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

1370 Late effects of respiratory or unspecified tuberculosis 1371 Late effects of central nervous system tuberculosis 1372 Late effects of genitourinary tuberculosis 1373 Late effects of tuberculosis of bones and joints 1374 Late effects of tuberculosis of other specified organs 138 Late effects of acute poliomyelitis 1390 Late effects of viral encephalitis 1391 Late effects of trachoma 1398 Late effects of other and unspecified infectious and parasitic diseases 2681 Rickets, late effect 326 Late effects of intracranial abscess or pyogenic infection 412 Old myocardial infarction 4380 Late effects of cerebrovascular disease, cognitive deficits 43810 Late effects of cerebrovascular disease, speech and language deficit, unspecified 43811 Late effects of cerebrovascular disease, aphasia 43812 Late effects of cerebrovascular disease, dysphasia 43813 Late effects of cerebrovascular disease, dysarthria 43814 Late effects of cerebrovascular disease, fluency disorder 43819 Late effects of cerebrovascular disease, other speech and language deficits 43820 Late effects of cerebrovascular disease, hemiplegia affecting unspecified side 43821 Late effects of cerebrovascular disease, hemiplegia affecting dominant side 43822 Late effects of cerebrovascular disease, hemiplegia affecting nondominant side 43830 Late effects of cerebrovascular disease, monoplegia of upper limb affecting unspecified side 43831 Late effects of cerebrovascular disease, monoplegia of upper limb affecting dominant side 43832 Late effects of cerebrovascular disease, monoplegia of upper limb affecting nondominant side 43840 Late effects of cerebrovascular disease, monoplegia of lower limb affecting unspecified side 43841 Late effects of cerebrovascular disease, monoplegia of lower limb affecting dominant side 43842 Late effects of cerebrovascular disease, monoplegia of lower limb affecting nondominant side 43850 Late effects of cerebrovascular disease, other paralytic syndrome affecting unspecified side 43851 Late effects of cerebrovascular disease, other paralytic syndrome affecting dominant side 43852 Late effects of cerebrovascular disease, other paralytic syndrome affecting nondominant side 43853 Late effects of cerebrovascular disease, other paralytic syndrome, bilateral 4386 Late effects of cerebrovascular disease, alterations of sensations 4387 Late effects of cerebrovascular disease, disturbances of vision 43881 Other late effects of cerebrovascular disease, apraxia 43882 Other late effects of cerebrovascular disease, dysphagia 43883 Other late effects of cerebrovascular disease, facial weakness 43884 Other late effects of cerebrovascular disease, ataxia 43885 Other late effects of cerebrovascular disease, vertigo 43889 Other late effects of cerebrovascular disease 4389 Unspecified late effects of cerebrovascular disease 650 Normal delivery 66070 Failed forceps or vacuum extractor, unspecified, unspecified as to episode of care or not applicable Page 1 of 54 Effective 10/1/2014

66071 Failed forceps or vacuum extractor, unspecified, delivered, with or without mention of antepartum condition 66073 Failed forceps or vacuum extractor, unspecified, antepartum condition or complication 677 Late effect of complication of pregnancy, childbirth, and the puerperium 7400 Anencephalus 7401 Craniorachischisis 7402 Iniencephaly 74100 Spina bifida with hydrocephalus, unspecified region 74101 Spina bifida with hydrocephalus, cervical region 74102 Spina bifida with hydrocephalus, dorsal (thoracic) region 74103 Spina bifida with hydrocephalus, lumbar region 74190 Spina bifida without mention of hydrocephalus, unspecified region 74191 Spina bifida without mention of hydrocephalus, cervical region 74192 Spina bifida without mention of hydrocephalus, dorsal (thoracic) region 74193 Spina bifida without mention of hydrocephalus, lumbar region 7420 Encephalocele 7421 Microcephalus 7422 Congenital reduction deformities of brain 7423 Congenital hydrocephalus 7424 Other specified congenital anomalies of brain 74251 Diastematomyelia 74253 Hydromyelia 74259 Other specified congenital anomalies of spinal cord 7428 Other specified congenital anomalies of nervous system 7429 Unspecified congenital anomaly of brain, spinal cord, and nervous system 74300 Clinical anophthalmos, unspecified 74303 Cystic eyeball, congenital 74306 Cryptophthalmos 74310 Microphthalmos, unspecified 74311 Simple microphthalmos 74312 Microphthalmos associated with other anomalies of eye and adnexa 74320 Buphthalmos, unspecified 74321 Simple buphthalmos 74322 Buphthalmos associated with other ocular anomalies 74330 Congenital cataract, unspecified 74331 Congenital capsular and subcapsular cataract 74332 Congenital cortical and zonular cataract 74333 Congenital nuclear cataract 74334 Total and subtotal cataract, congenital 74335 Congenital aphakia 74336 Congenital anomalies of lens shape 74337 Congenital ectopic lens 74339 Other congenital cataract and lens anomalies 74341 Congenital anomalies of corneal size and shape Page 2 of 54 Effective 10/1/2014

74342 Corneal opacities, interfering with vision, congenital 74343 Other corneal opacities, congenital 74344 Specified congenital anomalies of anterior chamber, chamber angle, and related structures 74345 Aniridia 74346 Other specified congenital anomalies of iris and ciliary body 74347 Specified congenital anomalies of sclera 74348 Multiple and combined congenital anomalies of anterior segment 74349 Other congenital anomalies of anterior segment 74351 Vitreous anomalies 74352 Fundus coloboma 74353 Chorioretinal degeneration, congenital 74354 Congenital folds and cysts of posterior segment 74355 Congenital macular changes 74356 Other retinal changes, congenital 74357 Specified congenital anomalies of optic disc 74358 Vascular anomalies 74359 Other congenital anomalies of posterior segment 74361 Congenital ptosis 74362 Congenital deformities of eyelids 74363 Other specified congenital anomalies of eyelid 74364 Specified congenital anomalies of lacrimal gland 74365 Specified congenital anomalies of lacrimal passages 74366 Specified congenital anomalies of orbit 74369 Other congenital anomalies of eyelids, lacrimal system, and orbit 7438 Other specified anomalies of eye 7439 Unspecified anomaly of eye 74400 Unspecified anomaly of ear with impairment of hearing 74401 Absence of external ear 74402 Other anomalies of external ear with impairment of hearing 74403 Anomaly of middle ear, except ossicles 74404 Anomalies of ear ossicles 74405 Anomalies of inner ear 74409 Other anomalies of ear causing impairment of hearing 7441 Accessory auricle 74421 Absence of ear lobe, congenital 74422 Macrotia 74423 Microtia 74424 Specified anomalies of Eustachian tube 74429 Other specified anomalies of ear 7443 Unspecified anomaly of ear 74441 Branchial cleft sinus or fistula 74442 Branchial cleft cyst 74443 Cervical auricle 74446 Preauricular sinus or fistula Page 3 of 54 Effective 10/1/2014

74447 Preauricular cyst Oregon Health Authority 74449 Other branchial cleft cyst or fistula; preauricular sinus 7445 Webbing of neck 74481 Macrocheilia 74482 Microcheilia 74483 Macrostomia 74484 Microstomia 74489 Other specified congenital anomalies of face and neck 7449 Unspecified congenital anomalies of face and neck 7450 Common truncus 74510 Complete transposition of great vessels 74511 Double outlet right ventricle 74512 Corrected transposition of great vessels 74519 Other transposition of great vessels 7452 Tetralogy of fallot 7453 Common ventricle 7454 Ventricular septal defect 7455 Ostium secundum type atrial septal defect 74560 Endocardial cushion defect, unspecified type 74561 Ostium primum defect 74569 Other endocardial cushion defects 7457 Cor biloculare 7458 Other bulbus cordis anomalies and anomalies of cardiac septal closure 7459 Unspecified defect of septal closure 74600 Congenital pulmonary valve anomaly, unspecified 74601 Atresia of pulmonary valve, congenital 74602 Stenosis of pulmonary valve, congenital 74609 Other congenital anomalies of pulmonary valve 7461 Tricuspid atresia and stenosis, congenital 7462 Ebstein's anomaly 7463 Congenital stenosis of aortic valve 7464 Congenital insufficiency of aortic valve 7465 Congenital mitral stenosis 7466 Congenital mitral insufficiency 7467 Hypoplastic left heart syndrome 74681 Subaortic stenosis 74682 Cor triatriatum 74683 Infundibular pulmonic stenosis 74684 Obstructive anomalies of heart, not elsewhere classified 74685 Coronary artery anomaly 74686 Congenital heart block 74687 Malposition of heart and cardiac apex 74689 Other specified congenital anomalies of heart 7469 Unspecified congenital anomaly of heart Page 4 of 54 Effective 10/1/2014

7470 Patent ductus arteriosus 74710 Coarctation of aorta (preductal) (postductal) 74711 Interruption of aortic arch 74720 Anomaly of aorta, unspecified 74721 Anomalies of aortic arch 74722 Atresia and stenosis of aorta 74729 Other anomalies of aorta 74731 Pulmonary artery coarctation and atresia 74732 Pulmonary arteriovenous malformation Oregon Health Authority 74739 Other anomalies of pulmonary artery and pulmonary circulation 74740 Anomaly of great veins, unspecified 74741 Total anomalous pulmonary venous connection 74742 Partial anomalous pulmonary venous connection 74749 Other anomalies of great veins 7475 Absence or hypoplasia of umbilical artery 74760 Anomaly of the peripheral vascular system, unspecified site 74761 Gastrointestinal vessel anomaly 74762 Renal vessel anomaly 74763 Upper limb vessel anomaly 74764 Lower limb vessel anomaly 74769 Anomalies of other specified sites of peripheral vascular system 74781 Anomalies of cerebrovascular system 74782 Spinal vessel anomaly 74783 Persistent fetal circulation 74789 Other specified anomalies of circulatory system 7479 Unspecified anomaly of circulatory system 7480 Choanal atresia 7481 Other anomalies of nose 7482 Web of larynx 7483 Other anomalies of larynx, trachea, and bronchus 7484 Congenital cystic lung 7485 Agenesis, hypoplasia, and dysplasia of lung 74860 Anomaly of lung, unspecified 74861 Congenital bronchiectasis 74869 Other congenital anomalies of lung 7488 Other specified anomalies of respiratory system 7489 Unspecified anomaly of respiratory system 74900 Cleft palate, unspecified 74901 Cleft palate, unilateral, complete 74902 Cleft palate, unilateral, incomplete 74903 Cleft palate, bilateral, complete 74904 Cleft palate, bilateral, incomplete 74910 Cleft lip, unspecified 74911 Cleft lip, unilateral, complete Page 5 of 54 Effective 10/1/2014

74912 Cleft lip, unilateral, incomplete 74913 Cleft lip, bilateral, complete 74914 Cleft lip, bilateral, incomplete 74920 Cleft palate with cleft lip, unspecified Oregon Health Authority 74921 Cleft palate with cleft lip, unilateral, complete 74922 Cleft palate with cleft lip, unilateral, incomplete 74923 Cleft palate with cleft lip, bilateral, complete 74924 Cleft palate with cleft lip, bilateral, incomplete 74925 Other combinations of cleft palate with cleft lip 7500 Tongue tie 75010 Congenital anomaly of tongue, unspecified 75011 Aglossia 75012 Congenital adhesions of tongue 75013 Fissure of tongue 75015 Macroglossia 75016 Microglossia 75019 Other congenital anomalies of tongue 75021 Absence of salivary gland 75022 Accessory salivary gland 75023 Atresia, salivary duct 75024 Congenital fistula of salivary gland 75025 Congenital fistula of lip 75026 Other specified anomalies of mouth 75027 Diverticulum of pharynx 75029 Other specified anomalies of pharynx 7503 Tracheoesophageal fistula, esophageal atresia and stenosis 7504 Other specified anomalies of esophagus 7505 Congenital hypertrophic pyloric stenosis 7506 Congenital hiatus hernia 7507 Other specified anomalies of stomach 7508 Other specified anomalies of upper alimentary tract 7509 Unspecified anomaly of upper alimentary tract 7510 Meckel's diverticulum 7511 Atresia and stenosis of small intestine 7512 Atresia and stenosis of large intestine, rectum, and anal canal 7513 Hirschsprung's disease and other congenital functional disorders of colon 7514 Anomalies of intestinal fixation 7515 Other anomalies of intestine 75160 Unspecified anomaly of gallbladder, bile ducts, and liver 75161 Biliary atresia 75162 Congenital cystic disease of liver 75169 Other anomalies of gallbladder, bile ducts, and liver 7517 Anomalies of pancreas 7518 Other specified anomalies of digestive system Page 6 of 54 Effective 10/1/2014

