SOME FREQUENTLY USED LOUISIANA WIC QUALIFYING MEDICAL CONDITIONS AND ICD-9 & ICD-10 CODES FOR EXEMPT (Special) FORMULAS
The list below includes only a limited number of ICD 9/10 Codes. Please use the web page, ICD9Data.Com or ICD-9-CM International Coding Standard for other ICD-9/10 Codes. A field is now located on the ICD-9Data.Com web page to convert from ICD-9 Codes to ICD-10 Codes.
ICD-10 Code Descriptions ICD 9 Codes ICD 10 Codes
WEIGHT RELATED Failure to Thrive (infant, child) 783.41 R62.51 Inadequate Growth (infants < 6 months only) 783.40 R62.50 Anorexia Nervosa 307.1 F50.0 PREMATURITY ICD 9 Codes ICD 10 Codes Premature Birth (extremely LBW, unspecified) 765.10 P07.32 Low Birth Weight, Unspecified V21.30 P07.00 Failure to Thrive 783.41 R62.51 Slow Growth and Fetal Malnutrition 764 - 764.99 (764.1, 764.2, 764.9) P05.9 (P05.0 – P05.29, P05.9 – P05.99) ALLERGIES ICD 9 Codes ICD 10 Codes Milk Protein Allergies (Cannot be used as the only qualifying 558.3 Z91.011 condition for those that do not require an exempt formula. Usually severe and not successfully managed with a Standard Formula) Soy Protein Allergies (Cannot be used as the only qualifying NA None found condition for those that do not require an exempt formula. Usually severe and not successfully managed with a Standard Formula) Lactose Intolerance (Cannot be used as the only qualifying 271.3 E74.39 condition for those that do not require an exempt formula. Usually severe and not successfully managed with a Standard Formula) Dermatitis Due to Food Taken Internally 693.1 L27.2 Allergy, Allergic Reaction, Hypersensitivity 995.3 T78.40XA
Anaphylactic Shock, Unspecified, Initial Encounter 995.0 T78.2XXA
1 Rev 08/2021 GP
SOME FREQUENTLY USED LOUISIANA WIC QUALIFYING MEDICAL CONDITIONS AND ICD-9 & ICD-10 CODES FOR EXEMPT (Special) FORMULAS
The list below includes only a limited number of ICD 9/10 Codes. Please use the web page, ICD9Data.Com or ICD-9-CM International Coding Standard for other ICD-9/10 Codes. A field is now located on the ICD-9Data.Com web page to convert from ICD-9 Codes to ICD-10 Codes.
ICD-9 & ICD-10 Code Descriptions
MALABSORPTION ICD 9 Codes ICD 10 Codes
Pancreatic Steatorrhea 579.4 K90.0 Unspecified Intestinal Malabsorption 579.9 K90.0 Nausea and Vomiting 787.07 R11 Vomiting Alone (Cannot be used as the only qualifying 787.03 R11.10 condition.) Celiac Disease 579.0 K90.0 Tropical Sprue 579.1 K90.1 GASTROINTESTINAL DISORDERS ICD 9 Codes ICD 10 Codes
GERD (Usually severe and not successfully managed with a 530.81 K52.2 , K21.9 standard formula) Functional Diarrhea, Inflammatory 787.91 R19.7 Irritable Bowel Syndrome 564.1 K58.9 Cholecystitis(Unspecified) 575.10 K81.9 Biliary Atresia 751.61 Q44.2 Gastroschesis 756.79 Q79.59 , Q79.3 Gastritis 535.5 K29.70, K29.90 Blood in Stool/Hematochezia 578.1 K92.1 Pyloric Stenosis 750.5 Q 40.0 Allergic Dietetic Gastroenteritis, Colitis reaction 558.31 K52.2 Enterocolitis 777 77.9, P77.9 Digestive System Disorder of Newborn NA P78, P78.9 Eosinophilic Esophagitis 530.13 K20.0
2 Rev 08/2021 GP
SOME FREQUENTLY USED LOUISIANA WIC QUALIFYING MEDICAL CONDITIONS AND ICD-9 & ICD-10 CODES FOR EXEMPT (Special) FORMULAS
The list below includes only a limited number of ICD 9/10 Codes. Please use the web page, ICD9Data.Com or ICD-9-CM International Coding Standard for other ICD-9/10 Codes. A field is now located on the ICD-9Data.Com web page to convert from ICD-9 Codes to ICD-10 Codes.
ICD-9 & ICD-10 Code Descriptions
METABOLIC DISORDERS ICD 9 Codes ICD 10 Codes
Cystic Fibrosis 277.0 E84.8, E84.9, E84.19 Phyenlketonuria(PKU) 270.1 E70.0, E70.6 Galactosemia 271.1 E74.21 Endocrine, Nutritional and Metabolic Diseases NA E00 - E88 Disorders of Fatty Acid Oxidation: LCAD, LCHAD, MCAD, VLCAD, SCAD 277.85 E 71.310-314, 318 Congenital, Malformation, Chromosomal Abnormalities NA Q00 – Q99
IMMUNE SYSTEM DISORDERS ICD 9 Codes ICD 10 Codes
HIV 042 B20 Immunodeficiency Disorders 279.3 D84.9 Gluten Enteropathy (Celiac Dz) 569.9 K63.9
OTHER CONDITIONS ICD 9 Codes ICD 10 Codes
Pulmonary Atresia 747.3 Q25.5 Bronchopulmonary Dysplasia 770.7 P27.1 Metabolic/Unclassified, Other Specified Congenital Anomalies 759.89 Q89.8, Q87.89 Pulmonary Hypertension 416.0 I 27.0 Tuberculosis, Pulmonary 011.9 A 15.0 Tuberculosis of Lungs Uremia of New Born NA P96.0
3 Rev 08/2021 GP
SOME FREQUENTLY USED LOUISIANA WIC QUALIFYING MEDICAL CONDITIONS AND ICD-9 & ICD-10 CODES FOR EXEMPT (Special) FORMULAS
The list below includes only a limited number of ICD 9/10 Codes. Please use the web page, ICD9Data.Com or ICD-9-CM International Coding Standard for other ICD-9/10 Codes. A field is now located on the ICD-9Data.Com web page to convert from ICD-9 Codes to ICD-10 Codes.
ICD-9 & ICD-10 Code Descriptions
OTHER CONDITIONS (Cont’d) ICD 9 Codes ICD 10 Codes
Acute Renal Failure 584 N 17 Acute Renal Insufficiency NA N28.9 Unspecified Renal Disease NA N 19 Chronic Renal Disease NA N 18 Jejunostomy V44.4 Z 93.4 Colostomy V44.3 Z 93.3 Gastrostomy V55.1 Z43.1 Heart Failure 300- 400s I 50 Pulmonary Heart Disease 300- 400s I 26 - I 28 Ischemic Heart Disease 300- 400s I 20 - I 25 Wound Open 879.8 531.000A Other Respiratory Problems of New Born(Apnea, Aspiration, etc) 770.9 J98.9 Burn, Body 948 T31.0, 32 Hirshsprung Disease 751.3 Q 43.1
4 Rev 08/2021 GP