ICD-10) Diagnostic Codes Related to Family Infant Toddler (FIT) Program Revised October 2015

Diagnostic Codes Related to Family Infant Toddler (FIT) Program

International Classification of Disease, 10th Revision (ICD-10) Diagnostic Codes Related to Family Infant Toddler (FIT) Program Revised October 2015

The following relevant diagnosis codes under the four Family Infant Toddler Program eligibility categories are taken directly from the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM).

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program Introduction:

The following is a guide for Family Infant Toddler (FIT) Program providers to determine the whether the child’s medical diagnosis meets eligibility under the “Established Condition” or “Medical / Biological Risk”, in accordance with the Requirements for Family Infant Toddler Early Intervention Services (NMAC 7.30.8). This guide is also to be used to determine the diagnostic billing codes (ICD-10 International Classification of Diseases) to be entered into FIT-KIDS (Key Information Data System) for any the FIT eligibility criteria.

This guide is categorized by four main categories of Developmental Delay, Established Condition, Medical/Biological Risk Condition, and Environmental Risk Factors. All codes have been converted from the ICD-9 to ICD-10 mapping.

The categories of Established Condition, and Medical/Biological Risk Condition have their own subcategories of the following: Genetic Disorders; Mental/Psychosocial Disorders (DC: 0-3 diagnosis are indicated in bold); Neurologic/Musculoskeletal; Perinatal Factors; Physical Impairments; and Sensory Abnormalities.

Reminder: Eligibility determination in the categories of Medical/Biological Risk Condition and Established Condition shall be made by a license Medical Practitioner.

The category of Environmental Risk Factors have subcategories of the following: Other personal history presenting hazards to health; Family history of certain chronic disabling diseases; family history of certain other specific conditions; family history of other conditions; health supervision of a child; housing, household, and economic circumstances; other family circumstances; and other psychosocial circumstances.

Reminder: Eligibility determination in the category of Environmental Risk Factors shall be made using the Environmental Risk Assessment (ERA) tool approved by the FIT program.

Any questions regarding conditions not on this guide must be directed to your FIT Manager who will work with a New Mexico Department of Health Medical Director/Physician to determine whether a proposed condition will be recognized. Reminder that there are 100,000 more codes in the ICD-10 conversion which makes the mapping process take longer.

Family Infant Toddler (FIT) Providers may keep this document electronically and in print. Note, that the electronic version has the option to find sections by clicking the table of contents (hyperlinks), diagnosis and ICD-10 Codes can also be found by clicking CTRL+F.

Note: for billing purposes through FIT-KIDS all codes that are not listed on the drop-down list may be entered in the Field/Box of “Other ICD-10 Code”.

Please contact your FIT Program Manager if you have any questions.

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program Table of Contents

DEVELOPMENTAL DELAY ...... 5

ESTABLISHED CONDITION: GENETIC DISORDERS ...... 6

ESTABLISHED CONDITION: NEUROLOGIC/MUSCULOSKELETAL ...... 10

ESTABLISHED CONDITION: PERINATAL FACTORS ...... 12

ESTABLISHED CONDITION: PHYSICAL IMPAIRMENTS ...... 13

ESTABLISHED CONDITION: SENSORY ABNORMALITIES ...... 14

MEDICAL/BIOLOGICAL RISK CONDITION: GENETIC DISORDERS...... 17

MEDICAL/BIOLOGICAL RISK CONDITION: MENTAL/PSYCHOSOCIAL DISORDERS ...... 22

MEDICAL/BIOLOGICAL RISK CONDITION: PERINATAL FACTORS ...... 29

MEDICAL/BIOLOGICAL RISK CONDITION: PERINATAL FACTORS (CONTINUED) ...... 30

MEDICAL/BIOLOGICAL RISK CONDITION: PHYSICAL IMPAIRMENTS ...... 31

MEDICAL/BIOLOGICAL RISK CONDITION: SENSORY ABNORMALITIES ...... 32

MEDICAL/BIOLOGICAL RISK CONDITION: SENSORY ABNORMALITIES (CONTINUED) ...... 33

ENVIRONMENTAL RISK FACTORS: PERSONAL HISTORY PRESENTING HAZARD TO HEALTH ...... 34 3 | Page ICD-10 Codes Revised October 2015

Diagnostic Codes Related to Family Infant Toddler (FIT) Program

ENVIRONMENTAL RISK FACTORS: FAMILY HISTORY OF CERTAIN CHRONIC DISABLING DISEASES ...... 34

ENVIRONMENTAL RISK FACTORS: FAMILY HISTORY OF OTHER CONDITIONS ...... 35

ENVIRONMENTAL RISK FACTORS: HEALTH SUPERVISION OF INFANT OR CHILD ...... 35

ENVIRONMENTAL RISK FACTORS: HOUSING, HOUSEHOLD, AND ECONOMIC CIRCUMSTANCES ...... 36

ENVIRONMENTAL RISK FACTORS: OTHER FAMILY CIRCUMSTANCES ...... 36

ENVIRONMENTAL RISK FACTORS: OTHER FAMILY CIRCUMSTANCES (CONTINUED) ...... 37

ENVIRONMENTAL RISK FACTORS: OTHER PSYCHOSOCIAL CIRCUMSTANCES...... 37

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program

Developmental Delay A delay of 25% or more, after correction for prematurity, in one or more of the following areas of development: cognitive; communication; physical/motor; social or emotional; or adaptive of the following: (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.)

Condition Type ICD-10 Code Condition/Diagnosis Development F70 Mild Intellectual Disabilities Development F71 Moderate Intellectual Disabilities Development F72 Severe Intellectual Disabilities Development F73 Profound Intellectual Disabilities Development F79 Unspecified Intellectual Disabilities F80.1 Expressive Language Disorder Development

Development F80.2 Mixed Receptive-Expressive Language Disorder Development F80.81 Childhood Onset Fluency Disorder Development F80.89 Other developmental disorders of speech and language Development F82 Specific Developmental Disorder of Motor Functions (Mixed Development Disorder) F84.0 Autistic Disorder (DC 0-3 R: 710 Multisystem Development Disorder) Development F84.9 Pervasive Development Disorder (PDD), Unspecified Development Development F88 Other disorders of psychological development Mixed Development Disorder Development F89 Other disorders of psychological development Other Specified Delays in Development

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program

ESTABLISHED CONDITION: Genetic Disorders A diagnosed physical, mental, or neurobiological condition that has a high probability of resulting in developmental delay. The established condition shall be diagnosed by a health care provider and documentation shall be kept on file. Established conditions include the following: (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.)

