NATIONAL PRESCRIPTION DRUG PLAN Formulary Supplement Plan ICD-9 Diagnosis... · NATIONAL PRESCRIPTION DRUG PLAN Formulary Supplement ... Diagnosis Codes for Benign Prostate Hypertrophy

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NATIONAL PRESCRIPTION DRUG PLAN Formulary Supplement

ICD-9 Diagnosis Code Reference 2012 - 2013

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TABLE OF CONTENTS

PREFACE ............................................................................................... 3

Diagnosis Codes for Arthritis ............................................................... 4

Diagnosis Codes for Asthma ................................................................ 6

Diagnosis Codes for Benign Prostate Hypertrophy ............................. 7

Diagnosis Codes for Cancer - (Breast & Prostate) .............................. 8

Diagnosis Codes for Diabetes............................................................ 10

Diagnosis Codes for Epilepsy ............................................................. 12

Diagnosis Codes for Glaucoma ......................................................... 13

Diagnosis Codes for Hypercholesterolemia ...................................... 16

Diagnosis Codes for Hypertension .................................................... 17

Diagnosis Codes for Ischaemic Disease ........................................... 19

Diagnosis Codes for Sickle Cell Anemia ............................................ 41

Diagnosis Codes for Thyroid Disease ................................................ 42

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PREFACE

The National Prescription Drug Plan (NPDP) is committed to providing accountable and pertinent information to all health care providers in The Bahamas. This supplementary booklet serves as a reference guide for physicians, nurses and other relevant staff of health care facilities who may assist in completing the NPDP Registration Forms for patients. The information provided in this supplementary booklet is derived from the 2012 ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification). It details the recommended ICD-9-CM codes for the 2012-2013 NPDP Chronic Conditions which include: Arthritis, Asthma, Benign Prostate Cancer (BPH), Cancer (Breast and Prostate), Diabetes, Epilepsy, Glaucoma, Hypercholesterolemia, Hypertension, Ischaemic Disease, Psychiatric Illness, Sickle Cell Anemia and Thyroid Disease.

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Diagnosis Codes for Arthritis

Code Description

714.0 Rheumatoid arthritis (excludes juvenile arthritis) Requires *5th digit subclassification as noted in brackets: (e.g. 715.01) 0 - site unspecified 1 - shoulder region 2 - upper arm 3 - forearm 4 - hand 5 - pelvic region and thigh 6 - lower leg 7 - ankle and foot 8 - other specified sites 9 - multiple sites

714.1 Felty’s syndrome (rheumatoid arthritis w/ splenoadenomegaly & leukopenia)

714.2 Other rheumatoid arthritis with visceral of systemic involvement (rheumatoid carditis)

714.3 Juvenile chronic polyarthritis

714.30 Polyarticular juvenile rheumatoid arthritis, chronic or unspecified (Still’s disease)

714.31 Polyarticular juvenile rheumatoid arthritis, acute

714.32 Pauciarticular juvenile rheumatoid arthritis

714.33 Monoarticular juvenile rheumatoid arthritis

714.4 Chronic post-rheumatic arthropathy

714.8 Other specified inflammatory polyarthopathies

714.81 Rheumatoid lung (Caplan’s syndrome)

715 Osteoarthrosis and allied disorders

*715.0 (0,4,9)

Osteoarthrosis, generalized (Degenerative joint disease, involving multiple joints)

*715.1 (0-8)

Osteoarthrosis, localized, primary (Localized osteoarthropathy, idiopathic)

*715.2 (0-8)

Osteoarthrosis, localized, secondary (Coxae malum senilis)

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Code Description

*715.3 (0-8)

Osteoarthrosis, localized, not specified whether primary or secondary

*715.8 (0,9)

Osteoarthosis involving, or with mention of more than one site, but not specified as generalized

*715.9 (0-8)

Osteoarthosis, unspecified whether generalized or localized

*716.2 (0-9) Allergic arthritis

*716.3 (0-9) Climacteric arthritis (Menopausal arthritis)

*716.5 (0-9) Unspecified polyarthropathy or polyarthritis

*716.6 (0-8) Unspecified monoarthritis

*716.8 (0-9) Other specified arthropathy

*716.9 (0-9) Arthropathy, unspecified (acute, chronic,subacute)

274 Gout

274.0 Gouty arthropathy

274.00 Gouty arthropathy, unspecified

274.01 Acute gouty arthropathy

274.1 Gouty nephropathy

274.10 Gout nephropathy, unspecified

274.11 Uric acid nephrolithiasis

274.9 Gout, unspecified

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Diagnosis Codes for Asthma

Code Description

493 Asthma (excludes wheezing) Requires *5th digit subclassification as noted in brackets: (e.g. 493.00) 0 - unspecified 1 - with status asthmaticus 2 - with (acute) exacerbation