7519 Unspecified anomaly of digestive system 7520 Anomalies of ovaries Oregon Health Authority 75210 Unspecified anomaly of fallopian tubes and broad ligaments 75211 Embryonic cyst of fallopian tubes and broad ligaments 75219 Other anomalies of fallopian tubes and broad ligaments 7522 Doubling of uterus 75231 Agenesis of uterus 75232 Hypoplasia of uterus 75233 Unicornuate uterus 75234 Bicornuate uterus 75235 Septate uterus 75236 Arcuate uterus 75239 Other anomalies of uterus 75240 Unspecified anomaly of cervix, vagina, and external female genitalia 75241 Embryonic cyst of cervix, vagina, and external female genitalia 75242 Imperforate hymen 75243 Cervical agenesis 75244 Cervical duplication 75245 Vaginal agenesis 75246 Transverse vaginal septum 75247 Longitudinal vaginal septum 75249 Other anomalies of cervix, vagina, and external female genitalia 75251 Undescended testis 75252 Retractile testis 75261 Hypospadias 75262 Epispadias 75263 Congenital chordee 75264 Micropenis 75265 Hidden penis 75269 Other penile anomalies 7527 Indeterminate sex and pseudohermaphroditism 75281 Scrotal transposition 75289 Other specified anomalies of genital organs 7529 Unspecified anomaly of genital organs 7530 Renal agenesis and dysgenesis 75310 Cystic kidney disease, unspecified 75311 Congenital single renal cyst 75312 Polycystic kidney, unspecified type 75313 Polycystic kidney, autosomal dominant 75314 Polycystic kidney, autosomal recessive 75315 Renal dysplasia 75316 Medullary cystic kidney 75317 Medullary sponge kidney 75319 Other specified cystic kidney disease Page 7 of 54 Effective 10/1/2014

75320 Unspecified obstructive defect of renal pelvis and ureter 75321 Congenital obstruction of ureteropelvic junction 75322 Congenital obstruction of ureterovesical junction 75323 Congenital ureterocele 75329 Other obstructive defects of renal pelvis and ureter 7533 Other specified anomalies of kidney 7534 Other specified anomalies of ureter 7535 Exstrophy of urinary bladder 7536 Atresia and stenosis of urethra and bladder neck 7537 Anomalies of urachus 7538 Other specified anomalies of bladder and urethra 7539 Unspecified anomaly of urinary system 7540 Congenital musculoskeletal deformities of skull, face, and jaw 7541 Congenital musculoskeletal deformities of sternocleidomastoid muscle 7542 Congenital musculoskeletal deformities of spine 75430 Congenital dislocation of hip, unilateral 75431 Congenital dislocation of hip, bilateral 75432 Congenital subluxation of hip, unilateral 75433 Congenital subluxation of hip, bilateral 75435 Congenital dislocation of one hip with subluxation of other hip 75440 Genu recurvatum 75441 Congenital dislocation of knee (with genu recurvatum) 75442 Congenital bowing of femur 75443 Congenital bowing of tibia and fibula 75444 Congenital bowing of unspecified long bones of leg 75450 Talipes varus 75451 Talipes equinovarus 75452 Metatarsus primus varus 75453 Metatarsus varus 75459 Other varus deformities of feet 75460 Talipes valgus 75461 Congenital pes planus 75462 Talipes calcaneovalgus 75469 Other valgus deformities of feet 75470 Talipes, unspecified 75471 Talipes cavus 75479 Other deformities of feet 75481 Pectus excavatum 75482 Pectus carinatum 75489 Other specified nonteratogenic anomalies 75500 Polydactyly, unspecified digits 75501 Polydactyly of fingers 75502 Polydactyly of toes 75510 Syndactyly of multiple and unspecified sites Page 8 of 54 Effective 10/1/2014

75511 Syndactyly of fingers without fusion of bone 75512 Syndactyly of fingers with fusion of bone 75513 Syndactyly of toes without fusion of bone 75514 Syndactyly of toes with fusion of bone Oregon Health Authority 75520 Unspecified reduction deformity of upper limb 75521 Transverse deficiency of upper limb 75522 Longitudinal deficiency of upper limb, not elsewhere classified 75523 Longitudinal deficiency, combined, involving humerus, radius, and ulna (complete or incomplete) 75524 Longitudinal deficiency, humeral, complete or partial (with or without distal deficiencies, incomplete) 75525 Longitudinal deficiency, radioulnar, complete or partial (with or without distal deficiencies, incomplete) 75526 Longitudinal deficiency, radial, complete or partial (with or without distal deficiencies, incomplete) 75527 Longitudinal deficiency, ulnar, complete or partial (with or without distal deficiencies, incomplete) 75528 Longitudinal deficiency, carpals or metacarpals, complete or partial (with or without incomplete phalangeal deficiency) 75529 Longitudinal deficiency, phalanges, complete or partial 75530 Unspecified reduction deformity of lower limb, 75531 Transverse deficiency of lower limb 75532 Longitudinal deficiency of lower limb, not elsewhere classified 75533 Longitudinal deficiency, combined, involving femur, tibia, and fibula (complete or incomplete) 75534 Longitudinal deficiency, femoral, complete or partial (with or without distal deficiencies, incomplete) 75535 Longitudinal deficiency, tibiofibular, complete or partial (with or without distal deficiencies, incomplete) 75536 Longitudinal deficiency, tibia, complete or partial (with or without distal deficiencies, incomplete) 75537 Longitudinal deficiency, fibular, complete or partial (with or without distal deficiencies, incomplete) 75538 Longitudinal deficiency, tarsals or metatarsals, complete or partial (with or without incomplete phalangeal deficiency) 75539 Longitudinal deficiency, phalanges, complete or partial 7554 Reduction deformities, unspecified limb 75550 Unspecified anomaly of upper limb 75551 Congenital deformity of clavicle 75552 Congenital elevation of scapula 75553 Radioulnar synostosis 75554 Madelung's deformity 75555 Acrocephalosyndactyly 75556 Accessory carpal bones 75557 Macrodactylia (fingers) 75558 Cleft hand, congenital 75559 Other anomalies of upper limb, including shoulder girdle 75560 Unspecified anomaly of lower limb Page 9 of 54 Effective 10/1/2014

75561 Coxa valga, congenital 75562 Coxa vara, congenital 75563 Other congenital deformity of hip (joint) 75564 Congenital deformity of knee (joint) 75565 Macrodactylia of toes 75566 Other anomalies of toes 75567 Anomalies of foot, not elsewhere classified Oregon Health Authority 75569 Other anomalies of lower limb, including pelvic girdle 7558 Other specified anomalies of unspecified limb 7559 Unspecified anomaly of unspecified limb 7560 Anomalies of skull and face bones 75610 Anomaly of spine, unspecified 75611 Spondylolysis, lumbosacral region 75612 Spondylolisthesis 75613 Absence of vertebra, congenital 75614 Hemivertebra 75615 Fusion of spine (vertebra), congenital 75616 Klippel-Feil syndrome 75617 Spina bifida occulta 75619 Other anomalies of spine 7562 Cervical rib 7563 Other anomalies of ribs and sternum 7564 Chondrodystrophy 75650 Congenital osteodystrophy, unspecified 75651 Osteogenesis imperfecta 75652 Osteopetrosis 75653 Osteopoikilosis 75654 Polyostotic fibrous dysplasia of bone 75655 Chondroectodermal dysplasia 75656 Multiple epiphyseal dysplasia 75659 Other osteodystrophies 7566 Anomalies of diaphragm 75670 Anomaly of abdominal wall, unspecified 75671 Prune belly syndrome 75672 Omphalocele 75673 Gastroschisis 75679 Other congenital anomalies of abdominal wall 75681 Absence of muscle and tendon 75682 Accessory muscle 75683 Ehlers-Danlos syndrome 75689 Other specified anomalies of muscle, tendon, fascia, and connective tissue 7569 Other and unspecified anomalies of musculoskeletal system 7570 Hereditary edema of legs 7571 Ichthyosis congenita Page 10 of 54 Effective 10/1/2014

7572 Dermatoglyphic anomalies 75731 Congenital ectodermal dysplasia 75732 Vascular hamartomas 75733 Congenital pigmentary anomalies of skin 75739 Other specified anomalies of skin 7574 Specified anomalies of hair 7575 Specified anomalies of nails 7576 Specified congenital anomalies of breast Oregon Health Authority 7578 Other specified anomalies of the integument 7579 Unspecified congenital anomaly of the integument 7580 Down's syndrome 7581 Patau's syndrome 7582 Edwards' syndrome 75831 Cri-du-chat syndrome 75832 Velo-cardio-facial syndrome 75833 Other microdeletions 75839 Other autosomal deletions 7584 Balanced autosomal translocation in normal individual 7585 Other conditions due to autosomal anomalies 7586 Gonadal dysgenesis 7587 Klinefelter's syndrome 75881 Other conditions due to sex chromosome anomalies 75889 Other conditions due to chromosome anomalies 7589 Conditions due to anomaly of unspecified chromosome 7590 Anomalies of spleen 7591 Anomalies of adrenal gland 7592 Anomalies of other endocrine glands 7593 Situs inversus 7594 Conjoined twins 7595 Tuberous sclerosis 7596 Other hamartoses, not elsewhere classified 7597 Multiple congenital anomalies, so described 75981 Prader-Willi syndrome 75982 Marfan syndrome 75983 Fragile X syndrome 75989 Other specified congenital anomalies 7599 Congenital anomaly, unspecified 9050 Late effect of fracture of skull and face bones 9051 Late effect of fracture of spine and trunk without mention of spinal cord lesion 9052 Late effect of fracture of upper extremities 9053 Late effect of fracture of neck of femur 9054 Late effect of fracture of lower extremities 9055 Late effect of fracture of multiple and unspecified bones 9056 Late effect of dislocation Page 11 of 54 Effective 10/1/2014

