Child Health Programs Eligibility Conditions 2011-2012
DIAGNOSES BY PROGRAM
CMS BCW FIRST CARE NEWBORN SCREENING HEARING
CATEGORIES, CODES, DIAGNOSES:
001-139: INFECTIOUS AND PARASITIC DISEASES 042 HIV X 052.9 Varicella, congenital X X 079.6 Respiratory syncytial virus (RSV) X 090.9 Syphilis, congenital-unspecified X
140-239: NEOPLASMS 190.5 Malignant neoplasm of retina (includes Retinoblastoma) X 216 Benign neoplasm of skin X X 237.70 Neurofibromatosis X
240-279: ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES, AND IMMUNITY DISORDERS 242.0 Toxic diffuse goiter (Hyperthyroidism) X 243 Congenital hypothyroidism X X X 244 Acquired hypothyroidism X 250 Diabetes mellitus X X 252 Disorders of the parathyroid gland X 253 Disorders of the pituitary gland X 253.3 Pituitary dwarfism X 253.5 Diabetes insipidus X 255 Disorders of adrenal glands X 255.0 Cushing's syndrome X 255.2 Adrenogenital disorders (includes Congenital adrenal hyperplasia) X X 259.0 Delay in sexual development and puberty X 259.1 Precocious sexual development and puberty X 259.8 Other specified endocrine disorders X 270.0 Disturbances of amino-acid transport (includes Cystinosis, Hartnup disease) X 270.1 Phenylketonuria (PKU), Hyperphenylalaninemia X X X Other disturbances of aromatic amino-acid metabolism (includes Albinism, Tyrosinosis, 270.2 Tyrosinuria/Tyrosemia-types I, II, III) X X X X (Albinism) Disturbances of branched-chain amino-acid metabolism (includes Maple syrup urine disease, Methylmalonic acidemia, Propionic acidemia, Isovaleric acidemia, Isobutyryl- 270.3 CoA dehydrogenase) X X X 270.4 Disturbances of sulphur-bearing amino-acid metabolism (includes Homocystinuria) X X X Disorders of urea cycle metabolism (includes Argininosuccinic aciduria, Citrullinemia, Carbamoyl phosphate synthetase I deficiency, Hyperargininemia, Ornithine 270.6 transcarbamylase deficiency) X X X Other disturbances of straight-chain amino-acid metabolism (includes Glutaric aciduria, 270.7 Type I) X X X
Other specified disorders of amino-acid metabolism (includes 2-Hydroxyglutaric aciduria, Lowe syndrome, Molybdenum cofactor deficiency, Pediatric neurotransmitter disease, 270.8 2-Methyl-3-hydroxybutaric aciduria, 2-Methylbutyryl-CoA dehydrogenase) X X X
270.9 Unspecified disorder of amino-acid metabolism (includes 3-Methylglutaconic aciduria) X X X Glycogenosis (includes Pompe disease-Type II, McArdle/myophosphorlase deficiency- 271.0 Type V) X X X (Type II) 271.1 Galactosemia (includes Galactokinase defiency, X X X
1 Child Health Programs Eligibility Conditions 2011-2012
DIAGNOSES BY PROGRAM
CMS BCW FIRST CARE NEWBORN SCREENING HEARING
CATEGORIES, CODES, DIAGNOSES:
Other specified disorders of carbohydrate transport and metabolism (includes Carbohydrate deficiency glycoprotein syndrome-Type I, Fucosidosis, Pyruvate carboxylase 271.8 deficiency, Pyruvate dehydrogenase deficiency) X X Unspecified disorder of carbohydrate transport and metabolism (Includes Schindler's 271.9 Disease) X 272.2 Mixed hyperlipidemia (includes Xanthomatosis) X X Lipoprotein deficiencies (includes Abetalipoproteinemia/Bassen-Kornzweig syndrome, 272.5 Hypobetalipoproteinemia) X X Lipidoses (includeds Infantile Gaucher disease, Cerebrotendinous Xanthomatosis, 272.7 Niemann-Pick syndrome) X X 275.1 Disorders of copper metabolism (includes Wilson's disease) X X 275.3 Disorders of phosphorus metabolism (includes Vitamin D-resistant rickets) X Other specified disorders of mineral metabolism (includes Menkes kinky hair syndrome 275.8 xq12-q13) X X Acidosis (includes 3-Hydroxy-3-Methylglutaryl-CoA Lyase deficiency, 3-Methylcrotonyl- CoA Carboxylase deficiency, B-Ketothiolase deficiency, Multiple-CoA-Carboxylase 276.2 deficiency) X X 277 Other and unspecifieid disorders of metabolism (includes Fumerase deficiency) X 277.0 Cystic Fibrosis X X X
277.2 Other disorders of purine and pyrimidine metabolism (includes Lesch-Nyhan disease) X X Mucopolysacharidosis I (Hunter Syndrome), II (Hurler Syndrome), III (Sanfilippo 277.5 Syndrome) X X 277.6 Other deficiencies of circulating enzymes (includes Biotinidase deficiency) X X X 277.81 Primary carnitine deficiency X X 277.82 Carnitine deficiency due to inborn errors of metabolism X X 277.84 Other secondary carnitine deficiency X X Disorders of fatty acid oxidation (includes the following deficiencies listed below*: LCHAD, 277.85 CUD, CPT1/CPT2, MAD, LCAD/VLCAD, MCADD, SCAD, TFP) X X *3-Hydroxy Long Chain Acyl-CoA Dehydrogenase (LCHAD) Deficiency X X *Carnitine Uptake Defect (CUD) X