*493.0 (0-2) Extrinsic asthma

*493.1 (0-2) Intrinsic asthma

*493.2 (0-2) Chronic obstructive asthma

493.8 Other forms of asthma

493.81 Exercise induced bronchospasm

493.82 Cough variant asthma

*493.9 (0-2) Asthma, unspecified

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Diagnosis Codes for Benign Prostate Hypertrophy (BPH)

Code Description

600 Hypertrophy (benign) of prostate

600.00 Hypertrophy (benign) of prostate without urinary obstruction and other lower tract symptoms (LUTS)

600.01 Hypertrophy (benign) of prostate with urinary obstruction and other lower tract symptoms (LUTS)

600.1 Nodular prostate

600.10 Nodular prostate without urinary obstruction

600.11 Nodular prostate with urinary obstruction

600.2 Benign localized hyperplasia of prostate

600.20 Benign localized hyperplasia of prostate without urinary obstruction and other lower urinary tract symptoms (LUTS)

600.21 Benign localized hyperplasia of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS)

600.3 Cyst of prostate

600.9 Hyperplasia of prostate, unspecified

600.90 Hyperplasia of prostate, unspecified, without urinary obstruction and other lower urinary tract symptoms

600.91 Hyperplasia of prostate, unspecified, with urinary obstruction and other lower urinary tract symptoms

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Diagnosis Codes for Cancer - (Breast & Prostate)

Breast Cancer:

Code Description

174 Malignant neoplasm of female breast (excludes skin of breast)

174.0 • Nipple and areola

174.1 • Central portion

174.2 • Upper-inner quadrant

174.3 • Lower-inner quadrant

174.4 • Upper-outer quadrant

174.5 • Lower-outer quadrant

174.6 • Axillary tail

174.8 Other specified sites of female breast

174.9 Breast (female), unspecified

175 Malignant neoplasm of male breast (excludes skin of breast)

175.0 • Nipple and areola

175.9 • Other specified sites of male breast

233 Carcinoma in situ of breast and genitourinary system

233.0 Carcinoma in situ of breast

239.3 Neoplasm of breast

198.8 Other specified sites (secondary malignant)

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198.81 • Breast

Prostate Cancer:

Code Description

185 Malignant neoplasm of prostate

198.82 Secondary malignant neoplasm of genital organ (includes prostate)

222.2 Benign neoplasm of prostate

233 Carcinoma in situ of breast and genitourinary system (Breast)

233.4 Carcinoma in situ of prostate

236.5 Neoplasm of uncertain behavior of genitourinary organs (Prostate)

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Diagnosis Codes for Diabetes

Code Description

*249 Secondary diabetes mellitus

Requires *4th or *5th digit subclassification as noted in brackets: (e.g. 250.1 or 250.01) 1 - type 1 (juvenile type), not stated as uncontrolled 2 - type 2 or unspecified type, uncontrolled 3 - type 1 (juvenile type), uncontrolled

*249.0 (0-1) Secondary diabetes mellitus without mention of complication

*249.1 (0-1) Secondary diabetes mellitus with ketoacidosis

*249.2 (0-1) Secondary diabetes mellitus with hyperosmolarity

*249.3 (0-1) Secondary diabetes mellitus with other coma (excludes hyperosmolar coma)

*249.4 (0-1) Secondary diabetes mellitus with renal manifestations

*249.5 (0-1) Secondary diabetes mellitus with opthalmic manifestations

*249.6 (0-1) Secondary diabetes mellitus with neurological manifestations

*249.7 (0-1) Secondary diabetes mellitus with peripheral circulatory disorders

*249.8 (0-1) Secondary diabetes mellitus with other specified manifestations

*249.9 (0-1) Secondary diabetes mellitus with unspecified complication

*250 Diabetes mellitus

*250.0 Diabetes mellitus without mention of complication

*250.1 (0-3) Diabetes with ketoacidosis

*250.2 (0-3) Diabetes with hyperosmolarity

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Code Description

*250.3 (0-3) Diabetes with other coma (excludes diabetes with hyperosmolarity coma)

*250.4 (0-3) Diabetes with renal manifestations

*250.5 (0-3) Diabetes with ophthalmic manifestations

*250.6 (0-3) Diabetes with neurological manifestations

*250.7 (0-3) Diabetes with peripheral circulatory disorders

*250.8 (0-3) Diabetes with other specified manifestations

*250.9 (0-3) Diabetes with unspecified complication

251 Other disorders of pancreatic internal secretion

251.0 Hypoglycemic coma

251.1 Other specified hypoglycemia: Hyperinsulinism; Hyperplasia of pancreatic islet beta cells NOS

251.2 Hypoglycemia, unspecified

251.3 Postsurgical hypoinsulinemia

251.4 Abnormality of secretion of glucagon

251.5 Abnormality of secretion of gastrin

251.8 Other specified disorders of pancreatic internal secretion

251.9 Unspecified disorder of pancreatic internal secretion

253.5 Diabetes insipidus

271.4 Renal glycosuria (renal diabetes)

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Diagnosis Codes for Epilepsy