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

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

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

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

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

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

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

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

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

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

E8273 E8274 E8278 E8279 E8280 E8282 E8284 E8288 E8289 E8290 E8294 E8298 E8299 E8300 E8301 E8302 E8303 E8304 E8305 E8306 E8307 E8308 E8309 E8310 E8311 E8312 E8313 E8314 E8315 E8316 E8317 E8318 E8319 E8320 E8321 E8322 E8323 E8324 E8325 Animal-drawn vehicle accident injuring occupant of animal drawn vehicle Animal-drawn vehicle accident injuring occupant of streetcar Animal-drawn vehicle accident injuring other specified person Animal-drawn vehicle accident injuring unspecified person Accident involving animal being ridden injuring pedestrian Accident involving animal being ridden injuring rider of animal Accident involving animal being ridden injuring occupant of streetcar Accident involving animal being ridden injuring other specified person Accident involving animal being ridden injuring unspecified person Other road vehicle accidents injuring pedestrian Other road vehicle accidents injuring occupant of streetcar Other road vehicle accidents injuring other specified person Other road vehicle accidents injuring unspecified person Accident to watercraft causing submersion injuring occupant of small boat, unpowered Accident to watercraft causing submersion injuring occupant of small boat, powered Accident to watercraft causing submersion injuring occupant of other watercraft û crew Accident to watercraft causing submersion injuring occupant of other watercraft -- other than crew Accident to watercraft causing submersion njuring water skier Accident to watercraft causing submersion njuring swimmer Accident to watercraft causing submersion injuring dockers, stevedores Accident to watercraft causing submersion, occupant of military watercraft, any type Accident to watercraft causing submersion injuring other specified person Accident to watercraft causing submersion injuring unspecified person Accident to watercraft causing other injury to occupant of small boat, unpowered Accident to watercraft causing other injury to occupant of small boat, powered Accident to watercraft causing other injury to occupant of other watercraft -- crew Accident to watercraft causing other injury to occupant of other watercraft -- other than crew Accident to watercraft causing other injury to water skier Accident to watercraft causing other injury to swimmer Accident to watercraft causing other injury to dockers, stevedores Accident to watercraft causing other injury, occupant of military watercraft, any type Accident to watercraft causing other injury to other specified person Accident to watercraft causing other injury to unspecified person Other accidental submersion or drowning in water transport accident injuring occupant of small boat, unpowered Other accidental submersion or drowning in water transport accident injuring occupant of small boat, powered Other accidental submersion or drowning in water transport accident injuring occupant of other watercraft -- crew Other accidental submersion or drowning in water transport accident injuring occupant of other watercraft -- other than crew Other accidental submersion or drowning in water transport accident injuring water skier Other accidental submersion or drowning in water transport accident injuring swimmer Page 22 of 54 Effective 10/1/2014

E8326 E8327 E8328 E8329 E8330 E8331 E8332 E8333 E8334 E8335 E8336 E8337 E8338 E8339 E8340 E8341 E8342 E8343 E8344 E8345 E8346 E8347 E8348 E8349 E8350 E8351 E8352 E8353 E8354 E8355 E8356 E8357 E8358 E8359 E8360 E8361 Other accidental submersion or drowning in water transport accident injuring dockers, stevedores Other accidental submersion or drowning in water transport accident, occupant of military watercraft, any type Other accidental submersion or drowning in water transport accident injuring other specified person Other accidental submersion or drowning in water transport accident injuring unspecified person Fall on stairs or ladders in water transport injuring occupant of small boat, unpowered Fall on stairs or ladders in water transport injuring occupant of small boat, powered Fall on stairs or ladders in water transport injuring occupant of other watercraft û crew Fall on stairs or ladders in water transport injuring occupant of other watercraft -- other than crew Fall on stairs or ladders in water transport injuring water skier Fall on stairs or ladders in water transport injuring swimmer Fall on stairs or ladders in water transport injuring dockers, stevedores Fall on stairs or ladders in water transport, occupant of military watercraft, any type Fall on stairs or ladders in water transport injuring other specified person Fall on stairs or ladders in water transport injuring unspecified person Other fall from one level to another in water transport injuring occupant of small boat, unpowered Other fall from one level to another in water transport injuring occupant of small boat, powered Other fall from one level to another in water transport injuring occupant of other watercraft -- crew Other fall from one level to another in water transport injuring occupant of other watercraft -- other than crew Other fall from one level to another in water transport injuring water skier Other fall from one level to another in water transport injuring swimmer Other fall from one level to another in water transport injuring dockers, stevedores Other fall from one level to another in water transport, occupant of military watercraft, any type Other fall from one level to another in water transport injuring other specified person Other fall from one level to another in water transport injuring unspecified person Other and unspecified fall in water transport injuring occupant of small boat, unpowered Other and unspecified fall in water transport injuring occupant of small boat, powered Other and unspecified fall in water transport injuring occupant of other watercraft û crew Other and unspecified fall in water transport injuring occupant of other watercraft -- other than crew Other and unspecified fall in water transport injuring water skier Other and unspecified fall in water transport injuring swimmer Other and unspecified fall in water transport injuring dockers, stevedores Other and unspecified fall in water transport, occupant of military watercraft, any type Other and unspecified fall in water transport injuring other specified person Other and unspecified fall in water transport injuring unspecified person Machinery accident in water transport injuring occupant of small boat, unpowered Machinery accident in water transport injuring occupant of small boat, powered Page 23 of 54 Effective 10/1/2014

E8362 E8363 E8364 E8365 E8366 E8367 E8368 E8369 E8370 E8371 E8372 E8373 E8374 E8375 E8376 E8377 E8378 E8379 E8380 E8381 E8382 E8383 E8384 E8385 E8386 E8387 E8388 E8389 E8400 E8401 E8402 E8403 E8404 E8405 E8406 E8407 E8408 E8409 E8410 E8411 Machinery accident in water transport injuring occupant of other watercraft -- crew Machinery accident in water transport injuring occupant of other watercraft -- other than crew Machinery accident in water transport injuring water skier Machinery accident in water transport injuring swimmer Machinery accident in water transport injuring dockers, stevedores Machinery accident in water transport, occupant of military watercraft, any type Machinery accident in water transport injuring other specified person Machinery accident in water transport injuring unspecified person Explosion, fire, or burning in watercraft injuring occupant of small boat, unpowered Explosion, fire, or burning in watercraft injuring occupant of small boat, powered Explosion, fire, or burning in watercraft injuring occupant of other watercraft û crew Explosion, fire, or burning in watercraft injuring occupant of other watercraft -- other than crew Explosion, fire, or burning in watercraft injuring water skier Explosion, fire, or burning in watercraft injuring swimmer Explosion, fire, or burning in watercraft injuring dockers, stevedores Explosion, fire, or burning in watercraft, occupant of military watercraft, any type Explosion, fire, or burning in watercraft injuring other specified person Explosion, fire, or burning in watercraft injuring unspecified person Other and unspecified water transport accident injuring occupant of small boat, unpowered Other and unspecified water transport accident injuring occupant of small boat, powered Other and unspecified water transport accident injuring occupant of other watercraft -- crew Other and unspecified water transport accident injuring occupant of other watercraft -- other than crew Other and unspecified water transport accident injuring water skier Other and unspecified water transport accident injuring swimmer Other and unspecified water transport accident injuring dockers, stevedores Other and unspecified water transport accident, occupant of military watercraft, any type Other and unspecified water transport accident injuring other specified person Other and unspecified water transport accident injuring unspecified person Accident to powered aircraft at takeoff or landing injuring occupant of spacecraft Accident to powered aircraft at takeoff or landing injuring occupant of military aircraft, any Accident to powered aircraft at takeoff or landing injuring crew of commercial aircraft (powered) in surface to surface transport Accident to powered aircraft at takeoff or landing injuring other occupant of commercial aircraft (powered) in surface to surface transport Accident to powered aircraft at takeoff or landing injuring occupant of commercial aircraft (powered) in surface to air transport Accident to powered aircraft at takeoff or landing injuring occupant of other powered aircraft Accident to powered aircraft at takeoff or landing injuring occupant of unpowered aircraft, except parachutist Accident to powered aircraft at takeoff or landing injuring parachutist (military) (other) Accident to powered aircraft at takeoff or landing injuring ground crew, airline employee Accident to powered aircraft at takeoff or landing injuring other person Accident to powered aircraft, other and unspecified, injuring occupant of spacecraft Accident to powered aircraft, other and unspecified, injuring occupant of military aircraft, any Page 24 of 54 Effective 10/1/2014

E8412 E8413 E8414 E8415 E8416 E8417 E8418 E8419 E8426 E8427 E8428 E8429 E8430 E8431 E8432 E8433 E8434 E8435 E8436 E8437 E8438 E8439 E8440 E8441 E8442 E8443 E8444 E8445 E8446 E8447 E8448 E8449 E8450 E8458 E8459 Accident to powered aircraft, other and unspecified, injuring crew of commercial aircraft (powered) in surface to surface transport Accident to powered aircraft, other and unspecified, injuring other occupant of commercial aircraft (powered) in surface to surface transport Accident to powered aircraft, other and unspecified, injuring occupant of commercial aircraft (powered) in surface to air transport Accident to powered aircraft, other and unspecified, injuring occupant of other powered aircraft Accident to powered aircraft, other and unspecified, injuring occupant of unpowered aircraft, except parachutist Accident to powered aircraft, other and unspecified, injuring parachutist (military) (other) Accident to powered aircraft, other and unspecified, injuring ground crew, airline employee Accident to powered aircraft, other and unspecified, injuring other person Accident to unpowered aircraft injuring occupant of unpowered aircraft, except parachutist Accident to unpowered aircraft injuring parachutist (military) (other) Accident to unpowered aircraft injuring ground crew, airline employee Accident to unpowered aircraft injuring other person Fall in, on, or from aircraft injuring occupant of spacecraft Fall in, on, or from aircraft injuring occupant of military aircraft, any Fall in, on, or from aircraft injuring crew of commercial aircraft (powered) in surface to surface transport Fall in, on, or from aircraft injuring other occupant of commercial aircraft (powered) in surface to surface transport Fall in, on, or from aircraft injuring occupant of commercial aircraft (powered) in surface to air transport Fall in, on, or from aircraft injuring occupant of other powered aircraft Fall in, on, or from aircraft injuring occupant of unpowered aircraft, except parachutist Fall in, on, or from aircraft injuring parachutist (military) (other) Fall in, on, or from aircraft injuring ground crew, airline employee Fall in, on, or from aircraft injuring other person Other specified air transport accidents injuring occupant of spacecraft Other specified air transport accidents injuring occupant of military aircraft, any Other specified air transport accidents injuring crew of commercial aircraft (powered) in surface to surface transport Other specified air transport accidents injuring other occupant of commercial aircraft (powered) in surface to surface transport Other specified air transport accidents injuring occupant of commercial aircraft (powered) in surface to air transport Other specified air transport accidents injuring occupant of other powered aircraft Other specified air transport accidents injuring occupant of unpowered aircraft, except parachutist Other specified air transport accidents injuring parachutist (military) (other) Other specified air transport accidents injuring ground crew, airline employee Other specified air transport accidents injuring other person Accident involving spacecraft injuring occupant of spacecraft Accident involving spacecraft injuring ground crew, airline employee Accident involving spacecraft injuring other person Page 25 of 54 Effective 10/1/2014

E846 E847 E848 E8490 E8491 E8492 E8493 E8494 E8495 E8496 E8498 E8499 E8831 E8832 E8840 E8841 E8850 E8851 E8852 E8853 E8854 E8860 E8900 E8901 E8902 E8903 E8908 E8909 E8930 E8932 E894 E895 E897 E9170 E9171 E9172 E9175 E9176 E9190 E9191 E9193 E9194 Accidents involving powered vehicles used solely within the buildings and premises of industrial or commercial establishment Accidents involving cable cars not running on rails Accidents involving other vehicles, not elsewhere classifiable Home accidents Farm accidents Mine and quarry accidents Accidents occurring in industrial places and premises Accidents occurring in place for recreation and sport Street and highway accidents Accidents occurring in public building Accidents occurring in other specified places Accidents occurring in unspecified place Accidental fall into well Accidental fall into storm drain or manhole Accidental fall from playground equipment Accidental fall from cliff Fall from (nonmotorized) scooter Fall from roller skates Fall from skateboard Fall from skis Fall from snowboard Fall on same level from collision, pushing, or shoving, by or with other person in sports Explosion caused by conflagration in private dwelling Fumes from combustion of polyvinylchloride [pvc] and similar material in conflagration in private dwelling Other smoke and fumes from conflagration in private dwelling Burning caused by conflagration in private dwelling Other accident resulting from conflagration in private dwelling Unspecified accident resulting from conflagration in private dwelling Accident caused by ignition of clothing from controlled fire in private dwelling Accident caused by ignition of clothing from controlled fire not in building or structure Ignition of highly inflammable material Accident caused by controlled fire in private dwelling Accident caused by controlled fire not in building or structure Striking against or struck accidentally by objects or persons in sports Striking against or struck accidentally by a crowd, by collective fear or panic Striking against or struck accidentally in running water Striking against or struck accidentally by object in sports with subsequent fall Striking against or struck accidentally caused by a crowd, by collective fear or panic with subsequent fall Accidents caused by agricultural machines Accidents caused by mining and earth-drilling machinery Accidents caused by metalworking machines Accidents caused by woodworking and forming machines Page 26 of 54 Effective 10/1/2014