Condition Type ICD-10 Code Condition/Diagnosis Genetic Disorders A81.1 Subacute Sclerosing Panencephalitis Genetic Disorders D33.2 Benign Neoplasm of Brain, Unspecified Genetic Disorders E70.20 Disorder of tyrosine metabolism, unspecified Genetic Disorders E70.21 Tyrosinemia, Type I (Tyrosinosis) and Type II (Richner-Hanhart Syndrome) Genetic Disorders E70.29 Disorder of tyrosine metabolism, unspecified Genetic Disorders E70.8 Other disorders of aromatic amino-acid metabolism (Waardenburg's Syndrome, Type I) Genetic Disorders E70.9 Disorder of aromatic amino-acid metabolism, unspecified Genetic Disorders E72.03 Lowe's Syndrome or (Oculocerebrorenal Syndrome) Genetic Disorders E75.23 Krabbe's Disease Genetic Disorders E75.29 Other sphingolipidosis (Canavan Disease) Genetic Disorders E75.3 Sphingolipidosis, unspecified Genetic Disorders E760.1 Hurler Syndrome Genetic Disorders E760.2 Hurler-Scheie syndrome Genetic Disorders E760.3 Scheie's syndrome Genetic Disorders E77.1 Defects in Glycoprotein Degradation (Mannosidosis) Genetic Disorders E77.8 Other disorders of glycoprotein metabolism Genetic Disorders E77.9 Disorder of glycoprotein metabolism, unspecified Genetic Disorders E79.1 Lesch-Nyhan Syndrome Genetic Disorders E83.00 Disorder of copper metabolism, unspecified Menkes' Syndrome (Kinky Hair Disease) Genetic Disorders E83.01 Wilson's Disease Genetic Disorders F84.2 Rett’s Syndrome Genetic Disorders G31.81 Alper's Disease

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program ESTABLISHED CONDITION: Genetic Disorders (Continued) Condition Type ICD-10 Code Condition/Diagnosis Genetic Disorders G31.82 Leigh’s Disease Genetic Disorders G70.00 Myasthenia Gravis, without (acute) exacerbation (Familial Infantile) Genetic Disorders G71.2 Congenital Myopathies Genetic Disorders G91.1 Obstructive Hydrocephalus Genetic Disorders M21.511 Acquired clawhand, right hand Genetic Disorders M21.512 Acquired clawhand, left hand Genetic Disorders M21.519 Acquired clawhand, unspecified hand Genetic Disorders M21.521 Acquired clubhand, right hand Genetic Disorders M21.522 Acquired clubhand, left hand Genetic Disorders M21.529 Acquired clubhand, unspecified hand Genetic Disorders M21.531 Acquired clawfoot, right foot Genetic Disorders M21.532 Acquired clawfoot, left foot Genetic Disorders M21.539 Acquired clawfoot, unspecified foot Genetic Disorders M21.541 Acquired Clubfoot, Right Foot Genetic Disorders M21.542 Acquired Clubfoot, Left Foot Genetic Disorders M21.549 Acquired Clubfoot, Unspecified Foot (Paralytic Clubbed Foot) Genetic Disorders M21.511 Acquired clawhand, right hand Genetic Disorders Q03.1 Atresia of foramina of Magendie and Luschka Dandy Walker Syndrome Genetic Disorders Q03.9 Congenital hydrocephalus, unspecified Genetic Disorders Q04.0 Congenital malformations of corpus callosum Genetic Disorders Q04.3 Other Reduction Deformities of Brain (Polymicrogyria) Genetic Disorders Q72.10 Congenital Absence of Unspecified limbs Genetic Disorders Q73.1 Phocomelia, unspecified limb(s) Genetic Disorders Q73.2 Other Reduction Defects of Unspecified Limb(s) Genetic Disorders Q75.9 Congenital Anomalies of Skull and Face Bone, unspecified (Goldenhar) Genetic Disorders Q87.89 Spondyloepiphyseal dysplasia Dyggve-Melchior-Clausen Syndrome (D-M-C Dwarfism) Genetic Disorders Q78.0 Osteogenesis Imperfecta

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program ESTABLISHED CONDITION: Genetic Disorders (Continued)

Condition Type ICD-10 Code Condition/Diagnosis Genetic Disorders Q80.8 Other congenital ichthyosis Sjogren-Larsson Syndrome Genetic Disorders Q85.1 Tuberous Sclerosis Genetic Disorders Q85.8 Other Phakomatosis, not elsewhere classified (Sturge-Weber Syndrome) Congenital malformation syndromes predominantly associated with short stature: (Prader- E78.72 Genetic Disorders Willi Syndrome) Congenital malformation syndromes predominantly associated with short stature: Q87.89 Genetic Disorders (DeLange’s Syndrome) Congenital malformation syndromes predominantly associated with short stature: Q87.89 Genetic Disorders (Dubowitz Syndrome) Congenital malformation syndromes predominantly associated with short stature: (Smith- Q87.1 Genetic Disorders Lemli-Opitz Syndrome) Congenital malformation syndromes predominantly involving limbs: Q87.2 Genetic Disorders (Caudal Regression Syndrome-Sirenomelia) Congenital malformation syndromes predominantly involving limbs: Q87.2 Genetic Disorders (Rubinstein-Taybi Syndrome) Other specified congenital malformation syndromes, not elsewhere classified Q87.89 Genetic Disorders Zellweger/Cerebrohepatorenal Syndrome Genetic Disorders Q90.0 Trisomy 21, nonmosaicism (meiotic nondisjunction) Genetic Disorders Q90.1 Trisomy 21, mosaicism (mitotic nondisjunction) Genetic Disorders Q90.2 Trisomy 21, translocation Genetic Disorders Q90.9 Down Syndrome, Unspecified Genetic Disorders Q91.0 Trisomy 18, nonmosaicism (meiotic nondisjunction) Genetic Disorders Q91.1 Trisomy 18, mosaicism (mitotic nondisjunction) Genetic Disorders Q91.2 Trisomy 18, translocation Genetic Disorders Q91.3 Trisomy 18, Unspecified (Edward's, E3) Genetic Disorders Q91.4 Trisomy 13, nonmosaicism (meiotic nondisjunction) Genetic Disorders Q91.5 Trisomy 13, mosaicism (mitotic nondisjunction)

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program ESTABLISHED CONDITION: Genetic Disorders (Continued)

Condition Type ICD-10 Code Condition/Diagnosis Genetic Disorders Q91.6 Trisomy 13, translocation Genetic Disorders Q91.7 Trisomy 13, Unspecified (Patau's, D1) Genetic Disorders Q93.4 Deletion of short arm of chromosome 5(Cri Du Chat or Cat's Cry) Genetic Disorders Q93.5 Other deletions of part of a chromosome (Angelman's Syndrome) Other Q99.9 Genetic Disorders deletions from the autosomes Williams Syndrome Genetic Disorders Q99.2 Fragile X Syndrome For Boys Genetic Disorders R47.01 Aphasia

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program

ESTABLISHED CONDITION: Neurologic/Musculoskeletal A diagnosed physical, mental, or neurobiological condition that has a high probability of resulting in developmental delay. The established condition shall be diagnosed by a health care provider and documentation shall be kept on file. Established conditions include the following: (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.) Condition Type ICD-10 Code Condition/Diagnosis Neurologic/Musculoskeletal A80.39 Paralysis, Other Specified

Neurologic/Musculoskeletal G06.2 Extradural and Subdural Abscess, Unspecified (Hemiplegia (Hemiparesis) Neurologic/Musculoskeletal G11.9 Hereditary Ataxia, Unspecified (Spinocerebellar Disorders) Neurologic/Musculoskeletal G24.1 Genetic Torsion Dystonia (Dystonia Musculorum Deformans) Neurologic/Musculoskeletal G25.3 Myoclonus Neurologic/Musculoskeletal G31.89 Other Specified Degenerative Diseases of Nervous System Neurologic/Musculoskeletal G60.9 Hereditary and Idiopathic Neuropathy, Unspecified Neurologic/Musculoskeletal G71.0 Muscular Dystrophy Neurologic/Musculoskeletal G71.11 Myotonic Muscular Dystrophy Neurologic/Musculoskeletal G71.12 Myotonia Congenita (Thomsen's Disease) Neurologic/Musculoskeletal G71.2 Congenital Myopathies Neurologic/Musculoskeletal G80.0 Spastic quadriplegic cerebral palsy Neurologic/Musculoskeletal G80.1 Spastic Diplegic Cerebral Palsy (Congenital Diplegia, Paraplegia) Spastic hemiplegic cerebral palsy (Congenital Hemiplegia) (Infantile Postnatal G80.2 Neurologic/Musculoskeletal NOS) (Spastic Infantile Paralysis) Neurologic/Musculoskeletal G80.3 Athetoid cerebral palsy Neurologic/Musculoskeletal G80.4 Ataxic cerebral palsy Neurologic/Musculoskeletal G80.8 Other cerebral palsy Neurologic/Musculoskeltal G80.9 Cerebral palsy, unspecified Neurologic/Musculoskeletal G82.20 Paraplegia, unspecified Paralysis of Both Lower Limbs (Paraplegia) Quadriplegia, unspecified Paralysis of All Four Limbs (Quadriplegia, G82.50 Neurologic/Musculoskeletal Quadriparesis,) Neurologic/Musculoskeletal G83.0 Diplegia of upper limbs Paralysis of Both Upper Limbs (Diplegia) 10 | Page ICD-10 Codes Revised October 2015

