emergency room services; kansas, professional · 2. if the professional emergency room provider...

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REIMBURSEMENT POLICY CMS-1500 Proprietary information of UnitedHealthcare Community Plan. Copyright 2017 United HealthCare Services, Inc. 2017R7115B Kansas Emergency Room Services Professional Policy (Medicaid) Policy Number 2017R7115B Annual Approval Date 3/8/2017 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission of accurate claims. This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. UnitedHealthcare Community Plan reimbursement policies uses Current Procedural Terminology (CPT ® *), Centers for Medicare and Medicaid Services (CMS) or other coding guidelines. References to CPT or other sources are for definitional purposes only and do not imply any right to reimbursement. This reimbursement policy applies to all health care services billed on CMS 1500 forms and, when specified, to those billed on UB04 forms. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy. This information is intended to serve only as a general reference resource regarding UnitedHealthcare Community Plan’s reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. Accordingly, UnitedHealthcare Community Plan may use reasonable discretion in interpreting and applying this policy to health care services provided in a particular case. Further, the policy does not address all issues related to reimbursement for health care services provided to UnitedHealthcare Community Plan enrollees. Other factors affecting reimbursement supplement, modify or, in some cases, supersede this policy. These factors include, but are not limited to: federal &/or state regulatory requirements, the physician or other provider contracts, the enrollee’s benefit coverage documents, and/or other reimbursement, medical or drug policies. Finally, this policy may not be implemented exactly the same way on the different electronic claims processing systems used by UnitedHealthcare Community Plan due to programming or other constraints; however, UnitedHealthcare Community Plan strives to minimize these variations. UnitedHealthcare Community Plan may modify this reimbursement policy at any time by publishing a new version of the policy on this Website. However, the information presented in this policy is accurate and current as of the date of publication. UnitedHealthcare Community Plan uses a customized version of the Optum Claims Editing System known as iCES Clearinghouse to process claims in accordance with UnitedHealthcare Community Plan reimbursement policies. *CPT ® is a registered trademark of the American Medical Association Proprietary information of UnitedHealthcare Community and State Copyright 2017 United HealthCare Services, Inc. Application This reimbursement policy applies to UnitedHealthcare Community Plan Medicaid products. This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form (a/k/a CMS-1500) or its electronic equivalent or its successor form. This policy applies to all products and all network and non-network physicians and other qualified health care professionals, including, but not limited to, non-network authorized and percent of charge contract physicians and other qualified health care professionals. Payment Policies for Medicare & Retirement and Employer & Individual please use this link. Medicare & Retirement Policies are listed under Medicare Advantage Reimbursement Policies. Employer & Individual are listed under Reimbursement Policies-Commercial.

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Page 1: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

REIMBURSEMENT POLICY

CMS-1500

Proprietary information of UnitedHealthcare Community Plan. Copyright 2017 United HealthCare Services, Inc. 2017R7115B

Kansas Emergency Room Services Professional Policy (Medicaid)

Policy Number 2017R7115B

Annual Approval Date

3/8/2017 Approved By

Reimbursement Policy Oversight Committee

IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY

You are responsible for submission of accurate claims. This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. UnitedHealthcare Community Plan reimbursement policies uses Current Procedural Terminology (CPT®*), Centers for Medicare and Medicaid Services (CMS) or other coding guidelines. References to CPT or other sources are for definitional purposes only and do not imply any right to reimbursement. This reimbursement policy applies to all health care services billed on CMS 1500 forms and, when specified, to those billed on UB04 forms. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy. This information is intended to serve only as a general reference resource regarding UnitedHealthcare Community Plan’s reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. Accordingly, UnitedHealthcare Community Plan may use reasonable discretion in interpreting and applying this policy to health care services provided in a particular case. Further, the policy does not address all issues related to reimbursement for health care services provided to UnitedHealthcare Community Plan enrollees. Other factors affecting reimbursement supplement, modify or, in some cases, supersede this policy. These factors include, but are not limited to: federal &/or state regulatory requirements, the physician or other provider contracts, the enrollee’s benefit coverage documents, and/or other reimbursement, medical or drug policies. Finally, this policy may not be implemented exactly the same way on the different electronic claims processing systems used by UnitedHealthcare Community Plan due to programming or other constraints; however, UnitedHealthcare Community Plan strives to minimize these variations. UnitedHealthcare Community Plan may modify this reimbursement policy at any time by publishing a new version of the policy on this Website. However, the information presented in this policy is accurate and current as of the date of publication. UnitedHealthcare Community Plan uses a customized version of the Optum Claims Editing System known as iCES Clearinghouse to process claims in accordance with UnitedHealthcare Community Plan reimbursement policies.

*CPT® is a registered trademark of the American Medical Association

Proprietary information of UnitedHealthcare Community and State Copyright 2017 United HealthCare Services, Inc.

Application This reimbursement policy applies to UnitedHealthcare Community Plan Medicaid products. This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form (a/k/a CMS-1500) or its electronic equivalent or its successor form. This policy applies to all products and all network and non-network physicians and other qualified health care professionals, including, but not limited to, non-network authorized and percent of charge contract physicians and other qualified health care professionals. Payment Policies for Medicare & Retirement and Employer & Individual please use this link. Medicare & Retirement Policies are listed under Medicare Advantage Reimbursement Policies. Employer & Individual are listed under Reimbursement Policies-Commercial.

Page 2: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

REIMBURSEMENT POLICY

CMS-1500

Proprietary information of UnitedHealthcare Community Plan. Copyright 2017 United HealthCare Services, Inc. 2017R7115B

Policy

Overview

This policy describes how emergency room physicians will be reimbursed for emergent and non-emergent emergency room visits for UnitedHealthcare Community Plan members. The Contractor Risk Agreement utilizes the Code of Federal Regulations (CFR) definition for an Emergency Medical Condition as described under 42 CFR 438.114 (a): (a) Definitions. As used in this section—

Emergency medical condition means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in the following:

(1) Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy.

(2) Serious impairment to bodily functions. (3) Serious dysfunction of any bodily organ or part. Emergency services means covered inpatient and outpatient services that are as follows: (1) Furnished by a provider that is qualified to furnish these services under this title. (2) Needed to evaluate or stabilize an emergency medical condition.

Reimbursement Guidelines

In order to appropriately reimburse for professional emergency room visit services provided in the Emergency Room the following guidelines will be followed:

1. If the professional emergency room provider bills CPT codes 99281-99285, 99291 or 99292 and it meets ER criteria based on the specific ICD–9 or ICD-10 diagnosis codes attached, the provider will be reimbursed with their appropriate Professional Fee Schedule amount.

2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based on the specific ICD–9 or ICD-10 diagnosis codes attached) the professional emergency room provider will be reimbursed with their appropriate Professional Fee Schedule amount for CPT 99281.

Provider Appeals Process Providers that have filed claims which have been processed and determined not to meet the Emergency Criteria, can appeal the denial by using the appeal process outlined in the Provider Administration Manual available at UHCCommunityPlan.com. ER Criteria ER Criteria is identified by ICD-9 or ICD-10 codes. These codes have been developed by the Kansas Department of Health and Environment with collaboration from community medical experts. Services will be considered an Emergency Medical Condition when the ICD–9 or ICD-10 codes reported in either the Diagnosis 1 and/or Diagnosis 2 field is considered emergency. Special Notes

• Emergency room visits will not be denied based on the ICD–9 or ICD-10 diagnosis code(s) billed. • Non-emergent claims will be reduced to the 99281 rate.

Page 3: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

REIMBURSEMENT POLICY

CMS-1500

Proprietary information of UnitedHealthcare Community Plan. Copyright 2017 United HealthCare Services, Inc. 2017R7115B

Attachments

UnitedHealthcare Community Plan Kansas ER Policy ICD-10 Diagnosis List

List of accepted emergency ICD-10 diagnosis codes.

Resources

Individual state Medicaid regulations, manuals & fee schedules American Medical Association, Current Procedural Terminology ( CPT® ) Professional Edition and associated publications and services Centers for Medicare and Medicaid Services, CMS Manual System and other CMS publications and services Centers for Medicare and Medicaid Services, Healthcare Common Procedure Coding System, HCPCS Release and Code Sets

History

3/23/2017 Annual renewal of policy approved by United HealthCare Community Plan Payment Policy Committee

1/30/2017 Annual Policy Version Change Annual Policy approval Date change Updated ICD10 list

1/1/2016 Annual Policy Version Change Annual Policy Approval Date Change Removed ICD-9 diagnosis list

11/11/2015 Annual renewal of policy approved by United HealthCare Community Plan Payment Policy Committee

10/1/2015 Policy Section: Replaced ICD-9 with ICD-10 Attachment Section: Added ICD-10 lists

3/8/2015 Application Section updated: removed reference to location of policy for MS Chip.

1/1/2015 Annual Version Change

11/12/2014 Annual renewal of policy approved by Payment Policy Oversight Committee (PPOC).

10/13/2014 Attachments: Kansas ER Policy Emergency Diagnosis List updated

8/4/2014 Application Section: Removed reference to location of policy for Florida Medicaid and Rhode Island Medicaid, added “including, but not limited to” verbiage, and added verbiage stating this policy applies to UnitedHealthcare Community Plan Medicaid and Medicare products.

3/31/2014 Disclaimer: Revised

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A001 CHOLERA DUE TO VIBRIO CHOLERAE 01 BIOVAR ELTOR

S36250A

MODERATE LACERATION OF HEAD OF PANCREAS INITIAL ENCOUNTER

A009 CHOLERA UNSPECIFIED

S36251A MODERATE LACERATION OF BODY OF PANCREAS INITIAL ENCOUNTER

A0100 TYPHOID FEVER UNSPECIFIED

S36252A MODERATE LACERATION OF TAIL OF PANCREAS INITIAL ENCOUNTER

A0101 TYPHOID MENINGITIS

S36259A MODERATE LACERATION OF UNSP PART OF PANCREAS INIT ENCNTR

A0102 TYPHOID FEVER WITH HEART INVOLVEMENT

S36260A

MAJOR LACERATION OF HEAD OF PANCREAS INITIAL ENCOUNTER

A0103 TYPHOID PNEUMONIA

S36261A MAJOR LACERATION OF BODY OF PANCREAS INITIAL ENCOUNTER

A0104 TYPHOID ARTHRITIS

S36262A MAJOR LACERATION OF TAIL OF PANCREAS INITIAL ENCOUNTER

A0105 TYPHOID OSTEOMYELITIS

S36269A MAJOR LACERATION OF UNSP PART OF PANCREAS INIT ENCNTR

A0109 TYPHOID FEVER WITH OTHER COMPLICATIONS

S36290A

OTHER INJURY OF HEAD OF PANCREAS INITIAL ENCOUNTER

A011 PARATYPHOID FEVER A

S36291A OTHER INJURY OF BODY OF PANCREAS INITIAL ENCOUNTER

A012 PARATYPHOID FEVER B

S36292A OTHER INJURY OF TAIL OF PANCREAS INITIAL ENCOUNTER

A013 PARATYPHOID FEVER C

S36299A OTHER INJURY OF UNSPECIFIED PART OF PANCREAS INIT ENCNTR

A014 PARATYPHOID FEVER UNSPECIFIED

S3630XA

UNSPECIFIED INJURY OF STOMACH INITIAL ENCOUNTER

A020 SALMONELLA ENTERITIS

S3632XA CONTUSION OF STOMACH INITIAL ENCOUNTER

A021 SALMONELLA SEPSIS

S3633XA LACERATION OF STOMACH INITIAL ENCOUNTER

A0220 LOCALIZED SALMONELLA INFECTION UNSPECIFIED

S3639XA

OTHER INJURY OF STOMACH INITIAL ENCOUNTER

A0221 SALMONELLA MENINGITIS

S36400A UNSPECIFIED INJURY OF DUODENUM INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A0222 SALMONELLA PNEUMONIA

S36408A UNSP INJURY OF OTHER PART OF SMALL INTESTINE INIT ENCNTR

A0223 SALMONELLA ARTHRITIS

S36409A UNSP INJURY OF UNSP PART OF SMALL INTESTINE INIT ENCNTR

A0224 SALMONELLA OSTEOMYELITIS

S36410A PRIMARY BLAST INJURY OF DUODENUM INITIAL ENCOUNTER

A0225 SALMONELLA PYELONEPHRITIS

S36418A PRIMARY BLAST INJURY OTH PRT SMALL INTESTINE INIT ENCNTR

A0229 SALMONELLA WITH OTHER LOCALIZED INFECTION

S36419A

PRIMARY BLAST INJURY OF UNSP PART OF SMALL INTESTINE INIT

A028 OTHER SPECIFIED SALMONELLA INFECTIONS

S36420A

CONTUSION OF DUODENUM INITIAL ENCOUNTER

A029 SALMONELLA INFECTION UNSPECIFIED

S36428A

CONTUSION OF OTHER PART OF SMALL INTESTINE INIT ENCNTR

A030 SHIGELLOSIS DUE TO SHIGELLA DYSENTERIAE

S36429A

CONTUSION OF UNSP PART OF SMALL INTESTINE INIT ENCNTR

A031 SHIGELLOSIS DUE TO SHIGELLA FLEXNERI

S36430A

LACERATION OF DUODENUM INITIAL ENCOUNTER

A032 SHIGELLOSIS DUE TO SHIGELLA BOYDII

S36438A

LACERATION OF OTHER PART OF SMALL INTESTINE INIT ENCNTR

A033 SHIGELLOSIS DUE TO SHIGELLA SONNEI

S36439A

LACERATION OF UNSP PART OF SMALL INTESTINE INIT ENCNTR

A038 OTHER SHIGELLOSIS

S36490A OTHER INJURY OF DUODENUM INITIAL ENCOUNTER

A039 SHIGELLOSIS UNSPECIFIED

S36498A OTHER INJURY OF OTHER PART OF SMALL INTESTINE INIT ENCNTR

A040 ENTEROPATHOGENIC ESCHERICHIA COLI INFECTION

S36499A

OTHER INJURY OF UNSP PART OF SMALL INTESTINE INIT ENCNTR

A041 ENTEROTOXIGENIC ESCHERICHIA COLI INFECTION

S36500A

UNSPECIFIED INJURY OF ASCENDING COLON INITIAL ENCOUNTER

A042 ENTEROINVASIVE ESCHERICHIA COLI INFECTION

S36501A

UNSPECIFIED INJURY OF TRANSVERSE COLON INITIAL ENCOUNTER

A043 ENTEROHEMORRHAGIC ESCHERICHIA COLI INFECTION

S36502A

UNSPECIFIED INJURY OF DESCENDING COLON INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A044 OTHER INTESTINAL ESCHERICHIA COLI INFECTIONS

S36503A

UNSPECIFIED INJURY OF SIGMOID COLON INITIAL ENCOUNTER

A045 CAMPYLOBACTER ENTERITIS

S36508A UNSPECIFIED INJURY OF OTHER PART OF COLON INITIAL ENCOUNTER

A046 ENTERITIS DUE TO YERSINIA ENTEROCOLITICA

S36509A

UNSPECIFIED INJURY OF UNSPECIFIED PART OF COLON INIT ENCNTR

A047 ENTEROCOLITIS DUE TO CLOSTRIDIUM DIFFICILE

S36510A

PRIMARY BLAST INJURY OF ASCENDING COLON INITIAL ENCOUNTER

A048 OTHER SPECIFIED BACTERIAL INTESTINAL INFECTIONS

S36511A

PRIMARY BLAST INJURY OF TRANSVERSE COLON INITIAL ENCOUNTER

A049 BACTERIAL INTESTINAL INFECTION UNSPECIFIED

S36512A

PRIMARY BLAST INJURY OF DESCENDING COLON INITIAL ENCOUNTER

A050 FOODBORNE STAPHYLOCOCCAL INTOXICATION

S36513A

PRIMARY BLAST INJURY OF SIGMOID COLON INITIAL ENCOUNTER

A051 BOTULISM FOOD POISONING

S36518A PRIMARY BLAST INJURY OF OTHER PART OF COLON INIT ENCNTR

A052 FOODBORNE CLOSTRIDIUM PERFRINGENS INTOXICATION

S36519A

PRIMARY BLAST INJURY OF UNSP PART OF COLON INIT ENCNTR

A053

FOODBORNE VIBRIO PARAHAEMOLYTICUS INTOXICATION

S36520A

CONTUSION OF ASCENDING [RIGHT] COLON INITIAL ENCOUNTER

A054 FOODBORNE BACILLUS CEREUS INTOXICATION

S36521A

CONTUSION OF TRANSVERSE COLON INITIAL ENCOUNTER

A055 FOODBORNE VIBRIO VULNIFICUS INTOXICATION

S36522A

CONTUSION OF DESCENDING [LEFT] COLON INITIAL ENCOUNTER

A058 OTHER SPECIFIED BACTERIAL FOODBORNE INTOXICATIONS

S36523A

CONTUSION OF SIGMOID COLON INITIAL ENCOUNTER

A059 BACTERIAL FOODBORNE INTOXICATION UNSPECIFIED

S36528A

CONTUSION OF OTHER PART OF COLON INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A060 ACUTE AMEBIC DYSENTERY

S36529A CONTUSION OF UNSPECIFIED PART OF COLON INITIAL ENCOUNTER

A061 CHRONIC INTESTINAL AMEBIASIS

S36530A

LACERATION OF ASCENDING [RIGHT] COLON INITIAL ENCOUNTER

A062 AMEBIC NONDYSENTERIC COLITIS

S36531A

LACERATION OF TRANSVERSE COLON INITIAL ENCOUNTER

A063 AMEBOMA OF INTESTINE

S36532A LACERATION OF DESCENDING [LEFT] COLON INITIAL ENCOUNTER

A064 AMEBIC LIVER ABSCESS

S36533A LACERATION OF SIGMOID COLON INITIAL ENCOUNTER

A065 AMEBIC LUNG ABSCESS

S36538A LACERATION OF OTHER PART OF COLON INITIAL ENCOUNTER

A066 AMEBIC BRAIN ABSCESS

S36539A LACERATION OF UNSPECIFIED PART OF COLON INITIAL ENCOUNTER

A067 CUTANEOUS AMEBIASIS

S36590A OTHER INJURY OF ASCENDING [RIGHT] COLON INITIAL ENCOUNTER

A0681 AMEBIC CYSTITIS

S36591A OTHER INJURY OF TRANSVERSE COLON INITIAL ENCOUNTER

A0682 OTHER AMEBIC GENITOURINARY INFECTIONS

S36592A

OTHER INJURY OF DESCENDING [LEFT] COLON INITIAL ENCOUNTER

A0689 OTHER AMEBIC INFECTIONS

S36593A OTHER INJURY OF SIGMOID COLON INITIAL ENCOUNTER

A069 AMEBIASIS UNSPECIFIED

S36598A OTHER INJURY OF OTHER PART OF COLON INITIAL ENCOUNTER

A070 BALANTIDIASIS

S36599A OTHER INJURY OF UNSPECIFIED PART OF COLON INITIAL ENCOUNTER

A071 GIARDIASIS [LAMBLIASIS]

S3660XA UNSPECIFIED INJURY OF RECTUM INITIAL ENCOUNTER

A072 CRYPTOSPORIDIOSIS

S3661XA PRIMARY BLAST INJURY OF RECTUM INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A073 ISOSPORIASIS

S3662XA CONTUSION OF RECTUM INITIAL ENCOUNTER

A074 CYCLOSPORIASIS

S3663XA LACERATION OF RECTUM INITIAL ENCOUNTER

A078 OTHER SPECIFIED PROTOZOAL INTESTINAL DISEASES

S3669XA

OTHER INJURY OF RECTUM INITIAL ENCOUNTER

A079 PROTOZOAL INTESTINAL DISEASE UNSPECIFIED

S3681XA

INJURY OF PERITONEUM INITIAL ENCOUNTER

A080 ROTAVIRAL ENTERITIS

S36892A

CONTUSION OF OTHER INTRA-ABDOMINAL ORGANS INITIAL ENCOUNTER

A0811 ACUTE GASTROENTEROPATHY DUE TO NORWALK AGENT

S36893A

LACERATION OF OTHER INTRA-ABDOMINAL ORGANS INIT ENCNTR

A0819

ACUTE GASTROENTEROPATHY DUE TO OTHER SMALL ROUND VIRUSES

S36898A

OTHER INJURY OF OTHER INTRA-ABDOMINAL ORGANS INIT ENCNTR

A082 ADENOVIRAL ENTERITIS

S36899A UNSP INJURY OF OTHER INTRA-ABDOMINAL ORGANS INIT ENCNTR

A0831 CALICIVIRUS ENTERITIS

S3690XA UNSP INJURY OF UNSP INTRA-ABDOMINAL ORGAN INIT ENCNTR

A0832 ASTROVIRUS ENTERITIS

S3692XA CONTUSION OF UNSPECIFIED INTRA-ABDOMINAL ORGAN INIT ENCNTR

A0839 OTHER VIRAL ENTERITIS

S3693XA LACERATION OF UNSPECIFIED INTRA-ABDOMINAL ORGAN INIT ENCNTR

A084 VIRAL INTESTINAL INFECTION UNSPECIFIED

S3699XA

OTHER INJURY OF UNSP INTRA-ABDOMINAL ORGAN INIT ENCNTR

A088 OTHER SPECIFIED INTESTINAL INFECTIONS

S37001A

UNSPECIFIED INJURY OF RIGHT KIDNEY INITIAL ENCOUNTER

A09 INFECTIOUS GASTROENTERITIS AND COLITIS UNSPECIFIED

S37002A

UNSPECIFIED INJURY OF LEFT KIDNEY INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A150 TUBERCULOSIS OF LUNG

S37009A UNSPECIFIED INJURY OF UNSPECIFIED KIDNEY INITIAL ENCOUNTER

A154 TUBERCULOSIS OF INTRATHORACIC LYMPH NODES

S37011A

MINOR CONTUSION OF RIGHT KIDNEY INITIAL ENCOUNTER

A155 TUBERCULOSIS OF LARYNX TRACHEA AND BRONCHUS

S37012A

MINOR CONTUSION OF LEFT KIDNEY INITIAL ENCOUNTER

A156 TUBERCULOUS PLEURISY

S37019A MINOR CONTUSION OF UNSPECIFIED KIDNEY INITIAL ENCOUNTER

A157 PRIMARY RESPIRATORY TUBERCULOSIS

S37021A

MAJOR CONTUSION OF RIGHT KIDNEY INITIAL ENCOUNTER

A158 OTHER RESPIRATORY TUBERCULOSIS

S37022A

MAJOR CONTUSION OF LEFT KIDNEY INITIAL ENCOUNTER

A159 RESPIRATORY TUBERCULOSIS UNSPECIFIED

S37029A

MAJOR CONTUSION OF UNSPECIFIED KIDNEY INITIAL ENCOUNTER

A170 TUBERCULOUS MENINGITIS

S37031A LACERATION OF RIGHT KIDNEY UNSPECIFIED DEGREE INIT ENCNTR

A171 MENINGEAL TUBERCULOMA

S37032A LACERATION OF LEFT KIDNEY UNSPECIFIED DEGREE INIT ENCNTR

A1781 TUBERCULOMA OF BRAIN AND SPINAL CORD

S37039A

LACERATION OF UNSP KIDNEY UNSPECIFIED DEGREE INIT ENCNTR

A1782 TUBERCULOUS MENINGOENCEPHALITIS

S37041A

MINOR LACERATION OF RIGHT KIDNEY INITIAL ENCOUNTER

A1783 TUBERCULOUS NEURITIS

S37042A MINOR LACERATION OF LEFT KIDNEY INITIAL ENCOUNTER

A1789 OTHER TUBERCULOSIS OF NERVOUS SYSTEM

S37049A

MINOR LACERATION OF UNSPECIFIED KIDNEY INITIAL ENCOUNTER

A179 TUBERCULOSIS OF NERVOUS SYSTEM UNSPECIFIED

S37051A

MODERATE LACERATION OF RIGHT KIDNEY INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A1801 TUBERCULOSIS OF SPINE

S37052A MODERATE LACERATION OF LEFT KIDNEY INITIAL ENCOUNTER

A1802 TUBERCULOUS ARTHRITIS OF OTHER JOINTS

S37059A

MODERATE LACERATION OF UNSPECIFIED KIDNEY INITIAL ENCOUNTER

A1803 TUBERCULOSIS OF OTHER BONES

S37061A

MAJOR LACERATION OF RIGHT KIDNEY INITIAL ENCOUNTER

A1809 OTHER MUSCULOSKELETAL TUBERCULOSIS

S37062A

MAJOR LACERATION OF LEFT KIDNEY INITIAL ENCOUNTER

A1810

TUBERCULOSIS OF GENITOURINARY SYSTEM UNSPECIFIED

S37069A

MAJOR LACERATION OF UNSPECIFIED KIDNEY INITIAL ENCOUNTER

A1811 TUBERCULOSIS OF KIDNEY AND URETER

S37091A

OTHER INJURY OF RIGHT KIDNEY INITIAL ENCOUNTER

A1812 TUBERCULOSIS OF BLADDER

S37092A OTHER INJURY OF LEFT KIDNEY INITIAL ENCOUNTER

A1813 TUBERCULOSIS OF OTHER URINARY ORGANS

S37099A

OTHER INJURY OF UNSPECIFIED KIDNEY INITIAL ENCOUNTER

A1814 TUBERCULOSIS OF PROSTATE

S3710XA UNSPECIFIED INJURY OF URETER INITIAL ENCOUNTER

A1815 TUBERCULOSIS OF OTHER MALE GENITAL ORGANS

S3712XA

CONTUSION OF URETER INITIAL ENCOUNTER

A1816 TUBERCULOSIS OF CERVIX

S3713XA LACERATION OF URETER INITIAL ENCOUNTER

A1817 TUBERCULOUS FEMALE PELVIC INFLAMMATORY DISEASE

S3719XA

OTHER INJURY OF URETER INITIAL ENCOUNTER

A1818 TUBERCULOSIS OF OTHER FEMALE GENITAL ORGANS

S3720XA

UNSPECIFIED INJURY OF BLADDER INITIAL ENCOUNTER

A182 TUBERCULOUS PERIPHERAL LYMPHADENOPATHY

S3722XA

CONTUSION OF BLADDER INITIAL ENCOUNTER

A1831 TUBERCULOUS PERITONITIS

S3723XA LACERATION OF BLADDER INITIAL ENCOUNTER

A1832 TUBERCULOUS ENTERITIS

S3729XA OTHER INJURY OF BLADDER INITIAL ENCOUNTER

A1839 RETROPERITONEAL TUBERCULOSIS

S3730XA

UNSPECIFIED INJURY OF URETHRA INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A184 TUBERCULOSIS OF SKIN AND SUBCUTANEOUS TISSUE

S3732XA

CONTUSION OF URETHRA INITIAL ENCOUNTER

A1850 TUBERCULOSIS OF EYE UNSPECIFIED

S3733XA

LACERATION OF URETHRA INITIAL ENCOUNTER

A1851 TUBERCULOUS EPISCLERITIS

S3739XA OTHER INJURY OF URETHRA INITIAL ENCOUNTER

A1852 TUBERCULOUS KERATITIS

S37401A UNSPECIFIED INJURY OF OVARY UNILATERAL INITIAL ENCOUNTER

A1853 TUBERCULOUS CHORIORETINITIS

S37421A

CONTUSION OF OVARY UNILATERAL INITIAL ENCOUNTER

A1854 TUBERCULOUS IRIDOCYCLITIS

S37421D CONTUSION OF OVARY UNILATERAL SUBSEQUENT ENCOUNTER

A1859 OTHER TUBERCULOSIS OF EYE

S37422A CONTUSION OF OVARY BILATERAL INITIAL ENCOUNTER

A186 TUBERCULOSIS OF (INNER) (MIDDLE) EAR

S37429A

CONTUSION OF OVARY UNSPECIFIED INITIAL ENCOUNTER

A187 TUBERCULOSIS OF ADRENAL GLANDS

S37431A

LACERATION OF OVARY UNILATERAL INITIAL ENCOUNTER

A1881 TUBERCULOSIS OF THYROID GLAND

S37432A

LACERATION OF OVARY BILATERAL INITIAL ENCOUNTER

A1882 TUBERCULOSIS OF OTHER ENDOCRINE GLANDS

S37439A

LACERATION OF OVARY UNSPECIFIED INITIAL ENCOUNTER

A1883 TUBERCULOSIS OF DIGESTIVE TRACT ORGANS NEC

S37491A

OTHER INJURY OF OVARY UNILATERAL INITIAL ENCOUNTER

A1884 TUBERCULOSIS OF HEART

S37492A OTHER INJURY OF OVARY BILATERAL INITIAL ENCOUNTER

A1885 TUBERCULOSIS OF SPLEEN

S37499A OTHER INJURY OF OVARY UNSPECIFIED INITIAL ENCOUNTER

A1889 TUBERCULOSIS OF OTHER SITES

S37501A UNSP INJURY OF FALLOPIAN TUBE UNILATERAL INIT ENCNTR

A190 ACUTE MILIARY TUBERCULOSIS OF A SINGLE SPECIFIED SITE

S37502A

UNSPECIFIED INJURY OF FALLOPIAN TUBE BILATERAL INIT ENCNTR

A191 ACUTE MILIARY TUBERCULOSIS OF MULTIPLE SITES

S37509A

UNSP INJURY OF FALLOPIAN TUBE UNSPECIFIED INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A192 ACUTE MILIARY TUBERCULOSIS UNSPECIFIED

S37511A

PRIMARY BLAST INJURY OF FALLOPIAN TUBE UNILATERAL INIT

A198 OTHER MILIARY TUBERCULOSIS

S37512A PRIMARY BLAST INJURY OF FALLOPIAN TUBE BILATERAL INIT

A199 MILIARY TUBERCULOSIS UNSPECIFIED

S37519A

PRIMARY BLAST INJURY OF FALLOPIAN TUBE UNSP INIT ENCNTR

A200 BUBONIC PLAGUE

S37521A CONTUSION OF FALLOPIAN TUBE UNILATERAL INITIAL ENCOUNTER

A201 CELLULOCUTANEOUS PLAGUE

S37522A CONTUSION OF FALLOPIAN TUBE BILATERAL INITIAL ENCOUNTER

A202 PNEUMONIC PLAGUE

S37529A CONTUSION OF FALLOPIAN TUBE UNSPECIFIED INITIAL ENCOUNTER

A203 PLAGUE MENINGITIS

S37531A LACERATION OF FALLOPIAN TUBE UNILATERAL INITIAL ENCOUNTER

A207 SEPTICEMIC PLAGUE

S37532A LACERATION OF FALLOPIAN TUBE BILATERAL INITIAL ENCOUNTER

A208 OTHER FORMS OF PLAGUE

S37539A LACERATION OF FALLOPIAN TUBE UNSPECIFIED INITIAL ENCOUNTER

A209 PLAGUE UNSPECIFIED

S37591A OTHER INJURY OF FALLOPIAN TUBE UNILATERAL INIT ENCNTR

A210 ULCEROGLANDULAR TULAREMIA

S37592A

OTHER INJURY OF FALLOPIAN TUBE BILATERAL INITIAL ENCOUNTER

A211 OCULOGLANDULAR TULAREMIA

S37599A OTHER INJURY OF FALLOPIAN TUBE UNSPECIFIED INIT ENCNTR

A212 PULMONARY TULAREMIA

S3760XA UNSPECIFIED INJURY OF UTERUS INITIAL ENCOUNTER

A213 GASTROINTESTINAL TULAREMIA

S3762XA

CONTUSION OF UTERUS INITIAL ENCOUNTER

A217 GENERALIZED TULAREMIA

S3763XA LACERATION OF UTERUS INITIAL ENCOUNTER

A218 OTHER FORMS OF TULAREMIA

S3769XA OTHER INJURY OF UTERUS INITIAL ENCOUNTER

A219 TULAREMIA UNSPECIFIED

S37812A CONTUSION OF ADRENAL GLAND INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A220 CUTANEOUS ANTHRAX

S37813A LACERATION OF ADRENAL GLAND INITIAL ENCOUNTER

A221 PULMONARY ANTHRAX

S37818A OTHER INJURY OF ADRENAL GLAND INITIAL ENCOUNTER

A222 GASTROINTESTINAL ANTHRAX

S37819A UNSPECIFIED INJURY OF ADRENAL GLAND INITIAL ENCOUNTER

A227 ANTHRAX SEPSIS

S37822A CONTUSION OF PROSTATE INITIAL ENCOUNTER

A228 OTHER FORMS OF ANTHRAX

S37823A LACERATION OF PROSTATE INITIAL ENCOUNTER

A229 ANTHRAX UNSPECIFIED

S37828A OTHER INJURY OF PROSTATE INITIAL ENCOUNTER

A230 BRUCELLOSIS DUE TO BRUCELLA MELITENSIS

S37829A

UNSPECIFIED INJURY OF PROSTATE INITIAL ENCOUNTER

A231 BRUCELLOSIS DUE TO BRUCELLA ABORTUS

S37892A

CONTUSION OF OTHER URINARY AND PELVIC ORGAN INIT ENCNTR

A232 BRUCELLOSIS DUE TO BRUCELLA SUIS

S37893A

LACERATION OF OTHER URINARY AND PELVIC ORGAN INIT ENCNTR

A233 BRUCELLOSIS DUE TO BRUCELLA CANIS

S37898A

OTHER INJURY OF OTHER URINARY AND PELVIC ORGAN INIT ENCNTR

A238 OTHER BRUCELLOSIS

S37899A UNSP INJURY OF OTHER URINARY AND PELVIC ORGAN INIT ENCNTR

A239 BRUCELLOSIS UNSPECIFIED

S3790XA UNSP INJURY OF UNSP URINARY AND PELVIC ORGAN INIT ENCNTR

A240 GLANDERS

S3792XA CONTUSION OF UNSP URINARY AND PELVIC ORGAN INIT ENCNTR

A241 ACUTE AND FULMINATING MELIOIDOSIS

S3793XA

LACERATION OF UNSP URINARY AND PELVIC ORGAN INIT ENCNTR

A242 SUBACUTE AND CHRONIC MELIOIDOSIS

S3799XA

OTHER INJURY OF UNSP URINARY AND PELVIC ORGAN INIT ENCNTR

A243 OTHER MELIOIDOSIS

S38001A CRUSHING INJURY OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

A249 MELIOIDOSIS UNSPECIFIED

S38002A CRUSHING INJ UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

A250 SPIRILLOSIS

S3801XA CRUSHING INJURY OF PENIS INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A251 STREPTOBACILLOSIS

S3802XA CRUSHING INJURY OF SCROTUM AND TESTIS INITIAL ENCOUNTER

A259 RAT-BITE FEVER UNSPECIFIED

S3803XA CRUSHING INJURY OF VULVA INITIAL ENCOUNTER

A270 LEPTOSPIROSIS ICTEROHEMORRHAGICA

S381XXA

CRUSHING INJURY OF ABDOMEN LOWER BACK AND PELVIS INIT

A2781 ASEPTIC MENINGITIS IN LEPTOSPIROSIS

S38211A

COMPLETE TRAUM AMP OF FEMALE EXTERNAL GENITAL ORGANS INIT

A2789 OTHER FORMS OF LEPTOSPIROSIS

S38212A

PARTIAL TRAUM AMP OF FEMALE EXTERNAL GENITAL ORGANS INIT

A279 LEPTOSPIROSIS UNSPECIFIED

S38221A COMPLETE TRAUMATIC AMPUTATION OF PENIS INITIAL ENCOUNTER

A280 PASTEURELLOSIS

S38222A PARTIAL TRAUMATIC AMPUTATION OF PENIS INITIAL ENCOUNTER

A281 CAT-SCRATCH DISEASE

S38231A COMPLETE TRAUMATIC AMPUTATION OF SCROTUM AND TESTIS INIT

A282 EXTRAINTESTINAL YERSINIOSIS

S38232A PARTIAL TRAUMATIC AMPUTATION OF SCROTUM AND TESTIS INIT

A288

OTH ZOONOTIC BACTERIAL DISEASES NOT ELSEWHERE CLASSIFIED

S383XXA

TRANSECTION (PARTIAL) OF ABDOMEN INITIAL ENCOUNTER

A289 ZOONOTIC BACTERIAL DISEASE UNSPECIFIED

S39001A

UNSP INJURY OF MUSCLE FASCIA AND TENDON OF ABDOMEN INIT

A301 TUBERCULOID LEPROSY

S39002A UNSP INJURY OF MUSCLE FASCIA AND TENDON OF LOWER BACK INIT

A310 PULMONARY MYCOBACTERIAL INFECTION

S39003A

UNSP INJURY OF MUSCLE FASCIA AND TENDON OF PELVIS INIT

A312

DISSEM MYCOBACTERIUM AVIUM-INTRACELLULARE COMPLEX (DMAC)

S39021A

LACERATION OF MUSCLE FASCIA AND TENDON OF ABDOMEN INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A318 OTHER MYCOBACTERIAL INFECTIONS

S39022A

LACERATION OF MUSCLE FASCIA AND TENDON OF LOWER BACK INIT

A319 MYCOBACTERIAL INFECTION UNSPECIFIED

S39023A

LACERATION OF MUSCLE FASCIA AND TENDON OF PELVIS INIT

A3211 LISTERIAL MENINGITIS

S39091A INJ MUSCLE FASCIA AND TENDON OF ABDOMEN INIT ENCNTR

A3212 LISTERIAL MENINGOENCEPHALITIS

S39092A

INJ MUSCLE FASCIA AND TENDON OF LOWER BACK INIT ENCNTR

A327 LISTERIAL SEPSIS

S39093A INJ MUSCLE FASCIA AND TENDON OF PELVIS INIT ENCNTR

A3281 OCULOGLANDULAR LISTERIOSIS

S3981XA OTHER SPECIFIED INJURIES OF ABDOMEN INITIAL ENCOUNTER

A3282 LISTERIAL ENDOCARDITIS

S3983XA OTHER SPECIFIED INJURIES OF PELVIS INITIAL ENCOUNTER

A3289 OTHER FORMS OF LISTERIOSIS

S39840A FRACTURE OF CORPUS CAVERNOSUM PENIS INITIAL ENCOUNTER

A329 LISTERIOSIS UNSPECIFIED

S39848A OTHER SPECIFIED INJURIES OF EXTERNAL GENITALS INIT ENCNTR

A33 TETANUS NEONATORUM

S3991XA UNSPECIFIED INJURY OF ABDOMEN INITIAL ENCOUNTER

A34 OBSTETRICAL TETANUS

S3992XA UNSPECIFIED INJURY OF LOWER BACK INITIAL ENCOUNTER

A35 OTHER TETANUS

S3993XA UNSPECIFIED INJURY OF PELVIS INITIAL ENCOUNTER

A360 PHARYNGEAL DIPHTHERIA

S3994XA UNSPECIFIED INJURY OF EXTERNAL GENITALS INITIAL ENCOUNTER

A361 NASOPHARYNGEAL DIPHTHERIA

S40011A CONTUSION OF RIGHT SHOULDER INITIAL ENCOUNTER

A362 LARYNGEAL DIPHTHERIA

S40012A CONTUSION OF LEFT SHOULDER INITIAL ENCOUNTER

A363 CUTANEOUS DIPHTHERIA

S40019A CONTUSION OF UNSPECIFIED SHOULDER INITIAL ENCOUNTER

A3681 DIPHTHERITIC CARDIOMYOPATHY

S40021A

CONTUSION OF RIGHT UPPER ARM INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A3682 DIPHTHERITIC RADICULOMYELITIS

S40022A

CONTUSION OF LEFT UPPER ARM INITIAL ENCOUNTER

A3683 DIPHTHERITIC POLYNEURITIS

S40029A CONTUSION OF UNSPECIFIED UPPER ARM INITIAL ENCOUNTER

A3684 DIPHTHERITIC TUBULO-INTERSTITIAL NEPHROPATHY

S40241A

EXTERNAL CONSTRICTION OF RIGHT SHOULDER INITIAL ENCOUNTER

A3685 DIPHTHERITIC CYSTITIS

S40242A EXTERNAL CONSTRICTION OF LEFT SHOULDER INITIAL ENCOUNTER

A3686 DIPHTHERITIC CONJUNCTIVITIS

S40249A EXTERNAL CONSTRICTION OF UNSPECIFIED SHOULDER INIT ENCNTR

A3689 OTHER DIPHTHERITIC COMPLICATIONS

S40841A

EXTERNAL CONSTRICTION OF RIGHT UPPER ARM INITIAL ENCOUNTER

A369 DIPHTHERIA UNSPECIFIED

S40842A EXTERNAL CONSTRICTION OF LEFT UPPER ARM INITIAL ENCOUNTER

A3700

WHOOPING COUGH DUE TO BORDETELLA PERTUSSIS WITHOUT PNEUMONIA

S40849A

EXTERNAL CONSTRICTION OF UNSPECIFIED UPPER ARM INIT ENCNTR

A3701

WHOOPING COUGH DUE TO BORDETELLA PERTUSSIS WITH PNEUMONIA

S41001A

UNSPECIFIED OPEN WOUND OF RIGHT SHOULDER INITIAL ENCOUNTER

A3710

WHOOPING COUGH DUE TO BORDETELLA PARAPERTUSSIS W/O PNEUMONIA

S41002A

UNSPECIFIED OPEN WOUND OF LEFT SHOULDER INITIAL ENCOUNTER

A3711

WHOOPING COUGH DUE TO BORDETELLA PARAPERTUSSIS W PNEUMONIA

S41009A

UNSPECIFIED OPEN WOUND OF UNSPECIFIED SHOULDER INIT ENCNTR

A3780

WHOOPING COUGH DUE TO OTHER BORDETELLA SPECIES W/O PNEUMONIA

S41011A

LACERATION W/O FOREIGN BODY OF RIGHT SHOULDER INIT ENCNTR

A3781

WHOOPING COUGH DUE TO OTH BORDETELLA SPECIES WITH PNEUMONIA

S41012A

LACERATION W/O FOREIGN BODY OF LEFT SHOULDER INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A3790

WHOOPING COUGH UNSPECIFIED SPECIES WITHOUT PNEUMONIA

S41019A

LACERATION W/O FOREIGN BODY OF UNSP SHOULDER INIT ENCNTR

A3791

WHOOPING COUGH UNSPECIFIED SPECIES WITH PNEUMONIA

S41021A

LACERATION WITH FOREIGN BODY OF RIGHT SHOULDER INIT ENCNTR

A381 SCARLET FEVER WITH MYOCARDITIS

S41022A

LACERATION WITH FOREIGN BODY OF LEFT SHOULDER INIT ENCNTR

A388 SCARLET FEVER WITH OTHER COMPLICATIONS

S41029A

LACERATION WITH FOREIGN BODY OF UNSP SHOULDER INIT ENCNTR

A390 MENINGOCOCCAL MENINGITIS

S41031A PUNCTURE WOUND W/O FOREIGN BODY OF RIGHT SHOULDER INIT

A391 WATERHOUSE-FRIDERICHSEN SYNDROME

S41032A

PUNCTURE WOUND W/O FOREIGN BODY OF LEFT SHOULDER INIT

A392 ACUTE MENINGOCOCCEMIA

S41039A PUNCTURE WOUND W/O FOREIGN BODY OF UNSP SHOULDER INIT

A393 CHRONIC MENINGOCOCCEMIA

S41041A PUNCTURE WOUND W FOREIGN BODY OF RIGHT SHOULDER INIT ENCNTR

A394 MENINGOCOCCEMIA UNSPECIFIED

S41042A

PUNCTURE WOUND W FOREIGN BODY OF LEFT SHOULDER INIT ENCNTR

A3950 MENINGOCOCCAL CARDITIS UNSPECIFIED

S41049A

PUNCTURE WOUND W FOREIGN BODY OF UNSP SHOULDER INIT ENCNTR

A3951 MENINGOCOCCAL ENDOCARDITIS

S41051A

OPEN BITE OF RIGHT SHOULDER INITIAL ENCOUNTER

A3952 MENINGOCOCCAL MYOCARDITIS

S41052A

OPEN BITE OF LEFT SHOULDER INITIAL ENCOUNTER

A3953 MENINGOCOCCAL PERICARDITIS

S41059A

OPEN BITE OF UNSPECIFIED SHOULDER INITIAL ENCOUNTER

A3981 MENINGOCOCCAL ENCEPHALITIS

S41101A

UNSPECIFIED OPEN WOUND OF RIGHT UPPER ARM INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A3982 MENINGOCOCCAL RETROBULBAR NEURITIS

S41102A

UNSPECIFIED OPEN WOUND OF LEFT UPPER ARM INITIAL ENCOUNTER

A3983 MENINGOCOCCAL ARTHRITIS

S41109A

UNSPECIFIED OPEN WOUND OF UNSPECIFIED UPPER ARM INIT ENCNTR

A3984 POSTMENINGOCOCCAL ARTHRITIS

S41111A

LACERATION W/O FOREIGN BODY OF RIGHT UPPER ARM INIT ENCNTR

A3989 OTHER MENINGOCOCCAL INFECTIONS

S41112A

LACERATION W/O FOREIGN BODY OF LEFT UPPER ARM INIT ENCNTR

A399 MENINGOCOCCAL INFECTION UNSPECIFIED

S41119A

LACERATION W/O FOREIGN BODY OF UNSP UPPER ARM INIT ENCNTR

A400 SEPSIS DUE TO STREPTOCOCCUS GROUP A

S41121A

LACERATION WITH FOREIGN BODY OF RIGHT UPPER ARM INIT ENCNTR

A401 SEPSIS DUE TO STREPTOCOCCUS GROUP B

S41122A

LACERATION WITH FOREIGN BODY OF LEFT UPPER ARM INIT ENCNTR

A403 SEPSIS DUE TO STREPTOCOCCUS PNEUMONIAE

S41129A

LACERATION WITH FOREIGN BODY OF UNSP UPPER ARM INIT ENCNTR

A408 OTHER STREPTOCOCCAL SEPSIS

S41131A PUNCTURE WOUND W/O FOREIGN BODY OF RIGHT UPPER ARM INIT

A409 STREPTOCOCCAL SEPSIS UNSPECIFIED

S41132A

PUNCTURE WOUND W/O FOREIGN BODY OF LEFT UPPER ARM INIT

A411 SEPSIS DUE TO OTHER SPECIFIED STAPHYLOCOCCUS

S41139A

PUNCTURE WOUND W/O FOREIGN BODY OF UNSP UPPER ARM INIT

A412 SEPSIS DUE TO UNSPECIFIED STAPHYLOCOCCUS

S41141A

PUNCTURE WOUND W FOREIGN BODY OF RIGHT UPPER ARM INIT

A413 SEPSIS DUE TO HEMOPHILUS INFLUENZAE

S41142A

PUNCTURE WOUND W FOREIGN BODY OF LEFT UPPER ARM INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A414 SEPSIS DUE TO ANAEROBES

S41149A PUNCTURE WOUND W FOREIGN BODY OF UNSP UPPER ARM INIT ENCNTR

A4150 GRAM-NEGATIVE SEPSIS UNSPECIFIED

S41151A

OPEN BITE OF RIGHT UPPER ARM INITIAL ENCOUNTER

A4151 SEPSIS DUE TO ESCHERICHIA COLI [E. COLI]

S41152A

OPEN BITE OF LEFT UPPER ARM INITIAL ENCOUNTER

A4152 SEPSIS DUE TO PSEUDOMONAS

S41159A OPEN BITE OF UNSPECIFIED UPPER ARM INITIAL ENCOUNTER

A4153 SEPSIS DUE TO SERRATIA

S42001A FRACTURE OF UNSP PART OF RIGHT CLAVICLE INIT FOR CLOS FX

A4159 OTHER GRAM-NEGATIVE SEPSIS

S42001B FRACTURE OF UNSP PART OF RIGHT CLAVICLE INIT FOR OPN FX

A4181 SEPSIS DUE TO ENTEROCOCCUS

S42002A FRACTURE OF UNSP PART OF LEFT CLAVICLE INIT FOR CLOS FX

A4189 OTHER SPECIFIED SEPSIS

S42002B FRACTURE OF UNSP PART OF LEFT CLAVICLE INIT FOR OPN FX

A419 SEPSIS UNSPECIFIED ORGANISM

S42009A FRACTURE OF UNSP PART OF UNSP CLAVICLE INIT FOR CLOS FX

A420 PULMONARY ACTINOMYCOSIS

S42009B FRACTURE OF UNSP PART OF UNSP CLAVICLE INIT FOR OPN FX

A421 ABDOMINAL ACTINOMYCOSIS

S42011A ANTERIOR DISP FX OF STERNAL END OF RIGHT CLAVICLE INIT

A422 CERVICOFACIAL ACTINOMYCOSIS

S42011B

ANT DISP FX OF STERNAL END OF R CLAVICLE INIT FOR OPN FX

A427 ACTINOMYCOTIC SEPSIS

S42012A ANTERIOR DISP FX OF STERNAL END OF LEFT CLAVICLE INIT

A4281 ACTINOMYCOTIC MENINGITIS

S42012B ANT DISP FX OF STERNAL END OF L CLAVICLE INIT FOR OPN FX

A4282 ACTINOMYCOTIC ENCEPHALITIS

S42013A ANTERIOR DISP FX OF STERNAL END OF UNSP CLAVICLE INIT

A4289 OTHER FORMS OF ACTINOMYCOSIS

S42013B

ANT DISP FX OF STERNAL END OF UNSP CLAVICLE INIT FOR OPN FX

A429 ACTINOMYCOSIS UNSPECIFIED

S42014A POSTERIOR DISP FX OF STERNAL END OF RIGHT CLAVICLE INIT

A430 PULMONARY NOCARDIOSIS

S42014B POST DISP FX OF STERNAL END OF R CLAVICLE INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A431 CUTANEOUS NOCARDIOSIS

S42014S POSTERIOR DISP FX OF STERNAL END OF RIGHT CLAVICLE SEQUELA

A438 OTHER FORMS OF NOCARDIOSIS

S42015A

POSTERIOR DISP FX OF STERNAL END OF LEFT CLAVICLE INIT

A439 NOCARDIOSIS UNSPECIFIED

S42015B POST DISP FX OF STERNAL END OF L CLAVICLE INIT FOR OPN FX

A440 SYSTEMIC BARTONELLOSIS

S42016A POSTERIOR DISP FX OF STERNAL END OF UNSP CLAVICLE INIT

A441

CUTANEOUS AND MUCOCUTANEOUS BARTONELLOSIS

S42016B

POST DISP FX OF STERNAL END UNSP CLAVICLE INIT FOR OPN FX

A448 OTHER FORMS OF BARTONELLOSIS

S42017A

NONDISP FX OF STERNAL END OF RIGHT CLAVICLE INIT

A449 BARTONELLOSIS UNSPECIFIED

S42017B NONDISP FX OF STERNAL END OF RIGHT CLAVICLE INIT FOR OPN FX

A46 ERYSIPELAS

S42018A NONDISP FX OF STERNAL END OF LEFT CLAVICLE INIT FOR CLOS FX

A480 GAS GANGRENE

S42018B NONDISP FX OF STERNAL END OF LEFT CLAVICLE INIT FOR OPN FX

A481 LEGIONNAIRES' DISEASE

S42019A NONDISP FX OF STERNAL END OF UNSP CLAVICLE INIT FOR CLOS FX

A482

NONPNEUMONIC LEGIONNAIRES' DISEASE [PONTIAC FEVER]

S42019B

NONDISP FX OF STERNAL END OF UNSP CLAVICLE INIT FOR OPN FX

A483 TOXIC SHOCK SYNDROME

S42021A DISP FX OF SHAFT OF RIGHT CLAVICLE INIT FOR CLOS FX

A484 BRAZILIAN PURPURIC FEVER

S42021B DISP FX OF SHAFT OF RIGHT CLAVICLE INIT FOR OPN FX

A4851 INFANT BOTULISM

S42022A DISP FX OF SHAFT OF LEFT CLAVICLE INIT FOR CLOS FX

A4852 WOUND BOTULISM

S42022B DISP FX OF SHAFT OF LEFT CLAVICLE INIT FOR OPN FX

A488 OTHER SPECIFIED BACTERIAL DISEASES

S42023A

DISP FX OF SHAFT OF UNSP CLAVICLE INIT FOR CLOS FX

A491 STREPTOCOCCAL INFECTION UNSPECIFIED SITE

S42023B

DISP FX OF SHAFT OF UNSP CLAVICLE INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A492 HEMOPHILUS INFLUENZAE INFECTION UNSPECIFIED SITE

S42024A

NONDISP FX OF SHAFT OF RIGHT CLAVICLE INIT FOR CLOS FX

A493 MYCOPLASMA INFECTION UNSPECIFIED SITE

S42024B

NONDISP FX OF SHAFT OF RIGHT CLAVICLE INIT FOR OPN FX

A498 OTHER BACTERIAL INFECTIONS OF UNSPECIFIED SITE

S42025A

NONDISP FX OF SHAFT OF LEFT CLAVICLE INIT FOR CLOS FX

A499 BACTERIAL INFECTION UNSPECIFIED

S42025B

NONDISP FX OF SHAFT OF LEFT CLAVICLE INIT FOR OPN FX

A5001 EARLY CONGENITAL SYPHILITIC OCULOPATHY

S42026A

NONDISP FX OF SHAFT OF UNSP CLAVICLE INIT FOR CLOS FX

A5002 EARLY CONGENITAL SYPHILITIC OSTEOCHONDROPATHY

S42026B

NONDISP FX OF SHAFT OF UNSP CLAVICLE INIT FOR OPN FX

A5003 EARLY CONGENITAL SYPHILITIC PHARYNGITIS

S42031A

DISP FX OF LATERAL END OF RIGHT CLAVICLE INIT FOR CLOS FX

A5004 EARLY CONGENITAL SYPHILITIC PNEUMONIA

S42031G

DISP FX OF LATERAL END R CLAVICLE SUBS FOR FX W DELAY HEAL

A5005 EARLY CONGENITAL SYPHILITIC RHINITIS

S42031S

DISPLACED FRACTURE OF LATERAL END OF RIGHT CLAVICLE SEQUELA

A5006 EARLY CUTANEOUS CONGENITAL SYPHILIS

S42032D

DISP FX OF LATERAL END L CLAVICLE SUBS FOR FX W ROUTN HEAL

A5007 EARLY MUCOCUTANEOUS CONGENITAL SYPHILIS

S42032P

DISP FX OF LATERAL END OF L CLAVICLE SUBS FOR FX W MALUNION

A5008 EARLY VISCERAL CONGENITAL SYPHILIS

S42033B

DISP FX OF LATERAL END OF UNSP CLAVICLE INIT FOR OPN FX

A5009 OTHER EARLY CONGENITAL SYPHILIS SYMPTOMATIC

S42033K

DISP FX OF LATERAL END UNSP CLAVICLE SUBS FOR FX W NONUNION

A501 EARLY CONGENITAL SYPHILIS LATENT

S42034A

NONDISP FX OF LATERAL END OF RIGHT CLAVICLE INIT

A502 EARLY CONGENITAL SYPHILIS UNSPECIFIED

S42034G

NONDISP FX OF LATERAL END R CLAVICLE 7THG

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A5030 LATE CONGENITAL SYPHILITIC OCULOPATHY UNSPECIFIED

S42034S

NONDISP FX OF LATERAL END OF RIGHT CLAVICLE SEQUELA

A5031 LATE CONGENITAL SYPHILITIC INTERSTITIAL KERATITIS

S42035D

NONDISP FX OF LATERAL END L CLAVICLE 7THD

A5032 LATE CONGENITAL SYPHILITIC CHORIORETINITIS

S42035P

NONDISP FX OF LATERAL END L CLAVICLE SUBS FOR FX W MALUNION

A5039 OTHER LATE CONGENITAL SYPHILITIC OCULOPATHY

S42036A

NONDISP FX OF LATERAL END OF UNSP CLAVICLE INIT FOR CLOS FX

A5040 LATE CONGENITAL NEUROSYPHILIS UNSPECIFIED

S42036B

NONDISP FX OF LATERAL END OF UNSP CLAVICLE INIT FOR OPN FX

A5041 LATE CONGENITAL SYPHILITIC MENINGITIS

S42036K

NONDISP FX OF LATERAL END UNSP CLAVICLE 7THK

A5042 LATE CONGENITAL SYPHILITIC ENCEPHALITIS

S42101A

FRACTURE OF UNSP PART OF SCAPULA RIGHT SHOULDER INIT

A750

EPIDEMIC LOUSE-BORNE TYPHUS FEVER D/T RICKETTSIA PROWAZEKII

S42101G

FX UNSP PART OF SCAPULA R SHLDR SUBS FOR FX W DELAY HEAL

A751 RECRUDESCENT TYPHUS [BRILL'S DISEASE]

S42101S

FRACTURE OF UNSP PART OF SCAPULA RIGHT SHOULDER SEQUELA

A752 TYPHUS FEVER DUE TO RICKETTSIA TYPHI

S42102D

FX UNSP PART OF SCAPULA L SHLDR SUBS FOR FX W ROUTN HEAL

A753 TYPHUS FEVER DUE TO RICKETTSIA TSUTSUGAMUSHI

S42102P

FX UNSP PART OF SCAPULA L SHOULDER SUBS FOR FX W MALUNION

A759 TYPHUS FEVER UNSPECIFIED

S42109B FX UNSP PART OF SCAPULA UNSP SHOULDER INIT FOR OPN FX

A770 SPOTTED FEVER DUE TO RICKETTSIA RICKETTSII

S42109K

FX UNSP PART OF SCAPULA UNSP SHLDR SUBS FOR FX W NONUNION

A771 SPOTTED FEVER DUE TO RICKETTSIA CONORII

S42111A

DISP FX OF BODY OF SCAPULA RIGHT SHOULDER INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A772 SPOTTED FEVER DUE TO RICKETTSIA SIBERICA

S42111B

DISP FX OF BODY OF SCAPULA RIGHT SHOULDER INIT FOR OPN FX

A773 SPOTTED FEVER DUE TO RICKETTSIA AUSTRALIS

S42112A

DISP FX OF BODY OF SCAPULA LEFT SHOULDER INIT FOR CLOS FX

A7740 EHRLICHIOSIS UNSPECIFIED

S42112B DISP FX OF BODY OF SCAPULA LEFT SHOULDER INIT FOR OPN FX

A7741 EHRLICHIOSIS CHAFEENSIS [E. CHAFEENSIS]

S42113A

DISP FX OF BODY OF SCAPULA UNSP SHOULDER INIT FOR CLOS FX

A7749 OTHER EHRLICHIOSIS

S42113B DISP FX OF BODY OF SCAPULA UNSP SHOULDER INIT FOR OPN FX

A778 OTHER SPOTTED FEVERS

S42114A NONDISP FX OF BODY OF SCAPULA RIGHT SHOULDER INIT

A779 SPOTTED FEVER UNSPECIFIED

S42114B NONDISP FX OF BODY OF SCAPULA R SHOULDER INIT FOR OPN FX

A78 Q FEVER

S42115A NONDISP FX OF BODY OF SCAPULA LEFT SHOULDER INIT

A790 TRENCH FEVER

S42115B NONDISP FX OF BODY OF SCAPULA L SHOULDER INIT FOR OPN FX

A800

ACUTE PARALYTIC POLIOMYELITIS VACCINE-ASSOCIATED

S42116A

NONDISP FX OF BODY OF SCAPULA UNSP SHOULDER INIT

A801

ACUTE PARALYTIC POLIOMYELITIS WILD VIRUS IMPORTED

S42116B

NONDISP FX OF BODY OF SCAPULA UNSP SHLDR INIT FOR OPN FX

A802

ACUTE PARALYTIC POLIOMYELITIS WILD VIRUS INDIGENOUS

S42121A

DISP FX OF ACROMIAL PROCESS RIGHT SHOULDER INIT

A8030 ACUTE PARALYTIC POLIOMYELITIS UNSPECIFIED

S42121B

DISP FX OF ACROMIAL PROCESS RIGHT SHOULDER INIT FOR OPN FX

A8039 OTHER ACUTE PARALYTIC POLIOMYELITIS

S42122A

DISP FX OF ACROMIAL PROCESS LEFT SHOULDER INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A804 ACUTE NONPARALYTIC POLIOMYELITIS

S42122B

DISP FX OF ACROMIAL PROCESS LEFT SHOULDER INIT FOR OPN FX

A809 ACUTE POLIOMYELITIS UNSPECIFIED

S42123A

DISP FX OF ACROMIAL PROCESS UNSP SHOULDER INIT FOR CLOS FX

A8100 CREUTZFELDT-JAKOB DISEASE UNSPECIFIED

S42123B

DISP FX OF ACROMIAL PROCESS UNSP SHOULDER INIT FOR OPN FX

A8101 VARIANT CREUTZFELDT-JAKOB DISEASE

S42124A

NONDISP FX OF ACROMIAL PROCESS RIGHT SHOULDER INIT

A8109 OTHER CREUTZFELDT-JAKOB DISEASE

S42124B

NONDISP FX OF ACROMIAL PROCESS R SHOULDER INIT FOR OPN FX

A811 SUBACUTE SCLEROSING PANENCEPHALITIS

S42125A

NONDISP FX OF ACROMIAL PROCESS LEFT SHOULDER INIT

A812 PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY

S42125B

NONDISP FX OF ACROMIAL PROCESS L SHOULDER INIT FOR OPN FX

A8181 KURU

S42126A NONDISP FX OF ACROMIAL PROCESS UNSP SHOULDER INIT

A8182 GERSTMANN-STRAUSSLER-SCHEINKER SYNDROME

S42126B

NONDISP FX OF ACROMIAL PROCESS UNSP SHLDR INIT FOR OPN FX

A8183 FATAL FAMILIAL INSOMNIA

S42131A DISP FX OF CORACOID PROCESS RIGHT SHOULDER INIT

A8189

OTHER ATYPICAL VIRUS INFECTIONS OF CENTRAL NERVOUS SYSTEM

S42131B

DISP FX OF CORACOID PROCESS RIGHT SHOULDER INIT FOR OPN FX

A819

ATYPICAL VIRUS INFECTION OF CENTRAL NERVOUS SYSTEM UNSP

S42132A

DISP FX OF CORACOID PROCESS LEFT SHOULDER INIT FOR CLOS FX

A820 SYLVATIC RABIES

S42132B DISP FX OF CORACOID PROCESS LEFT SHOULDER INIT FOR OPN FX

A821 URBAN RABIES

S42133A DISP FX OF CORACOID PROCESS UNSP SHOULDER INIT FOR CLOS FX

A829 RABIES UNSPECIFIED

S42133B DISP FX OF CORACOID PROCESS UNSP SHOULDER INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A830 JAPANESE ENCEPHALITIS

S42134A NONDISP FX OF CORACOID PROCESS RIGHT SHOULDER INIT

A831 WESTERN EQUINE ENCEPHALITIS

S42134B

NONDISP FX OF CORACOID PROCESS R SHOULDER INIT FOR OPN FX

A832 EASTERN EQUINE ENCEPHALITIS

S42135A NONDISP FX OF CORACOID PROCESS LEFT SHOULDER INIT

A833 ST LOUIS ENCEPHALITIS

S42135B NONDISP FX OF CORACOID PROCESS L SHOULDER INIT FOR OPN FX

A834 AUSTRALIAN ENCEPHALITIS

S42136A NONDISP FX OF CORACOID PROCESS UNSP SHOULDER INIT

A835 CALIFORNIA ENCEPHALITIS

S42136B NONDISP FX OF CORACOID PROCESS UNSP SHLDR INIT FOR OPN FX

A836 ROCIO VIRUS DISEASE

S42141A DISP FX OF GLENOID CAVITY OF SCAPULA RIGHT SHOULDER INIT

A838 OTHER MOSQUITO-BORNE VIRAL ENCEPHALITIS

S42141B

DISP FX OF GLENOID CAV OF SCAPULA R SHLDR INIT FOR OPN FX

A839 MOSQUITO-BORNE VIRAL ENCEPHALITIS UNSPECIFIED

S42142A

DISP FX OF GLENOID CAVITY OF SCAPULA LEFT SHOULDER INIT

A840 FAR EASTERN TICK-BORNE ENCEPHALITIS

S42142B

DISP FX OF GLENOID CAV OF SCAPULA L SHLDR INIT FOR OPN FX

A841 CENTRAL EUROPEAN TICK-BORNE ENCEPHALITIS

S42143A

DISP FX OF GLENOID CAVITY OF SCAPULA UNSP SHOULDER INIT

A848 OTHER TICK-BORNE VIRAL ENCEPHALITIS

S42143B

DISP FX OF GLENOID CAV OF SCAPULA UNSP SHLDR 7THB

A849 TICK-BORNE VIRAL ENCEPHALITIS UNSPECIFIED

S42144A

NONDISP FX OF GLENOID CAV OF SCAPULA RIGHT SHOULDER INIT

A850 ENTEROVIRAL ENCEPHALITIS

S42144B NONDISP FX OF GLENOID CAV OF SCAPULA R SHLDR 7THB

A851 ADENOVIRAL ENCEPHALITIS

S42145A NONDISP FX OF GLENOID CAVITY OF SCAPULA LEFT SHOULDER INIT

A852 ARTHROPOD-BORNE VIRAL ENCEPHALITIS UNSPECIFIED

S42145B

NONDISP FX OF GLENOID CAV OF SCAPULA L SHLDR 7THB

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A858 OTHER SPECIFIED VIRAL ENCEPHALITIS

S42146A

NONDISP FX OF GLENOID CAVITY OF SCAPULA UNSP SHOULDER INIT

A86 UNSPECIFIED VIRAL ENCEPHALITIS

S42146B

NONDISP FX OF GLENOID CAV OF SCAPULA UNSP SHLDR 7THB

A870 ENTEROVIRAL MENINGITIS

S42151A DISP FX OF NECK OF SCAPULA RIGHT SHOULDER INIT FOR CLOS FX

A871 ADENOVIRAL MENINGITIS

S42151B DISP FX OF NECK OF SCAPULA RIGHT SHOULDER INIT FOR OPN FX

A872 LYMPHOCYTIC CHORIOMENINGITIS

S42152A

DISP FX OF NECK OF SCAPULA LEFT SHOULDER INIT FOR CLOS FX

A878 OTHER VIRAL MENINGITIS

S42152B DISP FX OF NECK OF SCAPULA LEFT SHOULDER INIT FOR OPN FX

A879 VIRAL MENINGITIS UNSPECIFIED

S42153A

DISP FX OF NECK OF SCAPULA UNSP SHOULDER INIT FOR CLOS FX

A888

OTHER SPECIFIED VIRAL INFECTIONS OF CENTRAL NERVOUS SYSTEM

S42153B

DISP FX OF NECK OF SCAPULA UNSP SHOULDER INIT FOR OPN FX

A89 UNSPECIFIED VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM

S42154A

NONDISP FX OF NECK OF SCAPULA RIGHT SHOULDER INIT

A9231 WEST NILE VIRUS INFECTION WITH ENCEPHALITIS

S42154B

NONDISP FX OF NECK OF SCAPULA R SHOULDER INIT FOR OPN FX

A9232

WEST NILE VIRUS INFECTION WITH OTH NEUROLOGIC MANIFESTATION

S42155A

NONDISP FX OF NECK OF SCAPULA LEFT SHOULDER INIT

A9239 WEST NILE VIRUS INFECTION WITH OTHER COMPLICATIONS

S42155B

NONDISP FX OF NECK OF SCAPULA L SHOULDER INIT FOR OPN FX

A924 RIFT VALLEY FEVER

S42156A NONDISP FX OF NECK OF SCAPULA UNSP SHOULDER INIT

A928 OTHER SPECIFIED MOSQUITO-BORNE VIRAL FEVERS

S42156B

NONDISP FX OF NECK OF SCAPULA UNSP SHLDR INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A929 MOSQUITO-BORNE VIRAL FEVER UNSPECIFIED

S42191A

FRACTURE OF OTH PART OF SCAPULA RIGHT SHOULDER INIT

A930 OROPOUCHE VIRUS DISEASE

S42191B FRACTURE OTH PRT SCAPULA RIGHT SHOULDER INIT FOR OPN FX

A984 EBOLA VIRUS DISEASE

S42192A FRACTURE OF OTH PART OF SCAPULA LEFT SHOULDER INIT

A985 HEMORRHAGIC FEVER WITH RENAL SYNDROME

S42192B

FRACTURE OTH PRT SCAPULA LEFT SHOULDER INIT FOR OPN FX

A988 OTHER SPECIFIED VIRAL HEMORRHAGIC FEVERS

S42199A

FRACTURE OF OTH PART OF SCAPULA UNSP SHOULDER INIT

A99 UNSPECIFIED VIRAL HEMORRHAGIC FEVER

S42199B

FRACTURE OTH PRT SCAPULA UNSP SHOULDER INIT FOR OPN FX

B003 HERPESVIRAL MENINGITIS

S42201A UNSP FRACTURE OF UPPER END OF RIGHT HUMERUS INIT

B004 HERPESVIRAL ENCEPHALITIS

S42201B UNSP FRACTURE OF UPPER END OF RIGHT HUMERUS INIT FOR OPN FX

B0050 HERPESVIRAL OCULAR DISEASE UNSPECIFIED

S42202A

UNSP FRACTURE OF UPPER END OF LEFT HUMERUS INIT FOR CLOS FX

B0051 HERPESVIRAL IRIDOCYCLITIS

S42202B UNSP FRACTURE OF UPPER END OF LEFT HUMERUS INIT FOR OPN FX

B010 VARICELLA MENINGITIS

S42209A UNSP FRACTURE OF UPPER END OF UNSP HUMERUS INIT FOR CLOS FX

B0111 VARICELLA ENCEPHALITIS AND ENCEPHALOMYELITIS

S42209B

UNSP FRACTURE OF UPPER END OF UNSP HUMERUS INIT FOR OPN FX

B0112 VARICELLA MYELITIS

S42211A UNSP DISP FX OF SURGICAL NECK OF RIGHT HUMERUS INIT

B0189 OTHER VARICELLA COMPLICATIONS

S42211B

UNSP DISP FX OF SURGICAL NECK OF R HUMERUS INIT FOR OPN FX

B020 ZOSTER ENCEPHALITIS

S42212A UNSP DISP FX OF SURGICAL NECK OF LEFT HUMERUS INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

B021 ZOSTER MENINGITIS

S42212B UNSP DISP FX OF SURGICAL NECK OF L HUMERUS INIT FOR OPN FX

B0221 POSTHERPETIC GENICULATE GANGLIONITIS

S42213A

UNSP DISP FX OF SURGICAL NECK OF UNSP HUMERUS INIT

B050 MEASLES COMPLICATED BY ENCEPHALITIS

S42213B

UNSP DISP FX OF SURG NECK OF UNSP HUMERUS INIT FOR OPN FX

B051 MEASLES COMPLICATED BY MENINGITIS

S42214A

UNSP NONDISP FX OF SURGICAL NECK OF RIGHT HUMERUS INIT

B052 MEASLES COMPLICATED BY PNEUMONIA

S42214B

UNSP NONDISP FX OF SURG NECK OF R HUMERUS INIT FOR OPN FX

B0601 RUBELLA ENCEPHALITIS

S42215A UNSP NONDISP FX OF SURGICAL NECK OF LEFT HUMERUS INIT

B0602 RUBELLA MENINGITIS

S42215B UNSP NONDISP FX OF SURG NECK OF L HUMERUS INIT FOR OPN FX

B0609 OTHER NEUROLOGICAL COMPLICATIONS OF RUBELLA

S42216A

UNSP NONDISP FX OF SURGICAL NECK OF UNSP HUMERUS INIT

B0681 RUBELLA PNEUMONIA

S42216B UNSP NONDISP FX OF SURG NECK OF UNSP HUMER INIT FOR OPN FX

B0689 OTHER RUBELLA COMPLICATIONS

S42221A

2-PART DISP FX OF SURGICAL NECK OF RIGHT HUMERUS INIT

B08011 VACCINIA NOT FROM VACCINE

S42221B 2-PART DISP FX OF SURG NECK OF R HUMERUS INIT FOR OPN FX

B1009 OTHER HUMAN HERPESVIRUS ENCEPHALITIS

S42222A

2-PART DISP FX OF SURGICAL NECK OF LEFT HUMERUS INIT

B150 HEPATITIS A WITH HEPATIC COMA

S42222B

2-PART DISP FX OF SURG NECK OF L HUMERUS INIT FOR OPN FX

B159 HEPATITIS A WITHOUT HEPATIC COMA

S42223A

2-PART DISP FX OF SURGICAL NECK OF UNSP HUMERUS INIT

B160

ACUTE HEPATITIS B WITH DELTA-AGENT WITH HEPATIC COMA

S42223B

2-PART DISP FX OF SURG NECK OF UNSP HUMERUS INIT FOR OPN FX

B1711 ACUTE HEPATITIS C WITH HEPATIC COMA

S42224A

2-PART NONDISP FX OF SURGICAL NECK OF RIGHT HUMERUS INIT

B190 UNSPECIFIED VIRAL HEPATITIS WITH HEPATIC COMA

S42224B

2-PART NONDISP FX OF SURG NECK OF R HUMERUS INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

B261 MUMPS MENINGITIS

S42225A 2-PART NONDISP FX OF SURGICAL NECK OF LEFT HUMERUS INIT

B262 MUMPS ENCEPHALITIS

S42225B 2-PART NONDISP FX OF SURG NECK OF L HUMERUS INIT FOR OPN FX

B263 MUMPS PANCREATITIS

S42226A 2-PART NONDISP FX OF SURGICAL NECK OF UNSP HUMERUS INIT

B2701

GAMMAHERPESVIRAL MONONUCLEOSIS WITH POLYNEUROPATHY

S42226B

2-PART NONDISP FX OF SURG NK OF UNSP HUMER INIT FOR OPN FX

B2702

GAMMAHERPESVIRAL MONONUCLEOSIS WITH MENINGITIS

S42231A

3-PART FRACTURE OF SURGICAL NECK OF RIGHT HUMERUS INIT

B2712

CYTOMEGALOVIRAL MONONUCLEOSIS WITH MENINGITIS

S42231B

3-PART FX SURGICAL NECK OF R HUMERUS INIT FOR OPN FX

B2719

CYTOMEGALOVIRAL MONONUCLEOSIS WITH OTHER COMPLICATION

S42232A

3-PART FRACTURE OF SURGICAL NECK OF LEFT HUMERUS INIT

B2781

OTHER INFECTIOUS MONONUCLEOSIS WITH POLYNEUROPATHY

S42232B

3-PART FX SURGICAL NECK OF L HUMERUS INIT FOR OPN FX

B2782

OTHER INFECTIOUS MONONUCLEOSIS WITH MENINGITIS

S42239A

3-PART FRACTURE OF SURGICAL NECK OF UNSP HUMERUS INIT

B2789

OTHER INFECTIOUS MONONUCLEOSIS WITH OTHER COMPLICATION

S42239B

3-PART FX SURGICAL NECK OF UNSP HUMERUS INIT FOR OPN FX

B2792 INFECTIOUS MONONUCLEOSIS UNSPECIFIED WITH MENINGITIS

S42241A

4-PART FRACTURE OF SURGICAL NECK OF RIGHT HUMERUS INIT

B2799

INFECTIOUS MONONUCLEOSIS UNSP WITH OTHER COMPLICATION

S42241B

4-PART FX SURGICAL NECK OF R HUMERUS INIT FOR OPN FX

B3320 VIRAL CARDITIS UNSPECIFIED

S42242A 4-PART FRACTURE OF SURGICAL NECK OF LEFT HUMERUS INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

B3321 VIRAL ENDOCARDITIS

S42242B 4-PART FX SURGICAL NECK OF L HUMERUS INIT FOR OPN FX

B3322 VIRAL MYOCARDITIS

S42249A 4-PART FRACTURE OF SURGICAL NECK OF UNSP HUMERUS INIT

B3323 VIRAL PERICARDITIS

S42249B 4-PART FX SURGICAL NECK OF UNSP HUMERUS INIT FOR OPN FX

B3324 VIRAL CARDIOMYOPATHY

S42251A DISP FX OF GREATER TUBEROSITY OF RIGHT HUMERUS INIT

B334

HANTAVIRUS (CARDIO)-PULMONARY SYNDROME [HPS] [HCPS]

S42251B

DISP FX OF GREATER TUBEROSITY OF R HUMERUS INIT FOR OPN FX

B349 VIRAL INFECTION UNSPECIFIED

S42252A DISP FX OF GREATER TUBEROSITY OF LEFT HUMERUS INIT

B375 CANDIDAL MENINGITIS

S42252B DISP FX OF GREATER TUBEROSITY OF L HUMERUS INIT FOR OPN FX

B376 CANDIDAL ENDOCARDITIS

S42253A DISP FX OF GREATER TUBEROSITY OF UNSP HUMERUS INIT

B377 CANDIDAL SEPSIS

S42253B DISP FX OF GREATER TUBEROSITY OF UNSP HUMER INIT FOR OPN FX

B380 ACUTE PULMONARY COCCIDIOIDOMYCOSIS

S42254A

NONDISP FX OF GREATER TUBEROSITY OF RIGHT HUMERUS INIT

B384 COCCIDIOIDOMYCOSIS MENINGITIS

S42254B

NONDISP FX OF GREATER TUBEROSITY OF R HUMER INIT FOR OPN FX

B387 DISSEMINATED COCCIDIOIDOMYCOSIS

S42255A

NONDISP FX OF GREATER TUBEROSITY OF LEFT HUMERUS INIT

B390 ACUTE PULMONARY HISTOPLASMOSIS CAPSULATI

S42255B

NONDISP FX OF GREATER TUBEROSITY OF L HUMER INIT FOR OPN FX

B400 ACUTE PULMONARY BLASTOMYCOSIS

S42256A

NONDISP FX OF GREATER TUBEROSITY OF UNSP HUMERUS INIT

B4081 BLASTOMYCOTIC MENINGOENCEPHALITIS

S42256B

NONDISP FX OF GREATER TUBEROSITY OF UNSP HUMER 7THB

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

B4281 CEREBRAL SPOROTRICHOSIS

S42261A DISP FX OF LESSER TUBEROSITY OF RIGHT HUMERUS INIT

B431 PHEOMYCOTIC BRAIN ABSCESS

S42261B DISP FX OF LESSER TUBEROSITY OF R HUMERUS INIT FOR OPN FX

B451 CEREBRAL CRYPTOCOCCOSIS

S42262A DISP FX OF LESSER TUBEROSITY OF LEFT HUMERUS INIT

B5741 MENINGITIS IN CHAGAS' DISEASE

S42262B

DISP FX OF LESSER TUBEROSITY OF L HUMERUS INIT FOR OPN FX

B5742 MENINGOENCEPHALITIS IN CHAGAS' DISEASE

S42263A

DISP FX OF LESSER TUBEROSITY OF UNSP HUMERUS INIT

B582 TOXOPLASMA MENINGOENCEPHALITIS

S42263B

DISP FX OF LESSER TUBEROSITY OF UNSP HUMER INIT FOR OPN FX

B6011

MENINGOENCEPHALITIS DUE TO ACANTHAMOEBA (CULBERTSONI)

S42264A

NONDISP FX OF LESSER TUBEROSITY OF RIGHT HUMERUS INIT

C50011

MALIGNANT NEOPLASM OF NIPPLE AND AREOLA RIGHT FEMALE BREAST

S42264B

NONDISP FX OF LESSER TUBEROSITY OF R HUMER INIT FOR OPN FX

C50012

MALIGNANT NEOPLASM OF NIPPLE AND AREOLA LEFT FEMALE BREAST

S42265A

NONDISP FX OF LESSER TUBEROSITY OF LEFT HUMERUS INIT

C50019

MALIGNANT NEOPLASM OF NIPPLE AND AREOLA UNSP FEMALE BREAST

S42265B

NONDISP FX OF LESSER TUBEROSITY OF L HUMER INIT FOR OPN FX

C50021

MALIGNANT NEOPLASM OF NIPPLE AND AREOLA RIGHT MALE BREAST

S42266A

NONDISP FX OF LESSER TUBEROSITY OF UNSP HUMERUS INIT

C50022

MALIGNANT NEOPLASM OF NIPPLE AND AREOLA LEFT MALE BREAST

S42266B

NONDISP FX OF LESS TUBEROSITY OF UNSP HUMER INIT FOR OPN FX

C50029

MALIGNANT NEOPLASM OF NIPPLE AND AREOLA UNSP MALE BREAST

S42271A

TORUS FRACTURE OF UPPER END OF RIGHT HUMERUS INIT

C50111

MALIGNANT NEOPLASM OF CENTRAL PORTION OF RIGHT FEMALE BREAST

S42272A

TORUS FRACTURE OF UPPER END OF LEFT HUMERUS INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

C50112

MALIGNANT NEOPLASM OF CENTRAL PORTION OF LEFT FEMALE BREAST

S42279A

TORUS FRACTURE OF UPPER END OF UNSP HUMERUS INIT

C50119

MALIGNANT NEOPLASM OF CENTRAL PORTION OF UNSP FEMALE BREAST

S42291A

OTH DISP FX OF UPPER END OF RIGHT HUMERUS INIT FOR CLOS FX

C50121

MALIGNANT NEOPLASM OF CENTRAL PORTION OF RIGHT MALE BREAST

S42291B

OTH DISP FX OF UPPER END OF RIGHT HUMERUS INIT FOR OPN FX

C50122

MALIGNANT NEOPLASM OF CENTRAL PORTION OF LEFT MALE BREAST

S42292A

OTH DISP FX OF UPPER END OF LEFT HUMERUS INIT FOR CLOS FX

C50129

MALIGNANT NEOPLASM OF CENTRAL PORTION OF UNSP MALE BREAST

S42292B

OTH DISP FX OF UPPER END OF LEFT HUMERUS INIT FOR OPN FX

C50211

MALIG NEOPLM OF UPPER-INNER QUADRANT OF RIGHT FEMALE BREAST

S42293A

OTH DISP FX OF UPPER END OF UNSP HUMERUS INIT FOR CLOS FX

C50212

MALIG NEOPLASM OF UPPER-INNER QUADRANT OF LEFT FEMALE BREAST

S42293B

OTH DISP FX OF UPPER END OF UNSP HUMERUS INIT FOR OPN FX

C50219

MALIG NEOPLASM OF UPPER-INNER QUADRANT OF UNSP FEMALE BREAST

S42294A

OTH NONDISP FX OF UPPER END OF RIGHT HUMERUS INIT

C50221

MALIG NEOPLASM OF UPPER-INNER QUADRANT OF RIGHT MALE BREAST

S42294B

OTH NONDISP FX OF UPPER END OF R HUMERUS INIT FOR OPN FX

C50222

MALIG NEOPLASM OF UPPER-INNER QUADRANT OF LEFT MALE BREAST

S42295A

OTH NONDISP FX OF UPPER END OF LEFT HUMERUS INIT

C50229

MALIG NEOPLASM OF UPPER-INNER QUADRANT OF UNSP MALE BREAST

S42295B

OTH NONDISP FX OF UPPER END OF LEFT HUMERUS INIT FOR OPN FX

C50311

MALIG NEOPLM OF LOWER-INNER QUADRANT OF RIGHT FEMALE BREAST

S42296A

OTH NONDISP FX OF UPPER END OF UNSP HUMERUS INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

C50312

MALIG NEOPLASM OF LOWER-INNER QUADRANT OF LEFT FEMALE BREAST

S42296B

OTH NONDISP FX OF UPPER END OF UNSP HUMERUS INIT FOR OPN FX

C50319

MALIG NEOPLASM OF LOWER-INNER QUADRANT OF UNSP FEMALE BREAST

S42301A

UNSP FRACTURE OF SHAFT OF HUMERUS RIGHT ARM INIT

C50321

MALIG NEOPLASM OF LOWER-INNER QUADRANT OF RIGHT MALE BREAST

S42301B

UNSP FX SHAFT OF HUMERUS RIGHT ARM INIT FOR OPN FX

C50322

MALIG NEOPLASM OF LOWER-INNER QUADRANT OF LEFT MALE BREAST

S42302A

UNSP FRACTURE OF SHAFT OF HUMERUS LEFT ARM INIT

C50329

MALIG NEOPLASM OF LOWER-INNER QUADRANT OF UNSP MALE BREAST

S42302B

UNSP FRACTURE OF SHAFT OF HUMERUS LEFT ARM INIT FOR OPN FX

C50411

MALIG NEOPLM OF UPPER-OUTER QUADRANT OF RIGHT FEMALE BREAST

S42309A

UNSP FRACTURE OF SHAFT OF HUMERUS UNSP ARM INIT

C50412

MALIG NEOPLASM OF UPPER-OUTER QUADRANT OF LEFT FEMALE BREAST

S42309B

UNSP FRACTURE OF SHAFT OF HUMERUS UNSP ARM INIT FOR OPN FX

C50419

MALIG NEOPLASM OF UPPER-OUTER QUADRANT OF UNSP FEMALE BREAST

S42311A

GREENSTICK FRACTURE OF SHAFT OF HUMERUS RIGHT ARM INIT

C50421

MALIG NEOPLASM OF UPPER-OUTER QUADRANT OF RIGHT MALE BREAST

S42312A

GREENSTICK FRACTURE OF SHAFT OF HUMERUS LEFT ARM INIT

C50422

MALIG NEOPLASM OF UPPER-OUTER QUADRANT OF LEFT MALE BREAST

S42319A

GREENSTICK FRACTURE OF SHAFT OF HUMERUS UNSP ARM INIT

C50429

MALIG NEOPLASM OF UPPER-OUTER QUADRANT OF UNSP MALE BREAST

S42321A

DISPLACED TRANSVERSE FX SHAFT OF HUMERUS RIGHT ARM INIT

C50511

MALIG NEOPLM OF LOWER-OUTER QUADRANT OF RIGHT FEMALE BREAST

S42321B

DISPL TRANSVERSE FX SHAFT OF HUMER R ARM INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

C50512

MALIG NEOPLASM OF LOWER-OUTER QUADRANT OF LEFT FEMALE BREAST

S42322A

DISPLACED TRANSVERSE FX SHAFT OF HUMERUS LEFT ARM INIT

C50519

MALIG NEOPLASM OF LOWER-OUTER QUADRANT OF UNSP FEMALE BREAST

S42322B

DISPL TRANSVERSE FX SHAFT OF HUMER L ARM INIT FOR OPN FX

C50521

MALIG NEOPLASM OF LOWER-OUTER QUADRANT OF RIGHT MALE BREAST

S42323A

DISPLACED TRANSVERSE FX SHAFT OF HUMERUS UNSP ARM INIT

C50522

MALIG NEOPLASM OF LOWER-OUTER QUADRANT OF LEFT MALE BREAST

S42323B

DISPL TRANSVERSE FX SHAFT OF HUMER UNSP ARM 7THB

C50529

MALIG NEOPLASM OF LOWER-OUTER QUADRANT OF UNSP MALE BREAST

S42324A

NONDISP TRANSVERSE FX SHAFT OF HUMERUS RIGHT ARM INIT

C50611

MALIGNANT NEOPLASM OF AXILLARY TAIL OF RIGHT FEMALE BREAST

S42324B

NONDISP TRANSVERSE FX SHAFT OF HUMER R ARM INIT FOR OPN FX

C50612

MALIGNANT NEOPLASM OF AXILLARY TAIL OF LEFT FEMALE BREAST

S42325A

NONDISP TRANSVERSE FX SHAFT OF HUMERUS LEFT ARM INIT

C50619

MALIGNANT NEOPLASM OF AXILLARY TAIL OF UNSP FEMALE BREAST

S42325B

NONDISP TRANSVERSE FX SHAFT OF HUMER L ARM INIT FOR OPN FX

C50621

MALIGNANT NEOPLASM OF AXILLARY TAIL OF RIGHT MALE BREAST

S42326A

NONDISP TRANSVERSE FX SHAFT OF HUMERUS UNSP ARM INIT

C50622

MALIGNANT NEOPLASM OF AXILLARY TAIL OF LEFT MALE BREAST

S42326B

NONDISP TRANSVERSE FX SHAFT OF HUMER UNSP ARM 7THB

C50629

MALIGNANT NEOPLASM OF AXILLARY TAIL OF UNSP MALE BREAST

S42331A

DISPLACED OBLIQUE FX SHAFT OF HUMERUS RIGHT ARM INIT

C50811

MALIGNANT NEOPLASM OF OVRLP SITES OF RIGHT FEMALE BREAST

S42331B

DISPL OBLIQUE FX SHAFT OF HUMER RIGHT ARM INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

C50812

MALIGNANT NEOPLASM OF OVRLP SITES OF LEFT FEMALE BREAST

S42332A

DISPLACED OBLIQUE FX SHAFT OF HUMERUS LEFT ARM INIT

C50819

MALIGNANT NEOPLASM OF OVRLP SITES OF UNSP FEMALE BREAST

S42332B

DISPL OBLIQUE FX SHAFT OF HUMERUS LEFT ARM INIT FOR OPN FX

C50821

MALIGNANT NEOPLASM OF OVERLAPPING SITES OF RIGHT MALE BREAST

S42333A

DISPLACED OBLIQUE FX SHAFT OF HUMERUS UNSP ARM INIT

C50822

MALIGNANT NEOPLASM OF OVERLAPPING SITES OF LEFT MALE BREAST

S42333B

DISPL OBLIQUE FX SHAFT OF HUMERUS UNSP ARM INIT FOR OPN FX

C50829

MALIGNANT NEOPLASM OF OVERLAPPING SITES OF UNSP MALE BREAST

S42334A

NONDISP OBLIQUE FX SHAFT OF HUMERUS RIGHT ARM INIT

C50911

MALIGNANT NEOPLASM OF UNSP SITE OF RIGHT FEMALE BREAST

S42334B

NONDISP OBLIQUE FX SHAFT OF HUMER R ARM INIT FOR OPN FX

C50912

MALIGNANT NEOPLASM OF UNSPECIFIED SITE OF LEFT FEMALE BREAST

S42335A

NONDISP OBLIQUE FRACTURE OF SHAFT OF HUMERUS LEFT ARM INIT

C50919

MALIGNANT NEOPLASM OF UNSP SITE OF UNSPECIFIED FEMALE BREAST

S42335B

NONDISP OBLIQUE FX SHAFT OF HUMER LEFT ARM INIT FOR OPN FX

C50921

MALIGNANT NEOPLASM OF UNSPECIFIED SITE OF RIGHT MALE BREAST

S42336A

NONDISP OBLIQUE FRACTURE OF SHAFT OF HUMERUS UNSP ARM INIT

C50922

MALIGNANT NEOPLASM OF UNSPECIFIED SITE OF LEFT MALE BREAST

S42336B

NONDISP OBLIQUE FX SHAFT OF HUMER UNSP ARM INIT FOR OPN FX

C50929

MALIGNANT NEOPLASM OF UNSP SITE OF UNSPECIFIED MALE BREAST

S42341A

DISPLACED SPIRAL FX SHAFT OF HUMERUS RIGHT ARM INIT

C7981 SECONDARY MALIGNANT NEOPLASM OF BREAST

S42341B

DISPL SPIRAL FX SHAFT OF HUMERUS RIGHT ARM INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

C965

MULTIFOCAL AND UNISYSTEMIC LANGERHANS-CELL HISTIOCYTOSIS

S42342A

DISPLACED SPIRAL FX SHAFT OF HUMERUS LEFT ARM INIT

C966 UNIFOCAL LANGERHANS-CELL HISTIOCYTOSIS

S42342B

DISPL SPIRAL FX SHAFT OF HUMERUS LEFT ARM INIT FOR OPN FX

C969

MALIG NEOPLM OF LYMPHOID HEMATPOETC AND REL TISSUE UNSP

S42343A

DISPLACED SPIRAL FX SHAFT OF HUMERUS UNSP ARM INIT

C96Z

OTH MALIG NEOPLM OF LYMPHOID HEMATPOETC AND RELATED TISSUE

S42343B

DISPL SPIRAL FX SHAFT OF HUMERUS UNSP ARM INIT FOR OPN FX

D0500 LOBULAR CARCINOMA IN SITU OF UNSPECIFIED BREAST

S42344A

NONDISP SPIRAL FRACTURE OF SHAFT OF HUMERUS RIGHT ARM INIT

D0501 LOBULAR CARCINOMA IN SITU OF RIGHT BREAST

S42344B

NONDISP SPIRAL FX SHAFT OF HUMER RIGHT ARM INIT FOR OPN FX

D0502 LOBULAR CARCINOMA IN SITU OF LEFT BREAST

S42345A

NONDISP SPIRAL FRACTURE OF SHAFT OF HUMERUS LEFT ARM INIT

D0510 INTRADUCTAL CARCINOMA IN SITU OF UNSPECIFIED BREAST

S42345B

NONDISP SPIRAL FX SHAFT OF HUMER LEFT ARM INIT FOR OPN FX

D0511 INTRADUCTAL CARCINOMA IN SITU OF RIGHT BREAST

S42346A

NONDISP SPIRAL FRACTURE OF SHAFT OF HUMERUS UNSP ARM INIT

D0512 INTRADUCTAL CARCINOMA IN SITU OF LEFT BREAST

S42346B

NONDISP SPIRAL FX SHAFT OF HUMER UNSP ARM INIT FOR OPN FX

D0580 OTH TYPE OF CARCINOMA IN SITU OF UNSPECIFIED BREAST

S42351A

DISPLACED COMMINUTED FX SHAFT OF HUMERUS RIGHT ARM INIT

D0581

OTHER SPECIFIED TYPE OF CARCINOMA IN SITU OF RIGHT BREAST

S42351B

DISPL COMMNT FX SHAFT OF HUMERUS RIGHT ARM INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

D0582

OTHER SPECIFIED TYPE OF CARCINOMA IN SITU OF LEFT BREAST

S42352A

DISPLACED COMMINUTED FX SHAFT OF HUMERUS LEFT ARM INIT

D0590

UNSPECIFIED TYPE OF CARCINOMA IN SITU OF UNSPECIFIED BREAST

S42352B

DISPL COMMNT FX SHAFT OF HUMERUS LEFT ARM INIT FOR OPN FX

D0591

UNSPECIFIED TYPE OF CARCINOMA IN SITU OF RIGHT BREAST

S42353A

DISPLACED COMMINUTED FX SHAFT OF HUMERUS UNSP ARM INIT

D0592

UNSPECIFIED TYPE OF CARCINOMA IN SITU OF LEFT BREAST

S42353B

DISPL COMMNT FX SHAFT OF HUMERUS UNSP ARM INIT FOR OPN FX

D564 HEREDITARY PERSISTENCE OF FETAL HEMOGLOBIN [HPFH]

S42354A

NONDISP COMMINUTED FX SHAFT OF HUMERUS RIGHT ARM INIT

D568 OTHER THALASSEMIAS

S42354B NONDISP COMMNT FX SHAFT OF HUMER RIGHT ARM INIT FOR OPN FX

D569 THALASSEMIA UNSPECIFIED

S42355A NONDISP COMMINUTED FX SHAFT OF HUMERUS LEFT ARM INIT

D5700 HB-SS DISEASE WITH CRISIS UNSPECIFIED

S42355B

NONDISP COMMNT FX SHAFT OF HUMER LEFT ARM INIT FOR OPN FX

D5701 HB-SS DISEASE WITH ACUTE CHEST SYNDROME

S42356A

NONDISP COMMINUTED FX SHAFT OF HUMERUS UNSP ARM INIT

D5702 HB-SS DISEASE WITH SPLENIC SEQUESTRATION

S42356B

NONDISP COMMNT FX SHAFT OF HUMER UNSP ARM INIT FOR OPN FX

D571 SICKLE-CELL DISEASE WITHOUT CRISIS

S42361A

DISPLACED SEGMENTAL FX SHAFT OF HUMERUS RIGHT ARM INIT

D5720 SICKLE-CELL/HB-C DISEASE WITHOUT CRISIS

S42361B

DISPL SEG FX SHAFT OF HUMERUS RIGHT ARM INIT FOR OPN FX

D57211 SICKLE-CELL/HB-C DISEASE WITH ACUTE CHEST SYNDROME

S42362A

DISPLACED SEGMENTAL FX SHAFT OF HUMERUS LEFT ARM INIT

D57212 SICKLE-CELL/HB-C DISEASE WITH SPLENIC SEQUESTRATION

S42362B

DISPL SEG FX SHAFT OF HUMERUS LEFT ARM INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

D57219 SICKLE-CELL/HB-C DISEASE WITH CRISIS UNSPECIFIED

S42363A

DISPLACED SEGMENTAL FX SHAFT OF HUMERUS UNSP ARM INIT

D573 SICKLE-CELL TRAIT

S42363B DISPL SEG FX SHAFT OF HUMERUS UNSP ARM INIT FOR OPN FX

D5740 SICKLE-CELL THALASSEMIA WITHOUT CRISIS

S42364A

NONDISP SEGMENTAL FX SHAFT OF HUMERUS RIGHT ARM INIT

D57411 SICKLE-CELL THALASSEMIA WITH ACUTE CHEST SYNDROME

S42364B

NONDISP SEG FX SHAFT OF HUMERUS RIGHT ARM INIT FOR OPN FX

D57412 SICKLE-CELL THALASSEMIA WITH SPLENIC SEQUESTRATION

S42365A

NONDISP SEGMENTAL FX SHAFT OF HUMERUS LEFT ARM INIT

D57419 SICKLE-CELL THALASSEMIA WITH CRISIS UNSPECIFIED

S42365B

NONDISP SEG FX SHAFT OF HUMERUS LEFT ARM INIT FOR OPN FX

D5780 OTHER SICKLE-CELL DISORDERS WITHOUT CRISIS

S42366A

NONDISP SEGMENTAL FX SHAFT OF HUMERUS UNSP ARM INIT

D57811 OTHER SICKLE-CELL DISORDERS WITH ACUTE CHEST SYNDROME

S42366B

NONDISP SEG FX SHAFT OF HUMERUS UNSP ARM INIT FOR OPN FX

D57812 OTHER SICKLE-CELL DISORDERS WITH SPLENIC SEQUESTRATION

S42391A

OTH FRACTURE OF SHAFT OF RIGHT HUMERUS INIT FOR CLOS FX

D57819 OTHER SICKLE-CELL DISORDERS WITH CRISIS UNSPECIFIED

S42391B

OTH FRACTURE OF SHAFT OF RIGHT HUMERUS INIT FOR OPN FX

E0800

DIAB D/T UNDRL COND W HYPROSM W/O NONKET HYPRGLY-HYPROS COMA

S42392A

OTH FRACTURE OF SHAFT OF LEFT HUMERUS INIT FOR CLOS FX

E0801

DIABETES DUE TO UNDERLYING CONDITION W HYPROSM W COMA

S42392B

OTH FRACTURE OF SHAFT OF LEFT HUMERUS INIT FOR OPN FX

E0810

DIABETES DUE TO UNDERLYING CONDITION W KETOACIDOSIS W/O COMA

S42399A

OTH FRACTURE OF SHAFT OF UNSP HUMERUS INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E0811

DIABETES DUE TO UNDERLYING CONDITION W KETOACIDOSIS W COMA

S42399B

OTH FRACTURE OF SHAFT OF UNSP HUMERUS INIT FOR OPN FX

E0821

DIABETES DUE TO UNDERLYING CONDITION W DIABETIC NEPHROPATHY

S42401A

UNSP FRACTURE OF LOWER END OF RIGHT HUMERUS INIT

E0822

DIABETES DUE TO UNDRL COND W DIABETIC CHRONIC KIDNEY DISEASE

S42401B

UNSP FRACTURE OF LOWER END OF RIGHT HUMERUS INIT FOR OPN FX

E0829

DIABETES DUE TO UNDRL CONDITION W OTH DIABETIC KIDNEY COMP

S42402A

UNSP FRACTURE OF LOWER END OF LEFT HUMERUS INIT FOR CLOS FX

E08311

DIAB DUE TO UNDRL COND W UNSP DIABETIC RTNOP W MACULAR EDEMA

S42402B

UNSP FRACTURE OF LOWER END OF LEFT HUMERUS INIT FOR OPN FX

E08319

DIAB DUE TO UNDRL COND W UNSP DIAB RTNOP W/O MACULAR EDEMA

S42409A

UNSP FRACTURE OF LOWER END OF UNSP HUMERUS INIT FOR CLOS FX

E08321

DIAB D/T UNDRL COND W MILD NONPRLF DIAB RTNOP W MCLR EDEMA

S42409B

UNSP FRACTURE OF LOWER END OF UNSP HUMERUS INIT FOR OPN FX

E083211

Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema right eye

S42411A

DISPL SIMPLE SUPRCNDL FX W/O INTRCNDL FX R HUMERUS INIT

E083212

Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema left eye

S42411B

DISPL SIMP SUPRCNDL FX W/O INTRCNDL FX R HUMER 7THB

E083213

Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema bilateral

S42412A

DISPL SIMPLE SUPRCNDL FX W/O INTRCNDL FX L HUMERUS INIT

E08329

DIAB D/T UNDRL COND W MILD NONPRLF DIAB RTNOP W/O MCLR EDEMA

S42412B

DISPL SIMP SUPRCNDL FX W/O INTRCNDL FX L HUMER 7THB

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E08331

DIAB DUE TO UNDRL COND W MOD NONPRLF DIAB RTNOP W MCLR EDEMA

S42413A

DISPL SIMPLE SUPRCNDL FX W/O INTRCNDL FX UNSP HUMERUS INIT

E083311

Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema right eye

S42413B

DISPL SIMP SUPRCNDL FX W/O INTRCNDL FX UNSP HUMER 7THB

E083312

Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema left eye

S42414A

NONDISP SIMPLE SUPRCNDL FX W/O INTRCNDL FX R HUMERUS INIT

E083313

Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema bilateral

S42414B

NONDISP SIMP SUPRCNDL FX W/O INTRCNDL FX R HUMER 7THB

E08339

DIAB D/T UNDRL COND W MOD NONPRLF DIAB RTNOP W/O MCLR EDEMA

S42415A

NONDISP SIMPLE SUPRCNDL FX W/O INTRCNDL FX L HUMERUS INIT

E08341

DIAB D/T UNDRL COND W SEVERE NONPRLF DIAB RTNOP W MCLR EDEMA

S42415B

NONDISP SIMP SUPRCNDL FX W/O INTRCNDL FX L HUMER 7THB

E08.3411

Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema right eye

S42416A

NONDISP SIMPLE SUPRCNDL FX W/O INTRCNDL FX UNSP HUMER INIT

E08.3412

Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema left eye

S42416B

NONDISP SIMP SUPRCNDL FX W/O INTRCNDL FX UNSP HUMER 7THB

E08.3413

Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema bilateral

S42421A

DISPL COMMNT SUPRCNDL FX W/O INTRCNDL FX R HUMERUS INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E08349

DIAB D/T UNDRL COND W SEV NONPRLF DIAB RTNOP W/O MCLR EDEMA

S42421B

DISPL COMMNT SUPRCNDL FX W/O INTRCNDL FX R HUMER 7THB

E08351

DIAB DUE TO UNDRL COND W PROLIF DIAB RTNOP W MACULAR EDEMA

S42422A

DISPL COMMNT SUPRCNDL FX W/O INTRCNDL FX L HUMERUS INIT

E08359

DIAB DUE TO UNDRL COND W PROLIF DIAB RTNOP W/O MACULAR EDEMA

S42422B

DISPL COMMNT SUPRCNDL FX W/O INTRCNDL FX L HUMER 7THB

E0836

DIABETES DUE TO UNDERLYING CONDITION W DIABETIC CATARACT

S42423A

DISPL COMMNT SUPRCNDL FX W/O INTRCNDL FX UNSP HUMERUS INIT

E0839

DIABETES DUE TO UNDRL CONDITION W OTH DIABETIC OPTH COMP

S42423B

DISPL COMMNT SUPRCNDL FX W/O INTRCNDL FX UNSP HUMER 7THB

E0840

DIABETES DUE TO UNDERLYING CONDITION W DIABETIC NEUROP UNSP

S42424A

NONDISP COMMNT SUPRCNDL FX W/O INTRCNDL FX R HUMERUS INIT

E0841

DIABETES DUE TO UNDRL CONDITION W DIABETIC MONONEUROPATHY

S42424B

NONDISP COMMNT SUPRCNDL FX W/O INTRCNDL FX R HUMER 7THB

E0842

DIABETES DUE TO UNDERLYING CONDITION W DIABETIC POLYNEUROP

S42425A

NONDISP COMMNT SUPRCNDL FX W/O INTRCNDL FX L HUMERUS INIT

E0843

DIAB DUE TO UNDRL COND W DIABETIC AUTONM (POLY)NEUROPATHY

S42425B

NONDISP COMMNT SUPRCNDL FX W/O INTRCNDL FX L HUMER 7THB

E0844

DIABETES DUE TO UNDERLYING CONDITION W DIABETIC AMYOTROPHY

S42426A

NONDISP COMMNT SUPRCNDL FX W/O INTRCNDL FX UNSP HUMER INIT

E0849

DIABETES DUE TO UNDRL CONDITION W OTH DIABETIC NEURO COMP

S42426B

NONDISP COMMNT SUPRCNDL FX W/O INTRCNDL FX UNSP HUMER 7THB

E0851

DIAB DUE TO UNDRL COND W DIAB PRPH ANGIOPATH W/O GANGRENE

S42431A

DISP FX (AVULSION) OF LATERAL EPICONDYLE OF R HUMERUS INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E08.3511

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema right eye

S42431B

DISP FX OF LATERAL EPICONDYLE OF R HUMERUS INIT FOR OPN FX

E08.3512

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema left eye

S42432A

DISP FX (AVULSION) OF LATERAL EPICONDYLE OF L HUMERUS INIT

E08.3513

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema bilateral

S42432B

DISP FX OF LATERAL EPICONDYLE OF L HUMERUS INIT FOR OPN FX

E0852

DIAB DUE TO UNDRL COND W DIABETIC PRPH ANGIOPATH W GANGRENE

S42433A

DISP FX OF LATERAL EPICONDYLE OF UNSP HUMERUS INIT

E083521

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula right eye

S42433B

DISP FX OF LATERAL EPICONDYL OF UNSP HUMER INIT FOR OPN FX

E083522

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula left eye

S42434A

NONDISP FX OF LATERAL EPICONDYLE OF R HUMERUS INIT

E083523

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula bilateral

S42434B

NONDISP FX OF LATERAL EPICONDYL OF R HUMER INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E08.3531

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula right eye

S42435A

NONDISP FX OF LATERAL EPICONDYLE OF L HUMERUS INIT

E08.3532

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula left eye

S42435B

NONDISP FX OF LATERAL EPICONDYL OF L HUMER INIT FOR OPN FX

E08.3533

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula bilateral

S42436A

NONDISP FX OF LATERAL EPICONDYLE OF UNSP HUMERUS INIT

E08.3541

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment right eye

S42436B

NONDISP FX OF LATERAL EPICONDYL OF UNSP HUMER 7THB

E08.3542

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment left eye

S42441A

DISP FX (AVULSION) OF MEDIAL EPICONDYLE OF R HUMERUS INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E08.3543

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment bilateral

S42441B

DISP FX OF MEDIAL EPICONDYLE OF R HUMERUS INIT FOR OPN FX

E08.3551

Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy right eye

S42442A

DISP FX (AVULSION) OF MEDIAL EPICONDYLE OF L HUMERUS INIT

E0859

DIABETES DUE TO UNDERLYING CONDITION W OTH CIRCULATORY COMP

S42442B

DISP FX OF MEDIAL EPICONDYLE OF L HUMERUS INIT FOR OPN FX

E08610

DIABETES DUE TO UNDRL COND W DIABETIC NEUROPATHIC ARTHROP

S42443A

DISP FX OF MEDIAL EPICONDYLE OF UNSP HUMERUS INIT

E08618

DIABETES DUE TO UNDERLYING CONDITION W OTH DIABETIC ARTHROP

S42443B

DISP FX OF MEDIAL EPICONDYL OF UNSP HUMERUS INIT FOR OPN FX

E08620

DIABETES DUE TO UNDERLYING CONDITION W DIABETIC DERMATITIS

S42444A

NONDISP FX OF MEDIAL EPICONDYLE OF R HUMERUS INIT

E08621

DIABETES MELLITUS DUE TO UNDERLYING CONDITION W FOOT ULCER

S42444B

NONDISP FX OF MEDIAL EPICONDYL OF R HUMERUS INIT FOR OPN FX

E08622 DIABETES DUE TO UNDERLYING CONDITION W OTH SKIN ULCER

S42445A

NONDISP FX OF MEDIAL EPICONDYLE OF L HUMERUS INIT

E08628 DIABETES DUE TO UNDERLYING CONDITION W OTH SKIN COMP

S42445B

NONDISP FX OF MEDIAL EPICONDYL OF L HUMERUS INIT FOR OPN FX

E08641

DIABETES DUE TO UNDERLYING CONDITION W HYPOGLYCEMIA W COMA

S42446A

NONDISP FX OF MEDIAL EPICONDYLE OF UNSP HUMERUS INIT

E08649

DIABETES DUE TO UNDERLYING CONDITION W HYPOGLYCEMIA W/O COMA

S42446B

NONDISP FX OF MED EPICONDYL OF UNSP HUMER INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E0865 DIABETES DUE TO UNDERLYING CONDITION W HYPERGLYCEMIA

S42447A

INCARCERATED FRACTURE OF MEDIAL EPICONDYL OF R HUMERUS INIT

E0869

DIABETES DUE TO UNDERLYING CONDITION W OTH COMPLICATION

S42447B

INCARCERATED FX OF MED EPICONDYL OF R HUMER INIT FOR OPN FX

E088

DIABETES DUE TO UNDERLYING CONDITION W UNSP COMPLICATIONS

S42448A

INCARCERATED FRACTURE OF MEDIAL EPICONDYL OF L HUMERUS INIT

E089

DIABETES DUE TO UNDERLYING CONDITION W/O COMPLICATIONS

S42448B

INCARCERATED FX OF MED EPICONDYL OF L HUMER INIT FOR OPN FX

E0900

DRUG/CHEM DIAB W HYPROSM W/O NONKET HYPRGLY-HYPROS COMA

S42449A

INCARCERATED FX OF MEDIAL EPICONDYL OF UNSP HUMERUS INIT

E0901

DRUG/CHEM DIABETES MELLITUS W HYPEROSMOLARITY W COMA

S42449B

INCARCERATED FX OF MED EPICONDYL OF UNSP HUMER 7THB

E0910

DRUG/CHEM DIABETES MELLITUS W KETOACIDOSIS W/O COMA

S42451A

DISP FX OF LATERAL CONDYLE OF RIGHT HUMERUS INIT

E0911

DRUG/CHEM DIABETES MELLITUS W KETOACIDOSIS W COMA

S42451B

DISP FX OF LATERAL CONDYLE OF RIGHT HUMERUS INIT FOR OPN FX

E0921

DRUG/CHEM DIABETES MELLITUS W DIABETIC NEPHROPATHY

S42452A

DISP FX OF LATERAL CONDYLE OF LEFT HUMERUS INIT FOR CLOS FX

E0922

DRUG/CHEM DIABETES W DIABETIC CHRONIC KIDNEY DISEASE

S42452B

DISP FX OF LATERAL CONDYLE OF LEFT HUMERUS INIT FOR OPN FX

E0929

DRUG/CHEM DIABETES W OTH DIABETIC KIDNEY COMPLICATION

S42453A

DISP FX OF LATERAL CONDYLE OF UNSP HUMERUS INIT FOR CLOS FX

E09311

DRUG/CHEM DIABETES W UNSP DIABETIC RTNOP W MACULAR EDEMA

S42453B

DISP FX OF LATERAL CONDYLE OF UNSP HUMERUS INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E09319

DRUG/CHEM DIABETES W UNSP DIABETIC RTNOP W/O MACULAR EDEMA

S42454A

NONDISP FX OF LATERAL CONDYLE OF RIGHT HUMERUS INIT

E09321

DRUG/CHEM DIAB W MILD NONPRLF DIABETIC RTNOP W MACULAR EDEMA

S42454B

NONDISP FX OF LATERAL CONDYLE OF R HUMERUS INIT FOR OPN FX

E093211

Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema right eye

S42455A

NONDISP FX OF LATERAL CONDYLE OF LEFT HUMERUS INIT

E093212

Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema left eye

S42455B

NONDISP FX OF LATERAL CONDYLE OF L HUMERUS INIT FOR OPN FX

E093213

Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema bilateral

S42456A

NONDISP FX OF LATERAL CONDYLE OF UNSP HUMERUS INIT

E09329

DRUG/CHEM DIAB W MILD NONPRLF DIAB RTNOP W/O MACULAR EDEMA

S42456B

NONDISP FX OF LATERAL CONDYLE OF UNSP HUMER INIT FOR OPN FX

E09331

DRUG/CHEM DIAB W MODERATE NONPRLF DIAB RTNOP W MACULAR EDEMA

S42461A

DISP FX OF MEDIAL CONDYLE OF RIGHT HUMERUS INIT FOR CLOS FX

E093311

Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema right eye

S42461B

DISP FX OF MEDIAL CONDYLE OF RIGHT HUMERUS INIT FOR OPN FX

E093312

Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema left eye

S42462A

DISP FX OF MEDIAL CONDYLE OF LEFT HUMERUS INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E093313

Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema bilateral

S42462B

DISP FX OF MEDIAL CONDYLE OF LEFT HUMERUS INIT FOR OPN FX

E09339

DRUG/CHEM DIAB W MOD NONPRLF DIAB RTNOP W/O MACULAR EDEMA

S42463A

DISP FX OF MEDIAL CONDYLE OF UNSP HUMERUS INIT FOR CLOS FX

E09341

DRUG/CHEM DIAB W SEVERE NONPRLF DIAB RTNOP W MACULAR EDEMA

S42463B

DISP FX OF MEDIAL CONDYLE OF UNSP HUMERUS INIT FOR OPN FX

E093411

Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema right eye

S42464A

NONDISP FX OF MEDIAL CONDYLE OF RIGHT HUMERUS INIT

E093412

Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema left eye

S42464B

NONDISP FX OF MEDIAL CONDYLE OF R HUMERUS INIT FOR OPN FX

E093413

Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema bilateral

S42465A

NONDISP FX OF MEDIAL CONDYLE OF LEFT HUMERUS INIT

E09349

DRUG/CHEM DIAB W SEVERE NONPRLF DIAB RTNOP W/O MACULAR EDEMA

S42465B

NONDISP FX OF MEDIAL CONDYLE OF L HUMERUS INIT FOR OPN FX

E09351

DRUG/CHEM DIABETES W PROLIF DIABETIC RTNOP W MACULAR EDEMA

S42466A

NONDISP FX OF MEDIAL CONDYLE OF UNSP HUMERUS INIT

E093511

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema right eye

S42466B

NONDISP FX OF MEDIAL CONDYLE OF UNSP HUMER INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E093512

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema left eye

S42471A

DISPLACED TRANSCONDYLAR FRACTURE OF RIGHT HUMERUS INIT

E093513

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema bilateral

S42471B

DISPLACED TRANSCONDY FRACTURE OF R HUMERUS INIT FOR OPN FX

E093521

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula right eye

S42472A

DISPLACED TRANSCONDYLAR FRACTURE OF LEFT HUMERUS INIT

E093522

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula left eye

S42472B

DISPLACED TRANSCONDY FRACTURE OF L HUMERUS INIT FOR OPN FX

E093523

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula bilateral

S42473A

DISPLACED TRANSCONDYLAR FRACTURE OF UNSP HUMERUS INIT

E093531

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula right eye

S42473B

DISPLACED TRANSCONDY FX UNSP HUMERUS INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E093532

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula left eye

S42474A

NONDISPLACED TRANSCONDYLAR FRACTURE OF RIGHT HUMERUS INIT

E093533

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula bilateral

S42474B

NONDISP TRANSCONDY FRACTURE OF R HUMERUS INIT FOR OPN FX

E093541

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment right eye

S42475A

NONDISPLACED TRANSCONDYLAR FRACTURE OF LEFT HUMERUS INIT

E093542

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment left eye

S42475B

NONDISP TRANSCONDY FRACTURE OF L HUMERUS INIT FOR OPN FX

E093543

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment bilateral

S42476A

NONDISPLACED TRANSCONDYLAR FRACTURE OF UNSP HUMERUS INIT

E09359

DRUG/CHEM DIABETES W PROLIF DIABETIC RTNOP W/O MACULAR EDEMA

S42476B

NONDISP TRANSCONDY FRACTURE OF UNSP HUMERUS INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E0936

DRUG/CHEM DIABETES MELLITUS W DIABETIC CATARACT

S42481A

TORUS FRACTURE OF LOWER END OF RIGHT HUMERUS INIT

E0937X1

Drug or chemical induced diabetes mellitus with diabetic macular edema resolved following treatment right eye

S42481D

TORUS FX LOWER END OF R HUMERUS SUBS FOR FX W ROUTN HEAL

E0939

DRUG/CHEM DIABETES W OTH DIABETIC OPHTHALMIC COMPLICATION

S42482A

TORUS FRACTURE OF LOWER END OF LEFT HUMERUS INIT

E0940

DRUG/CHEM DIABETES W NEURO COMP W DIABETIC NEUROPATHY UNSP

S42489A

TORUS FRACTURE OF LOWER END OF UNSP HUMERUS INIT

E0941

DRUG/CHEM DIABETES W NEURO COMP W DIABETIC MONONEUROPATHY

S42491A

OTH DISP FX OF LOWER END OF RIGHT HUMERUS INIT FOR CLOS FX

E0942

DRUG/CHEM DIABETES W NEUROLOGICAL COMP W DIABETIC POLYNEUROP

S42491B

OTH DISP FX OF LOWER END OF RIGHT HUMERUS INIT FOR OPN FX

E0943

DRUG/CHEM DIAB W NEURO COMP W DIAB AUTONM (POLY)NEUROPATHY

S42492A

OTH DISP FX OF LOWER END OF LEFT HUMERUS INIT FOR CLOS FX

E0944

DRUG/CHEM DIABETES W NEUROLOGICAL COMP W DIABETIC AMYOTROPHY

S42492B

OTH DISP FX OF LOWER END OF LEFT HUMERUS INIT FOR OPN FX

E0949

DRUG/CHEM DIABETES W NEURO COMP W OTH DIABETIC NEURO COMP

S42493A

OTH DISP FX OF LOWER END OF UNSP HUMERUS INIT FOR CLOS FX

E0951

DRUG/CHEM DIABETES W DIABETIC PRPH ANGIOPATH W/O GANGRENE

S42493B

OTH DISP FX OF LOWER END OF UNSP HUMERUS INIT FOR OPN FX

E0952

DRUG/CHEM DIABETES W DIABETIC PRPH ANGIOPATH W GANGRENE

S42494A

OTH NONDISP FX OF LOWER END OF RIGHT HUMERUS INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E0959

DRUG/CHEM DIABETES MELLITUS W OTH CIRCULATORY COMPLICATIONS

S42494B

OTH NONDISP FX OF LOWER END OF R HUMERUS INIT FOR OPN FX

E09610

DRUG/CHEM DIABETES W DIABETIC NEUROPATHIC ARTHROPATHY

S42495A

OTH NONDISP FX OF LOWER END OF LEFT HUMERUS INIT

E09618

DRUG/CHEM DIABETES MELLITUS W OTH DIABETIC ARTHROPATHY

S42495B

OTH NONDISP FX OF LOWER END OF LEFT HUMERUS INIT FOR OPN FX

E09621

DRUG OR CHEMICAL INDUCED DIABETES MELLITUS WITH FOOT ULCER

S42496A

OTH NONDISP FX OF LOWER END OF UNSP HUMERUS INIT

E09622

DRUG OR CHEMICAL INDUCED DIABETES MELLITUS W OTH SKIN ULCER

S42496B

OTH NONDISP FX OF LOWER END OF UNSP HUMERUS INIT FOR OPN FX

E09641

DRUG/CHEM DIABETES MELLITUS W HYPOGLYCEMIA W COMA

S4290XA

FRACTURE OF UNSP SHOULDER GIRDLE PART UNSP INIT

E09649

DRUG/CHEM DIABETES MELLITUS W HYPOGLYCEMIA W/O COMA

S4290XB

FRACTURE OF UNSP SHOULDER GIRDLE PART UNSP INIT FOR OPN FX

E0965

DRUG OR CHEMICAL INDUCED DIABETES MELLITUS W HYPERGLYCEMIA

S4291XA

FRACTURE OF RIGHT SHOULDER GIRDLE PART UNSP INIT

E0969

DRUG/CHEM DIABETES MELLITUS W OTH COMPLICATION

S4291XB

FRACTURE OF R SHOULDER GIRDLE PART UNSP INIT FOR OPN FX

E1010

TYPE 1 DIABETES MELLITUS WITH KETOACIDOSIS WITHOUT COMA

S4292XA

FRACTURE OF LEFT SHOULDER GIRDLE PART UNSP INIT

E1011

TYPE 1 DIABETES MELLITUS WITH KETOACIDOSIS WITH COMA

S4292XB

FRACTURE OF LEFT SHOULDER GIRDLE PART UNSP INIT FOR OPN FX

E1021 TYPE 1 DIABETES MELLITUS WITH DIABETIC NEPHROPATHY

S43001A

UNSPECIFIED SUBLUXATION OF RIGHT SHOULDER JOINT INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E1022

TYPE 1 DIABETES MELLITUS W DIABETIC CHRONIC KIDNEY DISEASE

S43003A

UNSP SUBLUXATION OF UNSPECIFIED SHOULDER JOINT INIT ENCNTR

E1029

TYPE 1 DIABETES MELLITUS W OTH DIABETIC KIDNEY COMPLICATION

S43005A

UNSPECIFIED DISLOCATION OF LEFT SHOULDER JOINT INIT ENCNTR

E1049

TYPE 1 DIABETES W OTH DIABETIC NEUROLOGICAL COMPLICATION

S43011A

ANTERIOR SUBLUXATION OF RIGHT HUMERUS INITIAL ENCOUNTER

E1051

TYPE 1 DIABETES W DIABETIC PERIPHERAL ANGIOPATH W/O GANGRENE

S43013A

ANTERIOR SUBLUXATION OF UNSPECIFIED HUMERUS INIT ENCNTR

E1052

TYPE 1 DIABETES W DIABETIC PERIPHERAL ANGIOPATHY W GANGRENE

S43015A

ANTERIOR DISLOCATION OF LEFT HUMERUS INITIAL ENCOUNTER

E1059

TYPE 1 DIABETES MELLITUS WITH OTH CIRCULATORY COMPLICATIONS

S43021A

POSTERIOR SUBLUXATION OF RIGHT HUMERUS INITIAL ENCOUNTER

E10610

TYPE 1 DIABETES MELLITUS W DIABETIC NEUROPATHIC ARTHROPATHY

S43023A

POSTERIOR SUBLUXATION OF UNSPECIFIED HUMERUS INIT ENCNTR

E10618

TYPE 1 DIABETES MELLITUS WITH OTHER DIABETIC ARTHROPATHY

S43025A

POSTERIOR DISLOCATION OF LEFT HUMERUS INITIAL ENCOUNTER

E10621 TYPE 1 DIABETES MELLITUS WITH FOOT ULCER

S43031A

INFERIOR SUBLUXATION OF RIGHT HUMERUS INITIAL ENCOUNTER

E10622 TYPE 1 DIABETES MELLITUS WITH OTHER SKIN ULCER

S43033A

INFERIOR SUBLUXATION OF UNSPECIFIED HUMERUS INIT ENCNTR

E10628

TYPE 1 DIABETES MELLITUS WITH OTHER SKIN COMPLICATIONS

S43035A

INFERIOR DISLOCATION OF LEFT HUMERUS INITIAL ENCOUNTER

E103211

Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema right eye

S43081A

OTHER SUBLUXATION OF RIGHT SHOULDER JOINT INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E103212

Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema left eye

S43082A

OTHER SUBLUXATION OF LEFT SHOULDER JOINT INITIAL ENCOUNTER

E103213

Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema bilateral

S43083A

OTHER SUBLUXATION OF UNSPECIFIED SHOULDER JOINT INIT ENCNTR

E103311

Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema right eye

S43084A

OTHER DISLOCATION OF RIGHT SHOULDER JOINT INITIAL ENCOUNTER

E103312

Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema left eye

S43085A

OTHER DISLOCATION OF LEFT SHOULDER JOINT INITIAL ENCOUNTER

E103313

Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema bilateral

S43086A

OTHER DISLOCATION OF UNSPECIFIED SHOULDER JOINT INIT ENCNTR

E103411

Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema right eye

S43101A

UNSP DISLOCATION OF RIGHT ACROMIOCLAVICULAR JOINT INIT

E103412

Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema left eye

S43102A

UNSP DISLOCATION OF LEFT ACROMIOCLAVICULAR JOINT INIT

E103413

Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema bilateral

S43109A

UNSP DISLOCATION OF UNSP ACROMIOCLAVICULAR JOINT INIT

E103511

Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema right eye

S43111A

SUBLUXATION OF RIGHT ACROMIOCLAVICULAR JOINT INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E103512

Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema left eye

S43112A

SUBLUXATION OF LEFT ACROMIOCLAVICULAR JOINT INIT ENCNTR

E103513

Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema bilateral

S43119A

SUBLUXATION OF UNSP ACROMIOCLAVICULAR JOINT INIT ENCNTR

E103521

Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula right eye

S43121A

DISLOCATION OF R ACROMIOCLAV JT 100%-200% DISPLACMNT INIT

E103522

Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula left eye

S43122A

DISLOCATION OF L ACROMIOCLAV JT 100%-200% DISPLACMNT INIT

E103523

Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula bilateral

S43129A

DISLOC OF UNSP ACROMIOCLAV JT 100%-200% DISPLACMNT INIT

E103531

Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula right eye

S43131A

DISLOCATION OF R ACROMIOCLAV JT > 200% DISPLACMNT INIT

E103532

Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula left eye

S43132A

DISLOCATION OF L ACROMIOCLAV JT > 200% DISPLACMNT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E103533

Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula bilateral

S43139A

DISLOCATION OF UNSP ACROMIOCLAV JT > 200% DISPLACMNT INIT

E103541

Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment right eye

S43141A

INFERIOR DISLOCATION OF RIGHT ACROMIOCLAVICULAR JOINT INIT

E103542

Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment left eye

S43142A

INFERIOR DISLOCATION OF LEFT ACROMIOCLAVICULAR JOINT INIT

E10543

Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment bilateral

S43149A

INFERIOR DISLOCATION OF UNSP ACROMIOCLAVICULAR JOINT INIT

E10641

TYPE 1 DIABETES MELLITUS WITH HYPOGLYCEMIA WITH COMA

S43151A

POSTERIOR DISLOCATION OF RIGHT ACROMIOCLAVICULAR JOINT INIT

E10649

TYPE 1 DIABETES MELLITUS WITH HYPOGLYCEMIA WITHOUT COMA

S43152A

POSTERIOR DISLOCATION OF LEFT ACROMIOCLAVICULAR JOINT INIT

E1065 TYPE 1 DIABETES MELLITUS WITH HYPERGLYCEMIA

S43159A

POSTERIOR DISLOCATION OF UNSP ACROMIOCLAVICULAR JOINT INIT

E1069

TYPE 1 DIABETES MELLITUS WITH OTHER SPECIFIED COMPLICATION

S43201A

UNSP SUBLUXATION OF RIGHT STERNOCLAVICULAR JOINT INIT

E1100

TYPE 2 DIAB W HYPROSM W/O NONKET HYPRGLY-HYPROS COMA (NKHHC)

S43202A

UNSP SUBLUXATION OF LEFT STERNOCLAVICULAR JOINT INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E1101

TYPE 2 DIABETES MELLITUS WITH HYPEROSMOLARITY WITH COMA

S43203A

UNSP SUBLUXATION OF UNSP STERNOCLAVICULAR JOINT INIT ENCNTR

E1121 TYPE 2 DIABETES MELLITUS WITH DIABETIC NEPHROPATHY

S43204A

UNSP DISLOCATION OF RIGHT STERNOCLAVICULAR JOINT INIT

E1122

TYPE 2 DIABETES MELLITUS W DIABETIC CHRONIC KIDNEY DISEASE

S43205A

UNSP DISLOCATION OF LEFT STERNOCLAVICULAR JOINT INIT ENCNTR

E1129

TYPE 2 DIABETES MELLITUS W OTH DIABETIC KIDNEY COMPLICATION

S43206A

UNSP DISLOCATION OF UNSP STERNOCLAVICULAR JOINT INIT ENCNTR

E1149

TYPE 2 DIABETES W OTH DIABETIC NEUROLOGICAL COMPLICATION

S43211A

ANTERIOR SUBLUXATION OF RIGHT STERNOCLAVICULAR JOINT INIT

E1152

TYPE 2 DIABETES W DIABETIC PERIPHERAL ANGIOPATHY W GANGRENE

S43212A

ANTERIOR SUBLUXATION OF LEFT STERNOCLAVICULAR JOINT INIT

E1159

TYPE 2 DIABETES MELLITUS WITH OTH CIRCULATORY COMPLICATIONS

S43213A

ANTERIOR SUBLUXATION OF UNSP STERNOCLAVICULAR JOINT INIT

E11610

TYPE 2 DIABETES MELLITUS W DIABETIC NEUROPATHIC ARTHROPATHY

S43214A

ANTERIOR DISLOCATION OF RIGHT STERNOCLAVICULAR JOINT INIT

E11621 TYPE 2 DIABETES MELLITUS WITH FOOT ULCER

S43215A

ANTERIOR DISLOCATION OF LEFT STERNOCLAVICULAR JOINT INIT

E11622 TYPE 2 DIABETES MELLITUS WITH OTHER SKIN ULCER

S43216A

ANTERIOR DISLOCATION OF UNSP STERNOCLAVICULAR JOINT INIT

E11641

TYPE 2 DIABETES MELLITUS WITH HYPOGLYCEMIA WITH COMA

S43221A

POSTERIOR SUBLUXATION OF RIGHT STERNOCLAVICULAR JOINT INIT

E11649

TYPE 2 DIABETES MELLITUS WITH HYPOGLYCEMIA WITHOUT COMA

S43222A

POSTERIOR SUBLUXATION OF LEFT STERNOCLAVICULAR JOINT INIT

E1165 TYPE 2 DIABETES MELLITUS WITH HYPERGLYCEMIA

S43223A

POSTERIOR SUBLUXATION OF UNSP STERNOCLAVICULAR JOINT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E1300

OTH DIAB W HYPROSM W/O NONKET HYPRGLY-HYPROS COMA (NKHHC)

S43224A

POSTERIOR DISLOCATION OF RIGHT STERNOCLAVICULAR JOINT INIT

E1301

OTH DIABETES MELLITUS WITH HYPEROSMOLARITY WITH COMA

S43225A

POSTERIOR DISLOCATION OF LEFT STERNOCLAVICULAR JOINT INIT

E1310 OTH DIABETES MELLITUS WITH KETOACIDOSIS WITHOUT COMA

S43226A

POSTERIOR DISLOCATION OF UNSP STERNOCLAVICULAR JOINT INIT

E1311 OTH DIABETES MELLITUS WITH KETOACIDOSIS WITH COMA

S43301A

SUBLUXATION OF UNSP PARTS OF RIGHT SHOULDER GIRDLE INIT

E1322

OTH DIABETES MELLITUS WITH DIABETIC CHRONIC KIDNEY DISEASE

S43302A

SUBLUXATION OF UNSP PARTS OF LEFT SHOULDER GIRDLE INIT

E1329

OTH DIABETES MELLITUS WITH OTH DIABETIC KIDNEY COMPLICATION

S43303A

SUBLUXATION OF UNSP PARTS OF UNSP SHOULDER GIRDLE INIT

E113211

Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema right eye

S43304A

DISLOCATION OF UNSP PARTS OF RIGHT SHOULDER GIRDLE INIT

E113212

Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema left eye

S43305A

DISLOCATION OF UNSP PARTS OF LEFT SHOULDER GIRDLE INIT

E113213

Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema bilateral

S43306A

DISLOCATION OF UNSP PARTS OF UNSP SHOULDER GIRDLE INIT

E113311

Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema right eye

S43311A

SUBLUXATION OF RIGHT SCAPULA INITIAL ENCOUNTER

E113312

Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema left eye

S43312A

SUBLUXATION OF LEFT SCAPULA INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E113313

Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema bilateral

S43313A

SUBLUXATION OF UNSPECIFIED SCAPULA INITIAL ENCOUNTER

E113411

Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema right eye

S43314A

DISLOCATION OF RIGHT SCAPULA INITIAL ENCOUNTER

E113412

Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema left eye

S43315A

DISLOCATION OF LEFT SCAPULA INITIAL ENCOUNTER

E113413

Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema bilateral

S43316A

DISLOCATION OF UNSPECIFIED SCAPULA INITIAL ENCOUNTER

E113511

Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema right eye

S43391A

SUBLUXATION OF OTH PRT RIGHT SHOULDER GIRDLE INIT ENCNTR

E113512

Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema left eye

S43392A

SUBLUXATION OF OTH PRT LEFT SHOULDER GIRDLE INIT ENCNTR

E113513

Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema bilateral

S43393A

SUBLUXATION OF OTH PRT UNSP SHOULDER GIRDLE INIT ENCNTR

E113521

Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula right eye

S43394A

DISLOCATION OF OTH PRT RIGHT SHOULDER GIRDLE INIT ENCNTR

E113522

Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula left eye

S43395A

DISLOCATION OF OTH PRT LEFT SHOULDER GIRDLE INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E113523

Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula bilateral

S43396A

DISLOCATION OF OTH PRT UNSP SHOULDER GIRDLE INIT ENCNTR

E113531

Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula right eye

S43401A

UNSPECIFIED SPRAIN OF RIGHT SHOULDER JOINT INIT ENCNTR

E113532

Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula left eye

S43402A

UNSPECIFIED SPRAIN OF LEFT SHOULDER JOINT INITIAL ENCOUNTER

E113533

Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula bilateral

S43409A

UNSP SPRAIN OF UNSPECIFIED SHOULDER JOINT INIT ENCNTR

E113541

Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment right eye

S43411A

SPRAIN OF RIGHT CORACOHUMERAL (LIGAMENT) INITIAL ENCOUNTER

E113542

Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment left eye

S43412A

SPRAIN OF LEFT CORACOHUMERAL (LIGAMENT) INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E113543

Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment bilateral

S43419A

SPRAIN OF UNSPECIFIED CORACOHUMERAL (LIGAMENT) INIT ENCNTR

E133211

Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema right eye

S43421A

SPRAIN OF RIGHT ROTATOR CUFF CAPSULE INITIAL ENCOUNTER

E133212

Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema left eye

S43422A

SPRAIN OF LEFT ROTATOR CUFF CAPSULE INITIAL ENCOUNTER

E133213

Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema bilateral

S43429A

SPRAIN OF UNSPECIFIED ROTATOR CUFF CAPSULE INIT ENCNTR

E133311

Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema right eye

S43431A

SUPERIOR GLENOID LABRUM LESION OF RIGHT SHOULDER INIT

E133312

Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema left eye

S43432A

SUPERIOR GLENOID LABRUM LESION OF LEFT SHOULDER INIT ENCNTR

E133313

Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema bilateral

S43439A

SUPERIOR GLENOID LABRUM LESION OF UNSP SHOULDER INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E133411

Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema right eye

S43491A

OTHER SPRAIN OF RIGHT SHOULDER JOINT INITIAL ENCOUNTER

E133412

Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema left eye

S43492A

OTHER SPRAIN OF LEFT SHOULDER JOINT INITIAL ENCOUNTER

E133413

Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema bilateral

S43499A

OTHER SPRAIN OF UNSPECIFIED SHOULDER JOINT INIT ENCNTR

E1349 OTH DIABETES W OTH DIABETIC NEUROLOGICAL COMPLICATION

S4350XA

SPRAIN OF UNSPECIFIED ACROMIOCLAVICULAR JOINT INIT ENCNTR

E1351

OTH DIABETES W DIABETIC PERIPHERAL ANGIOPATHY W/O GANGRENE

S4351XA

SPRAIN OF RIGHT ACROMIOCLAVICULAR JOINT INITIAL ENCOUNTER

E133511

Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema right eye

S4352XA

SPRAIN OF LEFT ACROMIOCLAVICULAR JOINT INITIAL ENCOUNTER

E133512

Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema left eye

S4360XA

SPRAIN OF UNSPECIFIED STERNOCLAVICULAR JOINT INIT ENCNTR

E133513

Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema bilateral

S4361XA

SPRAIN OF RIGHT STERNOCLAVICULAR JOINT INITIAL ENCOUNTER

E1352

OTH DIABETES W DIABETIC PERIPHERAL ANGIOPATHY W GANGRENE

S4362XA

SPRAIN OF LEFT STERNOCLAVICULAR JOINT INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E133521

Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula right eye

S4380XA

SPRAIN OF OTH PARTS OF UNSP SHOULDER GIRDLE INIT ENCNTR

E133522

Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula left eye

S4381XA

SPRAIN OF OTH PARTS OF RIGHT SHOULDER GIRDLE INIT ENCNTR

E133523

Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula bilateral

S4382XA

SPRAIN OF OTH PARTS OF LEFT SHOULDER GIRDLE INIT ENCNTR

E133531

Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula right eye

S4390XA

SPRAIN OF UNSP PARTS OF UNSP SHOULDER GIRDLE INIT ENCNTR

E133532

Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula left eye

S4391XA

SPRAIN OF UNSP PARTS OF RIGHT SHOULDER GIRDLE INIT ENCNTR

E133533

Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula bilateral

S4392XA

SPRAIN OF UNSP PARTS OF LEFT SHOULDER GIRDLE INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E133541

Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment right eye

S4400XA

INJURY OF ULNAR NERVE AT UPPER ARM LEVEL UNSP ARM INIT

E133542

Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment left eye

S4401XA

INJURY OF ULNAR NERVE AT UPPER ARM LEVEL RIGHT ARM INIT

E13.3543

Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment bilateral

S4402XA

INJURY OF ULNAR NERVE AT UPPER ARM LEVEL LEFT ARM INIT

E1359

OTH DIABETES MELLITUS WITH OTHER CIRCULATORY COMPLICATIONS

S4410XA

INJURY OF MEDIAN NERVE AT UPPER ARM LEVEL UNSP ARM INIT

E13621 OTHER SPECIFIED DIABETES MELLITUS WITH FOOT ULCER

S4411XA

INJURY OF MEDIAN NERVE AT UPPER ARM LEVEL RIGHT ARM INIT

E13641 OTH DIABETES MELLITUS WITH HYPOGLYCEMIA WITH COMA

S4412XA

INJURY OF MEDIAN NERVE AT UPPER ARM LEVEL LEFT ARM INIT

E13649

OTH DIABETES MELLITUS WITH HYPOGLYCEMIA WITHOUT COMA

S4420XA

INJURY OF RADIAL NERVE AT UPPER ARM LEVEL UNSP ARM INIT

E1365

OTHER SPECIFIED DIABETES MELLITUS WITH HYPERGLYCEMIA

S4421XA

INJURY OF RADIAL NERVE AT UPPER ARM LEVEL RIGHT ARM INIT

E15 NONDIABETIC HYPOGLYCEMIC COMA

S4422XA

INJURY OF RADIAL NERVE AT UPPER ARM LEVEL LEFT ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E160

DRUG-INDUCED HYPOGLYCEMIA WITHOUT COMA

S4430XA

INJURY OF AXILLARY NERVE UNSPECIFIED ARM INITIAL ENCOUNTER

E161 OTHER HYPOGLYCEMIA

S4431XA INJURY OF AXILLARY NERVE RIGHT ARM INITIAL ENCOUNTER

E162 HYPOGLYCEMIA UNSPECIFIED

S4432XA INJURY OF AXILLARY NERVE LEFT ARM INITIAL ENCOUNTER

E163 INCREASED SECRETION OF GLUCAGON

S4440XA

INJURY OF MUSCULOCUTANEOUS NERVE UNSP ARM INIT ENCNTR

E164 INCREASED SECRETION OF GASTRIN

S4441XA

INJURY OF MUSCULOCUTANEOUS NERVE RIGHT ARM INIT ENCNTR

E168

OTHER SPECIFIED DISORDERS OF PANCREATIC INTERNAL SECRETION

S4442XA

INJURY OF MUSCULOCUTANEOUS NERVE LEFT ARM INIT ENCNTR

E169

DISORDER OF PANCREATIC INTERNAL SECRETION UNSPECIFIED

S4450XA

INJ CUTAN SENSORY NERVE AT SHLDR/UP ARM UNSP ARM INIT

E200 IDIOPATHIC HYPOPARATHYROIDISM

S4451XA

INJ CUTAN SENSORY NERVE AT SHLDR/UP ARM RIGHT ARM INIT

E201 PSEUDOHYPOPARATHYROIDISM

S4452XA INJ CUTAN SENSORY NERVE AT SHLDR/UP ARM LEFT ARM INIT

E208 OTHER HYPOPARATHYROIDISM

S448X1A INJURY OF NERVES AT SHLDR/UP ARM RIGHT ARM INIT

E209 HYPOPARATHYROIDISM UNSPECIFIED

S448X2A

INJURY OF NERVES AT SHLDR/UP ARM LEFT ARM INIT

E210 PRIMARY HYPERPARATHYROIDISM

S448X9A

INJURY OF NERVES AT SHLDR/UP ARM UNSP ARM INIT

E211

SECONDARY HYPERPARATHYROIDISM NOT ELSEWHERE CLASSIFIED

S4490XA

INJURY OF UNSP NERVE AT SHLDR/UP ARM UNSP ARM INIT

E212 OTHER HYPERPARATHYROIDISM

S4491XA

INJURY OF UNSP NERVE AT SHLDR/UP ARM RIGHT ARM INIT

E213 HYPERPARATHYROIDISM UNSPECIFIED

S4492XA

INJURY OF UNSP NERVE AT SHLDR/UP ARM LEFT ARM INIT

E214 OTHER SPECIFIED DISORDERS OF PARATHYROID GLAND

S45001A

UNSP INJURY OF AXILLARY ARTERY RIGHT SIDE INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E215 DISORDER OF PARATHYROID GLAND UNSPECIFIED

S45002A

UNSP INJURY OF AXILLARY ARTERY LEFT SIDE INIT ENCNTR

E220 ACROMEGALY AND PITUITARY GIGANTISM

S45009A

UNSP INJURY OF AXILLARY ARTERY UNSP SIDE INIT ENCNTR

E221 HYPERPROLACTINEMIA

S45011A LACERATION OF AXILLARY ARTERY RIGHT SIDE INITIAL ENCOUNTER

E222

SYNDROME OF INAPPROPRIATE SECRETION OF ANTIDIURETIC HORMONE

S45012A

LACERATION OF AXILLARY ARTERY LEFT SIDE INITIAL ENCOUNTER

E228 OTHER HYPERFUNCTION OF PITUITARY GLAND

S45019A

LACERATION OF AXILLARY ARTERY UNSPECIFIED SIDE INIT ENCNTR

E229 HYPERFUNCTION OF PITUITARY GLAND UNSPECIFIED

S45091A

OTH INJURY OF AXILLARY ARTERY RIGHT SIDE INIT ENCNTR

E230 HYPOPITUITARISM

S45092A OTH INJURY OF AXILLARY ARTERY LEFT SIDE INIT ENCNTR

E231 DRUG-INDUCED HYPOPITUITARISM

S45099A

OTH INJURY OF AXILLARY ARTERY UNSPECIFIED SIDE INIT ENCNTR

E232 DIABETES INSIPIDUS

S45101A UNSP INJURY OF BRACHIAL ARTERY RIGHT SIDE INIT ENCNTR

E233 HYPOTHALAMIC DYSFUNCTION NOT ELSEWHERE CLASSIFIED

S45102A

UNSP INJURY OF BRACHIAL ARTERY LEFT SIDE INIT ENCNTR

E236 OTHER DISORDERS OF PITUITARY GLAND

S45109A

UNSP INJURY OF BRACHIAL ARTERY UNSP SIDE INIT ENCNTR

E237 DISORDER OF PITUITARY GLAND UNSPECIFIED

S45111A

LACERATION OF BRACHIAL ARTERY RIGHT SIDE INITIAL ENCOUNTER

E240 PITUITARY-DEPENDENT CUSHING'S DISEASE

S45112A

LACERATION OF BRACHIAL ARTERY LEFT SIDE INITIAL ENCOUNTER

E241 NELSON'S SYNDROME

S45119A LACERATION OF BRACHIAL ARTERY UNSPECIFIED SIDE INIT ENCNTR

E242 DRUG-INDUCED CUSHING'S SYNDROME

S45191A

OTH INJURY OF BRACHIAL ARTERY RIGHT SIDE INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E243 ECTOPIC ACTH SYNDROME

S45192A OTH INJURY OF BRACHIAL ARTERY LEFT SIDE INIT ENCNTR

E244 ALCOHOL-INDUCED PSEUDO-CUSHING'S SYNDROME

S45199A

OTH INJURY OF BRACHIAL ARTERY UNSPECIFIED SIDE INIT ENCNTR

E248 OTHER CUSHING'S SYNDROME

S45201A UNSP INJURY OF AXILLARY OR BRACHIAL VEIN RIGHT SIDE INIT

E249 CUSHING'S SYNDROME UNSPECIFIED

S45202A

UNSP INJURY OF AXILLARY OR BRACHIAL VEIN LEFT SIDE INIT

E2601 CONN'S SYNDROME

S45209A UNSP INJURY OF AXILLARY OR BRACHIAL VEIN UNSP SIDE INIT

E272 ADDISONIAN CRISIS

S45211A LACERATION OF AXILLARY OR BRACHIAL VEIN RIGHT SIDE INIT

E3120

MULTIPLE ENDOCRINE NEOPLASIA [MEN] SYNDROME UNSPECIFIED

S45212A

LACERATION OF AXILLARY OR BRACHIAL VEIN LEFT SIDE INIT

E3121 MULTIPLE ENDOCRINE NEOPLASIA [MEN] TYPE I

S45219A

LACERATION OF AXILLARY OR BRACHIAL VEIN UNSP SIDE INIT

E3122 MULTIPLE ENDOCRINE NEOPLASIA [MEN] TYPE IIA

S45291A

INJ AXILLARY OR BRACHIAL VEIN RIGHT SIDE INIT ENCNTR

E3123 MULTIPLE ENDOCRINE NEOPLASIA [MEN] TYPE IIB

S45292A

INJ AXILLARY OR BRACHIAL VEIN LEFT SIDE INIT ENCNTR

E320 PERSISTENT HYPERPLASIA OF THYMUS

S45299A

INJ AXILLARY OR BRACHIAL VEIN UNSP SIDE INIT ENCNTR

E321 ABSCESS OF THYMUS

S45301A UNSP INJURY OF SUPERFIC VN AT SHLDR/UP ARM RIGHT ARM INIT

E328 OTHER DISEASES OF THYMUS

S45302A UNSP INJURY OF SUPERFIC VN AT SHLDR/UP ARM LEFT ARM INIT

E340 CARCINOID SYNDROME

S45309A UNSP INJURY OF SUPERFIC VN AT SHLDR/UP ARM UNSP ARM INIT

E3601

INTRAOP HEMOR/HEMTOM OF ENDO SYS ORG COMP AN ENDO SYS PROC

S45311A

LACERATION OF SUPERFIC VN AT SHLDR/UP ARM RIGHT ARM INIT

E3602

INTRAOP HEMOR/HEMTOM OF AN ENDO SYS ORG COMP OTH PROCEDURE

S45312A

LACERATION OF SUPERFIC VN AT SHLDR/UP ARM LEFT ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E3611

ACC PNCTR & LAC OF AN ENDO SYS ORG DURING AN ENDO SYS PROC

S45319A

LACERATION OF SUPERFIC VN AT SHLDR/UP ARM UNSP ARM INIT

E3612

ACC PNCTR & LAC OF AN ENDO SYS ORG DURING OTH PROCEDURE

S45391A

INJ SUPERFICIAL VEIN AT SHLDR/UP ARM RIGHT ARM INIT

E368

OTHER INTRAOPERATIVE COMPLICATIONS OF ENDOCRINE SYSTEM

S45392A

INJ SUPERFICIAL VEIN AT SHLDR/UP ARM LEFT ARM INIT

E40 KWASHIORKOR

S45399A INJ SUPERFICIAL VEIN AT SHLDR/UP ARM UNSP ARM INIT

E41 NUTRITIONAL MARASMUS

S45801A UNSP INJ BLOOD VESSELS AT SHLDR/UP ARM RIGHT ARM INIT

E42 MARASMIC KWASHIORKOR

S45802A UNSP INJURY OF BLOOD VESSELS AT SHLDR/UP ARM LEFT ARM INIT

E43 UNSPECIFIED SEVERE PROTEIN-CALORIE MALNUTRITION

S45809A

UNSP INJURY OF BLOOD VESSELS AT SHLDR/UP ARM UNSP ARM INIT

E45

RETARDED DEVELOPMENT FOLLOWING PROTEIN-CALORIE MALNUTRITION

S45811A

LACERATION OF BLOOD VESSELS AT SHLDR/UP ARM RIGHT ARM INIT

E46 UNSPECIFIED PROTEIN-CALORIE MALNUTRITION

S45812A

LACERATION OF BLOOD VESSELS AT SHLDR/UP ARM LEFT ARM INIT

E5111 DRY BERIBERI

S45819A LACERATION OF BLOOD VESSELS AT SHLDR/UP ARM UNSP ARM INIT

E5112 WET BERIBERI

S45891A INJ OTH BLOOD VESSELS AT SHLDR/UP ARM RIGHT ARM INIT

E512 WERNICKE'S ENCEPHALOPATHY

S45892A INJ OTH BLOOD VESSELS AT SHLDR/UP ARM LEFT ARM INIT

E518 OTHER MANIFESTATIONS OF THIAMINE DEFICIENCY

S45899A

INJ OTH BLOOD VESSELS AT SHLDR/UP ARM UNSP ARM INIT

E519 THIAMINE DEFICIENCY UNSPECIFIED

S45901A

UNSP INJ UNSP BLOOD VESS AT SHLDR/UP ARM RIGHT ARM INIT

E52 NIACIN DEFICIENCY [PELLAGRA]

S45902A UNSP INJ UNSP BLOOD VESS AT SHLDR/UP ARM LEFT ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E530 RIBOFLAVIN DEFICIENCY

S45909A UNSP INJ UNSP BLOOD VESS AT SHLDR/UP ARM UNSP ARM INIT

E531 PYRIDOXINE DEFICIENCY

S45911A LACERAT UNSP BLOOD VESSEL AT SHLDR/UP ARM RIGHT ARM INIT

E538 DEFICIENCY OF OTHER SPECIFIED B GROUP VITAMINS

S45912A

LACERAT UNSP BLOOD VESSEL AT SHLDR/UP ARM LEFT ARM INIT

E539 VITAMIN B DEFICIENCY UNSPECIFIED

S45919A

LACERAT UNSP BLOOD VESSEL AT SHLDR/UP ARM UNSP ARM INIT

E54 ASCORBIC ACID DEFICIENCY

S45991A INJ UNSP BLOOD VESSEL AT SHLDR/UP ARM RIGHT ARM INIT

E550 RICKETS ACTIVE

S45992A INJ UNSP BLOOD VESSEL AT SHLDR/UP ARM LEFT ARM INIT

E559 VITAMIN D DEFICIENCY UNSPECIFIED

S45999A

INJ UNSP BLOOD VESSEL AT SHLDR/UP ARM UNSP ARM INIT

E561 DEFICIENCY OF VITAMIN K

S46001A UNSP INJ MUSC/TEND THE ROTATOR CUFF OF R SHOULDER INIT

E662

MORBID (SEVERE) OBESITY WITH ALVEOLAR HYPOVENTILATION

S46002A

UNSP INJ MUSC/TEND THE ROTATOR CUFF OF L SHOULDER INIT

E7021 TYROSINEMIA

S46009A UNSP INJ MUSC/TEND THE ROTATOR CUFF OF UNSP SHOULDER INIT

E70330 CHEDIAK-HIGASHI SYNDROME

S46011A STRAIN OF MUSC/TEND THE ROTATOR CUFF OF RIGHT SHOULDER INIT

E70331 HERMANSKY-PUDLAK SYNDROME

S46012A

STRAIN OF MUSC/TEND THE ROTATOR CUFF OF LEFT SHOULDER INIT

E7041 HISTIDINEMIA

S46019A STRAIN OF MUSC/TEND THE ROTATOR CUFF OF UNSP SHOULDER INIT

E708

OTHER DISORDERS OF AROMATIC AMINO-ACID METABOLISM

S46021A

LACERATION OF MUSC/TEND THE ROTATOR CUFF OF R SHOULDER INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E709

DISORDER OF AROMATIC AMINO-ACID METABOLISM UNSPECIFIED

S46022A

LACERAT MUSC/TEND THE ROTATOR CUFF OF LEFT SHOULDER INIT

E7871 BARTH SYNDROME

S46029A LACERAT MUSC/TEND THE ROTATOR CUFF OF UNSP SHOULDER INIT

E89820

Postprocedural hematoma of an endocrine system organ or structure following an endocrine system procedure

S46091A

INJ MUSC/TEND THE ROTATOR CUFF OF RIGHT SHOULDER INIT

E89821

Postprocedural hematoma of an endocrine system organ or structure following other procedure

S46092A

INJ MUSC/TEND THE ROTATOR CUFF OF LEFT SHOULDER INIT

E89822

Postprocedural seroma of an endocrine system organ or structure following an endocrine system procedure

S46099A

INJ MUSC/TEND THE ROTATOR CUFF OF UNSP SHOULDER INIT

E89823

Postprocedural seroma of an endocrine system organ or structure following other procedure

S46101A

UNSP INJURY OF MUSC/FASC/TEND LONG HD BICEP RIGHT ARM INIT

F445 CONVERSION DISORDER WITH SEIZURES OR CONVULSIONS

S46102A

UNSP INJURY OF MUSC/FASC/TEND LONG HD BICEP LEFT ARM INIT

G000 HEMOPHILUS MENINGITIS

S46109A UNSP INJURY OF MUSC/FASC/TEND LONG HD BICEP UNSP ARM INIT

G001 PNEUMOCOCCAL MENINGITIS

S46111A STRAIN OF MUSC/FASC/TEND LONG HD BICEP RIGHT ARM INIT

G002 STREPTOCOCCAL MENINGITIS

S46112A STRAIN OF MUSC/FASC/TEND LONG HEAD OF BICEPS LEFT ARM INIT

G003 STAPHYLOCOCCAL MENINGITIS

S46119A STRAIN OF MUSC/FASC/TEND LONG HEAD OF BICEPS UNSP ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G008 OTHER BACTERIAL MENINGITIS

S46121A LACERATION OF MUSC/FASC/TEND LONG HD BICEP RIGHT ARM INIT

G009 BACTERIAL MENINGITIS UNSPECIFIED

S46122A

LACERATION OF MUSC/FASC/TEND LONG HD BICEP LEFT ARM INIT

G01

MENINGITIS IN BACTERIAL DISEASES CLASSIFIED ELSEWHERE

S46129A

LACERATION OF MUSC/FASC/TEND LONG HD BICEP UNSP ARM INIT

G02

MENINGITIS IN OTH INFEC/PARASTC DISEASES CLASSD ELSWHR

S46191A

INJ MUSC/FASC/TEND LONG HEAD OF BICEPS RIGHT ARM INIT

G030 NONPYOGENIC MENINGITIS

S46192A INJ MUSC/FASC/TEND LONG HEAD OF BICEPS LEFT ARM INIT

G031 CHRONIC MENINGITIS

S46199A INJ MUSC/FASC/TEND LONG HEAD OF BICEPS UNSP ARM INIT

G032 BENIGN RECURRENT MENINGITIS [MOLLARET]

S46201A

UNSP INJURY OF MUSC/FASC/TEND PRT BICEPS RIGHT ARM INIT

G038 MENINGITIS DUE TO OTHER SPECIFIED CAUSES

S46202A

UNSP INJURY OF MUSC/FASC/TEND PRT BICEPS LEFT ARM INIT

G039 MENINGITIS UNSPECIFIED

S46209A UNSP INJURY OF MUSC/FASC/TEND PRT BICEPS UNSP ARM INIT

G0400

ACUTE DISSEMINATED ENCEPHALITIS AND ENCEPHALOMYELITIS UNSP

S46211A

STRAIN OF MUSC/FASC/TEND PRT BICEPS RIGHT ARM INIT

G0401

POSTINFECT ACUTE DISSEM ENCEPHALITIS AND ENCEPHALOMYELITIS

S46212A

STRAIN OF MUSC/FASC/TEND PRT BICEPS LEFT ARM INIT

G042

BACTERIAL MENINGOENCEPHALITIS AND MENINGOMYELITIS NEC

S46219A

STRAIN OF MUSC/FASC/TEND PRT BICEPS UNSP ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G0430

ACUTE NECROTIZING HEMORRHAGIC ENCEPHALOPATHY UNSPECIFIED

S46221A

LACERATION OF MUSC/FASC/TEND PRT BICEPS RIGHT ARM INIT

G0431

POSTINFECTIOUS ACUTE NECROTIZING HEMORRHAGIC ENCEPHALOPATHY

S46222A

LACERATION OF MUSC/FASC/TEND PRT BICEPS LEFT ARM INIT

G0481 OTHER ENCEPHALITIS AND ENCEPHALOMYELITIS

S46229A

LACERATION OF MUSC/FASC/TEND PRT BICEPS UNSP ARM INIT

G0489 OTHER MYELITIS

S46291A INJ MUSCLE FASCIA AND TENDON OF PRT BICEPS RIGHT ARM INIT

G0490

ENCEPHALITIS AND ENCEPHALOMYELITIS UNSPECIFIED

S46292A

INJ MUSCLE FASCIA AND TENDON OF PRT BICEPS LEFT ARM INIT

G0491 MYELITIS UNSPECIFIED

S46299A INJ MUSCLE FASCIA AND TENDON OF PRT BICEPS UNSP ARM INIT

G053

ENCEPHALITIS AND ENCEPHALOMYELITIS IN DISEASES CLASSD ELSWHR

S46301A

UNSP INJURY OF MUSC/FASC/TEND TRICEPS RIGHT ARM INIT

G054 MYELITIS IN DISEASES CLASSIFIED ELSEWHERE

S46302A

UNSP INJURY OF MUSC/FASC/TEND TRICEPS LEFT ARM INIT

G060 INTRACRANIAL ABSCESS AND GRANULOMA

S46309A

UNSP INJURY OF MUSC/FASC/TEND TRICEPS UNSP ARM INIT

G061 INTRASPINAL ABSCESS AND GRANULOMA

S46311A

STRAIN OF MUSC/FASC/TEND TRICEPS RIGHT ARM INIT

G062 EXTRADURAL AND SUBDURAL ABSCESS UNSPECIFIED

S46312A

STRAIN OF MUSC/FASC/TEND TRICEPS LEFT ARM INIT

G07

INTCRN & INTRASPINAL ABSCS & GRANULOMA IN DIS CLASSD ELSWHR

S46319A

STRAIN OF MUSC/FASC/TEND TRICEPS UNSP ARM INIT

G08

INTRACRANIAL AND INTRASPINAL PHLEBITIS AND THROMBOPHLEBITIS

S46321A

LACERATION OF MUSC/FASC/TEND TRICEPS RIGHT ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G09

SEQUELAE OF INFLAMMATORY DISEASES OF CENTRAL NERVOUS SYSTEM

S46322A

LACERATION OF MUSC/FASC/TEND TRICEPS LEFT ARM INIT

G20 PARKINSON'S DISEASE

S46329A LACERATION OF MUSC/FASC/TEND TRICEPS UNSP ARM INIT

G210 MALIGNANT NEUROLEPTIC SYNDROME

S46391A

INJ MUSCLE FASCIA AND TENDON OF TRICEPS RIGHT ARM INIT

G2111 NEUROLEPTIC INDUCED PARKINSONISM

S46392A

INJ MUSCLE FASCIA AND TENDON OF TRICEPS LEFT ARM INIT

G254 DRUG-INDUCED CHOREA

S46399A INJ MUSCLE FASCIA AND TENDON OF TRICEPS UNSP ARM INIT

G2570 DRUG INDUCED MOVEMENT DISORDER UNSPECIFIED

S46801A

UNSP INJ MUSC/FASC/TEND AT SHLDR/UP ARM RIGHT ARM INIT

G2571 DRUG INDUCED AKATHISIA

S46802A UNSP INJ MUSC/FASC/TEND AT SHLDR/UP ARM LEFT ARM INIT

G2582 STIFF-MAN SYNDROME

S46809A UNSP INJ MUSC/FASC/TEND AT SHLDR/UP ARM UNSP ARM INIT

G259

EXTRAPYRAMIDAL AND MOVEMENT DISORDER UNSPECIFIED

S46811A

STRAIN OF MUSC/FASC/TEND AT SHLDR/UP ARM RIGHT ARM INIT

G26

EXTRAPYRAMIDAL AND MOVEMENT DISORD IN DISEASES CLASSD ELSWHR

S46812A

STRAIN OF MUSC/FASC/TEND AT SHLDR/UP ARM LEFT ARM INIT

G40211

LOCAL-REL SYMPTC EPI W CMPLX PARTIAL SEIZ NTRCT W STAT EPI

S46819A

STRAIN OF MUSC/FASC/TEND AT SHLDR/UP ARM UNSP ARM INIT

G40219

LOCAL-REL SYMPTC EPI W CMPLX PART SEIZ NTRCT W/O STAT EPI

S46821A

LACERAT MUSC/FASC/TEND AT SHLDR/UP ARM RIGHT ARM INIT

G40301 GEN IDIOPATHIC EPILEPSY NOT INTRACTABLE W STAT EPI

S46822A

LACERATION OF MUSC/FASC/TEND AT SHLDR/UP ARM LEFT ARM INIT

G40309 GEN IDIOPATHIC EPILEPSY NOT INTRACTABLE W/O STAT EPI

S46829A

LACERATION OF MUSC/FASC/TEND AT SHLDR/UP ARM UNSP ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G40311

GENERALIZED IDIOPATHIC EPILEPSY INTRACTABLE W STAT EPI

S46891A

INJ MUSC/FASC/TEND AT SHLDR/UP ARM RIGHT ARM INIT

G40319

GENERALIZED IDIOPATHIC EPILEPSY INTRACTABLE W/O STAT EPI

S46892A

INJ MUSC/FASC/TEND AT SHLDR/UP ARM LEFT ARM INIT

G40401 OTH GENERALIZED EPILEPSY NOT INTRACTABLE W STAT EPI

S46899A

INJ MUSC/FASC/TEND AT SHLDR/UP ARM UNSP ARM INIT

G40409

OTH GENERALIZED EPILEPSY NOT INTRACTABLE W/O STAT EPI

S46901A

UNSP INJ UNSP MUSC/FASC/TEND AT SHLDR/UP ARM R ARM INIT

G40411

OTH GENERALIZED EPILEPSY INTRACTABLE W STATUS EPILEPTICUS

S46902A

UNSP INJ UNSP MUSC/FASC/TEND AT SHLDR/UP ARM LEFT ARM INIT

G40419 OTH GENERALIZED EPILEPSY INTRACTABLE W/O STAT EPI

S46909A

UNSP INJ UNSP MUSC/FASC/TEND AT SHLDR/UP ARM UNSP ARM INIT

G40501 EPILEPTIC SEIZ REL TO EXTRN CAUSES NOT NTRCT W STAT EPI

S46911A

STRAIN UNSP MUSC/FASC/TEND AT SHLDR/UP ARM RIGHT ARM INIT

G40509

EPILEPTIC SEIZ REL TO EXTRN CAUSES NOT NTRCT W/O STAT EPI

S46912A

STRAIN UNSP MUSC/FASC/TEND AT SHLDR/UP ARM LEFT ARM INIT

G40801

OTHER EPILEPSY NOT INTRACTABLE WITH STATUS EPILEPTICUS

S46919A

STRAIN UNSP MUSC/FASC/TEND AT SHLDR/UP ARM UNSP ARM INIT

G40811 LENNOX-GASTAUT SYNDROME NOT INTRACTABLE W STAT EPI

S46922A

LACERAT UNSP MUSC/FASC/TEND AT SHLDR/UP ARM LEFT ARM INIT

G4089 OTHER SEIZURES

S46929A LACERAT UNSP MUSC/FASC/TEND AT SHLDR/UP ARM UNSP ARM INIT

G40901

EPILEPSY UNSP NOT INTRACTABLE WITH STATUS EPILEPTICUS

S46991A

INJ UNSP MUSC/FASC/TEND AT SHLDR/UP ARM RIGHT ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G40909

EPILEPSY UNSP NOT INTRACTABLE WITHOUT STATUS EPILEPTICUS

S46992A

INJ UNSP MUSC/FASC/TEND AT SHLDR/UP ARM LEFT ARM INIT

G40911

EPILEPSY UNSPECIFIED INTRACTABLE WITH STATUS EPILEPTICUS

S46999A

INJ UNSP MUSC/FASC/TEND AT SHLDR/UP ARM UNSP ARM INIT

G40919 EPILEPSY UNSP INTRACTABLE WITHOUT STATUS EPILEPTICUS

S471XXA

CRUSHING INJURY OF RIGHT SHOULDER AND UPPER ARM INIT ENCNTR

G43609

PERST MIGRAINE AURA W CEREB INFRC NOT NTRCT W/O STAT MIGR

S472XXA

CRUSHING INJURY OF LEFT SHOULDER AND UPPER ARM INIT ENCNTR

G43611

PERST MIGRAINE AURA W CEREBRAL INFRC NTRCT W STAT MIGR

S479XXA

CRUSHING INJURY OF SHOULDER AND UPPER ARM UNSP ARM INIT

G43619

PERST MIGRAINE AURA W CEREBRAL INFRC NTRCT W/O STAT MIGR

S48011A

COMPLETE TRAUMATIC AMPUTATION AT RIGHT SHOULDER JOINT INIT

G43701

CHRONIC MIGRAINE W/O AURA NOT INTRACTABLE W STAT MIGR

S48012A

COMPLETE TRAUMATIC AMPUTATION AT LEFT SHOULDER JOINT INIT

G450 VERTEBRO-BASILAR ARTERY SYNDROME

S48019A

COMPLETE TRAUMATIC AMPUTATION AT UNSP SHOULDER JOINT INIT

G451 CAROTID ARTERY SYNDROME (HEMISPHERIC)

