Contractor Information

Local Coverage Determination (LCD): Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma (L34076) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information Contractor Name Contract Type Contract Number Jurisdiction State(s) Noridian Healthcare Solutions, LLC A and B MAC 02101 - MAC A J - F Alaska Noridian Healthcare Solutions, LLC A and B MAC 02102 - MAC B J - F Alaska Noridian Healthcare Solutions, LLC A and B MAC 02201 - MAC A J - F Idaho Noridian Healthcare Solutions, LLC A and B MAC 02202 - MAC B J - F Idaho Noridian Healthcare Solutions, LLC A and B MAC 02301 - MAC A J - F Oregon Noridian Healthcare Solutions, LLC A and B MAC 02302 - MAC B J - F Oregon Noridian Healthcare Solutions, LLC A and B MAC 02401 - MAC A J - F Washington Noridian Healthcare Solutions, LLC A and B MAC 02402 - MAC B J - F Washington Noridian Healthcare Solutions, LLC A and B MAC 03101 - MAC A J - F Arizona Noridian Healthcare Solutions, LLC A and B MAC 03102 - MAC B J - F Arizona Noridian Healthcare Solutions, LLC A and B MAC 03201 - MAC A J - F Montana Noridian Healthcare Solutions, LLC A and B MAC 03202 - MAC B J - F Montana Noridian Healthcare Solutions, LLC A and B MAC 03301 - MAC A J - F North Dakota Noridian Healthcare Solutions, LLC A and B MAC 03302 - MAC B J - F North Dakota Noridian Healthcare Solutions, LLC A and B MAC 03401 - MAC A J - F South Dakota Noridian Healthcare Solutions, LLC A and B MAC 03402 - MAC B J - F South Dakota Noridian Healthcare Solutions, LLC A and B MAC 03501 - MAC A J - F Utah Noridian Healthcare Solutions, LLC A and B MAC 03502 - MAC B J - F Utah Noridian Healthcare Solutions, LLC A and B MAC 03601 - MAC A J - F Wyoming Noridian Healthcare Solutions, LLC A and B MAC 03602 - MAC B J - F Wyoming Back to Top LCD Information Document Information LCD ID L34076 Original ICD-9 LCD ID L24317 Previous Proposed LCD DL34076 LCD Title Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma AMA CPT / ADA CDT / AHA NUBC Copyright Statement Original Effective Date For services performed on or after 10/01/2015 Revision Effective Date For services performed on or after 10/01/2016 Revision Ending Date N/A Retirement Date N/A Notice Period Start Date N/A Notice Period End Date N/A Printed on 10/5/2016. Page 1 of 30

CPT only copyright 2002-2016 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright American Dental Association. All rights reserved. CDT and CDT-2016 are trademarks of the American Dental Association. UB-04 Manual. OFFICIAL UB-04 DATA SPECIFICATIONS MANUAL, 2014, is copyrighted by American Hospital Association ( AHA ), Chicago, Illinois. No portion of OFFICIAL UB-04 MANUAL may be reproduced, sorted in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior express, written consent of AHA. Health Forum reserves the right to change the copyright notice from time to time upon written notice to Company. CMS National Coverage Policy Title XVIII of the Social Security Act, Section 1862(a)(1)(A). This section allows coverage and payment for only those services that are considered to be medically reasonable and necessary. Title XVIII of the Social Security Act, Section 1833(e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim. Coverage Guidance Coverage Indications, Limitations, and/or Medical Necessity This policy addresses the injection of chemical substances, such as local anesthetics, steroids, sclerosing agents and/or neurolytic agents into ganglion cysts, tendon sheaths, tendon origins/insertions, ligaments, costochondral areas, or near nerves of the feet (e.g., Morton's neuroma) to affect therapy for a pathological condition. Note: the term "Morton's neuroma" is used in this policy generically to refer to a swollen inflamed nerve in the ball of the foot, including the more specific conditions of Morton's neuroma (lesion within the third intermetatarsal space), Heuter's neuroma (first intermetatarsal space), Hauser's neuroma (second intermetatarsal space) and Iselin's neuroma (fourth intermetatarsal space). This policy applies to each. Injection of a carpal tunnel is indicated for the patient with a mild case of the carpal tunnel syndrome if oral nonsteroidal anti-inflammatory drugs (NSAIDs) and orthoses have failed or are contraindicated. Though there are many similarities between Morton s neuroma and carpal tunnel syndrome, CPT 2009 contains 64455 (anesthetic and/or steroid) and 64632 (neurolytic agent), the specific codes for the Morton s neuroma injections. Providers are reminded to use the appropriate one of these codes instead of the previously instructed use of 28899. Injection into tendon sheaths, ligaments, tendon origins or insertions, ganglion cysts, or neuromas may be indicated to relieve pain or dysfunction resulting from inflammation or other pathological changes. Proper use of this modality with local anesthetics and/or steroids should be short-term, as part of an overall management plan including diagnostic evaluation, in order to clearly identify and properly treat the primary cause. In some circumstances after diagnosis has been confirmed, injection of a sclerosing or neurolytic agent may be appropriate for longer-term management. The signs or symptoms that justify these treatments should be resolved after one to three injections (see reference 2 below, under "Sources of Information and Basis for Decision"). Injections beyond three must be justified by the clinical record indicating a logical reason for failure of the prior therapy and why further treatment can reasonably be expected to succeed. A recurrence may justify a second course of therapy. Printed on 10/5/2016. Page 2 of 30