*Carnitine palmitoyltranserase deficiencies (CPT1, CPT2) X X X
*Glutaric Aciduria type II, Multiple Acyl-CoA Dehydrogenase (MAD) X X X
*Long Chain/Very Long Chain Acyl-CoA-Dehydrogenase Deficiency (LCAD, VLCAD) X X (VLCAD only) X *Medium-Chain Acyl CoA Dehydrogenase Deficiency (MCADD) X X X *Short chain acyl CoA dehydrogenase deficency (SCAD) X X *Trifunctioinal Protein (TFP) Deficiency X X Peroxisomal disorders (includes Adrenoleukodystrophy, Mevalonate kinase deficiency, 277.86 Zellweger syndrome, Rhizomelic chrondrodysplasia punctata) X X X (Zellweger) Disorders of mitochondrial metabolism (includes deficiencies, syndromes and disorders 277.87 listed below**) X X X **2-Ketoglutarate Dehydrogenase Deficiency X X **Complex I, II, III, IV, V deficiencies X X **Dihydrolipoyl Dehydrogenase deficiency X X **Kearns-Sayre syndrome X X X **Oxidative Phosphorylation Disorders X X
2 Child Health Programs Eligibility Conditions 2011-2012
DIAGNOSES BY PROGRAM
CMS BCW FIRST CARE NEWBORN SCREENING HEARING
CATEGORIES, CODES, DIAGNOSES:
**MELAS: Mitochondrial encephalomyopathy/lactic acidosis & strokelike episodes X X **MERRF: Myoclonic epilepsy with ragged red fibers X X X **NARP: Neurogenic weakness, ataxia, retinitis pigmentose X X 277.9 Unspecified disorder of metabolism (includes Enzymopathy NOS) X 279.11 DiGeorge’s syndrome X X to be added X
280-289: DISEASES OF THE BLOOD AND BLOOD-FORMING ORGANS 282 Herediatary hemolytic anemias X Other hemolytic anemias due to enzyme deficiency (includes Triosephosphate Isomerase 282.3 Deficiency/TPI) X X 282.4 Thalessemia X X 282.6 Sickle-cell disease X X X 282.7 Other hemoglobinopathies X X 286 Coagulation defects X
290-319: MENTAL DISORDERS 299.00 Autistic disorder current or active state X 299.10 Childhood disintegrative disorder current or active state X Other specified pervasive developmental disorders current or active state (includes 299.80 Asperger's disorder) X Unspecified pervasive developmental disorder current or active state (Includes Pervasive 299.90 Developmental Disorder NOS/PDD-NOS) X
320-389: DISEASES OF THE NERVOUS SYSTEM AND SENSE ORGANS
320 Bacterial Meningitis (for BCW: with Neurological sequelae/Severe neurological insult) X X 321 Meningitis due to other organisms X 323.9 Unspecified cause of encephalitis X Leukodystrophy (Includes Krabbe's disease, Pelizaeus-Merzbacher disease, Canavan 330.0 disease) X X Cerebral lipidoses (includes Sandhoff disease, Batten disease, Tay-Sachs, 330.1 Gangliosidosis/GM1, GM2) X X X 330.3 Cerebral degeneration of childhood in other diseases classified elsewhere X Other specified cerebral degenerations in childhood (includes Leigh's disease, Rett's 330.8 syndrome) X X X 330.9 Unspecified cerebral degeneration in childhood X 331.3 Communicating hydrocephalus X X X 331.4 Obstructive hydrocephalus X X X 331.9 Cerebral degeneration unspecified (includes Cortical atrophy) X X X Other extrapyramidal disease and abnormal movement disorders (includes Hallervorden- 333.0 Spatz syndrome, Huntington's Chorea) X X (Hallevorden-Spatz) 335.0 Werdnig-Hoffmann Disease (includes Infantile Spinal Muscular Atrophy) X X 335.11 Kugelberg-Welander disease X X 342.00 Flaccid hemiplegia and hemiparesis affecting unspecified side X 342.01 Flaccid hemiplegia and hemiparesis affecting dominant side X 342.02 Flaccid hemiplegia and hemiparesis affecting nondominant side X 342.1 Spastic hemiplegia and hemiparesis affecting unspecified side X 342.11 Spastic hemiplegia and hemiparesis affecting dominant side X 342.12 Spastic hemiplegia and hemiparesis affecting nondominant side X 342.80 Other specified hemiplegia and hemiparesis affecting unspecified side X
3 Child Health Programs Eligibility Conditions 2011-2012
DIAGNOSES BY PROGRAM
CMS BCW FIRST CARE NEWBORN SCREENING HEARING
CATEGORIES, CODES, DIAGNOSES:
342.81 Other specified hemiplegia and hemiparesis affecting dominant side X 342.82 Other specified hemiplegia and hemiparesis affecting nondominant side X 342.90 Unspecified hemiplegia and hemiparesis affecting unspecified side X 342.91 Unspecified hemiplegia and hemiparesis affecting dominant side X 342.92 Unspecified hemiplegia and hemiparesis affecting nondominant side X 343.0 Congenital diplegia (includes Congenital paraplegia) X X 343.1 Congenital hemiplegia X X 343.2 Congential quadriplegia X X 343.3 Congenital monoplegia X X 343.4 Infantile hemiplegia X X 343.8 Other specified infantile cerebral palsy X X X 343.9 Infantile cerebral palsy unspecified X X X 344.00 Quadriplegia unspecified X 344.01 Quadriplegia c1-c4 complete X 344.02 Quadriplegia c1-c4 incomplete X 344.03 Quadriplegia c5-c7 complete X 344.04 Quadriplegia c5-c7 incomplete X 344.09 Other quadriplegia X 344.1 Paraplegia X X 344.2 Diplegia of upper limbs X X 344.30 Monoplegia of lower limb affecting unspecified side X X 344.31 Monoplegia of lower limb affecting dominant side X X 344.32 Monoplegia of lower limp affecting nondominant side X X 344.40 Monoplegia of upper limb affecting unspecified side X X 344.41 Monoplegia of upper limb affecting dominant side X X 344.42 Monoplegia of upper limp affecting nondominant side X X 344.5 Unspecified monoplegia X 344.6 Cauda equina syndrome X 344.61 Cauda equina with neurogenic bladder X 344.9 Paralysis unspecified X 345 Epilepsy X X X 347.00 Cataplexy and Narcolepsy (narcolepsy with/without cataplexy) X 348.0 Cerebral cysts X 348.1 Anoxic brain dmage X 348.3 Encephalopathy NEC (for BCW: with Neurological sequelae) X X 348.31 Metabolic encephalopathy X X 348.39 Other encephalopathy X X 348.81 Temporal sclerosis X X 348.89 Other conditions of brain X 348.9 Unspecified condition of brain X 349.9 Unspecified disorders of nervous system X 356.0 Heriditary peripheral neuropathy (includes Dejerine-Sottas disease) X X 356.1 Peroneal muscular atrophy (includes Charcot-Marie-Tooth disease) X X X 356.3 Refsum's disease X X X 358.9 Myoneural disorders unspecified (includes Neuromyopathy NEC) X X
359.0 Congenital hereditary muscular dystrophy (includes diseases/disorders below***) X X X ***Central Core Disease X X ***Congenital muscular dystrophy (Fukuyama) X X X ***Infantile Neuroaxonal dystrophy (Seitelberger's disease II) X X ***Myotubular Myopathy (MTM) X X ***Nemaline Myopathy (NM), Nemaline Rod Myopathy X X
4 Child Health Programs Eligibility Conditions 2011-2012
DIAGNOSES BY PROGRAM
CMS BCW FIRST CARE NEWBORN SCREENING HEARING
CATEGORIES, CODES, DIAGNOSES:
Hereditary progressive muscular dystrophy (includes Duchenne MD, Emery-Dreifuss MD. 359.1 Facioscapulohumeral MD, Limb-girdle MD) X 359.21 Myotonic muscular dystrophy (includes Steinert's disease) X X X 359.22 Myotonia Congenital (includes Thomsen's disease) X X 361.0 Retinal detachment with retinal defect X 362.0 Diabetic retinopathy X 362.12 retinopathy X X 362.26 Retinopathy of Prematurity - Grade 4 X X 362.27 Retinopathy of Prematurity - Grade 5 X X Dystrophies primarily involving the retinal pigment epithelium (includes Leber's Congenital 362.76 Amaurosis) X X 365 Glaucoma X 366 Cataracts X 368.00 Amblyopia, unspecified X 369.00 Blindness of both eyes impairment level not further specified X X 369.01 Better eye total vision impairment; lesser eye not further specified X X 369.02 Better eye near total vision impairment; lesser eye not further specified X X 369.03 Better eye near total vision impairment; lesser eye total vision impairment X X 369.04 Better eye near total vision impairment; lesser eye near total vision impairment X X 369.05 Better eye profound vision impairment; lesser eye not further specified X X 369.06 Better eye profound vision impairment; lesser eye total vision impairment X X 369.07 Better eye profound vision impairment; lesser eye near total vision impairment X X 369.08 Better eye profound vision impairment; lesser eye profound vision impairment X X 369.11 Better eye severe vision impairment; lesser eye blind not further specified X X 369.12 Better eye severe vision impairment; lesser eye total vision impairment X X 369.13 Better eye severe vision impairment; lesser eye; near total vision impairment X X 369.14 Better eye sever vision impairment; lesser eye profound vision impairment X X 369.2 Moderate or Severe vision Impairment, both eyes X 369.3 Unqualified visual loss both eyes X 369.6 Profound vision impairment, one eye X 374.30 Ptosis of the eyelid unspecified (interfering with vision) X 377.11 Primary optic atrophy X X 377.75 Cortical blindness X X 378 Strabismus X 379.31 Aphakia (absence of lens) X 385.3 Cholesteatoma of middle ear and mastoid X X Hearing loss (defined as a threshold of 20 decibels or more in the in speech range 389 frequencies (500-4000) in the better ear) X X 389.0 Conductive hearing loss X X 389.06 Conductive hearing loss, bilateral X X 389.1 Sensorineural hearing loss X X 389.11 Sensory hearing loss (bilateral) X X X 389.12 Neural hearing loss (bilateral) X X X 389.18 Sensorineural hearing loss, bilateral X X X Mixed conductive and sensorineural 389.2 hearing loss X X 389.22 Mixed hearing loss, bilateral X X 389.8 Other specified forms of hearing loss (mild-moderate, bilateral) X X 389.9 Unspecified hearing loss (Deafness) (bilateral) X X X
