Definitions Of Medicare Code Edits - CMS
Definitions of Medicare Code EditsDRAFT ICD-10 VERSIONSoftware version 27.0 R1PBL–031 September 2011Manual updated March 2012
Document numberSeptember 2011PBL–031 ii Definitions of Medicare Code EditsSeptember 2011
About this documentTHE MEDICARE CODE EDITOR (MCE) detects and reportserrors in the coding claims data. This manual contains a description of each coding edit with corresponding ICD-10-CM andICD-10-PCS code lists which were published in December 2010.The coding edit information in this manual is effective from 10/01/2010 to 09/30/2011. However it is not intended to be used toprocess claims as the ICD- 10 code set will not be mandated for useuntil October 1, 2013.September 2011iii
iv Definitions of Medicare Code EditsSeptember 2011
ContentsPrefaceChapter 1About this document iiiEdit code lists1.31. Invalid diagnosis or procedure code 1.42. External causes of morbidity codes as principal diagnosis3. Duplicate of PDX 1.44. Age conflict 1.45. Sex conflict 1.586. Manifestation code as principal diagnosis 1.1617. Non-specific principal diagnosis 1.1668. Questionable admission 1.1669. Unacceptable principal diagnosis 1.16710. Non-specific O.R. procedure 1.18411. Non-covered procedure 1.18412. Open biopsy check 1.19113. Bilateral procedure 1.19114. Invalid age 1.19115. Invalid sex 1.19116. Invalid discharge status 1.19117. Limited coverage 1.19218. Wrong procedure performed 1.193Chapter 2September 2011Code list changes1.42.3Contents v
vi Definitions of Medicare Code EditsSeptember 2011
Chapter 1Edit code lists1
ContentsEdit code lists1.31. Invalid diagnosis or procedure code 1.42. External causes of morbidity codes as principal diagnosis3. Duplicate of PDX 1.44. Age conflict 1.45. Sex conflict 1.586. Manifestation code as principal diagnosis 1.1617. Non-specific principal diagnosis 1.1668. Questionable admission 1.1669. Unacceptable principal diagnosis 1.16710. Non-specific O.R. procedure 1.18411. Non-covered procedure 1.18412. Open biopsy check 1.19113. Bilateral procedure 1.19114. Invalid age 1.19115. Invalid sex 1.19116. Invalid discharge status 1.19117. Limited coverage 1.19218. Wrong procedure performed 1.1931.2 Definitions of Medicare Code Edits1.4September 2011
Chapter 1Edit code listsBELOW IS A LIST of edits described in this chapter.September 20111.Invalid diagnosis or procedure code2.External causes of morbidity codes as principal diagnosis3.Duplicate of PDX4.Age conflict5.Sex conflict6.Manifestation code as principal diagnosis7.Non-specific principal diagnosis (Discontinued as of 10/01/07)8.Questionable admission9.Unacceptable principal diagnosis10.Non-specific O.R. procedure (Discontinued as of 10/01/07)11.Non-covered procedure12.Open biopsy check (Discontinued as of 10/01/10)13.Bilateral procedure (Discontinued as of 10/01/13)14.Invalid age15.Invalid sex16.Invalid discharge status17.Limited coverage18.Wrong procedure performedEdit code lists 1.3
Invalidordiagnosisor1. Invalid1.diagnosisprocedure codeprocedure codeThe Medicare Code Editor checks each diagnosis including the admitting diagnosis and each procedure against a table of valid ICD-10-CMand ICD-10-PCS codes. If an entered code does not agree with anycode on the internal list, it is assumed to be invalid.For a list of all valid ICD-10-CM and ICD-10-PCS codes, see theInternational Classification of Diseases list.2. External causes of morbidity codes as2. Externalcausesofprincipaldiagnosismorbidity codes as principaldiagnosisExternal causes of morbidity codes are ICD-10-CM codes beginningwith the letter V through Y. They describe the circumstance causingan injury, not the nature of the injury, and therefore should not be usedas a principal diagnosis.For a list of all external causes of morbidity codes, see the International Classification of Diseases list.3. Duplicate of PDX4. Age conflictWhenever a secondary diagnosis is coded the same as the principaldiagnosis, the secondary diagnosis is identified as a