Injection therapies for Morton's neuroma do not involve the structures described by CPT code 20550 and 20551 or direct injection into other peripheral nerves but rather the focal injection of tissue surrounding a specific focus of inflammation on the foot. These therapies are not to be coded using 20550, 20551, 64450, 64640 or other assigned CPT codes. Rather, the provider of these therapies must bill with CPT code 64455 or 64632 Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton's neuroma). The provider must not bill CPT codes 64450 or 64640 for these injections, since those codes respectively address the additional work of an injection of an anesthetic agent (nerve block), neurolytic or sclerosing agent into relatively more difficult peripheral nerves, rather than that involved in an injection of relatively easily localized areas such as a carpal tunnel or Morton's neuroma. Injections for plantar fasciitis are addressed by 20550 and ICD-10-CM M72.2. Injections for calcaneal spurs are addressed as are other tendon origin/insertions by 20551. Injections to include both the plantar fascia and the area around a calcaneal spur are to be reported using a single 20551. Medical necessity for injections of more than two sites at one session or for frequent or repeated injections is questionable. Such injections are likely to result in a request for medical records which must evidence careful justification of necessity. "Dry needling" of ganglion cysts, ligaments, neuromas, tendon sheaths and their origins/insertions are noncovered procedures. Compliance with the provisions in this policy is subject to monitoring by post payment data analysis and subsequent medical review. Back to Top Coding Information Bill Type : Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims. 999x Not Applicable Revenue : Contractors may specify Revenue to help providers identify those Revenue typically used to report this service. In most instances Revenue are purely advisory. Unless specified in the policy, services reported under other Revenue are equally subject to this coverage determination. Complete absence of all Revenue indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue. 99999 Not Applicable CPT/HCPCS Group 1 Paragraph: N/A Group 1 : 20526 INJECTION, THERAPEUTIC (EG, LOCAL ANESTHETIC, CORTICOSTEROID), CARPAL TUNNEL 20550 INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG, PLANTAR "FASCIA") 20551 INJECTION(S); SINGLE TENDON ORIGIN/INSERTION 20612 ASPIRATION AND/OR INJECTION OF GANGLION CYST(S) ANY LOCATION INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, PLANTAR COMMON DIGITAL NERVE(S) (EG, 64455 MORTON'S NEUROMA) 64632 DESTRUCTION BY NEUROLYTIC AGENT; PLANTAR COMMON DIGITAL NERVE Printed on 10/5/2016. Page 3 of 30

that Support Medical Necessity Group 1 Paragraph: Note: Diagnosis codes are based on the current ICD-10-CM codes that are effective at the time of LCD publication. Any updates to ICD-10-CM codes will be reviewed by Noridian; and coverage should not be presumed until the results of such review have been published/posted. These are the only covered ICD-10-CM codes that support medical necessity: Group 1 : ICD-10 G56.01* Carpal tunnel syndrome, right upper limb G56.02* Carpal tunnel syndrome, left upper limb G56.03* Carpal tunnel syndrome, bilateral upper limbs G57.53* Tarsal tunnel syndrome, bilateral lower limbs G57.61* Lesion of plantar nerve, right lower limb G57.62* Lesion of plantar nerve, left lower limb G57.63* Lesion of plantar nerve, bilateral lower limbs M24.211 Disorder of ligament, right shoulder M24.212 Disorder of ligament, left shoulder M24.221 Disorder of ligament, right elbow M24.222 Disorder of ligament, left elbow M24.231 Disorder of ligament, right wrist M24.232 Disorder of ligament, left wrist M24.241 Disorder of ligament, right hand M24.242 Disorder of ligament, left hand M24.251 Disorder of ligament, right hip M24.252 Disorder of ligament, left hip M24.271 Disorder of ligament, right ankle M24.272 Disorder of ligament, left ankle M24.274 Disorder of ligament, right foot M24.275 Disorder of ligament, left foot M24.28 Disorder of ligament, vertebrae M25.711 Osteophyte, right shoulder M25.712 Osteophyte, left shoulder M25.721 Osteophyte, right elbow M25.722 Osteophyte, left elbow M25.731 Osteophyte, right wrist M25.732 Osteophyte, left wrist M25.741 Osteophyte, right hand M25.742 Osteophyte, left hand M25.751 Osteophyte, right hip M25.752 Osteophyte, left hip M25.761 Osteophyte, right knee M25.762 Osteophyte, left knee M25.771 Osteophyte, right ankle M25.772 Osteophyte, left ankle M25.774 Osteophyte, right foot M25.775 Osteophyte, left foot M35.7 Hypermobility syndrome M45.0 Ankylosing spondylitis of multiple sites in spine M45.1 Ankylosing spondylitis of occipito-atlanto-axial region M45.2 Ankylosing spondylitis of cervical region M45.3 Ankylosing spondylitis of cervicothoracic region M45.4 Ankylosing spondylitis of thoracic region M45.5 Ankylosing spondylitis of thoracolumbar region M45.6 Ankylosing spondylitis lumbar region M45.7 Ankylosing spondylitis of lumbosacral region Printed on 10/5/2016. Page 4 of 30

M45.8 Ankylosing spondylitis sacral and sacrococcygeal region M46.02 Spinal enthesopathy, cervical region M46.03 Spinal enthesopathy, cervicothoracic region M46.04 Spinal enthesopathy, thoracic region M46.05 Spinal enthesopathy, thoracolumbar region M46.06 Spinal enthesopathy, lumbar region M46.07 Spinal enthesopathy, lumbosacral region M46.08 Spinal enthesopathy, sacral and sacrococcygeal region M46.09 Spinal enthesopathy, multiple sites in spine M46.82 Other specified inflammatory spondylopathies, cervical region M46.83 Other specified inflammatory spondylopathies, cervicothoracic region M46.84 Other specified inflammatory spondylopathies, thoracic region M46.85 Other specified inflammatory spondylopathies, thoracolumbar region M46.86 Other specified inflammatory spondylopathies, lumbar region M46.87 Other specified inflammatory spondylopathies, lumbosacral region M46.88 Other specified inflammatory spondylopathies, sacral and sacrococcygeal region M46.89 Other specified inflammatory spondylopathies, multiple sites in spine M48.8X2 Other specified spondylopathies, cervical region M48.8X3 Other specified spondylopathies, cervicothoracic region M48.8X4 Other specified spondylopathies, thoracic region M48.8X5 Other specified spondylopathies, thoracolumbar region M48.8X6 Other specified spondylopathies, lumbar region M48.8X7 Other specified spondylopathies, lumbosacral region M48.8X8 Other specified spondylopathies, sacral and sacrococcygeal region M49.82 Spondylopathy in diseases classified elsewhere, cervical region M49.83 Spondylopathy in diseases classified elsewhere, cervicothoracic region M49.84 Spondylopathy in diseases classified elsewhere, thoracic region M49.85 Spondylopathy in diseases classified elsewhere, thoracolumbar region M49.86 Spondylopathy in diseases classified elsewhere, lumbar region M49.87 Spondylopathy in diseases classified elsewhere, lumbosacral region M49.88 Spondylopathy in diseases classified elsewhere, sacral and sacrococcygeal region M49.89 Spondylopathy in diseases classified elsewhere, multiple sites in spine M53.2X8 Spinal instabilities, sacral and sacrococcygeal region M53.3 Sacrococcygeal disorders, not elsewhere classified M60.811 Other myositis, right shoulder M60.812 Other myositis, left shoulder M60.821 Other myositis, right upper arm M60.822 Other myositis, left upper arm M60.831 Other myositis, right forearm M60.832 Other myositis, left forearm M60.841 Other myositis, right hand M60.842 Other myositis, left hand M60.851 Other myositis, right thigh M60.852 Other myositis, left thigh M60.861 Other myositis, right lower leg M60.862 Other myositis, left lower leg M60.871 Other myositis, right ankle and foot M60.872 Other myositis, left ankle and foot M60.88 Other myositis, other site M60.89 Other myositis, multiple sites M65.221 Calcific tendinitis, right upper arm M65.222 Calcific tendinitis, left upper arm M65.231 Calcific tendinitis, right forearm M65.232 Calcific tendinitis, left forearm M65.241 Calcific tendinitis, right hand M65.242 Calcific tendinitis, left hand M65.251 Calcific tendinitis, right thigh M65.252 Calcific tendinitis, left thigh Printed on 10/5/2016. Page 5 of 30