E9195 E9196 E9197 E9198 E9199 E9210 E9211 E9218 E9219 E9220 E9221 E9222 E9223 E9224 E9225 E9228 E9229 E9262 E9280 E9281 E9282 E9283 E9284 E9285 E9286 E9287 E9288 E9290 E9291 E9292 E9293 E9294 E9295 E9298 E9299 E959 E970 E971 E972 E973 E974 E975 E976 E977 Accidents caused by prime movers, except electrical motors Accidents caused by transmission machinery Accidents caused by earth moving, scraping, and other excavating machines Accidents caused by other specified machinery Accidents caused by unspecified machinery Accident caused by explosion of boilers Accident caused by explosion of gas cylinders Accident caused by explosion of other specified pressure vessels Accident caused by explosion of unspecified pressure vessel Accident caused by handgun Accident caused by shotgun (automatic) Accident caused by hunting rifle Accident caused by military firearms Accident caused by air gun Accident caused by paintball gun Accident caused by other specified firearm missile Accident caused by unspecified firearm missile Exposure to visible and ultraviolet light sources Prolonged stay in weightless environment Exposure to noise Vibration Human bite External constriction caused by hair External constriction caused by other object Environmental exposure to harmful algae and toxins Environmental and accidental causes, mechanism or component of firearm and air gun Other accidents Late effects of motor vehicle accident Late effects of other transport accident Late effects of accidental poisoning Late effects of accidental fall Late effects of accident caused by fire Late effects of accident due to natural and environmental factors Late effects of other accidents Late effects of unspecified accident Late effects of self-inflicted injury Injury due to legal intervention by firearms Injury due to legal intervention by explosives Injury due to legal intervention by gas Injury due to legal intervention by blunt object Injury due to legal intervention by cutting and piercing instrument Injury due to legal intervention by other specified means Injury due to legal intervention by unspecified means Late effects of injuries due to legal intervention Page 27 of 54 Effective 10/1/2014

E978 E9790 E9791 E9792 E9793 E9794 E9795 E9796 E9797 E9798 E9799 E9810 E9811 E9818 E9820 E9821 E9828 E9829 E9850 E9851 E9852 E9853 E9854 E9855 E9856 E9857 E9870 E9872 E989 E9900 E9901 E9902 E9903 E9909 E9910 E9911 E9912 E9913 E9914 Legal execution Terrorism involving explosion of marine weapons Terrorism involving destruction of aircraft Terrorism involving other explosions and fragments Terrorism involving fires Terrorism involving firearms Terrorism involving nuclear weapons Terrorism involving biological weapons Terrorism involving chemical weapons Terrorism involving other means Terrorism secondary effects Poisoning by gas distributed by pipeline, undetermined whether accidentally or purposely inflicted Poisoning by liquefied petroleum gas distributed in mobile containers, undetermined whether accidentally or purposely inflicted Poisoning by other utility gas, undetermined whether accidentally or purposely inflicted Poisoning by motor vehicle exhaust gas, undetermined whether accidentally or purposely inflicted Poisoning by other carbon monoxide, undetermined whether accidentally or purposely inflicted Poisoning by other specified gases and vapors, undetermined whether accidentally or purposely inflicted Poisoning by unspecified gases and vapors, undetermined whether accidentally or purposely inflicted Injury by handgun, undetermined whether accidentally or purposely inflicted Injury by shotgun, undetermined whether accidentally or purposely inflicted Injury by hunting rifle, undetermined whether accidentally or purposely inflicted Injury by military firearms, undetermined whether accidentally or purposely inflicted Injury by other and unspecified firearm, undetermined whether accidentally or purposely inflicted Injury by explosives, undetermined whether accidentally or purposely inflicted Injury by air gun, undetermined whether accidental or purposely inflicted Injury by paintball gun, undetermined whether accidental or purposely inflicted Falling from residential premises, undetermined whether accidentally or purposely inflicted Falling from natural sites, undetermined whether accidentally or purposely inflicted Late effects of injury, undetermined whether accidentally or purposely inflicted Injury due to war operations from gasoline bomb Injury due to war operations from flamethrower Injury due to war operations from incendiary bullet Injury due to war operations from fire caused indirectly from conventional weapon Injury due to war operations from other and unspecified source Injury due to war operations from rubber bullets (rifle) Injury due to war operations from pellets (rifle) Injury due to war operations from other bullets Injury due to war operations from antipersonnel bomb (fragments) Injury due to war operations by fragments from munitions Page 28 of 54 Effective 10/1/2014

E9915 E9916 E9917 E9918 E9919 E9920 E9921 E9922 E9923 E9928 E9929 E9930 E9931 E9932 E9933 E9934 E9935 E9936 E9937 E9938 E9939 E9940 E9941 E9942 E9943 E9948 E9949 E9950 E9951 E9952 E9953 E9954 E9958 E9959 E9960 E9961 E9962 E9963 E9968 E9969 E9970 E9971 Injury due to war operations by fragments from person-borne improvised explosive device [IED] Injury due to war operations by fragments from vehicle-borne improvised explosive device [IED] Injury due to war operations by fragments from other improvised explosive device [IED] Injury due to war operations by fragments from weapons Injury due to war operations from other and unspecified fragments Injury due to torpedo Injury due to depth charge Injury due to marine mines Injury due to sea-based artillery shell Injury due to war operations by other marine weapons Injury due to war operations by unspecified marine weapon Injury due to war operations by aerial bomb Injury due to war operations by guided missile Injury due to war operations by mortar Injury due to war operations by person-borne improvised explosive device [IED] Injury due to war operations by vehicle-borne improvised explosive device [IED] Injury due to war operations by other improvised explosive device [IED] Injury due to war operations by unintentional detonation of own munitions Injury due to war operations by unintentional discharge of own munitions launch device Injury due to war operations by other specified explosion Injury due to war operations by unspecified explosion Injury due to war operations by destruction of aircraft due to enemy fire or explosives Injury due to war operations by unintentional destruction of aircraft due to own onboard explosives Injury due to war operations by destruction of aircraft due to collision with other aircraft Injury due to war operations by destruction of aircraft due to onboard fire Injury due to war operations by other destruction of aircraft Injury due to war operations by unspecified destruction of aircraft Injury due to war operations by unarmed hand-to-hand combat Injury due to war operations, struck by blunt object Injury due to war operations by piercing object Injury due to war operations by intentional restriction of air and airway Injury due to war operations by unintentional drowning due to inability to surface or obtain air Injury due to war operations by other forms of conventional warfare Injury due to war operations by unspecified form of conventional warfare Injury due to war operations by direct blast effect of nuclear weapon Injury due to war operations by indirect blast effect of nuclear weapon Injury due to war operations by thermal radiation effect of nuclear weapon Injury due to war operations by nuclear radiation effects Injury due to war operations by other effects of nuclear weapons Injury due to war operations by unspecified effect of nuclear weapon Injury due to war operations by lasers Injury due to war operations by biological warfare Page 29 of 54 Effective 10/1/2014

E9972 E9973 E9978 E9979 E9980 E9981 E9988 E9989 E9990 E9991 V020 V021 V022 V023 V024 V0251 V0252 V0253 V0254 V0259 V0260 V0261 V0262 V0269 V027 V028 V029 V030 V031 V032 V033 V034 V035 V036 V037 V0381 V0382 V0389 V039 V040 V041 V042 V043 Injury due to war operations by gases, fumes, and chemicals Injury due to war operations by weapon of mass destruction [WMD], unspecified Injury due to other specified forms of unconventional warfare Injury due to unspecified form of unconventional warfare Injury due to war operations but occurring after cessation of hostilities by explosion of mines Injury due to war operations but occurring after cessation of hostilities by explosion of bombs Injury due to other war operations but occurring after cessation of hostilities Injury due to unspecified war operations but occurring after cessation of hostilities Late effect of injury due to war operations Late effect of injury due to terrorism Carrier or suspected carrier of cholera Carrier or suspected carrier of typhoid Carrier or suspected carrier of amebiasis Carrier or suspected carrier of other gastrointestinal pathogens Carrier or suspected carrier of diphtheria Carrier or suspected carrier of group B streptococcus Carrier or suspected carrier of other streptococcus Carrier or suspected carrier of Methicillin susceptible Staphylococcus aureus Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus Carrier or suspected carrier of other specified bacterial diseases Viral hepatitis carrier, unspecified Hepatitis B carrier Hepatitis C carrier Other viral hepatitis carrier Carrier or suspected carrier of gonorrhea Carrier or suspected carrier of other venereal diseases Carrier or suspected carrier of other specified infectious organism Need for prophylactic vaccination and inoculation against cholera alone Need for prophylactic vaccination and innoculation against typhoid-paratyphoid alone [TAB] Need for prophylactic vaccination and inoculation against tuberculosis [BCG] Need for prophylactic vaccination and inoculation against plague Need for prophylactic vaccination and inoculation against tularemia Need for prophylactic vaccination and inoculation against diphtheria alone Need for prophylactic vaccination and inoculation against pertussis alone Need for prophylactic vaccination and inoculation against tetanus toxoid alone Other specified vaccinations against hemophilus influenza, type B [Hib] Other specified vaccinations against streptococcus pneumoniae [pneumococcus] Other specified vaccination Need for prophylactic vaccination and inoculation against unspecified single bacterial disease Need for prophylactic vaccination and inoculation against poliomyelitis Need for prophylactic vaccination and inoculation against smallpox Need for prophylactic vaccination and inoculation against measles alone Need for prophylactic vaccination and inoculation against rubella alone Page 30 of 54 Effective 10/1/2014

V044 V045 V046 V047 V0481 V0482 V0489 V050 V051 Need for prophylactic vaccination and inoculation against yellow fever Need for prophylactic vaccination and inoculation against rabies Need for prophylactic vaccination and inoculation against mumps alone Need for prophylactic vaccination and inoculation against common cold Need for prophylactic vaccination and inoculation against influenza Need for prophylactic vaccination and inoculation against respiratory syncytial virus (RSV) Need for prophylactic vaccination and inoculation against other viral diseases Need for prophylactic vaccination and inoculation against arthropod-borne viral encephalitis Need for prophylactic vaccination and inoculation against other arthropod-borne viral diseases V052 Need for prophylactic vaccination and inoculation against leishmaniasis V053 Need for prophylactic vaccination and inoculation against viral hepatitis V054 Need for prophylactic vaccination and inoculation against varicella V058 Need for prophylactic vaccination and inoculation against other specified disease V059 Need for prophylactic vaccination and inoculation against unspecified single disease V060 Need for prophylactic vaccination and inoculation against cholera with typhoid-paratyphoid [cholera + TAB] V061 Need for prophylactic vaccination and inoculation against diphtheria-tetanus-pertussis, combined [DTP] [DTaP] V062 Need for prophylactic vaccination and inocluation against diptheria-tetanus- pertussis with typhoidparatyphoid (DTP + TAB) V063 Need for prophylactic vaccination and inoculation against diptheria-tetanus- pertussis with poliomyelitis [DTP + polio] V064 Need for prophylactic vaccination and inoculation against measles-mumps-rubella (MMR) V065 Need for prophylactic vaccination and inoculation against tetanus-diphtheria [Td] (DT) V066 Need for prophylactic vaccination and inoculation against streptococcus pneumoniae [pneumococcus] and influenza V068 Need for prophylactic vaccination and inoculation against other combinations of diseases V069 Unspecified combined vaccine V070 Need for isolation V071 Need for desensitization to allergens V072 Need for prophylactic immunotherapy V0731 Need for prophylactic fluoride administration V0739 Need for other prophylactic chemotherapy V074 Hormone replacement therapy (postmenopausal) V0751 Use of selective estrogen receptor modulators (SERMs) V0752 Use of aromatase inhibitors V0759 Use of other agents affecting estrogen receptors and estrogen levels V078 Other specified prophylactic or treatment measure V079 Unspecified prophylactic or treatment measure V1000 Personal history of malignant neoplasm of gastrointestinal tract, unspecified V1001 Personal history of malignant neoplasm of tongue V1002 Personal history of malignant neoplasm of other and unspecified oral cavity and pharynx V1003 Personal history of malignant neoplasm of esophagus V1004 Personal history of malignant neoplasm of stomach Page 31 of 54 Effective 10/1/2014