Diagnostic Codes Related to Family Infant Toddler (FIT) Program ESTABLISHED CONDITION: Neurologic/Musculoskeletal (Continued) Condition Type ICD-10 Code Condition/Diagnosis Monoplegia of lower limb affecting unspecified side Paralysis of One Lower Limb G83.10 Neurologic/Musculoskeletal (Monoplegia) Monoplegia of upper limb affecting unspecified side Paralysis of One Upper Limb G83.20 Neurologic/Musculoskeletal (Monoplegia) Neurologic/Musculoskeletal G83.9 Paralytic syndrome, unspecified Neurologic/Musculoskeletal G93.0 Cerebral Cysts Neurologic/Musculoskeletal G93.5 Compression of Brain Neurologic/Musculoskeletal G93.40 Encephalopathy, unspecified Neurologic/Musculoskeletal G93.49 Other encephalopathy Neurologic/Musculoskeletal P11.5 Birth injury to spine and spinal cord Neurologic/Musculoskeletal P90 Convulsions in newborn Neurologic/Musculoskeletal P91.60 Hypoxic ischemic encephalopathy [HIE], unspecified Neurologic/Musculoskeletal P94.2 Congenital hypotonia Neurologic/Musculoskeletal Q00.0 Anencephaly Neurologic/Musculoskeletal Q01.9 Encephalocele, Unspecified Neurologic/Musculoskeletal Q02 Microcephaly Neurologic/Musculoskeletal Q04.2 Holoprosencephaly Neurologic/Musculoskeletal Q04.3 Other reduction deformities of brain Lissencephaly Neurologic/Musculoskeletal Q04.6 Congenital cerebral cysts Cortical Dysplasia Neurologic/Musculoskeletal Q05.8 Sacral spina bifida without hydrocephalus (Meningomyelocele, Meningocele) Neurologic/Musculoskeletal Q05.9 Spina Bifida, Unspecified Neurologic/Musculoskeletal Q07.00 Sacral Spina Bifida Without Hydrocephalus Neurologic/Musculoskeletal Q07.01 Arnold-Chiari Syndrome with Spina Bifida Neurologic/Musculoskeletal Q07.03 Arnold-Chiari syndrome with spina bifida and hydrocephalus Neurologic/Musculoskeletal Q76.49 Other congenital malformations of spine, not associated with scoliosis (Sacral Agenesis) Please refer to your Neurologic/Musculoskeletal medical professional Traumatic Brain Injury

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program

ESTABLISHED CONDITION: Perinatal Factors A diagnosed physical, mental, or neurobiological condition that has a high probability of resulting in developmental delay. The established condition shall be diagnosed by a health care provider and documentation shall be kept on file. Established conditions include the following: (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.)

Condition Type ICD-10 Code Condition/Diagnosis Perinatal Factors P07.22 Extreme immaturity of newborn, gestational age 23 completed weeks Perinatal Factors P07.23 Extreme immaturity of newborn, gestational age 24 completed weeks Perinatal Factors P07.24 Extreme immaturity of newborn, gestational age 25 completed weeks Extreme immaturity of newborn, gestational age 26 completed weeks Perinatal Factors P07.25 Perinatal Factors P07.26 Extreme immaturity of newborn, gestational age 27 completed weeks Perinatal Factors P07.31 Preterm newborn, gestational age 28 completed weeks Perinatal Factors P35.0 Congenital rubella syndrome Perinatal Factors P39.9 Infection specific to the perinatal period, unspecified Perinatal Factors P84 Other Problems with Newborns (birth asphyxia NOS, Severe) Neonatal cerebral ischemia Perinatal Factors P91.0 Acquired periventricular cysts of newborn Perinatal Factors P91.1 Perinatal Factors P91.2 Neonatal cerebral leukomalacia

Perinatal Factors P91.4 Neonatal Cerebral Depression Perinatal Factors P91.5 Neonatal Coma Perinatal Factors P96.1 Neonatal withdrawal symptoms from maternal use of drugs of addiction

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program

ESTABLISHED CONDITION: Physical Impairments A diagnosed physical, mental, or neurobiological condition that has a high probability of resulting in developmental delay. The established condition shall be diagnosed by a health care provider and documentation shall be kept on file. Established conditions include the following: (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.)

Condition Type ICD-10 Code Condition/Diagnosis Malignant neoplasm of right conjunctiva (Retinoblastoma) Physical Impairments C69.01 Physical Impairments C69.02 Malignant neoplasm of left conjunctiva (Retinoblastoma) Physical Impairments H33.001 Unspecified retinal detachment with retinal break, right eye Physical Impairments Q11.1 Other Anophthalmos Physical Impairments Q11.2 Microphthalmia Physical Impairments Q13.1 Absence of Iris (Aniridia) Physical Impairments Q13.89 Other congenital malformations of anterior segment of eye Physical Impairments Q16.1 Congenital absence, atresia and stricture of auditory canal (external) Physical Impairments Q17.2 Microtia Physical Impairments Q17.8 Other specified congenital anomalies of ear Physical Impairments Q67.8 Other congenital deformities of chest

Physical Impairments Q74.9 Unspecified Congenital Malformation of Limb(s)

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program

ESTABLISHED CONDITION: Sensory Abnormalities A diagnosed physical, mental, or neurobiological condition that has a high probability of resulting in developmental delay. The established condition shall be diagnosed by a health care provider and documentation shall be kept on file. Established conditions include the following: (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.)

Condition Type ICD-10 Code Condition/Diagnosis Sensory Abnormalities H26.009 Unspecified Infantile and Juvenile Cataract, Unspecified Eye Sensory Abnormalities H27.03 Aphakia Bilateral Sensory Abnormalities H27.03 Aphakia. Bilateral Sensory Abnormalities H33.009 Unspecified Retinal Detachment with Retinal Break, Unspecified eye Sensory Abnormalities H35.029 Exudative Retinopathy, Unspecified Eye Sensory Abnormalities H35.119 Retinopathy of Prematurity, Stage 0, Unspecified Eye Sensory Abnormalities H35.129 Retinopathy of Prematurity, Stage 1, Unspecified Eye Sensory Abnormalities H35.139 Retinopathy of Prematurity, Stage 2, Unspecified Eye Sensory Abnormalities H35.149 Retinopathy of Prematurity, Stage 3, Unspecified Eye Sensory Abnormalities H35.159 Retinopathy of Prematurity, Stage 4, Unspecified Eye Sensory Abnormalities H35.169 Retinopathy of Prematurity, Stage 5, Unspecified Eye Sensory Abnormalities H35.179 Retrolental Fibroplasia, Unspecified Eye (ROP) Sensory Abnormalities H35.52 Pignentary Retinal Distrophy (RP) Dystrophies Primarily Involving the Retinal Pigment Epithelium/Leber’s Congenital H35.54 Sensory Abnormalities Amaurosis Sensory Abnormalities H47.039 Optic Nerve Hypoplasia, Unspecified Eye Sensory Abnormalities H47.20 Unspecified Optic Atrophy Sensory Abnormalities H47.619 Cortical Blindness, Unspecified Side of the Brain (Disorders of visual cortex) Sensory Abnormalities H53.40 Unspecified Visual Field Defects Sensory Abnormalities H53.469 Homonomymous Bilateral Field Defects, Unspecified Side 14 | Page ICD-10 Codes Revised October 2015