S48021A

PARTIAL TRAUMATIC AMPUTATION AT RIGHT SHOULDER JOINT INIT

G452

MULTIPLE AND BILATERAL PRECEREBRAL ARTERY SYNDROMES

S48022A

PARTIAL TRAUMATIC AMPUTATION AT LEFT SHOULDER JOINT INIT

G453 AMAUROSIS FUGAX

S48029A PARTIAL TRAUMATIC AMPUTATION AT UNSP SHOULDER JOINT INIT

G454 TRANSIENT GLOBAL AMNESIA

S48111A COMPLETE TRAUM AMP AT LEVEL BETW R SHOULDER AND ELBOW INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G458

OTH TRANSIENT CEREBRAL ISCHEMIC ATTACKS AND RELATED SYND

S48112A

COMPLETE TRAUM AMP AT LEVEL BETW L SHOULDER AND ELBOW INIT

G459 TRANSIENT CEREBRAL ISCHEMIC ATTACK UNSPECIFIED

S48119A

COMPLETE TRAUM AMP AT LEVEL BETW UNSP SHLDR AND ELBOW INIT

G460 MIDDLE CEREBRAL ARTERY SYNDROME

S48121A

PARTIAL TRAUM AMP AT LEVEL BETW R SHOULDER AND ELBOW INIT

G461 ANTERIOR CEREBRAL ARTERY SYNDROME

S48122A

PARTIAL TRAUM AMP AT LEVEL BETW L SHOULDER AND ELBOW INIT

G462 POSTERIOR CEREBRAL ARTERY SYNDROME

S48129A

PARTIAL TRAUM AMP AT LEVEL BETW UNSP SHLDR AND ELBOW INIT

G463 BRAIN STEM STROKE SYNDROME

S48911A

COMPLETE TRAUM AMP OF RIGHT SHLDR/UP ARM LEVEL UNSP INIT

G464 CEREBELLAR STROKE SYNDROME

S48912A

COMPLETE TRAUM AMP OF LEFT SHLDR/UP ARM LEVEL UNSP INIT

G465 PURE MOTOR LACUNAR SYNDROME

S48919A

COMPLETE TRAUM AMP OF UNSP SHLDR/UP ARM LEVEL UNSP INIT

G466 PURE SENSORY LACUNAR SYNDROME

S48921A

PARTIAL TRAUM AMP OF RIGHT SHLDR/UP ARM LEVEL UNSP INIT

G467 OTHER LACUNAR SYNDROMES

S48922A PARTIAL TRAUMATIC AMP OF LEFT SHLDR/UP ARM LEVEL UNSP INIT

G468

OTH VASCULAR SYNDROMES OF BRAIN IN CEREBROVASCULAR DISEASES

S48929A

PARTIAL TRAUMATIC AMP OF UNSP SHLDR/UP ARM LEVEL UNSP INIT

G500 TRIGEMINAL NEURALGIA

S49002A UNSP PHYSEAL FX UPPER END OF HUMERUS LEFT ARM INIT

G501 ATYPICAL FACIAL PAIN

S49009A UNSP PHYSEAL FX UPPER END OF HUMERUS UNSP ARM INIT

G508 OTHER DISORDERS OF TRIGEMINAL NERVE

S49011A

SLTR-HARIS TYPE I PHYSL FX UPPER END HUMER RIGHT ARM INIT

G509 DISORDER OF TRIGEMINAL NERVE UNSPECIFIED

S49012A

SLTR-HARIS TYPE I PHYSL FX UPPER END HUMER LEFT ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G510 BELL'S PALSY

S49019A SLTR-HARIS TYPE I PHYSL FX UPPER END HUMER UNSP ARM INIT

G511 GENICULATE GANGLIONITIS

S49021A SLTR-HARIS TYPE II PHYSL FX UPPER END HUMER RIGHT ARM INIT

G512 MELKERSSON'S SYNDROME

S49022A SLTR-HARIS TYPE II PHYSL FX UPPER END HUMER LEFT ARM INIT

G513 CLONIC HEMIFACIAL SPASM

S49029A SLTR-HARIS TYPE II PHYSL FX UPPER END HUMER UNSP ARM INIT

G514 FACIAL MYOKYMIA

S49031A SLTR-HARIS TYPE III PHYSL FX UPPER END HUMER R ARM INIT

G518 OTHER DISORDERS OF FACIAL NERVE

S49032A

SLTR-HARIS TYPE III PHYSL FX UPPER END HUMER LEFT ARM INIT

G519 DISORDER OF FACIAL NERVE UNSPECIFIED

S49039A

SLTR-HARIS TYPE III PHYSL FX UPPER END HUMER UNSP ARM INIT

G520 DISORDERS OF OLFACTORY NERVE

S49041A

SLTR-HARIS TYPE IV PHYSL FX UPPER END HUMER RIGHT ARM INIT

G521 DISORDERS OF GLOSSOPHARYNGEAL NERVE

S49042A

SLTR-HARIS TYPE IV PHYSL FX UPPER END HUMER LEFT ARM INIT

G522 DISORDERS OF VAGUS NERVE

S49049A SLTR-HARIS TYPE IV PHYSL FX UPPER END HUMER UNSP ARM INIT

G523 DISORDERS OF HYPOGLOSSAL NERVE

S49091A

OTH PHYSEAL FX UPPER END OF HUMERUS RIGHT ARM INIT

G527 DISORDERS OF MULTIPLE CRANIAL NERVES

S49092A

OTH PHYSEAL FRACTURE OF UPPER END OF HUMERUS LEFT ARM INIT

G528 DISORDERS OF OTHER SPECIFIED CRANIAL NERVES

S49099A

OTH PHYSEAL FRACTURE OF UPPER END OF HUMERUS UNSP ARM INIT

G529 CRANIAL NERVE DISORDER UNSPECIFIED

S49101A

UNSP PHYSEAL FX LOWER END OF HUMERUS RIGHT ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G53

CRANIAL NERVE DISORDERS IN DISEASES CLASSIFIED ELSEWHERE

S49102A

UNSP PHYSEAL FX LOWER END OF HUMERUS LEFT ARM INIT

G540 BRACHIAL PLEXUS DISORDERS

S49109A UNSP PHYSEAL FX LOWER END OF HUMERUS UNSP ARM INIT

G541 LUMBOSACRAL PLEXUS DISORDERS

S49111A

SLTR-HARIS TYPE I PHYSL FX LOWER END HUMER RIGHT ARM INIT

G542 CERVICAL ROOT DISORDERS NOT ELSEWHERE CLASSIFIED

S49112A

SLTR-HARIS TYPE I PHYSL FX LOWER END HUMER LEFT ARM INIT

G543 THORACIC ROOT DISORDERS NOT ELSEWHERE CLASSIFIED

S49119A

SLTR-HARIS TYPE I PHYSL FX LOWER END HUMER UNSP ARM INIT

G544

LUMBOSACRAL ROOT DISORDERS NOT ELSEWHERE CLASSIFIED

S49121A

SLTR-HARIS TYPE II PHYSL FX LOWER END HUMER RIGHT ARM INIT

G545 NEURALGIC AMYOTROPHY

S49122A SLTR-HARIS TYPE II PHYSL FX LOWER END HUMER LEFT ARM INIT

G546 PHANTOM LIMB SYNDROME WITH PAIN

S49129A

SLTR-HARIS TYPE II PHYSL FX LOWER END HUMER UNSP ARM INIT

G547 PHANTOM LIMB SYNDROME WITHOUT PAIN

S49131A

SLTR-HARIS TYPE III PHYSL FX LOW END HUMER RIGHT ARM INIT

G548 OTHER NERVE ROOT AND PLEXUS DISORDERS

S49132A

SLTR-HARIS TYPE III PHYSL FX LOWER END HUMER LEFT ARM INIT

G549 NERVE ROOT AND PLEXUS DISORDER UNSPECIFIED

S49139A

SLTR-HARIS TYPE III PHYSL FX LOWER END HUMER UNSP ARM INIT

G55

NERVE ROOT AND PLEXUS COMPRESSIONS IN DISEASES CLASSD ELSWHR

S49141A

SLTR-HARIS TYPE IV PHYSL FX LOWER END HUMER RIGHT ARM INIT

G5610

OTHER LESIONS OF MEDIAN NERVE UNSPECIFIED UPPER LIMB

S49142A

SLTR-HARIS TYPE IV PHYSL FX LOWER END HUMER LEFT ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G5611 OTHER LESIONS OF MEDIAN NERVE RIGHT UPPER LIMB

S49149A

SLTR-HARIS TYPE IV PHYSL FX LOWER END HUMER UNSP ARM INIT

G5612 OTHER LESIONS OF MEDIAN NERVE LEFT UPPER LIMB

S49191A

OTH PHYSEAL FX LOWER END OF HUMERUS RIGHT ARM INIT

G5613 Other lesions of median nerve bilateral upper limbs

S49192A

OTH PHYSEAL FRACTURE OF LOWER END OF HUMERUS LEFT ARM INIT

G5620 LESION OF ULNAR NERVE UNSPECIFIED UPPER LIMB

S49199A

OTH PHYSEAL FRACTURE OF LOWER END OF HUMERUS UNSP ARM INIT

G5621 LESION OF ULNAR NERVE RIGHT UPPER LIMB

S4980XA

OTH INJURIES OF SHOULDER AND UPPER ARM UNSP ARM INIT

G5622 LESION OF ULNAR NERVE LEFT UPPER LIMB

S5000XA

CONTUSION OF UNSPECIFIED ELBOW INITIAL ENCOUNTER

G5623 Lesion of ulnar nerve bilateral upper limbs

S5001XA

CONTUSION OF RIGHT ELBOW INITIAL ENCOUNTER

G5630 LESION OF RADIAL NERVE UNSPECIFIED UPPER LIMB

S5002XA

CONTUSION OF LEFT ELBOW INITIAL ENCOUNTER

G5631 LESION OF RADIAL NERVE RIGHT UPPER LIMB

S5010XA

CONTUSION OF UNSPECIFIED FOREARM INITIAL ENCOUNTER

G5632 LESION OF RADIAL NERVE LEFT UPPER LIMB

S5011XA

CONTUSION OF RIGHT FOREARM INITIAL ENCOUNTER

G5633 Lesion of radial nerve bilateral upper limbs

S5012XA

CONTUSION OF LEFT FOREARM INITIAL ENCOUNTER

G5640 CAUSALGIA OF UNSPECIFIED UPPER LIMB

S50341A

EXTERNAL CONSTRICTION OF RIGHT ELBOW INITIAL ENCOUNTER

G5641 CAUSALGIA OF RIGHT UPPER LIMB

S50342A

EXTERNAL CONSTRICTION OF LEFT ELBOW INITIAL ENCOUNTER

G5642 CAUSALGIA OF LEFT UPPER LIMB

S50349A

EXTERNAL CONSTRICTION OF UNSPECIFIED ELBOW INIT ENCNTR

G5643 Causalgia of bilateral upper limbs

S50351A

SUPERFICIAL FOREIGN BODY OF RIGHT ELBOW INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G5680

OTHER SPECIFIED MONONEUROPATHIES OF UNSPECIFIED UPPER LIMB

S50371A

OTHER SUPERFICIAL BITE OF RIGHT ELBOW INITIAL ENCOUNTER

G5681

OTHER SPECIFIED MONONEUROPATHIES OF RIGHT UPPER LIMB

S50372A

OTHER SUPERFICIAL BITE OF LEFT ELBOW INITIAL ENCOUNTER

G5682

OTHER SPECIFIED MONONEUROPATHIES OF LEFT UPPER LIMB

S50379A

OTHER SUPERFICIAL BITE OF UNSPECIFIED ELBOW INIT ENCNTR

G5683

Other specified mononeuropathies of bilateral upper limbs

S50841A

EXTERNAL CONSTRICTION OF RIGHT FOREARM INITIAL ENCOUNTER

G5690

UNSPECIFIED MONONEUROPATHY OF UNSPECIFIED UPPER LIMB

S50842A

EXTERNAL CONSTRICTION OF LEFT FOREARM INITIAL ENCOUNTER

G5691

UNSPECIFIED MONONEUROPATHY OF RIGHT UPPER LIMB

S50849A

EXTERNAL CONSTRICTION OF UNSPECIFIED FOREARM INIT ENCNTR

G5692

UNSPECIFIED MONONEUROPATHY OF LEFT UPPER LIMB

S50871A

OTHER SUPERFICIAL BITE OF RIGHT FOREARM INITIAL ENCOUNTER

G5693 Unspecified mononeuropathy of bilateral upper limbs

S50872A

OTHER SUPERFICIAL BITE OF LEFT FOREARM INITIAL ENCOUNTER

G5700 LESION OF SCIATIC NERVE UNSPECIFIED LOWER LIMB

S50879A

OTHER SUPERFICIAL BITE OF UNSPECIFIED FOREARM INIT ENCNTR

G5701 LESION OF SCIATIC NERVE RIGHT LOWER LIMB

S51001A

UNSPECIFIED OPEN WOUND OF RIGHT ELBOW INITIAL ENCOUNTER

G5702 LESION OF SCIATIC NERVE LEFT LOWER LIMB

S51002A

UNSPECIFIED OPEN WOUND OF LEFT ELBOW INITIAL ENCOUNTER

G5703 Lesion of sciatic nerve bilateral lower limbs

S51009A

UNSPECIFIED OPEN WOUND OF UNSPECIFIED ELBOW INIT ENCNTR

G5710 MERALGIA PARESTHETICA UNSPECIFIED LOWER LIMB

S51011A

LACERATION WITHOUT FOREIGN BODY OF RIGHT ELBOW INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G5711 MERALGIA PARESTHETICA RIGHT LOWER LIMB

S51012A

LACERATION WITHOUT FOREIGN BODY OF LEFT ELBOW INIT ENCNTR

G5712 MERALGIA PARESTHETICA LEFT LOWER LIMB

S51019A

LACERATION WITHOUT FOREIGN BODY OF UNSP ELBOW INIT ENCNTR

G5713 Meralgia paresthetica bilateral lower limbs

S51021A

LACERATION WITH FOREIGN BODY OF RIGHT ELBOW INIT ENCNTR

G5720 LESION OF FEMORAL NERVE UNSPECIFIED LOWER LIMB

S51022A

LACERATION WITH FOREIGN BODY OF LEFT ELBOW INIT ENCNTR

G5721 LESION OF FEMORAL NERVE RIGHT LOWER LIMB

S51029A

LACERATION WITH FOREIGN BODY OF UNSP ELBOW INIT ENCNTR

G5722 LESION OF FEMORAL NERVE LEFT LOWER LIMB

S51031A

PUNCTURE WOUND W/O FOREIGN BODY OF RIGHT ELBOW INIT ENCNTR

G5723 Lesion of femoral nerve bilateral lower limbs

S51032A

PUNCTURE WOUND W/O FOREIGN BODY OF LEFT ELBOW INIT ENCNTR

G5730

LESION OF LATERAL POPLITEAL NERVE UNSPECIFIED LOWER LIMB

S51039A

PUNCTURE WOUND W/O FOREIGN BODY OF UNSP ELBOW INIT ENCNTR

G5731 LESION OF LATERAL POPLITEAL NERVE RIGHT LOWER LIMB

S51041A

PUNCTURE WOUND WITH FOREIGN BODY OF RIGHT ELBOW INIT ENCNTR

G5732 LESION OF LATERAL POPLITEAL NERVE LEFT LOWER LIMB

S51042A

PUNCTURE WOUND WITH FOREIGN BODY OF LEFT ELBOW INIT ENCNTR

G5733 Lesion of lateral popliteal nerve bilateral lower limbs

S51049A

PUNCTURE WOUND WITH FOREIGN BODY OF UNSP ELBOW INIT ENCNTR

G5740

LESION OF MEDIAL POPLITEAL NERVE UNSPECIFIED LOWER LIMB

S52001A

UNSP FRACTURE OF UPPER END OF RIGHT ULNA INIT FOR CLOS FX

G5741 LESION OF MEDIAL POPLITEAL NERVE RIGHT LOWER LIMB

S52001B

UNSP FX UPPER END OF RIGHT ULNA INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G5742 LESION OF MEDIAL POPLITEAL NERVE LEFT LOWER LIMB

S52001C

UNSP FX UPPER END OF RIGHT ULNA INIT FOR OPN FX TYPE 3A/B/C

G5743 Lesion of medial popliteal nerve bilateral lower limbs

S52002A

UNSP FRACTURE OF UPPER END OF LEFT ULNA INIT FOR CLOS FX

G5750 TARSAL TUNNEL SYNDROME UNSPECIFIED LOWER LIMB

S52002B

UNSP FX UPPER END OF LEFT ULNA INIT FOR OPN FX TYPE I/2

G5751 TARSAL TUNNEL SYNDROME RIGHT LOWER LIMB

S52002C

UNSP FX UPPER END OF LEFT ULNA INIT FOR OPN FX TYPE 3A/B/C

G5752 TARSAL TUNNEL SYNDROME LEFT LOWER LIMB

S52009A

UNSP FRACTURE OF UPPER END OF UNSP ULNA INIT FOR CLOS FX

G5753 Tarsal tunnel syndrome bilateral lower limbs

S52009B

UNSP FX UPPER END OF UNSP ULNA INIT FOR OPN FX TYPE I/2

G5760 LESION OF PLANTAR NERVE UNSPECIFIED LOWER LIMB

S52009C

UNSP FX UPPER END OF UNSP ULNA INIT FOR OPN FX TYPE 3A/B/C

G5761 LESION OF PLANTAR NERVE RIGHT LOWER LIMB

S52022A

DISP FX OF OLECRAN PRO W/O INTARTIC EXTN LEFT ULNA INIT

G5762 LESION OF PLANTAR NERVE LEFT LOWER LIMB

S52022C

DISP FX OF OLECRAN PRO W/O INTARTIC EXTN L ULNA 7THC

G5763 Lesion of plantar nerve bilateral lower limbs

S52023A

DISP FX OF OLECRAN PRO W/O INTARTIC EXTN UNSP ULNA INIT

G5770 CAUSALGIA OF UNSPECIFIED LOWER LIMB

S52023C

DISP FX OF OLECRAN PRO W/O INTARTIC EXTN UNSP ULNA 7THC

G5771 CAUSALGIA OF RIGHT LOWER LIMB

S52024A

NONDISP FX OF OLECRAN PRO W/O INTARTIC EXTN RIGHT ULNA INIT

G5772 CAUSALGIA OF LEFT LOWER LIMB

S52024B

NONDISP FX OF OLECRAN PRO W/O INTARTIC EXTN R ULNA 7THB

G5773 Causalgia of bilateral lower limbs

S52024C

NONDISP FX OF OLECRAN PRO W/O INTARTIC EXTN R ULNA 7THC

G5780

OTHER SPECIFIED MONONEUROPATHIES OF UNSPECIFIED LOWER LIMB

S52025A

NONDISP FX OF OLECRAN PRO W/O INTARTIC EXTN LEFT ULNA INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G5781

OTHER SPECIFIED MONONEUROPATHIES OF RIGHT LOWER LIMB

S52025B

NONDISP FX OF OLECRAN PRO W/O INTARTIC EXTN L ULNA 7THB

G5782

OTHER SPECIFIED MONONEUROPATHIES OF LEFT LOWER LIMB

S52025C

NONDISP FX OF OLECRAN PRO W/O INTARTIC EXTN L ULNA 7THC

G5783

Other specified mononeuropathies of bilateral lower limbs

S52026A

NONDISP FX OF OLECRAN PRO W/O INTARTIC EXTN UNSP ULNA INIT

G5790

UNSPECIFIED MONONEUROPATHY OF UNSPECIFIED LOWER LIMB

S52026B

NONDISP FX OF OLECRAN PRO W/O INTARTIC EXTN UNSP ULNA 7THB

G5791

UNSPECIFIED MONONEUROPATHY OF RIGHT LOWER LIMB

S52026C

NONDISP FX OF OLECRAN PRO W/O INTARTIC EXTN UNSP ULNA 7THC

G5792

UNSPECIFIED MONONEUROPATHY OF LEFT LOWER LIMB

S52031A

DISP FX OF OLECRAN PRO W INTARTIC EXTN RIGHT ULNA INIT

G5793 Unspecified mononeuropathy of bilateral lower limbs

S52031B

DISP FX OF OLECRAN PRO W INTARTIC EXTN R ULNA 7THB

G580 INTERCOSTAL NEUROPATHY

S52031C DISP FX OF OLECRAN PRO W INTARTIC EXTN R ULNA 7THC

G587 MONONEURITIS MULTIPLEX

S52032A DISP FX OF OLECRAN PRO W INTARTIC EXTN LEFT ULNA INIT

G588 OTHER SPECIFIED MONONEUROPATHIES

S52032B

DISP FX OF OLECRAN PRO W INTARTIC EXTN L ULNA 7THB

G589 MONONEUROPATHY UNSPECIFIED

S52032C

DISP FX OF OLECRAN PRO W INTARTIC EXTN L ULNA 7THC

G59

MONONEUROPATHY IN DISEASES CLASSIFIED ELSEWHERE

S52033A

DISP FX OF OLECRAN PRO W INTARTIC EXTN UNSP ULNA INIT

G600 HEREDITARY MOTOR AND SENSORY NEUROPATHY

S52033B

DISP FX OF OLECRAN PRO W INTARTIC EXTN UNSP ULNA 7THB

G601 REFSUM'S DISEASE

S52033C DISP FX OF OLECRAN PRO W INTARTIC EXTN UNSP ULNA 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G602 NEUROPATHY IN ASSOCIATION WITH HEREDITARY ATAXIA

S52034A

NONDISP FX OF OLECRAN PRO W INTARTIC EXTN RIGHT ULNA INIT

G603 IDIOPATHIC PROGRESSIVE NEUROPATHY

S52034B

NONDISP FX OF OLECRAN PRO W INTARTIC EXTN R ULNA 7THB

G608 OTHER HEREDITARY AND IDIOPATHIC NEUROPATHIES

S52034C

NONDISP FX OF OLECRAN PRO W INTARTIC EXTN R ULNA 7THC

G609 HEREDITARY AND IDIOPATHIC NEUROPATHY UNSPECIFIED

S52035A

NONDISP FX OF OLECRAN PRO W INTARTIC EXTN LEFT ULNA INIT

G610 GUILLAIN-BARRE SYNDROME

S52035B NONDISP FX OF OLECRAN PRO W INTARTIC EXTN L ULNA 7THB

G611 SERUM NEUROPATHY

S52035C NONDISP FX OF OLECRAN PRO W INTARTIC EXTN L ULNA 7THC

G6181 CHRONIC INFLAMMATORY DEMYELINATING POLYNEURITIS

S52036A

NONDISP FX OF OLECRAN PRO W INTARTIC EXTN UNSP ULNA INIT

G6182 Multifocal motor neuropathy

S52036B NONDISP FX OF OLECRAN PRO W INTARTIC EXTN UNSP ULNA 7THB

G6189 OTHER INFLAMMATORY POLYNEUROPATHIES

S52036C

NONDISP FX OF OLECRAN PRO W INTARTIC EXTN UNSP ULNA 7THC

G619

INFLAMMATORY POLYNEUROPATHY UNSPECIFIED

S52041A

DISP FX OF CORONOID PROCESS OF RIGHT ULNA INIT FOR CLOS FX

G620 DRUG-INDUCED POLYNEUROPATHY

S52041B

DISP FX OF CORONOID PRO OF R ULNA INIT FOR OPN FX TYPE I/2

G621 ALCOHOLIC POLYNEUROPATHY

S52041C DISP FX OF CORONOID PRO OF R ULNA 7THC

G622 POLYNEUROPATHY DUE TO OTHER TOXIC AGENTS

S52042A

DISP FX OF CORONOID PROCESS OF LEFT ULNA INIT FOR CLOS FX

G6281 CRITICAL ILLNESS POLYNEUROPATHY

S52042B

DISP FX OF CORONOID PRO OF L ULNA INIT FOR OPN FX TYPE I/2

G6282 RADIATION-INDUCED POLYNEUROPATHY

S52042C

DISP FX OF CORONOID PRO OF L ULNA 7THC

G6289 OTHER SPECIFIED POLYNEUROPATHIES

S52043A

DISP FX OF CORONOID PROCESS OF UNSP ULNA INIT FOR CLOS FX

G629 POLYNEUROPATHY UNSPECIFIED

S52043B

DISP FX OF CORONOID PRO OF UNSP ULNA 7THB

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G63 POLYNEUROPATHY IN DISEASES CLASSIFIED ELSEWHERE

S52043C

DISP FX OF CORONOID PRO OF UNSP ULNA 7THC

G64 OTHER DISORDERS OF PERIPHERAL NERVOUS SYSTEM

S52044A

NONDISP FX OF CORONOID PROCESS OF RIGHT ULNA INIT

G650 SEQUELAE OF GUILLAIN-BARRE SYNDROME

S52044B

NONDISP FX OF CORONOID PRO OF R ULNA 7THB

G651

SEQUELAE OF OTHER INFLAMMATORY POLYNEUROPATHY

S52044C

NONDISP FX OF CORONOID PRO OF R ULNA 7THC

G652 SEQUELAE OF TOXIC POLYNEUROPATHY

S52045A

NONDISP FX OF CORONOID PROCESS OF LEFT ULNA INIT

G7000 MYASTHENIA GRAVIS WITHOUT (ACUTE) EXACERBATION

S52045B

NONDISP FX OF CORONOID PRO OF L ULNA 7THB

G7001 MYASTHENIA GRAVIS WITH (ACUTE) EXACERBATION

S52045C

NONDISP FX OF CORONOID PRO OF L ULNA 7THC

G701 TOXIC MYONEURAL DISORDERS

S52046A NONDISP FX OF CORONOID PROCESS OF UNSP ULNA INIT

G702 CONGENITAL AND DEVELOPMENTAL MYASTHENIA

S52046B

NONDISP FX OF CORONOID PRO OF UNSP ULNA 7THB

G709 MYONEURAL DISORDER UNSPECIFIED

S52046C

NONDISP FX OF CORONOID PRO OF UNSP ULNA 7THC

G710 MUSCULAR DYSTROPHY

S52091A OTH FRACTURE OF UPPER END OF RIGHT ULNA INIT FOR CLOS FX

G7111 MYOTONIC MUSCULAR DYSTROPHY

S52091B

OTH FX UPPER END OF RIGHT ULNA INIT FOR OPN FX TYPE I/2

G7112 MYOTONIA CONGENITA

S52091C OTH FX UPPER END OF RIGHT ULNA INIT FOR OPN FX TYPE 3A/B/C

G7113 MYOTONIC CHONDRODYSTROPHY

S52092A

OTH FRACTURE OF UPPER END OF LEFT ULNA INIT FOR CLOS FX

G7114 DRUG INDUCED MYOTONIA

S52092B OTH FX UPPER END OF LEFT ULNA INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G7119 OTHER SPECIFIED MYOTONIC DISORDERS

S52092C

OTH FX UPPER END OF LEFT ULNA INIT FOR OPN FX TYPE 3A/B/C

G712 CONGENITAL MYOPATHIES

S52099A OTH FRACTURE OF UPPER END OF UNSP ULNA INIT FOR CLOS FX

G713 MITOCHONDRIAL MYOPATHY NOT ELSEWHERE CLASSIFIED

S52099B

OTH FX UPPER END OF UNSP ULNA INIT FOR OPN FX TYPE I/2

G718 OTHER PRIMARY DISORDERS OF MUSCLES

S52099C

OTH FX UPPER END OF UNSP ULNA INIT FOR OPN FX TYPE 3A/B/C

G719 PRIMARY DISORDER OF MUSCLE UNSPECIFIED

S52101A

UNSP FRACTURE OF UPPER END OF RIGHT RADIUS INIT FOR CLOS FX

G720 DRUG-INDUCED MYOPATHY

S52101B UNSP FX UPPER END OF R RADIUS INIT FOR OPN FX TYPE I/2

G721 ALCOHOLIC MYOPATHY

S52101C UNSP FX UPPER END OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

G722 MYOPATHY DUE TO OTHER TOXIC AGENTS

S52102A

UNSP FRACTURE OF UPPER END OF LEFT RADIUS INIT FOR CLOS FX

G723 PERIODIC PARALYSIS

S52102B UNSP FX UPPER END OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

G7241 INCLUSION BODY MYOSITIS [IBM]

S52102C

UNSP FX UPPER END LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

G7249 OTH INFLAMMATORY AND IMMUNE MYOPATHIES NEC

S52109A

UNSP FRACTURE OF UPPER END OF UNSP RADIUS INIT FOR CLOS FX

G7281 CRITICAL ILLNESS MYOPATHY

S52109B UNSP FX UPPER END OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

G7289 OTHER SPECIFIED MYOPATHIES

S52109C UNSP FX UPPER END UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

G729 MYOPATHY UNSPECIFIED

S52111A TORUS FRACTURE OF UPPER END OF RIGHT RADIUS INIT

G731 LAMBERT-EATON SYNDROME IN NEOPLASTIC DISEASE

S52111D

TORUS FX UPPER END OF R RADIUS SUBS FOR FX W ROUTN HEAL

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G733

MYASTHENIC SYNDROMES IN OTHER DISEASES CLASSIFIED ELSEWHERE

S52111G

TORUS FX UPPER END OF R RADIUS SUBS FOR FX W DELAY HEAL

G737 MYOPATHY IN DISEASES CLASSIFIED ELSEWHERE

S52112A

TORUS FRACTURE OF UPPER END OF LEFT RADIUS INIT FOR CLOS FX

G800 SPASTIC QUADRIPLEGIC CEREBRAL PALSY

S52119A

TORUS FRACTURE OF UPPER END OF UNSP RADIUS INIT FOR CLOS FX

G801 SPASTIC DIPLEGIC CEREBRAL PALSY

S52121A

DISP FX OF HEAD OF RIGHT RADIUS INIT FOR CLOS FX

G802 SPASTIC HEMIPLEGIC CEREBRAL PALSY

S52121B

DISP FX OF HEAD OF RIGHT RADIUS INIT FOR OPN FX TYPE I/2

G803 ATHETOID CEREBRAL PALSY

S52121C DISP FX OF HEAD OF RIGHT RADIUS INIT FOR OPN FX TYPE 3A/B/C

G804 ATAXIC CEREBRAL PALSY

S52122A DISP FX OF HEAD OF LEFT RADIUS INIT FOR CLOS FX

G808 OTHER CEREBRAL PALSY

S52122B DISP FX OF HEAD OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

G809 CEREBRAL PALSY UNSPECIFIED

S52122C DISP FX OF HEAD OF LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

G834 CAUDA EQUINA SYNDROME

S52123A DISP FX OF HEAD OF UNSP RADIUS INIT FOR CLOS FX

G8381 BROWN-SEQUARD SYNDROME

S52123B DISP FX OF HEAD OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

G8382 ANTERIOR CORD SYNDROME

S52123C DISP FX OF HEAD OF UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

G8383 POSTERIOR CORD SYNDROME

S52124A NONDISP FX OF HEAD OF RIGHT RADIUS INIT FOR CLOS FX

G8384 TODD'S PARALYSIS (POSTEPILEPTIC)

S52124B

NONDISP FX OF HEAD OF RIGHT RADIUS INIT FOR OPN FX TYPE I/2

G8389 OTHER SPECIFIED PARALYTIC SYNDROMES

S52124C

NONDISP FX OF HEAD OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

G839 PARALYTIC SYNDROME UNSPECIFIED

S52125A

NONDISP FX OF HEAD OF LEFT RADIUS INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G890 CENTRAL PAIN SYNDROME

S52125B NONDISP FX OF HEAD OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

G8911 ACUTE PAIN DUE TO TRAUMA

S52125C NONDISP FX OF HEAD OF LEFT RAD INIT FOR OPN FX TYPE 3A/B/C

G8912 ACUTE POST-THORACOTOMY PAIN

S52126A

NONDISP FX OF HEAD OF UNSP RADIUS INIT FOR CLOS FX

G8918 OTHER ACUTE POSTPROCEDURAL PAIN

S52126B

NONDISP FX OF HEAD OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

G8921 CHRONIC PAIN DUE TO TRAUMA

S52126C

NONDISP FX OF HEAD OF UNSP RAD INIT FOR OPN FX TYPE 3A/B/C

G8922 CHRONIC POST-THORACOTOMY PAIN

S52131A

DISP FX OF NECK OF RIGHT RADIUS INIT FOR CLOS FX

G8928 OTHER CHRONIC POSTPROCEDURAL PAIN

S52131B

DISP FX OF NECK OF RIGHT RADIUS INIT FOR OPN FX TYPE I/2

G893 NEOPLASM RELATED PAIN (ACUTE) (CHRONIC)

S52131C

DISP FX OF NECK OF RIGHT RADIUS INIT FOR OPN FX TYPE 3A/B/C

G894 CHRONIC PAIN SYNDROME

S52132A DISP FX OF NECK OF LEFT RADIUS INIT FOR CLOS FX

G9001 CAROTID SINUS SYNCOPE

S52132B DISP FX OF NECK OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

G9009 OTHER IDIOPATHIC PERIPHERAL AUTONOMIC NEUROPATHY

S52132C

DISP FX OF NECK OF LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

G901 FAMILIAL DYSAUTONOMIA [RILEY-DAY]

S52133A

DISP FX OF NECK OF UNSP RADIUS INIT FOR CLOS FX

G902 HORNER'S SYNDROME

S52133B DISP FX OF NECK OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

G903

MULTI-SYSTEM DEGENERATION OF THE AUTONOMIC NERVOUS SYSTEM

S52133C

DISP FX OF NECK OF UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

G904 AUTONOMIC DYSREFLEXIA

S52134A NONDISP FX OF NECK OF RIGHT RADIUS INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G9050 COMPLEX REGIONAL PAIN SYNDROME I UNSPECIFIED

S52134B

NONDISP FX OF NECK OF RIGHT RADIUS INIT FOR OPN FX TYPE I/2

G90511

COMPLEX REGIONAL PAIN SYNDROME I OF RIGHT UPPER LIMB

S52134C

NONDISP FX OF NECK OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

G90512

COMPLEX REGIONAL PAIN SYNDROME I OF LEFT UPPER LIMB

S52135A

NONDISP FX OF NECK OF LEFT RADIUS INIT FOR CLOS FX

G90513

COMPLEX REGIONAL PAIN SYNDROME I OF UPPER LIMB BILATERAL

S52135B

NONDISP FX OF NECK OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

G90519

COMPLEX REGIONAL PAIN SYNDROME I OF UNSPECIFIED UPPER LIMB

S52135C

NONDISP FX OF NECK OF LEFT RAD INIT FOR OPN FX TYPE 3A/B/C

G90521

COMPLEX REGIONAL PAIN SYNDROME I OF RIGHT LOWER LIMB

S52136A

NONDISP FX OF NECK OF UNSP RADIUS INIT FOR CLOS FX

G90522

COMPLEX REGIONAL PAIN SYNDROME I OF LEFT LOWER LIMB

S52136B

NONDISP FX OF NECK OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

G90523

COMPLEX REGIONAL PAIN SYNDROME I OF LOWER LIMB BILATERAL

S52136C

NONDISP FX OF NECK OF UNSP RAD INIT FOR OPN FX TYPE 3A/B/C

G90529

COMPLEX REGIONAL PAIN SYNDROME I OF UNSPECIFIED LOWER LIMB

S52181A

OTH FRACTURE OF UPPER END OF RIGHT RADIUS INIT FOR CLOS FX

G9059

COMPLEX REGIONAL PAIN SYNDROME I OF OTHER SPECIFIED SITE

S52181B

OTH FX UPPER END OF R RADIUS INIT FOR OPN FX TYPE I/2

G908 OTHER DISORDERS OF AUTONOMIC NERVOUS SYSTEM

S52181C

OTH FX UPPER END OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

G909 DISORDER OF THE AUTONOMIC NERVOUS SYSTEM UNSPECIFIED

S52182A

OTH FRACTURE OF UPPER END OF LEFT RADIUS INIT FOR CLOS FX

G910 COMMUNICATING HYDROCEPHALUS

S52182B

OTH FX UPPER END OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G911 OBSTRUCTIVE HYDROCEPHALUS

S52182C OTH FX UPPER END OF LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

G912 (IDIOPATHIC) NORMAL PRESSURE HYDROCEPHALUS

S52189A

OTH FRACTURE OF UPPER END OF UNSP RADIUS INIT FOR CLOS FX

G913 POST-TRAUMATIC HYDROCEPHALUS UNSPECIFIED

S52189B

OTH FX UPPER END OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

G914 HYDROCEPHALUS IN DISEASES CLASSIFIED ELSEWHERE

S52189C

OTH FX UPPER END OF UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

G918 OTHER HYDROCEPHALUS

S52202A UNSP FRACTURE OF SHAFT OF LEFT ULNA INIT FOR CLOS FX

G919 HYDROCEPHALUS UNSPECIFIED

S52202B UNSP FX SHAFT OF LEFT ULNA INIT FOR OPN FX TYPE I/2

G92 TOXIC ENCEPHALOPATHY

S52202C UNSP FX SHAFT OF LEFT ULNA INIT FOR OPN FX TYPE 3A/B/C

G930 CEREBRAL CYSTS

S52209A UNSP FRACTURE OF SHAFT OF UNSP ULNA INIT FOR CLOS FX

G931 ANOXIC BRAIN DAMAGE NOT ELSEWHERE CLASSIFIED

S52209B

UNSP FX SHAFT OF UNSP ULNA INIT FOR OPN FX TYPE I/2

G932 BENIGN INTRACRANIAL HYPERTENSION

S52209C

UNSP FX SHAFT OF UNSP ULNA INIT FOR OPN FX TYPE 3A/B/C

G933 POSTVIRAL FATIGUE SYNDROME

S52211A

GREENSTICK FRACTURE OF SHAFT OF RIGHT ULNA INIT FOR CLOS FX

G9340 ENCEPHALOPATHY UNSPECIFIED

S52212A

GREENSTICK FRACTURE OF SHAFT OF LEFT ULNA INIT FOR CLOS FX

G9341 METABOLIC ENCEPHALOPATHY

S52219A GREENSTICK FRACTURE OF SHAFT OF UNSP ULNA INIT FOR CLOS FX

G9349 OTHER ENCEPHALOPATHY

S52221A DISPLACED TRANSVERSE FRACTURE OF SHAFT OF RIGHT ULNA INIT

G935 COMPRESSION OF BRAIN

S52221B DISPL TRANSVERSE FX SHAFT OF R ULNA 7THB

G936 CEREBRAL EDEMA

S52221C DISPL TRANSVERSE FX SHAFT OF R ULNA 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G937 REYE'S SYNDROME

S52222A DISPLACED TRANSVERSE FRACTURE OF SHAFT OF LEFT ULNA INIT

G9381 TEMPORAL SCLEROSIS

S52222B DISPL TRANSVERSE FX SHAFT OF L ULNA 7THB

G9389 OTHER SPECIFIED DISORDERS OF BRAIN

S52222C

DISPL TRANSVERSE FX SHAFT OF L ULNA 7THC

G939 DISORDER OF BRAIN UNSPECIFIED

S52223A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF UNSP ULNA INIT

G94

OTHER DISORDERS OF BRAIN IN DISEASES CLASSIFIED ELSEWHERE

S52223B

DISPL TRANSVERSE FX SHAFT OF UNSP ULNA 7THB

G950 SYRINGOMYELIA AND SYRINGOBULBIA

S52223C

DISPL TRANSVERSE FX SHAFT OF UNSP ULNA 7THC

G9511

ACUTE INFARCTION OF SPINAL CORD (EMBOLIC) (NONEMBOLIC)

S52224A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF RIGHT ULNA INIT

G9519 OTHER VASCULAR MYELOPATHIES

S52224B

NONDISP TRANSVERSE FX SHAFT OF R ULNA 7THB

G9520 UNSPECIFIED CORD COMPRESSION

S52224C

NONDISP TRANSVERSE FX SHAFT OF R ULNA 7THC

G9529 OTHER CORD COMPRESSION

S52225A

NONDISPLACED TRANSVERSE FRACTURE OF SHAFT OF LEFT ULNA INIT

G9581 CONUS MEDULLARIS SYNDROME

S52225B

NONDISP TRANSVERSE FX SHAFT OF L ULNA 7THB

G9589 OTHER SPECIFIED DISEASES OF SPINAL CORD

S52225C

NONDISP TRANSVERSE FX SHAFT OF L ULNA 7THC

G959 DISEASE OF SPINAL CORD UNSPECIFIED

S52231A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT ULNA INIT

G960 CEREBROSPINAL FLUID LEAK

S52231B DISPL OBLIQUE FX SHAFT OF R ULNA INIT FOR OPN FX TYPE I/2

G9611 DURAL TEAR

S52231C DISPL OBLIQUE FX SHAFT OF R ULNA 7THC

G9612 MENINGEAL ADHESIONS (CEREBRAL) (SPINAL)

S52232S

DISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT ULNA SEQUELA

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G9619

OTHER DISORDERS OF MENINGES NOT ELSEWHERE CLASSIFIED

S52233A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF UNSP ULNA INIT

G968 OTHER SPECIFIED DISORDERS OF CENTRAL NERVOUS SYSTEM

S52233B

DISPL OBLIQUE FX SHAFT OF UNSP ULNA 7THB

G969 DISORDER OF CENTRAL NERVOUS SYSTEM UNSPECIFIED

S52233C

DISPL OBLIQUE FX SHAFT OF UNSP ULNA 7THC

G970 CEREBROSPINAL FLUID LEAK FROM SPINAL PUNCTURE

S52234A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT ULNA INIT

G971 OTHER REACTION TO SPINAL AND LUMBAR PUNCTURE

S52234B

NONDISP OBLIQUE FX SHAFT OF R ULNA INIT FOR OPN FX TYPE I/2

G972

INTRACRANIAL HYPOTENSION FOLLOWING VENTRICULAR SHUNTING

S52234C

NONDISP OBLIQUE FX SHAFT OF R ULNA 7THC

G9731

INTRAOP HEMOR/HEMTOM OF A NERVOUS SYS ORG COMP NRV SYS PROC

S52235A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT ULNA INIT

G9732

INTRAOP HEMOR/HEMTOM OF A NERVOUS SYS ORG COMP OTH PROCEDURE

S52235B

NONDISP OBLIQUE FX SHAFT OF L ULNA INIT FOR OPN FX TYPE I/2

G9741

ACCIDENTAL PUNCTURE OR LACERATION OF DURA DURING A PROCEDURE

S52235C

NONDISP OBLIQUE FX SHAFT OF L ULNA 7THC

G9748

ACC PNCTR & LAC OF NERVOUS SYS ORG DURING A NERVOUS SYS PROC

S52241A

DISPLACED SPIRAL FRACTURE OF SHAFT OF ULNA RIGHT ARM INIT

G9749

ACC PNCTR & LAC OF NERVOUS SYS ORG DURING OTH PROCEDURE

S52241B

DISPL SPIRAL FX SHAFT OF ULNA R ARM 7THB

G9751

POSTPROC HEMOR/HEMTOM OF A NRV SYS ORG FOL A NRV SYS PROC

S52241C

DISPL SPIRAL FX SHAFT OF ULNA R ARM 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G9752

POSTPROC HEMOR/HEMTOM OF A NERVOUS SYS ORG FOL OTH PROCEDURE

S52242A

DISPLACED SPIRAL FRACTURE OF SHAFT OF ULNA LEFT ARM INIT

G9761

Postprocedural hematoma of a nervous system organ or structure following a nervous system procedure

S52242B

DISPL SPIRAL FX SHAFT OF ULNA L ARM 7THB

G9762

Postprocedural hematoma of a nervous system organ or structure following other procedure

S52242C

DISPL SPIRAL FX SHAFT OF ULNA L ARM 7THC

G9763

Postprocedural seroma of a nervous system organ or structure following a nervous system procedure

S52243A

DISPLACED SPIRAL FRACTURE OF SHAFT OF ULNA UNSP ARM INIT

G9764

Postprocedural seroma of a nervous system organ or structure following other procedure

S52243B

DISPL SPIRAL FX SHAFT OF ULNA UNSP ARM 7THB

G9781

OTHER INTRAOPERATIVE COMPLICATIONS OF NERVOUS SYSTEM

S52243C

DISPL SPIRAL FX SHAFT OF ULNA UNSP ARM 7THC

G9782

OTH POSTPROC COMPLICATIONS AND DISORDERS OF NERVOUS SYS

S52244A

NONDISP SPIRAL FRACTURE OF SHAFT OF ULNA RIGHT ARM INIT

G980 NEUROGENIC ARTHRITIS NOT ELSEWHERE CLASSIFIED

S52244B

NONDISP SPIRAL FX SHAFT OF ULNA R ARM 7THB

G988 OTHER DISORDERS OF NERVOUS SYSTEM

S52244C

NONDISP SPIRAL FX SHAFT OF ULNA R ARM 7THC

G990

AUTONOMIC NEUROPATHY IN DISEASES CLASSIFIED ELSEWHERE

S52245A

NONDISP SPIRAL FRACTURE OF SHAFT OF ULNA LEFT ARM INIT

G992 MYELOPATHY IN DISEASES CLASSIFIED ELSEWHERE

S52245B

NONDISP SPIRAL FX SHAFT OF ULNA L ARM 7THB

G998

OTH DISRD OF NERVOUS SYSTEM IN DISEASES CLASSIFIED ELSEWHERE

S52245C

NONDISP SPIRAL FX SHAFT OF ULNA L ARM 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H348110 Central retinal vein occlusion right eye with macular edema

S52251A

DISPLACED COMMINUTED FX SHAFT OF ULNA RIGHT ARM INIT

H348111

Central retinal vein occlusion right eye with retinal neovascularization

S52251B

DISPL COMMNT FX SHAFT OF ULNA R ARM 7THB

H348120 Central retinal vein occlusion left eye with macular edema

S52251C

DISPL COMMNT FX SHAFT OF ULNA R ARM 7THC

H348121

Central retinal vein occlusion left eye with retinal neovascularization

S52252A

DISPLACED COMMINUTED FX SHAFT OF ULNA LEFT ARM INIT

H348130 Central retinal vein occlusion bilateral with macular edema

S52252B

DISPL COMMNT FX SHAFT OF ULNA L ARM 7THB

H348131

Central retinal vein occlusion bilateral with retinal neovascularization

S52252C

DISPL COMMNT FX SHAFT OF ULNA L ARM 7THC

H348310

Tributary (branch) retinal vein occlusion right eye with macular edema

S52253A

DISPLACED COMMINUTED FX SHAFT OF ULNA UNSP ARM INIT

H348311

Tributary (branch) retinal vein occlusion right eye with retinal neovascularization

S52253B

DISPL COMMNT FX SHAFT OF ULNA UNSP ARM 7THB

H348320

Tributary (branch) retinal vein occlusion left eye with macular edema

S52253C

DISPL COMMNT FX SHAFT OF ULNA UNSP ARM 7THC

H348321

Tributary (branch) retinal vein occlusion left eye with retinal neovascularization

S52254A

NONDISP COMMINUTED FX SHAFT OF ULNA RIGHT ARM INIT

H348330

Tributary (branch) retinal vein occlusion bilateral with macular edema

S52254B

NONDISP COMMNT FX SHAFT OF ULNA R ARM 7THB

H348331

Tributary (branch) retinal vein occlusion bilateral with retinal neovascularization

S52254C

NONDISP COMMNT FX SHAFT OF ULNA R ARM 7THC

H353110

Nonexudative age-related macular degeneration right eye stage unspecified

S52255A

NONDISP COMMINUTED FRACTURE OF SHAFT OF ULNA LEFT ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H59331

Postprocedural hematoma of right eye and adnexa following an ophthalmic procedure

S52255B

NONDISP COMMNT FX SHAFT OF ULNA L ARM 7THB

H59332

Postprocedural hematoma of left eye and adnexa following an ophthalmic procedure

S52255C

NONDISP COMMNT FX SHAFT OF ULNA L ARM 7THC

H59333

Postprocedural hematoma of eye and adnexa following an ophthalmic procedure bilateral

S52256A

NONDISP COMMINUTED FRACTURE OF SHAFT OF ULNA UNSP ARM INIT

H59341

Postprocedural hematoma of right eye and adnexa following other procedure

S52256B

NONDISP COMMNT FX SHAFT OF ULNA UNSP ARM 7THB

H59342

Postprocedural hematoma of left eye and adnexa following other procedure

S52256C

NONDISP COMMNT FX SHAFT OF ULNA UNSP ARM 7THC

H59343

Postprocedural hematoma of eye and adnexa following other procedure bilateral

S52261A

DISPLACED SEGMENTAL FX SHAFT OF ULNA RIGHT ARM INIT

H59351

Postprocedural seroma of right eye and adnexa following an ophthalmic procedure

S52261B

DISPL SEG FX SHAFT OF ULNA R ARM INIT FOR OPN FX TYPE I/2

H59352

Postprocedural seroma of left eye and adnexa following an ophthalmic procedure

S52261C

DISPL SEG FX SHAFT OF ULNA R ARM 7THC

H59353

Postprocedural seroma of eye and adnexa following an ophthalmic procedure bilateral

S52262A

DISPLACED SEGMENTAL FX SHAFT OF ULNA LEFT ARM INIT

H59361

Postprocedural seroma of right eye and adnexa following other procedure

S52262B

DISPL SEG FX SHAFT OF ULNA L ARM INIT FOR OPN FX TYPE I/2

H59362

Postprocedural seroma of left eye and adnexa following other procedure

S52262C

DISPL SEG FX SHAFT OF ULNA L ARM 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H59363

Postprocedural seroma of eye and adnexa following other procedure bilateral

S52263A

DISPLACED SEGMENTAL FX SHAFT OF ULNA UNSP ARM INIT

H6120 IMPACTED CERUMEN UNSPECIFIED EAR

S52263B

DISPL SEG FX SHAFT OF ULNA UNSP ARM 7THB

H6121 IMPACTED CERUMEN RIGHT EAR

S52263C

DISPL SEG FX SHAFT OF ULNA UNSP ARM 7THC

H6122 IMPACTED CERUMEN LEFT EAR

S52264A NONDISP SEGMENTAL FRACTURE OF SHAFT OF ULNA RIGHT ARM INIT

H6123 IMPACTED CERUMEN BILATERAL

S52264B

NONDISP SEG FX SHAFT OF ULNA R ARM 7THB

H61301

ACQUIRED STENOSIS OF RIGHT EXTERNAL EAR CANAL UNSPECIFIED

S52264C

NONDISP SEG FX SHAFT OF ULNA R ARM 7THC

H61302

ACQUIRED STENOSIS OF LEFT EXTERNAL EAR CANAL UNSPECIFIED

S52265A

NONDISP SEGMENTAL FRACTURE OF SHAFT OF ULNA LEFT ARM INIT

H61303

ACQUIRED STENOSIS OF EXTERNAL EAR CANAL UNSP BILATERAL

S52265B

NONDISP SEG FX SHAFT OF ULNA L ARM 7THB

H61309

ACQUIRED STENOSIS OF EXTERNAL EAR CANAL UNSP UNSP EAR

S52265C

NONDISP SEG FX SHAFT OF ULNA L ARM 7THC

H61311

ACQUIRED STENOSIS OF R EXT EAR CANAL SECONDARY TO TRAUMA

S52266A

NONDISP SEGMENTAL FRACTURE OF SHAFT OF ULNA UNSP ARM INIT

H61312

ACQUIRED STENOSIS OF L EXT EAR CANAL SECONDARY TO TRAUMA

S52266B

NONDISP SEG FX SHAFT OF ULNA UNSP ARM 7THB

H61313

ACQUIRED STENOSIS OF EXT EAR CANAL SECONDARY TO TRAUMA BI

S52266C

NONDISP SEG FX SHAFT OF ULNA UNSP ARM 7THC

H61319

ACQUIRED STENOSIS OF EXT EAR CANAL SEC TO TRAUMA UNSP EAR

S52271A

MONTEGGIA'S FRACTURE OF RIGHT ULNA INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H61321

ACQUIRED STENOSIS OF R EXT EAR CANAL SEC TO INFLAM AND INFCT

S52271B

MONTEGGIA'S FRACTURE OF RIGHT ULNA INIT FOR OPN FX TYPE I/2

H61322

ACQUIRED STENOSIS OF L EXT EAR CANAL SEC TO INFLAM AND INFCT

S52271C

MONTEGGIA'S FX RIGHT ULNA INIT FOR OPN FX TYPE 3A/B/C

H61323

ACQ STENOSIS OF EXT EAR CANAL SEC TO INFLAM AND INFCT BI

S52272A

MONTEGGIA'S FRACTURE OF LEFT ULNA INIT FOR CLOS FX

H61329

ACQ STENOS OF EXT EAR CANAL SEC TO INFLAM & INFCT UNSP EAR

S52272B

MONTEGGIA'S FRACTURE OF LEFT ULNA INIT FOR OPN FX TYPE I/2

H61391 OTHER ACQUIRED STENOSIS OF RIGHT EXTERNAL EAR CANAL

S52272C

MONTEGGIA'S FX LEFT ULNA INIT FOR OPN FX TYPE 3A/B/C

H61392 OTHER ACQUIRED STENOSIS OF LEFT EXTERNAL EAR CANAL

S52279A

MONTEGGIA'S FRACTURE OF UNSP ULNA INIT FOR CLOS FX

H61393

OTHER ACQUIRED STENOSIS OF EXTERNAL EAR CANAL BILATERAL

S52279B

MONTEGGIA'S FRACTURE OF UNSP ULNA INIT FOR OPN FX TYPE I/2

H61399

OTHER ACQUIRED STENOSIS OF EXTERNAL EAR CANAL UNSP EAR

S52279C

MONTEGGIA'S FX UNSP ULNA INIT FOR OPN FX TYPE 3A/B/C

H61811 EXOSTOSIS OF RIGHT EXTERNAL CANAL

S52281A

BENT BONE OF RIGHT ULNA INIT ENCNTR FOR CLOSED FRACTURE

H61812 EXOSTOSIS OF LEFT EXTERNAL CANAL

S52281B

BENT BONE OF RIGHT ULNA INIT FOR OPN FX TYPE I/2

H61813 EXOSTOSIS OF EXTERNAL CANAL BILATERAL

S52281C

BENT BONE OF RIGHT ULNA INIT FOR OPN FX TYPE 3A/B/C

H61819 EXOSTOSIS OF EXTERNAL CANAL UNSPECIFIED EAR

S52282A

BENT BONE OF LEFT ULNA INIT ENCNTR FOR CLOSED FRACTURE

H61891 OTHER SPECIFIED DISORDERS OF RIGHT EXTERNAL EAR

S52282B

BENT BONE OF LEFT ULNA INIT FOR OPN FX TYPE I/2

H61892 OTHER SPECIFIED DISORDERS OF LEFT EXTERNAL EAR

S52282C

BENT BONE OF LEFT ULNA INIT FOR OPN FX TYPE 3A/B/C

H61893 OTHER SPECIFIED DISORDERS OF EXTERNAL EAR BILATERAL

S52283A

BENT BONE OF UNSP ULNA INIT ENCNTR FOR CLOSED FRACTURE

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H61899

OTHER SPECIFIED DISORDERS OF EXTERNAL EAR UNSPECIFIED EAR

S52283B

BENT BONE OF UNSP ULNA INIT FOR OPN FX TYPE I/2

H6190 DISORDER OF EXTERNAL EAR UNSPECIFIED UNSPECIFIED EAR

S52283C

BENT BONE OF UNSP ULNA INIT FOR OPN FX TYPE 3A/B/C

H6191 DISORDER OF RIGHT EXTERNAL EAR UNSPECIFIED

S52291A

OTH FRACTURE OF SHAFT OF RIGHT ULNA INIT FOR CLOS FX

H6192 DISORDER OF LEFT EXTERNAL EAR UNSPECIFIED

S52291B

OTH FX SHAFT OF RIGHT ULNA INIT FOR OPN FX TYPE I/2

H6193 DISORDER OF EXTERNAL EAR UNSPECIFIED BILATERAL

S52291C

OTH FX SHAFT OF RIGHT ULNA INIT FOR OPN FX TYPE 3A/B/C

H6240

OTITIS EXTERNA IN OTH DISEASES CLASSD ELSWHR UNSP EAR

S52292A

OTH FRACTURE OF SHAFT OF LEFT ULNA INIT FOR CLOS FX

H6241

OTITIS EXTERNA IN OTH DISEASES CLASSD ELSWHR RIGHT EAR

S52292B

OTH FRACTURE OF SHAFT OF LEFT ULNA INIT FOR OPN FX TYPE I/2

H6242

OTITIS EXTERNA IN OTH DISEASES CLASSD ELSWHR LEFT EAR

S52292C

OTH FX SHAFT OF LEFT ULNA INIT FOR OPN FX TYPE 3A/B/C

H6243

OTITIS EXTERNA IN OTH DISEASES CLASSD ELSWHR BILATERAL

S52299A

OTH FRACTURE OF SHAFT OF UNSP ULNA INIT FOR CLOS FX

H628X1 OTH DISORDERS OF R EXT EAR IN DISEASES CLASSD ELSWHR

S52299B

OTH FRACTURE OF SHAFT OF UNSP ULNA INIT FOR OPN FX TYPE I/2

H628X2

OTH DISORDERS OF LEFT EXTERNAL EAR IN DISEASES CLASSD ELSWHR

S52299C

OTH FX SHAFT OF UNSP ULNA INIT FOR OPN FX TYPE 3A/B/C

H628X3 OTH DISORDERS OF EXT EAR IN DISEASES CLASSD ELSWHR BI

S52301A

UNSP FRACTURE OF SHAFT OF RIGHT RADIUS INIT FOR CLOS FX

H628X9

OTH DISORDERS OF EXT EAR IN DISEASES CLASSD ELSWHR UNSP EAR

S52301B

UNSP FRACTURE OF SHAFT OF R RADIUS INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H6500 ACUTE SEROUS OTITIS MEDIA UNSPECIFIED EAR

S52301C

UNSP FX SHAFT OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

H6501 ACUTE SEROUS OTITIS MEDIA RIGHT EAR

S52302A

UNSP FRACTURE OF SHAFT OF LEFT RADIUS INIT FOR CLOS FX

H6502 ACUTE SEROUS OTITIS MEDIA LEFT EAR

S52302B

UNSP FX SHAFT OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

H6503 ACUTE SEROUS OTITIS MEDIA BILATERAL

S52302C

UNSP FX SHAFT OF LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

H6504 ACUTE SEROUS OTITIS MEDIA RECURRENT RIGHT EAR

S52309A

UNSP FRACTURE OF SHAFT OF UNSP RADIUS INIT FOR CLOS FX

H6505 ACUTE SEROUS OTITIS MEDIA RECURRENT LEFT EAR

S52309B

UNSP FX SHAFT OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

H6506 ACUTE SEROUS OTITIS MEDIA RECURRENT BILATERAL

S52309C

UNSP FX SHAFT OF UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

H6507 ACUTE SEROUS OTITIS MEDIA RECURRENT UNSPECIFIED EAR

S52311A

GREENSTICK FRACTURE OF SHAFT OF RADIUS RIGHT ARM INIT

H65111

ACUTE AND SUBACUTE ALLERGIC OTITIS MEDIA (SEROUS) R EAR

S52311S

GREENSTICK FRACTURE OF SHAFT OF RADIUS RIGHT ARM SEQUELA

H65112

ACUTE AND SUBACUTE ALLERGIC OTITIS MEDIA (SEROUS) LEFT EAR

S52312A

GREENSTICK FRACTURE OF SHAFT OF RADIUS LEFT ARM INIT

H65113

ACUTE AND SUBACUTE ALLERGIC OTITIS MEDIA (SEROUS) BI

S52319A

GREENSTICK FRACTURE OF SHAFT OF RADIUS UNSP ARM INIT

H65114

ACUTE AND SUBACUTE ALLERGIC OTITIS MEDIA RECUR R EAR

S52321A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF RIGHT RADIUS INIT

H65115

ACUTE AND SUBACUTE ALLERGIC OTITIS MEDIA RECUR LEFT EAR

S52321B

DISPL TRANSVERSE FX SHAFT OF R RAD INIT FOR OPN FX TYPE I/2

H65116

ACUTE AND SUBACUTE ALLERGIC OTITIS MEDIA (SEROUS) RECUR BI

S52321C

DISPL TRANSVERSE FX SHAFT OF R RAD 7THC

H65117

ACUTE AND SUBACUTE ALLERGIC OTITIS MEDIA RECUR UNSP EAR

S52322A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF LEFT RADIUS INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H65119

ACUTE AND SUBACUTE ALLERGIC OTITIS MEDIA (SEROUS) UNSP EAR

S52322B

DISPL TRANSVERSE FX SHAFT OF L RAD INIT FOR OPN FX TYPE I/2

H65191

OTHER ACUTE NONSUPPURATIVE OTITIS MEDIA RIGHT EAR

S52322C

DISPL TRANSVERSE FX SHAFT OF L RAD 7THC

H65192

OTHER ACUTE NONSUPPURATIVE OTITIS MEDIA LEFT EAR

S52323A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF UNSP RADIUS INIT

H65193

OTHER ACUTE NONSUPPURATIVE OTITIS MEDIA BILATERAL

S52323B

DISPL TRANSVERSE FX SHAFT OF UNSP RAD 7THB

H65194

OTH ACUTE NONSUPPURATIVE OTITIS MEDIA RECURRENT RIGHT EAR

S52323C

DISPL TRANSVERSE FX SHAFT OF UNSP RAD 7THC

H65195

OTHER ACUTE NONSUPPURATIVE OTITIS MEDIA RECURRENT LEFT EAR

S52324A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF RIGHT RADIUS INIT

H65196

OTH ACUTE NONSUPPURATIVE OTITIS MEDIA RECURRENT BILATERAL

S52324B

NONDISP TRANSVERSE FX SHAFT OF R RAD 7THB

H65197

OTHER ACUTE NONSUPPURATIVE OTITIS MEDIA RECURRENT UNSP EAR

S52324C

NONDISP TRANSVERSE FX SHAFT OF R RAD 7THC

H65199

OTHER ACUTE NONSUPPURATIVE OTITIS MEDIA UNSPECIFIED EAR

S52325A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF LEFT RADIUS INIT

H6520 CHRONIC SEROUS OTITIS MEDIA UNSPECIFIED EAR

S52325B

NONDISP TRANSVERSE FX SHAFT OF L RAD 7THB

H6521 CHRONIC SEROUS OTITIS MEDIA RIGHT EAR

S52325C

NONDISP TRANSVERSE FX SHAFT OF L RAD 7THC

H6522 CHRONIC SEROUS OTITIS MEDIA LEFT EAR

S52326A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF UNSP RADIUS INIT

H6523 CHRONIC SEROUS OTITIS MEDIA BILATERAL

S52326B

NONDISP TRANSVERSE FX SHAFT OF UNSP RAD 7THB

H6530 CHRONIC MUCOID OTITIS MEDIA UNSPECIFIED EAR

S52326C

NONDISP TRANSVERSE FX SHAFT OF UNSP RAD 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H6531 CHRONIC MUCOID OTITIS MEDIA RIGHT EAR

S52331A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT RADIUS INIT

H6532 CHRONIC MUCOID OTITIS MEDIA LEFT EAR

S52331B

DISPL OBLIQUE FX SHAFT OF R RADIUS INIT FOR OPN FX TYPE I/2

H6533 CHRONIC MUCOID OTITIS MEDIA BILATERAL

S52331C

DISPL OBLIQUE FX SHAFT OF R RAD INIT FOR OPN FX TYPE 3A/B/C

H65411 CHRONIC ALLERGIC OTITIS MEDIA RIGHT EAR

S52332A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT RADIUS INIT

H65412 CHRONIC ALLERGIC OTITIS MEDIA LEFT EAR

S52332B

DISPL OBLIQUE FX SHAFT OF LEFT RAD INIT FOR OPN FX TYPE I/2

H65413 CHRONIC ALLERGIC OTITIS MEDIA BILATERAL

S52332C

DISPL OBLIQUE FX SHAFT OF L RAD INIT FOR OPN FX TYPE 3A/B/C

H65419 CHRONIC ALLERGIC OTITIS MEDIA UNSPECIFIED EAR

S52333A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF UNSP RADIUS INIT

H65491

OTHER CHRONIC NONSUPPURATIVE OTITIS MEDIA RIGHT EAR

S52333B

DISPL OBLIQUE FX SHAFT OF UNSP RAD INIT FOR OPN FX TYPE I/2

H65492

OTHER CHRONIC NONSUPPURATIVE OTITIS MEDIA LEFT EAR

S52333C

DISPL OBLIQUE FX SHAFT OF UNSP RAD 7THC

H65493

OTHER CHRONIC NONSUPPURATIVE OTITIS MEDIA BILATERAL

S52334A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT RADIUS INIT

H65499

OTHER CHRONIC NONSUPPURATIVE OTITIS MEDIA UNSPECIFIED EAR

S52334B

NONDISP OBLIQUE FX SHAFT OF R RAD INIT FOR OPN FX TYPE I/2

H6590

UNSPECIFIED NONSUPPURATIVE OTITIS MEDIA UNSPECIFIED EAR

S52334C

NONDISP OBLIQUE FX SHAFT OF R RAD 7THC

H6591

UNSPECIFIED NONSUPPURATIVE OTITIS MEDIA RIGHT EAR

S52335A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT RADIUS INIT

H6592

UNSPECIFIED NONSUPPURATIVE OTITIS MEDIA LEFT EAR

S52335B

NONDISP OBLIQUE FX SHAFT OF L RAD INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H6593

UNSPECIFIED NONSUPPURATIVE OTITIS MEDIA BILATERAL

S52335C

NONDISP OBLIQUE FX SHAFT OF L RAD 7THC

H66001

ACUTE SUPPR OTITIS MEDIA W/O SPON RUPT EAR DRUM RIGHT EAR

S52336A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF UNSP RADIUS INIT

H66002

ACUTE SUPPR OTITIS MEDIA W/O SPON RUPT EAR DRUM LEFT EAR

S52336B

NONDISP OBLIQUE FX SHAFT OF UNSP RAD 7THB

H66003

ACUTE SUPPR OTITIS MEDIA W/O SPON RUPT EAR DRUM BILATERAL

S52336C

NONDISP OBLIQUE FX SHAFT OF UNSP RAD 7THC

H66004

AC SUPPR OTITIS MEDIA W/O SPON RUPT EAR DRUM RECUR R EAR

S52341A

DISPLACED SPIRAL FX SHAFT OF RADIUS RIGHT ARM INIT

H66005

AC SUPPR OTITIS MEDIA W/O SPON RUPT EAR DRUM RECUR L EAR

S52341B

DISPL SPIRAL FX SHAFT OF RAD R ARM 7THB

H66006

ACUTE SUPPR OTITIS MEDIA W/O SPON RUPT EAR DRUM RECUR BI

S52341C

DISPL SPIRAL FX SHAFT OF RAD R ARM 7THC

H66007

AC SUPPR OTITIS MEDIA W/O SPON RUPT EAR DRUMRECUR UNSP EAR

S52342A

DISPLACED SPIRAL FRACTURE OF SHAFT OF RADIUS LEFT ARM INIT

H66009

ACUTE SUPPR OTITIS MEDIA W/O SPON RUPT EAR DRUM UNSP EAR

S52342B

DISPL SPIRAL FX SHAFT OF RAD L ARM 7THB

H66011

ACUTE SUPPR OTITIS MEDIA W SPON RUPT EAR DRUM RIGHT EAR

S52342C

DISPL SPIRAL FX SHAFT OF RAD L ARM 7THC

H66012

ACUTE SUPPR OTITIS MEDIA W SPON RUPT EAR DRUM LEFT EAR

S52343A

DISPLACED SPIRAL FRACTURE OF SHAFT OF RADIUS UNSP ARM INIT

H66013

ACUTE SUPPR OTITIS MEDIA W SPON RUPT EAR DRUM BILATERAL

S52343B

DISPL SPIRAL FX SHAFT OF RAD UNSP ARM 7THB

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H66014

ACUTE SUPPR OTITIS MEDIA W SPON RUPT EAR DRUM RECUR R EAR

S52343C

DISPL SPIRAL FX SHAFT OF RAD UNSP ARM 7THC

H66015

ACUTE SUPPR OTITIS MEDIA W SPON RUPT EAR DRUM RECUR L EAR

S52344A

NONDISP SPIRAL FRACTURE OF SHAFT OF RADIUS RIGHT ARM INIT

H66016

ACUTE SUPPR OTITIS MEDIA W SPON RUPT EAR DRUM RECURRENT BI

S52344B

NONDISP SPIRAL FX SHAFT OF RAD R ARM 7THB

H66017

AC SUPPR OTITIS MEDIA W SPON RUPT EAR DRUM RECUR UNSP EAR

S52344C

NONDISP SPIRAL FX SHAFT OF RAD R ARM 7THC

H66019

ACUTE SUPPR OTITIS MEDIA W SPON RUPT EAR DRUM UNSP EAR

S52345A

NONDISP SPIRAL FRACTURE OF SHAFT OF RADIUS LEFT ARM INIT

H6610

CHRONIC TUBOTYMPANIC SUPPURATIVE OTITIS MEDIA UNSPECIFIED

S52345B

NONDISP SPIRAL FX SHAFT OF RAD L ARM 7THB

H6611

CHRONIC TUBOTYMPANIC SUPPURATIVE OTITIS MEDIA RIGHT EAR

S52345C

NONDISP SPIRAL FX SHAFT OF RAD L ARM 7THC

H6612

CHRONIC TUBOTYMPANIC SUPPURATIVE OTITIS MEDIA LEFT EAR

S52346A

NONDISP SPIRAL FRACTURE OF SHAFT OF RADIUS UNSP ARM INIT

H6613

CHRONIC TUBOTYMPANIC SUPPURATIVE OTITIS MEDIA BILATERAL

S52346B

NONDISP SPIRAL FX SHAFT OF RAD UNSP ARM 7THB

H6620

CHRONIC ATTICOANTRAL SUPPURATIVE OTITIS MEDIA UNSP EAR

S52346C

NONDISP SPIRAL FX SHAFT OF RAD UNSP ARM 7THC

H6621

CHRONIC ATTICOANTRAL SUPPURATIVE OTITIS MEDIA RIGHT EAR

S52351A

DISPLACED COMMINUTED FX SHAFT OF RADIUS RIGHT ARM INIT

H6622

CHRONIC ATTICOANTRAL SUPPURATIVE OTITIS MEDIA LEFT EAR

S52351B

DISPL COMMNT FX SHAFT OF RAD R ARM 7THB

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H6623

CHRONIC ATTICOANTRAL SUPPURATIVE OTITIS MEDIA BILATERAL

S52351C

DISPL COMMNT FX SHAFT OF RAD R ARM 7THC

H663X1 OTHER CHRONIC SUPPURATIVE OTITIS MEDIA RIGHT EAR

S52352A

DISPLACED COMMINUTED FX SHAFT OF RADIUS LEFT ARM INIT

H663X2 OTHER CHRONIC SUPPURATIVE OTITIS MEDIA LEFT EAR

S52352B

DISPL COMMNT FX SHAFT OF RAD L ARM 7THB

H663X3 OTHER CHRONIC SUPPURATIVE OTITIS MEDIA BILATERAL

S52352C

DISPL COMMNT FX SHAFT OF RAD L ARM 7THC

H663X9 OTHER CHRONIC SUPPURATIVE OTITIS MEDIA UNSPECIFIED EAR

S52353A

DISPLACED COMMINUTED FX SHAFT OF RADIUS UNSP ARM INIT

H6640 SUPPURATIVE OTITIS MEDIA UNSPECIFIED UNSPECIFIED EAR

S52353B

DISPL COMMNT FX SHAFT OF RAD UNSP ARM 7THB

H6641 SUPPURATIVE OTITIS MEDIA UNSPECIFIED RIGHT EAR

S52353C

DISPL COMMNT FX SHAFT OF RAD UNSP ARM 7THC

H6642 SUPPURATIVE OTITIS MEDIA UNSPECIFIED LEFT EAR

S52354A

NONDISP COMMINUTED FX SHAFT OF RADIUS RIGHT ARM INIT

H6643 SUPPURATIVE OTITIS MEDIA UNSPECIFIED BILATERAL

S52354B

NONDISP COMMNT FX SHAFT OF RAD R ARM 7THB

H6690 OTITIS MEDIA UNSPECIFIED UNSPECIFIED EAR

S52354C

NONDISP COMMNT FX SHAFT OF RAD R ARM 7THC

H6691 OTITIS MEDIA UNSPECIFIED RIGHT EAR

S52355A

NONDISP COMMINUTED FX SHAFT OF RADIUS LEFT ARM INIT

H6692 OTITIS MEDIA UNSPECIFIED LEFT EAR

S52355B

NONDISP COMMNT FX SHAFT OF RAD L ARM 7THB

H6693 OTITIS MEDIA UNSPECIFIED BILATERAL

S52355C

NONDISP COMMNT FX SHAFT OF RAD L ARM 7THC

H671

OTITIS MEDIA IN DISEASES CLASSIFIED ELSEWHERE RIGHT EAR

S52356A

NONDISP COMMINUTED FX SHAFT OF RADIUS UNSP ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H672

OTITIS MEDIA IN DISEASES CLASSIFIED ELSEWHERE LEFT EAR

S52356B

NONDISP COMMNT FX SHAFT OF RAD UNSP ARM 7THB

H673

OTITIS MEDIA IN DISEASES CLASSIFIED ELSEWHERE BILATERAL

S52356C

NONDISP COMMNT FX SHAFT OF RAD UNSP ARM 7THC

H679

OTITIS MEDIA IN DISEASES CLASSIFIED ELSEWHERE UNSP EAR

S52361A

DISPLACED SEGMENTAL FX SHAFT OF RADIUS RIGHT ARM INIT

H68001 UNSPECIFIED EUSTACHIAN SALPINGITIS RIGHT EAR

S52361B

DISPL SEG FX SHAFT OF RAD R ARM INIT FOR OPN FX TYPE I/2

H68002 UNSPECIFIED EUSTACHIAN SALPINGITIS LEFT EAR

S52361C

DISPL SEG FX SHAFT OF RAD R ARM 7THC

H68003 UNSPECIFIED EUSTACHIAN SALPINGITIS BILATERAL

S52362A

DISPLACED SEGMENTAL FX SHAFT OF RADIUS LEFT ARM INIT

H68009 UNSPECIFIED EUSTACHIAN SALPINGITIS UNSPECIFIED EAR

S52362B

DISPL SEG FX SHAFT OF RAD L ARM INIT FOR OPN FX TYPE I/2

H68011 ACUTE EUSTACHIAN SALPINGITIS RIGHT EAR

S52362C

DISPL SEG FX SHAFT OF RAD L ARM 7THC

H68012 ACUTE EUSTACHIAN SALPINGITIS LEFT EAR

S52363A

DISPLACED SEGMENTAL FX SHAFT OF RADIUS UNSP ARM INIT

H68013 ACUTE EUSTACHIAN SALPINGITIS BILATERAL

S52363B

DISPL SEG FX SHAFT OF RAD UNSP ARM 7THB

H68019 ACUTE EUSTACHIAN SALPINGITIS UNSPECIFIED EAR

S52363C

DISPL SEG FX SHAFT OF RAD UNSP ARM 7THC

H68021 CHRONIC EUSTACHIAN SALPINGITIS RIGHT EAR

S52364A

NONDISP SEGMENTAL FX SHAFT OF RADIUS RIGHT ARM INIT

H68022 CHRONIC EUSTACHIAN SALPINGITIS LEFT EAR

S52364B

NONDISP SEG FX SHAFT OF RAD R ARM INIT FOR OPN FX TYPE I/2

H68023 CHRONIC EUSTACHIAN SALPINGITIS BILATERAL

S52364C

NONDISP SEG FX SHAFT OF RAD R ARM 7THC

H68029 CHRONIC EUSTACHIAN SALPINGITIS UNSPECIFIED EAR

S52365A

NONDISP SEGMENTAL FX SHAFT OF RADIUS LEFT ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H68101 UNSPECIFIED OBSTRUCTION OF EUSTACHIAN TUBE RIGHT EAR

S52365B

NONDISP SEG FX SHAFT OF RAD L ARM INIT FOR OPN FX TYPE I/2

H68102 UNSPECIFIED OBSTRUCTION OF EUSTACHIAN TUBE LEFT EAR

S52365C

NONDISP SEG FX SHAFT OF RAD L ARM 7THC

H68103 UNSPECIFIED OBSTRUCTION OF EUSTACHIAN TUBE BILATERAL

S52366A

NONDISP SEGMENTAL FX SHAFT OF RADIUS UNSP ARM INIT

H68109

UNSPECIFIED OBSTRUCTION OF EUSTACHIAN TUBE UNSPECIFIED EAR

S52366B

NONDISP SEG FX SHAFT OF RAD UNSP ARM 7THB

H68111 OSSEOUS OBSTRUCTION OF EUSTACHIAN TUBE RIGHT EAR

S52366C

NONDISP SEG FX SHAFT OF RAD UNSP ARM 7THC

H68112 OSSEOUS OBSTRUCTION OF EUSTACHIAN TUBE LEFT EAR

S52371A

GALEAZZI'S FRACTURE OF RIGHT RADIUS INIT FOR CLOS FX

H68113 OSSEOUS OBSTRUCTION OF EUSTACHIAN TUBE BILATERAL

S52371B

GALEAZZI'S FRACTURE OF R RADIUS INIT FOR OPN FX TYPE I/2

H68119

OSSEOUS OBSTRUCTION OF EUSTACHIAN TUBE UNSPECIFIED EAR

S52371C

GALEAZZI'S FRACTURE OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

H68121

INTRINSIC CARTILAGENOUS OBST OF EUSTACH TUBE RIGHT EAR

S52372A

GALEAZZI'S FRACTURE OF LEFT RADIUS INIT FOR CLOS FX

H68122

INTRINSIC CARTILAGENOUS OBST OF EUSTACH TUBE LEFT EAR

S52372B

GALEAZZI'S FRACTURE OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

H68123

INTRINSIC CARTILAGENOUS OBST OF EUSTACH TUBE BILATERAL

S52372C

GALEAZZI'S FX LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

H68129

INTRINSIC CARTILAGENOUS OBST OF EUSTACH TUBE UNSP EAR

S52379A

GALEAZZI'S FRACTURE OF UNSP RADIUS INIT FOR CLOS FX

H68131

EXTRINSIC CARTILAGENOUS OBST OF EUSTACH TUBE RIGHT EAR

S52379B

GALEAZZI'S FRACTURE OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H68132

EXTRINSIC CARTILAGENOUS OBST OF EUSTACH TUBE LEFT EAR

S52379C

GALEAZZI'S FX UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

H68133

EXTRINSIC CARTILAGENOUS OBST OF EUSTACH TUBE BILATERAL

S52381A

BENT BONE OF RIGHT RADIUS INIT ENCNTR FOR CLOSED FRACTURE

H68139

EXTRINSIC CARTILAGENOUS OBST OF EUSTACH TUBE UNSP EAR

S52381B

BENT BONE OF RIGHT RADIUS INIT FOR OPN FX TYPE I/2

H6900 PATULOUS EUSTACHIAN TUBE UNSPECIFIED EAR

S52381C

BENT BONE OF RIGHT RADIUS INIT FOR OPN FX TYPE 3A/B/C

H6901 PATULOUS EUSTACHIAN TUBE RIGHT EAR

S52382A

BENT BONE OF LEFT RADIUS INIT ENCNTR FOR CLOSED FRACTURE

H6902 PATULOUS EUSTACHIAN TUBE LEFT EAR

S52382B

BENT BONE OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

H6903 PATULOUS EUSTACHIAN TUBE BILATERAL

S52382C

BENT BONE OF LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

H6980 OTH DISRD OF EUSTACHIAN TUBE UNSPECIFIED EAR

S52389A

BENT BONE OF UNSP RADIUS INIT ENCNTR FOR CLOSED FRACTURE

H6981

OTHER SPECIFIED DISORDERS OF EUSTACHIAN TUBE RIGHT EAR

S52389B

BENT BONE OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

H6982 OTHER SPECIFIED DISORDERS OF EUSTACHIAN TUBE LEFT EAR

S52389C

BENT BONE OF UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

H6983

OTHER SPECIFIED DISORDERS OF EUSTACHIAN TUBE BILATERAL

S52391A

OTH FRACTURE OF SHAFT OF RADIUS RIGHT ARM INIT FOR CLOS FX

H6990

UNSPECIFIED EUSTACHIAN TUBE DISORDER UNSPECIFIED EAR

S52391B

OTH FX SHAFT OF RADIUS RIGHT ARM INIT FOR OPN FX TYPE I/2

H6991 UNSPECIFIED EUSTACHIAN TUBE DISORDER RIGHT EAR

S52391C

OTH FX SHAFT OF RAD RIGHT ARM INIT FOR OPN FX TYPE 3A/B/C

H6992 UNSPECIFIED EUSTACHIAN TUBE DISORDER LEFT EAR

S52392A

OTH FRACTURE OF SHAFT OF RADIUS LEFT ARM INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H6993 UNSPECIFIED EUSTACHIAN TUBE DISORDER BILATERAL

S52392B

OTH FX SHAFT OF RADIUS LEFT ARM INIT FOR OPN FX TYPE I/2

H70001 ACUTE MASTOIDITIS WITHOUT COMPLICATIONS RIGHT EAR

S52392C

OTH FX SHAFT OF RAD LEFT ARM INIT FOR OPN FX TYPE 3A/B/C

H70002 ACUTE MASTOIDITIS WITHOUT COMPLICATIONS LEFT EAR

S52399A

OTH FRACTURE OF SHAFT OF RADIUS UNSP ARM INIT FOR CLOS FX

H70003 ACUTE MASTOIDITIS WITHOUT COMPLICATIONS BILATERAL

S52399B

OTH FX SHAFT OF RADIUS UNSP ARM INIT FOR OPN FX TYPE I/2

H70009

ACUTE MASTOIDITIS WITHOUT COMPLICATIONS UNSPECIFIED EAR

S52399C

OTH FX SHAFT OF RAD UNSP ARM INIT FOR OPN FX TYPE 3A/B/C

H70011 SUBPERIOSTEAL ABSCESS OF MASTOID RIGHT EAR

S52501A

UNSP FRACTURE OF THE LOWER END OF RIGHT RADIUS INIT

H70012 SUBPERIOSTEAL ABSCESS OF MASTOID LEFT EAR

S52501B

UNSP FX THE LOWER END OF R RADIUS INIT FOR OPN FX TYPE I/2

H70013 SUBPERIOSTEAL ABSCESS OF MASTOID BILATERAL

S52501C

UNSP FX THE LOWER END R RADIUS INIT FOR OPN FX TYPE 3A/B/C

H70019 SUBPERIOSTEAL ABSCESS OF MASTOID UNSPECIFIED EAR

S52502A

UNSP FRACTURE OF THE LOWER END OF LEFT RADIUS INIT

H70091

ACUTE MASTOIDITIS WITH OTHER COMPLICATIONS RIGHT EAR

S52502B

UNSP FX THE LOWER END LEFT RADIUS INIT FOR OPN FX TYPE I/2

H70092

ACUTE MASTOIDITIS WITH OTHER COMPLICATIONS LEFT EAR

S52502C

UNSP FX THE LOWER END LEFT RAD INIT FOR OPN FX TYPE 3A/B/C

H70093

ACUTE MASTOIDITIS WITH OTHER COMPLICATIONS BILATERAL

S52509A

UNSP FRACTURE OF THE LOWER END OF UNSP RADIUS INIT

H70099

ACUTE MASTOIDITIS WITH OTHER COMPLICATIONS UNSPECIFIED EAR

S52509B

UNSP FX THE LOWER END UNSP RADIUS INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H7010 CHRONIC MASTOIDITIS UNSPECIFIED EAR

S52509C

UNSP FX THE LOWER END UNSP RAD INIT FOR OPN FX TYPE 3A/B/C

H7011 CHRONIC MASTOIDITIS RIGHT EAR

S52511A

DISP FX OF RIGHT RADIAL STYLOID PROCESS INIT FOR CLOS FX

H7012 CHRONIC MASTOIDITIS LEFT EAR

S52511B

DISP FX OF R RADIAL STYLOID PRO INIT FOR OPN FX TYPE I/2

H7013 CHRONIC MASTOIDITIS BILATERAL

S52511C

DISP FX OF R RADIAL STYLOID PRO INIT FOR OPN FX TYPE 3A/B/C

H70201 UNSPECIFIED PETROSITIS RIGHT EAR

S52512A

DISP FX OF LEFT RADIAL STYLOID PROCESS INIT FOR CLOS FX

H70202 UNSPECIFIED PETROSITIS LEFT EAR

S52512B

DISP FX OF LEFT RADIAL STYLOID PRO INIT FOR OPN FX TYPE I/2

H70203 UNSPECIFIED PETROSITIS BILATERAL

S52512C

DISP FX OF L RADIAL STYLOID PRO INIT FOR OPN FX TYPE 3A/B/C

H70209 UNSPECIFIED PETROSITIS UNSPECIFIED EAR

S52512S

DISPLACED FRACTURE OF LEFT RADIAL STYLOID PROCESS SEQUELA

H70211 ACUTE PETROSITIS RIGHT EAR

S52513A DISP FX OF UNSP RADIAL STYLOID PROCESS INIT FOR CLOS FX

H70212 ACUTE PETROSITIS LEFT EAR

S52513B DISP FX OF UNSP RADIAL STYLOID PRO INIT FOR OPN FX TYPE I/2

H70213 ACUTE PETROSITIS BILATERAL

S52513C DISP FX OF UNSP RADIAL STYLOID PRO 7THC

H70219 ACUTE PETROSITIS UNSPECIFIED EAR

S52514A

NONDISP FX OF RIGHT RADIAL STYLOID PROCESS INIT FOR CLOS FX

H70221 CHRONIC PETROSITIS RIGHT EAR

S52514B

NONDISP FX OF R RADIAL STYLOID PRO INIT FOR OPN FX TYPE I/2

H70222 CHRONIC PETROSITIS LEFT EAR

S52514C NONDISP FX OF R RADIAL STYLOID PRO 7THC

H70223 CHRONIC PETROSITIS BILATERAL

S52515A

NONDISP FX OF LEFT RADIAL STYLOID PROCESS INIT FOR CLOS FX

H70229 CHRONIC PETROSITIS UNSPECIFIED EAR

S52515B

NONDISP FX OF L RADIAL STYLOID PRO INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H70811 POSTAURICULAR FISTULA RIGHT EAR

S52515C

NONDISP FX OF L RADIAL STYLOID PRO 7THC

H70812 POSTAURICULAR FISTULA LEFT EAR

S52516A

NONDISP FX OF UNSP RADIAL STYLOID PROCESS INIT FOR CLOS FX

H70813 POSTAURICULAR FISTULA BILATERAL

S52516B

NONDISP FX OF UNSP RADIAL STYLOID PRO 7THB

H70819 POSTAURICULAR FISTULA UNSPECIFIED EAR

S52516C

NONDISP FX OF UNSP RADIAL STYLOID PRO 7THC

H70891

OTHER MASTOIDITIS AND RELATED CONDITIONS RIGHT EAR

S52521A

TORUS FRACTURE OF LOWER END OF RIGHT RADIUS INIT

H70892 OTHER MASTOIDITIS AND RELATED CONDITIONS LEFT EAR

S52522A

TORUS FRACTURE OF LOWER END OF LEFT RADIUS INIT FOR CLOS FX

H70893

OTHER MASTOIDITIS AND RELATED CONDITIONS BILATERAL

S52529A

TORUS FRACTURE OF LOWER END OF UNSP RADIUS INIT FOR CLOS FX

H70899

OTHER MASTOIDITIS AND RELATED CONDITIONS UNSPECIFIED EAR

S52531A

COLLES' FRACTURE OF RIGHT RADIUS INIT FOR CLOS FX

H7090 UNSPECIFIED MASTOIDITIS UNSPECIFIED EAR

S52531B

COLLES' FRACTURE OF RIGHT RADIUS INIT FOR OPN FX TYPE I/2

H7091 UNSPECIFIED MASTOIDITIS RIGHT EAR

S52531C

COLLES' FRACTURE OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

H7092 UNSPECIFIED MASTOIDITIS LEFT EAR

S52532A

COLLES' FRACTURE OF LEFT RADIUS INIT FOR CLOS FX

H7093 UNSPECIFIED MASTOIDITIS BILATERAL

S52532B

COLLES' FRACTURE OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

H7100 CHOLESTEATOMA OF ATTIC UNSPECIFIED EAR

S52532C

COLLES' FRACTURE OF LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

H7101 CHOLESTEATOMA OF ATTIC RIGHT EAR

S52539A

COLLES' FRACTURE OF UNSP RADIUS INIT FOR CLOS FX

H7102 CHOLESTEATOMA OF ATTIC LEFT EAR

S52539B

COLLES' FRACTURE OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H7103 CHOLESTEATOMA OF ATTIC BILATERAL

S52539C

COLLES' FRACTURE OF UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

H7110 CHOLESTEATOMA OF TYMPANUM UNSPECIFIED EAR

S52541A

SMITH'S FRACTURE OF RIGHT RADIUS INIT FOR CLOS FX

H7111 CHOLESTEATOMA OF TYMPANUM RIGHT EAR

S52541B

SMITH'S FRACTURE OF RIGHT RADIUS INIT FOR OPN FX TYPE I/2

H7112 CHOLESTEATOMA OF TYMPANUM LEFT EAR

S52541C

SMITH'S FRACTURE OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

H7113 CHOLESTEATOMA OF TYMPANUM BILATERAL

S52542A

SMITH'S FRACTURE OF LEFT RADIUS INIT FOR CLOS FX

H7120 CHOLESTEATOMA OF MASTOID UNSPECIFIED EAR

S52542B

SMITH'S FRACTURE OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

H7121 CHOLESTEATOMA OF MASTOID RIGHT EAR

S52542C

SMITH'S FRACTURE OF LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

H7122 CHOLESTEATOMA OF MASTOID LEFT EAR

S52549A

SMITH'S FRACTURE OF UNSP RADIUS INIT FOR CLOS FX

H7123 CHOLESTEATOMA OF MASTOID BILATERAL

S52549B

SMITH'S FRACTURE OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

H7130 DIFFUSE CHOLESTEATOSIS UNSPECIFIED EAR

S52549C

SMITH'S FRACTURE OF UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

H7131 DIFFUSE CHOLESTEATOSIS RIGHT EAR

S52551A

OTH EXTRARTIC FRACTURE OF LOWER END OF RIGHT RADIUS INIT

H7132 DIFFUSE CHOLESTEATOSIS LEFT EAR

S52551B

OTH EXTRARTIC FX LOWER END R RAD INIT FOR OPN FX TYPE I/2

H7133 DIFFUSE CHOLESTEATOSIS BILATERAL

S52551C

OTH EXTRARTIC FX LOW END R RAD INIT FOR OPN FX TYPE 3A/B/C

H7190 UNSPECIFIED CHOLESTEATOMA UNSPECIFIED EAR

S52552A

OTH EXTRARTIC FRACTURE OF LOWER END OF LEFT RADIUS INIT

H7191 UNSPECIFIED CHOLESTEATOMA RIGHT EAR

S52552B

OTH EXTRARTIC FX LOW END LEFT RAD INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H7192 UNSPECIFIED CHOLESTEATOMA LEFT EAR

S52552C

OTH EXTRARTIC FX LOW END L RAD INIT FOR OPN FX TYPE 3A/B/C

H7193 UNSPECIFIED CHOLESTEATOMA BILATERAL

S52559A

OTH EXTRARTIC FRACTURE OF LOWER END OF UNSP RADIUS INIT

H7200

CENTRAL PERFORATION OF TYMPANIC MEMBRANE UNSPECIFIED EAR

S52559B

OTH EXTRARTIC FX LOW END UNSP RAD INIT FOR OPN FX TYPE I/2

H7201

CENTRAL PERFORATION OF TYMPANIC MEMBRANE RIGHT EAR

S52559C

OTH EXTRARTIC FX LOW END UNSP RAD 7THC

H7202

CENTRAL PERFORATION OF TYMPANIC MEMBRANE LEFT EAR

S52561A

BARTON'S FRACTURE OF RIGHT RADIUS INIT FOR CLOS FX

H7203

CENTRAL PERFORATION OF TYMPANIC MEMBRANE BILATERAL

S52561B

BARTON'S FRACTURE OF RIGHT RADIUS INIT FOR OPN FX TYPE I/2

H7210

ATTIC PERFORATION OF TYMPANIC MEMBRANE UNSPECIFIED EAR

S52561C

BARTON'S FRACTURE OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

H7211

ATTIC PERFORATION OF TYMPANIC MEMBRANE RIGHT EAR

S52562A

BARTON'S FRACTURE OF LEFT RADIUS INIT FOR CLOS FX

H7212

ATTIC PERFORATION OF TYMPANIC MEMBRANE LEFT EAR

S52562B

BARTON'S FRACTURE OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

H7213

ATTIC PERFORATION OF TYMPANIC MEMBRANE BILATERAL

S52562C

BARTON'S FX LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

H722X1

OTHER MARGINAL PERFORATIONS OF TYMPANIC MEMBRANE RIGHT EAR

S52569A

BARTON'S FRACTURE OF UNSP RADIUS INIT FOR CLOS FX

H722X2

OTHER MARGINAL PERFORATIONS OF TYMPANIC MEMBRANE LEFT EAR

S52569B

BARTON'S FRACTURE OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H722X3

OTHER MARGINAL PERFORATIONS OF TYMPANIC MEMBRANE BILATERAL

S52569C

BARTON'S FX UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

H722X9

OTHER MARGINAL PERFORATIONS OF TYMPANIC MEMBRANE UNSP EAR

S52571A

OTH INTARTIC FRACTURE OF LOWER END OF RIGHT RADIUS INIT

H72811

MULTIPLE PERFORATIONS OF TYMPANIC MEMBRANE RIGHT EAR

S52571B

OTH INTARTIC FX LOWER END R RADIUS INIT FOR OPN FX TYPE I/2

H72812

MULTIPLE PERFORATIONS OF TYMPANIC MEMBRANE LEFT EAR

S52571C

OTH INTARTIC FX LOWER END R RAD INIT FOR OPN FX TYPE 3A/B/C

H72813

MULTIPLE PERFORATIONS OF TYMPANIC MEMBRANE BILATERAL

S52572A

OTH INTARTIC FRACTURE OF LOWER END OF LEFT RADIUS INIT

H72819

MULTIPLE PERFORATIONS OF TYMPANIC MEMBRANE UNSPECIFIED EAR

S52572B

OTH INTARTIC FX LOWER END LEFT RAD INIT FOR OPN FX TYPE I/2

H72821

TOTAL PERFORATIONS OF TYMPANIC MEMBRANE RIGHT EAR

S52572C

OTH INTARTIC FX LOW END L RAD INIT FOR OPN FX TYPE 3A/B/C

H72822

TOTAL PERFORATIONS OF TYMPANIC MEMBRANE LEFT EAR

S52579A

OTH INTARTIC FRACTURE OF LOWER END OF UNSP RADIUS INIT

H72823

TOTAL PERFORATIONS OF TYMPANIC MEMBRANE BILATERAL

S52579B

OTH INTARTIC FX LOWER END UNSP RAD INIT FOR OPN FX TYPE I/2

H72829

TOTAL PERFORATIONS OF TYMPANIC MEMBRANE UNSPECIFIED EAR

S52579C

OTH INTARTIC FX LOW END UNSP RAD 7THC

H7290

UNSP PERFORATION OF TYMPANIC MEMBRANE UNSPECIFIED EAR

S52591A

OTH FRACTURES OF LOWER END OF RIGHT RADIUS INIT FOR CLOS FX

H7291

UNSPECIFIED PERFORATION OF TYMPANIC MEMBRANE RIGHT EAR

S52591B

OTH FX OF LOWER END OF R RADIUS INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H7292

UNSPECIFIED PERFORATION OF TYMPANIC MEMBRANE LEFT EAR

S52591C

OTH FX OF LOWER END OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

H7293

UNSPECIFIED PERFORATION OF TYMPANIC MEMBRANE BILATERAL

S52592A

OTH FRACTURES OF LOWER END OF LEFT RADIUS INIT FOR CLOS FX

H73001 ACUTE MYRINGITIS RIGHT EAR

S52592B OTH FX OF LOWER END OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

H73002 ACUTE MYRINGITIS LEFT EAR

S52592C OTH FX OF LOWER END LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

H73003 ACUTE MYRINGITIS BILATERAL

S52599A OTH FRACTURES OF LOWER END OF UNSP RADIUS INIT FOR CLOS FX

H73009 ACUTE MYRINGITIS UNSPECIFIED EAR

S52599B

OTH FX OF LOWER END OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

H73011 BULLOUS MYRINGITIS RIGHT EAR

S52599C

OTH FX OF LOWER END UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

H73012 BULLOUS MYRINGITIS LEFT EAR

S52601A UNSP FRACTURE OF LOWER END OF RIGHT ULNA INIT FOR CLOS FX

H73013 BULLOUS MYRINGITIS BILATERAL

S52601B

UNSP FX LOWER END OF RIGHT ULNA INIT FOR OPN FX TYPE I/2

H73019 BULLOUS MYRINGITIS UNSPECIFIED EAR

S52601C

UNSP FX LOWER END OF RIGHT ULNA INIT FOR OPN FX TYPE 3A/B/C

H73091 OTHER ACUTE MYRINGITIS RIGHT EAR

S52602A

UNSP FRACTURE OF LOWER END OF LEFT ULNA INIT FOR CLOS FX

H73092 OTHER ACUTE MYRINGITIS LEFT EAR

S52602B

UNSP FX LOWER END OF LEFT ULNA INIT FOR OPN FX TYPE I/2

H73093 OTHER ACUTE MYRINGITIS BILATERAL

S52602C

UNSP FX LOWER END OF LEFT ULNA INIT FOR OPN FX TYPE 3A/B/C

H73099 OTHER ACUTE MYRINGITIS UNSPECIFIED EAR

S52609A

UNSP FRACTURE OF LOWER END OF UNSP ULNA INIT FOR CLOS FX

H7310 CHRONIC MYRINGITIS UNSPECIFIED EAR

S52609B

UNSP FX LOWER END OF UNSP ULNA INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H7311 CHRONIC MYRINGITIS RIGHT EAR

S52609C

UNSP FX LOWER END OF UNSP ULNA INIT FOR OPN FX TYPE 3A/B/C

H7312 CHRONIC MYRINGITIS LEFT EAR

S52611A DISP FX OF RIGHT ULNA STYLOID PROCESS INIT FOR CLOS FX

H7313 CHRONIC MYRINGITIS BILATERAL

S52611B

DISP FX OF R ULNA STYLOID PROCESS INIT FOR OPN FX TYPE I/2

H7320 UNSPECIFIED MYRINGITIS UNSPECIFIED EAR

S52611C

DISP FX OF R ULNA STYLOID PRO INIT FOR OPN FX TYPE 3A/B/C

H7321 UNSPECIFIED MYRINGITIS RIGHT EAR

S52612A

DISP FX OF LEFT ULNA STYLOID PROCESS INIT FOR CLOS FX

H7322 UNSPECIFIED MYRINGITIS LEFT EAR

S52612B

DISP FX OF L ULNA STYLOID PROCESS INIT FOR OPN FX TYPE I/2

H7323 UNSPECIFIED MYRINGITIS BILATERAL

S52612C

DISP FX OF L ULNA STYLOID PRO INIT FOR OPN FX TYPE 3A/B/C

H73811 ATROPHIC FLACCID TYMPANIC MEMBRANE RIGHT EAR

S52613A

DISP FX OF UNSP ULNA STYLOID PROCESS INIT FOR CLOS FX

H73812 ATROPHIC FLACCID TYMPANIC MEMBRANE LEFT EAR

S52613B

DISP FX OF UNSP ULNA STYLOID PRO INIT FOR OPN FX TYPE I/2

H73813 ATROPHIC FLACCID TYMPANIC MEMBRANE BILATERAL

S52613C

DISP FX OF UNSP ULNA STYLOID PRO 7THC

H73819 ATROPHIC FLACCID TYMPANIC MEMBRANE UNSPECIFIED EAR

S52614A

NONDISP FX OF RIGHT ULNA STYLOID PROCESS INIT FOR CLOS FX

H73821

ATROPHIC NONFLACCID TYMPANIC MEMBRANE RIGHT EAR

S52614B

NONDISP FX OF R ULNA STYLOID PRO INIT FOR OPN FX TYPE I/2

H73822

ATROPHIC NONFLACCID TYMPANIC MEMBRANE LEFT EAR

S52614C

NONDISP FX OF R ULNA STYLOID PRO 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H73823

ATROPHIC NONFLACCID TYMPANIC MEMBRANE BILATERAL

S52615A

NONDISP FX OF LEFT ULNA STYLOID PROCESS INIT FOR CLOS FX

H73829

ATROPHIC NONFLACCID TYMPANIC MEMBRANE UNSPECIFIED EAR

S52615B

NONDISP FX OF L ULNA STYLOID PRO INIT FOR OPN FX TYPE I/2

H73891

OTHER SPECIFIED DISORDERS OF TYMPANIC MEMBRANE RIGHT EAR

S52615C

NONDISP FX OF L ULNA STYLOID PRO 7THC

H73892

OTHER SPECIFIED DISORDERS OF TYMPANIC MEMBRANE LEFT EAR

S52616A

NONDISP FX OF UNSP ULNA STYLOID PROCESS INIT FOR CLOS FX

H73893

OTHER SPECIFIED DISORDERS OF TYMPANIC MEMBRANE BILATERAL

S52616B

NONDISP FX OF UNSP ULNA STYLOID PRO 7THB

H73899 OTH DISRD OF TYMPANIC MEMBRANE UNSPECIFIED EAR

S52616C

NONDISP FX OF UNSP ULNA STYLOID PRO 7THC

H7390

UNSPECIFIED DISORDER OF TYMPANIC MEMBRANE UNSPECIFIED EAR

S52621A

TORUS FRACTURE OF LOWER END OF RIGHT ULNA INIT FOR CLOS FX

H7391

UNSPECIFIED DISORDER OF TYMPANIC MEMBRANE RIGHT EAR

S52622A

TORUS FRACTURE OF LOWER END OF LEFT ULNA INIT FOR CLOS FX

H7392

UNSPECIFIED DISORDER OF TYMPANIC MEMBRANE LEFT EAR

S52629A

TORUS FRACTURE OF LOWER END OF UNSP ULNA INIT FOR CLOS FX

H7393

UNSPECIFIED DISORDER OF TYMPANIC MEMBRANE BILATERAL

S52691A

OTH FRACTURE OF LOWER END OF RIGHT ULNA INIT FOR CLOS FX

H7401 TYMPANOSCLEROSIS RIGHT EAR

S52691B OTH FX LOWER END OF RIGHT ULNA INIT FOR OPN FX TYPE I/2

H7402 TYMPANOSCLEROSIS LEFT EAR

S52691C OTH FX LOWER END OF RIGHT ULNA INIT FOR OPN FX TYPE 3A/B/C

H7403 TYMPANOSCLEROSIS BILATERAL

S52692A OTH FRACTURE OF LOWER END OF LEFT ULNA INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H7409 TYMPANOSCLEROSIS UNSPECIFIED EAR

S52692B

OTH FX LOWER END OF LEFT ULNA INIT FOR OPN FX TYPE I/2

H7411 ADHESIVE RIGHT MIDDLE EAR DISEASE

S52692C

OTH FX LOWER END OF LEFT ULNA INIT FOR OPN FX TYPE 3A/B/C

H7412 ADHESIVE LEFT MIDDLE EAR DISEASE

S52699A

OTH FRACTURE OF LOWER END OF UNSP ULNA INIT FOR CLOS FX

H7413 ADHESIVE MIDDLE EAR DISEASE BILATERAL

S52699B

OTH FX LOWER END OF UNSP ULNA INIT FOR OPN FX TYPE I/2

H7419 ADHESIVE MIDDLE EAR DISEASE UNSPECIFIED EAR

S52699C

OTH FX LOWER END OF UNSP ULNA INIT FOR OPN FX TYPE 3A/B/C

H7420

DISCONTINUITY AND DISLOCATION OF EAR OSSICLES UNSP EAR

S5290XA

UNSP FRACTURE OF UNSP FOREARM INIT FOR CLOS FX

H7421

DISCONTINUITY AND DISLOCATION OF RIGHT EAR OSSICLES

S5290XB

UNSP FRACTURE OF UNSP FOREARM INIT FOR OPN FX TYPE I/2

H7422

DISCONTINUITY AND DISLOCATION OF LEFT EAR OSSICLES

S5290XC

UNSP FRACTURE OF UNSP FOREARM INIT FOR OPN FX TYPE 3A/B/C

H7423

DISCONTINUITY AND DISLOCATION OF EAR OSSICLES BILATERAL

S5291XA

UNSP FRACTURE OF RIGHT FOREARM INIT FOR CLOS FX

H74311 ANKYLOSIS OF EAR OSSICLES RIGHT EAR

S5291XB

UNSP FRACTURE OF RIGHT FOREARM INIT FOR OPN FX TYPE I/2

H74312 ANKYLOSIS OF EAR OSSICLES LEFT EAR

S5291XC

UNSP FRACTURE OF RIGHT FOREARM INIT FOR OPN FX TYPE 3A/B/C

H74313 ANKYLOSIS OF EAR OSSICLES BILATERAL

S5292XA

UNSP FRACTURE OF LEFT FOREARM INIT FOR CLOS FX

H74319 ANKYLOSIS OF EAR OSSICLES UNSPECIFIED EAR

S5292XB

UNSP FRACTURE OF LEFT FOREARM INIT FOR OPN FX TYPE I/2

H74321 PARTIAL LOSS OF EAR OSSICLES RIGHT EAR

S5292XC

UNSP FRACTURE OF LEFT FOREARM INIT FOR OPN FX TYPE 3A/B/C

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H74322 PARTIAL LOSS OF EAR OSSICLES LEFT EAR

S53001A

UNSPECIFIED SUBLUXATION OF RIGHT RADIAL HEAD INIT ENCNTR

H74323 PARTIAL LOSS OF EAR OSSICLES BILATERAL

S53002A

UNSPECIFIED SUBLUXATION OF LEFT RADIAL HEAD INIT ENCNTR

H74329 PARTIAL LOSS OF EAR OSSICLES UNSPECIFIED EAR

S53004A

UNSPECIFIED DISLOCATION OF RIGHT RADIAL HEAD INIT ENCNTR

H74391

OTHER ACQUIRED ABNORMALITIES OF RIGHT EAR OSSICLES

S53005A

UNSPECIFIED DISLOCATION OF LEFT RADIAL HEAD INIT ENCNTR

H74392

OTHER ACQUIRED ABNORMALITIES OF LEFT EAR OSSICLES

S53006A

UNSP DISLOCATION OF UNSPECIFIED RADIAL HEAD INIT ENCNTR

H74393

OTHER ACQUIRED ABNORMALITIES OF EAR OSSICLES BILATERAL

S53011A

ANTERIOR SUBLUXATION OF RIGHT RADIAL HEAD INITIAL ENCOUNTER

H74399

OTHER ACQUIRED ABNORMALITIES OF EAR OSSICLES UNSP EAR

S53012A

ANTERIOR SUBLUXATION OF LEFT RADIAL HEAD INITIAL ENCOUNTER

H7440 POLYP OF MIDDLE EAR UNSPECIFIED EAR

S53013A

ANTERIOR SUBLUXATION OF UNSPECIFIED RADIAL HEAD INIT ENCNTR

H7441 POLYP OF RIGHT MIDDLE EAR

S53014A ANTERIOR DISLOCATION OF RIGHT RADIAL HEAD INITIAL ENCOUNTER

H7442 POLYP OF LEFT MIDDLE EAR

S53015A ANTERIOR DISLOCATION OF LEFT RADIAL HEAD INITIAL ENCOUNTER

H7443 POLYP OF MIDDLE EAR BILATERAL

S53016A

ANTERIOR DISLOCATION OF UNSPECIFIED RADIAL HEAD INIT ENCNTR

H748X1

OTHER SPECIFIED DISORDERS OF RIGHT MIDDLE EAR AND MASTOID

S53021A

POSTERIOR SUBLUXATION OF RIGHT RADIAL HEAD INIT ENCNTR

H748X2

OTHER SPECIFIED DISORDERS OF LEFT MIDDLE EAR AND MASTOID

S53022A

POSTERIOR SUBLUXATION OF LEFT RADIAL HEAD INITIAL ENCOUNTER

H748X3 OTH DISRD OF MIDDLE EAR AND MASTOID BILATERAL

S53023A

POSTERIOR SUBLUXATION OF UNSP RADIAL HEAD INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H748X9

OTH DISRD OF MIDDLE EAR AND MASTOID UNSPECIFIED EAR

S53024A

POSTERIOR DISLOCATION OF RIGHT RADIAL HEAD INIT ENCNTR

H7490

UNSP DISORDER OF MIDDLE EAR AND MASTOID UNSPECIFIED EAR

S53025A

POSTERIOR DISLOCATION OF LEFT RADIAL HEAD INITIAL ENCOUNTER

H7491

UNSPECIFIED DISORDER OF RIGHT MIDDLE EAR AND MASTOID

S53026A

POSTERIOR DISLOCATION OF UNSP RADIAL HEAD INIT ENCNTR

H7492

UNSPECIFIED DISORDER OF LEFT MIDDLE EAR AND MASTOID

S53031A

NURSEMAID'S ELBOW RIGHT ELBOW INITIAL ENCOUNTER

H7493

UNSPECIFIED DISORDER OF MIDDLE EAR AND MASTOID BILATERAL

S53032A

NURSEMAID'S ELBOW LEFT ELBOW INITIAL ENCOUNTER

H7500

MASTOIDITIS IN INFEC/PARASTC DIS CLASSD ELSWHR UNSP EAR

S53033A

NURSEMAID'S ELBOW UNSPECIFIED ELBOW INITIAL ENCOUNTER

H7501

MASTOIDITIS IN INFEC/PARASTC DISEASES CLASSD ELSWHR R EAR

S53091A

OTHER SUBLUXATION OF RIGHT RADIAL HEAD INITIAL ENCOUNTER

H7502

MASTOIDITIS IN INFEC/PARASTC DIS CLASSD ELSWHR LEFT EAR

S53092A

OTHER SUBLUXATION OF LEFT RADIAL HEAD INITIAL ENCOUNTER

H7503

MASTOIDITIS IN INFEC/PARASTC DISEASES CLASSD ELSWHR BI

S53093A

OTHER SUBLUXATION OF UNSPECIFIED RADIAL HEAD INIT ENCNTR

H7580

OTH DISRD OF MID EAR AND MAST IN DIS CLASSD ELSWHR UNSP EAR

S53094A

OTHER DISLOCATION OF RIGHT RADIAL HEAD INITIAL ENCOUNTER

H7581

OTH DISRD OF R MID EAR AND MASTOID IN DISEASES CLASSD ELSWHR

S53095A

OTHER DISLOCATION OF LEFT RADIAL HEAD INITIAL ENCOUNTER

H7582

OTH DISRD OF L MID EAR AND MASTOID IN DISEASES CLASSD ELSWHR

S53096A

OTHER DISLOCATION OF UNSPECIFIED RADIAL HEAD INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H7583

OTH DISRD OF MID EAR AND MASTOID IN DIS CLASSD ELSWHR BI

S53101A

UNSP SUBLUXATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8000

OTOSCLEROSIS W OVAL WINDOW NONOBLITERATIVE UNSP EAR

S53102A

UNSP SUBLUXATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8001

OTOSCLEROSIS W OVAL WINDOW NONOBLITERATIVE RIGHT EAR

S53103A

UNSP SUBLUXATION OF UNSP ULNOHUMERAL JOINT INIT ENCNTR

H8002

OTOSCLEROSIS W OVAL WINDOW NONOBLITERATIVE LEFT EAR

S53104A

UNSP DISLOCATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8003

OTOSCLEROSIS INVOLVING OVAL WINDOW NONOBLITERATIVE BI

S53105A

UNSP DISLOCATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8010

OTOSCLEROSIS INVOLVING OVAL WINDOW OBLITERATIVE UNSP EAR

S53106A

UNSP DISLOCATION OF UNSP ULNOHUMERAL JOINT INIT ENCNTR

H8011

OTOSCLEROSIS INVOLVING OVAL WINDOW OBLITERATIVE RIGHT EAR

S53111A

ANTERIOR SUBLUXATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8012

OTOSCLEROSIS INVOLVING OVAL WINDOW OBLITERATIVE LEFT EAR

S53112A

ANTERIOR SUBLUXATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8013

OTOSCLEROSIS INVOLVING OVAL WINDOW OBLITERATIVE BILATERAL

S53114A

ANTERIOR DISLOCATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8020 COCHLEAR OTOSCLEROSIS UNSPECIFIED EAR

S53115A

ANTERIOR DISLOCATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8021 COCHLEAR OTOSCLEROSIS RIGHT EAR

S53116A

ANTERIOR DISLOCATION OF UNSP ULNOHUMERAL JOINT INIT ENCNTR

H8022 COCHLEAR OTOSCLEROSIS LEFT EAR

S53121A

POSTERIOR SUBLUXATION OF RIGHT ULNOHUMERAL JOINT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H8023 COCHLEAR OTOSCLEROSIS BILATERAL

S53122A

POSTERIOR SUBLUXATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8080 OTHER OTOSCLEROSIS UNSPECIFIED EAR

S53123A

POSTERIOR SUBLUXATION OF UNSP ULNOHUMERAL JOINT INIT ENCNTR

H8081 OTHER OTOSCLEROSIS RIGHT EAR

S53124A

POSTERIOR DISLOCATION OF RIGHT ULNOHUMERAL JOINT INIT

H8082 OTHER OTOSCLEROSIS LEFT EAR

S53125A POSTERIOR DISLOCATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8083 OTHER OTOSCLEROSIS BILATERAL

S53131A

MEDIAL SUBLUXATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8090 UNSPECIFIED OTOSCLEROSIS UNSPECIFIED EAR

S53132A

MEDIAL SUBLUXATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8091 UNSPECIFIED OTOSCLEROSIS RIGHT EAR

S53133A

MEDIAL SUBLUXATION OF UNSP ULNOHUMERAL JOINT INIT ENCNTR

H8092 UNSPECIFIED OTOSCLEROSIS LEFT EAR

S53134A

MEDIAL DISLOCATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8093 UNSPECIFIED OTOSCLEROSIS BILATERAL

S53135A

MEDIAL DISLOCATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8101 MENIERE'S DISEASE RIGHT EAR

S53136A MEDIAL DISLOCATION OF UNSP ULNOHUMERAL JOINT INIT ENCNTR

H8102 MENIERE'S DISEASE LEFT EAR

S53141A LATERAL SUBLUXATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8103 MENIERE'S DISEASE BILATERAL

S53142A LATERAL SUBLUXATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H8109 MENIERE'S DISEASE UNSPECIFIED EAR

S53143A

LATERAL SUBLUXATION OF UNSP ULNOHUMERAL JOINT INIT ENCNTR

H8110 BENIGN PAROXYSMAL VERTIGO UNSPECIFIED EAR

S53144A

LATERAL DISLOCATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8111 BENIGN PAROXYSMAL VERTIGO RIGHT EAR

S53145A

LATERAL DISLOCATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8112 BENIGN PAROXYSMAL VERTIGO LEFT EAR

S53146A

LATERAL DISLOCATION OF UNSP ULNOHUMERAL JOINT INIT ENCNTR

H8113 BENIGN PAROXYSMAL VERTIGO BILATERAL

S53191A

OTHER SUBLUXATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8120 VESTIBULAR NEURONITIS UNSPECIFIED EAR

S53192A

OTHER SUBLUXATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8121 VESTIBULAR NEURONITIS RIGHT EAR

S53194A

OTHER DISLOCATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8122 VESTIBULAR NEURONITIS LEFT EAR

S53195A

OTHER DISLOCATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8123 VESTIBULAR NEURONITIS BILATERAL

S53196A

OTHER DISLOCATION OF UNSP ULNOHUMERAL JOINT INIT ENCNTR

H81311 AURAL VERTIGO RIGHT EAR

S5320XA TRAUMATIC RUPTURE OF UNSP RADIAL COLLATERAL LIGAMENT INIT

H81312 AURAL VERTIGO LEFT EAR

S5321XA TRAUMATIC RUPTURE OF RIGHT RADIAL COLLATERAL LIGAMENT INIT

H81313 AURAL VERTIGO BILATERAL

S5322XA TRAUMATIC RUPTURE OF LEFT RADIAL COLLATERAL LIGAMENT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H81319 AURAL VERTIGO UNSPECIFIED EAR

S5330XA

TRAUMATIC RUPTURE OF UNSP ULNAR COLLATERAL LIGAMENT INIT

H81391 OTHER PERIPHERAL VERTIGO RIGHT EAR

S5331XA

TRAUMATIC RUPTURE OF RIGHT ULNAR COLLATERAL LIGAMENT INIT

H81392 OTHER PERIPHERAL VERTIGO LEFT EAR

S53401A

UNSPECIFIED SPRAIN OF RIGHT ELBOW INITIAL ENCOUNTER

H81393 OTHER PERIPHERAL VERTIGO BILATERAL

S53402A

UNSPECIFIED SPRAIN OF LEFT ELBOW INITIAL ENCOUNTER

H81399 OTHER PERIPHERAL VERTIGO UNSPECIFIED EAR

S53411A

RADIOHUMERAL (JOINT) SPRAIN OF RIGHT ELBOW INIT ENCNTR

H8141 VERTIGO OF CENTRAL ORIGIN RIGHT EAR

S53412A

RADIOHUMERAL (JOINT) SPRAIN OF LEFT ELBOW INITIAL ENCOUNTER

H8142 VERTIGO OF CENTRAL ORIGIN LEFT EAR

S53419A

RADIOHUMERAL (JOINT) SPRAIN OF UNSP ELBOW INIT ENCNTR

H8143 VERTIGO OF CENTRAL ORIGIN BILATERAL

S53421A

ULNOHUMERAL (JOINT) SPRAIN OF RIGHT ELBOW INITIAL ENCOUNTER

H8149 VERTIGO OF CENTRAL ORIGIN UNSPECIFIED EAR

S53422A

ULNOHUMERAL (JOINT) SPRAIN OF LEFT ELBOW INITIAL ENCOUNTER

H818X1

OTHER DISORDERS OF VESTIBULAR FUNCTION RIGHT EAR

S53431A

RADIAL COLLATERAL LIGAMENT SPRAIN OF RIGHT ELBOW INIT

H818X2

OTHER DISORDERS OF VESTIBULAR FUNCTION LEFT EAR

S53432A

RADIAL COLLATERAL LIGAMENT SPRAIN OF LEFT ELBOW INIT ENCNTR

H818X3

OTHER DISORDERS OF VESTIBULAR FUNCTION BILATERAL

S53441A

ULNAR COLLATERAL LIGAMENT SPRAIN OF RIGHT ELBOW INIT ENCNTR

H818X9

OTHER DISORDERS OF VESTIBULAR FUNCTION UNSPECIFIED EAR

S53442A

ULNAR COLLATERAL LIGAMENT SPRAIN OF LEFT ELBOW INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H8190

UNSPECIFIED DISORDER OF VESTIBULAR FUNCTION UNSPECIFIED EAR

S53491A

OTHER SPRAIN OF RIGHT ELBOW INITIAL ENCOUNTER

H8191

UNSPECIFIED DISORDER OF VESTIBULAR FUNCTION RIGHT EAR

S53492A

OTHER SPRAIN OF LEFT ELBOW INITIAL ENCOUNTER

H8192

UNSPECIFIED DISORDER OF VESTIBULAR FUNCTION LEFT EAR

S5400XA

INJURY OF ULNAR NERVE AT FOREARM LEVEL UNSP ARM INIT

H8193

UNSPECIFIED DISORDER OF VESTIBULAR FUNCTION BILATERAL

S5400XD

INJURY OF ULNAR NERVE AT FOREARM LEVEL UNSP ARM SUBS

H821

VERTIGINOUS SYNDROMES IN DISEASES CLASSD ELSWHR RIGHT EAR

S5400XS

INJURY OF ULNAR NERVE AT FOREARM LEVEL UNSP ARM SEQUELA

H822

VERTIGINOUS SYNDROMES IN DISEASES CLASSD ELSWHR LEFT EAR

S5401XA

INJURY OF ULNAR NERVE AT FOREARM LEVEL RIGHT ARM INIT

H823

VERTIGINOUS SYNDROMES IN DISEASES CLASSD ELSWHR BILATERAL

S5401XD

INJURY OF ULNAR NERVE AT FOREARM LEVEL RIGHT ARM SUBS

H829

VERTIGINOUS SYNDROMES IN DISEASES CLASSD ELSWHR UNSP EAR

S5401XS

INJURY OF ULNAR NERVE AT FOREARM LEVEL RIGHT ARM SEQUELA

H8301 LABYRINTHITIS RIGHT EAR

S5402XA INJURY OF ULNAR NERVE AT FOREARM LEVEL LEFT ARM INIT

H8302 LABYRINTHITIS LEFT EAR

S5402XD INJURY OF ULNAR NERVE AT FOREARM LEVEL LEFT ARM SUBS

H8303 LABYRINTHITIS BILATERAL

S5402XS INJURY OF ULNAR NERVE AT FOREARM LEVEL LEFT ARM SEQUELA

H8309 LABYRINTHITIS UNSPECIFIED EAR

S5410XA

INJURY OF MEDIAN NERVE AT FOREARM LEVEL UNSP ARM INIT

H8311 LABYRINTHINE FISTULA RIGHT EAR

S5410XD

INJURY OF MEDIAN NERVE AT FOREARM LEVEL UNSP ARM SUBS

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H8312 LABYRINTHINE FISTULA LEFT EAR

S5410XS

INJURY OF MEDIAN NERVE AT FOREARM LEVEL UNSP ARM SEQUELA

H8313 LABYRINTHINE FISTULA BILATERAL

S5411XA

INJURY OF MEDIAN NERVE AT FOREARM LEVEL RIGHT ARM INIT

H8319 LABYRINTHINE FISTULA UNSPECIFIED EAR

S5411XD

INJURY OF MEDIAN NERVE AT FOREARM LEVEL RIGHT ARM SUBS

H832X1 LABYRINTHINE DYSFUNCTION RIGHT EAR

S5411XS

INJURY OF MEDIAN NERVE AT FOREARM LEVEL RIGHT ARM SEQUELA

H832X2 LABYRINTHINE DYSFUNCTION LEFT EAR

S5412XA

INJURY OF MEDIAN NERVE AT FOREARM LEVEL LEFT ARM INIT

H832X3 LABYRINTHINE DYSFUNCTION BILATERAL

S5412XD

INJURY OF MEDIAN NERVE AT FOREARM LEVEL LEFT ARM SUBS

H832X9 LABYRINTHINE DYSFUNCTION UNSPECIFIED EAR

S5412XS

INJURY OF MEDIAN NERVE AT FOREARM LEVEL LEFT ARM SEQUELA

H833X1 NOISE EFFECTS ON RIGHT INNER EAR

S5420XA

INJURY OF RADIAL NERVE AT FOREARM LEVEL UNSP ARM INIT

H833X2 NOISE EFFECTS ON LEFT INNER EAR

S5420XD

INJURY OF RADIAL NERVE AT FOREARM LEVEL UNSP ARM SUBS

H833X3 NOISE EFFECTS ON INNER EAR BILATERAL

S5420XS

INJURY OF RADIAL NERVE AT FOREARM LEVEL UNSP ARM SEQUELA

H833X9 NOISE EFFECTS ON INNER EAR UNSPECIFIED EAR

S5421XA

INJURY OF RADIAL NERVE AT FOREARM LEVEL RIGHT ARM INIT

H838X1 OTHER SPECIFIED DISEASES OF RIGHT INNER EAR

S5421XD

INJURY OF RADIAL NERVE AT FOREARM LEVEL RIGHT ARM SUBS

H838X2 OTHER SPECIFIED DISEASES OF LEFT INNER EAR

S5421XS

INJURY OF RADIAL NERVE AT FOREARM LEVEL RIGHT ARM SEQUELA

H838X3 OTHER SPECIFIED DISEASES OF INNER EAR BILATERAL

S5422XA

INJURY OF RADIAL NERVE AT FOREARM LEVEL LEFT ARM INIT

H838X9 OTHER SPECIFIED DISEASES OF INNER EAR UNSPECIFIED EAR

S5422XD

INJURY OF RADIAL NERVE AT FOREARM LEVEL LEFT ARM SUBS

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H8390 UNSPECIFIED DISEASE OF INNER EAR UNSPECIFIED EAR

S5422XS

INJURY OF RADIAL NERVE AT FOREARM LEVEL LEFT ARM SEQUELA

H8391 UNSPECIFIED DISEASE OF RIGHT INNER EAR

S5430XA

INJURY OF CUTAN SENSORY NERVE AT FORARM LV UNSP ARM INIT

H8392 UNSPECIFIED DISEASE OF LEFT INNER EAR

S5430XD

INJURY OF CUTAN SENSORY NERVE AT FORARM LV UNSP ARM SUBS

H8393 UNSPECIFIED DISEASE OF INNER EAR BILATERAL

S5430XS

INJ CUTAN SENSORY NERVE AT FORARM LV UNSP ARM SEQUELA

H900 CONDUCTIVE HEARING LOSS BILATERAL

S5431XA

INJURY OF CUTAN SENSORY NERVE AT FORARM LV RIGHT ARM INIT

H9011

CONDCTV HEAR LOSS UNI RIGHT EAR W UNRESTR HEAR CNTRA SIDE

S5431XD

INJURY OF CUTAN SENSORY NERVE AT FORARM LV RIGHT ARM SUBS

H9012

CONDCTV HEAR LOSS UNI LEFT EAR W UNRESTR HEAR CNTRA SIDE

S5431XS

INJ CUTAN SENSORY NERVE AT FORARM LV RIGHT ARM SEQUELA

H902 CONDUCTIVE HEARING LOSS UNSPECIFIED

S5432XA

INJURY OF CUTAN SENSORY NERVE AT FORARM LV LEFT ARM INIT

H903 SENSORINEURAL HEARING LOSS BILATERAL

S5432XD

INJURY OF CUTAN SENSORY NERVE AT FORARM LV LEFT ARM SUBS

H9041

SNSRNRL HEAR LOSS UNI RIGHT EAR W UNRESTR HEAR CNTRA SIDE

S5432XS

INJ CUTAN SENSORY NERVE AT FORARM LV LEFT ARM SEQUELA

H9042

SNSRNRL HEAR LOSS UNI LEFT EAR W UNRESTR HEAR CNTRA SIDE

S548X1A

UNSP INJURY OF OTH NERVES AT FOREARM LEVEL RIGHT ARM INIT

H905 UNSPECIFIED SENSORINEURAL HEARING LOSS

S548X1D

UNSP INJURY OF OTH NERVES AT FOREARM LEVEL RIGHT ARM SUBS

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H906

MIXED CONDUCTIVE AND SENSORINEURAL HEARING LOSS BILATERAL

S548X1S

UNSP INJURY OF NERVES AT FOREARM LEVEL RIGHT ARM SEQUELA

H9071

MIX CNDCT/SNRL HEAR LOSSUNIR EARW UNRESTR HEAR CNTRA SIDE

S548X2A

UNSP INJURY OF OTH NERVES AT FOREARM LEVEL LEFT ARM INIT

H9072

MIX CNDCT/SNRL HEAR LOSSUNIL EARW UNRESTR HEAR CNTRA SIDE

S548X2D

UNSP INJURY OF OTH NERVES AT FOREARM LEVEL LEFT ARM SUBS

H908

MIXED CONDUCTIVE AND SENSORINEURAL HEARING LOSS UNSPECIFIED

S548X2S

UNSP INJURY OF NERVES AT FOREARM LEVEL LEFT ARM SEQUELA

H9101 OTOTOXIC HEARING LOSS RIGHT EAR

S548X9A

UNSP INJURY OF OTH NERVES AT FOREARM LEVEL UNSP ARM INIT

H9102 OTOTOXIC HEARING LOSS LEFT EAR

S548X9D

UNSP INJURY OF OTH NERVES AT FOREARM LEVEL UNSP ARM SUBS

H9103 OTOTOXIC HEARING LOSS BILATERAL

S548X9S

UNSP INJURY OF NERVES AT FOREARM LEVEL UNSP ARM SEQUELA

H9109 OTOTOXIC HEARING LOSS UNSPECIFIED EAR

S5490XA

INJURY OF UNSP NERVE AT FOREARM LEVEL UNSP ARM INIT ENCNTR

H9110 PRESBYCUSIS UNSPECIFIED EAR

S5490XD INJURY OF UNSP NERVE AT FOREARM LEVEL UNSP ARM SUBS ENCNTR

H9111 PRESBYCUSIS RIGHT EAR

S5490XS INJURY OF UNSP NERVE AT FOREARM LEVEL UNSP ARM SEQUELA

H9112 PRESBYCUSIS LEFT EAR

S5491XA INJURY OF UNSP NERVE AT FOREARM LEVEL RIGHT ARM INIT

H9113 PRESBYCUSIS BILATERAL

S5491XD INJURY OF UNSP NERVE AT FOREARM LEVEL RIGHT ARM SUBS

H9120 SUDDEN IDIOPATHIC HEARING LOSS UNSPECIFIED EAR

S5491XS

INJURY OF UNSP NERVE AT FOREARM LEVEL RIGHT ARM SEQUELA

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H9121 SUDDEN IDIOPATHIC HEARING LOSS RIGHT EAR

S5492XA

INJURY OF UNSP NERVE AT FOREARM LEVEL LEFT ARM INIT ENCNTR

H9122 SUDDEN IDIOPATHIC HEARING LOSS LEFT EAR

S5492XD

INJURY OF UNSP NERVE AT FOREARM LEVEL LEFT ARM SUBS ENCNTR

H9123 SUDDEN IDIOPATHIC HEARING LOSS BILATERAL

S5492XS

INJURY OF UNSP NERVE AT FOREARM LEVEL LEFT ARM SEQUELA

H913 DEAF NONSPEAKING NOT ELSEWHERE CLASSIFIED

S55001A

UNSP INJURY OF ULNAR ARTERY AT FORARM LV RIGHT ARM INIT

H918X1 OTHER SPECIFIED HEARING LOSS RIGHT EAR

S55002A

UNSP INJURY OF ULNAR ARTERY AT FOREARM LEVEL LEFT ARM INIT

H918X2 OTHER SPECIFIED HEARING LOSS LEFT EAR

S55011A

LACERATION OF ULNAR ARTERY AT FOREARM LEVEL RIGHT ARM INIT

H918X3 OTHER SPECIFIED HEARING LOSS BILATERAL

S55012A

LACERATION OF ULNAR ARTERY AT FOREARM LEVEL LEFT ARM INIT

H918X9 OTHER SPECIFIED HEARING LOSS UNSPECIFIED EAR

S55091A

INJ ULNAR ARTERY AT FOREARM LEVEL RIGHT ARM INIT ENCNTR

H9190 UNSPECIFIED HEARING LOSS UNSPECIFIED EAR

S55092A

INJ ULNAR ARTERY AT FOREARM LEVEL LEFT ARM INIT ENCNTR

H9191 UNSPECIFIED HEARING LOSS RIGHT EAR

S55101A

UNSP INJURY OF RADIAL ARTERY AT FORARM LV RIGHT ARM INIT

H9192 UNSPECIFIED HEARING LOSS LEFT EAR

S55102A

UNSP INJURY OF RADIAL ARTERY AT FORARM LV LEFT ARM INIT

H9193 UNSPECIFIED HEARING LOSS BILATERAL

S55111A

LACERATION OF RADIAL ARTERY AT FORARM LV RIGHT ARM INIT

H9201 OTALGIA RIGHT EAR

S55112A LACERATION OF RADIAL ARTERY AT FOREARM LEVEL LEFT ARM INIT

H9202 OTALGIA LEFT EAR

S55191A INJ RADIAL ARTERY AT FOREARM LEVEL RIGHT ARM INIT ENCNTR

H9203 OTALGIA BILATERAL

S55192A INJ RADIAL ARTERY AT FOREARM LEVEL LEFT ARM INIT ENCNTR

H9209 OTALGIA UNSPECIFIED EAR

S55201A UNSP INJURY OF VEIN AT FOREARM LEVEL RIGHT ARM INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H9210 OTORRHEA UNSPECIFIED EAR

S55202A UNSP INJURY OF VEIN AT FOREARM LEVEL LEFT ARM INIT ENCNTR

H9211 OTORRHEA RIGHT EAR

S55211A LACERATION OF VEIN AT FOREARM LEVEL RIGHT ARM INIT ENCNTR

H9212 OTORRHEA LEFT EAR

S55212A LACERATION OF VEIN AT FOREARM LEVEL LEFT ARM INIT ENCNTR

H9213 OTORRHEA BILATERAL

S55291A OTH INJURY OF VEIN AT FOREARM LEVEL RIGHT ARM INIT ENCNTR

H9220 OTORRHAGIA UNSPECIFIED EAR

S55292A OTH INJURY OF VEIN AT FOREARM LEVEL LEFT ARM INIT ENCNTR

H9221 OTORRHAGIA RIGHT EAR

S55801A UNSP INJURY OF BLOOD VESSELS AT FORARM LV RIGHT ARM INIT

H9222 OTORRHAGIA LEFT EAR

S55802A UNSP INJURY OF BLOOD VESSELS AT FORARM LV LEFT ARM INIT

H9223 OTORRHAGIA BILATERAL

S55811A LACERATION OF BLOOD VESSELS AT FORARM LV RIGHT ARM INIT

H93011 TRANSIENT ISCHEMIC DEAFNESS RIGHT EAR

S55812A

LACERATION OF BLOOD VESSELS AT FOREARM LEVEL LEFT ARM INIT

H93012 TRANSIENT ISCHEMIC DEAFNESS LEFT EAR

S55891A

INJ OTH BLOOD VESSELS AT FOREARM LEVEL RIGHT ARM INIT

H93013 TRANSIENT ISCHEMIC DEAFNESS BILATERAL

S55892A

INJ OTH BLOOD VESSELS AT FOREARM LEVEL LEFT ARM INIT

H93019 TRANSIENT ISCHEMIC DEAFNESS UNSPECIFIED EAR

S55901A

UNSP INJURY OF UNSP BLOOD VESS AT FORARM LV RIGHT ARM INIT

H93091

UNSPECIFIED DEGENERATIVE AND VASCULAR DISORDERS OF RIGHT EAR

S55902A

UNSP INJURY OF UNSP BLOOD VESS AT FORARM LV LEFT ARM INIT

H93092

UNSPECIFIED DEGENERATIVE AND VASCULAR DISORDERS OF LEFT EAR

S55911A

LACERAT UNSP BLOOD VESSEL AT FORARM LV RIGHT ARM INIT

H93093

UNSP DEGENERATIVE AND VASCULAR DISORDERS OF EAR BILATERAL

S55912A

LACERATION OF UNSP BLOOD VESSEL AT FORARM LV LEFT ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H93099

UNSP DEGENERATIVE AND VASCULAR DISORDERS OF UNSPECIFIED EAR

S55991A

INJ UNSP BLOOD VESSEL AT FOREARM LEVEL RIGHT ARM INIT

H9311 TINNITUS RIGHT EAR

S55992A INJ UNSP BLOOD VESSEL AT FOREARM LEVEL LEFT ARM INIT

H9312 TINNITUS LEFT EAR

S56001A UNSP INJ FLEXOR MUSC/FASC/TEND R THM AT FORARM LV INIT

H9313 TINNITUS BILATERAL

S56002A UNSP INJ FLEXOR MUSC/FASC/TEND L THM AT FORARM LV INIT

H9319 TINNITUS UNSPECIFIED EAR

S56009A

UNSP INJURY OF FLEXOR MUSC/FASC/TEND THMB AT FORARM LV INIT

H93211 AUDITORY RECRUITMENT RIGHT EAR

S56011A

STRAIN OF FLEXOR MUSC/FASC/TEND R THM AT FORARM LV INIT

H93212 AUDITORY RECRUITMENT LEFT EAR

S56012A

STRAIN OF FLEXOR MUSC/FASC/TEND L THM AT FORARM LV INIT

H93213 AUDITORY RECRUITMENT BILATERAL

S56019A

STRAIN OF FLEXOR MUSC/FASC/TEND THMB AT FOREARM LEVEL INIT

H93219 AUDITORY RECRUITMENT UNSPECIFIED EAR

S56021A

LACERAT FLEXOR MUSC/FASC/TEND RIGHT THUMB AT FORARM LV INIT

H93221 DIPLACUSIS RIGHT EAR

S56022A LACERAT FLEXOR MUSC/FASC/TEND LEFT THUMB AT FORARM LV INIT

H93222 DIPLACUSIS LEFT EAR

S56029A

LACERATION OF FLEXOR MUSC/FASC/TEND THMB AT FORARM LV INIT

H93223 DIPLACUSIS BILATERAL

S56091A INJ FLEXOR MUSC/FASC/TEND RIGHT THUMB AT FOREARM LEVEL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H93229 DIPLACUSIS UNSPECIFIED EAR

S56092D INJ FLEXOR MUSC/FASC/TEND LEFT THUMB AT FOREARM LEVEL SUBS

H93231 HYPERACUSIS RIGHT EAR

S56099A INJ FLEXOR MUSC/FASC/TEND THMB AT FOREARM LEVEL INIT

H93232 HYPERACUSIS LEFT EAR

S56101A UNSP INJ FLEXOR MUSC/FASC/TEND R IDX FNGR AT FORARM LV INIT

H93233 HYPERACUSIS BILATERAL

S56102A UNSP INJ FLEXOR MUSC/FASC/TEND L IDX FNGR AT FORARM LV INIT

H93239 HYPERACUSIS UNSPECIFIED EAR

S56103A UNSP INJ FLEXOR MUSC/FASC/TEND R MID FNGR AT FORARM LV INIT

H93241 TEMPORARY AUDITORY THRESHOLD SHIFT RIGHT EAR

S56104A

UNSP INJ FLEXOR MUSC/FASC/TEND L MID FNGR AT FORARM LV INIT

H93242 TEMPORARY AUDITORY THRESHOLD SHIFT LEFT EAR

S56105A

UNSP INJ FLEXOR MUSC/FASC/TEND R RNG FNGR AT FORARM LV INIT

H93243 TEMPORARY AUDITORY THRESHOLD SHIFT BILATERAL

S56106A

UNSP INJ FLEXOR MUSC/FASC/TEND L RNG FNGR AT FORARM LV INIT

H93249

TEMPORARY AUDITORY THRESHOLD SHIFT UNSPECIFIED EAR

S56107A

UNSP INJ FLXR MUSC/FASC/TEND R LIT FNGR AT FORARM LV INIT

H9325 CENTRAL AUDITORY PROCESSING DISORDER

S56108A

UNSP INJ FLXR MUSC/FASC/TEND L LIT FNGR AT FORARM LV INIT

H93291 OTHER ABNORMAL AUDITORY PERCEPTIONS RIGHT EAR

S56109A

UNSP INJ FLEXOR MUSC/FASC/TEND UNSP FNGR AT FORARM LV INIT

H93292 OTHER ABNORMAL AUDITORY PERCEPTIONS LEFT EAR

S56111A

STRAIN FLEXOR MUSC/FASC/TEND R IDX FNGR AT FORARM LV INIT

H93293 OTHER ABNORMAL AUDITORY PERCEPTIONS BILATERAL

S56112D

STRAIN FLEXOR MUSC/FASC/TEND L IDX FNGR AT FORARM LV SUBS

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H93299 OTHER ABNORMAL AUDITORY PERCEPTIONS UNSPECIFIED EAR

S56113A

STRAIN FLEXOR MUSC/FASC/TEND R MID FINGER AT FORARM LV INIT

H933X1 DISORDERS OF RIGHT ACOUSTIC NERVE

S56114A

STRAIN FLEXOR MUSC/FASC/TEND L MID FINGER AT FORARM LV INIT

H933X2 DISORDERS OF LEFT ACOUSTIC NERVE

S56115A

STRAIN FLEXOR MUSC/FASC/TEND R RNG FNGR AT FORARM LV INIT

H933X3 DISORDERS OF BILATERAL ACOUSTIC NERVES

S56116A

STRAIN FLEXOR MUSC/FASC/TEND L RNG FNGR AT FORARM LV INIT

H933X9 DISORDERS OF UNSPECIFIED ACOUSTIC NERVE

S56117A

STRAIN FLXR MUSC/FASC/TEND R LITTLE FNGR AT FORARM LV INIT

H938X1 OTHER SPECIFIED DISORDERS OF RIGHT EAR

S56118A

STRAIN FLXR MUSC/FASC/TEND L LITTLE FNGR AT FORARM LV INIT

H938X2 OTHER SPECIFIED DISORDERS OF LEFT EAR

S56119A

STRAIN FLEXOR MUSC/FASC/TEND OF UNSP FNGR AT FORARM LV INIT

H938X3 OTHER SPECIFIED DISORDERS OF EAR BILATERAL

S56121A

LACERAT FLEXOR MUSC/FASC/TEND R IDX FNGR AT FORARM LV INIT

H938X9 OTHER SPECIFIED DISORDERS OF EAR UNSPECIFIED EAR

S56122A

LACERAT FLEXOR MUSC/FASC/TEND L IDX FNGR AT FORARM LV INIT

H9390 UNSPECIFIED DISORDER OF EAR UNSPECIFIED EAR

S56123A

LACERAT FLEXOR MUSC/FASC/TEND R MID FNGR AT FORARM LV INIT

H9391 UNSPECIFIED DISORDER OF RIGHT EAR

S56124A

LACERAT FLEXOR MUSC/FASC/TEND L MID FNGR AT FORARM LV INIT

H9392 UNSPECIFIED DISORDER OF LEFT EAR

S56125A

LACERAT FLEXOR MUSC/FASC/TEND R RNG FNGR AT FORARM LV INIT

H9393 UNSPECIFIED DISORDER OF EAR BILATERAL

S56126A

LACERAT FLEXOR MUSC/FASC/TEND L RNG FNGR AT FORARM LV INIT

H93A1 Pulsatile tinnitus right ear

S56127A LACERAT FLXR MUSC/FASC/TEND R LITTLE FNGR AT FORARM LV INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H93A2 Pulsatile tinnitus left ear

S56128A LACERAT FLXR MUSC/FASC/TEND L LITTLE FNGR AT FORARM LV INIT

H93A3 Pulsatile tinnitus bilateral

S56129A LACERAT FLEXOR MUSC/FASC/TEND UNSP FINGER AT FORARM LV INIT

H93A9 Pulsatile tinnitus unspecified ear

S56191A

INJ FLEXOR MUSC/FASC/TEND R IDX FNGR AT FOREARM LEVEL INIT

H9400

ACUSTC NEURITIS IN INFEC/PARASTC DIS CLASSD ELSWHR UNSP EAR

S56192A

INJ FLEXOR MUSC/FASC/TEND L IDX FNGR AT FOREARM LEVEL INIT

H9401

ACUSTC NEURITIS IN INFEC/PARASTC DIS CLASSD ELSWHR R EAR

S56193A

INJ FLEXOR MUSC/FASC/TEND R MID FINGER AT FORARM LV INIT

H9402

ACUSTC NEURITIS IN INFEC/PARASTC DIS CLASSD ELSWHR LEFT EAR

S56194A

INJ FLEXOR MUSC/FASC/TEND L MID FINGER AT FORARM LV INIT

H9403

ACUSTC NEURITIS IN INFEC/PARASTC DISEASES CLASSD ELSWHR BI

S56195A

INJ FLEXOR MUSC/FASC/TEND R RNG FNGR AT FOREARM LEVEL INIT

H9480

OTH DISRD OF EAR IN DISEASES CLASSIFIED ELSEWHERE UNSP EAR

S56196A

INJ FLEXOR MUSC/FASC/TEND L RNG FNGR AT FOREARM LEVEL INIT

H9481

OTH DISRD OF RIGHT EAR IN DISEASES CLASSIFIED ELSEWHERE

S56197A

INJ FLEXOR MUSC/FASC/TEND R LITTLE FINGER AT FORARM LV INIT

H9482

OTH DISRD OF LEFT EAR IN DISEASES CLASSIFIED ELSEWHERE

S56198A

INJ FLEXOR MUSC/FASC/TEND L LITTLE FINGER AT FORARM LV INIT

H9483

OTH DISRD OF EAR IN DISEASES CLASSIFIED ELSEWHERE BILATERAL

S56199A

INJ FLEXOR MUSC/FASC/TEND UNSP FINGER AT FOREARM LEVEL INIT

H9500

RECUR CHOLESTEATOMA OF POSTMASTOIDECTOMY CAVITY UNSP EAR

S56201A

UNSP INJ FLEXOR MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

H9501

RECUR CHOLESTEATOMA OF POSTMASTOIDECTOMY CAVITY RIGHT EAR

S56202A

UNSP INJ FLEXOR MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H9502

RECUR CHOLESTEATOMA OF POSTMASTOIDECTOMY CAVITY LEFT EAR

S56209A

UNSP INJ FLEXOR MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

H9503

RECURRENT CHOLESTEATOMA OF POSTMASTOIDECTOMY CAVITY BI EARS

S56211A

STRAIN FLEXOR MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

H95111

CHRONIC INFLAMMATION OF POSTMASTOIDECTOMY CAVITY RIGHT EAR

S56212A

STRAIN OF FLEXOR MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

H95112

CHRONIC INFLAMMATION OF POSTMASTOIDECTOMY CAVITY LEFT EAR

S56219A

STRAIN OF FLEXOR MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

H95113

CHRONIC INFLAM OF POSTMASTOIDECTOMY CAVITY BILATERAL EARS

S56221A

LACERAT FLEXOR MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

H95119

CHRONIC INFLAMMATION OF POSTMASTOIDECTOMY CAVITY UNSP EAR

S56222A

LACERAT FLEXOR MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

H95121

GRANULATION OF POSTMASTOIDECTOMY CAVITY RIGHT EAR

S56229A

LACERAT FLEXOR MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

H95122

GRANULATION OF POSTMASTOIDECTOMY CAVITY LEFT EAR

S56291A

INJ OTH FLEXOR MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

H95123

GRANULATION OF POSTMASTOIDECTOMY CAVITY BILATERAL EARS

S56292A

INJ OTH FLEXOR MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

H95129

GRANULATION OF POSTMASTOIDECTOMY CAVITY UNSPECIFIED EAR

S56299A

INJ OTH FLEXOR MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

H95131

MUCOSAL CYST OF POSTMASTOIDECTOMY CAVITY RIGHT EAR

S56301A

UNSP INJ EXTN/ABDR MUSC/FASC/TEND OF R THM AT FORARM LVINIT

H95132

MUCOSAL CYST OF POSTMASTOIDECTOMY CAVITY LEFT EAR

S56302A

UNSP INJ EXTN/ABDR MUSC/FASC/TEND OF L THM AT FORARM LVINIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H95133

MUCOSAL CYST OF POSTMASTOIDECTOMY CAVITY BILATERAL EARS

S56309A

UNSP INJ EXTN/ABDR MUSC/FASC/TEND OF THMB AT FORARM LV INIT

H95139

MUCOSAL CYST OF POSTMASTOIDECTOMY CAVITY UNSPECIFIED EAR

S56311A

STRAIN EXTN/ABDR MUSC/FASC/TEND OF R THM AT FORARM LV INIT

H95191 OTHER DISORDERS FOLLOWING MASTOIDECTOMY RIGHT EAR

S56312A

STRAIN EXTN/ABDR MUSC/FASC/TEND OF L THM AT FORARM LV INIT

H95192 OTHER DISORDERS FOLLOWING MASTOIDECTOMY LEFT EAR

S56319A

STRAIN EXTN/ABDR MUSC/FASC/TEND OF THMB AT FORARM LV INIT

H95193

OTHER DISORDERS FOLLOWING MASTOIDECTOMY BILATERAL EARS

S56321A

LACERAT EXTN/ABDR MUSC/FASC/TEND OF R THM AT FORARM LV INIT

H95199

OTHER DISORDERS FOLLOWING MASTOIDECTOMY UNSPECIFIED EAR

S56322A

LACERAT EXTN/ABDR MUSC/FASC/TEND OF L THM AT FORARM LV INIT

H9521

INTRAOP HEMOR/HEMTOM OF EAR/MASTD COMP A PROC ON EAR/MASTD

S56329A

LACERAT EXTN/ABDR MUSC/FASC/TEND OF THMB AT FORARM LV INIT

H9522

INTRAOP HEMOR/HEMTOM OF EAR/MASTD COMPLICATING OTH PROCEDURE

S56391A

INJ EXTN/ABDR MUSC/FASC/TEND OF R THM AT FORARM LV INIT

H9531

ACC PNCTR & LAC OF THE EAR/MASTD DUR PROC ON THE EAR/MASTD

S56392A

INJ EXTN/ABDR MUSC/FASC/TEND OF L THM AT FORARM LV INIT

H9532

ACCIDENTAL PNCTR & LAC OF THE EAR/MASTD DURING OTH PROCEDURE

S56399A

INJ EXTN/ABDR MUSC/FASC/TEND OF THMB AT FOREARM LEVEL INIT

H9541

POSTPROC HEMOR/HEMTOM OF EAR/MASTD FOL PROC ON EAR/MASTD

S56401A

UNSP INJ EXTN MUSC/FASC/TEND R IDX FNGR AT FORARM LV INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H9542

POSTPROC HEMOR/HEMTOM OF EAR/MASTD FOLLOWING OTH PROCEDURE

S56402A

UNSP INJ EXTN MUSC/FASC/TEND L IDX FNGR AT FORARM LV INIT

H9551

Postprocedural hematoma of ear and mastoid process following a procedure on the ear and mastoid process

S56403A

UNSP INJ EXTN MUSC/FASC/TEND R MID FINGER AT FORARM LV INIT

H9552

Postprocedural hematoma of ear and mastoid process following other procedure

S56404A

UNSP INJ EXTN MUSC/FASC/TEND L MID FINGER AT FORARM LV INIT

H9553

Postprocedural seroma of ear and mastoid process following a procedure on the ear and mastoid process

S56405A

UNSP INJ EXTN MUSC/FASC/TEND R RNG FNGR AT FORARM LV INIT

H9554

Postprocedural seroma of ear and mastoid process following other procedure

S56406A

UNSP INJ EXTN MUSC/FASC/TEND L RNG FNGR AT FORARM LV INIT

H95811 POSTPROCEDURAL STENOSIS OF RIGHT EXTERNAL EAR CANAL

S56407A

UNSP INJ EXTN MUSC/FASC/TEND R LIT FNGR AT FORARM LV INIT

H95812 POSTPROCEDURAL STENOSIS OF LEFT EXTERNAL EAR CANAL

S56408A

UNSP INJ EXTN MUSC/FASC/TEND L LIT FNGR AT FORARM LV INIT

H95813

POSTPROCEDURAL STENOSIS OF EXTERNAL EAR CANAL BILATERAL

S56409A

UNSP INJ EXTN MUSC/FASC/TEND UNSP FINGER AT FORARM LV INIT

H95819

POSTPROCEDURAL STENOSIS OF UNSPECIFIED EXTERNAL EAR CANAL

S56411A

STRAIN EXTENSOR MUSC/FASC/TEND R IDX FNGR AT FORARM LV INIT

H9588

OTH INTRAOP COMP AND DISORDERS OF THE EAR/MASTD NEC

S56412A

STRAIN EXTENSOR MUSC/FASC/TEND L IDX FNGR AT FORARM LV INIT

H9589

OTH POSTPROC COMP AND DISORDERS OF THE EAR/MASTD NEC

S56413A

STRAIN EXTN MUSC/FASC/TEND R MID FINGER AT FORARM LV INIT

I160 Hypertensive urgency

S56414A STRAIN EXTN MUSC/FASC/TEND L MID FINGER AT FORARM LV INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I161 Hypertensive emergency

S56415A STRAIN EXTENSOR MUSC/FASC/TEND R RNG FNGR AT FORARM LV INIT

I169 Hypertensive crisis unspecified

S56416A STRAIN EXTENSOR MUSC/FASC/TEND L RNG FNGR AT FORARM LV INIT

I209 ANGINA PECTORIS UNSPECIFIED

S56417A STRAIN EXTN MUSC/FASC/TEND R LITTLE FNGR AT FORARM LV INIT

I2101 STEMI INVOLVING LEFT MAIN CORONARY ARTERY

S56418A

STRAIN EXTN MUSC/FASC/TEND L LITTLE FNGR AT FORARM LV INIT

I2102

STEMI INVOLVING LEFT ANTERIOR DESCENDING CORONARY ARTERY

S56419A

STRAIN EXTN MUSC/FASC/TEND FNGRUNSP FNGR AT FORARM LV INIT

I2109

STEMI INVOLVING OTH CORONARY ARTERY OF ANTERIOR WALL

S56421A

LACERAT EXTN MUSC/FASC/TEND R IDX FNGR AT FORARM LV INIT

I2111 STEMI INVOLVING RIGHT CORONARY ARTERY

S56422A

LACERAT EXTN MUSC/FASC/TEND L IDX FNGR AT FORARM LV INIT

I2119

STEMI INVOLVING OTH CORONARY ARTERY OF INFERIOR WALL

S56423A

LACERAT EXTN MUSC/FASC/TEND R MID FINGER AT FORARM LV INIT

I2121

STEMI INVOLVING LEFT CIRCUMFLEX CORONARY ARTERY

S56424A

LACERAT EXTN MUSC/FASC/TEND L MID FINGER AT FORARM LV INIT

I2129 STEMI INVOLVING OTH SITES

S56425A LACERAT EXTN MUSC/FASC/TEND R RNG FNGR AT FORARM LV INIT

I213

ST ELEVATION (STEMI) MYOCARDIAL INFARCTION OF UNSP SITE

S56426A

LACERAT EXTN MUSC/FASC/TEND L RNG FNGR AT FORARM LV INIT

I214 NON-ST ELEVATION (NSTEMI) MYOCARDIAL INFARCTION

S56427A

LACERAT EXTN MUSC/FASC/TEND R LITTLE FNGR AT FORARM LV INIT

I220 SUBSEQUENT STEMI OF ANTERIOR WALL

S56428A

LACERAT EXTN MUSC/FASC/TEND L LITTLE FNGR AT FORARM LV INIT

I221 SUBSEQUENT STEMI OF INFERIOR WALL

S56429A

LACERAT EXTN MUSC/FASC/TEND UNSP FINGER AT FORARM LV INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I222

SUBSEQUENT NON-ST ELEVATION (NSTEMI) MYOCARDIAL INFARCTION

S56491A

INJ EXTENSOR MUSC/FASC/TEND R IDX FNGR AT FORARM LV INIT

I228 SUBSEQUENT STEMI OF SITES

S56492A INJ EXTENSOR MUSC/FASC/TEND L IDX FNGR AT FORARM LV INIT

I229 SUBSEQUENT STEMI OF UNSP SITE

S56493A

INJ EXTENSOR MUSC/FASC/TEND R MID FINGER AT FORARM LV INIT

I230

HEMOPERICARDIUM AS CURRENT COMPLICATION FOLLOWING AMI

S56494A

INJ EXTENSOR MUSC/FASC/TEND L MID FINGER AT FORARM LV INIT

I231

ATRIAL SEPTAL DEFECT AS CURRENT COMPLICATION FOLLOWING AMI

S56495A

INJ EXTENSOR MUSC/FASC/TEND R RNG FNGR AT FORARM LV INIT

I232

VENTRICULAR SEPTAL DEFECT AS CURRENT COMP FOLLOWING AMI

S56496A

INJ EXTENSOR MUSC/FASC/TEND L RNG FNGR AT FORARM LV INIT

I233

RUPTURE OF CARD WALL W/O HEMOPERIC AS CURRENT COMP FOL AMI

S56497A

INJ EXTN MUSC/FASC/TEND R LITTLE FINGER AT FORARM LV INIT

I234

RUPTURE OF CHORD TENDNE AS CURRENT COMP FOLLOWING AMI

S56498A

INJ EXTN MUSC/FASC/TEND L LITTLE FINGER AT FORARM LV INIT

I235

RUPTURE OF PAPILLARY MUSCLE AS CURRENT COMP FOLLOWING AMI

S56499A

INJ EXTENSOR MUSC/FASC/TEND UNSP FINGER AT FORARM LV INIT

I236

THOMBOS OF ATRIUM/AURIC APPEND/VENTR AS CURRENT COMP FOL AMI

S56501A

UNSP INJ EXTN MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

I237 POSTINFARCTION ANGINA

S56502A UNSP INJ EXTN MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

I238 OTH CURRENT COMPLICATIONS FOLLOWING AMI

S56509A

UNSP INJ EXTN MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

I240

ACUTE CORONARY THROMBOSIS NOT RESULTING IN MYOCARDIAL INFRC

S56511A

STRAIN OF EXTN MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I241 DRESSLER'S SYNDROME

S56512A STRAIN OF EXTN MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

I248 OTHER FORMS OF ACUTE ISCHEMIC HEART DISEASE

S56519A

STRAIN OF EXTN MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

I249 ACUTE ISCHEMIC HEART DISEASE UNSPECIFIED

S56521A

LACERAT EXTN MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

I2510

ATHSCL HEART DISEASE OF NATIVE CORONARY ARTERY W/O ANG PCTRS

S56522A

LACERAT EXTN MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

I25110

ATHSCL HEART DISEASE OF NATIVE COR ART W UNSTABLE ANG PCTRS

S56529A

LACERAT EXTN MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

I25111

ATHSCL HEART DISEASE OF NATIVE COR ART W ANG PCTRS W SPASM

S56591A

INJ EXTN MUSC/FASC/TEND AT FOREARM LEVEL RIGHT ARM INIT

I25118

ATHSCL HEART DISEASE OF NATIVE COR ART W OTH ANG PCTRS

S56592A

INJ EXTN MUSC/FASC/TEND AT FOREARM LEVEL LEFT ARM INIT

I25119

ATHSCL HEART DISEASE OF NATIVE COR ART W UNSP ANG PCTRS

S56599A

INJ EXTN MUSC/FASC/TEND AT FOREARM LEVEL UNSP ARM INIT

I252 OLD MYOCARDIAL INFARCTION

S56801A UNSP INJURY OF MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

I253 ANEURYSM OF HEART

S56802A UNSP INJURY OF MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

I2541 CORONARY ARTERY ANEURYSM

S56809A UNSP INJURY OF MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

I2542 CORONARY ARTERY DISSECTION

S56811A STRAIN OF MUSC/FASC/TEND AT FOREARM LEVEL RIGHT ARM INIT

I255 ISCHEMIC CARDIOMYOPATHY

S56812A STRAIN OF MUSC/FASC/TEND AT FOREARM LEVEL LEFT ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I256 SILENT MYOCARDIAL ISCHEMIA

S56819A STRAIN OF MUSC/FASC/TEND AT FOREARM LEVEL UNSP ARM INIT

I25700

ATHEROSCLEROSIS OF CABG UNSP W UNSTABLE ANGINA PECTORIS

S56821A

LACERATION OF MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

I25701

ATHSCL CABG UNSP W ANGINA PECTORIS W DOCUMENTED SPASM

S56822A

LACERATION OF MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

I25708 ATHEROSCLEROSIS OF CABG UNSP W OTH ANGINA PECTORIS

S56829A

LACERATION OF MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

I25709

ATHEROSCLEROSIS OF CABG UNSP W UNSP ANGINA PECTORIS

S56891A

INJ MUSC/FASC/TEND AT FOREARM LEVEL RIGHT ARM INIT ENCNTR

I25710

ATHSCL AUTOLOGOUS VEIN CABG W UNSTABLE ANGINA PECTORIS

S56892A

INJ MUSC/FASC/TEND AT FOREARM LEVEL LEFT ARM INIT ENCNTR

I25711

ATHSCL AUTOLOGOUS VEIN CABG W ANG PCTRS W DOCUMENTED SPASM

S56899A

INJ MUSC/FASC/TEND AT FOREARM LEVEL UNSP ARM INIT ENCNTR

I25718 ATHSCL AUTOLOGOUS VEIN CABG W OTH ANGINA PECTORIS

S56901A

UNSP INJ UNSP MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

I25719

ATHSCL AUTOLOGOUS VEIN CABG W UNSP ANGINA PECTORIS

S56902A

UNSP INJ UNSP MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

I25720

ATHSCL AUTOLOGOUS ARTERY CABG W UNSTABLE ANGINA PECTORIS

S56909A

UNSP INJ UNSP MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

I25721

ATHSCL AUTOLOGOUS ARTERY CABG W ANG PCTRS W DOCUMENTED SPASM

S56911A

STRAIN OF UNSP MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

I25728 ATHSCL AUTOLOGOUS ARTERY CABG W OTH ANGINA PECTORIS

S56912A

STRAIN OF UNSP MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I25729

ATHSCL AUTOLOGOUS ARTERY CABG W UNSP ANGINA PECTORIS

S56919A

STRAIN OF UNSP MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

I25730

ATHSCL NONAUTOLOGOUS BIOLOGICAL CABG W UNSTABLE ANG PCTRS

S56921A

LACERAT UNSP MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

I25731

ATHSCL NONAUT BIOLOGICAL CABG W ANG PCTRS W DOCUMENTED SPASM

S56922A

LACERAT UNSP MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

I25738

ATHSCL NONAUTOLOGOUS BIOLOGICAL CABG W OTH ANGINA PECTORIS

S56929A

LACERAT UNSP MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

I25739

ATHSCL NONAUTOLOGOUS BIOLOGICAL CABG W UNSP ANGINA PECTORIS

S56991A

INJ UNSP MUSC/FASC/TEND AT FOREARM LEVEL RIGHT ARM INIT

I25750

ATHSCL NATIVE COR ART OF TXPLT HEART W UNSTABLE ANGINA

S56992A

INJ UNSP MUSC/FASC/TEND AT FOREARM LEVEL LEFT ARM INIT

I25751

ATHSCL NATIVE COR ART OF TXPLT HEART W ANG PCTRS W SPASM

S56999A

INJ UNSP MUSC/FASC/TEND AT FOREARM LEVEL UNSP ARM INIT

I25758

ATHSCL NATIVE COR ART OF TRANSPLANTED HEART W OTH ANG PCTRS

S5700XA

CRUSHING INJURY OF UNSPECIFIED ELBOW INITIAL ENCOUNTER

I25759

ATHSCL NATIVE COR ART OF TRANSPLANTED HEART W UNSP ANG PCTRS

S5701XA

CRUSHING INJURY OF RIGHT ELBOW INITIAL ENCOUNTER

I25760

ATHSCL BYPASS OF COR ART OF TXPLT HEART W UNSTABLE ANGINA

S5702XA

CRUSHING INJURY OF LEFT ELBOW INITIAL ENCOUNTER

I25761

ATHSCL BYPASS OF COR ART OF TXPLT HEART W ANG PCTRS W SPASM

S5781XA

CRUSHING INJURY OF RIGHT FOREARM INITIAL ENCOUNTER

I25768

ATHSCL BYPASS OF COR ART OF TXPLT HEART W OTH ANG PCTRS

S5782XA

CRUSHING INJURY OF LEFT FOREARM INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I25769