M65.261 Calcific tendinitis, right lower leg M65.262 Calcific tendinitis, left lower leg M65.271 Calcific tendinitis, right ankle and foot M65.272 Calcific tendinitis, left ankle and foot M65.28 Calcific tendinitis, other site M65.29 Calcific tendinitis, multiple sites M65.311 Trigger thumb, right thumb M65.312 Trigger thumb, left thumb M65.321 Trigger finger, right index finger M65.322 Trigger finger, left index finger M65.331 Trigger finger, right middle finger M65.332 Trigger finger, left middle finger M65.341 Trigger finger, right ring finger M65.342 Trigger finger, left ring finger M65.351 Trigger finger, right little finger M65.352 Trigger finger, left little finger M65.4 Radial styloid tenosynovitis [de Quervain] M65.811 Other synovitis and tenosynovitis, right shoulder M65.812 Other synovitis and tenosynovitis, left shoulder M65.821 Other synovitis and tenosynovitis, right upper arm M65.822 Other synovitis and tenosynovitis, left upper arm M65.831 Other synovitis and tenosynovitis, right forearm M65.832 Other synovitis and tenosynovitis, left forearm M65.841 Other synovitis and tenosynovitis, right hand M65.842 Other synovitis and tenosynovitis, left hand M65.851 Other synovitis and tenosynovitis, right thigh M65.852 Other synovitis and tenosynovitis, left thigh M65.861 Other synovitis and tenosynovitis, right lower leg M65.862 Other synovitis and tenosynovitis, left lower leg M65.871 Other synovitis and tenosynovitis, right ankle and foot M65.872 Other synovitis and tenosynovitis, left ankle and foot M65.88 Other synovitis and tenosynovitis, other site M65.89 Other synovitis and tenosynovitis, multiple sites M66.0 Rupture of popliteal cyst M66.111 Rupture of synovium, right shoulder M66.112 Rupture of synovium, left shoulder M66.121 Rupture of synovium, right elbow M66.122 Rupture of synovium, left elbow M66.131 Rupture of synovium, right wrist M66.132 Rupture of synovium, left wrist M66.141 Rupture of synovium, right hand M66.142 Rupture of synovium, left hand M66.144 Rupture of synovium, right finger(s) M66.145 Rupture of synovium, left finger(s) M66.151 Rupture of synovium, right hip M66.152 Rupture of synovium, left hip M66.171 Rupture of synovium, right ankle M66.172 Rupture of synovium, left ankle M66.174 Rupture of synovium, right foot M66.175 Rupture of synovium, left foot M66.177 Rupture of synovium, right toe(s) M66.178 Rupture of synovium, left toe(s) M66.18 Rupture of synovium, other site M66.211 Spontaneous rupture of extensor tendons, right shoulder M66.212 Spontaneous rupture of extensor tendons, left shoulder M66.221 Spontaneous rupture of extensor tendons, right upper arm M66.222 Spontaneous rupture of extensor tendons, left upper arm Printed on 10/5/2016. Page 6 of 30

M66.231 Spontaneous rupture of extensor tendons, right forearm M66.232 Spontaneous rupture of extensor tendons, left forearm M66.241 Spontaneous rupture of extensor tendons, right hand M66.242 Spontaneous rupture of extensor tendons, left hand M66.251 Spontaneous rupture of extensor tendons, right thigh M66.252 Spontaneous rupture of extensor tendons, left thigh M66.261 Spontaneous rupture of extensor tendons, right lower leg M66.262 Spontaneous rupture of extensor tendons, left lower leg M66.271 Spontaneous rupture of extensor tendons, right ankle and foot M66.272 Spontaneous rupture of extensor tendons, left ankle and foot M66.28 Spontaneous rupture of extensor tendons, other site M66.29 Spontaneous rupture of extensor tendons, multiple sites M66.311 Spontaneous rupture of flexor tendons, right shoulder M66.312 Spontaneous rupture of flexor tendons, left shoulder M66.321 Spontaneous rupture of flexor tendons, right upper arm M66.322 Spontaneous rupture of flexor tendons, left upper arm M66.331 Spontaneous rupture of flexor tendons, right forearm M66.332 Spontaneous rupture of flexor tendons, left forearm M66.341 Spontaneous rupture of flexor tendons, right hand M66.342 Spontaneous rupture of flexor tendons, left hand M66.351 Spontaneous rupture of flexor tendons, right thigh M66.352 Spontaneous rupture of flexor tendons, left thigh M66.361 Spontaneous rupture of flexor tendons, right lower leg M66.362 Spontaneous rupture of flexor tendons, left lower leg M66.371 Spontaneous rupture of flexor tendons, right ankle and foot M66.372 Spontaneous rupture of flexor tendons, left ankle and foot M66.38 Spontaneous rupture of flexor tendons, other site M66.39 Spontaneous rupture of flexor tendons, multiple sites M66.811 Spontaneous rupture of other tendons, right shoulder M66.812 Spontaneous rupture of other tendons, left shoulder M66.821 Spontaneous rupture of other tendons, right upper arm M66.822 Spontaneous rupture of other tendons, left upper arm M66.831 Spontaneous rupture of other tendons, right forearm M66.832 Spontaneous rupture of other tendons, left forearm M66.841 Spontaneous rupture of other tendons, right hand M66.842 Spontaneous rupture of other tendons, left hand M66.851 Spontaneous rupture of other tendons, right thigh M66.852 Spontaneous rupture of other tendons, left thigh M66.861 Spontaneous rupture of other tendons, right lower leg M66.862 Spontaneous rupture of other tendons, left lower leg M66.871 Spontaneous rupture of other tendons, right ankle and foot M66.872 Spontaneous rupture of other tendons, left ankle and foot M66.88 Spontaneous rupture of other tendons, other M66.89 Spontaneous rupture of other tendons, multiple sites M67.01 Short Achilles tendon (acquired), right ankle M67.02 Short Achilles tendon (acquired), left ankle M67.211 Synovial hypertrophy, not elsewhere classified, right shoulder M67.212 Synovial hypertrophy, not elsewhere classified, left shoulder M67.221 Synovial hypertrophy, not elsewhere classified, right upper arm M67.222 Synovial hypertrophy, not elsewhere classified, left upper arm M67.231 Synovial hypertrophy, not elsewhere classified, right forearm M67.232 Synovial hypertrophy, not elsewhere classified, left forearm M67.241 Synovial hypertrophy, not elsewhere classified, right hand M67.242 Synovial hypertrophy, not elsewhere classified, left hand M67.251 Synovial hypertrophy, not elsewhere classified, right thigh M67.252 Synovial hypertrophy, not elsewhere classified, left thigh M67.261 Synovial hypertrophy, not elsewhere classified, right lower leg M67.262 Synovial hypertrophy, not elsewhere classified, left lower leg Printed on 10/5/2016. Page 7 of 30

