Kansas Vertical Perspective Medical Assistance Program

December 2006 Provider Bulletin Number 688

General Providers

Emergent and Nonemergent Diagnosis Code List

Attached is a list of diagnosis codes and whether the Kansas Medical Assistance Program (KMAP) considers the code to be emergent or nonemergent. Providers are responsible for validating whether a particular diagnosis code is covered by KMAP under the beneficiary’s benefit plan and that all program requirements are met. This list does not imply or guarantee payment for listed diagnosis codes.

Information about the Kansas Medical Assistance Program as well as provider manuals and other publications are on the KMAP Web site at https://www.kmap-state-ks.us.

If you have any questions, please contact the KMAP Customer Service Center at 1-800-933-6593 (in-state providers) or (785) 274-5990 between 7:30 a.m. and 5:30 p.m., Monday through Friday.

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 1 of 347 Emergency Indicators as noted by KMAP: N – Never considered emergent S – Sometimes considered emergent (through supporting medical documentation) Y – Always considered emergent

Diagnosis Emergency Diagnosis Code Description Code Indicator 0010 Cholera due to Vibrio Cholerae S 0011 Cholera due to Vibrio Cholerae El Tor S 0019 Unspecified Cholera S 019 Late Effects of Tuberculosis N 0020 Typhoid Fever S 0021 Paratyphoid Fever A S 0022 Paratyphoid Fever B S 0023 Paratyphoid Fever C S 024 Glanders Y 025 Melioidosis Y 0029 Unspecified Paratyphoid Fever S 0030 Salmonella Gastroenteritis S 0031 Salmonella Septicemia S 035 Erysipelas N 037 Tetanus Y 0038 Other Specified Salmonella Infections S 0039 Unspecified Salmonella Infection S 0040 Shigella Dysenteriae S 0041 Shigella Flexneri S 0042 Shigella Boydii S 042 Human Immunodeficiency Virus [HIV] N 0043 Shigella Sonnei S 043 Human Immunodeficiency Virus (HIV) Disease N 044 Human Immunodeficiency Virus (HIV) Disease N 0048 Other Specified Shigella Infections S 048 Other Enterovirus Diseases of Central Nervous System N 0049 Unspecified Shigellosis S 0050 Staphylococcal Food Poisoning S 0051 Botulism S 0052 Food Poisoning due to Clostridium Perfringens (C. Welchii) S 0053 Food Poisoning due to Other Clostridia S 0054 Food Poisoning due to Vibrio Parahaemolyticus S 0059 Unspecified Food Poisoning S 0060 Acute Amebic Dysentery Without Mention of Abscess S 0061 Chronic Intestinal Amebiasis Without Mention of Abscess S 061 Dengue Y 0062 Amebic Nondysenteric Colitis S 0063 Amebic Liver Abscess Y 0064 Amebic Lung Abscess Y 064 Viral Encephalitis Transmitted by Other and Unspecified Arthropods Y 0065 Amebic Brain Abscess Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 2 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 0066 Amebic Skin Ulceration N 067 Arthropod-Borne Hemorrhagic Fever Y 0068 Amebic Infection of Other Sites N 068 Other Arthropod-Borne Viral Diseases N 0069 Unspecified Amebiasis N 0070 Balantidiasis Y 0071 Giardiasis N 071 Rabies Y 0072 Coccidiosis N 0073 Intestinal Trichomoniasis N 0074 Cryptosporidiosis N 0075 Cyclosporiasis N 075 Infectious Mononucleosis N 0078 Other Specified Protozoal Intestinal Diseases N 0079 Unspecified Protozoal Intestinal Disease N 080 Louse-Borne (Epidemic) Typhus N 0081 Intestinal Infection due to Arizona Group of Paracolon Bacilli N 0082 Intestinal Infection due to Aerobacter Aerogenes N 0083 Intestinal Infections due to Proteus (Mirabilis) (Morganii) N 0085 Intestinal Infection due to Unspecified Bacterial Enteritis N 0088 Intestinal Infection due to Other Organism, Nec N 089 Other Arthropod-Borne Diseases N 0090 Infectious Colitis, Enteritis, and Gastroenteritis N 0091 Colitis, Enteritis, and Gastroenteritis of Presumed Infectious Origin N 0092 Infectious Diarrhea N 0093 Diarrhea of Presumed Infectious Origin N 096 Late Syphilis, Latent N 101 Vincent's Angina N 113 Actinomycosis Y 118 Opportunistic Mycoses N 124 Trichinosis N 129 Unspecified Intestinal Parasitism N 135 Sarcoidosis N 138 Late Effects of Acute Poliomyelitis N 179 Malignant Neoplasm of Uterus, Part Unspecified N 181 Malignant Neoplasm of Placenta N 185 Malignant Neoplasm of Prostate N 193 Malignant Neoplasm of Thyroid Gland N 0200 Bubonic Plague Y 0201 Cellulocutaneous Plague Y 0202 Septicemic Plague Y 0203 Primary Pneumonic Plague Y 0204 Secondary Pneumonic Plague Y 0205 Pneumonic Plague, Unspecified Y 0208 Other Specified Types of Plague Y 0209 Unspecified Plague Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 3 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 209 Myelofibrosis N 0210 Ulceroglandular Tularemia Y 0211 Enteric Tularemia Y 0212 Pulmonary Tularemia Y 0213 Oculoglandular Tularemia Y 217 Benign Neoplasm of Breast N 0218 Other Specified Tularemia Y 0219 Unspecified Tularemia Y 0220 Cutaneous Anthrax Y 220 Benign Neoplasm of Ovary N 0221 Pulmonary Anthrax Y 0222 Gastrointestinal Anthrax Y 0223 Anthrax Septicemia Y 226 Benign Neoplasm of Thyroid Glands N 0228 Other Specified Manifestations of Anthrax Y 0229 Unspecified Anthrax Y 0230 Brucella Melitensis Y 0231 Brucella Abortus Y 0232 Brucella Suis Y 0233 Brucella Canis Y 0238 Other Brucellosis Y 0239 Burcellosis, Unspecified Y 243 Congenital Hypothyroidism N 0260 Spirillary Fever Y 260 Kwashiorkor N 0261 Streptobacillary Fever Y 261 Nutritional Marasmus N 262 Other Severe Protein-Calorie Malnutrition N 267 Ascorbic Acid Deficiency N 0269 Unspecified Rat-Bite Fever Y 0270 Listeriosis N 0271 Erysipelothrix Infection N 0272 Pasteurellosis N 0278 Other Specified Zoonotic Bacterial Diseases N 0279 Unspecified Zoonotic Bacterial Disease N 0300 Lepromatous Leprosy (Type L) N 0301 Tuberculoid Leprosy (Type T) N 0302 Indeterminate Leprosy (Group I) N 0303 Borderline Leprosy (Group B) N 0308 Other Specified Leprosy N 0309 Unspecified Leprosy N 0310 Pulmonary Diseases due to Other Mycobacteria S 0311 Cutaneous Diseases due to Other Mycobacteria N 311 Depressive Disorder, Not Elsewhere Classified Y 0312 Disseminated Diseases due to Other Mycobacteria N 316 Psychic Factors Associated With Diseases Classified Elsewhere N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 4 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 317 Mild Mental Retardation N 0318 Other Specified Diseases due to Other Mycobacteria N 0319 Unspecified Diseases due to Mycobacteria N 319 Unspecified Mental Retardation N 00320 Unspecified Localized Salmonella Infection S 0320 Faucial Diphtheria Y 00321 Salmonella Meningitis S 0321 Nasopharyngeal Diphtheria Y 00322 Salmonella Pneumonia S 0322 Anterior Nasal Diphtheria Y 00323 Salmonella Arthritis S 0323 Laryngeal Diphtheria Y 00324 Salmonella Osteomyelitis S 325 Phlebitis and Thrombophlebitis of Intracranial Venous Sinuses Y 326 Late Effects of Intracranial Abscess or Pyogenic Infection N 0328 Other Specified Diphtheria Y 00329 Other Localized Salmonella Infections S 0329 Unspecified Diphtheria Y 0330 Whooping Cough due to Bordetella Pertussis (P. Pertussis) Y 0331 Whooping Cough due to Bordetella Parapertussis (B. Parapertussis) Y 0338 Whooping Cough due to Other Specified Organism Y 0339 Whooping Cough, Unspecified Organism Y 0340 Streptococcal Sore Throat Y 340 Multiple Sclerosis S 0341 Scarlet Fever Y 347 Cataplexy and Narcolepsy N 0360 Meningococcal Meningitis Y 0361 Meningococcal Encephalitis Y 0362 Meningococcemia Y 0363 Waterhouse-Friderichsen Syndrome, Meningococcal Y 0368 Other Specified Meningococcal Infections Y 0369 Unspecified Meningococcal Infection Y 0380 Streptococcal Septicemia Y 0381 Staphylococcal Septicemia Y 0382 Pneumococcal Septicemia Y 0383 Septicemia due to Anaerobes Y 0388 Other Specified Septicemia Y 0389 Unspecified Septicemia Y 0390 Cutaneous Actinomycotic Infection Y 390 Rheumatic Fever Without Mention of Heart Involvement N 0391 Pulmonary Actinomycotic Infection Y 0392 Abdominal Actinomycotic Infection Y 0393 Cervicofacial Actinomycotic Infection Y 393 Chronic Rheumatic Pericarditis Y 0394 Madura Foot N 0398 Actinomycotic Infection of Other Specified Sites Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 5 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 0399 Actinomycotic Infection of Unspecified Site Y 0400 Gas Gangrene Y 400 Malignant Hypertension Y 0401 Rhinoscleroma N 0402 Whipple's Disease N 0403 Necrobacillosis N 0408 Other Specified Bacterial Diseases N 0412 Pneumococcus Infection in in Conditions Classified Elsewhere And of Unspecified Site N 412 Old Myocardial Infarction Y Friedlander's Bacillus Infection in Conditions Classified Elsewhere and of Unspecified 0413 Site N Escherichia Coli (E. Coli) Infection in Conditions Classified Elsewhere and of Unspecified 0414 Site N Hemophilus Influenzae (H. Influenzae) Infection in Conditions Classified Elsewhere and 0415 of Unspecified Site N Proteus (Mirabilis) (Morganii) Infection in Conditions Classified Elsewhere and of 0416 Unspecified Site N 0417 Pseudomonas Infection in Conditions Classified Elsewhere and of Unspecified Site N Bacterial Infection, Unspecified, in Conditions Classified Elsewhere and of Unspecified 0419 Site N 430 Subarachnoid Hemorrhage Y 431 Intracerebral Hemorrhage Y 436 Acute, but Ill-Defined, Cerebrovascular Disease Y 438 Late Effects of Cerebrovascular Disease N 445 Gangrene Y 450 Pulmonary Embolism and Infarction Y 452 Portal Vein Thrombosis Y 0460 Kuru N 460 Acute Nasopharyngitis (Common Cold) N 0461 Jakob-Creutzfeldt Disease N 0462 Subacute Sclerosing Panencephalitis N 462 Acute Pharyngitis Y 0463 Progressive Multifocal Leukoencephalopathy N 463 Acute Tonsillitis Y 0468 Other Specified Slow Virus Infection of Central Nervous System N 0469 Unspecified Slow Virus Infection 0f Central Nervous System N 0470 Meningitis due to Coxsackie Virus Y 470 Deviated Nasal Septum Y 0471 Meningitis due to Echo Virus Y 475 Peritonsillar Abscess Y 0478 Other Specified Viral Meningitis Y 0479 Unspecified Viral Meningitis Y 481 Pneumococcal Pneumonia (Streptococcus Pneumoniae Pneumonia) Y 485 Bronchopneumonia, Organism Unspecified Y 486 Pneumonia, Organism Unspecified Y 0490 Lymphocytic Choriomeningitis Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 6 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 490 Bronchitis, Not Specified as Acute or Chronic Y 0491 Meningitis due to Adenovirus Y 494 Bronchiectasis Y 496 Chronic Airway Obstruction, Not Elsewhere Classified Y 0498 Other Specified Non-Arthropod-Borne Viral Diseases of Central Nervous System Y 0499 Unspecified Non-Arthropod-Borne Viral Disease of Central Nervous System Y 0500 Variola Major Y 500 Coal Workers' Pneumoconiosis Y 0501 Alastrim Y 501 Asbestosis Y 0502 Modified Smallpox Y 502 Pneumoconiosis due to Other Silica or Silicates Y 503 Pneumoconiosis due to Other Inorganic Dust Y 504 Pneumonopathy due to Inhalation of Other Dust Y 505 Unspecified Pneumoconiosis Y 0509 Unspecified Smallpox Y 509 Miscellaneous Lung and Pleural Diseases N 0510 Cowpox Y 0511 Pseudocowpox Y 0512 Contagious Pustular Dermatitis Y 514 Pulmonary Congestion and Hypostasis Y 515 Postinflammatory Pulmonary Fibrosis Y 0519 Unspecified Paravaccinia Y 0520 Postvaricella Encephalitis Y 0521 Varicella (Hemorrhagic) Pneumonitis Y 0527 Chickenpox With Other Specified Complications S 0528 Chickenpox With Unspecified Complication N 0529 Varicella Without Mention of Complication N 0530 Herpes Zoster With Meningitis Y 0537 Herpes Zoster With Other Specified Complications S 0538 Unspecified Herpes Zoster Complication N 0539 Herpes Zoster Without Mention of Complication N 0540 Eczema Herpeticum N 541 Appendicitis, Unqualified Y 0542 Herpetic Gingivostomatitis N 542 Other Appendicitis Y 0543 Herpetic Meningoencephalitis Y 0545 Herpetic Septicemia Y 0546 Herpetic Whitlow N 0547 Herpes Simplex With Other Specified Complications N 0548 Unspecified Herpes Simplex Complication N 0549 Herpes Simplex Without Mention of Complication N 0550 Postmeasles Encephalitis Y 0551 Postmeasles Pneumonia Y 0552 Postmeasles Otitis Media N 0557 Measles With Other Specified Complications N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 7 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 0558 Unspecified Measles Complication N 0559 Measles Without Mention of Complication N 561 Noninfectious Gastroenteritis and Colitis S 563 Chronic Enteritis and Ulcerative Colitis S 566 Abscess of Anal and Rectal Regions Y 0567 Rubella With Other Specified Complications Y 0568 Unspecified Rubella Complications N 0569 Rubella Without Mention of Complication N 0570 Erythema Infectiosum (Fifth Disease) N 570 Acute and Subacute Necrosis of Liver Y 0578 Other Specified Viral Exanthemata N 0579 Unspecified Viral Exanthem N 00581 Food Poisoning due to Vibrio Vulnificus S 585 Chronic Renal Failure Y 586 Unspecified Renal Failure Y 587 Unspecified Renal Sclerosis Y 00589 Other Bacterial Food Poisoning S 591 Hydronephrosis Y 0600 Sylvatic Yellow Fever N 600 Hyperplasia of Prostate Y 0601 Urban Yellow Fever N 605 Redundant Prepuce and Phimosis Y 0609 Unspecified Yellow Fever N 0620 Japanese Encephalitis Y 0621 Western Equine Encephalitis Y 0622 Eastern Equine Encephalitis Y 0623 St. Louis Encephalitis Y 0624 Australian Encephalitis Y 0625 California Virus Encephalitis Y 0628 Other Specified Mosquito-Borne Viral Encephalitis Y 0629 Unspecified Mosquito-Borne Viral Encephalitis Y 0630 Russian Spring-Summer (Taiga) Encephalitis Y 630 Hydatidiform Mole N 0631 Louping Ill Y 631 Other Abnormal Product of Conception N 0632 Central European Encephalitis Y 632 Missed Abortion Y 637 Unspec Abortion Complicated by Genital Tract and Pelvic Infection N 0638 Other Specified Tick-Borne Viral Encephalitis Y 0639 Unspecified Tick-Borne Viral Encephalitis Y 00640 West Nile Fever, Unspecified Y 0650 Crimean Hemorrhagic Fever (CHF Congo Virus) Y 650 Normal Delivery Y 0651 Omsk Hemorrhagic Fever Y 0652 Kyasanur Forest Disease Y 0653 Other Tick-Borne Hemorrhagic Fever Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 8 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 0654 Mosquito-Borne Hemorrhagic Fever Y 0658 Other Specified Arthropod-Borne Hemorrhagic Fever Y 0659 Unspecified Arthropod-Borne Hemorrhagic Fever Y 0660 Phlebotomus Fever Y 0661 Tick-Borne Fever Y 0662 Venezuelan Equine Fever Y 0663 Other Mosquito-Borne Fever Y 0664 West Nile Fever Y 00664 West Nile Fever With Other Neurologic Manifestations Y 0668 Other Specified Arthropod-Borne Viral Diseases Y 0669 Unspecified Arthropod-Borne Viral Disease Y 677 Late Effect of Complication of Pregnancy, Childbirth, and the Puerperium N 683 Acute Lymphadenitis S 684 Impetigo N 0700 Viral Hepatitis a With Hepatic Coma Y 700 Corns and Callosities S 0701 Viral Hepatitis a Without Mention of Hepatic Coma N 0704 Other Specified Viral Hepatitis With Hepatic Coma Y 0705 Other Specified Viral Hepatitis Without Mention of Hepatic Coma N 0706 Unspecified Viral Hepatitis With Hepatic Coma Y 0709 Unspecified Viral Hepatitis Without Mention of Hepatic Coma N 0720 Mumps Orchitis Y 0721 Mumps Meningitis Y 0722 Mumps Encephalitis Y 0723 Mumps Pancreatitis Y 725 Polymyalgia Rheumatica N 0727 Mumps With Other Specified Complications Y 0728 Unspecified Mumps Complication N 0729 Mumps Without Mention of Complication N 0730 Ornithosis With Pneumonia S 734 Flat Foot N 0737 Ornithosis With Other Specified Complications S 0738 Ornithosis With Unspecified Complication S 0739 Unspecified Ornithosis S 0740 Herpangina S 0741 Epidemic Pleurodynia S 0743 Hand, Foot, and Mouth Disease N 0748 Other Specified Diseases due to Coxsackievirus N 0760 Initial Stage Trachoma N 0761 Active Stage Trachoma N 0769 Unspecified Trachoma N 769 Respiratory Distress Syndrome in Newborn Y 0770 Inclusion Conjunctivitis N 0771 Epidemic Keratoconjunctivitis N 0772 Pharyngoconjunctival Fever S 0773 Other Adenoviral Conjunctivitis Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 9 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 0774 Epidemic Hemorrhagic Conjunctivitis Y 0778 Other Viral Conjunctivitis Y 0780 Molluscum Contagiosum N 0782 Sweating Fever N 0783 Cat-Scratch Disease N 0784 Foot and Mouth Disease N 0785 Cytomegaloviral Disease Y 0786 Hemorrhagic Nephrosonephritis Y 0787 Arenaviral Hemorrhagic Fever S 0788 Other Specified Diseases due to Viruses and Chlamydiae N 788 Frequency of Urination and Polyuria N 0790 Adenovirus Infection in Conditions Classified Elsewhere And of Unspecified Site N 0791 Echo Virus Infection in Conditions Classified Elsewhere And of Unspecified Site N 0792 Coxsackievirus Infection in Conditions Classified Elsewhere and of Unspecified Site N 0793 Rhinovirus Infection in Conditions Classified Elsewhere and of Unspecified Site N 0794 Human Papilloma Virus in Conditions Classified Elsewhere and of Unspecified Site N 0796 Respiratory Syncytial Virus (RSV) N 797 Senility Without Mention of Psychosis N 00800 Intestinal Infection due to Unspecified E. Coli N 00801 Intestinal Infection due to Enteropathogenic E. Coli N 00802 Intestinal Infection due to Enterotoxigenic E. Coli N 00803 Intestinal Infection due to Enteroinvasive E. Coli N 00804 Intestinal Infection due to Enterohemorrhagic E. Coli N 00809 Intestinal Infection due to Other Intestinal E. Coli Infections N 0810 Murine (Endemic) Typhus Y 0811 Brill’s Disease Y 0812 Scrub Typhus S 0819 Unspecified Typhus S 0820 Spotted Fevers S 0821 Boutonneuse Fever S 0822 North Asian Tick Fever S 0823 Queensland Tick Typhus S 0828 Other Specified Tick-Borne Rickettsioses S 0829 Unspecified Tick-Borne Rickettsiosis S 0830 Q Fever S 0831 Trench Fever S 0832 Rickettsialpox S 0838 Other Specified Rickettsioses S 0839 Unspecified Rickettsiosis S 0840 Falciparum Malaria (Malignant Tertian) S 00841 Intestinal Infections due to Staphylococcus N 0841 Vivax Malaria (Benign Tertian) S 00842 Intestinal Infections due to Pseudomonas N 0842 Quartan Malaria S 00843 Intestinal Infections due to Campylobacter N 0843 Ovale Malaria S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 10 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 00844 Intestinal Infections due to Yersinia Enterocolitica N 0844 Other Malaria S 00845 Intestinal Infections due to Clostridium Difficile N 0845 Mixed Malaria S 00846 Intestinal Infections due to Other Anerobes N 0846 Unspecified Malaria S 00847 Intestinal Infections due to Other Gram-Negative Bacteria N 0847 Induced Malaria S 0848 Blackwater Fever S 00849 Intestinal Infection due to Other Organisms N 0849 Other Pernicious Complications of Malaria S 0850 Visceral Leishmaniasis (Kala-Azar) Y 0851 Cutaneous Leishmaniasis, Urban Y 0852 Cutaneous Leishmaniasis, Asian Desert Y 0853 Cutaneous Leishmaniasis, Ethiopian Y 0854 Cutaneous Leishmaniasis, American Y 0855 Mucocutaneous Leishmaniasis, (American) Y 0859 Unspecified Leishmaniasis Y 0860 Chagas' Disease With Heart Involvement Y 00861 Intestinal Infection, Enteritis due to Rotavirus N 0861 Chagas' Disease With Other Organ Involvement Y 00862 Intestinal Infection, Enteritis due to Adenovirus N 0862 Chagas' Disease Without Mention of Organ Involvement N 00863 Intestinal Infection, Enteritis due to Norwalk Virus N 0863 Gambian Trypanosomiasis N 00864 Intestinal Infection, Enteritis due to Other Small Round Viruses (SRVS) N 0864 Rhodesian Trypanosomiasis N 00865 Intestinal Infection, Enteritis due to Calcivirus N 0865 African Trypanosomiasis, Unspecified N 00866 Intestinal Infection, Enteritis due to Astrovirus N 00867 Intestinal Infection, Enteritis due to Enterovirus Not Elsewhere Classified N 00869 Intestinal Infection, Enteritis due to Other Viral Enteritis N 0869 Unspecified Trypanosomiasis N 0870 Louse-Borne Relapsing Fever S 0871 Tick-Borne Relapsing Fever S 0879 Unspecified Relapsing Fever S 0880 Bartonellosis N 0889 Unspecified Arthropod-Borne Disease N 0900 Early Congenital Syphilis, Symptomatic N 0901 Early Congenital Syphilis, Latent N 0902 Unspecified Early Congenital Syphilis N 0903 Syphilitic Interstitial Keratitis N 0905 Other Late Congenital Syphilis, Symptomatic N 0906 Late Congenital Syphilis, Latent N 0907 Late Congenital Syphilis, Unspecified N 0909 Congenital Syphilis, Unspecified N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 11 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 0910 Genital Syphilis (Primary) N 0911 Primary Anal Syphilis N 0912 Other Primary Syphilis N 0913 Secondary Syphilis of Skin or Mucous Membranes N 0914 Adenopathy due to Secondary Syphilis N 0916 Secondary Syphilitic Periostitis N 0917 Early Syphilis, Secondary Syphilis, Relapse N 0918 Other Forms of Secondary Syphilis N 0919 Early Syphilis, Unspecified Secondary Syphilis N 0920 Early Syphilis, Latent, Serological Relapse After Treatment N 920 Contusion of Face, Scalp, and Neck Except Eye(s) Y 0929 Early Syphilis, Latent, Unspecified N 0930 Aneurysm of Aorta, Specified as Syphilitic Y 0931 Syphilitic Aortitis Y 931 Foreign Body in Ear Y 932 Foreign Body in Nose Y 936 Foreign Body in Intestine and Colon S 937 Foreign Body in Anus and Rectum S 0938 Other Specified Cardiovascular Syphilis Y 938 Foreign Body in Digestive System, Unspecified S 0939 Unspecified Cardiovascular Syphilis Y 0940 Tabes Dorsalis N 0941 General Paresis N 0942 Syphilitic Meningitis Y 0943 Asymptomatic Neurosyphilis Y 0948 Other Specified Neurosyphilis N 0949 Unspecified Neurosyphilis N 0950 Syphilitic Episcleritis N 0951 Syphilis of Lung N 0952 Syphilitic Peritonitis N 0953 Syphilis of Liver N 0954 Syphilis of Kidney N 0955 Syphilis of Bone N 0956 Syphilis of Muscle N 0957 Syphilis of Synovium, Tendon, and Bursa N 0958 Other Specified Forms of Late Symptomatic Syphilis N 0959 Unspecified Late Symptomatic Syphilis N 0970 Unspecified Late Syphilis N 0971 Unspecified Latent Syphilis N 0979 Unspecified Syphilis N 0980 Gonococcal Infection (Acute) of Lower Genitourinary Tract S 981 Toxic Effect of Petroleum Products Y 0982 Gonococcal Infections, Chronic, of Lower Genitourinary Tract N 0986 Gonococcal Infection of Pharynx S 986 Toxic Effect of Carbon Monoxide Y 0987 Gonococcal Infection of Anus and Rectum S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 12 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 0988 Gonococcal Infection of Other Specified Sites N 0990 Chancroid N 990 Effects of Radiation, Unspecified Y 0991 Lymphogranuloma Venereum N 0992 Granuloma Inguinale N 0993 Reiter’s Disease N 0998 Other Specified Venereal Diseases N 0999 Unspecified Venereal Disease N 01000 Primary Tuberculous Complex, Confirmation Unspecified N 1000 Leptospirosis Icterohemorrhagica Y 01001 Primary Tuberculous Complex, Bacteriological or Histological Examination Not Done N Primary Tuberculous Complex, Bacteriological or Histological Examination Unknown (at 01002 Present) N 01003 Primary Tuberculous Complex, Tubercle Bacilli Found (in Sputum) by Microscopy N Primary Tuberculous Complex, Tubercle Bacilli Not Found (in Sputum) by Microscopy, 01004 but Found by Bacterial Culture N Primary Tuberculous Complex, Tubercle Bacilli Not Found by Bacteriological 01005 Examination, but Tuberculosis Confirmed Histologically N Primary Tuberculous Complex, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01006 Animals] N 1008 Other Specified Leptospiral Infections N 1009 Unspecified Leptospirosis N 01010 Tuberculous Pleurisy in Primary Progressive Tuberculosis, Confirmation Unspecified N Tuberculous Pleurisy in Primary Progressive Tuberculosis, Bacteriological or Histological 01011 Examination Not Done N Tuberculous Pleurisy in Primary Progressive Tuberculosis, Bacteriological or Histological 01012 Examination Results Unknown (at Present) N Tuberculous Pleurisy in Primary Progressive Tuberculosis, Tubercle Bacilli Found (in 01013 Sputum) by Microscopy N Tuberculous Pleurisy in Primary Progressive Tuberculosis, Tubercle Bacilli Not Found (in 01014 Sputum) by Microscopy, But Found by Bacterial Culture N Tuberculous Pleurisy in Primary Progressive Tuberculosis, Tubercle Bacilli Not Found by 01015 Bacteriological Examination, but Tuberculosis Confirmed Histologically N Tuberculous Pleurisy in Primary Progressive Tuberculosis, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other 01016 Methods [Inoculation of Animals] N 1020 Initial Lesions of Yaws N 1021 Multiple Papillomata and Wet Crab Yaws due to Yaws N 1022 Other Early Skin Lesions due to Yaws N 1023 Hyperkeratosis due to Yaws N 1024 Gummata and Ulcers due to Yaws N 1025 Gangosa due to Yaws N 1026 Bone and Joint Lesions due to Yaws N 1027 Other Manifestations due to Yaws N 1028 Latent Yaws N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 13 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 1029 Unspecified Yaws N 1030 Primary Lesions of Pinta N 1031 Intermediate Lesions of Pinta N 1032 Late Lesions of Pinta N 1033 Mixed Lesions of Pinta N 1039 Unspecified Pinta N 1040 Nonvenereal Endemic Syphilis N 1048 Other Specified Spirochetal Infections N 1049 Unspecified Spirochetal Infection N 01080 Other Primary Progressive Tuberculosis Infection, Confirmation Unspecified N Other Primary Progressive Tuberculosis Infection, Bacteriological or Histological 01081 Examination Not Done N Other Primary Progressive Tuberculosis Infection, Bacteriological or Histological 01082 Examination Unknown (At Present) N Other Primary Progressive Tuberculosis Infection, Tubercle Bacilli Found (in Sputum) by 01083 Microscopy N Other Primary Progressive Tuberculosis Infection, Tubercle Bacilli Not Found (in 01084 Sputum) by Microscopy, but Found by Bacterial Culture N Other Primary Progressive Tuberculosis Infection, Tubercle Bacilli Not Found by 01085 Bacteriological Examination, but Tuberculosis Confirmed Histologically N Other Primary Progressive Tuberculosis Infection, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other 01086 Methods [Inoculation of Animals] N 01090 Primary Tuberculous Infection, Unspecified, Confirmation Unspecified N Primary Tuberculous Infection, Unspecified, Bacteriological or Histological Examination 01091 Not Done N Primary Tuberculous Infection, Unspecified, Bacteriological or Histological Examination 01092 Unknown (at Present) N Primary Tuberculous Infection, Unspecified, Tubercle Bacilli Found (in Sputum) by 01093 Microscopy N Primary Tuberculous Infection, Unspecified, Tubercle Bacilli Not Found (in Sputum) by 01094 Microscopy, but Found by Bacterial Culture N Primary Tuberculous Infection, Unspecified, Tubercle Bacilli Not Found by 01095 Bacteriological Examination, but Tuberculosis Confirmed Histologically N Primary Tuberculous Infection, Unspecified, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other 01096 Methods [Inoculation of Animals] N 01100 Tuberculosis of Lung, Infiltrative, Confirmation Unspecified N 1100 Dermatophytosis of Scalp and Beard N 01101 Tuberculosis of Lung, Infiltrative, Bacteriological or Histological Examination Not Done N 1101 Dermatophytosis of Nail N Tuberculosis of Lung, Infiltrative, Bacteriological or Histological Examination Unknown 01102 (at Present) N 1102 Dermatophytosis of Hand N 01103 Tuberculosis of Lung, Infiltrative, Tubercle Bacilli Found (in Sputum) by Microscopy N 1103 Dermatophytosis of Groin and Perianal Area N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 14 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Tuberculosis of Lung, Infiltrative, Tubercle Bacilli Not Found (in Sputum) by Microscopy, 01104 but Found by Bacterial Culture N 1104 Dermatophytosis of Foot N Tuberculosis of Lung, Infiltrative, Tubercle Bacilli Not Found by Bacteriological 01105 Examination, but Tuberculosis Confirmed Histologically N 1105 Dermatophytosis of the Body N Tuberculosis of Lung, Infiltrative, Tubercle Bacilli Not Found Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods (Inoculation of 01106 Animals) N 1106 Deep Seated Dermatophytosis N 1108 Dermatophytosis of Other Specified Sites N 1109 Dermatophytosis of Unspecified Site N 01110 Tuberculosis of Lung, Nodular, Confirmation Unspecified N 1110 Pityriasis Versicolor N 01111 Tuberculosis of Lung, Nodular, Bacteriological or Histological Examination Not Done N 1111 Tinea Nigra N Tuberculosis of Lung, Nodular, Bacteriological or Histological Examination Unknown (at 01112 Present) N 1112 Tinea Blanca N 01113 Tuberculosis of Lung, Nodular, Tubercle Bacilli Found (in Sputum) by Microscopy N 1113 Black Piedra N Tuberculosis of Lung, Nodular, Tubercle Bacilli Not Found (in Sputum) by Microscopy, 01114 but Found by Bacterial Culture N Tuberculosis of Lung, Nodular, Tubercle Bacilli Not Found by Bacteriological 01115 Examination, but Tuberculosis Confirmed Histologically N Tuberculosis of Lung, Nodular, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01116 Animals] N 1118 Other Specified Dermatomycoses N 1119 Unspecified Dermatomycosis N 01120 Tuberculosis of Lung With Cavitation, Confirmation Unspecified N 1120 Candidiasis of Mouth N Tuberculosis of Lung With Cavitation, Bacteriological or Histological Examination Not 01121 Done N 1121 Candidiasis of Vulva and Vagina N Tuberculosis of Lung With Cavitation, Bacteriological or Histological Examination 01122 Unknown (at Present) N 1122 Candidiasis of Other Urogenital Sites N 01123 Tuberculosis of Lung With Cavitation, Tubercle Bacilli Found (in Sputum) by Microscopy N 1123 Candidiasis of Skin and Nails N Tuberculosis of Lung With Cavitation, Tubercle Bacilli Not Found (in Sputum) by 01124 Microscopy, but Found by Bacterial Culture N 1124 Candidiasis of Lung Y Tuberculosis of Lung With Cavitation, Tubercle Bacilli Not Found by Bacteriological 01125 Examination, but Tuberculosis Confirmed Histologically N 1125 Disseminated Candidiasis N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 15 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Tuberculosis of Lung With Cavitation, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01126 Animals] N 1128 Candidiasis of Other Specified Sites N 1129 Candidiasis of Unspecified Site N 01130 Tuberculosis of Bronchus, Confirmation Unspecified N 01131 Tuberculosis of Bronchus, Bacteriological or Histological Examination Not Done N Tuberculosis of Bronchus, Bacteriological or Histological Examination Unknown 01132 (at Present) N 01133 Tuberculosis of Bronchus, Tubercle Bacilli Found (in Sputum) by Microscopy N Tuberculosis of Bronchus, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but 01134 Found in Bacterial Culture N Tuberculosis of Bronchus, Tubercle Bacilli Not Found by Bacteriological Examination, 01135 but Tuberculosis Confirmed Histologically N Tuberculosis of Bronchus, Tubercle Bacilli Not Found by Bacteriological or Histological 01136 Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] N 01140 Tuberculous Fibrosis of Lung, Confirmation Unspecified N 1140 Primary Coccidioidomycosis (Pulmonary) Y 01141 Tuberculous Fibrosis of Lung, Bacteriological or Histological Examination Not Done N 1141 Primary Extrapulmonary Coccidioidomycosis Y Tuberculous Fibrosis of Lung, Bacteriological or Histological Examination Unknown (at 01142 Present) N 1142 Coccidioidal Meningitis Y 01143 Tuberculous Fibrosis of Lung, Tubercle Bacilli Found (in Sputum) by Microscopy N 1143 Other Forms of Progressive Coccidioidomycosis Y Tuberculous Fibrosis of Lung, Tubercle Bacilli Not Found (in Sputum) by Microscopy, 01144 but Found by Bacterial Culture N 1144 Chronic Pulmonary Coccidioidomycosis S Tuberculous Fibrosis of Lung, Tubercle Bacilli Not Found by Bacteriological 01145 Examination, but Tuberculosis Confirmed Histologically N 1145 Unspecified Pulmonary Coccidioidomycosis Y Tuberculous Fibrosis of Lung, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01146 Animals] N 1149 Unspecified Coccidioidomycosis N 01150 Tuberculous Bronchiectasis, Confirmation Unspecified N 01151 Tuberculous Bronchiectasis, Bacteriological or Histological Examination Not Done N Tuberculous Bronchiectasis, Bacteriological or Histological Examination Unknown 01152 (at Present) N 01153 Tuberculous Bronchiectasis, Tubercle Bacilli Found (in Sputum) by Microscopy N Tuberculous Bronchiectasis, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but 01154 Found by Bacterial Culture N Tuberculous Bronchiectasis, Tubercle Bacilli Not Found by Bacteriological Examination, 01155 but Tuberculosis Confirmed Histologically N Tuberculous Bronchiectasis, Tubercle Bacilli Not Found by Bacteriological or Histological 01156 Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 16 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 01160 Tuberculous Pneumonia (any Form), Confirmation Unspecified Y 1160 Blastomycosis N Tuberculous Pneumonia (any Form), Bacteriological or Histological Examination Not 01161 Done Y 1161 Paracoccidioidomycosis N Tuberculous Pneumonia (any Form), Bacteriological or Histological Examination 01162 Unknown (at Present) Y 1162 Lobomycosis N 01163 Tuberculous Pneumonia (any Form), Tubercle Bacilli Found (in Sputum) by Microscopy Y Tuberculous Pneumonia (any Form), Tubercle Bacilli Not Found (in Sputum) by 01164 Microscopy, but Found by Bacterial Culture Y Tuberculous Pneumonia (any Form), Tubercle Bacilli Not Found by Bacteriological 01165 Examination, but Tuberculosis Confirmed Histologically Y Tuberculous Pneumonia (any Form), Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01166 Animals] Y 01170 Tuberculous Pneumothorax, Confirmation Unspecified Y 1170 Rhinosporidiosis N 01171 Tuberculous Pneumothorax, Bacteriological or Histological Examination Not Done Y 1171 Sporotrichosis N Tuberculous Pneumothorax, Bacteriological or Histological Examination Unknown (at 01172 Present) Y 1172 Chromoblastomycosis N 01173 Tuberculous Pneumothorax, Tubercle Bacilli Not Found (in Sputum) by Microscopy Y 1173 Aspergillosis N Tuberculous Pneumothorax, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but 01174 Found by Bacterial Culture Y 1174 Mycotic Mycetomas N Tuberculous Pneumothorax, Tubercle Bacilli Not Found by Bacteriological Examination, 01175 but Tuberculosis Confirmed Histologically Y 1175 Cryptococcosis N Tuberculous Pneumothorax, Tubercle Bacilli Not Found by Bacteriological or Histological 01176 Examination but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] Y 1176 Allescheriosis (Petriellidosis) N 1177 Zygomycosis (Phycomycosis or Mucormycosis) N 1178 Infection by Dematiacious Fungi (Phaehyphomycosis) N 1179 Other and Unspecified Mycoses N 01180 Other Specified Pulmonary Tuberculosis, Confirmation Unspecified N Other Specified Pulmonary Tuberculosis, Bacteriological or Histological Examination Not 01181 Done N Other Specified Pulmonary Tuberculosis, Bacteriological or Histological Examination 01182 Unknown (at Present) N Other Specified Pulmonary Tuberculosis, Tubercle Bacilli Found (in Sputum) by 01183 Microscopy N Other Specified Pulmonary Tuberculosis, Tubercle Bacilli Not Found (in Sputum) by 01184 Microscopy, but Found by Bacterial Culture N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 17 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Other Specified Pulmonary Tuberculosis, Tubercle Bacilli Not Found by Bacteriological 01185 Examination, but Tuberculosis Confirmed Histologically N Other Specified Pulmonary Tuberculosis, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation 01186 of Animals] N 01190 Unspecified Pulmonary Tuberculosis, Confirmation Unspecified N Unspecified Pulmonary Tuberculosis, Bacteriological or Histological Examination Not 01191 Done N Unspecified Pulmonary Tuberculosis, Bacteriological or Histological Examination 01192 Unknown (at Present) N 01193 Unspecified Pulmonary Tuberculosis, Tubercle Bacilli Found (in Sputum) by Microscopy N Unspecified Pulmonary Tuberculosis, Tubercle Bacilli Not Found (in Sputum) by 01194 Microscopy, but Found by Bacterial Culture N Unspecified Pulmonary Tuberculosis, Tubercle Bacilli Not Found by Bacteriological 01195 Examination, but Tuberculosis Confirmed Histologically N Unspecified Pulmonary Tuberculosis, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01196 Animals] N 01200 Tuberculous Pleurisy, Confirmation Unspecified N 1200 Schistosomiasis due to Schistosoma Haematobium N 01201 Tuberculous Pleurisy, Bacteriological or Histological Examination Not Done N 1201 Schistosomiasis due to Schistosoma Mansoni Y Tuberculous Pleurisy, Bacteriological or Histological Examination Unknown 01202 (at Present) N 1202 Schistosomiasis due to Schistosoma Japonicum Y 01203 Tuberculous Pleurisy, Tubercle Bacilli Found (in Sputum) by Microscopy N 1203 Cutaneous Schistosomiasis Y Tuberculous Pleurisy, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but Found 01204 by Bacterial Culture N Tuberculous Pleurisy, Tubercle Bacilli Not Found by Bacteriological Examination, but 01205 Tuberculosis Confirmed Histologically N Tuberculous Pleurisy, Tubercle Bacilli Not Found by Bacteriological or Histological 01206 Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] N 1208 Other Specified Schistosomiasis Y 1209 Unspecified Schistosomiasis N 01210 Tuberculosis of Intrathoracic Lymph Nodes, Confirmation Unspecified N 1210 Opisthorchiasis N Tuberculosis of Intrathoracic Lymph Nodes, Bacteriological or Histological Examination 01211 Not Done N 1211 Clonorchiasis N Tuberculosis of Intrathoracic Lymph Nodes, Bacteriological or Histological Examination 01212 Unknown (at Present) N 1212 Paragonimiasis N Tuberculosis of Intrathoracic Lymph Nodes, Tubercle Bacilli Found (in Sputum) by 01213 Microscopy N 1213 Fascioliasis N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 18 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Tuberculosis of Intrathoracic Lymph Nodes, Tubercle Bacilli Not Found (in Sputum) by 01214 Microscopy, but Found by Bacterial Culture N 1214 Fasciolopsiasis N Tuberculosis of Intrathoracic Lymph Nodes, Tubercle Bacilli Not Found by 01215 Bacteriological Examination, but Tuberculosis Confirmed Histologically N 1215 Metagonimiasis N Tuberculosis of Intrathoracic Lymph Nodes, Tubercle Bacilli Not Found by Bacteriological or Histological Examination but Tuberculosis Confirmed by Other 01216 Methods N 1216 Heterophyiasis N 1218 Other Specified Trematode Infections N 1219 Unspecified Trematode Infection N 01220 Isolated Tracheal or Bronchial Tuberculosis, Unspecified N 1220 Echinococcus Granulosus Infection of Liver N Isolated Tracheal or Bronchial Tuberculosis, Bacteriological or Histological Examination 01221 Not Done N 1221 Echinococcus Granulosus Infection of Lung N Isolated Tracheal or Bronchial Tuberculosis, Bacteriological or Histological Examination 01222 Unknown (at Present) N 1222 Echinococcus Granulosus Infection of Thyroid N Isolated Tracheal or Bronchial Tuberculosis, Tubercle Bacilli Found (in Sputum) by 01223 Microscopy N 1223 Other Echinococcus Granulosus Infection N Isolated Tracheal or Bronchial Tuberculosis, Tubercle Bacilli Not Found (in Sputum) by 01224 Microscopy, but Found by Bacterial Culture N 1224 Unspecified Echinococcus Granulosus Infection N Isolated Tracheal or Bronchial Tuberculosis, Tubercle Bacilli Not Found by 01225 Bacteriological Examination, but Tuberculosis Confirmed Histologically N 1225 Echinococcus Multilocularis Infection of Liver N Isolated Tracheal or Bronchial Tuberculosis, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other 01226 Methods [Inoculation of Animals] N 1226 Other Echinococcus Multilocularis Infection N 1227 Unspecified Echinococcus Multilocularis Infection N 1228 Unspecified Echinococcus of Liver N 1229 Other and Unspecified Echinococcosis N 01230 Tuberculous Laryngitis, Confirmation Unspecified N 1230 Taenia Solium Infection, Intestinal Form N 01231 Tuberculous Laryngitis, Bacteriological or Histological Examination Not Done N 1231 Cysticercosis N Tuberculous Laryngitis, Bacteriological or Histological Examination Unknown 01232 (at Present) N 1232 Taenia Saginata Infection N 01233 Tuberculous Laryngitis, Tubercle Bacilli Found (in Sputum) by Microscopy N 1233 Taeniasis, Unspecified N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 19 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Tuberculous Laryngitis, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but 01234 Found by Bacterial Culture N 1234 Diphyllobothriasis, Intestinal N Tuberculous Laryngitis, Tubercle Bacilli Not Found by Bacteriological Examination, but 01235 Tuberculosis Confirmed Histologically N 1235 Sparganosis (Larval Diphyllobothriasis) N Tuberculous Laryngitis, Tubercle Bacilli Not Found by Bacteriological or Histological 01236 Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] N 1236 Hymenolepiasis N 1238 Other Specified Cestode Infection N 1239 Unspecified Cestode Infection N 1250 Bancroftian Filariasis N 1251 Malayan Filariasis N 1252 Loiasis N 1253 Onchocerciasis N 1254 Dipetalonemiasis N 1255 Mansonella Ozzardi Infection N 1256 Other Specified Filariasis N 1257 Dracontiasis N 1259 Unspecified Filariasis N 1260 Ancylostomiasis and Necatoriasis due to Ancylostoma Duodenale N 1261 Ancylostomiasis and Necatoriasis due to Necator Americanus N 1262 Ancylostomiasis and Necatoriasis due to Ancylostoma Braziliense N 1263 Ancylostomiasis and Necatoriasis due to Ancylostoma Ceylanicum N 1268 Ancylostomiasis and Necatoriasis due to Other Specified Ancylostoma N 1269 Unspecified Ancylostomiasis and Necatoriasis N 1270 Ascariasis N 1271 Anisakiasis N 1272 Strongyloidiasis N 1273 Trichuriasis N 1274 Enterobiasis N 1275 Capillariasis N 1276 Trichostrongyliasis N 1277 Other Specified Intestinal Helminthiasis N 1278 Mixed Intestinal Helminthiasis N 1279 Unspecified Intestinal Helminthiasis N 01280 Other Specified Respiratory Tuberculosis, Confirmation Unspecified N 1280 Toxocariasis N Other Specified Respiratory Tuberculosis, Bacteriological or Histological Examination 01281 Not Done N 1281 Gnathostomiasis N Other Specified Respiratory Tuberculosis, Bacteriological or Histological Examination 01282 Unknown (at Present) N Other Specified Respiratory Tuberculosis, Tubercle Bacilli Found (in Sputum) by 01283 Microscopy N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 20 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Other Specified Respiratory Tuberculosis, Tubercle Bacilli Not Found (in Sputum) by 01284 Microscopy, but Found by Bacterial Culture N Other Specified Respiratory Tuberculosis, Tubercle Bacilli Not Found by Bacteriological 01285 Examination, but Tuberculosis Confirmed Histologically N Other Specified Respiratory Tuberculosis, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation 01286 of Animals] N 1288 Other Specified Helminthiasis N 1289 Unspecified Helminth Infection N 01300 Tuberculous Meningitis, Confirmation Unspecified Y 1300 Meningoencephalitis due to Toxoplasmosis Y 01301 Tuberculous Meningitis, Bacteriological or Histological Examination Not Done Y 1301 Conjunctivitis due to Toxoplasmosis N Tuberculous Meningitis, Bacteriological or Histological Examination Unknown 01302 (at Present) Y 1302 Chorioretinitis due to Toxoplasmosis N 01303 Tuberculous Meningitis, Tubercle Bacilli Found (iIn Sputum) by Microscopy Y 1303 Myocarditis due to Toxoplasmosis Y Tuberculous Meningitis, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but 01304 Found by Bacterial Culture Y 1304 Pneumonitis due to Toxoplasmosis Y Tuberculous Meningitis, Tubercle Bacilli Not Found by Bacteriological Examination, but 01305 Tuberculosis Confirmed Histologically Y 1305 Hepatitis due to Toxoplasmosis Y Tuberculous Meningitis, Tubercle Bacilli Not Found by Bacteriological or Histological 01306 Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] Y 1307 Toxoplasmosis of Other Specified Sites N 1308 Multisystemic Disseminated Toxoplasmosis Y 1309 Unspecified Toxoplasmosis N 01310 Tuberculoma of Meninges, Confirmation Unspecified Y 01311 Tuberculoma of Meninges, Bacteriological or Histological Examination Not Done Y Tuberculoma of Meninges, Bacteriological or Histological Examination Unknown 01312 (at Present) Y 01313 Tuberculoma of Meninges, Tubercle Bacilli Found (In Sputum) by Microscopy Y Tuberculoma of Meninges, Tubercle Bacilli Not Found (In Sputum) by Microscopy, but 01314 Found by Bacterial Culture Y Tuberculoma of Meninges, Tubercle Bacilli Not Found by Bacteriological Examiation, but 01315 Tuberculosis Confirmed Histologically Y Tuberculoma of Meninges, Tubercle Bacilli Not Found by Bacteriological or Histological 01316 Examination but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] Y 1318 Trichomoniasis of Other Specified Sites N 1319 Unspecified Trichomoniasis N 01320 Tuberculoma of Brain, Confirmation Unspecified Y 1320 Pediculus Capitis (Head Louse) N 01321 Tuberculoma of Brain, Bacteriological or Histological Examination Not Done Y 1321 Pediculus Corporis (Body Louse) N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 21 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Tuberculoma of Brain, Bacteriological or Histological Examination Unknown 01322 (at Present) Y 1322 Phthirus Pubis (Pubic Louse) N 01323 Tuberculoma of Brain, Tubercle Bacilli Found (in Sputum) by Microscopy Y 1323 Mixed Pediculosis and Phthirus Infestation N Tuberculoma of Brain, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but Found 01324 by Bacterial Culture Y Tuberculoma of Brain, Tubercle Bacilli Not Found by Bacteriological Examination, but 01325 Tuberculosis Confirmed Histologically Y Tuberculoma of Brain, Tubercle Bacilli Not Found by Bacteriological or Histological 01326 Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] Y 1329 Unspecified Pediculosis N 01330 Tuberculous Abscess of Brain, Confirmation Unspecified Y 1330 Scabies N 01331 Tuberculous Abscess of Brain, Bacteriological or Histological Examination Not Done Y Tuberculous Abscess of Brain, Bacteriological or Histological Examination Unknown (at 01332 Present) Y 01333 Tuberculous Abscess of Brain, Tubercle Bacilli Found (in Sputum) by Microscopy Y Tuberculous Abscess of Brain, Tubercle Bacilli Not Found (in Sputum) by Microscopy, 01334 but Found by Bacterial Culture Y Tuberculous Abscess of Brain, Tubercle Bacilli Not Found by Bacteriological 01335 Examination, but Tuberculosis Confirmed Histologically Y Tuberculous Abscess of Brain, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01336 Animals] Y 1338 Other Acariasis N 1339 Unspecified Acariasis N 01340 Tuberculoma of Spinal Cord, Confirmation Unspecified Y 1340 Myiasis N 01341 Tuberculoma of Spinal Cord, Bacteriological or Histological Examination Not Done Y 1341 Other Arthropod Infestation N Tuberculoma of Spinal Cord, Bacteriological or Histological Examination Unknown 01342 (at Present) Y 1342 Hirudiniasis N 01343 Tuberculoma of Spinal Cord, Tubercle Bacilli Found (in Sputum) by Microscopy Y Tuberculoma of Spinal Cord, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but 01344 Found by Bacterial Culture Y Tuberculoma of Spinal Cord, Tubercle Bacilli Not Found by Bacteriological Examination, 01345 but Tuberculosis Confirmed Histologically Y Tuberculoma of Spinal Cord, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01346 Animals] Y 1348 Other Specified Infestations N 1349 Unspecified Infestation N 01350 Tuberculous Abscess of Spinal Cord, Confirmation Unspecified Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 22 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Tuberculous Abscess of Spinal Cord, Bacteriological or Histological Examination Not 01351 Done Y Tuberculous Abscess of Spinal Cord, Bacteriological or Histological Examination 01352 Unknown (at Present) Y 01353 Tuberculous Abscess of Spinal Cord, Tubercle Bacilli Found (in Sputum) by Microscopy Y Tuberculous Abscess of Spinal Cord, Tubercle Bacilli Not Found (in Sputum) by 01354 Microscopy, but Found by Bacterial Culture Y Tuberculous Abscess of Spinal Cord, Tubercle Bacilli Not Found by Bacteriological 01355 Examination, but Tuberculosis Confirmed Histologically Y Tuberculous Abscess of Spinal Cord, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01356 Animals] Y 01360 Tuberculous Encephalitis or Myelitis, Confirmation Unspecified Y 1360 Ainhum N Tuberculous Encephalitis or Myelitis, Bacteriological or Histological Examination Not 01361 Done Y 1361 Behcet’s Syndrome N Tuberculous Encephalitis or Myelitis, Bacteriological or Histological Examination 01362 Unknown (At Present) Y 1362 Specific Infections by Free-Living Amebae N 01363 Tuberculous Encephalitis or Myelitis, Tubercle Bacilli Found (in Sputum) by Microscopy Y 1363 Pneumocystosis N Tuberculous Encephalitis or Myelitis, Tubercle Bacilli Not Found (in Sputum) by 01364 Microscopy, but Found by Bacterial Culture Y 1364 Psorospermiasis N Tuberculous Encephalitis or Myelitis, Tubercle Bacilli Not Found by Bacteriological 01365 Examination, but Tuberculosis Confirmed Histologically Y 1365 Sarcosporidiosis N Tuberculous Encephalitis or Myelitis, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01366 Animals] Y 1368 Other Specified Infectious and Parasitic Diseases N 1369 Unspecified Infectious and Parasitic Diseases N 1370 Late Effects of Respiratory or Unspecified Tuberculosis N 1371 Late Effects of Central Nervous System Tuberculosis N 1372 Late Effects of Genitourinary Tuberculosis N 1373 Late Effects of Tuberculosis of Bones and Joints N 1374 Late Effects of Tuberculosis of Other Specified Organs N 01380 Other Specified Tuberculosis of Central Nervous System, Confirmation Unspecified N Other Specified Tuberculosis of Central Nervous System, Bacteriological or Histological 01381 Examination Not Done N Other Specified Tuberculosis of Central Nervous System, Bacteriological or Histological 01382 Examination Unknown (at Present) N Other Specified Tuberculosis of Central Nervous System, Tubercle Bacilli Found 01383 (in Sputum) by Microscopy N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 23 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Other Specified Tuberculosis of Central Nervous System, Tubercle Bacilli Not Found (in 01384 Sputum) by Microscopy, but Found by Bacterial Culture N Other Specified Tuberculosis of Central Nervous System, Tubercle Bacilli Not Found by 01385 Bacteriological Examination, but Tuberculosis Confirmed Histologically N Other Specified Tuberculosis of Central Nervous System, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other 01386 Methods [Inoculation of Animals] N 01390 Unspecified Tuberculosis of Central Nervous System, Confirmation Unspecified N 1390 Late Effects of Viral Encephalitis N Unspecified Tuberculosis of Central Nervous System, Bacteriological or Histological 01391 Examination Not Done N 1391 Late Effects of Trachoma N Unspecified Tuberculosis of Central Nervous System, Bacteriological or Histological 01392 Examination Unknown (at Present) N Unspecified Tuberculosis of Central Nervous System, Tubercle Bacilli Found (in Sputum) 01393 by Microscopy N Unspecified Tuberculosis of Central Nervous System, Tubercle Bacilli Not Found (in 01394 Sputum) by Microscopy, but Found by Bacterial Culture N Unspecified Tuberculosis of Central Nervous System, Tubercle Bacilli Not Found by 01395 Bacteriological Examination, but Tuberculosis Confirmed Histologically N Unspecified Tuberculosis of Central Nervous System, Tubercle Bacilli Not Found by Bacteriological or Histological Examination but Tuberculosis Confirmed by Other 01396 Methods [Inoculation of Animals] N 1398 Late Effects of Other and Unspecified Infectious and Parasitic Diseases N 01400 Tuberculous Pertonitis, Unspecified N 1400 Malignant Neoplasm of Upper Lip, Vermilion Border N 01401 Tuberculous Pertonitis, Bacteriological or Histological Examination Not Done N 1401 Malignant Neoplasm of Lower Lip, Vermilion Border N Tuberculous Peritonitis, Bacteriological or Histological Examination Unknown 01402 (at Present) N 01403 Tuberculous Peritonitis, Tubercle Bacilli Found (in Sputum) by Microscopy N 1403 Malignant Neoplasm of Upper Lip, Inner Aspect N Tuberculous Peritonitis, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but 01404 Found by Bacterial Culture N 1404 Malignant Neoplasm of Lower Lip, Inner Aspect N Tuberculous Peritonitis, Tubercle Bacilli Not Found by Bacteriological Examination, but 01405 Tuberculosis Confirmed Histologically N 1405 Malignant Neoplasm of Lip, Inner Aspect, Unspecified as to Upper or Lower N Tuberculous Peritonitis, Tubercle Bacilli Not Found by Bacteriological or Histological 01406 Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] N 1406 Malignant Neoplasm of Commissure of Lip N 1408 Malignant Neoplasm of Other Sites of Lip N 1409 Malignant Neoplasm of Lip, Vermilion Border, Unspecified as to Upper or Lower N 1410 Malignant Neoplasm of Base of Tongue N 1411 Malignant Neoplasm of Dorsal Surface of Tongue N 1412 Malignant Neoplasm of Tip and Lateral Border of Tongue N 1413 Malignant Neoplasm of Ventral Surface of Tongue N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 24 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 1414 Malignant Neoplasm of Anterior Two-Thirds of Tongue, Part Unspecified N 1415 Malignant Neoplasm of Junctional Zone of Tongue N 1416 Malignant Neoplasm of Lingual Tonsil N 1418 Malignant Neoplasm of Other Sites of Tongue N 1419 Malignant Neoplasm of Tongue, Unspecified Site N 1420 Malignant Neoplasm of Parotid Gland N 1421 Malignant Neoplasm of Submandibular Gland N 1422 Malignant Neoplasm of Sublingual Gland N 1428 Malignant Neoplasm of Other Major Salivary Glands N 1429 Malignant Neoplasm of Salivary Gland, Unspecified N 1430 Malignant Neoplasm of Upper Gum N 1431 Malignant Neoplasm of Lower Gum N 1438 Malignant Neoplasm of Other Sites of Gum N 1439 Malignant Neoplasm of Gum, Unspecified Site N 1440 Malignant Neoplasm of Anterior Portion of Floor of Mouth N 1441 Malignant Neoplasm of Lateral Portion of Floor of Mouth N 1448 Malignant Neoplasm of Other Sites of Floor of Mouth N 1449 Malignant Neoplasm of Floor of Mouth, Part Unspecified N 1450 Malignant Neoplasm of Cheek Mucosa N 1451 Malignant Neoplasm of Vestibule of Mouth N 1452 Malignant Neoplasm of Hard Palate N 1453 Malignant Neoplasm of Soft Palate N 1454 Malignant Neoplasm of Uvula N 1455 Malignant Neoplasm of Palate, Unspecified N 1456 Malignant Neoplasm of Retromolar Area N 1458 Malignant Neoplasm of Other Specified Parts of Mouth N 1459 Malignant Neoplasm of Mouth, Unspecified Site N 1460 Malignant Neoplasm of Tonsil N 1461 Malignant Neoplasm of Tonsillar Fossa N 1462 Malignant Neoplasm of Tonsillar Pillars (Anterior) (Posterior) N 1463 Malignant Neoplasm of Vallecula N 1464 Malignant Neoplasm of Anterior Aspect of Epiglottis N 1465 Malignant Neoplasm of Junctional Region of Oropharynx N 1466 Malignant Neoplasm of Lateral Wall of Oropharynx N 1467 Malignant Neoplasm of Posterior Wall of Oropharynx N 1468 Malignant Neoplasm of Other Specified Sites of Oropharynx N 1469 Malignant Neoplasm of Oropharynx, Unspecified Site N 1470 Malignant Neoplasm of Superior Wall of Nasopharynx N 1471 Malignant Neoplasm of Posterior Wall of Nasopharynx N 1472 Malignant Neoplasm of Lateral Wall of Nasopharynx N 1473 Malignant Neoplasm of Anterior Wall of Nasopharynx N 1478 Malignant Neoplasm of Other Specified Sites of Nasopharynx N 1479 Malignant Neoplasm of Nasopharynx, Unspecified Site N Tuberculosis of Intestines, Peritoneum, and Mesenteric Glands, Other, Confirmation 01480 Unspecified N 1480 Malignant Neoplasm of Postcricoid Region of Hypopharynx N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 25 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Tuberculosis of Intestines, Peritoneum, and Mesenteric Glands, Other, Bacteriological or 01481 Histological Examination Not Done N 1481 Malignant Neoplasm of Pyriform Sinus N Tuberculosis of Intestines, Peritoneum, and Mesenteric Glands, Other, Bacteriological or 01482 Histological Examination Unknown (at Present) N 1482 Malignant Neoplasm of Aryepiglottic Fold, Hypopharyngeal Aspect N Tuberculosis of Intestines, Peritoneum, and Mesenteric Glands, Other, Tubercle Bacilli 01483 Found (in Sputum) by Microscopy N 1483 Malignant Neoplasm of Posterior Hypopharyngeal Wall N Tuberculosis of Intestines, Peritoneum, and Mesenteric Glands, Other, Tubercle Bacilli 01484 Not Found (in Sputum) by Microscopy, but Found by Bacterial Culture N Tuberculosis of Intestines, Peritoneum, and Mesenteric Glands, Other, Tubercle Bacilli 01485 Not Found by Bacteriological Examination, but Tuberculosis Confirmed Histologically N Tuberculosis of Intestines, Peritoneum, and Mesenteric Glands, Other, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed 01486 by Other Methods [Inoculation of Animals] N 1488 Malignant Neoplasm of Other Specified Sites of Hypopharynx N 1489 Malignant Neoplasm of Hypopharynx, Unspecified Site N 1490 Malignant Neoplasm of Pharynx, Unspecified N 1491 Malignant Neoplasm of Waldeyer’s Ring N 1498 Malignant Neoplasm of Other Sites Within the Lip and Oral Cavity N 1499 Malignant Neoplasm of ill-Defined Sites of Lip and Oral Cavity N 01500 Tuberculosis of Vertebral Column, Confirmation Unspecified N 1500 Malignant Neoplasm of Cervical Esophagus N 01501 Tuberculosis of Vertebral Column, Bacteriological or Histological Examination Not Done N 1501 Malignant Neoplasm of Thoracic Esophagus N Tuberculosis of Vertebral Column, Bacteriological or Histological Examination Unknown 01502 (at Present) N 1502 Malignant Neoplasm of Abdominal Esophagus N 01503 Tuberculosis of Vertebral Column, Tubercle Bacilli Found (in Sputum) by Microscopy N 1503 Malignant Neoplasm of Upper Third of Esophagus N Tuberculosis of Vertebral Column, Tubercle Bacilli Not Found (in Sputum) by 01504 Microscopy, but Found by Bacterial Culture N 1504 Malignant Neoplasm of Middle Third of Esophagus N Tuberculosis of Vertebral Column, Tubercle Bacilli Not Found by Bacteriological 01505 Examination, but Tuberculosis Confirmed Histologically N 1505 Malignant Neoplasm of Lower Third of Esophagus N Tuberculosis of Vertebral Column, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01506 Animals] N 1508 Malignant Neoplasm of Other Specified Part of Esophagus N 1509 Malignant Neoplasm of Esophagus, Unspecified Site N 01510 Tuberculosis of Hip, Confirmation Unspecified N 1510 Malignant Neoplasm of Cardia N 01511 Tuberculosis of Hip, Bacteriological or Histological Examination Not Done N 1511 Malignant Neoplasm of Pylorus N 01512 Tuberculosis of Hip, Bacteriological or Histological Examination Unknown (at Present) N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 26 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 1512 Malignant Neoplasm of Pyloric Antrum N 01513 Tuberculosis of Hip, Tubercle Bacilli Found (in Sputum) by Microscopy N 1513 Malignant Neoplasm of Fundus of Stomach N Tuberculosis of Hip, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but Found 01514 by Bacterial Culture N 1514 Malignant Neoplasm of Body of Stomach N Tuberculosis of Hip, Tubercle Bacilli Not Found by Bacteriological Examination, but 01515 Tuberculosis Confirmed Histologically N 1515 Malignant Neoplasm of Lesser Curvature of Stomach, Unspecified N Tuberculosis of Hip, Tubercle Bacilli Not Found by Bacteriological or Histological 01516 Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] N 1516 Malignant Neoplasm of Greater Curvature of Stomach, Unspecified N 1518 Malignant Neoplasm of Other Specified Sites of Stomach N 1519 Malignant Neoplasm of Stomach, Unspecified Site N 01520 Tuberculosis of Knee, Confirmation Unspecified N 1520 Malignant Neoplasm of Duodenum N 01521 Tuberculosis of Knee, Bacteriological or Histological Examination Not Done N 1521 Malignant Neoplasm of Jejunum N Tuberculosis of Knee, Bacteriological or Histological Examination Unknown 01522 (at Present) N 1522 Malignant Neoplasm of Ileum N 01523 Tuberculosis of Knee, Tubercle Bacilli Found (in Sputum) by Microscopy N 1523 Malignant Neoplasm of Meckel’s Diverticulum N Tuberculosis of Knee, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but Found 01524 by Bacterial Culture N Tuberculosis of Knee, Tubercle Bacilli Not Found by Bacteriological Examination, but 01525 Tuberculosis Confirmed Histologically N Tuberculosis of Knee, Tubercle Bacilli Not Found by Bacteriological or Histological 01526 Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] N 1528 Malignant Neoplasm of Other Specified Sites of Small Intestine N 1529 Malignant Neoplasm of Small Intestine, Unspecified Site N 1530 Malignant Neoplasm of Hepatic Flexure N 1531 Malignant Neoplasm of Transverse Colon N 1532 Malignant Neoplasm of Descending Colon N 1533 Malignant Neoplasm of Sigmoid Colon N 1534 Malignant Neoplasm of Cecum N 1535 Malignant Neoplasm of Appendix N 1536 Malignant Neoplasm of Ascending Colon N 1537 Malignant Neoplasm of Splenic Flexure N 1538 Malignant Neoplasm of Other Specified Sites of Large Intestine N 1539 Malignant Neoplasm of Colon, Unspecified Site N 1540 Malignant Neoplasm of Rectosigmoid Junction N 1541 Malignant Neoplasm of Rectum N 1542 Malignant Neoplasm of Anal Canal N 1543 Malignant Neoplasm of Anus, Unspecified Site N 1548 Malignant Neoplasm of Other Sites of Rectum, Rectosigmoid Junction, and Anus N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 27 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 01550 Tuberculosis of Limb Bones, Confirmation Unspecified N 1550 Malignant Neoplasm of Liver, Primary N 01551 Tuberculosis of Limb Bones, Bacteriological or Histological Examination Not Done N 1551 Malignant Neoplasm of Intrahepatic Bile Ducts N Tuberculosis of Limb Bones, Bacteriological or Histological Examination Unknown 01552 (at Present) N 1552 Malignant Neoplasm of Liver, Not Specified as Primary or Secondary N 01553 Tuberculosis of Limb Bones, Tubercle Bacilli Found (in Sputum) by Microscopy N Tuberculosis of Limb Bones, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but 01554 Found by Bacterial Culture N Tuberculosis of Limb Bones, Tubercle Bacilli Not Found by Bacteriological Examination, 01555 but Tuberculosis Confirmed Histologically N Tuberculosis of Limb Bones, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01556 Animals] N 01560 Tuberculosis of Mastoid, Confirmation Unspecified N 1560 Malignant Neoplasm of Gallbladder N 01561 Tuberculosis of Mastoid, Bacteriological or Histological Examination Not Done N 1561 Malignant Neoplasm of Extrahepatic Bile Ducts N Tuberculosis of Mastoid, Bacteriological or Histological Examination Unknown 01562 (at Present) N 1562 Malignant Neoplasm of Ampulla of Vater N 01563 Tuberculosis of Mastoid, Tubercle Bacilli Found (in Sputum) by Microscopy N Tuberculosis of Mastoid, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but 01564 Found by Bacterial Culture N Tuberculosis of Mastoid, Tubercle Bacilli Not Found by Bacteriological Examination, but 01565 Tuberculosis Confirmed Histologically N Tuberculosis of Mastoid, Tubercle Bacilli Not Found by Bacteriological or Histological 01566 Examination but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] N 1568 Malignant Neoplasm of Other Specified Sites of Gallbladder and Extrahepatic Bile Ducts N 1569 Malignant Neoplasm of Biliary Tract, Part Unspecified Site N 01570 Tuberculosis of Other Specified Bone, Unspecified N 1570 Malignant Neoplasm of Head of Pancreas N Tuberculosis of Other Specified Bone, Bacteriological or Histological Examination Not 01571 Done N 1571 Malignant Neoplasm of Body of Pancreas N Tuberculosis of Other Specified Bone, Bacteriological or Histological Examination 01572 Unknown (at Present) N 1572 Malignant Neoplasm of Tail of Pancreas N 01573 Tuberculosis of Other Specified Bone, Tubercle Bacilli Found (in Sputum) by Microscopy N 1573 Malignant Neoplasm of Pancreatic Duct N Tuberculosis of Other Specified Bone, Tubercle Bacilli Not Found (in Sputum) by 01574 Microscopy, but Found by Bacterial Culture N 1574 Malignant Neoplasm of Islets of Langerhans N Tuberculosis of Other Specified Bone, Tubercle Bacilli Not Found by Bacteriological 01575 Examination, but Tuberculosis Confirmed Histologically N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 28 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Tuberculosis of Other Specified Bone, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, But Tuberculosis Confirmed by Other Methods [Inoculation of 01576 Animals] N 1578 Malignant Neoplasm of Other Specified Sites of Pancreas N 1579 Malignant Neoplasm of Pancreas, Part Unspecified N 01580 Tuberculosis of Other Specified Joint, Confirmation Unspecified N 1580 Malignant Neoplasm of Retroperitoneum N Tuberculosis of Other Specified Joint, Bacteriological or Histological Examination Not 01581 Done N Tuberculosis of Other Specified Joint, Bacteriological or Histological Examination 01582 Unknown (at Present) N

01583 Tuberculosis of Other Specified Joint, Tubercle Bacilli Found (in Sputum) by Microscopy N Tuberculosis of Other Specified Joint, Tubercle Bacilli Not Found (in Sputum) by 01584 Microscopy, but Found by Bacterial Culture N Tuberculosis of Other Specified Joint, Tubercle Bacilli Not Found by Bacteriological 01585 Examination, but Tuberculosis Confirmed Histologically N Tuberculosis of Other Specified Joint, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01586 Animals] N 1588 Malignant Neoplasm of Specified Parts of Peritoneum N 1589 Malignant Neoplasm of Peritoneum, Unspecified N 01590 Tuberculosis of Unspecified Bones and Joints, Confirmation Unspecified N 1590 Malignant Neoplasm of Intestinal Tract, Part Unspecified N Tuberculosis of Unspecified Bones and Joints, Bacteriological or Histological 01591 Examination Not Done N 1591 Malignant Neoplasm of Spleen, Not Elsewhere Classified N Tuberculosis of Unspecified Bones and Joints, Bacteriological or Histological 01592 Examination Unknown (at Present) N Tuberculosis of Unspecified Bones and Joints, Tubercle Bacilli Found (in Sputum) by 01593 Microscopy N Tuberculosis of Unspecified Bones and Joints, Tubercle Bacilli Not Found (in Sputum) by 01594 Microscopy, but Found by Bacterial Culture N Tuberculosis of Unspecified Bones and Joints, Tubercle Bacilli Not Found by 01595 Bacteriological Examination, but Tuberculosis Confirmed Histologically N Tuberculosis of Unspecified Bones and Joints, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other 01596 Methods [Inoculation of Animals] N 1598 Malignant Neoplasm of Other Sites of Digestive System and Intra-Abdominal Organs N 1599 Malignant Neoplasm of ill-Defined Sites of Digestive Organs and Peritoneum N 01600 Tuberculosis of Kidney, Confirmation Unspecified N 1600 Malignant Neoplasm of Nasal Cavities N 01601 Tuberculosis of Kidney, Bacteriological or Histological Examination Not Done N 1601 Malignant Neoplasm of Auditory Tube, Middle Ear, and Mastoid Air Cells N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 29 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Tuberculosis of Kidney, Bacteriological or Histological Examination Unknown 01602 (at Present) N 1602 Malignant Neoplasm of Maxillary Sinus N 01603 Tuberculosis of Kidney, Tubercle Bacilli Found (in Sputum) by Microscopy N 1603 Malignant Neoplasm of Ethmoidal Sinus N Tuberculosis of Kidney, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but 01604 Found by Bacterial Culture N 1604 Malignant Neoplasm of Frontal Sinus N Tuberculosis of Kidney, Tubercle Bacilli Not Found by Bacteriological Examination, but 01605 Tuberculosis Confirmed Histologically N 1605 Malignant Neoplasm of Sphenoidal Sinus N Tuberculosis of Kidney, Tubercle Bacilli Not Found by Bacteriological or Histological 01606 Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] N

1608 Malignant Neoplasm of Other Sites of Nasal Cavities, Middle Ear, and Accessory Sinuses N Malignant Neoplasm of Site of Nasal Cavities, Middle Ear, and Accessory Sinus, 1609 Unspecified Site N 01610 Tuberculosis of Bladder, Confirmation Unspecified N 1610 Malignant Neoplasm of Glottis N 01611 Tuberculosis of Bladder, Bacteriological or Histological Examination Not Done N 1611 Malignant Neoplasm of Supraglottis N Tuberculosis of Bladder, Bacteriological or Histological Examination Unknown 01612 (at Present) N 1612 Malignant Neoplasm of Subglottis N 01613 Tuberculosis of Bladder, Tubercle Bacilli Found (in Sputum) by Microscopy N 1613 Malignant Neoplasm of Laryngeal Cartilages N Tuberculosis of Bladder, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but 01614 Found by Bacterial Culture N Tuberculosis of Bladder, Tubercle Bacilli Not Found by Bacteriological Examination, But 01615 Tuberculosis Confirmed Histologically N Tuberculosis of Bladder, Tubercle Bacilli Not Found by Bacteriological or Histological 01616 Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] N 1618 Malignant Neoplasm of Other Specified Sites of Larynx N 1619 Malignant Neoplasm of Larynx, Unspecified Site N 01620 Tuberculosis of Ureter, Confirmation Unspecified N 1620 Malignant Neoplasm of Trachea N 01621 Tuberculosis of Ureter, Bacteriological or Histological Examination Not Done N Tuberculosis of Ureter, Bacteriological or Histological Examination Unknown 01622 (at Present) N 1622 Malignant Neoplasm of Main Bronchus N 01623 Tuberculosis of Ureter, Tubercle Bacilli Found (in Sputum) by Microscopy N 1623 Malignant Neoplasm of Upper Lobe, Bronchus, or Lung N Tuberculosis of Ureter, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but Found 01624 by Bacterial Culture N 1624 Malignant Neoplasm of Middle Lobe, Bronchus, or Lung N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 30 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Tuberculosis of Ureter, Tubercle Bacilli Not Found by Bacteriological Examination, but 01625 Tuberculosis Confirmed Histologically N 1625 Malignant Neoplasm of Lower Lobe, Bronchus, or Lung N Tuberculosis of Ureter, Tubercle Bacilli Not Found by Bacteriological or Histological 01626 Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] N 1628 Malignant Neoplasm of Other Parts of Bronchus or Lung N 1629 Malignant Neoplasm of Bronchus and Lung, Unspecified Site N 01630 Tuberculosis of Other Urinary Organs, Confirmation Unspecified N 1630 Malignant Neoplasm of Parietal Pleura N Tuberculosis of Other Urinary Organs, Bacteriological or Histological Examination Not 01631 Done N 1631 Malignant Neoplasm of Visceral Pleura N Tuberculosis of Other Urinary Organs, Bacteriological or Histological Examination 01632 Unknown (at Present) N

01633 Tuberculosis of Other Urinary Organs, Tubercle Bacilli Found (in Sputum) by Microscopy N Tuberculosis of Other Urinary Organs, Tubercle Bacilli Not Found (in Sputum) by 01634 Microscopy, but Found by Bacterial Culture N Tuberculosis of Other Urinary Organs, Tubercle Bacilli Not Found by Bacteriological 01635 Examination, but Tuberculosis Confirmed Histologically N Tuberculosis of Other Urinary Organs, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01636 Animals] N 1638 Malignant Neoplasm of Other Specified Sites of Pleura N 1639 Malignant Neoplasm of Pleura, Unspecified Site N 01640 Tuberculosis of Epididymis, Confirmation Unspecified N 1640 Malignant Neoplasm of Thymus N 01641 Tuberculosis of Epididymis, Bacteriological or Histological Examination Not Done N 1641 Malignant Neoplasm of Heart N Tuberculosis of Epididymis, Bacteriological or Histological Examination Unknown 01642 (at Present) N 1642 Malignant Neoplasm of Anterior Mediastinum N 01643 Tuberculosis of Epididymis, Tubercle Bacilli Found (in Sputum) by Microscopy N 1643 Malignant Neoplasm of Posterior Mediastinum N Tuberculosis of Epididymis, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but 01644 Found by Bacterial Culture N Tuberculosis of Epididymis, Tubercle Bacilli Not Found by Bacteriological Examination, 01645 but Tuberculosis Confirmed Histologically N

Tuberculosis of Epididymis, Tubercle Bacilli Not Found by Bacteriological or Histological 01646 Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] N 1648 Malignant Neoplasm of Other Parts of Mediastinum N 1649 Malignant Neoplasm of Mediastinum, Part Unspecified N 01650 Tuberculosis of Other Male Genital Organs, Confirmation Unspecified N 1650 Malignant Neoplasm of Upper Respiratory Tract, Part Unspecified N Tuberculosis of Other Male Genital Organs, Bacteriological or Histological Examination 01651 Not Done N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 31 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Tuberculosis of Other Male Genital Organs, Bacteriological or Histological Examination 01652 Unknown (at Present) N Tuberculosis of Other Male Genital Organs, Tubercle Bacilli Found (in Sputum) by 01653 Microscopy N Tuberculosis of Other Male Genital Organs, Tubercle Bacilli not Found (in Sputum) by 01654 Microscopy, but Found by Bacterial Culture N Tuberculosis of Other Male Genital Organs, Tubercle Bacilli Not Found by 01655 Bacteriological Examination, but Tuberculosis Confirmed Histologically N Tuberculosis of Other Male Genital Organs, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other 01656 Methods [Inoculation of Animals] N Malignant Neoplasm of Other Sites Within the Respiratory System and Intrathoracic 1658 Organs N 1659 Malignant Neoplasm of Ill-Defined Sites Within the Respiratory System N 01660 Tuberculous Oophoritis and Salpingitis, Confirmation Unspecified N Tuberculous Oophoritis and Salpingitis, Bacteriological or Histological Examination Not 01661 Done N Tuberculous Oophoritis and Salpingitis, Bacteriological or Histological Examination 01662 Unknown (at Present) N Tuberculous Oophoritis and Salpingitis, Tubercle Bacilli Found (in Sputum) by 01663 Microscopy N Tuberculous Oophoritis and Salpingitis, Tubercle Bacilli Not Found (in Sputum) by 01664 Microscopy, but Found by Bacterial Culture N Tuberculous Oophoritis and Salpingitis, Tubercle Bacilli Not Found by Bacteriological 01665 Examination, but Tuberculosis Confirmed Histologically N Tuberculous Oophoritis and Salpingitis, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01666 Animals] N 01670 Tuberculosis of Other Female Genital Organs, Confirmation Unspecified N Tuberculosis of Other Female Genital Organs, Bacteriological or Histological Examination 01671 Not Done N Tuberculosis of Other Female Genital Organs, Bacteriological or Histological Examination 01672 Unknown (at Present) N Tuberculosis of Other Female Genital Organs, Tubercle Bacilli Found (in Sputum) by 01673 Microscopy N Tuberculosis of Other Female Genital Organs, Tubercle Bacilli Not Found (in Sputum) by 01674 Microscopy, but Found by Bacterial Culture N Tuberculosis of Other Female Genital Organs, Tubercle Bacilli Not Found by 01675 Bacteriological Examination, but Tuberculosis Confirmed Histologically N Tuberculosis of Other Female Genital Organs, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other 01676 Methods [Inoculation of Animals] N 01690 Unspecified Genitourinary Tuberculosis, Confirmation Unspecified N Unspecified Genitourinary Tuberculosis, Bacteriological or Hisotological Examination 01691 Not Done N Unspecified Genitourinary Tuberculosis, Bacteriological or Histological Examination 01692 Unknown (at Present) N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 32 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Unspecified Genitourinary Tuberculosis, Tubercle Bacilli Found (in Sputum) by 01693 Microscopy N Unspecified Genitourinary Tuberculosis, Tubercle Bacilli Not Found (in Sputum) by 01694 Microcopy, but Found by Bacterial Culture N Unspecified Genitourinary Tuberculosis, Tubercle Bacilli Not Found by Bacteriological 01695 Examination, but Tuberculosis Confirmed Histologically N Unspecified Genitourinary Tuberculosis, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01696 Animals] N 01700 Tuberculosis of Skin and Subcutaneous Cellular Tissue, Confirmation Unspecified N 1700 Malignant Neoplasm of Bones of Skull and Face, Except Mandible N Tuberculosis of Skin and Subcutaneous Cellular Tissue, Bacteriological or Histological 01701 Examination Not Done N 1701 Malignant Neoplasm of Mandible N Tuberculosis of Skin and Subcutaneous Cellular Tissue, Bacteriological or Histological 01702 Examination Unknown (at Present) N 1702 Malignant Neoplasm of Vertebral Column, Excluding Sacrum and Coccyx N Tuberculosis of Skin and Subcutaneous Cellular Tissue, Tubercle Bacilli Found (in 01703 Sputum) by Microscopy N 1703 Malignant Neoplasm of Ribs, Sternum, and Clavicle N Tuberculosis of Skin and Subcutaneous Cellular Tissue, Tubercle Bacilli Not Found (in 01704 Sputum) by Microscopy, but Found by Bacterial Culture N 1704 Malignant Neoplasm of Scapula and Long Bones of Upper Limb N Tuberculosis of Skin and Subcutaneous Cellular Tissue, Tubercle Bacilli Not Found by 01705 Bacteriological Examination, but Tuberculosis Confirmed Histologically N 1705 Malignant Neoplasm of Short Bones of Upper Limb N Tuberculosis of Skin and Subcutaneous Cellular Tissue, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other 01706 Methods [Inoculation of Animals] N 1706 Malignant Neoplasm of Pelvic Bones, Sacrum, and Coccyx N 1707 Malignant Neoplasm of Long Bones of Lower Limb N 1708 Malignant Neoplasm of Short Bones of Lower Limb N 1709 Malignant Neoplasm of Bone and Articular Cartilage, Site Unspecified N Erythema Nodosum With Hypersensitivity Reaction in Tuberculosis, Confirmation 01710 Unspecified N 1710 Malignant Neoplasm of Connective and Other Soft Tissue of Head, Face, and Neck N Erythema Nodosum With Hypersensitivity Reaction in Tuberculosis, Bacteriological or 01711 Histological Examination Not Done N Erythema Nodosum With Hypersensitivity Reaction in Tuberculosis, Bacteriological or 01712 Histological Examination Unknown (at Present) N Malignant Neoplasm of Connective and Other Soft Tissue of Upper Limb, Including 1712 Shoulder N Erythema Nodosum With Hypersensitivity Reaction in Tuberculosis, Tubercle Bacilli 01713 Found (in Sputum) by Microscopy N

1713 Malignant Neoplasm of Connective and Other Soft Tissue of Lower Limb, Including Hip N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 33 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Erythema Nodosum With Hypersensitivity Reaction in Tuberculosis, Tubercle Bacilli Not 01714 Found (in Sputum) by Microscopy, but Found by Bacterial Culture N 1714 Malignant Neoplasm of Connective and Other Soft Tissue of Thorax N Erythema Nodosum With Hypersensitivity Reaction in Tuberculosis, Tubercle Bacilli Not 01715 Found by Bacteriological Examination, but Tuberculosis Confirmed Histologically N 1715 Malignant Neoplasm of Connective and Other Soft Tissue of Abdomen N Erythema Nodosum With Hypersensitivity Reaction in Tuberculosis, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by 01716 Other Methods [Inoculation of Animals] N 1716 Malignant Neoplasm of Connective and Other Soft Tissue of Pelvis N 1717 Malignant Neoplasm of Connective and Other Soft Tissue of Trunk, Unspecified Site N 1718 Malignant Neoplasm of Other Specified Sites of Connective and Other Soft Tissue N 1719 Malignant Neoplasm of Connective and Other Soft Tissue, Site Unspecified N 01720 Tuberculosis of Peripheral Lymph Nodes, Confirmation Unspecified N 1720 Malignant Melanoma of Skin of Lip N Tuberculosis of Peripheral Lymph Nodes, Bacteriological or Histological Examination Not 01721 Done N 1721 Malignant Melanoma of Skin of Eyelid, Including Canthus N Tuberculosis of Peripheral Lymph Nodes, Bacteriological or Histological Examination 01722 Unknown (at Present) N 1722 Malignant Melanoma of Skin of Ear and External Auditory Canal N Tuberculosis of Peripheral Lymph Nodes, Tubercle Bacilli Found (in Sputum) by 01723 Microscopy N 1723 Malignant Melanoma of Skin of Other and Unspecified Parts of Face N Tuberculosis of Peripheral Lymph Nodes, Tubercle Bacilli Not Found (in Sputum) by 01724 Microscopy, but Found by Bacterial Culture N 1724 Malignant Melanoma of Skin of Scalp and Neck N Tuberculosis of Peripheral Lymph Nodes, Tubercle Bacilli Not Found by Bacteriological 01725 Examination, but Tuberculosis Confirmed Histologically N 1725 Malignant Melanoma of Skin of Trunk, Except Scrotum N Tuberculosis of Peripheral Lymph Nodes, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation 01726 of Animals] N 1726 Malignant Melanoma of Skin of Upper Limb, Including Shoulder N 1727 Malignant Melanoma of Skin of Lower Limb, Including Hip N 1728 Malignant Melanoma of Other Specified Sites of Skin N 1729 Melanoma of Skin, Site Unspecified N 01730 Tuberculosis of Eye, Confirmation Unspecified N 1730 Other Malignant Neoplasm of Skin of Lip N 01731 Tuberculosis of Eye, Bacteriological or Histological Examination Not Done N 1731 Other Malignant Neoplasm of Skin of Eyelid, Including Canthus N 01732 Tuberculosis of Eye, Bacteriological or Histological Examination Unknown (at Present) N 1732 Other Malignant Neoplasm of Skin of Ear and External Auditory Canal N 01733 Tuberculosis of Eye, Tubercle Bacilli Found (in Sputum) by Microscopy N 1733 Other Malignant Neoplasm of Skin of Other and Unspecified Parts of Face N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 34 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Tuberculosis of Eye, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but Found 01734 by Bacterial Culture N 1734 Other Malignant Neoplasm of Scalp and Skin of Neck N Tuberculosis of Eye, Tubercle Bacilli Not Found by Bacteriological Examination, but 01735 Tuberculosis Confirmed Histologically N 1735 Other Malignant Neoplasm of Skin of Trunk, Except Scrotum N Tuberculosis of Eye, Tubercle Bacilli Not Found by Bacteriological or Histological 01736 Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] N 1736 Other Malignant Neoplasm of Skin of Upper Limb, Including Shoulder N 1737 Other Malignant Neoplasm of Skin of Lower Limb, Including Hip N 1738 Other Malignant Neoplasm of Other Specified Sites of Skin N 1739 Other Malignant Neoplasm of Skin, Site Unspecified N 01740 Tuberculosis of Ear, Confirmation Unspecified N 1740 Malignant Neoplasm of Nipple and Areola of Female Breast N 01741 Tuberculosis of Ear, Bacteriological or Histological Examination Not Done N 1741 Malignant Neoplasm of Central Portion of Female Breast N 01742 Tuberculosis of Ear, Bacteriological or Histological Examination Unknown (at Present) N 1742 Malignant Neoplasm of Upper-Inner Quadrant of Female Breast N 01743 Tuberculosis of Ear, Tubercle Bacilli Found (in Sputum) by Microscopy N 1743 Malignant Neoplasm of Lower-Inner Quadrant of Female Breast N Tuberculosis of Ear, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but Found 01744 by Bacterial Culture N 1744 Malignant Neoplasm of Upper-Outer Quadrant of Female Breast N Tuberculosis of Ear, Tubercle Bacilli Not Found by Bacteriological Examination, but 01745 Tuberculosis Confirmed Histologically N 1745 Malignant Neoplasm of Lower-Outer Quadrant of Female Breast N Tuberculosis of Ear, Tubercle Bacilli Not Found by Bacteriological or Histological 01746 Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] N 1746 Malignant Neoplasm of Axillary Tail of Female Breast N 1748 Malignant Neoplasm of Other Specified Sites of Female Breast N 1749 Malignant Neoplasm of Breast (Female), Unspecified Site N 01750 Tuberculosis of Thyroid Gland, Confirmation Unspecified N 1750 Malignant Neoplasm of Nipple and Areola of Male Breast N 01751 Tuberculosis of Thyroid Gland, Bacteriological or Histological Examination Not Done N Tuberculosis of Thyroid Gland, Bacteriological or Histological Examination Unknown (at 01752 Present) N 01753 Tuberculosis of Thyroid Gland, Tubercle Bacilli Found (in Sputum) by Microscopy N Tuberculosis of Thyroid Gland, Tubercle Bacilli Not Found (in Sputum) by Microscopy, 01754 but Found by Bacterial Culture N Tuberculosis of Thyroid Gland, Tubercle Bacilli Not Found by Bacteriological 01755 Examination, but Tuberculosis Confirmed Histologically N Tuberculosis of Thyroid Gland, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01756 Animals] N 1759 Malignant Neoplasm of Other and Unspecified Sites of Male Breast N 01760 Tuberculosis of Adrenal Glands, Confirmation Unspecified N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 35 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 1760 Kaposi's Sarcoma of Skin N 01761 Tuberculosis of Adrenal Glands, Bacteriological or Histological Examination Not Done N 1761 Kaposi's Sarcoma of Soft Tissue N Tuberculosis of Adrenal Glands, Bacteriological or Histological Examination Unknown (at 01762 Present) N 1762 Kaposi's Sarcoma of Palate N 01763 Tuberculosis of Adrenal Glands, Tubercle Bacilli Found (in Sputum) by Microscopy N 1763 Kaposi's Sarcoma of Gastrointestinal Sites N Tuberculosis of Adrenal Glands, Tubercle Bacilli Not Found (in Sputum) by Microscopy, 01764 but Found by Bacterial Culture N 1764 Kaposi's Sarcoma of Lung N Tuberculosis of Adrenal Glands, Tubercle Bacilli Not Found by Bacteriological 01765 Examination, but Tuberculosis Confirmed Histologically N 1765 Kaposi's Sarcoma of Lymph Nodes N Tuberculosis of Adrenal Glands, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01766 Animals] N 1768 Kaposi's Sarcoma of Other Specified Sites N 1769 Kaposi's Sarcoma of Unspecified Site N 01770 Tuberculosis of Spleen, Confirmation Unspecified N 01771 Tuberculosis of Spleen, Bacteriological or Histological Examination Not Done N Tuberculosis of Spleen, Bacteriological or Histological Examination Unknown 01772 (at Present) N 01773 Tuberculosis of Spleen, Tubercle Bacilli Found (in Sputum) by Microscopy N Tuberculosis of Spleen, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but 01774 Found by Bacterial Culture N Tuberculosis of Spleen, Tubercle Bacilli Not Found by Bacteriological Examination, but 01775 Tuberculosis Confirmed Histologically N Tuberculosis of Spleen, Tubercle Bacilli Not Found by Bacteriological or Histological 01776 Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] N 01780 Tuberculosis of Esophagus, Confirmation Unspecified N 01781 Tuberculosis of Esophagus, Bacteriological or Histological Examination Not Done N Tuberculosis of Esophagus, Bacteriological or Histological Examination Unknown 01782 (at Present) N 01783 Tuberculosis of Esophagus, Tubercle Bacilli Found (in Sputum) by Microscopy N Tuberculosis of Esophagus, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but 01784 Found by Bacterial Culture N Tuberculosis of Esophagus, Tubercle Bacilli Not Found by Bacteriological Examination, 01785 but Tuberculosis Confirmed Histologically N

Tuberculosis of Esophagus, Tubercle Bacilli Not Found by Bacteriological or Histological 01786 Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] N 01790 Tuberculosis of Other Specified Organs, Confirmation Unspecified N Tuberculosis of Other Specified Organs, Bacteriological or Histological Examination Not 01791 Done N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 36 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Tuberculosis of Other Specified Organs, Bacteriological or Histological Examination 01792 Unknown (at Present) N Tuberculosis of Other Specified Organs, Tubercle Bacilli Found (in Sputum) by 01793 Microscopy N Tuberculosis of Other Specified Organs, Tubercle Bacilli Not Found (in Sputum) by 01794 Microscopy, But Found by Bacterial Culture N Tuberculosis of Other Specified Organs, Tubercle Bacilli Not Found by Bacteriological 01795 Examination, but Tuberculosis Confirmed Histologically N Tuberculosis of Other Specified Organs, Tubercle Bacilli Not Found by Bacteriological or Histological Examination but Tuberculosis Confirmed by Other Methods [Inoculation of 01796 Animals] N 01800 Acute Miliary Tuberculosis, Unspecified N 1800 Malignant Neoplasm of Endocervix N 01801 Acute Miliary Tuberculosis, Bacteriological or Histological Examination Not Done N 1801 Malignant Neoplasm of Exocervix N Acute Miliary Tuberculosis, Bacteriological or Histological Examination Unknown 01802 (at Present) N 01803 Acute Miliary Tuberculosis, Tubercle Bacilli Found (in Sputum) by Microscopy N Acute Miliary Tuberculosis, Tubercle Bacilli Not Found (in Sputum) by Microscopy, but 01804 Found by Bacterial Culture N Acute Miliary Tuberculosis, Tubercle Bacilli Not Found by Bacteriological Examination, 01805 but Tuberculosis Confirmed Histologically N

Acute Miliary Tuberculosis, Tubercle Bacilli Not Found by Bacteriological or Histological 01806 Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of Animals] N 1808 Malignant Neoplasm of Other Specified Sites of Cervix N 1809 Malignant Neoplasm of Cervix Uteri, Unspecified Site N 1820 Malignant Neoplasm of Corpus Uteri, Except Isthmus N 1821 Malignant Neoplasm of Isthmus N 1828 Malignant Neoplasm of Other Specified Sites of Body of Uterus N 1830 Malignant Neoplasm of Ovary N 1832 Malignant Neoplasm of Fallopian Tube N 1833 Malignant Neoplasm of Broad Ligament of Uterus N 1834 Malignant Neoplasm of Parametrium of Uterus N 1835 Malignant Neoplasm of Round Ligament of Uterus N 1838 Malignant Neoplasm of Other Specified Sites of Uterine Adnexa N 1839 Malignant Neoplasm of Uterine Adnexa, Unspecified Site N 1840 Malignant Neoplasm of Vagina N 1841 Malignant Neoplasm of Labia Majora N 1842 Malignant Neoplasm of Labia Minora N 1843 Malignant Neoplasm of Clitoris N 1844 Malignant Neoplasm of Vulva, Unspecified Site N 1848 Malignant Neoplasm of Other Specified Sites of Female Genital Organs N 1849 Malignant Neoplasm of Female Genital Organ, Site Unspecified N 1860 Malignant Neoplasm of Undescended Testis N 1869 Malignant Neoplasm of Other and Unspecified Testis N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 37 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 1871 Malignant Neoplasm of Prepuce N 1872 Malignant Neoplasm of Glans Penis N 1873 Malignant Neoplasm of Body of Penis N 1874 Malignant Neoplasm of Penis, Part Unspecified N 1875 Malignant Neoplasm of Epididymis N 1876 Malignant Neoplasm of Spermatic Cord N 1877 Malignant Neoplasm of Scrotum N 1878 Malignant Neoplasm of Other Specified Sites of Male Genital Organs N 1879 Malignant Neoplasm of Male Genital Organ, Site Unspecified N 01880 Other Specified Miliary Tuberculosis, Confirmation Unspecified N 1880 Malignant Neoplasm of Trigone of Urinary Bladder N Other Specified Miliary Tuberculosis, Bacteriological or Histological Examination Not 01881 Done N 1881 Malignant Neoplasm of Dome of Urinary Bladder N Other Specified Miliary Tuberculosis, Bacteriological or Histological Examination 01882 Unknown (at Present) N 1882 Malignant Neoplasm of Lateral Wall of Urinary Bladder N

01883 Other Specified Miliary Tuberculosis, Tubercle Bacilli Found (in Sputum) by Microscopy N 1883 Malignant Neoplasm of Anterior Wall of Urinary Bladder N Other Specified Miliary Tuberculosis, Tubercle Bacilli Not Found (in Sputum) by 01884 Microscopy, but Found by Bacterial Culture N 1884 Malignant Neoplasm of Posterior Wall of Urinary Bladder N Other Specified Miliary Tuberculosis, Tubercle Bacilli Not Found by Bacteriological 01885 Examination, but Tuberculosis Confirmed Histologically N 1885 Malignant Neoplasm of Bladder Neck N Other Specified Miliary Tuberculosis, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01886 Animals] N 1886 Malignant Neoplasm of Ureteric Orifice N 1887 Malignant Neoplasm of Urachus N 1888 Malignant Neoplasm of Other Specified Sites of Bladder N 1889 Malignant Neoplasm of Bladder, Part Unspecified N 01890 Unspecified Miliary Tuberculosis, Unspecified N 1890 Malignant Neoplasm of Kidney, Except Pelvis N

01891 Unspecified Miliary Tuberculosis, Bacteriological or Histological Examination Not Done N 1891 Malignant Neoplasm of Renal Pelvis N Unspecified Miliary Tuberculosis, Bacteriological or Histological Examination Unknown 01892 (at Present) N 1892 Malignant Neoplasm of Ureter N 01893 Unspecified Miliary Tuberculosis, Tubercle Bacilli Found (in Sputum) by Microscopy N 1893 Malignant Neoplasm of Urethra N Unspecified Miliary Tuberculosis, Tubercle Bacilli Not Found (in Sputum) by 01894 Microscopy, but Found by Bacterial Culture N 1894 Malignant Neoplasm of Paraurethral Glands N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 38 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Unspecified Miliary Tuberculosis, Tubercle Bacilli Not Found by Bacteriological 01895 Examination, but Tuberculosis Confirmed Histologically N Unspecified Miliary Tuberculosis, Tubercle Bacilli Not Found by Bacteriological or Histological Examination, but Tuberculosis Confirmed by Other Methods [Inoculation of 01896 Animals] N 1898 Malignant Neoplasm of Other Specified Sites of Urinary Organs N 1899 Malignant Neoplasm of Urinary Organ, Site Unspecified N 1900 Malignant Neoplasm of Eyeball, Except Conjunctiva, Cornea, Retina, and Choroid N 1901 Malignant Neoplasm of Orbit N 1902 Malignant Neoplasm of Lacrimal Gland N 1903 Malignant Neoplasm of Conjunctiva N 1904 Malignant Neoplasm of Cornea N 1905 Malignant Neoplasm of Retina N 1906 Malignant Neoplasm of Choroid N 1907 Malignant Neoplasm of Lacrimal Duct N 1908 Malignant Neoplasm of Other Specified Sites of Eye N 1909 Malignant Neoplasm of Eye, Part Unspecified N 1910 Malignant Neoplasm of Cerebrum, Except Lobes and Ventricles N 1911 Malignant Neoplasm of Frontal Lobe of Brain N 1912 Malignant Neoplasm of Temporal Lobe of Brain N 1913 Malignant Neoplasm of Parietal Lobe of Brain N 1914 Malignant Neoplasm of Occipital Lobe of Brain N 1915 Malignant Neoplasm of Ventricles of Brain N 1916 Malignant Neoplasm of Cerebellum Nos N 1917 Malignant Neoplasm of Brain Stem N 1918 Malignant Neoplasm of Other Parts of Brain N 1919 Malignant Neoplasm of Brain, Unspecified Site N 1920 Malignant Neoplasm of Cranial Nerves N 1921 Malignant Neoplasm of Cerebral Meninges N 1922 Malignant Neoplasm of Spinal Cord N 1923 Malignant Neoplasm of Spinal Meninges N 1928 Malignant Neoplasm of Other Specified Sites of Nervous System N 1929 Malignant Neoplasm of Nervous System, Part Unspecified N 1940 Malignant Neoplasm of Adrenal Gland N 1941 Malignant Neoplasm of Parathyroid Gland N 1943 Malignant Neoplasm of Pituitary Gland and Craniopharyngeal Duct N 1944 Malignant Neoplasm of Pineal Gland N 1945 Malignant Neoplasm of Carotid Body N 1946 Malignant Neoplasm of Aortic Body and Other Paraganglia N 1948 Malignant Neoplasm of Other Endocrine Glands and Related Structures N 1949 Malignant Neoplasm of Endocrine Gland, Site Unspecified N 1950 Malignant Neoplasm of Head, Face, and Neck N 1951 Malignant Neoplasm of Thorax N 1952 Malignant Neoplasm of Abdomen N 1953 Malignant Neoplasm of Pelvis N 1954 Malignant Neoplasm of Upper Limb N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 39 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 1955 Malignant Neoplasm of Lower Limb N 1958 Malignant Neoplasm of Other Specified Sites N Secondary and Unspecified Malignant Neoplasm of Lymph Nodes of Head, Face, and 1960 Neck N 1961 Secondary and Unspecified Malignant Neoplasm of Intrathoracic Lymph Nodes N 1962 Secondary and Unspecified Malignant Neoplasm of Intra-Abdominal Lymph Nodes N Secondary and Unspecified Malignant Neoplasm of Lymph Nodes of Axilla and Upper 1963 Limb N Secondary and Unspecified Malignant Neoplasm of Lymph Nodes of Inguinal Region and 1965 Lower Limb N 1966 Secondary and Unspecified Malignant Neoplasm of Intrapelvic Lymph Nodes N 1968 Secondary and Unspecified Malignant Neoplasm of Lymph Nodes of Multiple Sites N 1969 Secondary and Unspecified Malignant Neoplasm of Lymph Nodes, Site Unspecified N 1970 Secondary Malignant Neoplasm of Lung N 1971 Secondary Malignant Neoplasm of Mediastinum N 1972 Secondary Malignant Neoplasm of Pleura N 1973 Secondary Malignant Neoplasm of Other Respiratory Organs N 1974 Secondary Malignant Neoplasm of Small Intestine Including Duodenum N 1975 Secondary Malignant Neoplasm of Large Intestine and Rectum N 1976 Secondary Malignant Neoplasm of Retroperitoneum and Peritoneum N 1977 Secondary Malignant Neoplasm of Liver N 1978 Secondary Malignant Neoplasm of Other Digestive Organs and Spleen N 1980 Secondary Malignant Neoplasm of Kidney N 1981 Secondary Malignant Neoplasm of Other Urinary Organs N 1982 Secondary Malignant Neoplasm of Skin N 1983 Secondary Malignant Neoplasm of Brain and Spinal Cord N 1984 Secondary Malignant Neoplasm of Other Parts of Nervous System N 1985 Secondary Malignant Neoplasm of Bone and Bone Marrow N 1986 Secondary Malignant Neoplasm of Ovary N 1987 Secondary Malignant Neoplasm of Adrenal Gland N 1988 Secondary Malignant Neoplasm of Other Specified Sites N 1990 Disseminated Malignant Neoplasm N 1991 Other Malignant Neoplasm of Unspecified Site N 2100 Benign Neoplasm of Lip N 2101 Benign Neoplasm of Tongue N 2102 Benign Neoplasm of Major Salivary Glands N 2103 Benign Neoplasm of Floor of Mouth N 2104 Benign Neoplasm of Other and Unspecified Parts of Mouth N 2105 Benign Neoplasm of Tonsil N 2106 Benign Neoplasm of Other Parts of Oropharynx N 2107 Benign Neoplasm of Nasopharynx N 2108 Benign Neoplasm of Hypopharynx N 2109 Benign Neoplasm of Pharynx, Unspecified N 2110 Benign Neoplasm of Esophagus N 2111 Benign Neoplasm of Stomach N 2112 Benign Neoplasm of Duodenum, Jejunum, and Ileum N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 40 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 2113 Benign Neoplasm of Colon N 2114 Benign Neoplasm of Rectum and Anal Canal N 2115 Benign Neoplasm of Liver and Biliary Passages N 2116 Benign Neoplasm of Pancreas, Except Islets of Langerhans N 2117 Benign Neoplasm of Islets of Langerhans N 2118 Benign Neoplasm of Retroperitoneum and Peritoneum N 2119 Benign Neoplasm of Other and Unspecified Site of the Digestive System N 2120 Benign Neoplasm of Nasal Cavities, Middle Ear, and Accessory Sinuses N 2121 Benign Neoplasm of Larynx N 2122 Benign Neoplasm of Trachea N 2123 Benign Neoplasm of Bronchus and Lung N 2124 Benign Neoplasm of Pleura N 2125 Benign Neoplasm of Mediastinum N 2126 Benign Neoplasm of Thymus N 2127 Benign Neoplasm of Heart N 2128 Benign Neoplasm of Other Specified Sites of Respiratory and Intrathoracic Organs N 2129 Benign Neoplasm of Respiratory and Intrathoracic Organs, Site Unspecified N 2130 Benign Neoplasm of Bones of Skull and Face N 2131 Benign Neoplasm of Lower Jaw Bone N 2132 Benign Neoplasm of Vertebral Column, Excluding Sacrum and Coccyx N 2133 Benign Neoplasm of Ribs, Sternum, and Clavicle N 2134 Benign Neoplasm of Scapula and Long Bones of Upper Limb N 2135 Benign Neoplasm of Short Bones of Upper Limb N 2136 Benign Neoplasm of Pelvic Bones, Sacrum, and Coccyx N 2137 Benign Neoplasm of Long Bones of Lower Limb N 2138 Benign Neoplasm of Short Bones of Lower Limb N 2139 Benign Neoplasm of Bone and Articular Cartilage, Site Unspecified N 2140 Lipoma of Skin and Subcutaneous Tissue of Face N 2141 Lipoma of Other Skin and Subcutaneous Tissue N 2142 Lipoma of Intrathoracic Organs N 2143 Lipoma of Intra-Abdominal Organs N 2144 Lipoma of Spermatic Cord N 2148 Lipoma of Other Specified Sites N 2149 Lipoma of Unspecified Site N 2150 Other Benign Neoplasm of Connective and Other Soft Tissue of Head, Face, and Neck N Other Benign Neoplasm of Connective and Other Soft Tissue of Upper Limb, Including 2152 Shoulder N Other Benign Neoplasm of Connective and Other Soft Tissue of Lower Limb, Including 2153 Hip N 2154 Other Benign Neoplasm of Connective and Other Soft Tissue of Thorax N 2155 Other Benign Neoplasm of Connective and Other Soft Tissue of Abdomen N 2156 Other Benign Neoplasm of Connective and Other Soft Tissue of Pelvis N 2157 Other Benign Neoplasm of Connective and Other Soft Tissue of Trunk, Unspecified N 2158 Other Benign Neoplasm of Connective and Other Soft Tissue of Other Specified Sites N 2159 Other Benign Neoplasm of Connective and Other Soft Tissue of Unspecified Site N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 41 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 2160 Benign Neoplasm of Skin of Lip N 2161 Benign Neoplasm of Eyelid, Including Canthus N 2162 Benign Neoplasm of Ear and External Auditory Canal N 2163 Benign Neoplasm of Skin of Other and Unspecified Parts of Face N 2164 Benign Neoplasm of Scalp and Skin of Neck N 2165 Benign Neoplasm of Skin of Trunk, Except Scrotum N 2166 Benign Neoplasm of Skin of Upper Limb, Including Shoulder N 2167 Benign Neoplasm of Skin of Lower Limb, Including Hip N 2168 Benign Neoplasm of Other Specified Sites of Skin N 2169 Benign Neoplasm of Skin, Site Unspecified N 2180 Submucous Leiomyoma of Uterus N 2181 Intramural Leiomyoma of Uterus N 2182 Subserous Leiomyoma of Uterus N 2189 Leiomyoma of Uterus, Unspecified N 2190 Benign Neoplasm of Cervix Uteri N 2191 Benign Neoplasm of Corpus Uteri N 2198 Benign Neoplasm of Other Specified Parts of Uterus N 2199 Benign Neoplasm of Uterus, Part Unspecified N 2210 Benign Neoplasm of Fallopian Tube and Uterine Ligaments N 2211 Benign Neoplasm of Vagina N 2212 Benign Neoplasm of Vulva N 2218 Benign Neoplasm of Other Specified Sites of Female Genital Organs N 2219 Benign Neoplasm of Female Genital Organ, Site Unspecified N 2220 Benign Neoplasm of Testis N 2221 Benign Neoplasm of Penis N 2222 Benign Neoplasm of Prostate N 2223 Benign Neoplasm of Epididymis N 2224 Benign Neoplasm of Scrotum N 2228 Benign Neoplasm of Other Specified Sites of Male Genital Organs N 2229 Benign Neoplasm of Male Genital Organ, Site Unspecified N 2230 Benign Neoplasm of Kidney, Except Pelvis N 2231 Benign Neoplasm of Renal Pelvis N 2232 Benign Neoplasm of Ureter N 2233 Benign Neoplasm of Bladder N 2238 Benign Neoplasm of Other Specified Sites of Urinary Organs N 2239 Benign Neoplasm of Urinary Organ, Site Unspecified N 2240 Benign Neoplasm of Eyeball, Except Conjunctiva, Cornea, Retina, and Choroid N 2241 Benign Neoplasm of Orbit N 2242 Benign Neoplasm of Lacrimal Gland N 2243 Benign Neoplasm of Conjunctiva N 2244 Benign Neoplasm of Cornea N 2245 Benign Neoplasm of Retina N 2246 Benign Neoplasm of Choroid N 2247 Benign Neoplasm of Lacrimal Duct N 2248 Benign Neoplasm of Other Specified Parts of Eye N 2249 Benign Neoplasm of Eye, Part Unspecified N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 42 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 2250 Benign Neoplasm of Brain N 2251 Benign Neoplasm of Cranial Nerves N 2252 Benign Neoplasm of Cerebral Meninges N 2253 Benign Neoplasm of Spinal Cord N 2254 Benign Neoplasm of Spinal Meninges N 2258 Benign Neoplasm of Other Specified Sites of Nervous System N 2259 Benign Neoplasm of Nervous System, Part Unspecified N 2270 Benign Neoplasm of Adrenal Gland N 2271 Benign Neoplasm of Parathyroid Gland N 2273 Benign Neoplasm of Pituitary Gland and Craniopharyngeal Duct (Pouch) N 2274 Benign Neoplasm of Pineal Gland N 2275 Benign Neoplasm of Carotid Body N 2276 Benign Neoplasm of Aortic Body and Other Paraganglia N 2278 Benign Neoplasm of Other Endocrine Glands and Related Structures N 2279 Benign Neoplasm of Endocrine Gland, Site Unspecified N 2281 Lymphangioma, any Site N 2290 Benign Neoplasm of Lymph Nodes N 2298 Benign Neoplasm of Other Specified Sites N 2299 Benign Neoplasm of Unspecified Site N 2300 Carcinoma in Situ of Lip, Oral Cavity, and Pharynx N 2301 Carcinoma in Situ of Esophagus N 2302 Carcinoma in Situ of Stomach N 2303 Carcinoma in Situ of Colon N 2304 Carcinoma in Situ of Rectum N 2305 Carcinoma in Situ of Anal Canal N 2306 Carcinoma in Situ of Anus, Unspecified N 2307 Carcinoma in Situ of Other and Unspecified Parts of Intestine N 2308 Carcinoma in Situ of Liver and Biliary System N 2309 Carcinoma in Situ of Other and Unspecified Digestive Organs N 2310 Carcinoma in Situ of Larynx N 2311 Carcinoma in Situ of Trachea N 2312 Carcinoma in Situ of Bronchus and Lung N 2318 Carcinoma in Situ of Other Specified Parts of Respiratory System N 2319 Carcinoma in Situ of Respiratory System, Part Unspecified N 2320 Carcinoma in Situ of Skin of Lip N 2321 Carcinoma in Situ of Eyelid, Including Canthus N 2322 Carcinoma in Situ of Skin of Ear and External Auditory Canal N 2323 Carcinoma in Situ of Skin of Other and Unspecified Parts of Face N 2324 Carcinoma in Situ of Scalp and Skin of Neck N 2325 Carcinoma in Situ of Skin of Trunk, Except Scrotum N 2326 Carcinoma in Situ of Skin of Upper Limb, Including Shoulder N 2327 Carcinoma in Situ of Skin of Lower Limb, Including Hip N 2328 Carcinoma in Situ of Other Specified Sites of Skin N 2329 Carcinoma in Situ of Skin, Site Unspecified N 2330 Carcinoma in Situ of Breast N 2331 Carcinoma in Situ of Cervix Uteri N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 43 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 2332 Carcinoma in Situ of Other and Unspecified Parts of Uterus N 2333 Carcinoma in Situ of Other and Unspecified Female Genital Organs N 2334 Carcinoma in Situ of Prostate N 2335 Carcinoma in Situ of Penis N 2336 Carcinoma in Situ of Other and Unspecified Male Genital Organs N 2337 Carcinoma in Situ of Bladder N 2339 Carcinoma in Situ of Other and Unspecified Urinary Organs N 2340 Carcinoma in Situ of Eye N 2348 Carcinoma in Situ of Other Specified Sites N 2349 Carcinoma in Situ, Site Unspecified N 2350 Neoplasm of Uncertain Behavior of Major Salivary Glands N 2351 Neoplasm of Uncertain Behavior of Lip, Oral Cavity, and Pharynx N 2352 Neoplasm of Uncertain Behavior of Stomach, Intestines, and Rectum N 2353 Neoplasm of Uncertain Behavior of Liver and Biliary Passages N 2354 Neoplasm of Uncertain Behavior of Retroperitoneum and Peritoneum N 2355 Neoplasm of Uncertain Behavior of Other and Unspecified Digestive Organs N 2356 Neoplasm of Uncertain Behavior of Larynx N 2357 Neoplasm of Uncertain Behavior of Trachea, Bronchus, and Lung N 2358 Neoplasm of Uncertain Behavior of Pleura, Thymus, and Mediastinum N 2359 Neoplasm of Uncertain Behavior of Other and Unspecified Respiratory Organs N 2360 Neoplasm of Uncertain Behavior of Uterus N 2361 Neoplasm of Uncertain Behavior of Placenta N 2362 Neoplasm of Uncertain Behavior of Ovary N 2363 Neoplasm of Uncertain Behavior of Other and Unspecified Female Genital Organs N 2364 Neoplasm of Uncertain Behavior of Testis N 2365 Neoplasm of Uncertain Behavior of Prostate N 2366 Neoplasm of Uncertain Behavior of Other and Unspecified Male Genital Organs N 2367 Neoplasm of Uncertain Behavior of Bladder N 2370 Neoplasm of Uncertain Behavior of Pituitary Gland and Craniopharyngeal Duct N 2371 Neoplasm of Uncertain Behavior of Pineal Gland N 2372 Neoplasm of Uncertain Behavior of Adrenal Gland N 2373 Neoplasm of Uncertain Behavior of Paraganglia N 2374 Neoplasm of Uncertain Behavior of Other and Unspecified Endocrine Glands N 2375 Neoplasm of Uncertain Behavior of Brain and Spinal Cord N 2376 Neoplasm of Uncertain Behavior of Meninges N 2379 Neoplasm of Uncertain Behavior of Other and Unspecified Parts of Nervous System N 2380 Neoplasm of Uncertain Behavior of Bone and Articular Cartilage N 2381 Neoplasm of Uncertain Behavior of Connective and Other Soft Tissue N 2382 Neoplasm of Uncertain Behavior of Skin N 2383 Neoplasm of Uncertain Behavior of Breast N 2384 Neoplasm of Uncertain Behavior of Polycythemia Vera N 2385 Neoplasm of Uncertain Behavior of Histiocytic and Mast Cells N 2386 Neoplasm of Uncertain Behavior of Plasma Cells N 2387 Neoplasm of Uncertain Behavior of Other Lymphatic and Hematopoietic Tissues N 2388 Neoplasm of Uncertain Behavior of Other Specified Sites N 2389 Neoplasm of Uncertain Behavior, Site Unspecified N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 44 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 2390 Neoplasm of Unspecified Nature of Digestive System N 2391 Neoplasm of Unspecified Nature of Respiratory System N 2392 Neoplasm of Unspecified Nature of Bone, Soft Tissue, and Skin N 2393 Neoplasm of Unspecified Nature of Breast N 2394 Neoplasm of Unspecified Nature of Bladder N 2395 Neoplasm of Unspecified Nature of Other Genitourinary Organs N 2396 Neoplasm of Unspecified Nature of Brain N

2397 Neoplasm of Unspecified Nature of Endocrine Glands and Other Parts of Nervous System N 2398 Neoplasm of Unspecified Nature of Other Specified Sites N 2399 Neoplasm of Unspecified Nature, Site Unspecified N 2400 Goiter, Specified as Simple N 2409 Goiter, Unspecified N 2410 Nontoxic Uninodular Goiter N 2411 Nontoxic Multinodular Goiter N 2419 Unspecified Nontoxic Nodular Goiter N 2440 Postsurgical Hypothyroidism Y 2441 Other Postablative Hypothyroidism Y 2442 Iodine Hypothyroidism Y 2443 Other Iatrogenic Hypothyroidism Y 2448 Other Specified Acquired Hypothyroidism Y 2449 Unspecified Hypothyroidism Y 2450 Acute Thyroiditis Y 2451 Subacute Thyroiditis Y 2452 Chronic Lymphocytic Thyroiditis Y 2453 Chronic Fibrous Thyroiditis Y 2454 Iatrogenic Thyroiditis Y 2458 Other and Unspecified Chronic Thyroiditis Y 2459 Unspecified Thyroiditis Y 2460 Disorders of Thyrocalcitonin Secretion Y 2461 Dyshormonogenic Goiter Y 2462 Cyst of Thyroid Y 2463 Hemorrhage and Infarction of Thyroid Y 2468 Other Specified Disorders of Thyroid N 2469 Unspecified Disorder of Thyroid N 2510 Hypoglycemic Coma Y 2511 Other Specified Hypoglycemia Y 2512 Hypoglycemia, Unspecified Y 2513 Postsurgical Hypoinsulinemia Y 2514 Abnormality of Secretion of Glucagon Y 2515 Abnormality of Secretion of Gastrin Y 2518 Other Specified Disorders of Pancreatic Internal Secretion Y 2519 Unspecified Disorder of Pancreatic Internal Secretion Y 2520 Hyperparathyroidism Y 2521 Hypoparathyroidism Y 2528 Other Specified Disorders of Parathyroid Gland Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 45 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 2529 Unspecified Disorder of Parathyroid Gland Y 2530 Acromegaly and Gigantism Y 2531 Other and Unspecified Anterior Pituitary Hyperfunction Y 2532 Panhypopituitarism Y 2533 Pituitary Dwarfism Y 2534 Other Anterior Pituitary Disorders Y 2535 Diabetes Insipidus S 2536 Other Disorders of Neurohypophysis N 2537 Iatrogenic Pituitary Disorders N