ATHSCL BYPASS OF COR ART OF TXPLT HEART W UNSP ANG PCTRS

S58011A

COMPLETE TRAUMATIC AMP AT ELBOW LEVEL RIGHT ARM INIT

I25790 ATHEROSCLEROSIS OF CABG W UNSTABLE ANGINA PECTORIS

S58012A

COMPLETE TRAUMATIC AMPUTATION AT ELBOW LEVEL LEFT ARM INIT

I25791

ATHEROSCLEROSIS OF CABG W ANGINA PECTORIS W DOCUMENTED SPASM

S58021A

PARTIAL TRAUMATIC AMPUTATION AT ELBOW LEVEL RIGHT ARM INIT

I25798 ATHEROSCLEROSIS OF CABG W OTH ANGINA PECTORIS

S58022A

PARTIAL TRAUMATIC AMPUTATION AT ELBOW LEVEL LEFT ARM INIT

I25799 ATHEROSCLEROSIS OF CABG W UNSP ANGINA PECTORIS

S58111A

COMPLETE TRAUM AMP AT LEV BETW ELBOW AND WRIST R ARM INIT

I25810 ATHEROSCLEROSIS OF CABG W/O ANGINA PECTORIS

S58112A

COMPLETE TRAUM AMP AT LEV BETW ELBOW AND WRS LEFT ARM INIT

I25811

ATHSCL NATIVE COR ART OF TRANSPLANTED HEART W/O ANG PCTRS

S58121A

PART TRAUM AMP AT LEV BETW ELBOW AND WRIST RIGHT ARM INIT

I25812

ATHSCL BYPASS OF COR ART OF TRANSPLANTED HEART W/O ANG PCTRS

S58122A

PART TRAUM AMP AT LEVEL BETW ELBOW AND WRIST LEFT ARM INIT

I2582 CHRONIC TOTAL OCCLUSION OF CORONARY ARTERY

S58911A

COMPLETE TRAUMATIC AMPUTATION OF R FOREARM LEVEL UNSP INIT

I2583 CORONARY ATHEROSCLEROSIS DUE TO LIPID RICH PLAQUE

S58912A

COMPLETE TRAUMATIC AMPUTATION OF L FOREARM LEVEL UNSP INIT

I2589 OTHER FORMS OF CHRONIC ISCHEMIC HEART DISEASE

S58921A

PARTIAL TRAUMATIC AMPUTATION OF R FOREARM LEVEL UNSP INIT

I259 CHRONIC ISCHEMIC HEART DISEASE UNSPECIFIED

S58922A

PARTIAL TRAUMATIC AMPUTATION OF L FOREARM LEVEL UNSP INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I2601 SEPTIC PULMONARY EMBOLISM WITH ACUTE COR PULMONALE

S59001A

UNSP PHYSEAL FRACTURE OF LOWER END OF ULNA RIGHT ARM INIT

I2609

OTHER PULMONARY EMBOLISM WITH ACUTE COR PULMONALE

S59002A

UNSP PHYSEAL FRACTURE OF LOWER END OF ULNA LEFT ARM INIT

I2690

SEPTIC PULMONARY EMBOLISM WITHOUT ACUTE COR PULMONALE

S59009A

UNSP PHYSEAL FRACTURE OF LOWER END OF ULNA UNSP ARM INIT

I2699

OTHER PULMONARY EMBOLISM WITHOUT ACUTE COR PULMONALE

S59011A

SLTR-HARIS TYPE I PHYSL FX LOWER END ULNA RIGHT ARM INIT

I270 PRIMARY PULMONARY HYPERTENSION

S59012A

SLTR-HARIS TYPE I PHYSL FX LOWER END OF ULNA LEFT ARM INIT

I271 KYPHOSCOLIOTIC HEART DISEASE

S59021A

SLTR-HARIS TYPE II PHYSL FX LOWER END ULNA RIGHT ARM INIT

I272 OTHER SECONDARY PULMONARY HYPERTENSION

S59022A

SLTR-HARIS TYPE II PHYSL FX LOWER END ULNA LEFT ARM INIT

I2781 COR PULMONALE (CHRONIC)

S59029A SLTR-HARIS TYPE II PHYSL FX LOWER END ULNA UNSP ARM INIT

I2782 CHRONIC PULMONARY EMBOLISM

S59031A

SLTR-HARIS TYPE III PHYSL FX LOWER END ULNA RIGHT ARM INIT

I2789 OTHER SPECIFIED PULMONARY HEART DISEASES

S59032A

SLTR-HARIS TYPE III PHYSL FX LOWER END ULNA LEFT ARM INIT

I279 PULMONARY HEART DISEASE UNSPECIFIED

S59041A

SLTR-HARIS TYPE IV PHYSL FX LOWER END ULNA RIGHT ARM INIT

I280 ARTERIOVENOUS FISTULA OF PULMONARY VESSELS

S59042A

SLTR-HARIS TYPE IV PHYSL FX LOWER END ULNA LEFT ARM INIT

I281 ANEURYSM OF PULMONARY ARTERY

S59091A

OTH PHYSEAL FRACTURE OF LOWER END OF ULNA RIGHT ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I288 OTHER DISEASES OF PULMONARY VESSELS

S59092A

OTH PHYSEAL FRACTURE OF LOWER END OF ULNA LEFT ARM INIT

I289 DISEASE OF PULMONARY VESSELS UNSPECIFIED

S59101A

UNSP PHYSEAL FRACTURE OF UPPER END RADIUS RIGHT ARM INIT

I300 ACUTE NONSPECIFIC IDIOPATHIC PERICARDITIS

S59102A

UNSP PHYSEAL FRACTURE OF UPPER END OF RADIUS LEFT ARM INIT

I301 INFECTIVE PERICARDITIS

S59111A SLTR-HARIS TYPE I PHYSL FX UPPER END RADIUS RIGHT ARM INIT

I308 OTHER FORMS OF ACUTE PERICARDITIS

S59112A

SLTR-HARIS TYPE I PHYSL FX UPPER END RADIUS LEFT ARM INIT

I309 ACUTE PERICARDITIS UNSPECIFIED

S59121A

SLTR-HARIS TYPE II PHYSL FX UPPER END RAD RIGHT ARM INIT

I310 CHRONIC ADHESIVE PERICARDITIS

S59122A

SLTR-HARIS TYPE II PHYSL FX UPPER END RADIUS LEFT ARM INIT

I311 CHRONIC CONSTRICTIVE PERICARDITIS

S59131A

SLTR-HARIS TYPE III PHYSL FX UPPER END RAD RIGHT ARM INIT

I312 HEMOPERICARDIUM NOT ELSEWHERE CLASSIFIED

S59132A

SLTR-HARIS TYPE III PHYSL FX UPPER END RAD LEFT ARM INIT

I313 PERICARDIAL EFFUSION (NONINFLAMMATORY)

S59141A

SLTR-HARIS TYPE IV PHYSL FX UPPER END RAD RIGHT ARM INIT

I314 CARDIAC TAMPONADE

S59142A SLTR-HARIS TYPE IV PHYSL FX UPPER END RADIUS LEFT ARM INIT

I318 OTHER SPECIFIED DISEASES OF PERICARDIUM

S59191A

OTH PHYSEAL FRACTURE OF UPPER END OF RADIUS RIGHT ARM INIT

I319 DISEASE OF PERICARDIUM UNSPECIFIED

S59192A

OTH PHYSEAL FRACTURE OF UPPER END OF RADIUS LEFT ARM INIT

I32 PERICARDITIS IN DISEASES CLASSIFIED ELSEWHERE

S59201A

UNSP PHYSEAL FRACTURE OF LOWER END RADIUS RIGHT ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I330 ACUTE AND SUBACUTE INFECTIVE ENDOCARDITIS

S59202A

UNSP PHYSEAL FRACTURE OF LOWER END OF RADIUS LEFT ARM INIT

I339 ACUTE AND SUBACUTE ENDOCARDITIS UNSPECIFIED

S59801A

OTHER SPECIFIED INJURIES OF RIGHT ELBOW INITIAL ENCOUNTER

I340 NONRHEUMATIC MITRAL (VALVE) INSUFFICIENCY

S59802A

OTHER SPECIFIED INJURIES OF LEFT ELBOW INITIAL ENCOUNTER

I341 NONRHEUMATIC MITRAL (VALVE) PROLAPSE

S59811A

OTHER SPECIFIED INJURIES RIGHT FOREARM INITIAL ENCOUNTER

I342 NONRHEUMATIC MITRAL (VALVE) STENOSIS

S59812A

OTHER SPECIFIED INJURIES LEFT FOREARM INITIAL ENCOUNTER

I348 OTHER NONRHEUMATIC MITRAL VALVE DISORDERS

S59901A

UNSPECIFIED INJURY OF RIGHT ELBOW INITIAL ENCOUNTER

I349 NONRHEUMATIC MITRAL VALVE DISORDER UNSPECIFIED

S59902A

UNSPECIFIED INJURY OF LEFT ELBOW INITIAL ENCOUNTER

I350 NONRHEUMATIC AORTIC (VALVE) STENOSIS

S59911A

UNSPECIFIED INJURY OF RIGHT FOREARM INITIAL ENCOUNTER

I351 NONRHEUMATIC AORTIC (VALVE) INSUFFICIENCY

S59912A

UNSPECIFIED INJURY OF LEFT FOREARM INITIAL ENCOUNTER

I352

NONRHEUMATIC AORTIC (VALVE) STENOSIS WITH INSUFFICIENCY

S60011A

CONTUSION OF RIGHT THUMB WITHOUT DAMAGE TO NAIL INIT ENCNTR

I358 OTHER NONRHEUMATIC AORTIC VALVE DISORDERS

S60012A

CONTUSION OF LEFT THUMB WITHOUT DAMAGE TO NAIL INIT ENCNTR

I359 NONRHEUMATIC AORTIC VALVE DISORDER UNSPECIFIED

S60021A

CONTUSION OF RIGHT INDEX FINGER W/O DAMAGE TO NAIL INIT

I360 NONRHEUMATIC TRICUSPID (VALVE) STENOSIS

S60022A

CONTUSION OF LEFT INDEX FINGER W/O DAMAGE TO NAIL INIT

I361 NONRHEUMATIC TRICUSPID (VALVE) INSUFFICIENCY

S60031A

CONTUSION OF RIGHT MIDDLE FINGER W/O DAMAGE TO NAIL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I362

NONRHEUMATIC TRICUSPID (VALVE) STENOSIS WITH INSUFFICIENCY

S60032A

CONTUSION OF LEFT MIDDLE FINGER W/O DAMAGE TO NAIL INIT

I368 OTHER NONRHEUMATIC TRICUSPID VALVE DISORDERS

S60041A

CONTUSION OF RIGHT RING FINGER W/O DAMAGE TO NAIL INIT

I369 NONRHEUMATIC TRICUSPID VALVE DISORDER UNSPECIFIED

S60042A

CONTUSION OF LEFT RING FINGER W/O DAMAGE TO NAIL INIT

I370 NONRHEUMATIC PULMONARY VALVE STENOSIS

S60051A

CONTUSION OF RIGHT LITTLE FINGER W/O DAMAGE TO NAIL INIT

I371 NONRHEUMATIC PULMONARY VALVE INSUFFICIENCY

S60052A

CONTUSION OF LEFT LITTLE FINGER W/O DAMAGE TO NAIL INIT

I372

NONRHEUMATIC PULMONARY VALVE STENOSIS WITH INSUFFICIENCY

S60111A

CONTUSION OF RIGHT THUMB WITH DAMAGE TO NAIL INIT ENCNTR

I378 OTHER NONRHEUMATIC PULMONARY VALVE DISORDERS

S60112A

CONTUSION OF LEFT THUMB WITH DAMAGE TO NAIL INIT ENCNTR

I379 NONRHEUMATIC PULMONARY VALVE DISORDER UNSPECIFIED

S60121A

CONTUSION OF RIGHT INDEX FINGER W DAMAGE TO NAIL INIT

I38 ENDOCARDITIS VALVE UNSPECIFIED

S60122A

CONTUSION OF LEFT INDEX FINGER W DAMAGE TO NAIL INIT ENCNTR

I39

ENDOCARDITIS AND HEART VALVE DISORD IN DIS CLASSD ELSWHR

S60131A

CONTUSION OF RIGHT MIDDLE FINGER W DAMAGE TO NAIL INIT

I400 INFECTIVE MYOCARDITIS

S60132A CONTUSION OF LEFT MIDDLE FINGER W DAMAGE TO NAIL INIT

I401 ISOLATED MYOCARDITIS

S60141A CONTUSION OF RIGHT RING FINGER W DAMAGE TO NAIL INIT ENCNTR

I408 OTHER ACUTE MYOCARDITIS

S60142A CONTUSION OF LEFT RING FINGER W DAMAGE TO NAIL INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I409 ACUTE MYOCARDITIS UNSPECIFIED

S60151A

CONTUSION OF RIGHT LITTLE FINGER W DAMAGE TO NAIL INIT

I41 MYOCARDITIS IN DISEASES CLASSIFIED ELSEWHERE

S60152A

CONTUSION OF LEFT LITTLE FINGER W DAMAGE TO NAIL INIT

I420 DILATED CARDIOMYOPATHY

S60211A CONTUSION OF RIGHT WRIST INITIAL ENCOUNTER

I421 OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY

S60212A

CONTUSION OF LEFT WRIST INITIAL ENCOUNTER

I422 OTHER HYPERTROPHIC CARDIOMYOPATHY

S60219A

CONTUSION OF UNSPECIFIED WRIST INITIAL ENCOUNTER

I423 ENDOMYOCARDIAL (EOSINOPHILIC) DISEASE

S60221A

CONTUSION OF RIGHT HAND INITIAL ENCOUNTER

I424 ENDOCARDIAL FIBROELASTOSIS

S60222A CONTUSION OF LEFT HAND INITIAL ENCOUNTER

I425 OTHER RESTRICTIVE CARDIOMYOPATHY

S60311A

ABRASION OF RIGHT THUMB INITIAL ENCOUNTER

I426 ALCOHOLIC CARDIOMYOPATHY

S60312A ABRASION OF LEFT THUMB INITIAL ENCOUNTER

I427 CARDIOMYOPATHY DUE TO DRUG AND EXTERNAL AGENT

S60341A

EXTERNAL CONSTRICTION OF RIGHT THUMB INITIAL ENCOUNTER

I428 OTHER CARDIOMYOPATHIES

S60342A EXTERNAL CONSTRICTION OF LEFT THUMB INITIAL ENCOUNTER

I429 CARDIOMYOPATHY UNSPECIFIED

S60351A

SUPERFICIAL FOREIGN BODY OF RIGHT THUMB INITIAL ENCOUNTER

I43 CARDIOMYOPATHY IN DISEASES CLASSIFIED ELSEWHERE

S60352A

SUPERFICIAL FOREIGN BODY OF LEFT THUMB INITIAL ENCOUNTER

I440 ATRIOVENTRICULAR BLOCK FIRST DEGREE

S60361A

INSECT BITE (NONVENOMOUS) OF RIGHT THUMB INITIAL ENCOUNTER

I441 ATRIOVENTRICULAR BLOCK SECOND DEGREE

S60362A

INSECT BITE (NONVENOMOUS) OF LEFT THUMB INITIAL ENCOUNTER

I442 ATRIOVENTRICULAR BLOCK COMPLETE

S60371A

OTHER SUPERFICIAL BITE OF RIGHT THUMB INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I4430 UNSPECIFIED ATRIOVENTRICULAR BLOCK

S60372A

OTHER SUPERFICIAL BITE OF LEFT THUMB INITIAL ENCOUNTER

I4439 OTHER ATRIOVENTRICULAR BLOCK

S60391A

OTHER SUPERFICIAL INJURIES OF RIGHT THUMB INITIAL ENCOUNTER

I444 LEFT ANTERIOR FASCICULAR BLOCK

S60392A

OTHER SUPERFICIAL INJURIES OF LEFT THUMB INITIAL ENCOUNTER

I445 LEFT POSTERIOR FASCICULAR BLOCK

S60410A

ABRASION OF RIGHT INDEX FINGER INITIAL ENCOUNTER

I4460 UNSPECIFIED FASCICULAR BLOCK

S60411A

ABRASION OF LEFT INDEX FINGER INITIAL ENCOUNTER

I4469 OTHER FASCICULAR BLOCK

S60412A ABRASION OF RIGHT MIDDLE FINGER INITIAL ENCOUNTER

I447 LEFT BUNDLE-BRANCH BLOCK UNSPECIFIED

S60413A

ABRASION OF LEFT MIDDLE FINGER INITIAL ENCOUNTER

I450 RIGHT FASCICULAR BLOCK

S60414A ABRASION OF RIGHT RING FINGER INITIAL ENCOUNTER

I4510 UNSPECIFIED RIGHT BUNDLE-BRANCH BLOCK

S60415A

ABRASION OF LEFT RING FINGER INITIAL ENCOUNTER

I4519 OTHER RIGHT BUNDLE-BRANCH BLOCK

S60416A

ABRASION OF RIGHT LITTLE FINGER INITIAL ENCOUNTER

I452 BIFASCICULAR BLOCK

S60417A ABRASION OF LEFT LITTLE FINGER INITIAL ENCOUNTER

I453 TRIFASCICULAR BLOCK

S60420A BLISTER (NONTHERMAL) OF RIGHT INDEX FINGER INIT ENCNTR

I454 NONSPECIFIC INTRAVENTRICULAR BLOCK

S60421A

BLISTER (NONTHERMAL) OF LEFT INDEX FINGER INITIAL ENCOUNTER

I455 OTHER SPECIFIED HEART BLOCK

S60422A BLISTER (NONTHERMAL) OF RIGHT MIDDLE FINGER INIT ENCNTR

I456 PRE-EXCITATION SYNDROME

S60423A BLISTER (NONTHERMAL) OF LEFT MIDDLE FINGER INIT ENCNTR

I4581 LONG QT SYNDROME

S60424A BLISTER (NONTHERMAL) OF RIGHT RING FINGER INITIAL ENCOUNTER

I4589 OTHER SPECIFIED CONDUCTION DISORDERS

S60425A

BLISTER (NONTHERMAL) OF LEFT RING FINGER INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I459 CONDUCTION DISORDER UNSPECIFIED

S60426A

BLISTER (NONTHERMAL) OF RIGHT LITTLE FINGER INIT ENCNTR

I462

CARDIAC ARREST DUE TO UNDERLYING CARDIAC CONDITION

S60427A

BLISTER (NONTHERMAL) OF LEFT LITTLE FINGER INIT ENCNTR

I468

CARDIAC ARREST DUE TO OTHER UNDERLYING CONDITION

S60440A

EXTERNAL CONSTRICTION OF RIGHT INDEX FINGER INIT ENCNTR

I469 CARDIAC ARREST CAUSE UNSPECIFIED

S60441A

EXTERNAL CONSTRICTION OF LEFT INDEX FINGER INIT ENCNTR

I470 RE-ENTRY VENTRICULAR ARRHYTHMIA

S60442A

EXTERNAL CONSTRICTION OF RIGHT MIDDLE FINGER INIT ENCNTR

I471 SUPRAVENTRICULAR TACHYCARDIA

S60443A

EXTERNAL CONSTRICTION OF LEFT MIDDLE FINGER INIT ENCNTR

I472 VENTRICULAR TACHYCARDIA

S60444A EXTERNAL CONSTRICTION OF RIGHT RING FINGER INIT ENCNTR

I479 PAROXYSMAL TACHYCARDIA UNSPECIFIED

S60445A

EXTERNAL CONSTRICTION OF LEFT RING FINGER INITIAL ENCOUNTER

I480 PAROXYSMAL ATRIAL FIBRILLATION

S60446A

EXTERNAL CONSTRICTION OF RIGHT LITTLE FINGER INIT ENCNTR

I481 PERSISTENT ATRIAL FIBRILLATION

S60447A

EXTERNAL CONSTRICTION OF LEFT LITTLE FINGER INIT ENCNTR

I4901 VENTRICULAR FIBRILLATION

S60450A SUPERFICIAL FOREIGN BODY OF RIGHT INDEX FINGER INIT ENCNTR

I4902 VENTRICULAR FLUTTER

S60451A SUPERFICIAL FOREIGN BODY OF LEFT INDEX FINGER INIT ENCNTR

I491 ATRIAL PREMATURE DEPOLARIZATION

S60452A

SUPERFICIAL FOREIGN BODY OF RIGHT MIDDLE FINGER INIT ENCNTR

I492 JUNCTIONAL PREMATURE DEPOLARIZATION

S60453A

SUPERFICIAL FOREIGN BODY OF LEFT MIDDLE FINGER INIT ENCNTR

I493 VENTRICULAR PREMATURE DEPOLARIZATION

S60454A

SUPERFICIAL FOREIGN BODY OF RIGHT RING FINGER INIT ENCNTR

I4940 UNSPECIFIED PREMATURE DEPOLARIZATION

S60455A

SUPERFICIAL FOREIGN BODY OF LEFT RING FINGER INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I4949 OTHER PREMATURE DEPOLARIZATION

S60456A

SUPERFICIAL FOREIGN BODY OF RIGHT LITTLE FINGER INIT ENCNTR

I495 SICK SINUS SYNDROME

S60457A SUPERFICIAL FOREIGN BODY OF LEFT LITTLE FINGER INIT ENCNTR

I498 OTHER SPECIFIED CARDIAC ARRHYTHMIAS

S60460A

INSECT BITE (NONVENOMOUS) OF RIGHT INDEX FINGER INIT ENCNTR

I499 CARDIAC ARRHYTHMIA UNSPECIFIED

S60461A

INSECT BITE (NONVENOMOUS) OF LEFT INDEX FINGER INIT ENCNTR

I501 LEFT VENTRICULAR FAILURE

S60462A INSECT BITE (NONVENOMOUS) OF RIGHT MIDDLE FINGER INIT

I5020 UNSPECIFIED SYSTOLIC (CONGESTIVE) HEART FAILURE

S60463A

INSECT BITE (NONVENOMOUS) OF LEFT MIDDLE FINGER INIT ENCNTR

I5021 ACUTE SYSTOLIC (CONGESTIVE) HEART FAILURE

S60464A

INSECT BITE (NONVENOMOUS) OF RIGHT RING FINGER INIT ENCNTR

I5022 CHRONIC SYSTOLIC (CONGESTIVE) HEART FAILURE

S60465A

INSECT BITE (NONVENOMOUS) OF LEFT RING FINGER INIT ENCNTR

I5023 ACUTE ON CHRONIC SYSTOLIC (CONGESTIVE) HEART FAILURE

S60466A

INSECT BITE (NONVENOMOUS) OF RIGHT LITTLE FINGER INIT

I5030 UNSPECIFIED DIASTOLIC (CONGESTIVE) HEART FAILURE

S60467A

INSECT BITE (NONVENOMOUS) OF LEFT LITTLE FINGER INIT ENCNTR

I5031 ACUTE DIASTOLIC (CONGESTIVE) HEART FAILURE

S60468A

INSECT BITE (NONVENOMOUS) OF OTHER FINGER INITIAL ENCOUNTER

I5032 CHRONIC DIASTOLIC (CONGESTIVE) HEART FAILURE

S60470A

OTHER SUPERFICIAL BITE OF RIGHT INDEX FINGER INIT ENCNTR

I5033 ACUTE ON CHRONIC DIASTOLIC (CONGESTIVE) HEART FAILURE

S60471A

OTHER SUPERFICIAL BITE OF LEFT INDEX FINGER INIT ENCNTR

I5040

UNSP COMBINED SYSTOLIC AND DIASTOLIC (CONGESTIVE) HRT FAIL

S60472A

OTHER SUPERFICIAL BITE OF RIGHT MIDDLE FINGER INIT ENCNTR

I5041

ACUTE COMBINED SYSTOLIC AND DIASTOLIC (CONGESTIVE) HRT FAIL

S60473A

OTHER SUPERFICIAL BITE OF LEFT MIDDLE FINGER INIT ENCNTR

I5042 CHRONIC COMBINED SYSTOLIC AND DIASTOLIC HRT FAIL

S60474A

OTHER SUPERFICIAL BITE OF RIGHT RING FINGER INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I5043

ACUTE ON CHRONIC COMBINED SYSTOLIC AND DIASTOLIC HRT FAIL

S60475A

OTHER SUPERFICIAL BITE OF LEFT RING FINGER INIT ENCNTR

I509 HEART FAILURE UNSPECIFIED

S60476A OTHER SUPERFICIAL BITE OF RIGHT LITTLE FINGER INIT ENCNTR

I510 CARDIAC SEPTAL DEFECT ACQUIRED

S60477A

OTHER SUPERFICIAL BITE OF LEFT LITTLE FINGER INIT ENCNTR

I511

RUPTURE OF CHORDAE TENDINEAE NOT ELSEWHERE CLASSIFIED

S60511A

ABRASION OF RIGHT HAND INITIAL ENCOUNTER

I512

RUPTURE OF PAPILLARY MUSCLE NOT ELSEWHERE CLASSIFIED

S60512A

ABRASION OF LEFT HAND INITIAL ENCOUNTER

I513 INTRACARDIAC THROMBOSIS NOT ELSEWHERE CLASSIFIED

S60521A

BLISTER (NONTHERMAL) OF RIGHT HAND INITIAL ENCOUNTER

I514 MYOCARDITIS UNSPECIFIED

S60522A BLISTER (NONTHERMAL) OF LEFT HAND INITIAL ENCOUNTER

I515 MYOCARDIAL DEGENERATION

S60541A EXTERNAL CONSTRICTION OF RIGHT HAND INITIAL ENCOUNTER

I517 CARDIOMEGALY

S60542A EXTERNAL CONSTRICTION OF LEFT HAND INITIAL ENCOUNTER

I5181 TAKOTSUBO SYNDROME

S60551A SUPERFICIAL FOREIGN BODY OF RIGHT HAND INITIAL ENCOUNTER

I5189 OTHER ILL-DEFINED HEART DISEASES

S60552A

SUPERFICIAL FOREIGN BODY OF LEFT HAND INITIAL ENCOUNTER

I519 HEART DISEASE UNSPECIFIED

S60561A INSECT BITE (NONVENOMOUS) OF RIGHT HAND INITIAL ENCOUNTER

I52

OTHER HEART DISORDERS IN DISEASES CLASSIFIED ELSEWHERE

S60562A

INSECT BITE (NONVENOMOUS) OF LEFT HAND INITIAL ENCOUNTER

I6000

NTRM SUBARACH HEMORRHAGE FROM UNSP CAROTID SIPHON AND BIFURC

S60571A

OTHER SUPERFICIAL BITE OF HAND OF RIGHT HAND INIT ENCNTR

I6001

NTRM SUBARACH HEMOR FROM RIGHT CAROTID SIPHON AND BIFURC

S60572A

OTHER SUPERFICIAL BITE OF HAND OF LEFT HAND INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I6002

NTRM SUBARACH HEMORRHAGE FROM LEFT CAROTID SIPHON AND BIFURC

S60811A

ABRASION OF RIGHT WRIST INITIAL ENCOUNTER

I6010

NTRM SUBARACH HEMORRHAGE FROM UNSP MIDDLE CEREBRAL ARTERY

S60812A

ABRASION OF LEFT WRIST INITIAL ENCOUNTER

I6011

NTRM SUBARACH HEMORRHAGE FROM RIGHT MIDDLE CEREBRAL ARTERY

S60821A

BLISTER (NONTHERMAL) OF RIGHT WRIST INITIAL ENCOUNTER

I6012

NTRM SUBARACH HEMORRHAGE FROM LEFT MIDDLE CEREBRAL ARTERY

S60822A

BLISTER (NONTHERMAL) OF LEFT WRIST INITIAL ENCOUNTER

I602

Nontraumatic subarachnoid hemorrhage from anterior communicating artery

S60829A

BLISTER (NONTHERMAL) OF UNSPECIFIED WRIST INITIAL ENCOUNTER

I6020

NTRM SUBARACH HEMOR FROM UNSP ANTERIOR COMMUNICATING ARTERY

S60841A

EXTERNAL CONSTRICTION OF RIGHT WRIST INITIAL ENCOUNTER

I6021

NTRM SUBARACH HEMOR FROM RIGHT ANTERIOR COMMUNICATING ARTERY

S60842A

EXTERNAL CONSTRICTION OF LEFT WRIST INITIAL ENCOUNTER

I6022

NTRM SUBARACH HEMOR FROM LEFT ANTERIOR COMMUNICATING ARTERY

S60851A

SUPERFICIAL FOREIGN BODY OF RIGHT WRIST INITIAL ENCOUNTER

I6030

NTRM SUBARACH HEMOR FROM UNSP POSTERIOR COMMUNICATING ARTERY

S60852A

SUPERFICIAL FOREIGN BODY OF LEFT WRIST INITIAL ENCOUNTER

I6031

NTRM SUBARACH HEMOR FROM RIGHT POST COMMUNICATING ARTERY

S60861A

INSECT BITE (NONVENOMOUS) OF RIGHT WRIST INITIAL ENCOUNTER

I6032

NTRM SUBARACH HEMOR FROM LEFT POSTERIOR COMMUNICATING ARTERY

S60862A

INSECT BITE (NONVENOMOUS) OF LEFT WRIST INITIAL ENCOUNTER

I604

NONTRAUMATIC SUBARACHNOID HEMORRHAGE FROM BASILAR ARTERY

S60871A

OTHER SUPERFICIAL BITE OF RIGHT WRIST INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I6050

NONTRAUMATIC SUBARACHNOID HEMORRHAGE FROM UNSP VERTEB ART

S60872A

OTHER SUPERFICIAL BITE OF LEFT WRIST INITIAL ENCOUNTER

I6051

NONTRAUMATIC SUBARACHNOID HEMORRHAGE FROM R VERTEB ART

S60911A

UNSPECIFIED SUPERFICIAL INJURY OF RIGHT WRIST INIT ENCNTR

I6052

NONTRAUMATIC SUBARACHNOID HEMORRHAGE FROM L VERTEB ART

S60912A

UNSPECIFIED SUPERFICIAL INJURY OF LEFT WRIST INIT ENCNTR

I606

NONTRAUMATIC SUBARACHNOID HEMORRHAGE FROM OTH INTRACRAN ART

S60921A

UNSPECIFIED SUPERFICIAL INJURY OF RIGHT HAND INIT ENCNTR

I607

NONTRAUMATIC SUBARACHNOID HEMORRHAGE FROM UNSP INTRACRAN ART

S60922A

UNSPECIFIED SUPERFICIAL INJURY OF LEFT HAND INIT ENCNTR

I608 OTHER NONTRAUMATIC SUBARACHNOID HEMORRHAGE

S60931A

UNSPECIFIED SUPERFICIAL INJURY OF RIGHT THUMB INIT ENCNTR

I609

NONTRAUMATIC SUBARACHNOID HEMORRHAGE UNSPECIFIED

S60932A

UNSPECIFIED SUPERFICIAL INJURY OF LEFT THUMB INIT ENCNTR

I610

NONTRAUMATIC INTCRBL HEMORRHAGE IN HEMISPHERE SUBCORTICAL

S60940A

UNSP SUPERFICIAL INJURY OF RIGHT INDEX FINGER INIT ENCNTR

I611

NONTRAUMATIC INTCRBL HEMORRHAGE IN HEMISPHERE CORTICAL

S60941A

UNSP SUPERFICIAL INJURY OF LEFT INDEX FINGER INIT ENCNTR

I612

NONTRAUMATIC INTRACEREBRAL HEMORRHAGE IN HEMISPHERE UNSP

S60942A

UNSP SUPERFICIAL INJURY OF RIGHT MIDDLE FINGER INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I613

NONTRAUMATIC INTRACEREBRAL HEMORRHAGE IN BRAIN STEM

S60943A

UNSP SUPERFICIAL INJURY OF LEFT MIDDLE FINGER INIT ENCNTR

I614

NONTRAUMATIC INTRACEREBRAL HEMORRHAGE IN CEREBELLUM

S60944A

UNSP SUPERFICIAL INJURY OF RIGHT RING FINGER INIT ENCNTR

I615

NONTRAUMATIC INTRACEREBRAL HEMORRHAGE INTRAVENTRICULAR

S60945A

UNSP SUPERFICIAL INJURY OF LEFT RING FINGER INIT ENCNTR

I616

NONTRAUMATIC INTRACEREBRAL HEMORRHAGE MULTIPLE LOCALIZED

S60946A

UNSP SUPERFICIAL INJURY OF RIGHT LITTLE FINGER INIT ENCNTR

I618 OTHER NONTRAUMATIC INTRACEREBRAL HEMORRHAGE

S60947A

UNSP SUPERFICIAL INJURY OF LEFT LITTLE FINGER INIT ENCNTR

I619

NONTRAUMATIC INTRACEREBRAL HEMORRHAGE UNSPECIFIED

S60948A

UNSPECIFIED SUPERFICIAL INJURY OF OTHER FINGER INIT ENCNTR

I6200 NONTRAUMATIC SUBDURAL HEMORRHAGE UNSPECIFIED

S61001A

UNSP OPEN WOUND OF RIGHT THUMB W/O DAMAGE TO NAIL INIT

I6201 NONTRAUMATIC ACUTE SUBDURAL HEMORRHAGE

S61002A

UNSP OPEN WOUND OF LEFT THUMB W/O DAMAGE TO NAIL INIT

I6202 NONTRAUMATIC SUBACUTE SUBDURAL HEMORRHAGE

S61011A

LACERATION W/O FB OF RIGHT THUMB W/O DAMAGE TO NAIL INIT

I6203 NONTRAUMATIC CHRONIC SUBDURAL HEMORRHAGE

S61012A

LACERATION W/O FB OF LEFT THUMB W/O DAMAGE TO NAIL INIT

I621 NONTRAUMATIC EXTRADURAL HEMORRHAGE

S61021A

LACERATION W FB OF RIGHT THUMB W/O DAMAGE TO NAIL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I629

NONTRAUMATIC INTRACRANIAL HEMORRHAGE UNSPECIFIED

S61022A

LACERATION W FB OF LEFT THUMB W/O DAMAGE TO NAIL INIT

I6300

CEREBRAL INFARCTION DUE TO THOMBOS UNSP PRECEREBRAL ARTERY

S61031A

PNCTR W/O FB OF RIGHT THUMB W/O DAMAGE TO NAIL INIT

I63011 CEREBRAL INFARCTION DUE TO THROMBOSIS OF R VERTEB ART

S61032A

PNCTR W/O FB OF LEFT THUMB W/O DAMAGE TO NAIL INIT

I63012 CEREBRAL INFARCTION DUE TO THROMBOSIS OF L VERTEB ART

S61041A

PNCTR W FOREIGN BODY OF RIGHT THUMB W/O DAMAGE TO NAIL INIT

I63013

Cerebral infarction due to thrombosis of bilateral vertebral arteries

S61042A

PNCTR W FOREIGN BODY OF LEFT THUMB W/O DAMAGE TO NAIL INIT

I63019

CEREBRAL INFARCTION DUE TO THOMBOS UNSP VERTEBRAL ARTERY

S61051A

OPEN BITE OF RIGHT THUMB WITHOUT DAMAGE TO NAIL INIT ENCNTR

I6302

CEREBRAL INFARCTION DUE TO THROMBOSIS OF BASILAR ARTERY

S61052A

OPEN BITE OF LEFT THUMB WITHOUT DAMAGE TO NAIL INIT ENCNTR

I63031

CEREBRAL INFRC DUE TO THROMBOSIS OF RIGHT CAROTID ARTERY

S61101A

UNSP OPEN WOUND OF RIGHT THUMB W DAMAGE TO NAIL INIT ENCNTR

I63032

CEREBRAL INFARCTION DUE TO THROMBOSIS OF LEFT CAROTID ARTERY

S61102A

UNSP OPEN WOUND OF LEFT THUMB W DAMAGE TO NAIL INIT ENCNTR

I63033

Cerebral infarction due to thrombosis of bilateral carotid arteries

S61111A

LACERATION W/O FB OF RIGHT THUMB W DAMAGE TO NAIL INIT

I63039

CEREBRAL INFARCTION DUE TO THROMBOSIS OF UNSP CAROTID ARTERY

S61112A

LACERATION W/O FB OF LEFT THUMB W DAMAGE TO NAIL INIT

I6309

CEREBRAL INFARCTION DUE TO THROMBOSIS OF PRECEREBRAL ARTERY

S61121A

LACERATION W FB OF RIGHT THUMB W DAMAGE TO NAIL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I6310

CEREBRAL INFARCTION DUE TO EMBOLISM OF UNSP PRECERB ARTERY

S61122A

LACERATION W FB OF LEFT THUMB W DAMAGE TO NAIL INIT

I63111 CEREBRAL INFARCTION DUE TO EMBOLISM OF R VERTEB ART

S61131A

PNCTR W/O FOREIGN BODY OF RIGHT THUMB W DAMAGE TO NAIL INIT

I63112

CEREBRAL INFARCTION DUE TO EMBOLISM OF LEFT VERTEBRAL ARTERY

S61132A

PNCTR W/O FOREIGN BODY OF LEFT THUMB W DAMAGE TO NAIL INIT

I63113

Cerebral infarction due to embolism of bilateral vertebral arteries

S61141A

PNCTR W FOREIGN BODY OF RIGHT THUMB W DAMAGE TO NAIL INIT

I63119

CEREBRAL INFARCTION DUE TO EMBOLISM OF UNSP VERTEBRAL ARTERY

S61142A

PNCTR W FOREIGN BODY OF LEFT THUMB W DAMAGE TO NAIL INIT

I6312 CEREBRAL INFARCTION DUE TO EMBOLISM OF BASILAR ARTERY

S61151A

OPEN BITE OF RIGHT THUMB WITH DAMAGE TO NAIL INIT ENCNTR

I63131

CEREBRAL INFARCTION DUE TO EMBOLISM OF RIGHT CAROTID ARTERY

S61152A

OPEN BITE OF LEFT THUMB WITH DAMAGE TO NAIL INIT ENCNTR

I63132

CEREBRAL INFARCTION DUE TO EMBOLISM OF LEFT CAROTID ARTERY

S61200A

UNSP OPEN WOUND OF R IDX FNGR W/O DAMAGE TO NAIL INIT

I63133

Cerebral infarction due to embolism of bilateral carotid arteries

S61201A

UNSP OPEN WOUND OF L IDX FNGR W/O DAMAGE TO NAIL INIT

I63139

CEREBRAL INFARCTION DUE TO EMBOLISM OF UNSP CAROTID ARTERY

S61202A

UNSP OPEN WOUND OF R MID FINGER W/O DAMAGE TO NAIL INIT

I6319

CEREBRAL INFARCTION DUE TO EMBOLISM OF PRECEREBRAL ARTERY

S61203A

UNSP OPEN WOUND OF L MID FINGER W/O DAMAGE TO NAIL INIT

I6320

CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF UNSP PRECERB ART

S61204A

UNSP OPEN WOUND OF R RNG FNGR W/O DAMAGE TO NAIL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I63211

CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF RIGHT VERTEB ART

S61205A

UNSP OPEN WOUND OF LEFT RING FINGER W/O DAMAGE TO NAIL INIT

I63212

CEREB INFRC DUE TO UNSP OCCLS OR STENOSIS OF LEFT VERTEB ART

S61206A

UNSP OPEN WOUND OF R LITTLE FINGER W/O DAMAGE TO NAIL INIT

I63213

Cerebral infarction due to unspecified occlusion or stenosis of bilateral vertebral arteries

S61207A

UNSP OPEN WOUND OF L LITTLE FINGER W/O DAMAGE TO NAIL INIT

I63219

CEREB INFRC DUE TO UNSP OCCLS OR STENOSIS OF UNSP VERTEB ART

S61210A

LACERATION W/O FB OF R IDX FNGR W/O DAMAGE TO NAIL INIT

I6322

CEREBRAL INFRC DUE TO UNSP OCCLS OR STENOSIS OF BASILAR ART

S61211A

LACERATION W/O FB OF L IDX FNGR W/O DAMAGE TO NAIL INIT

I63231

CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF RIGHT CAROTID ART

S61212A

LACERATION W/O FB OF R MID FINGER W/O DAMAGE TO NAIL INIT

I63232

CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF LEFT CAROTID ART

S61213A

LACERATION W/O FB OF L MID FINGER W/O DAMAGE TO NAIL INIT

I63233

Cerebral infarction due to unspecified occlusion or stenosis of bilateral carotid arteries

S61214A

LACERATION W/O FB OF R RNG FNGR W/O DAMAGE TO NAIL INIT

I63239

CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF UNSP CAROTID ART

S61215A

LACERATION W/O FB OF L RNG FNGR W/O DAMAGE TO NAIL INIT

I6329

CEREBRAL INFRC DUE TO UNSP OCCLS OR STENOSIS OF PRECERB ART

S61216A

LAC W/O FB OF R LITTLE FINGER W/O DAMAGE TO NAIL INIT

I6330

CEREBRAL INFARCTION DUE TO THOMBOS UNSP CEREBRAL ARTERY

S61217A

LAC W/O FB OF L LITTLE FINGER W/O DAMAGE TO NAIL INIT

I63311

CEREB INFRC DUE TO THOMBOS OF RIGHT MIDDLE CEREBRAL ARTERY

S61218A

LACERATION W/O FB OF FINGER W/O DAMAGE TO NAIL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I63312

CEREBRAL INFRC DUE TO THOMBOS OF LEFT MIDDLE CEREBRAL ARTERY

S61220A

LACERATION W FB OF R IDX FNGR W/O DAMAGE TO NAIL INIT

I63313

Cerebral infarction due to thrombosis of bilateral middle cerebral arteries

S61221A

LACERATION W FB OF L IDX FNGR W/O DAMAGE TO NAIL INIT

I63319

CEREBRAL INFRC DUE TO THOMBOS UNSP MIDDLE CEREBRAL ARTERY

S61222A

LACERATION W FB OF R MID FINGER W/O DAMAGE TO NAIL INIT

I63321

CEREBRAL INFRC DUE TO THOMBOS OF RIGHT ANT CEREBRAL ARTERY

S61223A

LACERATION W FB OF L MID FINGER W/O DAMAGE TO NAIL INIT

I63322

CEREBRAL INFRC DUE TO THOMBOS OF LEFT ANT CEREBRAL ARTERY

S61224A

LACERATION W FB OF R RNG FNGR W/O DAMAGE TO NAIL INIT

I63323

Cerebral infarction due to thrombosis of bilateral anterior arteries

S61225A

LACERATION W FB OF L RNG FNGR W/O DAMAGE TO NAIL INIT

I63329

CEREBRAL INFRC DUE TO THOMBOS UNSP ANTERIOR CEREBRAL ARTERY

S61226A

LACERATION W FB OF R LITTLE FINGER W/O DAMAGE TO NAIL INIT

I63331

CEREBRAL INFRC DUE TO THOMBOS OF RIGHT POST CEREBRAL ARTERY

S61227A

LACERATION W FB OF L LITTLE FINGER W/O DAMAGE TO NAIL INIT

I63332

CEREBRAL INFRC DUE TO THOMBOS OF LEFT POST CEREBRAL ARTERY

S61230A

PNCTR W/O FB OF R IDX FNGR W/O DAMAGE TO NAIL INIT

I63333

Cerebral infarction to thrombosis of bilateral posterior arteries

S61231A

PNCTR W/O FB OF L IDX FNGR W/O DAMAGE TO NAIL INIT

I63343

Cerebral infarction to thrombosis of bilateral cerebellar arteries

S61232A

PNCTR W/O FB OF R MID FINGER W/O DAMAGE TO NAIL INIT

I63339

CEREBRAL INFRC DUE TO THOMBOS UNSP POSTERIOR CEREBRAL ARTERY

S61233A

PNCTR W/O FB OF L MID FINGER W/O DAMAGE TO NAIL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I63341

CEREBRAL INFRC DUE TO THROMBOSIS OF RIGHT CEREBLR ARTERY

S61234A

PNCTR W/O FB OF R RNG FNGR W/O DAMAGE TO NAIL INIT

I63342

CEREBRAL INFARCTION DUE TO THROMBOSIS OF LEFT CEREBLR ARTERY

S61235A

PNCTR W/O FB OF L RNG FNGR W/O DAMAGE TO NAIL INIT

I63349

CEREBRAL INFARCTION DUE TO THOMBOS UNSP CEREBELLAR ARTERY

S61236A

PNCTR W/O FB OF R LITTLE FINGER W/O DAMAGE TO NAIL INIT

I6339

CEREBRAL INFARCTION DUE TO THROMBOSIS OF OTH CEREBRAL ARTERY

S61237A

PNCTR W/O FB OF L LITTLE FINGER W/O DAMAGE TO NAIL INIT

I6340

CEREBRAL INFARCTION DUE TO EMBOLISM OF UNSP CEREBRAL ARTERY

S61238A

PNCTR W/O FOREIGN BODY OF FINGER W/O DAMAGE TO NAIL INIT

I63411

CEREB INFRC DUE TO EMBOLISM OF RIGHT MIDDLE CEREBRAL ARTERY

S61240A

PNCTR W FOREIGN BODY OF R IDX FNGR W/O DAMAGE TO NAIL INIT

I63412

CEREB INFRC DUE TO EMBOLISM OF LEFT MIDDLE CEREBRAL ARTERY

S61241A

PNCTR W FOREIGN BODY OF L IDX FNGR W/O DAMAGE TO NAIL INIT

I63413

Cerebral infarction due to embolism of bilateral middle cerebral arteries

S61242A

PNCTR W FB OF R MID FINGER W/O DAMAGE TO NAIL INIT

I63419

CEREB INFRC DUE TO EMBOLISM OF UNSP MIDDLE CEREBRAL ARTERY

S61243A

PNCTR W FB OF L MID FINGER W/O DAMAGE TO NAIL INIT

I63421

CEREBRAL INFRC DUE TO EMBOLISM OF RIGHT ANT CEREBRAL ARTERY

S61244A

PNCTR W FOREIGN BODY OF R RNG FNGR W/O DAMAGE TO NAIL INIT

I63422

CEREBRAL INFRC DUE TO EMBOLISM OF LEFT ANT CEREBRAL ARTERY

S61245A

PNCTR W FOREIGN BODY OF L RNG FNGR W/O DAMAGE TO NAIL INIT

I63423

Cerebral infarction due to embolism of bilateral anterior cerebral arteries

S61246A

PNCTR W FB OF R LITTLE FINGER W/O DAMAGE TO NAIL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I63429

CEREBRAL INFRC DUE TO EMBOLISM OF UNSP ANT CEREBRAL ARTERY

S61247A

PNCTR W FB OF L LITTLE FINGER W/O DAMAGE TO NAIL INIT

I63431

CEREBRAL INFRC DUE TO EMBOLISM OF RIGHT POST CEREBRAL ARTERY

S61250A

OPEN BITE OF RIGHT INDEX FINGER W/O DAMAGE TO NAIL INIT

I63432

CEREBRAL INFRC DUE TO EMBOLISM OF LEFT POST CEREBRAL ARTERY

S61251A

OPEN BITE OF LEFT INDEX FINGER W/O DAMAGE TO NAIL INIT

I63433

Cerebral infarction due to embolism of bilateral posterior cerebral arteries

S61252A

OPEN BITE OF RIGHT MIDDLE FINGER W/O DAMAGE TO NAIL INIT

I63439

CEREBRAL INFRC DUE TO EMBOLISM OF UNSP POST CEREBRAL ARTERY

S61253A

OPEN BITE OF LEFT MIDDLE FINGER W/O DAMAGE TO NAIL INIT

I63441

CEREBRAL INFARCTION DUE TO EMBOLISM OF RIGHT CEREBLR ARTERY

S61254A

OPEN BITE OF RIGHT RING FINGER W/O DAMAGE TO NAIL INIT

I63442

CEREBRAL INFARCTION DUE TO EMBOLISM OF LEFT CEREBLR ARTERY

S61255A

OPEN BITE OF LEFT RING FINGER W/O DAMAGE TO NAIL INIT

I63443

Cerebral infarction due to embolism of bilateral cerebellar arteries

S61256A

OPEN BITE OF RIGHT LITTLE FINGER W/O DAMAGE TO NAIL INIT

I63449

CEREBRAL INFARCTION DUE TO EMBOLISM OF UNSP CEREBLR ARTERY

S61257A

OPEN BITE OF LEFT LITTLE FINGER W/O DAMAGE TO NAIL INIT

I6349

CEREBRAL INFARCTION DUE TO EMBOLISM OF OTHER CEREBRAL ARTERY

S61258A

OPEN BITE OF OTHER FINGER W/O DAMAGE TO NAIL INIT ENCNTR

I6350

CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF UNSP CEREB ARTERY

S61300A

UNSP OPEN WOUND OF RIGHT INDEX FINGER W DAMAGE TO NAIL INIT

I63511

CEREB INFRC D/T UNSP OCCLS OR STENOS OF RIGHT MID CEREB ART

S61301A

UNSP OPEN WOUND OF LEFT INDEX FINGER W DAMAGE TO NAIL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I63512

CEREB INFRC D/T UNSP OCCLS OR STENOS OF LEFT MID CEREB ART

S61302A

UNSP OPEN WOUND OF R MID FINGER W DAMAGE TO NAIL INIT

I63513

Cerebral infarction due to unspecified occlusion or stenosis of bilateral middle arteries

S61303A

UNSP OPEN WOUND OF LEFT MIDDLE FINGER W DAMAGE TO NAIL INIT

I63519

CEREB INFRC D/T UNSP OCCLS OR STENOS OF UNSP MID CEREB ART

S61304A

UNSP OPEN WOUND OF RIGHT RING FINGER W DAMAGE TO NAIL INIT

I63521

CEREB INFRC D/T UNSP OCCLS OR STENOS OF RIGHT ANT CEREB ART

S61305A

UNSP OPEN WOUND OF LEFT RING FINGER W DAMAGE TO NAIL INIT

I63522

CEREB INFRC D/T UNSP OCCLS OR STENOS OF LEFT ANT CEREB ART

S61306A

UNSP OPEN WOUND OF R LITTLE FINGER W DAMAGE TO NAIL INIT

I63523

Cerebral infarction due to unspecified occlusion or stenosis of bilateral anterior arteries

S61307A

UNSP OPEN WOUND OF LEFT LITTLE FINGER W DAMAGE TO NAIL INIT

I63529

CEREB INFRC D/T UNSP OCCLS OR STENOS OF UNSP ANT CEREB ART

S61310A

LACERATION W/O FB OF R IDX FNGR W DAMAGE TO NAIL INIT

I63531

CEREB INFRC D/T UNSP OCCLS OR STENOS OF RIGHT POST CEREB ART

S61311A

LACERATION W/O FB OF L IDX FNGR W DAMAGE TO NAIL INIT

I63532

CEREB INFRC D/T UNSP OCCLS OR STENOS OF LEFT POST CEREB ART

S61312A

LACERATION W/O FB OF R MID FINGER W DAMAGE TO NAIL INIT

I63533

Cerebral infarction due to unspecified occlusion or stenosis of bilateral posterior arteries

S61313A

LACERATION W/O FB OF L MID FINGER W DAMAGE TO NAIL INIT

I63539

CEREB INFRC D/T UNSP OCCLS OR STENOS OF UNSP POST CEREB ART

S61314A

LACERATION W/O FB OF R RNG FNGR W DAMAGE TO NAIL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I63541

CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF RIGHT CEREBLR ART

S61315A

LACERATION W/O FB OF L RNG FNGR W DAMAGE TO NAIL INIT

I63542

CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF LEFT CEREBLR ART

S61316A

LACERATION W/O FB OF R LITTLE FINGER W DAMAGE TO NAIL INIT

I63543

Cerebral infarction due to unspecified occlusion or stenosis of bilateral cerebellar arteries

S61317A

LACERATION W/O FB OF L LITTLE FINGER W DAMAGE TO NAIL INIT

I63549

CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF UNSP CEREBLR ART

S61320A

LACERATION W FB OF R IDX FNGR W DAMAGE TO NAIL INIT

I6359

CEREB INFRC DUE TO UNSP OCCLS OR STENOSIS OF CEREBRAL ARTERY

S61321A

LACERATION W FB OF L IDX FNGR W DAMAGE TO NAIL INIT

I636

CEREBRAL INFRC DUE TO CEREBRAL VENOUS THOMBOS NONPYOGENIC

S61322A

LACERATION W FB OF R MID FINGER W DAMAGE TO NAIL INIT

I638 OTHER CEREBRAL INFARCTION

S61323A LACERATION W FB OF L MID FINGER W DAMAGE TO NAIL INIT

I639 CEREBRAL INFARCTION UNSPECIFIED

S61324A

LACERATION W FB OF R RNG FNGR W DAMAGE TO NAIL INIT

I6501 OCCLUSION AND STENOSIS OF RIGHT VERTEBRAL ARTERY

S61325A

LACERATION W FB OF L RNG FNGR W DAMAGE TO NAIL INIT

I6502 OCCLUSION AND STENOSIS OF LEFT VERTEBRAL ARTERY

S61326A

LACERATION W FB OF R LITTLE FINGER W DAMAGE TO NAIL INIT

I6503

OCCLUSION AND STENOSIS OF BILATERAL VERTEBRAL ARTERIES

S61327A

LACERATION W FB OF L LITTLE FINGER W DAMAGE TO NAIL INIT

I6509

OCCLUSION AND STENOSIS OF UNSPECIFIED VERTEBRAL ARTERY

S61328A

LACERATION W FOREIGN BODY OF FINGER W DAMAGE TO NAIL INIT

I651 OCCLUSION AND STENOSIS OF BASILAR ARTERY

S61330A

PNCTR W/O FOREIGN BODY OF R IDX FNGR W DAMAGE TO NAIL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I6521 OCCLUSION AND STENOSIS OF RIGHT CAROTID ARTERY

S61331A

PNCTR W/O FOREIGN BODY OF L IDX FNGR W DAMAGE TO NAIL INIT

I6522 OCCLUSION AND STENOSIS OF LEFT CAROTID ARTERY

S61332A

PNCTR W/O FB OF R MID FINGER W DAMAGE TO NAIL INIT

I6523 OCCLUSION AND STENOSIS OF BILATERAL CAROTID ARTERIES

S61333A

PNCTR W/O FB OF L MID FINGER W DAMAGE TO NAIL INIT

I6529 OCCLUSION AND STENOSIS OF UNSPECIFIED CAROTID ARTERY

S61334A

PNCTR W/O FOREIGN BODY OF R RNG FNGR W DAMAGE TO NAIL INIT

I658 OCCLUSION AND STENOSIS OF OTHER PRECEREBRAL ARTERIES

S61335A

PNCTR W/O FOREIGN BODY OF L RNG FNGR W DAMAGE TO NAIL INIT

I659

OCCLUSION AND STENOSIS OF UNSPECIFIED PRECEREBRAL ARTERY

S61336A

PNCTR W/O FB OF R LITTLE FINGER W DAMAGE TO NAIL INIT

I6601

OCCLUSION AND STENOSIS OF RIGHT MIDDLE CEREBRAL ARTERY

S61337A

PNCTR W/O FB OF L LITTLE FINGER W DAMAGE TO NAIL INIT

I6602 OCCLUSION AND STENOSIS OF LEFT MIDDLE CEREBRAL ARTERY

S61340A

PNCTR W FOREIGN BODY OF R IDX FNGR W DAMAGE TO NAIL INIT

I6603

OCCLUSION AND STENOSIS OF BILATERAL MIDDLE CEREBRAL ARTERIES

S61341A

PNCTR W FOREIGN BODY OF L IDX FNGR W DAMAGE TO NAIL INIT

I6609

OCCLUSION AND STENOSIS OF UNSPECIFIED MIDDLE CEREBRAL ARTERY

S61342A

PNCTR W FOREIGN BODY OF R MID FINGER W DAMAGE TO NAIL INIT

I6611

OCCLUSION AND STENOSIS OF RIGHT ANTERIOR CEREBRAL ARTERY

S61343A

PNCTR W FOREIGN BODY OF L MID FINGER W DAMAGE TO NAIL INIT

I6612

OCCLUSION AND STENOSIS OF LEFT ANTERIOR CEREBRAL ARTERY

S61344A

PNCTR W FOREIGN BODY OF R RNG FNGR W DAMAGE TO NAIL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I6613

OCCLUSION AND STENOSIS OF BI ANTERIOR CEREBRAL ARTERIES

S61345A

PNCTR W FOREIGN BODY OF L RNG FNGR W DAMAGE TO NAIL INIT

I6619

OCCLUSION AND STENOSIS OF UNSP ANTERIOR CEREBRAL ARTERY

S61346A

PNCTR W FB OF R LITTLE FINGER W DAMAGE TO NAIL INIT

I6621

OCCLUSION AND STENOSIS OF RIGHT POSTERIOR CEREBRAL ARTERY

S61347A

PNCTR W FB OF L LITTLE FINGER W DAMAGE TO NAIL INIT

I6622

OCCLUSION AND STENOSIS OF LEFT POSTERIOR CEREBRAL ARTERY

S61350A

OPEN BITE OF RIGHT INDEX FINGER W DAMAGE TO NAIL INIT

I6623

OCCLUSION AND STENOSIS OF BI POSTERIOR CEREBRAL ARTERIES

S61351A

OPEN BITE OF LEFT INDEX FINGER W DAMAGE TO NAIL INIT ENCNTR

I6629

OCCLUSION AND STENOSIS OF UNSP POSTERIOR CEREBRAL ARTERY

S61352A

OPEN BITE OF RIGHT MIDDLE FINGER W DAMAGE TO NAIL INIT

I663 OCCLUSION AND STENOSIS OF CEREBELLAR ARTERIES

S61353A

OPEN BITE OF LEFT MIDDLE FINGER W DAMAGE TO NAIL INIT

I668 OCCLUSION AND STENOSIS OF OTHER CEREBRAL ARTERIES

S61354A

OPEN BITE OF RIGHT RING FINGER W DAMAGE TO NAIL INIT ENCNTR

I669 OCCLUSION AND STENOSIS OF UNSPECIFIED CEREBRAL ARTERY

S61355A

OPEN BITE OF LEFT RING FINGER W DAMAGE TO NAIL INIT ENCNTR

I670 DISSECTION OF CEREBRAL ARTERIES NONRUPTURED

S61356A

OPEN BITE OF RIGHT LITTLE FINGER W DAMAGE TO NAIL INIT

I671 CEREBRAL ANEURYSM NONRUPTURED

S61357A

OPEN BITE OF LEFT LITTLE FINGER W DAMAGE TO NAIL INIT

I672 CEREBRAL ATHEROSCLEROSIS

S61358A OPEN BITE OF OTHER FINGER WITH DAMAGE TO NAIL INIT ENCNTR

I673 PROGRESSIVE VASCULAR LEUKOENCEPHALOPATHY

S61401A

UNSPECIFIED OPEN WOUND OF RIGHT HAND INITIAL ENCOUNTER

I674 HYPERTENSIVE ENCEPHALOPATHY

S61402A

UNSPECIFIED OPEN WOUND OF LEFT HAND INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I675 MOYAMOYA DISEASE

S61411A LACERATION WITHOUT FOREIGN BODY OF RIGHT HAND INIT ENCNTR

I676

NONPYOGENIC THROMBOSIS OF INTRACRANIAL VENOUS SYSTEM

S61412A

LACERATION WITHOUT FOREIGN BODY OF LEFT HAND INIT ENCNTR

I677 CEREBRAL ARTERITIS NOT ELSEWHERE CLASSIFIED

S61421A

LACERATION WITH FOREIGN BODY OF RIGHT HAND INIT ENCNTR

I679 CEREBROVASCULAR DISEASE UNSPECIFIED

S61422A

LACERATION WITH FOREIGN BODY OF LEFT HAND INITIAL ENCOUNTER

I680 CEREBRAL AMYLOID ANGIOPATHY

S61431A

PUNCTURE WOUND W/O FOREIGN BODY OF RIGHT HAND INIT ENCNTR

I682

CEREBRAL ARTERITIS IN OTHER DISEASES CLASSIFIED ELSEWHERE

S61432A

PUNCTURE WOUND W/O FOREIGN BODY OF LEFT HAND INIT ENCNTR

I688

OTH CEREBROVASCULAR DISORDERS IN DISEASES CLASSD ELSWHR

S61441A

PUNCTURE WOUND WITH FOREIGN BODY OF RIGHT HAND INIT ENCNTR

I6900

UNSPECIFIED SEQUELAE OF NONTRAUMATIC SUBARACHNOID HEMORRHAGE

S61442A

PUNCTURE WOUND WITH FOREIGN BODY OF LEFT HAND INIT ENCNTR

I6901

COGNITIVE DEFICITS FOLLOWING NTRM SUBARACHNOID HEMORRHAGE

S61451A

OPEN BITE OF RIGHT HAND INITIAL ENCOUNTER

I69010

Attention and concentration deficit following nontraumatic subarachnoid hemorrhage

S61452A

OPEN BITE OF LEFT HAND INITIAL ENCOUNTER

I69011

Memory deficit following nontraumatic subarachnoid hemorrhage

S61501A

UNSPECIFIED OPEN WOUND OF RIGHT WRIST INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69012

Visuospatial deficit and spatial neglect following nontraumatic subarachnoid hemorrhage

S61502A

UNSPECIFIED OPEN WOUND OF LEFT WRIST INITIAL ENCOUNTER

I69013

Psychomotor deficit following nontraumatic subarachnoid hemorrhage

S61511A

LACERATION WITHOUT FOREIGN BODY OF RIGHT WRIST INIT ENCNTR

I69014

Frontal lobe and executive function deficit following nontraumatic subarachnoid hemorrhage

S61512A

LACERATION WITHOUT FOREIGN BODY OF LEFT WRIST INIT ENCNTR

I69015

Cognitive social or emotional deficit following nontraumatic subarachnoid hemorrhage

S61521A

LACERATION WITH FOREIGN BODY OF RIGHT WRIST INIT ENCNTR

I69018

Other symptoms and signs involving cognitive functions following nontraumatic subarachnoid hemorrhage

S61522A

LACERATION WITH FOREIGN BODY OF LEFT WRIST INIT ENCNTR

I69019

Unspecified symptoms and signs involving cognitive functions following nontraumatic subarachnoid hemorrhage

S61531A

PUNCTURE WOUND W/O FOREIGN BODY OF RIGHT WRIST INIT ENCNTR

I69021

DYSPHASIA FOLLOWING NONTRAUMATIC SUBARACHNOID HEMORRHAGE

S61532A

PUNCTURE WOUND W/O FOREIGN BODY OF LEFT WRIST INIT ENCNTR

I69022

DYSARTHRIA FOLLOWING NONTRAUMATIC SUBARACHNOID HEMORRHAGE

S61541A

PUNCTURE WOUND WITH FOREIGN BODY OF RIGHT WRIST INIT ENCNTR

I69023

FLUENCY DISORDER FOLLOWING NTRM SUBARACHNOID HEMORRHAGE

S61542A

PUNCTURE WOUND WITH FOREIGN BODY OF LEFT WRIST INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69028

OTH SPEECH/LANG DEFICITS FOLLOWING NTRM SUBARACH HEMORRHAGE

S61551A

OPEN BITE OF RIGHT WRIST INITIAL ENCOUNTER

I69031

MONOPLG UPR LMB FOL NTRM SUBARACH HEMOR AFF RIGHT DOM SIDE

S61552A

OPEN BITE OF LEFT WRIST INITIAL ENCOUNTER

I69032

MONOPLG UPR LMB FOL NTRM SUBARACH HEMOR AFF LEFT DOM SIDE

S62001A

UNSP FRACTURE OF NAVICULAR BONE OF RIGHT WRIST INIT

I69033

MONOPLG UPR LMB FOL NTRM SUBARACH HEMOR AFF R NONDOM SIDE

S62001B

UNSP FX NAVICULAR BONE OF RIGHT WRIST INIT FOR OPN FX

I69034

MONOPLG UPR LMB FOL NTRM SUBARACH HEMOR AFF LEFT NONDOM SIDE

S62002A

UNSP FRACTURE OF NAVICULAR BONE OF LEFT WRIST INIT

I69039

MONOPLG UPR LMB FOLLOWING NTRM SUBARACH HEMOR AFF UNSP SIDE

S62002B

UNSP FX NAVICULAR BONE OF LEFT WRIST INIT FOR OPN FX

I69041

MONOPLG LOW LMB FOL NTRM SUBARACH HEMOR AFF RIGHT DOM SIDE

S62011A

DISP FX OF DISTAL POLE OF NAVICULAR BONE OF R WRIST INIT

I69042

MONOPLG LOW LMB FOL NTRM SUBARACH HEMOR AFF LEFT DOM SIDE

S62011B

DISP FX OF DIST POLE OF NAVIC BONE OF R WRS INIT FOR OPN FX

I69043

MONOPLG LOW LMB FOL NTRM SUBARACH HEMOR AFF R NONDOM SIDE

S62012A

DISP FX OF DISTAL POLE OF NAVICULAR BONE OF LEFT WRIST INIT

I69044

MONOPLG LOW LMB FOL NTRM SUBARACH HEMOR AFF LEFT NONDOM SIDE

S62012B

DISP FX OF DIST POLE OF NAVIC BONE OF L WRS INIT FOR OPN FX

I69049

MONOPLG LOW LMB FOLLOWING NTRM SUBARACH HEMOR AFF UNSP SIDE

S62014A

NONDISP FX OF DISTAL POLE OF NAVICULAR BONE OF R WRIST INIT

I69051

HEMIPLGA FOL NTRM SUBARACH HEMOR AFF RIGHT DOMINANT SIDE

S62014B

NONDISP FX OF DIST POLE OF NAVIC BONE OF R WRS 7THB

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69052

HEMIPLGA FOL NTRM SUBARACH HEMOR AFF LEFT DOMINANT SIDE

S62015A

NONDISP FX OF DISTAL POLE OF NAVICULAR BONE OF L WRIST INIT

I69053

HEMIPLGA FOLLOWING NTRM SUBARACH HEMOR AFF RIGHT NONDOM SIDE

S62015B

NONDISP FX OF DIST POLE OF NAVIC BONE OF L WRS 7THB

I69054

HEMIPLGA FOLLOWING NTRM SUBARACH HEMOR AFF LEFT NONDOM SIDE

S62021A

DISP FX OF MIDDLE THIRD OF NAVICULAR BONE OF R WRIST INIT

I69059

HEMIPLGA FOLLOWING NTRM SUBARACH HEMOR AFFECTING UNSP SIDE

S62021B

DISP FX OF MID 3RD OF NAVIC BONE OF R WRIST INIT FOR OPN FX

I69061

OTH PARLYT SYND FOL NTRM SUBARACH HEMOR AFF RIGHT DOM SIDE

S62022A

DISP FX OF MIDDLE THIRD OF NAVICULAR BONE OF L WRIST INIT

I69062

OTH PARLYT SYND FOL NTRM SUBARACH HEMOR AFF LEFT DOM SIDE

S62022B

DISP FX OF MID 3RD OF NAVIC BONE OF L WRIST INIT FOR OPN FX

I69063

OTH PARLYT SYND FOL NTRM SUBARACH HEMOR AFF R NONDOM SIDE

S62024A

NONDISP FX OF MIDDLE THIRD OF NAVIC BONE OF R WRIST INIT

I69064

OTH PARLYT SYND FOL NTRM SUBARACH HEMOR AFF LEFT NONDOM SIDE

S62024B

NONDISP FX OF MID 3RD OF NAVIC BONE OF R WRS 7THB

I69065

OTH PARALYTIC SYNDROME FOLLOWING NTRM SUBARACH HEMOR BI

S62025A

NONDISP FX OF MIDDLE THIRD OF NAVIC BONE OF L WRIST INIT

I69069

OTH PARALYTIC SYNDROME FOL NTRM SUBARACH HEMOR AFF UNSP SIDE

S62025B

NONDISP FX OF MID 3RD OF NAVIC BONE OF L WRS 7THB

I69090

APRAXIA FOLLOWING NONTRAUMATIC SUBARACHNOID HEMORRHAGE

S62031A

DISP FX OF PROXIMAL THIRD OF NAVICULAR BONE OF R WRIST INIT

I69091

DYSPHAGIA FOLLOWING NONTRAUMATIC SUBARACHNOID HEMORRHAGE

S62031B

DISP FX OF PROX 3RD OF NAVIC BONE OF R WRS INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69092

FACIAL WEAKNESS FOLLOWING NTRM SUBARACHNOID HEMORRHAGE

S62032A

DISP FX OF PROXIMAL THIRD OF NAVICULAR BONE OF L WRIST INIT

I69093

ATAXIA FOLLOWING NONTRAUMATIC SUBARACHNOID HEMORRHAGE

S62032B

DISP FX OF PROX 3RD OF NAVIC BONE OF L WRS INIT FOR OPN FX

I69098

OTH SEQUELAE FOLLOWING NONTRAUMATIC SUBARACHNOID HEMORRHAGE

S62034A

NONDISP FX OF PROXIMAL THIRD OF NAVIC BONE OF R WRIST INIT

I6910

UNSP SEQUELAE OF NONTRAUMATIC INTRACEREBRAL HEMORRHAGE

S62034B

NONDISP FX OF PROX 3RD OF NAVIC BONE OF R WRS 7THB

I6911

COGNITIVE DEFICITS FOLLOWING NONTRAUMATIC INTCRBL HEMORRHAGE

S62035A

NONDISP FX OF PROXIMAL THIRD OF NAVIC BONE OF L WRIST INIT

I69110

Attention and concentration deficit following nontraumatic intracerebral hemorrhage

S62035B

NONDISP FX OF PROX 3RD OF NAVIC BONE OF L WRS 7THB

I69111

Memory deficit following nontraumatic intracerebral hemorrhage

S62101A

FRACTURE OF UNSP CARPAL BONE RIGHT WRIST INIT FOR CLOS FX

I69112

Visuospatial deficit and spatial neglect following nontraumatic intracerebral hemorrhage

S62101B

FRACTURE OF UNSP CARPAL BONE RIGHT WRIST INIT FOR OPN FX

I69113

Psychomotor deficit following nontraumatic intracerebral hemorrhage

S62102A

FRACTURE OF UNSP CARPAL BONE LEFT WRIST INIT FOR CLOS FX

I69114

Frontal lobe and executive function deficit following nontraumatic intracerebral hemorrhage

S62102B

FRACTURE OF UNSP CARPAL BONE LEFT WRIST INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69115

Cognitive social or emotional deficit following nontraumatic intracerebral hemorrhage

S62111A

DISP FX OF TRIQUETRUM BONE RIGHT WRIST INIT FOR CLOS FX

I69118

Other symptoms and signs involving cognitive functions following nontraumatic intracerebral hemorrhage

S62111B

DISP FX OF TRIQUETRUM BONE RIGHT WRIST INIT FOR OPN FX

I69119

Unspecified symptoms and signs involving cognitive functions following nontraumatic intracerebral hemorrhage

S62112A

DISP FX OF TRIQUETRUM BONE LEFT WRIST INIT FOR CLOS FX

I69120

APHASIA FOLLOWING NONTRAUMATIC INTRACEREBRAL HEMORRHAGE

S62112B

DISP FX OF TRIQUETRUM BONE LEFT WRIST INIT FOR OPN FX

I69121

DYSPHASIA FOLLOWING NONTRAUMATIC INTRACEREBRAL HEMORRHAGE

S62114A

NONDISP FX OF TRIQUETRUM BONE RIGHT WRIST INIT FOR CLOS FX

I69122

DYSARTHRIA FOLLOWING NONTRAUMATIC INTRACEREBRAL HEMORRHAGE

S62114B

NONDISP FX OF TRIQUETRUM BONE RIGHT WRIST INIT FOR OPN FX

I69123

FLUENCY DISORDER FOLLOWING NONTRAUMATIC INTCRBL HEMORRHAGE

S62115A

NONDISP FX OF TRIQUETRUM BONE LEFT WRIST INIT FOR CLOS FX

I69128

OTH SPEECH/LANG DEFICITS FOLLOWING NTRM INTCRBL HEMORRHAGE

S62115B

NONDISP FX OF TRIQUETRUM BONE LEFT WRIST INIT FOR OPN FX

I69131

MONOPLG UPR LMB FOL NTRM INTCRBL HEMOR AFF RIGHT DOM SIDE

S62121A

DISP FX OF LUNATE RIGHT WRIST INIT FOR CLOS FX

I69132

MONOPLG UPR LMB FOL NTRM INTCRBL HEMOR AFF LEFT DOM SIDE

S62121B

DISP FX OF LUNATE RIGHT WRIST INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69133

MONOPLG UPR LMB FOL NTRM INTCRBL HEMOR AFF RIGHT NONDOM SIDE

S62164A

NONDISP FX OF PISIFORM RIGHT WRIST INIT FOR CLOS FX

I69134

MONOPLG UPR LMB FOL NTRM INTCRBL HEMOR AFF LEFT NONDOM SIDE

S62164B

NONDISP FX OF PISIFORM RIGHT WRIST INIT FOR OPN FX

I69139

MONOPLG UPR LMB FOLLOWING NTRM INTCRBL HEMOR AFF UNSP SIDE

S62165A

NONDISP FX OF PISIFORM LEFT WRIST INIT FOR CLOS FX

I69141

MONOPLG LOW LMB FOL NTRM INTCRBL HEMOR AFF RIGHT DOM SIDE

S62165B

NONDISP FX OF PISIFORM LEFT WRIST INIT FOR OPN FX

I69142

MONOPLG LOW LMB FOL NTRM INTCRBL HEMOR AFF LEFT DOM SIDE

S62171A

DISP FX OF TRAPEZIUM RIGHT WRIST INIT FOR CLOS FX

I69143

MONOPLG LOW LMB FOL NTRM INTCRBL HEMOR AFF RIGHT NONDOM SIDE

S62171B

DISP FX OF TRAPEZIUM RIGHT WRIST INIT FOR OPN FX

I69144

MONOPLG LOW LMB FOL NTRM INTCRBL HEMOR AFF LEFT NONDOM SIDE

S62172A

DISP FX OF TRAPEZIUM LEFT WRIST INIT FOR CLOS FX

I69149

MONOPLG LOW LMB FOLLOWING NTRM INTCRBL HEMOR AFF UNSP SIDE

S62172B

DISP FX OF TRAPEZIUM LEFT WRIST INIT FOR OPN FX

I69151

HEMIPLGA FOL NTRM INTCRBL HEMOR AFF RIGHT DOMINANT SIDE

S62174A

NONDISP FX OF TRAPEZIUM RIGHT WRIST INIT FOR CLOS FX

I69152

HEMIPLGA FOLLOWING NTRM INTCRBL HEMOR AFF LEFT DOMINANT SIDE

S62174B

NONDISP FX OF TRAPEZIUM RIGHT WRIST INIT FOR OPN FX

I69153

HEMIPLGA FOLLOWING NTRM INTCRBL HEMOR AFF RIGHT NONDOM SIDE

S62175A

NONDISP FX OF TRAPEZIUM LEFT WRIST INIT FOR CLOS FX

I69154

HEMIPLGA FOLLOWING NTRM INTCRBL HEMOR AFF LEFT NONDOM SIDE

S62175B

NONDISP FX OF TRAPEZIUM LEFT WRIST INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69159

HEMIPLGA FOLLOWING NTRM INTCRBL HEMOR AFFECTING UNSP SIDE

S62181A

DISP FX OF TRAPEZOID RIGHT WRIST INIT FOR CLOS FX

I69161

OTH PARLYT SYND FOL NTRM INTCRBL HEMOR AFF RIGHT DOM SIDE

S62181B

DISP FX OF TRAPEZOID RIGHT WRIST INIT FOR OPN FX

I69162

OTH PARLYT SYNDROME FOL NTRM INTCRBL HEMOR AFF LEFT DOM SIDE

S62182A

DISP FX OF TRAPEZOID LEFT WRIST INIT FOR CLOS FX

I69163

OTH PARLYT SYND FOL NTRM INTCRBL HEMOR AFF RIGHT NONDOM SIDE

S62182B

DISP FX OF TRAPEZOID LEFT WRIST INIT FOR OPN FX

I69164

OTH PARLYT SYND FOL NTRM INTCRBL HEMOR AFF LEFT NONDOM SIDE

S62184A

NONDISP FX OF TRAPEZOID RIGHT WRIST INIT FOR CLOS FX

I69165

OTH PARALYTIC SYNDROME FOLLOWING NTRM INTCRBL HEMOR BI

S62184B

NONDISP FX OF TRAPEZOID RIGHT WRIST INIT FOR OPN FX

I69169

OTH PARALYTIC SYNDROME FOL NTRM INTCRBL HEMOR AFF UNSP SIDE

S62185A

NONDISP FX OF TRAPEZOID LEFT WRIST INIT FOR CLOS FX

I69190

APRAXIA FOLLOWING NONTRAUMATIC INTRACEREBRAL HEMORRHAGE

S62185B

NONDISP FX OF TRAPEZOID LEFT WRIST INIT FOR OPN FX

I69191

DYSPHAGIA FOLLOWING NONTRAUMATIC INTRACEREBRAL HEMORRHAGE

S62201A

UNSP FRACTURE OF FIRST METACARPAL BONE RIGHT HAND INIT

I69192

FACIAL WEAKNESS FOLLOWING NONTRAUMATIC INTCRBL HEMORRHAGE

S62201B

UNSP FX FIRST METACARPAL BONE RIGHT HAND INIT FOR OPN FX

I69193

ATAXIA FOLLOWING NONTRAUMATIC INTRACEREBRAL HEMORRHAGE

S62202A

UNSP FRACTURE OF FIRST METACARPAL BONE LEFT HAND INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69198

OTHER SEQUELAE OF NONTRAUMATIC INTRACEREBRAL HEMORRHAGE

S62202B

UNSP FX FIRST METACARPAL BONE LEFT HAND INIT FOR OPN FX

I6920

UNSP SEQUELAE OF OTHER NONTRAUMATIC INTRACRANIAL HEMORRHAGE

S62211A

BENNETT'S FRACTURE RIGHT HAND INIT FOR CLOS FX

I6921

COGNITIVE DEFICITS FOLLOWING OTH NTRM INTCRN HEMORRHAGE

S62211B

BENNETT'S FRACTURE RIGHT HAND INIT FOR OPN FX

I69210

Attention and concentration deficit following other nontraumatic intracranial hemorrhage

S62212A

BENNETT'S FRACTURE LEFT HAND INIT FOR CLOS FX

I69211

Memory deficit following other nontraumatic intracranial hemorrhage

S62212B

BENNETT'S FRACTURE LEFT HAND INIT ENCNTR FOR OPEN FRACTURE

I69212

Visuospatial deficit and spatial neglect following other nontraumatic intracranial hemorrhage

S62221A

DISPLACED ROLANDO'S FRACTURE RIGHT HAND INIT FOR CLOS FX

I69213

Psychomotor deficit following other nontraumatic intracranial hemorrhage

S62221B

DISPLACED ROLANDO'S FRACTURE RIGHT HAND INIT FOR OPN FX

I69214

Frontal lobe and executive function deficit following other nontraumatic intracranial hemorrhage

S62222A

DISPLACED ROLANDO'S FRACTURE LEFT HAND INIT FOR CLOS FX

I69215

Cognitive social or emotional deficit following other nontraumatic intracranial hemorrhage

S62222B

DISPLACED ROLANDO'S FRACTURE LEFT HAND INIT FOR OPN FX

I69218

Other symptoms and signs involving cognitive functions following other nontraumatic intracranial hemorrhage

S62224A

NONDISPLACED ROLANDO'S FRACTURE RIGHT HAND INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69219

Unspecified symptoms and signs involving cognitive functions following other nontraumatic intracranial hemorrhage

S62224B

NONDISPLACED ROLANDO'S FRACTURE RIGHT HAND INIT FOR OPN FX

I69220

APHASIA FOLLOWING OTHER NONTRAUMATIC INTRACRANIAL HEMORRHAGE

S62225A

NONDISPLACED ROLANDO'S FRACTURE LEFT HAND INIT FOR CLOS FX

I69221

DYSPHASIA FOLLOWING OTH NONTRAUMATIC INTRACRANIAL HEMORRHAGE

S62225B

NONDISPLACED ROLANDO'S FRACTURE LEFT HAND INIT FOR OPN FX

I69222

DYSARTHRIA FOLLOWING OTH NONTRAUMATIC INTCRN HEMORRHAGE

S62231A

OTH DISP FX OF BASE OF FIRST MC BONE RIGHT HAND INIT

I69223

FLUENCY DISORDER FOLLOWING OTH NTRM INTCRN HEMORRHAGE

S62231B

OTH DISP FX OF BASE OF 1ST MC BONE R HAND INIT FOR OPN FX

I69228

OTH SPEECH/LANG DEFICITS FOLLOWING OTH NTRM INTCRN HEMOR

S62232A

OTH DISP FX OF BASE OF FIRST MC BONE LEFT HAND INIT

I69231

MONOPLG UPR LMB FOL OTH NTRM INTCRN HEMOR AFF RIGHT DOM SIDE

S62232B

OTH DISP FX OF BASE OF 1ST MC BONE L HAND INIT FOR OPN FX

I69232

MONOPLG UPR LMB FOL OTH NTRM INTCRN HEMOR AFF LEFT DOM SIDE

S62233A

OTH DISP FX OF BASE OF FIRST MC BONE UNSP HAND INIT

I69233

MONOPLG UPR LMB FOL OTH NTRM INTCRN HEMOR AFF R NONDOM SIDE

S62233B

OTH DISP FX OF BASE OF 1ST MC BONE UNSP HAND 7THB

I69234

MONOPLG UPR LMB FOL OTH NTRM INTCRN HEMOR AFF L NONDOM SIDE

S62234A

OTH NONDISP FX OF BASE OF FIRST MC BONE RIGHT HAND INIT

I69239

MONOPLG UPR LMB FOL OTH NTRM INTCRN HEMOR AFF UNSP SIDE

S62234B

OTH NONDISP FX OF BASE OF 1ST MC BONE R HAND 7THB

I69241

MONOPLG LOW LMB FOL OTH NTRM INTCRN HEMOR AFF RIGHT DOM SIDE

S62235A

OTH NONDISP FX OF BASE OF FIRST MC BONE LEFT HAND INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69242

MONOPLG LOW LMB FOL OTH NTRM INTCRN HEMOR AFF LEFT DOM SIDE

S62235B

OTH NONDISP FX OF BASE OF 1ST MC BONE L HAND 7THB

I69243

MONOPLG LOW LMB FOL OTH NTRM INTCRN HEMOR AFF R NONDOM SIDE

S62241A

DISP FX OF SHAFT OF FIRST METACARPAL BONE RIGHT HAND INIT

I69244

MONOPLG LOW LMB FOL OTH NTRM INTCRN HEMOR AFF L NONDOM SIDE

S62241B

DISP FX OF SHAFT OF FIRST MC BONE R HAND INIT FOR OPN FX

I69249

MONOPLG LOW LMB FOL OTH NTRM INTCRN HEMOR AFF UNSP SIDE

S62242A

DISP FX OF SHAFT OF FIRST METACARPAL BONE LEFT HAND INIT

I69251

HEMIPLGA FOL OTH NTRM INTCRN HEMOR AFF RIGHT DOMINANT SIDE

S62242B

DISP FX OF SHAFT OF FIRST MC BONE L HAND INIT FOR OPN FX

I69252

HEMIPLGA FOL OTH NTRM INTCRN HEMOR AFF LEFT DOMINANT SIDE

S62244A

NONDISP FX OF SHAFT OF FIRST MC BONE RIGHT HAND INIT

I69253

HEMIPLGA FOL OTH NTRM INTCRN HEMOR AFF RIGHT NONDOM SIDE

S62244B

NONDISP FX OF SHAFT OF 1ST MC BONE R HAND INIT FOR OPN FX

I69254

HEMIPLGA FOL OTH NTRM INTCRN HEMOR AFF LEFT NONDOM SIDE

S62245A

NONDISP FX OF SHAFT OF FIRST MC BONE LEFT HAND INIT

I69259

HEMIPLGA FOLLOWING OTH NTRM INTCRN HEMOR AFFECTING UNSP SIDE

S62245B

NONDISP FX OF SHAFT OF 1ST MC BONE L HAND INIT FOR OPN FX

I69261

OTH PARLYT SYND FOL OTH NTRM INTCRN HEMOR AFF RIGHT DOM SIDE

S62251A

DISP FX OF NECK OF FIRST METACARPAL BONE RIGHT HAND INIT

I69262

OTH PARLYT SYND FOL OTH NTRM INTCRN HEMOR AFF LEFT DOM SIDE

S62251B

DISP FX OF NECK OF FIRST MC BONE R HAND INIT FOR OPN FX

I69263

OTH PARLYT SYND FOL OTH NTRM INTCRN HEMOR AFF R NONDOM SIDE

S62252A

DISP FX OF NECK OF FIRST METACARPAL BONE LEFT HAND INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69264

OTH PARLYT SYND FOL OTH NTRM INTCRN HEMOR AFF L NONDOM SIDE

S62252B

DISP FX OF NECK OF FIRST MC BONE LEFT HAND INIT FOR OPN FX

I69265

OTH PARALYTIC SYNDROME FOLLOWING OTH NTRM INTCRN HEMOR BI

S62253A

DISP FX OF NECK OF FIRST METACARPAL BONE UNSP HAND INIT

I69269

OTH PARLYT SYNDROME FOL OTH NTRM INTCRN HEMOR AFF UNSP SIDE

S62254A

NONDISP FX OF NECK OF FIRST MC BONE RIGHT HAND INIT

I69290

APRAXIA FOLLOWING OTHER NONTRAUMATIC INTRACRANIAL HEMORRHAGE

S62254B

NONDISP FX OF NECK OF FIRST MC BONE R HAND INIT FOR OPN FX

I69291

DYSPHAGIA FOLLOWING OTH NONTRAUMATIC INTRACRANIAL HEMORRHAGE

S62255A

NONDISP FX OF NECK OF FIRST METACARPAL BONE LEFT HAND INIT

I69292

FACIAL WEAKNESS FOLLOWING OTH NONTRAUMATIC INTCRN HEMORRHAGE

S62255B

NONDISP FX OF NECK OF FIRST MC BONE L HAND INIT FOR OPN FX

I69293

ATAXIA FOLLOWING OTHER NONTRAUMATIC INTRACRANIAL HEMORRHAGE

S62291A

OTH FRACTURE OF FIRST METACARPAL BONE RIGHT HAND INIT

I69298

OTHER SEQUELAE OF OTHER NONTRAUMATIC INTRACRANIAL HEMORRHAGE

S62291B

OTH FX FIRST METACARPAL BONE RIGHT HAND INIT FOR OPN FX

I6930 UNSPECIFIED SEQUELAE OF CEREBRAL INFARCTION

S62292A

OTH FRACTURE OF FIRST METACARPAL BONE LEFT HAND INIT

I6931

COGNITIVE DEFICITS FOLLOWING CEREBRAL INFARCTION

S62292B

OTH FX FIRST METACARPAL BONE LEFT HAND INIT FOR OPN FX

I69310

Attention and concentration deficit following cerebral infarction

S62300A

UNSP FRACTURE OF SECOND METACARPAL BONE RIGHT HAND INIT

I69311 Memory deficit following cerebral infarction

S62300B

UNSP FX SECOND METACARPAL BONE RIGHT HAND INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69312

Visuospatial deficit and spatial neglect following cerebral infarction

S62301A

UNSP FRACTURE OF SECOND METACARPAL BONE LEFT HAND INIT

I69313 Psychomotor deficit following cerebral infarction

S62301B

UNSP FX SECOND METACARPAL BONE LEFT HAND INIT FOR OPN FX

I69314

Frontal lobe and executive function deficit following cerebral infarction

S62302A

UNSP FRACTURE OF THIRD METACARPAL BONE RIGHT HAND INIT

I69315

Cognitive social or emotional deficit following cerebral infarction

S62302B

UNSP FX THIRD METACARPAL BONE RIGHT HAND INIT FOR OPN FX

I69318

Other symptoms and signs involving cognitive functions following cerebral infarction

S62303A

UNSP FRACTURE OF THIRD METACARPAL BONE LEFT HAND INIT

I69319

Unspecified symptoms and signs involving cognitive functions following cerebral infarction

S62303B

UNSP FX THIRD METACARPAL BONE LEFT HAND INIT FOR OPN FX

I69320 APHASIA FOLLOWING CEREBRAL INFARCTION

S62304A

UNSP FRACTURE OF FOURTH METACARPAL BONE RIGHT HAND INIT

I69321 DYSPHASIA FOLLOWING CEREBRAL INFARCTION

S62304B

UNSP FX FOURTH METACARPAL BONE RIGHT HAND INIT FOR OPN FX

I69322 DYSARTHRIA FOLLOWING CEREBRAL INFARCTION

S62305A

UNSP FRACTURE OF FOURTH METACARPAL BONE LEFT HAND INIT

I69323

FLUENCY DISORDER FOLLOWING CEREBRAL INFARCTION

S62305B

UNSP FX FOURTH METACARPAL BONE LEFT HAND INIT FOR OPN FX

I69328

OTH SPEECH/LANG DEFICITS FOLLOWING CEREBRAL INFARCTION

S62306A

UNSP FRACTURE OF FIFTH METACARPAL BONE RIGHT HAND INIT

I69331

MONOPLG UPR LMB FOL CEREBRAL INFRC AFF RIGHT DOMINANT SIDE

S62306B

UNSP FX FIFTH METACARPAL BONE RIGHT HAND INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69332

MONOPLG UPR LMB FOL CEREBRAL INFRC AFF LEFT DOMINANT SIDE

S62307A

UNSP FRACTURE OF FIFTH METACARPAL BONE LEFT HAND INIT

I69333

MONOPLG UPR LMB FOL CEREBRAL INFRC AFF RIGHT NONDOM SIDE

S62307B

UNSP FX FIFTH METACARPAL BONE LEFT HAND INIT FOR OPN FX

I69334

MONOPLG UPR LMB FOL CEREBRAL INFRC AFF LEFT NONDOM SIDE

S62310A

DISP FX OF BASE OF SECOND METACARPAL BONE RIGHT HAND INIT

I69339

MONOPLG UPR LMB FOLLOWING CEREBRAL INFRC AFFECTING UNSP SIDE

S62310B

DISP FX OF BASE OF SECOND MC BONE R HAND INIT FOR OPN FX

I69341

MONOPLG LOW LMB FOL CEREBRAL INFRC AFF RIGHT DOMINANT SIDE

S62311A

DISP FX OF BASE OF SECOND METACARPAL BONE. LEFT HAND INIT

I69342

MONOPLG LOW LMB FOL CEREBRAL INFRC AFF LEFT DOMINANT SIDE

S62311B

DISP FX OF BASE OF SECOND MC BONE. L HAND INIT FOR OPN FX

I69343

MONOPLG LOW LMB FOL CEREBRAL INFRC AFF RIGHT NONDOM SIDE

S62312A

DISP FX OF BASE OF THIRD METACARPAL BONE RIGHT HAND INIT

I69344

MONOPLG LOW LMB FOL CEREBRAL INFRC AFF LEFT NONDOM SIDE

S62312B

DISP FX OF BASE OF THIRD MC BONE R HAND INIT FOR OPN FX

I69349

MONOPLG LOW LMB FOLLOWING CEREBRAL INFRC AFFECTING UNSP SIDE

S62313A

DISP FX OF BASE OF THIRD METACARPAL BONE LEFT HAND INIT

I69351

HEMIPLGA FOLLOWING CEREBRAL INFRC AFF RIGHT DOMINANT SIDE

S62313B

DISP FX OF BASE OF THIRD MC BONE LEFT HAND INIT FOR OPN FX

I69352

HEMIPLGA FOLLOWING CEREBRAL INFRC AFF LEFT DOMINANT SIDE

S62314A

DISP FX OF BASE OF FOURTH METACARPAL BONE RIGHT HAND INIT

I69353

HEMIPLGA FOLLOWING CEREBRAL INFRC AFF RIGHT NONDOM SIDE

S62314B

DISP FX OF BASE OF FOURTH MC BONE R HAND INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69354

HEMIPLGA FOLLOWING CEREBRAL INFRC AFFECTING LEFT NONDOM SIDE

S62315A

DISP FX OF BASE OF FOURTH METACARPAL BONE LEFT HAND INIT

I69359

HEMIPLGA FOLLOWING CEREBRAL INFARCTION AFFECTING UNSP SIDE

S62315B

DISP FX OF BASE OF FOURTH MC BONE L HAND INIT FOR OPN FX

I69361

OTH PARLYT SYNDROME FOL CEREB INFRC AFF RIGHT DOMINANT SIDE

S62316A

DISP FX OF BASE OF FIFTH METACARPAL BONE RIGHT HAND INIT

I69362

OTH PARLYT SYNDROME FOL CEREB INFRC AFF LEFT DOMINANT SIDE

S62316B

DISP FX OF BASE OF FIFTH MC BONE R HAND INIT FOR OPN FX

I69363

OTH PARLYT SYNDROME FOL CEREBRAL INFRC AFF RIGHT NONDOM SIDE

S62317A

DISP FX OF BASE OF FIFTH METACARPAL BONE. LEFT HAND INIT

I69364

OTH PARLYT SYNDROME FOL CEREBRAL INFRC AFF LEFT NONDOM SIDE

S62317B

DISP FX OF BASE OF FIFTH MC BONE. LEFT HAND INIT FOR OPN FX

I69365

OTH PARALYTIC SYNDROME FOLLOWING CEREBRAL INFRC BILATERAL

S62320A

DISP FX OF SHAFT OF SECOND METACARPAL BONE RIGHT HAND INIT

I69369

OTH PARALYTIC SYNDROME FOL CEREBRAL INFRC AFF UNSP SIDE

S62320B

DISP FX OF SHAFT OF SECOND MC BONE R HAND INIT FOR OPN FX

I69390 APRAXIA FOLLOWING CEREBRAL INFARCTION

S62321A

DISP FX OF SHAFT OF SECOND METACARPAL BONE LEFT HAND INIT

I69391 DYSPHAGIA FOLLOWING CEREBRAL INFARCTION

S62321B

DISP FX OF SHAFT OF SECOND MC BONE L HAND INIT FOR OPN FX

I69392 FACIAL WEAKNESS FOLLOWING CEREBRAL INFARCTION

S62322A

DISP FX OF SHAFT OF THIRD METACARPAL BONE RIGHT HAND INIT

I69393 ATAXIA FOLLOWING CEREBRAL INFARCTION

S62322B

DISP FX OF SHAFT OF THIRD MC BONE R HAND INIT FOR OPN FX

I69398 OTHER SEQUELAE OF CEREBRAL INFARCTION

S62323A

DISP FX OF SHAFT OF THIRD METACARPAL BONE LEFT HAND INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I6980

UNSPECIFIED SEQUELAE OF OTHER CEREBROVASCULAR DISEASE

S62323B

DISP FX OF SHAFT OF THIRD MC BONE L HAND INIT FOR OPN FX

I6981

COGNITIVE DEFICITS FOLLOWING OTHER CEREBROVASCULAR DISEASE

S62324A

DISP FX OF SHAFT OF FOURTH METACARPAL BONE RIGHT HAND INIT

I69810

Attention and concentration deficit following other cerebrovascular disease

S62324B

DISP FX OF SHAFT OF FOURTH MC BONE R HAND INIT FOR OPN FX

I69811 Memory deficit following other cerebrovascular disease

S62325A

DISP FX OF SHAFT OF FOURTH METACARPAL BONE LEFT HAND INIT

I69812

Visuospatial deficit and spatial neglect following other cerebrovascular disease

S62325B

DISP FX OF SHAFT OF FOURTH MC BONE L HAND INIT FOR OPN FX

I69813 Psychomotor deficit following other cerebrovascular disease

S62326A

DISP FX OF SHAFT OF FIFTH METACARPAL BONE RIGHT HAND INIT

I69814

Frontal lobe and executive function deficit following other cerebrovascular disease

S62326B

DISP FX OF SHAFT OF FIFTH MC BONE R HAND INIT FOR OPN FX

I69815

Cognitive social or emotional deficit following other cerebrovascular disease

S62327A

DISP FX OF SHAFT OF FIFTH METACARPAL BONE LEFT HAND INIT

I69818

Other symptoms and signs involving cognitive functions following other cerebrovascular disease

S62327B

DISP FX OF SHAFT OF FIFTH MC BONE L HAND INIT FOR OPN FX

I69819

Unspecified symptoms and signs involving cognitive functions following other cerebrovascular disease

S62330A

DISP FX OF NECK OF SECOND METACARPAL BONE RIGHT HAND INIT

I69820 APHASIA FOLLOWING OTHER CEREBROVASCULAR DISEASE

S62330B

DISP FX OF NECK OF SECOND MC BONE R HAND INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69821 DYSPHASIA FOLLOWING OTHER CEREBROVASCULAR DISEASE

S62331A

DISP FX OF NECK OF SECOND METACARPAL BONE LEFT HAND INIT

I69822

DYSARTHRIA FOLLOWING OTHER CEREBROVASCULAR DISEASE

S62331B

DISP FX OF NECK OF SECOND MC BONE L HAND INIT FOR OPN FX

I69823

FLUENCY DISORDER FOLLOWING OTHER CEREBROVASCULAR DISEASE

S62332A

DISP FX OF NECK OF THIRD METACARPAL BONE RIGHT HAND INIT

I69828

OTH SPEECH/LANG DEFICITS FOLLOWING OTH CEREBVASC DISEASE

S62332B

DISP FX OF NECK OF THIRD MC BONE R HAND INIT FOR OPN FX

I69831

MONOPLG UPR LMB FOL OTH CEREBVASC DISEASE AFF RIGHT DOM SIDE

S62333A

DISP FX OF NECK OF THIRD METACARPAL BONE LEFT HAND INIT

I69832

MONOPLG UPR LMB FOL OTH CEREBVASC DISEASE AFF LEFT DOM SIDE

S62333B

DISP FX OF NECK OF THIRD MC BONE LEFT HAND INIT FOR OPN FX

I69833

MONOPLG UPR LMB FOL OTH CEREBVASC DIS AFF RIGHT NONDOM SIDE

S62334A

DISP FX OF NECK OF FOURTH METACARPAL BONE RIGHT HAND INIT

I69834

MONOPLG UPR LMB FOL OTH CEREBVASC DIS AFF LEFT NONDOM SIDE

S62334B

DISP FX OF NECK OF FOURTH MC BONE R HAND INIT FOR OPN FX

I69839

MONOPLG UPR LMB FOL OTH CEREBVASC DISEASE AFF UNSP SIDE

S62335A

DISP FX OF NECK OF FOURTH METACARPAL BONE LEFT HAND INIT

I69841

MONOPLG LOW LMB FOL OTH CEREBVASC DISEASE AFF RIGHT DOM SIDE

S62335B

DISP FX OF NECK OF FOURTH MC BONE L HAND INIT FOR OPN FX

I69842

MONOPLG LOW LMB FOL OTH CEREBVASC DISEASE AFF LEFT DOM SIDE

S62336A

DISP FX OF NECK OF FIFTH METACARPAL BONE RIGHT HAND INIT

I69843

MONOPLG LOW LMB FOL OTH CEREBVASC DIS AFF RIGHT NONDOM SIDE

S62336B

DISP FX OF NECK OF FIFTH MC BONE R HAND INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69844

MONOPLG LOW LMB FOL OTH CEREBVASC DIS AFF LEFT NONDOM SIDE

S62337A

DISP FX OF NECK OF FIFTH METACARPAL BONE LEFT HAND INIT

I69849

MONOPLG LOW LMB FOL OTH CEREBVASC DISEASE AFF UNSP SIDE

S62337B

DISP FX OF NECK OF FIFTH MC BONE LEFT HAND INIT FOR OPN FX

I69851

HEMIPLGA FOL OTH CEREBVASC DISEASE AFF RIGHT DOMINANT SIDE

S62340A

NONDISP FX OF BASE OF SECOND MC BONE RIGHT HAND INIT

I69852

HEMIPLGA FOL OTH CEREBVASC DISEASE AFF LEFT DOMINANT SIDE

S62340B

NONDISP FX OF BASE OF 2ND MC BONE R HAND INIT FOR OPN FX

I69853

HEMIPLGA FOL OTH CEREBVASC DISEASE AFF RIGHT NONDOM SIDE

S62341A

NONDISP FX OF BASE OF SECOND MC BONE. LEFT HAND INIT

I69854

HEMIPLGA FOL OTH CEREBVASC DISEASE AFF LEFT NONDOM SIDE

S62341B

NONDISP FX OF BASE OF 2ND MC BONE. L HAND INIT FOR OPN FX

I69859

HEMIPLGA FOLLOWING OTH CEREBVASC DISEASE AFFECTING UNSP SIDE

S62342A

NONDISP FX OF BASE OF THIRD MC BONE RIGHT HAND INIT

I69861

OTH PARLYT SYND FOL OTH CEREBVASC DISEASE AFF RIGHT DOM SIDE

S62342B

NONDISP FX OF BASE OF THIRD MC BONE R HAND INIT FOR OPN FX

I69862

OTH PARLYT SYND FOL OTH CEREBVASC DISEASE AFF LEFT DOM SIDE

S62343A

NONDISP FX OF BASE OF THIRD METACARPAL BONE LEFT HAND INIT

I69863

OTH PARLYT SYND FOL OTH CEREBVASC DIS AFF RIGHT NONDOM SIDE

S62343B

NONDISP FX OF BASE OF THIRD MC BONE L HAND INIT FOR OPN FX

I69864

OTH PARLYT SYND FOL OTH CEREBVASC DIS AFF LEFT NONDOM SIDE

S62344A

NONDISP FX OF BASE OF FOURTH MC BONE RIGHT HAND INIT

I69865

OTH PARALYTIC SYNDROME FOLLOWING OTH CEREBVASC DISEASE BI

S62344B

NONDISP FX OF BASE OF 4TH MC BONE R HAND INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69869

OTH PARLYT SYNDROME FOL OTH CEREBVASC DISEASE AFF UNSP SIDE

S62345A

NONDISP FX OF BASE OF FOURTH MC BONE LEFT HAND INIT

I69890 APRAXIA FOLLOWING OTHER CEREBROVASCULAR DISEASE

S62345B

NONDISP FX OF BASE OF 4TH MC BONE L HAND INIT FOR OPN FX

I69891 DYSPHAGIA FOLLOWING OTHER CEREBROVASCULAR DISEASE

S62346A

NONDISP FX OF BASE OF FIFTH MC BONE RIGHT HAND INIT

I69892

FACIAL WEAKNESS FOLLOWING OTHER CEREBROVASCULAR DISEASE

S62346B

NONDISP FX OF BASE OF FIFTH MC BONE R HAND INIT FOR OPN FX

I69893 ATAXIA FOLLOWING OTHER CEREBROVASCULAR DISEASE

S62347A

NONDISP FX OF BASE OF FIFTH METACARPAL BONE. LEFT HAND INIT

I69898 OTHER SEQUELAE OF OTHER CEREBROVASCULAR DISEASE

S62347B

NONDISP FX OF BASE OF FIFTH MC BONE. L HAND INIT FOR OPN FX

I6990

UNSPECIFIED SEQUELAE OF UNSPECIFIED CEREBROVASCULAR DISEASE

S62350A

NONDISP FX OF SHAFT OF SECOND MC BONE RIGHT HAND INIT

I6991

COGNITIVE DEFICITS FOLLOWING UNSP CEREBROVASCULAR DISEASE

S62350B

NONDISP FX OF SHAFT OF 2ND MC BONE R HAND INIT FOR OPN FX

I69910

Attention and concentration deficit following unspecified cerebrovascular disease

S62351A

NONDISP FX OF SHAFT OF SECOND MC BONE LEFT HAND INIT

I69911

Memory deficit following unspecified cerebrovascular disease

S62351B

NONDISP FX OF SHAFT OF 2ND MC BONE L HAND INIT FOR OPN FX

I69912

Visuospatial deficit and spatial neglect following unspecified cerebrovascular disease

S62352A

NONDISP FX OF SHAFT OF THIRD MC BONE RIGHT HAND INIT

I69913

Psychomotor deficit following unspecified cerebrovascular disease

S62352B

NONDISP FX OF SHAFT OF 3RD MC BONE R HAND INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69914

Frontal lobe and executive function deficit following unspecified cerebrovascular disease

S62353A

NONDISP FX OF SHAFT OF THIRD MC BONE LEFT HAND INIT

I69915

Cognitive social or emotional deficit following unspecified cerebrovascular disease

S62353B

NONDISP FX OF SHAFT OF 3RD MC BONE L HAND INIT FOR OPN FX

I69918

Other symptoms and signs involving cognitive functions following unspecified cerebrovascular disease

S62354A

NONDISP FX OF SHAFT OF FOURTH MC BONE RIGHT HAND INIT

I69919

Unspecified symptoms and signs involving cognitive functions following unspecified cerebrovascular disease

S62354B

NONDISP FX OF SHAFT OF 4TH MC BONE R HAND INIT FOR OPN FX

I69920

APHASIA FOLLOWING UNSPECIFIED CEREBROVASCULAR DISEASE

S62355A

NONDISP FX OF SHAFT OF FOURTH MC BONE LEFT HAND INIT

I69921

DYSPHASIA FOLLOWING UNSPECIFIED CEREBROVASCULAR DISEASE

S62355B

NONDISP FX OF SHAFT OF 4TH MC BONE L HAND INIT FOR OPN FX

I69922

DYSARTHRIA FOLLOWING UNSPECIFIED CEREBROVASCULAR DISEASE

S62356A

NONDISP FX OF SHAFT OF FIFTH MC BONE RIGHT HAND INIT

I69923

FLUENCY DISORDER FOLLOWING UNSP CEREBROVASCULAR DISEASE

S62356B

NONDISP FX OF SHAFT OF 5TH MC BONE R HAND INIT FOR OPN FX

I69928

OTH SPEECH/LANG DEFICITS FOLLOWING UNSP CEREBVASC DISEASE

S62357A

NONDISP FX OF SHAFT OF FIFTH MC BONE LEFT HAND INIT

I69931

MONOPLG UPR LMB FOL UNSP CEREBVASC DIS AFF RIGHT DOM SIDE

S62357B

NONDISP FX OF SHAFT OF 5TH MC BONE L HAND INIT FOR OPN FX

I69932

MONOPLG UPR LMB FOL UNSP CEREBVASC DISEASE AFF LEFT DOM SIDE

S62360A

NONDISP FX OF NECK OF SECOND MC BONE RIGHT HAND INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69933

MONOPLG UPR LMB FOL UNSP CEREBVASC DIS AFF RIGHT NONDOM SIDE

S62360B

NONDISP FX OF NECK OF 2ND MC BONE R HAND INIT FOR OPN FX

I69934

MONOPLG UPR LMB FOL UNSP CEREBVASC DIS AFF LEFT NONDOM SIDE

S62361A

NONDISP FX OF NECK OF SECOND MC BONE LEFT HAND INIT

I69939

MONOPLG UPR LMB FOL UNSP CEREBVASC DISEASE AFF UNSP SIDE

S62361B

NONDISP FX OF NECK OF 2ND MC BONE L HAND INIT FOR OPN FX

I69941

MONOPLG LOW LMB FOL UNSP CEREBVASC DIS AFF RIGHT DOM SIDE

S62362A

NONDISP FX OF NECK OF THIRD MC BONE RIGHT HAND INIT

I69942

MONOPLG LOW LMB FOL UNSP CEREBVASC DISEASE AFF LEFT DOM SIDE

S62362B

NONDISP FX OF NECK OF THIRD MC BONE R HAND INIT FOR OPN FX

I69943

MONOPLG LOW LMB FOL UNSP CEREBVASC DIS AFF RIGHT NONDOM SIDE

S62363A

NONDISP FX OF NECK OF THIRD METACARPAL BONE LEFT HAND INIT

I69944

MONOPLG LOW LMB FOL UNSP CEREBVASC DIS AFF LEFT NONDOM SIDE

S62363B

NONDISP FX OF NECK OF THIRD MC BONE L HAND INIT FOR OPN FX

I69949

MONOPLG LOW LMB FOL UNSP CEREBVASC DISEASE AFF UNSP SIDE

S62364A

NONDISP FX OF NECK OF FOURTH MC BONE RIGHT HAND INIT

I69951

HEMIPLGA FOL UNSP CEREBVASC DISEASE AFF RIGHT DOMINANT SIDE

S62364B

NONDISP FX OF NECK OF 4TH MC BONE R HAND INIT FOR OPN FX

I69952

HEMIPLGA FOL UNSP CEREBVASC DISEASE AFF LEFT DOMINANT SIDE

S62365A

NONDISP FX OF NECK OF FOURTH MC BONE LEFT HAND INIT

I69953

HEMIPLGA FOL UNSP CEREBVASC DISEASE AFF RIGHT NONDOM SIDE

S62365B

NONDISP FX OF NECK OF 4TH MC BONE L HAND INIT FOR OPN FX

I69954

HEMIPLGA FOL UNSP CEREBVASC DISEASE AFF LEFT NONDOM SIDE

S62366A

NONDISP FX OF NECK OF FIFTH MC BONE RIGHT HAND INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69959

HEMIPLGA FOLLOWING UNSP CEREBVASC DISEASE AFF UNSP SIDE

S62366B

NONDISP FX OF NECK OF FIFTH MC BONE R HAND INIT FOR OPN FX

I69961

OTH PARLYT SYND FOL UNSP CEREBVASC DIS AFF RIGHT DOM SIDE

S62367A

NONDISP FX OF NECK OF FIFTH METACARPAL BONE LEFT HAND INIT

I69962

OTH PARLYT SYND FOL UNSP CEREBVASC DISEASE AFF LEFT DOM SIDE

S62367B

NONDISP FX OF NECK OF FIFTH MC BONE L HAND INIT FOR OPN FX

I69963

OTH PARLYT SYND FOL UNSP CEREBVASC DIS AFF RIGHT NONDOM SIDE

S62390A

OTH FRACTURE OF SECOND METACARPAL BONE RIGHT HAND INIT

I69964

OTH PARLYT SYND FOL UNSP CEREBVASC DIS AFF LEFT NONDOM SIDE

S62390B

OTH FX SECOND METACARPAL BONE RIGHT HAND INIT FOR OPN FX

I69965

OTH PARALYTIC SYNDROME FOLLOWING UNSP CEREBVASC DISEASE BI

S62391A

OTH FRACTURE OF SECOND METACARPAL BONE LEFT HAND INIT

I69969

OTH PARLYT SYNDROME FOL UNSP CEREBVASC DISEASE AFF UNSP SIDE

S62391B

OTH FX SECOND METACARPAL BONE LEFT HAND INIT FOR OPN FX

I69990

APRAXIA FOLLOWING UNSPECIFIED CEREBROVASCULAR DISEASE

S62392A

OTH FRACTURE OF THIRD METACARPAL BONE RIGHT HAND INIT

I69991

DYSPHAGIA FOLLOWING UNSPECIFIED CEREBROVASCULAR DISEASE

S62392B

OTH FX THIRD METACARPAL BONE RIGHT HAND INIT FOR OPN FX

I69992

FACIAL WEAKNESS FOLLOWING UNSP CEREBROVASCULAR DISEASE

S62393A

OTH FRACTURE OF THIRD METACARPAL BONE LEFT HAND INIT

I69993

ATAXIA FOLLOWING UNSPECIFIED CEREBROVASCULAR DISEASE

S62393B

OTH FX THIRD METACARPAL BONE LEFT HAND INIT FOR OPN FX

I69998

OTHER SEQUELAE FOLLOWING UNSPECIFIED CEREBROVASCULAR DISEASE

S62394A

OTH FRACTURE OF FOURTH METACARPAL BONE RIGHT HAND INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I7092 CHRONIC TOTAL OCCLUSION OF ARTERY OF THE EXTREMITIES

S62394B

OTH FX FOURTH METACARPAL BONE RIGHT HAND INIT FOR OPN FX

I7100 DISSECTION OF UNSPECIFIED SITE OF AORTA

S62395A

OTH FRACTURE OF FOURTH METACARPAL BONE LEFT HAND INIT

I7101 DISSECTION OF THORACIC AORTA

S62395B

OTH FX FOURTH METACARPAL BONE LEFT HAND INIT FOR OPN FX

I7102 DISSECTION OF ABDOMINAL AORTA

S62396A

OTH FRACTURE OF FIFTH METACARPAL BONE RIGHT HAND INIT

I7103 DISSECTION OF THORACOABDOMINAL AORTA

S62396B

OTH FX FIFTH METACARPAL BONE RIGHT HAND INIT FOR OPN FX

I711 THORACIC AORTIC ANEURYSM RUPTURED

S62397A

OTH FRACTURE OF FIFTH METACARPAL BONE LEFT HAND INIT

I713 ABDOMINAL AORTIC ANEURYSM RUPTURED

S62397B

OTH FX FIFTH METACARPAL BONE LEFT HAND INIT FOR OPN FX

I715 THORACOABDOMINAL AORTIC ANEURYSM RUPTURED

S62501A

FRACTURE OF UNSP PHALANX OF RIGHT THUMB INIT FOR CLOS FX

I718 AORTIC ANEURYSM OF UNSPECIFIED SITE RUPTURED

S62501B

FRACTURE OF UNSP PHALANX OF RIGHT THUMB INIT FOR OPN FX

I719

AORTIC ANEURYSM OF UNSPECIFIED SITE WITHOUT RUPTURE

S62502A

FRACTURE OF UNSP PHALANX OF LEFT THUMB INIT FOR CLOS FX

I720 ANEURYSM OF CAROTID ARTERY

S62502B

FRACTURE OF UNSP PHALANX OF LEFT THUMB INIT FOR OPN FX

I721 ANEURYSM OF ARTERY OF UPPER EXTREMITY

S62511A

DISP FX OF PROXIMAL PHALANX OF RIGHT THUMB INIT FOR CLOS FX

I722 ANEURYSM OF RENAL ARTERY

S62511B DISP FX OF PROXIMAL PHALANX OF RIGHT THUMB INIT FOR OPN FX

I723 ANEURYSM OF ILIAC ARTERY

S62512A DISP FX OF PROXIMAL PHALANX OF LEFT THUMB INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I724 ANEURYSM OF ARTERY OF LOWER EXTREMITY

S62512B

DISP FX OF PROXIMAL PHALANX OF LEFT THUMB INIT FOR OPN FX

I725 Aneurysm of other precerebral arteries

S62514A

NONDISP FX OF PROXIMAL PHALANX OF RIGHT THUMB INIT

I726 Aneurysm of vertebral artery

S62514B NONDISP FX OF PROXIMAL PHALANX OF R THM INIT FOR OPN FX

I728 ANEURYSM OF OTHER SPECIFIED ARTERIES

S62515A

NONDISP FX OF PROXIMAL PHALANX OF LEFT THUMB INIT

I729 ANEURYSM OF UNSPECIFIED SITE

S62515B

NONDISP FX OF PROXIMAL PHALANX OF L THM INIT FOR OPN FX

I7300 RAYNAUD'S SYNDROME WITHOUT GANGRENE

S62521A

DISP FX OF DISTAL PHALANX OF RIGHT THUMB INIT FOR CLOS FX

I7301 RAYNAUD'S SYNDROME WITH GANGRENE

S62521B

DISP FX OF DISTAL PHALANX OF RIGHT THUMB INIT FOR OPN FX

I731

THROMBOANGIITIS OBLITERANS [BUERGER'S DISEASE]

S62522A

DISP FX OF DISTAL PHALANX OF LEFT THUMB INIT FOR CLOS FX

I7381 ERYTHROMELALGIA

S62522B DISP FX OF DISTAL PHALANX OF LEFT THUMB INIT FOR OPN FX

I7389 OTHER SPECIFIED PERIPHERAL VASCULAR DISEASES

S62524A

NONDISP FX OF DISTAL PHALANX OF RIGHT THUMB INIT

I739 PERIPHERAL VASCULAR DISEASE UNSPECIFIED

S62524B

NONDISP FX OF DISTAL PHALANX OF RIGHT THUMB INIT FOR OPN FX

I7410

EMBOLISM AND THROMBOSIS OF UNSPECIFIED PARTS OF AORTA

S62525A

NONDISP FX OF DISTAL PHALANX OF LEFT THUMB INIT FOR CLOS FX

I7411 EMBOLISM AND THROMBOSIS OF THORACIC AORTA

S62525B

NONDISP FX OF DISTAL PHALANX OF LEFT THUMB INIT FOR OPN FX

I7419 EMBOLISM AND THROMBOSIS OF OTHER PARTS OF AORTA

S62600A

FRACTURE OF UNSP PHALANX OF RIGHT INDEX FINGER INIT

I742

EMBOLISM AND THROMBOSIS OF ARTERIES OF THE UPPER EXTREMITIES

S62600B

FRACTURE OF UNSP PHALANX OF R IDX FNGR INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I743

EMBOLISM AND THROMBOSIS OF ARTERIES OF THE LOWER EXTREMITIES

S62601A

FRACTURE OF UNSP PHALANX OF LEFT INDEX FINGER INIT

I744

EMBOLISM AND THROMBOSIS OF ARTERIES OF EXTREMITIES UNSP

S62601B

FRACTURE OF UNSP PHALANX OF L IDX FNGR INIT FOR OPN FX

I745 EMBOLISM AND THROMBOSIS OF ILIAC ARTERY

S62602A

FRACTURE OF UNSP PHALANX OF RIGHT MIDDLE FINGER INIT

I748 EMBOLISM AND THROMBOSIS OF OTHER ARTERIES

S62602B

FRACTURE OF UNSP PHALANX OF R MID FINGER INIT FOR OPN FX

I749 EMBOLISM AND THROMBOSIS OF UNSPECIFIED ARTERY

S62603A

FRACTURE OF UNSP PHALANX OF LEFT MIDDLE FINGER INIT

I75011 ATHEROEMBOLISM OF RIGHT UPPER EXTREMITY

S62603B

FRACTURE OF UNSP PHALANX OF L MID FINGER INIT FOR OPN FX

I75012 ATHEROEMBOLISM OF LEFT UPPER EXTREMITY

S62604A

FRACTURE OF UNSP PHALANX OF RIGHT RING FINGER INIT

I75013 ATHEROEMBOLISM OF BILATERAL UPPER EXTREMITIES

S62604B

FRACTURE OF UNSP PHALANX OF R RNG FNGR INIT FOR OPN FX

I75019 ATHEROEMBOLISM OF UNSPECIFIED UPPER EXTREMITY

S62605A

FRACTURE OF UNSP PHALANX OF LEFT RING FINGER INIT

I75021 ATHEROEMBOLISM OF RIGHT LOWER EXTREMITY

S62605B

FRACTURE OF UNSP PHALANX OF L RNG FNGR INIT FOR OPN FX

I75022 ATHEROEMBOLISM OF LEFT LOWER EXTREMITY

S62606A

FRACTURE OF UNSP PHALANX OF RIGHT LITTLE FINGER INIT

I75023 ATHEROEMBOLISM OF BILATERAL LOWER EXTREMITIES

S62606B

FRACTURE OF UNSP PHALANX OF R LITTLE FINGER INIT FOR OPN FX

I75029

ATHEROEMBOLISM OF UNSPECIFIED LOWER EXTREMITY

S62607A

FRACTURE OF UNSP PHALANX OF LEFT LITTLE FINGER INIT

I7581 ATHEROEMBOLISM OF KIDNEY

S62607B FRACTURE OF UNSP PHALANX OF L LITTLE FINGER INIT FOR OPN FX

I7589 ATHEROEMBOLISM OF OTHER SITE

S62610A

DISP FX OF PROXIMAL PHALANX OF RIGHT INDEX FINGER INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I76 SEPTIC ARTERIAL EMBOLISM

S62610B DISP FX OF PROXIMAL PHALANX OF R IDX FNGR INIT FOR OPN FX

I770 ARTERIOVENOUS FISTULA ACQUIRED

S62611A

DISP FX OF PROXIMAL PHALANX OF LEFT INDEX FINGER INIT

I771 STRICTURE OF ARTERY

S62611B DISP FX OF PROXIMAL PHALANX OF L IDX FNGR INIT FOR OPN FX

I772 RUPTURE OF ARTERY

S62612A DISP FX OF PROXIMAL PHALANX OF RIGHT MIDDLE FINGER INIT

I773 ARTERIAL FIBROMUSCULAR DYSPLASIA

S62612B

DISP FX OF PROXIMAL PHALANX OF R MID FINGER INIT FOR OPN FX

I774 CELIAC ARTERY COMPRESSION SYNDROME

S62613A

DISP FX OF PROXIMAL PHALANX OF LEFT MIDDLE FINGER INIT

I775 NECROSIS OF ARTERY

S62613B DISP FX OF PROXIMAL PHALANX OF L MID FINGER INIT FOR OPN FX

I776 ARTERITIS UNSPECIFIED

S62614A DISP FX OF PROXIMAL PHALANX OF RIGHT RING FINGER INIT

I7770 Dissection of unspecified artery

S62614B DISP FX OF PROXIMAL PHALANX OF R RNG FNGR INIT FOR OPN FX

I7771 DISSECTION OF CAROTID ARTERY

S62615A

DISP FX OF PROXIMAL PHALANX OF LEFT RING FINGER INIT

I7772 DISSECTION OF ILIAC ARTERY

S62615B DISP FX OF PROXIMAL PHALANX OF L RNG FNGR INIT FOR OPN FX

I7773 DISSECTION OF RENAL ARTERY

S62616A DISP FX OF PROXIMAL PHALANX OF RIGHT LITTLE FINGER INIT

I7774 DISSECTION OF VERTEBRAL ARTERY

S62616B

DISP FX OF PROX PHALANX OF R LITTLE FINGER INIT FOR OPN FX

I7775 Dissection of other precerebral arteries

S62617A

DISP FX OF PROXIMAL PHALANX OF LEFT LITTLE FINGER INIT

I7776 Dissection of artery of upper extremity

S62617B

DISP FX OF PROX PHALANX OF L LITTLE FINGER INIT FOR OPN FX

I7777 Dissection of artery of lower extremity

S62620A

DISP FX OF MEDIAL PHALANX OF RIGHT INDEX FINGER INIT

I7779 DISSECTION OF OTHER ARTERY

S62620B DISP FX OF MEDIAL PHALANX OF R IDX FNGR INIT FOR OPN FX

I77810 THORACIC AORTIC ECTASIA

S62621A DISP FX OF MEDIAL PHALANX OF LEFT INDEX FINGER INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I77811 ABDOMINAL AORTIC ECTASIA

S62621B DISP FX OF MEDIAL PHALANX OF L IDX FNGR INIT FOR OPN FX

I77812 THORACOABDOMINAL AORTIC ECTASIA

S62622A

DISP FX OF MEDIAL PHALANX OF RIGHT MIDDLE FINGER INIT

I77819 AORTIC ECTASIA UNSPECIFIED SITE

S62622B

DISP FX OF MEDIAL PHALANX OF R MID FINGER INIT FOR OPN FX

I7789 OTHER SPECIFIED DISORDERS OF ARTERIES AND ARTERIOLES

S62623A

DISP FX OF MEDIAL PHALANX OF LEFT MIDDLE FINGER INIT

I779 DISORDER OF ARTERIES AND ARTERIOLES UNSPECIFIED

S62623B

DISP FX OF MEDIAL PHALANX OF L MID FINGER INIT FOR OPN FX

I780 HEREDITARY HEMORRHAGIC TELANGIECTASIA

S62624A

DISP FX OF MEDIAL PHALANX OF RIGHT RING FINGER INIT

I781 NEVUS NON-NEOPLASTIC

S62624B DISP FX OF MEDIAL PHALANX OF R RNG FNGR INIT FOR OPN FX

I788 OTHER DISEASES OF CAPILLARIES

S62625A

DISP FX OF MEDIAL PHALANX OF LEFT RING FINGER INIT

I789 DISEASE OF CAPILLARIES UNSPECIFIED

S62625B

DISP FX OF MEDIAL PHALANX OF L RNG FNGR INIT FOR OPN FX

I790

ANEURYSM OF AORTA IN DISEASES CLASSIFIED ELSEWHERE

S62626A

DISP FX OF MEDIAL PHALANX OF RIGHT LITTLE FINGER INIT

I791 AORTITIS IN DISEASES CLASSIFIED ELSEWHERE

S62626B

DISP FX OF MEDIAL PHALANX OF R LITTLE FNGR INIT FOR OPN FX

I798

OTH DISORD OF ARTARTERIOLES & CAPILARE IN DIS CLASSD ELSWHR

S62627A

DISP FX OF MEDIAL PHALANX OF LEFT LITTLE FINGER INIT

I8000

PHLBTS AND THOMBOPHLB OF SUPERFIC VESSELS OF UNSP LOW EXTRM

S62627B

DISP FX OF MEDIAL PHALANX OF L LITTLE FNGR INIT FOR OPN FX

I8001

PHLEBITIS AND THOMBOPHLB OF SUPERFIC VESSELS OF R LOW EXTREM

S62630A

DISP FX OF DISTAL PHALANX OF RIGHT INDEX FINGER INIT

I8002

PHLEBITIS AND THOMBOPHLB OF SUPERFIC VESSELS OF L LOW EXTREM

S62630B

DISP FX OF DISTAL PHALANX OF R IDX FNGR INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I8003

PHLBTS AND THOMBOPHLB OF SUPERFIC VESSELS OF LOW EXTRM BI

S62631A

DISP FX OF DISTAL PHALANX OF LEFT INDEX FINGER INIT

I8010

PHLEBITIS AND THROMBOPHLEBITIS OF UNSPECIFIED FEMORAL VEIN

S62631B

DISP FX OF DISTAL PHALANX OF L IDX FNGR INIT FOR OPN FX

I8011

PHLEBITIS AND THROMBOPHLEBITIS OF RIGHT FEMORAL VEIN

S62632A

DISP FX OF DISTAL PHALANX OF RIGHT MIDDLE FINGER INIT

I8012

PHLEBITIS AND THROMBOPHLEBITIS OF LEFT FEMORAL VEIN

S62632B

DISP FX OF DISTAL PHALANX OF R MID FINGER INIT FOR OPN FX

I8013

PHLEBITIS AND THROMBOPHLEBITIS OF FEMORAL VEIN BILATERAL

S62633A

DISP FX OF DISTAL PHALANX OF LEFT MIDDLE FINGER INIT

I80201

PHLBTS AND THOMBOPHLB OF UNSP DEEP VESSELS OF R LOW EXTREM

S62633B

DISP FX OF DISTAL PHALANX OF L MID FINGER INIT FOR OPN FX

I80202

PHLBTS AND THOMBOPHLB OF UNSP DEEP VESSELS OF L LOW EXTREM

S62634A

DISP FX OF DISTAL PHALANX OF RIGHT RING FINGER INIT

I80203

PHLBTS AND THOMBOPHLB OF UNSP DEEP VESSELS OF LOW EXTRM BI

S62634B

DISP FX OF DISTAL PHALANX OF R RNG FNGR INIT FOR OPN FX

I80209

PHLBTS AND THOMBOPHLB OF UNSP DEEP VESSELS OF UNSP LOW EXTRM

S62635A

DISP FX OF DISTAL PHALANX OF LEFT RING FINGER INIT

I80211

PHLEBITIS AND THROMBOPHLEBITIS OF RIGHT ILIAC VEIN

S62635B

DISP FX OF DISTAL PHALANX OF L RNG FNGR INIT FOR OPN FX

I80212

PHLEBITIS AND THROMBOPHLEBITIS OF LEFT ILIAC VEIN

S62636A

DISP FX OF DISTAL PHALANX OF RIGHT LITTLE FINGER INIT

I80213

PHLEBITIS AND THROMBOPHLEBITIS OF ILIAC VEIN BILATERAL

S62636B

DISP FX OF DIST PHALANX OF R LITTLE FINGER INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I80219

PHLEBITIS AND THROMBOPHLEBITIS OF UNSPECIFIED ILIAC VEIN

S62637A

DISP FX OF DISTAL PHALANX OF LEFT LITTLE FINGER INIT

I80221

PHLEBITIS AND THROMBOPHLEBITIS OF RIGHT POPLITEAL VEIN

S62637B

DISP FX OF DIST PHALANX OF L LITTLE FINGER INIT FOR OPN FX

I80222

PHLEBITIS AND THROMBOPHLEBITIS OF LEFT POPLITEAL VEIN

S62640A

NONDISP FX OF PROXIMAL PHALANX OF RIGHT INDEX FINGER INIT

I80223

PHLEBITIS AND THROMBOPHLEBITIS OF POPLITEAL VEIN BILATERAL

S62640B

NONDISP FX OF PROX PHALANX OF R IDX FNGR INIT FOR OPN FX

I80229

PHLEBITIS AND THROMBOPHLEBITIS OF UNSPECIFIED POPLITEAL VEIN

S62641A

NONDISP FX OF PROXIMAL PHALANX OF LEFT INDEX FINGER INIT

I80231

PHLEBITIS AND THROMBOPHLEBITIS OF RIGHT TIBIAL VEIN

S62641B

NONDISP FX OF PROX PHALANX OF L IDX FNGR INIT FOR OPN FX

I80232

PHLEBITIS AND THROMBOPHLEBITIS OF LEFT TIBIAL VEIN

S62642A

NONDISP FX OF PROXIMAL PHALANX OF RIGHT MIDDLE FINGER INIT

I80233

PHLEBITIS AND THROMBOPHLEBITIS OF TIBIAL VEIN BILATERAL

S62642B

NONDISP FX OF PROX PHALANX OF R MID FINGER INIT FOR OPN FX

I80239

PHLEBITIS AND THROMBOPHLEBITIS OF UNSPECIFIED TIBIAL VEIN

S62643A

NONDISP FX OF PROXIMAL PHALANX OF LEFT MIDDLE FINGER INIT

I80291

PHLEBITIS AND THOMBOPHLB OF DEEP VESSELS OF R LOW EXTREM

S62643B

NONDISP FX OF PROX PHALANX OF L MID FINGER INIT FOR OPN FX

I80292

PHLEBITIS AND THOMBOPHLB OF DEEP VESSELS OF L LOW EXTREM

S62644A

NONDISP FX OF PROXIMAL PHALANX OF RIGHT RING FINGER INIT

I80293

PHLEBITIS AND THOMBOPHLB OF DEEP VESSELS OF LOW EXTRM BI

S62644B

NONDISP FX OF PROX PHALANX OF R RNG FNGR INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I80299

PHLEBITIS AND THOMBOPHLB OF DEEP VESSELS OF UNSP LOW EXTRM

S62645A

NONDISP FX OF PROXIMAL PHALANX OF LEFT RING FINGER INIT

I803

PHLEBITIS AND THROMBOPHLEBITIS OF LOWER EXTREMITIES UNSP

S62645B

NONDISP FX OF PROX PHALANX OF L RNG FNGR INIT FOR OPN FX

I808

PHLEBITIS AND THROMBOPHLEBITIS OF OTHER SITES

S62646A

NONDISP FX OF PROXIMAL PHALANX OF RIGHT LITTLE FINGER INIT

I809

PHLEBITIS AND THROMBOPHLEBITIS OF UNSPECIFIED SITE

S62646B

NONDISP FX OF PROX PHALANX OF R LITTLE FNGR INIT FOR OPN FX

I81 PORTAL VEIN THROMBOSIS

S62647A NONDISP FX OF PROXIMAL PHALANX OF LEFT LITTLE FINGER INIT

I820 BUDD-CHIARI SYNDROME

S62647B NONDISP FX OF PROX PHALANX OF L LITTLE FNGR INIT FOR OPN FX

I821 THROMBOPHLEBITIS MIGRANS

S62650A NONDISP FX OF MEDIAL PHALANX OF RIGHT INDEX FINGER INIT

I82210

ACUTE EMBOLISM AND THROMBOSIS OF SUPERIOR VENA CAVA

S62650B

NONDISP FX OF MEDIAL PHALANX OF R IDX FNGR INIT FOR OPN FX

I82211

CHRONIC EMBOLISM AND THROMBOSIS OF SUPERIOR VENA CAVA

S62651A

NONDISP FX OF MEDIAL PHALANX OF LEFT INDEX FINGER INIT

I82220

ACUTE EMBOLISM AND THROMBOSIS OF INFERIOR VENA CAVA

S62651B

NONDISP FX OF MEDIAL PHALANX OF L IDX FNGR INIT FOR OPN FX

I82221

CHRONIC EMBOLISM AND THROMBOSIS OF INFERIOR VENA CAVA

S62652A

NONDISP FX OF MEDIAL PHALANX OF RIGHT MIDDLE FINGER INIT

I82290

ACUTE EMBOLISM AND THROMBOSIS OF OTHER THORACIC VEINS

S62652B

NONDISP FX OF MEDIAL PHALANX OF R MID FNGR INIT FOR OPN FX

I82291

CHRONIC EMBOLISM AND THROMBOSIS OF OTHER THORACIC VEINS

S62653A

NONDISP FX OF MEDIAL PHALANX OF LEFT MIDDLE FINGER INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I823 EMBOLISM AND THROMBOSIS OF RENAL VEIN

S62653B

NONDISP FX OF MEDIAL PHALANX OF L MID FNGR INIT FOR OPN FX

I82401

ACUTE EMBOLISM AND THOMBOS UNSP DEEP VEINS OF R LOW EXTREM

S62654A

NONDISP FX OF MEDIAL PHALANX OF RIGHT RING FINGER INIT

I82402

ACUTE EMBOLISM AND THOMBOS UNSP DEEP VEINS OF L LOW EXTREM

S62654B

NONDISP FX OF MEDIAL PHALANX OF R RNG FNGR INIT FOR OPN FX

I82403

ACUTE EMBOLISM AND THOMBOS UNSP DEEP VEINS OF LOW EXTRM BI

S62655A

NONDISP FX OF MEDIAL PHALANX OF LEFT RING FINGER INIT

I82409

ACUTE EMBOLISM AND THOMBOS UNSP DEEP VN UNSP LOWER EXTREMITY

S62655B

NONDISP FX OF MEDIAL PHALANX OF L RNG FNGR INIT FOR OPN FX

I82411

ACUTE EMBOLISM AND THROMBOSIS OF RIGHT FEMORAL VEIN

S62656A

NONDISP FX OF MEDIAL PHALANX OF RIGHT LITTLE FINGER INIT

I82412

ACUTE EMBOLISM AND THROMBOSIS OF LEFT FEMORAL VEIN

S62656B

NONDISP FX OF MEDIAL PHALANX OF R LIT FNGR INIT FOR OPN FX

I82413

ACUTE EMBOLISM AND THROMBOSIS OF FEMORAL VEIN BILATERAL

S62657A

NONDISP FX OF MEDIAL PHALANX OF LEFT LITTLE FINGER INIT

I82419

ACUTE EMBOLISM AND THROMBOSIS OF UNSPECIFIED FEMORAL VEIN

S62657B

NONDISP FX OF MEDIAL PHALANX OF L LIT FNGR INIT FOR OPN FX

I82421

ACUTE EMBOLISM AND THROMBOSIS OF RIGHT ILIAC VEIN

S62660A

NONDISP FX OF DISTAL PHALANX OF RIGHT INDEX FINGER INIT

I82422

ACUTE EMBOLISM AND THROMBOSIS OF LEFT ILIAC VEIN

S62660B

NONDISP FX OF DISTAL PHALANX OF R IDX FNGR INIT FOR OPN FX

I82423

ACUTE EMBOLISM AND THROMBOSIS OF ILIAC VEIN BILATERAL

S62661A

NONDISP FX OF DISTAL PHALANX OF LEFT INDEX FINGER INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I82429

ACUTE EMBOLISM AND THROMBOSIS OF UNSPECIFIED ILIAC VEIN

S62661B

NONDISP FX OF DISTAL PHALANX OF L IDX FNGR INIT FOR OPN FX

I82431

ACUTE EMBOLISM AND THROMBOSIS OF RIGHT POPLITEAL VEIN

S62662A

NONDISP FX OF DISTAL PHALANX OF RIGHT MIDDLE FINGER INIT

I82432

ACUTE EMBOLISM AND THROMBOSIS OF LEFT POPLITEAL VEIN

S62662B

NONDISP FX OF DIST PHALANX OF R MID FINGER INIT FOR OPN FX

I82433

ACUTE EMBOLISM AND THROMBOSIS OF POPLITEAL VEIN BILATERAL

S62663A

NONDISP FX OF DISTAL PHALANX OF LEFT MIDDLE FINGER INIT

I82439

ACUTE EMBOLISM AND THROMBOSIS OF UNSPECIFIED POPLITEAL VEIN

S62663B

NONDISP FX OF DIST PHALANX OF L MID FINGER INIT FOR OPN FX

I82441

ACUTE EMBOLISM AND THROMBOSIS OF RIGHT TIBIAL VEIN

S62664A

NONDISP FX OF DISTAL PHALANX OF RIGHT RING FINGER INIT

I82442

ACUTE EMBOLISM AND THROMBOSIS OF LEFT TIBIAL VEIN

S62664B

NONDISP FX OF DISTAL PHALANX OF R RNG FNGR INIT FOR OPN FX

I82443

ACUTE EMBOLISM AND THROMBOSIS OF TIBIAL VEIN BILATERAL

S62665A

NONDISP FX OF DISTAL PHALANX OF LEFT RING FINGER INIT

I82449

ACUTE EMBOLISM AND THROMBOSIS OF UNSPECIFIED TIBIAL VEIN

S62665B

NONDISP FX OF DISTAL PHALANX OF L RNG FNGR INIT FOR OPN FX

I82491

ACUTE EMBOLISM AND THROMBOSIS OF DEEP VEIN OF R LOW EXTREM

S62666A

NONDISP FX OF DISTAL PHALANX OF RIGHT LITTLE FINGER INIT

I82492

ACUTE EMBOLISM AND THROMBOSIS OF DEEP VEIN OF L LOW EXTREM

S62666B

NONDISP FX OF DIST PHALANX OF R LITTLE FNGR INIT FOR OPN FX

I82493

ACUTE EMBOLISM AND THOMBOS OF DEEP VEIN OF LOW EXTRM BI

S62667A

NONDISP FX OF DISTAL PHALANX OF LEFT LITTLE FINGER INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I82499

ACUTE EMBOLISM AND THROMBOSIS OF DEEP VEIN OF UNSP LOW EXTRM

S62667B

NONDISP FX OF DIST PHALANX OF L LITTLE FNGR INIT FOR OPN FX

I824Y1

AC EMBLSM AND THOMBOS UNSP DEEP VEINS OF R PROX LOW EXTRM

S6290XA

UNSP FRACTURE OF UNSP WRIST AND HAND INIT FOR CLOS FX

I824Y2

AC EMBLSM AND THOMBOS UNSP DEEP VEINS OF LEFT PROX LOW EXTRM

S6290XB

UNSP FRACTURE OF UNSP WRIST AND HAND INIT FOR OPN FX

I824Y3

AC EMBLSM AND THOMBOS UNSP DEEP VEINS OF PROX LOW EXTRM BI

S6291XA

UNSP FRACTURE OF RIGHT WRIST AND HAND INIT FOR CLOS FX

I824Y9

ACUTE EMBLSM AND THOMBOS UNSP DEEP VN UNSP PROX LOW EXTRM

S6291XB

UNSP FRACTURE OF RIGHT WRIST AND HAND INIT FOR OPN FX

I824Z1

AC EMBLSM AND THOMBOS UNSP DEEP VEINS OF R DIST LOW EXTRM

S6292XA

UNSP FRACTURE OF LEFT WRIST AND HAND INIT FOR CLOS FX

I824Z2

AC EMBLSM AND THOMBOS UNSP DEEP VEINS OF LEFT DIST LOW EXTRM

S63001A

UNSPECIFIED SUBLUXATION OF RIGHT WRIST AND HAND INIT ENCNTR

I824Z3

AC EMBLSM AND THOMBOS UNSP DEEP VEINS OF DIST LOW EXTRM BI

S63003A

UNSP SUBLUXATION OF UNSPECIFIED WRIST AND HAND INIT ENCNTR

I824Z9

ACUTE EMBLSM AND THOMBOS UNSP DEEP VN UNSP DISTAL LOW EXTRM

S63004A

UNSPECIFIED DISLOCATION OF RIGHT WRIST AND HAND INIT ENCNTR

I82501

CHRONIC EMBOLISM AND THOMBOS UNSP DEEP VEINS OF R LOW EXTREM

S63005A

UNSPECIFIED DISLOCATION OF LEFT WRIST AND HAND INIT ENCNTR

I82502

CHRONIC EMBOLISM AND THOMBOS UNSP DEEP VEINS OF L LOW EXTREM

S63012A

SUBLUXATION OF DISTAL RADIOULNAR JOINT OF LEFT WRIST INIT

I82503

CHRONIC EMBLSM AND THOMBOS UNSP DEEP VEINS OF LOW EXTRM BI

S63015A

DISLOCATION OF DISTAL RADIOULNAR JOINT OF LEFT WRIST INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I82509

CHRONIC EMBOLISM AND THOMBOS UNSP DEEP VN UNSP LOW EXTRM

S63016A

DISLOCATION OF DISTAL RADIOULNAR JOINT OF UNSP WRIST INIT

I82511

CHRONIC EMBOLISM AND THROMBOSIS OF RIGHT FEMORAL VEIN

S63021A

SUBLUXATION OF RADIOCARPAL JOINT OF RIGHT WRIST INIT ENCNTR

I82512

CHRONIC EMBOLISM AND THROMBOSIS OF LEFT FEMORAL VEIN

S63022A

SUBLUXATION OF RADIOCARPAL JOINT OF LEFT WRIST INIT ENCNTR

I82513

CHRONIC EMBOLISM AND THROMBOSIS OF FEMORAL VEIN BILATERAL

S63023A

SUBLUXATION OF RADIOCARPAL JOINT OF UNSP WRIST INIT ENCNTR

I82519

CHRONIC EMBOLISM AND THROMBOSIS OF UNSPECIFIED FEMORAL VEIN

S63025A

DISLOCATION OF RADIOCARPAL JOINT OF LEFT WRIST INIT ENCNTR

I82521

CHRONIC EMBOLISM AND THROMBOSIS OF RIGHT ILIAC VEIN

S63031A

SUBLUXATION OF MIDCARPAL JOINT OF RIGHT WRIST INIT ENCNTR

I82522

CHRONIC EMBOLISM AND THROMBOSIS OF LEFT ILIAC VEIN

S63032A

SUBLUXATION OF MIDCARPAL JOINT OF LEFT WRIST INIT ENCNTR

I82523

CHRONIC EMBOLISM AND THROMBOSIS OF ILIAC VEIN BILATERAL

S63033A

SUBLUXATION OF MIDCARPAL JOINT OF UNSP WRIST INIT ENCNTR

I82529

CHRONIC EMBOLISM AND THROMBOSIS OF UNSPECIFIED ILIAC VEIN

S63034A

DISLOCATION OF MIDCARPAL JOINT OF RIGHT WRIST INIT ENCNTR

I82531

CHRONIC EMBOLISM AND THROMBOSIS OF RIGHT POPLITEAL VEIN

S63035A

DISLOCATION OF MIDCARPAL JOINT OF LEFT WRIST INIT ENCNTR

I82532

CHRONIC EMBOLISM AND THROMBOSIS OF LEFT POPLITEAL VEIN

S63036A

DISLOCATION OF MIDCARPAL JOINT OF UNSP WRIST INIT ENCNTR

I82533

CHRONIC EMBOLISM AND THROMBOSIS OF POPLITEAL VEIN BILATERAL

S63041A

SUBLUXATION OF CARPOMETACARPAL JOINT OF RIGHT THUMB INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I82539

CHRONIC EMBOLISM AND THROMBOSIS OF UNSP POPLITEAL VEIN

S63042A

SUBLUXATION OF CARPOMETACARPAL JOINT OF LEFT THUMB INIT

I82541

CHRONIC EMBOLISM AND THROMBOSIS OF RIGHT TIBIAL VEIN

S63043A

SUBLUXATION OF CARPOMETACARPAL JOINT OF UNSP THUMB INIT

I82542

CHRONIC EMBOLISM AND THROMBOSIS OF LEFT TIBIAL VEIN

S63044A

DISLOCATION OF CARPOMETACARPAL JOINT OF RIGHT THUMB INIT

I82543

CHRONIC EMBOLISM AND THROMBOSIS OF TIBIAL VEIN BILATERAL

S63045A

DISLOCATION OF CARPOMETACARPAL JOINT OF LEFT THUMB INIT

I82549

CHRONIC EMBOLISM AND THROMBOSIS OF UNSPECIFIED TIBIAL VEIN

S63045S

DISLOCATION OF CARPOMETACARPAL JOINT OF LEFT THUMB SEQUELA

I82591

CHRONIC EMBOLISM AND THROMBOSIS OF DEEP VEIN OF R LOW EXTREM

S63052A

SUBLUXATION OF OTH CARPOMETACARPAL JOINT OF LEFT HAND INIT

I82592

CHRONIC EMBOLISM AND THROMBOSIS OF DEEP VEIN OF L LOW EXTREM

S63053A

SUBLUXATION OF OTH CARPOMETACARPAL JOINT OF UNSP HAND INIT

I82593

CHRONIC EMBOLISM AND THOMBOS OF DEEP VEIN OF LOW EXTRM BI

S63054A

DISLOCATION OF OTH CARPOMETACARPAL JOINT OF RIGHT HAND INIT

I82599

CHRONIC EMBOLISM AND THOMBOS OF DEEP VEIN OF UNSP LOW EXTRM

S63055A

DISLOCATION OF OTH CARPOMETACARPAL JOINT OF LEFT HAND INIT

I825Y1

CHR EMBLSM AND THOMBOS UNSP DEEP VEINS OF R PROX LOW EXTRM

S63056A

DISLOCATION OF OTH CARPOMETACARPAL JOINT OF UNSP HAND INIT

I825Y2

CHR EMBLSM AND THOMBOS UNSP DEEP VN OF LEFT PROX LOW EXTRM

S63061A

SUBLUX OF MC (BONE) PROXIMAL END OF RIGHT HAND INIT

I825Y3

CHR EMBLSM AND THOMBOS UNSP DEEP VEINS OF PROX LOW EXTRM BI

S63062A

SUBLUX OF METACARPAL (BONE) PROXIMAL END OF LEFT HAND INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I825Y9

CHRONIC EMBLSM AND THOMBOS UNSP DEEP VN UNSP PROX LOW EXTRM

S63063A

SUBLUX OF METACARPAL (BONE) PROXIMAL END OF UNSP HAND INIT

I825Z1

CHR EMBLSM AND THOMBOS UNSP DEEP VEINS OF R DIST LOW EXTRM

S63064A

DISLOC OF MC (BONE) PROXIMAL END OF RIGHT HAND INIT

I825Z2

CHR EMBLSM AND THOMBOS UNSP DEEP VN OF LEFT DIST LOW EXTRM

S63065A

DISLOC OF METACARPAL (BONE) PROXIMAL END OF LEFT HAND INIT

I825Z3

CHR EMBLSM AND THOMBOS UNSP DEEP VEINS OF DIST LOW EXTRM BI

S63066A

DISLOC OF METACARPAL (BONE) PROXIMAL END OF UNSP HAND INIT

I825Z9

CHR EMBLSM AND THOMBOS UNSP DEEP VN UNSP DISTAL LOW EXTRM

S63072A

SUBLUXATION OF DISTAL END OF LEFT ULNA INITIAL ENCOUNTER

I82601

ACUTE EMBOLISM AND THOMBOS UNSP VEINS OF R UP EXTREM

S63073A

SUBLUXATION OF DISTAL END OF UNSPECIFIED ULNA INIT ENCNTR

I82602

ACUTE EMBOLISM AND THOMBOS UNSP VEINS OF L UP EXTREM

S63074A

DISLOCATION OF DISTAL END OF RIGHT ULNA INITIAL ENCOUNTER

I82603

ACUTE EMBOLISM AND THOMBOS UNSP VEINS OF UP EXTREM BI

S63075A

DISLOCATION OF DISTAL END OF LEFT ULNA INITIAL ENCOUNTER

I82609

ACUTE EMBOLISM AND THOMBOS UNSP VN UNSP UPPER EXTREMITY

S63076A

DISLOCATION OF DISTAL END OF UNSPECIFIED ULNA INIT ENCNTR

I82611

ACUTE EMBOLISM AND THOMBOS OF SUPERFIC VEINS OF R UP EXTREM

S63091A

OTHER SUBLUXATION OF RIGHT WRIST AND HAND INITIAL ENCOUNTER

I82612

ACUTE EMBOLISM AND THOMBOS OF SUPERFIC VEINS OF L UP EXTREM

S63092A

OTHER SUBLUXATION OF LEFT WRIST AND HAND INITIAL ENCOUNTER

I82613

ACUTE EMBLSM AND THOMBOS OF SUPERFIC VEINS OF UP EXTREM BI

S63093A

OTHER SUBLUXATION OF UNSPECIFIED WRIST AND HAND INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I82619

ACUTE EMBOLISM AND THROMBOSIS OF SUPERFIC VN UNSP UP EXTREM

S63094A

OTHER DISLOCATION OF RIGHT WRIST AND HAND INITIAL ENCOUNTER

I82621

ACUTE EMBOLISM AND THROMBOSIS OF DEEP VEINS OF R UP EXTREM

S63095A

OTHER DISLOCATION OF LEFT WRIST AND HAND INITIAL ENCOUNTER

I82622

ACUTE EMBOLISM AND THROMBOSIS OF DEEP VEINS OF L UP EXTREM

S63096A

OTHER DISLOCATION OF UNSPECIFIED WRIST AND HAND INIT ENCNTR

I82623

ACUTE EMBOLISM AND THOMBOS OF DEEP VEINS OF UP EXTREM BI

S63101A

UNSPECIFIED SUBLUXATION OF RIGHT THUMB INITIAL ENCOUNTER

I82629

ACUTE EMBOLISM AND THROMBOSIS OF DEEP VN UNSP UP EXTREM

S63102A

UNSPECIFIED SUBLUXATION OF LEFT THUMB INITIAL ENCOUNTER

I82701

CHRONIC EMBOLISM AND THOMBOS UNSP VEINS OF R UP EXTREM

S63103A

UNSPECIFIED SUBLUXATION OF UNSPECIFIED THUMB INIT ENCNTR

I82702

CHRONIC EMBOLISM AND THOMBOS UNSP VEINS OF L UP EXTREM

S63104A

UNSPECIFIED DISLOCATION OF RIGHT THUMB INITIAL ENCOUNTER

I82703

CHRONIC EMBOLISM AND THOMBOS UNSP VEINS OF UP EXTREM BI

S63105A

UNSPECIFIED DISLOCATION OF LEFT THUMB INITIAL ENCOUNTER

I82709

CHRONIC EMBOLISM AND THOMBOS UNSP VN UNSP UPPER EXTREMITY

S63106A

UNSPECIFIED DISLOCATION OF UNSPECIFIED THUMB INIT ENCNTR

I82711

CHRONIC EMBLSM AND THOMBOS OF SUPERFIC VEINS OF R UP EXTREM

S63111A

SUBLUXATION OF MCP JOINT OF RIGHT THUMB INIT

I82712

CHRONIC EMBLSM AND THOMBOS OF SUPERFIC VEINS OF L UP EXTREM

S63112A

SUBLUXATION OF METACARPOPHALANGEAL JOINT OF LEFT THUMB INIT

I82713

CHR EMBLSM AND THOMBOS OF SUPERFIC VEINS OF UP EXTREM BI

S63113A

SUBLUXATION OF METACARPOPHALANGEAL JOINT OF UNSP THUMB INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I82719

CHRONIC EMBOLISM AND THOMBOS OF SUPERFIC VN UNSP UP EXTREM

S63114A

DISLOCATION OF MCP JOINT OF RIGHT THUMB INIT

I82721

CHRONIC EMBOLISM AND THROMBOSIS OF DEEP VEINS OF R UP EXTREM

S63115A

DISLOCATION OF METACARPOPHALANGEAL JOINT OF LEFT THUMB INIT

I82722

CHRONIC EMBOLISM AND THROMBOSIS OF DEEP VEINS OF L UP EXTREM

S63116A

DISLOCATION OF METACARPOPHALANGEAL JOINT OF UNSP THUMB INIT

I82723

CHRONIC EMBOLISM AND THOMBOS OF DEEP VEINS OF UP EXTREM BI

S63121A

SUBLUXATION OF UNSP INTERPHALN JOINT OF RIGHT THUMB INIT

I82729

CHRONIC EMBOLISM AND THROMBOSIS OF DEEP VN UNSP UP EXTREM

S63122A

SUBLUXATION OF UNSP INTERPHALN JOINT OF LEFT THUMB INIT

I82811

EMBOLISM AND THROMBOSIS OF SUPERFIC VEINS OF RIGHT LOW EXTRM

S63123A

SUBLUXATION OF UNSP INTERPHALANGEAL JOINT OF THMB INIT

I82812

EMBOLISM AND THROMBOSIS OF SUPERFIC VEINS OF LEFT LOW EXTRM

S63124A

DISLOCATION OF UNSP INTERPHALN JOINT OF RIGHT THUMB INIT

I82813

EMBOLISM AND THOMBOS OF SUPERFIC VEINS OF LOW EXTRM BI

S63125A

DISLOCATION OF UNSP INTERPHALN JOINT OF LEFT THUMB INIT

I82819

EMBOLISM AND THROMBOSIS OF SUPERFICIAL VN UNSP LOW EXTRM

S63126A

DISLOCATION OF UNSP INTERPHALANGEAL JOINT OF THMB INIT

I82890

ACUTE EMBOLISM AND THROMBOSIS OF OTHER SPECIFIED VEINS

S63131A

SUBLUXATION OF PROXIMAL INTERPHALN JOINT OF R THM INIT

I82891

CHRONIC EMBOLISM AND THROMBOSIS OF OTHER SPECIFIED VEINS

S63132A

SUBLUXATION OF PROXIMAL INTERPHALN JOINT OF LEFT THUMB INIT

I8290

ACUTE EMBOLISM AND THROMBOSIS OF UNSPECIFIED VEIN

S63133A

SUBLUXATION OF PROXIMAL INTERPHALANGEAL JOINT OF THMB INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I8291

CHRONIC EMBOLISM AND THROMBOSIS OF UNSPECIFIED VEIN

S63134A

DISLOC OF PROXIMAL INTERPHALN JOINT OF RIGHT THUMB INIT

I82A11

ACUTE EMBOLISM AND THROMBOSIS OF RIGHT AXILLARY VEIN

S63135A

DISLOCATION OF PROXIMAL INTERPHALN JOINT OF LEFT THUMB INIT

I82A12

ACUTE EMBOLISM AND THROMBOSIS OF LEFT AXILLARY VEIN

S63136A

DISLOCATION OF PROXIMAL INTERPHALANGEAL JOINT OF THMB INIT

I82A13

ACUTE EMBOLISM AND THROMBOSIS OF AXILLARY VEIN BILATERAL

S63141A

SUBLUXATION OF DISTAL INTERPHALN JOINT OF RIGHT THUMB INIT

I82A19

ACUTE EMBOLISM AND THROMBOSIS OF UNSPECIFIED AXILLARY VEIN

S63142A

SUBLUXATION OF DISTAL INTERPHALN JOINT OF LEFT THUMB INIT

I82A21

CHRONIC EMBOLISM AND THROMBOSIS OF RIGHT AXILLARY VEIN

S63143A

SUBLUXATION OF DISTAL INTERPHALANGEAL JOINT OF THMB INIT

I82A22

CHRONIC EMBOLISM AND THROMBOSIS OF LEFT AXILLARY VEIN

S63144A

DISLOCATION OF DISTAL INTERPHALN JOINT OF RIGHT THUMB INIT

I82A23

CHRONIC EMBOLISM AND THROMBOSIS OF AXILLARY VEIN BILATERAL

S63145A

DISLOCATION OF DISTAL INTERPHALN JOINT OF LEFT THUMB INIT

I82A29

CHRONIC EMBOLISM AND THROMBOSIS OF UNSPECIFIED AXILLARY VEIN

S63146A

DISLOCATION OF DISTAL INTERPHALANGEAL JOINT OF THMB INIT

I82B11

ACUTE EMBOLISM AND THROMBOSIS OF RIGHT SUBCLAVIAN VEIN

S63200A

UNSPECIFIED SUBLUXATION OF RIGHT INDEX FINGER INIT ENCNTR

I82B12

ACUTE EMBOLISM AND THROMBOSIS OF LEFT SUBCLAVIAN VEIN

S63201A

UNSPECIFIED SUBLUXATION OF LEFT INDEX FINGER INIT ENCNTR

I82B13

ACUTE EMBOLISM AND THROMBOSIS OF SUBCLAVIAN VEIN BILATERAL

S63202A

UNSPECIFIED SUBLUXATION OF RIGHT MIDDLE FINGER INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I82B19

ACUTE EMBOLISM AND THROMBOSIS OF UNSPECIFIED SUBCLAVIAN VEIN

S63203A

UNSPECIFIED SUBLUXATION OF LEFT MIDDLE FINGER INIT ENCNTR

I82B21

CHRONIC EMBOLISM AND THROMBOSIS OF RIGHT SUBCLAVIAN VEIN

S63204A

UNSPECIFIED SUBLUXATION OF RIGHT RING FINGER INIT ENCNTR

I82B22

CHRONIC EMBOLISM AND THROMBOSIS OF LEFT SUBCLAVIAN VEIN

S63205A

UNSPECIFIED SUBLUXATION OF LEFT RING FINGER INIT ENCNTR

I82B23

CHRONIC EMBOLISM AND THROMBOSIS OF SUBCLAV VEIN BILATERAL

S63206A

UNSPECIFIED SUBLUXATION OF RIGHT LITTLE FINGER INIT ENCNTR

I82B29

CHRONIC EMBOLISM AND THROMBOSIS OF UNSP SUBCLAVIAN VEIN

S63207A

UNSPECIFIED SUBLUXATION OF LEFT LITTLE FINGER INIT ENCNTR

I82C11

ACUTE EMBOLISM AND THROMBOSIS OF RIGHT INTERNAL JUGULAR VEIN

S63208A

UNSPECIFIED SUBLUXATION OF OTHER FINGER INITIAL ENCOUNTER

I82C12

ACUTE EMBOLISM AND THROMBOSIS OF LEFT INTERNAL JUGULAR VEIN

S63209A

UNSPECIFIED SUBLUXATION OF UNSPECIFIED FINGER INIT ENCNTR

I82C13

ACUTE EMBOLISM AND THROMBOSIS OF INT JUGULAR VEIN BILATERAL

S63210A

SUBLUXATION OF MCP JOINT OF RIGHT INDEX FINGER INIT

I82C19

ACUTE EMBOLISM AND THROMBOSIS OF UNSP INTERNAL JUGULAR VEIN

S63211A

SUBLUXATION OF MCP JOINT OF LEFT INDEX FINGER INIT

I82C21

CHRONIC EMBOLISM AND THROMBOSIS OF R INT JUGULAR VEIN

S63212A

SUBLUXATION OF MCP JOINT OF RIGHT MIDDLE FINGER INIT

I82C22

CHRONIC EMBOLISM AND THROMBOSIS OF L INT JUGULAR VEIN

S63213A

SUBLUXATION OF MCP JOINT OF LEFT MIDDLE FINGER INIT

I82C23

CHRONIC EMBOLISM AND THOMBOS OF INT JUGULAR VEIN BILATERAL

S63214A

SUBLUXATION OF MCP JOINT OF RIGHT RING FINGER INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I82C29

CHRONIC EMBOLISM AND THOMBOS UNSP INTERNAL JUGULAR VEIN

S63215A

SUBLUXATION OF MCP JOINT OF LEFT RING FINGER INIT

I83001

VARICOSE VEINS OF UNSP LOWER EXTREMITY WITH ULCER OF THIGH

S63216A

SUBLUXATION OF MCP JOINT OF RIGHT LITTLE FINGER INIT

I83002

VARICOSE VEINS OF UNSP LOWER EXTREMITY WITH ULCER OF CALF

S63217A

SUBLUXATION OF MCP JOINT OF LEFT LITTLE FINGER INIT

I83003

VARICOSE VEINS OF UNSP LOWER EXTREMITY WITH ULCER OF ANKLE

S63218A

SUBLUXATION OF METACARPOPHALANGEAL JOINT OF OTH FINGER INIT

I83004

VARICOS VN UNSP LOWER EXTREMITY W ULCER OF HEEL AND MIDFOOT

S63219A

SUBLUXATION OF MCP JOINT OF UNSP FINGER INIT

I83005

VARICOS VN UNSP LOWER EXTREMITY W ULCER OTH PART OF FOOT

S63220A

SUBLUXATION OF UNSP INTERPHALN JOINT OF R IDX FNGR INIT

I83008

VARICOS VN UNSP LOW EXTRM W ULCER OTH PART OF LOWER LEG

S63221A

SUBLUXATION OF UNSP INTERPHALN JOINT OF L IDX FNGR INIT

I83009

VARICOSE VEINS OF UNSP LOWER EXTREMITY W ULCER OF UNSP SITE

S63222A

SUBLUXATION OF UNSP INTERPHALN JOINT OF R MID FINGER INIT

I83011

VARICOSE VEINS OF RIGHT LOWER EXTREMITY WITH ULCER OF THIGH

S63223A

SUBLUXATION OF UNSP INTERPHALN JOINT OF L MID FINGER INIT

I83012

VARICOSE VEINS OF RIGHT LOWER EXTREMITY WITH ULCER OF CALF

S63224A

SUBLUXATION OF UNSP INTERPHALN JOINT OF R RNG FNGR INIT

I83013

VARICOSE VEINS OF RIGHT LOWER EXTREMITY WITH ULCER OF ANKLE

S63225A

SUBLUXATION OF UNSP INTERPHALN JOINT OF L RNG FNGR INIT

I83014

VARICOSE VEINS OF R LOW EXTREM W ULCER OF HEEL AND MIDFOOT

S63226A

SUBLUX OF UNSP INTERPHALN JOINT OF R LITTLE FINGER INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I83015

VARICOSE VEINS OF R LOW EXTREM W ULCER OTH PART OF FOOT

S63227A

SUBLUX OF UNSP INTERPHALN JOINT OF L LITTLE FINGER INIT

I83018

VARICOSE VEINS OF R LOW EXTREM W ULCER OTH PART OF LOWER LEG

S63228A

SUBLUXATION OF UNSP INTERPHALANGEAL JOINT OF FINGER INIT

I83019

VARICOSE VEINS OF RIGHT LOWER EXTREMITY W ULCER OF UNSP SITE

S63229A

SUBLUXATION OF UNSP INTERPHALN JOINT OF UNSP FINGER INIT

I83021

VARICOSE VEINS OF LEFT LOWER EXTREMITY WITH ULCER OF THIGH

S63230A

SUBLUXATION OF PROXIMAL INTERPHALN JOINT OF R IDX FNGR INIT

I83022

VARICOSE VEINS OF LEFT LOWER EXTREMITY WITH ULCER OF CALF

S63231A

SUBLUXATION OF PROXIMAL INTERPHALN JOINT OF L IDX FNGR INIT

I83023

VARICOSE VEINS OF LEFT LOWER EXTREMITY WITH ULCER OF ANKLE

S63232A

SUBLUX OF PROXIMAL INTERPHALN JOINT OF R MID FINGER INIT

I83024

VARICOSE VEINS OF L LOW EXTREM W ULCER OF HEEL AND MIDFOOT

S63233A

SUBLUX OF PROXIMAL INTERPHALN JOINT OF L MID FINGER INIT

I83025

VARICOSE VEINS OF L LOW EXTREM W ULCER OTH PART OF FOOT

S63234A

SUBLUXATION OF PROXIMAL INTERPHALN JOINT OF R RNG FNGR INIT

I83028

VARICOSE VEINS OF L LOW EXTREM W ULCER OTH PART OF LOWER LEG

S63235A

SUBLUXATION OF PROXIMAL INTERPHALN JOINT OF L RNG FNGR INIT

I83029

VARICOSE VEINS OF LEFT LOWER EXTREMITY W ULCER OF UNSP SITE

S63236A

SUBLUX OF PROXIMAL INTERPHALN JOINT OF R LITTLE FINGER INIT

I8310

VARICOSE VEINS OF UNSP LOWER EXTREMITY WITH INFLAMMATION

S63237A

SUBLUX OF PROXIMAL INTERPHALN JOINT OF L LITTLE FINGER INIT

I8311

VARICOSE VEINS OF RIGHT LOWER EXTREMITY WITH INFLAMMATION

S63238A

SUBLUXATION OF PROXIMAL INTERPHALN JOINT OF FINGER INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I8312

VARICOSE VEINS OF LEFT LOWER EXTREMITY WITH INFLAMMATION

S63239A

SUBLUX OF PROXIMAL INTERPHALN JOINT OF UNSP FINGER INIT

I83201

VARICOS VN UNSP LOW EXTRM W ULC OF THIGH AND INFLAMMATION

S63240A

SUBLUXATION OF DISTAL INTERPHALN JOINT OF R IDX FNGR INIT

I83202

VARICOS VN UNSP LOW EXTRM W ULC OF CALF AND INFLAMMATION

S63241A

SUBLUXATION OF DISTAL INTERPHALN JOINT OF L IDX FNGR INIT

I83203

VARICOS VN UNSP LOW EXTRM W ULC OF ANKLE AND INFLAMMATION

S63242A

SUBLUXATION OF DISTAL INTERPHALN JOINT OF R MID FINGER INIT

I83204

VARICOS VN UNSP LOW EXTRM W ULC OF HEEL AND MIDFT AND INFLAM

S63243A

SUBLUXATION OF DISTAL INTERPHALN JOINT OF L MID FINGER INIT

I83205

VARICOS VN UNSP LOW EXTRM W ULC OTH PART OF FOOT AND INFLAM

S63244A

SUBLUXATION OF DISTAL INTERPHALN JOINT OF R RNG FNGR INIT

I83208

VARICOS VN UNSP LOW EXTRM W ULC OTH PRT LOW EXTRM AND INFLAM

S63245A

SUBLUXATION OF DISTAL INTERPHALN JOINT OF L RNG FNGR INIT

I83209

VARICOS VN UNSP LOW EXTRM W ULC OF UNSP SITE AND INFLAM

S63246A

SUBLUX OF DISTAL INTERPHALN JOINT OF R LITTLE FINGER INIT

I83211

VARICOS VN OF R LOW EXTREM W ULC OF THIGH AND INFLAMMATION

S63247A

SUBLUX OF DISTAL INTERPHALN JOINT OF L LITTLE FINGER INIT

I83212

VARICOS VN OF R LOW EXTREM W ULC OF CALF AND INFLAMMATION

S63248A

SUBLUXATION OF DISTAL INTERPHALANGEAL JOINT OF FINGER INIT

I83213

VARICOS VN OF R LOW EXTREM W ULC OF ANKLE AND INFLAMMATION

S63249A

SUBLUXATION OF DISTAL INTERPHALN JOINT OF UNSP FINGER INIT

I83214

VARICOS VN OF R LOW EXTREM W ULC OF HEEL & MIDFT AND INFLAM

S63250A

UNSPECIFIED DISLOCATION OF RIGHT INDEX FINGER INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I83215

VARICOS VN OF R LOW EXTREM W ULC OTH PART OF FOOT AND INFLAM

S63251A

UNSPECIFIED DISLOCATION OF LEFT INDEX FINGER INIT ENCNTR

I83218

VARICOS VN OF R LOW EXTREM W ULC OTH PRT LOW EXTRM & INFLAM

S63252A

UNSPECIFIED DISLOCATION OF RIGHT MIDDLE FINGER INIT ENCNTR

I83219

VARICOS VN OF R LOW EXTREM W ULC OF UNSP SITE AND INFLAM

S63253A

UNSPECIFIED DISLOCATION OF LEFT MIDDLE FINGER INIT ENCNTR

I83221

VARICOS VN OF L LOW EXTREM W ULC OF THIGH AND INFLAMMATION

S63254A

UNSPECIFIED DISLOCATION OF RIGHT RING FINGER INIT ENCNTR

I83222

VARICOS VN OF L LOW EXTREM W ULC OF CALF AND INFLAMMATION

S63255A

UNSPECIFIED DISLOCATION OF LEFT RING FINGER INIT ENCNTR

I83223

VARICOS VN OF L LOW EXTREM W ULC OF ANKLE AND INFLAMMATION

S63256A

UNSPECIFIED DISLOCATION OF RIGHT LITTLE FINGER INIT ENCNTR

I83224

VARICOS VN OF L LOW EXTREM W ULC OF HEEL & MIDFT AND INFLAM

S63257A

UNSPECIFIED DISLOCATION OF LEFT LITTLE FINGER INIT ENCNTR

I83225

VARICOS VN OF L LOW EXTREM W ULC OTH PART OF FOOT AND INFLAM

S63258A

UNSPECIFIED DISLOCATION OF OTHER FINGER INITIAL ENCOUNTER

I83228

VARICOS VN OF L LOW EXTREM W ULC OTH PRT LOW EXTRM & INFLAM

S63259A

UNSPECIFIED DISLOCATION OF UNSPECIFIED FINGER INIT ENCNTR

I83229

VARICOS VN OF L LOW EXTREM W ULC OF UNSP SITE AND INFLAM

S63260A

DISLOCATION OF MCP JOINT OF RIGHT INDEX FINGER INIT

I83811

VARICOSE VEINS OF RIGHT LOWER EXTREMITIES WITH PAIN

S63261A

DISLOCATION OF MCP JOINT OF LEFT INDEX FINGER INIT

I83812

VARICOSE VEINS OF LEFT LOWER EXTREMITIES WITH PAIN

S63262A

DISLOCATION OF MCP JOINT OF RIGHT MIDDLE FINGER INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I83813

VARICOSE VEINS OF BILATERAL LOWER EXTREMITIES WITH PAIN

S63263A

DISLOCATION OF MCP JOINT OF LEFT MIDDLE FINGER INIT

I83819

VARICOSE VEINS OF UNSPECIFIED LOWER EXTREMITIES WITH PAIN

S63264A

DISLOCATION OF MCP JOINT OF RIGHT RING FINGER INIT

I83891 VARICOSE VEINS OF RIGHT LOW EXTRM W OTH COMPLICATIONS

S63265A

DISLOCATION OF MCP JOINT OF LEFT RING FINGER INIT

I83892

VARICOSE VEINS OF LEFT LOWER EXTREMITIES W OTH COMPLICATIONS

S63266A

DISLOCATION OF MCP JOINT OF RIGHT LITTLE FINGER INIT

I83893

VARICOSE VEINS OF BI LOW EXTREM W OTH COMPLICATIONS

S63267A

DISLOCATION OF MCP JOINT OF LEFT LITTLE FINGER INIT

I83899

VARICOSE VEINS OF UNSP LOWER EXTREMITIES W OTH COMPLICATIONS

S63268A

DISLOCATION OF METACARPOPHALANGEAL JOINT OF OTH FINGER INIT

I8390

ASYMPTOMATIC VARICOSE VEINS OF UNSPECIFIED LOWER EXTREMITY

S63269A

DISLOCATION OF MCP JOINT OF UNSP FINGER INIT

I8391

ASYMPTOMATIC VARICOSE VEINS OF RIGHT LOWER EXTREMITY

S63270A

DISLOCATION OF UNSP INTERPHALN JOINT OF R IDX FNGR INIT

I8392

ASYMPTOMATIC VARICOSE VEINS OF LEFT LOWER EXTREMITY

S63271A

DISLOCATION OF UNSP INTERPHALN JOINT OF L IDX FNGR INIT

I8393

ASYMPTOMATIC VARICOSE VEINS OF BILATERAL LOWER EXTREMITIES

S63272A

DISLOCATION OF UNSP INTERPHALN JOINT OF R MID FINGER INIT

I8500 ESOPHAGEAL VARICES WITHOUT BLEEDING

S63273A

DISLOCATION OF UNSP INTERPHALN JOINT OF L MID FINGER INIT

I8501 ESOPHAGEAL VARICES WITH BLEEDING

S63274A

DISLOCATION OF UNSP INTERPHALN JOINT OF R RNG FNGR INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I8510 SECONDARY ESOPHAGEAL VARICES WITHOUT BLEEDING