M67.271 Synovial hypertrophy, not elsewhere classified, right ankle and foot M67.272 Synovial hypertrophy, not elsewhere classified, left ankle and foot M67.28 Synovial hypertrophy, not elsewhere classified, other site M67.29 Synovial hypertrophy, not elsewhere classified, multiple sites M67.311 Transient synovitis, right shoulder M67.312 Transient synovitis, left shoulder M67.321 Transient synovitis, right elbow M67.322 Transient synovitis, left elbow M67.331 Transient synovitis, right wrist M67.332 Transient synovitis, left wrist M67.341 Transient synovitis, right hand M67.342 Transient synovitis, left hand M67.351 Transient synovitis, right hip M67.352 Transient synovitis, left hip M67.361 Transient synovitis, right knee M67.362 Transient synovitis, left knee M67.371 Transient synovitis, right ankle and foot M67.372 Transient synovitis, left ankle and foot M67.38 Transient synovitis, other site M67.39 Transient synovitis, multiple sites M67.411 Ganglion, right shoulder M67.412 Ganglion, left shoulder M67.421 Ganglion, right elbow M67.422 Ganglion, left elbow M67.431 Ganglion, right wrist M67.432 Ganglion, left wrist M67.441 Ganglion, right hand M67.442 Ganglion, left hand M67.451 Ganglion, right hip M67.452 Ganglion, left hip M67.461 Ganglion, right knee M67.462 Ganglion, left knee M67.471 Ganglion, right ankle and foot M67.472 Ganglion, left ankle and foot M67.48 Ganglion, other site M67.49 Ganglion, multiple sites M67.51 Plica syndrome, right knee M67.52 Plica syndrome, left knee M67.811 Other specified disorders of synovium, right shoulder M67.812 Other specified disorders of synovium, left shoulder M67.813 Other specified disorders of tendon, right shoulder M67.814 Other specified disorders of tendon, left shoulder M67.821 Other specified disorders of synovium, right elbow M67.822 Other specified disorders of synovium, left elbow M67.823 Other specified disorders of tendon, right elbow M67.824 Other specified disorders of tendon, left elbow M67.831 Other specified disorders of synovium, right wrist M67.832 Other specified disorders of synovium, left wrist M67.833 Other specified disorders of tendon, right wrist M67.834 Other specified disorders of tendon, left wrist M67.841 Other specified disorders of synovium, right hand M67.842 Other specified disorders of synovium, left hand M67.843 Other specified disorders of tendon, right hand M67.844 Other specified disorders of tendon, left hand M67.851 Other specified disorders of synovium, right hip M67.852 Other specified disorders of synovium, left hip M67.853 Other specified disorders of tendon, right hip Printed on 10/5/2016. Page 8 of 30

M67.854 Other specified disorders of tendon, left hip M67.861 Other specified disorders of synovium, right knee M67.862 Other specified disorders of synovium, left knee M67.863 Other specified disorders of tendon, right knee M67.864 Other specified disorders of tendon, left knee M67.871 Other specified disorders of synovium, right ankle and foot M67.872 Other specified disorders of synovium, left ankle and foot M67.873 Other specified disorders of tendon, right ankle and foot M67.874 Other specified disorders of tendon, left ankle and foot M67.88 Other specified disorders of synovium and tendon, other site M67.89 Other specified disorders of synovium and tendon, multiple sites M70.031 Crepitant synovitis (acute) (chronic), right wrist M70.032 Crepitant synovitis (acute) (chronic), left wrist M70.041 Crepitant synovitis (acute) (chronic), right hand M70.042 Crepitant synovitis (acute) (chronic), left hand M70.11 Bursitis, right hand M70.12 Bursitis, left hand M70.21 Olecranon bursitis, right elbow M70.22 Olecranon bursitis, left elbow M70.31 Other bursitis of elbow, right elbow M70.32 Other bursitis of elbow, left elbow M70.41 Prepatellar bursitis, right knee M70.42 Prepatellar bursitis, left knee M70.51 Other bursitis of knee, right knee M70.52 Other bursitis of knee, left knee M70.61 Trochanteric bursitis, right hip M70.62 Trochanteric bursitis, left hip M70.71 Other bursitis of hip, right hip M70.72 Other bursitis of hip, left hip M71.21 Synovial cyst of popliteal space [Baker], right knee M71.22 Synovial cyst of popliteal space [Baker], left knee M71.311 Other bursal cyst, right shoulder M71.312 Other bursal cyst, left shoulder M71.321 Other bursal cyst, right elbow M71.322 Other bursal cyst, left elbow M71.331 Other bursal cyst, right wrist M71.332 Other bursal cyst, left wrist M71.341 Other bursal cyst, right hand M71.342 Other bursal cyst, left hand M71.351 Other bursal cyst, right hip M71.352 Other bursal cyst, left hip M71.371 Other bursal cyst, right ankle and foot M71.372 Other bursal cyst, left ankle and foot M71.38 Other bursal cyst, other site M71.39 Other bursal cyst, multiple sites M71.421 Calcium deposit in bursa, right elbow M71.422 Calcium deposit in bursa, left elbow M71.431 Calcium deposit in bursa, right wrist M71.432 Calcium deposit in bursa, left wrist M71.441 Calcium deposit in bursa, right hand M71.442 Calcium deposit in bursa, left hand M71.451 Calcium deposit in bursa, right hip M71.452 Calcium deposit in bursa, left hip M71.461 Calcium deposit in bursa, right knee M71.462 Calcium deposit in bursa, left knee M71.471 Calcium deposit in bursa, right ankle and foot M71.472 Calcium deposit in bursa, left ankle and foot M71.48 Calcium deposit in bursa, other site Printed on 10/5/2016. Page 9 of 30

