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Group Name DIAGNOSIS ICD-10 CODES Traditional Categories Eligible Diagnoses and Diagnostic Codes for Enhanced Care Coordination Pilot Group Name DIAGNOSIS ICD-10 CODES Traditional Categories Blood Disorders F/S Beta Thalassemia (Major) D56.1 Delta-Beta Thalassemia D56.2 Beta-Thalassemia (Minor) D56.3 Hemoglobin E-Beta Thalassemia D56.5 Hemoglobin S/Beta Thalassemia D57.4 Hemoglobin C D57.20 Hemoglobin SC Disease D57.2 Hemophilia Hereditary Factor VIII Deficiency D66 Hemophilia Hereditary Factor IX Deficiency D67 Other Hemoglobinopathies D58.2 Hemoglobin SS Disease with Crisis, Unspecified D57.00 Sickle - Cell Disease without Crisis D57.1 Thalassemia D56 Von Willebrand Disease D68.0 Cardiac and Circulatory System Disorders Supravalvular Aortic Stenosis Q25.3 Aortopulmonary Septal Defect Q21.4 Atrioventricular Septal Defect Q21.2 Congenital Insufficiency of Aortic Valve Q23.1 Coarctation of Aorta Q25.1 Congenital Malformation of Heart, Unspecified Q24.9 Congenital Heart Block q24.6 Hypoplastic Left Heart Syndrome Q23.4 Hypoplastic Right Heart Syndrome Q22.6 Marfan's Syndrome Q87.4 PDA - Patent Ductus Arteriosus Q25.0 Congenital Pulmonary Valve Stenosis Q22.1 SVT - Superventricular Tachycardia I47.1 Total Anomalous Pulmonary Venous Connection Q26.2 TOF - Tetralogy of Fallot Q21.3 Discordant Ventriculoarterial Connection Q20.3 Congenital Tricuspid Atresia Q22.4 VSD - Ventriculoseptal Defect Q21.0 Atrial Septal Defect Q21.1 1 Pre - excitation Syndrome includes WPW - Wolf-Parkinson-White Syndrome I45.6 Congenital Malformations of Cardiac Chambers and Connection Q20 Congenital Renal Artery Stenosis Q27.1 Congenital Malformations of Circulatory System, Unspecified Q28.9 Congenital Subaortic Stenosis Q24.4 Congenital Malformation of Heart, Unspecified Q24.9 Interruption of Aortic Arch Q25.21 Other Atresia of Aorta Q25.29 Congenital Malformation of Aorta, Unspecified Q25.40 Absence and Aplasia of Aorta Q25.41 Congenital Aneurysm of Aorta Q25.43 Other Congenital Malformations of Aorta Q25.49 Situs Inversus Q89.3 Craniofacial Disorders Apert Syndrome Q87.0 Cleft Palate Q35 Cleft Hard Palate Q35.1 Cleft Soft Palate Q35.3 Cleft Hard Palate with Cleft Soft Palate Q35.5 Cleft Uvula Q35.7 Cleft Palate, Unspecified Q35.9 Cleft Lip Q36 Cleft Lip, Bilateral Q36.0 Cleft Lip, Median Q36.1 Cleft Lip, Unilateral Q36.9 Cleft Palate with Cleft Lip Q37 Other Congenital Malformations of Skull and Face Bones, Cranial Deformity Q75 Craniosynostosis Q75.0 Congenital Malformation Syndrome Predominantly Affecting Facial Appearance, Includes Goldenhar Syndrome and Pierre Robin Q87.0 Treacher-Collins Syndrome Q75.4 Endocrine Disorders CAH - Congenital Adrenal Hyperplasia E25.0 Adrenogenital Disorder Unspecified E25.9 Diabetes Mellitus due to Underlying Condition E08 Type I Diabetes Mellitus E10 2 Type II Diabetes Mellitus E11.8 Type II Diabetes Mellitus with Unspecified Complications E11.8 Congenital Hypothyroidism with Diffuse Goiter E03.0 Congenital Hypothyroidism without Goiter E03.1 ENT Disorders Hearing Loss - Conductive and Sensorineural H90 Hearing Loss - Other and Unspecified H91 Congenital Malformations of Ear Causing impairment of Hearing Q16 Congenital Absence of (Ear) Auricle Causing Hearing Loss Q16.0 Congenital Malformation of Ear Causing Impairment of Hearing, Unspecified Q16.9 Conductive Hearing Loss, Unspecified H90.2 Eye Disorders Other Specified Congenital Malformations of the Eye Q15.8 Aphakia (Aquired) H27.0 Aphakia (Congenital) Q12.3 Aphakia, Unspecified H27.00 Aphakia, Right Eye H27.01 Aphakia, Left Eye H27.02 Aphakia, Bilateral H27.03 Infantile and Juvenile Cataracts H26.0 Congenital Cataracts Q12.0 Eye Surgery - Enophitalmos due to Trauma or Surgery, Right Eye H05.421 Eye Surgery - Enophitalmos due to Trauma or Surgery, Left Eye H05.422 Unspecified Glaucoma H40.9 Legal Blindness, as Defined in USA H54.8 Retinopathy of Prematurity, Unspecified H35.1 Retinopathy of Prematurity, Right Eye H35.101 Retinopathy of Prematurity, Left Eye H35.102 Retinopathy of Prematurity, Bilateral H35.103 Retinopathy of Prematurity, Unspecified, Unspecified Eye H35.109 Presence of Artificial Eye Z97.0 Congenital and/or Genetic Disorders 2-Methylbutyryl-CoA Dehydrogenase Deficiency Long Chain / Very Long Chain E71.310 2-Methylbutyryl-CoA Dehydrogenase Deficiency Medium Chain E71.311 3 2-Methylbutyryl-CoA Dehydrogenase Deficiency Short Chain E71.312 Adrenoleukodystrophy E71.511 Biotindase Deficiency D81.810 CAH - Congenital Adrenal Hyperplasia with Enzyme Deficiency E25.0 Adrenogenital Disorder Unspecified E25.9 Chromosomal Anomaly O28.5 Cystic Fibrosis, Unspecified E84.9 Down Syndrome, Unspecified E90.9 Galactosemia E74.21 Hurler's Syndrome E76.01 Hypomelanosis of Ito (Other Disorder of Diminished melanin Formation) L81.6 Congenital Ichthyosis, Unspecified Q80.9 Marfan Syndrome Q87.4 MCAD E71.311 MSUD Maple Syrup Urine Disease E71.0 Other Unspecified Metabolic Disorders E88 PKU - Phenylketonuria, Classical E70.0 PPA - Propionic Acidemia E71.121 Congenital Malformation Syndrome Predominantly Involving Limbs Includes Rubinstein - Taybi Syndrome Q87.2 Sanfilippo Syndrome E76.22 Turner's Syndrome Q96 TYR I Tyrosinemia Type I E70.21 Fetal Alcohol Syndrome Q86.0 Congenital Cytomegalovirus Infection P35.1 Congenital Toxoplasmosis P37.1 Prune Belly Syndrome Q79.4 Ehlers Danlos, Unspecified Q79.60 Sanfilippo Syndrome E76.22 Hurler's Syndrome E76.01 Pompe Disease E74.02 Other Glycogen Storage Disease E74.09 Mitochondrial Metabolism Disorder, Unspecified E88.40 Trisomy 18, Unspecified Q91.3 Trisomy 13, Unspecified Q91.7 Trisomy and Partial Trisomy of Autosomes, Unspecified Q92.9 Phakomatoses, Not Elsewhere Classified Q85.8 Phakomatoses, Unspecified Q85.9 4 Other Liped Storage Disorder E75.5 Other GM2 Gangliosidosis E75.09 Other Congenital Malformation Syndrome Predominantly Associated with Short Stature Q87.19 VATER Syndrome C24.1 Velocardiofacial Syndrome / Digeorge Syndrome D82.1 Ichthyosis Vulgaris Q80.0 Fragile X Q99.2 Hereditary Vitamin D - Dependent Rickets (Type I) (Type II) E83.32 Other Specified Chromosome Abnormalities Q99.8 Williams Syndrome Q93.82 Prader - Willi Syndrome Q87.11 Klinefelter's Syndrome, Unspecified Q98.4 Marfan's Syndrome, Unspecified Q87.40 Polyostic Fibrous Dysplasia - McCune Albright Stemberg Syndrome Q78.1 Multiple Congenital Anomalies, Not Elsewhere Classified Q89.7 Other Specified Congenital Anomalies Q89.8 Mitochondrial Disorder, Unspecified E88.40 