duplicate of theprincipal diagnosis.The Medicare Code Editor detects inconsistencies between a patient’sage and any diagnosis on the patient’s record. For example, afive-year-old patient with benign prostatic hypertrophy or a78-year-old patient coded with a delivery.In the above cases, the diagnosis is clinically and virtually impossiblein a patient of the stated age. Therefore, either the diagnosis or the ageis presumed to be incorrect. There are four age categories for diagnoses in the program: Newborn. Age of 0 years; a subset of diagnoses intended only fornewborns and neonates (e.g., fetal distress, perinatal jaundice). Pediatric. Age range is 0–17 years inclusive (e.g., Reye’s syndrome, routine child health exam). Maternity. Age range is 12–55 years inclusive (e.g., diabetes inpregnancy, antepartum pulmonary complication). Adult. Age range is 15–124 years inclusive (e.g., senile delirium,mature cataract).The following pages contain lists of ICD-10-CM diagnosis codes withcorresponding English descriptions for each of the age categoriesdescribed above.1.4 Definitions of Medicare Code EditsSeptember 2011
Newborn us neonatorumTransient hypogammaglobulinemia of infancyNeonatal adrenoleukodystrophyMeconium ileus in cystic fibrosisNeonatal obstruction of right nasolacrimal ductNeonatal obstruction of left nasolacrimal ductNeonatal obstruction of bilateral nasolacrimal ductNeonatal obstruction of unspecified nasolacrimal ductAdherent prepuce, newbornNewborn affected by maternal hypertensive disordersNewborn aff by maternal renal and urinary tract diseasesNewborn affected by maternal infec/parastc diseasesNewborn affected by oth maternal circ and resp diseasesNewborn affected by maternal nutritional disordersNewborn (suspected to be) affected by maternal injuryNewborn affected by surgical procedure on motherNewborn affected by oth medical procedures on mother, NECNewborn affected by periodontal disease in motherNewborn affected by oth maternal conditionsNewborn affected by unsp maternal conditionNewborn (suspected to be) affected by incompetent cervixNewborn (suspected to be) affected by premature ROMNewborn (suspected to be) affected by oligohydramniosNewborn (suspected to be) affected by polyhydramniosNewborn (suspected to be) affected by ectopic pregnancyNewborn (suspected to be) affected by multiple pregnancyNewborn (suspected to be) affected by maternal deathNewborn affected by malpresentation before laborNewborn affected by oth maternal complications of pregnancyNewborn affected by maternal complication of pregnancy, unspNewborn (suspected to be) affected by placenta previaNewborn affected by oth placental separation and hemorrhageNewborn aff by unsp morpholog and functn abnlt of placentaNewborn aff by oth morpholog and functn abnlt of placentaNewborn affected by placental transfusion syndromesNewborn (suspected to be) affected by prolapsed cordNewborn affected by oth compression of umbilical cordNewborn affected by unsp conditions of umbilical cordNewborn affected by oth conditions of umbilical cordNewborn (suspected to be) affected by chorioamnionitisNewborn affected by oth abnormalities of membranesNewborn affected by abnormality of membranes, unspNewborn affected by breech delivery and extractionNB aff by oth malpresent, malpos & disproprtn dur labr & delNewborn (suspected to be) affected by forceps deliveryNewborn affected by delivery by vacuum extractorNewborn (suspected to be) affected by Cesarean deliveryNewborn (suspected to be) affected by precipitate deliveryNewborn affected by abnormal uterine contractionsNB aff by abnlt in fetl heart rate or rhythm bef onset laborNB aff by abnlt in fetal heart rate or rhythm during laborNB aff by abnlt in fetl hrt rate or rhythm, unsp time onsetMeconium passage during deliveryNewborn affected by oth complications of labor and deliveryNewborn affected by complication of labor and delivery, unspNB aff by matern anesth and analgesia in preg, labor and delNewborn affected by oth maternal medicationNewborn affected by maternal use of tobaccoNewborn affected by maternal use of alcoholNewborn affected by maternal use of cocaineNewborn affected by maternal use of drugs of addictionNewborn aff by maternal use of nutritional chemical substncNewborn aff by maternal exposure to environ chemical substncNewborn affected by oth maternal noxious substancesNewborn affected by maternal noxious substance, unspSeptember 2011Edit code lists 1.5