M71.49 Calcium deposit in bursa, multiple sites M71.521 Other bursitis, not elsewhere classified, right elbow M71.522 Other bursitis, not elsewhere classified, left elbow M71.531 Other bursitis, not elsewhere classified, right wrist M71.532 Other bursitis, not elsewhere classified, left wrist M71.541 Other bursitis, not elsewhere classified, right hand M71.542 Other bursitis, not elsewhere classified, left hand M71.551 Other bursitis, not elsewhere classified, right hip M71.552 Other bursitis, not elsewhere classified, left hip M71.561 Other bursitis, not elsewhere classified, right knee M71.562 Other bursitis, not elsewhere classified, left knee M71.571 Other bursitis, not elsewhere classified, right ankle and foot M71.572 Other bursitis, not elsewhere classified, left ankle and foot M71.58 Other bursitis, not elsewhere classified, other site M71.811 Other specified bursopathies, right shoulder M71.812 Other specified bursopathies, left shoulder M71.821 Other specified bursopathies, right elbow M71.822 Other specified bursopathies, left elbow M71.831 Other specified bursopathies, right wrist M71.832 Other specified bursopathies, left wrist M71.841 Other specified bursopathies, right hand M71.842 Other specified bursopathies, left hand M71.851 Other specified bursopathies, right hip M71.852 Other specified bursopathies, left hip M71.861 Other specified bursopathies, right knee M71.862 Other specified bursopathies, left knee M71.871 Other specified bursopathies, right ankle and foot M71.872 Other specified bursopathies, left ankle and foot M71.88 Other specified bursopathies, other site M71.89 Other specified bursopathies, multiple sites M72.2 Plantar fascial fibromatosis M72.4 Pseudosarcomatous fibromatosis M75.01 Adhesive capsulitis of right shoulder M75.02 Adhesive capsulitis of left shoulder M75.121 Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic M75.122 Complete rotator cuff tear or rupture of left shoulder, not specified as traumatic M75.21 Bicipital tendinitis, right shoulder M75.22 Bicipital tendinitis, left shoulder M75.31 Calcific tendinitis of right shoulder M75.32 Calcific tendinitis of left shoulder M75.41 Impingement syndrome of right shoulder M75.42 Impingement syndrome of left shoulder M75.51 Bursitis of right shoulder M75.52 Bursitis of left shoulder M75.81 Other shoulder lesions, right shoulder M75.82 Other shoulder lesions, left shoulder M76.01 Gluteal tendinitis, right hip M76.02 Gluteal tendinitis, left hip M76.11 Psoas tendinitis, right hip M76.12 Psoas tendinitis, left hip M76.21 Iliac crest spur, right hip M76.22 Iliac crest spur, left hip M76.31 Iliotibial band syndrome, right leg M76.32 Iliotibial band syndrome, left leg M76.41 Tibial collateral bursitis [Pellegrini-Stieda], right leg M76.42 Tibial collateral bursitis [Pellegrini-Stieda], left leg M76.51 Patellar tendinitis, right knee Printed on 10/5/2016. Page 10 of 30

M76.52 Patellar tendinitis, left knee M76.61 Achilles tendinitis, right leg M76.62 Achilles tendinitis, left leg M76.71 Peroneal tendinitis, right leg M76.72 Peroneal tendinitis, left leg M76.811 Anterior tibial syndrome, right leg M76.812 Anterior tibial syndrome, left leg M76.821 Posterior tibial tendinitis, right leg M76.822 Posterior tibial tendinitis, left leg M76.891 Other specified enthesopathies of right lower limb, excluding foot M76.892 Other specified enthesopathies of left lower limb, excluding foot M77.01 Medial epicondylitis, right elbow M77.02 Medial epicondylitis, left elbow M77.11 Lateral epicondylitis, right elbow M77.12 Lateral epicondylitis, left elbow M77.21 Periarthritis, right wrist M77.22 Periarthritis, left wrist M77.31 Calcaneal spur, right foot M77.32 Calcaneal spur, left foot M77.41 Metatarsalgia, right foot M77.42 Metatarsalgia, left foot M77.51 Other enthesopathy of right foot M77.52 Other enthesopathy of left foot M77.8 Other enthesopathies, not elsewhere classified M79.1 Myalgia M94.0 Chondrocostal junction syndrome [Tietze] S03.41XA Sprain of jaw, right side, initial S03.41XD Sprain of jaw, right side, subsequent S03.41XS Sprain of jaw, right side, sequela S03.42XA Sprain of jaw, left side, initial S03.42XD Sprain of jaw, left side, subsequent S03.42XS Sprain of jaw, left side, sequela S03.43XA Sprain of jaw, bilateral, initial S03.43XD Sprain of jaw, bilateral, subsequent S03.43XS Sprain of jaw, bilateral, sequela S03.8XXA Sprain of joints and ligaments of other parts of head, initial S03.8XXD Sprain of joints and ligaments of other parts of head, subsequent S03.8XXS Sprain of joints and ligaments of other parts of head, sequela S13.4XXA Sprain of ligaments of cervical spine, initial S13.4XXD Sprain of ligaments of cervical spine, subsequent S13.4XXS Sprain of ligaments of cervical spine, sequela S13.8XXA Sprain of joints and ligaments of other parts of neck, initial S13.8XXD Sprain of joints and ligaments of other parts of neck, subsequent S13.8XXS Sprain of joints and ligaments of other parts of neck, sequela S16.1XXA Strain of muscle, fascia and tendon at neck level, initial S16.1XXD Strain of muscle, fascia and tendon at neck level, subsequent S16.1XXS Strain of muscle, fascia and tendon at neck level, sequela S23.3XXA Sprain of ligaments of thoracic spine, initial S23.3XXD Sprain of ligaments of thoracic spine, subsequent S23.3XXS Sprain of ligaments of thoracic spine, sequela S23.41XA Sprain of ribs, initial S23.41XD Sprain of ribs, subsequent S23.41XS Sprain of ribs, sequela S23.420A Sprain of sternoclavicular (joint) (ligament), initial S23.420D Sprain of sternoclavicular (joint) (ligament), subsequent S23.420S Sprain of sternoclavicular (joint) (ligament), sequela S23.421A Sprain of chondrosternal joint, initial S23.421D Sprain of chondrosternal joint, subsequent Printed on 10/5/2016. Page 11 of 30