2538 Other Disorders of The Pituitary and Other Syndromes of Diencephalohypophyseal Origin N 2539 Unspecified Disorder of The Pituitary Gland and its Hypothalamic Control N 2540 Persistent Hyperplasia of Thymus N 2541 Abscess of Thymus Y 2548 Other Specified Diseases of Thymus Gland N 2549 Unspecified Disease of Thymus Gland N 2550 Cushing's Syndrome N 2551 Hyperaldosteronism N 2552 Adrenogenital Disorders N 2553 Other Corticoadrenal Overactivity N 2554 Corticoadrenal Insufficiency N 2555 Other Adrenal Hypofunction N 2556 Medulloadrenal Hyperfunction N 2558 Other Specified Disorders of Adrenal Glands N 2559 Unspecified Disorder of Adrenal Glands N 2560 Hyperestrogenism N 2561 Other Ovarian Hyperfunction N 2562 Postablative Ovarian Failure N 2563 Other Ovarian Failure N 2564 Polycystic Ovaries N 2568 Other Ovarian Dysfunction N 2569 Unspecified Ovarian Dysfunction N 2570 Testicular Hyperfunction N 2571 Postablative Testicular Hypofunction N 2572 Other Testicular Hypofunction N 2578 Other Testicular Dysfunction N 2579 Unspecified Testicular Dysfunction N 2580 Polyglandular Activity in Multiple Endocrine Adenomatosis N 2581 Other Combinations of Endocrine Dysfunction N 2588 Other Specified Polyglandular Dysfunction N 2589 Unspecified Polyglandular Dysfunction N 2590 Delay in Sexual Development and Puberty, Not Elsewhere Classified N 2591 Precocious Sexual Development and Puberty, Not Elsewhere Classified N 2592 Carcinoid Syndrome N 2593 Ectopic Hormone Secretion, Not Elsewhere Classified N 2594 Dwarfism, Not Elsewhere Classified N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 46 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 2595 Androgen Insensitivity Syndrome N 2598 Other Specified Endocrine Disorders N 2599 Unspecified Endocrine Disorder N 2630 Malnutrition of Moderate Degree N 2631 Malnutrition of Mild Degree N 2632 Arrested Development Following Protein-Calorie Malnutrition N 2638 Other Protein-Calorie Malnutrition N 2639 Unspecified Protein-Calorie Malnutrition N 2640 Vitamin a Deficiency With Conjunctival Xerosis N 2641 Vitamin a Deficiency With Conjunctival Xerosis and Bitot's Spot N 2642 Vitamin a Deficiency With Corneal Xerosis N 2643 Vitamin a Deficiency With Corneal Ulceration and Xerosis N 2644 Vitamin a Deficiency With Keratomalacia N 2645 Vitamin a Deficiency With Night Blindness N 2646 Vitamin a Deficiency With Xerophthalmic Scars of Cornea N 2647 Other Ocular Manifestations of Vitamin a Deficiency N 2648 Other Manifestations of Vitamin a Deficiency N 2649 Unspecified Vitamin a Deficiency N 2650 Beriberi N 2651 Other and Unspecified Manifestations of Thiamine Deficiency N 2652 Pellagra N 2660 Ariboflavinosis N 2661 Vitamin B6 Deficiency N 2662 Other B-Complex Deficiencies N 2669 Unspecified Vitamin B Deficiency N 2680 Rickets, Active N 2681 Rickets, Late Effect N 2682 Osteomalacia, Unspecified N 2689 Unspecified Vitamin D Deficiency N 2690 Deficiency of Vitamin K N 2691 Deficiency of Other Vitamins N 2692 Unspecified Vitamin Deficiency N 2693 Mineral Deficiency, Not Elsewhere Classified N 2698 Other Nutritional Deficiency N 2699 Unspecified Nutritional Deficiency N 2700 Disturbances of Amino-Acid Transport N 2701 Phenylketonuria (PKU) N 2702 Other Disturbances of Aromatic Amino-Acid Metabolism N 2703 Disturbances of Branched-Chain Amino-Acid Metabolism N 2704 Disturbances of Sulphur-Bearing Amino-Acid Metabolism N 2705 Disturbances of Histidine Metabolism N 2706 Disorders of Urea Cycle Metabolism N 2707 Other Disturbances of Straight-Chain Amino-Acid Metabolism N 2708 Other Specified Disorders of Amino-Acid Metabolism N 2709 Unspecified Disorder of Amino-Acid Metabolism N 2710 Glycogenosis N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 47 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 2711 Galactosemia N 2712 Hereditary Fructose Intolerance N 2713 Intestinal Disaccharidase Deficiencies and Disaccharide Malabsorption N 2714 Renal Glycosuria N 2718 Other Specified Disorders of Carbohydrate Transport and Metabolism N 2719 Unspecified Disorder of Carbohydrate Transport and Metabolism N 2720 Pure Hypercholesterolemia N 2721 Pure Hyperglyceridemia N 2722 Mixed Hyperlipidemia N 2723 Hyperchylomicronemia N 2724 Other and Unspecified Hyperlipidemia N 2725 Lipoprotein Deficiencies N 2726 Lipodystrophy N 2727 Lipidoses N 2728 Other Disorders of Lipoid Metabolism N 2729 Unspecified Disorder of Lipoid Metabolism N 2730 Polyclonal Hypergammaglobulinemia N 2731 Monoclonal Paraproteinemia N 2732 Other Paraproteinemias N 2733 Macroglobulinemia N 2734 Alpha-A-Antitrypsin Deficiency N 2738 Other Disorders of Plasma Protein Metabolism N 2739 Unspecified Disorder of Plasma Protein Metabolism N 2740 Gouty Arthropathy S 2748 Gout With Other Specified Manifestations N 2749 Gout, Unspecified N 2750 Disorders of Iron Metabolism N 2751 Disorders of Copper Metabolism N 2752 Disorders of Magnesium Metabolism N 2753 Disorders of Phosphorus Metabolism N 2754 Disorders of Calcium Metabolism N 2758 Other Specified Disorders of Mineral Metabolism N 2759 Unspecified Disorder of Mineral Metabolism N 2760 Hyperosmolality and/or Hypernatremia Y 2761 Hyposmolality and/or Hyponatremia Y 2762 Acidosis Y 2763 Alkalosis Y 2764 Mixed Acid-Base Balance Disorder Y 2765 Volume Depletion Y 2766 Fluid Overload Y 2767 Hyperpotassemia Y 2768 Hypopotassemia Y 2769 Electrolyte and Fluid Disorders Not Elsewhere Classified Y 2771 Disorders of Porphyrin Metabolism N 2772 Other Disorders of Purine and Pyrimidine Metabolism N 2773 Amyloidosis N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 48 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 2774 Disorders of Bilirubin Excretion N 2775 Mucopolysaccharidosis N 2776 Other Deficiencies of Circulating Enzymes N 2777 Dysmetabolic Syndrome X N 2778 Other Specified Disorders of Metabolism N 2779 Unspecified Disorder of Metabolism N 2781 Localized Adiposity N 2782 Hypervitaminosis A N 2783 Hypercarotinemia N 2784 Hypervitaminosis D N 2788 Other Hyperalimentation N 2792 Combined Immunity Deficiency N 2793 Unspecified Immunity Deficiency N 2794 Autoimmune Disease, Not Elsewhere Classified N 2798 Other Specified Disorders Involving the Immune Mechanism N 2799 Unspecified Disorder of Immune Mechanism N 2800 Iron Deficiency Anemia Secondary to Blood Loss (Chronic) N 2801 Iron Deficiency Anemia Secondary to Inadequate Dietary Iron Intake N 2808 Other Specified Iron Deficiency Anemias N 2809 Unspecified Iron Deficiency Anemia N 2810 Pernicious Anemia N 2811 Other Vitamin B12 Deficiency Anemia N 2812 Folate-Deficiency Anemia N 2813 Other Specified Megaloblastic Anemias Not Elsewhere Classified N 2814 Protein-Deficiency Anemia N 2818 Anemia Associated With Other Specified Nutritional Deficiency N 2819 Unspecified Deficiency Anemia N 2820 Hereditary Spherocytosis Y 2821 Hereditary Elliptocytosis Y 2822 Anemias due to Disorders of Glutathione Metabolism N 2823 Other Hemolytic Anemias due to Enzyme Deficiency N 2824 Thalassemias Y 2825 Sickle-Cell Trait N 2827 Other Hemoglobinopathies N 2828 Other Specified Hereditary Hemolytic Anemias N 2829 Unspecified Hereditary Hemolytic Anemia N 2830 Autoimmune Hemolytic Anemias Y 2832 Hemoglobinuria due to Hemolysis From External Causes Y 2839 Acquired Hemolytic Anemia, Unspecified Y 2840 Constitutional Aplastic Anemia Y 2848 Other Specified Aplastic Anemias Y 2849 Unspecified Aplastic Anemia Y 2850 Sideroblastic Anemia Y 2851 Acute Posthemorrhagic Anemia S 2858 Other Specified Anemias Y 2859 Unspecified Anemia Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 49 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 2860 Congenital Factor VIII Disorder Y 2861 Congenital Factor IX Disorder Y 2862 Congenital Factor XI Deficiency Y 2863 Congenital Deficiency of Other Clotting Factors Y 2864 Von Willebrand's Disease N 2865 Hemorrhagic Disorder due to Intrinsic Circulating Anticoagulants Y 2866 Defibrination Syndrome Y 2867 Acquired Coagulation Factor Deficiency Y 2869 Other and Unspecified Coagulation Defects Y 2870 Allergic Purpura Y 2871 Qualitative Platelet Defects Y 2872 Other Nonthrombocytopenic Purpuras Y 2873 Primary Thrombocytopenia Y 2874 Secondary Thrombocytopenia Y 2875 Unspecified Thrombocytopenia Y 2878 Other Specified Hemorrhagic Conditions Y 2879 Unspecified Hemorrhagic Conditions Y 2880 Agranulocytosis Y 2881 Functional Disorders of Polymorphonuclear Neutrophils Y 2882 Genetic Anomalies of Leukocytes Y 2883 Eosinophilia N 2888 Other Specified Disease of White Blood Cells Y 2889 Unspecified Disease of White Blood Cells N 2890 Polycythemia, Secondary N 2891 Chronic Lymphadenitis N 2892 Nonspecific Mesenteric Lymphadenitis N 2893 Lymphadenitis, Unspecified, Except Mesenteric N 2894 Hypersplenism N 2896 Familial Polycythemia N 2897 Methemoglobinemia N 2898 Other Specified Diseases of Blood and Blood-Forming Organs N 2899 Unspecified Diseases of Blood and Blood-Forming Organs N 2900 Senile Dementia, Uncomplicated N 2903 Senile Dementia With Delirium Y 2908 Other Specified Senile Psychotic Conditions Y 2909 Unspecified Senile Psychotic Condition Y 2910 Alcohol Withdrawal Delirium Y 2911 Alcohol-Induced Persisting Amnestic Disorder Y 2912 Alcohol-Induced Persisting Dementia N 2913 Alcohol-Induced Psychotic Disorder With Hallucinations Y 2914 Idiosyncratic Alcohol Intoxication Y 2915 Alcohol-Induced Psychotic Disorder With Delusions Y 2918 Other Specified Alcoholic Psychosis S 2919 Unspecified Alcohol-Induced Mental Disorders Y 2920 Drug Withdrawal Y 2921 Paranoid and/or Hallucinatory States Induced by Drugs Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 50 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 2922 Pathological Drug Intoxication Y 2928 Other Specified Drug-Induced Mental Disorders Y 2929 Unspecified Drug-Induced Mental Disorder Y 2930 Delirium due to Conditions Classified Elsewhere Y 2931 Subacute Delirium Y 2938 Other Specified Transient Organic Mental Disorders Y 2939 Unspecified Transient Mental Disorder in Conditions Classified Elsewhere Y 2940 Amnestic Disorder in Conditions Classified Elsewhere Y 2941 Dementia in Conditions Classified Elsewhere Y 2948 Other Persistent Mental Disorders due to Conditions Classified Elsewhere Y 2949 Unspecified Persistent Mental Disorders due to Conditions Classified Elsewhere Y 2967 Bipolar I Disorder, Most Recent Episode (or Current) Unspecified N 2970 Paranoid State, Simple Y 2971 Delusional Disorder Y 2972 Paraphrenia Y 2973 Shared Psychotic Disorder Y 2978 Other Specified Paranoid States Y 2979 Unspecified Paranoid State Y 2980 Depressive Type Psychosis Y 2981 Excitative Type Psychosis Y 2982 Reactive Confusion Y 2983 Acute Paranoid Reaction Y 2984 Psychogenic Paranoid Psychosis Y 2988 Other and Unspecified Reactive Psychosis Y 2989 Unspecified Psychosis Y 3003 Obsessive-Compulsive Disorders Y 3004 Dysthymic Disorder Y 3005 Neurasthenia Y 3006 Depersonalization Disorder Y 3007 Hypochondriasis Y 3008 Other Neurotic Disorders Y 3009 Unspecified Nonpsychotic Mental Disorder Y 3010 Paranoid Personality Disorder Y 3013 Explosive Personality Disorder S 3014 Obsessive-Compulsive Personality Disorder S 3016 Dependent Personality Disorder S 3017 Antisocial Personality Disorder S 3018 Other Personality Disorders N 3019 Unspecified Personality Disorder S 3020 Ego-Dystonic Sexual Orientation S 3021 Zoophilia S 3022 Pedophilia S 3023 Transvestic Fetishism S 3024 Exhibitionism S 3026 Gender Identity Disorder in Children S 3028 Other Specified Psychosexual Disorders N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 51 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 3029 Unspecified Psychosexual Disorder S 3051 Nondependent Tobacco Use Disorder S 3060 Musculoskeletal Malfunction Arising From Mental Factors S 3061 Respiratory Malfunction Arising From Mental Factors Y 3062 Cardiovascular Malfunction Arising From Mental Factors Y 3063 Skin Malfunction Arising From Mental Factors N 3064 Gastrointestinal Malfunction Arising From Mental Factors N 3066 Endocrine Malfunction Arising From Mental Factors N 3067 Malfunction of Organs of Special Sense Arising From Mental Factors N 3068 Other Specified Psychophysiological Malfunction N 3069 Unspecified Psychophysiological Malfunction N 3070 Stuttering N 3071 Anorexia Nervosa N 3073 Stereotypic Movement Disorder N 3076 Enuresis N 3077 Encopresis N 3079 Other and Unspecified Special Symptom or Syndrome, Not Elsewhere Classified N 3080 Predominant Disturbance of Emotions N 3081 Predominant Disturbance of Consciousness as Reaction to Stress N 3082 Predominant Psychomotor Disturbance as Reaction to Stress N 3083 Other Acute Reactions to Stress N 3084 Mixed Disorders as Reaction to Stress N 3089 Unspecified Acute Reaction to Stress N 3090 Adjustment Disorder With Depressed Mood N 3091 Prolonged Depressive Reaction as Adjustment Reaction N 3092 Adjustment Reaction With Predominant Disturbance of Other Emotions N 3093 Adjustment Disorder With Disturbance of Conduct N 3094 Adjustment Disorder With Mixed Disturbance of Emotions and Conduct N 3098 Other Specified Adjustment Reactions N 3099 Unspecified Adjustment Reaction N 3100 Frontal Lobe Syndrome Y 3101 Personality Change due to Conditions Classified Elsewhere Y 3102 Postconcussion Syndrome Y 3108 Other Specified Nonpsychotic Mental Disorder Following Organic Brain Damage Y 3109 Unspecified Nonpsychotic Mental Disorder Following Organic Brain Damage Y 3124 Mixed Disturbance of Conduct and Emotions N 3128 Other Specified Disturbances of Conduct, Not Elsewhere Classified N 3129 Unspecified Disturbance of Conduct N 3130 Overanxious Disorder Specific to Childhood and Adolescence N 3131 Misery and Unhappiness Disorder Specific to Childhood and Adolescence N 3132 Sensitivity, Shyness, and Social Withdrawal Disorder Specific to Child N 3133 Relationship Problems Specific to Childhood and Adolescence N 3138 Other or Mixed Emotional Disturbances of Childhood or Adolescence N 3139 Unspecified Emotional Disturbance of Childhood or Adolescence N 3141 Hyperkinesis of Childhood With Developmental Delay N 3142 Hyperkinetic Conduct Disorder of Childhood N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 52 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 3148 Other Specified Manifestations of Hyperkinetic Syndrome of Childhood N 3149 Unspecified Hyperkinetic Syndrome of Childhood N 3151 Mathematics Disorder N 3152 Other Specific Developmental Learning Difficulties N 3153 Developmental Speech or Language Disorder N 3154 Developmental Coordination Disorder N 3155 Mixed Development Disorder N 3158 Other Specified Delay in Development N 3159 Unspecified Delay in Development N 3180 Moderate Mental Retardation N 3181 Severe Mental Retardation N 3182 Profound Mental Retardation N 3200 Hemophilus Meningitis Y 3201 Pneumococcal Meningitis Y 3202 Streptococcal Meningitis Y 3203 Staphylococcal Meningitis Y 3207 Meningitis in Other Bacterial Diseases Classified Elsewhere Y 3209 Meningitis due to Unspecified Bacterium Y 3210 Cryptococcal Meningitis Y 3211 Meningitis in Other Fungal Diseases Y 3212 Meningitis due to Viruses Not Elsewhere Classified Y 3213 Meningitis due to Trypanosomiasis Y 3214 Meningitis in Sarcoidosis Y 3218 Meningitis due to Other Nonbacterial Organisms Classified Elsewhere Y 3220 Nonpyogenic Meningitis Y 3221 Eosinophilic Meningitis Y 3222 Chronic Meningitis Y 3229 Unspecified Meningitis Y 3230 Encephalitis in Viral Diseases Classified Elsewhere Y 3231 Encephalitis in Rickettsial Diseases Classified Elsewhere Y 3232 Encephalitis in Protozoal Diseases Classified Elsewhere Y 3234 Other Encephalitis due to Infection Classified Elsewhere Y 3235 Encephalitis Following Immunization Procedures Y 3236 Postinfectious Encephalitis Y 3237 Toxic Encephalitis Y 3238 Other Causes of Encephalitis Y 3239 Unspecified Cause of Encephalitis Y 3240 Intracranial Abscess Y 3241 Intraspinal Abscess Y 3249 Intracranial and Intraspinal Abscess of Unspecified Site Y 3278 Other Organic Sleep Disorders N 03281 Conjunctival Diphtheria Y 03282 Diphtheritic Myocarditis Y 03283 Diphtheritic Peritonitis Y 03284 Diphtheritic Cystitis Y 03285 Cutaneous Diphtheria Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 53 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 03289 Other Specified Diphtheria Y 3300 Leukodystrophy N 3301 Cerebral Lipidoses N 3302 Cerebral Degeneration in Generalized Lipidoses N 3303 Cerebral Degeneration of Childhood in Other Diseases Classified Elsewhere N 3308 Other Specified Cerebral Degenerations in Childhood N 3309 Unspecified Cerebral Degeneration in Childhood N 3310 Alzheimer's Disease S 3311 Pick's Disease Y 3312 Senile Degeneration of Brain N 3313 Communicating Hydrocephalus Y 3314 Obstructive Hydrocephalus Y 3317 Cerebral Degeneration in Diseases Classified Elsewhere N 3318 Other Cerebral Degeneration N 3319 Unspecified Cerebral Degeneration N 3320 Paralysis Agitans N 3321 Secondary Parkinsonism N 3330 Other Degenerative Diseases of the Basal Ganglia S 3331 Essential and Other Specified Forms of Tremor S 3332 Myoclonus Y 3333 Tics of Organic Origin N 3334 Huntington's Chorea S 3335 Other Choreas S 3336 Idiopathic Torsion Dystonia N 3337 Symptomatic Torsion Dystonia Y 3338 Fragments of Torsion Dystonia N 3340 Friedreich's Ataxia S 3341 Hereditary Spastic Paraplegia S 3342 Primary Cerebellar Degeneration S 3343 Other Cerebellar Ataxia S 3344 Cerebellar Ataxia in Diseases Classified Elsewhere S 3348 Other Spinocerebellar Diseases S 3349 Unspecified Spinocerebellar Disease S 3350 Werdnig-Hoffmann Disease S 3358 Other Anterior Horn Cell Diseases N 3359 Unspecified Anterior Horn Cell Disease N 3360 Syringomyelia and Syringobulbia N 3361 Vascular Myelopathies N 3362 Subacute Combined Degeneration of Spinal Cord in Diseases Classified Elsewhere N 3363 Myelopathy in Other Diseases Classified Elsewhere N 3368 Other Myelopathy N 3369 Unspecified Disease of Spinal Cord N 3370 Idiopathic Peripheral Autonomic Neuropathy N 3371 Peripheral Autonomic Neuropathy in Disorders Classified Elsewhere N 3373 Autonomic Dysreflexia N 3379 Unspecified Disorder of Autonomic Nervous System N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 54 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 3410 Neuromyelitis Optica S 3411 Schilder’s Disease S 3418 Other Demyelinating Diseases of Central Nervous System S 3419 Unspecified Demyelinating Disease of Central Nervous System S 3430 Diplegic Infantile Cerebral Palsy Y 3431 Hemiplegic Infantile Cerebral Palsy Y 3432 Quadriplegic Infantile Cerebral Palsy Y 3433 Monoplegic Infantile Cerebral Palsy Y 3434 Infantile Hemiplegia Y 3438 Other Specified Infantile Cerebral Palsy Y 3439 Unspecified Infantile Cerebral Palsy Y 3441 Paraplegia Y 3442 Diplegia of Upper Limbs Y 3445 Unspecified Monoplegia Y 3449 Unspecified Paralysis Y 3452 Epileptic Petit Mal Status Y 3453 Epileptic Grand Mal Status Y 3480 Cerebral Cysts Y 3481 Anoxic Brain Damage Y 3482 Benign Intracranial Hypertension Y 3483 Encephalopathy, Unspecified Y 3484 Compression of Brain Y 3485 Cerebral Edema Y 3488 Other Conditions of Brain N 3489 Unspecified Condition of Brain N 3490 Reaction to Spinal or Lumbar Puncture N 3491 Nervous System Complications From Surgically Implanted Device N 3492 Disorders of Meninges, Not Elsewhere Classified N 3498 Other Specified Disorders of Nervous System N 3499 Unspecified Disorders of Nervous System N 3501 Trigeminal Neuralgia S 3502 Atypical Face Pain S 3508 Other Specified Trigeminal Nerve Disorders S 3509 Unspecified Trigeminal Nerve Disorder S 3510 Bell's Palsy Y 3511 Geniculate Ganglionitis Y 3518 Other Facial Nerve Disorders Y 3519 Unspecified Facial Nerve Disorder Y 3520 Disorders of Olfactory (1st) Nerve Y 3521 Glossopharyngeal Neuralgia Y 3522 Other Disorders of Glossopharyngeal (9th) Nerve Y 3523 Disorders of Pneumogastric (10th) Nerve Y 3524 Disorders of Accessory (11th) Nerve Y 3525 Disorders of Hypoglossal (12th) Nerve Y 3526 Multiple Cranial Nerve Palsies Y 3529 Unspecified Disorder of Cranial Nerves Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 55 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 3530 Brachial Plexus Lesions Y 3531 Lumbosacral Plexus Lesions Y 3532 Cervical Root Lesions, Not Elsewhere Classified Y 3533 Thoracic Root Lesions, Not Elsewhere Classified Y 3534 Lumbosacral Root Lesions, Not Elsewhere Classified Y 3535 Neuralgic Amyotrophy Y 3536 Phantom Limb (Syndrome) N 3538 Other Nerve Root and Plexus Disorders N 3539 Unspecified Nerve Root and Plexus Disorder N 3540 Carpal Tunnel Syndrome N 3541 Other Lesion of Median Nerve N 3542 Lesion of Ulnar Nerve N 3543 Lesion of Radial Nerve N 3544 Causalgia of Upper Limb N 3545 Mononeuritis Multiplex N 3548 Other Mononeuritis of Upper Limb N 3549 Unspecified Mononeuritis of Upper Limb N 3550 Lesion of Sciatic Nerve N 3551 Meralgia Paresthetica N 3552 Other Lesion of Femoral Nerve N 3553 Lesion of Lateral Popliteal Nerve N 3554 Lesion of Medial Popliteal Nerve N 3555 Tarsal Tunnel Syndrome N 3556 Lesion of Plantar Nerve N 3558 Unspecified Mononeuritis of Lower Limb N 3559 Mononeuritis of Unspecified Site N 3560 Hereditary Peripheral Neuropathy N 3561 Peroneal Muscular Atrophy N 3562 Hereditary Sensory Neuropathy N 3563 Refsum’s Disease N 3564 Idiopathic Progressive Polyneuropathy N 3568 Other Specified Idiopathic Peripheral Neuropathy N 3569 Unspecified Hereditary and Idiopathic Peripheral Neuropathy N 3570 Acute Infective Polyneuritis N 3571 Polyneuropathy in Collagen Vascular Disease N 3572 Polyneuropathy in Diabetes N 3573 Polyneuropathy in Malignant Disease N 3574 Polyneuropathy in Other Diseases Classified Elsewhere N 3575 Alcoholic Polyneuropathy N 3576 Polyneuropathy due to Drugs N 3577 Polyneuropathy due to Other Toxic Agents N 3578 Other Inflammatory and Toxic Neuropathies N 3579 Unspecified Inflammatory and Toxic Neuropathy N 3580 Myasthenia Gravis Y 3581 Myasthenic Syndromes in Diseases Classified Elsewhere Y 3582 Toxic Myoneural Disorders Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 56 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 3588 Other Specified Myoneural Disorders Y 3589 Unspecified Myoneural Disorders N 3590 Congenital Hereditary Muscular Dystrophy N 3591 Hereditary Progressive Muscular Dystrophy N 3592 Myotonic Disorders N 3593 Familial Periodic Paralysis N 3594 Toxic Myopathy N 3595 Myopathy in Endocrine Diseases Classified Elsewhere N 3596 Symptomatic Inflammatory Myopathy in Diseases Classified Elsewhere N 3598 Other Myopathies N 3599 Unspecified Myopathy N 3601 Other Endophthalmitis N 3608 Other Disorders of Globe Y 3609 Unspecified Disorder of Globe Y 3612 Serous Retinal Detachment Y 3618 Other Forms of Retinal Detachment Y 3619 Unspecified Retinal Detachment Y 3620 Diabetic Retinopathy N 3622 Other Proliferative Retinopathy N 3628 Other Retinal Disorders Y 3629 Unspecified Retinal Disorder Y 3636 Choroidal Hemorrhage and Rupture Y 3638 Other Disorders of Choroid Y 3639 Unspecified Disorder of Choroid Y 03640 Meningococcal Carditis, Unspecified Y 03641 Meningococcal Pericarditis Y 03642 Meningococcal Endocarditis Y 3642 Certain Types of Iridocyclitis Y 03643 Meningococcal Myocarditis Y 3643 Unspecified Iridocyclitis Y 3644 Vascular Disorders of Iris and Ciliary Body Y 3645 Degenerations of Iris and Ciliary Body Y 3648 Other Disorders of Iris and Ciliary Body Y 3649 Unspecified Disorder of Iris and Ciliary Body Y 3653 Corticosteroid-Induced Glaucoma Y 3654 Glaucoma Associated With Congenital Anomalies, Dystrophies, and System Y 3655 Glaucoma Associated With Disorders of the Lens Y 3658 Other Specified Forms of Glaucoma Y 3659 Unspecified Glaucoma Y 3664 Cataract Associated With Other Disorders Y 3668 Other Cataract Y 3669 Unspecified Cataract Y 3670 Hypermetropia Y 3671 Myopia Y 3673 Anisometropia and Aniseikonia Y 3674 Presbyopia Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 57 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 3675 Disorders of Accommodation Y 3678 Other Disorders of Refraction and Accommodation Y 3679 Unspecified Disorder of Refraction and Accommodation Y 03681 Meningococcal Optic Neuritis Y 03682 Meningococcal Arthropathy Y 3682 Diplopia Y 3685 Color Vision Deficiencies Y 3688 Other Specified Visual Disturbances Y 03689 Other Specified Meningococcal Infections Y 3689 Unspecified Visual Disturbance Y 3693 Unqualified Visual Loss, Both Eyes Y 3694 Legal Blindness, as Defined in USA Y 3698 Unqualified Visual Loss, One Eye Y 3699 Unspecified Visual Loss Y 3703 Certain Types of Keratoconjunctivitis Y 3708 Other Forms of Keratitis Y 3709 Unspecified Keratitis Y 3718 Other Corneal Disorders Y 3719 Unspecified Corneal Disorder Y 3726 Conjunctival Scars Y 3727 Conjunctival Vascular Disorders and Cysts Y 3728 Other Disorders of Conjunctiva Y 3729 Unspecified Disorder of Conjunctiva Y 3731 Hordeolum and Other Deep Inflammation of Eyelid Y 3732 Chalazion Y 3733 Noninfectious Dermatoses of Eyelid Y 3734 Infective Dermatitis of Eyelid of Types Resulting in Deformity Y 3735 Other Infective Dermatitis of Eyelid Y 3736 Parasitic Infestation of Eyelid Y 3738 Other Inflammations of Eyelids Y 3739 Unspecified Inflammation of Eyelid Y 3744 Other Disorders Affecting Eyelid Function Y 3748 Other Disorders of Eyelid Y 3749 Unspecified Disorder of Eyelid Y 3751 Other Disorders of Lacrimal Gland Y 3754 Chronic Inflammation of Lacrimal Passages Y 3755 Stenosis and Insufficiency of Lacrimal Passages Y 3756 Other Changes of Lacrimal Passages Y 3758 Other Disorders of Lacrimal System Y 3759 Unspecified Disorder of Lacrimal System Y 3762 Endocrine Exophthalmos Y 3766 Retained (Old) Foreign Body Following Penetrating Wound of Orbit Y 3768 Other Orbital Disorders Y 3769 Unspecified Disorder of Orbit Y 3772 Other Disorders of Optic Disc Y 3774 Other Disorders of Optic Nerve Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 58 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 3775 Disorders of Optic Chiasm Y 3776 Disorders of Other Visual Pathways Y 3777 Disorders of Visual Cortex Y 3779 Unspecified Disorder of Optic Nerve and Visual Pathways Y 3787 Other Specified Strabismus Y 3788 Other Disorders of Binocular Eye Movements Y 3789 Unspecified Disorder of Eye Movements Y 3791 Other Disorders of Sclera Y 3792 Disorders of Vitreous Body Y 3793 Aphakia and Other Disorders of Lens Y 3798 Other Specified Disorders of Eye and Adnexa Y 3802 Other Otitis Externa N 3804 Impacted Cerumen N 3808 Other Disorders of External Ear N 3809 Unspecified Disorder of External Ear N 03810 Unspecified Staphylococcal Septicemia Y 03811 Staphylococcus Aureus Septicemia Y 3813 Other and Unspecified Chronic Nonsuppurative Otitis Media Y 3814 Nonsuppurative Otitis Media, Not Specified as Acute or Chronic Y 3817 Patulous Eustachian Tube Y 3818 Other Disorders of Eustachian Tube Y 03819 Other Staphylococcal Septicemia Y 3819 Unspecified Eustachian Tube Disorder Y 3821 Chronic Tubotympanic Suppurative Otitis Media N 3822 Chronic Atticoantral Suppurative Otitis Media N 3823 Unspecified Chronic Suppurative Otitis Media N 3824 Unspecified Suppurative Otitis Media S 3829 Unspecified Otitis Media S 3831 Chronic Mastoiditis N 3838 Other Disorders of Mastoid N 3839 Unspecified Mastoiditis N 03840 Septicemia due to Unspecified Gram-Negative Organism Y 03841 Septicemia due to Hemophilus Influenzae (H. Influenzae) Y 3841 Chronic Myringitis Without Mention of Otitis Media Y 03842 Septicemia due to Escherichia Coli (E. Coli) Y 03843 Septicemia due to Pseudomonas Y 03844 Septicemia due to Serratia Y 3848 Other Specified Disorders of Tympanic Membrane Y 03849 Other Septicemia due to Gram-Negative Organism Y 3849 Unspecified Disorder of Tympanic Membrane Y 3852 Other Acquired Abnormality of Ear Ossicles Y 3858 Other Disorders of Middle Ear and Mastoid Y 3859 Unspecified Disorder of Middle Ear and Mastoid Y 3862 Vertigo of Central Origin Y 3868 Other Disorders of Labyrinth N 3869 Unspecified Vertiginous Syndromes and Labyrinthine Disorders N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 59 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 3870 Otosclerosis Involving Oval Window, Nonobliterative N 3871 Otosclerosis Involving Oval Window, Obliterative N 3872 Cochlear Otosclerosis N 3878 Other Otosclerosis N 3879 Unspecified Otosclerosis N 3882 Unspecified Sudden Hearing Loss N 3885 Disorders of Acoustic Nerve N 3888 Other Disorders of Ear N 3889 Unspecified Disorder of Ear N 3892 Mixed Conductive and Sensorineural Hearing Loss N 3897 Deaf Mutism, Not Elsewhere Classifiable N 3898 Other Specified Forms of Hearing Loss N 3899 Unspecified Hearing Loss N 3910 Acute Rheumatic Pericarditis Y 3911 Acute Rheumatic Endocarditis Y 3912 Acute Rheumatic Myocarditis Y 3918 Other Acute Rheumatic Heart Disease Y 3919 Unspecified Acute Rheumatic Heart Disease Y 3920 Rheumatic Chorea With Heart Involvement Y 3929 Rheumatic Chorea Without Mention of Heart Involvement Y 3940 Mitral Stenosis Y 3941 Rheumatic Mitral Insufficiency Y 3942 Mitral Stenosis With Insufficiency Y 3949 Other and Unspecified Mitral Valve Diseases Y 3950 Rheumatic Aortic Stenosis Y 3951 Rheumatic Aortic Insufficiency Y 3952 Rheumatic Aortic Stenosis With Insufficiency Y 3959 Other and Unspecified Rheumatic Aortic Diseases Y 3960 Mitral Valve Stenosis and Aortic Valve Stenosis Y 3961 Mitral Valve Stenosis and Aortic Valve Insufficiency Y 3962 Mitral Valve Insufficiency and Aortic Valve Stenosis Y 3963 Mitral Valve Insufficiency and Aortic Valve Insufficiency Y 3968 Multiple Involvement of Mitral and Aortic Valves Y 3969 Unspecified Mitral and Aortic Valve Diseases Y 3970 Diseases of Tricuspid Valve Y 3971 Rheumatic Diseases of Pulmonary Valve Y 3979 Rheumatic Diseases of Endocardium, Valve Unspecified Y 3980 Rheumatic Myocarditis Y 4010 Essential Hypertension, Malignant Y 4011 Essential Hypertension, Benign Y 4019 Unspecified Essential Hypertension Y 4050 Malignant Secondary Hypertension S 4051 Benign Secondary Hypertension S 4059 Unspecified Secondary Hypertension N 04081 Tropical Pyomyositis N 04082 Toxic Shock Syndrome N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 60 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 04089 Other Specified Bacterial Diseases N Unspecified Streptococcus Infection in Conditions Classified Elsewhere and of 04100 Unspecified Site N Streptococcus Infection in Conditions Classified Elsewhere and of Unspecified Site, 04101 Group A N Streptococcus Infection in Conditions Classified Elsewhere and of Unspecified Site, 04102 Group B N Streptococcus Infection in Conditions Classified Elsewhere and of Unspecified Site, 04103 Group C N Streptococcus Infection in Conditions Classified Elsewhere and of Unspecified Site, 04104 Group D [Enterococcus] N Streptococcus Infection in Conditions Classified Elsewhere and of Unspecified Site, 04105 Group G N

04109 Other Streptococcus Infection in Conditions Classified Elsewhere and of Unspecified Site N Unspecified Staphylococcus Infection in Conditions Classified Elsewhere and of 04110 Unspecified Site N 4110 Postmyocardial Infarction Syndrome Y Staphylococcus Aureus Infection in Conditions Classified Elsewhere and of Unspecified 04111 Site N 4111 Intermediate Coronary Syndrome Y Other Staphylococcus Infection in Conditions Classified Elsewhere and of Unspecified 04119 Site N 4130 Angina Decubitus Y 4131 Prinzmetal Angina Y 4139 Other and Unspecified Angina Pectoris Y 4148 Other Specified Forms of Chronic Ischemic Heart Disease N 4149 Unspecified Chronic Ischemic Heart Disease N 4150 Acute Cor Pulmonale Y 4151 Pulmonary Embolism and Infarction Y 4160 Primary Pulmonary Hypertension Y 4161 Kyphoscoliotic Heart Disease S 4168 Other Chronic Pulmonary Heart Diseases S 4169 Unspecified Chronic Pulmonary Heart Disease S 4170 Arteriovenous Fistula of Pulmonary Vessels S 4171 Aneurysm of Pulmonary Artery S 4178 Other Specified Disease of Pulmonary Circulation S 4179 Unspecified Disease of Pulmonary Circulation S 04181 Mycoplasma Infection in Conditions Classified Elsewhere and of Unspecified Site N 04182 Bacillus Fragilis N Clostridium Perfringens Infection in Conditions Classified Elsewhere and of Unspecified 04183 Site N Infection due to Other Anaerobes in Conditions Classified Elsewhere and of Unspecified 04184 Site N Infection due to Other Gram-Negative Organisms in Conditions Classified Elsewhere and 04185 of Unspecified Site N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 61 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 04186 Helicobacter Pylori (H. Pylori) Infection N Infection due to Other Specified Bacteria in Conditions Classified Elsewhere and of 04189 Unspecified Site N 4200 Acute Pericarditis in Diseases Classified Elsewhere Y 4210 Acute and Subacute Bacterial Endocarditis Y 4211 Acute and Subacute Infective Endocarditis in Diseases Classified Elsewhere Y 4219 Unspecified Acute Endocarditis Y 4220 Acute Myocarditis in Diseases Classified Elsewhere Y 4230 Hemopericardium Y 4231 Adhesive Pericarditis Y 4232 Constrictive Pericarditis Y 4238 Other Specified Diseases of Pericardium Y 4239 Unspecified Disease of Pericardium Y 4240 Mitral Valve Disorders Y 4241 Aortic Valve Disorders Y 4242 Tricuspid Valve Disorders, Specified as Nonrheumatic Y 4243 Pulmonary Valve Disorders Y 4250 Endomyocardial Fibrosis Y 4251 Hypertrophic Obstructive Cardiomyopathy Y 4252 Obscure Cardiomyopathy of Africa Y 4253 Endocardial Fibroelastosis Y 4254 Other Primary Cardiomyopathies Y 4255 Alcoholic Cardiomyopathy Y 4257 Nutritional and Metabolic Cardiomyopathy Y 4258 Cardiomyopathy in Other Diseases Classified Elsewhere Y 4259 Unspecified Secondary Cardiomyopathy Y 4260 Atrioventricular Block, Complete Y 4262 Left Bundle Branch Hemiblock Y 4263 Other Left Bundle Branch Block Y 4264 Right Bundle Branch Block Y 4266 Other Heart Block Y 4267 Anomalous Atrioventricular Excitation Y 4268 Other Specified Conduction Disorders Y 4269 Unspecified Conduction Disorder Y 4270 Paroxysmal Supraventricular Tachycardia Y 4271 Paroxysmal Ventricular Tachycardia Y 4272 Unspecified Paroxysmal Tachycardia Y 4273 Atrial Fibrillation and Flutter Y 4274 Ventricular Fibrillation and Flutter Y 4275 Cardiac Arrest Y 4278 Other Specified Cardiac Dysrhythmias Y 4279 Unspecified Cardiac Dysrhythmia Y 4280 Congestive Heart Failure, Unspecified Y 4281 Left Heart Failure Y 4289 Unspecified Heart Failure Y 4290 Unspecified Myocarditis Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 62 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 4291 Myocardial Degeneration Y 4292 Unspecified Cardiovascular Disease Y 4293 Cardiomegaly Y 4294 Functional Disturbances Following Cardiac Surgery Y 4295 Rupture of Chordae Tendineae Y 4296 Rupture of Papillary Muscle Y 4298 Other Ill-Defined Heart Diseases Y 4299 Unspecified Heart Disease Y 04310 Causing Specified Diseases of The Central Nervous System Y 04320 Causing Other Disorders Involving the Immune Mechanism Y 4320 Nontraumatic Extradural Hemorrhage Y 4321 Subdural Hemorrhage Y 4329 Unspecified Intracranial Hemorrhage Y 04330 Causing Other Specified Conditions Y 4350 Basilar Artery Syndrome Y 4351 Vertebral Artery Syndrome Y 4352 Subclavian Steal Syndrome Y 4353 Vertebrobasilar Artery Syndrome Y 4358 Other Specified Transient Cerebral Ischemias Y 4359 Unspecified Transient Cerebral Ischemia Y 4370 Cerebral Atherosclerosis Y 4371 Other Generalized Ischemic Cerebrovascular Disease Y 4372 Hypertensive Encephalopathy Y 4373 Cerebral Aneurysm, Nonruptured Y 4374 Cerebral Arteritis Y 4375 Moyamoya Disease Y 4376 Nonpyogenic Thrombosis of Intracranial Venous Sinus Y 4377 Transient Global Amnesia Y 4378 Other Ill-Defined Cerebrovascular Disease Y 4379 Unspecified Cerebrovascular Disease Y 4380 Cognitive Deficits due to Cerebrovascular Disease N 4386 Alteration of Sensations as Late Effect of Cerebrovascular Disease N 4387 Disturbance of Vision as Late Effect of Cerebrovascular Disease N 4389 Unspecified Late Effects of Cerebrovascular Disease due to Cerebrovascular Disease N 04390 Acquired Immunodeficiency Syndrome-Related Complex, Unspecified N 4400 Atherosclerosis of Aorta Y 4401 Atherosclerosis of Renal Artery Y 4408 Atherosclerosis of Other Specified Arteries Y 4409 Generalized and Unspecified Atherosclerosis N 4411 Thoracic Aneurysm, Ruptured Y 4412 Thoracic Aneurysm Without Mention of Rupture Y 4413 Abdominal Aneurysm, Ruptured Y 4414 Abdominal Aneurysm Without Mention of Rupture Y 4415 Aortic Aneurysm of Unspecified Site, Ruptured Y 4416 Thoracoabdominal Aneurysm, Ruptured Y 4417 Thoracoabdominal Aneurysm Without Mention of Rupture Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 63 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 4419 Aortic Aneurysm of Unspecified Site Without Mention of Rupture Y 4420 Aneurysm of Artery of Upper Extremity Y 4421 Aneurysm of Renal Artery Y 4422 Aneurysm of Iliac Artery Y 4423 Aneurysm of Artery of Lower Extremity Y 4428 Aneurysm of Other Specified Artery Y 4429 Other Aneurysm of Unspecified Site Y 4430 Raynaud's Syndrome N 4431 Thromboangiitis Obliterans (Buerger's Disease) N 4438 Other Specified Peripheral Vascular Diseases N 4439 Unspecified Peripheral Vascular Disease N 4440 Embolism and Thrombosis of Abdominal Aorta Y 4441 Embolism and Thrombosis of Thoracic Aorta Y 4442 Embolism and Thrombosis of Arteries of the Extremities Y 4448 Embolism and Thrombosis of Other Specified Artery Y 4449 Embolism and Thrombosis of Unspecified Artery Y 4460 Polyarteritis Nodosa Y 4461 Acute Febrile Mucocutaneous Lymph Node Syndrome (MCLS) Y 4463 Lethal Midline Granuloma Y 4464 Wegener's Granulomatosis Y 4465 Giant Cell Arteritis Y 4466 Thrombotic Microangiopathy Y 4467 Takayasu's Disease Y 4470 Arteriovenous Fistula, Acquired Y 4471 Stricture of Artery Y 4472 Rupture of Artery Y 4473 Hyperplasia of Renal Artery Y 4474 Celiac Artery Compression Syndrome Y 4475 Necrosis of Artery Y 4476 Unspecified Arteritis Y 4478 Other Specified Disorders of Arteries and Arterioles Y 4479 Unspecified Disorders of Arteries and Arterioles Y 4480 Hereditary Hemorrhagic Telangiectasia Y 4481 Nevus, Non-Neoplastic N 4489 Other and Unspecified Capillary Diseases N 04490 Human Immunodeficiency Virus Infection, Unspecified N 04500 Acute Paralytic Poliomyelitis Specified as Bulbar, Unspecified Poliovirus Y 04501 Acute Paralytic Poliomyelitis Specified as Bulbar, Poliovirus Type I Y 04502 Acute Paralytic Poliomyelitis Specified as Bulbar, Poliovirus Type II Y 04503 Acute Paralytic Poliomyelitis Specified as Bulbar, Poliovirus Type III Y 04510 Acute Poliomyelitis With Other Paralysis, Unspecified Poliovirus Y 4510 Phlebitis and Thrombophlebitis of Superficial Vessels of Lower Extremities Y 04511 Acute Poliomyelitis With Other Paralysis, Poliovirus Type I Y 4511 Phlebitis and Thrombophlebitis of Deep Veins of Lower Extremities Y 04512 Acute Poliomyelitis With Other Paralysis, Poliovirus Type II Y 4512 Phlebitis and Thrombophlebitis of Lower Extremities, Unspecified Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 64 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 04513 Acute Poliomyelitis With Other Paralysis, Poliovirus Type III Y 4518 Phlebitis and Thrombophlebitis of Other Sites Y 4519 Phlebitis and Thrombophlebitis of Unspecified Site Y 04520 Acute Nonparalytic Poliomyelitis, Unspecified Poliovirus Y 04521 Acute Nonparalytic Poliomyelitis, Poliovirus Type I Y 04522 Acute Nonparalytic Poliomyelitis, Poliovirus Type II Y 04523 Acute Nonparalytic Poliomyelitis, Poliovirus Type III Y 4530 Budd-Chiari Syndrome Y 4531 Thrombophlebitis Migrans Y 4532 Embolism and Thrombosis of Vena Cava Y 4533 Embolism and Thrombosis of Renal Vein Y 4538 Embolism and Thrombosis of Other Specified Veins Y 4539 Embolism and Thrombosis of Unspecified Site Y 4540 Varicose Veins of Lower Extremities With Ulcer Y 4541 Varicose Veins of Lower Extremities With Inflammation Y 4542 Varicose Veins of Lower Extremities With Ulcer and Inflammation Y 4548 Varicose Veins of the Lower Extremities With Other Complications Y 4549 Asymptomatic Varicose Veins Y 4550 Internal Hemorrhoids Without Mention of Complication Y 4551 Internal Thrombosed Hemorrhoids Y 4552 Internal Hemorrhoids With Other Complication Y 4553 External Hemorrhoids Without Mention of Complication Y 4554 External Thrombosed Hemorrhoids Y 4555 External Hemorrhoids With Other Complication Y 4556 Unspecified Hemorrhoids Without Mention of Complication Y 4557 Unspecified Thrombosed Hemorrhoids Y 4558 Unspecified Hemorrhoids With Other Complication N 4559 Residual Hemorrhoidal Skin Tags N 4560 Esophageal Varices With Bleeding Y 4561 Esophageal Varices Without Mention of Bleeding Y 4563 Sublingual Varices N 4564 Scrotal Varices N 4565 Pelvic Varices N 4566 Vulval Varices N 4568 Varices of Other Sites N 4570 Postmastectomy Lymphedema Syndrome Y 4571 Other Noninfectious Lymphedema Y 4572 Lymphangitis Y 4578 Other Noninfectious Disorders of Lymphatic Channels N 4579 Unspecified Noninfectious Disorder of Lymphatic Channels N 4580 Orthostatic Hypotension S 4581 Chronic Hypotension N 4582 Latrogenic Hypotension S 4588 Other Specified Hypotension N 4589 Unspecified Hypotension N 04590 Acute Unspecified Poliomyelitis, Unspecified Poliovirus Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 65 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 4590 Unspecified Hemorrhage Y 04591 Acute Unspecified Poliomyelitis, Poliovirus Type I Y 4591 Postphlebitic Syndrome S 04592 Acute Unspecified Poliomyelitis, Poliovirus Type III Y 4592 Compression of Vein Y 04593 Acute Unspecified Poliomyelitis, Poliovirus Type III Y 4598 Other Specified Disorders of Circulatory System N 4599 Unspecified Circulatory System Disorder N 4610 Acute Maxillary Sinusitis Y 4611 Acute Frontal Sinusitis Y 4612 Acute Ethmoidal Sinusitis Y 4613 Acute Sphenoidal Sinusitis Y 4618 Other Acute Sinusitis Y 4619 Acute Sinusitis, Unspecified Y 4640 Acute Laryngitis Y 4644 Croup Y 4650 Acute Laryngopharyngitis Y 4658 Acute Upper Respiratory Infections of Other Multiple Sites Y 4659 Acute Upper Respiratory Infections of Unspecified Site Y 4660 Acute Bronchitis Y 4710 Polyp of Nasal Cavity Y 4711 Polypoid Sinus Degeneration Y 4718 Other Polyp of Sinus Y 4719 Unspecified Nasal Polyp Y 4720 Chronic Rhinitis Y 4721 Chronic Pharyngitis Y 4722 Chronic Nasopharyngitis Y 4730 Chronic Maxillary Sinusitis Y 4731 Chronic Frontal Sinusitis Y 4732 Chronic Ethmoidal Sinusitis Y 4733 Chronic Sphenoidal Sinusitis Y 4738 Other Chronic Sinusitis Y 4739 Unspecified Sinusitis (Chronic) Y 4740 Chronic Tonsillitis Y 4742 Adenoid Vegetations Y 4748 Other Chronic Disease of Tonsils and Adenoids Y 4749 Unspecified Chronic Disease of Tonsils and Adenoids Y 4760 Chronic Laryngitis Y 4761 Chronic Laryngotracheitis Y 4770 Allergic Rhinitis due to Pollen Y 4771 Allergic Rhinitis, due to Food Y 4772 Allergic Rhinitis, due to Animal (Cat/Dog) Hair and Dander S 4778 Allergic Rhinitis due to Other Allergen Y 4779 Allergic Rhinitis, Cause Unspecified Y 4780 Hypertrophy of Nasal Turbinates Y 4781 Other Diseases of Nasal Cavity and Sinuses Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 66 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 4784 Polyp of Vocal Cord or Larynx Y 4785 Other Diseases of Vocal Cords Y 4786 Edema of Larynx Y 4788 Upper Respiratory Tract Hypersensitivity Reaction, Site Unspecified Y 4789 Other and Unspecified Diseases of Upper Respiratory Tract N 4800 Pneumonia due to Adenovirus Y 4801 Pneumonia due to Respiratory Syncytial Virus Y 4802 Pneumonia due to Parainfluenza Virus Y 4808 Pneumonia due to Other Virus Not Elsewhere Classified Y 4809 Unspecified Viral Pneumonia Y 4820 Pneumonia due to Klebsiella Pneumoniae Y 4821 Pneumonia due to Pseudomonas Y 4822 Pneumonia due to Hemophilus Influenzae (H. Influenzae) Y 4824 Pneumonia due to Staphylococcus Y 4829 Unspecified Bacterial Pneumonia Y 4830 Pneumonia due to Mycoplasma Pneumoniae Y 4831 Pneumonia due to Chlamydia Y 4838 Pneumonia due to Other Specified Organism Y 4841 Pneumonia in Cytomegalic Inclusion Disease Y 4843 Pneumonia in Whooping Cough Y 4845 Pneumonia in Anthrax Y 4846 Pneumonia in Aspergillosis Y 4847 Pneumonia in Other Systemic Mycoses Y 4848 Pneumonia in Other Infectious Diseases Classified Elsewhere Y 4870 Influenza With Pneumonia Y 4871 Influenza With Other Respiratory Manifestations Y 4878 Influenza With Other Manifestations Y 4910 Simple Chronic Bronchitis Y 4911 Mucopurulent Chronic Bronchitis Y 4918 Other Chronic Bronchitis Y 4919 Unspecified Chronic Bronchitis Y 4920 Emphysematous Bleb Y 4928 Other Emphysema Y 4940 Bronchiectasis Without Acute Exacerbation Y 4941 Bronchiectasis With Acute Exacerbation Y 4950 Farmers' Lung Y 4951 Bagassosis Y 4952 Bird-Fanciers' Lung Y 4953 Suberosis Y 4954 Malt Workers' Lung Y 4955 Mushroom Workers' Lung Y 4956 Maple Bark-Strippers' Lung Y 4957 "Ventilation" Pneumonitis Y 4958 Other Specified Allergic Alveolitis and Pneumonitis Y 4959 Unspecified Allergic Alveolitis and Pneumonitis Y 5060 Bronchitis and Pneumonitis due to Fumes and Vapors Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 67 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 5061 Acute Pulmonary Edema due to Fumes and Vapors Y 5062 Upper Respiratory Inflammation due to Fumes and Vapors Y 5063 Other Acute and Subacute Respiratory Conditions due to Fumes and Vapors Y 5064 Chronic Respiratory Conditions due to Fumes and Vapors Y 5069 Unspecified Respiratory Conditions due to Fumes and Vapors Y 5070 Pneumonitis due to Inhalation of Food or Vomitus Y 5071 Pneumonitis due to Inhalation of Oils and Essences Y 5078 Pneumonitis due to Other Solids and Liquids Y 5080 Acute Pulmonary Manifestations due to Radiation Y 5081 Chronic and Other Pulmonary Manifestations due to Radiation Y 5088 Respiratory Conditions due to Other Specified External Agents Y 5089 Respiratory Conditions due to Unspecified External Agent Y 5100 Empyema With Fistula Y 5109 Empyema Without Mention of Fistula Y 5110 Pleurisy Without Mention of Effusion or Current Tuberculosis S 5111 Pleurisy With Effusion, With Mention of Bacterial Cause Other Than Tuberculosis S 5118 Pleurisy With Other Specified Forms of Effusion, Except Tuberculous Y 5119 Unspecified Pleural Effusion Y 5120 Spontaneous Tension Pneumothorax Y 5121 Iatrogenic Pneumothroax Y 5128 Other Spontaneous Pneumothorax Y 5130 Abscess of Lung Y 5131 Abscess of Mediastinum Y 5160 Pulmonary Alveolar Proteinosis Y 5161 Idiopathic Pulmonary Hemosiderosis Y 5162 Pulmonary Alveolar Microlithiasis Y 5163 Idiopathic Fibrosing Alveolitis Y 5168 Other Specified Alveolar and Parietoalveolar Pneumonopathies Y 5169 Unspecified Alveolar and Parietoalveolar Pneumonopathy Y 5171 Rheumatic Pneumonia Y 5172 Lung Involvement in Systemic Sclerosis Y 5173 Acute Chest Syndrome Y 5178 Lung Involvement in Other Diseases Classified Elsewhere Y 5180 Pulmonary Collapse Y 5181 Interstitial Emphysema Y 5182 Compensatory Emphysema Y 5183 Pulmonary Eosinophilia Y 5184 Unspecified Acute Edema of Lung Y 5185 Pulmonary Insufficiency Following Trauma and Surgery Y 5186 Allergic Bronchopulmonary Aspergillosis Y 5188 Other Diseases of Lung Y 5190 Tracheostomy Complication Y 5191 Other Diseases of Trachea and Bronchus, Not Elsewhere Classified Y 5192 Mediastinitis Y 5193 Other Diseases of Mediastinum, Not Elsewhere Classified Y 5194 Disorders of Diaphragm Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 68 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 5198 Other Diseases of Respiratory System, Not Elsewhere Classified N 5199 Unspecified Disease of Respiratory System N 5200 Anodontia N 5201 Supernumerary Teeth N 5202 Abnormalities of Size and Form of Teeth N 5203 Mottled Teeth N 5204 Disturbances of Tooth Formation N 5205 Hereditary Disturbances in Tooth Structure, Not Elsewhere Classified N 5206 Disturbances in Tooth Eruption N 5207 Teething Syndrome N 5208 Other Specified Disorders of Tooth Development and Eruption N 5209 Unspecified Disorder of Tooth Development and Eruption N 5210 Dental Caries N 5211 Excessive Attrition of Teeth N 5212 Abrasion of Teeth N 5213 Erosion of Teeth N 5214 Pathological Resorption of Teeth N 5215 Hypercementosis N 5216 Ankylosis of Teeth N 5217 Intrinsic Posteruptive Color Changes N 5218 Other Specified Diseases of Hard Tissues of Teeth N 5219 Unspecified Disease of Hard Tissues of Teeth N 5220 Pulpitis N 5221 Necrosis of Dental Pulp N 5222 Dental Pulp Degeneration N 5223 Abnormal Hard Tissue Formation in Dental Pulp N 5224 Acute Apical Periodontitis of Pulpal Origin N 5225 Periapical Abscess Without Sinus N 5226 Chronic Apical Periodontitis N 5227 Periapical Abscess With Sinus N 5228 Radicular Cyst of Dental Pulp N 5229 Other and Unspecified Diseases of Pulp and Periapical Tissues N 5230 Acute Gingivitis N 5231 Chronic Gingivitis N 5232 Gingival Recession N 5233 Acute Periodontitis N 5234 Chronic Periodontitis N 5235 Periodontosis N 5236 Accretions on Teeth N 5238 Other Specified Periodontal Diseases N 5239 Unspecified Gingival and Periodontal Disease N 5242 Anomalies of Dental Arch Relationship N 5243 Anomalies of Tooth Position N 5244 Unspecified Malocclusion N 5245 Dentofacial Functional Abnormalities N 5248 Other Specified Dentofacial Anomalies N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 69 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 5249 Unspecified Dentofacial Anomalies N 5250 Exfoliation of Teeth due to Systemic Causes N 5251 Loss of Teeth due to Accident, Extraction, or Local Periodontal Diseas N 5252 Atrophy of Edentulous Alveolar Ridge N 5253 Retained Dental Root N 5258 Other Specified Disorders of the Teeth and Supporting Structures N 5259 Unspecified Disorder of the Teeth and Supporting Structures N 5260 Developmental Odontogenic Cysts N 5261 Fissural Cysts of Jaw N 5262 Other Cysts of Jaws N 5263 Central Giant Cell (Reparative) Granuloma N 5264 Inflammatory Conditions of Jaw N 5265 Alveolitis of Jaw N 5268 Other Specified Diseases of the Jaws N 5269 Unspecified Disease of the Jaws N 5270 Atrophy of Salivary Gland N 5271 Hypertrophy of Salivary Gland N 5272 Sialoadenitis Y 5273 Abscess of Salivary Gland Y 5274 Fistula of Salivary Gland Y 5275 Sialolithiasis Y 5276 Mucocele of Salivary Gland Y 5277 Disturbance of Salivary Secretion Y 5278 Other Specified Diseases of the Salivary Glands Y 5279 Unspecified Disease of the Salivary Glands Y 5280 Stomatitis Y 5281 Cancrum Oris Y 5282 Oral Aphthae Y 5283 Cellulitis and Abscess of Oral Soft Tissues Y 5284 Cysts of Oral Soft Tissues Y 5285 Diseases of Lips Y 5286 Leukoplakia of Oral Mucosa, Including Tongue Y 5287 Other Disturbances of Oral Epithelium, Including Tongue Y 5288 Oral Submucosal Fibrosis, Including of Tongue Y 5289 Other and Unspecified Diseases of the Oral Soft Tissues Y 5290 Glossitis Y 5291 Geographic Tongue Y 5292 Median Rhomboid Glossitis Y 5293 Hypertrophy of Tongue Papillae Y 5294 Atrophy of Tongue Papillae Y 5295 Plicated Tongue Y 5296 Glossodynia Y 5298 Other Specified Conditions of the Tongue Y 5299 Unspecified Condition of the Tongue Y 5300 Achalasia and Cardiospasm S 5302 Ulcer of Esophagus Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 70 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 5303 Stricture and Stenosis of Esophagus Y 5304 Perforation of Esophagus Y 5305 Dyskinesia of Esophagus Y 5306 Diverticulum of Esophagus, Acquired Y 5307 Gastroesophageal Laceration-Hemorrhage Syndrome Y 5309 Unspecified Disorder of Esophagus N 05310 Herpes Zoster With Unspecified Nervous System Complication S 05311 Geniculate Herpes Zoster S 05312 Postherpetic Trigeminal Neuralgia S 05313 Postherpetic Polyneuropathy S 05319 Other Herpes Zoster With Nervous System Complications S 05320 Herpes Zoster Dermatitis of Eyelid S 05321 Herpes Zoster Keratoconjunctivitis S 05322 Herpes Zoster Iridocyclitis S 05329 Other Ophthalmic Herpes Zoster Complications S 5360 Achlorhydria N 5361 Acute Dilatation of Stomach N 5362 Persistent Vomiting S 5363 Gastroparesis N 5368 Dyspepsia and Other Specified Disorders of Function of Stomach N 5369 Unspecified Functional Disorder of Stomach N 5370 Acquired Hypertrophic Pyloric Stenosis S 05371 Otitis Externa due to Herpes Zoster N 5371 Gastric Diverticulum S 5372 Chronic Duodenal Ileus S 5373 Other Obstruction of Duodenum Y 5374 Fistula of Stomach or Duodenum Y 5375 Gastroptosis Y 5376 Hourglass Stricture or Stenosis of Stomach Y 5378 Other Specified Disorders of Stomach and Duodenum Y 05379 Other Specified Herpes Zoster Complications N 5379 Unspecified Disorder of Stomach and Duodenum N 5400 Acute Appendicitis With Generalized Peritonitis Y 5401 Acute Appendicitis With Peritoneal Abscess Y 5409 Acute Appendicitis Without Mention of Peritonitis Y 05410 Unspecified Genital Herpes N 05411 Herpetic Vulvovaginitis N 05412 Herpetic Ulceration of Vulva N 05413 Herpetic Infection of Penis N 05419 Other Genital Herpes N 5430 Hyperplasia of Appendix (Lymphoid) Y 5439 Other and Unspecified Diseases of Appendix Y 05440 Unspecified Ophthalmic Complication Herpes Simplex N 05441 Herpes Simplex Dermatitis of Eyelid N 05442 Dendritic Keratitis N 05443 Herpes Simplex Disciform Keratitis N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 71 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 05444 Herpes Simplex Iridocyclitis N 05449 Herpes Simplex With Other Ophthalmic Complications N 05471 Visceral Herpes Simplex N 05472 Herpes Simplex Meningitis Y 05473 Herpes Simplex Otitis Externa N 05479 Other Specified Herpes Simplex Complications N 5511 Umbilical Hernia With Gangrene Y 5513 Diaphragmatic Hernia With Gangrene Y 5518 Hernia of Other Specified Sites, With Gangrene Y 5519 Hernia of Unspecified Site, With Gangrene Y 5521 Umbilical Hernia With Obstruction Y 5523 Diaphragmatic Hernia With Obstruction Y 5528 Hernia of Other Specified Site, With Obstruction Y 5529 Hernia of Unspecified Site, With Obstruction Y 5531 Umbilical Hernia Without Mention of Obstruction or Gangrene Y 5533 Diaphragmatic Hernia Without Mention of Obstruction or Gangrene Y Hernia of Other Specified Sites of Abdominal Cavity Without Mention of Obstruction or 5538 Gangrene Y Hernia of Unspecified Site of Abdominal Cavity Without Mention of Obstruction or 5539 Gangrene Y 5550 Regional Enteritis of Small Intestine Y 5551 Regional Enteritis of Large Intestine Y 5552 Regional Enteritis of Small Intestine With Large Intestine Y 5559 Regional Enteritis of Unspecified Site Y 5560 Ulcerative (Chronic) Enterocolitis Y 5561 Ulcerative (Chronic) Ileocolitis Y 5562 Ulcerative (Chronic) Proctitis Y 5563 Ulcerative (Chronic) Proctosigmoiditis Y 5564 Pseudopolyposis of Colon Y 5565 Left Sided Ulcerative (Chronic) Colitis Y 5566 Universal Ulcerative (Chronic) Colitis Y 5568 Other Ulcerative Colitis Y 5569 Unspecified Ulcerative Colitis Y 5570 Acute Vascular Insufficiency of Intestine Y 05571 Measles Keratoconjunctivitis N 5571 Chronic Vascular Insufficiency of Intestine Y 05579 Other Specified Measles Complications N 5579 Unspecified Vascular Insufficiency of Intestine Y 5581 Gastroenteritis and Colitis due to Radiation Y 5582 Toxic Gastroenteritis and Colitis Y 5583 Gastroenteritis and Colitis, Allergic Y 5589 Other and Unspecified Noninfectious Gastroenteritis and Colitis Y 05600 Unspecified Rubella Neurological Complication Y 5600 Intussusception Y 05601 Encephalomyelitis due to Rubella Y 5601 Paralytic Ileus Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 72 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 5602 Volvulus Y 5608 Other Specified Intestinal Obstruction Y 05609 Other Neurological Rubella Complications Y 5609 Unspecified Intestinal Obstruction Y 5640 Constipation Y 5641 Irritable Bowel Syndrome Y 5642 Postgastric Surgery Syndromes Y 5643 Vomiting Following Gastrointestinal Surgery Y 5644 Other Postoperative Functional Disorders Y 5645 Functional Diarrhea Y 5646 Anal Spasm Y 5647 Megacolon, Other Than Hirschsprung's Y 5648 Other Specified Functional Disorders of Intestine Y 5649 Unspecified Functional Disorder of Intestine N 5650 Anal Fissure Y 5651 Anal Fistula Y 5670 Peritonitis in Infectious Diseases Classified Elsewhere Y 05671 Arthritis due to Rubella N 5671 Pneumococcal Peritonitis Y 5672 Other Suppurative Peritonitis Y 5678 Other Specified Peritonitis Y 05679 Rubella With Other Specified Complications Y 5679 Unspecified Peritonitis Y 5680 Peritoneal Adhesions (Postoperative) (Postinfection) Y 5688 Other Specified Disorders of Peritoneum Y 5689 Unspecified Disorder of Peritoneum N 5690 Anal and Rectal Polyp Y 5691 Rectal Prolapse Y 5692 Stenosis of Rectum and Anus Y 5693 Hemorrhage of Rectum and Anus Y 5694 Other Specified Disorders of Rectum and Anus Y 5695 Abscess of Intestine Y 5698 Other Specified Disorders of Intestine N 5699 Unspecified Disorder of Intestine N 5710 Alcoholic Fatty Liver N 5711 Acute Alcoholic Hepatitis Y 5712 Alcoholic Cirrhosis of Liver N 5713 Unspecified Alcoholic Liver Damage N 5715 Cirrhosis of Liver Without Mention of Alcohol N 5716 Biliary Cirrhosis N 5718 Other Chronic Nonalcoholic Liver Disease N 5719 Unspecified Chronic Liver Disease Without Mention of Alcohol N 5720 Abscess of Liver Y 5721 Portal Pyemia Y 5722 Hepatic Coma Y 5723 Portal Hypertension Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 73 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 5724 Hepatorenal Syndrome Y 5728 Other Sequelae of Chronic Liver Disease S 5730 Chronic Passive Congestion of Liver N 5731 Hepatitis in Viral Diseases Classified Elsewhere N 5732 Hepatitis in Other Infectious Diseases Classified Elsewhere N 5733 Unspecified Hepatitis N 5734 Hepatic Infarction Y 5738 Other Specified Disorders of Liver N 5739 Unspecified Disorder of Liver N 5750 Acute Cholecystitis Y 5752 Obstruction of Gallbladder Y 5753 Hydrops of Gallbladder Y 5754 Perforation of Gallbladder Y 5755 Fistula of Gallbladder Y 5756 Cholesterolosis of Gallbladder Y 5758 Other Specified Disorder of Gallbladder Y 5759 Unspecified Disorder of Gallbladder Y 5760 Postcholecystectomy Syndrome Y 5761 Cholangitis Y 5762 Obstruction of Bile Duct Y 5763 Perforation of Bile Duct Y 5764 Fistula of Bile Duct Y 5765 Spasm of Sphincter of Oddi Y 5768 Other Specified Disorders of Biliary Tract Y 5769 Unspecified Disorder of Biliary Tract N 5770 Acute Pancreatitis Y 5771 Chronic Pancreatitis Y 5772 Cyst and Pseudocyst of Pancreas Y 5778 Other Specified Disease of Pancreas Y 5779 Unspecified Disease of Pancreas N 5780 Hematemesis Y 5781 Blood in Stool Y 5789 Unspecified, Hemorrhage of Gastrointestinal Tract Y 5790 Celiac Disease S 5791 Tropical Sprue S 5792 Blind Loop Syndrome S 5793 Other and Unspecified Postsurgical Nonabsorption N 5794 Pancreatic Steatorrhea N 5798 Other Specified Intestinal Malabsorption N 5799 Unspecified Intestinal Malabsorption N 5800 Acute Glomerulonephritis With Lesion of Proliferative Glomerulonephritis Y 5804 Acute Glomerulonephritis With Lesion of Rapidly Progressive Glomerulonephritis Y 5808 Acute Glomerulonephritis W/ Other Spec Pathological Lesion Kidney Y 5809 Acute Glomerulonephritis With Unspecified Pathological Lesion in Kidney Y 5810 Nephrotic Syndrome With Lesion of Proliferative Glomerulonephritis Y 5811 Nephrotic Syndrome With Lesion of Membranous Glomerulonephritis Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 74 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 5812 Nephrotic Syndrome With Lesion of Membranoproliferative Glomerulonephritis Y 5813 Nephrotic Syndrome With Lesion of Minimal Change Glomerulonephritis Y 5818 Nephrotic Syndrome W/ Other Spec Pathological Lesion Kidney S 5819 Nephrotic Syndrome With Unspecified Pathological Lesion in Kidney Y 5820 Chronic Glomerulonephritis With Lesion of Proliferative Glomerulonephritis Y 5821 Chronic Glomerulonephritis With Lesion of Membranous Glomerulonephritis Y 5822 Chronic Glomerulonephritis With Lesion of Membranoproliferative Glomerulonephritis Y 5824 Chronic Glomerulonephritis With Lesion of Rapidly Progressive Glomerulonephritis Y 5828 Chronic Glomerulonephritis W/ Other Spec Pathological Lesion Kidney N 5829 Chronic Glomerulonephritis With Unspecified Pathological Lesion in Kidney Y Nephritis and Nephropathy, Not Specified as Acute or Chronic, With Lesion of 5830 Proliferative Glomerulonephritis Y Nephritis and Nephropathy, Not Specified as Acute or Chronic, With Lesion of 5831 Membranous Glomerulonephritis Y Nephritis and Nephropathy, Not Specified as Acute or Chronic, With Lesion of 5832 Membranoproliferative Glomerulonephritis Y Nephritis and Nephropathy, Not Specified as Acute or Chronic, With Lesion of Rapidly 5834 Progressive Glomerulonephritis Y Nephritis and Nephropathy, Not Specified as Acute or Chronic, With Lesion of Renal 5836 Cortical Necrosis Y Nephritis and Nephropathy, Not Specified as Acute or Chronic, With Lesion of Renal 5837 Medullary Necrosis Y 5838 Nephritis & Nephropathy Not Spec Acute/Chronic W/ Oth Spec Path Lesion S Nephritis and Nephropathy, Not Specified as Acute or Chronic, With Unspecified 5839 Pathological Lesion in Kidney Y 5845 Acute Renal Failure With Lesion of Tubular Necrosis Y 5846 Acute Renal Failure With Lesion of Renal Cortical Necrosis Y 5847 Acute Renal Failure With Lesion of Renal Medullary (Papillary) Necrosis Y 5848 Acute Renal Failure With Other Specified Pathological Lesion in Kidney Y 5849 Unspecified Acute Renal Failure Y 5851 Chronic Kidney Disease, Stage I Y 5852 Chronic Kidney Disease, Stage II (Mild) Y 5853 Chronic Kidney Disease, Stage III (Moderate) Y 5854 Chronic Kidney Disease, Stage IV (Severe) Y 5855 Chronic Kidney Disease, Stage V Y 5856 End Stage Renal Disease Y 5859 Chronic Kidney Disease, Unspecified Y 5880 Renal Osteodystrophy Y 5881 Nephrogenic Diabetes Insipidus Y 5888 Other Specified Disorder Resulting From Impaired Renal Function Y 5889 Unspecified Disorder Resulting From Impaired Renal Function Y 5890 Unilateral Small Kidney Y 5891 Bilateral Small Kidneys Y 5899 Unspecified Small Kidney Y 5902 Renal and Perinephric Abscess Y 5903 Pyeloureteritis Cystica Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 75 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 5909 Unspecified Infection of Kidney Y 5920 Calculus of Kidney Y 5921 Calculus of Ureter Y 5929 Unspecified Urinary Calculus Y 5930 Nephroptosis Y 5931 Hypertrophy of Kidney Y 5932 Acquired Cyst of Kidney Y 5933 Stricture or Kinking of Ureter Y 5934 Other Ureteric Obstruction Y 5935 Hydroureter Y 5936 Postural Proteinuria Y 5938 Other Specified Disorders of Kidney and Ureter N 5939 Unspecified Disorder of Kidney and Ureter Y 5940 Calculus in Diverticulum of Bladder Y 5941 Other Calculus in Bladder Y 5942 Calculus in Urethra Y 5948 Other Lower Urinary Tract Calculus Y 5949 Unspecified Calculus of Lower Urinary Tract Y 5950 Acute Cystitis Y 5951 Chronic Interstitial Cystitis Y 5952 Other Chronic Cystitis Y 5953 Trigonitis Y 5954 Cystitis in Diseases Classified Elsewhere Y 5958 Other Specified Types of Cystitis N 5959 Unspecified Cystitis Y 5960 Bladder Neck Obstruction Y 5961 Intestinovesical Fistula Y 5962 Vesical Fistula, Not Elsewhere Classified Y 5963 Diverticulum of Bladder Y 5964 Atony of Bladder Y 5966 Nontraumatic Rupture of Bladder Y 5967 Hemorrhage Into Bladder Wall Y 5968 Other Specified Disorder of Bladder Y 5969 Unspecified Disorder of Bladder N 5970 Urethral Abscess Y 5981 Traumatic Urethral Stricture Y 5982 Postoperative Urethral Stricture Y 5988 Other Specified Causes of Urethral Stricture Y 5989 Unspecified Urethral Stricture Y 5990 Urinary Tract Infection, Site Not Specified Y 5991 Urethral Fistula Y 5992 Urethral Diverticulum Y 5993 Urethral Caruncle Y 5994 Urethral False Passage Y 5995 Prolapsed Urethral Mucosa Y 5996 Unspecified Urinary Obstruction Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 76 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 5997 Hematuria Y 5999 Unspecified Disorder of Urethra and Urinary Tract N 6000 Hypertrophy (Benign) of Prostate Y 6001 Nodular Prostate Y 6002 Benign Localized Hyperplasia of Prostate Y 6003 Cyst of Prostate Y 6009 Hyperplasia of Prostate, Unspecified Y 6010 Acute Prostatitis Y 6011 Chronic Prostatitis Y 6012 Abscess of Prostate Y 6013 Prostatocystitis Y 6014 Prostatitis in Diseases Classified Elsewhere Y 6018 Other Specified Inflammatory Disease of Prostate Y 6019 Unspecified Prostatitis Y 6020 Calculus of Prostate Y 6021 Congestion or Hemorrhage of Prostate Y 6022 Atrophy of Prostate Y 6023 Dysplasia of Prostate Y 6028 Other Specified Disorder of Prostate Y 6029 Unspecified Disorder of Prostate Y 6030 Encysted Hydrocele Y 6031 Infected Hydrocele Y 6038 Other Specified Type of Hydrocele Y 6039 Unspecified Hydrocele Y 6040 Orchitis, Epididymitis, and Epididymo-Orchitis, With Abscess Y 6060 Azoospermia Y 6061 Oligospermia Y 6068 Infertility due to Extratesticular Causes Y 6069 Unspecified Male Infertility Y 6070 Leukoplakia of Penis Y 6071 Balanoposthitis Y 6072 Other Inflammatory Disorders of Penis Y 6073 Priapism Y 6078 Other Specified Disorders of Penis N 6079 Unspecified Disorder of Penis N 6080 Seminal Vesiculitis Y 6081 Spermatocele Y 6082 Torsion of Testis Y 6083 Atrophy of Testis Y 6084 Other Inflammatory Disorder of Male Genital Organs Y 6088 Other Specified Disorders of Male Genital Organs Y 6089 Unspecified Disorder of Male Genital Organs N 6100 Solitary Cyst of Breast N 6101 Diffuse Cystic Mastopathy N 6102 Fibroadenosis of Breast N 6103 Fibrosclerosis of Breast N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 77 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 6104 Mammary Duct Ectasia N 6108 Other Specified Benign Mammary Dysplasias N 6109 Unspecified Benign Mammary Dysplasia N 6110 Inflammatory Disease of Breast S 6111 Hypertrophy of Breast N 6112 Fissure of Nipple N 6113 Fat Necrosis of Breast N 6114 Atrophy of Breast N 6115 Galactocele N 6116 Galactorrhea Not Associated With Childbirth N 6117 Signs and Symptoms in Breast N 6118 Other Specified Disorder of Breast N 6119 Unspecified Breast Disorder N 6140 Acute Salpingitis and Oophoritis Y 6141 Chronic Salpingitis and Oophoritis Y 6142 Salpingitis and Oophoritis Not Specified as Acute, Subacute, or Chronic Y 6143 Acute Parametritis and Pelvic Cellulitis Y 6144 Chronic or Unspecified Parametritis and Pelvic Cellulitis Y 6145 Acute or Unspecified Pelvic Peritonitis, Female Y 6146 Pelvic Peritoneal Adhesions, Female (Postoperative) (Postinfection) Y 6147 Other Chronic Pelvic Peritonitis, Female Y 6148 Other Specified Inflammatory Disease of Female Pelvic Organs and Tissues Y 6149 Unspecified Inflammatory Disease of Female Pelvic Organs and Tissues Y 6150 Acute Inflammatory Disease of Uterus, Except Cervix Y 6151 Chronic Inflammatory Disease of Uterus, Except Cervix Y 6159 Unspecified Inflammatory Disease of Uterus Y 6160 Cervicitis and Endocervicitis Y 6162 Cyst of Bartholin’s Gland Y 6163 Abscess of Bartholin’s Gland Y 6164 Other Abscess of Vulva Y 6168 Other Specified Inflammatory Disease of Cervix, Vagina, and Vulva Y 6169 Unspecified Inflammatory Disease of Cervix, Vagina, and Vulva Y 6170 Endometriosis of Uterus Y 6171 Endometriosis of Ovary Y 6172 Endometriosis of Fallopian Tube Y 6173 Endometriosis of Pelvic Peritoneum Y 6174 Endometriosis of Rectovaginal Septum and Vagina Y 6175 Endometriosis of Intestine Y 6176 Endometriosis in Scar of Skin Y 6178 Endometriosis of Other Specified Sites Y 6179 Endometriosis, Site Unspecified Y 6180 Prolapse of Vaginal Walls Without Mention of Uterine Prolapse Y 6181 Uterine Prolapse Without Mention of Vaginal Wall Prolapse Y 6182 Uterovaginal Prolapse, Incomplete Y 6183 Uterovaginal Prolapse, Complete Y 6184 Uterovaginal Prolapse, Unspecified Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 78 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 6185 Prolapse of Vaginal Vault After Hysterectomy Y 6186 Vaginal Enterocele, Congenital or Acquired N 6187 Genital Prolapse, Old Laceration of Muscles of Pelvic Floor N 6188 Other Specified Genital Prolapse N 6189 Unspecified Genital Prolapse N 6190 Urinary-Genital Tract Fistula, Female N 6191 Digestive-Genital Tract Fistula, Female N 6192 Genital Tract-Skin Fistula, Female N 6198 Other Specified Fistula Involving Female Genital Tract N 6199 Unspecified Fistula Involving Female Genital Tract N 6200 Follicular Cyst of Ovary N 6201 Corpus Luteum Cyst or Hematoma N 6202 Other and Unspecified Ovarian Cyst N 6203 Acquired Atrophy of Ovary and Fallopian Tube N 6204 Prolapse or Hernia of Ovary and Fallopian Tube N 6205 Torsion of Ovary, Ovarian Pedicle, or Fallopian Tube Y 6206 Broad Ligament Laceration Syndrome Y 6207 Hematoma of Broad Ligament Y 6208 Other Noninflammatory Disorder of Ovary, Fallopian Tube, and Broad Ligament Y 6209 Unspecified Noninflammatory Disorder of Ovary, Fallopian Tube, and Broad Ligament N 6210 Polyp of Corpus Uteri N 6211 Chronic Subinvolution of Uterus N 6212 Hypertrophy of Uterus N 6213 Endometrial Cystic Hyperplasia N 6214 Hematometra N 6215 Intrauterine Synechiae N 6216 Malposition of Uterus N 6217 Chronic Inversion of Uterus N 6218 Other Specified Disorders of Uterus, Not Elsewhere Classified N 6219 Unspecified Disorder of Uterus N 6220 Erosion and Ectropion of Cervix N 6221 Dysplasia of Cervix (Uteri) N 6222 Leukoplakia of Cervix (Uteri) N 6223 Old Laceration of Cervix N 6224 Stricture and Stenosis of Cervix N 6225 Incompetence of Cervix N 6226 Hypertrophic Elongation of Cervix N 6227 Mucous Polyp of Cervix N 6228 Other Specified Noninflammatory Disorder of Cervix Y 6229 Unspecified Noninflammatory Disorder of Cervix Y 6230 Dysplasia of Vagina Y 6231 Leukoplakia of Vagina Y 6232 Stricture or Atresia of Vagina Y 6233 Tight Hymenal Ring Y 6234 Old Vaginal Laceration Y 6235 Leukorrhea, Not Specified as Infective Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 79 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 6236 Vaginal Hematoma Y 6237 Polyp of Vagina Y 6238 Other Specified Noninflammatory Disorder of Vagina Y 6239 Unspecified Noninflammatory Disorder of Vagina Y 6240 Dystrophy of Vulva Y 6241 Atrophy of Vulva Y 6242 Hypertrophy of Clitoris Y 6243 Hypertrophy of Laboia Y 6244 Old Laceration or Scarring of Vulva Y 6245 Hematoma of Vulva Y 6246 Polyp of Labia and Vulva Y 6248 Other Specified Noninflammatory Disorder of Vulva and Perineum Y 6249 Unspecified Noninflammatory Disorder of Vulva and Perineum Y 6250 Dyspareunia Y 6251 Vaginismus Y 6252 Mittelschmerz Y 6253 Dysmenorrhea Y 6254 Premenstrual Tension Syndromes Y 6255 Pelvic Congestion Syndrome N 6256 Female Stress Incontinence Y 6258 Other Specified Symptom Associated With Female Genital Organs Y 6259 Unspecified Symptom Associated With Female Genital Organs Y 6260 Absence of Menstruation Y 6261 Scanty or Infrequent Menstruation Y 6262 Excessive or Frequent Menstruation Y 6263 Puberty Bleeding Y 6264 Irregular Menstrual Cycle Y 6265 Ovulation Bleeding Y 6266 Metrorrhagia Y 6267 Postcoital Bleeding Y

6268 Other Disorder of Menstruation and Other Abnormal Bleeding From Female Genital Tract Y Unspecified Disorder of Menstruation and Other Abnormal Bleeding From Female Genital 6269 Tract Y 6270 Premenopausal Menorrhagia Y 6271 Postmenopausal Bleeding Y 6272 Symptomatic Menopausal or Female Climacteric States Y 6273 Postmenopausal Atrophic Vaginitis Y 6274 Symptomatic States Associated With Artificial Menopause Y 6278 Other Specified Menopausal and Postmenopausal Disorder Y 6279 Unspecified Menopausal and Postmenopausal Disorder Y 6280 Female Infertility Associated With Anovulation Y 6281 Female Infertility of Pituitary-Hypothalamic Origin Y 6282 Female Infertility of Tubal Origin Y 6283 Female Infertility of Uterine Origin Y 6284 Female Infertility of Cervical or Vaginal Origin Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 80 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 6288 Female Infertility of Other Specified Origin Y 6289 Female Infertility of Unspecified Origin Y 6290 Hematocele, Female, Not Elsewhere Classified Y 6291 Hydrocele, Canal of Nuck Y 6298 Other Specified Disorder of Female Genital Organs N 6299 Unspecified Disorder of Female Genital Organs N 6330 Abdominal Pregnancy Y 6331 Tubal Pregnancy Y 6332 Ovarian Pregnancy Y 6338 Other Ectopic Pregnancy Y 6339 Unspecified Ectopic Pregnancy Y 6380 Failed Attempted Abortion Complicated by Genital Tract and Pelvic Infection Y 6381 Failed Attempted Abortion Complicated by Delayed or Excessive Hemorrhage Y 6382 Failed Attempted Abortion Complicated by Damage to Pelvic Organs or Tissues Y 6383 Failed Attempted Abortion Complicated by Renal Failure Y 6384 Failed Attempted Abortion Complicated by Metabolic Disorder Y 6385 Failed Attempted Abortion Complicated by Shock Y 6386 Failed Attempted Abortion Complicated by Embolism Y 6387 Failed Attempted Abortion With Other Specified Complication Y 6388 Failed Attempted Abortion With Unspecified Complication Y 6389 Failed Attempted Abortion Without Mention of Complication Y

6390 Genital Tract and Pelvic Infection Following Abortion or Ectopic and Molar Pregnancies Y

6391 Delayed or Excessive Hemorrhage Following Abortion or Ectopic and Molar Pregnancies Y Damage to Pelvic Organs and Tissues Following Abortion or Ectopic and Molar 6392 Pregnancies Y 6393 Renal Failure Following Abortion or Ectopic and Molar Pregnancies Y 6394 Metabolic Disorders Following Abortion or Ectopic and Molar Pregnancies Y 6395 Shock Following Abortion or Ectopic and Molar Pregnancies Y 6396 Embolism Following Abortion or Ectopic and Molar Pregnancies Y 6398 Other Specified Complication Following Abortion or Ectopic and Molar Pregnancies Y 6399 Unspecified Complication Following Abortion or Ectopic and Molar Pregnancies N 06640 West Nile Fever, Unspecified Y 06641 West Nile Fever With Encephalitis Y 06642 West Nile Fever With Other Neurologic Manifestation Y 06649 West Nile Fever With Other Complications Y 6800 Carbuncle and Furuncle of Face N 6801 Carbuncle and Furuncle of Neck N 6802 Carbuncle and Furuncle of Trunk N 6803 Carbuncle and Furuncle of Upper Arm and Forearm N 6804 Carbuncle and Furuncle of Hand N 6805 Carbuncle and Furuncle of Buttock N 6806 Carbuncle and Furuncle of Leg, Except Foot N 6807 Carbuncle and Furuncle of Foot N 6808 Carbuncle and Furuncle of Other Specified Sites N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 81 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 6809 Carbuncle and Furuncle of Unspecified Site N 6819 Cellulitis and Abscess of Unspecified Digit N 6820 Cellulitis and Abscess of Face Y 6821 Cellulitis and Abscess of Neck Y 6822 Cellulitis and Abscess of Trunk Y 6823 Cellulitis and Abscess of Upper Arm and Forearm Y 6824 Cellulitis and Abscess of Hand, Except Fingers and Thumb Y 6825 Cellulitis and Abscess of Buttock Y 6826 Cellulitis and Abscess of Leg, Except Foot Y 6827 Cellulitis and Abscess of Foot, Except Toes Y 6828 Cellulitis and Abscess of Other Specified Site Y 6829 Cellulitis and Abscess of Unspecified Site Y 6850 Pilonidal Cyst With Abscess N 6851 Pilonidal Cyst Without Mention of Abscess N 6860 Pyoderma of Skin and Subcutaneous Tissue N 6861 Pyogenic Granuloma of Skin and Subcutaneous Tissue N 6868 Other Specified Local Infections of Skin and Subcutaneous Tissue N 6869 Unspecified Local Infection of Skin and Subcutaneous Tissue N 6908 Other Erythematosquamous Dermatosis N 6910 Diaper or Napkin Rash N 6918 Other Atopic Dermatitis and Related Conditions N 6920 Contact Dermatitis and Other Eczema due to Detergents S 6921 Contact Dermatitis and Other Eczema due to Oils and Greases S 6922 Contact Dermatitis and Other Eczema due to Solvents S

6923 Contact Dermatitis and Other Eczema due to Drugs and Medicines in Contact With Skin S 6924 Contact Dermatitis and Other Eczema due to Other Chemical Products S 6925 Contact Dermatitis and Other Eczema due to Food in Contact With Skin S 6926 Contact Dermatitis and Other Eczema due to Plants (Except Food) S 6928 Contact Dermatitis and Other Eczema due to Other Specified Agents N 6929 Contact Dermatitis and Other Eczema, due to Unspecified Cause S 6930 Dermatitis due to Drugs and Medicines Taken Internally S 6931 Dermatitis due to Food Taken Internally S 6938 Dermatitis due to Other Specified Substances Taken Internally S 6939 Dermatitis due to Unspecified Substance Taken Internally N 6940 Dermatitis Herpetiformis S 6941 Subcorneal Pustular Dermatosis S 6942 Juvenile Dermatitis Herpetiformis S 6943 Impetigo Herpetiformis S 6944 Pemphigus S 6945 Pemphigoid S 6948 Other Specified Bullous Dermatosis S 6949 Unspecified Bullous Dermatosis S 6950 Toxic Erythema Y 6951 Erythema Multiforme Y 6952 Erythema Nodosum Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 82 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 6953 Rosacea S 6954 Lupus Erythematosus S 6958 Other Specified Erythematous Conditions S 6959 Unspecified Erythematous Condition S 6960 Psoriatic Arthropathy S 6961 Other Psoriasis and Similar Disorders S 6962 Parapsoriasis S 6963 Pityriasis Rosea S 6964 Pityriasis Rubra Pilaris S 6965 Other and Unspecified Pityriasis S 6968 Other Psoriasis and Similar Disorders S 6970 Lichen Planus S 6971 Lichen Nitidus S 6978 Other Lichen, Not Elsewhere Classified S 6979 Unspecified Lichen S 6980 Pruritus Ani S 6981 Pruritus of Genital Organs S 6982 Prurigo S 6983 Lichenification and Lichen Simplex Chronicus S 6984 Dermatitis Factitia (Artefacta) S 6988 Other Specified Pruritic Conditions S 6989 Unspecified Pruritic Disorder S 7010 Circumscribed Scleroderma S 7011 Acquired Keratoderma S 7012 Acquired Acanthosis Nigricans S 7013 Striae Atrophicae S 7014 Keloid Scar S 7015 Other Abnormal Granulation Tissue S 7018 Other Specified Hypertrophic and Atrophic Condition of Skin S 7019 Unspecified Hypertrophic and Atrophic Condition of Skin S Viral Hepatitis B With Hepatic Coma, Acute or Unspecified, Without Mention of Hepatitis 07020 Delta Y 7020 Actinic Keratosis S 07021 Viral Hepatitis B With Hepatic Coma, Acute or Unspecified, With Hepatitis Delta Y 07022 Viral Hepatitis B With Hepatic Coma, Chronic, Without Mention of Hepatitis Delta Y 07023 Viral Hepatitis B With Hepatic Coma, Chronic, With Hepatitis Delta Y 7028 Other Specified Dermatoses S Viral Hepatitis B Without Mention of Hepatic Coma, Acute or Unspecified, Without 07030 Mention of Hepatitis Delta N 7030 Ingrowing Nail S Viral Hepatitis B Without Mention of Hepatic Coma, Acute or Unspecified, With Hepatitis 07031 Delta N Viral Hepatitis B Without Mention of Hepatic Coma, Chronic, Without Mention of 07032 Hepatitis Delta N 07033 Viral Hepatitis B Without Mention of Hepatic Coma, Chronic, With Hepatitis Delta N 7038 Other Specified Disease of Nail S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 83 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 7039 Unspecified Disease of Nail S 07041 Acute Hepatitis C With Hepatic Coma Y 7041 Hirsutism S 07042 Hepatitis Delta Without Mention of Active Hepatitis B Disease With Hepatic Coma Y 7042 Abnormalities of The Hair S 07043 Hepatitis E With Hepatic Coma Y 7043 Variations in Hair Color S 07044 Chronic Hepatitis C With Hepatic Coma Y 7048 Other Specified Disease of Hair and Hair Follicles S 07049 Other Specified Viral Hepatitis With Hepatic Coma Y 7049 Unspecified Disease of Hair and Hair Follicles S 7050 Anhidrosis S 07051 Acute Hepatitis C Without Mention of Hepatic Coma N 7051 Prickly Heat S 07052 Hepatitis Delta Without Mention of Active Hepatitis B Disease or Hepatic Coma N 07053 Hepatitis E Without Mention of Hepatic Coma N 07054 Chronic Hepatitis C Without Mention of Hepatic Coma N 7058 Other Specified Disorders of Sweat Glands N 07059 Other Specified Viral Hepatitis Without Mention of Hepatic Coma N 7059 Unspecified Disorder of Sweat Glands S 7060 Acne Varioliformis S 7061 Other Acne S 7062 Sebaceous Cyst S 7063 Seborrhea S 7068 Other Specified Disease of Sebaceous Glands S 7069 Unspecified Disease of Sebaceous Glands S 7070 Decubitus Ulcer S 07070 Unspecified Viral Hepatitis Without Hepatic Coma N 7071 Ulcer of Lower Limbs, Except Decubitus Ulcer S 07071 Unspecified Viral Hepatitis C With Hepatic Coma Y 7078 Chronic Ulcer of Other Specified Site S 7079 Chronic Ulcer of Unspecified Site S 7080 Allergic Urticaria Y 7081 Idiopathic Urticaria Y 7082 Urticaria due to Cold and Heat Y 7083 Dermatographic Urticaria Y 7084 Vibratory Urticaria Y 7085 Cholinergic Urticaria Y 7088 Other Specified Urticaria Y 7089 Unspecified Urticaria Y 7091 Vascular Disorder of Skin S 7092 Scar Condition and Fibrosis of Skin S 7093 Degenerative Skin Disorder S 7094 Foreign Body Granuloma of Skin and Subcutaneous Tissue S 7098 Other Specified Disorder of Skin S 7099 Unspecified Disorder of Skin and Subcutaneous Tissue S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 84 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 7100 Systemic Lupus Erythematosus S 7101 Systemic Sclerosis S 7102 Sicca Syndrome S 7103 Dermatomyositis S 7104 Polymyositis S 7105 Eosinophilia Myalgia Syndrome S 7108 Other Specified Diffuse Disease of Connective Tissue N 7109 Unspecified Diffuse Connective Tissue Disease N 7130 Arthropathy Associated With Other Endocrine and Metabolic Disorders S 7131 Arthropathy Associated With Gastrointestinal Conditions Other Than Infections S 7132 Arthropathy Associated With Hematological Disorders S 7133 Arthropathy Associated With Dermatological Disorders S 7134 Arthropathy Associated With Respiratory Disorders S 7135 Arthropathy Associated With Neurological Disorders S 7136 Arthropathy Associated With Hypersensitivity Reaction S 7137 Other General Diseases With Articular Involvement S 7138 Arthropathy Associated With Other Conditions Classifiable Elsewhere S 7140 Rheumatoid Arthritis S 7141 Felty’s Syndrome S 7142 Other Rheumatoid Arthritis With Visceral or Systemic Involvement S 7144 Chronic Postrheumatic Arthropathy S 7148 Other Specified Inflammatory Polyarthropathies S 7149 Unspecified Inflammatory Polyarthropathy S 7170 Old Bucket Handle Tear of Medial Meniscus S 7171 Derangement of Anterior Horn of Medial Meniscus S 7172 Derangement of Posterior Horn of Medial Meniscus S 7173 Other and Unspecified Derangement of Medial Meniscus S 7175 Derangement of Meniscus, Not Elsewhere Classified S 7176 Loose Body in Knee S 7177 Chondromalacia of Patella S 7178 Other Internal Derangement of Knee S 7179 Unspecified Internal Derangement of Knee N 7197 Difficulty in Walking S 7200 Ankylosing Spondylitis S 7201 Spinal Enthesopathy S 7202 Sacroiliitis, Not Elsewhere Classified S 7208 Other Inflammatory Spondylopathies S 7209 Unspecified Inflammatory Spondylopathy S 7210 Cervical Spondylosis Without Myelopathy S 7211 Cervical Spondylosis With Myelopathy S 7212 Thoracic Spondylosis Without Myelopathy S 7213 Lumbosacral Spondylosis Without Myelopathy S 7214 Thoracic or Lumbar Spondylosis With Myelopathy S 7215 Kissing Spine S 7216 Ankylosing Vertebral Hyperostosis S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 85 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 7217 Traumatic Spondylopathy S 7218 Other Allied Disorders of Spine S 7220 Displacement of Cervical Intervertebral Disc Without Myelopathy S 7222 Displacement of Intervertebral Disc, Site Unspecified, Without Myelopathy S 7224 Degeneration of Cervical Intervertebral Disc N 7225 Degeneration of Thoracic or Lumbar Intervertebral Disc N 7226 Degeneration of Intervertebral Disc, Site Unspecified N 7230 Spinal Stenosis in Cervical Region S 7231 Cervicalgia S 7232 Cervicocranial Syndrome S 7233 Cervicobrachial Syndrome (Diffuse) S 7234 Brachial Neuritis or Radiculitis Nos S 7235 Torticollis, Unspecified S 7236 Panniculitis Specified as Affecting Neck S 7237 Ossification of Posterior Longitudinal Ligament in Cervical Region S 7238 Other Syndromes Affecting Cervical Region S 7239 Unspecified Musculoskeletal Disorders and Symptoms Referable to Neck S 7241 Pain in Thoracic Spine S 7242 Lumbago S 7243 Sciatica S 7244 Thoracic or Lumbosacral Neuritis or Radiculitis, Unspecified S 7245 Unspecified Backache N 7246 Disorders of Sacrum N 7248 Other Symptoms Referable to Back N 7249 Other Unspecified Back Disorder N 7260 Adhesive Capsulitis of Shoulder N 7262 Other Affections of Shoulder Region, Not Elsewhere Classified N 7264 Enthesopathy of Wrist and Carpus N 7265 Enthesopathy of Hip Region N 7268 Other Peripheral Enthesopathies N 07271 Mumps Hepatitis Y 7271 Bunion N 07272 Mumps Polyneuropathy Y 7272 Specific Bursitides Often of Occupational Origin N 7273 Other Bursitis Disorders N 7278 Other Disorders of Synovium, Tendon, and Bursa N 07279 Mumps With Other Specified Complications N 7279 Unspecified Disorder of Synovium, Tendon, and Bursa N 7280 Infective Myositis N 7282 Muscular Wasting and Disuse Atrophy, Not Elsewhere Classified N 7283 Other Specific Muscle Disorders N 7284 Laxity of Ligament N 7285 Hypermobility Syndrome N 7286 Contracture of Palmar Fascia N 7287 Other Fibromatoses of Muscle, Ligament, and Fascia N 7288 Other Disorders of Muscle, Ligament, and Fascia N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 86 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 7289 Unspecified Disorder of Muscle, Ligament, and Fascia N 7290 Rheumatism, Unspecified and Fibrositis N 7291 Unspecified Myalgia and Myositis N 7292 Unspecified Neuralgia, Neuritis, and Radiculitis N 7294 Unspecified Fasciitis N 7295 Pain in Soft Tissues of Limb N 7296 Residual Foreign Body in Soft Tissue S 7298 Other Musculoskeletal Symptoms Referable to Limbs N 7299 Other and Unspecified Disorders of Soft Tissue N 7310 Osteitis Deformans Without Mention of Bone Tumor N 7311 Osteitis Deformans in Diseases Classified Elsewhere N 7312 Hypertrophic Pulmonary Osteoarthropathy N 7318 Other Bone Involvement in Diseases Classified Elsewhere N 7320 Juvenile Osteochondrosis of Spine N 7321 Juvenile Osteochondrosis of Hip and Pelvis N 7322 Nontraumatic Slipped Upper Femoral Epiphysis N 7323 Juvenile Osteochondrosis of Upper Extremity N 7324 Juvenile Osteochondrosis of Lower Extremity, Excluding Foot N 7325 Juvenile Osteochondrosis of Foot N 7326 Other Juvenile Osteochondrosis N 7327 Osteochondritis Dissecans N 7328 Other Specified Forms of Osteochondropathy N 7329 Unspecified Osteochondropathy N 7333 Hyperostosis of Skull Y 7335 Osteitis Condensans Y 7336 Tietze's Disease Y 7337 Algoneurodystrophy Y 7338 Malunion and Nonunion of Fracture N 7350 Hallux Valgus (Acquired) N 7351 Hallux Varus (Acquired) N 7352 Hallux Rigidus N 7353 Hallux Malleus N 7354 Other Hammer Toe (Acquired) N 7355 Claw Toe (Acquired) N 7358 Other Acquired Deformity of Toe N 7359 Unspecified Acquired Deformity of Toe N 7361 Mallet Finger N 7364 Genu Valgum or Varum (Acquired) N 7365 Genu Recurvatum (Acquired) N 7366 Other Acquired Deformities of Knee N 7368 Acquired Deformities of Other Parts of Limbs N 7369 Acquired Deformity of Limb, Site Unspecified N 7370 Adolescent Postural Kyphosis N 7378 Other Curvatures of Spine Associated With Other Conditions N 7379 Unspecified Curvature of Spine Associated With Other Condition N 7380 Acquired Deformity of Nose N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 87 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 7382 Acquired Deformity of Neck N 7383 Acquired Deformity of Chest and Rib N 7384 Acquired Spondylolisthesis N 7385 Other Acquired Deformity of Back or Spine N 7386 Acquired Deformity of Pelvis N 7387 Cauliflower Ear N 7388 Acquired Musculoskeletal Deformity of Other Specified Site N 7389 Acquired Musculoskeletal Deformity of Unspecified Site N 7390 Nonallopathic Lesion of Head Region, Not Elsewhere Classified N 7391 Nonallopathic Lesion of Cervical Region, Not Elsewhere Classified N 7392 Nonallopathic Lesion of Thoracic Region, Not Elsewhere Classified N 7393 Nonallopathic Lesion of Lumbar Region, Not Elsewhere Classified N 7394 Nonallopathic Lesion of Sacral Region, Not Elsewhere Classified N 7395 Nonallopathic Lesion of Pelvic Region, Not Elsewhere Classified N 7396 Nonallopathic Lesion of Lower Extremities, Not Elsewhere Classified N 7397 Nonallopathic Lesion of Upper Extremities, Not Elsewhere Classified N 7398 Nonallopathic Lesion of Rib Cage, Not Elsewhere Classified N 7399 Nonallopathic Lesion of Abdomen and Other Sites, Not Elsewhere Classified N 7400 Anencephalus N 7401 Craniorachischisis N 7402 Iniencephaly N 07420 Coxsackie Carditis, Unspecified Y 7420 Encephalocele N 07421 Coxsackie Pericarditis Y 7421 Microcephalus N 07422 Coxsackie Endocarditis Y 7422 Congenital Reduction Deformities of Brain N 07423 Coxsackie Myocarditis Y 7423 Congenital Hydrocephalus N 7424 Other Specified Congenital Anomalies of Brain N 7425 Other Specified Congenital Anomalies of Spinal Cord N 7428 Other Specified Congenital Anomalies of Nervous System N 7429 Unspecified Congenital Anomaly of Brain, Spinal Cord, and Nervous System N 7434 Coloboma and Other Anomalies of Anterior Segment N 7435 Congenital Anomalies of Posterior Segment N 7436 Congenital Anomalies of Eyelids, Lacrimal System, and Orbit N 7438 Other Specified Congenital Anomalies of Eye N 7439 Unspecified Congenital Anomaly of Eye N 7441 Congenital Anomalies of Accessory Auricle N 7442 Other Specified Congenital Anomalies of Ear N 7443 Unspecified Congenital Anomaly of Ear N 7444 Branchial Cleft Cyst or Fistula; Preauricular Sinus N 7445 Congenital Webbing of Neck N 7448 Other Specified Congenital Anomalies of Face and Neck N 7449 Unspecified Congenital Anomaly of Face and Neck N 7450 Bulbus Cordis Anomalies and Anomalies of Cardiac Septal Closure, Common Truncus Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 88 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 7452 Tetralogy of Fallot Y 7453 Bulbus Cordis Anomalies and Anomalies of Cardiac Septal Closure, Common Ventricle Y 7454 Ventricular Septal Defect Y 7455 Ostium Secundum Type Atrial Septal Defect Y 7457 Cor Biloculare Y 7458 Other Bulbus Cordis Anomalies and Anomalies of Cardiac Septal Closure Y 7459 Unspecified Congenital Defect of Septal Closure Y 7461 Congenital Tricuspid Atresia and Stenosis Y 7462 Ebstein's Anomaly Y 7463 Congenital Stenosis of Aortic Valve Y 7464 Congenital Insufficiency of Aortic Valve Y 7465 Congenital Mitral Stenosis Y 7466 Congenital Mitral Insufficiency Y 7467 Hypoplastic Left Heart Syndrome Y 7468 Other Specified Congenital Anomalies of Heart S 7469 Unspecified Congenital Anomaly of Heart Y 7470 Patent Ductus Arteriosus Y 7473 Congenital Anomalies of Pulmonary Artery Y 7475 Congenital Absence or Hypoplasia of Umbilical Artery Y 7478 Other Specified Congenital Anomalies of Circulatory System S 7479 Unspecified Congenital Anomaly of Circulatory System N 7480 Congenital Choanal Atresia Y 7481 Other Congenital Anomaly of Nose Y 7482 Congenital Web of Larynx Y 7483 Other Congenital Anomaly of Larynx, Trachea, and Bronchus Y 7484 Congenital Cystic Lung Y 7485 Congenital Agenesis, Hypoplasia, and Dysplasia of Lung Y 7488 Other Specified Congenital Anomaly of Respiratory System Y 7489 Unspecified Congenital Anomaly of Respiratory System Y 7500 Tongue Tie N 7502 Other Specified Congenital Anomalies of Mouth and Pharynx N 7503 Congenital Tracheoesophageal Fistula, Esophageal Atresia and Stenosis N 7504 Other Specified Congenital Anomaly of Esophagus N 7505 Congenital Hypertrophic Pyloric Stenosis N 7506 Congenital Hiatus Hernia N 7507 Other Specified Congenital Anomalies of Stomach N 7508 Other Specified Congenital Anomalies of Upper Alimentary Tract N 7509 Unspecified Congenital Anomaly of Upper Alimentary Tract N 7510 Meckel’s Diverticulum N 7511 Congenital Atresia and Stenosis of Small Intestine N 7512 Congenital Atresia and Stenosis of Large Intestine, Rectum, and Anal Canal N 7513 Hirschsprung’s Disease and Other Congenital Functional Disorders of Colon N 7514 Congenital Anomalies of Intestinal Fixation N 7515 Other Congenital Anomalies of Intestine N 7517 Congenital Anomalies of Pancreas N 7518 Other Specified Congenital Anomalies of Digestive System N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 89 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 7519 Unspecified Congenital Anomaly of Digestive System N 7520 Congenital Anomalies of Ovaries N 7522 Congenital Doubling of Uterus N 7523 Other Congenital Anomaly of Uterus N 7525 Undescended and Retractile Testicle N 7526 Hypospadias and Epispadias and Other Penile Anomalies N 7527 Indeterminate Sex and Pseudohermaphroditism N 7528 Other Specified Congenital Anomalies of Genital Organs N 7529 Unspecified Congenital Anomaly of Genital Organs N 7530 Congenital Renal Agenesis and Dysgenesis N 7533 Other Specified Congenital Anomalies of Kidney N 7534 Other Specified Congenital Anomalies of Ureter N 7535 Exstrophy of Urinary Bladder N 7536 Congenital Atresia and Stenosis of Urethra and Bladder Neck N 7537 Congenital Anomalies of Urachus N 7538 Other Specified Congenital Anomaly of Bladder and Urethra N 7539 Unspecified Congenital Anomaly of Urinary System N 7540 Congenital Musculoskeletal Deformities of Skull, Face, and Jaw N 7541 Congenital Musculoskeletal Deformity of Sternocleidomastoid Muscle N 7542 Congenital Musculoskeletal Deformity of Spine N 7548 Other Specified Nonteratogenic Anomalies N 7554 Congenital Reduction Deformities, Unspecified Limb N 7558 Other Specified Congenital Anomalies of Unspecified Limb N 7559 Unspecified Congenital Anomaly of Unspecified Limb N 7560 Congenital Anomalies of Skull and Face Bones N 7562 Cervical Rib N 7563 Other Congenital Anomaly of Ribs and Sternum N 7564 Chondrodystrophy N 7566 Congenital Anomaly of Diaphragm N 7567 Congenital Anomalies of Abdominal Wall N 7568 Congenital Absence of Muscle and Tendon N 7569 Other and Unspecified Congenital Anomaly of Musculoskeletal System N 7570 Hereditary Edema of Legs N 7571 Ichthyosis Congenita N 7572 Dermatoglyphic Anomalies N 7573 Other Specified Congenital Anomalies of Skin N 7574 Specified Congenital Anomalies of Hair N 7575 Specified Congenital Anomalies of Nails N 7576 Specified Congenital Anomalies of Breast N 7578 Other Specified Congenital Anomalies of the Integument N 7579 Unspecified Congenital Anomaly of the Integument N 7580 Down’s Syndrome N 7581 Patau’s Syndrome N 7582 Edwards' Syndrome N 7583 Autosomal Deletion Syndromes N 7584 Balanced Autosomal Translocation in Normal Individual N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 90 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 7585 Other Conditions due to Autosomal Anomalies N 7586 Gonadal Dysgenesis N 7587 Klinefelter’s Syndrome N 7588 Other Conditions due to Chromosome Anomalies N 7589 Conditions due to Anomaly of Unspecified Chromosome N 7590 Congenital Anomalies of Spleen N 7591 Congenital Anomalies of Adrenal Gland N 7592 Congenital Anomalies of Other Endocrine Glands N 7593 Situs Inversus N 7594 Conjoined Twins N 7595 Tuberous Sclerosis N 7596 Other Congenital Hamartoses, Not Elsewhere Classified N 7597 Multiple Congenital Anomalies, So Described N 7598 Other Specified Anomalies N 7599 Unspecified Congenital Anomaly N 7600 Fetus or Newborn Affected by Maternal Hypertensive Disorders N 7601 Fetus or Newborn Affected by Maternal Renal and Urinary Tract Diseases N 7602 Fetus or Newborn Affected by Maternal Infections N Fetus or Newborn Affected by Other Chronic Maternal Circulatory and Respiratory 7603 Diseases N 7604 Fetus or Newborn Affected by Maternal Nutritional Disorders N 7605 Fetus or Newborn Affected by Maternal Injury N 7606 Fetus or Newborn Affected by Surgical Operation on Mother N 7608 Other Specified Maternal Conditions Affecting Fetus or Newborn Y 7609 Unspecified Maternal Condition Affecting Fetus or Newborn Y 7610 Fetus or Newborn Affected by Incompetent Cervix of Mother Y 7611 Fetus or Newborn Affected by Premature Rupture of Membranes of Mother Y 7612 Fetus or Newborn Affected by Oligohydramnios Y 7613 Fetus or Newborn Affected by Polyhydramnios Y 7614 Fetus or Newborn Affected by Ectopic Pregnancy of Mother Y 7615 Fetus or Newborn Affected by Multiple Pregnancy of Mother Y 7616 Fetus or Newborn Affected by Maternal Death Y 7617 Fetus or Newborn Affected by Malpresentation Before Labor Y 7618 Fetus or Newborn Affected by Other Specified Maternal Complications of Pregnancy Y 7619 Fetus or Newborn Affected by Unspecified Maternal Complication of Pregnancy Y 7620 Fetus or Newborn Affected by Placenta Previa Y 7621 Fetus or Newborn Affected by Other Forms of Placental Separation and Hemorrhage Y Fetus or Newborn Affected by Other Forms of Other and Unspecified Morphological and 7622 Functional Abnormalities of Placenta Y 7623 Fetus or Newborn Affected by Placental Transfusion Syndromes Y 7624 Fetus or Newborn Affected by Prolapsed Cord Y 7625 Fetus or Newborn Affected by Other Compression of Umbilical Cord Y 7626 Fetus or Newborn Affected by Other and Unspecified Conditions of Umbilical Cord Y 7627 Fetus or Newborn Affected by Chorioamnionitis Y 7628 Fetus or Newborn Affected by Other Specified Abnormalities of Chorion and Amnion Y 7629 Fetus or Newborn Affected by Unspecified Abnormality of Chorion and Amnion N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 91 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 7630 Fetus or Newborn Affected by Breech Delivery and Extraction Y Fetus or Newborn Affected by Other Malpresentation, Malposition, and Disproportion 7631 During Labor and Delivery Y 7632 Fetus or Newborn Affected by Forceps Delivery Y 7633 Fetus or Newborn Affected by Delivery by Vacuum Extractor Y 7634 Fetus or Newborn Affected by Cesarean Delivery Y 7635 Fetus or Newborn Affected by Maternal Anesthesia and Analgesia Y 7636 Fetus or Newborn Affected by Precipitate Delivery Y 7637 Fetus or Newborn Affected by Abnormal Uterine Contractions Y 7638 Other Specified Complications of Labor and Delivery Affecting Fetus Or Y 7639 Unspecified Complication of Labor and Delivery Affecting Fetus or Newborn Y 7660 Exceptionally Large Baby Relating to Long Gestation Y 7661 Other "Heavy-For-Dates" Infants Not Related to Gestation Period Y 7662 Post-Term Infant, Not "Heavy-For-Dates" Y 7670 Subdural and Cerebral Hemorrhage, Birth Trauma Y 7671 Injuries to Scalp due to Birth Trauma Y 7672 Fracture of Clavicle, Birth Trauma Y 7673 Other Injuries to Skeleton, Birth Trauma Y 7674 Injury to Spine and Spinal Cord, Birth Trauma Y 7675 Facial Nerve Injury, Birth Trauma Y 7676 Injury to Brachial Plexus, Birth Trauma Y 7677 Other Cranial and Peripheral Nerve Injuries, Birth Trauma Y 7678 Other Specified Birth Trauma Y 7679 Unspecified Birth Trauma Y 7680 Fetal Death From Asphyxia or Anoxia Before Onset of Labor or at Unspecified Time Y 7681 Fetal Death From Asphyxia or Anoxia During Labor Y 7682 Fetal Distress Before Onset of Labor, in Liveborn Infant Y 7683 Fetal Distress First Noted During Labor, in Liveborn Infant Y 7684 Fetal Distress, Unspecified as to Time of Onset, in Liveborn Infant Y 7685 Severe Birth Asphyxia Y 7686 Mild or Moderate Birth Asphyxia Y 7689 Unspecified Birth Asphyxia in Liveborn Infant Y 7700 Congenital Pneumonia Y 7701 Meconium Aspiration Syndrome Y 7702 Interstitial Emphysema and Related Conditions of Newborn Y 7703 Pulmonary Hemorrhage of Fetus or Newborn Y 7704 Primary Atelectasis of Newborn Y 7705 Other and Unspecified Atelectasis of Newborn Y 7706 Transitory Tachypnea of Newborn Y 7707 Chronic Respiratory Disease Arising in the Perinatal Period Y 7708 Other Newborn Respiratory Problems Y 7709 Unspecified Respiratory Condition of Fetus and Newborn Y 7710 Congenital Rubella Y 7711 Congenital Cytomegalovirus Infection Y 7712 Other Congenital Infection Specific to the Perinatal Period Y 7713 Tetanus Neonatorum Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 92 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 7714 Omphalitis of the Newborn Y 7715 Neonatal Infective Mastitis Y 7716 Neonatal Conjunctivitis and Dacryocystitis Y 7717 Neonatal Candida Infection Y 7718 Other Type of Infection Specific to the Perinatal Period Y 7720 Fetal Blood Loss Y 7721 Intraventricular Hemorrhage of Fetus or Newborn Y 7722 Fetal and Neonatal Subarachnoid Hemorrhage of Newborn Y 7723 Umbilical Hemorrhage After Birth Y 7724 Fetal and Neonatal Gastrointestinal Hemorrhage Y 7725 Fetal and Neonatal Adrenal Hemorrhage Y 7726 Fetal and Neonatal Cutaneous Hemorrhage Y 7728 Other Specified Hemorrhage of Fetus or Newborn Y 7729 Unspecified Hemorrhage of Newborn Y 7730 Hemolytic Disease due to Rh Isoimmunization of Fetus or Newborn Y 7731 Hemolytic Disease due to Abo Isoimmunization of Fetus or Newborn Y 7732 Hemolytic Disease due to Other and Unspecified Isoimmunization of Fetus or Newborn Y 7733 Hydrops Fetalis due to Isoimmunization Y 7734 Kernicterus due to Isoimmunization of Fetus or Newborn Y 7735 Late Anemia due to Isoimmunization of Fetus or Newborn Y 7740 Perinatal Jaundice From Hereditary Hemolytic Anemias Y 7741 Perinatal Jaundice From Other Excessive Hemolysis Y 7742 Neonatal Jaundice Associated With Preterm Delivery Y 7744 Perinatal Jaundice due to Hepatocellular Damage N 7745 Perinatal Jaundice From Other Causes Y 7746 Unspecified Fetal and Neonatal Jaundice Y 7747 Kernicterus of Fetus or Newborn Not due to Isoimmunization Y 7750 Syndrome of "Infant of Diabetic Mother" Y 7751 Neonatal Diabetes Mellitus Y 7752 Neonatal Myasthenia Gravis Y 7753 Neonatal Thyrotoxicosis Y 7754 Hypocalcemia and Hypomagnesemia of Newborn Y 7755 Other Transitory Neonatal Electrolyte Disturbances Y 7756 Neonatal Hypoglycemia Y 7757 Late Metabolic Acidosis of Newborn Y 7758 Other Transitory Neonatal Endocrine and Metabolic Disturbances Y 7759 Unspecified Endocrine and Metabolic Disturbances Specific to the Fetus and Newborn Y 7760 Hemorrhagic Disease of Newborn Y 7761 Transient Neonatal Thrombocytopenia Y 7762 Disseminated Intravascular Coagulation in Newborn Y 7763 Other Transient Neonatal Disorders of Coagulation Y 7764 Polycythemia Neonatorum Y 7765 Congenital Anemia Y 7766 Anemia of Neonatal Prematurity Y 7767 Transient Neonatal Neutropenia Y 7768 Other Specified Transient Hematological Disorders of Fetus or Newborn Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 93 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 7769 Unspecified Hematological Disorder Specific to Fetus or Newborn Y 7771 Fetal and Newborn Meconium Obstruction Y 7772 Neonatal Intestinal Obstruction due to Inspissated Milk Y 7773 Neonatal Hematemesis and Melena due to Swallowed Maternal Blood Y 7774 Transitory Ileus of Newborn Y 7775 Necrotizing Enterocolitis in Fetus or Newborn Y 7776 Perinatal Intestinal Perforation Y 7778 Other Specified Perinatal Disorder of Digestive System Y 7779 Unspecified Perinatal Disorder of Digestive System Y 7780 Hydrops Fetalis Not due to Isoimmunization Y 7781 Sclerema Neonatorum Y 7782 Cold Injury Syndrome of Newborn Y 7783 Other Hypothermia of Newborn Y 7784 Other Disturbance of Temperature Regulation of Newborn Y 7785 Other and Unspecified Edema of Newborn Y 7786 Congenital Hydrocele Y 7787 Breast Engorgement in Newborn Y 7788 Other Specified Condition Involving the Integument of Fetus and Newborn Y Unspecified Condition Involving the Integument and Temperature Regulation of Fetus and 7789 Newborn Y 7790 Convulsions in Newborn Y 7791 Other and Unspecified Cerebral Irritability in Newborn Y 7792 Cerebral Depression, Coma, and Other Abnormal Cerebral Signs in Fetus or Newborn Y 7793 Feeding Problems in Newborn Y 7794 Drug Reactions and Intoxications Specific to Newborn Y 7795 Drug Withdrawal Syndrome in Newborn Y 7796 Termination of Pregnancy (Fetus) Y 7797 Periventricular Leukomalacia Y 07798 Unspecified Diseases of Conjunctiva due to Chlamydiae Y 7798 Other Specified Conditions Originating in the Perinatal Period Y 07799 Unspecified Diseases of Conjunctiva due to Viruses Y 7799 Unspecified Condition Originating in the Perinatal Period Y 7801 Hallucinations Y 7802 Syncope and Collapse Y 7803 Convulsions Y 7804 Dizziness and Giddiness N 7806 Fever S 7807 Malaise and Fatigue N 7808 Generalized Hyperhidrosis N 7809 Other General Symptoms N 07810 Unspecified Viral Warts N 7810 Abnormal Involuntary Movements N 07811 Condyloma Acuminatum N 7811 Disturbances of Sensation of Smell and Taste N 7812 Abnormality of Gait N 7813 Lack of Coordination N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 94 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 7814 Transient Paralysis of Limb Y 7815 Clubbing of Fingers N 7816 Meningismus S 7817 Tetany S 7818 Neurological Neglect Syndrome Y 07819 Other Specified Viral Warts N 7819 Other Symptoms Involving Nervous and Musculoskeletal Systems N 7820 Disturbance of Skin Sensation N 7821 Rash and Other Nonspecific Skin Eruption N 7822 Localized Superficial Swelling, Mass, or Lump N 7823 Edema N 7824 Jaundice, Unspecified, Not of Newborn N 7825 Cyanosis Y 7826 Pallor and Flushing N 7827 Spontaneous Ecchymoses Y 7828 Changes in Skin Texture N 7829 Other Symptoms Involving Skin and Integumentary Tissues N 7830 Anorexia N 7831 Abnormal Weight Gain N 7832 Abnormal Loss of Weight N 7833 Feeding Difficulties and Mismanagement N 7834 Lack of Expected Normal Physiological Development N 7835 Polydipsia N 7836 Polyphagia N 7837 Adult Failure to Thrive N 7839 Other Symptoms Concerning Nutrition, Metabolism, and Development N 7840 Headache N 7841 Throat Pain N 7842 Swelling, Mass, or Lump in Head and Neck Y 7843 Aphasia Y 7845 Other Speech Disturbance N 7847 Epistaxis Y 7848 Hemorrhage From Throat Y 7849 Other Symptoms Involving Head and Neck N 7850 Unspecified Tachycardia Y 7851 Palpitations Y 7852 Undiagnosed Cardiac Murmurs S 7853 Other Abnormal Heart Sounds S 7854 Gangrene Y 7856 Enlargement of Lymph Nodes N 7859 Other Symptoms Involving Cardiovascular System N 7861 Stridor Y 7862 Cough Y 7863 Hemoptysis Y 7864 Abnormal Sputum Y 7866 Swelling, Mass, or Lump in Chest Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 95 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 7867 Abnormal Chest Sounds N 7868 Hiccough N 7869 Other Symptoms Involving Respiratory System and Chest N 7871 Heartburn N 7872 Dysphagia N 7873 Flatulence, Eructation, and Gas Pain N 7874 Visible Peristalsis N 7875 Abnormal Bowel Sounds N 7876 Incontinence of Feces N 7877 Abnormal Feces N 7880 Renal Colic S 07881 Epidemic Vertigo N 7881 Dysuria S 07882 Epidemic Vomiting Syndrome N 7885 Oliguria and Anuria S 7887 Urethral Discharge N 07888 Other Specified Diseases due to Chlamydiae N 7888 Extravasation of Urine N 07889 Other Specified Diseases due to Viruses N 7889 Other Symptoms Involving Urinary System N 7891 Hepatomegaly Y 7892 Splenomegaly Y 7895 Ascites Y 7899 Other Symptoms Involving Abdomen and Pelvis Y 7900 Abnormality of Red Blood Cells N 7901 Elevated Sedimentation Rate N 7902 Abnormal Glucose Tolerance Test N 7903 Excessive Blood Level of Alcohol N 7904 Nonspecific Elevation of Levels of Transaminase or Lactic Acid Dehydrogenase (Ldh) N 7905 Other Nonspecific Abnormal Serum Enzyme Levels N 7906 Other Abnormal Blood Chemistry N 7907 Bacteremia N 7908 Unspecified Viremia N 7910 Proteinuria N 7911 Chyluria N 7912 Hemoglobinuria N 7913 Myoglobinuria N 7914 Biliuria N 7915 Glycosuria N 7916 Acetonuria N 7917 Other Cells and Casts in Urine N 7919 Other Nonspecific Finding on Examination of Urine N 7920 Nonspecific Abnormal Finding in Cerebrospinal Fluid N 7921 Nonspecific Abnormal Finding in Stool Contents N 7922 Nonspecific Abnormal Finding in Semen N 7923 Nonspecific Abnormal Finding in Amniotic Fluid N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 96 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 7924 Nonspecific Abnormal Finding in Saliva N 7925 Cloudy (Hemodialysis) (Peritoneal) Dialysis Affluent N 7929 Other Nonspecific Abnormal Finding in Body Substances N Nonspecific Abnormal Findings on Radiological and Other Examination of Skull and 7930 Head N 7931 Nonspecific Abnormal Findings on Radiological and Other Examination of Lung Field N Nonspecific Abnormal Findings on Radiological and Other Examination of Other 7932 Intrathoracic Organs N

