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Home , A9 (classification), Amyotrophy, CADASIL, Christianson syndrome, De Barsy syndrome, Dyssomnia

Diagnoses Cues for the Adult Long Term Care Functional Screen (LTCFS) December 2020 This alphabetical listing indicates which box screeners should check on the Diagnoses Table of the Adult LTCFS for diagnoses common to people with long-term care needs. The Diagnoses Table contains categories A through K, with numbered rows within each category. When selecting “Other” in any category, a diagnosis must be entered in the text box provided on the Functional Screen Information Access (FSIA) application. • Screeners must verify a person’s diagnoses. Diagnoses are verified by referring to health records, consulting with a nurse or other health care professional, or if very clearly stated, in exact medical terms, by the person, family, guardian, advocate, etc. Exceptions to these criteria are that a screener must verify a psychiatric, behavioral, or diagnosis directly with a health care provider, medical record, the Children’s Long Term Support Functional Screen or the disability determination diagnosis from the Social Security Administration. See Module 4: Diagnoses, of the Wisconsin LTCFS Instructions for further information on verification of diagnoses. • Do not list any diagnosis that pertains to a condition that has been cured or eliminated by medical treatment, or . Often medical records from health care providers or diagnoses used to find an individual eligible for Social Security benefits are not current. Select diagnoses only for CURRENT conditions. When in doubt, consult with the health care provider treating the person for whom you are completing the LTCFS. • Do not guess which box to check on the Diagnoses Table. For every diagnosis, the screener should: 1. Determine if the diagnosis is listed on the LTCFS Diagnoses Table and select the relevant box on the Diagnoses Table. 2. If a diagnosis is not on the Diagnoses Table, look for it on this cue sheet. Record the corresponding code on the Diagnoses Table. While searching for a diagnosis on this cue sheet, the screener may need to search each of the words in the diagnosis to find the code. An attempt has been made to include newer and older medical terminology, along with non-medical terms for the diagnosis. 3. A key of “Ø” means that the diagnosis is not included on the LTCFS Diagnoses Table and the screener should not code it. The “Ø” symbol has several meanings, including: o The diagnosis is a procedure or surgery; o The diagnosis is not germane to LTCFS eligibility logic; or o The diagnosis is too general and more information is needed to code it. For example, vascular disease is any condition that affects the circulatory system, including , arterial insufficiency and bloods clots. Identify and code the more specific diagnosis.

P-00814 (12/2020) 4. Any diagnosis with the “Ø” symbol should not be coded as “K5: Other” or “K6: Additional Diagnoses” on the Diagnoses Table. Include diagnoses of this nature in the Notes section of the LTCFS. 5. If the diagnosis is not listed on the LTCFS Diagnoses Table or on this cue sheet and is not needed for a primary or secondary diagnosis, select “K6: Additional Diagnoses” on the LTCFS Diagnoses Table and record the diagnosis in the text box provided. Do not list any diagnosis in “K6: Additional Diagnoses” unless you have verified that the diagnosis is not on this cue sheet or on the Diagnoses Table. 6. If a diagnosis is not listed on the Diagnoses Table or this cue sheet and it is a primary or secondary diagnosis needed to complete the LTCFS, the screen liaison is to contact DHS at [email protected] prior to proceeding with the screen until the DHS screen team has responded with coding information. • This cue sheet is intended to list diagnostic names for discrete conditions, not symptoms that may be present for a number of different conditions or diagnoses. However, common medical practice often uses a symptom as a proxy for a diagnostic name. Therefore, some symptoms have been included on this cue sheet, but this listing is not intended to be complete or all- inclusive.

P-00814 (12/2020) Items in red are new since last update

DIAGNOSIS CODE DIAGNOSIS CODE 18p Deleti on Acute Bronchitis F2 AAA = Abdominal Aortic C5 Acute Disseminated , E4 AAA Repair Ø if onset at age 22 or after AA A/Triple A Syndrome A9 Acute Disseminated Encephalomyelitis, Aarskog Syndrome A9 if onset before age 22 Abdominal Aneurysm C5 Acute Intermittent Porphyria B6 Abdominal Aortic Aneurysm (AAA) C5 Acute Injury G3 Abdominal D12 Acute Toxic , if onset at E4 Abdominal Ø age 22 or after Acute , if onset Abdominal Pannus Ø A3 Abnormal Blood Glucose Ø before age 22 Abnormal Electrocardiogram Ø ADD = Attention Deficit Disorder K2 Abnormal Gait D13 Addiction to Pain Kille rs K1 Abnormal Involuntary Movement D13 Addison's Disease B7 Abnormal Liver or Function Adenocarcinoma J2 Ø Tests Adenoid Hypertrophy Ø Abnormal D13 Adenoidectomy Ø Abnormal Posture Ø Adenoma, Parathyroid B7 Abnormal Weight Gain Ø Adenoma, Pituitary B7 Abnormal Weight Loss Ø Adenomatous Colon Polyps Ø Abov e the Amputation (AKA) D1 Adenopathy/Lymphadenopathy C5 ADHD = Attention Deficit/Hyperactivity Abscess of Liver B4 K2 Abscess of Skin K4 Disorder Absence of Joint (explantation of Adhesions on Colon B5 D4 ) Adhesive Capsulitis D4 Absence of Teeth B5 H5 Absence, Agenesis or Dysgenesis of Adrenal Insufficiency B7 A9 Corpus Callosum (ACC or DCC) Adrenal Mass/Tumor, if cancerous and if J2 Acanthosis Nigricans Ø in past 5 years ACC = Absence/A genesis of Corpus Adrenal Mass/Tumor, if noncancerous B7 A9 Callosum Adrenomyeloneuropathy E7 Achalasia B5 Adult Onset Mellitus (AODM) B1 Achilles Tendonitis D4 Adult Still's Disease D2 Acid Maltase Deficiency/Pompe Disease B6 Adverse Medication Reactions J1 Acid Peptic Disease B5 Affective Disorder H5 Acid Reflux B5 AFib/AF = Atrial Fibrillation C3 (Metabolic) B6 Agenesis of /Pulmonary Agenesis F5 Acidosis (Respiratory) F5 Agenesis/Absence of Corpus Callosum A9 Acne J3 Agent Orange Exposure Ø Acne Rosacea J3 Aggressive Behavior Ø Acquired Immunodeficiency S yndrome Agitation Ø J5 (AIDS) H1 Acrocallosal Syndrome A7 Agranulocytosis C1 Acrodysostosis A9 AHD = Arteriosclerotic Disease C2 Acromegaly B7 Aicardi Syndrome A7 Actinic Keratosis J3 AIDS = Acquired Immunodeficiency J5 Active Hepatitis B4 Syndrome P-00814 (12/2020) Page 1 of 26

Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Airway Obstruction F5 Angioma, Cerebral, if onset at age 22 or E6 AKA = Above the Knee Amputation D1 after D13 Angioma, Cerebral, if onset before age A3 Albinism Ø 22 Albright's Hereditary Os teodystrophy A9 Angioplasty, Coronary or Non -coronary Ø Alcohol and Other Drug Abuse (AODA) K1 Anisometropia I2 Alcohol Dependence In Remission Ø Ankle Edema Ø Alcohol Encephalopathy/Dementia E2 Ankle Equinus D4 Alcohol Related Neurodevelopmental Ankle Fracture D4 A9 Disorder (ARND) Ankle Fusion D4 Alcohol Withdrawal K1 Ankle Ulcer K4 Alcoholic Dementia E2 D2 /Alcohol Abuse/Ad diction/ Anorexia or B10 K1 Dependence Anoxic Injury, if onset at age 22 or E4 Allergic Conjunctivitis J1 after J1 Anoxic Brain Injury, if onset before age A3 J1 22 Alopecia Ø Anoxic Encephalopathy, if onset at age E4 Alport's Syndrome G1 22 or after An oxic Encephalopathy, if onset before ALS = Amyotrophic Lateral Sclerosis D7 A3 Alström Syndrome K5 age 22 Antibiotic Resistant Infections (for Altered Mental Status Ø J6 Alternating Hemiparesis of Childhood example, MRSA) A9 (AHC) Anticoagulation/Anticoagulant Use Ø Alternating Hemiplegia of Childhood A9 Antiphospholipid Syndrome J7 Alzheimer's Disease E1 Antisynthetase Syndrome J7 Eye I2 Antral Erosion/Ulcer B5 Amblyopia I2 Anxiety/Anxiety Disorde r H1 Syndrome (such as tetra) D13 AODA = Alcohol and Other Drug Abuse K1 Amenorrhea G4 AODM = Adult Onset Diabetes Mellitus B1 Amnestic Disorder NOS E7 Aorta Coartation C8 Amnestic Disorder/Syndrome E7 Aortic Aneurysm C5 Amniotic Band Syndrome D13 Aortic Dissection C5 Amputation D1 Aortic Insufficiency C8 Amyloidosis K5 Aortic Regurgitation C8 Amyotrophic Lateral Sclerosis (ALS) D7 Aortic Sclerosis/Aortic Valve Sclerosis C8 Amyotrophy D13 Aortic St enosis/Aortic Valve Stenosis C8 Anal Fissure/Fistula B5 Aortic Valve Disease/Disorder C8 Andersen -Tawil Syndrome K5 Aortoiliac Occlusive Disease C5 Anemia C1 A9 Aneurysm, Aortic, Abdominal, or AAA C5 Aphakia I2 Aneurysm, Cerebral, if onset at age 22 Aphasia, Expressive or Receptive E7 E3 or after Apical Calcification (Cardiac) C8 Aneurysm, Cerebral, if onset before age Apical Calcification (Pulmonary) F5 A3 22 Appendectomy Ø A7 Apraxia E7 Angina C2 Arnold -Chiari Malformation Syndrome A7 C3 P-00814 (12/2020) Page 2 of 26

Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Arsonist K6 Automatic Implantable Cardioverter - C3 Ø Arterial Insufficiency C5 Defibrillator (AICD) Arteriosclerotic Cardiovascular Disease Autonomic Dysfunction/Neuropathy D13 C2 (ASCVD) Autonomic Dysreflexia D13 Arteriosclerotic Heart Disease (AHD) C2 AV (Atriovent ricular) Block C3 Arteriovenous Malformation (AVM) C5 Avascular Necrosis D5 Arteritis C5 Avoidant Restrictive Food Intake B10 Artho gyrposis D6 Azotemia G1 D4 B-12 /B Complex Deficiency B6 Arthritic Pain D12 Back Pain or D12 D2 Back Surgery Ø Arthrodesis D4 Baclofen Pump Ø Multiplex (Congenital) D6 Bacteremia J6 D4 Bacterial , if onset at age 22 E4 Arthrosclerosis D4 or after Arthroscopy of Knee Ø Bact erial Meningitis, if onset before age A3 Artificial Bladder G3 22 Asbestosis F5 Bacterial Vaginosis G4 Ascites B4 Bainbridge -Ropers Syndrome A7 ASCVD = Arteriosclerotic Ca rdiovascular Baker's Cyst D4 C2 Disease Balance Problems D13 ASD = Spectrum Disorder Balanitis G4 ASHD = Arteriosclerotic Heart Disease C2 Balint's Syndrome E7 Asperger's Syndrome A2 Bannayan Riley Ruvalcaba Syndrome A9 Aspiration Pneumonia F2 Baraitser -Winter Syndrome A9 Asteroid Hyalitis I2 Bardet Biedl Syndrome A7 F6 Barrett's Esophagus B5 Astigmatism I2 Basal Cell Carcinoma, if in past 5 years J2 D13 Batten Disease/neuronal ceroid E2 Ataxia -Telangiectasia A9 lipofuscinosis (NCL) adult onset Ataxic gait D13 Batten Disease/neuronal ceroid Atelectasis F5 lipofuscinosis (NCL) infantile or juvenile A7 Atherosclerosis C5 onset Athlete's Foot J3 Beckwith -Wiedemann Sy ndrome K5 Atonic Bladder G3 Bedsore K4 Atonic Colon B5 Behavior Disorder K2 Atrial Fib/Fibrillation C3 Behcet's Disease/Syndrome C5 Atrial Flutter C3 Bell's Palsy D13 C8 Below the Knee Amputation (BKA) D1 Atrophic Urethritis G3 Benign Neoplasm Ø Atrophic Vaginitis G4 Benign Nephrosclerosis G1 Attention Deficit Disorder (ADD) K2 Benign Positional I4 Attention Deficit/Hyperactivity Disorder Benign Prostatic Hypertrophy/ K2 G4 (ADHD) Hyperplasia (BPH) Auditory Hallucinations Ø Benign Proxysmal Positional Vertigo I4 Autism A2 Benign / D13 Disorder (ASD) A2 Benign Tumor Ø

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Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Beta -propeller Protein -Associated Brachial Plexopathy/Brachial Plexus A9 D13 (BPAN) Dysfunction Biceps Tendonitis D4 Brachial Plexus Birth Palsy D13 Biliary Duct Obstruction B5 D13 Bipolar Affective Disorder H2 Bradycardia C3 H2 Bradykinesia D13 BKA = Below the Knee Amputation D1 Brain Atrophy, if onset at age 22 or a fter E6 Bladder Cancer, if in past 5 years J2 Brain Atrophy, if onset before age 22 A3 Bladder Incontinence G3 Brain Injury, if onset at age 22 or after E4 Bladder Infection G2 Brain Injury, if onset before age 22 A3 Bladder Prolapse G3 Brain Lesions, if onset at age 22 or after E6 Bladder Spasms G3 Brain Lesions, if onset before age 22 A3 Bladder Surgery Ø Brain Surgery, if onset at ag e 22 or after E4 Blastomycosis J6 Brain Surgery, if onset before age 22 A3 Bleeding Disorder C1 Brain Tumor, if cancerous or Bleeding Ulcer (Gastric, Duoden al, noncancerous AND if in past 5 years E4 B5 Intestinal) AND if onset at age 22 or after Blepharitis Ø Brain Tumor, if cancerous or Ø noncancerous AND if in past 5 years A3 Blind I1 AND If onset before age 22 Brain/Cerebral Aneurysm, if onset at age Blood Clots C1 E3 Blood Disease C1 22 or after Brain/Cerebral Aneurysm, if onset Blood Infection J6 A3 Bohring -Opitz Syndrome A7 before age 22 and Cartilage Disorder D13 Breast Cancer, if in past 5 years J2 Breast Cyst/ Lump/ Mass, if Bone and Mineral Disease D5 Ø Bone Marrow Cancer, if in past 5 years J2 noncancerous Bone M arrow Suppression C1 Breast Lumpectomy Ø Bone Spurs D13 Bronchiectasis F5 Borderline Diabetes B6 Bronchiolitis F5 Borderline Intellectual/Cognitive Bron chiolitis Obliterans F5 A10 Functioning and due to I/DD Bronchitis, Acute F2 Borderline Intellectual/Cognitive Bronchitis, Chronic F1 Functioning, if due to ADD, ADHD, Bronchopneumonia F2 Mental Illness, Behavioral Diagnoses, K6 Bronchospasm F5 Emotional Disturbances, Learning Brow -Sequard Syndrome D9 Disability Ø Borderline Intellectual/Cognitive Buerger’s Disease (Thromboangiitis K1 C5 Functioning, if due to Substance Use Obliterans) Borderline Personality H5 Bulimia or B10 Borjeson -Forssman -Lehmann Syndrome A7 Bullous Pemphigold J7 Boucher -Neuhauser Syndrome K5 Bund le Branch Block C3 Bowel Impaction B5 D13 Bowel Incontinence B5 Bunionectomy Ø Bowel Obstruct ion B5 Burn K4 Bowel Resection Ø Bursitis D4 BPH = Benign Prostatic Bypass Surgery, Coronary Ø G4 Hypertrophy/Hyperplasia Bypass Surgery, Non -coronary Ø P-00814 (12/2020) Page 4 of 26

Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE C Syndrome/ Opitz I2 A7 Syndrome Cauda Equina Syndrome D13 C. difficile/diff = Clostridium Difficile J6 Caudal Regression Syndrome D13 CA = Cancer, if in past 5 years (n ot Cecostomy B5 J2 including brain/cerebral cancers) Celiac Disease B5 CABG = Coronary Artery Bypass Graft Ø Celiac Sprue B5 Cachexia B6 Cellulitis J6 CAD = Coronary Artery Disease C2 Central Cord Syndrome D9 CADASIL, if onset at age 22 or after E3 Central Pain Syndrome D12 CADASIL, if onset before age 22 A3 Central Pontine Myelinolysis (CPM), if E6 Calcaneal Spur D13 onset at age 22 or after Calciphylaxis J3 Central Pontine Myelinolysis (CPM), if A3 Pyroph osphate Deposition onset before age 22 D2 (CPPD) Central Sensitization Syndrome D12 Calculus of Gallbladder B5 Central Apnea F5 Calculus of Kidney G3 Cephalgia, Chronic D12 Callosities Ø Cerebella r Ataxia D13 Ø Cerebellar Atrophy, if onset at age 22 or E6 Ø after Camurati -Engelmann Disease Cerebellar Atrophy, if onset before age D5 A9 (CED)/Progressive Diaphyseal Dysplasia 22 Cancer = CA, if in past 5 years (not Cerebellar Hypoplasia A9 J2 including brain/cerebral cancers) Degeneration, if onset at E6 Candida (Vaginal) G4 age 22 or after Candida/Candidiasis (skin) J3 Cerebellum Degeneration, if onset A9 Canker Sores Ø before age 22 Cannabis Abuse K1 Cerebra l Amyloid Angiopathy E6 Carbohydrate -Deficient Glycoprotein Cerebral Atrophy, if onset at age 22 or A9 E6 Syndrome after Carcinoid Syndrome J2 Cerebral Atrophy, if onset before age 22 A3 Carcinoma, if in past 5 years (not Cerebral Contusion, if onset before age J2 A3 including brain/cerebral cancers) 22 Cardiac Dysrh ythmia C3 Cerebral Contusion, if onset at age 22 or E4 Cardiofaciocutaneous Syndrome A9 after Cardiomegaly C8 Cerebral Cysts, if onset at age 22 o r after E4 Cardiomyopathy C8 Cerebral Cysts, if onset before age 22 A3 Cardiovascular Disease C2 Cerebral Degeneration, if onset at age E6 Caries B5 22 or after Cerebral Degeneration, if onset before Carnitine Deficiency B6 A3 Carotid Artery Disease C5 age 22 Carotid Endarterectomy Ø Cerebral Dysgenesis A9 Carotid Occlusion C5 Cerebral Emboli, if onset before age 22 A3 Cerebral Emboli, if onset at age 22 or Carotid Stenosis C5 E3 Carpal Tunnel Re lease Ø after Carpal Tunnel Syndrome D13 Cerebral Infarct, if onset before age 22 A3 Cerebral Infarct, if onset at age 22 or Cat Eye Syndrome A9 E3 D13 after Extraction Ø P-00814 (12/2020) Page 5 of 26

Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Cerebral Ischemia, if onset before age Charcot D4 A3 22 Charcot -Marie -Tooth Disease D13 Cerebral Ischemia, if onset at age 22 or CHARGE Syndrome A7 E3 after Charles Bonnet Syndrome Ø Cerebral or , i f Chediak - Steinbrink J7 E3 onset at age 22 or after Chest Pain C2 Cerebral or Intracerebral Hemorrhage, if A3 CHF = Congestive Heart Disease C4 onset before age 22 Chiari (Arnold -Chiari) Malformation E7 Cerebral Palsy (CP) (includes all types of Syndrome, if onset at age 22 or after CP: Spastic, Dyskinetic, Ataxia, and Chiari (Arnold -Chi ari) Malformation A7 A9 Mixed) Syndrome, if onset before age 22 Cerebral Spinal Fluid (CSF) Leak E7 Childhood Disintegrative Disorder A2 Cerebral Thrombosis, if onset before A3 Choanal Atresia F5 age 22 Cholecystectomy Ø Cerebral Thrombosis, if onset at age 22 E3 Cholecystitis B5 or after Cholelithiasis B5 Cerebral Tumor, if cancerous AND if in A3 Cholesterol, High B6 past 5 years AND if onset before age 22 Cholinesterase Deficiency Ø Cerebral Tumor, if cancerous AND if in D4 past 5 years AND if onset at age 22 or E4 D13 after Christianson Syndrome A7 Cerebral Tu mor, if not cancerous AND if A3 onset before age 22 disorder/abnormality/anomaly including Cerebral Tumor, if not cancerous AND if deletions, duplications, translocations, E4 A9 onset at age 22 or after inversions, rings, and numeric Cerebral Vascular Accident (CVA), if A3 abnormalities such as ; If not onset before age 22 listed elsewhere Cerebral Vascular Accident (CVA), if E3 Chronic Syndrome (CFS) D12 onset at age 22 or after Chronic Inf lammatory Demyelinating Cereb ral/Brain Aneurysm, if onset D13 A3 before age 22 Chronic Inflammatory Response Cerebral/Brain Aneurysm, if onset at age K5 E3 Syndrome (CIRS) 22 or after Chronic Iridiocyclitis I2 , if onset at age E3 Chronic Obstructive Asthma F6 22 or after Chronic Obstructive Pulmonary Disease Cerebrovascular Disease, if onset before F1 A3 (COPD) age 22 Chronic Pain D12 Cerumen Build -Up or Impaction Ø Chronic Paroxysmal Hemicrania D12 Cervical Disc Disease D12 Ch ronic Vertigo I4 Cervical Dysplasia Ø Circulatory Disease C5 Cervical Fusion D4 Cirrhosis B4 Cervical Myelopathy D12 Claudication C5 Cervical Polyp Ø H1 Cervical Radiculopathy D12 Cleft Foot D13 Cervical Spondylosis D12 Cleft Palate/Lip B5 Cervical Stenosis D12 Clostridium/Clostridium Difficile J6 Cervicalgia D12 Club Foot/Feet D13 CFS = Chronic Fatigue Syndrome D12 CMV = Cytomegalovirus J6 P-00814 (12/2020) Page 6 of 26

Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Coagulation Defects C1 Compliance Issues Ø Coccidiodomycosis/S an Joaquin Valley Compre ssed Vertebra D4 J6 K2 (CS) A7 Confusion Ø Coffin Siris Syndrome A9 Congenital Ptosis Ø Coffin -Lowry Syndrome A9 Congenital Absence or Deformity of D13 Code limb(s) according to Congenital Anomalies Ø Cognitive Communication Disorder condition / Congenital Centronuclear D8 cause Dystrophy/ Cognitive Delay and due to I/DD A10 Congenital Chromosome Abnormality Ø Cognitive Delay, if due to ADD, ADHD, Congenital Cytomegaloviru s (CMV) A9 Mental Illness, Behavioral Diagnoses, K6 Congenital Disorder of Glycosylation A9 Emotional Disturbances, Learning C8 Disability Congenital Myasthenic Syndromes D13 Cognitive Delay, if due to Substance Use K1 (CMS) Cognitive Disorder (Decline, Deficit, Congenital Rubella A7 Dysfunction, or Impairment) and due to A10 Congenital Toxoplasmosis Ø I/DD Congestive Heart Failure (CHF) C4 Cognitive Disorder (Decline, Deficit, Conjunctivitis J6 Dysfunction, or Impairment), if due to Connective Tissue Overlap S yndrome D6 ADD, ADHD, Mental Illness, Behavioral K6 Constipation B5 Diagnoses, Emotional Disturbances, Constricted Esophagus B5 Learning Disability D6 Cognitive Disorder (Decline, Deficit, H5 Dysfunction, or Impairment), if due to K1 COPD = Chronic Obstructive Pulmonary Substance Use F1 Disease Cognitive Disorder, Declin e, Deficit, Cor Pulmonale C8 Dysfunction or Impairment, If not E7 Corneal Edema I2 irreversible dementia Corneal Scars I2 Cohen Syndrome A7 Corneal Transplant Ø Cold K6 Cornelia de Lange Syndrome/de Lange Colitis B5 A7 Syndrome Colobomas I2 Corns Ø Colon Cancer, if in past 5 years J2 Coronary Artery Bypass Graft (CABG) Ø Colon Disease B5 Coronary Artery Disease (CAD) C2 Colon Polyps, Polyposis Ø Coronary Atherosclerosis C2 Colon Resection Ø Coronary Vascular Disease C2 Colostomy B5 Corpus Callosum Dysplasia A9 Colpolcephaly A7 Cortical Blindness I2 Coma, if onset at age 22 or after E4 Cortical Senile Cataract I2 Coma, if onset before age 22 A3 Corticobasal Degen eration, if onset at Communication Disorder Ø E6 age 22 or after D13 Corticobasal Degeneration, if onset A3 Complete Edentulism B5 before age 22 Complex Regional Pain Syndrome D12 Corticosterone Methyloxidase Type 2 Complex Regional Pain Syndrome = B7 D12 Deficiency CRPS A7 P-00814 (12/2020) Page 7 of 26

Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Costochondritis D13 de Lange Syndrome/Cornelia de Lange A7 Cough Ø Syndrome COVID -19 (Coronavirus Disease) J6 De Quervain's Tenosynovitis/Radial D4 CP = Cerebral Palsy (in cludes all types of Styloid Tenosynovitis CP: Spastic, Dyskinetic, Ataxia, and A4 Deaf I3 Mixed) Debility Ø Cracked D4 Deconditioned State Ø Cranial Meningioma, if cancerous AND if Decreased Appetite Ø in past 5 years AND if onset at age 22 or E4 Decreased Mobility Ø after Decubiti/Decubitus/Decubitus Ulcer K4 Cranial Meningioma, if cancerous AND if Deep Vein Thrombosis (DVT) C1 in past 5 years AND if onset before age A3 Defibrillator Impl ant C3 22 Deficiency, B -12 or other Vitamin B6 Cranial Meningioma, if noncancerous E4 Degenerative Arthritis D2 AND if onset at age 22 or after Degenerative Brain Disorder, if onset at Cranial Meningioma, if noncancerous E6 A3 age 22 or after AND if onset before age 22 Degenerative Brain Disorder, if onset A3 Craniofrontonasal Dysplasia A9 before age 22 Craniotomy, if onset at age 22 or after E4 Degenerative Disc Disease D12 Craniotomy, if onset before age 22 A3 Degenerative Joint Disease (DJD) D2 Ø Dehydration B3 Cretinism A7 K6 Creutzfeldt -Jakob Disease E2 H5 CRF = Chronic Renal Failure G1 Delusions Ø Cri Du Chat Syndrome A7 Demand Ischemia C2 Cricopharyngeal Incoordination B5 Dementia, Irreversible (not Alzheimer's) E2 Crigler -Najjar Syndrome A9 Dental Caries/Disease/Disorders B5 Crohn's Disease B5 Dependent Edema Ø Cryoglobulinemia C1 /Depressive Disorder H3 Cryptosporidiosis J6 Dercum Disease K5 Cubital T unnel Syndrome D13 Dermatitis J3 Curvature of the Spine D4 Dermatochalasis Ø Cushing's Disease/Syndrome B7 Dermatographism J3 CVA = Cerebral Vascular Accident, if E3 Dermatophytosis (of skin or nail) J3 onset at age 22 or after Development Disorder of Scholastic CVA = Cerebral Vascular Accident, if K6 A3 Skills, Unspecified onset before age 22 Developmental Coordination Disorder D13 Cyclic Vomiting (Syndrome) B5 Developmental Delay (and due to I/DD) A10 Cyclothymic Disorder H5 (DD) (and due A10 F5 to I/DD) Cystitis G2 Developmental Reading Disorder K6 Cystocele G3 Deviated (Nasal) Septum Ø Cytomegalovirus (CMV) (not congenital) J6 B3 Dandy Walker Syndrome/Malformation A9 Diabetes/Diabetes Mellitus B1 Danon Disease A9 Diabetic (Peripheral) Neuropathy D13 DD = Developmental Disability and due A10 Diabetic Kidney Disease G1 to I/DD Diabetic Nephropathy G1 De Barsy Syndrome A7 Diabetic Retinopathy I2 P-00814 (12/2020) Page 8 of 26

Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Dialys is G1 Drug Induc ed Tremor D13 Dialysis Access Steal Syndrome (DASS)/ Drusen I2 C5 Vascular Access Steal Syndrome (VASS) Dry Eye Syndrome/Keratoconjunctivitis I2 Diaphragmatic Hernia B5 Sicca Diaphragmatic Paralysis (Paralyzed Dry Eyes Ø F5 Diaphragm) Dry Mouth Ø Diarrhea B5 Dry Skin Ø Diastolic (Cardiac) Dysfunction C4 A9 DID = Dissociative Identity Disorder H5 Duchenne's Muscular Dystrophy D8 Dif ficulties in Speech Ø Dumping Syndrome B5 Difficulty Walking D13 Duodenal Disease B5 Diffuse Idiopathic Skeletal Hyperostosis Duodenitis B5 D13 (DISH) Dupuytren's Disease/Contractur e D13 DiGeorge Syndrome A9 DVT = Deep Vein Thrombosis C1 Digestive Disorder B5 Dwarfism D13 Diplegia (not form of Cerebral Palsy) D10 Dyke -Davidoff -Masson Syndrome E6 Diplopia Ø (DDMS), if onset at age 22 or after Disaccharide Malabsorption B6 Dyke -Davidoff -Masson Syndrome A3 Disc/Disk Disease/Displa cement D12 (DDMS), if onset before age 22 Disequilibrium Ø D13 Disinhibited Attachment Dysautonomia D13 Disorder/Disinhibited Social H5 Dyscalculia K6 Engagement Disorder Dysconjugate Gaze I2 Disorder of the Back Ø Dysesthesia D13 Disorder of the Bone Ø Dysfunctional Uterine Bleeding G4 Disorder of the Ø Dysgenesis of Corpus Callosum A9 Disorientation Ø Dyshidrosis J3 Disruptive Behavior K6 K5 Disruptive Mood Dysregula tion Disorder D13 H5 (DMDD) Dyslexia K6 Dissociated Vertical Deviation (DVD) I2 Dyslipidemia B6 Dissociative Amnesia H5 Dysmenorrhea G4 Dissociative Identity Disorder (DID) H5 Dysmetabolic Syndrome/Syndrome X B6 Disturbance of Gait D13 Dysosmia Ø Diverticular Colon Disease B5 Dyspeps ia B5 Diverticulitis, Diverticulosis B5 Dysphagia (not psychogenic) B5 Dizziness K5 Dysphonia K5 DJD = Degenerative Joint Disease D2 Dyspnea F5 DMDD = Disruptive Mood Dysregulation H5 Dyspraxia E7 Disorder Dysreflexia D13 DNR = Do Not Resuscitate Ø Dyssomnia K5 Down Syndrome/Trisomy 21 H3 Dravet Syndrome Dysthymic Disorder H3 Droopy Eyelids Ø D13 Drop Attack K5 Dystrophic Toenails Ø Drop Foot D13 Dysuria G3 Drug Dependency K1 E. Coli J6 Drug Induced D13 P-00814 (12/2020) Page 9 of 26

Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Ear Infections J6 Endocarditis C8 B10 Endometrial Adenocarcinoma, if in past J2 Echolali a Ø 5 years Ectodermal Dysplasia J3 Endometriosis G4 Eczema/Eczematoid Dermatitis J3 Endosalpingiosis G4 Edema Ø Enlarged bladder G3 Edentulous B5 Enlarged heart C8 /Trisomy 18 A7 Enlarged prostate G4 Ehlers -Danlos Syndrome D6 Enlarged Spleen C5 Eisenmenger's Complex Secondary To Enteritis B5 C8 Septal Defect Enteroenteral and Enterocutaneous B5 Electrolyte Imbalance B3 Fistulas Elephantitis C5 Enteropathy B5 Elevated Alkal ine Ø Enthesitis/Enthesopathy D4 Elevated Diaphragm F5 Enuresis G3 Elevated Fasting Glucose Ø Eosinophilia C1 Elevated LFTs (Liver Function Tests/ Epicondylitis, Lateral/Tennis D4 Ø Liver ) Epidermolysis Bullosa J3 Elevated PSA Ø Epididymitis G4 Elevated Transaminases Ø Epigastric pain Ø Emanuel Syndrome A7 , if onset at age 22 or after E5 Embolectomy Ø Epilepsy, if onset before age 22 A6 Embolism, Cerebral, if onset at age 22 or Epiretinal Membrane I2 E3 after Epistaxis Ø Embolism, Cerebral, if onset before age Epithelial Basement Membrane Corneal A3 I2 22 Dystrophy Embolism, not Cerebral or Pulmonary C1 Erb's Palsy D13 Embolism, Pulmonary F5 Ø Emesis/Vomiting Ø Erythema Nodosum J3 Emphysema F1 Erythrocytosis C1 Empty Sella Syndrome B7 C5 Empyema F5 Esophageal Erosion, Fistula, Stricture, or B5 , if onset at age 22 or after E4 Ulcer Encephalitis, if onset before age 22 A3 Esophageal Obstruction B5 Encephalomalacia E7 Esophageal Reflux Disease B5 Encephalomyelitis, Acute Disseminated, Esophageal Spasms B5 E4 if onset at age 22 or after Esophage al Varices B5 Encephalomyelitis, Acute Disseminated, Esophagitis B5 A3 if onset before age 22 Esotropia/Exotropia Ø Encephalopathy, Alcohol (irreversible) E2 ESRD = End Stage Renal Disease G1 Encephalopathy, Not due to Alcohol, if ESRF = End Stage Renal Failure G1 E4 onset at age 22 or after Essential Tremor D13 Encephalopathy, Not due to Alcohol, if ETOH (alcohol) Abuse/Addiction/ A3 K1 onset before age 22 Dependence Encopresis Ø Eustachian Tube Dysfunction Ø End Stage Renal Disease (EDRD) G1 Excessive Daytime Sleepiness K5 End Stage Renal Failure (ESRF) G1 Excoriated Skin Ø Endarterectomy Ø P-00814 (12/2020) Page 10 of 26

Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE H1 Foot Fungus J3 Exogenous Obesity B8 Foot Pain D12 Exotropia/Esotropia Ø Foot Ulcer K4 Explosive K2 Forgetfulness Ø Extended Spectrum Beta -Lactamase Fracture or J oint Replacement (not ) D4 J6 (ESBL) Fragile X Syndrome A7 Extrapyramidal Symptoms D13 Freeman -Sheldon Syndrome A9 Fabry's Disease K5 Friedrich's Ataxia with Dementia D13 and E2 Facet Hypertrophy D4 Friedrich's Ataxia without Dementia D13 Facet Syndrome D4 Frontal Lobe Syndrome (not psychiatric E7 Factor Five Deficiency C1 cause) Factor V Leiden C1 E2 Fahr's Syndrome/Idiopathic Basal Frost Bi te K5 D13 Ganglion Calcification Frozen D4 Failed Back Syndrome/Post - Fuchs Endothelial Dystrophy I2 D12 Laminectomy Syndrome Functional Movement Disorder H5 (Adult or Geriatric) K5 Functional H5 Falls/Fall Risk Ø Gait Abnormality/Disorder/Instability D13 Familial Tremor D13 Gait Disturbances/Dysfunction/ D13 FAS = Fe tal Alcohol Syndrome A9 Impairment Fatigue/Malaise Ø Galactosemia A9 Fatty Liver B4 Gall Bladder Remov al Ø Fecal Incontinence B5 Gallstones B5 Female Incontinence Ø Gambling Addiction K6 Femoral Embolectomy Ø Ganglion Cyst D4 Femoral Popliteal Bypass Graft Ø Gangrene J6 Fetal Alcohol Spectrum Disorders A9 Gardnerella Vaginalis G4 Fetal Alcohol Syndrome (FAS) A9 Gastrectomy B5 Fetal Central N ervous System Gastric Antral Vascular Ectasia (GAVE) B5 Ø Malformation Gastric Banding or Bypass K6 Fetal Valproate Syndrome A9 Gastric Bleed B5 Fetishistic Disorder K2 Gastric Erosion B5 FG Syndrome/Opitz -Kaveggia A7 Gastric Outlet (Obstruction) Syndrome B5 Fibrocystic Breast Disease K5 Gastric Reflux B5 Fibrodysplasia Ossificans Progressiva Gastric Ulcer B5 D13 (FOB) Gastritis B5 /Fibromyalgia Syndrome D12 Gastroduodenitis B5 Fibrous Dysplasia D5 Gastroenteritis B5 Fitz -Hugh -Curtis Syndrome B5 Gastroesophageal Reflux (GER) B5 Flank Pain Ø Gastroesophageal Reflux Disease (GERD) B5 Ø Gastroesophagitis B5 Floating Harbor Syndrome A9 Gastrointestinal Bleed or Hemorrhage B5 Fluid Overload B3 Gastrointe stinal Distress B5 Fluid Retention Ø Gastrointestinal Fistula B5 Folliculitis J3 Gastroparesis B5 Foot Deformity D13 Gastrostomy B5 D13

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Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE GDD = Global Developmental D13 A10 Delay/Disability Hand Paresthesias D13 Genital Herpes G4 Hand Tremor D13 or D4 Hanhart Syndrome K5 GER = Gastroesophageal Reflux B5 Hard Of (HOH) I4 GERD = Gastroesophageal Reflux HDL (High Density Lipoprotein) B5 Ø Disease Deficiency Gestational Diabetes B1 Head Injury/Trauma, if documented GI Bleed = Gastrointestinal Bleed B5 brain injury and if onset at age 22 or E4 GI Reflux = Gastrointestinal Reflux B5 after C5 Head Injury/Trauma, if documented A3 Giantism B7 brain injury and if onset before age 22 Gingivitis B5 , Chronic D12 Glaucoma I2 Hearing Impairment/Deficit/Loss, Partial I4 Glioblastoma, if in past 5 years AND If , Total I3 E4 onset at age 22 or after Heart Attack C2 Glioblastoma, if in past 5 years AND If Heart Block C3 A3 onset before age 22 Heart Failure C4 Global Developmental Delay/Disability Heart Murmur C8 A10 (GDD) Heart Transplant C8 Glomerulonephritis G1 Heart Valve Replacement Ø Glossectomy B5 Heel Spurs D13 Glossitis B5 Helicobacter Pylor i B5 Glucose Intolerance B6 Hemangioma C5 Glucose Transporter Type 1 Deficiency D4 A9 Syndrome Hematemesis B5 GLUT 1 Deficiency A9 Hematochezia B5 Gluta ric Acidemia A9 Hematuria G3 Goiter B7 Hemianopia I2 /Oculo -Auricular - Hemihyperplasia/Hemihypertrophy K5 A9 Vertebral (OAV) Hemiparesis (not form of Cerebral Palsy) D13 Gonadal Dysgenesis G4 Hemiplegia (not form of Cerebral Palsy) D10 /Gouty Arthritis D2 Hemochromatosis C1 Graft Versus Host Disease (GVHD) J7 Hemodialy sis Ø Grave's Disease B2 Hemophilia C1 Graves Ophthalmopathy I2 Hemoptysis F5 Grief Reaction H5 Hemorrhage (Subarachnoid), if onset at E3 Growth Hormone Deficie ncy B7 age 22 or after Guillian -Barre Syndrome D10 Hemorrhage (Subarachnoid), if onset A3 Gum Disease B5 before age 22 Gynecomastia Ø Hemorrhagic Gastritis B5 H. Pylori B5 Hemorrhoidectomy Ø Habit and Impulse Disorder K2 Hemorrhoids B5 Hair Loss Ø Hepatic Cysts B4 Hallermann -Streiff Syndrome A9 , if onset at age E4 Hallucinations Ø 22 or after Hallux Valgus D13 Hepatic Encephalopathy, if onset before A3 Hammer D13 age 22 P-00814 (12/2020) Page 12 of 26

Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Hepatic Failure B4 Hurler -Scheie Syndrome/Scheie Hepatitis B4 Syndrome/Attenuated A9 Hepatitis B Carrier Ø Mucopolysaccaridosis Type 1 Hepatitis C Carrier Ø Hydranencephaly/Hydrancephaly A9 Hepatomegaly B4 Hydrocele G4 Hereditary Spastic Paraplegia Hydroce phalus, if onset at age 22 or D13 E6 (HSP)/Familial Spastic Paraplegia (FSP) after Her mansky -Pudlak Syndrome K5 , if onset before age 22 A3 Hernia B5 Hydronephrosis G1 Hernia Repair Ø Hyperactivity K6 Hernia, Inguinal B5 Hypercalcemia B3 Herniated Disc D12 F5 Herpes Simplex J6 Hypercholesterolemia B6 Herpes Zoster/Shingles J6 Hyperglycemia B6 Heterotopic Ossification D13 Hyperhidrosis J3 Hiatal Hernia B5 B3 Hidradenitis J3 Hyperkeratosis J3 Hidradenitis Suppurativa J3 Hyper kinetic Syndrome K2 High Cholesterol B6 Hyperlipidemia B6 High B3 Hypermetropia Ø Hind Foot Instability Ø Hypernatremia B3 D4 Hyperopia I2 D4 Hyperornithinemia -Hyperammonemia - A9 Hip Fracture D3 Homocitrullinuria (HHH) Syndrome Hip Pain D12 Hyperparathyroid(ism) B7 Hip Pinning Ø Hyperpotassemia B3 D3 Hyperreflexia D13 Hirschsprung's Disease B5 Hypersalivation Ø Hirsutism Ø / Hypersomnolence K5 Histoplasmosis J6 Hypersplenism C5 HIV (Human Immunodeficiency Virus) Hypertension (HTN) C6 J4 Positive Hypertensive Heart Disease C8 Hoarding Disorder H1 Hyperthyroidism B2 Hodgkins Disease, if in past 5 years J2 /Hypertonic Muscles D13 HOH = Hard of Hearing I4 Hypertriglyceridemia B6 Holoprosencephaly A9 Hypertrophic Nail Ø Holt -Oram Syndrome K5 Hypertropia I2 Homonymous Hemianopsia I2 Hyperuricemia B6 Horner's Syndrome Ø Hyperventilation Ø HTN = Hypertension C6 Hypoalbum inemia C1 Human Papilloma Virus J6 Hypocalcemia B3 Human T -Lymphotropic V irus 1 infection Hypocholesterolemia B6 J6 (HTLV-1) Hypoestrogenemia B7 Huntington's Disease/Chorea E2 Hypoglycemia B6 Hurler Syndrome/Severe Hypogonadism G4 A7 Mucopolysaccaridosis Type 1 Hypokalemia B3 Hypomagnesemia B3

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Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Hyponatremia B3 Intellectual Impairment and due to I/DD A10 Hypo -osmolality Ø Intellec tual Impairment, if due to ADD, Hypoparathyroidism B7 ADHD, Mental Illness, Behavioral K6 Hypopotassemia B3 Diagnoses, Emotional Disturbances, Hypotension C7 Learning Disability Intellectual Impairment, if due to Hypothyroidism B2 K1 D13 Substance Use Hypoventilation F5 Intermittent Explosive Disorder K2 Hypovitaminosis D B6 Interstitial Lung Disease F5 Hypoxemia F5 Intertrigo J3 Intracranial Bleeding, if onset at age 22 Hypoxia F5 E3 Hysterectomy Ø or after Intracranial Bleeding, if onset before age ICD = Impulse Control Disorder K2 A3 Icthyosis J3 22 IDDM = Dependent Diabetes Intracranial Hypertension/Pseudotumor B1 E7 Mellitus Cerebri Idiopathic Thrombocytopenic Purpura C1 Intracranial Hypotension E7 Intramedullary Ileostomy B5 D13 Ileus B5 Hemorrhage/Hematomyelia Iliotibial Band Syndrome D13 Inverted Uterus G4 Imbalance (musculoskeletal) D13 Iridoc clitis I2 Immunodeficiency Diseases J7 Iritis I2 Impacted Cerumen Ø Iron Deficiency C1 Impaired Gait D13 Iron Deficiency Anemia C1 Impaired Glucose Tolerance B6 Irregular Menses Ø Impaired Mobility D13 Irreversible Dementia (not Alzheimer's) E2 Irreversible Multi -Infarct Disease Impaired Thermoregulation D13 E2 Impetigo J6 Dementia Impotence Ø Irritable Bowel Syndrome B5 Impulse C ontrol Disorder (ICD) K2 Ischemic Heart Disease C2 Impulsive Behavior K2 Itchy Skin Ø Incisional Hernia B5 Jaco bsen Syndrome/11q Deletion A9 Incontinence (bladder, urinary and urge, Joint Hypermobility Syndrome D4 G3 NOT stress) Joint Pain D12 Joseph's Disease/Machado -Joseph Incontinence (bowel, fecal) B5 D13 Incontinence (stress) Ø Disease Infected (wound or ulcer) K4 A9 Infected Pacemaker Site J6 Kabuki Syndrome A9 Infection in Bloodstream J6 Kashin Beck Disease D4 Inflamed Seborrheic Keratosis J3 Kearns -Sayre Syndrome K5 Influenza K6 Keloid/Keloid Scar Ø Ingrown Toenail(s) Ø Kennedy's Syndrom e D13 Keratitis -Ichthyosis - (KID) Inguinal Hernia B5 A9 K5 Syndrome Insulin -Dependent Diabetes Mellitus Keratoconosis I2 B1 (IDDM) Keratoderma J3 Intellectual Disability/Disorder Ketoacidosis B6 Kidney Disease G1 P-00814 (12/2020) Page 14 of 26

Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Kidney Stone(s) G1 or Kidney Transplant G3 Leukoencephalopathies, if onset before A3 Kleefstra Syndrome A7 age 22 Kleinfelter's Syndrome A9 Leukomalacia, if onset at age 22 or after E6 Klein -Levin Syndrome K5 Leukomalacia, if onset before age 22 A3 Klippel - Feil Syndrome D4 Leukopenia C1 Klippel -Trenaunay Syndrome/Klippel - Lewy Body Dementia E2 K5 Trenaunay-Weber Syndrome Lichen Scler osis J3 Knee deformity D4 Lichen Simplex J3 Knee Fusion D4 Lipedema K5 Knee Instability D4 Lipodystrophy B6 Knee Pain D12 Lipoma Ø Knee Replacement D4 Lissencephaly A9 Korsakoff's Disease Syndrome E2 Lithium Toxicity D13 A9 Liver Disease/Failure/Necrosis B4 Kufor -Rakeb Syndrome E2 Liver Transplant B5 Kufs D isease E2 Locked -in Syndrome D10 Kyphoscoliosis D4 Loeys -Dietz Syndrome D6 D4 Long QT Syndrome C3 L1 Syndrome A7 Lou Gehrig's Disease D7 I4 Low Back Pain D12 Lack Of Coordination D13 Low Blood Pressure C7 Lactose Intolerant B6 Low Bone Density/Mass D5 Lambert -Eaton Myasthenic Syndrome J7 Lumbago D12 Laminectomy Ø Lumbar Disc Degeneration D12 Lance Adams Syndrome (LAS) D13 Lumbar Laminectomy Ø Landau Kleffners Syndrome E7 Lumbar Radiculopathy D12 Langerhans C ell Histiocytosis (Not Lumbar Spondylosis D12 A9 Pulmonary), if onset before age 22 Lumbar Stenosis D12 Langerhans Cell Histiocytosis (Not Lumbosacral Spondylosis D12 K5 Pulmonary), If onset at age 22 or after Lump In Breast Ø Laurence -Moon -Bardet -Biedl Syndrome A9 Lung Abscess F5 Learning Disability K6 Lung Disease F5 Lebers Congenital Amaurosis I2 Lung Nodule F5 Leg /Spasms /Pain D12 Lung Transplant F5 Leg Length Discrepancy D13 J7 Legal Blindness I1 Lupus Anticoagulant Syndrome C1 Legg -Calve -Perthes Syndrome D5 LV (Left Ventricular) Diastolic C4 Leigh Disease A9 Dysfunction Lennox -Gastaut Syndrome A6 Lyme Disease J6 Lens Implant/Replacement Ø Lymphadenopathy/Adenopathy C5 Lesch -Nyhans A9 Lymphatic Malformation C5 Leukemia, if in past 5 years J2 Lymphedema C5 Leukocytosis C1 Lymph itis C5 Leukodystrophy or Lymphoma, if in past 5 years J2 Leukoencephalopathies, if onset at age E4 Lymphoproliferative Disorder C1 22 or after A9

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Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Macrocytosis C1 Memory Macrodactylia D13 Deficit/Difficulties/Dysfunction/loss/Imp Macroglossia B5 airment, if not due to ADD, ADHD, K5 Macromastia Ø Mental Illness, Behavioral Diagnoses, Macular Degeneration (wet or dry) I2 Emotional Disturbances, Learning Macular Dystrophy I2 Disability, Substance Use Macular Edema I2 Meniere's Disease I4 Macular Hole I2 Meningeal Sarcoidosis J7 Meningioma, if cancerous A ND if in past Madelung's Disease B6 A3 Malabsorption Syndrome B6 5 years AND if onset before age 22 Meningioma, if cancerous AND if in past Malaise Ø E4 Malaise/Fatigue Ø 5 years AND onset at age 22 or after Meningioma, if noncancerous AND if Malignant Ø E4 Malignant Neoplasm, if in past 5 years onset at age 22 or after J2 Meningioma, if noncancerous AND if (not including brain/cerebral cancers) A3 Malnutrition B9 onset before age 22 Mandibular Hypoplasia -Deafness - Meningitis, if onset at age 22 or after E4 K5 Progeroid (MDP) Syndrome Meningitis, if onset before age 22 A3 , if onset at age 22 Manic -Depressive H2 E4 Mannosidosis A9 or after Meningoencephalitis, if onset before Maple Syrup Disease A9 A3 Marfanoid Intellectual Disability age 22 A7 Syndrome Meningomyelocele D11 Marfan's Syndrome D6 of Knee D4 Marshall Smith Syndrome A7 Menopausal Syndrome Ø MASA A7 Menorrhagia G4 Mast Cell Activation Syndrome (MCAS) J7 Mental Confusion Ø Mental Retardation (outdated Mastectomy Ø A1 Mastodynia Ø terminology) Mastoiditi s J6 Mental Status Changes Ø McCune -Albright Syndrome K5 Meralgia Paresthetica D13 Mediastinal Fibrosis/Fibrosing Metabolic Syndrome B6 F5 Mediastinitis Metastasis, if in past 5 years J2 Medication Induced Movement Disorder D13 Metatarsalgia D12 Methicillin -resistant Staphylococcus Megacolon B5 J6 Melanoma, if in past 5 years J2 aureus (MRSA) MELAS (Mitochondrial Encephalopathy, MI = Myocardial Infarction C2 A3 or E4 Lactic Acidosis and -like episodes) Microalbuminuria G1 Memory Microcephalus/ A9 Deficit/Difficulties/Dysfunction/loss/Imp Microcytosis C1 airment, if due to ADD, ADHD, Mental K6 Micrognathia D13 Illness, Behavioral Diagnoses, Emotional MIDAS/ MLS Syndrome A9 Disturbances, Learning Disability Migraines D12 Mild Cognitive Impairment/Disorder and Memory A10 Deficit/Difficulties/Dysfunction/loss/Imp K1 due to I/DD airment, if due to Substance Use

