Oth psychoactv sub use, unsp w psych disorder w hallucin (Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with hallucinations) F11.959 10/01/2015 Opioid use, unspecified with opioid-induced psychotic disorder, unspecified F11.981 10/01/2015 Opioid use, unspecified with opioid-induced sexual dysfunction F11.982 10/01/2015 Opioid use, unspecified w/ opioid-induced sleep disorder F11.988 10/01/2015 Opioid use, unspecified with other opioid-induced disorder F11.99 10/01/2015 Opioid use, unsp with unspecified opioid-induced disorder (Opioid use, unspecified with unspecified opioid-induced disorder) *F12.10 10/01/2015 Cannabis abuse, uncomplicated F12.120 10/01/2015 Cannabis abuse w/ intoxication, uncomplicated F12.121 10/01/2015 Cannabis abuse w/ intoxication delirium F12.122 10/01/2015 Cannabis abuse with intoxication with perceptual disturbance F12.129 10/01/2015 Cannabis abuse w/ intoxication, unspecified F12.150 10/01/2015 Cannabis abuse w/ psychotic disorder w/ delusions F12.151 10/01/2015 Cannabis abuse w/ psychotic disorder w/ hallucinations F12.159 10/01/2015 Cannabis abuse with psychotic disorder, unspecified F12.180 10/01/2015 Cannabis abuse with cannabis-induced anxiety disorder F12.188 10/01/2015 Cannabis abuse with other cannabis-induced disorder F12.19 10/01/2015 Cannabis abuse with unspecified cannabis-induced disorder *F12.20 10/01/2015 Cannabis dependence, uncomplicated *F12.21 10/01/2015 Cannabis dependence, in remission F12.220 10/01/2015 Cannabis dependence with intoxication, uncomplicated F12.221 10/01/2015 Cannabis dependence with intoxication delirium F12.222 10/01/2015 Cannabis dependence with intoxication with perceptual disturbance F12.229 10/01/2015 Cannabis dependence with intoxication, unspecified F12.250 10/01/2015 Cannabis dependence with psychotic disorder with delusions F12.251 10/01/2015 Cannabis dependence with psychotic disorder with 4
Attachment B Code Beginning Review hallucinations F12.259 10/01/2015 Cannabis dependence with psychotic disorder, unspecified F12.280 10/01/2015 Cannabis dependence with cannabis-induced anxiety disorder F12.288 10/01/2015 Cannabis dependence with other cannabis-induced disorder F12.29 10/01/2015 Cannabis dependence with unspecified cannabis-induced disorder *F12.90 10/01/2015 Cannabis use, unspecified, uncomplicated F12.920 10/01/2015 Cannabis use, unspecified w/ intoxication, uncomplicated F12.921 10/01/2015 Cannabis use, unspecified w/ intoxication delirium F12.922 10/01/2015 Cannabis use, unspecified with intoxication with perceptual disturbance F12.929 10/01/2015 Cannabis use, unspecified w/ intoxication, unspecified F12.950 10/01/2015 Cannabis use, unspecified w/ psychotic disorder w/ delusions F12.951 10/01/2015 Cannabis use, unspecified w/ psychotic disorder w/ hallucinations F12.959 10/01/2015 Cannabis use, unspecified with psychotic disorder, unspecified F12.980 10/01/2015 Cannabis use, unspecified with anxiety disorder F12.988 10/01/2015 Cannabis use, unspecified with other cannabis-induced disorder F12.99 10/01/2015 Cannabis use, unsp with unsp cannabis-induced disorder (Cannabis use, unspecified with unspecified cannabis-induced disorder) *F13.10 10/01/2015 Sedative, hypnotic or anxiolytic abuse, uncomplicated *F13.120 10/01/2015 Sedative, hypnotic or anxiolytic abuse with intoxication, uncomplicated F13.121 10/01/2015 Sedative, hypnotic or anxiolytic abuse w/ intoxication delirium F13.129 10/01/2015 Sedative, hypnotic or anxiolytic abuse w intoxication, unsp (Sedative, hypnotic or anxiolytic abuse with intoxication, unspecified F13.14 10/01/2015 Sedative, hypnotic or anxiolytic abuse w/ sedative, hypnotic or anxiolytic-induced mood disorder F13.150 10/01/2015 Sedative, hypnotic or anxiolytic abuse w/ sedative, hypnotic or anxiolytic-induced psychotic disorder w/ delusions F13.151 10/01/2015 Sedative, hypnotic or anxiolytic abuse w/ sedative, hypnotic or anxiolytic-induced psychotic disorder w/ hallucinations F13.159 10/01/2015 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified F13.180 10/01/2015 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced anxiety disorder 5
Attachment B Code Beginning Review F13.181 10/01/2015 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced sexual dysfunction F13.182 10/01/2015 Sedative, hypnotic or anxiolytic abuse w/ sedative, hypnotic or anxiolytic-induced sleep disorder F13.188 10/01/2015 Sedative, hypnotic or anxiolytic abuse with other sedative, hypnotic or anxiolytic-induced disorder F13.19 10/01/2015 Sedative, hypnotic or anxiolytic abuse w unsp disorder (Sedative, hypnotic or anxiolytic abuse with unspecified sedative, hypnotic or anxiolytic-induced disorder) *F13.20 10/01/2015 Sedative, hypnotic or anxiolytic dependence, uncomplicated *F13.21 10/01/2015 Sedative, hypnotic or anxiolytic dependence, in remission F13.220 10/01/2015 Sedative, hypnotic or anxiolytic dependence with intoxication, uncomplicated F13.221 10/01/2015 Sedative, hypnotic or anxiolytic dependence with intoxication delirium F13.229 10/01/2015 Sedative, hypnotic or anxiolytic dependence with intoxication, unspecified F13.230 10/01/2015 Sedative, hypnotic or anxiolytic dependence with withdrawal, uncomplicated F13.231 10/01/2015 Sedative, hypnotic or anxiolytic dependence with withdrawal delirium F13.232 10/01/2015 Sedative, hypnotic or anxiolytic dependence with withdrawal with perceptual disturbance F13.239 10/01/2015 Sedative, hypnotic or anxiolytic dependence with withdrawal, unspecified F13.24 10/01/2015 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced mood disorder F13.250 10/01/2015 Sedative, hypnotic or anxiolytic dependence w/ sedative, hypnotic or anxiolytic-induced psychotic disorder w/ delusions F13.251 10/01/2015 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations F13.259 10/01/2015 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified F13.26 10/01/2015 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder F13.27 10/01/2015 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting dementia F13.280 10/01/2015 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced anxiety disorder 6
Attachment B Code Beginning Review F13.281 10/01/2015 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sexual dysfunction F13.282 10/01/2015 Sedative, hypnotic or anxiolytic dependence w/ sedative, hypnotic or anxiolytic-induced sleep disorder F13.288 10/01/2015 Sedative, hypnotic or anxiolytic dependence with other sedative, hypnotic or anxiolytic-induced disorder F13.29 10/01/2015 Sedative, hypnotic or anxiolytic dependence with unspecified sedative, hypnotic or anxiolytic-induced disorder *F13.90 10/01/2015 Sedative, hypnotic or anxiolytic use, unspecified, uncomplicated F13.920 10/01/2015 Sedatv/hyp/anxiolytc use, unsp w intoxication, uncomplicated (Sedative, hypnotic or anxiolytic use, unspecified with intoxication, uncomplicated) F13.921 10/01/2015 Sedative, hypnotic or anxiolytic use, unspecified w/ intoxication delirium F13.929 10/01/2015 Sedatv/hyp/anxiolytc use, unsp w intoxication, unsp (Sedative, hypnotic or anxiolytic use, unspecified with intoxication, unspecified) F13.930 10/01/2015 Sedative, hypnotic or anxiolytic use, unspecified w/ withdrawal, uncomplicated F13.931 10/01/2015 Sedative, hypnotic or anxiolytic use, unspecified w/ withdrawal delirium F13.932 10/01/2015 Sedative, hypnotic or anxiolytic use, unspecified w/ withdrawal w/ perceptual disturbances F13.939 10/01/2015 Sedative, hypnotic or anxiolytic use, unspecified w/ withdrawal, unspecified F13.94 10/01/2015 Sedative, hypnotic or anxiolytic use, unspecified w/ sedative, hypnotic or anxiolytic-induced mood disorder F13.950 10/01/2015 Sedative, hypnotic or anxiolytic use, unspecified w/ sedative, hypnotic or anxiolytic-induced psychotic disorder w/ delusions F13.951 10/01/2015 Sedative, hypnotic or anxiolytic use unspecified w/ sedative, hypnotic or anxiolytic-induced psychotic disorder w/ hallucinations F13.959 10/01/2015 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified F13.96 10/01/2015 Sedative, hypnotic or anxiolytic use, unspecified w/ sedative, hypnotic or anxiolytic-induced persisting amnestic disorder F13.97 10/01/2015 Sedative, hypnotic or anxiolytic use, unspecified w/ sedative, hypnotic or anxiolytic-induced persisting dementia 7
Attachment B Code Beginning Review F13.980 10/01/2015 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced anxiety disorder F13.981 10/01/2015 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced sexual dysfunction F13.982 10/01/2015 Sedative, hypnotic or anxiolytic use, unspecified w/ sedative, hypnotic or anxiolytic-induced sleep disorder F13.988 10/01/2015 Sedative, hypnotic or anxiolytic use, unspecified with other sedative, hypnotic or anxiolytic-induced disorder F13.99 10/01/2015 Sedative, hypnotic or anxiolytic use, unsp w unsp disorder (Sedative, hypnotic or anxiolytic use, unspecified with unspecified sedative, hypnotic or anxiolytic-induced disorder) *F14.10 10/01/2015 Cocaine abuse, uncomplicated *F14.120 10/01/2015 Cocaine abuse with intoxication, uncomplicated F14.121 10/01/2015 Cocaine abuse w/ intoxication w/ delirium F14.122 10/01/2015 Cocaine abuse with intoxication with perceptual disturbance F14.129 10/01/2015 Cocaine abuse with intoxication, unspecified F14.14 10/01/2015 Cocaine abuse w/ cocaine-induced mood disorder F14.150 10/01/2015 Cocaine abuse w/ cocaine-induced psychotic disorder w/ delusions F14.151 10/01/2015 cocaine abuse w/ cocaine-induced psychotic disorder w/ hallucinations F14.159 10/01/2015 Cocaine abuse with cocaine-induced psychotic disorder, unspecified F14.180 10/01/2015 Cocaine abuse with cocaine-induced anxiety disorder F14.181 10/01/2015 Cocaine abuse with cocaine-induced sexual dysfunction F14.182 10/01/2015 Cocaine abuse w/ cocaine-induced sleep disorder F14.188 10/01/2015 Cocaine abuse with other cocaine-induced disorder F14.19 10/01/2015 Cocaine abuse with unspecified cocaine-induced disorder F14.20 10/01/2015 Cocaine dependence, uncomplicated *F14.21 10/01/2015 Cocaine dependence, in remission F14.220 10/01/2015 Cocaine dependence with intoxication, uncomplicated F14.221 10/01/2015 Cocaine dependence with intoxication delirium F14.222 10/01/2015 Cocaine dependence with intoxication with perceptual disturbance F14.229 10/01/2015 Cocaine dependence with intoxication, unspecified F14.23 10/01/2015 Cocaine dependence with withdrawal F14.24 10/01/2015 Cocaine dependence with cocaine-induced mood disorder F14.250 10/01/2015 Cocaine dependence with cocaine-induced psychotic disorder with delusions F14.251 10/01/2015 Cocaine dependence with cocaine-induced psychotic disorder with hallucinations 8
Attachment B Code Beginning Review F14.259 10/01/2015 Cocaine dependence with cocaine-induced psychotic disorder, unspecified F14.280 10/01/2015 Cocaine dependence with cocaine-induced anxiety disorder F14.281 10/01/2015 Cocaine dependence with cocaine-induced sexual dysfunction F14.282 10/01/2015 Cocaine dependence w/ cocaine-induced sleep disorder F14.288 10/01/2015 Cocaine dependence with other cocaine-induced disorder F14.29 10/01/2015 Cocaine dependence with unspecified cocaine-induced disorder *F14.90 10/01/2015 Cocaine use, unspecified, uncomplicated F14.920 10/01/2015 Cocaine use, unspecified with intoxication, uncomplicated F14.921 10/01/2015 Cocaine use, unspecified w/ intoxication delirium F14.922 10/01/2015 Cocaine use, unspecified with intoxication with perceptual disturbance F14.929 10/01/2015 Cocaine use, unspecified with intoxication, unspecified F14.94 10/01/2015 Cocaine use, unspecified w/ cocaine-induced mood disorder F14.950 10/01/2015 Cocaine use, unspecified w/ cocaine-induced psychotic disorder w/ delusions F14.951 10/01/2015 Cocaine use, unspecified w/ cocaine-induced psychotic disorder w/ hallucinations F14.959 10/01/2015 Cocaine use, unspecified with cocaine-induced psychotic disorder, unspecified F14.980 10/01/2015 Cocaine use, unspecified with cocaine-induced anxiety disorder F14.981 10/01/2015 Cocaine use, unspecified with cocaine-induced sexual dysfunction F14.982 10/01/2015 Cocaine use, unspecified w/ cocaine-induced sleep disorder F14.988 10/01/2015 Cocaine use, unspecified with other cocaine-induced disorder F14.99 10/01/2015 Cocaine use, unsp with unspecified cocaine-induced disorder (Cocaine use, unspecified with unspecified cocaine-induced disorder) *F15.10 10/01/2015 Other stimulant abuse, uncomplicated F15.120 10/01/2015 Other stimulant abuse with intoxication, uncomplicated F15.121 10/01/2015 Other stimulant use, unspecified with intoxication delirium F15.122 10/01/2015 Other stimulant abuse with intoxication with perceptual disturbance F15.129 10/01/2015 Other stimulant abuse with intoxication, unspecified F15.14 10/01/2015 Other stimulant abuse w/ stimulant-induced mood disorder F15.150 10/01/2015 Other stimulant abuse w/ stimulant-induced psychotic disorder w/ delusions 9
Attachment B Code Beginning Review F15.151 10/01/2015 Oth stimulant abuse w stim-induce psych disorder w hallucin (Other stimulant abuse with stimulant-induced psychotic disorder with hallucinations) F15.159 10/01/2015 Other stimulant abuse with stimulant-induced psychotic disorder, unspecified F15.180 10/01/2015 Other stimulant abuse with stimulant-induced anxiety disorder F15.181 10/01/2015 Other stimulant abuse with stimulant-induced sexual dysfunction F15.182 10/01/2015 Other stimulant abuse w/ stimulant-induced sleep disorder F15.188 10/01/2015 Other stimulant abuse with other stimulant-induced disorder F15.19 10/01/2015 Other stimulant abuse with unsp stimulant-induced disorder (Other stimulant abuse with unspecified stimulant-induced disorder) *F15.20 10/01/2015 Other stimulant dependence, uncomplicated *F15.21 10/01/2015 Other stimulant dependence, in remission F15.222 10/01/2015 Other stimulant dependence with intoxication with perceptual disturbance F15.259 10/01/2015 Other stimulant dependence with stimulant-induced psychotic disorder, unspecified F15.280 10/01/2015 Other stimulant dependence with stimulant-induced anxiety disorder F15.281 10/01/2015 Other stimulant dependence with stimulant-induced sexual dysfunction F15.282 10/01/2015 Other stimulant dependence w/ stimulant-induced sleep disorder F15.288 10/01/2015 Other stimulant dependence with other stimulant-induced disorder *F15.90 10/01/2015 Other stimulant use, unspecified, uncomplicated F15.920 10/01/2015 Other stimulant use, unsp with intoxication, uncomplicated (Other stimulant use, unspecified with intoxication, uncomplicated) F15.921 10/01/2015 Other stimulant use, unspecified w/ intoxication delirium F15.922 10/01/2015 Other stimulant use, unspecified with intoxication with perceptual disturbance F15.929 10/01/2015 Other stimulant use, unsp with intoxication, unspecified (Other stimulant use, unspecified with intoxication, unspecified) F15.93 10/01/2015 Other stimulant use, unspecified w/ withdrawal F15.94 10/01/2015 Other stimulant use, unspecified w/ stimulant-induced mood disorder F15.950 10/01/2015 Other stimulant use, unspecified w/ stimulant-induced psychotic disorder w/ delusions 10
Attachment B Code Beginning Review F15.951 10/01/2015 Oth stim use, unsp w stim-induce psych disorder w hallucin (Other stimulant use, unspecified with stimulant-induced psychotic disorder with hallucinations) F15.959 10/01/2015 Other stimulant use, unspecified with stimulant-induced psychotic disorder, unspecified F15.980 10/01/2015 Other stimulant use, unspecified with stimulant-induced anxiety disorder F15.981 10/01/2015 Other stimulant use, unspecified with stimulant-induced sexual dysfunction F15.982 10/01/2015 Other stimulant use, unspecified w/ stimulant-induced sleep disorder F15.988 10/01/2015 Other stimulant use, unspecified with other stimulant-induced disorder F15.99 10/01/2015 Oth stimulant use, unsp with unsp stimulant-induced disorder (Other stimulant use, unspecified with unspecified stimulantinduced disorder) *F16.10 10/01/2015 Hallucinogen abuse, uncomplicated F16.120 10/01/2015 Hallucinogen abuse with intoxication, uncomplicated F16.121 10/01/2015 Hallucinogen abuse w/ intoxication w/ delirium F16.122 10/01/2015 Hallucinogen abuse with intoxication with perceptual disturbance F16.129 10/01/2015 Hallucinogen abuse with intoxication, unspecified F16.14 10/01/2015 Hallucinogen abuse w/ hallucinogen-induced mood disorder F16.150 10/01/2015 Hallucinogen abuse w/ hallucinogen-induced psychotic disorder w/ delusions F16.151 10/01/2015 Hallucinogen abuse w/ hallucinogen-induced psychotic disorder w/ hallucinations F16.159 10/01/2015 Hallucinogen abuse with hallucinogen-induced psychotic disorder, unspecified F16.180 10/01/2015 Hallucinogen abuse with hallucinogen-induced anxiety disorder F16.183 10/01/2015 Hallucinogen abuse with hallucinogen persisting perception disorder F16.188 10/01/2015 Hallucinogen abuse with other hallucinogen-induced disorder F16.19 10/01/2015 Hallucinogen abuse with unsp hallucinogen-induced disorder (Hallucinogen abuse with unspecified hallucinogen-induced disorder) F16.20 10/01/2015 Hallucinogen dependence, uncomplicated *F16.21 10/01/2015 Hallucinogen dependence, in remission F16.220 10/01/2015 Hallucinogen dependence with intoxication, uncomplicated F16.221 10/01/2015 Hallucinogen dependence w/ intoxication w/ delirium 11
Attachment B Code Beginning Review F16.229 10/01/2015 Hallucinogen dependence with intoxication, unspecified F16.24 10/01/2015 Hallucinogen dependence w/ hallucinogen-induced mood disorder F16.250 10/01/2015 Hallucinogen dependence with hallucinogen-induced psychotic disorder with delusions F16.251 10/01/2015 Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations F16.259 10/01/2015 Hallucinogen dependence with hallucinogen-induced psychotic disorder, unspecified F16.280 10/01/2015 Hallucinogen dependence with hallucinogen-induced anxiety disorder F16.283 10/01/2015 Hallucinogen dependence with hallucinogen persisting perception disorder (flashbacks) F16.288 10/01/2015 Hallucinogen dependence with other hallucinogen-induced disorder F16.29 10/01/2015 Hallucinogen dependence with unspecified hallucinogeninduced disorder *F16.90 10/01/2015 Hallucinogen use, unspecified, uncomplicated F16.920 10/01/2015 Hallucinogen use, unsp with intoxication, uncomplicated (Hallucinogen use, unspecified with intoxication, uncomplicated) F16.921 10/01/2015 Hallucinogen use, unspecified w/ intoxication w/ delirium F16.929 10/01/2015 Hallucinogen use, unspecified with intoxication, unspecified F16.94 10/01/2015 Hallucinogen use, unspecified w/ hallucinogen-induced mood disorder F16.950 10/01/2015 Hallucinogen use, unspecified w/ hallucinogen-induced psychotic disorder w/ delusions F16.951 10/01/2015 Hallucinogen use, unspecified w/ hallucinogen-induced psychotic disorder w/ hallucinations F16.959 10/01/2015 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder F16.980 10/01/2015 Hallucinogen use, unspecified with hallucinogen-induced anxiety disorder F16.983 10/01/2015 Hallucinogen use, unspecified with hallucinogen persisting perception disorder F16.988 10/01/2015 Hallucinogen use, unspecified with other hallucinogeninduced disorder F16.99 10/01/2015 Hallucinogen use, unsp w unsp hallucinogen-induced disorder (Hallucinogen use, unspecified with unspecified hallucinogeninduced disorder F17.203 10/01/2015 Nicotine dependence unspecified, w/ withdrawal 12