7933 Nonspecific Abnormal Findings on Radiological and Other Examination of Biliary Tract N Nonspecific Abnormal Findings on Radiological and Other Examination of 7934 Gastrointestinal Tract N Nonspecific Abnormal Findings on Radiological and Other Examination of Genitourinary 7935 Organs N Nonspecific Abnormal Findings on Radiological and Other Examination of Abdominal 7936 Area, Including Retroperitoneum N Nonspecific Abnormal Findings on Radiological and Other Examination of 7937 Musculoskeletal System N 7938 Nonspecific Abnormal Findings on Radiologic and Other Exam Breast N Nonspecific Abnormal Findings on Radiological and Other Examination of Other Site of 7939 Body N 7942 Nonspecific Abnormal Results of Pulmonary System Function Study N 7944 Nonspecific Abnormal Results of Kidney Function Study N 7945 Nonspecific Abnormal Results of Thyroid Function Study N 7946 Nonspecific Abnormal Results of Other Endocrine Function Study N 7947 Nonspecific Abnormal Results of Basal Metabolism Function Study N 7948 Nonspecific Abnormal Results of Liver Function Study N 7949 Nonspecific Abnormal Results of Other Specified Function Study N 07950 Unspecified Retrovirus in Conditions Classified Elsewhere And of Unspecified Site N 7950 Nonspecific Abnormal Papanicolaou Smear Cervix N Human T-Cell Lymphotrophic Virus, Type I (Htlv-I), in Conditions Classified Elsewhere 07951 And of Unspecified Site N 7951 Nonspecific Abnormal Papanicolaou Smear of Other Site N Human T-Cell Lymphotrophic Virus, Type II (Htlv-II), in Conditions Classified Elsewhere 07952 And of Unspecified Site N 7952 Nonspecific Abnormal Findings on Chromosomal Analysis N Human Immunodeficiency Virus, Type 2 (Hiv 2), in Conditions Classified Elsewhere And 07953 of Unspecified Site N 7953 Nonspecific Positive Culture Findings N 7954 Other Nonspecific Abnormal Histological Findings N 7955 Nonspecific Reaction to Tuberculin Skin Test Without Active Tuberculosis N 7956 False Positive Serological Test for Syphilis N 07959 Other Specified Retrovirus, in Conditions Classified Elsewhere And of Unspecified Site N 7960 Nonspecific Abnormal Toxicological Findings N 7961 Abnormal Reflex N 7962 Elevated Blood Pressure Reading Without Diagnosis of Hypertension N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 97 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 7963 Nonspecific Low Blood Pressure Reading N 7964 Other Abnormal Clinical Finding N 7965 Abnormal Finding on Antenatal Screening N 7966 Nonspecific Abnormal Findings on Neonatal Screening N 7969 Other Nonspecific Abnormal Finding N 7980 Sudden Infant Death Syndrome Y 07981 Hantavirus Infection N 7981 Instantaneous Death Y Death Occurring in Less Than 24 Hours From Onset of Symptoms, Not Otherwise 7982 Explained Y Other Specified Chlamydial Infection, in Conditions Classified Elsewhere and of 07988 Unspecified Site N Other Specified Viral Infection, in Conditions Classified Elsewhere and of Unspecified 07989 Site N 7989 Unattended Death Y 7990 Asphyxia Y 7991 Respiratory Arrest Y 7992 Nervousness N 7993 Unspecified Debility N 7994 Cachexia N Unspecified Chlamydial Infection, in Conditions Classified Elsewhere and of Unspecified 07998 Site N 7998 Other Ill-Defined Conditions N 07999 Unspecified Viral Infection, in Conditions Classified Elsewhere and of Unspecified Site N 7999 Other Unknown and Unspecified Cause of Morbidity or Mortality N 8020 Nasal Bones, Closed Fracture Y 8021 Nasal Bones, Open Fracture Y 8024 Malar and Maxillary Bones, Closed Fracture Y 8025 Malar and Maxillary Bones, Open Fracture Y 8026 Orbital Floor (Blow-Out), Closed Fracture Y 8027 Orbital Floor (Blow-Out), Open Fracture Y 8028 Other Facial Bones, Closed Fracture Y 8029 Other Facial Bones, Open Fracture Y 8052 Closed Fracture of Dorsal (Thoracic) Vertebra Without Mention of Spinal Cord Injury Y 8053 Open Fracture of Dorsal (Thoracic) Vertebra Without Mention of Spinal Cord Injury Y 8054 Closed Fracture of Lumbar Vertebra Without Mention of Spinal Cord Injury Y 8055 Open Fracture of Lumbar Vertebra Without Mention of Spinal Cord Injury Y 8056 Closed Fracture of Sacrum and Coccyx Without Mention of Spinal Cord Injury Y 8057 Open Fracture of Sacrum and Coccyx Without Mention of Spinal Cord Injury Y Closed Fracture of Unspecified Part of Vertebral Column Without Mention of Spinal Cord 8058 Injury Y Open Fracture of Unspecified Part of Vertebral Column Without Mention of Spinal Cord 8059 Injury Y 8064 Closed Fracture of Lumbar Spine With Spinal Cord Injury Y 8065 Open Fracture of Lumbar Spine With Spinal Cord Injury Y 8068 Closed Fracture of Unspecified Vertebra With Spinal Cord Injury Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 98 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 8069 Open Fracture of Unspecified Vertebra With Spinal Cord Injury Y 8072 Closed Fracture of Sternum Y 8073 Open Fracture of Sternum Y 8074 Flail Chest Y 8075 Closed Fracture of Larynx and Trachea Y 8076 Open Fracture of Larynx and Trachea Y 8080 Closed Fracture of Acetabulum Y 8081 Open Fracture of Acetabulum Y 8082 Closed Fracture of Pubis Y 8083 Open Fracture of Pubis Y 8084 Closed Fracture of Other Specified Part of Pelvis Y 8085 Open Fracture of Other Specified Part of Pelvis Y 8088 Unspecified Closed Fracture of Pelvis Y 8089 Unspecified Open Fracture of Pelvis Y 8090 Fracture of Bones of Trunk, Closed Y 8091 Fracture of Bones of Trunk, Open Y 8170 Multiple Closed Fractures of Hand Bones Y 8171 Multiple Open Fractures of Hand Bones Y 8180 Ill-Defined Closed Fractures of Upper Limb Y 8181 Ill-Defined Open Fractures of Upper Limb Y Multiple Closed Fractures Involving Both Upper Limbs, and Upper Limb With Rib(s) and 8190 Sternum Y Multiple Open Fractures Involving Both Upper Limbs, and Upper Limb With Rib(s) and 8191 Sternum Y 8208 Closed Fracture of Unspecified Part of Neck of Femur Y 8209 Open Fracture of Unspecified Part of Neck of Femur Y 8220 Closed Fracture of Patella Y 8221 Open Fracture of Patella Y 08240 Ehrlichiosis, Unspecified S 8240 Closed Fracture of Medial Malleolus Y 08241 Ehrlichiosis Chafeensis [E. Chafeensis] S 8241 Open Fracture of Medial Malleolus Y 8242 Closed Fracture of Lateral Malleolus Y 8243 Open Fracture of Lateral Malleolus Y 8244 Closed Bimalleolar Fracture Y 8245 Open Bimalleolar Fracture Y 8246 Closed Trimalleolar Fracture Y 8247 Open Trimalleolar Fracture Y 8248 Unspecified Closed Fracture of Ankle Y 08249 Other Ehrlichiosis S 8249 Unspecified Open Fracture of Ankle Y 8250 Closed Fracture of Calcaneus Y 8251 Open Fracture of Calcaneus Y 8260 Closed Fracture of One or More Phalanges of Foot Y 8261 Open Fracture of One or More Phalanges of Foot Y 8270 Other, Multiple and Ill-Defined Closed Fractures of Lower Limb Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 99 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 8271 Other, Multiple and Ill-Defined Open Fractures of Lower Limb Y Multiple Closed Fractures Involving Both Lower Limbs, Lower With Upper Limb, and 8280 Lower Limb(s) With Rib(s) and Sternum Y Multiple Fractures Involving Both Lower Limbs, Lower With Upper Limb, and Lower 8281 Limb(s) With Rib(s) and Sternum, Open Y 8290 Closed Fracture of Unspecified Bone Y 8291 Open Fracture of Unspecified Bone Y 8300 Closed Dislocation of Jaw Y 8301 Open Dislocation of Jaw Y 8360 Tear of Medial Cartilage or Meniscus of Knee, Current Y 8361 Tear of Lateral Cartilage or Meniscus of Knee, Current Y 8362 Other Tear of Cartilage or Meniscus of Knee, Current Y 8363 Closed Dislocation of Patella Y 8364 Open Dislocation of Patella Y 8370 Closed Dislocation of Ankle Y 8371 Open Dislocation of Ankle Y 8398 Closed Dislocation, Multiple and Ill-Defined Sites Y 8399 Open Dislocation, Multiple and Ill-Defined Sites Y 8400 Acromioclavicular (Joint) (Ligament) Sprain and Strain Y 8401 Coracoclavicular (Ligament) Sprain and Strain Y 8402 Coracohumeral (Ligament) Sprain and Strain Y 8403 Infraspinatus (Muscle) (Tendon) Sprain and Strain Y 8404 Rotator Cuff (Capsule) Sprain and Strain Y 8405 Subscapularis (Muscle) Sprain and Strain Y 8406 Supraspinatus (Muscle) (Tendon) Sprain and Strain Y 8407 Superior Glenoid Labrum Lesions (Slap) Y 8408 Sprain and Strain of Other Specified Sites of Shoulder and Upper Arm Y 8409 Sprain and Strain of Unspecified Site of Shoulder and Upper Arm Y 8410 Radial Collateral Ligament Sprain and Strain Y 8411 Ulnar Collateral Ligament Sprain and Strain Y 8412 Radiohumeral (Joint) Sprain and Strain Y 8413 Ulnohumeral (Joint) Sprain and Strain Y 8418 Sprain and Strain of Other Specified Sites of Elbow and Forearm Y 8419 Sprain and Strain of Unspecified Site of Elbow and Forearm Y 8430 Iliofemoral (Ligament) Sprain and Strain Y 8431 Ischiocapsular (Ligament) Sprain and Strain Y 8438 Sprain and Strain of Other Specified Sites of Hip and Thigh Y 8439 Sprain and Strain of Unspecified Site of Hip and Thigh Y 8440 Sprain and Strain of Lateral Collateral Ligament of Knee Y 8441 Sprain and Strain of Medial Collateral Ligament of Knee Y 8442 Sprain and Strain of Cruciate Ligament of Knee Y 8443 Sprain and Strain of Tibiofibular (Joint) (Ligament) Superior, of Knee Y 8448 Sprain and Strain of Other Specified Sites of Knee and Leg Y 8449 Sprain and Strain of Unspecified Site of Knee and Leg Y 8460 Sprain and Strain of Lumbosacral (Joint) (Ligament) Y 8461 Sprain and Strain of Sacroiliac (Ligament) Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 100 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 8462 Sprain and Strain of Sacrospinatus (Ligament) Y 8463 Sprain and Strain of Sacrotuberous (Ligament) Y 8468 Other Specified Sites of Sacroiliac Region Sprain and Strain Y 8469 Unspecified Site of Sacroiliac Region Sprain and Strain Y 8470 Neck Sprain and Strain Y 8471 Thoracic Sprain and Strain Y 8472 Lumbar Sprain and Strain Y 8473 Sprain and Strain of Sacrum Y 8474 Sprain and Strain of Coccyx Y 8479 Sprain and Strain of Unspecified Site of Back Y 8480 Sprain and Strain of Septal Cartilage of Nose Y 8481 Sprain and Strain of Jaw Y 8482 Sprain and Strain of Thyroid Region Y 8483 Sprain and Strain of Ribs Y 8485 Pelvic Sprain and Strains Y 8488 Other Specified Sites of Sprains and Strains Y 8489 Unspecified Site of Sprain and Strain N 8500 Concussion With No Loss of Consciousness Y 8501 Concussion With Brief Loss of Consciousness Y 8502 Concussion With Moderate (1-24 Hours) Loss of Consciousness Y Concussion With Prolonged (More Than 24 Hours) Loss of Consciousness and Return to 8503 Pre-Existing Conscious Level Y Concussion With Prolonged (More Than 24 Hours) Loss of Consciousness, Without 8504 Return to Pre-Existing Conscious Level Y 8505 Concussion With Loss of Consciousness of Unspecified Duration Y 8509 Unspecified Concussion Y 8600 Traumatic Pneumothorax Without Mention of Open Wound Into Thorax Y 8601 Traumatic Pneumothorax With Open Wound Into Thorax Y 8602 Traumatic Hemothorax Without Mention of Open Wound Into Thorax Y 8603 Traumatic Hemothorax With Open Wound Into Thorax Y 8604 Traumatic Pneumohemothorax Without Mention of Open Wound Into Thorax Y 8605 Traumatic Pneumohemothorax With Open Wound Into Thorax Y 8620 Diaphragm Injury Without Mention of Open Wound Into Cavity Y 8621 Diaphragm Injury With Open Wound Into Cavity Y 8622 Injury to Other Specified Intrathoracic Organs Without Mention of Open Y 8623 Injury to Other Specified Intrathoracic Organs With Open Wound Into Ca Y Injury to Multiple and Unspecified Intrathoracic Organs Without Mention of Open Wound 8628 Into Cavity Y 8629 Injury to Multiple and Unspecified Intrathoracic Organs With Open Wound Into Cavity Y 8630 Stomach Injury Without Mention of Open Wound Into Cavity Y 8631 Stomach Injury With Open Wound Into Cavity Y 8670 Bladder and Urethra Injury Without Mention of Open Wound Into Cavity Y 8671 Bladder and Urethra Injury With Open Wound Into Cavity Y 8672 Ureter Injury Without Mention of Open Wound Into Cavity Y 8673 Ureter Injury With Open Wound Into Cavity Y 8674 Uterus Injury Without Mention of Open Wound Into Cavity Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 101 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 8675 Uterus Injury With Open Wound Into Cavity Y 8676 Injury to Other Specified Pelvic Organs Without Mention of Open Wound Into Cavity Y 8677 Injury to Other Specified Pelvic Organs With Open Wound Into Cavity Y 8678 Injury to Unspecified Pelvic Organ Without Mention of Open Wound Into Cavity Y 8679 Injury to Unspecified Pelvic Organ With Open Wound Into Cavity Y Internal Injury to Unspecified or Ill-Defined Organs Without Mention of Open Wound 8690 Into Cavity Y 8691 Internal Injury to Unspecified or Ill-Defined Organs With Open Wound Into Cavity Y 8700 Laceration of Skin of Eyelid and Periocular Area Y 8701 Laceration of Eyelid, Full-Thickness, Not Involving Lacrimal Passages Y 8702 Laceration of Eyelid Involving Lacrimal Passages Y 8703 Penetrating Wound of Orbit, Without Mention of Foreign Body Y 8704 Penetrating Wound of Orbit With Foreign Body Y 8708 Other Specified Open Wound of Ocular Adnexa Y 8709 Unspecified Open Wound of Ocular Adnexa Y 8710 Ocular Laceration Without Prolapse of Intraocular Tissue Y 8711 Ocular Laceration With Prolapse or Exposure of Intraocular Tissue Y 8712 Rupture of Eye With Partial Loss of Intraocular Tissue Y 8713 Avulsion of Eye Y 8714 Unspecified Laceration of Eye Y 8715 Penetration of Eyeball With Magnetic Foreign Body Y 8716 Penetration of Eyeball With (Nonmagnetic) Foreign Body Y 8717 Unspecified Ocular Penetration Y 8719 Unspecified Open Wound of Eyeball Y 8726 Open Wound of Other Specified Parts of Ear, Without Mention of Complic Y 8727 Open Wound of Other Specified Parts of Ear, Complicated Y 8728 Open Wound of Ear, Part Unspecified, Without Mention of Complication Y 8729 Open Wound of Ear, Part Unspecified, Complicated Y 8730 Open Wound of Scalp, Without Mention of Complication Y 8731 Open Wound of Scalp, Complicated Y 8738 Other and Unspecified Open Wound of Head Without Mention of Complication Y 8739 Other and Unspecified Open Wound of Head, Complicated Y 8742 Open Wound of Thyroid Gland, Without Mention of Complication Y 8743 Open Wound of Thyroid Gland, Complicated Y 8744 Open Wound of Pharynx, Without Mention of Complication Y 8745 Open Wound of Pharynx, Complicated Y

8748 Open Wound of Other and Unspecified Parts of Neck, Without Mention of Complication Y 8749 Open Wound of Other and Unspecified Parts of Neck, Complicated Y 8750 Open Wound of Chest (Wall), Without Mention of Complication Y 8751 Open Wound of Chest (Wall), Complicated Y 8760 Open Wound of Back, Without Mention of Complication Y 8761 Open Wound of Back, Complicated Y 8770 Open Wound of Buttock, Without Mention of Complication Y 8771 Open Wound of Buttock, Complicated Y 8780 Open Wound of Penis, Without Mention of Complication Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 102 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 8781 Open Wound of Penis, Complicated Y 8782 Open Wound of Scrotum and Testes, Without Mention of Complication Y 8783 Open Wound of Scrotum and Testes, Complicated Y 8784 Open Wound of Vulva, Without Mention of Complication Y 8785 Open Wound of Vulva, Complicated Y 8786 Open Wound of Vagina, Without Mention of Complication Y 8787 Open Wound of Vagina, Complicated Y Open Wound of Other and Unspecified Parts of Genital Organs, Without Mention of 8788 Complication Y 8789 Open Wound of Other and Unspecified Parts of Genital Organs, Complicated Y 8790 Open Wound of Breast, Without Mention of Complication Y 8791 Open Wound of Breast, Complicated Y 8792 Open Wound of Abdominal Wall, Anterior, Without Mention of Complication Y 8793 Open Wound of Abdominal Wall, Anterior, Complicated Y 8794 Open Wound of Abdominal Wall, Lateral, Without Mention of Complication Y 8795 Open Wound of Abdominal Wall, Lateral, Complicated Y

8796 Open Wound of Other and Unspecified Parts of Trunk, Without Mention of Complication Y 8797 Open Wound of Other and Unspecified Parts of Trunk, Complicated Y 8798 Open Wound(s) (Multiple) of Unspecified Site(s), Without Mention of Complication Y 8799 Open Wound(s) (Multiple) of Unspecified Site(s), Complicated Y 8820 Open Wound of Hand Except Finger(s) Alone, Without Mention of Complication Y 8821 Open Wound of Hand Except Finger(s) Alone, Complicated Y 8822 Open Wound of Hand Except Finger(s) Alone, With Tendon Involvement Y 8830 Open Wound of Finger(s), Without Mention of Complication Y 8831 Open Wound of Finger(s), Complicated Y 8832 Open Wound of Finger(s), With Tendon Involvement Y

8840 Multiple and Unspecified Open Wound of Upper Limb, Without Mention of Complication Y 8841 Multiple and Unspecified Open Wound of Upper Limb, Complicated Y 8842 Multiple and Unspecified Open Wound of Upper Limb, With Tendon Involvement Y

8850 Traumatic Amputation of Thumb (Complete) (Partial), Without Mention of Complication Y 8851 Traumatic Amputation of Thumb (Complete) (Partial), Complicated Y Traumatic Amputation of Other Finger(s) (Complete) (Partial), Without Mention of 8860 Complication Y 8861 Traumatic Amputation of Other Finger(s) (Complete) (Partial), Complicated Y Traumatic Amputation of Arm and Hand (Complete) (Partial), Unilateral, Below Elbow, 8870 Without Mention of Complication Y Traumatic Amputation of Arm and Hand (Complete) (Partial), Unilateral, Below Elbow, 8871 Complicated Y Traumatic Amputation of Arm and Hand (Complete) (Partial), Unilateral, at or Above 8872 Elbow, Without Mention of Complication Y Traumatic Amputation of Arm and Hand (Complete) (Partial), Unilateral, at or Above 8873 Elbow, Complicated Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 103 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Traumatic Amputation of Arm and Hand (Complete) (Partial), Unilateral, Level Not 8874 Specified, Without Mention of Complication Y Traumatic Amputation of Arm and Hand (Complete) (Partial), Unilateral, Level Not 8875 Specified, Complicated Y Traumatic Amputation of Arm and Hand (Complete) (Partial), Bilateral (any Level), 8876 Without Mention of Complication Y Traumatic Amputation of Arm and Hand (Complete) (Partial), Bilateral (any Level), 8877 Complicated Y 08881 Lyme Disease Y 08882 Babesiosis N 08889 Other Specified Arthropod-Borne Diseases N 8900 Open Wound of Hip and Thigh, Without Mention of Complication Y 8901 Open Wound of Hip and Thigh, Complicated Y 8902 Open Wound of Hip and Thigh, With Tendon Involvement Y

8910 Open Wound of Knee, Leg (Except Thigh), and Ankle, Without Mention of Complication Y 8911 Open Wound of Knee, Leg (Except Thigh), and Ankle, Complicated Y 8912 Open Wound of Knee, Leg (Except Thigh), and Ankle, With Tendon Involvement Y 8920 Open Wound of Foot Except Toe(s) Alone, Without Mention of Complication Y 8921 Open Wound of Foot Except Toe(s) Alone, Complicated Y 8922 Open Wound of Foot Except Toe(s) Alone, With Tendon Involvement Y 8930 Open Wound of Toe(s), Without Mention of Complication Y 8931 Open Wound of Toe(s), Complicated Y 8932 Open Wound of Toe(s), With Tendon Involvement Y

8940 Multiple and Unspecified Open Wound of Lower Limb, Without Mention of Complication Y 8941 Multiple and Unspecified Open Wound of Lower Limb, Complicated Y 8942 Multiple and Unspecified Open Wound of Lower Limb, With Tendon Involvement Y

8950 Traumatic Amputation of Toe(s) (Complete) (Partial), Without Mention of Complication Y 8951 Traumatic Amputation of Toe(s) (Complete) (Partial), Complicated Y Traumatic Amputation of Foot (Complete) (Partial), Unilateral, Without Mention of 8960 Complication Y 8961 Traumatic Amputation of Foot (Complete) (Partial), Unilateral, Complicated Y Traumatic Amputation of Foot (Complete) (Partial), Bilateral, Without Mention of 8962 Complication Y 8963 Traumatic Amputation of Foot (Complete) (Partial), Bilateral, Complicated Y Traumatic Amputation of Leg(s) (Complete) (Partial), Unilateral, Below Knee, Without 8970 Mention of Complication Y Traumatic Amputation of Leg(s) (Complete) (Partial), Unilateral, Below Knee, 8971 Complicated Y Traumatic Amputation of Leg(s) (Complete) (Partial), Unilateral, at or Above Knee, 8972 Without Mention of Complication Y Traumatic Amputation of Leg(s) (Complete) (Partial), Unilateral, at or Above Knee, 8973 Complicated Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 104 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Traumatic Amputation of Leg(s) (Complete) (Partial), Unilateral, Level Not Specified, 8974 Without Mention of Complication Y Traumatic Amputation of Leg(s) (Complete) (Partial), Unilateral, Level Not Specified, 8975 Complicated Y Traumatic Amputation of Leg(s) (Complete) (Partial), Bilateral (any Level), Without 8976 Mention of Complication Y

8977 Traumatic Amputation of Leg(s) (Complete) (Partial), Bilateral (any Level), Complicated Y 9001 Internal Jugular Vein Injury Y 9008 Injury to Other Specified Blood Vessels of Head and Neck Y 9009 Injury to Unspecified Blood Vessel of Head and Neck Y 9010 Thoracic Aorta Injury Y 9011 Innominate and Subclavian Artery Injury Y 9012 Superior Vena Cava Injury Y 9013 Innominate and Subclavian Vein Injury Y 9018 Injury to Other Specified Blood Vessels of Thorax Y 9019 Injury to Unspecified Blood Vessel of Thorax Y 9020 Abdominal Aorta Injury Y 9023 Injury to Portal and Splenic Veins Y 9029 Injury to Blood Vessel of Abdomen and Pelvis, Unspecified Y 9031 Brachial Blood Vessels Injury Y 9032 Radial Blood Vessels Injury Y 9033 Ulnar Blood Vessels Injury Y 9034 Palmar Artery Injury Y 9035 Digital Blood Vessels Injury Y 9038 Injury to Specified Blood Vessels of Upper Extremity, Other Y 9039 Injury to Unspecified Blood Vessel of Upper Extremity Y 09040 Unspecified Juvenile Neurosyphilis N 9040 Common Femoral Artery Injury Y 09041 Congenital Syphilitic Encephalitis Y 9041 Superficial Femoral Artery Injury Y 09042 Congenital Syphilitic Meningitis Y 9042 Femoral Vein Injury Y 9043 Saphenous Vein Injury Y 9046 Deep Plantar Blood Vessels Injury Y 9047 Injury to Specified Blood Vessels of Lower Extremity, Other Y 9048 Injury to Unspecified Blood Vessel of Lower Extremity Y 09049 Other Juvenile Neurosyphilis N 9049 Injury to Blood Vessels, Unspecified Site Y 9050 Late Effect of Fracture of Skull and Face Bones N 9051 Late Effect of Fracture of Spine and Trunk Without Mention of Spinal Cord Lesion N 9052 Late Effect of Fracture of Upper Extremities N 9053 Late Effect of Fracture of Neck of Femur N 9054 Late Effect of Fracture of Lower Extremities N 9055 Late Effect of Fracture of Multiple and Unspecified Bones N 9056 Late Effect of Dislocation N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 105 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 9057 Late Effect of Sprain and Strain Without Mention of Tendon Injury N 9058 Late Effect of Tendon Injury N 9059 Late Effect of Traumatic Amputation N 9060 Late Effect of Open Wound of Head, Neck, and Trunk N 9061 Late Effect of Open Wound of Extremities Without Mention of Tendon Injury N 9062 Late Effect of Superficial Injury N 9063 Late Effect of Contusion N 9064 Late Effect of Crushing N 9065 Late Effect of Burn of Eye, Face, Head, and Neck N 9066 Late Effect of Burn of Wrist and Hand N 9067 Late Effect of Burn of Other Extremities N 9068 Late Effect of Burns of Other Specified Sites N 9069 Late Effect of Burn of Unspecified Site N 9070 Late Effect of Intracranial Injury Without Mention of Skull Fracture N 9071 Late Effect of Injury to Cranial Nerve N 9072 Late Effect of Spinal Cord Injury N 9073 Late Effect of Injury to Nerve Root(s), Spinal Plexus(Es), and Other Nerves of Trunk N 9074 Late Effect of Injury to Peripheral Nerve of Shoulder Girdle and Upper Limb N 9075 Late Effect of Injury to Peripheral Nerve of Pelvic Girdle and Lower Limb N 9079 Late Effect of Injury to Other and Unspecified Nerve N 9080 Late Effect of Internal Injury to Chest N 9081 Late Effect of Internal Injury to Intra-Abdominal Organs N 9082 Late Effect of Internal Injury to Other Internal Organs N 9083 Late Effect of Injury to Blood Vessel of Head, Neck, and Extremities N 9084 Late Effect of Injury to Blood Vessel of Thorax, Abdomen, and Pelvis N 9085 Late Effect of Foreign Body in Orifice N 9086 Late Effect of Certain Complications of Trauma N 9089 Late Effect of Unspecified Injury N 9090 Late Effect of Poisoning due to Drug, Medicinal or Biological Substance N 9091 Late Effect of Toxic Effects of Nonmedical Substances N 9092 Late Effect of Radiation N 9093 Late Effect of Complications of Surgical and Medical Care N 9094 Late Effect of Certain Other External Causes N 9095 Late Effect of Adverse Effect of Drug, Medical or Biological Substance N 9099 Late Effect of Other and Unspecified External Causes N Face, Neck, and Scalp, Except Eye, Abrasion or Friction Burn, Without Mention of 9100 Infection N 9101 Face, Neck, and Scalp Except Eye, Abrasion or Friction Burn, Infected Y 9102 Face, Neck, and Scalp Except Eye, Blister, Without Mention of Infection N 9103 Face, Neck, and Scalp Except Eye, Blister, Infected Y Face, Neck, and Scalp Except Eye, Insect Bite, Nonvenomous, Without Mention of 9104 Infection N 9105 Face, Neck, and Scalp Except Eye, Insect Bite, Nonvenomous,Infected Y Face, Neck, and Scalp, Except Eye, Superficial Foreign Body (Splinter), Without Major 9106 Open Wound or Mention of Infection N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 106 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Face, Neck, and Scalp Except Eye, Superficial Foreign Body (Splinter), Without Major 9107 Open Wound, Infected Y Other and Unspecified Superficial Injury of Face, Neck, and Scalp, Without Mention of 9108 Infection N 9109 Other and Unspecified Superficial Injury of Face, Neck, and Scalp, Infected Y 9110 Trunk Abrasion or Friction Burn, Without Mention of Infection N 9111 Trunk Abrasion or Friction Burn, Infected Y 9112 Trunk Blister, Without Mention of Infection N 9113 Trunk Blister, Infected Y 9114 Trunk, Insect Bite, Nonvenomous, Without Mention of Infection N 9115 Trunk, Insect Bite, Nonvenomous, Infected Y Trunk, Superficial Foreign Body (Splinter), Without Major Open Wound and Without 9116 Mention of Infection N 9117 Trunk, Superficial Foreign Body (Splinter), Without Major Open Wound, Infected Y 9118 Other and Unspecified Superficial Injury of Trunk, Without Mention of Infection N 9119 Other and Unspecified Superficial Injury of Trunk, Infected Y 9120 Shoulder and Upper Arm, Abrasion or Friction Burn, Without Mention of Infection N 9121 Shoulder and Upper Arm, Abrasion or Friction Burn, Infected Y 9122 Shoulder and Upper Arm, Blister, Without Mention of Infection N 9123 Shoulder and Upper Arm, Blister, Infected Y 9124 Shoulder and Upper Arm, Insect Bite, Nonvenomous, Without Mention of Infection N 9125 Shoulder and Upper Arm, Insect Bite, Nonvenomous, Infected Y Shoulder and Upper Arm, Superficial Foreign Body (Splinter), Without Major Open 9126 Wound and Without Mention of Infection N Shoulder and Upper Arm, Superficial Foreign Body (Splinter), Without Major Open 9127 Wound, Infected Y Other and Unspecified Superficial Injury of Shoulder and Upper Arm, Without Mention of 9128 Infection N 9129 Other and Unspecified Superficial Injury of Shoulder and Upper Arm, Infected Y 9130 Elbow, Forearm, and Wrist, Abrasion or Friction Burn, Without Mention of Infection N 9131 Elbow, Forearm, and Wrist, Abrasion or Friction Burn, Infected Y 9132 Elbow, Forearm, and Wrist, Blister, Without Mention of Infection N 9133 Elbow, Forearm, and Wrist, Blister Infected Y 9134 Elbow, Forearm, and Wrist, Insect Bite, Nonvenomous, Without Mention of Infection S 9135 Elbow, Forearm, and Wrist, Insect Bite, Nonvenomous, Infected S Elbow, Forearm, and Wrist, Superficial Foreign Body (Splinter), Without Major Open 9136 Wound and Without Mention of Infection S Elbow, Forearm, and Wrist, Superficial Foreign Body (Splinter), Without Major Open 9137 Wound, Infected S Other and Unspecified Superficial Injury of Elbow, Forearm, and Wrist, Without Mention 9138 of Infection S 9139 Other and Unspecified Superficial Injury of Elbow, Forearm, and Wrist, Infected S

9140 Hand(s) Except Finger(s) Alone, Abrasion or Friction Burn, Without Mention of Infection S 9141 Hand(s) Except Finger(s) Alone, Abrasion or Friction Burn, Infected S 9142 Hand(s) Except Finger(s) Alone, Blister, Without Mention of Infection S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 107 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 9143 Hand(s) Except Finger(s) Alone, Blister, Infected S

9144 Hand(s) Except Finger(s) Alone, Insect Bite, Nonvenomous, Without Mention of Infection S 9145 Hand(s) Except Finger(s) Alone, Insect Bite, Nonvenomous, Infected S Hand(s) Except Finger(s) Alone, Superficial Foreign Body (Splinter), Without Major Open 9146 Wound and Without Mention of Infection S Hand(s) Except Finger(s) Alone, Superficial Foreign Body (Splinter) Without Major Open 9147 Wound, Infected S Other and Unspecified Superficial Injury of Hand(s) Except Finger(s) Alone, Without 9148 Mention of Infection S 9149 Other and Unspecified Superficial Injury of Hand(s) Except Finger(s) Alone, Infected S 09150 Early Syphilis, Syphilitic Uveitis, Unspecified N 9150 Abrasion or Friction Burn of Finger, Without Mention of Infection S 09151 Early Syphilis, Syphilitic Chorioretinitis (Secondary) N 9151 Finger, Abrasion or Friction Burn, Infected S 09152 Early Syphilis, Syphilitic Iridocyclitis (Secondary) N 9152 Finger, Blister, Without Mention of Infection S 9153 Finger, Blister, Infected S 9154 Finger, Insect Bite, Nonvenomous, Without Mention of Infection S 9155 Finger, Insect Bite, Nonvenomous, Infected S Finger, Superficial Foreign Body (Splinter), Without Major Open Wound and Without 9156 Mention of Infection S 9157 Finger, Superficial Foreign Body (Splinter), Without Major Open Wound, Infected S 9158 Other and Unspecified Superficial Injury of Finger Without Mention of Infection S 9159 Other and Unspecified Superficial Injury of Finger, Infected S 9160 Hip, Thigh, Leg, and Ankle, Abrasion or Friction Burn, Without Mention of Infection S 09161 Early Syphilis, Secondary Syphilitic Periostitis N 9161 Hip, Thigh, Leg, and Ankle, Abrasion or Friction Burn, Infected S 09162 Early Syphilis, Secondary Syphilitic Hepatitis N 9162 Hip, Thigh, Leg, and Ankle, Blister, Without Mention of Infection S 9163 Hip, Thigh, Leg, and Ankle, Blister, Infected S 9164 Hip, Thigh, Leg, and Ankle, Insect Bite, Nonvenomous, Without Mention of Infection S 9165 Hip, Thigh, Leg, and Ankle, Insect Bite, Nonvenomous, Infected S Hip, Thigh, Leg, and Ankle, Superficial Foreign Body (Splinter), Without Major Open 9166 Wound and Without Mention of Infection S Hip, Thigh, Leg, and Ankle, Superficial Foreign Body (Splinter), Without Major Open 9167 Wound, Infected S Other and Unspecified Superficial Injury of Hip, Thigh, Leg, and Ankle, Without Mention 9168 of Infection S 09169 Early Syphilis, Secondary Syphilis of Other Viscera N 9169 Other and Unspecified Superficial Injury of Hip, Thigh, Leg, and Ankle, Infected S 9170 Abrasion or Friction Burn of Foot and Toe(s), Without Mention of Infection S 9171 Foot and Toe(s), Abrasion or Friction Burn, Infected S 9172 Foot and Toe(s), Blister, Without Mention of Infection S 9173 Foot and Toe(s), Blister, Infected S 9174 Foot and Toe(s), Insect Bite, Nonvenomous, Without Mention of Infection S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 108 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 9175 Foot and Toe(s), Insect Bite, Nonvenomous, Infected S Foot and Toe(s), Superficial Foreign Body (Splinter), Without Major Open Wound and 9176 Without Mention of Infection S Foot and Toe(s), Superficial Foreign Body (Splinter), Without Major Open Wound, 9177 Infected S

9178 Other and Unspecified Superficial Injury of Foot and Toes, Without Mention of Infection Y 9179 Other and Unspecified Superficial Injury of Foot and Toes, Infected Y 9180 Superficial Injury of Eyelids and Periocular Area Y 09181 Early Syphilis, Acute Syphilitic Meningitis (Secondary) Y 9181 Superficial Injury of Cornea Y 09182 Early Syphilis, Syphilitic Alopecia N 9182 Superficial Injury of Conjunctiva Y 09189 Early Syphilis, Other Forms of Secondary Syphilis N 9189 Other and Unspecified Superficial Injuries of Eye Y Abrasion or Friction Burn of Other, Multiple, and Unspecified Sites, Without Mention of 9190 Infection Y 9191 Other, Multiple, and Unspecified Sites, Abrasion or Friction Burn, Infected Y 9192 Other, Multiple, and Unspecified Sites, Blister, Without Mention of Infection Y 9193 Other, Multiple, and Unspecified Sites, Blister, Infected Y Other, Multiple, and Unspecified Sites, Insect Bite, Nonvenomous, Without Mention of 9194 Infection N 9195 Other, Multiple, and Unspecified Sites, Insect Bite, Nonvenomous, Infected Y Other, Multiple, and Unspecified Sites, Superficial Foreign Body (Splinter), Without 9196 Major Open Wound and Without Mention of Infection S Other, Multiple, and Unspecified Sites, Superficial Foreign Body (Splinter), Without 9197 Major Open Wound, Infected S Other and Unspecified Superficial Injury of Other, Multiple, and Unspecified Sites, 9198 Without Mention of Infection Y Other and Unspecified Superficial Injury of Other, Multiple, and Unspecified Sites, 9199 Infected Y 9210 Black Eye, Not Otherwise Specified Y 9211 Contusion of Eyelids and Periocular Area Y 9212 Contusion of Orbital Tissues Y 9213 Contusion of Eyeball Y 9219 Unspecified Contusion of Eye Y 9220 Contusion of Breast Y 9221 Contusion of Chest Wall Y 9222 Contusion of Abdominal Wall Y 9223 Contusion of Back Y 9224 Contusion of Genital Organs Y 9228 Contusion of Multiple Sites of Trunk Y 9229 Contusion of Unspecified Part of Trunk Y 9233 Contusion of Finger Y 9238 Contusion of Multiple Sites of Upper Limb Y 9239 Contusion of Unspecified Part of Upper Limb Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 109 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 9243 Contusion of Toe Y 9244 Contusion of Multiple Sites of Lower Limb Y 9245 Contusion of Unspecified Part of Lower Limb Y 9248 Contusion of Multiple Sites, Not Elsewhere Classified Y 9249 Contusion of Unspecified Site Y 9251 Crushing Injury of Face and Scalp Y 9252 Crushing Injury of Neck Y 9260 Crushing Injury of External Genitalia Y 9261 Crushing Injury of Other Specified Sites of Trunk Y 9268 Crushing Injury of Multiple Sites of Trunk Y 9269 Crushing Injury of Unspecified Site of Trunk Y 9273 Crushing Injury of Finger(s) Y 9278 Crushing Injury of Multiple Sites of Upper Limb Y 9279 Crushing Injury of Unspecified Site of Upper Limb Y 9283 Crushing Injury of Toe(s) Y 9288 Crushing Injury of Multiple Sites of Lower Limb Y 9289 Crushing Injury of Unspecified Site of Lower Limb Y 9290 Crushing Injury of Multiple Sites, Not Elsewhere Classified Y 9299 Crushing Injury of Unspecified Site Y 9300 Foreign Body in Cornea Y 9301 Foreign Body in Conjunctival Sac Y 9302 Foreign Body in Lacrimal Punctum Y 9308 Foreign Body in Other and Combined Sites on External Eye Y 9309 Foreign Body in Unspecified Site on External Eye Y 09320 Unspecified Syphilitic Endocarditis of Valve Y 09321 Syphilitic Endocarditis, Mitral Valve Y 09322 Syphilitic Endocarditis, Aortic Valve Y 09323 Syphilitic Endocarditis, Tricuspid Valve Y 09324 Syphilitic Endocarditis, Pulmonary Valve Y 9330 Foreign Body in Pharynx Y 9331 Foreign Body in Larynx Y 9340 Foreign Body in Trachea Y 9341 Foreign Body in Main Bronchus Y 9348 Foreign Body in Other Specified Parts of Trachea, Bronchus, and Lung Y 9349 Foreign Body in Respiratory Tree, Unspecified Y 9350 Foreign Body in Mouth S 9351 Foreign Body in Esophagus S 9352 Foreign Body in Stomach S 09381 Syphilitic Pericarditis Y 09382 Syphilitic Myocarditis Y 09389 Other Specified Cardiovascular Syphilis Y 9390 Foreign Body in Bladder and Urethra S 9391 Foreign Body in Uterus, Any Part S 9392 Foreign Body in Vulva and Vagina S 9393 Foreign Body in Penis S 9399 Foreign Body in Unspecified Site in Genitourinary Tract S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 110 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 9400 Chemical Burn of Eyelids and Periocular Area Y 9401 Other Burns of Eyelids and Periocular Area Y 9402 Alkaline Chemical Burn of Cornea and Conjunctival Sac Y 9403 Acid Chemical Burn of Cornea and Conjunctival Sac Y 9404 Other Burn of Cornea and Conjunctival Sac Y 9405 Burn With Resulting Rupture and Destruction of Eyeball Y 9409 Unspecified Burn of Eye and Adnexa Y 9460 Burns of Multiple Specified Sites, Unspecified Degree Y 9461 Erythema due to Burn (First Degree) of Multiple Specified Sites Y 9462 Blisters With Epidermal Loss due to Burn (Second Degree) of Multiple Specified Sites Y 9463 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Multiple Specified Sites Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Multiple 9464 Specified Sites, Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Multiple 9465 Specified Sites, With Loss of a Body Part Y 9470 Burn of Mouth and Pharynx Y 9471 Burn of Larynx, Trachea, and Lung Y 9472 Burn of Esophagus Y 9473 Burn of Gastrointestinal Tract Y 9474 Burn of Vagina and Uterus Y 9478 Burn of Other Specified Sites of Internal Organs Y 9479 Burn of Internal Organs, Unspecified Site Y 09481 Syphilitic Encephalitis Y 09482 Syphilitic Parkinsonism N 09483 Syphilitic Disseminated Retinochoroiditis N 09484 Syphilitic Optic Atrophy N 09485 Syphilitic Retrobulbar Neuritis N 09486 Syphilitic Acoustic Neuritis N 09487 Syphilitic Ruptured Cerebral Aneurysm Y 09489 Other Specified Neurosyphilis N 9490 Burn of Unspecified Site, Unspecified Degree Y 9491 Erythema due to Burn (First Degree), Unspecified Site Y 9492 Blisters With Epidermal Loss due to Burn (Second Degree), Unspecified Site Y 9493 Full-Thickness Skin Loss due to Burn (Third Degree Nos), Unspecified Site Y Deep Necrosis of Underlying Tissue due to Burn (Deep Third Degree), Unspecified Site 9494 Without Mention of Loss of Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree, Unspecified Site 9495 With Loss of Body Part Y 9500 Optic Nerve Injury Y 9501 Injury to Optic Chiasm Y 9502 Injury to Optic Pathways Y 9503 Injury to Visual Cortex Y 9509 Injury to Unspecified Optic Nerve and Pathways Y 9510 Injury to Oculomotor Nerve Y 9511 Injury to Trochlear Nerve Y 9512 Injury to Trigeminal Nerve Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 111 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 9513 Injury to Abducens Nerve Y 9514 Injury to Facial Nerve Y 9515 Injury to Acoustic Nerve Y 9516 Injury to Accessory Nerve Y 9517 Injury to Hypoglossal Nerve Y 9518 Injury to Other Specified Cranial Nerves Y 9519 Injury to Unspecified Cranial Nerve Y 9522 Lumbar Spinal Cord Injury Without Spinal Bone Injury Y 9523 Sacral Spinal Cord Injury Without Spinal Bone Injury Y 9524 Cauda Equina Spinal Cord Injury Without Spinal Bone Injury Y 9528 Multiple Sites of Spinal Cord Injury Without Spinal Bone Injury Y 9529 Unspecified Site of Spinal Cord Injury Without Spinal Bone Injury Y 9530 Injury to Cervical Nerve Root Y 9531 Injury to Dorsal Nerve Root Y 9532 Injury to Lumbar Nerve Root Y 9533 Injury to Sacral Nerve Root Y 9534 Injury to Brachial Plexus Y 9535 Injury to Lumbosacral Plexus Y 9538 Injury to Multiple Sites of Nerve Roots and Spinal Plexus Y 9539 Injury to Unspecified Site of Nerve Roots and Spinal Plexus Y 9540 Injury to Cervical Sympathetic Nerve, Excluding Shoulder and Pelvic Girdles Y 9541 Injury to Other Sympathetic Nerve, Excluding Shoulder and Pelvic Girdles Y 9548 Injury to Other Specified Nerve(s) of Trunk, Excluding Shoulder and Pelvic Girdles Y 9549 Injury to Unspecified Nerve of Trunk, Excluding Shoulder and Pelvic Girdles Y 9550 Injury to Axillary Nerve Y 9551 Injury to Median Nerve Y 9552 Injury to Ulnar Nerve Y 9553 Injury to Radial Nerve Y 9554 Injury to Musculocutaneous Nerve Y 9555 Injury to Cutaneous Sensory Nerve, Upper Limb Y 9556 Injury to Digital Nerve, Upper Limb Y 9557 Injury to Other Specified Nerve(s) of Shoulder Girdle and Upper Limb Y 9558 Injury to Multiple Nerves of Shoulder Girdle and Upper Limb Y 9559 Injury to Unspecified Nerve of Shoulder Girdle and Upper Limb Y 9560 Injury to Sciatic Nerve Y 9561 Injury to Femoral Nerve Y 9562 Injury to Posterior Tibial Nerve Y 9563 Injury to Peroneal Nerve Y 9564 Injury to Cutaneous Sensory Nerve, Lower Limb Y 9565 Injury to Other Specified Nerve(s) of Pelvic Girdle and Lower Limb Y 9568 Injury to Multiple Nerves of Pelvic Girdle and Lower Limb Y 9569 Injury to Unspecified Nerve of Pelvic Girdle and Lower Limb Y 9570 Injury to Superficial Nerves of Head and Neck Y 9571 Injury to Other Specified Nerve(s) Y 9578 Injury to Multiple Nerves in Several Parts Y 9579 Injury to Nerves, Unspecified Site Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 112 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 9580 Air Embolism as An Early Complication of Trauma Y 9581 Fat Embolism as An Early Complication of Trauma Y 9582 Secondary and Recurrent Hemorrhage as An Early Complication of Trauma Y 9583 Posttraumatic Wound Infection Not Elsewhere Classified Y 9584 Traumatic Shock Y 9585 Traumatic Anuria Y 9586 Volkmann’s Ischemic Contracture Y 9587 Traumatic Subcutaneous Emphysema Y 9588 Other Early Complications of Trauma Y 9590 Other and Unspecified Injury to Face and Neck Y 9591 Other and Unspecified Injury to Trunk Y 9592 Injury, Other and Unspecified, Shoulder and Upper Arm Y 9593 Injury, Other and Unspecified, Elbow, Forearm, and Wrist Y 9594 Injury, Other and Unspecified, Hand, Except Finger Y 9595 Injury, Other and Unspecified, Finger Y 9596 Injury, Other and Unspecified, Hip and Thigh Y 9597 Injury, Other and Unspecified, Knee, Leg, Ankle, and Foot Y 9598 Injury, Other and Unspecified, Other Specified Sites, Including Multiple Y 9599 Injury, Other and Unspecified, Unspecified Site N 9600 Poisoning by Penicillins Y 9601 Poisoning by Antifungal Antibiotics Y 9602 Poisoning by Chloramphenicol Group Y 9603 Poisoning by Erythromycin and Other Macrolides Y 9604 Poisoning by Tetracycline Group Y 9605 Poisoning of Cephalosporin Group Y 9606 Poisoning of Antimycobacterial Antibiotics Y 9607 Poisoning by Antineoplastic Antibiotics Y 9608 Poisoning by Other Specified Antibiotics Y 9609 Poisoning by Unspecified Antibiotic Y 9610 Poisoning by Sulfonamides Y 9611 Poisoning by Arsenical Anti-Infectives Y 9612 Poisoning by Heavy Metal Anti-Infectives Y 9613 Poisoning by Quinoline and Hydroxyquinoline Derivatives Y 9614 Poisoning by Antimalarials and Drugs Acting on Other Blood Protozoa Y 9615 Poisoning by Other Antiprotozoal Drugs Y 9616 Poisoning by Anthelmintics Y 9617 Poisoning by Antiviral Drugs Y 9618 Poisoning by Other Antimycobacterial Drugs Y 9619 Poisoning by Other and Unspecified Anti-Infectives Y 9620 Poisoning by Adrenal Cortical Steroids Y 9621 Poisoning by Androgens and Anabolic Congeners Y 9622 Poisoning by Ovarian Hormones and Synthetic Substitutes Y 9623 Poisoning by Insulins and Antidiabetic Agents Y 9624 Poisoning by Anterior Pituitary Hormones Y 9625 Poisoning by Posterior Pituitary Hormones Y 9626 Poisoning by Parathyroid and Parathyroid Derivatives Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 113 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 9627 Poisoning by Thyroid and Thyroid Derivatives Y 9628 Poisoning by Antithyroid Agents Y 9629 Poisoning by Other and Unspecified Hormones and Synthetic Substitutes Y 9630 Poisoning by Antiallergic and Antiemetic Drugs Y 9631 Poisoning by Antineoplastic and Immunosuppressive Drugs Y 9632 Poisoning by Acidifying Agents Y 9633 Poisoning by Alkalizing Agents Y 9634 Poisoning by Enzymes, Not Elsewhere Classified Y 9635 Poisoning by Vitamins, Not Elsewhere Classified Y 9638 Poisoning by Other Specified Systemic Agents Y 9639 Poisoning by Unspecified Systemic Agent Y 9640 Poisoning by Iron and Its Compounds Y 9641 Poisoning by Liver Preparations and Other Antianemic Agents Y 9642 Poisoning by Anticoagulants Y 9643 Poisoning by Vitamin K (Phytonadione) Y 9644 Poisoning by Fibrinolysis-Affecting Drugs Y 9645 Poisoning by Anticoagulant Antagonists and Other Coagulants Y 9646 Poisoning by Gamma Globulin Y 9647 Poisoning by Natural Blood and Blood Products Y 9648 Poisoning by Other Specified Agents Affecting Blood Constituents Y 9649 Poisoning by Unspecified Agent Affecting Blood Constituents Y 9651 Poisoning by Salicylates Y 9654 Poisoning by Aromatic Analgesics, Not Elsewhere Classified Y 9655 Poisoning by Pyrazole Derivatives Y 9656 Poisoning by Antirheumatics (Antiphlogistics) Y 9657 Poisoning by Other Non-Narcotic Analgesics Y 9658 Poisoning by Other Specified Analgesics and Antipyretics Y 9659 Poisoning by Unspecified Analgesic and Antipyretic Y 9660 Poisoning by Oxazolidine Derivatives Y 9661 Poisoning by Hydantoin Derivatives Y 9662 Poisoning by Succinimides Y 9663 Poisoning by Other and Unspecified Anticonvulsants Y 9664 Poisoning by Anti-Parkinsonism Drugs Y 9670 Poisoning by Barbiturates Y 9671 Poisoning by Chloral Hydrate Group Y 9672 Poisoning by Paraldehyde Y 9673 Poisoning by Bromine Compounds Y 9674 Poisoning by Methaqualone Compounds Y 9675 Poisoning by Glutethimide Group Y 9676 Poisoning by Mixed Sedatives, Not Elsewhere Classified Y 9678 Poisoning by Other Sedatives and Hypnotics Y 9679 Poisoning by Unspecified Sedative or Hypnotic Y 9680 Poisoning by Central Nervous System Muscle-Tone Depressants Y 9681 Poisoning by Halothane Y 9682 Poisoning by Other Gaseous Anesthetics Y 9683 Poisoning by Intravenous Anesthetics Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 114 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 9684 Poisoning by Other and Unspecified General Anesthetics Y 9685 Poisoning by Surface (Topical) and Infiltration Anesthetics Y 9686 Poisoning by Peripheral Nerve- and Plexus-Blocking Anesthetics Y 9687 Poisoning by Spinal Anesthetics Y 9689 Poisoning by Other and Unspecified Local Anesthetics Y 9690 Poisoning by Antidepressants Y 9691 Poisoning by Phenothiazine-Based Tranquilizers Y 9692 Poisoning by Butyrophenone-Based Tranquilizers Y 9693 Poisoning by Other Antipsychotics, Neuroleptics, and Major Tranquilizers Y 9694 Poisoning by Benzodiazepine-Based Tranquilizers Y 9695 Poisoning by Other Tranquilizers Y 9696 Poisoning by Psychodysleptics (Hallucinogens) Y 9697 Poisoning by Psychostimulants Y 9698 Poisoning by Other Specified Psychotropic Agents Y 9699 Poisoning by Unspecified Psychotropic Agent Y 9700 Poisoning by Analeptics Y 9701 Poisoning by Opiate Antagonists Y 9708 Poisoning by Other Specified Central Nervous System Stimulants Y 9709 Poisoning by Unspecified Central Nervous System Stimulant Y 9710 Poisoning by Parasympathomimetics (Cholinergics) Y Poisoning by Parasympatholytics (Anticholinergics and Antimuscarinics) and 9711 Spasmolytics Y 9712 Poisoning by Sympathomimetics (Adrenergics) Y 9713 Poisoning by Sympatholytics (Antiadrenergics) Y 9719 Poisoning by Unspecified Drug Primarily Affecting Autonomic Nervous System Y 9720 Poisoning by Cardiac Rhythm Regulators Y 9721 Poisoning by Cardiotonic Glycosides and Drugs of Similar Action Y 9722 Poisoning by Antilipemic and Antiarteriosclerotic Drugs Y 9723 Poisoning by Ganglion-Blocking Agents Y 9724 Poisoning by Coronary Vasodilators Y 9725 Poisoning by Other Vasodilators Y 9726 Poisoning by Other Antihypertensive Agents Y 9727 Poisoning by Antivaricose Drugs, Including Sclerosing Agents Y 9728 Poisoning by Capillary-Active Drugs Y Poisoning by Other and Unspecified Agents Primarily Affecting the Cardiovascular 9729 System Y 9730 Poisoning by Antacids and Antigastric Secretion Drugs Y 9731 Poisoning by Irritant Cathartics Y 9732 Poisoning by Emollient Cathartics Y 9733 Poisoning by Other Cathartics, Including Intestinal Atonia Drugs Y 9734 Poisoning by Digestants Y 9735 Poisoning by Antidiarrheal Drugs Y 9736 Poisoning by Emetics Y 9738 Poisoning by Other Specified Agents Primarily Affecting the Gastrointestinal System Y 9739 Poisoning by Unspecified Agent Primarily Affecting the Gastrointestinal System Y 9740 Poisoning by Mercurial Diuretics Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 115 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 9741 Poisoning by Purine Derivative Diuretics Y 9742 Poisoning by Carbonic Acid Anhydrase Inhibitors Y 9743 Poisoning by Saluretics Y 9744 Poisoning by Other Diuretics Y 9745 Poisoning by Electrolytic, Caloric, and Water-Balance Agents Y 9746 Poisoning by Other Mineral Salts, Not Elsewhere Classified Y 9747 Poisoning by Uric Acid Metabolism Drugs Y 9750 Poisoning by Oxytocic Agents Y 9751 Poisoning by Smooth Muscle Relaxants Y 9752 Poisoning by Skeletal Muscle Relaxants Y 9753 Poisoning by Other and Unspecified Drugs Acting on Muscles Y 9754 Poisoning by Antitussives Y 9755 Poisoning by Expectorants Y 9756 Poisoning by Anti-Common Cold Drugs Y 9757 Poisoning by Antiasthmatics Y 9758 Poisoning by Other and Unspecified Respiratory Drugs Y 9760 Poisoning by Local Anti-Infectives and Anti-Inflammatory Drugs Y 9761 Poisoning by Antipruritics Y 9762 Poisoning by Local Astringents and Local Detergents Y 9763 Poisoning by Emollients, Demulcents, and Protectants Y 9764 Poisoning by Keratolytics, Keratoplastics, Other Hair Treatment Drugs and Preparations Y 9765 Poisoning by Eye Anti-Infectives and Other Eye Drugs Y

9766 Poisoning by Anti-Infectives and Other Drugs and Preparations for Ear, Nose, and Throat Y 9767 Poisoning by Dental Drugs Topically Applied Y 9768 Poisoning by Other Agents Primarily Affecting Skin and Mucous Membrane Y 9769 Poisoning by Unspecified Agent Primarily Affecting Skin and Mucous Membrane Y 9770 Poisoning by Dietetics Y 9771 Poisoning by Lipotropic Drugs Y 9772 Poisoning by Antidotes and Chelating Agents, Not Elsewhere Classified Y 9773 Poisoning by Alcohol Deterrents Y 9774 Poisoning by Pharmaceutical Excipients Y 9778 Poisoning by Other Specified Drugs and Medicinal Substances Y 9779 Poisoning by Unspecified Drug or Medicinal Substance Y 9780 Poisoning by Bcg Vaccine Y 9781 Poisoning by Typhoid and Paratyphoid Vaccine Y 9782 Poisoning by Cholera Vaccine Y 9783 Poisoning by Plague Vaccine Y 9784 Poisoning by Tetanus Vaccine Y 9785 Poisoning by Diphtheria Vaccine Y 9786 Poisoning by Pertussis Vaccine, Including Combinations With Pertussis Component Y 9788 Poisoning by Other and Unspecified Bacterial Vaccines Y

9789 Poisoning by Mixed Bacterial Vaccines, Except Combinations With Pertussis Component Y 9790 Poisoning by Smallpox Vaccine Y 9791 Poisoning by Rabies Vaccine Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 116 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 9792 Poisoning by Typhus Vaccine Y 9793 Poisoning by Yellow Fever Vaccine Y 9794 Poisoning by Measles Vaccine Y 9795 Poisoning by Poliomyelitis Vaccine Y 9796 Poisoning by Other and Unspecified Viral and Rickettsial Vaccines Y Poisoning by Mixed Viral-Rickettsial and Bacterial Vaccines, Except Combinations With 9797 Pertussis Component Y 9799 Poisoning by Other and Unspecified Vaccines and Biological Substances Y 9800 Toxic Effect of Ethyl Alcohol Y 9801 Toxic Effect of Methyl Alcohol Y 9802 Toxic Effect of Isopropyl Alcohol Y 9803 Toxic Effect of Fusel Oil Y 9808 Toxic Effect of Other Specified Alcohols Y 9809 Toxic Effect of Unspecified Alcohol N 09810 Gonococcal Infection (Acute) of Upper Genitourinary Tract, Site Unspecified S 09811 Gonococcal Cystitis (Acute) S 09812 Gonococcal Prostatitis (Acute) S 09813 Gonococcal Epididymo-Orchitis (Acute) S 09814 Gonococcal Seminal Vesiculitis (Acute) S 09815 Gonococcal Cervicitis (Acute) S 09816 Gonococcal Endometritis (Acute) S 09817 Gonococcal Salpingitis, Specified as Acute S 09819 Other Gonococcal Infections (Acute) of Upper Genitourinary Tract S 9820 Toxic Effect of Benzene and Homologues Y 9821 Toxic Effect of Carbon Tetrachloride Y 9822 Toxic Effect of Carbon Disulfide Y 9823 Toxic Effect of Other Chlorinated Hydrocarbon Solvents Y 9824 Toxic Effect of Nitroglycol Y 9828 Toxic Effect of Other Nonpetroleum-Based Solvents Y 09830 Chronic Gonococcal Infection of Upper Genitourinary Tract, Site Unspecified S 9830 Toxic Effect of Corrosive Aromatics Y 09831 Gonococcal Cystitis, Chronic S 9831 Toxic Effect of Acids Y 09832 Gonococcal Prostatitis, Chronic N 9832 Toxic Effect of Caustic Alkalis Y 09833 Gonococcal Epididymo-Orchitis, Chronic S 09834 Gonococcal Seminal Vesiculitis, Chronic S 09835 Gonococcal Cervicitis, Chronic S 09836 Gonococcal Endometritis, Chronic S 09837 Gonococcal Salpingitis (Chronic) S 09839 Other Chronic Gonococcal Infections of Upper Genitourinary Tract S 9839 Toxic Effect of Caustic, Unspecified N 09840 Gonococcal Conjunctivitis (Neonatorum) S 9840 Toxic Effect of Inorganic Lead Compounds Y 09841 Gonococcal Iridocyclitis S 9841 Toxic Effect of Organic Lead Compounds Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 117 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 09842 Gonococcal Endophthalmia S 09843 Gonococcal Keratitis S 9848 Toxic Effect of Other Lead Compounds Y 09849 Other Gonococcal Infection of Eye N 9849 Toxic Effect of Unspecified Lead Compound N 09850 Gonococcal Arthritis S 9850 Toxic Effect of Mercury and Its Compounds Y 09851 Gonococcal Synovitis and Tenosynovitis S 9851 Toxic Effect of Arsenic and Its Compounds Y 09852 Gonococcal Bursitis S 9852 Toxic Effect of Manganese and Its Compounds Y 09853 Gonococcal Spondylitis S 9853 Toxic Effect of Beryllium and Its Compounds Y 9854 Toxic Effect of Antimony and Its Compounds Y 9855 Toxic Effect of Cadmium and Its Compounds Y 9856 Toxic Effect of Chromium Y 9858 Toxic Effect of Other Specified Metals Y 09859 Other Gonococcal Infection of Joint S 9859 Toxic Effect of Unspecified Metal N 9870 Toxic Effect of Liquefied Petroleum Gases Y 9871 Toxic Effect of Other Hydrocarbon Gas Y 9872 Toxic Effect of Nitrogen Oxides Y 9873 Toxic Effect of Sulfur Dioxide Y 9874 Toxic Effect of Freon Y 9875 Toxic Effect of Lacrimogenic Gas Y 9876 Toxic Effect of Chlorine Gas Y 9877 Toxic Effect of Hydrocyanic Acid Gas Y 9878 Toxic Effect of Other Specified Gases, Fumes, or Vapors Y 9879 Toxic Effect of Unspecified Gas, Fume, or Vapor Y 9880 Toxic Effect of Fish and Shellfish Y 09881 Gonococcal Keratosis (Blennorrhagica) S 9881 Toxic Effect of Mushrooms Y 09882 Gonococcal Meningitis S 9882 Toxic Effect of Berries and Other Plants Y 09883 Gonococcal Pericarditis S 09884 Gonococcal Endocarditis S 09885 Other Gonococcal Heart Disease S 09886 Gonococcal Peritonitis S 9888 Toxic Effect of Other Specified Noxious Substances Y 09889 Gonococcal Infection of Other Specified Sites S 9889 Toxic Effect of Unspecified Noxious Substance Y 9890 Toxic Effect of Hydrocyanic Acid and Cyanides Y 9891 Toxic Effect of Strychnine and Salts Y 9892 Toxic Effect of Chlorinated Hydrocarbons Y 9893 Toxic Effect of Organophosphate and Carbamate Y 9894 Toxic Effect of Other Pesticides, Not Elsewhere Classified Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 118 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 9895 Toxic Effect of Venom Y 9896 Toxic Effect of Soaps and Detergents Y 9897 Toxic Effect of Aflatoxin and Other Mycotoxin (Food Contaminants) Y 9899 Toxic Effect of Unspecified Substance, Chiefly Nonmedicinal as to Source Y 9910 Frostbite of Face Y 9911 Frostbite of Hand Y 9912 Frostbite of Foot Y 9913 Frostbite of Other and Unspecified Sites Y 9914 Effects of Immersion of Foot Y 9915 Effects of Chilblains Y 9916 Effects of Hypothermia Y 9918 Other Specified Effects of Reduced Temperature Y 9919 Unspecified Effect of Reduced Temperature Y 9920 Heat Stroke and Sunstroke Y 9921 Heat Syncope Y 9922 Heat Cramps Y 9923 Heat Exhaustion, Anhydrotic Y 9924 Heat Exhaustion due to Salt Depletion Y 9925 Heat Exhaustion, Unspecified Y 9926 Heat Fatigue, Transient Y 9927 Heat Edema Y 9928 Other Specified Heat Effects Y 9929 Unspecified Effects of Heat and Light N 9930 Barotrauma, Otitic Y 9931 Barotrauma, Sinus Y 9932 Other and Unspecified Effects of High Altitude Y 9933 Caisson Disease Y 9934 Effects of Air Pressure Caused by Explosion Y 9938 Other Specified Effects of Air Pressure Y 9939 Unspecified Effect of Air Pressure N 09940 Unspecified Nongonococcal Urethritis (Ngu) N 9940 Effects of Lightning Y 09941 Nongonococcal Urethritis (Ngu) due to Chlamydia Trachomatis N 9941 Drowning and Nonfatal Submersion Y 9942 Effects of Hunger Y 9943 Effects of Thirst Y 9944 Exhaustion due to Exposure Y 9945 Exhaustion due to Excessive Exertion Y 9946 Motion Sickness N 9947 Asphyxiation and Strangulation Y 9948 Electrocution and Nonfatal Effects of Electric Current Y 09949 Nongonococcal Urethritis (Ngu) due to Other Specified Organism N 9949 Other Effects of External Causes Y 09950 Chlamydia Trachomatis Infection of Unspecified Site N 9950 Other Anaphylactic Shock Not Else Where Classifed Y 09951 Chlamydia Trachomatis Infection of Pharynx N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 119 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 9951 Angioneurotic Edema Not Elsewhere Classified Y 09952 Chlamydia Trachomatis Infection of Anus and Rectum N Unspecified Adverse Effect of Drug Medicinal and Biological Substance, Not Elsewhere 9952 Classified Y 09953 Chlamydia Trachomatis Infection of Lower Genitourinary Sites N 9953 Allergy, Unspecified Not Elsewhere Classified N 09954 Chlamydia Trachomatis Infection of Other Genitourinary Sites N 9954 Shock due to Anesthesia Not Elsewhere Classified Y 09955 Chlamydia Trachomatis Infection of Unspecified Genitourinary Site N 09956 Chlamydia Trachomatis Infection of Peritoneum N 9957 Other Adverse Food Reactions, Not Elsewhere Classified Y 09959 Chlamydia Trachomatis Infection of Other Specified Site N 9961 Mechanical Complication of Other Vascular Device, Implant, and Graft Y 9962 Mechanical Complication of Nervous System Device, Implant, and Graft Y 9964 Mechanical Complication of Internal Orthopedic Device, Implant, and Graft Y 9965 Mechanical Complication of Other Specified Prosthetic Device, Implant, Y 9971 Cardiac Complications Y 9972 Peripheral Vascular Complications Y 9973 Respiratory Complications Y 9974 Digestive System Complication Y 9975 Urinary Complications Y 9980 Postoperative Shock, Not Elsewhere Classified Y 9981 Hemorrhage or Hematoma or Seroma Complicating a Procedure, Not El Y 9982 Accidental Puncture or Laceration During Procedure Y 9983 Disruption of Operation Wound, Not Elsewhere Classified Y 9984 Foreign Body Accidentally Left During Procedure, Not Elsewhere Classified S 9985 Postoperative Infection, Not Elsewhere Classified Y 9986 Persistent Postoperative Fistula, Not Elsewhere Classified Y Acute Reaction to Foreign Substance Accidentally Left During Procedure, Not Elsewhere 9987 Classified Y 9989 Unspecified Complication of Procedure, Not Elsewhere Classified N 9990 Generalized Vaccinia as Complication of Medical Care, Not Elsewhere Classified Y 9991 Air Embolism as Complication of Medical Care, Not Elsewhere Classified Y 9992 Other Vascular Complications of Medical Care, Not Elsewhere Classified Y 9993 Other Infection due to Medical Care, Not Elsewhere Classified Y 9994 Anaphylactic Shock due to Serum, Not Elsewhere Classified Y 9995 Other Serum Reaction, Not Elsewhere Classified Y 9996 Abo Incompatibility Reaction, Not Elsewhere Classified Y 9997 Rh Incompatibility Reaction, Not Elsewhere Classified Y 9998 Other Transfusion Reaction, Not Elsewhere Classified Y 9999 Other and Unspecified Complications of Medical Care, Not Elsewhere Classified Y 10081 Leptospiral Meningitis (Aseptic) Y 10089 Other Specified Leptospiral Infections N 11281 Candidal Endocarditis Y 11282 Candidal Otitis Externa N 11283 Candidal Meningitis Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 120 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 11284 Candidiasis of the Esophagus N 11285 Candidiasis of the Intestine N 11289 Other Candidiasis of Other Specified Sites N 11500 Histoplasma Capsulatum, Without Mention of Manifestation N 11501 Histoplasma Capsulatum Meningitis Y 11502 Histoplasma Capsulatum Retinitis N 11503 Histoplasma Capsulatum Pericarditis Y 11504 Histoplasma Capsulatum Endocarditis Y 11505 Histoplasma Capsulatum Pneumonia Y 11509 Histoplasma Capsulatum, With Mention of Other Manifestation N 11510 Histoplasma Duboisii, Without Mention of Manifestation N 11511 Histoplasma Duboisii Meningitis Y 11512 Histoplasma Duboisii Retinitis N 11513 Histoplasma Duboisii Pericarditis Y 11514 Histoplasma Duboisii Endocarditis Y 11515 Histoplasma Duboisii Pneumonia Y 11519 Histoplasma Duboisii With Mention of Other Manifestation N 11590 Unspecified Histoplasmosis Without Mention of Manifestation N 11591 Unspecified Histoplasmosis Meningitis Y 11592 Unspecified Histoplasmosis Retinitis N 11593 Unspecified Histoplasmosis Pericarditis Y 11594 Unspecified Histoplasmosis Endocarditis Y 11595 Unspecified Histoplasmosis Pneumonia Y 11599 Unspecified Histoplasmosis With Mention of Other Manifestation N 13100 Unspecified Urogenital Trichomoniasis N 13101 Trichomonal Vulvovaginitis N 13102 Trichomonal Urethritis N 13103 Trichomonal Prostatitis N 13109 Other Urogenital Trichomoniasis N 19881 Secondary Malignant Neoplasm of Breast N 19882 Secondary Malignant Neoplasm of Genital Organs N 19889 Secondary Malignant Neoplasm of Other Specified Sites N 20000 Reticulosarcoma, Unspecified Site, Extranodal and Solid Organ Sites N 20001 Reticulosarcoma of Lymph Nodes of Head, Face, and Neck N 20002 Reticulosarcoma of Intrathoracic Lymph Nodes N 20003 Reticulosarcoma of Intra-Abdominal Lymph Nodes N 20004 Reticulosarcoma of Lymph Nodes of Axilla and Upper Limb N 20005 Reticulosarcoma of Lymph Nodes of Inguinal Region and Lower Limb N 20006 Reticulosarcoma of Intrapelvic Lymph Nodes N 20007 Reticulosarcoma of Spleen N 20008 Reticulosarcoma of Lymph Nodes of Multiple Sites N 20010 Lymphosarcoma, Unspecified Site, Extranodal and Solid Organ Sites N 20011 Lymphosarcoma of Lymph Nodes of Head, Face, and Neck N 20012 Lymphosarcoma of Intrathoracic Lymph Nodes N 20013 Lymphosarcoma of Intra-Abdominal Lymph Nodes N 20014 Lymphosarcoma of Lymph Nodes of Axilla and Upper Limb N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 121 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 20015 Lymphosarcoma of Lymph Nodes of Inguinal Region and Lower Limb N 20016 Lymphosarcoma of Intrapelvic Lymph Nodes N 20017 Lymphosarcoma of Spleen N 20018 Lymphosarcoma of Lymph Nodes of Multiple Sites N 20020 Burkitt’s Tumor or Lymphoma, Unspecified Site, Extranodal and Solid Organ Sites N 20021 Burkitt’s Tumor or Lymphoma of Lymph Nodes of Head, Face, and Neck N 20022 Burkitt’s Tumor or Lymphoma of Intrathoracic Lymph Nodes N 20023 Burkitt’s Tumor or Lymphoma of Intra-Abdominal Lymph Nodes N 20024 Burkitt’s Tumor or Lymphoma of Lymph Nodes of Axilla and Upper Limb N 20025 Burkitt’s Tumor or Lymphoma of Lymph Nodes of Inguinal Region and Lower Limb N 20026 Burkitt’s Tumor or Lymphoma of Intrapelvic Lymph Nodes N 20027 Burkitt’s Tumor or Lymphoma of Spleen N 20028 Burkitt’s Tumor or Lymphoma of Lymph Nodes of Multiple Sites N 20080 Other Named Variants, Unspecified Site, Extranodal and Solid Organ Sites N Other Named Variants of Lymphosarcoma and Reticulosarcoma of Lymph Nodes of Head, 20081 Face, and Neck N Other Named Variants of Lymphosarcoma and Reticulosarcoma of Intrathoracic Lymph 20082 Nodes N Other Named Variants of Lymphosarcoma and Reticulosarcoma of Intra-Abdominal 20083 Lymph Nodes N Other Named Variants of Lymphosarcoma and Reticulosarcoma of Lymph Nodes of 20084 Axilla and Upper Limb N Other Named Variants of Lymphosarcoma and Reticulosarcoma of Lymph Nodes of 20085 Inguinal Region and Lower Limb N Other Named Variants of Lymphosarcoma and Reticulosarcoma of Intrapelvic Lymph 20086 Nodes N 20087 Other Named Variants of Lymphosarcoma and Reticulosarcoma of Spleen N Other Named Variants of Lymphosarcoma and Reticulosarcoma of Lymph Nodes of 20088 Multiple Sites N 20100 Hodgkin’s Paragranuloma, Unspecified Site, Extranodal and Solid Organ Sites N 20101 Hodgkin’s Paragranuloma of Lymph Nodes of Head, Face, and Neck N 20102 Hodgkin’s Paragranuloma of Intrathoracic Lymph Nodes N 20103 Hodgkin’s Paragranuloma of Intra-Abdominal Lymph Nodes N 20104 Hodgkin’s Paragranuloma of Lymph Nodes of Axilla and Upper Limb N 20105 Hodgkin’s Paragranuloma of Lymph Nodes of Inguinal Region and Lower Limb N 20106 Hodgkin’s Paragranuloma of Intrapelvic Lymph Nodes N 20107 Hodgkin’s Paragranuloma of Spleen N 20108 Hodgkin’s Paragranuloma of Lymph Nodes of Multiple Sites N 20110 Hodgkin’s Granuloma, Unspecified Site, Extranodal and Solid Organ Sites N 20111 Hodgkin’s Granuloma of Lymph Nodes of Head, Face, and Neck N 20112 Hodgkin’s Granuloma of Intrathoracic Lymph Nodes N 20113 Hodgkin’s Granuloma of Intra-Abdominal Lymph Nodes N 20114 Hodgkin’s Granuloma of Lymph Nodes of Axilla and Upper Limb N 20115 Hodgkin’s Granuloma of Lymph Nodes of Inguinal Region and Lower Limb N 20116 Hodgkin’s Granuloma of Intrapelvic Lymph Nodes N 20117 Hodgkin’s Granuloma of Spleen N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 122 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 20118 Hodgkin’s Granuloma of Lymph Nodes of Multiple Sites N 20120 Hodgkin’s Sarcoma, Unspecified Site, Extranodal and Solid Organ Sites N 20121 Hodgkin’s Sarcoma of Lymph Nodes of Head, Face, and Neck N 20122 Hodgkin’s Sarcoma of Intrathoracic Lymph Nodes N 20123 Hodgkin’s Sarcoma of Intra-Abdominal Lymph Nodes N 20124 Hodgkin’s Sarcoma of Lymph Nodes of Axilla and Upper Limb N 20125 Hodgkin’s Sarcoma of Lymph Nodes of Inguinal Region and Lower Limb N 20126 Hodgkin’s Sarcoma of Intrapelvic Lymph Nodes N 20127 Hodgkin’s Sarcoma of Spleen N 20128 Hodgkin’s Sarcoma of Lymph Nodes of Multiple Sites N Hodgkin’s Disease, Lymphocytic-Histiocytic Predominance, Unspecified Site, Extranodal 20140 and Solid Organ Sites N Hodgkin’s Disease, Lymphocytic-Histiocytic Predominance of Lymph Nodes of Head, 20141 Face, and Neck N

20142 Hodgkin’s Disease, Lymphocytic-Histiocytic Predominance of Intrathoracic Lymph Nodes N Hodgkin’s Disease, Lymphocytic-Histiocytic Predominance of Intra-Abdominal Lymph 20143 Nodes N Hodgkin’s Disease, Lymphocytic-Histiocytic Predominance of Lymph Nodes of Axilla 20144 and Upper Limb N Hodgkin’s Disease, Lymphocytic-Histiocytic Predominance of Lymph Nodes of Inguinal 20145 Region and Lower Limb N

20146 Hodgkin’s Disease, Lymphocytic-Histiocytic Predominance of Intrapelvic Lymph Nodes N 20147 Hodgkin’s Disease, Lymphocytic-Histiocytic Predominance of Spleen N Hodgkin’s Disease, Lymphocytic-Histiocytic Predominance of Lymph Nodes of Multiple 20148 Sites N

20150 Hodgkin’s Disease, Nodular Sclerosis, Unspecified Site, Extranodal and Solid Organ Sites N 20151 Hodgkin’s Disease, Nodular Sclerosis, of Lymph Nodes of Head, Face, and Neck N 20152 Hodgkin’s Disease, Nodular Sclerosis, of Intrathoracic Lymph Nodes N 20153 Hodgkin’s Disease, Nodular Sclerosis, of Intra-Abdominal Lymph Nodes N 20154 Hodgkin’s Disease, Nodular Sclerosis, of Lymph Nodes of Axilla and Upper Limb N Hodgkin’s Disease, Nodular Sclerosis, of Lymph Nodes of Inguinal Region and Lower 20155 Limb N 20156 Hodgkin’s Disease, Nodular Sclerosis, of Intrapelvic Lymph Nodes N 20157 Hodgkin’s Disease, Nodular Sclerosis, of Spleen N 20158 Hodgkin’s Disease, Nodular Sclerosis, of Lymph Nodes of Multiple Sites N

20160 Hodgkin’s Disease, Mixed Cellularity, Unspecified Site, Extranodal and Solid Organ Sites N

20161 Hodgkin’s Disease, Mixed Cellularity, Involving Lymph Nodes of Head, Face, and Neck N 20162 Hodgkin’s Disease, Mixed Cellularity, of Intrathoracic Lymph Nodes N 20163 Hodgkin’s Disease, Mixed Cellularity, of Intra-Abdominal Lymph Nodes N 20164 Hodgkin’s Disease, Mixed Cellularity, of Lymph Nodes of Axilla and Upper Limb N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 123 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Hodgkin’s Disease, Mixed Cellularity, of Lymph Nodes of Inguinal Region and Lower 20165 Limb N 20166 Hodgkin’s Disease, Mixed Cellularity, of Intrapelvic Lymph Nodes N 20167 Hodgkin’s Disease, Mixed Cellularity, of Spleen N 20168 Hodgkin’s Disease, Mixed Cellularity, of Lymph Nodes of Multiple Sites N Hodgkin’s Disease, Lymphocytic Depletion, Unspecified Site, Extranodal and Solid Organ 20170 Sites N 20171 Hodgkin’s Disease, Lymphocytic Depletion, of Lymph Nodes of Head, Face, and Neck N 20172 Hodgkin’s Disease, Lymphocytic Depletion, of Intrathoracic Lymph Nodes N 20173 Hodgkin’s Disease, Lymphocytic Depletion, of Intra-Abdominal Lymph Nodes N

20174 Hodgkin’s Disease, Lymphocytic Depletion, of Lymph Nodes of Axilla and Upper Limb N Hodgkin’s Disease, Lymphocytic Depletion, of Lymph Nodes of Inguinal Region and 20175 Lower Limb N 20176 Hodgkin’s Disease, Lymphocytic Depletion, of Intrapelvic Lymph Nodes N 20177 Hodgkin’s Disease, Lymphocytic Depletion, of Spleen N 20178 Hodgkin’s Disease, Lymphocytic Depletion, of Lymph Nodes of Multiple Sites N

20190 Hodgkin’s Disease, Unspecified Type, Unspecified Site, Extranodal and Solid Organ Sites N 20191 Hodgkin’s Disease, Unspecified Type, of Lymph Nodes of Head, Face, and Neck N 20192 Hodgkin’s Disease, Unspecified Type, of Intrathoracic Lymph Nodes N 20193 Hodgkin’s Disease, Unspecified Type, of Intra-Abdominal Lymph Nodes N 20194 Hodgkin’s Disease, Unspecified Type, of Lymph Nodes of Axilla and Upper Limb N Hodgkin’s Disease, Unspecified Type, of Lymph Nodes of Inguinal Region and Lower 20195 Limb N 20196 Hodgkin’s Disease, Unspecified Type, of Intrapelvic Lymph Nodes N 20197 Hodgkin’s Disease, Unspecified Type, of Spleen N 20198 Hodgkin’s Disease, Unspecified Type, of Lymph Nodes of Multiple Sites N 20200 Nodular Lymphoma, Unspecified Site, Extranodal and Solid Organ Sites N 20201 Nodular Lymphoma of Lymph Nodes of Head, Face, and Neck N 20202 Nodular Lymphoma of Intrathoracic Lymph Nodes N 20203 Nodular Lymphoma of Intra-Abdominal Lymph Nodes N 20204 Nodular Lymphoma of Lymph Nodes of Axilla and Upper Limb N 20205 Nodular Lymphoma of Lymph Nodes of Inguinal Region and Lower Limb N 20206 Nodular Lymphoma of Intrapelvic Lymph Nodes N 20207 Nodular Lymphoma of Spleen N 20208 Nodular Lymphoma of Lymph Nodes of Multiple Sites N 20210 Mycosis Fungoides, Unspecified Site, Extranodal and Solid Organ Sites N 20211 Mycosis Fungoides of Lymph Nodes of Head, Face, and Neck N 20212 Mycosis Fungoides of Intrathoracic Lymph Nodes N 20213 Mycosis Fungoides of Intra-Abdominal Lymph Nodes N 20214 Mycosis Fungoides of Lymph Nodes of Axilla and Upper Limb N 20215 Mycosis Fungoides of Lymph Nodes of Inguinal Region and Lower Limb N 20216 Mycosis Fungoides of Intrapelvic Lymph Nodes N 20217 Mycosis Fungoides of Spleen N 20218 Mycosis Fungoides of Lymph Nodes of Multiple Sites N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 124 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 20220 Sezary’s Disease, Unspecified Site, Extranodal and Solid Organ Sites N 20221 Sezary’s Disease of Lymph Nodes of Head, Face, and Neck N 20222 Sezary’s Disease of Intrathoracic Lymph Nodes N 20223 Sezary’s Disease of Intra-Abdominal Lymph Nodes N 20224 Sezary’s Disease of Lymph Nodes of Axilla and Upper Limb N 20225 Sezary’s Disease of Lymph Nodes of Inguinal Region and Lower Limb N 20226 Sezary’s Disease of Intrapelvic Lymph Nodes N 20227 Sezary’s Disease of Spleen N 20228 Sezary’s Disease of Lymph Nodes of Multiple Sites N 20230 Malignant Histiocytosis, Unspecified Site, Extranodal and Solid Organ Sites N 20231 Malignant Histiocytosis of Lymph Nodes of Head, Face, and Neck N 20232 Malignant Histiocytosis of Intrathoracic Lymph Nodes N 20233 Malignant Histiocytosis of Intra-Abdominal Lymph Nodes N 20234 Malignant Histiocytosis of Lymph Nodes of Axilla and Upper Limb N 20235 Malignant Histiocytosis of Lymph Nodes of Inguinal Region and Lower Limb N 20236 Malignant Histiocytosis of Intrapelvic Lymph Nodes N 20237 Malignant Histiocytosis of Spleen N 20238 Malignant Histiocytosis of Lymph Nodes of Multiple Sites N 20240 Leukemic Reticuloendotheliosis, Unspecified Site, Extranodal and Solid Organ Sites N 20241 Leukemic Reticuloendotheliosis of Lymph Nodes of Head, Face, and Neck N 20242 Leukemic Reticuloendotheliosis of Intrathoracic Lymph Nodes N 20243 Leukemic Reticuloendotheliosis of Intra-Abdominal Lymph Nodes N 20244 Leukemic Reticuloendotheliosis of Lymph Nodes of Axilla and Upper Limb N 20245 Leukemic Reticuloendotheliosis of Lymph Nodes of Inguinal Region and Lower Limb N 20246 Leukemic Reticuloendotheliosis of Intrapelvic Lymph Nodes N 20247 Leukemic Reticuloendotheliosis of Spleen N 20248 Leukemic Reticuloendotheliosis of Lymph Nodes of Multipes Sites N 20250 Letterer-Siwe Disease, Unspecified Site, Extranodal and Solid Organ Sites N 20251 Letterer-Siwe Disease of Lymph Nodes of Head, Face, and Neck N 20252 Letterer-Siwe Disease of Intrathoracic Lymph Nodes N 20253 Letterer-Siwe Disease of Intra-Abdominal Lymph Nodes N 20254 Letterer-Siwe Disease of Lymph Nodes of Axilla and Upper Limb N 20255 Letterer-Siwe Disease of Lymph Nodes of Inguinal Region and Lower Limb N 20256 Letterer-Siwe Disease of Intrapelvic Lymph Nodes N 20257 Letterer-Siwe Disease of Spleen N 20258 Letterer-Siwe Disease of Lymph Nodes of Multiple Sites N 20260 Malignant Mast Cell Tumors, Unspecified Site, Extranodal and Solid Organ Sites N 20261 Malignant Mast Cell Tumors of Lymph Nodes of Head, Face, and Neck N 20262 Malignant Mast Cell Tumors of Intrathoracic Lymph Nodes N 20263 Malignant Mast Cell Tumors of Intra-Abdominal Lymph Nodes N 20264 Malignant Mast Cell Tumors of Lymph Nodes of Axilla and Upper Limb N 20265 Malignant Mast Cell Tumors of Lymph Nodes of Inguinal Region and Lower Limb N 20266 Malignant Mast Cell Tumors of Intrapelvic Lymph Nodes N 20267 Malignant Mast Cell Tumors of Spleen N 20268 Malignant Mast Cell Tumors of Lymph Nodes of Multiple Sites N 20280 Other Malignant Lymphomas, Unspecified Site, Extranodal and Solid Organ Sites N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 125 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 20281 Other Malignant Lymphomas of Lymph Nodes of Head, Face, and Neck N 20282 Other Malignant Lymphomas of Intrathoracic Lymph Nodes N 20283 Other Malignant Lymphomas of Intra-Abdominal Lymph Nodes N 20284 Other Malignant Lymphomas of Lymph Nodes of Axilla and Upper Limb N 20285 Other Malignant Lymphomas of Lymph Nodes of Inguinal Region and Lower Limb N 20286 Other Malignant Lymphomas of Intrapelvic Lymph Nodes N 20287 Other Malignant Lymphomas of Spleen N 20288 Other Malignant Lymphomas of Lymph Nodes of Multiple Sites N Other and Unspecified Malignant Neoplasms of Lymphoid and Histiocytic Tissue, 20290 Unspecified Site, Extranodal and Solid Organ Sites N Other and Unspecified Malignant Neoplasms of Lymphoid and Histiocytic Tissue of 20291 Lymph Nodes of Head, Face, and Neck N Other and Unspecified Malignant Neoplasms of Lymphoid and Histiocytic Tissue of 20292 Intrathoracic Lymph Nodes N Other and Unspecified Malignant Neoplasms of Lymphoid and Histiocytic Tissue of Intra- 20293 Abdominal Lymph Nodes N Other and Unspecified Malignant Neoplasms of Lymphoid and Histiocytic Tissue of 20294 Lymph Nodes of Axilla and Upper Limb N Other and Unspecified Malignant Neoplasms of Lymphoid and Histiocytic Tissue of 20295 Lymph Nodes of Inguinal Region and Lower Limb N Other and Unspecified Malignant Neoplasms of Lymphoid and Histiocytic Tissue of 20296 Intrapelvic Lymph Nodes N Other and Unspecified Malignant Neoplasms of Lymphoid and Histiocytic Tissue of 20297 Spleen N Other and Unspecified Malignant Neoplasms of Lymphoid and Histiocytic Tissue of 20298 Lymph Nodes of Multiple Sites N 20300 Multiple Myeloma Without Mention of Remission N 20301 Multiple Myeloma in Remission N 20310 Plasma Cell Leukemia Without Mention of Remission N 20311 Plasma Cell Leukemia in Remission N 20380 Other Immunoproliferative Neoplasms Without Mention of Remission N 20381 Other Immunoproliferative Neoplasms in Remission N 20400 Acute Lymphoid Leukemia Without Mention of Remission Y 20401 Acute Lymphoid Leukemia in Remission N 20410 Chronic Lymphoid Leukemia Without Mention of Remission N 20411 Chronic Lymphoid Leukemia in Remission N 20420 Subacute Lymphoid Leukemia Without Mention of Remission N 20421 Subacute Lymphoid Leukemia in Remission N 20480 Other Lymphoid Leukemia Without Mention of Remission N 20481 Other Lymphoid Leukemia in Remission N 20490 Unspecified Lymphoid Leukemia Without Mention of Remission N 20491 Unspecified Lymphoid Leukemia in Remission N 20500 Acute Myeloid Leukemia Without Mention of Remission Y 20501 Acute Myeloid Leukemia in Remission N 20510 Chronic Myeloid Leukemia Without Mention of Remission N 20511 Chronic Myeloid Leukemia in Remission N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 126 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 20520 Subacute Myeloid Leukemia Without Mention of Remission N 20521 Subacute Myeloid Leukemia in Remission N 20530 Myeloid Sarcoma Without Mention of Remission N 20531 Myeloid Sarcoma in Remission N 20580 Other Myeloid Leukemia Without Mention of Remission N 20581 Other Myeloid Leukemia in Remission N 20590 Unspecified Myeloid Leukemia Without Mention of Remission N 20591 Unspecified Myeloid Leukemia in Remission N 20600 Acute Monocytic Leukemia Without Mention of Remission Y 20601 Acute Monocytic Leukemia in Remission N 20610 Chronic Monocytic Leukemia Without Mention of Remission N 20611 Chronic Monocytic Leukemia in Remission N 20620 Subacute Monocytic Leukemia Without Mention of Remission N 20621 Subacute Monocytic Leukemia in Remission N 20680 Other Monocytic Leukemia Without Mention of Remission N 20681 Other Monocytic Leukemia in Remission N 20690 Unspecified Monocytic Leukemia Without Mention of Remission N 20691 Unspecified Monocytic Leukemia in Remission N 20700 Acute Erythremia and Erythroleukemia Without Mention of Remission Y 20701 Acute Erythremia and Erythroleukemia in Remission N 20710 Chronic Erythremia Without Mention of Remission N 20711 Chronic Erythremia in Remission N 20720 Megakaryoctic Leukemia Without Mention of Remission N 20721 Megakaryocytic Leukemia in Remission N 20780 Other Specified Leukemia Without Mention of Remission N 20781 Other Specified Leukemia in Remission N 20800 Acute Leukemia of Unspecified Cell Type Without Mention of Remission Y 20801 Acute Leukemia of Unspecified Cell Type in Remission N 20810 Chronic Leukemia of Unspecified Cell Type Without Mention of Remission N 20811 Chronic Leukemia of Unspecified Cell Type in Remission N 20820 Subacute Leukemia of Unspecified Cell Type Without Mention of Remission N 20821 Subactue Leukemia of Unspecified Cell Type in Remission N 20880 Other Leukemia of Unspecified Cell Type Without Mention of Remission N 20881 Other Leukemia of Unspecified Cell Type in Remission N 20890 Unspecified Leukemia Without Mention of Remission N 20891 Unspecified Leukemia in Remission N 22381 Benign Neoplasm of Urethra N 22389 Benign Neoplasm of Other Specified Sites of Urinary Organs N 22800 Hemangioma of Unspecified Site N 22801 Hemangioma of Skin and Subcutaneous Tissue N 22802 Hemangioma of Intracranial Structures N 22803 Hemangioma of Retina N 22804 Hemangioma of Intra-Abdominal Structures N 22809 Hemangioma of Other Sites N 23690 Neoplasm of Uncertain Behavior of Urinary Organ, Unspecified N 23691 Neoplasm of Uncertain Behavior of Kidney and Ureter N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 127 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 23699 Neoplasm of Uncertain Behavior of Other and Unspecified Urinary Organs N 23770 Neurofibromatosis, Unspecified N 23771 Neurofibromatosis, Type 1 (Von Recklinghausen’s Disease) N 23772 Neurofibromatosis, Type 2 (Acoustic Neurofibromatosis) N 24200 Toxic Diffuse Goiter Without Mention of Thyrotoxic Crisis or Storm N 24201 Toxic Diffuse Goiter With Mention of Thyrotoxic Crisis or Storm Y 24210 Toxic Uninodular Goiter Without Mention of Thyrotoxic Crisis or Storm Y 24211 Toxic Uninodular Goiter With Mention of Thyrotoxic Crisis or Storm S 24220 Toxic Multinodular Goiter Without Mention of Thyrotoxic Crisis or Storm Y 24221 Toxic Multinodular Goiter With Mention of Thyrotoxic Crisis or Storm S

24230 Toxic Nodular Goiter, Unspecified Type, Without Mention of Thyrotoxic Crisis or Storm Y 24231 Toxic Nodular Goiter, Unspecified Type, With Mention of Thyrotoxic Crisis or Storm S Thyrotoxicosis From Ectopic Thyroid Nodule Without Mention of Thyrotoxic Crisis or 24240 Storm Y

24241 Thyrotoxicosis From Ectopic Thyroid Nodule With Mention of Thyrotoxic Crisis or Storm S

24280 Thyrotoxicosis of Other Specified Origin Without Mention of Thyrotoxic Crisis or Storm Y 24281 Thyrotoxicosis of Other Specified Origin With Mention of Thyrotoxic Crisis or Storm S Thyrotoxicosis Without Mention of Goiter or Other Cause, Without Mention of 24290 Thyrotoxic Crisis or Storm Y Thyrotoxicosis Without Mention of Goiter or Other Cause, With Mention of Thyrotoxic 24291 Crisis or Storm S Diabetes Mellitus Without Mention of Complication, Type II or Unspecified Type, Not 25000 Stated as Uncontrolled N Diabetes Mellitus Without Mention of Complication, Type I (Juvenile Type), Not Stated 25001 as Uncontrolled N Diabetes Mellitus Without Mention of Complication, Type II or Unspecified Type, 25002 Uncontrolled N

25003 Diabetes Mellitus Without Mention of Complication, Type I (Juvenile Type), Uncontrolled N 25010 Diabetes With Ketoacidosis, Type II or Unspecified Type, Not Stated as Uncontrolled Y 25011 Diabetes With Ketoacidosis, Type I (Juvenile Type), Not Stated as Uncontrolled Y 25012 Diabetes With Ketoacidosis, Type II or Unspecified Type, Uncontrolled Y 25013 Diabetes With Ketoacidosis, Type I (Juvenile Type), Uncontrolled Y

25020 Diabetes With Hyperosmolarity, Type II or Unspecified Type, Not Stated as Uncontrolled Y 25021 Diabetes With Hyperosmolarity, Type I (Juvenile Type), Not Stated as Uncontrolled Y 25022 Diabetes With Hyperosmolarity, Type II or Unspecified Type, Uncontrolled Y 25023 Diabetes With Hyperosmolarity, Type I (Juvenile Type), Uncontrolled Y 25030 Diabetes With Other Coma, Type II or Unspecified Type, Not Stated as Uncontrolled Y 25031 Diabetes With Other Coma, Type I (Juvenile Type) Not Stated as Uncontrolled Y 25032 Diabetes With Other Coma, Type II or Unspecified Type, Uncontrolled Y 25033 Diabetes With Other Coma, Type I (Juvenile Type), Uncontrolled Y Diabetes With Renal Manifestations , Type II or Unspecified Type, Not Stated as 25040 Uncontrolled Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 128 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator

25041 Diabetes With Renal Manifestations, Type I (Juvenile Type), Not Stated as Uncontrolled S 25042 Diabetes With Renal Manifestations, Type II or Unspecified Type, Uncontrolled S 25043 Diabetes With Renal Manifestations, Type I (Juvenile Type), Uncontrolled S Diabetes With Ophthalmic Manifestations, Type II or Unspecified Type, Not Stated as 25050 Uncontrolled Y Diabetes With Ophthalmic Manifestations, Type I (Juvenile Type), Not Stated as 25051 Uncontrolled N 25052 Diabetes With Ophthalmic Manifestations, Type II or Unspecified Type, Uncontrolled N 25053 Diabetes With Ophthalmic Manifestations, Type I (Juvenile Type), Uncontrolled N Diabetes With Neurological Manifestations, Type II or Unspecified Type, Not Stated as 25060 Uncontrolled Y Diabetes With Neurological Manifestations, Type I (Juvenile Type), Not Stated as 25061 Uncontrolled N 25062 Diabetes With Neurological Manifestations, Type II or Unspecified Type, Uncontrolled N 25063 Diabetes With Neurological Manifestations, Type I (Juvenile Type), Uncontrolled N Diabetes With Peripheral Circulatory Disorders, Type II or Unspecified Type, Not Stated 25070 as Uncontrolled Y Diabetes With Peripheral Circulatory Disorders, Type I (Juvenile Type) Not Stated as 25071 Uncontrolled N Diabetes With Peripheral Circulatory Disorders, Type II or Unspecified Type, 25072 Uncontrolled N 25073 Diabetes With Peripheral Circulatory Disorders, Type I (Juvenile Type), Uncontrolled N Diabetes With Other Specified Manifestations, Type II or Unspecified Type, Not Stated as 25080 Uncontrolled Y Diabetes With Other Specified Manifestations, Type I (Juvenile Type), Not Stated as 25081 Uncontrolled N

25082 Diabetes With Other Specified Manifestations, Type II or Unspecified Type, Uncontrolled N 25083 Diabetes With Other Specified Manifestations, Type I (Juvenile Type), Uncontrolled N Diabetes With Unspecified Complication, Type II or Unspecified Type, Not Stated as 25090 Uncontrolled. Y Diabetes With Unspecified Complication, Type I (Juvenile Type), Not Stated as 25091 Uncontrolled N 25092 Diabetes With Unspecified Complication, Type II or Unspecified Type, Uncontrolled N 25093 Diabetes With Unspecified Complication, Type I (Juvenile Type), Uncontrolled N 25200 Hyperparathyroidism Unspecified Y 25201 Primary Hyperparathyroidism Y 25202 Secondary Hyperparathyroidism, Non-Renal Y 25208 Other Hyperparathyroidism Y 25510 Primary Aldosteronism N 25511 Glucocorticoid-Remediable Aldosteronism N 25512 Conn’s Syndrome N 25513 Bartter’s Syndrome N 25514 Other Secondary Aldosteronism N 25631 Premature Menopause N 25639 Other Ovarian Failure N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 129 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 27410 Gouty Nephropathy, Unspecified N 27411 Uric Acid Nephrolithiasis N 27419 Other Gouty Nephropathy N 27481 Gouty Tophi of Ear N 27482 Gouty Tophi of Other Sites N 27489 Gout With Other Specified Manifestations N 27540 Unspecified Disorder of Calcium Metabolism N 27541 Hypocalcemia N 27542 Hypercalcemia N 27549 Other Disorders of Calcium Metabolism N 27650 Volume Depletion,Unspecified Y 27651 Dehydration Y 27652 Hypovolemia Y 27700 Cystic Fibrosis Without Mention of Meconium Ileus Y 27701 Cystic Fibrosis With Meconium Ileus Y 27702 Cystic Fibrosis With Pulmonary Manifestations Y 27703 Cystic Fibrosis With Gastrointestinal Manifestations Y 27709 Cystic Fibrosis With Other Manifestations Y 27781 Primary Carnitine Deficiency N 27782 Carnitine Deficiency due to Inborn Errors of Metabolism N 27783 Iatrogenic Carnitine Deficiency N 27784 Other Secondary Carnitine Deficiency N 27785 Disorders of Fatty Acid Oxidation N 27786 Peroxisomal Disorders N 27787 Disorders of Mitochondrial Metabolism N 27789 Other Specified Disorders of Metabolism N 27800 Obesity, Unspecified N 27801 Morbid Obesity N 27802 Overweight N 27900 Unspecified Hypogammaglobulinemia N 27901 Selective Iga Immunodeficiency N 27902 Selective Igm Immunodeficiency N 27903 Other Selective Immunoglobulin Deficiencies N 27904 Congenital Hypogammaglobulinemia N 27905 Immunodeficiency With Increased Igm N 27906 Common Variable Immunodeficiency N 27909 Other Deficiency of Humoral Immunity N 27910 Unspecified Immunodeficiency With Predominant T-Cell Defect N 27911 Digeorge’s Syndrome N 27912 Wiskott-Aldrich Syndrome N 27913 Nezelof’s Syndrome N 27919 Other Deficiency of Cell-Mediated Immunity N 28241 Sickle-Cell Thalassemia Without Crisis Y 28242 Sickle-Cell Thalassemia With Crisis Y 28249 Other Thalassemia Y 28260 Sickle-Cell Disease, Unspecified Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 130 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 28261 Hb-Ss Disease Without Crisis S 28262 Hb-Ss Disease With Crisis Y 28263 Sickle-Cell/Hb-C Disease Without Crisis S 28264 Sickle-Cell/Hb-C Disease With Crisis Y 28268 Other Sickle-Cell Disease Without Crisis Y 28269 Other Sickle-Cell Disease With Crisis Y 28310 Unspecified Non-Autoimmune Hemolytic Anemia Y 28311 Hemolytic-Uremic Syndrome Y 28319 Other Non-Autoimmune Hemolytic Anemias Y 28521 Anemia in Chronic Kidney Disease Y 28522 Anemia in Neoplastic Disease Y 28529 Anemia of Other Chronic Illness Y 28730 Primary Thrombocytopenia, Unspecified Y 28731 Immune Thrombocytopenic Purpura Y 28732 Evans' Syndrome Y 28733 Congenital and Hereditary Thrombocytopenic Purpura Y 28739 Other Primary Thrombocytopenia Y 28950 Unspecified Disease of Spleen N 28951 Chronic Congestive Splenomegaly N 28952 Splenic Sequestration N 28959 Other Diseases of Spleen N 28981 Primary Hypercoagulable State Y 28982 Secondary Hypercoagulable State Y 28989 Other Specified Diseases of Blood and Blood-Forming Organs N 29010 Presenile Dementia, Uncomplicated N 29011 Presenile Dementia With Delirium Y 29012 Presenile Dementia With Delusional Features Y 29013 Presenile Dementia With Depressive Features Y 29020 Senile Dementia With Delusional Features Y 29021 Senile Dementia With Depressive Features Y 29040 Vascular Dementia, Uncomplicated Y 29041 Vasculardementia, With Delirium Y 29042 Vascular Dementia, With Delusions Y 29043 Vascular Dementia With Depressed Mood Y 29181 Alcohol Withdrawal Y 29182 Alcohol Induced Sleep Disorders N 29189 Other Specified Alcohol-Induced Mental Disorders Y 29211 Drug-Induced Psychotic Disorder With Delusions Y 29212 Drug-Induced Psychotic Disorder With Hallucinations Y 29281 Drug-Induced Delirium Y 29282 Drug-Induced Persisting Dementia Y 29283 Drug-Induced Persisting Amnestic Disorder Y 29284 Drug-Induced Mood Disorder Y 29285 Drug Induced Sleep Disorders N 29289 Other Specified Drug-Induced Mental Disorder Y 29381 Psychotic Disorder With Delusions in Conditions Classified Elsewhere Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 131 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 29382 Psychotic Disorder With Hallucinations in Conditions Classified Elsewhere Y 29383 Mood Disorder in Conditions Classified Elsewhere Y 29384 Anxiety Disorder in Conditions Classified Elsewhere Y

29389 Other Specified Transient Mental Disorders due to Conditions Classified Elsewhere, Other Y 29410 Dementia in Conditions Classified Elsewhere Without Behavioral Disturbance Y 29411 Dementia in Conditions Classified Elsewhere With Behavioral Disturbance Y 29500 Simple Schizophrenia, Unspecified Condition Y 29501 Simple Schizophrenia, Subchronic Condition N 29502 Simple Schizophrenia, Chronic Condition N 29503 Simple Schizophrenia, Subchronic Condition With Acute Exacerbation S 29504 Simple Schizophrenia, Chronic Condition With Acute Exacerbation S 29505 Simple Schizophrenia, in Remission N 29510 Disorganized Schizophrenia, Unspecified Condition Y 29511 Disorganized Schizophrenia, Subchronic Condition N 29512 Disorganized Schizophrenia, Chronic Condition N 29513 Disorganized Schizophrenia, Subchronic Condition With Acute Exacerbation S 29514 Disorganized Schizophrenia, Chronic Condition With Acute Exacerbation S 29515 Disorganized Schizophrenia, in Remission N 29520 Catatonic Schizophrenia, Unspecified Condition Y 29521 Catatonic Schizophrenia, Subchronic Condition N 29522 Catatonic Schizophrenia, Chronic Condition N 29523 Catatonic Schizophrenia, Subchronic Condition With Acute Exacerbation S 29524 Catatonic Schizophrenia, Chronic Condition With Acute Exacerbation S 29525 Catatonic Schizophrenia, in Remission N 29530 Paranoid Schizophrenia, Unspecified Condition Y 29531 Paranoid Schizophrenia, Subchronic Condition Y 29532 Paranoid Schizophrenia, Chronic Condition Y 29533 Paranoid Schizophrenia, Subchronic Condition With Acute Exacerbation Y 29534 Paranoid Schizophrenia, Chronic Condition With Acute Exacerbation Y 29535 Paranoid Schizophrenia, in Remission N 29540 Schizophreniform Disorder, Unspecified Y 29541 Schizophreniform Disorder, Subchronic Y 29542 Schizophreniform Disorder, Chronic Y 29543 Schizophreniform Disorder, Subchronic With Acute Exacerbation Y 29544 Schizophreniform Disorder, Chronic With Acute Exacerbation Y 29545 Schizophreniform Disorder, in Remission S 29550 Latent Schizophrenia, Unspecified Condition N 29551 Latent Schizophrenia, Subchronic Condition N 29552 Latent Schizophrenia, Chronic Condition N 29553 Latent Schizophrenia, Subchronic Condition With Acute Exacerbation S 29554 Latent Schizophrenia, Chronic Condition With Acute Exacerbation S 29555 Latent Schizophrenia, in Remission N 29560 Schizophrenic Disorder, Residual Type, Unspecified N 29561 Schizophrenic Disorders, Residual Type, Subchronic N 29562 Schizophrenic Disorders, Residual Type, Chronic N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 132 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 29563 Schizophrenic Disorders, Residual Type, Subchronic With Acute Exacerbation S 29564 Schizophrenic Disorders, Residual Type, Chronic With Acute Exacerbation Y 29565 Schizophrenic Disorders, Residual Type, in Remission N 29570 Schizoaffective Disorder, Unspecified N 29571 Schizoaffective Disorder, Subchronic N 29572 Schizoaffective Disorder, Chronic N 29573 Schizoaffective Disorder, Subchronic With Acute Exacerbation Y 29574 Schizoaffective Disorder, Chronic With Acute Exacerbation Y 29575 Schizoaffective Disorder, in Remission N 29580 Other Specified Types of Schizophrenia, Unspecified Condition N 29581 Other Specified Types of Schizophrenia, Subchronic Condition N 29582 Other Specified Types of Schizophrenia, Chronic Condition N

29583 Other Specified Types of Schizophrenia, Subchronic Condition With Acute Exacerbation Y 29584 Other Specified Types of Schizophrenia, Chronic Condition With Acute Exacerbation Y 29585 Other Specified Types of Schizophrenia, in Remission N 29590 Unspecified Schizophrenia, Unspecified Condition Y 29591 Unspecified Schizophrenia, Subchronic Condition Y 29592 Unspecified Schizophrenia, Chronic Condition Y 29593 Unspecified Schizophrenia, Subchronic Condition With Acute Exacerbation Y 29594 Unspecified Schizophrenia, Chronic Condition With Acute Exacerbation Y 29595 Unspecified Schizophrenia, in Remission Y 29600 Bipolar I Disorder, Single Manic Episode, Unspecified Y 29601 Bipolar I Disorder, Single Manic Episode, Mild Y 29602 Bipolar I Disorder, Single Manic Episode, Moderate Y

29603 Bipolar I Disorder, Single Manic Episode, Severe, Without Mention of Psychotic Behavior Y

29604 Bipolar I Disorder, Single Manic Episode, Severe, Specified as With Psychotic Behavior Y 29605 Bipolar I Disorder, Single Manic Episode, in Partial or Unspecified Remission Y 29606 Bipolar I Disorder, Single Manic Episode, in Full Remission Y 29610 Manic Disorder, Recurrent Episode, Unspecified Y 29611 Manic Disorder, Recurrent Episode, Mild N 29612 Manic Disorder, Recurrent Episode, Moderate N 29613 Manic Disorder, Recurrent Episode, Severe, Without Mention of Psychotic Behavior N 29614 Manic Disorder, Recurrent Episode, Severe, Specified as With Psychotic Behavior S 29615 Manic Disorder, Recurrent Episode, in Partial or Unspecified Remission N 29616 Manic Disorder, Recurrent Episode, in Full Remission N 29620 Major Depressive Disorder, Single Episode, Unspecified Y 29621 Major Depressive Disorder, Single Episode, Mild N 29622 Major Depressive Disorder, Single Episode, Moderate N Major Depressive Disorder, Single Episode, Severe, Without Mention of Psychotic 29623 Behavior N

