Date of service: Waiver? l Patient name: Insurance: Subscriber name: Address: Group #: Previous balance: Copay: Today’s charges: Phone: Account #: Today’s payment: check# DOB: Age: Sex: Physician name: Balance due:

RANK Office visit New Est RANK Office procedures RANK Laboratory Minimal 99211 Anoscopy 46600 Venipuncture 36415 Problem focused 99201 99212 Audiometry 92551 Blood glucose, monitoring device 82962 Expanded problem focused 99202 99213 Cerumen removal 69210 Blood glucose, visual dipstick 82948 Detailed 99203 99214 Colposcopy 57452 CBC, w/ auto differential 85025 Comprehensive 99204 99215 Colposcopy w/biopsy 57455 CBC, w/o auto differential 85027 Comprehensive (new patient) 99205 ECG, w/interpretation 93000 Cholesterol 82465 Significant, separate service -25 -25 ECG, rhythm strip 93040 Hemoccult, guaiac 82270 Well visit New Est Endometrial biopsy 58100 Hemoccult, immunoassay 82274 < 1 y 99381 99391 Flexible sigmoidoscopy 45330 Hemoglobin A1C 85018 1-4 y 99382 99392 Flexible sigmoidoscopy w/biopsy 45331 Lipid panel 80061 5-11 y 99383 99393 Fracture care, cast/splint 29_____ Liver panel 80076 12-17 y 99384 99394 Site: ______KOH prep (skin, hair, nails) 87220 18-39 y 99385 99395 Nebulizer 94640 Metabolic panel, basic 80048 40-64 y 99386 99396 Nebulizer demo 94664 Metabolic panel, comprehensive 80053 65 y + 99387 99397 Spirometry 94010 Mononucleosis 86308 Medicare preventive services Spirometry, pre and post 94060 Pregnancy, blood 84703 Pap Q0091 Tympanometry 92567 Pregnancy, urine 81025 Pelvic & breast G0101 Vasectomy 55250 Renal panel 80069 Prostate/PSA G0103 Skin procedures Units Sedimentation rate 85651 Tobacco counseling/3-10 min 99406 Burn care, initial 16000 Strep, rapid 86403 Tobacco counseling/>10 min 99407 Foreign body, skin, simple 10120 Strep culture 87081 Welcome to Medicare exam G0344 Foreign body, skin, complex 10121 Strep A 87880 ECG w/Welcome to Medicare exam G0366 I&D, abscess 10060 TB 86580 Flexible sigmoidoscopy G0104 I&D, hematoma/seroma 10140 UA, complete, non-automated 81000 Hemoccult, guaiac G0107 Laceration repair, simple 120____ UA, w/o micro, non-automated 81002 Flu shot G0008 Site: ______Size: _____ UA, w/ micro, non-automated 81003 Pneumonia shot G0009 Laceration repair, layered 120____ Urine colony count 87086 Consultation/preop clearance Site: ______Size: _____ Urine culture, presumptive 87088 Expanded problem focused 99242 Lesion, biopsy, one 11100 Wet mount/KOH 87210 Detailed 99243 Lesion, biopsy, each add’l 11101 Vaccines Comprehensive/mod complexity 99244 Lesion, destruct., benign, 1-14 17110 DT, <7 y 90702 Comprehensive/high complexity 99245 Lesion, destruct., premal., single 17000 DTP 90701 Other services Lesion, destruct., premal., ea. add’l 17003 DtaP, <7 y 90700 After posted hours 99050 Lesion, excision, benign 114____ Flu, 6-35 months 90657 Evening/weekend appointment 99051 Site: ______Size: _____ Flu, 3 y + 90658 Home health certification G0180 Lesion, excision, malignant 116____ Hep A, adult 90632 Home health recertification G0179 Site: ______Size: _____ Hep A, ped/adol, 2 dose 90633 Post-op follow-up 99024 Lesion, paring/cutting, one 11055 Hep B, adult 90746 Prolonged/30-74 min 99354 Lesion, paring/cutting, 2-4 11056 Hep B, ped/adol 3 dose 90744 Special reports/forms 99080 Lesion, shave 113____ Hep B-Hib 90748 Disability/Workers comp 99455 Site: ______Size: _____ Hib, 4 dose 90645 Radiology Nail removal, partial 11730 HPV 90649 Nail removal, w/matrix 11750 IPV 90713 Skin tag, 1-15 11200 MMR 90707 Diagnoses Medications Units Pneumonia, >2 y 90732 1 Ampicillin, up to 500mg J0290 Pneumonia conjugate, <5 y 90669 2 B-12, up to 1,000 mcg J3420 Td, >7 y 90718 3 Epinephrine, up to 1ml J0170 Varicella 90716 4 Kenalog, 10mg J3301 Immunizations & Injections Units Next office visit Lidocaine, 10mg J2001 Allergen, one 95115 Recheck Prev PRN ______D W M Y Normal saline, 1000cc J7030 Allergen, multiple 95117 Instructions: Phenergan, up to 50mg J2550 Imm admin, one 90471 Progesterone, 150mg J1055 Imm admin, each add’l 90472 Rocephin, 250mg J0696 Imm admin, intranasal, one 90473 Testosterone, 200mg J1080 Imm admin, intranasal, each add’l 90474 Referral Tigan, up to 200 mg J3250 Injection, joint, small 20600 To: Toradol, 15mg J1885 Injection, joint, intermediate 20605 Miscellaneous services Injection, joint, major 20610 Instructions: Injection, ther/proph/diag 90772 Injection, trigger point 20552 Physician signature Supplies

X ______Infectious & Parasitic Diseases Mental Disorders H66.006 Acute suppurative otitis media without B00.9 Herpesviral infection, unspecified F41.9 Anxiety disorder, unspecified spontaneous rupture of ear drum, A60.9 Anogenital herpesviral infection F90.0 Attention-deficit hyperactivity disorder, recurrent, bilateral B02.9 Zoster without complications predominantly inattentive type H66.007 Acute suppurative otitis media without B27.00 Gammaherpesviral mononucleosis F90.9 Attention-deficit hyperactivity disorder, spontaneous rupture of ear drum, without complication unspecified type recurrent, unspecified ear B27.01 Gammaherpesviral mononucleosis with F03 Unspecified dementia H66.009 Acute suppurative otitis media without polyneuropathy F33.9 Major depressive disorder, recurrent, spontaneous rupture of ear drum, B27.02 Gammaherpesviral mononucleosis with unspecified unspecified ear meningitis Nervous System & Sense Organ Disorders B27.09 Gammaherpesviral mononucleosis with Circulatory System other complications Nervous System Diseases Arrythmias B27.10 Cytomegaloviral mononucleosis without G56.00 Carpal tunnel syndrome, unspecified I48.0 Atrial fibrillation complications side B27.11 Cytomegaloviral mononucleosis with G56.01 Carpal tunnel syndrome, right side Cardiac polyneuropathy G56.02 Carpal tunnel syndrome, left side I20.8 Other forms of angina pectoris B27.12 Cytomegaloviral mononucleosis with G40.90 Epilepsy, unspecified, not intractable I20.9 Angina pectoris, unspecified meningitis G40.901 Epilepsy, unspecified, not intractable, I25.701 Atherosclerosis of coronary artery B27.19 Cytomegaloviral mononucleosis with with status epilepticus bypass graft(s), unspecified, with other complication G40.909 Epilepsy, unspecified, not intractable, angina pectoris with documented B27.80 Other infectious mononucleosis without without status epilepticus spasm complication G43.90 Migraine, unspecified, not intractable I25.111 Atherosclerotic heart disease of native B27.81 Other infectious mononucleosis with G44.039 Episodic paroxysmal hemicrania, not coronary artery with angina pectoris polyneuropathy intractable Episodic paroxysmal with documented spasm B27.82 Other infectious mononucleosis with hemicrania NOS I25.118 Atherosclerotic heart disease of native meningitis G44.049 Chronic paroxysmal hemicrania, not coronary artery with other forms of B27.89 Other infectious mononucleosis with intractable Chronic paroxysmal angina pectoris other complication hemicrania NOS I25.119 Atherosclerotic heart disease of native B27.90 Infectious mononucleosis, unspecified coronary artery with unspecified angina without complication Eye Diseases pectoris B27.91 Infectious mononucleosis, unspecified H10.9 Unspecified conjunctivitis I25.708 Atherosclerosis of coronary artery with polyneuropathy H53.10 Unspecified