Diagnostic Codes Related to Family Infant Toddler (FIT) Program ESTABLISHED CONDITION: Sensory Abnormalities (continued)

Condition Type ICD-10 Code Condition/Diagnosis Sensory Abnormalities H53.47 Heteronymous Bilateral Field Defects Sensory Abnormalities H53.51 Achromatopsia Sensory Abnormalities H54.7 Cortical Visual Impairment (CVI) (Unspecified Visual Loss) Sensory Abnormalities H54.8 Blindness Sensory Abnormalities H55.00 Unspecified nystagmus Sensory Abnormalities H55.01 Congenital nystagmus Sensory Abnormalities H55.09 Other Forms of Nystagmus Sensory Abnormalities H90.3 Sensorineural Hearing Loss, Bilateral Sensorineural Hearing Loss, Unilateral, Right Ear, with Unrestricted Hearing on the Sensory Abnormalities H90.41 Contralateral Side Sensorineural Hearing Loss, Unilateral, Left Ear, with Unrestricted Hearing on the Sensory Abnormalities H90.42 Contralateral Side Sensory Abnormalities H90.5 Unspecified Sensorineural Hearing Loss Sensory Abnormalities H90.8 Mixed Conductive and Sensorineural Hearing Loss, Unspecified

Sensory Abnormalities H90.6 Mixed conductive and sensorineural hearing loss, bilateral Sensory Abnormalities Mixed conductive and sensorineural hearing loss, unilateral, right ear, with H90.71 unrestricted hearing on the contralateral side

Sensory Abnormalities Mixed conductive and sensorineural hearing loss, unilateral, left ear, with unrestricted H90.72 hearing on the contralateral side

Sensory Abnormalities H91.90 Unspecified Hearing Loss, Unspecified Ear Unspecified hearing loss, right ear Sensory Abnormalities H91.91 Unspecified hearing loss, left ear Sensory Abnormalities H91.92 15 | Page ICD-10 Codes Revised October 2015

Diagnostic Codes Related to Family Infant Toddler (FIT) Program ESTABLISHED CONDITION: Sensory Abnormalities (continued)

Unspecified hearing loss, bilateral Sensory Abnormalities H91.93 Sensory Abnormalities Q15.0 Congenital Glaucoma Sensory Abnormalities Q16.9 Congenital Malformations of Ear Causing Impairment of hearing, Unspecified Sensory Abnormalities Q89.8 Other Specified Congenital Malformations

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program

MEDICAL/BIOLOGICAL RISK CONDITION: Genetic Disorders A diagnosed physical, mental, or neurobiological condition. The biological or medical risk condition shall be diagnosed by a health care provider and documentation shall be kept on file. Biological and medical risk conditions include the following: (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.)

*Questions Regarding conditions not on this list shall be directed to your FIT Manager who will work with a Department of Health Physician to determine whether a proposed condition will be recognized.

Condition Type ICD-10 Code Condition/Diagnosis Genetic Disorders D82.1 Di George's Syndrome Genetic Disorders E00.9 Congenital iodine-deficiency syndrome, unspecified Genetic Disorders E70.0 Classical phenylketonuria Genetic Disorders E70.30 Albinism, unspecified Genetic Disorders E71.0 Maple Syrup Urine Disease Genetic Disorders E71.110 Isovaleric Acidemia Genetic Disorders E71.121 Methylmalonic Aciduria Genetic Disorders E71.522 Adrenomyeloneuropathy Other disorders of amino-acid transport (Fanconi (-de Toni) (-Debre) Syndrome) Genetic Disorders E72.09 Genetic Disorders E72.11 Homocystinuria Genetic Disorders E72.22 Argininosuccinic Aciduria Genetic Disorders E72.51 Non-ketotic hyperglycinemia Genetic Disorders E74.02 Pompe's Disease Genetic Disorders E74.21 Galactosemia Genetic Disorders E75.02 Tay-Sachs disease Genetic Disorders E77.0 Defects in Post Translational Modification of Lysosomal Enzymes

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program MEDICAL/BIOLOGICAL RISK CONDITION: Genetic Disorders (continued)

Condition Type ICD-10 Code Condition/Diagnosis Genetic Disorders E75.19 Other gangliosidosis Genetic Disorders E75.22 Gaucher’s Disease Genetic Disorders E75.240 Niemann-Pick disease type A

Genetic Disorders E75.25 Metachromatic Leukodystrophy

Genetic Disorders E75.4 Neuronal Ceroid Lipofuscinoses

Genetic Disorders E75.01 Sandhoff disease

Genetic Disorders F19.939 Other psychoactive substance use, unspecified with withdrawal, unspecified

Genetic Disorders G11.3 Cerebellar ataxia with defective DNA repair

Genetic Disorders G12.0 Infantile Spinal Muscular Atrophy Werdnig-Hoffman Disease,

Genetic Disorders G60.9 Hypertrophic Interstitial Neuritis

Genetic Disorders G90.1 Familial Dysautonomia (Riley-Day Syndrome, HSAN III)

Genetic Disorders I67.9 Cerebrovascular Disease, Unspecified

Genetic Disorders Q79.6 Cutis laxa senilis

Genetic Disorders L94.0 Linear scleroderma

Genetic Disorders P02.8 Newborn (suspected to be) affected by other abnormalities of membranes

Genetic Disorders P35.1 Congenital cytomegalovirus infection

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program MEDICAL/BIOLOGICAL RISK CONDITION: Genetic Disorders (continued)

Condition Type ICD-10 Code Condition/Diagnosis Genetic Disorders G93.89 Other Conditions of the Brain

Genetic Disorders Q06.2 Diastematomyelia

Genetic Disorders Q26.2 Total anomalous pulmonary venous connection Genetic Disorders Other specified congenital musculoskeletal deformities Q87.40 (Beals-Hecht Syndrome) Genetic Disorders Q74.8 Other specified congenital malformations of limb(s) Larsen's Syndrome

Genetic Disorders Q77.0 Achondrogenesis

Genetic Disorders Q77.4 Achondroplasia

Genetic Disorders Q77.5 Diastrophic Dysplasia Genetic Disorders Other osteochondrodysplasia with defects of growth of tubular bones and spine Kniest's Q79.9 Syndrome (Metatrophic Dwarfism II) Genetic Disorders Q78.8 Other Specified Osteochondrodysplasia (Acrodysplasia I)

Genetic Disorders Q78.9 Osteochondrodysplasia, unspecified

Genetic Disorders Q79.6 Ehlers-Danlos Syndrome

Genetic Disorders Q80.9 Congenita Ichthyosis, Unspecified (Harlequin Fetus)

Genetic Disorders Q82.1 Xeroderma Pigmentosum Genetic Disorders Q85.01 Other Neurofibromatosis Genetic Disorders Congenital malformation syndromes predominantly affecting facial appearance Apert's Q87.0 Syndrome (Acrocephalosyndactyly I, ACS I) Genetic Disorders Congenital malformation syndromes predominantly affecting facial appearance Saethre- Q87.0 Chotzen Syndrome (Chotzen's, Acrocephalosyndactyly III) 19 | Page ICD-10 Codes Revised October 2015