29624 Major Depressive Disorder, Single Episode, Severe, Specified as With Psychotic Behavior S 29625 Major Depressive Disorder, Single Episode, in Partial or Unspecified Remission N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 133 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 29626 Major Depressive Disorder, Single Episode in Full Remission N 29630 Major Depressive Disorder, Recurrent Episode, Unspecified Y 29631 Major Depressive Disorder, Recurrent Episode, Mild Y 29632 Major Depressive Disorder, Recurrent Episode, Moderate Y Major Depressive Disorder, Recurrent Episode, Severe, Without Mention of Psychotic 29633 Behavior Y Major Depressive Disorder, Recurrent Episode, Severe, Specified as With Psychotic 29634 Behavior Y 29635 Major Depressive Disorder, Recurrent Episode, in Partial or Unspecified Remission N 29636 Major Depressive Disorder, Recurrent Episode, in Full Remission N 29640 Bipolar I Disorder, Most Recent Episode (or Current) Manic, Unspecified N 29641 Bipolar I Disorder, Most Recent Episode (or Current) Manic, Mild N 29642 Bipolar I Disorder, Most Recent Episode (or Current) Manic, Moderate N Bipolar I Disorder, Most Recent Episode (or Current) Manic, Severe, Without Mention of 29643 Psychotic Behavior N Bipolar I Disorder, Most Recent Episode (or Current) Manic, Severe, Specified as With 29644 Psychotic Behavior Y Bipolar I Disorder, Most Recent Episode (or Current) Manic, in Partial or Unspecified 29645 Remission N 29646 Bipolar I Disorder, Most Recent Episode ( or Current) Manic, in Full Remission N 29650 Bipolar I Disorder, Most Recent Episode (or Current) Depressed, Unspecified N 29651 Bipolar I Disorder, Most Recent Episode (or Current) Depressed, Mild N 29652 Bipolar I Disorder, Most Recent Episode (or Current) Depressed, Moderate N Bipolar I Disorder, Most Recent Episode (or Current) Depressed, Severe, Without Mention 29653 of Psychotic Behavior N Bipolar I Disorder, Most Recent Episode (or Current) Depressed, Severe, Specified as 29654 With Psychotic Behavior Y Bipolar I Disorder, Most Recent Episode (or Current) Depressed, in Partial or Unspecified 29655 Remission N 29656 Bipolar I Disorder, Most Recent (or Current) Depressed, in Full Remission N 29660 Bipolar I Disorder, Most Recent Episode (or Current) Mixed, Unspecified N 29661 Bipolar I Disorder, Most Recent Episode (or Current) Mixed, Mild N 29662 Bipolar I Disorder, Most Recent Episode (or Current) Mixed, Moderate N Bipolar I Disorder, Most Recent Episode (or Current) Mixed, Severe, Without Mention of 29663 Psychotic Behavior N Bipolar I Disorder, Most Recent Episode (or Current) Mixed, Severe, Specified as With 29664 Psychotic Behavior Y Bipolar I Disorder, Most Recent Episode (or Current) Mixed, in Partial or Unspecified 29665 Remission N 29666 Bipolar I Disorder, Most Recent Episode (or Current) Mixed, in Full Remission N 29680 Bipolar Disorder, Unspecified N 29681 Atypical Manic Disorder N 29682 Atypical Depressive Disorder N 29689 Other and Unspecified Bipolar Disorder, Other N 29690 Unspecified Episodic Mood Disorder N 29699 Other Specified Episodic Mood Disorder N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 134 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 29900 Autistic Disorder, Current or Active State Y 29901 Autistic Disorder, Residual State N 29910 Childhood Disintegrative Disorder, Current or Active State Y 29911 Childhood Disintegrative Disorder, Residual State N 29980 Other Specified Pervasive Developmental Disorders, Current or Active State Y 29981 Other Specified Pervasive Developmental Disorders, Residual State N 29990 Unspecified Pervasive Developmental Disorder, Current or Active State Y 29991 Unspecified Pervasive Developmental Disorder, Residual State N 30000 Anxiety State, Unspecified Y 30001 Panic Disorder Without Agoraphobia Y 30002 Generalized Anxiety Disorder Y 30009 Other Anxiety States Y 30010 Hysteria, Unspecified Y 30011 Conversion Disorder Y 30012 Dissociative Amnesia Y 30013 Psychogenic Fugue Y 30014 Dissociative Identity Disorder N 30015 Dissociative Disorder or Reaction, Unspecified Y 30016 Factitious Disorder With Predominantly Psychological Signs and Symptoms Y 30019 Other and Unspecified Factitious Illness Y 30020 Phobia, Unspecified Y 30021 Agoraphobia With Panic Disorder Y 30022 Agoraphobia Without Mention of Panic Attacks Y 30023 Social Phobia Y 30029 Other Isolated or Specific Phobias Y 30081 Somatization Disorder Y 30082 Undifferentiated Somatoform Disorder Y 30089 Other Somatoform Disorders Y 30110 Affective Personality Disorder, Unspecified Y 30111 Chronic Hypomanic Personality Disorder N 30112 Chronic Depressive Personality Disorder N 30113 Cyclothymic Disorder S 30120 Schizoid Personality Disorder, Unspecified S 30121 Introverted Personality S 30122 Schizotypal Personality Disorder S 30150 Histrionic Personality Disorder, Unspecified S 30151 Chronic Factitious Illness With Physical Symptoms S 30159 Other Histrionic Personality Disorder S 30181 Narcissistic Personality Disorder S 30182 Avoidant Personality Disorder S 30183 Borderline Personality Disorder S 30184 Passive-Aggressive Personality S 30189 Other Personality Disorder Y 30250 Trans-Sexualism With Unspecified Sexual History S 30251 Trans-Sexualism With Asexual History S 30252 Trans-Sexualism With Homosexual History S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 135 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 30253 Trans-Sexualism With Heterosexual History S 30270 Psychosexual Dysfunction, Unspecified S 30271 Hypoactive Sexual Desire Disorder S 30272 Psychosexual Dysfunction With Inhibited Sexual Excitement S 30273 Female Orgasmic Disorder S 30274 Male Orgasmic Disorder S 30275 Premature Ejaculation S 30276 Dyspareunia, Psychogenic S 30279 Psychosexual Dysfunction With Other Specified Psychosexual Dysfunctions Y 30281 Fetishism S 30282 Voyeurism S 30283 Sexual Masochism S 30284 Sexual Sadism S 30285 Gender Identity Disorder in Adolescents or Adults S 30289 Other Specified Psychosexual Disorder Y 30300 Acute Alcoholic Intoxication, Unspecified Drunkenness S 30301 Acute Alcoholic Intoxication, Continuous Drunkenness S 30302 Acute Alcoholic Intoxication, Episodic Drunkenness S 30303 Acute Alcoholic Intoxication, in Remission S 30390 Other and Unspecified Alcohol Dependence, Unspecified Drunkenness S 30391 Other and Unspecified Alcohol Dependence, Continuous Drunkenness S 30392 Other and Unspecified Alcohol Dependence, Episodic Drunkenness S 30393 Other and Unspecified Alcohol Dependence, in Remission S 30400 Opioid Type Dependence, Unspecified Abuse S 30401 Opioid Type Dependence, Continuous Abuse S 30402 Opioid Type Dependence, Episodic Abuse S 30403 Opioid Type Dependence, in Remission S 30410 Sedative, Hypnotic or Anxiolytic Dependence, Unspecified S 30411 Sedative, Hypnotic or Anxiolytic Dependence, Continuous S 30412 Sedative, Hypnotic or Anxiolytic Dependence, Episodic S 30413 Sedative, Hypnotic or Anxiolytic Dependence, in Remission S 30420 Cocaine Dependence, Unspecified Abuse S 30421 Cocaine Dependence, Continuous Abuse S 30422 Cocaine Dependence, Episodic Abuse S 30423 Cocaine Dependence, in Remission S 30430 Cannabis Dependence, Unspecified Abuse S 30431 Cannabis Dependence, Continuous Abuse S 30432 Cannabis Dependence, Episodic Abuse S 30433 Cannabis Dependence, in Remission S 30440 Amphetamine and Other Psychostimulant Dependence, Unspecified Abuse S 30441 Amphetamine and Other Psychostimulant Dependence, Continuous Abuse S 30442 Amphetamine and Other Psychostimulant Dependence, Episodic Abuse S 30443 Amphetamine and Other Psychostimulant Dependence, in Remission S 30450 Hallucinogen Dependence, Unspecified Abuse S 30451 Hallucinogen Dependence, Continuous Abuse S 30452 Hallucinogen Dependence, Episodic Abuse S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 136 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 30453 Hallucinogen Dependence, in Remission S 30460 Other Specified Drug Dependence, Unspecified Abuse S 30461 Other Specified Drug Dependence, Continuous Abuse S 30462 Other Specified Drug Dependence, Episodic Abuse S 30463 Other Specified Drug Dependence, in Remission S

30470 Combinations of Opioid Type Drug With any Other Drug Dependence, Unspecified Abuse S

30471 Combinations of Opioid Type Drug With any Other Drug Dependence, Continuous Abuse S 30472 Combinations of Opioid Type Drug With any Other Drug Dependence, Episodic Abuse S 30473 Combinations of Opioid Type Drug With any Other Drug Dependence, in Remission S 30480 Combinations of Drug Dependence Excluding Opioid Type Drug, Unspecified Abuse S 30481 Combinations of Drug Dependence Excluding Opioid Type Drug, Continuous Abuse S 30482 Combinations of Drug Dependence Excluding Opioid Type Drug, Episodic Abuse S 30483 Combinations of Drug Dependence Excluding Opioid Type Drug, in Remission S 30490 Unspecified Drug Dependence, Unspecified Abuse S 30491 Unspecified Drug Dependence, Continuous Abuse S 30492 Unspecified Drug Dependence, Episodic Abuse S 30493 Unspecified Drug Dependence, in Remission S 30500 Nondependent Alcohol Abuse, Unspecified Drunkenness S 30501 Nondependent Alcohol Abuse, Continuous Drunkenness S 30502 Nondependent Alcohol Abuse, Episodic Drunkenness S 30503 Nondependent Alcohol Abuse, in Remission S 30520 Nondependent Cannabis Abuse, Unspecified S 30521 Nondependent Cannabis Abuse, Continuous S 30522 Nondependent Cannabis Abuse, Episodic S 30523 Nondependent Cannabis Abuse, in Remission S 30530 Nondependent Hallucinogen Abuse, Unspecified S 30531 Nondependent Hallucinogen Abuse, Continuous S 30532 Nondependent Hallucinogen Abuse, Episodic S 30533 Nondependent Hallucinogen Abuse, in Remission S 30540 Sedative, Hypnotic or Anxiolytic Abuse, Unspecified S 30541 Sedative, Hypnotic or Anxiolytic Abuse, Continuous S 30542 Sedative, Hypnotic or Anxiolytic Abuse, Episodic S 30543 Sedative, Hypnotic or Anxiolytic Abuse, in Remission S 30550 Nondependent Opioid Abuse, Unspecified S 30551 Nondependent Opioid Abuse, Continuous S 30552 Nondependent Opioid Abuse, Episodic S 30553 Nondependent Opioid Abuse, in Remission S 30560 Nondependent Cocaine Abuse, Unspecified S 30561 Nondependent Cocaine Abuse, Continuous S 30562 Nondependent Cocaine Abuse, Episodic S 30563 Nondependent Cocaine Abuse, in Remission S 30570 Nondependent Amphetamine or Related Acting Sympathomimetic Abuse, Unspecified S 30571 Nondependent Amphetamine or Related Acting Sympathomimetic Abuse, Continuous S 30572 Nondependent Amphetamine or Related Acting Sympathomimetic Abuse, Episodic S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 137 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 30573 Nondependent Amphetamine or Related Acting Sympathomimetic Abuse, in Remission S 30580 Nondependent Antidepressant Type Abuse, Unspecified S 30581 Nondependent Antidepressant Type Abuse, Continuous S 30582 Nondependent Antidepressant Type Abuse, Episodic S 30583 Nondependent Antidepressant Type Abuse, in Remission S 30590 Other, Mixed, or Unspecified Nondependent Drug Abuse, Unspecified S 30591 Other, Mixed, or Unspecified Nondependent Drug Abuse, Continuous S 30592 Other, Mixed, or Unspecified Nondependent Drug Abuse, Episodic S 30593 Other, Mixed, or Unspecified Nondependent Drug Abuse, in Remission S 30650 Psychogenic Genitourinary Malfunction, Unspecified N 30651 Psychogenic Vaginismus N 30652 Psychogenic Dysmenorrhea N 30653 Psychogenic Dysuria N 30659 Other Genitourinary Malfunction Arising From Mental Factors N 30720 Tic Disorder, Unspecified N 30721 Transient Tic Disorder N 30722 Chronic Motor or Vocal Tic Disorder N 30723 Tourette’s Disorder N 30740 Nonorganic Sleep Disorder, Unspecified N 30741 Transient Disorder of Initiating or Maintaining Sleep N 30742 Persistent Disorder of Initiating or Maintaining Sleep N 30743 Transient Disorder of Initiating or Maintaining Wakefulness N 30744 Persistent Disorder of Initiating or Maintaining Wakefulness N 30745 Circadian Rhythm Sleep Disorder of Nonorganic Origin N 30746 Sleep Arousal Disorder N 30747 Other Dysfunctions of Sleep Stages or Arousal From Sleep N 30748 Repetitive Intrusions of Sleep N 30749 Other Specific Disorder of Sleep of Nonorganic Origin N 30750 Eating Disorder, Unspecified N 30751 Bulimia Nervosa N 30752 Pica N 30753 Rumination Disorder N 30754 Psychogenic Vomiting N 30759 Other Disorder of Eating N 30780 Psychogenic Pain, Site Unspecified N 30781 Tension Headache N 30789 Other, Pain Disorder Related to Psychological Factors N 30921 Separation Anxiety Disorder N 30922 Emancipation Disorder of Adolescence and Early Adult Life N 30923 Specific Academic or Work Inhibition as Adjustment Reaction N 30924 Adjustment Disorder With Anxiety N 30928 Adjustment Disorder With Mixed Anxiety and Depressed Mood N 30929 Other Adjustment Reaction With Predominant Disturbance of Other Emotions N 30981 Post Traumatic Stress Disorder N 30982 Adjustment Reaction With Physical Symptoms N 30983 Adjustment Reaction With Withdrawal N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 138 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 30989 Other Specified Adjustment Reaction N 31200 Undersocialized Conduct Disorder, Aggressive Type, Unspecified Y 31201 Undersocialized Conduct Disorder, Aggressive Type, Mild Y 31202 Undersocialized Conduct Disorder, Aggressive Type, Moderate N 31203 Undersocialized Conduct Disorder, Aggressive Type, Severe Y 31210 Undersocialized Conduct Disorder, Unaggressive Type, Unspecified N 31211 Undersocialized Conduct Disorder, Unaggressive Type, Mild N 31212 Undersocialized Conduct Disorder, Unaggressive Type, Moderate N 31213 Undersocialized Conduct Disorder, Unaggressive Type, Severe N 31220 Socialized Conduct Disorder, Unspecified N 31221 Socialized Conduct Disorder, Mild N 31222 Socialized Conduct Disorder, Moderate N 31223 Socialized Conduct Disorder, Severe N 31230 Impulse Control Disorder, Unspecified N 31231 Pathological Gambling N 31232 Kleptomania N 31233 Pyromania N 31234 Intermittent Explosive Disorder N 31235 Isolated Explosive Disorder N 31239 Other Disorder of Impulse Control N 31281 Conduct Disorder, Childhood Onset Type N 31282 Conduct Disorder, Adolescent Onset Type N 31289 Other Specified Disturbance of Conduct, Not Elsewhere Classified N 31321 Shyness Disorder of Childhood N 31322 Introverted Disorder of Childhood N 31323 Selective Mutism N 31381 Oppositional Defiant Disorder N 31382 Identity Disorder of Childhood or Adolescence N 31383 Academic Underachievement Disorder of Childhood or Adolescence N 31389 Other Emotional Disturbance of Childhood or Adolescence N 31400 Attention Deficit Disorder of Childhood Without Mention of Hyperactivity N 31401 Attention Deficit Disorder of Childhood With Hyperactivity N 31500 Developmental Reading Disorder, Unspecified N 31501 Alexia N 31502 Developmental Dyslexia N 31509 Other Specific Developmental Reading Disorder N 31531 Expressive Language Disorder N 31532 Mixed Receptive-Expressive Language Disorder N 31539 Other Developmental Speech or Language Disorder N 32081 Anaerobic Meningitis Y 32082 Meningitis due to Gram-Negative Bacteria, Not Elsewhere Classified Y 32089 Meningitis due to Other Specified Bacteria Y 32700 Organic Insomnia, Unspecified N 32701 Insomnia due to Medical Condition Classified Elsewhere N 32702 Insomnia due to Mental Disorder N 32709 Other Organic Insomnia N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 139 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 32710 Organic Hypersomnia, Unspecified N 32711 Idiopathic Hypersomnia With Long Sleep Time N 32712 Idiopathic Hypersomnia Without Long Sleep Time N 32713 Recurrent Hypersomnia N 32714 Hypersomnia due to Medical Condition Classified Elsewhere N 32715 Hypersomnia due to Mental Disorder N 32719 Other Organic Hypersomnia N 32720 Organic Sleep Apnea, Unspecified N 32721 Primary Central Sleep Apnea N 32722 High Altitude Periodic Breathing Y 32723 Obstructive Sleep Apnea (Adult) (Pediatric) N 32724 Idiopathic Sleep Related Non-Obstructive Alveolar Hypoventilation N 32725 Congenital Central Alveolar Hypoventilation Syndrome Y 32726 Sleep Related Hypoventilation/Hypoxemia in Conditions Classified Elsewhere N 32727 Central Sleep Apnea in Conditions Classified Elsewhere N 32729 Other Organic Sleep Apnea N 32730 Circadian Rhythm Sleep Disorder, Unspecified N 32731 Cirdadian Rhythm Sleep Disorder, Delayed Sleep Phase Type N 32732 Circadian Rhythm Sleep Disorder, Advanced Sleep Phase Type N 32733 Circadian Rhythm Sleep Disorder, Irregular Sleep-Wake Type N 32734 Circadian Rhythm Sleep Disorder, Free-Running Type N 32735 Circadian Rhythm Sleep Disorder, Jet Lag Type N 32736 Circadian Rhythm Sleep Disorder, Shift Work Type N 32737 Circadian Rhythm Sleep Disorder in Conditions Classified Elsewhere N 32739 Other Circadian Rhythm Sleep Disorder N 32740 Organic Parasomnia, Unspecified N 32741 Confusional Arousals N 32742 Rem Sleep Behavior Disorder N 32743 Recurrent Isolated Sleep Paralysis N 32744 Parasomnia in Conditions Classified Elsewhere N 32749 Other Organic Parasomnia N 32751 Periodic Limb Movement Disorder N 32752 Sleep Related Leg Cramps N 32753 Sleep Related Bruxism N 32759 Other Organic Sleep Related Movement Disorders N 33111 Pick’s Disease Y 33119 Other Frontotemporal Dementia Y 33181 Reye’s Syndrome Y 33182 Dementia With Lewy Bodies Y 33189 Other Cerebral Degeneration N 33381 Blepharospasm N 33382 Orofacial Dyskinesia N 33383 Spasmodic Torticollis N 33384 Organic Writers' Cramp N 33389 Other Fragments of Torsion Dystonia N 33390 Unspecified Extrapyramidal Disease and Abnormal Movement Disorder N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 140 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 33391 Stiff-Man Syndrome N 33392 Neuroleptic Malignant Syndrome N 33393 Benign Shuddering Attacks N 33399 Other Extrapyramidal Disease and Abnormal Movement Disorder N 33510 Unspecified Spinal Muscular Atrophy S 33511 Kugelberg-Welander Disease S 33519 Other Spinal Muscular Atrophy S 33520 Amyotrophic Lateral Sclerosis S 33521 Progressive Muscular Atrophy S 33522 Progressive Bulbar Palsy S 33523 Pseudobulbar Palsy N 33524 Primary Lateral Sclerosis N 33529 Other Motor Neuron Diseases N 33720 Unspecified Reflex Sympathetic Dystrophy N 33721 Reflex Sympathetic Dystrophy of the Upper Limb N 33722 Reflex Sympathetic Dystrophy of the Lower Limb N 33729 Reflex Sympathetic Dystrophy of Other Specified Site N 34200 Flacid Hemiplegia Affecting Unspecified Side Y 34201 Flacid Hemiplegia Affecting Dominant Side Y 34202 Flacid Hemiplegia Affecting Nondominant Side Y 34210 Spastic Hemiplegia Affecting Unspecified Side Y 34211 Spastic Hemiplegia Affecting Dominant Side S 34212 Spastic Hemiplegia Affecting Nondominant Side S 34280 Other Specified Hemiplegia Affecting Unspecified Side Y 34281 Other Specified Hemiplegia Affecting Dominant Side S 34282 Other Specified Hemiplegia Affecting Nondominant Side S 34290 Unspecified Hemiplegia Affecting Unspecified Side Y 34291 Unspecified Hemiplegia Affecting Dominant Side S 34292 Unspecified Hemiplegia Affecting Nondominant Side S 34400 Unspecified Quadriplegia Y 34401 Quadriplegia and Quadriparesis, C1-C4, Complete Y 34402 Quadriplegia and Quadriparesis, C1-C4, Incomplete Y 34403 Quadriplegia and Quadriparesis, C5-C7, Complete Y 34404 C5-C7, Incomplete Y 34409 Other Quadriplegia and Quadriparesis Y 34430 Monoplegia of Lower Limb Affecting Unspecified Side Y 34431 Monoplegia of Lower Limb Affecting Dominant Side Y 34432 Monoplegia of Lower Limb Affecting Nondominant Side Y 34440 Monoplegia of Upper Limb Affecting Unspecified Side Y 34441 Monoplegia of Upper Limb Affecting Dominant Side Y 34442 Monoplegia of Upper Limb Affecting Nondominant Side Y 34460 Cauda Equina Syndrome Without Mention of Neurogenic Bladder Y 34461 Cauda Equina Syndrome With Neurogenic Bladder S 34481 Locked-In State Y 34489 Other Specified Paralytic Syndrome Y 34500 Generalized Nonconvulsive Epilepsy Without Mention of Intractable Epilepsy Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 141 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 34501 Generalized Nonconvulsive Epilepsy With Intractable Epilepsy Y 34510 Generalized Convulsive Epilepsy Without Mention of Intractable Epilepsy Y 34511 Generalized Convulsive Epilepsy With Intractable Epilepsy S Partial Epilepsy With Impairment of Consciousness, Without Mention of Intractable 34540 Epilepsy Y 34541 Partial Epilepsy With Impairment of Consciousness, With Intractable Epilepsy Y Partial Epilepsy Without Mention of Impairment of Consciousness, Without Mention of 34550 Intractable Epilepsy Y Partial Epilepsy Without Mention of Impairment of Consciousness, With Intractable 34551 Epilepsy N 34560 Infantile Spasms Without Mention of Intractable Epilepsy Y 34561 Infantile Spasms With Intractable Epilepsy N 34570 Epilepsia Partialis Continua Without Mention of Intractable Epilepsy Y 34571 Epilepsia Partialis Continua With Intractable Epilepsy Y 34580 Other Forms of Epilepsy Without Mention of Intractable Epilepsy Y 34581 Other Forms of Epilepsy With Intractable Epilepsy S 34590 Unspecified Epilepsy Without Mention of Intractable Epilepsy Y 34591 Unspecified Epilepsy With Intractable Epilepsy S 34600 Classical Migraine Without Mention of Intractable Migraine N 34601 Classical Migraine With Intractable Migraine, So Stated N 34610 Common Migraine Without Mention of Intractable Migraine N 34611 Common Migraine With Intractable Migraine, So Stated N 34620 Variants of Migraine Without Mention of Intractable Migraine N 34621 Variants of Migraine With Intractable Migraine, So Stated N 34680 Other Forms of Migraine Without Mention of Intractable Migraine N 34681 Other Forms of Migraine With Intractable Migraine, So Stated N 34690 Unspecified Migraine Without Mention of Intractable Migraine N 34691 Unspecified Migraine With Intractable Migraine, So Stated N 34700 Narcolepsy, Without Cataplexy N 34701 Narcolepsy, With Cataplexy N 34710 Narcolepsy in Conditions Classified Elsewhere, Without Cataplexy N 34711 Narcolepsy in Conditions Classified Elsewhere, With Cataplexy N 34830 Encephalopathy, Unspecified Y 34831 Metabolic Encephalopathy Y 34839 Other Encephalopathy Y 34981 Cerebrospinal Fluid Rhinorrhea N 34982 Toxic Encephalopathy Y 34989 Other Specified Disorder of Nervous System N 35571 Causalgia of Lower Limb N 35579 Other Mononeuritis of Lower Limb N 35781 Chronic Inflammatory Demyelinating Polyneuritis N 35782 Critical Illness Polyneuropathy N 35789 Other Inflammatory and Toxic Neuropathy N 35800 Myasthenia Gravis Without (Acute) Exacerbation Y 35801 Myasthenia Gravis With (Acute) Exacerbation Y 35981 Critical Illness Myopathy N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 142 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 35989 Other Myopathies N 36000 Unspecified Purulent Endophthalmitis N 36001 Acute Endophthalmitis N 36002 Panophthalmitis N 36003 Chronic Endophthalmitis N 36004 Vitreous Abscess Y 36011 Sympathetic Uveitis Y 36012 Panuveitis Y 36013 Parasitic Endophthalmitis Nos Y 36014 Ophthalmia Nodosa Y 36019 Other Endophthalmitis Y 36020 Unspecified Degenerative Disorder of Globe Y 36021 Progressive High (Degenerative) Myopia Y 36023 Siderosis of Globe Y 36024 Other Metallosis of Globe Y 36029 Other Degenerative Disorders of Globe Y 36030 Unspecified Hypotony of Eye Y 36031 Primary Hypotony of Eye Y 36032 Ocular Fistula Causing Hypotony Y 36033 Hypotony Associated With Other Ocular Disorders Y 36034 Flat Anterior Chamber of Eye Y 36040 Unspecified Degenerated Globe or Eye Y 36041 Blind Hypotensive Eye Y 36042 Blind Hypertensive Eye Y 36043 Hemophthalmos, Except Current Injury Y 36044 Leucocoria Y 36050 Foreign Body, Magnetic, Intraocular, Unspecified Y 36051 Foreign Body, Magnetic, in Anterior Chamber of Eye Y 36052 Foreign Body, Magnetic, in Iris or Ciliary Body Y 36053 Foreign Body, Magnetic, in Lens Y 36054 Foreign Body, Magnetic, in Vitreous Y 36055 Foreign Body, Magnetic, in Posterior Wall N 36059 Intraocular Foreign Body, Magnetic, in Other or Multiple Sites Y 36060 Foreign Body, Intraocular, Unspecified Y 36061 Foreign Body in Anterior Chamber Y 36062 Foreign Body in Iris or Ciliary Body Y 36063 Foreign Body in Lens Y 36064 Foreign Body in Vitreous Y 36065 Foreign Body in Posterior Wall of Eye Y 36069 Foreign Body in Other or Multiple Sites of Eye Y 36081 Luxation of Globe Y 36089 Other Disorders of Globe Y 36100 Retinal Detachment With Retinal Defect, Unspecified Y 36101 Recent Retinal Detachment, Partial, With Single Defect Y 36102 Recent Retinal Detachment, Partial, With Multiple Defects Y 36103 Recent Retinal Detachment, Partial, With Giant Tear Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 143 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 36104 Recent Retinal Detachment, Partial, With Retinal Dialysis Y 36105 Recent Retinal Detachment, Total or Subtotal Y 36106 Old Retinal Detachment, Partial Y 36107 Old Retinal Detachment, Total or Subtotal Y 36110 Unspecified Retinoschisis Y 36111 Flat Retinoschisis Y 36112 Bullous Retinoschisis Y 36113 Primary Retinal Cysts Y 36114 Secondary Retinal Cysts Y 36119 Other Retinoschisis and Retinal Cysts Y 36130 Unspecified Retinal Defect Y 36131 Round Hole of Retina Without Detachment Y 36132 Horseshoe Tear of Retina Without Detachment Y 36133 Multiple Defects of Retina Without Detachment Y 36181 Traction Detachment of Retina Y 36189 Other Forms of Retinal Detachment Y 36201 Background Diabetic Retinopathy N 36202 Proliferative Diabetic Retinopathy N 36203 Nonproliferative Diabetic Retinopathy Nos N 36204 Mild Nonproliferative Diabetic Retinopathy N 36205 Moderate Nonproliferative Diabetic Retinopathy N 36206 Severe Nonproliferative Diabetic Retinopathy N 36207 Diabetic Macular Edema N 36210 Unspecified Background Retinopathy N 36211 Hypertensive Retinopathy N 36212 Exudative Retinopathy N 36213 Changes in Vascular Appearance of Retina N 36214 Retinal Microaneurysms Nos N 36215 Retinal Telangiectasia N 36216 Retinal Neovascularization Nos N 36217 Other Intraretinal Microvascular Abnormalities N 36218 Retinal Vasculitis N 36221 Retrolental Fibroplasia N 36229 Other Nondiabetic Proliferative Retinopathy N 36230 Unspecified Retinal Vascular Occlusion N 36231 Central Artery Occlusion of Retina Y 36232 Arterial Branch Occlusion of Retina Y 36233 Partial Arterial Occlusion of Retina Y 36234 Transient Arterial Occlusion of Retina Y 36235 Central Vein Occlusion of Retina Y 36236 Venous Tributary (Branch) Occlusion of Retina Y 36237 Venous Engorgement of Retina Y 36240 Unspecified Retinal Layer Separation Y 36241 Central Serous Retinopathy Y 36242 Serous Detachment of Retinal Pigment Epithelium S 36243 Hemorrhagic Detachment of Retinal Pigment Epithelium Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 144 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 36250 Macular Degeneration (Senile) of Retina, Unspecified Y 36251 Nonexudative Senile Macular Degeneration of Retina Y 36252 Exudative Senile Macular Degeneration of Retina Y 36253 Cystoid Macular Degeneration of Retina Y 36254 Macular Cyst, Hole, or Pseudohole of Retina Y 36255 Toxic Maculopathy of Retina Y 36256 Macular Puckering of Retina Y 36257 Drusen (Degenerative) of Retina Y 36260 Unspecified Peripheral Retinal Degeneration Y 36261 Paving Stone Degeneration of Peripheral Retina Y 36262 Microcystoid Degeneration of Peripheral Retina Y 36263 Lattice Degeneration of Peripheral Retina Y 36264 Senile Reticular Degeneration of Peripheral Retina Y 36265 Secondary Pigmentary Degeneration of Peripheral Retina Y 36266 Secondary Vitreoretinal Degenerations Peripheral Retina Y 36270 Unspecified Hereditary Retinal Dystrophy Y 36271 Retinal Dystrophy in Systemic or Cerebroretinal Lipidoses Y 36272 Retinal Dystrophy in Other Systemic Disorders and Syndromes Y 36273 Vitreoretinal Dystrophies Y 36274 Pigmentary Retinal Dystrophy Y 36275 Other Dystrophies Primarily Involving the Sensory Retina Y 36276 Dystrophies Primarily Involving the Retinal Pigment Epithelium Y 36277 Retinal Dystrophies Primarily Involving Bruch’s Membrane Y 36281 Retinal Hemorrhage Y 36282 Retinal Exudates and Deposits N 36283 Retinal Edema Y 36284 Retinal Ischemia Y 36285 Retinal Nerve Fiber Bundle Defects Y 36289 Other Retinal Disorders Y 36300 Unspecified Focal Chorioretinitis Y 36301 Focal Choroiditis and Chorioretinitis, Juxtapapillary Y 36303 Focal Choroiditis and Chorioretinitis of Other Posterior Pole Y 36304 Focal Choroiditis and Chorioretinitis, Peripheral Y 36305 Focal Retinitis and Retinochoroiditis, Juxtapapillary Y 36306 Focal Retinitis and Retinochoroiditis, Macular or Paramacular Y 36307 Focal Retinitis and Retinochoroiditis of Other Posterior Pole Y 36308 Focal Retinitis and Retinochoroiditis, Peripheral Y 36310 Unspecified Disseminated Chorioretinitis Y 36311 Disseminated Choroiditis and Chorioretinitis, Posterior Pole Y 36312 Disseminated Choroiditis and Chorioretinitis, Peripheral Y 36313 Disseminated Choroiditis and Chorioretinitis, Generalized Y 36314 Disseminated Retinitis and Retinochoroiditis, Metastatic Y 36315 Disseminated Retinitis and Retinochoroiditis, Pigment Epitheliopathy Y 36320 Unspecified Chorioretinitis Y 36321 Pars Planitis Y 36322 Harada’s Disease Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 145 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 36330 Unspecified Chorioretinal Scar Y 36331 Solar Retinopathy Y 36332 Other Macular Scars of Chorioretina Y 36333 Other Scars of Posterior Pole of Chorioretina Y 36334 Peripheral Scars of the Chorioretina Y 36335 Disseminated Scars of the Chorioretina Y 36340 Unspecified Choroidal Degeneration Y 36341 Senile Atrophy of Choroid Y 36342 Diffuse Secondary Atrophy of Choroid Y 36343 Angioid Streaks of Choroid Y 36350 Unspecified Hereditary Choroidal Dystrophy or Atrophy Y 36351 Circumpapillary Dystrophy of Choroid, Partial Y 36352 Circumpapillary Dystrophy of Choroid, Total Y 36353 Central Dystrophy of Choroid, Partial Y 36354 Central Choroidal Atrophy, Total Y 36355 Choroideremia Y 36356 Other Diffuse or Generalized Dystrophy of Choroid, Partial Y 36357 Other Diffuse or Generalized Dystrophy of Choroid, Total Y 36361 Unspecified Choroidal Hemorrhage Y 36362 Expulsive Choroidal Hemorrhage Y 36363 Choroidal Rupture Y 36370 Unspecified Choroidal Detachment Y 36371 Serous Choroidal Detachment Y 36372 Hemorrhagic Choroidal Detachment Y 36400 Unspecified Acute and Subacute Iridocyclitis Y 36401 Primary Iridocyclitis Y 36402 Recurrent Iridocyclitis Y 36403 Secondary Iridocyclitis, Infectious Y 36404 Secondary Iridocyclitis, Noninfectious Y 36405 Hypopyon Y 36410 Unspecified Chronic Iridocyclitis Y 36411 Chronic Iridocyclitis in Diseases Classified Elsewhere Y 36421 Fuchs' Heterochromic Cyclitis Y 36422 Glaucomatocyclitic Crises Y 36423 Lens-Induced Iridocyclitis Y 36424 Vogt-Koyanagi Syndrome Y 36441 Hyphema Y 36442 Rubeosis Iridis Y 36451 Essential or Progressive Iris Atrophy Y 36452 Iridoschisis Y 36453 Pigmentary Iris Degeneration Y 36454 Degeneration of Pupillary Margin Y 36455 Miotic Cysts of Pupillary Margin Y 36456 Degenerative Changes of Chamber Angle Y 36457 Degenerative Changes of Ciliary Body Y 36459 Other Iris Atrophy Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 146 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 36460 Idiopathic Cysts of Iris, Ciliary Body, and Anterior Chamber Y 36461 Implantation Cysts of Iris, Ciliary Body, and Anterior Chamber Y 36462 Exudative Cysts of Iris or Anterior Chamber Y 36463 Primary Cyst of Pars Plana Y 36464 Exudative Cyst of Pars Plana Y 36470 Unspecified Adhesions of Iris Y 36471 Posterior Synechiae Y 36472 Anterior Synechiae Y 36473 Goniosynechiae Y 36474 Adhesions and Disruptions of Pupillary Membranes Y 36475 Pupillary Abnormalities Y 36476 Iridodialysis Y 36477 Recession of Chamber Angle of Eye Y 36500 Unspecified Preglaucoma Y 36501 Borderline Glaucoma, Open Angle With Borderline Findings Y 36502 Borderline Glaucoma With Anatomical Narrow Angle Y 36503 Borderline Glaucoma With Steroid Responders Y 36504 Borderline Glaucoma With Ocular Hypertension Y 36510 Unspecified Open-Angle Glaucoma Y 36511 Primary Open-Angle Glaucoma Y 36512 Low Tension Open-Angle Glaucoma Y 36513 Pigmentary Open-Angle Glaucoma Y 36514 Open-Angle Glaucoma of Childhood Y 36515 Residual Stage of Open Angle Glaucoma Y 36520 Unspecified Primary Angle-Closure Glaucoma Y 36521 Intermittent Angle-Closure Glaucoma Y 36522 Acute Angle-Closure Glaucoma Y 36523 Chronic Angle-Closure Glaucoma Y 36524 Residual Stage of Angle-Closure Glaucoma Y 36531 Corticosteroid-Induced Glaucoma, Glaucomatous Stage Y 36532 Corticosteroid-Induced Glaucoma, Residual Stage Y 36541 Glaucoma Associated With Chamber Angle Anomalies Y 36542 Glaucoma Associated With Anomalies of Iris Y 36543 Glaucoma Associated With Other Anterior Segment Anomalies Y 36544 Glaucoma Associated With Systemic Syndromes Y 36551 Phacolytic Glaucoma Y 36552 Pseudoexfoliation Glaucoma Y 36559 Glaucoma Associated With Other Lens Disorders Y 36560 Glaucoma Associated With Unspecified Ocular Disorder Y 36561 Glaucoma Associated With Pupillary Block Y 36562 Glaucoma Associated With Ocular Inflammations Y 36563 Glaucoma Associated With Vascular Disorders of Eye Y 36564 Glaucoma Associated With Tumors or Cysts Y 36565 Glaucoma Associated With Ocular Trauma Y 36581 Hypersecretion Glaucoma Y 36582 Glaucoma With Increased Episcleral Venous Pressure Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 147 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 36583 Aqueous Misdirection Y 36589 Other Specified Glaucoma Y 36600 Unspecified Nonsenile Cataract Y 36601 Anterior Subcapsular Polar Cataract, Nonsenile Y 36602 Posterior Subcapsular Polar Cataract, Nonsenile Y 36603 Cortical, Lamellar, or Zonular Cataract, Nonsenile Y 36604 Nuclear Cataract, Nonsenile Y 36609 Other and Combined Forms of Nonsenile Cataract Y 36610 Unspecified Senile Cataract Y 36611 Pseudoexfoliation of Lens Capsule Y 36612 Incipient Cataract Y 36613 Anterior Subcapsular Polar Senile Cataract Y 36614 Posterior Subcapsular Polar Senile Cataract Y 36615 Cortical Senile Cataract Y 36616 Nuclear Sclerosis Y 36617 Total or Mature Senile Cataract Y 36618 Hypermature Senile Cataract Y 36619 Other and Combined Forms of Senile Cataract Y 36620 Unspecified Traumatic Cataract Y 36621 Localized Traumatic Opacities of Cataract Y 36622 Total Traumatic Cataract Y 36623 Partially Resolved Traumatic Cataract Y 36630 Unspecified Cataracta Complicata Y 36631 Cataract Secondary to Glaucomatous Flecks (Subcapsular) Y 36632 Cataract in Inflammatory Ocular Disorders Y 36633 Cataract With Ocular Neovascularization Y 36634 Cataract in Degenerative Ocular Disorders Y 36641 Diabetic Cataract Y 36642 Tetanic Cataract Y 36643 Myotonic Cataract Y 36644 Cataract Associated With Other Syndromes Y 36645 Toxic Cataract Y 36646 Cataract Associated With Radiation and Other Physical Influences Y 36650 Unspecified After-Cataract Y 36651 Soemmering’s Ring Y 36652 Other After-Cataract, Not Obscuring Vision Y 36653 After-Cataract, Obscuring Vision Y 36720 Unspecified Astigmatism Y 36721 Regular Astigmatism Y 36722 Irregular Astigmatism Y 36731 Anisometropia Y 36732 Aniseikonia Y 36751 Paresis of Accommodation Y 36752 Total or Complete Internal Ophthalmoplegia Y 36753 Spasm of Accommodation Y 36781 Transient Refractive Change Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 148 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 36789 Other Disorders of Refraction and Accommodation Y 36800 Unspecified Amblyopia Y 36801 Strabismic Amblyopia Y 36802 Deprivation Amblyopia Y 36803 Refractive Amblyopia Y 36810 Unspecified Subjective Visual Disturbance Y 36811 Sudden Visual Loss Y 36812 Transient Visual Loss Y 36813 Visual Discomfort Y 36814 Visual Distortions of Shape and Size Y 36815 Other Visual Distortions and Entoptic Phenomena Y 36816 Psychophysical Visual Disturbances Y 36830 Unspecified Binocular Vision Disorder Y 36831 Suppression of Binocular Vision Y 36832 Simultaneous Visual Perception Without Fusion Y 36833 Fusion With Defective Stereopsis Y 36834 Abnormal Retinal Correspondence Y 36840 Unspecified Visual Field Defect Y 36841 Scotoma Involving Central Area in Visual Field Y 36842 Scotoma of Blind Spot Area in Visual Field Y 36843 Sector or Arcuate Defects in Visual Field Y 36844 Other Localized Visual Field Defect Y 36845 Generalized Contraction or Constriction in Visual Field Y 36846 Homonymous Bilateral Field Defects in Visual Field Y 36847 Heteronymous Bilateral Field Defects in Visual Field Y 36851 Protan Defect in Color Vision Y 36852 Deutan Defect in Color Vision Y 36853 Tritan Defect in Color Vision Y 36854 Achromatopsia Y 36855 Acquired Color Vision Deficiencies Y 36859 Other Color Vision Deficiencies Y 36860 Unspecified Night Blindness Y 36861 Congenital Night Blindness Y 36862 Acquired Night Blindness Y 36863 Abnormal Dark Adaptation Curve Y 36869 Other Night Blindness Y 36900 Blindness of Both Eyes, Impairment Level Not Further Specified Y 36901 Better Eye: Total Vision Impairment; Lesser Eye: Total Vision Impairment Y 36902 Better Eye: Near-Total Vision Impairment; Lesser Eye: Not Further Specified Y 36903 Better Eye: Near-Total Vision Impairment; Lesser Eye: Total Vision Impairment Y 36904 Better Eye: Near-Total Vision Impairment; Lesser Eye: Near-Total Vision Impairment Y 36905 Better Eye: Profound Vision Impairment; Lesser Eye: Not Further Specified Y 36906 Better Eye: Profound Vision Impairment; Lesser Eye: Total Vision Impairment Y 36907 Better Eye: Profound Vision Impairment; Lesser Eye: Near-Total Vision Impairment Y 36908 Better Eye: Profound Vision Impairment; Lesser Eye: Profound Vision Impairment Y 36910 Profound, Moderate or Severe Vision Impairment, Not Further Specified Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 149 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 36911 Better Eye: Severe Vision Impairment; Lesser Eye: Blind, Not Further Specified Y 36912 Better Eye: Severe Vision Impairment; Lesser Eye: Total Vision Impairment Y 36913 Better Eye: Severe Vision Impairment; Lesser Eye: Near-Total Vision Impairment Y 36914 Better Eye: Severe Vision Impairment; Lesser Eye: Profound Vision Impairment Y 36915 Better Eye: Moderate Vision Impairment; Lesser Eye: Blind, Not Further Specified Y 36916 Better Eye: Moderate Vision Impairment; Lesser Eye: Total Vision Impairment Y 36917 Better Eye: Moderate Vision Impairment; Lesser Eye: Near-Total Vision Impairment Y 36918 Better Eye: Moderate Vision Impairment; Lesser Eye: Profound Vision Impairment Y 36920 Vision Impairment, Both Eyes, Impairment Level Not Further Specified Y 36921 Better Eye: Severe Vision Impairment; Lesser Eye; Impairment Not Further Specified Y 36922 Better Eye: Severe Vision Impairment; Lesser Eye: Severe Vision Impairment Y

36923 Better Eye: Moderate Vision Impairment; Lesser Eye: Impairment Not Further Specified Y 36924 Better Eye: Moderate Vision Impairment; Lesser Eye: Severe Vision Impairment Y 36925 Better Eye: Moderate Vision Impairment; Lesser Eye: Moderate Vision Impairment Y 36960 Impairment Level Not Further Specified Y 36961 One Eye: Total Vision Impairment; Other Eye: Not Specified Y 36962 One Eye: Total Vision Impairment; Other Eye: Near-Normal Vision Y 36963 One Eye: Total Vision Impairment; Other Eye: Normal Vision Y 36964 One Eye: Near-Total Vision Impairment; Other Eye: Vision Not Specified Y 36965 One Eye: Near-Total Vision Impairment; Other Eye: Near-Normal Vision Y 36966 One Eye: Near-Total Vision Impairment; Other Eye: Normal Vision Y 36967 One Eye: Profound Vision Impairment; Other Eye: Vision Not Specified Y 36968 One Eye: Profound Vision Impairment; Other Eye: Near-Normal Vision Y 36969 One Eye: Profound Vision Impairment; Other Eye: Normal Vision Y 36970 Low Vision, One Eye, Not Otherwise Specified Y 36971 One Eye: Severe Vision Impairment; Other Eye: Vision Not Specified Y 36972 One Eye: Severe Vision Impairment; Other Eye: Near-Normal Vision Y 36973 One Eye: Severe Vision Impairment; Other Eye: Normal Vision Y 36974 One Eye: Moderate Vision Impairment; Other Eye: Vision Not Specified Y 36975 One Eye: Moderate Vision Impairment; Other Eye: Near-Normal Vision Y 36976 One Eye: Moderate Vision Impairment; Other Eye: Normal Vision Y 37000 Unspecified Corneal Ulcer Y 37001 Marginal Corneal Ulcer Y 37002 Ring Corneal Ulcer Y 37003 Central Corneal Ulcer Y 37004 Hypopyon Ulcer Y 37005 Mycotic Corneal Ulcer Y 37006 Perforated Corneal Ulcer Y 37007 Mooren’s Ulcer Y 37020 Unspecified Superficial Keratitis Y 37021 Punctate Keratitis Y 37022 Macular Keratitis Y 37023 Filamentary Keratitis Y 37024 Photokeratitis Y 37031 Phlyctenular Keratoconjunctivitis Y 37032 Limbar and Corneal Involvement in Vernal Conjunctivitis Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 150 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 37033 Keratoconjunctivitis Sicca, Not Specified as Sjogren’s Y 37034 Exposure Keratoconjunctivitis Y 37035 Neurotrophic Keratoconjunctivitis Y 37040 Unspecified Keratoconjunctivitis Y 37044 Keratitis or Keratoconjunctivitis in Exanthema Y 37049 Other Unspecified Keratoconjunctivitis Y 37050 Unspecified Interstitial Keratitis Y 37052 Diffuse Interstitial Keratitis Y 37054 Sclerosing Keratitis Y 37055 Corneal Abscess Y 37059 Other Interstitial and Deep Keratitis Y 37060 Unspecified Corneal Neovascularization Y 37061 Localized Vascularization of Cornea Y 37062 Pannus (Corneal) Y 37063 Deep Vascularization of Cornea Y 37064 Ghost Vessels (Corneal) in Corneal Neovascularization Y 37100 Unspecified Corneal Opacity Y 37101 Minor Opacity of Cornea Y 37102 Peripheral Opacity of Cornea Y 37103 Central Opacity of Cornea Y 37104 Adherent Leucoma Y 37105 Phthisical Cornea Y 37110 Unspecified Corneal Deposit Y 37111 Anterior Pigmentations of Cornea Y 37112 Stromal Pigmentations of Cornea Y 37113 Posterior Pigmentations of Cornea Y 37114 Kayser-Fleischer Ring Y 37115 Other Deposits of Cornea Associated With Metabolic Disorders Y 37116 Argentous Deposits of Cornea Y 37120 Unspecified Corneal Edema Y 37121 Idiopathic Corneal Edema Y 37122 Secondary Corneal Edema Y 37123 Bullous Keratopathy Y 37124 Corneal Edema due to Wearing of Contact Lenses Y 37130 Unspecified Corneal Membrane Change Y 37131 Folds and Rupture of Bowman’s Membrane Y 37132 Folds in Descemet’s Membrane Y 37133 Rupture in Descemet’s Membrane Y 37140 Unspecified Corneal Degeneration Y 37141 Senile Corneal Changes Y 37142 Recurrent Erosion of Cornea Y 37143 Band-Shaped Keratopathy Y 37144 Other Calcerous Degenerations of Cornea Y 37145 Keratomalacia Nos Y 37146 Nodular Degeneration of Cornea Y 37148 Peripheral Degenerations of Cornea Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 151 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 37149 Other Corneal Degenerations Y 37150 Unspecified Hereditary Corneal Dystrophy Y 37151 Juvenile Epithelial Corneal Dystrophy Y 37152 Other Anterior Corneal Dystrophies Y 37153 Granular Corneal Dystrophy Y 37154 Lattice Corneal Dystrophy Y 37155 Macular Corneal Dystrophy Y 37156 Other Stromal Corneal Dystrophies Y 37157 Endothelial Corneal Dystrophy Y 37158 Other Posterior Corneal Dystrophies Y 37160 Unspecified Keratoconus Y 37161 Keratoconus, Stable Condition Y 37162 Keratoconus, Acute Hydrops Y 37170 Unspecified Corneal Deformity Y 37171 Corneal Ectasia Y 37172 Descemetocele Y 37173 Corneal Staphyloma Y 37181 Corneal Anesthesia and Hypoesthesia Y 37182 Corneal Disorder due to Contact Lens Y 37189 Other Corneal Disorder Y 37200 Unspecified Acute Conjunctivitis Y 37201 Serous Conjunctivitis, Except Viral Y 37202 Acute Follicular Conjunctivitis Y 37203 Other Mucopurulent Conjunctivitis Y 37204 Pseudomembranous Conjunctivitis Y 37205 Acute Atopic Conjunctivitis Y 37210 Unspecified Chronic Conjunctivitis Y 37211 Simple Chronic Conjunctivitis Y 37212 Chronic Follicular Conjunctivitis Y 37213 Vernal Conjunctivitis Y 37214 Other Chronic Allergic Conjunctivitis Y 37215 Parasitic Conjunctivitis Y 37220 Unspecified Blepharoconjunctivitis Y 37221 Angular Blepharoconjunctivitis Y 37222 Contact Blepharoconjunctivitis Y 37230 Unspecified Conjunctivitis Y 37231 Rosacea Conjunctivitis Y 37233 Conjunctivitis in Mucocutaneous Disease Y 37239 Other and Unspecified Conjunctivitis Y 37240 Unspecified Pterygium Y 37241 Peripheral Ptergium, Stationary Y 37242 Peripheral Pterygium, Progressive Y 37243 Central Pterygium Y 37244 Double Pterygium Y 37245 Recurrent Pterygium Y 37250 Unspecified Conjunctival Degeneration Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 152 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 37251 Pinguecula Y 37252 Pseudopterygium Y 37253 Conjunctival Xerosis Y 37254 Conjunctival Concretions Y 37255 Conjunctival Pigmentations Y 37256 Conjunctival Deposits Y 37261 Granuloma of Conjunctiva Y 37262 Localized Adhesions and Strands of Conjunctiva Y 37263 Symblepharon Y 37264 Scarring of Conjunctiva Y 37271 Hyperemia of Conjunctiva Y 37272 Conjunctival Hemorrhage Y 37273 Conjunctival Edema Y 37274 Vascular Abnormalities of Conjunctiva Y 37275 Conjunctival Cysts Y 37281 Conjunctivochalasis Y 37289 Other Disorders of Conjunctiva Y 37300 Blepharitis, Unspecified Y 37301 Ulcerative Blepharitis Y 37302 Squamous Blepharitis Y 37311 Hordeolum Externum Y 37312 Hordeolum Internum Y 37313 Abscess of Eyelid Y 37331 Eczematous Dermatitis of Eyelid Y 37332 Contact and Allergic Dermatitis of Eyelid Y 37333 Xeroderma of Eyelid Y 37334 Discoid Lupus Erythematosus of Eyelid Y 37400 Unspecified Entropion Y 37401 Senile Entropion Y 37402 Mechanical Entropion Y 37403 Spastic Entropion Y 37404 Cicatricial Entropion Y 37405 Trichiasis of Eyelid Without Entropion Y 37410 Unspecified Ectropion Y 37411 Senile Ectropion Y 37412 Mechanical Ectropion Y 37413 Spastic Ectropion Y 37414 Cicatricial Ectropion Y 37420 Unspecified Lagophthalmos Y 37421 Paralytic Lagophthalmos Y 37422 Mechanical Lagophthalmos Y 37423 Cicatricial Lagophthalmos Y 37430 Unspecified Ptosis of Eyelid Y 37431 Paralytic Ptosis Y 37432 Myogenic Ptosis Y 37433 Mechanical Ptosis Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 153 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 37434 Blepharochalasis Y 37441 Eyelid Retraction or Lag Y 37443 Abnormal Innervation Syndrome of Eyelid Y 37444 Sensory Disorders of Eyelid Y 37445 Other Sensorimotor Disorders of Eyelid Y 37446 Blepharophimosis Y 37450 Unspecified Degenerative Disorder of Eyelid Y 37451 Xanthelasma of Eyelid Y 37452 Hyperpigmentation of Eyelid Y 37453 Hypopigmentation of Eyelid Y 37454 Hypertrichosis of Eyelid Y 37455 Hypotrichosis of Eyelid Y 37456 Other Degenerative Disorders of Skin Affecting Eyelid Y 37481 Hemorrhage of Eyelid Y 37482 Edema of Eyelid Y 37483 Elephantiasis of Eyelid Y 37484 Cysts of Eyelids Y 37485 Vascular Anomalies of Eyelid Y 37486 Retained Foreign Body of Eyelid Y 37487 Dermatochalasis Y 37489 Other Disorders of Eyelid Y 37500 Unspecified Dacryoadenitis Y 37501 Acute Dacryoadenitis Y 37502 Chronic Dacryoadenitis Y 37503 Chronic Enlargement of Lacrimal Gland Y 37511 Dacryops Y 37512 Other Lacrimal Cysts and Cystic Degeneration Y 37513 Primary Lacrimal Atrophy Y 37514 Secondary Lacrimal Atrophy Y 37515 Unspecified Tear Film Insufficiency Y 37516 Dislocation of Lacrimal Gland Y 37520 Epiphora, Unspecified as to Cause Y 37521 Epiphora due to Excess Lacrimation Y 37522 Epiphora due to Insufficient Drainage Y 37530 Unspecified Dacryocystitis Y 37531 Acute Canaliculitis, Lacrimal Y 37532 Acute Dacryocystitis Y 37533 Phlegmonous Dacryocystitis Y 37541 Chronic Canaliculitis Y 37542 Chronic Dacryocystitis Y 37543 Lacrimal Mucocele Y 37551 Eversion of Lacrimal Punctum Y 37552 Stenosis of Lacrimal Punctum Y 37553 Stenosis of Lacrimal Canaliculi Y 37554 Stenosis of Lacrimal Sac Y 37555 Obstruction of Nasolacrimal Duct, Neonatal Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 154 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 37556 Stenosis of Nasolacrimal Duct, Acquired Y 37557 Dacryolith Y 37561 Lacrimal Fistula Y 37569 Other Change of Lacrimal Passages Y 37581 Granuloma of Lacrimal Passages Y 37589 Other Disorder of Lacrimal System Y 37600 Unspecified Acute Inflammation of Orbit Y 37601 Orbital Cellulitis Y 37602 Orbital Periostitis Y 37603 Orbital Osteomyelitis Y 37604 Orbital Tenonitis Y 37610 Unspecified Chronic Inflammation of Orbit Y 37611 Orbital Granuloma Y 37612 Orbital Myositis Y 37613 Parasitic Infestation of Orbit Y 37621 Thyrotoxic Exophthalmos Y 37622 Exophthalmic Ophthalmoplegia Y 37630 Unspecified Exophthalmos Y 37631 Constant Exophthalmos Y 37632 Orbital Hemorrhage Y 37633 Orbital Edema or Congestion Y 37634 Intermittent Exophthalmos Y 37635 Pulsating Exophthalmos Y 37636 Lateral Displacement of Globe of Eye Y 37640 Unspecified Deformity of Orbit Y 37641 Hypertelorism of Orbit Y 37642 Exostosis of Orbit Y 37643 Local Deformities of Orbit due to Bone Disease Y 37644 Orbital Deformities Associated With Craniofacial Deformities Y 37645 Atrophy of Orbit Y 37646 Enlargement of Orbit Y 37647 Deformity of Orbit due to Trauma or Surgery Y 37650 Enophthalmos, Unspecified as to Cause Y 37651 Enophthalmos due to Atrophy of Orbital Tissue Y 37652 Enophthalmos due to Trauma or Surgery Y 37681 Orbital Cysts Y 37682 Myopathy of Extraocular Muscles Y 37689 Other Orbital Disorder Y 37700 Unspecified Papilledema Y 37701 Papilledema Associated With Increased Intracranial Pressure Y 37702 Papilledema Associated With Decreased Ocular Pressure Y 37703 Papilledema Associated With Retinal Disorder Y 37704 Foster-Kennedy Syndrome Y 37710 Unspecified Optic Atrophy Y 37711 Primary Optic Atrophy Y 37712 Postinflammatory Optic Atrophy Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 155 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 37713 Optic Atrophy Associated With Retinal Dystrophies Y 37714 Glaucomatous Atrophy (Cupping) of Optic Disc Y 37715 Partial Optic Atrophy Y 37716 Hereditary Optic Atrophy Y 37721 Drusen of Optic Disc Y 37722 Crater-Like Holes of Optic Disc Y 37723 Coloboma of Optic Disc Y 37724 Pseudopapilledema Y 37730 Unspecified Optic Neuritis Y 37731 Optic Papillitis Y 37732 Retrobulbar Neuritis (Acute) Y 37733 Nutritional Optic Neuropathy Y 37734 Toxic Optic Neuropathy Y 37739 Other Optic Neuritis Y 37741 Ischemic Optic Neuropathy Y 37742 Hemorrhage in Optic Nerve Sheaths Y 37749 Other Disorder of Optic Nerve Y 37751 Disorders of Optic Chiasm Associated With Pituitary Neoplasms and Disorders Y 37752 Disorders of Optic Chiasm Associated With Other Neoplasms Y 37753 Disorders of Optic Chiasm Associated With Vascular Disorders Y 37754 Disorders of Optic Chiasm Associated With Inflammatory Disorders Y 37761 Disorders of Other Visual Pathways Associated With Neoplasms Y 37762 Disorders of Other Visual Pathways Associated With Vascular Disorders Y 37763 Disorders of Other Visual Pathways Associated With Inflammatory Disorders Y 37771 Disorders of Visual Cortex Associated With Neoplasms Y 37772 Disorders of Visual Cortex Associated With Vascular Disorders Y 37773 Disorders of Visual Cortex Associated With Inflammatory Disorders Y 37775 Disorders of Visual Cortex Associated With Cortical Blindness Y 37800 Unspecified Esotropia Y 37801 Monocular Esotropia Y 37802 Monocular Esotropia With a Pattern Y 37803 Monocular Esotropia With V Pattern Y 37804 Monocular Esotropia With Other Noncomitancies Y 37805 Alternating Esotropia Y 37806 Alternating Esotropia With a Pattern Y 37807 Alternating Esotropia With V Pattern Y 37808 Alternating Esotropia With Other Noncomitancies Y 37810 Unspecified Exotropia Y 37811 Monocular Exotropia Y 37812 Monocular Exotropia With a Pattern Y 37813 Monocular Exotropia With V Pattern Y 37814 Monocular Exotropia With Other Noncomitancies Y 37815 Alternating Exotropia Y 37816 Alternating Exotropia With a Pattern Y 37817 Alternating Exotropia With V Pattern Y 37818 Alternating Exotropia With Other Noncomitancies Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 156 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 37820 Unspecified Intermittent Heterotropia Y 37821 Intermittent Esotropia, Monocular Y 37822 Intermittent Esotropia, Alternating Y 37823 Intermittent Exotropia, Monocular Y 37824 Intermittent Exotropia, Alternating Y 37830 Unspecified Heterotropia Y 37831 Hypertropia Y 37832 Hypotropia Y 37833 Cyclotropia Y 37834 Monofixation Syndrome Y 37835 Accommodative Component in Esotropia Y 37840 Unspecified Heterophoria Y 37841 Esophoria Y 37842 Exophoria Y 37843 Vertical Heterophoria Y 37844 Cyclophoria Y 37845 Alternating Hyperphoria Y 37850 Unspecified Paralytic Strabismus Y 37851 Paralytic Strabismus, Third or Oculomotor Nerve Palsy, Partial Y 37852 Paralytic Strabismus, Third or Oculomotor Nerve Palsy, Total Y 37853 Paralytic Strabismus, Fourth or Trochlear Nerve Palsy Y 37854 Paralytic Strabismus, Sixth or Abducens Nerve Palsy Y 37855 Paralytic Strabismus, External Ophthalmoplegia Y 37856 Paralytic Strabismus, Total Ophthalmoplegia Y 37860 Unspecified Mechanical Strabismus Y 37861 Mechanical Strabismus From Brown’s (Tendon) Sheath Syndrome Y 37862 Mechanical Strabismus From Other Musculofascial Disorders Y 37863 Mechanical Strabismus From Limited Duction Associated With Other Conditions Y 37871 Duane’s Syndrome Y 37872 Progressive External Ophthalmoplegia Y 37873 Strabismus in Other Neuromuscular Disorders Y 37881 Palsy of Conjugate Gaze Y 37882 Spasm of Conjugate Gaze Y 37883 Convergence Insufficiency or Palsy in Binocular Eye Movement Y 37884 Convergence Excess or Spasm in Binocular Eye Movement Y 37885 Anomalies of Divergence in Binocular Eye Movement Y 37886 Internuclear Ophthalmoplegia Y 37887 Other Dissociated Deviation of Eye Movements Y 37900 Unspecified Scleritis Y 37901 Episcleritis Periodica Fugax Y 37902 Nodular Episcleritis Y 37903 Anterior Scleritis Y 37904 Scleromalacia Perforans Y 37905 Scleritis With Corneal Involvement Y 37906 Brawny Scleritis Y 37907 Posterior Scleritis Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 157 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 37909 Other Scleritis and Episcleritis Y 37911 Scleral Ectasia Y 37912 Staphyloma Posticum Y 37913 Equatorial Staphyloma Y 37914 Anterior Staphyloma, Localized Y 37915 Ring Staphyloma Y 37916 Other Degenerative Disorders of Sclera Y 37919 Other Scleral Disorder Y 37921 Vitreous Degeneration Y 37922 Crystalline Deposits in Vitreous Y 37923 Vitreous Hemorrhage Y 37924 Other Vitreous Opacities Y 37925 Vitreous Membranes and Strands Y 37926 Vitreous Prolapse Y 37929 Other Disorders of Vitreous Y 37931 Aphakia Y 37932 Subluxation of Lens Y 37933 Anterior Dislocation of Lens Y 37934 Posterior Dislocation of Lens Y 37939 Other Disorders of Lens Y 37940 Unspecified Abnormal Pupillary Function Y 37941 Anisocoria Y 37942 Miosis (Persistent), Not due to Miotics Y 37943 Mydriasis (Persistent), Not due to Mydriatics Y 37945 Argyll Robertson Pupil, Atypical Y 37946 Tonic Pupillary Reaction Y 37949 Other Anomaly of Pupillary Function Y 37950 Unspecified Nystagmus Y 37951 Congenital Nystagmus Y 37952 Latent Nystagmus Y 37953 Visual Deprivation Nystagmus Y 37954 Nystagmus Associated With Disorders of the Vestibular System Y 37955 Dissociated Nystagmus Y 37956 Other Forms of Nystagmus Y 37957 Nystagmus With Deficiencies of Saccadic Eye Movements Y 37958 Nystagmus With Deficiencies of Smooth Pursuit Movements Y 37959 Other Irregularities of Eye Movements Y 37990 Unspecified Disorder of Eye Y 37991 Pain In or Around Eye Y 37992 Swelling or Mass of Eye Y 37993 Redness or Discharge of Eye N 37999 Other Ill-Defined Disorder of Eye N 38000 Unspecified Perichondritis of Pinna N 38001 Acute Perichondritis of Pinna N 38002 Chronic Perichondritis of Pinna N 38003 Chondritis of Pinna N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 158 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 38010 Unspecified Infective Otitis Externa N 38011 Acute Infection of Pinna N 38012 Acute Swimmers' Ear N 38013 Other Acute Infections of External Ear N 38014 Malignant Otitis Externa N 38015 Chronic Mycotic Otitis Externa N 38016 Other Chronic Infective Otitis Externa N 38021 Cholesteatoma of External Ear N 38022 Other Acute Otitis Externa N 38023 Other Chronic Otitis Externa N 38030 Unspecified Disorder of Pinna N 38031 Hematoma of Auricle or Pinna N 38032 Acquired Deformities of Auricle or Pinna N 38039 Other Noninfectious Disorder of Pinna N 38050 Acquired Stenosis of External Ear Canal Unspecified as to Cause N 38051 Acquired Stenosis of External Ear Canal Secondary to Trauma N 38052 Acquired Stenosis of External Ear Canal Secondary to Surgery N 38053 Acquired Stenosis of External Ear Canal Secondary to Inflammation N 38081 Exostosis of External Ear Canal N 38089 Other Disorder of External Ear N 38100 Unspecified Acute Nonsuppurative Otitis Media N 38101 Acute Serous Otitis Media N 38102 Acute Mucoid Otitis Media N 38103 Acute Sanguinous Otitis Media N 38104 Acute Allergic Serous Otitis Media Y 38105 Acute Allergic Mucoid Otitis Media Y 38106 Acute Allergic Sanguinous Otitis Media Y 38110 Simple or Unspecified Chronic Serous Otitis Media Y 38119 Other Chronic Serous Otitis Media Y 38120 Simple or Unspecified Chronic Mucoid Otitis Media Y 38129 Other Chronic Mucoid Otitis Media Y 38150 Unspecified Eustachian Salpingitis Y 38151 Acute Eustachian Salpingitis Y 38152 Chronic Eustachian Salpingitis Y 38160 Unspecified Obstruction of Eustachian Tube Y 38161 Osseous Obstruction of Eustachian Tube Y 38162 Intrinsic Cartilagenous Obstruction of Eustachian Tube Y 38163 Extrinsic Cartilagenous Obstruction of Eustachian Tube Y 38181 Dysfunction of Eustachian Tube Y 38189 Other Disorders of Eustachian Tube Y 38200 Acute Suppurative Otitis Media Without Spontaneous Rupture of Eardrum Y 38201 Acute Suppurative Otitis Media With Spontaneous Rupture of Eardrum Y 38202 Acute Suppurative Otitis Media in Diseases Classified Elsewhere Y 38300 Acute Mastoiditis Without Complications S 38301 Subperiosteal Abscess of Mastoid Y 38302 Acute Mastoiditis With Other Complications Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 159 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 38320 Unspecified Petrositis N 38321 Acute Petrositis Y 38322 Chronic Petrositis N 38330 Unspecified Postmastoidectomy Complication N 38331 Mucosal Cyst of Postmastoidectomy Cavity N 38332 Recurrent Cholesteatoma of Postmastoidectomy Cavity N 38333 Granulations of Postmastoidectomy Cavity N 38381 Postauricular Fistula N 38389 Other Disorder of Mastoid N 38400 Unspecified Acute Myringitis S 38401 Bullous Myringitis Y 38409 Other Acute Myringitis Without Mention of Otitis Media Y 38420 Unspecified Perforation of Tympanic Membrane Y 38421 Central Perforation of Tympanic Membrane Y 38422 Attic Perforation of Tympanic Membrane Y 38423 Other Marginal Perforation of Tympanic Membrane Y 38424 Multiple Perforations of Tympanic Membrane Y 38425 Total Perforation of Tympanic Membrane Y 38481 Atrophic Flaccid Tympanic Membrane Y 38482 Atrophic Nonflaccid Tympanic Membrane Y 38500 Tympanosclerosis, Unspecified as to Involvement Y 38501 Tympanosclerosis Involving Tympanic Membrane Only Y 38502 Tympanosclerosis Involving Tympanic Membrane and Ear Ossicles Y 38503 Tympanosclerosis Involving Tympanic Membrane, Ear Ossicles, and Middle Ear Y 38509 Tympanosclerosis Involving Other Combination of Structures Y 38510 Adhesive Middle Ear Disease, Unspecified as to Involvement Y 38511 Adhesions of Drum Head to Incus Y 38512 Adhesions of Drum Head to Stapes Y 38513 Adhesions of Drum Head to Promontorium Y 38519 Other Middle Ear Adhesions and Combinations Y 38521 Impaired Mobility of Malleus Y 38522 Impaired Mobility of Other Ear Ossicles Y 38523 Discontinuity or Dislocation of Ear Ossicles Y 38524 Partial Loss or Necrosis of Ear Ossicles Y 38530 Unspecified Cholesteatoma Y 38531 Cholesteatoma of Attic Y 38532 Cholesteatoma of Middle Ear Y 38533 Cholesteatoma of Middle Ear and Mastoid Y 38535 Diffuse Cholesteatosis of Middle Ear and Mastoid Y 38582 Cholesterin Granuloma of Middle Ear Y 38583 Retained Foreign Body of Middle Ear Y 38589 Other Disorders of Middle Ear and Mastoid Y 38600 Unspecified Meniere’s Disease Y 38601 Active Meniere’s Disease, Cochleovestibular Y 38602 Active Meniere’s Disease, Cochlear Y 38603 Active Meniere’s Disease, Vestibular Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 160 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 38604 Inactive Meniere’s Disease Y 38610 Unspecified Peripheral Vertigo Y 38611 Benign Paroxysmal Positional Vertigo Y 38612 Vestibular Neuronitis Y 38619 Other and Unspecified Peripheral Vertigo Y 38630 Unspecified Labyrinthitis Y 38631 Serous Labyrinthitis Y 38632 Circumscribed Labyrinthitis Y 38633 Suppurative Labyrinthitis Y 38634 Toxic Labyrinthitis Y 38635 Viral Labyrinthitis N 38640 Unspecified Labyrinthine Fistula N 38641 Round Window Fistula N 38642 Oval Window Fistula N 38643 Semicircular Canal Fistula N 38648 Labyrinthine Fistula of Combined Sites N 38650 Unspecified Labyrinthine Dysfunction N 38651 Hyperactive Labyrinth, Unilateral N 38652 Hyperactive Labyrinth, Bilateral N 38653 Hypoactive Labyrinth, Unilateral N 38654 Hypoactive Labyrinth, Bilateral N 38655 Loss of Labyrinthine Reactivity, Unilateral N 38656 Loss of Labyrinthine Reactivity, Bilateral N 38658 Other Forms and Combinations of Labyrinthine Dysfunction N 38800 Unspecified Degenerative and Vascular Disorders N 38801 Presbyacusis N 38802 Transient Ischemic Deafness N 38810 Unspecified Noise Effects on Inner Ear N 38811 Acoustic Trauma (Explosive) to Ear N 38812 Noise-Induced Hearing Loss N 38830 Unspecified Tinnitus N 38831 Subjective Tinnitus N 38832 Objective Tinnitus N 38840 Unspecified Abnormal Auditory Perception N 38841 Diplacusis N 38842 Hyperacusis N 38843 Impairment of Auditory Discrimination N 38844 Other Abnormal Auditory Perception, Recruitment N 38860 Unspecified Otorrhea N 38861 Cerebrospinal Fluid Otorrhea N 38869 Other Otorrhea N 38870 Unspecified Otalgia N 38871 Otogenic Pain N 38872 Referred Otogenic Pain N 38900 Unspecified Conductive Hearing Loss N 38901 Conductive Hearing Loss, External Ear N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 161 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 38902 Conductive Hearing Loss, Tympanic Membrane N 38903 Conductive Hearing Loss, Middle Ear N 38904 Conductive Hearing Loss, Inner Ear N 38908 Conductive Hearing Loss of Combined Types N 38910 Unspecified Sensorineural Hearing Loss N 38911 Sensory Hearing Loss N 38912 Neural Hearing Loss N 38914 Central Hearing Loss N 38918 Sensorineural Hearing Loss of Combined Types N 39890 Unspecified Rheumatic Heart Disease Y 39891 Rheumatic Heart Failure (Congestive) Y 39899 Other and Unspecified Rheumatic Heart Diseases Y 40200 Malignant Hypertensive Heart Disease Without Heart Failure Y 40201 Malignant Hypertensive Heart Disease With Heart Failure Y 40210 Benign Hypertensive Heart Disease Without Heart Failure Y 40211 Benign Hypertensive Heart Disease With Heart Failure Y 40290 Unspecified Hypertensive Heart Disease Without Heart Failure Y 40291 Unspecified Hypertensive Heart Disease With Heart Failure Y 40300 Hypertensive Kidney Disease, Malignant, Without Chronic Kidney Disease Y 40301 Hypertensive Kidney Disease, Malignant, With Chronic Kidney Disease Y 40310 Hypertensive Kidney Disease, Benign, Without Chronic Kidney Disease N 40311 Hypertensive Kidney Disease, Benign, With Chronic Kidney Disease Y 40390 Hypertensive Kidney Disease, Unspecified, Without Chronic Kidney Disease N 40391 Hypertensive Kidney Disease, Unspecified, With Chronic Kidney Disease N Hypertensive Heart and Kidney Disease, Malignant, Without Heart Failure or Chronic 40400 Kidney Disease N 40401 Hypertensive Heart and Kidney Disease, Malignant, With Heart Failure Y 40402 Hypeertensive Heart and Kidney Disease, Malignant, With Chronic Kidney Disease Y Hypertensive Heart and Kidney Disease, Malignant, With Heart Failure and Chronic 40403 Kidney Disease Y Hypertensive Heart and Kidney Disease, Benign, Without Heart Failure or Chronic 40410 Kidney Disease Y 40411 Hypertensive Heart and Kidney Disease, Benign, With Heart Failure Y 40412 Hypertensive Heart and Kidney Disease, Benign, With Chronic Kidney Disease Y Hypertensive Heart and Kidney Disease, Benign, With Heart Failure and Chronic Kidney 40413 Disease Y Hypertensive Heart and Kidney Disease, Unspecified, Without Heart Failure or Chronic 40490 Kidney Disease Y 40491 Hypertensive Heart and Kidney Disease, Unspecified, With Heart Failure Y 40492 Hypertensive Heart and Kidney Disease, Unspecified, With Chronic Kidney Disease Y Hypertensive Heart and Kidney Disease, Unspecified, With Heart Failure and Chronic 40493 Kidney Disease Y 40501 Secondary Renovascular Hypertension, Malignant Y 40509 Other Secondary Hypertension, Malignant Y 40511 Secondary Renovascular Hypertension, Benign Y 40519 Other Secondary Hypertension, Benign Y 40591 Secondary Renovascular Hypertension, Unspecified Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 162 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 40599 Other Secondary Hypertension, Unspecified Y 41000 Acute Myocardial Infarction of Anterolateral Wall, Episode of Care Unspecified Y 41001 Acute Myocardial Infarction of Anterolateral Wall, Initial Episode of Care Y 41002 Acute Myocardial Infarction of Anterolateral Wall, Subsequent Episode of Care Y 41010 Acute Myocardial Infarction of Other Anterior Wall, Episode of Care Unspecified Y 41011 Acute Myocardial Infarction of Other Anterior Wall, Initial Episode of Care Y 41012 Acute Myocardial Infarction of Other Anterior Wall, Subsequent Episode of Care Y 41020 Acute Myocardial Infarction of Inferolateral Wall, Episode of Care Unspecified Y 41021 Acute Myocardial Infarction of Inferolateral Wall, Initial Episode of Care Y 41022 Acute Myocardial Infarction of Inferolateral Wall, Subsequent Episode of Care Y 41030 Acute Myocardial Infarction of Inferoposterior Wall, Episode of Care Unspecified Y 41031 Acute Myocardial Infarction of Inferoposterior Wall, Initial Episode of Care Y 41032 Acute Myocardial Infarction of Inferoposterior Wall, Subsequent Episode of Care Y 41040 Acute Myocardial Infarction of Other Inferior Wall, Episode of Care Unspecified Y 41041 Acute Myocardial Infarction of Other Inferior Wall, Initial Episode of Care Y 41042 Acute Myocardial Infarction of Other Inferior Wall, Subsequent Episode of Care Y 41050 Acute Myocardial Infarction of Other Lateral Wall, Episode of Care Unspecified Y 41051 Acute Myocardial Infarction of Other Lateral Wall, Initial Episode of Care Y 41052 Acute Myocardial Infarction of Other Lateral Wall, Subsequent Episode of Care Y

41060 Acute Myocardial Infarction, True Posterior Wall Infarction, Episode of Care Unspecified Y 41061 Acute Myocardial Infarction, True Posterior Wall Infarction, Initial Episode of Care Y

41062 Acute Myocardial Infarction, True Posterior Wall Infarction, Subsequent Episode of Care Y 41070 Acute Myocardial Infarction, Subendocardial Infarction, Episode of Care Unspecified Y 41071 Acute Myocardial Infarction, Subendocardial Infarction, Initial Episode of Care Y 41072 Acute Myocardial Infarction, Subendocardial Infarction, Subsequent Episode of Care Y 41080 Acute Myocardial Infarction of Other Specified Sites, Episode of Care Unspecified Y 41081 Acute Myocardial Infarction of Other Specified Sites, Initial Episode of Care Y 41082 Acute Myocardial Infarction of Other Specified Sites, Subsequent Episode of Care Y 41090 Acute Myocardial Infarction, Unspecified Site, Episode of Care Unspecified Y 41091 Acute Myocardial Infarction, Unspecified Site, Initial Episode of Care Y 41092 Acute Myocardial Infarction, Unspecified Site, Subsequent Episode of Care Y 41181 Acute Coronary Occlusion Without Myocardial Infarction Y 41189 Other Acute and Subacute Form of Ischemic Heart Disease Y 41400 Coronary Atherosclerosis of Unspecified Type of Vessel, Native or Graft Y 41401 Coronary Atherosclerosis of Native Coronary Artery Y 41402 Coronary Atherosclerosis of Autologous Vein Bypass Graft Y 41403 Coronary Atherosclerosis of Nonautologous Biological Bypass Graft Y 41404 Coronary Atherosclerosis of Artery Bypass Graft Y 41405 Coronary Atherosclerosis of Unspecified Type of Bypass Graft Y 41406 Coronary Atherosclerosis, of Native Coronary Artery of Transplanted Heart Y 41407 Coronary Atherosclerosis, of Bypass Graft (Artery) (Vein) of Transplanted Heart Y 41410 Aneurysm of Heart Y 41411 Aneurysm of Coronary Vessels Y 41412 Dissection of Coronary Artery Y 41419 Other Aneurysm of Heart Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 163 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 41511 Iatrogenic Pulmonary Embolism and Infarction Y 41519 Other Pulmonary Embolism and Infarction Y 42090 Unspecified Acute Pericarditis Y 42091 Acute Idiopathic Pericarditis Y 42099 Other Acute Pericarditis Y 42290 Unspecified Acute Myocarditis Y 42291 Idiopathic Myocarditis Y 42292 Septic Myocarditis Y 42293 Toxic Myocarditis Y 42299 Other Acute Myocarditis Y 42490 Endocarditis, Valve Unspecified, Unspecified Cause Y 42491 Endocarditis in Diseases Classified Elsewhere Y 42499 Other Endocarditis, Valve Unspecified Y 42610 Unspecified Atrioventricular Block Y 42611 First Degree Atrioventricular Block Y 42612 Mobitz (Type) II Atrioventricular Block Y 42613 Other Second Degree Atrioventricular Block Y 42650 Unspecified Bundle Branch Block Y 42651 Right Bundle Branch Block and Left Posterior Fascicular Block Y 42652 Right Bundle Branch Block and Left Anterior Fascicular Block Y 42653 Other Bilateral Bundle Branch Block Y 42654 Trifascicular Block Y 42681 Lown-Ganong-Levine Syndrome Y 42682 Long Qt Syndrome N 42689 Other Specified Conduction Disorder Y 42731 Atrial Fibrillation Y 42732 Atrial Flutter Y 42741 Ventricular Fibrillation Y 42742 Ventricular Flutter Y 42760 Unspecified Premature Beats Y 42761 Supraventricular Premature Beats Y 42769 Other Premature Beats Y 42781 Sinoatrial Node Dysfunction Y 42789 Other Specified Cardiac Dysrhythmias Y 42820 Unspecified Systolic Heart Failure Y 42821 Acute Systolic Heart Failure Y 42822 Chronic Systolic Heart Failure Y 42823 Acute on Chronic Systolic Heart Failure Y 42830 Unspecified Diastolic Heart Failure Y 42831 Acute Diastolic Heart Failure Y 42832 Chronic Diastolic Heart Failure Y 42833 Acute on Chronic Diastolic Heart Failure Y 42840 Unspecified Combined Systolic and Diastolic Heart Failure Y 42841 Acute Combined Systolic and Diastolic Heart Failure Y 42842 Chronic Combined Systolic and Diastolic Heart Failure Y 42843 Acute on Chronic Combined Systolic and Diastolic Heart Failure Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 164 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 42971 Acquired Cardiac Septal Defect Y 42979 Other Certain Sequelae of Myocardial Infarction, Not Elsewhere Classified Y 42981 Other Disorders of Papillary Muscle Y 42982 Hyperkinetic Heart Disease Y 42989 Other Ill-Defined Heart Disease Y 43300 Occlusion and Stenosis of Basilar Artery Without Mention of Cerebral Infarction Y 43301 Occlusion and Stenosis of Basilar Artery With Cerebral Infarction Y 43310 Occlusion and Stenosis of Carotid Artery Without Mention of Cerebral Infarction Y 43311 Occlusion and Stenosis of Carotid Artery With Cerebral Infarction Y 43320 Occlusion and Stenosis of Vertebral Artery Without Mention of Cerebral Infarction Y 43321 Occlusion and Stenosis of Vertebral Artery With Cerebral Infarction Y Occlusion and Stenosis of Multiple and Bilateral Precerebral Arteries Without Mention of 43330 Cerebral Infarction Y Occlusion and Stenosis of Multiple and Bilateral Precerebral Arteries With Cerebral 43331 Infarction Y Occlusion and Stenosis of Other Specified Precerebral Artery Without Mention of 43380 Cerebral Infarction Y 43381 Occlusion and Stenosis of Other Specified Precerebral Artery With Cerebral Infarction Y Occlusion and Stenosis of Unspecified Precerebral Artery Without Mention of Cerebral 43390 Infarction Y 43391 Occlusion and Stenosis of Unspecified Precerebral Artery With Cerebral Infarction Y 43400 Cerebral Thrombosis Without Mention of Cerebral Infarction Y 43401 Cerebral Thrombosis With Cerebral Infarction Y 43410 Cerebral Embolism Without Mention of Cerebral Infarction Y 43411 Cerebral Embolism With Cerebral Infarction Y 43490 Unspecified Cerebral Artery Occlusion Without Mention of Cerebral Infarction Y 43491 Unspecified Cerebral Artery Occlusion With Cerebral Infarction Y 43810 Unspecified Speech and Language Deficit due to Cerebrovascular Disease N 43811 Aphasia due to Cerebrovascular Disease N 43812 Dysphasia due to Cerebrovascular Disease N 43819 Other Speech and Language Deficits due to Cerebrovascular Disease N 43820 Hemiplegia Affecting Unspecified Side due to Cerebrovascular Disease N 43821 Hemiplegia Affecting Dominant Side due to Cerebrovascular Disease N 43822 Hemiplegia Affecting Nondominant Side due to Cerebrovascular Disease N 43830 Monoplegia of Upper Limb Affecting Unspecified Side due to Cerebrovascular Disease N 43831 Monoplegia of Upper Limb Affecting Dominant Side due to Cerebrovascular Disease N

43832 Monoplegia of Upper Limb Affecting Nondominant Side due to Cerebrovascular Disease N 43840 Monoplegia of Lower Limb Affecting Unspecified Side due to Cerebrovascular Disease N 43841 Monoplegia of Lower Limb Affecting Dominant Side due to Cerebrovascular Disease N

43842 Monoplegia of Lower Limb Affecting Nondominant Side due to Cerebrovascular Disease N 43850 Other Paralytic Syndrome Affecting Unspecified Side due to Cerebrovascular Disease N 43851 Other Paralytic Syndrome Affecting Dominant Side due to Cerebrovascular Disease N 43852 Other Paralytic Syndrome Affecting Nondominant Side due to Cerebrovascular Disease N 43853 Other Paralytic Syndrome, Bilateral N 43881 Apraxia due to Cerebrovascular Disease N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 165 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 43882 Dysphagia due to Cerebrovascular Disease N 43883 Facial Weakness as Late Effect of Cerebrovascular Disease N 43884 Ataxia as Late Effect of Cerebrovascular Disease N 43885 Vertigo as Late Effect of Cerebrovascular Disease N 43889 Other Late Effects of Cerebrovascular Disease N 44020 Atherosclerosis of Native Arteries of the Extremities, Unspecified N 44021 Atherosclerosis of Native Arteries of the Extremities With Intermittent Claudication N 44022 Atherosclerosis of Native Arteries of the Extremities With Rest Pain N 44023 Atherosclerosis of Native Arteries of the Extremities With Ulceration N 44024 Atherosclerosis of Native Arteries of the Extremities With Gangrene S 44029 Other Atherosclerosis of Native Arteries of the Extremities N 44030 Atheroslerosis of Unspecified Bypass Graft of Extremities N 44031 Atheroslerosis of Autologous Vein Bypass Graft of Extremities N 44032 Atheroslerosis of Nonautologous Biological Bypass Graft of Extremities N 44100 Dissecting Aortic Aneurysm (any Part), Unspecified Site Y 44101 Dissecting Aortic Aneurysm (any Part), Thoracic Y 44102 Dissecting Aortic Aneurysm (any Part), Abdominal Y 44103 Dissecting Aortic Aneurysm (any Part), Thoracoabdominal Y 44281 Aneurysm of Artery of Neck Y 44282 Aneurysm of Subclavian Artery Y 44283 Aneurysm of Splenic Artery Y 44284 Aneurysm of Other Visceral Artery Y 44289 Aneurysm of Other Specified Artery Y 44321 Dissection of Carotid Artery Y 44322 Dissection of Iliac Artery Y 44323 Dissection of Renal Artery Y 44324 Dissection of Vertebral Artery Y 44329 Dissection of Other Artery Y 44381 Peripheral Angiopathy in Diseases Classified Elsewhere N 44382 Erythromelalgia N 44389 Other Peripheral Vascular Disease N 44421 Embolism and Thrombosis of Arteries of Upper Extremity Y 44422 Embolism and Thrombosis of Arteries of Lower Extremity Y 44481 Embolism and Thrombosis of Iliac Artery Y 44489 Embolism and Thrombosis of Other Specified Artery Y 44501 Atheroembolism of Upper Extremity Y 44502 Atheroembolism of Lower Extremity Y 44581 Atheroembolism of Kidney N 44589 Atheroembolism of Other Site Y 44620 Unspecified Hypersensitivity Angiitis Y 44621 Goodpasture’s Syndrome S 44629 Other Specified Hypersensitivity Angiitis S 45111 Phlebitis and Thrombophlebitis of Femoral Vein (Deep) (Superficial) Y 45119 Phlebitis and Thrombophlebitis of Other Deep Vessels of Lower Extremities Y 45181 Phlebitis and Thrombophlebitis of Iliac Vein Y 45182 Phlebitis and Thrombophlebitis of Superficial Veins of Upper Extremities Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 166 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 45183 Phlebitis and Thrombophlebitis of Deep Veins of Upper Extremities Y 45184 Phlebitis and Thrombophlebitis of Upper Extremities, Unspecified Y 45189 Phlebitis and Thrombophlebitis of Other Site Y 45340 Venous Embolism and Thrombosis of Unspecified Deep Vessels of Lower Extremity Y 45341 Venous Embolism and Thrombosis of Deep Vessels of Proximal Lower Extremity Y 45342 Venous Embolism and Thrombosis of Deep Vessels of Distal Lower Extremity Y 45620 Esophageal Varices With Bleeding in Diseases Classified Elsewhere Y 45621 Esophageal Varices Without Mention of Bleeding in Diseases Classified Elsewhere Y 45821 Hypotension of Hemodialysis N 45829 Other Iatrogenic Hypotension S 45910 Postphlebitic Syndrome Without Complications S 45911 Postphlebitic Syndrome With Ulcer S 45912 Postphlebitic Syndrome With Inflammation S 45913 Postphlebitic Syndrome With Ulcer and Inflammation S 45919 Postphlebitic Syndrome With Other Complication S 45930 Chronic Venous Hypertension Without Complications N 45931 Chronic Venous Hypertension With Ulcer N 45932 Chronic Venous Hypertension With Inflammation N 45933 Chronic Venous Hypertension With Ulcer and Inflammation N 45939 Chronic Venous Hypertension With Other Complication N 45981 Unspecified Venous (Peripheral) Insufficiency N 45989 Other Specified Circulatory System Disorders N 46400 Acute Laryngitis, Without Mention of Obstruction Y 46401 Acute Laryngitis, With Obstruction Y 46410 Acute Tracheitis Without Mention of Obstruction Y 46411 Acute Tracheitis With Obstruction Y 46420 Acute Laryngotracheitis Without Mention of Obstruction Y 46421 Acute Laryngotracheitis With Obstruction Y 46430 Acute Epiglottitis Without Mention of Obstruction Y 46431 Acute Epiglottitis With Obstruction Y 46450 Unspecified Supraglottis, Without Mention of Obstruction Y 46451 Unspecified Supraglottis, With Obstruction Y 46611 Acute Bronchiolitis due to Respiratory Syncytial Virus (RSV) Y 46619 Acute Bronchiolitis due to Other Infectious Organisms Y 47400 Chronic Tonsillitis Y 47401 Chronic Adenoiditis Y 47402 Chronic Tonsillitis and Adenoiditis Y 47410 Hypertrophy of Tonsil With Adenoids Y 47411 Hypertrophy of Tonsils Alone Y 47412 Hypertrophy of Adenoids Alone Y 47820 Unspecified Disease of Pharynx Y 47821 Cellulitis of Pharynx or Nasopharynx Y 47822 Parapharyngeal Abscess Y 47824 Retropharyngeal Abscess Y 47825 Edema of Pharynx or Nasopharynx Y 47826 Cyst of Pharynx or Nasopharynx Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 167 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 47829 Other Disease of Pharynx or Nasopharynx Y 47830 Unspecified Paralysis of Vocal Cords or Larynx Y 47831 Unilateral Partial Paralysis of Vocal Cords or Larynx Y 47832 Unilateral Complete Paralysis of Vocal Cords or Larynx Y 47833 Bilateral Partial Paralysis of Vocal Cords or Larynx Y 47834 Bilateral Complete Paralysis of Vocal Cords or Larynx Y 47870 Unspecified Disease of Larynx Y 47871 Cellulitis and Perichondritis of Larynx Y 47874 Stenosis of Larynx N 47875 Laryngeal Spasm Y 47879 Other Diseases of Larynx Y 48230 Pneumonia due to Unspecified Streptococcus Y 48231 Pneumonia due to Streptococcus, Group A Y 48232 Pneumonia due to Streptococcus, Group B Y 48239 Pneumonia due to Other Streptococcus Y 48240 Pneumonia due to Staphylococcus, Unspecified Y 48241 Pneumonia due to Staphylococcus Aureus Y 48249 Other Staphylococcus Pneumonia Y 48281 Pneumonia due to Anaerobes Y 48282 Pneumonia due to Escherichia Coli (E. Coli) Y 48283 Pneumonia due to Other Gram-Negative Bacteria Y 48284 Legionnaires' Disease Y 48289 Pneumonia due to Other Specified Bacteria Y 49120 Obstructive Chronic Bronchitis, Without Exacerbation Y 49121 Obstructive Chronic Bronchitis, With (Acute) Exacerbation Y 49122 Obstructive Chronic Bronchitis With Acute Bronchitis Y 49300 Extrinsic Asthma, Unspecified Y 49301 Extrinsic Asthma With Status Asthmaticus Y 49302 Extrinsic Asthma, With (Acute) Exacerbation Y 49310 Intrinsic Asthma, Unspecified Y 49311 Intrinsic Asthma With Status Asthmaticus Y 49312 Intrinsic Asthma, With (Acute) Exacerbation Y 49320 Chronic Obstructive Asthma, Unspecified Y 49321 Chronic Obstructive Asthma With Status Asthmaticus Y 49322 Chronic Obstructive Asthma, With (Acute) Exacerbation Y 49381 Exercise Induced Bronchospasm Y 49382 Cough Variant Asthma Y 49390 Asthma, Unspecified, Unspecified Y 49391 Unspecified Asthma, With Status Asthmaticus Y 49392 Asthma, Unspecified, With (Acute) Exacerbation Y 51881 Acute Respiratory Failure Y 51882 Other Pulmonary Insufficiency, Not Elsewhere Classified Y 51883 Chronic Respiratory Failure Y 51884 Acute and Chronic Respiratory Failure Y 51889 Other Diseases of Lung, Not Elsewhere Classified Y 51900 Unspecified Tracheostomy Complication Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 168 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 51901 Infection of Tracheostomy Y 51902 Mechanical Complication of Tracheostomy Y 51904 Tracheostomy Complication S 51909 Other Tracheostomy Complications Y 52100 Unspecified Dental Caries N 52101 Dental Caries Limited to Enamel N 52102 Dental Caries Extending Into Dentine N 52103 Dental Caries Extending Into Pulp N 52104 Arrested Dental Caries N 52105 Odontoclasia N 52106 Dental Caries Pit and Fissure N 52107 Dental Caries of Smooth Surface N 52108 Dental Caries of Root Surface N 52109 Other Dental Caries N 52110 Excessive Attrition, Unspecified N 52111 Excessive Attrition, Limited to Enamel N 52112 Excessive Attrition Extending Into Dentine N 52113 Excessive Attrition Extending Into Pulp N 52114 Excessive Attrition Localized N 52115 Excessive Attrition Generalized N 52120 Abrasion, Unspecified N 52121 Abrasion, Limited to Enamel N 52122 Abrasion Extending Into Dentine N 52123 Abrasion Extending Into Pulp N 52124 Abrasion, Localized N 52125 Abrasion Generalized N 52130 Erosion, Unspecified N 52131 Erosion, Limited to Enamel N 52132 Erosion, Extending Into Dentine N 52133 Erosion Extending Into Pulp N 52134 Erosion, Localized N 52135 Erosion, Generalized N 52140 Pathological Resorption, Unspecified N 52141 Pathological Resorption, Internal N 52142 Pathological Resorption, External N 52149 Other Pathological Resorption N 52320 Gingival Recession, Unspecified N 52321 Gingival Recession, Minimal N 52322 Gingival Recession, Moderate N 52323 Gingival Recession, Severe N 52324 Gingival Recession Localized N 52325 Gingival Recession Generalized N 52400 Unspecified Major Anomaly of Jaw Size N 52401 Maxillary Hyperplasia N 52402 Mandibular Hyperplasia N 52403 Maxillary Hypoplasia N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 169 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 52404 Mandibular Hypoplasia N 52405 Macrogenia N 52406 Microgenia N 52407 Excessive Tuberosity of Jaw N 52409 Other Specified Major Anomaly of Jaw Size N 52410 Unspecified Anomaly of Relationship of Jaw to Cranial Base N 52411 Maxillary Asymmetry N 52412 Other Jaw Asymmetry N 52419 Other Specified Anomaly of Relationship of Jaw to Cranial Base N 52420 Unspecified Anomaly of Dental Arch Relationship N 52421 Angle’s Class I N 52422 Angle’s Class II N 52423 Angle’s Class III N 52424 Open Anterior Occlusal Relationship N 52425 Open Posterior Occlusal Relationship N 52426 Excessive Horizontal Overlap N 52427 Reverse Articulation N 52428 Anomalies of Interarch Distance N 52429 Other Anomalies of Dental Arch Relationship N 52430 Unspecified Anomaly of Tooth Position N 52431 Crowding of Teeth N 52432 Excessive Spacing of Teeth N 52433 Horizontal Displacement of Teeth N 52434 Vertical Displacement of Teeth N 52435 Rotation of Teeth N 52436 Insufficient Interocclusal Distance of Teeth (Ridge) N 52437 Excessive Interocclusal Distance of Teeth N 52439 Other Anomalies of Tooth Position N 52450 Dentofacial Functional Abnormality, Unspecified N 52451 Abnormal Jaw Closure N 52452 Limited Mandibular Range of Motion N 52453 Deviation in Opening and Closing of Mandible N 52454 Insufficient Anterior Guidance N 52455 Centric Occlusion Maximum Intercuspation Discrepancy N 52456 Non-Working Side Interference N 52457 Lack of Posterior Occlusal Support N 52459 Other Dentofacial Functional Abnormalities N 52460 Unspecified Temporomandibular Joint Disorders N 52461 Adhesions and Ankylosis (Bony or Fibrous) of Temporomandibular Joint N 52462 Arthralgia of Temporomandibular Joint N 52463 Articular Disc Disorder (Reducing or Non-Reducing) of Temporomandibular Joint N 52464 Temporomandibular Joint Sounds on Opening And/Or Closing of Jaw N 52469 Other Specified Temporomandibular Joint Disorders N 52470 Unspecified Alveolar Anomaly N 52471 Alveolar Maxillary Hyperplasia N 52472 Alveolar Mandibular Hyperplasia N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 170 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 52473 Alveolar Maxillary Hypoplasia N 52474 Alveolar Mandibular Hypoplasia N 52475 Vertical Displacement of Alveolus and Teeth N 52476 Occlusal Plane Deviation N 52479 Other Specified Alveolar Anomaly N 52481 Anterior Soft Tissue Impingement N 52482 Posterior Soft Tissue Impingement N 52489 Other Specified Dentofacial Anomalies N 52510 Unspecified Acquired Absence of Teeth N 52511 Loss of Teeth due to Trauma N 52512 Loss of Teeth due to Periodontal Disease N 52513 Loss of Teeth due to Caries N 52519 Other Loss of Teeth N 52520 Unspecified Atrophy of Edentulous Alveolar Ridge N 52521 Minimal Atrophy of the Mandible N 52522 Moderate Atrophy of the Mandible N 52523 Severe Atrophy of the Mandible N 52524 Minimal Atrophy of the Maxilla N 52525 Moderate Atrophy of the Maxilla N 52526 Severe Atrophy of the Maxilla N 52540 Complete Edentulism, Unspecified N 52541 Complete Edentulism, Class I N 52542 Complete Edentulism, Class II N 52543 Complete Edentulism, Class III N 52544 Complete Edentulism, Class IV N 52550 Partial Edentulism, Unspecified N 52551 Partial Edentulism, Class I N 52552 Partial Edentulism, Class II N 52553 Partial Edentulism, Class III N 52554 Partial Edentulism, Class IV N 52681 Exostosis of Jaw N 52689 Other Specified Disease of the Jaws N 52871 Minimal Keratinized Residual Ridge Mucosa S 52872 Excessive Keratinized Residual Ridge Mucosa Y 52879 Other Disturbances of Oral Epithelium, Including Tongue Y 53010 Unspecified Esophagitis Y 53011 Reflux Esophagitis Y 53012 Acute Esophagitis Y 53019 Other Esophagitis Y 53020 Ulcer of Esophagus Without Bleeding Y 53021 Ulcer of Esophagus With Bleeding Y 53081 Esophageal Reflux Y 53082 Esophageal Hemorrhage Y 53083 Esophageal Leukoplakia Y 53084 Tracheoesophageal Fistula Y 53085 Barrett’s Esophagus Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 171 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 53086 Infection of Esophagostomy Y 53087 Mechanical Complication of Esophagostomy Y 53089 Other Specified Disorder of the Esophagus Y 53100 Acute Gastric Ulcer With Hemorrhage, Without Mention of Obstruction Y 53101 Acute Gastric Ulcer With Hemorrhage and Obstruction Y 53110 Acute Gastric Ulcer With Perforation, Without Mention of Obstruction Y 53111 Acute Gastric Ulcer With Perforation and Obstruction Y 53120 Acute Gastric Ulcer With Hemorrhage and Perforation, Without Mention of Obstruction Y 53121 Acute Gastric Ulcer With Hemorrhage, Perforation, and Obstruction Y 53130 Acute Gastric Ulcer Without Mention of Hemorrhage, Perforation, or Obstruction Y 53131 Acute Gastric Ulcer Without Mention of Hemorrhage or Perforation, With Obstruction Y

53140 Chronic or Unspecified Gastric Ulcer With Hemorrhage, Without Mention of Obstruction Y 53141 Chronic or Unspecified Gastric Ulcer With Hemorrhage and Obstruction Y

53150 Chronic or Unspecified Gastric Ulcer With Perforation, Without Mention of Obstruction Y 53151 Chronic or Unspecified Gastric Ulcer With Perforation and Obstruction Y Chronic or Unspecified Gastric Ulcer With Hemorrhage and Perforation, Without Mention 53160 of Obstruction Y 53161 Chronic or Unspecified Gastric Ulcer With Hemorrhage, Perforation, and Obstruction Y Chronic Gastric Ulcer Without Mention of Hemorrhage, Perforation, Without Mention of 53170 Obstruction N

53171 Chronic Gastric Ulcer Without Mention of Hemorrhage or Perforation, With Obstruction Y Gastric Ulcer, Unspecified as Acute or Chronic, Without Mention of Hemorrhage, 53190 Perforation, or Obstruction N Gastric Ulcer, Unspecified as Acute or Chronic, Without Mention of Hemorrhage or 53191 Perforation, With Obstruction Y 53200 Acute Duodenal Ulcer With Hemorrhage, Without Mention of Obstruction Y 53201 Acute Duodenal Ulcer With Hemorrhage and Obstruction Y 53210 Acute Duodenal Ulcer With Perforation, Without Mention of Obstruction Y 53211 Acute Duodenal Ulcer With Perforation and Obstruction Y

53220 Acute Duodenal Ulcer With Hemorrhage and Perforation, Without Mention of Obstruction Y 53221 Acute Duodenal Ulcer With Hemorrhage, Perforation, and Obstruction Y 53230 Acute Duodenal Ulcer Without Mention of Hemorrhage, Perforation, or Obstruction Y

53231 Acute Duodenal Ulcer Without Mention of Hemorrhage or Perforation, With Obstruction Y Chronic or Unspecified Duodenal Ulcer With Hemorrhage, Without Mention of 53240 Obstruction Y 53241 Chronic or Unspecified Duodenal Ulcer With Hemorrhage and Obstruction Y

53250 Chronic or Unspecified Duodenal Ulcer With Perforation, Without Mention of Obstruction Y 53251 Chronic or Unspecified Duodenal Ulcer With Perforation and Obstruction Y Chronic or Unspecified Duodenal Ulcer With Hemorrhage and Perforation, Without 53260 Mention of Obstruction Y 53261 Chronic or Unspecified Duodenal Ulcer With Hemorrhage, Perforation, and Obstruction Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 172 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 53270 Chronic Duodenal Ulcer Without Mention of Hemorrhage, Perforation, or Obstruction N Chronic Duodenal Ulcer Without Mention of Hemorrhage or Perforation, With 53271 Obstruction Y Duodenal Ulcer, Unspecified as Acute or Chronic, Without Hemorrhage, Perforation, or 53290 Obstruction N Duodenal Ulcer, Unspecified as Acute or Chronic, Without Mention of Hemorrhage or 53291 Perforation, With Obstruction Y

53300 Acute Peptic Ulcer, Unspecified Site, With Hemorrhage, Without Mention of Obstruction Y 53301 Acute Peptic Ulcer, Unspecified Site, With Hemorrhage and Obstruction Y

53310 Acute Peptic Ulcer, Unspecified Site, With Perforation, Without Mention of Obstruction S 53311 Acute Peptic Ulcer, Unspecified Site, With Perforation and Obstruction S Acute Peptic Ulcer, Unspecified Site, With Hemorrhage and Perforation, Without Mention 53320 of Obstruction S 53321 Acute Peptic Ulcer, Unspecified Site, With Hemorrhage, Perforation, and Obstruction S Acute Peptic Ulcer, Unspecified Site, Without Mention of Hemorrhage, Perforation, or 53330 Obstruction S Acute Peptic Ulcer, Unspecified Site, Without Mention of Hemorrhage and Perforation, 53331 With Obstruction S Chronic or Unspecified Peptic Ulcer, Unspecified Site, With Hemorrhage, Without 53340 Mention of Obstruction S

53341 Chronic or Unspecified Peptic Ulcer, Unspecified Site, With Hemorrhage and Obstruction S Chronic or Unspecified Peptic Ulcer, Unspecified Site, With Perforation, Without Mention 53350 of Obstruction S

53351 Chronic or Unspecified Peptic Ulcer, Unspecified Site, With Perforation and Obstruction S Chronic or Unspecified Peptic Ulcer, Unspecified Site, With Hemorrhage and Perforation, 53360 Without Mention of Obstruction S Chronic or Unspecified Peptic Ulcer, Unspecified Site, With Hemorrhage, Perforation, and 53361 Obstruction S Chronic Peptic Ulcer, Unspecified Site, Without Mention of Hemorrhage, Perforation, or 53370 Obstruction S Chronic Peptic Ulcer of Unspecified Site Without Mention of Hemorrhage or Perforation, 53371 With Obstruction S Peptic Ulcer, Unspecified Site, Unspecified as Acute or Chronic, Without Mention of 53390 Hemorrhage, Perforation, or Obstruction S Peptic Ulcer, Unspecified Site, Unspecified as Acute or Chronic, Without Mention of 53391 Hemorrhage or Perforation, With Obstruction S 53400 Acute Gastrojejunal Ulcer With Hemorrhage, Without Mention of Obstruction S 53401 Acute Gastrojejunal Ulcer, With Hemorrhage and Obstruction S 53410 Acute Gastrojejunal Ulcer With Perforation, Without Mention of Obstruction S 53411 Acute Gastrojejunal Ulcer With Perforation and Obstruction S Acute Gastrojejunal Ulcer With Hemorrhage and Perforation, Without Mention of 53420 Obstruction S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 173 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 53421 Acute Gastrojejunal Ulcer With Hemorrhage, Perforation, and Obstruction S 53430 Acute Gastrojejunal Ulcer Without Mention of Hemorrhage, Perforation, or Obstruction S Acute Gastrojejunal Ulcer Without Mention of Hemorrhage or Perforation, With 53431 Obstruction S Chronic or Unspecified Gastrojejunal Ulcer With Hemorrhage, Without Mention of 53440 Obstruction S 53441 Chronic or Unspecified Gastrojejunal Ulcer, With Hemorrhage and Obstruction S Chronic or Unspecified Gastrojejunal Ulcer With Perforation, Without Mention of 53450 Obstruction S 53451 Chronic or Unspecified Gastrojejunal Ulcer With Perforation and Obstruction S Chronic or Unspecified Gastrojejunal Ulcer With Hemorrhage and Perforation, Without 53460 Mention of Obstruction S Chronic or Unspecified Gastrojejunal Ulcer With Hemorrhage, Perforation, and 53461 Obstruction S

53470 Chronic Gastrojejunal Ulcer Without Mention of Hemorrhage, Perforation, or Obstruction S Chronic Gastrojejunal Ulcer Without Mention of Hemorrhage or Perforation, With 53471 Obstruction S Gastrojejunal Ulcer, Unspecified as Acute or Chronic, Without Mention of Hemorrhage, 53490 Perforation, or Obstruction S Gastrojejunal Ulcer, Unspecified as Acute or Chronic, Without Mention of Hemorrhage or 53491 Perforation, With Obstruction S 53500 Acute Gastritis Without Mention of Hemorrhage S 53501 Acute Gastritis With Hemorrhage S 53510 Atrophic Gastritis Without Mention of Hemorrhage S 53511 Atrophic Gastritis With Hemorrhage S 53520 Gastric Mucosal Hypertrophy Without Mention of Hemorrhage S 53521 Gastric Mucosal Hypertrophy With Hemorrhage S 53530 Alcoholic Gastritis Without Mention of Hemorrhage S 53531 Alcoholic Gastritis With Hemorrhage S 53540 Other Specified Gastritis Without Mention of Hemorrhage S 53541 Other Specified Gastritis With Hemorrhage S 53550 Unspecified Gastritis and Gastroduodenitis Without Mention of Hemorrhage S 53551 Unspecified Gastritis and Gastroduodenitis With Hemorrhage S 53560 Duodenitis Without Mention of Hemorrhage S 53561 Duodenitis With Hemorrhage S 53640 Unspecified Gastrostomy Complication S 53641 Infection of Gastrostomy S 53642 Mechanical Complication of Gastrostomy S 53649 Other Gastrostomy Complications S 53781 Pylorospasm Y 53782 Angiodysplasia of Stomach and Duodenum (Without Mention of Hemorrhage) Y 53783 Angiodysplasia of Stomach and Duodenum With Hemorrhage Y 53784 Dieulafoy Lesion (Hemorrhagic) of Stomach and Duodenum Y 53789 Other Specified Disorder of Stomach and Duodenum Y 55000 Inguinal Hernia With Gangrene, Unilateral or Unspecified, (Not Specified as Recurrent) Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 174 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 55001 Inguinal Hernia With Gangrene, Recurrent Unilateral or Unspecified Inguinal Hernia Y 55002 Inguinal Hernia With Gangrene, Bilateral Y 55003 Inguinal Hernia With Gangrene, Recurrent Bilateral Y Inguinal Hernia With Obstruction, Without Mention of Gangrene, Unilateral or 55010 Unspecified, (Not Specified as Recurrent) Y Inguinal Hernia With Obstruction, Without Mention of Gangrene, Recurrent Unilateral or 55011 Unspecified Y Inguinal Hernia With Obstruction, Without Mention Gangrene, Bilateral, (Not Specified as 55012 Recurrent) Y 55013 Inguinal Hernia With Obstruction, Without Mention of Gangrene, Recurrent Bilateral Y Inguinal Hernia Without Mention of Obstruction or Gangrene, Unilateral or Unspecified, 55090 (Not Specified as Recurrent) N Inguinal Hernia Without Mention of Obstruction or Gangrene, Recurrent Unilateral or 55091 Unspecified N Inguinal Hernia Without Mention of Obstruction or Gangrene, Bilateral, (Not Specified as 55092 Recurrent) N 55093 Inguinal Hernia Without Mention of Obstruction or Gangrene, Recurrent Bilateral N 55100 Femoral Hernia With Gangrene, Unilateral or Unspecified (Not Specified as Recurrent) Y 55101 Femoral Hernia With Gangrene, Recurrent Unilateral or Unspecified Y 55102 Femoral Hernia With Gangrene, Bilateral, (Not Specified as Recurrent) Y 55103 Femoral Hernia With Gangrene, Recurrent Bilateral Y 55120 Unspecified Ventral Hernia With Gangrene Y 55121 Incisional Ventral Hernia, With Gangrene Y 55129 Other Ventral Hernia With Gangrene Y 55200 Unilateral or Unspecified Femoral Hernia With Obstruction Y 55201 Recurrent Unilateral or Unspecified Femoral Hernia With Obstruction Y 55202 Bilateral Femoral Hernia With Obstruction Y 55203 Recurrent Bilateral Femoral Hernia With Obstruction Y 55220 Unspecified Ventral Hernia With Obstruction Y 55221 Incisional Hernia With Obstruction Y 55229 Other Ventral Hernia With Obstruction Y Unilateral or Unspecified Femoral Hernia Without Mention of Obstruction or Gangrene, 55300 Unilateral or Unspecified Y Femoral Hernia Without Mention of Obstruction or Gangrene, Recurrent Unilateral or 55301 Unspecified Y 55302 Femoral Hernia Without Mention of Obstruction or Gangrene, Bilateral Y 55303 Femoral Hernia Without Mention of Obstruction or Gangrene, Recurrent Bilateral Y 55320 Unspecified Ventral Hernia Without Mention of Obstruction or Gangrene Y 55321 Incisional Hernia Without Mention of Obstruction or Gangrene Y 55329 Other Ventral Hernia Without Mention of Obstruction or Gangrene Y 56030 Unspecified Impaction of Intestine Y 56031 Gallstone Ileus Y 56039 Other Impaction of Intestine Y 56081 Intestinal or Peritoneal Adhesions With Obstruction (Postoperative) (Postinfection) Y 56089 Other Specified Intestinal Obstruction Y 56200 Diverticulosis of Small Intestine (Without Mention of Hemorrhage) Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 175 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 56201 Diverticulitis of Small Intestine (Without Mention of Hemorrhage) Y 56202 Diverticulosis of Small Intestine With Hemorrhage Y 56203 Divertulitis of Small Intestine With Hemorrhage Y 56210 Diverticulosis of Colon (Without Mention of Hemorrhage) Y 56211 Diverticulitis of Colon (Without Mention of Hemorrhage) Y 56212 Diverticulosis of Colon With Hemorrhage Y 56213 Diverticulitis of Colon With Hemorrhage Y 56400 Unspecified Constipation Y 56401 Slow Transit Constipation Y 56402 Outlet Dysfunction Constipation Y 56409 Other Constipation Y 56481 Neurogenic Bowel N 56489 Other Functional Disorders of Intestine N 56721 Peritonitis (Acute) Generalized Y 56722 Peritoneal Abscess Y 56723 Spontaneous Bacterial Peritonitis Y 56729 Other Suppurative Peritonitis Y 56731 Psoas Muscle Abscess Y 56738 Other Retroperitoneal Abscess Y 56739 Other Retroperitoneal Infections Y 56781 Choleperitonitis Y 56782 Sclerosing Mesenteritis Y 56789 Other Specified Peritonitis Y 56881 Hemoperitoneum (Nontraumatic) Y 56882 Peritoneal Effusion (Chronic) Y 56889 Other Specified Disorder of Peritoneum Y 56941 Ulcer of Anus and Rectum Y 56942 Anal or Rectal Pain Y 56949 Other Specified Disorder of Rectum and Anus Y 56960 Unspecified Complication of Colostomy or Enterostomy Y 56961 Infection of Colostomy or Enterostomy Y 56962 Mechanical Complication of Colostomy and Enterostomy Y 56969 Other Complication of Colostomy or Enterostomy Y 56981 Fistula of Intestine, Excluding Rectum and Anus Y 56982 Ulceration of Intestine Y 56983 Perforation of Intestine Y 56984 Angiodysplasia of Intestine (Without Mention of Hemorrhage) Y 56985 Angiodysplasia of Intestine With Hemorrhage Y 56986 Dieulafoy Lesion (Hemorrhagic) of Intestine Y 56989 Other Specified Disorder of Intestines Y 57140 Unspecified Chronic Hepatitis N 57141 Chronic Persistent Hepatitis N 57149 Other Chronic Hepatitis N 57400 Calculus of Gallbladder With Acute Cholecystitis, Without Mention of Obstruction Y 57401 Calculus of Gallbladder With Acute Cholecystitis and Obstruction Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 176 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 57410 Calculus of Gallbladder With Other Cholecystitis, Without Mention of Obstruction Y 57411 Calculus of Gallbladder With Other Cholecystitis and Obstruction Y 57420 Calculus of Gallbladder Without Mention of Cholecystitis or Obstruction Y 57421 Calculus of Gallbladder Without Mention of Cholecystitis, With Obstruction Y 57430 Calculus of Bile Duct With Acute Cholecystitis Without Mention of Obstruction Y 57431 Calculus of Bile Duct With Acute Cholecystitis and Obstruction Y 57440 Calculus of Bile Duct With Other Cholecystitis, Without Mention of Obstruction Y 57441 Calculus of Bile Duct With Other Cholecystitis and Obstruction Y 57450 Calculus of Bile Duct Without Mention of Cholecystitis or Obstruction Y 57451 Calculus of Bile Duct Without Mention of Cholecystitis, With Obstruction Y Calculus of Gallbladder and Bile Duct With Acute Cholecystitis, Without Mention of 57460 Obstruction Y 57461 Calculus of Gallbladder and Bile Duct With Acute Cholecystitis, With Obstruction Y Calculus of Gallbladder and Bile Duct With Other Cholecystitis, Without Mention of 57470 Obstruction Y 57471 Calculus of Gallbladder and Bile Duct With Other Cholecystitis, With Obstruction Y Calculus of Gallbladder and Bile Duct With Acute and Chronic Cholecystitis, Without 57480 Mention of Obstruction Y Calculus of Gallbladder and Bile Duct With Acute and Chronic Cholecystitis, With 57481 Obstruction Y Calculus of Gallbladder and Bile Duct Without Cholecystitis, Without Mention of 57490 Obstruction Y 57491 Calculus of Gallbladder and Bile Duct Without Cholecystitis, With Obstruction Y 57510 Cholecystitis, Unspecified Y 57511 Chronic Cholecystitis Y 57512 Acute and Chronic Cholecystitis Y Acute Glomerulonephritis With Other Specified Pathological Lesion in Kidney in Disease 58081 Classified Elsewhere Y 58089 Other Acute Glomerulonephritis With Other Specified Pathological Lesion in Kidney Y Nephrotic Syndrome With Other Specified Pathological Lesion in Kidney in Diseases 58181 Classified Elsewhere Y 58189 Other Nephrotic Syndrome With Specified Pathological Lesion in Kidney Y Chronic Glomerulonephritis With Other Specified Pathological Lesion in Kidney in 58281 Diseases Classified Elsewhere Y 58289 Other Chronic Glomerulonephritis With Specified Pathological Lesion in Kidney Y Nephritis and Nephropathy, Not Specified as Acute or Chronic, With Other Specified 58381 Pathological Lesion in Kidney, in Diseases Classified Elsewhere Y Other Nephritis and Nephropathy, Not Specified as Acute or Chronic, With Specified 58389 Pathological Lesion in Kidney Y 58881 Secondary Hyperparathyroidism (of Renal Origin) Y 58889 Other Specified Disorders Resulting From Impaired Renal Function Y 59000 Chronic Pyelonephritis Without Lesion of Renal Medullary Necrosis Y 59001 Chronic Pyelonephritis With Lesion of Renal Medullary Necrosis Y 59010 Acute Pyelonephritis Without Lesion of Renal Medullary Necrosis Y 59011 Acute Pyelonephritis With Lesion of Renal Medullary Necrosis Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 177 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 59080 Unspecified Pyelonephritis Y 59081 Pyelitis or Pyelonephritis in Diseases Classified Elsewhere Y 59370 Vesicoureteral Reflux, Unspecified or Without Reflex Nephropathy Y 59371 Vesicoureteral Reflux With Reflux Nephropathy, Unilateral Y 59372 Vesicoureteral Reflux With Reflux Nephropathy, Bilateral Y 59373 Vesicoureteral Reflux With Reflux Nephropathy, Nos Y 59381 Vascular Disorders of Kidney Y 59382 Ureteral Fistula Y 59389 Other Specified Disorder of Kidney and Ureter Y 59581 Cystitis Cystica Y 59582 Irradiation Cystitis Y 59589 Other Specified Types of Cystitis Y 59651 Hypertonicity of Bladder Y 59652 Low Bladder Compliance Y 59653 Paralysis of Bladder Y 59654 Neurogenic Bladder, Nos Y 59655 Detrusor Sphincter Dyssynergia Y 59659 Other Functional Disorder of Bladder Y 59780 Unspecified Urethritis Y 59781 Urethral Syndrome Nos Y 59789 Other Urethritis Y 59800 Urethral Stricture due to Unspecified Infection Y 59801 Urethral Stricture due to Infective Diseases Classified Elsewhere Y 59960 Urinary Obstruction, Unspecified Y 59969 Urinary Obstruction, Not Elsewhere Classified Y 59981 Urethral Hypermobility Y 59982 Intrinsic (Urethral) Sphincter Deficiency (ISD) Y 59983 Urethral Instability N 59984 Other Specified Disorders of Urethra Y 59989 Other Specified Disorders of Urinary Tract Y 60000 Hypertrophy (Benign) of Prostate Without Urinary Obstruction Y 60001 Hypertrophy (Benign) of Prostate With Urinary Obstruction Y 60010 Nodular Prostate Without Urinary Obstruction Y 60011 Nodular Prostate With Urinary Obstruction Y 60020 Benign Localized Hyperplasia of Prostate Without Urinary Obstruction Y 60021 Benign Localized Hyperplasia of Prostate With Urinary Obstruction Y 60090 Hyperplasia of Prostate, Unspecified, Without Urinary Obstruction Y 60091 Hyperplasia of Prostate, Unspecified, With Urinary Obstruction Y 60490 Unspecified Orchitis and Epididymitis Y 60491 Orchitis and Epididymitis in Disease Classified Elsewhere Y 60499 Other Orchitis, Epididymitis, and Epididymo-Orchitis, Without Mention of Abscess Y 60781 Balanitis Xerotica Obliterans Y 60782 Vascular Disorders of Penis Y 60783 Edema of Penis Y 60784 Impotence of Organic Origin Y 60785 Peyronie’s Disease Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 178 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 60789 Other Specified Disorder of Penis Y 60881 Specified Disorder of Male Genital Organs in Diseases Classified Elsewhere Y 60882 Hematospermia Y 60883 Specified Vascular Disorder of Male Genital Organs Y 60884 Chylocele of Tunica Vaginalis Y 60885 Stricture of Male Genital Organs Y 60886 Edema of Male Genital Organs N 60887 Retrograde Ejaculation Y 60889 Other Specified Disorder of Male Genital Organs N 61171 Mastodynia N 61172 Lump or Mass in Breast N 61179 Other Sign and Symptom in Breast N 61610 Unspecified Vaginitis and Vulvovaginitis Y 61611 Vaginitis and Vulvovaginitis in Diseases Classified Elsewhere Y 61650 Unspecified Ulceration of Vulva Y 61651 Ulceration of Vulva in Disease Classified Elsewhere Y 61800 Unspecified Prolapse of Vaginal Walls Y 61801 Cystocele, Midline Y 61802 Cystocele, Lateral Y 61803 Urethrocele Y 61804 Rectocele Y 61805 Perineocele Y 61809 Other Prolapse of Vaginal Walls Without Mention of Uterine Prolapse Y 61881 Incompetence or Weakening of Pubocervical Tissue Y 61882 Incompetence or Weakening of Rectovaginal Tissue Y 61883 Pelvic Muscle Wasting Y 61889 Other Specified Genital Prolapse Y 62130 Endometrial Hyperplasia, Unspecified S 62131 Simple Endometrial Hyperplasia Without Atypia S 62132 Complex Endometrial Hyperplasia Without Atypia S 62133 Endometrial Hyperplasia With Atypia S 62210 Dysplasia of Cervix, Unspecified N 62211 Mild Dysplasia of Cervix N 62212 Moderate Dysplasia or Cervix N 62920 Female Genital Mutilation Status, Unspecified S 62921 Female Genital Mutilation Type I Status S 62922 Female Genital Mutilation Type II Status S 62923 Female Genital Mutilation Type III Status S 63300 Abdominal Pregnancy Without Intrauterine Pregnancy Y 63301 Abdominal Pregnancy With Intrauterine Pregnancy Y 63310 Tubal Pregnancy Without Intrauterine Pregnancy Y 63311 Tubal Pregnancy With Intrauterine Pregnancy Y 63320 Ovarian Pregnancy Without Intrauterine Pregnancy Y 63321 Ovarian Pregnancy With Intrauterine Pregnancy Y 63380 Other Ectopic Pregnancy Without Intrauterine Pregnancy Y 63381 Other Ectopic Pregnancy With Intrauterine Pregnancy Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 179 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 63390 Unspecified Ectopic Pregnancy Without Intrauterine Pregnancy Y 63391 Unspecified Ectopic Pregnancy With Intrauterine Pregnancy Y 63400 Unspecified Spontaneous Abortion Complicated by Genital Tract and Pelvic Infection Y 63401 Incomplete Spontaneous Abortion Complicated by Genital Tract and Pelvic Infection Y 63402 Complete Spontaneous Abortion Complicated by Genital Tract and Pelvic Infection Y 63410 Unspecified Spontaneous Abortion Complicated by Delayed or Excessive Hemorrhage Y 63411 Incomplete Spontaneous Abortion Complicated by Delayed or Excessive Hemorrhage Y 63412 Complete Spontaneous Abortion Complicated by Delayed or Excessive Hemorrhage Y