Attachment B Code Beginning Review F17.208 10/01/2015 Nicotine dependence, unspecified, with other nicotine-induced disorders F17.209 10/01/2015 Nicotine dependence, unsp, w unsp nicotine-induced disorders (Nicotine dependence, unspecified, with unspecified nicotineinduced disorders F17.213 10/01/2015 Nicotine dependence, cigarettes, w/ withdrawal F17.218 10/01/2015 Nicotine dependence, other tobacco product, with other nicotine-induced disorders F17.219 10/01/2015 Nicotine dependence, cigarettes, w unsp disorders (Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders) F17.223 10/01/2015 Nicotine dependence, chewing tobacco, w/ withdrawal F17.228 10/01/2015 Inhalant abuse with inhalant-induced psychotic disorder, unspecified F17.229 10/01/2015 Nicotine dependence, chewing tobacco, w unsp disorders (Nicotine dependence, chewing tobacco, with unspecified nicotine-induced disorders) F17.293 10/01/2015 Nicotine dependence, other tobacco product, w/ withdrawal F17.298 10/01/2015 Inhalant abuse with inhalant-induced anxiety disorder F17.299 10/01/2015 Nicotine dependence, oth tobacco product, w unsp disorders (Nicotine dependence, other tobacco product, with unspecified nicotine-induced disorders) *F18.10 10/01/2015 Inhalant abuse, uncomplicated F18.120 10/01/2015 Inhalant abuse with intoxication, uncomplicated F18.121 10/01/2015 Inhalant abuse with intoxication delirium F18.129 10/01/2015 Inhalant abuse with intoxication, unspecified F18.14 10/01/2015 Inhalant abuse w/ inhalant-induced mood disorder F18.150 10/01/2015 Inhalant abuse w/ inhalant-induced psychotic disorder w/ delusions F18.151 10/01/2015 Inhalant abuse w/ inhalant-induced psychotic disorder w/ hallucinations F18.159 10/01/2015 Inhalant abuse with inhalant-induced psychotic disorder, unspecified F18.17 10/01/2015 Inhalant abuse with inhalant-induced dementia F18.180 10/01/2015 Inhalant dependence with inhalant-induced anxiety disorder *F18.188 10/01/2015 Inhalant abuse with other inhalant-induced disorder F18.19 10/01/2015 Inhalant abuse with unspecified inhalant-induced disorder *F18.20 10/01/2015 Inhalant dependence, uncomplicated *F18.21 10/01/2015 Inhalant dependence, in remission F18.220 10/01/2015 Inhalant dependence with intoxication, uncomplicated F18.221 10/01/2015 Inhalant dependence with intoxication delirium 13
Attachment B Code Beginning Review F18.229 10/01/2015 Other psychoactive substance dependence with intoxication, unspecified F18.24 10/01/2015 Inhalant dependence with inhalant-induced mood disorder F18.250 10/01/2015 Inhalant dependence with inhalant-induced psychotic disorder with delusions F18.251 10/01/2015 Inhalant dependence with inhalant-induced psychotic disorder with hallucinations F18.259 10/01/2015 Inhalant dependence with inhalant-induced psychotic disorder, unspecified F18.27 10/01/2015 Inhalant dependence with inhalant-induced dementia F18.280 10/01/2015 Inhalant dependence with inhalant-induced anxiety disorder F18.288 10/01/2015 Inhalant dependence with other inhalant-induced disorder F18.29 10/01/2015 Inhalant dependence with unspecified inhalant-induced disorder F18.90 10/01/2015 Inhalant use, unspecified, uncomplicated F18.920 10/01/2015 Inhalant use, unspecified with intoxication, uncomplicated F18.921 10/01/2015 Inhalant use, unspecified w/ intoxication w/ delirium F18.929 10/01/2015 Inhalant use, unspecified with intoxication, unspecified F18.94 10/01/2015 Inhalant use, unspecified w/ inhalant-induced mood disorder F18.950 10/01/2015 Inhalant use, unspecified w/ inhalant-induced psychotic disorder w/ delusions F18.951 10/01/2015 Inhalant use, unspecified w/ inhalant-induced psychotic disorder w/ hallucinations F18.959 10/01/2015 Inhalant use, unspecified with inhalant-induced psychotic disorder, unspecified F18.97 10/01/2015 Inhalant use, unsp with inhalant-induced persisting dementia (Inhalant use, unspecified with inhalant-induced persisting dementia) F18.980 10/01/2015 Inhalant use, unspecified with inhalant-induced anxiety disorder F18.988 10/01/2015 Inhalant use, unspecified with other inhalant-induced disorder F18.99 10/01/2015 Inhalant use, unsp with unsp inhalant-induced disorder (Inhalant use, unspecified with unspecified inhalant-induced disorder) *F19.10 10/01/2015 Other psychoactive substance abuse, uncomplicated F19.120 10/01/2015 Other psychoactive substance abuse with intoxication, uncomplicated F19.121 10/01/2015 Other psychoactive substance abuse w/ intoxication delirium F19.122 10/01/2015 Other psychoactive substance abuse with intoxication with perceptual disturbances F19.129 10/01/2015 Other psychoactive substance abuse with intoxication, 14
Attachment B Code Beginning Review unspecified F19.14 10/01/2015 Other psychoactive substance abuse w/ psychoactive substance-induced mood disorder F19.150 10/01/2015 Oth psychoactv substance abuse w psych disorder w delusions (Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with delusions) F19.151 10/01/2015 Other psychoactive substance abuse w/ psychoactive substance-induced psychotic disorder w/ hallucinations F19.159 10/01/2015 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder, unspecified F19.16 10/01/2015 Other psychoactive substance abuse w/ psychoactive substance-induced persisting amnestic disorder F19.17 10/01/2015 Other psychoactive substance abuse w/ psychoactive substance-induced persisting dementia F19.180 10/01/2015 Other psychoactive substance abuse with psychoactive substance-induced anxiety disorder F19.181 10/01/2015 Other psychoactive substance abuse with psychoactive substance-induced sexual dysfunction F19.182 10/01/2015 Other psychoactive substance abuse w/ psychoactive substance-induced sleep disorder F19.188 10/01/2015 Other psychoactive substance abuse with other psychoactive substance F19.19 10/01/2015 Oth psychoactive substance abuse w unsp disorder (Other psychoactive substance abuse with unspecified psychoactive substance-induced disorder) *F19.20 10/01/2015 Other psychoactive substance dependence, uncomplicated *F19.21 10/01/2015 Other psychoactive substance dependence, in remission F19.220 10/01/2015 Other psychoactive substance dependence with intoxication, uncomplicated *F19.221 10/01/2015 (Other psychoactive substance dependence with intoxication delirium F19.222 10/01/2015 Other psychoactive substance dependence with intoxication with perceptual disturbance F19.229 10/01/2015 Other psychoactive substance dependence with intoxication, unspecified F19.230 10/01/2015 Other psychoactive substance dependence with withdrawal, uncomplicated F19.231 10/01/2015 Other psychoactive substance dependence with withdrawal delirium F19.232 10/01/2015 Other psychoactive substance dependence with withdrawal with perceptual disturbance 15
Attachment B Code Beginning Review F19.239 10/01/2015 Other psychoactive substance dependence with withdrawal, unspecified F19.24 10/01/2015 Other psychoactive substance dependence with psychoactive substance-induced mood disorder F19.250 10/01/2015 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with delusions F19.251 10/01/2015 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with hallucinations F19.259 10/01/2015 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder, unspecified F19.26 10/01/2015 Other psychoactive substance dependence with psychoactive substance-induced persisting amnestic disorder F19.27 10/01/2015 Other psychoactive substance dependence with psychoactive substance-induced persisting dementia F19.280 10/01/2015 Other psychoactive substance dependence with psychoactive substance-induced anxiety disorder F19.281 10/01/2015 Other psychoactive substance dependence with psychoactive substance-induced sexual dysfunction F19.282 10/01/2015 Other psychoactive substance dependence w/ psychoactive substance-induced sleep disorder F19.288 10/01/2015 Other psychoactive substance dependence with other psychoactive substance-induced disorder *F19.90 10/01/2015 Other psychoactive substance use, unspecified, uncomplicated F19.920 10/01/2015 Other psychoactive substance use, unspecified with intoxication, uncomplicated F19.921 10/01/2015 Oth psychoactive substance use, unsp w intox w delirium (Other psychoactive substance use, unspecified with intoxication with delirium) F19.922 10/01/2015 Other psychoactive substance use, unspecified with intoxication with perceptual disturbance F19.929 10/01/2015 Oth psychoactive substance use, unsp with intoxication, unsp (Other psychoactive substance use, unspecified with intoxication, unspecified) F19.930 10/01/2015 Other psychoactive substance use, unspecified w/ withdrawal, uncomplicated F19.931 10/01/2015 Other psychoactive substance use, unspecified w/ withdrawal delirium F19.932 10/01/2015 Other psychoactive substance use, unspecified w/ withdrawal perceptual disturbance F19.939 10/01/2015 Other psychoactive substance use, unspecified w/ withdrawal, unspecified 16
Attachment B Code Beginning Review F19.94 10/01/2015 Other psychoactive substance use, unspecified w/ psychoactive substance-induced mood disorder F19.950 10/01/2015 Oth psychoactv sub use, unsp w psych disorder w delusions (Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with delusions) F19.951 10/01/2015 Opioid abuse w/ opioid-induced psychotic disorder w/ hallucinations F19.959 10/01/2015 Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified F19.96 10/01/2015 Other psychoactive substance use, unspecified w/ psychoactive substance-induced persisting amnestic disorder F19.97 10/01/2015 Other psychoactive substance use, unspecified w/ psychoactive substance-induced persisting dementia F19.980 10/01/2015 Other psychoactive substance use, unspecified with psychoactive substance-induced anxiety disorder F19.981 10/01/2015 Other psychoactive substance use, unspecified with psychoactive substance-induced sexual dysfunction F19.982 10/01/2015 Other psychoactive substance use, unspecified w/ psychoactive substance-induced sleep disorder F19.988 10/01/2015 Other psychoactive substance use, unspecified with other psychoactive substance-induced disorder F19.99 10/01/2015 Other psychoactive substance use, unspecified with unspecified psychoactive substance-induced disorder *F45.42 10/01/2015 Pain disorder with related psychological factors *F48.2 10/01/2015 Pseudobulbar affect *F50.00 10/01/2015 Anorexia nervosa, unspecified *F50.01 10/01/2015 Anorexia nervosa, restricting type *F50.02 10/01/2015 Anorexia nervosa, binge eating/purging type *F50.2 10/01/2015 Bulimia nervosa *F50.8 10/01/2015 Other eating disorders *F52.5 10/01/2015 Vaginismus not due to a substance or known physiological condition *F54 10/01/2015 Psychological and behavioral factors associated w/ disorders or diseases classified elsewhere *F55.0 10/01/2015 Abuse of antacids *F55.1 10/01/2015 Abuse of herbal or folk remedies *F55.2 10/01/2015 Abuse of laxatives *F55.3 10/01/2015 Abuse of steroids or hormones *F55.4 10/01/2015 Abuse of vitamins 17
Attachment B Code Beginning Review *F55.8 10/01/2015 Abuse of other non-psychoactive substances *F59 10/01/2015 Unspecified behavioral syndromes associated with physiological disturbances and physical factors *F98.21 10/01/2015 Rumination disorder of infancy *F98.29 10/01/2015 Other feeding disorders of infancy and early childhood *F98.3 10/01/2015 Pica of infancy and childhood *G44.209 10/01/2015 Tension-type headache, unspecified *R78.0 10/01/2015 Blood alcohol level of less than 20mg/100ml 18
Attachment C ICD-10-CM Diagnosis Codes Subject to Certification of Admission/Concurrent/Continued Stay Review Based on the Admitting Diagnosis Code A40.0 10/01/2015 Sepsis due to streptococcus, group A A40.1 10/01/2015 Sepsis due to streptococcus, group B A40.3 10/01/2015 Sepsis due to streptococcus pneumoniae A40.3 10/01/2015 Sepsis due to Streptococcus pneumoniae A40.8 10/01/2015 Other streptococcal sepsis A40.9 10/01/2015 Streptococcal sepsis, unspecified A41.01 10/01/2015 Sepsis due to methicillin susceptible staphylococcus aureus A41.1 10/01/2015 Sepsis due to other specified staphylococcus A41.2 10/01/2015 Sepsis due to unspecified staphylococcus A41.3 10/01/2015 Sepsis due to Hemophilus influenzae A41.4 10/01/2015 Sepsis due to anaerobes A41.50 10/01/2015 Gram-negative sepsis, unspecified A41.51 10/01/2015 Sepsis due to Escherichia coli [E. coli] A41.52 10/01/2015 Sepsis due to pseudomonas A41.53 10/01/2015 Sepsis due to serratia A41.59 10/01/2015 Other Gram-negative sepsis A41.81 10/01/2015 Sepsis due to Enterococcus A41.89 10/01/2015 Other specified sepsis A41.9 10/01/2015 Sepsis, unspecified organism A42.7 10/01/2015 Actinomycotic sepsis D50.0 10/01/2015 Iron deficiency anemia secondary to blood loss (chronic) D50.9 10/01/2015 Iron deficiency anemia, unspecified D64.9 10/01/2015 Anemia, unspecified E10.10 10/01/2015 Type 1 diabetes mellitus w/ ketoacidosis w/o coma E10.618 10/01/2015 Type 1 diabetes mellitus w/ other diabetic arthropathy E10.620 10/01/2015 Type 1 diabetes mellitus w/ diabetic dermatitis E10.621 10/01/2015 Type 1 diabetes mellitus w/ foot ulcer E10.622 10/01/2015 Type 1 diabetes mellitus w/ other skin ulcer E10.628 10/01/2015 Type 1 diabetes mellitus w/ other skin complications E10.630 10/01/2015 Type 1 diabetes mellitus w/ periodontal disease E10.638 10/01/2015 Type 1 diabetes mellitus w/ other oral complications E10.649 10/01/2015 Type 1 diabetes mellitus w/ hypoglycemia w/o coma E10.65 10/01/2015 Type 1 diabetes mellitus w/ hyperglycemia E10.69 10/01/2015 Type 1 diabetes mellitus w/ other specified complication E10.9 10/01/2015 Type 1 diabetes mellitus w/o complications 1
Attachment C E11.00 10/01/2015 Type 2 diabetes mellitus w/ hyperosmolarity w/o nonketotic hyperglycemic-hyperosmolar coma (NKHHC) E11.01 10/01/2015 Type 2 diabetes mellitus w/ hyperosmolarity w/ coma E11.618 10/01/2015 Type 2 diabetes mellitus w/ other diabetic arthropathy E11.620 10/01/2015 Type 2 diabetes mellitus w/ diabetic dermatitis E11.621 10/01/2015 Type 2 diabetes mellitus w/ foot ulcer E11.622 10/01/2015 Type 2 diabetes mellitus w/ other skin ulcer E11.628 10/01/2015 Type 2 diabetes mellitus w/ other skin complications E11.630 10/01/2015 Type 2 diabetes mellitus w/ periodontal disease E11.638 10/01/2015 Type 2 diabetes mellitus w/ other oral complications E11.649 10/01/2015 Type 2 diabetes mellitus w/ hypoglycemia E11.65 10/01/2015 Type 2 diabetes mellitus w/ hyperglycemia E11.69 10/01/2015 Type 2 diabetes mellitus w/ other specified complication E11.9 10/01/2015 Type 2 diabetes mellitus w/o complications E13.00 10/01/2015 Other specified diabetes mellitus w/ hyperosmolarity w/o nonketotic hyperglycemic-hyperosmolar coma (NKHHC) E13.01 10/01/2015 Other specified diabetes mellitus w/ hyperosmolarity w/ coma E13.10 10/01/2015 Other specified diabetes mellitus w/ ketoacidosis w/o coma E13.618 10/01/2015 Other specified diabetes mellitus w/ other diabetic arthropathy E13.620 10/01/2015 Other specified diabetes mellitus w/ diabetic dermatitis E13.621 10/01/2015 Other specified diabetes mellitus w/ foot ulcer E13.622 10/01/2015 Other specified diabetes mellitus w/ other skin ulcer E13.628 10/01/2015 Other specified diabetes mellitus w/ other skin complications E13.630 10/01/2015 Other specified diabetes mellitus w/ periodontal disease E13.638 10/01/2015 Other specified diabetes mellitus w/ other oral complications E13.649 10/01/2015 Other specified diabetes mellitus w/ hypoglycemia w/o coma E13.65 10/01/2015 Other specified diabetes mellitus with hyperglycemia E13.69 10/01/2015 Other specified diabetes mellitus w/ other specified complication E13.9 10/01/2015 Other specified diabetes mellitus without complications E86.0 10/01/2015 Dehydration E86.1 10/01/2015 Hypovolemia E86.9 10/01/2015 Volume depletion, unspecified E87.1 10/01/2015 Hypo-osmolality and hyponatremia E87.5 10/01/2015 Hyperkalemia E87.6 10/01/2015 Hypokalemia G40.901 10/01/2015 Epilepsy, unspecified, not intractable, w/ status epilepticus G40.909 10/01/2015 Epilepsy, unspecified, not intractable, w/o status epilepticus I10 10/01/2015 Essential (primary) hypertension I12.0 10/01/2015 Hypertensive chronic kidney disease w/ stage 5 chronic kidney disease or end stage renal disease 2
Attachment C I20.0 10/01/2015 Unstable angina I21.01 10/01/2015 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall I21.02 10/01/2015 STEMI) myocardial infarction involving left main coronary artery I21.09 10/01/2015 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall I21.11 10/01/2015 ST elevation (STEMI) myocardial infarction involving right coronary artery I21.19 10/01/2015 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall I21.29 10/01/2015 STEMI involving oth sites (ST elevation (STEMI) myocardial infarction involving other sites) I21.3 10/01/2015 ST elevation (STEMI) myocardial infarction of unspecified site I21.4 10/01/2015 Non-ST elevation (NSTEMI) myocardial infarction I22.0 10/01/2015 Subsequent ST elevation (STEMI) myocardial infarction of anterior wa I22.1 10/01/2015 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall I22.8 10/01/2015 Subsequent ST elevation (STEMI) myocardial infarction of other sites I22.9 10/01/2015 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site I24.0 10/01/2015 Acute coronary thrombosis not resulting in myocardial infarction I24.1 10/01/2015 Dressler's syndrome I24.8 10/01/2015 Other forms of acute ischemic heart disease I24.9 10/01/2015 Acute ischemic heart disease, unspecified I50.1 10/01/2015 Left ventricular failure I50.20 10/01/2015 Unspecified systolic (congestive) heart failure I50.21 10/01/2015 Acute systolic (congestive) heart failure I50.22 10/01/2015 Chronic systolic (congestive) heart failure I50.23 10/01/2015 Acute on chronic systolic (congestive) heart failure I50.30 10/01/2015 Unspecified diastolic (congestive) heart failure I50.31 10/01/2015 Acute diastolic (congestive) heart failure I50.32 10/01/2015 Chronic diastolic (congestive) heart failure I50.33 10/01/2015 Acute on chronic diastolic (congestive) heart failure I50.40 10/01/2015 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure I50.41 10/01/2015 Acute combined systolic (congestive) and diastolic (congestive) heart failure I50.42 10/01/2015 Chronic combined systolic (congestive) and diastolic (congestive) heart failure 3
Attachment C I50.43 10/01/2015 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure I50.9 10/01/2015 Heart failure, unspecified I82.210 10/01/2015 Acute embolism and thrombosis of superior vena cava I82.211 10/01/2015 Chronic embolism and thrombosis of superior vena cava I82.290 10/01/2015 Acute embolism and thrombosis of other thoracic veins I82.291 10/01/2015 Chronic embolism and thrombosis of other thoracic veins I82.401 10/01/2015 Acute embolism and thrombosis of unspecified deep veins of right lower extremity I82.402 10/01/2015 Acute embolism and thrombosis of unspecified deep veins of left lower extremity I82.403 10/01/2015 Acute embolism and thrombosis of unspecified deep veins of lower extremity, bilateral I82.409 10/01/2015 Acute embolism and thrombosis of unspecified deep veins of unspecified lower extremity I82.411 10/01/2015 Acute embolism and thrombosis of right femoral vein I82.412 10/01/2015 Acute embolism and thrombosis of left femoral vein I82.413 10/01/2015 Acute embolism and thrombosis of femoral vein, bilateral I82.419 10/01/2015 Acute embolism and thrombosis of unspecified femoral vein I82.421 10/01/2015 Acute embolism and thrombosis of right iliac vein I82.422 10/01/2015 Acute embolism and thrombosis of left iliac vein I82.423 10/01/2015 Acute embolism and thrombosis of iliac vein, bilateral I82.429 10/01/2015 Acute embolism and thrombosis of unspecified iliac vein I82.431 10/01/2015 Acute embolism and thrombosis of right popliteal vein I82.432 10/01/2015 Acute embolism and thrombosis of left popliteal vein I82.433 10/01/2015 Acute embolism and thrombosis of popliteal vein, bilateral I82.439 10/01/2015 Acute embolism and thrombosis of unspecified popliteal vein I82.441 10/01/2015 Acute embolism and thrombosis of right tibial vein I82.442 10/01/2015 Acute embolism and thrombosis of let tibial vein I82.443 10/01/2015 Acute embolism and thrombosis of tibial vein, bilateral I82.449 10/01/2015 Acute embolism and thrombosis of unspecified tibial vein I82.491 10/01/2015 Acute embolism and thrombosis of other specified deep vein of right lower extremity I82.492 10/01/2015 Acute embolism and thrombosis of other specified deep vein of left lower extremity I82.493 10/01/2015 Acute embolism and thrombosis of other specified deep vein of lower extremity, bilateral I82.499 10/01/2015 Acute embolism and thrombosis of other specified deep vein of unspecified lower extremity I82.4Y1 10/01/2015 Acute embolism and thrombosis of unspecified deep veins of right proximal lower extremity 4