subjective visual bypass graft(s), unspecified, with other B27.92 Infectious mononucleosis, unspecified disturbances forms of angina pectoris with meningitis H53.11 Day blindness I25.709 Atherosclerosis of coronary artery B27.99 Infectious mononucleosis, unspecified bypass graft(s), unspecified, with with other complication Ear Diseases unspecified angina pectoris J02.0 Streptococcal pharyngitis H61.20 Impacted cerumen, unspecified ear I25.711 Atherosclerosis of autologous vein J03.00 Acute streptococcal tonsillitis, H61.21 Impacted cerumen, right ear coronary artery bypass graft(s) with unspecified H61.22 Impacted cerumen, left ear angina pectoris with documented J03.01 Acute recurrent streptococcal tonsillitis H61.23 Impacted cerumen, bilateral spasm J02.0 Streptococcal sore throat H60.00 Abscess of external ear, unspecified I25.718 Atherosclerosis of autologous vein B97.8 Other viral agents as the cause of ear coronary artery bypass graft(s) with diseases classified elsewhere H60.01 Abscess of right external ear other forms of angina pectoris B07 Viral warts H60.02 Abscess of left external ear I25.719 Atherosclerosis of autologous vein H60.03 Abscess of external ear, bilateral coronary artery bypass graft(s) with Neoplasms H60.10 Cellulitis of external ear, unspecified unspecified angina pectoris Benign Neoplasms ear I25.721 Atherosclerosis of autologous artery D49.2 Neoplasm of unspecified behavior of H60.11 Cellulitis of right external ear coronary artery bypass graft(s) with bone, soft tissue, and skin H60.12 Cellulitis of left external ear angina pectoris with documented D23.9 Other benign neoplasm of skin, H60.13 Cellulitis of external ear, bilateral spasm unspecified H60.311 Diffuse otitis externa, right ear I25.728 Atherosclerosis of autologous artery H60.312 Diffuse otitis externa, left ear coronary artery bypass graft(s) with Endocrine, Nutritional & Metabolic Disorders H60.313 Diffuse otitis externa, bilateral other forms of angina pectoris H60.319 Diffuse otitis externa, unspecified ear I25.729 Atherosclerosis of autologous artery Endocrine H60.32 Hemorrhagic otitis externa coronary artery bypass graft(s) with E10.8 Type 1 diabetes mellitus with H60.321 Hemorrhagic otitis externa, right ear unspecified angina pectoris unspecified complications H60.322 Hemorrhagic otitis externa, left ear I25.731 Atherosclerosis of nonautologous E10.9 Type 1 diabetes mellitus without H60.323 Hemorrhagic otitis externa, bilateral biological coronary artery bypass complications H60.329 Hemorrhagic otitis externa, unspecified graft(s) with angina pectoris with E11.8 Type 2 diabetes mellitus with ear documented spasm unspecified complications H60.391 Other infective otitis externa, right ear I25.738 Atherosclerosis of nonautologous E11.9 Type 2 diabetes mellitus without H60.392 Other infective otitis externa, left ear biological coronary artery bypass complications H60.393 Other infective otitis externa, bilateral graft(s) with other forms of angina E05.90 Thyrotoxicosis, unspecified without H60.399 Other infective otitis externa, pectoris thyrotoxic crisis or storm unspecified ear I25.739 Atherosclerosis of nonautologous E03.9 Hypothyroidism, unspecified H66.001 Acute suppurative otitis media without biological coronary artery bypass spontaneous rupture of ear drum, right graft(s) with unspecified angina pectoris Metabolic/Other ear I25.751 Atherosclerosis of native coronary M10.9 Gout, unspecified H66.002 Acute suppurative otitis media without artery of transplanted heart with angina E78.0 Pure hypercholesterolemia spontaneous rupture of ear drum, left pectoris with documented spasm E78.2 Mixed hyperlipidemia ear I25.758 Atherosclerosis of native coronary E66.1 Drug-induced obesity H66.003 Acute suppurative otitis media without artery of transplanted heart with other E66.9 Obesity, unspecified spontaneous rupture of ear drum, forms of angina pectoris E66.3 Overweight bilateral I25.759 Atherosclerosis of native coronary E66.09 Other obesity due to excess calories H66.004 Acute suppurative otitis media without artery of transplanted heart with spontaneous rupture of ear drum, unspecified angina pectoris Blood Diseases recurrent, right ear I25.761 Atherosclerosis of bypass graft of D64.9 Anemia, unspecified H66.005 Acute suppurative otitis media without coronary artery of transplanted heart spontaneous rupture of ear drum, with angina pectoris with documented recurrent, left ear spasm

2 I25.768 Atherosclerosis of bypass graft of Digestive System F52.21 Male erectile disorder coronary artery of transplanted heart K92.1 Melena N41.9 Inflammatory disease of prostate, with other forms of angina pectoris K59.00 Constipation, unspecified unspecified I25.769 Atherosclerosis of bypass graft of K57.30 Diverticulosis of large intestine without coronary artery of transplanted heart perforation or abscess without bleeding Breast Diseases with unspecified angina pectoris K57.50 Diverticulosis of both small and large N63 Unspecified lump in breast I25.791 Atherosclerosis of other coronary artery intestine without perforation or abscess bypass graft(s) with angina pectoris without bleeding Female Genital Organ Diseases with documented spasm K57.90 Diverticulosis of intestine, part Z87.44 Personal history of cervical dysplasia I25.798 Atherosclerosis of other coronary artery unspecified, without perforation or N72 Inflammatory disease of cervix uteri bypass graft(s) with other forms of abscess without bleeding N87.9 Dysplasia of cervix uteri, unspecified angina pectoris K57.20 Diverticulitis of large intestine with N76.0 Acute vaginitis I25.799 Atherosclerosis of other coronary artery perforation and abscess without N76.1 Subacute and chronic vaginitis bypass graft(s) with unspecified angina bleeding N76.2 Acute vulvitis pectoris K57.40 Diverticulitis of both small and large N76.3 Subacute and chronic vulvitis I50.9 Heart failure, unspecified intestine with perforation and abscess N76.4 Abscess of vulva I35.0 Nonrheumatic aortic (valve) stenosis without bleeding I35.1 Nonrheumatic aortic (valve) K57.52 Diverticulitis of both small and large Disorders of Menstruation insufficiency intestine without perforation or abscess N91.0 Primary amenorrhea I35.2 Nonrheumatic aortic (valve) stenosis without bleeding N91.1 Secondary amenorrhea with insufficiency K57.80 Diverticulitis of intestine, part N91.2 Amenorrhea, unspecified I35.8 Other nonrheumatic aortic valve unspecified, with perforation and N95.9 Unspecified menopausal and disorders abscess without bleeding perimenopausal disorder I35.9 Nonrheumatic aortic valve disorder, K57.92 Diverticulitis of intestine, part N92.0 Excessive and frequent menstruation unspecified unspecified, without perforation or with regular cycle I39 Endocarditis and heart valve disorders abscess without bleeding N92.1 Excessive and frequent menstruation in diseases classified elsewhere K29.70 Gastritis, unspecified, without bleeding with irregular cycle I25.9 Chronic ischemic heart disease, K29.90 Gastroduodenitis, unspecified, without N94.4 Primary dysmenorrhea unspecified bleeding N94.5 Secondary dysmenorrhea K52.8 Other specified noninfective N94.6 Dysmenorrhea, unspecified Vascular gastroenteritis and colitis N92.1 Excessive and frequent