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Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Mild Cognitive Impairment/Di sorder, if Murmur C8 due to ADD, ADHD, Mental Illness, /Wasting D13 K6 Behavioral Diagnoses, Emotional Muscle Spasms D13 Disturbances, Learning Disability Muscular Dystrophy D8 Mild Cognitive Impairment/Disorder, if K1 Mute/Mutism (not ) K5 due to Substance Use MVA = Motor Vehicle Accident Ø Mild Cognitive Impairment/Disorder, if E7 MVP = Mitral Valve Prol apse C8 not irreversible dementia D12 Mild Sl eep Disorder K5 J7 Milk Intolerance B6 Mycobacterium Avium Complex Miller Syndrome K5 (MAC)/Mycobacterium Avium- J6 Milroy's Disease C5 Intracellulare (MAI) / A9 Mycotic Nail(s) J3 Mitral Insufficiency C8 Myelin Oligodendrocyte Glycoprotein E7 Mitral Regurgitation C8 (MOG) Antibody Disease (MOG-AD) Mitral Valve Disease/Prolapse/Stenosis C8 Myelitis D13 Mixed Connective Tissue Disease D6 Myelodysplasia C1 Mixed Dement ia E2 Myelody splastic Syndrome C1 Moebius Syndrome A9 Myelomeningocele D11 Monoclonal Gammopathy C1 Myelopathy D13 Monoclonal Paraproteinemia Ø Myocardial infarction (MI) C2 Mononeuritis D13 Myocarditis C8 Monoplegia (not form of cerebral palsy) D10 (Epileptic), if onset at age 22 E5 H5 or after Morgellon Disease/Syndrome J6 Myoclonus (Epileptic), if onset before A6 Morton's Neuroma D13 age 22 Motor Vehicle Accident (MVA) Ø Myofascial Pain D12 Mouth Disease Ø Myonecrosis D13 Movement Disorder (not psychogenic) D13 Myoneu ral Disorder D13 C5 Myopathy D13 MRSA = Methicillin -resistant Myopia I2 J6 Staphylococcus aureus D13 MRSA Carrier Ø Congenita D13 MS = D7 D8 MTHFR Gene B6 E7 Multi -Infarct Dementia E2 Narcolepsy Cataplexy E7 Multiple Body Dysfunction Ø Narcotic Dependence K1 Mult iple Chemical Sensitivities/Chemical Narcotic Use Ø K5 Nasal Polyps Ø Multiple Congenital Abnormalities K5 Nasal Septal Perforation Ø Multiple Epiphyseal Dysplasia (MED) D13 Nausea Ø Multiple Myeloma J2 Neck Pain D12 Multiple Sclerosis (MS) D7 Necrotizing Fasciitis J3 /Multisystem Necrotizing Scleritis I2 Degeneration of the Autonomic Nervous E7 Nelson's Syndrome B7 System/Shy-Drager Syndrome Neoplasm, Benign Ø Munchausen Syndrome/Factitious H5 Disorder P-00814 (12/2020) Page 17 of 26

Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Neoplasm, if cancerous and if in past 5 Neuroleptic Malignant Syndrome (NMS) Ø years (not including brain/cerebral J2 Neurologic Neglect Syndrom e E7 cancers) Neuromyelitis Opticia/Devic's Syndrome J7 Nephrectomy Ø Neuropathic Pain D12 Nephritis G1 Neuropathy, optic I2 Nephrogenic Systemic Fibrosis K5 Neuropathy, peripheral D13 Nephrolithi asis G1 Neuropraxia D13 Nephropathy G1 Neurosyphillis, general paresis type E2 Nephrosclerosis G1 Neurosyphillis, not general paresis type E6 Nephrotic Syndrome G1 Neutropenia C1 Nerve Pain D12 Nicotine/Tobacco Dependence/Use K6 Nerve Palsy D13 NIDDM = Non -Insulin -Dependent B1 Neuralgia D12 Diabetes Mellitus Neuritis (not optic) D13 Niemann -Pick Disease A9 Neuroblastoma, if in past 5 years J2 Nijmegen Breakage Syndrome A7 Neurocardiogenic Syncope C8 Ø Neurocognitive Disorder, Major or Mild, NOD2 -Associated Autoinflammatory E1 K5 if due to Alzheimer’s disease (NAID) Neurocognitive Disorder, Major or Mild, Nodular Corneal if due to an irreversible dementia other E2 Degeneration/Salzmann's Nodular I2 than Alzheimer’s Degeneration Neurocognitive Disorder, Major or Mild, Non Healing Wound K4 if due to any of the following: ADD, Non -Circadian Rhythm K5 ADHD, Behavioral Diagnoses, Emotional K6 Non -Insulin -Dependent Diabetes B1 Disturbances, Learning Disability, Mental Mellitus (NIDDM) Illness Non -Verbal learning disorder/disability K6 Code Noonan's Syndrome D13 Neurocognitive Disorder, Major or Mild, accordng to Normal Pressure Hydrocephalus with E2 if due to medical condition medical Dementia condition Normal Pressure Hydrocephalus, if onset E6 Neurocognitive Disorder, Major or Mild, at age 22 or after if due to Substance/Medication and Normal Pressure Hydrocephalus, if onset E2 A3 Irreversible (includes Alcohol before age 22 Encephalopathy/Dementia) Norrie Disease A9 Neurocognitive Disorder, Major or Mild, Nose Bleeds Ø if due to Substance/Medication and K1 Nuclear Sclerosis I2 Reversible Numbness Ø Neurocognitive Disorder, Major or Mild, Code as TBI Numbness in Feet Ø if due to Traumatic Brain Injury Nutritional Deficiencies B6 Neurocognitive Disorder, Major or Mild, E7 Nutritional Imbalances B6 if not irreversible dementia Obesity B8 Neurocognitive Disorder, Unspecified Ø Obesity, Morbid B8 Neurodermatitis J3 OBS = , if onset Neurodevelopmental Disorder (if not E6 A10 at age 22 or after specified) OBS = Organic Brain Syndrome, if onset A3 Neurofibromatosis D13 before age 22 Neurogenic Bladder G3 Obsessive -Compulsive Disorder (OCD) H1 Neurogenic Bowel B5 Obstructive Lung Disease F5 P-00814 (12/2020) Page 18 of 26

Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Obstructive F5 Osteitis D5 Obstructive uropathy G3 /Osteoarthrosis D2 Ocular Cicatri cial Pemphigoid (OCP) J7 Osteoarthropathy D4 Ocular Hypertension I2 Osteochondroma D13 Oculocerebrorenal Syndrome/Lowe Osteogenesis Imperfecta D5 A9 Syndrome Osteolysis D5 Ogilvie's Syndrome/Acute Colonic D5 B5 Pseudo-Obstruction Osteomyelitis D5 Oligomenorrhea Ø Osteonecrosis D5 Olivopontocerebellar atrophy, if onset at Osteopenia D5 E6 age 22 or after Osteoporosis D5 Olivopontocerebellar atro phy, if onset A9 Otalgia Ø before age 22 Other Infections J6 Onychauxis Ø Otitis J6 Onychia Ø Otopalatodigital Syndrome Type 2 A9 Onychocryptosis Ø Ovarian Cyst G4 Onychodystrophy Ø Overactive Bladder G3 Onychogryposis Ø Overweight Ø Onychomycosis/Onychomycoses/Onych J3 Oxygen Dependent Ø omychosis Pacemaker C3 Ø Ophthalmoplegia I2 PAD = Periph eral Artery/Arterial Disease C5 Opitz -Frias Syndrome A9 Paget's Disease D5 Opitz -Kaveggia/FG Syndrome A7 Pallister -Hall Syndrome K5 Oppositional Defian t Disorder K2 Pallister -Killian Syndrome A9 Opsoclonus -Myoclonus Syndrome E7 Palpitations C3 (OMS) Palsy, Bell's D13 Optic Atrophy I2 Palsy, Cerebral (includes all types of CP: A4 Optic Nerve Hypoplasia I2 Spastic, Dyskinetic, Ataxia, and Mixed) I2 Palsy, Progressive Supranuclear with D13 and E2 I2 Dementia Oral Facial Dyskinesia D13 Palsy, Progressive Supranuclear without D13 Oral Thrush B5 Dementia Oral Ulcers B5 Transplant B5 Orchitis G4 Pancreatic Cyst B5 Organic Brain Syndrome (OBS), if onset E6 Pancreatitis B5 at age 22 or after Pancytopenia C1 Organic Brain Syndrome (OBS), if onset A3 PANDAS J7 before age 22 Panhypopituitarism B7 Organic Insomnia K5 H1 Organic , if onset at age Pannus (such as rheumatoid or c orneal, E6 K5 22 or after not panniculus) Organic Mental Disorder, if onset before A3 Panuveitis I2 age 22 Papilledema I2 Organic Mood Disorder H5 Paralysis Agitans with Dementia E2 Ornithine Transcarbamyla se Deficiency A9 Paralysis Agitans without Dementia D13 Orthostatic Hypotension C7 Paraneoplastic Syndrome K5 Osler -Weber -Rendu Disease/Hereditary C5 Paranoia H5 Hemorrhage Telangiectasis P-00814 (12/2020) Page 19 of 26

Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE , any type K2 Phelan -McDermid/22q13 deletion A7 Paraplegia due to Injury D9 syndrome Paraplegia not due to Spinal Cord Injury D10 Phenylketonuria (PKU) B6 Parathyroid Adenoma B7 Pheochromocytoma B7 Parathyroidectomy Ø Phimosis Ø Paresis D13 Phlebitis C5 Paresthesia D13 H1 Parkinsonism D13 D13 Parkinson's with Dementia D13 and E2 Phonological Disorder K5 Parkinson's without Dementia D13 Pica B9 Paronychia J3 Pick's Disease E2 Patellofemoral Pain Syndrome D12 Pickwickian Syndrome F5 Patent For amen Ovale C8 Pierre Robin Syndrome/Sequence K5 Pathological Bone Fracture D4 Pilonidal Cyst J3 PDD -NOS = Pervasive Developmental Piriformis Syndrome D12 Delay/Disability - Not Otherwise A2 Pitts Syndrome A7 Specified Pituitary Adenoma B7 Pearson Syndrome K5 Pituitary Tumor, if cancerous and if in J2 D13 past 5 years Pedophilia K2 Pituitary Tumor, if noncancerous B7 Pelizaeus -Merzbacher Disease A9 PKU = Phenylketonuria B6 Pelvic Relaxation Ø Plantar Fasciitis D13 Pemphigus Foliace us or Pemphigus Pleural Effusion F5 J7 Vulgaris Pneumonia F2 Peptic Ulcer Disease (PUD) B5 Pneumonitis F2 Pericardial Cyst C8 Pneumothorax F5 Pericardial Effusion C8 Polio D10 Pericarditis C8 Poliomyelitis Osteopathy D5 Periodontal Abscess B5 Polyarteritis Nodosa (PAN) C5 Periodontal Disease B5 Polycystic Ovarian Syndrome G4 Peripheral Artery/Arterial Disease (PAD) C5 Polycythemia C1 Peripheral Neuropathy D13 Polydipsia (not psychogenic) K2 Peripheral V ascular Disease (PVD) C5 Polymicrogyria A9 Peripheral Visual Field Defect I2 Polymyalgia Rheumatica D2 Persistent Vegetative State, if onset at Polymyositis D13 E4 age 22 or after Polyneuropathy D13 Persistent Vegetative State, if onset Polyuria K6 A3 before age 22 Poor Appetite Ø Personality Disorder H5 Poor Balance D13 Pervasive Developmental Poor Coordination D13 Delay/Disability - Not Otherwise A2 Poor Dentition B5 Specified = PDD-NOS Poor Gait D13 Pes Planovalgus Ø Post Cholecyst ectomy Syndrome B5 Pes Planus Ø Post Traumatic Stress Disorder (PTSD) H1 Pessary Ø Post -Concussion Syndrome, if onset at E6 Peters Anomaly I2 age 22 or after Phantom Leg Pain D12

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Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Post -Concussion Syndrome, if onset Pseudodementia H5 A3 before age 22 Pseudogout D2 Posterior Capsule Opacification I2 Pseudophakia/Pseudophakos Ø Posterior Fossa Syndrome K5 Pseudoseizures H5 Postherpetic Neur algia D12 Pseudoxanthoma Elasticum (PXE) A9 Postmenopausal Ø Psoriasis J3 Postmenopausal Bleeding G4 D2 Post -Polio Syndrome D10 Psychogenic Dysphagia H5 Postural Orthostatic Psychogenic Movement Disorder H5 C3 Syndrome (POTS) Psyc hogenic Polydipsia/Water Drinking H5 Potocki -Lupski Syndrome A7 Psychogenic H5 Prader -Willi Syndrome Psychogenic Syncope H5 Pre -Diabetes/Pre -Diabetic B6 (NOS) H5 Premature Birth Ø Psychotic Disorder H5 Prerenal Azotemia G1 Pterygium I2 I4 Ptosis Ø Presbyesophagus B5 PTSD = Post Traumatic Stress Disorder H1 Presbyopia I2 PUD = Peptic Ulcer Disease B5 Pressure Ulcer K4 Pulmonary Alveolar Proteinosi s F5 Presyncope C8 Pulmonary Atresia C8 Primary Biliary Cholangitis/Cirrhosis B5 Pulmonary Edema F5 Primary Lateral Sclerosis D13 Pulmonary Embolism F5 Progressive Bulbular Palsy D13 Pulmonary Fibrosis F5 Progressive Multifocal Pulmonary HTN = Hypertension F5 leukoencephaolpathy (PML), if onset at E4 Pulmonary Insufficiency F5 age 22 or after Pulmonary Langerhans Cell Histiocytosis F5 Progressive Multifocal Pulmonary Nodules F5 leukoencephaolpathy (PML), if onset A3 Punctate Keratitis I2 before age 22 Pura Syndrom e A7 Progressive Supranuclear Palsy with D13 and E2 PVD = Peripheral Vascular Disease C5 Dementia Pyelonephritis G1 Progressive Supranuclear Palsy without D13 Pyoderma Gangrenosum J3 Dementia Pyruvate Carboxylase Deficiency/PC A9 Prolapsed Bladder G3 Deficiency Prolapsed Uterus G4 Quadriparesis (not a type of Cerebral D13 Pron ation of Feet Ø Palsy) Prostatic Hypertrophy G4 Quadriplegia due to Spinal Cord Injury D9 Prostatitis G4 Quadriplegia not due to S pinal Cord D10 Protein C Deficiency C1 Injury Proteinuria G1 RA = D2 A9 Radiculitis D12 Protruding Vertebral Disc D12 Radiculopathy D12 /Acetabular D4 Ram's Horn Nail Ø Protrusion Rash Ø Prune Belly Syndrome G3 Rathke's Cleft Cyst B7 Pruritus (itching) Ø Raynaud's Disease/ C5 Pseudobulba r Affect K5 Syndrome/Phenomenon D13 P-00814 (12/2020) Page 21 of 26

Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Reactive Airway Disease F5 Rotator Cuff Tendonitis/Syndrome D4 Reactive Attachment Disorder H5 Rubinstein Taybi Syndrome A7 Recreationa l Drug Use Ø Rumination Disorder B10 Rectal Prolapse B5 Ruptured Disc D12 Rectocele B5 Russell -Silver (RSS)/Silver -Russell (SRS) A9 Recurrent C -Diff J6 Syndrome Recurrent Cerumen Impactions Ø Sacrococcygeal Disorders D13 Recurrent Ear Infection J6 Sacroiliac Joint Dysfunction or Sacroiliitis D12 Recurrent Falls Ø SAD = Seasonal Affective Disorder H3 Recurrent Syncope C8 Salivary Gland Disturbance B5 Recurring Warts Ø Sanfilippo Syndrome A7 Reflex Sympathetic Dystrophy D13 Sarcoidosis J7 Reflux (disease) B5 Sarcopenia D13 Renal Artery Stenosis G1 Scabies J6 Renal Calculi G1 Schatzki's Ring B5 Renal Cyst G1 Schilders Disease D7 Renal Failure G1 Schizencephaly A9 Renal Insufficiency G1 (bipolar an d H5 Renal Mass, if cancerous and if in past 5 depressive types) J2 years H4 Renal Mass, if noncancerous G1 Schizophreniform H5 Renal Osteodystrophy D5 and G1 SCI = Spinal Cord Injury D9 Respiratory Failure F5 Sciatica D12 Resting Tremor D13 Scleroderma J7 Restles s Leg Syndrome D13 Sclerosis Ø Restrictive Lung Disease F5 D4 Retinal Artery Occlusion/Embolic Stroke Seasonal Affective Disorder (SAD) H3 I2 of Eye Seasonal Allergies J1 Retinal Degeneration, Detachment or Sebaceous Cyst J3 I2 Hemorrhage Seborrhea J3 Retinal Keratosis I2 Seborrheic De rmatitis J3 Retinal Vein Occlusion I2 Seborrheic Eczema J3 Retinitis Pigmentosa I2 Seborrheic Keratosis J3 Retinopathy I2 A7 Retroperitoneal Fibrosis/Ormond's Secondary Hyperparathyroidism B7 K5 Disease Segawa Syndrome/Dopamine - D13 Rett Disorder/Syndrome A7 Responsive Dystonia (DRD) Reyes Syndrome K5 Segmental Dysfunction of the Spine D4 Rhabdomyolosis D13 Disorder, if onset at age 22 or E5 D13 after Rheumatic Heart Disease C8 Seizure Disorder, if onset before age 22 A6 Rheumatism D2 Selective Mutism H1 Rheumatoid Arthritis (RA) D2 Self -Injurious Behavior (SIB) K2 Rhinitis (allergic) J1 Self -Mutilation K2 Rhinosinusitis F2 Senile Nuclear Sclerosis I2 Rhizomelic Chondrodyspl asia Punctata A7 Rosacea Ø