S23.421S S23.428A S23.428D S23.428S S23.8XXA S23.8XXD S23.8XXS S29.011A S29.011D S29.011S S29.012A S29.012D S29.012S S33.4XXA S33.4XXD S33.4XXS S33.5XXA S33.5XXD S33.5XXS S33.6XXA S33.6XXD S33.6XXS S33.8XXA S33.8XXD S33.8XXS S39.011A S39.011D S39.011S S39.012A S39.012D S39.012S S39.013A S39.013D S39.013S S43.411A S43.411D S43.411S S43.412A S43.412D S43.412S S43.421A S43.421D S43.421S S43.422A S43.422D S43.422S S43.431A S43.431D S43.431S S43.432A S43.432D S43.432S S43.491A S43.491D S43.491S S43.492A S43.492D Sprain of chondrosternal joint, sequela Other sprain of sternum, initial Other sprain of sternum, subsequent Other sprain of sternum, sequela Sprain of other specified parts of thorax, initial Sprain of other specified parts of thorax, subsequent Sprain of other specified parts of thorax, sequela Strain of muscle and tendon of front wall of thorax, initial Strain of muscle and tendon of front wall of thorax, subsequent Strain of muscle and tendon of front wall of thorax, sequela Strain of muscle and tendon of back wall of thorax, initial Strain of muscle and tendon of back wall of thorax, subsequent Strain of muscle and tendon of back wall of thorax, sequela Traumatic rupture of symphysis pubis, initial Traumatic rupture of symphysis pubis, subsequent Traumatic rupture of symphysis pubis, sequela Sprain of ligaments of lumbar spine, initial Sprain of ligaments of lumbar spine, subsequent Sprain of ligaments of lumbar spine, sequela Sprain of sacroiliac joint, initial Sprain of sacroiliac joint, subsequent Sprain of sacroiliac joint, sequela Sprain of other parts of lumbar spine and pelvis, initial Sprain of other parts of lumbar spine and pelvis, subsequent Sprain of other parts of lumbar spine and pelvis, sequela Strain of muscle, fascia and tendon of abdomen, initial Strain of muscle, fascia and tendon of abdomen, subsequent Strain of muscle, fascia and tendon of abdomen, sequela Strain of muscle, fascia and tendon of lower back, initial Strain of muscle, fascia and tendon of lower back, subsequent Strain of muscle, fascia and tendon of lower back, sequela Strain of muscle, fascia and tendon of pelvis, initial Strain of muscle, fascia and tendon of pelvis, subsequent Strain of muscle, fascia and tendon of pelvis, sequela Sprain of right coracohumeral (ligament), initial Sprain of right coracohumeral (ligament), subsequent Sprain of right coracohumeral (ligament), sequela Sprain of left coracohumeral (ligament), initial Sprain of left coracohumeral (ligament), subsequent Sprain of left coracohumeral (ligament), sequela Sprain of right rotator cuff capsule, initial Sprain of right rotator cuff capsule, subsequent Sprain of right rotator cuff capsule, sequela Sprain of left rotator cuff capsule, initial Sprain of left rotator cuff capsule, subsequent Sprain of left rotator cuff capsule, sequela Superior glenoid labrum lesion of right shoulder, initial Superior glenoid labrum lesion of right shoulder, subsequent Superior glenoid labrum lesion of right shoulder, sequela Superior glenoid labrum lesion of left shoulder, initial Superior glenoid labrum lesion of left shoulder, subsequent Superior glenoid labrum lesion of left shoulder, sequela Other sprain of right shoulder joint, initial Other sprain of right shoulder joint, subsequent Other sprain of right shoulder joint, sequela Other sprain of left shoulder joint, initial Other sprain of left shoulder joint, subsequent Printed on 10/5/2016. Page 12 of 30

S43.492S Other sprain of left shoulder joint, sequela S43.51XA Sprain of right acromioclavicular joint, initial S43.51XD Sprain of right acromioclavicular joint, subsequent S43.51XS Sprain of right acromioclavicular joint, sequela S43.52XA Sprain of left acromioclavicular joint, initial S43.52XD Sprain of left acromioclavicular joint, subsequent S43.52XS Sprain of left acromioclavicular joint, sequela S43.61XA Sprain of right sternoclavicular joint, initial S43.61XD Sprain of right sternoclavicular joint, subsequent S43.61XS Sprain of right sternoclavicular joint, sequela S43.62XA Sprain of left sternoclavicular joint, initial S43.62XD Sprain of left sternoclavicular joint, subsequent S43.62XS Sprain of left sternoclavicular joint, sequela S43.81XA Sprain of other specified parts of right shoulder girdle, initial S43.81XD Sprain of other specified parts of right shoulder girdle, subsequent S43.81XS Sprain of other specified parts of right shoulder girdle, sequela S43.82XA Sprain of other specified parts of left shoulder girdle, initial S43.82XD Sprain of other specified parts of left shoulder girdle, subsequent S43.82XS Sprain of other specified parts of left shoulder girdle, sequela S46.011A Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, initial S46.011D Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, subsequent S46.011S Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, sequela S46.012A Strain of muscle(s) and tendon(s) of the rotator cuff of left shoulder, initial S46.012D Strain of muscle(s) and tendon(s) of the rotator cuff of left shoulder, subsequent S46.012S Strain of muscle(s) and tendon(s) of the rotator cuff of left shoulder, sequela S46.111A Strain of muscle, fascia and tendon of long head of biceps, right arm, initial S46.111D Strain of muscle, fascia and tendon of long head of biceps, right arm, subsequent S46.111S Strain of muscle, fascia and tendon of long head of biceps, right arm, sequela S46.112A Strain of muscle, fascia and tendon of long head of biceps, left arm, initial S46.112D Strain of muscle, fascia and tendon of long head of biceps, left arm, subsequent S46.112S Strain of muscle, fascia and tendon of long head of biceps, left arm, sequela S46.211A Strain of muscle, fascia and tendon of other parts of biceps, right arm, initial S46.211D Strain of muscle, fascia and tendon of other parts of biceps, right arm, subsequent S46.211S Strain of muscle, fascia and tendon of other parts of biceps, right arm, sequela S46.212A Strain of muscle, fascia and tendon of other parts of biceps, left arm, initial S46.212D Strain of muscle, fascia and tendon of other parts of biceps, left arm, subsequent S46.212S Strain of muscle, fascia and tendon of other parts of biceps, left arm, sequela S46.311A Strain of muscle, fascia and tendon of triceps, right arm, initial S46.311D Strain of muscle, fascia and tendon of triceps, right arm, subsequent S46.311S Strain of muscle, fascia and tendon of triceps, right arm, sequela S46.312A Strain of muscle, fascia and tendon of triceps, left arm, initial S46.312D Strain of muscle, fascia and tendon of triceps, left arm, subsequent S46.312S Strain of muscle, fascia and tendon of triceps, left arm, sequela S46.811A Strain of other muscles, fascia and tendons at shoulder and upper arm level, right arm, initial S46.811D Strain of other muscles, fascia and tendons at shoulder and upper arm level, right arm, subsequent S46.811S Strain of other muscles, fascia and tendons at shoulder and upper arm level, right arm, sequela S46.812A Strain of other muscles, fascia and tendons at shoulder and upper arm level, left arm, initial S46.812D Strain of other muscles, fascia and tendons at shoulder and upper arm level, left arm, subsequent S46.812S Strain of other muscles, fascia and tendons at shoulder and upper arm level, left arm, sequela S53.21XA Traumatic rupture of right radial collateral ligament, initial S53.21XD Traumatic rupture of right radial collateral ligament, subsequent S53.21XS Traumatic rupture of right radial collateral ligament, sequela S53.22XA Traumatic rupture of left radial collateral ligament, initial S53.22XD Traumatic rupture of left radial collateral ligament, subsequent Printed on 10/5/2016. Page 13 of 30