Diagnostic Codes Related to Family Infant Toddler (FIT) Program MEDICAL/BIOLOGICAL RISK CONDITION: Genetic Disorders (Continued)

Condition Type ICD-10 Code Condition/Diagnosis Genetic Disorders Congenital malformation syndromes predominantly affecting facial appearance Robin’s Q87.0 Syndrome Genetic Disorders Congenital malformation syndromes predominantly affecting facial appearance Oral- Q87.5 Facial-Digital Syndrome Genetic Disorders Congenital malformation syndromes predominantly associated with short stature Q87.89 Noonan's Syndrome Genetic Disorders Congenital malformation syndromes predominantly associated with short stature Russell Q87.1 (-Silver) Syndrome Genetic Disorders Congenital malformation syndromes predominantly involving limbs Q87.2 Holt-Oram (Cardiac-Limb) Syndrome (Atriodigital Dysplasia) (Klippel-Trenaunay-Weber Syndrome) Otopalatodigital Syndrome Genetic Disorders Congenital malformation syndromes predominantly involving limbs Q87.2 Klippel-Trenaunay-Weber Syndrome Genetic Disorders Congenital malformation syndromes predominantly involving limbs Otopalatodigital Q87.2 Syndrome Genetic Disorders Congenital malformation syndromes predominantly involving limbs Otopalatodigital Q87.2 Syndrome Genetic Disorders Q87.2 Congenital malformation syndromes predominantly involving limbs VATER Syndrome

Genetic Disorders Q87.2 Congenital malformation syndromes predominantly involving limbs VATER Syndrome Genetic Disorders Congenital malformation syndromes involving early overgrowth Cerebral Gigantism Q87.3 (Soto's Syndrome) Genetic Disorders Q87.40 Marfan's Syndrome, Unspecified Genetic Disorders Other specified congenital malformation syndromes, not elsewhere classified Q87.89 Langer-Giedion Syndrome (Acrodysplasia V, Klingmuller's) Genetic Disorders Q89.8 Other Specified Congenital Malformations CHARGE Syndrome (CHARGE Association)

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program MEDICAL/BIOLOGICAL RISK CONDITION: Genetic Disorders (Continued)

Condition Type ICD-10 Code Condition/Diagnosis Genetic Disorders Q92.8 Other specified trisomies and partial trisomies of autosomes

Genetic Disorders Q93.7 Deletions with other complex rearrangements

Genetic Disorders Q93.81 Velo-cardio-facial Syndrome

Genetic Disorders Q96.9 Turner's syndrome, unspecified

Genetic Disorders Q97.8 Other specified sex chromosome abnormalities, female phenotype

Genetic Disorders Q98.4 Klinefelter syndrome, unspecified

Genetic Disorders Q98.8 Other specified sex chromosome abnormalities, male phenotype

Genetic Disorders Q99.9 Chromosomal Abnormality, Unspecified, (Coffin-Lowry Syndrome)

Genetic Disorders R62.7 Failure to thrive (child)

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program

MEDICAL/BIOLOGICAL RISK CONDITION: Mental/Psychosocial Disorders A diagnosed physical, mental, or neurobiological condition. The biological or medical risk condition shall be diagnosed by a health care provider and documentation shall be kept on file. Biological and medical risk conditions include the following: (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.)

Condition Type ICD-10 Code Condition/Diagnosis Major Depressive Affective Disorder Single Episode Unspecified (DC 0-3 R: F32.0 Mental/Psychosocial Disorders 231 Type I Major Depression) Episodic Mood Disorder Unspecified (DC 0-3 R: 231 Type II Depressive F39 Mental/Psychosocial Disorders Disorder) Mental/Psychosocial Disorders F40.10 Social Phobia, Unspecified (DC 0-3 R: 220's Anxiety Disorder Disorder) Mental/Psychosocial Disorders F40.8 Other Phobic Anxiety Disorders (DC 0-3 R: 220's Anxiety Disorder Disorder) Mental/Psychosocial Disorders F41.1 Generalized Anxiety Disorder (DC 0-3 R: 220's Anxiety Disorder Disorder) Mental/Psychosocial Disorders F41.9 Anxiety Disorder, unspecified (DC 0-3 R: 225 Anxiety Disorder NOS) Post-traumatic stress disorder, unspecified (DC 0-3 R: 100 Post Traumatic F43.10 Mental/Psychosocial Disorders Stress Disorder) Mental/Psychosocial Disorders F43.20 Adjustment disorder, unspecified (DC 0-3 R: 300 Adjustment Disorder) Adjustment disorder with depressed mood (DC 0-3 R: 210 Prolonged F43.21 Mental/Psychosocial Disorders Bereavement/Grief Reaction) Mental/Psychosocial Disorders F43.22 Adjustment disorder with anxiety (DC 0-3 R: 300 Adjustment Disorder) Adjustment disorder with mixed anxiety and depressed mood (DC 0-3 R: 300 F43.23 Mental/Psychosocial Disorders Adjustment Disorder) Adjustment disorder with disturbance of conduct (DC 0-3 R: 400's Regulation F43.24 Mental/Psychosocial Disorders Disorder of Sensory Processing)

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program MEDICAL/BIOLOGICAL RISK CONDITION: Mental/Psychosocial Disorders (Continued)

Condition Type ICD-10 Code Condition/Diagnosis Adjustment disorder with mixed disturbance of emotions and conduct (DC 0- F43.25 3 R: 150 Deprivation /Maltreatment Disorder or DC 0-3 R: 900 Relationship Mental/Psychosocial Disorders Disorder If PIR-GAS of 40 or below) Mental/Psychosocial Disorders F50.00 Anorexia Nervosa, Unspecified (DC 0-3 R: 600's Feeding Behavior Disorder) Bulimia Nervosa (DC 0-3 R: 600's Feeding Behavior Disorder) Mental/Psychosocial Disorders F50.2 Eating disorder, unspecified (DC 0-3 R: 600's Feeding Behavior Disorder) Mental/Psychosocial Disorders F50.9 Mental/Psychosocial Disorders F51.02 Adjustiment Insominia (DC 0-3 R: 500's Sleep Behavior Disorder) Other insomnia not due to a substance or known physiological condition (DC F51.09 0-3 R: 500's Sleep Behavior Disorder) Mental/Psychosocial Disorders Other Specified Pervasive Developmental Disorder (DC 0-3 R: 710 F84.8 Mental/Psychosocial Disorders Multisystem Development Disorder) Separation anxiety disorder of childhood (DC 0-3 R: 220's Anxiety Disorder F93.0 Mental/Psychosocial Disorders Disorder) Childhood emotional disorder, unspecified (DC 0-3 R: 240 Mixed Disorder of F93.9 Mental/Psychosocial Disorders Emotional Expressiveness) Other childhood disorders of social functioning (DC 0-3 R: 300 Adjustment F43.29 Mental/Psychosocial Disorders Disorder) Mental/Psychosocial Disorders F98.21 Rumination Disorder of Infancy (DC 0-3 R: 600's Feeding Behavior Disorder) Other feeding disorders of infancy and early childhood (DC 0-3 R: 600's F98.29 Mental/Psychosocial Disorders Feeding Behavior Disorder) Mental/Psychosocial Disorders F98.3 PICA of Infancy and Childhood (DC 0-3 R: 600's Feeding Behavior Disorder)

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program

MEDICAL/BIOLOGICAL RISK CONDITION: Neurologic/Musculoskeletal A diagnosed physical, mental, or neurobiological condition. The biological or medical risk condition shall be diagnosed by a health care provider and documentation shall be kept on file. Biological and medical risk conditions include the following: (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.)