menstruation R03.0 Elevated blood-pressure reading, K52.9 Noninfective gastroenteritis and colitis, with irregular cycle without diagnosis of hypertension unspecified I10 Essential (primary) hypertension K21.9 Gastro-esophageal reflux disease Pregnancy, Childbirth I95.1 Orthostatic hypotension without esophagitis O46.90 Antepartum hemorrhage, unspecified, I73.9 Peripheral vascular disease, I84.20 Unspecified hemorrhoids without unspecified trimester unspecified complication Z39.2 Encounter for routine postpartum I80.9 Phlebitis and thrombophlebitis of K58.0 Irritable bowel syndrome with diarrhea follow-up unspecified site K58.9 Irritable bowel syndrome without Z33.1 Pregnant state, incidental I87.2 Venous insufficiency (chronic) diarrhea Z34.00 Encounter for supervision of normal (peripheral) first pregnancy, unspecified trimester I87.9 Disorder of vein, unspecified Genitourinary System Z34.01 Encounter for supervision of normal Urinary System Diseases first pregnancy, unspecified trimester Respiratory System N20.2 Calculus of kidney with calculus of Z34.02 Encounter for supervision of normal Lower Respiratory Tract ureter first pregnancy, second trimester J45.909 Unspecified asthma, uncomplicated N20.9 Urinary calculus, unspecified Z34.03 Encounter for supervision of normal J45.998 Other asthma N30.00 Acute cystitis without hematuria first pregnancy, third trimester J20.0 Acute bronchitis due to Mycoplasma N30.01 Acute cystitis with hematuria V22.1 Prenatal care, normal, other pregnancy pneumoniae R31.0 Gross hematuria Z34.80 Encounter for supervision of other J20.1 Acute bronchitis due to Hemophilus R31.1 Benign essential microscopic hematuria normal pregnancy, unspecified influenzae R31.2 Other microscopic hematuria trimester J20.2 Acute bronchitis due to streptococcus R31.9 Hematuria, unspecified Z34.81 Encounter for supervision of other J20.3 Acute bronchitis due to coxsackievirus N28.9 Disorder of kidney and ureter, normal pregnancy, first trimester J20.4 Acute bronchitis due to parainfluenza unspecified Z34.82 Encounter for supervision of other virus N29 Other disorders of kidney and ureter in normal pregnancy, second trimester J20.5 Acute bronchitis due to respiratory diseases classified elsewhere Z34.83 Encounter for supervision of other syncytial virus N39.0 Urinary tract infection, site not specified normal pregnancy, third trimester J20.6 Acute bronchitis due to rhinovirus Z34.90 Encounter for supervision of normal J20.7 Acute bronchitis due to echovirus Male Genital Organ Diseases pregnancy, unspecified, unspecified J20.8 Acute bronchitis due to other specified N52.01 Erectile dysfunction due to arterial trimester organisms insufficiency Z34.91 Encounter for supervision of normal J20.9 Acute bronchitis, unspecified N52.02 Corporo-venous occlusive erectile pregnancy, unspecified, first trimester J44.9 Chronic obstructive pulmonary disease, dysfunction Z34.92 Encounter for supervision of normal unspecified N52.03 Combined arterial insufficiency and pregnancy, unspecified, second J18.8 Other pneumonia, unspecified corporo-venous occlusive erectile trimester organism dysfunction Z34.93 Encounter for supervision of normal J18.9 Pneumonia, unspecified organism N52.1 Erectile dysfunction due to diseases pregnancy, unspecified, third trimester classified elsewhere Upper Respiratory Tract N52.2 Drug-induced erectile dysfunction Skin, Subcutaneous Tissue J02.8 Acute pharyngitis due to other specified N52.31 Erectile dysfunction following radical L70.0 Acne vulgaris organisms prostatectomy L70.1 Acne conglobata J02.9 Acute pharyngitis, unspecified N52.32 Erectile dysfunction following radical L70.3 Acne tropica J30.0 Vasomotor rhinitis cystectomy L70.4 Infantile acne J30.9 Allergic rhinitis, unspecified N52.33 Erectile dysfunction following urethral L70.5 Acné excoriée des jeunes filles J01.90 Acute sinusitis, unspecified surgery L70.8 Other acne J01.91 Acute recurrent sinusitis, unspecified N52.34 Erectile dysfunction following simple L70.9 Acne, unspecified J01.80 Other acute sinusitis prostatectomy L73.0 Acne keloid J01.81 Other acute recurrent sinusitis N52.39 Other post-surgical erectile dysfunction L57.0 Actinic keratosis J06.9 Acute upper respiratory infection, N53.8 Other male sexual dysfunction L03.90 Cellulitis, unspecified unspecified N53.9 Unspecified male sexual dysfunction L03.91 Acute lymphangitis, unspecified

3 L03.129 Acute lymphangitis of unspecified part M60.859 Other myositis, unspecified thigh M05.76 Rheumatoid arthritis with rheumatoid of limb M60.861 Other myositis, right lower leg factor of knee without organ or systems L03.119 Cellulitis of unspecified part of limb M60.862 Other myositis, left lower leg involvement L98.3 Eosinophilic cellulitis [Wells] M60.869 Other myositis, unspecified lower leg M05.761 Rheumatoid arthritis with rheumatoid L23.9 Allergic contact dermatitis, unspecified M60.871 Other myositis, right ankle and foot factor of right knee without organ or cause M60.872 Other myositis, left ankle and foot systems involvement L24.9 Irritant contact dermatitis, unspecified M60.879 Other myositis, unspecified ankle and M05.762 Rheumatoid arthritis with rheumatoid cause foot factor of left knee without organ or L25.9 Unspecified contact dermatitis, M60.88 Other myositis, Other site systems involvement unspecified cause M60.89 Other myositis, multiple sites M05.769 Rheumatoid arthritis with rheumatoid L30.0 Nummular dermatitis M60.9 Myositis, unspecified factor of unspecified knee without L30.2 Cutaneous autosensitization M79.1 Myalgia organ or systems involvement L30.8 Other specified dermatitis M79.7 Fibromyalgia M05.77 Rheumatoid arthritis with rheumatoid L30.9 Dermatitis, unspecified M15.9 Polyosteoarthritis, unspecified factor of ankle and foot without organ or L20.8 Other atopic dermatitis M19.90 Unspecified osteoarthritis, unspecified systems involvement L20.81 Atopic neurodermatitis site M05.771 Rheumatoid arthritis with rheumatoid L20.82 Flexural eczema M81.8 Other osteoporosis without current factor of right ankle and foot without L20.83 Infantile (acute) (chronic) eczema pathological fracture organ or systems involvement L20.84 Intrinsic (allergic) eczema M05.70 Rheumatoid arthritis with rheumatoid M05.772 Rheumatoid arthritis with rheumatoid L20.89 Other atopic dermatitis factor of unspecified site without organ factor of left ankle and foot without L20.9 Atopic dermatitis, unspecified or systems involvement organ or systems involvement L21.8 Other seborrheic dermatitis M05.71 Rheumatoid arthritis with rheumatoid M05.779 Rheumatoid arthritis with rheumatoid L60.0 Ingrowing nail factor of shoulder without organ or factor of unspecified ankle and foot B35.1 Tinea unguium systems involvement without organ or systems involvement L44.9 Papulosquamous disorder, unspecified M05.711 Rheumatoid arthritis with rheumatoid M05.79 Rheumatoid arthritis with rheumatoid L45 Papulosquamous disorders in diseases factor of right shoulder without organ or factor of multiple sites without organ or classified elsewhere systems involvement systems involvement L98.9 Disorder of the skin and subcutaneous M05.712 Rheumatoid arthritis with rheumatoid M05.80 Other rheumatoid arthritis with tissue, unspecified factor