S53.22XS S53.31XA S53.31XD S53.31XS S53.32XA S53.32XD S53.32XS S53.411A S53.411D S53.411S S53.412A S53.412D S53.412S S53.421A S53.421D S53.421S S53.422A S53.422D S53.422S S53.431A S53.431D S53.431S S53.432A S53.432D S53.432S S53.441A S53.441D S53.441S S53.442A S53.442D S53.442S S53.491A S53.491D S53.491S S53.492A S53.492D S53.492S S56.011A S56.011D S56.011S S56.012A S56.012D S56.012S S56.111A S56.111D S56.111S S56.112A S56.112D S56.112S S56.113A S56.113D S56.113S S56.114A S56.114D Traumatic rupture of left radial collateral ligament, sequela Traumatic rupture of right ulnar collateral ligament, initial Traumatic rupture of right ulnar collateral ligament, subsequent Traumatic rupture of right ulnar collateral ligament, sequela Traumatic rupture of left ulnar collateral ligament, initial Traumatic rupture of left ulnar collateral ligament, subsequent Traumatic rupture of left ulnar collateral ligament, sequela Radiohumeral (joint) sprain of right elbow, initial Radiohumeral (joint) sprain of right elbow, subsequent Radiohumeral (joint) sprain of right elbow, sequela Radiohumeral (joint) sprain of left elbow, initial Radiohumeral (joint) sprain of left elbow, subsequent Radiohumeral (joint) sprain of left elbow, sequela Ulnohumeral (joint) sprain of right elbow, initial Ulnohumeral (joint) sprain of right elbow, subsequent Ulnohumeral (joint) sprain of right elbow, sequela Ulnohumeral (joint) sprain of left elbow, initial Ulnohumeral (joint) sprain of left elbow, subsequent Ulnohumeral (joint) sprain of left elbow, sequela Radial collateral ligament sprain of right elbow, initial Radial collateral ligament sprain of right elbow, subsequent Radial collateral ligament sprain of right elbow, sequela Radial collateral ligament sprain of left elbow, initial Radial collateral ligament sprain of left elbow, subsequent Radial collateral ligament sprain of left elbow, sequela Ulnar collateral ligament sprain of right elbow, initial Ulnar collateral ligament sprain of right elbow, subsequent Ulnar collateral ligament sprain of right elbow, sequela Ulnar collateral ligament sprain of left elbow, initial Ulnar collateral ligament sprain of left elbow, subsequent Ulnar collateral ligament sprain of left elbow, sequela Other sprain of right elbow, initial Other sprain of right elbow, subsequent Other sprain of right elbow, sequela Other sprain of left elbow, initial Other sprain of left elbow, subsequent Other sprain of left elbow, sequela Strain of flexor muscle, fascia and tendon of right thumb at forearm level, initial Strain of flexor muscle, fascia and tendon of right thumb at forearm level, subsequent Strain of flexor muscle, fascia and tendon of right thumb at forearm level, sequela Strain of flexor muscle, fascia and tendon of left thumb at forearm level, initial Strain of flexor muscle, fascia and tendon of left thumb at forearm level, subsequent Strain of flexor muscle, fascia and tendon of left thumb at forearm level, sequela Strain of flexor muscle, fascia and tendon of right index finger at forearm level, initial Strain of flexor muscle, fascia and tendon of right index finger at forearm level, subsequent Strain of flexor muscle, fascia and tendon of right index finger at forearm level, sequela Strain of flexor muscle, fascia and tendon of left index finger at forearm level, initial Strain of flexor muscle, fascia and tendon of left index finger at forearm level, subsequent Strain of flexor muscle, fascia and tendon of left index finger at forearm level, sequela Strain of flexor muscle, fascia and tendon of right middle finger at forearm level, initial Strain of flexor muscle, fascia and tendon of right middle finger at forearm level, subsequent Strain of flexor muscle, fascia and tendon of right middle finger at forearm level, sequela Strain of flexor muscle, fascia and tendon of left middle finger at forearm level, initial Strain of flexor muscle, fascia and tendon of left middle finger at forearm level, subsequent Printed on 10/5/2016. Page 14 of 30