63420 Unspecified Spontaneous Abortion Complicated by Damage to Pelvic Organs or Tissues Y 63421 Incomplete Spontaneous Abortion Complicated by Damage to Pelvic Organs or Tissues Y 63422 Complete Spontaneous Abortion Complicated by Damage to Pelvic Organs or Tissues Y 63430 Unspecified Spontaneous Abortion Complicated by Renal Failure Y 63431 Incomplete Spontaneous Abortion Complicated by Renal Failure Y 63432 Complete Spontaneous Abortion Complicated by Renal Failure Y 63440 Unspecified Spontaneous Abortion Complicated by Metabolic Disorder Y 63441 Incomplete Spontaneous Abortion Complicated by Metabolic Disorder Y 63442 Complete Spontaneous Abortion Complicated by Metabolic Disorder Y 63450 Unspecified Spontaneous Abortion Complicated by Shock Y 63451 Incomplete Spontaneous Abortion Complicated by Shock Y 63452 Complete Spontaneous Abortion Complicated by Shock Y 63460 Unspecified Spontaneous Abortion Complicated by Embolism Y 63461 Incomplete Spontaneous Abortion Complicated by Embolism Y 63462 Complete Spontaneous Abortion Complicated by Embolism Y 63470 Unspecified Spontaneous Abortion With Other Specified Complications Y 63471 Incomplete Spontaneous Abortion With Other Specified Complications Y 63472 Complete Spontaneous Abortion With Other Specified Complications Y 63480 Unspecified Spontaneous Abortion With Unspecified Complication Y 63481 Incomplete Spontaneous Abortion With Unspecified Complication Y 63482 Complete Spontaneous Abortion With Unspecified Complication Y 63490 Unspecified Spontaneous Abortion Without Mention of Complication Y 63491 Incomplete Spontaneous Abortion Without Mention of Complication Y 63492 Complete Spontaneous Abortion Without Mention of Complication Y

63500 Unspecified Legally Induced Abortion Complicated by Genital Tract and Pelvic Infection N

63501 Incomplete Legally Induced Abortion Complicated by Genital Tract and Pelvic Infection N 63502 Complete Legally Induced Abortion Complicated by Genital Tract and Pelvic Infection N

63510 Unspecified Legally Induced Abortion Complicated by Delayed or Excessive Hemorrhage Y

63511 Incomplete Legally Induced Abortion Complicated by Delayed or Excessive Hemorrhage Y 63512 Complete Legally Induced Abortion Complicated by Delayed or Excessive Hemorrhage Y Unspecified Legally Induced Abortion Complicated by Damage to Pelvic Organs or 63520 Tissues Y Legally Induced Abortion Complicated by Damage to Pelvic Organs or Tissues, 63521 Incomplete Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 180 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator

63522 Complete Legally Induced Abortion Complicated by Damage to Pelvic Organs or Tissues Y 63530 Unspecified Legally Induced Abortion Complicated by Renal Failure Y 63531 Incomplete Legally Induced Abortion Complicated by Renal Failure Y 63532 Complete Legally Induced Abortion Complicated by Renal Failure Y 63540 Unspecified Legally Induced Abortion Complicated by Metabolic Disorder Y 63541 Incomplete Legally Induced Abortion Complicated by Metabolic Disorder Y 63542 Complete Legally Induced Abortion Complicated by Metabolic Disorder Y 63550 Unspecified Legally Induced Abortion Complicated by Shock Y 63551 Legally Induced Abortion, Complicated by Shock, Incomplete Y 63552 Complete Legally Induced Abortion Complicated by Shock Y 63560 Unspecified Legally Induced Abortion Complicated by Embolism Y 63561 Incomplete Legally Induced Abortion Complicated by Embolism Y 63562 Complete Legally Induced Abortion Complicated by Embolism Y 63570 Unspecified Legally Induced Abortion With Other Specified Complications Y 63571 Incomplete Legally Induced Abortion With Other Specified Complications Y 63572 Complete Legally Induced Abortion With Other Specified Complications Y 63580 Unspecified Legally Induced Abortion With Unspecified Complication Y 63581 Incomplete Legally Induced Abortion With Unspecified Complication Y 63582 Complete Legally Induced Abortion With Unspecified Complication Y 63590 Unspecified Legally Induced Abortion Without Mention of Complication Y 63591 Incomplete Legally Induced Abortion Without Mention of Complication Y 63592 Complete Legally Induced Abortion Without Mention of Complication Y

63600 Unspecified Illegally Induced Abortion Complicated by Genital Tract and Pelvic Infection Y Incomplete Illegally Induced Abortion Complicated by Genital Tractm and Pelvic 63601 Infection Y 63602 Complete Illegally Induced Abortion Complicated by Genital Tract and Pelvic Infection Y Unspecified Illegally Induced Abortion Complicated by Delayed or Excessive 63610 Hemorrhage Y

63611 Incomplete Illegally Induced Abortion Complicated by Delayed or Excessive Hemorrhage Y

63612 Complete Illegally Induced Abortion Complicated by Delayed or Excessive Hemorrhage Y Unspecified Illegally Induced Abortion Complicated by Damage to Pelvic Organs or 63620 Tissues Y Incomplete Illegally Induced Abortion Complicated by Damage to Pelvic Organs or 63621 Tissues Y

63622 Complete Illegally Induced Abortion Complicated by Damage to Pelvic Organs or Tissues Y 63630 Unspecified Illegally Induced Abortion Complicated by Renal Failure Y 63631 Incomplete Illegally Induced Abortion Complicated by Renal Failure Y 63632 Complete Illegally Induced Abortion Complicated by Renal Failure Y 63640 Unspecified Illegally Induced Abortion Complicated by Metabnolic Disorder Y 63641 Incomplete Illegally Induced Abortion Complicated by Metabolic Disorder Y 63642 Complete Illegally Induced Abortion Complicated by Metabolic Disorder Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 181 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 63650 Unspecified Illegally Induced Abortion Complicated by Shock Y 63651 Incomplete Illegally Induced Abortion Complicated by Shock Y 63652 Complete Illegally Induced Abortion Complicated by Shock Y 63660 Unspecified Illegally Induced Abortion Complicated by Embolism Y 63661 Incomplete Illegally Induced Abortion Complicated by Embolism Y 63662 Complete Illegally Induced Abortion Complicated by Embolism Y 63670 Unspecified Illegally Induced Abortion With Other Specified Complications Y 63671 Incomplete Illegally Induced Abortion With Other Specified Complications Y 63672 Complete Illegally Induced Abortion With Other Specified Complications Y 63680 Unspecified Illegally Induced Abortion With Unspecified Complication Y 63681 Incomplete Illegally Induced Abortion With Unspecified Complication Y 63682 Complete Illegally Induced Abortion With Unspecified Complication Y 63690 Unspecified Illegally Induced Abortion Without Mention of Complication Y 63691 Incomplete Illegally Induced Abortion Without Mention of Complication Y 63692 Complete Illegally Induced Abortion Without Mention of Complication Y Legally Unspecified Abortion, Incomplete, Complicated by Genital Tract and Pelvic 63701 Infection Y Legally Unspecified Abortion, Complete, Complicated by Genital Tract and Pelvic 63702 Infection Y Abortion, Unspecified as to Completion or Legality, Complicated by Delayed or Excessive 63710 Hemorrhage Y Legally Unspecified Abortion, Incomplete, Complicated by Delayed or Excessive 63711 Hemorrhage Y Legally Unspecified Abortion, Complete, Complicated by Delayed or Excessive 63712 Hemorrhage Y Abortion, Unspecified as to Completion or Legality, Complicated by Damage to Pelvic 63720 Organs or Tissues Y Legally Unspecified Abortion, Incomplete, Complicated by Damage to Pelvic Organs or 63721 Tissues Y Legally Unspecified Abortion, Complete, Complicated by Damage to Pelvic Organs or 63722 Tissues Y 63730 Abortion, Unspecified as to Completion or Legality, Complicated by Renal Failure Y 63731 Legally Unspecified Abortion, Incomplete, Complicated by Renal Failure Y 63732 Legally Unspecified Abortion, Complete, Complicated by Renal Failure Y

63740 Abortion, Unspecified as to Completeness or Legality, Complicated by Metabolic Disorder Y 63741 Legally Unspecified Abortion, Incomplete, Complicated by Metabolic Disorder Y 63742 Legally Unspecified Abortion, Complete, Complicated by Metabolic Disorder Y 63750 Abortion, Unspecified as to Completion or Legality, Complicated by Shock Y 63751 Legally Unspecified Abortion, Incomplete, Complicated by Shock Y 63752 Legally Unspecified Abortion, Complete, Complicated by Shock Y 63760 Abortion, Unspecified as to Completion or Legality, Complicated by Embolism Y 63761 Legally Unspecified Abortion, Incomplete, Complicated by Embolism Y 63762 Legally Unspecified Abortion, Complete, Complicated by Embolism Y

63770 Abortion, Unspecified as to Completion or Legality, With Other Specified Complications Y 63771 Legally Unspecified Abortion, Incomplete, With Other Specified Complications Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 182 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 63772 Legally Unspecified Abortion, Complete, With Other Specified Complications Y 63780 Abortion, Unspecified as to Completion or Legality, With Unspecified Complication Y 63781 Legally Unspecified Abortion, Incomplete, With Unspecified Complication Y 63782 Legally Unspecified Abortion, Complete, With Unspecified Complication Y Unspecified Type of Abortion, Unspecified as to Completion or Legality, Without 63790 Mention of Complication Y 63791 Legally Unspecified Abortion, Incomplete, Without Mention of Complication N 63792 Legally Unspecified Abortion, Complete, Without Mention of Complication N 64000 Threatened Abortion, Unspecified as to Episode of Care Y 64001 Threatened Abortion, Delivered Y 64003 Threatened Abortion, Antepartum Y 64080 Other Specified Hemorrhage in Early Pregnancy, Unspecified as to Episode of Care Y 64081 Other Specified Hemorrhage in Early Pregnancy, Delivered Y 64083 Other Specified Hemorrhage in Early Pregnancy, Antepartum Y 64090 Unspecified Hemorrhage in Early Pregnancy, Unspecified as to Episode of Care N 64091 Unspecified Hemorrhage in Early Pregnancy, Delivered N 64093 Unspecified Hemorrhage in Early Pregnancy, Antepartum Y 64100 Placenta Previa Without Hemorrhage, Unspecified as to Episode of Care Y 64101 Placenta Previa Without Hemorrhage, With Delivery Y 64103 Placenta Previa Without Hemorrhage, Antepartum Y 64110 Hemorrhage From Placenta Previa, Unspecified as to Episode of Care Y 64111 Hemorrhage From Placenta Previa, With Delivery Y 64113 Hemorrhage From Placenta Previa, Antepartum Y 64120 Premature Separation of Placenta, Unspecified as to Episode of Care Y 64121 Premature Separation of Placenta, With Delivery Y 64123 Premature Separation of Placenta, Antepartum Y Antepartum Hemorrhage Associated With Coagulation Defects, Unspecified as to Episode 64130 of Care Y 64131 Antepartum Hemorrhage Associated With Coagulation Defects, With Delivery Y 64133 Antepartum Hemorrhage Associated With Coagulation Defect, Antepartumm Y 64180 Other Antepartum Hemorrhage, Unspecified as to Episode of Care Y 64181 Other Antepartum Hemorrhage, With Delivery Y 64183 Other Antepartum Hemorrhage, Antepartum Y 64190 Unspecified Antepartum Hemorrhage, Unspecified as to Episode of Care Y 64191 Unspecified Antepartum Hemorrhage, With Delivery Y 64193 Unspecified Antepartum Hemorrhage, Antepartum Y Benign Essential Hypertension Complicating Pregnancy, Childbirth, and the Puerperium, 64200 Unspecified as to Episode of Care S 64201 Benign Essential Hypertension With Delivery S 64202 Benign Essential Hypertension, With Delivery, With Current Postpartum Complication S 64203 Benign Essential Hypertension Antepartum S 64204 Benign Essential Hypertension, Previous Postpartum Complication S Hypertension Secondary to Renal Disease, Complicating Pregnancy, Childbirth, and the 64210 Puerperium, Unspecified as to Episode of Care S 64211 Hypertension Secondary to Renal Disease, With Delivery S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 183 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Hypertension Secondary to Renal Disease, With Delivery, With Current Postpartum 64212 Complication S 64213 Hypertension Secondary to Renal Disease, Antepartum S 64214 Hypertension Secondary to Renal Disease, Previous Postpartum Condition S Other Pre-Existing Hypertension Complicating Pregnancy, Childbirth, and the 64220 Puerperium, Unspecified as to Episode of Care S 64221 Other Pre-Existing Hypertension, With Delivery S

64222 Other Pre-Existing Hypertension, With Delivery, With Current Postpartum Complication S 64223 Other Pre-Existing Hypertension, Antepartum S 64224 Other Pre-Existing Hypertension, Previous Postpartum Condition S 64230 Transient Hypertension of Pregnancy, Unspecified as to Episode of Care S 64231 Transient Hypertension of Pregnancy, With Delivery S Transient Hypertension of Pregnancy, With Delivery, With Current Postpartum 64232 Complication S 64233 Transient Hypertension of Pregnancy, Antepartum S 64234 Transient Hypertension of Pregnancy, Previous Postpartum Condition S 64240 Mild or Unspecified Pre-Eclampsia, Unspecified as to Episode of Care S 64241 Mild or Unspecified Pre-Eclampsia, With Delivery S Mild or Unspecified Pre-Eclampsia, With Delivery, With Current Postpartum 64242 Complication S 64243 Mild or Unspecified Pre-Eclampsia, Antepartum S 64244 Mild or Unspecified Pre-Eclampsia, Previous Postpartum Condition S 64250 Severe Pre-Eclampsia, Unspecified as to Episode of Care Y 64251 Severe Pre-Eclampsia, With Delivery Y 64252 Severe Pre-Eclampsia, With Delivery, With Current Postpartum Complication Y 64253 Severe Pre-Eclampsia, Antepartum Y 64254 Severe Pre-Eclampsia, Previous Postpartum Condition Y Eclampsia Complicating Pregnancy, Childbirth or the Puerperium, Unspecified as to 64260 Episode of Care Y 64261 Eclampsia, With Delivery Y 64262 Eclampsia, With Delivery, With Current Postpartum Complication Y 64263 Eclampsia, Antepartum Y 64264 Eclampsia, Previous Postpartum Condition Y Pre-Eclampsia or Eclampsia Superimposed on Pre-Existing Hypertension, Complicating 64270 Pregnancy, Childbirth, or the Puerperium, Unspecified as to Episode of Care Y

64271 Pre-Eclampsia or Eclampsia Superimposed on Pre-Existing Hypertension, With Delivery Y Pre-Eclampsia or Eclampsia Superimposed on Pre-Existing Hypertension, With Delivery, 64272 With Current Postpartum Complication Y 64273 Pre-Eclampsia or Eclampsia Superimposed on Pre-Existing Hypertension, Antepartum Y 64274 Pre-Eclampsia or Eclampsia Superimposed on Pre-Existing Hypertension, Postpartum Y Unspecified Hypertension Complicating Pregnancy, Childbirth, or the Puerperium, 64290 Unspecified as to Episode of Care N 64291 Unspecified Hypertension, With Delivery N 64292 Unspecified Hypertension, With Delivery, With Current Postpartum Complication N 64293 Unspecified Hypertension Antepartum N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 184 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 64294 Unspecified Hypertension, Previous Postpartum Condition N 64300 Mild Hyperemesis Gravidarum, Unspecified as to Episode of Care N 64301 Mild Hyperemesis Gravidarum, Delivered N 64303 Mild Hyperemesis Gravidarum, Antepartum N

64310 Hyperemesis Gravidarum With Metabolic Disturbance, Unspecified as to Episode of Care S 64311 Hyperemesis Gravidarum With Metabolic Disturbance, Delivered S 64313 Hyperemesis Gravidarum With Metabolic Disturbance, Antepartum S 64320 Late Vomiting of Pregnancy, Unspecified as to Episode of Care S 64321 Late Vomiting of Pregnancy, Delivered S 64323 Late Vomiting of Pregnancy, Antepartum S 64380 Other Vomiting Complicating Pregnancy, Unspecified as to Episode of Care S 64381 Other Vomiting Complicating Pregnancy, Delivered S 64383 Other Vomiting Complicating Pregnancy, Antepartum S 64390 Unspecified Vomiting of Pregnancy, Unspecified as to Episode of Care S 64391 Unspecified Vomiting of Pregnancy, Delivered S 64393 Unspecified Vomiting of Pregnancy, Antepartum S 64400 Threatened Premature Labor, Unspecified as to Episode of Care Y 64403 Threatened Premature Labor, Antepartum Y 64410 Other Threatened Labor, Unspecified as to Episode of Care Y 64413 Other Threatened Labor, Antepartum Y 64420 Early Onset of Delivery, Unspecified as to Episode of Care Y 64421 Early Onset of Delivery, Delivered, With or Without Mention of Antepartum Condition Y 64500 Prolonged Pregnancy Unspecified as to Episode of Care or Not Applicabl N 64501 Prolonged Pregnancy, With Delivery N 64503 Prolonged Pregnancy, Antepartum N 64510 Post Term Pregnancy, Unspecified as to Episode of Care or Not Applicable N 64511 Post Term Pregnancy, Delivered, With or Without Mention of Antepartum Condition N 64513 Post Term Pregnancy, Antepartum Condition or Complication N 64520 Prolonged Pregnancy, Unspecified as to Episode of Care or Not Applicable N 64521 Prolonged Pregnancy, Delivered, With or Without Mention of Antepartum Condition N 64523 Prolonged Pregnancy, Delivered, Antepartum Condition or Complication N 64600 Papyraceous Fetus, Unspecified as to Episode of Care N 64601 Papyraceous Fetus, Delivered, With or Without Mention of Antepartum Condition N 64603 Papyraceous Fetus, Antepartum N 64610 Edema or Excessive Weight Gain in Pregnancy, Unspecified as to Episode of Care N Edema or Excessive Weight Gain in Pregnancy, With Delivery, With or Without Mention 64611 of Antepartum Complication N Edema or Excessive Weight Gain in Pregnancy, With Delivery, With Current Postpartum 64612 Complication N 64613 Edema or Excessive Weight Gain, Antepartum N 64614 Edema or Excessive Weight Gain, Previous Postpartum Condition N 64620 Unspecified Renal Disease in Pregnancy, Unspecified as to Episode of Care Y 64621 Unspecified Renal Disease in Pregnancy, With Delivery Y Unspecified Renal Disease in Pregnancy, With Delivery, With Current Postpartum 64622 Complication Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 185 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 64623 Unspecified Antepartum Renal Disease Y 64624 Unspecified Renal Disease, Previous Postpartum Condition Y 64630 Pregnancy Complication, Habitual Aborter Unspecified as to Episode of Care Y Pregnancy Complication, Habitual Aborter With or Without Mention of Antepartum 64631 Condition Y 64633 Habitual Aborter, Antepartum Condition or Complication Y 64640 Peripheral Neuritis in Pregnancy, Unspecified as to Episode of Care Y 64641 Peripheral Neuritis in Pregnancy, With Delivery Y

64642 Peripheral Neuritis in Pregnancy, With Delivery, With Current Postpartum Complication Y 64643 Peripheral Neuritis Antepartum Y 64644 Peripheral Neuritis, Previous Postpartum Condition Y 64650 Asymptomatic Bacteriuria in Pregnancy, Unspecified as to Episode of Care Y 64651 Asymptomatic Bacteriuria in Pregnancy, With Delivery Y Asymptomatic Bacteriuria in Pregnancy, With Delivery, With Current Postpartum 64652 Complication Y 64653 Asymptomatic Bacteriuria Antepartum Y 64654 Asymptomatic Bacteriuria, Previous Postpartum Condition Y 64660 Infections of Genitourinary Tract in Pregnancy, Unspecified as to Episode of Care Y 64661 Infections of Genitourinary Tract in Pregnancy, With Delivery Y Infections of Genitourinary Tract in Pregnancy, With Delivery, With Current Postpartum 64662 Complication Y 64663 Infections of Genitourinary Tract Antepartum Y 64664 Infections of Genitourinary Tract, Previous Postpartum Condition Y 64670 Liver Disorders in Pregnancy, Unspecified as to Episode of Care Y 64671 Liver Disorders in Pregnancy, With Delivery Y 64673 Liver Disorders Antepartum Y 64680 Other Specified Complication of Pregnancy, Unspecified as to Episode of Care Y 64681 Other Specified Complication of Pregnancy, With Delivery Y Other Specified Complications of Pregnancy, With Delivery, With Current Postpartum 64682 Complication Y 64683 Other Specifed Complication, Antepartum Y 64684 Other Specified Complications, Previous Postpartum Condition Y 64690 Unspecified Complication of Pregnancy, Unspecified as to Episode of Care Y 64691 Unspecified Complication of Pregnancy, With Delivery Y 64693 Unspecified Complication of Pregnancy, Antepartum Y Maternal Syphilis, Complicating Pregnancy, Childbirth, or the Puerperium, Unspecified as 64700 to Episode of Care Y 64701 Maternal Syphilis, Complicating Pregnancy, With Delivery Y Maternal Syphilis, Complicating Pregnancy, With Delivery, With Current Postpartum 64702 Complication Y 64703 Maternal Syphilis, Antepartum Y 64704 Maternal Syphilis, Previous Postpartum Condition Y Maternal Gonorrhea Complicating Pregnancy, Childbirth, or the Puerperium, Unspecified 64710 as to Episode of Care Y 64711 Maternal Gonorrhea With Delivery Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 186 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 64712 Maternal Gonorrhea, With Delivery, With Current Postpartum Complication Y 64713 Maternal Gonorrhea, Antepartum Y 64714 Maternal Gonorrhea, Previous Postpartum Condition Y Other Maternal Venereal Diseases, Complicating Pregnancy, Childbirth, or the 64720 Puerperium, Unspecified as to Episode of Care Y 64721 Other Maternal Venereal Diseases With Delivery Y

64722 Other Maternal Venereal Diseases With Delivery, With Current Postpartum Complication Y 64723 Other Antepartum Maternal Venereal Disease, Previous Postpartum Condition Y 64724 Other Postpartum Venereal Diseases Y Maternal Tuberculosis Complicating Pregnancy, Childbirth, or the Puerperium, 64730 Unspecified as to Episode of Care Y 64731 Maternal Tuberculosis With Delivery Y 64732 Maternal Tuberculosis With Delivery, With Current Postpartum Complication Y 64733 Maternal Tuberculosis, Antepartum Y 64734 Maternal Tuberculosis, Previous Postpartum Condition Y Maternal Malaria Complicating Pregnancy, Childbirth or the Puerperium, Unspecified as 64740 to Episode of Care Y 64741 Maternal Malaria With Delivery Y 64742 Maternal Malaria With Delivery, With Current Postpartum Complication Y 64743 Maternal Malaria, Antepartum Y 64744 Maternal Malaria, Previous Postpartum Condition Y Maternal Rubella Complicating Pregnancy, Childbirth, or the Puerperium, Unspecified as 64750 to Episode of Care Y 64751 Maternal Rubella With Delivery Y 64752 Maternal Rubella With Delivery, With Current Postpartum Complication Y 64753 Maternal Rubella, Antepartum Y 64754 Maternal Rubella, Previous Postpartum Condition Y Other Maternal Viral Disease Complicating Pregnancy, Childbirth, or the Puerperium, 64760 Unspecified as to Episode of Care Y 64761 Other Maternal Viral Disease With Delivery Y 64762 Other Maternal Viral Disease With Delivery, With Current Postpartum Complication Y 64763 Other Maternal Viral Disease, Antepartum Y 64764 Other Maternal Viral Disease, Previous Postpartum Condition Y Other Specified Maternal Infectious and Parasitic Disease Complicating Pregnancy, 64780 Childbirth, or the Puerperium, Unspecified as to Episode of Care Y 64781 Other Specified Maternal Infectious and Parasitic Disease With Delivery Y Other Specified Maternal Infectious and Parasitic Disease With Delivery, With Current 64782 Postpartum Complication Y 64783 Other Specified Maternal Infectious and Parasitic Disease, Antepartum Y

64784 Other Specified Maternal Infectious and Parasitic Disease, Previous Postpartum Condition Y Unspecified Maternal Infection or Infestation Complicating Pregnancy, Childbirth, or the 64790 Puerperium, Unspecified as to Episode of Care Y 64791 Unspecified Maternal Infection or Infestation With Delivery Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 187 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Unspecified Maternal Infection or Infestation With Delivery, With Current Postpartum 64792 Complication Y 64793 Unspecified Maternal Infection or Infestation, Antepartum Y 64794 Unspecified Maternal Infection or Infestation, Previous Postpartum Condition Y Maternal Diabetes Mellitus, Complicating Pregnancy, Childbirth, or the Puerperium, 64800 Unspecified as to Episode of Care Y 64801 Maternal Diabetes Mellitus With Delivery Y 64802 Maternal Diabetes Mellitus With Delivery, With Current Postpartum Complication Y 64803 Maternal Diabetes Mellitus, Antepartum Y 64804 Maternal Diabetes Mellitus, Previous Postpartum Condition Y Maternal Thyroid Dysfunction Complicating Pregnancy, Childbirth, or the Puerperium, 64810 Unspecified as to Episode of Care or Not Applicable Y Maternal Thyroid Dysfunction With Delivery, With or Without Mention of Antepartum 64811 Condition Y 64812 Maternal Thyroid Dysfunction With Delivery, With Current Postpartum Complication Y 64813 Maternal Thyroid Dysfunction, Antepartum Condition or Complication Y 64814 Maternal Thyroid Dysfunction, Previous Postpartum Condition or Complication Y Maternal Anemia of Mother, Complicating Pregnancy, Childbirth, or the Puerperium, 64820 Unspecified as to Episode of Care Y 64821 Maternal Anemia, With Delivery Y 64822 Maternal Anemia With Delivery, With Current Postpartum Complication Y 64823 Maternal Anemia, Antepartum Y 64824 Maternal Anemia, Previous Postpartum Condition Y Maternal Drug Dependence Complicating Pregnancy, Childbirth, or the Puerperium, 64830 Unspecified as to Episode of Care Y 64831 Maternal Drug Dependence, With Delivery Y 64832 Maternal Drug Dependence, With Delivery, With Current Postpartum Complication Y 64833 Maternal Drug Dependence, Antepartum Y 64834 Maternal Drug Dependence, Previous Postpartum Condition Y Maternal Mental Disorders, Complicating Pregnancy, Childbirth, or the Puerperium, 64840 Unspecified as to Episode of Care Y 64841 Maternal Mental Disorders, With Delivery Y 64842 Maternal Mental Disorders, With Delivery, With Current Postpartum Complication Y 64843 Maternal Mental Disorders, Antepartum Y 64844 Maternal Mental Disorders, Previous Postpartum Condition Y Maternal Congenital Cardiovascular Disorders, Complicating Pregnancy, Childbirth, or 64850 the Puerperium, Unspecified as to Episode of Care Y 64851 Maternal Congenital Cardiovascular Disorders, With Delivery Y Maternal Congenital Cardiovascular Disorders, With Delivery, With Current Postpartum 64852 Complication Y 64853 Maternal Congenital Cardiovascular Disorders, Antepartum Y 64854 Maternal Congenital Cardiovascular Disorders, Previous Postpartum Condition Y Other Maternal Cardiovascular Diseases Complicating Pregnancy, Childbirth, or the 64860 Puerperium, Unspecified as to Episode of Care Y 64861 Other Maternal Cardiovascular Diseases, With Delivery Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 188 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Other Maternal Cardiovascular Diseases, With Delivery, With Current Postpartum 64862 Complication Y 64863 Other Maternal Cardiovascular Diseases, Antepartum Y 64864 Other Maternal Cardiovascular Diseases, Previous Postpartum Condition Y Bone and Joint Disorders of Maternal Back, Pelvis, and Lower Limbs, Complicating 64870 Pregnancy, Childbirth, or the Puerperium, Unspecified as to Episode of Care Y 64871 Bone and Joint Disorders of Maternal Back, Pelvis, and Lower Limbs, With Delivery Y Bone and Joint Disorders of Maternal Back, Pelvis, and Lower Limbs, With Delivery, 64872 With Current Postpartum Complication Y 64873 Bone and Joint Disorders of Maternal Back, Pelvis, and Lower Limbs, Antepartum Y Bone and Joint Disorders of Maternal Back, Pelvis, and Lower Limbs, Previous 64874 Postpartum Condition Y Abnormal Maternal Glucose Tolerance, Complicating Pregnancy, Childbirth, or the 64880 Puerperium, Unspecified as to Episode of Care Y 64881 Abnormal Maternal Glucose Tolerance, With Delivery Y Abnormal Maternal Glucose Tolerance, With Delivery, With Current Postpartum 64882 Complication Y 64883 Abnormal Maternal Glucose Tolerance, Antepartum Y 64884 Abnormal Maternal Glucose Tolerance, Previous Postpartum Condition Y Other Current Maternal Conditions Classifiable Elsewhere, Complicating Pregnancy, 64890 Childbirth, or the Puerperium, Unspecified as to Episode of Care Y 64891 Other Current Maternal Conditions Classifiable Elsewhere, With Delivery Y Other Current Maternal Conditions Classifiable Elsewhere, With Delivery, With Current 64892 Postpartum Complication Y 64893 Other Current Maternal Conditions Classifiable Elsewhere, Antepartum Y Other Current Maternal Conditions Classifiable Elsewhere, Previous Postpartum 64894 Condition Y 65100 Twin Pregnancy, Unspecified as to Episode of Care Y 65101 Twin Pregnancy, Delivered Y 65103 Twin Pregnancy, Antepartum Y 65110 Triplet Pregnancy, Unspecified as to Episode of Care Y 65111 Triplet Pregnancy, Delivered Y 65113 Triplet Pregnancy, Antepartum Y 65120 Quadruplet Pregnancy, Unspecified as to Episode of Care Y 65121 Quadruplet Pregnancy, Delivered Y 65123 Quadruplet Pregnancy, Antepartum Y Twin Pregnancy With Fetal Loss and Retention of One Fetus, Unspecified as to Episode of 65130 Care or Not Applicable Y 65131 Twin Pregnancy With Fetal Loss and Retention of One Fetus, Delivered Y 65133 Twin Pregnancy With Fetal Loss and Retention of One Fetus, Antepartum Y Triplet Pregnancy With Fetal Loss and Retention of One or More, Unspecified as to 65140 Episode of Care or Not Applicable Y 65141 Triplet Pregnancy With Fetal Loss and Retention of One or More, Delivered Y 65143 Triplet Pregnancy With Fetal Loss and Retention of One or More, Antepartum Y Quadruplet Pregnancy With Fetal Loss and Retention of One or More, Unspecified as to 65150 Episode of Care or Not Applicable Y 65151 Quadruplet Pregnancy With Fetal Loss and Retention of One or More, Delivered Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 189 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 65153 Quadruplet Pregnancy With Fetal Loss and Retention of One or More, Antepartum Y Other Multiple Pregnancy With Fetal Loss and Retention of One or More Fetus(Es), 65160 Unspecified as to Episode of Care or Not Applicable Y Other Multiple Pregnancy With Fetal Loss and Retention of One or More Fetus(Es), 65161 Delivered Y Other Multiple Pregnancy With Fetal Loss and Retention of One or More Fetus(Es), 65163 Antepartum Y Multiple Gestation Following (Elective) Fetal Reduction, Unspecified as to Episode of 65170 Care or Not Applicable Y Multiple Gestation Following (Elective) Fetal Reduction, Delivered, With or Without 65171 Mention of Antepartum Condition. Y Multiple Gestation Following (Elective) Fetal Reduction, Antepartum Condition or 65173 Complication Y 65180 Other Specified Multiple Gestation, Unspecified as to Episode of Care Y 65181 Other Specified Multiple Gestation, Delivered Y 65183 Other Specified Multiple Gestation, Antepartum Y 65190 Unspecified Multiple Gestation, Unspecified as to Episode of Care N 65191 Unspecified Multiple Gestation, Delivered Y 65193 Unspecified Multiple Gestation, Antepartum Y 65200 Unstable Lie of Fetus, Unspecified as to Episode of Care Y 65201 Unstable Lie of Fetus, Delivered Y 65203 Unstable Lie of Fetus, Antepartum Y Breech or Other Malpresentation Successfully Converted to Cephalic Presentation, 65210 Unspecified as to Episode of Care Y Breech or Other Malpresentation Successfully Converted to Cephalic Presentation, 65211 Delivered Y Breech or Other Malpresentation Successfully Converted to Cephalic Presentation, 65213 Antepartum Y 65220 Breech Presentation Without Mention of Version, Unspecified as to Episode of Care Y 65221 Breech Presentation Without Mention of Version, Delivered Y 65223 Breech Presentation Without Mention of Version, Antepartum Y 65230 Transverse or Oblique Fetal Presentation, Unspecified as to Episode of Care Y 65231 Transverse or Oblique Fetal Presentation, Delivered Y 65233 Transverse or Oblique Fetal Presentation, Antepartum Y 65240 Fetal Face or Brow Presentation, Unspecified as to Episode of Care Y 65241 Fetal Face or Brow Presentation, Delivered Y 65243 Fetal Face or Brow Presentation, Antepartum Y 65250 High Fetal Head at Term, Unspecified as to Episode of Care Y 65251 High Fetal Head at Term, Delivered Y 65253 High Fetal Head at Term, Antepartum Y Multiple Gestation With Malpresentation of One Fetus or More, Unspecified as to Episode 65260 of Care Y 65261 Multiple Gestation With Malpresentation of One Fetus or More, Delivered Y 65263 Multiple Gestation With Malpresentation of One Fetus or More, Antepartum Y 65270 Prolapsed Arm of Fetus, Unspecified as to Episode of Care Y 65271 Prolapsed Arm of Fetus, Delivered Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 190 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 65273 Prolapsed Arm of Fetus, Antepartum Condition or Complication Y Other Specified Malposition or Malpresentation of Fetus, Unspecified as to Episode of 65280 Care Y 65281 Other Specified Malposition or Malpresentation of Fetus, Delivered Y 65283 Other Specified Malposition or Malpresentation of Fetus, Antepartum Y 65290 Unspecified Malposition or Malpresentation of Fetus, Unspecified as to Episode of Care Y 65291 Unspecified Malposition or Malpresentation of Fetus, Delivered Y 65293 Unspecified Malposition or Malpresentation of Fetus, Antepartum Y Major Abnormality of Bony Pelvis, Not Further Specified in Pregnancy, Unspecified as to 65300 Episode of Care Y 65301 Major Abnormality of Bony Pelvis, Not Further Specified, Delivered Y 65303 Major Abnormality of Bony Pelvis, Not Further Specified, Antepartum Y

65310 Generally Contracted Pelvis in Pregnancy, Unspecified as to Episode of Care in Pregnancy Y 65311 Generally Contracted Pelvis in Pregnancy, Delivered Y 65313 Generally Contracted Pelvis in Pregnancy, Antepartum Y

65320 Inlet Contraction of Pelvis in Pregnancy, Unspecified as to Episode of Care in Pregnancy Y 65321 Inlet Contraction of Pelvis in Pregnancy, Delivered Y 65323 Inlet Contraction of Pelvis in Pregnancy, Antepartum Y

65330 Outlet Contraction of Pelvis in Pregnancy, Unspecified as to Episode of Care in Pregnancy Y 65331 Outlet Contraction of Pelvis in Pregnancy, Delivered Y 65333 Outlet Contraction of Pelvis in Pregnancy, Antepartum Y 65340 Fetopelvic Disproportion, Unspecified as to Episode of Care Y 65341 Fetopelvic Disproportion, Delivered Y 65343 Fetopelvic Disproportion, Antepartum Y 65350 Unusually Large Fetus Causing Disproportion, Unspecified as to Episode of Care Y 65351 Unusually Large Fetus Causing Disproportion, Delivered Y 65353 Unusually Large Fetus Causing Disproportion, Antepartum Y 65360 Hydrocephalic Fetus Causing Disproportion, Unspecified as to Episode of Care Y 65361 Hydrocephalic Fetus Causing Disproportion, Delivered Y 65363 Hydrocephalic Fetus Causing Disproportion, Antepartum Y 65370 Other Fetal Abnormality Causing Disproportion, Unspecified as to Episode of Care Y 65371 Other Fetal Abnormality Causing Disproportion, Delivered Y 65373 Other Fetal Abnormality Causing Disproportion, Antepartum Y 65380 Fetal Disproportion of Other Origin, Unspecified as to Episode of Care Y 65381 Fetal Disproportion of Other Origin, Delivered Y 65383 Fetal Disproportion of Other Origin, Antepartum Y 65390 Unspecified Fetal Disproportion, Unspecified as to Episode of Care Y 65391 Unspecified Fetal Disproportion, Delivered Y 65393 Unspecified Fetal Disproportion, Antepartum Y 65400 Congenital Abnormalities of Pregnant Uterus, Unspecified as to Episode of Care Y 65401 Congenital Abnormalities of Pregnant Uterus, Delivered Y Congenital Abnormalities of Pregnant Uterus, Delivered, With Mention of Postpartum 65402 Complication N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 191 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 65403 Congenital Abnormalities of Pregnant Uterus, Antepartum Y 65404 Congenital Abnormalities of Pregnant Uterus Y 65410 Tumors of Body of Pregnant Uterus, Unspecified as to Episode of Care in Pregnancy Y 65411 Tumors of Body of Uterus, Delivered Y 65412 Tumors of Body of Uterus, Delivered, With Mention of Postpartum Complication N 65413 Tumors of Body of Uterus, Antepartum Condition or Complication Y 65414 Tumors of Body of Uterus, Postpartum Condition or Complication Y 65420 Previous Cesarean Delivery, Unspecified as to Episode of Care or Not Applicable Y Previous Cesarean Delivery, Delivered, With or Without Mention of Antepartum 65421 Condition Y 65423 Previous Cesarean Delivery, Antepartum Condition or Complication Y 65430 Retroverted and Incarcerated Gravid Uterus, Unspecified as to Episode of Care Y 65431 Retroverted and Incarcerated Gravid Uterus, Delivered Y Retroverted and Incarcerated Gravid Uterus, Delivered, With Mention of Postpartum 65432 Complication Y 65433 Retroverted and Incarcerated Gravid Uterus, Antepartum Y 65434 Retroverted and Incarcerated Gravid Uterus, Postpartum Y Other Abnormalities in Shape or Position of Gravid Uterus And of Neighboring 65440 Structures, Unspecified as to Episode of Care Y Other Abnormalities in Shape or Position of Gravid Uterus And of Neighboring 65441 Structures, Delivered Y Other Abnormalities in Shape or Position of Gravid Uterus And of Neighboring 65442 Structures, Delivered, With Mention of Postpartum Complication S Other Abnormalities in Shape or Position of Gravid Uterus And of Neighboring 65443 Structures, Antepartum Y Other Abnormalities in Shape or Position of Gravid Uterus And of Neighboring 65444 Structures, Postpartum Y 65450 Cervical Incompetence, Unspecified as to Episode of Care in Pregnancy Y 65451 Cervical Incompetence, Delivered Y 65452 Cervical Incompetence, Delivered, With Mention of Postpartum Complication S 65453 Cervical Incompetence, Antepartum Condition or Complication Y 65454 Cervical Incompetence, Postpartum Condition or Complication Y Other Congenital or Acquired Abnormality of Cervix, Unspecified as to Episode of Care 65460 in Pregnancy Y 65461 Other Congenital or Acquired Abnormality of Cervix, With Delivery Y Other Congenital or Acquired Abnormality of Cervix, Delivered, With Mention of 65462 Postpartum Complication N Other Congenital or Acquired Abnormality of Cervix, Antepartum Condition or 65463 Complication Y Other Congenital or Acquired Abnormality of Cervix, Postpartum Condition or 65464 Complication Y Congenital or Acquired Abnormality of Vagina, Unspecified as to Episode of Care in 65470 Pregnancy Y 65471 Congenital or Acquired Abnormality of Vagina, With Delivery Y Congenital or Acquired Abnormality of Vagina, Delivered, With Mention of Postpartum 65472 Complication N 65473 Congenital or Acquired Abnormality of Vagina, Antepartum Condition or Complication Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 192 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 65474 Congenital or Acquired Abnormality of Vagina, Postpartum Condition or Complication Y Congenital or Acquired Abnormality of Vulva, Unspecified as to Episode of Care in 65480 Pregnancy Y 65481 Congenital or Acquired Abnormality of Vulva, With Delivery Y Congenital or Acquired Abnormality of Vulva, Delivered, With Mention of Postpartum 65482 Complication N 65483 Congenital or Acquired Abnormality of Vulva, Antepartum Condition or Complication Y 65484 Congenital or Acquired Abnormality of Vulva, Postpartum Condition or Complication Y Other and Unspecified Abnormality of Organs and Soft Tissues of Pelvis, Unspecified as 65490 to Episode of Care in Pregnancy Y

65491 Other and Unspecified Abnormality of Organs and Soft Tissues of Pelvis, With Delivery Y Other and Unspecified Abnormality of Organs and Soft Tissues of Pelvis, Delivered, With 65492 Mention of Postpartum Complication N Other and Unspecified Abnormality of Organs and Soft Tissues of Pelvis, Antepartum 65493 Condition or Complication Y Other and Unspecified Abnormality of Organs and Soft Tissues of Pelvis, Postpartum 65494 Condition or Complication Y Central Nervous System Malformation in Fetus, Unspecified as to Episode of Care in 65500 Pregnancy Y 65501 Central Nervous System Malformation in Fetus, With Delivery Y 65503 Central Nervous System Malformation in Fetus, Antepartum Y Chromosomal Abnormality in Fetus, Affecting Management of Mother, Unspecified as to 65510 Episode of Care in Pregnancy Y 65511 Chromosomal Abnormality in Fetus, Affecting Management of Mother, With Delivery Y 65513 Chromosomal Abnormality in Fetus, Affecting Management of Mother, Antepartum Y Hereditary Disease in Family Possibly Affecting Fetus, Affecting Management of Mother, 65520 Unspecified as to Episode of Care in Pregnancy Y Hereditary Disease in Family Possibly Affecting Fetus, Affecting Management of Mother, 65521 With Delivery Y Hereditary Disease in Family Possibly Affecting Fetus, Affecting Management of Mother, 65523 Antepartum Condition or Complication Y Suspected Damage to Fetus From Viral Disease in Mother, Affecting Management of 65530 Mother, Unspecified as to Episode of Care in Pregnancy Y Suspected Damage to Fetus From Viral Disease in Mother, Affecting Management of 65531 Mother, With Delivery Y Suspected Damage to Fetus From Viral Disease in Mother, Affecting Management of 65533 Mother, Antepartum Condition or Complication Y Suspected Damage to Fetus From Other Disease in Mother, Affecting Management of 65540 Mother, Unspecified as to Episode of Care in Pregnancy Y Suspected Damage to Fetus From Other Disease in Mother, Affecting Management of 65541 Mother, With Delivery Y Suspected Damage to Fetus From Other Disease in Mother, Affecting Management of 65543 Mother, Antepartum Condition or Complication Y Suspected Damage to Fetus From Drugs, Affecting Management of Mother, Unspecified 65550 as to Episode of Care Y 65551 Suspected Damage to Fetus From Drugs, Affecting Management of Mother, Delivered Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 193 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator

65553 Suspected Damage to Fetus From Drugs, Affecting Management of Mother, Antepartum Y Suspected Damage to Fetus From Radiation, Affecting Management of Mother, 65560 Unspecified as to Episode of Care Y

65561 Suspected Damage to Fetus From Radiation, Affecting Management of Mother, Delivered Y Suspected Damage to Fetus From Radiation, Affecting Management of Mother, 65563 Antepartum Condition or Complication Y 65570 Decreased Fetal Movements, Unspecified as to Episode of Care Y 65571 Decreased Fetal Movements, Affecting Management of Mother, Delivered Y Decreased Fetal Movements, Affecting Management of Mother, Antepartum Condition or 65573 Complication Y Other Known or Suspected Fetal Abnormality, Not Elsewhere Classified, Affecting 65580 Management of Mother, Unspecified as to Episode of Care Y Other Known or Suspected Fetal Abnormality, Not Elsewhere Classified, Affecting 65581 Management of Mother, Delivery Y Other Known or Suspected Fetal Abnormality, Not Elsewhere Classified, Affecting 65583 Management of Mother, Antepartum Condition or Complication Y Unspecified Fetal Abnormality Affecting Management of Mother, Unspecified as to 65590 Episode of Care Y 65591 Unspecified Fetal Abnormality Affecting Management of Mother, Delivery Y Unspecified Fetal Abnormality Affecting Management of Mother, Antepartum Condition 65593 or Complication Y 65600 Fetal-Maternal Hemorrhage, Unspecified as to Episode of Care in Pregnancy Y 65601 Fetal-Maternal Hemorrhage, With Delivery Y 65603 Fetal-Maternal Hemorrhage, Antepartum Condition or Complication Y 65610 Rhesus Isoimmunization Unspecified as to Episode of Care in Pregnancy Y 65611 Rhesus Isoimmunization Affecting Management of Mother, Delivered Y 65613 Rhesus Isoimmunization Affecting Management of Mother, Antepartum Condition Y Isoimmunization From Other and Unspecified Blood-Group Incompatibility, Unspecified 65620 as to Episode of Care in Pregnancy Y Isoimmunization From Other and Unspecified Blood-Group Incompatibility, Affecting 65621 Management of Mother, Delivered Y Isoimmunization From Other and Unspecified Blood-Group Incompatibility, Affecting 65623 Management of Mother, Antepartum Y 65630 Fetal Distress Affecting Management of Mother, Unspecified as to Episode of Care Y 65631 Fetal Distress Affecting Management of Mother, Delivered Y 65633 Fetal Distress Affecting Management of Mother, Antepartum Y 65640 Intrauterine Death Affecting Management of Mother, Unspecified as to Episode of Care Y 65641 Intrauterine Death Affecting Management of Mother, Delivered Y 65643 Intrauterine Death Affecting Management of Mother, Antepartum Y

65650 Poor Fetal Growth, Affecting Management of Mother, Unspecified as to Episode of Care Y 65651 Poor Fetal Growth, Affecting Management of Mother, Delivered Y Poor Fetal Growth, Affecting Management of Mother, Antepartum Condition or 65653 Complication Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 194 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Excessive Fetal Growth Affecting Management of Mother, Unspecified as to Episode of 65660 Care Y 65661 Excessive Fetal Growth Affecting Management of Mother, Delivered Y 65663 Excessive Fetal Growth Affecting Management of Mother, Antepartum Y Other Placental Conditions Affecting Management of Mother, Unspecified as to Episode 65670 of Care Y 65671 Other Placental Conditions Affecting Management of Mother, Delivered Y 65673 Other Placental Conditions Affecting Management of Mother, Antepartum Y Other Specified Fetal and Placental Problems Affecting Management of Mother, 65680 Unspecified as to Episode of Care Y

65681 Other Specified Fetal and Placental Problems Affecting Management of Mother, Delivered Y Other Specified Fetal and Placental Problems Affecting Management of Mother, 65683 Antepartum Y Unspecified Fetal and Placental Problem Affecting Management of Mother, Unspecified 65690 as to Episode of Care Y 65691 Unspecified Fetal and Placental Problem Affecting Management of Mother, Delivered Y 65693 Unspecified Fetal and Placental Problem Affecting Management of Mother, Antepartum Y 65700 Polyhydramnios, Unspecified as to Episode of Care Y 65701 Polyhydramnios, With Delivery Y 65703 Polyhydramnios, Antepartum Complication Y 65800 Oligohydramnios, Unspecified as to Episode of Care Y 65801 Oligohydramnios, Delivered Y 65803 Oligohydramnios, Antepartum Y 65810 Premature Rupture of Membranes in Pregnancy, Unspecified as to Episode of Care Y 65811 Premature Rupture of Membranes in Pregnancy, Delivered Y 65813 Premature Rupture of Membranes in Pregnancy, Antepartum Y Delayed Delivery After Spontaneous or Unspecified Rupture of Membranes, Unspecified 65820 as to Episode of Care Y 65821 Delayed Delivery After Spontaneous or Unspecified Rupture of Membranes, Delivered Y

65823 Delayed Delivery After Spontaneous or Unspecified Rupture of Membranes, Antepartum Y Delayed Delivery After Artificial Rupture of Membranes, Unspecified as to Episode of 65830 Care Y 65831 Delayed Delivery After Artificial Rupture of Membranes, Delivered Y 65833 Delayed Delivery After Artificial Rupture of Membranes, Antepartum Y 65840 Infection of Amniotic Cavity, Unspecified as to Episode of Care Y 65841 Infection of Amniotic Cavity, Delivered Y 65843 Infection of Amniotic Cavity, Antepartum Y Other Problem Associated With Amniotic Cavity and Membranes, Unspecified as to 65880 Episode of Care Y 65881 Other Problem Associated With Amniotic Cavity and Membranes, Delivered Y 65883 Other Problem Associated With Amniotic Cavity and Membranes, Antepartum Y Unspecified Problem Associated With Amniotic Cavity and Membranes, Unspecified as to 65890 Episode of Care Y 65891 Unspecified Problem Associated With Amniotic Cavity and Membranes, Delivered Y 65893 Unspecified Problem Associated With Amniotic Cavity and Membranes, Antepartum Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 195 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 65900 Failed Mechanical Induction of Labor, Unspecified as to Episode of Care Y 65901 Failed Mechanical Induction of Labor, Delivered Y 65903 Failed Mechanical Induction of Labor, Antepartum Y 65910 Failed Medical or Unspecified Induction of Labor, Unspecified as to Episode of Care Y 65911 Failed Medical or Unspecified Induction of Labor, Delivered Y 65913 Failed Medical or Unspecified Induction of Labor, Antepartum Y 65920 Unspecified Maternal Pyrexia During Labor, Unspecified as to Episode of Care Y 65921 Unspecified Maternal Pyrexia During Labor, Delivered Y 65923 Unspecified Maternal Pyrexia, Antepartum Y 65930 Generalized Infection During Labor, Unspecified as to Episode of Care Y 65931 Generalized Infection During Labor, Delivered Y 65933 Generalized Infection During Labor, Antepartum Y 65940 Grand Multiparity With Current Pregnancy, Unspecified as to Episode of Care Y 65941 Grand Multiparity, Delivered, With or Without Mention of Antepartum Condition Y 65943 Grand Multiparity With Current Pregnancy, Antepartum Y 65950 Elderly Primigravida, Unspecified as to Episode of Care Y 65951 Elderly Primigravida, Delivered Y 65953 Elderly Primigravida, Antepartum Y 65960 Elderly Multigravida, Unspecified as to Episode of Care or Not Applicable Y 65961 Elderly Multigravida, Delivered, With Mention of Antepartum Condition Y 65963 Elderly Multigravida, With Antepartum Condition or Complication Y Abnormality in Fetal Heart Rate or Rhythm, Unspecified as to Episode of Care or Not 65970 Applicable Y Abnormality in Fetal Heart Rate or Rhythm, Delivered, With or Without Mention of 65971 Antepartum Condition Y 65973 Abnormality in Fetal Heart Rate or Rhythm, Antepartum Condition or Complication Y Other Specified Indication for Care or Intervention Related to Labor and Delivery, 65980 Unspecified as to Episode of Care Y Other Specified Indication for Care or Intervention Related to Labor and Delivery, 65981 Delivered Y Other Specified Indication for Care or Intervention Related to Labor and Delivery, 65983 Antepartum Y Unspecified Indication for Care or Intervention Related to Labor and Delivery, 65990 Unspecified as to Episode of Care Y

65991 Unspecified Indication for Care or Intervention Related to Labor and Delivery, Delivered Y Unspecified Indication for Care or Intervention Related to Labor and Delivery, 65993 Antepartum Y Obstruction Caused by Malposition of Fetus at Onset of Labor, Unspecified as to Episode 66000 of Care Y 66001 Obstruction Caused by Malposition of Fetus at Onset of Labor, Delivered Y 66003 Obstruction Caused by Malposition of Fetus at Onset of Labor, Antepartum Y

66010 Obstruction by Bony Pelvis During Labor and Delivery, Unspecified as to Episode of Care Y 66011 Obstruction by Bony Pelvis During Labor and Delivery, Delivered Y 66013 Obstruction by Bony Pelvis During Labor and Delivery, Antepartum Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 196 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Obstruction by Abnormal Pelvic Soft Tissues During Labor and Delivery, Unspecified as 66020 to Episode of Care Y 66021 Obstruction by Abnormal Pelvic Soft Tissues During Laborand Delivery, Delivered Y 66023 Obstruction by Abnormal Pelvic Soft Tissues During Labor and Delivery, Antepartum Y Deep Transverse Arrest and Persistent Occipitoposterior Position During Labor and 66030 Delivery, Unspecified as to Episode of Care Y Deep Transverse Arrest and Persistent Occipitoposterior Position During Labor and 66031 Deliver, Delivered Y Deep Transverse Arrest and Persistent Occipitoposterior Position During Labor and 66033 Delivery, Antepartum Y

66040 Shoulder (Girdle) Dystocia During Labor and Delivery, Unspecified as to Episode of Care Y 66041 Shoulder (Girdle) Dystocia During Labor and Deliver, Delivered Y 66043 Shoulder (Girdle) Dystocia During Labor and Delivery, Antepartum Y Locked Twins During Labor and Delivery, Unspecified as to Episode of Care in 66050 Pregnancy Y 66051 Locked Twins, Delivered Y 66053 Locked Twins, Antepartum Y 66060 Unspecified Failed Trial of Labor, Unspecifed as to Episode Y 66061 Unspecified Failed Trial of Labor, Delivered Y 66063 Unspecified Failed Trial of Labor, Antepartum Y 66070 Unspecified Failed Forceps or Vacuum Extractor, Unspecified as to Episode of Care Y 66071 Unspecified Failed Forceps or Vacuum Extractor, Delivered Y 66073 Failed Forceps or Vacuum Extractor, Unspecified, Antepartum Y 66080 Other Causes of Obstructed Labor, Unspecified as to Episode of Care Y 66081 Other Causes of Obstructed Labor, Delivered Y 66083 Other Causes of Obstructed Labor, Antepartum Y 66090 Unspecified Obstructed Labor, Unspecified as to Episode of Care Y 66091 Unspecified Obstructed Labor, With Delivery Y 66093 Unspecified Obstructed Labor, Antepartum Y 66100 Primary Uterine Inertia, Unspecified as to Episode of Care Y 66101 Primary Uterine Inertia, With Delivery Y 66103 Primary Uterine Inertia, Antepartum Y 66110 Secondary Uterine Inertia, Unspecified as to Episode of Care Y 66111 Secondary Uterine Inertia, With Delivery Y 66113 Secondary Uterine Inertia, Antepartum Y 66120 Other and Unspecified Uterine Inertia, Unspecified as to Episode of Care Y 66121 Other and Unspecified Uterine Inertia, With Delivery Y 66123 Other and Unspecified Uterine Inertia, Antepartum Y 66130 Precipitate Labor, Unspecified as to Episode of Care Y 66131 Precipitate Labor, With Delivery Y 66133 Precipitate Labor, Antepartum Y Hypertonic, Incoordinate, or Prolonged Uterine Contractions, Unspecified as to Episode of 66140 Care Y 66141 Hypertonic, Incoordinate, or Prolonged Uterine Contractions, With Delivery Y 66143 Hypertonic, Incoordinate, or Prolonged Uterine Contractions, Antepartum Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 197 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 66190 Unspecified Abnormality of Labor, Unspecified as to Episode of Care Y 66191 Unspecified Abnormality of Labor, With Delivery Y 66193 Unspecified Abnormality of Labor, Antepartum Y 66200 Prolonged First Stage of Labor, Unspecified as to Episode of Care Y 66201 Prolonged First Stage of Labor, Delivered Y 66203 Prolonged First Stage of Labor, Antepartum Y 66210 Unspecified Prolonged Labor, Unspecified as to Episode of Care Y 66211 Unspecified Prolonged Labor, Delivered Y 66213 Unspecified Prolonged Labor, Antepartum Y 66220 Prolonged Second Stage of Labor, Unspecified as to Episode of Care Y 66221 Prolonged Second Stage of Labor, Delivered Y 66223 Prolonged Second Stage of Labor, Antepartum Y 66230 Delayed Delivery of Second Twin, Triplet, Etc., Unspecified as to Episode of Care Y 66231 Delayed Delivery of Second Twin, Triplet, Etc., Delivered Y 66233 Delayed Delivery of Second Twin, Triplet, Etc., Antepartum Y 66300 Prolapse of Cord, Complicating Labor and Delivery, Unspecified as to Episode of Care Y 66301 Prolapse of Cord, Complicating Labor and Delivery, Delivered Y 66303 Prolapse of Cord, Complicating Labor and Delivery, Antepartum Y Cord Around Neck, With Compression, Complicating Labor and Delivery, Unspecified as 66310 to Episode of Care Y 66311 Cord Around Neck, With Compression, Complicating Labor and Delivery, Delivered Y 66313 Cord Around Neck, With Compression, Complicating Labor and Delivery, Antepartum Y Other and Unspecified Cord Entanglement, With Compression, Complicating Labor and 66320 Delivery, Unspecified as to Episode of Care Y Other and Unspecified Cord Entanglement, With Compression, Complicating Labor and 66321 Delivery, Delivered Y Other and Unspecified Cord Entanglement, With Compression, Complicating Labor and 66323 Delivery, Antepartum Y Other and Unspecified Cord Entanglement, Without Mention of Compression, 66330 Complicating Labor and Delivery, Unspecified as to Episode of Care Y Other and Unspecified Cord Entanglement, Without Mention of Compression, 66331 Complicating Labor and Delivery, Delivered Y Other and Unspecified Cord Entanglement, Without Mention of Compression, 66333 Complicating Labor and Delivery, Antepartum Y 66340 Short Cord Complicating Labor and Delivery, Unspecified as to Episode of Care Y 66341 Short Cord Complicating Labor and Delivery, Delivered Y 66343 Short Cord Complicating Labor and Delivery, Antepartum Y 66350 Vasa Previa Complicating Labor and Delivery, Unspecified as to Episode of Care Y 66351 Vasa Previa Complicating Labor and Delivery, Delivered Y 66353 Vasa Previa Complicating Labor and Delivery, Antepartum Y Vascular Lesions of Cord Complicating Labor and Delivery, Unspecified as to Episode of 66360 Care Y 66361 Vascular Lesions of Cord Complicating Labor and Delivery, Delivered Y 66363 Vascular Lesions of Cord Complicating Labor and Delivery, Antepartum Y Other Umbilical Cord Complications During Labor and Delivery, Unspecified as to 66380 Episode of Care Y 66381 Other Umbilical Cord Complications During Labor and Delivery, Delivered Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 198 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 66383 Other Umbilical Cord Complications During Labor and Delivery, Antepartum Y Unspecified Umbilical Cord Complication During Labor and Delivery, Unspecified as to 66390 Episode of Care Y 66391 Unspecified Umbilical Cord Complication During Labor and Delivery, Delivered Y 66393 Unspecified Umbilical Cord Complication During Labor and Delivery, Antepartum Y 66400 First-Degree Perineal Laceration, Unspecified as to Episode of Care in Pregnancy Y 66401 First-Degree Perineal Laceration, With Delivery Y 66404 First-Degree Perineal Laceration, Postpartum Y 66410 Second-Degree Perineal Laceration, Unspecified as to Episode of Care in Pregnancy Y 66411 Second-Degree Perineal Laceration, With Delivery Y 66414 Second-Degree Perineal Laceration, Postpartum Y 66420 Third-Degree Perineal Laceration, Unspecified as to Episode of Care in Pregnancy Y 66421 Third-Degree Perineal Laceration, With Delivery Y 66424 Third-Degree Perineal Laceration, Postpartum Y 66430 Fourth-Degree Perineal Laceration, Unspecified as to Episode of Care in Pregnancy Y 66431 Fourth-Degree Perineal Laceration, With Delivery Y 66434 Fourth-Degree Perineal Laceration, Postpartum Y 66440 Unspecified Perineal Laceration, Unspecified as to Episode of Care in Pregnancy Y 66441 Unspecified Perineal Laceration, With Delivery Y 66444 Unspecified Perineal Laceration, Postpartum Y 66450 Vulvar and Perineal Hematoma, Unspecified as to Episode of Care in Pregnancy Y 66451 Vulvar and Perineal Hematoma, With Delivery Y 66454 Vulvar and Perineal Hematoma, Postpartum Y Other Specified Trauma to Perineum and Vulva, Unspecified as to Episode of Care in 66480 Pregnancy Y 66481 Other Specified Trauma to Perineum and Vulva, With Delivery Y 66484 Other Specified Trauma to Perineum and Vulva, Postpartum Y Unspecified Trauma to Perineum and Vulva, Unspecified as to Episode of Care in 66490 Pregnancy Y 66491 Unspecified Trauma to Perineum and Vulva, With Delivery Y 66494 Unspecified Trauma to Perineum and Vulva, Postpartum Y 66500 Rupture of Uterus Before Onset of Labor, Unspecified as to Episode of Care Y 66501 Rupture of Uterus Before Onset of Labor, With Delivery Y 66503 Rupture of Uterus Before Onset of Labor, Antepartum Y 66510 Rupture of Uterus During Labor, Unspecified as to Episode Y 66511 Rupture of Uterus During Labor, With Delivery Y 66512 Rupture of Uterus, Delivered With Postpartum Complication Y 66514 Rupture of Uterus, Postpartum Y 66520 Inversion of Uterus, Unspecified as to Episode of Care in Pregnancy Y 66522 Inversion of Uterus, Delivered With Postpartum Complication Y 66524 Inversion of Uterus, Postpartum Y 66530 Laceration of Cervix, Unspecified as to Episode of Care in Pregnancy Y 66531 Laceration of Cervix, With Delivery Y 66534 Laceration of Cervix, Postpartum Y 66540 High Vaginal Laceration, Unspecified as to Episode of Care in Pregnancy Y 66541 High Vaginal Laceration, With Delivery Y 66544 High Vaginal Laceration, Postpartum Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 199 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 66550 Other Injury to Pelvic Organs, Unspecified as to Episode of Care in Pregnancy Y 66551 Other Injury to Pelvic Organs, With Delivery Y 66554 Other Injury to Pelvic Organs, Postpartum Y

66560 Damage to Pelvic Joints and Ligaments, Unspecified as to Episode of Care in Pregnancy Y 66561 Damage to Pelvic Joints and Ligaments, With Delivery Y 66564 Damage to Pelvic Joints and Ligaments, Postpartum Y 66570 Pelvic Hematoma, Unspecified as to Episode of Care Y 66571 Pelvic Hematoma, With Delivery N 66572 Pelvic Hematoma, Delivered With Postpartum Complication Y 66574 Pelvic Hematoma, Postpartum Y 66580 Other Specified Obstetrical Trauma, Unspecified as to Episode of Care Y 66581 Other Specified Obstetrical Trauma, With Delivery Y 66582 Other Specified Obstetrical Trauma, Delivered, With Postpartum Y 66583 Other Specified Obstetrical Trauma, Antepartum Y 66584 Other Specified Obstetrical Trauma, Postpartum Y 66590 Unspecified Obstetrical Trauma, Unspecified as to Episode of Care Y 66591 Unspecified Obstetrical Trauma, With Delivery Y 66592 Unspecified Obstetrical Trauma, Delivered, With Postpartum Complication Y 66593 Unspecified Obstetrical Trauma, Antepartum Y 66594 Unspecified Obstetrical Trauma, Postpartum Y 66600 Third-Stage Postpartum Hemorrhage, Unspecified as to Episode of Care Y 66602 Third-Stage Postpartum Hemorrhage, With Delivery Y 66604 Third-Stage Postpartum Hemorrhage, Postpartum Y 66610 Other Immediate Postpartum Hemorrhage, Unspecified as to Episode of Care Y 66612 Other Immediate Postpartum Hemorrhage, With Delivery Y 66614 Other Immediate Postpartum Hemorrhage, Postpartum Y 66620 Delayed and Secondary Postpartum Hemorrhage, Unspecified as to Episode of Care Y 66622 Delayed and Secondary Postpartum Hemorrhage, With Delivery Y 66624 Delayed and Secondary Postpartum Hemorrhage, Postpartum Y 66630 Postpartum Coagulation Defects, Unspecified as to Episode of Care Y 66632 Postpartum Coagulation Defects, With Delivery Y 66634 Postpartum Coagulation Defects, Postpartum Y 66700 Retained Placenta Without Hemorrhage, Unspecified as to Episode of Care Y Retained Placenta Without Hemorrhage, With Delivery, With Mention of Postpartum 66702 Complication Y 66704 Retained Placenta Without Hemorrhage, Postpartum Condition or Complication Y Retained Portions of Placenta or Membranes, Without Hemorrhage, Unspecified as to 66710 Episode of Care Y Retained Portions of Placenta or Membranes, Without Hemorrhage, Delivered, With 66712 Mention of Postpartum Complication Y Retained Portions of Placenta or Membranes, Without Hemorrhage, Postpartum Condition 66714 or Complication Y Pulmonary Complications of the Administration of Anesthesia or Other Sedation in Labor 66800 and Delivery, Unspecified as to Episode of Care Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 200 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Pulmonary Complications of the Administration of Anesthesia or Other Sedation in Labor 66801 and Delivery, Delivered Y Pulmonary Complications of the Administration of Anesthesia or Other Sedation in Labor 66802 and Delivery, Delivered, With Mention of Postpartum Complication Y Pulmonary Complications of the Administration of Anesthesia or Other Sedation in Labor 66803 and Delivery, Antepartum Y Pulmonary Complications of the Administration of Anesthesia or Other Sedation in Labor 66804 and Delivery, Postpartum Y Cardiac Complications of the Administration of Anesthesia or Other Sedation in Labor and 66810 Delivery, Unspecified as to Episode of Care Y Cardiac Complications of the Administration of Anesthesia or Other Sedation in Labor and 66811 Delivery, Delivered Y Cardiac Complications of the Administration of Anesthesia or Other Sedation in Labor and 66812 Delivery, Delivered, With Mention of Postpartum Complication Y Cardiac Complications of the Administration of Anesthesia or Other Sedation in Labor and 66813 Delivery, Antepartum Y Cardiac Complications of the Administration of Anesthesia or Other Sedation in Labor and 66814 Delivery, Postpartum Y Central Nervous System Complications of the Administration of Anesthesia or Other 66820 Sedation in Labor and Delivery, Unspecified as to Episode of Care Y Central Nervous System Complications of the Administration of Anesthesia or Other 66821 Sedation in Labor and Delivery, Delivered Y Central Nervous System Complications of the Administration of Anesthesia or Other 66822 Sedation in Labor and Delivery, Delivered, With Mention of Postpartum Complication Y Central Nervous System Complications of the Administration of Anesthesia or Other 66823 Sedation in Labor and Delivery, Antepartum Y Central Nervous System Complications of the Administration of Anesthesia or Other 66824 Sedation in Labor and Delivery, Postpartum Y Other Complications of the Administration of Anesthesia or Other Sedation in Labor and 66880 Delivery, Unspecified as to Episode of Care Y Other Complications of the Administration of Anesthesia or Other Sedation in Labor and 66881 Delivery, Delivered Y Other Complications of the Administration of Anesthesia or Other Sedation in Labor and 66882 Delivery, Delivered, With Mention of Postpartum Complication Y Other Complications of the Administration of Anesthesia or Other Sedation in Labor and 66883 Delivery, Antepartum Y Other Complications of the Administration of Anesthesia or Other Sedation in Labor and 66884 Delivery, Postpartum Y Unspecified Complication of the Administration of Anesthesia or Other Sedation in Labor 66890 and Delivery, Unspecified as to Episode of Care Y Unspecified Complication of the Administration of Anesthesia or Other Sedation in Labor 66891 and Delivery, Delivered Y Unspecified Complication of the Administration of Anesthesia or Other Sedation in Labor 66892 and Delivery, Delivered, With Mention of Postpartum Complication Y Unspecified Complication of the Administration of Anesthesia or Other Sedation in Labor 66893 and Delivery, Antepartum Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 201 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Unspecified Complication of the Administration of Anesthesia or Other Sedation in Labor 66894 and Delivery, Postpartum Y 66900 Maternal Distress Complicating Labor and Delivery, Unspecified as to Episode of Care Y 66901 Maternal Distress, With Delivery, With or Without Mention of Antepartum Condition Y 66902 Maternal Distress, With Delivery, With Mention of Postpartum Complication Y Maternal Distress Complicating Labor and Delivery, Antepartum Condition or 66903 Complication Y Maternal Distress Complicating Labor and Delivery, Postpartum Condition or 66904 Complication Y 66910 Shock During or Following Labor and Delivery, Unspecified as to Episode of Care Y Shock During or Following Labor and Delivery, With Delivery, With or Without Mention 66911 of Antepartum Condition Y Shock During or Following Labor and Delivery, With Delivery, With Mention of 66912 Postpartum Complication Y 66913 Shock During or Following Labor and Delivery, Antepartum Shock Y 66914 Shock During or Following Labor and Delivery, Postpartum Shock Y Maternal Hypotension Syndrome Complicating Labor and Delivery, Unspecified as to 66920 Episode of Care Y Maternal Hypotension Syndrome, With Delivery, With or Without Mention of Antepartum 66921 Condition Y Maternal Hypotension Syndrome, With Delivery, With Mention of Postpartum 66922 Complication Y 66923 Maternal Hypotension Syndrome, Antepartum Y 66924 Maternal Hypotension Syndrome, Postpartum Y 66930 Acute Renal Failure Following Labor and Delivery, Unspecified as to Episode of Care Y 66932 Acute Renal Failure With Delivery, With Mention of Postpartum Complication Y Acute Renal Failure Following Labor and Delivery, Postpartum Condition or 66934 Complication Y Other Complications of Obstetrical Surgery and Procedures, Unspecified as to Episode of 66940 Care Y Other Complications of Obstetrical Surgery and Procedures, With Delivery, With or 66941 Without Mention of Antepartum Condition Y Other Complications of Obstetrical Surgery and Procedures, With Delivery, With Mention 66942 of Postpartum Complication Y Other Complications of Obstetrical Surgery and Procedures, Antepartum Condition or 66943 Complication Y Other Complications of Obstetrical Surgery and Procedures, Postpartum Condition or 66944 Complication S Forceps or Vacuum Extractor Delivery Without Mention of Indication, Unspecified as to 66950 Episode of Care Y Forceps or Vacuum Extractor Delivery Without Mention of Indication, Delivered, With or 66951 Without Mention of Antepartum Condition Y 66960 Breech Extraction, Without Mention of Indication, Unspecified as to Episode of Care Y Breech Extraction, Without Mention of Indication, Delivered, With or Without Mention of 66961 Antepartum Condition Y 66970 Cesarean Delivery, Without Mention of Indication, Unspecified as to Episode of Care Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 202 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Cesarean Delivery, Without Mention of Indication, Delivered, With or Without Mention of 66971 Antepartum Condition Y 66980 Other Complication of Labor and Delivery, Unspecified as to Episode of Care Y Other Complication of Labor and Delivery, Delivered, With or Without Mention of 66981 Antepartum Condition Y Other Complication of Labor and Delivery, Delivered, With Mention of Postpartum 66982 Complication Y 66983 Other Complication of Labor and Delivery, Antepartum Condition or Complication Y 66984 Other Complication of Labor and Delivery, Postpartum Condition or Complication Y 66990 Unspecified Complication of Labor and Delivery, Unspecified as to Episode of Care Y Unspecified Complication of Labor and Delivery, With Delivery, With or Without 66991 Mention of Antepartum Condition Y Unspecified Complication of Labor and Delivery, With Delivery, With Mention of 66992 Postpartum Complication Y

66993 Unspecified Complication of Labor and Delivery, Antepartum Condition or Complication Y

66994 Unspecified Complication of Labor and Delivery, Postpartum Condition or Complication Y 67000 Major Puerperal Infection, Unspecified as to Episode of Care Y 67002 Major Puerperal Infection, Delivered, With Mention of Postpartum Complication Y 67004 Major Puerperal Infection, Postpartum Y Varicose Veins of Legs Complicating Pregnancy and the Puerperium, Unspecified as to 67100 Episode of Care Y Varicose Veins of Legs, With Delivery, With or Without Mention of Antepartum 67101 Condition Y 67102 Varicose Veins of Legs, With Delivery, With Mention of Postpartum Complication Y 67103 Varicose Veins of Legs, Antepartum Y 67104 Varicose Veins of Legs, Postpartum Y Varicose Veins of Vulva and Perineum Complicating Pregnancy and the Puerperium, 67110 Unspecified as to Episode of Care Y Varicose Veins of Vulva and Perineum, With Delivery, With or Without Mention of 67111 Antepartum Condition Y Varicose Veins of Vulva and Perineum, With Delivery, With Mention of Postpartum 67112 Complication Y 67113 Varicose Veins of Vulva and Perineum, Antepartum Y 67114 Varicose Veins of Vulva and Perineum, Postpartum Y Superficial Thrombophlebitis Complicating Pregnancy and the Puerperium, Unspecified as 67120 to Episode of Care Y Superficial Thrombophlebitis With Delivery, With or Without Mention of Antepartum 67121 Condition Y

67122 Superficial Thrombophlebitis With Delivery, With Mention of Postpartum Complication Y 67123 Superficial Thrombophlebitis, Antepartum Y 67124 Superficial Thrombophlebitis, Postpartum Y 67130 Deep Phlebothrombosis, Antepartum, Unspecified as to Episode of Care Y 67131 Deep Phlebothrombosis, Antepartum, With Delivery Y 67133 Deep Phlebothrombosis, Antepartum Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 203 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 67140 Deep Phlebothrombosis, Postpartum, Unspecified as to Episode of Care Y 67142 Deep Phlebothrombosis, Postpartum, With Delivery Y 67144 Deep Phlebothrombosis, Postpartum Y Other Phlebitis and Thrombosis Complicating Pregnancy and the Puerperium, Unspecified 67150 as to Episode of Care Y Other Phlebitis and Thrombosis With Delivery, With or Without Mention of Antepartum 67151 Condition Y

67152 Other Phlebitis and Thrombosis With Delivery, With Mention of Postpartum Complication Y 67153 Other Antepartum Phlebitis and Thrombosis Y 67154 Other Postpartum Phlebitis and Thrombosis Y Other Venous Complication of Pregnancy and the Puerperium, Unspecified as to Episode 67180 of Care Y Other Venous Complication, With Delivery, With or Without Mention of Antepartum 67181 Condition Y 67182 Other Venous Complication, With Delivery, With Mention of Postpartum Complication Y 67183 Other Venous Complication, Antepartum Y 67184 Other Venous Complication, Postpartum Y Unspecified Venous Complication of Pregnancy and the Puerperium, Unspecified as to 67190 Episode of Care Y Unspecified Venous Complication, With Delivery, With or Without Mention of 67191 Antepartum Condition Y Unspecified Venous Complication, With Delivery, With Mention of Postpartum 67192 Complication Y 67193 Unspecified Venous Complication, Antepartum Y 67194 Unspecified Venous Complication, Postpartum Y 67200 Puerperal Pyrexia of Unknown Origin, Unspecified as to Episode of Care Y Puerperal Pyrexia of Unknown Origin, Delivered, With Mention of Postpartum 67202 Complication Y 67204 Puerperal Pyrexia of Unknown Origin, Postpartum Y 67300 Obstetrical Air Embolism, Unspecified as to Episode of Care Y Obstetrical Air Embolism, With Delivery, With or Without Mention of Antepartum 67301 Condition Y 67302 Obstetrical Air Embolism, With Delivery, With Mention of Postpartum Complication Y 67303 Obstetrical Air Embolism, Antepartum Condition or Complication Y 67304 Obstetrical Air Embolism, Postpartum Condition or Complication Y 67310 Amniotic Fluid Embolism, Unspecified as to Episode of Care Y Amniotic Fluid Embolism, With Delivery, With or Without Mention of Antepartum 67311 Condition Y 67312 Amniotic Fluid Embolism, With Delivery, With Mention of Postpartum Complication Y 67313 Amniotic Fluid Embolism, Antepartum Condition or Complication Y 67314 Amniotic Fluid Embolism, Postpartum Condition or Complication Y 67320 Obstetrical Blood-Clot Embolism, Unspecified as to Episode of Care Y Obstetrical Blood-Clot Embolism, With Delivery, With or Without Mention of 67321 Antepartum Condition Y 67322 Obstetrical Blood-Clot Embolism, With Mention of Postpartum Complication Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 204 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 67323 Obstetrical Blood-Clot Embolism, Antepartum Y 67324 Obstetrical Blood-Clot Embolism, Postpartum Y 67330 Obstetrical Pyemic and Septic Embolism, Unspecified as to Episode of Care Y Obstetrical Pyemic and Septic Embolism, With Delivery, With or Without Mention of 67331 Antepartum Condition Y Obstetrical Pyemic and Septic Embolism, With Delivery, With Mention of Postpartum 67332 Complicaton Y 67333 Obstetrical Pyemic and Septic Embolism, Antepartum Y 67334 Obstetrical Pyemic and Septic Embolism, Postpartum Y 67380 Other Obstetrical Pulmonary Embolism, Unspecified as to Episode of Care Y Other Obstetrical Pulmonary Embolism, With Delivery, With or Without Mention of 67381 Antepartum Condition Y Other Obstetrical Pulmonary Embolism, With Delivery, With Mention of Postpartum 67382 Complication Y 67383 Other Obstetrical Pulmonary Embolism, Antepartum Y 67384 Other Obstetrical Pulmonary Embolism, Postpartum Y Cerebrovascular Disorder Occurring in Pregnancy, Childbirth, or the Puerperium, 67400 Unspecified as to Episode of Care Y Cerebrovascular Disorder, With Delivery, With or Without Mention of Antepartum 67401 Condition Y 67402 Cerebrovascular Disorder, With Delivery, With Mention of Postpartum Complication Y 67403 Cerebrovascular Disorder, Antepartum Y 67404 Cerebrovascular Disorder, Postpartum Y 67410 Disruption of Cesarean Wound, Unspecified as to Episode of Care Y

67412 Disruption of Cesarean Wound, With Delivery, With Mention of Postpartum Complication Y 67414 Disruption of Cesarean Wound, Postpartum Y 67420 Disruption of Perineal Wound, Unspecified as to Episode of Care in Pregnancy Y

67422 Disruption of Perineal Wound, With Delivery, With Mention of Postpartum Complicaton Y 67424 Disruption of Perineal Wound, Postpartum Y 67430 Other Complication of Obstetrical Surgical Wounds, Unspecified as to Episode of Care Y Other Complication of Obstetrical Surgical Wounds, With Delivery, With Mention of 67432 Postpartum Complication Y Other Complication of Obstetrical Surgical Wounds, Postpartum Condition or 67434 Complication Y 67440 Placental Polyp, Unspecified as to Episode of Care Y 67442 Placental Polyp, With Delivery, With Mention of Postpartum Complication Y 67444 Placental Polyp, Postpartum Y 67450 Peripartum Cardiomyopathy, Unspecified as to Episode of Care or Not Applicable Y Peripartum Cardiomyopathy, Delivered, With or Without Mention of Antepartum 67451 Condition Y 67452 Peripartum Cardiomyopathy, Delivered, With Mention of Postpartum Condition Y 67453 Peripartum Cardiomyopathy, Antepartum Condition or Complication Y 67454 Peripartum Cardiomyopathy, Postpartum Condition or Complication Y 67480 Other Complication of Puerperium, Unspecified as to Episode of Care Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 205 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Other Complication of Puerperium, With Delivery, With Mention of Postpartum 67482 Complication Y 67484 Other Complication of Puerperium Y 67490 Unspecified Complications of Puerperium, Unspecified as to Episode of Care Y Unspecified Complications of Puerperium, With Delivery, With Mention of Postpartum 67492 Complication Y 67494 Unspecified Complications of Puerperium Y 67500 Infection of Nipple Associated With Childbirth, Unspecified as to Episode of Care Y Infection of Nipple Associated With Childbirth, Delivered, With or Without Mention of 67501 Antepartum Condition Y Infection of Nipple Associated With Childbirth, Delivered With Mention of Postpartum 67502 Complication Y 67503 Infection of Nipple, Antepartum Y 67504 Infection of Nipple, Postpartum Y 67510 Abscess of Breast Associated With Childbirth, Unspecified as to Episode of Care Y Abscess of Breast Associated With Childbirth, Delivered, With or Without Mention of 67511 Antepartum Condition Y Abscess of Breast Associated With Childbirth, Delivered, With Mention of Postpartum 67512 Complication Y 67513 Abscess of Breast, Antepartum Y 67514 Abscess of Breast, Postpartum Y 67520 Nonpurulent Mastitis, Unspecified as to Episode of Prenatal or Postnatal Care Y 67521 Nonpurulent Mastitis, Delivered, With or Without Mention of Antepartum Condition Y 67522 Nonpurulent Mastitis, Delivered, With Mention of Postpartum Complication Y 67523 Nonpurulent Mastitis, Antepartum Y 67524 Nonpurulent Mastitis, Postpartum Y Other Specified Infection of the Breast and Nipple Associated With Childbirth, 67580 Unspecified as to Episode of Care Y Other Specified Infection of the Breast and Nipple Associated With Childbirth, Delivered, 67581 With or Without Mention of Antepartum Condition Y Other Specified Infection of the Breast and Nipple Associated With Childbirth, Delivered, 67582 With Mention of Postpartum Complication Y 67583 Other Specified Infection of the Breast and Nipple, Antepartum Y 67584 Other Specified Infection of the Breast and Nipple, Postpartum Y Unspecified Infection of the Breast and Nipple, Unspecified as to Prenatal or Postnatal 67590 Episode of Care N Unspecified Infection of the Breast and Nipple, Delivered, With or Without Mention of 67591 Antepartum Condition N Unspecified Infection of the Breast and Nipple, Delivered, With Mention of Postpartum 67592 Complication N 67593 Unspecified Infection of the Breast and Nipple, Antepartum N 67594 Unspecified Infection of the Breast and Nipple, Postpartum N 67600 Retracted Nipple, Unspecified as to Prenatal or Postnatal Episode of Care N 67601 Retracted Nipple, Delivered, With or Without Mention of Antepartum Condition N 67602 Retracted Nipple, Delivered, With Mention of Postpartum Complication N 67603 Retracted Nipple, Antepartum Condition or Complication N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 206 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 67604 Retracted Nipple, Postpartum Condition or Complication N 67610 Cracked Nipple, Unspecified as to Prenatal or Postnatal Episode of Care N 67611 Cracked Nipple, Delivered, With or Without Mention of Antepartum Condition N 67612 Cracked Nipple, Delivered, With Mention of Postpartum Complication N 67613 Cracked Nipple, Antepartum Condition or Complication N 67614 Cracked Nipple, Postpartum Condition or Complication N 67620 Engorgement of Breasts, Unspecified as to Prenatal or Postnatal Episode of Care N 67621 Engorgement of Breasts, Delivered, With or Without Mention of Antepartum Condition N 67622 Engorgement of Breasts, Delivered, With Mention of Postpartum Complication N 67623 Engorgement of Breast, Antepartum N 67624 Engorement of Breast, Postpartum N Other and Unspecified Disorder of Breast Associated With Childbirth, Unspecified as to 67630 Episode of Care N Other and Unspecified Disorder of Breast Associated With Childbirth, Delivered, With or 67631 Without Mention of Antepartum Condition N Other and Unspecified Disorder of Breast Associated With Childbirth, Delivered, With 67632 Mention of Postpartum Complication N Other and Unspecified Disorder of Breast Associated With Childbirth, Antepartum 67633 Condition or Complication N Other and Unspecified Disorder of Breast Associated With Childbirth, Postpartum 67634 Condition or Complication N 67640 Failure of Lactation, Unspecified as to Episode of Care N 67641 Failure of Lactation, With Delivery, With or Without Mention of Antepartum Condition N 67642 Failure of Lactation, With Delivery, With Mention of Postpartum Complication N 67643 Failure of Lactation, Antepartum Condition or Complication N 67644 Failure of Lactation, Postpartum Condition or Complication N 67650 Suppressed Lactation, Unspecified as to Episode of Care N

67651 Suppressed Lactation, With Delivery, With or Without Mention of Antepartum Condition N 67652 Suppressed Lactation, With Delivery, With Mention of Postpartum Complication N 67653 Suppressed Lactation, Antepartum Condition or Complication N 67654 Suppressed Lactation, Postpartum Condition or Complication N 67660 Galactorrhea Associated With Childbirth, Unspecified as to Episode of Care N 67661 Galactorrhea, With Delivery, With or Without Mention of Antepartum Condition N 67662 Galactorrhea, With Delivery, With Mention of Postpartum Complication N 67663 Galactorrhea, Antepartum Condition or Complication N 67664 Galactorrhea, Postpartum Condition or Complication N 67680 Other Disorder of Lactation, Unspecified as to Episode of Care N Other Disorder of Lactation, With Delivery, With or Without Mention of Antepartum 67681 Condition N 67682 Other Disorder of Lactation, With Delivery, With Mention of Postpartum Complication N 67683 Other Disorder of Lactation, Antepartum Condition or Complication N 67684 Other Disorder of Lactation, Postpartum Condition or Complication N 67690 Unspecified Disorder of Lactation, Unspecified as to Episode of Care N Unspecified Disorder of Lactation, With Delivery, With or Without Mention of 67691 Antepartum Condition N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 207 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Unspecified Disorder of Lactation, With Delivery, With Mention of Postpartum 67692 Complication N 67693 Unspecified Disorder of Lactation, Antepartum Condition or Complication N 67694 Unspecified Disorder of Lactation, Postpartum Condition or Complication N 68100 Unspecified Cellulitis and Abscess of Finger N 68101 Felon N 68102 Onychia and Paronychia of Finger N 68110 Unspecified Cellulitis and Abscess of Toe N 68111 Onychia and Paronychia of Toe N 68600 Unspecified Pyoderma N 68601 Pyoderma Gangrenosum N 68609 Other Pyoderma N 69010 Unspecified Seborrheic Dermatitis N 69011 Seborrhea Capitis N 69012 Seborrheic Infantile Dermatitis N 69018 Other Seborrheic Dermatitis N 69270 Unspecified Dermatitis due to Sun S 69271 Contact Dermatitis and Other Eczema due to Sunburn S 69272 Acute Dermatitis due to Solar Radiation S 69273 Actinic Reticuloid and Actinic Granuloma S 69274 Other Chronic Dermatitis due to Solar Radiation S 69275 Disseminated Superficial Actinic Porokeratosis (Dsap) N 69276 Sunburn of Second Degree S 69277 Sunburn of Third Degree S 69279 Other Dermatitis due to Solar Radiation S 69281 Dermatitis due to Cosmetics S 69282 Dermatitis due to Other Radiation S 69283 Dermatitis due to Metals S 69284 Contact Dermatitis and Other Eczema due to Animal (Cat) (Dog) Dander S 69289 Contact Dermatitis and Other Eczema due to Other Specified Agent S 69460 Benign Mucous Membrane Pemphigoid Without Mention of Ocular Involvement S 69461 Benign Mucous Membrane Pemphigoid With Ocular Involvement S 69581 Ritter’s Disease S 69589 Other Specified Erythematous Condition S 70211 Inflamed Seborrheic Keratosis S 70219 Other Seborrheic Keratosis S 70400 Unspecified Alopecia S 70401 Alopecia Areata S 70402 Telogen Effluvium S 70409 Other Alopecia S 70521 Primary Focal Hyperhidrosis S 70522 Secondary Focal Hyperhidrosis S 70581 Dyshidrosis S 70582 Fox-Fordyce Disease S 70583 Hidradenitis S 70589 Other Specified Disorder of Sweat Glands S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 208 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 70700 Decubitus Ulcer, Unspecified Site S 70701 Decubitus Ulcer, Elbow S 70702 Decubitus Ulcer, Upper Back S 70703 Decubitus Ulcer, Lower Back S 70704 Decubitus Ulcer, Hip S 70705 Decubitus Ulcer, Buttock S 70706 Decubitus Ulcer, Ankle S 70707 Decubitus Ulcer, Heel S 70709 Decubitus Ulcer, Other Site S 70710 Ulcer of Lower Limb, Unspecified S 70711 Ulcer of Thigh S 70712 Ulcer of Calf S 70713 Ulcer of Ankle S 70714 Ulcer of Heel and Midfoot S 70715 Ulcer of Other Part of Foot S 70719 Ulcer of Other Part of Lower Limb S 70900 Dyschromia, Unspecified S 70901 Vitiligo S 70909 Other Dyschromia S 71100 Pyogenic Arthritis, Site Unspecified S 71101 Pyogenic Arthritis, Shoulder Region S 71102 Pyogenic Arthritis, Upper Arm S 71103 Pyogenic Arthritis, Forearm S 71104 Pyogenic Arthritis, Hand S 71105 Pyogenic Arthritis, Pelvic Region and Thigh S 71106 Pyogenic Arthritis, Lower Leg S 71107 Pyogenic Arthritis, Ankle and Foot S 71108 Pyogenic Arthritis, Other Specified Sites S 71109 Pyogenic Arthritis, Multiple Sites S Arthropathy Associated With Reiter’s Disease and Nonspecific Urethritis, Site 71110 Unspecified S Arthropathy Associated With Reiter’s Disease and Nonspecific Urethritis, Shoulder 71111 Region S 71112 Arthropathy Associated With Reiter’s Disease and Nonspecific Urethritis, Upper Arm S 71113 Arthropathy Associated With Reiter’s Disease and Nonspecific Urethritis, Forearm S 71114 Arthropathy Associated With Reiter’s Disease and Nonspecific Urethritis, Hand S Arthropathy Associated With Reiter’s Disease and Nonspecific Urethritis, Pelvic Region 71115 and Thigh S 71116 Arthropathy Associated With Reiter’s Disease and Nonspecific Urethritis, Lower Leg S

71117 Arthropathy Associated With Reiter’s Disease and Nonspecific Urethritis, Ankle and Foot S Arthropathy Associated With Reiter’s Disease and Nonspecific Urethritis, Other Specified 71118 Site S

71119 Arthropathy Associated With Reiter’s Disease and Nonspecific Urethritis, Multiple Sites S 71120 Arthropathy in Behcet’s Syndrome, Site Unspecified S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 209 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 71121 Arthropathy in Behcet’s Syndrome, Shoulder Region S 71122 Arthropathy in Behcet’s Syndrome,Upper Arm S 71123 Arthropathy in Behcet’s Syndrome, Forearm S 71124 Arthropathy in Behcet’s Syndrome, Hand S 71125 Arthropathy in Behcet’s Syndrome, Pelvic Region and Thigh S 71126 Arthropathy in Behcet’s Syndrome, Lower Leg S 71127 Arthropathy in Behcet’s Syndrome, Ankle and Foot S 71128 Arthropathy in Behcet’s Syndrome, Other Specified Sites S 71129 Arthropathy in Behcet’s Syndrome, Multiple Sites S 71130 Postdysenteric Arthropathy, Site Unspecified S 71131 Postdysenteric Arthropathy, Shoulder Region S 71132 Postdysenteric Arthropathy, Upper Arm S 71133 Postdysenteric Arthropathy, Forearm S 71134 Postdysenteric Arthropathy, Hand S 71135 Postdysenteric Arthropathy, Pelvic Region and Thigh S 71136 Postdysenteric Arthropathy, Lower Leg S 71137 Postdysenteric Arthropathy, Ankle and Foot S 71138 Postdysenteric Arthropathy, Other Specified Sites S 71139 Postdysenteric Arthropathy, Multiple Sites S 71140 Arthropathy Associated With Other Bacterial Diseases, Site Unspecified S 71141 Arthropathy Associated With Other Bacterial Diseases, Shoulder Region S 71142 Arthropathy Associated With Other Bacterial Diseases, Upper Arm S 71143 Arthropathy Associated With Other Bacterial Diseases, Forearm S 71144 Arthropathy, Associated With Other Bacterial Diseases, Hand S 71145 Arthropathy Associated With Other Bacterial Diseases, Pelvic Region and Thigh S 71146 Arthropathy Associated With Other Bacterial Diseases, Lower Leg S 71147 Arthropathy Associated With Other Bacterial Disease, Ankle and Foot S 71148 Arthropathy Associated With Other Bacterial Diseases, Other Specific Sites S 71149 Arthropathy Associated With Other Bacterial Diseases, Multiple Sites S 71150 Arthropathy Associated With Other Viral Diseases, Site Unspecified S 71151 Arthropathy Associated With Other Viral Diseases, Shoulder Region S 71152 Arthropathy Associated With Other Viral Diseases, Upper Arm S 71153 Arthropathy Associated With Other Viral Diseases, Forearm S 71154 Arthropathy Associated With Other Viral Diseases, Hand S 71155 Arthropathy Associated With Other Viral Diseases, Pelvic Region and Thigh S 71156 Arthropathy Associated With Other Viral Diseases, Lower Leg S 71157 Arthropathy Associated With Other Viral Diseases, Ankle and Foot S 71158 Arthropathy Associated With Other Viral Diseases, Other Specified Sites S 71159 Arthropathy Associated With Other Viral Diseases, of Multiple Sites S 71160 Arthropathy Associated With Mycoses, Site Unspecified S 71161 Arthropathy Associated With Mycoses, Shoulder Region S 71162 Arthropathy Associated With Mycoses, Upper Arm S 71163 Arthropathy Associated With Mycoses, Forearm S 71164 Arthropathy Associated With Mycoses, Hand S 71165 Arthropathy Associated With Mycoses, Pelvic Region and Thigh S 71166 Arthropathy Associated With Mycoses, Lower Leg S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 210 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 71167 Arthropathy Associated With Mycoses, Ankle and Foot S 71168 Arthropathy Associated With Mycoses, Other Specified Site S 71169 Arthropathy Associated With Mycoses, Multiple Sites S 71170 Arthropathy Associated With Helminthiasis, Site Unspecified S 71171 Arthropathy Associated With Helminthiasis, Shoulder Region S 71172 Arthropathy Associated With Helminthiasis, Upper Arm S 71173 Arthropathy Associated With Helminthiasis, Forearm S 71174 Arthropathy Associated With Helminthiasis, Hand S 71175 Arthropathy Associated With Helminthiasis, Pelvic Region and Thigh S 71176 Arthropathy Associated With Helminthiasis, Lower Leg S 71177 Arthropathy Associated With Helminthiasis, Ankle and Foot S 71178 Arthropathy Associated With Helminthiasis, Other Specified Site S 71179 Arthropathy Associated With Helminthiasis, Multiple Sites S 71180 Arthropathy Associated With Other Infectious and Parasitic Diseases, Site Unspecified S 71181 Arthropathy Associated With Other Infectious and Parasitic Diseases, Shoulder Region S 71182 Arthropathy Associated With Other Infectious and Parasitic Diseases, Upper Arm S 71183 Arthropathy Associated With Other Infectious and Parasitic Diseases, Forearm S 71184 Arthropathy Associated With Other Infectious and Parasitic Diseases, Hand S Arthropathy Associated With Other Infectious and Parasitic Diseases, Pelvic Region and 71185 Thigh S 71186 Arthropathy Associated With Other Infectious and Parasitic Diseases, Lower Leg S 71187 Arthropathy Associated With Other Infectious and Parasitic Diseases, Ankle and Foot S

71188 Arthropathy Associated With Other Infectious and Parasitic Diseases, Other Specific Site S 71189 Arthropathy Associated With Other Infectious and Parasitic Diseases, Multiple Sites S 71190 Unspecified Infective Arthritis, Site Unspecified S 71191 Unspecified Infective Arthritis, Shoulder Region S 71192 Unspecified Infective Arthritis, Upper Arm S 71193 Unspecified Infective Arthritis, Forearm S 71194 Unspecified Infective Arthritis, Hand S 71195 Unspecified Infective Arthritis, Pelvic Region and Thigh S 71196 Unspecified Infective Arthritis, Lower Leg S 71197 Unspecified Infective Arthritis, Ankle and Foot S 71198 Unspecified Infective Arthritis, Other Specified Sites S 71199 Unspecified Infective Arthritis, Multiple Sites S 71210 Chondrocalcinosis due to Dicalcium Phosphate Crystals, Unspecified Site S 71211 Chondrocalcinosis due to Dicalcium Phosphate Crystals, Shoulder Region S 71212 Chondrocalcinosis due to Dicalcium Phosphate Crystals, Upper Arm S 71213 Chondrocalcinosis due to Dicalcium Phosphate Crystals, Forearm S 71214 Chondrocalcinosis due to Dicalcium Phosphate Crystals, Hand S 71215 Chondrocalcinosis due to Dicalcium Phosphate Crystals, Pelvic Region and Thigh S 71216 Chondrocalcinosis due to Dicalcium Phosphate Crystals, Lower Leg S 71217 Chondrocalcinosis due to Dicalcium Phosphate Crystals, Ankle and Foot S 71218 Chondrocalcinosis due to Dicalcium Phosphate Crystals, Other Specified Sites S 71219 Chondrocalcinosis due to Dicalcium Phosphate Crystals, Multiple Sites S 71220 Chondrocalcinosis due to Pyrophosphate Crystals, Unspecified Site S 71221 Chondrocalcinosis due to Pyrophosphate Crystals, Shoulder Region S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 211 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 71222 Chondrocalcinosis due to Pyrophosphate Crystals, Upper Arm S 71223 Chondrocalcinosis due to Pyrophosphate Crystals, Forearm S 71224 Chondrocalcinosis due to Pyrophosphate Crystals, Hand S 71225 Chondrocalcinosis due to Pyrophosphate Crystals, Pelvic Region and Thigh S 71226 Chondrocalcinosis due to Pyrophosphate Crystals, Lower Leg S 71227 Chondrocalcinosis due to Pyrophosphate Crystals, Ankle and Foot S 71228 Chondrocalcinosis due to Pyrophosphate Crystals, Other Specified Sites S 71229 Chondrocalcinosis due to Pyrophosphate Crystals, Multiple Sites S 71230 Chondrocalcinosis, Cause Unspecified, Involving Unspecified Site S 71231 Chondrocalcinosis, Cause Unspecified, Involving Shoulder Region S 71232 Chondrocalcinosis, Cause Unspecified, Involving Upper Arm S 71233 Chondrocalcinosis, Cause Unspecified, Involving Forearm S 71234 Chondrocalcinosis, Cause Unspecified, Involving Hand S 71235 Chondrocalcinosis, Cause Unspecified, Involving Pelvic Region and Thigh S 71236 Chondrocalcinosis, Cause Unspecified, Involving Lower Leg S 71237 Chondrocalcinosis, Cause Unspecified, Involving Ankle and Foot S 71238 Chondrocalcinosis, Cause Unspecified, Involving Other Specified Sites S 71239 Chondrocalcinosis, Cause Unspecified, Involving Multiple Sites S 71280 Other Specified Crystal Arthropathies, Site Unspecified S 71281 Other Specified Crystal Arthropathies, Shoulder Region S 71282 Other Specified Crystal Arthropathies, Upper Arm S 71283 Other Specified Crystal Arthropathies, Forearm S 71284 Other Specified Crystal Arthropathies, Hand S 71285 Other Specified Crystal Arthropathies, Pelvic Region and Thigh S 71286 Other Specified Crystal Arthropathies, Lower Leg S 71287 Other Specified Crystal Arthropathies, Ankle and Foot S 71288 Other Specified Crystal Arthropathies, Other Specified Sites S 71289 Other Specified Crystal Arthropathies, Multiple Sites S 71290 Unspecified Crystal Arthropathy, Site Unspecified S 71291 Unspecified Crystal Arthropathy, Shoulder Region S 71292 Unspecified Crystal Arthropathy, Upper Arm S 71293 Unspecified Crystal Arthropathy, Forearm S 71294 Unspecified Crystal Arthropathy, Hand S 71295 Unspecified Crystal Arthropathy, Pelvic Region and Thigh S 71296 Unspecified Crystal Arthropathy, Lower Leg S 71297 Unspecified Crystal Arthropathy, Ankle and Foot S 71298 Unspecified Crystal Arthropathy, Other Specified Sites S 71299 Unspecified Crystal Arthropathy, Multiple Sites S 71430 Polyarticular Juvenile Rheumatoid Arthritis, Chronic or Unspecified S 71431 Polyarticular Juvenile Rheumatoid Arthritis, Acute S 71432 Pauciarticular Juvenile Rheumatoid Arthritis S 71433 Monoarticular Juvenile Rheumatoid Arthritis S 71481 Rheumatoid Lung S 71489 Other Specified Inflammatory Polyarthropathies S 71500 Generalized Osteoarthrosis, Unspecified Site S 71504 Generalized Osteoarthrosis, Involving Hand S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 212 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 71505 Osteoarthrosis, Generalized, Involving Pelvic Region and Thigh N 71509 Generalized Osteoarthrosis, Involving Multiple Sites S 71510 Primary Localized Osteoarthrosis, Specified Site S 71511 Primary Localized Osteoarthrosis, Shoulder Region S 71512 Primary Localized Osteoarthrosis, Upper Arm S 71513 Primary Localized Osteoarthrosis, Forearm S 71514 Primary Localized Osteoarthrosis, Hand S 71515 Primary Localized Osteoarthrosis, Pelvic Region and Thigh S 71516 Primary Localized Osteoarthrosis, Lower Leg S 71517 Primary Localized Osteoarthrosis, Ankle and Foot S 71518 Primary Localized Osteoarthrosis, Other Specified Sites S 71520 Secondary Localized Osteoarthrosis, Unspecified Site S 71521 Secondary Localized Osteoarthrosis, Shoulder Region S 71522 Secondary Localized Osteoarthrosis, Upper Arm S 71523 Secondary Localized Osteoarthrosis, Forearm S 71524 Secondary Localized Osteoarthrosis, Involving Hand S 71525 Secondary Localized Osteoarthrosis, Pelvic Region and Thigh S 71526 Secondary Localized Osteoarthrosis, Lower Leg N 71527 Secondary Localized Osteoarthrosis, Ankle and Foot S 71528 Secondary Localized Osteoarthrosis, Other Specified Site S

71530 Localized Osteoarthrosis Not Specified Whether Primary or Secondary, Unspecified Site S

71531 Localized Osteoarthrosis Not Specified Whether Primary or Secondary, Shoulder Region S 71532 Localized Osteoarthrosis Not Specified Whether Primary or Secondary, Upper Arm S 71533 Localized Osteoarthrosis Not Specified Whether Primary or Secondary, Forearm S 71534 Localized Osteoarthrosis Not Specified Whether Primary or Secondary, Hand S Localized Osteoarthrosis Not Specified Whether Primary or Secondary, Pelvic Region and 71535 Thigh S 71536 Localized Osteoarthrosis Not Specified Whether Primary or Secondary, Lower Leg S 71537 Localized Osteoarthrosis Not Specified Whether Primary or Secondary, Ankle and Foot S Localized Osteoarthrosis Not Specified Whether Primary or Secondary, Other Specified 71538 Sites S Osteoarthrosis Involving More Than One Site, But Not Specified as Generalized, 71580 Unspecified Site S 71589 Osteoarthrosis Involving Multiple Sites, But Not Specified as Generalized S 71590 Osteoarthrosis, Unspecified Whether Generalized or Localized, Unspecified Site N 71591 Osteoarthrosis, Unspecified Whether Generalized or Localized, Shoulder Region S 71592 Osteoarthrosis, Unspecified Whether Generalized or Localized, Upper Arm S 71593 Osteoarthrosis, Unspecified Whether Generalized or Localized, Forearm S 71594 Osteoarthrosis, Unspecified Whether Generalized or Localized, Hand N