Code Description

345 Epilepsy and recurrent seizures

Requires * 4th or *5th digit subclassification as noted in brackets: (e.g. 345.1, 345.11) 0 – without mention of intractable epilepsy 1 - with intractable epilepsy

*345.0 (0,1) Generalized non-convulsive epilepsy

*345.1 (0,1) Generalized convulsive epilepsy

*345.2 (0,1) Petit mal status

*345.3 (0,1) Grand mal status

*345.4 (0,1) Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures

*345.5 (0,1) Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures

*345.6 (0,1) Infantile spasms

*345.7 (0,1) Epilepsia partialis continua

*345.8 (0,1) Other forms of epilepsy and recurrent seizures

*345.9 (0,1) Epilepsy, unspecified

780.3 Convulsions

780.31 Febrile convulsions (simple), unspecified

780.32 Complex febrile convulsions

780.33 Post traumatic seizures

780.39 Other convulsions (Fits NOS, Recurrent convulsions NOS, Seizures NOS, Convulsive disorder NOS)

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Diagnosis Codes for Glaucoma

Code Description

365 Glaucoma (excludes absolute glaucoma)

365.0 Borderline glaucoma (glaucoma suspect)

365.00 Pre-glaucoma, unspecified

365.01 Open angle with borderline findings

365.02 Anatomical narrow angle

365.03 Steroid responders

365.04 Ocular hypertension

365.1 Open angle glaucoma

365.10 Open angle glaucoma, unspecified

365.11 Primary open angle glaucoma

365.12 Low tension glaucoma

365.13 Pigmentary glaucoma

365.14 Glaucoma of childhood

365.15 Residual stage of open angle glaucoma

365.2 Primary angle-closure glaucoma

365.20 Primary angle-closure glaucoma, unspecified

365.21 Intermittent angle-closure glaucoma

365.22 Acute angle-closure glaucoma

365.23 Chronic angle-closure glaucoma

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Code Description

365.24 Residual stage of angle-closure glaucoma

365.3 Corticosteroid-induced glaucoma

365.31 • Glaucomatous stage

365.32 • Residual stage

365.4 Glaucoma associated with congenital anomalies, dystrophies, and systemic syndromes

365.41 Glaucoma associated with chamber angle anomalies

365.42 Glaucoma associated with anomalies of iris

365.43 Glaucoma associated with other anterior segment anomalies

(250.00) Glaucoma associated with systemic syndromes (diabetes)

365.44

365.5 Glaucoma associated with disorders of the lens

365.51 Phacolytic glaucoma

365.52 Pseudo-exfoliation glaucoma

365.59 Glaucoma associated with other lens disorders

365.6 Glaucoma associated with other ocular disorders

365.60 Glaucoma associated with unspecified ocular disorders

365.61 Glaucoma associated with pupillary block

365.62 Glaucoma associated with ocular inflammation

365.63 Glaucoma associated vascular disorders

365.64 Glaucoma associated with tumors or cysts

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Code Description

365.65 Glaucoma associated with ocular trauma

365.7 Glaucoma stage

365.70 Glaucoma stage, unspecified

365.71 Mild stage glaucoma

365.72 Moderate stage glaucoma

365.73 Severe stage glaucoma

365.74 Indeterminate stage glaucoma

365.8 Other specified forms of glaucoma

365.81 Hypersecretion of glaucoma

365.82 Glaucoma with increased episcleral venous pressure

365.83 Aqueous misdirection (malignant glaucoma)

365.89 Other specified glaucoma

365.9 Unspecified glaucoma

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Diagnosis Codes for Hypercholesterolemia

Code Description

272 Disorders of lipid metabolism

272.0 Pure hypercholesterolemia

272.1 Pure hyperglyeridemia

272.2 Mixed hyperlipidemia

272.3 Hyperchylomicronemia

272.4 Other and unspecified hyperlipidemia

272.5 Lipoprotein deficiencies

272.6 Lipodystrophy

272.7 Lipidoses

272.8 Other disorders of lipoid metabolism

272.9 Unspecified disorder of lipoid metabolism

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Diagnosis Codes for Hypertension

Code Description

401 Essential hypertension

Requires *4th or *5th digit sub-classification as noted in brackets: (e.g. 404.2, 404.91) 0 - without heart failure and with chronic kidney disease stage 1 thru 4 or specified 1 - with heart failure and with chronic kidney disease stage 1 thru 4 or specified

401.0 • Malignant (Severe high arterial BP possibly resulting in necrosis)