S63275A

DISLOCATION OF UNSP INTERPHALN JOINT OF L RNG FNGR INIT

I8511 SECONDARY ESOPHAGEAL VARICES WITH BLEEDING

S63276A

DISLOC OF UNSP INTERPHALN JOINT OF R LITTLE FINGER INIT

I860 SUBLINGUAL VARICES

S63277A DISLOC OF UNSP INTERPHALN JOINT OF L LITTLE FINGER INIT

I861 SCROTAL VARICES

S63278A

DISLOCATION OF UNSP INTERPHALANGEAL JOINT OF FINGER INIT

I862 PELVIC VARICES

S63279A DISLOCATION OF UNSP INTERPHALN JOINT OF UNSP FINGER INIT

I863 VULVAL VARICES

S63280A

DISLOCATION OF PROXIMAL INTERPHALN JOINT OF R IDX FNGR INIT

I864 GASTRIC VARICES

S63281A DISLOCATION OF PROXIMAL INTERPHALN JOINT OF L IDX FNGR INIT

I868 VARICOSE VEINS OF OTHER SPECIFIED SITES

S63282A

DISLOC OF PROXIMAL INTERPHALN JOINT OF R MID FINGER INIT

I87001

POSTTHROMBOTIC SYNDROME W/O COMPLICATIONS OF R LOW EXTREM

S63283A

DISLOC OF PROXIMAL INTERPHALN JOINT OF L MID FINGER INIT

I87002

POSTTHROMBOTIC SYNDROME W/O COMPLICATIONS OF L LOW EXTREM

S63284A

DISLOCATION OF PROXIMAL INTERPHALN JOINT OF R RNG FNGR INIT

I87003

POSTTHROM SYNDROME W/O COMPLICATIONS OF BILATERAL LOW EXTRM

S63285A

DISLOCATION OF PROXIMAL INTERPHALN JOINT OF L RNG FNGR INIT

I87009

POSTTHROMBOTIC SYNDROME W/O COMPLICATIONS OF UNSP EXTREMITY

S63286A

DISLOC OF PROXIMAL INTERPHALN JOINT OF R LITTLE FINGER INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I87011

POSTTHROMBOTIC SYNDROME WITH ULCER OF RIGHT LOWER EXTREMITY

S63287A

DISLOC OF PROXIMAL INTERPHALN JOINT OF L LITTLE FINGER INIT

I87012

POSTTHROMBOTIC SYNDROME WITH ULCER OF LEFT LOWER EXTREMITY

S63288A

DISLOCATION OF PROXIMAL INTERPHALN JOINT OF FINGER INIT

I87013

POSTTHROMBOTIC SYNDROME W ULCER OF BILATERAL LOWER EXTREMITY

S63289A

DISLOC OF PROXIMAL INTERPHALN JOINT OF UNSP FINGER INIT

I87019

POSTTHROMBOTIC SYNDROME WITH ULCER OF UNSP LOWER EXTREMITY

S63290A

DISLOCATION OF DISTAL INTERPHALN JOINT OF R IDX FNGR INIT

I87021

POSTTHROMBOTIC SYNDROME W INFLAMMATION OF R LOW EXTREM

S63291A

DISLOCATION OF DISTAL INTERPHALN JOINT OF L IDX FNGR INIT

I87022

POSTTHROMBOTIC SYNDROME W INFLAMMATION OF L LOW EXTREM

S63292A

DISLOCATION OF DISTAL INTERPHALN JOINT OF R MID FINGER INIT

I87023

POSTTHROM SYNDROME W INFLAMMATION OF BILATERAL LOW EXTRM

S63293A

DISLOCATION OF DISTAL INTERPHALN JOINT OF L MID FINGER INIT

I87029

POSTTHROMBOTIC SYNDROME W INFLAMMATION OF UNSP LOW EXTRM

S63294A

DISLOCATION OF DISTAL INTERPHALN JOINT OF R RNG FNGR INIT

I87031

POSTTHROM SYNDROME W ULCER AND INFLAMMATION OF R LOW EXTREM

S63295A

DISLOCATION OF DISTAL INTERPHALN JOINT OF L RNG FNGR INIT

I87032

POSTTHROM SYNDROME W ULCER AND INFLAMMATION OF L LOW EXTREM

S63296A

DISLOC OF DISTAL INTERPHALN JOINT OF R LITTLE FINGER INIT

I87033

POSTTHROM SYNDROME W ULCER AND INFLAM OF BILATERAL LOW EXTRM

S63297A

DISLOC OF DISTAL INTERPHALN JOINT OF L LITTLE FINGER INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I87039

POSTTHROM SYNDROME W ULCER AND INFLAM OF UNSP LOW EXTRM

S63298A

DISLOCATION OF DISTAL INTERPHALANGEAL JOINT OF FINGER INIT

I87091

POSTTHROMBOTIC SYNDROME W OTH COMPLICATIONS OF R LOW EXTREM

S63299A

DISLOCATION OF DISTAL INTERPHALN JOINT OF UNSP FINGER INIT

I87092

POSTTHROMBOTIC SYNDROME W OTH COMPLICATIONS OF L LOW EXTREM

S63301A

TRAUMATIC RUPTURE OF UNSP LIGAMENT OF RIGHT WRIST INIT

I87093

POSTTHROM SYNDROME W OTH COMP OF BILATERAL LOW EXTRM

S63302A

TRAUMATIC RUPTURE OF UNSP LIGAMENT OF LEFT WRIST INIT

I87099

POSTTHROM SYNDROME W OTH COMPLICATIONS OF UNSP LOW EXTRM

S63309A

TRAUMATIC RUPTURE OF UNSP LIGAMENT OF UNSP WRIST INIT

I871 COMPRESSION OF VEIN

S63311A TRAUMATIC RUPTURE OF COLLATERAL LIGAMENT OF R WRIST INIT

I872 VENOUS INSUFFICIENCY (CHRONIC) (PERIPHERAL)

S63312A

TRAUMATIC RUPTURE OF COLLATERAL LIGAMENT OF LEFT WRIST INIT

I87301

CHRONIC VENOUS HYPERTENSION W/O COMP OF R LOW EXTREM

S63319A

TRAUMATIC RUPTURE OF COLLATERAL LIGAMENT OF UNSP WRIST INIT

I87302

CHRONIC VENOUS HYPERTENSION W/O COMP OF L LOW EXTREM

S63321A

TRAUMATIC RUPTURE OF RIGHT RADIOCARPAL LIGAMENT INIT ENCNTR

I87303

CHRONIC VENOUS HYPERTENSION W/O COMP OF BILATERAL LOW EXTRM

S63322A

TRAUMATIC RUPTURE OF LEFT RADIOCARPAL LIGAMENT INIT ENCNTR

I87309

CHRONIC VENOUS HYPERTENSION W/O COMP OF UNSP LOW EXTRM

S63329A

TRAUMATIC RUPTURE OF UNSP RADIOCARPAL LIGAMENT INIT ENCNTR

I87311

CHRONIC VENOUS HYPERTENSION W ULCER OF R LOW EXTREM

S63331A

TRAUM RUPTURE OF RIGHT ULNOCARPAL (PALMAR) LIGAMENT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I87312

CHRONIC VENOUS HYPERTENSION W ULCER OF L LOW EXTREM

S63332A

TRAUMATIC RUPTURE OF LEFT ULNOCARPAL (PALMAR) LIGAMENT INIT

I87313

CHRONIC VENOUS HYPERTENSION W ULCER OF BILATERAL LOW EXTRM

S63339A

TRAUMATIC RUPTURE OF UNSP ULNOCARPAL (PALMAR) LIGAMENT INIT

I87319

CHRONIC VENOUS HYPERTENSION W ULCER OF UNSP LOW EXTRM

S63391A

TRAUMATIC RUPTURE OF OTH LIGAMENT OF RIGHT WRIST INIT

I87321

CHRONIC VENOUS HYPERTENSION W INFLAMMATION OF R LOW EXTREM

S63392A

TRAUMATIC RUPTURE OF OTH LIGAMENT OF LEFT WRIST INIT ENCNTR

I87322

CHRONIC VENOUS HYPERTENSION W INFLAMMATION OF L LOW EXTREM

S63399A

TRAUMATIC RUPTURE OF OTH LIGAMENT OF UNSP WRIST INIT ENCNTR

I87323

CHRONIC VENOUS HTN W INFLAMMATION OF BILATERAL LOW EXTRM

S63400A

TRAUM RUPTURE OF UNSP LIGMT OF R IDX FNGR AT MCP/IP JT INIT

I87329

CHRONIC VENOUS HYPERTENSION W INFLAMMATION OF UNSP LOW EXTRM

S63401A

TRAUM RUPTURE OF UNSP LIGMT OF L IDX FNGR AT MCP/IP JT INIT

I87331

CHRONIC VENOUS HTN W ULCER AND INFLAMMATION OF R LOW EXTREM

S63402A

TRAUM RUPT OF UNSP LIGMT OF R MID FINGER AT MCP/IP JT INIT

I87332

CHRONIC VENOUS HTN W ULCER AND INFLAMMATION OF L LOW EXTREM

S63403A

TRAUM RUPT OF UNSP LIGMT OF L MID FINGER AT MCP/IP JT INIT

I87333

CHRONIC VENOUS HTN W ULCER AND INFLAM OF BILATERAL LOW EXTRM

S63404A

TRAUM RUPTURE OF UNSP LIGMT OF R RNG FNGR AT MCP/IP JT INIT

I87339

CHRONIC VENOUS HTN W ULCER AND INFLAM OF UNSP LOW EXTRM

S63405A

TRAUM RUPTURE OF UNSP LIGMT OF L RNG FNGR AT MCP/IP JT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I87391

CHRONIC VENOUS HYPERTENSION W OTH COMP OF R LOW EXTREM

S63406A

TRAUM RUPT OF UNSP LIGMT OF R LITTLE FNGR AT MCP/IP JT INIT

I87392

CHRONIC VENOUS HYPERTENSION W OTH COMP OF L LOW EXTREM

S63407A

TRAUM RUPT OF UNSP LIGMT OF L LITTLE FNGR AT MCP/IP JT INIT

I87393

CHRONIC VENOUS HTN W OTH COMP OF BILATERAL LOW EXTRM

S63408A

TRAUM RUPTURE OF UNSP LIGAMENT OF FINGER AT MCP/IP JT INIT

I87399

CHRONIC VENOUS HYPERTENSION W OTH COMP OF UNSP LOW EXTRM

S63409A

TRAUM RUPT OF UNSP LIGMT OF UNSP FINGER AT MCP/IP JT INIT

I878 OTHER SPECIFIED DISORDERS OF VEINS

S63410A

TRAUM RUPT OF COLLAT LIGMT OF R IDX FNGR AT MCP/IP JT INIT

I879 DISORDER OF VEIN UNSPECIFIED

S63411A

TRAUM RUPT OF COLLAT LIGMT OF L IDX FNGR AT MCP/IP JT INIT

I880 NONSPECIFIC MESENTERIC LYMPHADENITIS

S63412A

TRAUM RUPT OF COLLAT LIGMT OF R MID FNGR AT MCP/IP JT INIT

I881 CHRONIC LYMPHADENITIS EXCEPT MESENTERIC

S63413A

TRAUM RUPT OF COLLAT LIGMT OF L MID FNGR AT MCP/IP JT INIT

I888 OTHER NONSPECIFIC LYMPHADENITIS

S63414A

TRAUM RUPT OF COLLAT LIGMT OF R RNG FNGR AT MCP/IP JT INIT

I889 NONSPECIFIC LYMPHADENITIS UNSPECIFIED

S63415A

TRAUM RUPT OF COLLAT LIGMT OF L RNG FNGR AT MCP/IP JT INIT

I890 LYMPHEDEMA NOT ELSEWHERE CLASSIFIED

S63416A

TRAUM RUPT OF COLLAT LIGMT OF R LIT FNGR AT MCP/IP JT INIT

I891 LYMPHANGITIS

S63417A TRAUM RUPT OF COLLAT LIGMT OF L LIT FNGR AT MCP/IP JT INIT

I898

OTH NONINFECTIVE DISORDERS OF LYMPHATIC VESSELS AND NODES

S63418A

TRAUM RUPTURE OF COLLAT LIGMT OF FINGER AT MCP/IP JT INIT

I899

NONINFECTIVE DISORDER OF LYMPHATIC VESSELS AND NODES UNSP

S63419A

TRAUM RUPT OF COLLAT LIGMT OF UNSP FINGER AT MCP/IP JT INIT

I950 IDIOPATHIC HYPOTENSION

S63420A TRAUM RUPT OF PALMAR LIGMT OF R IDX FNGR AT MCP/IP JT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I951 ORTHOSTATIC HYPOTENSION

S63421A TRAUM RUPT OF PALMAR LIGMT OF L IDX FNGR AT MCP/IP JT INIT

I952 HYPOTENSION DUE TO DRUGS

S63422A TRAUM RUPT OF PALMAR LIGMT OF R MID FNGR AT MCP/IP JT INIT

I953 HYPOTENSION OF HEMODIALYSIS

S63423A

TRAUM RUPT OF PALMAR LIGMT OF L MID FNGR AT MCP/IP JT INIT

I9581 POSTPROCEDURAL HYPOTENSION

S63424A

TRAUM RUPT OF PALMAR LIGMT OF R RNG FNGR AT MCP/IP JT INIT

I9589 OTHER HYPOTENSION

S63425A TRAUM RUPT OF PALMAR LIGMT OF L RNG FNGR AT MCP/IP JT INIT

I959 HYPOTENSION UNSPECIFIED

S63426A TRAUM RUPT OF PALMAR LIGMT OF R LIT FNGR AT MCP/IP JT INIT

I96 GANGRENE NOT ELSEWHERE CLASSIFIED

S63427A

TRAUM RUPT OF PALMAR LIGMT OF L LIT FNGR AT MCP/IP JT INIT

I970 POSTCARDIOTOMY SYNDROME

S63428A TRAUM RUPTURE OF PALMAR LIGMT OF FINGER AT MCP/IP JT INIT

I97110

POSTPROC CARDIAC INSUFFICIENCY FOLLOWING CARDIAC SURGERY

S63429A

TRAUM RUPT OF PALMAR LIGMT OF UNSP FINGER AT MCP/IP JT INIT

I97111

POSTPROCEDURAL CARDIAC INSUFFICIENCY FOLLOWING OTHER SURGERY

S63430A

TRAUM RUPT OF VOLAR PLATE OF R IDX FNGR AT MCP/IP JT INIT

I97120

POSTPROCEDURAL CARDIAC ARREST FOLLOWING CARDIAC SURGERY

S63431A

TRAUM RUPT OF VOLAR PLATE OF L IDX FNGR AT MCP/IP JT INIT

I97121

POSTPROCEDURAL CARDIAC ARREST FOLLOWING OTHER SURGERY

S63433A

TRAUM RUPT OF VOLAR PLATE OF L MID FINGER AT MCP/IP JT INIT

I97130

POSTPROCEDURAL HEART FAILURE FOLLOWING CARDIAC SURGERY

S63434A

TRAUM RUPT OF VOLAR PLATE OF R RNG FNGR AT MCP/IP JT INIT

I97131

POSTPROCEDURAL HEART FAILURE FOLLOWING OTHER SURGERY

S63435A

TRAUM RUPT OF VOLAR PLATE OF L RNG FNGR AT MCP/IP JT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I97190

OTH POSTPROC CARDIAC FUNCTN DISTURB FOL CARDIAC SURGERY

S63437A

TRAUM RUPT OF VOLAR PLATE OF L LIT FNGR AT MCP/IP JT INIT

I97191

OTH POSTPROC CARDIAC FUNCTN DISTURB FOLLOWING OTH SURGERY

S63438A

TRAUM RUPTURE OF VOLAR PLATE OF FINGER AT MCP/IP JT INIT

I972 POSTMASTECTOMY LYMPHEDEMA SYNDROME

S63439A

TRAUM RUPT OF VOLAR PLATE OF UNSP FINGER AT MCP/IP JT INIT

I973 POSTPROCEDURAL HYPERTENSION

S63490A

TRAUM RUPTURE OF LIGAMENT OF R IDX FNGR AT MCP/IP JT INIT

I97410

INTRAOPERATIVE HEMOR/HEMTOM OF A CIRC SYS ORG COMP CARD CATH

S63491A

TRAUM RUPTURE OF LIGAMENT OF L IDX FNGR AT MCP/IP JT INIT

I97411

INTRAOP HEMOR/HEMTOM OF A CIRC SYS ORG COMP CARD BYPASS

S63492A

TRAUM RUPTURE OF LIGAMENT OF R MID FINGER AT MCP/IP JT INIT

I97418

INTRAOP HEMOR/HEMTOM OF CIRC SYS ORG COMP OTH CIRC SYS PROC

S63493A

TRAUM RUPTURE OF LIGAMENT OF L MID FINGER AT MCP/IP JT INIT

I9742

INTRAOP HEMOR/HEMTOM OF A CIRC SYS ORG COMP OTH PROCEDURE

S63494A

TRAUM RUPTURE OF LIGAMENT OF R RNG FNGR AT MCP/IP JT INIT

I9751

ACC PNCTR & LAC OF A CIRC SYS ORG DURING A CIRC SYS PROC

S63495A

TRAUM RUPTURE OF LIGAMENT OF L RNG FNGR AT MCP/IP JT INIT

I9752

ACC PNCTR & LAC OF A CIRC SYS ORG DURING OTH PROCEDURE

S63496A

TRAUM RUPTURE OF LIGMT OF R LITTLE FINGER AT MCP/IP JT INIT

I97610

POSTPROC HEMOR/HEMTOM OF A CIRC SYS ORG FOL A CARDIAC CATH

S63497A

TRAUM RUPTURE OF LIGMT OF L LITTLE FINGER AT MCP/IP JT INIT

I97611

POSTPROC HEMOR/HEMTOM OF A CIRC SYS ORG FOL CARDIAC BYPASS

S63498A

TRAUMATIC RUPTURE OF LIGAMENT OF FINGER AT MCP/IP JT INIT

I97618

POSTPROC HEMOR/HEMTOM OF CIRC SYS ORG FOL OTH CIRC SYS PROC

S63499A

TRAUM RUPTURE OF LIGAMENT OF UNSP FINGER AT MCP/IP JT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I9762

POSTPROC HEMOR/HEMTOM OF A CIRC SYS ORG FOL OTH PROCEDURE

S63501A

UNSPECIFIED SPRAIN OF RIGHT WRIST INITIAL ENCOUNTER

I97620

Postprocedural hemorrhage of a circulatory system organ or structure following other procedure

S63502A

UNSPECIFIED SPRAIN OF LEFT WRIST INITIAL ENCOUNTER

I97621

Postprocedural hematoma of a circulatory system organ or structure following other procedure

S63509A

UNSPECIFIED SPRAIN OF UNSPECIFIED WRIST INITIAL ENCOUNTER

I97622

Postprocedural seroma of a circulatory system organ or structure following other procedure

S63511A

SPRAIN OF CARPAL JOINT OF RIGHT WRIST INITIAL ENCOUNTER

I97630

Postprocedural hematoma of a circulatory system organ or structure following a cardiac catheterization

S63512A

SPRAIN OF CARPAL JOINT OF LEFT WRIST INITIAL ENCOUNTER

I97631

Postprocedural hematoma of a circulatory system organ or structure following cardiac bypass

S63521A

SPRAIN OF RADIOCARPAL JOINT OF RIGHT WRIST INIT ENCNTR

I97638

Postprocedural hematoma of a circulatory system organ or structure following other circulatory system procedure

S63522A

SPRAIN OF RADIOCARPAL JOINT OF LEFT WRIST INITIAL ENCOUNTER

I97640

Postprocedural seroma of a circulatory system organ or structure following a cardiac catheterization

S63591A

OTHER SPECIFIED SPRAIN OF RIGHT WRIST INITIAL ENCOUNTER

I97641

Postprocedural seroma of a circulatory system organ or structure following cardiac bypass

S63592A

OTHER SPECIFIED SPRAIN OF LEFT WRIST INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I97648

Postprocedural seroma of a circulatory system organ or structure following other circulatory system procedure

S63601A

UNSPECIFIED SPRAIN OF RIGHT THUMB INITIAL ENCOUNTER

I97710

INTRAOPERATIVE CARDIAC ARREST DURING CARDIAC SURGERY

S63602D

UNSPECIFIED SPRAIN OF LEFT THUMB SUBSEQUENT ENCOUNTER

I97711

INTRAOPERATIVE CARDIAC ARREST DURING OTHER SURGERY

S63609A

UNSPECIFIED SPRAIN OF UNSPECIFIED THUMB INITIAL ENCOUNTER

I97790

OTH INTRAOP CARDIAC FUNCTN DISTURB DURING CARDIAC SURGERY

S63610A

UNSPECIFIED SPRAIN OF RIGHT INDEX FINGER INITIAL ENCOUNTER

I97791

OTH INTRAOP CARDIAC FUNCTIONAL DISTURB DURING OTH SURGERY

S63611A

UNSPECIFIED SPRAIN OF LEFT INDEX FINGER INITIAL ENCOUNTER

I97810

INTRAOPERATIVE CEREBVASC INFARCTION DURING CARDIAC SURGERY

S63612A

UNSPECIFIED SPRAIN OF RIGHT MIDDLE FINGER INITIAL ENCOUNTER

I97811

INTRAOPERATIVE CEREBROVASCULAR INFARCTION DURING OTH SURGERY

S63613A

UNSPECIFIED SPRAIN OF LEFT MIDDLE FINGER INITIAL ENCOUNTER

I97820

POSTPROCEDURAL CEREBVASC INFARCTION DURING CARDIAC SURGERY

S63614A

UNSPECIFIED SPRAIN OF RIGHT RING FINGER INITIAL ENCOUNTER

I97821

POSTPROCEDURAL CEREBROVASCULAR INFARCTION DURING OTH SURGERY

S63615A

UNSPECIFIED SPRAIN OF LEFT RING FINGER INITIAL ENCOUNTER

I9788

OTH INTRAOPERATIVE COMPLICATIONS OF THE CIRC SYS NEC

S63616A

UNSPECIFIED SPRAIN OF RIGHT LITTLE FINGER INITIAL ENCOUNTER

I9789

OTH POSTPROC COMP AND DISORDERS OF THE CIRC SYS NEC

S63617A

UNSPECIFIED SPRAIN OF LEFT LITTLE FINGER INITIAL ENCOUNTER

I998 OTHER DISORDER OF CIRCULATORY SYSTEM

S63618A

UNSPECIFIED SPRAIN OF OTHER FINGER INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I999 UNSPECIFIED DISORDER OF CIRCULATORY SYSTEM

S63619A

UNSPECIFIED SPRAIN OF UNSPECIFIED FINGER INITIAL ENCOUNTER

J00 ACUTE NASOPHARYNGITIS [COMMON COLD]

S63621A

SPRAIN OF INTERPHALANGEAL JOINT OF RIGHT THUMB INIT ENCNTR

J0100 ACUTE MAXILLARY SINUSITIS UNSPECIFIED

S63622A

SPRAIN OF INTERPHALANGEAL JOINT OF LEFT THUMB INIT ENCNTR

J0101 ACUTE RECURRENT MAXILLARY SINUSITIS

S63630A

SPRAIN OF INTERPHALANGEAL JOINT OF RIGHT INDEX FINGER INIT

J0110 ACUTE FRONTAL SINUSITIS UNSPECIFIED

S63631A

SPRAIN OF INTERPHALANGEAL JOINT OF LEFT INDEX FINGER INIT

J0111 ACUTE RECURRENT FRONTAL SINUSITIS

S63632A

SPRAIN OF INTERPHALANGEAL JOINT OF RIGHT MIDDLE FINGER INIT

J0120 ACUTE ETHMOIDAL SINUSITIS UNSPECIFIED

S63633A

SPRAIN OF INTERPHALANGEAL JOINT OF LEFT MIDDLE FINGER INIT

J0121 ACUTE RECURRENT ETHMOIDAL SINUSITIS

S63634A

SPRAIN OF INTERPHALANGEAL JOINT OF RIGHT RING FINGER INIT

J0130 ACUTE SPHENOIDAL SINUSITIS UNSPECIFIED

S63635A

SPRAIN OF INTERPHALANGEAL JOINT OF LEFT RING FINGER INIT

J0131 ACUTE RECURRENT SPHENOIDAL SINUSITIS

S63636A

SPRAIN OF INTERPHALANGEAL JOINT OF RIGHT LITTLE FINGER INIT

J0140 ACUTE PANSINUSITIS UNSPECIFIED

S63637A

SPRAIN OF INTERPHALANGEAL JOINT OF LEFT LITTLE FINGER INIT

J0141 ACUTE RECURRENT PANSINUSITIS

S63638A

SPRAIN OF INTERPHALANGEAL JOINT OF OTHER FINGER INIT ENCNTR

J0180 OTHER ACUTE SINUSITIS

S63641A SPRAIN OF METACARPOPHALANGEAL JOINT OF RIGHT THUMB INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J0181 OTHER ACUTE RECURRENT SINUSITIS

S63642A

SPRAIN OF METACARPOPHALANGEAL JOINT OF LEFT THUMB INIT

J0190 ACUTE SINUSITIS UNSPECIFIED

S63650A SPRAIN OF MCP JOINT OF RIGHT INDEX FINGER INIT

J0191 ACUTE RECURRENT SINUSITIS UNSPECIFIED

S63651A

SPRAIN OF MCP JOINT OF LEFT INDEX FINGER INIT

J020 STREPTOCOCCAL PHARYNGITIS

S63652A SPRAIN OF MCP JOINT OF RIGHT MIDDLE FINGER INIT

J0410 ACUTE TRACHEITIS WITHOUT OBSTRUCTION

S63653A

SPRAIN OF MCP JOINT OF LEFT MIDDLE FINGER INIT

J0411 ACUTE TRACHEITIS WITH OBSTRUCTION

S63654A

SPRAIN OF MCP JOINT OF RIGHT RING FINGER INIT

J042 ACUTE LARYNGOTRACHEITIS

S63655A SPRAIN OF MCP JOINT OF LEFT RING FINGER INIT

J0430 SUPRAGLOTTITIS UNSPECIFIED WITHOUT OBSTRUCTION

S63656A

SPRAIN OF MCP JOINT OF RIGHT LITTLE FINGER INIT

J0431 SUPRAGLOTTITIS UNSPECIFIED WITH OBSTRUCTION

S63657A

SPRAIN OF MCP JOINT OF LEFT LITTLE FINGER INIT

J050 ACUTE OBSTRUCTIVE LARYNGITIS [CROUP]

S63658A

SPRAIN OF METACARPOPHALANGEAL JOINT OF OTH FINGER INIT

J0510 ACUTE EPIGLOTTITIS WITHOUT OBSTRUCTION

S63681A

OTHER SPRAIN OF RIGHT THUMB INITIAL ENCOUNTER

J0511 ACUTE EPIGLOTTITIS WITH OBSTRUCTION

S63682A

OTHER SPRAIN OF LEFT THUMB INITIAL ENCOUNTER

J060 ACUTE LARYNGOPHARYNGITIS

S63690A OTHER SPRAIN OF RIGHT INDEX FINGER INITIAL ENCOUNTER

J069 ACUTE UPPER RESPIRATORY INFECTION UNSPECIFIED

S63691A

OTHER SPRAIN OF LEFT INDEX FINGER INITIAL ENCOUNTER

J102

INFLUENZA DUE TO OTH IDENT INFLUENZA VIRUS W GI MANIFEST

S63692A

OTHER SPRAIN OF RIGHT MIDDLE FINGER INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J1081

INFLUENZA DUE TO OTH IDENT INFLUENZA VIRUS W ENCEPHALOPATHY

S63693A

OTHER SPRAIN OF LEFT MIDDLE FINGER INITIAL ENCOUNTER

J1082

INFLUENZA DUE TO OTH IDENT INFLUENZA VIRUS W MYOCARDITIS

S63694A

OTHER SPRAIN OF RIGHT RING FINGER INITIAL ENCOUNTER

J1083

INFLUENZA DUE TO OTH IDENT INFLUENZA VIRUS W OTITIS MEDIA

S63695A

OTHER SPRAIN OF LEFT RING FINGER INITIAL ENCOUNTER

J1089

INFLUENZA DUE TO OTH IDENT INFLUENZA VIRUS W OTH MANIFEST

S63696A

OTHER SPRAIN OF RIGHT LITTLE FINGER INITIAL ENCOUNTER

J1100

FLU DUE TO UNIDENTIFIED FLU VIRUS W UNSP TYPE OF PNEUMONIA

S63697A

OTHER SPRAIN OF LEFT LITTLE FINGER INITIAL ENCOUNTER

J1108

FLU DUE TO UNIDENTIFIED FLU VIRUS W SPECIFIED PNEUMONIA

S63698A

OTHER SPRAIN OF OTHER FINGER INITIAL ENCOUNTER

J111

FLU DUE TO UNIDENTIFIED INFLUENZA VIRUS W OTH RESP MANIFEST

S638X1A

SPRAIN OF OTHER PART OF RIGHT WRIST AND HAND INIT ENCNTR

J112

INFLUENZA DUE TO UNIDENTIFIED INFLUENZA VIRUS W GI MANIFEST

S638X2A

SPRAIN OF OTHER PART OF LEFT WRIST AND HAND INIT ENCNTR

J1181

FLU DUE TO UNIDENTIFIED INFLUENZA VIRUS W ENCEPHALOPATHY

S6391XA

SPRAIN OF UNSP PART OF RIGHT WRIST AND HAND INIT ENCNTR

J1182

INFLUENZA DUE TO UNIDENTIFIED INFLUENZA VIRUS W MYOCARDITIS

S6392XA

SPRAIN OF UNSP PART OF LEFT WRIST AND HAND INIT ENCNTR

J1183

INFLUENZA DUE TO UNIDENTIFIED INFLUENZA VIRUS W OTITIS MEDIA

S6400XA

INJURY OF ULNAR NERVE AT WRS/HND LV OF UNSP ARM INIT

J1189

INFLUENZA DUE TO UNIDENTIFIED INFLUENZA VIRUS W OTH MANIFEST

S6401XA

INJURY OF ULNAR NERVE AT WRS/HND LV OF RIGHT ARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J120 ADENOVIRAL PNEUMONIA

S6402XA INJURY OF ULNAR NERVE AT WRS/HND LV OF LEFT ARM INIT

J121 RESPIRATORY SYNCYTIAL VIRUS PNEUMONIA

S6411XD

INJURY OF MEDIAN NERVE AT WRS/HND LV OF RIGHT ARM SUBS

J122 PARAINFLUENZA VIRUS PNEUMONIA

S6412XA

INJURY OF MEDIAN NERVE AT WRS/HND LV OF LEFT ARM INIT

J123 HUMAN METAPNEUMOVIRUS PNEUMONIA

S6421XA

INJURY OF RADIAL NERVE AT WRS/HND LV OF RIGHT ARM INIT

J1281 PNEUMONIA DUE TO SARS-ASSOCIATED CORONAVIRUS

S6422XA

INJURY OF RADIAL NERVE AT WRS/HND LV OF LEFT ARM INIT

J1289 OTHER VIRAL PNEUMONIA

S6430XA INJURY OF DIGITAL NERVE OF UNSPECIFIED THUMB INIT ENCNTR

J129 VIRAL PNEUMONIA UNSPECIFIED

S6431XA

INJURY OF DIGITAL NERVE OF RIGHT THUMB INITIAL ENCOUNTER

J13 PNEUMONIA DUE TO STREPTOCOCCUS PNEUMONIAE

S6432XA

INJURY OF DIGITAL NERVE OF LEFT THUMB INITIAL ENCOUNTER

J14 PNEUMONIA DUE TO HEMOPHILUS INFLUENZAE

S64490A

INJURY OF DIGITAL NERVE OF RIGHT INDEX FINGER INIT ENCNTR

J150 PNEUMONIA DUE TO KLEBSIELLA PNEUMONIAE

S64491D

INJURY OF DIGITAL NERVE OF LEFT INDEX FINGER SUBS ENCNTR

J151 PNEUMONIA DUE TO PSEUDOMONAS

S64492A

INJURY OF DIGITAL NERVE OF RIGHT MIDDLE FINGER INIT ENCNTR

J1520

PNEUMONIA DUE TO STAPHYLOCOCCUS UNSPECIFIED

S64493A

INJURY OF DIGITAL NERVE OF LEFT MIDDLE FINGER INIT ENCNTR

J1529 PNEUMONIA DUE TO OTHER STAPHYLOCOCCUS

S64494A

INJURY OF DIGITAL NERVE OF RIGHT RING FINGER INIT ENCNTR

J153 PNEUMONIA DUE TO STREPTOCOCCUS GROUP B

S64495A

INJURY OF DIGITAL NERVE OF LEFT RING FINGER INIT ENCNTR

J154 PNEUMONIA DUE TO OTHER STREPTOCOCCI

S64496A

INJURY OF DIGITAL NERVE OF RIGHT LITTLE FINGER INIT ENCNTR

J155 PNEUMONIA DUE TO ESCHERICHIA COLI

S64497A

INJURY OF DIGITAL NERVE OF LEFT LITTLE FINGER INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J156

PNEUMONIA DUE TO OTHER AEROBIC GRAM-NEGATIVE BACTERIA

S64498A

INJURY OF DIGITAL NERVE OF OTHER FINGER INITIAL ENCOUNTER

J157 PNEUMONIA DUE TO MYCOPLASMA PNEUMONIAE

S648X1A

INJURY OF NERVES AT WRIST AND HAND LEVEL OF RIGHT ARM INIT

J158 PNEUMONIA DUE TO OTHER SPECIFIED BACTERIA

S648X2A

INJURY OF NERVES AT WRIST AND HAND LEVEL OF LEFT ARM INIT

J159 UNSPECIFIED BACTERIAL PNEUMONIA

S6491XA

INJURY OF UNSP NERVE AT WRS/HND LV OF RIGHT ARM INIT

J160 CHLAMYDIAL PNEUMONIA

S6492XA INJURY OF UNSP NERVE AT WRS/HND LV OF LEFT ARM INIT

J168

PNEUMONIA DUE TO OTHER SPECIFIED INFECTIOUS ORGANISMS

S65011A

LACERATION OF ULNAR ARTERY AT WRS/HND LV OF RIGHT ARM INIT

J17 PNEUMONIA IN DISEASES CLASSIFIED ELSEWHERE

S65012A

LACERATION OF ULNAR ARTERY AT WRS/HND LV OF LEFT ARM INIT

J180 BRONCHOPNEUMONIA UNSPECIFIED ORGANISM

S65019A

LACERATION OF ULNAR ARTERY AT WRS/HND LV OF UNSP ARM INIT

J181 LOBAR PNEUMONIA UNSPECIFIED ORGANISM

S65111A

LACERATION OF RADIAL ARTERY AT WRS/HND LV OF RIGHT ARM INIT

J182 HYPOSTATIC PNEUMONIA UNSPECIFIED ORGANISM

S65112A

LACERATION OF RADIAL ARTERY AT WRS/HND LV OF LEFT ARM INIT

J188 OTHER PNEUMONIA UNSPECIFIED ORGANISM

S65119A

LACERATION OF RADIAL ARTERY AT WRS/HND LV OF UNSP ARM INIT

J189 PNEUMONIA UNSPECIFIED ORGANISM

S65211A

LACERATION OF SUPERFICIAL PALMAR ARCH OF RIGHT HAND INIT

J200 ACUTE BRONCHITIS DUE TO MYCOPLASMA PNEUMONIAE

S65212A

LACERATION OF SUPERFICIAL PALMAR ARCH OF LEFT HAND INIT

J201 ACUTE BRONCHITIS DUE TO HEMOPHILUS INFLUENZAE

S65219A

LACERATION OF SUPERFICIAL PALMAR ARCH OF UNSP HAND INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J202 ACUTE BRONCHITIS DUE TO STREPTOCOCCUS

S65311A

LACERATION OF DEEP PALMAR ARCH OF RIGHT HAND INIT ENCNTR

J203 ACUTE BRONCHITIS DUE TO COXSACKIEVIRUS

S65312A

LACERATION OF DEEP PALMAR ARCH OF LEFT HAND INIT ENCNTR

J204 ACUTE BRONCHITIS DUE TO PARAINFLUENZA VIRUS

S65319A

LACERATION OF DEEP PALMAR ARCH OF UNSP HAND INIT ENCNTR

J205 ACUTE BRONCHITIS DUE TO RESPIRATORY SYNCYTIAL VIRUS

S65411A

LACERATION OF BLOOD VESSEL OF RIGHT THUMB INITIAL ENCOUNTER

J206 ACUTE BRONCHITIS DUE TO RHINOVIRUS

S65412A

LACERATION OF BLOOD VESSEL OF LEFT THUMB INITIAL ENCOUNTER

J207 ACUTE BRONCHITIS DUE TO ECHOVIRUS

S65419A

LACERATION OF BLOOD VESSEL OF UNSPECIFIED THUMB INIT ENCNTR

J208 ACUTE BRONCHITIS DUE TO OTHER SPECIFIED ORGANISMS

S65510A

LACERATION OF BLOOD VESSEL OF RIGHT INDEX FINGER INIT

J209 ACUTE BRONCHITIS UNSPECIFIED

S65511A

LACERATION OF BLOOD VESSEL OF LEFT INDEX FINGER INIT ENCNTR

J210 ACUTE BRONCHIOLITIS DUE TO RESPIRATORY SYNCYTIAL VIRUS

S65512A

LACERATION OF BLOOD VESSEL OF RIGHT MIDDLE FINGER INIT

J211 ACUTE BRONCHIOLITIS DUE TO HUMAN METAPNEUMOVIRUS

S65513A

LACERATION OF BLOOD VESSEL OF LEFT MIDDLE FINGER INIT

J218 ACUTE BRONCHIOLITIS DUE TO OTHER SPECIFIED ORGANISMS

S65514A

LACERATION OF BLOOD VESSEL OF RIGHT RING FINGER INIT ENCNTR

J219 ACUTE BRONCHIOLITIS UNSPECIFIED

S65515A

LACERATION OF BLOOD VESSEL OF LEFT RING FINGER INIT ENCNTR

J22 UNSPECIFIED ACUTE LOWER RESPIRATORY INFECTION

S65516A

LACERATION OF BLOOD VESSEL OF RIGHT LITTLE FINGER INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J300 VASOMOTOR RHINITIS

S65517A LACERATION OF BLOOD VESSEL OF LEFT LITTLE FINGER INIT

J301 ALLERGIC RHINITIS DUE TO POLLEN

S65518A

LACERATION OF BLOOD VESSEL OF OTHER FINGER INIT ENCNTR

J302 OTHER SEASONAL ALLERGIC RHINITIS

S65519A

LACERATION OF BLOOD VESSEL OF UNSP FINGER INIT ENCNTR

J305 ALLERGIC RHINITIS DUE TO FOOD

S65811A

LACERATION OF BLOOD VESSELS AT WRS/HND LV OF RIGHT ARM INIT

J3081

ALLERGIC RHINITIS DUE TO ANIMAL (CAT) (DOG) HAIR AND DANDER

S65812A

LACERATION OF BLOOD VESSELS AT WRS/HND LV OF LEFT ARM INIT

J3501 CHRONIC TONSILLITIS

S65819A LACERATION OF BLOOD VESSELS AT WRS/HND LV OF UNSP ARM INIT

J3502 CHRONIC ADENOIDITIS

S65911A LACERAT UNSP BLOOD VESSEL AT WRS/HND LV OF RIGHT ARM INIT

J3503 CHRONIC TONSILLITIS AND ADENOIDITIS

S65912A

LACERAT UNSP BLOOD VESSEL AT WRS/HND LV OF LEFT ARM INIT

J351 HYPERTROPHY OF TONSILS

S65919A LACERAT UNSP BLOOD VESSEL AT WRS/HND LV OF UNSP ARM INIT

J352 HYPERTROPHY OF ADENOIDS

S66011A

STRAIN LONG FLEXOR MUSC/FASC/TEND R THM AT WRS/HND LV INIT

J353

HYPERTROPHY OF TONSILS WITH HYPERTROPHY OF ADENOIDS

S66012A

STRAIN LONG FLEXOR MUSC/FASC/TEND L THM AT WRS/HND LV INIT

J358 OTHER CHRONIC DISEASES OF TONSILS AND ADENOIDS

S66019A

STRAIN LONG FLEXOR MUSC/FASC/TEND THMB AT WRS/HND LV INIT

J359 CHRONIC DISEASE OF TONSILS AND ADENOIDS UNSPECIFIED

S66021A

LACERAT LONG FLEXOR MUSC/FASC/TEND R THM AT WRS/HND LV INIT

J36 PERITONSILLAR ABSCESS

S66022A

LACERAT LONG FLEXOR MUSC/FASC/TEND L THM AT WRS/HND LV INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J370 CHRONIC LARYNGITIS

S66029A

LACERAT LONG FLEXOR MUSC/FASC/TEND THMB AT WRS/HND LV INIT

J371 CHRONIC LARYNGOTRACHEITIS

S66110A STRAIN FLEXOR MUSC/FASC/TEND R IDX FNGR AT WRS/HND LV INIT

J3800 PARALYSIS OF VOCAL CORDS AND LARYNX UNSPECIFIED

S66111A

STRAIN FLEXOR MUSC/FASC/TEND L IDX FNGR AT WRS/HND LV INIT

J3801 PARALYSIS OF VOCAL CORDS AND LARYNX UNILATERAL

S66112A

STRAIN FLEXOR MUSC/FASC/TEND R MID FNGR AT WRS/HND LV INIT

J3802 PARALYSIS OF VOCAL CORDS AND LARYNX BILATERAL

S66113A

STRAIN FLEXOR MUSC/FASC/TEND L MID FNGR AT WRS/HND LV INIT

J381 POLYP OF VOCAL CORD AND LARYNX

S66114A

STRAIN FLEXOR MUSC/FASC/TEND R RNG FNGR AT WRS/HND LV INIT

J382 NODULES OF VOCAL CORDS

S66115A STRAIN FLEXOR MUSC/FASC/TEND L RNG FNGR AT WRS/HND LV INIT

J383 OTHER DISEASES OF VOCAL CORDS

S66116A

STRAIN FLXR MUSC/FASC/TEND R LITTLE FNGR AT WRS/HND LV INIT

J385 LARYNGEAL SPASM

S66117A STRAIN FLXR MUSC/FASC/TEND L LITTLE FNGR AT WRS/HND LV INIT

J386 STENOSIS OF LARYNX

S66118A STRAIN OF FLEXOR MUSC/FASC/TEND FINGER AT WRS/HND LV INIT

J387 OTHER DISEASES OF LARYNX

S66119A STRAIN FLEXOR MUSC/FASC/TEND UNSP FINGER AT WRS/HND LV INIT

J390 RETROPHARYNGEAL AND PARAPHARYNGEAL ABSCESS

S66120A

LACERAT FLEXOR MUSC/FASC/TEND R IDX FNGR AT WRS/HND LV INIT

J391 OTHER ABSCESS OF PHARYNX

S66121A LACERAT FLEXOR MUSC/FASC/TEND L IDX FNGR AT WRS/HND LV INIT

J392 OTHER DISEASES OF PHARYNX

S66122A LACERAT FLEXOR MUSC/FASC/TEND R MID FNGR AT WRS/HND LV INIT

J393

UPPER RESPIRATORY TRACT HYPERSENSITIVITY REACTION SITE UNSP

S66123A

LACERAT FLEXOR MUSC/FASC/TEND L MID FNGR AT WRS/HND LV INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J398 OTHER SPECIFIED DISEASES OF UPPER RESPIRATORY TRACT

S66124A

LACERAT FLEXOR MUSC/FASC/TEND R RNG FNGR AT WRS/HND LV INIT

J399

DISEASE OF UPPER RESPIRATORY TRACT UNSPECIFIED

S66125A

LACERAT FLEXOR MUSC/FASC/TEND L RNG FNGR AT WRS/HND LV INIT

J40 BRONCHITIS NOT SPECIFIED AS ACUTE OR CHRONIC

S66126A

LACERAT FLXR MUSC/FASC/TEND R LIT FNGR AT WRS/HND LV INIT

J410 SIMPLE CHRONIC BRONCHITIS

S66127A LACERAT FLXR MUSC/FASC/TEND L LIT FNGR AT WRS/HND LV INIT

J411 MUCOPURULENT CHRONIC BRONCHITIS

S66128A

LACERAT FLEXOR MUSC/FASC/TEND FINGER AT WRS/HND LV INIT

J418

MIXED SIMPLE AND MUCOPURULENT CHRONIC BRONCHITIS

S66129A

LACERAT FLEXOR MUSC/FASC/TEND UNSP FNGR AT WRS/HND LV INIT

J42 UNSPECIFIED CHRONIC BRONCHITIS

S66211A

STRAIN OF EXTENSOR MUSC/FASC/TEND R THM AT WRS/HND LV INIT

J430

UNILATERAL PULMONARY EMPHYSEMA [MACLEOD'S SYNDROME]

S66212A

STRAIN OF EXTENSOR MUSC/FASC/TEND L THM AT WRS/HND LV INIT

J4522 MILD INTERMITTENT ASTHMA WITH STATUS ASTHMATICUS

S66219A

STRAIN OF EXTENSOR MUSC/FASC/TEND THMB AT WRS/HND LV INIT

J4532 MILD PERSISTENT ASTHMA WITH STATUS ASTHMATICUS

S66221A

LACERAT EXTENSOR MUSC/FASC/TEND R THM AT WRS/HND LV INIT

J4542

MODERATE PERSISTENT ASTHMA WITH STATUS ASTHMATICUS

S66222A

LACERAT EXTENSOR MUSC/FASC/TEND L THM AT WRS/HND LV INIT

J4552 SEVERE PERSISTENT ASTHMA WITH STATUS ASTHMATICUS

S66229A

LACERAT EXTENSOR MUSC/FASC/TEND THMB AT WRS/HND LV INIT

J45902 UNSPECIFIED ASTHMA WITH STATUS ASTHMATICUS

S66310A

STRAIN EXTN MUSC/FASC/TEND R IDX FNGR AT WRS/HND LV INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J45909 UNSPECIFIED ASTHMA UNCOMPLICATED

S66311A

STRAIN EXTN MUSC/FASC/TEND L IDX FNGR AT WRS/HND LV INIT

J45990 EXERCISE INDUCED BRONCHOSPASM

S66312A

STRAIN EXTN MUSC/FASC/TEND R MID FINGER AT WRS/HND LV INIT

J45991 COUGH VARIANT ASTHMA

S66313A STRAIN EXTN MUSC/FASC/TEND L MID FINGER AT WRS/HND LV INIT

J45998 OTHER ASTHMA

S66314A STRAIN EXTN MUSC/FASC/TEND R RNG FNGR AT WRS/HND LV INIT

J470

BRONCHIECTASIS WITH ACUTE LOWER RESPIRATORY INFECTION

S66315A

STRAIN EXTN MUSC/FASC/TEND L RNG FNGR AT WRS/HND LV INIT

J471 BRONCHIECTASIS WITH (ACUTE) EXACERBATION

S66316A

STRAIN EXTN MUSC/FASC/TEND R LITTLE FNGR AT WRS/HND LV INIT

J479 BRONCHIECTASIS UNCOMPLICATED

S66317A

STRAIN EXTN MUSC/FASC/TEND L LITTLE FNGR AT WRS/HND LV INIT

J60 COALWORKER'S PNEUMOCONIOSIS

S66318A

STRAIN OF EXTENSOR MUSC/FASC/TEND FINGER AT WRS/HND LV INIT

J61

PNEUMOCONIOSIS DUE TO ASBESTOS AND OTHER MINERAL FIBERS

S66319A

STRAIN EXTN MUSC/FASC/TEND UNSP FINGER AT WRS/HND LV INIT

J620 PNEUMOCONIOSIS DUE TO TALC DUST

S66320A

LACERAT EXTN MUSC/FASC/TEND R IDX FNGR AT WRS/HND LV INIT

J628

PNEUMOCONIOSIS DUE TO OTHER DUST CONTAINING SILICA

S66321A

LACERAT EXTN MUSC/FASC/TEND L IDX FNGR AT WRS/HND LV INIT

J630 ALUMINOSIS (OF LUNG)

S66322A LACERAT EXTN MUSC/FASC/TEND R MID FINGER AT WRS/HND LV INIT

J631 BAUXITE FIBROSIS (OF LUNG)

S66323A LACERAT EXTN MUSC/FASC/TEND L MID FINGER AT WRS/HND LV INIT

J632 BERYLLIOSIS

S66324A LACERAT EXTN MUSC/FASC/TEND R RNG FNGR AT WRS/HND LV INIT

J633 GRAPHITE FIBROSIS (OF LUNG)

S66325A LACERAT EXTN MUSC/FASC/TEND L RNG FNGR AT WRS/HND LV INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J634 SIDEROSIS

S66326A LACERAT EXTN MUSC/FASC/TEND R LIT FNGR AT WRS/HND LV INIT

J635 STANNOSIS

S66327A LACERAT EXTN MUSC/FASC/TEND L LIT FNGR AT WRS/HND LV INIT

J636

PNEUMOCONIOSIS DUE TO OTHER SPECIFIED INORGANIC DUSTS

S66328A

LACERAT EXTENSOR MUSC/FASC/TEND FINGER AT WRS/HND LV INIT

J64 UNSPECIFIED PNEUMOCONIOSIS

S66329A

LACERAT EXTN MUSC/FASC/TEND UNSP FINGER AT WRS/HND LV INIT

J65 PNEUMOCONIOSIS ASSOCIATED WITH TUBERCULOSIS

S66411A

STRAIN OF INTRINSIC MUSC/FASC/TEND R THM AT WRS/HND LV INIT

J660 BYSSINOSIS

S66412A

STRAIN OF INTRINSIC MUSC/FASC/TEND L THM AT WRS/HND LV INIT

J661 FLAX-DRESSERS' DISEASE

S66419A

STRAIN OF INTRINSIC MUSC/FASC/TEND THMB AT WRS/HND LV INIT

J662 CANNABINOSIS

S66421A LACERAT INTRINSIC MUSC/FASC/TEND R THM AT WRS/HND LV INIT

J668

AIRWAY DISEASE DUE TO OTHER SPECIFIC ORGANIC DUSTS

S66422A

LACERAT INTRINSIC MUSC/FASC/TEND L THM AT WRS/HND LV INIT

J670 FARMER'S LUNG

S66429A LACERAT INTRINSIC MUSC/FASC/TEND THMB AT WRS/HND LV INIT

J671 BAGASSOSIS

S66510A STRAIN INTRNS MUSC/FASC/TEND R IDX FNGR AT WRS/HND LV INIT

J672 BIRD FANCIER'S LUNG

S66511A STRAIN INTRNS MUSC/FASC/TEND L IDX FNGR AT WRS/HND LV INIT

J673 SUBEROSIS

S66512A STRAIN INTRNS MUSC/FASC/TEND R MID FNGR AT WRS/HND LV INIT

J674 MALTWORKER'S LUNG

S66513A STRAIN INTRNS MUSC/FASC/TEND L MID FNGR AT WRS/HND LV INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J675 MUSHROOM-WORKER'S LUNG

S66514A STRAIN INTRNS MUSC/FASC/TEND R RNG FNGR AT WRS/HND LV INIT

J676 MAPLE-BARK-STRIPPER'S LUNG

S66515A STRAIN INTRNS MUSC/FASC/TEND L RNG FNGR AT WRS/HND LV INIT

J677 AIR CONDITIONER AND HUMIDIFIER LUNG

S66516A

STRAIN INTRNS MUSC/FASC/TEND R LIT FNGR AT WRS/HND LV INIT

J678

HYPERSENSITIVITY PNEUMONITIS DUE TO OTHER ORGANIC DUSTS

S66517A

STRAIN INTRNS MUSC/FASC/TEND L LIT FNGR AT WRS/HND LV INIT

J679

HYPERSENSITIVITY PNEUMONITIS DUE TO UNSPECIFIED ORGANIC DUST

S66518A

STRAIN OF INTRNS MUSC/FASC/TEND FINGER AT WRS/HND LV INIT

J680

BRONCHITIS & PNEUMONITIS D/T CHEMICALS GAS FUMES & VAPORS

S66519A

STRAIN INTRNS MUSC/FASC/TEND UNSP FINGER AT WRS/HND LV INIT

J681

PULMONARY EDEMA DUE TO CHEMICALS GASES FUMES AND VAPORS

S66520A

LACERAT INTRNS MUSC/FASC/TEND R IDX FNGR AT WRS/HND LV INIT

J682

UPPER RESP INFLAM D/T CHEMICALS GAS FUMES AND VAPORS NEC

S66521A

LACERAT INTRNS MUSC/FASC/TEND L IDX FNGR AT WRS/HND LV INIT

J683

OTH AC & SUBAC RESP COND D/T CHEMICALS GAS FUMES & VAPORS

S66522A

LACERAT INTRNS MUSC/FASC/TEND R MID FNGR AT WRS/HND LV INIT

J684

CHRONIC RESP COND DUE TO CHEMICALS GASES FUMES AND VAPORS

S66523A

LACERAT INTRNS MUSC/FASC/TEND L MID FNGR AT WRS/HND LV INIT

J688

OTH RESP COND DUE TO CHEMICALS GASES FUMES AND VAPORS

S66524A

LACERAT INTRNS MUSC/FASC/TEND R RNG FNGR AT WRS/HND LV INIT

J689

UNSP RESP COND DUE TO CHEMICALS GASES FUMES AND VAPORS

S66525A

LACERAT INTRNS MUSC/FASC/TEND L RNG FNGR AT WRS/HND LV INIT

J690

PNEUMONITIS DUE TO INHALATION OF FOOD AND VOMIT

S66526A

LACERAT INTRNS MUSC/FASC/TEND R LIT FNGR AT WRS/HND LV INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J691

PNEUMONITIS DUE TO INHALATION OF OILS AND ESSENCES

S66527A

LACERAT INTRNS MUSC/FASC/TEND L LIT FNGR AT WRS/HND LV INIT

J698

PNEUMONITIS DUE TO INHALATION OF OTHER SOLIDS AND LIQUIDS

S66528A

LACERAT INTRINSIC MUSC/FASC/TEND FINGER AT WRS/HND LV INIT

J700

ACUTE PULMONARY MANIFESTATIONS DUE TO RADIATION

S66529A

LACERAT INTRNS MUSC/FASC/TEND UNSP FNGR AT WRS/HND LV INIT

J701

CHRONIC AND OTHER PULMONARY MANIFESTATIONS DUE TO RADIATION

S66811A

STRAIN OF MUSC/FASC/TEND AT WRS/HND LV RIGHT HAND INIT

J702 ACUTE DRUG-INDUCED INTERSTITIAL LUNG DISORDERS

S66812A

STRAIN OF MUSC/FASC/TEND AT WRS/HND LV LEFT HAND INIT

J703 CHRONIC DRUG-INDUCED INTERSTITIAL LUNG DISORDERS

S66819A

STRAIN OF MUSC/FASC/TEND AT WRS/HND LV UNSP HAND INIT

J704 DRUG-INDUCED INTERSTITIAL LUNG DISORDERS UNSPECIFIED

S66821A

LACERATION OF MUSC/FASC/TEND AT WRS/HND LV RIGHT HAND INIT

J708 RESPIRATORY CONDITIONS DUE TO OTH EXTERNAL AGENTS

S66822A

LACERATION OF MUSC/FASC/TEND AT WRS/HND LV LEFT HAND INIT

J709

RESPIRATORY CONDITIONS DUE TO UNSPECIFIED EXTERNAL AGENT

S66829A

LACERATION OF MUSC/FASC/TEND AT WRS/HND LV UNSP HAND INIT

J80 ACUTE RESPIRATORY DISTRESS SYNDROME

S66911A

STRAIN OF UNSP MUSC/FASC/TEND AT WRS/HND LV R HAND INIT

J810 ACUTE PULMONARY EDEMA

S66912A STRAIN OF UNSP MUSC/FASC/TEND AT WRS/HND LV LEFT HAND INIT

J811 CHRONIC PULMONARY EDEMA

S66919A STRAIN OF UNSP MUSC/FASC/TEND AT WRS/HND LV UNSP HAND INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J82 PULMONARY EOSINOPHILIA NOT ELSEWHERE CLASSIFIED

S66921A

LACERAT UNSP MUSC/FASC/TEND AT WRS/HND LV RIGHT HAND INIT

J842 LYMPHOID INTERSTITIAL PNEUMONIA

S66922A

LACERAT UNSP MUSC/FASC/TEND AT WRS/HND LV LEFT HAND INIT

J849 INTERSTITIAL PULMONARY DISEASE UNSPECIFIED

S66929A

LACERAT UNSP MUSC/FASC/TEND AT WRS/HND LV UNSP HAND INIT

J850 GANGRENE AND NECROSIS OF LUNG

S6700XA

CRUSHING INJURY OF UNSPECIFIED THUMB INITIAL ENCOUNTER

J851 ABSCESS OF LUNG WITH PNEUMONIA

S6701XA

CRUSHING INJURY OF RIGHT THUMB INITIAL ENCOUNTER

J852 ABSCESS OF LUNG WITHOUT PNEUMONIA

S6702XA

CRUSHING INJURY OF LEFT THUMB INITIAL ENCOUNTER

J853 ABSCESS OF MEDIASTINUM

S6710XA CRUSHING INJURY OF UNSPECIFIED FINGER(S) INITIAL ENCOUNTER

J860 PYOTHORAX WITH FISTULA

S67190A CRUSHING INJURY OF RIGHT INDEX FINGER INITIAL ENCOUNTER

J869 PYOTHORAX WITHOUT FISTULA

S67191A CRUSHING INJURY OF LEFT INDEX FINGER INITIAL ENCOUNTER

J90 PLEURAL EFFUSION NOT ELSEWHERE CLASSIFIED

S67192A

CRUSHING INJURY OF RIGHT MIDDLE FINGER INITIAL ENCOUNTER

J910 MALIGNANT PLEURAL EFFUSION

S67193A

CRUSHING INJURY OF LEFT MIDDLE FINGER INITIAL ENCOUNTER

J918

PLEURAL EFFUSION IN OTHER CONDITIONS CLASSIFIED ELSEWHERE

S67194A

CRUSHING INJURY OF RIGHT RING FINGER INITIAL ENCOUNTER

J920 PLEURAL PLAQUE WITH PRESENCE OF ASBESTOS

S67195A

CRUSHING INJURY OF LEFT RING FINGER INITIAL ENCOUNTER

J929 PLEURAL PLAQUE WITHOUT ASBESTOS

S67196A

CRUSHING INJURY OF RIGHT LITTLE FINGER INITIAL ENCOUNTER

J930 SPONTANEOUS TENSION PNEUMOTHORAX

S67197A

CRUSHING INJURY OF LEFT LITTLE FINGER INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J939 PNEUMOTHORAX UNSPECIFIED

S67198A CRUSHING INJURY OF OTHER FINGER INITIAL ENCOUNTER

J940 CHYLOUS EFFUSION

S6720XA CRUSHING INJURY OF UNSPECIFIED HAND INITIAL ENCOUNTER

J941 FIBROTHORAX

S6721XA CRUSHING INJURY OF RIGHT HAND INITIAL ENCOUNTER

J942 HEMOTHORAX

S6722XA CRUSHING INJURY OF LEFT HAND INITIAL ENCOUNTER

J948 OTHER SPECIFIED PLEURAL CONDITIONS

S6730XA

CRUSHING INJURY OF UNSPECIFIED WRIST INITIAL ENCOUNTER

J949 PLEURAL CONDITION UNSPECIFIED

S6731XA

CRUSHING INJURY OF RIGHT WRIST INITIAL ENCOUNTER

J9500 UNSPECIFIED TRACHEOSTOMY COMPLICATION

S6732XA

CRUSHING INJURY OF LEFT WRIST INITIAL ENCOUNTER

J9501 HEMORRHAGE FROM TRACHEOSTOMY STOMA

S6740XA

CRUSHING INJURY OF UNSPECIFIED WRIST AND HAND INIT ENCNTR

J9503 MALFUNCTION OF TRACHEOSTOMY STOMA

S6741XA

CRUSHING INJURY OF RIGHT WRIST AND HAND INITIAL ENCOUNTER

J9504

TRACHEO-ESOPHAGEAL FISTULA FOLLOWING TRACHEOSTOMY

S6742XA

CRUSHING INJURY OF LEFT WRIST AND HAND INITIAL ENCOUNTER

J9509 OTHER TRACHEOSTOMY COMPLICATION

S6790XA

CRUSH INJ UNSP PART(S) OF UNSP WRIST HAND AND FINGERS INIT

J951

ACUTE PULMONARY INSUFFICIENCY FOLLOWING THORACIC SURGERY

S6791XA

CRUSHING INJ UNSP PART(S) OF R WRIST HAND AND FINGERS INIT

J952

ACUTE PULMONARY INSUFFICIENCY FOLLOWING NONTHORACIC SURGERY

S6792XA

CRUSHING INJ UNSP PART(S) OF L WRIST HAND AND FINGERS INIT

J953

CHRONIC PULMONARY INSUFFICIENCY FOLLOWING SURGERY

S68011A

COMPLETE TRAUMATIC MCP AMPUTATION OF RIGHT THUMB INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J954 CHEMICAL PNEUMONITIS DUE TO ANESTHESIA

S68012A

COMPLETE TRAUMATIC MCP AMPUTATION OF LEFT THUMB INIT

J955 POSTPROCEDURAL SUBGLOTTIC STENOSIS

S68019A

COMPLETE TRAUMATIC MCP AMPUTATION OF THMB INIT

J9561

INTRAOP HEMOR/HEMTOM OF A RESP SYS ORG COMP RESP SYS PROC

S68021A

PARTIAL TRAUMATIC MCP AMPUTATION OF RIGHT THUMB INIT

J9562

INTRAOP HEMOR/HEMTOM OF A RESP SYS ORG COMP OTH PROCEDURE

S68022A

PARTIAL TRAUMATIC MCP AMPUTATION OF LEFT THUMB INIT

J9571

ACCIDENTAL PNCTR & LAC OF A RESP SYS ORG DUR RESP SYS PROC

S68029A

PARTIAL TRAUMATIC MCP AMPUTATION OF THMB INIT

J9572

ACC PNCTR & LAC OF A RESP SYS ORG DURING OTH PROCEDURE

S68110A

COMPLETE TRAUMATIC MCP AMPUTATION OF R IDX FNGR INIT

J95830

POSTPROC HEMOR/HEMTOM OF A RESP SYS ORG FOL A RESP SYS PROC

S68111A

COMPLETE TRAUMATIC MCP AMPUTATION OF LEFT INDEX FINGER INIT

J95831

POSTPROC HEMOR/HEMTOM OF A RESP SYS ORG FOL OTH PROCEDURE

S68112A

COMPLETE TRAUMATIC MCP AMPUTATION OF R MID FINGER INIT

J9584 TRANSFUSION-RELATED ACUTE LUNG INJURY (TRALI)

S68113A

COMPLETE TRAUMATIC MCP AMPUTATION OF L MID FINGER INIT

J95850 MECHANICAL COMPLICATION OF RESPIRATOR

S68114A

COMPLETE TRAUMATIC MCP AMPUTATION OF RIGHT RING FINGER INIT

J95851 VENTILATOR ASSOCIATED PNEUMONIA

S68115A

COMPLETE TRAUMATIC MCP AMPUTATION OF LEFT RING FINGER INIT

J95859 OTHER COMPLICATION OF RESPIRATOR [VENTILATOR]

S68116A

COMPLETE TRAUMATIC MCP AMPUTATION OF R LITTLE FINGER INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J95860

Postprocedural hematoma of a respiratory system organ or structure following a respiratory system procedure

S68117A

COMPLETE TRAUMATIC MCP AMPUTATION OF L LITTLE FINGER INIT

J95861

Postprocedural hematoma of a respiratory system organ or structure following other procedure

S68118A

COMPLETE TRAUMATIC MCP AMPUTATION OF FINGER INIT

J95862

Postprocedural seroma of a respiratory system organ or structure following a respiratory system procedure

S68119A

COMPLETE TRAUMATIC MCP AMPUTATION OF UNSP FINGER INIT

J95863

Postprocedural seroma of a respiratory system organ or structure following other procedure

S68120A

PARTIAL TRAUMATIC MCP AMPUTATION OF RIGHT INDEX FINGER INIT

J9588

OTH INTRAOPERATIVE COMPLICATIONS OF RESPIRATORY SYSTEM NEC

S68121A

PARTIAL TRAUMATIC MCP AMPUTATION OF LEFT INDEX FINGER INIT

J9589

OTH POSTPROC COMPLICATIONS AND DISORDERS OF RESP SYS NEC

S68122A

PARTIAL TRAUMATIC MCP AMPUTATION OF R MID FINGER INIT

J9600

ACUTE RESPIRATORY FAILURE UNSP W HYPOXIA OR HYPERCAPNIA

S68123A

PARTIAL TRAUMATIC MCP AMPUTATION OF LEFT MIDDLE FINGER INIT

J9601 ACUTE RESPIRATORY FAILURE WITH HYPOXIA

S68124A

PARTIAL TRAUMATIC MCP AMPUTATION OF RIGHT RING FINGER INIT

J9602 ACUTE RESPIRATORY FAILURE WITH HYPERCAPNIA

S68125A

PARTIAL TRAUMATIC MCP AMPUTATION OF LEFT RING FINGER INIT

J9610

CHRONIC RESPIRATORY FAILURE UNSP W HYPOXIA OR HYPERCAPNIA

S68126A

PARTIAL TRAUMATIC MCP AMPUTATION OF R LITTLE FINGER INIT

J9611 CHRONIC RESPIRATORY FAILURE WITH HYPOXIA

S68127A

PARTIAL TRAUMATIC MCP AMPUTATION OF LEFT LITTLE FINGER INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J9612 CHRONIC RESPIRATORY FAILURE WITH HYPERCAPNIA

S68128A

PARTIAL TRAUMATIC MCP AMPUTATION OF FINGER INIT

J9620

ACUTE AND CHR RESP FAILURE UNSP W HYPOXIA OR HYPERCAPNIA

S68129A

PARTIAL TRAUMATIC MCP AMPUTATION OF UNSP FINGER INIT

J9621

ACUTE AND CHRONIC RESPIRATORY FAILURE WITH HYPOXIA

S68411A

COMPLETE TRAUMATIC AMP OF RIGHT HAND AT WRIST LEVEL INIT

J9622

ACUTE AND CHRONIC RESPIRATORY FAILURE WITH HYPERCAPNIA

S68412A

COMPLETE TRAUMATIC AMP OF LEFT HAND AT WRIST LEVEL INIT

J9690

RESPIRATORY FAILURE UNSP UNSP W HYPOXIA OR HYPERCAPNIA

S68419A

COMPLETE TRAUMATIC AMP OF UNSP HAND AT WRIST LEVEL INIT

J9691 RESPIRATORY FAILURE UNSPECIFIED WITH HYPOXIA

S68421A

PARTIAL TRAUMATIC AMP OF RIGHT HAND AT WRIST LEVEL INIT

J9692

RESPIRATORY FAILURE UNSPECIFIED WITH HYPERCAPNIA

S68422A

PARTIAL TRAUMATIC AMP OF LEFT HAND AT WRIST LEVEL INIT

J9801 ACUTE BRONCHOSPASM

S68429A PARTIAL TRAUMATIC AMP OF UNSP HAND AT WRIST LEVEL INIT

J9809 OTHER DISEASES OF BRONCHUS NOT ELSEWHERE CLASSIFIED

S68511A

COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF RIGHT THUMB INIT

J9811 ATELECTASIS

S68512A COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF LEFT THUMB INIT

J9819 OTHER PULMONARY COLLAPSE

S68519A

COMPLETE TRAUMATIC TRANSPHALANGEAL AMPUTATION OF THMB INIT

J982 INTERSTITIAL EMPHYSEMA

S68521A PARTIAL TRAUMATIC TRNSPHAL AMPUTATION OF RIGHT THUMB INIT

J983 COMPENSATORY EMPHYSEMA

S68522A PARTIAL TRAUMATIC TRNSPHAL AMPUTATION OF LEFT THUMB INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J984 OTHER DISORDERS OF LUNG

S68529A

PARTIAL TRAUMATIC TRANSPHALANGEAL AMPUTATION OF THMB INIT

J985 DISEASES OF MEDIASTINUM NOT ELSEWHERE CLASSIFIED

S68610A

COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF R IDX FNGR INIT

J9851 Mediastinitis

S68611A COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF L IDX FNGR INIT

J9859 Other diseases of mediastinum not elsewhere classified

S68612A

COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF R MID FINGER INIT

J986 DISORDERS OF DIAPHRAGM

S68613A COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF L MID FINGER INIT

J988 OTHER SPECIFIED RESPIRATORY DISORDERS

S68614A

COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF R RNG FNGR INIT

J989 RESPIRATORY DISORDER UNSPECIFIED

S68615A

COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF L RNG FNGR INIT

J99

RESPIRATORY DISORDERS IN DISEASES CLASSIFIED ELSEWHERE

S68616A

COMPLETE TRAUMATIC TRNSPHAL AMP OF R LITTLE FINGER INIT

K200 EOSINOPHILIC ESOPHAGITIS

S68617A COMPLETE TRAUMATIC TRNSPHAL AMP OF L LITTLE FINGER INIT

K208 OTHER ESOPHAGITIS

S68618A COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF FINGER INIT

K209 ESOPHAGITIS UNSPECIFIED

S68619A COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF UNSP FINGER INIT

K210 GASTRO-ESOPHAGEAL REFLUX DISEASE WITH ESOPHAGITIS

S68620A

PARTIAL TRAUMATIC TRNSPHAL AMPUTATION OF R IDX FNGR INIT

K219

GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS

S68621A

PARTIAL TRAUMATIC TRNSPHAL AMPUTATION OF L IDX FNGR INIT

K220 ACHALASIA OF CARDIA

S68622A PARTIAL TRAUMATIC TRNSPHAL AMPUTATION OF R MID FINGER INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K2210 ULCER OF ESOPHAGUS WITHOUT BLEEDING

S68623A

PARTIAL TRAUMATIC TRNSPHAL AMPUTATION OF L MID FINGER INIT

K2211 ULCER OF ESOPHAGUS WITH BLEEDING

S68624A

PARTIAL TRAUMATIC TRNSPHAL AMPUTATION OF R RNG FNGR INIT

K222 ESOPHAGEAL OBSTRUCTION

S68625A PARTIAL TRAUMATIC TRNSPHAL AMPUTATION OF L RNG FNGR INIT

K223 PERFORATION OF ESOPHAGUS

S68626A PARTIAL TRAUMATIC TRNSPHAL AMP OF R LITTLE FINGER INIT

K224 DYSKINESIA OF ESOPHAGUS

S68627A PARTIAL TRAUMATIC TRNSPHAL AMP OF L LITTLE FINGER INIT

K225 DIVERTICULUM OF ESOPHAGUS ACQUIRED

S68628A

PARTIAL TRAUMATIC TRANSPHALANGEAL AMPUTATION OF FINGER INIT

K226

GASTRO-ESOPHAGEAL LACERATION-HEMORRHAGE SYNDROME

S68629A

PARTIAL TRAUMATIC TRNSPHAL AMPUTATION OF UNSP FINGER INIT

K2270 BARRETT'S ESOPHAGUS WITHOUT DYSPLASIA

S68711A

COMPLETE TRAUMATIC TRANSMETCRPL AMP OF RIGHT HAND INIT

K22710 BARRETT'S ESOPHAGUS WITH LOW GRADE DYSPLASIA

S68712A

COMPLETE TRAUMATIC TRANSMETCRPL AMP OF LEFT HAND INIT

K22711 BARRETT'S ESOPHAGUS WITH HIGH GRADE DYSPLASIA

S68719A

COMPLETE TRAUMATIC TRANSMETCRPL AMP OF UNSP HAND INIT

K22719 BARRETT'S ESOPHAGUS WITH DYSPLASIA UNSPECIFIED

S68721A

PARTIAL TRAUMATIC TRANSMETCRPL AMP OF RIGHT HAND INIT

K228 OTHER SPECIFIED DISEASES OF ESOPHAGUS

S68722A

PARTIAL TRAUMATIC TRANSMETCRPL AMPUTATION OF LEFT HAND INIT

K229 DISEASE OF ESOPHAGUS UNSPECIFIED

S68729A

PARTIAL TRAUMATIC TRANSMETCRPL AMPUTATION OF UNSP HAND INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K23

DISORDERS OF ESOPHAGUS IN DISEASES CLASSIFIED ELSEWHERE

S7000XA

CONTUSION OF UNSPECIFIED HIP INITIAL ENCOUNTER

K250 ACUTE GASTRIC ULCER WITH HEMORRHAGE

S7001XA

CONTUSION OF RIGHT HIP INITIAL ENCOUNTER

K251 ACUTE GASTRIC ULCER WITH PERFORATION

S7002XA

CONTUSION OF LEFT HIP INITIAL ENCOUNTER

K252

ACUTE GASTRIC ULCER WITH BOTH HEMORRHAGE AND PERFORATION

S7010XA

CONTUSION OF UNSPECIFIED THIGH INITIAL ENCOUNTER

K253

ACUTE GASTRIC ULCER WITHOUT HEMORRHAGE OR PERFORATION

S7011XA

CONTUSION OF RIGHT THIGH INITIAL ENCOUNTER

K254

CHRONIC OR UNSPECIFIED GASTRIC ULCER WITH HEMORRHAGE

S7012XA

CONTUSION OF LEFT THIGH INITIAL ENCOUNTER

K255

CHRONIC OR UNSPECIFIED GASTRIC ULCER WITH PERFORATION

S70211A

ABRASION RIGHT HIP INITIAL ENCOUNTER

K256

CHRONIC OR UNSP GASTRIC ULCER W BOTH HEMORRHAGE AND PERF

S70212A

ABRASION LEFT HIP INITIAL ENCOUNTER

K257

CHRONIC GASTRIC ULCER WITHOUT HEMORRHAGE OR PERFORATION

S70219A

ABRASION UNSPECIFIED HIP INITIAL ENCOUNTER

K259

GASTRIC ULCER UNSP AS ACUTE OR CHRONIC W/O HEMOR OR PERF

S70221A

BLISTER (NONTHERMAL) RIGHT HIP INITIAL ENCOUNTER

K260 ACUTE DUODENAL ULCER WITH HEMORRHAGE

S70222A

BLISTER (NONTHERMAL) LEFT HIP INITIAL ENCOUNTER

K261 ACUTE DUODENAL ULCER WITH PERFORATION

S70229A

BLISTER (NONTHERMAL) UNSPECIFIED HIP INITIAL ENCOUNTER

K262

ACUTE DUODENAL ULCER WITH BOTH HEMORRHAGE AND PERFORATION

S70241A

EXTERNAL CONSTRICTION RIGHT HIP INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K263

ACUTE DUODENAL ULCER WITHOUT HEMORRHAGE OR PERFORATION

S70242A

EXTERNAL CONSTRICTION LEFT HIP INITIAL ENCOUNTER

K264

CHRONIC OR UNSPECIFIED DUODENAL ULCER WITH HEMORRHAGE

S70249A

EXTERNAL CONSTRICTION UNSPECIFIED HIP INITIAL ENCOUNTER

K265

CHRONIC OR UNSPECIFIED DUODENAL ULCER WITH PERFORATION

S70341A

EXTERNAL CONSTRICTION RIGHT THIGH INITIAL ENCOUNTER

K266

CHRONIC OR UNSP DUODENAL ULCER W BOTH HEMORRHAGE AND PERF

S70342A

EXTERNAL CONSTRICTION LEFT THIGH INITIAL ENCOUNTER

K267

CHRONIC DUODENAL ULCER WITHOUT HEMORRHAGE OR PERFORATION

S70349A

EXTERNAL CONSTRICTION UNSPECIFIED THIGH INITIAL ENCOUNTER

K269

DUODENAL ULCER UNSP AS ACUTE OR CHRONIC W/O HEMOR OR PERF

S71001A

UNSPECIFIED OPEN WOUND RIGHT HIP INITIAL ENCOUNTER

K270

ACUTE PEPTIC ULCER SITE UNSPECIFIED WITH HEMORRHAGE

S71002A

UNSPECIFIED OPEN WOUND LEFT HIP INITIAL ENCOUNTER

K271

ACUTE PEPTIC ULCER SITE UNSPECIFIED WITH PERFORATION

S71009A

UNSPECIFIED OPEN WOUND UNSPECIFIED HIP INITIAL ENCOUNTER

K272

ACUTE PEPTIC ULCER SITE UNSP W BOTH HEMORRHAGE AND PERF

S71011A

LACERATION WITHOUT FOREIGN BODY RIGHT HIP INIT ENCNTR

K273

ACUTE PEPTIC ULCER SITE UNSP W/O HEMORRHAGE OR PERFORATION

S71012A

LACERATION WITHOUT FOREIGN BODY LEFT HIP INITIAL ENCOUNTER

K274

CHRONIC OR UNSP PEPTIC ULCER SITE UNSP WITH HEMORRHAGE

S71019A

LACERATION WITHOUT FOREIGN BODY UNSP HIP INIT ENCNTR

K275

CHRONIC OR UNSP PEPTIC ULCER SITE UNSP WITH PERFORATION

S71021A

LACERATION WITH FOREIGN BODY RIGHT HIP INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K276

CHR OR UNSP PEPTIC ULCER SITE UNSP W BOTH HEMOR AND PERF

S71022A

LACERATION WITH FOREIGN BODY LEFT HIP INITIAL ENCOUNTER

K277

CHRONIC PEPTIC ULCER SITE UNSP W/O HEMORRHAGE OR PERF

S71029A

LACERATION WITH FOREIGN BODY UNSPECIFIED HIP INIT ENCNTR

K279

PEPTIC ULC SITE UNSP UNSP AS AC OR CHR W/O HEMOR OR PERF

S71031A

PUNCTURE WOUND WITHOUT FOREIGN BODY RIGHT HIP INIT ENCNTR

K280 ACUTE GASTROJEJUNAL ULCER WITH HEMORRHAGE

S71032A

PUNCTURE WOUND WITHOUT FOREIGN BODY LEFT HIP INIT ENCNTR

K281 ACUTE GASTROJEJUNAL ULCER WITH PERFORATION

S71039A

PUNCTURE WOUND WITHOUT FOREIGN BODY UNSP HIP INIT ENCNTR

K282

ACUTE GASTROJEJUNAL ULCER W BOTH HEMORRHAGE AND PERFORATION

S71041A

PUNCTURE WOUND WITH FOREIGN BODY RIGHT HIP INIT ENCNTR

K283

ACUTE GASTROJEJUNAL ULCER WITHOUT HEMORRHAGE OR PERFORATION

S71042A

PUNCTURE WOUND WITH FOREIGN BODY LEFT HIP INIT ENCNTR

K284

CHRONIC OR UNSPECIFIED GASTROJEJUNAL ULCER WITH HEMORRHAGE

S71049A

PUNCTURE WOUND WITH FOREIGN BODY UNSP HIP INIT ENCNTR

K285

CHRONIC OR UNSPECIFIED GASTROJEJUNAL ULCER WITH PERFORATION

S71051A

OPEN BITE RIGHT HIP INITIAL ENCOUNTER

K286

CHRONIC OR UNSP GASTROJEJUNAL ULCER W BOTH HEMOR AND PERF

S71052A

OPEN BITE LEFT HIP INITIAL ENCOUNTER

K287

CHRONIC GASTROJEJUNAL ULCER W/O HEMORRHAGE OR PERFORATION

S71059A

OPEN BITE UNSPECIFIED HIP INITIAL ENCOUNTER

K4100

BI FEMORAL HERNIA W OBST W/O GANGRENE NOT SPCF AS RECUR

S71101A

UNSPECIFIED OPEN WOUND RIGHT THIGH INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K4101

BILATERAL FEMORAL HERNIA W OBST W/O GANGRENE RECURRENT

S71102A

UNSPECIFIED OPEN WOUND LEFT THIGH INITIAL ENCOUNTER

K4110

BI FEMORAL HERNIA W GANGRENE NOT SPECIFIED AS RECURRENT

S71109A

UNSPECIFIED OPEN WOUND UNSPECIFIED THIGH INITIAL ENCOUNTER

K4111 BILATERAL FEMORAL HERNIA WITH GANGRENE RECURRENT

S71111A

LACERATION WITHOUT FOREIGN BODY RIGHT THIGH INIT ENCNTR

K4120

BI FEMORAL HERNIA W/O OBST OR GANGRENE NOT SPCF AS RECUR

S71112A

LACERATION WITHOUT FOREIGN BODY LEFT THIGH INIT ENCNTR

K4121

BILATERAL FEMORAL HERNIA W/O OBST OR GANGRENE RECURRENT

S71119A

LACERATION WITHOUT FOREIGN BODY UNSP THIGH INIT ENCNTR

K4130

UNIL FEMORAL HERNIA W OBST W/O GANGRENE NOT SPCF AS RECUR

S71121A

LACERATION WITH FOREIGN BODY RIGHT THIGH INITIAL ENCOUNTER

K4131

UNILATERAL FEMORAL HERNIA W OBST W/O GANGRENE RECURRENT

S71122A

LACERATION WITH FOREIGN BODY LEFT THIGH INITIAL ENCOUNTER

K4140

UNIL FEMORAL HERNIA W GANGRENE NOT SPECIFIED AS RECURRENT

S71129A

LACERATION WITH FOREIGN BODY UNSPECIFIED THIGH INIT ENCNTR

K4141 UNILATERAL FEMORAL HERNIA WITH GANGRENE RECURRENT

S71131A

PUNCTURE WOUND W/O FOREIGN BODY RIGHT THIGH INIT ENCNTR

K4190

UNIL FEMORAL HERNIA W/O OBST OR GANGRENE NOT SPCF AS RECUR

S71132A

PUNCTURE WOUND WITHOUT FOREIGN BODY LEFT THIGH INIT ENCNTR

K4191

UNILATERAL FEMORAL HERNIA W/O OBST OR GANGRENE RECURRENT

S71139A

PUNCTURE WOUND WITHOUT FOREIGN BODY UNSP THIGH INIT ENCNTR

K420

UMBILICAL HERNIA WITH OBSTRUCTION WITHOUT GANGRENE

S71141A

PUNCTURE WOUND WITH FOREIGN BODY RIGHT THIGH INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K421 UMBILICAL HERNIA WITH GANGRENE

S71142A

PUNCTURE WOUND WITH FOREIGN BODY LEFT THIGH INIT ENCNTR

K429 UMBILICAL HERNIA WITHOUT OBSTRUCTION OR GANGRENE

S71149A

PUNCTURE WOUND WITH FOREIGN BODY UNSP THIGH INIT ENCNTR

K440

DIAPHRAGMATIC HERNIA WITH OBSTRUCTION WITHOUT GANGRENE

S71151A

OPEN BITE RIGHT THIGH INITIAL ENCOUNTER

K441 DIAPHRAGMATIC HERNIA WITH GANGRENE

S71152A

OPEN BITE LEFT THIGH INITIAL ENCOUNTER

K449

DIAPHRAGMATIC HERNIA WITHOUT OBSTRUCTION OR GANGRENE

S71159A

OPEN BITE UNSPECIFIED THIGH INITIAL ENCOUNTER

K450

OTH ABDOMINAL HERNIA WITH OBSTRUCTION WITHOUT GANGRENE

S72001A

FRACTURE OF UNSP PART OF NECK OF RIGHT FEMUR INIT

K451 OTHER SPECIFIED ABDOMINAL HERNIA WITH GANGRENE

S72001B

FX UNSP PART OF NECK OF R FEMUR INIT FOR OPN FX TYPE I/2

K458

OTH ABDOMINAL HERNIA WITHOUT OBSTRUCTION OR GANGRENE

S72001C

FX UNSP PART OF NECK OF R FEMUR INIT FOR OPN FX TYPE 3A/B/C

K460

UNSP ABDOMINAL HERNIA WITH OBSTRUCTION WITHOUT GANGRENE

S72002A

FRACTURE OF UNSP PART OF NECK OF LEFT FEMUR INIT

K461 UNSPECIFIED ABDOMINAL HERNIA WITH GANGRENE

S72002B

FX UNSP PART OF NECK OF LEFT FEMUR INIT FOR OPN FX TYPE I/2

K469

UNSPECIFIED ABDOMINAL HERNIA WITHOUT OBSTRUCTION OR GANGRENE

S72002C

FX UNSP PART OF NECK OF L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K5221 Food protein-induced enterocolitis syndrome

S72009A

FRACTURE OF UNSP PART OF NECK OF UNSP FEMUR INIT

K5222 Food protein-induced enteropathy

S72009B

FX UNSP PART OF NECK OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K5229 Other allergic and dietetic gastroenteritis and colitis

S72009C

FX UNSP PART OF NK OF UNSP FEMR INIT FOR OPN FX TYPE 3A/B/C

K523 Indeterminate colitis

S72011A UNSP INTRACAPSULAR FRACTURE OF RIGHT FEMUR INIT FOR CLOS FX

K52831 Collagenous colitis

S72011B UNSP INTRACAP FX RIGHT FEMUR INIT FOR OPN FX TYPE I/2

K52832 Lymphocytic colitis

S72011C UNSP INTRACAP FX RIGHT FEMUR INIT FOR OPN FX TYPE 3A/B/C

K52838 Other microscopic colitis

S72012A UNSP INTRACAPSULAR FRACTURE OF LEFT FEMUR INIT FOR CLOS FX

K55011

Focal (segmental) acute (reversible) ischemia of small intestine

S72012B

UNSP INTRACAP FX LEFT FEMUR INIT FOR OPN FX TYPE I/2

K55012 Diffuse acute (reversible) ischemia of small intestine

S72012C

UNSP INTRACAP FX LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

K55019

Acute (reversible) ischemia of small intestine extent unspecified

S72019A

UNSP INTRACAPSULAR FRACTURE OF UNSP FEMUR INIT FOR CLOS FX

K55021 Focal (segmental) acute infarction of small intestine

S72019B

UNSP INTRACAP FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

K55022 Diffuse acute infarction of small intestine

S72019C

UNSP INTRACAP FX UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

K55029 Acute infarction of small intestine extent unspecified

S72021A

DISP FX OF EPIPHYSIS (SEPARATION) (UPPER) OF R FEMUR INIT

K55031

Focal (segmental) acute (reversible) ischemia of large intestine

S72021B

DISP FX OF EPIPHY (SEPARATION) (UPPER) OF R FEMR 7THB

K55032 Diffuse acute (reversible) ischemia of large intestine

S72021C

DISP FX OF EPIPHY (SEPARATION) (UPPER) OF R FEMR 7THC

K55039

Acute (reversible) ischemia of large intestine extent unspecified

S72022A

DISP FX OF EPIPHYSIS (SEPARATION) (UPPER) OF L FEMUR INIT

K55041 Focal (segmental) acute infarction of large intestine

S72022B

DISP FX OF EPIPHY (SEPARATION) (UPPER) OF L FEMR 7THB

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K55042 Diffuse acute infarction of large intestine

S72022C

DISP FX OF EPIPHY (SEPARATION) (UPPER) OF L FEMR 7THC

K55049 Acute infarction of large intestine extent unspecified

S72023A

DISP FX OF EPIPHY (SEPARATION) (UPPER) OF UNSP FEMUR INIT

K55051

Focal (segmental) acute (reversible) ischemia of intestine part unspecified

S72023B

DISP FX OF EPIPHY (SEPARATION) (UPPER) OF UNSP FEMR 7THB

K55052

Diffuse acute (reversible) ischemia of intestine part unspecified

S72023C

DISP FX OF EPIPHY (SEPARATION) (UPPER) OF UNSP FEMR 7THC

K55059

Acute (reversible) ischemia of intestine part and extent unspecified

S72024A

NONDISP FX OF EPIPHY (SEPARATION) (UPPER) OF R FEMUR INIT

K55061

Focal (segmental) acute infarction of intestine part unspecified

S72024B

NONDISP FX OF EPIPHY (SEPARATION) (UPPER) OF R FEMR 7THB

K55062 Diffuse acute infarction of intestine part unspecified

S72024C

NONDISP FX OF EPIPHY (SEPARATION) (UPPER) OF R FEMR 7THC

K55069 Acute infarction of intestine part and extent unspecified

S72025A

NONDISP FX OF EPIPHY (SEPARATION) (UPPER) OF L FEMUR INIT

K5530 Necrotizing enterocolitis unspecified

S72025B

NONDISP FX OF EPIPHY (SEPARATION) (UPPER) OF L FEMR 7THB

K5531 Stage 1 necrotizing enterocolitis

S72025C NONDISP FX OF EPIPHY (SEPARATION) (UPPER) OF L FEMR 7THC

K5532 Stage 2 necrotizing enterocolitis

S72026A NONDISP FX OF EPIPHY (SEPARATION) (UPPER) OF UNSP FEMR INIT

K5533 Stage 3 necrotizing enterocolitis

S72026B NONDISP FX OF EPIPHY (SEPARATION) (UPPER) OF UNSP FEMR 7THB

K5931 Toxic megacolon

S72026C NONDISP FX OF EPIPHY (SEPARATION) (UPPER) OF UNSP FEMR 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K5939 Other megacolon

S72031A DISPLACED MIDCERVICAL FRACTURE OF RIGHT FEMUR INIT

K625 HEMORRHAGE OF ANUS AND RECTUM

S72031B

DISPLACED MIDCERVICAL FX R FEMUR INIT FOR OPN FX TYPE I/2

K630 ABSCESS OF INTESTINE

S72031C DISPL MIDCERVICAL FX R FEMUR INIT FOR OPN FX TYPE 3A/B/C

K631 PERFORATION OF INTESTINE (NONTRAUMATIC)

S72032A

DISPLACED MIDCERVICAL FRACTURE OF LEFT FEMUR INIT

K632 FISTULA OF INTESTINE

S72032B DISPLACED MIDCERVICAL FX L FEMUR INIT FOR OPN FX TYPE I/2

K633 ULCER OF INTESTINE

S72032C DISPL MIDCERVICAL FX L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K634 ENTEROPTOSIS

S72033A DISPLACED MIDCERVICAL FRACTURE OF UNSP FEMUR INIT

K635 POLYP OF COLON

S72033B DISPL MIDCERVICAL FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

K639 DISEASE OF INTESTINE UNSPECIFIED

S72033C

DISPL MIDCERVICAL FX UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

K650 GENERALIZED (ACUTE) PERITONITIS

S72034A

NONDISPLACED MIDCERVICAL FRACTURE OF RIGHT FEMUR INIT

K651 PERITONEAL ABSCESS

S72034B NONDISP MIDCERVICAL FX RIGHT FEMUR INIT FOR OPN FX TYPE I/2

K652 SPONTANEOUS BACTERIAL PERITONITIS

S72034C

NONDISP MIDCERVICAL FX R FEMUR INIT FOR OPN FX TYPE 3A/B/C

K653 CHOLEPERITONITIS

S72035A NONDISPLACED MIDCERVICAL FRACTURE OF LEFT FEMUR INIT

K654 SCLEROSING MESENTERITIS

S72035B NONDISP MIDCERVICAL FX LEFT FEMUR INIT FOR OPN FX TYPE I/2

K658 OTHER PERITONITIS

S72035C NONDISP MIDCERVICAL FX L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K659 PERITONITIS UNSPECIFIED

S72036A NONDISPLACED MIDCERVICAL FRACTURE OF UNSP FEMUR INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K660

PERITONEAL ADHESIONS (POSTPROCEDURAL) (POSTINFECTION)

S72036B

NONDISP MIDCERVICAL FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

K661 HEMOPERITONEUM

S72036C NONDISP MIDCERVICAL FX UNSP FEMR 7THC

K668 OTHER SPECIFIED DISORDERS OF PERITONEUM

S72041A

DISP FX OF BASE OF NECK OF RIGHT FEMUR INIT FOR CLOS FX

K669 DISORDER OF PERITONEUM UNSPECIFIED

S72041B

DISP FX OF BASE OF NECK OF R FEMUR INIT FOR OPN FX TYPE I/2

K67

DISORDERS OF PERITONEUM IN INFECTIOUS DISEASES CLASSD ELSWHR

S72041C

DISP FX OF BASE OF NK OF R FEMR INIT FOR OPN FX TYPE 3A/B/C

K6811 POSTPROCEDURAL RETROPERITONEAL ABSCESS

S72042A

DISP FX OF BASE OF NECK OF LEFT FEMUR INIT FOR CLOS FX

K6812 PSOAS MUSCLE ABSCESS

S72042B DISP FX OF BASE OF NECK OF L FEMUR INIT FOR OPN FX TYPE I/2

K6819 OTHER RETROPERITONEAL ABSCESS

S72042C

DISP FX OF BASE OF NK OF L FEMR INIT FOR OPN FX TYPE 3A/B/C

K689 OTHER DISORDERS OF RETROPERITONEUM

S72043A

DISP FX OF BASE OF NECK OF UNSP FEMUR INIT FOR CLOS FX

K700 ALCOHOLIC FATTY LIVER

S72043B DISP FX OF BASE OF NK OF UNSP FEMR INIT FOR OPN FX TYPE I/2

K7010 ALCOHOLIC HEPATITIS WITHOUT ASCITES

S72043C

DISP FX OF BASE OF NK OF UNSP FEMR 7THC

K7011 ALCOHOLIC HEPATITIS WITH ASCITES

S72044A

NONDISP FX OF BASE OF NECK OF RIGHT FEMUR INIT FOR CLOS FX

K702 ALCOHOLIC FIBROSIS AND SCLEROSIS OF LIVER

S72044B

NONDISP FX OF BASE OF NK OF R FEMR INIT FOR OPN FX TYPE I/2

K7030 ALCOHOLIC CIRRHOSIS OF LIVER WITHOUT ASCITES

S72044C

NONDISP FX OF BASE OF NK OF R FEMR 7THC

K7031 ALCOHOLIC CIRRHOSIS OF LIVER WITH ASCITES

S72045A

NONDISP FX OF BASE OF NECK OF LEFT FEMUR INIT FOR CLOS FX

K7040 ALCOHOLIC HEPATIC FAILURE WITHOUT COMA

S72045B

NONDISP FX OF BASE OF NK OF L FEMR INIT FOR OPN FX TYPE I/2

K7041 ALCOHOLIC HEPATIC FAILURE WITH COMA

S72045C

NONDISP FX OF BASE OF NK OF L FEMR 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K709 ALCOHOLIC LIVER DISEASE UNSPECIFIED

S72046A

NONDISP FX OF BASE OF NECK OF UNSP FEMUR INIT FOR CLOS FX

K710 TOXIC LIVER DISEASE WITH CHOLESTASIS

S72046B

NONDISP FX OF BASE OF NK OF UNSP FEMR 7THB

K7110

TOXIC LIVER DISEASE WITH HEPATIC NECROSIS WITHOUT COMA

S72046C

NONDISP FX OF BASE OF NK OF UNSP FEMR 7THC

K7111 TOXIC LIVER DISEASE WITH HEPATIC NECROSIS WITH COMA

S72051A

UNSP FRACTURE OF HEAD OF RIGHT FEMUR INIT FOR CLOS FX

K712 TOXIC LIVER DISEASE WITH ACUTE HEPATITIS

S72051B

UNSP FX HEAD OF RIGHT FEMUR INIT FOR OPN FX TYPE I/2

K713

TOXIC LIVER DISEASE WITH CHRONIC PERSISTENT HEPATITIS

S72051C

UNSP FX HEAD OF RIGHT FEMUR INIT FOR OPN FX TYPE 3A/B/C

K714 TOXIC LIVER DISEASE WITH CHRONIC LOBULAR HEPATITIS

S72052A

UNSP FRACTURE OF HEAD OF LEFT FEMUR INIT FOR CLOS FX

K7150

TOXIC LIVER DISEASE W CHRONIC ACTIVE HEPATITIS W/O ASCITES

S72052B

UNSP FX HEAD OF LEFT FEMUR INIT FOR OPN FX TYPE I/2

K7151

TOXIC LIVER DISEASE W CHRONIC ACTIVE HEPATITIS WITH ASCITES

S72052C

UNSP FX HEAD OF LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

K716

TOXIC LIVER DISEASE WITH HEPATITIS NOT ELSEWHERE CLASSIFIED

S72059A

UNSP FRACTURE OF HEAD OF UNSP FEMUR INIT FOR CLOS FX

K717

TOXIC LIVER DISEASE WITH FIBROSIS AND CIRRHOSIS OF LIVER

S72059B

UNSP FX HEAD OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

K718 TOXIC LIVER DISEASE WITH OTHER DISORDERS OF LIVER

S72059C

UNSP FX HEAD OF UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

K719 TOXIC LIVER DISEASE UNSPECIFIED

S72061A

DISPLACED ARTICULAR FRACTURE OF HEAD OF RIGHT FEMUR INIT

K7200 ACUTE AND SUBACUTE HEPATIC FAILURE WITHOUT COMA

S72061B

DISPLACED ARTIC FX HEAD OF R FEMUR INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K7201 ACUTE AND SUBACUTE HEPATIC FAILURE WITH COMA

S72061C

DISPL ARTIC FX HEAD OF R FEMUR INIT FOR OPN FX TYPE 3A/B/C

K7210 CHRONIC HEPATIC FAILURE WITHOUT COMA

S72062A

DISPLACED ARTICULAR FRACTURE OF HEAD OF LEFT FEMUR INIT

K7211 CHRONIC HEPATIC FAILURE WITH COMA

S72062B

DISPLACED ARTIC FX HEAD OF L FEMUR INIT FOR OPN FX TYPE I/2

K7290 HEPATIC FAILURE UNSPECIFIED WITHOUT COMA

S72062C

DISPL ARTIC FX HEAD OF L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K7291 HEPATIC FAILURE UNSPECIFIED WITH COMA

S72063A

DISPLACED ARTICULAR FRACTURE OF HEAD OF UNSP FEMUR INIT

K730

CHRONIC PERSISTENT HEPATITIS NOT ELSEWHERE CLASSIFIED

S72063B

DISPL ARTIC FX HEAD OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

K731 CHRONIC LOBULAR HEPATITIS NOT ELSEWHERE CLASSIFIED

S72063C

DISPL ARTIC FX HEAD OF UNSP FEMR 7THC

K732 CHRONIC ACTIVE HEPATITIS NOT ELSEWHERE CLASSIFIED

S72064A

NONDISPLACED ARTICULAR FRACTURE OF HEAD OF RIGHT FEMUR INIT

K738 OTHER CHRONIC HEPATITIS NOT ELSEWHERE CLASSIFIED

S72064B

NONDISP ARTIC FX HEAD OF R FEMUR INIT FOR OPN FX TYPE I/2

K739 CHRONIC HEPATITIS UNSPECIFIED

S72064C

NONDISP ARTIC FX HEAD OF R FEMR INIT FOR OPN FX TYPE 3A/B/C

K740 HEPATIC FIBROSIS

S72065A NONDISPLACED ARTICULAR FRACTURE OF HEAD OF LEFT FEMUR INIT

K741 HEPATIC SCLEROSIS

S72065B NONDISP ARTIC FX HEAD OF L FEMUR INIT FOR OPN FX TYPE I/2

K742 HEPATIC FIBROSIS WITH HEPATIC SCLEROSIS

S72065C

NONDISP ARTIC FX HEAD OF L FEMR INIT FOR OPN FX TYPE 3A/B/C

K743 PRIMARY BILIARY CIRRHOSIS

S72066A NONDISPLACED ARTICULAR FRACTURE OF HEAD OF UNSP FEMUR INIT

K744 SECONDARY BILIARY CIRRHOSIS

S72066B NONDISP ARTIC FX HEAD OF UNSP FEMR INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K745 BILIARY CIRRHOSIS UNSPECIFIED

S72066C

NONDISP ARTIC FX HEAD OF UNSP FEMR 7THC

K7460 UNSPECIFIED CIRRHOSIS OF LIVER

S72091A

OTH FRACTURE OF HEAD AND NECK OF RIGHT FEMUR INIT

K7469 OTHER CIRRHOSIS OF LIVER

S72091B OTH FX HEAD/NECK OF RIGHT FEMUR INIT FOR OPN FX TYPE I/2

K750 ABSCESS OF LIVER

S72091C OTH FX HEAD/NECK OF RIGHT FEMUR INIT FOR OPN FX TYPE 3A/B/C

K751 PHLEBITIS OF PORTAL VEIN

S72092A OTH FRACTURE OF HEAD AND NECK OF LEFT FEMUR INIT

K752 NONSPECIFIC REACTIVE HEPATITIS

S72092B

OTH FX HEAD/NECK OF LEFT FEMUR INIT FOR OPN FX TYPE I/2

K753 GRANULOMATOUS HEPATITIS NOT ELSEWHERE CLASSIFIED

S72092C

OTH FX HEAD/NECK OF LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

K754 AUTOIMMUNE HEPATITIS

S72099A OTH FRACTURE OF HEAD AND NECK OF UNSP FEMUR INIT

K7581 NONALCOHOLIC STEATOHEPATITIS (NASH)

S72099B

OTH FX HEAD/NECK OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

K7589

OTHER SPECIFIED INFLAMMATORY LIVER DISEASES

S72099C

OTH FX HEAD/NECK OF UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

K759 INFLAMMATORY LIVER DISEASE UNSPECIFIED

S72101A

UNSP TROCHANTERIC FRACTURE OF RIGHT FEMUR INIT FOR CLOS FX

K760 FATTY (CHANGE OF) LIVER NOT ELSEWHERE CLASSIFIED

S72101B

UNSP TROCHAN FX RIGHT FEMUR INIT FOR OPN FX TYPE I/2

K761 CHRONIC PASSIVE CONGESTION OF LIVER

S72101C

UNSP TROCHAN FX RIGHT FEMUR INIT FOR OPN FX TYPE 3A/B/C

K762 CENTRAL HEMORRHAGIC NECROSIS OF LIVER

S72102A

UNSP TROCHANTERIC FRACTURE OF LEFT FEMUR INIT FOR CLOS FX

K763 INFARCTION OF LIVER

S72102B UNSP TROCHAN FX LEFT FEMUR INIT FOR OPN FX TYPE I/2

K764 PELIOSIS HEPATIS

S72102C UNSP TROCHAN FX LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K765 HEPATIC VENO-OCCLUSIVE DISEASE

S72109A

UNSP TROCHANTERIC FRACTURE OF UNSP FEMUR INIT FOR CLOS FX

K766 PORTAL HYPERTENSION

S72109B UNSP TROCHAN FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

K767 HEPATORENAL SYNDROME

S72109C UNSP TROCHAN FX UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

K769 LIVER DISEASE UNSPECIFIED

S72111A DISP FX OF GREATER TROCHANTER OF RIGHT FEMUR INIT

K77 LIVER DISORDERS IN DISEASES CLASSIFIED ELSEWHERE

S72111B

DISP FX OF GREATER TROCHANTER OF R FEMR 7THB

K8000

CALCULUS OF GALLBLADDER W ACUTE CHOLECYST W/O OBSTRUCTION

S72111C

DISP FX OF GREATER TROCHANTER OF R FEMR 7THC

K8001

CALCULUS OF GALLBLADDER W ACUTE CHOLECYSTITIS W OBSTRUCTION

S72112A

DISP FX OF GREATER TROCHANTER OF LEFT FEMUR INIT

K8010

CALCULUS OF GALLBLADDER W CHRONIC CHOLECYST W/O OBSTRUCTION

S72112B

DISP FX OF GREATER TROCHANTER OF L FEMR 7THB

K8011

CALCULUS OF GALLBLADDER W CHRONIC CHOLECYST W OBSTRUCTION

S72112C

DISP FX OF GREATER TROCHANTER OF L FEMR 7THC

K8012

CALCULUS OF GB W ACUTE AND CHRONIC CHOLECYST W/O OBSTRUCTION

S72113A

DISP FX OF GREATER TROCHANTER OF UNSP FEMUR INIT

K8013

CALCULUS OF GB W ACUTE AND CHRONIC CHOLECYST W OBSTRUCTION

S72113B

DISP FX OF GREATER TROCHANTER OF UNSP FEMR 7THB

K8018

CALCULUS OF GALLBLADDER W OTH CHOLECYSTITIS W/O OBSTRUCTION

S72113C

DISP FX OF GREATER TROCHANTER OF UNSP FEMR 7THC

K8019

CALCULUS OF GALLBLADDER W OTH CHOLECYSTITIS WITH OBSTRUCTION

S72114A

NONDISP FX OF GREATER TROCHANTER OF RIGHT FEMUR INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K8020

CALCULUS OF GALLBLADDER W/O CHOLECYSTITIS W/O OBSTRUCTION

S72114B

NONDISP FX OF GREATER TROCHANTER OF R FEMR 7THB

K8021

CALCULUS OF GALLBLADDER W/O CHOLECYSTITIS WITH OBSTRUCTION

S72114C

NONDISP FX OF GREATER TROCHANTER OF R FEMR 7THC

K8030

CALCULUS OF BILE DUCT W CHOLANGITIS UNSP W/O OBSTRUCTION

S72115A

NONDISP FX OF GREATER TROCHANTER OF LEFT FEMUR INIT

K8031

CALCULUS OF BILE DUCT W CHOLANGITIS UNSP WITH OBSTRUCTION

S72115B

NONDISP FX OF GREATER TROCHANTER OF L FEMR 7THB

K8032

CALCULUS OF BILE DUCT WITH ACUTE CHOLANGITIS W/O OBSTRUCTION

S72115C

NONDISP FX OF GREATER TROCHANTER OF L FEMR 7THC

K8033

CALCULUS OF BILE DUCT W ACUTE CHOLANGITIS WITH OBSTRUCTION

S72116A

NONDISP FX OF GREATER TROCHANTER OF UNSP FEMUR INIT

K8034

CALCULUS OF BILE DUCT W CHRONIC CHOLANGITIS W/O OBSTRUCTION

S72116B

NONDISP FX OF GREATER TROCHANTER OF UNSP FEMR 7THB

K8035

CALCULUS OF BILE DUCT W CHRONIC CHOLANGITIS WITH OBSTRUCTION

S72116C

NONDISP FX OF GREATER TROCHANTER OF UNSP FEMR 7THC

K8036

CALCULUS OF BILE DUCT W ACUTE AND CHR CHOLANGITIS W/O OBST

S72121A

DISP FX OF LESSER TROCHANTER OF RIGHT FEMUR INIT

K8037

CALCULUS OF BILE DUCT W ACUTE AND CHRONIC CHOLANGITIS W OBST

S72121B

DISP FX OF LESS TROCHANTER OF R FEMR 7THB

K8040

CALCULUS OF BILE DUCT W CHOLECYSTITIS UNSP W/O OBSTRUCTION

S72121C

DISP FX OF LESS TROCHANTER OF R FEMR 7THC

K8041

CALCULUS OF BILE DUCT W CHOLECYSTITIS UNSP W OBSTRUCTION

S72122A

DISP FX OF LESSER TROCHANTER OF LEFT FEMUR INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K8042

CALCULUS OF BILE DUCT W ACUTE CHOLECYSTITIS W/O OBSTRUCTION

S72122B

DISP FX OF LESS TROCHANTER OF L FEMR 7THB

K8043

CALCULUS OF BILE DUCT W ACUTE CHOLECYSTITIS WITH OBSTRUCTION

S72122C

DISP FX OF LESS TROCHANTER OF L FEMR 7THC

K8044

CALCULUS OF BILE DUCT W CHRONIC CHOLECYST W/O OBSTRUCTION

S72123A

DISP FX OF LESSER TROCHANTER OF UNSP FEMUR INIT FOR CLOS FX

K8045

CALCULUS OF BILE DUCT W CHRONIC CHOLECYSTITIS W OBSTRUCTION

S72123B

DISP FX OF LESS TROCHANTER OF UNSP FEMR 7THB

K8046

CALCULUS OF BILE DUCT W ACUTE AND CHRONIC CHOLECYST W/O OBST

S72123C

DISP FX OF LESS TROCHANTER OF UNSP FEMR 7THC

K8047

CALCULUS OF BILE DUCT W ACUTE AND CHRONIC CHOLECYST W OBST

S72124A

NONDISP FX OF LESSER TROCHANTER OF RIGHT FEMUR INIT

K8050

CALCULUS OF BILE DUCT W/O CHOLANGITIS OR CHOLECYST W/O OBST

S72124B

NONDISP FX OF LESS TROCHANTER OF R FEMR 7THB

K8051

CALCULUS OF BILE DUCT W/O CHOLANGITIS OR CHOLECYST W OBST

S72124C

NONDISP FX OF LESS TROCHANTER OF R FEMR 7THC

K8060

CALCULUS OF GB AND BILE DUCT W CHOLECYST UNSP W/O OBST

S72125A

NONDISP FX OF LESSER TROCHANTER OF LEFT FEMUR INIT

K8061

CALCULUS OF GB AND BILE DUCT W CHOLECYST UNSP W OBST

S72125B

NONDISP FX OF LESS TROCHANTER OF L FEMR 7THB

K8062

CALCULUS OF GB AND BILE DUCT W ACUTE CHOLECYST W/O OBST

S72125C

NONDISP FX OF LESS TROCHANTER OF L FEMR 7THC

K8063

CALCULUS OF GB AND BILE DUCT W ACUTE CHOLECYST W OBSTRUCTION

S72126A

NONDISP FX OF LESSER TROCHANTER OF UNSP FEMUR INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K8064

CALCULUS OF GB AND BILE DUCT W CHRONIC CHOLECYST W/O OBST

S72126B

NONDISP FX OF LESS TROCHANTER OF UNSP FEMR 7THB

K8065

CALCULUS OF GB AND BILE DUCT W CHRONIC CHOLECYST W OBST

S72126C

NONDISP FX OF LESS TROCHANTER OF UNSP FEMR 7THC

K8066

CALCULUS OF GB AND BILE DUCT W AC AND CHR CHOLECYST W/O OBST

S72131A

DISPLACED APOPHYSEAL FRACTURE OF RIGHT FEMUR INIT

K8067

CALCULUS OF GB AND BILE DUCT W AC AND CHR CHOLECYST W OBST

S72131B

DISPLACED APOPHYSEAL FX R FEMUR INIT FOR OPN FX TYPE I/2

K8070

CALCULUS OF GB AND BILE DUCT W/O CHOLECYST W/O OBSTRUCTION

S72131C

DISPLACED APOPHYSEAL FX R FEMUR INIT FOR OPN FX TYPE 3A/B/C

K8071

CALCULUS OF GB AND BILE DUCT W/O CHOLECYST W OBSTRUCTION

S72132A

DISPLACED APOPHYSEAL FRACTURE OF LEFT FEMUR INIT

K8080 OTHER CHOLELITHIASIS WITHOUT OBSTRUCTION

S72132B

DISPLACED APOPHYSEAL FX LEFT FEMUR INIT FOR OPN FX TYPE I/2

K8081 OTHER CHOLELITHIASIS WITH OBSTRUCTION

S72132C

DISPLACED APOPHYSEAL FX L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K810 ACUTE CHOLECYSTITIS

S72133A DISPLACED APOPHYSEAL FRACTURE OF UNSP FEMUR INIT

K811 CHRONIC CHOLECYSTITIS

S72133B DISPLACED APOPHYSEAL FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

K812 ACUTE CHOLECYSTITIS WITH CHRONIC CHOLECYSTITIS

S72133C

DISPL APOPHYSEAL FX UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

K819 CHOLECYSTITIS UNSPECIFIED

S72134A NONDISPLACED APOPHYSEAL FRACTURE OF RIGHT FEMUR INIT

K820 OBSTRUCTION OF GALLBLADDER

S72134B

NONDISP APOPHYSEAL FX RIGHT FEMUR INIT FOR OPN FX TYPE I/2

K821 HYDROPS OF GALLBLADDER

S72134C NONDISP APOPHYSEAL FX R FEMUR INIT FOR OPN FX TYPE 3A/B/C

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K822 PERFORATION OF GALLBLADDER

S72135A

NONDISPLACED APOPHYSEAL FRACTURE OF LEFT FEMUR INIT

K823 FISTULA OF GALLBLADDER

S72135B NONDISP APOPHYSEAL FX LEFT FEMUR INIT FOR OPN FX TYPE I/2

K824 CHOLESTEROLOSIS OF GALLBLADDER

S72135C

NONDISP APOPHYSEAL FX L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K828 OTHER SPECIFIED DISEASES OF GALLBLADDER

S72136A

NONDISPLACED APOPHYSEAL FRACTURE OF UNSP FEMUR INIT

K829 DISEASE OF GALLBLADDER UNSPECIFIED

S72136B

NONDISP APOPHYSEAL FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

K830 CHOLANGITIS

S72136C NONDISP APOPHYSEAL FX UNSP FEMR INIT FOR OPN FX TYPE 3A/B/C

K831 OBSTRUCTION OF BILE DUCT

S72141A DISPLACED INTERTROCHANTERIC FRACTURE OF RIGHT FEMUR INIT

K832 PERFORATION OF BILE DUCT

S72141B DISPLACED INTERTROCH FX R FEMUR INIT FOR OPN FX TYPE I/2

K833 FISTULA OF BILE DUCT

S72141C DISPLACED INTERTROCH FX R FEMUR INIT FOR OPN FX TYPE 3A/B/C

K834 SPASM OF SPHINCTER OF ODDI

S72142A DISPLACED INTERTROCHANTERIC FRACTURE OF LEFT FEMUR INIT

K835 BILIARY CYST

S72142B DISPLACED INTERTROCH FX LEFT FEMUR INIT FOR OPN FX TYPE I/2

K838 OTHER SPECIFIED DISEASES OF BILIARY TRACT

S72142C

DISPLACED INTERTROCH FX L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K839 DISEASE OF BILIARY TRACT UNSPECIFIED

S72143A

DISPLACED INTERTROCHANTERIC FRACTURE OF UNSP FEMUR INIT

K850 IDIOPATHIC ACUTE PANCREATITIS

S72143B

DISPLACED INTERTROCH FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

K8500 Idiopathic acute pancreatitis without necrosis or infection

S72143C

DISPL INTERTROCH FX UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K8501 Idiopathic acute pancreatitis with uninfected necrosis

S72144A

NONDISPLACED INTERTROCHANTERIC FRACTURE OF RIGHT FEMUR INIT

K8502 Idiopathic acute pancreatitis with infected necrosis

S72144B

NONDISP INTERTROCH FX RIGHT FEMUR INIT FOR OPN FX TYPE I/2

K851 BILIARY ACUTE PANCREATITIS

S72144C NONDISP INTERTROCH FX R FEMUR INIT FOR OPN FX TYPE 3A/B/C

K8510 Biliary acute pancreatitis without necrosis or infection

S72145A

NONDISPLACED INTERTROCHANTERIC FRACTURE OF LEFT FEMUR INIT

K8511 Biliary acute pancreatitis with uninfected necrosis

S72145B

NONDISP INTERTROCH FX LEFT FEMUR INIT FOR OPN FX TYPE I/2

K8512 Biliary acute pancreatitis with infected necrosis

S72145C

NONDISP INTERTROCH FX L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K852 ALCOHOL INDUCED ACUTE PANCREATITIS

S72146A

NONDISPLACED INTERTROCHANTERIC FRACTURE OF UNSP FEMUR INIT

K8520

Alcohol induced acute pancreatitis without necrosis or infection

S72146B

NONDISP INTERTROCH FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

K8521

Alcohol induced acute pancreatitis with uninfected necrosis

S72146C

NONDISP INTERTROCH FX UNSP FEMR INIT FOR OPN FX TYPE 3A/B/C

K8522

Alcohol induced acute pancreatitis with infected necrosis

S7221XA

DISPLACED SUBTROCHANTERIC FRACTURE OF RIGHT FEMUR INIT

K853 DRUG INDUCED ACUTE PANCREATITIS

S7221XB

DISPLACED SUBTROCHNT FX R FEMUR INIT FOR OPN FX TYPE I/2

K8530 Drug induced acute pancreatitis without necrosis or infection

S7221XC

DISPLACED SUBTROCHNT FX R FEMUR INIT FOR OPN FX TYPE 3A/B/C

K8531 Drug induced acute pancreatitis with uninfected necrosis

S7222XA

DISPLACED SUBTROCHANTERIC FRACTURE OF LEFT FEMUR INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K8532 Drug induced acute pancreatitis with infected necrosis

S7222XB

DISPLACED SUBTROCHNT FX LEFT FEMUR INIT FOR OPN FX TYPE I/2

K858 OTHER ACUTE PANCREATITIS

S7222XC DISPLACED SUBTROCHNT FX L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K8580 Other acute pancreatitis without necrosis or infection

S7223XA

DISPLACED SUBTROCHANTERIC FRACTURE OF UNSP FEMUR INIT

K8581 Other acute pancreatitis with uninfected necrosis

S7223XB

DISPLACED SUBTROCHNT FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

K8582 Other acute pancreatitis with infected necrosis

S7223XC

DISPL SUBTROCHNT FX UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

K859 ACUTE PANCREATITIS UNSPECIFIED

S7224XA

NONDISPLACED SUBTROCHANTERIC FRACTURE OF RIGHT FEMUR INIT

K8590

Acute pancreatitis without necrosis or infection unspecified

S7224XB

NONDISP SUBTROCHNT FX RIGHT FEMUR INIT FOR OPN FX TYPE I/2

K8591 Acute pancreatitis with uninfected necrosis unspecified

S7224XC

NONDISP SUBTROCHNT FX R FEMUR INIT FOR OPN FX TYPE 3A/B/C

K8592 Acute pancreatitis with infected necrosis unspecified

S7225XA

NONDISPLACED SUBTROCHANTERIC FRACTURE OF LEFT FEMUR INIT

K860 ALCOHOL-INDUCED CHRONIC PANCREATITIS

S7225XB

NONDISP SUBTROCHNT FX LEFT FEMUR INIT FOR OPN FX TYPE I/2

K861 OTHER CHRONIC PANCREATITIS

S7225XC NONDISP SUBTROCHNT FX L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K862 CYST OF PANCREAS

S7226XA NONDISPLACED SUBTROCHANTERIC FRACTURE OF UNSP FEMUR INIT

K863 PSEUDOCYST OF PANCREAS

S7226XB NONDISP SUBTROCHNT FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K868 OTHER SPECIFIED DISEASES OF PANCREAS

S7226XC

NONDISP SUBTROCHNT FX UNSP FEMR INIT FOR OPN FX TYPE 3A/B/C

K8681 Exocrine pancreatic insufficiency

S72301A

UNSP FRACTURE OF SHAFT OF RIGHT FEMUR INIT FOR CLOS FX

K8689 Other specified diseases of pancreas

S72301B

UNSP FX SHAFT OF RIGHT FEMUR INIT FOR OPN FX TYPE I/2

K869 DISEASE OF PANCREAS UNSPECIFIED

S72301C

UNSP FX SHAFT OF RIGHT FEMUR INIT FOR OPN FX TYPE 3A/B/C

K87

DISORD OF GB BILIARY TRAC AND PANCREAS IN DIS CLASSD ELSWHR

S72302A

UNSP FRACTURE OF SHAFT OF LEFT FEMUR INIT FOR CLOS FX

K902 BLIND LOOP SYNDROME NOT ELSEWHERE CLASSIFIED

S72302B

UNSP FX SHAFT OF LEFT FEMUR INIT FOR OPN FX TYPE I/2

K903 PANCREATIC STEATORRHEA

S72302C UNSP FX SHAFT OF LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

K904

MALABSORPTION DUE TO INTOLERANCE NOT ELSEWHERE CLASSIFIED

S72309A

UNSP FRACTURE OF SHAFT OF UNSP FEMUR INIT FOR CLOS FX

K9081 WHIPPLE'S DISEASE

S72309B UNSP FX SHAFT OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

K9089 OTHER INTESTINAL MALABSORPTION

S72309C

UNSP FX SHAFT OF UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

K909 INTESTINAL MALABSORPTION UNSPECIFIED

S72321A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF RIGHT FEMUR INIT

K910 VOMITING FOLLOWING GASTROINTESTINAL SURGERY

S72321B

DISPL TRANSVERSE FX SHAFT OF R FEMR 7THB

K911 POSTGASTRIC SURGERY SYNDROMES

S72321C

DISPL TRANSVERSE FX SHAFT OF R FEMR 7THC

K912

POSTSURGICAL MALABSORPTION NOT ELSEWHERE CLASSIFIED

S72322A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF LEFT FEMUR INIT

K913 POSTPROCEDURAL INTESTINAL OBSTRUCTION

S72322B

DISPL TRANSVERSE FX SHAFT OF L FEMR 7THB

K915 POSTCHOLECYSTECTOMY SYNDROME

S72322C

DISPL TRANSVERSE FX SHAFT OF L FEMR 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K9161

INTRAOP HEMOR/HEMTOM OF DGSTV SYS ORG COMP A DGSTV SYS PROC

S72323A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF UNSP FEMUR INIT

K9162

INTRAOP HEMOR/HEMTOM OF A DGSTV SYS ORG COMP OTH PROCEDURE

S72323B

DISPL TRANSVERSE FX SHAFT OF UNSP FEMR 7THB

K9171

ACCIDENTAL PNCTR & LAC OF A DGSTV SYS ORG DUR DGSTV SYS PROC

S72323C

DISPL TRANSVERSE FX SHAFT OF UNSP FEMR 7THC

K9172

ACC PNCTR & LAC OF A DGSTV SYS ORG DURING OTH PROCEDURE

S72324A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF RIGHT FEMUR INIT

K9181

OTHER INTRAOPERATIVE COMPLICATIONS OF DIGESTIVE SYSTEM

S72324B

NONDISP TRANSVERSE FX SHAFT OF R FEMR 7THB

K9182 POSTPROCEDURAL HEPATIC FAILURE

S72324C

NONDISP TRANSVERSE FX SHAFT OF R FEMR 7THC

K9183 POSTPROCEDURAL HEPATORENAL SYNDROME

S72325A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF LEFT FEMUR INIT

K91840

POSTPROC HEMOR/HEMTOM OF DGSTV SYS ORG FOL A DGSTV SYS PROC

S72325B

NONDISP TRANSVERSE FX SHAFT OF L FEMR 7THB

K91841

POSTPROC HEMOR/HEMTOM OF A DGSTV SYS ORG FOL OTH PROCEDURE

S72325C

NONDISP TRANSVERSE FX SHAFT OF L FEMR 7THC

K91850 POUCHITIS

S72326A NONDISP TRANSVERSE FRACTURE OF SHAFT OF UNSP FEMUR INIT

K91858 OTHER COMPLICATIONS OF INTESTINAL POUCH

S72326B

NONDISP TRANSVERSE FX SHAFT OF UNSP FEMR 7THB

K91870

Postprocedural hematoma of a digestive system organ or structure following a digestive system procedure

S72326C

NONDISP TRANSVERSE FX SHAFT OF UNSP FEMR 7THC

K91871

Postprocedural hematoma of a digestive system organ or structure following other procedure

S72331A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT FEMUR INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K91872

Postprocedural seroma of a digestive system organ or structure following a digestive system procedure

S72331B

DISPL OBLIQUE FX SHAFT OF R FEMUR INIT FOR OPN FX TYPE I/2

K91873

Postprocedural seroma of a digestive system organ or structure following other procedure

S72331C

DISPL OBLIQUE FX SHAFT OF R FEMR 7THC

K9189

OTH POSTPROCEDURAL COMPLICATIONS AND DISORDERS OF DGSTV SYS

S72332A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT FEMUR INIT

K920 HEMATEMESIS

S72332B DISPL OBLIQUE FX SHAFT OF L FEMUR INIT FOR OPN FX TYPE I/2

K921 MELENA

S72332C DISPL OBLIQUE FX SHAFT OF L FEMR 7THC

K922 GASTROINTESTINAL HEMORRHAGE UNSPECIFIED

S72333A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF UNSP FEMUR INIT

K9281 GASTROINTESTINAL MUCOSITIS (ULCERATIVE)

S72333B

DISPL OBLIQUE FX SHAFT OF UNSP FEMR 7THB

K9289 OTHER SPECIFIED DISEASES OF THE DIGESTIVE SYSTEM

S72333C

DISPL OBLIQUE FX SHAFT OF UNSP FEMR 7THC

K929 DISEASE OF DIGESTIVE SYSTEM UNSPECIFIED

S72334A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT FEMUR INIT

K9400 COLOSTOMY COMPLICATION UNSPECIFIED

S72334B

NONDISP OBLIQUE FX SHAFT OF R FEMR INIT FOR OPN FX TYPE I/2

K9401 COLOSTOMY HEMORRHAGE

S72334C NONDISP OBLIQUE FX SHAFT OF R FEMR 7THC

K9402 COLOSTOMY INFECTION

S72335A NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT FEMUR INIT

K9403 COLOSTOMY MALFUNCTION

S72335B NONDISP OBLIQUE FX SHAFT OF L FEMR INIT FOR OPN FX TYPE I/2

K9409 OTHER COMPLICATIONS OF COLOSTOMY

S72335C

NONDISP OBLIQUE FX SHAFT OF L FEMR 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K9410 ENTEROSTOMY COMPLICATION UNSPECIFIED

S72336A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF UNSP FEMUR INIT

K9411 ENTEROSTOMY HEMORRHAGE

S72336B NONDISP OBLIQUE FX SHAFT OF UNSP FEMR 7THB

K9412 ENTEROSTOMY INFECTION

S72336C NONDISP OBLIQUE FX SHAFT OF UNSP FEMR 7THC

K9413 ENTEROSTOMY MALFUNCTION

S72341A DISPLACED SPIRAL FRACTURE OF SHAFT OF RIGHT FEMUR INIT

K9419 OTHER COMPLICATIONS OF ENTEROSTOMY

S72341B

DISPL SPIRAL FX SHAFT OF R FEMUR INIT FOR OPN FX TYPE I/2

K9420 GASTROSTOMY COMPLICATION UNSPECIFIED

S72341C

DISPL SPIRAL FX SHAFT OF R FEMR INIT FOR OPN FX TYPE 3A/B/C

K9421 GASTROSTOMY HEMORRHAGE

S72342A DISPLACED SPIRAL FRACTURE OF SHAFT OF LEFT FEMUR INIT

K9422 GASTROSTOMY INFECTION

S72342B DISPL SPIRAL FX SHAFT OF L FEMUR INIT FOR OPN FX TYPE I/2

K9423 GASTROSTOMY MALFUNCTION

S72342C DISPL SPIRAL FX SHAFT OF L FEMR INIT FOR OPN FX TYPE 3A/B/C

K9429 OTHER COMPLICATIONS OF GASTROSTOMY

S72343A

DISPLACED SPIRAL FRACTURE OF SHAFT OF UNSP FEMUR INIT

K9430 ESOPHAGOSTOMY COMPLICATIONS UNSPECIFIED

S72343B

DISPL SPIRAL FX SHAFT OF UNSP FEMR INIT FOR OPN FX TYPE I/2

K9431 ESOPHAGOSTOMY HEMORRHAGE

S72343C

DISPL SPIRAL FX SHAFT OF UNSP FEMR 7THC

K9432 ESOPHAGOSTOMY INFECTION

S72344A NONDISPLACED SPIRAL FRACTURE OF SHAFT OF RIGHT FEMUR INIT

K9433 ESOPHAGOSTOMY MALFUNCTION

S72344B

NONDISP SPIRAL FX SHAFT OF R FEMUR INIT FOR OPN FX TYPE I/2

K9439 OTHER COMPLICATIONS OF ESOPHAGOSTOMY

S72344C

NONDISP SPIRAL FX SHAFT OF R FEMR 7THC

L00 STAPHYLOCOCCAL SCALDED SKIN SYNDROME

S72345A

NONDISPLACED SPIRAL FRACTURE OF SHAFT OF LEFT FEMUR INIT

L03211 CELLULITIS OF FACE

S72345B NONDISP SPIRAL FX SHAFT OF L FEMUR INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

L03212 ACUTE LYMPHANGITIS OF FACE

S72345C NONDISP SPIRAL FX SHAFT OF L FEMR 7THC

L03213 Periorbital cellulitis

S72346A NONDISPLACED SPIRAL FRACTURE OF SHAFT OF UNSP FEMUR INIT

L03221 CELLULITIS OF NECK

S72346B NONDISP SPIRAL FX SHAFT OF UNSP FEMR 7THB

L03222 ACUTE LYMPHANGITIS OF NECK

S72346C NONDISP SPIRAL FX SHAFT OF UNSP FEMR 7THC

L121 CICATRICIAL PEMPHIGOID

S72351A DISPLACED COMMINUTED FRACTURE OF SHAFT OF RIGHT FEMUR INIT

L490

EXFOLIATN DUE TO ERYTHEMAT COND W < 10 PCT OF BODY SURFACE

S72351B

DISPL COMMNT FX SHAFT OF R FEMUR INIT FOR OPN FX TYPE I/2

L491

EXFOLIATN DUE TO ERYTHEMAT COND W 10-19 PCT OF BODY SURFACE

S72351C

DISPL COMMNT FX SHAFT OF R FEMR INIT FOR OPN FX TYPE 3A/B/C

L492

EXFOLIATN DUE TO ERYTHEMAT COND W 20-29 PCT OF BODY SURFACE

S72352A

DISPLACED COMMINUTED FRACTURE OF SHAFT OF LEFT FEMUR INIT

L493

EXFOLIATN DUE TO ERYTHEMAT COND W 30-39 PCT OF BODY SURFACE

S72352B

DISPL COMMNT FX SHAFT OF L FEMUR INIT FOR OPN FX TYPE I/2

L494

EXFOLIATN DUE TO ERYTHEMAT COND W 40-49 PCT OF BODY SURFACE

S72352C

DISPL COMMNT FX SHAFT OF L FEMR INIT FOR OPN FX TYPE 3A/B/C

L495

EXFOLIATN DUE TO ERYTHEMAT COND W 50-59 PCT OF BODY SURFACE

S72353A

DISPLACED COMMINUTED FRACTURE OF SHAFT OF UNSP FEMUR INIT

L496

EXFOLIATN DUE TO ERYTHEMAT COND W 60-69 PCT OF BODY SURFACE

S72353B

DISPL COMMNT FX SHAFT OF UNSP FEMR INIT FOR OPN FX TYPE I/2

L497

EXFOLIATN DUE TO ERYTHEMAT COND W 70-79 PCT OF BODY SURFACE

S72353C

DISPL COMMNT FX SHAFT OF UNSP FEMR 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

L498

EXFOLIATN DUE TO ERYTHEMAT COND W 80-89 PCT OF BODY SURFACE

S72354A

NONDISP COMMINUTED FRACTURE OF SHAFT OF RIGHT FEMUR INIT

L499

EXFOLIATN D/T ERYTHEMAT COND W 90 OR MORE PCT OF BODY SURFC

S72354B

NONDISP COMMNT FX SHAFT OF R FEMUR INIT FOR OPN FX TYPE I/2

L500 ALLERGIC URTICARIA

S72354C NONDISP COMMNT FX SHAFT OF R FEMR 7THC

L501 IDIOPATHIC URTICARIA

S72355A NONDISP COMMINUTED FRACTURE OF SHAFT OF LEFT FEMUR INIT

L502 URTICARIA DUE TO COLD AND HEAT

S72355B

NONDISP COMMNT FX SHAFT OF L FEMUR INIT FOR OPN FX TYPE I/2

L503 DERMATOGRAPHIC URTICARIA

S72355C NONDISP COMMNT FX SHAFT OF L FEMR 7THC

L504 VIBRATORY URTICARIA

S72356A NONDISP COMMINUTED FRACTURE OF SHAFT OF UNSP FEMUR INIT

L505 CHOLINERGIC URTICARIA

S72356B NONDISP COMMNT FX SHAFT OF UNSP FEMR 7THB

L506 CONTACT URTICARIA

S72356C NONDISP COMMNT FX SHAFT OF UNSP FEMR 7THC

L508 OTHER URTICARIA

S72361A DISPLACED SEGMENTAL FRACTURE OF SHAFT OF RIGHT FEMUR INIT

L509 URTICARIA UNSPECIFIED

S72361B DISPL SEG FX SHAFT OF R FEMUR INIT FOR OPN FX TYPE I/2

L510 NONBULLOUS ERYTHEMA MULTIFORME

S72361C

DISPL SEG FX SHAFT OF R FEMUR INIT FOR OPN FX TYPE 3A/B/C

L511 STEVENS-JOHNSON SYNDROME

S72362A DISPLACED SEGMENTAL FRACTURE OF SHAFT OF LEFT FEMUR INIT

L512 TOXIC EPIDERMAL NECROLYSIS [LYELL]

S72362B

DISPL SEG FX SHAFT OF L FEMUR INIT FOR OPN FX TYPE I/2

L513

STEVENS-JOHNSON SYND-TOX EPDRML NECROLYSIS OVERLAP SYNDROME

S72362C

DISPL SEG FX SHAFT OF L FEMUR INIT FOR OPN FX TYPE 3A/B/C

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

L518 OTHER ERYTHEMA MULTIFORME

S72363A

DISPLACED SEGMENTAL FRACTURE OF SHAFT OF UNSP FEMUR INIT

L519 ERYTHEMA MULTIFORME UNSPECIFIED

S72363B

DISPL SEG FX SHAFT OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

L52 ERYTHEMA NODOSUM

S72363C DISPL SEG FX SHAFT OF UNSP FEMR INIT FOR OPN FX TYPE 3A/B/C

L530 TOXIC ERYTHEMA

S72364A NONDISP SEGMENTAL FRACTURE OF SHAFT OF RIGHT FEMUR INIT

L531 ERYTHEMA ANNULARE CENTRIFUGUM

S72364B

NONDISP SEG FX SHAFT OF R FEMUR INIT FOR OPN FX TYPE I/2

L532 ERYTHEMA MARGINATUM

S72364C NONDISP SEG FX SHAFT OF R FEMUR INIT FOR OPN FX TYPE 3A/B/C

L533 OTHER CHRONIC FIGURATE ERYTHEMA

S72365A

NONDISPLACED SEGMENTAL FRACTURE OF SHAFT OF LEFT FEMUR INIT

L538 OTHER SPECIFIED ERYTHEMATOUS CONDITIONS

S72365B

NONDISP SEG FX SHAFT OF L FEMUR INIT FOR OPN FX TYPE I/2

L539 ERYTHEMATOUS CONDITION UNSPECIFIED

S72365C

NONDISP SEG FX SHAFT OF L FEMUR INIT FOR OPN FX TYPE 3A/B/C

L54 ERYTHEMA IN DISEASES CLASSIFIED ELSEWHERE

S72366A

NONDISPLACED SEGMENTAL FRACTURE OF SHAFT OF UNSP FEMUR INIT

L550 SUNBURN OF FIRST DEGREE

S72366B NONDISP SEG FX SHAFT OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

L551 SUNBURN OF SECOND DEGREE

S72366C NONDISP SEG FX SHAFT OF UNSP FEMR 7THC

L552 SUNBURN OF THIRD DEGREE

S72391A OTH FRACTURE OF SHAFT OF RIGHT FEMUR INIT FOR CLOS FX

L559 SUNBURN UNSPECIFIED

S72391B OTH FX SHAFT OF RIGHT FEMUR INIT FOR OPN FX TYPE I/2

L560 DRUG PHOTOTOXIC RESPONSE

S72391C OTH FX SHAFT OF RIGHT FEMUR INIT FOR OPN FX TYPE 3A/B/C

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

L561 DRUG PHOTOALLERGIC RESPONSE

S72392A

OTH FRACTURE OF SHAFT OF LEFT FEMUR INIT FOR CLOS FX

L562 PHOTOCONTACT DERMATITIS [BERLOQUE DERMATITIS]

S72392B

OTH FX SHAFT OF LEFT FEMUR INIT FOR OPN FX TYPE I/2

L563 SOLAR URTICARIA

S72392C OTH FX SHAFT OF LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

L564 POLYMORPHOUS LIGHT ERUPTION

S72399A

OTH FRACTURE OF SHAFT OF UNSP FEMUR INIT FOR CLOS FX

L565

DISSEMINATED SUPERFICIAL ACTINIC POROKERATOSIS (DSAP)

S72399B

OTH FX SHAFT OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

L568 OTH ACUTE SKIN CHANGES DUE TO ULTRAVIOLET RADIATION

S72399C

OTH FX SHAFT OF UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

L569

ACUTE SKIN CHANGE DUE TO ULTRAVIOLET RADIATION UNSPECIFIED

S72401A

UNSP FRACTURE OF LOWER END OF RIGHT FEMUR INIT FOR CLOS FX

L570 ACTINIC KERATOSIS

S72401B UNSP FX LOWER END OF RIGHT FEMUR INIT FOR OPN FX TYPE I/2

L571 ACTINIC RETICULOID

S72401C UNSP FX LOWER END OF R FEMUR INIT FOR OPN FX TYPE 3A/B/C

L572 CUTIS RHOMBOIDALIS NUCHAE

S72402A UNSP FRACTURE OF LOWER END OF LEFT FEMUR INIT FOR CLOS FX

L573 POIKILODERMA OF CIVATTE

S72402B UNSP FX LOWER END OF LEFT FEMUR INIT FOR OPN FX TYPE I/2

L574 CUTIS LAXA SENILIS

S72402C UNSP FX LOWER END OF LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

L575 ACTINIC GRANULOMA

S72409A UNSP FRACTURE OF LOWER END OF UNSP FEMUR INIT FOR CLOS FX

L578

OTH SKIN CHANGES DUE TO CHR EXPSR TO NONIONIZING RADIATION

S72409B

UNSP FX LOWER END OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

L579

SKIN CHANGES DUE TO CHR EXPSR TO NONIONIZING RADIATION UNSP

S72409C

UNSP FX LOWER END OF UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

L580 ACUTE RADIODERMATITIS

S72411A DISPLACED UNSP CONDYLE FX LOWER END OF RIGHT FEMUR INIT

L581 CHRONIC RADIODERMATITIS

S72411B DISPL UNSP CONDYLE FX LOW END R FEMR 7THB

L589 RADIODERMATITIS UNSPECIFIED

S72411C

DISPL UNSP CONDYLE FX LOW END R FEMR 7THC

L590 ERYTHEMA AB IGNE [DERMATITIS AB IGNE]

S72412A

DISPLACED UNSP CONDYLE FX LOWER END OF LEFT FEMUR INIT

L598 OTH DISRD OF THE SKIN SUBCU RELATED TO RADIATION

S72412B

DISPL UNSP CONDYLE FX LOW END L FEMR 7THB

L599 DISORDER OF THE SKIN SUBCU RELATED TO RADIATION UNSP

S72412C

DISPL UNSP CONDYLE FX LOW END L FEMR 7THC

L7601

INTRAOP HEMOR/HEMTOM OF SKIN SUBCU COMP A DERMATOLOGIC PROC

S72413A

DISPLACED UNSP CONDYLE FX LOWER END OF UNSP FEMUR INIT

L7602

INTRAOP HEMOR/HEMTOM OF SKIN SUBCU COMP OTH PROCEDURE

S72413B

DISPL UNSP CONDYLE FX LOW END UNSP FEMR 7THB

L7611

ACC PNCTR & LAC OF SKIN SUBCU DURING A DERMATOLOGIC PROC

S72413C

DISPL UNSP CONDYLE FX LOW END UNSP FEMR 7THC

L7612

ACCIDENTAL PNCTR & LAC OF SKIN SUBCU DURING OTH PROCEDURE

S72414A

NONDISP UNSP CONDYLE FX LOWER END OF RIGHT FEMUR INIT

L7621

POSTPROC HEMOR/HEMTOM OF SKIN SUBCU FOL A DERMATOLOGIC PROC

S72414B

NONDISP UNSP CONDYLE FX LOW END R FEMR 7THB

L7622

POSTPROC HEMOR/HEMTOM OF SKIN SUBCU FOLLOWING OTH PROCEDURE

S72414C

NONDISP UNSP CONDYLE FX LOW END R FEMR 7THC

L7681

OTH INTRAOPERATIVE COMPLICATIONS OF SKIN SUBCU

S72415A

NONDISP UNSP CONDYLE FX LOWER END OF LEFT FEMUR INIT

L7682

OTH POSTPROCEDURAL COMPLICATIONS OF SKIN SUBCU

S72415B

NONDISP UNSP CONDYLE FX LOW END L FEMR 7THB

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

L88 PYODERMA GANGRENOSUM

S72415C NONDISP UNSP CONDYLE FX LOW END L FEMR 7THC

L97413

NON-PRS CHR ULCER OF RIGHT HEEL AND MIDFOOT W NECROS MUSCLE

S72416A

NONDISP UNSP CONDYLE FX LOWER END OF UNSP FEMUR INIT

L97414

NON-PRS CHR ULCER OF RIGHT HEEL AND MIDFOOT W NECROS BONE

S72416B

NONDISP UNSP CONDYLE FX LOW END UNSP FEMR 7THB

L97419

NON-PRS CHR ULCER OF RIGHT HEEL AND MIDFOOT W UNSP SEVERT

S72416C

NONDISP UNSP CONDYLE FX LOW END UNSP FEMR 7THC

L97423

NON-PRS CHR ULCER OF LEFT HEEL AND MIDFOOT W NECROS MUSCLE

S72421A

DISP FX OF LATERAL CONDYLE OF RIGHT FEMUR INIT FOR CLOS FX

L97424

NON-PRS CHRONIC ULCER OF LEFT HEEL AND MIDFOOT W NECROS BONE

S72421B

DISP FX OF LATERAL CONDYLE OF R FEMR 7THB

L97429

NON-PRS CHRONIC ULCER OF LEFT HEEL AND MIDFOOT W UNSP SEVERT

S72421C

DISP FX OF LATERAL CONDYLE OF R FEMR 7THC

L97503

NON-PRS CHRONIC ULCER OTH PRT UNSP FOOT W NECROSIS OF MUSCLE

S72422A

DISP FX OF LATERAL CONDYLE OF LEFT FEMUR INIT FOR CLOS FX

L97504

NON-PRS CHRONIC ULCER OTH PRT UNSP FOOT W NECROSIS OF BONE

S72422B

DISP FX OF LATERAL CONDYLE OF L FEMR 7THB

L97509

NON-PRESSURE CHRONIC ULCER OTH PRT UNSP FOOT W UNSP SEVERITY

S72422C

DISP FX OF LATERAL CONDYLE OF L FEMR 7THC

L97513

NON-PRS CHRONIC ULCER OTH PRT RIGHT FOOT W NECROS MUSCLE

S72423A

DISP FX OF LATERAL CONDYLE OF UNSP FEMUR INIT FOR CLOS FX

L97514

NON-PRS CHRONIC ULCER OTH PRT RIGHT FOOT W NECROSIS OF BONE

S72423B

DISP FX OF LATERAL CONDYLE OF UNSP FEMR 7THB

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

L97519

NON-PRS CHRONIC ULCER OTH PRT RIGHT FOOT W UNSP SEVERITY

S72423C

DISP FX OF LATERAL CONDYLE OF UNSP FEMR 7THC

L97523

NON-PRS CHRONIC ULCER OTH PRT LEFT FOOT W NECROSIS OF MUSCLE

S72424A

NONDISP FX OF LATERAL CONDYLE OF RIGHT FEMUR INIT

L97524

NON-PRS CHRONIC ULCER OTH PRT LEFT FOOT W NECROSIS OF BONE

S72424B

NONDISP FX OF LATERAL CONDYLE OF R FEMR 7THB

L97529

NON-PRESSURE CHRONIC ULCER OTH PRT LEFT FOOT W UNSP SEVERITY

S72424C

NONDISP FX OF LATERAL CONDYLE OF R FEMR 7THC

L97803

NON-PRS CHRONIC ULCER OTH PRT UNSP LOWER LEG W NECROS MUSCLE

S72425A

NONDISP FX OF LATERAL CONDYLE OF LEFT FEMUR INIT

L97804

NON-PRS CHRONIC ULCER OTH PRT UNSP LOWER LEG W NECROS BONE

S72425B

NONDISP FX OF LATERAL CONDYLE OF L FEMR 7THB

L97809

NON-PRS CHRONIC ULCER OTH PRT UNSP LOWER LEG W UNSP SEVERITY

S72425C

NONDISP FX OF LATERAL CONDYLE OF L FEMR 7THC

L97813

NON-PRS CHRONIC ULCER OTH PRT R LOW LEG W NECROSIS OF MUSCLE

S72426A

NONDISP FX OF LATERAL CONDYLE OF UNSP FEMUR INIT

L97814

NON-PRS CHRONIC ULCER OTH PRT R LOW LEG W NECROSIS OF BONE

S72426B

NONDISP FX OF LATERAL CONDYLE OF UNSP FEMR 7THB

L97823

NON-PRS CHRONIC ULCER OTH PRT L LOW LEG W NECROSIS OF MUSCLE

S72426C

NONDISP FX OF LATERAL CONDYLE OF UNSP FEMR 7THC

L97824

NON-PRS CHRONIC ULCER OTH PRT L LOW LEG W NECROSIS OF BONE

S72431A

DISP FX OF MEDIAL CONDYLE OF RIGHT FEMUR INIT FOR CLOS FX

L97903

NON-PRS CHRONIC ULC UNSP PRT OF UNSP LOW LEG W NECROS MUSCLE

S72431B

DISP FX OF MED CONDYLE OF R FEMUR INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

L97904

NON-PRS CHRONIC ULC UNSP PRT OF UNSP LOWER LEG W NECROS BONE

S72431C

DISP FX OF MED CONDYLE OF R FEMR 7THC

L97913

NON-PRS CHRONIC ULC UNSP PRT OF R LOW LEG W NECROS MUSCLE

S72432A

DISP FX OF MEDIAL CONDYLE OF LEFT FEMUR INIT FOR CLOS FX

L97914

NON-PRS CHRONIC ULC UNSP PRT OF R LOW LEG W NECROSIS OF BONE

S72432B

DISP FX OF MED CONDYLE OF L FEMUR INIT FOR OPN FX TYPE I/2

L97923

NON-PRS CHRONIC ULC UNSP PRT OF L LOW LEG W NECROS MUSCLE

S72432C

DISP FX OF MED CONDYLE OF L FEMR 7THC

L97924

NON-PRS CHRONIC ULC UNSP PRT OF L LOW LEG W NECROSIS OF BONE

S72433A

DISP FX OF MEDIAL CONDYLE OF UNSP FEMUR INIT FOR CLOS FX

L98413

NON-PRESSURE CHRONIC ULCER OF BUTTOCK W NECROSIS OF MUSCLE

S72433B

DISP FX OF MED CONDYLE OF UNSP FEMR 7THB

L98414

NON-PRESSURE CHRONIC ULCER OF BUTTOCK WITH NECROSIS OF BONE

S72433C

DISP FX OF MED CONDYLE OF UNSP FEMR 7THC

L98423

NON-PRESSURE CHRONIC ULCER OF BACK WITH NECROSIS OF MUSCLE

S72434A

NONDISP FX OF MEDIAL CONDYLE OF RIGHT FEMUR INIT

L98424

NON-PRESSURE CHRONIC ULCER OF BACK WITH NECROSIS OF BONE

S72434B

NONDISP FX OF MED CONDYLE OF R FEMR 7THB

L98494

NON-PRS CHRONIC ULCER OF SKIN OF SITES W NECROSIS OF BONE

S72434C

NONDISP FX OF MED CONDYLE OF R FEMR 7THC

M2430 PATHOLOGICAL DISLOCATION OF UNSP JOINT NEC

S72435A

NONDISP FX OF MEDIAL CONDYLE OF LEFT FEMUR INIT FOR CLOS FX

M24311 PATHOLOGICAL DISLOCATION OF RIGHT SHOULDER NEC

S72435B

NONDISP FX OF MED CONDYLE OF L FEMR 7THB

M24312 PATHOLOGICAL DISLOCATION OF LEFT SHOULDER NEC

S72435C

NONDISP FX OF MED CONDYLE OF L FEMR 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M24319 PATHOLOGICAL DISLOCATION OF UNSP SHOULDER NEC

S72436A

NONDISP FX OF MEDIAL CONDYLE OF UNSP FEMUR INIT FOR CLOS FX

M24321 PATHOLOGICAL DISLOCATION OF RIGHT ELBOW NEC

S72436B

NONDISP FX OF MED CONDYLE OF UNSP FEMR 7THB

M24322 PATHOLOGICAL DISLOCATION OF LEFT ELBOW NEC

S72436C

NONDISP FX OF MED CONDYLE OF UNSP FEMR 7THC

M24329 PATHOLOGICAL DISLOCATION OF UNSP ELBOW NEC

S72441A

DISP FX OF LOWER EPIPHYSIS (SEPARATION) OF RIGHT FEMUR INIT

M24331 PATHOLOGICAL DISLOCATION OF RIGHT WRIST NEC

S72441B

DISP FX OF LOW EPIPHY (SEPARATION) OF R FEMR 7THB

M24332 PATHOLOGICAL DISLOCATION OF LEFT WRIST NEC

S72441C

DISP FX OF LOW EPIPHY (SEPARATION) OF R FEMR 7THC

M24339 PATHOLOGICAL DISLOCATION OF UNSP WRIST NEC

S72442A

DISP FX OF LOWER EPIPHYSIS (SEPARATION) OF LEFT FEMUR INIT

M24341 PATHOLOGICAL DISLOCATION OF RIGHT HAND NEC

S72442B

DISP FX OF LOW EPIPHY (SEPARATION) OF L FEMR 7THB

M24342 PATHOLOGICAL DISLOCATION OF LEFT HAND NEC

S72442C

DISP FX OF LOW EPIPHY (SEPARATION) OF L FEMR 7THC

M24349 PATHOLOGICAL DISLOCATION OF UNSP HAND NEC

S72443A

DISP FX OF LOWER EPIPHYSIS (SEPARATION) OF UNSP FEMUR INIT

M24351 PATHOLOGICAL DISLOCATION OF RIGHT HIP NEC

S72443B

DISP FX OF LOW EPIPHY (SEPARATION) OF UNSP FEMR 7THB

M24352 PATHOLOGICAL DISLOCATION OF LEFT HIP NEC

S72443C

DISP FX OF LOW EPIPHY (SEPARATION) OF UNSP FEMR 7THC

M24359 PATHOLOGICAL DISLOCATION OF UNSP HIP NEC

S72444A

NONDISP FX OF LOWER EPIPHYSIS (SEPARATION) OF R FEMUR INIT

M24361 PATHOLOGICAL DISLOCATION OF RIGHT KNEE NEC

S72444B

NONDISP FX OF LOW EPIPHY (SEPARATION) OF R FEMR 7THB

M24362 PATHOLOGICAL DISLOCATION OF LEFT KNEE NEC

S72444C

NONDISP FX OF LOW EPIPHY (SEPARATION) OF R FEMR 7THC

M24369 PATHOLOGICAL DISLOCATION OF UNSP KNEE NEC

S72445A

NONDISP FX OF LOWER EPIPHYSIS (SEPARATION) OF L FEMUR INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M24371 PATHOLOGICAL DISLOCATION OF RIGHT ANKLE NEC

S72445B

NONDISP FX OF LOW EPIPHY (SEPARATION) OF L FEMR 7THB

M24372 PATHOLOGICAL DISLOCATION OF LEFT ANKLE NEC

S72445C

NONDISP FX OF LOW EPIPHY (SEPARATION) OF L FEMR 7THC

M24373 PATHOLOGICAL DISLOCATION OF UNSP ANKLE NEC

S72446A

NONDISP FX OF LOWER EPIPHY (SEPARATION) OF UNSP FEMUR INIT

M24374 PATHOLOGICAL DISLOCATION OF RIGHT FOOT NEC

S72446B

NONDISP FX OF LOW EPIPHY (SEPARATION) OF UNSP FEMR 7THB

M24375 PATHOLOGICAL DISLOCATION OF LEFT FOOT NEC

S72446C

NONDISP FX OF LOW EPIPHY (SEPARATION) OF UNSP FEMR 7THC

M24376 PATHOLOGICAL DISLOCATION OF UNSP FOOT NEC

S72451A

DISPL SUPRCNDL FX W/O INTRCNDL EXTN LOWER END R FEMUR INIT

M310 HYPERSENSITIVITY ANGIITIS

S72451B DISPL SUPRCNDL FX W/O INTRCNDL EXTN LOW END R FEMR 7THB

M311 THROMBOTIC MICROANGIOPATHY

S72451C

DISPL SUPRCNDL FX W/O INTRCNDL EXTN LOW END R FEMR 7THC

M312 LETHAL MIDLINE GRANULOMA

S72452A DISPL SUPRCNDL FX W/O INTRCNDL EXTN LOWER END L FEMUR INIT

M314 AORTIC ARCH SYNDROME [TAKAYASU]

S72452B

DISPL SUPRCNDL FX W/O INTRCNDL EXTN LOW END L FEMR 7THB

M318 OTHER SPECIFIED NECROTIZING VASCULOPATHIES

S72452C

DISPL SUPRCNDL FX W/O INTRCNDL EXTN LOW END L FEMR 7THC

M319 NECROTIZING VASCULOPATHY UNSPECIFIED

S72453A

DISPL SUPRCNDL FX W/O INTRCNDL EXTN LOW END UNSP FEMR INIT

M3211 ENDOCARDITIS IN SYSTEMIC LUPUS ERYTHEMATOSUS

S72453B

DISPL SUPRCNDL FX W/O INTRCNDL EXTN LOW END UNSP FEMR 7THB

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M3212 PERICARDITIS IN SYSTEMIC LUPUS ERYTHEMATOSUS

S72453C

DISPL SUPRCNDL FX W/O INTRCNDL EXTN LOW END UNSP FEMR 7THC

M3213

LUNG INVOLVEMENT IN SYSTEMIC LUPUS ERYTHEMATOSUS

S72454A

NONDISP SUPRCNDL FX W/O INTRCNDL EXTN LOWER END R FEMR INIT

M3214

GLOMERULAR DISEASE IN SYSTEMIC LUPUS ERYTHEMATOSUS

S72454B

NONDISP SUPRCNDL FX W/O INTRCNDL EXTN LOW END R FEMR 7THB

M3215

TUBULO-INTERSTITIAL NEUROPATH IN SYS LUPUS ERYTHEMATOSUS

S72454C

NONDISP SUPRCNDL FX W/O INTRCNDL EXTN LOW END R FEMR 7THC

M3219

OTH ORGAN OR SYSTEM INVOLV IN SYSTEMIC LUPUS ERYTHEMATOSUS

S72455A

NONDISP SUPRCNDL FX W/O INTRCNDL EXTN LOWER END L FEMR INIT

M328 OTHER FORMS OF SYSTEMIC LUPUS ERYTHEMATOSUS

S72455B

NONDISP SUPRCNDL FX W/O INTRCNDL EXTN LOW END L FEMR 7THB

M329 SYSTEMIC LUPUS ERYTHEMATOSUS UNSPECIFIED

S72455C

NONDISP SUPRCNDL FX W/O INTRCNDL EXTN LOW END L FEMR 7THC

M4830 TRAUMATIC SPONDYLOPATHY SITE UNSPECIFIED

S72456A

NONDISP SUPRCNDL FX W/O INTRCNDL EXTN LOW END UNSP FEMRINIT

M4831

TRAUMATIC SPONDYLOPATHY OCCIPITO-ATLANTO-AXIAL REGION

S72456B

NONDISP SUPRCNDL FX W/O INTRCNDL EXTN LOW END UNSP FEMR7THB

M4832 TRAUMATIC SPONDYLOPATHY CERVICAL REGION

S72456C

NONDISP SUPRCNDL FX W/O INTRCNDL EXTN LOW END UNSP FEMR7THC

M4833 TRAUMATIC SPONDYLOPATHY CERVICOTHORACIC REGION

S72461A

DISPL SUPRCNDL FX W INTRCNDL EXTN LOWER END OF R FEMUR INIT

M4834 TRAUMATIC SPONDYLOPATHY THORACIC REGION

S72461B

DISPL SUPRCNDL FX W INTRCNDL EXTN LOW END R FEMR 7THB

M4835 TRAUMATIC SPONDYLOPATHY THORACOLUMBAR REGION

S72461C

DISPL SUPRCNDL FX W INTRCNDL EXTN LOW END R FEMR 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M4836 TRAUMATIC SPONDYLOPATHY LUMBAR REGION