71595 Osteoarthrosis, Unspecified Whether Generalized or Localized, Pelvic Region and Thigh S 71596 Osteoarthrosis, Unspecified Whether Generalized or Localized, Lower Leg S 71597 Osteoarthrosis, Unspecified Whether Generalized or Localized, Ankle and Foot N 71598 Osteoarthrosis, Unspecified Whether Generalized or Localized, Other Specified Sites S 71600 Kaschin-Beck Disease, Site Unspecified S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 213 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 71601 Kaschin-Beck Disease, Shoulder Region S 71602 Kaschin-Beck Disease, Upper Arm S 71603 Kaschin-Beck Disease, Forearm S 71604 Kaschin-Beck Disease, Hand S 71605 Kaschin-Beck Disease Pelvic, Region and Thigh S 71606 Kaschin-Beck Disease, Lower Leg S 71607 Kaschin-Beck Disease, Ankle and Foot S 71608 Kaschin-Beck Disease, Other Specified Sites S 71609 Kaschin-Beck Disease, Multiple Sites S 71610 Traumatic Arthropathy, Site Unspecified S 71611 Traumatic Arthropathy, Shoulder Region S 71612 Traumatic Arthropathy, Upper Arm S 71613 Traumatic Arthropathy, Forearm S 71614 Traumatic Arthropathy, Hand S 71615 Traumatic Arthropathy, Pelvic Region and Thigh S 71616 Traumatic Arthropathy, Lower Leg S 71617 Traumatic Arthropathy, Ankle and Foot S 71618 Traumatic Arthropathy, Other Specified Sites S 71619 Traumatic Arthropathy, Multiple Sites S 71620 Allergic Arthritis, Site Unspecified S 71621 Allergic Arthritis, Shoulder Region S 71622 Allergic Arthritis, Upper Arm S 71623 Allergic Arthritis, Forearm S 71624 Allergic Arthritis, Hand S 71625 Allergic Arthritis, Pelvic Region and Thigh S 71626 Allergic Arthritis, Lower Leg S 71627 Allergic Arthritis, Ankle and Foot S 71628 Allergic Arthritis, Other Specified Sites S 71629 Allergic Arthritis, Multiple Sites S 71630 Climacteric Arthritis, Site Unspecified S 71631 Climacteric Arthritis, Shoulder Region S 71632 Climacteric Arthritis, Upper Arm S 71633 Climacteric Arthritis, Forearm S 71634 Climacteric Arthritis, Hand S 71635 Climacteric Arthritis, Pelvic Region and Thigh S 71636 Climacteric Arthritis, Lower Leg S 71637 Climacteric Arthritis Involving Ankle and Foot S 71638 Climacteric Arthritis Involving Other Specified Sites S 71639 Climacteric Arthritis Involving Multiple Sites S 71640 Transient Arthropathy, Site Unspecified S 71641 Transient Arthropathy, Shoulder Region S 71642 Transient Arthropathy, Upper Arm S 71643 Transient Arthropathy, Forearm S 71644 Transient Arthropathy, Hand S 71645 Transient Arthropathy, Pelvic Region and Thigh S 71646 Transient Arthropathy, Lower Leg S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 214 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 71647 Transient Arthropathy, Ankle and Foot S 71648 Transient Arthropathy, Other Specified Site S 71649 Transient Arthropathy, Multiple Sites S 71650 Unspecified Polyarthropathy or Polyarthritis, Site Unspecified S 71651 Unspecified Polyarthropathy or Polyarthritis, Shoulder Region S 71652 Unspecified Polyarthropathy or Polyarthritis, Upper Arm S 71653 Unspecified Polyarthropathy or Polyarthritis, Forearm S 71654 Unspecified Polyarthropathy or Polyarthritis, Hand S 71655 Unspecified Polyarthropathy or Polyarthritis, Pelvic Region and Thigh S 71656 Unspecified Polyarthropathy or Polyarthritis, Lower Leg S 71657 Unspecified Polyarthropathy or Polyarthritis, Ankle and Foot S 71658 Unspecified Polyarthropathy or Polyarthritis, Other Specified Sites S 71659 Unspecified Polyarthropathy or Polyarthritis, Multiple Sites S 71660 Unspecified Monoarthritis, Site Unspecified S 71661 Unspecified Monoarthritis, Shoulder Region S 71662 Unspecified Monoarthritis, Upper Arm S 71663 Unspecified Monoarthritis, Forearm S 71664 Unspecified Monoarthritis, Hand S 71665 Unspecified Monoarthritis, Pelvic Region and Thigh S 71666 Unspecified Monoarthritis, Lower Leg S 71667 Unspecified Monoarthritis, Ankle and Foot S 71668 Unspecified Monoarthritis, Other Specified Sites S 71680 Other Specified Arthropathy, Site Unspecified S 71681 Other Specified Arthropathy, Shoulder Region S 71682 Other Specified Arthropathy, Upper Arm S 71683 Other Specified Arthropathy, Forearm S 71684 Other Specified Arthropathy, Hand S 71685 Other Specified Arthropathy, Pelvic Region and Thigh S 71686 Other Specified Arthropathy, Lower Leg S 71687 Other Specified Arthropathy, Ankle and Foot S 71688 Other Specified Arthropathy, Other Specified Sites S 71689 Other Specified Arthropathy, Multiple Sites S 71690 Unspecified Arthropathy, Site Unspecified S 71691 Unspecified Arthropathy, Shoulder Region S 71692 Unspecified Arthropathy, Upper Arm S 71693 Unspecified Arthropathy, Forearm S 71694 Unspecified Arthopathy, Hand N 71695 Unspecified Arthropathy, Pelvic Region and Thigh S 71696 Unspecified Arthropathy, Lower Leg S 71697 Unspecified Arthropathy, Ankle and Foot S 71698 Unspecified Arthropathy, Other Unspecified Sites S 71699 Unspecified Arthropathy, Multiple Sites S 71740 Unspecified Derangement of Lateral Meniscus S 71741 Bucket Handle Tear of Lateral Meniscus S 71742 Derangement of Anterior Horn of Lateral Meniscus S 71743 Derangement of Posterior Horn of Lateral Meniscus S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 215 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 71749 Other Derangement of Lateral Meniscus S 71781 Old Disruption of Lateral Collateral Ligament S 71782 Old Disruption of Medial Collateral Ligament S 71783 Old Disruption of Anterior Cruciate Ligament S 71784 Old Disruption of Posterior Cruciate Ligament S 71785 Old Disruption of Other Ligament of Knee S 71789 Other Internal Derangement of Knee S 71800 Articular Cartilage Disorder, Site Unspecified S 71801 Articular Cartilage Disorder, Shoulder Region S 71802 Articular Cartilage Disorder, Upper Arm S 71803 Articular Cartilage Disorder, Forearm S 71804 Articular Cartilage Disorder, Hand S 71805 Articular Cartilage Disorder, Pelvic Region and Thigh S 71807 Articular Cartilage Disorder, Ankle and Foot S 71808 Articular Cartilage Disorder, Other Specified Site S 71809 Articular Cartilage Disorder, Multiple Sites S 71810 Loose Body in Joint, Site Unspecified S 71811 Loose Body in Shoulder Joint S 71812 Loose Body in Upper Arm Joint S 71813 Loose Body in Forearm Joint S 71814 Loose Body in Hand Joint S 71815 Loose Body in Pelvic Joint S 71817 Loose Body in Ankle and Foot Joint S 71818 Loose Body in Joint of Other Specified Site S 71819 Loose Body in Joint of Multiple Sites S 71820 Pathological Dislocation of Joint, Site Unspecified Y 71821 Pathological Dislocation of Shoulder Joint Y 71822 Pathological Dislocation of Upper Arm Joint Y 71823 Pathological Dislocation of Forearm Joint Y 71824 Pathological Dislocation of Hand Joint Y 71825 Pathological Dislocation of Pelvic Region and Thigh Joint Y 71826 Pathological Dislocation of Lower Leg Joint Y 71827 Pathological Dislocation of Ankle and Foot Joint Y 71828 Pathological Dislocation of Joint of Other Specified Site Y 71829 Pathological Dislocation of Joint of Multiple Sites Y 71830 Recurrent Dislocation of Joint, Site Unspecified Y 71831 Recurrent Dislocation of Shoulder Joint Y 71832 Recurrent Dislocation of Upper Arm Joint Y 71833 Recurrent Dislocation of Forearm Joint Y 71834 Recurrent Dislocation of Hand Joint Y 71835 Recurrent Dislocation of Pelvic Region and Thigh Joint Y 71836 Recurrent Dislocation of Lower Leg Joint Y 71837 Recurrent Dislocation of Ankle and Foot Joint Y 71838 Recurrent Dislocation of Joint of Other Specified Site Y 71839 Recurrent Dislocation of Joint of Multiple Sites Y 71840 Contracture of Joint, Site Unspecified N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 216 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 71841 Contracture of Shoulder Joint N 71842 Contracture of Upper Arm Joint N 71843 Contracture of Forearm Joint N 71844 Contracture of Hand Joint N 71845 Contracture of Pelvic Joint N 71846 Contracture of Lower Leg Joint N 71847 Contracture of Ankle and Foot Joint N 71848 Contracture of Joint of Other Specified Site N 71849 Contracture of Joint of Multiple Sites N 71850 Ankylosis of Joint, Site Unspecified N 71851 Ankylosis of Joint of Shoulder Region N 71852 Ankylosis of Upper Arm Joint N 71853 Ankylosis of Forearm Joint N 71854 Ankylosis of Hand Joint N 71855 Ankylosis of Pelvic Region and Thigh Joint N 71856 Ankylosis of Lower Leg Joint N 71857 Ankylosis of Ankle and Foot Joint N 71858 Ankylosis of Joint of Other Specified Site N 71859 Ankylosis of Joint of Multiple Sites N 71860 Unspecified Intrapelvic Protrusion of Acetabulum, Site Unspecified N 71865 Unspecified Intrapelvic Protrusion Acetabulum, Pelvic Region and Thigh N 71870 Developmental Dislocation of Joint, Site Unspecified N 71871 Developmental Dislocation of Joint, Shoulder Region N 71872 Developmental Dislocation of Joint, Upper Arm N 71873 Developmental Dislocation of Joint, Forearm N 71874 Developmental Dislocation of Joint, Hand N 71875 Developmental Dislocation of Joint, Pelvic Region and Thigh N 71876 Developmental Dislocation of Joint, Lower Leg N 71877 Developmental Dislocation of Joint, Ankle and Foot N 71878 Developmental Dislocation of Joint, Other Specified Sites N 71879 Developmental Dislocation of Joint, Multiple Sites N 71880 Other Joint Derangement, Not Elsewhere Classified, Unspecified Site N 71881 Other Joint Derangement, Not Elsewhere Classified, Shoulder Region N 71882 Other Joint Derangement, Not Elsewhere Classified, Upper Arm N 71883 Other Joint Derangement, Not Elsewhere Classified, Forearm N 71884 Other Joint Derangement, Not Elsewhere Classified, Hand N 71885 Other Joint Derangement, Not Elsewhere Classified, Pelvic Region and Thigh N 71886 Other Joint Derangement, Not Elsewhere Classified, Lower Leg N 71887 Other Joint Derangement, Not Elsewhere Classified, Ankle and Foot N 71888 Other Joint Derangement, Not Elsewhere Classified, Other Specified Site N 71889 Other Joint Derangement, Not Elsewhere Classified, Multiple Sites N 71890 Unspecified Derangement, Joint, Site Unspecified N 71891 Unspecified Derangement, Shoulder Region N 71892 Unspecified Derangement, Upper Arm Joint N 71893 Unspecified Derangement, Forearm Joint N 71894 Unspecified Derangement of Hand Joint N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 217 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 71895 Unspecified Pelvic Joint Derangement N 71897 Unspecified Ankle and Foot Joint Derangement N 71898 Unspecified Derangement of Joint, Other Specified Sites N 71899 Unspecified Derangement of Joint, Multiple Sites N 71900 Effusion of Joint, Site Unspecified N 71901 Effusion of Shoulder Joint Y 71902 Effusion of Upper Arm Joint Y 71903 Effusion of Forearm Joint Y 71904 Effusion of Hand Joint Y 71905 Effusion of Pelvic Joint Y 71906 Effusion of Lower Leg Joint Y 71907 Effusion of Ankle and Foot Joint Y 71908 Effusion of Joint, Other Specified Site Y 71909 Effusion of Joint, Multiple Sites Y 71910 Hemarthrosis, Site Unspecified S 71911 Herarthrosis, Shoulder Region S 71912 Hemarthorsis, Upper Arm S 71913 Hemarthrosis, Forearm S 71914 Hemarthrosis, Hand S 71915 Hemarthrosis, Pelvic Region and Thigh S 71916 Hemarthrosis, Lower Leg S 71917 Hemarthrosis, Ankle and Foot S 71918 Hemarthrosis, Other Specified Site S 71919 Hemarthrosis, Multiple Sites S 71920 Villonodular Synovitis, Site Unspecified S 71921 Villonodular Synovitis, Shoulder Region S 71922 Villonodular Synovitis, Upper Arm S 71923 Villonodular Synovitis, Forearm S 71924 Villonodular Synovitis, Hand S 71925 Villonodular Synovitis, Pelvic Region and Thigh S 71926 Villonodular Synovitis, Lower Leg S 71927 Villonodular Synovitis, Ankle and Foot S 71928 Villonodular Synovitis, Other Specified Sites S 71929 Villonodular Synovitis, Multiple Sites S 71930 Palindromic Rheumatism, Site Unspecified S 71931 Palindromic Rheumatism, Shoulder Region S 71932 Palindromic Rheumatism, Upper Arm S 71933 Palindromic Rheumatism, Forearm S 71934 Palindromic Rheumatism, Hand S 71935 Palindromic Rheumatism, Pelvic Region and Thigh S 71936 Palindromic Rheumatism, Lower Leg S 71937 Palindromic Rheumatism, Ankle and Foot S 71938 Palindromic Rheumatism, Other Specified Sites S 71939 Palindromic Rheumatism, Multiple Sites S 71940 Pain in Joint, Site Unspecified S 71941 Pain in Joint, Shoulder Region S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 218 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 71942 Pain in Joint, Upper Arm S 71943 Pain in Joint, Forearm S 71944 Pain in Joint, Hand S 71945 Pain in Joint, Pelvic Region and Thigh S 71946 Pain in Joint, Lower Leg S 71947 Pain in Joint, Ankle and Foot S 71948 Pain in Joint, Other Specified Sites S 71949 Pain in Joint, Multiple Sites S 71950 Stiffness of Joint, Not Elsewhere Classified, Unspecified Site S 71951 Stiffness of Joint, Not Elsewhere Classified, Shoulder Region S 71952 Stiffness of Joint, Not Elsewhere Classified, Upper Arm S 71953 Stiffness of Joint, Not Elsewhere Classified, Forearm S 71954 Stiffness of Joint, Not Elsewhere Classified, Hand S 71955 Stiffness of Joint, Not Elsewhere Classified, Pelvic Region and Thigh S 71956 Stiffness of Joint, Not Elsewhere Classified, Lower Leg S 71957 Stiffness of Joint, Not Elsewhere Classified, Ankle and Foot S 71958 Stiffness of Joint, Not Elsewhere Classified, Other Specified Site S 71959 Stiffness of Joints, Not Elsewhere Classified, Multiple Sites S 71960 Other Symptoms Referable to Joint, Site Unspecified S 71961 Other Symptoms Referable to Shoulder Joint S 71962 Other Symptoms Referable to Upper Arm Joint S 71963 Other Symptoms Referable to Forearm Joint S 71964 Other Symptoms Referable to Hand Joint S 71965 Other Symptoms Referable to Pelvic Joint S 71966 Other Symptoms Referable to Lower Leg Joint S 71967 Other Symptoms Referable to Ankle and Foot Joint S 71968 Other Symptoms Referable to Joint of Other Specified Site S 71969 Other Symptoms Referable to Joints of Multiple Sites S 71970 Difficulty in Walking Involving Joint, Site Unspecified S 71975 Difficulty in Walking Involving Joint of Pelvic Region and *Thigh S 71976 Difficulty in Walking Involving Lower Leg Joint N 71977 Difficulty in Walking Involving Ankle and Foot Joint N 71978 Difficulty in Walking Involving Joint of Other Specified Sites N 71979 Difficulty in Walking Involving Joint of Multiple Sites S 71980 Other Specified Disorders of Joint, Site Unspecified S 71981 Other Specified Disorders of Shoulder Joint S 71982 Other Specified Disorders of Upper Arm Joint S 71983 Other Specified Disorders of Forearm Joint S 71984 Other Specified Disorders of Hand Joint S 71985 Other Specified Disorders of Pelvic Joint S 71986 Other Specified Disorders of Lower Leg Joint S 71987 Other Specified Disorders of Ankle and Foot Joint S 71988 Other Specified Disorders of Joint of Other Specified Site S 71989 Other Specified Disorders of Joints of Multiple Sites S 71990 Unspecified Disorder of Joint, Site Unspecified S 71991 Unspecified Disorder of Shoulder Joint S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 219 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 71992 Unspecified Disorder of Upper Arm Joint S 71993 Unspecified Disorder of Forearm Joint S 71994 Unspecified Disorder of Hand Joint S 71995 Unspecified Disorder of Joint of Pelvic Region and Thigh S 71996 Unspecified Disorder of Lower Leg Joint S 71997 Unspecified Disorder of Ankle and Foot Joint S 71998 Unspecified Joint Disorder of Other Specified Site S 71999 Unspecified Joint Disorder of Multiple Sites S 72081 Inflammatory Spondylopathies in Diseases Classified Elsewhere S 72089 Other Inflammatory Spondylopathies S 72141 Spondylosis With Myelopathy, Thoracic Region S 72142 Spondylosis With Myelopathy, Lumbar Region S 72190 Spondylosis of Unspecified Site Without Mention of Myelopathy S 72191 Spondylosis of Unspecified Site With Myelopathy S 72210 Displacement of Lumbar Intervertebral Disc Without Myelopathy S 72211 Displacement of Thoracic Intervertebral Disc Without Myelopathy S 72230 Schmorl’s Nodes, Unspecified Region Y 72231 Schmorl’s Nodes, Thoracic Region Y 72232 Schmorl’s Nodes, Lumbar Region Y 72239 Schmorl’s Nodes, Other Spinal Region Y 72251 Degeneration of Thoracic or Thoracolumbar Intervertebral Disc N 72252 Degeneration of Lumbar or Lumbosacral Intervertebral Disc N 72270 Intervertebral Disc Disorder With Myelopathy, Unspecified Region N 72271 Intervertebral Cervical Disc Disorder With Myelopathy, Cervical Region S 72272 Intervertebral Thoracic Disc Disorder With Myelopathy, Thoracic Region S 72273 Intervertebral Lumbar Disc Disorder With Myelopathy, Lumbar Region S 72280 Postlaminectomy Syndrome, Unspecified Region S 72281 Postlaminectomy Syndrome, Cervical Region S 72282 Postlaminectomy Syndrome, Thoracic Region S 72283 Postlaminectomy Syndrome, Lumbar Region S 72290 Other and Unspecified Disc Disorder of Unspecified Region N 72291 Other and Unspecified Disc Disorder of Cervical Region S 72292 Other and Unspecified Disc Disorder of Thoracic Region S 72293 Other and Unspecified Disc Disorder of Lumbar Region S 72400 Spinal Stenosis, Unspecified Region Other Than Cervical S 72401 Spinal Stenosis of Thoracic Region S 72402 Spinal Stenosis of Lumbar Region S 72409 Spinal Stenosis, Other Region Other Than Cervical S 72470 Unspecified Disorder of Coccyx N 72471 Hypermobility of Coccyx N 72479 Other Disorder of Coccyx N 72610 Unspecified Disorders of Bursae and Tendons in Shoulder Region N 72611 Calcifying Tendinitis of Shoulder N 72612 Bicipital Tenosynovitis N 72619 Other Specified Disorders of Rotator Cuff Syndrome of Shoulder and Allied Disorders N 72630 Unspecified Enthesopathy of Elbow N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 220 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 72631 Medial Epicondylitis of Elbow N 72632 Lateral Epicondylitis of Elbow N 72633 Olecranon Bursitis N 72639 Other Enthesopathy of Elbow Region N 72660 Unspecified Enthesopathy of Knee N 72661 Pes Anserinus Tendinitis or Bursitis N 72662 Tibial Collateral Ligament Bursitis N 72663 Fibular Collateral Ligament Bursitis N 72664 Patellar Tendinitis N 72665 Prepatellar Bursitis N 72669 Other Enthesopathy of Knee N 72670 Unspecified Enthesopathy of Ankle and Tarsus N 72671 Achilles Bursitis or Tendinitis N 72672 Tibialis Tendinitis N 72673 Calcaneal Spur N 72679 Other Enthesopathy of Ankle and Tarsus N 72690 Enthesopathy of Unspecified Site N 72691 Exostosis of Unspecified Site N 72700 Unspecified Synovitis and Tenosynovitis N 72701 Synovitis and Tenosynovitis in Diseases Classified Elsewhere N 72702 Giant Cell Tumor of Tendon Sheath N 72703 Trigger Finger (Acquired) N 72704 Radial Styloid Tenosynovitis N 72705 Other Tenosynovitis of Hand and Wrist N 72706 Tenosynovitis of Foot and Ankle N 72709 Other Synovitis and Tenosynovitis N 72740 Unspecified Synovial Cyst N 72741 Ganglion of Joint N 72742 Ganglion of Tendon Sheath N 72743 Unspecified Ganglion N 72749 Other Ganglion and Cyst of Synovium, Tendon, and Bursa N 72750 Unspecified Rupture of Synovium N 72751 Synovial Cyst of Popliteal Space N 72759 Other Rupture of Synovium N 72760 Nontraumatic Rupture of Unspecified Tendon Y 72761 Complete Rupture of Rotator Cuff Y 72762 Nontraumatic Rupture of Tendons of Biceps (Long Head) Y 72763 Nontraumatic Rupture of Extensor Tendons of Hand and Wrist Y 72764 Nontraumatic Rupture of Flexor Tendons of Hand and Wrist Y 72765 Nontraumatic Rupture of Quadriceps Tendon Y 72766 Nontraumatic Rupture of Patellar Tendon Y 72767 Nontraumatic Rupture of Achilles Tendon Y 72768 Nontraumatic Rupture of Other Tendons of Foot and Ankle Y 72769 Nontraumatic Rupture of Other Tendon Y 72781 Contracture of Tendon (Sheath) N 72782 Calcium Deposits in Tendon and Bursa N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 221 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 72783 Plica Syndrome N 72789 Other Disorders of Synovium, Tendon, and Bursa N 72810 Unspecified Calcification and Ossification N 72811 Progressive Myositis Ossificans N 72812 Traumatic Myositis Ossificans N 72813 Postoperative Heterotopic Calcification N 72819 Other Muscular Calcification and Ossification N 72871 Plantar Fascial Fibromatosis N 72879 Other Fibromatoses of Muscle, Ligament, and Fascia N 72881 Interstitial Myositis N 72882 Foreign Body Granuloma of Muscle N 72883 Rupture of Muscle, Nontraumatic Y 72884 Diastasis of Muscle N 72885 Spasm of Muscle N 72886 Necrotizing Fasciitis N 72887 Muscle Weakness (Generalized) N 72888 Rhabdomyolysis N 72889 Other Disorder of Muscle, Ligament, and Fascia N 72930 Panniculitis, Unspecified Site N 72931 Hypertrophy of Fat Pad, Knee N 72939 Panniculitis of Other Sites N 72981 Swelling of Limb N 72982 Cramp of Limb N 72989 Other Musculoskeletal Symptoms Referable to Limbs N 73000 Acute Osteomyelitis, Site Unspecified Y 73001 Acute Osteomyelitis, Shoulder Region Y 73002 Acute Osteomyelitis, Upper Arm Y 73003 Acute Osteomyelitis, Forearm Y 73004 Acute Osteomyelitis, Hand Y 73005 Acute Osteomyelitis, Pelvic Region and Thigh Y 73006 Acute Osteomyelitis, Lower Leg Y 73007 Acute Osteomyelitis, Ankle and Foot Y 73008 Acute Osteomyelitis, Other Specified Site Y 73009 Acute Osteomyelitis, Multiple Sites Y 73010 Chronic Osteomyelitis, Site Unspecified N 73011 Chronic Osteomyelitis, Shoulder Region N 73012 Chronic Osteomyelitis, Upper Arm N 73013 Chronic Osteomyelitis, Forearm N 73014 Chronic Osteomyelitis, Hand N 73015 Chronic Osteomyelitis, Pelvic Region and Thigh N 73016 Chronic Osteomyelitis, Lower Leg N 73017 Chronic Osteomyelitis, Ankle and Foot N 73018 Chronic Osteomyelitis, Other Specified Sites N 73019 Chronic Osteomyelitis, Multiple Sites N 73020 Unspecified Osteomyelitis, Site Unspecified N 73021 Unspecified Osteomyelitis, Shoulder Region N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 222 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 73022 Unspecified Osteomyelitis, Upper Arm N 73023 Unspecified Osteomyelitis, Forearm N 73024 Unspecified Osteomyelitis, Hand N 73025 Unspecified Osteomyelitis, Pelvic Region and Thigh N 73026 Unspecified Osteomyelitis, Lower Leg N 73027 Unspecified Osteomyelitis, Ankle and Foot N 73028 Unspecified Osteomyelitis, Other Specified Sites N 73029 Unspecified Osteomyelitis, Multiple Sites N 73030 Periostitis, Without Mention of Osteomyelitis, Unspecified Site N 73031 Periostitis, Without Mention of Osteomyelitis, Shoulder Region N 73032 Periostitis, Without Mention of Osteomyelitis, Upper Arm N 73033 Periostitis, Without Mention of Osteomyelitis, Forearm N 73034 Periostitis, Without Mention of Osteomyelitis, Hand N 73035 Periostitis, Without Mention of Osteomyelitis, Pelvic Region and Thigh N 73036 Periostitis, Without Mention of Osteomyelitis, Lower Leg N 73037 Periostitis, Without Mention of Osteomyelitis, Ankle and Foot N 73038 Periostitis, Without Mention of Osteomyelitis, Other Specified Sites N 73039 Periostitis, Without Mention of Osteomyelitis, Multiple Sites N 73070 Osteopathy Resulting From Poliomyelitis, Unspecified Site N 73071 Osteopathy Resulting From Poliomyelitis, Shoulder Region N 73072 Osteopathy Resulting From Poliomyelitis, Upper Arm N 73073 Osteopathy Resulting From Poliomyelitis, Forearm N 73074 Osteopathy Resulting From Poliomyelitis, Hand N 73075 Osteopathy Resulting From Poliomyelitis, Pelvic Region and Thigh N 73076 Osteopathy Resulting From Poliomyelitis, Lower Leg N 73077 Osteopathy Resulting From Poliomyelitis, Ankle and Foot N 73078 Osteopathy Resulting From Poliomyelitis, Other Specified Sites N 73079 Osteopathy Resulting From Poliomyelitis, Multiple Sites N 73080 Other Infections Involving Bone in Diseases Classified Elsewhere, Site Unspecified N 73081 Other Infections Involving Bone Diseases Classified Elsewhere, Shoulder Region N 73082 Other Infections Involving Bone Diseases Classified Elsewhere, Upper Arm N 73083 Other Infections Involving Bone in Diseases Classified Elsewhere, Forearm N 73084 Other Infections Involving Diseases Classified Elsewhere, Hand Bone N

73085 Other Infections Involving Bone Diseases Classified Elsewhere, Pelvic Region and Thigh N 73086 Other Infections Involving Bone Diseases Classified Elsewhere, Lower Leg N 73087 Other Infections Involving Bone Diseases Classified Elsewhere, Ankle and Foot N 73088 Other Infections Involving Bone Diseases Classified Elsewhere, Other Specified Sites N 73089 Other Infections Involving Bone Diseases Classified Elsewhere, Multiple Sites N 73090 Unspecified Infection of Bone, Site Unspecified N 73091 Unspecified Infection of Bone, Shoulder Region N 73092 Unspecified Infection of Bone, Upper Arm N 73093 Unspecified Infection of Bone, Forearm N 73094 Unspecified Infection of Bone, Hand N 73095 Unspecified Infection of Bone, Pelvic Region and Thigh N 73096 Unspecified Infection of Bone, Lower Leg N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 223 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 73097 Unspecified Infection of Bone, Ankle and Foot N 73098 Unspecified Infection of Bone of Other Specified Site N 73099 Unspecified Infection of Bone in Multiple Sites N 73300 Unspecified Osteoporosis N 73301 Senile Osteoporosis N 73302 Idiopathic Osteoporosis N 73303 Disuse Osteoporosis N 73309 Other Osteoporosis N 73310 Pathologic Fracture, Unspecified Site Y 73311 Pathologic Fracture of Humerus Y 73312 Pathologic Fracture of Distal Radius and Ulna Y 73313 Pathologic Fracture of Vertebrae Y 73314 Pathologic Fracture of Neck of Femur Y 73315 Pathologic Fracture of Other Specified Part of Femur Y 73316 Pathologic Fracture of Tibia and Fibula Y 73319 Pathologic Fracture of Other Specified Site Y 73320 Unspecified Cyst of Bone (Localized) Y 73321 Solitary Bone Cyst Y 73322 Aneurysmal Bone Cyst Y 73329 Other Cyst of Bone Y 73340 Aseptic Necrosis of Bone, Site Unspecified Y 73341 Aseptic Necrosis of Head of Humerus Y 73342 Aseptic Necrosis of Head and Neck of Femur Y 73343 Aseptic Necrosis of Medial Femoral Condyle Y 73344 Aseptic Necrosis of Talus Y 73349 Aseptic Necrosis of Other Bone Site Y 73381 Malunion of Fracture Y 73382 Nonunion of Fracture Y 73390 Disorder of Bone and Cartilage, Unspecified N 73391 Arrest of Bone Development or Growth N 73392 Chondromalacia N 73393 Stress Fracture of Tibia or Fibula N 73394 Stress Fracture of the Metatarsals N 73395 Stress Fracture of Other Bone N 73399 Other Disorders of Bone and Cartilage N 73600 Unspecified Deformity of Forearm, Excluding Fingers N 73601 Cubitus Valgus (Acquired) N 73602 Cubitus Varus (Acquired) N 73603 Valgus Deformity of Wrist (Acquired) N 73604 Varus Deformity of Wrist (Acquired) N 73605 Wrist Drop (Acquired) N 73606 Claw Hand (Acquired) N 73607 Club Hand, Acquired N 73609 Other Acquired Deformities of Forearm, Excluding Fingers N 73620 Unspecified Deformity of Finger N 73621 Boutonniere Deformity N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 224 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 73622 Swan-Neck Deformity N 73629 Other Acquired Deformity of Finger N 73630 Unspecified Acquired Deformity of Hip N 73631 Coxa Valga (Acquired) N 73632 Coxa Vara (Acquired) N 73639 Other Acquired Deformities of Hip N 73641 Genu Valgum (Acquired) N 73642 Genu Varum (Acquired) N 73670 Unspecified Deformity of Ankle and Foot, Acquired N 73671 Acquired Equinovarus Deformity N 73672 Equinus Deformity of Foot, Acquired N 73673 Cavus Deformity of Foot, Acquired N 73674 Claw Foot, Acquired N 73675 Cavovarus Deformity of Foot, Acquired N 73676 Other Acquired Calcaneus Deformity N 73679 Other Acquired Deformity of Ankle and Foot N 73681 Unequal Leg Length (Acquired) N 73689 Other Acquired Deformity of Other Parts of Limb N 73710 Kyphosis (Acquired) (Postural) N 73711 Kyphosis due to Radiation N 73712 Kyphosis, Postlaminectomy N 73719 Other Kyphosis (Acquired) N 73720 Lordosis (Acquired) (Postural) N 73721 Lordosis, Postlaminectomy N 73722 Other Postsurgical Lordosis N 73729 Other Lordosis (Acquired) N 73730 Scoliosis (And Kyphoscoliosis), Idiopathic N 73731 Resolving Infantile Idiopathic Scoliosis N 73732 Progressive Infantile Idiopathic Scoliosis N 73733 Scoliosis due to Radiation N 73734 Thoracogenic Scoliosis N 73739 Other Kyphoscoliosis and Scoliosis N 73740 Unspecified Curvature of Spine Associated With Other Condition N 73741 Kyphosis Associated With Other Condition N 73742 Lordosis Associated With Other Condition N 73743 Scoliosis Associated With Other Condition N 73810 Unspecified Acquired Deformity of Head N 73811 Zygomatic Hyperplasia N 73812 Zygomatic Hypoplasia N 73819 Other Specified Acquired Deformity of Head N 74100 Spina Bifida With Hydrocephalus, Unspecified Region N 74101 Spina Bifida With Hydrocephalus, Cervical Region N 74102 Spina Bifida With Hydrocephalus, Dorsal (Thoracic) Region N 74103 Spina Bifida With Hydrocephalus, Lumbar Region N 74190 Spina Bifida Without Mention of Hydrocephalus, Unspecified Region N 74191 Spina Bifida Without Mention of Hydrocephalus, Cervical Region N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 225 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 74192 Spina Bifida Without Mention of Hydrocephalus, Dorsal (Thoracic) Region N 74193 Spina Bifida Without Mention of Hydrocephalus, Lumbar Region N 74251 Diastematomyelia N 74253 Hydromyelia N 74259 Other Specified Congenital Anomaly of Spinal Cord N 74300 Unspecified Clinical Anophthalmos N 74303 Cystic Eyeball, Congenital N 74306 Cryptophthalmos N 74310 Unspecified Microphthalmos N 74311 Simple Microphthalmos N 74312 Microphthalmos Associated With Other Anomalies of Eye and Adnexa N 74320 Unspecified Buphthalmos N 74321 Simple Buphthalmos N 74322 Buphthalmos Associated With Other Ocular Anomaly N 74330 Unspecified Congenital Cataract N 74331 Congenital Capsular and Subcapsular Cataract N 74332 Congenital Cortical and Zonular Cataract N 74333 Congenital Nuclear Cataract N 74334 Congenital Total and Subtotal Cataract N 74335 Congenital Aphakia N 74336 Congenital Anomalies of Lens Shape N 74337 Congenital Ectopic Lens N 74339 Other Congenital Cataract and Lens Anomalies N 74341 Congenital Anomaly of Corneal Size and Shape N 74342 Congenital Corneal Opacity, Interfering With Vision N 74343 Other Congenital Corneal Opacity N Specified Congenital Anomaly of Anterior Chamber, Chamber Angle, and Related 74344 Structures N 74345 Aniridia N 74346 Other Specified Congenital Anomaly of Iris and Ciliary Body N 74347 Specified Congenital Anomaly of Sclera N 74348 Multiple and Combined Congenital Anomalies of Anterior Segment of Eye N 74349 Other Congenital Anomaly of Anterior Segment of Eye N 74351 Vitreous Anomaly, Congenital N 74352 Fundus Coloboma N 74353 Congenital Chorioretinal Degeneration N 74354 Congenital Folds and Cysts of Posterior Segment of Eye N 74355 Congenital Macular Change N 74356 Other Congenital Retinal Changes N 74357 Specified Congenital Anomalies of Optic Disc N 74358 Congenital Vascular Anomalies of Posterior Segment of Eye N 74359 Other Congenital Anomalies of Posterior Segment of Eye N 74361 Congenital Ptosis of Eyelid N 74362 Congenital Deformity of Eyelid N 74363 Other Specified Congenital Anomaly of Eyelid N 74364 Specified Congenital Anomaly of Lacrimal Gland N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 226 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 74365 Specified Congenital Anomaly of Lacrimal Passages N 74366 Specified Congenital Anomaly of Orbit N 74369 Other Congenital Anomalies of Eyelids, Lacrimal System, and Orbit N 74400 Unspecified Congenital Anomaly of Ear Causing Impairment of Hearing N 74401 Congenital Absence of External Ear Causing Impairment of Hearing N 74402 Other Congenital Anomaly of External Ear Causing Impairment of Hearing N 74403 Congenital Anomaly of Middle Ear, Except Ossicles, Causing Impairment of Hearing N 74404 Congenital Anomalies of Ear Ossicles N 74405 Congenital Anomalies of Inner Ear N 74409 Other Congenital Anomalies of Ear Causing Impairment of Hearing N 74421 Congenital Absence of Ear Lobe N 74422 Macrotia N 74423 Microtia N 74424 Specified Congenital Anomaly of Eustachian Tube N 74429 Other Congenital Anomaly of Ear N 74441 Congenital Branchial Cleft Sinus or Fistula N 74442 Congenital Branchial Cleft Cyst N 74443 Congenital Cervical Auricle N 74446 Congenital Preauricular Sinus or Fistula N 74447 Congenital Preauricular Cyst N 74449 Other Congenital Branchial Cleft Cyst or Fistula; Preauricular Sinus N 74481 Macrocheilia N 74482 Microcheilia N 74483 Macrostomia N 74484 Microstomia N 74489 Other Specified Congenital Anomaly of Face and Neck N 74510 Complete Transposition of Great Vessels Y 74511 Transposition of Great Vessels, Double Outlet Right Ventricle Y 74512 Corrected Transposition of Great Vessels Y 74519 Other Transposition of Great Vessels Y 74560 Unspecified Type Congenital Endocardial Cushion Defect Y 74561 Ostium Primum Defect Y 74569 Other Congenital Endocardial Cushion Defect Y 74600 Unspecified Congenital Pulmonary Valve Anomaly Y 74601 Congenital Atresia of Pulmonary Valve Y 74602 Congenital Stenosis of Pulmonary Valve Y 74609 Other Congenital Anomalies of Pulmonary Valve Y 74681 Congenital Subaortic Stenosis Y 74682 Cor Triatriatum Y 74683 Congenital Infundibular Pulmonic Stenosis Y 74684 Congenital Obstructive Anomalies of Heart, Not Elsewhere Classified Y 74685 Congenital Coronary Artery Anomaly Y 74686 Congenital Heart Block Y 74687 Congenital Malposition of Heart and Cardiac Apex Y 74689 Other Specified Congenital Anomaly of Heart Y 74710 Coarctation of Aorta (Preductal) (Postductal) Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 227 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 74711 Congenital Interruption of Aortic Arch Y 74720 Unspecified Congenital Anomaly of Aorta Y 74721 Congenital Anomaly of Aortic Arch Y 74722 Congenital Atresia and Stenosis of Aorta Y 74729 Other Congenital Anomaly of Aorta Y 74740 Congenital Anomaly of Great Veins Unspecified Y 74741 Total Congenital Anomalous Pulmonary Venous Connection Y 74742 Partial Congenital Anomalous Pulmonary Venous Connection Y 74749 Other Congenital Anomalies of Great Veins Y 74760 Congenital Anomaly of the Peripheral Vascular System, Unspecified Site Y 74761 Congenital Gastrointestinal Vessel Anomaly Y 74762 Congenital Renal Vessel Anomaly Y 74763 Congenital Upper Limb Vessel Anomaly Y 74764 Congenital Lower Limb Vessel Anomaly Y 74769 Congenital Anomaly of Other Specified Site of Peripheral Vascular System Y 74781 Congenital Anomaly of Cerebrovascular System Y 74782 Congenital Spinal Vessel Anomaly Y 74783 Persistent Fetal Circulation Y 74789 Other Specified Congenital Anomaly of Circulatory System Y 74860 Unspecified Congenital Anomaly of Lung Y 74861 Congenital Bronchiectasis Y 74869 Other Congenital Anomaly of Lung Y 74900 Unspecified Cleft Palate N 74901 Unilateral Cleft Palate, Complete N 74902 Unilateral Cleft Palate, Incomplete N 74903 Bilateral Cleft Palate, Complete N 74904 Bilateral Cleft Palate, Incomplete N 74910 Unspecified Cleft Lip N 74911 Unilateral Cleft Lip, Complete N 74912 Unilateral Cleft Lip, Incomplete N 74913 Bilateral Cleft Lip, Complete N 74914 Bilateral Cleft Lip, Incomplete N 74920 Unspecified Cleft Palate With Cleft Lip N 74921 Unilateral Cleft Palate With Cleft Lip, Complete N 74922 Unilateral Cleft Palate With Cleft Lip, Incomplete N 74923 Bilateral Cleft Palate With Cleft Lip, Complete N 74924 Bilateral Cleft Palate With Cleft Lip, Incomplete N 74925 Other Combinations of Cleft Palate With Cleft Lip N 75010 Congenital Anomaly of Tongue, Unspecified N 75011 Aglossia N 75012 Congenital Adhesions of Tongue N 75013 Congenital Fissure of Tongue N 75015 Macroglossia N 75016 Microglossia N 75019 Other Congenital Anomaly of Tongue N 75021 Congenital Absence of Salivary Gland N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 228 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 75022 Congenital Accessory Salivary Gland N 75023 Congenital Atresia, Salivary Duct N 75024 Congenital Fistula of Salivary Gland N 75025 Congenital Fistula of Lip N 75026 Other Specified Congenital Anomalies of Mouth N 75027 Congenital Diverticulum of Pharynx N 75029 Other Specified Congenital Anomaly of Pharynx N 75160 Unspecified Congenital Anomaly of Gallbladder, Bile Ducts, and Liver N 75161 Congenital Biliary Atresia N 75162 Congenital Cystic Disease of Liver N 75169 Other Congenital Anomaly of Gallbladder, Bile Ducts, and Liver N 75210 Unspecified Congenital Anomaly of Fallopian Tubes and Broad Ligaments N 75211 Embryonic Cyst of Fallopian Tubes and Broad Ligaments N 75219 Other Congenital Anomaly of Fallopian Tubes and Broad Ligaments N 75240 Unspecified Congenital Anomaly of Cervix, Vagina, and External Female Genitalia N 75241 Embryonic Cyst of Cervix, Vagina, and External Female Genitalia N 75242 Imperforate Hymen N 75249 Other Congenital Anomaly of Cervix, Vagina, and External Female Genitalia N 75251 Undescended Testis N 75252 Retractile Testis N 75261 Hypospadias N 75262 Epispadias N 75263 Congenital Chordee N 75264 Micropenis N 75265 Hidden Penis N 75269 Other Penile Anomalies N 75281 Scrotal Transposition N 75289 Other Specified Anomalies of Genital Organs N 75310 Unspecified Congenital Cystic Kidney Disease N 75311 Congenital Single Renal Cyst N 75312 Congenital Polycystic Kidney, Unspecified Type N 75313 Congenital Polycystic Kidney, Autosomal Dominant N 75314 Congenital Polycystic Kidney, Autosomal Recessive N 75315 Congenital Renal Dysplasia N 75316 Congenital Medullary Cystic Kidney N 75317 Congenital Medullary Sponge Kidney N 75319 Other Specified Congenital Cystic Kidney Disease N 75320 Unspecified Obstructive Defect of Renal Pelvis and Ureter N 75321 Congenital Obstruction of Ureteropelvic Junction N 75322 Congenital Obstruction of Ureterovesical Junction N 75323 Congenital Ureterocele N 75329 Other Obstructive Defect of Renal Pelvis and Ureter N 75430 Congenital Dislocation of Hip, Unilateral N 75431 Congenital Dislocation of Hip, Bilateral N 75432 Congenital Subluxation of Hip, Unilateral N 75433 Congenital Subluxation of Hip, Bilateral N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 229 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 75435 Congenital Dislocation of One Hip With Subluxation of Other Hip N 75440 Congenital Genu Recurvatum N 75441 Congenital Dislocation of Knee (With Genu Recurvatum) N 75442 Congenital Bowing of Femur N 75443 Congenital Bowing of Tibia and Fibula N 75444 Congenital Bowing of Unspecified Long Bones of Leg N 75450 Congenital Talipes Varus N 75451 Congenital Talipes Equinovarus N 75452 Congenital Metatarsus Primus Varus N 75453 Congenital Metatarsus Varus N 75459 Other Congenital Varus Deformity of Feet N 75460 Congenital Talipes Valgus N 75461 Congenital Pes Planus N 75462 Talipes Calcaneovalgus N 75469 Other Congenital Valgus Deformity of Feet N 75470 Unspecified Talipes N 75471 Talipes Cavus N 75479 Other Congenital Deformity of Feet N 75481 Pectus Excavatum N 75482 Pectus Carinatum N 75489 Other Specified Nonteratogenic Anomalies N 75500 Polydactyly, Unspecified Digits N 75501 Polydactyly of Fingers N 75502 Polydactyly of Toes N 75510 Syndactyly of Multiple and Unspecified Sites N 75511 Syndactyly of Fingers Without Fusion of Bone N 75512 Syndactyly of Fingers With Fusion of Bone N 75513 Syndactyly of Toes Without Fusion of Bone N 75514 Syndactyly of Toes With Fusion of Bone N 75520 Congenital Unspecified Reduction Deformity of Upper Limb N 75521 Congenital Transverse Deficiency of Upper Limb N 75522 Congenital Longitudinal Deficiency of Upper Limb, Not Elsewhere Classified N Congenital Longitudinal Deficiency, Combined, Involving Humerus, Radius, and Ulna 75523 (Complete or Incomplete) N Congenital Longitudinal Deficiency, Humeral, Complete or Partial (With or Without 75524 Distal Deficiencies, Incomplete) N Congenital Longitudinal Deficiency, Radioulnar, Complete or Partial (With or Without 75525 Distal Deficiencies, Incomplete) N Congenital Longitudinal Deficiency, Radial, Complete or Partial (With or Without Distal 75526 Deficiencies, Incomplete) N Congenital Longitudinal Deficiency, Ulnar, Complete or Partial (With or Without Distal 75527 Deficiencies, Incomplete) N Congenital Longitudinal Deficiency, Carpals or Metacarpals, Complete or Partial (With or 75528 Without Incomplete Phalangeal Deficiency) N 75529 Congenital Longitudinal Deficiency, Phalanges, Complete or Partial N 75530 Congenital Unspecified Reduction Deformity of Lower Limb N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 230 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 75531 Congenital Transverse Deficiency of Lower Limb N 75532 Congenital Longitudinal Deficiency of Lower Limb, Not Elsewhere Classified N Congenital Longitudinal Deficiency, Combined, Involving Femur, Tibia, and Fibula 75533 (Complete or Incomplete) N Congenital Longitudinal Deficiency, Femoral, Complete or Partial (With or Without Distal 75534 Deficiencies, Incomplete) N Congenital Longitudinal Deficiency, Tibiofibular, Complete or Partial (With or Without 75535 Distal Deficiencies, Incomplete) N Congenital Longitudinal Deficiency, Tibia, Complete or Partial (With or Without Distal 75536 Deficiencies, Incomplete) N Congenital Longitudinal Deficiency, Fibular, Complete or Partial (With or Without Distal 75537 Deficiencies, Incomplete) N Congenital Longitudinal Deficiency, Tarsals or Metatarsals, Complete or Partial (With or 75538 Without Incomplete Phalangeal Deficiency) N 75539 Congenital Longitudinal Deficiency, Phalanges, Complete or Partial N 75550 Unspecified Congenital Anomaly of Upper Limb N 75551 Congenital Deformity of Clavicle N 75552 Congenital Elevation of Scapula N 75553 Radioulnar Synostosis N 75554 Madelung’s Deformity N 75555 Acrocephalosyndactyly N 75556 Accessory Carpal Bones N 75557 Macrodactylia (Fingers) N 75558 Congenital Cleft Hand N 75559 Other Congenital Anomaly of Upper Limb, Including Shoulder Girdle N 75560 Unspecified Congenital Anomaly of Lower Limb N 75561 Congenital Coxa Valga N 75562 Congenital Coxa Vara N 75563 Other Congenital Deformity of Hip (Joint) N 75564 Congenital Deformity of Knee (Joint) N 75565 Macrodactylia of Toes N 75566 Other Congenital Anomaly of Toes N 75567 Congenital Anomalies of Foot, Not Elsewhere Classified N 75569 Other Congenital Anomaly of Lower Limb, Including Pelvic Girdle N 75610 Congenital Anomaly of Spine, Unspecified N 75611 Congenital Spondylolysis, Lumbosacral Region N 75612 Congenital Spondylolisthesis N 75613 Congenital Absence of Vertebra N 75614 Hemivertebra N 75615 Congenital Fusion of Spine (Vertebra) N 75616 Klippel-Feil Syndrome N 75617 Spina Bifida Occulta N 75619 Other Congenital Anomaly of Spine N 75650 Unspecified Congenital Osteodystrophy N 75651 Osteogenesis Imperfecta N 75652 Osteopetrosis N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 231 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 75653 Osteopoikilosis N 75654 Polyostotic Fibrous Dysplasia of Bone N 75655 Chondroectodermal Dysplasia N 75656 Multiple Epiphyseal Dysplasia N 75659 Other Congenital Osteodystrophy N 75670 Unspecified Congenital Anomaly of Abdominal Wall N 75671 Prune Belly Syndrome N 75679 Other Congenital Anomalies of Abdominal Wall N 75681 Congenital Absence of Muscle and Tendon N 75682 Accessory Muscle N 75683 Ehlers-Danlos Syndrome N 75689 Other Specified Congenital Anomaly of Muscle, Tendon, Fascia, and Connective Tissue N 75731 Congenital Ectodermal Dysplasia N 75732 Congenital Vascular Hamartomas N 75733 Congenital Pigmentary Anomaly of Skin N 75739 Other Specified Congenital Anomaly of Skin N 75831 Cri-Du-Chat Syndrome N 75832 Velo-Cardio-Facial Syndrome N 75833 Other Microdeletions N 75839 Other Autosomal Deletions N 75881 Other Conditions due to Sex Chromosome Anomalies N 75889 Other Conditions due to Chromosome Anomalies N 75981 Prader-Willi Syndrome N 75982 Marfan’s Syndrome N 75983 Fragile X Syndrome N 75989 Other Specified Multiple Congenital Anomalies, So Described N Noxious Influences Affecting Fetus or Newborn Via Placenta or Breast Milk, Unspecified 76070 Noxious Substance Y 76071 Noxious Influences Affecting Fetus or Newborn Via Placenta or Breast Milk, Alcohol Y 76072 Noxious Influences Affecting Fetus or Newborn Via Placenta or Breast Milk, Narcotics Y Noxious Influences Affecting Fetus or Newborn Via Placenta or Breast Milk, 76073 Hallucinogenic Agents Y Noxious Influences Affecting Fetus or Newborn Via Placenta or Breast Milk, Anti- 76074 Infectives Y 76075 Noxious Influences Affecting Fetus or Newborn Via Placenta or Breast Milk, Cocaine Y Noxious Influences Affecting Fetus or Newborn Via Placenta or Breast Milk, 76076 Diethylstilbestrol (Des) Y 76077 Anticonvulsants N 76078 Antimetabolic Agents N 76079 Noxious Influences Affecting Fetus or Newborn Via Placenta or Breast Milk, Other Y 76381 Abnormality in Fetal Heart Rate or Rhythm Before the Onset of Labor Y 76382 Abnormality in Fetal Heart Rate or Rhythm During Labor Y 76383 Abnormality in Fetal Heart Rate or Rhythm, Unspecified as to Time of Onset Y 76384 Meconium Passage During Delivery Y 76389 Other Specified Complications of Labor and Delivery Affecting Fetus or Newborn Y 76400 "Light-For-Dates" Without Mention of Fetal Malnutrition, Unspecified (Weight) Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 232 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 76401 "Light-For-Dates" Without Mention of Fetal Malnutrition, Less Than 500 Grams Y 76402 "Light-For-Dates" Without Mention of Fetal Malnutrition, 500-749 Grams Y 76403 "Light-For-Dates" Without Mention of Fetal Malnutrition, 750-999 Grams Y 76404 "Light-For-Dates" Without Mention of Fetal Malnutrition, 1,000-1,249 Grams Y 76405 "Light-For-Dates" Without Mention of Fetal Malnutrition, 1,250-1,499 Grams Y 76406 "Light-For-Dates" Without Mention of Fetal Malnutrition, 1,500-1,749 Grams Y 76407 "Light-For-Dates" Without Mention of Fetal Malnutrition, 1,750-1,999 Grams Y 76408 "Light-For-Dates" Without Mention of Fetal Malnutrition, 2,000-2,499 Grams Y 76409 "Light-For-Dates" Without Mention of Fetal Malnutrition, 2,500 or More Grams Y 76410 "Light-For-Dates" With Signs of Fetal Malnutrition, Unspecified (Weight) Y 76411 "Light-For-Dates" With Signs of Fetal Malnutrition, Less Than 500 Grams Y 76412 "Light-For-Dates" With Signs of Fetal Malnutrition, 500-749 Grams Y 76413 "Light-For-Dates" With Signs of Fetal Malnutrition, 750-999 Grams Y 76414 "Light-For-Dates" With Signs of Fetal Malnutrition, 1,000-1,249 Grams Y 76415 "Light-For-Dates" With Signs of Fetal Malnutrition, 1,250-1,499 Grams Y 76416 "Light-For-Dates" With Signs of Fetal Malnutrition, 1,500-1,749 Grams Y 76417 "Light-For-Dates" With Signs of Fetal Malnutrition, 1,750-1,999 Grams Y 76418 "Light-For-Dates" With Signs of Fetal Malnutrition, 2,000-2,499 Grams Y 76419 "Light-For-Dates" With Signs of Fetal Malnutrition, 2,500 or More Grams Y 76420 Fetal Malnutrition Without Mention of "Light-For-Dates", Unspecified (Weight) Y 76421 Fetal Malnutrition Without Mention of "Light-For-Dates", Less Than 500 Grams Y 76422 Fetal Malnutrition Without Mention of "Light-For-Dates", 500-749 Grams Y 76423 Fetal Malnutrition Without Mention of "Light-For-Dates", 750-999 Grams Y 76424 Fetal Malnutrition Without Mention of "Light-For-Dates", 1,000-1,249 Grams Y 76425 Fetal Malnutrition Without Mention of "Light-For-Dates", 1,250-1,499 Grams Y 76426 Fetal Malnutrition Without Mention of "Light-For-Dates", 1,500-1,749 Grams Y 76427 Fetal Malnutrition Without Mention of "Light-For-Dates", 1,750-1,999 Grams Y 76428 Fetal Malnutrition Without Mention of "Light-For-Dates", 2,000-2,499 Grams Y 76429 Fetal Malnutrition Without Mention of "Light-For-Dates", 2,500 or More Grams Y 76490 Unspecified Fetal Growth Retardation, Unspecified (Weight) Y 76491 Unspecified Fetal Growth Retardation, Less Than 500 Grams Y 76492 Unspecified Fetal Growth Retardation, 500-749 Grams Y 76493 Unspecified Fetal Growth Retardation, 750-999 Grams Y 76494 Unspecified Fetal Growth Retardation, 1,000-1,249 Grams Y 76495 Unspecified Fetal Growth Retardation, 1,250-1,499 Grams Y 76496 Unspecified Fetal Growth Retardation, 1,500-1,749 Grams Y 76497 Unspecified Fetal Growth Retardation, 1,750-1,999 Grams Y 76498 Unspecified Fetal Growth Retardation, 2,000-2,499 Grams Y 76499 Unspecified Fetal Growth Retardation, 2,500 or More Grams Y 76500 Extreme Fetal Immaturity, Unspecified (Weight) Y 76501 Extreme Fetal Immaturity, Less Than 500 Grams Y 76502 Extreme Fetal Immaturity, 500-749 Grams Y 76503 Extreme Fetal Immaturity, 750-999 Grams Y 76504 Extreme Fetal Immaturity, 1,000-1,249 Grams Y 76505 Extreme Fetal Immaturity, 1,250-1,499 Grams Y 76506 Extreme Fetal Immaturity, 1,500-1,749 Grams Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 233 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 76507 Extreme Fetal Immaturity, 1,750-1,999 Grams Y 76508 Extreme Fetal Immaturity, 2,000-2,499 Grams Y 76509 Extreme Fetal Immaturity, 2,500 or More Grams Y 76510 Other Preterm Infants, Unspecified (Weight) Y 76511 Other Preterm Infants, Less Than 500 Grams Y 76512 Other Preterm Infants, 500-749 Grams Y 76513 Other Preterm Infants, 750-999 Grams Y 76514 Other Preterm Infants, 1,000-1,249 Grams Y 76515 Other Preterm Infants, 1,250-1,499 Grams Y 76516 Other Preterm Infants, 1,500-1,749 Grams Y 76517 Other Preterm Infants, 1,750-1,999 Grams Y 76518 Other Preterm Infants, 2,000-2,499 Grams Y 76519 Other Preterm Infants, 2,500 or More Grams Y 76520 Unspecified Weeks of Gestation Y 76521 Less Than 24 Completed Weeks of Gestation Y 76522 24 Completed Weeks of Gestation Y 76523 25-26 Completed Weeks of Gestation Y 76524 27-28 Completed Weeks of Gestation Y 76525 29-30 Completed Weeks of Gestation Y 76526 31-32 Completed Weeks of Gestation Y 76527 33-34 Completed Weeks of Gestation Y 76528 35-36 Completed Weeks of Gestation Y 76529 37 or More Completed Weeks of Gestation N 76621 Post-Term Infant Y 76622 Prolonged Gestation of Infant Y 76711 Epicranial Subaponeurotic Hemorrhage (Massive) Y 76719 Other Injuries to Scalp Y 77010 Fetal and Newborn Aspiration, Unspecified Y 77011 Meconium Aspiration Without Respiratory Symptoms Y 77012 Meconium Aspiration With Respiratory Symptoms Y 77013 Aspiration of Clear Amniotic Fluid Without Respiratory Symptoms Y 77014 Aspiration of Clear Amniotic Fluid With Respiratory Symptoms Y 77015 Aspiration of Blood Without Respiratory Symptoms Y 77016 Aspiration of Blood With Respiratory Symptoms Y 77017 Other Fetal and Newborn Aspiration Without Respiratory Symptoms Y 77018 Other Fetal and Newborn Aspiration With Respiratory Symptoms Y 77081 Primary Apnea of Newborn Y 77082 Other Apnea of Newborn Y 77083 Cyanotic Attacks of Newborn Y 77084 Respiratory Failure of Newborn Y 77085 Aspiration of Postnatal Stomach Contents Without Respiratory Symptoms Y 77086 Aspiration of Postnatal Stomach Contents With Respiratory Symptoms Y 77089 Other Respiratory Problems of Newborn After Birth Y 77181 Septicemia (Sepsis) of Newborn Y 77182 Urinary Tract Infection of Newborn Y 77183 Bacteremia of Newborn Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 234 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 77189 Other Infections Specific to the Perinatal Period Y 77210 Intraventricular Hemorrhage, Unspecified Grade Y 77211 Intraventricular Hemorrhage, Grade I Y 77212 Intraventricular Hemorrhage, Grade II Y 77213 Intraventricular Hemorrhage, Grade III Y 77214 Intraventricular Hemorrhage, Grade IV Y 77430 Neonatal Jaundice due to Delayed Conjugation, Cause Unspecified Y 77431 Neonatal Jaundice due to Delayed Conjugation in Diseases Classified Elsewhere Y 77439 Other Neonatal Jaundice due to Delayed Conjugation From Other Causes Y 77981 Neonatal Bradycardia Y 77982 Neonatal Tachycardia Y 77983 Delayed Separation of Umbilical Cord Y 77984 Meconium Staining N 77989 Other Specified Conditions Originating in the Perinatal Period Y 78001 Coma Y 78002 Transient Alteration of Awareness Y 78003 Persistent Vegetative State Y 78009 Other Alteration of Consciousness Y 78031 Febrile Convulsions Y 78039 Other Convulsions Y 78050 Unspecified Sleep Disturbance N 78051 Insomnia With Sleep Apnea, Unspecified N 78052 Insomnia, Unspecified N 78053 Hypersomnia With Sleep Apnea, Unspecified N 78054 Hypersomnia, Unspecified N 78055 Disruption of 24 Hour Sleep Wake Cycle, Unspecified N 78056 Dysfunctions Associated With Sleep Stages or Arousal From Sleep N 78057 Unspecified Sleep Apnea N 78058 Sleep Related Movement Disorder, Unspecified N 78059 Other Sleep Disturbances N 78071 Chronic Fatigue Syndrome N 78079 Other Malaise and Fatigue N 78091 Fussy Infant (Baby) N 78092 Excessive Crying of Infant (Baby) N 78093 Memory Loss N 78094 Early Satiety N 78095 Other Excessive Crying N 78099 Other General Symptoms N 78191 Loss of Height N 78192 Abnormal Posture N 78193 Ocular Torticollis N 78194 Facial Weakness N 78199 Other Symptoms Involving Nervous and Musculoskeletal Systems N 78261 Pallor N 78262 Flushing N 78321 Loss of Weight N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 235 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 78322 Underweight N 78340 Lack of Normal Physiological Development, Unspecified N 78341 Failure to Thrive N 78342 Delayed Milestones N 78343 Short Stature N 78440 Unspecified Voice Disturbance N 78441 Aphonia N 78449 Other Voice Disturbance N 78460 Symbolic Dysfunction, Unspecified N 78461 Alexia and Dyslexia N 78469 Other Symbolic Dysfunction N 78550 Unspecified Shock S 78551 Cardiogenic Shock Y 78552 Septic Shock Y 78559 Other Shock Without Mention of Trauma Y 78600 Unspecified Respiratory Abnormality N 78601 Hyperventilation N 78602 Orthopnea Y 78603 Apnea Y 78604 Cheyne-Stokes Respiration Y 78605 Shortness of Breath Y 78606 Tachypnea Y 78607 Wheezing Y 78609 Other Dyspnea and Respiratory Abnormalities Y 78650 Unspecified Chest Pain Y 78651 Precordial Pain Y 78652 Painful Respiration Y 78659 Other Chest Pain Y 78701 Nausea With Vomiting N 78702 Nausea Alone N 78703 Vomiting Alone N 78791 Diarrhea N 78799 Other Symptoms Involving Digestive System N 78820 Unspecified Retention of Urine S 78821 Incomplete Bladder Emptying S 78829 Other Specified Retention of Urine S 78830 Unspecified Urinary Incontinence N 78831 Urge Incontinence N 78832 Stress Incontinence, Male N 78833 Mixed Incontinence Urge and Stress (Male)(Female) N 78834 Incontinence Without Sensory Awareness N 78835 Post-Void Dribbling N 78836 Nocturnal Enuresis N 78837 Continuous Leakage N 78838 Overflow Incontinence N 78839 Other Urinary Incontinence N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 236 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 78841 Urinary Frequency N 78842 Polyuria N 78843 Nocturia N 78861 Splitting of Urinary Stream N 78862 Slowing of Urinary Stream N 78863 Urgency of Urination N 78869 Other Abnormality of Urination N 78900 Abdominal Pain, Unspecified Site Y 78901 Abdominal Pain, Right Upper Quadrant Y 78902 Abdominal Pain, Left Upper Quadrant Y 78903 Abdominal Pain, Right Lower Quadrant Y 78904 Abdominal Pain, Left Lower Quadrant Y 78905 Abdominal Pain, Periumbilic Y 78906 Abdominal Pain, Epigastric Y 78907 Abdominal Pain, Generalized Y 78909 Abdominal Pain, Other Specified Site Y 78930 Abdominal or Pelvic Swelling, Mass or Lump, Unspecified Site Y 78931 Abdominal or Pelvic Swelling, Mass, or Lump, Right Upper Quadrant S 78932 Abdominal or Pelvic Swelling, Mass, or Lump, Left Upper Quadrant S 78933 Abdominal or Pelvic Swelling, Mass, or Lump, Right Lower Quadrant S 78934 Abdominal or Pelvic Swelling, Mass, or Lump, Left Lower Quadrant S 78935 Abdominal or Pelvic Swelling, Mass or Lump, Periumbilic S 78936 Abdominal or Pelvic Swelling, Mass, or Lump, Epigastric S 78937 Abdominal or Pelvic Swelling, Mass, or Lump, Epigastric, Generalized S 78939 Abdominal or Pelvic Swelling, Mass, or Lump, Other Specified Site S 78940 Abdominal Rigidity, Unspecified Site Y 78941 Abdominal Rigidity, Right Upper Quadrant S 78942 Abdominal Rigidity, Left Upper Quadrant S 78943 Abdominal Rigidity, Right Lower Quadrant S 78944 Abdominal Rigidity, Left Lower Quadrant S 78945 Abdominal Rigidity, Periumbilic S 78946 Abdominal Rigidity, Epigastric S 78947 Abdominal Rigidity, Generalized S 78949 Abdominal Rigidity, Other Specified Site S 78960 Abdominal Tenderness, Unspecified Site Y 78961 Abdominal Tenderness, Right Upper Quadrant S 78962 Abdominal Tenderness, Left Upper Quadrant S 78963 Abdominal Tenderness, Right Lower Quadrant S 78964 Abdominal Tenderness, Left Lower Quadrant S 78965 Abdominal Tenderness, Periumbilic S 78966 Abdominal Tenderness, Epigastric S 78967 Abdominal Tenderness, Generalized S 78969 Abdominal Tenderness, Other Specified Site S 79001 Precipitous Drop in Hematocrit N 79009 Other Abnormality of Red Blood Cells N 79021 Impaired Fasting Glucose N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 237 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 79022 Impaired Glucose Tolerance Test (Oral) N 79029 Other Abnormal Glucose N 79091 Abnormal Arterial Blood Gases N 79092 Abnormal Coagulation Profile N 79093 Elevated Prostate Specific Antigen (PSA) N 79094 Euthyroid Sick Syndrome N 79095 Elevated C-Reactive Protein (CRP) N 79099 Other Nonspecific Findings on Examination of Blood N 79380 Unspecified Abnormal Mammogram N 79381 Mammographic Microcalcification N 79389 Other Abnormal Findings on Radiological Examination of Breast N 79400 Unspecified Abnormal Function Study of Brain and Central Nervous System N 79401 Nonspecific Abnormal Echoencephalogram N 79402 Nonspecific Abnormal Electroencephalogram (EEG) N Other Nonspecific Abnormal Result of Function Study of Brain and Central Nervous 79409 System N 79410 Nonspecific Abnormal Response to Unspecified Nerve Stimulation N 79411 Nonspecific Abnormal Retinal Function Studies N 79412 Nonspecific Abnormal Electro-Oculogram (EOG) N 79413 Nonspecific Abnormal Visually Evoked Potential N 79414 Nonspecific Abnormal Oculomotor Studies N 79415 Nonspecific Abnormal Auditory Function Studies N 79416 Nonspecific Abnormal Vestibular Function Studies N 79417 Nonspecific Abnormal Electromyogram (EMG) N Other Nonspecific Abnormal Result of Function Study of Peripheral Nervous System and 79419 Special Senses N 79430 Nonspecific Abnormal Unspecified Cardiovascular Function Study N 79431 Nonspecific Abnormal Electrocardiogram (ECG) (EKG) N 79439 Other Nonspecific Abnormal Cardiovascular System Function Study N 79500 Abnormal Glandular Papanicolaou Smear of Cervix N Papanicolaou Smear of Cervix With Atypical Squamous Cells of Undetermined 79501 Significance (ASC-US) N Papanicolaou Smear of Cervix With Atypical Squamous Cells Cannot Exclude High 79502 Grade Squamous Intraepithelial Lesion (ASC-H) N

79503 Papanicolaou Smear of Cervix With Low Grade Squamous Intraepithelial Lesion (LGSIL) N Papanicolaou Smear of Cervix With High Grade Squamous Intraepithelial Lesion 79504 (HGSIL) N 79505 Cervical High Risk Human Papillomavirus (HPV) Dna Test Positive N 79508 Nonspecific Abnormal Papanicolaou Smear of Cervix, Unsatisfactory Smear N 79509 Other Abnormal Papanicolaou Smear of Cervix and Cervical HPV N 79531 Nonspecific Positive Findings for Anthrax N 79539 Other Nonspecific Positive Culture Findings N 79571 Nonspecific Serologic Evidence of Human Immunodeficiency Virus (HIV) N 79579 Other and Unspecified Nonspecific Immunological Findings N 79901 Asphyxia Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 238 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 79902 Hypoxemia Y 79981 Decreased Libido N 79989 Other Ill-Defined Conditions N Closed Fracture of Vault of Skull Without Mention of Intracranial Injury, Unspecified 80000 State of Consciousness Y Closed Fracture of Vault of Skull Without Mention of Intracranial Injury, No Loss of 80001 Consciousness Y Closed Fracture of Vault of Skull Without Mention of Intracranial Injury, Brief (Less Than 80002 One Hour) Loss of Consciousness Y Closed Fracture of Vault of Skull Without Mention of Intracranial Injury, Moderate (1-24 80003 Hours) Loss of Consciousness Y

Closed Fracture of Vault of Skull Without Mention of Intracranial Injury, Prolonged 80004 (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y Closed Fracture of Vault of Skull Without Mention of Intracranial Injury, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious 80005 Level Y Closed Fracture of Vault of Skull Without Mention of Intracranial Injury, Loss of 80006 Consciousness of Unspecified Duration Y Closed Fracture of Vault of Skull Without Mention of Intracranial Injury, Unspecified 80009 Concussion Y Closed Fracture of Vault of Skull With Cerebral Laceration and Contusion, Unspecified 80010 State of Consciousness Y Closed Fracture of Vault of Skull With Cerebral Laceration and Contusion, No Loss of 80011 Consciousness Y Closed Fracture of Vault of Skull With Cerebral Laceration and Contusion, Brief (Less 80012 Than One Hour) Loss of Consciousness Y Closed Fracture of Vault of Skull With Cerebral Laceration and Contusion, Moderate (1- 80013 24 Hours) Loss of Consciousness Y

Closed Fracture of Vault of Skull With Cerebral Laceration and Contusion, Prolonged 80014 (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y Closed Fracture of Vault of Skull With Cerebral Laceration and Contusion, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious 80015 Level Y Closed Fracture of Vault of Skull With Cerebral Laceration and Contusion, Loss of 80016 Consciousness of Unspecified Duration Y Closed Fracture of Vault of Skull With Cerebral Laceration and Contusion, Unspecified 80019 Concussion Y Closed Fracture of Vault of Skull With Subarachnoid, Subdural, and Extradural 80020 Hemorrhage, Unspecified State of Consciousness Y Closed Fracture of Vault of Skull With Subarachnoid, Subdural, and Extradural 80021 Hemorrhage, No Loss of Consciousness Y Closed Fracture of Vault of Skull With Subarachnoid, Subdural, and Extradural 80022 Hemorrhage, Brief (Less Than One Hour) Loss of Consciousness Y Closed Fracture of Vault of Skull With Subarachnoid, Subdural, and Extradural 80023 Hemorrhage, Moderate (1-24 Hours) Loss of Consciousness Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 239 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Closed Fracture of Vault of Skull With Subarachnoid, Subdural, and Extradural Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre- 80024 Existing Conscious Level Y Closed Fracture of Vault of Skull With Subarachnoid, Subdural, and Extradural Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to 80025 Pre-Existing Conscious Level Y Closed Fracture of Vault of Skull With Subarachnoid, Subdural, and Extradural 80026 Hemorrhage, Loss of Consciousness of Unspecified Duration Y Closed Fracture of Vault of Skull With Subarachnoid, Subdural, and Extradural 80029 Hemorrhage, Unspecified Concussion Y Closed Fracture of Vault of Skull With Other and Unspecified Intracranial Hemorrhage, 80030 Unspecified State of Consciousness Y Closed Fracture of Vault of Skull With Other and Unspecified Intracranial Hemorrhage, 80031 No Loss of Consciousness Y Closed Fracture of Vault of Skull With Other and Unspecified Intracranial Hemorrhage, 80032 Brief (Less Than One Hour) Loss of Consciousness Y Closed Fracture of Vault of Skull With Other and Unspecified Intracranial Hemorrhage, 80033 Moderate (1-24 Hours) Loss of Consciousness Y Closed Fracture of Vault of Skull With Other and Unspecified Intracranial Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing 80034 Conscious Level Y Closed Fracture of Vault of Skull With Other and Unspecified Intracranial Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing 80035 Conscious Level Y Closed Fracture of Vault of Skull With Other and Unspecified Intracranial Hemorrhage, 80036 Loss of Consciousness of Unspecified Duration Y Closed Fracture of Vault of Skull With Other and Unspecified Intracranial Hemorrhage, 80039 Unspecified Concussion Y Closed Fracture of Vault of Skull With Intracranial Injury of Other and Unspecified 80040 Nature, Unspecified State of Consciousness Y Closed Fracture of Vault of Skull With Intracranial Injury of Other and Unspecified 80041 Nature, No Loss of Consciousness Y Closed Fracture of Vault of Skull With Intracranial Injury of Other and Unspecified 80042 Nature, Brief (Less Than One Hour) Loss of Consciousness Y Closed Fracture of Vault of Skull With Intracranial Injury of Other and Unspecified 80043 Nature, Moderate (1-24 Hours) Loss of Consciousness Y Closed Fracture of Vault of Skull With Intracranial Injury of Other and Unspecified Nature, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre- 80044 Existing Conscious Level Y Closed Fracture of Vault of Skull With Intracranial Injury of Other and Unspecified Nature, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre- 80045 Existing Conscious Level Y Closed Fracture of Vault of Skull With Intracranial Injury of Other and Unspecified 80046 Nature, Loss of Consciousness of Unspecified Duration Y Closed Fracture of Vault of Skull With Intracranial Injury of Other and Unspecified 80049 Nature, Unspecified Concussion Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 240 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Open Fracture of Vault of Skull Without Mention of Intracranial Injury, Unspecified State 80050 of Consciousness Y Open Fracture of Vault of Skull Without Mention of Intracranial Injury, No Loss of 80051 Consciousness Y Open Fracture of Vault of Skull Without Mention of Intracranial Injury, Brief (Less Than 80052 One Hour) Loss of Consciousness Y Open Fracture of Vault of Skull Without Mention of Intracranial Injury, Moderate (1-24 80053 Hours) Loss of Consciousness Y

Open Fracture of Vault of Skull Without Mention of Intracranial Injury, Prolonged (More 80054 Than 24 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y

Open Fracture of Vault of Skull Without Mention of Intracranial Injury, Prolonged (More 80055 Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious Level Y Open Fracture of Vault of Skull Without Mention of Intracranial Injury, Loss of 80056 Consciousness of Unspecified Duration Y Open Fracture of Vault of Skull Without Mention of Intracranial Injury, Unspecified 80059 Concussion Y Open Fracture of Vault of Skull With Cerebral Laceration and Contusion, Unspecified 80060 State of Consciousness Y Open Fracture of Vault of Skull With Cerebral Laceration and Contusion, No Loss of 80061 Consciousness Y Open Fracture of Vault of Skull With Cerebral Laceration and Contusion, Brief (Less 80062 Than One Hour) Loss of Consciousness Y Open Fracture of Vault of Skull With Cerebral Laceration and Contusion, Moderate (1-24 80063 Hours) Loss of Consciousness Y

Open Fracture of Vault of Skull With Cerebral Laceration and Contusion, Prolonged 80064 (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y Open Fracture of Vault of Skull With Cerebral Laceration and Contusion, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious 80065 Level Y Open Fracture of Vault of Skull With Cerebral Laceration and Contusion, Loss of 80066 Consciousness of Unspecified Duration Y Open Fracture of Vault of Skull With Cerebral Laceration and Contusion, Unspecified 80069 Concussion Y Open Fracture of Vault of Skull With Subarachnoid, Subdural, and Extradural 80070 Hemorrhage, Unspecified State of Consciousness Y Open Fracture of Vault of Skull With Subarachnoid, Subdural, and Extradural 80071 Hemorrhage, No Loss of Consciousness Y Open Fracture of Vault of Skull With Subarachnoid, Subdural, and Extradural 80072 Hemorrhage, Brief (Less Than One Hour) Loss of Consciousness Y Open Fracture of Vault of Skull With Subarachnoid, Subdural, and Extradural 80073 Hemorrhage, Moderate (1-24 Hours) Loss of Consciousness Y Open Fracture of Vault of Skull With Subarachnoid, Subdural, and Extradural Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre- 80074 Existing Conscious Level Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 241 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Open Fracture of Vault of Skull With Subarachnoid, Subdural, and Extradural Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to 80075 Pre-Existing Conscious Level Y Open Fracture of Vault of Skull With Subarachnoid, Subdural, and Extradural 80076 Hemorrhage, Loss of Consciousness of Unspecified Duration Y Open Fracture of Vault of Skull With Subarachnoid, Subdural, and Extradural 80079 Hemorrhage, Unspecified Concussion Y Open Fracture of Vault of Skull With Other and Unspecified Intracranial Hemorrhage, 80080 Unspecified State of Consciousness Y Open Fracture of Vault of Skull With Other and Unspecified Intracranial Hemorrhage, No 80081 Loss of Consciousness Y Open Fracture of Vault of Skull With Other and Unspecified Intracranial Hemorrhage, 80082 Brief (Less Than One Hour) Loss of Consciousness Y Open Fracture of Vault of Skull With Other and Unspecified Intracranial Hemorrhage, 80083 Moderate (1-24 Hours) Loss of Consciousness Y Open Fracture of Vault of Skull With Other and Unspecified Intracranial Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing 80084 Conscious Level Y Open Fracture of Vault of Skull With Other and Unspecified Intracranial Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing 80085 Conscious Level Y Open Fracture of Vault of Skull With Other and Unspecified Intracranial Hemorrhage, 80086 Loss of Consciousness of Unspecified Duration Y Open Fracture of Vault of Skull With Other and Unspecified Intracranial Hemorrhage, 80089 Unspecified Concussion Y Open Fracture of Vault of Skull With Intracranial Injury of Other and Unspecified Nature, 80090 Unspecified State of Consciousness Y Open Fracture of Vault of Skull With Intracranial Injury of Other and Unspecified Nature, 80091 No Loss of Consciousness Y Open Fracture of Vault of Skull With Intracranial Injury of Other and Unspecified Nature, 80092 Brief (Less Than One Hour) Loss of Consciousness Y Open Fracture of Vault of Skull With Intracranial Injury of Other and Unspecified Nature, 80093 Moderate (1-24 Hours) Loss of Consciousness Y Open Fracture of Vault of Skull With Intracranial Injury of Other and Unspecified Nature, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing 80094 Conscious Level Y Open Fracture of Vault of Skull With Intracranial Injury of Other and Unspecified Nature, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing 80095 Conscious Level Y Open Fracture of Vault of Skull With Intracranial Injury of Other and Unspecified Nature, 80096 Loss of Consciousness of Unspecified Duration Y Open Fracture of Vault of Skull With Intracranial Injury of Other and Unspecified Nature, 80099 Unspecified Concussion Y Closed Fracture of Base of Skull Without Mention of Intracranial Injury, Unspecified State 80100 of Consciousness Y Closed Fracture of Base of Skull Without Mention of Intracranial Injury, No Loss of 80101 Consciousness Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 242 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Closed Fracture of Base of Skull Without Mention of Intracranial Injury, Brief (Less Than 80102 One Hour) Loss of Consciousness Y Closed Fracture of Base of Skull Without Mention of Intracranial Injury, Moderate (1-24 80103 Hours) Loss of Consciousness Y

Closed Fracture of Base of Skull Without Mention of Intracranial Injury, Prolonged (More 80104 Than 24 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y

Closed Fracture of Base of Skull Without Mention of Intracranial Injury, Prolonged (More 80105 Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious Level Y Closed Fracture of Base of Skull Without Mention of Intracranial Injury, Loss of 80106 Consciousness of Unspecified Duration Y Closed Fracture of Base of Skull Without Mention of Intracranial Injury, Unspecified 80109 Concussion Y Closed Fracture of Base of Skull With Cerebral Laceration and Contusion, Unspecified 80110 State of Consciousness Y Closed Fracture of Base of Skull With Cerebral Laceration and Contusion, No Loss of 80111 Consciousness Y Closed Fracture of Base of Skull With Cerebral Laceration and Contusion, Brief (Less 80112 Than One Hour) Loss of Consciousness Y Closed Fracture of Base of Skull With Cerebral Laceration and Contusion, Moderate (1-24 80113 Hours) Loss of Consciousness Y

Closed Fracture of Base of Skull With Cerebral Laceration and Contusion, Prolonged 80114 (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y Closed Fracture of Base of Skull With Cerebral Laceration and Contusion, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious 80115 Level Y Closed Fracture of Base of Skull With Cerebral Laceration and Contusion, Loss of 80116 Consciousness of Unspecified Duration Y Closed Fracture of Base of Skull With Cerebral Laceration and Contusion, Unspecified 80119 Concussion Y Closed Fracture of Base of Skull With Subarachnoid, Subdural, and Extradural 80120 Hemorrhage, Unspecified State of Consciousness Y Closed Fracture of Base of Skull With Subarachnoid, Subdural, and Extradural 80121 Hemorrhage, No Loss of Consciousness Y Closed Fracture of Base of Skull With Subarachnoid, Subdural, and Extradural 80122 Hemorrhage, Brief (Less Than One Hour) Loss of Consciousness Y Closed Fracture of Base of Skull With Subarachnoid, Subdural, and Extradural 80123 Hemorrhage, Moderate (1-24 Hours) Loss of Consciousness Y Closed Fracture of Base of Skull With Subarachnoid, Subdural, and Extradural Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre- 80124 Existing Conscious Level Y Closed Fracture of Base of Skull With Subarachnoid, Subdural, and Extradural Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to 80125 Pre-Existing Conscious Level Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 243 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Closed Fracture of Base of Skull With Subarachnoid, Subdural, and Extradural 80126 Hemorrhage, Loss of Consciousness of Unspecified Duration Y Closed Fracture of Base of Skull With Subarachnoid, Subdural, and Extradural 80129 Hemorrhage, Unspecified Concussion Y Closed Fracture of Base of Skull With Other and Unspecified Intracranial Hemorrhage, 80130 Unspecified State of Consciousness Y Closed Fracture of Base of Skull With Other and Unspecified Intracranial Hemorrhage, No 80131 Loss of Consciousness Y Closed Fracture of Base of Skull With Other and Unspecified Intracranial Hemorrhage, 80132 Brief (Less Than One Hour) Loss of Consciousness Y Closed Fracture of Base of Skull With Other and Unspecified Intracranial Hemorrhage, 80133 Moderate (1-24 Hours) Loss of Consciousness Y Closed Fracture of Base of Skull With Other and Unspecified Intracranial Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing 80134 Conscious Level Y Closed Fracture of Base of Skull With Other and Unspecified Intracranial Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing 80135 Conscious Level Y Closed Fracture of Base of Skull With Other and Unspecified Intracranial Hemorrhage, 80136 Loss of Consciousness of Unspecified Duration Y Closed Fracture of Base of Skull With Other and Unspecified Intracranial Hemorrhage, 80139 Unspecified Concussion Y Closed Fracture of Base of Skull With Intracranial Injury of Other and Unspecified Nature, 80140 Unspecified State of Consciousness Y Closed Fracture of Base of Skull With Intracranial Injury of Other and Unspecified Nature, 80141 No Loss of Consciousness Y Closed Fracture of Base of Skull With Intracranial Injury of Other and Unspecified Nature, 80142 Brief (Less Than One Hour) Loss of Consciousness Y Closed Fracture of Base of Skull With Intracranial Injury of Other and Unspecified Nature, 80143 Moderate (1-24 Hours) Loss of Consciousness Y Closed Fracture of Base of Skull With Intracranial Injury of Other and Unspecified Nature, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing 80144 Conscious Level Y Closed Fracture of Base of Skull With Intracranial Injury of Other and Unspecified Nature, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing 80145 Conscious Level Y Closed Fracture of Base of Skull With Intracranial Injury of Other and Unspecified Nature, 80146 Loss of Consciousness of Unspecified Duration Y Closed Fracture of Base of Skull With Intracranial Injury of Other and Unspecified Nature, 80149 Unspecified Concussion Y Open Fracture of Base of Skull Without Mention of Intracranial Injury, Unspecified State 80150 of Consciousness Y Open Fracture of Base of Skull Without Mention of Intracranial Injury, No Loss of 80151 Consciousness Y Open Fracture of Base of Skull Without Mention of Intracranial Injury, Brief (Less Than 80152 One Hour) Loss of Consciousness Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 244 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Open Fracture of Base of Skull Without Mention of Intracranial Injury, Moderate (1-24 80153 Hours) Loss of Consciousness Y

Open Fracture of Base of Skull Without Mention of Intracranial Injury, Prolonged (More 80154 Than 24 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y

Open Fracture of Base of Skull Without Mention of Intracranial Injury, Prolonged (More 80155 Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious Level Y Open Fracture of Base of Skull Without Mention of Intracranial Injury, Loss of 80156 Consciousness of Unspecified Duration Y Open Fracture of Base of Skull Without Mention of Intracranial Injury, Unspecified 80159 Concussion Y Open Fracture of Base of Skull With Cerebral Laceration and Contusion, Unspecified 80160 State of Consciousness Y Open Fracture of Base of Skull With Cerebral Laceration and Contusion, No Loss of 80161 Consciousness Y Open Fracture of Base of Skull With Cerebral Laceration and Contusion, Brief (Less Than 80162 One Hour) Loss of Consciousness Y Open Fracture of Base of Skull With Cerebral Laceration and Contusion, Moderate (1-24 80163 Hours) Loss of Consciousness Y

Open Fracture of Base of Skull With Cerebral Laceration and Contusion, Prolonged (More 80164 Than 24 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y

Open Fracture of Base of Skull With Cerebral Laceration and Contusion, Prolonged (More 80165 Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious Level Y Open Fracture of Base of Skull With Cerebral Laceration and Contusion, Loss of 80166 Consciousness of Unspecified Duration Y Open Fracture of Base of Skull With Cerebral Laceration and Contusion, Unspecified 80169 Concussion Y Open Fracture of Base of Skull With Subarachnoid, Subdural, and Extradural Hemorrhage, 80170 Unspecified State of Consciousness Y Open Fracture of Base of Skull With Subarachnoid, Subdural, and Extradural Hemorrhage, 80171 No Loss of Consciousness Y Open Fracture of Base of Skull With Subarachnoid, Subdural, and Extradural Hemorrhage, 80172 Brief (Less Than One Hour) Loss of Consciousness Y Open Fracture of Base of Skull With Subarachnoid, Subdural, and Extradural Hemorrhage, 80173 Moderate (1-24 Hours) Loss of Consciousness Y Open Fracture of Base of Skull With Subarachnoid, Subdural, and Extradural Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing 80174 Conscious Level Y Open Fracture of Base of Skull With Subarachnoid, Subdural, and Extradural Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing 80175 Conscious Level Y Open Fracture of Base of Skull With Subarachnoid, Subdural, and Extradural Hemorrhage, 80176 Loss of Consciousness of Unspecified Duration Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 245 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Open Fracture of Base of Skull With Subarachnoid, Subdural, and Extradural Hemorrhage, 80179 Unspecified Concussion Y Open Fracture of Base of Skull With Other and Unspecified Intracranial Hemorrhage, 80180 Unspecified State of Consciousness Y Open Fracture of Base of Skull With Other and Unspecified Intracranial Hemorrhage, No 80181 Loss of Consciousness Y Open Fracture of Base of Skull With Other and Unspecified Intracranial Hemorrhage, 80182 Brief (Less Than One Hour) Loss of Consciousness Y Open Fracture of Base of Skull With Other and Unspecified Intracranial Hemorrhage, 80183 Moderate (1-24 Hours) Loss of Consciousness Y Open Fracture of Base of Skull With Other and Unspecified Intracranial Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing 80184 Conscious Level Y Open Fracture of Base of Skull With Other and Unspecified Intracranial Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing 80185 Conscious Level Y Open Fracture of Base of Skull With Other and Unspecified Intracranial Hemorrhage, 80186 Loss of Consciousness of Unspecified Duration Y Open Fracture of Base of Skull With Other and Unspecified Intracranial Hemorrhage, 80189 Unspecified Concussion Y Open Fracture of Base of Skull With Intracranial Injury of Other and Unspecified Nature, 80190 Unspecified State of Consciousness Y Open Fracture of Base of Skull With Intracranial Injury of Other and Unspecified Nature, 80191 No Loss of Consciousness Y Open Fracture of Base of Skull With Intracranial Injury of Other and Unspecified Nature, 80192 Brief (Less Than One Hour) Loss of Consciousness Y Open Fracture of Base of Skull With Intracranial Injury of Other and Unspecified Nature, 80193 Moderate (1-24 Hours) Loss of Consciousness Y Open Fracture of Base of Skull With Intracranial Injury of Other and Unspecified Nature, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing 80194 Conscious Level Y Open Fracture of Base of Skull With Intracranial Injury of Other and Unspecified Nature, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing 80195 Conscious Level Y Open Fracture of Base of Skull With Intracranial Injury of Other and Unspecified Nature, 80196 Loss of Consciousness of Unspecified Duration Y Open Fracture of Base of Skull With Intracranial Injury of Other and Unspecified Nature, 80199 Unspecified Concussion Y 80220 Closed Fracture of Unspecified Site of Mandible Y 80221 Closed Fracture of Condylar Process of Mandible Y 80222 Closed Fracture of Subcondylar Process of Mandible Y 80223 Closed Fracture of Coronoid Process of Mandible Y 80224 Closed Fracture of Unspecified Part of Ramus of Mandible Y 80225 Closed Fracture of Angle of Jaw Y 80226 Closed Fracture of Symphysis of Body of Mandible Y 80227 Closed Fracture of Alveolar Border of Body of Mandible Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 246 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 80228 Closed Fracture of Other and Unspecified Part of Body of Mandible Y 80229 Closed Fracture of Multiple Sites of Mandible Y 80230 Open Fracture of Unspecified Site of Mandible Y 80231 Open Fracture of Condylar Process of Mandible Y 80232 Open Fracture of Subcondylar Process of Mandible Y 80233 Open Fracture of Coronoid Process of Mandible Y 80234 Open Fracture of Unspecified Part of Ramus of Mandible Y 80235 Open Fracture of Angle of Jaw Y 80236 Open Fracture of Symphysis of Body of Mandible Y 80237 Open Fracture of Alveolar Border of Body of Mandible Y 80238 Open Fracture of Other and Unspecified Part of Body of Mandible Y 80239 Open Fracture of Multiple Sites of Mandible Y Other Closed Skull Fracture Without Mention of Intracranial Injury, Unspecified State of 80300 Consciousness Y Other Closed Skull Fracture Without Mention of Intracranial Injury, No Loss of 80301 Consciousness Y Other Closed Skull Fracture Without Mention of Intracranial Injury, Brief (Less Than One 80302 Hour) Loss of Consciousness Y Other Closed Skull Fracture Without Mention of Intracranial Injury, Moderate (1-24 80303 Hours) Loss of Consciousness Y Other Closed Skull Fracture Without Mention of Intracranial Injury, Prolonged (More 80304 Than 24 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y

Other Closed Skull Fracture Without Mention of Intracranial Injury, Prolonged (More 80305 Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious Level Y Other Closed Skull Fracture Without Mention of Intracranial Injury, Loss of 80306 Consciousness of Unspecified Duration Y Other Closed Skull Fracture Without Mention of Intracranial Injury, Unspecified 80309 Concussion Y Other Closed Skull Fracture With Cerebral Laceration and Contusion, Unspecified State of 80310 Consciousness Y Other Closed Skull Fracture With Cerebral Laceration and Contusion, No Loss of 80311 Consciousness Y Other Closed Skull Fracture With Cerebral Laceration and Contusion, Brief (Less Than 80312 One Hour) Loss of Consciousness Y Other Closed Skull Fracture With Cerebral Laceration and Contusion, Moderate (1-24 80313 Hours) Loss of Consciousness Y Other Closed Skull Fracture With Cerebral Laceration and Contusion, Prolonged (More 80314 Than 24 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y

Other Closed Skull Fracture With Cerebral Laceration and Contusion, Prolonged (More 80315 Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious Level Y Other Closed Skull Fracture With Cerebral Laceration and Contusion, Loss of 80316 Consciousness of Unspecified Duration Y Other Closed Skull Fracture With Cerebral Laceration and Contusion, Unspecified 80319 Concussion Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 247 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Other Closed Skull Fracture With Subarachnoid, Subdural, and Extradural Hemorrhage, 80320 Unspecified State of Consciousness Y Other Closed Skull Fracture With Subarachnoid, Subdural, and Extradural Hemorrhage, 80321 No Loss of Consciousness Y Other Closed Skull Fracture With Subarachnoid, Subdural, and Extradural Hemorrhage, 80322 Brief (Less Than One Hour) Loss of Consciousness Y Other Closed Skull Fracture With Subarachnoid, Subdural, and Extradural Hemorrhage, 80323 Moderate (1-24 Hours) Loss of Consciousness Y Other Closed Skull Fracture With Subarachnoid, Subdural, and Extradural Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing 80324 Conscious Level Y Other Closed Skull Fracture With Subarachnoid, Subdural, and Extradural Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing 80325 Conscious Level Y Other Closed Skull Fracture With Subarachnoid, Subdural, and Extradural Hemorrhage, 80326 Loss of Consciousness of Unspecified Duration Y Other Closed Skull Fracture With Subarachnoid, Subdural, and Extradural Hemorrhage, 80329 Unspecified Concussion Y Other Closed Skull Fracture With Other and Unspecified Intracranial Hemorrhage, 80330 Unspecified State of Unconsciousness Y Other Closed Skull Fracture With Other and Unspecified Intracranial Hemorrhage, No 80331 Loss of Consciousness Y Other Closed Skull Fracture With Other and Unspecified Intracranial Hemorrhage, Brief 80332 (Less Than One Hour) Loss of Consciousness Y Other Closed Skull Fracture With Other and Unspecified Intracranial Hemorrhage, 80333 Moderate (1-24 Hours) Loss of Consciousness Y Other Closed Skull Fracture With Other and Unspecified Intracranial Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing 80334 Conscious Level Y Other Closed Skull Fracture With Other and Unspecified Intracranial Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing 80335 Conscious Level Y Other Closed Skull Fracture With Other and Unspecified Intracranial Hemorrhage, Loss of 80336 Consciousness of Unspecified Duration Y Other Closed Skull Fracture With Other and Unspecified Intracranial Hemorrhage, 80339 Unspecified Concussion Y Other Closed Skull Fracture With Intracranial Injury of Other and Unspecified Nature, 80340 Unspecified State of Consciousness Y Other Closed Skull Fracture With Intracranial Injury of Other and Unspecified Nature, No 80341 Loss of Consciousness Y Other Closed Skull Fracture With Intracranial Injury of Other and Unspecified Nature, 80342 Brief (Less Than One Hour) Loss of Consciousness Y Other Closed Skull Fracture With Intracranial Injury of Other and Unspecified Nature, 80343 Moderate (1-24 Hours) Loss of Consciousness Y Other Closed Skull Fracture With Intracranial Injury of Other and Unspecified Nature, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing 80344 Conscious Level Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 248 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Other Closed Skull Fracture With Intracranial Injury of Other and Unspecified Nature, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing 80345 Conscious Level Y Other Closed Skull Fracture With Intracranial Injury of Other and Unspecified Nature, 80346 Loss of Consciousness of Unspecified Duration Y Other Closed Skull Fracture With Intracranial Injury of Other and Unspecified Nature, 80349 Unspecified Concussion Y

80350 Other Open Skull Fracture Without Mention of Injury, State of Consciousness Unspecified Y Other Open Skull Fracture Without Mention of Intracranial Injury, No Loss of 80351 Consciousness Y Other Open Skull Fracture Without Mention of Intracranial Injury, Brief (Less Than One 80352 Hour) Loss of Consciousness Y Other Open Skull Fracture Without Mention of Intracranial Injury, Moderate (1-24 Hours) 80353 Loss of Consciousness Y Other Open Skull Fracture Without Mention of Intracranial Injury, Prolonged (More Than 80354 24 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y

Other Open Skull Fracture Without Mention of Intracranial Injury, Prolonged (More Than 80355 24 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious Level Y Other Open Skull Fracture Without Mention of Intracranial Injury, Loss of Consciousness 80356 of Unspecified Duration Y Other Open Skull Fracture Without Mention of Intracranial Injury, Unspecified 80359 Concussion Y Other Open Skull Fracture With Cerebral Laceration and Contusion, Unspecified State of 80360 Consciousness Y Other Open Skull Fracture With Cerebral Laceration and Contusion, No Loss of 80361 Consciousness Y Other Open Skull Fracture With Cerebral Laceration and Contusion, Brief (Less Than One 80362 Hour) Loss of Consciousness Y Other Open Skull Fracture With Cerebral Laceration and Contusion, Moderate (1-24 80363 Hours) Loss of Consciousness Y Other Open Skull Fracture With Cerebral Laceration and Contusion, Prolonged (More 80364 Than 24 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y

Other Open Skull Fracture With Cerebral Laceration and Contusion, Prolonged (More 80365 Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious Level Y Other Open Skull Fracture With Cerebral Laceration and Contusion, Loss of 80366 Consciousness of Unspecified Duration Y Other Open Skull Fracture With Cerebral Laceration and Contusion, Unspecified 80369 Concussion Y Other Open Skull Fracture With Subarachnoid, Subdural, and Extradural Hemorrhage, 80370 Unspecified State of Consciousness Y Other Open Skull Fracture With Subarachnoid, Subdural, and Extradural Hemorrhage, No 80371 Loss of Consciousness Y Other Open Skull Fracture With Subarachnoid, Subdural, and Extradural Hemorrhage, 80372 Brief (Less Than One Hour) Loss of Consciousness Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 249 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Other Open Skull Fracture With Subarachnoid, Subdural, and Extradural Hemorrhage, 80373 Moderate (1-24 Hours) Loss of Consciousness Y Other Open Skull Fracture With Subarachnoid, Subdural, and Extradural Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing 80374 Conscious Level Y Other Open Skull Fracture With Subarachnoid, Subdural, and Extradural Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing 80375 Conscious Level Y Other Open Skull Fracture With Subarachnoid, Subdural, and Extradural Hemorrhage, 80376 Loss of Consciousness of Unspecified Duration Y Other Open Skull Fracture With Subarachnoid, Subdural, and Extradural Hemorrhage, 80379 Unspecified Concussion Y Other Open Skull Fracture With Other and Unspecified Intracranial Hemorrhage, 80380 Unspecified State of Consciousness Y Other Open Skull Fracture With Other and Unspecified Intracranial Hemorrhage, No Loss 80381 of Consciousness Y Other Open Skull Fracture With Other and Unspecified Intracranial Hemorrhage, Brief 80382 (Less Than One Hour) Loss of Consciousness Y Other Open Skull Fracture With Other and Unspecified Intracranial Hemorrhage, 80383 Moderate (1-24 Hours) Loss of Consciousness Y Other Open Skull Fracture With Other and Unspecified Intracranial Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing 80384 Conscious Level Y Other Open Skull Fracture With Other and Unspecified Intracranial Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing 80385 Conscious Level Y Other Open Skull Fracture With Other and Unspecified Intracranial Hemorrhage, Loss of 80386 Consciousness of Unspecified Duration Y Other Open Skull Fracture With Other and Unspecified Intracranial Hemorrhage, 80389 Unspecified Concussion Y Other Open Skull Fracture With Intracranial Injury of Other and Unspecified Nature, 80390 Unspecified State of Consciousness Y Other Open Skull Fracture With Intracranial Injury of Other and Unspecified Nature, No 80391 Loss of Consciousness Y Other Open Skull Fracture With Intracranial Injury of Other and Unspecified Nature, Brief 80392 (Less Than One Hour) Loss of Consciousness Y Other Open Skull Fracture With Intracranial Injury of Other and Unspecified Nature, 80393 Moderate (1-24 Hours) Loss of Consciousness Y Other Open Skull Fracture With Intracranial Injury of Other and Unspecified Nature, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing 80394 Conscious Level Y Other Open Skull Fracture With Intracranial Injury of Other and Unspecified Nature, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing 80395 Conscious Level Y Other Open Skull Fracture With Intracranial Injury of Other and Unspecified Nature, Loss 80396 of Consciousness of Unspecified Duration Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 250 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Other Open Skull Fracture With Intracranial Injury of Other and Unspecified Nature, 80399 Unspecified Concussion Y Closed Fractures Involving Skull or Face With Other Bones, Without Mention of 80400 Intracranial Injury, Unspecified State of Consciousness Y Closed Fractures Involving Skull or Face With Other Bones, Without Mention of 80401 Intracranial Injury, No Loss of Consciousness Y Closed Fractures Involving Skull or Face With Other Bones, Without Mention of 80402 Intracranial Injury, Brief (Less Than One Hour) Loss of Consciousness Y Closed Fractures Involving Skull or Face With Other Bones, Without Mention of 80403 Intracranial Injury, Moderate (1-24 Hours) Loss of Consciousness Y Closed Fractures Involving Skull or Face With Other Bones, Without Mention or Intracranial Injury, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to 80404 Pre-Existing Conscious Level Y Closed Fractures Involving Skull of Face With Other Bones, Without Mention of Intracranial Injury, Prolonged (More Than 24 Hours) Loss of Consciousness, Without 80405 Return to Pre-Existing Conscious Level Y Closed Fractures Involving Skull of Face With Other Bones, Without Mention of 80406 Intracranial Injury, Loss of Consciousness of Unspecified Duration Y Closed Fractures Involving Skull of Face With Other Bones, Without Mention of 80409 Intracranial Injury, Unspecified Concussion Y Closed Fractures Involving Skull or Face With Other Bones, With Cerebral Laceration and 80410 Contusion, Unspecified State of Consciousness Y Closed Fractures Involving Skull or Face With Other Bones, With Cerebral Laceration and 80411 Contusion, No Loss of Consciousness Y Closed Fractures Involving Skull or Face With Other Bones, With Cerebral Laceration and 80412 Contusion, Brief (Less Than One Hour) Loss of Consciousness Y Closed Fractures Involving Skull or Face With Other Bones, With Cerebral Laceration and 80413 Contusion, Moderate (1-24 Hours) Loss of Consciousness Y Closed Fractures Involving Skull or Face With Other Bones, With Cerebral Laceration and Contusion, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre- 80414 Existing Conscious Level Y Closed Fractures Involving Skull or Face With Other Bones, With Cerebral Laceration and Contusion, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to 80415 Pre-Existing Conscious Level Y Closed Fractures Involving Skull or Face With Other Bones, With Cerebral Laceration and 80416 Contusion, Loss of Consciousness of Unspecified Duration Y Closed Fractures Involving Skull or Face With Other Bones, With Cerebral Laceration and 80419 Contusion, Unspecified Concussion Y Closed Fractures Involving Skull or Face With Other Bones With Subarachnoid, Subdural, 80420 and Extradural Hemorrhage, Unspecified State of Consciousness Y Closed Fractures Involving Skull or Face With Other Bones With Subarachnoid, Subdural, 80421 and Extradural Hemorrhage, No Loss of Consciousness Y

Closed Fractures Involving Skull or Face With Other Bones With Subarachnoid, Subdural, 80422 and Extradural Hemorrhage, Brief (Less Than One Hour) Loss of Consciousness Y Closed Fractures Involving Skull or Face With Other Bones With Subarachnoid, Subdural, 80423 and Extradural Hemorrhage, Moderate (1-24 Hours) Loss of Consciousness Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 251 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Closed Fractures Involving Skull or Face With Other Bones With Subarachnoid, Subdural, and Extradural Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness and 80424 Return to Pre-Existing Conscious Level Y Closed Fractures Involving Skull or Face With Other Bones With Subarachnoid, Subdural, and Extradural Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness, 80425 Without Return to Pre-Existing Conscious Level Y Closed Fractures Involving Skull or Face With Other Bones With Subarachnoid, Subdural, 80426 and Extradural Hemorrhage, Loss of Consciousness of Unspecified Duration Y Closed Fractures Involving Skull or Face With Other Bones With Subarachnoid, Subdural, 80429 and Extradural Hemorrhage, Unspecified Concussion Y Closed Fractures Involving Skull or Face With Other Bones, With Other and Unspecified 80430 Intracranial Hemorrhage, Unspecified State of Consciousness Y Closed Fractures Involving Skull or Face With Other Bones, With Other and Unspecified 80431 Intracranial Hemorrhage, No Loss of Consciousness Y

Closed Fractures Involving Skull or Face With Other Bones, With Other and Unspecified 80432 Intracranial Hemorrhage, Brief (Less Than One Hour) Loss of Consciousness Y Closed Fractures Involving Skull or Face With Other Bones, With Other and Unspecified 80433 Intracranial Hemorrrhage, Moderate (1-24 Hours) Loss of Consciousness Y Closed Fractures Involving Skull or Face With Other Bones, With Other and Unspecified Intracranial Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness and 80434 Return to Preexisting Conscious Level Y Closed Fractures Involving Skull or Face With Other Bones, With Other and Unspecified Intracranial Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness, 80435 Without Return to Pre-Existing Conscious Level Y Closed Fractures Involving Skull or Face With Other Bones, With Other and Unspecified 80436 Intracranial Hemorrhage, Loss of Consciousness of Unspecified Duration Y Closed Fractures Involving Skull or Face With Other Bones, With Other and Unspecified 80439 Intracranial Hemorrhage, Unspecified Concussion Y Closed Fractures Involving Skull or Face With Other Bones, With Intracranial Injury of 80440 Other and Unspecified Nature, Unspecified State of Consciousness Y Closed Fractures Involving Skull or Face With Other Bones, With Intracranial Injury of 80441 Other and Unspecified Nature, No Loss of Consciousness Y Closed Fractures Involving Skull or Face With Other Bones, With Intracranial Injury of 80442 Other and Unspecified Nature, Brief (Less Than One Hour) Loss of Consciousness Y Closed Fractures Involving Skull or Face With Other Bones, With Intracranial Injury of 80443 Other and Unspecified Nature, Moderate (1-24 Hours) Loss of Consciousness Y Closed Fractures Involving Skull or Face With Other Bones, With Intracranial Injury of Other and Unspecified Nature, Prolonged (More Than 24 Hours) Loss of Consciousness 80444 and Return to Pre-Existing Conscious Level Y Closed Fractures Involving Skull or Face With Other Bones, With Intracranial Injury of Other and Unspecified Nature, Prolonged (More Than 24 Hours) Loss of Consciousness, 80445 Without Return to Pre-Existing Conscious Level Y Closed Fractures Involving Skull or Face With Other Bones, With Intracranial Injury of 80446 Other and Unspecified Nature, Loss of Consciousness of Unspecified Duration Y Closed Fractures Involving Skull or Face With Other Bones, With Intracranial Injury of 80449 Other and Unspecified Nature, Unspecified Concussion Y Open Fractures Involving Skull or Face With Other Bones, Without Mention of 80450 Intracranial Injury, Unspecified State of Consciousness Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 252 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Open Fractures Involving Skull or Face With Other Bones, Without Mention of 80451 Intracranial Injury, No Loss of Consciousness Y Open Fractures Involving Skull or Face With Other Bones, Without Mention of 80452 Intracranial Injury, Brief (Less Than One Hour) Loss of Consciousness Y Open Fractures Involving Skull or Face With Other Bones, Without Mention of 80453 Intracranial Injury, Moderate (1-24 Hours) Loss of Consciousness Y Open Fractures Involving Skull or Face With Other Bones, Without Mention of Intracranial Injury, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to 80454 Pre-Existing Conscious Level Y Open Fractures Involving Skull or Face With Other Bones, Without Mention of Intracranial Injury, Prolonged (More Than 24 Hours) Loss of Consciousness, Without 80455 Return to Pre-Existing Conscious Level Y Open Fractures Involving Skull or Face With Other Bones, Without Mention of 80456 Intracranial Injury, Loss of Consciousness of Unspecified Duration Y Open Fractures Involving Skull or Face With Other Bones, Without Mention of 80459 Intracranial Injury, Unspecified Concussion Y Open Fractures Involving Skull or Face With Other Bones, With Cerebral Laceration and 80460 Contusion, Unspecified State of Consciousness Y Open Fractures Involving Skull or Face With Other Bones, With Cerebral Laceration and 80461 Contusion, No Loss of Consciousness Y Open Fractures Involving Skull or Face With Other Bones, With Cerebral Laceration and 80462 Contusion, Brief (Less Than One Hour) Loss of Consciousness Y Open Fractures Involving Skull or Face With Other Bones, With Cerebral Laceration and 80463 Contusion, Moderate (1-24 Hours) Loss of Consciousness Y Open Fractures Involving Skull or Face With Other Bones, With Cerebral Laceration and Contusion, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre- 80464 Existing Conscious Level Y Open Fractures Involving Skull or Face With Other Bones, With Cerebral Laceration and Contusion, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to 80465 Pre-Existing Conscious Level Y Open Fractures Involving Skull or Face With Other Bones, With Cerebral Laceration and 80466 Contusion, Loss of Consciousness of Unspecified Duration Y Open Fractures Involving Skull or Face With Other Bones, With Cerebral Laceration and 80469 Contusion, Unspecified Concussion Y Open Fractures Involving Skull or Face With Other Bones With Subarachnoid, Subdural, 80470 and Extradural Hemorrhage, Unspecified State of Consciousness Y Open Fractures Involving Skull or Face With Other Bones With Subarachnoid, Subdural, 80471 and Extradural Hemorrhage, No Loss of Consciousness Y

Open Fractures Involving Skull or Face With Other Bones With Subarachnoid, Subdural, 80472 and Extradural Hemorrhage, Brief (Less Than One Hour) Loss of Consciousness Y Open Fractures Involving Skull or Face With Other Bones With Subarachnoid, Subdural, 80473 and Extradural Hemorrhage, Moderate (1-24 Hours) Loss of Consciousness Y Open Fractures Involving Skull or Face With Other Bones With Subarachnoid, Subdural, and Extradural Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness and 80474 Return to Pre-Existing Conscious Level Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 253 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Open Fractures Involving Skull or Face With Other Bones With Subarachnoid, Subdural, and Extradural Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness, 80475 Without Return to Pre-Existing Conscious Level Y Open Fractures Involving Skull or Face With Other Bones With Subarachnoid, Subdural, 80476 and Extradural Hemorrhage, Loss of Consciousness of Unspecified Duration Y Open Fractures Involving Skull or Face With Other Bones With Subarachnoid, Subdural, 80479 and Extradural Hemorrhage, Unspecified Concussion Y Open Fractures Involving Skull or Face With Other Bones, With Other and Unspecified 80480 Intracranial Hemorrhage, Unspecified State of Consciousness Y Open Fractures Involving Skull or Face With Other Bones, With Other and Unspecified 80481 Intracranial Hemorrhage, No Loss of Consciousness Y Open Fractures Involving Skull or Face With Other Bones, With Other and Unspecified 80482 Intracranial Hemorrhage, Brief (Less Than One Hour) Loss of Consciousness Y Open Fractures Involving Skull or Face With Other Bones, With Other and Unspecified 80483 Intracranial Hemorrhage, Moderate (1-24 Hours) Loss of Consciousness Y Open Fractures Involving Skull or Face With Other Bones, With Other and Unspecified Intracranial Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness and 80484 Return to Pre-Existing Conscious Level Y Open Fractures Involving Skull or Face With Other Bones, With Other and Unspecified Intracranial Hemorrhage, Prolonged (More Than 24 Hours) Loss of Consciousness, 80485 Without Return to Pre-Existing Conscious Level Y Open Fractures Involving Skull or Face With Other Bones, With Other and Unspecified 80486 Intracranial Hemorrhage, Loss of Consciousness of Unspecified Duration Y Open Fractures Involving Skull or Face With Other Bones, With Other and Unspecified 80489 Intracranial Hemorrhage, Unspecified Concussion Y Open Fractures Involving Skull or Face With Other Bones, With Intracranial Injury of 80490 Other and Unspecified Nature, Unspecified State of Consciousness Y Open Fractures Involving Skull or Face With Other Bones, With Intracranial Injury of 80491 Other and Unspecified Nature, No Loss of Consciousness Y Open Fractures Involving Skull or Face With Other Bones, With Intracranial Injury of 80492 Other and Unspecified Nature, Brief (Less Than One Hour) Loss of Consciousness Y Open Fractures Involving Skull or Face With Other Bones, With Intracranial Injury of 80493 Other and Unspecified Nature, Moderate (1-24 Hours) Loss of Consciousness Y Open Fractures Involving Skull or Face With Other Bones, With Intracranial Injury of Other and Unspecified Nature, Prolonged (More Than 24 Hours) Loss of Consciousness 80494 and Return to Pre-Existing Conscious Level Y Open Fractures Involving Skull or Face With Other Bones, With Intracranial Injury of Other and Unspecified Nature, Prolonged (More Than 24 Hours) Loss of Consciousness, 80495 Without Return to Pre-Existing Level Y Open Fractures Involving Skull or Face With Other Bones, With Intracranial Injury of 80496 Other and Unspecified Nature, Loss of Consciousness of Unspecified Duration Y Open Fractures Involving Skull or Face With Other Bones, With Intracranial Injury of 80499 Other and Unspecified Nature, Unspecified Concussion Y Closed Fracture of Cervical Vertebra, Unspecified Level Without Mention of Spinal Cord 80500 Injury Y 80501 Closed Fracture of First Cervical Vertebra Without Mention of Spinal Cord Injury Y 80502 Closed Fracture of Second Cervical Vertebra Without Mention of Spinal Cord Injury Y 80503 Closed Fracture of Third Cervical Vertebra Without Mention of Spinal Cord Injury Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 254 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 80504 Closed Fracture of Fourth Cervical Vertebra Without Mention of Spinal Cord Injury Y 80505 Closed Fracture of Fifth Cervical Vertebra Without Mention of Spinal Cord Injury Y 80506 Closed Fracture of Sixth Cervical Vertebra Without Mention of Spinal Cord Injury Y 80507 Closed Fracture of Seventh Cervical Vertebra Without Mention of Spinal Cord Injury Y 80508 Closed Fracture of Multiple Cervical Vertebrae Without Mention of Spinal Cord Injury Y Open Fracture of Cervical Vertebra, Unspecified Level Without Mention of Spinal Cord 80510 Injury Y 80511 Open Fracture of First Cervical Vertebra Without Mention of Spinal Cord Injury Y 80512 Open Fracture of Second Cervical Vertebra Without Mention of Spinal Cord Injury Y 80513 Open Fracture of Third Cervical Vertebra Without Mention of Spinal Cord Injury Y 80514 Open Fracture of Fourth Cervical Vertebra Without Mention of Spinal Cord Injury Y 80515 Open Fracture of Fifth Cervical Vertebra Without Mention of Spinal Cord Injury Y 80516 Open Fracture of Sixth Cervical Vertebra Without Mention of Spinal Cord Injury Y 80517 Open Fracture of Seventh Cervical Vertebra Without Mention of Spinal Cord Injury Y 80518 Open Fracture of Multiple Cervical Vertebrae Without Mention of Spinal Cord Injury Y 80600 Closed Fracture of C1-C4 Level With Unspecified Spinal Cord Injury Y 80601 Closed Fracture of C1-C4 Level With Complete Lesion of Cord Y 80602 Closed Fracture of C1-C4 Level With Anterior Cord Syndrome Y 80603 Closed Fracture of C1-C4 Level With Central Cord Syndrome Y 80604 Closed Fracture of C1-C4 Level With Other Specified Spinal Cord Injury Y 80605 Closed Fracture of C5-C7 Level With Unspecified Spinal Cord Injury Y 80606 Closed Fracture of C5-C7 Level With Complete Lesion of Cord Y 80607 Closed Fracture of C5-C7 Level With Anterior Cord Syndrome Y 80608 Closed Fracture of C5-C7 Level With Central Cord Syndrome Y 80609 Closed Fracture of C5-C7 Level With Other Specified Spinal Cord Injury Y 80610 Open Fracture of C1-C4 Level With Unspecified Spinal Cord Injury Y 80611 Open Fracture of C1-C4 Level With Complete Lesion of Cord Y 80612 Open Fracture of C1-C4 Level With Anterior Cord Syndrome Y 80613 Open Fracture of C1-C4 Level With Central Cord Syndrome Y 80614 Open Fracture of C1-C4 Level With Other Specified Spinal Cord Injury Y 80615 Open Fracture of C5-C7 Level With Unspecified Spinal Cord Injury Y 80616 Open Fracture of C5-C7 Level With Complete Lesion of Cord Y 80617 Open Fracture of C5-C7 Level With Anterior Cord Syndrome Y 80618 Open Fracture of C5-C7 Level With Central Cord Syndrome Y 80619 Open Fracture of C5-C7 Level With Other Specified Spinal Cord Injury Y 80620 Closed Fracture of T1-T6 Level With Unspecified Spinal Cord Injury Y 80621 Closed Fracture of T1-T6 Level With Complete Lesion of Cord Y 80622 Closed Fracture of T1-T6 Level With Anterior Cord Syndrome Y 80623 Closed Fracture of T1-T6 Level With Central Cord Syndrome Y 80624 Closed Fracture of T1-T6 Level With Other Specified Spinal Cord Injury Y 80625 Closed Fracture of T7-T12 Level With Unspecified Spinal Cord Injury Y 80626 Closed Fracture of T7-T12 Level With Complete Lesion of Cord Y 80627 Closed Fracture of T7-T12 Level With Anterior Cord Syndrome Y 80628 Closed Fracture of T7-T12 Level With Central Cord Syndrome Y 80629 Closed Fracture of T7-T12 Level With Other Specified Spinal Cord Injury Y 80630 Open Fracture of T1-T6 Level With Unspecified Spinal Cord Injury Y 80631 Open Fracture of T1-T6 Level With Complete Lesion of Cord Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 255 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 80632 Open Fracture of T1-T6 Level With Anterior Cord Syndrome Y 80633 Open Fracture of T1-T6 Level With Central Cord Syndrome Y 80634 Open Fracture of T1-T6 Level With Other Specified Spinal Cord Injury Y 80635 Open Fracture of T7-T12 Level With Unspecified Spinal Cord Injury Y 80636 Open Fracture of T7-T12 Level With Complete Lesion of Cord Y 80637 Open Fracture of T7-T12 Level With Anterior Cord Syndrome Y 80638 Open Fracture of T7-T12 Level With Central Cord Syndrome Y 80639 Open Fracture of T7-T12 Level With Other Specified Spinal Cord Injury Y 80660 Closed Fracture of Sacrum and Coccyx With Unspecified Spinal Cord Injury Y 80661 Closed Fracture of Sacrum and Coccyx With Complete Cauda Equina Lesion Y 80662 Closed Fracture of Sacrum and Coccyx With Other Cauda Equina Injury Y 80669 Closed Fracture of Sacrum and Coccyx With Other Spinal Cord Injury Y 80670 Open Fracture of Sacrum and Coccyx With Unspecified Spinal Cord Injury Y 80671 Open Fracture of Sacrum and Coccyx With Complete Cauda Equina Lesion Y 80672 Open Fracture of Sacrum and Coccyx With Other Cauda Equina Injury Y 80679 Open Fracture of Sacrum and Coccyx With Other Spinal Cord Injury Y 80700 Closed Fracture of Rib(s), Unspecified Y 80701 Closed Fracture of One Rib Y 80702 Closed Fracture of Two Ribs Y 80703 Closed Fracture of Three Ribs Y 80704 Closed Fracture of Four Ribs Y 80705 Closed Fracture of Five Ribs Y 80706 Closed Fracture of Six Ribs Y 80707 Closed Fracture of Seven Ribs Y 80708 Closed Fracture of Eight or More Ribs Y 80709 Closed Fracture of Multiple Ribs, Unspecified Y 80710 Open Fracture of Rib(s), Unspecified Y 80711 Open Fracture of One Rib Y 80712 Open Fracture of Two Ribs Y 80713 Open Fracture of Three Ribs Y 80714 Open Fracture of Four Ribs Y 80715 Open Fracture of Five Ribs Y 80716 Open Fracture of Six Ribs Y 80717 Open Fracture of Seven Ribs Y 80718 Open Fracture of Eight or More Ribs Y 80719 Open Fracture of Multiple Ribs, Unspecified Y 80841 Closed Fracture of Ilium Y 80842 Closed Fracture of Ischium Y 80843 Multiple Closed Pelvic Fractures With Disruption of Pelvic Circle Y 80849 Closed Fracture of Other Specified Part of Pelvis Y 80851 Open Fracture of Ilium Y 80852 Open Fracture of Ischium Y 80853 Multiple Open Pelvic Fractures With Disruption of Pelvic Circle Y 80859 Open Fracture of Other Specified Part of Pelvis Y 81000 Unspecified Part of Closed Fracture of Clavicle Y 81001 Closed Fracture of Sternal End of Clavicle Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 256 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 81002 Closed Fracture of Shaft of Clavicle Y 81003 Closed Fracture of Acromial End of Clavicle Y 81010 Unspecified Part of Open Fracture of Clavicle Y 81011 Open Fracture of Sternal End of Clavicle Y 81012 Open Fracture of Shaft of Clavicle Y 81013 Open Fracture of Acromial End of Clavicle Y 81100 Closed Fracture of Unspecified Part of Scapula Y 81101 Closed Fracture of Acromial Process of Scapula Y 81102 Closed Fracture of Coracoid Process of Scapula Y 81103 Closed Fracture of Glenoid Cavity and Neck of Scapula Y 81109 Closed Fracture of Other Part of Scapula Y 81110 Open Fracture of Unspecified Part of Scapula Y 81111 Open Fracture of Acromial Process of Scapula Y 81112 Open Fracture of Coracoid Process Y 81113 Open Fracture of Glenoid Cavity and Neck of Scapula Y 81119 Open Fracture of Other Part of Scapula Y 81200 Closed Fracture of Unspecified Part of Upper End of Humerus Y 81201 Closed Fracture of Surgical Neck of Humerus Y 81202 Closed Fracture of Anatomical Neck of Humerus Y 81203 Closed Fracture of Greater Tuberosity of Humerus Y 81209 Other Closed Fractures of Upper End of Humerus Y 81210 Open Fracture of Unspecified Part of Upper End of Humerus Y 81211 Open Fracture of Surgical Neck of Humerus Y 81212 Open Fracture of Anatomical Neck of Humerus Y 81213 Open Fracture of Greater Tuberosity of Humerus Y 81219 Other Open Fracture of Upper End of Humerus Y 81220 Closed Fracture of Unspecified Part of Humerus Y 81221 Closed Fracture of Shaft of Humerus Y 81230 Open Fracture of Unspecified Part of Humerus Y 81231 Open Fracture of Shaft of Humerus Y 81240 Closed Fracture of Unspecified Part of Lower End of Humerus Y 81241 Closed Fracture of Supracondylar Humerus Y 81242 Closed Fracture of Lateral Condyle of Humerus Y 81243 Closed Fracture of Medial Condyle of Humerus Y 81244 Closed Fracture of Unspecified Condyle(s) of Humerus Y 81249 Other Closed Fracture of Lower End of Humerus Y 81250 Open Fracture of Unspecified Part of Lower End of Humerus Y 81251 Open Fracture of Supracondylar Humerus Y 81252 Open Fracture of Lateral Condyle of Humerus Y 81253 Open Fracture of Medial Condyle of Humerus Y 81254 Open Fracture of Unspecified Condyle(s) of Humerus Y 81259 Other Open Fracture of Lower End of Humerus Y 81300 Unspecified Fracture of Radius and Ulna, Upper End of Forearm, Closed Y 81301 Closed Fracture of Olecranon Process of Ulna Y 81302 Closed Fracture of Coronoid Process of Ulna Y 81303 Closed Monteggia’s Fracture Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 257 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 81304 Other and Unspecified Closed Fractures of Proximal End of Ulna (Alone) Y 81305 Closed Fracture of Head of Radius Y 81306 Closed Fracture of Neck of Radius Y 81307 Other and Unspecified Closed Fractures of Proximal End of Radius (Alone) Y 81308 Closed Fracture of Radius With Ulna, Upper End (Any Part) Y 81310 Unspecified Open Fracture of Upper End of Forearm Y 81311 Open Fracture of Olecranon Process of Ulna Y 81312 Open Fracture of Coronoid Process of Ulna Y 81313 Open Monteggia’s Fracture Y 81314 Other and Unspecified Open Fractures of Proximal End of Ulna (Alone) Y 81315 Open Fracture of Head of Radius Y 81316 Open Fracture of Neck of Radius Y 81317 Other and Unspecified Open Fractures of Proximal End of Radius (Alone) Y 81318 Open Fracture of Radius With Ulna, Upper End (Any Part) Y 81320 Unspecified Closed Fracture of Shaft of Radius or Ulna Y 81321 Closed Fracture of Shaft of Radius (Alone) Y 81322 Closed Fracture of Shaft of Ulna (Alone) Y 81323 Closed Fracture of Shaft of Radius With Ulna Y 81330 Unspecified Open Fracture of Shaft of Radius or Ulna Y 81331 Open Fracture of Shaft of Radius (Alone) Y 81332 Open Fracture of Shaft of Ulna (Alone) Y 81333 Open Fracture of Shaft of Radius With Ulna Y 81340 Unspecified Closed Fracture of Lower End of Forearm Y 81341 Closed Colles' Fracture Y 81342 Other Closed Fractures of Distal End of Radius (Alone) Y 81343 Closed Fracture of Distal End of Ulna (Alone) Y 81344 Closed Fracture of Lower End of Radius With Ulna Y 81345 Torus Fracture of Lower End of Radius Y 81350 Unspecified Open Fracture of Lower End of Forearm Y 81351 Open Colles' Fracture Y 81352 Other Open Fractures of Distal End of Radius (Alone) Y 81353 Open Fracture of Distal End of Ulna (Alone) Y 81354 Open Fracture of Lower End of Radius With Ulna Y 81380 Closed Fracture of Unspecified Part of Forearm Y 81381 Closed Fracture of Unspecified Part of Radius (Alone) Y 81382 Closed Fracture of Unspecified Part of Ulna (Alone) Y 81383 Closed Fracture of Unspecified Part of Radius With Ulna Y 81390 Open Fracture of Unspecified Part of Forearm Y 81391 Open Fracture of Unspecified Part of Radius (Alone) Y 81392 Open Fracture of Unspecified Part of Ulna (Alone) Y 81393 Open Fracture of Unspecified Part of Radius With Ulna Y 81400 Unspecified Closed Fracture of Carpal Bone Y 81401 Closed Fracture of Navicular (Scaphoid) Bone of Wrist Y 81402 Closed Fracture of Lunate (Semilunar) Bone of Wrist Y 81403 Closed Fracture of Triquetral (Cuneiform) Bone of Wrist Y 81404 Closed Fracture of Pisiform Bone of Wrist Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 258 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 81405 Closed Fracture of Trapezium Bone (Larger Multangular) of Wrist Y 81406 Closed Fracture of Trapezoid Bone (Smaller Multangular) of Wrist Y 81407 Closed Fracture of Capitate Bone (Os Magnum) of Wrist Y 81408 Closed Fracture of Hamate (Unciform) Bone of Wrist Y 81409 Closed Fracture of Other Bone of Wrist Y 81410 Unspecified Open Fracture of Carpal Bone Y 81411 Open Fracture of Navicular (Scaphoid) Bone of Wrist Y 81412 Open Fracture of Lunate (Semilunar) Bone of Wrist Y 81413 Open Fracture of Triquetral (Cuneiform) Bone of Wrist Y 81414 Open Fracture of Pisiform Bone of Wrist Y 81415 Open Fracture of Trapezium Bone (Larger Multangular) of Wrist Y 81416 Open Fracture of Trapezoid Bone (Smaller Multangular) of Wrist Y 81417 Open Fracture of Capitate Bone (Os Magnum) of Wrist Y 81418 Open Fracture of Hamate (Unciform) Bone of Wrist Y 81419 Open Fracture of Other Bone of Wrist Y 81500 Closed Fracture of Metacarpal Bone(s), Site Unspecified Y 81501 Closed Fracture of Base of Thumb (First) Metacarpal Bone(s) Y 81502 Closed Fracture of Base of Other Metacarpal Bone(s) Y 81503 Closed Fracture of Shaft of Metacarpal Bone(s) Y 81504 Closed Fracture of Neck of Metacarpal Bone(s) Y 81509 Closed Fracture of Multiple Sites of Metacarpus Y 81510 Open Fracture of Metacarpal Bone(s), Site Unspecified Y 81511 Open Fracture of Base of Thumb (First) Metacarpal Bone(s) Y 81512 Open Fracture of Base of Other Metacarpal Bone(s) Y 81513 Open Fracture of Shaft of Metacarpal Bone(s) Y 81514 Open Fracture of Neck of Metacarpal Bone(s) Y 81519 Open Fracture of Multiple Sites of Metacarpus Y 81600 Closed Fracture of Unspecified Phalanx or Phalanges of Hand Y 81601 Closed Fracture of Middle or Proximal Phalanx or Phalanges of Hand Y 81602 Closed Fracture of Distal Phalanx or Phalanges of Hand Y 81603 Closed Fracture of Multiple Sites of Phalanx or Phalanges of Hand Y 81610 Open Fracture of Phalanx or Phalanges of Hand, Unspecified Y 81611 Open Fracture of Middle or Proximal Phalanx or Phalanges of Hand Y 81612 Open Fracture of Distal Phalanx or Phalanges of Hand Y 81613 Open Fractures of Multiple Sites of Phalanx or Phalanges of Hand Y 82000 Closed Fracture of Unspecified Intracapsular Section of Neck of Femur Y 82001 Closed Fracture of Epiphysis (Separation) (Upper) of Neck of Femur Y 82002 Closed Fracture of Midcervical Section of Femur Y 82003 Closed Fracture of Base of Neck of Femur Y 82009 Other Closed Transcervical Fracture of Femur Y 82010 Open Fracture of Unspecified Intracapsular Section of Neck of Femur Y 82011 Open Fracture of Epiphysis (Separation) (Upper) of Neck of Femur Y 82012 Open Fracture of Midcervical Section of Femur Y 82013 Open Fracture of Base of Neck of Femur Y 82019 Other Open Transcervical Fracture of Femur Y 82020 Closed Fracture of Unspecified Trochanteric Section of Femur Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 259 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 82021 Closed Fracture of Intertrochanteric Section of Femur Y 82022 Closed Fracture of Subtrochanteric Section of Femur Y 82030 Open Fracture of Unspecified Trochanteric Section of Femur Y 82031 Open Fracture of Intertrochanteric Section of Femur Y 82032 Open Fracture of Subtrochanteric Section of Femur Y 82100 Closed Fracture of Unspecified Part of Femur Y 82101 Closed Fracture of Shaft of Femur Y 82110 Open Fracture of Unspecified Part of Femur Y 82111 Open Fracture of Shaft of Femur Y 82120 Closed Fracture of Unspecified Part of Lower End of Femur Y 82121 Closed Fracture of Femoral Condyle Y 82122 Closed Fracture of Lower Epiphysis of Femur Y 82123 Closed Supracondylar Fracture of Femur Y 82129 Other Closed Fracture of Lower End of Femur Y 82130 Open Fracture of Unspecified Part of Lower End of Femur Y 82131 Open Fracture of Femoral Condyle Y 82132 Open Fracture of Lower Epiphysis of Femur Y 82133 Open Supracondylar Fracture of Femur Y 82139 Other Open Fracture of Lower End of Femur Y 82300 Closed Fracture of Upper End of Tibia Y 82301 Closed Fracture of Upper End of Fibula Y 82302 Closed Fracture of Upper End of Fibula With Tibia Y 82310 Open Fracture of Upper End of Tibia Y 82311 Open Fracture of Upper End of Fibula Y 82312 Open Fracture of Upper End of Fibula With Tibia Y 82320 Closed Fracture of Shaft of Tibia Y 82321 Closed Fracture of Shaft of Fibula Y 82322 Closed Fracture of Shaft of Fibula With Tibia Y 82330 Open Fracture of Shaft of Tibia Y 82331 Open Fracture of Shaft of Fibula Y 82332 Open Fracture of Shaft of Fibula With Tibia Y 82340 Torus Fracture of Tibia Alone Y 82341 Torus Fracture of Fibula Alone Y 82342 Torus Fracture of Fibula With Tibia Y 82380 Closed Fracture of Unspecified Part of Tibia Y 82381 Closed Fracture of Unspecified Part of Fibula Y 82382 Closed Fracture of Unspecified Part of Fibula With Tibia Y 82390 Open Fracture of Unspecified Part of Tibia Y 82391 Open Fracture of Unspecified Part of Fibula Y 82392 Open Fracture of Unspecified Part of Fibula With Tibia Y 82520 Closed Fracture of Unspecified Bone(s) of Foot (Except Toes) Y 82521 Closed Fracture of Astragalus Y 82522 Closed Fracture of Navicular (Scaphoid) Bone of Foot Y 82523 Closed Fracture of Cuboid Bone Y 82524 Closed Fracture of Cuneiform Bone of Foot Y 82525 Closed Fracture of Metatarsal Bone(s) Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 260 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 82529 Other Closed Fracture of Tarsal and Metatarsal Bones Y 82530 Open Fracture of Unspecified Bone(s) of Foot (Except Toes) Y 82531 Open Fracture of Astragalus Y 82532 Open Fracture of Navicular (Scaphoid) Bone of Foot Y 82533 Open Fracture of Cuboid Bone Y 82534 Open Fracture of Cuneiform Bone of Foot, Y 82535 Open Fracture of Metatarsal Bone(s) Y 82539 Other Open Fractures of Tarsal and Metatarsal Bones Y 83100 Closed Dislocation of Shoulder, Unspecified Site Y 83101 Closed Anterior Dislocation of Humerus Y 83102 Closed Posterior Dislocation of Humerus Y 83103 Closed Inferior Dislocation of Humerus Y 83104 Closed Dislocation of Acromioclavicular (Joint) Y 83109 Closed Dislocation of Other Site of Shoulder Y 83110 Open Unspecified Dislocation of Shoulder Y 83111 Open Anterior Dislocation of Humerus Y 83112 Open Posterior Dislocation of Humerus Y 83113 Open Inferior Dislocation of Humerus Y 83114 Open Dislocation of Acromioclavicular (Joint) Y 83119 Open Dislocation of Other Site of Shoulder Y 83200 Closed Unspecified Dislocation of Elbow Y 83201 Closed Anterior Dislocation of Elbow Y 83202 Closed Posterior Dislocation of Elbow Y 83203 Closed Medial Dislocation of Elbow Y 83204 Closed Lateral Dislocation of Elbow Y 83209 Closed Dislocation of Other Site of Elbow Y 83210 Open Unspecified Dislocation of Elbow Y 83211 Open Anterior Dislocation of Elbow Y 83212 Open Posterior Dislocation of Elbow Y 83213 Open Medial Dislocation of Elbow Y 83214 Open Lateral Dislocation of Elbow Y 83219 Open Dislocation of Other Site of Elbow Y 83300 Closed Dislocation of Wrist, Unspecified Part Y 83301 Closed Dislocation of Distal Radioulnar (Joint) Y 83302 Closed Dislocation of Radiocarpal (Joint) Y 83303 Closed Dislocation of Midcarpal (Joint) Y 83304 Closed Dislocation of Carpometacarpal (Joint) Y 83305 Closed Dislocation of Proximal End of Metacarpal (Bone) Y 83309 Closed Dislocation of Other Part of Wrist Y 83310 Open Dislocation of Wrist, Unspecified Part Y 83311 Open Dislocation of Distal Radioulnar (Joint) Y 83312 Open Dislocation of Radiocarpal (Joint) Y 83313 Open Dislocation of Midcarpal (Joint) Y 83314 Open Dislocation of Carpometacarpal (Joint) Y 83315 Open Dislocation of Proximal End of Metacarpal (Bone) Y 83319 Open Dislocation of Other Part of Wrist Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 261 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 83400 Closed Dislocation of Finger, Unspecified Part Y 83401 Closed Dislocation of Metacarpophalangeal (Joint) Y 83402 Closed Dislocation of Interphalangeal (Joint), Hand Y 83410 Open Dislocation of Finger, Unspecified Part Y 83411 Open Dislocation of Metacarpophalangeal (Joint) Y 83412 Open Dislocation Interphalangeal (Joint), Hand Y 83500 Closed Dislocation of Hip, Unspecified Site Y 83501 Closed Posterior Dislocation of Hip Y 83502 Closed Obturator Dislocation of Hip Y 83503 Other Closed Anterior Dislocation of Hip Y 83510 Open Dislocation of Hip, Unspecified Site Y 83511 Open Posterior Dislocation of Hip Y 83512 Open Obturator Dislocation of Hip Y 83513 Other Open Anterior Dislocation of Hip Y 83650 Closed Dislocation of Knee, Unspecified Part Y 83651 Closed Anterior Dislocation of Tibia, Proximal End Y 83652 Closed Posterior Dislocation of Tibia, Proximal End Y 83653 Closed Medial Dislocation of Tibia, Proximal End Y 83654 Closed Lateral Dislocation of Tibia, Proximal End Y 83659 Other Closed Dislocation of Knee Y 83660 Open Dislocation of Knee Unspecified Part Y 83661 Open Anterior Dislocation of Tibia, Proximal End Y 83662 Open Posterior Dislocation of Tibia, Proximal End Y 83663 Open Medial Dislocation of Tibia, Proximal End Y 83664 Open Lateral Dislocation of Tibia, Proximal End Y 83669 Other Open Dislocation of Knee Y 83800 Closed Dislocation of Foot, Unspecified Part Y 83801 Closed Dislocation of Tarsal (Bone), Joint Unspecified Y 83802 Closed Dislocation of Midtarsal (Joint) Y 83803 Closed Dislocation of Tarsometatarsal (Joint) Y 83804 Closed Dislocation of Metatarsal (Bone), Joint Unspecified Y 83805 Closed Dislocation of Metatarsophalangeal (Joint) Y 83806 Closed Dislocation of Interphalangeal (Joint), Foot Y 83809 Closed Dislocation of Other Part of Foot Y 83810 Open Dislocation of Foot, Unspecified Part Y 83811 Open Dislocation of Tarsal (Bone), Joint Unspecified Y 83812 Open Dislocation of Midtarsal (Joint) Y 83813 Open Dislocation of Tarsometatarsal (Joint) Y 83814 Open Dislocation of Metatarsal (Bone), Joint Unspecified Y 83815 Open Dislocation of Metatarsophalangeal (Joint) Y 83816 Open Dislocation of Interphalangeal (Joint), Foot Y 83819 Open Dislocation of Other Part of Foot Y 83900 Closed Dislocation, Unspecified Cervical Vertebra Y 83901 Closed Dislocation, First Cervical Vertebra Y 83902 Closed Dislocation, Second Cervical Vertebra Y 83903 Closed Dislocation, Third Cervical Vertebra Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 262 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 83904 Closed Dislocation, Fourth Cervical Vertebra Y 83905 Closed Dislocation, Fifth Cervical Vertebra Y 83906 Closed Dislocation, Sixth Cervical Vertebra Y 83907 Closed Dislocation, Seventh Cervical Vertebra Y 83908 Closed Dislocation, Multiple Cervical Vertebrae Y 83910 Open Dislocation, Unspecified Cervical Vertebra Y 83911 Open Dislocation, First Cervical Vertebra Y 83912 Open Dislocation, Second Cervical Vertebra Y 83913 Open Dislocation, Third Cervical Vertebra Y 83914 Open Dislocation, Fourth Cervical Vertebra Y 83915 Open Dislocation, Fifth Cervical Vertebra Y 83916 Open Dislocation, Sixth Cervical Vertebra Y 83917 Open Dislocation, Seventh Cervical Vertebra Y 83918 Open Dislocation, Multiple Cervical Vertebrae Y 83920 Closed Dislocation, Lumbar Vertebra Y 83921 Closed Dislocation, Thoracic Vertebra Y 83930 Open Dislocation, Lumbar Vertebra Y 83931 Open Dislocation, Thoracic Vertebra Y 83940 Closed Dislocation, Vertebra, Unspecified Site Y 83941 Closed Dislocation, Coccyx Y 83942 Closed Dislocation, Sacrum Y 83949 Closed Dislocation, Other Vertebra Y 83950 Open Dislocation, Vertebra, Unspecified Site Y 83951 Open Dislocation, Coccyx Y 83952 Open Dislocation, Sacrum Y 83959 Open Dislocation, Other Vertebra Y 83961 Closed Dislocation, Sternum Y 83969 Closed Dislocation, Other Location Y 83971 Open Dislocation, Sternum Y 83979 Open Dislocation, Other Location Y 84200 Sprain and Strain of Unspecified Site of Wrist Y 84201 Sprain and Strain of Carpal (Joint) of Wrist Y 84202 Sprain and Strain of Radiocarpal (Joint) (Ligament) of Wrist Y 84209 Other Wrist Sprain and Strain Y 84210 Sprain and Strain of Unspecified Site of Hand Y 84211 Sprain and Strain of Carpometacarpal (Joint) of Hand Y 84212 Sprain and Strain of Metacarpophalangeal (Joint) of Hand Y 84213 Sprain and Strain of Interphalangeal (Joint) of Hand Y 84219 Other Hand Sprain and Strain Y 84500 Unspecified Site of Ankle Sprain and Strain Y 84501 Sprain and Strain of Deltoid (Ligament) of Ankle Y 84502 Sprain and Strain of Calcaneofibular (Ligament) Y 84503 Sprain and Strain of Tibiofibular (Ligament) Y 84509 Other Ankle Sprain and Strain Y 84510 Sprain and Strain of Unspecified Site of Foot Y 84511 Sprain and Strain of Tarsometatarsal (Joint) (Ligament) Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 263 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 84512 Sprain and Strain of Metatarsaophalangeal (Joint) Y 84513 Sprain and Strain of Interphalangeal (Joint), of Toe Y 84519 Other Foot Sprain and Strain Y 84840 Sprain and Strain of Sternum, Unspecified Part Y 84841 Sprain and Strain of Sternoclavicular (Joint) (Ligament) Y 84842 Sprain and Strain of Chondrosternal (Joint) Y 84849 Other Sprain and Strains of Sternum Y 85011 Concussion, With Loss of Consciousness of 30 Minutes or Less Y 85012 Concussion, With Loss of Consciousness 31 to 59 Minutes Y Cortex (Cerebral) Contusion Without Mention of Open Intracranial Wound, State of 85100 Consciousness Unspecified Y Cortex (Cerebral) Contusion Without Mention of Open Intracranial Wound, No Loss of 85101 Consciousness Y Cortex (Cerebral) Contusion Without Mention of Open Intracranial Wound, Brief (Less 85102 Than 1 Hour) Loss of Consciousness Y Cortex (Cerebral) Contusion Without Mention of Open Intracranial Wound, Moderate (1- 85103 24 Hours) Loss of Consciousness Y Cortex (Cerebral) Contusion Without Mention of Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre-Exisiting Conscious 85104 Level Y Cortex (Cerebral) Contusion Without Mention of Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious 85105 Level Y Cortex (Cerebral) Contusion Without Mention of Open Intracranial Wound, Loss of 85106 Consciousness of Unspecified Duration Y Cortex (Cerebral) Contusion Without Mention of Open Intracranial Wound, Unspecified 85109 Concussion Y Cortex (Cerebral) Contusion With Open Intracranial Wound, Unspecified State of 85110 Consciousness Y 85111 Cortex (Cerebral) Contusion With Open Intracranial Wound, No Loss of Consciousness Y Cortex (Cerebral) Contusion With Open Intracranial Wound, Brief (Less Than 1 Hour) 85112 Loss of Consciousness Y Cortex (Cerebral) Contusion With Open Intracranial Wound, Moderate (1-24 Hours) Loss 85113 of Consciousness Y Cortex (Cerebral) Contusion With Open Intracranial Wound, Prolonged (More Than 24 85114 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y Cortex (Cerebral) Contusion With Open Intracranial Wound, Prolonged (More Than 24 85115 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious Level Y Cortex (Cerebral) Contusion With Open Intracranial Wound, Loss of Consciousness of 85116 Unspecified Duration Y 85119 Cortex (Cerebral) Contusion With Open Intracranial Wound, Unspecified Concussion Y Cortex (Cerebral) Laceration Without Mention of Open Intracranial Wound, Unspecified 85120 State of Consciousness Y Cortex (Cerebral) Laceration Without Mention of Open Intracranial Wound, No Loss of 85121 Consciousness Y Cortex (Cerebral) Laceration Without Mention of Open Intracranial Wound, Brief (Less 85122 Than 1 Hour) Loss of Consciousness Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 264 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Cortex (Cerebral) Laceration Without Mention of Open Intracranial Wound, Moderate (1- 85123 24 Hours) Loss of Consciousness Y