401.1 • Benign (Mildly elevated arterial blood pressure)

402 Hypertensive heart disease

402.0 • Malignant

402.00 >> without heart failure

402.01 >> with heart failure

402.1 • Benign



402.9 Unspecified hypertension (Cardiomegaly, cardiopathy, CV disease, heart disease failure)



*403 Hypertensive chronic kidney disease

*403.0 (0,1) Malignant chronic kidney disease

*403.1 (0,1) Benign chronic kidney disease

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Code Description

*403.9 (0,1) Unspecified chronic kidney disease

*404 (0-3) Hypertensive heart and chronic kidney disease

*404.0 (0-3) • Malignant

*404.1 (0-3) • Benign

*404.9 (0-3) • Unspecified

405 Secondary hypertension (High arterial BP due to primary diseases eg. Renal disorders)

405.0 Malignant secondary hypertension

405.01 • Renovascular

405.09 • Other

405.1 Benign secondary hypertension


405.19 • Other

405.9 Unspecified secondary hypertension


405.99 • Other

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Diagnosis Codes for Ischaemic Disease

Code Description

*410 Acute myocardial infarction

*Requires 5th digit classification as noted in brackets: (e.g. 410.02, 410.61)* 0 – episode of care unspecified 1 – initial episode of care 2 – subsequent episode of care

*410.0 • Of anterolateral wall

*410.1 • Of other anterior wall

*410.2 • Of inferolateral wall

*410.3 • Of inferoposterior wall

*410.4 • Of other inferior wall (diagphragmatic wall NOS)

*410.5 • Of other lateral wall (apical-lateral; basal lateral; high lateral; posterolateral)

*410.6 True posterior wall infarction

*410.7 Subendocardial infarction

*410.8 Of other specified sites (atrium, papillary muscle, septum alone)

*410.9 Unspecified site (acute myocardial infarction NOS, coronary occlusion NOS, myocardial infarction NOS)

411 Other acute and subacute forms of ischemic heart disease

411.0 Postmyocardial infarction syndrome

411.1 Intermediate coronary syndrome (impending infarction, pre-infarction angina, pre-infarction syndrome, unstable angina)