390-459: DISEASES OF THE CIRCULATORY SYSTEM 393 Chronic rheumatic pericarditis X
5 Child Health Programs Eligibility Conditions 2011-2012
DIAGNOSES BY PROGRAM
CMS BCW FIRST CARE NEWBORN SCREENING HEARING
CATEGORIES, CODES, DIAGNOSES:
394 Disease of mitral valve X 395 Disease of aortic valve X 396 Disease of mitral and aortic valves X 397.0 Disease of tricuspid valve X 397.1 Rheumatic disease of pulmonary valve X 397.9 Rheumatic disease of endocardium valve, unspecified X 398.0 Rheumatic myocarditis X 398.91 Rheumatic heart failure (congestive) X 414.10 Aneurysm of heart wall X 414.11 Aneurysm of coronary vessel X 415.0 Acute cor pulmonale X 416.0 Primary pulmonary hypertension X X 416.1 Kyphoscoliotic heart disease X 422 Acute myocarditis X 424.0 Mitral valve disorders X 424.1 Aortic valve disorders X 424.2 Tricuspid valve disorders X 424.3 Pulmonary valve disorders X 424.9 Endocarditis, valve unspecified X 425 Cardiomyopathy X 426 Conduction disorders X 427 Cardiac dysrhythmia X 428 Heart failure X 429.0 Myocarditis, unspecified X 429.3 Cardiomegaly X 446.1 Acute febrile mucocutaneous lymph node syndrome (includes Kawasaki disease) X X
460-519: DISEASES OF THE RESPIRATORY SYSTEM 478.4 Polyp of vocal cord or larynx X 478.74 Stenosis of larynx X 493 Asthma X 496 Chronic airway obstruction not elsewhere classified X
520-579: DISEASES OF THE DIGESTIVE SYSTEM 520 Anodontia X Dentofacial anomalies, malocclusion (not to include routine dental care or cosmetic 524 orthodonture) X 530.13 Eosinophilic Esophagitis X 555.9 Regional enteritis of unspecified site (includes Crohn's Disease) X
580-629: DISEASES OF THE GENITOURINARY SYSTEM 593.7 Vesicoureteral reflux X
630-679: COMPLICATIONS OF PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM No listings
680-709: DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE 701.4 Keloid scar (only if painful, not for cosmetic purposes) X 709.2 Scar conditions and fibrosis of skin- Follow-up X
710-739: DISEASES OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE
6 Child Health Programs Eligibility Conditions 2011-2012
DIAGNOSES BY PROGRAM
CMS BCW FIRST CARE NEWBORN SCREENING HEARING
CATEGORIES, CODES, DIAGNOSES:
710.0 Systemic lupus erythematosus X 714.0 Rheumatoid arthritis X 714.3 Juvenile chronic polyarthritis X 727.81 Contracture of tendons X 728.3 Other specific muscle disorders (includes Arthrogryposis) X 730.1 Osteomyelitis - chronic X 732.1 Juvenile osteochondrosis of hip and pelvis (includes Legg-Calve-Perthes) X 732.2 Nontraumatic slipped upper femoral epiphysis X Juvenile osteochondrosis of lower extremity, excluding lower foot (includes Osgood- 732.4 Schlatter’s disease) X 733.4 Aseptic necrosis of bone X 733.41 Aseptic necrosis of head of humerus X 733.42 Aseptic necrosis of head and neck of femur X 733.43 Aseptic necrosis of medial femoral condyle X 733.8 Malunion and nonunion of fracture X 736.2 Other acquired deformities of finger X 736.3 Acquired deformities of hip X 736.31 Coxa valga (acquired) X 736.32 Coxa vara (acquired) X 736.4 Genu valgum or varum (acquired) X 736.5 Genu recurvatum (acquired) X 736.6 Other acquired deformities of knee X 736.7 Other acquired deformities of ankle and foot X 736.8 Acquired deformities of other parts of limbs X 736.81 Unequal leg length (acquired) X 736.9 Acquired deformity of limb, site unspecified X 737 Curvature of spine X 737.1 Kyphosis (acquired) X 737.2 Lordosis (acquired) X 737.30 Scoliosis (and kyphoscoliosis) idioipathic X 737.4 Curvature of spine associated with other conditions X
740-759: CONGENITAL ANOMALIES 740.0 Anencephalus X X 740.1 Craniorachischisis X X 740.2 Iniencephaly X X 741 Spina Bifida X X X X