Attachment C I82.4Y2 10/01/2015 Acute embolism and thrombosis of unspecified deep veins of left proximal lower extremity I82.4Y3 10/01/2015 Acute embolism and thrombosis of unspecified deep veins of proximal lower extremity, bilateral I82.4Y9 10/01/2015 Acute embolism and thrombosis of unspecified deep veins of unspecified proximal lower extremity I82.4Z1 10/01/2015 Acute embolism and thrombosis of unspecified deep veins of right distal lower extremity I82.4Z2 10/01/2015 Acute embolism and thrombosis of unspecified deep veins of left distal lower extremity I82.4Z3 10/01/2015 Acute embolism and thrombosis of unspecified deep veins of distal lower extremity, bilateral I82.4Z9 10/01/2015 Acute embolism and thrombosis of unspecified deep veins of unspecified distal lower extremity I82.501 10/01/2015 Chronic embolism and thrombosis of unspecified deep veins of right lower extremity I82.502 10/01/2015 Chronic embolism and thrombosis of unspecified deep veins of left lower extremity I82.503 10/01/2015 Chronic embolism and thrombosis of unspecified deep veins of lower extremity, bilateral I82.509 10/01/2015 Chronic embolism and thrombosis of unspecified deep veins of unspecified lower extremity I82.511 10/01/2015 Chronic embolism and thrombosis of right femoral vein I82.512 10/01/2015 Chronic embolism and thrombosis of left femoral vein I82.513 10/01/2015 Chronic embolism and thrombosis of femoral vein, bilateral I82.519 10/01/2015 Chronic embolism and thrombosis of unspecified femoral vein I82.521 10/01/2015 Chronic embolism and thrombosis of right iliac vein I82.522 10/01/2015 Chronic embolism and thrombosis of left iliac vein I82.523 10/01/2015 Chronic embolism and thrombosis of iliac vein, bilateral I82.529 10/01/2015 Chronic embolism and thrombosis of unspecified iliac vein I82.531 10/01/2015 Chronic embolism and thrombosis of right popliteal vein I82.532 10/01/2015 Chronic embolism and thrombosis of left popliteal vein I82.533 10/01/2015 Chronic embolism and thrombosis of popliteal vein, bilateral I82.539 10/01/2015 Chronic embolism and thrombosis of unspecified popliteal vein I82.541 10/01/2015 Chronic embolism and thrombosis of right tibial vein I82.542 10/01/2015 Chronic embolism and thrombosis of left tibial vein I82.543 10/01/2015 Chronic embolism and thrombosis of tibial vein, bilateral I82.549 10/01/2015 Chronic embolism and thrombosis of unspecified tibial vein I82.591 10/01/2015 Chronic embolism and thrombosis of other specified deep vein of right lower extremity I82.592 10/01/2015 Chronic embolism and thrombosis of other specified deep vein of left lower extremity 5
Attachment C I82.593 10/01/2015 Chronic embolism and thrombosis of other specified deep vein of lower extremity, bilateral I82.599 10/01/2015 Chronic embolism and thrombosis of other specified deep vein of unspecified lower extremity I82.5Y1 10/01/2015 Chronic embolism and thrombosis of unspecified deep veins of right proximal lower extremity I82.5Y2 10/01/2015 Chronic embolism and thrombosis of unspecified deep veins of left proximal lower extremity I82.5Y3 10/01/2015 Chronic embolism and thrombosis of unspecified deep veins of proximal lower extremity, bilateral I82.5Y9 10/01/2015 Chronic embolism and thrombosis of unspecified deep veins of unspecified proximal lower extremity I82.5Z1 10/01/2015 Chronic embolism and thrombosis of unspecified deep veins of right distal lower extremity I82.5Z2 10/01/2015 Chronic embolism and thrombosis of unspecified deep veins of left distal lower extremity I825Z3 10/01/2015 Chronic embolism and thrombosis of unspecified deep veins of distal lower extremity, bilateral I82.5Z9 10/01/2015 Chronic embolism and thrombosis of unspecified deep veins of unspecified distal lower extremity I82.601 10/01/2015 Acute embolism and thrombosis of unspecified veins of right upper extremity I82.602 10/01/2015 Acute embolism and thrombosis of unspecified veins of left upper extremity I82.603 10/01/2015 Acute embolism and thrombosis of unspecified veins of upper extremity, bilateral I82.609 10/01/2015 Acute embolism and thrombosis of unspecified veins of unspecified upper extremity I82.611 10/01/2015 Acute embolism and thrombosis of superficial veins of right upper extremity I82.612 10/01/2015 Acute embolism and thrombosis of superficial veins of left upper extremity I82.613 10/01/2015 Acute embolism and thrombosis of superficial veins of upper extremity, bilateral I82.619 10/01/2015 Acute embolism and thrombosis of superficial veins of unspecified upper extremity I82.621 10/01/2015 Acute embolism an thrombosis of deep veins of right upper extremity I82.622 10/01/2015 Acute embolism and thrombosis of deep veins of left upper extremity I82.623 10/01/2015 Acute embolism and thrombosis of deep veins of upper extremity, bilateral I82.629 10/01/2015 Acute embolism and thrombosis of deep veins of unspecified 6
Attachment C upper extremity I82.701 10/01/2015 Chronic embolism and thrombosis of unspecified veins of right upper extremity I82.702 10/01/2015 Chronic embolism and thrombosis of unspecified veins of left upper extremity I82.703 10/01/2015 Chronic embolism and thrombosis of unspecified veins of upper extremity, bilateral I82.709 10/01/2015 Chronic embolism and thrombosis of unspecified veins of unspecified upper extremity I82.711 10/01/2015 Chronic embolism and thrombosis of superficial veins of right upper extremity I82.712 10/01/2015 Chronic embolism and thrombosis of superficial veins of left upper extremity I82.713 10/01/2015 Chronic embolism and thrombosis of superficial veins of upper extremity, bilateral I82.719 10/01/2015 Chronic embolism and thrombosis of superficial veins of unspecified upper extremity I82.721 10/01/2015 Chronic embolism and thrombosis of deep veins of right upper extremity I82.722 10/01/2015 Chronic embolism and thrombosis of deep veins of left upper extremity I82.723 10/01/2015 Chronic embolism and thrombosis of deep veins of upper extremity, bilateral I82.729 10/01/2015 Chronic embolism and thrombosis of deep veins of unspecified upper extremity I82.811 10/01/2015 Embolism and thrombosis of superficial veins of right lower extremities I82.812 10/01/2015 Embolism and thrombosis of superficial veins of left lower extremities I82.813 10/01/2015 Embolism and thrombosis of superficial veins of lower extremities, bilateral I82.819 10/01/2015 Embolism and thrombosis of superficial veins of unspecified lower extremities I82.890 10/01/2015 Acute embolism and thrombosis of other specified veins I82.891 10/01/2015 Chronic embolism and thrombosis of other specified veins I82.90 10/01/2015 Acute embolism and thrombosis of unspecified vein I82.91 10/01/2015 Chronic embolism and thrombosis of unspecified vein I82.A11 10/01/2015 Acute embolism and thrombosis of right axillary vein I82.A12 10/01/2015 Acute embolism and thrombosis of left axillary vein I82.A13 10/01/2015 Acute embolism and thrombosis of axillary vein, bilateral I82.A19 10/01/2015 Acute embolism and thrombosis of unspecified axillary vein I82.A21 10/01/2015 Chronic embolism and thrombosis of right axillary vein 7
Attachment C I82.A22 10/01/2015 Chronic embolism and thrombosis of left axillary vein I82.A23 10/01/2015 Chronic embolism and thrombosis of axillary vein, bilateral I82.A29 10/01/2015 Chronic embolism and thrombosis of unspecified axillary vein I82.B11 10/01/2015 Acute embolism and thrombosis of right subclavian vein I82.B12 10/01/2015 Acute embolism and thrombosis of left subclavian vein I82.B13 10/01/2015 Acute embolism and thrombosis of subclavian vein, bilateral I82.B19 10/01/2015 Acute embolism and thrombosis of unspecified subclavian vein I82.B21 10/01/2015 Chronic embolism and thrombosis of right subclavian vein I82.B22 10/01/2015 Chronic embolism and thrombosis of left subclavian vein I82.B23 10/01/2015 Chronic embolism and thrombosis of subclavian vein, bilateral I82.B29 10/01/2015 Chronic embolism and thrombosis of unspecified subclavian vein I82.C11 10/01/2015 Acute embolism and thrombosis of right internal jugular vein I82.C12 10/01/2015 Acute embolism and thrombosis of left internal jugular vein I82.C13 10/01/2015 Acute embolism and thrombosis of internal jugular vein, bilateral I82.C19 10/01/2015 Acute embolism and thrombosis of unspecified internal jugular vein I82.C21 10/01/2015 Chronic embolism and thrombosis of right internal jugular vein I82.C22 10/01/2015 Chronic embolism and thrombosis of left internal jugular vein I82.C23 10/01/2015 Chronic embolism and thrombosis of internal jugular vein, bilateral I82.C29 10/01/2015 Chronic embolism and thrombosis of unspecified internal jugular vein J18.8 10/01/2015 Other pneumonia, unspecified organism J18.9 10/01/2015 Pneumonia, unspecified organism J40 10/01/2015 Bronchitis, not specified as acute or chronic J44.0 10/01/2015 Chronic obstructive pulmonary disease with acute lower respiratory infection J44.1 10/01/2015 Chronic obstructive pulmonary disease w/ (acute) exacerbation J44.9 10/01/2015 Chronic obstructive pulmonary disease, unspecified J45.20 10/01/2015 Mild intermittent asthma, uncomplicated J45.21 10/01/2015 Mild intermittent asthma w/ (acute) exacerbation J45.22 10/01/2015 Mild intermittent asthma w/ status asthmaticus J45.30 10/01/2015 Mild persistent asthma, uncomplicated J45.31 10/01/2015 Mild persistent asthma w/ (acute) exacerbation J45.32 10/01/2015 Mild persistent asthma w/ status asthmaticus J45.40 10/01/2015 Moderate persistent asthma, uncomplicated J45.41 10/01/2015 Moderate persistent asthma w/ (acute) exacerbation J45.42 10/01/2015 Moderate persistent asthma w/ status asthmaticus 8
Attachment C J45.50 10/01/2015 Severe persistent asthma, uncomplicated J45.51 10/01/2015 Severe persistent asthma w/ (acute) exacerbation J45.52 10/01/2015 Severe persistent asthma w/ status asthmaticus J45.901 10/01/2015 Unspecified asthma with (acute) exacerbation J45.902 10/01/2015 Unspecified asthma with status asthmaticus J45.909 10/01/2015 Unspecified asthma, uncomplicated J45.990 10/01/2015 Exercise induced bronchospasm J45.991 10/01/2015 Cough variant asthma J45.998 10/01/2015 Other asthma K21.9 10/01/2015 Gastro-esophageal reflux disease w/o esophagitis K29.00 10/01/2015 Acute gastritis w/o bleeding K29.30 10/01/2015 Chronic superficial gastritis without bleeding K29.60 10/01/2015 Other gastritis w/o bleeding K29.70 10/01/2015 Gastritis, unspecified w/o bleeding K29.90 10/01/2015 Gastroduodenitis, unspecified, w/o bleeding K52.81 10/01/2015 Eosinophilic gastritis or gastroenteritis K52.89 10/01/2015 Other specified noninfective gastroenteritis and colitis K52.9 10/01/2015 Noninfective gastroenteritis and colitis, unspecified K70.2 10/01/2015 Alcoholic fibrosis and sclerosis of liver K70.30 10/01/2015 Alcoholic cirrhosis of liver w/o ascites K70.31 10/01/2015 Alcoholic cirrhosis of liver w/ ascites L59.124 10/01/2015 Pressure ulcer of left upper back, stage 4 L89.000 10/01/2015 Pressure ulcer of unspecified elbow, unstageable L89.0003 10/01/2015 Pressure ulcer of unspecified elbow, stage 3 L89.001 10/01/2015 Pressure ulcer of unspecified elbow, stage 1 L89.002 10/01/2015 Pressure ulcer of unspecified elbow, stage 2 L89.004 10/01/2015 Pressure ulcer of unspecified elbow, stage 4 L89.009 10/01/2015 Pressure ulcer of unspecified elbow, unspecified stage L89.010 10/01/2015 Pressure ulcer of right elbow, unstageable L89.011 10/01/2015 Pressure ulcer of right elbow, stage 1 L89.012 10/01/2015 Pressure ulcer of right elbow, stage 2 L89.013 10/01/2015 Pressure ulcer of right elbow, stage 3 L89.014 10/01/2015 Pressure ulcer of right elbow, stage 4 L89.019 10/01/2015 Pressure ulcer of right elbow, unspecified stage L89.020 10/01/2015 Pressure ulcer of left elbow, unstageable L89.021 10/01/2015 Pressure ulcer of left elbow, stage 1 L89.022 10/01/2015 Pressure ulcer of left elbow, stage 2 L89.023 10/01/2015 Pressure ulcer of left elbow, stage 3 L89.024 10/01/2015 Pressure ulcer of left elbow, stage 4 9
Attachment C L89.029 10/01/2015 Pressure ulcer of left elbow, unspecified stage L89.100 10/01/2015 Pressure ulcer of unspecified part of back, unstageable L89.101 10/01/2015 Pressure ulcer of unspecified part of back, stage 1 L89.102 10/01/2015 Pressure ulcer of unspecified part of back, stage 2 L89.103 10/01/2015 Pressure ulcer of unspecified part of back, stage 3 L89.104 10/01/2015 Pressure ulcer of unspecified part of back, stage 4 L89.109 10/01/2015 Pressure ulcer of unspecified part of back, unspecified stage L89.110 10/01/2015 Pressure ulcer of right upper back, unstageable L89.111 10/01/2015 Pressure ulcer of right upper back, stage 1 L89.112 10/01/2015 Pressure ulcer of right upper back, stage 2 L89.113 10/01/2015 Pressure ulcer of right upper back, stage 3 L89.114 10/01/2015 Pressure ulcer of right upper back, stage 4 L89.119 10/01/2015 Pressure ulcer of right upper back, unspecified stage L89.120 10/01/2015 Pressure ulcer of left upper back, unstageable L89.121 10/01/2015 Pressure ulcer of left upper back, stage 1 L89.122 10/01/2015 Pressure ulcer of left upper back, stage 2 L89.123 10/01/2015 Pressure ulcer of left upper back, stage 3 L89.129 10/01/2015 Pressure ulcer of left upper back, unspecified stage L89.130 10/01/2015 Pressure ulcer of right lower back, unstageable L89.131 10/01/2015 Pressure ulcer of right lower back, stage 1 L89.132 10/01/2015 Pressure ulcer of right lower back, stage 2 L89.133 10/01/2015 Pressure ulcer of right lower back, stage 3 L89.134 10/01/2015 Pressure ulcer of right lower back, stage 4 L89.139 10/01/2015 Pressure ulcer or right lower back, unspecified stage L89.140 10/01/2015 Pressure ulcer of left lower back, unstageable L89.141 10/01/2015 Pressure ulcer of left lower back, stage 1 L89.142 10/01/2015 Pressure ulcer of left lower back, stage 2 L89.143 10/01/2015 Pressure ulcer of left lower back, stage 3 L89.144 10/01/2015 Pressure ulcer of left lower back, stage 4 L89.149 10/01/2015 Pressure ulcer of left lower back, unspecified stage L89.150 10/01/2015 Pressure ulcer of sacral region, unstageable L89.151 10/01/2015 Pressure ulcer of sacral region, stage 1 L89.152 10/01/2015 Pressure ulcer of sacral region, stage 2 L89.153 10/01/2015 Pressure ulcer of sacral region, stage 3 L89.154 10/01/2015 Pressure ulcer of sacral region, stage 4 L89.159 10/01/2015 Pressure ulcer of sacral region, unspecified stage L89.200 10/01/2015 Pressure ulcer of unspecified hip, unstageable L89.201 10/01/2015 Pressure ulcer of unspecified hip, stage 1 L89.202 10/01/2015 Pressure ulcer of unspecified hip, stage 2 10
Attachment C L89.203 10/01/2015 Pressure ulcer of unspecified hip, stage 3 L89.204 10/01/2015 Pressure ulcer of unspecified hip, stage 4 L89.209 10/01/2015 Pressure ulcer of unspecified hip, unspecified stage L89.210 10/01/2015 Pressure ulcer of right hip, unstageable L89.211 10/01/2015 Pressure ulcer of right hip, stage 1 L89.212 10/01/2015 Pressure ulcer of right hip, stage 2 L89.213 10/01/2015 Pressure ulcer of right hip, stage 3 L89.214 10/01/2015 Pressure ulcer of right hip, stage 4 L89.219 10/01/2015 Pressure ulcer of right hip, unspecified stage L89.220 10/01/2015 Presure ulcer of left hip, unstageable L89.221 10/01/2015 Pressure ulcer of left hip, stage 1 L89.222 10/01/2015 Pressure ulcer of left hip, stage 2 L89.223 10/01/2015 Pressure ulcer of left hip, stage 3 L89.224 10/01/2015 Pressure ulcer of left hip, stage 4 L89.229 10/01/2015 Pressure ulcer of left hip, unspecified stage L89.300 10/01/2015 Pressure ulcer of unspecified buttock, unstageable L89.301 10/01/2015 Pressure ulcer of unspecified buttock, stage 1 L89.302 10/01/2015 Pressure ulcer of unspecified buttock, stage 2 L89.303 10/01/2015 Pressure ulcer of unspecified buttock, stage 3 L89.304 10/01/2015 Pressure ulcer of unspecified buttock, stage 4 L89.309 10/01/2015 Pressure ulcer of unspecified buttock, unspecified stage L89.310 10/01/2015 Pressure ulcer of right buttock, unstageable L89.311 10/01/2015 Pressure ulcer of right buttock, stage 1 L89.312 10/01/2015 Pressure ulcer of right buttock, stage 2 L89.313 10/01/2015 Pressure ulcer of right buttock, stage 3 L89.314 10/01/2015 Pressure ulcer of right buttock, stage 4 L89.319 10/01/2015 Pressure ulcer of right buttock, unspecified stage L89.320 10/01/2015 Pressure ulcer of left buttock, unstageable L89.321 10/01/2015 Pressure ulcer of left buttock, stage 1 L89.322 10/01/2015 Pressure ulcer of left buttock, stage 2 L89.323 10/01/2015 Pressure ulcer of left buttock, stage 3 L89.324 10/01/2015 Pressure ulcer of left buttock, stage 4 L89.329 10/01/2015 Pressure ulcer of left buttock, unspecified stage L89.40 10/01/2015 Pressure ulcer of contiguous site of back, buttock, and hip, unspecified stage L89.41 10/01/2015 Pressure ulcer of contiguous site of back, buttock, and hip, stage 1 L89.42 10/01/2015 Pressure ulcer of contiguous site of back, buttock, and hip, stage 2 L89.43 10/01/2015 Pressure ulcer of contiguous site of back, buttock, and hip, stage 11
Attachment C 3 L89.44 10/01/2015 Pressure ulcer of contiguous site of back, buttock, and hip, stage 4 L89.45 10/01/2015 Pressure ulcer of contiguous site of back, buttock, and hip, unstageable L89.500 10/01/2015 Pressure ulcer of unspecified ankle, unstageable L89.501 10/01/2015 Pressure ulcer of unspecified ankle, stage 1 L89.502 10/01/2015 Pressure ulcer of unspecified ankle, stage 2 L89.503 10/01/2015 Pressure ulcer of unspecified ankle, stage 3 L89.504 10/01/2015 Pressure ulcer of unspecified ankle, stage 4 L89.510 10/01/2015 Pressure ulcer of right ankle, unstageable L89.511 10/01/2015 Pressure ulcer of right ankle, stage 1 L89.512 10/01/2015 Pressure ulcer of right ankle, stage 2 L89.513 10/01/2015 Pressure ulcer of right ankle, stage 3 L89.514 10/01/2015 Pressure ulcer of right ankle, stage 4 L89.519 10/01/2015 Pressure ulcer of right ankle, unspecified stage L89.520 10/01/2015 Pressure ulcer of left ankle, unstageable L89.521 10/01/2015 Pressure ulcer of left ankle, stage 1 L89.522 10/01/2015 Pressure ulcer of left ankle, stage 2 L89.523 10/01/2015 Pressure ulcer of left ankle, stage 3 L89.524 10/01/2015 Pressure ulcer of left ankle, stage 4 L89.529 10/01/2015 Pressure ulcer of left ankle, unspecified stage L89.600 10/01/2015 Pressure ulcer of unspecified heel, unstageable L89.601 10/01/2015 Pressure ulcer of unspecified heel, stage 1 L89.602 10/01/2015 Pressure ulcer of unspecified heel, stage 2 L89.603 10/01/2015 Pressure ulcer of unspecified heel, stage 3 L89.604 10/01/2015 Pressure ulcer of unspecified heel, stage 4 L89.609 10/01/2015 Pressure ulcer of unspecified heel, unspecified stage L89.610 10/01/2015 Pressure ulcer of right heel, unstageable L89.611 10/01/2015 Pressure ulcer of right heel, stage 1 L89.612 10/01/2015 Pressure ulcer of right heel, stage 2 L89.613 10/01/2015 Pressure ulcer of right heel, stage 3 L89.614 10/01/2015 Pressure ulcer of right heel, stage 4 L89.619 10/01/2015 Pressure ulcer of right heel, unspecified stage L89.620 10/01/2015 Pressure ulcer of left heel, unstageable L89.621 10/01/2015 Pressure ulcer of left heel, stage 1 L89.622 10/01/2015 Pressure ulcer of left heel, stage 2 L89.623 10/01/2015 Pressure ulcer of left heel, stage 3 L89.624 10/01/2015 Pressure ulcer of left heel, stage 4 L89.629 10/01/2015 Pressure ulcer of left heel, unspecified stage 12