S56.114S S56.115A S56.115D S56.115S S56.116A S56.116D S56.116S S56.117A S56.117D S56.117S S56.118A S56.118D S56.118S S56.211A S56.211D S56.211S S56.212A S56.212D S56.212S S56.311A S56.311D S56.311S S56.312A S56.312D S56.312S S56.411A S56.411D S56.411S S56.412A S56.412D S56.412S S56.413A S56.413D S56.413S S56.414A S56.414D S56.414S S56.415A S56.415D S56.415S S56.416A S56.416D S56.416S S56.417A S56.417D Strain of flexor muscle, fascia and tendon of left middle finger at forearm level, sequela Strain of flexor muscle, fascia and tendon of right ring finger at forearm level, initial Strain of flexor muscle, fascia and tendon of right ring finger at forearm level, subsequent Strain of flexor muscle, fascia and tendon of right ring finger at forearm level, sequela Strain of flexor muscle, fascia and tendon of left ring finger at forearm level, initial Strain of flexor muscle, fascia and tendon of left ring finger at forearm level, subsequent Strain of flexor muscle, fascia and tendon of left ring finger at forearm level, sequela Strain of flexor muscle, fascia and tendon of right little finger at forearm level, initial Strain of flexor muscle, fascia and tendon of right little finger at forearm level, subsequent Strain of flexor muscle, fascia and tendon of right little finger at forearm level, sequela Strain of flexor muscle, fascia and tendon of left little finger at forearm level, initial Strain of flexor muscle, fascia and tendon of left little finger at forearm level, subsequent Strain of flexor muscle, fascia and tendon of left little finger at forearm level, sequela Strain of other flexor muscle, fascia and tendon at forearm level, right arm, initial Strain of other flexor muscle, fascia and tendon at forearm level, right arm, subsequent Strain of other flexor muscle, fascia and tendon at forearm level, right arm, sequela Strain of other flexor muscle, fascia and tendon at forearm level, left arm, initial Strain of other flexor muscle, fascia and tendon at forearm level, left arm, subsequent Strain of other flexor muscle, fascia and tendon at forearm level, left arm, sequela Strain of extensor or abductor muscles, fascia and tendons of right thumb at forearm level, initial Strain of extensor or abductor muscles, fascia and tendons of right thumb at forearm level, subsequent Strain of extensor or abductor muscles, fascia and tendons of right thumb at forearm level, sequela Strain of extensor or abductor muscles, fascia and tendons of left thumb at forearm level, initial Strain of extensor or abductor muscles, fascia and tendons of left thumb at forearm level, subsequent Strain of extensor or abductor muscles, fascia and tendons of left thumb at forearm level, sequela Strain of extensor muscle, fascia and tendon of right index finger at forearm level, initial Strain of extensor muscle, fascia and tendon of right index finger at forearm level, subsequent Strain of extensor muscle, fascia and tendon of right index finger at forearm level, sequela Strain of extensor muscle, fascia and tendon of left index finger at forearm level, initial Strain of extensor muscle, fascia and tendon of left index finger at forearm level, subsequent Strain of extensor muscle, fascia and tendon of left index finger at forearm level, sequela Strain of extensor muscle, fascia and tendon of right middle finger at forearm level, initial Strain of extensor muscle, fascia and tendon of right middle finger at forearm level, subsequent Strain of extensor muscle, fascia and tendon of right middle finger at forearm level, sequela Strain of extensor muscle, fascia and tendon of left middle finger at forearm level, initial Strain of extensor muscle, fascia and tendon of left middle finger at forearm level, subsequent Strain of extensor muscle, fascia and tendon of left middle finger at forearm level, sequela Strain of extensor muscle, fascia and tendon of right ring finger at forearm level, initial Strain of extensor muscle, fascia and tendon of right ring finger at forearm level, subsequent Strain of extensor muscle, fascia and tendon of right ring finger at forearm level, sequela Strain of extensor muscle, fascia and tendon of left ring finger at forearm level, initial Strain of extensor muscle, fascia and tendon of left ring finger at forearm level, subsequent Strain of extensor muscle, fascia and tendon of left ring finger at forearm level, sequela Strain of extensor muscle, fascia and tendon of right little finger at forearm level, initial Strain of extensor muscle, fascia and tendon of right little finger at forearm level, subsequent Printed on 10/5/2016. Page 15 of 30

S56.417S S56.418A S56.418D S56.418S S56.511A S56.511D S56.511S S56.512A S56.512D S56.512S S56.811A S56.811D S56.811S S56.812A S56.812D S56.812S S63.311A S63.311D S63.311S S63.312A S63.312D S63.312S S63.321A S63.321D S63.321S S63.322A S63.322D S63.322S S63.331A S63.331D S63.331S S63.332A S63.332D S63.332S S63.391A S63.391D S63.391S S63.392A S63.392D S63.392S S63.410A S63.410D S63.410S S63.411A S63.411D S63.411S S63.412A S63.412D Strain of extensor muscle, fascia and tendon of right little finger at forearm level, sequela Strain of extensor muscle, fascia and tendon of left little finger at forearm level, initial Strain of extensor muscle, fascia and tendon of left little finger at forearm level, subsequent Strain of extensor muscle, fascia and tendon of left little finger at forearm level, sequela Strain of other extensor muscle, fascia and tendon at forearm level, right arm, initial Strain of other extensor muscle, fascia and tendon at forearm level, right arm, subsequent Strain of other extensor muscle, fascia and tendon at forearm level, right arm, sequela Strain of other extensor muscle, fascia and tendon at forearm level, left arm, initial Strain of other extensor muscle, fascia and tendon at forearm level, left arm, subsequent Strain of other extensor muscle, fascia and tendon at forearm level, left arm, sequela Strain of other muscles, fascia and tendons at forearm level, right arm, initial Strain of other muscles, fascia and tendons at forearm level, right arm, subsequent Strain of other muscles, fascia and tendons at forearm level, right arm, sequela Strain of other muscles, fascia and tendons at forearm level, left arm, initial Strain of other muscles, fascia and tendons at forearm level, left arm, subsequent Strain of other muscles, fascia and tendons at forearm level, left arm, sequela Traumatic rupture of collateral ligament of right wrist, initial Traumatic rupture of collateral ligament of right wrist, subsequent Traumatic rupture of collateral ligament of right wrist, sequela Traumatic rupture of collateral ligament of left wrist, initial Traumatic rupture of collateral ligament of left wrist, subsequent Traumatic rupture of collateral ligament of left wrist, sequela Traumatic rupture of right radiocarpal ligament, initial Traumatic rupture of right radiocarpal ligament, subsequent Traumatic rupture of right radiocarpal ligament, sequela Traumatic rupture of left radiocarpal ligament, initial Traumatic rupture of left radiocarpal ligament, subsequent Traumatic rupture of left radiocarpal ligament, sequela Traumatic rupture of right ulnocarpal (palmar) ligament, initial Traumatic rupture of right ulnocarpal (palmar) ligament, subsequent Traumatic rupture of right ulnocarpal (palmar) ligament, sequela Traumatic rupture of left ulnocarpal (palmar) ligament, initial Traumatic rupture of left ulnocarpal (palmar) ligament, subsequent Traumatic rupture of left ulnocarpal (palmar) ligament, sequela Traumatic rupture of other ligament of right wrist, initial Traumatic rupture of other ligament of right wrist, subsequent Traumatic rupture of other ligament of right wrist, sequela Traumatic rupture of other ligament of left wrist, initial Traumatic rupture of other ligament of left wrist, subsequent Traumatic rupture of other ligament of left wrist, sequela Traumatic rupture of collateral ligament of right index finger at metacarpophalangeal and interphalangeal joint, initial Traumatic rupture of collateral ligament of right index finger at metacarpophalangeal and interphalangeal joint, subsequent Traumatic rupture of collateral ligament of right index finger at metacarpophalangeal and Traumatic rupture of collateral ligament of left index finger at metacarpophalangeal and interphalangeal joint, initial Traumatic rupture of collateral ligament of left index finger at metacarpophalangeal and interphalangeal joint, subsequent Traumatic rupture of collateral ligament of left index finger at metacarpophalangeal and Traumatic rupture of collateral ligament of right middle finger at metacarpophalangeal and interphalangeal joint, initial Traumatic rupture of collateral ligament of right middle finger at metacarpophalangeal and interphalangeal joint, subsequent Printed on 10/5/2016. Page 16 of 30