V1005 V1006 V1007 V1009 V1011 V1012 V1020 V1021 V1022 V1029 V103 V1040 V1041 V1042 V1043 V1044 V1045 V1046 V1047 V1048 V1049 V1050 V1051 V1052 V1053 V1059 V1060 V1061 V1062 V1063 V1069 V1071 V1072 V1079 V1081 V1082 V1083 V1084 V1085 V1086 V1087 V1088 V1089 V1090 Personal history of malignant neoplasm of large intestine Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus Personal history of malignant neoplasm of liver Personal history of malignant neoplasm of other gastrointestinal tract Personal history of malignant neoplasm of bronchus and lung Personal history of malignant neoplasm of trachea Personal history of malignant neoplasm of respiratory organ, unspecified Personal history of malignant neoplasm of larynx Personal history of malignant neoplasm of nasal cavities, middle ear, and accessory sinuses Personal history of malignant neoplasm of other respiratory and intrathoracic organs Personal history of malignant neoplasm of breast Personal history of malignant neoplasm of female genital organ, unspecified Personal history of malignant neoplasm of cervix uteri Personal history of malignant neoplasm of other parts of uterus Personal history of malignant neoplasm of ovary Personal history of malignant neoplasm of other female genital organs Personal history of malignant neoplasm of male genital organ, unspecified Personal history of malignant neoplasm of prostate Personal history of malignant neoplasm of testis Personal history of malignant neoplasm of epididymis Personal history of malignant neoplasm of other male genital organs Personal history of malignant neoplasm of urinary organ, unspecified Personal history of malignant neoplasm of bladder Personal history of malignant neoplasm of kidney Personal history of malignant neoplasm of renal pelvis Personal history of malignant neoplasm of other urinary organs Personal history of leukemia, unspecified Personal history of lymphoid leukemia Personal history of myeloid leukemia Personal history of monocytic leukemia Personal history of other leukemia Personal history of lymphosarcoma and reticulosarcoma Personal history of hodgkin's disease Personal history of other lymphatic and hematopoietic neoplasms Personal history of malignant neoplasm of bone Personal history of malignant melanoma of skin Personal history of other malignant neoplasm of skin Personal history of malignant neoplasm of eye Personal history of malignant neoplasm of brain Personal history of malignant neoplasm of other parts of nervous system Personal history of malignant neoplasm of thyroid Personal history of malignant neoplasm of other endocrine glands and related structures Personal history of malignant neoplasm of other sites Personal history of unspecified malignant neoplasm Page 32 of 54 Effective 10/1/2014

V1091 V110 V111 V112 V113 V114 V118 V119 V1200 V1201 V1202 V1203 V1204 V1209 V121 V1221 v1229 V123 V1240 V1241 V1242 V1249 V1250 V1251 V1252 V1253 V1254 v1255 V1259 V1260 V1261 V1269 V1270 V1271 V1272 V1279 V1300 V1301 V1302 V1303 V1309 V131 V1321 Personal history of malignant neuroendocrine tumor Personal history of schizophrenia Personal history of affective disorders Personal history of neurosis Personal history of alcoholism Personal history of combat and operational stress reaction Personal history of other mental disorders Personal history of unspecified mental disorder Personal history of unspecified infectious and parasitic disease Personal history of tuberculosis Personal history of poliomyelitis Personal history of malaria Personal history of Methicillin resistant Staphylococcus aureus Personal history of other infectious and parasitic diseases Personal history of nutritional deficiency Personal history of gestational diabetes Personal history of other endocrine, metabolic, and immunity disorders Personal history of diseases of blood and blood-forming organs Personal history of unspecified disorder of nervous system and sense organs Personal history of benign neoplasm of the brain Personal history of infections of the central nervous system Personal history of other disorders of nervous system and sense organs Personal history of unspecified circulatory disease Personal history of venous thrombosis and embolism Personal history of thrombophlebitis Personal history of sudden cardiac arrest Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits Personal history of pulmonary embolism Personal history of other diseases of circulatory system Personal history of unspecified disease of respiratory system Personal history of pneumonia (recurrent) Personal history of other diseases of respiratory system Personal history of unspecified digestive disease Personal history of peptic ulcer disease Personal history of colonic polyps Personal history of other diseases of digestive system Personal history of unspecified urinary disorder Personal history of urinary calculi Personal history, urinary (tract) infection Personal history, nephrotic syndrome Personal history of other specified urinary system disorders Personal history of trophoblastic disease Personal history of pre-term labor Page 33 of 54 Effective 10/1/2014

V1322 V1323 V1324 V1329 V133 V134 V1351 V1352 V1359 V1361 V1362 V1363 V1364 V1365 V1366 V1367 V1368 V1369 V137 V1381 v1389 V139 V140 V141 V142 V143 V144 V145 V146 V147 V148 V149 V1501 V1502 V1503 V1504 V1505 V1506 V1507 V1508 V1509 V151 V1521 Personal history of cervical dysplasia Personal history of vaginal dysplasia Personal history of vulvar dysplasia Personal history of other genital system and obstetric disorders Personal history of diseases of skin and subcutaneous tissue Personal history of arthritis Personal history of pathologic fracture Personal history of stress fracture Personal history of other musculoskeletal disorders Personal history of (corrected) hypospadias Personal history of other (corrected) congenital malformations of genitourinary system Personal history of (corrected) congenital malformations of nervous system Personal history of (corrected) congenital malformations of eye, ear, face and neck Personal history of (corrected) congenital malformations of heart and circulatory system Personal history of (corrected) congenital malformations of respiratory system Personal history of (corrected) congenital malformations of digestive system Personal history of (corrected) congenital malformations of integument, limbs, and musculoskeletal systems Personal history of other (corrected) congenital malformations Personal history of perinatal problems Personal history of anaphylaxis Personal history of other specified diseases Personal history of unspecified disease Personal history of allergy to penicillin Personal history of allergy to other antibiotic agent Personal history of allergy to sulfonamides Personal history of allergy to other anti-infective agent Personal history of allergy to anesthetic agent Personal history of allergy to narcotic agent Personal history of allergy to analgesic agent Personal history of allergy to serum or vaccine Personal history of allergy to other specified medicinal agents Personal history of allergy to unspecified medicinal agent Allergy to peanuts Allergy to milk products Allergy to eggs Allergy to seafood Allergy to other foods Allergy to insects and arachnids Allergy to latex Allergy to radiographic dye Other allergy, other than to medicinal agents Personal history of surgery to heart and great vessels, presenting hazards to health Personal history of undergoing in utero procedure during pregnancy Page 34 of 54 Effective 10/1/2014

V1522 V1529 V153 V1541 V1542 V1549 V1551 V1552 V1553 V1559 V156 V157 V1580 V1581 V1582 V1583 V1584 V1585 V1586 V1587 V1588 V1589 V159 V160 V161 V162 V163 V1640 V1641 V1642 V1643 V1649 V1651 V1652 V1659 V166 V167 V168 V169 V170 V171 V172 V173 Personal history of undergoing in utero procedure while a fetus Personal history of surgery to other organs Personal history of irradiation, presenting hazards to health History of physical abuse History of emotional abuse Other psychological trauma Personal history of traumatic fracture Personal history of traumatic brain injury Personal history of retained foreign body fully removed Personal history of other injury Personal history of poisoning, presenting hazards to health Personal history of contraception, presenting hazards to health Personal history of failed moderate sedation Personal history of noncompliance with medical treatment, presenting hazards to health Personal history of tobacco use Personal history of underimmunization status Personal history of contact with and (suspected) exposure to asbestos Personal history of contact with and (suspected) exposure to potentially hazardous body fluids Personal history of contact with and (suspected) exposure to lead History of extracorporeal membrane oxygenation (ECMO) History of fall Other specified personal history presenting hazards to health Unspecified personal history presenting hazards to health Family history of malignant neoplasm of gastrointestinal tract Family history of malignant neoplasm of trachea, bronchus, and lung Family history of malignant neoplasm of other respiratory and intrathoracic organs Family history of malignant neoplasm of breast Family history of malignant neoplasm of genital organ, unspecified Family history of malignant neoplasm of ovary Family history of malignant neoplasm of prostate Family history of malignant neoplasm of testis Family history of malignant neoplasm of other Family history of malignant neoplasm of kidney Family history of malignant neoplasm, bladder Family history of malignant neoplasm of other Family history of leukemia Family history of other lymphatic and hematopoietic neoplasms Family history of other specified malignant neoplasm Family history of unspecified malignant neoplasm Family history of psychiatric condition Family history of stroke (cerebrovascular) Family history of other neurological diseases Family history of ischemic heart disease Page 35 of 54 Effective 10/1/2014

V1741 V1749 V175 V176 V177 V1781 V1789 V180 V1811 V1819 V182 V183 V184 V1851 V1859 V1861 V1869 V187 V188 V189 V190 V1911 v1919 V192 V193 V194 V195 V196 V197 V198 V200 V201 V202 V2031 V2032 V210 V211 V212 V2130 V2131 V2132 V2133 V2134 V2135 Family history of sudden cardiac death (SCD) Family history of other cardiovascular diseases Family history of asthma Family history of other chronic respiratory conditions Family history of arthritis Family history, Osteoporosis Family history, Other musculoskeletal diseases Family history of diabetes mellitus Family history of multiple endocrine neoplasia [MEN] syndrome Family history of other endocrine and metabolic diseases Family history of anemia Family history of other blood disorders Family history of mental retardation Family history of colonic polyps Family history of other digestive disorders Family history of polycystic kidney Family history of other kidney diseases Family history of other genitourinary diseases Family history of infectious and parasitic diseases Family history of genetic disease carrier Family history of blindness or visual loss Family history of glaucoma Family history of other specifed eye disorder Family history of deafness or hearing loss Family history of other ear disorders Family history of skin conditions Family history of congenital anomalies Family history of allergic disorders Family history of consanguinity Family history of other condition Health supervision of foundling Other healthy infant or child receiving care Routine infant or child health check Health supervision for newborn under 8 days old Health supervision for newborn 8 to 28 days old Period of rapid growth in childhood Puberty Other development of adolescence Low birth weight status, unspecified Low birth weight status, less than 500 grams Low birth weight status, 500-999 grams Low birth weight status, 1000-1499 grams Low birth weight status, 1500-1999 grams Low birth weight status, 2000-2500 grams Page 36 of 54 Effective 10/1/2014