of left shoulder without organ or rheumatoid factor of unspecified site L40.0 Psoriasis vulgaris systems involvement M05.811 Other rheumatoid arthritis with L40.1 Generalized pustular psoriasis M05.719 Rheumatoid arthritis with rheumatoid rheumatoid factor of right shoulder L40.2 Acrodermatitis continua factor of unspecified shoulder without M05.812 Other rheumatoid arthritis with L40.3 Pustulosis palmaris et plantaris organ or systems involvement rheumatoid factor of left shoulder L40.4 Guttate psoriasis M05.721 Rheumatoid arthritis with rheumatoid M05.819 Other rheumatoid arthritis with L40.8 Other psoriasis factor of right elbow without organ or rheumatoid factor of unspecified L40.9 Psoriasis, unspecified systems involvement shoulder L71.0 Perioral dermatitis M05.722 Rheumatoid arthritis with rheumatoid M05.82 Other rheumatoid arthritis with L71.1 Rhinophyma factor of left elbow without organ or rheumatoid factor of elbow L71.8 Other rosacea systems involvement M05.821 Other rheumatoid arthritis with L71.9 Rosacea, unspecified M05.729 Rheumatoid arthritis with rheumatoid rheumatoid factor of right elbow L72.0 Epidermal cyst factor of unspecified elbow without M05.822 Other rheumatoid arthritis with L72.1 Trichodermal cyst organ or systems involvement rheumatoid factor of left elbow L72.2 Steatocystoma multiplex M05.73 Rheumatoid arthritis with rheumatoid M05.829 Other rheumatoid arthritis with L72.8 Other follicular cysts of the skin and factor of wrist without organ or systems rheumatoid factor of unspecified elbow subcutaneous tissue involvement M05.83 Other rheumatoid arthritis with L72.9 Follicular cyst of the skin and M05.731 Rheumatoid arthritis with rheumatoid rheumatoid factor of wrist subcutaneous tissue, unspecified factor of right wrist without organ or M05.831 Other rheumatoid arthritis with L82.0 Inflamed seborrheic keratosis systems involvement rheumatoid factor of right wrist L82.1 Other seborrheic keratosis M05.732 Rheumatoid arthritis with rheumatoid M05.832 Other rheumatoid arthritis with L98.491 Non-pressure chronic ulcer of skin of factor of left wrist without organ or rheumatoid factor of left wrist other sites limited to breakdown of skin systems involvement M05.839 Other rheumatoid arthritis with L98.492 Non-pressure chronic ulcer of skin of M05.739 Rheumatoid arthritis with rheumatoid rheumatoid factor of unspecified wrist other sites with fat layer exposed factor of unspecified wrist without organ M05.84 Other rheumatoid arthritis with L98.493 Non-pressure chronic ulcer of skin of or systems involvement rheumatoid factor of hand other sites with necrosis of muscle M05.74 Rheumatoid arthritis with rheumatoid M05.841 Other rheumatoid arthritis with L98.494 Non-pressure chronic ulcer of skin of factor of hand without organ or systems rheumatoid factor of right hand other sites with necrosis of bone involvement M05.842 Other rheumatoid arthritis with L98.499 Non-pressure chronic ulcer of skin of M05.741 Rheumatoid arthritis with rheumatoid rheumatoid factor of left hand other sites with unspecified severity factor of right hand without organ or M05.849 Other rheumatoid arthritis with L50.9 Urticaria, unspecified systems involvement rheumatoid factor of unspecified hand M05.742 Rheumatoid arthritis with rheumatoid M05.85 Other rheumatoid arthritis with Musculoskeletal & Connective Tissue factor of left hand without organ or rheumatoid factor of hip systems involvement M05.851 Other rheumatoid arthritis with General M05.749 Rheumatoid arthritis with rheumatoid rheumatoid factor of right hip M12.9 Arthropathy, unspecified factor of unspecified hand without M05.852 Other rheumatoid arthritis with M60.80 Other myositis, unspecified site organ or systems involvement rheumatoid factor of left hip M60.811 Other myositis, right shoulder M05.75 Rheumatoid arthritis with rheumatoid M05.859 Other rheumatoid arthritis with M60.812 Other myositis, left shoulder factor of hip without organ or systems rheumatoid factor of unspecified hip M60.819 Other myositis, unspecified shoulder involvement M05.86 Other rheumatoid arthritis with M60.821 Other myositis, right upper arm M05.751 Rheumatoid arthritis with rheumatoid rheumatoid factor of knee M60.822 Other myositis, left upper arm factor of right hip without organ or M05.861 Other rheumatoid arthritis with M60.829 Other myositis, unspecified upper arm systems involvement rheumatoid factor of right knee M60.831 Other myositis, right forearm M05.752 Rheumatoid arthritis with rheumatoid M05.862 Other rheumatoid arthritis with M60.832 Other myositis, left forearm factor of left hip without organ or rheumatoid factor of left knee M60.839 Other myositis, unspecified forearm systems involvement M05.869 Other rheumatoid arthritis with M60.841 Other myositis, right hand M05.759 Rheumatoid arthritis with rheumatoid rheumatoid factor of unspecified knee M60.842 Other myositis, left hand factor of unspecified hip without organ M05.87 Other rheumatoid arthritis with M60.849 Other myositis, unspecified hand or systems involvement rheumatoid factor of ankle and foot M60.851 Other myositis, right thigh M60.852 Other myositis, left thigh

4 M05.871 Other rheumatoid arthritis with M06.219 Rheumatoid bursitis, unspecified M06.83 Other specified rheumatoid arthritis, rheumatoid factor of right ankle and shoulder wrist foot M06.22 Rheumatoid bursitis, elbow M06.831 Other specified rheumatoid arthritis, M05.872 Other rheumatoid arthritis with M06.221 Rheumatoid bursitis, right elbow right wrist rheumatoid factor of left ankle and foot M06.222 Rheumatoid bursitis, left elbow M06.832 Other specified rheumatoid arthritis, left M05.879 Other rheumatoid arthritis with M06.229 Rheumatoid bursitis, unspecified elbow wrist rheumatoid factor of unspecified ankle M06.23 Rheumatoid bursitis, wrist M06.839 Other specified rheumatoid arthritis, and foot M06.231 Rheumatoid bursitis, right wrist unspecified wrist M05.89 Other rheumatoid arthritis with M06.232 Rheumatoid bursitis, left wrist M06.84 Other specified rheumatoid arthritis, rheumatoid factor of multiple sites M06.239 Rheumatoid bursitis, unspecified wrist hand M05.9 Rheumatoid arthritis with rheumatoid M06.24 Rheumatoid bursitis, hand M06.841 Other specified rheumatoid arthritis, factor, unspecified M06.241 Rheumatoid bursitis, right hand right hand M06.00 Rheumatoid arthritis without M06.242 Rheumatoid bursitis, left hand M06.842 Other specified rheumatoid arthritis, left rheumatoid factor, unspecified site M06.249 Rheumatoid bursitis, unspecified hand hand M06.01 Rheumatoid arthritis without M06.25 Rheumatoid bursitis, hip M06.849 Other specified rheumatoid arthritis, rheumatoid factor, shoulder M06.251 Rheumatoid bursitis, right hip unspecified hand M06.011 Rheumatoid arthritis without M06.252 Rheumatoid bursitis, left hip M06.85 Other specified rheumatoid arthritis, hip rheumatoid factor, right shoulder M06.259 Rheumatoid bursitis, unspecified hip M06.851 Other specified rheumatoid arthritis, M06.012 Rheumatoid arthritis without M06.26 Rheumatoid bursitis, knee right hip rheumatoid factor, left shoulder M06.261 Rheumatoid bursitis, right knee M06.852 Other specified rheumatoid arthritis, left M06.019 Rheumatoid arthritis without M06.262 Rheumatoid