Cortex (Cerebral) Laceration Without Mention of Open Intracranial Wound, Prolonged 85124 (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y Cortex (Cerebral) Laceration Without Mention of Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious 85125 Level Y Cortex (Cerebral) Laceration Without Mention of Open Intracranial Wound, Loss of 85126 Consciousness of Unspecified Duration Y Cortex (Cerebral) Laceration Without Mention of Open Intracranial Wound, Unspecified 85129 Concussion Y Cortex (Cerebral) Laceration With Open Intracranial Wound, Unspecified State of 85130 Consciousness Y 85131 Cortex (Cerebral) Laceration With Open Intracranial Wound, No Loss of Consciousness Y Cortex (Cerebral) Laceration With Open Intracranial Wound, Brief (Less Than 1 Hour) 85132 Loss of Consciousness Y Cortex (Cerebral) Laceration With Open Intracranial Wound, Moderate (1-24 Hours) Loss 85133 of Consciousness Y Cortex (Cerebral) Laceration With Open Intracranial Wound, Prolonged (More Than 24 85134 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y Cortex (Cerebral) Laceration With Open Intracranial Wound, Prolonged (More Than 24 85135 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious Level Y Cortex (Cerebral) Laceration With Open Intracranial Wound, Loss of Consciousness of 85136 Unspecified Duration Y 85139 Cortex (Cerebral) Laceration With Open Intracranial Wound, Unspecified Concussion Y Cerebellar or Brain Stem Contusion Without Mention of Open Intracranial Wound, 85140 Unspecified State of Consciousness Y Cerebellar or Brain Stem Contusion Without Mention of Open Intracranial Wound, No 85141 Loss of Consciousness Y Cerebellar or Brain Stem Contusion Without Mention of Open Intracranial Wound, Brief 85142 (Less Than 1 Hour) Loss of Consciousness Y Cerebellar or Brain Stem Contusion Without Mention of Open Intracranial Wound, 85143 Moderate (1-24 Hours) Loss of Consciousness Y Cerebellar or Brain Stem Contusion Without Mention of Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss Consciousness and Return to Pre-Existing 85144 Conscious Level Y Cerebellar or Brain Stem Contusion Without Mention of Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing 85145 Conscious Level Y Cerebellar or Brain Stem Contusion Without Mention of Open Intracranial Wound, Loss 85146 of Consciousness of Unspecified Duration Y Cerebellar or Brain Stem Contusion Without Mention of Open Intracranial Wound, 85149 Unspecified Concussion Y Cerebellar or Brain Stem Contusion With Open Intracranial Wound, Unspecified State of 85150 Consciousness Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 265 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Cerebellar or Brain Stem Contusion With Open Intracranial Wound, No Loss of 85151 Consciousness Y Cerebellar or Brain Stem Contusion With Open Intracranial Wound, Brief (Less Than 1 85152 Hour) Loss of Consciousness Y Cerebellar or Brain Stem Contusion With Open Intracranial Wound, Moderate (1-24 85153 Hours) Loss of Consciousness Y Cerebellar or Brain Stem Contusion With Open Intracranial Wound, Prolonged (More 85154 Than 24 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y

Cerebellar or Brain Stem Contusion With Open Intracranial Wound, Prolonged (More 85155 Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious Level Y Cerebellar or Brain Stem Contusion With Open Intracranial Wound, Loss of 85156 Consciousness of Unspecified Duration Y Cerebellar or Brain Stem Contusion With Open Intracranial Wound, Unspecified 85159 Concussion Y Cerebellar or Brain Stem Laceration Without Mention of Open Intracranial Wound, 85160 Unspecified State of Consciousness Y Cerebellar or Brain Stem Laceration Without Mention of Open Intracranial Wound, No 85161 Loss of Consciousness Y Cerebellar or Brain Stem Laceration Without Mention of Open Intracranial Wound, Brief 85162 (Less Than 1 Hour) Loss of Consciousness Y Cerebellar or Brain Stem Laceration Without Mention of Open Intracranial Wound, 85163 Moderate (1-24 Hours) Loss of Consciousness Y Cerebellar or Brain Stem Laceration Without Mention of Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing 85164 Conscious Leve Y Cerebellar or Brain Stem Laceration Without Mention of Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing 85165 Conscious Level Y Cerebellar or Brain Stem Laceration Without Mention of Open Intracranial Wound, Loss 85166 of Consciousness of Unspecified Duration Y Cerebellar or Brain Stem Laceration Without Mention of Open Intracranial Wound, 85169 Unspecified Concussion Y Cerebellar or Brain Stem Laceration With Open Intracranial Wound, State of 85170 Consciousness Unspecified Y Cerebellar or Brain Stem Laceration With Open Intracranial Wound, No Loss of 85171 Consciousness Y Cerebellar or Brain Stem Laceration With Open Intracranial Wound, Brief (Less Than One 85172 Hour) Loss of Consciousness Y Cerebellar or Brain Stem Laceration With Open Intracranial Wound, Moderate (1-24 85173 Hours) Loss of Consciousness Y Cerebellar or Brain Stem Laceration With Open Intracranial Wound, Prolonged (More 85174 Than 24 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y

Cerebellar or Brain Stem Laceration With Open Intracranial Wound, Prolonged (More 85175 Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious Level Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 266 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Cerebellar or Brain Stem Laceration With Open Intracranial Wound, Loss of 85176 Consciousness of Unspecified Duration Y Cerebellar or Brain Stem Laceration With Open Intracranial Wound, Unspecified 85179 Concussion Y Other and Unspecified Cerebral Laceration and Contusion, Without Mention of Open 85180 Intracranial Wound, Unspecified State of Consciousness Y Other and Unspecified Cerebral Laceration and Contusion, Without Mention of Open 85181 Intracranial Wound, No Loss of Consciousness Y Other and Unspecified Cerebral Laceration and Contusion, Without Mention of Open 85182 Intracranial Wound, Brief (Less Than 1 Hour) Loss of Consciousness Y Other and Unspecified Cerebral Laceration and Contusion, Without Mention of Open 85183 Intracranial Wound, Moderate (1-24 Hours) Loss of Consciousness Y Other and Unspecified Cerebral Laceration and Contusion, Without Mention of Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness and Return 85184 to Preexisting Conscious Level Y Other and Unspecified Cerebral Laceration and Contusion, Without Mention of Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness, Without 85185 Return to Pre-Existing Conscious Level Y Other and Unspecified Cerebral Laceration and Contusion, Without Mention of Open 85186 Intracranial Wound, Loss of Consciousness of Unspecified Duration Y Other and Unspecified Cerebral Laceration and Contusion, Without Mention of Open 85189 Intracranial Wound, Unspecified Concussion Y Other and Unspecified Cerebral Laceration and Contusion, With Open Intracranial 85190 Wound, Unspecified State of Consciousness Y Other and Unspecified Cerebral Laceration and Contusion, With Open Intracranial 85191 Wound, No Loss of Consciousness Y Other and Unspecified Cerebral Laceration and Contusion, With Open Intracranial 85192 Wound, Brief (Less Than 1 Hour) Loss of Consciousness Y Other and Unspecified Cerebral Laceration and Contusion, With Open Intracranial 85193 Wound, Moderate (1-24 Hours) Loss of Consciousness Y Other and Unspecified Cerebral Laceration and Contusion, With Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre- 85194 Existing Conscious Level Y Other and Unspecified Cerebral Laceration and Contusion, With Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre- 85195 Existing Conscious Level Y Other and Unspecified Cerebral Laceration and Contusion, With Open Intracranial 85196 Wound, Loss of Consciousness of Unspecified Duration Y Other and Unspecified Cerebral Laceration and Contusion, With Open Intracranial 85199 Wound, Unspecified Concussion Y Subarachnoid Hemorrhage Following Injury, Without Mention of Open Intracranial 85200 Wound, Unspecified State of Consciousness Y Subarachnoid Hemorrhage Following Injury, Without Mention of Open Intracranial 85201 Wound, No Loss of Consciousness Y Subarachnoid Hemorrhage Following Injury, Without Mention of Open Intracranial 85202 Wound, Brief (Less Than 1 Hour) Loss of Consciousness Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 267 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Subarachnoid Hemorrhage Following Injury, Without Mention of Open Intracranial 85203 Wound, Moderate (1-24 Hours) Loss of Consciousness Y Subarachnoid Hemorrhage Following Injury, Without Mention of Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre- 85204 Existing Conscious Level Y Subarachnoid Hemorrhage Following Injury, Without Mention of Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre- 85205 Existing Conscious Level Y Subarachnoid Hemorrhage Following Injury, Without Mention of Open Intracranial 85206 Wound, Loss of Consciousness of Unspecified Duration Y Subarachnoid Hemorrhage Following Injury, Without Mention of Open Intracranial 85209 Wound, Unspecified Concussion Y Subarachnoid Hemorrhage Following Injury, With Open Intracranial Wound, Unspecified 85210 State of Consciousness Y Subarachnoid Hemorrhage Following Injury, With Open Intracranial Wound, No Loss of 85211 Consciousness Y Subarachnoid Hemorrhage Following Injury, With Open Intracranial Wound, Brief (Less 85212 Than 1 Hour) Loss of Consciousness Y Subarachnoid Hemorrhage Following Injury, With Open Intracranial Wound, Moderate 85213 (1-24 Hours) Loss of Consciousness Y

Subarachnoid Hemorrhage Following Injury, With Open Intracranial Wound, Prolonged 85214 (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y Subarachnoid Hemorrhage Following Injury, With Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious 85215 Level Y Subarachnoid Hemorrhage Following Injury, With Open Intracranial Wound, Loss of 85216 Consciousness of Unspecified Duration Y Subarachnoid Hemorrhage Following Injury, With Open Intracranial Wound, Unspecified 85219 Concussion Y Subdural Hemorrhage Following Injury, Without Mention of Open Intracranial Wound, 85220 Unspecified State of Consciousness Y Subdural Hemorrhage Following Injury, Without Mention of Open Intracranial Wound, 85221 No Loss of Consciousness Y Subdural Hemorrhage Following Injury, Without Mention of Open Intracranial Wound, 85222 Brief (Less Than One Hour) Loss of Consciousness Y Subdural Hemorrhage Following Injury, Without Mention of Open Intracranial Wound, 85223 Moderate (1-24 Hours) Loss of Consciousness Y Subdural Hemorrhage Following Injury, Without Mention of Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing 85224 Conscious Level Y Subdural Hemorrhage Following Injury, Without Mention of Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing 85225 Conscious Level Y Subdural Hemorrhage Following Injury, Without Mention of Open Intracranial Wound, 85226 Loss of Consciousness of Unspecified Duration Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 268 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Subdural Hemorrhage Following Injury, Without Mention of Open Intracranial Wound, 85229 Unspecified Concussion Y Subdural Hemorrhage Following Injury, With Open Intracranial Wound, State of 85230 Consciousness Unspecified Y Subdural Hemorrhage Following Injury, With Open Intracranial Wound, No Loss of 85231 Consciousness Y Subdural Hemorrhage Following Injury, With Open Intracranial Wound, Brief (Less Than 85232 1 Hour) Loss of Consciousness Y Subdural Hemorrhage Following Injury, With Open Intracranial Wound, Moderate (1-24 85233 Hours) Loss of Consciousness Y

Subdural Hemorrhage Following Injury, With Open Intracranial Wound, Prolonged (More 85234 Than 24 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y

Subdural Hemorrhage Following Injury, With Open Intracranial Wound, Prolonged (More 85235 Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious Level Y Subdural Hemorrhage Following Injury, With Open Intracranial Wound, Loss of 85236 Consciousness of Unspecified Duration Y Subdural Hemorrhage Following Injury, With Open Intracranial Wound, Unspecified 85239 Concussion Y Extradural Hemorrhage Following Injury, Without Mention of Open Intracranial Wound, 85240 Unspecified State of Consciousness Y Extradural Hemorrhage Following Injury, Without Mention of Open Intracranial Wound, 85241 No Loss of Consciousness Y Extradural Hemorrhage Following Injury, Without Mention of Open Intracranial Wound, 85242 Brief (Less Than 1 Hour) Loss of Consciousness Y Extradural Hemorrhage Following Injury, Without Mention of Open Intracranial Wound, 85243 Moderate (1-24 Hours) Loss of Consciousness Y Extradural Hemorrhage Following Injury, Without Mention of Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing 85244 Conscious Level Y Extradural Hemorrhage Following Injury, Without Mention of Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing 85245 Conscious Level Y Extradural Hemorrhage Following Injury, Without Mention of Open Intracranial Wound, 85246 Loss of Consciousness of Unspecified Duration Y Extradural Hemorrhage Following Injury, Without Mention of Open Intracranial Wound, 85249 Unspecified Concussion Y Extradural Hemorrhage Following Injury, With Open Intracranial Wound, State of 85250 Consciousness Unspecified Y Extradural Hemorrhage Following Injury, With Open Intracranial Wound, No Loss of 85251 Consciousness Y Extradural Hemorrhage Following Injury, With Open Intracranial Wound, Brief (Less 85252 Than 1 Hour) Loss of Consciousness Y Extradural Hemorrhage Following Injury, With Open Intracranial Wound, Moderate (1-24 85253 Hours) Loss of Consciousness Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 269 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator

Extradural Hemorrhage Following Injury, With Open Intracranial Wound, Prolonged 85254 (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing Conscious Level Y Extradural Hemorrhage Following Injury, With Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing Conscious 85255 Level Y Extradural Hemorrhage Following Injury, With Open Intracranial Wound, Loss of 85256 Consciousness of Unspecified Duration Y Extradural Hemorrhage Following Injury, With Open Intracranial Wound, 85259 Unspecifiedconcussion Y Other and Unspecified Intracranial Hemorrhage Following Injury, Without Mention of 85300 Open Intracranial Wound, Unspecified State of Consciousness Y Other and Unspecified Intracranial Hemorrhage Following Injury, Without Mention of 85301 Open Intracranial Wound, No Loss of Consciousness Y Other and Unspecified Intracranial Hemorrhage Following Injury, Without Mention of 85302 Open Intracranial Wound, Brief (Less Than 1 Hour) Loss of Consciousness Y Other and Unspecified Intracranial Hemorrhage Following Injury, Without Mention of 85303 Open Intracranial Wound, Moderate (1-24 Hours) Loss of Consciousness Y Other and Unspecified Intracranial Hemorrhage Following Injury, Without Mention of Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness and 85304 Return to Preexisting Conscious Level Y Other and Unspecified Intracranial Hemorrhage Following Injury. Without Mention of Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness, 85305 Without Return to Pre-Existing Conscious Level Y Other and Unspecified Intracranial Hemorrhage Following Injury, Without Mention of 85306 Open Intracranial Wound, Loss of Consciousness of Unspecified Duration Y Other and Unspecified Intracranial Hemorrhage Following Injury, Without Mention of 85309 Open Intracranial Wound, Unspecified Concussion Y Other and Unspecified Intracranial Hemorrhage Following Injury, With Open Intracranial 85310 Wound, Unspecified State of Consciousness Y Other and Unspecified Intracranial Hemorrhage Following Injury, With Open Intracranial 85311 Wound, No Loss of Consciousness Y Other and Unspecified Intracranial Hemorrhage Following Injury, With Open Intracranial 85312 Wound, Brief (Less Than 1 Hour) Loss of Consciousness Y Other and Unspecified Intracranial Hemorrhage Following Injury, With Open Intracranial 85313 Wound, Moderate (1-24 Hours) Loss of Consciousness Y Other and Unspecified Intracranial Hemorrhage Following Injury, With Open Intracranial Wound, Prolonged ( More Than 24 Hours) Loss of Consciousness and Return to Pre- 85314 Existing Conscious Level Y Other and Unspecified Intracranial Hemorrhage Following Injury, With Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre- 85315 Existing Conscious Level Y Other and Unspecified Intracranial Hemorrhage Following Injury, With Open Intracranial 85316 Wound, Loss of Consciousness of Unspecified Duration Y Other and Unspecified Intracranial Hemorrhage Following Injury, With Open Intracranial 85319 Wound, Unspecified Concussion Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 270 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Intracranial Injury of Other and Unspecified Nature, Without Mention of Open Intracranial 85400 Wound, Unspecified State of Consciousness Y Intracranial Injury of Other and Unspecified Nature, Without Mention of Open Intracranial 85401 Wound, No Loss of Consciousness Y Intracranial Injury of Other and Unspecified Nature, Without Mention of Open Intracranial 85402 Wound, Brief (Less Than 1 Hour) Loss of Consciousness Y Intracranial Injury of Other and Unspecified Nature, Without Mention of Open Intracranial 85403 Wound, Moderate (1-24 Hours) Loss of Consciousness Y Intracranial Injury of Other and Unspecified Nature, Without Mention of Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre- 85404 Existing Conscious Level Y Intracranial Injury of Other and Unspecified Nature, Without Mention of Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre- 85405 Existing Conscious Level Y Intracranial Injury of Other and Unspecified Nature, Without Mention of Open Intracranial 85406 Wound, Loss of Consciousness of Unspecified Duration Y Intracranial Injury of Other and Unspecified Nature, Without Mention of Open Intracranial 85409 Wound, Unspecified Concussion Y Intracranial Injury of Other and Unspecified Nature, With Open Intracranial Wound, 85410 Unspecified State of Consciousness Y Intracranial Injury of Other and Unspecified Nature, With Open Intracranial Wound, No 85411 Loss of Consciousness Y Intracranial Injury of Other and Unspecified Nature, With Open Intracranial Wound, Brief 85412 (Less Than 1 Hour) Loss of Consciousness Y Intracranial Injury of Other and Unspecified Nature, With Open Intracranial Wound, 85413 Moderate (1-24 Hours) Loss of Consciousness Y Intracranial Injury of Other and Unspecified Nature, With Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness and Return to Pre-Existing 85414 Conscious Level Y Intracranial Injury of Other and Unspecified Nature, With Open Intracranial Wound, Prolonged (More Than 24 Hours) Loss of Consciousness, Without Return to Pre-Existing 85415 Conscious Level Y Intracranial Injury of Other and Unspecified Nature, With Open Intracranial Wound, Loss 85416 of Consciousness of Unspecified Duration Y Intracranial Injury of Other and Unspecified Nature, With Open Intracranial Wound, With 85419 Unspecified Concussion Y 86100 Unspecified Injury to Heart Without Mention of Open Wound Into Thorax Y 86101 Heart Contusion Without Mention of Open Wound Into Thorax Y Heart Laceration Without Penetration of Heart Chambers or Mention of Open Wound Into 86102 Thorax Y Heart Laceration With Penetration of Heart Chambers, Without Mention of Open Wound 86103 Into Thorax Y 86110 Unspecified Injury to Heart With Open Wound Into Thorax Y 86111 Heart Contusion With Open Wound Into Thorax Y

86112 Heart Laceration Without Penetration of Heart Chambers, With Open Wound Into Thorax Y 86113 Heart Laceration With Penetration of Heart Chambers and Open Wound Into Thorax Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 271 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 86120 Unspecified Lung Injury Without Mention of Open Wound Into Thorax Y 86121 Lung Contusion Without Mention of Open Wound Into Thorax Y 86122 Lung Laceration Without Mention of Open Wound Into Thorax Y 86130 Unspecified Lung Injury With Open Wound Into Thorax Y 86131 Lung Contusion With Open Wound Into Thorax Y 86132 Lung Laceration With Open Wound Into Thorax Y 86221 Bronchus Injury Without Mention of Open Wound Into Cavity Y 86222 Esophagus Injury Without Mention of Open Wound Into Cavity Y Injury to Other Specified Intrathoracic Organs Without Mention of Open Wound Into 86229 Cavity Y 86231 Bronchus Injury With Open Wound Into Cavity Y 86232 Esophagus Injury With Open Wound Into Cavity Y 86239 Injury to Other Specified Intrathoracic Organs With Open Wound Into Cavity Y 86320 Small Intestine Injury, Unspecified Site, Without Mention of Open Wound Into Cavity Y 86321 Duodenum Injury Without Mention of Open Wound Into Cavity Y 86329 Other Injury to Small Intestine Without Mention of Open Wound Into Cavity Y 86330 Small Intestine Injury, Unspecified Site, With Open Wound Into Cavity Y 86331 Duodenum Injury With Open Wound Into Cavity Y 86339 Other Injury to Small Intestine With Open Wound Into Cavity Y 86340 Colon Injury Unspecified Site, Without Mention of Open Wound Into Cavity Y 86341 Ascending (Right) Colon Injury Without Mention of Open Wound Into Cavity Y 86342 Transverse Colon Injury Without Mention of Open Wound Into Cavity Y 86343 Descending (Left) Colon Injury Without Mention of Open Wound Into Cavity Y 86344 Sigmoid Colon Injury Without Mention of Open Wound Into Cavity Y 86345 Rectum Injury Without Mention of Open Wound Into Cavity Y Injury to Multiple Sites in Colon and Rectum Without Mention of Open Wound Into 86346 Cavity Y 86349 Other Colon and Rectum Injury, Without Mention of Open Wound Into Cavity Y 86350 Colon Injury, Unspecified Site, With Open Wound Into Cavity Y 86351 Ascending (Right) Colon Injury With Open Wound Into Cavity Y 86352 Transverse Colon Injury With Open Wound Into Cavity Y 86353 Descending (Left) Colon Injury With Open Wound Into Cavity Y 86354 Sigmoid Colon Injury With Open Wound Into Cavity Y 86355 Rectum Injury With Open Wound Into Cavity Y 86356 Injury to Multiple Sites in Colon and Rectum With Open Wound Into Cavity Y 86359 Other Injury to Colon and Rectum With Open Wound Into Cavity Y Gastrointestinal Tract Injury, Unspecified Site, Without Mention of Open Wound Into 86380 Cavity Y 86381 Pancreas Head Injury Without Mention of Open Wound Into Cavity Y 86382 Pancreas Body Injury Without Mention of Open Wound Into Cavity Y 86383 Pancreas Tail Injury Without Mention of Open Wound Into Cavity Y Pancreas Injury, Multiple and Unspecified Sites, Without Mention of Open Wound Into 86384 Cavity Y 86385 Appendix Injury Without Mention of Open Wound Into Cavity Y Injury to Other and Unspecified Gastrointestinal Sites Without Mention of Open Wound 86389 Into Cavity Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 272 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 86390 Gastrointestinal Tract Injury, Unspecified Site, With Open Wound Into Cavity Y 86391 Pancreas Head Injury With Open Wound Into Cavity Y 86392 Pancreas Body Injury With Open Wound Into Cavity Y 86393 Pancreas Tail Injury With Open Wound Into Cavity Y 86394 Pancreas Injury, Multiple and Unspecified Sites, With Open Wound Into Cavity Y 86395 Appendix Injury With Open Wound Into Cavity Y 86399 Injury to Other and Unspecified Gastrointestinal Sites With Open Wound Into Cavity Y 86400 Unspecified Injury to Liver Without Mention of Open Wound Into Cavity Y 86401 Liver Hematoma and Contusion Without Mention of Open Wound Into Cavity Y 86402 Liver Laceration, Minor, Without Mention of Open Wound Into Cavity Y 86403 Liver Laceration, Moderate, Without Mention of Open Wound Into Cavity Y 86404 Liver Laceration, Major, Without Mention of Open Wound Into Cavity Y 86405 Liver Injury Without Mention of Open Wound Into Cavity, Unspecified Laceration Y 86409 Other Liver Injury Without Mention of Open Wound Into Cavity Y 86410 Unspecified Liver Injury With Open Wound Into Cavity Y 86411 Liver Hematoma and Contusion With Open Wound Into Cavity Y 86412 Liver Laceration, Minor, With Open Wound Into Cavity Y 86413 Liver Laceration, Moderate, With Open Wound Into Cavity Y 86414 Liver Laceration, Major, With Open Wound Into Cavity Y 86415 Liver Injury With Open Wound Into Cavity, Unspecified Laceration Y 86419 Other Liver Injury With Open Wound Into Cavity Y 86500 Unspecified Spleen Injury Without Mention of Open Wound Into Cavity Y 86501 Spleen Hematoma, Without Rupture of Capsule or Mention of Open Wound Into Cavity Y Capsular Tears to Spleen, Without Major Disruption of Parenchyma or Mention of Open 86502 Wound Into Cavity Y Spleen Laceration Extending Into Parenchyma Without Mention of Open Wound Into 86503 Cavity Y

86504 Massive Parenchymal Disruption of Spleen Without Mention of Open Wound Into Cavity Y 86509 Other Spleen Injury Without Mention of Open Wound Into Cavity Y 86510 Unspecified Spleen Injury With Open Wound Into Cavity Y 86511 Spleen Hematoma, Without Rupture of Capsule, With Open Wound Into Cavity Y Capsular Tears to Spleen, Without Major Disruption of Parenchyma, With Open Wound 86512 Into Cavity Y 86513 Spleen Laceration Extending Into Parenchyma, With Open Wound Into Cavity Y 86514 Massive Parenchyma Disruption of Spleen With Open Wound Into Cavity Y 86519 Other Spleen Injury With Open Wound Into Cavity Y 86600 Unspecified Kidney Injury Without Mention of Open Wound Into Cavity Y 86601 Kidney Hematoma Without Rupture of Capsule or Mention of Open Wound Into Cavity Y 86602 Kidney Laceration Without Mention of Open Wound Into Cavity Y Complete Disruption of Kidney Parenchyma, Without Mention of Open Wound Into 86603 Cavity Y 86610 Unspecified Ikidney Injury With Open Wound Into Cavity Y 86611 Kidney Hematoma, Without Rupture of Capsule, With Open Wound Into Cavity Y 86612 Kidney Laceration With Open Wound Into Cavity Y 86613 Complete Disruption of Kidney Parenchyma, With Open Wound Into Cavity Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 273 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Injury to Unspecified Intra-Abdominal Organ Without Mention of Open Wound Into 86800 Cavity Y 86801 Adrenal Gland Injury Without Mention of Open Wound Into Cavity Y 86802 Bile Duct and Gallbladder Injury Without Mention of Open Wound Into Cavity Y 86803 Peritoneum Injury Without Mention of Open Wound Into Cavity Y 86804 Retroperitoneum Injury Without Mention of Open Wound Into Cavity Y Injury to Other and Multiple Intra-Abdominal Organs Without Mention of Open Wound 86809 Into Cavity Y 86810 Injury to Unspecified Intra-Abdominal Organ, With Open Wound Into Cavity Y 86811 Adrenal Gland Injury, With Open Wound Into Cavity Y 86812 Bile Duct and Gallbladder Injury, With Open Wound Into Cavity Y 86813 Peritoneum Injury With Open Wound Into Cavity Y 86814 Retroperitoneum Injury With Open Wound Into Cavity Y 86819 Injury to Other and Multiple Intra-Abdominal Organs, With Open Wound Into Cavity Y 87200 Open Wound of External Ear, Unspecified Site, Without Mention of Complication Y 87201 Open Wound of Auricle, Without Mention of Complication Y 87202 Open Wound of Auditory Canal, Without Mention of Complication Y 87210 Open Wound of External Ear, Unspecified Site, Complicated Y 87211 Open Wound of Auricle, Complicated Y 87212 Open Wound of Auditory Canal, Complicated Y 87261 Open Wound of Ear Drum, Without Mention of Complication Y 87262 Open Wound of Ossicles, Without Mention of Complication Y 87263 Open Wound of Eustachian Tube, Without Mention of Complication Y 87264 Open Wound of Cochlea, Without Mention of Complication Y 87269 Open Wound of Other and Multiple Sites, Without Mention of Complication Y 87271 Open Wound of Ear Drum, Complicated Y 87272 Open Wound of Ossicles, Complicated Y 87273 Open Wound of Eustachian Tube, Complicated Y 87274 Open Wound of Cochlea, Complicated Y 87279 Open Wound of Other and Multiple Sites, Complicated Y 87320 Open Wound of Nose, Unspecified Site, Without Mention of Complication Y 87321 Open Wound of Nasal Septum, Without Mention of Complication Y 87322 Open Wound of Nasal Cavity, Without Mention of Complication Y 87323 Open Wound of Nasal Sinus, Without Mention of Complication Y 87329 Open Wound of Nose, Multiple Sites, Without Mention of Complication Y 87330 Open Wound of Nose, Unspecified Site, Complicated Y 87331 Open Wound of Nasal Septum, Complicated Y 87332 Open Wound of Nasal Cavity, Complicated Y 87333 Open Wound of Nasal Sinus, Complicated Y 87339 Open Wound of Nose, Multiple Sites, Complicated Y 87340 Open Wound of Face, Unspecified Site, Without Mention of Complication Y 87341 Open Wound of Cheek, Without Mention of Complication Y 87342 Open Wound of Forehead, Without Mention of Complication Y 87343 Open Wound of Lip, Without Mention of Complication Y 87344 Open Wound of Jaw, Without Mention of Complication Y 87349 Open Wound of Face, Other and Multiple Sites, Without Mention of Complication Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 274 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 87350 Open Wound of Face, Unspecified Site, Complicated Y 87351 Open Wound of Cheek, Complicated Y 87352 Open Wound of Forehead, Complicated Y 87353 Open Wound of Lip, Complicated Y 87354 Open Wound of Jaw, Complicated Y 87359 Open Wound of Face, Other and Multiple Sites, Complicated Y 87360 Open Wound of Mouth, Unspecified Site, Without Mention of Complication Y 87361 Open Wound of Buccal Mucosa, Without Mention of Complication Y 87362 Open Wound of Gum (Alveolar Process), Without Mention of Complication Y 87363 Open Wound of Tooth (Broken), Without Mention of Complication Y 87364 Open Wound of Tongue and Floor of Mouth, Without Mention of Complication Y 87365 Open Wound of Palate, Without Mention of Complication Y 87369 Open Wound of Mouth, Other and Multiple Sites, Without Mention of Complication Y 87370 Open Wound of Mouth, Unspecified Site, Complicated Y 87371 Open Wound of Buccal Mucosa, Complicated Y 87372 Open Wound of Gum (Alveolar Process), Complicated Y 87373 Open Wound of Tooth (Broken), Complicated Y 87374 Open Wound of Tongue and Floor of Mouth, Complicated Y 87375 Open Wound of Palate, Complicated Y 87379 Open Wound of Mouth, Other and Multiple Sites, Complicated Y 87400 Open Wound of Larynx With Trachea, Without Mention of Complication Y 87401 Open Wound of Larynx, Without Mention of Complication Y 87402 Open Wound of Trachea, Without Mention of Complication Y 87410 Open Wound of Larynx With Trachea, Complicated Y 87411 Open Wound of Larynx, Complicated Y 87412 Open Wound of Trachea, Complicated Y 88000 Open Wound of Shoulder Region, Without Mention of Complication Y 88001 Open Wound of Scapular Region, Without Mention of Complication Y 88002 Open Wound of Axillary Region, Without Mention of Complication Y 88003 Open Wound of Upper Arm, Without Mention of Complication Y Open Wound of Multiple Sites of Shoulder and Upper Arm, Without Mention of 88009 Complication Y 88010 Open Wound of Shoulder Region, Complicated Y 88011 Open Wound of Scapular Region, Complicated Y 88012 Open Wound of Axillary Region, Complicated Y 88013 Open Wound of Upper Arm, Complicated Y 88019 Open Wound of Multiple Sites of Shoulder and Upper Arm, Complicated Y 88020 Open Wound of Shoulder Region, With Tendon Involvement Y 88021 Open Wound of Scapular Region, With Tendon Involvement Y 88022 Open Wound of Axillary Region, With Tendon Involvement Y 88023 Open Wound of Upper Arm, With Tendon Involvement Y 88029 Open Wound of Multiple Sites of Shoulder and Upper Arm, With Tendon Involvement Y 88100 Open Wound of Forearm, Without Mention of Complication Y 88101 Open Wound of Elbow, Without Mention of Complication Y 88102 Open Wound of Wrist, Without Mention of Complication Y 88110 Open Wound of Forearm, Complicated Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 275 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 88111 Open Wound of Elbow, Complicated Y 88112 Open Wound of Wrist, Complicated Y 88120 Open Wound of Forearm, With Tendon Involvement Y 88121 Open Wound of Elbow, With Tendon Involvement Y 88122 Open Wound of Wrist, With Tendon Involvement Y 90000 Injury to Carotid Artery, Unspecified Y 90001 Common Carotid Artery Injury Y 90002 External Carotid Artery Injury Y 90003 Internal Carotid Artery Injury Y 90081 External Jugular Vein Injury Y 90082 Injury to Multiple Blood Vessels of Head and Neck Y 90089 Injury to Other Specified Blood Vessels of Head and Neck Y 90140 Injury to Unspecified Pulmonary Vessel(s) Y 90141 Pulmonary Artery Injury Y 90142 Pulmonary Vein Injury Y 90181 Intercostal Artery or Vein Injury Y 90182 Internal Mammary Artery or Vein Injury Y 90183 Injury to Multiple Blood Vessels of Thorax Y 90189 Injury to Specified Blood Vessels of Thorax, Other Y 90210 Unspecified Inferior Vena Cava Injury Y 90211 Hepatic Vein Injury Y 90219 Injury to Specified Branches of Inferior Vena Cava, Other Y 90220 Unspecified Celiac and Mesenteric Artery Injury Y 90221 Gastric Artery Injury Y 90222 Hepatic Artery Injury Y 90223 Splenic Artery Injury Y 90224 Injury to Specified Branches of Celiac Axis, Other Y 90225 Superior Mesenteric Artery (Trunk) Injury Y 90226 Injury to Primary Branches of Superior Mesenteric Artery Y 90227 Inferior Mesenteric Artery Injury Y 90229 Injury to Celiac and Mesenteric Arteries, Other Y 90231 Injury to Superior Mesenteric Vein and Primary Subdivisions Y 90232 Inferior Mesenteric Vein Injury Y 90233 Portal Vein Injury Y 90234 Splenic Vein Injury Y 90239 Injury to Portal and Splenic Veins, Other Y 90240 Renal Vessel(s) Injury, Unspecified Y 90241 Renal Artery Injury Y 90242 Renal Vein Injury Y 90249 Renal Blood Vessel Injury, Other Y 90250 Unspecified Iliac Vessel(s) Injury Y 90251 Hypogastric Artery Injury Y 90252 Hypogastric Vein Injury Y 90253 Iliac Artery Injury Y 90254 Iliac Vein Injury Y 90255 Uterine Artery Injury Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 276 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 90256 Uterine Vein Injury Y 90259 Injury to Iliac Blood Vessels, Other Y 90281 Ovarian Artery Injury Y 90282 Ovarian Vein Injury Y 90287 Injury to Multiple Blood Vessels of Abdomen and Pelvis Y 90289 Injury to Specified Blood Vessels of Abdomen and Pelvis, Other Y 90300 Axillary Vessel(s) Injury, Unspecified Y 90301 Axillary Artery Injury Y 90302 Axillary Vein Injury Y 90440 Unspecified Popliteal Vessel(s) Injury Y 90441 Popliteal Artery Injury Y 90442 Popliteal Vein Injury Y 90450 Unspecified Tibial Vessel(s) Injury Y 90451 Anterior Tibial Artery Injury Y 90452 Anterior Tibial Vein Injury Y 90453 Posterior Tibial Artery Injury Y 90454 Posterior Tibial Vein Injury Y 92231 Contusion of Back Y 92232 Contusion of Buttock Y 92233 Contusion of Interscapular Region Y 92300 Contusion of Shoulder Region Y 92301 Contusion of Scapular Region Y 92302 Contusion of Axillary Region Y 92303 Contusion of Upper Arm Y 92309 Contusion of Multiple Sites of Shoulder and Upper Arm Y 92310 Contusion of Forearm Y 92311 Contusion of Elbow Y 92320 Contusion of Hand(s) Y 92321 Contusion of Wrist Y 92400 Contusion of Thigh Y 92401 Contusion of Hip S 92410 Contusion of Lower Leg S 92411 Contusion of Knee S 92420 Contusion of Foot Y 92421 Contusion of Ankle Y 92611 Crushing Injury of Back Y 92612 Crushing Injury of Buttock Y 92619 Crushing Injury of Other Specified Sites of Trunk Y 92700 Crushing Injury of Shoulder Region Y 92701 Crushing Injury of Scapular Region S 92702 Crushing Injury of Axillary Region Y 92703 Crushing Injury of Upper Arm Y 92709 Crushing Injury of Multiple Sites of Upper Arm Y 92710 Crushing Injury of Forearm Y 92711 Crushing Injury of Elbow Y 92720 Crushing Injury of Hand(s) Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 277 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 92721 Crushing Injury of Wrist S 92800 Crushing Injury of Thigh Y 92801 Crushing Injury of Hip Y 92810 Crushing Injury of Lower Leg Y 92811 Crushing Injury of Knee Y 92820 Crushing Injury of Foot Y 92821 Crushing Injury of Ankle Y 94100 Burn of Unspecified Degree of Unspecified Site of Face and Head Y 94101 Burn of Unspecified Degree of Ear (Any Part) Y 94102 Burn of Unspecified Degree of Eye (With Other Parts of Face, Head, and Neck) Y 94103 Burn of Unspecified Degree of Lip(s) Y 94104 Burn of Unspecified Degree of Chin Y 94105 Burn of Unspecified Degree of Nose (Septum) Y 94106 Burn of Unspecified Degree of Scalp (any Part) Y 94107 Burn of Unspecified Degree of Forehead and Cheek Y 94108 Burn of Unspecified Degree of Neck Y

94109 Burn of Unspecified Degree of Multiple Sites (Except With Eye) of Face, Head, and Neck Y 94110 Erythema due to Burn (First Degree) of Unspecified Site of Face and Head Y 94111 Erythema due to Burn (First Degree) of Ear (Any Part) Y 94112 Erythema due to Burn (First Degree) of Eye (With Other Parts Face, Head, and Neck) Y 94113 Erythema due to Burn (First Degree) of Lip(s) Y 94114 Erythema due to Burn (First Degree) of Chin Y 94115 Erythema due to Burn (First Degree) of Nose (Septum) Y 94116 Erythema due to Burn (First Degree) of Scalp (any Part) Y 94117 Erythema due to Burn (First Degree) of Forehead and Cheek Y 94118 Erythema due to Burn (First Degree) of Neck Y Erythema due to Burn (First Degree) of Multiple Sites (Except With Eye) of Face, Head, 94119 and Neck Y Blisters, With Epidermal Loss due to Burn (Second Degree) of Face and Head, 94120 Unspecified Site Y 94121 Blisters, With Epidermal Loss due to Burn (Second Degree) of Ear (any Part) Y Blisters, With Epidermal Loss due to Burn (Second Degree) of Eye (With Other Parts of 94122 Face, Head, and Neck) Y 94123 Blisters, With Epidermal Loss due to Burn (Second Degree) of Lip(s) Y 94124 Blisters, With Epidermal Loss due to Burn (Second Degree) of Chin Y 94125 Blisters, With Epidermal Loss due to Burn (Second Degree) of Nose (Septum) Y 94126 Blisters, With Epidermal Loss due to Burn (Second Degree) of Scalp (any Part) Y 94127 Blisters, With Epidermal Loss due to Burn (Second Degree) of Forehead and Cheek Y 94128 Blisters, With Epidermal Loss due to Burn (Second Degree) of Neck Y Blisters, With Epidermal Loss due to Burn (Second Degree) of Multiple Sites (Except 94129 With Eye) of Face, Head, and Neck Y Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Unspecified Site of Face and 94130 Head Y 94131 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Ear (any Part) Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 278 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Eye (With Other Parts of 94132 Face, Head, and Neck) Y 94133 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Lip(s) Y 94134 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Chin Y 94135 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Nose (Septum) Y 94136 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Scalp (any Part) Y 94137 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Forehead and Cheek Y 94138 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Neck Y Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Multiple Sites (Except With 94139 Eye) of Face, Head, and Neck Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Unspecified 94140 Site of Face and Head, Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Ear (any Part), 94141 Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Eye (With 94142 Other Parts of Face, Head, and Neck), Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Lip(s), Without 94143 Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Chin, Without 94144 Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Nose (Septum), 94145 Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Scalp (any 94146 Part), Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Forehead and 94147 Cheek, Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Neck, Without 94148 Mention of Loss of a Body Part Y

Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Multiple Sites 94149 (Except With Eye) of Face, Head, and Neck, Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Face and Head, 94150 Unspecified Site, With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Ear (any Part), 94151 With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Eye (With 94152 Other Parts of Face, Head, and Neck), With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Lip(s), With 94153 Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Chin, With 94154 Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Nose (Septum), 94155 With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Scalp (any 94156 Part), With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Forehead and 94157 Cheek, With Loss of a Body Part Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 279 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Neck, With 94158 Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Multiple Sites 94159 (Except Eye) of Face, Head, and Neck, With Loss of a Body Part Y 94200 Burn of Unspecified Degree of Trunk, Unspecified Site Y 94201 Burn of Trunk, Unspecified Degree of Breast Y 94202 Burn of Trunk, Unspecified Degree of Chest Wall, Excluding Breast and Nipple Y 94203 Burn of Trunk, Unspecified Degree of Abdominal Wall Y 94204 Burn of Trunk, Unspecified Degree of Back (any Part) Y 94205 Burn of Trunk, Unspecified Degree of Genitalia Y 94209 Burn of Trunk, Unspecified Degree of Other and Multiple Sites Y 94210 Erythema due to Burn (First Degree) of Unspecified Site of Trunk Y 94211 Erythema due to Burn (First Degree) of Breast Y 94212 Erythema due to Burn (First Degree) of Chest Wall, Excluding Breast and Nipple Y 94213 Erythema due to Burn (First Degree) of Abdominal Wall Y 94214 Erythema due to Burn (First Degree) of Back (any Part) Y 94215 Erythema due to Burn (First Degree) of Genitalia Y 94219 Erythema due to Burn (First Degree) of Other and Multiple Sites of Trunk Y

94220 Blisters With Epidermal Loss due to Burn (Second Degree) of Unspecified Site of Trunk Y 94221 Blisters With Epidermal Loss due to Burn (Second Degree) of Breast Y Blisters With Epidermal Loss due to Burn (Second Degree) of Chest Wall, Excluding 94222 Breast and Nipple Y 94223 Blisters With Epidermal Loss due to Burn (Second Degree) of Abdominal Wall Y 94224 Blisters With Epidermal Loss due to Burn (Second Degree) of Back (any Part) Y 94225 Blisters With Epidermal Loss due to Burn (Second Degree) of Genitalia Y Blisters With Epidermal Loss due to Burn (Second Degree) of Other and Multiple Sites of 94229 Trunk Y 94230 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Unspecified Site of Trunk Y 94231 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Breast Y Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Chest Wall, Excluding 94232 Breast and Nipple Y 94233 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Abdominal Wall Y 94234 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Back (any Part) Y 94235 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Genitalia Y Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Other and Multiple Sites of 94239 Trunk Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Trunk, 94240 Unspecified Site, Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Breast, Without 94241 Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Chest Wall, 94242 Excluding Breast and Nipple, Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Abdominal 94243 Wall, Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Back (any Part), 94244 Without Mention of Loss of a Body Part Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 280 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Genitalia, 94245 Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Other and 94249 Multiple Sites of Trunk, Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Unspecified 94250 Site of Trunk, With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Breast, With 94251 Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Chest Wall, 94252 Excluding Breast and Nipple, With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Abdominal 94253 Wall With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Back (Any 94254 Part), With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Genitalia, With 94255 Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Other and 94259 Multiple Sites of Trunk, With Loss of a Body Part Y 94300 Burn of Unspecified Degree of Unspecified Site of Upper Limb Y 94301 Burn of Unspecified Degree of Forearm Y 94302 Burn of Unspecified Degree of Elbow Y 94303 Burn of Unspecified Degree of Upper Arm Y 94304 Burn of Unspecified Degree of Axilla Y 94305 Burn of Unspecified Degree of Shoulder Y 94306 Burn of Unspecified Degree of Scapular Region Y 94309 Burn of Unspecified Degree Multiple Sites of Upper Limb, Except Wrist and Hand Y 94310 Erythema due to Burn (First Degree) of Unspecified Site of Upper Limb Y 94311 Erythema due to Burn (First Degree) of Forearm Y 94312 Erythema due to Burn (First Degree) of Elbow Y 94313 Erythema due to Burn (First Degree) of Upper Arm Y 94314 Erythema due to Burn (First Degree) of Axilla Y 94315 Erythema due to Burn (First Degree) of Shoulder Y 94316 Erythema due to Burn (First Degree) of Scapular Region Y Erythema due to Burn (First Degree) of Multiple Sites of Upper Limb, Except Wrist and 94319 Hand Y Blisters With Epidermal Loss due to Burn (Second Degree) of Unspecified Site of Upper 94320 Limb Y 94321 Blisters With Epidermal Loss due to Burn (Second Degree) of Forearm Y 94322 Blisters With Epidermal Loss due to Burn (Second Degree) of Elbow Y 94323 Blisters With Epidermal Loss due to Burn (Second Degree) of Upper Arm Y 94324 Blisters With Epidermal Loss due to Burn (Second Degree) of Axilla Y 94325 Blisters With Epidermal Loss due to Burn (Second Degree) of Shoulder Y 94326 Blisters With Epidermal Loss due to Burn (Second Degree) of Scapular Region Y Blisters With Epidermal Loss due to Burn (Second Degree) of Multiple Sites of Upper 94329 Limb, Except Wrist and Hand Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 281 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Unspecified Site of Upper 94330 Limb Y 94331 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Forearm Y 94332 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Elbow Y 94333 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Upper Arm Y 94334 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Axilla Y 94335 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Shoulder Y 94336 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Scapular Region Y Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Multiple Sites of Upper 94339 Limb, Except Wrist and Hand Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Unspecified 94340 Site of Upper Limb, Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Forearm, 94341 Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Elbow, Without 94342 Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Upper Arm, 94343 Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Axilla, Without 94344 Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Shoulder, 94345 Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Scapular 94346 Region, Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Multiple Sites 94349 of Upper Limb, Except Wrist and Hand, Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Unspecified 94350 Site of Upper Limb, With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Forearm, With 94351 Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Elbow, With 94352 Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Upper Arm, 94353 With Loss of Upper a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Axilla, With 94354 Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Shoulder, With 94355 Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Scapular 94356 Region, With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Multiple Sites 94359 of Upper Limb, Except Wrist and Hand, With Loss of a Body Part Y 94400 Burn of Unspecified Degree of Unspecified Site of Hand Y 94401 Burn of Unspecified Degree of Single Digit [Finger (Nail)] Other Than Thumb Y 94402 Burn of Unspecified Degree of Thumb (Nail) Y 94403 Burn of Unspecified Degree of Two or More Digits of Hand, Not Including Thumb Y 94404 Burn of Unspecified Degree of Two or More Digits of Hand, Including Thumb Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 282 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 94405 Burn of Unspecified Degree of Palm of Hand Y 94406 Burn of Unspecified Degree of Back of Hand Y 94407 Burn of Unspecified Degree of Wrist Y 94408 Burn of Unspecified Degree of Multiple Sites of Wrist(s) and Hand(s) Y 94410 Erythema due to Burn (First Degree) of Unspecified Site of Hand Y 94411 Erythema due to Burn (First Degree) of Single Digit [Finger (Nail)] Other Than Thumb Y 94412 Erythema due to Burn (First Degree) of Thumb (Nail) Y Erythema due to Burn (First Degree) of Two or More Digits of Hand, Not Including 94413 Thumb Y 94414 Erythema due to Burn (First Degree) of Two or More Digits of Hand Including Thumb Y 94415 Erythema due to Burn (First Degree) of Palm of Hand Y 94416 Erythema due to Burn (First Degree) of Back of Hand Y 94417 Erythema due to Burn (First Degree) of Wrist Y 94418 Erythema due to Burn (First Degree) of Multiple Sites of Wrist(s) and Hand(s) Y 94420 Blisters With Epidermal Loss due to Burn (Second Degree) of Unspecified Site of Hand Y Blisters With Epidermal Loss due to Burn (Second Degree) of Single Digit [Finger (Nail)] 94421 Other Than Thumb Y 94422 Blisters With Epidermal Loss due to Burn of (Second Degree) of Thumb (Nail) Y Blisters With Epidermal Loss due to Burn (Second Degree) of Two or More Digits of 94423 Hand, Not Including Thumb Y Blisters With Epidermal Loss due to Burn (Second Degree) of Two or More Digits of 94424 Hand Including Thumb Y 94425 Blisters With Epidermal Loss due to Burn (Second Degree) of Palm of Hand Y 94426 Blisters With Epidermal Loss due to Burn (Second Degree) of Back of Hand Y 94427 Blisters With Epidermal Loss due to Burn (Second Degree) of Wrist Y Blisters With Epidermal Loss due to Burn (Second Degree) of Multiple Sites of Wrist(s) 94428 and Hand(s) Y 94430 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Unspecified Site of Hand Y Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Single Digit [Finger (Nail)] 94431 Other Than Thumb Y 94432 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Thumb (Nail) Y Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Two or More Digits of Hand, 94433 Not Including Thumb Y Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Two or More Digits of Hand 94434 Including Thumb Y 94435 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Palm of Hand Y 94436 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Back of Hand Y 94437 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Wrist Y Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Multiple Sites of Wrist(s) 94438 and Hand(s) Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Unspecified 94440 Site of Hand, Without Mention of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Single Digit 94441 [Finger (Nail)] Other Than Thumb, Without Mention of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Thumb (Nail), 94442 Without Mention of Loss of a Body Part Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 283 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Two or More 94443 Digits of Hand, Not Including Thumb, Without Mention of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Two or More 94444 Digits of Hand Including Thumb, Without Mention of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Palm of Hand, 94445 Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Back of Hand, 94446 Without Mention of Loss of Back of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Wrist, Without 94447 Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Multiple Sites 94448 of Wrist(s) and Hand(s), Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Unspecified 94450 Site of Hand, With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Single Digit 94451 (Finger (Nail)) Other Than Thumb, With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Thumb (Nail), 94452 With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Two or More 94453 Digits of Hand, Not Including Thumb, With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Two or More 94454 Digits of Hand Including Thumb, With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Palm of Hand, 94455 With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Back of Hand, 94456 With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Wrist, With 94457 Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Multiple Sites 94458 of Wrist(s) and Hand(s), With Loss of a Body Part Y 94500 Burn of Unspecified Degree of Unspecified Site of Lower Limb (Leg) Y 94501 Burn of Unspecified Degree of Toe(s) (Nail) Y 94502 Burn of Unspecified Degree of Foot Y 94503 Burn of Unspecified Degree of Ankle Y 94504 Burn of Unspecified Degree of Lower Leg Y 94505 Burn of Unspecified Degree of Knee Y 94506 Burn of Unspecified Degree of Thigh (Any Part) Y 94509 Burn of Unspecified Degree of Multiple Sites of Lower Limb(s) Y 94510 Erythema due to Burn (First Degree) of Unspecified Site of Lower Limb (Leg) Y 94511 Erythema due to Burn (First Degree) of Toe(s) (Nail) Y 94512 Erythema due to Burn (First Degree) of Foot Y 94513 Erythema due to Burn (First Degree) of Ankle Y 94514 Erythema due to Burn (First Degree) of Lower Leg Y 94515 Erythema due to Burn (First Degree) of Knee Y 94516 Erythema due to Burn (First Degree) of Thigh (Any Part) Y 94519 Erythema due to Burn (First Degree) of Multiple Sites of Lower Limb(s) Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 284 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Blisters With Epidermal Loss due to Burn (Second Degree) of Unspecified Site of Lower 94520 Limb (Leg) Y 94521 Blisters With Epidermal Loss due to Burn (Second Degree) of Toe(s) (Nail) Y 94522 Blisters With Epidermal Loss due to Burn (Second Degree) of Foot Y 94523 Blisters With Epidermal Loss due to Burn (Second Degree) of Ankle Y 94524 Blisters With Epidermal Loss due to Burn (Second Degree) of Lower Leg Y 94525 Blisters With Epidermal Loss due to Burn (Second Degree) of Knee Y 94526 Blisters With Epidermal Loss due to Burn (Second Degree) of Thigh (any Part) Y Blisters With Epidermal Loss due to Burn (Second Degree) of Multiple Sites of Lower 94529 Limb(s) Y Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Unspecified Site of Lower 94530 Limb Y 94531 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Toe(s) (Nail) Y 94532 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Foot Y 94533 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Ankle Y 94534 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Lower Leg Y 94535 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Knee Y 94536 Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Thigh (any Part) Y Full-Thickness Skin Loss due to Burn (Third Degree Nos) of Multiple Sites of Lower 94539 Limb(s) Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Unspecified 94540 Site of Lower Limb (Leg), Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Toe(s) (Nail), 94541 Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Foot, Without 94542 Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Ankle, Without 94543 Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Lower Leg, 94544 Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Knee, Without 94545 Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Thigh (any 94546 Part), Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Multiple Sites 94549 of Lower Limb(s), Without Mention of Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Unspecified 94550 Site Lower Limb (Leg), With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Toe(s) (Nail), 94551 With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Foot, With Loss 94552 of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Ankle, With 94553 Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Lower Leg, 94554 With Loss of a Body Part Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 285 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Knee, With 94555 Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Thigh (any 94556 Part), With Loss of a Body Part Y Deep Necrosis of Underlying Tissues due to Burn (Deep Third Degree) of Multiple Sites 94559 of Lower Limb(s), With Loss of a Body Part Y Burn (Any Degree) Involving Less Than 10% of Body Surface With Third Degree Burn of 94800 Less Than 10% or Unspecified Amount Y Burn (Any Degree) Involving 10-19% of Body Surface With Third Degree Burn of Less 94810 Than 10% or Unspecified Amount Y Burn (Any Degree) Involving 10-19% of Body Surface With Third Degree Burn of 10- 94811 19% Y Burn (Any Degree) Involving 20-29% of Body Surface With Third Degree Burn of Less 94820 Than 10% or Unspecified Amount Y Burn (Any Degree) Involving 20-29% of Body Surface With Third Degree Burn of 10- 94821 19% Y Burn (Any Degree) Involving 20-29% of Body Surface With Third Degree Burn of 20- 94822 29% Y Burn (Any Degree) Involving 30-39% of Body Surface With Third Degree Burn of Less 94830 Than 10% or Unspecified Amount Y Burn (Any Degree) Involving 30-39% of Body Surface With Third Degree Burn of 10- 94831 19% Y Burn (Any Degree) Involving 30-39% of Body Surface With Third Degree Burn of 20- 94832 29% Y Burn (Any Degree) Involving 30-39% of Body Surface With Third Degree Burn of 30- 94833 39% Y Burn (Any Degree) Involving 40-49% of Body Surface With Third Degree Burn of Less 94840 Than 10% or Unspecified Amount Y Burn (Any Degree) Involving 40-49% of Body Surface With Third Degree Burn of 10- 94841 19% Y Burn (Any Degree) Involving 40-49% of Body Surface With Third Degree Burn of 20- 94842 29% Y Burn (Any Degree) Involving 40-49% of Body Surface With Third Degree Burn of 30- 94843 39% Y Burn (Any Degree) Involving 40-49% of Body Surface With Third Degree Burn of 40- 94844 49% Y Burn (Any Degree) Involving 50-59% of Body Surface With Third Degree Burn of Less 94850 Than 10% or Unspecified Amount Y Burn (Any Degree) Involving 50-59% of Body Surface With Third Degree Burn of 10- 94851 19% Y Burn (Any Degree) Involving 50-59% of Body Surface With Third Degree Burn of 20- 94852 29% Y Burn (Any Degree) Involving 50-59% of Body Surface With Third Degree Burn of 30- 94853 39% Y Burn (Any Degree) Involving 50-59% of Body Surface With Third Degree Burn of 40- 94854 49% Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 286 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Burn (Any Degree) Involving 50-59% of Body Surface With Third Degree Burn of 50- 94855 59% Y Burn (Any Degree) Involving 60-69% of Body Surface With Third Degree Burn of Less 94860 Than 10% or Unspecified Amount Y Burn (Any Degree) Involving 60-69% of Body Surface With Third Degree Burn of 10- 94861 19% Y Burn (Any Degree) Involving 60-69% of Body Surface With Third Degree Burn of 20- 94862 29% Y Burn (Any Degree) Involving 60-69% of Body Surface With Third Degree Burn of 30- 94863 39% Y Burn (Any Degree) Involving 60-69% of Body Surface With Third Degree Burn of 40- 94864 49% Y Burn (Any Degree) Involving 60-69% of Body Surface With Third Degree Burn of 50- 94865 59% Y Burn (Any Degree) Involving 60-69% of Body Surface With Third Degree Burn of 60- 94866 69% Y Burn (Any Degree) Involving 70-79% of Body Surface With Third Degree Burn of Less 94870 Than 10% or Unspecified Amount Y Burn (Any Degree) Involving 70-79% of Body Surface With Third Degree Burn of 10- 94871 19% Y Burn (Any Degree) Involving 70-79% of Body Surface With Third Degree Burn of 20- 94872 29% Y Burn (Any Degree) Involving 70-79% of Body Surface With Third Degree Burn of 30- 94873 39% Y Burn (Any Degree) Involving 70-79% of Body Surface With Third Degree Burn of 40- 94874 49% Y Burn (Any Degree) Involving 70-79% of Body Surface With Third Degree Burn of 50- 94875 59% Y Burn (Any Degree) Involving 70-79% of Body Surface With Third Degree Burn of 60- 94876 69% Y Burn (Any Degree) Involving 70-79% of Body Surface With Third Degree Burn of 70- 94877 79% Y Burn (Any Degree) Involving 80-89% of Body Surface With Third Degree Burn of Less 94880 Than 10% or Unspecified Amount Y Burn (Any Degree) Involving 80-89% of Body Surface With Third Degree Burn of 10- 94881 19% Y Burn (Any Degree) Involving 80-89% of Body Surface With Third Degree Burn of 20- 94882 29% Y Burn (Any Degree) Involving 80-89% of Body Surface With Third Degree Burn of 30- 94883 39% Y Burn (Any Degree) Involving 80-89% of Body Surface With Third Degree Burn of 40- 94884 49% Y Burn (Any Degree) Involving 80-89% of Body Surface With Third Degree Burn of 50- 94885 59% Y Burn (Any Degree) Involving 80-89% of Body Surface With Third Degree Burn of 60- 94886 69% Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 287 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Burn (Any Degree) Involving 80-89% of Body Surface With Third Degree Burn of 70- 94887 79% Y Burn (Any Degree) Involving 80-89% of Body Surface With Third Degree Burn of 80- 94888 89% Y Burn (Any Degree) Involving 90% or More of Body Surface With Third Degree Burn of 94890 Less Than 10% or Unspecified Amount Y Burn (Any Degree) Involving 90% or More of Body Surface With Third Degree Burn of 94891 10-19% Y Burn (Any Degree) Involving 90% or More of Body Surface With Third Degree Burn of 94892 20-29% Y Burn (Any Degree) Involving 90% or More of Body Surface With Third Degree Burn of 94893 30-39% Y Burn (Any Degree) Involving 90% or More of Body Surface With Third Degree Burn of 94894 40-49% Y Burn (Any Degree) Involving 90% or More of Body Surface With Third Degree Burn of 94895 50-59% Y Burn (Any Degree) Involving 90% or More of Body Surface With Third Degree Burn of 94896 60-69% Y Burn (Any Degree) Involving 90% or More of Body Surface With Third Degree Burn of 94897 70-79% Y Burn (Any Degree) Involving 90% or More of Body Surface With Third Degree Burn of 94898 80-89% Y Burn (Any Degree) Involving 90% or More of Body Surface With Third Degree Burn of 94899 90% or More of Body Surface Y 95200 C1-C4 Level Spinal Cord Injury, Unspecified Y 95201 C1-C4 Level With Complete Lesion of Spinal Cord Y 95202 C1-C4 Level With Anterior Cord Syndrome Y 95203 C1-C4 Level With Central Cord Syndrome Y 95204 C1-C4 Level With Other Specified Spinal Cord Injury Y 95205 C5-C7 Level Spinal Cord Injury, Unspecified Y 95206 C5-C7 Level With Complete Lesion of Spinal Cord Y 95207 C5-C7 Level With Anterior Cord Syndrome Y 95208 C5-C7 Level With Central Cord Syndrome Y 95209 C5-C7 Level With Other Specified Spinal Cord Injury Y 95210 T1-T6 Level Spinal Cord Injury, Unspecified Y 95211 T1-T6 Level With Complete Lesion of Spinal Cord Y 95212 T1-T6 Level With Anterior Cord Syndrome Y 95213 T1-T6 Level With Central Cord Syndrome Y 95214 T1-T6 Level With Other Specified Spinal Cord Injury Y 95215 T7-T12 Level Spinal Cord Injury, Unspecified Y 95216 T7-T12 Level With Complete Lesion of Spinal Cord Y 95217 T7-T12 Level With Anterior Cord Syndrome Y 95218 T7-T12 Level With Central Cord Syndrome Y 95219 T7-T12 Level With Other Specified Spinal Cord Injury Y 95901 Head Injury, Unspecified S 95909 Injury of Face and Neck, Other and Unspecified S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 288 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 95911 Other Injury of Chest Wall Y 95912 Other Injury of Abdomen Y 95913 Other Injury, Fracture of Corpus Cavernosum Penis Y 95914 Other Injury of External Genitals Y 95919 Other Injury of Other Sites of Trunk Y 96500 Poisoning by Opium (Alkaloids), Unspecified Y 96501 Poisoning by Heroin Y 96502 Poisoning by Methadone Y 96509 Poisoning by Opiates and Related Narcotics, Other Y 96561 Poisoning by Propionic Acid Derivatives Y 96569 Poisoning by Other Antirheumatics Y 98981 Toxic Effect of Asbestos Y 98982 Toxic Effect of Latex Y 98983 Toxic Effect of Silicone Y 98984 Toxic Effect of Tobacco Y 98989 Toxic Effect of Other Substances Y 99550 Child Abuse, Unspecified Y 99551 Child Emotional/Psychological Abuse Y 99552 Child Neglect (Nutritional) Y 99553 Child Sexual Abuse Y 99554 Child Physical Abuse Y 99555 Shaken Infant Syndrome Y 99559 Other Child Abuse and Neglect Y 99560 Anaphylactic Shock due to Unspecified Food Y 99561 Anaphylactic Shock due to Peanuts Y 99562 Anaphylactic Shock due to Crustaceans Y 99563 Anaphylactic Shock due to Fruits and Vegetables Y 99564 Anaphylactic Shock due to Tree Nuts and Seeds Y 99565 Anaphylactic Shock due to Fish Y 99566 Anaphylactic Shock due to Food Additives Y 99567 Anaphylactic Shock due to Milk Products Y 99568 Anaphylactic Shock due to Eggs Y 99569 Anaphylactic Shock due to Other Specified Food Y 99580 Adult Maltreatment, Usnpecified Y 99581 Adult Physical Abuse Y 99582 Adult Emotional/Psychological Abuse Y 99583 Adult Sexual Abuse Y 99584 Adult Neglect (Nutritional) Y 99585 Other Adult Abuse and Neglect Y 99586 Malignant Hyperthermia Y 99589 Certain Adverse Effects, Not Elsewhere Classified, Other Y 99590 Systemic Inflammatory Response Syndrome, Unspecified Y Systemic Inflammatory Response Syndrome due to Infectious Process Without Organ 99591 Dysfunction Y Systemic Inflammatory Response Syndrome due to Infectious Process With Organ 99592 Dysfunction Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 289 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Systemic Inflammatory Response Syndrome due to Non-Infectious Process Without Organ 99593 Dysfunction Y Systemic Inflammatory Response Syndrome due to Non-Infectious Process With Organ 99594 Dysfunction Y 99600 Mechanical Complication of Unspecified Cardiac Device, Implant, and Graft Y 99601 Mechanical Complication due to Cardiac Pacemaker (Electrode) Y 99602 Mechanical Complication due to Heart Valve Prosthesis Y 99603 Mechanical Complication due to Coronary Bypass Graft Y 99604 Mechanical Complication due to Automatic Implantable Cardiac Defibrillator Y 99609 Mechanical Complication of Cardiac Device, Implant, and Graft, Other Y 99630 Mechanical Complication of Unspecified Genitourinary Device, Implant, and Graft Y 99631 Mechanical Complication due to Urethral (Indwelling) Catheter Y 99632 Mechanical Complication due to Intrauterine Contraceptive Device Y 99639 Mechanical Complication of Genitourinary Device, Implant, and Graft, Other Y

99640 Unspecified Mechanical Complication of Internal Orthopedic Device, Implant, and Graft Y 99641 Mechanical Loosening of Prosthetic Joint Y 99642 Dislocation of Prosthetic Joint Y 99643 Prosthetic Joint Implant Failure Y 99644 Peri-Prosthetic Fracture Around Prosthetic Joint Y 99645 Peri-Prosthetic Osteolysis Y 99646 Articular Bearing Surface Wear of Prosthetic Joint Y 99647 Other Mechanical Complication of Prosthetic Joint Implant Y

99649 Other Mechanical Complication of Other Internal Orthopedic Device, Implant, and Graft Y 99651 Mechanical Complication due to Corneal Graft Y 99652 Mechanical Complication due to Other Tissue Graft, Not Elsewhere Classified Y 99653 Mechanical Complication due to Ocular Lens Prosthesis Y 99654 Mechanical Complication due to Breast Prosthesis Y 99655 Mechanical Complications due to Artificial Skin Graft and Decellularized Allodermis Y 99656 Mechanical Complications due to Peritoneal Dialysis Catheter Y 99657 Mechanical Complication due to Insulin Pump Y Mechanical Complication due to Other Implant and Internal Device, Not Elsewhere 99659 Classified Y 99660 Infection and Inflammatory Reaction due to Unspecified Device, Implant, and Graft Y 99661 Infection and Inflammatory Reaction due to Cardiac Device, Implant, and Graft Y 99662 Infection and Inflammatory Reaction due to Other Vascular Device, Implant, and Graft Y 99663 Infection and Inflammatory Reaction due to Nervous System Device, Implant, and Graft Y 99664 Infection and Inflammatory Reaction due to Indwelling Urinary Catheter Y Infection and Inflammatory Reaction due to Other Genitourinary Device, Implant, and 99665 Graft Y 99666 Infection and Inflammatory Reaction due to Internal Joint Prosthesis Y Infection and Inflammatory Reaction due to Other Internal Orthopedic Device, Implant, 99667 and Graft Y 99668 Infection and Inflammatory Reaction due to Peritoneal Dialysis Catheter Y Infection and Inflammatory Reaction due to Other Internal Prosthetic Device, Implant, and 99669 Graft Y

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 290 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 99670 Other Complications due to Unspecified Device, Implant, and Graft Y 99671 Other Complications due to Heart Valve Prosthesis Y 99672 Other Complications due to Other Cardiac Device, Implant, and Graft Y 99673 Other Complications due to Renal Dialysis Device, Implant, and Graft Y 99674 Other Complications due to Other Vascular Device, Implant, and Graft Y 99675 Other Complications due to Nervous System Device, Implant, and Graft Y 99676 Other Complications due to Genitourinary Device, Implant, and Graft Y 99677 Other Complications due to Internal Joint Prosthesis Y 99678 Other Complications due to Other Internal Orthopedic Device, Implant, and Graft Y 99679 Other Complications due to Other Internal Prosthetic Device, Implant, and Graft Y 99680 Complications of Transplanted Organ, Unspecified Site Y 99681 Complications of Transplanted Kidney Y 99682 Complications of Transplanted Liver Y 99683 Complications of Transplanted Heart Y 99684 Complications of Transplanted Lung Y 99685 Complications of Bone Marrow Transplant Y 99686 Complications of Transplanted Pancreas Y 99687 Complications of Transplanted Organ, Intestine Y 99689 Complications of Other Transplanted Organ Y 99690 Complications of Unspecified Reattached Extremity Y 99691 Complications of Reattached Forearm Y 99692 Complications of Reattached Hand Y 99693 Complications of Reattached Finger(s) Y 99694 Complications of Reattached Upper Extremity, Other and Unspecified Y 99695 Complications of Reattached Foot and Toe(s) Y 99696 Complications of Reattached Lower Extremity, Other and Unspecified Y 99699 Complications of Other Specified Reattached Body Part Y 99700 Unspecified Nervous System Complication N 99701 Central Nervous System Complication Y 99702 Iatrogenic Cerebrovascular Infarction or Hemorrhage Y 99709 Other Nervous System Complications N 99760 Late Complications of Amputation Stump, Unspecified N 99761 Neuroma of Amputation Stump N 99762 Infection (Chronic) of Amputation Stump N 99769 Other Late Amputation Stump Complication N 99771 Vascular Complications of Mesenteric Artery Y 99772 Vascular Complications of Renal Artery Y 99779 Vascular Complications of Other Vessels Y 99791 Hypertension Y 99799 Other Complications Affecting Other Specified Body Systems, Nec Y 99811 Hemorrhage Complicating a Procedure Y 99812 Hematoma Complicating a Procedure Y 99813 Seroma Complicating a Procedure Y 99831 Disruption of Internal Operation Wound Y 99832 Disruption of External Operation Wound Y 99851 Infected Postoperative Seroma S

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 291 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator 99859 Other Postoperative Infection S 99881 Emphysema (Subcutaneous) (Surgical) Resulting From a Procedure Y 99882 Cataract Fragments in Eye Following Surgery Y 99883 Non-Healing Surgical Wound S 99889 Other Specified Complications N D01 Employment N D02 Job Readiness N D03 Post Surgical Resection N D04 Post Surgical Repair N D05 Gastric Intestinal Ulcer N D06 Loss Significant Amount of Weight N D07 Chronic Gastritis Enteritis Colitis N D08 Chronic Disease of Gall Bladder N D09 Post or Malignancy Intestinal Tract N D10 Cardiac Hypertensive Special Diet N D11 Sev Metabolic Dis Special Diet N D12 Neurological Disease Special Diet N D13 Chronic Renal Disease Special Diet N E8000 Railway Accident Involving Collision With Rolling Stock, Injuring Railway Employee N

E8001 Railway Accident Involving Collision With Rolling Stock, Injuring Passenger on Railway N E8002 Railway Accident Involving Collision With Rolling Stock, Injuring Pedestrian N E8003 Railway Accident Involving Collision With Rolling Stock, Injuring Pedal Cyclist N Railway Accident Involving Collision With Rolling Stock, Injuring Other Specified E8008 Person N E8009 Railway Accident Involving Collision With Rolling Stock, Injuring Unspecified Person N E8010 Railway Accident Involving Collision With Other Object, Injuring Railway Employee N

E8011 Railway Accident Involving Collision With Other Object, Injuring Passenger on Railway N E8012 Railway Accident Involving Collision With Other Object, Injuring Pedestrian N E8013 Railway Accident Involving Collision With Other Object, Injuring Pedal Cyclist N

E8018 Railway Accident Involving Collision With Other Object, Injuring Other Specified Person N E8019 Railway Accident Involving Collision With Other Object, Injuring Unspecified Person N Railway Accident Involving Derailment Without Antecedent Collision, Injuring Railway E8020 Employee N Railway Accident Involving Derailment Without Antecedent Collision, Injuring Passenger E8021 on Railway N

E8022 Railway Accident Involving Derailment Without Antecedent Collision, Injuring Pedestrian N Railway Accident Involving Derailment Without Antecedent Collision, Injuring Pedal E8023 Cyclist N Railway Accident Involving Derailment Without Antecedent Collision, Injuring Other E8028 Specified Person N Railway Accident Involving Derailment Without Antecedent Collision, Injuring E8029 Unspecified Person N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 292 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator E8030 Railway Accident Involving Explosion, Fire, or Burning, Injuring Railway Employee N E8031 Railway Accident Involving Explosion, Fire, or Burning, Injuring Passenger on Railway N E8032 Railway Accident Involving Explosion, Fire, or Burning, Injuring Pedestrian N E8033 Railway Accident Involving Explosion, Fire, or Burning, Injuring Pedal Cyclist N

E8038 Railway Accident Involving Explosion, Fire, or Burning, Injuring Other Specified Person N E8039 Railway Accident Involving Explosion, Fire, or Burning, Injuring Unspecified Person N E8040 Fall In, On, or From Railway Train, Injuring Railway Employee N E8041 Fall In, On, or From Railway Train, Injuring Passenger on Railway N E8042 Fall In, On, or From Railway Train, Injuring Pedestrian N E8043 Fall In, On, or From Railway Train, Injuring Pedal Cyclist N E8048 Fall In, On, or From Railway Train, Injuring Other Specified Person N E8049 Fall In, On, or From Railway Train, Injuring Unspecified Person N E8050 Railway Employee Hit by Rolling Stock N E8051 Passenger on Railway Hit by Rolling Stock N E8052 Pedestrian Hit by Rolling Stock N E8053 Pedal Cyclist Hit by Rolling Stock N E8058 Other Specified Person Hit by Rolling Stock N E8059 Unspecified Person Hit by Rolling Stock N E8060 Other Specified Railway Accident Injuring Railway Employee N E8061 Other Specified Railway Accident Injuring Passenger on Railway N E8062 Other Specified Railway Accident Injuring Pedestrian N E8063 Other Specified Railway Accident Injuring Pedal Cyclist N E8068 Other Specified Railway Accident Injuring Other Specified Person N E8069 Other Specified Railway Accident Injuring Unspecified Person N E8070 Railway Accident of Unspecified Nature Injuring Railway Employee N E8071 Railway Accident of Unspecified Nature Injuring Passenger on Railway N E8072 Railway Accident of Unspecified Nature Injuring Pedestrian N E8073 Railway Accident of Unspecified Nature Injuring Pedal Cyclist N E8078 Railway Accident of Unspecified Nature Injuring Other Specified Person N E8079 Railway Accident of Unspecified Nature Injuring Unspecified Person N Motor Vehicle Collision With Train, Injuring Driver of Motor Vehicle Other Than E8100 Motorcycle N Motor Vehicle Collision With Train, Injuring Passenger in Motor Vehicle Other Than E8101 Motorcycle N E8102 Motor Vehicle Collision With Train, Injuring Motorcyclist N E8103 Motor Vehicle Collision With Train, Injuring Passenger on Motorcycle N E8104 Motor Vehicle Collision With Train, Injuring Occupant of Streetcar N Motor Vehicle Collision With Train, Injuring Rider of Animal; Occupant of Animal- E8105 Drawn Vehicle N E8106 Motor Vehicle Collision With Train, Injuring Pedal Cyclist N E8107 Motor Vehicle Collision With Train, Injuring Pedestrian N E8108 Motor Vehicle Collision With Train, Injuring Other Specified Person N E8109 Motor Vehicle Collision With Train, Injuring Unspecified Person N Motor Vehicle Traffic Accident Involving Re-Entrant Collision With Another Motor E8110 Vehicle, Injuring Driver of Motor Vehicle Other Than Motorcycle N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 293 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Motor Vehicle Traffic Accident Involving Re-Entrant Collision With Another Motor E8111 Vehicle, Injuring Passenger in Motor Vehicle Other Than Motorcycle N Motor Vehicle Traffic Accident Involving Re-Entrant Collision With Another Motor E8112 Vehicle, Injuring Motorcyclist N Motor Vehicle Traffic Accident Involving Re-Entrant Collision With Another Motor E8113 Vehicle, Injuring Passenger on Motorcycle N Motor Vehicle Traffic Accident Involving Re-Entrant Collision With Another Motor E8114 Vehicle, Injuring Occupant of Streetcar N Motor Vehicle Traffic Accident Involving Re-Entrant Collision With Another Motor E8115 Vehicle, Injuring Rider of Animal; Occupant of Animal-Drawn Vehicle N Motor Vehicle Traffic Accident Involving Re-Entrant Collision With Another Motor E8116 Vehicle, Injuring Pedal Cyclist N Motor Vehicle Traffic Accident Involving Re-Entrant Collision With Another Motor E8117 Vehicle, Injuring Pedestrian N Motor Vehicle Traffic Accident Involving Re-Entrant Collision With Another Motor E8118 Vehicle, Injuring Other Specified Person N Motor Vehicle Traffic Accident Involving Re-Entrant Collision With Another Motor E8119 Vehicle, Injuring Unspecified Person N Other Motor Vehicle Collision With Unmoving Motor Vehicle, Injuring Driver of Motor E8120 Vehicle Other Than Motorcycle N Other Motor Vehicle Collision With Unmoving Motor Vehicle, Injuring Passenger in E8121 Motor Vehicle Other Than Motorcycle N E8122 Other Motor Vehicle Collision With Unmoving Motor Vehicle, Injuring Motorcyclist N Other Motor Vehicle Collision With Unmoving Motor Vehicle, Injuring Passenger on E8123 Motorcycle N Other Motor Vehicle Collision With Unmoving Motor Vehicle, Injuring Occupant of E8124 Streetcar N Other Motor Vehicle Collision With Unmoving Motor Vehicle, Injuring Rider of Animal; E8125 Occupant of Animal-Drawn Vehicle N E8126 Other Motor Vehicle Collision With Unmoving Motor Vehicle, Injuring Pedal Cyclist N E8127 Other Motor Vehicle Collision With Unmoving Motor Vehicle, Injuring Pedestrian N Other Motor Vehicle Collision With Unmoving Motor Vehicle, Injuring Other Specified E8128 Person N Other Motor Vehicle Collision With Unmoving Motor Vehicle, Injuring Unspecified E8129 Person N Motor Vehicle Collision With Nonmotor Transport Vehicle, Injuring Driver of Motor E8130 Vehicle Other Than Motorcycle N Motor Vehicle Collision With Nonmotor Transport Vehicle, Injuring Passenger in Motor E8131 Vehicle Other Than Motorcycle N E8132 Motor Vehicle Collision With Nonmotor Transport Vehicle, Injuring Motorcyclist N Motor Vehicle Collision With Nonmotor Transport Vehicle, Injuring Passenger on E8133 Motorcycle N Motor Vehicle Collision With Nonmotor Transport Vehicle, Injuring Occupant of E8134 Streetcar N Motor Vehicle Collision With Nonmotor Transport Vehicle, Injuring Rider of Animal; E8135 Occupant of Animal-Drawn Vehicle N E8136 Motor Vehicle Collision With Nonmotor Transport Vehicle, Injuring Pedal Cyclist N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 294 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator E8137 Motor Vehicle Collision With Nonmotor Transport Vehicle, Injuring Pedestrian N Motor Vehicle Collision With Nonmotor Transport Vehicle, Injuring Other Specified E8138 Person N

E8139 Motor Vehicle Collision With Nonmotor Transport Vehicle, Injuring Unspecified Person N Motor Vehicle Collision With Pedestrian, Injuring Driver of Motor Vehicle Other Than E8140 Motorcycle N Motor Vehicle Collision With Pedestrian, Injuring Passenger in Motor Vehicle Other Than E8141 Motorcycle N E8142 Motor Vehicle Collision With Pedestrian, Injuring Motorcyclist N E8143 Motor Vehicle Collision With Pedestrian, Injuring Passenger on Motorcycle N E8144 Motor Vehicle Collision With Pedestrian, Injuring Occupant of Streetcar N Motor Vehicle Collision With Pedestrian, Injuring Rider of Animal; Occupant of Animal- E8145 Drawn Vehicle N E8146 Motor Vehicle Collision With Pedestrian, Injuring Pedal Cyclist N E8147 Motor Vehicle Collision With Pedestrian, Injuring Pedestrian N E8148 Motor Vehicle Collision With Pedestrian, Injuring Other Specified Person N E8149 Motor Vehicle Collision With Pedestrian, Injuring Unspecified Person N Other Motor Vehicle Collision With Object on the Highway, Injuring Driver of Motor E8150 Vehicle Other Than Motorcycle N Other Motor Vehicle Collision With Object on the Highway, Injuring Passenger in Motor E8151 Vehicle Other Than Motorcycle N E8152 Other Motor Vehicle Collision With Object on the Highway, Injuring Motorcyclist N Other Motor Vehicle Collision With Object on the Highway, Injuring Passenger on E8153 Motorcycle N Other Motor Vehicle Collision With Object on the Highway, Injuring Occupant of E8154 Streetcar N Other Motor Vehicle Collision With Object on the Highway, Injuring Rider of Animal; E8155 Occupant of Animal-Drawn Vehicle N E8156 Other Motor Vehicle Collision With Object on the Highway, Injuring Pedal Cyclist N E8157 Other Motor Vehicle Collision With Object on the Highway, Injuring Pedestrian N Other Motor Vehicle Collision With Object on the Highway, Injuring Other Specified E8158 Person N

E8159 Other Motor Vehicle Collision With Object on the Highway, Injuring Unspecified Person N Motor Vehicle Traffic Accident due to Loss of Control, Without Collision on the E8160 Highway, Injuring Driver of Motor Vehicle Other Than Motorcycle N Motor Vehicle Traffic Accident due to Loss of Control, Without Collision on the E8161 Highway, Injuring Passenger in Motor Vehicle Other Than Motorcycle N Motor Vehicle Traffic Accident due to Loss of Control, Without Collision on the E8162 Highway, Injuring Motorcyclist N Motor Vehicle Traffic Accident due to Loss of Control, Without Collision on the E8163 Highway, Injuring Passenger on Motorcycle N Motor Vehicle Traffic Accident due to Loss of Control, Without Collision on the E8164 Highway, Injuring Occupant of Streetcar N Motor Vehicle Traffic Accident due to Loss of Control, Without Collision on the E8165 Highway, Injuring Rider of Animal; Occupant of Animal-Drawn Vehicle N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 295 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Motor Vehicle Traffic Accident due to Loss of Control, Without Collision on the E8166 Highway, Injuring Pedal Cyclist N Motor Vehicle Traffic Accident due to Loss of Control, Without Collision on the E8167 Highway, Injuring Pedestrian N Motor Vehicle Traffic Accident due to Loss of Control, Without Collision on the E8168 Highway, Injuring Other Specified Person N Motor Vehicle Traffic Accident due to Loss of Control, Without Collision on the E8169 Highway, Injuring Unspecified Person N Noncollision Motor Vehicle Traffic Accident Injuring Driver of Motor Vehicle Other E8170 Than Motorcycle While Boarding or Alighting N Noncollision Motor Vehicle Traffic Accident Injuring Passenger in Motor Vehicle Other E8171 Than Motorcycle While Boarding or Alighting N Noncollision Motor Vehicle Traffic Accident Injuring Motorcyclist While Boarding or E8172 Alighting N Noncollision Motor Vehicle Traffic Accident Injuring Passenger on Motorcycle While E8173 Boarding or Alighting N Noncollision Motor Vehicle Traffic Accident Injuring Occupant of Streetcar While E8174 Boarding or Alighting N Noncollision Motor Vehicle Traffic Accident Injuring Rider of Animal; Occupant of E8175 Animal-Drawn Vehicle While Boarding or Alighting N Noncollision Motor Vehicle Traffic Accident Injuring Pedal Cyclist While Boarding or E8176 Alighting N Noncollision Motor Vehicle Traffic Accident Injuring Pedestrian While Boarding or E8177 Alighting N Noncollision Motor Vehicle Traffic Accident Injuring Other Specified Person While E8178 Boarding or Alighting N Noncollision Motor Vehicle Traffic Accident Injuring Unspecified Person While Boarding E8179 or Alighting N Other Noncollision Motor Vehicle Traffic Accident Injuring Driver of Motor Vehicle E8180 Other Than Motorcycle N Other Noncollision Motor Vehicle Traffic Accident Injuring Passenger in Motor Vehicle E8181 Other Than Motorcycle N E8182 Other Noncollision Motor Vehicle Traffic Accident Injuring Motorcyclist N E8183 Other Noncollision Motor Vehicle Traffic Accident Injuring Passenger on Motorcycle N E8184 Other Noncollision Motor Vehicle Traffic Accident Injuring Occupant of Streetcar N Other Noncollision Motor Vehicle Traffic Accident Injuring Rider of Animal; Occupant of E8185 Animal-Drawn Vehicle N E8186 Other Noncollision Motor Vehicle Traffic Accident Injuring Pedal Cyclist N E8187 Other Noncollision Motor Vehicle Traffic Accident Injuring Pedestrian N E8188 Other Noncollision Motor Vehicle Traffic Accident Injuring Other Specified Person N E8189 Other Noncollision Motor Vehicle Traffic Accident Injuring Unspecified Person N Motor Vehicle Traffic Accident of Unspecified Nature Injuring Driver of Motor Vehicle E8190 Other Than Motorcycle N Motor Vehicle Traffic Accident of Unspecified Nature Injuring Passenger in Motor E8191 Vehicle Other Than Motorcycle N E8192 Motor Vehicle Traffic Accident of Unspecified Nature Injuring Motorcyclist N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 296 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator

E8193 Motor Vehicle Traffic Accident of Unspecified Nature Injuring Passenger on Motorcycle N E8194 Motor Vehicle Traffic Accident of Unspecified Nature Injuring Occupant of Streetcar N Motor Vehicle Traffic Accident of Unspecified Nature Injuring Rider of Animal; E8195 Occupant of Animal-Drawn Vehicle N E8196 Motor Vehicle Traffic Accident of Unspecified Nature Injuring Pedal Cyclist N E8197 Motor Vehicle Traffic Accident of Unspecified Nature Injuring Pedestrian N E8198 Motor Vehicle Traffic Accident of Unspecified Nature Injuring Other Specified Person N E8199 Motor Vehicle Traffic Accident of Unspecified Nature Injuring Unspecified Person N Nontraffic Accident Involving Motor-Driven Snow Vehicle Injuring Driver of Motor E8200 Vehicle Other Than Motorcycle N Nontraffic Accident Involving Motor-Driven Snow Vehicle Injuring Passenger in Motor E8201 Vehicle Other Than Motorcycle N E8202 Nontraffic Accident Involving Motor-Driven Snow Vehicle Injuring Motorcyclist N Nontraffic Accident Involving Motor-Driven Snow Vehicle Injuring Passenger on E8203 Motorcycle N

E8204 Nontraffic Accident Involving Motor-Driven Snow Vehicle Injuring Occupant of Streetcar N Nontraffic Accident Involving Motor-Driven Snow Vehicle Injuring Rider of Animal; E8205 Occupant of Animal-Drawn Vehicle N E8206 Nontraffic Accident Involving Motor-Driven Snow Vehicle Injuring Pedal Cyclist N E8207 Nontraffic Accident Involving Motor-Driven Snow Vehicle Injuring Pedestrian N Nontraffic Accident Involving Motor-Driven Snow Vehicle Injuring Other Specified E8208 Person N E8209 Nontraffic Accident Involving Motor-Driven Snow Vehicle Injuring Unspecified Person N Nontraffic Accident Involving Other Off-Road Motor Vehicle Injuring Driver of Motor E8210 Vehicle Other Than Motorcycle N Nontraffic Accident Involving Other Off-Road Motor Vehicle Injuring Passenger in Motor E8211 Vehicle Other Than Motorcycle N E8212 Nontraffic Accident Involving Other Off-Road Motor Vehicle Injuring Motorcyclist N Nontraffic Accident Involving Other Off-Road Motor Vehicle Injuring Passenger on E8213 Motorcycle N Nontraffic Accident Involving Other Off-Road Motor Vehicle Injuring Occupant of E8214 Streetcar N Nontraffic Accident Involving Other Off-Road Motor Vehicle Injuring Rider of Animal; E8215 Occupant of Animal-Drawn Vehicle N E8216 Nontraffic Accident Involving Other Off-Road Motor Vehicle Injuring Pedal Cyclist N E8217 Nontraffic Accident Involving Other Off-Road Motor Vehicle Injuring Pedestrian N Nontraffic Accident Involving Other Off-Road Motor Vehicle Injuring Other Specified E8218 Person N

E8219 Nontraffic Accident Involving Other Off-Road Motor Vehicle Injuring Unspecified Person N Other Motor Vehicle Nontraffic Accident Involving Collision With Moving Object E8220 Injuring Driver of Motor Vehicle Other Than Motorcycle N Other Motor Vehicle Nontraffic Accident Involving Collision With Moving Object E8221 Injuring Passenger in Motor Vehicle Other Than Motorcycle N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 297 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Other Motor Vehicle Nontraffic Accident Involving Collision With Moving Object E8222 Injuring Motorcyclist N Other Motor Vehicle Nontraffic Accident Involving Collision With Moving Object E8223 Injuring Passenger on Motorcycle N Other Motor Vehicle Nontraffic Accident Involving Collision With Moving Object E8224 Injuring Occupant of Streetcar N Other Motor Vehicle Nontraffic Accident Involving Collision With Moving Object E8225 Injuring Rider of Animal; Occupant of Animal-Drawn Vehicle N Other Motor Vehicle Nontraffic Accident Involving Collision With Moving Object E8226 Injuring Pedal Cyclist N Other Motor Vehicle Nontraffic Accident Involving Collision With Moving Object E8227 Injuring Pedestrian N Other Motor Vehicle Nontraffic Accident Involving Collision With Moving Object E8228 Injuring Other Specified Person N Other Motor Vehicle Nontraffic Accident Involving Collision With Moving Object E8229 Injuring Unspecified Person N Other Motor Vehicle Nontraffic Accident Involving Collision With Stationary Object E8230 Injuring Driver of Motor Vehicle Other Than Motorcycle N Other Motor Vehicle Nontraffic Accident Involving Collision With Stationary Object E8231 Injuring Passenger in Motor Vehicle Other Than Motorcycle N Other Motor Vehicle Nontraffic Accident Involving Collision With Stationary Object E8232 Injuring Motorcyclist N Other Motor Vehicle Nontraffic Accident Involving Collision With Stationary Object E8233 Injuring Passenger on Motorcycle N Other Motor Vehicle Nontraffic Accident Involving Collision With Stationary Object E8234 Injuring Occupant of Streetcar N Other Motor Vehicle Nontraffic Accident Involving Collision With Stationary Object E8235 Injuring Rider of Animal; Occupant of Animal-Drawn Vehicle N Other Motor Vehicle Nontraffic Accident Involving Collision With Stationary Object E8236 Injuring Pedal Cyclist N Other Motor Vehicle Nontraffic Accident Involving Collision With Stationary Object E8237 Injuring Pedestrian N Other Motor Vehicle Nontraffic Accident Involving Collision With Stationary Object E8238 Injuring Other Specified Person N Other Motor Vehicle Nontraffic Accident Involving Collision With Stationary Object E8239 Injuring Unspecified Person N Other Motor Vehicle Nontraffic Accident Injuring Driver of Motor Vehicle Other Than E8240 Motorcycle While Boarding and Alighting N Other Motor Vehicle Nontraffic Accident Injuring Passenger in Motor Vehicle Other Than E8241 Motorcycle While Boarding and Alighting N Other Motor Vehicle Nontraffic Accident Injuring Motorcyclist While Boarding and E8242 Alighting N Other Motor Vehicle Nontraffic Accident Injuring Passenger on Motorcycle While E8243 Boarding and Alighting N Other Motor Vehicle Nontraffic Accident Injuring Occupant of Streetcar While Boarding E8244 and Alighting N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 298 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Other Motor Vehicle Nontraffic Accident Injuring Rider of Animal; Occupant of Animal- E8245 Drawn Vehicle While Boarding and Alighting N Other Motor Vehicle Nontraffic Accident Injuring Pedal Cyclist While Boarding and E8246 Alighting N Other Motor Vehicle Nontraffic Accident Injuring Pedestrian While Boarding and E8247 Alighting N Other Motor Vehicle Nontraffic Accident Injuring Other Specified Person While Boarding E8248 and Alighting N Other Motor Vehicle Nontraffic Accident Injuring Unspecified Person While Boarding E8249 and Alighting N Other Motor Vehicle Nontraffic Accident of Other and Unspecified Nature Injuring Driver E8250 of Motor Vehicle Other Than Motorcycle N Other Motor Vehicle Nontraffic Accident of Other and Unspecified Nature Injuring E8251 Passenger in Motor Vehicle Other Than Motorcycle N Other Motor Vehicle Nontraffic Accident of Other and Unspecified Nature Injuring E8252 Motorcyclist N Other Motor Vehicle Nontraffic Accident of Other and Unspecified Nature Injuring E8253 Passenger on Motorcycle N Other Motor Vehicle Nontraffic Accident of Other and Unspecified Nature Injuring E8254 Occupant of Streetcar N Other Motor Vehicle Nontraffic Accident of Other and Unspecified Nature Injuring Rider E8255 of Animal; Occupant of Animal-Drawn Vehicle N Other Motor Vehicle Nontraffic Accident of Other and Unspecified Nature Injuring Pedal E8256 Cyclist N Other Motor Vehicle Nontraffic Accident of Other and Unspecified Nature Injuring E8257 Pedestrian N Other Motor Vehicle Nontraffic Accident of Other and Unspecified Nature Injuring Other E8258 Specified Person N Other Motor Vehicle Nontraffic Accident of Other and Unspecified Nature Injuring E8259 Unspecified Person N E8260 Pedal Cycle Accident Injuring Pedestrian N E8261 Pedal Cycle Accident Injuring Pedal Cyclist N E8262 Pedal Cycle Accident Injuring Rider of Animal N E8263 Pedal Cycle Accident Injuring Occupant of Animal-Drawn Vehicle N E8264 Pedal Cycle Accident Injuring Occupant of Streetcar N E8268 Pedal Cycle Accident Injuring Other Specified Person N E8269 Pedal Cycle Accident Injuring Unspecified Person N E8270 Animal-Drawn Vehicle Accident Injuring Pedestrian N E8272 Animal-Drawn Vehicle Accident Injuring Rider of Animal N E8273 Animal-Drawn Vehicle Accident Injuring Occupant of Animal-Drawn Vehicle N E8274 Animal-Drawn Vehicle Accident Injuring Occupant of Streetcar N E8278 Animal-Drawn Vehicle Accident Injuring Other Specified Person N E8279 Animal-Drawn Vehicle Accident Injuring Unspecified Person N E8280 Accident Involving Animal Being Ridden Injuring Pedestrian N E8282 Accident Involving Animal Being Ridden Injuring Rider of Animal N E8284 Accident Involving Animal Being Ridden Injuring Occupant of Streetcar N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 299 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator E8288 Accident Involving Animal Being Ridden Injuring Other Specified Person N E8289 Accident Involving Animal Being Ridden Injuring Unspecified Person N E8290 Other Road Vehicle Accidents Injuring Pedestrian N E8294 Other Road Vehicle Accidents Injuring Occupant of Streetcar N E8298 Other Road Vehicle Accidents Injuring Other Specified Person N E8299 Other Road Vehicle Accidents Injuring Unspecified Person N

E8300 Accident to Watercraft Causing Submersion, Injuring Occupant of Small Unpowered Boat N

E8301 Accident to Watercraft Causing Submersion, Injuring Occupant of Small Unpowered Boat N

E8302 Accident to Watercraft Causing Submersion, Injuring Occupant of Other Watercraft, Crew N Accident to Watercraft Causing Submersion, Injuring Occupant of Other Watercraft, Other E8303 Than Crew N E8304 Accident to Watercraft Causing Submersion, Injuring Water Skier N E8305 Accident to Watercraft Causing Submersion, Injuring Swimmer N E8306 Accident to Watercraft Causing Submersion, Injuring Dockers, Stevedores N E8308 Accident to Watercraft Causing Submersion, Injuring Other Specified Person N E8309 Accident to Watercraft Causing Submersion, Injuring Unspecified Person N E8310 Accident to Watercraft Causing Other Injury to Occupant of Small Powered Boat N E8311 Accident to Watercraft Causing Other Injury to Occupant of Small Powered Boat N E8312 Accident to Watercraft Causing Other Injury to Occupant of Other Watercraft, Crew N Accident to Watercraft Causing Other Injury to Occupant of Other Watercraft, Other Than E8313 Crew N E8314 Accident to Watercraft Causing Other Injury to Water Skier N E8315 Accident to Watercraft Causing Other Injury to Swimmer N E8316 Accident to Watercraft Causing Other Injury to Dockers, Stevedores N E8318 Accident to Watercraft Causing Other Injury to Other Specified Person N E8319 Accident to Watercraft Causing Other Injury to Unspecified Person N Other Accidental Submersion or Drowning in Water Transport Accident Injuring E8320 Occupant of Small Unpowered Boat N Other Accidental Submersion or Drowning in Water Transport Accident Injuring E8321 Occupant of Small Powered Boat N Other Accidental Submersion or Drowning in Water Transport Accident Injuring E8322 Occupant of Other Watercraft, Crew N Other Accidental Submersion or Drowning in Water Transport Accident Injuring E8323 Occupant of Other Watercraft, Other Than Crew N Other Accidental Submersion or Drowning in Water Transport Accident Injuring Water E8324 Skier N Other Accidental Submersion or Drowning in Water Transport Accident Injuring E8325 Swimmer N Other Accidental Submersion or Drowning in Water Transport Accident Injuring Dockers, E8326 Stevedores N Other Accidental Submersion or Drowning in Water Transport Accident Injuring Other E8328 Specified Person N Other Accidental Submersion or Drowning in Water Transport Accident Injuring E8329 Unspecified Person N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 300 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator

E8330 Fall on Stairs or Ladders in Water Transport Injuring Occupant of Small Unpowered Boat N E8331 Fall on Stairs or Ladders in Water Transport Injuring Occupant of Small Powered Boat N

E8332 Fall on Stairs or Ladders in Water Transport Injuring Occupant of Other Watercraft, Crew N Fall on Stairs or Ladders in Water Transport Injuring Occupant of Other Watercraft, Other E8333 Than Crew N E8334 Fall on Stairs or Ladders in Water Transport Injuring Water Skier N E8335 Fall on Stairs or Ladders in Water Transport Injuring Swimmer N E8336 Fall on Stairs or Ladders in Water Transport Injuring Dockers, Stevedores N E8338 Fall on Stairs or Ladders in Water Transport Injuring Other Specified Person N E8339 Fall on Stairs or Ladders in Water Transport Injuring Unspecified Person N Other Fall From One Level to Another in Water Transport Injuring Occupant of Small E8340 Unpowered Boat N Other Fall From One Level to Another in Water Transport Injuring Occupant of Small E8341 Powered Boat N Other Fall From One Level to Another in Water Transport Injuring Occupant of Other E8342 Watercraft, Crew N Other Fall From One Level to Another in Water Transport Injuring Occupant of Other E8343 Watercraft, Other Than Crew N E8344 Other Fall From One Level to Another in Water Transport Injuring Water Skier N E8345 Other Fall From One Level to Another in Water Transport Injuring Swimmer N E8346 Other Fall From One Level to Another in Water Transport Injuring Dockers, Stevedores N

E8348 Other Fall From One Level to Another in Water Transport Injuring Other Specified Person N E8349 Other Fall From One Level to Another in Water Transport Injuring Unspecified Person N Other and Unspecified Fall in Water Transport Injuring Occupant of Small Unpowered E8350 Boat N