Newborn 129P130P131P132P133Newborn light for gestational age, unspecified weightNewborn light for gestational age, less than 500 gramsNewborn light for gestational age, 500-749 gramsNewborn light for gestational age, 750-999 gramsNewborn light for gestational age, 1000-1249 gramsNewborn light for gestational age, 1250-1499 gramsNewborn light for gestational age, 1500-1749 gramsNewborn light for gestational age, 1750-1999 gramsNewborn light for gestational age, 2000-2499 gramsNewborn small for gestational age, unspecified weightNewborn small for gestational age, less than 500 gramsNewborn small for gestational age, 500-749 gramsNewborn small for gestational age, 750-999 gramsNewborn small for gestational age, 1000-1249 gramsNewborn small for gestational age, 1250-1499 gramsNewborn small for gestational age, 1500-1749 gramsNewborn small for gestational age, 1750-1999 gramsNewborn small for gestational age, 2000-2499 gramsNB aff by fetal malnut not light or small for gestatnl ageNewborn affected by slow intrauterine growth, unspecifiedExtremely low birth weight newborn, unspecified weightExtremely low birth weight newborn, less than 500 gramsExtremely low birth weight newborn, 500-749 gramsExtremely low birth weight newborn, 750-999 gramsOther low birth weight newborn, unspecified weightOther low birth weight newborn, 1000-1249 gramsOther low birth weight newborn, 1250-1499 gramsOther low birth weight newborn, 1500-1749 gramsOther low birth weight newborn, 1750-1999 gramsOther low birth weight newborn, 2000-2499 gramsExtreme immaturity of newborn, unspecified weeksExtreme immaturity of newborn, less than 24 completed weeksExtreme immaturity of newborn, 24-26 completed weeksExtreme immaturity of newborn, 27 completed weeksOther preterm newborn, unspecified weeksOther preterm newborn, 28-31 completed weeksOther preterm newborn, 32-36 completed weeksExceptionally large newborn babyOther heavy for gestational age newbornPost-term newbornProlonged gestation of newbornAbnormal findings on neonatal screeningSubdural hemorrhage due to birth injuryCerebral hemorrhage due to birth injuryIntraventricular hemorrhage due to birth injurySubarachnoid hemorrhage due to birth injuryTentorial tear due to birth injuryOth intcrn lacerations and hemorrhages due to birth injuryUnsp intcrn laceration and hemorrhage due to birth injuryCerebral edema due to birth injuryOther specified brain damage due to birth injuryUnspecified brain damage due to birth injuryBirth injury to facial nerveBirth injury to other cranial nervesBirth injury to spine and spinal cordBirth injury to central nervous system, unspecifiedCephalhematoma due to birth injuryChignon (from vacuum extraction) due to birth injuryEpicranial subaponeurotic hemorrhage due to birth injuryBruising of scalp due to birth injuryInjury of scalp of newborn due to monitoring equipmentCaput succedaneumOther birth injuries to scalpBirth injury to scalp, unspecifiedFracture of skull due to birth injuryOther birth injuries to skullBirth injury to femurBirth injury to other long bones1.6 Definitions of Medicare Code EditsSeptember 2011