bursitis, left knee hip rheumatoid factor, unspecified shoulder M06.269 Rheumatoid bursitis, unspecified knee M06.859 Other specified rheumatoid arthritis, M06.021 Rheumatoid arthritis without M06.27 Rheumatoid bursitis, ankle and foot unspecified hip rheumatoid factor, right elbow M06.271 Rheumatoid bursitis, right ankle and M06.86 Other specified rheumatoid arthritis, M06.022 Rheumatoid arthritis without foot knee rheumatoid factor, left elbow M06.272 Rheumatoid bursitis, left ankle and foot M06.861 Other specified rheumatoid arthritis, M06.029 Rheumatoid arthritis without M06.279 Rheumatoid bursitis, unspecified ankle right knee rheumatoid factor, unspecified elbow and foot M06.862 Other specified rheumatoid arthritis, left M06.03 Rheumatoid arthritis without M06.28 Rheumatoid bursitis, vertebrae knee rheumatoid factor, wrist M06.29 Rheumatoid bursitis, multiple sites M06.869 Other specified rheumatoid arthritis, M06.031 Rheumatoid arthritis without M06.30 Rheumatoid nodule, unspecified site unspecified knee rheumatoid factor, right wrist M06.31 Rheumatoid nodule, shoulder M06.87 Other specified rheumatoid arthritis, M06.032 Rheumatoid arthritis without M06.311 Rheumatoid nodule, right shoulder ankle and foot rheumatoid factor, left wrist M06.312 Rheumatoid nodule, left shoulder M06.871 Other specified rheumatoid arthritis, M06.039 Rheumatoid arthritis without M06.319 Rheumatoid nodule, unspecified right ankle and foot rheumatoid factor, unspecified wrist shoulder M06.872 Other specified rheumatoid arthritis, M06.04 Rheumatoid arthritis without M06.32 Rheumatoid nodule, elbow left ankle and foot rheumatoid factor, hand M06.321 Rheumatoid nodule, right elbow M06.879 Other specified rheumatoid arthritis, M06.041 Rheumatoid arthritis without M06.322 Rheumatoid nodule, left elbow unspecified ankle and foot rheumatoid factor, right hand M06.329 Rheumatoid nodule, unspecified elbow M06.88 Other specified rheumatoid arthritis, M06.042 Rheumatoid arthritis without M06.33 Rheumatoid nodule, wrist M06.89 Other specified rheumatoid arthritis, rheumatoid factor, left hand M06.331 Rheumatoid nodule, right wrist multiple sites M06.049 Rheumatoid arthritis without M06.332 Rheumatoid nodule, left wrist M06.9 Rheumatoid arthritis, unspecified rheumatoid factor, unspecified hand M06.339 Rheumatoid nodule, unspecified wrist M65.9 Synovitis and tenosynovitis, M06.05 Rheumatoid arthritis without M06.34 Rheumatoid nodule, hand unspecified rheumatoid factor, hip M06.341 Rheumatoid nodule, right hand M06.051 Rheumatoid arthritis without M06.342 Rheumatoid nodule, left hand Lower Extremity rheumatoid factor, right hip M06.349 Rheumatoid nodule, unspecified hand M79.601 Pain in right arm M06.052 Rheumatoid arthritis without M06.352 Rheumatoid nodule, left hip M79.602 Pain in left arm rheumatoid factor, left hip M06.359 Rheumatoid nodule, unspecified hip M79.603 Pain in arm, unspecified M06.059 Rheumatoid arthritis without M06.36 Rheumatoid nodule, knee M79.604 Pain in right leg rheumatoid factor, unspecified hip M06.361 Rheumatoid nodule, right knee M79.605 Pain in left leg M06.06 Rheumatoid arthritis without M06.362 Rheumatoid nodule, left knee M79.606 Pain in leg, unspecified rheumatoid factor, knee M06.369 Rheumatoid nodule, unspecified knee M79.609 Pain in unspecified limb M06.061 Rheumatoid arthritis without M06.37 Rheumatoid nodule, ankle and foot M79.621 Pain in right upper arm rheumatoid factor, right knee M06.371 Rheumatoid nodule, right ankle and M79.622 Pain in left upper arm M06.062 Rheumatoid arthritis without foot M79.629 Pain in unspecified upper arm rheumatoid factor, left knee M06.372 Rheumatoid nodule, left ankle and foot M79.631 Pain in right forearm M06.069 Rheumatoid arthritis without M06.379 Rheumatoid nodule, unspecified ankle M79.632 Pain in left forearm rheumatoid factor, unspecified knee and foot M79.639 Pain in unspecified forearm M06.07 Rheumatoid arthritis without M06.38 Rheumatoid nodule, vertebrae M79.641 Pain in right hand rheumatoid factor, ankle and foot M06.39 Rheumatoid nodule, multiple sites M79.642 Pain in left hand M06.071 Rheumatoid arthritis without M06.80 Other specified rheumatoid arthritis, M79.643 Pain in unspecified hand rheumatoid factor, right ankle and foot unspecified site M79.644 Pain in right finger(s) M06.072 Rheumatoid arthritis without M06.81 Other specified rheumatoid arthritis, M79.645 Pain in left finger(s) rheumatoid factor, left ankle and foot shoulder M79.646 Pain in unspecified (s) M06.079 Rheumatoid arthritis without M06.811 Other specified rheumatoid arthritis, M79.651 Pain in right thigh rheumatoid factor, unspecified ankle right shoulder M79.652 Pain in left thigh and foot M06.812 Other specified rheumatoid arthritis, left M79.659 Pain in unspecified thigh M06.08 Rheumatoid arthritis without shoulder M79.661 Pain in right lower leg rheumatoid factor, vertebrae M06.819 Other specified rheumatoid arthritis, M79.662 Pain in left lower leg M06.09 Rheumatoid arthritis without unspecified shoulder M79.669 Pain in unspecified lower leg rheumatoid factor, multiple sites M06.82 Other specified rheumatoid arthritis, M79.671 Pain in right foot M06.1 Adult-onset Still's disease elbow M79.672 Pain in left foot M06.2 Rheumatoid bursitis M06.821 Other specified rheumatoid arthritis, M79.673 Pain in unspecified foot M06.20 Rheumatoid bursitis, unspecified site right elbow M79.674 Pain in right toe(s) M06.21 Rheumatoid bursitis, shoulder M06.822 Other specified rheumatoid arthritis, left M79.675 Pain in left toe(s) M06.211 Rheumatoid bursitis, right shoulder elbow M79.676 Pain in unspecified toe(s) M06.212 Rheumatoid bursitis, left shoulder M06.829 Other specified rheumatoid arthritis, unspecified elbow

5 Spine/Torso G44.321 Chronic post-traumatic headache, S93.409A Sprain of unspecified ligament of M54.14 Radiculopathy, thoracic region intractable unspecified ankle; initial encounter M54.15 Radiculopathy, thoracolumbar region G44.329 Chronic post-traumatic headache, not S93.409D Sprain of unspecified ligament of M54.16 Radiculopathy, lumbar region intractable unspecified ankle; subsequent M54.17 Radiculopathy, lumbosacral region G44.40 Drug-induced headache, not encounter M51.14 Intervertebral disc disorders with elsewhere classified, not intractable S96.919A Strain of unspecified muscle and radiculopathy, thoracic region G44.41 Drug-induced headache, not tendon at ankle and foot level, M51.15 Intervertebral disc disorders with elsewhere classified, intractable unspecified side; initial encounter radiculopathy, thoracolumbar region G44.51 Hemicrania continua S96.919D Strain of unspecified muscle and M51.16 Intervertebral disc disorders with G44.52 New daily persistent headache tendon at ankle and foot level, radiculopathy, lumbar region (NDPH) unspecified side; subsequent M51.17 Intervertebral disc disorders with G44.53 Primary thunderclap headache encounter radiculopathy, lumbosacral region G44.59 Other complicated headache S93.609A Unspecified sprain of unspecified foot; M53.9 Dorsopathy, unspecified syndrome initial encounter G44.81 Hypnic headache S93.609D Unspecified sprain of unspecified foot; Upper Extremity G44.82 Headache associated with sexual subsequent encounter M75.10 Rotator cuff syndrome, unspecified