Maryland Healthchoice ER Auto-Pay List Effective November 1, 2012
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Maryland HealthChoice ER Auto-Pay List Effective November 1, 2012 Diagnosis DESCRIPTION 033.9Cd Whooping cough; unspecified organism 040.82 Toxic shock syndrome 053.21 Herpes zoster keratoconjunctivitis 101 Vincent's angina 250.10 Diabetes with ketoacidosis; type II 250.11 Diabetes with ketoacidosis; type I 250.12 Diabetes with ketoacidosis, type II 250.13 Diabetes with ketoacidosis, type I 250.30 Diabetes with other coma, type II 250.32 Diabetes with other coma, type II 251.0 Hypoglycemic coma 251.1 Other specified hypoglycemia 251.2 Hypoglycemia, unspecified 276.5 Volume depletion 276.50 Volume depletion; unspecified 276.51 Dehydration 276.52 Hypovolemia 276.7 Hyperpotassemia 276.8 Hypopotassemia 282.42 Sickle-Cell Thalassemia w/Crisis 282.62 Hb-S disease with mention of crisis 282.64 Sickle-cell/Hb-C disease with crisis 282.69 Other sickle-cell disease (HbS with D or E) with crisis 288.0 Neutropenia 303.00 Acute alcoholic intoxication; unspec 303.01 Acute alcoholic intoxication, conti 345.10 Generalized convulsive epilepsy 345.11 Generalized convulsive epilepsy 345.3 Epileptic grand mal status 345.90 Unspecified epilepsy without mention of intractable epilepsy 351.0 Bell’s palsy 376.01 Orbital cellulitis 410.41 Acute myocardial infarction 410.71 Acute myocardial infarction 410.90 Acute myocardial infarction, unspecified site, unspecified episode of care 410.91 Acute myocardial infarction; unspecified site; initial episode of care 411.1 Intermediate coronary syndrome 415.19 Other pulmonary embolism and infarc 427.0 Paroxysmal supraventricular tachycaradia 427.41 Ventricular fibrillation 427.5 Cardiac arrest 427.89 Other specified cardiac dysrhythmias 430 Subarachnoid hemorrhage 431 Intracerebral hemorrhage 432.1 Subdural hemorrhage 434.91 Unspecified cerebral artery occlusi 435.9 Unspecified transient cerebral isch 444.9 Arterial Embolism and thrombosis of unspecifed artery 451.0 Phlebitis and thrombophlebitis of superfical vessels of LE 451.19 Phlebitis and thrombophlebitis of deep vessels of LE _ Other 451.2 Phlebitis and thrombophlebitis of LE, unspecified 451.82 Phlebitis and thrombophlebitis of superfical veins of UE 451.9 Phlebitis and thrombophlebitis of unspecified site 453.40 Venous Embolism And Thrombosis Of unspecified deep vessels of LE 453.42 Venous Embolism And Thrombosis Of Deep vessels of distal LE 453.8 Embolism and thrombosis of other specified veins 453.81 Acute venous embo & thromb sup veins upper ext 458.0 Orthostatic hypotension 464.30 Acute epiglottitis without mention of complication 464.4 Croup 466.11 Acute bronchiolitis due to respiratory syncytial virus 475 Peritonsillar abscess 491.21 Obstructive chronic bronchitis, with (acute) exace 493.01 Extrinsic asthma with status asthma 493.02 Extrinsic asthma, with (acute) exacerbation 493.11 Intrinsic asthma with status asthma 493.21 Chronic obstructive asthma with status 493.22 Chronic obstructive asthma, with (acute exacerbation) 493.91 Unspecified asthma, with status asthmaticus 493.92 Asthma, unspecified, with (acute) exacerbation 511.0 Pleurisy without mention of effusion or current tuberculosis 512.1 Iatrogenic pneumothroax 512.8 Other spontaneous pneumothorax 518.0 Pulmonary collapse 518.81 Acute respiratory failure 519.11 Acute bronchospasm 525.11 Loss of teeth due to trauma 528.3 Cellulitis and abscess of oral soft 535.30 Alcoholic gastritis without mention of hemorrhage 537.0 Acquired hypertrophic pyloric stenosis 540.9 Acute appendicitis without mention 541 Appendicitis; unqualified 550.10 Inguinal hernia with obstruction; without mention of gangrene 560.0 Intussusception 562.11 Diverticulitis of colon (without mention of hemorrhage 567.22 Peritoneal abscess 569.1 Rectal prolapse 574.10 Calculus of gallbladder with other cholecystitis 574.20 Calculus of gallbladder without mention of cholecystitis 575.0 Acute cholecystitis 575.10 Cholecystitis; unspecified without mention of calculus 578.0 Hematemesis 578.9 Unspecified; hemorrhage of gastrointestinal tract 590.10 Acute pyelonephritis without lesion of renal medullary necrosis 590.80 Unspecified pyelonephritis, not specified as acute or chronic 592.0 Calculus of kidney 592.1 Calculus of ureter 592.9 Unspecified urinary calculus 596.0 Bladder neck obstruction 607.3 Priapism 608.20 Torsion of testis, unspecified 608.23 Torsion of appendix testis 616.3 Abscess of Bartholin's gland 616.4 Other abscess of vulva 632 Missed abortion 633.00 Abdominal pregnancy without intrauterine implantation (abdominal pregnancy) 633.01 Abdominal pregnancy with intrauterine pregnancy BOTH 633.10 Tubal pregnancy without intrauterine pregnancy (UBAL ONLY) 633.90 Unspecified ectopic pregnancy without intrauterine pregnancy 634.10 Unspecified