Condition Type ICD-10 Code Condition/Diagnosis A87.9 Viral meningitis, unspecified Neurologic/Musculoskeletal Neurologic/Musculoskeletal C72.9 Malignant neoplasm of central nervous system, unspecified Neurologic/Musculoskeletal G03.9 Meningitis, Unspecified Localization-related (focal) (partial) idiopathic epilepsy and epileptic G40.001 syndromes with seizures of localized onset, not intractable, with status epilepticus Neurologic/Musculoskeletal Localization-related (focal) (partial) idiopathic epilepsy and epileptic G40.009 syndromes with seizures of localized onset, not intractable, without status epilepticus Neurologic/Musculoskeletal Localization-related (focal) (partial) idiopathic epilepsy and epileptic G40.011 syndromes with seizures of localized onset, intractable, with status epilepticus Neurologic/Musculoskeletal Localization-related (focal) (partial) idiopathic epilepsy and epileptic G40.019 syndromes with seizures of localized onset, intractable, without status epilepticus Neurologic/Musculoskeletal Localization-related (focal) (partial) symptomatic epilepsy and epileptic G40.111 syndromes with simple partial seizures, not intractable, with status epilepticus Neurologic/Musculoskeletal 24 | Page ICD-10 Codes Revised October 2015

Diagnostic Codes Related to Family Infant Toddler (FIT) Program MEDICAL/BIOLOGICAL RISK CONDITION: Neurologic/Musculoskeletal (continued)

Condition Type ICD-10 Code Condition/Diagnosis Localization-related (focal) (partial) symptomatic epilepsy and epileptic G40.109 syndromes with simple partial seizures, not intractable, without status epilepticus Neurologic/Musculoskeletal Localization-related (focal) (partial) symptomatic epilepsy and epileptic G40.111 syndromes with simple partial seizures, intractable, with status epilepticus Neurologic/Musculoskeletal Localization-related (focal) (partial) symptomatic epilepsy and epileptic G40.011 syndromes with complex partial seizures, not intractable, with status epilepticus Neurologic/Musculoskeletal Localization-related (focal) (partial) symptomatic epilepsy and epileptic G40.009 syndromes with complex partial seizures, not intractable, without status epilepticus Neurologic/Musculoskeletal Localization-related (focal) (partial) symptomatic epilepsy and epileptic G40.019 syndromes with complex partial seizures, intractable, with status epilepticus Neurologic/Musculoskeletal Localization-related (focal) (partial) symptomatic epilepsy and epileptic G40.119 syndromes with complex partial seizures, intractable, without status epilepticus Neurologic/Musculoskeletal Generalized idiopathic epilepsy and epileptic syndromes, not intractable, with G40.301 status epilepticus Neurologic/Musculoskeletal Generalized idiopathic epilepsy and epileptic syndromes, not intractable, G40.309 without status epilepticus Neurologic/Musculoskeletal

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program MEDICAL/BIOLOGICAL RISK CONDITION: Neurologic/Musculoskeletal (continued)

Condition Type ICD-10 Code Condition/Diagnosis Generalized idiopathic epilepsy and epileptic syndromes, intractable, with G40.A11 status epilepticus Neurologic/Musculoskeletal Generalized idiopathic epilepsy and epileptic syndromes, intractable, without G40.A19 status epilepticus Neurologic/Musculoskeletal Other generalized epilepsy and epileptic syndromes, not intractable, with status G40.821 epilepticus Neurologic/Musculoskeletal Other generalized epilepsy and epileptic syndromes, not intractable, without G40.822 status epilepticus Neurologic/Musculoskeletal Other generalized epilepsy and epileptic syndromes, intractable, with status G40.823 epilepticus Neurologic/Musculoskeletal Other generalized epilepsy and epileptic syndromes, intractable, without status G40.824 epilepticus Neurologic/Musculoskeletal G40.801 Other epilepsy, not intractable, with status epilepticus Neurologic/Musculoskeletal G40.802 Other epilepsy, not intractable, without status epilepticus Neurologic/Musculoskeletal G40.803 Other epilepsy, intractable, with status epilepticus Neurologic/Musculoskeletal G40.804 Other epilepsy, intractable, without status epilepticus Neurologic/Musculoskeletal Neurologic/Musculoskeletal G40.812 Lennox-Gastaut Syndrome (Gastaut's Syndrome) G40.901 Epilepsy, unspecified, not intractable, with status epilepticus Neurologic/Musculoskeletal

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program

MEDICAL/BIOLOGICAL RISK CONDITION: Neurologic/Musculoskeletal (continued)

Condition Type ICD-10 Code Condition/Diagnosis G40.909 Epilepsy, unspecified, not intractable, without status epilepticus Neurologic/Musculoskeletal G40.911 Epilepsy, unspecified, intractable, with status epilepticus Neurologic/Musculoskeletal G40.919 Epilepsy, unspecified, intractable, without status epilepticus Neurologic/Musculoskeletal G40.B01 Juvenile myoclonic epilepsy, not intractable, with status epilepticus Neurologic/Musculoskeletal G40.B09 Juvenile myoclonic epilepsy, not intractable, without status epilepticus Neurologic/Musculoskeletal G40.B11 Juvenile myoclonic epilepsy, intractable, with status epilepticus Neurologic/Musculoskeletal G40.B19 Juvenile myoclonic epilepsy, intractable, without status epilepticus Neurologic/Musculoskeletal Neurologic/Musculoskeletal G72.9 Myopathy Unspecified Neurologic/Musculoskeletal G83.89 Other Specified Paralytic Syndromes Neurologic/Musculoskeletal G95.0 Syringomyelia and syringobulbia Neurologic/Musculoskeletal G95.89 Other specified diseases of spinal cord Neurologic/Musculoskeletal H55.89 Other irregular eye movements (Kinsbourne Syndrome) Neurologic/Musculoskeletal I61.9 Nontraumatic intracerebral hemorrhage, unspecified Neurologic/Musculoskeletal P14.0 Erb’s Paralysis due to Birth Injury Neurologic/Musculoskeletal Q03.8 Other congenital hydrocephalus Neurologic/Musculoskeletal Q04.6 Congenital cerebral cysts Q04.8 Other Specified Congenital malformations of brain Neurologic/Musculoskeletal R56.9 Unspecified convulsions Neurologic/Musculoskeletal

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program MEDICAL/BIOLOGICAL RISK CONDITION: Neurologic/Musculoskeletal (continued)

Condition Type ICD-10 Code Condition/Diagnosis S14.3XXA Injury of Brachial Plexus, Initial Encounter Neurologic/Musculoskeletal S14.3XXD Injury of Brachial Plexus, Subsequent Encounter Neurologic/Musculoskeletal S14.3XXS Injury of Brachial Plexus, Sequela Encounter Neurologic/Musculoskeletal Toxic Effects of Lead and Its Compounds, accidental (Sequela), Initial T56.0X1A Encounter Neurologic/Musculoskeletal Toxic Effects of Lead and Its Compounds, accidental (unintentional), Initial T56.0X1A Encounter Neurologic/Musculoskeletal T74.4XXA Shaken infant syndrome, initial encounter Neurologic/Musculoskeletal T74.4XXD Shaken infant syndrome, subsequent encounter Neurologic/Musculoskeletal T74.4XXS Shaken infant syndrome, sequela Neurologic/Musculoskeletal

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program

MEDICAL/BIOLOGICAL RISK CONDITION: Perinatal Factors A diagnosed physical, mental, or neurobiological condition. The biological or medical risk condition shall be diagnosed by a health care provider and documentation shall be kept on file. Biological and medical risk conditions include the following: (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.)