Newborn cture of clavicle due to birth injuryBirth injuries to other parts of skeletonBirth injury to skeleton, unspecifiedErb's paralysis due to birth injuryKlumpke's paralysis due to birth injuryPhrenic nerve paralysis due to birth injuryOther brachial plexus birth injuriesBirth injuries to other parts of peripheral nervous systemBirth injury to peripheral nervous system, unspecifiedBirth injury to liverBirth injury to spleenSternomastoid injury due to birth injuryBirth injury to eyeBirth injury to faceBirth injury to external genitaliaSubcutaneous fat necrosis due to birth injuryOther specified birth injuriesBirth injury, unspecifiedMetabolic acidemia in newborn first noted before onset laborMetabolic acidemia in newborn first noted during laborMetabolic acidemia noted at birthMetabolic acidemia, unspecifiedRespiratory distress syndrome of newbornTransient tachypnea of newbornOther respiratory distress of newbornRespiratory distress of newborn, unspecifiedCongenital pneumonia due to viral agentCongenital pneumonia due to ChlamydiaCongenital pneumonia due to staphylococcusCongenital pneumonia due to streptococcus, group BCongenital pneumonia due to Escherichia coliCongenital pneumonia due to PseudomonasCongenital pneumonia due to other bacterial agentsCongenital pneumonia due to other organismsCongenital pneumonia, unspecifiedMeconium aspiration without respiratory symptomsMeconium aspiration with respiratory symptomsNeonatal aspirat of amnio fluid and mucus w/o resp sympNeonatal aspirat of amnio fluid and mucus w resp sympNeonatal aspiration of blood without respiratory symptomsNeonatal aspiration of blood with respiratory symptomsNeonatal aspirat of milk and regurgitated food w/o resp sympNeonatal aspirat of milk and regurgitated food w resp sympOther neonatal aspiration without respiratory symptomsOther neonatal aspiration with respiratory symptomsNeonatal aspiration, unspecifiedInterstitial emphysema originating in the perinatal periodPneumothorax originating in the perinatal periodPneumomediastinum originating in the perinatal periodPneumopericardium originating in the perinatal periodOth cond rel to interstit emphysema origin in perinat periodTracheobronchial hemorrhage origin in the perinatal periodMassive pulmonary hemorrhage origin in the perinatal periodOth pulmonary hemorrhages origin in the perinatal periodUnsp pulmonary hemorrhage origin in the perinatal periodPrimary atelectasis of newbornUnspecified atelectasis of newbornResorption atelectasis without respiratory distress syndromeOther atelectasis of newbornCyanotic attacks of newbornPrimary sleep apnea of newbornOther apnea of newbornRespiratory failure of newbornRespiratory arrest of newbornOther specified respiratory conditions of newbornRespiratory condition of newborn, unspecifiedNeonatal cardiac failureNeonatal tachycardiaSeptember 2011Edit code lists 1.7
Newborn P526P528P529P53P540P541P542P543P544P545Neonatal bradycardiaNeonatal hypertensionPersistent fetal circulationTransient myocardial ischemia in newbornCardiac arrest of newbornOth cardiovasc disorders originating in the perinatal periodCardiovasc disorder origin in the perinatal period, unspCongenital rubella syndromeCongenital cytomegalovirus infectionCongenital herpesviral [herpes simplex] infectionCongenital viral hepatitisOther congenital viral diseasesCongenital viral disease, unspecifiedSepsis of newborn due to streptococcus, group BSepsis of newborn due to unspecified streptococciSepsis of newborn due to other streptococciSepsis of newborn due to Staphylococcus aureusSepsis of newborn due to unspecified staphylococciSepsis of newborn due to other staphylococciSepsis of newborn due to Escherichia coliSepsis of newborn due to anaerobesOther bacterial sepsis of newbornBacterial sepsis of newborn, unspecifiedCongenital tuberculosisCongenital toxoplasmosisNeonatal (disseminated) listeriosisCongenital falciparum malariaOther congenital malariaNeonatal candidiasisOther specified congenital infectious and parasitic diseasesCongenital infectious or parasitic disease, unspecifiedOmphalitis with mild hemorrhageOmphalitis without hemorrhageNeonatal infective mastitisNeonatal conjunctivitis and dacryocystitisIntra-amniotic infection affecting newborn, NECNeonatal urinary tract infectionNeonatal skin infectionOther specified infections specific to the perinatal periodInfection specific to the perinatal