S72462A

DISPL SUPRCNDL FX W INTRCNDL EXTN LOWER END OF L FEMUR INIT

M4837 TRAUMATIC SPONDYLOPATHY LUMBOSACRAL REGION

S72462B

DISPL SUPRCNDL FX W INTRCNDL EXTN LOW END L FEMR 7THB

M4838

TRAUMATIC SPONDYLOPATHY SACRAL AND SACROCOCCYGEAL REGION

S72462C

DISPL SUPRCNDL FX W INTRCNDL EXTN LOW END L FEMR 7THC

M4840XA

FATIGUE FRACTURE OF VERTEBRA SITE UNSP INIT FOR FX

S72463A

DISPL SUPRCNDL FX W INTRCNDL EXTN LOWER END UNSP FEMUR INIT

M4841XA

FATIGUE FRACTURE OF VERTEBRA OCCIPT-ATLAN-AX REGION INIT

S72463B

DISPL SUPRCNDL FX W INTRCNDL EXTN LOW END UNSP FEMR 7THB

M4842XA

FATIGUE FRACTURE OF VERTEBRA CERVICAL REGION INIT FOR FX

S72463C

DISPL SUPRCNDL FX W INTRCNDL EXTN LOW END UNSP FEMR 7THC

M4843XA

FATIGUE FRACTURE OF VERTEBRA CERVICOTHORACIC REGION INIT

S72464A

NONDISP SUPRCNDL FX W INTRCNDL EXTN LOWER END R FEMUR INIT

M4844XA

FATIGUE FRACTURE OF VERTEBRA THORACIC REGION INIT FOR FX

S72464B

NONDISP SUPRCNDL FX W INTRCNDL EXTN LOW END R FEMR 7THB

M4845XA

FATIGUE FRACTURE OF VERTEBRA THORACOLUMBAR REGION INIT

S72464C

NONDISP SUPRCNDL FX W INTRCNDL EXTN LOW END R FEMR 7THC

M4846XA

FATIGUE FRACTURE OF VERTEBRA LUMBAR REGION INIT FOR FX

S72465A

NONDISP SUPRCNDL FX W INTRCNDL EXTN LOWER END L FEMUR INIT

M4847XA

FATIGUE FRACTURE OF VERTEBRA LUMBOSACRAL REGION INIT

S72465B

NONDISP SUPRCNDL FX W INTRCNDL EXTN LOW END L FEMR 7THB

M4848XA

FATIGUE FRACTURE OF VERTEBRA SACR/SACROCYGL REGION INIT

S72465C

NONDISP SUPRCNDL FX W INTRCNDL EXTN LOW END L FEMR 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M4850XA COLLAPSED VERTEBRA NEC SITE UNSP INIT

S72466A

NONDISP SUPRCNDL FX W INTRCNDL EXTN LOW END UNSP FEMR INIT

M4851XA

COLLAPSED VERTEBRA NEC OCCIPITO-ATLANTO-AXIAL REGION INIT

S72466B

NONDISP SUPRCNDL FX W INTRCNDL EXTN LOW END UNSP FEMR 7THB

M4852XA COLLAPSED VERTEBRA NEC CERVICAL REGION INIT

S72466C

NONDISP SUPRCNDL FX W INTRCNDL EXTN LOW END UNSP FEMR 7THC

M4853XA COLLAPSED VERTEBRA NEC CERVICOTHORACIC REGION INIT

S72471A

TORUS FRACTURE OF LOWER END OF RIGHT FEMUR INIT FOR CLOS FX

M4854XA COLLAPSED VERTEBRA NEC THORACIC REGION INIT

S72472A

TORUS FRACTURE OF LOWER END OF LEFT FEMUR INIT FOR CLOS FX

M4855XA COLLAPSED VERTEBRA NEC THORACOLUMBAR REGION INIT

S72479A

TORUS FRACTURE OF LOWER END OF UNSP FEMUR INIT FOR CLOS FX

M4856XA COLLAPSED VERTEBRA NEC LUMBAR REGION INIT

S72491A

OTH FRACTURE OF LOWER END OF RIGHT FEMUR INIT FOR CLOS FX

M4857XA COLLAPSED VERTEBRA NEC LUMBOSACRAL REGION INIT

S72491B

OTH FX LOWER END OF RIGHT FEMUR INIT FOR OPN FX TYPE I/2

M4858XA COLLAPSED VERTEBRA NEC SACR/SACROCYGL REGION INIT

S72491C

OTH FX LOWER END OF RIGHT FEMUR INIT FOR OPN FX TYPE 3A/B/C

M5001

CERVICAL DISC DISORDER W MYELOPATHY HIGH CERVICAL REGION

S72492A

OTH FRACTURE OF LOWER END OF LEFT FEMUR INIT FOR CLOS FX

M5002

CERVICAL DISC DISORDER WITH MYELOPATHY MID-CERVICAL REGION

S72492B

OTH FX LOWER END OF LEFT FEMUR INIT FOR OPN FX TYPE I/2

M50020

Cervical disc disorder with myelopathy mid-cervical region unspecified level

S72492C

OTH FX LOWER END OF LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

M50021 Cervical disc disorder at C4-C5 level with myelopathy

S72499A

OTH FRACTURE OF LOWER END OF UNSP FEMUR INIT FOR CLOS FX

M50022 Cervical disc disorder at C5-C6 level with myelopathy

S72499B

OTH FX LOWER END OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M50023 Cervical disc disorder at C6-C7 level with myelopathy

S72499C

OTH FX LOWER END OF UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

M5003

CERVICAL DISC DISORDER W MYELOPATHY CERVICOTHORACIC REGION

S728X1A

OTH FRACTURE OF RIGHT FEMUR INIT ENCNTR FOR CLOSED FRACTURE

M5010

CERVICAL DISC DISORDER W RADICULOPATHY UNSP CERVICAL REGION

S728X1B

OTH FRACTURE OF RIGHT FEMUR INIT FOR OPN FX TYPE I/2

M5011

CERV DISC DISORDER W RADICULOPATHY HIGH CERVICAL REGION

S728X1C

OTH FRACTURE OF RIGHT FEMUR INIT FOR OPN FX TYPE 3A/B/C

M5012

CERVICAL DISC DISORDER W RADICULOPATHY MID-CERVICAL REGION

S728X2A

OTH FRACTURE OF LEFT FEMUR INIT ENCNTR FOR CLOSED FRACTURE

M50120 Mid-cervical disc disorder unspecified

S728X2B

OTH FRACTURE OF LEFT FEMUR INIT FOR OPN FX TYPE I/2

M50121 Cervical disc disorder at C4-C5 level with radiculopathy

S728X2C

OTH FRACTURE OF LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

M50122 Cervical disc disorder at C5-C6 level with radiculopathy

S728X9A

OTH FRACTURE OF UNSP FEMUR INIT ENCNTR FOR CLOSED FRACTURE

M50123 Cervical disc disorder at C6-C7 level with radiculopathy

S728X9B

OTH FRACTURE OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

M5013

CERVICAL DISC DISORDER W RADICULOPATHY CERVICOTHOR REGION

S728X9C

OTH FRACTURE OF UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

M5020

OTHER CERVICAL DISC DISPLACEMENT UNSP CERVICAL REGION

S7290XA

UNSP FRACTURE OF UNSP FEMUR INIT ENCNTR FOR CLOSED FRACTURE

M5021

OTHER CERVICAL DISC DISPLACEMENT HIGH CERVICAL REGION

S7290XB

UNSP FRACTURE OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

M5022

OTHER CERVICAL DISC DISPLACEMENT MID-CERVICAL REGION

S7290XC

UNSP FRACTURE OF UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M50220

Other cervical disc displacement mid-cervical region unspecified level

S7291XA

UNSP FRACTURE OF RIGHT FEMUR INIT FOR CLOS FX

M50221 Other cervical disc displacement at C4-C5 level

S7291XB

UNSP FRACTURE OF RIGHT FEMUR INIT FOR OPN FX TYPE I/2

M50222 Other cervical disc displacement at C5-C6 level

S7291XC

UNSP FRACTURE OF RIGHT FEMUR INIT FOR OPN FX TYPE 3A/B/C

M50223 Other cervical disc displacement at C6-C7 level

S7292XA

UNSP FRACTURE OF LEFT FEMUR INIT ENCNTR FOR CLOSED FRACTURE

M5023

OTHER CERVICAL DISC DISPLACEMENT CERVICOTHORACIC REGION

S7292XB

UNSP FRACTURE OF LEFT FEMUR INIT FOR OPN FX TYPE I/2

M5030

OTHER CERVICAL DISC DEGENERATION UNSP CERVICAL REGION

S7292XC

UNSP FRACTURE OF LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

M5031

OTHER CERVICAL DISC DEGENERATION HIGH CERVICAL REGION

S73001A

UNSPECIFIED SUBLUXATION OF RIGHT HIP INITIAL ENCOUNTER

M5032

OTHER CERVICAL DISC DEGENERATION MID-CERVICAL REGION

S73002A

UNSPECIFIED SUBLUXATION OF LEFT HIP INITIAL ENCOUNTER

M50320

Other cervical disc degeneration mid-cervical region unspecified level

S73003A

UNSPECIFIED SUBLUXATION OF UNSPECIFIED HIP INIT ENCNTR

M50321 Other cervical disc degeneration at C4-C5 level

S73004A

UNSPECIFIED DISLOCATION OF RIGHT HIP INITIAL ENCOUNTER

M50322 Other cervical disc degeneration at C5-C6 level

S73005A

UNSPECIFIED DISLOCATION OF LEFT HIP INITIAL ENCOUNTER

M50323 Other cervical disc degeneration at C6-C7 level

S73006A

UNSPECIFIED DISLOCATION OF UNSPECIFIED HIP INIT ENCNTR

M5033

OTHER CERVICAL DISC DEGENERATION CERVICOTHORACIC REGION

S73011A

POSTERIOR SUBLUXATION OF RIGHT HIP INITIAL ENCOUNTER

M5080

OTHER CERVICAL DISC DISORDERS UNSPECIFIED CERVICAL REGION

S73012A

POSTERIOR SUBLUXATION OF LEFT HIP INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M5081

OTHER CERVICAL DISC DISORDERS HIGH CERVICAL REGION

S73013A

POSTERIOR SUBLUXATION OF UNSPECIFIED HIP INITIAL ENCOUNTER

M5082

OTHER CERVICAL DISC DISORDERS MID-CERVICAL REGION

S73014A

POSTERIOR DISLOCATION OF RIGHT HIP INITIAL ENCOUNTER

M50820

Other cervical disc disorders mid-cervical region unspecified level

S73015A

POSTERIOR DISLOCATION OF LEFT HIP INITIAL ENCOUNTER

M50821 Other cervical disc disorders at C4-C5 level

S73016A

POSTERIOR DISLOCATION OF UNSPECIFIED HIP INITIAL ENCOUNTER

M50822 Other cervical disc disorders at C5-C6 level

S73021A

OBTURATOR SUBLUXATION OF RIGHT HIP INITIAL ENCOUNTER

M50823 Other cervical disc disorders at C6-C7 level

S73022A

OBTURATOR SUBLUXATION OF LEFT HIP INITIAL ENCOUNTER

M5083

OTHER CERVICAL DISC DISORDERS CERVICOTHORACIC REGION

S73023A

OBTURATOR SUBLUXATION OF UNSPECIFIED HIP INITIAL ENCOUNTER

M5090 CERVICAL DISC DISORDER UNSP UNSPECIFIED CERVICAL REGION

S73024A

OBTURATOR DISLOCATION OF RIGHT HIP INITIAL ENCOUNTER

M5091

CERVICAL DISC DISORDER UNSPECIFIED HIGH CERVICAL REGION

S73025A

OBTURATOR DISLOCATION OF LEFT HIP INITIAL ENCOUNTER

M5092

CERVICAL DISC DISORDER UNSPECIFIED MID-CERVICAL REGION

S73026A

OBTURATOR DISLOCATION OF UNSPECIFIED HIP INITIAL ENCOUNTER

M50920

Unspecified cervical disc disorder mid-cervical region unspecified level

S73031A

OTHER ANTERIOR SUBLUXATION OF RIGHT HIP INITIAL ENCOUNTER

M50921 Unspecified cervical disc disorder at C4-C5 level

S73032A

OTHER ANTERIOR SUBLUXATION OF LEFT HIP INITIAL ENCOUNTER

M50922 Unspecified cervical disc disorder at C5-C6 level

S73033A

OTHER ANTERIOR SUBLUXATION OF UNSPECIFIED HIP INIT ENCNTR

M50923 Unspecified cervical disc disorder at C6-C7 level

S73034A

OTHER ANTERIOR DISLOCATION OF RIGHT HIP INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M5093

CERVICAL DISC DISORDER UNSPECIFIED CERVICOTHORACIC REGION

S73035A

OTHER ANTERIOR DISLOCATION OF LEFT HIP INITIAL ENCOUNTER

M5104

INTERVERTEBRAL DISC DISORDERS W MYELOPATHY THORACIC REGION

S73036A

OTHER ANTERIOR DISLOCATION OF UNSPECIFIED HIP INIT ENCNTR

M5105

INTVRT DISC DISORDERS W MYELOPATHY THORACOLUMBAR REGION

S73041A

CENTRAL SUBLUXATION OF RIGHT HIP INITIAL ENCOUNTER

M5106

INTERVERTEBRAL DISC DISORDERS WITH MYELOPATHY LUMBAR REGION

S73042A

CENTRAL SUBLUXATION OF LEFT HIP INITIAL ENCOUNTER

M5114

INTVRT DISC DISORDERS W RADICULOPATHY THORACIC REGION

S73043A

CENTRAL SUBLUXATION OF UNSPECIFIED HIP INITIAL ENCOUNTER

M5115

INTVRT DISC DISORDERS W RADICULOPATHY THORACOLUMBAR REGION

S73044A

CENTRAL DISLOCATION OF RIGHT HIP INITIAL ENCOUNTER

M5116

INTERVERTEBRAL DISC DISORDERS W RADICULOPATHY LUMBAR REGION

S73045A

CENTRAL DISLOCATION OF LEFT HIP INITIAL ENCOUNTER

M5117

INTVRT DISC DISORDERS W RADICULOPATHY LUMBOSACRAL REGION

S73046A

CENTRAL DISLOCATION OF UNSPECIFIED HIP INITIAL ENCOUNTER

M5124

OTHER INTERVERTEBRAL DISC DISPLACEMENT THORACIC REGION

S73111A

ILIOFEMORAL LIGAMENT SPRAIN OF RIGHT HIP INITIAL ENCOUNTER

M5125

OTHER INTERVERTEBRAL DISC DISPLACEMENT THORACOLUMBAR REGION

S73112A

ILIOFEMORAL LIGAMENT SPRAIN OF LEFT HIP INITIAL ENCOUNTER

M5126

OTHER INTERVERTEBRAL DISC DISPLACEMENT LUMBAR REGION

S73119A

ILIOFEMORAL LIGAMENT SPRAIN OF UNSPECIFIED HIP INIT ENCNTR

M5127

OTHER INTERVERTEBRAL DISC DISPLACEMENT LUMBOSACRAL REGION

S73121A

ISCHIOCAPSULAR LIGAMENT SPRAIN OF RIGHT HIP INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M5134

OTHER INTERVERTEBRAL DISC DEGENERATION THORACIC REGION

S73122A

ISCHIOCAPSULAR LIGAMENT SPRAIN OF LEFT HIP INIT ENCNTR

M5135

OTHER INTERVERTEBRAL DISC DEGENERATION THORACOLUMBAR REGION

S73129A

ISCHIOCAPSULAR LIGAMENT SPRAIN OF UNSP HIP INIT ENCNTR

M5136

OTHER INTERVERTEBRAL DISC DEGENERATION LUMBAR REGION

S73191A

OTHER SPRAIN OF RIGHT HIP INITIAL ENCOUNTER

M5137

OTHER INTERVERTEBRAL DISC DEGENERATION LUMBOSACRAL REGION

S73192A

OTHER SPRAIN OF LEFT HIP INITIAL ENCOUNTER

M5144 SCHMORL'S NODES THORACIC REGION

S73199A

OTHER SPRAIN OF UNSPECIFIED HIP INITIAL ENCOUNTER

M5145 SCHMORL'S NODES THORACOLUMBAR REGION

S7400XA

INJURY OF SCIATIC NRV AT HIP AND THIGH LEVEL UNSP LEG INIT

M5146 SCHMORL'S NODES LUMBAR REGION

S7401XA

INJURY OF SCIATIC NRV AT HIP AND THI LEV RIGHT LEG INIT

M5147 SCHMORL'S NODES LUMBOSACRAL REGION

S7402XA

INJURY OF SCIATIC NRV AT HIP AND THIGH LEVEL LEFT LEG INIT

M5184 OTHER INTERVERTEBRAL DISC DISORDERS THORACIC REGION

S7410XA

INJURY OF FEMORAL NRV AT HIP AND THIGH LEVEL UNSP LEG INIT

M5185

OTHER INTERVERTEBRAL DISC DISORDERS THORACOLUMBAR REGION

S7411XA

INJURY OF FEMORAL NRV AT HIP AND THI LEV RIGHT LEG INIT

M5186 OTHER INTERVERTEBRAL DISC DISORDERS LUMBAR REGION

S7412XA

INJURY OF FEMORAL NRV AT HIP AND THIGH LEVEL LEFT LEG INIT

M5187

OTHER INTERVERTEBRAL DISC DISORDERS LUMBOSACRAL REGION

S7420XA

INJ CUTAN SENSORY NERVE AT HIP AND THI LEV UNSP LEG INIT

M519

UNSP THORACIC THORACOLUM AND LUMBOSACR INTVRT DISC DISORDER

S7421XA

INJ CUTAN SENS NERVE AT HIP AND HIGH LEVEL RIGHT LEG INIT

M530 CERVICOCRANIAL SYNDROME

S7422XA INJ CUTAN SENSORY NERVE AT HIP AND THI LEV LEFT LEG INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M531 CERVICOBRACHIAL SYNDROME

S748X1A INJURY OF OTH NERVES AT HIP AND THIGH LEVEL RIGHT LEG INIT

M532X1 SPINAL INSTABILITIES OCCIPITO-ATLANTO-AXIAL REGION

S748X2A

INJURY OF OTH NERVES AT HIP AND THIGH LEVEL LEFT LEG INIT

M532X2 SPINAL INSTABILITIES CERVICAL REGION

S748X9A

INJURY OF OTH NERVES AT HIP AND THIGH LEVEL UNSP LEG INIT

M532X3 SPINAL INSTABILITIES CERVICOTHORACIC REGION

S7490XA

INJURY OF UNSP NERVE AT HIP AND THIGH LEVEL UNSP LEG INIT

M532X4 SPINAL INSTABILITIES THORACIC REGION

S7491XA

INJURY OF UNSP NERVE AT HIP AND THIGH LEVEL RIGHT LEG INIT

M532X5 SPINAL INSTABILITIES THORACOLUMBAR REGION

S7492XA

INJURY OF UNSP NERVE AT HIP AND THIGH LEVEL LEFT LEG INIT

M532X6 SPINAL INSTABILITIES LUMBAR REGION

S75011A

MINOR LACERATION OF FEMORAL ARTERY RIGHT LEG INIT ENCNTR

M532X7 SPINAL INSTABILITIES LUMBOSACRAL REGION

S75012A

MINOR LACERATION OF FEMORAL ARTERY LEFT LEG INIT ENCNTR

M532X8

SPINAL INSTABILITIES SACRAL AND SACROCOCCYGEAL REGION

S75019A

MINOR LACERATION OF FEMORAL ARTERY UNSP LEG INIT ENCNTR

M532X9 SPINAL INSTABILITIES SITE UNSPECIFIED

S75021A

MAJOR LACERATION OF FEMORAL ARTERY RIGHT LEG INIT ENCNTR

M533 SACROCOCCYGEAL DISORDERS NOT ELSEWHERE CLASSIFIED

S75022A

MAJOR LACERATION OF FEMORAL ARTERY LEFT LEG INIT ENCNTR

M5380

OTHER SPECIFIED DORSOPATHIES SITE UNSPECIFIED

S75029A

MAJOR LACERATION OF FEMORAL ARTERY UNSP LEG INIT ENCNTR

M5381

OTHER SPECIFIED DORSOPATHIES OCCIPITO-ATLANTO-AXIAL REGION

S75111A

MINOR LACERAT FEMOR VEIN AT HIP AND THI LEV RIGHT LEG INIT

M5382

OTHER SPECIFIED DORSOPATHIES CERVICAL REGION

S75112A

MINOR LACERAT FEMOR VEIN AT HIP AND THI LEV LEFT LEG INIT

M5383

OTHER SPECIFIED DORSOPATHIES CERVICOTHORACIC REGION

S75119A

MINOR LACERAT FEMOR VEIN AT HIP AND THI LEV UNSP LEG INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M5384

OTHER SPECIFIED DORSOPATHIES THORACIC REGION

S75121A

MAJOR LACERAT FEMOR VEIN AT HIP AND THI LEV RIGHT LEG INIT

M5385

OTHER SPECIFIED DORSOPATHIES THORACOLUMBAR REGION

S75122A

MAJOR LACERAT FEMOR VEIN AT HIP AND THI LEV LEFT LEG INIT

M5386

OTHER SPECIFIED DORSOPATHIES LUMBAR REGION

S75129A

MAJOR LACERAT FEMOR VEIN AT HIP AND THI LEV UNSP LEG INIT

M5387

OTHER SPECIFIED DORSOPATHIES LUMBOSACRAL REGION

S75211A

MINOR LACERAT GREAT SAPH AT HIP AND THI LEV RIGHT LEG INIT

M5388

OTH DORSOPATHIES SACRAL AND SACROCOCCYGEAL REGION

S75212A

MINOR LACERAT GREAT SAPH AT HIP AND THI LEV LEFT LEG INIT

M539 DORSOPATHY UNSPECIFIED

S75219A MINOR LACERAT GREAT SAPH AT HIP AND THI LEV UNSP LEG INIT

M62212

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE LEFT SHOULDER

S75221A

MAJOR LACERAT GREAT SAPH AT HIP AND THI LEV RIGHT LEG INIT

M62219

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE UNSP SHOULDER

S75222A

MAJOR LACERAT GREAT SAPH AT HIP AND THI LEV LEFT LEG INIT

M62221

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE RIGHT UPPER ARM

S75229A

MAJOR LACERAT GREAT SAPH AT HIP AND THI LEV UNSP LEG INIT

M62222

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE LEFT UPPER ARM

S75811A

LACERAT BLOOD VESSELS AT HIP AND THI LEV RIGHT LEG INIT

M62229

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE UNSP UPPER ARM

S75812A

LACERAT BLOOD VESSELS AT HIP AND THIGH LEVEL LEFT LEG INIT

M62231

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE RIGHT FOREARM

S75819A

LACERAT BLOOD VESSELS AT HIP AND THIGH LEVEL UNSP LEG INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M62232

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE LEFT FOREARM

S75911A

LACERAT UNSP BLOOD VESS AT HIP AND THI LEV RIGHT LEG INIT

M62239

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE UNSP FOREARM

S75912A

LACERAT UNSP BLOOD VESS AT HIP AND THI LEV LEFT LEG INIT

M62241

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE RIGHT HAND

S75919A

LACERAT UNSP BLOOD VESS AT HIP AND THI LEV UNSP LEG INIT

M62242

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE LEFT HAND

S76011A

STRAIN OF MUSCLE FASCIA AND TENDON OF RIGHT HIP INIT

M62249

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE UNSPECIFIED HAND

S76012A

STRAIN OF MUSCLE FASCIA AND TENDON OF LEFT HIP INIT ENCNTR

M62251

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE RIGHT THIGH

S76019A

STRAIN OF MUSCLE FASCIA AND TENDON OF UNSP HIP INIT ENCNTR

M62252

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE LEFT THIGH

S76021A

LACERATION OF MUSCLE FASCIA AND TENDON OF RIGHT HIP INIT

M62259

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE UNSP THIGH

S76022A

LACERATION OF MUSCLE FASCIA AND TENDON OF LEFT HIP INIT

M62261

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE RIGHT LOWER LEG

S76029A

LACERATION OF MUSCLE FASCIA AND TENDON OF UNSP HIP INIT

M62262

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE LEFT LOWER LEG

S76111A

STRAIN OF RIGHT QUADRICEPS MUSCLE FASCIA AND TENDON INIT

M62269

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE UNSP LOWER LEG

S76112A

STRAIN OF LEFT QUADRICEPS MUSCLE FASCIA AND TENDON INIT

M62271

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE RIGHT ANK/FT

S76119A

STRAIN OF UNSP QUADRICEPS MUSCLE FASCIA AND TENDON INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M62272

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE LEFT ANK/FT

S76121A

LACERATION OF RIGHT QUADRICEPS MUSC/FASC/TEND INIT

M62279

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE UNSP ANK/FT

S76122A

LACERATION OF LEFT QUADRICEPS MUSC/FASC/TEND INIT

M6228

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE OTHER SITE

S76129A

LACERATION OF UNSP QUADRICEPS MUSC/FASC/TEND INIT

M660 RUPTURE OF POPLITEAL CYST

S76211A STRAIN OF ADDUCTOR MUSC/FASC/TEND RIGHT THIGH INIT

M6610 RUPTURE OF SYNOVIUM UNSPECIFIED JOINT

S76212A

STRAIN OF ADDUCTOR MUSC/FASC/TEND LEFT THIGH INIT

M66111 RUPTURE OF SYNOVIUM RIGHT SHOULDER

S76219A

STRAIN OF ADDUCTOR MUSC/FASC/TEND UNSP THIGH INIT

M66112 RUPTURE OF SYNOVIUM LEFT SHOULDER

S76221A

LACERATION OF ADDUCTOR MUSC/FASC/TEND RIGHT THIGH INIT

M66119 RUPTURE OF SYNOVIUM UNSPECIFIED SHOULDER

S76222A

LACERATION OF ADDUCTOR MUSC/FASC/TEND LEFT THIGH INIT

M66121 RUPTURE OF SYNOVIUM RIGHT ELBOW

S76229A

LACERATION OF ADDUCTOR MUSC/FASC/TEND UNSP THIGH INIT

M66122 RUPTURE OF SYNOVIUM LEFT ELBOW

S76311A

STRAIN MSL/FASC/TND POST GRP AT THI LEV RIGHT THIGH INIT

M66129 RUPTURE OF SYNOVIUM UNSPECIFIED ELBOW

S76312A

STRAIN OF MSL/FASC/TND POST GRP AT THI LEV LEFT THIGH INIT

M66131 RUPTURE OF SYNOVIUM RIGHT WRIST

S76319A

STRAIN OF MSL/FASC/TND POST GRP AT THI LEV UNSP THIGH INIT

M66132 RUPTURE OF SYNOVIUM LEFT WRIST

S76321A

LACERAT MSL/FASC/TND POST GRP AT THI LEV RIGHT THIGH INIT

M66139 RUPTURE OF SYNOVIUM UNSPECIFIED WRIST

S76322A

LACERAT MSL/FASC/TND POST GRP AT THI LEV LEFT THIGH INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M66141 RUPTURE OF SYNOVIUM RIGHT HAND

S76329A

LACERAT MSL/FASC/TND POST GRP AT THI LEV UNSP THIGH INIT

M66142 RUPTURE OF SYNOVIUM LEFT HAND

S76811A

STRAIN OF MUSC/FASC/TEND AT THIGH LEVEL RIGHT THIGH INIT

M66143 RUPTURE OF SYNOVIUM UNSPECIFIED HAND

S76812A

STRAIN OF MUSC/FASC/TEND AT THIGH LEVEL LEFT THIGH INIT

M66144 RUPTURE OF SYNOVIUM RIGHT FINGER(S)

S76819A

STRAIN OF MUSC/FASC/TEND AT THIGH LEVEL UNSP THIGH INIT

M66145 RUPTURE OF SYNOVIUM LEFT FINGER(S)

S76821A

LACERAT MUSC/FASC/TEND AT THIGH LEVEL RIGHT THIGH INIT

M66146 RUPTURE OF SYNOVIUM UNSPECIFIED FINGER(S)

S76822A

LACERAT MUSC/FASC/TEND AT THIGH LEVEL LEFT THIGH INIT

M66151 RUPTURE OF SYNOVIUM RIGHT HIP

S76829A

LACERAT MUSC/FASC/TEND AT THIGH LEVEL UNSP THIGH INIT

M66152 RUPTURE OF SYNOVIUM LEFT HIP

S76911A

STRAIN OF UNSP MUSC/FASC/TEND AT THI LEV RIGHT THIGH INIT

M66159 RUPTURE OF SYNOVIUM UNSPECIFIED HIP

S76912A

STRAIN OF UNSP MUSC/FASC/TEND AT THI LEV LEFT THIGH INIT

M66171 RUPTURE OF SYNOVIUM RIGHT ANKLE

S76919A

STRAIN OF UNSP MUSC/FASC/TEND AT THI LEV UNSP THIGH INIT

M66172 RUPTURE OF SYNOVIUM LEFT ANKLE

S76921A

LACERAT UNSP MUSC/FASC/TEND AT THI LEV RIGHT THIGH INIT

M66173 RUPTURE OF SYNOVIUM UNSPECIFIED ANKLE

S76922A

LACERAT UNSP MUSC/FASC/TEND AT THIGH LEVEL LEFT THIGH INIT

M66174 RUPTURE OF SYNOVIUM RIGHT FOOT

S76929A

LACERAT UNSP MUSC/FASC/TEND AT THIGH LEVEL UNSP THIGH INIT

M66175 RUPTURE OF SYNOVIUM LEFT FOOT

S7700XA

CRUSHING INJURY OF UNSPECIFIED HIP INITIAL ENCOUNTER

M66176 RUPTURE OF SYNOVIUM UNSPECIFIED FOOT

S7701XA

CRUSHING INJURY OF RIGHT HIP INITIAL ENCOUNTER

M66177 RUPTURE OF SYNOVIUM RIGHT TOE(S)

S7702XA

CRUSHING INJURY OF LEFT HIP INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M66178 RUPTURE OF SYNOVIUM LEFT TOE(S)

S7710XA

CRUSHING INJURY OF UNSPECIFIED THIGH INITIAL ENCOUNTER

M66179 RUPTURE OF SYNOVIUM UNSPECIFIED TOE(S)

S7711XA

CRUSHING INJURY OF RIGHT THIGH INITIAL ENCOUNTER

M6618 RUPTURE OF SYNOVIUM OTHER SITE

S7712XA

CRUSHING INJURY OF LEFT THIGH INITIAL ENCOUNTER

M6620

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS UNSPECIFIED SITE

S7720XA

CRUSHING INJURY OF UNSPECIFIED HIP WITH THIGH INIT ENCNTR

M66211

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS RIGHT SHOULDER

S7721XA

CRUSHING INJURY OF RIGHT HIP WITH THIGH INITIAL ENCOUNTER

M66212

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS LEFT SHOULDER

S7722XA

CRUSHING INJURY OF LEFT HIP WITH THIGH INITIAL ENCOUNTER

M66219

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS UNSP SHOULDER

S78011A

COMPLETE TRAUMATIC AMPUTATION AT RIGHT HIP JOINT INIT

M66221

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS RIGHT UPPER ARM

S78012A

COMPLETE TRAUMATIC AMPUTATION AT LEFT HIP JOINT INIT ENCNTR

M66222

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS LEFT UPPER ARM

S78019A

COMPLETE TRAUMATIC AMPUTATION AT UNSP HIP JOINT INIT ENCNTR

M66229

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS UNSP UPPER ARM

S78021A

PARTIAL TRAUMATIC AMPUTATION AT RIGHT HIP JOINT INIT ENCNTR

M66231

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS RIGHT FOREARM

S78022A

PARTIAL TRAUMATIC AMPUTATION AT LEFT HIP JOINT INIT ENCNTR

M66232

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS LEFT FOREARM

S78029A

PARTIAL TRAUMATIC AMPUTATION AT UNSP HIP JOINT INIT ENCNTR

M66239

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS UNSPECIFIED FOREARM

S78111A

COMPLETE TRAUMATIC AMP AT LEVEL BETW R HIP AND KNEE INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M66241

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS RIGHT HAND

S78112A

COMPLETE TRAUMATIC AMP AT LEVEL BETW LEFT HIP AND KNEE INIT

M66242

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS LEFT HAND

S78119A

COMPLETE TRAUMATIC AMP AT LEVEL BETW UNSP HIP AND KNEE INIT

M66249

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS UNSPECIFIED HAND

S78121A

PARTIAL TRAUMATIC AMP AT LEVEL BETW RIGHT HIP AND KNEE INIT

M66251

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS RIGHT THIGH

S78122A

PARTIAL TRAUMATIC AMP AT LEVEL BETW LEFT HIP AND KNEE INIT

M66252

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS LEFT THIGH

S78129A

PARTIAL TRAUMATIC AMP AT LEVEL BETW UNSP HIP AND KNEE INIT

M66259

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS UNSPECIFIED THIGH

S78911A

COMPLETE TRAUMATIC AMP OF R HIP AND THIGH LEVEL UNSP INIT

M66261

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS RIGHT LOWER LEG

S78912A

COMPLETE TRAUM AMP OF LEFT HIP AND THIGH LEVEL UNSP INIT

M66262

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS LEFT LOWER LEG

S78919A

COMPLETE TRAUM AMP OF UNSP HIP AND THIGH LEVEL UNSP INIT

M66269

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS UNSP LOWER LEG

S78921A

PARTIAL TRAUMATIC AMP OF R HIP AND THIGH LEVEL UNSP INIT

M66271

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS RIGHT ANK/FT

S78922A

PARTIAL TRAUM AMP OF LEFT HIP AND THIGH LEVEL UNSP INIT

M66272

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS LEFT ANKLE AND FOOT

S78929A

PARTIAL TRAUM AMP OF UNSP HIP AND THIGH LEVEL UNSP INIT

M66279

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS UNSP ANKLE AND FOOT

S79001A

UNSP PHYSEAL FRACTURE OF UPPER END OF RIGHT FEMUR INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M6628

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS OTHER SITE

S79002A

UNSP PHYSEAL FRACTURE OF UPPER END OF LEFT FEMUR INIT

M6629

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS MULTIPLE SITES

S79009A

UNSP PHYSEAL FRACTURE OF UPPER END OF UNSP FEMUR INIT

M6630

SPONTANEOUS RUPTURE OF FLEXOR TENDONS UNSPECIFIED SITE

S79011A

SLTR-HARIS TYPE I PHYSEAL FX UPPER END OF RIGHT FEMUR INIT

M66311

SPONTANEOUS RUPTURE OF FLEXOR TENDONS RIGHT SHOULDER

S79012A

SLTR-HARIS TYPE I PHYSEAL FX UPPER END OF LEFT FEMUR INIT

M66312

SPONTANEOUS RUPTURE OF FLEXOR TENDONS LEFT SHOULDER

S79019A

SLTR-HARIS TYPE I PHYSEAL FX UPPER END OF UNSP FEMUR INIT

M66319

SPONTANEOUS RUPTURE OF FLEXOR TENDONS UNSPECIFIED SHOULDER

S79091A

OTH PHYSEAL FRACTURE OF UPPER END OF RIGHT FEMUR INIT

M66321

SPONTANEOUS RUPTURE OF FLEXOR TENDONS RIGHT UPPER ARM

S79092A

OTH PHYSEAL FRACTURE OF UPPER END OF LEFT FEMUR INIT

M66322

SPONTANEOUS RUPTURE OF FLEXOR TENDONS LEFT UPPER ARM

S79099A

OTH PHYSEAL FRACTURE OF UPPER END OF UNSP FEMUR INIT

M66329

SPONTANEOUS RUPTURE OF FLEXOR TENDONS UNSPECIFIED UPPER ARM

S79101A

UNSP PHYSEAL FRACTURE OF LOWER END OF RIGHT FEMUR INIT

M66331

SPONTANEOUS RUPTURE OF FLEXOR TENDONS RIGHT FOREARM

S79102A

UNSP PHYSEAL FRACTURE OF LOWER END OF LEFT FEMUR INIT

M66332

SPONTANEOUS RUPTURE OF FLEXOR TENDONS LEFT FOREARM

S79109A

UNSP PHYSEAL FRACTURE OF LOWER END OF UNSP FEMUR INIT

M66339

SPONTANEOUS RUPTURE OF FLEXOR TENDONS UNSPECIFIED FOREARM

S79111A

SLTR-HARIS TYPE I PHYSEAL FX LOWER END OF RIGHT FEMUR INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M66341 SPONTANEOUS RUPTURE OF FLEXOR TENDONS RIGHT HAND

S79112A

SLTR-HARIS TYPE I PHYSEAL FX LOWER END OF LEFT FEMUR INIT

M66342 SPONTANEOUS RUPTURE OF FLEXOR TENDONS LEFT HAND

S79119A

SLTR-HARIS TYPE I PHYSEAL FX LOWER END OF UNSP FEMUR INIT

M66349

SPONTANEOUS RUPTURE OF FLEXOR TENDONS UNSPECIFIED HAND

S79121A

SLTR-HARIS TYPE II PHYSEAL FX LOWER END OF RIGHT FEMUR INIT

M66351 SPONTANEOUS RUPTURE OF FLEXOR TENDONS RIGHT THIGH

S79122A

SLTR-HARIS TYPE II PHYSEAL FX LOWER END OF LEFT FEMUR INIT

M66352 SPONTANEOUS RUPTURE OF FLEXOR TENDONS LEFT THIGH

S79129A

SLTR-HARIS TYPE II PHYSEAL FX LOWER END OF UNSP FEMUR INIT

M66359

SPONTANEOUS RUPTURE OF FLEXOR TENDONS UNSPECIFIED THIGH

S79131A

SLTR-HARIS TYPE III PHYSEAL FX LOWER END OF R FEMUR INIT

M66361

SPONTANEOUS RUPTURE OF FLEXOR TENDONS RIGHT LOWER LEG

S79132A

SLTR-HARIS TYPE III PHYSEAL FX LOWER END OF LEFT FEMUR INIT

M66362

SPONTANEOUS RUPTURE OF FLEXOR TENDONS LEFT LOWER LEG

S79139A

SLTR-HARIS TYPE III PHYSEAL FX LOWER END OF UNSP FEMUR INIT

M66369

SPONTANEOUS RUPTURE OF FLEXOR TENDONS UNSPECIFIED LOWER LEG

S79141A

SLTR-HARIS TYPE IV PHYSEAL FX LOWER END OF RIGHT FEMUR INIT

M66371

SPONTANEOUS RUPTURE OF FLEXOR TENDONS RIGHT ANKLE AND FOOT

S79142A

SLTR-HARIS TYPE IV PHYSEAL FX LOWER END OF LEFT FEMUR INIT

M66372

SPONTANEOUS RUPTURE OF FLEXOR TENDONS LEFT ANKLE AND FOOT

S79149A

SLTR-HARIS TYPE IV PHYSEAL FX LOWER END OF UNSP FEMUR INIT

M66379

SPONTANEOUS RUPTURE OF FLEXOR TENDONS UNSP ANKLE AND FOOT

S79191A

OTH PHYSEAL FRACTURE OF LOWER END OF RIGHT FEMUR INIT

M6638 SPONTANEOUS RUPTURE OF FLEXOR TENDONS OTHER SITE

S79192A

OTH PHYSEAL FRACTURE OF LOWER END OF LEFT FEMUR INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M6639

SPONTANEOUS RUPTURE OF FLEXOR TENDONS MULTIPLE SITES

S79199A

OTH PHYSEAL FRACTURE OF LOWER END OF UNSP FEMUR INIT

M6680

SPONTANEOUS RUPTURE OF OTHER TENDONS UNSPECIFIED SITE

S80241A

EXTERNAL CONSTRICTION RIGHT KNEE INITIAL ENCOUNTER

M66811

SPONTANEOUS RUPTURE OF OTHER TENDONS RIGHT SHOULDER

S80242A

EXTERNAL CONSTRICTION LEFT KNEE INITIAL ENCOUNTER

M66812

SPONTANEOUS RUPTURE OF OTHER TENDONS LEFT SHOULDER

S80249A

EXTERNAL CONSTRICTION UNSPECIFIED KNEE INITIAL ENCOUNTER

M66819

SPONTANEOUS RUPTURE OF OTHER TENDONS UNSPECIFIED SHOULDER

S80841A

EXTERNAL CONSTRICTION RIGHT LOWER LEG INITIAL ENCOUNTER

M66821

SPONTANEOUS RUPTURE OF OTHER TENDONS RIGHT UPPER ARM

S80842A

EXTERNAL CONSTRICTION LEFT LOWER LEG INITIAL ENCOUNTER

M66822

SPONTANEOUS RUPTURE OF OTHER TENDONS LEFT UPPER ARM

S80849A

EXTERNAL CONSTRICTION UNSPECIFIED LOWER LEG INIT ENCNTR

M66829

SPONTANEOUS RUPTURE OF OTHER TENDONS UNSPECIFIED UPPER ARM

S81001A

UNSPECIFIED OPEN WOUND RIGHT KNEE INITIAL ENCOUNTER

M66831

SPONTANEOUS RUPTURE OF OTHER TENDONS RIGHT FOREARM

S81002A

UNSPECIFIED OPEN WOUND LEFT KNEE INITIAL ENCOUNTER

M66832

SPONTANEOUS RUPTURE OF OTHER TENDONS LEFT FOREARM

S81009A

UNSPECIFIED OPEN WOUND UNSPECIFIED KNEE INITIAL ENCOUNTER

M66839

SPONTANEOUS RUPTURE OF OTHER TENDONS UNSPECIFIED FOREARM

S81011A

LACERATION WITHOUT FOREIGN BODY RIGHT KNEE INIT ENCNTR

M66841 SPONTANEOUS RUPTURE OF OTHER TENDONS RIGHT HAND

S81012A

LACERATION WITHOUT FOREIGN BODY LEFT KNEE INIT ENCNTR

M66842 SPONTANEOUS RUPTURE OF OTHER TENDONS LEFT HAND

S81019A

LACERATION WITHOUT FOREIGN BODY UNSP KNEE INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M66849

SPONTANEOUS RUPTURE OF OTHER TENDONS UNSPECIFIED HAND

S81021A

LACERATION WITH FOREIGN BODY RIGHT KNEE INITIAL ENCOUNTER

M66851 SPONTANEOUS RUPTURE OF OTHER TENDONS RIGHT THIGH

S81022A

LACERATION WITH FOREIGN BODY LEFT KNEE INITIAL ENCOUNTER

M66852 SPONTANEOUS RUPTURE OF OTHER TENDONS LEFT THIGH

S81029A

LACERATION WITH FOREIGN BODY UNSPECIFIED KNEE INIT ENCNTR

M66859

SPONTANEOUS RUPTURE OF OTHER TENDONS UNSPECIFIED THIGH

S81031A

PUNCTURE WOUND WITHOUT FOREIGN BODY RIGHT KNEE INIT ENCNTR

M66861

SPONTANEOUS RUPTURE OF OTHER TENDONS RIGHT LOWER LEG

S81032A

PUNCTURE WOUND WITHOUT FOREIGN BODY LEFT KNEE INIT ENCNTR

M66862

SPONTANEOUS RUPTURE OF OTHER TENDONS LEFT LOWER LEG

S81039A

PUNCTURE WOUND WITHOUT FOREIGN BODY UNSP KNEE INIT ENCNTR

M66869

SPONTANEOUS RUPTURE OF OTHER TENDONS UNSPECIFIED LOWER LEG

S81041A

PUNCTURE WOUND WITH FOREIGN BODY RIGHT KNEE INIT ENCNTR

M66871

SPONTANEOUS RUPTURE OF OTHER TENDONS RIGHT ANKLE AND FOOT

S81042A

PUNCTURE WOUND WITH FOREIGN BODY LEFT KNEE INIT ENCNTR

M66872

SPONTANEOUS RUPTURE OF OTHER TENDONS LEFT ANKLE AND FOOT

S81049A

PUNCTURE WOUND WITH FOREIGN BODY UNSP KNEE INIT ENCNTR

M66879

SPONTANEOUS RUPTURE OF OTHER TENDONS UNSP ANKLE AND FOOT

S81051A

OPEN BITE RIGHT KNEE INITIAL ENCOUNTER

M6688 SPONTANEOUS RUPTURE OF OTHER TENDONS OTHER

S81052A

OPEN BITE LEFT KNEE INITIAL ENCOUNTER

M6689

SPONTANEOUS RUPTURE OF OTHER TENDONS MULTIPLE SITES

S81059A

OPEN BITE UNSPECIFIED KNEE INITIAL ENCOUNTER

M669 SPONTANEOUS RUPTURE OF UNSPECIFIED TENDON

S81801A

UNSPECIFIED OPEN WOUND RIGHT LOWER LEG INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M726 NECROTIZING FASCIITIS

S81802A UNSPECIFIED OPEN WOUND LEFT LOWER LEG INITIAL ENCOUNTER

M729 FIBROBLASTIC DISORDER UNSPECIFIED

S81809A

UNSPECIFIED OPEN WOUND UNSPECIFIED LOWER LEG INIT ENCNTR

M7500 ADHESIVE CAPSULITIS OF UNSPECIFIED SHOULDER

S81811A

LACERATION W/O FOREIGN BODY RIGHT LOWER LEG INIT ENCNTR

M7501 ADHESIVE CAPSULITIS OF RIGHT SHOULDER

S81812A

LACERATION WITHOUT FOREIGN BODY LEFT LOWER LEG INIT ENCNTR

M7502 ADHESIVE CAPSULITIS OF LEFT SHOULDER

S81819A

LACERATION WITHOUT FOREIGN BODY UNSP LOWER LEG INIT ENCNTR

M7520 BICIPITAL TENDINITIS UNSPECIFIED SHOULDER

S81821A

LACERATION WITH FOREIGN BODY RIGHT LOWER LEG INIT ENCNTR

M7521 BICIPITAL TENDINITIS RIGHT SHOULDER

S81822A

LACERATION WITH FOREIGN BODY LEFT LOWER LEG INIT ENCNTR

M7522 BICIPITAL TENDINITIS LEFT SHOULDER

S81829A

LACERATION WITH FOREIGN BODY UNSP LOWER LEG INIT ENCNTR

M7530 CALCIFIC TENDINITIS OF UNSPECIFIED SHOULDER

S81831A

PUNCTURE WOUND W/O FOREIGN BODY RIGHT LOWER LEG INIT

M7531 CALCIFIC TENDINITIS OF RIGHT SHOULDER

S81832A

PUNCTURE WOUND W/O FOREIGN BODY LEFT LOWER LEG INIT ENCNTR

M7532 CALCIFIC TENDINITIS OF LEFT SHOULDER

S81839A

PUNCTURE WOUND W/O FOREIGN BODY UNSP LOWER LEG INIT ENCNTR

M7540 IMPINGEMENT SYNDROME OF UNSPECIFIED SHOULDER

S81841A

PUNCTURE WOUND W FOREIGN BODY RIGHT LOWER LEG INIT ENCNTR

M7541 IMPINGEMENT SYNDROME OF RIGHT SHOULDER

S81842A

PUNCTURE WOUND W FOREIGN BODY LEFT LOWER LEG INIT ENCNTR

M7542 IMPINGEMENT SYNDROME OF LEFT SHOULDER

S81849A

PUNCTURE WOUND W FOREIGN BODY UNSP LOWER LEG INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M7550 BURSITIS OF UNSPECIFIED SHOULDER

S81851A

OPEN BITE RIGHT LOWER LEG INITIAL ENCOUNTER

M7551 BURSITIS OF RIGHT SHOULDER

S81852A OPEN BITE LEFT LOWER LEG INITIAL ENCOUNTER

M7552 BURSITIS OF LEFT SHOULDER

S81859A OPEN BITE UNSPECIFIED LOWER LEG INITIAL ENCOUNTER

M7580 OTHER SHOULDER LESIONS UNSPECIFIED SHOULDER

S82001A

UNSP FRACTURE OF RIGHT PATELLA INIT FOR CLOS FX

M7581 OTHER SHOULDER LESIONS RIGHT SHOULDER

S82001B

UNSP FRACTURE OF RIGHT PATELLA INIT FOR OPN FX TYPE I/2

M7582 OTHER SHOULDER LESIONS LEFT SHOULDER

S82001C

UNSP FRACTURE OF RIGHT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7590

SHOULDER LESION UNSPECIFIED UNSPECIFIED SHOULDER

S82002A

UNSP FRACTURE OF LEFT PATELLA INIT FOR CLOS FX

M7591 SHOULDER LESION UNSPECIFIED RIGHT SHOULDER

S82002B

UNSP FRACTURE OF LEFT PATELLA INIT FOR OPN FX TYPE I/2

M7592 SHOULDER LESION UNSPECIFIED LEFT SHOULDER

S82002C

UNSP FRACTURE OF LEFT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7600 GLUTEAL TENDINITIS UNSPECIFIED HIP

S82009A

UNSP FRACTURE OF UNSP PATELLA INIT FOR CLOS FX

M7601 GLUTEAL TENDINITIS RIGHT HIP

S82009B UNSP FRACTURE OF UNSP PATELLA INIT FOR OPN FX TYPE I/2

M7602 GLUTEAL TENDINITIS LEFT HIP

S82009C UNSP FRACTURE OF UNSP PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7610 PSOAS TENDINITIS UNSPECIFIED HIP

S82011A

DISPLACED OSTEOCHONDRAL FRACTURE OF RIGHT PATELLA INIT

M7611 PSOAS TENDINITIS RIGHT HIP

S82011B DISPL OSTEOCHON FX RIGHT PATELLA INIT FOR OPN FX TYPE I/2

M7612 PSOAS TENDINITIS LEFT HIP

S82011C DISPL OSTEOCHON FX R PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7620 ILIAC CREST SPUR UNSPECIFIED HIP

S82012A

DISPLACED OSTEOCHONDRAL FRACTURE OF LEFT PATELLA INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M7621 ILIAC CREST SPUR RIGHT HIP

S82012B DISPL OSTEOCHON FX LEFT PATELLA INIT FOR OPN FX TYPE I/2

M7622 ILIAC CREST SPUR LEFT HIP

S82012C DISPL OSTEOCHON FX LEFT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7630 ILIOTIBIAL BAND SYNDROME UNSPECIFIED LEG

S82013A

DISPLACED OSTEOCHONDRAL FRACTURE OF UNSP PATELLA INIT

M7631 ILIOTIBIAL BAND SYNDROME RIGHT LEG

S82013B

DISPL OSTEOCHON FX UNSP PATELLA INIT FOR OPN FX TYPE I/2

M7632 ILIOTIBIAL BAND SYNDROME LEFT LEG

S82013C

DISPL OSTEOCHON FX UNSP PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7640 TIBIAL COLLATERAL BURSITIS UNSPECIFIED LEG

S82014A

NONDISPLACED OSTEOCHONDRAL FRACTURE OF RIGHT PATELLA INIT

M7641 TIBIAL COLLATERAL BURSITIS [PELLEGRINI-STIEDA] RIGHT LEG

S82014B

NONDISP OSTEOCHON FX RIGHT PATELLA INIT FOR OPN FX TYPE I/2

M7642 TIBIAL COLLATERAL BURSITIS [PELLEGRINI-STIEDA] LEFT LEG

S82014C

NONDISP OSTEOCHON FX R PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7650 PATELLAR TENDINITIS UNSPECIFIED KNEE

S82015A

NONDISPLACED OSTEOCHONDRAL FRACTURE OF LEFT PATELLA INIT

M7651 PATELLAR TENDINITIS RIGHT KNEE

S82015B

NONDISP OSTEOCHON FX LEFT PATELLA INIT FOR OPN FX TYPE I/2

M7652 PATELLAR TENDINITIS LEFT KNEE

S82015C

NONDISP OSTEOCHON FX L PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7660 ACHILLES TENDINITIS UNSPECIFIED LEG

S82016A

NONDISPLACED OSTEOCHONDRAL FRACTURE OF UNSP PATELLA INIT

M7661 ACHILLES TENDINITIS RIGHT LEG

S82016B NONDISP OSTEOCHON FX UNSP PATELLA INIT FOR OPN FX TYPE I/2

M7662 ACHILLES TENDINITIS LEFT LEG

S82016C NONDISP OSTEOCHON FX UNSP PATELLA 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M7670 PERONEAL TENDINITIS UNSPECIFIED LEG

S82021A

DISPLACED LONGITUDINAL FRACTURE OF RIGHT PATELLA INIT

M7671 PERONEAL TENDINITIS RIGHT LEG

S82021B

DISPL LONGITUD FX RIGHT PATELLA INIT FOR OPN FX TYPE I/2

M7672 PERONEAL TENDINITIS LEFT LEG

S82021C DISPL LONGITUD FX RIGHT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M76811 ANTERIOR TIBIAL SYNDROME RIGHT LEG

S82022A

DISPLACED LONGITUDINAL FRACTURE OF LEFT PATELLA INIT

M76812 ANTERIOR TIBIAL SYNDROME LEFT LEG

S82022B

DISPLACED LONGITUD FX LEFT PATELLA INIT FOR OPN FX TYPE I/2

M76819 ANTERIOR TIBIAL SYNDROME UNSPECIFIED LEG

S82022C

DISPL LONGITUD FX LEFT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M76821 POSTERIOR TIBIAL TENDINITIS RIGHT LEG

S82023A

DISPLACED LONGITUDINAL FRACTURE OF UNSP PATELLA INIT

M76822 POSTERIOR TIBIAL TENDINITIS LEFT LEG

S82023B

DISPLACED LONGITUD FX UNSP PATELLA INIT FOR OPN FX TYPE I/2

M76829 POSTERIOR TIBIAL TENDINITIS UNSPECIFIED LEG

S82023C

DISPL LONGITUD FX UNSP PATELLA INIT FOR OPN FX TYPE 3A/B/C

M76891

OTH ENTHESOPATHIES OF RIGHT LOWER LIMB EXCLUDING FOOT

S82024A

NONDISPLACED LONGITUDINAL FRACTURE OF RIGHT PATELLA INIT

M76892 OTH ENTHESOPATHIES OF LEFT LOWER LIMB EXCLUDING FOOT

S82024B

NONDISP LONGITUD FX RIGHT PATELLA INIT FOR OPN FX TYPE I/2

M76899

OTH ENTHESOPATHIES OF UNSPECIFIED LOWER LIMB EXCLUDING FOOT

S82024C

NONDISP LONGITUD FX R PATELLA INIT FOR OPN FX TYPE 3A/B/C

M769 UNSPECIFIED ENTHESOPATHY LOWER LIMB EXCLUDING FOOT

S82025A

NONDISPLACED LONGITUDINAL FRACTURE OF LEFT PATELLA INIT

M7700 MEDIAL EPICONDYLITIS UNSPECIFIED ELBOW

S82025B

NONDISP LONGITUD FX LEFT PATELLA INIT FOR OPN FX TYPE I/2

M7701 MEDIAL EPICONDYLITIS RIGHT ELBOW

S82025C

NONDISP LONGITUD FX L PATELLA INIT FOR OPN FX TYPE 3A/B/C

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M7702 MEDIAL EPICONDYLITIS LEFT ELBOW

S82026A

NONDISPLACED LONGITUDINAL FRACTURE OF UNSP PATELLA INIT

M7710 LATERAL EPICONDYLITIS UNSPECIFIED ELBOW

S82026B

NONDISP LONGITUD FX UNSP PATELLA INIT FOR OPN FX TYPE I/2

M7711 LATERAL EPICONDYLITIS RIGHT ELBOW

S82026C

NONDISP LONGITUD FX UNSP PATELLA 7THC

M7712 LATERAL EPICONDYLITIS LEFT ELBOW

S82031A

DISPLACED TRANSVERSE FRACTURE OF RIGHT PATELLA INIT

M7720 PERIARTHRITIS UNSPECIFIED WRIST

S82031B

DISPL TRANSVERSE FX RIGHT PATELLA INIT FOR OPN FX TYPE I/2

M7721 PERIARTHRITIS RIGHT WRIST

S82031C DISPL TRANSVERSE FX R PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7722 PERIARTHRITIS LEFT WRIST

S82032A DISPLACED TRANSVERSE FRACTURE OF LEFT PATELLA INIT

M7730 CALCANEAL SPUR UNSPECIFIED FOOT

S82032B

DISPL TRANSVERSE FX LEFT PATELLA INIT FOR OPN FX TYPE I/2

M7731 CALCANEAL SPUR RIGHT FOOT

S82032C DISPL TRANSVERSE FX L PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7732 CALCANEAL SPUR LEFT FOOT

S82033A DISPLACED TRANSVERSE FRACTURE OF UNSP PATELLA INIT

M7740 METATARSALGIA UNSPECIFIED FOOT

S82033B

DISPL TRANSVERSE FX UNSP PATELLA INIT FOR OPN FX TYPE I/2

M7741 METATARSALGIA RIGHT FOOT

S82033C DISPL TRANSVERSE FX UNSP PATELLA 7THC

M7742 METATARSALGIA LEFT FOOT

S82034A NONDISPLACED TRANSVERSE FRACTURE OF RIGHT PATELLA INIT

M7750 OTHER ENTHESOPATHY OF UNSPECIFIED FOOT

S82034B

NONDISP TRANSVERSE FX R PATELLA INIT FOR OPN FX TYPE I/2

M7751 OTHER ENTHESOPATHY OF RIGHT FOOT

S82034C

NONDISP TRANSVERSE FX R PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7752 OTHER ENTHESOPATHY OF LEFT FOOT

S82035A

NONDISPLACED TRANSVERSE FRACTURE OF LEFT PATELLA INIT

M778 OTHER ENTHESOPATHIES NOT ELSEWHERE CLASSIFIED

S82035B

NONDISP TRANSVERSE FX LEFT PATELLA INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M779 ENTHESOPATHY UNSPECIFIED

S82035C NONDISP TRANSVERSE FX L PATELLA INIT FOR OPN FX TYPE 3A/B/C

M790 RHEUMATISM UNSPECIFIED

S82036A NONDISPLACED TRANSVERSE FRACTURE OF UNSP PATELLA INIT

M791 MYALGIA

S82036B NONDISP TRANSVERSE FX UNSP PATELLA INIT FOR OPN FX TYPE I/2

M792 NEURALGIA AND NEURITIS UNSPECIFIED

S82036C

NONDISP TRANSVERSE FX UNSP PATELLA 7THC

M793 PANNICULITIS UNSPECIFIED

S82041A DISPLACED COMMINUTED FRACTURE OF RIGHT PATELLA INIT

M794 HYPERTROPHY OF (INFRAPATELLAR) FAT PAD

S82041B

DISPLACED COMMNT FX RIGHT PATELLA INIT FOR OPN FX TYPE I/2

M795 RESIDUAL FOREIGN BODY IN SOFT TISSUE

S82041C

DISPL COMMNT FX RIGHT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M79A11

NONTRAUMATIC COMPARTMENT SYNDROME OF RIGHT UPPER EXTREMITY

S82042A

DISPLACED COMMINUTED FRACTURE OF LEFT PATELLA INIT

M79A12

NONTRAUMATIC COMPARTMENT SYNDROME OF LEFT UPPER EXTREMITY

S82042B

DISPLACED COMMNT FX LEFT PATELLA INIT FOR OPN FX TYPE I/2

M79A19

NONTRAUMATIC COMPARTMENT SYNDROME OF UNSP UPPER EXTREMITY

S82042C

DISPL COMMNT FX LEFT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M79A21

NONTRAUMATIC COMPARTMENT SYNDROME OF RIGHT LOWER EXTREMITY

S82043A

DISPLACED COMMINUTED FRACTURE OF UNSP PATELLA INIT

M79A22

NONTRAUMATIC COMPARTMENT SYNDROME OF LEFT LOWER EXTREMITY

S82043B

DISPLACED COMMNT FX UNSP PATELLA INIT FOR OPN FX TYPE I/2

M79A29

NONTRAUMATIC COMPARTMENT SYNDROME OF UNSP LOWER EXTREMITY

S82043C

DISPL COMMNT FX UNSP PATELLA INIT FOR OPN FX TYPE 3A/B/C

M79A3

NONTRAUMATIC COMPARTMENT SYNDROME OF ABDOMEN

S82044A

NONDISPLACED COMMINUTED FRACTURE OF RIGHT PATELLA INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M79A9

NONTRAUMATIC COMPARTMENT SYNDROME OF OTHER SITES

S82044B

NONDISP COMMNT FX RIGHT PATELLA INIT FOR OPN FX TYPE I/2

M8000XA

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE UNSP SITE INIT

S82044C

NONDISP COMMNT FX RIGHT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M80011A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE R SHOULDER INIT

S82045A

NONDISPLACED COMMINUTED FRACTURE OF LEFT PATELLA INIT

M80012A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE L SHOULDER INIT

S82045B

NONDISP COMMINUTED FX LEFT PATELLA INIT FOR OPN FX TYPE I/2

M80019A

AGE-REL OSTEOPOR W CURRENT PATH FX UNSP SHOULDER INIT

S82045C

NONDISP COMMNT FX LEFT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M80021A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE R HUMERUS INIT

S82046A

NONDISPLACED COMMINUTED FRACTURE OF UNSP PATELLA INIT

M80022A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE L HUMERUS INIT

S82046B

NONDISP COMMINUTED FX UNSP PATELLA INIT FOR OPN FX TYPE I/2

M80029A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE UNSP HUMERUS INIT

S82046C

NONDISP COMMNT FX UNSP PATELLA INIT FOR OPN FX TYPE 3A/B/C

M80031A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE R FOREARM INIT

S82091A

OTH FRACTURE OF RIGHT PATELLA INIT FOR CLOS FX

M80032A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE L FOREARM INIT

S82091B

OTH FRACTURE OF RIGHT PATELLA INIT FOR OPN FX TYPE I/2

M80039A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE UNSP FOREARM INIT

S82091C

OTH FRACTURE OF RIGHT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M80041A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE RIGHT HAND INIT

S82092A

OTH FRACTURE OF LEFT PATELLA INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M80042A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE LEFT HAND INIT

S82092B

OTH FRACTURE OF LEFT PATELLA INIT FOR OPN FX TYPE I/2

M80049A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE UNSP HAND INIT

S82092C

OTH FRACTURE OF LEFT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M80051A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE RIGHT FEMUR INIT

S82099A

OTH FRACTURE OF UNSP PATELLA INIT FOR CLOS FX

M80052A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE LEFT FEMUR INIT

S82099B

OTH FRACTURE OF UNSP PATELLA INIT FOR OPN FX TYPE I/2

M80059A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE UNSP FEMUR INIT

S82099C

OTH FRACTURE OF UNSP PATELLA INIT FOR OPN FX TYPE 3A/B/C

M80061A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE R LOW LEG INIT

S82101A

UNSP FRACTURE OF UPPER END OF RIGHT TIBIA INIT FOR CLOS FX

M80062A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE L LOW LEG INIT

S82101B

UNSP FX UPPER END OF RIGHT TIBIA INIT FOR OPN FX TYPE I/2

M80069A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE UNSP LOW LEG INIT

S82101C

UNSP FX UPPER END OF R TIBIA INIT FOR OPN FX TYPE 3A/B/C

M80071A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE RIGHT ANK/FT INIT

S82102A

UNSP FRACTURE OF UPPER END OF LEFT TIBIA INIT FOR CLOS FX

M80072A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE LEFT ANK/FT INIT

S82102B

UNSP FX UPPER END OF LEFT TIBIA INIT FOR OPN FX TYPE I/2

M80079A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE UNSP ANK/FT INIT

S82102C

UNSP FX UPPER END OF LEFT TIBIA INIT FOR OPN FX TYPE 3A/B/C

M8008XA

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE VERTEBRA(E) INIT

S82109A

UNSP FRACTURE OF UPPER END OF UNSP TIBIA INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M8080XA OTH OSTEOPOR W CURRENT PATH FRACTURE UNSP SITE INIT

S82109B

UNSP FX UPPER END OF UNSP TIBIA INIT FOR OPN FX TYPE I/2

M80811A

OTH OSTEOPOR W CURRENT PATH FRACTURE R SHOULDER INIT

S82109C

UNSP FX UPPER END OF UNSP TIBIA INIT FOR OPN FX TYPE 3A/B/C

M80812A

OTH OSTEOPOR W CURRENT PATH FRACTURE L SHOULDER INIT

S82111A

DISP FX OF RIGHT TIBIAL SPINE INIT FOR CLOS FX

M80819A

OTH OSTEOPOR W CURRENT PATH FRACTURE UNSP SHOULDER INIT

S82111B

DISP FX OF RIGHT TIBIAL SPINE INIT FOR OPN FX TYPE I/2

M80821A

OTH OSTEOPOR W CURRENT PATH FRACTURE R HUMERUS INIT

S82111C

DISP FX OF RIGHT TIBIAL SPINE INIT FOR OPN FX TYPE 3A/B/C

M80822A

OTH OSTEOPOR W CURRENT PATH FRACTURE L HUMERUS INIT

S82112A

DISP FX OF LEFT TIBIAL SPINE INIT FOR CLOS FX

M80829A

OTH OSTEOPOR W CURRENT PATH FRACTURE UNSP HUMERUS INIT

S82112B

DISP FX OF LEFT TIBIAL SPINE INIT FOR OPN FX TYPE I/2

M80831A

OTH OSTEOPOR W CURRENT PATH FRACTURE R FOREARM INIT

S82112C

DISP FX OF LEFT TIBIAL SPINE INIT FOR OPN FX TYPE 3A/B/C

M80832A

OTH OSTEOPOR W CURRENT PATH FRACTURE L FOREARM INIT

S82113A

DISP FX OF UNSP TIBIAL SPINE INIT FOR CLOS FX

M80839A

OTH OSTEOPOR W CURRENT PATH FRACTURE UNSP FOREARM INIT

S82113B

DISP FX OF UNSP TIBIAL SPINE INIT FOR OPN FX TYPE I/2

M80841A

OTH OSTEOPOR W CURRENT PATH FRACTURE RIGHT HAND INIT

S82113C

DISP FX OF UNSP TIBIAL SPINE INIT FOR OPN FX TYPE 3A/B/C

M80842A

OTH OSTEOPOR W CURRENT PATH FRACTURE LEFT HAND INIT

S82114A

NONDISP FX OF RIGHT TIBIAL SPINE INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M80849A

OTH OSTEOPOR W CURRENT PATH FRACTURE UNSP HAND INIT

S82114B

NONDISP FX OF RIGHT TIBIAL SPINE INIT FOR OPN FX TYPE I/2

M80851A

OTH OSTEOPOR W CURRENT PATH FRACTURE RIGHT FEMUR INIT

S82114C

NONDISP FX OF R TIBIAL SPINE INIT FOR OPN FX TYPE 3A/B/C

M80852A

OTH OSTEOPOR W CURRENT PATH FRACTURE LEFT FEMUR INIT

S82115A

NONDISP FX OF LEFT TIBIAL SPINE INIT FOR CLOS FX

M80859A

OTH OSTEOPOR W CURRENT PATH FRACTURE UNSP FEMUR INIT

S82115B

NONDISP FX OF LEFT TIBIAL SPINE INIT FOR OPN FX TYPE I/2

M80861A

OTH OSTEOPOR W CURRENT PATH FRACTURE R LOW LEG INIT

S82115C

NONDISP FX OF LEFT TIBIAL SPINE INIT FOR OPN FX TYPE 3A/B/C

M80862A

OTH OSTEOPOR W CURRENT PATH FRACTURE L LOW LEG INIT

S82116A

NONDISP FX OF UNSP TIBIAL SPINE INIT FOR CLOS FX

M80869A

OTH OSTEOPOR W CURRENT PATH FRACTURE UNSP LOWER LEG INIT

S82116B

NONDISP FX OF UNSP TIBIAL SPINE INIT FOR OPN FX TYPE I/2

M80871A

OTH OSTEOPOR W CURRENT PATH FRACTURE RIGHT ANK/FT INIT

S82116C

NONDISP FX OF UNSP TIBIAL SPINE INIT FOR OPN FX TYPE 3A/B/C

M80872A

OTH OSTEOPOR W CURRENT PATH FRACTURE LEFT ANK/FT INIT

S82121A

DISP FX OF LATERAL CONDYLE OF RIGHT TIBIA INIT FOR CLOS FX

M80879A

OTH OSTEOPOR W CURRENT PATH FRACTURE UNSP ANK/FT INIT

S82121B

DISP FX OF LATERAL CONDYLE OF R TIBIA 7THB

M8088XA

OTH OSTEOPOR W CURRENT PATH FRACTURE VERTEBRA(E) INIT

S82121C

DISP FX OF LATERAL CONDYLE OF R TIBIA 7THC

M8430XA

STRESS FRACTURE UNSPECIFIED SITE INIT ENCNTR FOR FRACTURE

S82122A

DISP FX OF LATERAL CONDYLE OF LEFT TIBIA INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84311A

STRESS FRACTURE RIGHT SHOULDER INIT ENCNTR FOR FRACTURE

S82122B

DISP FX OF LATERAL CONDYLE OF L TIBIA 7THB

M84312A

STRESS FRACTURE LEFT SHOULDER INIT ENCNTR FOR FRACTURE

S82122C

DISP FX OF LATERAL CONDYLE OF L TIBIA 7THC

M84319A

STRESS FRACTURE UNSP SHOULDER INIT ENCNTR FOR FRACTURE

S82123A

DISP FX OF LATERAL CONDYLE OF UNSP TIBIA INIT FOR CLOS FX

M84321A

STRESS FRACTURE RIGHT HUMERUS INIT ENCNTR FOR FRACTURE

S82123B

DISP FX OF LATERAL CONDYLE OF UNSP TIBIA 7THB

M84322A

STRESS FRACTURE LEFT HUMERUS INIT ENCNTR FOR FRACTURE

S82123C

DISP FX OF LATERAL CONDYLE OF UNSP TIBIA 7THC

M84329A

STRESS FRACTURE UNSP HUMERUS INIT ENCNTR FOR FRACTURE

S82124A

NONDISP FX OF LATERAL CONDYLE OF RIGHT TIBIA INIT

M84331A

STRESS FRACTURE RIGHT ULNA INITIAL ENCOUNTER FOR FRACTURE

S82124B

NONDISP FX OF LATERAL CONDYLE OF R TIBIA 7THB

M84332A

STRESS FRACTURE LEFT ULNA INITIAL ENCOUNTER FOR FRACTURE

S82124C

NONDISP FX OF LATERAL CONDYLE OF R TIBIA 7THC

M84333A

STRESS FRACTURE RIGHT RADIUS INIT ENCNTR FOR FRACTURE

S82125A

NONDISP FX OF LATERAL CONDYLE OF LEFT TIBIA INIT

M84334A

STRESS FRACTURE LEFT RADIUS INITIAL ENCOUNTER FOR FRACTURE

S82125B

NONDISP FX OF LATERAL CONDYLE OF L TIBIA 7THB

M84339A STRESS FRACTURE UNSP ULNA AND RADIUS INIT FOR FX

S82125C

NONDISP FX OF LATERAL CONDYLE OF L TIBIA 7THC

M84341A

STRESS FRACTURE RIGHT HAND INITIAL ENCOUNTER FOR FRACTURE

S82126A

NONDISP FX OF LATERAL CONDYLE OF UNSP TIBIA INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84342A

STRESS FRACTURE LEFT HAND INITIAL ENCOUNTER FOR FRACTURE

S82126B

NONDISP FX OF LATERAL CONDYLE OF UNSP TIBIA 7THB

M84343A

STRESS FRACTURE UNSPECIFIED HAND INIT ENCNTR FOR FRACTURE

S82126C

NONDISP FX OF LATERAL CONDYLE OF UNSP TIBIA 7THC

M84344A

STRESS FRACTURE RIGHT FINGER(S) INIT ENCNTR FOR FRACTURE

S82131A

DISP FX OF MEDIAL CONDYLE OF RIGHT TIBIA INIT FOR CLOS FX

M84345A

STRESS FRACTURE LEFT FINGER(S) INIT ENCNTR FOR FRACTURE

S82131B

DISP FX OF MED CONDYLE OF R TIBIA INIT FOR OPN FX TYPE I/2

M84346A

STRESS FRACTURE UNSP FINGER(S) INIT ENCNTR FOR FRACTURE

S82131C

DISP FX OF MED CONDYLE OF R TIBIA 7THC

M84350A

STRESS FRACTURE PELVIS INITIAL ENCOUNTER FOR FRACTURE

S82132A

DISP FX OF MEDIAL CONDYLE OF LEFT TIBIA INIT FOR CLOS FX

M84351A

STRESS FRACTURE RIGHT FEMUR INITIAL ENCOUNTER FOR FRACTURE

S82132B

DISP FX OF MED CONDYLE OF L TIBIA INIT FOR OPN FX TYPE I/2

M84352A

STRESS FRACTURE LEFT FEMUR INITIAL ENCOUNTER FOR FRACTURE

S82132C

DISP FX OF MED CONDYLE OF L TIBIA 7THC

M84353A

STRESS FRACTURE UNSPECIFIED FEMUR INIT ENCNTR FOR FRACTURE

S82133A

DISP FX OF MEDIAL CONDYLE OF UNSP TIBIA INIT FOR CLOS FX

M84359A

STRESS FRACTURE HIP UNSPECIFIED INIT ENCNTR FOR FRACTURE

S82133B

DISP FX OF MED CONDYLE OF UNSP TIBIA 7THB

M84361A

STRESS FRACTURE RIGHT TIBIA INITIAL ENCOUNTER FOR FRACTURE

S82133C

DISP FX OF MED CONDYLE OF UNSP TIBIA 7THC

M84362A

STRESS FRACTURE LEFT TIBIA INITIAL ENCOUNTER FOR FRACTURE

S82134A

NONDISP FX OF MEDIAL CONDYLE OF RIGHT TIBIA INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84363A

STRESS FRACTURE RIGHT FIBULA INIT ENCNTR FOR FRACTURE

S82134B

NONDISP FX OF MED CONDYLE OF R TIBIA 7THB

M84364A

STRESS FRACTURE LEFT FIBULA INITIAL ENCOUNTER FOR FRACTURE

S82134C

NONDISP FX OF MED CONDYLE OF R TIBIA 7THC

M84369A STRESS FRACTURE UNSP TIBIA AND FIBULA INIT FOR FX

S82135A

NONDISP FX OF MEDIAL CONDYLE OF LEFT TIBIA INIT FOR CLOS FX

M84371A

STRESS FRACTURE RIGHT ANKLE INITIAL ENCOUNTER FOR FRACTURE

S82135B

NONDISP FX OF MED CONDYLE OF L TIBIA 7THB

M84372A

STRESS FRACTURE LEFT ANKLE INITIAL ENCOUNTER FOR FRACTURE

S82135C

NONDISP FX OF MED CONDYLE OF L TIBIA 7THC

M84373A

STRESS FRACTURE UNSPECIFIED ANKLE INIT ENCNTR FOR FRACTURE

S82136A

NONDISP FX OF MEDIAL CONDYLE OF UNSP TIBIA INIT FOR CLOS FX

M84374A

STRESS FRACTURE RIGHT FOOT INITIAL ENCOUNTER FOR FRACTURE

S82136B

NONDISP FX OF MED CONDYLE OF UNSP TIBIA 7THB

M84375A

STRESS FRACTURE LEFT FOOT INITIAL ENCOUNTER FOR FRACTURE

S82136C

NONDISP FX OF MED CONDYLE OF UNSP TIBIA 7THC

M84376A

STRESS FRACTURE UNSPECIFIED FOOT INIT ENCNTR FOR FRACTURE

S82141A

DISPLACED BICONDYLAR FRACTURE OF RIGHT TIBIA INIT

M84377A STRESS FRACTURE RIGHT TOE(S) INIT ENCNTR FOR FRACTURE

S82141B

DISPLACED BICONDYLAR FX R TIBIA INIT FOR OPN FX TYPE I/2

M84378A

STRESS FRACTURE LEFT TOE(S) INITIAL ENCOUNTER FOR FRACTURE

S82141C

DISPLACED BICONDYLAR FX R TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84379A STRESS FRACTURE UNSP TOE(S) INIT ENCNTR FOR FRACTURE

S82142A

DISPLACED BICONDYLAR FRACTURE OF LEFT TIBIA INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M8438XA

STRESS FRACTURE OTHER SITE INITIAL ENCOUNTER FOR FRACTURE

S82142B

DISPLACED BICONDYLAR FX LEFT TIBIA INIT FOR OPN FX TYPE I/2

M8440XA

PATHOLOGICAL FRACTURE UNSP SITE INIT ENCNTR FOR FRACTURE

S82142C

DISPLACED BICONDYLAR FX L TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84411A PATHOLOGICAL FRACTURE RIGHT SHOULDER INIT FOR FX

S82143A

DISPLACED BICONDYLAR FRACTURE OF UNSP TIBIA INIT

M84412A PATHOLOGICAL FRACTURE LEFT SHOULDER INIT FOR FX

S82143B

DISPLACED BICONDYLAR FX UNSP TIBIA INIT FOR OPN FX TYPE I/2

M84419A PATHOLOGICAL FRACTURE UNSP SHOULDER INIT FOR FX

S82143C

DISPL BICONDYLAR FX UNSP TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84421A PATHOLOGICAL FRACTURE RIGHT HUMERUS INIT FOR FX

S82144A

NONDISPLACED BICONDYLAR FRACTURE OF RIGHT TIBIA INIT

M84422A PATHOLOGICAL FRACTURE LEFT HUMERUS INIT FOR FX

S82144B

NONDISP BICONDYLAR FX RIGHT TIBIA INIT FOR OPN FX TYPE I/2

M84429A PATHOLOGICAL FRACTURE UNSP HUMERUS INIT FOR FX

S82144C

NONDISP BICONDYLAR FX R TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84431A

PATHOLOGICAL FRACTURE RIGHT ULNA INIT ENCNTR FOR FRACTURE

S82145A

NONDISPLACED BICONDYLAR FRACTURE OF LEFT TIBIA INIT

M84432A

PATHOLOGICAL FRACTURE LEFT ULNA INIT ENCNTR FOR FRACTURE

S82145B

NONDISP BICONDYLAR FX LEFT TIBIA INIT FOR OPN FX TYPE I/2

M84433A PATHOLOGICAL FRACTURE RIGHT RADIUS INIT FOR FX

S82145C

NONDISP BICONDYLAR FX L TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84434A

PATHOLOGICAL FRACTURE LEFT RADIUS INIT ENCNTR FOR FRACTURE

S82146A

NONDISPLACED BICONDYLAR FRACTURE OF UNSP TIBIA INIT

M84439A

PATHOLOGICAL FRACTURE UNSP ULNA AND RADIUS INIT FOR FX

S82146B

NONDISP BICONDYLAR FX UNSP TIBIA INIT FOR OPN FX TYPE I/2

M84441A

PATHOLOGICAL FRACTURE RIGHT HAND INIT ENCNTR FOR FRACTURE

S82146C

NONDISP BICONDYLAR FX UNSP TIBIA 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84442A

PATHOLOGICAL FRACTURE LEFT HAND INIT ENCNTR FOR FRACTURE

S82151A

DISP FX OF RIGHT TIBIAL TUBEROSITY INIT FOR CLOS FX

M84443A

PATHOLOGICAL FRACTURE UNSP HAND INIT ENCNTR FOR FRACTURE

S82151B

DISP FX OF RIGHT TIBIAL TUBEROSITY INIT FOR OPN FX TYPE I/2

M84444A PATHOLOGICAL FRACTURE RIGHT FINGER(S) INIT FOR FX

S82151C

DISP FX OF R TIBIAL TUBEROSITY INIT FOR OPN FX TYPE 3A/B/C

M84445A PATHOLOGICAL FRACTURE LEFT FINGER(S) INIT FOR FX

S82152A

DISP FX OF LEFT TIBIAL TUBEROSITY INIT FOR CLOS FX

M84446A PATHOLOGICAL FRACTURE UNSP FINGER(S) INIT FOR FX

S82152B

DISP FX OF LEFT TIBIAL TUBEROSITY INIT FOR OPN FX TYPE I/2

M84451A

PATHOLOGICAL FRACTURE RIGHT FEMUR INIT ENCNTR FOR FRACTURE

S82152C

DISP FX OF L TIBIAL TUBEROSITY INIT FOR OPN FX TYPE 3A/B/C

M84452A

PATHOLOGICAL FRACTURE LEFT FEMUR INIT ENCNTR FOR FRACTURE

S82153A

DISP FX OF UNSP TIBIAL TUBEROSITY INIT FOR CLOS FX

M84453A

PATHOLOGICAL FRACTURE UNSP FEMUR INIT ENCNTR FOR FRACTURE

S82153B

DISP FX OF UNSP TIBIAL TUBEROSITY INIT FOR OPN FX TYPE I/2

M84454A

PATHOLOGICAL FRACTURE PELVIS INIT ENCNTR FOR FRACTURE

S82153C

DISP FX OF UNSP TIBIAL TUBEROSITY 7THC

M84459A

PATHOLOGICAL FRACTURE HIP UNSP INIT ENCNTR FOR FRACTURE

S82154A

NONDISP FX OF RIGHT TIBIAL TUBEROSITY INIT FOR CLOS FX

M84461A

PATHOLOGICAL FRACTURE RIGHT TIBIA INIT ENCNTR FOR FRACTURE

S82154B

NONDISP FX OF R TIBIAL TUBEROSITY INIT FOR OPN FX TYPE I/2

M84462A

PATHOLOGICAL FRACTURE LEFT TIBIA INIT ENCNTR FOR FRACTURE

S82154C

NONDISP FX OF R TIBIAL TUBEROSITY 7THC

M84463A PATHOLOGICAL FRACTURE RIGHT FIBULA INIT FOR FX

S82155A

NONDISP FX OF LEFT TIBIAL TUBEROSITY INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84464A

PATHOLOGICAL FRACTURE LEFT FIBULA INIT ENCNTR FOR FRACTURE

S82155B

NONDISP FX OF L TIBIAL TUBEROSITY INIT FOR OPN FX TYPE I/2

M84469A

PATHOLOGICAL FRACTURE UNSP TIBIA AND FIBULA INIT FOR FX

S82155C

NONDISP FX OF L TIBIAL TUBEROSITY 7THC

M84471A

PATHOLOGICAL FRACTURE RIGHT ANKLE INIT ENCNTR FOR FRACTURE

S82156A

NONDISP FX OF UNSP TIBIAL TUBEROSITY INIT FOR CLOS FX

M84472A

PATHOLOGICAL FRACTURE LEFT ANKLE INIT ENCNTR FOR FRACTURE

S82156B

NONDISP FX OF UNSP TIBIAL TUBEROSITY 7THB

M84473A

PATHOLOGICAL FRACTURE UNSP ANKLE INIT ENCNTR FOR FRACTURE

S82156C

NONDISP FX OF UNSP TIBIAL TUBEROSITY 7THC

M84474A

PATHOLOGICAL FRACTURE RIGHT FOOT INIT ENCNTR FOR FRACTURE

S82161A

TORUS FRACTURE OF UPPER END OF RIGHT TIBIA INIT FOR CLOS FX

M84475A

PATHOLOGICAL FRACTURE LEFT FOOT INIT ENCNTR FOR FRACTURE

S82162A

TORUS FRACTURE OF UPPER END OF LEFT TIBIA INIT FOR CLOS FX

M84476A

PATHOLOGICAL FRACTURE UNSP FOOT INIT ENCNTR FOR FRACTURE

S82169A

TORUS FRACTURE OF UPPER END OF UNSP TIBIA INIT FOR CLOS FX

M84477A PATHOLOGICAL FRACTURE RIGHT TOE(S) INIT FOR FX

S82191A

OTH FRACTURE OF UPPER END OF RIGHT TIBIA INIT FOR CLOS FX

M84478A

PATHOLOGICAL FRACTURE LEFT TOE(S) INIT ENCNTR FOR FRACTURE

S82191B

OTH FX UPPER END OF RIGHT TIBIA INIT FOR OPN FX TYPE I/2

M84479A

PATHOLOGICAL FRACTURE UNSP TOE(S) INIT ENCNTR FOR FRACTURE

S82191C

OTH FX UPPER END OF RIGHT TIBIA INIT FOR OPN FX TYPE 3A/B/C

M8448XA

PATHOLOGICAL FRACTURE OTHER SITE INIT ENCNTR FOR FRACTURE

S82192A

OTH FRACTURE OF UPPER END OF LEFT TIBIA INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M8450XA

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE UNSP SITE INIT

S82192B

OTH FX UPPER END OF LEFT TIBIA INIT FOR OPN FX TYPE I/2

M84511A PATH FRACTURE IN NEOPLASTIC DISEASE R SHOULDER INIT

S82192C

OTH FX UPPER END OF LEFT TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84512A PATH FRACTURE IN NEOPLASTIC DISEASE L SHOULDER INIT

S82199A

OTH FRACTURE OF UPPER END OF UNSP TIBIA INIT FOR CLOS FX

M84519A PATH FRACTURE IN NEOPLASTIC DISEASE UNSP SHOULDER INIT

S82199B

OTH FX UPPER END OF UNSP TIBIA INIT FOR OPN FX TYPE I/2

M84521A

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE R HUMERUS INIT

S82199C

OTH FX UPPER END OF UNSP TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84522A

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE L HUMERUS INIT

S82201A

UNSP FRACTURE OF SHAFT OF RIGHT TIBIA INIT FOR CLOS FX

M84529A PATH FRACTURE IN NEOPLASTIC DISEASE UNSP HUMERUS INIT

S82201B

UNSP FX SHAFT OF RIGHT TIBIA INIT FOR OPN FX TYPE I/2

M84531A PATH FRACTURE IN NEOPLASTIC DISEASE RIGHT ULNA INIT

S82201C

UNSP FX SHAFT OF RIGHT TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84532A

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE LEFT ULNA INIT

S82202A

UNSP FRACTURE OF SHAFT OF LEFT TIBIA INIT FOR CLOS FX

M84533A PATH FRACTURE IN NEOPLASTIC DISEASE RIGHT RADIUS INIT

S82202B

UNSP FX SHAFT OF LEFT TIBIA INIT FOR OPN FX TYPE I/2

M84534A PATH FRACTURE IN NEOPLASTIC DISEASE LEFT RADIUS INIT

S82202C

UNSP FX SHAFT OF LEFT TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84539A

PATH FRACTURE IN NEOPLTC DISEASE UNSP ULNA AND RADIUS INIT

S82209A

UNSP FRACTURE OF SHAFT OF UNSP TIBIA INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84541A PATH FRACTURE IN NEOPLASTIC DISEASE RIGHT HAND INIT

S82209B

UNSP FX SHAFT OF UNSP TIBIA INIT FOR OPN FX TYPE I/2

M84542A

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE LEFT HAND INIT

S82209C

UNSP FX SHAFT OF UNSP TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84549A

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE UNSP HAND INIT

S82221A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF RIGHT TIBIA INIT

M84550A

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE PELVIS INIT

S82221B

DISPL TRANSVERSE FX SHAFT OF R TIBIA 7THB

M84551A PATH FRACTURE IN NEOPLASTIC DISEASE RIGHT FEMUR INIT

S82221C

DISPL TRANSVERSE FX SHAFT OF R TIBIA 7THC

M84552A PATH FRACTURE IN NEOPLASTIC DISEASE LEFT FEMUR INIT

S82222A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF LEFT TIBIA INIT

M84553A PATH FRACTURE IN NEOPLASTIC DISEASE UNSP FEMUR INIT

S82222B

DISPL TRANSVERSE FX SHAFT OF L TIBIA 7THB

M84559A

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE HIP UNSP INIT

S82222C

DISPL TRANSVERSE FX SHAFT OF L TIBIA 7THC

M84561A PATH FRACTURE IN NEOPLASTIC DISEASE RIGHT TIBIA INIT

S82223A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF UNSP TIBIA INIT

M84562A PATH FRACTURE IN NEOPLASTIC DISEASE LEFT TIBIA INIT

S82223B

DISPL TRANSVERSE FX SHAFT OF UNSP TIBIA 7THB

M84563A PATH FRACTURE IN NEOPLASTIC DISEASE RIGHT FIBULA INIT

S82223C

DISPL TRANSVERSE FX SHAFT OF UNSP TIBIA 7THC

M84564A PATH FRACTURE IN NEOPLASTIC DISEASE LEFT FIBULA INIT

S82224A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF RIGHT TIBIA INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84569A PATH FX IN NEOPLTC DISEASE UNSP TIBIA AND FIBULA INIT

S82224B

NONDISP TRANSVERSE FX SHAFT OF R TIBIA 7THB

M84571A PATH FRACTURE IN NEOPLASTIC DISEASE RIGHT ANKLE INIT

S82224C

NONDISP TRANSVERSE FX SHAFT OF R TIBIA 7THC

M84572A PATH FRACTURE IN NEOPLASTIC DISEASE LEFT ANKLE INIT

S82225A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF LEFT TIBIA INIT

M84573A PATH FRACTURE IN NEOPLASTIC DISEASE UNSP ANKLE INIT

S82225B

NONDISP TRANSVERSE FX SHAFT OF L TIBIA 7THB

M84574A PATH FRACTURE IN NEOPLASTIC DISEASE RIGHT FOOT INIT

S82225C

NONDISP TRANSVERSE FX SHAFT OF L TIBIA 7THC

M84575A

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE LEFT FOOT INIT

S82226A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF UNSP TIBIA INIT

M84576A

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE UNSP FOOT INIT

S82226B

NONDISP TRANSVERSE FX SHAFT OF UNSP TIBIA 7THB

M8458XA

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE OTH SITE INIT

S82226C

NONDISP TRANSVERSE FX SHAFT OF UNSP TIBIA 7THC

M8460XA

PATHOLOGICAL FRACTURE IN OTH DISEASE UNSP SITE INIT FOR FX

S82231A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT TIBIA INIT

M84611A

PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT SHOULDER INIT

S82231B

DISPL OBLIQUE FX SHAFT OF R TIBIA INIT FOR OPN FX TYPE I/2

M84612A

PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT SHOULDER INIT

S82231C

DISPL OBLIQUE FX SHAFT OF R TIBIA 7THC

M84619A

PATHOLOGICAL FRACTURE IN OTH DISEASE UNSP SHOULDER INIT

S82232A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT TIBIA INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84621A

PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT HUMERUS INIT

S82232B

DISPL OBLIQUE FX SHAFT OF L TIBIA INIT FOR OPN FX TYPE I/2

M84622A

PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT HUMERUS INIT

S82232C

DISPL OBLIQUE FX SHAFT OF L TIBIA 7THC

M84629A

PATHOLOGICAL FRACTURE IN OTH DISEASE UNSP HUMERUS INIT

S82233A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF UNSP TIBIA INIT

M84631A PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT ULNA INIT

S82233B

DISPL OBLIQUE FX SHAFT OF UNSP TIBIA 7THB

M84632A

PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT ULNA INIT FOR FX

S82233C

DISPL OBLIQUE FX SHAFT OF UNSP TIBIA 7THC

M84633A

PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT RADIUS INIT

S82234A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT TIBIA INIT

M84634A PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT RADIUS INIT

S82234B

NONDISP OBLIQUE FX SHAFT OF R TIBIA 7THB

M84639A

PATH FRACTURE IN OTH DISEASE UNSP ULNA AND RADIUS INIT

S82234C

NONDISP OBLIQUE FX SHAFT OF R TIBIA 7THC

M84641A PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT HAND INIT

S82235A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT TIBIA INIT

M84642A

PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT HAND INIT FOR FX

S82235B

NONDISP OBLIQUE FX SHAFT OF L TIBIA 7THB

M84649A

PATHOLOGICAL FRACTURE IN OTH DISEASE UNSP HAND INIT FOR FX

S82235C

NONDISP OBLIQUE FX SHAFT OF L TIBIA 7THC

M84650A

PATHOLOGICAL FRACTURE IN OTH DISEASE PELVIS INIT FOR FX

S82236A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF UNSP TIBIA INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84651A

PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT FEMUR INIT

S82236B

NONDISP OBLIQUE FX SHAFT OF UNSP TIBIA 7THB

M84652A PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT FEMUR INIT

S82236C

NONDISP OBLIQUE FX SHAFT OF UNSP TIBIA 7THC

M84653A PATHOLOGICAL FRACTURE IN OTH DISEASE UNSP FEMUR INIT

S82241A

DISPLACED SPIRAL FRACTURE OF SHAFT OF RIGHT TIBIA INIT

M84659A

PATHOLOGICAL FRACTURE IN OTH DISEASE HIP UNSP INIT FOR FX

S82241B

DISPL SPIRAL FX SHAFT OF R TIBIA INIT FOR OPN FX TYPE I/2

M84661A PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT TIBIA INIT

S82241C

DISPL SPIRAL FX SHAFT OF R TIBIA 7THC

M84662A PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT TIBIA INIT

S82242A

DISPLACED SPIRAL FRACTURE OF SHAFT OF LEFT TIBIA INIT

M84663A PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT FIBULA INIT

S82242B

DISPL SPIRAL FX SHAFT OF L TIBIA INIT FOR OPN FX TYPE I/2

M84664A PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT FIBULA INIT

S82242C

DISPL SPIRAL FX SHAFT OF L TIBIA 7THC

M84669A

PATH FRACTURE IN OTH DISEASE UNSP TIBIA AND FIBULA INIT

S82243A

DISPLACED SPIRAL FRACTURE OF SHAFT OF UNSP TIBIA INIT

M84671A PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT ANKLE INIT

S82243B

DISPL SPIRAL FX SHAFT OF UNSP TIBIA 7THB

M84672A PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT ANKLE INIT

S82243C

DISPL SPIRAL FX SHAFT OF UNSP TIBIA 7THC

M84673A PATHOLOGICAL FRACTURE IN OTH DISEASE UNSP ANKLE INIT

S82244A

NONDISPLACED SPIRAL FRACTURE OF SHAFT OF RIGHT TIBIA INIT

M84674A PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT FOOT INIT

S82244B

NONDISP SPIRAL FX SHAFT OF R TIBIA INIT FOR OPN FX TYPE I/2

M84675A

PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT FOOT INIT FOR FX

S82244C

NONDISP SPIRAL FX SHAFT OF R TIBIA 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84676A

PATHOLOGICAL FRACTURE IN OTH DISEASE UNSP FOOT INIT FOR FX

S82245A

NONDISPLACED SPIRAL FRACTURE OF SHAFT OF LEFT TIBIA INIT

M8468XA

PATHOLOGICAL FRACTURE IN OTH DISEASE OTH SITE INIT FOR FX

S82245B

NONDISP SPIRAL FX SHAFT OF L TIBIA INIT FOR OPN FX TYPE I/2

M84750A

Atypical femoral fracture unspecified initial encounter for fracture

S82245C

NONDISP SPIRAL FX SHAFT OF L TIBIA 7THC

M84751A

Incomplete atypical femoral fracture right leg initial encounter for fracture

S82246A

NONDISPLACED SPIRAL FRACTURE OF SHAFT OF UNSP TIBIA INIT

M84752A

Incomplete atypical femoral fracture left leg initial encounter for fracture

S82246B

NONDISP SPIRAL FX SHAFT OF UNSP TIBIA 7THB

M84753A

Incomplete atypical femoral fracture unspecified leg initial encounter for fracture

S82246C

NONDISP SPIRAL FX SHAFT OF UNSP TIBIA 7THC

M84754A

Complete transverse atypical femoral fracture right leg initial encounter for fracture

S82251A

DISPLACED COMMINUTED FRACTURE OF SHAFT OF RIGHT TIBIA INIT

M84755A

Complete transverse atypical femoral fracture left leg initial encounter for fracture

S82251B

DISPL COMMNT FX SHAFT OF R TIBIA INIT FOR OPN FX TYPE I/2

M84756A

Complete transverse atypical femoral fracture unspecified leg initial encounter for fracture

S82251C

DISPL COMMNT FX SHAFT OF R TIBIA 7THC

M84757A

Complete oblique atypical femoral fracture right leg initial encounter for fracture

S82252A

DISPLACED COMMINUTED FRACTURE OF SHAFT OF LEFT TIBIA INIT

M84758A

Complete oblique atypical femoral fracture, left leg, initial encounter for fracture

S82252B

DISPL COMMNT FX SHAFT OF L TIBIA INIT FOR OPN FX TYPE I/2

M84759A

Complete oblique atypical femoral fracture unspecified leg initial encounter for fracture

S82252C

DISPL COMMNT FX SHAFT OF L TIBIA 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M8480

OTHER DISORDERS OF CONTINUITY OF BONE UNSPECIFIED SITE

S82253A

DISPLACED COMMINUTED FRACTURE OF SHAFT OF UNSP TIBIA INIT

M84811

OTHER DISORDERS OF CONTINUITY OF BONE RIGHT SHOULDER

S82253B

DISPL COMMNT FX SHAFT OF UNSP TIBIA 7THB

M84812

OTHER DISORDERS OF CONTINUITY OF BONE LEFT SHOULDER

S82253C

DISPL COMMNT FX SHAFT OF UNSP TIBIA 7THC

M84819

OTHER DISORDERS OF CONTINUITY OF BONE UNSPECIFIED SHOULDER

S82254A

NONDISP COMMINUTED FRACTURE OF SHAFT OF RIGHT TIBIA INIT

M84821

OTHER DISORDERS OF CONTINUITY OF BONE RIGHT HUMERUS

S82254B

NONDISP COMMNT FX SHAFT OF R TIBIA INIT FOR OPN FX TYPE I/2

M84822

OTHER DISORDERS OF CONTINUITY OF BONE LEFT HUMERUS

S82254C

NONDISP COMMNT FX SHAFT OF R TIBIA 7THC

M84829

OTHER DISORDERS OF CONTINUITY OF BONE UNSPECIFIED HUMERUS

S82255A

NONDISP COMMINUTED FRACTURE OF SHAFT OF LEFT TIBIA INIT

M84831

OTHER DISORDERS OF CONTINUITY OF BONE RIGHT ULNA

S82255B

NONDISP COMMNT FX SHAFT OF L TIBIA INIT FOR OPN FX TYPE I/2

M84832

OTHER DISORDERS OF CONTINUITY OF BONE LEFT ULNA

S82255C

NONDISP COMMNT FX SHAFT OF L TIBIA 7THC

M84833

OTHER DISORDERS OF CONTINUITY OF BONE RIGHT RADIUS

S82256A

NONDISP COMMINUTED FRACTURE OF SHAFT OF UNSP TIBIA INIT

M84834

OTHER DISORDERS OF CONTINUITY OF BONE LEFT RADIUS

S82256B

NONDISP COMMNT FX SHAFT OF UNSP TIBIA 7THB

M84839

OTHER DISORDERS OF CONTINUITY OF BONE UNSP ULNA AND RADIUS

S82256C

NONDISP COMMNT FX SHAFT OF UNSP TIBIA 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84841

OTHER DISORDERS OF CONTINUITY OF BONE RIGHT HAND

S82261A

DISPLACED SEGMENTAL FRACTURE OF SHAFT OF RIGHT TIBIA INIT

M84842

OTHER DISORDERS OF CONTINUITY OF BONE LEFT HAND

S82261B

DISPL SEG FX SHAFT OF R TIBIA INIT FOR OPN FX TYPE I/2

M84849

OTHER DISORDERS OF CONTINUITY OF BONE UNSPECIFIED HAND

S82261C

DISPL SEG FX SHAFT OF R TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84851

OTH DISORD OF CONTINUITY OF BONE RIGHT PELV RGN AND THIGH

S82262A

DISPLACED SEGMENTAL FRACTURE OF SHAFT OF LEFT TIBIA INIT

M84852

OTH DISORD OF CONTINUITY OF BONE LEFT PELV REGION AND THIGH

S82262B

DISPL SEG FX SHAFT OF L TIBIA INIT FOR OPN FX TYPE I/2

M84859

OTH DISORD OF CONTINUITY OF BONE UNSP PELV REGION AND THIGH

S82262C

DISPL SEG FX SHAFT OF L TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84861

OTHER DISORDERS OF CONTINUITY OF BONE RIGHT TIBIA

S82263A

DISPLACED SEGMENTAL FRACTURE OF SHAFT OF UNSP TIBIA INIT

M84862

OTHER DISORDERS OF CONTINUITY OF BONE LEFT TIBIA

S82263B

DISPL SEG FX SHAFT OF UNSP TIBIA INIT FOR OPN FX TYPE I/2

M84863

OTHER DISORDERS OF CONTINUITY OF BONE RIGHT FIBULA

S82263C

DISPL SEG FX SHAFT OF UNSP TIBIA 7THC

M84864

OTHER DISORDERS OF CONTINUITY OF BONE LEFT FIBULA

S82264A

NONDISP SEGMENTAL FRACTURE OF SHAFT OF RIGHT TIBIA INIT

M84869

OTHER DISORDERS OF CONTINUITY OF BONE UNSP TIBIA AND FIBULA

S82264B

NONDISP SEG FX SHAFT OF R TIBIA INIT FOR OPN FX TYPE I/2

M84871

OTHER DISORDERS OF CONTINUITY OF BONE RIGHT ANKLE AND FOOT

S82264C

NONDISP SEG FX SHAFT OF R TIBIA INIT FOR OPN FX TYPE 3A/B/C

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84872

OTHER DISORDERS OF CONTINUITY OF BONE LEFT ANKLE AND FOOT

S82265A

NONDISPLACED SEGMENTAL FRACTURE OF SHAFT OF LEFT TIBIA INIT

M84879

OTHER DISORDERS OF CONTINUITY OF BONE UNSP ANKLE AND FOOT

S82265B

NONDISP SEG FX SHAFT OF L TIBIA INIT FOR OPN FX TYPE I/2

M8488

OTHER DISORDERS OF CONTINUITY OF BONE OTHER SITE

S82265C

NONDISP SEG FX SHAFT OF L TIBIA INIT FOR OPN FX TYPE 3A/B/C

M849 DISORDER OF CONTINUITY OF BONE UNSPECIFIED

S82266A

NONDISPLACED SEGMENTAL FRACTURE OF SHAFT OF UNSP TIBIA INIT

M8600

ACUTE HEMATOGENOUS OSTEOMYELITIS UNSPECIFIED SITE

S82266B

NONDISP SEG FX SHAFT OF UNSP TIBIA INIT FOR OPN FX TYPE I/2

M86011

ACUTE HEMATOGENOUS OSTEOMYELITIS RIGHT SHOULDER

S82266C

NONDISP SEG FX SHAFT OF UNSP TIBIA 7THC

M86012

ACUTE HEMATOGENOUS OSTEOMYELITIS LEFT SHOULDER

S82291A

OTH FRACTURE OF SHAFT OF RIGHT TIBIA INIT FOR CLOS FX

M86019

ACUTE HEMATOGENOUS OSTEOMYELITIS UNSPECIFIED SHOULDER

S82291B

OTH FX SHAFT OF RIGHT TIBIA INIT FOR OPN FX TYPE I/2

M86021

ACUTE HEMATOGENOUS OSTEOMYELITIS RIGHT HUMERUS

S82291C

OTH FX SHAFT OF RIGHT TIBIA INIT FOR OPN FX TYPE 3A/B/C

M86022 ACUTE HEMATOGENOUS OSTEOMYELITIS LEFT HUMERUS

S82292A

OTH FRACTURE OF SHAFT OF LEFT TIBIA INIT FOR CLOS FX

M86029

ACUTE HEMATOGENOUS OSTEOMYELITIS UNSPECIFIED HUMERUS

S82292B

OTH FX SHAFT OF LEFT TIBIA INIT FOR OPN FX TYPE I/2

M86031

ACUTE HEMATOGENOUS OSTEOMYELITIS RIGHT RADIUS AND ULNA

S82292C

OTH FX SHAFT OF LEFT TIBIA INIT FOR OPN FX TYPE 3A/B/C

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M86032

ACUTE HEMATOGENOUS OSTEOMYELITIS LEFT RADIUS AND ULNA

S82299A

OTH FRACTURE OF SHAFT OF UNSP TIBIA INIT FOR CLOS FX

M86039

ACUTE HEMATOGENOUS OSTEOMYELITIS UNSP RADIUS AND ULNA

S82299B

OTH FX SHAFT OF UNSP TIBIA INIT FOR OPN FX TYPE I/2

M86041 ACUTE HEMATOGENOUS OSTEOMYELITIS RIGHT HAND

S82299C

OTH FX SHAFT OF UNSP TIBIA INIT FOR OPN FX TYPE 3A/B/C

M86042 ACUTE HEMATOGENOUS OSTEOMYELITIS LEFT HAND

S82301A

UNSP FRACTURE OF LOWER END OF RIGHT TIBIA INIT FOR CLOS FX

M86049

ACUTE HEMATOGENOUS OSTEOMYELITIS UNSPECIFIED HAND

S82301B

UNSP FX LOWER END OF RIGHT TIBIA INIT FOR OPN FX TYPE I/2

M86051 ACUTE HEMATOGENOUS OSTEOMYELITIS RIGHT FEMUR

S82301C

UNSP FX LOWER END OF R TIBIA INIT FOR OPN FX TYPE 3A/B/C

M86052 ACUTE HEMATOGENOUS OSTEOMYELITIS LEFT FEMUR

S82302A

UNSP FRACTURE OF LOWER END OF LEFT TIBIA INIT FOR CLOS FX

M86059

ACUTE HEMATOGENOUS OSTEOMYELITIS UNSPECIFIED FEMUR

S82302B

UNSP FX LOWER END OF LEFT TIBIA INIT FOR OPN FX TYPE I/2

M86061

ACUTE HEMATOGENOUS OSTEOMYELITIS RIGHT TIBIA AND FIBULA

S82302C

UNSP FX LOWER END OF LEFT TIBIA INIT FOR OPN FX TYPE 3A/B/C

M86062

ACUTE HEMATOGENOUS OSTEOMYELITIS LEFT TIBIA AND FIBULA

S82309A

UNSP FRACTURE OF LOWER END OF UNSP TIBIA INIT FOR CLOS FX

M86069

ACUTE HEMATOGENOUS OSTEOMYELITIS UNSP TIBIA AND FIBULA

S82309B

UNSP FX LOWER END OF UNSP TIBIA INIT FOR OPN FX TYPE I/2

M86071

ACUTE HEMATOGENOUS OSTEOMYELITIS RIGHT ANKLE AND FOOT

S82309C

UNSP FX LOWER END OF UNSP TIBIA INIT FOR OPN FX TYPE 3A/B/C

M86072

ACUTE HEMATOGENOUS OSTEOMYELITIS LEFT ANKLE AND FOOT

S82311A

TORUS FRACTURE OF LOWER END OF RIGHT TIBIA INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M86079

ACUTE HEMATOGENOUS OSTEOMYELITIS UNSPECIFIED ANKLE AND FOOT

S82312A

TORUS FRACTURE OF LOWER END OF LEFT TIBIA INIT FOR CLOS FX

M8608 ACUTE HEMATOGENOUS OSTEOMYELITIS OTHER SITES

S82319A

TORUS FRACTURE OF LOWER END OF UNSP TIBIA INIT FOR CLOS FX

M8609

ACUTE HEMATOGENOUS OSTEOMYELITIS MULTIPLE SITES

S82391A

OTH FRACTURE OF LOWER END OF RIGHT TIBIA INIT FOR CLOS FX

M8610 OTHER ACUTE OSTEOMYELITIS UNSPECIFIED SITE

S82391B

OTH FX LOWER END OF RIGHT TIBIA INIT FOR OPN FX TYPE I/2

M86111 OTHER ACUTE OSTEOMYELITIS RIGHT SHOULDER

S82391C

OTH FX LOWER END OF RIGHT TIBIA INIT FOR OPN FX TYPE 3A/B/C

M86112 OTHER ACUTE OSTEOMYELITIS LEFT SHOULDER

S82392A

OTH FRACTURE OF LOWER END OF LEFT TIBIA INIT FOR CLOS FX

M86119 OTHER ACUTE OSTEOMYELITIS UNSPECIFIED SHOULDER

S82392B

OTH FX LOWER END OF LEFT TIBIA INIT FOR OPN FX TYPE I/2

M86121 OTHER ACUTE OSTEOMYELITIS RIGHT HUMERUS

S82392C

OTH FX LOWER END OF LEFT TIBIA INIT FOR OPN FX TYPE 3A/B/C

M86122 OTHER ACUTE OSTEOMYELITIS LEFT HUMERUS

S82399A

OTH FRACTURE OF LOWER END OF UNSP TIBIA INIT FOR CLOS FX

M86129 OTHER ACUTE OSTEOMYELITIS UNSPECIFIED HUMERUS

S82399B

OTH FX LOWER END OF UNSP TIBIA INIT FOR OPN FX TYPE I/2

M86131 OTHER ACUTE OSTEOMYELITIS RIGHT RADIUS AND ULNA

S82399C

OTH FX LOWER END OF UNSP TIBIA INIT FOR OPN FX TYPE 3A/B/C

M86132 OTHER ACUTE OSTEOMYELITIS LEFT RADIUS AND ULNA

S82401A

UNSP FRACTURE OF SHAFT OF RIGHT FIBULA INIT FOR CLOS FX

M86139

OTHER ACUTE OSTEOMYELITIS UNSPECIFIED RADIUS AND ULNA

S82401B

UNSP FRACTURE OF SHAFT OF R FIBULA INIT FOR OPN FX TYPE I/2

M86141 OTHER ACUTE OSTEOMYELITIS RIGHT HAND

S82401C

UNSP FX SHAFT OF R FIBULA INIT FOR OPN FX TYPE 3A/B/C

M86142 OTHER ACUTE OSTEOMYELITIS LEFT HAND

S82402A

UNSP FRACTURE OF SHAFT OF LEFT FIBULA INIT FOR CLOS FX

M86149 OTHER ACUTE OSTEOMYELITIS UNSPECIFIED HAND

S82402B

UNSP FX SHAFT OF LEFT FIBULA INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M86151 OTHER ACUTE OSTEOMYELITIS RIGHT FEMUR

S82402C

UNSP FX SHAFT OF LEFT FIBULA INIT FOR OPN FX TYPE 3A/B/C

M86152 OTHER ACUTE OSTEOMYELITIS LEFT FEMUR

S82409A

UNSP FRACTURE OF SHAFT OF UNSP FIBULA INIT FOR CLOS FX

M86159 OTHER ACUTE OSTEOMYELITIS UNSPECIFIED FEMUR

S82409B

UNSP FX SHAFT OF UNSP FIBULA INIT FOR OPN FX TYPE I/2

M86161 OTHER ACUTE OSTEOMYELITIS RIGHT TIBIA AND FIBULA

S82409C

UNSP FX SHAFT OF UNSP FIBULA INIT FOR OPN FX TYPE 3A/B/C

M86162 OTHER ACUTE OSTEOMYELITIS LEFT TIBIA AND FIBULA

S82421A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF RIGHT FIBULA INIT

M86169 OTHER ACUTE OSTEOMYELITIS UNSPECIFIED TIBIA AND FIBULA

S82421B

DISPL TRANSVERSE FX SHAFT OF R FIBULA 7THB

M86171 OTHER ACUTE OSTEOMYELITIS RIGHT ANKLE AND FOOT

S82421C

DISPL TRANSVERSE FX SHAFT OF R FIBULA 7THC

M86172 OTHER ACUTE OSTEOMYELITIS LEFT ANKLE AND FOOT

S82422A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF LEFT FIBULA INIT

M86179 OTHER ACUTE OSTEOMYELITIS UNSPECIFIED ANKLE AND FOOT

S82422B

DISPL TRANSVERSE FX SHAFT OF L FIBULA 7THB

M8618 OTHER ACUTE OSTEOMYELITIS OTHER SITE

S82422C

DISPL TRANSVERSE FX SHAFT OF L FIBULA 7THC

M8619 OTHER ACUTE OSTEOMYELITIS MULTIPLE SITES

S82423A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF UNSP FIBULA INIT

M93011 ACUTE SLIPPED UPPER FEMORAL EPIPHYSIS RIGHT HIP

S82423B

DISPL TRANSVERSE FX SHAFT OF UNSP FIBULA 7THB

M93012 ACUTE SLIPPED UPPER FEMORAL EPIPHYSIS LEFT HIP

S82423C

DISPL TRANSVERSE FX SHAFT OF UNSP FIBULA 7THC

M93013 ACUTE SLIPPED UPPER FEMORAL EPIPHYSIS UNSP HIP

S82424A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF RIGHT FIBULA INIT

M93031

ACUTE ON CHRONIC SLIPPED UPPER FEMORAL EPIPHYSIS RIGHT HIP

S82424B

NONDISP TRANSVERSE FX SHAFT OF R FIBULA 7THB

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M93032

ACUTE ON CHRONIC SLIPPED UPPER FEMORAL EPIPHYSIS LEFT HIP

S82424C

NONDISP TRANSVERSE FX SHAFT OF R FIBULA 7THC

M93033

ACUTE ON CHRONIC SLIPPED UPPER FEMORAL EPIPHYSIS UNSP HIP

S82425A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF LEFT FIBULA INIT

M96621

FX HUMERUS FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT RIGHT ARM

S82425B

NONDISP TRANSVERSE FX SHAFT OF L FIBULA 7THB

M96622

FX HUMERUS FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT LEFT ARM

S82425C

NONDISP TRANSVERSE FX SHAFT OF L FIBULA 7THC

M96629

FX HUMERUS FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT UNSP ARM

S82426A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF UNSP FIBULA INIT

M96631

FX RAD/ULNA FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT R ARM

S82426B

NONDISP TRANSVERSE FX SHAFT OF UNSP FIBULA 7THB

M96632

FX RAD/ULNA FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT LEFT ARM

S82426C

NONDISP TRANSVERSE FX SHAFT OF UNSP FIBULA 7THC

M96639

FX RAD/ULNA FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT UNSP ARM

S82431A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT FIBULA INIT

M9665

FX PELVIS FOLLOWING INSRT ORTHO IMPLNT/PROSTH/BONE PLT

S82431B

DISPL OBLIQUE FX SHAFT OF R FIBULA INIT FOR OPN FX TYPE I/2

M96661

FX FEMUR FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT RIGHT LEG

S82431C

DISPL OBLIQUE FX SHAFT OF R FIBULA 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M96662

FX FEMUR FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT LEFT LEG

S82432A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT FIBULA INIT

M96669

FX FEMUR FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT UNSP LEG

S82432B

DISPL OBLIQUE FX SHAFT OF L FIBULA INIT FOR OPN FX TYPE I/2

M96671

FX TIB/FIB FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT RIGHT LEG

S82432C

DISPL OBLIQUE FX SHAFT OF L FIBULA 7THC

M96672

FX TIB/FIB FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT LEFT LEG

S82433A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF UNSP FIBULA INIT

M96679

FX TIB/FIB FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT UNSP LEG

S82433B

DISPL OBLIQUE FX SHAFT OF UNSP FIBULA 7THB

M96840

Postprocedural hematoma of a musculoskeletal structure following a musculoskeletal system procedure

S82433C

DISPL OBLIQUE FX SHAFT OF UNSP FIBULA 7THC

M96841

Postprocedural hematoma of a musculoskeletal structure following other procedure

S82434A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT FIBULA INIT

M96842

Postprocedural seroma of a musculoskeletal structure following a musculoskeletal system procedure

S82434B

NONDISP OBLIQUE FX SHAFT OF R FIBULA 7THB

M96843

Postprocedural seroma of a musculoskeletal structure following other procedure

S82434C

NONDISP OBLIQUE FX SHAFT OF R FIBULA 7THC

M9701XA

Periprosthetic fracture around internal prosthetic right hip joint initial encounter

S82435A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT FIBULA INIT

M9702XA

Periprosthetic fracture around internal prosthetic left hip joint initial encounter

S82435B

NONDISP OBLIQUE FX SHAFT OF L FIBULA 7THB

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M9711XA

Periprosthetic fracture around internal prosthetic right knee joint initial encounter

S82435C

NONDISP OBLIQUE FX SHAFT OF L FIBULA 7THC

M9712XA

Periprosthetic fracture around internal prosthetic left knee joint initial encounter

S82436A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF UNSP FIBULA INIT

M9721XA

Periprosthetic fracture around internal prosthetic right ankle joint initial encounter

S82436B

NONDISP OBLIQUE FX SHAFT OF UNSP FIBULA 7THB

M9722XA

Periprosthetic fracture around internal prosthetic left ankle joint initial encounter

S82436C

NONDISP OBLIQUE FX SHAFT OF UNSP FIBULA 7THC

M9731XA

Periprosthetic fracture around internal prosthetic right shoulder joint initial encounter

S82441A

DISPLACED SPIRAL FRACTURE OF SHAFT OF RIGHT FIBULA INIT

M9732XA

Periprosthetic fracture around internal prosthetic left shoulder joint initial encounter

S82441B

DISPL SPIRAL FX SHAFT OF R FIBULA INIT FOR OPN FX TYPE I/2

M9741XA

Periprosthetic fracture around internal prosthetic right elbow joint initial encounter

S82441C

DISPL SPIRAL FX SHAFT OF R FIBULA 7THC

M9742XA

Periprosthetic fracture around internal prosthetic left elbow joint initial encounter

S82442A

DISPLACED SPIRAL FRACTURE OF SHAFT OF LEFT FIBULA INIT

M978XXA

Periprosthetic fracture around other internal prosthetic joint initial encounter

S82442B

DISPL SPIRAL FX SHAFT OF L FIBULA INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M979XXA

Periprosthetic fracture around unspecified internal prosthetic joint initial encounter

S82442C

DISPL SPIRAL FX SHAFT OF L FIBULA 7THC

N130

Hydronephrosis with ureteropelvic junction obstruction

S82443A

DISPLACED SPIRAL FRACTURE OF SHAFT OF UNSP FIBULA INIT

N170 ACUTE KIDNEY FAILURE WITH TUBULAR NECROSIS

S82443B

DISPL SPIRAL FX SHAFT OF UNSP FIBULA 7THB

N171 ACUTE KIDNEY FAILURE WITH ACUTE CORTICAL NECROSIS

S82443C

DISPL SPIRAL FX SHAFT OF UNSP FIBULA 7THC

N172 ACUTE KIDNEY FAILURE WITH MEDULLARY NECROSIS

S82444A

NONDISPLACED SPIRAL FRACTURE OF SHAFT OF RIGHT FIBULA INIT

N178 OTHER ACUTE KIDNEY FAILURE

S82444B NONDISP SPIRAL FX SHAFT OF R FIBULA 7THB

N179 ACUTE KIDNEY FAILURE UNSPECIFIED

S82444C

NONDISP SPIRAL FX SHAFT OF R FIBULA 7THC

N181 CHRONIC KIDNEY DISEASE STAGE 1

S82445A

NONDISPLACED SPIRAL FRACTURE OF SHAFT OF LEFT FIBULA INIT

N182 CHRONIC KIDNEY DISEASE STAGE 2 (MILD)

S82445B

NONDISP SPIRAL FX SHAFT OF L FIBULA 7THB

N183 CHRONIC KIDNEY DISEASE STAGE 3 (MODERATE)

S82445C

NONDISP SPIRAL FX SHAFT OF L FIBULA 7THC

N184 CHRONIC KIDNEY DISEASE STAGE 4 (SEVERE)

S82446A

NONDISPLACED SPIRAL FRACTURE OF SHAFT OF UNSP FIBULA INIT

N185 CHRONIC KIDNEY DISEASE STAGE 5

S82446B

NONDISP SPIRAL FX SHAFT OF UNSP FIBULA 7THB

N186 END STAGE RENAL DISEASE

S82446C NONDISP SPIRAL FX SHAFT OF UNSP FIBULA 7THC

N189 CHRONIC KIDNEY DISEASE UNSPECIFIED

S82451A

DISPLACED COMMINUTED FRACTURE OF SHAFT OF RIGHT FIBULA INIT

N19 UNSPECIFIED KIDNEY FAILURE

S82451B DISPL COMMNT FX SHAFT OF R FIBULA INIT FOR OPN FX TYPE I/2

N200 CALCULUS OF KIDNEY

S82451C DISPL COMMNT FX SHAFT OF R FIBULA 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N201 CALCULUS OF URETER

S82452A DISPLACED COMMINUTED FRACTURE OF SHAFT OF LEFT FIBULA INIT

N202 CALCULUS OF KIDNEY WITH CALCULUS OF URETER

S82452B

DISPL COMMNT FX SHAFT OF L FIBULA INIT FOR OPN FX TYPE I/2

N209 URINARY CALCULUS UNSPECIFIED

S82452C

DISPL COMMNT FX SHAFT OF L FIBULA 7THC

N210 CALCULUS IN BLADDER

S82453A DISPLACED COMMINUTED FRACTURE OF SHAFT OF UNSP FIBULA INIT

N211 CALCULUS IN URETHRA

S82453B DISPL COMMNT FX SHAFT OF UNSP FIBULA 7THB

N218 OTHER LOWER URINARY TRACT CALCULUS

S82453C

DISPL COMMNT FX SHAFT OF UNSP FIBULA 7THC

N219 CALCULUS OF LOWER URINARY TRACT UNSPECIFIED

S82454A

NONDISP COMMINUTED FRACTURE OF SHAFT OF RIGHT FIBULA INIT

N22

CALCULUS OF URINARY TRACT IN DISEASES CLASSIFIED ELSEWHERE

S82454B

NONDISP COMMNT FX SHAFT OF R FIBULA 7THB

N23 UNSPECIFIED RENAL COLIC

S82454C NONDISP COMMNT FX SHAFT OF R FIBULA 7THC

N250 RENAL OSTEODYSTROPHY

S82455A NONDISP COMMINUTED FRACTURE OF SHAFT OF LEFT FIBULA INIT

N251 NEPHROGENIC DIABETES INSIPIDUS

S82455B

NONDISP COMMNT FX SHAFT OF L FIBULA 7THB

N2581

SECONDARY HYPERPARATHYROIDISM OF RENAL ORIGIN

S82455C

NONDISP COMMNT FX SHAFT OF L FIBULA 7THC

N2589

OTH DISORDERS RESULTING FROM IMPAIRED RENAL TUBULAR FUNCTION

S82456A

NONDISP COMMINUTED FRACTURE OF SHAFT OF UNSP FIBULA INIT

N259

DISORDER RSLT FROM IMPAIRED RENAL TUBULAR FUNCTION UNSP

S82456B

NONDISP COMMNT FX SHAFT OF UNSP FIBULA 7THB

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N261 ATROPHY OF KIDNEY (TERMINAL)

S82456C

NONDISP COMMNT FX SHAFT OF UNSP FIBULA 7THC

N262 PAGE KIDNEY

S82461A DISPLACED SEGMENTAL FRACTURE OF SHAFT OF RIGHT FIBULA INIT

N269 RENAL SCLEROSIS UNSPECIFIED

S82461B DISPL SEG FX SHAFT OF R FIBULA INIT FOR OPN FX TYPE I/2

N270 SMALL KIDNEY UNILATERAL

S82461C DISPL SEG FX SHAFT OF R FIBULA INIT FOR OPN FX TYPE 3A/B/C

N271 SMALL KIDNEY BILATERAL

S82462A DISPLACED SEGMENTAL FRACTURE OF SHAFT OF LEFT FIBULA INIT

N279 SMALL KIDNEY UNSPECIFIED

S82462B DISPL SEG FX SHAFT OF L FIBULA INIT FOR OPN FX TYPE I/2

N280 ISCHEMIA AND INFARCTION OF KIDNEY

S82462C

DISPL SEG FX SHAFT OF L FIBULA INIT FOR OPN FX TYPE 3A/B/C

N281 CYST OF KIDNEY ACQUIRED

S82463A DISPLACED SEGMENTAL FRACTURE OF SHAFT OF UNSP FIBULA INIT

N2881 HYPERTROPHY OF KIDNEY

S82463B DISPL SEG FX SHAFT OF UNSP FIBULA INIT FOR OPN FX TYPE I/2

N2882 MEGALOURETER

S82463C DISPL SEG FX SHAFT OF UNSP FIBULA 7THC

N2883 NEPHROPTOSIS

S82464A NONDISP SEGMENTAL FRACTURE OF SHAFT OF RIGHT FIBULA INIT

N2884 PYELITIS CYSTICA

S82464B NONDISP SEG FX SHAFT OF R FIBULA INIT FOR OPN FX TYPE I/2

N2885 PYELOURETERITIS CYSTICA

S82464C NONDISP SEG FX SHAFT OF R FIBULA 7THC

N2886 URETERITIS CYSTICA

S82465A NONDISP SEGMENTAL FRACTURE OF SHAFT OF LEFT FIBULA INIT

N2889 OTHER SPECIFIED DISORDERS OF KIDNEY AND URETER

S82465B

NONDISP SEG FX SHAFT OF L FIBULA INIT FOR OPN FX TYPE I/2

N289 DISORDER OF KIDNEY AND URETER UNSPECIFIED

S82465C

NONDISP SEG FX SHAFT OF L FIBULA 7THC

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N29

OTH DISORDERS OF KIDNEY AND URETER IN DISEASES CLASSD ELSWHR

S82466A

NONDISP SEGMENTAL FRACTURE OF SHAFT OF UNSP FIBULA INIT

N3000 ACUTE CYSTITIS WITHOUT HEMATURIA

S82466B

NONDISP SEG FX SHAFT OF UNSP FIBULA 7THB

N3001 ACUTE CYSTITIS WITH HEMATURIA

S82466C

NONDISP SEG FX SHAFT OF UNSP FIBULA 7THC

N3010

INTERSTITIAL CYSTITIS (CHRONIC) WITHOUT HEMATURIA

S82491A

OTH FRACTURE OF SHAFT OF RIGHT FIBULA INIT FOR CLOS FX

N3011 INTERSTITIAL CYSTITIS (CHRONIC) WITH HEMATURIA

S82491B

OTH FRACTURE OF SHAFT OF R FIBULA INIT FOR OPN FX TYPE I/2

N3020 OTHER CHRONIC CYSTITIS WITHOUT HEMATURIA

S82491C

OTH FX SHAFT OF R FIBULA INIT FOR OPN FX TYPE 3A/B/C

N3021 OTHER CHRONIC CYSTITIS WITH HEMATURIA

S82492A

OTH FRACTURE OF SHAFT OF LEFT FIBULA INIT FOR CLOS FX

N3030 TRIGONITIS WITHOUT HEMATURIA

S82492B

OTH FX SHAFT OF LEFT FIBULA INIT FOR OPN FX TYPE I/2

N3031 TRIGONITIS WITH HEMATURIA

S82492C OTH FX SHAFT OF LEFT FIBULA INIT FOR OPN FX TYPE 3A/B/C

N3040 IRRADIATION CYSTITIS WITHOUT HEMATURIA

S82499A

OTH FRACTURE OF SHAFT OF UNSP FIBULA INIT FOR CLOS FX

N3041 IRRADIATION CYSTITIS WITH HEMATURIA

S82499B

OTH FX SHAFT OF UNSP FIBULA INIT FOR OPN FX TYPE I/2

N3080 OTHER CYSTITIS WITHOUT HEMATURIA

S82499C

OTH FX SHAFT OF UNSP FIBULA INIT FOR OPN FX TYPE 3A/B/C

N3081 OTHER CYSTITIS WITH HEMATURIA

S8251XA

DISP FX OF MEDIAL MALLEOLUS OF RIGHT TIBIA INIT FOR CLOS FX

N3090 CYSTITIS UNSPECIFIED WITHOUT HEMATURIA

S8251XB

DISP FX OF MED MALLEOLUS OF R TIBIA 7THB

N3091 CYSTITIS UNSPECIFIED WITH HEMATURIA

S8251XC

DISP FX OF MED MALLEOLUS OF R TIBIA 7THC

N310

UNINHIBITED NEUROPATHIC BLADDER NOT ELSEWHERE CLASSIFIED

S8252XA

DISP FX OF MEDIAL MALLEOLUS OF LEFT TIBIA INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N311

REFLEX NEUROPATHIC BLADDER NOT ELSEWHERE CLASSIFIED

S8252XB

DISP FX OF MED MALLEOLUS OF L TIBIA 7THB

N312

FLACCID NEUROPATHIC BLADDER NOT ELSEWHERE CLASSIFIED

S8252XC

DISP FX OF MED MALLEOLUS OF L TIBIA 7THC

N318 OTHER NEUROMUSCULAR DYSFUNCTION OF BLADDER

S8253XA

DISP FX OF MEDIAL MALLEOLUS OF UNSP TIBIA INIT FOR CLOS FX

N319

NEUROMUSCULAR DYSFUNCTION OF BLADDER UNSPECIFIED

S8253XB

DISP FX OF MED MALLEOLUS OF UNSP TIBIA 7THB

N320 BLADDER-NECK OBSTRUCTION

S8253XC DISP FX OF MED MALLEOLUS OF UNSP TIBIA 7THC

N321 VESICOINTESTINAL FISTULA

S8254XA NONDISP FX OF MEDIAL MALLEOLUS OF RIGHT TIBIA INIT

N322 VESICAL FISTULA NOT ELSEWHERE CLASSIFIED

S8254XB

NONDISP FX OF MED MALLEOLUS OF R TIBIA 7THB

N323 DIVERTICULUM OF BLADDER

S8254XC NONDISP FX OF MED MALLEOLUS OF R TIBIA 7THC

N3281 OVERACTIVE BLADDER

S8255XA NONDISP FX OF MEDIAL MALLEOLUS OF LEFT TIBIA INIT

N3289 OTHER SPECIFIED DISORDERS OF BLADDER

S8255XB

NONDISP FX OF MED MALLEOLUS OF L TIBIA 7THB

N329 BLADDER DISORDER UNSPECIFIED

S8255XC

NONDISP FX OF MED MALLEOLUS OF L TIBIA 7THC

N33

BLADDER DISORDERS IN DISEASES CLASSIFIED ELSEWHERE

S8256XA

NONDISP FX OF MEDIAL MALLEOLUS OF UNSP TIBIA INIT

N340 URETHRAL ABSCESS

S8256XB NONDISP FX OF MED MALLEOLUS OF UNSP TIBIA 7THB

N341 NONSPECIFIC URETHRITIS

S8256XC NONDISP FX OF MED MALLEOLUS OF UNSP TIBIA 7THC

N342 OTHER URETHRITIS

S8261XA DISP FX OF LATERAL MALLEOLUS OF RIGHT FIBULA INIT

N343 URETHRAL SYNDROME UNSPECIFIED

S8261XB

DISP FX OF LATERAL MALLEOLUS OF R FIBULA 7THB

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N35010 POST-TRAUMATIC URETHRAL STRICTURE MALE MEATAL

S8261XC

DISP FX OF LATERAL MALLEOLUS OF R FIBULA 7THC

N35011 POST-TRAUMATIC BULBOUS URETHRAL STRICTURE

S8262XA

DISP FX OF LATERAL MALLEOLUS OF LEFT FIBULA INIT

N35012

POST-TRAUMATIC MEMBRANOUS URETHRAL STRICTURE

S8262XB

DISP FX OF LATERAL MALLEOLUS OF L FIBULA 7THB

N35013 POST-TRAUMATIC ANTERIOR URETHRAL STRICTURE

S8262XC

DISP FX OF LATERAL MALLEOLUS OF L FIBULA 7THC

N35014 POST-TRAUMATIC URETHRAL STRICTURE MALE UNSPECIFIED

S8263XA

DISP FX OF LATERAL MALLEOLUS OF UNSP FIBULA INIT

N35021 URETHRAL STRICTURE DUE TO CHILDBIRTH

S8263XB

DISP FX OF LATERAL MALLEOLUS OF UNSP FIBULA 7THB

N35028 OTHER POST-TRAUMATIC URETHRAL STRICTURE FEMALE

S8263XC

DISP FX OF LATERAL MALLEOLUS OF UNSP FIBULA 7THC

N35111 POSTINFECTIVE URETHRAL STRICTURE NEC MALE MEATAL

S8264XA

NONDISP FX OF LATERAL MALLEOLUS OF RIGHT FIBULA INIT

N35112 POSTINFECTIVE BULBOUS URETHRAL STRICTURE NEC

S8264XB

NONDISP FX OF LATERAL MALLEOLUS OF R FIBULA 7THB

N35113 POSTINFECTIVE MEMBRANOUS URETHRAL STRICTURE NEC

S8264XC

NONDISP FX OF LATERAL MALLEOLUS OF R FIBULA 7THC

N35114 POSTINFECTIVE ANTERIOR URETHRAL STRICTURE NEC

S8265XA

NONDISP FX OF LATERAL MALLEOLUS OF LEFT FIBULA INIT

N35119 POSTINFECTIVE URETHRAL STRICTURE NEC MALE UNSP

S8265XB

NONDISP FX OF LATERAL MALLEOLUS OF L FIBULA 7THB

N3512 POSTINFECTIVE URETHRAL STRICTURE NEC FEMALE

S8265XC

NONDISP FX OF LATERAL MALLEOLUS OF L FIBULA 7THC

N358 OTHER URETHRAL STRICTURE

S8266XA NONDISP FX OF LATERAL MALLEOLUS OF UNSP FIBULA INIT

N359 URETHRAL STRICTURE UNSPECIFIED

S8266XB

NONDISP FX OF LATERAL MALLEOLUS OF UNSP FIBULA 7THB

N360 URETHRAL FISTULA

S8266XC NONDISP FX OF LATERAL MALLEOLUS OF UNSP FIBULA 7THC

N361 URETHRAL DIVERTICULUM

S82811A TORUS FRACTURE OF UPPER END OF RIGHT FIBULA INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N362 URETHRAL CARUNCLE

S82812A TORUS FRACTURE OF UPPER END OF LEFT FIBULA INIT FOR CLOS FX

N3641 HYPERMOBILITY OF URETHRA

S82819A TORUS FRACTURE OF UPPER END OF UNSP FIBULA INIT FOR CLOS FX

N3642 INTRINSIC SPHINCTER DEFICIENCY (ISD)

S82821A

TORUS FRACTURE OF LOWER END OF RIGHT FIBULA INIT

N401

ENLARGED PROSTATE WITH LOWER URINARY TRACT SYMPTOMS

S82822A

TORUS FRACTURE OF LOWER END OF LEFT FIBULA INIT FOR CLOS FX

N413 PROSTATOCYSTITIS

S82829A TORUS FRACTURE OF LOWER END OF UNSP FIBULA INIT FOR CLOS FX

N414 GRANULOMATOUS PROSTATITIS

S82831A

OTH FRACTURE OF UPPER AND LOWER END OF RIGHT FIBULA INIT

N4281 PROSTATODYNIA SYNDROME

S82831B OTH FX UPPER AND LOW END R FIBULA INIT FOR OPN FX TYPE I/2

N4400 TORSION OF TESTIS UNSPECIFIED

S82831C

OTH FX UPR AND LOW END R FIBULA INIT FOR OPN FX TYPE 3A/B/C

N4401 EXTRAVAGINAL TORSION OF SPERMATIC CORD

S82832A

OTH FRACTURE OF UPPER AND LOWER END OF LEFT FIBULA INIT

N4402 INTRAVAGINAL TORSION OF SPERMATIC CORD

S82832B

OTH FX UPPER AND LOW END L FIBULA INIT FOR OPN FX TYPE I/2

N4403 TORSION OF APPENDIX TESTIS

S82832C OTH FX UPR AND LOW END L FIBULA INIT FOR OPN FX TYPE 3A/B/C

N4404 TORSION OF APPENDIX EPIDIDYMIS

S82839A

OTH FRACTURE OF UPPER AND LOWER END OF UNSP FIBULA INIT

N451 EPIDIDYMITIS

S82839B OTH FX UPR AND LOW END UNSP FIBULA INIT FOR OPN FX TYPE I/2

N452 ORCHITIS

S82839C OTH FX UPR & LOW END UNSP FIBULA 7THC

N493 FOURNIER GANGRENE

S82841A DISPLACED BIMALLEOLAR FRACTURE OF RIGHT LOWER LEG INIT

N50811 Right testicular pain

S82841B DISPLACED BIMALLEOL FX R LOW LEG INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N50812 Left testicular pain

S82841C DISPL BIMALLEOL FX R LOW LEG INIT FOR OPN FX TYPE 3A/B/C

N50819 Testicular pain unspecified

S82842A DISPLACED BIMALLEOLAR FRACTURE OF LEFT LOWER LEG INIT

N5082 Scrotal pain

S82842B DISPLACED BIMALLEOL FX L LOW LEG INIT FOR OPN FX TYPE I/2

N6001 SOLITARY CYST OF RIGHT BREAST

S82842C

DISPL BIMALLEOL FX L LOW LEG INIT FOR OPN FX TYPE 3A/B/C

N6002 SOLITARY CYST OF LEFT BREAST

S82843A DISPLACED BIMALLEOLAR FRACTURE OF UNSP LOWER LEG INIT

N6009 SOLITARY CYST OF UNSPECIFIED BREAST

S82843B

DISPL BIMALLEOL FX UNSP LOWER LEG INIT FOR OPN FX TYPE I/2

N6011 DIFFUSE CYSTIC MASTOPATHY OF RIGHT BREAST

S82843C

DISPL BIMALLEOL FX UNSP LOW LEG INIT FOR OPN FX TYPE 3A/B/C

N6012 DIFFUSE CYSTIC MASTOPATHY OF LEFT BREAST

S82844A

NONDISPLACED BIMALLEOLAR FRACTURE OF RIGHT LOWER LEG INIT

N6019 DIFFUSE CYSTIC MASTOPATHY OF UNSPECIFIED BREAST

S82844B

NONDISP BIMALLEOL FX R LOW LEG INIT FOR OPN FX TYPE I/2

N6021 FIBROADENOSIS OF RIGHT BREAST

S82844C

NONDISP BIMALLEOL FX R LOW LEG INIT FOR OPN FX TYPE 3A/B/C

N6022 FIBROADENOSIS OF LEFT BREAST

S82845A

NONDISPLACED BIMALLEOLAR FRACTURE OF LEFT LOWER LEG INIT

N6029 FIBROADENOSIS OF UNSPECIFIED BREAST

S82845B

NONDISP BIMALLEOL FX L LOW LEG INIT FOR OPN FX TYPE I/2

N6031 FIBROSCLEROSIS OF RIGHT BREAST

S82845C

NONDISP BIMALLEOL FX L LOW LEG INIT FOR OPN FX TYPE 3A/B/C

N6032 FIBROSCLEROSIS OF LEFT BREAST

S82846A

NONDISPLACED BIMALLEOLAR FRACTURE OF UNSP LOWER LEG INIT

N6039 FIBROSCLEROSIS OF UNSPECIFIED BREAST

S82846B

NONDISP BIMALLEOL FX UNSP LOW LEG INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N6041 MAMMARY DUCT ECTASIA OF RIGHT BREAST

S82846C

NONDISP BIMALLEOL FX UNSP LOW LEG 7THC

N6042 MAMMARY DUCT ECTASIA OF LEFT BREAST

S82851A

DISPLACED TRIMALLEOLAR FRACTURE OF RIGHT LOWER LEG INIT

N6049 MAMMARY DUCT ECTASIA OF UNSPECIFIED BREAST

S82851B

DISPLACED TRIMALLEOL FX R LOW LEG INIT FOR OPN FX TYPE I/2

N6081 OTHER BENIGN MAMMARY DYSPLASIAS OF RIGHT BREAST

S82851C

DISPL TRIMALLEOL FX R LOW LEG INIT FOR OPN FX TYPE 3A/B/C

N6082 OTHER BENIGN MAMMARY DYSPLASIAS OF LEFT BREAST

S82852A

DISPLACED TRIMALLEOLAR FRACTURE OF LEFT LOWER LEG INIT

N6089

OTHER BENIGN MAMMARY DYSPLASIAS OF UNSPECIFIED BREAST

S82852B

DISPLACED TRIMALLEOL FX L LOW LEG INIT FOR OPN FX TYPE I/2

N6091

UNSPECIFIED BENIGN MAMMARY DYSPLASIA OF RIGHT BREAST

S82852C

DISPL TRIMALLEOL FX L LOW LEG INIT FOR OPN FX TYPE 3A/B/C

N6092

UNSPECIFIED BENIGN MAMMARY DYSPLASIA OF LEFT BREAST

S82853A

DISPLACED TRIMALLEOLAR FRACTURE OF UNSP LOWER LEG INIT

N6099

UNSPECIFIED BENIGN MAMMARY DYSPLASIA OF UNSPECIFIED BREAST

S82853B

DISPL TRIMALLEOL FX UNSP LOWER LEG INIT FOR OPN FX TYPE I/2

N61 INFLAMMATORY DISORDERS OF BREAST

S82853C

DISPL TRIMALLEOL FX UNSP LOW LEG 7THC

N610 Mastitis without abscess

S82854A NONDISPLACED TRIMALLEOLAR FRACTURE OF RIGHT LOWER LEG INIT

N611 Abscess of the breast and nipple

S82854B

NONDISP TRIMALLEOL FX R LOW LEG INIT FOR OPN FX TYPE I/2

N62 HYPERTROPHY OF BREAST

S82854C NONDISP TRIMALLEOL FX R LOW LEG INIT FOR OPN FX TYPE 3A/B/C

N63 UNSPECIFIED LUMP IN BREAST

S82855A NONDISPLACED TRIMALLEOLAR FRACTURE OF LEFT LOWER LEG INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N641 FAT NECROSIS OF BREAST

S82855B NONDISP TRIMALLEOL FX L LOW LEG INIT FOR OPN FX TYPE I/2

N642 ATROPHY OF BREAST

S82855C NONDISP TRIMALLEOL FX L LOW LEG INIT FOR OPN FX TYPE 3A/B/C

N8341 Prolapse and hernia of right ovary and fallopian tube

S82856A

NONDISPLACED TRIMALLEOLAR FRACTURE OF UNSP LOWER LEG INIT

N8342 Prolapse and hernia of left ovary and fallopian tube

S82856B

NONDISP TRIMALLEOL FX UNSP LOW LEG INIT FOR OPN FX TYPE I/2

N83511 Torsion of right ovary and ovarian pedicle

S82856C

NONDISP TRIMALLEOL FX UNSP LOW LEG 7THC

N83512 Torsion of left ovary and ovarian pedicle

S82861A

DISPLACED MAISONNEUVE'S FRACTURE OF RIGHT LEG INIT

N83521 Torsion of right fallopian tube

S82861B DISPL MAISONNEUVE'S FX RIGHT LEG INIT FOR OPN FX TYPE I/2

N83522 Torsion of left fallopian tube

S82861C DISPL MAISONNEUVE'S FX R LEG INIT FOR OPN FX TYPE 3A/B/C

N990 POSTPROCEDURAL (ACUTE) (CHRONIC) KIDNEY FAILURE

S82862A

DISPLACED MAISONNEUVE'S FRACTURE OF LEFT LEG INIT

N99110 POSTPROCEDURAL URETHRAL STRICTURE MALE MEATAL

S82862B

DISPL MAISONNEUVE'S FX LEFT LEG INIT FOR OPN FX TYPE I/2

N99111 POSTPROCEDURAL BULBOUS URETHRAL STRICTURE

S82862C

DISPL MAISONNEUVE'S FX LEFT LEG INIT FOR OPN FX TYPE 3A/B/C

N99112

POSTPROCEDURAL MEMBRANOUS URETHRAL STRICTURE

S82863A

DISPLACED MAISONNEUVE'S FRACTURE OF UNSP LEG INIT

N99113 POSTPROCEDURAL ANTERIOR URETHRAL STRICTURE

S82863B

DISPL MAISONNEUVE'S FX UNSP LEG INIT FOR OPN FX TYPE I/2

N99114 POSTPROCEDURAL URETHRAL STRICTURE MALE UNSPECIFIED

S82863C

DISPL MAISONNEUVE'S FX UNSP LEG INIT FOR OPN FX TYPE 3A/B/C

N99115 Postprocedural fossa navicularis urethral stricture

S82864A

NONDISPLACED MAISONNEUVE'S FRACTURE OF RIGHT LEG INIT

N9912 POSTPROCEDURAL URETHRAL STRICTURE FEMALE

S82864B

NONDISP MAISONNEUVE'S FX RIGHT LEG INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N99510 CYSTOSTOMY HEMORRHAGE

S82864C NONDISP MAISONNEUVE'S FX R LEG INIT FOR OPN FX TYPE 3A/B/C

N99520

HEMORRHAGE OF OTHER EXTERNAL STOMA OF URINARY TRACT

S82865A

NONDISPLACED MAISONNEUVE'S FRACTURE OF LEFT LEG INIT

N99524 Stenosis of incontinent stoma of urinary tract

S82865B

NONDISP MAISONNEUVE'S FX LEFT LEG INIT FOR OPN FX TYPE I/2

N99530 HEMORRHAGE OF OTHER STOMA OF URINARY TRACT

S82865C

NONDISP MAISONNEUVE'S FX L LEG INIT FOR OPN FX TYPE 3A/B/C

N99533 Herniation of continent stoma of urinary tract

S82866A

NONDISPLACED MAISONNEUVE'S FRACTURE OF UNSP LEG INIT

N99534 Stenosis of continent stoma of urinary tract

S82866B

NONDISP MAISONNEUVE'S FX UNSP LEG INIT FOR OPN FX TYPE I/2

N9961

INTRAOP HEMOR/HEMTOM OF A GU SYS ORG COMP A GU SYS PROCEDURE

S82866C

NONDISP MAISONNEUVE'S FX UNSP LEG 7THC

N99840

Postprocedural hematoma of a genitourinary system organ or structure following a genitourinary system procedure

S82871A

DISPLACED PILON FRACTURE OF RIGHT TIBIA INIT FOR CLOS FX

N99841

Postprocedural hematoma of a genitourinary system organ or structure following other procedure

S82871B

DISPLACED PILON FX RIGHT TIBIA INIT FOR OPN FX TYPE I/2

N99842

Postprocedural seroma of a genitourinary system organ or structure following a genitourinary system procedure

S82871C

DISPLACED PILON FX RIGHT TIBIA INIT FOR OPN FX TYPE 3A/B/C

N99843

Postprocedural seroma of a genitourinary system organ or structure following other procedure

S82872A

DISPLACED PILON FRACTURE OF LEFT TIBIA INIT FOR CLOS FX

O000 ABDOMINAL PREGNANCY

S82872B DISPLACED PILON FX LEFT TIBIA INIT FOR OPN FX TYPE I/2

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O0000 Abdominal pregnancy without intrauterine pregnancy

S82872C

DISPLACED PILON FX LEFT TIBIA INIT FOR OPN FX TYPE 3A/B/C

O0001 Abdominal pregnancy with intrauterine pregnancy

S82873A

DISPLACED PILON FRACTURE OF UNSP TIBIA INIT FOR CLOS FX

O001 TUBAL PREGNANCY

S82873B DISPLACED PILON FX UNSP TIBIA INIT FOR OPN FX TYPE I/2

O0010 Tubal pregnancy without intrauterine pregnancy

S82873C

DISPLACED PILON FX UNSP TIBIA INIT FOR OPN FX TYPE 3A/B/C

O0011 Tubal pregnancy with intrauterine pregnancy

S82874A

NONDISPLACED PILON FRACTURE OF RIGHT TIBIA INIT FOR CLOS FX

O002 OVARIAN PREGNANCY

S82874B NONDISP PILON FX RIGHT TIBIA INIT FOR OPN FX TYPE I/2

O0020 Ovarian pregnancy without intrauterine pregnancy

S82874C

NONDISP PILON FX RIGHT TIBIA INIT FOR OPN FX TYPE 3A/B/C

O0021 Ovarian pregnancy with intrauterine pregnancy

S82875A

NONDISPLACED PILON FRACTURE OF LEFT TIBIA INIT FOR CLOS FX

O008 OTHER ECTOPIC PREGNANCY

S82875B NONDISP PILON FX LEFT TIBIA INIT FOR OPN FX TYPE I/2

O0080 Other ectopic pregnancy without intrauterine pregnancy

S82875C

NONDISP PILON FX LEFT TIBIA INIT FOR OPN FX TYPE 3A/B/C

O0081 Other ectopic pregnancy with intrauterine pregnancy

S82876A

NONDISPLACED PILON FRACTURE OF UNSP TIBIA INIT FOR CLOS FX

O009 ECTOPIC PREGNANCY UNSPECIFIED

S82876B

NONDISP PILON FX UNSP TIBIA INIT FOR OPN FX TYPE I/2

O0090 Unspecified ectopic pregnancy without intrauterine pregnancy

S82876C

NONDISP PILON FX UNSP TIBIA INIT FOR OPN FX TYPE 3A/B/C

O0091 Unspecified ectopic pregnancy with intrauterine pregnancy

S82891A

OTH FRACTURE OF RIGHT LOWER LEG INIT FOR CLOS FX

O010 CLASSICAL HYDATIDIFORM MOLE

S82891B

OTH FRACTURE OF RIGHT LOWER LEG INIT FOR OPN FX TYPE I/2

O011 INCOMPLETE AND PARTIAL HYDATIDIFORM MOLE

S82891C

OTH FRACTURE OF RIGHT LOWER LEG INIT FOR OPN FX TYPE 3A/B/C

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O019 HYDATIDIFORM MOLE UNSPECIFIED

S82892A

OTH FRACTURE OF LEFT LOWER LEG INIT FOR CLOS FX

O020 BLIGHTED OVUM AND NONHYDATIDIFORM MOLE

S82892B

OTH FRACTURE OF LEFT LOWER LEG INIT FOR OPN FX TYPE I/2

O021 MISSED ABORTION

S82892C OTH FRACTURE OF LEFT LOWER LEG INIT FOR OPN FX TYPE 3A/B/C

O029 ABNORMAL PRODUCT OF CONCEPTION UNSPECIFIED

S82899A

OTH FRACTURE OF UNSP LOWER LEG INIT FOR CLOS FX

O031

DELAYED OR EXCESSIVE HEMOR FOLLOWING INCMPL SPON ABORTION

S82899B

OTH FRACTURE OF UNSP LOWER LEG INIT FOR OPN FX TYPE I/2

O032

EMBOLISM FOLLOWING INCOMPLETE SPONTANEOUS ABORTION

S82899C

OTH FRACTURE OF UNSP LOWER LEG INIT FOR OPN FX TYPE 3A/B/C

O0331

SHOCK FOLLOWING INCOMPLETE SPONTANEOUS ABORTION

S8290XA

UNSP FRACTURE OF UNSP LOWER LEG INIT FOR CLOS FX

O0336

CARDIAC ARREST FOLLOWING INCOMPLETE SPONTANEOUS ABORTION

S8290XB

UNSP FRACTURE OF UNSP LOWER LEG INIT FOR OPN FX TYPE I/2

O0337

SEPSIS FOLLOWING INCOMPLETE SPONTANEOUS ABORTION

S8290XC

UNSP FRACTURE OF UNSP LOWER LEG INIT FOR OPN FX TYPE 3A/B/C

O036

DELAYED OR EXCESS HEMOR FOL COMPLETE OR UNSP SPON ABORTION

S8291XA

UNSP FRACTURE OF RIGHT LOWER LEG INIT FOR CLOS FX

O037

EMBOLISM FOLLOWING COMPLETE OR UNSP SPONTANEOUS ABORTION

S8291XB

UNSP FRACTURE OF RIGHT LOWER LEG INIT FOR OPN FX TYPE I/2

O0381

SHOCK FOLLOWING COMPLETE OR UNSPECIFIED SPONTANEOUS ABORTION

S8291XC

UNSP FRACTURE OF R LOW LEG INIT FOR OPN FX TYPE 3A/B/C

O0382

RENAL FAILURE FOLLOWING COMPLETE OR UNSP SPON ABORTION

S8292XA

UNSP FRACTURE OF LEFT LOWER LEG INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O0383

METABOLIC DISORDER FOLLOWING COMPLETE OR UNSP SPON ABORTION

S8292XB

UNSP FRACTURE OF LEFT LOWER LEG INIT FOR OPN FX TYPE I/2

O0386

CARDIAC ARREST FOLLOWING COMPLETE OR UNSP SPON ABORTION

S8292XC

UNSP FRACTURE OF LEFT LOWER LEG INIT FOR OPN FX TYPE 3A/B/C

O0387

SEPSIS FOLLOWING COMPLETE OR UNSP SPONTANEOUS ABORTION

S83001A

UNSPECIFIED SUBLUXATION OF RIGHT PATELLA INITIAL ENCOUNTER

O046

DELAYED OR EXCESS HEMOR FOL (INDUCED) TERM OF PREGNANCY

S83002A

UNSPECIFIED SUBLUXATION OF LEFT PATELLA INITIAL ENCOUNTER

O047

EMBOLISM FOLLOWING (INDUCED) TERMINATION OF PREGNANCY

S83003A

UNSPECIFIED SUBLUXATION OF UNSPECIFIED PATELLA INIT ENCNTR

O0481 SHOCK FOLLOWING (INDUCED) TERMINATION OF PREGNANCY

S83004A

UNSPECIFIED DISLOCATION OF RIGHT PATELLA INITIAL ENCOUNTER

O0482

RENAL FAILURE FOLLOWING (INDUCED) TERMINATION OF PREGNANCY

S83005A

UNSPECIFIED DISLOCATION OF LEFT PATELLA INITIAL ENCOUNTER

O0483

METABOLIC DISORDER FOLLOWING (INDUCED) TERM OF PREGNANCY

S83006A

UNSPECIFIED DISLOCATION OF UNSPECIFIED PATELLA INIT ENCNTR

O0485

OTH VENOUS COMP FOLLOWING (INDUCED) TERMINATION OF PREGNANCY

S83011A

LATERAL SUBLUXATION OF RIGHT PATELLA INITIAL ENCOUNTER

O0486

CARDIAC ARREST FOLLOWING (INDUCED) TERMINATION OF PREGNANCY

S83012A

LATERAL SUBLUXATION OF LEFT PATELLA INITIAL ENCOUNTER

O0487 SEPSIS FOLLOWING (INDUCED) TERMINATION OF PREGNANCY

S83013A

LATERAL SUBLUXATION OF UNSPECIFIED PATELLA INIT ENCNTR

O071

DELAYED OR EXCESS HEMOR FOL FAILED ATTEMPT TERM OF PREGNANCY

S83014A

LATERAL DISLOCATION OF RIGHT PATELLA INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O072

EMBOLISM FOLLOWING FAILED ATTEMPTED TERMINATION OF PREGNANCY

S83015A

LATERAL DISLOCATION OF LEFT PATELLA INITIAL ENCOUNTER

O0731

SHOCK FOLLOWING FAILED ATTEMPTED TERMINATION OF PREGNANCY

S83016A

LATERAL DISLOCATION OF UNSPECIFIED PATELLA INIT ENCNTR

O0732

RENAL FAILURE FOLLOWING FAILED ATTEMPTED TERM OF PREGNANCY

S83091A

OTHER SUBLUXATION OF RIGHT PATELLA INITIAL ENCOUNTER

O0733

METABOLIC DISORDER FOL FAILED ATTEMPT TERM OF PREGNANCY

S83092A

OTHER SUBLUXATION OF LEFT PATELLA INITIAL ENCOUNTER

O0735

OTH VENOUS COMP FOLLOWING FAILED ATTEMPTED TERM OF PREGNANCY

S83093A

OTHER SUBLUXATION OF UNSPECIFIED PATELLA INITIAL ENCOUNTER

O0736

CARDIAC ARREST FOLLOWING FAILED ATTEMPTED TERM OF PREGNANCY

S83094A

OTHER DISLOCATION OF RIGHT PATELLA INITIAL ENCOUNTER

O0737

SEPSIS FOLLOWING FAILED ATTEMPTED TERMINATION OF PREGNANCY

S83095A

OTHER DISLOCATION OF LEFT PATELLA INITIAL ENCOUNTER

O081

DELAYED OR EXCESS HEMOR FOL ECTOPIC AND MOLAR PREGNANCY

S83096A

OTHER DISLOCATION OF UNSPECIFIED PATELLA INITIAL ENCOUNTER

O082

EMBOLISM FOLLOWING ECTOPIC AND MOLAR PREGNANCY

S83101A

UNSPECIFIED SUBLUXATION OF RIGHT KNEE INITIAL ENCOUNTER

O083 SHOCK FOLLOWING ECTOPIC AND MOLAR PREGNANCY

S83102A

UNSPECIFIED SUBLUXATION OF LEFT KNEE INITIAL ENCOUNTER

O084

RENAL FAILURE FOLLOWING ECTOPIC AND MOLAR PREGNANCY

S83103A

UNSPECIFIED SUBLUXATION OF UNSPECIFIED KNEE INIT ENCNTR

O085

METABOLIC DISORDERS FOLLOWING AN ECTOPIC AND MOLAR PREGNANCY

S83104A

UNSPECIFIED DISLOCATION OF RIGHT KNEE INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O086

DAMAGE TO PELVIC ORGANS AND TISS FOL AN ECT AND MOLAR PREG

S83105A

UNSPECIFIED DISLOCATION OF LEFT KNEE INITIAL ENCOUNTER

O087

OTH VENOUS COMP FOLLOWING AN ECTOPIC AND MOLAR PREGNANCY

S83106A

UNSPECIFIED DISLOCATION OF UNSPECIFIED KNEE INIT ENCNTR

O0881

CARDIAC ARREST FOLLOWING AN ECTOPIC AND MOLAR PREGNANCY

S83111A

ANTERIOR SUBLUX OF PROXIMAL END OF TIBIA RIGHT KNEE INIT

O0882 SEPSIS FOLLOWING ECTOPIC AND MOLAR PREGNANCY

S83112A

ANTERIOR SUBLUX OF PROXIMAL END OF TIBIA LEFT KNEE INIT

O10011

PRE-EXISTING ESSENTIAL HTN COMP PREGNANCY FIRST TRIMESTER

S83113A

ANTERIOR SUBLUX OF PROXIMAL END OF TIBIA UNSP KNEE INIT

O10012

PRE-EXISTING ESSENTIAL HTN COMP PREGNANCY SECOND TRIMESTER

S83114A

ANTERIOR DISLOC OF PROXIMAL END OF TIBIA RIGHT KNEE INIT

O10013

PRE-EXISTING ESSENTIAL HTN COMP PREGNANCY THIRD TRIMESTER

S83115A

ANTERIOR DISLOC OF PROXIMAL END OF TIBIA LEFT KNEE INIT

O10019

PRE-EXISTING ESSENTIAL HTN COMP PREGNANCY UNSP TRIMESTER

S83116A

ANTERIOR DISLOC OF PROXIMAL END OF TIBIA UNSP KNEE INIT

O1002

PRE-EXISTING ESSENTIAL HYPERTENSION COMPLICATING CHILDBIRTH

S83121A

POSTERIOR SUBLUX OF PROXIMAL END OF TIBIA RIGHT KNEE INIT

O1003

PRE-EXISTING ESSENTIAL HYPERTENSION COMP THE PUERPERIUM

S83122A

POSTERIOR SUBLUX OF PROXIMAL END OF TIBIA LEFT KNEE INIT

O10111

PRE-EXIST HYP HEART DISEASE COMP PREGNANCY FIRST TRIMESTER

S83123A

POSTERIOR SUBLUX OF PROXIMAL END OF TIBIA UNSP KNEE INIT

O10112

PRE-EXIST HYP HEART DISEASE COMP PREGNANCY SECOND TRIMESTER

S83124A

POSTERIOR DISLOC OF PROXIMAL END OF TIBIA RIGHT KNEE INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O10113

PRE-EXIST HYP HEART DISEASE COMP PREGNANCY THIRD TRIMESTER

S83125A

POSTERIOR DISLOC OF PROXIMAL END OF TIBIA LEFT KNEE INIT

O10119

PRE-EXIST HYP HEART DISEASE COMP PREGNANCY UNSP TRIMESTER

S83126A

POSTERIOR DISLOC OF PROXIMAL END OF TIBIA UNSP KNEE INIT

O1012

PRE-EXISTING HYPERTENSIVE HEART DISEASE COMP CHILDBIRTH

S83131A

MEDIAL SUBLUX OF PROXIMAL END OF TIBIA RIGHT KNEE INIT

O1013

PRE-EXISTING HYPERTENSIVE HEART DISEASE COMP THE PUERPERIUM

S83132A

MEDIAL SUBLUXATION OF PROXIMAL END OF TIBIA LEFT KNEE INIT

O10211

PRE-EXIST HYP CHRONIC KIDNEY DISEASE COMP PREG FIRST TRI

S83133A

MEDIAL SUBLUXATION OF PROXIMAL END OF TIBIA UNSP KNEE INIT

O10212

PRE-EXIST HYP CHRONIC KIDNEY DISEASE COMP PREG SECOND TRI

S83134A

MEDIAL DISLOC OF PROXIMAL END OF TIBIA RIGHT KNEE INIT

O10213

PRE-EXIST HYP CHRONIC KIDNEY DISEASE COMP PREG THIRD TRI

S83135A

MEDIAL DISLOCATION OF PROXIMAL END OF TIBIA LEFT KNEE INIT

O10219

PRE-EXIST HYP CHRONIC KIDNEY DISEASE COMP PREG UNSP TRI

S83136A

MEDIAL DISLOCATION OF PROXIMAL END OF TIBIA UNSP KNEE INIT

O1022

PRE-EXISTING HYP CHRONIC KIDNEY DISEASE COMP CHILDBIRTH

S83141A

LATERAL SUBLUX OF PROXIMAL END OF TIBIA RIGHT KNEE INIT

O1023

PRE-EXISTING HYP CHRONIC KIDNEY DISEASE COMP THE PUERPERIUM

S83142A

LATERAL SUBLUX OF PROXIMAL END OF TIBIA LEFT KNEE INIT

O10311

PRE-EXIST HYP HEART AND CHR KIDNEY DIS COMP PREG FIRST TRI

S83143A

LATERAL SUBLUX OF PROXIMAL END OF TIBIA UNSP KNEE INIT

O10312

PRE-EXIST HYP HEART AND CHR KIDNEY DIS COMP PREG SECOND TRI

S83144A

LATERAL DISLOC OF PROXIMAL END OF TIBIA RIGHT KNEE INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O10313

PRE-EXIST HYP HEART AND CHR KIDNEY DIS COMP PREG THIRD TRI

S83145A

LATERAL DISLOC OF PROXIMAL END OF TIBIA LEFT KNEE INIT

O10319

PRE-EXIST HYP HEART AND CHR KIDNEY DIS COMP PREG UNSP TRI

S83146A

LATERAL DISLOC OF PROXIMAL END OF TIBIA UNSP KNEE INIT

O1032

PRE-EXIST HYP HEART AND CHRONIC KIDNEY DISEASE COMP CHLDBRTH

S83191A

OTHER SUBLUXATION OF RIGHT KNEE INITIAL ENCOUNTER

O1033

PRE-EXIST HYP HEART AND CHR KIDNEY DISEASE COMP THE PUERP

S83192A

OTHER SUBLUXATION OF LEFT KNEE INITIAL ENCOUNTER

O10411

PRE-EXISTING SECONDARY HTN COMP PREGNANCY FIRST TRIMESTER

S83193A

OTHER SUBLUXATION OF UNSPECIFIED KNEE INITIAL ENCOUNTER

O10412

PRE-EXISTING SECONDARY HTN COMP PREGNANCY SECOND TRIMESTER

S83194A

OTHER DISLOCATION OF RIGHT KNEE INITIAL ENCOUNTER

O10413

PRE-EXISTING SECONDARY HTN COMP PREGNANCY THIRD TRIMESTER

S83195A

OTHER DISLOCATION OF LEFT KNEE INITIAL ENCOUNTER

O10419

PRE-EXISTING SECONDARY HTN COMP PREGNANCY UNSP TRIMESTER

S83196A

OTHER DISLOCATION OF UNSPECIFIED KNEE INITIAL ENCOUNTER

O1042

PRE-EXISTING SECONDARY HYPERTENSION COMPLICATING CHILDBIRTH

S83200A

BUCKET-HNDL TEAR OF UNSP MENSC CURRENT INJURY R KNEE INIT

O1043

PRE-EXISTING SECONDARY HYPERTENSION COMP THE PUERPERIUM

S83201A

BUCKET-HNDL TEAR OF UNSP MENSC CURRENT INJURY L KNEE INIT

O10911 UNSP PRE-EXISTING HTN COMP PREGNANCY FIRST TRIMESTER

S83202A

BUCKET-HNDL TEAR OF UNSP MENSC CRNT INJURY UNSP KNEE INIT

O10912

UNSP PRE-EXISTING HTN COMP PREGNANCY SECOND TRIMESTER

S83211A

BUCKET-HNDL TEAR OF MEDIAL MENSC CRNT INJURY R KNEE INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O10913 UNSP PRE-EXISTING HTN COMP PREGNANCY THIRD TRIMESTER