Attachment C L89.810 10/01/2015 Pressure ulcer of head, unstageable L89.811 10/01/2015 Pressure ulcer of head, stage 1 L89.812 10/01/2015 Pressure ulcer of head, stage 2 L89.813 10/01/2015 Pressure ulcer of head, stage 3 L89.814 10/01/2015 Pressure ulcer of head, stage 4 L89.819 10/01/2015 Pressure ulcer of head, unspecified stage L89.890 10/01/2015 Pressure ulcer of other site, unstageable L89.891 10/01/2015 Pressure ulcer of other site, stage 1 L89.892 10/01/2015 Pressure ulcer of other site, stage 2 L89.893 10/01/2015 Pressure ulcer of other site, stage 3 L89.894 10/01/2015 Pressure ulcer of other site, stage 4 L89.899 10/01/2015 Pressure ulcer of other site, unspecified stage L89.90 10/01/2015 Pressure ulcer of unspecified site, unspecified stage L89.91 10/01/2015 Pressure ulcer of unspecified site, stage 1 L89.92 10/01/2015 Pressure ulcer of unspecified site, stage 2 L89.93 10/01/2015 Pressure ulcer of unspecified site, stage 3 L89.94 10/01/2015 Pressure ulcer of unspecified site, stage 4 L89.95 10/01/2015 Pressure ulcer of unspecified site, unstageable L97.101 10/01/2015 Non-pressure chronic ulcer of unspecified thigh limited to breakdown of skin L97.102 10/01/2015 Non-pressure chronic ulcer of unspecified thigh w/ fat layer exposed L97.103 10/01/2015 Non-pressure chronic ulcer of unspecified thigh w/ necrosis of muscle L97.104 10/01/2015 Non-pressure chronic ulcer of unspecified thigh w/ necrosis of bone L97.109 10/01/2015 Non-pressure chronic ulcer of unspecified thigh w/ unspecified severity L97.111 10/01/2015 Non-pressure chronic ulcer of right thigh limited to breakdown of skin L97.112 10/01/2015 Non-pressure chronic ulcer of right thigh w/ fat layer exposed L97.113 10/01/2015 Non-pressure chronic ulcer of right thigh w/ necrosis of muscle L97.114 10/01/2015 Non-pressure chronic ulcer of right thigh w/ necrosis of bone L97.119 10/01/2015 Non-pressure chronic ulcer of right thigh w/ unspecified severity L97.121 10/01/2015 Non-pressure chronic ulcer of left thigh limited to breakdown of skin L97.122 10/01/2015 Non-pressure chronic ulcer of left thigh w/ fat layer exposed L97.123 10/01/2015 Non-pressure chronic ulcer of left thigh w/ necrosis of muscle L97.124 10/01/2015 Non-pressure chronic ulcer of left thigh w/ necrosis of bone L97.129 10/01/2015 Non-pressure chronic ulcer of left thigh w/ unspecified severity L97.201 10/01/2015 Non-pressure chronic ulcer of unspecified calf limited to 13
Attachment C breakdown of skin L97.202 10/01/2015 Non-pressure chronic ulcer of unspecified calf w/ fat layer exposed L97.203 10/01/2015 Non-pressure chronic ulcer of unspecified calf w/ necrosis of muscle L97.204 10/01/2015 Non-pressure chronic ulcer of unspecified calf w/ necrosis of bone L97.209 10/01/2015 Non-pressure chronic ulcer of unspecified calf w/ unspecified severity L97.211 10/01/2015 Non-pressure chronic ulcer of right calf limited to breakdown of skin L97.212 10/01/2015 Non-pressure chronic ulcer of right calf w/ fat layer exposed L97.213 10/01/2015 Non-pressure chronic ulcer of right calf w/ necrosis of muscle L97.214 10/01/2015 Non-pressure chronic ulcer of right calf w/ necrosis of bone L97.219 10/01/2015 Non-pressure chronic ulcer of right calf w/ unspecified severity L97.221 10/01/2015 Non-pressure chronic ulcer of left calf limited to breakdown of skin L97.222 10/01/2015 Non-pressure chronic ulcer of left calf w/ fat layer exposed L97.223 10/01/2015 Non-pressure chronic ulcer of left calf w/ necrosis of muscle L97.224 10/01/2015 Non-pressure chronic ulcer of left calf w/ necrosis of bone L97.229 10/01/2015 Non-pressure chronic ulcer of left calf w/ unspecified severity L97.301 10/01/2015 Non-pressure chronic ulcer of unspecified ankle limited to breakdown of skin L97.302 10/01/2015 Non-pressure chronic ulcer of unspecified ankle w/ fat layer exposed L97.303 10/01/2015 Non-pressure chronic ulcer of unspecified ankle w/ necrosis of muscle L97.304 10/01/2015 Non-pressure chronic ulcer of unspecified ankle w/ necrosis of bone L97.309 10/01/2015 Non-pressure chronic ulcer of unspecified ankle w/ unspecified severity L97.311 10/01/2015 Non-pressure chronic ulcer of right ankle limited to breakdown of skin L97.312 10/01/2015 Non-pressure chronic ulcer of right ankle w/ fat layer exposed L97.313 10/01/2015 Non-pressure chronic ulcer of right ankle w/ necrosis of muscle L97.314 10/01/2015 Non-pressure chronic ulcer of right ankle w/ necrosis of bone L97.319 10/01/2015 Non-pressure chronic ulcer of right ankle w/ unspecified severity L97.321 10/01/2015 Non-pressure chronic ulcer of left ankle limited to breakdown of skin L97.322 10/01/2015 Non-pressure chronic ulcer of left ankle w/ fat layer exposed L97.323 10/01/2015 Non-pressure chronic ulcer of left ankle w/ necrosis of muscle L97.324 10/01/2015 Non-pressure chronic ulcer of left ankle w/ necrosis of bone 14
Attachment C L97.329 10/01/2015 Non-pressure chronic ulcer of left ankle w/ unspecified severity L97.401 10/01/2015 Non-pressure chronic ulcer of unspecified heel and midfoot limited to breakdown of skin L97.402 10/01/2015 Non-pressure chronic ulcer of unspecified heel and midfoot w/ fat layer exposed L97.403 10/01/2015 Non-pressure chronic ulcer of unspecified heel and midfoot w/ necrosis of muscle L97.404 10/01/2015 Non-pressure chronic ulcer of unspecified heel and midfoot w/ necrosis of bone L97.409 10/01/2015 Non-pressure chronic ulcer of unspecified heel and midfoot w/ unspecified severity L97.411 10/01/2015 Non-pressure chronic ulcer of right heel and midfoot limited to breakdown of skin L97.412 10/01/2015 Non-pressure chronic ulcer of right heel and midfoot w/ fat layer exposed L97.413 10/01/2015 Non-pressure chronic ulcer of right heel and midfoot w/ necrosis of muscle L97.414 10/01/2015 Non-pressure chronic ulcer of right heel and midfoot w/ necrosis of bone L97.419 10/01/2015 Non-pressure chronic ulcer of right heel and midfoot w/ unspecified severity L97.421 10/01/2015 Non-pressure chronic ulcer of left heel and midfoot limited to breakdown of skin L97.422 10/01/2015 Non-pressure chronic ulcer of left heel and midfoot w/ fat layer exposed L97.423 10/01/2015 Non-pressure chronic ulcer of left heel and midfoot w/ necrosis of muscle L97.424 10/01/2015 Non-pressure chronic ulcer of left heel and midfoot w/ necrosis of bone L97.429 10/01/2015 Non-pressure chronic ulcer of left heel and midfoot w/ unspecified severity L97.501 10/01/2015 Non-pressure chronic ulcer of other part of unspecified foot limited to breakdown of skin L97.502 10/01/2015 Non-pressure chronic ulcer of other part of unspecified foot w/ fat layer exposed L97.503 10/01/2015 Non-pressure chronic ulcer of other part of unspecified foot w/ necrosis of muscle L97.504 10/01/2015 Non-pressure chronic ulcer of other part of unspecified foot w/ necrosis of bone L97.509 10/01/2015 Non-pressure chronic ulcer of other part of unspecified foot w/ unspecified severity L97.511 10/01/2015 Non-pressure chronic ulcer of other part of right foot limited to breakdown of skin 15
Attachment C L97.512 10/01/2015 Non-pressure chronic ulcer of other part of right foot w/ fat layer exposed L97.513 10/01/2015 Non-pressure chronic ulcer of other part of right foot w/ necrosis of muscle L97.514 10/01/2015 Non-pressure chronic ulcer of other part of right foot w/ necrosis of bone L97.519 10/01/2015 Non-pressure chronic ulcer of other part of right foot w/ unspecified severity L97.521 10/01/2015 Non-pressure chronic ulcer of other part of left foot limited to breakdown of skin L97.522 10/01/2015 Non-pressure chronic ulcer of other part of left foot w/ fat layer exposed L97.523 10/01/2015 Non-pressure chronic ulcer of other part of left foot w/ necrosis of muscle L97.524 10/01/2015 Non-pressure chronic ulcer of other part of left foot w/ necrosis of bone L97.529 10/01/2015 Non-pressure chronic ulcer of other part of left foot w/ unspecified severity L97.801 10/01/2015 Non-pressure chronic ulcer of other part of unspecified lower leg limited to breakdown of skin L97.802 10/01/2015 Non-pressure chronic ulcer of other part of unspecified lower leg w/ fat layer exposed L97.803 10/01/2015 Non-pressure chronic ulcer of other part of unspecified lower leg w/ necrosis of muscle L97.804 10/01/2015 Non-pressure chronic ulcer of other part of unspecified lower leg w/ necrosis of bone L97.809 10/01/2015 Non-pressure chronic ulcer of other part of unspecified lower leg w/ unspecified severity L97.811 10/01/2015 Non-pressure chronic ulcer of other part of right lower leg limited to breakdown of skin L97.812 10/01/2015 Non-pressure chronic ulcer of other part of right lower leg w/ fat layer exposed L97.813 10/01/2015 Non-pressure chronic ulcer of other part of right lower leg w/ necrosis of muscle L97.814 10/01/2015 Non-pressure chronic ulcer of other part of right lower leg w/ necrosis of bone L97.819 10/01/2015 Non-pressure chronic ulcer of other part of right lower leg w/ unspecified severity L97.821 10/01/2015 Non-pressure chronic ulcer of other part of left lower leg limited to breakdown of skin L97.822 10/01/2015 Non-pressure chronic ulcer of other part of left lower leg w/ fat layer exposed L97.823 10/01/2015 Non-pressure chronic ulcer of other part of left lower leg w/ 16
Attachment C necrosis of muscle L97.824 10/01/2015 Non-pressure chronic ulcer of other part of left lower leg w/ necrosis of bone L97.829 10/01/2015 Non-pressure chronic ulcer of other part of left lower leg w/ unspecified severity L97.901 10/01/2015 Non-pressure chronic ulcer of unspecified part of unspecified lower leg limited to breakdown of skin L97.902 10/01/2015 Non-pressure chronic ulcer of unspecified part of unspecified lower leg w/ fat layer exposed L97.903 10/01/2015 Non-pressure chronic ulcer of unspecified part of unspecified lower leg w/ necrosis of muscle L97.904 10/01/2015 Non-pressure chronic ulcer of unspecified part of unspecified lower leg w/ necrosis of bone L97.909 10/01/2015 Non-pressure chronic ulcer of unspecified part of unspecified lower leg w/ unspecified severity L97.911 10/01/2015 Non-pressure chronic ulcer of unspecified part of right lower leg limited to breakdown of skin L97.912 10/01/2015 Non-pressure chronic ulcer of unspecified part of right lower leg w/ fat layer exposed L97.913 10/01/2015 Non-pressure chronic ulcer of unspecified part of right lower leg w/ necrosis of muscle L97.914 10/01/2015 Non-pressure chronic ulcer of unspecified part of right lower leg w/ necrosis of bone L97.919 10/01/2015 Non-pressure chronic ulcer of unspecified part of right lower leg w/ unspecified severity L97.921 10/01/2015 Non-pressure chronic ulcer of unspecified part of left lower leg limited to breakdown of skin L97.922 10/01/2015 Non-pressure chronic ulcer of unspecified part of left lower leg w/ fat layer exposed L97.923 10/01/2015 Non-pressure chronic ulcer of unspecified part of left lower leg w/ necrosis of muscle L97.924 10/01/2015 Non-pressure chronic ulcer of unspecified part of left lower leg w/ necrosis of bone L97.929 10/01/2015 Non-pressure chronic ulcer of unspecified part of left lower leg w/ unspecified severity L98.411 10/01/2015 Non-pressure chronic ulcer of buttock limited to breakdown of skin L98.412 10/01/2015 Non-pressure chronic ulcer of buttock w/ fat layer exposed L98.413 10/01/2015 Non-pressure chronic ulcer of buttock w/ necrosis of muscle L98.414 10/01/2015 Non-pressure chronic ulcer of buttock w/ necrosis of bone L98.419 10/01/2015 Non-pressure chronic ulcer of buttock w/ unspecified severity L98.421 10/01/2015 Non-pressure chronic ulcer of back limited to breakdown of skin L98.422 10/01/2015 Non-pressure chronic ulcer of back w/ fat layer exposed 17
Attachment C L98.423 10/01/2015 Non-pressure chronic ulcer of back w/ necrosis of muscle L98.424 10/01/2015 Non-pressure chronic ulcer of back w/ necrosis of bone L98.429 10/01/2015 Non-pressure chronic ulcer of back w/ unspecified severity M17.9 10/01/2015 Osteoarthritis of knee, unspecified M54.5 10/01/2015 Low back pain N18.1 10/01/2015 Chronic kidney disease, stage 1 N18.2 10/01/2015 Chronic kidney disease, Stage 2 (mild) N18.3 10/01/2015 Chronic kidney disease, Stage 3 (moderate) N18.4 10/01/2015 Chronic kidney disease, Stage 4 (severe) N18.5 10/01/2015 Chronic kidney disease, Stage 5 N18.6 10/01/2015 End stage renal disease N18.9 10/01/2015 Chronic kidney disease, unspecified N39.0 10/01/2015 Urinary tract infection, site not specified R06.00 10/01/2015 Dyspnea, unspecified R06.02 10/01/2015 Shortness of breath R06.09 10/01/2015 Other forms of dyspnea R06.3 10/01/2015 Periodic breathing R06.83 10/01/2015 Snoring R06.89 10/01/2015 Other abnormalities of breathing R07.82 10/01/2015 Intercostal pain R07.89 10/01/2015 Other chest pain R07.9 10/01/2015 Chest pain, unspecified R10.0 10/01/2015 Acute abdomen R10.31 10/01/2015 Pain localized to other parts of lower abdomen, right lower quadrant pain R10.32 10/01/2015 Pain localized to other parts of lower abdomen, left lower quadrant pain R10.9 10/01/2015 Unspecified abdominal pain R11.10 10/01/2015 Vomiting, unspecified R11.11 10/01/2015 Vomiting w/o nausea R11.12 10/01/2015 Projectile vomiting R11.2 10/01/2015 Nausea w/ vomiting, unspecified R18.0 10/01/2015 Malignant ascites R18.8 10/01/2015 Other ascites R42 10/01/2015 Dizziness and giddiness R55 10/01/2015 Syncope and collapse R56.9 10/01/2015 Unspecified convulsions R63.0 10/01/2015 Anorexia 18
Attachment D APR DRG Codes Subject to Prepayment Review For Inpatient Discharges On and After July 1, 2014 APR DRG Severity of Illness Indicator Beginning Review 053 1 07/01/14 Seizure (Note: No review of patients < 17 years of age) 054 1 07/01/14 Migraine and Other Headaches 199 1-4 07/01/14 Hypertension 203 1-4 07/01/14 Chest Pain 243 1 07/01/14 Other Esophageal Disorders (Note: No review of newborns 0-28 days of age) 249 1 07/01/14 Non-bacterial Gastroenteritis, Nausea and Vomiting (Note: No review of newborns 0-28 days of age) 251 1 07/01/14 Abdominal Pain (Note: No review of newborns 0-28 days of age) 347 1-4 07/01/14 Other Back and Neck Disorders, Fractures and Injuries 532 1-4 07/01/14 Menstrual and Other Female Reproductive System Disorders 540 1-4 07/01/14 Cesarean Delivery 544 1-4 07/01/14 Dilation and Curettage, Aspiration Curettage or Hysterotomy for Obstetric Diagnoses 773 1 07/01/14 Opioid Abuse and Dependence (Note: No review of newborns 0-28 days of age) 774 1 07/01/14 Cocaine Abuse and Dependence (Note: No review of newborns 0-28 days of age) 775 1 07/01/14 Alcohol Abuse and Dependence (Note: No review of newborns 0-28 days of age) 776 1 07/01/14 Other Drug Abuse and Dependence (Note: No review of newborns 0-28 days of age) 950 1-4 07/01/14 Extensive Procedure Unrelated to Principal Diagnosis 952 1-4 07/01/14 Non-Extensive OR procedure Unrelated to Principal Diagnosis 1
Attachment E ICD-10-CM DIAGNOSIS CODES Subject to Prepayment Review Based on the Admitting Diagnosis Code A DRG or per diem-reimbursed claim for a one-day stay that contains an Admitting Diagnosis code below may be subject to prepayment review when the discharge or transfer occurs on the same calendar date as the admission, or occurs on the date following the admission. E66.01 10/01/2015 Morbid (severe) obesity due to excess calories J21.8 10/01/2015 Acute bronchiolitis due to other specified organisms J21.1 10/01/2015 Acute bronchiolitis due to human metapneumovirus J21.9 10/01/2015 Acute bronchiolitis, unspecified K35.80 10/01/2015 Unspecified acute appendicitis K35.89 10/01/2015 Other acute appendicitis K85.9 10/01/2015 Acute pancreatitis, unspecified K85.0 10/01/2015 Idiopathic acute pancreatitis K85.1 10/01/2015 Biliary acute pancreatitis K85.2 10/01/2015 Alcohol induced acute pancreatitis K85.3 10/01/2015 Drug induced acute pancreatitis K85.8 10/01/2015 Other acute pancreatitis K92.2 10/01/2015 Gastrointestinal hemorrhage, unspecified L03.119 10/01/2015 Cellulitis of unspecified part of limb L03.129 10/01/2015 Acute lymphangitis of unspecified part of limb L02.415 10/01/2015 Cutaneous abscess of right lower limb L02.416 10/01/2015 Cutaneous abscess of left lower limb L02.419 10/01/2015 Cutaneous abscess of limb, unspecified L03.115 10/01/2015 Cellulitis of right lower limb L03.116 10/01/2015 Cellulitis of left lower limb L03.125 10/01/2015 Acute lymphangitis of right lower limb L03.126 10/01/2015 Acute lymphangitis of left lower limb R41.82 10/01/2015 Altered mental status, unspecified R41.0 10/01/2015 Disorientation, unspecified 1
Attachment F ICD-10 CM Procedure Codes Subject to Prior Authorization Review Based on Elective Admissions for the Planned Procedure Code All elective admissions for ICD-10-PCS procedure codes identified on Attachment F require prior authorization review. Hospitals enrolled as Long Term Acute Care (LTAC) hospitals are exempt from this type of review. Coronary Artery Bypass Surgery Code Beginning Review 0210093 10/01/2015 Bypass Coronary Artery, One Site from Coronary Artery with Autologous Venous Tissue, Open 0210098 10/01/2015 Bypass Coronary Artery, One Site from Right Internal Mammary with Autologous Venous Tissue, Open 0210099 10/01/2015 Bypass Coronary Artery, One Site from Left Internal Mammary with Autologous Venous Tissue, Open 021009C 10/01/2015 Bypass Coronary Artery, One Site from Thoracic Artery with Autologous Venous Tissue, Open 021009F 10/01/2015 Bypass Coronary Artery, One Site from Abdominal Artery with Autologous Venous Tissue, Open 021009W 10/01/2015 Bypass Coronary Artery, One Site from Aorta with Autologous Venous Tissue, Open 02100A3 10/01/2015 Bypass Coronary Artery, One Site from Coronary Artery with Autologous Arterial Tissue, Open 02100A8 10/01/2015 Bypass Coronary Artery, One Site from Right Internal Mammary with Autologous Arterial Tissue, Open 02100A9 10/01/2015 Bypass Coronary Artery, One Site from Left Internal Mammary with Autologous Arterial Tissue, Open 02100AC 10/01/2015 Bypass Coronary Artery, One Site from Thoracic Artery with Autologous Arterial Tissue, Open 02100AF 10/01/2015 Bypass Coronary Artery, One Site from Abdominal Artery with Autologous Arterial Tissue, Open 02100AW 10/01/2015 Bypass Coronary Artery, One Site from Aorta with Autologous Arterial Tissue, Open 02100J3 10/01/2015 Bypass Coronary Artery, One Site from Coronary Artery with Synthetic Substitute, Open 02100J8 10/01/2015 Bypass Coronary Artery, One Site from Right Internal Mammary with Synthetic Substitute, Open 02100J9 10/01/2015 Bypass Coronary Artery, One Site from Left Internal Mammary with Synthetic Substitute, Open 02100JC 10/01/2015 Bypass Coronary Artery, One Site from Thoracic Artery with Synthetic Substitute, Open 02100JF 10/01/2015 Bypass Coronary Artery, One Site from Abdominal Artery with Synthetic Substitute, Open 1
Attachment F Code Beginning Review 02100JW 10/01/2015 Bypass Coronary Artery, One Site from Aorta with Synthetic Substitute, Open 02100K3 10/01/2015 Bypass Coronary Artery, One Site from Coronary Artery with Nonautologous Tissue Substitute, Open 02100K8 10/01/2015 Bypass Coronary Artery, One Site from Right Internal Mammary with Nonautologous Tissue Substitute, Open 02100K9 10/01/2015 Bypass Coronary Artery, One Site from Left Internal Mammary with Nonautologous Tissue Substitute, Open 02100KC 10/01/2015 Bypass Coronary Artery, One Site from Thoracic Artery with Nonautologous Tissue Substitute, Open 02100KF 10/01/2015 Bypass Coronary Artery, One Site from Abdominal Artery with Nonautologous Tissue Substitute, Open 02100KW 10/01/2015 Bypass Coronary Artery, One Site from Aorta with Nonautologous Tissue Substitute, Open 02100Z3 10/01/2015 Bypass Coronary Artery, One Site from Coronary Artery, Open 02100Z8 10/01/2015 Bypass Coronary Artery, One Site from Right Internal Mammary, Open 02100Z9 10/01/2015 Bypass Coronary Artery, One Site from Left Internal Mammary, Open 02100ZC 10/01/2015 Bypass Coronary Artery, One Site from Thoracic Artery, Open 02100ZF 10/01/2015 Bypass Coronary Artery, One Site from Abdominal Artery, Open 0210493 10/01/2015 Bypass Coronary Artery, One Site from Coronary Artery with Autologous Venous Tissue, Percutaneous Endoscopic 0210498 10/01/2015 Bypass Coronary Artery, One Site from Right Internal Mammary with Autologous Venous Tissue, Percutaneous Endoscopic 0210499 10/01/2015 Bypass Coronary Artery, One Site from Left Internal Mammary with Autologous Venous Tissue, Percutaneous Endoscopic 021049C 10/01/2015 Bypass Coronary Artery, One Site from Thoracic Artery with Autologous Venous Tissue, Percutaneous Endoscopic 021049F 10/01/2015 Bypass Coronary Artery, One Site from Abdominal Artery with Autologous Venous Tissue, Percutaneous Endoscopic 021049W 10/01/2015 Bypass Coronary Artery, One Site from Aorta with Autologous Venous Tissue, Percutaneous Endoscopic 2