period, unspecifiedNewborn aff by uterin (fetal) blood loss from vasa previaNewborn aff by uterin (fetal) blood loss from ruptured cordNewborn affected by uterin (fetal) blood loss from placentaNewborn affected by hemorrhage into co-twinNewborn affected by hemorrhage into maternal circulationNB aff by uterin blood loss from cut end of co-twin's cordNewborn affected by other intrauterine (fetal) blood lossNewborn affected by intrauterine (fetal) blood loss, unspMassive umbilical hemorrhage of newbornOther umbilical hemorrhages of newbornUmbilical hemorrhage of newborn, unspecifiedIntraventricular (nontraumatic) hemor, grade 1, of newbornIntraventricular (nontraumatic) hemor, grade 2, of newbornIntraventricular (nontraumatic) hemor, grade 3, of newbornIntraventricular (nontraumatic) hemor, grade 4, of newbornUnsp intraventricular (nontraumatic) hemorrhage of newbornIntracerebral (nontraumatic) hemorrhage of newbornSubarachnoid (nontraumatic) hemorrhage of newbornCereblr (nontraumatic) and posterior fossa hemor of newbornOther intracranial (nontraumatic) hemorrhages of newbornIntracranial (nontraumatic) hemorrhage of newborn, unspHemorrhagic disease of newbornNeonatal hematemesisNeonatal melenaNeonatal rectal hemorrhageOther neonatal gastrointestinal hemorrhageNeonatal adrenal hemorrhageNeonatal cutaneous hemorrhage1.8 Definitions of Medicare Code EditsSeptember 2011
Newborn P741P742P743P744P745P746P748P749P760Neonatal vaginal hemorrhageOther specified neonatal hemorrhagesNeonatal hemorrhage, unspecifiedRh isoimmunization of newbornABO isoimmunization of newbornOther hemolytic diseases of newbornHemolytic disease of newborn, unspecifiedHydrops fetalis due to isoimmunizationHydrops fetalis due to unspecified hemolytic diseaseHydrops fetalis due to other hemolytic diseaseKernicterus due to isoimmunizationOther specified kernicterusKernicterus, unspecifiedNeonatal jaundice due to bruisingNeonatal jaundice due to bleedingNeonatal jaundice due to infectionNeonatal jaundice due to polycythemiaNeonatal jaundice d/t drugs or toxins transmitd from motherNeonatal jaundice due to drugs or toxins given to newbornNeonatal jaundice due to swallowed maternal bloodNeonatal jaundice due to other specified excessive hemolysisNeonatal jaundice due to excessive hemolysis, unspecifiedNeonatal jaundice associated with preterm deliveryInspissated bile syndromeNeonatal jaundice from unspecified hepatocellular damageNeonatal jaundice from other hepatocellular damageNeonatal jaundice from breast milk inhibitorNeonatal jaundice from other specified causesNeonatal jaundice, unspecifiedDisseminated intravascular coagulation of newbornTransient neonatal thrombocytopeniaPolycythemia neonatorumAnemia of prematurityCongenital anemia from fetal blood lossOther congenital anemias, not elsewhere classifiedTransient neonatal neutropeniaOther transient neonatal disorders of coagulationOther specified perinatal hematological disordersPerinatal hematological disorder, unspecifiedSyndrome of infant of mother with gestational diabetesSyndrome of infant of a diabetic motherNeonatal diabetes mellitusIatrogenic neonatal hypoglycemiaOther neonatal hypoglycemiaOth transitory disorders of carbohydrate metab of newbornTransitory disorder of carbohydrate metab of newborn, unspCow's milk hypocalcemia in newbornOther neonatal hypocalcemiaNeonatal hypomagnesemiaNeonatal tetany without calcium or magnesium deficiencyTransitory neonatal hypoparathyroidismOth transitory neonatal disord of calcium & magnesium metabTransitory neonatal disord of calcium & magnesium metab,unspNeonatal goiter, not elsewhere classifiedTransitory neonatal hyperthyroidismOth transitory neonatal disorders of thyroid function, NECOther specified transitory neonatal endocrine disordersTransitory neonatal endocrine disorder, unspecifiedLate metabolic acidosis of newbornDehydration of newbornDisturbances of sodium balance of newbornDisturbances of potassium balance of newbornOther transitory electrolyte disturbances of newbornTransitory tyrosinemia of newbornTransitory hyperammonemia of newbornOther transitory metabolic disturbances of newbornTransitory metabolic disturbance of newborn, unspecifiedMeconium plug syndromeSeptember 2011Edit code lists 1.9