411.81 Acute coronary occlusion without myocardial infarction

411.89 Other (coronary insufficiency (acute)); subendocardial ischaemia

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Code Description

412 Old myocardial infarction

413 Angina pectoris

413.0 Angina decubitus (nocturnal angina)

413.1 Prinzmetal angina (variant angina pectoris)

413.9 Other and unspecified angina pectoris (angina syndrome, status anginosus, stenocardia, syncope anginosa)

414 Other forms of chronic ischemic heart disease

414.0 Coronary atherosclerosis

414.00 Of unspecified type of vessel, native or graft

414.01 Of native coronary artery

414.02 Of autologous vein bypass graft

414.03 Of nonautologous biological bypass graft

414.04 Of artery bypass graft

414.05 Of unspecified type of bypass graft

414.06 Of native coronary artery of transplanted heart

414.07 Of bypass graft (artery) (vein) of transplanted heart

414.1 Aneurysm and dissection of heart

414.10 Aneurysm of heart (wall)

414.11 Aneurysm of coronary vessels

414.12 Dissection of coronary artery

414.19 Other aneurysm of heart

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Code Description

414.2 Chronic total occlusion of coronary artery

414.3 Coronary atherosclerosis due to lipid rich plaque

414.8 Other specified forms of chronic ischemic heart disease

414.9 Chronic ischemic heart disease, unspecified

415 Acute pulmonary heart disease

415.0 Acute cor pulmonale

415.1 Pulmonary embolism and infarction

415.11 Iatrogenic pulmonary embolism and infarction

415.12 Septic pulmonary embolism

415.13 Saddle embolus of pulmonary artery

416 Chronic pulmonary heart disease

416.0 Primary pulmonary hypertension

416.1 Kyphoscoliotic heart disease

416.2 Chronic pulmonary embolism

416.8 Other chronic pulmonary heart disease

416.9 Chronic pulmonary heart disease, unspecified

417 Other diseases of pulmonary circulation

417.0 Arteriovenous fistula of pulmonary vessels

417.1 Aneurysm of pulmonary artery

417.8 Other specified diseases of pulmonary circulation

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Code Description

417.9 Unspecified disease of pulmonary circulation

427 Cardiac disrhythmias

427.0 Paroxysmal supraventricular tachycardia

427.1 Paroxysmal ventricular tachycardia

427.2 Paroxysmal tachycardia, unspecified

427.3 Atrial fibrillation and flutter

427.31 Atrial fibrillation

427.32 Atrial flutter

427.4 Ventricular fibrillation and flutter

427.41 Ventricular fibrillation

427.42 Ventricular flutter

427.5 Cardiac arrest

427.6 Premature beats

427.60 Premature beats, unspecified

427.61 Supraventricula premature beats

427.69 Other (Ventricular premature beats, contractions or systoles)

427.8 Other specified cardiac dysrhythmias

427.81 Sinoatrial node dysfunction

427.89 Other (Rhythm disorder: coronary sinus, ectopic or nodal; wandering (atrial) pacemaker)

427.9 Cardiac dysrhythmia, unspecified

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Code Description

428 Heart failure

428.0 Congestive heart failure, unspecified

428.1 Left heart failure

428.2 Systolic heart failure

428.20 • Unspecified

428.21 • Acute

428.22 • Chronic

428.23 • Acute on chronic

428.3 Diastolic heart failure


428.31 • Acute

428.32 • Chronic


428.4 Combined systolic and diastolic heart failure


428.41 • Acute

428.42 • Chronic


428.9 Heart failure, unspecified

429 Ill-defined descriptions and complications of heart disease

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Code Description

429.0 Myocarditis, unspecified

429.1 Myocardial degeneration

429.2 Cardiovascular disease, unspecified

429.3 Cardiomegaly

429.4 Functional disturbances following cardiac surgery

429.5 Rupture of chordae tendineae

429.6 Rupture of papillary muscle

429.7 Certain sequelae of myocardial infarction, not elsewhere classified

429.71 Acquired cardiac septal defect

429.79 Other (Mural thrombus (atrial) (ventricular) acquired following myocardial infarction)

429.8 Other ill-defined heart diseases

429.81 Other disorders of papillary muscle

429.82 Hyperkinetic heart disease

429.83 Takotsubo syndrome

429.89 Other (Carditis)

429.9 Heart disease, unspecified

*433 Occlusion and stenosis precerebral arteries

*433.0 Basilar artery

*433.1 Carotid artery

*433.2 Vertebral artery

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Code Description

*433.3 Multiple and bilateral *Requires 4th or 5th digit classification as noted in brackets: (eg. 433.31, 433.00, etc.) 0 – without mention of cerebral infarction 1 – with cerebral infarction

*433.8 Other specified precerebral artery

*433.9 Unspecified precerebral artery

*434 Occlusion of cerebral arteries

*434.0 Cerebral thrombosis

*434.1 Cerebral embolism

*434.9 Cerebral artery occlusion, unspecified

435 Transient cerebral ischemia

435.0 Basilar artery syndrome

435.1 Vertebral artery syndrome

435.2 Subclavian steal syndrome

435.3 Vertebrobasilar artery syndrome

435.8 Other specified transient cerebral ischemias

435.9 Unspecified transient cerebral ischemia

437 Cerebral atherosclerosis

437.1 Other generalized ischemic cerebrovascular disease

440 Atherosclerosis

440.0 • Of aorta

440.1 • Of renal artery

440.2 • Of native arteries of the extremities

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Code Description

440.20 Atherosclerosis of the extremities, unspecified

440.21 Atherosclerosis of the extremities with intermittent claudication

440.22 Atherosclerosis of the extremities with rest pain

440.23 Atherosclerosis of the extremities with ulceration

440.24 Atherosclerosis of the extremities with gangrene

440.29 Other

440.3 Of bypass graft of the extremities

440.30 • Of unspecified graft

440.31 • Of autologous vein bypass graft

440.32 • Of nonautologous vein bypass graft

440.4 Chronis total occlusion of artery of the extremities

440.8 Of other specified arteries

440.9 Generalized and unspecified atherosclerosis

443 Other peripheral vascular disease

443.0 Raynaud’s syndrome

443.9 Peripheral vascular disease, unspecified

444 Arterial embolism and thrombosis

444.0 • Of abdominal aorta

440.09 Other arterial embolism and thrombosis of abdominal aorta

444.1 • Of thoracic aorta

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Code Description

444.2 • Of arteries of the extremities

444.21 Upper extremity

444.22 Lower extremity

444.8 • Of other specified artery

444.81 Iliac artery

444.89 Other

445 Atheroembolism

445.0 • Of extremities

445.01 Upper extremity

445.02 Lower extremity

445.8 • Of other sites

445.81 Kidney

445.89 Other site

785.51 Cardiogenic shock

786.5 Chest pain, unspecified

786.52 Precordial pain

786.59 Other chest pain (exhibiting discomfort, pressure and tightness)

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Diagnosis Codes for Psychiatric Illness