V218 V219 V220 V221 V222 V230 V231 V232 V233 V2341 v2342 V2349 V235 V237 V2381 V2382 V2383 V2384 V2385 V2386 v2387 V2389 V239 V240 V241 V242 V2501 V2502 V2503 V2504 V2509 V2511 V2512 V2513 V252 V253 V2540 V2541 V2542 V2543 V2549 V255 V258 V259 Other specified constitutional states in development Unspecified constitutional state in development Supervision of normal first pregnancy Supervision of other normal pregnancy Pregnant state, incidental Supervision of high-risk pregnancy with history of infertility Supervision of high-risk pregnancy with history of trophoblastic disease Supervision of high-risk pregnancy with history of abortion Supervision of high-risk pregnancy with grand multiparity Pregnancy with history of pre-term labor Pregnancy with history of ectopic pregnancy Pregnancy with other poor obstetric history Supervision of high-risk pregnancy with other poor reproductive history Supervision of high-risk pregnancy with insufficient prenatal care Supervision of high-risk pregnancy with elderly primigravida Supervision of high-risk pregnancy with elderly multigravida Supervision of high-risk pregnancy with young primigravida Supervision of high-risk pregnancy with young multigravida Pregnancy resulting from assisted reproductive technology Pregnancy with history of in utero procedure during previous pregnancy Pregnancy with inconclusive fetal viability Supervision of other high-risk pregnancy Supervision of unspecified high-risk pregnancy Postpartum care and examination immediately after delivery Postpartum care and examination of lactating mother Routine postpartum follow-up General counseling on prescription of oral contraceptives General counseling on initiation of other contraceptive measures Encounter for emergency contraceptive counseling and prescription Counseling and instruction in natural family planning to avoid pregnancy Other general counseling and advice on contraceptive management Encounter for insertion of intrauterine contraceptive device Encounter for removal of intrauterine contraceptive device Encounter for removal and reinsertion of intrauterine contraceptive device Sterilization Menstrual extraction Contraceptive surveillance, unspecified Surveillance of contraceptive pill Surveillance of intrauterine contraceptive device Surveillance of implantable subdermal contraceptive Surveillance of other contraceptive method Insertion of implantable subdermal contraceptive Other specified contraceptive management Unspecified contraceptive management Page 37 of 54 Effective 10/1/2014

V260 V261 V2621 V2622 V2629 V2631 V2632 V2633 V2634 V2635 V2639 V2641 V2642 V2649 V2651 V2652 V2681 V2682 V2689 V269 V270 V271 V272 V273 V274 V275 V276 V277 V279 V280 V281 V282 V283 V284 V285 V286 V2881 V2882 V2889 V289 V290 V291 V292 V293 Tuboplasty or vasoplasty after previous sterilization Artificial insemination Fertility testing Aftercare following sterilization reversal Other investigation and testing Testing of female for genetic disease carrier status Other genetic testing of female Genetic counseling Testing of male for genetic disease carrier status Encounter for testing of male partner of female with recurrent pregnancy loss Other genetic testing of male Procreative counseling and advice using natural family planning Encounter for fertility preservation counseling Other procreative management, counseling and advice Tubal ligation status Vasectomy status Encounter for assisted reproductive fertility procedure cycle Encounter for fertility preservation procedure Other specified procreative management Unspecified procreative management Outcome of delivery, single liveborn Outcome of delivery, single stillborn Outcome of delivery, twins, both liveborn Outcome of delivery, twins, one liveborn and one stillborn Outcome of delivery, twins, both stillborn Outcome of delivery, other multiple birth, all liveborn Outcome of delivery, other multiple birth, some liveborn Outcome of delivery, other multiple birth, all stillborn Outcome of delivery, unspecified outcome of delivery Antenatal screening for chromosomal anomalies by amniocentesis Antenatal screening for raised alpha-fetoprotein levels in amniotic fluid Other antenatal screening based on amniocentesis Encounter for routine screening for malformation using ultrasonics Antenatal screening for fetal growth retardation using ultrasonics Antenatal screening for isoimmunization Antenatal screening for Streptococcus B Encounter for fetal anatomic survey Encounter for screening for risk of pre-term labor Other specified antenatal screening Unspecified antenatal screening Observation for suspected infectious condition Observation for suspected neurological conditions Observation and evaluation of newborn for suspected respiratory condition Observation for suspected genetic or metabolic condition Page 38 of 54 Effective 10/1/2014

V298 V299 V3000 V3001 V301 V302 V3100 V3101 V311 V312 V3200 V3201 V321 V322 V3300 V3301 V331 V332 V3400 V3401 V341 V342 V3500 V3501 V351 V352 V3600 V3601 V361 V362 V3700 V3701 V371 Observation for other specified suspected conditions Observation for unspecified suspected conditions Single liveborn, born in hospital, delivered without mention of cesarean section Single liveborn, born in hospital, delivered by cesarean section Single liveborn, born before admission to hospital Single liveborn, born outside hospital and not hospitalized Twin birth, mate liveborn, born in hospital, delivered without mention of cesarean section Twin birth, mate liveborn, born in hospital, delivered by cesarean section Twin birth, mate liveborn, born before admission to hospital Twin birth, mate liveborn, born outside hospital and not hospitalized Twin birth, mate stillborn, born in hospital, delivered without mention of cesarean section Twin birth, mate stillborn, born in hospital, delivered by cesarean section Twin birth, mate stillborn, born before admission to hospital Twin birth, mate stillborn, born outside hospital and not hospitalized Twin birth, unspecified whether mate liveborn or stillborn, born in hospital, delivered without mention of cesarean section Twin birth, unspecified whether mate liveborn or stillborn, born in hospital, delivered by cesarean section Twin birth, unspecified whether mate liveborn or stillborn, born before admission to hospital Twin birth, unspecified whether mate liveborn or stillborn, born outside hospital and not hospitalized Other multiple birth (three or more), mates all liveborn, born in hospital, delivered without mention of cesarean section Other multiple birth (three or more), mates all liveborn, born in hospital, delivered by cesarean section Other multiple birth (three or more), mates all liveborn, born before admission to hospital Other multiple birth (three or more), mates all liveborn, born outside hospital and not hospitalized Other multiple birth (three or more), mates all still born, born in hospital, delivered without mention of cesarean section Other multiple birth (three or more), mates all still born, born in hospital, delivered by cesarean section Other multiple birth (three or more), mates all stillborn, born before admission to hospital Other multiple birth (three or more), mates all stillborn, born outside of hospital and not hospitalized Other multiple birth (three or more), mates liveborn and stillborn, born in hospital, delivered without mention of cesarean section Other multiple birth (three or more), mates liveborn and stillborn, born in hospital, delivered without mention of cesarean section Other multiple birth (three or more), mates liveborn and stillborn, born before admission to hospital Other multiple birth (three or more), mates liveborn and stillborn, born outside hospital and not hospitalized Other multiple birth (three or more), unspecified whether mates liveborn or stillborn, born in hospital, delivered without mention of cesarean section Other multiple birth (three or more), unspecified whether mates liveborn or stillborn, born in hospital, delivered by cesarean section Other multiple birth (three or more), unspecified whether mates liveborn or stillborn, born before admission to hospital Page 39 of 54 Effective 10/1/2014

V372 V3900 V3901 V391 V392 V420 V421 V422 V423 V424 V425 V426 V427 V4281 V4282 V4283 V4284 V4289 V429 V430 V431 V4321 V4322 V433 V434 V435 V4360 V4361 V4362 V4363 V4364 V4365 V4366 V4369 V437 V4381 V4382 V4383 V4389 V440 V441 Other multiple birth (three or more), unspecified whether mates liveborn or stillborn, born outside of hospital Liveborn, unspecified whether single, twin or multiple, born in hospital, delivered without mention of cesarean section Liveborn, unspecified whether single, twin or multiple, born in hospital, delivered by cesarean section Liveborn, unspecified whether single, twin or multiple, born before admission to hospital Liveborn, unspecified whether single, twin or multiple, born outside hospital and not hospitalized Kidney replaced by transplant Heart replaced by transplant Heart valve replaced by transplant Skin replaced by transplant Bone replaced by transplant Cornea replaced by transplant Lung replaced by transplant Liver replaced by transplant Bone marrow replaced by transplant Peripheral stem cells replaced by transplant Pancreas replaced by transplant Organ or tissue replaced by transplant, intestines Other specified organ or tissue replaced by transplant Unspecified organ or tissue replaced by transplant Eye globe replaced by other means Lens replaced by other means Organ or tissue replaced by other means, heart assist device Organ or tissue replaced by other means, fully implantable artificial heart Heart valve replaced by other means Blood vessel replaced by other means Bladder replaced by other means Unspecified joint replacement Shoulder joint replacement Elbow joint replacement Wrist joint replacement Hip joint replacement Knee joint replacement Ankle joint replacement Other joint replacement Limb replaced by other means Larynx replacement Breast replacement Artificial skin replacement Other organ or tissue replaced by other means Tracheostomy status Gastrostomy status Page 40 of 54 Effective 10/1/2014

V442 V443 V444 V4450 V4451 V4452 V4459 V446 V447 V448 V449 V4500 V4501 V4502 V4509 V4511 V4512 V452 V453 V454 V4551 V4552 V4559 V4561 V4569 V4571 V4572 V4573 V4574 V4575 V4576 V4577 V4578 V4579 V4581 V4582 V4583 V4584 V4585 V4586 V4587 V4588 V4589 Ileostomy status Colostomy status Status of other artificial opening of gastrointestinal tract Cystostomy, unspecified Cutaneous-vesicostomy Appendico-vesicostomy Other cystostomy Other artificial opening of urinary tract status Artificial vagina status Other artificial opening status Unspecified artificial opening status Unspecified cardiac device in situ Cardiac pacemaker in situ Automatic implantable cardiac defibrillator in situ Other specified cardiac device in situ Renal dialysis status Noncompliance with renal dialysis Presence of cerebrospinal fluid drainage device Intestinal bypass or anastomosis status Arthrodesis status Presence of intrauterine contraceptive device Presence of subdermal contraceptive implant Presence of other contraceptive device Cataract extraction status Other states following surgery of eye and adnexa Acquired absence of breast and nipple Acquired absence of intestine (large) (small) Acquired absence of kidney Acquired absence of organ, other parts of urinary tract Acquired absence of organ, stomach Acquired absence of organ, lung Acquired absence of organ, genital organs Acquired absence of organ, eye Other acquired absence of organ Aortocoronary bypass status Percutaneous transluminal coronary angioplasty status Breast implant removal status Dental restoration status Insulin pump status Bariatric surgery status Transplanted organ removal status Status post administration of tpa (rtpa) in a different facility within the last 24 hours prior to admission to current facility Other postprocedural status Page 41 of 54 Effective 10/1/2014

V460 V4611 V4612 V4613 V4614 V462 V463 V468 V469 V4960 V4961 V4962 V4963 V4964 V4965 V4966 V4967 V4970 V4971 V4972 V4973 V4974 V4975 V4976 V4977 V4981 V4982 V4983 V4984 V4985 V500 V501 V502 V503 V5041 V5042 V5049 V508 V509 V510 V518 V520 V521 V522 Dependence on aspirator Dependence on respirator, status Encounter for respirator dependence during power failure Encounter for weaning from respirator [ventilator] Mechanical complication of respirator [ventilator] Other dependence on machines, supplemental oxygen Wheelchair dependence Dependence on other enabling machines Unspecified machine dependence Unspecified level upper limb amputation status Thumb amputation status Other finger(s) amputation status Hand amputation status Wrist amputation status Below elbow amputation status Above elbow amputation status Shoulder amputation status Unspecified level lower limb amputation status Great toe amputation status Other toe(s) amputation status Foot amputation status Ankle amputation status Below knee amputation status Above knee amputation status Hip amputation status Asymptomatic postmenopausal status (age-related) (natural) Dental sealant status Awaiting organ transplant status Bed confinement status Dual sensory impairment Elective hair transplant for purposes other than remedying health states Other plastic surgery for unacceptable cosmetic appearance Routine or ritual circumcision Ear piercing Prophylactic breast removal Prophylactic ovary removal Other prophylactic gland removal Other elective surgery for purposes other than remedying health states Unspecified elective surgery for purposes other than remedying health states Encounter for breast reconstruction following mastectomy Other aftercare involving the use of plastic surgery Fitting and adjustment of artificial arm (complete) (partial) Fitting and adjustment of artificial leg (complete) (partial) Fitting and adjustment of artificial eye Page 42 of 54 Effective 10/1/2014