Newborn 8P940P941P942P948P949P95P960P961P962P963Transitory ileus of newbornIntestinal obstruction due to inspissated milkOther specified intestinal obstruction of newbornIntestinal obstruction of newborn, unspecifiedStage 1 necrotizing enterocolitis in newbornStage 2 necrotizing enterocolitis in newbornStage 3 necrotizing enterocolitis in newbornNecrotizing enterocolitis in newborn, unspecifiedPerinatal intestinal perforationOther neonatal peritonitisNeonatal hematemesis and melena d/t swallowed matern bloodNoninfective neonatal diarrheaCongenital cirrhosis (of liver)Peptic ulcer of newbornNewborn esophageal refluxOther specified perinatal digestive system disordersPerinatal digestive system disorder, unspecifiedCold injury syndromeOther hypothermia of newbornHypothermia of newborn, unspecifiedEnvironmental hyperthermia of newbornOth disturbances of temperature regulation of newbornDisturbance of temperature regulation of newborn, unspSclerema neonatorumNeonatal erythema toxicumHydrops fetalis not due to hemolytic diseaseUnspecified edema specific to newbornOther edema specific to newbornBreast engorgement of newbornUmbilical polyp of newbornOther specified conditions of integument specific to newbornCondition of the integument specific to newborn, unspecifiedOther problems with newbornConvulsions of newbornNeonatal cerebral ischemiaAcquired periventricular cysts of newbornNeonatal cerebral leukomalaciaNeonatal cerebral irritabilityNeonatal cerebral depressionNeonatal comaHypoxic ischemic encephalopathy [HIE], unspecifiedMild hypoxic ischemic encephalopathy [HIE]Moderate hypoxic ischemic encephalopathy [HIE]Severe hypoxic ischemic encephalopathy [HIE]Other specified disturbances of cerebral status of newbornDisturbance of cerebral status of newborn, unspecifiedBilious vomiting of newbornOther vomiting of newbornRegurgitation and rumination of newbornSlow feeding of newbornUnderfeeding of newbornOverfeeding of newbornNeonatal difficulty in feeding at breastFailure to thrive in newbornOther feeding problems of newbornFeeding problem of newborn, unspecifiedGrey baby syndromeOth reactions and intoxications d/t drugs administered to NBTransient neonatal myasthenia gravisCongenital hypertoniaCongenital hypotoniaOther disorders of muscle tone of newbornDisorder of muscle tone of newborn, unspecifiedStillbirthCongenital renal failureNeonatal w/drawal symp from matern use of drugs of addictionWithdrawal symptoms from therapeutic use of drugs in newbornWide cranial sutures of newborn1.10 Definitions of Medicare Code EditsSeptember 2011
Newborn 3864Z3865Z3866Z3868Z3869Z387Z388Comp to newborn due to (fetal) intrauterine procedureDelayed separation of umbilical cordMeconium stainingOth conditions originating in the perinatal periodCondition originating in the perinatal period, unspecifiedFetal hydantoin syndromeHealth examination for newborn under 8 days oldHealth examination for newborn 8 to 28 days oldSingle liveborn infant, delivered vaginallySingle liveborn infant, delivered by cesareanSingle liveborn infant, born outside hospitalSingle liveborn infant, unspecified as to place of birthTwin liveborn infant, delivered vaginallyTwin liveborn infant, delivered by cesareanTwin liveborn infant, born outside hospitalTwin liveborn infant, unspecified as to place of birthTriplet liveborn infant, delivered vaginallyTriplet liveborn infant, delivered by cesareanQuadruplet liveborn infant, delivered vaginallyQuadruplet liveborn infant, delivered by cesareanQuintuplet liveborn infant, delivered vaginallyQuintuplet liveborn infant, delivered by cesareanOther multiple liveborn infant, delivered vaginallyOther multiple liveborn infant, delivered by cesareanOther multiple liveborn infant, born outside hospitalOther multiple liveborn infant, unsp as to place of birthSeptember 2011Edit code lists 1.11