Condition Type ICD-10 Code Condition/Diagnosis Perinatal Factors A33 Tetanus neonatorum Perinatal Factors E80.7 Disorder of bilirubin metabolism, unspecified Triplet pregnancy, unspecified number of placenta and unspecified number of amniotic O30.109 Perinatal Factors sacs, unspecified trimester Perinatal Factors O30.129 Triplet pregnancy with two or more monoamniotic fetuses, unspecified trimester Perinatal Factors Triplet pregnancy, unable to determine number of placenta and number of amniotic sacs, O30.199 unspecified trimester Perinatal Factors P00.9 Newborn (suspected to be) affected by unspecified maternal condition Perinatal Factors P04.3 Newborn (suspected to be) affected by maternal use of alcohol Perinatal Factors P04.41 Newborn (suspected to be) affected by maternal use of cocaine Perinatal Factors P04.49 Newborn (suspected to be) affected by maternal use of other drugs of addiction Perinatal Factors P04.9 Newborn (suspected to be) affected by maternal noxious substance, unspecified Perinatal Factors P05.00 Newborn light for gestational age, unspecified weight Extremely low birth weight newborn, less than 500 grams Perinatal Factors P07.01 Perinatal Factors P07.02 Extremely low birth weight newborn, 500-749 grams Perinatal Factors P07.03 Extremely low birth weight newborn, 750-999 grams Perinatal Factors P07.10 Other low birth weight newborn, unspecified weight Perinatal Factors P07.14 Other low birth weight newborn, 1000-1249 grams

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program

MEDICAL/BIOLOGICAL RISK CONDITION: Perinatal Factors (continued)

Condition Type ICD-10 Code Condition/Diagnosis Perinatal Factors P07.15 Other low birth weight newborn, 1250-1499 grams Perinatal Factors P07.16 Other low birth weight newborn, 1500-1749 grams Perinatal Factors P07.32 Preterm newborn, gestational age 29 completed weeks Perinatal Factors P07.33 Preterm newborn, gestational age 30 completed weeks Perinatal Factors P07.34 Preterm newborn, gestational age 31 completed weeks Perinatal Factors P07.35 Preterm newborn, gestational age 32 completed weeks Perinatal Factors P07.36 Preterm newborn, gestational age 33 completed weeks Perinatal Factors P07.37 Preterm newborn, gestational age 34 completed weeks Perinatal Factors P09 Abnormal findings on neonatal screening Perinatal Factors P29.81 Cardiac arrest of newborn Perinatal Factors P52.0 Intraventricular (nontraumatic) hemorrhage, grade 1, of newborn Perinatal Factors P52.1 Intraventricular (nontraumatic) hemorrhage, grade 2, of newborn Perinatal Factors P52.21 Intraventricular (nontraumatic) hemorrhage, grade 3, of newborn Perinatal Factors P52.22 Intraventricular (nontraumatic) hemorrhage, grade 4, of newborn Perinatal Factors P52.3 Unspecified intraventricular (nontraumatic) hemorrhage of newborn Perinatal Factors P52.5 Subarachnoid (nontraumatic) hemorrhage of newborn Perinatal Factors P61.9 Perinatal hematological disorder, unspecified Perinatal Factors P70.4 Other neonatal hypoglycemia Perinatal Factors P84 Other problems with newborn Intrauterine hypoxia Perinatal Factors P92.9 Feeding problem of newborn, unspecified Perinatal Factors P93.8 Other reactions and intoxications due to drugs administered to newborn Perinatal Factors P04.8 Newborn (Suspected to be) affected by other maternal noxious substances

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program

MEDICAL/BIOLOGICAL RISK CONDITION: Physical Impairments A diagnosed physical, mental, or neurobiological condition. The biological or medical risk condition shall be diagnosed by a health care provider and documentation shall be kept on file. Biological and medical risk conditions include the following: (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.) *Questions Regarding conditions not on this list shall be directed to your FIT Manager who will work with a Department of Health Physician to determine whether a proposed condition will be recognized.

Condition Type ICD-10 Code Condition/Diagnosis Physical Impairments M06.9 Rheumatoid arthritis, unspecified Physical Impairments M41.20 Other idiopathic scoliosis, site unspecified Physical Impairments Q68.0 Congenital Torticollis Physical Impairments Q35.9 Cleft palate, unspecified Physical Impairments Q36.0 Cleft Lip, Bilateral Physical Impairments Q36.9 Cleft Lip, unilateral Physical Impairments Q37.9 Cleft Palate with Cleft Lip Physical Impairments Q71.60 Lobster-claw hand, unspecified hand Physical Impairments Q71.61 Lobster-Claw Right Hand Physical Impairments Q71.62 Lobster-Claw Left Hand Physical Impairments Q71.63 Lobster-Claw Hand, Bilateral Physical Impairments Q73.8 Other Reduction Defects of Unspecified Limbs Physical Impairments Q74.3 Arthrogryposis multiplex congenita Physical Impairments Q74.9 Unspecified Congenital Malformation of Limb(s) Physical Impairments Q75.0 Craniosynostosis Physical Impairments Q75.4 Mandibulofacial Dysostosis (Franschetti-Klein Syndrome) Physical Impairments Q79.0 Congenital Diaphragmatic Hernia Physical Impairments Q79.3 Gastronschisis Physical Impairments Q79.4 Prune Belly Syndrome Physical Impairments Q79.8 Other Congenital Malformations of Musculoskeletal System Poland’s Syndrome Congenital Malformation Syndrome Predominantly Affecting Facial Appearance Q87.0 Physical Impairments Goldenhar’s Syndrome (Oculouriculoverterbral Dysplasia)0

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program

MEDICAL/BIOLOGICAL RISK CONDITION: Sensory Abnormalities A diagnosed physical, mental, or neurobiological condition. The biological or medical risk condition shall be diagnosed by a health care provider and documentation shall be kept on file. Biological and medical risk conditions include the following: (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.)

Condition Type ICD-10 Code Condition/Diagnosis Stereotyped Movement Disorder (Spasmus Nutans) Sensory Abnormalities F98.4 Unspecified ptosis of right eyelid Sensory Abnormalities H02.401 Unspecified ptosis of left eyelid Sensory Abnormalities H02.402 Unspecified ptosis of bilateral eyelids Sensory Abnormalities H02.403 Sensory Abnormalities H50.00 Esotropia Unspecified Sensory Abnormalities H50.10 Exotropia Unspecified Sensory Abnormalities H50.811 Duane’s Syndrome, Right Eye Sensory Abnormalities H50.812 Duane’s Syndrome, Left Eye Sensory Abnormalities H50.89 Other Specified Strabismus Sensory Abnormalities H51.9 Unspecified disorder of binocular movement Sensory Abnormalities H52.00 Hypermetropia, unspecified eye

Sensory Abnormalities H52.01 Hypermetropia, right eye

Sensory Abnormalities H52.02 Hypermetropia, left eye

Sensory Abnormalities H52.03 Hypermetropia, bilateral

Sensory Abnormalities H52.13 Myopia, Bilateral

Sensory Abnormalities H52.10 Myopia, unspecified eye

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program

MEDICAL/BIOLOGICAL RISK CONDITION: Sensory Abnormalities (Continued)

Condition Type ICD-10 Code Condition/Diagnosis Sensory Abnormalities H52.11 Myopia, right eye

Sensory Abnormalities H52.12 Myopia, left eye

Sensory Abnormalities H53.001 Unspecified amblyopia, right eye

Sensory Abnormalities H53.002 Unspecified amblyopia, left eye

Sensory Abnormalities H53.003 Unspecified amblyopia, bilateral

Sensory Abnormalities H53.009 Unspecified Amblyopia

Sensory Abnormalities H53.8 Other visual disturbances Sensory Abnormalities H53.9 Unspecified Visual Disturbance Sensory Abnormalities H53.9 unspecified visual loss (Delayed Visual Maturation) Chronic serous otitis media, unspecified ear Sensory Abnormalities H65.20 Chronic serous otitis media, right ear Sensory Abnormalities H65.21 Sensory Abnormalities H65.22 Chronic serous otitis media, left ear

Sensory Abnormalities H65.23 Chronic serous otitis media, bilateral

Sensory Abnormalities H90.2 Conductive hearing loss, unspecified Congenital ptosis Sensory Abnormalities Q10.0 Sensory Abnormalities Q17.9 Congenital malformation of ear, unspecified

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program

ENVIRONMENTAL RISK FACTORS: Personal History Presenting Hazard to Health A presence of adverse family factors in the child’s environment that increases the risk for developmental delay in children. Eligibility determination shall be made using the Environmental Risk Assessment (ERA) tool approved by the FIT program. (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.)