V523 V524 V528 V529 V5301 V5302 V5309 V531 V532 V5331 V5332 V5339 V534 V5350 V5351 V5359 V536 V537 V538 V5390 V5391 V5399 V5401 V5402 V5409 V5410 V5411 V5412 V5413 V5414 V5415 V5416 V5417 V5419 V5420 V5421 V5422 V5423 V5424 V5425 V5426 V5427 V5429 V5481 Fitting and adjustment of dental prosthetic device Fitting and adjustment of breast prosthesis and implant Fitting and adjustment of other specified prosthetic device Fitting and adjustment of unspecified prosthetic device Fitting and adjustment of cerebral ventricular (communicating) shunt Fitting and adjustment of neuropacemaker (brain) (peripheral nerve) (spinal cord) Fitting and adjustment of other devices related to nervous system and special senses Fitting and adjustment of spectacles and contact lenses Fitting and adjustment of hearing aid Fitting and adjustment of cardiac pacemaker Fitting and adjustment of automatic implantable cardiac defibrillator Fitting and adjustment of other cardiac device Fitting and adjustment of orthodontic devices Fitting and adjustment of intestinal appliance and device Fitting and adjustment of gastric lap band Fitting and adjustment of other gastrointestinal appliance and device Fitting and adjustment of urinary devices Fitting and adjustment of orthopedic devices Fitting and adjustment of wheelchair Fitting and adjustment, unspecified device Fitting and adjustment of insulin pump Fitting and adjustment, other device Encounter for removal of internal fixation device Encounter for lengthening/adjustment of growth rod Other aftercare involving internal fixation device Aftercare for healing traumatic fracture of arm, unspecified Aftercare for healing traumatic fracture of upper arm Aftercare for healing traumatic fracture of lower arm Aftercare for healing traumatic fracture of hip Aftercare for healing traumatic fracture of leg, unspecified Aftercare for healing traumatic fracture of upper leg Aftercare for healing traumatic fracture of lower leg Aftercare for healing traumatic fracture of vertebrae Aftercare for healing traumatic fracture of other bone Aftercare for healing pathologic fracture of arm, unspecified Aftercare for healing pathologic fracture of upper arm Aftercare for healing pathologic fracture of lower arm Aftercare for healing pathologic fracture of hip Aftercare for healing pathologic fracture of leg, unspecified Aftercare for healing pathologic fracture of upper leg Aftercare for healing pathologic fracture of lower leg Aftercare for healing pathologic fracture of vertebrae Aftercare for healing pathologic fracture of other bone Aftercare following joint replacement Page 43 of 54 Effective 10/1/2014

v5482 V5489 V549 V550 V551 V552 V553 V554 V555 V556 V557 V558 V559 V560 V561 V562 V5631 V5632 V568 V570 V571 V5721 V5722 V573 V574 V5781 V5789 V579 V580 V5811 V5812 V582 V5830 V5831 V5832 V5841 V5842 V5843 V5844 V5849 V585 V5861 V5862 V5863 Aftercare following explantation of joint prosthesis Other orthopedic aftercare Unspecified orthopedic aftercare Attention to tracheostomy Attention to gastrostomy Attention to ileostomy Attention to colostomy Attention to other artificial opening of digestive tract Attention to cystostomy Attention to other artificial opening of urinary tract Attention to artificial vagina Attention to other specified artificial opening Attention to unspecified artificial opening Encounter for extracorporeal dialysis Fitting and adjustment of extracorporeal dialysis catheter Fitting and adjustment of peritoneal dialysis catheter Encounter for adequacy testing for hemodialysis Encounter for adequacy testing for peritoneal dialysis Encounter for other dialysis Care involving breathing exercises Care involving other physical therapy Encounter for occupational therapy Encounter for vocational therapy Care involving speech-language therapy Care involving orthoptic training Care involving orthotic training Care involving other specified rehabilitation procedure Care involving unspecified rehabilitation procedure Encounter for radiotherapy Encounter for antineoplastic chemotherapy Encounter for anitneoplastic immunotherapy Blood transfusion, without reported diagnosis Encounter for change or removal of nonsurgical wound dressing Encounter for change or removal of surgical wound dressing Encounter for removal of sutures Encounter for planned post-operative wound closure Aftercare following surgery for neoplasm Aftercare following surgery for injury and trauma Aftercare following organ transplant Other specified aftercare following surgery Orthodontics aftercare Long-term (current) use of anticoagulants Long-term (current) use of antibiotics Long-term (current) use of antiplatelet/antithrombotic Page 44 of 54 Effective 10/1/2014

V5864 V5865 V5866 V5867 v5868 V5869 V5871 V5872 V5873 V5874 V5875 V5876 V5877 V5878 V5881 V5882 V5883 V5889 V589 V5901 V5902 V5909 V591 V592 V593 V594 V595 V596 V5970 V5971 V5972 V5973 V5974 V598 V599 V600 V601 V602 V603 V604 V605 V606 V6081 V6089 Long-term (current) use of non-steroidal anti-inflammatories (NSAID) Long-term (current) use of steroids Long-term (current) use of aspirin Long-term (current) use of insulin Long-term (current) use of biphosphonates Long-term (current) use of other medications Aftercare following surgery of the sense organs, NEC Aftercare following surgery of the nervous system, NEC Aftercare following surgery of the circulatory system, NEC Aftercare following surgery of the respiratory system, NEC Aftercare following surgery of the teeth, oral cavity and digestive system, NEC Aftercare following surgery of the genitourinary system, NEC Aftercare following surgery of the skin and subcutaneous tissue, NEC Aftercare following surgery of the musculoskeletal system, NEC Fitting and adjustment of vascular catheter Fitting and adjustment of nonvascular catheter, NEC Encounter for therapeutic drug monitoring Other specified aftercare Unspecified aftercare Blood donors, whole blood Blood donors, stem cells Other blood donors Skin donors Bone donors Bone marrow donors Kidney donors Cornea donors Liver donors Egg (oocyte) (ovum) donor, unspecified Egg (oocyte) (ovum) donor, under age 35,anonymous recipient Egg (oocyte) (ovum) donor, under age 35,designated recipient Egg (oocyte) (ovum) donor, age 35 and over,anonymous recipient Egg (oocyte) (ovum) donor, age 35 and over,designated recipient Donors of other specified organ or tissue Donors of unspecified organ or tissue Lack of housing Inadequate housing Inadequate material resources Person living alone No other household member able to render care Holiday relief care Person living in residential institution Foster care (status) Other specified housing or economic circumstances Page 45 of 54 Effective 10/1/2014

V609 V6101 V6102 V6103 V6104 V6105 V6106 V6107 V6108 V6109 V6110 V6111 V6112 V6120 V6121 V6122 V6123 V6124 V6125 V6129 V613 V6141 V6142 V6149 V615 V616 V617 V618 V619 V620 V621 V6221 V6222 V6229 V623 V624 V625 V626 V6281 V6282 V6283 V6284 V6285 V6289 Unspecified housing or economic circumstance Family disruption due to family member on military deployment Family disruption due to return of family member from military deployment Family disruption due to divorce or legal separation Family disruption due to parent-child estrangement Family disruption due to child in welfare custody Family disruption due to child in foster care or in care of non-parental family member Family disruption due to death of family member Family disruption due to other extended absence of family member Other family disruption Counseling for marital and partner problems, unspecified Counseling for victim of spousal and partner abuse Counseling for perpetrator of spousal and partner abuse Counseling for parent-child problem, unspecified Counseling for victim of child abuse Counseling for perpetrator of spousal and partner abuse Counseling for parent-biological child problem Counseling for parent-adopted child problem Counseling for parent (guardian)-foster child problem Other parent-child problems Problems with aged parents or in-laws Alcoholism in family Substance abuse in family Other health problems within the family Multiparity Illegitimacy or illegitimate pregnancy Other unwanted pregnancy Other specified family circumstances Unspecified family circumstance Unemployment Adverse effects of work environment Personal current military deployment status Personal history of return from military deployment Other occupational circumstances or maladjustment Educational circumstances Social maladjustment Legal circumstances Refusal of treatment for reasons of religion or conscience Interpersonal problems, not elsewhere classified Bereavement, uncomplicated Counseling for perpetrator of physical/sexual abuse Suicidal ideation Homicidal ideation Other psychological or physical stress, not elsewhere classified Page 46 of 54 Effective 10/1/2014

V629 V6400 V6401 V6402 V6403 V6404 V6405 V6406 V6407 V6408 V6409 V641 V642 V643 V6441 V6442 V6443 V650 V6511 V6519 V652 V653 V6540 V6541 V6542 V6543 V6544 V6545 V6546 V6549 V655 V658 V659 V660 V661 V662 V663 V664 V665 V666 V667 V669 V6700 V6701 Unspecified psychosocial circumstance Vaccination not carried out, unspecified reason Vaccination not carried out because of acute illness Vaccination not carried out because of chronic illness or condition Vaccination not carried out because of immune compromised state Vaccination not carried out because of allergy to vaccine or component Vaccination not carried out because of caregiver refusal Vaccination not carried out because of patient refusal Vaccination not carried out for religious reasons Vaccination not carried outbecause patient had disease being vaccinated against Vaccination not carried out for other reason Surgical or other procedure not carried out because of contraindication Surgical or other procedure not carried out because of patient's decision Procedure not carried out for other reasons Laparoscopic surgical procedure coverted to open procedure Thoracoscopic surgical procedure converted to open procedure Arthroscopic surgical procedure converted to open procedure Healthy person accompanying sick person Pediatric pre-birth visit for expectant parent(s) Other person consulting on behalf of another person Person feigning illness Dietary surveillance and counseling Counseling NOS Exercise counseling Counseling on substance use and abuse Counseling on injury prevention Human immunodeficiency virus (HIV) counseling Counseling on other sexually transmitted diseases Encounter for insulin pump training Other specified counseling Person with feared complaint in whom no diagnosis was made Other reasons for seeking consultation Unspecified reason for consultation Convalescence following surgery Convalescence following radiotherapy Convalescence following chemotherapy Convalescence following psychotherapy and other treatment for mental disorder Convalescence following treatment of fracture Convalescence following other treatment Convalescence following combined treatment Encounter for palliative care Unspecified convalescence Follow-up examination, following surgery, unspecified Following surgery, follow-up vaginal pap smear Page 47 of 54 Effective 10/1/2014