Attachment F Code Beginning Review 02104A3 10/01/2015 Bypass Coronary Artery, One Site from Coronary Artery with Autologous Arterial Tissue, Percutaneous Endoscopic 02104A8 10/01/2015 Bypass Coronary Artery, One Site from Right Internal Mammary with Autologous Arterial Tissue, Percutaneous Endoscopic 02104A9 10/01/2015 Bypass Coronary Artery, One Site from Left Internal Mammary with Autologous Arterial Tissue, Percutaneous Endoscopic 02104AC 10/01/2015 Bypass Coronary Artery, One Site from Thoracic Artery with Autologous Arterial Tissue, Percutaneous Endoscopic 02104AF 10/01/2015 Bypass Coronary Artery, One Site from Abdominal Artery with Autologous Arterial Tissue, Percutaneous Endoscopic 02104AW 10/01/2015 Bypass Coronary Artery, One Site from Aorta with Autologous Arterial Tissue, Percutaneous Endoscopic 02104J3 10/01/2015 Bypass Coronary Artery, One Site from Coronary Artery with Synthetic Substitute, Percutaneous Endoscopic 02104J8 10/01/2015 Bypass Coronary Artery, One Site from Right Internal Mammary with Synthetic Substitute, Percutaneous Endoscopic 02104J9 10/01/2015 Bypass Coronary Artery, One Site from Left Internal Mammary with Synthetic Substitute, Percutaneous Endoscopic 02104JC 10/01/2015 Bypass Coronary Artery, One Site from Thoracic Artery with Synthetic Substitute, Percutaneous Endoscopic 02104JF 10/01/2015 Bypass Coronary Artery, One Site from Abdominal Artery with with Synthetic Substitute, Percutaneous Endoscopic / 02104JW 10/01/2015 Bypass Coronary Artery, One Site from Aorta with Synthetic Substitute, Percutaneous Endoscopic 02104K3 10/01/2015 Bypass Coronary Artery, One Site from Coronary Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02104K8 10/01/2015 Bypass Coronary Artery, One Site from Right Internal Mammary with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02104K9 10/01/2015 Bypass Coronary Artery, One Site from Left Internal Mammary with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02104KC 10/01/2015 Bypass Coronary Artery, One Site from Thoracic Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic 3
Attachment F Code Beginning Review 02104KF 10/01/2015 Bypass Coronary Artery, One Site from Abdominal Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02104KW 10/01/2015 Bypass Coronary Artery, One Site from Aorta with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02104Z3 10/01/2015 Bypass Coronary Artery, One Site from Coronary Artery, Percutaneous Endoscopic 02104Z8 10/01/2015 Bypass Coronary Artery, One Site from Right Internal Mammary, Percutaneous Endoscopic 02104Z9 10/01/2015 Bypass Coronary Artery, One Site from Left Internal Mammary, Percutaneous Endoscopic 02104ZC 10/01/2015 Bypass Coronary Artery, One Site from Thoracic Artery, Percutaneous Endoscopic 02104ZF 10/01/2015 Bypass Coronary Artery, One Site from Abdominal Artery, Percutaneous Endoscopic 0211093 10/01/2015 Bypass Coronary Artery, Two Sites from Coronary Artery with Autologous Venous Tissue, Open 0211098 10/01/2015 Bypass Coronary Artery, Two Sites from Right Internal Mammary with Autologous Venous Tissue, Open 0211099 10/01/2015 Bypass Coronary Artery, Two Sites from Left Internal Mammary with Autologous Venous Tissue, Open 021109C 10/01/2015 Bypass Coronary Artery, Two Sites from Thoracic Artery with Autologous Venous Tissue, Open 021109F 10/01/2015 Bypass Coronary Artery, Two Sites from Abdominal Artery with Autologous Venous Tissue, Open 021109W 10/01/2015 Bypass Coronary Artery, Two Sites from Aorta with Autologous Venous Tissue, Open 02110A3 10/01/2015 Bypass Coronary Artery, Two Sites from Coronary Artery with Autologous Arterial Tissue, Open 02110A8 10/01/2015 Bypass Coronary Artery, Two Sites from Right Internal Mammary with Autologous Arterial Tissue, Open 02110A9 10/01/2015 Bypass Coronary Artery, Two Sites from Left Internal Mammary with Autologous Arterial Tissue, Open 02110AC 10/01/2015 Bypass Coronary Artery, Two Sites from Thoracic Artery with Autologous Arterial Tissue, Open 02110AF 10/01/2015 Bypass Coronary Artery, Two Sites from Abdominal Artery with Autologous Arterial Tissue, Open 02110AW 10/01/2015 Bypass Coronary Artery, Two Sites from Aorta with Autologous Arterial Tissue, Open 02110J3 10/01/2015 Bypass Coronary Artery, Two Sites from Coronary Artery with Synthetic Substitute, Open 02110J8 10/01/2015 Bypass Coronary Artery, Two Sites from Right Internal 4
Attachment F Code Beginning Review Mammary with Synthetic Substitute, Open 02110J9 10/01/2015 Bypass Coronary Artery, Two Sites from Left Internal Mammary with Synthetic Substitute, Open 02110JC 10/01/2015 Bypass Coronary Artery, Two Sites from Thoracic Artery with Synthetic Substitute, Open 02110JF 10/01/2015 Bypass Coronary Artery, Two Sites from Abdominal Artery with Synthetic Substitute, Open 02110JW 10/01/2015 Bypass Coronary Artery, Two Sites from Aorta with Synthetic Substitute, Open 02110K3 10/01/2015 Bypass Coronary Artery, Two Sites from Coronary Artery with Nonautologous Tissue Substitute, Open 02110K8 10/01/2015 Bypass Coronary Artery, Two Sites from Right Internal Mammary with Nonautologous Tissue Substitute, Open 02110K9 10/01/2015 Bypass Coronary Artery, Two Sites from Left Internal Mammary with Nonautologous Tissue Substitute, Open 02110KC 10/01/2015 Bypass Coronary Artery, Two Sites from Thoracic Artery with Nonautologous Tissue Substitute, Open 02110KF 10/01/2015 Bypass Coronary Artery, Two Sites from Abdominal Artery with Nonautologous Tissue Substitute, Open 02110KW 10/01/2015 Bypass Coronary Artery, Two Sites from Aorta with Nonautologous Tissue Substitute, Open 02110Z3 10/01/2015 Bypass Coronary Artery, Two Sites from Coronary Artery, Open 02110Z8 10/01/2015 Bypass Coronary Artery, Two Sites from Right Internal Mammary, Open 02110Z9 10/01/2015 Bypass Coronary Artery, Two Sites from Left Internal Mammary, Open 02110ZC 10/01/2015 Bypass Coronary Artery, Two Sites from Thoracic Artery, Open 02110ZF 10/01/2015 Bypass Coronary Artery, Two Sites from Abdominal Artery, Open 0211493 10/01/2015 Bypass Coronary Artery, Two Sites from Coronary Artery with Autologous Venous Tissue, Percutaneous Endoscopic 0211498 10/01/2015 Bypass Coronary Artery, Two Sites from Right Internal Mammary with Autologous Venous Tissue, Percutaneous Endoscopic 0211499 10/01/2015 Bypass Coronary Artery, Two Sites from Left Internal Mammary with Autologous Venous Tissue, Percutaneous Endoscopic 021149C 10/01/2015 Bypass Coronary Artery, Two Sites from Thoracic Artery with Autologous Venous Tissue, Percutaneous Endoscopic 5
Attachment F Code Beginning Review 021149F 10/01/2015 Bypass Coronary Artery, Two Sites from Abdominal Artery with Autologous Venous Tissue, Percutaneous Endoscopic 021149W 10/01/2015 (Bypass Coronary Artery, Two Sites from Aorta with Autologous Venous Tissue, Percutaneous Endoscopic 02114A3 10/01/2015 Bypass Coronary Artery, Two Sites from Coronary Artery with Autologous Arterial Tissue, Percutaneous Endoscopic 02114A8 10/01/2015 Bypass Coronary Artery, Two Sites from Right Internal Mammary with Autologous Arterial Tissue, Percutaneous Endoscopic 02114A9 10/01/2015 Bypass Coronary Artery, Two Sites from Left Internal Mammary with Autologous Arterial Tissue, Percutaneous Endoscopic 02114AC 10/01/2015 Bypass Coronary Artery, Two Sites from Thoracic Artery with Autologous Arterial Tissue, Percutaneous Endoscopic 02114AF 10/01/2015 Bypass Coronary Artery, Two Sites from Abdominal Artery with Autologous Arterial Tissue, Percutaneous Endoscopic 02114AW 10/01/2015 (Bypass Coronary Artery, Two Sites from Aorta with Autologous Arterial Tissue, Percutaneous Endoscopic 02114J3 10/01/2015 Bypass Coronary Artery, Two Sites from Coronary Artery with Synthetic Substitute, Percutaneous Endoscopic 02114J8 10/01/2015 Bypass Coronary Artery, Two Sites from Right Internal Mammary with Synthetic Substitute, Percutaneous Endoscopic 02114J9 10/01/2015 Bypass Coronary Artery, Two Sites from Left Internal Mammary with Synthetic Substitute, Percutaneous Endoscopic 02114JC 10/01/2015 Bypass Coronary Artery, Two Sites from Thoracic Artery with Synthetic Substitute, Percutaneous Endoscopic 02114JF 10/01/2015 Bypass Coronary Artery, Two Sites from Abdominal Artery with Synthetic Substitute, Percutaneous Endoscopic 02114JW 10/01/2015 (Bypass Coronary Artery, Two Sites from Aorta with Synthetic Substitute, Percutaneous Endoscopic 02114K3 10/01/2015 Bypass Coronary Artery, Two Sites from Coronary Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02114K8 10/01/2015 Bypass Coronary Artery, Two Sites from Right Internal Mammary with Nonautologous Tissue Substitute, 6
Attachment F Code Beginning Review Percutaneous Endoscopic 02114K9 10/01/2015 Bypass Coronary Artery, Two Sites from Left Internal Mammary with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02114KC 10/01/2015 Bypass Coronary Artery, Two Sites from Thoracic Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02114KF 10/01/2015 Bypass Coronary Artery, Two Sites from Abdominal Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02114KW 10/01/2015 Bypass Coronary Artery, Two Sites from Aorta with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02114Z3 10/01/2015 Bypass Coronary Artery, Two Sites from Coronary Artery, Percutaneous Endoscopic 02114Z8 10/01/2015 Bypass Coronary Artery, Two Sites from Right Internal Mammary, Percutaneous Endoscopic 02114Z9 10/01/2015 Bypass Coronary Artery, Two Sites from Left Internal Mammary, Percutaneous Endoscopic 02114ZC 10/01/2015 Bypass Coronary Artery, Two Sites from Thoracic Artery, Percutaneous Endoscopic 02114ZF 10/01/2015 Bypass Coronary Artery, Two Sites from Abdominal Artery, Percutaneous Endoscopic 0212093 10/01/2015 Bypass Coronary Artery, Three Sites from Coronary Artery with Autologous Venous Tissue, Open 0212098 10/01/2015 Bypass Coronary Artery, Three Sites from Right Internal Mammary with Autologous Venous Tissue, Open 0212099 10/01/2015 Bypass Coronary Artery, Three Sites from Left Internal Mammary with Autologous Venous Tissue, Open 021209C 10/01/2015 Bypass Coronary Artery, Three Sites from Thoracic Artery with Autologous Venous Tissue, Open 021209F 10/01/2015 Bypass Coronary Artery, Three Sites from Abdominal Artery with Autologous Venous Tissue, Open 021209W 10/01/2015 Bypass Coronary Artery, Three Sites from Aorta with Autologous Venous Tissue, Open ) 02120A3 10/01/2015 Bypass Coronary Artery, Three Sites from Coronary Artery with Autologous Arterial Tissue, Open 02120A8 10/01/2015 Bypass Coronary Artery, Three Sites from Right Internal Mammary with Autologous Arterial Tissue, Open 02120A9 10/01/2015 Bypass Coronary Artery, Three Sites from Left Internal Mammary with Autologous Arterial Tissue, Open 02120AC 10/01/2015 Bypass Coronary Artery, Three Sites from Thoracic Artery with Autologous Arterial Tissue, Open 02120AF 10/01/2015 Bypass Coronary Artery, Three Sites from Abdominal Artery 7
Attachment F Code Beginning Review with Autologous Arterial Tissue, Open 02120AW 10/01/2015 Bypass Coronary Artery, Three Sites from Aorta with Autologous Arterial Tissue, Open ) 02120J3 10/01/2015 Bypass Coronary Artery, Three Sites from Coronary Artery with Synthetic Substitute, Open 02120J8 10/01/2015 Bypass Coronary Artery, Three Sites from Right Internal Mammary with Synthetic Substitute, Open 02120J9 10/01/2015 Bypass Coronary Artery, Three Sites from Left Internal Mammary with Synthetic Substitute, Open 02120JC 10/01/2015 Bypass Coronary Artery, Three Sites from Thoracic Artery with Synthetic Substitute, Open 02120JF 10/01/2015 Bypass Coronary Artery, Three Sites from Abdominal Artery with Synthetic Substitute, Open 02120JW 10/01/2015 Bypass Coronary Artery, Three Sites from Aorta with Synthetic Substitute, Open ) 02120K3 10/01/2015 Bypass Coronary Artery, Three Sites from Coronary Artery with Nonautologous Tissue Substitute, Open 02120K8 10/01/2015 Bypass Coronary Artery, Three Sites from Right Internal Mammary with Nonautologous Tissue Substitute, Open 02120K9 10/01/2015 Bypass Coronary Artery, Three Sites from Left Internal Mammary with Nonautologous Tissue Substitute, Open 02120KC 10/01/2015 Bypass Coronary Artery, Three Sites from Thoracic Artery with Nonautologous Tissue Substitute, Open 02120KF 10/01/2015 Bypass Coronary Artery, Three Sites from Abdominal Artery, Open 02120KW 10/01/2015 Bypass Coronary Artery, Three Sites from Aorta with Nonautologous Tissue Substitute, Open ) 02120Z3 10/01/2015 Bypass Coronary Artery, Three Sites from Coronary Artery, Open 02120Z8 10/01/2015 Bypass Coronary Artery, Three Sites from Right Internal Mammary, Open 02120Z9 10/01/2015 Bypass Coronary Artery, Three Sites from Left Internal Mammary, Open 02120ZC 10/01/2015 Bypass Coronary Artery, Three Sites from Thoracic Artery, Open 02120ZF 10/01/2015 Bypass Coronary Artery, Three Sites from Abdominal Artery, Open 0212493 10/01/2015 Bypass Coronary Artery, Three Sites from Coronary Artery with Autologous Venous Tissue, Percutaneous Endoscopic 0212498 10/01/2015 Bypass Coronary Artery, Three Sites from Right Internal Mammary with Autologous Venous Tissue, Percutaneous 8
Attachment F Code Beginning Review Endoscopic 0212499 10/01/2015 Bypass Coronary Artery, Three Sites from Left Internal Mammary with Autologous Venous Tissue, Percutaneous Endoscopic 021249C 10/01/2015 Bypass Coronary Artery, Three Sites from Thoracic Artery with Autologous Venous Tissue, Percutaneous Endoscopic 021249F 10/01/2015 Bypass Coronary Artery, Three Sites from Abdominal Artery with Autologous Venous Tissue, Percutaneous Endoscopic 021249W 10/01/2015 Bypass Coronary Artery, Three Sites from Aorta with Autologous Venous Tissue, Percutaneous Endoscopic ) 02124A3 10/01/2015 Bypass Coronary Artery, Three Sites from Coronary Artery with Autologous Arterial Tissue, Percutaneous Endoscopic 02124A8 10/01/2015 Bypass Coronary Artery, Three Sites from Right Internal Mammary with Autologous Arterial Tissue, Percutaneous Endoscopic 02124A9 10/01/2015 Bypass Coronary Artery, Three Sites from Left Internal Mammary with Autologous Arterial Tissue, Percutaneous Endoscopic 02124AC 10/01/2015 Bypass Coronary Artery, Three Sites from Thoracic Artery with Autologous Arterial Tissue, Percutaneous Endoscopic 02124AF 10/01/2015 Bypass Coronary Artery, Three Sites from Abdominal Artery with Autologous Arterial Tissue, Percutaneous Endoscopic 02124AW 10/01/2015 Bypass Coronary Artery, Three Sites from Aorta with Autologous Arterial Tissue, Percutaneous Endoscopic ) 02124J3 10/01/2015 Bypass Coronary Artery, Three Sites from Coronary Artery with Synthetic Substitute, Percutaneous Endoscopic 02124J8 10/01/2015 Bypass Coronary Artery, Three Sites from Right Internal Mammary with Synthetic Substitute, Percutaneous Endoscopic 02124J9 10/01/2015 Bypass Coronary Artery, Three Sites from Left Internal Mammary with Synthetic Substitute, Percutaneous Endoscopic 02124JC 10/01/2015 Bypass Coronary Artery, Three Sites from Thoracic Artery with Synthetic Substitute, Percutaneous Endoscopic 02124JF 10/01/2015 Bypass Coronary Artery, Three Sites from Abdominal Artery with Synthetic Substitute, Percutaneous Endoscopic 02124JW 10/01/2015 Bypass Coronary Artery, Three Sites from Aorta with 9
Attachment F Code Beginning Review Synthetic Substitute, Percutaneous Endoscopic ) 02124K3 10/01/2015 Bypass Coronary Artery, Three Sites from Coronary Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02124K8 10/01/2015 Bypass Coronary Artery, Three Sites from Right Internal Mammary with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02124K9 10/01/2015 Bypass Coronary Artery, Three Sites from Left Internal Mammary with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02124KC 10/01/2015 Bypass Coronary Artery, Three Sites from Thoracic Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02124KF 10/01/2015 Bypass Coronary Artery, Three Sites from Abdominal Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02124KW 10/01/2015 Bypass Coronary Artery, Three Sites from Aorta with Nonautologous Tissue Substitute, Percutaneous Endoscopic ) 02124Z3 10/01/2015 Bypass Coronary Artery, Three Sites from Coronary Artery, Percutaneous Endoscopic 02124Z8 10/01/2015 Bypass Coronary Artery, Three Sites from Right Internal Mammary, Percutaneous Endoscopic 02124Z9 10/01/2015 Bypass Coronary Artery, Three Sites from Left Internal Mammary, Percutaneous Endoscopic 02124ZC 10/01/2015 Bypass Coronary Artery, Three Sites from Thoracic Artery, Percutaneous Endoscopic 02124ZF 10/01/2015 Bypass Coronary Artery, Three Sites from Abdominal Artery, Percutaneous Endoscopic 0213093 10/01/2015 Bypass Coronary Artery, Four or More Sites from Coronary Artery with Autologous Venous Tissue, Open 0213098 10/01/2015 Bypass Coronary Artery, Four or More Sites from Right Internal Mammary with Autologous Venous Tissue, Open 0213099 10/01/2015 Bypass Coronary Artery, Four or More Sites from Left Internal Mammary with Autologous Venous Tissue, Open 021309C 10/01/2015 Bypass Coronary Artery, Four or More Sites from Thoracic Artery with Autologous Venous Tissue, Open 021309F 10/01/2015 Bypass Coronary Artery, Four or More Sites from Abdominal Artery with Autologous Venous Tissue, Open 021309W 10/01/2015 Bypass Coronary Artery, Four or More Sites from Aorta with Autologous Venous Tissue, Open 02130A3 10/01/2015 Bypass Coronary Artery, Four or More Sites from Coronary 10
Attachment F Code Beginning Review Artery with Autologous Arterial Tissue, Open 02130A8 10/01/2015 Bypass Coronary Artery, Four or More Sites from Right Internal Mammary with Autologous Arterial Tissue, Open 02130A9 10/01/2015 Bypass Coronary Artery, Four or More Sites from Left Internal Mammary with Autologous Arterial Tissue, Open 02130AC 10/01/2015 Bypass Coronary Artery, Four or More Sites from Thoracic Artery with Autologous Arterial Tissue, Open 02130AF 10/01/2015 Bypass Coronary Artery, Four or More Sites from Abdominal Artery with Autologous Arterial Tissue, Open 02130AW 10/01/2015 Bypass Coronary Artery, Four or More Sites from Aorta with Autologous Arterial Tissue, Open 02130J3 10/01/2015 Bypass Coronary Artery, Four or More Sites from Coronary Artery with Synthetic Substitute, Open 02130J8 10/01/2015 Bypass Coronary Artery, Four or More Sites from Right Internal Mammary with Synthetic Substitute, Open 02130J9 10/01/2015 Bypass Coronary Artery, Four or More Sites from Left Internal Mammary with Synthetic Substitute, Open 02130JC 10/01/2015 Bypass Coronary Artery, Four or More Sites from Thoracic Artery with Synthetic Substitute, Open 02130JF 10/01/2015 Bypass Coronary Artery, Four or More Sites from Abdominal Artery with Synthetic Substitute, Open 02130JW 10/01/2015 Bypass Coronary Artery, Four or More Sites from Aorta with Synthetic Substitute, Open 02130K3 10/01/2015 Bypass Coronary Artery, Four or More Sites from Coronary Artery with Nonautologous Tissue Substitute, Open 02130K8 10/01/2015 Bypass Coronary Artery, Four or More Sites from Right Internal Mammary with Nonautologous Tissue Substitute, Open 02130K9 10/01/2015 Bypass Coronary Artery, Four or More Sites from Left Internal Mammary with Nonautologous Tissue Substitute, Open 02130KC 10/01/2015 Bypass Coronary Artery, Four or More Sites from Thoracic Artery with Nonautologous Tissue Substitute, Open 02130KF 10/01/2015 Bypass Coronary Artery, Four or More Sites from Abdominal Artery with Nonautologous Tissue Substitute, Open 02130KW 10/01/2015 Bypass Coronary Artery, Four or More Sites from Aorta with Nonautologous Tissue Substitute, Open 02130Z3 10/01/2015 Bypass Coronary Artery, Four or More Sites from Coronary Artery, Open 02130Z8 10/01/2015 Bypass Coronary Artery, Four or More Sites from Right Internal Mammary, Open 02130Z9 10/01/2015 Bypass Coronary Artery, Four or More Sites from Left 11