741.0 Spina Bifida with hydrocephalus (includes Arnold-Chiari Syndrome, Chiari Malformation) X X X X 741.01 Spina bifida cervical region, with hydrocephalus X X X 741.02 Spina bifida dorsal (thoracic) region with hydrocephalus X X X 741.03 Spina bifida lumbar region with hydrocephalus X X X 741.91 Spina bifida cervical region without hydrocephalus X X X 741.92 Spina bifida dorsal (thoracic) region without hydrocephalus X X X 741.93 Spina bifida lumbar region without hydrocephalus X X X Spina Bifida without mention of hydrocephalus (includes Myelomeningocele without 741.9 hydrocephalus) X X X X 742.0 Encephalocele X X X 742.1 Microcephalus X X X X
7 Child Health Programs Eligibility Conditions 2011-2012
DIAGNOSES BY PROGRAM
CMS BCW FIRST CARE NEWBORN SCREENING HEARING
CATEGORIES, CODES, DIAGNOSES:
Congenital reduction deformities of brain (includes Agenesis of corpus callosum, Holoprosencephaly, Lissencephaly, Agyria, Microgyria, Polymicrogyria, Septo-optic 742.2 dysplasia, Aicardi syndrome) X X X Congenital hydrocephalus (includes Dandy Walker Syndrome, Walker-Warburg 742.3 Syndrome, Hydranencephaly) X X X X Other specified congenital anomalies of brain (includes Macroencephaly, 742.4 **Megalencephaly, **Porencephaly, **Schizencephaly) X X (only those with **) 742.51 Diastematomyelia X X 742.53 Hydromyelia X X
742.59 Other specified congenital anomalies of spinal cord X X Other specified congenital anomalies of nervous system (includes Riley-Day syndrome, 742.8 Familial dysautonomia) X X Unspecified congenital anomaly of brain spinal cord and nervous system (includes Cebocephaly, Colpocephaly, Ethmocephaly, Isotretinoin or Accutane Embryopathy/IE, 742.9 Schinzel-Giedion syndrome/SGS) X X 743 Congenital anomalies of eye X 743.0 Anophthalmos X X 743.1 Microphthalmos (bilateral) X X Specified congenital anomalies of optic disc (includes Coloboma of optic disc 743.57 [congenital], bilateral) X X
743.62 Congenital deformities of eyelids (includes Ablepharon Macrostomia syndrome) X X 744.0 Congenital anomalies of ear causing impairment of hearing X X 745.0 Common truncus X X 745.1 Transposition of great vessels X X X 745.2 Tetralogy of Fallot X X X 745.3 Common ventricle X X 745.4 Ventricular septal defect X X 745.5 Atrial septal defect - ostium secundum type X X 745.6 Endocardial cushion defects X X 745.69 Other endocardial cushion defects (includes Atrioventricular canal) X X 746 Other congenital anomalies of heart X X 746.0 Anomalies of pulmonary valve congenital X X 746.1 Tricuspid atresia and stenosis congenital X X X 746.2 Ebstein’s anomaly X X X 746.3 Congenital stenosis of aortic valve X X 746.5 Congenital mitral stenosis X X 746.6 Congenital mitral insufficiency X X 746.7 Hypoplastic left heart syndrome X X X X 746.86 Congenital heart block X X 746.87 Malposition of heart and cardiac apex X X
Unspecified congenital anomaly of heart (**for BCW only: Congenital Heart Disease co- 746.9 occurring with either 759.0 [Polysplenia or Asplenia] or 759.3 [Situs inversus]) X X** X 747.0 Patent ductus arteriosus X X 747.1 Coarctation of aorta X X X 747.3 Congenital anomalies of pulmonary artery X X X 747.4 Congenital anomalies of great veins X X 747.41 Total anomalous pulmonary venous connection X X X X 748.0 Choanal atresia X
8 Child Health Programs Eligibility Conditions 2011-2012
DIAGNOSES BY PROGRAM
CMS BCW FIRST CARE NEWBORN SCREENING HEARING
CATEGORIES, CODES, DIAGNOSES:
Other congenital anomalies of larynx, trachea, bronchus (includes Tracheomalacia, 748.3 congenital) X 748.61 Congenital bronchiectasis X 749 Cleft palate and cleft lip X X X 749.10 Cleft lip, unspecified X X X 750.0 Tongue tie X 750.3 Congenital tracheoesophageal fistula, esophageal atresia and stenosis X X 751.0 Meckel's diverticulum X 751.1 Congenital atresia and stenosis of small intestine X Congenital atresia and stenosis of large intestine rectum and anal canal (includes Bowel 751.2 atresia, Imperforate anus) X 751.3 Hirschsprungs disease and other congenital function disorders of colon X 751.5 Other congenital anomalies of intestine (includes Duplication of rectum) X 752 Congenital anomalies of genital organs 752.5 Undescended and retractile testicle(s) X 752.6 Hypospadias and epispadias and other penile anomalies X 752.7 Indeterminate sex and pseudohermaphroditism X 753 Congenital anomalies of urinary system 753.1 Cystic kidney disease X 753.20 Congenital obstructive defect of renal pelvis and ureter X 753.3 Other specified anomalies of kidney (includes Horseshoe kidney) X 753.4 Other specified anoamlies of ureter (includes Duplication of ureters) X 753.5 Exstrophy of urinary bladder X 753.6 Congenital atresia and stenosis of urethra and bladder neck X 753.8 Other specified anomalies of bladder and urethra X 754.0 Congenital musculoskeletal deformities of skull, face, and jaw X