spontaneous abortion complicated by delayed or excessive hemorrage 634.11 Incomplete spontaneous abortion complicated by delayed or excessive hemorrhage 634.12 Complete spontaneous abortion complicated by delayed or excessive hemorrhage 634.70 Unspecified spontaneous abortion with other specified complications 634.72 Complete spontaneous abortion with other specified complications 634.81 Incomplete spontaneous abortion with unspecified complications 634.90 Unspecified spontaneous abortion without mention of complication 634.91 Incomplete spontaneous abortion without mention of complication 634.92 Complete spontaneous abortion without mention of complication 635.10 Unspecified legally induced abortion complicated by delayed or excessive hemorrage 635.11 Incomplete legally induced abortion complicated by delayed or excessive hemorrhage 635.12 Complete legally induced abortion complicated by delayed or excessive hemorrhage 635.71 Incomplete legally induced abortion with other specified complication 635.90 Unspecified legally induced abortion without mention of complication 635.91 Incomplete legally induced abortion without mention of complications 637.10 Abortion, unspecified as to complete complicated by delayed or excessive hemorrage 637.11 Legally unspecified abortion; incomplete; complicated by delayed or excessive hemorrhage 637.12 Legally unspecified abortion, complete, complicate 637.71 Legally unspecified abortion; incomplete; with other specified complications 637.90 Unspecified type of abortion; unspecified 637.91 Legally unspecified abortion, incomplete, without mention of complication 639.8 Other specified complication following abortion or ectopic and molar pregnancy 640.00 Threatened abortion; unspecified 640.03 Threatened abortion, antepartum 640.83 Other specified hemorrhage in early pregnancy 640.90 Unspecified hemorrhage in early pregnancy; unspecified episode of care 640.93 Unspecified hemorrhage in early pregnancy 641.13 Hemorrhage from placenta previa; antepartum 641.83 Other antepartum hemorrhage; antepartum assoc with trauma 641.93 Unspecified antepartum hemorrhage, 642.03 Benign essential hypertension antepartum 642.33 Transient hypertension of pregnancy, antepartum 642.43 Mild or unspecified pre-eclampsia, 642.44 Mild or unspecified pre-eclampsia; 642.54 Severe pre-eclampsia; previous post 642.73 Pre-eclampsia or eclampsia superimp 643.13 Hyperemesis gravidarum with metabolic disturbance 643.23 Late vomiting of pregnancy; antepartum condition/complication, Antepartum obstetric condition 644.03 Threatened premature labor, antepartum 644.1 Other threatened labor 644.13 Other threatened labor, antepartum 644.20 Early onset of delivery; unspecified 648.03 Maternal diabetes mellitus; antepartum 648.83 Abnormal maternal glucose tolerance, antepartum 649.53 Spotting complicating pregnancy; antepartum condit 655.73 Decreased fetal movements; affecting management of 657.03 Polyhydramnios, antepartum complication 658.03 Oligohydramnios, antepartum 658.13 Premature rupture of membranes in pregnancy, antepartum 661.93 Unspecified abnormality of labor; antepartum 674.84 Other complication of puerperium 681.01 Cellulitis and absess, Felon 681.9 Cellulitis and abscess of unspecified digit 682.0 Cellulitis and abscess of face 682.1 Cellulitis and abscess of neck 682.2 Cellulitis and abscess of trunk 682.3 Cellulitis and abscess of upper arm 682.4 Cellulitis and abscess of hand, excluding fingers and thumb 682.5 Cellulitis and abscess of buttock 682.6 Cellulitis and abscess of leg, except foot 682.7 Cellulitis and abscess of foot, except toes 682.8 Cellulitis and abscess of other specified place on head not face 682.9 Cellulitis and abscess of unspecified site 683 Acute lymphadenitis 685.0 Pilonidal cyst with abscess 728.86 Necrotizing fasciitis 728.88 Rhabdomyolysis 732.2 Nontraumatic slipped upper femoral epiphysis 736.1 Mallet finger 750.5 Congenital hypertrophic pyloric stenosis 767.0 Subdural and cerebral hemorrhage 770.81 Primary apnea of newborn 770.89 Other respiratory problems of newborn 780.01 Coma 780.2 Syncope and collapse 780.3 Convulsions 780.31 Febrile convulsions 780.32 Complex febrile convulsions 780.39 Other convulsions 782.5 Cyanosis 785.1 Palpitations 786.03 Apnea 786.07 Wheezing 786.1 Stridor 788.0 Renal colic 798.0 Sudden infant death syndrome 798.1 Instantaneous death 799.02 Hypoxemia 800.36 Closed fracture of vault of skull with other and unspec intracranial hem 801.00 Closed fracture of base of skull without mention 801.01 Closed fracture of base of skull 801.21 Closed fracture of base of skull 802.0 Nasal bones, closed fracture 802.20 Closed fracture of unspecified site 802.24 Closed fracture of unspecified part 802.25 Closed fracture of angle of jaw 802.27 Closed fracture of alveolar border 802.4 Malar and maxillary bones, closed fracture 802.6