activity S63.90A Initial encounter; Sprain of shoulder G44.83 Primary cough headache unspecified part of unspecified wrist M75.11 Rotator cuff syndrome, right shoulder G44.84 Primary exertional headache and hand M75.12 Rotator cuff syndrome, left shoulder G44.85 Primary stabbing headache S63.90D Subsequent encounter; Sprain of G44.89 Other headache syndrome unspecified part of unspecified wrist Perinatal (Infant) R32 Unspecified urinary incontinence and hand P92.0 Vomiting of newborn R22.0 Localized swelling, mass and lump, S63.509A Initial encounter; Unspecified sprain P92.1 Regurgitation and rumination of head of unspecified wrist newborn R22.1 Localized swelling, mass and lump, S63.509D Subsequent encounter; Unspecified P92.2 Slow feeding of newborn neck sprain of unspecified wrist P92.3 Underfeeding of newborn R22.2 Localized swelling, mass and lump, S66.919A Strain of unspecified muscle, fascia P92.4 Overfeeding of newborn trunk and tendon at wrist and hand level of P92.5 Neonatal difficulty in feeding at breast R22.30 Localized swelling, mass and lump, unspecified side; Initial encounter P92.8 Other feeding problems of newborn upper limb, unspecified side S66.919D Strain of unspecified muscle, fascia P92.9 Feeding problem of newborn, R22.31 Localized swelling, mass and lump, and tendon at wrist and hand level of unspecified right upper limb unspecified side; Subsequent R22.32 Localized swelling, mass and lump, encounter Signs & Symptoms left upper limb S83.90A Initial encounter; Sprain of R10.0 Acute abdomen R22.33 Localized swelling, mass and lump, unspecified site of knee, unspecified R10.83 Colic upper limb, bilateral side R10.9 Unspecified abdominal pain R22.40 Localized swelling, mass and lump, S83.90D Subsequent encounter; Sprain of R87.619 Unspecified abnormal cytological lower limb, unspecified side unspecified site of knee, unspecified findings in specimens from cervix R22.41 Localized swelling, mass and lump, S86.919A Initial encounter; Strain of uteri right lower limb unspecified muscle(s) and tendon(s) M25.50 Pain in unspecified joint R22.42 Localized swelling, mass and lump, at lower leg level, unspecified leg K62.5 Hemorrhage of anus and rectum left lower limb S86.919D Subsequent encounter; Strain of R07.81 Pleurodynia R22.43 Localized swelling, mass and lump, unspecified muscle(s) and tendon(s) R07.82 Intercostal pain lower limb, bilateral at lower leg level, unspecified leg R07.89 Other chest pain R22.9 Localized swelling, mass and lump, S16.1A Initial encounter; Strain of muscle, R07.9 Chest pain, unspecified unspecified fascia and tendon at neck level R05 Cough R59.0 Localized enlarged lymph nodes S16.1D Subsequent encounter; Strain of R19.7 Diarrhea, unspecified R59.1 Generalized enlarged lymph nodes muscle, fascia and tendon at neck R42 Dizziness and giddiness R59.9 Enlarged lymph nodes, unspecified level R13.10 Dysphagia, unspecified R53.0 Neoplastic (malignant) related fatigue S13.4A Initial encounter; Sprain of ligaments R13.11 Dysphagia, oral phase R53.1 Weakness of cervical spine R13.12 Dysphagia, oropharyngeal phase R53.2 Functional quadriplegia S13.4D Subsequent encounter; Sprain of R13.13 Dysphagia, pharyngeal phase R53.81 Other malaise ligaments of cervical spine R13.14 Dysphagia, pharyngoesophageal R53.83 Other fatigue S13.8A Initial encounter; Sprain of joints and phase G93.3 Postviral fatigue syndrome ligaments of other parts of neck R13.19 Other dysphagia R11.1 Nausea alone S13.8D Subsequent encounter; Sprain of R30.0 Dysuria R11.0 Nausea with vomiting joints and ligaments of other parts of R30.9 Painful micturition, unspecified M25.561 Pain in right knee neck R60.0 Localized edema M25.562 Pain in left knee S43.409A Initial encounter; Unspecified sprain R60.1 Generalized edema M25.569 Pain in unspecified knee of unspecified shoulder joint R60.9 Edema, unspecified M54.5 Low back pain S43.409D Subsequent encounter; Unspecified R63.3 Feeding difficulties R00.2 Palpitations sprain of unspecified shoulder joint R50.2 Drug induced fever R35.8 Other polyuria S43.90A Initial encounter; Sprain of R50.8 Other specified fever R21 Rash and other nonspecific skin unspecified parts of shoulder girdle, R50.9 Fever, unspecified eruption unspecified side E74.9 Disorder of carbohydrate metabolism, R20.1 Hypoesthesia of skin S43.90D Subsequent encounter; Sprain of unspecified R20.2 Paresthesia of skin unspecified parts of shoulder girdle, G44.10 Vascular headache, not elsewhere R20.3 Hyperesthesia unspecified side classified, not intractable R20.8 Other disturbances of skin sensation S46.919A Strain of unspecified muscle, fascia G44.11 Vascular headache, not elsewhere R20.9 Unspecified disturbances of skin and tendon at shoulder and upper classified, intractable sensation arm level, unspecified arm; Initial G44.301 Post-traumatic headache, R06.02 Shortness of breath encounter unspecified, intractable R55 Syncope and collapse S46.919D Strain of unspecified muscle, fascia G44.309 Post-traumatic headache, R35.0 Frequency of micturition and tendon at shoulder and upper unspecified, not intractable R11.2 Projectile vomiting arm level, unspecified arm; G44.311 Acute post-traumatic headache, R11.3 Other vomiting without nausea Subsequent encounter intractable R63.4 Abnormal weight loss G44.319 Acute post-traumatic headache, not Other Trauma, Adverse Effects Intractable Injuries & Adverse Effects S00.01A Abrasion of scalp; Initial encounter Dislocations, Sprains & Strains

6 S00.01D Abrasion of scalp; Subsequent S30.817D Abrasion of anus; Subsequent S00.531D Contusion of lip; Subsequent encounter encounter encounter S00.219A Abrasion of unspecified eyelid and S40.219A Abrasion of unspecified shoulder; S00.532A Contusion of oral cavity; Initial periocular area; Initial encounter Initial encounter encounter S00.219D Abrasion of unspecified eyelid and S40.219D Abrasion of unspecified shoulder; S00.532D Contusion of oral cavity; Subsequent periocular area; Subsequent Subsequent encounter encounter encounter S40.819A Abrasion of unspecified upper arm; S10.0A Contusion of throat; Initial encounter S00.31A Abrasion of nose; Initial encounter Initial encounter S10.0D Contusion of throat; Subsequent S00.31D Abrasion of nose; Subsequent S40.819D Abrasion of unspecified upper arm; encounter encounter Subsequent encounter S10.83A Contusion of other part of neck; Initial S00.419A Abrasion of unspecified ear; Initial S50.319A Abrasion of unspecified elbow; Initial encounter encounter encounter S10.83D Contusion of other part of necks; S00.419D Abrasion of unspecified ear; S50.319D Abrasion of unspecified elbow; Subsequent encounter Subsequent encounter Subsequent encounter S10.93A Contusion of unspecified part of neck; S00.511A Abrasion of lip; Initial encounter S50.819A Abrasion of unspecified forearm; Initial encounter S00.511D Abrasion of lip; Subsequent Initial encounter S10.93D Contusion of unspecified part of neck; encounter S50.819D Abrasion of unspecified forearm; Subsequent encounter S00.512A Abrasion of oral cavity; Initial Subsequent encounter S20.00A Contusion of breast, unspecified encounter S60.319A Abrasion of unspecified thumb; Initial breast; Initial encounter S00.512D Abrasion of oral cavity; Subsequent encounter S20.00D