754.1 Congenital musculoskeletal deformities of sternocleidomastoid muscle (includes Torticollis) X 754.2 Congenital musculoskeletal deformities of spine X 754.3 Congenital dislocation of hip X 754.50 Congenital talipes varus X 754.51 Congenital talipes equinovarus (includes Club foot) X 754.6 Congenital valgus deformities of feet X 754.81 Pectus excavatum (funnel chest) X 754.82 Pectus carinatum (pigeon chest) X Other specified nonteratogenic anomalies (includes Arthrogryposis Muliplex 754.89 Congenita/AMC, Club hand) X X 755.0 Polydactyly X 755.1 Syndactyly X 755.2 Reduction deformities of upper limb congenital X 755.3 Congenital reduction deformities of lower limb X 755.55 Acrocephalosyndactyly, Type I (Apert Syndrome, Pfeiffer’s Syndrome) X X X 755.61 Coxa valga, congenital X 755.62 Coxa vara, congenital X 755.64 Congenital deformity of knee (joint) X Congenital anomalies of skull and face bones (includes Crouzon's, Pierre-Robin, Treacher Collins, Craniofacial dysplasia, Craniostenosis, Craniosynostosis, Shprintzen- 756.0 Goldberg Craniosynostosis Syndrome) X X 756.1 Congenital anomalies of spine X 756.12 Spondylolisthesis X
9 Child Health Programs Eligibility Conditions 2011-2012
DIAGNOSES BY PROGRAM
CMS BCW FIRST CARE NEWBORN SCREENING HEARING
CATEGORIES, CODES, DIAGNOSES:
756.14 Hemivertebra X 756.16 Klippel-Feil Syndrome X X X 756.3 Other conenital anomalies of ribs and sternum X 756.4 Chondrodystrophy (includes Achondroplasia, Chondrodysplasia) X X 756.5 Congenital osteodystrophies (includes Bannayan-Riley-Ruvalcaba Syndrome) X X 756.51 Osteogenesis imperfecta X X X 756.6 Congenital anomalies of diaphragm (includes Congenital diaphragmatic hernia) X 756.73 Gastroschisis X 756.83 Ehlers Danlos Syndrome X Other and unspecified congenital anomalies of musculoskeletal system (includes 756.9 Camptomelic dysplasia) X X 757.1 Ichthyosis congenita X 757.33 Incontinentia pigmenti (also known as Hypomelanosis of Ito) X X 757.39 Other specified congenital anomalies of skin X 758 Chromosomal anomalies X X 758.0 Trisomy 21 (Down Syndrome) X X X X 758.0 Trisomy 22/Cat Eye Syndrome (Coloboma of Iris-Anal Atresia Syndrome) X X 758.1 Trisomy 13 (Patau’s Syndrome) X X X 758.2 Trisomy 16, Trisomy 18 (Edwards’ Syndrome) X X X 758.3 Trisomy 11 mosaicism X X 758.31 Cri-du-Chat Syndrome (Deletion 5p syndrome) X X X
758.32 Velo-Cardio-Facial Syndrome; Shprintzen Syndrome (Deletion 22q11 syndrome) X X X Other Autosomal deletion syndromes del. 3p, 4p, 4q, 7, 9p, 9q, 11q, 13q, 18p, 18q, 22 758.33 (includes Miller-Deiker syndrome, Smith-Magenis syndrome) X X X Other autosomal deletions (Includes Aniridia-Wilms Tumor Association/WAGR syndrome 758.39 - del. 11p13) X X 758.4 Balanced autosomal translocation in normal individual X 758.4 Trisomy 16 mosaicism X X Other conditions due to autosomal anomalies (includes Tetrasomy 12p/Pallister-Killain 758.5 syndrome, Trisomy 8, Trisomy 9,10,15, & 19 mosaicism) X X X 758.6 Gonadal dysgenesis (includes XO syndrome, Turner syndrome) X X X 758.7 Klinefelter’s Syndrome X X X Triploidy and diploid/triploid 758.8 mixooploid syn (69,xxy; 46,xx/69xxy) X X Other chromosmal anomalies 758.8 dup. 3q, 4p,9q, 10q, 15q X X Other conditions due to sex chromosome anomalies (includes XYY, XXX, XXXX XXXY, 758.81 XXXXX XXXXY syndromes) X X 758.89 Other conditions due to chromosome anomalies X X 758.9 Trisomy 7 mosaicism X 759.5 Tuberous Sclerosis (TS) X X
759.6 Other congenital hamartoses not elsewhere classified (includes Sturge-Weber Syndrome) X X 759.7 Multiple congenital anomalies so described X X 759.81 Prader-Willi Syndrome X X 759.82 Marfan Syndrome X X 759.83 Fragile X Syndrome X X X
10 Child Health Programs Eligibility Conditions 2011-2012
DIAGNOSES BY PROGRAM
CMS BCW FIRST CARE NEWBORN SCREENING HEARING
CATEGORIES, CODES, DIAGNOSES:
Other specified congenital anomalies (includes the following syndromes: Angelman, Brachman-de Lange, CHARGE Association, Cockayne's, Cornelia de Lange's, Joubert, 759.89 Mohr's -types I and II, Noonan's, Rubinstein-Taybi's, Smith-Lemli-Opitz, Williams) X X X Congenital malformation syndrome affecting multiple systems, not elsewhere classified - 759.89 Beckwith, Vater, Goldenhar, Knist, etc. X X