E8351 Other and Unspecified Fall in Water Transport Injuring Occupant of Small Powered Boat N Other and Unspecified Fall in Water Transport Injuring Occupant of Other Watercraft, E8352 Crew N Other and Unspecified Fall in Water Transport Injuring Occupant of Other Watercraft, E8353 Other Than Crew N E8354 Other and Unspecified Fall in Water Transport Injuring Water Skier N E8355 Other and Unspecified Fall in Water Transport Injuring Swimmer N E8356 Other and Unspecified Fall in Water Transport Injuring Dockers, Stevedores N E8358 Other and Unspecified Fall in Water Transport Injuring Other Specified Person N E8359 Other and Unspecified Fall in Water Transport Injuring Unspecified Person N E8360 Machinery Accident in Water Transport Injuring Occupant of Small Unpowered Boat N E8361 Machinery Accident in Water Transport Injuring Occupant of Small Powered Boat N E8362 Machinery Accident in Water Transport Injuring Occupant of Other Watercraft, Crew N Machinery Accident in Water Transport Injuring Occupant of Other Watercraft, Other E8363 Than Crew N E8364 Machinery Accident in Water Transport Injuring Water Skier N E8365 Machinery Accident in Water Transport Injuring Swimmer N E8366 Machinery Accident in Water Transport Injuring Dockers, Stevedores N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 301 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator E8368 Machinery Accident in Water Transport Injuring Other Specified Person N E8369 Machinery Accident in Water Transport Injuring Unspecified Person N E8370 Explosion, Fire, or Burning in Watercraft Injuring Occupant of Small Unpowered Boat N E8371 Explosion, Fire, or Burning in Watercraft Injuring Occupant of Small Powered Boat N E8372 Explosion, Fire, or Burning in Watercraft Injuring Occupant of Other Watercraft, Crew N Explosion, Fire, or Burning in Watercraft Injuring Occupant of Other Watercraft, Other E8373 Than Crew N E8374 Explosion, Fire, or Burning in Watercraft Injuring Water Skier N E8375 Explosion, Fire, or Burning in Watercraft Injuring Swimmer N E8376 Explosion, Fire, or Burning in Watercraft Injuring Dockers, Stevedores N E8378 Explosion, Fire, or Burning in Watercraft Injuring Other Specified Person N E8379 Explosion, Fire, or Burning in Watercraft Injuring Unspecified Person N Other and Unspecified Water Transport Accident Injuring Occupant of Small Unpowered E8380 Boat N Other and Unspecified Water Transport Accident Injuring Occupant of Small Powered E8381 Boat N Other and Unspecified Water Transport Accident Injuring Occupant of Other Watercraft, E8382 Crew N Other and Unspecified Water Transport Accident Injuring Occupant of Other Watercraft, E8383 Other Than Crew N E8384 Other and Unspecified Water Transport Accident Injuring Water Skier N E8385 Other and Unspecified Water Transport Accident Injuring Swimmer N E8386 Other and Unspecified Water Transport Accident Injuring Dockers, Stevedores N E8388 Other and Unspecified Water Transport Accident Injuring Other Specified Person N E8389 Other and Unspecified Water Transport Accident Injuring Unspecified Person N E8400 Accident to Powered Aircraft at Takeoff or Landing, Injuring Occupant of Spacecraft N Accident to Powered Aircraft at Takeoff or Landing, Injuring Any Occupant of Military E8401 Aircraft N Accident to Powered Aircraft at Takeoff or Landing, Injuring Crew of Commercial E8402 Aircraft (Powered) in Surface to Surface Transport N Accident to Powered Aircraft at Takeoff or Landing, Injuring Other Occupant of E8403 Commercial Aircraft (Powered) in Surface to Surface Transport N Accident to Powered Aircraft at Takeoff or Landing, Injuring Occupant of Commercial E8404 Aircraft (Powered) in Surface to Air Transport N Accident to Powered Aircraft at Takeoff or Landing, Injuring Occupant of Other Powered E8405 Aircraft N Accident to Powered Aircraft at Takeoff or Landing, Injuring Occupant of Unpowered E8406 Aircraft, Except Parachutist N Accident to Powered Aircraft at Takeoff or Landing, Injuring Parachutist (Military) E8407 (Other) N Accident to Powered Aircraft at Takeoff or Landing, Injuring Ground Crew, Airline E8408 Employee N E8409 Accident to Powered Aircraft at Takeoff or Landing, Injuring Other Person N E8410 Accident to Powered Aircraft, Other and Unspecified, Injuring Occupant of Spacecraft N Accident to Powered Aircraft, Other and Unspecified, Injuring Any Occupant of Military E8411 Aircraft N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 302 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Accident to Powered Aircraft, Other and Unspecified, Injuring Crew of Commercial E8412 Aircraft (Powered) in Surface to Surface Transport N Accident to Powered Aircraft, Other and Unspecified, Injuring Other Occupant of E8413 Commercial Aircraft (Powered) in Surface to Surface Transport N Accident to Powered Aircraft, Other and Unspecified, Injuring Occupant of Commercial E8414 Aircraft (Powered) in Surface to Air Transport N Accident to Powered Aircraft, Other and Unspecified, Injuring Occupant of Other E8415 Powered Aircraft N Accident to Powered Aircraft, Other and Unspecified, Injuring Occupant of Unpowered E8416 Aircraft, Except Parachutist N Accident to Powered Aircraft, Other and Unspecified, Injuring Parachutist (Military) E8417 (Other) N Accident to Powered Aircraft, Other and Unspecified, Injuring Ground Crew, Airline E8418 Employee N E8419 Accident to Powered Aircraft, Other and Unspecified, Injuring Other Person N Accident to Unpowered Aircraft Injuring Occupant of Unpowered Aircraft, Except E8426 Parachutist N E8427 Accident to Unpowered Aircraft Injuring Parachutist (Military) (Other) N E8428 Accident to Unpowered Aircraft Injuring Ground Crew, Airline Employee N E8429 Accident to Unpowered Aircraft Injuring Other Person N E8430 Fall In, On, or From Aircraft, Injuring Occupant of Spacecraft N E8431 Fall In, On, or From Aircraft, Injuring Any Occupant of Military Aircraft N Fall In, On, or From Aircraft, Injuring Crew of Commercial Aircraft (Powered) in Surface E8432 to Surface Transport N Fall In, On, or From Aircraft, Injuring Other Occupant of Commercial Aircraft (Powered) E8433 in Surface to Surface Transport N Fall In, On, or From Aircraft, Injuring Occupant of Commercial Aircraft (Powered) in E8434 Surface to Air Transport N E8435 Fall In, On, or From Aircraft, Injuring Occupant of Other Powered Aircraft N Fall In, On, or From Aircraft, Injuring Occupant of Unpowered Aircraft, Except E8436 Parachutist N E8437 Fall In, On, or From Aircraft, Injuring Parachutist (Military) (Other) N E8438 Fall In, On, or From Aircraft, Injuring Ground Crew, Airline Employee N E8439 Fall In, On, or From Aircraft, Injuring Other Person N E8440 Other Specified Air Transport Accidents Injuring Occupant of Spacecraft N E8441 Other Specified Air Transport Accidents Injuring Any Occupant of Military Aircraft N Other Specified Air Transport Accidents Injuring Crew of Commercial Aircraft (Powered) E8442 in Surface to Surface Transport N Other Specified Air Transport Accidents Injuring Other Occupant of Commercial Aircraft E8443 (Powered) in Surface to Surface Transport N Other Specified Air Transport Accidents Injuring Occupant of Commercial Aircraft E8444 (Powered) in Surface to Air Transport N E8445 Other Specified Air Transport Accidents Injuring Occupant of Other Powered Aircraft N Other Specified Air Transport Accidents Injuring Occupant of Unpowered Aircraft, E8446 Except Parachutist N E8447 Other Specified Air Transport Accidents Injuring Parachutist (Military) (Other) N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 303 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator E8448 Other Specified Air Transport Accidents Injuring Ground Crew, Airline Employee N E8449 Other Specified Air Transport Accidents Injuring Other Person N E8450 Accident Involving Spacecraft Injuring Occupant of Spacecraft N E8458 Accident Involving Spacecraft Injuring Ground Crew, Airline Employee N E8459 Accident Involving Spacecraft Injuring Other Person N Accidents Involving Powered Vehicles Used Solely Within the Buildings and Premises of E846 Industrial or Commercial Establishment N E847 Accidents Involving Cable Cars Not Running on Rails N E848 Accidents Involving Other Vehicles, Not Elsewhere Classifiable N E8490 Place of Occurrence, Home N E8491 Place of Occurrence, Farm N E8492 Place of Occurrence, Mine and Quarry N E8493 Place of Occurrence, Industrial Places and Premises N E8494 Place of Occurrence, Place for Recreation and Sport N E8495 Place of Occurrence, Street and Highway N E8496 Place of Occurrence, Public Building N E8497 Place of Occurrence, Residential Institution N E8498 Other Specified Place of Occurrence N E8499 Unspecified Place of Occurrence N E8500 Accidental Poisoning by Heroin N E8501 Accidental Poisoning by Methadone N E8502 Accidental Poisoning by Other Opiates and Related Narcotics N E8503 Accidental Poisoning by Salicylates N E8504 Accidental Poisoning by Aromatic Analgesics, Not Elsewhere Classified N E8505 Accidental Poisoning by Pyrazole Derivatives N E8506 Accidental Poisoning by Antirheumatics (Antiphlogistics) N E8507 Accidental Poisoning by Other Non-Narcotic Analgesics N E8508 Accidental Poisoning by Other Specified Analgesics and Antipyretics N E8509 Accidental Poisoning by Unspecified Analgesic or Antipyretic N E851 Accidental Poisoning by Barbiturates N E8520 Accidental Poisoning by Chloral Hydrate Group N E8521 Accidental Poisoning by Paraldehyde N E8522 Accidental Poisoning by Bromine Compounds N E8523 Accidental Poisoning by Methaqualone Compounds N E8524 Accidental Poisoning by Glutethimide Group N E8525 Accidental Poisoning by Mixed Sedatives, Not Elsewhere Classified N E8528 Accidental Poisoning by Other Specified Sedative and Hypnotic N E8529 Accidental Poisoning by Unspecified Sedative or Hypnotic N E8530 Accidental Poisoning by Phenothiazine-Based Tranquilizers N E8531 Accidental Poisoning by Butyrophenone-Based Tranquilizers N E8532 Accidental Poisoning by Benzodiazepine-Based Tranquilizers N E8538 Accidental Poisoning by Other Specified Tranquilizers N E8539 Accidental Poisoning by Unspecified Tranquilizer N E854 Accidental Poisoning, Other Psychotropic Agents N E8540 Accidental Poisoning by Antidepressants N E8541 Accidental Poisoning by Psychodysleptics (Hallucinogens) N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 304 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator E8542 Accidental Poisoning by Psychostimulants N E8543 Accidental Poisoning by Central Nervous System Stimulants N E8550 Accidental Poisoning by Anticonvulsant and Anti-Parkinsonism Drugs N E8551 Accidental Poisoning by Other Central Nervous System Depressants N E8552 Accidental Poisoning by Local Anesthetics N E8553 Accidental Poisoning by Parasympathomimetics (Cholinergics) N Accidental Poisoning by Parasympatholytics (Anticholinergics and Antimuscarinics) and E8554 Spasmolytics N E8555 Accidental Poisoning by Sympathomimetics (Adrenergics) N E8556 Accidental Poisoning by Sympatholytics (Antiadrenergics) N Accidental Poisoning by Other Specified Drugs Acting on Central and Autonomic E8558 Nervous Systems N Accidental Poisoning by Unspecified Drug Acting on Central and Autonomic Nervous E8559 Systems N E856 Accidental Poisoning by Antibiotics N E857 Accidental Poisoning by Other Anti-Infectives N E8580 Accidental Poisoning by Hormones and Synthetic Substitutes N E8581 Accidental Poisoning by Primarily Systemic Agents N E8582 Accidental Poisoning by Agents Primarily Affecting Blood Constituents N E8583 Accidental Poisoning by Agents Primarily Affecting Cardiovascular System N E8584 Accidental Poisoning by Agents Primarily Affecting Gastrointestinal System N E8585 Accidental Poisoning by Water, Mineral, and Uric Acid Metabolism Drugs N Accidental Poisoning by Agents Primarily Acting on the Smooth and Skeletal Muscles and E8586 Respiratory System N Accidental Poisoning by Agents Primarily Affecting Skin and Mucous Membrane, E8587 Ophthalmological, Otorhinolaryngological, and Dental Drugs N E8588 Accidental Poisoning by Other Specified Drugs N E8589 Accidental Poisoning by Unspecified Drug N E8600 Accidental Poisoning by Alcoholic Beverages N E8601 Accidental Poisoning by Other and Unspecified Ethyl Alcohol and Its Products N E8602 Accidental Poisoning by Methyl Alcohol N E8603 Accidental Poisoning by Isopropyl Alcohol N E8604 Accidental Poisoning by Fusel Oil N E8608 Accidental Poisoning by Other Specified Alcohols N E8609 Accidental Poisoning by Unspecified Alcohol N E8610 Accidental Poisoning by Synthetic Detergents and Shampoos N E8611 Accidental Poisoning by Soap Products N E8612 Accidental Poisoning by Polishes N E8613 Accidental Poisoning by Other Cleansing and Polishing Agents N E8614 Accidental Poisoning by Disinfectants N E8615 Accidental Poisoning by Lead Paints N E8616 Accidental Poisoning by Other Paints and Varnishes N Accidental Poisonings by Unspecified Cleansing and Polishing Agents, Disinfectants, E8619 Paints, and Varnishes N E8620 Accidental Poisoning by Petroleum Solvents N E8621 Accidental Poisoning by Petroleum Fuels and Cleaners N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 305 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator E8622 Accidental Poisoning by Lubricating Oils N E8623 Accidental Poisoning by Petroleum Solids N E8624 Accidental Poisoning by Other Specified Solvents N E8629 Accidental Poisoning by Unspecified Solvent N E8630 Accidental Poisoning by Insecticides of Organochlorine Compounds N E8631 Accidental Poisoning by Insecticides of Organophosphorus Compounds N E8632 Accidental Poisoning by Carbamates N E8633 Accidental Poisoning by Mixtures of Insecticides N E8634 Accidental Poisoning by Other and Unspecified Insecticides N E8635 Accidental Poisoning by Herbicides N E8636 Accidental Poisoning by Fungicides N E8637 Accidental Poisoning by Rodenticides N E8638 Accidental Poisoning by Fumigants N Accidental Poisoning by Other and Unspecified Agricultural and Horticultural Chemical E8639 and Pharmaceutical Preparations Other Than Plant Foods and Fertilizers N E8640 Accidental Poisoning by Corrosive Aromatics Not Elsewhere Classified N E8641 Accidental Poisoning by Acids Not Elsewhere Classified N E8642 Accidental Poisoning by Caustic Alkalis Not Elsewhere Classified N Accidental Poisoning by Other Specified Corrosives and Caustics Not Elsewhere E8643 Classified N E8644 Accidental Poisoning by Unspecified Corrosives and Caustics Not Elsewhere Classified N E8650 Accidental Poisoning by Meat N E8651 Accidental Poisoning by Shellfish N E8652 Accidental Poisoning From Other Fish N E8653 Accidental Poisoning From Berries and Seeds N E8654 Accidental Poisoning From Other Specified Plants N E8655 Accidental Poisoning From Mushrooms and Other Fungi N E8658 Accidental Poisoning From Other Specified Foods N E8659 Accidental Poisoning From Unspecified Foodstuff or Poisonous Plant N E8660 Accidental Poisoning by Lead and Its Compounds and Fumes N E8661 Accidental Poisoning by Mercury and Its Compounds and Fumes N E8662 Accidental Poisoning by Antimony and Its Compounds and Fumes N E8663 Accidental Poisoning by Arsenic and Its Compounds and Fumes N E8664 Accidental Poisoning by Other Metals and Their Compounds and Fumes N E8665 Accidental Poisoning by Plant Foods and Fertilizers N E8666 Accidental Poisoning by Glues and Adhesives N E8667 Accidental Poisoning by Cosmetics N E8668 Accidental Poisoning by Other Specified Solid or Liquid Substances N E8669 Accidental Poisoning by Unspecified Solid or Liquid Substance N E867 Accidental Poisoning by Gas Distributed by Pipeline N E8680 Accidental Poisoning by Liquefied Petroleum Gas Distributed in Mobile Containers N E8681 Accidental Poisoning by Other and Unspecified Utility Gas N E8682 Accidental Poisoning by Motor Vehicle Exhaust Gas N Accidental Poisoning by Carbon Monoxide From Incomplete Combustion of Other E8683 Domestic Fuels N E8688 Accidental Poisoning by Carbon Monoxide From Other Sources N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 306 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator E8689 Accidental Poisoning by Unspecified Carbon Monoxide N E869 Accidental Poisoning;Second-Hand Tobacco Smoke N E8690 Accidental Poisoning by Nitrogen Oxides N E8691 Accidental Poisoning by Sulfur Dioxide N E8692 Accidental Poisoning by Freon N E8693 Accidental Poisoning by Lacrimogenic Gas (Tear Gas) N E8694 Accidental Poisoning by Second-Hand Tobacco Smoke N E8698 Accidental Poisoning by Other Specified Gases and Vapors N E8699 Accidental Poisoning by Unspecified Gases and Vapors N E8700 Accidental Cut, Puncture, Perforation, or Hemorrhage During Surgical Operation N E8701 Accidental Cut, Puncture, Perforation, or Hemorrhage During Infusion or Transfusion N Accidental Cut, Puncture, Perforation, or Hemorrhage During Kidney Dialysis or Other E8702 Perfusion N E8703 Accidental Cut, Puncture, Perforation, or Hemorrhage During Injection or Vaccination N E8704 Accidental Cut, Puncture, Perforation, or Hemorrhage During Endoscopic Examination N Accidental Cut, Puncture, Perforation, or Hemorrhage During Aspiration of Fluid or E8705 Tissue, Puncture, and Catheterization N E8706 Accidental Cut, Puncture, Perforation, or Hemorrhage During Heart Catheterization N E8707 Accidental Cut, Puncture, Perforation, or Hemorrhage During Administration of Enema N Accidental Cut, Puncture, Perforation, or Hemorrhage During Other Specified Medical E8708 Care N

E8709 Accidental Cut, Puncture, Perforation, or Hemorrhage During Unspecified Medical Care N E8710 Foreign Object Left in Body During Surgical Operation N E8711 Foreign Object Left in Body During Infusion or Transfusion N E8712 Foreign Object Left in Body During Kidney Dialysis or Other Perfusion N E8713 Foreign Object Left in Body During Injection or Vaccination N E8714 Foreign Object Left in Body During Endoscopic Examination N Foreign Object Left in Body During Aspiration of Fluid or Tissue, Puncture, and E8715 Catheterization N E8716 Foreign Object Left in Body During Heart Catheterization N E8717 Foreign Object Left in Body During Removal of Catheter or Packing N E8718 Foreign Object Left in Body During Other Specified Procedure N E8719 Foreign Object Left in Body During Unspecified Procedure N E8720 Failure of Sterile Precautions During Surgical Operation N E8721 Failure of Sterile Precautions During Infusion or Transfusion N E8722 Failure of Sterile Precautions During Kidney Dialysis and Other Perfusion N E8723 Failure of Sterile Precautions During Injection or Vaccination N E8724 Failure of Sterile Precautions During Endoscopic Examination N Failure of Sterile Precautions During Aspiration of Fluid or Tissue, Puncture, and E8725 Catheterization N E8726 Failure of Sterile Precautions During Heart Catheterization N E8728 Failure of Sterile Precautions During Other Specified Procedure N E8729 Failure of Sterile Precautions During Unspecified Procedure N E8730 Excessive Amount of Blood or Other Fluid During Transfusion or Infusion N E8731 Incorrect Dilution of Fluid During Infusion N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 307 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator E8732 Overdose of Radiation in Therapy N E8733 Inadvertent Exposure of Patient to Radiation During Medical Care N E8734 Failure in Dosage in Electroshock or Insulin-Shock Therapy N E8735 Inappropriate (Too Hot or Too Cold) Temperature in Local Application and Packing N E8736 Nonadministration of Necessary Drug or Medicinal Substance N E8738 Other Specified Failure in Dosage N E8739 Unspecified Failure in Dosage N E8740 Mechanical Failure of Instrument or Apparatus During Surgical Operation N E8741 Mechanical Failure of Instrument or Apparatus During Infusion and Transfusion N Mechanical Failure of Instrument or Apparatus During Kidney Dialysis and Other E8742 Perfusion N E8743 Mechanical Failure of Instrument or Apparatus During Endoscopic Examination N Mechanical Failure of Instrument or Apparatus During Aspiration of Fluid or Tissue, E8744 Puncture, and Catheterization N E8745 Mechanical Failure of Instrument or Apparatus During Heart Catheterization N E8748 Mechanical Failure of Instrument or Apparatus During Other Specified Procedure N E8749 Mechanical Failure of Instrument or Apparatus During Unspecified Procedure N E8750 Contaminated Substance Transfused or Infused N E8751 Contaminated Substance Injected or Used for Vaccination N E8752 Contaminated Drug or Biological Substance Administered by Other Means N E8758 Other Contamination of Patient During Medical Care N E8759 Unspecified Contamination of Patient During Medical Care N E8760 Mismatched Blood in Transfusion N E8761 Wrong Fluid in Infusion N E8762 Failure in Suture and Ligature During Surgical Operation N E8763 Endotracheal Tube Wrongly Placed During Anesthetic Procedure N E8764 Failure to Introduce or to Remove Other Tube or Instrument N E8765 Performance of Inappropriate Operation N E8768 Other Specified Misadventure During Medical Care N E8769 Unspecified Misadventure During Medical Care N

Surgical Operation With Transplant of Whole Organ Causing Abnormal Patient Reaction, E8780 or Later Complication, Without Mention of Misadventure at Time of Operation N

Surgical Operation With Implant of Artificial Internal Device Causing Abnormal Patient E8781 Reaction, or Later Complication, Without Mention of Misadventure at Time of Operation N Surgical Operation With Anastomosis, Bypass, or Graft, With Natural or Artificial Tissues Used as Implant Causing Abnormal Patient Reaction, or Later Complication, Without E8782 Mention of Misadventure at Time of Operation N

Surgical Operation With Formation of External Stoma Causing Abnormal Patient E8783 Reaction, or Later Complication, Without Mention of Misadventure at Time of Operation N Other Restorative Surgery Causing Abnormal Patient Reaction, or Later Complication, E8784 Without Mention of Misadventure at Time of Operation N Amputation of Limb(s) Causing Abnormal Patient Reaction, or Later Complication, E8785 Without Mention of Misadventure at Time of Operation N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 308 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Removal of Other Organ (Partial) (Total) Causing Abnormal Patient Reaction, or Later E8786 Complication, Without Mention of Misadventure at Time of Operation N Other Specified Surgical Operation and Procedure Causing Abnormal Patient Reaction, or E8788 Later Complication, Without Mention of Misadventure at Time of Operation N Unspecified Surgical Operation and Procedure Causing Abnormal Patient Reaction, or E8789 Later Complication, Without Mention of Misadventure at Time of Operation N Cardiac Catheterization as the Cause of Abnormal Reaction of Patient, Or of Later E8790 Complication, Without Mention of Misadventure at Time of Procedure N Kidney Dialysis as the Cause of Abnormal Reaction of Patient, Or of Later Complication, E8791 Without Mention of Misadventure at Time of Procedure N

Radiological Procedure and Radiotherapy as the Cause of Abnormal Reaction of Patient, E8792 or of Later Complication, Without Mention of Misadventure at Time of Procedure N Shock Therapy as the Cause of Abnormal Reaction of Patient, Or of Later Complication, E8793 Without Mention of Misadventure at Time of Procedure N Aspiration of Fluid as the Cause of Abnormal Reaction of Patient, Or of Later E8794 Complication, Without Mention of Misadventure at Time of Procedure N Insertion of Gastric or Duodenal Sound as the Cause of Abnormal Reaction of Patient, Or E8795 of Later Complication, Without Mention of Misadventure of Time of Procedure N Urinary Catheterization as the Cause of Abnormal Reaction of Patient, Or of Later E8796 Complication, Without Mention of Misadventure at Time of Procedure N Blood Sampling as the Cause of Abnormal Reaction of Patient, Or of Later Complication, E8797 Without Mention of Misadventure at Time of Procedure N Other Specified Procedure as the Cause of Abnormal Reaction of Patient, Or of Later E8798 Complication, Without Mention of Misadventure at Time of Procedure N Unspecified Procedure as the Cause of Abnormal Reaction of Patient, Or of Later E8799 Complication, Without Mention of Misadventure at Time of Procedure N E880 Fall On or From Sidewalk Curb N E8800 Accidental Fall On or From Escalator N E8801 Accidental Fall On or From Sidewalk Curb N E8809 Accidental Fall On or From Other Stairs or Steps N E8810 Accidental Fall From Ladder N E8811 Accidental Fall From Scaffolding N E882 Accidental Fall From or Out of Building or Other Structure N E8830 Accident From Diving or Jumping Into Water (Swimming Pool) N E8831 Accidental Fall Into Well N E8832 Accidental Fall Into Storm Drain or Manhole N E8839 Accidental Fall Into Other Hole or Other Opening in Surface N E884 Other Fall From One Level to Another; Fall From Wheelchair N E8840 Accidental Fall From Playground Equipment N E8841 Accidental Fall From Cliff N E8842 Accidental Fall From Chair N E8843 Accidental Fall From Wheelchair N E8844 Accidental Fall From Bed N E8845 Accidental Fall From Other Furniture N E8849 Other Accidental Fall From One Level to Another N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 309 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator E885 Fall on Same Level From Slipping, Tripping, or Stumbling N E8851 Fall From Roller Skates N E8852 Fall From Skateboard N E8853 Fall From Skis N E8854 Fall From Snowboard N E8859 Fall From Other Slipping, Tripping, or Stumbling N Accidental Fall on Same Level From Collision, Pushing, or Shoving, By or With Other E8860 Person in Sports N Other and Unspecified Accidental Falls on Same Level From Collision, Pushing, or E8869 Shoving, By or With Other Person N E887 Fracture in Accidental Fall, Cause Unspecified N E888 Other and Unspecified Fall N E8880 Fall Resulting in Striking Against Sharp Object N E8881 Fall Resulting in Striking Against Other Object N E8888 Other Fall N E8889 Unspecified Fall N E8900 Explosion Caused by Conflagration in Private Dwelling N Fumes From Combustion of Polyvinylchloride (Pvc) and Similar Material in Conflagration E8901 in Private Dwelling N E8902 Other Smoke and Fumes From Conflagration in Private Dwelling N E8903 Burning Caused by Conflagration in Private Dwelling N E8908 Other Accident Resulting From Conflagration in Private Dwelling N E8909 Unspecified Accident Resulting From Conflagration in Private Dwelling N E8910 Explosion Caused by Conflagration in Other and Unspecified Building or Structure N Fumes From Combustion of Polyvinylchloride (Pvc) and Similar Material in Conflagration E8911 in Other and Unspecified Building or Structure N Other Smoke and Fumes From Conflagration in Other and Unspecified Building or E8912 Structure N E8913 Burning Caused by Conflagration in Other and Unspecified Building or Structure N Other Accident Resulting From Conflagration in Other and Unspecified Building or E8918 Structure N Unspecified Accident Resulting From Conflagration of Other and Unspecified Building or E8919 Structure N E892 Conflagration Not in Building or Structure N E8930 Accident Caused by Ignition of Clothing From Controlled Fire in Private Dwelling N Accident Caused by Ignition of Clothing From Controlled Fire in Other Building or E8931 Structure N Accident Caused by Ignition of Clothing From Controlled Fire Not in Building or E8932 Structure N E8938 Accident Caused by Ignition of Clothing From Other Specified Sources N E8939 Accident Caused by Ignition of Clothing by Unspecified Source N E894 Ignition of Highly Inflammable Material N E895 Accident Caused by Controlled Fire in Private Dwelling N E896 Accident Caused by Controlled Fire in Other and Unspecified Building or Structure N E897 Accident Caused by Controlled Fire Not in Building or Structure N E8980 Accident Caused by Burning Bedclothes N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 310 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator E8981 Accident Caused by Other Burning Materials N E899 Accident Caused by Unspecified Fire N E9000 Accident due to Excessive Heat Weather Conditions N E9001 Accident due to Excessive Heat, Man-Made Origin N E9009 Accident due to Excessive Heat, Unspecified Origin N E9010 Accident due to Excessive Cold, Weather Conditions N E9011 Accident due to Excessive Cold, Man-Made Origin N E9018 Accident due to Excessive Cold, Other Specified Origin N E9019 Accident due to Excessive Cold, Unspecified Origin N E9020 Accident due to Residence or Prolonged Visit at High Altitude N E9021 Accident due to Changes in Airpressure in Aircraft N E9022 Accident due to Changes in Air Pressure due to Diving N E9028 Accident due to Changes in Air Pressure due to Other Specified Cause N E9029 Accident due to Changes in Air Pressure From Unspecified Cause N E903 Accident due to Travel and Motion N E9040 Accident due to Abandonment or Neglect of Infant and Helpless Person N E9041 Accident due to Lack of Food N E9042 Accident due to Lack of Water N E9043 Accident due to Exposure (To Weather Conditions), Not Elsewhere Classifiable N E9049 Accident due to Unqualified Privation N E9050 Venomous Snakes and Lizards as the Cause of Poisoning and Toxic Reactions N E9051 Venomous Spiders as the Cause of Poisoning and Toxic Reactions N E9052 Scorpion Sting as the Cause of Poisoning and Toxic Reactions N E9053 Sting of Hornets, Wasps, and Bees as the Cause of Poisoning and Toxic Reactions N Centipede and Venomous Millipede (Tropical) Bite as the Cause of Poisoning and Toxic E9054 Reactions N E9055 Other Venomous Arthropods as the Cause of Poisoning and Toxic Reactions N E9056 Venomous Marine Animals and Plants as the Cause of Poisoning and Toxic Reactions N E9057 Poisoning and Toxic Reactions Caused by Other Plants N E9058 Poisoning and Toxic Reactions Caused by Other Specified Animals and Plants N E9059 Poisoning and Toxic Reactions Caused by Unspecified Animals and Plants N E906 Other Injury Caused by Bite of Unspecified Animal N E9060 Dog Bite N E9061 Rat Bite N E9062 Bite of Nonvenomous Snakes and Lizards N E9063 Bite of Other Animal Except Arthropod N E9064 Bite of Nonvenomous Arthropod N E9068 Other Specified Injury Caused by Animal N E9069 Unspecified Injury Caused by Animal N E907 Accident due to Lightning N E908 Cataclysmic Storms, Hurricanes N E909 Earthquakes N E9100 Accidental Drowning and Submersion While Water-Skiing N Accidental Drowning and Submersion While Engaged in Other Sport or Recreational E9101 Activity With Diving Equipment N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 311 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Accidental Drowning and Submersion While Engaged in Other Sport or Recreational E9102 Activity Without Diving Equipment N Accidental Drowning and Submersion While Swimming or Diving for Purposes Other E9103 Than Recreation or Sport N E9104 Accidental Drowning and Submersion in Bathtub N E9108 Other Accidental Drowning or Submersion N E9109 Unspecified Accidental Drowning or Submersion N

E911 Inhalation and Ingestion of Food Causing Obstruction of Respiratory Tract or Suffocation N Inhalation and Ingestion of Other Object Causing Obstruction of Respiratory Tract or E912 Suffocation N E9130 Accidental Mechanical Suffocation in Bed or Cradle N E9131 Accidental Mechanical Suffocation by Plastic Bag N E9132 Accidental Mechanical Suffocation due to Lack of Air (In Closed Place) N E9133 Accidental Mechanical Suffocation by Falling Earth or Other Substance N E9138 Accidental Mechanical Suffocation by Other Specified Means N E9139 Accidental Mechanical Suffocation by Unspecified Means N E914 Foreign Body Accidentally Entering Eye and Adnexa N E915 Foreign Body Accidentally Entering Other Orifice N E916 Struck Accidentally by Falling Object N E9170 Striking Against or Struck Accidentally by Objects or Persons in Sports N E9171 Striking Against or Struck Accidentally by Crowd, by Collective Fear or Panic N E9172 Striking Against or Struck Accidentally in Running Water N E9173 Strike Against or Struck Accidentally by Furniture Without Subsequent Fall N

E9174 Strike Against or Struck Accidentally by Other Stationary Object Without Subsequent Fall N E9175 Strike Against or Struck Accidentally by Other Object in Sports With Subsequent Fall N "Strike Against or Struck Accidentally by Crowd, by Collective Fear or Panic With E9176 Subsequent Fall" N E9177 Strike Against or Struck Accidentally by Furniture With Subsequent Fall N E9178 Strike Against or Struck Accidentally by Other Stationary Object With Subsequent Fall N Other Accident Caused by Striking Against or Being Struck Accidentally by Objects or E9179 Persons N E918 Caught Accidentally In or Between Objects N E9190 Accident Caused by Agricultural Machines N E9191 Accident Caused by Mining and Earth-Drilling Machinery N E9192 Accident Caused by Lifting Machines and Appliances N E9193 Accident Caused by Metalworking Machines N E9194 Accident Caused by Woodworking and Forming Machines N E9195 Accident Caused by Prime Movers, Except Electrical Motors N E9196 Accident Caused by Transmission Machinery N E9197 Accident Caused by Earth Moving, Scraping, and Other Excavating Machines N E9198 Accident Caused by Other Specified Machinery N E9199 Accident Caused by Unspecified Machinery N E920 Accidents Caused by Cutting and Piercing Instruments or Objects; Hypod N E9200 Accident Caused by Powered Lawn Mower N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 312 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator E9201 Accident Caused by Other Powered Hand Tools N E9202 Accident Caused by Powered Household Appliances and Implements N E9203 Accident Caused by Knives, Swords, and Daggers N E9204 Accident Caused by Other Hand Tools and Implements N E9208 Accident Caused by Other Specified Cutting and Piercing Instruments or Objects N E9209 Accident Caused by Unspecified Cutting and Piercing Instrument or Object N E9210 Accident Caused by Explosion of Boilers N E9211 Accident Caused by Explosion of Gas Cylinders N E9218 Accident Caused by Explosion of Other Specified Pressure Vessels N E9219 Accident Caused by Explosion of Unspecified Pressure Vessel N E9220 Accident Caused by Handgun N E9221 Accident Caused by Shotgun (Automatic) N E9222 Accident Caused by Hunting Rifle N E9223 Accident Caused by Military Firearms N E9224 Accident Caused by Air Gun N E9228 Accident Caused by Other Specified Firearm Missile N E9229 Accident Caused by Unspecified Firearm Missile N E9230 Accident Caused by Fireworks N E9231 Accident Caused by Blasting Materials N E9232 Accident Caused by Explosive Gases N E9238 Accident Caused by Other Explosive Materials N E9239 Accident Caused by Unspecified Explosive Material N E924 Accident Caused by Hot Substances or Object, Caustic or Corrosive Mate N E9240 Accident Caused by Hot Liquids and Vapors, Including Steam N E9241 Accident Caused by Caustic and Corrosive Substances N E9242 Accident Caused by Hot (Boiling) Tap Water N E9248 Accident Caused by Other Hot Substance or Object N E9249 Accident Caused by Unspecified Hot Substance or Object N E9250 Electrical Accident Caused by Domestic Wiring and Appliances N Electrical Accident Caused by Electric Current in Electric Power Generating Plants, E9251 Distribution Stations, Transmission Lines N E9252 Electrical Accident Caused by Industrial Wiring, Appliances, and Electrical Machinery N E9258 Accident Caused by Other Electric Current N E9259 Accident Caused by Unspecified Electric Current N E9260 Exposure to Radiofrequency Radiation N E9261 Exposure to Infrared Radiation From Heaters and Lamps N E9262 Exposure to Visible and Ultraviolet Light Sources N E9263 Exposure to X-Rays and Other Electromagnetic Ionizing Radiation N E9264 Exposure to Lasers N E9265 Exposure to Radioactive Isotopes N E9268 Exposure to Other Specified Radiation N E9269 Exposure to Unspecified Radiation N E927 Overexertion and Strenuous Movements N E9280 Prolonged Stay in Weightless Environment N E9281 Exposure to Noise N E9282 Accident Caused by Vibration N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 313 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator E9283 Accidental Human Bite N E9284 External Constriction Caused by Hair N E9285 External Constriction Caused by Other Object N E9288 Other Accident N E9289 Unspecified Accident N E9290 Late Effects of Motor Vehicle Accident N E9291 Late Effects of Other Transport Accident N E9292 Late Effects of Accidental Poisoning N E9293 Late Effects of Accidental Fall N E9294 Late Effects of Accident Caused by Fire N E9295 Late Effects of Accident due to Natural and Environmental Factors N E9298 Late Effects of Other Accidents N E9299 Late Effects of Unspecified Accident N E9300 Penicillins Causing Adverse Effect in Therapeutic Use N E9301 Antifungal Antibiotics Causing Adverse Effect in Therapeutic Use N E9302 Chloramphenicol Group Causing Adverse Effect in Therapeutic Use N E9303 Erythromycin and Other Macrolides Causing Adverse Effect in Therapeutic Use N E9304 Tetracycline Group Causing Adverse Effect in Therapeutic Use N E9305 Cephalosporin Group Causing Adverse Effect in Therapeutic Use N E9306 Antimycobacterial Antibiotics Causing Adverse Effect in Therapeutic Use N E9307 Antineoplastic Antibiotics Causing Adverse Effect in Therapeutic Use N E9308 Other Specified Antibiotics Causing Adverse Effect in Therapeutic Use N E9309 Unspecified Antibiotic Causing Adverse Effect in Therapeutic Use N E9310 Sulfonamides Causing Adverse Effect in Therapeutic Use N E9311 Arsenical Anti-Infectives Causing Adverse Effect in Therapeutic Use N E9312 Heavy Metal Anti-Infectives Causing Adverse Effect in Therapeutic Use N

E9313 Quinoline and Hydroxyquinoline Derivatives Causing Adverse Effect in Therapeutic Use N Antimalarials and Drugs Acting on Other Blood Protozoa Causing Adverse Effect in E9314 Therapeutic Use N E9315 Other Antiprotozoal Drugs Causing Adverse Effect in Therapeutic Use N E9316 Anthelmintics Causing Adverse Effect in Therapeutic Use N E9317 Antiviral Drugs Causing Adverse Effect in Therapeutic Use N E9318 Other Antimycobacterial Drugs Causing Adverse Effect in Therapeutic Use N E9319 Other and Unspecified Anti-Infectives Causing Adverse Effect in Therapeutic Use N E9320 Adrenal Cortical Steroids Causing Adverse Effect in Therapeutic Use N E9321 Androgens and Anabolic Congeners Causing Adverse Effect in Therapeutic Use N

E9322 Ovarian Hormones and Synthetic Substitutes Causing Adverse Effect in Therapeutic Use N E9323 Insulins and Antidiabetic Agents Causing Adverse Effect in Therapeutic Use N E9324 Anterior Pituitary Hormones Causing Adverse Effect in Therapeutic Use N E9325 Posterior Pituitary Hormones Causing Adverse Effect in Therapeutic Use N E9326 Parathyroid and Parathyroid Derivatives Causing Adverse Effect in Therapeutic Use N E9327 Thyroid and Thyroid Derivatives Causing Adverse Effect in Therapeutic Use N E9328 Antithyroid Agents Causing Adverse Effect in Therapeutic Use N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 314 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Other and Unspecified Hormones and Synthetic Substitutes Causing Adverse Effect in E9329 Therapeutic Use N E9330 Antiallergic and Antiemetic Drugs Causing Adverse Effect in Therapeutic Use N

E9331 Antineoplastic and Immunosuppressive Drugs Causing Adverse Effect in Therapeutic Use N E9332 Acidifying Agents Causing Adverse Effect in Therapeutic Use N E9333 Alkalizing Agents Causing Adverse Effect in Therapeutic Use N E9334 Enzymes, Not Elsewhere Classified, Causing Adverse Effect in Therapeutic Use N E9335 Vitamins, Not Elsewhere Classified, Causing Adverse Effect in Therapeutic Use N Other Systemic Agents, Not Elsewhere Classified, Causing Adverse Effect in Therapeutic E9338 Use N E9339 Unspecified Systemic Agent Causing Adverse Effect in Therapeutic Use N E9340 Iron and Its Compounds Causing Adverse Effect in Therapeutic Use N Liver Preparations and Other Antianemic Agents Causing Adverse Effect in Therapeutic E9341 Use N E9342 Anticoagulants Causing Adverse Effect in Therapeutic Use N E9343 Vitamin K (Phytonadione) Causing Adverse Effect in Therapeutic Use N E9344 Fibrinolysis-Affecting Drugs Causing Adverse Effect in Therapeutic Use N Anticoagulant Antagonists and Other Coagulants Causing Adverse Effect in Therapeutic E9345 Use N E9346 Gamma Globulin Causing Adverse Effect in Therapeutic Use N E9347 Natural Blood and Blood Products Causing Adverse Effect in Therapeutic Use N E9348 Other Agents Affecting Blood Constituents Causing Adverse Effect in Therapeutic Use N Unspecified Agent Affecting Blood Constituents Causing Adverse Effect in Therapeutic E9349 Use N E9350 Heroin Causing Adverse Effect in Therapeutic Use N E9351 Methadone Causing Averse Effect in Therapeutic Use N E9352 Other Opiates and Related Narcotics Causing Adverse Effect in Therapeutic Use N E9353 Salicylates Causing Adverse Effect in Therapeutic Use N Aromatic Analgesics, Not Elsewhere Classified, Causing Adverse Effect in Therapeutic E9354 Use N E9355 Pyrazole Derivatives Causing Adverse Effect in Therapeutic Use N E9356 Antirheumatics (Antiphlogistics) Causing Adverse Effect in Therapeutic Use N E9357 Other Non-Narcotic Analgesics Causing Adverse Effect in Therapeutic Use N

E9358 Other Specified Analgesics and Antipyretics Causing Adverse Effect in Therapeutic Use N E9359 Unspecified Analgesic and Antipyretic Causing Adverse Effect in Therapeutic Use N E9360 Oxazolidine Derivatives Causing Adverse Effect in Therapeutic Use N E9361 Hydantoin Derivatives Causing Adverse Effect in Therapeutic Use N E9362 Succinimides Causing Adverse Effect in Therapeutic Use N E9363 Other and Unspecified Anticonvulsants Causing Adverse Effect in Therapeutic Use N E9364 Anti-Parkinsonism Drugs Causing Adverse Effect in Therapeutic Use N E9370 Barbiturates Causing Adverse Effect in Therapeutic Use N E9371 Chloral Hydrate Group Causing Adverse Effect in Therapeutic Use N E9372 Paraldehyde Causing Adverse Effect in Therapeutic Use N E9373 Bromine Compounds Causing Adverse Effect in Therapeutic Use N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 315 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator E9374 Methaqualone Compounds Causing Adverse Effect in Therapeutic Use N E9375 Glutethimide Group Causing Adverse Effect in Therapeutic Use N E9376 Mixed Sedatives, Not Elsewhere Classified, Causing Adverse Effect in Therapeutic Use N E9378 Other Sedatives and Hypnotics Causing Adverse Effect in Therapeutic Use N E9379 Unspecified Sedatives and Hypnotics Causing Adverse Effect in Therapeutic Use N Central Nervous System Muscle-Tone Depressants Causing Adverse Effect in Therapeutic E9380 Use N E9381 Halothane Causing Adverse Effect in Therapeutic Use N E9382 Other Gaseous Anesthetics Causing Adverse Effect in Therapeutic Use N E9383 Intravenous Anesthetics Causing Adverse Effect in Therapeutic Use N E9384 Other and Unspecified General Anesthetics Causing Adverse Effect in Therapeutic Use N E9385 Surface and Infiltration Anesthetics Causing Adverse Effect in Therapeutic Use N Peripheral Nerve- and Plexus-Blocking Anesthetics Causing Adverse Effect in E9386 Therapeutic Use N E9387 Spinal Anesthetics Causing Adverse Effect in Therapeutic Use N E9389 Other and Unspecified Local Anesthetics Causing Adverse Effect in Therapeutic Use N E9390 Antidepressants Causing Adverse Effect in Therapeutic Use N E9391 Phenothiazine-Based Tranquilizers Causing Adverse Effect in Therapeutic Use N E9392 Butyrophenone-Based Tranquilizers Causing Adverse Effect in Therapeutic Use N Other Antipsychotics, Neuroleptics, and Major Tranquilizers Causing Adverse Effect in E9393 Therapeutic Use N E9394 Benzodiazepine-Based Tranquilizers Causing Adverse Effect in Therapeutic Use N E9395 Other Tranquilizers Causing Adverse Effect in Therapeutic Use N E9396 Psychodysleptics (Hallucinogens) Causing Adverse Effect in Therapeutic Use N E9397 Psychostimulants Causing Adverse Effect in Therapeutic Use N E9398 Other Psychotropic Agents Causing Adverse Effect in Therapeutic Use N E9399 Unspecified Psychotropic Agent Causing Adverse Effect in Therapeutic Use N E9400 Analeptics Causing Adverse Effect in Therapeutic Use N E9401 Opiate Antagonists Causing Adverse Effect in Therapeutic Use N Other Specified Central Nervous System Stimulants Causing Adverse Effect in E9408 Therapeutic Use N Unspecified Central Nervous System Stimulant Causing Adverse Effect in Therapeutic E9409 Use N E9410 Parasympathomimetics (Cholinergics) Causing Adverse Effect in Therapeutic Use N Parasympatholytics (Anticholinergics and Antimuscarinics) and Spasmolytics Causing E9411 Adverse Effect in Therapeutic Use N E9412 Sympathomimetics (Adrenergics) Causing Adverse Effect in Therapeutic Use N E9413 Sympatholytics (Antiadrenergics) Causing Adverse Effect in Therapeutic Use N Unspecified Drug Primarily Affecting the Autonomic Nervous System Causing Adverse E9419 Effect in Therapeutic Use N E9420 Cardiac Rhythm Regulators Causing Adverse Effect in Therapeutic Use N Cardiotonic Glycosides and Drugs of Similar Action Causing Adverse Effect in E9421 Therapeutic Use N E9422 Antilipemic and Antiarteriosclerotic Drugs Causing Adverse Effect in Therapeutic Use N E9423 Ganglion-Blocking Agents Causing Adverse Effect in Therapeutic Use N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 316 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator E9424 Coronary Vasodilators Causing Adverse Effect in Therapeutic Use N E9425 Other Vasodilators Causing Adverse Effect in Therapeutic Use N E9426 Other Antihypertensive Agents Causing Adverse Effect in Therapeutic Use N Antivaricose Drugs, Including Sclerosing Agents, Causing Adverse Effect in Therapeutic E9427 Use N E9428 Capillary-Active Drugs Causing Adverse Effect in Therapeutic Use N Other and Unspecified Agents Primarily Affecting the Cardiovascular System Causing E9429 Adverse Effect in Therapeutic Use N E9430 Antacids and Antigastric Secretion Drugs Causing Adverse Effect in Therapeutic Use N E9431 Irritant Cathartics Causing Adverse Effect in Therapeutic Use N E9432 Emollient Cathartics Causing Adverse Effect in Therapeutic Use N Other Cathartics, Including Intestinal Atonia Drugs, Causing Adverse Effect in E9433 Therapeutic Use N E9434 Digestants Causing Adverse Effect in Therapeutic Use N E9435 Antidiarrheal Drugs Causing Adverse Effect in Therapeutic Use N E9436 Emetics Causing Adverse Effect in Therapeutic Use N Other Specified Agents Primarily Affecting the Gastrointestinal System Causing Adverse E9438 Effect in Therapeutic Use N Unspecified Agent Primarily Affecting the Gastrointestinal System Causing Adverse E9439 Effect in Therapeutic Use N E9440 Mercurial Diuretics Causing Adverse Effect in Therapeutic Use N E9441 Purine Derivative Diuretics Causing Adverse Effect in Therapeutic Use N E9442 Carbonic Acid Anhydrase Inhibitors Causing Adverse Effect in Therapeutic Use N E9443 Saluretics Causing Adverse Effect in Therapeutic Use N E9444 Other Diuretics Causing Adverse Effect in Therapeutic Use N Electolytic, Caloric, and Water-Balance Agents Causing Adverse Effect in Therapeutic E9445 Use N

E9446 Other Mineral Salts, Not Elsewhere Classified, Causing Adverse Effect in Therapeutic Use N E9447 Uric Acid Metabolism Drugs Causing Adverse Effect in Therapeutic Use N E9450 Oxytocic Agents Causing Adverse Effect in Therapeutic Use N E9451 Smooth Muscle Relaxants Causing Adverse Effect in Therapeutic Use N E9452 Skeletal Muscle Relaxants Causing Adverse Effect in Therapeutic Use N Other and Unspecified Drugs Acting on Muscles Causing Adverse Effect in Therapeutic E9453 Use N E9454 Antitussives Causing Adverse Effect in Therapeutic Use N E9455 Expectorants Causing Adverse Effect in Therapeutic Use N E9456 Anti-Common Cold Drugs Causing Adverse Effect in Therapeutic Use N E9457 Antiasthmatics Causing Adverse Effect in Therapeutic Use N E9458 Other and Unspecified Respiratory Drugs Causing Adverse Effect in Therapeutic Use N Local Anti-Infectives and Anti-Inflammatory Drugs Causing Adverse Effect in E9460 Therapeutic Use N E9461 Antipruritics Causing Adverse Effect in Therapeutic Use N E9462 Local Astringents and Local Detergents Causing Adverse Effect in Therapeutic Use N E9463 Emollients, Demulcents, and Protectants Causing Adverse Effect in Therapeutic Use N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 317 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Keratolytics, Keratoplastics, Other Hair Treatment Drugs and Preparations Causing E9464 Adverse Effect in Therapeutic Use N E9465 Eye Anti-Infectives and Other Eye Drugs Causing Adverse Effect in Therapeutic Use N Anti-Infectives and Other Drugs and Preparations for Ear, Nose, and Throat Causing E9466 Adverse Effect in Therapeutic Use N E9467 Dental Drugs Topically Applied Causing Adverse Effect in Therapeutic Use N Other Agents Primarily Affecting Skin and Mucous Membrane Causing Adverse Effect in E9468 Therapeutic Use N Unspecified Agent Primarily Affecting Skin and Mucous Membrane Causing Adverse E9469 Effect in Therapeutic Use N E9470 Dietetics Causing Adverse Effect in Therapeutic Use N E9471 Lipotropic Drugs Causing Adverse Effect in Therapeutic Use N Antidotes and Chelating Agents, Not Elsewhere Classified, Causing Adverse Effect in E9472 Therapeutic Use N E9473 Alcohol Deterrents Causing Adverse Effect in Therapeutic Use N E9474 Pharmaceutical Excipients Causing Adverse Effect in Therapeutic Use N E9478 Other Drugs and Medicinal Substances Causing Adverse Effect in Therapeutic Use N E9479 Unspecified Drug or Medicinal Substance Causing Adverse Effect in Therapeutic Use N E9480 Bcg Vaccine Causing Adverse Effect in Therapeutic Use N E9481 Typhoid and Paratyphoid Vaccines Causing Adverse Effect in Therapeutic Use N E9482 Cholera Vaccine Causing Adverse Effect in Therapeutic Use N E9483 Plague Vaccine Causing Adverse Effect in Therapeutic Use N E9484 Tetanus Vaccine Causing Adverse Effect in Therapeutic Use N E9485 Diphtheria Vaccine Causing Adverse Effect in Therapeutic Use N Pertussis Vaccine, Including Combinations With Pertussis Component, Causing Adverse E9486 Effect in Therapeutic Use N E9488 Other and Unspecified Bacterial Vaccines Causing Adverse Effect in Therapeutic Use N Mixed Bacterial Vaccines, Except Combinations With Pertussis Component, Causing E9489 Adverse Effect in Therapeutic Use N E9490 Smallpox Vaccine Causing Adverse Effect in Therapeutic Use N E9491 Rabies Vaccine Causing Adverse Effect in Therapeutic Use N E9492 Typhus Vaccine Causing Adverse Effect in Therapeutic Use N E9493 Yellow Fever Vaccine Causing Adverse Effect in Therapeutic Use N E9494 Measles Vaccine Causing Adverse Effect in Therapeutic Use N E9495 Poliomyelitis Vaccine Causing Adverse Effect in Therapeutic Use N Other and Unspecified Viral and Rickettsial Vaccines Causing Adverse Effect in E9496 Therapeutic Use N Mixed Viral-Rickettsial and Bacterial Vaccines, Except Combinations With Pertussis E9497 Component, Causing Adverse Effect in Therapeutic Use N Other and Unspecified Vaccines and Biological Substances Causing Adverse Effect in E9499 Therapeutic Use N E9500 Suicide and Self-Inflicted Poisoning by Analgesics, Antipyretics, and Antirheumatics N E9501 Suicide and Self-Inflicted Poisoning by Barbiturates N E9502 Suicide and Self-Inflicted Poisoning by Other Sedatives and Hypnotics N E9503 Suicide and Self-Inflicted Poisoning by Tranquilizers and Other Psychotropic Agents N

E9504 Suicide and Self-Inflicted Poisoning by Other Specified Drugs and Medicinal Substances N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 318 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator E9505 Suicide and Self-Inflicted Poisoning by Unspecified Drug or Medicinal Substance N Suicide and Self-Inflicted Poisoning by Agricultural and Horticultural Chemical and E9506 Pharmaceutical Preparations Other Than Plant Foods and Fertilizers N E9507 Suicide and Self-Inflicted Poisoning by Corrosive and Caustic Substances N E9508 Suicide and Self-Inflicted Poisoning by Arsenic and Its Compounds N Suicide and Self-Inflicted Poisoning by Other and Unspecified Solid and Liquid E9509 Substances N E9510 Suicide and Self-Inflicted Poisoning by Gas Distributed by Pipeline N Suicide and Self-Inflicted Poisoning by Liquefied Petroleum Gas Distributed in Mobile E9511 Containers N E9518 Suicide and Self-Inflicted Poisoning by Other Utility Gas N E9520 Suicide and Self-Inflicted Poisoning by Motor Vehicle Exhaust Gas N E9521 Suicide and Self-Inflicted Poisoning by Other Carbon Monoxide N E9528 Suicide and Self-Inflicted Poisoning by Other Specified Gases and Vapors N E9529 Suicide and Self-Inflicted Poisoning by Unspecified Gases and Vapors N E9530 Suicide and Self-Inflicted Injury by Hanging N E9531 Suicide and Self-Inflicted Injury by Suffocation by Plastic Bag N E9538 Suicide and Self-Inflicted Injury by Other Specified Means N E9539 Suicide and Self-Inflicted Injury by Unspecified Means N E954 Suicide and Self-Inflicted Injury by Submersion (Drowning) N E9550 Suicide and Self-Inflicted Injury by Handgun N E9551 Suicide and Self-Inflicted Injury by Shotgun N E9552 Suicide and Self-Inflicted Injury by Hunting Rifle N E9553 Suicide and Self-Inflicted Injury by Military Firearms N E9554 Suicide and Self-Inflicted Injury by Other and Unspecified Firearm N E9555 Suicide and Self-Inflicted Injury by Explosives N E9556 Suicide and Self-Inflicted Injury by Air Gun N E9559 Suicide and Self-Inflicted Injury by Firearms and Explosives, Unspecified N E956 Suicide and Self-Inflicted Injury by Cutting and Piercing Instrument N E9570 Suicide and Self-Inflicted Injuries by Jumping From Residential Premises N E9571 Suicide and Self-Inflicted Injuries by Jumping From Other Man-Made Structures N E9572 Suicide and Self-Inflicted Injuries by Jumping From Natural Sites N E9579 Suicide and Self-Inflicted Injuries by Jumping From Unspecified Site N E9580 Suicide and Self-Inflicted Injury by Jumping or Lying Before Moving Object N E9581 Suicide and Self-Inflicted Injury by Burns, Fire N E9582 Suicide and Self-Inflicted Injury by Scald N E9583 Suicide and Self-Inflicted Injury by Extremes of Cold N E9584 Suicide and Self-Inflicted Injury by Electrocution N E9585 Suicide and Self-Inflicted Injury by Crashing of Motor Vehicle N E9586 Suicide and Self-Inflicted Injury by Crashing of Aircraft N E9587 Suicide and Self-Inflicted Injury by Caustic Substances, Except Poisoning N E9588 Suicide and Self-Inflicted Injury by Other Specified Means N E9589 Suicide and Self-Inflicted Injury by Unspecified Means N E959 Late Effects of Self-Inflicted Injury N E9600 Unarmed Fight or Brawl N E9601 Rape N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 319 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator E961 Assault by Corrosive or Caustic Substance, Except Poisoning N E9620 Assault by Drugs and Medicinal Substances N E9621 Assault by Other Solid and Liquid Substances N E9622 Assault by Other Gases and Vapors N E9629 Assault by Unspecified Poisoning N E963 Assault by Hanging and Strangulation N E964 Assault by Submersion (Drowning) N E9650 Assault by Handgun N E9651 Assault by Shotgun N E9652 Assault by Hunting Rifle N E9653 Assault by Military Firearms N E9654 Assault by Other and Unspecified Firearm N E9655 Assault by Antipersonnel Bomb N E9656 Assault by Gasoline Bomb N E9657 Assault by Letter Bomb N E9658 Assault by Other Specified Explosive N E9659 Assault by Unspecified Explosive N E966 Assault by Cutting and Piercing Instrument N E9670 Child and Adult Battering and Other Maltreatment by Father or Stepfather N E9671 Child and Adult Battering and Other Maltreatment by Other Specified Person N E9672 Child and Adult Battering and Other Maltreatment by Mother or Stepmother N E9673 Child and Adult Battering and Other Maltreatment by Spouse or Partner N E9674 Child and Adult Battering and Other Maltreatment by Child N E9675 Child and Adult Battering and Other Maltreatment by Sibling N E9676 Child and Adult Battering and Other Maltreatment by Grandparent N E9677 Child and Adult Battering and Other Maltreatment by Other Relative N E9678 Child and Adult Battering and Other Maltreatment by Non-Related Caregiver N E9679 Child and Adult Battering and Other Maltreatment by Unspecified Person N E968 Assault by Other and Unspecified Means; Transport Vehicle N E9680 Assault by Fire N E9681 Assault by Pushing From High Place N E9682 Assault by Striking by Blunt or Thrown Object N E9683 Assault by Hot Liquid N E9684 Criminal Neglect N E9686 Assault by Air Gun N E9687 Assault by Human Bite N E9688 Assault by Other Specified Means N E9689 Assault by Unspecified Means N E969 Late Effects of Injury Purposely Inflicted by Other Person N E970 Injury due to Legal Intervention by Firearms N E971 Injury due to Legal Intervention by Explosives N E972 Injury due to Legal Intervention by Gas N E973 Injury due to Legal Intervention by Blunt Object N E974 Injury due to Legal Intervention by Cutting and Piercing Instrument N E975 Injury due to Legal Intervention by Other Specified Means N E976 Injury due to Legal Intervention by Unspecified Means N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 320 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator E977 Late Effects of Injuries due to Legal Intervention N E978 Legal Execution N Poisoning by Analgesics, Antipyretics, and Antirheumatics, Undetermined Whether E9800 Accidentally or Purposely Inflicted N E9801 Poisoning by Barbiturates, Undetermined Whether Accidentally or Purposely Inflicted N Poisoning by Other Sedatives and Hypnotics, Undetermined Whether Accidentally or E9802 Purposely Inflicted N Poisoning by Tranquilizers and Other Psychotropic Agents, Undetermined Whether E9803 Accidentally or Purposely Inflicted N Poisoning by Other Specified Drugs and Medicinal Substances, Undetermined Whether E9804 Accidentally or Purposely Inflicted N Poisoning by Unspecified Drug or Medicinal Substance, Undetermined Whether E9805 Accidentally or Purposely Inflicted N Poisoning by Corrosive and Caustic Substances, Undetermined Whether Accidentally or E9806 Purposely Inflicted N Poisoning by Agricultural and Horticultural Chemical and Pharmaceutical Preparations Other Than Plant Foods and Fertilizers, Undertermined Whether Accidentally or E9807 Purposely Inflicted N Poisoning by Arsenic and Its Compounds, Undetermined Whether Accidentally or E9808 Purposely Inflicted N Poisoning by Other and Unspecified Solid and Liquid Substances, Undetermined Whether E9809 Accidentally or Purposely Inflicted N Poisoning by Gas Distributed by Pipeline, Undetermined Whether Accidentally or E9810 Purposely Inflicted N Poisoning by Liquefied Petroleum Gas Distributed in Mobile Containers, Undetermined E9811 Whether Accidentally or Purposely Inflicted N Poisoning by Other Utility Gas, Undetermined Whether Accidentally or Purposely E9818 Inflicted N Poisoning by Motor Vehicle Exhaust Gas, Undetermined Whether Accidentally or E9820 Purposely Inflicted N Poisoning by Other Carbon Monoxide, Undetermined Whether Accidentally or Purposely E9821 Inflicted N Poisoning by Other Specified Gases and Vapors, Undetermined Whether Accidentally or E9828 Purposely Inflicted N Poisoning by Unspecified Gases and Vapors, Undetermined Whether Accidentally or E9829 Purposely Inflicted N E9830 Hanging, Undetermined Whether Accidentally or Purposely Inflicted N E9831 Suffocation by Plastic Bag, Undetermined Whether Accidentally or Purposely Inflicted N Strangulation or Suffocation by Other Specified Means, Undetermined Whether E9838 Accidentally or Purposely Inflicted N Strangulation or Suffocation by Unspecified Means, Undetermined Whether Accidentally E9839 or Purposely Inflicted N E984 Submersion (Drowning), Undetermined Whether Accidentally or Purposely Inflicted N E9850 Injury by Handgun, Undetermined Whether Accidentally or Purposely Inflicted N E9851 Injury by Shotgun, Undetermined Whether Accidentally or Purposely Inflicted N E9852 Injury by Hunting Rifle, Undetermined Whether Accidentally or Purposely Inflicted N E9853 Injury by Military Firearms, Undetermined Whether Accidentally or Purposely Inflicted N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 321 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Injury by Other and Unspecified Firearm, Undetermined Whether Accidentally or E9854 Purposely Inflicted N E9855 Injury by Explosives, Undetermined Whether Accidentally or Purposely Inflicted N E9856 Injury by Air Gun, Undetermined Whether Accidental,Or Purposefully Inflicted N Injury by Cutting and Piercing Instruments, Undetermined Whether Accidentally or E986 Purposely Inflicted N Falling From High Place on Residential Premises, Undetermined Whether Accidentally or E9870 Purposely Inflicted N Falling From High Place on Other Man-Made Structures, Undetermined Whether E9871 Accidentally or Purposely Inflicted N Falling From High Place on Natural Sites, Undetermined Whether Accidentally or E9872 Purposely Inflicted N Falling From Unspecified High Place, Undetermined Whether Accidentally or Purposely E9879 Inflicted N Injury by Jumping or Lying Before Moving Object, Undetermined Whether Accidentally E9880 or Purposely Inflicted N E9881 Injury by Burns or Fire, Undetermined Whether Accidentally or Purposely Inflicted N E9882 Injury by Scald, Undetermined Whether Accidentally or Purposely Inflicted N E9883 Injury by Extremes of Cold, Undetermined Whether Accidentally or Purposely Inflicted N E9884 Injury by Electrocution, Undetermined Whether Accidentally or Purposely Inflicted N Injury by Crashing of Motor Vehicle, Undetermined Whether Accidentally or Purposely E9885 Inflicted N

E9886 Injury by Crashing of Aircraft, Undetermined Whether Accidentally or Purposely Inflicted N Injury by Caustic Substances, Except Poisoning, Undetermined Whether Accidentally or E9887 Purposely Inflicted N Injury by Other Specified Means, Undetermined Whether Accidentally or Purposely E9888 Inflicted N

E9889 Injury by Unspecified Means, Undetermined Whether Accidentally or Purposely Inflicted N E989 Late Effects of Injury, Undetermined Whether Accidentally or Purposely Inflicted N E9900 Injury due to War Operations From Gasoline Bomb N E9909 Injury due to War Operations From Other and Unspecified Source N E9910 Injury due to War Operations From Rubber Bullets (Rifle) N E9911 Injury due to War Operations From Pellets (Rifle) N E9912 Injury due to War Operations From Other Bullets N E9913 Injury due to War Operations From Antipersonnel Bomb (Fragments) N E9919 Injury due to War Operations From Other and Unspecified Fragments N E992 Injury due to War Operations by Explosion of Marine Weapons N E993 Injury due to War Operations by Other Explosion N E994 Injury due to War Operations by Destruction of Aircraft N E995 Injury due to War Operations by Other and Unspecified Forms of Conventional Warfare N E996 Injury due to War Operations by Nuclear Weapons N E9970 Injury due to War Operations by Lasers N E9971 Injury due to War Operations by Biological Warfare N E9972 Injury due to War Operations by Gases, Fumes, and Chemicals N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 322 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator E9978 Injury due to Other Specified Forms of Unconventional Warfare N E9979 Injury due to Unspecified Form of Unconventional Warfare N E998 Injury due to War Operations But Occurring After Cessation of Hostilities N E999 Late Effect of Injury due to War Operations N EPS Epsdt Screening N OPD Pre-Scheduled Outpatient Visit N V010 Contact With or Exposure to Cholera N V011 Contact With or Exposure to Tuberculosis N V012 Contact With or Exposure to Poliomyelitis N V013 Contact With or Exposure to Smallpox N V014 Contact With or Exposure to Rubella N V015 Contact With or Exposure to Rabies N V016 Contact With or Exposure to Venereal Diseases N V017 Contact With or Exposure to Other Viral Diseases N V0171 Contact or Exposure to Varicella N V0179 Contact or Exposure to Other Viral Diseases N V018 Contact With or Exposure to Other Communicable Diseases N V0181 Contact With or Exposure to Anthrax N V0183 Contact or Exposure to Escherichia Coli (E. Coli) N V0184 Contact or Exposure to Meningococcus N V0189 Contact or Exposure to Other Communicable Diseases N V019 Contact With or Exposure to Unspecified Communicable Disease N V020 Carrier or Suspected Carrier of Cholera N V021 Carrier or Suspected Carrier of Typhoid N V022 Carrier or Suspected Carrier of Amebiasis N V023 Carrier or Suspected Carrier of Other Gastrointestinal Pathogens N V024 Carrier or Suspected Carrier of Diphtheria N V025 Carrier or Suspected Carrier of Other Specified Bacterial Diseases N V0251 Carrier or Suspected Carrier of Group B Streptococcus N V0252 Carrier or Suspected Carrier of Other Streptococcus N V0259 Carrier or Suspected Carrier of Other Specified Bacterial Diseases N V026 Carrier or Suspected Carrier of Viral Hepatitis N V0260 Unspecified Viral Hepatitis Carrier N V0261 Hepatitis B Carrier N V0262 Hepatitis C Carrier N V0269 Other Viral Hepatitis Carrier N V027 Carrier or Suspected Carrier of Gonorrhea N V028 Carrier or Suspected Carrier of Other Venereal Diseases N V029 Carrier or Suspected Carrier of Other Specified Infectious Organism N V030 Need for Prophylactic Vaccination and Inoculation Against Cholera Alone N V031 Need for Prophylactic Vaccination With Typhoid-Paratyphiod Alone (TAB) N V032 Need for Prophylactic Vaccination With Tuberculosis (BCG) Vaccine N V033 Need for Prophylactic Vaccination and Inoculation Against Plague N V034 Need for Prophylactic Vaccination and Inoculation Against Tularemia N V035 Need for Prophylactic Vaccination and Inoculation Against Diphtheria Alone N V036 Need for Prophylactic Vaccination and Inoculation Against Pertussis Alone N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 323 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V037 Need for Prophylactic Vaccination With Tetanus Toxoid Alone N V0381 Need for Prophylatic Vaccination Against Hemophilus Influenza Type B (HIB) N V0382 Need for Prophylatic Vaccination Against Streptococcus Pneumoniae (Pneumococcus) N V0389 Need for Prophylatic Vaccination Against Other Specified Vaccination N Need for Prophylactic Vaccination and Inoculation Against Unspecified Single Bacterial V039 Disease N V040 Need for Prophylactic Vaccination and Inoculation Against Poliomyelitis N V041 Need for Prophylactic Vaccination and Inoculation Against Smallpox N V042 Need for Prophylactic Vaccination and Inoculation Against Measles Alone N V043 Need for Prophylactic Vaccination and Inoculation Against Rubella Alone N V044 Need for Prophylactic Vaccination and Inoculation Against Yellow Fever N V045 Need for Prophylactic Vaccination and Inoculation Against Rabies Y V046 Need for Prophylactic Vaccination and Inoculation Against Mumps Alone N V047 Need for Prophylactic Vaccination and Inoculation Against Common Cold N V048 Need for Prophylactic Vaccination and Inoculation Against Influenza N V0481 Need for Prophylactic Vaccination and Inoculation, Influenza N V0482 Need for Prophylactic Vaccination and Inoculation, Respiratory Syncytial Virus (RSV) N V0489 Need for Prophylactic Vaccination and Inoculation, Other Viral Diseases N Need for Prophylactic Vaccination and Inoculation Against Arthropod-Borne Viral V050 Encephalitis N Need for Prophylactic Vaccination and Inoculation Against Other Arthropod-Borne Viral V051 Diseases N V052 Need for Prophylactic Vaccination and Inoculation Against Leishmaniasis N V053 Need for Prophylactic Vaccination and Inoculation Against Viral Hepatitis N V054 Need for Prophylactic Vaccination and Inoculation Against Varicella N V058 Need for Prophylactic Vaccination and Inoculation Against Other Specified Disease N V059 Need for Prophylactic Vaccination and Inoculation Against Unspecified Single Disease N Need for Prophylactic Vaccination Against Cholera With Typhoid-Paratyphoid (Cholera + V060 TAB) Vaccine N V061 Diphtheria-Tetanus-Pertussis, Combined [DTP] [DTAP] N Need for Prophylactic Vaccination With Diptheria-Tetanus-Pertussis With Typhoid- V062 Paratyphoid (DTP + TAB) Vaccine N Need for Prophylactic Vaccination With Diptheria-Tetanus-Pertussis With Poliomyelitis V063 (DTP + Polio) Vaccine N V064 Need for Prophylactic Vaccination With Measles-Mumps-Rubella (MMR) Vaccine N V065 Tetanus-Diphtheria [TD] [DT] N Need for Prophylactic Vaccination With Streptococcus Pneumoniae (Pneumococcus) and V066 Influenza N Need for Prophylactic Vaccination and Inoculation Against Other Combinations of V068 Diseases N V069 Need for Prophylactic Vaccination With Unspecified Combined Vaccine N V070 Need for Isolation N V071 Need for Desensitization to Allergens N V072 Need for Prophylactic Immunotherapy N V0731 Need for Prophylactic Fluoride Administration N V0739 Need for Other Prophylactic Chemotherapy N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 324 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V074 Hormone Replacement Therapy (Postmenopausal) N V078 Need for Other Specified Prophylactic Measure N V079 Need for Unspecified Prophylactic Measure N V08 Asymptomatic Human Immunodeficiency Virus (Hiv) Infection Status N V090 Infection With Microorganisms Resistant to Penicillins N Infection With Microorganisms Resistant to Cephalosporins and Other B-Lactam V091 Antibiotics N V092 Infection With Microorganisms Resistant to Macrolides N V093 Infection With Microorganisms Resistant to Tetracyclines N V094 Infection With Microorganisms Resistant to Aminoglycosides N Infection With Microorganisms Resistant to Quinolones and Fluoroquinolones Without V0950 Mention of Resistance to Multiple Quinolones and Fluoroquinolones N Infection With Microorganisms Resistant to Quinolones and Fluoroquinolones With V0951 Resistance to Multiple Quinolones and Fluoroquinolones N V096 Infection With Microorganisms Resistant to Sulfonamides N Infection With Microorganisms Resistant to Other Specified Antimycobacterial Agents V0970 Without Mention of Resistance to Multiple Antimycobacterial Agents N Infection With Microorganisms Resistant to Other Specified Antimycobacterial Agents V0971 With Resistance to Multiple Antimycobacterial Agents N Infection With Microorganisms Resistant to Other Specified Drugs Without Mention of V0980 Resistance to Multiple Drugs N Infection With Microorganisms Resistant to Other Specified Drugs With Resistance to V0981 Multiple Drugs N Infection With Unspecified Drug-Resistant Microorganisms, Without Mention of Multiple V0990 Drug Resistance N Infection With Unspecified Drug-Resistant Microorganisms, With Multiple Drug V0991 Resistance N V1000 Personal History of Malignant Neoplasm of Unspecified Site in Gastrointestinal Tract N V1001 Personal History of Malignant Neoplasm of Tongue N Personal History of Malignant Neoplasm of Other and Unspecified Parts of Oral Cavity V1002 and Pharynx N V1003 Personal History of Malignant Neoplasm of Esophagus N V1004 Personal History of Malignant Neoplasm of Stomach N V1005 Personal History of Malignant Neoplasm of Large Intestine N V1006 Personal History of Malignant Neoplasm of Rectum, Rectosigmoid Junction, and Anus N V1007 Personal History of Malignant Neoplasm of Liver N V1009 Personal History of Malignant Neoplasm of Other Site in Gastrointestinal Tract N V101 Personal History of Malignant Neoplasm of Trachea, Bronchus, and Lung N V1011 Personal History of Malignant Neoplasm of Bronchus and Lung N V1012 Personal History of Malignant Neoplasm of Trachea N V1020 Personal History of Malignant Neoplasm of Unspecified Respiratory Organ N V1021 Personal History of Malignant Neoplasm of Larynx N Personal History of Malignant Neoplasm of Nasal Cavities, Middle Ear, and Accessory V1022 Sinuses N V1029 Personal History of Malignant Neoplasm of Other Respiratory and Intrathoracic Organs N V103 Personal History of Malignant Neoplasm of Breast N V1040 Personal History of Malignant Neoplasm of Unspecified Female Genital Organ N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 325 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V1041 Personal History of Malignant Neoplasm of Cervix Uteri N V1042 Personal History of Malignant Neoplasm of Other Parts of Uterus N V1043 Personal History of Malignant Neoplasm of Ovary N V1044 Personal History of Malignant Neoplasm of Other Female Genital Organs N V1045 Personal History of Malignant Neoplasm of Unspecified Male Genital Organ N V1046 Personal History of Malignant Neoplasm of Prostate N V1047 Personal History of Malignant Neoplasm of Testis N V1048 Personal History of Malignant Neoplasm of Epididymis N V1049 Personal History of Malignant Neoplasm of Other Male Genital Organs N V1050 Personal History of Malignant Neoplasm of Unspecified Urinary Organ N V1051 Personal History of Malignant Neoplasm of Bladder N V1052 Personal History of Malignant Neoplasm of Kidney N V1053 Personal History of Malignant Neoplasm, Renal Pelvis N V1059 Personal History of Malignant Neoplasm of Other Urinary Organ N V1060 Personal History of Unspecified Leukemia N V1061 Personal History of Lymphoid Leukemia N V1062 Personal History of Myeloid Leukemia N V1063 Personal History of Monocytic Leukemia N V1069 Personal History of Other Leukemia N V107 Personal History of Other Lymphatic and Hematopoietic Neoplasms N V1071 Personal History of Lymphosarcoma and Reticulosarcoma N V1072 Personal History of Hodgkin’s Disease N V1079 Personal History of Other Lymphatic and Hematopoietic Neoplasm N V108 Personal History of Malignant Neoplasm of Other Sites N V1081 Personal History of Malignant Neoplasm of Bone N V1082 Personal History of Malignant Melanoma of Skin N V1083 Personal History of Other Malignant Neoplasm of Skin N V1084 Personal History of Malignant Neoplasm of Eye N V1085 Personal History of Malignant Neoplasm of Brain N V1086 Personal History of Malignant Neoplasm of Other Parts of Nervous System N V1087 Personal History of Malignant Neoplasm of Thyroid N Personal History of Malignant Neoplasm of Other Endocrine Glands and Related V1088 Structures N V1089 Personal History of Malignant Neoplasm of Other Site N V109 Unspecified Personal History of Malignant Neoplasm N V110 Personal History of Schizophrenia N V111 Personal History of Affective Disorder N V112 Personal History of Neurosis N V113 Personal History of Alcoholism N V118 Personal History of Other Mental Disorder N V119 Personal History of Unspecified Mental Disorder N V1200 Personal History of Unspecified Infectious and Parasitic Disease N V1201 Personal History of Tuberculosis N V1202 Personal History of Poliomyelitis N V1203 Personal History of Malaria N V1209 Personal History of Other Infectious and Parasitic Disease N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 326 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V121 Personal History of Nutritional Deficiency N V122 Personal History of Endocrine, Metabolic, and Immunity Disorders N V123 Personal History of Diseases of Blood and Blood-Forming Organs N V124 Personal History of Disorders of Nervous System and Sense Organs N V1240 Unspecified Disorer of Nervous System and Sense Organs N V1241 Benign Neoplasm of the Brain N V1242 Personal History, Infections of the Central Nervous System N V1249 Other Disorders of Nervous System and Sense Organs N V1250 Unspecified Circulatory Disease N V1251 Venous Thrombosis and Embolism N V1252 Thrombophlebitis N V1259 Other Diseases of Circulatory System N V126 Personal History of Diseases of Respiratory System N V1260 Personal History, Unspecified Disease of Respiratory System N V1261 Personal History, Pneumonia (Recurrent) N V1269 Personal History, Other Diseases of Respiratory System N V1270 Personal History of Unspecified Digestive Disease N V1271 Personal History of Peptic Ulcer Disease N V1272 Personal History of Colonic Polyps N V1279 Personal History of Other Diseases of Digestive Disease N V1300 Personal History of Unspecified Urinary Disorder N V1301 Personal History of Urinary Calculi N V1302 Personal History, Urinary (Tract) Infection N V1303 Personal History, Nephrotic Syndrome N V1309 Personal History of Other Disorder of Urinary System N V131 Personal History of Trophoblastic Disease N V132 Personal History of Other Genital System and Obstetric Disorders N V1321 Personal History of Pre-Term Labor N V1329 Personal History of Other Genital System and Obstetric Disorders N V133 Personal History of Diseases of Skin and Subcutaneous Tissue N V134 Personal History of Arthritis N V135 Personal History of Other Musculoskeletal Disorders N V136 Personal History of Congenital Malformations N V1361 Personal History of Hypospadias N V1369 Personal History of Other Congenital Malformations N V137 Personal History of Perinatal Problems N V138 Personal History of Other Specified Diseases N V139 Personal History of Unspecified Disease N V140 Personal History of Allergy to Penicillin N V141 Personal History of Allergy to Other Antibiotic Agent N V142 Personal History of Allergy to Sulfonamides N V143 Personal History of Allergy to Other Anti-Infective Agent N V144 Personal History of Allergy to Anesthetic Agent N V145 Personal History of Allergy to Narcotic Agent N V146 Personal History of Allergy to Analgesic Agent N V147 Personal History of Allergy to Serum or Vaccine N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 327 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V148 Personal History of Allergy to Other Specified Medicinal Agents N V149 Personal History of Allergy to Unspecified Medicinal Agent N V150 Personal History of Allergy, Other Than to Medicinal Agents, Presentin N V1501 Personal History of Allergy to Peanuts N V1502 Personal History of Allergy to Milk Products N V1503 Personal History of Allergy to Eggs N V1504 Personal History of Allergy to Seafood N V1505 Personal History of Allergy to Other Foods N V1506 Personal History of Allergy to Insects N V1507 Personal History of Allergy to Latex N V1508 Personal History of Allergy to Radiographic Dye N V1509 Personal History of Other Allergy, Other Than to Medicinal Agents N V151 Personal History of Surgery to Heart and Great Vessels, Presenting Hazards to Health N V152 Personal History of Surgery to Other Major Organs, Presenting Hazards to Health N V153 Personal History of Irradiation, Presenting Hazards to Health N V154 Personal History of Psychological Trauma, Presenting Hazards to Health N V1541 Personal History of Physical Abuse, Presenting Hazards to Health N V1542 Personal History of Emotional Abuse, Presenting Hazards to Health N V1549 Other Personal History of Psychological Trauma, Presenting Hazards to Health N V155 Personal History of Injury, Presenting Hazards to Health N V156 Personal History of Poisoning, Presenting Hazards to Health N V157 Personal History of Contraception, Presenting Hazards to Health N V158 Other Specified Personal History Presenting Hazards to Health N Personal History of Noncompliance With Medical Treatment, Presenting Hazards to V1581 Health N V1582 Personal History of Tobacco Use, Presenting Hazards to Health N V1584 Personal History of Exposure to Asbestos, Presenting Hazards to Health N Personal History of Exposure to Potentially Hazardous Body Fluids, Presenting Hazards to V1585 Health N V1586 Personal History of Exposure to Lead, Presenting Hazards to Health N V1587 History of Extracorporeal Membrane Oxygenation [Ecmo] N V1588 History of Fall N V1589 Other Specified Personal History Presenting Hazards to Health N V159 Unspecified Personal History Presenting Hazards to Health N V160 Family History of Malignant Neoplasm of Gastrointestinal Tract N V161 Family History of Malignant Neoplasm of Trachea, Bronchus, and Lung N V162 Family History of Malignant Neoplasm of Other Respiratory and Intrathoracic Organs N V163 Family History of Malignant Neoplasm of Breast N V164 Family History of Malignant Neoplasm of Genital Organs N V1640 Family History of Malignant Neoplasm, Unspecified Genital Organ N V1641 Family History of Malignant Neoplasm, Ovary N V1642 Family History of Malignant Neoplasm, Prostate N V1643 Family History of Malignant Neoplasm, Testis N V1649 Family History of Other Malignant Neoplasm N V165 Family History of Malignant Neoplasm of Urinary Organs N V1651 Family History of Malignant Neoplasm of Kidney N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 328 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V1659 Familiy History of Malignant Neoplasm of Other Urinary Organs N V166 Family History of Leukemia N V167 Family History of Other Lymphatic and Hematopoietic Neoplasms N V168 Family History of Other Specified Malignant Neoplasm N V169 Family History of Unspecified Malignant Neoplasm N V170 Family History of Psychiatric Condition N V171 Family History of Stroke (Cerebrovascular) N V172 Family History of Other Neurological Diseases N V173 Family History of Ischemic Heart Disease N V174 Family History of Other Cardiovascular Diseases N V175 Family History of Asthma N V176 Family History of Other Chronic Respiratory Conditions N V177 Family History of Arthritis N V178 Family History of Other Musculoskeletal Diseases N V1781 Family History, Osteoporosis N V1789 Family History, Other Musculoskeletal Diseases N V180 Family History of Diabetes Mellitus N V181 Family History of Other Endocrine and Metabolic Diseases N V182 Family History of Anemia N V183 Family History of Other Blood Disorders N V184 Family History of Mental Retardation N V185 Family History of Digestive Disorders N V186 Family History of Kidney Diseases N V1861 Family History of Polycystic Kidney N V1869 Family History of Other Kidney Diseases N V187 Family History of Other Genitourinary Diseases N V188 Family History of Infectious and Parasitic Diseases N V189 Family History, Genetic Disease Carrier N V190 Family History of Blindness or Visual Loss N V191 Family History of Other Eye Disorders N V192 Family History of Deafness or Hearing Loss N V193 Family History of Other Ear Disorders N V194 Family History of Skin Conditions N V195 Family History of Congenital Anomalies N V196 Family History of Allergic Disorders N V197 Family History of Consanguinity N V198 Family History of Other Condition N V200 Health Supervision of Foundling N V201 Health Supervision of Other Healthy Infant or Child Receiving Care N V202 Routine Infant or Child Health Check N V210 Period of Rapid Growth in Childhood N V211 Puberty N V212 Other Development of Adolescence N V2130 Low Birth Weight Status, Unspecified N V2131 Low Birth Weight Status, Less Than 500 Grams N V2132 Low Birth Weight Status, 500-999 Grams N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 329 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V2133 Low Birth Weight Status, 1000-1499 Grams N V2134 Low Birth Weight Status, 1500-1999 Grams N V2135 Low Birth Weight Status, 2000-2500 Grams N V218 Other Specified Constitutional States in Development N V219 Unspecified Constitutional State in Development N V220 Supervision of Normal First Pregnancy N V221 Supervision of Other Normal Pregnancy N V222 Pregnant State, Incidental N V230 Pregnancy With History of Infertility N V231 Pregnancy With History of Trophoblastic Disease N V232 Pregnancy With History of Abortion N V233 Pregnancy With Grand Multiparity N V234 Supervision of High-Risk Pregnancy With Other Poor Obstetric History N V2341 Supervision of Pregnancy With History of Pre-Term Labor N V2349 Supervision of Pregnancy With Other Poor Obstetric History N V235 Pregnancy With Other Poor Reproductive History N V237 Insufficient Prenatal Care N V238 Supervision of Other High-Risk Pregnancy N V2381 Supervision of High-Risk Pregnancy of Elderly Primigravida N V2382 Supervision of High-Risk Pregnancy of Elderly Multigravida N V2383 Supervision of High-Risk Pregnancy of Young Primigravida N V2384 Supervision of High-Risk Pregnancy of Young Multigravida N V2389 Supervision of Other High-Risk Pregnancy N V239 Unspecified High-Risk Pregnancy N V240 Postpartum Care and Examination Immediately After Delivery N V241 Postpartum Care and Examination of Lactating Mother N V242 Routine Postpartum Follow-Up N V250 General Counseling and Advice; Encounter for Contraceptive Management N V2501 General Counseling for Prescription of Oral Contraceptives N V2502 General Counseling for Initiation of Other Contraceptive Measures N V2503 Encounter for Emergency Contraceptive Counseling and Prescription N V2509 Other General Counseling and Advice for Contraceptive Management N V251 Insertion of Intrauterine Contraceptive Device N V252 Sterilization N V253 Menstrual Extraction N V2540 Unspecified Contraceptive Surveillance N V2541 Surveillance of Previously Prescribed Contraceptive Pill N V2542 Surveillance of Previously Prescribed Intrauterine Contraceptive Device N V2543 Surveillance of Previously Prescribed Implantable Subdermal Contraceptive N V2549 Surveillance of Other Previously Prescribed Contraceptive Method N V255 Insertion of Implantable Subdermal Contraceptive N V258 Other Specified Contraceptive Management N V259 Unspecified Contraceptive Management N V260 Tuboplasty or Vasoplasty After Previous Sterilization N V261 Artificial Insemination N V262 Procreation Management Investigation and Testing N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 330 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V2621 Fertility Testing N V2622 Aftercare Following Sterilization Reversal N V2629 Other Investigation and Testing N V263 Genetic Counseling and Testing N V2631 Testing for Genetic Disease Carrier Status N V2632 Other Genetic Testing N V2633 Genetic Counseling N V264 General Counseling and Advice for Procreative Management N V2651 Tubal Ligation Sterilization Status N V2652 Vasectomy Sterilization Status N V268 Other Specified Procreative Management N V269 Unspecified Procreative Management N V270 Outcome of Delivery, Single Liveborn N V271 Outcome of Delivery, Single Stillborn N V272 Outcome of Delivery, Twins, Both Liveborn N V273 Outcome of Delivery, Twins, One Liveborn and One Stillborn N V274 Outcome of Delivery, Twins, Both Stillborn N V275 Outcome of Delivery, Other Multiple Birth, All Liveborn N V276 Outcome of Delivery, Other Multiple Birth, Some Liveborn N V277 Outcome of Delivery, Other Multiple Birth, All Stillborn N V279 Outcome of Delivery, Unspecified N V280 Antenatal Screening for Chromosomal Anomalies by Amniocentesis N V281 Antenatal Screening for Raised Alpha-Fetoprotein Levels in Amniotic Fluid N V282 Other Antenatal Screening Based on Amniocentesis N V283 Antenatal Screening for Malformation Using Ultrasonics N V284 Antenatal Screening for Fetal Growth Retardation Using Ultrasonics N V285 Antenatal Screening for Isoimmunization N V286 Screening of Streptococcus B N V288 Other Specified Antenatal Screening N V289 Unspecified Antenatal Screening N Observation and Evaluation of Newborns and Infants for Suspected Infectious Condition V290 Not Found N Observation and Evaluation of Newborns and Infants for Suspected Neurological V291 Condition Not Found N Observation and Evaluation of Newborns and Infants for Suspected Respiratory Condition V292 Not Found N V293 Observation for Suspected Genetic or Metabolic Condition N Observation and Evaluation of Newborns and Infants for Other Specified Suspected V298 Condition Not Found N Observation and Evaluation of Newborns and Infants for Unspecified Suspected Condition V299 Not Found N V3000 Single Liveborn, Born in Hospital, Delivered Without Mention of Cesarean Delivery N V3001 Single Liveborn, Born in Hospital, Delivered by Cesarean Delivery N V301 Single Liveborn, Born Before Admission to Hospital N V302 Single Liveborn, Born Outside Hospital and Not Hospitalized N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 331 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator

V3100 Twin, Mate Liveborn, Born in Hospital, Delivered Without Mention of Cesarean Delivery N V3101 Twin, Mate Liveborn, Born in Hospital, Delivered by Cesarean Delivery N V311 Twin Birth, Mate Liveborn, Born Before Admission to Hospital N V312 Twin Birth, Mate Liveborn, Born Outside Hospital and Not Hospitalized N

V3200 Twin, Mate Stillborn, Born in Hospital, Delivered Without Mention of Cesarean Delivery N V3201 Twin, Mate Stillborn, Born in Hospital, Delivered by Cesarean Delivery N V321 Twin Birth, Mate Stillborn, Born Before Admission to Hospital N V322 Twin Birth, Mate Stillborn, Born Outside Hospital and Not Hospitalized N Twin, Unspecified Whether Mate Stillborn or Liveborn, Born in Hospital, Delivered V3300 Without Mention of Cesarean Delivery N Twin, Unspecified Whether Mate Stillborn or Liveborn, Born in Hospital, Delivered by V3301 Cesarean Delivery N Twin Birth, Unspecified Whether Mate Liveborn or Stillborn, Born Before Admission to V331 Hospital N Twin Birth, Unspecified Whether Mate Liveborn or Stillborn, Born Outside Hospital and V332 Not Hospitalized N Other Multiple, Mates All Liveborn, Born in Hospital, Delivered Without Mention of V3400 Cesarean Delivery N V3401 Other Multiple, Mates All Liveborn, Born in Hospital, Delivered by Cesarean Delivery N Other Multiple Birth (Three or More), Mates All Liveborn, Born Before Admission to V341 Hospital N Other Multiple Birth (Three or More), Mates All Liveborn, Born Outside Hospital and Not V342 Hospitalized N Other Multiple, Mates All Stillborn, Born in Hospital, Delivered Without Mention of V3500 Cesarean Delivery N V3501 Other Multiple, Mates All Stillborn, Born in Hospital, Delivered by Cesarean Delivery N Other Multiple Birth (Three or More), Mates All Stillborn, Born Before Admission to V351 Hospital N Other Multiple Birth (Three or More), Mates All Stillborn, Born Outside of Hospital and V352 Not Hospitalized N Other Multiple, Mates Liveborn and Stillborn, Born in Hospital, Delivered Without V3600 Mention of Cesarean Delivery N Other Multiple, Mates Liveborn and Stillborn, Born in Hospital, Delivered by Cesarean V3601 Delivery N Other Multiple Birth (Three or More), Mates Liveborn and Stillborn, Born Before V361 Admission to Hospital N Other Multiple Birth (Three or More), Mates Liveborn and Stillborn, Born Outside V362 Hospital and Not Hospitalized N Other Multiple, Unspecified Whether Mates Stillborn or Liveborn, Born in Hospital, V3700 Delivered Without Mention of Cesarean Delivery N Other Multiple, Unspecified Whether Mates Stillborn or Liveborn, Born in Hospital, V3701 Delivered by Cesarean Delivery N Other Multiple Birth (Three or More), Unspecified Whether Mates Liveborn or Stillborn, V371 Born Before Admission to Hospital N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 332 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Other Multiple Birth (Three or More), Unspecified Whether Mates Liveborn or Stillborn, V372 Born Outside of Hospital N Liveborn Infant, Unspecified Whether Single, Twin, or Multiple, Born in Hospital, V3900 Delivered Without Mention of Cesarean Delivery N Liveborn Infant, Unspecified Whether Single, Twin, or Multiple, Born in Hospital, V3901 Delivered by Cesarean N Liveborn, Unspecified Whether Single, Twin or Multiple, Born Before Admission to V391 Hospital N Liveborn, Unspecified Whether Single, Twin or Multiple, Born Outside Hospital and Not V392 Hospitalized N V400 Problems With Learning N V401 Problems With Communication (Including Speech) N V402 Other Mental Problems N V403 Other Behavioral Problems N V409 Unspecified Mental or Behavioral Problem N V410 Problems With Sight N V411 Other Eye Problems N V412 Problems With Hearing N V413 Other Ear Problems N V414 Problems With Voice Production N V415 Problems With Smell and Taste N V416 Problems With Swallowing and Mastication N V417 Problems With Sexual Function N V418 Other Problems With Special Functions N V419 Unspecified Problem With Special Functions N V420 Kidney Replaced by Transplant N V421 Heart Replaced by Transplant N V422 Heart Valve Replaced by Transplant N V423 Skin Replaced by Transplant N V424 Bone Replaced by Transplant N V425 Cornea Replaced by Transplant N V426 Lung Replaced by Transplant N V427 Liver Replaced by Transplant N V428 Other Specified Organ or Tissue Replaced by Transplant N V4281 Bone Marrow Replaced by Transplant N V4282 Peripheral Stem Cells Replaced by Transplant N V4283 Pancreas Replaced by Transplant N V4284 Organ or Tissue Replaced by Transplant, Intestines N V4289 Other Organ or Tissue Replaced by Transplant N V429 Unspecified Organ or Tissue Replaced by Transplant N V430 Eye Globe Replaced by Other Means N V431 Lens Replaced by Other Means N V432 Heart Replaced by Other Means N V4321 Organ or Tissue Replaced by Other Means, Heart Assist Device N V4322 Organ or Tissue Replaced by Other Means, Fully Implantable Artificial Heart N V433 Heart Valve Replaced by Other Means N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 333 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V434 Blood Vessel Replaced by Other Means N V435 Bladder Replaced by Other Means N V4360 Unspecified Joint Replacement by Other Means N V4361 Shoulder Joint Replacement by Other Means N V4362 Elbow Joint Replacement by Other Means N V4363 Wrist Joint Replacement by Other Means N V4364 Hip Joint Replacement by Other Means N V4365 Knee Joint Replacement by Other Means N V4366 Ankle Joint Replacement by Other Means N V4369 Other Joint Replacement by Other Means N V437 Limb Replaced by Other Means N V4381 Larynx Replaced by Other Means N V4382 Breast Replaced by Other Means N V4383 Organ or Tissue Replaced by Artificial Skin N V4389 Other Organ or Tissue Replaced by Other Means N V440 Tracheostomy Status N V441 Gastrostomy Status N V442 Ileostomy Status N V443 Colostomy Status N V444 Status of Other Artificial Opening of Gastrointestinal Tract N V445 Cystostomy Status N V4450 Unspecified Cystostomy Status N V4451 Cutaneous-Vesicostomy Status N V4452 Appendico-Vesicostomy Status N V4459 Other Cystostomy Status N V446 Status of Other Artificial Opening of Urinary Tract N V447 Artificial Vagina Status N V448 Other Artificial Opening Status N V449 Unspecified Artificial Opening Status N V4500 Unspecified Cardiac Device in Situ N V4501 Cardiac Pacemaker in Situ N V4502 Automatic Implantable Cardiac Defibrillator in Situ N V4509 Other Specified Cardiac Device in Situ N V451 Renal Dialysis Status N V452 Presence of Cerebrospinal Fluid Drainage Device N V453 Intestinal Bypass or Anastomosis Status N V454 Arthrodesis Status N V4551 Presence of Intrauterine Contraceptive Device N V4552 Presence of Subdermal Contraceptive Device N V4559 Presence of Other Contraceptive Device N V456 Postsurgical States Following Surgery of Eye and Adnexa N V4561 Cataract Extraction Status N V4569 Other States Following Surgery of Eye and Adnexa N V4571 Acquired Absence of Breast N V4572 Acquired Absence of Intestine (Large) (Small) N V4573 Acquired Absence of Kidney N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 334 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V4574 Acquired Absence of Organ, Other Parts of Urinary Tract N V4575 Acquired Absence of Organ, Stomach N V4576 Acquired Absence of Organ, Lung N V4577 Acquired Absence of Organ, Genital Organs N V4578 Acquired Absence of Organ, Eye N V4579 Other Acquired Absence of Organ N V458 Other Postsurgical Status N V4581 Postsurgical Aortocoronary Bypass Status N V4582 Postsurgical Percutaneous Transluminal Coronary Angioplasty Status N V4583 Breast Implant Removal Status N V4584 Dental Restoration Status N V4585 Insulin Pump Status N V4589 Other Postsurgical Status N V460 Dependence on Aspirator N V461 Dependence on Respirator N V4611 Dependence on Respirator, Status N V4612 Encounter for Respirator Dependence During Power Failure N V4613 Encounter for Weaning From Respirator (Ventilator) N V4614 Mechanical Complication of Respirator (Ventilator) N V462 Dependence on Machine for Supplemental Oxygen N V468 Dependence on Other Enabling Machine N V469 Unspecified Machine Dependence N V470 Deficiencies of Internal Organs N V471 Mechanical and Motor Problems With Internal Organs N V472 Other Cardiorespiratory Problems N V473 Other Digestive Problems N V474 Other Urinary Problems N V475 Other Genital Problems N V479 Unspecified Problems With Internal Organs N V480 Deficiencies of Head N V481 Deficiencies of Neck and Trunk N V482 Mechanical and Motor Problems With Head N V483 Mechanical and Motor Problems With Neck and Trunk N V484 Sensory Problem With Head N V485 Sensory Problem With Neck and Trunk N V486 Disfigurements of Head N V487 Disfigurements of Neck and Trunk N V488 Other Problems With Head, Neck, and Trunk N V489 Unspecified Problem With Head, Neck, or Trunk N V490 Deficiencies of Limbs N V491 Mechanical Problems With Limbs N V492 Motor Problems With Limbs N V493 Sensory Problems With Limbs N V494 Disfigurements of Limbs N V495 Other Problems of Limbs N V4960 Upper Limb Amputation, Unspecified Level N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 335 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V4961 Upper Limb Amputation, Thumb N V4962 Upper Limb Amputation, Other Finger(s) N V4963 Upper Limb Amputation, Hand N V4964 Upper Limb Amputation, Wrist N V4965 Upper Limb Amputation, Below Elbow N V4966 Upper Limb Amputation, Above Elbow N V4967 Upper Limb Amputation, Shoulder N V4970 Lower Limb Amputation, Unspecified Level N V4971 Lower Limb Amputation, Great Toe N V4972 Lower Limb Amputation, Other Toe(s) N V4973 Lower Limb Amputation, Foot N V4974 Lower Limb Amputation, Ankle N V4975 Lower Limb Amputation, Below Knee N V4976 Lower Limb Amputation, Above Knee N V4977 Lower Limb Amputation, Hip N V498 Other Specified Problems With Limbs Influencing Health Status N V4981 Asymptomatic Postmenopausal Status (Age-Related) (Natural) N V4982 Dental Sealant Status N V4983 Awaiting Organ Transplant Status N V4984 Bed Confinement Status N V4989 Other Specified Conditions Influencing Health Status N V499 Unspecified Problems With Limbs and Other Problems N V500 Elective Hair Transplant for Purposes Other Than Remedying Health States N V501 Other Plastic Surgery for Unacceptable Cosmetic Appearance N V502 Routine or Ritual Circumcision N V503 Ear Piercing N V5041 Prophylactic Breast Removal N V5042 Prophylactic Ovary Removal N V5049 Other Prophylactic Gland Removal N V508 Other Elective Surgery for Purposes Other Than Remedying Health States N V509 Unspecified Elective Surgery for Purposes Other Than Remedying Health States N V51 Aftercare Involving the Use of Plastic Surgery N V520 Fitting and Adjustment of Artificial Arm (Complete) (Partial) N V521 Fitting and Adjustment of Artificial Leg (Complete) (Partial) N V522 Fitting and Adjustment of Artificial Eye N V523 Fitting and Adjustment of Dental Prosthetic Device N V524 Fitting and Adjustment of Breast Prosthesis and Implant N V528 Fitting and Adjustment of Other Specified Prosthetic Device N V529 Fitting and Adjustment of Unspecified Prosthetic Device N V530 Fitting and Adjustment of Devices Related to Nervous System and Specia N V5301 Fitting and Adjustment of Cerebral Ventricular (Communicating) Shunt N V5302 Neuropacemaker (Brain) (Peripheral Nerve) (Spinal Cord) N V5309 Fitting and Adjustment of Other Devices Related to Nervous System and Special Senses N V531 Fitting and Adjustment of Spectacles and Contact Lenses N V532 Fitting and Adjustment of Hearing Aid N V5331 Fitting and Adjustment of Cardiac Pacemaker N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 336 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V5332 Fitting and Adjustment of Automatic Implantable Cardiac Defibrillator N V5339 Fitting and Adjustment of Other Cardiac Device N V534 Fitting and Adjustment of Orthodontic Devices N V535 Fitting and Adjustment of Other Intestinal Appliance N V536 Fitting and Adjustment of Urinary Device N V537 Fitting and Adjustment of Orthopedic Device N V538 Fitting and Adjustment of Wheelchair N V539 Fitting and Adjustment of Other and Unspecified Device N V5390 Fitting and Adjustmentof Other and Unspecified Device, Unspecified Device N V5391 Fitting and Adjustment of Insulin Pump N V5399 Fitting and Adjustment, Other Device N V540 Orthopedic Aftercare Involving Removal of Fx Plate or Other Int Fixati N V5401 Encounter for Removal of Internal Fixation Device N V5402 Encounter for Lengthening/Adjustment of Growth Rod N V5409 Other Aftercare Involving Internal Fixation Device N V5410 Aftercare for Healing Traumatic Fracture of Arm, Unspecified N V5411 Aftercare for Healing Traumatic Fracture of Upper Arm N V5412 Aftercare for Healing Traumatic Fracture of Lower Arm N V5413 Aftercare for Healing Traumatic Fracture of Hip N V5414 Aftercare for Healing Traumatic Fracture of Leg, Unspecified N V5415 Aftercare for Healing Traumatic Fracture of Upper Leg N V5416 Aftercare for Healing Traumatic Fracture of Lower Leg N V5417 Aftercare for Healing Traumatic Fracture of Vertebrae N V5419 Aftercare for Healing Traumatic Fracture of Other Bone N V5420 Aftercare for Healing Pathologic Fracture of Arm, Unspecified N V5421 Aftercare for Healing Pathologic Fracture of Upper Arm N V5422 Aftercare for Healing Pathologic Fracture of Lower Arm N V5423 Aftercare for Healing Pathologic Fracture of Hip N V5424 Aftercare for Healing Pathologic Fracture of Leg, Unspecified N V5425 Aftercare for Healing Pathologic Fracture of Upper Leg N V5426 Aftercare for Healing Pathologic Fracture of Lower Leg N V5427 Aftercare for Healing Pathologic Fracture of Vertebrae N V5429 Aftercare for Healing Pathologic Fracture of Other Bone N V548 Other Orthopedic Aftercare N V5481 Aftercare Following Joint Replacement N V5489 Other Orthopedic Aftercare N V549 Unspecified Orthopedic Aftercare N V550 Attention to Tracheostomy N V551 Attention to Gastrostomy N V552 Attention to Ileostomy N V553 Attention to Colostomy N V554 Attention to Other Artificial Opening of Digestive Tract N V555 Attention to Cystostomy N V556 Attention to Other Artificial Opening of Urinary Tract N V557 Attention to Artificial Vagina N V558 Attention to Other Specified Artificial Opening N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 337 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V559 Attention to Unspecified Artificial Opening N V560 Encounter for Extracorporeal Dialysis N V561 Fitting and Adjustment of Extracorporeal Dialysis Catheter N V562 Fitting and Adjustment of Peritoneal Dialysis Catheter N V5631 Encounter for Adequacy Testing for Hemodialysis N V5632 Encounter for Adequacy Testing for Peritoneal Dialysis N V568 Encounter Other Dialysis N V570 Care Involving Breathing Exercises N V571 Other Physical Therapy N V5721 Encounter for Occupational Therapy N V5722 Encounter for Vocational Therapy N V573 Speech Therapy N V574 Orthoptic Training N V578 Care Involving Other Specified Rehabilitation Procedure N V5781 Orthotic Training N V5789 Other Specified Rehabilitation Procedure N V579 Unspecified Rehabilitation Procedure N V580 Radiotherapy N V581 Chemotherapy N V5811 Encounter for Antineoplastic Chemotherapy N V5812 Encounter for Immunotherapy for Neoplastic Condition N V582 Blood Transfusion, Without Reported Diagnosis N V583 Attention to Surgical Dressings and Sutures N V5841 Planned Postoperative Wound Closure N V5842 Aftercare Following Surgery for Neoplasm N V5843 Aftercare Following Surgery for Injury and Trauma N V5844 Aftercare Following Organ Transplant N V5849 Other Specified Aftercare Following Surgery N V585 Orthodontics Aftercare N V5861 Encounter for Long-Term (Current) Use of Anticoagulants N V5862 Encounter for Aftercare for Long-Term (Current) Use of Antibiotics N V5863 Long-Term (Current) Use of Antiplatelet/Antithrombotic N V5864 Long-Term (Current) Use of Nonsteroidal Anti-Inflammatories (Nsaid) N V5865 Long-Term (Current) Use of Steroids N V5866 Long-Term (Current) Use of Aspirin N V5867 Long-Term (Current) Use of Insulin N V5869 Encounter for Long-Term (Current) Use of Other Medications N V5871 Aftercare Following Surgery of the Sense Organs, Nec N V5872 Aftercare Following Surgery of the Nervous System, Nec N V5873 Aftercare Following Surgery of the Circulatory System, Nec N V5874 Aftercare Following Surgery of the Respiratory System, Nec N V5875 Aftercare Following Surgery of the Teeth, Oral Cavity, and Digestive System, Nec N V5876 Aftercare Following Surgery of the Genitourinary System, Nec N V5877 Aftercare Following Surgery of the Skin and Subcutaneous Tissue, Nec N V5878 Aftercare Following Surgery of the Musculoskeletal System, Nec N V5881 Fitting and Adjustment of Vascular Catheter N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 338 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V5882 Encounter for Fitting and Adjustment of Non-Vascular Catheter Nec N V5883 Encounter for Therapeutic Drug Monitoring N V5889 Encounter for Other Specified Aftercare N V589 Unspecified Aftercare N V5901 Whole Blood Donor N V5902 Stem Cell Donor N V5909 Blood Donor, Other N V591 Skin Donor N V592 Bone Donor N V593 Bone Marrow Donor N V594 Kidney Donor N V595 Cornea Donor N V596 Liver Donor N V5970 Egg (Oocyte) (Ovum) Donor, Unspecified N V5971 Egg (Oocyte) (Ovum) Donor, Under Age 35, Anonymous Recipient N V5972 Egg (Oocyte) (Ovum) Donor, Under Age 35, Designated Recipient N V5973 Egg (Oocyte) (Ovum) Donor, Age 35 and Over, Anonymous Donor N V5974 Egg (Oocyte) (Ovum) Donor, Age 35 and Over, Designated Recipient N V598 Donor of Other Specified Organ or Tissue N V599 Donor of Unspecified Organ or Tissue N V600 Lack of Housing N V601 Inadequate Housing N V602 Inadequate Material Resources N V603 Person Living Alone N V604 No Other Household Member Able to Render Care N V605 Holiday Relief Care N V606 Person Living in Residential Institution N V608 Other Specified Housing or Economic Circumstances N V609 Unspecified Housing or Economic Circumstance N V610 Family Disruption N V611 Counseling for Marital and Partner Problems N V6110 Counseling for Marital and Partner Problems, Unspecified N V6111 Counseling for Victim of Spousal and Partner Abuse N V6112 Counseling for Perpetrator of Spousal and Partner Abuse N V6120 Counseling for Parent-Child Problem, Unspecified N V6121 Counseling for Victim of Child Abuse N V6122 Counseling for Perpetrator of Parental Child Abuse N V6129 Counseling for Perpetrator of Parental Child Abuse N V613 Problems With Aged Parents or In-Laws N V614 Health Problems Within Family N V6141 Alcoholism in Family N V6149 Other Health Problem Within the Family N V615 Multiparity N V616 Illegitimacy or Illegitimate Pregnancy N V617 Other Unwanted Pregnancy N V618 Other Specified Family Circumstance N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 339 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V619 Unspecified Family Circumstance N V620 Unemployment N V621 Adverse Effects of Work Environment N V622 Other Occupational Circumstance or Maladjustment N V623 Educational Circumstance N V624 Social Maladjustment N V625 Legal Circumstance N V626 Refusal of Treatment for Reasons of Religion or Conscience N V628 Other Psychological or Physical Stress, Not Elsewhere Classified N V6281 Interpersonal Problem, Not Elsewhere Classified N V6282 Bereavement, Uncomplicated N V6283 Counseling for Perpetrator of Physical/Sexual Abuse N V6284 Suicidal Ideation Y V6289 Other Psychological or Physical Stress, Not Elsewhere Classified N V629 Unspecified Psychosocial Circumstance N V630 Residence Remote From Hospital or Other Health Care Facility N V631 Medical Services in Home Not Available N V632 Person Awaiting Admission to Adequate Facility Elsewhere N V638 Other Specified Reason for Unavailability of Medical Facilities N V639 Unspecified Reason for Unavailability of Medical Facilities N V640 Vaccination Not Carried Out Because of Contraindication N V6400 Vacination Not Carried Out, Unspecified Reason N V6401 Vaccination Not Carried Out Because of Acute Illness N V6402 Vaccination Not Carried Out Because of Chronic Illness or Condition N V6403 Vaccination Not Carried Out Because of Immune Compromised State N V6404 Vaccination Not Carried Out Because of Allergy to Vaccine or Component N V6405 Vaccination Not Carried Out Because of Caregiver Refusal N V6406 Vaccination Not Carried Out Because of Patient Refusal N V6407 Vaccination Not Carried Out for Religious Reasons N V6408 Vaccination Not Carried Out Because Patient Had Disease Being Vaccinated Against N V6409 Vaccination Not Carried Out for Other Reason N V641 Surgical or Other Procedure Not Carried Out Because of Contraindication N V642 Surgical or Other Procedure Not Carried Out Because of Patient’s Decision N V643 Procedure Not Carried Out for Other Reasons N V644 Laproscopic Surgical Procedure Converted to Open Procedure N V6441 Laparoscopic Surgical Procedure Converted to Open Procedure N V6442 Thorascopic Surgical Procedure Converted to Open Procedure N V6443 Arthroscopic Surgical Procedure Converted to Open Procedure N V650 Healthy Person Accompanying Sick Person N V651 Person Consulting on Behalf of Another Person N V6511 Pediatric Pre-Birth Visit for Expectant Mother N V6519 Other Person Consulting on Behalf of Another Person N V652 Person Feigning Illness N V653 Dietary Surveillance and Counseling N V6540 Counseling Nos N V6541 Excercise Counseling N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 340 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V6542 Counseling on Substance Use and Abuse N V6543 Counseling on Injury Prevention N V6544 Human Immunodeficiency Virus (Hiv) Counseling N V6545 Counseling on Other Sexually Transmitted Diseases N V6546 Encounter for Insulin Pump Training N V6549 Other Specified Counseling N V655 Person With Feared Complaint in Whom No Diagnosis Was Made N V658 Other Reasons for Seeking Consultation N V659 Unspecified Reason for Consultation N V660 Convalescence Following Surgery N V661 Convalescence Following Radiotherapy N V662 Convalescence Following Chemotherapy N V663 Convalescence Following Psychotherapy and Other Treatment for Mental Disorder N V664 Convalescence Following Treatment of Fracture N V665 Convalescence Following Other Treatment N V666 Convalescence Following Combined Treatment N V667 Encounter for Palliative Care N V669 Unspecified Convalescence N V670 Follow-Up Examination Following Surgery N V6700 Follow-Up Examination, Following Unspecified Surgery N V6701 Following Surgery Follow-Up Vaginal Pap Smear N V6709 Follow-Up Examination, Following Other Surgery N V671 Radiotherapy Follow-Up Examination N V672 Chemotherapy Follow-Up Examination N V673 Psychotherapy and Other Treatment for Mental Disorder Follow-Up Examination N V674 Treatment of Healed Fracture Follow-Up Examination N V675 Follow-Up Examination Following Other Treatment N Follow-Up Examination Following Completed Treatment With High-Risk Medications, V6751 Not Elsewhere Classified N V6759 Other Follow-Up Examination N V676 Combined Treatment Follow-Up Examination N V679 Unspecified Follow-Up Examination N V680 Issue of Medical Certificates N V681 Issue of Repeat Prescriptions N V682 Request for Expert Evidence N V688 Encounters for Other Specified Administrative Purpose N V6881 Referral of Patient Without Examination or Treatment N V6889 Encounters for Other Specified Administrative Purpose N V689 Encounters for Unspecified Administrative Purpose N V690 Problems Related to Lack of Physical Excercise N V691 Problems Related to Inappropriate Diet and Eating Habits N V692 Problems Related to High-Risk Sexual Behavior N V693 Problems Related to Gambling and Betting N V694 Lack of Adequate Sleep N V695 Behavioral Insomnia of Childhood N V698 Other Problems Related to Lifestyle N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 341 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V699 Unspecified Problems Related to Lifestyle N V700 Routine General Medical Examination at Health Care Facility N V701 General Psychiatric Examination Requested by the Authority N V702 Other and Unspecified General Psychiatric Examination N V703 Other General Medical Examination for Administrative Purposes N V704 Examination for Medicolegal Reason N V705 Health Examination of Defined Subpopulation N V706 Health Examination in Population Survey N V707 Examination of Participant in Clinical Trial N V708 Other Specified General Medical Examination N V709 Unspecified General Medical Examination N V710 Observation and Evaluation for Suspected Conditions Not Found N V7101 Observation of Adult Antisocial Behavior N V7102 Observation of Childhood or Adolescent Antisocial Behavior N V7109 Observation of Other Suspected Mental Condition N V711 Observation for Suspected Malignant Neoplasm N V712 Observation for Suspected Tuberculosis N V713 Observation Following Accident at Work N V714 Observation Following Other Accident N V715 Observation Following Alleged Rape or Seduction Y V716 Observation Following Other Inflicted Injury N V717 Observation for Suspected Cardiovascular Disease N V718 Observation for Other Specified Suspected Conditions N V7181 Observation for Suspected Abuse and Neglect N V7182 Observation and Evaluation for Suspected Exposure to Anthrax N V7183 Observation and Evaluation for Suspected Exposure to Other Biological Agent N V7189 Observation for Other Specified Suspected Conditions N V719 Observation for Unspecified Suspected Condition N V720 Examination of Eyes and Vision N V721 Examination of Ears and Hearing N V722 Dental Examination N V723 Gynecological Examination N V7231 Routine Gynecological Examination N Encounter for Papanicolaou Cervical Smear to Confirm Findings of Recent Normal Smear V7232 Following Initial Abnormal Smear N V724 Pregnancy Examination or Test, Pregnancy Unconfirmed N V7240 Pregnancy Examination or Test, Pregnancy Unconfirmed N V7241 Pregnancy Examination or Test, Negative Result N V7242 Pregnancy Examination or Test, Positive Result N V725 Radiological Examination, Not Elsewhere Classified N V726 Laboratory Examination N V727 Diagnostic Skin and Sensitization Tests N V7281 Pre-Operative Cardiovascular Examination N V7282 Pre-Operative Respiratory Examination N V7283 Other Specified Pre-Operative Examination N V7284 Unspecified Pre-Operative Examination N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 342 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V7285 Other Specified Examination N V7286 Encounter for Blood Typing N V729 Unspecified Examination N V730 Screening Examination for Poliomyelitis N V731 Screening Examination for Smallpox N V732 Screening Examination for Measles N V733 Screening Examination for Rubella N V734 Screening Examination for Yellow Fever N V735 Screening Examination for Other Arthropod-Borne Viral Diseases N V736 Screening Examination for Trachoma N V7388 Special Screening Examination for Other Specified Chlamydial Diseases N V7389 Special Screening Examination for Other Specified Viral Diseases N V7398 Special Screening Examination for Unspecified Chlamydial Disease N V7399 Special Screening Examination for Unspecified Viral Disease N V740 Screening Examination for Cholera N V741 Screening Examination for Pulmonary Tuberculosis N V742 Screening Examination for Leprosy (Hansen’s Disease) N V743 Screening Examination for Diphtheria N V744 Screening Examination for Bacterial Conjunctivitis N V745 Screening Examination for Venereal Disease N V746 Screening Examination for Yaws N V748 Screening Examination for Other Specified Bacterial and Spirochetal Diseases N V749 Screening Examination for Unspecified Bacterial and Spirochetal Diseases N V750 Screening Examination for Rickettsial Diseases N V751 Screening Examination for Malaria N V752 Screening Examination for Leishmaniasis N V753 Screening Examination for Trypanosomiasis N V754 Screening Examination for Mycotic Infections N V755 Screening Examination for Schistosomiasis N V756 Screening Examination for Filariasis N V757 Screening Examination for Intestinal Helminthiasis N V758 Screening Examination for Other Specified Parasitic Infections N V759 Screening Examination for Unspecified Infectious Disease N V760 Special Screening for Malignant Neoplasm of the Respiratory Organs N V761 Screening for Malignant Neoplasms of the Breast N V7610 Unspecified Breast Screening N V7611 Screening Mammogram for High-Risk Patient N V7612 Other Screening Mammogram N V7619 Other Screening Breast Examination N V762 Screening for Malignant Neoplasm of the Cervix N V763 Screening for Malignant Neoplasm of the Bladder N V764 Special Screening for Malignant Neoplasms of Other Sites N V7641 Screening for Malignant Neoplasm of the Rectum N V7642 Screening for Malignant Neoplasm of the Oral Cavity N V7643 Screening for Malignant Neoplasm of the Skin N V7644 Special Screening for Malignant Neoplasm of Prostate N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 343 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V7645 Special Screening for Malignant Neoplasm of Testis N V7646 Special Screening for Malignant Neoplasms, Ovary N V7647 Special Screening for Malignant Neoplasms, Vagina N V7649 Special Screening for Malignant Neoplasms, Other Sites N V7650 Special Screening for Malignant Neoplasms, Intestine, Unspecified N V7651 Special Screening for Malignant Neoplasms, Colon N V7652 Special Screening for Malignant Neoplasms, Small Intestine N V768 Screening for Other Malignant Neoplasms N V7681 Special Screening for Malignant Neoplasms, Nervous System N V7689 Special Screening for Other Malignant Neoplasm N V769 Screening for Unspecified Malignant Neoplasm N V770 Screening for Thyroid Disorder N V771 Screening for Diabetes Mellitus N V772 Screening for Malnutrition N V773 Screening for Phenylketonuria (Pku) N V774 Screening for Galactosemia N V775 Screening for Gout N V776 Screening for Cystic Fibrosis N V777 Screening for Other Inborn Errors of Metabolism N V778 Screening for Obesity N V779 Screening for Other and Unspecified Endocrine, Nutritional, Metabolic N V7791 Screening for Lipoid Disorders N V7799 Other and Unspecified Endocrine, Nutritional, Metabolic, and Immunity Disorders N V780 Screening for Iron Deficiency Anemia N V781 Screening for Other and Unspecified Deficiency Anemia N V782 Screening for Sickle-Cell Disease or Trait N V783 Screening for Other Hemoglobinopathies N V788 Screening for Other Disorders of Blood and Blood-Forming Organs N V789 Screening for Unspecified Disorder of Blood and Blood-Forming Organs N V790 Screening for Depression N V791 Screening for Alcoholism N V792 Screening for Mental Retardation N V793 Screening for Developmental Handicaps in Early Childhood N V798 Screening for Other Specified Mental Disorders and Developmental Handicaps N V799 Screening for Unspecified Mental Disorder and Developmental Handicap N V800 Screening for Neurological Conditions N V801 Screening for Glaucoma N V802 Screening for Other Eye Conditions N V803 Screening for Ear Diseases N V810 Screening for Ischemic Heart Disease N V811 Screening for Hypertension N V812 Screening for Other and Unspecified Cardiovascular Conditions N V813 Screening for Chronic Bronchitis and Emphysema N V814 Screening for Other and Unspecified Respiratory Condition N V815 Screening for Nephropathy N V816 Screening for Other and Unspecified Genitourinary Condition N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 344 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator V820 Screening for Skin Condition N V821 Screening for Rheumatoid Arthritis N V822 Screening for Other Rheumatic Disorder N V823 Screening for Congenital Dislocation of Hip N V824 Maternal Postnatal Screening of Chromosomal Anomalies N V825 Screening for Chemical Poisoning and Other Contamination N V826 Multiphasic Screening N V828 Screening for Other Specified Conditions N V8281 Special Screening for Osteoporosis N V8289 Special Screening for Other Specified Conditions N V829 Screening for Unspecified Condition N V8301 Asymptomatic Hemophilia a Carrier N V8302 Symptomatic Hemophilia a Carrier N V8381 Cystic Fibrosis Gene Carrier N V8389 Other Genetic Carrier Status N V8401 Genetic Susceptibility to Malignant Neoplasm of Breast N V8402 Genetic Susceptibility to Malignant Neoplasm of Ovary N V8403 Genetic Susceptibility to Malignant Neoplasm of Prostate N V8404 Genetic Susceptibility to Malignant Neoplasm of Endometrium N V8409 Genetic Susceptibility to Other Malignant Neoplasm N V848 Genetic Susceptibility to Other Disease N V850 Body Mass Index Less Than 19, Adult N V851 Body Mass Index Between 19-24, Adult N V8521 Body Mass Index 25.0-25.9, Adult N V8522 Body Mass Index 26.0-26.9, Adult N V8523 Body Mass Index 27.0-27.9, Adult N V8524 Body Mass Index 28.0-28.9, Adult N V8525 Body Mass Index 29.0-29.9, Adult N V8530 Body Mass Index 30.0-39.0, Adult N V8531 Body Mass Index 31.0-31.9, Adult N V8532 Body Mass Index 32.0-32.9, Adult N V8533 Body Mass Index 33.0-33.9, Adult N V8534 Body Mass Index 34.0-34.9, Adult N V8535 Body Mass Index 35.0-35.9, Adult N V8536 Body Mass Index 36.0-36.9, Adult N V8537 Body Mass Index 37.0-37.9, Adult N V8538 Body Mass Index 38.0-38.9, Adult N V8539 Body Mass Index 39.0-39.9, Adult N V854 Body Mass Index 40 and Over, Adult N Y00 Eye Examination N Y01 Skin Immunity and Sensitization Tests N Y02 Immunizations N Y03 Follow-Up Exam - No Further Care Needed N Y04 Contact With Infective/Parasitic Disease N Y05 Carrier or Suspected Carrier-Infected Org N Y06 Antepartum Care N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 345 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Y07 Postparium Care N Y08 History of Malignancy N Y09 Binaural Hearing Loss N Y10 Medical Examination of Individuals N Y11 History of Malignancy Other Organs N Y12 Fitting of Prosthetic Device N Y15 Medical and Surgical Aftercare N Y16 Attention to Artifical Openings N Y18 Bilateral Sensorineural Hearing Disorder N Y20 Nursery Care N Y21 Single Birth Preterm Spontaneous Deliver N Y22 Twin Term Spontaneous Delivery N Y23 Twin, Preterm,Hosp. Birth N Y24 Other Multiple Term N Y25 Other Multiple Preterm N Y26 Single Term Nonhospital Birth N Y27 Single Preterm Nonhospital Birth N Y28 Multiple Term Nonhospital Birth N Y29 Multiple Preterm Nonhospital Birth N Y30 Fetal Death N Y32 Theraputic Abortion Medically Necessary N Y33 Abortion-Result of Rape or Incest N Y44 Medicare-Medicaid Unspecified N Y46 Children and Family Services (CFS) Adoption Contract N Y47 Children and Family Services (CFS) Family Preservation Contract N Y48 Children and Family Services (CFS) Foster Care Contract N Y50 Implants and Other Postsurgical Conditio N Y51 Organs Replaced by Transplant N Y53 Dental Exam and Prophylaxis N Y54 Partial Absence of Organ N Y55 Unilateral Sensorineural Hearing Disorde N Y56 Bilateral Conductive Hearing Disorder N Y57 Impairment of Neromusculoskeletal Functi N Y58 Blindness N Y59 Hearing Exam N Y60 History Allergy to Medicinal Agents N Y61 Family History Malignant Neoplasm N Y62 Family History Other Disease N Y69 AIDS (Auto-Immune Deficiency Syndrome) S Y70 Abnormal Hematologic Findings N Y71 Abnormal Blood Serum or Plasma Levels N Y72 Other Abnormal Blood Serum Level N Y73 Auto Accident N Y74 Other Abnormal Urinary Findings N Y75 Pathology and Lab N Y76 Unspecified Radiology N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 346 of 347 Diagnosis Emergency Diagnosis Code Description Code Indicator Y77 Abnormal Radiological Findings N Y78 Abnormal Function Study and Scans N Y79 Other Abnormal Findings Lab Investigativ N Y80 Unilateral Conductive Hearing Disorder N Y81 Prophylactic Vaccinations and Inoculati N Y82 Desensitization and Other Vac and Inocul N Y83 Family Planning N Y84 Referral and Evaluations N Y85 AIDS (Auto-Immune Deficiency Syndrome) S Y90 General Anesthesia N Y91 Rx for DME / Ambulance N Y92 Bilateral Mixed Hearing Disorder N Y93 Unilateral Mixed Hearing Disorder N Y94 Psuedo Hearing Loss N Y95 Central Hearing Loss N Y96 Post Cataract Surgery N Y97 Employment Education or Training N Y98 Hardship N

EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 347 of 347