Attachment F Code Beginning Review Internal Mammary, Open 02130ZC 10/01/2015 Bypass Coronary Artery, Four or More Sites from Thoracic Artery, Open 02130ZF 10/01/2015 Bypass Coronary Artery, Four or More Sites from Abdominal Artery, Open 0213493 10/01/2015 Bypass Coronary Artery, Four or More Sites from Coronary Artery with Autologous Venous Tissue, Percutaneous Endoscopic 0213498 10/01/2015 Bypass Coronary Artery, Four or More Sites from Right Internal Mammary with Autologous Venous Tissue, Percutaneous Endoscopic 0213499 10/01/2015 Bypass Coronary Artery, Four or More Sites from Left Internal Mammary with Autologous Venous Tissue, Percutaneous Endoscopic 021349C 10/01/2015 Bypass Coronary Artery, Four or More Sites from Thoracic Artery with Autologous Venous Tissue, Percutaneous Endoscopic 021349F 10/01/2015 Bypass Coronary Artery, Four or More Sites from Abdominal Artery with Autologous Venous Tissue, Percutaneous Endoscopic 021349W 10/01/2015 Bypass Coronary Artery, Four or More Sites from Aorta with Autologous Venous Tissue, Percutaneous Endoscopic 02134A3 10/01/2015 Bypass Coronary Artery, Four or More Sites from Coronary Artery with Autologous Arterial Tissue, Percutaneous Endoscopic 02134A8 10/01/2015 Bypass Coronary Artery, Four or More Sites from Right Internal Mammary with Autologous Arterial Tissue, Percutaneous Endoscopic 02134A9 10/01/2015 Bypass Coronary Artery, Four or More Sites from Left Internal Mammary with Autologous Arterial Tissue, Percutaneous Endoscopic 02134AC 10/01/2015 Bypass Coronary Artery, Four or More Sites from Thoracic Artery with Autologous Arterial Tissue, Percutaneous Endoscopic 02134AF 10/01/2015 Bypass Coronary Artery, Four or More Sites from Abdominal Artery with Autologous Arterial Tissue, Percutaneous Endoscopic 02134AW 10/01/2015 Bypass Coronary Artery, Four or More Sites from Aorta with Autologous Arterial Tissue, Percutaneous Endoscopic 02134J3 10/01/2015 Bypass Coronary Artery, Four or More Sites from Coronary Artery with Synthetic Substitute, Percutaneous Endoscopic 12
Attachment F Code Beginning Review 02134J8 10/01/2015 Bypass Coronary Artery, Four or More Sites from Right Internal Mammary with Synthetic Substitute, Percutaneous Endoscopic 02134J9 10/01/2015 Bypass Coronary Artery, Four or More Sites from Left Internal Mammary with Synthetic Substitute, Percutaneous Endoscopic 02134JC 10/01/2015 Bypass Coronary Artery, Four or More Sites from Thoracic Artery with Synthetic Substitute, Percutaneous Endoscopic 02134JF 10/01/2015 Bypass Coronary Artery, Four or More Sites from Abdominal Artery with Synthetic Substitute, Percutaneous Endoscopic 02134JW 10/01/2015 Bypass Coronary Artery, Four or More Sites from Aorta with Synthetic Substitute, Percutaneous Endoscopic 02134K3 10/01/2015 Bypass Coronary Artery, Four or More Sites from Coronary Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02134K8 10/01/2015 Bypass Coronary Artery, Four or More Sites from Right Internal Mammary with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02134K9 10/01/2015 Bypass Coronary Artery, Four or More Sites from Left Internal Mammary with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02134KC 10/01/2015 Bypass Coronary Artery, Four or More Sites from Thoracic Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02134KF 10/01/2015 Bypass Coronary Artery, Four or More Sites from Abdominal Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02134KW 10/01/2015 Bypass Coronary Artery, Four or More Sites from Aorta with Nonautologous Tissue Substitute, Percutaneous Endoscopic 02134Z3 10/01/2015 Bypass Coronary Artery, Four or More Sites from Coronary Artery, Percutaneous Endoscopic 02134Z8 10/01/2015 Bypass Coronary Artery, Four or More Sites from Right Internal Mammary, Percutaneous Endoscopic 02134Z9 10/01/2015 Bypass Coronary Artery, Four or More Sites from Left Internal Mammary, Percutaneous Endoscopic 02134ZC 10/01/2015 Bypass Coronary Artery, Four or More Sites from Thoracic Artery, Percutaneous Endoscopic 02134ZF 10/01/2015 Bypass Coronary Artery, Four or More Sites from Abdominal Artery, Percutaneous Endoscopic 13
Attachment F Back Surgery 0R530ZZ 10/01/2015 Destruction of Cervical Vertebral Disc, Open 0R533ZZ 10/01/2015 Destruction of Cervical Vertebral Disc, Percutaneous 0R534ZZ 10/01/2015 Destruction of Cervical Vertebral Disc, Percutaneous Endoscopic 0R550ZZ 10/01/2015 Destruction of Cervicothoracic Vertebral Disc, Open 0R553ZZ 10/01/2015 Destruction of Cervicothoracic Vertebral Disc, Percutaneous 0R554ZZ 10/01/2015 Destruction of Cervicothoracic Vertebral Disc, Percutaneous Endoscopic 0R590ZZ 10/01/2015 Destruction of Thoracic Vertebral Disc, Open 0R593ZZ 10/01/2015 Destruction of Thoracic Vertebral Disc, Percutaneous 0R594ZZ 10/01/2015 Destruction of Thoracic Vertebral Disc, Percutaneous Endoscopic 0R5B0ZZ 10/01/2015 Destruction of Thoracolumbar Vertebral Disc, Open 0R5B3ZZ 10/01/2015 Destruction of Thoracolumbar Vertebral Disc, Percutaneous 0R5B4ZZ 10/01/2015 Destruction of Thoracolumbar Vertebral Disc, Percutaneous Endoscopic 0RB30ZZ 10/01/2015 Excision of Cervical Vertebral Disc, Open 0RB33ZZ 10/01/2015 Excision of Cervical Vertebral Disc, Percutaneous 0RB34ZZ 10/01/2015 Excision of Cervical Vertebral Disc, Percutaneous Endoscopic 0RB50ZZ 10/01/2015 Excision of Cervicothoracic Vertebral Disc, Open 0RB53ZZ 10/01/2015 Excision of Cervicothoracic Vertebral Disc, Percutaneous 0RB54ZZ 10/01/2015 Excision of Cervicothoracic Vertebral Disc, Percutaneous Endoscopic 0RB90ZZ 10/01/2015 Excision of Thoracic Vertebral Disc, Open 0RB93ZZ 10/01/2015 Excision of Thoracic Vertebral Disc, Percutaneous 0RB94ZZ 10/01/2015 Excision of Thoracic Vertebral Disc, Percutaneous Endoscopic 0RBB0ZZ 10/01/2015 Excision of Thoracolumbar Vertebral Disc, Open 0RBB3ZZ 10/01/2015 Excision of Thoracolumbar Vertebral Disc, Percutaneous 0RBB4ZZ 10/01/2015 Excision of Thoracolumbar Vertebral Disc, Percutaneous Endoscopic 14
Attachment F 0RG1070 10/01/2015 Fusion of Cervical Vertebral Joint with Autologous Tissue Substitute, Anterior, Anterior Column, Open 0RG1071 10/01/2015 Fusion of Cervical Vertebral Joint with Autologous Tissue Substitute, Posterior, Posterior Column, Open 0RG107J 10/01/2015 Fusion of Cervical Vertebral Joint with Autologous Tissue Substitute, Posterior, Anterior Column, Open 0RG10A0 10/01/2015 Fusion of Cervical Vertebral Joint with Interbody Fusion Device, Anterior, Anterior Column, Open 0RG10A1 10/01/2015 Fusion of Cervical Vertebral Joint with Interbody Fusion Device, Posterior, Posterior Column, Open 0RG10AJ 10/01/2015 Fusion of Cervical Vertebral Joint with Interbody Fusion Device, Posterior, Anterior Column, Open 0RG10J0 10/01/2015 Fusion of Cervical Vertebral Joint with Synthetic Substitute, Anterior, Anterior Column, Open 0RG10J1 10/01/2015 Fusion of Cervical Vertebral Joint with Synthetic Substitute, Posterior, Posterior Column, Open 0RG10JJ 10/01/2015 Fusion of Cervical Vertebral Joint with Synthetic Substitute, Posterior, Anterior Column, Open 0RG10K0 10/01/2015 Fusion of Cervical Vertebral Joint with Nonautologous Tissue Substitute, Anterior, Anterior Column, Open 0RG10K1 10/01/2015 Fusion of Cervical Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Posterior Column, Open 0RG10KJ 10/01/2015 Fusion of Cervical Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Anterior Column, Open 0RG10Z0 10/01/2015 Fusion of Cervical Vertebral Joint, Anterior, Anterior Column, Open 0RG10Z1 10/01/2015 Fusion of Cervical Vertebral Joint, Posterior, Posterior Column, Open 0RG10ZJ 10/01/2015 Fusion of Cervical Vertebral Joint, Posterior, Anterior Column, Open 0RG1370 10/01/2015 Fusion of Cervical Vertebral Joint with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0RG1371 10/01/2015 Fusion of Cervical Vertebral Joint with Autologous Tissue Substitute, Posterior, Posterior Column, 15
Attachment F Percutaneous 0RG137J 10/01/2015 Fusion of Cervical Vertebral Joint with Autologous Tissue Substitute, Posterior, Anterior Column, Percutaneous 0RG13A0 10/01/2015 Fusion of Cervical Vertebral Joint with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous 0RG13A1 10/01/2015 Fusion of Cervical Vertebral Joint with Interbody Fusion Device, Posterior, Posterior Column, Percutaneous 0RG13AJ 10/01/2015 Fusion of Cervical Vertebral Joint with Interbody Fusion Device, Posterior, Anterior Column, Percutaneous 0RG13J0 10/01/2015 Fusion of Cervical Vertebral Joint with Synthetic Substitute, Anterior, Anterior Column, Percutaneous 0RG13J1 10/01/2015 Fusion of Cervical Vertebral Joint with Synthetic Substitute, Posterior, Posterior Column, Percutaneous 0RG13JJ 10/01/2015 Fusion of Cervical Vertebral Joint with Synthetic Substitute, Posterior, Anterior Column, Percutaneous 0RG13K0 10/01/2015 Fusion of Cervical Vertebral Joint with Nonautologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0RG13K1 10/01/2015 Fusion of Cervical Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous 0RG13KJ 10/01/2015 Fusion of Cervical Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Anterior Column, Percutaneous 0RG13Z0 10/01/2015 Fusion of Cervical Vertebral Joint, Anterior, Anterior Column, Percutaneous 0RG13Z1 10/01/2015 Fusion of Cervical Vertebral Joint, Posterior, Posterior Column, Percutaneous 0RG13ZJ 10/01/2015 Fusion of Cervical Vertebral Joint, Posterior, Anterior Column, Percutaneous 0RG1470 10/01/2015 Fusion of Cervical Vertebral Joint with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RG1471 10/01/2015 Fusion of Cervical Vertebral Joint with Autologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0RG147J 10/01/2015 Fusion of Cervical Vertebral Joint with Autologous Tissue Substitute, Posterior, Anterior Column, 16
Attachment F Percutaneous Endoscopic 0RG14A0 10/01/2015 Fusion of Cervical Vertebral Joint with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous Endoscopic 0RG14A1 10/01/2015 Fusion of Cervical Vertebral Joint with Interbody Fusion Device, Posterior, Posterior Column, Percutaneous Endoscopic 0RG14AJ 10/01/2015 Fusion of Cervical Vertebral Joint with Interbody Fusion Device, Posterior, Anterior Column, Percutaneous Endoscopic 0RG14J0 10/01/2015 Fusion of Cervical Vertebral Joint with Synthetic Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RG14J1 10/01/2015 Fusion of Cervical Vertebral Joint with Synthetic Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0RG14JJ 10/01/2015 Fusion of Cervical Vertebral Joint with Synthetic Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0RG14K0 10/01/2015 Fusion of Cervical Vertebral Joint with Nonautologous Tissue Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RG14K1 10/01/2015 Fusion of Cervical Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0RG14KJ 10/01/2015 Fusion of Cervical Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0RG14Z0 10/01/2015 Fusion of Cervical Vertebral Joint, Anterior, Anterior Column, Percutaneous Endoscopic 0RG14Z1 10/01/2015 Fusion of Cervical Vertebral Joint, Posterior, Posterior Column, Percutaneous Endoscopic 0RG14ZJ 10/01/2015 Fusion of Cervical Vertebral Joint, Posterior, Anterior Column, Percutaneous Endoscopic 0RG2070 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Autologous Tissue Substitute, Anterior, Anterior Column, Open 0RG2071 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Autologous Tissue Substitute, Posterior, Posterior Column, Open 0RG207J 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Autologous Tissue Substitute, Posterior, Anterior Column, Open 0RG20A0 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Interbody 17
Attachment F Fusion Device, Anterior, Anterior Column, Open 0RG20A1 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Interbody Fusion Device, Posterior, Posterior Column, Open 0RG20AJ 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Interbody Fusion Device, Posterior, Anterior Column, Open 0RG20J0 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Synthetic Substitute, Anterior, Anterior Column, Open 0RG20J1 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Synthetic Substitute, Posterior, Posterior Column, Open 0RG20JJ 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Synthetic Substitute, Posterior, Anterior Column, Open 0RG20K0 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Nonautologous Tissue Substitute, Anterior, Anterior Column, Open 0RG20K1 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Posterior Column, Open 0RG20KJ 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Anterior Column, Open 0RG20Z0 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints, Anterior, Anterior Column, Open 0RG20Z1 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints, Posterior, Posterior Column, Open 0RG20ZJ 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints, Posterior, Anterior Column, Open 0RG2370 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0RG2371 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Autologous Tissue Substitute, Posterior, Posterior Column, Percutaneous 0RG237J 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Autologous Tissue Substitute, Posterior, Anterior Column, Percutaneous 0RG23A0 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous 18
Attachment F 0RG23A1 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Interbody Fusion Device, Posterior, Posterior Column, Percutaneous 0RG23AJ 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Interbody Fusion Device, Posterior, Anterior Column, Percutaneous 0RG23J0 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Synthetic Substitute, Anterior, Anterior Column, Percutaneous 0RG23J1 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Synthetic Substitute, Posterior, Posterior Column, Percutaneous 0RG23JJ 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Synthetic Substitute, Posterior, Anterior Column, Percutaneous 0RG23K0 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Nonautologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0RG23K1 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous 0RG23KJ 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Anterior Column, Percutaneous 0RG23Z0 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints, Anterior, Anterior Column, Percutaneous 0RG23Z1 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints, Posterior, Posterior Column, Percutaneous 0RG23ZJ 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints, Posterior, Anterior Column, Percutaneous 0RG2470 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RG2471 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Autologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0RG247J 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Autologous Tissue Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0RG24A0 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous Endoscopic 0RG24A1 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Interbody Fusion Device, Posterior, Posterior Column, 19
Attachment F Percutaneous Endoscopic 0RG24AJ 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Interbody Fusion Device, Posterior, Anterior Column, Percutaneous Endoscopic 0RG24J0 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Synthetic Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RG24J1 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Synthetic Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0RG24JJ 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Synthetic Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0RG24K0 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Nonautologous Tissue Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RG24K1 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0RG24KJ 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0RG24Z0 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints, Anterior, Anterior Column, Percutaneous Endoscopic 0RG24Z1 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints, Posterior, Posterior Column, Percutaneous Endoscopic 0RG24ZJ 10/01/2015 Fusion of 2 or more Cervical Vertebral Joints, Posterior, Anterior Column, Percutaneous Endoscopic 0RG4070 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Autologous Tissue Substitute, Anterior, Anterior Column, Open 0RG4071 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Autologous Tissue Substitute, Posterior, Posterior Column, Open 0RG407J 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Autologous Tissue Substitute, Posterior, Anterior Column, Open 0RG40A0 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Interbody Fusion Device, Anterior, Anterior Column, Open 0RG40A1 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Interbody 20
Attachment F Fusion Device, Posterior, Posterior Column, Open 0RG40AJ 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Interbody Fusion Device, Posterior, Anterior Column, Open 0RG40J0 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Synthetic Substitute, Anterior, Anterior Column, Open 0RG40J1 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Synthetic Substitute, Posterior, Posterior Column, Open 0RG40JJ 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Synthetic Substitute, Posterior, Anterior Column, Open 0RG40K0 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Nonautologous Tissue Substitute, Anterior, Anterior Column, Open 0RG40K1 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Posterior Column, Open 0RG40KJ 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Anterior Column, Open 0RG40Z0 10/01/2015 Fusion of Cervicothoracic Vertebral Joint, Anterior, Anterior Column, Open 0RG40Z1 10/01/2015 Fusion of Cervicothoracic Vertebral Joint, Posterior, Posterior Column, Open 0RG40ZJ 10/01/2015 Fusion of Cervicothoracic Vertebral Joint, Posterior, Anterior Column, Open 0RG4370 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0RG4371 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Autologous Tissue Substitute, Posterior, Posterior Column, Percutaneous 0RG437J 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Autologous Tissue Substitute, Posterior, Anterior Column, Percutaneous 0RG43A0 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous 0RG43A1 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Interbody Fusion Device, Posterior, Posterior Column, Percutaneous 21
Attachment F 0RG43AJ 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Interbody Fusion Device, Posterior, Anterior Column, Percutaneous 0RG43J0 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Synthetic Substitute, Anterior, Anterior Column, Percutaneous 0RG43J1 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Synthetic Substitute, Posterior, Posterior Column, Percutaneous 0RG43JJ 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Synthetic Substitute, Posterior, Anterior Column, Percutaneous 0RG43K0 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Nonautologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0RG43K1 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous 0RG43KJ 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Anterior Column, Percutaneous 0RG43Z0 10/01/2015 Fusion of Cervicothoracic Vertebral Joint, Anterior, Anterior Column, Percutaneous 0RG43Z1 10/01/2015 Fusion of Cervicothoracic Vertebral Joint, Posterior, Posterior Column, Percutaneous 0RG43ZJ 10/01/2015 Fusion of Cervicothoracic Vertebral Joint, Posterior, Anterior Column, Percutaneous 0RG4470 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RG4471 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Autologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0RG447J 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Autologous Tissue Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0RG44A0 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous Endoscopic 0RG44A1 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Interbody Fusion Device, Posterior, Posterior Column, Percutaneous Endoscopic 0RG44AJ 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Interbody Fusion Device, Posterior, Anterior Column, 22