Condition Type ICD-10 Code Condition/Diagnosis Personal History Presenting Hazard to Health Z77.011 Contact with and (suspected) exposure to lead Other contact with and (suspected) exposures hazardous to Z77.9 Personal History Presenting Hazard to Health health Personal history of adult physical and sexual abuse (e.g., sexual Z91.410 Personal History Presenting Hazard to Health abuse or rape) Personal History Presenting Hazard to Health Z91.412 Personal history of adult neglect (e.g., neglect) Other personal history of psychological trauma, not elsewhere Z91.49 Personal History Presenting Hazard to Health classified Personal History Presenting Hazard to Health Z77.9 Other specified personal risk factors, not elsewhere classified

ENVIRONMENTAL RISK FACTORS: Family History of Certain Chronic Disabling Diseases A presence of adverse family factors in the child’s environment that increases the risk for developmental delay in children. Eligibility determination shall be made using the Environmental Risk Assessment (ERA) tool approved by the FIT program. (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.)

Condition Type ICD-10 Code Condition/Diagnosis Family history of other mental and behavioral Z81.8 Family History of Certain Chronic Disabling Diseases disorders Family history of epilepsy and other diseases of the Z82.0 Family History of Certain Chronic Disabling Diseases nervous system Family history of other diseases of the musculoskeletal Z82.69 Family History of Certain Chronic Disabling Diseases system and connective tissue

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program ENVIRONMENTAL RISK FACTORS: Family History of Certain Other Specific Conditions A presence of adverse family factors in the child’s environment that increases the risk for developmental delay in children. Eligibility determination shall be made using the Environmental Risk Assessment (ERA) tool approved by the FIT program. (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.)

Condition Type ICD-10 Code Condition/Diagnosis Family History of Certain Other Specific Conditions Z81.0 Family History of Intellectual Disabilities

ENVIRONMENTAL RISK FACTORS: Family History of Other Conditions A presence of adverse family factors in the child’s environment that increases the risk for developmental delay in children. Eligibility determination shall be made using the Environmental Risk Assessment (ERA) tool approved by the FIT program. (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.)

Condition Type ICD-10 Code Condition/Diagnosis Family History of Other Conditions Z82.1 Family history of blindness and visual loss Family History of Other Conditions Z82.2 Family history of deafness and hearing loss Family history of other congenital malformations, deformations and Z82.79 Family History of Other Conditions chromosomal abnormalities Family History of Other Conditions Z84.89 Family history of other specified conditions

ENVIRONMENTAL RISK FACTORS: Health Supervision of Infant or Child A presence of adverse family factors in the child’s environment that increases the risk for developmental delay in children. Eligibility determination shall be made using the Environmental Risk Assessment (ERA) tool approved by the FIT program. (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.)

Condition Type ICD-10 Code Condition/Diagnosis Encounter for health supervision and care of other healthy infant and Z76.2 child (e.g., supervision of healthy infant in cases of socioeconomic Health Supervision of Infant or Child adverse condition at home)

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program

ENVIRONMENTAL RISK FACTORS: Housing, Household, and Economic Circumstances A presence of adverse family factors in the child’s environment that increases the risk for developmental delay in children. Eligibility determination shall be made using the Environmental Risk Assessment (ERA) tool approved by the FIT program. (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.)

Condition Type ICD-10 Code Condition/Diagnosis Housing, Household, and Economic Circumstances Z59.0 Homelessness (e.g., Social migrants, Transients) Inadequate housing (e.g., Lack of heating, Restriction of Z59.1 Housing, Household, and Economic Circumstances space) Housing, Household, and Economic Circumstances Z59.6 Low income (e.g., Economic problem, Poverty) Other problems related to housing and economic Z59.8 Housing, Household, and Economic Circumstances circumstances Housing, Household, and Economic Circumstances Z59.9 Unspecified housing or economic circumstance Need for assistance at home and no other household Z74.2 Housing, Household, and Economic Circumstances member able to render care

ENVIRONMENTAL RISK FACTORS: Other Family Circumstances A presence of adverse family factors in the child’s environment that increases the risk for developmental delay in children. Eligibility determination shall be made using the Environmental Risk Assessment (ERA) tool approved by the FIT program. (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.)

Condition Type ICD-10 Code Condition/Diagnosis Other specified problems related to upbringing (e.g., Problem concerning Z62.898 adopted or foster child) Other Family Circumstances Dependent relative needing care at home (e.g., Care of sick or handicapped Z63.6 Other Family Circumstances person in family or household) Other Family Circumstances Z63.72 Alcoholism and drug addiction in family Other Family Circumstances Z62.891 Other specified problems related to primary support group Encounter for mental health services for perpetrator of parental child abuse Z69.010 Other Family Circumstances Counseling for parent-child problem, unspecified

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Diagnostic Codes Related to Family Infant Toddler (FIT) Program

ENVIRONMENTAL RISK FACTORS: Other Family Circumstances (Continued) Condition Type ICD-10 Code Condition/Diagnosis Encounter for mental health services for victim of parental child abuse Z69.020 Other Family Circumstances Counseling for victim of child abuse Encounter for mental health services for victim of spousal or partner abuse Z69.11 Other Family Circumstances (Counseling for victim of spousal and partner abuse) Encounter for mental health services for perpetrator of spousal or partner Z69.12 abuse (Counseling for perpetrator of spousal and partner abuse) Other Family Circumstances Other specified counseling (Counseling for marital and partner problems, Z69.020 Other Family Circumstances unspecified)

ENVIRONMENTAL RISK FACTORS: Other Psychosocial Circumstances A presence of adverse family factors in the child’s environment that increases the risk for developmental delay in children. Eligibility determination shall be made using the Environmental Risk Assessment (ERA) tool approved by the FIT program. (NMAC 7.30.8.10.9 Requirements for Family Infant Toddler Early Intervention Services.)

Condition Type ICD-10 Code Condition/Diagnosis Other Psychosocial Circumstances Z13.4 Encounter for screening for certain developmental disorders in childhood Acculturation difficulty (e.g., Cultural deprivation, Social isolation or Z60.3 Other Psychosocial Circumstances persecution) Problem related to primary support group, unspecified Other Psychosocial Circumstances Z63.9 Other Psychosocial Circumstances Z65.3 Problems related to other legal circumstances (e.g., Imprisonment) Other specified problems related to psychosocial circumstances (e.g., Life Z65.8 Other Psychosocial Circumstances circumstance problems) Other specified problems related to psychosocial circumstances Z64.4 Other Psychosocial Circumstances (Interpersonal problems, not elsewhere classified) Other Psychosocial Circumstances Z65.9 Problem related to unspecified psychosocial circumstances

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