Pediatric diagnoses (age 0 through R6259R6811R6812R6813R6819T7402XAInfant botulismExanthema subitum [sixth disease], unspecifiedExanthema subitum [sixth disease] due to human herpesvirus 6Exanthema subitum [sixth disease] due to human herpesvirus 7Precocious pubertyOther disorders of pubertyGender identity disorder of childhoodOther childhood disintegrative disorderSeparation anxiety disorder of childhoodOther childhood emotional disordersChildhood emotional disorder, unspecifiedReactive attachment disorder of childhoodDisinhibited attachment disorder of childhoodOther childhood disorders of social functioningChildhood disorder of social functioning, unspecifiedRumination disorder of infancyOther feeding disorders of infancy and early childhoodPica of infancy and childhoodOth behav/emotn disord w onset usly occur in chldhd and adolUnsp behav/emotn disord w onst usly occur in chldhd and adolReye's syndromeUnspecified infantile and juvenile cataract, right eyeUnspecified infantile and juvenile cataract, left eyeUnspecified infantile and juvenile cataract, bilateralUnspecified infantile and juvenile cataract, unspecified eyeInfantile and juv cortical/lamellar/zonular cataract, r eyeInfantile and juv cortical/lamellar/zonular cataract, l eyeInfantile and juv cortical/lamellar/zonular cataract, biInfantile & juv cortical/lamellar/zonular cataract, unsp eyeInfantile and juvenile nuclear cataract, right eyeInfantile and juvenile nuclear cataract, left eyeInfantile and juvenile nuclear cataract, bilateralInfantile and juvenile nuclear cataract, unspecified eyeAnt subcapsular polar infantile and juvenile cataract, r eyeAnt subcapsular polar infantile and juv cataract, left eyeAnt subcapsular polar infantile and juvenile cataract, biAnt subcapsular polar infantile and juv cataract, unsp eyePost subcapsular polar infantile and juv cataract, r eyePost subcapsular polar infantile and juv cataract, left eyePost subcapsular polar infantile and juvenile cataract, biPost subcapsular polar infantile and juv cataract, unsp eyeCombined forms of infantile and juvenile cataract, right eyeCombined forms of infantile and juvenile cataract, left eyeCombined forms of infantile and juvenile cataract, bilateralCombined forms of infantile and juvenile cataract, unsp eyeOther infantile and juvenile cataractChronic bullous disease of childhoodInfantile (acute) (chronic) eczemaSeborrhea capitisSeborrheic infantile dermatitisInfantile papular acrodermatitis [Gianotti-Crosti]Infantile acneExcessive menstruation at pubertyAcute idiopathic pulmonary hemorrhage in infantsColicDelayed milestone in childhoodUnsp lack of expected normal physiol dev in childhoodFailure to thrive (child)Short stature (child)Oth lack of expected normal physiol development in childhoodExcessive crying of infant (baby)Fussy infant (baby)Apparent life threatening event in infant (ALTE)Other nonspecific symptoms peculiar to infancyChild neglect or abandonment, confirmed, initial encounter1.12 Definitions of Medicare Code EditsSeptember 2011
Pediatric diagnoses (age 0 through 2Child neglect or abandonment, confirmed, subs encntrChild neglect or abandonment, confirmed, sequelaChild physical abuse, confirmed, initial encounterChild physical abuse, confirmed, subsequent encounterChild physical abuse, confirmed, sequelaChild sexual abuse, confirmed, initial encounterChild sexual abuse, confirmed, subsequent encounterChild sexual abuse, confirmed, sequelaChild psychological abuse, confirmed, initial enc
P007 Newborn affected by oth medical procedures on mother, NEC P0081 Newborn affected by periodontal disease in mother P0089 Newborn affected by oth maternal conditions P009 Newborn affected by unsp maternal condition P010 Newborn (suspected to be) affected by incompetent cervix P011 Newborn (suspected to be) affected by premature ROMFile Size: 1MB
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