Attachment F Percutaneous Endoscopic 0RG44J0 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Synthetic Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RG44J1 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Synthetic Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0RG44JJ 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Synthetic Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0RG44K0 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Nonautologous Tissue Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RG44K1 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0RG44KJ 10/01/2015 Fusion of Cervicothoracic Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0RG44Z0 10/01/2015 Fusion of Cervicothoracic Vertebral Joint, Anterior, Anterior Column, Percutaneous Endoscopic 0RG44Z1 10/01/2015 Fusion of Cervicothoracic Vertebral Joint, Posterior, Posterior Column, Percutaneous Endoscopic 0RG44ZJ 10/01/2015 Fusion of C-thor Jt, Post Appr A Col, Perc Endo (Fusion of Cervicothoracic Vertebral Joint, Posterior, Anterior Column, Percutaneous Endoscopic ) 0RG6070 10/01/2015 Fusion of Thoracic Vertebral Joint with Autologous Tissue Substitute, Anterior, Anterior Column, Open 0RG6071 10/01/2015 Fusion of Thoracic Vertebral Joint with Autologous Tissue Substitute, Posterior, Posterior Column, Open 0RG607J 10/01/2015 Fusion of Thoracic Vertebral Joint with Autologous Tissue Substitute, Posterior, Anterior Column, Open 0RG60A0 10/01/2015 Fusion of Thoracic Vertebral Joint with Interbody Fusion Device, Anterior, Anterior Column, Open 0RG60A1 10/01/2015 Fusion of Thoracic Vertebral Joint with Interbody Fusion Device, Posterior, Posterior Column, Open 0RG60AJ 10/01/2015 Fusion of Thoracic Vertebral Joint with Interbody Fusion 23
Attachment F Device, Posterior, Anterior Column, Open 0RG60J0 10/01/2015 Fusion of Thoracic Vertebral Joint with Synthetic Substitute, Anterior, Anterior Column, Open 0RG60J1 10/01/2015 Fusion of Thoracic Vertebral Joint with Synthetic Substitute, Posterior, Posterior Column, Open 0RG60JJ 10/01/2015 Fusion of Thoracic Vertebral Joint with Synthetic Substitute, Posterior, Anterior Column, Open 0RG60K0 10/01/2015 Fusion of Thoracic Vertebral Joint with Nonautologous Tissue Substitute, Anterior, Anterior Column, Open 0RG60K1 10/01/2015 Fusion of Thoracic Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Posterior Column, Open 0RG60KJ 10/01/2015 Fusion of Thoracic Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Anterior Column, Open 0RG60Z0 10/01/2015 Fusion of Thoracic Vertebral Joint, Anterior, Anterior Column, Open 0RG60Z1 10/01/2015 Fusion of Thoracic Vertebral Joint, Posterior, Posterior Column, Open 0RG60ZJ 10/01/2015 Fusion of Thoracic Vertebral Joint, Posterior, Anterior Column, Open 0RG6370 10/01/2015 Fusion of Thoracic Vertebral Joint with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0RG6371 10/01/2015 Fusion of Thoracic Vertebral Joint with Autologous Tissue Substitute, Posterior, Posterior Column, Percutaneous 0RG637J 10/01/2015 Fusion of Thoracic Vertebral Joint with Autologous Tissue Substitute, Posterior, Anterior Column, Percutaneous 0RG63A0 10/01/2015 Fusion of Thoracic Vertebral Joint with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous 0RG63A1 10/01/2015 Fusion of Thoracic Vertebral Joint with Interbody Fusion Device, Posterior, Posterior Column, Percutaneous 0RG63AJ 10/01/2015 Fusion of Thoracic Vertebral Joint with Interbody Fusion Device, Posterior, Anterior Column, Percutaneous 0RG63J0 10/01/2015 Fusion of Thoracic Vertebral Joint with Synthetic Substitute, Anterior, Anterior Column, Percutaneous 0RG63J1 10/01/2015 Fusion of Thoracic Vertebral Joint with Synthetic Substitute, 24
Attachment F Posterior, Posterior Column, Percutaneous 0RG63JJ 10/01/2015 Fusion of Thoracic Vertebral Joint with Synthetic Substitute, Posterior, Anterior Column, Percutaneous 0RG63K0 10/01/2015 Fusion of Thoracic Vertebral Joint with Nonautologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0RG63K1 10/01/2015 Fusion of Thoracic Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous 0RG63KJ 10/01/2015 Fusion of Thoracic Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Anterior Column, Percutaneous 0RG63Z0 10/01/2015 Fusion of Thoracic Vertebral Joint, Anterior, Anterior Column, Percutaneous 0RG63Z1 10/01/2015 Fusion of Thoracic Vertebral Joint, Posterior, Posterior Column, Percutaneous 0RG63ZJ 10/01/2015 Fusion of Thoracic Vertebral Joint, Posterior, Anterior Column, Percutaneous 0RG6470 10/01/2015 Fusion of Thoracic Vertebral Joint with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RG6471 10/01/2015 Fusion of Thoracic Vertebral Joint with Autologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0RG647J 10/01/2015 Fusion of Thoracic Vertebral Joint with Autologous Tissue Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0RG64A0 10/01/2015 Fusion of Thoracic Vertebral Joint with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous Endoscopic 0RG64A1 10/01/2015 Fusion of Thoracic Vertebral Joint with Interbody Fusion Device, Posterior, Posterior Column, Percutaneous Endoscopic 0RG64AJ 10/01/2015 Fusion of Thoracic Vertebral Joint with Interbody Fusion Device, Posterior, Anterior Column, Percutaneous Endoscopic 0RG64J0 10/01/2015 Fusion of Thoracic Vertebral Joint with Synthetic Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RG64J1 10/01/2015 Fusion of Thoracic Vertebral Joint with Synthetic Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 25
Attachment F 0RG64JJ 10/01/2015 Fusion of Thoracic Vertebral Joint with Synthetic Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0RG64K0 10/01/2015 Fusion of Thoracic Vertebral Joint with Nonautologous Tissue Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RG64K1 10/01/2015 Fusion of Thoracic Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0RG64KJ 10/01/2015 Fusion of Thoracic Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0RG64Z0 10/01/2015 Fusion of Thoracic Vertebral Joint, Anterior, Anterior Column, Percutaneous Endoscopic 0RG64Z1 10/01/2015 Fusion of Thoracic Vertebral Joint, Posterior, Posterior Column, Percutaneous Endoscopic 0RG64ZJ 10/01/2015 Fusion of Thoracic Vertebral Joint, Posterior, Anterior Column, Percutaneous Endoscopic 0RG7070 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Autologous Tissue Substitute, Anterior, Anterior Column, Open 0RG7071 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Autologous Tissue Substitute, Posterior, Posterior Column, Open 0RG707J 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Autologous Tissue Substitute, Posterior, Anterior Column, Open 0RG70A0 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Interbody Fusion Device, Anterior, Anterior Column, Open 0RG70A1 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Interbody Fusion Device, Posterior, Posterior Column, Open 0RG70AJ 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Interbody Fusion Device, Posterior, Anterior Column, Open 0RG70J0 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Synthetic Substitute, Anterior, Anterior Column, Open 0RG70J1 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Synthetic Substitute, Posterior, Posterior Column, Open 0RG70JJ 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Synthetic Substitute, Posterior, Anterior Column, Open 26
Attachment F 0RG70K0 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Nonautologous Tissue Substitute, Anterior, Anterior Column, Open 0RG70K1 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Posterior Column, Open 0RG70KJ 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Anterior Column, Open 0RG70Z0 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints, Anterior, Anterior Column, Open 0RG70Z1 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints, Posterior, Posterior Column, Open 0RG70ZJ 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints, Posterior, Anterior Column, Open 0RG7370 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0RG7371 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Autologous Tissue Substitute, Posterior, Posterior Column, Percutaneous 0RG737J 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Autologous Tissue Substitute, Posterior, Anterior Column, Percutaneous 0RG73A0 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous 0RG73A1 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Interbody Fusion Device, Posterior, Posterior Column, Percutaneous 0RG73AJ 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Interbody Fusion Device, Posterior, Anterior Column, Percutaneous 0RG73J0 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Synthetic Substitute, Anterior, Anterior Column, Percutaneous 0RG73J1 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Synthetic Substitute, Posterior, Posterior Column, Percutaneous 0RG73JJ 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Synthetic Substitute, Posterior, Anterior Column, Percutaneous 0RG73K0 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with 27
Attachment F Nonautologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0RG73K1 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous 0RG73KJ 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Anterior Column, Percutaneous 0RG73Z0 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints, Anterior, Anterior Column, Percutaneous 0RG73Z1 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints, Posterior, Posterior Column, Percutaneous 0RG73ZJ 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints, Posterior, Anterior Column, Percutaneous 0RG7470 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RG7471 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Autologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0RG747J 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Autologous Tissue Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0RG74A0 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous Endoscopic 0RG74A1 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Interbody Fusion Device, Posterior, Posterior Column, Percutaneous Endoscopic 0RG74AJ 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Interbody Fusion Device, Posterior, Anterior Column, Percutaneous Endoscopic 0RG74J0 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Synthetic Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RG74J1 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Synthetic Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0RG74JJ 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Synthetic Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0RG74K0 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Nonautologous Tissue Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 28
Attachment F 0RG74K1 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0RG74KJ 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0RG74Z0 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints, Anterior, Anterior Column, Percutaneous Endoscopic 0RG74Z1 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints, Posterior, Posterior Column, Percutaneous Endoscopic 0RG74ZJ 10/01/2015 Fusion of 2 to 7 Thoracic Vertebral Joints, Posterior, Anterior Column, Percutaneous Endoscopic 0RG8070 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Autologous Tissue Substitute, Anterior, Anterior Column, Open 0RG8071 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Autologous Tissue Substitute, Posterior, Posterior Column, Open 0RG807J 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Autologous Tissue Substitute, Posterior, Anterior Column, Open 0RG80A0 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Interbody Fusion Device, Anterior, Anterior Column, Open 0RG80A1 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Interbody Fusion Device, Posterior, Posterior Column, Open 0RG80AJ 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Interbody Fusion Device, Posterior, Anterior Column, Open 0RG80J0 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Synthetic Substitute, Anterior, Anterior Column, Open 0RG80J1 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Synthetic Substitute, Posterior, Posterior Column, Open 0RG80JJ 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Synthetic Substitute, Posterior, Anterior Column, Open 0RG80K0 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Nonautologous Tissue Substitute, Anterior, 29
Attachment F Anterior Column, Open 0RG80K1 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Posterior Column, Open 0RG80KJ 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Anterior Column, Open 0RG80Z0 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints, Anterior, Anterior Column, Open 0RG80Z1 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints, Posterior, Posterior Column, Open 0RG80ZJ 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints, Posterior, Anterior Column, Open 0RG8370 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0RG8371 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Autologous Tissue Substitute, Posterior, Posterior Column, Percutaneous 0RG837J 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Autologous Tissue Substitute, Posterior, Anterior Column, Percutaneous 0RG83A0 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous 0RG83A1 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Interbody Fusion Device, Posterior, Posterior Column, Percutaneous 0RG83AJ 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Interbody Fusion Device, Posterior, Anterior Column, Percutaneous 0RG83J0 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Synthetic Substitute, Anterior, Anterior Column, Percutaneous 0RG83J1 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Synthetic Substitute, Posterior, Posterior Column, Percutaneous 0RG83JJ 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Synthetic Substitute, Posterior, Anterior Column, Percutaneous 0RG83K0 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Nonautologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0RG83K1 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with 30
Attachment F Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous 0RG83KJ 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Anterior Column, Percutaneous 0RG83Z0 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints, Anterior, Anterior Column, Percutaneous 0RG83Z1 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints, Posterior, Posterior Column, Percutaneous 0RG83ZJ 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints, Posterior, Anterior Column, Percutaneous 0RG8470 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RG8471 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Autologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0RG847J 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Autologous Tissue Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0RG84A0 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous Endoscopic 0RG84A1 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Interbody Fusion Device, Posterior, Posterior Column, Percutaneous Endoscopic 0RG84AJ 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Interbody Fusion Device, Posterior, Anterior Column, Percutaneous Endoscopic 0RG84J0 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Synthetic Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RG84J1 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Synthetic Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0RG84JJ 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Synthetic Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0RG84K0 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Nonautologous Tissue Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RG84K1 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 31
Attachment F 0RG84KJ 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0RG84Z0 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints, Anterior, Anterior Column, Percutaneous Endoscopic 0RG84Z1 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints, Posterior, Posterior Column, Percutaneous Endoscopic 0RG84ZJ 10/01/2015 Fusion of 8 or more Thoracic Vertebral Joints, Posterior, Anterior Column, Percutaneous Endoscopic 0RGA070 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Autologous Tissue Substitute, Anterior, Anterior Column, Open 0RGA071 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Autologous Tissue Substitute, Posterior, Posterior Column, Open 0RGA07J 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Autologous Tissue Substitute, Posterior, Anterior Column, Open 0RGA0A0 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Interbody Fusion Device, Anterior, Anterior Column, Open 0RGA0A1 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Interbody Fusion Device, Posterior, Posterior Column, Open 0RGA0AJ 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Interbody Fusion Device, Posterior, Anterior Column, Open 0RGA0J0 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Synthetic Substitute, Anterior, Anterior Column, Open 0RGA0J1 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Synthetic Substitute, Posterior, Posterior Column, Open 0RGA0JJ 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Synthetic Substitute, Posterior, Anterior Column, Open 0RGA0K0 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Nonautologous Tissue Substitute, Anterior, Anterior Column, Open 0RGA0K1 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Posterior Column, 32
Attachment F Open 0RGA0KJ 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Anterior Column, Open 0RGA0Z0 10/01/2015 Fusion of Thoracolumbar Vertebral Joint, Anterior, Anterior Column, Open 0RGA0Z1 10/01/2015 Fusion of Thoracolumbar Vertebral Joint, Posterior, Posterior Column, Open 0RGA0ZJ 10/01/2015 Fusion of Thoracolumbar Vertebral Joint, Posterior, Anterior Column, Open 0RGA370 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0RGA371 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Autologous Tissue Substitute, Posterior, Posterior Column, Percutaneous 0RGA37J 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Autologous Tissue Substitute, Posterior, Anterior Column, Percutaneous 0RGA3A0 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous 0RGA3A1 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Interbody Fusion Device, Posterior, Posterior Column, Percutaneous 0RGA3AJ 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Interbody Fusion Device, Posterior, Anterior Column, Percutaneous 0RGA3J0 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Synthetic Substitute, Anterior, Anterior Column, Percutaneous 0RGA3J1 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Synthetic Substitute, Posterior, Posterior Column, Percutaneous 0RGA3JJ 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Synthetic Substitute, Posterior, Anterior Column, Percutaneous 0RGA3K0 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Nonautologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0RGA3K1 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous 0RGA3KJ 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Nonautologous 33
Attachment F Tissue Substitute, Posterior, Anterior Column, Percutaneous 0RGA3Z0 10/01/2015 Fusion of Thoracolumbar Vertebral Joint, Anterior, Anterior Column, Percutaneous 0RGA3Z1 10/01/2015 Fusion of Thoracolumbar Vertebral Joint, Posterior, Posterior Column, Percutaneous 0RGA3ZJ 10/01/2015 Fusion of Thoracolumbar Vertebral Joint, Posterior, Anterior Column, Percutaneous 0RGA470 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RGA471 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Autologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0RGA47J 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Autologous Tissue Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0RGA4A0 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous Endoscopic 0RGA4A1 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Interbody Fusion Device, Posterior, Posterior Column, Percutaneous Endoscopic 0RGA4AJ 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Interbody Fusion Device, Posterior, Anterior Column, Percutaneous Endoscopic 0RGA4J0 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Synthetic Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RGA4J1 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Synthetic Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0RGA4JJ 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Synthetic Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0RGA4K0 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Nonautologous Tissue Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0RGA4K1 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0RGA4KJ 10/01/2015 Fusion of Thoracolumbar Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 34