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Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Code Soft Palate Deformity Ø according to Solitary Thyroid Nodule B2 Sensory Integration Dysfunction condition / Somatization/Somatoform H5 cause Disorder/ or Septicemia J6 K5 Septo -Optic Dysplasia A9 Soto Syndrome A9 Ø Sphenoid Wing Meningioma, if Sexual Abuse Ø cancerous AND if in past 5 years AND if E4 Shaken Baby Syndrome A3 onset at age 22 or after Sheehan's Syndrome B7 Sphenoid Wing Meningioma, if Shingles/Herpes Zoster J6 cancerous AND if in past 5 years AND if A3 Short Bowel Syndrome (SBS)/ Short Gut B5 onset before age 22 Ø Sphenoid Wing Meningioma, if Shoulder Dislocation D4 noncancerous AND if onset at age 22 or E4 Shoulder Impingement D4 after Shoulder Pain D12 Sphenoid Wing Meningiom a, if Shoulder Replacement/Arthroplasty D4 noncancerous AND if onset before age A3 Shy -Drager Syndrome/Multiple System 22 Atrophy/Multisystem Degeneration of E7 Spielmeyer -Vogt -Batten Disease A7 the Autonomic Nervous System D11 SIADH = Syndrome of Inappropriate Spinal Cord Infarct D13 B7 Antidiuretic Hormone Secretion Spinal Cord Injury (SCI) D9 SIB = Self -Injurious Behavior K2 Spinal Fusion D4 Sicca Syndrome J7 D13 Sick Sinus Syndrome C3 Spinal Radiculopathy D12 Sickle Cell Disease C1 Spinal Stenosis D12 Silver -Russell (SRS)/Russell -Silver (RSS) Spin al Subluxation D4 A9 Syndrome Spinocerebellar D13 Sinoatrial Node Dysfunction C3 Disease/Degeneration/Ataxia (SCA) Sinus Infections F2 Splenectomy Ø Sinus Node Dysfunction C3 Splenomegaly C5 C3 Spondylolistheses D12 Sinusitis F2 Spondylopathy D12 Sjogren -Larsson Syndrom e A9 Spondylosis D12 Sjogren's Syndrome J7 Sprain D13 Skin Infections J3 Stargardt Disease I2 Skin Irritation, Rash, or Tags Ø Stasis Dermatitis J3 Skin Lesion J3 Stasis Ulcer K4 Static Encephalop athy, if onset at age 22 Skin Ulcer K4 E4 Sleep Apnea F5 or after Static Encephalopathy, if onset before K5 A3 Sleep Disturbances K5 age 22 Slipped Syndrome D13 Static Tremor D13 , if onset at age 22 or SMART Syndrome E7 E5 Smith -Lemli -Opitz Syndrome A7 after Smith -Magenis Syndrome A7 Status Epilepticus, if onset before age 22 A6 Sneddon Syndrome C5 Steatohepatitis B4 SOB = Shortness of Breath F5 Stent Placement (coronary) Ø P-00814 (12/2020) Page 23 of 26

Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Stent Placement (non -coronary blood Tendon Dy sfunction/Ruptured/Torn D4 Ø vessels) Tendonitis D4 Steven -Johnson Syndrome J3 Tennis Elbow/Epicondylitis, Lateral D4 Stickler Syndrome K5 Tenosynovitis D4 Stiff Person Disease/Syndrome D13 Terminal Illness (prognosis < or = 12 K3 Stimulant Abuse K1 months) Strabismus I2 Testosterone Deficiency B7 Stress Incontinence Ø Tethered Spinal Cord D13 Stroke, if onset at age 22 or after E3 C8 Stroke, if onset before a ge 22 A3 Thalassemia C1 Sturge -Weber Syndrome A9 Thoracic Ou tlet Syndrome (TOS) D13 Ø THR = Total Hip Replacement D3 , if onset at Thrombocytopenia C1 E3 age 22 or after Thrombocytopenia - Absent Radius K5 Subarachnoid Hemorrhage, if onset (TAR) Syndrome A3 before age 22 Thrombocytosis C1 Subcortical Microvascular Ischemia Thromboembolus, Cerebral, if onset at E3 E3 Occlusive Disease age 22 or after /Hemorrhage , if Thromboembolus, Cerebral, if onset E3 A3 onset at age 22 or after before age 22 Subdural Hematoma/Hemorrhage, if Thromboembolus, not Cerebral C1 A3 onset before age 22 Thrombosis C1 Subglottic Stenosis F5 Thrush B5 Subluxation D4 Thyroid Deficiency B2 Substance Use Disorder K1 Thyroid Nodule, if cancerous and if in J2 Succinic Semialdehyde Dehydrogenase past 5 years A7 (SSADH) Deficiency Thyroid Nodule, if noncancerous B7 Suicidal Ideations H5 Thyroidectomy Ø Superior Mesenteric Artery Syndrome Thyroiditis B7 B5 (SMAS) TIA = Transient Ischemic Attacks C5 Superior Vena Cava Obstruction C8 Tibia F racture D4 SVT = Supraventricular Tachycardia C3 Tibial Torsion D13 D4 (persistent or provisional) E7 Syncope (not Psychogenic) C8 Tietze Disease D13 Syndrome of Inappropriate Antidiuretic B7 Tinea Cruris J3 Hormone Secretion = SIADH Tinea Pedis J3 Synovial Cyst D4 Tinea Unguium J3 Syphyilis J6 TKR = Total Knee Replacement D4 Syringo myelia D13 TMJ = Temporomandibular Joint D4 Systolic Heart Failure C4 Disorder Tachycardia C3 Toenail Fungus Ø Tardive Dyskinesia D13 Tonsillectom y Ø Tarsal Tunnel Syndrome D13 Tooth Disease B5 Tatton Brown Rahman Syndrome A7 Toriello -Carey Syndrome A9 Tay -Sacks Disease A7 Torn Rotator Cuff/ D4 TB = J6 Torticollis/ D13 Temporal Arteritis C5 Tortuous Aorta C8 Temporomandibular Joint Disorder D4 Total Hip Replacement (THR) D3 P-00814 (12/2020) Page 24 of 26

Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Total Knee Replacement (TKR) D4 Umbilical Hernia B5 /Disease E7 Underweight Ø Tracheal Ste nosis F5 Unstable Gait D13 Tracheobronchomalacia F5 Upper Respiratory Tract Infection (URTI) F2 Tracheomalacia F5 Urethra l Stricture G3 Tracheostomy F3 Urge Incontinence G3 Transient Cerebral Ischemia C5 Uric Acid Nephrolithiasis G1 Transient Ischemic Attacks (TIA) C5 , not stress G3 Transitional Vertebrae D4 Urinary Obstruction G3 Transplant of Heart C8 Urinary Retention G3 Transplant of Kidney G3 Urinary Tract Infection (UTI) G2 Transplant of Liver B5 Urinary Urgency Ø Transplant of L ung F5 Urosepsis J6 Transplant of Pancreas B5 Urostomy G3 Transurethral Resection of Prostrate URTI = Upper Respiratory Tract Infection F2 Ø (TURP) Urticaria J3 Trauma Ø I4 Traumatic Brain Injury, if onset at age 22 Uterine Bleeding E4 G4 or after (Dysfunctional/Abnormal) Traumatic Brain Injury, if onset before Uterine Fibroid G4 A3 age 22 Uterine Hypoplasia G4 Tremor D13 UTI = Urinary Tract Infection G2 Trench/Immersion Foot K5 Uveitis I2 Trichorhinophalang eal Syndrome Type VACTERL Association/VATER Syndrome K5 A9 II/Langer Giedion Syndrome Vaginal Candidiasis G4 A9 Vagin al Prolapse G4 H1 Vaginitis G4 Tricuspid Regurgitation C8 Valvular Heart Disease C8 Trigeminal Neuralgia D12 Varicose Veins Ø Trigeminal Schwannoma, if onset at age E4 E2 22 or after Vascular Disease Ø Trigeminal Schwannoma, if onset before A3 Vasculitis C5 age 22 Vasectomy Ø Tr igger Finger/Stenosing Tenosynovitis D4 Vasomotor Rhinitis J1 Triplegia (not form of Cerebral Palsy) D10 Vasovagal Syncope C8 Trisomy 13/Patau Syndrome A7 VCF = Velo -Cardio -Facial Syndrome A9 Trisomy 18/Edwards Syndrome A7 Velocardiofacial Syndrome A9 Trisomy X Syndrome A9 Venous Insufficiency C5 Tubal Ligation Ø Venous Stasis C5 Tuberculosis (TB) J6 Venous Stasis Edema Ø A9 Ventilator Dependent F4 Tubulovillous Adenoma o f the Signoid Ø Ventral Hernia B5 Colon Ventricular Bigeminy C3 Tumor, Benign Ø Ventricular Dysfunction C4 A9 Ventricular Ectopy C3 TURP = Transurethral Resection of Ø Ventricular Hypertrophy C8 Prostrate Ventricular Septal Defect C8 Ulcers (gastric, peptic, or duodenal) B5 P-00814 (12/2020) Page 25 of 26

Items in red are new since last update DIAGNOSIS CODE DIAGNOSIS CODE Ventric ulo/lar Peritoneal (VP) Shunt E7 (general or muscle) D13 Vertebral Compression/Fracture D4 Weg ener's Disease/ Granulomatosis C5 Vertebrobasilar Syndrome C5 Weight Gain (abnormal/unexplained) Ø Vertigo I4 Weight Loss (abnormal/unexplained) Ø Vestibular Hypofunction I4 Wernicke -Korsakoff Syndrome E2 Vestibular Neuronitis I4 Disease, if onset at age 22 E6 Vestibular Schwannoma/Acoustic or after D13 Neuroma White Matter Disease, if onset before A3 Victim of Sexual Abuse Ø age 22 Viral Warts Ø WHS = Wolf -Hirschhorn Syndrome A7 Visual Disturbances I2 Williams Syndrome A9 Visual Hallucinations Ø Wilson Disease K5 Visual Impairment I2 Wolff -Parkinson -White Syndrome C3 Vitamin B12 Deficiency B6 Wolfram Syndrome A9 Vitamin D Deficiency B6 Wound Dehiscence K4 Vitreous Degeneration, Detachment or Wound Infection K4 I2 Hemorrhage Wrist Fusion D4 VKH = Vogt -Koyanagi -Harada Syndrome I2 Xeroderma Pigmentosa (XP) A9 Vocal Cord Disorder/Dysfunction/ Xeropthalmia due to Vitamin A K5 I2 Paralysis deficiency Vogt -Koyanagi -Harada Syndrome (VKH) I2 Xerosis Ø Vomiting/Emesis Ø Xerosis Cutis Ø Von Hippel -Lindau Disease/Syndrome K5 Xerostomia Ø Von Willebrand Disease C1 XXYY Syndrome A9 VP (Ventriculo/lar Peritoneal) Shunt E7 Yeast Infection (skin) J3 Waardenburg Syndrome A9 Yeast Infection (vaginal) G4 Warts Ø Zenker's Diverticulum B5 Water Retention Ø

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