Contusion of breast, unspecified encounter S60.319D Abrasion of unspecified thumb; breast; Subsequent encounter S10.11A Abrasion of throat; Initial encounter Subsequent encounter S20.219A Contusion of unspecified front wall of S10.11D Abrasion of throat; Subsequent S60.419A Abrasion of unspecified finger; Initial thorax; Initial encounter encounter encounter S20.219D Contusion of unspecified front wall of S10.81A Abrasion of other part of neck; Initial S60.419D Abrasion of unspecified finger; thorax; Subsequent encounter encounter Subsequent encounter S20.229A Contusion of unspecified back wall of S10.81S Abrasion of other part of necks S60.519A Abrasion of unspecified hand; Initial thorax; Initial encounter subsequent encounter encounter S20.229D Contusion of unspecified back wall of S10.91A Abrasion of unspecified part of neck; S60.519D Abrasion of unspecified hand; thorax; Subsequent encounter Initial encounter Subsequent encounter S30.00A Contusion of lower back and pelvis; S10.91D Abrasion of unspecified part of neck; S60.819A Abrasion of unspecified wrist; Initial Initial encounter Subsequent encounter encounter S30.00D Contusion of lower back and pelvis; S20.119A Abrasion of breast, unspecified S60.819D Abrasion of unspecified wrist; Subsequent encounter breast; Initial encounter Subsequent encounter S30.1A Contusion of abdominal wall; Initial S20.119D Abrasion of breast, unspecified S70.219A Abrasion, unspecified hip; Initial encounter breast; Subsequent encounter encounter S30.1D Contusion of abdominal wall; S20.319A Abrasion of unspecified front wall of S70.219D Abrasion, unspecified hip; Subsequent encounter thorax; Initial encounter Subsequent encounter S30.21A Contusion of penis; Initial encounter S20.319D Abrasion of unspecified front wall of S70.319A Abrasion, unspecified thigh; Initial S30.21D Contusion of penis; Subsequent thorax; Subsequent encounter encounter encounter S20.419A Abrasion of unspecified back wall of S70.319D Abrasion, unspecified thigh; S30.22A Contusion of scrotum and testes; thorax; Initial encounter Subsequent encounter Initial encounter S20.419D Abrasion of unspecified back wall of S80.219A Abrasion, unspecified knee; Initial S30.22D Contusion of scrotum and testes; thorax; Subsequent encounter encounter Subsequent encounter S20.91A Abrasion of unspecified parts of S80.219D Abrasion, unspecified knee; S30.23A Contusion of vagina and vulva; Initial thorax; Initial encounter Subsequent encounter encounter S20.91D Abrasion of unspecified parts of S90.413A Abrasion, unspecified great toe; Initial S30.23D Contusion of vagina and vulva; thorax; Subsequent encounter encounter Subsequent encounter S30.810A Abrasion of lower back and pelvis; S90.413D Abrasion, unspecified great toe; S30.201A Contusion of unspecified external Initial encounter Subsequent encounter genital organs, male; Initial encounter S30.810D Abrasion of lower back and pelvis; S90.416A Abrasion, unspecified lesser toe(s); S30.201D Contusion of unspecified external Subsequent encounter Initial encounter genital organs, male; Subsequent S30.811A Abrasion of abdominal wall; Initial S90.416D Abrasion, unspecified lesser toe(s); encounter encounter Subsequent encounter S30.202A Contusion of unspecified external S30.811D Abrasion of abdominal wall; S90.519A Abrasion, unspecified ankle; Initial genital organs, female; Initial Subsequent encounter encounter encounter S30.812A Abrasion of penis; Initial encounter S90.519D Abrasion, unspecified ankle; S30.202D Contusion of unspecified external S30.812D Abrasion of penis; Subsequent Subsequent encounter genital organs, female; Subsequent encounter S90.819A Abrasion, unspecified foot; Initial encounter S30.813A Abrasion of scrotum and testes; Initial encounter S30.3A Contusion of anus; Initial encounter encounter S90.819D Abrasion, unspecified foot; S30.3D Contusion of anus; Subsequent S30.813D Abrasion of scrotum and testes; Subsequent encounter encounter Subsequent encounter S00.03A Contusion of scalp; Initial encounter S40.019A Contusion of unspecified shoulder; S30.814A Abrasion of vagina and vulva; Initial S00.03D Contusion of scalp; Subsequent Initial encounter encounter encounter S40.019D Contusion of unspecified shoulder; S30.814D Abrasion of vagina and vulva; S00.19A Contusion of unspecified eyelid and Subsequent encounter Subsequent encounter periocular area; Initial encounter S40.029A Contusion of unspecified upper arm; S30.815A Abrasion of unspecified external S00.19D Contusion of unspecified eyelid and Initial encounter genital organs, male; Initial encounter periocular area; Subsequent S40.029D Contusion of unspecified upper arm; S30.815D Abrasion of unspecified external encounter Subsequent encounter genital organs, male; Subsequent S00.33A Contusion of nose; Initial encounter S50.00A Contusion of unspecified elbow; Initial encounter S00.33D Contusion of nose; Subsequent encounter S30.816A Abrasion of unspecified external encounter S50.00D Contusion of unspecified elbow; genital organs, female; Initial S00.439A Contusion of unspecified ear; Initial Subsequent encounter encounter encounter S50.10A Contusion of unspecified forearm; S30.816D Abrasion of unspecified external S00.439D Contusion of unspecified ear; Initial encounter genital organs, female; Subsequent Subsequent encounter S50.10D Contusion of unspecified forearm; encounter S00.531A Contusion of lip; Initial encounter Subsequent encounter S30.817A Abrasion of anus; Initial encounter S60.019 Contusion of unspecified thumb; Initial encounter

7 S60.019 Contusion of unspecified thumb; S10.96D Insect bite of unspecified part of neck; S40.269D Insect bite of unspecified shoulder; Subsequent encounter Subsequent encounter Subsequent encounter S60.00A Contusion of unspecified finger S20.161A Insect bite of breast, right breast; S40.869A Insect bite of unspecified upper arm; without damage to nail; Initial Initial encounter Initial encounter encounter S20.161D Insect bite of breast, right breast; S40.869D Insect bite of unspecified upper arm; S60.00D Contusion of unspecified finger Subsequent encounter Subsequent encounter without damage to nail; Subsequent S20.162A Insect bite of breast, left breast; Initial S50.369A Insect bite of unspecified elbow; Initial encounter encounter encounter S60.229A Contusion of unspecified hand; Initial S20.162D Insect bite of breast, left breast; S50.369D Insect bite of unspecified elbow; encounter Subsequent encounter Subsequent encounter S60.229D Contusion of unspecified hand; S20.169A Insect bite of breast, unspecified S50.869A Insect bite of unspecified forearm; Subsequent encounter breast; Initial encounter Initial encounter S60.211A Contusion of right wrist; Initial S20.169D Insect bite of breast, unspecified S50.869D Insect bite of unspecified forearm; encounter breast; Subsequent encounter Subsequent encounter S60.211D Contusion of right wrist; Subsequent S20.361A Insect bite of right front wall of thorax; S60.369A Insect bite of unspecified thumb; encounter Initial encounter Initial encounter S60.212A Contusion of left wrist; Initial S20.361D Insect bite of right front wall of thorax; S60.369D Insect bite of unspecified thumb; encounter Subsequent encounter Subsequent encounter S60.212D Contusion of