Attachment F 0RGA4Z0 10/01/2015 Fusion of Thoracolumbar Vertebral Joint, Anterior, Anterior Column, Percutaneous Endoscopic 0RGA4Z1 10/01/2015 Fusion of Thoracolumbar Vertebral Joint, Posterior, Posterior Column, Percutaneous Endoscopic 0RGA4ZJ 10/01/2015 Fusion of Thoracolumbar Vertebral Joint, Posterior, Anterior Column, Percutaneous Endoscopic 0RT30ZZ 10/01/2015 Resection of Cervical Vertebral Disc, Open 0RT40ZZ 10/01/2015 Resection of Cervicothoracic Vertebral Joint, Open 0RT50ZZ 10/01/2015 Resection of Cervicothoracic Vertebral Disc, Open 0RT90ZZ 10/01/2015 Resection of Thoracic Vertebral Disc, Open 0RTB0ZZ 10/01/2015 Resection of Thoracolumbar Vertebral Disc, Open 0S520ZZ 10/01/2015 Destruction of Lumbar Vertebral Disc, Open 0S523ZZ 10/01/2015 Destruction of Lumbar Vertebral Disc, Percutaneous 0S524ZZ 10/01/2015 Destruction of Lumbar Vertebral Disc, Percutaneous Endoscopic 0S540ZZ 10/01/2015 Destruction of Lumbosacral Disc, Open 0S543ZZ 10/01/2015 Destruction of Lumbosacral Disc, Percutaneous 0S544ZZ 10/01/2015 Destruction of Lumbosacral Disc, Percutaneous Endoscopic 0SB20ZZ 10/01/2015 Excision of Lumbar Vertebral Disc, Open 0SB23ZZ 10/01/2015 Excision of Lumbar Vertebral Disc, Percutaneous 0SB24ZZ 10/01/2015 Excision of Lumbar Vertebral Disc, Percutaneous Endoscopic 0SB40ZZ 10/01/2015 Excision of Lumbosacral Disc, Open 0SB43ZZ 10/01/2015 Excision of Lumbosacral Disc, Percutaneous 0SB44ZZ 10/01/2015 Excision of Lumbosacral Disc, Percutaneous Endoscopic 0SG0070 10/01/2015 Fusion of Lumbar Vertebral Joint with Autologous Tissue Substitute, Anterior, Anterior Column, Open 0SG0071 10/01/2015 Fusion of Lumbar Vertebral Joint with Autologous Tissue Substitute, Posterior, Posterior Column, Open 0SG007J 10/01/2015 Fusion of Lumbar Vertebral Joint with Autologous Tissue Substitute, Posterior, Anterior Column, Open 0SG00A0 10/01/2015 Fusion of Lumbar Vertebral Joint with Interbody Fusion Device, Anterior, Anterior Column, Open 0SG00A1 10/01/2015 Fusion of Lumbar Vertebral Joint with Interbody Fusion Device, Posterior, Posterior Column, Open 35
Attachment F 0SG00AJ 10/01/2015 Fusion of Lumbar Vertebral Joint with Interbody Fusion Device, Posterior, Anterior Column, Open 0SG00J0 10/01/2015 Fusion of Lumbar Vertebral Joint with Synthetic Substitute, Anterior, Anterior Column, Open 0SG00J1 10/01/2015 Fusion of Lumbar Vertebral Joint with Synthetic Substitute, Posterior, Posterior Column, Open 0SG00JJ 10/01/2015 Fusion of Lumbar Vertebral Joint with Synthetic Substitute, Posterior, Anterior Column, Open 0SG00K0 10/01/2015 Fusion of Lumbar Vertebral Joint with Nonautologous Tissue Substitute, Anterior, Anterior Column, Open 0SG00K1 10/01/2015 Fusion of Lumbar Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Posterior Column, Open 0SG00KJ 10/01/2015 Fusion of Lumbar Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Anterior Column, Open 0SG00Z0 10/01/2015 Fusion of Lumbar Vertebral Joint, Anterior, Anterior Column, Open 0SG00Z1 10/01/2015 Fusion of Lumbar Vertebral Joint, Posterior, Posterior Column, Open 0SG00ZJ 10/01/2015 Fusion of Lumbar Vertebral Joint, Posterior, Anterior Column, Open 0SG0370 10/01/2015 Fusion of Lumbar Vertebral Joint with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0SG0371 10/01/2015 Fusion of Lumbar Vertebral Joint with Autologous Tissue Substitute, Posterior, Posterior Column, Percutaneous 0SG037J 10/01/2015 Fusion of Lumbar Vertebral Joint with Autologous Tissue Substitute, Posterior, Anterior Column, Percutaneous 0SG03A0 10/01/2015 Fusion of Lumbar Vertebral Joint with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous 0SG03A1 10/01/2015 Fusion of Lumbar Vertebral Joint with Interbody Fusion Device, Posterior, Posterior Column, Percutaneous 0SG03AJ 10/01/2015 Fusion of Lumbar Vertebral Joint with Interbody Fusion Device, Posterior, Anterior Column, Percutaneous 0SG03J0 10/01/2015 Fusion of Lumbar Vertebral Joint with Synthetic Substitute, Anterior, Anterior Column, Percutaneous 36
Attachment F 0SG03J1 10/01/2015 Fusion of Lumbar Vertebral Joint with Synthetic Substitute, Posterior, Posterior Column, Percutaneous 0SG03JJ 10/01/2015 Fusion of Lumbar Vertebral Joint with Synthetic Substitute, Posterior, Anterior Column, Percutaneous 0SG03K0 10/01/2015 Fusion of Lumbar Vertebral Joint with Nonautologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0SG03K1 10/01/2015 Fusion of Lumbar Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous 0SG03KJ 10/01/2015 Fusion of Lumbar Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Anterior Column, Percutaneous 0SG03Z0 10/01/2015 Fusion of Lumbar Vertebral Joint, Anterior, Anterior Column, Percutaneous 0SG03Z1 10/01/2015 Fusion of Lumbar Vertebral Joint, Posterior, Posterior Column, Percutaneous 0SG03ZJ 10/01/2015 Fusion of Lumbar Vertebral Joint, Posterior, Anterior Column, Percutaneous 0SG0470 10/01/2015 Fusion of Lumbar Vertebral Joint with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0SG0471 10/01/2015 Fusion of Lumbar Vertebral Joint with Autologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0SG047J 10/01/2015 Fusion of Lumbar Vertebral Joint with Autologous Tissue Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0SG04A0 10/01/2015 Fusion of Lumbar Vertebral Joint with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous Endoscopic 0SG04A1 10/01/2015 Fusion of Lumbar Vertebral Joint with Interbody Fusion Device, Posterior, Posterior Column, Percutaneous Endoscopic 0SG04AJ 10/01/2015 Fusion of Lumbar Vertebral Joint with Interbody Fusion Device, Posterior, Anterior Column, Percutaneous Endoscopic 0SG04J0 10/01/2015 Fusion of Lumbar Vertebral Joint with Synthetic Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0SG04J1 10/01/2015 Fusion of Lumbar Vertebral Joint with Synthetic Substitute, Posterior, Posterior Column, Percutaneous 37
Attachment F Endoscopic 0SG04JJ 10/01/2015 Fusion of Lumbar Vertebral Joint with Synthetic Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0SG04K0 10/01/2015 Fusion of Lumbar Vertebral Joint with Nonautologous Tissue Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0SG04K1 10/01/2015 Fusion of Lumbar Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0SG04KJ 10/01/2015 Fusion of Lumbar Vertebral Joint with Nonautologous Tissue Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0SG04Z0 10/01/2015 Fusion of Lumbar Vertebral Joint, Anterior, Anterior Column, Percutaneous Endoscopic 0SG04Z1 10/01/2015 Fusion of Lumbar Vertebral Joint, Posterior, Posterior Column, Percutaneous Endoscopic 0SG04ZJ 10/01/2015 Fusion of Lumbar Vertebral Joint, Posterior, Anterior Column, Percutaneous Endoscopic 0SG1070 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Autologous Tissue Substitute, Anterior, Anterior Column, Open 0SG1071 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Autologous Tissue Substitute, Posterior, Posterior Column, Open 0SG107J 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Autologous Tissue Substitute, Posterior, Anterior Column, Open 0SG10A0 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Interbody Fusion Device, Anterior, Anterior Column, Open 0SG10A1 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Interbody Fusion Device, Posterior, Posterior Column, Open 0SG10AJ 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Interbody Fusion Device, Posterior, Anterior Column, Open 0SG10J0 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Synthetic Substitute, Anterior, Anterior Column, Open 0SG10J1 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Synthetic Substitute, Posterior, Posterior Column, Open 0SG10JJ 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Synthetic 38
Attachment F Substitute, Posterior, Anterior Column, Open 0SG10K0 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Nonautologous Tissue Substitute, Anterior, Anterior Column, Open 0SG10K1 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Posterior Column, Open 0SG10KJ 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Anterior Column, Open 0SG10Z0 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints, Anterior, Anterior Column, Open 0SG10Z1 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints, Posterior, Posterior Column, Open 0SG10ZJ 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints, Posterior, Anterior Column, Open 0SG1370 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0SG1371 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Autologous Tissue Substitute, Posterior, Posterior Column, Percutaneous 0SG137J 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Autologous Tissue Substitute, Posterior, Anterior Column, Percutaneous 0SG13A0 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous 0SG13A1 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Interbody Fusion Device, Posterior, Posterior Column, Percutaneous 0SG13AJ 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Interbody Fusion Device, Posterior, Anterior Column, Percutaneous 0SG13J0 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Synthetic Substitute, Anterior, Anterior Column, Percutaneous 0SG13J1 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Synthetic Substitute, Posterior, Posterior Column, Percutaneous 0SG13JJ 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Synthetic Substitute, Posterior, Anterior Column, Percutaneous 39
Attachment F 0SG13K0 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Nonautologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0SG13K1 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous 0SG13KJ 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Anterior Column, Percutaneous 0SG13Z0 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints, Anterior, Anterior Column, Percutaneous 0SG13Z1 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints, Posterior, Posterior Column, Percutaneous 0SG13ZJ 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints, Posterior, Anterior Column, Percutaneous 0SG1470 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0SG1471 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Autologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0SG147J 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Autologous Tissue Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0SG14A0 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous Endoscopic 0SG14A1 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Interbody Fusion Device, Posterior, Posterior Column, Percutaneous Endoscopic 0SG14AJ 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Interbody Fusion Device, Posterior, Anterior Column, Percutaneous Endoscopic 0SG14J0 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Synthetic Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0SG14J1 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Synthetic Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0SG14JJ 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Synthetic Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0SG14K0 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Nonautologous Tissue Substitute, Anterior, 40
Attachment F Anterior Column, Percutaneous Endoscopic 0SG14K1 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0SG14KJ 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints with Nonautologous Tissue Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0SG14Z0 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints, Anterior, Anterior Column, Percutaneous Endoscopic 0SG14Z1 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints, Posterior, Posterior Column, Percutaneous Endoscopic 0SG14ZJ 10/01/2015 Fusion of 2 or more Lumbar Vertebral Joints, Posterior, Anterior Column, Percutaneous Endoscopic 0SG3070 10/01/2015 Fusion of Lumbosacral Joint with Autologous Tissue Substitute, Anterior, Anterior Column, Open 0SG3071 10/01/2015 Fusion of Lumbosacral Joint with Autologous Tissue Substitute, Posterior, Posterior Column, Open 0SG307J 10/01/2015 Fusion of Lumbosacral Joint with Autologous Tissue Substitute, Posterior, Anterior Column, Open 0SG30A0 10/01/2015 Fusion of Lumbosacral Joint with Interbody Fusion Device, Anterior, Anterior Column, Open 0SG30A1 10/01/2015 Fusion of Lumbosacral Joint with Interbody Fusion Device, Posterior, Posterior Column, Open 0SG30AJ 10/01/2015 Fusion of Lumbosacral Joint with Interbody Fusion Device, Posterior, Anterior Column, Open 0SG30J0 10/01/2015 Fusion of Lumbosacral Joint with Synthetic Substitute, Anterior, Anterior Column, Open 0SG30J1 10/01/2015 Fusion of Lumbosacral Joint with Synthetic Substitute, Posterior, Posterior Column, Open 0SG30JJ 10/01/2015 Fusion of Lumbosacral Joint with Synthetic Substitute, Posterior, Anterior Column, Open 0SG30K0 10/01/2015 Fusion of Lumbosacral Joint with Nonautologous Tissue Substitute, Anterior, Anterior Column, Open 0SG30K1 10/01/2015 Fusion of Lumbosacral Joint with Nonautologous Tissue Substitute, Posterior, Posterior Column, Open 0SG30KJ 10/01/2015 Fusion of Lumbosacral Joint with Nonautologous Tissue 41
Attachment F Substitute, Posterior, Anterior Column, Open 0SG30Z0 10/01/2015 Fusion of Lumbosacral Joint, Anterior, Anterior Column, Open 0SG30Z1 10/01/2015 Fusion of Lumbosacral Joint, Posterior, Posterior Column, Open 0SG30ZJ 10/01/2015 Fusion of Lumbosacral Joint, Posterior, Anterior Column, Open 0SG3370 10/01/2015 Fusion of Lumbosacral Joint with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0SG3371 10/01/2015 Fusion of Lumbosacral Joint with Autologous Tissue Substitute, Posterior, Posterior Column, Percutaneous 0SG337J 10/01/2015 Fusion of Lumbosacral Joint with Autologous Tissue Substitute, Posterior, Anterior Column, Percutaneous 0SG33A0 10/01/2015 Fusion of Lumbosacral Joint with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous 0SG33A1 10/01/2015 Fusion of Lumbosacral Joint with Interbody Fusion Device, Posterior, Posterior Column, Percutaneous 0SG33AJ 10/01/2015 Fusion of Lumbosacral Joint with Interbody Fusion Device, Posterior, Anterior Column, Percutaneous 0SG33J0 10/01/2015 Fusion of Lumbosacral Joint with Synthetic Substitute, Anterior, Anterior Column, Percutaneous 0SG33J1 10/01/2015 Fusion of Lumbosacral Joint with Synthetic Substitute, Posterior, Posterior Column, Percutaneous 0SG33JJ 10/01/2015 Fusion of Lumbosacral Joint with Synthetic Substitute, Posterior, Anterior Column, Percutaneous 0SG33K0 10/01/2015 Fusion of Lumbosacral Joint with Nonautologous Tissue Substitute, Anterior, Anterior Column, Percutaneous 0SG33K1 10/01/2015 Fusion of Lumbosacral Joint with Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous 0SG33KJ 10/01/2015 Fusion of Lumbosacral Joint with Nonautologous Tissue Substitute, Posterior, Anterior Column, Percutaneous 0SG33Z0 10/01/2015 Fusion of Lumbosacral Joint, Anterior, Anterior Column, Percutaneous 42
Attachment F 0SG33Z1 10/01/2015 Fusion of Lumbosacral Joint, Posterior, Posterior Column, Percutaneous 0SG33ZJ 10/01/2015 Fusion of Lumbosacral Joint, Posterior, Anterior Column, Percutaneous 0SG3470 10/01/2015 Fusion of Lumbosacral Joint with Autologous Tissue Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0SG3471 10/01/2015 Fusion of Lumbosacral Joint with Autologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0SG347J 10/01/2015 Fusion of Lumbosacral Joint with Autologous Tissue Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0SG34A0 10/01/2015 Fusion of Lumbosacral Joint with Interbody Fusion Device, Anterior, Anterior Column, Percutaneous Endoscopic 0SG34A1 10/01/2015 Fusion of Lumbosacral Joint with Interbody Fusion Device, Posterior, Posterior Column, Percutaneous Endoscopic 0SG34AJ 10/01/2015 Fusion of Lumbosacral Joint with Interbody Fusion Device, Posterior, Anterior Column, Percutaneous Endoscopic 0SG34J0 10/01/2015 Fusion of Lumbosacral Joint with Synthetic Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0SG34J1 10/01/2015 Fusion of Lumbosacral Joint with Synthetic Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0SG34JJ 10/01/2015 Fusion of Lumbosacral Joint with Synthetic Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0SG34K0 10/01/2015 Fusion of Lumbosacral Joint with Nonautologous Tissue Substitute, Anterior, Anterior Column, Percutaneous Endoscopic 0SG34K1 10/01/2015 Fusion of Lumbosacral Joint with Nonautologous Tissue Substitute, Posterior, Posterior Column, Percutaneous Endoscopic 0SG34KJ 10/01/2015 Fusion of Lumbosacral Joint with Nonautologous Tissue Substitute, Posterior, Anterior Column, Percutaneous Endoscopic 0SG34Z0 10/01/2015 Fusion of Lumbosacral Joint, Anterior, Anterior Column, Percutaneous Endoscopic 0SG34Z1 10/01/2015 Fusion of Lumbosacral Joint, Posterior, Posterior Column, Percutaneous Endoscopic 43
Attachment F 0SG34ZJ 10/01/2015 Fusion of Lumbosacral Joint, Posterior, Anterior Column, Percutaneous Endoscopic 0SG704Z 10/01/2015 Fusion of Right Sacroiliac Joint with Internal Fixation Device, Open 0SG70JZ 10/01/2015 Fusion of Right Sacroiliac Joint with Synthetic Substitute, Open 0SG70KZ 10/01/2015 Fusion of Right Sacroiliac Joint with Nonautologous Tissue Substitute, Open 0SG70ZZ 10/01/2015 Fusion of Right Sacroiliac Joint, Open 0SG734Z 10/01/2015 Fusion of Right Sacroiliac Joint with Internal Fixation Device, Percutaneous 0SG737Z 10/01/2015 Fusion of Right Sacroiliac Joint with Autologous Tissue Substitute, Percutaneous 0SG73JZ 10/01/2015 Fusion of Right Sacroiliac Joint with Synthetic Substitute, Percutaneous 0SG73KZ 10/01/2015 Fusion of Right Sacroiliac Joint with Nonautologous Tissue Substitute, Percutaneous 0SG73ZZ 10/01/2015 Fusion of Right Sacroiliac Joint, Percutaneous 0SG744Z 10/01/2015 Fusion of Right Sacroiliac Joint with Internal Fixation Device, Percutaneous Endoscopic 0SG747Z 10/01/2015 Fusion of Right Sacroiliac Joint with Autologous Tissue Substitute, Percutaneous Endoscopic 0SG74JZ 10/01/2015 Fusion of Right Sacroiliac Joint with Synthetic Substitute, Percutaneous Endoscopic 0SG74KZ 10/01/2015 Fusion of Right Sacroiliac Joint with Nonautologous Tissue Substitute, Percutaneous Endoscopic 0SG74ZZ 10/01/2015 Fusion of Right Sacroiliac Joint, Percutaneous Endoscopic 0SG804Z 10/01/2015 Fusion of Left Sacroiliac Joint with Internal Fixation Device, Open 0SG807Z 10/01/2015 Fusion of Left Sacroiliac Joint with Autologous Tissue Substitute, Open 0SG80JZ 10/01/2015 Fusion of Left Sacroiliac Joint with Synthetic Substitute, Open 0SG80KZ 10/01/2015 Fusion of Left Sacroiliac Joint with Nonautologous Tissue Substitute, Open 0SG80ZZ 10/01/2015 Fusion of Left Sacroiliac Joint, Open 0SG834Z 10/01/2015 Fusion of Left Sacroiliac Joint with Internal Fixation Device, Percutaneous 0SG837Z 10/01/2015 Fusion of Left Sacroiliac Joint with Autologous Tissue Substitute, Percutaneous 0SG83JZ 10/01/2015 Fusion of Left Sacroiliac Joint with Synthetic Substitute, Percutaneous 0SG83KZ 10/01/2015 Fusion of Left Sacroiliac Joint with Nonautologous Tissue 44
Attachment F Substitute, Percutaneous 0SG83ZZ 10/01/2015 Fusion of Left Sacroiliac Joint, Percutaneous 0SG844Z 10/01/2015 Fusion of Left Sacroiliac Joint with Internal Fixation Device, Percutaneous Endoscopic 0SG847Z 10/01/2015 Fusion of Left Sacroiliac Joint with Autologous Tissue Substitute, Percutaneous Endoscopic 0SG84JZ 10/01/2015 Fusion of Left Sacroiliac Joint with Synthetic Substitute, Percutaneous Endoscopic 0SG84KZ 10/01/2015 Fusion of Left Sacroiliac Joint with Nonautologous Tissue Substitute, Percutaneous Endoscopic 0SG84ZZ 10/01/2015 Fusion of Left Sacroiliac Joint, Percutaneous Endoscopic 0ST20ZZ 10/01/2015 Resection of Lumbar Vertebral Disc, Open 0ST40ZZ 10/01/2015 Resection of Lumbosacral Disc, Open 3E0U0GB 10/01/2015 Introduction of Recombinant Bone Morphogenetic Protein into Joints, Open 3E0U3GB 10/01/2015 Introduction of Recombinant Bone Morphogenetic Protein into Joints, Percutaneous 3E0V0GB 10/01/2015 Introduction of Recombinant Bone Morphogenetic Protein into Bones, Open 3E0V3GB 10/01/2015 Introduction of Recombinant Bone Morphogenetic Protein into Bones, Percutaneous 0SG707Z 10/01/2015 Fusion of R Sacroiliac Jt with Autol Sub, Open (Fusion of Right Sacroiliac Joint with Autologous Tissue Substitute, Open ) 45