Code Description

290 Dementias

290.0 Senile dementia, uncomplicated

290.1 Presenile dementia

290.10 Presenile dementia, unspecified

290.11 Presenile dementia with delirium

290.12 Presenile dementia with delusional features

290.13 Presenile dementia with delusional or depressive features

290.2 Senile dementia with delusional or depressive features

290.20 Senile dementia with delusional features

290.21 Senile dementia with depressive features

290.3 Senile dementia with delirium

290.4 Vascular dementia

290.40 Vascular dementia, uncomplicated

290.41 Vascular dementia, with delirium

290.42 Vascular dementia, with delusions

290.43 Vascular dementia, with depressed mood

290.8 Other specified senile psychotic condition

290.9 Unspecified senile psychotic condition

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Code Description

293 Transient mental disorders due to condition classified elsewhere

293.0 Delirium due to conditions classified elsewhere

293.1 Subacute delirium

293.8 Other specified transient mental disorders due to conditions classified elsewhere

293.81 Psychotic disorder with delusions in conditions classified elsewhere

293.82 Psychotic disorder with hallucinations in conditions classified elsewhere

293.83 Mood disorder in conditions classified elsewhere

293.84 Anxiety disorder in conditions classified elsewhere

293.89 • Other

293.9 Unspecified transient mental disorder in conditions classified elsewhere

294 Persistent mental disorders due to conditions classified elsewhere

294.2 Dementia, unspecified

294.20 Dementia, unspecified, without behavioral disturbance

294.21 Dementia, unspecified, with behavioral disturbance

294.8

Other persistent mental disorders due to conditions classified elsewhere (Amnestic disorder NOS, Dementia NOS, Epileptic psychosis NOS, Mixed paranoid and affective organic psychotic states)

294.9 Unspecified persistent mental disorder mental disorders due to conditions classified elsewhere (Cognitive disorder NOS)

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Code Description

*295 (0-5) Schizophrenia disorders

*Requires 4th or 5th digit classification as noted in brackets: (295.04, 295.65, etc.) 0 – unspecified 1 – subchronic 2 – chronic 3 – chronic with acute exacerbation 4 – chronic with acute exacerbation 5 – in remission

*295.0 (0-5) • Simple type

*295.1 (0-5) • Disorganized type

295.2 (0-5) • Catatonic type

*295.3 (0-5) • Paranoid type

*295.5 (0-5) • Latent schizophrenia

*295.6 (0-5) • Residual type

*295.7 (0-5) • Schizoaffective disorder

*295.8 (0-5) • Other specified types of schizophrenia (acute, atypical or cenesthopathic schizophrenia)

*296 Episodic mood disorders *Requires 4th or 5th digit classification as noted in brackets: (296.36, 296.61) 0 – unspecified 1 – mild 2 – moderate 3 – severe, without mention of psychotic behavior 4 – severe, specified as with psychotic behavior 5 – in partial or unspecified remission 6 – in full remission

*296.0 (0-6) Bipolar 1 disorder, single manic episode

*296.1 (0-6) Manic disorder, recurrent episode

*296.2 (0-6) Major depressive disorder, single episode

*296.3 (0-6) Major depressive disorder, recurrent episode

*296.4 (0-6) Bipolar 1 disorder, most recent episode (or current) manic

*296.5 (0-6) Bipolar 1 disorder, most recent episode (or current) depressed

*296.6 (0-6) Bipolar 1 disorder, most recent episode (or current) mixed

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Code Description

296.7 Bipolar 1 disorder, most recent episode (or current) unspecified

296.8 Other and unspecified bipolar disorders

296.80 • Bipolar disorder, unspecified

296.81 • Atypical manic disorder

296.82 • Atypical depressive order

296.89 • Other

296.9 Other and unspecified episodic mood disorder

296.90 • Unspecified episodic mood disorder

296.99 • Other specified mood disorder

297 Delusional disorders

297.0 Paranoid state, simple

297.1 Delusional disorder

297.2 Paraphrenia

297.3 Shared psychotic disorder

297.8 Other specified paranoid states

297.9 Unspecified paranoid state

298 Other nonorganic psychoses (emotional stress or environmental factors as major part of etiology)

298.0 Depressive type psychosis

298.1 Excitative type psychosis 298.2 Reactive confusion

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Code Description

298.3 Acute paranoid reaction

298.4 Psychogenic paranoid psychosis

298.8 Other and unspecified reactive psychosis

298.9 Unspecified psychosis

*299.0 (0,1) Autistic disorder

*Requires 5th digit classification as noted in brackets: (e.g. 299.01, etc) 0 – current or active state 1 – residual state