V6709 V671 V672 V673 V674 V6751 V6759 V676 V679 V6801 V6809 V681 V682 V6881 V6889 V689 V690 V691 V692 V693 V694 V695 V698 V699 V700 V701 V702 V703 V704 V705 V706 V707 V708 V709 V7101 V7102 V7109 V711 V712 V713 V714 V715 V716 Follow-up examination, following other surgery Follow-up examination, following radiotherapy Follow-up examination, following chemotherapy Follow-up examination, following psychotherapy and other treatment for mental disorder Follow-up examination, following treatment of healed fracture Follow-up examination, following completed treatment with high-risk medication, not elsewhere classified Other follow-up examination Follow-up examination, following combined treatment Unspecified follow-up examination Disability examination Other issue of medical certificates Issue of repeat prescriptions Request for expert evidence Referral of patient without examination or treatment Encounters for other specified administrative purpose Encounters for unspecified administrative purpose Lack of physical exercise Inappropriate diet and eating habits High-risk sexual behavior Gambling and betting Lack of adequate sleep Behavioral insomnia of childhood Other problems related to lifestyle Unspecified problem related to lifestyle Routine general medical examination at a health care facility General psychiatric examination, requested by the authority General psychiatric examination, other and unspecified Other general medical examination for administrative purposes Examination for medicolegal reasons Health examination of defined subpopulations Health examination in population surveys Examination of participant in clinical trial Other specified general medical examinations Unspecified general medical examination Observation for adult antisocial behavior Observation for childhood or adolescent antisocial behavior Observation for other suspected mental condition Observation for suspected malignant neoplasm Observation for suspected tuberculosis Observation following accident at work Observation following other accident Observation following alleged rape or seduction Observation following other inflicted injury Page 48 of 54 Effective 10/1/2014

V717 V7181 V7182 V7183 V7189 V719 V720 V7211 V7212 V7219 V722 V7231 V7232 V7240 V7241 V7242 V725 V7260 V7261 V7262 V7263 V7269 V727 V7281 V7282 V7283 V7284 V7285 V7286 V729 V730 V731 V732 V733 V734 V735 V736 V7381 V7388 V7389 V7398 V7399 V740 Observation for suspected cardiovascular disease Observation and evaluation for suspected abuse and neglect Observation and evaluation for suspected exposure to anthrax Observation and evaluation for suspected exposure to other biological agent Observation and evaluation for other specified suspected conditions Observation for unspecified suspected condition Examination of eyes and vision Encounter for hearing examination following failed hearing screening Encounter for hearing conservation and treatment Other examination of ears and hearing Dental examination Routine gynecological examination Encounter for Papanicolaou cervical smear to confirm findings of recent normal smear following initial abnormal smear Pregnancy examination or test, pregnancy unconfirmed Pregnancy examination or test, negative result Pregnancy examination or test, positive result Radiological examination, not elsewhere classified Laboratory examination, unspecified Antibody response examination Laboratory examination ordered as part of a routine general medical examination Pre-procedural laboratory examination Other laboratory examination Diagnostic skin and sensitization tests Pre-operative cardiovascular examination Pre-operative respiratory examination Other specified pre-operative examination Pre-operative examination, unspecified Other specified examination Encounter for blood typing Unspecified examination Screening examination for poliomyelitis Screening examination for smallpox Screening examination for measles Screening examination for rubella Screening examination for yellow fever Screening examination for other arthropod-borne viral diseases Screening examination for trachoma Special screening examination for Human papillomavirus (HPV) Special screening examination for other specified chlamydial diseases Special screening examination for other specified viral diseases Special screening examination for unspecified chlamydial disease Special screening examination for unspecified viral disease Screening examination for cholera Page 49 of 54 Effective 10/1/2014

V741 V742 V743 V744 V745 V746 V748 V749 V750 V751 V752 V753 V754 V755 V756 V757 V758 V759 V760 V7610 V7611 V7612 V7619 V762 V763 V7641 V7642 V7643 V7644 V7645 V7646 V7647 V7649 V7650 V7651 V7652 V7681 V7689 V769 V770 V771 V772 V773 V774 Screening examination for pulmonary tuberculosis Screening examination for leprosy (Hansen's disease) Screening examination for diphtheria Screening examination for bacterial conjunctivitis Screening examination for venereal disease Screening examination for yaws Screening examination for other specified bacterial and spirochetal diseases Screening examination for unspecified bacterial and spirochetal diseases Screening examination for rickettsial diseases Screening examination for malaria Screening examination for leishmaniasis Screening examination for trypanosomiasis Screening examination for mycotic infections Screening examination for schistosomiasis Screening examination for filariasis Screening examination for intestinal helminthiasis Screening examination for other specified parasitic infections Screening examination for unspecified infectious disease Special screening for malignant neoplasms of respiratory organs Breast screening, unspecified Screening mammogram for high-risk patient Other screening mammogram Other screening breast examination Screening for malignant neoplasms of cervix Screening for malignant neoplasms of bladder Screening for malignant neoplasms of rectum Screening for malignant neoplasms of oral cavity Screening for malignant neoplasms of skin Screening for malignant neoplasms of prostate Screening for malignant neoplasms of testis Special screening for malignant neoplasms of ovary Special screening for malignant neoplasms of vagina Special screening for malignant neoplasms of other sites Special screening for malignant neoplasms for intestine, unspecified Special screening for malignant neoplasms of colon Special screening for malignant neoplasms of small intestine Special screening for malignant neoplasms of nervous system Special screening for other malignant neoplasms Special screening for unspecified malignant neoplasms Screening for thyroid disorders Screening for diabetes mellitus Screening for malnutrition Screening for phenylketonuria (PKU) Screening for galactosemia Page 50 of 54 Effective 10/1/2014

V775 V776 V777 V778 V7791 V7799 V780 V781 V782 V783 V788 V789 V790 V791 V792 V793 V798 V799 V8001 V8009 V801 V802 V803 V810 V811 V812 V813 V814 V815 V816 V820 V821 V822 V823 V824 V825 V826 V8271 V8279 V8281 V8289 V829 V8301 V8302 Screening for gout Screening for cystic fibrosis Screening for other inborn errors of metabolism Screening for obesity Screening for lipoid disorders Screening for other and unspecified endocrine, nutritional, metabolic, and immunity disorders Screening for iron deficiency anemia Screening for other and unspecified deficiency anemia Screening for sickle-cell disease or trait Screening for other hemoglobinopathies Screening for other disorders of blood and blood-forming organs Screening for unspecified disorder of blood and blood-forming organs Screening for depression Screening for alcoholism Screening for mental retardation Screening for developmental handicaps in early childhood Screening for other specified mental disorders and developmental handicaps Screening for unspecified mental disorder and developmental handicap Special screening for traumatic brain injury Special screening for other neurological conditions Screening for glaucoma Screening for other eye conditions Screening for ear diseases Screening for ischemic heart disease Screening for hypertension Screening for other and unspecified cardiovascular conditions Screening for chronic bronchitis and emphysema Screening for other and unspecified respiratory conditions Screening for nephropathy Screening for other and unspecified genitourinary conditions Screening for skin conditions Screening for rheumatoid arthritis Screening for other rheumatic disorders Screening for congenital dislocation of hip Maternal postnatal screening for chromosomal anomalies Screening for chemical poisoning and other contamination Multiphasic screening Screening for genetic disease carrier status Other genetic screening Special screening for osteoporosis Special screening for other specified conditions Screening for unspecified condition Asymptomatic hemophilia A carrier Symptomatic hemophilia A carrier Page 51 of 54 Effective 10/1/2014

V8381 V8389 V8401 V8402 V8403 V8404 V8409 V8481 V8489 V850 V851 V8521 V8522 V8523 V8524 V8525 V8530 V8531 V8532 V8533 V8534 V8535 V8536 V8537 V8538 V8539 V8541 V8542 V8543 V8544 V8545 V8551 V8552 V8553 V8554 V860 V861 V8732 V8741 V8742 V8743 V8744 V8745 V8746 Cystic fibrosis gene carrier Other genetic carrier status Genetic susceptibility to malignant neoplasm of breast Genetic susceptibility to malignant neoplasm of ovary Genetic susceptibility to malignant neoplasm of prostate Genetic susceptibility to malignant neoplasm of endometrium Genetic susceptibility to other malignant neoplasm Genetic susceptibility to multiple endocrine neoplasia [MEN] Genetic susceptibility to other disease Body Mass Index less than 19, adult Body Mass Index between 19-24, adult Body Mass Index 25.0-25.9, adult Body Mass Index 26.0-26.9, adult Body Mass Index 27.0-27.9, adult Body Mass Index 28.0-28.9, adult Body Mass Index 29.0-29.9, adult Body Mass Index 30.0-30.9, adult Body Mass Index 31.0-31.9, adult Body Mass Index 32.0-32.9, adult Body Mass Index 33.0-33.9, adult Body Mass Index 34.0-34.9, adult Body Mass Index 35.0-35.9, adult Body Mass Index 36.0-36.9, adult Body Mass Index 37.0-37.9, adult Body Mass Index 38.0-38.9, adult Body Mass Index 39.0-39.9, adult Body Mass Index 40.0-44.9, adult Body Mass Index 45.0-49.9, adult Body Mass Index 50.0-59.9, adult Body Mass Index 60.0-69.9, adult Body Mass Index 70 and over, adult Body Mass Index, pediatric, less than 5th percentile for age Body Mass Index, pediatric, 5th percentile to less than 85th percentile for age Body Mass Index, pediatric, 85th percentile to less than 95th percentile for age Body Mass Index, pediatric, greater than or equal to 95th percentile for age Estrogen receptor positive status [ER+] Estrogen receptor negative status [ER-] Contact with and (suspected) exposure to algae bloom Personal history of antineoplastic chemotherapy Personal history of monoclonal drug therapy Personal history of estrogen therapy Personal history of inhaled steroid therapy Personal history of systemic steroid therapy Personal history of immunosuppressive therapy Page 52 of 54 Effective 10/1/2014

V8749 V8801 V8802 V8803 V8811 V8812 v8821 V8822 V8829 V8901 V8902 V8903 V8904 V8905 V8909 V9001 V9009 V9010 V9011 V9012 V902 V9031 V9032 V9033 V9039 V9081 V9083 V9089 V909 V9100 V9101 V9102 V9103 V9109 V9110 V9111 V9112 V9119 V9120 V9121 V9122 V9129 Personal history of other drug therapy Acquired absence of both cervix and uterus Acquired absence of uterus with remaining cervical stump Acquired absence of cervix with remaining uterus Acquired total absence of pancreas Acquired partial absence of pancreas Acquired absence of hip joint Acquired absence of knee joint Acquired absence of other joint Suspected problem with amniotic cavity and membrane not found Suspected placental problem not found Suspected fetal anomaly not found Suspected problem with fetal growth not found Suspected cervical shortening not found Other suspected maternal and fetal condition not found Retained depleted uranium fragments Other retained radioactive fragments Retained metal fragments, unspecified Retained magnetic metal fragments Retained nonmagnetic metal fragments Retained plastic fragments Retained animal quills or spines Retained tooth Retained wood fragments Other retained organic fragments Retained glass fragments Retained stone or crystalline fragments Other specified retained foreign body Retained foreign body, unspecified material Twin gestation, unspecified number of placenta, unspecified number of amniotic sacs Twin gestation, monochorionic/monoamniotic (one placenta, one amniotic sac) Twin gestation, monochorionic/diamniotic (one placenta, two amniotic sacs) Twin gestation, dichorionic/diamniotic (two placentae, two amniotic sacs) Twin gestation, unable to determine number of placenta and number of amniotic sacs Triplet gestation, unspecified number of placenta and unspecified number of amniotic sacs Triplet gestation, with two or more monochorionic fetuses Triplet gestation, with two or more monoamniotic fetuses Triplet gestation, unable to determine number of placenta and number of amniotic sacs Quadruplet gestation, unspecified number of placenta and unspecified number of amniotic sacs Quadruplet gestation, with two or more monochorionic fetuses Quadruplet gestation, with two or more monoamniotic fetuses Quadruplet gestation, unable to determine number of placenta and number of amniotic sacs Page 53 of 54 Effective 10/1/2014

V9190 V9191 V9192 V9199 Other specified multiple gestation, unspecified number of placenta and unspecified number of amniotic sacs Other specified multiple gestation, with two or more monochorionic fetuses Other specified multiple gestation, with two or more monoamniotic fetuses Other specified multiple gestation, unable to determine number of placenta and number of amniotic sacs Page 54 of 54 Effective 10/1/2014