760-779: CERTAIN CONDITIONS ORIGINATING IN THE PERINATAL PERIOD Alcohol affecting fetus or newborn via placenta or breast milk (includes Fetal Alcohol 760.71 Syndrome) X X Anti-infectives affecting fetus or newborn via placenta or breast milk (includes 760.74 Methylmercury poisoning, severe) X X
Anticonvulsants affecting fetus or newborn via placenta or breastmilk (includes 760.77 Phenytoin/Dilantin, Valproic acid, Phenobarital, Carbamazepine) X Antimetabolic agents affecting fetus or newborn via placenta or breast milk (includes 760.78 Aminopterin) X Other noxious influences affecting fetus or newborn via placenta or breast milk (includes 760.79 Accutane, Dicumarol, Thalidomide) X 765.00 Disorders relating to extreme immaturity of infant unspecified weight X 765.01 Disorders relating to extreme immaturity of infant <500 gms X 765.02 Disorders relating to extreme immaturity of infant 500-749 gms X 765.03 Disorders relating to extreme immaturity of infant 750-999 gms X 765.04 Disorders relating to extreme immaturity of infant 1000-1249 gms X 765.05 Disorders relating to extreme immaturity of infant 1250-1499 gms X 765.06 Disorders relating to extreme immaturity of infant 1500-1749 gms X 765.07 Disorders relating to extreme immaturity of infant 1750-1999 gms X 765.08 Disorders relating to extreme immaturity of infant 2000-2499 gms X 765.10 Disorders relating to other preterm infants unspecified weight X 765.11 Disorders relating to other preterm infants <500 gms X 765.12 Disorders relating to other preterm infants 500-749 gms X 765.13 Disorders relating to other preterm infants 750-999 gms X 765.14 Disorders relating to other preterm infants 1000-1249 gms X 765.15 Disorders relating to other preterm infants 1250-1499 gms X 765.16 Disorders relating to other preterm infants 1500-1749 gms X 765.17 Disorders relating to other preterm infants 1750-1999 gms X 765.18 Disorders relating to other preterm infants 2000-2499 gms X 767.0 Subdural and cerebral hemorrhage due to birth trauma (Injury during perinatal period) X
768.5 Severe birth asphyxia (with neurlogic involvement - APGAR < or equal to 3 at 5 minutes) X X 768.70 Hypoxic-ischemic encephalopathy (HIE) unspecified X X X 769 Respiratory distress syndrome in newborn X Chronic respiratory disease arising in the perinatal period (includes Bronchopulmonary 770.7 dysplasia) X X Unpecified respiratory condition of fetus and newborn (significant respiratory distress - vent. 770.9 > 48 hrs.) X 771.0 Congenital rubella X X 771.1 Congenital cytomegalovirus (CMV) infection X X
11 Child Health Programs Eligibility Conditions 2011-2012
DIAGNOSES BY PROGRAM
CMS BCW FIRST CARE NEWBORN SCREENING HEARING
CATEGORIES, CODES, DIAGNOSES:
Other congenital infections specific to the perinatal period (includes Herpes Simplex - 771.2 congenital, Toxoplasmosis) X X X 772.13 Intraventricular Hemorrhage (IVH) Grade III X X X 772.14 Intraventricular Hemorrhage (IVH) Grade IV X X X
774.6 Unspecified fetal and neonatal jaundice (Hyperbilirubinemia requiring exchange transfusion) 775.2 Neonatal myasthenia gravis X 777.53 Stage III necrotizing enterocolitis (NEC) in newborn X 779.0 Convulsions in newborn (seizures) X 779.7 Periventricular (or Preventricular) Leukomalacia (PVL) X X X
780-799: SYMPTOMS, SIGNS, AND ILL-DEFINED CONDITIONS 783.41 Failure to Thrive X Other abnormal clinical findings FOR DIAGNOSTIC PERIOD ONLY - NOT TO EXCEED 6 796.4 (SIX) MONTHS X
800-999: INJURY AND POISONING 887 Traumatic amputation of arm and hand (partial)(complete) X 896 Traumatic amputation of foot (complete)(partial) X 897 Traumatic amputation of leg(s) (partial)(complete) X 959.01 Other and unspecified injury to head NEC X X 984 Toxic effect of lead and its compounds (including fumes) X X 995.55 Shaken baby syndrome X 996.83 Complicatons of transplanted heart X X
12 To search document for condition with unknown diagnostic code:
1. The easiest way to search the document is to press the "Ctrl" key along with "F" (for "Find"), then follow the instructions in #2 below. Alternatively, you may also locate codes/conditions by using the toolbar. Using Excel 2007, inside the "Home" tab of the toolbar, locate the "Find & Select" button (with the binocular icon) on the far right of the toolbar. Click the button and select "Find" in the drop-down menu. NOTE: In older versions of Excel, click "Edit" above the toolbar, then on the drop-down list, select "Find" (with binocular icon).