S83212A

BUCKET-HNDL TEAR OF MEDIAL MENSC CRNT INJURY L KNEE INIT

O10919 UNSP PRE-EXISTING HTN COMP PREGNANCY UNSP TRIMESTER

S83219A

BUCKET-HNDL TEAR OF MEDIAL MENSC CRNT INJ UNSP KNEE INIT

O1092

UNSP PRE-EXISTING HYPERTENSION COMPLICATING CHILDBIRTH

S83221A

PRPH TEAR OF MEDIAL MENISCUS CURRENT INJURY R KNEE INIT

O1093

UNSP PRE-EXISTING HYPERTENSION COMPLICATING THE PUERPERIUM

S83222A

PRPH TEAR OF MEDIAL MENISCUS CURRENT INJURY L KNEE INIT

O111

PRE-EXISTING HYPERTENSION W PRE-ECLAMPSIA FIRST TRIMESTER

S83229A

PRPH TEAR OF MEDIAL MENSC CURRENT INJURY UNSP KNEE INIT

O112

PRE-EXISTING HYPERTENSION W PRE-ECLAMPSIA SECOND TRIMESTER

S83231A

COMPLEX TEAR OF MEDIAL MENSC CURRENT INJURY R KNEE INIT

O113

PRE-EXISTING HYPERTENSION W PRE-ECLAMPSIA THIRD TRIMESTER

S83232A

COMPLEX TEAR OF MEDIAL MENSC CURRENT INJURY L KNEE INIT

O114

Pre-existing hypertension with pre-eclampsia complicating childbirth

S83239A

CMPLX TEAR OF MEDIAL MENSC CURRENT INJURY UNSP KNEE INIT

O115

Pre-existing hypertension with pre-eclampsia complicating the puerperium

S83241A

OTH TEAR OF MEDIAL MENISCUS CURRENT INJURY R KNEE INIT

O119

PRE-EXISTING HYPERTENSION WITH PRE-ECLAMPSIA UNSP TRIMESTER

S83242A

OTH TEAR OF MEDIAL MENISCUS CURRENT INJURY LEFT KNEE INIT

O1200 GESTATIONAL EDEMA UNSPECIFIED TRIMESTER

S83249A

OTH TEAR OF MEDIAL MENISCUS CURRENT INJURY UNSP KNEE INIT

O1201 GESTATIONAL EDEMA FIRST TRIMESTER

S83251A

BUCKET-HNDL TEAR OF LAT MENSC CURRENT INJURY R KNEE INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O1202 GESTATIONAL EDEMA SECOND TRIMESTER

S83252A

BUCKET-HNDL TEAR OF LAT MENSC CURRENT INJURY L KNEE INIT

O1203 GESTATIONAL EDEMA THIRD TRIMESTER

S83259A

BUCKET-HNDL TEAR OF LAT MENSC CRNT INJURY UNSP KNEE INIT

O1204 Gestational edema complicating childbirth

S83261A

PRPH TEAR OF LAT MENSC CURRENT INJURY RIGHT KNEE INIT

O1205 Gestational edema complicating the puerperium

S83262A

PRPH TEAR OF LAT MENSC CURRENT INJURY LEFT KNEE INIT

O1210 GESTATIONAL PROTEINURIA UNSPECIFIED TRIMESTER

S83269A

PRPH TEAR OF LAT MENSC CURRENT INJURY UNSP KNEE INIT

O1211 GESTATIONAL PROTEINURIA FIRST TRIMESTER

S83271A

COMPLEX TEAR OF LAT MENSC CURRENT INJURY RIGHT KNEE INIT

O1212 GESTATIONAL PROTEINURIA SECOND TRIMESTER

S83272A

COMPLEX TEAR OF LAT MENSC CURRENT INJURY LEFT KNEE INIT

O1213 GESTATIONAL PROTEINURIA THIRD TRIMESTER

S83279A

COMPLEX TEAR OF LAT MENSC CURRENT INJURY UNSP KNEE INIT

O1214 Gestational proteinuria complicating childbirth

S83281A

OTH TEAR OF LAT MENSC CURRENT INJURY RIGHT KNEE INIT

O1215 Gestational proteinuria complicating the puerperium

S83282A

OTH TEAR OF LAT MENSC CURRENT INJURY LEFT KNEE INIT

O1220

GESTATIONAL EDEMA WITH PROTEINURIA UNSPECIFIED TRIMESTER

S83289A

OTH TEAR OF LAT MENSC CURRENT INJURY UNSP KNEE INIT

O1221 GESTATIONAL EDEMA WITH PROTEINURIA FIRST TRIMESTER

S8330XA

TEAR OF ARTICULAR CARTILAGE OF UNSP KNEE CURRENT INIT

O1222

GESTATIONAL EDEMA WITH PROTEINURIA SECOND TRIMESTER

S8331XA

TEAR OF ARTICULAR CARTILAGE OF RIGHT KNEE CURRENT INIT

O1223

GESTATIONAL EDEMA WITH PROTEINURIA THIRD TRIMESTER

S8332XA

TEAR OF ARTICULAR CARTILAGE OF LEFT KNEE CURRENT INIT

O1224

Gestational edema with proteinuria complicating childbirth

S83401A

SPRAIN OF UNSP COLLATERAL LIGAMENT OF RIGHT KNEE INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O1225

Gestational edema with proteinuria complicating the puerperium

S83402A

SPRAIN OF UNSP COLLATERAL LIGAMENT OF LEFT KNEE INIT ENCNTR

O131

GESTATIONAL HTN W/O SIGNIFICANT PROTEINURIA FIRST TRIMESTER

S83409A

SPRAIN OF UNSP COLLATERAL LIGAMENT OF UNSP KNEE INIT ENCNTR

O132

GESTATNL HTN W/O SIGNIFICANT PROTEINURIA SECOND TRIMESTER

S83411A

SPRAIN OF MEDIAL COLLATERAL LIGAMENT OF RIGHT KNEE INIT

O133

GESTATIONAL HTN W/O SIGNIFICANT PROTEINURIA THIRD TRIMESTER

S83412A

SPRAIN OF MEDIAL COLLATERAL LIGAMENT OF LEFT KNEE INIT

O134

Gestational [pregnancy-induced] hypertension without significant proteinuria complicating childbirth

S83419A

SPRAIN OF MEDIAL COLLATERAL LIGAMENT OF UNSP KNEE INIT

O135

Gestational [pregnancy-induced] hypertension without significant proteinuria complicating the puerperium

S83421A

SPRAIN OF LATERAL COLLATERAL LIGAMENT OF RIGHT KNEE INIT

O139

GESTATIONAL HTN W/O SIGNIFICANT PROTEINURIA UNSP TRIMESTER

S83422A

SPRAIN OF LATERAL COLLATERAL LIGAMENT OF LEFT KNEE INIT

O1400

MILD TO MODERATE PRE-ECLAMPSIA UNSPECIFIED TRIMESTER

S83429A

SPRAIN OF LATERAL COLLATERAL LIGAMENT OF UNSP KNEE INIT

O1402

MILD TO MODERATE PRE-ECLAMPSIA SECOND TRIMESTER

S83501A

SPRAIN OF UNSP CRUCIATE LIGAMENT OF RIGHT KNEE INIT ENCNTR

O1403 MILD TO MODERATE PRE-ECLAMPSIA THIRD TRIMESTER

S83502A

SPRAIN OF UNSP CRUCIATE LIGAMENT OF LEFT KNEE INIT ENCNTR

O1404 Mild to moderate pre-eclampsia complicating childbirth

S83509A

SPRAIN OF UNSP CRUCIATE LIGAMENT OF UNSP KNEE INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O1405 Mild to moderate pre-eclampsia complicating the puerperium

S83511A

SPRAIN OF ANTERIOR CRUCIATE LIGAMENT OF RIGHT KNEE INIT

O1410 SEVERE PRE-ECLAMPSIA UNSPECIFIED TRIMESTER

S83512A

SPRAIN OF ANTERIOR CRUCIATE LIGAMENT OF LEFT KNEE INIT

O1412 SEVERE PRE-ECLAMPSIA SECOND TRIMESTER

S83519A

SPRAIN OF ANTERIOR CRUCIATE LIGAMENT OF UNSP KNEE INIT

O1413 SEVERE PRE-ECLAMPSIA THIRD TRIMESTER

S83521A

SPRAIN OF POSTERIOR CRUCIATE LIGAMENT OF RIGHT KNEE INIT

O1414 Severe pre-eclampsia complicating childbirth

S83522A

SPRAIN OF POSTERIOR CRUCIATE LIGAMENT OF LEFT KNEE INIT

O1415 Severe pre-eclampsia complicating the puerperium

S83529A

SPRAIN OF POSTERIOR CRUCIATE LIGAMENT OF UNSP KNEE INIT

O1420 HELLP SYNDROME (HELLP) UNSPECIFIED TRIMESTER

S8360XA

SPRAIN OF SUPER TIBIOFIBUL JOINT AND LIGMT UNSP KNEE INIT

O1422 HELLP SYNDROME (HELLP) SECOND TRIMESTER

S8361XA

SPRAIN OF THE SUPER TIBIOFIBUL JOINT AND LIGMT R KNEE INIT

O1423 HELLP SYNDROME (HELLP) THIRD TRIMESTER

S8362XA

SPRAIN OF THE SUPER TIBIOFIBUL JOINT AND LIGMT L KNEE INIT

O1424 HELLP syndrome complicating childbirth

S838X1A

SPRAIN OF OTHER SPECIFIED PARTS OF RIGHT KNEE INIT ENCNTR

O1425 HELLP syndrome complicating the puerperium

S838X2A

SPRAIN OF OTHER SPECIFIED PARTS OF LEFT KNEE INIT ENCNTR

O1490 UNSPECIFIED PRE-ECLAMPSIA UNSPECIFIED TRIMESTER

S838X9A

SPRAIN OF OTH PARTS OF UNSPECIFIED KNEE INIT ENCNTR

O1492 UNSPECIFIED PRE-ECLAMPSIA SECOND TRIMESTER

S8390XA

SPRAIN OF UNSPECIFIED SITE OF UNSPECIFIED KNEE INIT ENCNTR

O1493 UNSPECIFIED PRE-ECLAMPSIA THIRD TRIMESTER

S8391XA

SPRAIN OF UNSPECIFIED SITE OF RIGHT KNEE INITIAL ENCOUNTER

O1494 Unspecified pre-eclampsia complicating childbirth

S8392XA

SPRAIN OF UNSPECIFIED SITE OF LEFT KNEE INITIAL ENCOUNTER

O1495 Unspecified pre-eclampsia complicating the puerperium

S8400XA

INJURY OF TIBIAL NERVE AT LOWER LEG LEVEL UNSP LEG INIT

O1500 ECLAMPSIA IN PREGNANCY UNSPECIFIED TRIMESTER

S8401XA

INJURY OF TIBIAL NERVE AT LOWER LEG LEVEL RIGHT LEG INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O1502 ECLAMPSIA IN PREGNANCY SECOND TRIMESTER

S8402XA

INJURY OF TIBIAL NERVE AT LOWER LEG LEVEL LEFT LEG INIT

O1503 ECLAMPSIA IN PREGNANCY THIRD TRIMESTER

S8410XA

INJURY OF PERONEAL NERVE AT LOWER LEG LEVEL UNSP LEG INIT

O151 ECLAMPSIA IN LABOR

S8411XA INJURY OF PERONEAL NERVE AT LOWER LEG LEVEL RIGHT LEG INIT

O152 ECLAMPSIA IN THE PUERPERIUM

S8412XA

INJURY OF PERONEAL NERVE AT LOWER LEG LEVEL LEFT LEG INIT

O159 ECLAMPSIA UNSPECIFIED AS TO TIME PERIOD

S8420XA

INJ CUTAN SENSORY NERVE AT LOWER LEG LEVEL UNSP LEG INIT

O161

UNSPECIFIED MATERNAL HYPERTENSION FIRST TRIMESTER

S8421XA

INJ CUTAN SENSORY NERVE AT LOWER LEG LEVEL RIGHT LEG INIT

O162

UNSPECIFIED MATERNAL HYPERTENSION SECOND TRIMESTER

S8422XA

INJ CUTAN SENSORY NERVE AT LOWER LEG LEVEL LEFT LEG INIT

O163

UNSPECIFIED MATERNAL HYPERTENSION THIRD TRIMESTER

S84801A

INJURY OF OTH NERVES AT LOWER LEG LEVEL RIGHT LEG INIT

O164

Unspecified maternal hypertension complicating childbirth

S84802A

INJURY OF OTH NERVES AT LOWER LEG LEVEL LEFT LEG INIT

O165

Unspecified maternal hypertension complicating the puerperium

S84809A

INJURY OF OTH NERVES AT LOWER LEG LEVEL UNSP LEG INIT

O169

UNSPECIFIED MATERNAL HYPERTENSION UNSPECIFIED TRIMESTER

S8490XA

INJURY OF UNSP NERVE AT LOWER LEG LEVEL UNSP LEG INIT

O200 THREATENED ABORTION

S8491XA INJURY OF UNSP NERVE AT LOWER LEG LEVEL RIGHT LEG INIT

O208 OTHER HEMORRHAGE IN EARLY PREGNANCY

S8492XA

INJURY OF UNSP NERVE AT LOWER LEG LEVEL LEFT LEG INIT

O209 HEMORRHAGE IN EARLY PREGNANCY UNSPECIFIED

S85011A

LACERATION OF POPLITEAL ARTERY RIGHT LEG INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O210 MILD HYPEREMESIS GRAVIDARUM

S85012A

LACERATION OF POPLITEAL ARTERY LEFT LEG INITIAL ENCOUNTER

O2230

DEEP PHLEBOTHROMBOSIS IN PREGNANCY UNSPECIFIED TRIMESTER

S85019A

LACERATION OF POPLITEAL ARTERY UNSPECIFIED LEG INIT ENCNTR

O2231 DEEP PHLEBOTHROMBOSIS IN PREGNANCY FIRST TRIMESTER

S85111A

LACERATION OF UNSP TIBIAL ARTERY RIGHT LEG INIT ENCNTR

O2232

DEEP PHLEBOTHROMBOSIS IN PREGNANCY SECOND TRIMESTER

S85112A

LACERATION OF UNSP TIBIAL ARTERY LEFT LEG INIT ENCNTR

O2233 DEEP PHLEBOTHROMBOSIS IN PREGNANCY THIRD TRIMESTER

S85119A

LACERATION OF UNSP TIBIAL ARTERY UNSP LEG INIT ENCNTR

O2250

CEREBRAL VENOUS THROMBOSIS IN PREGNANCY UNSP TRIMESTER

S85141A

LACERATION OF ANTERIOR TIBIAL ARTERY RIGHT LEG INIT ENCNTR

O2251

CEREBRAL VENOUS THROMBOSIS IN PREGNANCY FIRST TRIMESTER

S85142A

LACERATION OF ANTERIOR TIBIAL ARTERY LEFT LEG INIT ENCNTR

O2252

CEREBRAL VENOUS THROMBOSIS IN PREGNANCY SECOND TRIMESTER

S85149A

LACERATION OF ANTERIOR TIBIAL ARTERY UNSP LEG INIT ENCNTR

O2253

CEREBRAL VENOUS THROMBOSIS IN PREGNANCY THIRD TRIMESTER

S85171A

LACERATION OF POSTERIOR TIBIAL ARTERY RIGHT LEG INIT

O228X1

OTHER VENOUS COMPLICATIONS IN PREGNANCY FIRST TRIMESTER

S85172A

LACERATION OF POSTERIOR TIBIAL ARTERY LEFT LEG INIT ENCNTR

O228X2

OTHER VENOUS COMPLICATIONS IN PREGNANCY SECOND TRIMESTER

S85179A

LACERATION OF POSTERIOR TIBIAL ARTERY UNSP LEG INIT ENCNTR

O228X3

OTHER VENOUS COMPLICATIONS IN PREGNANCY THIRD TRIMESTER

S85211A

LACERATION OF PERONEAL ARTERY RIGHT LEG INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O228X9

OTHER VENOUS COMPLICATIONS IN PREGNANCY UNSP TRIMESTER

S85212A

LACERATION OF PERONEAL ARTERY LEFT LEG INITIAL ENCOUNTER

O2290

VENOUS COMPLICATION IN PREGNANCY UNSP UNSP TRIMESTER

S85219A

LACERATION OF PERONEAL ARTERY UNSPECIFIED LEG INIT ENCNTR

O2291

VENOUS COMPLICATION IN PREGNANCY UNSP FIRST TRIMESTER

S85311A

LACERAT GREAT SAPHENOUS AT LOWER LEG LEVEL RIGHT LEG INIT

O2292

VENOUS COMPLICATION IN PREGNANCY UNSP SECOND TRIMESTER

S85312A

LACERAT GREAT SAPHENOUS AT LOWER LEG LEVEL LEFT LEG INIT

O2293

VENOUS COMPLICATION IN PREGNANCY UNSP THIRD TRIMESTER

S85319A

LACERAT GREAT SAPHENOUS AT LOWER LEG LEVEL UNSP LEG INIT

O26851 SPOTTING COMPLICATING PREGNANCY FIRST TRIMESTER

S85411A

LACERAT LESS SAPHENOUS AT LOWER LEG LEVEL RIGHT LEG INIT

O26852

SPOTTING COMPLICATING PREGNANCY SECOND TRIMESTER

S85412A

LACERAT LESS SAPHENOUS AT LOWER LEG LEVEL LEFT LEG INIT

O26853 SPOTTING COMPLICATING PREGNANCY THIRD TRIMESTER

S85419A

LACERAT LESS SAPHENOUS AT LOWER LEG LEVEL UNSP LEG INIT

O26859

SPOTTING COMPLICATING PREGNANCY UNSPECIFIED TRIMESTER

S85511A

LACERATION OF POPLITEAL VEIN RIGHT LEG INITIAL ENCOUNTER

O283

ABNORMAL ULTRASONIC FINDING ON ANTENATAL SCREENING OF MOTHER

S85512A

LACERATION OF POPLITEAL VEIN LEFT LEG INITIAL ENCOUNTER

O29011

ASPIRAT PNEUMONITIS DUE TO ANESTH DURING PREG FIRST TRI

S85519A

LACERATION OF POPLITEAL VEIN UNSPECIFIED LEG INIT ENCNTR

O29012

ASPIRAT PNEUMONITIS DUE TO ANESTH DURING PREG SECOND TRI

S85811A

LACERAT BLOOD VESSELS AT LOWER LEG LEVEL RIGHT LEG INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O29013

ASPIRAT PNEUMONITIS DUE TO ANESTH DURING PREG THIRD TRI

S85812A

LACERAT BLOOD VESSELS AT LOWER LEG LEVEL LEFT LEG INIT

O29019

ASPIRAT PNEUMONITIS DUE TO ANESTH DURING PREG UNSP TRI

S85819A

LACERAT BLOOD VESSELS AT LOWER LEG LEVEL UNSP LEG INIT

O29021

PRESSR COLLAPSE OF LUNG DUE TO ANESTH DURING PREG FIRST TRI

S85911A

LACERAT UNSP BLOOD VESS AT LOWER LEG LEVEL RIGHT LEG INIT

O29022

PRESSR COLLAPSE OF LUNG D/T ANESTH DURING PREG SECOND TRI

S85912A

LACERAT UNSP BLOOD VESSEL AT LOWER LEG LEVEL LEFT LEG INIT

O29023

PRESSR COLLAPSE OF LUNG DUE TO ANESTH DURING PREG THIRD TRI

S85919A

LACERAT UNSP BLOOD VESSEL AT LOWER LEG LEVEL UNSP LEG INIT

O29029

PRESSR COLLAPSE OF LUNG DUE TO ANESTH DURING PREG UNSP TRI

S86011A

STRAIN OF RIGHT ACHILLES TENDON INITIAL ENCOUNTER

O29091

OTH PULMONARY COMP OF ANESTH DURING PREG FIRST TRIMESTER

S86012A

STRAIN OF LEFT ACHILLES TENDON INITIAL ENCOUNTER

O29092

OTH PULMONARY COMP OF ANESTH DURING PREG SECOND TRIMESTER

S86019A

STRAIN OF UNSPECIFIED ACHILLES TENDON INITIAL ENCOUNTER

O29093

OTH PULMONARY COMP OF ANESTH DURING PREG THIRD TRIMESTER

S86021A

LACERATION OF RIGHT ACHILLES TENDON INITIAL ENCOUNTER

O29099

OTH PULMONARY COMP OF ANESTH DURING PREG UNSP TRIMESTER

S86022A

LACERATION OF LEFT ACHILLES TENDON INITIAL ENCOUNTER

O29111

CARDIAC ARREST DUE TO ANESTH DURING PREG FIRST TRIMESTER

S86029A

LACERATION OF UNSPECIFIED ACHILLES TENDON INITIAL ENCOUNTER

O29112

CARDIAC ARREST DUE TO ANESTH DURING PREG SECOND TRIMESTER

S86111A

STRAIN MUSC/TEND POST GRP AT LOW LEG LEVEL RIGHT LEG INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O29113

CARDIAC ARREST DUE TO ANESTH DURING PREG THIRD TRIMESTER

S86112A

STRAIN MUSC/TEND POST GRP AT LOW LEG LEVEL LEFT LEG INIT

O29119

CARDIAC ARREST DUE TO ANESTH DURING PREG UNSP TRIMESTER

S86119A

STRAIN MUSC/TEND POST GRP AT LOW LEG LEVEL UNSP LEG INIT

O29121

CARDIAC FAILURE DUE TO ANESTH DURING PREG FIRST TRIMESTER

S86121A

LACERAT MUSC/TEND POST GRP AT LOW LEG LEVEL RIGHT LEG INIT

O29122

CARDIAC FAILURE DUE TO ANESTH DURING PREG SECOND TRIMESTER

S86122A

LACERAT MUSC/TEND POST GRP AT LOW LEG LEVEL LEFT LEG INIT

O29123

CARDIAC FAILURE DUE TO ANESTH DURING PREG THIRD TRIMESTER

S86129A

LACERAT MUSC/TEND POST GRP AT LOW LEG LEVEL UNSP LEG INIT

O29129

CARDIAC FAILURE DUE TO ANESTH DURING PREG UNSP TRIMESTER

S86211A

STRAIN MUSC/TEND ANT GRP AT LOW LEG LEVEL RIGHT LEG INIT

O29191

OTH CARDIAC COMP OF ANESTH DURING PREGNANCY FIRST TRIMESTER

S86212A

STRAIN MUSC/TEND ANT GRP AT LOW LEG LEVEL LEFT LEG INIT

O29192

OTH CARDIAC COMP OF ANESTH DURING PREG SECOND TRIMESTER

S86219A

STRAIN MUSC/TEND ANT GRP AT LOW LEG LEVEL UNSP LEG INIT

O29193

OTH CARDIAC COMP OF ANESTH DURING PREGNANCY THIRD TRIMESTER

S86221A

LACERAT MUSC/TEND ANT GRP AT LOW LEG LEVEL RIGHT LEG INIT

O29199

OTH CARDIAC COMP OF ANESTH DURING PREGNANCY UNSP TRIMESTER

S86222A

LACERAT MUSC/TEND ANT GRP AT LOW LEG LEVEL LEFT LEG INIT

O29211

CEREBRAL ANOXIA DUE TO ANESTH DURING PREG FIRST TRIMESTER

S86229A

LACERAT MUSC/TEND ANT GRP AT LOW LEG LEVEL UNSP LEG INIT

O29212

CEREBRAL ANOXIA DUE TO ANESTH DURING PREG SECOND TRIMESTER

S86311A

STRAIN MUSC/TEND PERONEAL GRP AT LOW LEG LEV R LEG INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O29213

CEREBRAL ANOXIA DUE TO ANESTH DURING PREG THIRD TRIMESTER

S86312A

STRAIN MUSC/TEND PERONEAL GRP AT LOW LEG LEV LEFT LEG INIT

O29219

CEREBRAL ANOXIA DUE TO ANESTH DURING PREG UNSP TRIMESTER

S86319A

STRAIN MUSC/TEND PERONEAL GRP AT LOW LEG LEV UNSP LEG INIT

O29291

OTH CNSL COMP OF ANESTH DURING PREGNANCY FIRST TRIMESTER

S86321A

LACERAT MUSC/TEND PERONEAL GRP AT LOW LEG LEV R LEG INIT

O29292

OTH CNSL COMP OF ANESTH DURING PREGNANCY SECOND TRIMESTER

S86322A

LACERAT MUSC/TEND PERONEAL GRP AT LOW LEG LEV L LEG INIT

O29293

OTH CNSL COMP OF ANESTH DURING PREGNANCY THIRD TRIMESTER

S86329A

LACERAT MUSC/TEND PERONEAL GRP AT LOW LEG LEVUNSP LEG INIT

O29299

OTH CNSL COMP OF ANESTHESIA DURING PREGNANCY UNSP TRIMESTER

S86811A

STRAIN OF MUSC/TEND AT LOWER LEG LEVEL RIGHT LEG INIT

O293X1

TOXIC REACTION TO LOCAL ANESTH DURING PREG FIRST TRIMESTER

S86812A

STRAIN OF MUSC/TEND AT LOWER LEG LEVEL LEFT LEG INIT

O293X2

TOXIC REACTION TO LOCAL ANESTH DURING PREG SECOND TRIMESTER

S86819A

STRAIN OF MUSC/TEND AT LOWER LEG LEVEL UNSP LEG INIT

O293X3

TOXIC REACTION TO LOCAL ANESTH DURING PREG THIRD TRIMESTER

S86821A

LACERATION OF MUSC/TEND AT LOWER LEG LEVEL RIGHT LEG INIT

O293X9

TOXIC REACTION TO LOCAL ANESTH DURING PREG UNSP TRIMESTER

S86822A

LACERATION OF MUSC/TEND AT LOWER LEG LEVEL LEFT LEG INIT

O2960

FAILED OR DIFFICULT INTUBATION FOR ANESTH DUR PREG UNSP TRI

S86829A

LACERATION OF MUSC/TEND AT LOWER LEG LEVEL UNSP LEG INIT

O2961

FAIL OR DIFFICULT INTUBATION FOR ANESTH DUR PREG FIRST TRI

S86911A

STRAIN OF UNSP MUSC/TEND AT LOWER LEG LEVEL RIGHT LEG INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O2962

FAIL OR DIFFICULT INTUBATION FOR ANESTH DUR PREG SECOND TRI

S86912A

STRAIN OF UNSP MUSC/TEND AT LOWER LEG LEVEL LEFT LEG INIT

O2963

FAIL OR DIFFICULT INTUBATION FOR ANESTH DUR PREG THIRD TRI

S86919A

STRAIN OF UNSP MUSC/TEND AT LOWER LEG LEVEL UNSP LEG INIT

O298X1

OTH COMP OF ANESTHESIA DURING PREGNANCY FIRST TRIMESTER

S86921A

LACERAT UNSP MUSC/TEND AT LOWER LEG LEVEL RIGHT LEG INIT

O298X2

OTH COMP OF ANESTHESIA DURING PREGNANCY SECOND TRIMESTER

S86922A

LACERAT UNSP MUSC/TEND AT LOWER LEG LEVEL LEFT LEG INIT

O298X3

OTH COMP OF ANESTHESIA DURING PREGNANCY THIRD TRIMESTER

S86929A

LACERAT UNSP MUSC/TEND AT LOWER LEG LEVEL UNSP LEG INIT

O298X9

OTH COMP OF ANESTHESIA DURING PREGNANCY UNSP TRIMESTER

S8700XA

CRUSHING INJURY OF UNSPECIFIED KNEE INITIAL ENCOUNTER

O2990

UNSP COMP OF ANESTHESIA DURING PREGNANCY UNSP TRIMESTER

S8701XA

CRUSHING INJURY OF RIGHT KNEE INITIAL ENCOUNTER

O2991

UNSP COMP OF ANESTHESIA DURING PREGNANCY FIRST TRIMESTER

S8702XA

CRUSHING INJURY OF LEFT KNEE INITIAL ENCOUNTER

O2992

UNSP COMP OF ANESTHESIA DURING PREGNANCY SECOND TRIMESTER

S8780XA

CRUSHING INJURY OF UNSPECIFIED LOWER LEG INITIAL ENCOUNTER

O2993

UNSP COMP OF ANESTHESIA DURING PREGNANCY THIRD TRIMESTER

S8781XA

CRUSHING INJURY OF RIGHT LOWER LEG INITIAL ENCOUNTER

O320XX0

MATERNAL CARE FOR UNSTABLE LIE NOT APPLICABLE OR UNSP

S8782XA

CRUSHING INJURY OF LEFT LOWER LEG INITIAL ENCOUNTER

O320XX1 MATERNAL CARE FOR UNSTABLE LIE FETUS 1

S88011A

COMPLETE TRAUMATIC AMPUTATION AT KNEE LEVEL R LOW LEG INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O320XX2 MATERNAL CARE FOR UNSTABLE LIE FETUS 2

S88012A

COMPLETE TRAUMATIC AMPUTATION AT KNEE LEVEL L LOW LEG INIT

O320XX3 MATERNAL CARE FOR UNSTABLE LIE FETUS 3

S88019A

COMPLETE TRAUMATIC AMP AT KNEE LEVEL UNSP LOWER LEG INIT

O320XX4 MATERNAL CARE FOR UNSTABLE LIE FETUS 4

S88021A

PARTIAL TRAUMATIC AMPUTATION AT KNEE LEVEL R LOW LEG INIT

O320XX5 MATERNAL CARE FOR UNSTABLE LIE FETUS 5

S88022A

PARTIAL TRAUMATIC AMPUTATION AT KNEE LEVEL L LOW LEG INIT

O320XX9 MATERNAL CARE FOR UNSTABLE LIE OTHER FETUS

S88029A

PARTIAL TRAUMATIC AMP AT KNEE LEVEL UNSP LOWER LEG INIT

O321XX0 MATERNAL CARE FOR BREECH PRESENTATION UNSP

S88111A

COMPLETE TRAUM AMP AT LEV BETW KN AND ANKL R LOW LEG INIT

O321XX1 MATERNAL CARE FOR BREECH PRESENTATION FETUS 1

S88112A

COMPLETE TRAUM AMP AT LEV BETW KN AND ANKL L LOW LEG INIT

O321XX2 MATERNAL CARE FOR BREECH PRESENTATION FETUS 2

S88119A

COMPLETE TRAUM AMP AT LEV BETW KN & ANKL UNSP LOW LEG INIT

O321XX3 MATERNAL CARE FOR BREECH PRESENTATION FETUS 3

S88121A

PART TRAUM AMP AT LEVEL BETW KNEE AND ANKLE R LOW LEG INIT

O321XX4 MATERNAL CARE FOR BREECH PRESENTATION FETUS 4

S88122A

PART TRAUM AMP AT LEVEL BETW KNEE AND ANKLE L LOW LEG INIT

O321XX5 MATERNAL CARE FOR BREECH PRESENTATION FETUS 5

S88129A

PART TRAUM AMP AT LEV BETW KNEE AND ANKL UNSP LOW LEG INIT

O321XX9 MATERNAL CARE FOR BREECH PRESENTATION OTHER FETUS

S88911A

COMPLETE TRAUMATIC AMPUTATION OF R LOW LEG LEVEL UNSP INIT

O322XX0

MATERNAL CARE FOR TRANSVERSE AND OBLIQUE LIE UNSP

S88912A

COMPLETE TRAUMATIC AMPUTATION OF L LOW LEG LEVEL UNSP INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O322XX1

MATERNAL CARE FOR TRANSVERSE AND OBLIQUE LIE FETUS 1

S88919A

COMPLETE TRAUMATIC AMP OF UNSP LOWER LEG LEVEL UNSP INIT

O322XX2

MATERNAL CARE FOR TRANSVERSE AND OBLIQUE LIE FETUS 2

S88921A

PARTIAL TRAUMATIC AMPUTATION OF R LOW LEG LEVEL UNSP INIT

O322XX3

MATERNAL CARE FOR TRANSVERSE AND OBLIQUE LIE FETUS 3

S88929A

PARTIAL TRAUMATIC AMP OF UNSP LOWER LEG LEVEL UNSP INIT

O322XX4

MATERNAL CARE FOR TRANSVERSE AND OBLIQUE LIE FETUS 4

S89001A

UNSP PHYSEAL FRACTURE OF UPPER END OF RIGHT TIBIA INIT

O322XX5

MATERNAL CARE FOR TRANSVERSE AND OBLIQUE LIE FETUS 5

S89002A

UNSP PHYSEAL FRACTURE OF UPPER END OF LEFT TIBIA INIT

O322XX9

MATERNAL CARE FOR TRANSVERSE AND OBLIQUE LIE OTHER FETUS

S89009A

UNSP PHYSEAL FRACTURE OF UPPER END OF UNSP TIBIA INIT

O323XX0

MATERNAL CARE FOR FACE BROW AND CHIN PRESENTATION UNSP

S89011A

SLTR-HARIS TYPE I PHYSEAL FX UPPER END OF RIGHT TIBIA INIT

O323XX1

MATERNAL CARE FOR FACE BROW AND CHIN PRESENTATION FETUS 1

S89012A

SLTR-HARIS TYPE I PHYSEAL FX UPPER END OF LEFT TIBIA INIT

O323XX2

MATERNAL CARE FOR FACE BROW AND CHIN PRESENTATION FETUS 2

S89019A

SLTR-HARIS TYPE I PHYSEAL FX UPPER END OF UNSP TIBIA INIT

O323XX3

MATERNAL CARE FOR FACE BROW AND CHIN PRESENTATION FETUS 3

S89021A

SLTR-HARIS TYPE II PHYSEAL FX UPPER END OF RIGHT TIBIA INIT

O323XX4

MATERNAL CARE FOR FACE BROW AND CHIN PRESENTATION FETUS 4

S89022A

SLTR-HARIS TYPE II PHYSEAL FX UPPER END OF LEFT TIBIA INIT

O323XX5

MATERNAL CARE FOR FACE BROW AND CHIN PRESENTATION FETUS 5

S89029A

SLTR-HARIS TYPE II PHYSEAL FX UPPER END OF UNSP TIBIA INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O323XX9

MATERNAL CARE FOR FACE BROW AND CHIN PRESENTATION OTH

S89031A

SLTR-HARIS TYPE III PHYSEAL FX UPPER END OF R TIBIA INIT

O324XX0

MATERNAL CARE FOR HIGH HEAD AT TERM NOT APPLICABLE OR UNSP

S89032A

SLTR-HARIS TYPE III PHYSEAL FX UPPER END OF LEFT TIBIA INIT

O324XX1 MATERNAL CARE FOR HIGH HEAD AT TERM FETUS 1

S89039A

SLTR-HARIS TYPE III PHYSEAL FX UPPER END OF UNSP TIBIA INIT

O324XX2 MATERNAL CARE FOR HIGH HEAD AT TERM FETUS 2

S89041A

SLTR-HARIS TYPE IV PHYSEAL FX UPPER END OF RIGHT TIBIA INIT

O324XX3 MATERNAL CARE FOR HIGH HEAD AT TERM FETUS 3

S89042A

SLTR-HARIS TYPE IV PHYSEAL FX UPPER END OF LEFT TIBIA INIT

O324XX4 MATERNAL CARE FOR HIGH HEAD AT TERM FETUS 4

S89049A

SLTR-HARIS TYPE IV PHYSEAL FX UPPER END OF UNSP TIBIA INIT

O324XX5 MATERNAL CARE FOR HIGH HEAD AT TERM FETUS 5

S89091A

OTH PHYSEAL FRACTURE OF UPPER END OF RIGHT TIBIA INIT

O324XX9 MATERNAL CARE FOR HIGH HEAD AT TERM OTHER FETUS

S89092A

OTH PHYSEAL FRACTURE OF UPPER END OF LEFT TIBIA INIT

O326XX0

MATERNAL CARE FOR COMPOUND PRESENTATION UNSP

S89099A

OTH PHYSEAL FRACTURE OF UPPER END OF UNSP TIBIA INIT

O326XX1

MATERNAL CARE FOR COMPOUND PRESENTATION FETUS 1

S89101A

UNSP PHYSEAL FRACTURE OF LOWER END OF RIGHT TIBIA INIT

O326XX2

MATERNAL CARE FOR COMPOUND PRESENTATION FETUS 2

S89102A

UNSP PHYSEAL FRACTURE OF LOWER END OF LEFT TIBIA INIT

O326XX3

MATERNAL CARE FOR COMPOUND PRESENTATION FETUS 3

S89109A

UNSP PHYSEAL FRACTURE OF LOWER END OF UNSP TIBIA INIT

O326XX4

MATERNAL CARE FOR COMPOUND PRESENTATION FETUS 4

S89111A

SLTR-HARIS TYPE I PHYSEAL FX LOWER END OF RIGHT TIBIA INIT

O326XX5

MATERNAL CARE FOR COMPOUND PRESENTATION FETUS 5

S89112A

SLTR-HARIS TYPE I PHYSEAL FX LOWER END OF LEFT TIBIA INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O326XX9

MATERNAL CARE FOR COMPOUND PRESENTATION OTHER FETUS

S89119A

SLTR-HARIS TYPE I PHYSEAL FX LOWER END OF UNSP TIBIA INIT

O328XX0

MATERNAL CARE FOR OTH MALPRESENTATION OF FETUS UNSP

S89121A

SLTR-HARIS TYPE II PHYSEAL FX LOWER END OF RIGHT TIBIA INIT

O328XX1

MATERNAL CARE FOR OTHER MALPRESENTATION OF FETUS FETUS 1

S89122A

SLTR-HARIS TYPE II PHYSEAL FX LOWER END OF LEFT TIBIA INIT

O328XX2

MATERNAL CARE FOR OTHER MALPRESENTATION OF FETUS FETUS 2

S89129A

SLTR-HARIS TYPE II PHYSEAL FX LOWER END OF UNSP TIBIA INIT

O328XX3

MATERNAL CARE FOR OTHER MALPRESENTATION OF FETUS FETUS 3

S89131A

SLTR-HARIS TYPE III PHYSEAL FX LOWER END OF R TIBIA INIT

O328XX4

MATERNAL CARE FOR OTHER MALPRESENTATION OF FETUS FETUS 4

S89132A

SLTR-HARIS TYPE III PHYSEAL FX LOWER END OF LEFT TIBIA INIT

O328XX5

MATERNAL CARE FOR OTHER MALPRESENTATION OF FETUS FETUS 5

S89139A

SLTR-HARIS TYPE III PHYSEAL FX LOWER END OF UNSP TIBIA INIT

O328XX9

MATERNAL CARE FOR OTH MALPRESENTATION OF FETUS OTHER FETUS

S89141A

SLTR-HARIS TYPE IV PHYSEAL FX LOWER END OF RIGHT TIBIA INIT

O329XX1

MATERNAL CARE FOR MALPRESENTATION OF FETUS UNSP FETUS 1

S89142A

SLTR-HARIS TYPE IV PHYSEAL FX LOWER END OF LEFT TIBIA INIT

O329XX2

MATERNAL CARE FOR MALPRESENTATION OF FETUS UNSP FETUS 2

S89149A

SLTR-HARIS TYPE IV PHYSEAL FX LOWER END OF UNSP TIBIA INIT

O329XX3

MATERNAL CARE FOR MALPRESENTATION OF FETUS UNSP FETUS 3

S89191A

OTH PHYSEAL FRACTURE OF LOWER END OF RIGHT TIBIA INIT

O329XX4

MATERNAL CARE FOR MALPRESENTATION OF FETUS UNSP FETUS 4

S89192A

OTH PHYSEAL FRACTURE OF LOWER END OF LEFT TIBIA INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O329XX5

MATERNAL CARE FOR MALPRESENTATION OF FETUS UNSP FETUS 5

S89199A

OTH PHYSEAL FRACTURE OF LOWER END OF UNSP TIBIA INIT

O329XX9

MATERNAL CARE FOR MALPRESENTATION OF FETUS UNSP OTH FETUS

S89201A

UNSP PHYSEAL FRACTURE OF UPPER END OF RIGHT FIBULA INIT

O330

MATERN CARE FOR DISPROPRTN D/T DEFORMITY OF MATERN PELV BONE

S89202A

UNSP PHYSEAL FRACTURE OF UPPER END OF LEFT FIBULA INIT

O331

MATERN CARE FOR DISPROPRTN D/T GENERALLY CONTRACTED PELVIS

S89209A

UNSP PHYSEAL FRACTURE OF UPPER END OF UNSP FIBULA INIT

O332

MATERNAL CARE FOR DISPROPRTN DUE TO INLET CONTRCTN OF PELVIS

S89211A

SLTR-HARIS TYPE I PHYSEAL FX UPPER END OF R FIBULA INIT

O333XX0

MATERN CARE FOR DISPROPRTN D/T OUTLET CONTRCTN OF PELV UNSP

S89212A

SLTR-HARIS TYPE I PHYSEAL FX UPPER END OF LEFT FIBULA INIT

O333XX1

MATERN CARE FOR DISPROPRTN D/T OUTLET CONTRCTN OF PELV FTS1

S89219A

SLTR-HARIS TYPE I PHYSEAL FX UPPER END OF UNSP FIBULA INIT

O333XX2

MATERN CARE FOR DISPROPRTN D/T OUTLET CONTRCTN OF PELV FTS2

S89221A

SLTR-HARIS TYPE II PHYSEAL FX UPPER END OF R FIBULA INIT

O333XX3

MATERN CARE FOR DISPROPRTN D/T OUTLET CONTRCTN OF PELV FTS3

S89222A

SLTR-HARIS TYPE II PHYSEAL FX UPPER END OF LEFT FIBULA INIT

O333XX4

MATERN CARE FOR DISPROPRTN D/T OUTLET CONTRCTN OF PELV FTS4

S89229A

SLTR-HARIS TYPE II PHYSEAL FX UPPER END OF UNSP FIBULA INIT

O333XX5

MATERN CARE FOR DISPROPRTN D/T OUTLET CONTRCTN OF PELV FTS5

S89291A

OTH PHYSEAL FRACTURE OF UPPER END OF RIGHT FIBULA INIT

O333XX9

MATERN CARE FOR DISPROPRTN D/T OUTLET CONTRCTN OF PELV OTH

S89292A

OTH PHYSEAL FRACTURE OF UPPER END OF LEFT FIBULA INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O334XX1

MATERN CARE FOR DISPROPRTN OF MIX MATERN & FETL ORIGIN FTS1

S89299A

OTH PHYSEAL FRACTURE OF UPPER END OF UNSP FIBULA INIT

O334XX2

MATERN CARE FOR DISPROPRTN OF MIX MATERN & FETL ORIGIN FTS2

S89301A

UNSP PHYSEAL FRACTURE OF LOWER END OF RIGHT FIBULA INIT

O334XX3

MATERN CARE FOR DISPROPRTN OF MIX MATERN & FETL ORIGIN FTS3

S89302A

UNSP PHYSEAL FRACTURE OF LOWER END OF LEFT FIBULA INIT

O334XX4

MATERN CARE FOR DISPROPRTN OF MIX MATERN & FETL ORIGIN FTS4

S89309A

UNSP PHYSEAL FRACTURE OF LOWER END OF UNSP FIBULA INIT

O334XX5

MATERN CARE FOR DISPROPRTN OF MIX MATERN & FETL ORIGIN FTS5

S89311A

SLTR-HARIS TYPE I PHYSEAL FX LOWER END OF R FIBULA INIT

O334XX9

MATERN CARE FOR DISPROPRTN OF MIX MATERN & FETL ORIGIN OTH

S89312A

SLTR-HARIS TYPE I PHYSEAL FX LOWER END OF LEFT FIBULA INIT

O335XX1

MATERN CARE FOR DISPROPRTN D/T UNUSUALLY LARGE FETUS FTS1

S89319A

SLTR-HARIS TYPE I PHYSEAL FX LOWER END OF UNSP FIBULA INIT

O335XX2

MATERN CARE FOR DISPROPRTN D/T UNUSUALLY LARGE FETUS FTS2

S89321A

SLTR-HARIS TYPE II PHYSEAL FX LOWER END OF R FIBULA INIT

O335XX3

MATERN CARE FOR DISPROPRTN D/T UNUSUALLY LARGE FETUS FTS3

S89322A

SLTR-HARIS TYPE II PHYSEAL FX LOWER END OF LEFT FIBULA INIT

O335XX4

MATERN CARE FOR DISPROPRTN D/T UNUSUALLY LARGE FETUS FTS4

S89329A

SLTR-HARIS TYPE II PHYSEAL FX LOWER END OF UNSP FIBULA INIT

O335XX5

MATERN CARE FOR DISPROPRTN D/T UNUSUALLY LARGE FETUS FTS5

S89391A

OTH PHYSEAL FRACTURE OF LOWER END OF RIGHT FIBULA INIT

O335XX9

MATERN CARE FOR DISPROPRTN DUE TO UNUSUALLY LARGE FETUS OTH

S89392A

OTH PHYSEAL FRACTURE OF LOWER END OF LEFT FIBULA INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O336XX1

MATERN CARE FOR DISPROPRTN DUE TO HYDROCEPHALIC FETUS FTS1

S89399A

OTH PHYSEAL FRACTURE OF LOWER END OF UNSP FIBULA INIT

O336XX2

MATERN CARE FOR DISPROPRTN DUE TO HYDROCEPHALIC FETUS FTS2

S91011A

LACERATION WITHOUT FOREIGN BODY RIGHT ANKLE INIT ENCNTR

O336XX3

MATERN CARE FOR DISPROPRTN DUE TO HYDROCEPHALIC FETUS FTS3

S91012A

LACERATION WITHOUT FOREIGN BODY LEFT ANKLE INIT ENCNTR

O336XX4

MATERN CARE FOR DISPROPRTN DUE TO HYDROCEPHALIC FETUS FTS4

S91019A

LACERATION WITHOUT FOREIGN BODY UNSP ANKLE INIT ENCNTR

O336XX5

MATERN CARE FOR DISPROPRTN DUE TO HYDROCEPHALIC FETUS FTS5

S91021A

LACERATION WITH FOREIGN BODY RIGHT ANKLE INITIAL ENCOUNTER

O336XX9

MATERNAL CARE FOR DISPROPRTN DUE TO HYDROCEPHALIC FETUS OTH

S91022A

LACERATION WITH FOREIGN BODY LEFT ANKLE INITIAL ENCOUNTER

O337

MATERNAL CARE FOR DISPROPORTION DUE TO OTH FETAL DEFORMITIES

S91029A

LACERATION WITH FOREIGN BODY UNSPECIFIED ANKLE INIT ENCNTR

O338

MATERNAL CARE FOR DISPROPORTION OF OTHER ORIGIN

S91031A

PUNCTURE WOUND W/O FOREIGN BODY RIGHT ANKLE INIT ENCNTR

O3401

MATERNAL CARE FOR UNSP CONGEN MALFORM OF UTERUS FIRST TRI

S91032A

PUNCTURE WOUND WITHOUT FOREIGN BODY LEFT ANKLE INIT ENCNTR

O3402

MATERNAL CARE FOR UNSP CONGEN MALFORM OF UTERUS SECOND TRI

S91039A

PUNCTURE WOUND WITHOUT FOREIGN BODY UNSP ANKLE INIT ENCNTR

O3403

MATERNAL CARE FOR UNSP CONGEN MALFORM OF UTERUS THIRD TRI

S91041A

PUNCTURE WOUND WITH FOREIGN BODY RIGHT ANKLE INIT ENCNTR

O3411

MATERNAL CARE FOR BENIGN TUMOR OF CORPUS UTERI FIRST TRI

S91042A

PUNCTURE WOUND WITH FOREIGN BODY LEFT ANKLE INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O3412

MATERNAL CARE FOR BENIGN TUMOR OF CORPUS UTERI SECOND TRI

S91049A

PUNCTURE WOUND WITH FOREIGN BODY UNSP ANKLE INIT ENCNTR

O3413

MATERNAL CARE FOR BENIGN TUMOR OF CORPUS UTERI THIRD TRI

S91051A

OPEN BITE RIGHT ANKLE INITIAL ENCOUNTER

O3421

MATERNAL CARE FOR SCAR FROM PREVIOUS CESAREAN DELIVERY

S91052A

OPEN BITE LEFT ANKLE INITIAL ENCOUNTER

O3429

MATERNAL CARE DUE TO UTERINE SCAR FROM OTH PREVIOUS SURGERY

S91059A

OPEN BITE UNSPECIFIED ANKLE INITIAL ENCOUNTER

O3431

MATERNAL CARE FOR CERVICAL INCOMPETENCE FIRST TRIMESTER

S91111A

LAC W/O FB OF RIGHT GREAT TOE W/O DAMAGE TO NAIL INIT

O3432

MATERNAL CARE FOR CERVICAL INCOMPETENCE SECOND TRIMESTER

S91112A

LACERATION W/O FB OF LEFT GREAT TOE W/O DAMAGE TO NAIL INIT

O3433

MATERNAL CARE FOR CERVICAL INCOMPETENCE THIRD TRIMESTER

S91113A

LACERATION W/O FB OF UNSP GREAT TOE W/O DAMAGE TO NAIL INIT

O3441

MATERNAL CARE FOR OTH ABNLT OF CERVIX FIRST TRIMESTER

S91114A

LAC W/O FB OF RIGHT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O3442

MATERNAL CARE FOR OTH ABNLT OF CERVIX SECOND TRIMESTER

S91115A

LAC W/O FB OF LEFT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O3443

MATERNAL CARE FOR OTH ABNLT OF CERVIX THIRD TRIMESTER

S91116A

LAC W/O FB OF UNSP LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O34511

MATERNAL CARE FOR INCARCERATION OF GRAVID UTERUS FIRST TRI

S91119A

LACERATION W/O FB OF UNSP TOE W/O DAMAGE TO NAIL INIT

O34512

MATERNAL CARE FOR INCARCERATION OF GRAVID UTERUS SECOND TRI

S91121A

LACERATION W FB OF RIGHT GREAT TOE W/O DAMAGE TO NAIL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O34513

MATERNAL CARE FOR INCARCERATION OF GRAVID UTERUS THIRD TRI

S91122A

LACERATION W FB OF LEFT GREAT TOE W/O DAMAGE TO NAIL INIT

O34521

MATERNAL CARE FOR PROLAPSE OF GRAVID UTERUS FIRST TRIMESTER

S91123A

LACERATION W FB OF UNSP GREAT TOE W/O DAMAGE TO NAIL INIT

O34522

MATERNAL CARE FOR PROLAPSE OF GRAVID UTERUS SECOND TRI

S91124A

LAC W FB OF RIGHT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O34523

MATERNAL CARE FOR PROLAPSE OF GRAVID UTERUS THIRD TRIMESTER

S91125A

LAC W FB OF LEFT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O34531

MATERNAL CARE FOR RETROVERSION OF GRAVID UTERUS FIRST TRI

S91126A

LAC W FB OF UNSP LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O34532

MATERNAL CARE FOR RETROVERSION OF GRAVID UTERUS SECOND TRI

S91129A

LACERATION W FB OF UNSP TOE(S) W/O DAMAGE TO NAIL INIT

O34533

MATERNAL CARE FOR RETROVERSION OF GRAVID UTERUS THIRD TRI

S91131A

PNCTR W/O FB OF RIGHT GREAT TOE W/O DAMAGE TO NAIL INIT

O34591

MATERNAL CARE FOR OTH ABNLT OF GRAVID UTERUS FIRST TRI

S91132A

PNCTR W/O FB OF LEFT GREAT TOE W/O DAMAGE TO NAIL INIT

O34592

MATERNAL CARE FOR OTH ABNLT OF GRAVID UTERUS SECOND TRI

S91133A

PNCTR W/O FB OF UNSP GREAT TOE W/O DAMAGE TO NAIL INIT

O34593

MATERNAL CARE FOR OTH ABNLT OF GRAVID UTERUS THIRD TRI

S91134A

PNCTR W/O FB OF RIGHT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O3481

MATERNAL CARE FOR OTH ABNLT OF PELVIC ORGANS FIRST TRI

S91135A

PNCTR W/O FB OF LEFT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O3482

MATERNAL CARE FOR OTH ABNLT OF PELVIC ORGANS SECOND TRI

S91136A

PNCTR W/O FB OF UNSP LESSER TOE(S) W/O DAMAGE TO NAIL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O3483

MATERNAL CARE FOR OTH ABNLT OF PELVIC ORGANS THIRD TRI

S91139A

PNCTR W/O FB OF UNSP TOE(S) W/O DAMAGE TO NAIL INIT

O3491 MATERNAL CARE FOR ABNLT OF PELVIC ORGAN UNSP FIRST TRI

S91141A

PNCTR W FB OF RIGHT GREAT TOE W/O DAMAGE TO NAIL INIT

O3492

MATERNAL CARE FOR ABNLT OF PELVIC ORGAN UNSP SECOND TRI

S91142A

PNCTR W FB OF LEFT GREAT TOE W/O DAMAGE TO NAIL INIT

O3493 MATERNAL CARE FOR ABNLT OF PELVIC ORGAN UNSP THIRD TRI

S91143A

PNCTR W FB OF UNSP GREAT TOE W/O DAMAGE TO NAIL INIT

O353XX1

MATERN CARE FOR DAMAG TO FTS FROM VIRAL DIS IN MOTHER FTS1

S91144A

PNCTR W FB OF RIGHT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O353XX2

MATERN CARE FOR DAMAG TO FTS FROM VIRAL DIS IN MOTHER FTS2

S91145A

PNCTR W FB OF LEFT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O353XX3

MATERN CARE FOR DAMAG TO FTS FROM VIRAL DIS IN MOTHER FTS3

S91146A

PNCTR W FB OF UNSP LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O353XX4

MATERN CARE FOR DAMAG TO FTS FROM VIRAL DIS IN MOTHER FTS4

S91149A

PNCTR W FOREIGN BODY OF UNSP TOE(S) W/O DAMAGE TO NAIL INIT

O353XX5

MATERN CARE FOR DAMAG TO FTS FROM VIRAL DIS IN MOTHER FTS5

S91151A

OPEN BITE OF RIGHT GREAT TOE W/O DAMAGE TO NAIL INIT ENCNTR

O353XX9

MATERN CARE FOR DAMAG TO FETUS FROM VIRAL DIS IN MOTHER OTH

S91152A

OPEN BITE OF LEFT GREAT TOE W/O DAMAGE TO NAIL INIT ENCNTR

O3621X1

MATERNAL CARE FOR HYDROPS FETALIS FIRST TRIMESTER FETUS 1

S91153A

OPEN BITE OF UNSP GREAT TOE W/O DAMAGE TO NAIL INIT ENCNTR

O3621X2

MATERNAL CARE FOR HYDROPS FETALIS FIRST TRIMESTER FETUS 2

S91154A

OPEN BITE OF RIGHT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O3621X3

MATERNAL CARE FOR HYDROPS FETALIS FIRST TRIMESTER FETUS 3

S91155A

OPEN BITE OF LEFT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O3621X4

MATERNAL CARE FOR HYDROPS FETALIS FIRST TRIMESTER FETUS 4

S91156A

OPEN BITE OF UNSP LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O3621X5

MATERNAL CARE FOR HYDROPS FETALIS FIRST TRIMESTER FETUS 5

S91159A

OPEN BITE OF UNSP TOE(S) WITHOUT DAMAGE TO NAIL INIT ENCNTR

O3621X9 MATERNAL CARE FOR HYDROPS FETALIS FIRST TRIMESTER OTH

S91211A

LACERATION W/O FB OF RIGHT GREAT TOE W DAMAGE TO NAIL INIT

O3622X1

MATERNAL CARE FOR HYDROPS FETALIS SECOND TRIMESTER FETUS 1

S91212A

LACERATION W/O FB OF LEFT GREAT TOE W DAMAGE TO NAIL INIT

O3622X2

MATERNAL CARE FOR HYDROPS FETALIS SECOND TRIMESTER FETUS 2

S91213A

LACERATION W/O FB OF UNSP GREAT TOE W DAMAGE TO NAIL INIT

O3622X3

MATERNAL CARE FOR HYDROPS FETALIS SECOND TRIMESTER FETUS 3

S91214A

LAC W/O FB OF RIGHT LESSER TOE(S) W DAMAGE TO NAIL INIT

O3622X4

MATERNAL CARE FOR HYDROPS FETALIS SECOND TRIMESTER FETUS 4

S91215A

LAC W/O FB OF LEFT LESSER TOE(S) W DAMAGE TO NAIL INIT

O3622X5

MATERNAL CARE FOR HYDROPS FETALIS SECOND TRIMESTER FETUS 5

S91216A

LAC W/O FB OF UNSP LESSER TOE(S) W DAMAGE TO NAIL INIT

O3622X9

MATERNAL CARE FOR HYDROPS FETALIS SECOND TRIMESTER OTH

S91219A

LACERATION W/O FB OF UNSP TOE(S) W DAMAGE TO NAIL INIT

O3623X1

MATERNAL CARE FOR HYDROPS FETALIS THIRD TRIMESTER FETUS 1

S91221A

LACERATION W FB OF RIGHT GREAT TOE W DAMAGE TO NAIL INIT

O3623X2

MATERNAL CARE FOR HYDROPS FETALIS THIRD TRIMESTER FETUS 2

S91222A

LACERATION W FB OF LEFT GREAT TOE W DAMAGE TO NAIL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O3623X3

MATERNAL CARE FOR HYDROPS FETALIS THIRD TRIMESTER FETUS 3

S91223A

LACERATION W FB OF UNSP GREAT TOE W DAMAGE TO NAIL INIT

O3623X4

MATERNAL CARE FOR HYDROPS FETALIS THIRD TRIMESTER FETUS 4

S91224A

LAC W FB OF RIGHT LESSER TOE(S) W DAMAGE TO NAIL INIT

O3623X5

MATERNAL CARE FOR HYDROPS FETALIS THIRD TRIMESTER FETUS 5

S91225A

LACERATION W FB OF LEFT LESSER TOE(S) W DAMAGE TO NAIL INIT

O3623X9 MATERNAL CARE FOR HYDROPS FETALIS THIRD TRIMESTER OTH

S91226A

LACERATION W FB OF UNSP LESSER TOE(S) W DAMAGE TO NAIL INIT

O364XX1 MATERNAL CARE FOR INTRAUTERINE DEATH FETUS 1

S91229A

LACERATION W FB OF UNSP TOE(S) W DAMAGE TO NAIL INIT

O364XX2 MATERNAL CARE FOR INTRAUTERINE DEATH FETUS 2

S91231A

PNCTR W/O FB OF RIGHT GREAT TOE W DAMAGE TO NAIL INIT

O364XX3 MATERNAL CARE FOR INTRAUTERINE DEATH FETUS 3

S91232A

PNCTR W/O FB OF LEFT GREAT TOE W DAMAGE TO NAIL INIT

O364XX4 MATERNAL CARE FOR INTRAUTERINE DEATH FETUS 4

S91233A

PNCTR W/O FB OF UNSP GREAT TOE W DAMAGE TO NAIL INIT

O364XX5 MATERNAL CARE FOR INTRAUTERINE DEATH FETUS 5

S91234A

PNCTR W/O FB OF RIGHT LESSER TOE(S) W DAMAGE TO NAIL INIT

O364XX9

MATERNAL CARE FOR INTRAUTERINE DEATH OTHER FETUS

S91235A

PNCTR W/O FB OF LEFT LESSER TOE(S) W DAMAGE TO NAIL INIT

O365111

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 1ST TRI FTS1

S91236A

PNCTR W/O FB OF UNSP LESSER TOE(S) W DAMAGE TO NAIL INIT

O365112

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 1ST TRI FTS2

S91239A

PNCTR W/O FOREIGN BODY OF UNSP TOE(S) W DAMAGE TO NAIL INIT

O365113

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 1ST TRI FTS3

S91241A

PNCTR W FB OF RIGHT GREAT TOE W DAMAGE TO NAIL INIT

O365114

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 1ST TRI FTS4

S91242A

PNCTR W FB OF LEFT GREAT TOE W DAMAGE TO NAIL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O365115

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 1ST TRI FTS5

S91243A

PNCTR W FB OF UNSP GREAT TOE W DAMAGE TO NAIL INIT

O365119

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF FIRST TRI OTH

S91244A

PNCTR W FB OF RIGHT LESSER TOE(S) W DAMAGE TO NAIL INIT

O365121

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 2ND TRI FTS1

S91245A

PNCTR W FB OF LEFT LESSER TOE(S) W DAMAGE TO NAIL INIT

O365122

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 2ND TRI FTS2

S91246A

PNCTR W FB OF UNSP LESSER TOE(S) W DAMAGE TO NAIL INIT

O365123

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 2ND TRI FTS3

S91249A

PNCTR W FOREIGN BODY OF UNSP TOE(S) W DAMAGE TO NAIL INIT

O365124

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 2ND TRI FTS4

S91251A

OPEN BITE OF RIGHT GREAT TOE W DAMAGE TO NAIL INIT ENCNTR

O365125

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 2ND TRI FTS5

S91252A

OPEN BITE OF LEFT GREAT TOE WITH DAMAGE TO NAIL INIT ENCNTR

O365129

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 2ND TRI OTH

S91253A

OPEN BITE OF UNSP GREAT TOE WITH DAMAGE TO NAIL INIT ENCNTR

O365131

MATERN CARE FOR OR SUSP PLACNTL INSUFF THIRD TRI FTS1

S91254A

OPEN BITE OF RIGHT LESSER TOE(S) W DAMAGE TO NAIL INIT

O365132

MATERN CARE FOR OR SUSP PLACNTL INSUFF THIRD TRI FTS2

S91255A

OPEN BITE OF LEFT LESSER TOE(S) W DAMAGE TO NAIL INIT

O365133

MATERN CARE FOR OR SUSP PLACNTL INSUFF THIRD TRI FTS3

S91256A

OPEN BITE OF UNSP LESSER TOE(S) W DAMAGE TO NAIL INIT

O365134

MATERN CARE FOR OR SUSP PLACNTL INSUFF THIRD TRI FTS4

S91259A

OPEN BITE OF UNSP TOE(S) WITH DAMAGE TO NAIL INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O365135

MATERN CARE FOR OR SUSP PLACNTL INSUFF THIRD TRI FTS5

S91311A

LACERATION WITHOUT FOREIGN BODY RIGHT FOOT INIT ENCNTR

O365139

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF THIRD TRI OTH

S91312A

LACERATION WITHOUT FOREIGN BODY LEFT FOOT INIT ENCNTR

O365191

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF UNSP TRI FTS1

S91319A

LACERATION WITHOUT FOREIGN BODY UNSP FOOT INIT ENCNTR

O365192

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF UNSP TRI FTS2

S91321A

LACERATION WITH FOREIGN BODY RIGHT FOOT INITIAL ENCOUNTER

O365193

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF UNSP TRI FTS3

S91322A

LACERATION WITH FOREIGN BODY LEFT FOOT INITIAL ENCOUNTER

O365194

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF UNSP TRI FTS4

S91329A

LACERATION WITH FOREIGN BODY UNSPECIFIED FOOT INIT ENCNTR

O365195

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF UNSP TRI FTS5

S91331A

PUNCTURE WOUND WITHOUT FOREIGN BODY RIGHT FOOT INIT ENCNTR

O365199

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF UNSP TRI OTH

S91332A

PUNCTURE WOUND WITHOUT FOREIGN BODY LEFT FOOT INIT ENCNTR

O368121

DECREASED FETAL MOVEMENTS SECOND TRIMESTER FETUS 1

S91339A

PUNCTURE WOUND WITHOUT FOREIGN BODY UNSP FOOT INIT ENCNTR

O368122

DECREASED FETAL MOVEMENTS SECOND TRIMESTER FETUS 2

S91341A

PUNCTURE WOUND WITH FOREIGN BODY RIGHT FOOT INIT ENCNTR

O368123

DECREASED FETAL MOVEMENTS SECOND TRIMESTER FETUS 3

S91342A

PUNCTURE WOUND WITH FOREIGN BODY LEFT FOOT INIT ENCNTR

O368124

DECREASED FETAL MOVEMENTS SECOND TRIMESTER FETUS 4

S91349A

PUNCTURE WOUND WITH FOREIGN BODY UNSP FOOT INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O368125

DECREASED FETAL MOVEMENTS SECOND TRIMESTER FETUS 5

S91351A

OPEN BITE RIGHT FOOT INITIAL ENCOUNTER

O368129

DECREASED FETAL MOVEMENTS SECOND TRIMESTER OTHER FETUS

S91352A

OPEN BITE LEFT FOOT INITIAL ENCOUNTER

O368131

DECREASED FETAL MOVEMENTS THIRD TRIMESTER FETUS 1

S92001A

UNSP FRACTURE OF RIGHT CALCANEUS INIT FOR CLOS FX

O368132

DECREASED FETAL MOVEMENTS THIRD TRIMESTER FETUS 2

S92001B

UNSP FRACTURE OF RIGHT CALCANEUS INIT FOR OPN FX

O368133

DECREASED FETAL MOVEMENTS THIRD TRIMESTER FETUS 3

S92002A

UNSP FRACTURE OF LEFT CALCANEUS INIT FOR CLOS FX

O368134

DECREASED FETAL MOVEMENTS THIRD TRIMESTER FETUS 4

S92002B

UNSP FRACTURE OF LEFT CALCANEUS INIT FOR OPN FX

O368135

DECREASED FETAL MOVEMENTS THIRD TRIMESTER FETUS 5

S92009A

UNSP FRACTURE OF UNSP CALCANEUS INIT FOR CLOS FX

O368139

DECREASED FETAL MOVEMENTS THIRD TRIMESTER OTHER FETUS

S92009B

UNSP FRACTURE OF UNSP CALCANEUS INIT FOR OPN FX

O368191

DECREASED FETAL MOVEMENTS UNSPECIFIED TRIMESTER FETUS 1

S92011A

DISP FX OF BODY OF RIGHT CALCANEUS INIT FOR CLOS FX

O368192

DECREASED FETAL MOVEMENTS UNSPECIFIED TRIMESTER FETUS 2

S92011B

DISP FX OF BODY OF RIGHT CALCANEUS INIT FOR OPN FX

O368193

DECREASED FETAL MOVEMENTS UNSPECIFIED TRIMESTER FETUS 3

S92012A

DISP FX OF BODY OF LEFT CALCANEUS INIT FOR CLOS FX

O368194

DECREASED FETAL MOVEMENTS UNSPECIFIED TRIMESTER FETUS 4

S92012B

DISP FX OF BODY OF LEFT CALCANEUS INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O368195

DECREASED FETAL MOVEMENTS UNSPECIFIED TRIMESTER FETUS 5

S92013A

DISP FX OF BODY OF UNSP CALCANEUS INIT FOR CLOS FX

O368199

DECREASED FETAL MOVEMENTS UNSP TRIMESTER OTHER FETUS

S92013B

DISP FX OF BODY OF UNSP CALCANEUS INIT FOR OPN FX

O368910

MATERNAL CARE FOR OTH FETAL PROBLEMS FIRST TRIMESTER UNSP

S92014A

NONDISP FX OF BODY OF RIGHT CALCANEUS INIT FOR CLOS FX

O368911

MATERNAL CARE FOR OTH FETAL PROBLEMS FIRST TRI FETUS 1

S92014B

NONDISP FX OF BODY OF RIGHT CALCANEUS INIT FOR OPN FX

O368912

MATERNAL CARE FOR OTH FETAL PROBLEMS FIRST TRI FETUS 2

S92015A

NONDISP FX OF BODY OF LEFT CALCANEUS INIT FOR CLOS FX

O368913

MATERNAL CARE FOR OTH FETAL PROBLEMS FIRST TRI FETUS 3

S92015B

NONDISP FX OF BODY OF LEFT CALCANEUS INIT FOR OPN FX

O368914

MATERNAL CARE FOR OTH FETAL PROBLEMS FIRST TRI FETUS 4

S92016A

NONDISP FX OF BODY OF UNSP CALCANEUS INIT FOR CLOS FX

O368915

MATERNAL CARE FOR OTH FETAL PROBLEMS FIRST TRI FETUS 5

S92016B

NONDISP FX OF BODY OF UNSP CALCANEUS INIT FOR OPN FX

O368919

MATERNAL CARE FOR OTH FETAL PROBLEMS FIRST TRIMESTER OTH

S92021A

DISP FX OF ANTERIOR PROCESS OF RIGHT CALCANEUS INIT

O368921

MATERNAL CARE FOR OTH FETAL PROBLEMS SECOND TRI FETUS 1

S92021B

DISP FX OF ANTERIOR PROCESS OF R CALCANEUS INIT FOR OPN FX

O368922

MATERNAL CARE FOR OTH FETAL PROBLEMS SECOND TRI FETUS 2

S92022A

DISP FX OF ANTERIOR PROCESS OF LEFT CALCANEUS INIT

O368923

MATERNAL CARE FOR OTH FETAL PROBLEMS SECOND TRI FETUS 3

S92022B

DISP FX OF ANTERIOR PROCESS OF L CALCANEUS INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O368924

MATERNAL CARE FOR OTH FETAL PROBLEMS SECOND TRI FETUS 4

S92023A

DISP FX OF ANTERIOR PROCESS OF UNSP CALCANEUS INIT

O368925

MATERNAL CARE FOR OTH FETAL PROBLEMS SECOND TRI FETUS 5

S92023B

DISP FX OF ANT PROCESS OF UNSP CALCANEUS INIT FOR OPN FX

O368929

MATERNAL CARE FOR OTH FETAL PROBLEMS SECOND TRIMESTER OTH

S92024A

NONDISP FX OF ANTERIOR PROCESS OF RIGHT CALCANEUS INIT

O368931

MATERNAL CARE FOR OTH FETAL PROBLEMS THIRD TRI FETUS 1

S92024B

NONDISP FX OF ANT PROCESS OF R CALCANEUS INIT FOR OPN FX

O368932

MATERNAL CARE FOR OTH FETAL PROBLEMS THIRD TRI FETUS 2

S92025A

NONDISP FX OF ANTERIOR PROCESS OF LEFT CALCANEUS INIT

O368933

MATERNAL CARE FOR OTH FETAL PROBLEMS THIRD TRI FETUS 3

S92025B

NONDISP FX OF ANT PROCESS OF L CALCANEUS INIT FOR OPN FX

O368934

MATERNAL CARE FOR OTH FETAL PROBLEMS THIRD TRI FETUS 4

S92026A

NONDISP FX OF ANTERIOR PROCESS OF UNSP CALCANEUS INIT

O368935

MATERNAL CARE FOR OTH FETAL PROBLEMS THIRD TRI FETUS 5

S92026B

NONDISP FX OF ANT PROCESS OF UNSP CALCANEUS INIT FOR OPN FX

O368939

MATERNAL CARE FOR OTH FETAL PROBLEMS THIRD TRIMESTER OTH

S92031A

DISPLACED AVULSION FX TUBEROSITY OF R CALCANEUS INIT

O368991

MATERNAL CARE FOR OTH FETAL PROBLEMS UNSP TRI FETUS 1

S92031B

DISPL AVULSION FX TUBEROSITY OF R CALCANEUS INIT FOR OPN FX

O368992

MATERNAL CARE FOR OTH FETAL PROBLEMS UNSP TRI FETUS 2

S92032A

DISPLACED AVULSION FX TUBEROSITY OF L CALCANEUS INIT

O368993

MATERNAL CARE FOR OTH FETAL PROBLEMS UNSP TRI FETUS 3

S92032B

DISPL AVULSION FX TUBEROSITY OF L CALCANEUS INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O368994

MATERNAL CARE FOR OTH FETAL PROBLEMS UNSP TRI FETUS 4

S92033A

DISPLACED AVULSION FX TUBEROSITY OF UNSP CALCANEUS INIT

O368995

MATERNAL CARE FOR OTH FETAL PROBLEMS UNSP TRI FETUS 5

S92033B

DISPL AVULS FX TUBEROSITY OF UNSP CALCANEUS INIT FOR OPN FX

O368999

MATERNAL CARE FOR OTH FETAL PROBLEMS UNSP TRIMESTER OTH

S92034A

NONDISP AVULSION FRACTURE OF TUBEROSITY OF R CALCANEUS INIT

O3690X1

MATERNAL CARE FOR FETAL PROBLEM UNSP UNSP TRI FETUS 1

S92034B

NONDISP AVULS FX TUBEROSITY OF R CALCANEUS INIT FOR OPN FX

O3690X2

MATERNAL CARE FOR FETAL PROBLEM UNSP UNSP TRI FETUS 2

S92035A

NONDISP AVULSION FRACTURE OF TUBEROSITY OF L CALCANEUS INIT

O3690X3

MATERNAL CARE FOR FETAL PROBLEM UNSP UNSP TRI FETUS 3

S92035B

NONDISP AVULS FX TUBEROSITY OF L CALCANEUS INIT FOR OPN FX

O3690X4

MATERNAL CARE FOR FETAL PROBLEM UNSP UNSP TRI FETUS 4

S92036A

NONDISP AVULSION FX TUBEROSITY OF UNSP CALCANEUS INIT

O3690X5

MATERNAL CARE FOR FETAL PROBLEM UNSP UNSP TRI FETUS 5

S92036B

NONDISP AVULS FX TUBEROSITY OF UNSP CALCANEUS 7THB

O3690X9

MATERNAL CARE FOR FETAL PROBLEM UNSP UNSP TRIMESTER OTH

S92041A

DISPLACED OTH FRACTURE OF TUBEROSITY OF R CALCANEUS INIT

O3691X1

MATERNAL CARE FOR FETAL PROBLEM UNSP FIRST TRI FETUS 1

S92041B

DISPLACED OTH FX TUBEROSITY OF R CALCANEUS INIT FOR OPN FX

O3691X2

MATERNAL CARE FOR FETAL PROBLEM UNSP FIRST TRI FETUS 2

S92042A

DISPLACED OTH FRACTURE OF TUBEROSITY OF LEFT CALCANEUS INIT

O3691X3

MATERNAL CARE FOR FETAL PROBLEM UNSP FIRST TRI FETUS 3

S92042B

DISPLACED OTH FX TUBEROSITY OF L CALCANEUS INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O3691X4

MATERNAL CARE FOR FETAL PROBLEM UNSP FIRST TRI FETUS 4

S92043A

DISPLACED OTH FRACTURE OF TUBEROSITY OF UNSP CALCANEUS INIT

O3691X5

MATERNAL CARE FOR FETAL PROBLEM UNSP FIRST TRI FETUS 5

S92043B

DISPL OTH FX TUBEROSITY OF UNSP CALCANEUS INIT FOR OPN FX

O3691X9

MATERNAL CARE FOR FETAL PROBLEM UNSP FIRST TRIMESTER OTH

S92044A

NONDISPLACED OTH FRACTURE OF TUBEROSITY OF R CALCANEUS INIT

O3692X0

MATERNAL CARE FOR FETAL PROBLEM UNSP SECOND TRI UNSP

S92044B

NONDISP OTH FX TUBEROSITY OF R CALCANEUS INIT FOR OPN FX

O3692X1

MATERNAL CARE FOR FETAL PROBLEM UNSP SECOND TRI FETUS 1

S92045A

NONDISPLACED OTH FRACTURE OF TUBEROSITY OF L CALCANEUS INIT

O3692X2

MATERNAL CARE FOR FETAL PROBLEM UNSP SECOND TRI FETUS 2

S92045B

NONDISP OTH FX TUBEROSITY OF L CALCANEUS INIT FOR OPN FX

O3692X3

MATERNAL CARE FOR FETAL PROBLEM UNSP SECOND TRI FETUS 3

S92046A

NONDISP OTH FRACTURE OF TUBEROSITY OF UNSP CALCANEUS INIT

O3692X4

MATERNAL CARE FOR FETAL PROBLEM UNSP SECOND TRI FETUS 4

S92046B

NONDISP OTH FX TUBEROSITY OF UNSP CALCANEUS INIT FOR OPN FX

O3692X5

MATERNAL CARE FOR FETAL PROBLEM UNSP SECOND TRI FETUS 5

S92051A

DISPLACED OTH EXTRAARTICULAR FRACTURE OF R CALCANEUS INIT

O3692X9

MATERNAL CARE FOR FETAL PROBLEM UNSP SECOND TRIMESTER OTH

S92051B

DISPLACED OTH EXTRARTIC FX R CALCANEUS INIT FOR OPN FX

O3693X1

MATERNAL CARE FOR FETAL PROBLEM UNSP THIRD TRI FETUS 1

S92052A

DISPLACED OTH EXTRARTIC FRACTURE OF LEFT CALCANEUS INIT

O3693X2

MATERNAL CARE FOR FETAL PROBLEM UNSP THIRD TRI FETUS 2

S92052B

DISPLACED OTH EXTRARTIC FX L CALCANEUS INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O3693X3

MATERNAL CARE FOR FETAL PROBLEM UNSP THIRD TRI FETUS 3

S92053A

DISPLACED OTH EXTRARTIC FRACTURE OF UNSP CALCANEUS INIT

O3693X4

MATERNAL CARE FOR FETAL PROBLEM UNSP THIRD TRI FETUS 4

S92053B

DISPLACED OTH EXTRARTIC FX UNSP CALCANEUS INIT FOR OPN FX

O3693X5

MATERNAL CARE FOR FETAL PROBLEM UNSP THIRD TRI FETUS 5

S92054A

NONDISPLACED OTH EXTRARTIC FRACTURE OF R CALCANEUS INIT

O3693X9

MATERNAL CARE FOR FETAL PROBLEM UNSP THIRD TRIMESTER OTH

S92054B

NONDISP OTH EXTRARTIC FX R CALCANEUS INIT FOR OPN FX

O401XX1 POLYHYDRAMNIOS FIRST TRIMESTER FETUS 1

S92055A

NONDISPLACED OTH EXTRARTIC FRACTURE OF LEFT CALCANEUS INIT

O401XX2 POLYHYDRAMNIOS FIRST TRIMESTER FETUS 2

S92055B

NONDISP OTH EXTRARTIC FX L CALCANEUS INIT FOR OPN FX

O401XX3 POLYHYDRAMNIOS FIRST TRIMESTER FETUS 3

S92056A

NONDISPLACED OTH EXTRARTIC FRACTURE OF UNSP CALCANEUS INIT

O401XX4 POLYHYDRAMNIOS FIRST TRIMESTER FETUS 4

S92056B

NONDISP OTH EXTRARTIC FX UNSP CALCANEUS INIT FOR OPN FX

O401XX5 POLYHYDRAMNIOS FIRST TRIMESTER FETUS 5

S92061A

DISPLACED INTRAARTICULAR FRACTURE OF RIGHT CALCANEUS INIT

O401XX9 POLYHYDRAMNIOS FIRST TRIMESTER OTHER FETUS

S92061B

DISPLACED INTARTIC FRACTURE OF R CALCANEUS INIT FOR OPN FX

O402XX1 POLYHYDRAMNIOS SECOND TRIMESTER FETUS 1

S92062A

DISPLACED INTRAARTICULAR FRACTURE OF LEFT CALCANEUS INIT

O402XX2 POLYHYDRAMNIOS SECOND TRIMESTER FETUS 2

S92062B

DISPLACED INTARTIC FRACTURE OF L CALCANEUS INIT FOR OPN FX

O402XX3 POLYHYDRAMNIOS SECOND TRIMESTER FETUS 3

S92063A

DISPLACED INTRAARTICULAR FRACTURE OF UNSP CALCANEUS INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O402XX4 POLYHYDRAMNIOS SECOND TRIMESTER FETUS 4

S92063B

DISPLACED INTARTIC FX UNSP CALCANEUS INIT FOR OPN FX

O402XX5 POLYHYDRAMNIOS SECOND TRIMESTER FETUS 5

S92064A

NONDISPLACED INTRAARTICULAR FRACTURE OF R CALCANEUS INIT

O402XX9 POLYHYDRAMNIOS SECOND TRIMESTER OTHER FETUS

S92064B

NONDISP INTARTIC FRACTURE OF R CALCANEUS INIT FOR OPN FX

O403XX1 POLYHYDRAMNIOS THIRD TRIMESTER FETUS 1

S92065A

NONDISPLACED INTRAARTICULAR FRACTURE OF LEFT CALCANEUS INIT

O403XX2 POLYHYDRAMNIOS THIRD TRIMESTER FETUS 2

S92065B

NONDISP INTARTIC FRACTURE OF L CALCANEUS INIT FOR OPN FX

O403XX3 POLYHYDRAMNIOS THIRD TRIMESTER FETUS 3

S92066A

NONDISPLACED INTRAARTICULAR FRACTURE OF UNSP CALCANEUS INIT

O403XX4 POLYHYDRAMNIOS THIRD TRIMESTER FETUS 4

S92066B

NONDISP INTARTIC FRACTURE OF UNSP CALCANEUS INIT FOR OPN FX

O403XX5 POLYHYDRAMNIOS THIRD TRIMESTER FETUS 5

S92101A

UNSP FRACTURE OF RIGHT TALUS INIT FOR CLOS FX

O403XX9 POLYHYDRAMNIOS THIRD TRIMESTER OTHER FETUS

S92101B

UNSP FRACTURE OF RIGHT TALUS INIT ENCNTR FOR OPEN FRACTURE

O409XX1

POLYHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 1

S92102A

UNSP FRACTURE OF LEFT TALUS INIT ENCNTR FOR CLOSED FRACTURE

O409XX2

POLYHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 2

S92102B

UNSP FRACTURE OF LEFT TALUS INIT ENCNTR FOR OPEN FRACTURE

O409XX3

POLYHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 3

S92109A

UNSP FRACTURE OF UNSP TALUS INIT ENCNTR FOR CLOSED FRACTURE

O409XX4

POLYHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 4

S92109B

UNSP FRACTURE OF UNSP TALUS INIT ENCNTR FOR OPEN FRACTURE

O409XX5

POLYHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 5

S92111A

DISP FX OF NECK OF RIGHT TALUS INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O409XX9

POLYHYDRAMNIOS UNSPECIFIED TRIMESTER OTHER FETUS

S92111B

DISP FX OF NECK OF RIGHT TALUS INIT FOR OPN FX

O4100X1

OLIGOHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 1

S92112A

DISP FX OF NECK OF LEFT TALUS INIT FOR CLOS FX

O4100X2

OLIGOHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 2

S92112B

DISP FX OF NECK OF LEFT TALUS INIT ENCNTR FOR OPEN FRACTURE

O4100X3

OLIGOHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 3

S92113A

DISP FX OF NECK OF UNSP TALUS INIT FOR CLOS FX

O4100X4

OLIGOHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 4

S92113B

DISP FX OF NECK OF UNSP TALUS INIT ENCNTR FOR OPEN FRACTURE

O4100X5

OLIGOHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 5

S92114A

NONDISP FX OF NECK OF RIGHT TALUS INIT FOR CLOS FX

O4100X9

OLIGOHYDRAMNIOS UNSPECIFIED TRIMESTER OTHER FETUS

S92114B

NONDISP FX OF NECK OF RIGHT TALUS INIT FOR OPN FX

O4101X1 OLIGOHYDRAMNIOS FIRST TRIMESTER FETUS 1

S92115A

NONDISP FX OF NECK OF LEFT TALUS INIT FOR CLOS FX

O4101X2 OLIGOHYDRAMNIOS FIRST TRIMESTER FETUS 2

S92115B

NONDISP FX OF NECK OF LEFT TALUS INIT FOR OPN FX

O4101X3 OLIGOHYDRAMNIOS FIRST TRIMESTER FETUS 3

S92116A

NONDISP FX OF NECK OF UNSP TALUS INIT FOR CLOS FX

O4101X4 OLIGOHYDRAMNIOS FIRST TRIMESTER FETUS 4

S92116B

NONDISP FX OF NECK OF UNSP TALUS INIT FOR OPN FX

O4101X5 OLIGOHYDRAMNIOS FIRST TRIMESTER FETUS 5

S92121A

DISP FX OF BODY OF RIGHT TALUS INIT FOR CLOS FX

O4101X9 OLIGOHYDRAMNIOS FIRST TRIMESTER OTHER FETUS

S92121B

DISP FX OF BODY OF RIGHT TALUS INIT FOR OPN FX

O4102X1 OLIGOHYDRAMNIOS SECOND TRIMESTER FETUS 1

S92122A

DISP FX OF BODY OF LEFT TALUS INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O4102X2 OLIGOHYDRAMNIOS SECOND TRIMESTER FETUS 2

S92122B

DISP FX OF BODY OF LEFT TALUS INIT ENCNTR FOR OPEN FRACTURE

O4102X3 OLIGOHYDRAMNIOS SECOND TRIMESTER FETUS 3

S92123A

DISP FX OF BODY OF UNSP TALUS INIT FOR CLOS FX

O4102X4 OLIGOHYDRAMNIOS SECOND TRIMESTER FETUS 4

S92123B

DISP FX OF BODY OF UNSP TALUS INIT ENCNTR FOR OPEN FRACTURE

O4102X5 OLIGOHYDRAMNIOS SECOND TRIMESTER FETUS 5

S92124A

NONDISP FX OF BODY OF RIGHT TALUS INIT FOR CLOS FX

O4102X9 OLIGOHYDRAMNIOS SECOND TRIMESTER OTHER FETUS

S92124B

NONDISP FX OF BODY OF RIGHT TALUS INIT FOR OPN FX

O4103X1 OLIGOHYDRAMNIOS THIRD TRIMESTER FETUS 1

S92125A

NONDISP FX OF BODY OF LEFT TALUS INIT FOR CLOS FX

O4103X2 OLIGOHYDRAMNIOS THIRD TRIMESTER FETUS 2

S92125B

NONDISP FX OF BODY OF LEFT TALUS INIT FOR OPN FX

O4103X3 OLIGOHYDRAMNIOS THIRD TRIMESTER FETUS 3

S92126A

NONDISP FX OF BODY OF UNSP TALUS INIT FOR CLOS FX

O4103X4 OLIGOHYDRAMNIOS THIRD TRIMESTER FETUS 4

S92126B

NONDISP FX OF BODY OF UNSP TALUS INIT FOR OPN FX

O4103X5 OLIGOHYDRAMNIOS THIRD TRIMESTER FETUS 5

S92131A

DISP FX OF POSTERIOR PROCESS OF RIGHT TALUS INIT

O4103X9 OLIGOHYDRAMNIOS THIRD TRIMESTER OTHER FETUS

S92131B

DISP FX OF POSTERIOR PROCESS OF RIGHT TALUS INIT FOR OPN FX

O411010

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP FIRST TRI UNSP

S92132A

DISP FX OF POSTERIOR PROCESS OF LEFT TALUS INIT FOR CLOS FX

O411011

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP FIRST TRI FETUS 1

S92132B

DISP FX OF POSTERIOR PROCESS OF LEFT TALUS INIT FOR OPN FX

O411012

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP FIRST TRI FETUS 2

S92133A

DISP FX OF POSTERIOR PROCESS OF UNSP TALUS INIT FOR CLOS FX

O411013

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP FIRST TRI FETUS 3

S92133B

DISP FX OF POSTERIOR PROCESS OF UNSP TALUS INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O411014

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP FIRST TRI FETUS 4

S92134A

NONDISP FX OF POSTERIOR PROCESS OF RIGHT TALUS INIT

O411015

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP FIRST TRI FETUS 5

S92134B

NONDISP FX OF POST PROCESS OF RIGHT TALUS INIT FOR OPN FX

O411019 INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP FIRST TRI OTH

S92135A

NONDISP FX OF POSTERIOR PROCESS OF LEFT TALUS INIT

O411021

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP SECOND TRI FETUS 1

S92135B

NONDISP FX OF POST PROCESS OF LEFT TALUS INIT FOR OPN FX

O411022

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP SECOND TRI FETUS 2

S92136A

NONDISP FX OF POSTERIOR PROCESS OF UNSP TALUS INIT

O411023

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP SECOND TRI FETUS 3

S92136B

NONDISP FX OF POST PROCESS OF UNSP TALUS INIT FOR OPN FX

O411024

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP SECOND TRI FETUS 4

S92141A

DISPLACED DOME FRACTURE OF RIGHT TALUS INIT FOR CLOS FX

O411025

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP SECOND TRI FETUS 5

S92141B

DISPLACED DOME FRACTURE OF RIGHT TALUS INIT FOR OPN FX

O411029

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP SECOND TRI OTH

S92142A

DISPLACED DOME FRACTURE OF LEFT TALUS INIT FOR CLOS FX

O411031

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP THIRD TRI FETUS 1

S92142B

DISPLACED DOME FRACTURE OF LEFT TALUS INIT FOR OPN FX

O411032

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP THIRD TRI FETUS 2

S92143A

DISPLACED DOME FRACTURE OF UNSP TALUS INIT FOR CLOS FX

O411033

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP THIRD TRI FETUS 3

S92143B

DISPLACED DOME FRACTURE OF UNSP TALUS INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O411034

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP THIRD TRI FETUS 4

S92144A

NONDISPLACED DOME FRACTURE OF RIGHT TALUS INIT FOR CLOS FX

O411035

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP THIRD TRI FETUS 5

S92144B

NONDISPLACED DOME FRACTURE OF RIGHT TALUS INIT FOR OPN FX

O411039

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP THIRD TRI OTH

S92145A

NONDISPLACED DOME FRACTURE OF LEFT TALUS INIT FOR CLOS FX

O411091

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP UNSP TRI FETUS 1

S92145B

NONDISPLACED DOME FRACTURE OF LEFT TALUS INIT FOR OPN FX

O411092

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP UNSP TRI FETUS 2

S92146A

NONDISPLACED DOME FRACTURE OF UNSP TALUS INIT FOR CLOS FX

O411093

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP UNSP TRI FETUS 3

S92146B

NONDISPLACED DOME FRACTURE OF UNSP TALUS INIT FOR OPN FX

O411094

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP UNSP TRI FETUS 4

S92151A

DISPL AVULSION FRACTURE (CHIP FRACTURE) OF RIGHT TALUS INIT

O411095

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP UNSP TRI FETUS 5

S92151B

DISPL AVULS FX (CHIP FRACTURE) OF R TALUS INIT FOR OPN FX

O411099

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP UNSP TRIMESTER OTH

S92152A

DISPL AVULSION FRACTURE (CHIP FRACTURE) OF LEFT TALUS INIT

O411210

CHORIOAMNIONITIS FIRST TRIMESTER NOT APPLICABLE OR UNSP

S92152B

DISPL AVULS FX (CHIP FRACTURE) OF L TALUS INIT FOR OPN FX

O411211 CHORIOAMNIONITIS FIRST TRIMESTER FETUS 1

S92153A

DISPL AVULSION FRACTURE (CHIP FRACTURE) OF UNSP TALUS INIT

O411212 CHORIOAMNIONITIS FIRST TRIMESTER FETUS 2

S92153B

DISPL AVULS FX (CHIP FRACTURE) OF UNSP TALUS 7THB

O411213 CHORIOAMNIONITIS FIRST TRIMESTER FETUS 3

S92154A

NONDISP AVULS FRACTURE (CHIP FRACTURE) OF RIGHT TALUS INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O411214 CHORIOAMNIONITIS FIRST TRIMESTER FETUS 4

S92154B

NONDISP AVULS FX (CHIP FRACTURE) OF R TALUS INIT FOR OPN FX

O411215 CHORIOAMNIONITIS FIRST TRIMESTER FETUS 5

S92155A

NONDISP AVULS FRACTURE (CHIP FRACTURE) OF LEFT TALUS INIT

O411219 CHORIOAMNIONITIS FIRST TRIMESTER OTHER FETUS

S92155B

NONDISP AVULS FX (CHIP FRACTURE) OF L TALUS INIT FOR OPN FX

O411220

CHORIOAMNIONITIS SECOND TRIMESTER NOT APPLICABLE OR UNSP

S92156A

NONDISP AVULS FRACTURE (CHIP FRACTURE) OF UNSP TALUS INIT

O411221 CHORIOAMNIONITIS SECOND TRIMESTER FETUS 1

S92156B

NONDISP AVULS FX (CHIP FRACTURE) OF UNSP TALUS 7THB

O411222 CHORIOAMNIONITIS SECOND TRIMESTER FETUS 2

S92191A

OTH FRACTURE OF RIGHT TALUS INIT ENCNTR FOR CLOSED FRACTURE

O411223 CHORIOAMNIONITIS SECOND TRIMESTER FETUS 3

S92191B

OTHER FRACTURE OF RIGHT TALUS INIT ENCNTR FOR OPEN FRACTURE

O411224 CHORIOAMNIONITIS SECOND TRIMESTER FETUS 4

S92192A

OTH FRACTURE OF LEFT TALUS INIT ENCNTR FOR CLOSED FRACTURE

O411225 CHORIOAMNIONITIS SECOND TRIMESTER FETUS 5

S92192B

OTHER FRACTURE OF LEFT TALUS INIT ENCNTR FOR OPEN FRACTURE

O411229 CHORIOAMNIONITIS SECOND TRIMESTER OTHER FETUS

S92199A

OTH FRACTURE OF UNSP TALUS INIT ENCNTR FOR CLOSED FRACTURE

O411230

CHORIOAMNIONITIS THIRD TRIMESTER NOT APPLICABLE OR UNSP

S92199B

OTHER FRACTURE OF UNSP TALUS INIT ENCNTR FOR OPEN FRACTURE

O411231 CHORIOAMNIONITIS THIRD TRIMESTER FETUS 1

S92201A

FRACTURE OF UNSP TARSAL BONE(S) OF RIGHT FOOT INIT

O411232 CHORIOAMNIONITIS THIRD TRIMESTER FETUS 2

S92201B

FX UNSP TARSAL BONE(S) OF RIGHT FOOT INIT FOR OPN FX

O411233 CHORIOAMNIONITIS THIRD TRIMESTER FETUS 3

S92202A

FRACTURE OF UNSP TARSAL BONE(S) OF LEFT FOOT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O411234 CHORIOAMNIONITIS THIRD TRIMESTER FETUS 4

S92202B

FX UNSP TARSAL BONE(S) OF LEFT FOOT INIT FOR OPN FX

O411235 CHORIOAMNIONITIS THIRD TRIMESTER FETUS 5

S92209A

FRACTURE OF UNSP TARSAL BONE(S) OF UNSP FOOT INIT

O411239 CHORIOAMNIONITIS THIRD TRIMESTER OTHER FETUS

S92209B

FX UNSP TARSAL BONE(S) OF UNSP FOOT INIT FOR OPN FX

O411290

CHORIOAMNIONITIS UNSP TRIMESTER NOT APPLICABLE OR UNSP

S92211A

DISP FX OF CUBOID BONE OF RIGHT FOOT INIT FOR CLOS FX

O411291

CHORIOAMNIONITIS UNSPECIFIED TRIMESTER FETUS 1

S92211B

DISP FX OF CUBOID BONE OF RIGHT FOOT INIT FOR OPN FX

O411292

CHORIOAMNIONITIS UNSPECIFIED TRIMESTER FETUS 2

S92212A

DISP FX OF CUBOID BONE OF LEFT FOOT INIT FOR CLOS FX

O411293

CHORIOAMNIONITIS UNSPECIFIED TRIMESTER FETUS 3

S92212B

DISP FX OF CUBOID BONE OF LEFT FOOT INIT FOR OPN FX

O411294

CHORIOAMNIONITIS UNSPECIFIED TRIMESTER FETUS 4

S92213A

DISP FX OF CUBOID BONE OF UNSP FOOT INIT FOR CLOS FX

O411295

CHORIOAMNIONITIS UNSPECIFIED TRIMESTER FETUS 5

S92213B

DISP FX OF CUBOID BONE OF UNSP FOOT INIT FOR OPN FX

O411299

CHORIOAMNIONITIS UNSPECIFIED TRIMESTER OTHER FETUS

S92214A

NONDISP FX OF CUBOID BONE OF RIGHT FOOT INIT FOR CLOS FX

O411410

PLACENTITIS FIRST TRIMESTER NOT APPLICABLE OR UNSPECIFIED

S92214B

NONDISP FX OF CUBOID BONE OF RIGHT FOOT INIT FOR OPN FX

O411411 PLACENTITIS FIRST TRIMESTER FETUS 1

S92215A

NONDISP FX OF CUBOID BONE OF LEFT FOOT INIT FOR CLOS FX

O411412 PLACENTITIS FIRST TRIMESTER FETUS 2

S92215B

NONDISP FX OF CUBOID BONE OF LEFT FOOT INIT FOR OPN FX

O411413 PLACENTITIS FIRST TRIMESTER FETUS 3

S92216A

NONDISP FX OF CUBOID BONE OF UNSP FOOT INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O411414 PLACENTITIS FIRST TRIMESTER FETUS 4

S92216B

NONDISP FX OF CUBOID BONE OF UNSP FOOT INIT FOR OPN FX

O411415 PLACENTITIS FIRST TRIMESTER FETUS 5

S92221A

DISP FX OF LATERAL CUNEIFORM OF RIGHT FOOT INIT FOR CLOS FX

O411419 PLACENTITIS FIRST TRIMESTER OTHER FETUS

S92221B

DISP FX OF LATERAL CUNEIFORM OF RIGHT FOOT INIT FOR OPN FX

O411420

PLACENTITIS SECOND TRIMESTER NOT APPLICABLE OR UNSPECIFIED

S92222A

DISP FX OF LATERAL CUNEIFORM OF LEFT FOOT INIT FOR CLOS FX

O411421 PLACENTITIS SECOND TRIMESTER FETUS 1

S92222B

DISP FX OF LATERAL CUNEIFORM OF LEFT FOOT INIT FOR OPN FX

O411422 PLACENTITIS SECOND TRIMESTER FETUS 2

S92223A

DISP FX OF LATERAL CUNEIFORM OF UNSP FOOT INIT FOR CLOS FX

O411423 PLACENTITIS SECOND TRIMESTER FETUS 3

S92223B

DISP FX OF LATERAL CUNEIFORM OF UNSP FOOT INIT FOR OPN FX

O411424 PLACENTITIS SECOND TRIMESTER FETUS 4

S92224A

NONDISP FX OF LATERAL CUNEIFORM OF RIGHT FOOT INIT

O411425 PLACENTITIS SECOND TRIMESTER FETUS 5

S92224B

NONDISP FX OF LATERAL CUNEIFORM OF R FOOT INIT FOR OPN FX

O411429 PLACENTITIS SECOND TRIMESTER OTHER FETUS

S92225A

NONDISP FX OF LATERAL CUNEIFORM OF LEFT FOOT INIT

O411430

PLACENTITIS THIRD TRIMESTER NOT APPLICABLE OR UNSPECIFIED

S92225B

NONDISP FX OF LATERAL CUNEIFORM OF L FOOT INIT FOR OPN FX

O411431 PLACENTITIS THIRD TRIMESTER FETUS 1

S92226A

NONDISP FX OF LATERAL CUNEIFORM OF UNSP FOOT INIT

O411432 PLACENTITIS THIRD TRIMESTER FETUS 2

S92226B

NONDISP FX OF LATERAL CUNEIFORM OF UNSP FT INIT FOR OPN FX

O411433 PLACENTITIS THIRD TRIMESTER FETUS 3

S92231A

DISP FX OF INTERMEDIATE CUNEIFORM OF RIGHT FOOT INIT

O411434 PLACENTITIS THIRD TRIMESTER FETUS 4

S92231B

DISP FX OF INTERMED CUNEIFORM OF RIGHT FOOT INIT FOR OPN FX

O411435 PLACENTITIS THIRD TRIMESTER FETUS 5

S92232A

DISP FX OF INTERMEDIATE CUNEIFORM OF LEFT FOOT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O411439 PLACENTITIS THIRD TRIMESTER OTHER FETUS

S92232B

DISP FX OF INTERMED CUNEIFORM OF LEFT FOOT INIT FOR OPN FX

O411490

PLACENTITIS UNSP TRIMESTER NOT APPLICABLE OR UNSPECIFIED

S92233A

DISP FX OF INTERMEDIATE CUNEIFORM OF UNSP FOOT INIT

O411491 PLACENTITIS UNSPECIFIED TRIMESTER FETUS 1

S92233B

DISP FX OF INTERMED CUNEIFORM OF UNSP FOOT INIT FOR OPN FX

O411492 PLACENTITIS UNSPECIFIED TRIMESTER FETUS 2

S92234A

NONDISP FX OF INTERMEDIATE CUNEIFORM OF RIGHT FOOT INIT

O411493 PLACENTITIS UNSPECIFIED TRIMESTER FETUS 3

S92234B

NONDISP FX OF INTERMED CUNEIFORM OF R FOOT INIT FOR OPN FX

O411494 PLACENTITIS UNSPECIFIED TRIMESTER FETUS 4

S92235A

NONDISP FX OF INTERMEDIATE CUNEIFORM OF LEFT FOOT INIT

O411495 PLACENTITIS UNSPECIFIED TRIMESTER FETUS 5

S92235B

NONDISP FX OF INTERMED CUNEIFORM OF L FOOT INIT FOR OPN FX

O411499 PLACENTITIS UNSPECIFIED TRIMESTER OTHER FETUS

S92236A

NONDISP FX OF INTERMEDIATE CUNEIFORM OF UNSP FOOT INIT

O418X10 OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS FIRST TRI UNSP

S92236B

NONDISP FX OF INTERMED CUNEIFORM OF UNSP FT INIT FOR OPN FX

O418X11

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS FIRST TRI FETUS 1

S92241A

DISP FX OF MEDIAL CUNEIFORM OF RIGHT FOOT INIT FOR CLOS FX

O418X12

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS FIRST TRI FETUS 2

S92241B

DISP FX OF MEDIAL CUNEIFORM OF RIGHT FOOT INIT FOR OPN FX

O418X13

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS FIRST TRI FETUS 3

S92242A

DISP FX OF MEDIAL CUNEIFORM OF LEFT FOOT INIT FOR CLOS FX

O418X14

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS FIRST TRI FETUS 4

S92242B

DISP FX OF MEDIAL CUNEIFORM OF LEFT FOOT INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O418X15

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS FIRST TRI FETUS 5

S92243A

DISP FX OF MEDIAL CUNEIFORM OF UNSP FOOT INIT FOR CLOS FX

O418X19 OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS FIRST TRI OTH

S92243B

DISP FX OF MEDIAL CUNEIFORM OF UNSP FOOT INIT FOR OPN FX

O418X20

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS SECOND TRI UNSP

S92244A

NONDISP FX OF MEDIAL CUNEIFORM OF RIGHT FOOT INIT

O418X21

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS SECOND TRI FETUS 1

S92244B

NONDISP FX OF MEDIAL CUNEIFORM OF R FOOT INIT FOR OPN FX

O418X22

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS SECOND TRI FETUS 2

S92245A

NONDISP FX OF MEDIAL CUNEIFORM OF LEFT FOOT INIT

O418X23

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS SECOND TRI FETUS 3

S92245B

NONDISP FX OF MEDIAL CUNEIFORM OF LEFT FOOT INIT FOR OPN FX

O418X24

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS SECOND TRI FETUS 4

S92246A

NONDISP FX OF MEDIAL CUNEIFORM OF UNSP FOOT INIT

O418X25

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS SECOND TRI FETUS 5

S92246B

NONDISP FX OF MEDIAL CUNEIFORM OF UNSP FOOT INIT FOR OPN FX

O418X29

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS SECOND TRI OTH

S92251A

DISP FX OF NAVICULAR OF RIGHT FOOT INIT FOR CLOS FX

O418X30

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS THIRD TRI UNSP

S92251B

DISP FX OF NAVICULAR OF RIGHT FOOT INIT FOR OPN FX

O418X31

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS THIRD TRI FETUS 1

S92252A

DISP FX OF NAVICULAR OF LEFT FOOT INIT FOR CLOS FX

O418X32

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS THIRD TRI FETUS 2

S92252B

DISP FX OF NAVICULAR OF LEFT FOOT INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O418X33

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS THIRD TRI FETUS 3

S92253A

DISP FX OF NAVICULAR OF UNSP FOOT INIT FOR CLOS FX

O418X34

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS THIRD TRI FETUS 4

S92253B

DISP FX OF NAVICULAR OF UNSP FOOT INIT FOR OPN FX

O418X35

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS THIRD TRI FETUS 5

S92254A

NONDISP FX OF NAVICULAR OF RIGHT FOOT INIT FOR CLOS FX

O418X39 OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS THIRD TRI OTH

S92254B

NONDISP FX OF NAVICULAR OF RIGHT FOOT INIT FOR OPN FX

O418X90 OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS UNSP TRI UNSP

S92255A

NONDISP FX OF NAVICULAR OF LEFT FOOT INIT FOR CLOS FX

O418X91

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS UNSP TRI FETUS 1

S92255B

NONDISP FX OF NAVICULAR OF LEFT FOOT INIT FOR OPN FX

O418X92

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS UNSP TRI FETUS 2

S92256A

NONDISP FX OF NAVICULAR OF UNSP FOOT INIT FOR CLOS FX

O418X93

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS UNSP TRI FETUS 3

S92256B

NONDISP FX OF NAVICULAR OF UNSP FOOT INIT FOR OPN FX

O418X94

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS UNSP TRI FETUS 4

S92301A

FRACTURE OF UNSP METATARSAL BONE(S) RIGHT FOOT INIT

O418X95

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS UNSP TRI FETUS 5

S92301B

FX UNSP METATARSAL BONE(S) RIGHT FOOT INIT FOR OPN FX

O418X99

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS UNSP TRIMESTER OTH

S92302A

FRACTURE OF UNSP METATARSAL BONE(S) LEFT FOOT INIT

O4190X0

DISORDER OF AMNIOTIC FLUID AND MEMBRNS UNSP UNSP TRI UNSP

S92302B

FX UNSP METATARSAL BONE(S) LEFT FOOT INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O4190X1

DISORDER OF AMNIO FLUID AND MEMBRNS UNSP UNSP TRI FETUS 1

S92309A

FRACTURE OF UNSP METATARSAL BONE(S) UNSP FOOT INIT

O4190X2

DISORDER OF AMNIO FLUID AND MEMBRNS UNSP UNSP TRI FETUS 2

S92309B

FX UNSP METATARSAL BONE(S) UNSP FOOT INIT FOR OPN FX

O4190X3

DISORDER OF AMNIO FLUID AND MEMBRNS UNSP UNSP TRI FETUS 3

S92311A

DISP FX OF FIRST METATARSAL BONE RIGHT FOOT INIT

O4190X4

DISORDER OF AMNIO FLUID AND MEMBRNS UNSP UNSP TRI FETUS 4

S92311B

DISP FX OF FIRST METATARSAL BONE R FOOT INIT FOR OPN FX

O4190X5

DISORDER OF AMNIO FLUID AND MEMBRNS UNSP UNSP TRI FETUS 5

S92312A

DISP FX OF FIRST METATARSAL BONE LEFT FOOT INIT

O4190X9

DISORDER OF AMNIOTIC FLUID AND MEMBRNS UNSP UNSP TRI OTH

S92312B

DISP FX OF FIRST METATARSAL BONE LEFT FOOT INIT FOR OPN FX

O4191X0

DISORDER OF AMNIO FLUID AND MEMBRNS UNSP FIRST TRI UNSP

S92313A

DISP FX OF FIRST METATARSAL BONE UNSP FOOT INIT

O4191X1

DISORD OF AMNIO FLUID AND MEMBRNS UNSP FIRST TRI FETUS 1

S92313B

DISP FX OF FIRST METATARSAL BONE UNSP FOOT INIT FOR OPN FX

O4191X2

DISORD OF AMNIO FLUID AND MEMBRNS UNSP FIRST TRI FETUS 2

S92314A

NONDISP FX OF FIRST METATARSAL BONE RIGHT FOOT INIT

O4191X3

DISORD OF AMNIO FLUID AND MEMBRNS UNSP FIRST TRI FETUS 3

S92314B

NONDISP FX OF FIRST METATARSAL BONE R FOOT INIT FOR OPN FX

O4191X4

DISORD OF AMNIO FLUID AND MEMBRNS UNSP FIRST TRI FETUS 4

S92315A

NONDISP FX OF FIRST METATARSAL BONE LEFT FOOT INIT

O4191X5

DISORD OF AMNIO FLUID AND MEMBRNS UNSP FIRST TRI FETUS 5

S92315B

NONDISP FX OF FIRST METATARSAL BONE L FOOT INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O4191X9

DISORDER OF AMNIOTIC FLUID AND MEMBRNS UNSP FIRST TRI OTH

S92316A

NONDISP FX OF FIRST METATARSAL BONE UNSP FOOT INIT

O4192X0

DISORDER OF AMNIO FLUID AND MEMBRNS UNSP SECOND TRI UNSP

S92316B

NONDISP FX OF 1ST METATARSAL BONE UNSP FT INIT FOR OPN FX

O4192X1

DISORD OF AMNIO FLUID AND MEMBRNS UNSP SECOND TRI FETUS 1

S92321A

DISP FX OF SECOND METATARSAL BONE RIGHT FOOT INIT

O4192X2

DISORD OF AMNIO FLUID AND MEMBRNS UNSP SECOND TRI FETUS 2

S92321B

DISP FX OF SECOND METATARSAL BONE R FOOT INIT FOR OPN FX

O4192X3

DISORD OF AMNIO FLUID AND MEMBRNS UNSP SECOND TRI FETUS 3

S92322A

DISP FX OF SECOND METATARSAL BONE LEFT FOOT INIT

O4192X4

DISORD OF AMNIO FLUID AND MEMBRNS UNSP SECOND TRI FETUS 4

S92322B

DISP FX OF SECOND METATARSAL BONE L FOOT INIT FOR OPN FX

O4192X5

DISORD OF AMNIO FLUID AND MEMBRNS UNSP SECOND TRI FETUS 5

S92323A

DISP FX OF SECOND METATARSAL BONE UNSP FOOT INIT

O4192X9

DISORDER OF AMNIO FLUID AND MEMBRNS UNSP SECOND TRI OTH

S92323B

DISP FX OF 2ND METATARSAL BONE UNSP FOOT INIT FOR OPN FX

O4193X0

DISORDER OF AMNIO FLUID AND MEMBRNS UNSP THIRD TRI UNSP

S92324A

NONDISP FX OF SECOND METATARSAL BONE RIGHT FOOT INIT

O4193X1

DISORD OF AMNIO FLUID AND MEMBRNS UNSP THIRD TRI FETUS 1

S92324B

NONDISP FX OF 2ND METATARSAL BONE R FOOT INIT FOR OPN FX

O4193X2

DISORD OF AMNIO FLUID AND MEMBRNS UNSP THIRD TRI FETUS 2

S92325A

NONDISP FX OF SECOND METATARSAL BONE LEFT FOOT INIT

O4193X3

DISORD OF AMNIO FLUID AND MEMBRNS UNSP THIRD TRI FETUS 3

S92325B

NONDISP FX OF 2ND METATARSAL BONE L FOOT INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O4193X4

DISORD OF AMNIO FLUID AND MEMBRNS UNSP THIRD TRI FETUS 4

S92326A

NONDISP FX OF SECOND METATARSAL BONE UNSP FOOT INIT

O4193X5

DISORD OF AMNIO FLUID AND MEMBRNS UNSP THIRD TRI FETUS 5

S92326B

NONDISP FX OF 2ND METATARSAL BONE UNSP FT INIT FOR OPN FX

O4193X9

DISORDER OF AMNIOTIC FLUID AND MEMBRNS UNSP THIRD TRI OTH

S92331A

DISP FX OF THIRD METATARSAL BONE RIGHT FOOT INIT

O4200

PREM ROM ONSET LABOR W/N 24 HR OF RUPT UNSP WEEKS OF GEST

S92331B

DISP FX OF THIRD METATARSAL BONE R FOOT INIT FOR OPN FX

O42011

PRETRM PREM ROM ONSET LABOR W/N 24 HOURS OF RUPT FIRST TRI

S92332A

DISP FX OF THIRD METATARSAL BONE LEFT FOOT INIT

O42012

PRETRM PREM ROM ONSET LABOR W/N 24 HOURS OF RUPT 2ND TRI

S92332B

DISP FX OF THIRD METATARSAL BONE LEFT FOOT INIT FOR OPN FX

O42013

PRETRM PREM ROM ONSET LABOR W/N 24 HOURS OF RUPT THIRD TRI

S92333A

DISP FX OF THIRD METATARSAL BONE UNSP FOOT INIT

O42019

PRETRM PREM ROM ONSET LABOR W/N 24 HOURS OF RUPT UNSP TRI

S92333B

DISP FX OF THIRD METATARSAL BONE UNSP FOOT INIT FOR OPN FX

O4202

FULL-TERM PREM ROM ONSET LABOR WITHIN 24 HOURS OF RUPTURE

S92334A

NONDISP FX OF THIRD METATARSAL BONE RIGHT FOOT INIT

O4210

PREM ROM ONSET LABOR > 24 HR FOL RUPT UNSP WEEKS OF GEST

S92334B

NONDISP FX OF THIRD METATARSAL BONE R FOOT INIT FOR OPN FX

O42111

PRETRM PREM ROM ONSET LABOR > 24 HOURS FOL RUPT FIRST TRI

S92335A

NONDISP FX OF THIRD METATARSAL BONE LEFT FOOT INIT

O42112

PRETRM PREM ROM ONSET LABOR > 24 HOURS FOL RUPT SECOND TRI

S92335B

NONDISP FX OF THIRD METATARSAL BONE L FOOT INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O42113

PRETRM PREM ROM ONSET LABOR > 24 HOURS FOL RUPT THIRD TRI

S92336A

NONDISP FX OF THIRD METATARSAL BONE UNSP FOOT INIT

O42119

PRETRM PREM ROM ONSET LABOR > 24 HOURS FOL RUPT UNSP TRI

S92336B

NONDISP FX OF 3RD METATARSAL BONE UNSP FT INIT FOR OPN FX

O4212

FULL-TERM PREMATURE ROM ONSET LABOR > 24 HOURS FOL RUPTURE

S92341A

DISP FX OF FOURTH METATARSAL BONE RIGHT FOOT INIT

O4290

PREM ROM 7TH0 BETW RUPT & ONST LABR UNSP WEEKS OF GEST

S92341B

DISP FX OF FOURTH METATARSAL BONE R FOOT INIT FOR OPN FX

O42911

PRETRM PREM ROM UNSP TIME BETW RUPT AND ONSET LABR 1ST TRI

S92342A

DISP FX OF FOURTH METATARSAL BONE LEFT FOOT INIT

O42912

PRETRM PREM ROM UNSP TIME BETW RUPT AND ONSET LABR 2ND TRI

S92342B

DISP FX OF FOURTH METATARSAL BONE L FOOT INIT FOR OPN FX

O42913

PRETRM PREM ROM UNSP TIME BETW RUPT AND ONST LABR 3RD TRI

S92343A

DISP FX OF FOURTH METATARSAL BONE UNSP FOOT INIT

O42919

PRETRM PREM ROM UNSP TIME BETW RUPT AND ONST LABR UNSP TRI

S92343B

DISP FX OF 4TH METATARSAL BONE UNSP FOOT INIT FOR OPN FX

O4292

FULL-TERM PREM ROM UNSP TIME BETW RUPTURE AND ONSET LABOR

S92344A

NONDISP FX OF FOURTH METATARSAL BONE RIGHT FOOT INIT

O43013

FETOMATERNAL PLACENTAL TRANSFUSION SYNDROME THIRD TRIMESTER

S92344B

NONDISP FX OF 4TH METATARSAL BONE R FOOT INIT FOR OPN FX

O43022

FETUS-TO-FETUS PLACNTL TRANSFUSE SYNDROME SECOND TRIMESTER

S92345A

NONDISP FX OF FOURTH METATARSAL BONE LEFT FOOT INIT

O43101 MALFORMATION OF PLACENTA UNSPECIFIED FIRST TRIMESTER

S92345B

NONDISP FX OF 4TH METATARSAL BONE L FOOT INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O43109

MALFORMATION OF PLACENTA UNSPECIFIED UNSPECIFIED TRIMESTER

S92346A

NONDISP FX OF FOURTH METATARSAL BONE UNSP FOOT INIT

O43113 CIRCUMVALLATE PLACENTA THIRD TRIMESTER

S92346B

NONDISP FX OF 4TH METATARSAL BONE UNSP FT INIT FOR OPN FX

O4420

Partial placenta previa NOS or without hemorrhage unspecified trimester

S92351A

DISP FX OF FIFTH METATARSAL BONE RIGHT FOOT INIT

O4421

Partial placenta previa NOS or without hemorrhage first trimester

S92351B

DISP FX OF FIFTH METATARSAL BONE R FOOT INIT FOR OPN FX

O4422

Partial placenta previa NOS or without hemorrhage second trimester

S92352A

DISP FX OF FIFTH METATARSAL BONE LEFT FOOT INIT

O4423

Partial placenta previa NOS or without hemorrhage third trimester

S92352B

DISP FX OF FIFTH METATARSAL BONE LEFT FOOT INIT FOR OPN FX

O4430

Partial placenta previa with hemorrhage unspecified trimester

S92353A

DISP FX OF FIFTH METATARSAL BONE UNSP FOOT INIT

O4431 Partial placenta previa with hemorrhage first trimester

S92353B

DISP FX OF FIFTH METATARSAL BONE UNSP FOOT INIT FOR OPN FX

O4432 Partial placenta previa with hemorrhage second trimester

S92354A

NONDISP FX OF FIFTH METATARSAL BONE RIGHT FOOT INIT

O4433 Partial placenta previa with hemorrhage third trimester

S92354B

NONDISP FX OF FIFTH METATARSAL BONE R FOOT INIT FOR OPN FX

O4450

Low lying placenta with hemorrhage unspecified trimester

S92355A

NONDISP FX OF FIFTH METATARSAL BONE LEFT FOOT INIT

O4451 Low lying placenta with hemorrhage first trimester

S92355B

NONDISP FX OF FIFTH METATARSAL BONE L FOOT INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O4452 Low lying placenta with hemorrhage second trimester

S92356A

NONDISP FX OF FIFTH METATARSAL BONE UNSP FOOT INIT

O4453 Low lying placenta with hemorrhage third trimester

S92356B

NONDISP FX OF 5TH METATARSAL BONE UNSP FT INIT FOR OPN FX

O6000

PRETERM LABOR WITHOUT DELIVERY UNSPECIFIED TRIMESTER

S92401A

DISPLACED UNSP FRACTURE OF RIGHT GREAT TOE INIT FOR CLOS FX

O6002 PRETERM LABOR WITHOUT DELIVERY SECOND TRIMESTER

S92401B

DISPLACED UNSP FRACTURE OF RIGHT GREAT TOE INIT FOR OPN FX

O6003 PRETERM LABOR WITHOUT DELIVERY THIRD TRIMESTER

S92402A

DISPLACED UNSP FRACTURE OF LEFT GREAT TOE INIT FOR CLOS FX

O6010X0

PRETERM LABOR W PRETERM DELIVERY UNSP TRIMESTER UNSP

S92402B

DISPLACED UNSP FRACTURE OF LEFT GREAT TOE INIT FOR OPN FX

O6010X1

PRETERM LABOR WITH PRETERM DELIVERY UNSP TRIMESTER FETUS 1

S92403A

DISPLACED UNSP FRACTURE OF UNSP GREAT TOE INIT FOR CLOS FX

O6010X2

PRETERM LABOR WITH PRETERM DELIVERY UNSP TRIMESTER FETUS 2

S92403B

DISPLACED UNSP FRACTURE OF UNSP GREAT TOE INIT FOR OPN FX

O6010X3

PRETERM LABOR WITH PRETERM DELIVERY UNSP TRIMESTER FETUS 3

S92404A

NONDISPLACED UNSP FRACTURE OF RIGHT GREAT TOE INIT

O6010X4

PRETERM LABOR WITH PRETERM DELIVERY UNSP TRIMESTER FETUS 4

S92404B

NONDISP UNSP FRACTURE OF RIGHT GREAT TOE INIT FOR OPN FX

O6010X5

PRETERM LABOR WITH PRETERM DELIVERY UNSP TRIMESTER FETUS 5

S92405A

NONDISPLACED UNSP FRACTURE OF LEFT GREAT TOE INIT

O6010X9

PRETERM LABOR W PRETERM DELIVERY UNSP TRIMESTER OTH FETUS

S92405B

NONDISP UNSP FRACTURE OF LEFT GREAT TOE INIT FOR OPN FX

O6012X0

PRETERM LABOR SECOND TRI W PRETERM DELIVERY SECOND TRI UNSP

S92406A

NONDISPLACED UNSP FRACTURE OF UNSP GREAT TOE INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O6012X1

PRETERM LABOR SECOND TRI W PRETERM DEL SECOND TRI FETUS 1

S92406B

NONDISP UNSP FRACTURE OF UNSP GREAT TOE INIT FOR OPN FX

O6012X2

PRETERM LABOR SECOND TRI W PRETERM DEL SECOND TRI FETUS 2

S92411A

DISP FX OF PROXIMAL PHALANX OF RIGHT GREAT TOE INIT

O6012X3

PRETERM LABOR SECOND TRI W PRETERM DEL SECOND TRI FETUS 3

S92411B

DISP FX OF PROX PHALANX OF RIGHT GREAT TOE INIT FOR OPN FX

O6012X4

PRETERM LABOR SECOND TRI W PRETERM DEL SECOND TRI FETUS 4

S92412A

DISP FX OF PROXIMAL PHALANX OF LEFT GREAT TOE INIT

O6012X5

PRETERM LABOR SECOND TRI W PRETERM DEL SECOND TRI FETUS 5

S92412B

DISP FX OF PROX PHALANX OF LEFT GREAT TOE INIT FOR OPN FX

O6012X9

PRETERM LABOR SECOND TRI W PRETERM DELIVERY SECOND TRI OTH

S92413A

DISP FX OF PROXIMAL PHALANX OF UNSP GREAT TOE INIT

O6013X1

PRETERM LABOR SECOND TRI W PRETERM DEL THIRD TRI FETUS 1

S92413B

DISP FX OF PROX PHALANX OF UNSP GREAT TOE INIT FOR OPN FX

O6013X2

PRETERM LABOR SECOND TRI W PRETERM DEL THIRD TRI FETUS 2

S92414A

NONDISP FX OF PROXIMAL PHALANX OF RIGHT GREAT TOE INIT

O6013X3

PRETERM LABOR SECOND TRI W PRETERM DEL THIRD TRI FETUS 3

S92414B

NONDISP FX OF PROX PHALANX OF R GREAT TOE INIT FOR OPN FX

O6013X4

PRETERM LABOR SECOND TRI W PRETERM DEL THIRD TRI FETUS 4

S92415A

NONDISP FX OF PROXIMAL PHALANX OF LEFT GREAT TOE INIT

O6013X5

PRETERM LABOR SECOND TRI W PRETERM DEL THIRD TRI FETUS 5

S92415B

NONDISP FX OF PROX PHALANX OF L GREAT TOE INIT FOR OPN FX

O6013X9

PRETERM LABOR SECOND TRI W PRETERM DELIVERY THIRD TRI OTH

S92416A

NONDISP FX OF PROXIMAL PHALANX OF UNSP GREAT TOE INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O6014X1

PRETERM LABOR THIRD TRI W PRETERM DEL THIRD TRI FETUS 1

S92416B

NONDISP FX OF PROX PHALANX OF UNSP GREAT TOE 7THB

O6014X2

PRETERM LABOR THIRD TRI W PRETERM DEL THIRD TRI FETUS 2

S92421A

DISP FX OF DISTAL PHALANX OF RIGHT GREAT TOE INIT

O6014X3

PRETERM LABOR THIRD TRI W PRETERM DEL THIRD TRI FETUS 3

S92421B

DISP FX OF DIST PHALANX OF RIGHT GREAT TOE INIT FOR OPN FX

O6014X4

PRETERM LABOR THIRD TRI W PRETERM DEL THIRD TRI FETUS 4

S92422A

DISP FX OF DISTAL PHALANX OF LEFT GREAT TOE INIT

O6014X5

PRETERM LABOR THIRD TRI W PRETERM DEL THIRD TRI FETUS 5

S92422B

DISP FX OF DISTAL PHALANX OF LEFT GREAT TOE INIT FOR OPN FX

O6014X9

PRETERM LABOR THIRD TRI W PRETERM DELIVERY THIRD TRI OTH

S92423A

DISP FX OF DISTAL PHALANX OF UNSP GREAT TOE INIT

O6020X0 TERM DELIVERY W PRETERM LABOR UNSP TRIMESTER UNSP

S92423B

DISP FX OF DISTAL PHALANX OF UNSP GREAT TOE INIT FOR OPN FX

O6020X1

TERM DELIVERY WITH PRETERM LABOR UNSP TRIMESTER FETUS 1

S92424A

NONDISP FX OF DISTAL PHALANX OF RIGHT GREAT TOE INIT

O6020X2

TERM DELIVERY WITH PRETERM LABOR UNSP TRIMESTER FETUS 2

S92424B

NONDISP FX OF DIST PHALANX OF R GREAT TOE INIT FOR OPN FX

O6020X3

TERM DELIVERY WITH PRETERM LABOR UNSP TRIMESTER FETUS 3

S92425A

NONDISP FX OF DISTAL PHALANX OF LEFT GREAT TOE INIT

O6020X4

TERM DELIVERY WITH PRETERM LABOR UNSP TRIMESTER FETUS 4

S92425B

NONDISP FX OF DIST PHALANX OF L GREAT TOE INIT FOR OPN FX

O6020X5

TERM DELIVERY WITH PRETERM LABOR UNSP TRIMESTER FETUS 5

S92426A

NONDISP FX OF DISTAL PHALANX OF UNSP GREAT TOE INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O6020X9

TERM DELIVERY WITH PRETERM LABOR UNSP TRIMESTER OTH FETUS

S92426B

NONDISP FX OF DIST PHALANX OF UNSP GREAT TOE 7THB

O6022X0

TERM DELIVERY W PRETERM LABOR SECOND TRIMESTER UNSP

S92491A

OTH FRACTURE OF RIGHT GREAT TOE INIT FOR CLOS FX

O6022X1

TERM DELIVERY WITH PRETERM LABOR SECOND TRIMESTER FETUS 1

S92491B

OTH FRACTURE OF RIGHT GREAT TOE INIT FOR OPN FX

O6022X2

TERM DELIVERY WITH PRETERM LABOR SECOND TRIMESTER FETUS 2

S92492A

OTH FRACTURE OF LEFT GREAT TOE INIT FOR CLOS FX

O6022X3

TERM DELIVERY WITH PRETERM LABOR SECOND TRIMESTER FETUS 3

S92492B

OTH FRACTURE OF LEFT GREAT TOE INIT FOR OPN FX

O6022X4

TERM DELIVERY WITH PRETERM LABOR SECOND TRIMESTER FETUS 4

S92499A

OTH FRACTURE OF UNSP GREAT TOE INIT FOR CLOS FX

O6022X5

TERM DELIVERY WITH PRETERM LABOR SECOND TRIMESTER FETUS 5

S92499B

OTH FRACTURE OF UNSP GREAT TOE INIT FOR OPN FX

O6022X9

TERM DELIVERY W PRETERM LABOR SECOND TRIMESTER OTH FETUS

S92501A

DISPLACED UNSP FRACTURE OF RIGHT LESSER TOE(S) INIT

O6023X0 TERM DELIVERY W PRETERM LABOR THIRD TRIMESTER UNSP

S92501B

DISPLACED UNSP FX RIGHT LESSER TOE(S) INIT FOR OPN FX

O6023X1

TERM DELIVERY WITH PRETERM LABOR THIRD TRIMESTER FETUS 1

S92502A

DISPLACED UNSP FRACTURE OF LEFT LESSER TOE(S) INIT

O6023X2

TERM DELIVERY WITH PRETERM LABOR THIRD TRIMESTER FETUS 2

S92502B

DISPLACED UNSP FX LEFT LESSER TOE(S) INIT FOR OPN FX

O6023X3

TERM DELIVERY WITH PRETERM LABOR THIRD TRIMESTER FETUS 3

S92503A

DISPLACED UNSP FRACTURE OF UNSP LESSER TOE(S) INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O6023X4

TERM DELIVERY WITH PRETERM LABOR THIRD TRIMESTER FETUS 4

S92503B

DISPLACED UNSP FX UNSP LESSER TOE(S) INIT FOR OPN FX

O6023X5

TERM DELIVERY WITH PRETERM LABOR THIRD TRIMESTER FETUS 5

S92504A

NONDISPLACED UNSP FRACTURE OF RIGHT LESSER TOE(S) INIT

O6023X9

TERM DELIVERY WITH PRETERM LABOR THIRD TRIMESTER OTH FETUS

S92504B

NONDISP UNSP FX RIGHT LESSER TOE(S) INIT FOR OPN FX

O610 FAILED MEDICAL INDUCTION OF LABOR

S92505A

NONDISPLACED UNSP FRACTURE OF LEFT LESSER TOE(S) INIT

O611 FAILED INSTRUMENTAL INDUCTION OF LABOR

S92505B

NONDISP UNSP FRACTURE OF LEFT LESSER TOE(S) INIT FOR OPN FX

O618 OTHER FAILED INDUCTION OF LABOR

S92506A

NONDISPLACED UNSP FRACTURE OF UNSP LESSER TOE(S) INIT

O619 FAILED INDUCTION OF LABOR UNSPECIFIED

S92506B

NONDISP UNSP FRACTURE OF UNSP LESSER TOE(S) INIT FOR OPN FX

O620 PRIMARY INADEQUATE CONTRACTIONS

S92511A

DISP FX OF PROXIMAL PHALANX OF RIGHT LESSER TOE(S) INIT

O621 SECONDARY UTERINE INERTIA

S92511B DISP FX OF PROX PHALANX OF R LESS TOE(S) INIT FOR OPN FX

O622 OTHER UTERINE INERTIA

S92512A DISP FX OF PROXIMAL PHALANX OF LEFT LESSER TOE(S) INIT

O623 PRECIPITATE LABOR

S92512B DISP FX OF PROX PHALANX OF LEFT LESS TOE(S) INIT FOR OPN FX

O624

HYPERTONIC INCOORDINATE AND PROLONGED UTERINE CONTRACTIONS

S92513A

DISP FX OF PROXIMAL PHALANX OF UNSP LESSER TOE(S) INIT

O628 OTHER ABNORMALITIES OF FORCES OF LABOR

S92513B

DISP FX OF PROX PHALANX OF UNSP LESS TOE(S) INIT FOR OPN FX

O629 ABNORMALITY OF FORCES OF LABOR UNSPECIFIED

S92514A

NONDISP FX OF PROXIMAL PHALANX OF RIGHT LESSER TOE(S) INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O630 PROLONGED FIRST STAGE (OF LABOR)

S92514B

NONDISP FX OF PROX PHALANX OF R LESS TOE(S) INIT FOR OPN FX

O631 PROLONGED SECOND STAGE (OF LABOR)

S92515A

NONDISP FX OF PROXIMAL PHALANX OF LEFT LESSER TOE(S) INIT

O632 DELAYED DELIVERY OF SECOND TWIN TRIPLET ETC.

S92515B

NONDISP FX OF PROX PHALANX OF L LESS TOE(S) INIT FOR OPN FX

O639 LONG LABOR UNSPECIFIED

S92516A NONDISP FX OF PROXIMAL PHALANX OF UNSP LESSER TOE(S) INIT

O640XX0

OBSTRUCTED LABOR DUE TO INCMPL ROTATION OF FETAL HEAD UNSP

S92516B

NONDISP FX OF PROX PHALANX OF UNSP LESS TOE(S) 7THB

O640XX1

OBST LABOR DUE TO INCMPL ROTATION OF FETAL HEAD FETUS 1

S92521A

DISP FX OF MEDIAL PHALANX OF RIGHT LESSER TOE(S) INIT

O640XX2

OBST LABOR DUE TO INCMPL ROTATION OF FETAL HEAD FETUS 2

S92521B

DISP FX OF MED PHALANX OF RIGHT LESS TOE(S) INIT FOR OPN FX

O640XX3

OBST LABOR DUE TO INCMPL ROTATION OF FETAL HEAD FETUS 3

S92522A

DISP FX OF MEDIAL PHALANX OF LEFT LESSER TOE(S) INIT

O640XX4

OBST LABOR DUE TO INCMPL ROTATION OF FETAL HEAD FETUS 4

S92522B

DISP FX OF MED PHALANX OF LEFT LESS TOE(S) INIT FOR OPN FX

O640XX5

OBST LABOR DUE TO INCMPL ROTATION OF FETAL HEAD FETUS 5

S92523A

DISP FX OF MEDIAL PHALANX OF UNSP LESSER TOE(S) INIT

O640XX9

OBSTRUCTED LABOR DUE TO INCMPL ROTATION OF FETAL HEAD OTH

S92523B

DISP FX OF MED PHALANX OF UNSP LESS TOE(S) INIT FOR OPN FX

O641XX0 OBSTRUCTED LABOR DUE TO BREECH PRESENTATION UNSP

S92524A

NONDISP FX OF MEDIAL PHALANX OF RIGHT LESSER TOE(S) INIT

O641XX1

OBSTRUCTED LABOR DUE TO BREECH PRESENTATION FETUS 1

S92524B

NONDISP FX OF MED PHALANX OF R LESS TOE(S) INIT FOR OPN FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O641XX2

OBSTRUCTED LABOR DUE TO BREECH PRESENTATION FETUS 2

S92525A

NONDISP FX OF MEDIAL PHALANX OF LEFT LESSER TOE(S) INIT

O641XX3

OBSTRUCTED LABOR DUE TO BREECH PRESENTATION FETUS 3

S92525B

NONDISP FX OF MED PHALANX OF L LESS TOE(S) INIT FOR OPN FX

O641XX4

OBSTRUCTED LABOR DUE TO BREECH PRESENTATION FETUS 4

S92526A

NONDISP FX OF MEDIAL PHALANX OF UNSP LESSER TOE(S) INIT

O641XX5

OBSTRUCTED LABOR DUE TO BREECH PRESENTATION FETUS 5

S92526B

NONDISP FX OF MED PHALANX OF UNSP LESS TOE(S) 7THB

O641XX9

OBSTRUCTED LABOR DUE TO BREECH PRESENTATION OTHER FETUS

S92531A

DISP FX OF DISTAL PHALANX OF RIGHT LESSER TOE(S) INIT

O642XX1 OBSTRUCTED LABOR DUE TO FACE PRESENTATION FETUS 1

S92531B

DISP FX OF DIST PHALANX OF R LESS TOE(S) INIT FOR OPN FX

O642XX2 OBSTRUCTED LABOR DUE TO FACE PRESENTATION FETUS 2

S92532A

DISP FX OF DISTAL PHALANX OF LEFT LESSER TOE(S) INIT

O642XX3 OBSTRUCTED LABOR DUE TO FACE PRESENTATION FETUS 3

S92532B

DISP FX OF DIST PHALANX OF LEFT LESS TOE(S) INIT FOR OPN FX

O642XX4 OBSTRUCTED LABOR DUE TO FACE PRESENTATION FETUS 4

S92533A

DISP FX OF DISTAL PHALANX OF UNSP LESSER TOE(S) INIT

O642XX5 OBSTRUCTED LABOR DUE TO FACE PRESENTATION FETUS 5

S92533B

DISP FX OF DIST PHALANX OF UNSP LESS TOE(S) INIT FOR OPN FX

O642XX9

OBSTRUCTED LABOR DUE TO FACE PRESENTATION OTHER FETUS

S92534A

NONDISP FX OF DISTAL PHALANX OF RIGHT LESSER TOE(S) INIT

O643XX1 OBSTRUCTED LABOR DUE TO BROW PRESENTATION FETUS 1

S92534B

NONDISP FX OF DIST PHALANX OF R LESS TOE(S) INIT FOR OPN FX

O643XX2 OBSTRUCTED LABOR DUE TO BROW PRESENTATION FETUS 2

S92535A

NONDISP FX OF DISTAL PHALANX OF LEFT LESSER TOE(S) INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O643XX3 OBSTRUCTED LABOR DUE TO BROW PRESENTATION FETUS 3

S92535B

NONDISP FX OF DIST PHALANX OF L LESS TOE(S) INIT FOR OPN FX

O643XX4 OBSTRUCTED LABOR DUE TO BROW PRESENTATION FETUS 4

S92536A

NONDISP FX OF DISTAL PHALANX OF UNSP LESSER TOE(S) INIT

O643XX5 OBSTRUCTED LABOR DUE TO BROW PRESENTATION FETUS 5

S92536B

NONDISP FX OF DIST PHALANX OF UNSP LESS TOE(S) 7THB

O643XX9

OBSTRUCTED LABOR DUE TO BROW PRESENTATION OTHER FETUS

S92591A

OTH FRACTURE OF RIGHT LESSER TOE(S) INIT FOR CLOS FX

O644XX1

OBSTRUCTED LABOR DUE TO SHOULDER PRESENTATION FETUS 1

S92591B

OTH FRACTURE OF RIGHT LESSER TOE(S) INIT FOR OPN FX

O644XX2

OBSTRUCTED LABOR DUE TO SHOULDER PRESENTATION FETUS 2

S92592A

OTH FRACTURE OF LEFT LESSER TOE(S) INIT FOR CLOS FX

O644XX3

OBSTRUCTED LABOR DUE TO SHOULDER PRESENTATION FETUS 3

S92592B

OTH FRACTURE OF LEFT LESSER TOE(S) INIT FOR OPN FX

O644XX4

OBSTRUCTED LABOR DUE TO SHOULDER PRESENTATION FETUS 4

S92599A

OTH FRACTURE OF UNSP LESSER TOE(S) INIT FOR CLOS FX

O644XX5

OBSTRUCTED LABOR DUE TO SHOULDER PRESENTATION FETUS 5

S92599B

OTH FRACTURE OF UNSP LESSER TOE(S) INIT FOR OPN FX

O644XX9

OBSTRUCTED LABOR DUE TO SHOULDER PRESENTATION OTHER FETUS

S92811A

Other fracture of right foot initial encounter for closed fracture

O645XX1

OBSTRUCTED LABOR DUE TO COMPOUND PRESENTATION FETUS 1

S92811B

Other fracture of right foot initial encounter for open fracture

O645XX2

OBSTRUCTED LABOR DUE TO COMPOUND PRESENTATION FETUS 2

S92812A

Other fracture of left foot initial encounter for closed fracture

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O645XX3

OBSTRUCTED LABOR DUE TO COMPOUND PRESENTATION FETUS 3

S92812B

Other fracture of left foot initial encounter for open fracture

O645XX4

OBSTRUCTED LABOR DUE TO COMPOUND PRESENTATION FETUS 4

S92819A

Other fracture of unspecified foot initial encounter for closed fracture

O645XX5

OBSTRUCTED LABOR DUE TO COMPOUND PRESENTATION FETUS 5

S92819B

Other fracture of unspecified foot initial encounter for open fracture

O645XX9

OBSTRUCTED LABOR DUE TO COMPOUND PRESENTATION OTHER FETUS

S92901A

UNSP FRACTURE OF RIGHT FOOT INIT ENCNTR FOR CLOSED FRACTURE

O648XX1

OBSTRUCTED LABOR DUE TO OTH MALPOS AND MALPRESENT FETUS 1

S92901B

UNSP FRACTURE OF RIGHT FOOT INIT ENCNTR FOR OPEN FRACTURE

O648XX2

OBSTRUCTED LABOR DUE TO OTH MALPOS AND MALPRESENT FETUS 2

S92902A

UNSP FRACTURE OF LEFT FOOT INIT ENCNTR FOR CLOSED FRACTURE

O648XX3

OBSTRUCTED LABOR DUE TO OTH MALPOS AND MALPRESENT FETUS 3

S92902B

UNSP FRACTURE OF LEFT FOOT INIT ENCNTR FOR OPEN FRACTURE

O648XX4

OBSTRUCTED LABOR DUE TO OTH MALPOS AND MALPRESENT FETUS 4

S92909A

UNSP FRACTURE OF UNSP FOOT INIT ENCNTR FOR CLOSED FRACTURE

O648XX5

OBSTRUCTED LABOR DUE TO OTH MALPOS AND MALPRESENT FETUS 5

S92909B

UNSP FRACTURE OF UNSP FOOT INIT ENCNTR FOR OPEN FRACTURE

O648XX9

OBSTRUCTED LABOR DUE TO OTH MALPOSITION AND MALPRESENT OTH

S92911A

UNSP FRACTURE OF RIGHT TOE(S) INIT FOR CLOS FX

O649XX1

OBSTRUCTED LABOR DUE TO MALPOS AND MALPRESENT UNSP FETUS 1

S92911B

UNSP FRACTURE OF RIGHT TOE(S) INIT ENCNTR FOR OPEN FRACTURE

O649XX2

OBSTRUCTED LABOR DUE TO MALPOS AND MALPRESENT UNSP FETUS 2

S92912A

UNSP FRACTURE OF LEFT TOE(S) INIT FOR CLOS FX

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O649XX3

OBSTRUCTED LABOR DUE TO MALPOS AND MALPRESENT UNSP FETUS 3

S92912B

UNSP FRACTURE OF LEFT TOE(S) INIT ENCNTR FOR OPEN FRACTURE

O649XX4

OBSTRUCTED LABOR DUE TO MALPOS AND MALPRESENT UNSP FETUS 4

S92919A

UNSP FRACTURE OF UNSP TOE(S) INIT FOR CLOS FX

O649XX5

OBSTRUCTED LABOR DUE TO MALPOS AND MALPRESENT UNSP FETUS 5

S92919B

UNSP FRACTURE OF UNSP TOE(S) INIT ENCNTR FOR OPEN FRACTURE

O649XX9

OBSTRUCTED LABOR DUE TO MALPOS AND MALPRESENT UNSP OTH

S9301XA

SUBLUXATION OF RIGHT ANKLE JOINT INITIAL ENCOUNTER

O650 OBSTRUCTED LABOR DUE TO DEFORMED PELVIS

S9302XA

SUBLUXATION OF LEFT ANKLE JOINT INITIAL ENCOUNTER

O651

OBSTRUCTED LABOR DUE TO GENERALLY CONTRACTED PELVIS

S9303XA

SUBLUXATION OF UNSPECIFIED ANKLE JOINT INITIAL ENCOUNTER

O652 OBSTRUCTED LABOR DUE TO PELVIC INLET CONTRACTION

S9304XA

DISLOCATION OF RIGHT ANKLE JOINT INITIAL ENCOUNTER

O653

OBST LABOR DUE TO PELVIC OUTLET AND MID-CAVITY CONTRCTN

S9305XA

DISLOCATION OF LEFT ANKLE JOINT INITIAL ENCOUNTER

O654

OBSTRUCTED LABOR DUE TO FETOPELVIC DISPROPORTION UNSP

S93111A

DISLOCATION OF INTERPHALN JOINT OF RIGHT GREAT TOE INIT

O655

OBSTRUCTED LABOR DUE TO ABNLT OF MATERNAL PELVIC ORGANS

S93112A

DISLOCATION OF INTERPHALANGEAL JOINT OF LEFT GREAT TOE INIT

O658

OBSTRUCTED LABOR DUE TO OTHER MATERNAL PELVIC ABNORMALITIES

S93113A

DISLOCATION OF INTERPHALANGEAL JOINT OF UNSP GREAT TOE INIT

O659

OBSTRUCTED LABOR DUE TO MATERNAL PELVIC ABNORMALITY UNSP

S93114A

DISLOCATION OF INTERPHALN JOINT OF RIGHT LESSER TOE(S) INIT

O660 OBSTRUCTED LABOR DUE TO SHOULDER DYSTOCIA

S93115A

DISLOCATION OF INTERPHALN JOINT OF LEFT LESSER TOE(S) INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O661 OBSTRUCTED LABOR DUE TO LOCKED TWINS

S93116A

DISLOCATION OF INTERPHALN JOINT OF UNSP LESSER TOE(S) INIT

O662 OBSTRUCTED LABOR DUE TO UNUSUALLY LARGE FETUS

S93119A

DISLOCATION OF INTERPHALANGEAL JOINT OF UNSP TOE(S) INIT

O663

OBSTRUCTED LABOR DUE TO OTHER ABNORMALITIES OF FETUS

S93121A

DISLOCATION OF MTP JOINT OF RIGHT GREAT TOE INIT

O6640 FAILED TRIAL OF LABOR UNSPECIFIED

S93122A

DISLOCATION OF MTP JOINT OF LEFT GREAT TOE INIT

O6641

FAILED ATTEMPT VAGINAL BIRTH AFTER PREVIOUS CESAREAN DEL

S93123A

DISLOCATION OF MTP JOINT OF UNSP GREAT TOE INIT

O665

ATTEMPTED APPLICATION OF VACUUM EXTRACTOR AND FORCEPS

S93124A

DISLOCATION OF MTP JOINT OF RIGHT LESSER TOE(S) INIT

O666 OBSTRUCTED LABOR DUE TO OTHER MULTIPLE FETUSES

S93125A

DISLOCATION OF MTP JOINT OF LEFT LESSER TOE(S) INIT

O668 OTHER SPECIFIED OBSTRUCTED LABOR

S93126A

DISLOCATION OF MTP JOINT OF UNSP LESSER TOE(S) INIT

O669 OBSTRUCTED LABOR UNSPECIFIED

S93129A

DISLOCATION OF MTP JOINT OF UNSP TOE(S) INIT

O670 INTRAPARTUM HEMORRHAGE WITH COAGULATION DEFECT

S93131A

SUBLUXATION OF INTERPHALN JOINT OF RIGHT GREAT TOE INIT

O678 OTHER INTRAPARTUM HEMORRHAGE

S93132A

SUBLUXATION OF INTERPHALANGEAL JOINT OF LEFT GREAT TOE INIT

O679 INTRAPARTUM HEMORRHAGE UNSPECIFIED

S93133A

SUBLUXATION OF INTERPHALANGEAL JOINT OF UNSP GREAT TOE INIT

O68

LABOR AND DELIVERY COMP BY ABNLT OF FETAL ACID-BASE BALANCE

S93134A

SUBLUXATION OF INTERPHALN JOINT OF RIGHT LESSER TOE(S) INIT

O690XX0

LABOR AND DELIVERY COMPLICATED BY PROLAPSE OF CORD UNSP

S93135A

SUBLUXATION OF INTERPHALN JOINT OF LEFT LESSER TOE(S) INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O690XX1

LABOR AND DELIVERY COMPLICATED BY PROLAPSE OF CORD FETUS 1

S93136A

SUBLUXATION OF INTERPHALN JOINT OF UNSP LESSER TOE(S) INIT

O690XX2

LABOR AND DELIVERY COMPLICATED BY PROLAPSE OF CORD FETUS 2

S93139A

SUBLUXATION OF INTERPHALANGEAL JOINT OF UNSP TOE(S) INIT

O690XX3

LABOR AND DELIVERY COMPLICATED BY PROLAPSE OF CORD FETUS 3

S93141A

SUBLUXATION OF MTP JOINT OF RIGHT GREAT TOE INIT

O690XX4

LABOR AND DELIVERY COMPLICATED BY PROLAPSE OF CORD FETUS 4

S93142A

SUBLUXATION OF MTP JOINT OF LEFT GREAT TOE INIT

O690XX5

LABOR AND DELIVERY COMPLICATED BY PROLAPSE OF CORD FETUS 5

S93143A

SUBLUXATION OF MTP JOINT OF UNSP GREAT TOE INIT

O690XX9

LABOR AND DELIVERY COMPLICATED BY PROLAPSE OF CORD OTH

S93144A

SUBLUXATION OF MTP JOINT OF RIGHT LESSER TOE(S) INIT

O691XX0

LABOR AND DELIVERY COMP BY CORD AROUND NECK W COMPRSN UNSP

S93145A

SUBLUXATION OF MTP JOINT OF LEFT LESSER TOE(S) INIT

O691XX1

LABOR AND DEL COMP BY CORD AROUND NECK W COMPRSN FETUS 1

S93146A

SUBLUXATION OF MTP JOINT OF UNSP LESSER TOE(S) INIT

O691XX2

LABOR AND DEL COMP BY CORD AROUND NECK W COMPRSN FETUS 2

S93149A

SUBLUXATION OF MTP JOINT OF UNSP TOE(S) INIT

O691XX3

LABOR AND DEL COMP BY CORD AROUND NECK W COMPRSN FETUS 3

S93311A

SUBLUXATION OF TARSAL JOINT OF RIGHT FOOT INITIAL ENCOUNTER

O691XX4

LABOR AND DEL COMP BY CORD AROUND NECK W COMPRSN FETUS 4

S93312A

SUBLUXATION OF TARSAL JOINT OF LEFT FOOT INITIAL ENCOUNTER

O691XX5

LABOR AND DEL COMP BY CORD AROUND NECK W COMPRSN FETUS 5

S93313A

SUBLUXATION OF TARSAL JOINT OF UNSPECIFIED FOOT INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O691XX9

LABOR AND DELIVERY COMP BY CORD AROUND NECK W COMPRSN OTH

S93314A

DISLOCATION OF TARSAL JOINT OF RIGHT FOOT INITIAL ENCOUNTER

O692XX0

LABOR AND DEL COMP BY OTH CORD ENTANGLE W COMPRSN UNSP

S93315A

DISLOCATION OF TARSAL JOINT OF LEFT FOOT INITIAL ENCOUNTER

O692XX1

LABOR AND DEL COMP BY OTH CORD ENTANGLE W COMPRSN FETUS 1

S93316A

DISLOCATION OF TARSAL JOINT OF UNSPECIFIED FOOT INIT ENCNTR

O692XX2

LABOR AND DEL COMP BY OTH CORD ENTANGLE W COMPRSN FETUS 2

S93321A

SUBLUXATION OF TARSOMETATARSAL JOINT OF RIGHT FOOT INIT

O692XX3

LABOR AND DEL COMP BY OTH CORD ENTANGLE W COMPRSN FETUS 3

S93322A

SUBLUXATION OF TARSOMETATARSAL JOINT OF LEFT FOOT INIT

O692XX4

LABOR AND DEL COMP BY OTH CORD ENTANGLE W COMPRSN FETUS 4

S93323A

SUBLUXATION OF TARSOMETATARSAL JOINT OF UNSP FOOT INIT

O692XX5

LABOR AND DEL COMP BY OTH CORD ENTANGLE W COMPRSN FETUS 5

S93324A

DISLOCATION OF TARSOMETATARSAL JOINT OF RIGHT FOOT INIT

O692XX9

LABOR AND DELIVERY COMP BY OTH CORD ENTANGLE W COMPRSN OTH

S93325A

DISLOCATION OF TARSOMETATARSAL JOINT OF LEFT FOOT INIT

O693XX0

LABOR AND DELIVERY COMPLICATED BY SHORT CORD UNSP

S93326A

DISLOCATION OF TARSOMETATARSAL JOINT OF UNSP FOOT INIT

O693XX1

LABOR AND DELIVERY COMPLICATED BY SHORT CORD FETUS 1

S93401A

SPRAIN OF UNSPECIFIED LIGAMENT OF RIGHT ANKLE INIT ENCNTR

O693XX2

LABOR AND DELIVERY COMPLICATED BY SHORT CORD FETUS 2

S93402A

SPRAIN OF UNSPECIFIED LIGAMENT OF LEFT ANKLE INIT ENCNTR

O693XX3

LABOR AND DELIVERY COMPLICATED BY SHORT CORD FETUS 3

S93409A

SPRAIN OF UNSP LIGAMENT OF UNSPECIFIED ANKLE INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O693XX4

LABOR AND DELIVERY COMPLICATED BY SHORT CORD FETUS 4

S93411A

SPRAIN OF CALCANEOFIBULAR LIGAMENT OF RIGHT ANKLE INIT

O693XX5

LABOR AND DELIVERY COMPLICATED BY SHORT CORD FETUS 5

S93412A

SPRAIN OF CALCANEOFIBULAR LIGAMENT OF LEFT ANKLE INIT

O693XX9

LABOR AND DELIVERY COMPLICATED BY SHORT CORD OTHER FETUS

S93419A

SPRAIN OF CALCANEOFIBULAR LIGAMENT OF UNSP ANKLE INIT

O694XX0

LABOR AND DELIVERY COMPLICATED BY VASA PREVIA UNSP

S93421A

SPRAIN OF DELTOID LIGAMENT OF RIGHT ANKLE INITIAL ENCOUNTER

O694XX1

LABOR AND DELIVERY COMPLICATED BY VASA PREVIA FETUS 1

S93422A

SPRAIN OF DELTOID LIGAMENT OF LEFT ANKLE INITIAL ENCOUNTER

O694XX2

LABOR AND DELIVERY COMPLICATED BY VASA PREVIA FETUS 2

S93429A

SPRAIN OF DELTOID LIGAMENT OF UNSPECIFIED ANKLE INIT ENCNTR

O694XX3

LABOR AND DELIVERY COMPLICATED BY VASA PREVIA FETUS 3

S93431A

SPRAIN OF TIBIOFIBULAR LIGAMENT OF RIGHT ANKLE INIT ENCNTR

O694XX4

LABOR AND DELIVERY COMPLICATED BY VASA PREVIA FETUS 4

S93432A

SPRAIN OF TIBIOFIBULAR LIGAMENT OF LEFT ANKLE INIT ENCNTR

O694XX5

LABOR AND DELIVERY COMPLICATED BY VASA PREVIA FETUS 5

S93439A

SPRAIN OF TIBIOFIBULAR LIGAMENT OF UNSP ANKLE INIT ENCNTR

O694XX9

LABOR AND DELIVERY COMPLICATED BY VASA PREVIA OTHER FETUS

S93491A

SPRAIN OF OTHER LIGAMENT OF RIGHT ANKLE INITIAL ENCOUNTER

O695XX0

LABOR AND DELIVERY COMP BY VASCULAR LESION OF CORD UNSP

S93492A

SPRAIN OF OTHER LIGAMENT OF LEFT ANKLE INITIAL ENCOUNTER

O695XX1

LABOR AND DELIVERY COMP BY VASCULAR LESION OF CORD FETUS 1

S93499A

SPRAIN OF OTHER LIGAMENT OF UNSPECIFIED ANKLE INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O695XX2

LABOR AND DELIVERY COMP BY VASCULAR LESION OF CORD FETUS 2

S93511A

SPRAIN OF INTERPHALANGEAL JOINT OF RIGHT GREAT TOE INIT

O695XX3

LABOR AND DELIVERY COMP BY VASCULAR LESION OF CORD FETUS 3

S93512A

SPRAIN OF INTERPHALANGEAL JOINT OF LEFT GREAT TOE INIT

O695XX4

LABOR AND DELIVERY COMP BY VASCULAR LESION OF CORD FETUS 4

S93513A

SPRAIN OF INTERPHALANGEAL JOINT OF UNSP GREAT TOE INIT

O695XX5

LABOR AND DELIVERY COMP BY VASCULAR LESION OF CORD FETUS 5

S93514A

SPRAIN OF INTERPHALANGEAL JOINT OF RIGHT LESSER TOE(S) INIT

O695XX9

LABOR AND DELIVERY COMP BY VASCULAR LESION OF CORD OTH

S93515A

SPRAIN OF INTERPHALANGEAL JOINT OF LEFT LESSER TOE(S) INIT

O6981X0

LABOR AND DEL COMP BY CORD AROUND NECK W/O COMPRSN UNSP

S93516A

SPRAIN OF INTERPHALANGEAL JOINT OF UNSP LESSER TOE(S) INIT

O6981X1

LABOR AND DEL COMP BY CORD AROUND NECK W/O COMPRSN FETUS 1

S93519A

SPRAIN OF INTERPHALANGEAL JOINT OF UNSP TOE(S) INIT ENCNTR

O6981X2

LABOR AND DEL COMP BY CORD AROUND NECK W/O COMPRSN FETUS 2

S93521A

SPRAIN OF METATARSOPHALANGEAL JOINT OF RIGHT GREAT TOE INIT

O6981X3

LABOR AND DEL COMP BY CORD AROUND NECK W/O COMPRSN FETUS 3

S93522A

SPRAIN OF METATARSOPHALANGEAL JOINT OF LEFT GREAT TOE INIT

O6981X4

LABOR AND DEL COMP BY CORD AROUND NECK W/O COMPRSN FETUS 4

S93523A

SPRAIN OF METATARSOPHALANGEAL JOINT OF UNSP GREAT TOE INIT

O6981X5

LABOR AND DEL COMP BY CORD AROUND NECK W/O COMPRSN FETUS 5

S93524A

SPRAIN OF MTP JOINT OF RIGHT LESSER TOE(S) INIT

O6981X9

LABOR AND DEL COMP BY CORD AROUND NECK W/O COMPRSN OTH

S93525A

SPRAIN OF MTP JOINT OF LEFT LESSER TOE(S) INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O6982X0

LABOR AND DEL COMP BY OTH CORD ENTANGLE W/O COMPRSN UNSP

S93526A

SPRAIN OF MTP JOINT OF UNSP LESSER TOE(S) INIT

O6982X1

LABOR AND DEL COMP BY OTH CORD ENTANGLE W/O COMPRSN FTS1

S93529A

SPRAIN OF METATARSOPHALANGEAL JOINT OF UNSP TOE(S) INIT

O6982X2

LABOR AND DEL COMP BY OTH CORD ENTANGLE W/O COMPRSN FTS2

S93611A

SPRAIN OF TARSAL LIGAMENT OF RIGHT FOOT INITIAL ENCOUNTER

O6982X3

LABOR AND DEL COMP BY OTH CORD ENTANGLE W/O COMPRSN FTS3

S93612A

SPRAIN OF TARSAL LIGAMENT OF LEFT FOOT INITIAL ENCOUNTER

O6982X4

LABOR AND DEL COMP BY OTH CORD ENTANGLE W/O COMPRSN FTS4

S93619A

SPRAIN OF TARSAL LIGAMENT OF UNSPECIFIED FOOT INIT ENCNTR

O6982X5

LABOR AND DEL COMP BY OTH CORD ENTANGLE W/O COMPRSN FTS5

S93621A

SPRAIN OF TARSOMETATARSAL LIGAMENT OF RIGHT FOOT INIT

O6982X9

LABOR AND DEL COMP BY OTH CORD ENTANGLE W/O COMPRSN OTH

S93622A

SPRAIN OF TARSOMETATARSAL LIGAMENT OF LEFT FOOT INIT ENCNTR

O6989X0

LABOR AND DELIVERY COMPLICATED BY OTH CORD COMP UNSP

S93629A

SPRAIN OF TARSOMETATARSAL LIGAMENT OF UNSP FOOT INIT ENCNTR

O6989X1

LABOR AND DELIVERY COMPLICATED BY OTH CORD COMP FETUS 1

S93691A

OTHER SPRAIN OF RIGHT FOOT INITIAL ENCOUNTER

O6989X2

LABOR AND DELIVERY COMPLICATED BY OTH CORD COMP FETUS 2

S93692A

OTHER SPRAIN OF LEFT FOOT INITIAL ENCOUNTER

O6989X3

LABOR AND DELIVERY COMPLICATED BY OTH CORD COMP FETUS 3

S93699A

OTHER SPRAIN OF UNSPECIFIED FOOT INITIAL ENCOUNTER

O6989X4

LABOR AND DELIVERY COMPLICATED BY OTH CORD COMP FETUS 4

S95011A

LACERATION OF DORSAL ARTERY OF RIGHT FOOT INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O6989X5

LABOR AND DELIVERY COMPLICATED BY OTH CORD COMP FETUS 5

S95012A

LACERATION OF DORSAL ARTERY OF LEFT FOOT INITIAL ENCOUNTER

O6989X9

LABOR AND DELIVERY COMPLICATED BY OTH CORD COMP OTH

S95019A

LACERATION OF DORSAL ARTERY OF UNSPECIFIED FOOT INIT ENCNTR

O699XX0

LABOR AND DELIVERY COMPLICATED BY CORD COMP UNSP UNSP

S95111A

LACERATION OF PLANTAR ARTERY OF RIGHT FOOT INIT ENCNTR

O699XX1

LABOR AND DELIVERY COMPLICATED BY CORD COMP UNSP FETUS 1

S95112A

LACERATION OF PLANTAR ARTERY OF LEFT FOOT INITIAL ENCOUNTER

O699XX2

LABOR AND DELIVERY COMPLICATED BY CORD COMP UNSP FETUS 2

S95119A

LACERATION OF PLANTAR ARTERY OF UNSP FOOT INIT ENCNTR

O699XX3

LABOR AND DELIVERY COMPLICATED BY CORD COMP UNSP FETUS 3

S95211A

LACERATION OF DORSAL VEIN OF RIGHT FOOT INITIAL ENCOUNTER

O699XX4

LABOR AND DELIVERY COMPLICATED BY CORD COMP UNSP FETUS 4

S95212A

LACERATION OF DORSAL VEIN OF LEFT FOOT INITIAL ENCOUNTER

O699XX5

LABOR AND DELIVERY COMPLICATED BY CORD COMP UNSP FETUS 5

S95219A

LACERATION OF DORSAL VEIN OF UNSPECIFIED FOOT INIT ENCNTR

O699XX9

LABOR AND DELIVERY COMPLICATED BY CORD COMP UNSP OTH

S95811A

LACERATION OF BLOOD VESSELS AT ANK/FT LEVEL RIGHT LEG INIT

O7100

RUPTURE OF UTERUS BEFORE ONSET OF LABOR UNSP TRIMESTER

S95812A

LACERATION OF BLOOD VESSELS AT ANK/FT LEVEL LEFT LEG INIT

O7102

RUPTURE OF UTERUS BEFORE ONSET OF LABOR SECOND TRIMESTER

S95819A

LACERATION OF BLOOD VESSELS AT ANK/FT LEVEL UNSP LEG INIT

O7103

RUPTURE OF UTERUS BEFORE ONSET OF LABOR THIRD TRIMESTER

S95911A

LACERAT UNSP BLOOD VESSEL AT ANK/FT LEVEL RIGHT LEG INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O711 RUPTURE OF UTERUS DURING LABOR