*299.8 (0,1) Other specified pervasive developmental disorders

*299.9 (0,1) Unspecified pervasive developmental disorder

300 Anxiety, dissociative and somatoform disorders

300.0 • Anxiety states

300.00 Anxiety state, unspecified

300.01 Panic disorder without agoraphobia

300.02 Generalized anxiety disorder

300.09 Other

300.1 Dissociative, conversion and factitious disorders

300.10 Hysteria, unspecified

300.11 Conversion disorder

300.12 Dissociative amnesia

300.13 Dissociative fugue

300.14 Dissociative identity disorder

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Code Description

300.15 Dissociative disorder with predominantly psychological signs and symptoms

300.16 Factitious disorder with predominantly psychological signs and symptoms

300.19 Other and unspecified factitious illness

300.2 Phobic disorders

300.2 Phobia, unspecified

300.21 Agoraphobia with panic disorder

300.22 Agoraphobia without mention of panic attacks

300.23 Social phobia

300.29 Other isolated or specified phobias

300.3 Obsessive-compulsive disorders

300.4 Dysthymic disorder

300.5 Neurasthenia

300.6 Depersonalization disorder

300.7 Hypochondriasis

300.8 Somatoform disorders

300.81 • Somatization disorder

300.82 • Undifferentiated somatoform disorders

300.89 • Other somatoform disorders

300.9 Unspecified nonpsychotic mental disorder 301 Paranoid personality disorders

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Code Description

301.1 Affective personality disorder


301.11 Chronic hypomanic personality disorder

301.12 Chronic depressive personality disorder

301.13 Cyclothymic disorder

301.2 Schizoid personality disorder


301.21 Introvert personality

301.22 Schizotypal personality disorder

301.3 Explosive personality disorder

301.5 Histrionic personality disorder


301.51 Chronic factitious illness with physical symptoms

301.59 Other histrionic personality disorder

301.6 Dependent personality disorder

301.7 Antisocial personality disorder

301.8 Other personality disorders

301.81 Narcissistic personality disorder

301.82 Avoidant personality disorder

301.83 Borderline personality disorder

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Code Description

301.84 Passive-aggressive personality

301.89 • Other

301.9 Unspecified personality disorder

*303 Alcohol dependence syndrome *Requires 4th or 5th digit classification as noted in brackets: (e.g. 303.2, 303.01) 0 – unspecified 1 – continuous 2 – episodic 3 – in remission

*303.0 (0-3) Acute alcoholic intoxication

*303.9 (0-3) Other and specified alcohol dependence

*304 Drug dependence

*304.0 (0-3) Opoid type dependence

*304.1 (0-3) Sedative, hypnotic or anxiolytic dependence

*304.2 (0-3) Cocaine dependence

*304.3 (0-3) Cannabis dependence

*304.4 (0-3) Amphetamine and other psychostimulant dependence

*304.5 (0-3) Hallucinogen dependence

*304.6 (0-3) Other specified drug dependence

*304.7 (0-3) Combination of opoid type drug with any other

*304.8 (0-3) Combinations of drug dependence excluding opoid type drug

*304.9 (0-3) Unspecified drug dependence

*305 (0-3) Nondependent abuse of drugs

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Code Description

*305.0 (0-3) Alcohol abuse

305.1 Tobacco use disorder

*305.2 (0-3) Cannabis abuse

*305.3 (0-3) Hallucinogen abuse

*305.4 (0-3) Sedative, hypnotic or anxiolytic abuse

*305.6 (0-3) Cocaine abuse

*305.7 (0-3) Amphetamine or related acting sympathomimetic abuse

*305.8 (0-3) Antidepressant type abuse

*305.9 (0-3) Other, mixed, or unspecified drug abuse

*306 (0-3) Physiological malfunction arising from mental factors

306.0 • Musculoskeletal (psychogenic paralysis; psychogenic torticollis)

306.1 • Respiratory (air hunger; hiccough, cough, hyperventilation, etc.)

306.2 • Cardiovascular (cardiac neurosis;

neurocirculatory asthenia; psychogenic cardiovascular disorder)

306.3 • Skin (psychogenic pruritus)

306.4 • Gastrointestinal (aerophagy; cyclical vomiting; nervous gastritis, etc.)