2. A small box entitled "Find and Replace" will open containing two tabs labeled "Find" and "Replace". box The "Find" tab will be on top. At the "Find what" box, enter the name of the diagnosis you want to search for. Click the "Find All" button to locate the diagnosis within the document. The location of the search term entered (indicated by cell's letter and number) will appear below within the "Find and Replace" box. The search term will also be highlighted on the worksheet/spreadsheet in the location specified by the "Find and Replace" box. ADDED
277.85 *Short chain acyl CoA dehydrogenase deficency (SCAD) added under CMS 11/16/2011 282.4 Thalessemia added under CMS 11/16/2011 348.31 Metabolic encephalopathy added under CMS 11/16/2011 348.39 Other encephalopathy added under CMS 11/16/2011 348.81 Temporal Sclerosis added under CMS 11/16/2011 356.0 Hereditary peripheral neuropathy (incl. Dejerine-Sottas disease) added under CMS 11/16/2011 740.0 Anencephalus added under CMS 11/16/2011 740.1 Craniorachischisis added under CMS 11/16/2011 740.2 Iniencephaly added under CMS 11/16/2011 742.51 Diastematomyelia added under CMS 11/16/2011 742.53 Hydromyelia added under CMS 11/16/2011 Other specified congenital anomalies of nervous system (includes Riley-Day syndrome, Familial 742.8 dysautonomia) added under CMS 11/16/2011 747.41 Total anomalous pulmonary venous connection added under CMS 11/16/2011 758.4 Trisomy 16 mosaicism added under CMS 11/16/2011 Other conditions due to autosomal anomalies (includes Tetrasomy 12p/Pallister-Killain syndrome, 758.5 Trisomy 8, Trisomy 9,10,15, & 19 mosaicism) added under CMS 11/16/2011 758.9 Trisomy 7 mosaicism added under CMS 11/16/2011 Other specified congenital anomalies (includes the following syndromes: Angelman, Brachman-de Lange, CHARGE Association, Cockayne's, Cornelia de Lange's, Joubert, Mohr's -types I and II, 759.89 Noonan's, Rubinstein-Taybi's, Smith-Lemli-Opitz) added under CMS 11/16/2011 768.5 Severe birth asphyxia (with neurlogic involvement - APGAR < or equal to 3 at 5 minutes) added under CMS 11/16/2011 768.70 Hypoxic-ischemic encephalopathy (HIE) unspecified added under CMS 11/16/2011 Disorders of fatty acid oxidation (includes the following deficiencies listed below*: LCHAD, CUD, 277.85 CPT1/CPT2, MAD, LCAD/VLCAD, MCADD, SCAD, TFP) *Long Chain/Very Long Chain Acyl-CoA-Dehydrogenase Deficiency (LCAD, VLCAD) added VLCAD (only) under BCW 1/6/2012 Disorders of mitochondrial metabolism (includes deficiencies, syndromes and disorders listed 277.87 below**) **2-Ketoglutarate Dehydrogenase Deficiency added under BCW 1/6/2012 Other and unspecified congenital anomalies of musculoskeletal system (includes Camptomelic 756.9 dysplasia) added under BCW 1/6/2012
DELETED 342.80 Other specified hemiplegia and hemiparesis affecting unspecified side deleted under CMS 11/16/2011 530.8 Other specified disorders of espohagus deleted under CMS 11/16/2011 530.81 Esophageal reflux (GE reflux or GERD) deleted under CMS 11/16/2011 564.10 Irritable Bowel Syndrome deleted under CMS 11/16/2011 752 Congenital anomalies of genital organs deleted under CMS 11/16/2011 753 Congenital anomalies of urinary system deleted under CMS 11/16/2011 754 Certain congenital musculoskeletal deformities deleted under CMS 11/16/2011
760.71 Alcohol affecting fetus or newborn via placenta or breast milk (includes Fetal Alcohol Syndrome) deleted under CMS 11/16/2011 Other specified abnormalities of chorion and amnion affecting fetus or newborn (includes Amniotic 762.8 band syndrome) deleted under CMS 11/16/2011 315.3 Developmental speech or language disorder deleted under BCW 11/29/2011 315.9 Unspecified delay in development deleted under BCW 11/29/2011
EDITED
added "FOR DIAGNOSTIC PERIOD ONLY - NOT TO 796.40 Other abnormal clinical findings EXCEED 6 MONTHS" (for clarification, under CMS) 11/16/2011 Other extrapyramidal disease and abnormal movement disorders (includes Hallervorden-Spatz 333 syndrome, Huntington's Chorea) changed CPT code to 333.0 for accuracy 1/6/2012 added "includes Arnold-Chiari Syndrome, Chiari 741.0 Spina Bifida with hydrocephalus (includes Arnold-Chiari Syndrome, Chiari Malformation) Malformation" 1/6/2012 Congenital reduction deformities of brain (includes Agenesis of corpus callosum, Holoprosencephaly, Lissencephaly, Agyria, Microgyria, Polymicrogyria, Septo-optic dysplasia, 742.2 Aicardi syndrome) added "Aicardi syndrome" to includes list 1/6/2012 specified Megalencephaly, Porencephaly and Other specified congenital anomalies of brain (includes Macroencephaly, **Megalencephaly, Schizencephaly (indicated with **) as Cat. 1 Diagnoses 742.4 **Porencephaly, **Schizencephaly) for BCW 1/6/2012 Unspecified congenital anomaly of heart (**for BCW only: Congenital Heart Disease co-occurring with Abdominal Heterotaxy which includes either 759.0 [Polysplenia or Asplenia] or 759.3 specified Congenital heart disease WITH co-occurring 746.9 [Situs inversus]) conditions for BCW Cat. 1 diagnosis 1/6/2012 740.74 Methylmercury poisoning severe Changed CPT code to 740.79 for accuracy 1/6/2012
Other specified congenital anomalies (includes the following syndromes: Angelman, Brachman-de Lange, CHARGE Association, Cockayne's, Cornelia de Lange's, Joubert, Mohr's -types I and II, added "Williams" syndrome under this line as 759.89 Noonan's, Rubinstein-Taybi's, Smith-Lemli-Opitz, Williams) syndromes in this line are included in BCW Cat. 1 list 1/6/2012 deleted "Williams" syndrome under this line as Congenital malformation syndrome affecting multiple systems, not elsewhere classified - Beckwith, syndromes in this line are not included in BCW Cat. 1 759.89 Vater, Goldenhar, Knist, etc. list 1/6/2012