S95912A

LACERAT UNSP BLOOD VESSEL AT ANK/FT LEVEL LEFT LEG INIT

O712 POSTPARTUM INVERSION OF UTERUS

S95919A

LACERAT UNSP BLOOD VESSEL AT ANK/FT LEVEL UNSP LEG INIT

O715 OTHER OBSTETRIC INJURY TO PELVIC ORGANS

S96011A

STRAIN MSL/TND LNG FLXR MSL TOE AT ANK/FT LEV R FOOT INIT

O716 OBSTETRIC DAMAGE TO PELVIC JOINTS AND LIGAMENTS

S96012A

STRAIN MSL/TND LNG FLXR MSL TOE AT ANK/FT LEV L FOOT INIT

O717 OBSTETRIC HEMATOMA OF PELVIS

S96019A

STRAIN MSL/TND LNG FLXR MSL TOE AT ANK/FT LEV UNSP FT INIT

O7181 LACERATION OF UTERUS NOT ELSEWHERE CLASSIFIED

S96021A

LACERAT MSL/TND LNG FLXR MSL TOE AT ANK/FT LEV R FOOT INIT

O7182 OTHER SPECIFIED TRAUMA TO PERINEUM AND VULVA

S96022A

LACERAT MSL/TND LNG FLXR MSL TOE AT ANK/FT LEV L FOOT INIT

O7189 OTHER SPECIFIED OBSTETRIC TRAUMA

S96029A

LACERAT MSL/TND LNG FLXR MSL TOE AT ANK/FT LEVUNSP FT INIT

O719 OBSTETRIC TRAUMA UNSPECIFIED

S96111A

STRAIN MSL/TND LNG EXTN MSL TOE AT ANK/FT LEV R FOOT INIT

O720 THIRD-STAGE HEMORRHAGE

S96112A STRAIN MSL/TND LNG EXTN MSL TOE AT ANK/FT LEV L FOOT INIT

O721 OTHER IMMEDIATE POSTPARTUM HEMORRHAGE

S96119A

STRAIN MSL/TND LNG EXTN MSL TOE AT ANK/FT LEV UNSP FT INIT

O722 DELAYED AND SECONDARY POSTPARTUM HEMORRHAGE

S96121A

LACERAT MSL/TND LNG EXTN MSL TOE AT ANK/FT LEV R FOOT INIT

O723 POSTPARTUM COAGULATION DEFECTS

S96122A

LACERAT MSL/TND LNG EXTN MSL TOE AT ANK/FT LEV L FOOT INIT

O730 RETAINED PLACENTA WITHOUT HEMORRHAGE

S96129A

LACERAT MSL/TND LNG EXTN MSL TOE AT ANK/FT LEVUNSP FT INIT

O731

RETAINED PORTIONS OF PLACENTA AND MEMBRANES W/O HEMORRHAGE

S96211A

STRAIN OF INTRINSIC MSL/TND AT ANK/FT LEVEL R FOOT INIT

O740

ASPIRAT PNEUMONITIS DUE TO ANESTH DURING LABOR AND DELIVERY

S96212A

STRAIN OF INTRINSIC MSL/TND AT ANK/FT LEVEL LEFT FOOT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O741

OTH PULMONARY COMP OF ANESTHESIA DURING LABOR AND DELIVERY

S96219A

STRAIN OF INTRINSIC MSL/TND AT ANK/FT LEVEL UNSP FOOT INIT

O742 CARDIAC COMP OF ANESTHESIA DURING LABOR AND DELIVERY

S96221A

LACERAT INTRINSIC MSL/TND AT ANK/FT LEVEL RIGHT FOOT INIT

O743

CNSL COMPLICATIONS OF ANESTHESIA DURING LABOR AND DELIVERY

S96222A

LACERAT INTRINSIC MSL/TND AT ANK/FT LEVEL LEFT FOOT INIT

O744

TOXIC REACTION TO LOCAL ANESTHESIA DURING LABOR AND DELIVERY

S96229A

LACERAT INTRINSIC MSL/TND AT ANK/FT LEVEL UNSP FOOT INIT

O747

FAILED OR DIFFICULT INTUBATION FOR ANESTH DUR LABOR AND DEL

S96811A

STRAIN OF MUSCLES AND TENDONS AT ANK/FT LEVEL R FOOT INIT

O748

OTHER COMPLICATIONS OF ANESTHESIA DURING LABOR AND DELIVERY

S96812A

STRAIN OF MUSCLES AND TENDONS AT ANK/FT LEVEL L FOOT INIT

O749

COMPLICATION OF ANESTHESIA DURING LABOR AND DELIVERY UNSP

S96819A

STRAIN MUSCLES AND TENDONS AT ANK/FT LEVEL UNSP FOOT INIT

O750 MATERNAL DISTRESS DURING LABOR AND DELIVERY

S96821A

LACERAT MUSCLES AND TENDONS AT ANK/FT LEVEL R FOOT INIT

O751 SHOCK DURING OR FOLLOWING LABOR AND DELIVERY

S96822A

LACERAT MUSCLES AND TENDONS AT ANK/FT LEVEL LEFT FOOT INIT

O752 PYREXIA DURING LABOR NOT ELSEWHERE CLASSIFIED

S96829A

LACERAT MUSCLES AND TENDONS AT ANK/FT LEVEL UNSP FOOT INIT

O753 OTHER INFECTION DURING LABOR

S96911A

STRAIN OF UNSP MSL/TND AT ANK/FT LEVEL RIGHT FOOT INIT

O754

OTHER COMPLICATIONS OF OBSTETRIC SURGERY AND PROCEDURES

S96912A

STRAIN OF UNSP MSL/TND AT ANK/FT LEVEL LEFT FOOT INIT

O755

DELAYED DELIVERY AFTER ARTIFICIAL RUPTURE OF MEMBRANES

S96919A

STRAIN OF UNSP MSL/TND AT ANK/FT LEVEL UNSP FOOT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O7581

MATERNAL EXHAUSTION COMPLICATING LABOR AND DELIVERY

S96921A

LACERATION OF UNSP MSL/TND AT ANK/FT LEVEL RIGHT FOOT INIT

O7589

OTHER SPECIFIED COMPLICATIONS OF LABOR AND DELIVERY

S96922A

LACERATION OF UNSP MSL/TND AT ANK/FT LEVEL LEFT FOOT INIT

O759 COMPLICATION OF LABOR AND DELIVERY UNSPECIFIED

S96929A

LACERATION OF UNSP MSL/TND AT ANK/FT LEVEL UNSP FOOT INIT

O76

ABNLT IN FETAL HEART RATE AND RHYTHM COMP LABOR AND DELIVERY

S9700XA

CRUSHING INJURY OF UNSPECIFIED ANKLE INITIAL ENCOUNTER

O770

LABOR AND DELIVERY COMPLICATED BY MECONIUM IN AMNIOTIC FLUID

S9701XA

CRUSHING INJURY OF RIGHT ANKLE INITIAL ENCOUNTER

O771

FETAL STRESS IN LABOR OR DELIVERY DUE TO DRUG ADMINISTRATION

S9702XA

CRUSHING INJURY OF LEFT ANKLE INITIAL ENCOUNTER

O778

LABOR AND DELIVERY COMP BY OTH EVIDENCE OF FETAL STRESS

S97101A

CRUSHING INJURY OF UNSPECIFIED RIGHT TOE(S) INIT ENCNTR

O779

LABOR AND DELIVERY COMPLICATED BY FETAL STRESS UNSPECIFIED

S97102A

CRUSHING INJURY OF UNSPECIFIED LEFT TOE(S) INIT ENCNTR

O873

CEREBRAL VENOUS THROMBOSIS IN THE PUERPERIUM

S97109A

CRUSHING INJURY OF UNSPECIFIED TOE(S) INITIAL ENCOUNTER

O88011 AIR EMBOLISM IN PREGNANCY FIRST TRIMESTER

S97111A

CRUSHING INJURY OF RIGHT GREAT TOE INITIAL ENCOUNTER

O88012 AIR EMBOLISM IN PREGNANCY SECOND TRIMESTER

S97112A

CRUSHING INJURY OF LEFT GREAT TOE INITIAL ENCOUNTER

O88013 AIR EMBOLISM IN PREGNANCY THIRD TRIMESTER

S97119A

CRUSHING INJURY OF UNSPECIFIED GREAT TOE INITIAL ENCOUNTER

O88019 AIR EMBOLISM IN PREGNANCY UNSPECIFIED TRIMESTER

S97121A

CRUSHING INJURY OF RIGHT LESSER TOE(S) INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O8802 AIR EMBOLISM IN CHILDBIRTH

S97122A CRUSHING INJURY OF LEFT LESSER TOE(S) INITIAL ENCOUNTER

O8803 AIR EMBOLISM IN THE PUERPERIUM

S97129A

CRUSHING INJURY OF UNSPECIFIED LESSER TOE(S) INIT ENCNTR

O88111 AMNIOTIC FLUID EMBOLISM IN PREGNANCY FIRST TRIMESTER

S9780XA

CRUSHING INJURY OF UNSPECIFIED FOOT INITIAL ENCOUNTER

O88112

AMNIOTIC FLUID EMBOLISM IN PREGNANCY SECOND TRIMESTER

S9781XA

CRUSHING INJURY OF RIGHT FOOT INITIAL ENCOUNTER

O88113 AMNIOTIC FLUID EMBOLISM IN PREGNANCY THIRD TRIMESTER

S9782XA

CRUSHING INJURY OF LEFT FOOT INITIAL ENCOUNTER

O88119

AMNIOTIC FLUID EMBOLISM IN PREGNANCY UNSPECIFIED TRIMESTER

S98011A

COMPLETE TRAUMATIC AMP OF RIGHT FOOT AT ANKLE LEVEL INIT

O8812 AMNIOTIC FLUID EMBOLISM IN CHILDBIRTH

S98012A

COMPLETE TRAUMATIC AMP OF LEFT FOOT AT ANKLE LEVEL INIT

O8813 AMNIOTIC FLUID EMBOLISM IN THE PUERPERIUM

S98019A

COMPLETE TRAUMATIC AMP OF UNSP FOOT AT ANKLE LEVEL INIT

O88211 THROMBOEMBOLISM IN PREGNANCY FIRST TRIMESTER

S98021A

PARTIAL TRAUMATIC AMP OF RIGHT FOOT AT ANKLE LEVEL INIT

O88212

THROMBOEMBOLISM IN PREGNANCY SECOND TRIMESTER

S98022A

PARTIAL TRAUMATIC AMP OF LEFT FOOT AT ANKLE LEVEL INIT

O88213 THROMBOEMBOLISM IN PREGNANCY THIRD TRIMESTER

S98029A

PARTIAL TRAUMATIC AMP OF UNSP FOOT AT ANKLE LEVEL INIT

O88219

THROMBOEMBOLISM IN PREGNANCY UNSPECIFIED TRIMESTER

S98111A

COMPLETE TRAUMATIC AMPUTATION OF RIGHT GREAT TOE INIT

O8822 THROMBOEMBOLISM IN CHILDBIRTH

S98112A

COMPLETE TRAUMATIC AMPUTATION OF LEFT GREAT TOE INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O8823 THROMBOEMBOLISM IN THE PUERPERIUM

S98119A

COMPLETE TRAUMATIC AMPUTATION OF UNSP GREAT TOE INIT ENCNTR

O88311

PYEMIC AND SEPTIC EMBOLISM IN PREGNANCY FIRST TRIMESTER

S98121A

PARTIAL TRAUMATIC AMPUTATION OF RIGHT GREAT TOE INIT ENCNTR

O88312

PYEMIC AND SEPTIC EMBOLISM IN PREGNANCY SECOND TRIMESTER

S98122A

PARTIAL TRAUMATIC AMPUTATION OF LEFT GREAT TOE INIT ENCNTR

O88313

PYEMIC AND SEPTIC EMBOLISM IN PREGNANCY THIRD TRIMESTER

S98129A

PARTIAL TRAUMATIC AMPUTATION OF UNSP GREAT TOE INIT ENCNTR

O88319

PYEMIC AND SEPTIC EMBOLISM IN PREGNANCY UNSP TRIMESTER

S98131A

COMPLETE TRAUMATIC AMPUTATION OF ONE RIGHT LESSER TOE INIT

O8832 PYEMIC AND SEPTIC EMBOLISM IN CHILDBIRTH

S98132A

COMPLETE TRAUMATIC AMPUTATION OF ONE LEFT LESSER TOE INIT

O8833 PYEMIC AND SEPTIC EMBOLISM IN THE PUERPERIUM

S98139A

COMPLETE TRAUMATIC AMPUTATION OF ONE UNSP LESSER TOE INIT

O88811 OTHER EMBOLISM IN PREGNANCY FIRST TRIMESTER

S98141A

PARTIAL TRAUMATIC AMPUTATION OF ONE RIGHT LESSER TOE INIT

O88812

OTHER EMBOLISM IN PREGNANCY SECOND TRIMESTER

S98142A

PARTIAL TRAUMATIC AMPUTATION OF ONE LEFT LESSER TOE INIT

O88813 OTHER EMBOLISM IN PREGNANCY THIRD TRIMESTER

S98149A

PARTIAL TRAUMATIC AMPUTATION OF ONE UNSP LESSER TOE INIT

O88819

OTHER EMBOLISM IN PREGNANCY UNSPECIFIED TRIMESTER

S98211A

COMPLETE TRAUM AMP OF TWO OR MORE RIGHT LESSER TOES INIT

O8882 OTHER EMBOLISM IN CHILDBIRTH

S98212A

COMPLETE TRAUMATIC AMP OF TWO OR MORE LEFT LESSER TOES INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O8883 OTHER EMBOLISM IN THE PUERPERIUM

S98219A

COMPLETE TRAUMATIC AMP OF TWO OR MORE UNSP LESSER TOES INIT

O8901

ASPIRATION PNEUMONITIS DUE TO ANESTH DURING THE PUERPERIUM

S98221A

PARTIAL TRAUMATIC AMP OF TWO OR MORE RIGHT LESSER TOES INIT

O8909

OTH PULMONARY COMP OF ANESTHESIA DURING THE PUERPERIUM

S98222A

PARTIAL TRAUMATIC AMP OF TWO OR MORE LEFT LESSER TOES INIT

O891

CARDIAC COMPLICATIONS OF ANESTHESIA DURING THE PUERPERIUM

S98229A

PARTIAL TRAUMATIC AMP OF TWO OR MORE UNSP LESSER TOES INIT

O892

CNSL COMPLICATIONS OF ANESTHESIA DURING THE PUERPERIUM

S98311A

COMPLETE TRAUMATIC AMPUTATION OF RIGHT MIDFOOT INIT ENCNTR

O893

TOXIC REACTION TO LOCAL ANESTHESIA DURING THE PUERPERIUM

S98312A

COMPLETE TRAUMATIC AMPUTATION OF LEFT MIDFOOT INIT ENCNTR

O894

SPINAL AND EPIDUR ANESTHESIA-INDUCED HDACHE DURING THE PUERP

S98319A

COMPLETE TRAUMATIC AMPUTATION OF UNSP MIDFOOT INIT ENCNTR

O895

OTH COMP OF SPINAL AND EPIDURAL ANESTH DURING THE PUERPERIUM

S98321A

PARTIAL TRAUMATIC AMPUTATION OF RIGHT MIDFOOT INIT ENCNTR

O896

FAILED OR DIFFICULT INTUBATION FOR ANESTH DURING THE PUERP

S98322A

PARTIAL TRAUMATIC AMPUTATION OF LEFT MIDFOOT INIT ENCNTR

O898

OTHER COMPLICATIONS OF ANESTHESIA DURING THE PUERPERIUM

S98329A

PARTIAL TRAUMATIC AMPUTATION OF UNSP MIDFOOT INIT ENCNTR

O903 PERIPARTUM CARDIOMYOPATHY

S98911A

COMPLETE TRAUMATIC AMP OF RIGHT FOOT LEVEL UNSP INIT

O904 POSTPARTUM ACUTE KIDNEY FAILURE

S98912A

COMPLETE TRAUMATIC AMPUTATION OF LEFT FOOT LEVEL UNSP INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O905 POSTPARTUM THYROIDITIS

S98919A COMPLETE TRAUMATIC AMPUTATION OF UNSP FOOT LEVEL UNSP INIT

O99820

STREPTOCOCCUS B CARRIER STATE COMPLICATING PREGNANCY

S98921A

PARTIAL TRAUMATIC AMPUTATION OF RIGHT FOOT LEVEL UNSP INIT

O99824

STREPTOCOCCUS B CARRIER STATE COMPLICATING CHILDBIRTH

S98922A

PARTIAL TRAUMATIC AMPUTATION OF LEFT FOOT LEVEL UNSP INIT

O99825

STREPTOCOCCUS B CARRIER STATE COMPLICATING THE PUERPERIUM

S98929A

PARTIAL TRAUMATIC AMPUTATION OF UNSP FOOT LEVEL UNSP INIT

O9A311

PHYSICAL ABUSE COMPLICATING PREGNANCY FIRST TRIMESTER

S99001A

Unspecified physeal fracture of right calcaneus initial encounter for closed fracture

O9A312

PHYSICAL ABUSE COMPLICATING PREGNANCY SECOND TRIMESTER

S99001B

Unspecified physeal fracture of right calcaneus initial encounter for open fracture

O9A313

PHYSICAL ABUSE COMPLICATING PREGNANCY THIRD TRIMESTER

S99002A

Unspecified physeal fracture of left calcaneus initial encounter for closed fracture

O9A319

PHYSICAL ABUSE COMPLICATING PREGNANCY UNSPECIFIED TRIMESTER

S99002B

Unspecified physeal fracture of left calcaneus initial encounter for open fracture

O9A32 PHYSICAL ABUSE COMPLICATING CHILDBIRTH

S99009A

Unspecified physeal fracture of unspecified calcaneus initial encounter for closed fracture

O9A33

PHYSICAL ABUSE COMPLICATING THE PUERPERIUM

S99009B

Unspecified physeal fracture of unspecified calcaneus initial encounter for open fracture

O9A411 SEXUAL ABUSE COMPLICATING PREGNANCY FIRST TRIMESTER

S99011A

Salter-Harris Type I physeal fracture of right calcaneus initial encounter for closed fracture

O9A412

SEXUAL ABUSE COMPLICATING PREGNANCY SECOND TRIMESTER

S99011B

Salter-Harris Type I physeal fracture of right calcaneus initial encounter for open fracture

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O9A413 SEXUAL ABUSE COMPLICATING PREGNANCY THIRD TRIMESTER

S99012A

Salter-Harris Type I physeal fracture of left calcaneus initial encounter for closed fracture

O9A419

SEXUAL ABUSE COMPLICATING PREGNANCY UNSPECIFIED TRIMESTER

S99012B

Salter-Harris Type I physeal fracture of left calcaneus initial encounter for open fracture

O9A42 SEXUAL ABUSE COMPLICATING CHILDBIRTH

S99019A

Salter-Harris Type I physeal fracture of unspecified calcaneus initial encounter for closed fracture

O9A43 SEXUAL ABUSE COMPLICATING THE PUERPERIUM

S99019B

Salter-Harris Type I physeal fracture of unspecified calcaneus initial encounter for open fracture

P0382 MECONIUM PASSAGE DURING DELIVERY

S99021A

Salter-Harris Type II physeal fracture of right calcaneus initial encounter for closed fracture

P043 NEWBORN AFFECTED BY MATERNAL USE OF ALCOHOL

S99021B

Salter-Harris Type II physeal fracture of right calcaneus initial encounter for open fracture

P0441 NEWBORN AFFECTED BY MATERNAL USE OF COCAINE

S99022A

Salter-Harris Type II physeal fracture of left calcaneus initial encounter for closed fracture

P0449

NEWBORN AFFECTED BY MATERNAL USE OF DRUGS OF ADDICTION

S99022B

Salter-Harris Type II physeal fracture of left calcaneus initial encounter for open fracture

P048

NEWBORN AFFECTED BY OTH MATERNAL NOXIOUS SUBSTANCES

S99029A

Salter-Harris Type II physeal fracture of unspecified calcaneus initial encounter for closed fracture

P049

NEWBORN AFFECTED BY MATERNAL NOXIOUS SUBSTANCE UNSP

S99029B

Salter-Harris Type II physeal fracture of unspecified calcaneus initial encounter for open fracture

P0500

NEWBORN LIGHT FOR GESTATIONAL AGE UNSPECIFIED WEIGHT

S99031A

Salter-Harris Type III physeal fracture of right calcaneus initial encounter for closed fracture

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P0501

NEWBORN LIGHT FOR GESTATIONAL AGE LESS THAN 500 GRAMS

S99031B

Salter-Harris Type III physeal fracture of right calcaneus initial encounter for open fracture

P0502

NEWBORN LIGHT FOR GESTATIONAL AGE 500-749 GRAMS

S99032A

Salter-Harris Type III physeal fracture of left calcaneus initial encounter for closed fracture

P0503

NEWBORN LIGHT FOR GESTATIONAL AGE 750-999 GRAMS

S99032B

Salter-Harris Type III physeal fracture of left calcaneus initial encounter for open fracture

P0504

NEWBORN LIGHT FOR GESTATIONAL AGE 1000-1249 GRAMS

S99039A

Salter-Harris Type III physeal fracture of unspecified calcaneus initial encounter for closed fracture

P0505

NEWBORN LIGHT FOR GESTATIONAL AGE 1250-1499 GRAMS

S99039B

Salter-Harris Type III physeal fracture of unspecified calcaneus initial encounter for open fracture

P0506

NEWBORN LIGHT FOR GESTATIONAL AGE 1500-1749 GRAMS

S99041A

Salter-Harris Type IV physeal fracture of right calcaneus initial encounter for closed fracture

P0507

NEWBORN LIGHT FOR GESTATIONAL AGE 1750-1999 GRAMS

S99041B

Salter-Harris Type IV physeal fracture of right calcaneus initial encounter for open fracture

P0508

NEWBORN LIGHT FOR GESTATIONAL AGE 2000-2499 GRAMS

S99042A

Salter-Harris Type IV physeal fracture of left calcaneus initial encounter for closed fracture

P0509 Newborn light for gestational age 2500 grams and over

S99042B

Salter-Harris Type IV physeal fracture of left calcaneus initial encounter for open fracture

P0510

NEWBORN SMALL FOR GESTATIONAL AGE UNSPECIFIED WEIGHT

S99049A

Salter-Harris Type IV physeal fracture of unspecified calcaneus initial encounter for closed fracture

P0511

NEWBORN SMALL FOR GESTATIONAL AGE LESS THAN 500 GRAMS

S99049B

Salter-Harris Type IV physeal fracture of unspecified calcaneus initial encounter for open fracture

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P0512

NEWBORN SMALL FOR GESTATIONAL AGE 500-749 GRAMS

S99091A

Other physeal fracture of right calcaneus initial encounter for closed fracture

P0513

NEWBORN SMALL FOR GESTATIONAL AGE 750-999 GRAMS

S99091B

Other physeal fracture of right calcaneus initial encounter for open fracture

P0514

NEWBORN SMALL FOR GESTATIONAL AGE 1000-1249 GRAMS

S99092A

Other physeal fracture of left calcaneus initial encounter for closed fracture

P0515

NEWBORN SMALL FOR GESTATIONAL AGE 1250-1499 GRAMS

S99092B

Other physeal fracture of left calcaneus initial encounter for open fracture

P0516

NEWBORN SMALL FOR GESTATIONAL AGE 1500-1749 GRAMS

S99099A

Other physeal fracture of unspecified calcaneus initial encounter for closed fracture

P0517

NEWBORN SMALL FOR GESTATIONAL AGE 1750-1999 GRAMS

S99099B

Other physeal fracture of unspecified calcaneus initial encounter for open fracture

P0518

NEWBORN SMALL FOR GESTATIONAL AGE 2000-2499 GRAMS

S99101A

Unspecified physeal fracture of right metatarsal initial encounter for closed fracture

P0519 Newborn small for gestational age other

S99101B

Unspecified physeal fracture of right metatarsal initial encounter for open fracture

P052

NB AFF BY FETAL MALNUT NOT LIGHT OR SMALL FOR GESTATNL AGE

S99102A

Unspecified physeal fracture of left metatarsal initial encounter for closed fracture

P0700

EXTREMELY LOW BIRTH WEIGHT NEWBORN UNSPECIFIED WEIGHT

S99102B

Unspecified physeal fracture of left metatarsal initial encounter for open fracture

P0701

EXTREMELY LOW BIRTH WEIGHT NEWBORN LESS THAN 500 GRAMS

S99109A

Unspecified physeal fracture of unspecified metatarsal initial encounter for closed fracture

P0702

EXTREMELY LOW BIRTH WEIGHT NEWBORN 500-749 GRAMS

S99109B

Unspecified physeal fracture of unspecified metatarsal initial encounter for open fracture

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P0703

EXTREMELY LOW BIRTH WEIGHT NEWBORN 750-999 GRAMS

S99111A

Salter-Harris Type I physeal fracture of right metatarsal initial encounter for closed fracture

P0710

OTHER LOW BIRTH WEIGHT NEWBORN UNSPECIFIED WEIGHT

S99111B

Salter-Harris Type I physeal fracture of right metatarsal initial encounter for open fracture

P0714 OTHER LOW BIRTH WEIGHT NEWBORN 1000-1249 GRAMS

S99112A

Salter-Harris Type I physeal fracture of left metatarsal initial encounter for closed fracture

P0715 OTHER LOW BIRTH WEIGHT NEWBORN 1250-1499 GRAMS

S99112B

Salter-Harris Type I physeal fracture of left metatarsal initial encounter for open fracture

P0716 OTHER LOW BIRTH WEIGHT NEWBORN 1500-1749 GRAMS

S99119A

Salter-Harris Type I physeal fracture of unspecified metatarsal initial encounter for closed fracture

P0717 OTHER LOW BIRTH WEIGHT NEWBORN 1750-1999 GRAMS

S99119B

Salter-Harris Type I physeal fracture of unspecified metatarsal initial encounter for open fracture

P0718 OTHER LOW BIRTH WEIGHT NEWBORN 2000-2499 GRAMS

S99121A

Salter-Harris Type II physeal fracture of right metatarsal initial encounter for closed fracture

P0720

EXTREME IMMATURITY OF NEWBORN UNSP WEEKS OF GESTATION

S99121B

Salter-Harris Type II physeal fracture of right metatarsal initial encounter for open fracture

P0721

EXTREME IMMATURITY OF NB GESTATNL AGE < 23 COMPLETED WEEKS

S99122A

Salter-Harris Type II physeal fracture of left metatarsal initial encounter for closed fracture

P0722

EXTREME IMMATURITY OF NB GESTATNL AGE 23 COMPLETED WEEKS

S99122B

Salter-Harris Type II physeal fracture of left metatarsal initial encounter for open fracture

P0723

EXTREME IMMATURITY OF NB GESTATNL AGE 24 COMPLETED WEEKS

S99129A

Salter-Harris Type II physeal fracture of unspecified metatarsal initial encounter for closed fracture

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P0730

PRETERM NEWBORN UNSPECIFIED WEEKS OF GESTATION

S99129B

Salter-Harris Type II physeal fracture of unspecified metatarsal initial encounter for open fracture

P0731

PRETERM NEWBORN GESTATIONAL AGE 28 COMPLETED WEEKS

S99131A

Salter-Harris Type III physeal fracture of right metatarsal initial encounter for closed fracture

P0732

PRETERM NEWBORN GESTATIONAL AGE 29 COMPLETED WEEKS

S99131B

Salter-Harris Type III physeal fracture of right metatarsal initial encounter for open fracture

P100 SUBDURAL HEMORRHAGE DUE TO BIRTH INJURY

S99132A

Salter-Harris Type III physeal fracture of left metatarsal initial encounter for closed fracture

P101 CEREBRAL HEMORRHAGE DUE TO BIRTH INJURY

S99132B

Salter-Harris Type III physeal fracture of left metatarsal initial encounter for open fracture

P102

INTRAVENTRICULAR HEMORRHAGE DUE TO BIRTH INJURY

S99139A

Salter-Harris Type III physeal fracture of unspecified metatarsal initial encounter for closed fracture

P103 SUBARACHNOID HEMORRHAGE DUE TO BIRTH INJURY

S99139B

Salter-Harris Type III physeal fracture of unspecified metatarsal initial encounter for open fracture

P104 TENTORIAL TEAR DUE TO BIRTH INJURY

S99141A

Salter-Harris Type IV physeal fracture of right metatarsal initial encounter for closed fracture

P108

OTH INTCRN LACERATIONS AND HEMORRHAGES DUE TO BIRTH INJURY

S99141B

Salter-Harris Type IV physeal fracture of right metatarsal initial encounter for open fracture

P109

UNSP INTCRN LACERATION AND HEMORRHAGE DUE TO BIRTH INJURY

S99142A

Salter-Harris Type IV physeal fracture of left metatarsal initial encounter for closed fracture

P110 CEREBRAL EDEMA DUE TO BIRTH INJURY

S99142B

Salter-Harris Type IV physeal fracture of left metatarsal initial encounter for open fracture

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P111 OTHER SPECIFIED BRAIN DAMAGE DUE TO BIRTH INJURY

S99149A

Salter-Harris Type IV physeal fracture of unspecified metatarsal initial encounter for closed fracture

P112 UNSPECIFIED BRAIN DAMAGE DUE TO BIRTH INJURY

S99149B

Salter-Harris Type IV physeal fracture of unspecified metatarsal initial encounter for open fracture

P113 BIRTH INJURY TO FACIAL NERVE

S99191A

Other physeal fracture of right metatarsal initial encounter for closed fracture

P114 BIRTH INJURY TO OTHER CRANIAL NERVES

S99191B

Other physeal fracture of right metatarsal initial encounter for open fracture

P115 BIRTH INJURY TO SPINE AND SPINAL CORD

S99192A

Other physeal fracture of left metatarsal initial encounter for closed fracture

P119 BIRTH INJURY TO CENTRAL NERVOUS SYSTEM UNSPECIFIED

S99192B

Other physeal fracture of left metatarsal initial encounter for open fracture

P120 CEPHALHEMATOMA DUE TO BIRTH INJURY

S99199A

Other physeal fracture of unspecified metatarsal initial encounter for closed fracture

P121

CHIGNON (FROM VACUUM EXTRACTION) DUE TO BIRTH INJURY

S99199B

Other physeal fracture of unspecified metatarsal initial encounter for open fracture

P122

EPICRANIAL SUBAPONEUROTIC HEMORRHAGE DUE TO BIRTH INJURY

S99201A

Unspecified physeal fracture of phalanx of right toe initial encounter for closed fracture

P130 FRACTURE OF SKULL DUE TO BIRTH INJURY

S99201B

Unspecified physeal fracture of phalanx of right toe initial encounter for open fracture

P131 OTHER BIRTH INJURIES TO SKULL

S99202A

Unspecified physeal fracture of phalanx of left toe initial encounter for closed fracture

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P150 BIRTH INJURY TO LIVER

S99202B

Unspecified physeal fracture of phalanx of left toe initial encounter for open fracture

P151 BIRTH INJURY TO SPLEEN

S99209A

Unspecified physeal fracture of phalanx of unspecified toe initial encounter for closed fracture

P190

METABOLIC ACIDEMIA IN NEWBORN FIRST NOTED BEFORE ONSET LABOR

S99209B

Unspecified physeal fracture of phalanx of unspecified toe initial encounter for open fracture

P191

METABOLIC ACIDEMIA IN NEWBORN FIRST NOTED DURING LABOR

S99211A

Salter-Harris Type I physeal fracture of phalanx of right toe initial encounter for closed fracture

P192 METABOLIC ACIDEMIA NOTED AT BIRTH

S99211B

Salter-Harris Type I physeal fracture of phalanx of right toe initial encounter for open fracture

P199 METABOLIC ACIDEMIA UNSPECIFIED

S99212A

Salter-Harris Type I physeal fracture of phalanx of left toe initial encounter for closed fracture

P220 RESPIRATORY DISTRESS SYNDROME OF NEWBORN

S99212B

Salter-Harris Type I physeal fracture of phalanx of left toe initial encounter for open fracture

P221 TRANSIENT TACHYPNEA OF NEWBORN

S99219A

Salter-Harris Type I physeal fracture of phalanx of unspecified toe initial encounter for closed fracture

P228 OTHER RESPIRATORY DISTRESS OF NEWBORN

S99219B

Salter-Harris Type I physeal fracture of phalanx of unspecified toe initial encounter for open fracture

P229 RESPIRATORY DISTRESS OF NEWBORN UNSPECIFIED

S99221A

Salter-Harris Type II physeal fracture of phalanx of right toe initial encounter for closed fracture

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P230 CONGENITAL PNEUMONIA DUE TO VIRAL AGENT

S99221B

Salter-Harris Type II physeal fracture of phalanx of right toe initial encounter for open fracture

P231 CONGENITAL PNEUMONIA DUE TO CHLAMYDIA

S99222A

Salter-Harris Type II physeal fracture of phalanx of left toe initial encounter for closed fracture

P232 CONGENITAL PNEUMONIA DUE TO STAPHYLOCOCCUS

S99222B

Salter-Harris Type II physeal fracture of phalanx of left toe initial encounter for open fracture

P233 CONGENITAL PNEUMONIA DUE TO STREPTOCOCCUS GROUP B

S99229A

Salter-Harris Type II physeal fracture of phalanx of unspecified toe initial encounter for closed fracture

P234 CONGENITAL PNEUMONIA DUE TO ESCHERICHIA COLI

S99229B

Salter-Harris Type II physeal fracture of phalanx of unspecified toe initial encounter for open fracture

P235 CONGENITAL PNEUMONIA DUE TO PSEUDOMONAS

S99231A

Salter-Harris Type III physeal fracture of phalanx of right toe initial encounter for closed fracture

P236 CONGENITAL PNEUMONIA DUE TO OTHER BACTERIAL AGENTS

S99231B

Salter-Harris Type III physeal fracture of phalanx of right toe initial encounter for open fracture

P238 CONGENITAL PNEUMONIA DUE TO OTHER ORGANISMS

S99232A

Salter-Harris Type III physeal fracture of phalanx of left toe initial encounter for closed fracture

P239 CONGENITAL PNEUMONIA UNSPECIFIED

S99232B

Salter-Harris Type III physeal fracture of phalanx of left toe initial encounter for open fracture

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P2400

MECONIUM ASPIRATION WITHOUT RESPIRATORY SYMPTOMS

S99239A

Salter-Harris Type III physeal fracture of phalanx of unspecified toe initial encounter for closed fracture

P2401 MECONIUM ASPIRATION WITH RESPIRATORY SYMPTOMS

S99239B

Salter-Harris Type III physeal fracture of phalanx of unspecified toe initial encounter for open fracture

P2410

NEONATAL ASPIRAT OF AMNIO FLUID AND MUCUS W/O RESP SYMP

S99241A

Salter-Harris Type IV physeal fracture of phalanx of right toe initial encounter for closed fracture

P2411

NEONATAL ASPIRAT OF AMNIO FLUID AND MUCUS W RESP SYMP

S99241B

Salter-Harris Type IV physeal fracture of phalanx of right toe initial encounter for open fracture

P2420

NEONATAL ASPIRATION OF BLOOD WITHOUT RESPIRATORY SYMPTOMS

S99242A

Salter-Harris Type IV physeal fracture of phalanx of left toe initial encounter for closed fracture

P2421

NEONATAL ASPIRATION OF BLOOD WITH RESPIRATORY SYMPTOMS

S99242B

Salter-Harris Type IV physeal fracture of phalanx of left toe initial encounter for open fracture

P2430

NEONATAL ASPIRAT OF MILK AND REGURGITATED FOOD W/O RESP SYMP

S99249A

Salter-Harris Type IV physeal fracture of phalanx of unspecified toe initial encounter for closed fracture

P2431

NEONATAL ASPIRAT OF MILK AND REGURGITATED FOOD W RESP SYMP

S99249B

Salter-Harris Type IV physeal fracture of phalanx of unspecified toe initial encounter for open fracture

P2480

OTHER NEONATAL ASPIRATION WITHOUT RESPIRATORY SYMPTOMS

S99291A

Other physeal fracture of phalanx of right toe initial encounter for closed fracture

P2481 OTHER NEONATAL ASPIRATION WITH RESPIRATORY SYMPTOMS

S99291B

Other physeal fracture of phalanx of right toe initial encounter for open fracture

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P249 NEONATAL ASPIRATION UNSPECIFIED

S99292A

Other physeal fracture of phalanx of left toe initial encounter for closed fracture

P250

INTERSTITIAL EMPHYSEMA ORIGINATING IN THE PERINATAL PERIOD

S99292B

Other physeal fracture of phalanx of left toe initial encounter for open fracture

P251 PNEUMOTHORAX ORIGINATING IN THE PERINATAL PERIOD

S99299A

Other physeal fracture of phalanx of unspecified toe initial encounter for closed fracture

P252

PNEUMOMEDIASTINUM ORIGINATING IN THE PERINATAL PERIOD

S99299B

Other physeal fracture of phalanx of unspecified toe initial encounter for open fracture

P253

PNEUMOPERICARDIUM ORIGINATING IN THE PERINATAL PERIOD

T1491 SUICIDE ATTEMPT

P258

OTH COND REL TO INTERSTIT EMPHYSEMA ORIGIN IN PERINAT PERIOD

T1500XA

FOREIGN BODY IN CORNEA UNSPECIFIED EYE INITIAL ENCOUNTER

P260

TRACHEOBRONCHIAL HEMORRHAGE ORIGIN IN THE PERINATAL PERIOD

T1501XA

FOREIGN BODY IN CORNEA RIGHT EYE INITIAL ENCOUNTER

P261

MASSIVE PULMONARY HEMORRHAGE ORIGIN IN THE PERINATAL PERIOD

T1502XA

FOREIGN BODY IN CORNEA LEFT EYE INITIAL ENCOUNTER

P268

OTH PULMONARY HEMORRHAGES ORIGIN IN THE PERINATAL PERIOD

T1510XA

FOREIGN BODY IN CONJUNCTIVAL SAC UNSP EYE INIT ENCNTR

P269

UNSP PULMONARY HEMORRHAGE ORIGIN IN THE PERINATAL PERIOD

T1511XA

FOREIGN BODY IN CONJUNCTIVAL SAC RIGHT EYE INIT ENCNTR

P270 WILSON-MIKITY SYNDROME

T1512XA FOREIGN BODY IN CONJUNCTIVAL SAC LEFT EYE INIT ENCNTR

P271

BRONCHOPULMONARY DYSPLASIA ORIGIN IN THE PERINATAL PERIOD

T1580XA

FB IN OTH AND MULTIPLE PARTS OF EXTERNAL EYE UNSP EYE INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P278

OTH CHRONIC RESP DISEASES ORIGIN IN THE PERINATAL PERIOD

T1581XA

FB IN OTH AND MULTIPLE PARTS OF EXTERNAL EYE R EYE INIT

P279

UNSP CHRONIC RESP DISEASE ORIGIN IN THE PERINATAL PERIOD

T1582XA

FB IN OTH AND MULTIPLE PARTS OF EXTERNAL EYE LEFT EYE INIT

P280 PRIMARY ATELECTASIS OF NEWBORN

T1590XA

FOREIGN BODY ON EXTERNAL EYE PART UNSP UNSP EYE INIT

P2810 UNSPECIFIED ATELECTASIS OF NEWBORN

T1591XA

FOREIGN BODY ON EXTERNAL EYE PART UNSP RIGHT EYE INIT

P2811

RESORPTION ATELECTASIS WITHOUT RESPIRATORY DISTRESS SYNDROME

T1592XA

FOREIGN BODY ON EXTERNAL EYE PART UNSP LEFT EYE INIT

P2819 OTHER ATELECTASIS OF NEWBORN

T161XXA

FOREIGN BODY IN RIGHT EAR INITIAL ENCOUNTER

P282 CYANOTIC ATTACKS OF NEWBORN

T162XXA

FOREIGN BODY IN LEFT EAR INITIAL ENCOUNTER

P283 PRIMARY SLEEP APNEA OF NEWBORN

T169XXA

FOREIGN BODY IN EAR UNSPECIFIED EAR INITIAL ENCOUNTER

P284 OTHER APNEA OF NEWBORN

T170XXA FOREIGN BODY IN NASAL SINUS INITIAL ENCOUNTER

P285 RESPIRATORY FAILURE OF NEWBORN

T171XXA

FOREIGN BODY IN NOSTRIL INITIAL ENCOUNTER

P2881 RESPIRATORY ARREST OF NEWBORN

T17200A

UNSP FOREIGN BODY IN PHARYNX CAUSING ASPHYXIATION INIT

P2889 OTHER SPECIFIED RESPIRATORY CONDITIONS OF NEWBORN

T17208A

UNSP FOREIGN BODY IN PHARYNX CAUSING OTH INJURY INIT ENCNTR

P289 RESPIRATORY CONDITION OF NEWBORN UNSPECIFIED

T17210A

GASTRIC CONTENTS IN PHARYNX CAUSING ASPHYXIATION INIT

P290 NEONATAL CARDIAC FAILURE

T17218A GASTRIC CONTENTS IN PHARYNX CAUSING OTH INJURY INIT ENCNTR

P2911 NEONATAL TACHYCARDIA

T17220A FOOD IN PHARYNX CAUSING ASPHYXIATION INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P2912 NEONATAL BRADYCARDIA

T17228A FOOD IN PHARYNX CAUSING OTHER INJURY INITIAL ENCOUNTER

P292 NEONATAL HYPERTENSION

T17290A OTH FOREIGN OBJECT IN PHARYNX CAUSING ASPHYXIATION INIT

P293 PERSISTENT FETAL CIRCULATION

T17298A

OTH FOREIGN OBJECT IN PHARYNX CAUSING OTH INJURY INIT

P294 TRANSIENT MYOCARDIAL ISCHEMIA IN NEWBORN

T17300A

UNSP FOREIGN BODY IN LARYNX CAUSING ASPHYXIATION INIT

P2981 CARDIAC ARREST OF NEWBORN

T17308A UNSP FOREIGN BODY IN LARYNX CAUSING OTH INJURY INIT ENCNTR

P2989

OTH CARDIOVASC DISORDERS ORIGINATING IN THE PERINATAL PERIOD

T17310A

GASTRIC CONTENTS IN LARYNX CAUSING ASPHYXIATION INIT ENCNTR

P299

CARDIOVASC DISORDER ORIGIN IN THE PERINATAL PERIOD UNSP

T17318A

GASTRIC CONTENTS IN LARYNX CAUSING OTHER INJURY INIT ENCNTR

P350 CONGENITAL RUBELLA SYNDROME

T17320A

FOOD IN LARYNX CAUSING ASPHYXIATION INITIAL ENCOUNTER

P351 CONGENITAL CYTOMEGALOVIRUS INFECTION

T17328A

FOOD IN LARYNX CAUSING OTHER INJURY INITIAL ENCOUNTER

P352 CONGENITAL HERPESVIRAL [HERPES SIMPLEX] INFECTION

T17390A

OTH FOREIGN OBJECT IN LARYNX CAUSING ASPHYXIATION INIT

P353 CONGENITAL VIRAL HEPATITIS

T17398A OTH FOREIGN OBJECT IN LARYNX CAUSING OTH INJURY INIT ENCNTR

P358 OTHER CONGENITAL VIRAL DISEASES

T17400A

UNSP FOREIGN BODY IN TRACHEA CAUSING ASPHYXIATION INIT

P359 CONGENITAL VIRAL DISEASE UNSPECIFIED

T17408A

UNSP FOREIGN BODY IN TRACHEA CAUSING OTH INJURY INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P360 SEPSIS OF NEWBORN DUE TO STREPTOCOCCUS GROUP B

T17410A

GASTRIC CONTENTS IN TRACHEA CAUSING ASPHYXIATION INIT

P3610 SEPSIS OF NEWBORN DUE TO UNSPECIFIED STREPTOCOCCI

T17418A

GASTRIC CONTENTS IN TRACHEA CAUSING OTH INJURY INIT ENCNTR

P3619 SEPSIS OF NEWBORN DUE TO OTHER STREPTOCOCCI

T17420A

FOOD IN TRACHEA CAUSING ASPHYXIATION INITIAL ENCOUNTER

P362 SEPSIS OF NEWBORN DUE TO STAPHYLOCOCCUS AUREUS

T17428A

FOOD IN TRACHEA CAUSING OTHER INJURY INITIAL ENCOUNTER

P3630 SEPSIS OF NEWBORN DUE TO UNSPECIFIED STAPHYLOCOCCI

T17490A

OTH FOREIGN OBJECT IN TRACHEA CAUSING ASPHYXIATION INIT

P3639 SEPSIS OF NEWBORN DUE TO OTHER STAPHYLOCOCCI

T17498A

OTH FOREIGN OBJECT IN TRACHEA CAUSING OTH INJURY INIT

P364 SEPSIS OF NEWBORN DUE TO ESCHERICHIA COLI

T17500A

UNSP FOREIGN BODY IN BRONCHUS CAUSING ASPHYXIATION INIT

P365 SEPSIS OF NEWBORN DUE TO ANAEROBES

T17508A

UNSP FOREIGN BODY IN BRONCHUS CAUSING OTH INJURY INIT

P368 OTHER BACTERIAL SEPSIS OF NEWBORN

T17510A

GASTRIC CONTENTS IN BRONCHUS CAUSING ASPHYXIATION INIT

P369 BACTERIAL SEPSIS OF NEWBORN UNSPECIFIED

T17518A

GASTRIC CONTENTS IN BRONCHUS CAUSING OTH INJURY INIT ENCNTR

P370 CONGENITAL TUBERCULOSIS

T17520A FOOD IN BRONCHUS CAUSING ASPHYXIATION INITIAL ENCOUNTER

P371 CONGENITAL TOXOPLASMOSIS

T17528A FOOD IN BRONCHUS CAUSING OTHER INJURY INITIAL ENCOUNTER

P372 NEONATAL (DISSEMINATED) LISTERIOSIS

T17590A

OTH FOREIGN OBJECT IN BRONCHUS CAUSING ASPHYXIATION INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P373 CONGENITAL FALCIPARUM MALARIA

T17598A

OTH FOREIGN OBJECT IN BRONCHUS CAUSING OTH INJURY INIT

P374 OTHER CONGENITAL MALARIA

T17800A UNSP FOREIGN BODY IN OTH PRT RESP TRACT CAUSING ASPHYX INIT

P375 NEONATAL CANDIDIASIS

T17808A UNSP FB IN OTH PRT RESP TRACT CAUSING OTH INJURY INIT

P378

OTHER SPECIFIED CONGENITAL INFECTIOUS AND PARASITIC DISEASES

T17810A

GASTRIC CONTENTS IN OTH PRT RESP TRACT CAUSING ASPHYX INIT

P379

CONGENITAL INFECTIOUS OR PARASITIC DISEASE UNSPECIFIED

T17818A

GASTR CONTENTS IN OTH PRT RESP TRACT CAUSE OTH INJURY INIT

P381 OMPHALITIS WITH MILD HEMORRHAGE

T17820A

FOOD IN OTH PRT RESPIRATORY TRACT CAUSING ASPHYXIATION INIT

P389 OMPHALITIS WITHOUT HEMORRHAGE

T17828A

FOOD IN OTH PRT RESPIRATORY TRACT CAUSING OTH INJURY INIT

P390 NEONATAL INFECTIVE MASTITIS

T17890A OTH FOREIGN OBJECT IN OTH PRT RESP TRACT CAUSE ASPHYX INIT

P391 NEONATAL CONJUNCTIVITIS AND DACRYOCYSTITIS

T17898A

OTH FORN OBJECT IN OTH PRT RESP TRACT CAUSE OTH INJURY INIT

P392 INTRA-AMNIOTIC INFECTION AFFECTING NEWBORN NEC

T17900A

UNSP FB IN RESP TRACT PART UNSP CAUSING ASPHYX INIT

P393 NEONATAL URINARY TRACT INFECTION

T17908A

UNSP FB IN RESP TRACT PART UNSP CAUSING OTH INJURY INIT

P394 NEONATAL SKIN INFECTION

T17910A GASTRIC CONTENTS IN RESP TRACT PART UNSP CAUSE ASPHYX INIT

P398

OTHER SPECIFIED INFECTIONS SPECIFIC TO THE PERINATAL PERIOD

T17918A

GASTR CONTENTS IN RESP TRACT PART UNSP CAUSE OTH INJ INIT

P399

INFECTION SPECIFIC TO THE PERINATAL PERIOD UNSPECIFIED

T17920A

FOOD IN RESP TRACT PART UNSP CAUSING ASPHYXIATION INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P500

NEWBORN AFF BY UTERIN (FETAL) BLOOD LOSS FROM VASA PREVIA

T17928A

FOOD IN RESP TRACT PART UNSP CAUSING OTH INJURY INIT

P501

NEWBORN AFF BY UTERIN (FETAL) BLOOD LOSS FROM RUPTURED CORD

T17990A

OTH FORN OBJ IN RESP TRACT PART UNSP IN CAUSE ASPHYX INIT

P502

NEWBORN AFFECTED BY UTERIN (FETAL) BLOOD LOSS FROM PLACENTA

T17998A

OTH FORN OBJECT IN RESP TRACT PART UNSP CAUSE OTH INJ INIT

P503 NEWBORN AFFECTED BY HEMORRHAGE INTO CO-TWIN

T180XXA

FOREIGN BODY IN MOUTH INITIAL ENCOUNTER

P504

NEWBORN AFFECTED BY HEMORRHAGE INTO MATERNAL CIRCULATION

T18100A

UNSP FB IN ESOPHAGUS CAUSING COMPRESSION OF TRACHEA INIT

P505

NB AFF BY UTERIN BLOOD LOSS FROM CUT END OF CO-TWIN'S CORD

T18108A

UNSP FOREIGN BODY IN ESOPHAGUS CAUSING OTH INJURY INIT

P508

NEWBORN AFFECTED BY OTHER INTRAUTERINE (FETAL) BLOOD LOSS

T18110A

GASTRIC CONTENTS IN ESOPH CAUSING COMPRSN OF TRACHEA INIT

P509

NEWBORN AFFECTED BY INTRAUTERINE (FETAL) BLOOD LOSS UNSP

T18118A

GASTRIC CONTENTS IN ESOPHAGUS CAUSING OTH INJURY INIT

P510 MASSIVE UMBILICAL HEMORRHAGE OF NEWBORN

T18120A

FOOD IN ESOPHAGUS CAUSING COMPRESSION OF TRACHEA INIT

P518 OTHER UMBILICAL HEMORRHAGES OF NEWBORN

T18128A

FOOD IN ESOPHAGUS CAUSING OTHER INJURY INITIAL ENCOUNTER

P519 UMBILICAL HEMORRHAGE OF NEWBORN UNSPECIFIED

T18190A

OTH FOREIGN OBJECT IN ESOPH CAUSING COMPRSN OF TRACHEA INIT

P520

INTRAVENTRICULAR HEMORRHAGE GRADE 1 OF NEWBORN

T18198A

OTH FOREIGN OBJECT IN ESOPHAGUS CAUSING OTH INJURY INIT

P521

INTRAVENTRICULAR HEMORRHAGE GRADE 2 OF NEWBORN

T182XXA

FOREIGN BODY IN STOMACH INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P5221

INTRAVENTRICULAR HEMORRHAGE GRADE 3 OF NEWBORN

T183XXA

FOREIGN BODY IN SMALL INTESTINE INITIAL ENCOUNTER

P5222

INTRAVENTRICULAR HEMORRHAGE GRADE 4 OF NEWBORN

T184XXA

FOREIGN BODY IN COLON INITIAL ENCOUNTER

P523

UNSP INTRAVENTRICULAR (NONTRAUMATIC) HEMORRHAGE OF NEWBORN

T185XXA

FOREIGN BODY IN ANUS AND RECTUM INITIAL ENCOUNTER

P524

INTRACEREBRAL (NONTRAUMATIC) HEMORRHAGE OF NEWBORN

T188XXA

FOREIGN BODY IN OTHER PARTS OF ALIMENTARY TRACT INIT ENCNTR

P525

SUBARACHNOID (NONTRAUMATIC) HEMORRHAGE OF NEWBORN

T189XXA

FOREIGN BODY OF ALIMENTARY TRACT PART UNSP INIT ENCNTR

P526

CEREBELLAR AND POSTERIOR FOSSA HEMORRHAGE OF NEWBORN

T190XXA

FOREIGN BODY IN URETHRA INITIAL ENCOUNTER

P528

OTHER INTRACRANIAL (NONTRAUMATIC) HEMORRHAGES OF NEWBORN

T191XXA

FOREIGN BODY IN BLADDER INITIAL ENCOUNTER

P529

INTRACRANIAL (NONTRAUMATIC) HEMORRHAGE OF NEWBORN UNSP

T192XXA

FOREIGN BODY IN VULVA AND VAGINA INITIAL ENCOUNTER

P53 HEMORRHAGIC DISEASE OF NEWBORN

T193XXA

FOREIGN BODY IN UTERUS INITIAL ENCOUNTER

P540 NEONATAL HEMATEMESIS

T194XXA FOREIGN BODY IN PENIS INITIAL ENCOUNTER

P541 NEONATAL MELENA

T198XXA FOREIGN BODY IN OTH PRT GENITOURINARY TRACT INIT ENCNTR

P542 NEONATAL RECTAL HEMORRHAGE

T199XXA

FOREIGN BODY IN GENITOURINARY TRACT PART UNSP INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P543

OTHER NEONATAL GASTROINTESTINAL HEMORRHAGE

T2020XA

BURN SECOND DEGREE OF HEAD FACE AND NECK UNSP SITE INIT

P544 NEONATAL ADRENAL HEMORRHAGE

T20211A

BURN OF SECOND DEGREE OF RIGHT EAR INITIAL ENCOUNTER

P545 NEONATAL CUTANEOUS HEMORRHAGE

T20212A

BURN OF SECOND DEGREE OF LEFT EAR INITIAL ENCOUNTER

P546 NEONATAL VAGINAL HEMORRHAGE

T20219A

BURN OF SECOND DEGREE OF UNSPECIFIED EAR INITIAL ENCOUNTER

P548 OTHER SPECIFIED NEONATAL HEMORRHAGES

T2022XA

BURN OF SECOND DEGREE OF LIP(S) INITIAL ENCOUNTER

P549 NEONATAL HEMORRHAGE UNSPECIFIED

T2023XA

BURN OF SECOND DEGREE OF CHIN INITIAL ENCOUNTER

P550 RH ISOIMMUNIZATION OF NEWBORN

T2024XA

BURN OF SECOND DEGREE OF NOSE (SEPTUM) INITIAL ENCOUNTER

P551 ABO ISOIMMUNIZATION OF NEWBORN

T2025XA

BURN OF SECOND DEGREE OF SCALP [ANY PART] INITIAL ENCOUNTER

P558 OTHER HEMOLYTIC DISEASES OF NEWBORN

T2026XA

BURN OF SECOND DEGREE OF FOREHEAD AND CHEEK INIT ENCNTR

P559 HEMOLYTIC DISEASE OF NEWBORN UNSPECIFIED

T2027XA

BURN OF SECOND DEGREE OF NECK INITIAL ENCOUNTER

P560 HYDROPS FETALIS DUE TO ISOIMMUNIZATION

T2029XA

BURN OF 2ND DEG MUL SITES OF HEAD FACE AND NECK INIT

P5690

HYDROPS FETALIS DUE TO UNSPECIFIED HEMOLYTIC DISEASE

T2030XA

BURN THIRD DEGREE OF HEAD FACE AND NECK UNSP SITE INIT

P5699 HYDROPS FETALIS DUE TO OTHER HEMOLYTIC DISEASE

T20311A

BURN OF THIRD DEGREE OF RIGHT EAR INITIAL ENCOUNTER

P570 KERNICTERUS DUE TO ISOIMMUNIZATION

T20312A

BURN OF THIRD DEGREE OF LEFT EAR INITIAL ENCOUNTER

P578 OTHER SPECIFIED KERNICTERUS

T20319A BURN OF THIRD DEGREE OF UNSPECIFIED EAR INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P579 KERNICTERUS UNSPECIFIED

T2032XA BURN OF THIRD DEGREE OF LIP(S) INITIAL ENCOUNTER

P580 NEONATAL JAUNDICE DUE TO BRUISING

T2033XA

BURN OF THIRD DEGREE OF CHIN INITIAL ENCOUNTER

P581 NEONATAL JAUNDICE DUE TO BLEEDING

T2034XA

BURN OF THIRD DEGREE OF NOSE (SEPTUM) INITIAL ENCOUNTER

P582 NEONATAL JAUNDICE DUE TO INFECTION

T2035XA

BURN OF THIRD DEGREE OF SCALP [ANY PART] INITIAL ENCOUNTER

P583 NEONATAL JAUNDICE DUE TO POLYCYTHEMIA

T2036XA

BURN OF THIRD DEGREE OF FOREHEAD AND CHEEK INIT ENCNTR

P5841

NB JAUND DUE TO DRUGS OR TOXINS TRANSMITTED FROM MOTHER

T2037XA

BURN OF THIRD DEGREE OF NECK INITIAL ENCOUNTER

P5842

NEONATAL JAUNDICE DUE TO DRUGS OR TOXINS GIVEN TO NEWBORN

T2039XA

BURN OF 3RD DEG MU SITES OF HEAD FACE AND NECK INIT

P585

NEONATAL JAUNDICE DUE TO SWALLOWED MATERNAL BLOOD

T2060XA

CORROS SECOND DEG OF HEAD FACE AND NECK UNSP SITE INIT

P588

NEONATAL JAUNDICE DUE TO OTHER SPECIFIED EXCESSIVE HEMOLYSIS

T20611A

CORROSION OF SECOND DEGREE OF RIGHT EAR INITIAL ENCOUNTER

P589

NEONATAL JAUNDICE DUE TO EXCESSIVE HEMOLYSIS UNSPECIFIED

T20612A

CORROSION OF SECOND DEGREE OF LEFT EAR INITIAL ENCOUNTER

P590

NEONATAL JAUNDICE ASSOCIATED WITH PRETERM DELIVERY

T20619A

CORROSION OF SECOND DEGREE OF UNSPECIFIED EAR INIT ENCNTR

P591 INSPISSATED BILE SYNDROME

T2062XA CORROSION OF SECOND DEGREE OF LIP(S) INITIAL ENCOUNTER

P5920

NEONATAL JAUNDICE FROM UNSPECIFIED HEPATOCELLULAR DAMAGE

T2063XA

CORROSION OF SECOND DEGREE OF CHIN INITIAL ENCOUNTER

P5929

NEONATAL JAUNDICE FROM OTHER HEPATOCELLULAR DAMAGE

T2064XA

CORROSION OF SECOND DEGREE OF NOSE (SEPTUM) INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P593 NEONATAL JAUNDICE FROM BREAST MILK INHIBITOR

T2065XA

CORROSION OF SECOND DEGREE OF SCALP INITIAL ENCOUNTER

P598 NEONATAL JAUNDICE FROM OTHER SPECIFIED CAUSES

T2066XA

CORROSION OF SECOND DEGREE OF FOREHEAD AND CHEEK INIT

P599 NEONATAL JAUNDICE UNSPECIFIED

T2067XA

CORROSION OF SECOND DEGREE OF NECK INITIAL ENCOUNTER

P60

DISSEMINATED INTRAVASCULAR COAGULATION OF NEWBORN

T2069XA

CORROSION OF 2ND DEG MUL SITES OF HEAD FACE AND NECK INIT

P610 TRANSIENT NEONATAL THROMBOCYTOPENIA

T2070XA

CORROS THIRD DEGREE OF HEAD FACE AND NECK UNSP SITE INIT

P611 POLYCYTHEMIA NEONATORUM

T20711A CORROSION OF THIRD DEGREE OF RIGHT EAR INITIAL ENCOUNTER

P612 ANEMIA OF PREMATURITY

T20712A CORROSION OF THIRD DEGREE OF LEFT EAR INITIAL ENCOUNTER

P613 CONGENITAL ANEMIA FROM FETAL BLOOD LOSS

T20719A

CORROSION OF THIRD DEGREE OF UNSPECIFIED EAR INIT ENCNTR

P614 OTHER CONGENITAL ANEMIAS NOT ELSEWHERE CLASSIFIED

T2072XA

CORROSION OF THIRD DEGREE OF LIP(S) INITIAL ENCOUNTER

P615 TRANSIENT NEONATAL NEUTROPENIA

T2073XA

CORROSION OF THIRD DEGREE OF CHIN INITIAL ENCOUNTER

P616 OTHER TRANSIENT NEONATAL DISORDERS OF COAGULATION

T2074XA

CORROSION OF THIRD DEGREE OF NOSE (SEPTUM) INIT ENCNTR

P618 OTHER SPECIFIED PERINATAL HEMATOLOGICAL DISORDERS

T2075XA

CORROSION OF THIRD DEGREE OF SCALP INITIAL ENCOUNTER

P619 PERINATAL HEMATOLOGICAL DISORDER UNSPECIFIED

T2076XA

CORROSION OF THIRD DEGREE OF FOREHEAD AND CHEEK INIT ENCNTR

P700

SYNDROME OF INFANT OF MOTHER WITH GESTATIONAL DIABETES

T2077XA

CORROSION OF THIRD DEGREE OF NECK INITIAL ENCOUNTER

P701 SYNDROME OF INFANT OF A DIABETIC MOTHER

T2079XA

CORROSION OF 3RD DEG MU SITES OF HEAD FACE AND NECK INIT

P702 NEONATAL DIABETES MELLITUS

T2120XA BURN OF SECOND DEGREE OF TRUNK UNSP SITE INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P703 IATROGENIC NEONATAL HYPOGLYCEMIA

T2121XA

BURN OF SECOND DEGREE OF CHEST WALL INITIAL ENCOUNTER

P704 OTHER NEONATAL HYPOGLYCEMIA

T2122XA

BURN OF SECOND DEGREE OF ABDOMINAL WALL INITIAL ENCOUNTER

P708

OTH TRANSITORY DISORDERS OF CARBOHYDRATE METAB OF NEWBORN

T2123XA

BURN OF SECOND DEGREE OF UPPER BACK INITIAL ENCOUNTER

P709

TRANSITORY DISORDER OF CARBOHYDRATE METAB OF NEWBORN UNSP

T2124XA

BURN OF SECOND DEGREE OF LOWER BACK INITIAL ENCOUNTER

P710 COW'S MILK HYPOCALCEMIA IN NEWBORN

T2125XA

BURN OF SECOND DEGREE OF BUTTOCK INITIAL ENCOUNTER

P711 OTHER NEONATAL HYPOCALCEMIA

T2126XA

BURN OF SECOND DEGREE OF MALE GENITAL REGION INIT ENCNTR

P712 NEONATAL HYPOMAGNESEMIA

T2127XA BURN OF SECOND DEGREE OF FEMALE GENITAL REGION INIT ENCNTR

P713

NEONATAL TETANY WITHOUT CALCIUM OR MAGNESIUM DEFICIENCY

T2129XA

BURN OF SECOND DEGREE OF OTHER SITE OF TRUNK INIT ENCNTR

P714 TRANSITORY NEONATAL HYPOPARATHYROIDISM

T2130XA

BURN OF THIRD DEGREE OF TRUNK UNSPECIFIED SITE INIT ENCNTR

P718

OTH TRANSITORY NEONATAL DISORD OF CALCIUM & MAGNESIUM METAB

T2131XA

BURN OF THIRD DEGREE OF CHEST WALL INITIAL ENCOUNTER

P719

TRANSITORY NEONATAL DISORD OF CALCIUM & MAGNESIUM METABUNSP

T2132XA

BURN OF THIRD DEGREE OF ABDOMINAL WALL INITIAL ENCOUNTER

P720 NEONATAL GOITER NOT ELSEWHERE CLASSIFIED

T2133XA

BURN OF THIRD DEGREE OF UPPER BACK INITIAL ENCOUNTER

P721 TRANSITORY NEONATAL HYPERTHYROIDISM

T2134XA

BURN OF THIRD DEGREE OF LOWER BACK INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P722

OTH TRANSITORY NEONATAL DISORDERS OF THYROID FUNCTION NEC

T2135XA

BURN OF THIRD DEGREE OF BUTTOCK INITIAL ENCOUNTER

P728

OTHER SPECIFIED TRANSITORY NEONATAL ENDOCRINE DISORDERS

T2136XA

BURN OF THIRD DEGREE OF MALE GENITAL REGION INIT ENCNTR

P729

TRANSITORY NEONATAL ENDOCRINE DISORDER UNSPECIFIED

T2137XA

BURN OF THIRD DEGREE OF FEMALE GENITAL REGION INIT ENCNTR

P740 LATE METABOLIC ACIDOSIS OF NEWBORN

T2139XA

BURN OF THIRD DEGREE OF OTHER SITE OF TRUNK INIT ENCNTR

P741 DEHYDRATION OF NEWBORN

T2160XA CORROSION OF SECOND DEGREE OF TRUNK UNSP SITE INIT ENCNTR

P742 DISTURBANCES OF SODIUM BALANCE OF NEWBORN

T2161XA

CORROSION OF SECOND DEGREE OF CHEST WALL INITIAL ENCOUNTER

P743 DISTURBANCES OF POTASSIUM BALANCE OF NEWBORN

T2162XA

CORROSION OF SECOND DEGREE OF ABDOMINAL WALL INIT ENCNTR

P744

OTHER TRANSITORY ELECTROLYTE DISTURBANCES OF NEWBORN

T2163XA

CORROSION OF SECOND DEGREE OF UPPER BACK INITIAL ENCOUNTER

P745 TRANSITORY TYROSINEMIA OF NEWBORN

T2164XA

CORROSION OF SECOND DEGREE OF LOWER BACK INITIAL ENCOUNTER

P746

TRANSITORY HYPERAMMONEMIA OF NEWBORN

T2165XA

CORROSION OF SECOND DEGREE OF BUTTOCK INITIAL ENCOUNTER

P748

OTHER TRANSITORY METABOLIC DISTURBANCES OF NEWBORN

T2166XA

CORROSION OF SECOND DEGREE OF MALE GENITAL REGION INIT

P749

TRANSITORY METABOLIC DISTURBANCE OF NEWBORN UNSPECIFIED

T2167XA

CORROSION OF SECOND DEGREE OF FEMALE GENITAL REGION INIT

P760 MECONIUM PLUG SYNDROME

T2169XA CORROSION OF SECOND DEGREE OF OTH SITE OF TRUNK INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P761 TRANSITORY ILEUS OF NEWBORN

T2170XA

CORROSION OF THIRD DEGREE OF TRUNK UNSP SITE INIT ENCNTR

P762 INTESTINAL OBSTRUCTION DUE TO INSPISSATED MILK

T2171XA

CORROSION OF THIRD DEGREE OF CHEST WALL INITIAL ENCOUNTER

P768 OTHER SPECIFIED INTESTINAL OBSTRUCTION OF NEWBORN

T2172XA

CORROSION OF THIRD DEGREE OF ABDOMINAL WALL INIT ENCNTR

P769 INTESTINAL OBSTRUCTION OF NEWBORN UNSPECIFIED

T2173XA

CORROSION OF THIRD DEGREE OF UPPER BACK INITIAL ENCOUNTER

P771 STAGE 1 NECROTIZING ENTEROCOLITIS IN NEWBORN

T2174XA

CORROSION OF THIRD DEGREE OF LOWER BACK INITIAL ENCOUNTER

P772 STAGE 2 NECROTIZING ENTEROCOLITIS IN NEWBORN

T2175XA

CORROSION OF THIRD DEGREE OF BUTTOCK INITIAL ENCOUNTER

P773 STAGE 3 NECROTIZING ENTEROCOLITIS IN NEWBORN

T2176XA

CORROSION OF THIRD DEGREE OF MALE GENITAL REGION INIT

P779 NECROTIZING ENTEROCOLITIS IN NEWBORN UNSPECIFIED

T2177XA

CORROSION OF THIRD DEGREE OF FEMALE GENITAL REGION INIT

P780 PERINATAL INTESTINAL PERFORATION

T2179XA

CORROSION OF THIRD DEGREE OF OTH SITE OF TRUNK INIT ENCNTR

P781 OTHER NEONATAL PERITONITIS

T2220XA BURN SECOND DEG OF SHLDR/UP LMB EX WRS/HND UNSP SITE INIT

P782

NEONATAL HEMATEMESIS AND MELENA D/T SWALLOWED MATERN BLOOD

T22211A

BURN OF SECOND DEGREE OF RIGHT FOREARM INITIAL ENCOUNTER

P783 NONINFECTIVE NEONATAL DIARRHEA

T22212A

BURN OF SECOND DEGREE OF LEFT FOREARM INITIAL ENCOUNTER

P7881 CONGENITAL CIRRHOSIS (OF LIVER)

T22219A

BURN OF SECOND DEGREE OF UNSPECIFIED FOREARM INIT ENCNTR

P7882 PEPTIC ULCER OF NEWBORN

T22221A BURN OF SECOND DEGREE OF RIGHT ELBOW INITIAL ENCOUNTER

P7883 NEWBORN ESOPHAGEAL REFLUX

T22222A

BURN OF SECOND DEGREE OF LEFT ELBOW INITIAL ENCOUNTER

P7889 OTHER SPECIFIED PERINATAL DIGESTIVE SYSTEM DISORDERS

T22229A

BURN OF SECOND DEGREE OF UNSPECIFIED ELBOW INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P789 PERINATAL DIGESTIVE SYSTEM DISORDER UNSPECIFIED

T22231A

BURN OF SECOND DEGREE OF RIGHT UPPER ARM INITIAL ENCOUNTER

P800 COLD INJURY SYNDROME

T22232A BURN OF SECOND DEGREE OF LEFT UPPER ARM INITIAL ENCOUNTER

P808 OTHER HYPOTHERMIA OF NEWBORN

T22239A

BURN OF SECOND DEGREE OF UNSPECIFIED UPPER ARM INIT ENCNTR

P809 HYPOTHERMIA OF NEWBORN UNSPECIFIED

T22241A

BURN OF SECOND DEGREE OF RIGHT AXILLA INITIAL ENCOUNTER

P810 ENVIRONMENTAL HYPERTHERMIA OF NEWBORN

T22242A

BURN OF SECOND DEGREE OF LEFT AXILLA INITIAL ENCOUNTER

P818

OTH DISTURBANCES OF TEMPERATURE REGULATION OF NEWBORN

T22249A

BURN OF SECOND DEGREE OF UNSPECIFIED AXILLA INIT ENCNTR

P819

DISTURBANCE OF TEMPERATURE REGULATION OF NEWBORN UNSP

T22251A

BURN OF SECOND DEGREE OF RIGHT SHOULDER INITIAL ENCOUNTER

P830 SCLEREMA NEONATORUM

T22252A BURN OF SECOND DEGREE OF LEFT SHOULDER INITIAL ENCOUNTER

P831 NEONATAL ERYTHEMA TOXICUM

T22259A

BURN OF SECOND DEGREE OF UNSPECIFIED SHOULDER INIT ENCNTR

P832 HYDROPS FETALIS NOT DUE TO HEMOLYTIC DISEASE

T22261A

BURN OF SECOND DEGREE OF RIGHT SCAPULAR REGION INIT ENCNTR

P8330 UNSPECIFIED EDEMA SPECIFIC TO NEWBORN

T22262A

BURN OF SECOND DEGREE OF LEFT SCAPULAR REGION INIT ENCNTR

P8339 OTHER EDEMA SPECIFIC TO NEWBORN

T22269A

BURN OF SECOND DEGREE OF UNSP SCAPULAR REGION INIT ENCNTR

P834 BREAST ENGORGEMENT OF NEWBORN

T22291A

BURN 2ND DEG MUL SITES OF R SHLDR/UP LMB EX WRS/HND INIT

P835 CONGENITAL HYDROCELE

T22292A BURN 2ND DEG MUL SITE OF LEFT SHLDR/UP LMB EX WRS/HND INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P836 UMBILICAL POLYP OF NEWBORN

T22299A

BURN 2ND DEG MUL SITES OF SHLDR/UP LMB EXCEPT WRS/HND INIT

P838

OTHER SPECIFIED CONDITIONS OF INTEGUMENT SPECIFIC TO NEWBORN

T2230XA

BURN THIRD DEG OF SHLDR/UP LMB EX WRS/HND UNSP SITE INIT

P839

CONDITION OF THE INTEGUMENT SPECIFIC TO NEWBORN UNSPECIFIED

T22311A

BURN OF THIRD DEGREE OF RIGHT FOREARM INITIAL ENCOUNTER

P84 OTHER PROBLEMS WITH NEWBORN

T22312A

BURN OF THIRD DEGREE OF LEFT FOREARM INITIAL ENCOUNTER

P90 CONVULSIONS OF NEWBORN

T22319A BURN OF THIRD DEGREE OF UNSPECIFIED FOREARM INIT ENCNTR

P910 NEONATAL CEREBRAL ISCHEMIA

T22321A

BURN OF THIRD DEGREE OF RIGHT ELBOW INITIAL ENCOUNTER

P911 ACQUIRED PERIVENTRICULAR CYSTS OF NEWBORN

T22322A

BURN OF THIRD DEGREE OF LEFT ELBOW INITIAL ENCOUNTER

P912 NEONATAL CEREBRAL LEUKOMALACIA

T22329A

BURN OF THIRD DEGREE OF UNSPECIFIED ELBOW INITIAL ENCOUNTER

P913 NEONATAL CEREBRAL IRRITABILITY

T22331A

BURN OF THIRD DEGREE OF RIGHT UPPER ARM INITIAL ENCOUNTER

P914 NEONATAL CEREBRAL DEPRESSION

T22332A

BURN OF THIRD DEGREE OF LEFT UPPER ARM INITIAL ENCOUNTER

P915 NEONATAL COMA

T22339A

BURN OF THIRD DEGREE OF UNSPECIFIED UPPER ARM INIT ENCNTR

P9160

HYPOXIC ISCHEMIC ENCEPHALOPATHY [HIE] UNSPECIFIED

T22341A

BURN OF THIRD DEGREE OF RIGHT AXILLA INITIAL ENCOUNTER

P9161 MILD HYPOXIC ISCHEMIC ENCEPHALOPATHY [HIE]

T22342A

BURN OF THIRD DEGREE OF LEFT AXILLA INITIAL ENCOUNTER

P9162 MODERATE HYPOXIC ISCHEMIC ENCEPHALOPATHY [HIE]

T22349A

BURN OF THIRD DEGREE OF UNSPECIFIED AXILLA INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P9163 SEVERE HYPOXIC ISCHEMIC ENCEPHALOPATHY [HIE]

T22351A

BURN OF THIRD DEGREE OF RIGHT SHOULDER INITIAL ENCOUNTER

P918

OTHER SPECIFIED DISTURBANCES OF CEREBRAL STATUS OF NEWBORN

T22352A

BURN OF THIRD DEGREE OF LEFT SHOULDER INITIAL ENCOUNTER

P919

DISTURBANCE OF CEREBRAL STATUS OF NEWBORN UNSPECIFIED

T22359A

BURN OF THIRD DEGREE OF UNSPECIFIED SHOULDER INIT ENCNTR

P9201 BILIOUS VOMITING OF NEWBORN

T22361A

BURN OF THIRD DEGREE OF RIGHT SCAPULAR REGION INIT ENCNTR

P9209 OTHER VOMITING OF NEWBORN

T22362A

BURN OF THIRD DEGREE OF LEFT SCAPULAR REGION INIT ENCNTR

P921 REGURGITATION AND RUMINATION OF NEWBORN

T22369A

BURN OF THIRD DEGREE OF UNSP SCAPULAR REGION INIT ENCNTR

P922 SLOW FEEDING OF NEWBORN

T22391A BURN 3RD DEG MU SITES OF R SHLDR/UP LMB EX WRS/HND INIT

P923 UNDERFEEDING OF NEWBORN

T22392A BURN 3RD DEG MU SITES OF LEFT SHLDR/UP LMB EX WRS/HND INIT

P924 OVERFEEDING OF NEWBORN

T22399A BURN 3RD DEG MU SITES OF SHLDR/UP LMB EXCEPT WRS/HND INIT

P925 NEONATAL DIFFICULTY IN FEEDING AT BREAST

T2260XA

CORROS 2ND DEG OF SHLDR/UP LMB EX WRS/HND UNSP SITE INIT

P926 FAILURE TO THRIVE IN NEWBORN

T22611A

CORROSION OF SECOND DEGREE OF RIGHT FOREARM INIT ENCNTR

P928 OTHER FEEDING PROBLEMS OF NEWBORN

T22612A

CORROSION OF SECOND DEGREE OF LEFT FOREARM INIT ENCNTR

P929 FEEDING PROBLEM OF NEWBORN UNSPECIFIED

T22619A

CORROSION OF SECOND DEGREE OF UNSP FOREARM INIT ENCNTR

P930 GREY BABY SYNDROME

T22621A CORROSION OF SECOND DEGREE OF RIGHT ELBOW INITIAL ENCOUNTER

P938

OTH REACTIONS AND INTOXICATIONS D/T DRUGS ADMINISTERED TO NB

T22622A

CORROSION OF SECOND DEGREE OF LEFT ELBOW INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P940 TRANSIENT NEONATAL MYASTHENIA GRAVIS

T22629A

CORROSION OF SECOND DEGREE OF UNSPECIFIED ELBOW INIT ENCNTR

P941 CONGENITAL HYPERTONIA

T22631A CORROSION OF SECOND DEGREE OF RIGHT UPPER ARM INIT ENCNTR

P942 CONGENITAL HYPOTONIA

T22632A CORROSION OF SECOND DEGREE OF LEFT UPPER ARM INIT ENCNTR

P948 OTHER DISORDERS OF MUSCLE TONE OF NEWBORN

T22639A

CORROSION OF SECOND DEGREE OF UNSP UPPER ARM INIT ENCNTR

P949 DISORDER OF MUSCLE TONE OF NEWBORN UNSPECIFIED

T22641A

CORROSION OF SECOND DEGREE OF RIGHT AXILLA INIT ENCNTR

P95 STILLBIRTH

T22642A CORROSION OF SECOND DEGREE OF LEFT AXILLA INITIAL ENCOUNTER

P960 CONGENITAL RENAL FAILURE

T22649A CORROSION OF SECOND DEGREE OF UNSP AXILLA INIT ENCNTR

P961

NEONATAL W/DRAWAL SYMP FROM MATERN USE OF DRUGS OF ADDICTION

T22651A

CORROSION OF SECOND DEGREE OF RIGHT SHOULDER INIT ENCNTR

P962

WITHDRAWAL SYMPTOMS FROM THERAPEUTIC USE OF DRUGS IN NEWBORN

T22652A

CORROSION OF SECOND DEGREE OF LEFT SHOULDER INIT ENCNTR

P963 WIDE CRANIAL SUTURES OF NEWBORN

T22659A

CORROSION OF SECOND DEGREE OF UNSP SHOULDER INIT ENCNTR

P965

COMP TO NEWBORN DUE TO (FETAL) INTRAUTERINE PROCEDURE

T22661A

CORROSION OF SECOND DEGREE OF RIGHT SCAPULAR REGION INIT

P9681

EXPSR TO (ENVIRONMENTAL) TOBACCO SMOKE IN THE PERINAT PERIOD

T22662A

CORROSION OF SECOND DEGREE OF LEFT SCAPULAR REGION INIT

P9682 DELAYED SEPARATION OF UMBILICAL CORD

T22669A

CORROSION OF SECOND DEGREE OF UNSP SCAPULAR REGION INIT

P9683 MECONIUM STAINING

T22691A CORROS 2ND DEG MUL SITES OF R SHLDR/UP LMB EX WRS/HND INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P9689 OTH CONDITIONS ORIGINATING IN THE PERINATAL PERIOD

T22692A

CORROS 2ND DEG MUL SITE OF L SHLDR/UP LMB EX WRS/HND INIT

P969

CONDITION ORIGINATING IN THE PERINATAL PERIOD UNSPECIFIED

T22699A

CORROS 2ND DEG MUL SITES OF SHLDR/UP LMB EX WRS/HND INIT

Q000 ANENCEPHALY

T2270XA CORROS 3RD DEG OF SHLDR/UP LMB EX WRS/HND UNSP SITE INIT

Q001 CRANIORACHISCHISIS

T22711A CORROSION OF THIRD DEGREE OF RIGHT FOREARM INIT ENCNTR

Q002 INIENCEPHALY

T22712A CORROSION OF THIRD DEGREE OF LEFT FOREARM INITIAL ENCOUNTER

Q010 FRONTAL ENCEPHALOCELE

T22719A CORROSION OF THIRD DEGREE OF UNSP FOREARM INIT ENCNTR

Q011 NASOFRONTAL ENCEPHALOCELE

T22721A

CORROSION OF THIRD DEGREE OF RIGHT ELBOW INITIAL ENCOUNTER

Q012 OCCIPITAL ENCEPHALOCELE

T22722A CORROSION OF THIRD DEGREE OF LEFT ELBOW INITIAL ENCOUNTER

Q018 ENCEPHALOCELE OF OTHER SITES

T22729A

CORROSION OF THIRD DEGREE OF UNSPECIFIED ELBOW INIT ENCNTR

Q019 ENCEPHALOCELE UNSPECIFIED

T22731A CORROSION OF THIRD DEGREE OF RIGHT UPPER ARM INIT ENCNTR

Q02 MICROCEPHALY

T22732A CORROSION OF THIRD DEGREE OF LEFT UPPER ARM INIT ENCNTR

Q030 MALFORMATIONS OF AQUEDUCT OF SYLVIUS

T22739A

CORROSION OF THIRD DEGREE OF UNSP UPPER ARM INIT ENCNTR

Q031 ATRESIA OF FORAMINA OF MAGENDIE AND LUSCHKA

T22741A

CORROSION OF THIRD DEGREE OF RIGHT AXILLA INITIAL ENCOUNTER

Q038 OTHER CONGENITAL HYDROCEPHALUS

T22742A

CORROSION OF THIRD DEGREE OF LEFT AXILLA INITIAL ENCOUNTER

Q039 CONGENITAL HYDROCEPHALUS UNSPECIFIED

T22749A

CORROSION OF THIRD DEGREE OF UNSPECIFIED AXILLA INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

Q040 CONGENITAL MALFORMATIONS OF CORPUS CALLOSUM

T22751A

CORROSION OF THIRD DEGREE OF RIGHT SHOULDER INIT ENCNTR

Q041 ARHINENCEPHALY

T22752A CORROSION OF THIRD DEGREE OF LEFT SHOULDER INIT ENCNTR

Q042 HOLOPROSENCEPHALY

T22759A CORROSION OF THIRD DEGREE OF UNSP SHOULDER INIT ENCNTR

Q043 OTHER REDUCTION DEFORMITIES OF BRAIN

T22761A

CORROSION OF THIRD DEGREE OF RIGHT SCAPULAR REGION INIT

Q044 SEPTO-OPTIC DYSPLASIA OF BRAIN

T22762A

CORROSION OF THIRD DEGREE OF LEFT SCAPULAR REGION INIT

Q045 MEGALENCEPHALY

T22769A CORROSION OF THIRD DEGREE OF UNSP SCAPULAR REGION INIT

Q046 CONGENITAL CEREBRAL CYSTS

T22791A CORROS 3RD DEG MU SITES OF R SHLDR/UP LMB EX WRS/HND INIT

Q048 OTHER SPECIFIED CONGENITAL MALFORMATIONS OF BRAIN

T22792A

CORROS 3RD DEG MU SITE OF L SHLDR/UP LMB EX WRS/HND INIT

Q049 CONGENITAL MALFORMATION OF BRAIN UNSPECIFIED

T22799A

CORROS 3RD DEG MU SITES OF SHLDR/UP LMB EX WRS/HND INIT

Q050 CERVICAL SPINA BIFIDA WITH HYDROCEPHALUS

T23201A

BURN OF SECOND DEGREE OF RIGHT HAND UNSP SITE INIT ENCNTR

Q051 THORACIC SPINA BIFIDA WITH HYDROCEPHALUS

T23202A

BURN OF SECOND DEGREE OF LEFT HAND UNSP SITE INIT ENCNTR

Q052 LUMBAR SPINA BIFIDA WITH HYDROCEPHALUS

T23209A

BURN OF SECOND DEGREE OF UNSP HAND UNSP SITE INIT ENCNTR

Q053 SACRAL SPINA BIFIDA WITH HYDROCEPHALUS

T23211A

BURN OF SECOND DEGREE OF RIGHT THUMB (NAIL) INIT ENCNTR

Q054 UNSPECIFIED SPINA BIFIDA WITH HYDROCEPHALUS

T23212A

BURN OF SECOND DEGREE OF LEFT THUMB (NAIL) INIT ENCNTR

Q055 CERVICAL SPINA BIFIDA WITHOUT HYDROCEPHALUS

T23219A

BURN OF SECOND DEGREE OF UNSP THUMB (NAIL) INIT ENCNTR

Q056 THORACIC SPINA BIFIDA WITHOUT HYDROCEPHALUS

T23221A

BURN SECOND DEGREE OF SINGLE R FINGER EXCEPT THUMB INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

Q057 LUMBAR SPINA BIFIDA WITHOUT HYDROCEPHALUS

T23222A

BURN SECOND DEGREE OF SINGLE L FINGER EXCEPT THUMB INIT

Q058 SACRAL SPINA BIFIDA WITHOUT HYDROCEPHALUS

T23229A

BURN SECOND DEGREE OF UNSP SINGLE FINGER EXCEPT THUMB INIT

Q059 SPINA BIFIDA UNSPECIFIED

T23231A BURN 2ND DEG MUL RIGHT FINGERS (NAIL) NOT INC THUMB INIT

Q060 AMYELIA

T23232A BURN OF 2ND DEG MUL LEFT FINGERS (NAIL) NOT INC THUMB INIT

Q061 HYPOPLASIA AND DYSPLASIA OF SPINAL CORD

T23239A

BURN SECOND DEGREE OF UNSP MULT FNGR NOT INC THUMB INIT

Q062 DIASTEMATOMYELIA

T23241A BURN OF 2ND DEG MUL RIGHT FINGERS (NAIL) INC THUMB INIT

Q063 OTHER CONGENITAL CAUDA EQUINA MALFORMATIONS

T23242A

BURN OF 2ND DEG MUL LEFT FINGERS (NAIL) INC THUMB INIT

Q064 HYDROMYELIA

T23249A BURN SECOND DEGREE OF UNSP MULT FNGR (NAIL) INC THUMB INIT

Q068

OTHER SPECIFIED CONGENITAL MALFORMATIONS OF SPINAL CORD

T23251A

BURN OF SECOND DEGREE OF RIGHT PALM INITIAL ENCOUNTER

Q069 CONGENITAL MALFORMATION OF SPINAL CORD UNSPECIFIED

T23252A

BURN OF SECOND DEGREE OF LEFT PALM INITIAL ENCOUNTER

Q0700

ARNOLD-CHIARI SYNDROME WITHOUT SPINA BIFIDA OR HYDROCEPHALUS

T23259A

BURN OF SECOND DEGREE OF UNSPECIFIED PALM INITIAL ENCOUNTER

Q0701 ARNOLD-CHIARI SYNDROME WITH SPINA BIFIDA

T23261A

BURN OF SECOND DEGREE OF BACK OF RIGHT HAND INIT ENCNTR

Q0702 ARNOLD-CHIARI SYNDROME WITH HYDROCEPHALUS

T23262A

BURN OF SECOND DEGREE OF BACK OF LEFT HAND INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

Q0703

ARNOLD-CHIARI SYNDROME WITH SPINA BIFIDA AND HYDROCEPHALUS

T23269A

BURN OF SECOND DEGREE OF BACK OF UNSP HAND INIT ENCNTR

Q078

OTHER SPECIFIED CONGENITAL MALFORMATIONS OF NERVOUS SYSTEM

T23271A

BURN OF SECOND DEGREE OF RIGHT WRIST INITIAL ENCOUNTER

Q079

CONGENITAL MALFORMATION OF NERVOUS SYSTEM UNSPECIFIED

T23272A

BURN OF SECOND DEGREE OF LEFT WRIST INITIAL ENCOUNTER

Q100 CONGENITAL PTOSIS

T23279A BURN OF SECOND DEGREE OF UNSPECIFIED WRIST INIT ENCNTR

Q101 CONGENITAL ECTROPION

T23291A BURN OF 2ND DEG MUL SITES OF RIGHT WRIST AND HAND INIT

Q102 CONGENITAL ENTROPION

T23292A BURN OF 2ND DEG MUL SITES OF LEFT WRIST AND HAND INIT

Q103 OTHER CONGENITAL MALFORMATIONS OF EYELID

T23299A

BURN OF 2ND DEG MUL SITES OF UNSP WRIST AND HAND INIT

Q104 ABSENCE AND AGENESIS OF LACRIMAL APPARATUS

T23301A

BURN OF THIRD DEGREE OF RIGHT HAND UNSP SITE INIT ENCNTR

Q105 CONGENITAL STENOSIS AND STRICTURE OF LACRIMAL DUCT

T23302A

BURN OF THIRD DEGREE OF LEFT HAND UNSP SITE INIT ENCNTR

Q106

OTHER CONGENITAL MALFORMATIONS OF LACRIMAL APPARATUS

T23309A

BURN OF THIRD DEGREE OF UNSP HAND UNSP SITE INIT ENCNTR

Q107 CONGENITAL MALFORMATION OF ORBIT

T23311A

BURN OF THIRD DEGREE OF RIGHT THUMB (NAIL) INIT ENCNTR

Q110 CYSTIC EYEBALL

T23312A BURN OF THIRD DEGREE OF LEFT THUMB (NAIL) INITIAL ENCOUNTER

Q111 OTHER ANOPHTHALMOS

T23319A BURN OF THIRD DEGREE OF UNSP THUMB (NAIL) INIT ENCNTR

Q112 MICROPHTHALMOS

T23321A BURN THIRD DEGREE OF SINGLE R FINGER EXCEPT THUMB INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

Q113 MACROPHTHALMOS

T23322A BURN THIRD DEGREE OF SINGLE L FINGER EXCEPT THUMB INIT

Q120 CONGENITAL CATARACT

T23329A BURN THIRD DEGREE OF UNSP SINGLE FINGER EXCEPT THUMB INIT

Q121 CONGENITAL DISPLACED LENS

T23331A BURN OF 3RD DEG MU RIGHT FINGERS (NAIL) NOT INC THUMB INIT

Q122 COLOBOMA OF LENS

T23332A BURN OF 3RD DEG MU LEFT FINGERS (NAIL) NOT INC THUMB INIT

Q123 CONGENITAL APHAKIA

T23339A BURN THIRD DEGREE OF UNSP MULT FNGR NOT INC THUMB INIT

Q124 SPHEROPHAKIA

T23341A BURN OF 3RD DEG MU RIGHT FINGERS (NAIL) INC THUMB INIT

Q128 OTHER CONGENITAL LENS MALFORMATIONS

T23342A

BURN OF 3RD DEG MU LEFT FINGERS (NAIL) INC THUMB INIT

Q129 CONGENITAL LENS MALFORMATION UNSPECIFIED

T23349A

BURN THIRD DEGREE OF UNSP MULT FNGR (NAIL) INC THUMB INIT

Q130 COLOBOMA OF IRIS

T23351A BURN OF THIRD DEGREE OF RIGHT PALM INITIAL ENCOUNTER

Q131 ABSENCE OF IRIS

T23352A BURN OF THIRD DEGREE OF LEFT PALM INITIAL ENCOUNTER

Q132 OTHER CONGENITAL MALFORMATIONS OF IRIS

T23359A

BURN OF THIRD DEGREE OF UNSPECIFIED PALM INITIAL ENCOUNTER

Q133 CONGENITAL CORNEAL OPACITY

T23361A

BURN OF THIRD DEGREE OF BACK OF RIGHT HAND INIT ENCNTR

Q134 OTHER CONGENITAL CORNEAL MALFORMATIONS

T23362A

BURN OF THIRD DEGREE OF BACK OF LEFT HAND INITIAL ENCOUNTER

Q135 BLUE SCLERA

T23369A BURN OF THIRD DEGREE OF BACK OF UNSP HAND INIT ENCNTR

Q1381 RIEGER'S ANOMALY

T23371A BURN OF THIRD DEGREE OF RIGHT WRIST INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

Q2521 Interruption of aortic arch

T23372A BURN OF THIRD DEGREE OF LEFT WRIST INITIAL ENCOUNTER

Q2529 Other atresia of aorta

T23379A

BURN OF THIRD DEGREE OF UNSPECIFIED WRIST INITIAL ENCOUNTER

Q2540 Congenital malformation of aorta unspecified

T23391A

BURN OF 3RD DEG MU SITES OF RIGHT WRIST AND HAND INIT

Q2541 Absence and aplasia of aorta

T23392A BURN OF 3RD DEG MU SITES OF LEFT WRIST AND HAND INIT

Q2542 Hypoplasia of aorta

T23399A BURN OF 3RD DEG MU SITES OF UNSP WRIST AND HAND INIT

Q2543 Congenital aneurysm of aorta

T23601A CORROSION OF SECOND DEGREE OF RIGHT HAND UNSP SITE INIT

Q2544 Congenital dilation of aorta

T23602A CORROSION OF SECOND DEGREE OF LEFT HAND UNSP SITE INIT

Q2545 Double aortic arch

T23609A CORROSION OF SECOND DEGREE OF UNSP HAND UNSP SITE INIT

Q2546 Tortuous aortic arch

T23611A CORROSION OF SECOND DEGREE OF RIGHT THUMB (NAIL) INIT

Q2547 Right aortic arch

T23612A CORROSION OF SECOND DEGREE OF LEFT THUMB (NAIL) INIT ENCNTR

Q2548 Anomalous origin of subclavian artery

T23619A

CORROSION OF SECOND DEGREE OF UNSP THUMB (NAIL) INIT ENCNTR

Q2549 Other congenital malformations of aorta

T23621A

CORROS SECOND DEGREE OF SINGLE R FINGER EXCEPT THUMB INIT

Q822 MASTOCYTOSIS

T23622A CORROS SECOND DEGREE OF SINGLE L FINGER EXCEPT THUMB INIT

Q8740 MARFAN'S SYNDROME UNSPECIFIED

T23629A

CORROS SECOND DEG OF UNSP SINGLE FINGER EXCEPT THUMB INIT

Q87410 MARFAN'S SYNDROME WITH AORTIC DILATION

T23631A

CORROS 2ND DEG MUL RIGHT FINGERS (NAIL) NOT INC THUMB INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

Q87418

MARFAN'S SYNDROME WITH OTHER CARDIOVASCULAR MANIFESTATIONS

T23632A

CORROS 2ND DEG MUL LEFT FINGERS (NAIL) NOT INC THUMB INIT

Q8742 MARFAN'S SYNDROME WITH OCULAR MANIFESTATIONS

T23639A

CORROS SECOND DEGREE OF UNSP MULT FNGR NOT INC THUMB INIT

Q8743 MARFAN'S SYNDROME WITH SKELETAL MANIFESTATION

T23641A

CORROS 2ND DEG MUL RIGHT FINGERS (NAIL) INC THUMB INIT

Q875

OTH CONGENITAL MALFORMATION SYNDROMES W OTH SKELETAL CHANGES

T23642A

CORROS 2ND DEG MUL LEFT FINGERS (NAIL) INC THUMB INIT

Q8782 Arterial tortuosity syndrome

T23649A CORROS SECOND DEGREE OF UNSP MULT FNGR INC THUMB INIT

R000 TACHYCARDIA UNSPECIFIED

T23651A CORROSION OF SECOND DEGREE OF RIGHT PALM INITIAL ENCOUNTER

R001 BRADYCARDIA UNSPECIFIED

T23652A CORROSION OF SECOND DEGREE OF LEFT PALM INITIAL ENCOUNTER

R002 PALPITATIONS

T23659A CORROSION OF SECOND DEGREE OF UNSPECIFIED PALM INIT ENCNTR

R008 OTHER ABNORMALITIES OF HEART BEAT

T23661A

CORROSION OF SECOND DEGREE BACK OF RIGHT HAND INIT ENCNTR

R009 UNSPECIFIED ABNORMALITIES OF HEART BEAT

T23662A

CORROSION OF SECOND DEGREE BACK OF LEFT HAND INIT ENCNTR

R010 BENIGN AND INNOCENT CARDIAC MURMURS

T23669A

CORROSION OF SECOND DEGREE BACK OF UNSP HAND INIT ENCNTR

R011 CARDIAC MURMUR UNSPECIFIED

T23671A

CORROSION OF SECOND DEGREE OF RIGHT WRIST INITIAL ENCOUNTER

R030

ELEVATED BLOOD-PRESSURE READING W/O DIAGNOSIS OF HTN

T23672A

CORROSION OF SECOND DEGREE OF LEFT WRIST INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R031 NONSPECIFIC LOW BLOOD-PRESSURE READING

T23679A

CORROSION OF SECOND DEGREE OF UNSPECIFIED WRIST INIT ENCNTR

R040 EPISTAXIS

T23691A CORROSION OF 2ND DEG MUL SITES OF RIGHT WRIST AND HAND INIT

R041 HEMORRHAGE FROM THROAT

T23692A CORROSION OF 2ND DEG MUL SITES OF LEFT WRIST AND HAND INIT

R042 HEMOPTYSIS

T23699A CORROSION OF 2ND DEG MUL SITES OF UNSP WRIST AND HAND INIT

R0481

ACUTE IDIOPATHIC PULMONARY HEMORRHAGE IN INFANTS

T23701A

CORROSION OF THIRD DEGREE OF RIGHT HAND UNSP SITE INIT

R0489

HEMORRHAGE FROM OTHER SITES IN RESPIRATORY PASSAGES

T23702A

CORROSION OF THIRD DEGREE OF LEFT HAND UNSP SITE INIT

R049

HEMORRHAGE FROM RESPIRATORY PASSAGES UNSPECIFIED

T23709A

CORROSION OF THIRD DEGREE OF UNSP HAND UNSP SITE INIT

R0600 DYSPNEA UNSPECIFIED

T23711A CORROSION OF THIRD DEGREE OF RIGHT THUMB (NAIL) INIT ENCNTR

R0601 ORTHOPNEA

T23712A CORROSION OF THIRD DEGREE OF LEFT THUMB (NAIL) INIT ENCNTR

R0602 SHORTNESS OF BREATH

T23719A CORROSION OF THIRD DEGREE OF UNSP THUMB (NAIL) INIT ENCNTR

R0609 OTHER FORMS OF DYSPNEA

T23721A CORROS THIRD DEGREE OF SINGLE R FINGER EXCEPT THUMB INIT

R061 STRIDOR

T23722A CORROS THIRD DEGREE OF SINGLE L FINGER EXCEPT THUMB INIT

R062 WHEEZING

T23729A CORROS THIRD DEGREE OF UNSP SINGLE FINGER EXCEPT THUMB INIT

R063 PERIODIC BREATHING

T23731A CORROS 3RD DEG MU RIGHT FINGERS (NAIL) NOT INC THUMB INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R071 CHEST PAIN ON BREATHING

T23732A CORROS 3RD DEG MU LEFT FINGERS (NAIL) NOT INC THUMB INIT

R0782 INTERCOSTAL PAIN

T23739A CORROS THIRD DEGREE OF UNSP MULT FNGR NOT INC THUMB INIT

R0789 OTHER CHEST PAIN

T23741A CORROS 3RD DEG MU RIGHT FINGERS (NAIL) INC THUMB INIT

R0901 ASPHYXIA

T23742A CORROS 3RD DEG MU LEFT FINGERS (NAIL) INCLUDING THUMB INIT

R0902 HYPOXEMIA

T23749A CORROS THIRD DEGREE OF UNSP MULT FNGR INC THUMB INIT

R092 RESPIRATORY ARREST

T23751A CORROSION OF THIRD DEGREE OF RIGHT PALM INITIAL ENCOUNTER

R0989

OTH SYMPTOMS AND SIGNS INVOLVING THE CIRC AND RESP SYSTEMS

T23752A

CORROSION OF THIRD DEGREE OF LEFT PALM INITIAL ENCOUNTER

R100 ACUTE ABDOMEN

T23759A CORROSION OF THIRD DEGREE OF UNSPECIFIED PALM INIT ENCNTR

R1114 BILIOUS VOMITING

T23761A CORROSION OF THIRD DEGREE OF BACK OF RIGHT HAND INIT ENCNTR

R130 APHAGIA

T23762A CORROSION OF THIRD DEGREE OF BACK OF LEFT HAND INIT ENCNTR

R1312 DYSPHAGIA OROPHARYNGEAL PHASE

T23769A

CORROSION OF THIRD DEGREE BACK OF UNSP HAND INIT ENCNTR

R1313 DYSPHAGIA PHARYNGEAL PHASE

T23771A

CORROSION OF THIRD DEGREE OF RIGHT WRIST INITIAL ENCOUNTER

R1314 DYSPHAGIA PHARYNGOESOPHAGEAL PHASE

T23772A

CORROSION OF THIRD DEGREE OF LEFT WRIST INITIAL ENCOUNTER

R221 LOCALIZED SWELLING MASS AND LUMP NECK

T23779A

CORROSION OF THIRD DEGREE OF UNSPECIFIED WRIST INIT ENCNTR

R230 CYANOSIS

T23791A CORROSION OF 3RD DEG MU SITES OF RIGHT WRIST AND HAND INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R231 PALLOR

T23792A CORROSION OF 3RD DEG MU SITES OF LEFT WRIST AND HAND INIT

R232 FLUSHING

T23799A CORROSION OF 3RD DEG MU SITES OF UNSP WRIST AND HAND INIT

R233 SPONTANEOUS ECCHYMOSES

T24201A BURN 2ND DEG OF UNSP SITE RIGHT LOWER LIMB EX ANK/FT INIT

R234 CHANGES IN SKIN TEXTURE

T24202A BURN 2ND DEG OF UNSP SITE LEFT LOWER LIMB EX ANK/FT INIT

R238 OTHER SKIN CHANGES

T24209A BURN 2ND DEG OF UNSP SITE UNSP LOWER LIMB EX ANK/FT INIT

R239 UNSPECIFIED SKIN CHANGES

T24211A BURN OF SECOND DEGREE OF RIGHT THIGH INITIAL ENCOUNTER

R250 ABNORMAL HEAD MOVEMENTS

T24212A BURN OF SECOND DEGREE OF LEFT THIGH INITIAL ENCOUNTER

R251 TREMOR UNSPECIFIED

T24219A BURN OF SECOND DEGREE OF UNSPECIFIED THIGH INIT ENCNTR

R290 TETANY

T24221A BURN OF SECOND DEGREE OF RIGHT KNEE INITIAL ENCOUNTER

R291 MENINGISMUS

T24222A BURN OF SECOND DEGREE OF LEFT KNEE INITIAL ENCOUNTER

R295 TRANSIENT PARALYSIS

T24229A

BURN OF SECOND DEGREE OF UNSPECIFIED KNEE INITIAL ENCOUNTER

R29700 NIHSS score 0

T24231A BURN OF SECOND DEGREE OF RIGHT LOWER LEG INITIAL ENCOUNTER

R29701 NIHSS score 1

T24232A BURN OF SECOND DEGREE OF LEFT LOWER LEG INITIAL ENCOUNTER

R29702 NIHSS score 2

T24239A BURN OF SECOND DEGREE OF UNSPECIFIED LOWER LEG INIT ENCNTR

R29703 NIHSS score 3

T24291A BURN 2ND DEG MUL SITES OF RIGHT LOWER LIMB EX ANK/FT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R29704 NIHSS score 4

T24292A BURN 2ND DEG MUL SITES OF LEFT LOWER LIMB EX ANK/FT INIT

R29705 NIHSS score 5

T24299A BURN 2ND DEG MUL SITES OF UNSP LOWER LIMB EX ANK/FT INIT

R29706 NIHSS score 6

T24301A BURN THIRD DEG OF UNSP SITE RIGHT LOW LIMB EX ANK/FT INIT

R29707 NIHSS score 7

T24302A BURN THIRD DEG OF UNSP SITE LEFT LOWER LIMB EX ANK/FT INIT

R29708 NIHSS score 8

T24309A BURN THIRD DEG OF UNSP SITE UNSP LOWER LIMB EX ANK/FT INIT

R29709 NIHSS score 9

T24311A BURN OF THIRD DEGREE OF RIGHT THIGH INITIAL ENCOUNTER

R29710 NIHSS score 10

T24312A BURN OF THIRD DEGREE OF LEFT THIGH INITIAL ENCOUNTER

R29711 NIHSS score 11

T24319A

BURN OF THIRD DEGREE OF UNSPECIFIED THIGH INITIAL ENCOUNTER

R29712 NIHSS score 12

T24321A BURN OF THIRD DEGREE OF RIGHT KNEE INITIAL ENCOUNTER

R29713 NIHSS score 13

T24322A BURN OF THIRD DEGREE OF LEFT KNEE INITIAL ENCOUNTER

R29714 NIHSS score 14

T24329A

BURN OF THIRD DEGREE OF UNSPECIFIED KNEE INITIAL ENCOUNTER

R29715 NIHSS score 15

T24331A BURN OF THIRD DEGREE OF RIGHT LOWER LEG INITIAL ENCOUNTER

R29716 NIHSS score 16

T24332A BURN OF THIRD DEGREE OF LEFT LOWER LEG INITIAL ENCOUNTER

R29717 NIHSS score 17

T24339A BURN OF THIRD DEGREE OF UNSPECIFIED LOWER LEG INIT ENCNTR

R29718 NIHSS score 18

T24391A BURN 3RD DEG MU SITES OF RIGHT LOWER LIMB EX ANK/FT INIT

R29719 NIHSS score 19

T24392A BURN 3RD DEG MU SITES OF LEFT LOWER LIMB EX ANK/FT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R29720 NIHSS score 20

T24399A BURN 3RD DEG MU SITES OF UNSP LOWER LIMB EX ANK/FT INIT

R29721 NIHSS score 21

T24601A CORROS 2ND DEG OF UNSP SITE RIGHT LOW LIMB EX ANK/FT INIT

R29722 NIHSS score 22

T24602A CORROS 2ND DEG OF UNSP SITE LEFT LOWER LIMB EX ANK/FT INIT

R29723 NIHSS score 23

T24609A CORROS 2ND DEG OF UNSP SITE UNSP LOWER LIMB EX ANK/FT INIT

R29724 NIHSS score 24

T24611A CORROSION OF SECOND DEGREE OF RIGHT THIGH INITIAL ENCOUNTER

R29725 NIHSS score 25

T24612A CORROSION OF SECOND DEGREE OF LEFT THIGH INITIAL ENCOUNTER

R29726 NIHSS score 26

T24619A CORROSION OF SECOND DEGREE OF UNSPECIFIED THIGH INIT ENCNTR

R29727 NIHSS score 27

T24621A CORROSION OF SECOND DEGREE OF RIGHT KNEE INITIAL ENCOUNTER

R29728 NIHSS score 28

T24622A CORROSION OF SECOND DEGREE OF LEFT KNEE INITIAL ENCOUNTER

R29729 NIHSS score 29

T24629A CORROSION OF SECOND DEGREE OF UNSPECIFIED KNEE INIT ENCNTR

R29730 NIHSS score 30

T24631A CORROSION OF SECOND DEGREE OF RIGHT LOWER LEG INIT ENCNTR

R29731 NIHSS score 31

T24632A CORROSION OF SECOND DEGREE OF LEFT LOWER LEG INIT ENCNTR

R29732 NIHSS score 32

T24639A CORROSION OF SECOND DEGREE OF UNSP LOWER LEG INIT ENCNTR

R29733 NIHSS score 33

T24691A CORROS 2ND DEG MUL SITES OF RIGHT LOW LIMB EX ANK/FT INIT

R29734 NIHSS score 34

T24692A CORROS 2ND DEG MUL SITES OF LEFT LOWER LIMB EX ANK/FT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R29735 NIHSS score 35

T24699A CORROS 2ND DEG MUL SITES OF UNSP LOWER LIMB EX ANK/FT INIT

R29736 NIHSS score 36

T24701A CORROS THIRD DEG OF UNSP SITE R LOW LIMB EX ANK/FT INIT

R29737 NIHSS score 37

T24702A CORROS THIRD DEG OF UNSP SITE LEFT LOW LIMB EX ANK/FT INIT

R29738 NIHSS score 38

T24709A CORROS THIRD DEG OF UNSP SITE UNSP LOW LIMB EX ANK/FT INIT

R29739 NIHSS score 39

T24711A CORROSION OF THIRD DEGREE OF RIGHT THIGH INITIAL ENCOUNTER

R29740 NIHSS score 40

T24712A CORROSION OF THIRD DEGREE OF LEFT THIGH INITIAL ENCOUNTER

R29741 NIHSS score 41

T24719A CORROSION OF THIRD DEGREE OF UNSPECIFIED THIGH INIT ENCNTR

R29742 NIHSS score 42

T24721A CORROSION OF THIRD DEGREE OF RIGHT KNEE INITIAL ENCOUNTER

R29810 FACIAL WEAKNESS

T24722A CORROSION OF THIRD DEGREE OF LEFT KNEE INITIAL ENCOUNTER

R29891 OCULAR TORTICOLLIS

T24729A CORROSION OF THIRD DEGREE OF UNSPECIFIED KNEE INIT ENCNTR

R301 VESICAL TENESMUS

T24731A CORROSION OF THIRD DEGREE OF RIGHT LOWER LEG INIT ENCNTR

R309 PAINFUL MICTURITION UNSPECIFIED

T24732A

CORROSION OF THIRD DEGREE OF LEFT LOWER LEG INIT ENCNTR

R310 GROSS HEMATURIA

T24739A CORROSION OF THIRD DEGREE OF UNSP LOWER LEG INIT ENCNTR

R360 URETHRAL DISCHARGE WITHOUT BLOOD

T24791A

CORROS 3RD DEG MU SITES OF RIGHT LOWER LIMB EX ANK/FT INIT

R361 HEMATOSPERMIA

T24792A CORROS 3RD DEG MU SITES OF LEFT LOWER LIMB EX ANK/FT INIT

R369 URETHRAL DISCHARGE UNSPECIFIED

T24799A

CORROS 3RD DEG MU SITES OF UNSP LOWER LIMB EX ANK/FT INIT

R3912 POOR URINARY STREAM

T25211A BURN OF SECOND DEGREE OF RIGHT ANKLE INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R3913 SPLITTING OF URINARY STREAM

T25212A BURN OF SECOND DEGREE OF LEFT ANKLE INITIAL ENCOUNTER

R3919 OTHER DIFFICULTIES WITH MICTURITION

T25219A

BURN OF SECOND DEGREE OF UNSPECIFIED ANKLE INIT ENCNTR

R392 EXTRARENAL UREMIA

T25221A BURN OF SECOND DEGREE OF RIGHT FOOT INITIAL ENCOUNTER

R3989

OTHER SYMPTOMS AND SIGNS INVOLVING THE GENITOURINARY SYSTEM

T25222A

BURN OF SECOND DEGREE OF LEFT FOOT INITIAL ENCOUNTER

R399

UNSP SYMPTOMS AND SIGNS INVOLVING THE GENITOURINARY SYSTEM

T25229A

BURN OF SECOND DEGREE OF UNSPECIFIED FOOT INITIAL ENCOUNTER

R4020 UNSPECIFIED COMA

T25231A BURN OF SECOND DEGREE OF RIGHT TOE(S) (NAIL) INIT ENCNTR

R402110 COMA SCALE EYES OPEN NEVER UNSPECIFIED TIME

T25232A

BURN OF SECOND DEGREE OF LEFT TOE(S) (NAIL) INIT ENCNTR

R402111 COMA SCALE EYES OPEN NEVER IN THE FIELD

T25239A

BURN OF SECOND DEGREE OF UNSP TOE(S) (NAIL) INIT ENCNTR

R402112 COMA SCALE EYES OPEN NEVER EMR

T25291A

BURN OF 2ND DEG MUL SITES OF RIGHT ANKLE AND FOOT INIT

R402113 COMA SCALE EYES OPEN NEVER AT HOSPITAL ADMISSION

T25292A

BURN OF 2ND DEG MUL SITES OF LEFT ANKLE AND FOOT INIT

R402114 COMA SCALE EYES OPEN NEVER 24+HRS

T25299A

BURN OF 2ND DEG MUL SITES OF UNSP ANKLE AND FOOT INIT

R402120 COMA SCALE EYES OPEN TO PAIN UNSPECIFIED TIME

T25311A

BURN OF THIRD DEGREE OF RIGHT ANKLE INITIAL ENCOUNTER

R402121 COMA SCALE EYES OPEN TO PAIN IN THE FIELD

T25312A

BURN OF THIRD DEGREE OF LEFT ANKLE INITIAL ENCOUNTER

R402122 COMA SCALE EYES OPEN TO PAIN EMR

T25319A

BURN OF THIRD DEGREE OF UNSPECIFIED ANKLE INITIAL ENCOUNTER

R402123 COMA SCALE EYES OPEN TO PAIN AT HOSPITAL ADMISSION

T25321A

BURN OF THIRD DEGREE OF RIGHT FOOT INITIAL ENCOUNTER

R402124 COMA SCALE EYES OPEN TO PAIN 24+HRS

T25322A

BURN OF THIRD DEGREE OF LEFT FOOT INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R402130 COMA SCALE EYES OPEN TO SOUND UNSPECIFIED TIME

T25329A

BURN OF THIRD DEGREE OF UNSPECIFIED FOOT INITIAL ENCOUNTER

R402131 COMA SCALE EYES OPEN TO SOUND IN THE FIELD

T25331A

BURN OF THIRD DEGREE OF RIGHT TOE(S) (NAIL) INIT ENCNTR

R402132 COMA SCALE EYES OPEN TO SOUND EMR

T25332A

BURN OF THIRD DEGREE OF LEFT TOE(S) (NAIL) INIT ENCNTR

R402133

COMA SCALE EYES OPEN TO SOUND AT HOSPITAL ADMISSION

T25339A

BURN OF THIRD DEGREE OF UNSP TOE(S) (NAIL) INIT ENCNTR

R402134 COMA SCALE EYES OPEN TO SOUND 24+HRS

T25391A

BURN OF 3RD DEG MU SITES OF RIGHT ANKLE AND FOOT INIT

R402140

COMA SCALE EYES OPEN SPONTANEOUS UNSPECIFIED TIME

T25392A

BURN OF 3RD DEG MU SITES OF LEFT ANKLE AND FOOT INIT

R402141 COMA SCALE EYES OPEN SPONTANEOUS IN THE FIELD

T25399A

BURN OF 3RD DEG MU SITES OF UNSP ANKLE AND FOOT INIT

R402142 COMA SCALE EYES OPEN SPONTANEOUS EMR

T25611A

CORROSION OF SECOND DEGREE OF RIGHT ANKLE INITIAL ENCOUNTER

R402143

COMA SCALE EYES OPEN SPONTANEOUS AT HOSPITAL ADMISSION

T25612A

CORROSION OF SECOND DEGREE OF LEFT ANKLE INITIAL ENCOUNTER

R402144 COMA SCALE EYES OPEN SPONTANEOUS 24+HRS

T25619A

CORROSION OF SECOND DEGREE OF UNSPECIFIED ANKLE INIT ENCNTR

R402210

COMA SCALE BEST VERBAL RESPONSE NONE UNSPECIFIED TIME

T25621A

CORROSION OF SECOND DEGREE OF RIGHT FOOT INITIAL ENCOUNTER

R402211 COMA SCALE BEST VERBAL RESPONSE NONE IN THE FIELD

T25622A

CORROSION OF SECOND DEGREE OF LEFT FOOT INITIAL ENCOUNTER

R402212 COMA SCALE BEST VERBAL RESPONSE NONE EMR

T25629A

CORROSION OF SECOND DEGREE OF UNSPECIFIED FOOT INIT ENCNTR

R402213 COMA SCALE BEST VERBAL RESPONSE NONE ADMIT

T25631A

CORROSION OF SECOND DEGREE OF RIGHT TOE(S) (NAIL) INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R402214 COMA SCALE BEST VERBAL RESPONSE NONE 24+HRS

T25632A

CORROSION OF SECOND DEGREE OF LEFT TOE(S) (NAIL) INIT

R402220

COMA SCALE BEST VERB INCOMPREHENSIBLE WORDS UNSP TIME

T25639A

CORROSION OF SECOND DEGREE OF UNSP TOE(S) (NAIL) INIT

R402221

COMA SCALE BEST VERB INCOMPREHENSIBLE WORDS IN THE FIELD

T25691A

CORROSION OF SECOND DEGREE OF RIGHT ANKLE AND FOOT INIT

R402222

COMA SCALE BEST VERB INCOMPREHENSIBLE WORDS EMR

T25692A

CORROSION OF SECOND DEGREE OF LEFT ANKLE AND FOOT INIT

R402223

COMA SCALE BEST VERB INCOMPREHENSIBLE WORDS ADMIT

T25699A

CORROSION OF SECOND DEGREE OF UNSP ANKLE AND FOOT INIT

R402224

COMA SCALE BEST VERB INCOMPREHENSIBLE WORDS 24+HRS

T25711A

CORROSION OF THIRD DEGREE OF RIGHT ANKLE INITIAL ENCOUNTER

R402230

COMA SCALE BEST VERB INAPPROPRIATE WORDS UNSP TIME

T25712A

CORROSION OF THIRD DEGREE OF LEFT ANKLE INITIAL ENCOUNTER

R402231

COMA SCALE BEST VERB INAPPROPRIATE WORDS IN THE FIELD

T25719A

CORROSION OF THIRD DEGREE OF UNSPECIFIED ANKLE INIT ENCNTR

R402232

COMA SCALE BEST VERBAL RESPONSE INAPPROPRIATE WORDS EMR

T25721A

CORROSION OF THIRD DEGREE OF RIGHT FOOT INITIAL ENCOUNTER

R402233

COMA SCALE BEST VERBAL RESPONSE INAPPROPRIATE WORDS ADMIT

T25722A

CORROSION OF THIRD DEGREE OF LEFT FOOT INITIAL ENCOUNTER

R402234

COMA SCALE BEST VERB INAPPROPRIATE WORDS 24+HRS

T25729A

CORROSION OF THIRD DEGREE OF UNSPECIFIED FOOT INIT ENCNTR

R402240

COMA SCALE BEST VERB CONFUSED CONVERSATION UNSP TIME

T25731A

CORROSION OF THIRD DEGREE OF RIGHT TOE(S) (NAIL) INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R402241

COMA SCALE BEST VERB CONFUSED CONVERSATION IN THE FIELD

T25732A

CORROSION OF THIRD DEGREE OF LEFT TOE(S) (NAIL) INIT ENCNTR

R402242

COMA SCALE BEST VERBAL RESPONSE CONFUSED CONVERSATION EMR

T25739A

CORROSION OF THIRD DEGREE OF UNSP TOE(S) (NAIL) INIT ENCNTR

R402243

COMA SCALE BEST VERB CONFUSED CONVERSATION ADMIT

T25791A

CORROSION OF 3RD DEG MU SITES OF RIGHT ANKLE AND FOOT INIT

R402244

COMA SCALE BEST VERB CONFUSED CONVERSATION 24+HRS

T25792A

CORROSION OF 3RD DEG MU SITES OF LEFT ANKLE AND FOOT INIT

R402250

COMA SCALE BEST VERBAL RESPONSE ORIENTED UNSPECIFIED TIME

T25799A

CORROSION OF 3RD DEG MU SITES OF UNSP ANKLE AND FOOT INIT

R402251

COMA SCALE BEST VERBAL RESPONSE ORIENTED IN THE FIELD

T2600XA

BURN OF UNSPECIFIED EYELID AND PERIOCULAR AREA INIT ENCNTR

R402252 COMA SCALE BEST VERBAL RESPONSE ORIENTED EMR

T2601XA

BURN OF RIGHT EYELID AND PERIOCULAR AREA INITIAL ENCOUNTER

R402253 COMA SCALE BEST VERBAL RESPONSE ORIENTED ADMIT

T2602XA

BURN OF LEFT EYELID AND PERIOCULAR AREA INITIAL ENCOUNTER

R402254 COMA SCALE BEST VERBAL RESPONSE ORIENTED 24+HRS

T2610XA

BURN OF CORNEA AND CONJUNCTIVAL SAC UNSP EYE INIT ENCNTR

R402310

COMA SCALE BEST MOTOR RESPONSE NONE UNSPECIFIED TIME

T2611XA

BURN OF CORNEA AND CONJUNCTIVAL SAC RIGHT EYE INIT ENCNTR

R402311 COMA SCALE BEST MOTOR RESPONSE NONE IN THE FIELD

T2612XA

BURN OF CORNEA AND CONJUNCTIVAL SAC LEFT EYE INIT ENCNTR

R402312 COMA SCALE BEST MOTOR RESPONSE NONE EMR

T2620XA

BURN W RESULTING RUPTURE AND DEST OF UNSP EYEBALL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R402313

COMA SCALE BEST MOTOR RESPONSE NONE AT HOSPITAL ADMISSION

T2621XA

BURN W RESULTING RUPTURE AND DEST OF RIGHT EYEBALL INIT

R402314 COMA SCALE BEST MOTOR RESPONSE NONE 24+HRS

T2622XA

BURN W RESULTING RUPTURE AND DEST OF LEFT EYEBALL INIT

R402320

COMA SCALE BEST MOTOR RESPONSE EXTENSION UNSPECIFIED TIME

T2630XA

BURNS OF OTH PARTS OF UNSP EYE AND ADNEXA INIT ENCNTR

R402321

COMA SCALE BEST MOTOR RESPONSE EXTENSION IN THE FIELD

T2631XA

BURNS OF OTH PARTS OF RIGHT EYE AND ADNEXA INIT ENCNTR

R402322 COMA SCALE BEST MOTOR RESPONSE EXTENSION EMR

T2632XA

BURNS OF OTH PARTS OF LEFT EYE AND ADNEXA INIT ENCNTR

R402323 COMA SCALE BEST MOTOR RESPONSE EXTENSION ADMIT

T2640XA

BURN OF UNSP EYE AND ADNEXA PART UNSPECIFIED INIT ENCNTR

R402324 COMA SCALE BEST MOTOR RESPONSE EXTENSION 24+HRS

T2641XA

BURN OF RIGHT EYE AND ADNEXA PART UNSPECIFIED INIT ENCNTR

R402330

COMA SCALE BEST MOTOR RESPONSE ABNORMAL UNSPECIFIED TIME

T2642XA

BURN OF LEFT EYE AND ADNEXA PART UNSPECIFIED INIT ENCNTR

R402331

COMA SCALE BEST MOTOR RESPONSE ABNORMAL IN THE FIELD

T2650XA

CORROSION OF UNSP EYELID AND PERIOCULAR AREA INIT ENCNTR

R402332 COMA SCALE BEST MOTOR RESPONSE ABNORMAL EMR

T2651XA

CORROSION OF RIGHT EYELID AND PERIOCULAR AREA INIT ENCNTR

R402333 COMA SCALE BEST MOTOR RESPONSE ABNORMAL ADMIT

T2652XA

CORROSION OF LEFT EYELID AND PERIOCULAR AREA INIT ENCNTR

R402334 COMA SCALE BEST MOTOR RESPONSE ABNORMAL 24+HRS

T2660XA

CORROSION OF CORNEA AND CONJUNCTIVAL SAC UNSP EYE INIT

R402340

COMA SCALE BEST MOTOR FLEXION WITHDRAWAL UNSP TIME

T2661XA

CORROSION OF CORNEA AND CONJUNCTIVAL SAC RIGHT EYE INIT

R402341

COMA SCALE BEST MOTOR FLEXION WITHDRAWAL IN THE FIELD

T2662XA

CORROSION OF CORNEA AND CONJUNCTIVAL SAC LEFT EYE INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R402342

COMA SCALE BEST MOTOR RESPONSE FLEXION WITHDRAWAL EMR

T2670XA

CORROSION W RESULTING RUPTURE AND DEST OF UNSP EYEBALL INIT

R402343

COMA SCALE BEST MOTOR RESPONSE FLEXION WITHDRAWAL ADMIT

T2671XA

CORROS W RESULTING RUPTURE AND DEST OF RIGHT EYEBALL INIT

R402344

COMA SCALE BEST MOTOR RESPONSE FLEXION WITHDRAWAL 24+HRS

T2672XA

CORROSION W RESULTING RUPTURE AND DEST OF LEFT EYEBALL INIT

R402350

COMA SCALE BEST MOTOR RESPONSE LOCALIZES PAIN UNSP TIME

T2680XA

CORROSIONS OF OTH PARTS OF UNSP EYE AND ADNEXA INIT ENCNTR

R402351 COMA SCALE BEST MOTOR LOCALIZES PAIN IN THE FIELD

T2681XA

CORROSIONS OF OTH PARTS OF RIGHT EYE AND ADNEXA INIT ENCNTR

R402352 COMA SCALE BEST MOTOR RESPONSE LOCALIZES PAIN EMR

T2682XA

CORROSIONS OF OTH PARTS OF LEFT EYE AND ADNEXA INIT ENCNTR

R402353

COMA SCALE BEST MOTOR RESPONSE LOCALIZES PAIN ADMIT

T2690XA

CORROSION OF UNSP EYE AND ADNEXA PART UNSP INIT ENCNTR

R402354

COMA SCALE BEST MOTOR RESPONSE LOCALIZES PAIN 24+HRS

T2691XA

CORROSION OF RIGHT EYE AND ADNEXA PART UNSP INIT ENCNTR

R402360

COMA SCALE BEST MOTOR RESPONSE OBEYS COMMANDS UNSP TIME

T2692XA

CORROSION OF LEFT EYE AND ADNEXA PART UNSP INIT ENCNTR

R402361

COMA SCALE BEST MOTOR OBEYS COMMANDS IN THE FIELD

T270XXA

BURN OF LARYNX AND TRACHEA INITIAL ENCOUNTER

R402362

COMA SCALE BEST MOTOR RESPONSE OBEYS COMMANDS EMR

T271XXA

BURN INVOLVING LARYNX AND TRACHEA WITH LUNG INIT ENCNTR

R402363

COMA SCALE BEST MOTOR RESPONSE OBEYS COMMANDS ADMIT

T272XXA

BURN OF OTHER PARTS OF RESPIRATORY TRACT INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R402364

COMA SCALE BEST MOTOR RESPONSE OBEYS COMMANDS 24+HRS

T273XXA

BURN OF RESPIRATORY TRACT PART UNSPECIFIED INIT ENCNTR

R402410 Glasgow coma scale score 13-15 unspecified time

T274XXA

CORROSION OF LARYNX AND TRACHEA INITIAL ENCOUNTER

R402411 Glasgow coma scale score 13-15 in the field [EMT or ambulance]

T275XXA

CORROSION INVOLVING LARYNX AND TRACHEA W LUNG INIT ENCNTR

R402412

Glasgow coma scale score 13-15 at arrival to emergency department

T276XXA

CORROSION OF OTHER PARTS OF RESPIRATORY TRACT INIT ENCNTR

R402420 Glasgow coma scale score 9-12 unspecified time

T277XXA

CORROSION OF RESPIRATORY TRACT PART UNSP INIT ENCNTR

R402421 Glasgow coma scale score 9-12 in the field [EMT or ambulance]

T280XXA

BURN OF MOUTH AND PHARYNX INITIAL ENCOUNTER

R402422

Glasgow coma scale score 9-12 at arrival to emergency department

T281XXA

BURN OF ESOPHAGUS INITIAL ENCOUNTER

R402430 Glasgow coma scale score 3-8 unspecified time

T282XXA

BURN OF OTHER PARTS OF ALIMENTARY TRACT INITIAL ENCOUNTER

R402431 Glasgow coma scale score 3-8 in the field [EMT or ambulance]

T283XXA

BURN OF INTERNAL GENITOURINARY ORGANS INITIAL ENCOUNTER

R402432

Glasgow coma scale score 3-8 at arrival to emergency department

T2840XA

BURN OF UNSPECIFIED INTERNAL ORGAN INITIAL ENCOUNTER

R402440

Other coma without documented Glasgow coma scale score or with partial score reported unspecified time

T28411A

BURN OF RIGHT EAR DRUM INITIAL ENCOUNTER

R402441

Other coma without documented Glasgow coma scale score or with partial score reported in the field [EMT or ambulance]

T28412A

BURN OF LEFT EAR DRUM INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R402442

Other coma without documented Glasgow coma scale score or with partial score reported at arrival to emergency department

T28419A

BURN OF UNSPECIFIED EAR DRUM INITIAL ENCOUNTER

R403 PERSISTENT VEGETATIVE STATE

T2849XA BURN OF OTHER INTERNAL ORGAN INITIAL ENCOUNTER

R404 TRANSIENT ALTERATION OF AWARENESS

T285XXA

CORROSION OF MOUTH AND PHARYNX INITIAL ENCOUNTER

R410 DISORIENTATION UNSPECIFIED

T286XXA CORROSION OF ESOPHAGUS INITIAL ENCOUNTER

R411 ANTEROGRADE AMNESIA

T287XXA CORROSION OF OTHER PARTS OF ALIMENTARY TRACT INIT ENCNTR

R412 RETROGRADE AMNESIA

T288XXA

CORROSION OF INTERNAL GENITOURINARY ORGANS INIT ENCNTR

R413 OTHER AMNESIA

T2890XA

CORROSIONS OF UNSPECIFIED INTERNAL ORGANS INITIAL ENCOUNTER

R414 NEUROLOGIC NEGLECT SYNDROME

T28911A

CORROSIONS OF RIGHT EAR DRUM INITIAL ENCOUNTER

R4182 ALTERED MENTAL STATUS UNSPECIFIED

T28912A

CORROSIONS OF LEFT EAR DRUM INITIAL ENCOUNTER

R41841 COGNITIVE COMMUNICATION DEFICIT

T28919A

CORROSIONS OF UNSPECIFIED EAR DRUM INITIAL ENCOUNTER

R41842 VISUOSPATIAL DEFICIT

T2899XA CORROSIONS OF OTHER INTERNAL ORGANS INITIAL ENCOUNTER

R41843 PSYCHOMOTOR DEFICIT

T3110 BURNS OF 10-19% OF BODY SURFC W 0% TO 9% THIRD DEGREE BURNS

R41844 FRONTAL LOBE AND EXECUTIVE FUNCTION DEFICIT

T3111

BURNS OF 10-19% OF BODY SURFACE W 10-19% THIRD DEGREE BURNS

R4189

OTH SYMPTOMS AND SIGNS W COGNITIVE FUNCTIONS AND AWARENESS

T3120

BURNS OF 20-29% OF BODY SURFC W 0% TO 9% THIRD DEGREE BURNS

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R419

UNSP SYMPTOMS AND SIGNS W COGNITIVE FUNCTIONS AND AWARENESS

T3121

BURNS OF 20-29% OF BODY SURFACE W 10-19% THIRD DEGREE BURNS

R454 IRRITABILITY AND ANGER

T3122 BURNS OF 20-29% OF BODY SURFACE W 20-29% THIRD DEGREE BURNS

R455 HOSTILITY

T3130 BURNS OF 30-39% OF BODY SURFC W 0% TO 9% THIRD DEGREE BURNS

R456 VIOLENT BEHAVIOR

T3131 BURNS OF 30-39% OF BODY SURFACE W 10-19% THIRD DEGREE BURNS

R45850 HOMICIDAL IDEATIONS

T3132 BURNS OF 30-39% OF BODY SURFACE W 20-29% THIRD DEGREE BURNS

R45851 SUICIDAL IDEATIONS

T3133 BURNS OF 30-39% OF BODY SURFACE W 30-39% THIRD DEGREE BURNS

R4587 IMPULSIVENESS

T3140 BURNS OF 40-49% OF BODY SURFC W 0% TO 9% THIRD DEGREE BURNS

R4589 OTHER SYMPTOMS AND SIGNS INVOLVING EMOTIONAL STATE

T3141

BURNS OF 40-49% OF BODY SURFACE W 10-19% THIRD DEGREE BURNS

R4701 APHASIA

T3142 BURNS OF 40-49% OF BODY SURFACE W 20-29% THIRD DEGREE BURNS

R4781 SLURRED SPEECH

T3143 BURNS OF 40-49% OF BODY SURFACE W 30-39% THIRD DEGREE BURNS

R5081

FEVER PRESENTING WITH CONDITIONS CLASSIFIED ELSEWHERE

T3144

BURNS OF 40-49% OF BODY SURFACE W 40-49% THIRD DEGREE BURNS

R5082 POSTPROCEDURAL FEVER

T3150 BURNS OF 50-59% OF BODY SURFC W 0% TO 9% THIRD DEGREE BURNS

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R5084 FEBRILE NONHEMOLYTIC TRANSFUSION REACTION

T3151

BURNS OF 50-59% OF BODY SURFACE W 10-19% THIRD DEGREE BURNS

R530 NEOPLASTIC (MALIGNANT) RELATED FATIGUE

T3152

BURNS OF 50-59% OF BODY SURFACE W 20-29% THIRD DEGREE BURNS

R55 SYNCOPE AND COLLAPSE

T3153 BURNS OF 50-59% OF BODY SURFACE W 30-39% THIRD DEGREE BURNS

R5600 SIMPLE FEBRILE CONVULSIONS

T3154 BURNS OF 50-59% OF BODY SURFACE W 40-49% THIRD DEGREE BURNS

R5601 COMPLEX FEBRILE CONVULSIONS

T3155

BURNS OF 50-59% OF BODY SURFACE W 50-59% THIRD DEGREE BURNS

R561 POST TRAUMATIC SEIZURES

T3160 BURNS OF 60-69% OF BODY SURFC W 0% TO 9% THIRD DEGREE BURNS

R569 UNSPECIFIED CONVULSIONS

T3161 BURNS OF 60-69% OF BODY SURFACE W 10-19% THIRD DEGREE BURNS

R570 CARDIOGENIC SHOCK

T3162 BURNS OF 60-69% OF BODY SURFACE W 20-29% THIRD DEGREE BURNS

R571 HYPOVOLEMIC SHOCK

T3163 BURNS OF 60-69% OF BODY SURFACE W 30-39% THIRD DEGREE BURNS

R578 OTHER SHOCK

T3164 BURNS OF 60-69% OF BODY SURFACE W 40-49% THIRD DEGREE BURNS

R579 SHOCK UNSPECIFIED

T3165 BURNS OF 60-69% OF BODY SURFACE W 50-59% THIRD DEGREE BURNS

R58 HEMORRHAGE NOT ELSEWHERE CLASSIFIED

T3166

BURNS OF 60-69% OF BODY SURFACE W 60-69% THIRD DEGREE BURNS

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R590 LOCALIZED ENLARGED LYMPH NODES

T3170

BURNS OF 70-79% OF BODY SURFC W 0% TO 9% THIRD DEGREE BURNS

R591 GENERALIZED ENLARGED LYMPH NODES

T3171

BURNS OF 70-79% OF BODY SURFACE W 10-19% THIRD DEGREE BURNS

R599 ENLARGED LYMPH NODES UNSPECIFIED

T3172

BURNS OF 70-79% OF BODY SURFACE W 20-29% THIRD DEGREE BURNS

R609 EDEMA UNSPECIFIED

T3173 BURNS OF 70-79% OF BODY SURFACE W 30-39% THIRD DEGREE BURNS

R61 GENERALIZED HYPERHIDROSIS

T3174 BURNS OF 70-79% OF BODY SURFACE W 40-49% THIRD DEGREE BURNS

R6251 FAILURE TO THRIVE (CHILD)

T3175 BURNS OF 70-79% OF BODY SURFACE W 50-59% THIRD DEGREE BURNS

R627 ADULT FAILURE TO THRIVE

T3176 BURNS OF 70-79% OF BODY SURFACE W 60-69% THIRD DEGREE BURNS

R630 ANOREXIA

T3177 BURNS OF 70-79% OF BODY SURFACE W 70-79% THIRD DEGREE BURNS

R6520 SEVERE SEPSIS WITHOUT SEPTIC SHOCK

T3180

BURNS OF 80-89% OF BODY SURFC W 0% TO 9% THIRD DEGREE BURNS

R6521 SEVERE SEPSIS WITH SEPTIC SHOCK

T3181

BURNS OF 80-89% OF BODY SURFACE W 10-19% THIRD DEGREE BURNS

R6813 APPARENT LIFE THREATENING EVENT IN INFANT (ALTE)

T3182

BURNS OF 80-89% OF BODY SURFACE W 20-29% THIRD DEGREE BURNS

R920

MAMMOGRAPHIC MICROCALCIFICATION FOUND ON DX IMAGING OF BRST

T3183

BURNS OF 80-89% OF BODY SURFACE W 30-39% THIRD DEGREE BURNS

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R921

MAMMOGRAPHIC CALCIFCN FOUND ON DIAGNOSTIC IMAGING OF BREAST

T3184

BURNS OF 80-89% OF BODY SURFACE W 40-49% THIRD DEGREE BURNS

R922 INCONCLUSIVE MAMMOGRAM

T3185 BURNS OF 80-89% OF BODY SURFACE W 50-59% THIRD DEGREE BURNS

R928

OTH ABN AND INCONCLUSIVE FINDINGS ON DX IMAGING OF BREAST

T3186

BURNS OF 80-89% OF BODY SURFACE W 60-69% THIRD DEGREE BURNS

S0000XA

UNSPECIFIED SUPERFICIAL INJURY OF SCALP INITIAL ENCOUNTER

T3187

BURNS OF 80-89% OF BODY SURFACE W 70-79% THIRD DEGREE BURNS

S0001XA ABRASION OF SCALP INITIAL ENCOUNTER

T3188

BURNS OF 80-89% OF BODY SURFACE W 80-89% THIRD DEGREE BURNS

S0001XS ABRASION OF SCALP SEQUELA

T3190 BURNS OF 90%/MORE OF BODY SURFC W 0% TO 9% THIRD DEG BURNS

S0002XS BLISTER (NONTHERMAL) OF SCALP SEQUELA

T3191

BURNS OF 90%/MORE OF BODY SURFC W 10-19% THIRD DEGREE BURNS

S0004XA

EXTERNAL CONSTRICTION OF PART OF SCALP INITIAL ENCOUNTER

T3192

BURNS OF 90%/MORE OF BODY SURFC W 20-29% THIRD DEGREE BURNS

S0005XA SUPERFICIAL FOREIGN BODY OF SCALP INITIAL ENCOUNTER

T3193

BURNS OF 90%/MORE OF BODY SURFC W 30-39% THIRD DEGREE BURNS

S0006XA INSECT BITE (NONVENOMOUS) OF SCALP INITIAL ENCOUNTER

T3194

BURNS OF 90%/MORE OF BODY SURFC W 40-49% THIRD DEGREE BURNS

S0007XA OTHER SUPERFICIAL BITE OF SCALP INITIAL ENCOUNTER

T3195

BURNS OF 90%/MORE OF BODY SURFC W 50-59% THIRD DEGREE BURNS

S0010XA

CONTUSION OF UNSP EYELID AND PERIOCULAR AREA INIT ENCNTR

T3196

BURNS OF 90%/MORE OF BODY SURFC W 60-69% THIRD DEGREE BURNS

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0011XA

CONTUSION OF RIGHT EYELID AND PERIOCULAR AREA INIT ENCNTR

T3197

BURNS OF 90%/MORE OF BODY SURFC W 70-79% THIRD DEGREE BURNS

S0012XA

CONTUSION OF LEFT EYELID AND PERIOCULAR AREA INIT ENCNTR

T3198

BURNS OF 90%/MORE OF BODY SURFC W 80-89% THIRD DEGREE BURNS

S00201A

UNSP SUPERFIC INJ RIGHT EYELID AND PERIOCULR AREA INIT

T3199

BURNS OF 90%/MORE OF BODY SURFC W 90%/MORE THIRD DEG BURNS

S00202A

UNSP SUPERFIC INJURY OF LEFT EYELID AND PERIOCULR AREA INIT

T320

CORROSIONS INVOLVING LESS THAN 10% OF BODY SURFACE

S00209A

UNSP SUPERFIC INJURY OF UNSP EYELID AND PERIOCULR AREA INIT

T3210

CORROS 10-19% OF BODY SURFACE W 0% TO 9% THIRD DEGREE CORROS

S00211A

ABRASION OF RIGHT EYELID AND PERIOCULAR AREA INIT ENCNTR

T3211

CORROS 10-19% OF BODY SURFACE W 10-19% THIRD DEGREE CORROS

S00212A ABRASION OF LEFT EYELID AND PERIOCULAR AREA INIT ENCNTR

T3220

CORROS 20-29% OF BODY SURFACE W 0% TO 9% THIRD DEGREE CORROS

S00219A

ABRASION OF UNSP EYELID AND PERIOCULAR AREA INIT ENCNTR

T3221

CORROS 20-29% OF BODY SURFACE W 10-19% THIRD DEGREE CORROS

S00221A BLISTER OF RIGHT EYELID AND PERIOCULAR AREA INIT

T3222

CORROS 20-29% OF BODY SURFACE W 20-29% THIRD DEGREE CORROS

S00222A BLISTER OF LEFT EYELID AND PERIOCULAR AREA INIT

T3230

CORROS 30-39% OF BODY SURFACE W 0% TO 9% THIRD DEGREE CORROS

S00229A BLISTER OF UNSP EYELID AND PERIOCULAR AREA INIT

T3231

CORROS 30-39% OF BODY SURFACE W 10-19% THIRD DEGREE CORROS

S00241A

EXTERNAL CONSTRICT OF RIGHT EYELID AND PERIOCULAR AREA INIT

T3232

CORROS 30-39% OF BODY SURFACE W 20-29% THIRD DEGREE CORROS

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S00242A

EXTERNAL CONSTRICT OF LEFT EYELID AND PERIOCULAR AREA INIT

T3233

CORROS 30-39% OF BODY SURFACE W 30-39% THIRD DEGREE CORROS

S00249A

EXTERNAL CONSTRICT OF UNSP EYELID AND PERIOCULAR AREA INIT

T3240

CORROS 40-49% OF BODY SURFACE W 0% TO 9% THIRD DEGREE CORROS

S00251A

SUPERFICIAL FB OF RIGHT EYELID AND PERIOCULAR AREA INIT

T3241

CORROS 40-49% OF BODY SURFACE W 10-19% THIRD DEGREE CORROS

S00252A SUPERFICIAL FB OF LEFT EYELID AND PERIOCULAR AREA INIT

T3242

CORROS 40-49% OF BODY SURFACE W 20-29% THIRD DEGREE CORROS

S00259A

SUPERFICIAL FB OF UNSP EYELID AND PERIOCULAR AREA INIT

T3243

CORROS 40-49% OF BODY SURFACE W 30-39% THIRD DEGREE CORROS

S00261A INSECT BITE OF RIGHT EYELID AND PERIOCULAR AREA INIT

T3244

CORROS 40-49% OF BODY SURFACE W 40-49% THIRD DEGREE CORROS

S00262A INSECT BITE OF LEFT EYELID AND PERIOCULAR AREA INIT

T3250

CORROS 50-59% OF BODY SURFACE W 0% TO 9% THIRD DEGREE CORROS

S00269A INSECT BITE OF UNSP EYELID AND PERIOCULAR AREA INIT

T3251

CORROS 50-59% OF BODY SURFACE W 10-19% THIRD DEGREE CORROS

S00271A

OTH SUPERFIC BITE OF RIGHT EYELID AND PERIOCULAR AREA INIT

T3252

CORROS 50-59% OF BODY SURFACE W 20-29% THIRD DEGREE CORROS

S00272A

OTH SUPERFIC BITE OF LEFT EYELID AND PERIOCULAR AREA INIT

T3253

CORROS 50-59% OF BODY SURFACE W 30-39% THIRD DEGREE CORROS

S0093XA

CONTUSION OF UNSPECIFIED PART OF HEAD INITIAL ENCOUNTER

T3254

CORROS 50-59% OF BODY SURFACE W 40-49% THIRD DEGREE CORROS

S0100XA UNSPECIFIED OPEN WOUND OF SCALP INITIAL ENCOUNTER

T3255

CORROS 50-59% OF BODY SURFACE W 50-59% THIRD DEGREE CORROS

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0103XA

PUNCTURE WOUND WITHOUT FOREIGN BODY OF SCALP INIT ENCNTR

T3260

CORROS 60-69% OF BODY SURFACE W 0% TO 9% THIRD DEGREE CORROS

S0104XA

PUNCTURE WOUND WITH FOREIGN BODY OF SCALP INITIAL ENCOUNTER

T3261

CORROS 60-69% OF BODY SURFACE W 10-19% THIRD DEGREE CORROS

S020XXA

FRACTURE OF VAULT OF SKULL INIT ENCNTR FOR CLOSED FRACTURE

T3262

CORROS 60-69% OF BODY SURFACE W 20-29% THIRD DEGREE CORROS

S020XXB

FRACTURE OF VAULT OF SKULL INIT ENCNTR FOR OPEN FRACTURE

T3263

CORROS 60-69% OF BODY SURFACE W 30-39% THIRD DEGREE CORROS

S020XXD FRACTURE OF VAULT OF SKULL SUBS FOR FX W ROUTN HEAL

T3264

CORROS 60-69% OF BODY SURFACE W 40-49% THIRD DEGREE CORROS

S020XXG FRACTURE OF VAULT OF SKULL SUBS FOR FX W DELAY HEAL

T3265

CORROS 60-69% OF BODY SURFACE W 50-59% THIRD DEGREE CORROS

S020XXK FRACTURE OF VAULT OF SKULL SUBS FOR FX W NONUNION

T3266

CORROS 60-69% OF BODY SURFACE W 60-69% THIRD DEGREE CORROS

S020XXS FRACTURE OF VAULT OF SKULL SEQUELA

T3270

CORROS 70-79% OF BODY SURFACE W 0% TO 9% THIRD DEGREE CORROS

S0210XA UNSP FRACTURE OF BASE OF SKULL INIT FOR CLOS FX

T3271

CORROS 70-79% OF BODY SURFACE W 10-19% THIRD DEGREE CORROS

S0210XB UNSP FRACTURE OF BASE OF SKULL INIT FOR OPN FX

T3272

CORROS 70-79% OF BODY SURFACE W 20-29% THIRD DEGREE CORROS

S0210XD

UNSP FRACTURE OF BASE OF SKULL SUBS FOR FX W ROUTN HEAL

T3273

CORROS 70-79% OF BODY SURFACE W 30-39% THIRD DEGREE CORROS

S0210XG

UNSP FRACTURE OF BASE OF SKULL SUBS FOR FX W DELAY HEAL

T3274

CORROS 70-79% OF BODY SURFACE W 40-49% THIRD DEGREE CORROS

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0210XK

UNSP FRACTURE OF BASE OF SKULL SUBS FOR FX W NONUNION

T3275

CORROS 70-79% OF BODY SURFACE W 50-59% THIRD DEGREE CORROS

S0210XS UNSPECIFIED FRACTURE OF BASE OF SKULL SEQUELA

T3276

CORROS 70-79% OF BODY SURFACE W 60-69% THIRD DEGREE CORROS

S02101A

Fracture of base of skull right side initial encounter for closed fracture

T3277

CORROS 70-79% OF BODY SURFACE W 70-79% THIRD DEGREE CORROS

S02101B

Fracture of base of skull right side initial encounter for open fracture

T3280

CORROS 80-89% OF BODY SURFACE W 0% TO 9% THIRD DEGREE CORROS

S02102A

Fracture of base of skull left side initial encounter for closed fracture

T3281

CORROS 80-89% OF BODY SURFACE W 10-19% THIRD DEGREE CORROS

S02102B

Fracture of base of skull left side initial encounter for open fracture

T3282

CORROS 80-89% OF BODY SURFACE W 20-29% THIRD DEGREE CORROS

S02102D Fracture of base of skull left side sequela

T3283

CORROS 80-89% OF BODY SURFACE W 30-39% THIRD DEGREE CORROS

S02102G

Fracture of base of skull left side subsequent encounter for fracture with delayed healing

T3284

CORROS 80-89% OF BODY SURFACE W 40-49% THIRD DEGREE CORROS

S02102K

Fracture of base of skull left side subsequent encounter for fracture with nonunion

T3285

CORROS 80-89% OF BODY SURFACE W 50-59% THIRD DEGREE CORROS

S02102S

Fracture of base of skull left side subsequent encounter for fracture with routine healing

T3286

CORROS 80-89% OF BODY SURFACE W 60-69% THIRD DEGREE CORROS

S02109A

Fracture of base of skull unspecified side initial encounter for closed fracture

T3287

CORROS 80-89% OF BODY SURFACE W 70-79% THIRD DEGREE CORROS

S02109B

Fracture of base of skull unspecified side initial encounter for open fracture

T3288

CORROS 80-89% OF BODY SURFACE W 80-89% THIRD DEGREE CORROS

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S02109S Fracture of base of skull unspecified side sequela

T3290

CORROS 90%/MORE OF BODY SURFC W 0% TO 9% THIRD DEGREE CORROS

S02110A TYPE I OCCIPITAL CONDYLE FRACTURE INIT FOR CLOS FX

T3291

CORROS 90%/MORE OF BODY SURFACE W 10-19% THIRD DEGREE CORROS

S02110B TYPE I OCCIPITAL CONDYLE FRACTURE INIT FOR OPN FX

T3292

CORROS 90%/MORE OF BODY SURFACE W 20-29% THIRD DEGREE CORROS

S02110D

TYPE I OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W ROUTN HEAL

T3293

CORROS 90%/MORE OF BODY SURFACE W 30-39% THIRD DEGREE CORROS

S02110G

TYPE I OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W DELAY HEAL

T3294

CORROS 90%/MORE OF BODY SURFACE W 40-49% THIRD DEGREE CORROS

S02110K

TYPE I OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W NONUNION

T3295

CORROS 90%/MORE OF BODY SURFACE W 50-59% THIRD DEGREE CORROS

S02110S TYPE I OCCIPITAL CONDYLE FRACTURE SEQUELA

T3296

CORROS 90%/MORE OF BODY SURFACE W 60-69% THIRD DEGREE CORROS

S02111A TYPE II OCCIPITAL CONDYLE FRACTURE INIT FOR CLOS FX

T3297

CORROS 90%/MORE OF BODY SURFACE W 70-79% THIRD DEGREE CORROS

S02111B TYPE II OCCIPITAL CONDYLE FRACTURE INIT FOR OPN FX

T3298

CORROS 90%/MORE OF BODY SURFACE W 80-89% THIRD DEGREE CORROS

S02111D

TYPE II OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W ROUTN HEAL

T3299

CORROS 90%/MORE OF BODY SURFC W 90%/MORE THIRD DEGREE CORROS

S02111G

TYPE II OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W DELAY HEAL

T33011A

SUPERFICIAL FROSTBITE OF RIGHT EAR INITIAL ENCOUNTER

S02111K

TYPE II OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W NONUNION

T33012A

SUPERFICIAL FROSTBITE OF LEFT EAR INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S02111S TYPE II OCCIPITAL CONDYLE FRACTURE SEQUELA

T33019A

SUPERFICIAL FROSTBITE OF UNSPECIFIED EAR INITIAL ENCOUNTER

S02112A TYPE III OCCIPITAL CONDYLE FRACTURE INIT FOR CLOS FX

T3302XA

SUPERFICIAL FROSTBITE OF NOSE INITIAL ENCOUNTER

S02112B TYPE III OCCIPITAL CONDYLE FRACTURE INIT FOR OPN FX

T3309XA

SUPERFICIAL FROSTBITE OF OTHER PART OF HEAD INIT ENCNTR

S02112D TYPE III OCCIPITAL CONDYLE FX SUBS FOR FX W ROUTN HEAL

T331XXA

SUPERFICIAL FROSTBITE OF NECK INITIAL ENCOUNTER

S02112G TYPE III OCCIPITAL CONDYLE FX SUBS FOR FX W DELAY HEAL

T332XXA

SUPERFICIAL FROSTBITE OF THORAX INITIAL ENCOUNTER

S02112K

TYPE III OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W NONUNION

T333XXA

SUPERFIC FROSTBITE OF ABD WALL LOWER BACK AND PELVIS INIT

S02112S TYPE III OCCIPITAL CONDYLE FRACTURE SEQUELA

T3340XA

SUPERFICIAL FROSTBITE OF UNSPECIFIED ARM INITIAL ENCOUNTER

S02113A UNSP OCCIPITAL CONDYLE FRACTURE INIT FOR CLOS FX

T3341XA

SUPERFICIAL FROSTBITE OF RIGHT ARM INITIAL ENCOUNTER

S02113B UNSP OCCIPITAL CONDYLE FRACTURE INIT FOR OPN FX

T3342XA

SUPERFICIAL FROSTBITE OF LEFT ARM INITIAL ENCOUNTER

S02113D

UNSP OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W ROUTN HEAL

T33511A

SUPERFICIAL FROSTBITE OF RIGHT WRIST INITIAL ENCOUNTER

S02113G

UNSP OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W DELAY HEAL

T33512A

SUPERFICIAL FROSTBITE OF LEFT WRIST INITIAL ENCOUNTER

S02113K

UNSP OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W NONUNION

T33519A

SUPERFICIAL FROSTBITE OF UNSPECIFIED WRIST INIT ENCNTR

S02113S UNSPECIFIED OCCIPITAL CONDYLE FRACTURE SEQUELA

T33521A

SUPERFICIAL FROSTBITE OF RIGHT HAND INITIAL ENCOUNTER

S02118A

OTHER FRACTURE OF OCCIPUT INIT ENCNTR FOR CLOSED FRACTURE

T33522A

SUPERFICIAL FROSTBITE OF LEFT HAND INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S02118B

OTHER FRACTURE OF OCCIPUT INIT ENCNTR FOR OPEN FRACTURE

T33529A

SUPERFICIAL FROSTBITE OF UNSPECIFIED HAND INITIAL ENCOUNTER

S02119A

UNSP FRACTURE OF OCCIPUT INIT ENCNTR FOR CLOSED FRACTURE

T33531A

SUPERFICIAL FROSTBITE OF RIGHT FINGER(S) INITIAL ENCOUNTER

S02119B

UNSP FRACTURE OF OCCIPUT INIT ENCNTR FOR OPEN FRACTURE

T33532A

SUPERFICIAL FROSTBITE OF LEFT FINGER(S) INITIAL ENCOUNTER

S0211AA

Type I occipital condyle fracture right side initial encounter for closed fracture

T33539A

SUPERFICIAL FROSTBITE OF UNSPECIFIED FINGER(S) INIT ENCNTR

S0211AB

Type I occipital condyle fracture right side initial encounter for open fracture

T3360XA

SUPERFICIAL FROSTBITE OF UNSP HIP AND THIGH INIT ENCNTR

S0211BA

Type I occipital condyle fracture left side initial encounter for closed fracture

T3361XA

SUPERFICIAL FROSTBITE OF RIGHT HIP AND THIGH INIT ENCNTR

S0211BB

Type I occipital condyle fracture left side initial encounter for open fracture

T3362XA

SUPERFICIAL FROSTBITE OF LEFT HIP AND THIGH INIT ENCNTR

S0211CA

Type II occipital condyle fracture right side initial encounter for closed fracture

T3370XA

SUPERFICIAL FROSTBITE OF UNSP KNEE AND LOWER LEG INIT

S0211CB

Type II occipital condyle fracture right side initial encounter for open fracture

T3371XA

SUPERFICIAL FROSTBITE OF RIGHT KNEE AND LOWER LEG INIT

S0211DA

Type II occipital condyle fracture left side initial encounter for closed fracture

T3372XA

SUPERFICIAL FROSTBITE OF LEFT KNEE AND LOWER LEG INIT

S0211DB

Type II occipital condyle fracture left side initial encounter for open fracture

T33811A

SUPERFICIAL FROSTBITE OF RIGHT ANKLE INITIAL ENCOUNTER

S0211EA

Type III occipital condyle fracture right side initial encounter for closed fracture

T33812A

SUPERFICIAL FROSTBITE OF LEFT ANKLE INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0211EB

Type III occipital condyle fracture right side initial encounter for open fracture

T33819A

SUPERFICIAL FROSTBITE OF UNSPECIFIED ANKLE INIT ENCNTR

S0211ED

Type III occipital condyle fracture right side subsequent encounter for fracture with routine healing

T33821A

SUPERFICIAL FROSTBITE OF RIGHT FOOT INITIAL ENCOUNTER

S0211FA

Type III occipital condyle fracture left side initial encounter for closed fracture

T33822A

SUPERFICIAL FROSTBITE OF LEFT FOOT INITIAL ENCOUNTER

S0211FB

Type III occipital condyle fracture left side initial encounter for open fracture

T33829A

SUPERFICIAL FROSTBITE OF UNSPECIFIED FOOT INITIAL ENCOUNTER

S0211GA

Other fracture or occiput right side initial encounter for closed fracture

T33831A

SUPERFICIAL FROSTBITE OF RIGHT TOE(S) INITIAL ENCOUNTER

S0211GB

Other fracture or occiput right side initial encounter for open fracture

T33832A

SUPERFICIAL FROSTBITE OF LEFT TOE(S) INITIAL ENCOUNTER

S0211HA

Other fracture or occiput left side initial encounter for closed fracture

T33839A

SUPERFICIAL FROSTBITE OF UNSPECIFIED TOE(S) INIT ENCNTR

S0211HB

Other fracture or occiput left side initial encounter for open fracture

T3390XA

SUPERFICIAL FROSTBITE OF UNSPECIFIED SITES INIT ENCNTR

S0219XA OTH FRACTURE OF BASE OF SKULL INIT FOR CLOS FX

T3399XA

SUPERFICIAL FROSTBITE OF OTHER SITES INITIAL ENCOUNTER

S0219XB

OTH FRACTURE OF BASE OF SKULL INIT ENCNTR FOR OPEN FRACTURE

T34011A

FROSTBITE WITH TISSUE NECROSIS OF RIGHT EAR INIT ENCNTR

S022XXA

FRACTURE OF NASAL BONES INIT ENCNTR FOR CLOSED FRACTURE

T34012A

FROSTBITE WITH TISSUE NECROSIS OF LEFT EAR INIT ENCNTR

S022XXB

FRACTURE OF NASAL BONES INITIAL ENCOUNTER FOR OPEN FRACTURE

T34019A

FROSTBITE WITH TISSUE NECROSIS OF UNSP EAR INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0230XA

Fracture of orbital floor unspecified side initial encounter for closed fracture

T3402XA

FROSTBITE WITH TISSUE NECROSIS OF NOSE INITIAL ENCOUNTER

S0230XB

Fracture of orbital floor unspecified side initial encounter for open fracture

T3409XA

FROSTBITE W TISSUE NECROSIS OF OTH PART OF HEAD INIT ENCNTR

S0231XA

Fracture of orbital floor right side initial encounter for closed fracture

T341XXA

FROSTBITE WITH TISSUE NECROSIS OF NECK INITIAL ENCOUNTER

S0231XB

Fracture of orbital floor right side initial encounter for open fracture

T342XXA

FROSTBITE WITH TISSUE NECROSIS OF THORAX INITIAL ENCOUNTER

S0232XA

Fracture of orbital floor left side initial encounter for closed fracture

T343XXA

FRSTBTE W TISSUE NECROS ABD WALL LOW BACK AND PELVIS INIT

S0232XB

Fracture of orbital floor left side initial encounter for open fracture

T3440XA

FROSTBITE WITH TISSUE NECROSIS OF UNSP ARM INIT ENCNTR

S023XXA

FRACTURE OF ORBITAL FLOOR INIT ENCNTR FOR CLOSED FRACTURE

T3441XA

FROSTBITE WITH TISSUE NECROSIS OF RIGHT ARM INIT ENCNTR

S023XXB

FRACTURE OF ORBITAL FLOOR INIT ENCNTR FOR OPEN FRACTURE

T3442XA

FROSTBITE WITH TISSUE NECROSIS OF LEFT ARM INIT ENCNTR

S02400A

MALAR FRACTURE UNSPECIFIED INIT ENCNTR FOR CLOSED FRACTURE

T34511A

FROSTBITE WITH TISSUE NECROSIS OF RIGHT WRIST INIT ENCNTR

S02400B

MALAR FRACTURE UNSPECIFIED INIT ENCNTR FOR OPEN FRACTURE

T34512A

FROSTBITE WITH TISSUE NECROSIS OF LEFT WRIST INIT ENCNTR

S02401A

MAXILLARY FRACTURE UNSP INIT ENCNTR FOR CLOSED FRACTURE

T34519A

FROSTBITE WITH TISSUE NECROSIS OF UNSP WRIST INIT ENCNTR

S02401B

MAXILLARY FRACTURE UNSP INIT ENCNTR FOR OPEN FRACTURE

T34521A

FROSTBITE WITH TISSUE NECROSIS OF RIGHT HAND INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S02402A

ZYGOMATIC FRACTURE UNSP INIT ENCNTR FOR CLOSED FRACTURE

T34522A

FROSTBITE WITH TISSUE NECROSIS OF LEFT HAND INIT ENCNTR

S02402B

ZYGOMATIC FRACTURE UNSP INIT ENCNTR FOR OPEN FRACTURE

T34529A

FROSTBITE WITH TISSUE NECROSIS OF UNSP HAND INIT ENCNTR

S0240AA Malar fracture right side initial encounter for closed fracture

T34531A

FROSTBITE W TISSUE NECROSIS OF RIGHT FINGER(S) INIT ENCNTR

S0240AB Malar fracture right side initial encounter for open fracture

T34532A

FROSTBITE W TISSUE NECROSIS OF LEFT FINGER(S) INIT ENCNTR

S0240BA Malar fracture left side initial encounter for closed fracture

T34539A

FROSTBITE W TISSUE NECROSIS OF UNSP FINGER(S) INIT ENCNTR

S0240BB Malar fracture left side initial encounter for open fracture

T3460XA

FROSTBITE W TISSUE NECROSIS OF UNSP HIP AND THIGH INIT

S0240CA

Maxillary fracture right side initial encounter for closed fracture

T3461XA

FROSTBITE W TISSUE NECROSIS OF RIGHT HIP AND THIGH INIT

S0240CB

Maxillary fracture right side initial encounter for open fracture

T3462XA

FROSTBITE W TISSUE NECROSIS OF LEFT HIP AND THIGH INIT

S0240DA

Maxillary fracture left side initial encounter for closed fracture

T3470XA

FROSTBITE W TISSUE NECROSIS OF UNSP KNEE AND LOWER LEG INIT

S0240DB

Maxillary fracture left side initial encounter for open fracture

T3471XA

FROSTBITE W TISSUE NECROS RIGHT KNEE AND LOWER LEG INIT

S0240EA

Zygomatic fracture right side initial encounter for closed fracture

T3472XA

FROSTBITE W TISSUE NECROSIS OF LEFT KNEE AND LOWER LEG INIT

S0240EB

Zygomatic fracture right side initial encounter for open fracture

T34811A

FROSTBITE WITH TISSUE NECROSIS OF RIGHT ANKLE INIT ENCNTR

S0240FA

Zygomatic fracture left side initial encounter for closed fracture

T34812A

FROSTBITE WITH TISSUE NECROSIS OF LEFT ANKLE INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0240FB

Zygomatic fracture left side initial encounter for open fracture

T34819A

FROSTBITE WITH TISSUE NECROSIS OF UNSP ANKLE INIT ENCNTR

S02411A

LEFORT I FRACTURE INITIAL ENCOUNTER FOR CLOSED FRACTURE

T34821A

FROSTBITE WITH TISSUE NECROSIS OF RIGHT FOOT INIT ENCNTR

S02411B

LEFORT I FRACTURE INITIAL ENCOUNTER FOR OPEN FRACTURE

T34822A

FROSTBITE WITH TISSUE NECROSIS OF LEFT FOOT INIT ENCNTR

S02412A

LEFORT II FRACTURE INITIAL ENCOUNTER FOR CLOSED FRACTURE

T34829A

FROSTBITE WITH TISSUE NECROSIS OF UNSP FOOT INIT ENCNTR

S02412B

LEFORT II FRACTURE INITIAL ENCOUNTER FOR OPEN FRACTURE

T34831A

FROSTBITE WITH TISSUE NECROSIS OF RIGHT TOE(S) INIT ENCNTR

S02413A

LEFORT III FRACTURE INITIAL ENCOUNTER FOR CLOSED FRACTURE

T34832A

FROSTBITE WITH TISSUE NECROSIS OF LEFT TOE(S) INIT ENCNTR

S02413B

LEFORT III FRACTURE INITIAL ENCOUNTER FOR OPEN FRACTURE

T34839A

FROSTBITE WITH TISSUE NECROSIS OF UNSP TOE(S) INIT ENCNTR

S0242XA FRACTURE OF ALVEOLUS OF MAXILLA INIT FOR CLOS FX

T3490XA

FROSTBITE WITH TISSUE NECROSIS OF UNSP SITES INIT ENCNTR

S0242XB FRACTURE OF ALVEOLUS OF MAXILLA INIT FOR OPN FX

T3499XA

FROSTBITE WITH TISSUE NECROSIS OF OTHER SITES INIT ENCNTR

S02600A

FRACTURE OF UNSP PART OF BODY OF MANDIBLE INIT FOR CLOS FX

T360X1A

POISONING BY PENICILLINS ACCIDENTAL (UNINTENTIONAL) INIT

S02600B

FRACTURE OF UNSP PART OF BODY OF MANDIBLE INIT FOR OPN FX

T360X2A

POISONING BY PENICILLINS INTENTIONAL SELF-HARM INIT ENCNTR

S02600D

FX UNSP PART OF BODY OF MANDIBLE SUBS FOR FX W ROUTN HEAL

T360X3A

POISONING BY PENICILLINS ASSAULT INITIAL ENCOUNTER

S02600G

FX UNSP PART OF BODY OF MANDIBLE SUBS FOR FX W DELAY HEAL

T360X4A

POISONING BY PENICILLINS UNDETERMINED INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S02600K

FX UNSP PART OF BODY OF MANDIBLE SUBS FOR FX W NONUNION

T361X1A

POISONING BY CEPHALOSPOR/OTH BETA-LACTM ANTIBIOT ACC INIT

S02600S

FRACTURE OF UNSPECIFIED PART OF BODY OF MANDIBLE SEQUELA

T361X2A

POISN BY CEPHALOSPOR/OTH BETA-LACTM ANTIBIOT SLF-HRM INIT

S02601A

Fracture of unspecified part of body of right mandible initial encounter for closed fracture