left wrist; Subsequent S20.361S Insect bite of right front wall of thorax; S60.468A Insect bite of other finger; Initial encounter Subsequent encounter encounter S60.219A Contusion of unspecified wrist; Initial S20.362A Insect bite of left front wall of thorax; S60.468D Insect bite of other finger; Subsequent encounter Initial encounter encounter S60.219D Contusion of unspecified wrist; S20.362D Insect bite of left front wall of thorax; S60.469A Insect bite of unspecified finger; Initial Subsequent encounter Subsequent encounter encounter S70.00A Contusion, unspecified hip; Initial S20.369A Insect bite of unspecified front wall of S60.469D Insect bite of unspecified finger; encounter thorax; Initial encounter Subsequent encounter S70.00D Contusion, unspecified hip; S20.369D Insect bite of unspecified front wall of S60.569A Insect bite of unspecified hand; Initial Subsequent encounter thorax; Subsequent encounter encounter S70.10A Contusion, unspecified thigh; Initial S20.461A Insect bite of right back wall of thorax; S60.569D Insect bite of unspecified hand; encounter Initial encounter Subsequent encounter S70.10D Contusion, unspecified thigh; S20.461D Insect bite of right back wall of thorax; S60.869A Insect bite of unspecified wrist; Initial Subsequent encounter Subsequent encounter encounter S80.00A Contusion, unspecified knee; Initial S20.462A Insect bite of left back wall of thorax; S60.869D Insect bite of unspecified wrist; encounter Initial encounter Subsequent encounter S80.00D Contusion, unspecified knee; S20.462D Insect bite of left back wall of thorax; S70.269A Insect bite, unspecified hip; Initial Subsequent encounter Subsequent encounter encounter S90.11A Contusion, unspecified great toe; S20.469A Insect bite of unspecified back wall of S70.269D Insect bite, unspecified hip; Initial encounter thorax; Initial encounter Subsequent encounter S90.11D Contusion, unspecified great toe; S20.469D Insect bite of unspecified back wall of S70.369A Insect bite, unspecified thigh; Initial Subsequent encounter thorax; Subsequent encounter encounter S90.129A Contusion, unspecified lesser toe(s); S20.96A Insect bite of unspecified parts of S70.369D Insect bite, unspecified thigh; Initial encounter thorax; Initial encounter Subsequent encounter S90.129D Contusion, unspecified lesser toe(s); S20.96D Insect bite of unspecified parts of S80.269A Insect bite, unspecified knee; Initial Subsequent encounter thorax; Subsequent encounter encounter S90.00A Contusion, unspecified ankle; Initial S30.860A Insect bite of lower back and pelvis; S80.269D Insect bite, unspecified knee; encounter Initial encounter Subsequent encounter S90.00D Contusion, unspecified ankle; S30.860D Insect bite of lower back and pelvis; S90.463A Insect bite, unspecified great toe; Subsequent encounter Subsequent encounter Initial encounter S00.06A Insect bite of scalp; Initial encounter S30.861A Insect bite of abdominal wall; Initial S90.463D Insect bite, unspecified great toe; S00.06D Insect bite of scalp; Subsequent encounter Subsequent encounter encounter S30.861D Insect bite of abdominal wall; S90.466A Insect bite, unspecified lesser toe(s); S00.269A Insect bite of unspecified eyelid and Subsequent encounter Initial encounter periocular area; Initial encounter S30.862A Insect bite of penis; Initial encounter S90.466D Insect bite, unspecified lesser toe(s); S00.269D Insect bite of unspecified eyelid and S30.862D Insect bite of penis; Subsequent Subsequent encounter periocular area; Subsequent encounter S90.569A Insect bite, unspecified ankle; Initial encounter S30.863A Insect bite of scrotum and testes; encounter S00.36A Insect bite of nose; Initial encounter Initial encounter S90.569D Insect bite, unspecified ankle; S00.36D Insect bite of nose; Subsequent S30.863D Insect bite of scrotum and testes; Subsequent encounter encounter Subsequent encounter S90.869A Insect bite, unspecified foot; Initial S00.469A Insect bite of unspecified ear; Initial S30.864A Insect bite of vagina and vulva; Initial encounter encounter encounter S90.869D Insect bite, unspecified foot; S00.469D Insect bite of unspecified ear; S30.864D Insect bite of vagina and vulva; Subsequent encounter Subsequent encounter Subsequent encounter S71.009A Unspecified open wound, unspecified S00.561A Insect bite of lip; Initial encounter S30.865A Insect bite of unspecified external hip; Initial encounter S00.561D Insect bite of lip; Subsequent genital organs, male; Initial encounter S71.009D Unspecified open wound, unspecified encounter S30.865D Insect bite of unspecified external hip; Subsequent encounter S00.562A Insect bite of oral cavity; Initial genital organs, male; Subsequent S71.109A Unspecified open wound, unspecified encounter encounter thigh; Initial encounter S00.562D Insect bite of oral cavity; Subsequent S30.866A Insect bite of unspecified external S71.109D Unspecified open wound, unspecified encounter genital organs, female; Initial thigh; Subsequent encounter S10.16A Insect bite of throat; Initial encounter encounter S41.009A Unspecified open wound of S10.16D Insect bite of throat; Subsequent S30.866D Insect bite of unspecified external unspecified shoulder; Initial encounter encounter genital organs, female; Subsequent S41.009D Unspecified open wound of S10.86A Insect bite of other part of neck; Initial encounter unspecified shoulder; Subsequent encounter S30.867A Insect bite of anus; Initial encounter encounter S10.86S Insect bite of other part of necks; S30.867D Insect bite of anus; Subsequent S41.109A Unspecified open wound of subsequent encounter encounter unspecified upper arm; Initial S10.96A Insect bite of unspecified part of neck; S40.269A Insect bite of unspecified shoulder; encounter Initial encounter Initial encounter

8 S41.109D Unspecified open wound of unspecified upper arm; Subsequent encounter S51.009A Unspecified open wound of unspecified elbow; Initial encounter S51.009D Unspecified open wound of unspecified elbow; Subsequent encounter S51.809A Unspecified open wound of unspecified forearm; Initial encounter S51.809D Unspecified open wound of unspecified forearm; Subsequent encounter

Supplemental Classification Z30.011 Encounter for initial prescription of contraceptive pills Z30.013 Encounter for initial prescription of injectable contraceptive Z30.018 Encounter for initial prescription of other contraceptives Z30.019 Encounter for initial prescription of contraceptives, unspecified Z48.01 Encounter for change or removal of surgical wound dressing Z20.9 Contact with and exposure to unspecified communicable disease Z01.411 Encounter for gynecological examination (general) (routine) with abnormal findings Z01.419 Encounter for gynecological examination (general) (routine) without abnormal findings Z01.42 Encounter for cervical smear to confirm findings of recent normal smear following initial abnormal smear Z23 Encounter for immunization Z30.2 Encounter for sterilization Z00.00 Encounter for general adult medical examination without abnormal findings Z00.01 Encounter for general adult medical examination with abnormal findings Z00.10 Encounter for routine child health examination without abnormal findings Z00.11 Encounter for routine child health examination with abnormal findings

9