Metabolic Disorder, Unspecified E88.9 Juvenile Dermatoymyositis with Myopathy M33.02 Juvenile Dermatoymyositis without Myopathy M33.03 Rheumatoid Disorders Juvenile Arthritis, Unspecified, Unspecified Site M08.09 Rheumatiod Arthritis, Unspecified M06.9 Genitourinary System Indeterminate Sex, Unspecified - Ambiguous Genitalia Q56.4 Renal Agenesis, Unilateral Q60.0 Renal Agenesis, Bilateral Q60.1 Renal Agenesis, Unspecified Q60.2 Renal Hypoplasia, Unilateral Q60.3 Renal Hypoplasia, Bilateral Q60.4 Renal Hypoplasia, Unspecified Q60.5 Potter's Syndrome Q60.6 Other Unspecified Congenital Malformations of the Bladder and Urethra Q64.7 Hermaphroditism, Not Elsewhere Classified Q56.0 Congenital Malformation of Male Genitalia Organ, Unspecified Q55.9 5 Congenital Malformation of Female Genitalia, Unspecified Q52.9 Congenital Malformation of Ovaries, Fallopian Tubes and Broad Ligaments, Unilateral Q50.01 Congenital Malformation of Ovaries, Fallopian Tubes and Broad Ligaments, Bilateral Q50.02 Developmental Ovarian Cyst Q50.1 Congenital Torision of Ovary Q50.2 Accessory Ovary Q50.31 Ovarian Streak Q50.32 Other Congenital Malformation of Ovary Q50.39 Embryonic Cyst of Fallopian Tube Q50.4 Embryonic Cyst of Broad Ligament Q50.5 Other Congenital Malformations of Fallopian Tube and Broad Ligament Q50.6 Congenital Malformation of Uterus and Cervix, Unspecified Q51.9 Undescended Testicle, Unspecified Q53.9 Ectopic Testicle, Unspecified Q53.00 Hypospadias, Unspecified Q54.9 Indeterminate Sex and Pseudohermaphroditism Q56.4 Other Specified Congenital Malformation of Intestines Q43.8 Neuromuscular Dysfunction of Bladder, Unspecified - Neuogenic Bladder N31.9 Renal Agenesis, Unspecified Q60.2 Renal Dysplasia / Hypoplasia Q61.4 Congenital Hydronephrosis Q62.0 Agenesis of Ureter Q62.4 Hypospadias, Unspecified Q54.9 Polycystic Kidney Infantile Type Q61.1 Malformation of Other Organ Systems Laryngeal Hypoplasia Q31.2 Hirschsprung's Disease Q43.1 Congenital Malformation of Intestines, Unspecified Q43.9 Neurogenic Bowel, Not Elsewhere Classified K59.2 Congenital Malformations of Musculoskeletal System Q79.8 Congenital Tracheomalacia Q32.0 Other Specified Congenital Malformations of Digestive System Q45.8 Gastroschisis Q79.3 6 Congenital Diaphragmatic Hernia Q79.0 Congenital Malformations of the Gastointestional Tract, Unspecified Q40.9 Other Congenital Malformation Syndromes Due to Known Exogenous Causes Q86.8 Congenital Malformation of Respiratory System, Unspecified Q34.9 Atresia of Esophagus with Tracheo - Esophageal Fistula Q39.1 Congenital Tracheo - Esophageal Fistula without Atresia Q39.2 Neurological Disorders Brachial Plexus Disorders G54.0 Cerebral Palsy, Unspecified G80.9 Demyelinating Disorder - Multiple Sclerosis G35 Neurofibromatosis Q85.00 Other Demyelinating Disease of Central Nervous System, Unspecified G37.9 Encephalocele, Unspecified Q01.9 Erbs Palsy, Unspecified G80.9 Fetal Alcohol Syndrome (Dysmorphic) Q86.0 Tuberous Sclerosis Q85.1 Hydrocephalus, Unspecified G91.9 Phakomatosis, Unspecified - Neurocutaneous Syndrome Q85.9 Neurofibromatosis, Unspecified Q85.00 Seizures (Epilepsy) G40 Spina Bifida Occulta Q76.0 Spina Bifida, Unspecified Q05.9 Congenital
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