306.5 • Genitourinary

306.50 Psychogenic genitourinary malfunction, unspecified

306.51 Psychogenic vaginismus

306.52 Psychogenic dysmenorrhea

306.53 Psychogenic dysuria

37

Code Description

306.6 • Endocrine

306.7 • Organs of special sense

306.8 • Other specified psychophysiological malfunction

306.9 • Unspecified psychophysiological malfunction

307.5 Other and unspecified disorders of eating

307.50 Eating disorder, unspecified

307.51 Bulimia nervosa

307.52 Pica

307.53 Rumination disorder

307.54 Psychogenic vomiting

307.59 Other

307.6 Enuresis

307.7 Encopresis

307.9 Other and unspecified symptoms or syndromes not elsewhere classified

308 Acute reaction to stress

308.0 Predominant disturbance of emotions

308.1 Predominant disturbance of consciousness

308.2 Predominant psychomotor disturbance

308.3 Other acute reactions to stress

308.4 Mixed disorders as reactions to stress

38

Code Description

308.9 Unspecified acute reaction to stress

309 Adjustment reaction

309.0 Adjustment disorder with depressed mood

309.1 Prolonged depressive reaction

309.2 With predominant disturbance of other emotions

309.21 Separation anxiety disorder

309.22 Emancipation disorder of adolescence and early adult life

309.23 Specific academic or work inhibition

309.24 Adjustment disorder with anxiety

309.28 Adjustment disorder with mixed anxiety and depressed mood

309.29 • Other

309.3 Adjustment disorder with disturbance of conduct

309.4 Adjustment disorder with mixed disturbance of emotions

309.8 Other specified adjustment reactions

309.81 Post-traumatic stress disorder

309.82 Adjustment reaction with physical symptoms

309.83 Adjustment reaction with withdrawal

309.9 Unspecified adjustment reaction

310 Specific non-psychotic mental disorders due to brain damage

310.0 Frontal lobe syndrome

39

Code Description

310.1 Personality change due to conditions classified elsewhere

310.2 Post-concussion syndrome

310.8 Other specific non-psychotic mental disorders following organic brain damage

310.81 • Pseudobulbar affect

310.89 • Other specified non-psychotic mental disorders

310.9 Unspecified non-psychotic mental disorder following organic brain damage

311 Depressive disorder, not elsewhere classified

*312 Disturbance of conduct, not elsewhere classified

*Requires 4th or 5th digit classification as noted in brackets: (e.g. 312.23, 312.01, etc) 0 – unspecified 1 – mild 2 – moderate 3 - severe

*312.0 (0-3) Under-socialized conduct disorder, aggressive type

*312.1(0-3) Under-socialized conduct disorder, unaggressive type

*312.2 (0-3) Socialized conduct disorder

312.3 Disorders of impulse control, not elsewhere classified

312.30 Impulse control disorder, unspecified

312.31 Pathological gambling

312.32 Kleptomania

312.33 Pyromania

312.34 Intermittent explosive disorder

312.35 Isolated explosive disorder

40

Code Description

312.39 • Other

312.4 Mixed disturbance of conduct and emotions

312.8 Other specified disturbances of conduct, not elsewhere classified

312.81 Conduct disorder, childhood onset type

312.82 Conduct disorder, adolescent onset type

312.89 Other conduct disorder

312.9 Unspecified disturbance of conduct

314 Hyperkinetic syndrome childhood

314.0 Attention deficit disorder

314.00 • Without mention of hyperactivity

314.01 • With hyperactivity

314.1 Hyperkinesis with development delay

314.2 Hyperkinetic conduct disorder

314.8 Other specified manifestations of hyperkinetic syndrome

314.9 Unspecified hyperkinetic syndrome

41

Diagnosis Codes for Sickle Cell Anemia

Code Description

282.6 Sickle-cell disease

282.6 Sickle-cell disease, unspecified

282.61 Hb-SS disease without crisis

282.62 Hb-SS disease with crisis

282.63 Sickle-cell/Hb-C disease without crisis

282.64 Sickle-cell/Hb-C disease with crisis

282.68 Other sickle-cell disease without crisis

282.69 Other sickle-cell disease with crisis

42

Diagnosis Codes for Thyroid Disease

Code Description

240 Simple and unspecified goiter

240.0 Goiter, specified as simple

240.9 Goiter, unspecified

241 Nontoxic nodular goiter

241.0 Nontoxic uninodular goiter

241.1 Nontoxic multinodular goiter

241.9 Unspecified nontoxic with or without goiter

*242 Thyrotoxicosis with or without goiter

242.0 (0,1) Toxic diffuse goiter

*242.1 (0,1) Toxic uninodular goiter

*242.2 (0,1) Toxic multinodular goiter

*242.3 (0,1) Toxic nodular goiter, unspecified

*242.4 (0,1) Thyrotoxicosis from ectopic thyroid nodule

*242.8 (0,1) Thyrotoxicosis of other specified origin

*242.9 (0,1) Thyrotoxicosis without mention of goiter or other cause

243 Congenital hypothyroidism

244 Acquired hypothyroidism

244.0 Postsurgical hypothyroidism

43

Code Description

244.1 Other postablative hypothyroidism

244.2 Iodine hypothyroidism

244.3 Other iatrogenic hypothyroidism

244.8 Other specified acquired hypothyroidism

244.9 Unspecified hypothyroidism

245 Thyroiditis

245.0 Acute thyroiditis

245.1 Subacute thyroiditis

245.2 Chronic lymphocytic thyroiditis

245.3 Chronic fibrous thyroiditis

245.4 Iatrogenic thyroiditis

245.8 Other and unspecified chronic thyroiditis

245.9 Thyroiditis, unspecified

246 Other disorders of thyroid

246.0 Disorders of thyrocalcitonin secretion

246.1 Dyshormonogenic goiter

246.2 Cyst of thyroid

246.3 Hemorrhage and infarction of thyroid

246.8 Other specified disorders of thyroid

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