T361X3A

POISN BY CEPHALOSPOR/OTH BETA-LACTM ANTIBIOT ASSAULT INIT

S02601B

Fracture of unspecified part of body of right mandible initial encounter for open fracture

T361X4A

POISN BY CEPHALOSPOR/OTH BETA-LACTM ANTIBIOT UNDET INIT

S02602A

Fracture of unspecified part of body of left mandible initial encounter for closed fracture

T362X1A

POISONING BY CHLORAMPHENICOL GROUP ACCIDENTAL INIT

S02602B

Fracture of unspecified part of body of left mandible initial encounter for open fracture

T362X2A

POISONING BY CHLORAMPHENICOL GROUP SELF-HARM INIT

S02609A

FRACTURE OF MANDIBLE UNSP INIT ENCNTR FOR CLOSED FRACTURE

T362X3A

POISONING BY CHLORAMPHENICOL GROUP ASSAULT INIT ENCNTR

S02609B

FRACTURE OF MANDIBLE UNSP INIT ENCNTR FOR OPEN FRACTURE

T362X4A

POISONING BY CHLORAMPHENICOL GROUP UNDETERMINED INIT

S02609D FRACTURE OF MANDIBLE UNSP SUBS FOR FX W ROUTN HEAL

T363X1A

POISONING BY MACROLIDES ACCIDENTAL (UNINTENTIONAL) INIT

S02609G FRACTURE OF MANDIBLE UNSP SUBS FOR FX W DELAY HEAL

T363X2A

POISONING BY MACROLIDES INTENTIONAL SELF-HARM INIT ENCNTR

S02609K FRACTURE OF MANDIBLE UNSP SUBS FOR FX W NONUNION

T363X3A

POISONING BY MACROLIDES ASSAULT INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S02609S FRACTURE OF MANDIBLE UNSPECIFIED SEQUELA

T363X4A

POISONING BY MACROLIDES UNDETERMINED INITIAL ENCOUNTER

S02610A

Fracture of condylar process of mandible unspecified side initial encounter for closed fracture

T364X1A

POISONING BY TETRACYCLINES ACCIDENTAL (UNINTENTIONAL) INIT

S02610B

Fracture of condylar process of mandible unspecified side initial encounter for open fracture

T364X2A

POISONING BY TETRACYCLINES INTENTIONAL SELF-HARM INIT

S02611A

Fracture of condylar process of right mandible initial encounter for closed fracture

T364X3A

POISONING BY TETRACYCLINES ASSAULT INITIAL ENCOUNTER

S02611B

Fracture of condylar process of right mandible initial encounter for open fracture

T364X4A

POISONING BY TETRACYCLINES UNDETERMINED INITIAL ENCOUNTER

S02612A

Fracture of condylar process of left mandible initial encounter for closed fracture

T365X1A

POISONING BY AMINOGLYCOSIDES ACCIDENTAL INIT

S02612B

Fracture of condylar process of left mandible initial encounter for open fracture

T365X2A

POISONING BY AMINOGLYCOSIDES INTENTIONAL SELF-HARM INIT

S0261XA

FRACTURE OF CONDYLAR PROCESS OF MANDIBLE INIT FOR CLOS FX

T365X3A

POISONING BY AMINOGLYCOSIDES ASSAULT INITIAL ENCOUNTER

S0261XB

FRACTURE OF CONDYLAR PROCESS OF MANDIBLE INIT FOR OPN FX

T365X4A

POISONING BY AMINOGLYCOSIDES UNDETERMINED INIT ENCNTR

S0261XD

FX CONDYLAR PROCESS OF MANDIBLE SUBS FOR FX W ROUTN HEAL

T366X1A

POISONING BY RIFAMPICINS ACCIDENTAL (UNINTENTIONAL) INIT

S0261XG

FX CONDYLAR PROCESS OF MANDIBLE SUBS FOR FX W DELAY HEAL

T366X2A

POISONING BY RIFAMPICINS INTENTIONAL SELF-HARM INIT ENCNTR

S0261XK

FX CONDYLAR PROCESS OF MANDIBLE SUBS FOR FX W NONUNION

T366X3A

POISONING BY RIFAMPICINS ASSAULT INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0261XS

FRACTURE OF CONDYLAR PROCESS OF MANDIBLE SEQUELA

T366X4A

POISONING BY RIFAMPICINS UNDETERMINED INITIAL ENCOUNTER

S02620A

Fracture of subcondylar process of mandible unspecified side initial encounter for closed fracture

T367X1A

POISONING BY ANTIFUNGAL ANTIBIOT SYS USED ACC INIT

S02620B

Fracture of subcondylar process of mandible unspecified side initial encounter for open fracture

T367X2A

POISONING BY ANTIFUNGAL ANTIBIOT SYS USED SELF-HARM INIT

S02621A

Fracture of subcondylar process of right mandible initial encounter for closed fracture

T367X3A

POISONING BY ANTIFUNGAL ANTIBIOTICS SYS USED ASSAULT INIT

S02621B

Fracture of subcondylar process of right mandible initial encounter for open fracture

T367X4A

POISONING BY ANTIFUNGAL ANTIBIOTICS SYS USED UNDET INIT

S02622A

Fracture of subcondylar process of left mandible initial encounter for closed fracture

T368X1A

POISONING BY OTH SYSTEMIC ANTIBIOTICS ACCIDENTAL INIT

S02622B

Fracture of subcondylar process of left mandible initial encounter for open fracture

T368X2A

POISONING BY OTH SYSTEMIC ANTIBIOTICS SELF-HARM INIT

S0262XA FRACTURE OF SUBCONDYLAR PROCESS OF MANDIBLE INIT

T368X3A

POISONING BY OTH SYSTEMIC ANTIBIOTICS ASSAULT INIT ENCNTR

S0262XB

FRACTURE OF SUBCONDYLAR PROCESS OF MANDIBLE INIT FOR OPN FX

T368X4A

POISONING BY OTH SYSTEMIC ANTIBIOTICS UNDETERMINED INIT

S0262XD

FX SUBCONDYLAR PROCESS OF MANDIBLE SUBS FOR FX W ROUTN HEAL

T3691XA

POISONING BY UNSP SYSTEMIC ANTIBIOTIC ACCIDENTAL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0262XG

FX SUBCONDYLAR PROCESS OF MANDIBLE SUBS FOR FX W DELAY HEAL

T3692XA

POISONING BY UNSP SYSTEMIC ANTIBIOTIC SELF-HARM INIT

S0262XK

FX SUBCONDYLAR PROCESS OF MANDIBLE SUBS FOR FX W NONUNION

T3693XA

POISONING BY UNSP SYSTEMIC ANTIBIOTIC ASSAULT INIT ENCNTR

S0262XS

FRACTURE OF SUBCONDYLAR PROCESS OF MANDIBLE SEQUELA

T3694XA

POISONING BY UNSP SYSTEMIC ANTIBIOTIC UNDETERMINED INIT

S02630A

Fracture of coronoid process of mandible unspecified side initial encounter for closed fracture

T370X1A

POISONING BY SULFONAMIDES ACCIDENTAL (UNINTENTIONAL) INIT

S02630B

Fracture of coronoid process of mandible unspecified side initial encounter for open fracture

T370X2A

POISONING BY SULFONAMIDES INTENTIONAL SELF-HARM INIT

S02631A

Fracture of coronoid process of right mandible initial encounter for closed fracture

T370X3A

POISONING BY SULFONAMIDES ASSAULT INITIAL ENCOUNTER

S02631B

Fracture of coronoid process of right mandible initial encounter for open fracture

T370X4A

POISONING BY SULFONAMIDES UNDETERMINED INITIAL ENCOUNTER

S02632A

Fracture of coronoid process of left mandible initial encounter for closed fracture

T371X1A

POISONING BY ANTIMYCOBAC DRUGS ACCIDENTAL INIT

S02632B

Fracture of coronoid process of left mandible initial encounter for open fracture

T371X2A

POISONING BY ANTIMYCOBACTERIAL DRUGS SELF-HARM INIT

S0263XA

FRACTURE OF CORONOID PROCESS OF MANDIBLE INIT FOR CLOS FX

T371X3A

POISONING BY ANTIMYCOBACTERIAL DRUGS ASSAULT INIT ENCNTR

S0263XB

FRACTURE OF CORONOID PROCESS OF MANDIBLE INIT FOR OPN FX

T371X4A

POISONING BY ANTIMYCOBACTERIAL DRUGS UNDETERMINED INIT

S0263XD

FX CORONOID PROCESS OF MANDIBLE SUBS FOR FX W ROUTN HEAL

T372X1A

POISN BY ANTIMALARI/DRUGS ACTING ON BLD PROTZOA ACC INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0263XG

FX CORONOID PROCESS OF MANDIBLE SUBS FOR FX W DELAY HEAL

T372X2A

POISN BY ANTIMALARI/DRUGS ACT ON BLD PROTZOA SLF-HRM INIT

S0263XK

FX CORONOID PROCESS OF MANDIBLE SUBS FOR FX W NONUNION

T372X3A

POISN BY ANTIMALARI/DRUGS ACTING ON BLD PROTZOA ASSLT INIT

S0263XS

FRACTURE OF CORONOID PROCESS OF MANDIBLE SEQUELA

T372X4A

POISN BY ANTIMALARI/DRUGS ACTING ON BLD PROTZOA UNDET INIT

S02640A

Fracture of ramus of mandible unspecified side initial encounter for closed fracture

T373X1A

POISONING BY OTH ANTIPROTOZOAL DRUGS ACCIDENTAL INIT

S02640B

Fracture of ramus of mandible unspecified side initial encounter for open fracture

T373X2A

POISONING BY OTH ANTIPROTOZOAL DRUGS SELF-HARM INIT

S02641A

Fracture of ramus of right mandible initial encounter for closed fracture

T373X3A

POISONING BY OTHER ANTIPROTOZOAL DRUGS ASSAULT INIT ENCNTR

S02641B

Fracture of ramus of right mandible initial encounter for open fracture

T373X4A

POISONING BY OTH ANTIPROTOZOAL DRUGS UNDETERMINED INIT

S02642A

Fracture of ramus of left mandible initial encounter for closed fracture

T374X1A

POISONING BY ANTHELMINTHICS ACCIDENTAL INIT

S02642B

Fracture of ramus of left mandible initial encounter for open fracture

T374X2A

POISONING BY ANTHELMINTHICS INTENTIONAL SELF-HARM INIT

S0264XA FRACTURE OF RAMUS OF MANDIBLE INIT FOR CLOS FX

T374X3A

POISONING BY ANTHELMINTHICS ASSAULT INITIAL ENCOUNTER

S0264XB

FRACTURE OF RAMUS OF MANDIBLE INIT ENCNTR FOR OPEN FRACTURE

T374X4A

POISONING BY ANTHELMINTHICS UNDETERMINED INITIAL ENCOUNTER

S0264XD

FRACTURE OF RAMUS OF MANDIBLE SUBS FOR FX W ROUTN HEAL

T375X1A

POISONING BY ANTIVIRAL DRUGS ACCIDENTAL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0264XG

FRACTURE OF RAMUS OF MANDIBLE SUBS FOR FX W DELAY HEAL

T375X2A

POISONING BY ANTIVIRAL DRUGS INTENTIONAL SELF-HARM INIT

S0264XK

FRACTURE OF RAMUS OF MANDIBLE SUBS FOR FX W NONUNION

T375X3A

POISONING BY ANTIVIRAL DRUGS ASSAULT INITIAL ENCOUNTER

S0264XS FRACTURE OF RAMUS OF MANDIBLE SEQUELA

T375X4A

POISONING BY ANTIVIRAL DRUGS UNDETERMINED INIT ENCNTR

S02650A

Fracture of angle of mandible unspecified side initial encounter for closed fracture

T378X1A

POISONING BY OTH SYSTEMIC ANTI-INFECT/PARASIT ACC INIT

S02650B

Fracture of angle of mandible unspecified side initial encounter for open fracture

T378X2A

POISN BY OTH SYSTEMIC ANTI-INFECT/PARASIT SELF-HARM INIT

S02651A

Fracture of angle of right mandible initial encounter for closed fracture

T378X3A

POISONING BY OTH SYSTEMIC ANTI-INFECT/PARASIT ASSAULT INIT

S02651B

Fracture of angle of right mandible initial encounter for open fracture

T378X4A

POISONING BY OTH SYSTEMIC ANTI-INFECT/PARASIT UNDET INIT

S02652A

Fracture of angle of left mandible initial encounter for closed fracture

T3791XA

POISN BY UNSP SYS ANTI-INFECT AND ANTIPARASTC ACC INIT

S02652B

Fracture of angle of left mandible initial encounter for open fracture

T3792XA

POISN BY UNSP SYS ANTI-INFECT AND ANTIPARASTC SLF-HRM INIT

S0265XA FRACTURE OF ANGLE OF MANDIBLE INIT FOR CLOS FX

T3793XA

POISN BY UNSP SYS ANTI-INFECT AND ANTIPARASTC ASSAULT INIT

S0265XB

FRACTURE OF ANGLE OF MANDIBLE INIT ENCNTR FOR OPEN FRACTURE

T3794XA

POISN BY UNSP SYS ANTI-INFECT AND ANTIPARASTC UNDET INIT

S0265XD

FRACTURE OF ANGLE OF MANDIBLE SUBS FOR FX W ROUTN HEAL

T380X1A

POISONING BY GLUCOCORT/SYNTH ANALOG ACCIDENTAL INIT

S0265XG

FRACTURE OF ANGLE OF MANDIBLE SUBS FOR FX W DELAY HEAL

T380X2A

POISONING BY GLUCOCORT/SYNTH ANALOG SELF-HARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0265XK

FRACTURE OF ANGLE OF MANDIBLE SUBS FOR FX W NONUNION

T380X3A

POISONING BY GLUCOCORT/SYNTH ANALOG ASSAULT INIT

S0265XS FRACTURE OF ANGLE OF MANDIBLE SEQUELA

T380X4A

POISONING BY GLUCOCORT/SYNTH ANALOG UNDETERMINED INIT

S0266XA FRACTURE OF SYMPHYSIS OF MANDIBLE INIT FOR CLOS FX

T381X1A

POISONING BY THYROID HORMONES AND SUB ACCIDENTAL INIT

S0266XB FRACTURE OF SYMPHYSIS OF MANDIBLE INIT FOR OPN FX

T381X2A

POISONING BY THYROID HORMONES AND SUB SELF-HARM INIT

S0266XD

FRACTURE OF SYMPHYSIS OF MANDIBLE SUBS FOR FX W ROUTN HEAL

T381X3A

POISONING BY THYROID HORMONES AND SUBSTITUTES ASSAULT INIT

S0266XG

FRACTURE OF SYMPHYSIS OF MANDIBLE SUBS FOR FX W DELAY HEAL

T381X4A

POISONING BY THYROID HORMONES AND SUBSTITUTES UNDET INIT

S0266XK

FRACTURE OF SYMPHYSIS OF MANDIBLE SUBS FOR FX W NONUNION

T382X1A

POISONING BY ANTITHYROID DRUGS ACCIDENTAL INIT

S0266XS FRACTURE OF SYMPHYSIS OF MANDIBLE SEQUELA

T382X2A

POISONING BY ANTITHYROID DRUGS INTENTIONAL SELF-HARM INIT

S02670A

Fracture of alveolus of mandible unspecified side initial encounter for closed fracture

T382X3A

POISONING BY ANTITHYROID DRUGS ASSAULT INITIAL ENCOUNTER

S02670B

Fracture of alveolus of mandible unspecified side initial encounter for open fracture

T382X4A

POISONING BY ANTITHYROID DRUGS UNDETERMINED INIT ENCNTR

S02671A

Fracture of alveolus of right mandible initial encounter for closed fracture

T383X1A

POISONING BY INSULIN AND ORAL HYPOGLYCEMIC DRUGS ACC INIT

S02671B

Fracture of alveolus of right mandible initial encounter for open fracture

T383X2A

POISN BY INSULIN AND ORAL HYPOGLYCEMIC DRUGS SLF-HRM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S02672A

Fracture of alveolus of left mandible initial encounter for closed fracture

T383X3A

POISN BY INSULIN AND ORAL HYPOGLYCEMIC DRUGS ASSAULT INIT

S02672B

Fracture of alveolus of left mandible initial encounter for open fracture

T383X4A

POISN BY INSULIN AND ORAL HYPOGLYCEMIC DRUGS UNDET INIT

S0267XA FRACTURE OF ALVEOLUS OF MANDIBLE INIT FOR CLOS FX

T384X1A

POISONING BY ORAL CONTRACEPTIVES ACCIDENTAL INIT

S0267XB FRACTURE OF ALVEOLUS OF MANDIBLE INIT FOR OPN FX

T384X2A

POISONING BY ORAL CONTRACEPTIVES SELF-HARM INIT

S0267XD

FRACTURE OF ALVEOLUS OF MANDIBLE SUBS FOR FX W ROUTN HEAL

T384X3A

POISONING BY ORAL CONTRACEPTIVES ASSAULT INITIAL ENCOUNTER

S0267XG

FRACTURE OF ALVEOLUS OF MANDIBLE SUBS FOR FX W DELAY HEAL

T384X4A

POISONING BY ORAL CONTRACEPTIVES UNDETERMINED INIT ENCNTR

S0267XK

FRACTURE OF ALVEOLUS OF MANDIBLE SUBS FOR FX W NONUNION

T385X1A

POISONING BY OTH ESTROGENS AND PROGSTRN ACCIDENTAL INIT

S0267XS FRACTURE OF ALVEOLUS OF MANDIBLE SEQUELA

T385X2A

POISONING BY OTH ESTROGENS AND PROGESTOGENS SELF-HARM INIT

S0269XA FRACTURE OF MANDIBLE OF OTH SITE INIT FOR CLOS FX

T385X3A

POISONING BY OTH ESTROGENS AND PROGESTOGENS ASSAULT INIT

S0269XB FRACTURE OF MANDIBLE OF OTH SITE INIT FOR OPN FX

T385X4A

POISONING BY OTH ESTROGENS AND PROGSTRN UNDETERMINED INIT

S0269XD

FRACTURE OF MANDIBLE OF OTH SITE SUBS FOR FX W ROUTN HEAL

T386X1A

POISONING BY ANTIGONADTR/ANTIESTR/ANTIANDRG NEC ACC INIT

S0269XG

FRACTURE OF MANDIBLE OF OTH SITE SUBS FOR FX W DELAY HEAL

T386X2A

POISN BY ANTIGONADTR/ANTIESTR/ANTIANDRG NEC SLF-HRM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0269XK

FRACTURE OF MANDIBLE OF OTH SITE SUBS FOR FX W NONUNION

T386X3A

POISN BY ANTIGONADTR/ANTIESTR/ANTIANDRG NEC ASSAULT INIT

S0269XS FRACTURE OF MANDIBLE OF OTHER SPECIFIED SITE SEQUELA

T386X4A

POISN BY ANTIGONADTR/ANTIESTR/ANTIANDRG NEC UNDET INIT

S0280XA

Fracture of other specified skull and facial bones unspecified side initial encounter for closed fracture

T387X1A

POISONING BY ANDROGENS AND ANABOLIC CONGENERS ACC INIT

S0280XB

Fracture of other specified skull and facial bones unspecified side initial encounter for open fracture

T387X2A

POISN BY ANDROGENS AND ANABOLIC CONGENERS SELF-HARM INIT

S0281XA

Fracture of other specified skull and facial bones right side initial encounter for closed fracture

T387X3A

POISONING BY ANDROGENS AND ANABOLIC CONGENERS ASSAULT INIT

S0281XB

Fracture of other specified skull and facial bones right side initial encounter for open fracture

T387X4A

POISONING BY ANDROGENS AND ANABOLIC CONGENERS UNDET INIT

S0282XA

Fracture of other specified skull and facial bones left side initial encounter for closed fracture

T38801A

POISONING BY UNSP HORMONES AND SYNTHETIC SUB ACC INIT

S0282XB

Fracture of other specified skull and facial bones left side initial encounter for open fracture

T38802A

POISN BY UNSP HORMONES AND SYNTHETIC SUB SELF-HARM INIT

S028XXA FRACTURES OF OTH SKULL AND FACIAL BONES INIT FOR CLOS FX

T38803A

POISONING BY UNSP HORMONES AND SYNTHETIC SUB ASSAULT INIT

S028XXB FRACTURES OF OTH SKULL AND FACIAL BONES INIT FOR OPN FX

T38804A

POISONING BY UNSP HORMONES AND SYNTHETIC SUB UNDET INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0291XA

UNSP FRACTURE OF SKULL INIT ENCNTR FOR CLOSED FRACTURE

T38811A

POISONING BY ANTERIOR PITUITARY HORMONES ACCIDENTAL INIT

S0291XB

UNSPECIFIED FRACTURE OF SKULL INIT ENCNTR FOR OPEN FRACTURE

T38812A

POISONING BY ANTERIOR PITUITARY HORMONES SELF-HARM INIT

S0292XA UNSP FRACTURE OF FACIAL BONES INIT FOR CLOS FX

T38813A

POISONING BY ANTERIOR PITUITARY HORMONES ASSAULT INIT

S0292XB

UNSP FRACTURE OF FACIAL BONES INIT ENCNTR FOR OPEN FRACTURE

T38814A

POISONING BY ANTERIOR PITUITARY HORMONES UNDETERMINED INIT

S0300XA Dislocation of jaw unspecified side initial encounter

T38891A

POISONING BY OTH HORMONES AND SYNTHETIC SUB ACC INIT

S0301XA Dislocation of jaw right side initial encounter

T38892A

POISONING BY OTH HORMONES AND SYNTHETIC SUB SELF-HARM INIT

S0302XA Dislocation of jaw left side initial encounter

T38893A

POISONING BY OTH HORMONES AND SYNTHETIC SUB ASSAULT INIT

S0303XA Dislocation of jaw bilateral initial encounter

T38894A

POISONING BY OTH HORMONES AND SYNTHETIC SUB UNDET INIT

S030XXA DISLOCATION OF JAW INITIAL ENCOUNTER

T38901A

POISONING BY UNSP HORMONE ANTAGONISTS ACCIDENTAL INIT

S031XXA

DISLOCATION OF SEPTAL CARTILAGE OF NOSE INITIAL ENCOUNTER

T38902A

POISONING BY UNSP HORMONE ANTAGONISTS SELF-HARM INIT

S032XXA DISLOCATION OF TOOTH INITIAL ENCOUNTER

T38903A

POISONING BY UNSP HORMONE ANTAGONISTS ASSAULT INIT ENCNTR

S0340XA Sprain of jaw unspecified side initial encounter

T38904A

POISONING BY UNSP HORMONE ANTAGONISTS UNDETERMINED INIT

S0341XA Sprain of jaw right side initial encounter

T38991A

POISONING BY OTH HORMONE ANTAGONISTS ACCIDENTAL INIT

S0342XA Sprain of jaw left side initial encounter

T38992A

POISONING BY OTH HORMONE ANTAGONISTS SELF-HARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0343XA Sprain of jaw bilateral initial encounter

T38993A

POISONING BY OTHER HORMONE ANTAGONISTS ASSAULT INIT ENCNTR

S034XXA SPRAIN OF JAW INITIAL ENCOUNTER

T38994A

POISONING BY OTH HORMONE ANTAGONISTS UNDETERMINED INIT

S038XXA

SPRAIN OF JOINTS AND LIGAMENTS OF OTH PRT HEAD INIT ENCNTR

T39011A

POISONING BY ASPIRIN ACCIDENTAL (UNINTENTIONAL) INIT

S039XXA

SPRAIN OF JOINTS AND LIGAMENTS OF UNSP PARTS OF HEAD INIT

T39012A

POISONING BY ASPIRIN INTENTIONAL SELF-HARM INIT ENCNTR

S04011A INJURY OF OPTIC NERVE RIGHT EYE INITIAL ENCOUNTER

T39013A

POISONING BY ASPIRIN ASSAULT INITIAL ENCOUNTER

S04012A INJURY OF OPTIC NERVE LEFT EYE INITIAL ENCOUNTER

T39014A

POISONING BY ASPIRIN UNDETERMINED INITIAL ENCOUNTER

S04019A

INJURY OF OPTIC NERVE UNSPECIFIED EYE INITIAL ENCOUNTER

T39091A

POISONING BY SALICYLATES ACCIDENTAL (UNINTENTIONAL) INIT

S0402XA INJURY OF OPTIC CHIASM INITIAL ENCOUNTER

T39092A

POISONING BY SALICYLATES INTENTIONAL SELF-HARM INIT ENCNTR

S04031A

INJURY OF OPTIC TRACT AND PATHWAYS RIGHT EYE INIT ENCNTR

T39093A

POISONING BY SALICYLATES ASSAULT INITIAL ENCOUNTER

S04032A

INJURY OF OPTIC TRACT AND PATHWAYS LEFT EYE INIT ENCNTR

T39094A

POISONING BY SALICYLATES UNDETERMINED INITIAL ENCOUNTER

S04039A

INJURY OF OPTIC TRACT AND PATHWAYS UNSP EYE INIT ENCNTR

T391X1A

POISONING BY 4-AMINOPHENOL DERIVATIVES ACCIDENTAL INIT

S04041A INJURY OF VISUAL CORTEX RIGHT EYE INITIAL ENCOUNTER

T391X2A

POISONING BY 4-AMINOPHENOL DERIVATIVES SELF-HARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S04042A INJURY OF VISUAL CORTEX LEFT EYE INITIAL ENCOUNTER

T391X3A

POISONING BY 4-AMINOPHENOL DERIVATIVES ASSAULT INIT ENCNTR

S0410XA

INJURY OF OCULOMOTOR NERVE UNSPECIFIED SIDE INIT ENCNTR

T391X4A

POISONING BY 4-AMINOPHENOL DERIVATIVES UNDETERMINED INIT

S0411XA

INJURY OF OCULOMOTOR NERVE RIGHT SIDE INITIAL ENCOUNTER

T392X1A

POISONING BY PYRAZOLONE DERIVATIVES ACCIDENTAL INIT

S0412XA

INJURY OF OCULOMOTOR NERVE LEFT SIDE INITIAL ENCOUNTER

T392X2A

POISONING BY PYRAZOLONE DERIVATIVES SELF-HARM INIT

S0421XA INJURY OF TROCHLEAR NERVE RIGHT SIDE INITIAL ENCOUNTER

T392X3A

POISONING BY PYRAZOLONE DERIVATIVES ASSAULT INIT ENCNTR

S0422XA INJURY OF TROCHLEAR NERVE LEFT SIDE INITIAL ENCOUNTER

T392X4A

POISONING BY PYRAZOLONE DERIVATIVES UNDETERMINED INIT

S0431XA INJURY OF TRIGEMINAL NERVE RIGHT SIDE INITIAL ENCOUNTER

T39311A

POISONING BY PROPIONIC ACID DERIVATIVES ACCIDENTAL INIT

S0432XA INJURY OF TRIGEMINAL NERVE LEFT SIDE INITIAL ENCOUNTER

T39312A

POISONING BY PROPIONIC ACID DERIVATIVES SELF-HARM INIT

S0441XA INJURY OF ABDUCENT NERVE RIGHT SIDE INITIAL ENCOUNTER

T39313A

POISONING BY PROPIONIC ACID DERIVATIVES ASSAULT INIT

S0442XA INJURY OF ABDUCENT NERVE LEFT SIDE INITIAL ENCOUNTER

T39314A

POISONING BY PROPIONIC ACID DERIVATIVES UNDETERMINED INIT

S0451XA INJURY OF FACIAL NERVE RIGHT SIDE INITIAL ENCOUNTER

T39391A

POISONING BY OTH NONSTEROID ANTI-INFLAM DRUGS ACC INIT

S0452XA INJURY OF FACIAL NERVE LEFT SIDE INITIAL ENCOUNTER

T39392A

POISN BY OTH NONSTEROID ANTI-INFLAM DRUGS SELF-HARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0461XA INJURY OF ACOUSTIC NERVE RIGHT SIDE INITIAL ENCOUNTER

T39393A

POISONING BY OTH NONSTEROID ANTI-INFLAM DRUGS ASSAULT INIT

S0462XA INJURY OF ACOUSTIC NERVE LEFT SIDE INITIAL ENCOUNTER

T39394A

POISONING BY OTH NONSTEROID ANTI-INFLAM DRUGS UNDET INIT

S0471XA INJURY OF ACCESSORY NERVE RIGHT SIDE INITIAL ENCOUNTER

T394X1A

POISONING BY ANTIRHEUMATICS NEC ACCIDENTAL INIT

S0472XA INJURY OF ACCESSORY NERVE LEFT SIDE INITIAL ENCOUNTER

T394X2A

POISONING BY ANTIRHEUMATICS NEC SELF-HARM INIT

S04811A INJURY OF OLFACTORY NERVE RIGHT SIDE INITIAL ENCOUNTER

T394X3A

POISONING BY ANTIRHEUMATICS NEC ASSAULT INIT

S04812A INJURY OF OLFACTORY NERVE LEFT SIDE INITIAL ENCOUNTER

T394X4A

POISONING BY ANTIRHEUMATICS NEC UNDETERMINED INIT

S04891A

INJURY OF OTHER CRANIAL NERVES RIGHT SIDE INIT ENCNTR

T398X1A

POISONING BY OTH NONOPIO ANALGES/ANTIPYRET NEC ACC INIT

S04892A

INJURY OF OTHER CRANIAL NERVES LEFT SIDE INITIAL ENCOUNTER

T398X2A

POISN BY OTH NONOPIO ANALGES/ANTIPYRET NEC SELF-HARM INIT

S04899A

INJURY OF OTHER CRANIAL NERVES UNSP SIDE INIT ENCNTR

T398X3A

POISN BY OTH NONOPIO ANALGES/ANTIPYRET NEC ASSAULT INIT

S049XXA

INJURY OF UNSPECIFIED CRANIAL NERVE INITIAL ENCOUNTER

T398X4A

POISONING BY OTH NONOPIO ANALGES/ANTIPYRET NEC UNDET INIT

S0500XA

INJ CONJUNCTIVA AND CORNEAL ABRASION W/O FB UNSP EYE INIT

T3991XA

POISONING BY UNSP NONOPI ANALGS/ANTIPYR/ANTIRHEU ACC INIT

S0501XA

INJ CONJUNCTIVA AND CORNEAL ABRASION W/O FB RIGHT EYE INIT

T3992XA

POISN BY UNSP NONOPI ANALGS/ANTIPYR/ANTIRHEU SLF-HRM INIT

S0502XA

INJ CONJUNCTIVA AND CORNEAL ABRASION W/O FB LEFT EYE INIT

T3993XA

POISN BY UNSP NONOPI ANALGS/ANTIPYR/ANTIRHEU ASSAULT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0510XA CONTUSION OF EYEBALL AND ORBITAL TISSUES UNSP EYE INIT

T3994XA

POISN BY UNSP NONOPI ANALGS/ANTIPYR/ANTIRHEU UNDET INIT

S0511XA

CONTUSION OF EYEBALL AND ORBITAL TISSUES RIGHT EYE INIT

T400X1A

POISONING BY OPIUM ACCIDENTAL (UNINTENTIONAL) INIT ENCNTR

S0512XA CONTUSION OF EYEBALL AND ORBITAL TISSUES LEFT EYE INIT

T400X2A

POISONING BY OPIUM INTENTIONAL SELF-HARM INITIAL ENCOUNTER

S0520XA

OCLR LAC/RUPT W PROLAPS/LOSS OF INTRAOC TISS UNSP EYE INIT

T400X3A

POISONING BY OPIUM ASSAULT INITIAL ENCOUNTER

S0521XA

OCLR LAC/RUPT W PROLAPS/LOSS OF INTRAOC TISSUE R EYE INIT

T400X4A

POISONING BY OPIUM UNDETERMINED INITIAL ENCOUNTER

S0522XA

OCLR LAC/RUPT W PROLAPS/LOSS OF INTRAOC TISSUE L EYE INIT

T401X1A

POISONING BY HEROIN ACCIDENTAL (UNINTENTIONAL) INIT ENCNTR

S0530XA

OCLR LAC W/O PROLAPS/LOSS OF INTRAOC TISSUE UNSP EYE INIT

T401X2A

POISONING BY HEROIN INTENTIONAL SELF-HARM INIT ENCNTR

S0531XA

OCULAR LAC W/O PROLAPS/LOSS OF INTRAOC TISSUE R EYE INIT

T401X3A

POISONING BY HEROIN ASSAULT INITIAL ENCOUNTER

S0532XA

OCULAR LAC W/O PROLAPS/LOSS OF INTRAOC TISSUE L EYE INIT

T401X4A

POISONING BY HEROIN UNDETERMINED INITIAL ENCOUNTER

S0540XA

PENETRATING WOUND OF ORBIT W OR W/O FB UNSP EYE INIT

T402X1A

POISONING BY OTH OPIOIDS ACCIDENTAL (UNINTENTIONAL) INIT

S0541XA

PENETRATING WOUND OF ORBIT W OR W/O FB RIGHT EYE INIT

T402X2A

POISONING BY OTH OPIOIDS INTENTIONAL SELF-HARM INIT ENCNTR

S0542XA

PENETRATING WOUND OF ORBIT W OR W/O FB LEFT EYE INIT

T402X3A

POISONING BY OTHER OPIOIDS ASSAULT INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0551XA

PENETRATING WOUND W FOREIGN BODY OF RIGHT EYEBALL INIT

T402X4A

POISONING BY OTHER OPIOIDS UNDETERMINED INITIAL ENCOUNTER

S0552XA

PENETRATING WOUND W FOREIGN BODY OF LEFT EYEBALL INIT

T403X1A

POISONING BY METHADONE ACCIDENTAL (UNINTENTIONAL) INIT

S0560XA

PENETRATING WOUND W/O FOREIGN BODY OF UNSP EYEBALL INIT

T403X2A

POISONING BY METHADONE INTENTIONAL SELF-HARM INIT ENCNTR

S0561XA

PENETRATING WOUND W/O FOREIGN BODY OF RIGHT EYEBALL INIT

T403X3A

POISONING BY METHADONE ASSAULT INITIAL ENCOUNTER

S0562XA

PENETRATING WOUND W/O FOREIGN BODY OF LEFT EYEBALL INIT

T403X4A

POISONING BY METHADONE UNDETERMINED INITIAL ENCOUNTER

S0570XA AVULSION OF UNSPECIFIED EYE INITIAL ENCOUNTER

T404X1A

POISONING BY OTH SYNTHETIC NARCOTICS ACCIDENTAL INIT

S0571XA AVULSION OF RIGHT EYE INITIAL ENCOUNTER

T404X2A

POISONING BY OTH SYNTHETIC NARCOTICS SELF-HARM INIT

S0572XA AVULSION OF LEFT EYE INITIAL ENCOUNTER

T404X3A

POISONING BY OTHER SYNTHETIC NARCOTICS ASSAULT INIT ENCNTR

S058X1A OTHER INJURIES OF RIGHT EYE AND ORBIT INITIAL ENCOUNTER

T404X4A

POISONING BY OTH SYNTHETIC NARCOTICS UNDETERMINED INIT

S058X2A OTHER INJURIES OF LEFT EYE AND ORBIT INITIAL ENCOUNTER

T405X1A

POISONING BY COCAINE ACCIDENTAL (UNINTENTIONAL) INIT

S058X9A

OTHER INJURIES OF UNSPECIFIED EYE AND ORBIT INIT ENCNTR

T405X2A

POISONING BY COCAINE INTENTIONAL SELF-HARM INIT ENCNTR

S0590XA

UNSPECIFIED INJURY OF UNSPECIFIED EYE AND ORBIT INIT ENCNTR

T405X3A

POISONING BY COCAINE ASSAULT INITIAL ENCOUNTER

S0591XA

UNSPECIFIED INJURY OF RIGHT EYE AND ORBIT INITIAL ENCOUNTER

T405X4A

POISONING BY COCAINE UNDETERMINED INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0592XA

UNSPECIFIED INJURY OF LEFT EYE AND ORBIT INITIAL ENCOUNTER

T40601A

POISONING BY UNSP NARCOTICS ACCIDENTAL INIT

S060X0A

CONCUSSION WITHOUT LOSS OF CONSCIOUSNESS INITIAL ENCOUNTER

T40602A

POISONING BY UNSP NARCOTICS INTENTIONAL SELF-HARM INIT

S060X1A CONCUSSION W LOC OF 30 MINUTES OR LESS INIT

T40603A

POISONING BY UNSPECIFIED NARCOTICS ASSAULT INIT ENCNTR

S060X2A

CONCUSSION W LOSS OF CONSCIOUSNESS OF 31-59 MIN INIT

T40604A

POISONING BY UNSP NARCOTICS UNDETERMINED INIT ENCNTR

S060X3A

CONCUSSION W LOSS OF CONSCIOUSNESS OF 1-5 HRS 59 MIN INIT

T40691A

POISONING BY OTH NARCOTICS ACCIDENTAL (UNINTENTIONAL) INIT

S060X4A CONCUSSION W LOC OF 6 HOURS TO 24 HOURS INIT

T40692A

POISONING BY OTH NARCOTICS INTENTIONAL SELF-HARM INIT

S060X5A CONCUSSION W LOC >24 HR W RET CONSC LEV INIT

T40693A

POISONING BY OTHER NARCOTICS ASSAULT INITIAL ENCOUNTER

S060X6A CONCUSSION W LOC >24 HR W/O RET CONSC W SURV INIT

T40694A

POISONING BY OTHER NARCOTICS UNDETERMINED INIT ENCNTR

S060X7A

CONCUSSION W LOC W DEATH DUE TO BRAIN INJURY BF CONSC INIT

T407X1A

POISONING BY CANNABIS (DERIVATIVES) ACCIDENTAL INIT

S060X8A

CONCUSSION W LOC W DEATH DUE TO OTH CAUSE BF CONSC INIT

T407X2A

POISONING BY CANNABIS (DERIVATIVES) SELF-HARM INIT

S060X9A

CONCUSSION W LOSS OF CONSCIOUSNESS OF UNSP DURATION INIT

T407X3A

POISONING BY CANNABIS (DERIVATIVES) ASSAULT INIT ENCNTR

S061X0A

TRAUMATIC CEREBRAL EDEMA W/O LOSS OF CONSCIOUSNESS INIT

T407X4A

POISONING BY CANNABIS (DERIVATIVES) UNDETERMINED INIT

S061X1A

TRAUMATIC CEREBRAL EDEMA W LOC OF 30 MINUTES OR LESS INIT

T408X1A

POISONING BY LYSERGIDE ACCIDENTAL (UNINTENTIONAL) INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S061X2A TRAUMATIC CEREBRAL EDEMA W LOC OF 31-59 MIN INIT

T408X2A

POISONING BY LYSERGIDE INTENTIONAL SELF-HARM INIT ENCNTR

S061X3A TRAUMATIC CEREBRAL EDEMA W LOC OF 1-5 HRS 59 MIN INIT

T408X3A

POISONING BY LYSERGIDE [LSD] ASSAULT INITIAL ENCOUNTER

S061X4A

TRAUMATIC CEREBRAL EDEMA W LOC OF 6 HOURS TO 24 HOURS INIT

T408X4A

POISONING BY LYSERGIDE UNDETERMINED INITIAL ENCOUNTER

S061X5A

TRAUMATIC CEREBRAL EDEMA W LOC >24 HR W RET CONSC LEV INIT

T40901A

POISONING BY UNSP PSYCHODYSLEPT ACCIDENTAL INIT

S061X6A

TRAUM CEREBRAL EDEMA W LOC >24 HR W/O RET CONSC W SURV INIT

T40902A

POISONING BY UNSP PSYCHODYSLEPTICS SELF-HARM INIT

S061X7A

TRAUM CEREB EDEMA W LOC W DEATH D/T BRAIN INJ BF CONSC INIT

T40903A

POISONING BY UNSP PSYCHODYSLEPTICS ASSAULT INIT ENCNTR

S061X8A

TRAUM CEREB EDEMA W LOC W DEATH D/T OTH CAUSE BF CONSC INIT

T40904A

POISONING BY UNSP PSYCHODYSLEPTICS UNDETERMINED INIT

S061X9A TRAUMATIC CEREBRAL EDEMA W LOC OF UNSP DURATION INIT

T40991A

POISONING BY OTH PSYCHODYSLEPT ACCIDENTAL INIT

S062X0A DIFFUSE TBI W/O LOSS OF CONSCIOUSNESS INIT

T40992A

POISONING BY OTH PSYCHODYSLEPTICS SELF-HARM INIT

S062X1A DIFFUSE TBI W LOC OF 30 MINUTES OR LESS INIT

T40993A

POISONING BY OTHER PSYCHODYSLEPTICS ASSAULT INIT ENCNTR

S062X2A

DIFFUSE TBI W LOSS OF CONSCIOUSNESS OF 31-59 MIN INIT

T40994A

POISONING BY OTH PSYCHODYSLEPTICS UNDETERMINED INIT ENCNTR

S062X3A

DIFFUSE TBI W LOSS OF CONSCIOUSNESS OF 1-5 HRS 59 MIN INIT

T410X1A

POISONING BY INHALED ANESTHETICS ACCIDENTAL INIT

S062X4A DIFFUSE TBI W LOC OF 6 HOURS TO 24 HOURS INIT

T410X2A

POISONING BY INHALED ANESTHETICS SELF-HARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S062X5A

DIFFUSE TBI W LOC >24 HR W RETURN TO CONSCIOUS LEVELS INIT

T410X3A

POISONING BY INHALED ANESTHETICS ASSAULT INITIAL ENCOUNTER

S062X6A DIFFUSE TBI W LOC >24 HR W/O RET CONSC W SURV INIT

T410X4A

POISONING BY INHALED ANESTHETICS UNDETERMINED INIT ENCNTR

S062X7A

DIFFUSE TBI W LOC W DEATH DUE TO BRAIN INJURY BF CONSC INIT

T411X1A

POISONING BY INTRAVENOUS ANESTHETICS ACCIDENTAL INIT

S062X8A

DIFFUSE TBI W LOC W DEATH DUE TO OTH CAUSE BF CONSC INIT

T411X2A

POISONING BY INTRAVENOUS ANESTHETICS SELF-HARM INIT

S062X9A

DIFFUSE TBI W LOSS OF CONSCIOUSNESS OF UNSP DURATION INIT

T411X3A

POISONING BY INTRAVENOUS ANESTHETICS ASSAULT INIT ENCNTR

S06300A UNSP FOCAL TBI W/O LOSS OF CONSCIOUSNESS INIT

T411X4A

POISONING BY INTRAVENOUS ANESTHETICS UNDETERMINED INIT

S06301A UNSP FOCAL TBI W LOC OF 30 MINUTES OR LESS INIT

T41201A

POISONING BY UNSP GENERAL ANESTHETICS ACCIDENTAL INIT

S06302A

UNSP FOCAL TBI W LOSS OF CONSCIOUSNESS OF 31-59 MIN INIT

T41202A

POISONING BY UNSP GENERAL ANESTHETICS SELF-HARM INIT

S06303A UNSP FOCAL TBI W LOC OF 1-5 HRS 59 MIN INIT

T41203A

POISONING BY UNSP GENERAL ANESTHETICS ASSAULT INIT ENCNTR

S06304A UNSP FOCAL TBI W LOC OF 6 HOURS TO 24 HOURS INIT

T41204A

POISONING BY UNSP GENERAL ANESTHETICS UNDETERMINED INIT

S06305A UNSP FOCAL TBI W LOC >24 HR W RET CONSC LEV INIT

T41291A

POISONING BY OTH GENERAL ANESTHETICS ACCIDENTAL INIT

S06306A UNSP FOCAL TBI W LOC >24 HR W/O RET CONSC W SURV INIT

T41292A

POISONING BY OTH GENERAL ANESTHETICS SELF-HARM INIT

S06307A

UNSP FOCAL TBI W LOC W DEATH D/T BRAIN INJURY BF CONSC INIT

T41293A

POISONING BY OTHER GENERAL ANESTHETICS ASSAULT INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S06307S

UNSP FOCAL TBI W LOC W DEATH D/T BRAIN INJURY BF CONSC SQLA

T41294A

POISONING BY OTH GENERAL ANESTHETICS UNDETERMINED INIT

S06308A

UNSP FOCAL TBI W LOC W DEATH DUE TO OTH CAUSE BF CONSC INIT

T413X1A

POISONING BY LOCAL ANESTHETICS ACCIDENTAL INIT

S06308S

UNSP FOCAL TBI W LOC W DEATH DUE TO OTH CAUSE BF CONSC SQLA

T413X2A

POISONING BY LOCAL ANESTHETICS INTENTIONAL SELF-HARM INIT

S06309A UNSP FOCAL TBI W LOC OF UNSP DURATION INIT

T413X3A

POISONING BY LOCAL ANESTHETICS ASSAULT INITIAL ENCOUNTER

S06310A

CONTUS/LAC RIGHT CEREBRUM W/O LOSS OF CONSCIOUSNESS INIT

T413X4A

POISONING BY LOCAL ANESTHETICS UNDETERMINED INIT ENCNTR

S06311A

CONTUS/LAC RIGHT CEREBRUM W LOC OF 30 MINUTES OR LESS INIT

T4141XA

POISONING BY UNSP ANESTHETIC ACCIDENTAL INIT

S06312A CONTUS/LAC RIGHT CEREBRUM W LOC OF 31-59 MIN INIT

T4142XA

POISONING BY UNSP ANESTHETIC INTENTIONAL SELF-HARM INIT

S06313A CONTUS/LAC RIGHT CEREBRUM W LOC OF 1-5 HRS 59 MIN INIT

T4143XA

POISONING BY UNSPECIFIED ANESTHETIC ASSAULT INIT ENCNTR

S06314A

CONTUS/LAC RIGHT CEREBRUM W LOC OF 6 HOURS TO 24 HOURS INIT

T4144XA

POISONING BY UNSP ANESTHETIC UNDETERMINED INIT ENCNTR

S06315A

CONTUS/LAC RIGHT CEREBRUM W LOC >24 HR W RET CONSC LEV INIT

T415X1A

POISONING BY THERAPEUTIC GASES ACCIDENTAL INIT

S06316A

CONTUS/LAC R CEREB W LOC >24 HR W/O RET CONSC W SURV INIT

T415X2A

POISONING BY THERAPEUTIC GASES INTENTIONAL SELF-HARM INIT

S06317A

CONTUS/LAC R CEREB W LOC W DTH D/T BRAIN INJ BF CONSC INIT

T415X3A

POISONING BY THERAPEUTIC GASES ASSAULT INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S06318A

CONTUS/LAC R CEREB W LOC W DTH D/T OTH CAUSE BF CONSC INIT

T415X4A

POISONING BY THERAPEUTIC GASES UNDETERMINED INIT ENCNTR

S06319A CONTUS/LAC RIGHT CEREBRUM W LOC OF UNSP DURATION INIT

T420X1A

POISONING BY HYDANTOIN DERIVATIVES ACCIDENTAL INIT

S06320A

CONTUS/LAC LEFT CEREBRUM W/O LOSS OF CONSCIOUSNESS INIT

T420X2A

POISONING BY HYDANTOIN DERIVATIVES SELF-HARM INIT

S06321A

CONTUS/LAC LEFT CEREBRUM W LOC OF 30 MINUTES OR LESS INIT

T420X3A

POISONING BY HYDANTOIN DERIVATIVES ASSAULT INIT ENCNTR

S06322A CONTUS/LAC LEFT CEREBRUM W LOC OF 31-59 MIN INIT

T420X4A

POISONING BY HYDANTOIN DERIVATIVES UNDETERMINED INIT

S06323A CONTUS/LAC LEFT CEREBRUM W LOC OF 1-5 HRS 59 MIN INIT

T421X1A

POISONING BY IMINOSTILBENES ACCIDENTAL INIT

S06324A

CONTUS/LAC LEFT CEREBRUM W LOC OF 6 HOURS TO 24 HOURS INIT

T421X2A

POISONING BY IMINOSTILBENES INTENTIONAL SELF-HARM INIT

S06325A

CONTUS/LAC LEFT CEREBRUM W LOC >24 HR W RET CONSC LEV INIT

T421X3A

POISONING BY IMINOSTILBENES ASSAULT INITIAL ENCOUNTER

S06326A

CONTUS/LAC L CEREB W LOC >24 HR W/O RET CONSC W SURV INIT

T421X4A

POISONING BY IMINOSTILBENES UNDETERMINED INITIAL ENCOUNTER

S06327A

CONTUS/LAC L CEREB W LOC W DTH D/T BRAIN INJ BF CONSC INIT

T422X1A

POISONING BY SUCCINIMIDES AND OXAZOLIDINEDIONES ACC INIT

S06328A

CONTUS/LAC L CEREB W LOC W DTH D/T OTH CAUSE BF CONSC INIT

T422X2A

POISN BY SUCCINIMIDES AND OXAZOLIDINEDIONES SELF-HARM INIT

S06329A CONTUS/LAC LEFT CEREBRUM W LOC OF UNSP DURATION INIT

T422X3A

POISN BY SUCCINIMIDES AND OXAZOLIDINEDIONES ASSAULT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S06330A CONTUS/LAC CEREB W/O LOSS OF CONSCIOUSNESS INIT

T422X4A

POISONING BY SUCCINIMIDES AND OXAZOLIDINEDIONES UNDET INIT

S06331A CONTUS/LAC CEREB W LOC OF 30 MINUTES OR LESS INIT

T423X1A

POISONING BY BARBITURATES ACCIDENTAL (UNINTENTIONAL) INIT

S06332A

CONTUS/LAC CEREB W LOSS OF CONSCIOUSNESS OF 31-59 MIN INIT

T423X2A

POISONING BY BARBITURATES INTENTIONAL SELF-HARM INIT

S06333A CONTUS/LAC CEREB W LOC OF 1-5 HRS 59 MIN INIT

T423X3A

POISONING BY BARBITURATES ASSAULT INITIAL ENCOUNTER

S06334A CONTUS/LAC CEREB W LOC OF 6 HOURS TO 24 HOURS INIT

T423X4A

POISONING BY BARBITURATES UNDETERMINED INITIAL ENCOUNTER

S06335A CONTUS/LAC CEREB W LOC >24 HR W RET CONSC LEV INIT

T424X1A

POISONING BY BENZODIAZEPINES ACCIDENTAL INIT

S06336A

CONTUS/LAC CEREB W LOC >24 HR W/O RET CONSC W SURV INIT

T424X2A

POISONING BY BENZODIAZEPINES INTENTIONAL SELF-HARM INIT

S06337A

CONTUS/LAC CEREB W LOC W DEATH D/T BRAIN INJ BF CONSC INIT

T424X3A

POISONING BY BENZODIAZEPINES ASSAULT INITIAL ENCOUNTER

S06338A

CONTUS/LAC CEREB W LOC W DEATH D/T OTH CAUSE BF CONSC INIT

T424X4A

POISONING BY BENZODIAZEPINES UNDETERMINED INIT ENCNTR

S06339A CONTUS/LAC CEREB W LOC OF UNSP DURATION INIT

T425X1A

POISONING BY MIXED ANTIEPILEPTICS ACCIDENTAL INIT

S06340A

TRAUM HEMOR RIGHT CEREBRUM W/O LOSS OF CONSCIOUSNESS INIT

T425X2A

POISONING BY MIXED ANTIEPILEPTICS SELF-HARM INIT

S06341A

TRAUM HEMOR RIGHT CEREBRUM W LOC OF 30 MINUTES OR LESS INIT

T425X3A

POISONING BY MIXED ANTIEPILEPTICS ASSAULT INIT ENCNTR

S06342A

TRAUM HEMOR RIGHT CEREBRUM W LOC OF 31-59 MIN INIT

T425X4A

POISONING BY MIXED ANTIEPILEPTICS UNDETERMINED INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S06343A

TRAUM HEMOR RIGHT CEREBRUM W LOC OF 1-5 HRS 59 MINUTES INIT

T426X1A

POISONING BY OTH ANTIEPLPTC AND SED-HYPNTC DRUGS ACC INIT

S06344A

TRAUM HEMOR RIGHT CEREBRUM W LOC OF 6-24 HRS INIT

T426X2A

POISN BY OTH ANTIEPLPTC AND SED-HYPNTC DRUGS SLF-HRM INIT

S06345A TRAUM HEMOR R CEREB W LOC >24 HR W RET CONSC LEV INIT

T426X3A

POISN BY OTH ANTIEPLPTC AND SED-HYPNTC DRUGS ASSAULT INIT

S06346A

TRAUM HEMOR R CEREB W LOC >24 HR W/O RET CONSC W SURV INIT

T426X4A

POISN BY OTH ANTIEPLPTC AND SED-HYPNTC DRUGS UNDET INIT

S06347A

TRAUM HEMOR R CEREB W LOC W DTH D/T BRAIN INJ BF CONSC INIT

T4271XA

POISN BY UNSP ANTIEPLPTC AND SED-HYPNTC DRUGS ACC INIT

S06348A

TRAUM HEMOR R CEREB W LOC W DTH D/T OTH CAUSE BF CONSC INIT

T4272XA

POISN BY UNSP ANTIEPLPTC AND SED-HYPNTC DRUGS SLF-HRM INIT

S06349A

TRAUM HEMOR RIGHT CEREBRUM W LOC OF UNSP DURATION INIT

T4273XA

POISN BY UNSP ANTIEPLPTC AND SED-HYPNTC DRUGS ASSAULT INIT

S06350A

TRAUM HEMOR LEFT CEREBRUM W/O LOSS OF CONSCIOUSNESS INIT

T4274XA

POISN BY UNSP ANTIEPLPTC AND SED-HYPNTC DRUGS UNDET INIT

S06351A

TRAUM HEMOR LEFT CEREBRUM W LOC OF 30 MINUTES OR LESS INIT

T428X1A

POISN BY ANTIPARKNS DRUG/CENTR MUSC-TONE DEPR ACC INIT

S06352A

TRAUM HEMOR LEFT CEREBRUM W LOC OF 31-59 MIN INIT

T428X2A

POISN BY ANTIPARKNS DRUG/CENTR MUSC-TONE DEPR SLF-HRM INIT

S06353A

TRAUM HEMOR LEFT CEREBRUM W LOC OF 1-5 HRS 59 MINUTES INIT

T428X3A

POISN BY ANTIPARKNS DRUG/CENTR MUSC-TONE DEPR ASSAULT INIT

S06354A

TRAUM HEMOR LEFT CEREBRUM W LOC OF 6 HOURS TO 24 HOURS INIT

T428X4A

POISN BY ANTIPARKNS DRUG/CENTR MUSC-TONE DEPR UNDET INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S06355A

TRAUM HEMOR LEFT CEREBRUM W LOC >24 HR W RET CONSC LEV INIT

T43011A

POISONING BY TRICYCLIC ANTIDEPRESSANTS ACCIDENTAL INIT

S06356A

TRAUM HEMOR L CEREB W LOC >24 HR W/O RET CONSC W SURV INIT

T43012A

POISONING BY TRICYCLIC ANTIDEPRESSANTS SELF-HARM INIT

S06357A

TRAUM HEMOR L CEREB W LOC W DTH D/T BRAIN INJ BF CONSC INIT

T43013A

POISONING BY TRICYCLIC ANTIDEPRESSANTS ASSAULT INIT ENCNTR

S06358A

TRAUM HEMOR L CEREB W LOC W DTH D/T OTH CAUSE BF CONSC INIT

T43014A

POISONING BY TRICYCLIC ANTIDEPRESSANTS UNDETERMINED INIT

S06359A

TRAUM HEMOR LEFT CEREBRUM W LOC OF UNSP DURATION INIT

T43021A

POISONING BY TETRACYCLIC ANTIDEPRESSANTS ACCIDENTAL INIT

S06360A TRAUM HEMOR CEREB W/O LOSS OF CONSCIOUSNESS INIT

T43022A

POISONING BY TETRACYCLIC ANTIDEPRESSANTS SELF-HARM INIT

S06361A TRAUM HEMOR CEREB W LOC OF 30 MINUTES OR LESS INIT

T43023A

POISONING BY TETRACYCLIC ANTIDEPRESSANTS ASSAULT INIT

S06362A TRAUM HEMOR CEREB W LOC OF 31-59 MIN INIT

T43024A

POISONING BY TETRACYCLIC ANTIDEPRESSANTS UNDETERMINED INIT

S06363A TRAUM HEMOR CEREB W LOC OF 1-5 HRS 59 MINUTES INIT

T431X1A

POISONING BY MAO INHIB ANTIDEPRESSANTS ACCIDENTAL INIT

S06364A TRAUM HEMOR CEREB W LOC OF 6 HOURS TO 24 HOURS INIT

T431X2A

POISONING BY MAO INHIB ANTIDEPRESSANTS SELF-HARM INIT

S06365A TRAUM HEMOR CEREB W LOC >24 HR W RET CONSC LEV INIT

T431X3A

POISONING BY MAO INHIB ANTIDEPRESSANTS ASSAULT INIT

S06366A

TRAUM HEMOR CEREB W LOC >24 HR W/O RET CONSC W SURV INIT

T431X4A

POISONING BY MAO INHIB ANTIDEPRESSANTS UNDETERMINED INIT

S06367A

TRAUM HEMOR CEREB W LOC W DTH D/T BRAIN INJ BF CONSC INIT

T43201A

POISONING BY UNSP ANTIDEPRESSANTS ACCIDENTAL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S06368A

TRAUM HEMOR CEREB W LOC W DTH D/T OTH CAUSE BF CONSC INIT

T43202A

POISONING BY UNSP ANTIDEPRESSANTS SELF-HARM INIT

S06369A TRAUM HEMOR CEREB W LOC OF UNSP DURATION INIT

T43203A

POISONING BY UNSP ANTIDEPRESSANTS ASSAULT INIT ENCNTR

S06370A CONTUS/LAC/HEM CRBLM W/O LOSS OF CONSCIOUSNESS INIT

T43204A

POISONING BY UNSP ANTIDEPRESSANTS UNDETERMINED INIT ENCNTR

S06371A

CONTUS/LAC/HEM CRBLM W LOC OF 30 MINUTES OR LESS INIT

T43211A

POISN BY SLCTV SEROTON/NOREPINEPH REUP INHIBTR ACC INIT

S06372A CONTUS/LAC/HEM CRBLM W LOC OF 31-59 MIN INIT

T43212A

POISN BY SLCTV SEROTON/NOREPINEPH REUP INHIBTRSLF-HRM INIT

S06373A CONTUS/LAC/HEM CRBLM W LOC OF 1-5 HRS 59 MIN INIT

T43213A

POISN BY SLCTV SEROTON/NOREPINEPH REUP INHIBTR ASSLT INIT

S06374A

CONTUS/LAC/HEM CRBLM W LOC OF 6 HOURS TO 24 HOURS INIT

T43214A

POISN BY SLCTV SEROTON/NOREPINEPH REUP INHIBTR UNDET INIT

S06375A

CONTUS/LAC/HEM CRBLM W LOC >24 HR W RET CONSC LEV INIT

T43221A

POISN BY SELECTIVE SEROTONIN REUPTAKE INHIBTR ACC INIT

S06376A

CONTUS/LAC/HEM CRBLM W LOC >24 HR W/O RET CONSC W SURV INIT

T43222A

POISN BY SLCTV SEROTONIN REUPTAKE INHIBTR SELF-HARM INIT

S06377A

CONTUS/LAC/HEM CRBLM W LOC W DTH D/T BRAIN INJ BF CONSCINIT

T43223A

POISN BY SELECTIVE SEROTONIN REUPTAKE INHIBTR ASSAULT INIT

S06378A

CONTUS/LAC/HEM CRBLM W LOC W DTH D/T OTH CAUSE BF CONSCINIT

T43224A

POISN BY SELECTIVE SEROTONIN REUPTAKE INHIBTR UNDET INIT

S06379A CONTUS/LAC/HEM CRBLM W LOC OF UNSP DURATION INIT

T43291A

POISONING BY OTH ANTIDEPRESSANTS ACCIDENTAL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S06380A

CONTUS/LAC/HEM BRAINSTEM W/O LOSS OF CONSCIOUSNESS INIT

T43292A

POISONING BY OTH ANTIDEPRESSANTS SELF-HARM INIT

S06381A

CONTUS/LAC/HEM BRAINSTEM W LOC OF 30 MINUTES OR LESS INIT

T43293A

POISONING BY OTHER ANTIDEPRESSANTS ASSAULT INIT ENCNTR

S06382A CONTUS/LAC/HEM BRAINSTEM W LOC OF 31-59 MIN INIT

T43294A

POISONING BY OTH ANTIDEPRESSANTS UNDETERMINED INIT ENCNTR

S06383A CONTUS/LAC/HEM BRAINSTEM W LOC OF 1-5 HRS 59 MIN INIT

T433X1A

POISONING BY PHENOTHIAZ ANTIPSYCHOT/NEUROLEPT ACC INIT

S06384A

CONTUS/LAC/HEM BRAINSTEM W LOC OF 6 HOURS TO 24 HOURS INIT

T433X2A

POISN BY PHENOTHIAZ ANTIPSYCHOT/NEUROLEPT SELF-HARM INIT

S06385A

CONTUS/LAC/HEM BRAINSTEM W LOC >24 HR W RET CONSC LEV INIT

T433X3A

POISONING BY PHENOTHIAZ ANTIPSYCHOT/NEUROLEPT ASSAULT INIT

S06386A

CONTUS/LAC/HEM BRNST W LOC >24 HR W/O RET CONSC W SURV INIT

T433X4A

POISONING BY PHENOTHIAZ ANTIPSYCHOT/NEUROLEPT UNDET INIT

S06387A

CONTUS/LAC/HEM BRNST W LOC W DTH D/T BRAIN INJ BF CONSCINIT

T434X1A

POISONING BY BUTYROPHEN/THIOTHIXEN NEUROLEPTC ACC INIT

S06388A

CONTUS/LAC/HEM BRNST W LOC W DTH D/T OTH CAUSE BF CONSCINIT

T434X2A

POISN BY BUTYROPHEN/THIOTHIXEN NEUROLEPTC SELF-HARM INIT

S06389A CONTUS/LAC/HEM BRAINSTEM W LOC OF UNSP DURATION INIT

T434X3A

POISONING BY BUTYROPHEN/THIOTHIXEN NEUROLEPTC ASSAULT INIT

S064X0A

EPIDURAL HEMORRHAGE W/O LOSS OF CONSCIOUSNESS INIT ENCNTR

T434X4A

POISONING BY BUTYROPHEN/THIOTHIXEN NEUROLEPTC UNDET INIT

S064X1A

EPIDURAL HEMORRHAGE W LOC OF 30 MINUTES OR LESS INIT

T43501A

POISONING BY UNSP ANTIPSYCHOT/NEUROLEPT ACCIDENTAL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S064X2A EPIDURAL HEMORRHAGE W LOC OF 31-59 MIN INIT

T43502A

POISONING BY UNSP ANTIPSYCHOT/NEUROLEPT SELF-HARM INIT

S064X3A EPIDURAL HEMORRHAGE W LOC OF 1-5 HRS 59 MIN INIT

T43503A

POISONING BY UNSP ANTIPSYCHOT/NEUROLEPT ASSAULT INIT

S064X4A

EPIDURAL HEMORRHAGE W LOC OF 6 HOURS TO 24 HOURS INIT

T43504A

POISONING BY UNSP ANTIPSYCHOT/NEUROLEPT UNDETERMINED INIT

S064X5A

EPIDURAL HEMORRHAGE W LOC >24 HR W RET CONSC LEV INIT

T43591A

POISONING BY OTH ANTIPSYCHOT/NEUROLEPT ACCIDENTAL INIT

S064X6A

EPIDURAL HEMORRHAGE W LOC >24 HR W/O RET CONSC W SURV INIT

T43592A

POISONING BY OTH ANTIPSYCHOT/NEUROLEPT SELF-HARM INIT

S064X7A

EPIDUR HEMOR W LOC W DEATH D/T BRAIN INJURY BF CONSC INIT

T43593A

POISONING BY OTH ANTIPSYCHOT/NEUROLEPT ASSAULT INIT

S064X8A

EPIDUR HEMOR W LOC W DEATH DUE TO OTH CAUSES BF CONSC INIT

T43594A

POISONING BY OTH ANTIPSYCHOT/NEUROLEPT UNDETERMINED INIT

S064X9A EPIDURAL HEMORRHAGE W LOC OF UNSP DURATION INIT

T43601A

POISONING BY UNSP PSYCHOSTIM ACCIDENTAL INIT

S065X0A TRAUM SUBDR HEM W/O LOSS OF CONSCIOUSNESS INIT

T43602A

POISONING BY UNSP PSYCHOSTIMULANTS SELF-HARM INIT

S065X1A TRAUM SUBDR HEM W LOC OF 30 MINUTES OR LESS INIT

T43603A

POISONING BY UNSP PSYCHOSTIMULANTS ASSAULT INIT ENCNTR

S065X2A

TRAUM SUBDR HEM W LOSS OF CONSCIOUSNESS OF 31-59 MIN INIT

T43604A

POISONING BY UNSP PSYCHOSTIMULANTS UNDETERMINED INIT

S065X3A TRAUM SUBDR HEM W LOC OF 1-5 HRS 59 MIN INIT

T43611A

POISONING BY CAFFEINE ACCIDENTAL (UNINTENTIONAL) INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S065X4A TRAUM SUBDR HEM W LOC OF 6 HOURS TO 24 HOURS INIT

T43612A

POISONING BY CAFFEINE INTENTIONAL SELF-HARM INIT ENCNTR

S065X5A TRAUM SUBDR HEM W LOC >24 HR W RET CONSC LEV INIT

T43613A

POISONING BY CAFFEINE ASSAULT INITIAL ENCOUNTER

S065X6A

TRAUM SUBDR HEM W LOC >24 HR W/O RET CONSC W SURV INIT

T43614A

POISONING BY CAFFEINE UNDETERMINED INITIAL ENCOUNTER

S065X7A

TRAUM SUBDR HEM W LOC W DTH D/T BRAIN INJ BEF REG CONSCINIT

T43621A

POISONING BY AMPHETAMINES ACCIDENTAL (UNINTENTIONAL) INIT

S065X8A

TRAUM SUBDR HEM W LOC W DTH D/T OTH CAUSE BEF REG CONSCINIT

T43622A

POISONING BY AMPHETAMINES INTENTIONAL SELF-HARM INIT

S065X9A TRAUM SUBDR HEM W LOC OF UNSP DURATION INIT

T43623A

POISONING BY AMPHETAMINES ASSAULT INITIAL ENCOUNTER

S066X0A TRAUM SUBRAC HEM W/O LOSS OF CONSCIOUSNESS INIT

T43624A

POISONING BY AMPHETAMINES UNDETERMINED INITIAL ENCOUNTER

S066X1A TRAUM SUBRAC HEM W LOC OF 30 MINUTES OR LESS INIT

T43631A

POISONING BY METHYLPHENIDATE ACCIDENTAL INIT

S066X2A

TRAUM SUBRAC HEM W LOSS OF CONSCIOUSNESS OF 31-59 MIN INIT

T43632A

POISONING BY METHYLPHENIDATE INTENTIONAL SELF-HARM INIT

S066X3A TRAUM SUBRAC HEM W LOC OF 1-5 HRS 59 MIN INIT

T43633A

POISONING BY METHYLPHENIDATE ASSAULT INITIAL ENCOUNTER

S066X4A TRAUM SUBRAC HEM W LOC OF 6 HOURS TO 24 HOURS INIT

T43634A

POISONING BY METHYLPHENIDATE UNDETERMINED INIT ENCNTR

S066X5A TRAUM SUBRAC HEM W LOC >24 HR W RET CONSC LEV INIT

T43691A

POISONING BY OTH PSYCHOSTIM ACCIDENTAL INIT

S066X6A

TRAUM SUBRAC HEM W LOC >24 HR W/O RET CONSC W SURV INIT

T43692A

POISONING BY OTH PSYCHOSTIMULANTS SELF-HARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S066X7A

TRAUM SUBRAC HEM W LOC W DEATH D/T BRAIN INJ BF CONSC INIT

T43693A

POISONING BY OTHER PSYCHOSTIMULANTS ASSAULT INIT ENCNTR

S066X8A

TRAUM SUBRAC HEM W LOC W DEATH D/T OTH CAUSE BF CONSC INIT

T43694A

POISONING BY OTH PSYCHOSTIMULANTS UNDETERMINED INIT ENCNTR

S066X9A TRAUM SUBRAC HEM W LOC OF UNSP DURATION INIT

T438X1A

POISONING BY OTH PSYCHOTROPIC DRUGS ACCIDENTAL INIT

S06810A INJURY OF R INT CAROTID INTCR W/O LOC INIT

T438X2A

POISONING BY OTH PSYCHOTROPIC DRUGS SELF-HARM INIT

S06811A

INJ R INT CAROTID INTCR W LOC OF 30 MINUTES OR LESS INIT

T438X3A

POISONING BY OTHER PSYCHOTROPIC DRUGS ASSAULT INIT ENCNTR

S06812A

INJURY OF R INT CAROTID INTCR W LOC OF 31-59 MIN INIT

T438X4A

POISONING BY OTH PSYCHOTROPIC DRUGS UNDETERMINED INIT

S06813A

INJURY OF R INT CAROTID INTCR W LOC OF 1-5 HRS 59 MIN INIT

T4391XA

POISONING BY UNSP PSYCHOTROPIC DRUG ACCIDENTAL INIT

S06814A INJURY OF R INT CAROTID INTCR W LOC OF 6-24 HRS INIT

T4392XA

POISONING BY UNSP PSYCHOTROPIC DRUG SELF-HARM INIT

S06815A

INJ R INT CAROTID INTCR W LOC >24 HR W RET CONSC LEV INIT

T4393XA

POISONING BY UNSP PSYCHOTROPIC DRUG ASSAULT INIT ENCNTR

S06816A

INJ R INT CRTDINTCR W LOC >24 HR W/O RET CONSC W SURV INIT

T4394XA

POISONING BY UNSP PSYCHOTROPIC DRUG UNDETERMINED INIT

S06817A

INJ R INT CRTDINTCR W LOC W DTH D/T BRAIN INJ BF CONSCINIT

T440X1A

POISONING BY ANTICHOLIN AGENTS ACCIDENTAL INIT

S06818A

INJ R INT CRTDINTCR W LOC W DTH D/T OTH CAUSE BF CONSCINIT

T440X2A

POISONING BY ANTICHOLINESTERASE AGENTS SELF-HARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S06819A

INJURY OF R INT CAROTID INTCR W LOC OF UNSP DURATION INIT

T440X3A

POISONING BY ANTICHOLINESTERASE AGENTS ASSAULT INIT ENCNTR

S06820A INJURY OF L INT CAROTID INTCR W/O LOC INIT

T440X4A

POISONING BY ANTICHOLINESTERASE AGENTS UNDETERMINED INIT

S06821A INJ L INT CAROTID INTCR W LOC OF 30 MINUTES OR LESS INIT

T441X1A

POISONING BY OTH PARASYMPATH ACCIDENTAL INIT

S06822A INJURY OF L INT CAROTID INTCR W LOC OF 31-59 MIN INIT

T441X2A

POISONING BY OTH PARASYMPATHOMIMETICS SELF-HARM INIT

S06823A INJURY OF L INT CAROTID INTCR W LOC OF 1-5 HRS 59 MIN INIT

T441X3A

POISONING BY OTH PARASYMPATHOMIMETICS ASSAULT INIT ENCNTR

S06824A INJURY OF L INT CAROTID INTCR W LOC OF 6-24 HRS INIT

T441X4A

POISONING BY OTH PARASYMPATHOMIMETICS UNDETERMINED INIT

S06825A INJ L INT CAROTID INTCR W LOC >24 HR W RET CONSC LEV INIT

T442X1A

POISONING BY GANGLIONIC BLOCKING DRUGS ACCIDENTAL INIT

S06826A

INJ L INT CRTDINTCR W LOC >24 HR W/O RET CONSC W SURV INIT

T442X2A

POISONING BY GANGLIONIC BLOCKING DRUGS SELF-HARM INIT

S06827A

INJ L INT CRTDINTCR W LOC W DTH D/T BRAIN INJ BF CONSCINIT

T442X3A

POISONING BY GANGLIONIC BLOCKING DRUGS ASSAULT INIT ENCNTR

S06828A

INJ L INT CRTDINTCR W LOC W DTH D/T OTH CAUSE BF CONSCINIT

T442X4A

POISONING BY GANGLIONIC BLOCKING DRUGS UNDETERMINED INIT

S06829A INJURY OF L INT CAROTID INTCR W LOC OF UNSP DURATION INIT

T443X1A

POISONING BY OTH PARASYMPATH AND SPASMOLYTICS ACC INIT

S06890A INTCRAN INJ W/O LOSS OF CONSCIOUSNESS INIT ENCNTR

T443X2A

POISN BY OTH PARASYMPATH AND SPASMOLYTICS SELF-HARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S06891A INTCRAN INJ W LOC OF 30 MINUTES OR LESS INIT

T443X3A

POISONING BY OTH PARASYMPATH AND SPASMOLYTICS ASSAULT INIT

S06892A

INTCRAN INJ W LOSS OF CONSCIOUSNESS OF 31-59 MIN INIT

T443X4A

POISONING BY OTH PARASYMPATH AND SPASMOLYTICS UNDET INIT

S06893A

INTCRAN INJ W LOSS OF CONSCIOUSNESS OF 1-5 HRS 59 MIN INIT

T444X1A

POISONING BY PREDOM ALPHA-ADRENOCPT AGONISTS ACC INIT

S06894A INTCRAN INJ W LOC OF 6 HOURS TO 24 HOURS INIT

T444X2A

POISN BY PREDOM ALPHA-ADRENOCPT AGONISTS SELF-HARM INIT

S06895A INTCRAN INJ W LOC >24 HR W RET CONSC LEV INIT

T444X3A

POISONING BY PREDOM ALPHA-ADRENOCPT AGONISTS ASSAULT INIT

S06896A INTCRAN INJ W LOC >24 HR W/O RET CONSC W SURV INIT

T444X4A

POISONING BY PREDOM ALPHA-ADRENOCPT AGONISTS UNDET INIT

S06897A

INTCRAN INJ W LOC W DEATH DUE TO BRAIN INJURY BF CONSC INIT

T445X1A

POISONING BY PREDOM BETA-ADRENOCPT AGONISTS ACC INIT

S06898A

INTCRAN INJ W LOC W DEATH DUE TO OTH CAUSE BF CONSC INIT

T445X2A

POISONING BY PREDOM BETA-ADRENOCPT AGONISTS SELF-HARM INIT

S06899A

INTCRAN INJ W LOSS OF CONSCIOUSNESS OF UNSP DURATION INIT

T445X3A

POISONING BY PREDOM BETA-ADRENOCPT AGONISTS ASSAULT INIT

S069X0A

UNSP INTRACRANIAL INJURY W/O LOSS OF CONSCIOUSNESS INIT

T445X4A

POISONING BY PREDOM BETA-ADRENOCPT AGONISTS UNDET INIT

S069X1A

UNSP INTRACRANIAL INJURY W LOC OF 30 MINUTES OR LESS INIT

T446X1A

POISONING BY ALPHA-ADRENOCPT ANTAGONISTS ACCIDENTAL INIT

S069X2A UNSP INTRACRANIAL INJURY W LOC OF 31-59 MIN INIT

T446X2A

POISONING BY ALPHA-ADRENOCPT ANTAGONISTS SELF-HARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S069X3A UNSP INTRACRANIAL INJURY W LOC OF 1-5 HRS 59 MIN INIT

T446X3A

POISONING BY ALPHA-ADRENORECEPTOR ANTAGONISTS ASSAULT INIT

S069X4A

UNSP INTRACRANIAL INJURY W LOC OF 6 HOURS TO 24 HOURS INIT

T446X4A

POISONING BY ALPHA-ADRENOCPT ANTAGONISTS UNDETERMINED INIT

S069X5A

UNSP INTRACRANIAL INJURY W LOC >24 HR W RET CONSC LEV INIT

T447X1A

POISONING BY BETA-ADRENOCPT ANTAGONISTS ACCIDENTAL INIT

S069X6A

UNSP INTCRN INJURY W LOC >24 HR W/O RET CONSC W SURV INIT

T447X2A

POISONING BY BETA-ADRENOCPT ANTAGONISTS SELF-HARM INIT

S069X7A

UNSP INTCRN INJ W LOC W DEATH D/T BRAIN INJ BF CONSC INIT

T447X3A

POISONING BY BETA-ADRENORECEPTOR ANTAGONISTS ASSAULT INIT

S069X8A

UNSP INTCRN INJ W LOC W DEATH D/T OTH CAUSE BF CONSC INIT

T447X4A

POISONING BY BETA-ADRENOCPT ANTAGONISTS UNDETERMINED INIT

S070XXA CRUSHING INJURY OF FACE INITIAL ENCOUNTER

T448X1A

POISONING BY CENTR-ACTING/ADREN-NEURN-BLOCK AGNT ACC INIT

S071XXA CRUSHING INJURY OF SKULL INITIAL ENCOUNTER

T448X2A

POISN BY CENTR-ACTING/ADREN-NEURN-BLOCK AGNT SLF-HRM INIT

S078XXA

CRUSHING INJURY OF OTHER PARTS OF HEAD INITIAL ENCOUNTER

T448X3A

POISN BY CENTR-ACTING/ADREN-NEURN-BLOCK AGNT ASSAULT INIT

S079XXA

CRUSHING INJURY OF HEAD PART UNSPECIFIED INITIAL ENCOUNTER

T448X4A

POISN BY CENTR-ACTING/ADREN-NEURN-BLOCK AGNT UNDET INIT

S080XXA AVULSION OF SCALP INITIAL ENCOUNTER

T44901A

POISN BY UNSP DRUGS AFF THE AUTONM NERVOUS SYS ACC INIT

S08111A

COMPLETE TRAUMATIC AMPUTATION OF RIGHT EAR INIT ENCNTR

T44902A

POISN BY UNSP DRUGS AFF THE AUTONM NRV SYS SLF-HRM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S08112A

COMPLETE TRAUMATIC AMPUTATION OF LEFT EAR INITIAL ENCOUNTER

T44903A

POISN BY UNSP DRUGS AFF THE AUTONM NERVOUS SYS ASSLT INIT

S08119A

COMPLETE TRAUMATIC AMPUTATION OF UNSP EAR INIT ENCNTR

T44904A

POISN BY UNSP DRUGS AFF THE AUTONM NERVOUS SYS UNDET INIT

S08121A

PARTIAL TRAUMATIC AMPUTATION OF RIGHT EAR INITIAL ENCOUNTER

T44991A

POISONING BY OTH DRUG AFF THE AUTONM NERVOUS SYS ACC INIT

S08122A

PARTIAL TRAUMATIC AMPUTATION OF LEFT EAR INITIAL ENCOUNTER

T44992A

POISN BY OTH DRUG AFF THE AUTONM NERVOUS SYS SLF-HRM INIT

S08129A

PARTIAL TRAUMATIC AMPUTATION OF UNSPECIFIED EAR INIT ENCNTR

T44993A

POISN BY OTH DRUG AFF THE AUTONM NERVOUS SYS ASSAULT INIT

S08811A

COMPLETE TRAUMATIC AMPUTATION OF NOSE INITIAL ENCOUNTER

T44994A

POISN BY OTH DRUG AFF THE AUTONM NERVOUS SYS UNDET INIT

S08812A

PARTIAL TRAUMATIC AMPUTATION OF NOSE INITIAL ENCOUNTER

T450X1A

POISONING BY ANTIALLERG/ANTIEMETIC ACCIDENTAL INIT

S0889XA

TRAUMATIC AMPUTATION OF OTHER PARTS OF HEAD INIT ENCNTR

T450X2A

POISONING BY ANTIALLERG/ANTIEMETIC SELF-HARM INIT

S090XXA INJURY OF BLOOD VESSELS OF HEAD NEC INIT

T450X3A

POISONING BY ANTIALLERG/ANTIEMETIC ASSAULT INIT

S0910XA

UNSPECIFIED INJURY OF MUSCLE AND TENDON OF HEAD INIT ENCNTR

T450X4A

POISONING BY ANTIALLERG/ANTIEMETIC UNDETERMINED INIT

S0911XA

STRAIN OF MUSCLE AND TENDON OF HEAD INITIAL ENCOUNTER

T451X1A

POISONING BY ANTINEOPL AND IMMUNOSUP DRUGS ACC INIT

S0912XA

LACERATION OF MUSCLE AND TENDON OF HEAD INITIAL ENCOUNTER

T451X2A

POISONING BY ANTINEOPL AND IMMUNOSUP DRUGS SELF-HARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0919XA OTH INJURY OF MUSCLE AND TENDON OF HEAD INIT ENCNTR

T451X3A

POISONING BY ANTINEOPL AND IMMUNOSUP DRUGS ASSAULT INIT

S0920XA

TRAUMATIC RUPTURE OF UNSPECIFIED EAR DRUM INITIAL ENCOUNTER

T451X4A

POISONING BY ANTINEOPL AND IMMUNOSUP DRUGS UNDET INIT

S0921XA

TRAUMATIC RUPTURE OF RIGHT EAR DRUM INITIAL ENCOUNTER

T452X1A

POISONING BY VITAMINS ACCIDENTAL (UNINTENTIONAL) INIT

S0922XA TRAUMATIC RUPTURE OF LEFT EAR DRUM INITIAL ENCOUNTER

T452X2A

POISONING BY VITAMINS INTENTIONAL SELF-HARM INIT ENCNTR

S09301A UNSP INJURY OF RIGHT MIDDLE AND INNER EAR INIT ENCNTR

T452X3A

POISONING BY VITAMINS ASSAULT INITIAL ENCOUNTER

S09302A

UNSPECIFIED INJURY OF LEFT MIDDLE AND INNER EAR INIT ENCNTR

T452X4A

POISONING BY VITAMINS UNDETERMINED INITIAL ENCOUNTER

S09309A

UNSP INJURY OF UNSPECIFIED MIDDLE AND INNER EAR INIT ENCNTR

T453X1A

POISONING BY ENZYMES ACCIDENTAL (UNINTENTIONAL) INIT

S09311A PRIMARY BLAST INJURY OF RIGHT EAR INITIAL ENCOUNTER

T453X2A

POISONING BY ENZYMES INTENTIONAL SELF-HARM INIT ENCNTR

S09312A PRIMARY BLAST INJURY OF LEFT EAR INITIAL ENCOUNTER

T453X3A

POISONING BY ENZYMES ASSAULT INITIAL ENCOUNTER

S09313A PRIMARY BLAST INJURY OF EAR BILATERAL INITIAL ENCOUNTER

T453X4A

POISONING BY ENZYMES UNDETERMINED INITIAL ENCOUNTER

S09319A

PRIMARY BLAST INJURY OF UNSPECIFIED EAR INITIAL ENCOUNTER

T454X1A

POISONING BY IRON AND ITS COMPOUNDS ACCIDENTAL INIT

S09391A OTH INJURY OF RIGHT MIDDLE AND INNER EAR INIT ENCNTR

T454X2A

POISONING BY IRON AND ITS COMPOUNDS SELF-HARM INIT

S09392A OTH INJURY OF LEFT MIDDLE AND INNER EAR INIT ENCNTR

T454X3A

POISONING BY IRON AND ITS COMPOUNDS ASSAULT INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S09399A

OTH INJURY OF UNSPECIFIED MIDDLE AND INNER EAR INIT ENCNTR

T454X4A

POISONING BY IRON AND ITS COMPOUNDS UNDETERMINED INIT

S098XXA OTHER SPECIFIED INJURIES OF HEAD INITIAL ENCOUNTER

T45511A

POISONING BY ANTICOAGULANTS ACCIDENTAL INIT

S100XXA CONTUSION OF THROAT INITIAL ENCOUNTER

T45512A

POISONING BY ANTICOAGULANTS INTENTIONAL SELF-HARM INIT

S1010XA

UNSPECIFIED SUPERFICIAL INJURIES OF THROAT INIT ENCNTR

T45513A

POISONING BY ANTICOAGULANTS ASSAULT INITIAL ENCOUNTER

S1011XA ABRASION OF THROAT INITIAL ENCOUNTER

T45514A

POISONING BY ANTICOAGULANTS UNDETERMINED INITIAL ENCOUNTER

S1012XA BLISTER (NONTHERMAL) OF THROAT INITIAL ENCOUNTER

T45521A

POISONING BY ANTITHROMBOTIC DRUGS ACCIDENTAL INIT

S1014XA

EXTERNAL CONSTRICTION OF PART OF THROAT INITIAL ENCOUNTER

T45522A

POISONING BY ANTITHROMBOTIC DRUGS SELF-HARM INIT

S1015XA SUPERFICIAL FOREIGN BODY OF THROAT INITIAL ENCOUNTER

T45523A

POISONING BY ANTITHROMBOTIC DRUGS ASSAULT INIT ENCNTR

S1016XA

INSECT BITE (NONVENOMOUS) OF THROAT INITIAL ENCOUNTER

T45524A

POISONING BY ANTITHROMBOTIC DRUGS UNDETERMINED INIT ENCNTR

S1017XA OTHER SUPERFICIAL BITE OF THROAT INITIAL ENCOUNTER

T45601A

POISONING BY UNSP FIBRIN-AFFCT DRUGS ACCIDENTAL INIT

S1080XA

UNSP SUPERFICIAL INJURY OF OTH PART OF NECK INIT ENCNTR

T45602A

POISONING BY UNSP FIBRIN-AFFCT DRUGS SELF-HARM INIT

S1081XA

ABRASION OF OTHER SPECIFIED PART OF NECK INITIAL ENCOUNTER

T45603A

POISONING BY UNSP FIBRIN-AFFCT DRUGS ASSAULT INIT

S1082XA

BLISTER (NONTHERMAL) OF OTH PART OF NECK INIT ENCNTR

T45604A

POISONING BY UNSP FIBRIN-AFFCT DRUGS UNDETERMINED INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S1083XA

CONTUSION OF OTHER SPECIFIED PART OF NECK INITIAL ENCOUNTER

T45611A

POISONING BY THROMBOLYTIC DRUG ACCIDENTAL INIT

S1084XA

EXTERNAL CONSTRICTION OF OTH PART OF NECK INIT ENCNTR

T45612A

POISONING BY THROMBOLYTIC DRUG INTENTIONAL SELF-HARM INIT

S1085XA

SUPERFICIAL FOREIGN BODY OF OTH PART OF NECK INIT ENCNTR

T45613A

POISONING BY THROMBOLYTIC DRUG ASSAULT INITIAL ENCOUNTER

S1086XA

INSECT BITE OF OTHER SPECIFIED PART OF NECK INIT ENCNTR

T45614A

POISONING BY THROMBOLYTIC DRUG UNDETERMINED INIT ENCNTR

S1087XA

OTHER SUPERFICIAL BITE OF OTH PART OF NECK INIT ENCNTR

T45621A

POISONING BY HEMOSTATIC DRUG ACCIDENTAL INIT

S1090XA

UNSP SUPERFICIAL INJURY OF UNSP PART OF NECK INIT ENCNTR

T45622A

POISONING BY HEMOSTATIC DRUG INTENTIONAL SELF-HARM INIT

S1091XA

ABRASION OF UNSPECIFIED PART OF NECK INITIAL ENCOUNTER

T45623A

POISONING BY HEMOSTATIC DRUG ASSAULT INITIAL ENCOUNTER

S1092XA

BLISTER (NONTHERMAL) OF UNSP PART OF NECK INIT ENCNTR

T45624A

POISONING BY HEMOSTATIC DRUG UNDETERMINED INIT ENCNTR

S1093XA

CONTUSION OF UNSPECIFIED PART OF NECK INITIAL ENCOUNTER

T45691A

POISONING BY OTH FIBRIN-AFFCT DRUGS ACCIDENTAL INIT

S1094XA

EXTERNAL CONSTRICTION OF UNSP PART OF NECK INIT ENCNTR

T45692A

POISONING BY OTH FIBRIN-AFFCT DRUGS SELF-HARM INIT

S1095XA

SUPERFICIAL FOREIGN BODY OF UNSP PART OF NECK INIT ENCNTR

T45693A

POISONING BY OTH FIBRINOLYSIS-AFFECTING DRUGS ASSAULT INIT

S1096XA

INSECT BITE OF UNSPECIFIED PART OF NECK INITIAL ENCOUNTER

T45694A

POISONING BY OTH FIBRIN-AFFCT DRUGS UNDETERMINED INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S1097XA

OTHER SUPERFICIAL BITE OF UNSP PART OF NECK INIT ENCNTR

T457X1A

POISN BY ANTICOAG ANTAG VITAMIN K AND OTH COAG ACC INIT

S11011A

LACERATION WITHOUT FOREIGN BODY OF LARYNX INITIAL ENCOUNTER

T457X2A

POISN BY ANTICOAG ANTAG VIT K AND OTH COAG SLF-HRM INIT

S11012A

LACERATION WITH FOREIGN BODY OF LARYNX INITIAL ENCOUNTER

T457X3A

POISN BY ANTICOAG ANTAG VIT K AND OTH COAG ASSAULT INIT

S11013A

PUNCTURE WOUND WITHOUT FOREIGN BODY OF LARYNX INIT ENCNTR

T457X4A

POISN BY ANTICOAG ANTAG VITAMIN K AND OTH COAG UNDET INIT

S11014A

PUNCTURE WOUND WITH FOREIGN BODY OF LARYNX INIT ENCNTR

T458X1A

POISN BY OTH PRIM SYSTEMIC AND HEMATOLOG AGENTS ACC INIT

S11015A OPEN BITE OF LARYNX INITIAL ENCOUNTER

T458X2A

POISN BY OTH PRIM SYS AND HEMATOLOG AGENTS SLF-HRM INIT

S11019A UNSPECIFIED OPEN WOUND OF LARYNX INITIAL ENCOUNTER

T458X3A

POISN BY OTH PRIM SYS AND HEMATOLOG AGENTS ASSAULT INIT

S11021A

LACERATION WITHOUT FOREIGN BODY OF TRACHEA INIT ENCNTR

T458X4A

POISN BY OTH PRIM SYSTEMIC AND HEMATOLOG AGENTS UNDET INIT

S11022A

LACERATION WITH FOREIGN BODY OF TRACHEA INITIAL ENCOUNTER

T4591XA

POISN BY UNSP PRIM SYSTEMIC AND HEMATOLOG AGENT ACC INIT

S11023A

PUNCTURE WOUND WITHOUT FOREIGN BODY OF TRACHEA INIT ENCNTR

T4592XA

POISN BY UNSP PRIM SYS AND HEMATOLOG AGENT SLF-HRM INIT

S11024A

PUNCTURE WOUND WITH FOREIGN BODY OF TRACHEA INIT ENCNTR

T4593XA

POISN BY UNSP PRIM SYS AND HEMATOLOG AGENT ASSAULT INIT

S11025A OPEN BITE OF TRACHEA INITIAL ENCOUNTER

T4594XA

POISN BY UNSP PRIM SYSTEMIC AND HEMATOLOG AGENT UNDET INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S11029A UNSPECIFIED OPEN WOUND OF TRACHEA INITIAL ENCOUNTER

T460X1A

POISONING BY CARDI-STIM GLYCOS/DRUG SIMLAR ACT ACC INIT

S11031A

LACERATION WITHOUT FOREIGN BODY OF VOCAL CORD INIT ENCNTR

T460X2A

POISN BY CARDI-STIM GLYCOS/DRUG SIMLAR ACT SELF-HARM INIT

S11032A

LACERATION WITH FOREIGN BODY OF VOCAL CORD INIT ENCNTR

T460X3A

POISN BY CARDI-STIM GLYCOS/DRUG SIMLAR ACT ASSAULT INIT

S11033A

PUNCTURE WOUND W/O FOREIGN BODY OF VOCAL CORD INIT ENCNTR

T460X4A

POISONING BY CARDI-STIM GLYCOS/DRUG SIMLAR ACT UNDET INIT

S11034A

PUNCTURE WOUND WITH FOREIGN BODY OF VOCAL CORD INIT ENCNTR

T461X1A

POISONING BY CALCIUM-CHANNEL BLOCKERS ACCIDENTAL INIT

S1122XA

LACERATION W FB OF PHARYNX AND CERVICAL ESOPHAGUS INIT

T461X2A

POISONING BY CALCIUM-CHANNEL BLOCKERS SELF-HARM INIT

S1123XA

PNCTR W/O FB OF PHARYNX AND CERVICAL ESOPHAGUS INIT

T461X3A

POISONING BY CALCIUM-CHANNEL BLOCKERS ASSAULT INIT ENCNTR

S1124XA

PNCTR W FOREIGN BODY OF PHARYNX AND CERVICAL ESOPHAGUS INIT

T461X4A

POISONING BY CALCIUM-CHANNEL BLOCKERS UNDETERMINED INIT

S1125XA

OPEN BITE OF PHARYNX AND CERVICAL ESOPHAGUS INIT ENCNTR

T462X1A

POISONING BY OTH ANTIDYSRHYTHMIC DRUGS ACCIDENTAL INIT

S1180XA

UNSPECIFIED OPEN WOUND OF OTH PART OF NECK INIT ENCNTR

T462X2A

POISONING BY OTH ANTIDYSRHYTHMIC DRUGS SELF-HARM INIT

S1181XA

LACERATION W/O FOREIGN BODY OF OTH PART OF NECK INIT ENCNTR

T462X3A

POISONING BY OTH ANTIDYSRHYTHMIC DRUGS ASSAULT INIT ENCNTR

S1182XA

LACERATION W FOREIGN BODY OF OTH PART OF NECK INIT ENCNTR

T462X4A

POISONING BY OTH ANTIDYSRHYTHMIC DRUGS UNDETERMINED INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S1183XA

PUNCTURE WOUND W/O FOREIGN BODY OTH PRT NECK INIT ENCNTR

T463X1A

POISONING BY CORONARY VASODILATORS ACCIDENTAL INIT

S1184XA

PUNCTURE WOUND W FOREIGN BODY OTH PRT NECK INIT ENCNTR

T463X2A

POISONING BY CORONARY VASODILATORS SELF-HARM INIT

S1185XA

OPEN BITE OF OTHER SPECIFIED PART OF NECK INITIAL ENCOUNTER

T463X3A

POISONING BY CORONARY VASODILATORS ASSAULT INIT ENCNTR

S1189XA OTHER OPEN WOUND OF OTH PART OF NECK INIT ENCNTR

T463X4A

POISONING BY CORONARY VASODILATORS UNDETERMINED INIT

S1190XA

UNSP OPEN WOUND OF UNSPECIFIED PART OF NECK INIT ENCNTR

T464X1A

POISONING BY ANGIOTENS-CONVERT-ENZYME INHIBITORS ACC INIT

S1191XA

LACERATION W/O FOREIGN BODY OF UNSP PART OF NECK INIT

T464X2A

POISN BY ANGIOTENS-CONVERT-ENZYME INHIBTR SELF-HARM INIT

S1192XA

LACERATION W FOREIGN BODY OF UNSP PART OF NECK INIT ENCNTR

T464X3A

POISONING BY ANGIOTENS-CONVERT-ENZYME INHIBTR ASSAULT INIT

S1193XA

PUNCTURE WOUND W/O FOREIGN BODY OF UNSP PART OF NECK INIT

T464X4A

POISONING BY ANGIOTENS-CONVERT-ENZYME INHIBTR UNDET INIT

S1194XA

PUNCTURE WOUND W FOREIGN BODY OF UNSP PART OF NECK INIT

T465X1A

POISONING BY OTH ANTIHYPERTN DRUGS ACCIDENTAL INIT

S1195XA

OPEN BITE OF UNSPECIFIED PART OF NECK INITIAL ENCOUNTER

T465X2A

POISONING BY OTH ANTIHYPERTENSIVE DRUGS SELF-HARM INIT

S12000A

UNSP DISP FX OF FIRST CERVICAL VERTEBRA INIT FOR CLOS FX

T465X3A

POISONING BY OTH ANTIHYPERTENSIVE DRUGS ASSAULT INIT

S12001A

UNSP NONDISP FX OF FIRST CERVICAL VERTEBRA INIT FOR CLOS FX

T465X4A

POISONING BY OTH ANTIHYPERTENSIVE DRUGS UNDETERMINED INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12001B

UNSP NONDISP FX OF FIRST CERVICAL VERTEBRA INIT FOR OPN FX

T466X1A

POISONING BY ANTIHYPERLIP AND ANTIARTERIO DRUGS ACC INIT

S1201XA STABLE BURST FRACTURE OF FIRST CERVICAL VERTEBRA INIT

T466X2A

POISN BY ANTIHYPERLIP AND ANTIARTERIO DRUGS SELF-HARM INIT

S1201XB

STABLE BURST FX FIRST CERVCAL VERTEBRA INIT FOR OPN FX

T466X3A

POISN BY ANTIHYPERLIP AND ANTIARTERIO DRUGS ASSAULT INIT

S1202XA UNSTABLE BURST FRACTURE OF FIRST CERVICAL VERTEBRA INIT

T466X4A

POISONING BY ANTIHYPERLIP AND ANTIARTERIO DRUGS UNDET INIT

S1202XB

UNSTABLE BURST FX FIRST CERVCAL VERTEBRA INIT FOR OPN FX

T467X1A

POISONING BY PERIPHERAL VASODILATORS ACCIDENTAL INIT

S12030A DISPLACED POSTERIOR ARCH FX FIRST CERVCAL VERTEBRA INIT

T467X2A

POISONING BY PERIPHERAL VASODILATORS SELF-HARM INIT

S12030B

DISPL POST ARCH FX FIRST CERVCAL VERTEBRA INIT FOR OPN FX

T467X3A

POISONING BY PERIPHERAL VASODILATORS ASSAULT INIT ENCNTR

S12031A NONDISP POSTERIOR ARCH FX FIRST CERVCAL VERTEBRA INIT

T467X4A

POISONING BY PERIPHERAL VASODILATORS UNDETERMINED INIT

S12031B

NONDISP POST ARCH FX FIRST CERVCAL VERTEBRA INIT FOR OPN FX

T468X1A

POISONING BY ANTIVARIC DRUGS INC SCLER AGENTS ACC INIT

S12040A DISPLACED LATERAL MASS FX FIRST CERVCAL VERTEBRA INIT

T468X2A

POISN BY ANTIVARIC DRUGS INC SCLER AGENTS SELF-HARM INIT

S12040B DISPL LATERAL MASS FX FIRST CERVCAL VERT INIT FOR OPN FX

T468X3A

POISN BY ANTIVARIC DRUGS INC SCLER AGENTS ASSAULT INIT

S12041A NONDISP LATERAL MASS FX FIRST CERVCAL VERTEBRA INIT

T468X4A

POISONING BY ANTIVARIC DRUGS INC SCLER AGENTS UNDET INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12041B

NONDISP LATERAL MASS FX FIRST CERVCAL VERT INIT FOR OPN FX

T46901A

POISONING BY UNSP AGENTS AFF THE CARDIOVASC SYS ACC INIT

S12090A OTH DISP FX OF FIRST CERVICAL VERTEBRA INIT FOR CLOS FX

T46902A

POISN BY UNSP AGENTS AFF THE CARDIOVASC SYS SELF-HARM INIT

S12090B OTH DISP FX OF FIRST CERVICAL VERTEBRA INIT FOR OPN FX

T46903A

POISN BY UNSP AGENTS AFF THE CARDIOVASC SYS ASSAULT INIT

S12091A

OTH NONDISP FX OF FIRST CERVICAL VERTEBRA INIT FOR CLOS FX

T46904A

POISONING BY UNSP AGENTS AFF THE CARDIOVASC SYS UNDET INIT

S12091B

OTH NONDISP FX OF FIRST CERVICAL VERTEBRA INIT FOR OPN FX

T46991A

POISONING BY OTH AGENTS AFF THE CARDIOVASC SYS ACC INIT

S12100A

UNSP DISP FX OF SECOND CERVICAL VERTEBRA INIT FOR CLOS FX

T46992A

POISN BY OTH AGENTS AFF THE CARDIOVASC SYS SELF-HARM INIT

S12100B

UNSP DISP FX OF SECOND CERVICAL VERTEBRA INIT FOR OPN FX

T46993A

POISN BY OTH AGENTS AFF THE CARDIOVASC SYS ASSAULT INIT

S12101A UNSP NONDISP FX OF SECOND CERVICAL VERTEBRA INIT

T46994A

POISONING BY OTH AGENTS AFF THE CARDIOVASC SYS UNDET INIT

S12101B

UNSP NONDISP FX OF SECOND CERVICAL VERTEBRA INIT FOR OPN FX

T470X1A

POISONING BY HISTAMINE H2-RECEPTOR BLOCKERS ACC INIT

S12110A

ANTERIOR DISPLACED TYPE II DENS FRACTURE INIT FOR CLOS FX

T470X2A

POISONING BY HISTAMINE H2-RECEPTOR BLOCKERS SELF-HARM INIT

S12110B

ANTERIOR DISPLACED TYPE II DENS FRACTURE INIT FOR OPN FX

T470X3A

POISONING BY HISTAMINE H2-RECEPTOR BLOCKERS ASSAULT INIT

S12111A

POSTERIOR DISPLACED TYPE II DENS FRACTURE INIT FOR CLOS FX

T470X4A

POISONING BY HISTAMINE H2-RECEPTOR BLOCKERS UNDET INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12111B

POSTERIOR DISPLACED TYPE II DENS FRACTURE INIT FOR OPN FX

T471X1A

POISN BY OTH ANTACIDS AND ANTI-GSTRC-SEC DRUGS ACC INIT

S12112A NONDISPLACED TYPE II DENS FRACTURE INIT FOR CLOS FX

T471X2A

POISN BY OTH ANTACIDS & ANTI-GSTRC-SEC DRUGS SLF-HRM INIT

S12112B NONDISPLACED TYPE II DENS FRACTURE INIT FOR OPN FX

T471X3A

POISN BY OTH ANTACIDS AND ANTI-GSTRC-SEC DRUGS ASSLT INIT

S12120A

OTH DISPLACED DENS FRACTURE INIT ENCNTR FOR CLOSED FRACTURE

T471X4A

POISN BY OTH ANTACIDS AND ANTI-GSTRC-SEC DRUGS UNDET INIT

S12120B

OTHER DISPLACED DENS FRACTURE INIT ENCNTR FOR OPEN FRACTURE

T472X1A

POISONING BY STIMULANT LAXATIVES ACCIDENTAL INIT

S12121A OTH NONDISPLACED DENS FRACTURE INIT FOR CLOS FX

T472X2A

POISONING BY STIMULANT LAXATIVES SELF-HARM INIT

S12121B OTH NONDISPLACED DENS FRACTURE INIT FOR OPN FX

T472X3A

POISONING BY STIMULANT LAXATIVES ASSAULT INITIAL ENCOUNTER

S12130A

UNSP TRAUM DISPL SPONDYLOLYSIS OF SECOND CERVCAL VERT INIT

T472X4A

POISONING BY STIMULANT LAXATIVES UNDETERMINED INIT ENCNTR

S12130B

UNSP TRAUM DISPL SPONDYLOLYSIS OF 2ND CERVCAL VERT 7THB

T473X1A

POISONING BY SALINE AND OSMOTIC LAXATIVES ACCIDENTAL INIT

S12131A

UNSP TRAUM NONDISP SPONDYLOLYSIS OF 2ND CERVCAL VERT INIT

T473X2A

POISONING BY SALINE AND OSMOTIC LAXATIVES SELF-HARM INIT

S12131B

UNSP TRAUM NONDISP SPONDYLOLYSIS OF 2ND CERVCAL VERT 7THB

T473X3A

POISONING BY SALINE AND OSMOTIC LAXATIVES ASSAULT INIT

S1214XA TYPE III TRAUM SPONDYLOLYSIS OF SECOND CERVCAL VERT INIT

T473X4A

POISONING BY SALINE AND OSMOTIC LAXATIVES UNDET INIT

S1214XB TYPE III TRAUM SPONDYLOLYSIS OF 2ND CERVCAL VERT 7THB

T474X1A

POISONING BY OTH LAXATIVES ACCIDENTAL (UNINTENTIONAL) INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12150A

OTH TRAUM DISPL SPONDYLOLYSIS OF SECOND CERVCAL VERT INIT

T474X2A

POISONING BY OTH LAXATIVES INTENTIONAL SELF-HARM INIT

S12150B

OTH TRAUM DISPL SPONDYLOLYSIS OF 2ND CERVCAL VERT 7THB

T474X3A

POISONING BY OTHER LAXATIVES ASSAULT INITIAL ENCOUNTER

S12151A

OTH TRAUM NONDISP SPONDYLOLYSIS OF SECOND CERVCAL VERT INIT

T474X4A

POISONING BY OTHER LAXATIVES UNDETERMINED INIT ENCNTR

S12151B

OTH TRAUM NONDISP SPONDYLOLYSIS OF 2ND CERVCAL VERT 7THB

T475X1A

POISONING BY DIGESTANTS ACCIDENTAL (UNINTENTIONAL) INIT

S12190A

OTH DISP FX OF SECOND CERVICAL VERTEBRA INIT FOR CLOS FX

T475X2A

POISONING BY DIGESTANTS INTENTIONAL SELF-HARM INIT ENCNTR

S12190B

OTH DISP FX OF SECOND CERVICAL VERTEBRA INIT FOR OPN FX

T475X3A

POISONING BY DIGESTANTS ASSAULT INITIAL ENCOUNTER

S12191A

OTH NONDISP FX OF SECOND CERVICAL VERTEBRA INIT FOR CLOS FX

T475X4A

POISONING BY DIGESTANTS UNDETERMINED INITIAL ENCOUNTER

S12191B

OTH NONDISP FX OF SECOND CERVICAL VERTEBRA INIT FOR OPN FX

T476X1A

POISONING BY ANTIDIARRHEAL DRUGS ACCIDENTAL INIT

S12200A

UNSP DISP FX OF THIRD CERVICAL VERTEBRA INIT FOR CLOS FX

T476X2A

POISONING BY ANTIDIARRHEAL DRUGS SELF-HARM INIT

S12200B

UNSP DISP FX OF THIRD CERVICAL VERTEBRA INIT FOR OPN FX

T476X3A

POISONING BY ANTIDIARRHEAL DRUGS ASSAULT INITIAL ENCOUNTER

S12201A

UNSP NONDISP FX OF THIRD CERVICAL VERTEBRA INIT FOR CLOS FX

T476X4A

POISONING BY ANTIDIARRHEAL DRUGS UNDETERMINED INIT ENCNTR

S12201B

UNSP NONDISP FX OF THIRD CERVICAL VERTEBRA INIT FOR OPN FX

T477X1A

POISONING BY EMETICS ACCIDENTAL (UNINTENTIONAL) INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12230A

UNSP TRAUM DISPL SPONDYLOLYSIS OF THIRD CERVCAL VERT INIT

T477X2A

POISONING BY EMETICS INTENTIONAL SELF-HARM INIT ENCNTR

S12230B

UNSP TRAUM DISPL SPONDYLOLYSIS OF 3RD CERVCAL VERT 7THB

T477X3A

POISONING BY EMETICS ASSAULT INITIAL ENCOUNTER

S12231A

UNSP TRAUM NONDISP SPONDYLOLYSIS OF THIRD CERVCAL VERT INIT

T477X4A

POISONING BY EMETICS UNDETERMINED INITIAL ENCOUNTER

S12231B

UNSP TRAUM NONDISP SPONDYLOLYSIS OF 3RD CERVCAL VERT 7THB

T478X1A

POISONING BY OTH AGENTS AFF GI SYS ACCIDENTAL INIT

S1224XA

TYPE III TRAUM SPONDYLOLYSIS OF THIRD CERVCAL VERTEBRA INIT

T478X2A

POISONING BY OTH AGENTS AFF GI SYS SELF-HARM INIT

S1224XB TYPE III TRAUM SPONDYLOLYSIS OF 3RD CERVCAL VERT 7THB

T478X3A

POISONING BY OTH AGENTS AFF GI SYS ASSAULT INIT

S12250A

OTH TRAUM DISPL SPONDYLOLYSIS OF THIRD CERVCAL VERT INIT

T478X4A

POISONING BY OTH AGENTS AFF GI SYS UNDETERMINED INIT

S12250B

OTH TRAUM DISPL SPONDYLOLYSIS OF 3RD CERVCAL VERT 7THB

T4791XA

POISONING BY UNSP AGENTS AFF THE GI SYS ACCIDENTAL INIT

S12251A

OTH TRAUM NONDISP SPONDYLOLYSIS OF THIRD CERVCAL VERT INIT

T4792XA

POISONING BY UNSP AGENTS AFF THE GI SYS SELF-HARM INIT

S12251B

OTH TRAUM NONDISP SPONDYLOLYSIS OF 3RD CERVCAL VERT 7THB

T4793XA

POISONING BY UNSP AGENTS AFF THE GI SYS ASSAULT INIT

S12290A

OTH DISP FX OF THIRD CERVICAL VERTEBRA INIT FOR CLOS FX

T4794XA

POISONING BY UNSP AGENTS AFF THE GI SYS UNDETERMINED INIT

S12290B

OTH DISP FX OF THIRD CERVICAL VERTEBRA INIT FOR OPN FX

T480X1A

POISONING BY OXYTOCIC DRUGS ACCIDENTAL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12291A

OTH NONDISP FX OF THIRD CERVICAL VERTEBRA INIT FOR CLOS FX

T480X2A

POISONING BY OXYTOCIC DRUGS INTENTIONAL SELF-HARM INIT

S12291B

OTH NONDISP FX OF THIRD CERVICAL VERTEBRA INIT FOR OPN FX

T480X3A

POISONING BY OXYTOCIC DRUGS ASSAULT INITIAL ENCOUNTER

S12300A

UNSP DISP FX OF FOURTH CERVICAL VERTEBRA INIT FOR CLOS FX

T480X4A

POISONING BY OXYTOCIC DRUGS UNDETERMINED INITIAL ENCOUNTER

S12300B

UNSP DISP FX OF FOURTH CERVICAL VERTEBRA INIT FOR OPN FX

T481X1A

POISONING BY SKELETAL MUSCLE RELAXANTS ACCIDENTAL INIT

S12301A UNSP NONDISP FX OF FOURTH CERVICAL VERTEBRA INIT

T481X2A

POISONING BY SKELETAL MUSCLE RELAXANTS SELF-HARM INIT

S12301B

UNSP NONDISP FX OF FOURTH CERVICAL VERTEBRA INIT FOR OPN FX

T481X3A

POISONING BY SKELETAL MUSCLE RELAXANTS ASSAULT INIT ENCNTR

S12330A

UNSP TRAUM DISPL SPONDYLOLYSIS OF FOURTH CERVCAL VERT INIT

T481X4A

POISONING BY SKELETAL MUSCLE RELAXANTS UNDETERMINED INIT

S12330B

UNSP TRAUM DISPL SPONDYLOLYSIS OF 4TH CERVCAL VERT 7THB

T48201A

POISONING BY UNSP DRUGS ACTING ON MUSCLES ACCIDENTAL INIT

S12331A

UNSP TRAUM NONDISP SPONDYLOLYSIS OF 4TH CERVCAL VERT INIT

T48202A

POISONING BY UNSP DRUGS ACTING ON MUSCLES SELF-HARM INIT

S12331B

UNSP TRAUM NONDISP SPONDYLOLYSIS OF 4TH CERVCAL VERT 7THB

T48203A

POISONING BY UNSP DRUGS ACTING ON MUSCLES ASSAULT INIT

S1234XA TYPE III TRAUM SPONDYLOLYSIS OF FOURTH CERVCAL VERT INIT

T48204A

POISONING BY UNSP DRUGS ACTING ON MUSCLES UNDET INIT

S1234XB TYPE III TRAUM SPONDYLOLYSIS OF 4TH CERVCAL VERT 7THB

T48291A

POISONING BY OTH DRUGS ACTING ON MUSCLES ACCIDENTAL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12350A

OTH TRAUM DISPL SPONDYLOLYSIS OF FOURTH CERVCAL VERT INIT

T48292A

POISONING BY OTH DRUGS ACTING ON MUSCLES SELF-HARM INIT

S12350B

OTH TRAUM DISPL SPONDYLOLYSIS OF 4TH CERVCAL VERT 7THB

T48293A

POISONING BY OTH DRUGS ACTING ON MUSCLES ASSAULT INIT

S12351A

OTH TRAUM NONDISP SPONDYLOLYSIS OF FOURTH CERVCAL VERT INIT

T48294A

POISONING BY OTH DRUGS ACTING ON MUSCLES UNDETERMINED INIT

S12351B

OTH TRAUM NONDISP SPONDYLOLYSIS OF 4TH CERVCAL VERT 7THB

T483X1A

POISONING BY ANTITUSSIVES ACCIDENTAL (UNINTENTIONAL) INIT

S12390A

OTH DISP FX OF FOURTH CERVICAL VERTEBRA INIT FOR CLOS FX

T483X2A

POISONING BY ANTITUSSIVES INTENTIONAL SELF-HARM INIT

S12390B

OTH DISP FX OF FOURTH CERVICAL VERTEBRA INIT FOR OPN FX

T483X3A

POISONING BY ANTITUSSIVES ASSAULT INITIAL ENCOUNTER

S12391A

OTH NONDISP FX OF FOURTH CERVICAL VERTEBRA INIT FOR CLOS FX

T483X4A

POISONING BY ANTITUSSIVES UNDETERMINED INITIAL ENCOUNTER

S12391B

OTH NONDISP FX OF FOURTH CERVICAL VERTEBRA INIT FOR OPN FX

T484X1A

POISONING BY EXPECTORANTS ACCIDENTAL (UNINTENTIONAL) INIT

S12400A

UNSP DISP FX OF FIFTH CERVICAL VERTEBRA INIT FOR CLOS FX

T484X2A

POISONING BY EXPECTORANTS INTENTIONAL SELF-HARM INIT

S12400B

UNSP DISP FX OF FIFTH CERVICAL VERTEBRA INIT FOR OPN FX

T484X3A

POISONING BY EXPECTORANTS ASSAULT INITIAL ENCOUNTER

S12401A

UNSP NONDISP FX OF FIFTH CERVICAL VERTEBRA INIT FOR CLOS FX

T484X4A

POISONING BY EXPECTORANTS UNDETERMINED INITIAL ENCOUNTER

S12401B

UNSP NONDISP FX OF FIFTH CERVICAL VERTEBRA INIT FOR OPN FX

T485X1A

POISONING BY OTH ANTI-CMN-COLD DRUGS ACCIDENTAL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12430A

UNSP TRAUM DISPL SPONDYLOLYSIS OF FIFTH CERVCAL VERT INIT

T485X2A

POISONING BY OTH ANTI-COMMON-COLD DRUGS SELF-HARM INIT

S12430B

UNSP TRAUM DISPL SPONDYLOLYSIS OF 5TH CERVCAL VERT 7THB

T485X3A

POISONING BY OTH ANTI-COMMON-COLD DRUGS ASSAULT INIT

S12431A

UNSP TRAUM NONDISP SPONDYLOLYSIS OF FIFTH CERVCAL VERT INIT

T485X4A

POISONING BY OTH ANTI-COMMON-COLD DRUGS UNDETERMINED INIT

S12431B

UNSP TRAUM NONDISP SPONDYLOLYSIS OF 5TH CERVCAL VERT 7THB

T486X1A

POISONING BY ANTIASTHMATICS ACCIDENTAL INIT

S1244XA

TYPE III TRAUM SPONDYLOLYSIS OF FIFTH CERVCAL VERTEBRA INIT

T486X2A

POISONING BY ANTIASTHMATICS INTENTIONAL SELF-HARM INIT

S1244XB TYPE III TRAUM SPONDYLOLYSIS OF 5TH CERVCAL VERT 7THB

T486X3A

POISONING BY ANTIASTHMATICS ASSAULT INITIAL ENCOUNTER

S12450A

OTH TRAUM DISPL SPONDYLOLYSIS OF FIFTH CERVCAL VERT INIT

T486X4A

POISONING BY ANTIASTHMATICS UNDETERMINED INITIAL ENCOUNTER

S12450B

OTH TRAUM DISPL SPONDYLOLYSIS OF 5TH CERVCAL VERT 7THB

T48901A

POISN BY UNSP AGENTS PRIM ACTING ON THE RESP SYS ACC INIT

S12451A

OTH TRAUM NONDISP SPONDYLOLYSIS OF FIFTH CERVCAL VERT INIT

T48902A

POISN BY UNSP AGENTS PRIM ACT ON THE RESP SYS SLF-HRM INIT

S12451B

OTH TRAUM NONDISP SPONDYLOLYSIS OF 5TH CERVCAL VERT 7THB

T48903A

POISN BY UNSP AGENTS PRIM ACT ON THE RESP SYS ASSLT INIT

S12490A OTH DISP FX OF FIFTH CERVICAL VERTEBRA INIT FOR CLOS FX

T48904A

POISN BY UNSP AGENTS PRIM ACT ON THE RESP SYS UNDET INIT

S12490B OTH DISP FX OF FIFTH CERVICAL VERTEBRA INIT FOR OPN FX

T48991A

POISN BY OTH AGENTS PRIM ACTING ON THE RESP SYS ACC INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12491A

OTH NONDISP FX OF FIFTH CERVICAL VERTEBRA INIT FOR CLOS FX

T48992A

POISN BY OTH AGENTS PRIM ACT ON THE RESP SYS SLF-HRM INIT

S12491B

OTH NONDISP FX OF FIFTH CERVICAL VERTEBRA INIT FOR OPN FX

T48993A

POISN BY OTH AGENTS PRIM ACTING ON THE RESP SYS ASSLT INIT

S12500A

UNSP DISP FX OF SIXTH CERVICAL VERTEBRA INIT FOR CLOS FX

T48994A

POISN BY OTH AGENTS PRIM ACTING ON THE RESP SYS UNDET INIT

S12500B

UNSP DISP FX OF SIXTH CERVICAL VERTEBRA INIT FOR OPN FX

T490X1A

POISONING BY LOCAL ANTIFUNG/INFECT/INFLAMM DRUGS ACC INIT

S12501A

UNSP NONDISP FX OF SIXTH CERVICAL VERTEBRA INIT FOR CLOS FX

T490X2A

POISN BY LOCAL ANTIFUNG/INFECT/INFLAMM DRUGS SLF-HRM INIT

S12501B

UNSP NONDISP FX OF SIXTH CERVICAL VERTEBRA INIT FOR OPN FX

T490X3A

POISN BY LOCAL ANTIFUNG/INFECT/INFLAMM DRUGS ASSAULT INIT

S12530A

UNSP TRAUM DISPL SPONDYLOLYSIS OF SIXTH CERVCAL VERT INIT

T490X4A

POISN BY LOCAL ANTIFUNG/INFECT/INFLAMM DRUGS UNDET INIT

S12530B

UNSP TRAUM DISPL SPONDYLOLYSIS OF SIXTH CERVCAL VERT 7THB

T491X1A

POISONING BY ANTIPRURITICS ACCIDENTAL (UNINTENTIONAL) INIT

S12531A

UNSP TRAUM NONDISP SPONDYLOLYSIS OF SIXTH CERVCAL VERT INIT

T491X2A

POISONING BY ANTIPRURITICS INTENTIONAL SELF-HARM INIT

S12531B

UNSP TRAUM NONDISP SPONDYLOLYSIS OF SIXTH CERVCAL VERT 7THB

T491X3A

POISONING BY ANTIPRURITICS ASSAULT INITIAL ENCOUNTER

S1254XA

TYPE III TRAUM SPONDYLOLYSIS OF SIXTH CERVCAL VERTEBRA INIT

T491X4A

POISONING BY ANTIPRURITICS UNDETERMINED INITIAL ENCOUNTER

S1254XB TYPE III TRAUM SPONDYLOLYSIS OF SIXTH CERVCAL VERT 7THB

T492X1A

POISONING BY LOCAL ASTRINGENTS/DETERGENTS ACCIDENTAL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12550A

OTH TRAUM DISPL SPONDYLOLYSIS OF SIXTH CERVCAL VERT INIT

T492X2A

POISONING BY LOCAL ASTRINGENTS/DETERGENTS SELF-HARM INIT

S12550B

OTH TRAUM DISPL SPONDYLOLYSIS OF SIXTH CERVCAL VERT 7THB

T492X3A

POISONING BY LOCAL ASTRINGENTS/DETERGENTS ASSAULT INIT

S12551A

OTH TRAUM NONDISP SPONDYLOLYSIS OF SIXTH CERVCAL VERT INIT

T492X4A

POISONING BY LOCAL ASTRINGENTS/DETERGENTS UNDET INIT

S12551B

OTH TRAUM NONDISP SPONDYLOLYSIS OF SIXTH CERVCAL VERT 7THB

T493X1A

POISONING BY EMOLLIENTS DEMULCENTS AND PROTECT ACC INIT

S12590A OTH DISP FX OF SIXTH CERVICAL VERTEBRA INIT FOR CLOS FX

T493X2A

POISN BY EMOLLIENTS DEMULCENTS AND PROTECT SELF-HARM INIT

S12590B OTH DISP FX OF SIXTH CERVICAL VERTEBRA INIT FOR OPN FX

T493X3A

POISN BY EMOLLIENTS DEMULCENTS AND PROTECT ASSAULT INIT

S12591A

OTH NONDISP FX OF SIXTH CERVICAL VERTEBRA INIT FOR CLOS FX

T493X4A

POISONING BY EMOLLIENTS DEMULCENTS AND PROTECT UNDET INIT

S12591B

OTH NONDISP FX OF SIXTH CERVICAL VERTEBRA INIT FOR OPN FX

T494X1A

POISONING BY KERATOLYT/KERATPLST/HAIR TRMT DRUG ACC INIT

S12600A

UNSP DISP FX OF SEVENTH CERVICAL VERTEBRA INIT FOR CLOS FX

T494X2A

POISN BY KERATOLYT/KERATPLST/HAIR TRMT DRUG SELF-HARM INIT

S12600B

UNSP DISP FX OF SEVENTH CERVICAL VERTEBRA INIT FOR OPN FX

T494X3A

POISN BY KERATOLYT/KERATPLST/HAIR TRMT DRUG ASSAULT INIT

S12601A UNSP NONDISP FX OF SEVENTH CERVICAL VERTEBRA INIT

T494X4A

POISONING BY KERATOLYT/KERATPLST/HAIR TRMT DRUG UNDET INIT

S12601B

UNSP NONDISP FX OF SEVENTH CERVCAL VERTEBRA INIT FOR OPN FX

T495X1A

POISONING BY OPTH DRUGS AND PREPARATIONS ACCIDENTAL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12630A

UNSP TRAUM DISPL SPONDYLOLYSIS OF SEVENTH CERVCAL VERT INIT

T495X2A

POISONING BY OPTH DRUGS AND PREPARATIONS SELF-HARM INIT

S12630B

UNSP TRAUM DISPL SPONDYLOLYSIS OF 7TH CERVCAL VERT 7THB

T495X3A

POISONING BY OPTH DRUGS AND PREPARATIONS ASSAULT INIT

S12631A

UNSP TRAUM NONDISP SPONDYLOLYSIS OF 7TH CERVCAL VERT INIT

T495X4A

POISONING BY OPTH DRUGS AND PREPARATIONS UNDETERMINED INIT

S12631B

UNSP TRAUM NONDISP SPONDYLOLYSIS OF 7TH CERVCAL VERT 7THB

T496X1A

POISONING BY OTORHINO DRUGS AND PREP ACCIDENTAL INIT

S1264XA

TYPE III TRAUM SPONDYLOLYSIS OF SEVENTH CERVCAL VERT INIT

T496X2A

POISONING BY OTORHINO DRUGS AND PREP SELF-HARM INIT

S1264XB TYPE III TRAUM SPONDYLOLYSIS OF 7TH CERVCAL VERT 7THB

T496X3A

POISONING BY OTORHINO DRUGS AND PREPARATIONS ASSAULT INIT

S12650A

OTH TRAUM DISPL SPONDYLOLYSIS OF SEVENTH CERVCAL VERT INIT

T496X4A

POISONING BY OTORHINO DRUGS AND PREP UNDETERMINED INIT

S12650B

OTH TRAUM DISPL SPONDYLOLYSIS OF 7TH CERVCAL VERT 7THB

T497X1A

POISONING BY DENTAL DRUGS TOPICALLY APPLIED ACC INIT

S12651A

OTH TRAUM NONDISP SPONDYLOLYSIS OF 7TH CERVCAL VERT INIT

T497X2A

POISN BY DENTAL DRUGS TOPICALLY APPLIED SELF-HARM INIT

S12651B

OTH TRAUM NONDISP SPONDYLOLYSIS OF 7TH CERVCAL VERT 7THB

T497X3A

POISONING BY DENTAL DRUGS TOPICALLY APPLIED ASSAULT INIT

S12690A

OTH DISP FX OF SEVENTH CERVICAL VERTEBRA INIT FOR CLOS FX

T497X4A

POISONING BY DENTAL DRUGS TOPICALLY APPLIED UNDET INIT

S12690B

OTH DISP FX OF SEVENTH CERVICAL VERTEBRA INIT FOR OPN FX

T498X1A

POISONING BY OTH TOPICAL AGENTS ACCIDENTAL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12691A OTH NONDISP FX OF SEVENTH CERVICAL VERTEBRA INIT

T498X2A

POISONING BY OTH TOPICAL AGENTS INTENTIONAL SELF-HARM INIT

S12691B

OTH NONDISP FX OF SEVENTH CERVICAL VERTEBRA INIT FOR OPN FX

T498X3A

POISONING BY OTHER TOPICAL AGENTS ASSAULT INIT ENCNTR

S128XXA FRACTURE OF OTHER PARTS OF NECK INITIAL ENCOUNTER

T498X4A

POISONING BY OTHER TOPICAL AGENTS UNDETERMINED INIT ENCNTR

S129XXA

FRACTURE OF NECK UNSPECIFIED INITIAL ENCOUNTER

T4991XA

POISONING BY UNSP TOPICAL AGENT ACCIDENTAL INIT

S130XXA

TRAUMATIC RUPTURE OF CERVICAL INTERVERTEBRAL DISC INIT

T4992XA

POISONING BY UNSP TOPICAL AGENT INTENTIONAL SELF-HARM INIT

S13100A

SUBLUXATION OF UNSPECIFIED CERVICAL VERTEBRAE INIT ENCNTR

T4993XA

POISONING BY UNSPECIFIED TOPICAL AGENT ASSAULT INIT ENCNTR

S13101A

DISLOCATION OF UNSPECIFIED CERVICAL VERTEBRAE INIT ENCNTR

T4994XA

POISONING BY UNSP TOPICAL AGENT UNDETERMINED INIT ENCNTR

S13110A

SUBLUXATION OF C0/C1 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T500X1A

POISONING BY MINERALOCORTICOIDS AND THEIR ANTAG ACC INIT

S13111A

DISLOCATION OF C0/C1 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T500X2A

POISONING BY MINERALOCORTICOIDS AND ANTAG SELF-HARM INIT

S13120A

SUBLUXATION OF C1/C2 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T500X3A

POISONING BY MINERALOCORTICOIDS AND ANTAG ASSAULT INIT

S13121A

DISLOCATION OF C1/C2 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T500X4A

POISONING BY MINERALOCORTICOIDS AND THEIR ANTAG UNDET INIT

S13130A

SUBLUXATION OF C2/C3 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T501X1A

POISONING BY LOOP DIURETICS ACCIDENTAL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S13131A

DISLOCATION OF C2/C3 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T501X2A

POISONING BY LOOP DIURETICS INTENTIONAL SELF-HARM INIT

S13140A

SUBLUXATION OF C3/C4 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T501X3A

POISONING BY LOOP DIURETICS ASSAULT INITIAL ENCOUNTER

S13141A

DISLOCATION OF C3/C4 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T501X4A

POISONING BY LOOP DIURETICS UNDETERMINED INITIAL ENCOUNTER

S13150A

SUBLUXATION OF C4/C5 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T502X1A

POISN BY CRBNC-ANHYDR INHIBTR BENZO/OTH DIURETC ACC INIT

S13151A

DISLOCATION OF C4/C5 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T502X2A

POISN BY CRBNC-ANHYDR INHIBTRBENZO/OTH DIURETCSLF-HRMINIT

S13160A

SUBLUXATION OF C5/C6 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T502X3A

POISN BY CRBNC-ANHYDR INHIBTRBENZO/OTH DIURETC ASSLT INIT

S13161A

DISLOCATION OF C5/C6 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T502X4A

POISN BY CRBNC-ANHYDR INHIBTRBENZO/OTH DIURETC UNDET INIT

S13170A

SUBLUXATION OF C6/C7 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T503X1A

POISONING BY ELECTROLYTIC/CALORIC/WTR-BAL AGNT ACC INIT

S13171A

DISLOCATION OF C6/C7 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T503X2A

POISN BY ELECTROLYTIC/CALORIC/WTR-BAL AGNT SELF-HARM INIT

S13180A

SUBLUXATION OF C7/T1 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T503X3A

POISN BY ELECTROLYTIC/CALORIC/WTR-BAL AGNT ASSAULT INIT

S13181A

DISLOCATION OF C7/T1 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T503X4A

POISONING BY ELECTROLYTIC/CALORIC/WTR-BAL AGNT UNDET INIT

S1320XA

DISLOCATION OF UNSPECIFIED PARTS OF NECK INITIAL ENCOUNTER

T504X1A

POISONING BY DRUGS AFFECTING URIC ACID METAB ACC INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S1329XA DISLOCATION OF OTHER PARTS OF NECK INITIAL ENCOUNTER

T504X2A

POISONING BY DRUGS AFF URIC ACID METAB SELF-HARM INIT

S134XXA

SPRAIN OF LIGAMENTS OF CERVICAL SPINE INITIAL ENCOUNTER

T504X3A

POISONING BY DRUGS AFFECTING URIC ACID METAB ASSAULT INIT

S135XXA SPRAIN OF THYROID REGION INITIAL ENCOUNTER

T504X4A

POISONING BY DRUGS AFFECTING URIC ACID METAB UNDET INIT

S138XXA

SPRAIN OF JOINTS AND LIGAMENTS OF OTH PRT NECK INIT ENCNTR

T505X1A

POISONING BY APPETITE DEPRESSANTS ACCIDENTAL INIT

S139XXA

SPRAIN OF JOINTS AND LIGAMENTS OF UNSP PARTS OF NECK INIT

T505X2A

POISONING BY APPETITE DEPRESSANTS SELF-HARM INIT

S140XXA

CONCUSSION AND EDEMA OF CERVICAL SPINAL CORD INIT ENCNTR

T505X3A

POISONING BY APPETITE DEPRESSANTS ASSAULT INIT ENCNTR

S14101A

UNSP INJURY AT C1 LEVEL OF CERVICAL SPINAL CORD INIT ENCNTR

T505X4A

POISONING BY APPETITE DEPRESSANTS UNDETERMINED INIT ENCNTR

S14102A

UNSP INJURY AT C2 LEVEL OF CERVICAL SPINAL CORD INIT ENCNTR

T506X1A

POISONING BY ANTIDOTES AND CHELATING AGENTS ACC INIT

S14103A

UNSP INJURY AT C3 LEVEL OF CERVICAL SPINAL CORD INIT ENCNTR

T506X2A

POISONING BY ANTIDOTES AND CHELATING AGENTS SELF-HARM INIT

S14104A

UNSP INJURY AT C4 LEVEL OF CERVICAL SPINAL CORD INIT ENCNTR

T506X3A

POISONING BY ANTIDOTES AND CHELATING AGENTS ASSAULT INIT

S14105A

UNSP INJURY AT C5 LEVEL OF CERVICAL SPINAL CORD INIT ENCNTR

T506X4A

POISONING BY ANTIDOTES AND CHELATING AGENTS UNDET INIT

S14106A

UNSP INJURY AT C6 LEVEL OF CERVICAL SPINAL CORD INIT ENCNTR

T507X1A

POISN BY ANALEPTICS AND OPIOID RECEPTOR ANTAG ACC INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S14107A

UNSP INJURY AT C7 LEVEL OF CERVICAL SPINAL CORD INIT ENCNTR

T507X2A

POISN BY ANALEPTICS AND OPIOID RECEPTOR ANTAG SLF-HRM INIT

S14108A

UNSP INJURY AT C8 LEVEL OF CERVICAL SPINAL CORD INIT ENCNTR

T507X3A

POISN BY ANALEPTICS AND OPIOID RECEPTOR ANTAG ASSAULT INIT

S14109A UNSP INJURY AT UNSP LEVEL OF CERVICAL SPINAL CORD INIT

T507X4A

POISN BY ANALEPTICS AND OPIOID RECEPTOR ANTAG UNDET INIT

S14111A COMPLETE LESION AT C1 LEVEL OF CERVICAL SPINAL CORD INIT

T508X1A

POISONING BY DIAGNOSTIC AGENTS ACCIDENTAL INIT

S14112A COMPLETE LESION AT C2 LEVEL OF CERVICAL SPINAL CORD INIT

T508X2A

POISONING BY DIAGNOSTIC AGENTS INTENTIONAL SELF-HARM INIT

S14113A COMPLETE LESION AT C3 LEVEL OF CERVICAL SPINAL CORD INIT

T508X3A

POISONING BY DIAGNOSTIC AGENTS ASSAULT INITIAL ENCOUNTER

S14114A COMPLETE LESION AT C4 LEVEL OF CERVICAL SPINAL CORD INIT

T508X4A

POISONING BY DIAGNOSTIC AGENTS UNDETERMINED INIT ENCNTR

S14115A COMPLETE LESION AT C5 LEVEL OF CERVICAL SPINAL CORD INIT

T50901A

POISONING BY UNSP DRUG/MEDS/BIOL SUBST ACCIDENTAL INIT

S14116A COMPLETE LESION AT C6 LEVEL OF CERVICAL SPINAL CORD INIT

T50902A

POISONING BY UNSP DRUG/MEDS/BIOL SUBST SELF-HARM INIT

S14117A COMPLETE LESION AT C7 LEVEL OF CERVICAL SPINAL CORD INIT

T50903A

POISONING BY UNSP DRUG/MEDS/BIOL SUBST ASSAULT INIT

S14118A COMPLETE LESION AT C8 LEVEL OF CERVICAL SPINAL CORD INIT

T50904A

POISONING BY UNSP DRUG/MEDS/BIOL SUBST UNDETERMINED INIT

S14119A

COMPLETE LESION AT UNSP LEVEL OF CERVICAL SPINAL CORD INIT

T50991A

POISONING BY OTH DRUG/MEDS/BIOL SUBST ACCIDENTAL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S14121A CENTRAL CORD SYNDROME AT C1 INIT

T50992A

POISONING BY OTH DRUG/MEDS/BIOL SUBST SELF-HARM INIT

S14122A CENTRAL CORD SYNDROME AT C2 INIT

T50993A

POISONING BY OTH DRUG/MEDS/BIOL SUBST ASSAULT INIT

S14123A CENTRAL CORD SYNDROME AT C3 INIT

T50994A

POISONING BY OTH DRUG/MEDS/BIOL SUBST UNDETERMINED INIT

S14124A CENTRAL CORD SYNDROME AT C4 INIT

T50A11A

POISN BY PERTUSS VACCINE INC COMBIN W PERTUSS ACC INIT

S14125A CENTRAL CORD SYNDROME AT C5 INIT

T50A12A

POISN BY PERTUSS VACCN INC COMBIN W PERTUSS SLF-HRM INIT

S14126A CENTRAL CORD SYNDROME AT C6 INIT

T50A13A

POISN BY PERTUSS VACCINE INC COMBIN W PERTUSS ASSLT INIT

S14127A CENTRAL CORD SYNDROME AT C7 INIT

T50A14A

POISN BY PERTUSS VACCINE INC COMBIN W PERTUSS UNDET INIT

S14128A CENTRAL CORD SYNDROME AT C8 INIT

T50A21A

POISONING BY MIXED BACT VACCINES W/O A PERTUSS ACC INIT

S14129A

CENTRAL CORD SYND AT UNSP LEVEL OF CERV SPINAL CORD INIT

T50A22A

POISN BY MIXED BACT VACCINES W/O A PERTUSS SELF-HARM INIT

S14131A ANTERIOR CORD SYNDROME AT C1 INIT

T50A23A

POISN BY MIXED BACT VACCINES W/O A PERTUSS ASSAULT INIT

S14132A ANTERIOR CORD SYNDROME AT C2 INIT

T50A24A

POISONING BY MIXED BACT VACCINES W/O A PERTUSS UNDET INIT

S14133A ANTERIOR CORD SYNDROME AT C3 INIT

T50A91A

POISONING BY OTH BACTERIAL VACCINES ACCIDENTAL INIT

S14134A ANTERIOR CORD SYNDROME AT C4 INIT

T50A92A

POISONING BY OTH BACTERIAL VACCINES SELF-HARM INIT

S14135A ANTERIOR CORD SYNDROME AT C5 INIT

T50A93A

POISONING BY OTHER BACTERIAL VACCINES ASSAULT INIT ENCNTR

S14136A ANTERIOR CORD SYNDROME AT C6 INIT

T50A94A

POISONING BY OTH BACTERIAL VACCINES UNDETERMINED INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S14137A ANTERIOR CORD SYNDROME AT C7 INIT

T50B11A

POISONING BY SMALLPOX VACCINES ACCIDENTAL INIT

S14138A ANTERIOR CORD SYNDROME AT C8 INIT

T50B12A

POISONING BY SMALLPOX VACCINES INTENTIONAL SELF-HARM INIT

S14139A

ANT CORD SYNDROME AT UNSP LEVEL OF CERV SPINAL CORD INIT

T50B13A

POISONING BY SMALLPOX VACCINES ASSAULT INITIAL ENCOUNTER

S14141A BROWN-SEQUARD SYNDROME AT C1 INIT

T50B14A

POISONING BY SMALLPOX VACCINES UNDETERMINED INIT ENCNTR

S14142A BROWN-SEQUARD SYNDROME AT C2 INIT

T50B91A

POISONING BY OTH VIRAL VACCINES ACCIDENTAL INIT

S14143A BROWN-SEQUARD SYNDROME AT C3 INIT

T50B92A

POISONING BY OTH VIRAL VACCINES INTENTIONAL SELF-HARM INIT

S14144A BROWN-SEQUARD SYNDROME AT C4 INIT

T50B93A

POISONING BY OTHER VIRAL VACCINES ASSAULT INIT ENCNTR

S14145A BROWN-SEQUARD SYNDROME AT C5 INIT

T50B94A

POISONING BY OTHER VIRAL VACCINES UNDETERMINED INIT ENCNTR

S14146A BROWN-SEQUARD SYNDROME AT C6 INIT

T50Z11A

POISONING BY IMMUNOGLOBULIN ACCIDENTAL INIT

S14147A BROWN-SEQUARD SYNDROME AT C7 INIT

T50Z12A

POISONING BY IMMUNOGLOBULIN INTENTIONAL SELF-HARM INIT

S14148A BROWN-SEQUARD SYNDROME AT C8 INIT

T50Z13A

POISONING BY IMMUNOGLOBULIN ASSAULT INITIAL ENCOUNTER

S14149A

BROWN-SEQUARD SYND AT UNSP LEVEL OF CERV SPINAL CORD INIT

T50Z14A

POISONING BY IMMUNOGLOBULIN UNDETERMINED INITIAL ENCOUNTER

S14151A OTH INCOMPLETE LESION AT C1 INIT

T50Z91A

POISONING BY OTH VACCINES AND BIOLG SUBSTANCES ACC INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S14152A OTH INCOMPLETE LESION AT C2 INIT

T50Z92A

POISONING BY OTH VACCINES AND BIOLG SUBSTNC SELF-HARM INIT

S14153A OTH INCOMPLETE LESION AT C3 INIT

T50Z93A

POISONING BY OTH VACCINES AND BIOLG SUBSTNC ASSAULT INIT

S14154A OTH INCOMPLETE LESION AT C4 INIT

T50Z94A

POISONING BY OTH VACCINES AND BIOLG SUBSTANCES UNDET INIT

S14155A OTH INCOMPLETE LESION AT C5 INIT

T510X1A

TOXIC EFFECT OF ETHANOL ACCIDENTAL (UNINTENTIONAL) INIT

S14156A OTH INCOMPLETE LESION AT C6 INIT

T510X2A

TOXIC EFFECT OF ETHANOL INTENTIONAL SELF-HARM INIT ENCNTR

S14157A OTH INCOMPLETE LESION AT C7 INIT

T510X3A

TOXIC EFFECT OF ETHANOL ASSAULT INITIAL ENCOUNTER

S14158A OTH INCOMPLETE LESION AT C8 INIT

T510X4A

TOXIC EFFECT OF ETHANOL UNDETERMINED INITIAL ENCOUNTER

S14159A

OTH INCMPL LESION AT UNSP LEVEL OF CERV SPINAL CORD INIT

T511X1A

TOXIC EFFECT OF METHANOL ACCIDENTAL (UNINTENTIONAL) INIT

S142XXA

INJURY OF NERVE ROOT OF CERVICAL SPINE INITIAL ENCOUNTER

T511X2A

TOXIC EFFECT OF METHANOL INTENTIONAL SELF-HARM INIT ENCNTR

S143XXA INJURY OF BRACHIAL PLEXUS INITIAL ENCOUNTER

T511X3A

TOXIC EFFECT OF METHANOL ASSAULT INITIAL ENCOUNTER

S144XXA INJURY OF PERIPHERAL NERVES OF NECK INITIAL ENCOUNTER

T511X4A

TOXIC EFFECT OF METHANOL UNDETERMINED INITIAL ENCOUNTER

S145XXA

INJURY OF CERVICAL SYMPATHETIC NERVES INITIAL ENCOUNTER

T512X1A

TOXIC EFFECT OF 2-PROPANOL ACCIDENTAL (UNINTENTIONAL) INIT

S148XXA

INJURY OF OTHER SPECIFIED NERVES OF NECK INITIAL ENCOUNTER

T512X2A

TOXIC EFFECT OF 2-PROPANOL INTENTIONAL SELF-HARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S149XXA

INJURY OF UNSPECIFIED NERVES OF NECK INITIAL ENCOUNTER

T512X3A

TOXIC EFFECT OF 2-PROPANOL ASSAULT INITIAL ENCOUNTER

S15001A UNSPECIFIED INJURY OF RIGHT CAROTID ARTERY INIT ENCNTR

T512X4A

TOXIC EFFECT OF 2-PROPANOL UNDETERMINED INITIAL ENCOUNTER

S15002A

UNSPECIFIED INJURY OF LEFT CAROTID ARTERY INITIAL ENCOUNTER

T513X1A

TOXIC EFFECT OF FUSEL OIL ACCIDENTAL (UNINTENTIONAL) INIT

S15009A UNSP INJURY OF UNSPECIFIED CAROTID ARTERY INIT ENCNTR

T513X2A

TOXIC EFFECT OF FUSEL OIL INTENTIONAL SELF-HARM INIT

S15011A

MINOR LACERATION OF RIGHT CAROTID ARTERY INITIAL ENCOUNTER

T513X3A

TOXIC EFFECT OF FUSEL OIL ASSAULT INITIAL ENCOUNTER

S15012A

MINOR LACERATION OF LEFT CAROTID ARTERY INITIAL ENCOUNTER

T513X4A

TOXIC EFFECT OF FUSEL OIL UNDETERMINED INITIAL ENCOUNTER

S15019A

MINOR LACERATION OF UNSPECIFIED CAROTID ARTERY INIT ENCNTR

T518X1A

TOXIC EFFECT OF ALCOHOLS ACCIDENTAL (UNINTENTIONAL) INIT

S15021A

MAJOR LACERATION OF RIGHT CAROTID ARTERY INITIAL ENCOUNTER

T518X2A

TOXIC EFFECT OF OTH ALCOHOLS INTENTIONAL SELF-HARM INIT

S15022A

MAJOR LACERATION OF LEFT CAROTID ARTERY INITIAL ENCOUNTER

T518X3A

TOXIC EFFECT OF OTHER ALCOHOLS ASSAULT INITIAL ENCOUNTER

S15029A

MAJOR LACERATION OF UNSPECIFIED CAROTID ARTERY INIT ENCNTR

T518X4A

TOXIC EFFECT OF OTHER ALCOHOLS UNDETERMINED INIT ENCNTR

S15091A

OTHER SPECIFIED INJURY OF RIGHT CAROTID ARTERY INIT ENCNTR

T5191XA

TOXIC EFFECT OF UNSP ALCOHOL ACCIDENTAL INIT

S15092A

OTHER SPECIFIED INJURY OF LEFT CAROTID ARTERY INIT ENCNTR

T5192XA

TOXIC EFFECT OF UNSP ALCOHOL INTENTIONAL SELF-HARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S15099A OTH INJURY OF UNSPECIFIED CAROTID ARTERY INIT ENCNTR

T5193XA

TOXIC EFFECT OF UNSPECIFIED ALCOHOL ASSAULT INIT ENCNTR

S15101A

UNSPECIFIED INJURY OF RIGHT VERTEBRAL ARTERY INIT ENCNTR

T5194XA

TOXIC EFFECT OF UNSP ALCOHOL UNDETERMINED INIT ENCNTR

S15102A

UNSPECIFIED INJURY OF LEFT VERTEBRAL ARTERY INIT ENCNTR

T520X1A

TOXIC EFFECT OF PETROLEUM PRODUCTS ACCIDENTAL INIT

S15109A

UNSP INJURY OF UNSPECIFIED VERTEBRAL ARTERY INIT ENCNTR

T520X2A

TOXIC EFFECT OF PETROLEUM PRODUCTS SELF-HARM INIT

S15111A

MINOR LACERATION OF RIGHT VERTEBRAL ARTERY INIT ENCNTR

T520X3A

TOXIC EFFECT OF PETROLEUM PRODUCTS ASSAULT INIT ENCNTR

S15112A

MINOR LACERATION OF LEFT VERTEBRAL ARTERY INITIAL ENCOUNTER

T520X4A

TOXIC EFFECT OF PETROLEUM PRODUCTS UNDETERMINED INIT

S15119A

MINOR LACERATION OF UNSP VERTEBRAL ARTERY INIT ENCNTR

T521X1A

TOXIC EFFECT OF BENZENE ACCIDENTAL (UNINTENTIONAL) INIT

S15121A

MAJOR LACERATION OF RIGHT VERTEBRAL ARTERY INIT ENCNTR

T521X2A

TOXIC EFFECT OF BENZENE INTENTIONAL SELF-HARM INIT ENCNTR

S15122A

MAJOR LACERATION OF LEFT VERTEBRAL ARTERY INITIAL ENCOUNTER

T521X3A

TOXIC EFFECT OF BENZENE ASSAULT INITIAL ENCOUNTER

S15129A

MAJOR LACERATION OF UNSP VERTEBRAL ARTERY INIT ENCNTR

T521X4A

TOXIC EFFECT OF BENZENE UNDETERMINED INITIAL ENCOUNTER

S15191A

OTH INJURY OF RIGHT VERTEBRAL ARTERY INIT ENCNTR

T522X1A

TOXIC EFFECT OF HOMOLOGUES OF BENZENE ACCIDENTAL INIT

S15192A

OTHER SPECIFIED INJURY OF LEFT VERTEBRAL ARTERY INIT ENCNTR

T522X2A

TOXIC EFFECT OF HOMOLOGUES OF BENZENE SELF-HARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S15199A

OTH INJURY OF UNSPECIFIED VERTEBRAL ARTERY INIT ENCNTR

T522X3A

TOXIC EFFECT OF HOMOLOGUES OF BENZENE ASSAULT INIT ENCNTR

S15201A

UNSP INJURY OF RIGHT EXTERNAL JUGULAR VEIN INIT ENCNTR

T522X4A

TOXIC EFFECT OF HOMOLOGUES OF BENZENE UNDETERMINED INIT

S15202A

UNSP INJURY OF LEFT EXTERNAL JUGULAR VEIN INIT ENCNTR

T523X1A

TOXIC EFFECT OF GLYCOLS ACCIDENTAL (UNINTENTIONAL) INIT

S15209A

UNSP INJURY OF UNSP EXTERNAL JUGULAR VEIN INIT ENCNTR

T523X2A

TOXIC EFFECT OF GLYCOLS INTENTIONAL SELF-HARM INIT ENCNTR

S15211A

MINOR LACERATION OF RIGHT EXTERNAL JUGULAR VEIN INIT ENCNTR

T523X3A

TOXIC EFFECT OF GLYCOLS ASSAULT INITIAL ENCOUNTER

S15212A

MINOR LACERATION OF LEFT EXTERNAL JUGULAR VEIN INIT ENCNTR

T523X4A

TOXIC EFFECT OF GLYCOLS UNDETERMINED INITIAL ENCOUNTER

S15219A

MINOR LACERATION OF UNSP EXTERNAL JUGULAR VEIN INIT ENCNTR

T524X1A

TOXIC EFFECT OF KETONES ACCIDENTAL (UNINTENTIONAL) INIT

S15221A

MAJOR LACERATION OF RIGHT EXTERNAL JUGULAR VEIN INIT ENCNTR

T524X2A

TOXIC EFFECT OF KETONES INTENTIONAL SELF-HARM INIT ENCNTR

S15222A

MAJOR LACERATION OF LEFT EXTERNAL JUGULAR VEIN INIT ENCNTR

T524X3A

TOXIC EFFECT OF KETONES ASSAULT INITIAL ENCOUNTER

S15229A

MAJOR LACERATION OF UNSP EXTERNAL JUGULAR VEIN INIT ENCNTR

T524X4A

TOXIC EFFECT OF KETONES UNDETERMINED INITIAL ENCOUNTER

S15291A

OTH INJURY OF RIGHT EXTERNAL JUGULAR VEIN INIT ENCNTR

T528X1A

TOXIC EFFECT OF ORGANIC SOLVENTS ACCIDENTAL INIT

S15292A OTH INJURY OF LEFT EXTERNAL JUGULAR VEIN INIT ENCNTR

T528X2A

TOXIC EFFECT OF ORGANIC SOLVENTS SELF-HARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S15299A

OTH INJURY OF UNSPECIFIED EXTERNAL JUGULAR VEIN INIT ENCNTR

T528X3A

TOXIC EFFECT OF OTHER ORGANIC SOLVENTS ASSAULT INIT ENCNTR

S15301A

UNSP INJURY OF RIGHT INTERNAL JUGULAR VEIN INIT ENCNTR

T528X4A

TOXIC EFFECT OF OTH ORGANIC SOLVENTS UNDETERMINED INIT

S15302A UNSP INJURY OF LEFT INTERNAL JUGULAR VEIN INIT ENCNTR

T5291XA

TOXIC EFFECT OF UNSP ORGANIC SOLVENT ACCIDENTAL INIT

S15309A

UNSP INJURY OF UNSP INTERNAL JUGULAR VEIN INIT ENCNTR

T5292XA

TOXIC EFFECT OF UNSP ORGANIC SOLVENT SELF-HARM INIT

S15311A

MINOR LACERATION OF RIGHT INTERNAL JUGULAR VEIN INIT ENCNTR

T5293XA

TOXIC EFFECT OF UNSP ORGANIC SOLVENT ASSAULT INIT ENCNTR

S15312A

MINOR LACERATION OF LEFT INTERNAL JUGULAR VEIN INIT ENCNTR

T5294XA

TOXIC EFFECT OF UNSP ORGANIC SOLVENT UNDETERMINED INIT

S15319A

MINOR LACERATION OF UNSP INTERNAL JUGULAR VEIN INIT ENCNTR

T530X1A

TOXIC EFFECT OF CARBON TETRACHLORIDE ACCIDENTAL INIT

S15321A

MAJOR LACERATION OF RIGHT INTERNAL JUGULAR VEIN INIT ENCNTR

T530X2A

TOXIC EFFECT OF CARBON TETRACHLORIDE SELF-HARM INIT

S15322A

MAJOR LACERATION OF LEFT INTERNAL JUGULAR VEIN INIT ENCNTR

T530X3A

TOXIC EFFECT OF CARBON TETRACHLORIDE ASSAULT INIT ENCNTR

S15329A

MAJOR LACERATION OF UNSP INTERNAL JUGULAR VEIN INIT ENCNTR

T530X4A

TOXIC EFFECT OF CARBON TETRACHLORIDE UNDETERMINED INIT

S15391A

OTH INJURY OF RIGHT INTERNAL JUGULAR VEIN INIT ENCNTR

T531X1A

TOXIC EFFECT OF CHLOROFORM ACCIDENTAL (UNINTENTIONAL) INIT

S15392A OTH INJURY OF LEFT INTERNAL JUGULAR VEIN INIT ENCNTR

T531X2A

TOXIC EFFECT OF CHLOROFORM INTENTIONAL SELF-HARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S15399A

OTH INJURY OF UNSPECIFIED INTERNAL JUGULAR VEIN INIT ENCNTR

T531X3A

TOXIC EFFECT OF CHLOROFORM ASSAULT INITIAL ENCOUNTER

S158XXA INJURY OF OTH BLOOD VESSELS AT NECK LEVEL INIT ENCNTR

T531X4A

TOXIC EFFECT OF CHLOROFORM UNDETERMINED INITIAL ENCOUNTER

S159XXA INJURY OF UNSP BLOOD VESSEL AT NECK LEVEL INIT ENCNTR

T532X1A

TOXIC EFFECT OF TRICHLOROETHYLENE ACCIDENTAL INIT

S161XXA STRAIN OF MUSCLE FASCIA AND TENDON AT NECK LEVEL INIT

T532X2A

TOXIC EFFECT OF TRICHLOROETHYLENE SELF-HARM INIT

S162XXA

LACERATION OF MUSCLE FASCIA AND TENDON AT NECK LEVEL INIT

T532X3A

TOXIC EFFECT OF TRICHLOROETHYLENE ASSAULT INIT ENCNTR

S168XXA

INJ MUSCLE FASCIA AND TENDON AT NECK LEVEL INIT ENCNTR

T532X4A

TOXIC EFFECT OF TRICHLOROETHYLENE UNDETERMINED INIT ENCNTR

S169XXA

UNSP INJURY OF MUSCLE FASCIA AND TENDON AT NECK LEVEL INIT

T533X1A

TOXIC EFFECT OF TETRACHLOROETHYLENE ACCIDENTAL INIT

S170XXA

CRUSHING INJURY OF LARYNX AND TRACHEA INITIAL ENCOUNTER

T533X2A

TOXIC EFFECT OF TETRACHLOROETHYLENE SELF-HARM INIT

S178XXA CRUSHING INJURY OF OTH PARTS OF NECK INIT ENCNTR

T533X3A

TOXIC EFFECT OF TETRACHLOROETHYLENE ASSAULT INIT ENCNTR

S179XXA

CRUSHING INJURY OF NECK PART UNSPECIFIED INITIAL ENCOUNTER

T533X4A

TOXIC EFFECT OF TETRACHLOROETHYLENE UNDETERMINED INIT

S1980XA OTH INJURIES OF UNSPECIFIED PART OF NECK INIT ENCNTR

T534X1A

TOXIC EFFECT OF DICHLOROMETHANE ACCIDENTAL INIT

S1981XA OTHER SPECIFIED INJURIES OF LARYNX INITIAL ENCOUNTER

T534X2A

TOXIC EFFECT OF DICHLOROMETHANE INTENTIONAL SELF-HARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S1982XA

OTHER SPECIFIED INJURIES OF CERVICAL TRACHEA INIT ENCNTR

T534X3A

TOXIC EFFECT OF DICHLOROMETHANE ASSAULT INITIAL ENCOUNTER

S1983XA

OTHER SPECIFIED INJURIES OF VOCAL CORD INITIAL ENCOUNTER

T534X4A

TOXIC EFFECT OF DICHLOROMETHANE UNDETERMINED INIT ENCNTR

S1984XA

OTHER SPECIFIED INJURIES OF THYROID GLAND INITIAL ENCOUNTER

T535X1A

TOXIC EFFECT OF CHLOROFLUOROCARBONS ACCIDENTAL INIT

S1985XA

OTH INJURIES OF PHARYNX AND CERVICAL ESOPHAGUS INIT ENCNTR

T535X2A

TOXIC EFFECT OF CHLOROFLUOROCARBONS SELF-HARM INIT

S1989XA

OTH INJURIES OF OTHER SPECIFIED PART OF NECK INIT ENCNTR

T535X3A

TOXIC EFFECT OF CHLOROFLUOROCARBONS ASSAULT INIT ENCNTR

S199XXA UNSPECIFIED INJURY OF NECK INITIAL ENCOUNTER

T535X4A

TOXIC EFFECT OF CHLOROFLUOROCARBONS UNDETERMINED INIT

S2000XA

CONTUSION OF BREAST UNSPECIFIED BREAST INITIAL ENCOUNTER

T536X1A

TOXIC EFF OF HALGN DERIV OF ALIPHATIC HYDROCRB ACC INIT

S2001XA CONTUSION OF RIGHT BREAST INITIAL ENCOUNTER

T536X2A

TOX EFF OF HALGN DERIV OF ALIPHATIC HYDROCRB SLF-HRM INIT

S2002XA CONTUSION OF LEFT BREAST INITIAL ENCOUNTER

T536X3A

TOXIC EFF OF HALGN DERIV OF ALIPHATIC HYDROCRB ASSLT INIT

S20101A UNSP SUPERFICIAL INJURIES OF BREAST RIGHT BREAST INIT

T536X4A

TOXIC EFF OF HALGN DERIV OF ALIPHATIC HYDROCRB UNDET INIT

S20102A UNSP SUPERFICIAL INJURIES OF BREAST LEFT BREAST INIT

T537X1A

TOXIC EFFECT OF HALGN DERIV OF AROMATIC HYDROCRB ACC INIT

S20109A UNSP SUPERFICIAL INJURIES OF BREAST UNSP BREAST INIT

T537X2A

TOXIC EFF OF HALGN DERIV OF AROMATIC HYDROCRB SLF-HRM INIT

S20111A ABRASION OF BREAST RIGHT BREAST INITIAL ENCOUNTER

T537X3A

TOXIC EFF OF HALGN DERIV OF AROMATIC HYDROCRB ASSLT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S20112A ABRASION OF BREAST LEFT BREAST INITIAL ENCOUNTER

T537X4A

TOXIC EFF OF HALGN DERIV OF AROMATIC HYDROCRB UNDET INIT

S20119A

ABRASION OF BREAST UNSPECIFIED BREAST INITIAL ENCOUNTER

T5391XA

TOXIC EFF OF UNSP HALGN DERIV OF AROMAT HYDROCRB ACC INIT

S20121A

BLISTER (NONTHERMAL) OF BREAST RIGHT BREAST INIT ENCNTR

T5392XA

TOX EFF OF UNSP HALGN DERIV OF AROMAT HYDROCRBSLF-HRM INIT

S20122A

BLISTER (NONTHERMAL) OF BREAST LEFT BREAST INIT ENCNTR

T5393XA

TOX EFF OF UNSP HALGN DERIV OF AROMAT HYDROCRB ASSLT INIT

S20129A

BLISTER (NONTHERMAL) OF BREAST UNSP BREAST INIT ENCNTR

T5394XA

TOX EFF OF UNSP HALGN DERIV OF AROMAT HYDROCRB UNDET INIT

S20141A

EXTERNAL CONSTRICTION OF PART OF BREAST RIGHT BREAST INIT

T540X1A

TOXIC EFFECT OF PHENOL AND PHENOL HOMOLOGUES ACC INIT

S20142A

EXTERNAL CONSTRICTION OF PART OF BREAST LEFT BREAST INIT

T540X2A

TOXIC EFFECT OF PHENOL AND PHENOL HOMOLOG SELF-HARM INIT

S20149A

EXTERNAL CONSTRICTION OF PART OF BREAST UNSP BREAST INIT

T540X3A

TOXIC EFFECT OF PHENOL AND PHENOL HOMOLOGUES ASSAULT INIT

S20151A SUPERFICIAL FOREIGN BODY OF BREAST RIGHT BREAST INIT

T540X4A

TOXIC EFFECT OF PHENOL AND PHENOL HOMOLOGUES UNDET INIT

S20152A

SUPERFICIAL FOREIGN BODY OF BREAST LEFT BREAST INIT ENCNTR

T541X1A

TOXIC EFFECT OF CORROSIVE ORGANIC COMPOUNDS ACC INIT

S20159A

SUPERFICIAL FOREIGN BODY OF BREAST UNSP BREAST INIT ENCNTR

T541X2A

TOXIC EFFECT OF CORROSIVE ORGANIC COMPOUNDS SELF-HARM INIT

S20161A INSECT BITE (NONVENOMOUS) OF BREAST RIGHT BREAST INIT

T541X3A

TOXIC EFFECT OF CORROSIVE ORGANIC COMPOUNDS ASSAULT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S20162A INSECT BITE (NONVENOMOUS) OF BREAST LEFT BREAST INIT

T541X4A

TOXIC EFFECT OF CORROSIVE ORGANIC COMPOUNDS UNDET INIT

S20169A INSECT BITE (NONVENOMOUS) OF BREAST UNSP BREAST INIT

T542X1A

TOXIC EFF OF CORROSV ACIDS AND ACID-LIKE SUBSTNC ACC INIT

S20171A

OTHER SUPERFICIAL BITE OF BREAST RIGHT BREAST INIT ENCNTR

T542X2A

TOX EFF OF CORROSV ACIDS & ACID-LIKE SUBSTNC SLF-HRM INIT

S20172A

OTHER SUPERFICIAL BITE OF BREAST LEFT BREAST INIT ENCNTR

T542X3A

TOX EFF OF CORROSV ACIDS AND ACID-LIKE SUBSTNC ASSLT INIT

S20179A

OTHER SUPERFICIAL BITE OF BREAST UNSP BREAST INIT ENCNTR

T542X4A

TOX EFF OF CORROSV ACIDS AND ACID-LIKE SUBSTNC UNDET INIT

S2020XA

CONTUSION OF THORAX UNSPECIFIED INITIAL ENCOUNTER

T543X1A

TOX EFF OF CORROSV ALKALIS AND ALK-LIKE SUBSTNC ACC INIT

S20211A

CONTUSION OF RIGHT FRONT WALL OF THORAX INITIAL ENCOUNTER

T543X2A

TOX EFF OF CORROSV ALKALIS & ALK-LIKE SUBSTNC SLF-HRM INIT

S20212A

CONTUSION OF LEFT FRONT WALL OF THORAX INITIAL ENCOUNTER

T543X3A

TOX EFF OF CORROSV ALKALIS AND ALK-LIKE SUBSTNC ASSLT INIT

S20219A

CONTUSION OF UNSPECIFIED FRONT WALL OF THORAX INIT ENCNTR

T543X4A

TOX EFF OF CORROSV ALKALIS AND ALK-LIKE SUBSTNC UNDET INIT

S20221A

CONTUSION OF RIGHT BACK WALL OF THORAX INITIAL ENCOUNTER

T5491XA

TOXIC EFFECT OF UNSP CORROSIVE SUBSTANCE ACCIDENTAL INIT

S20222A

CONTUSION OF LEFT BACK WALL OF THORAX INITIAL ENCOUNTER

T5492XA

TOXIC EFFECT OF UNSP CORROSIVE SUBSTANCE SELF-HARM INIT

S20229A

CONTUSION OF UNSPECIFIED BACK WALL OF THORAX INIT ENCNTR

T5493XA

TOXIC EFFECT OF UNSP CORROSIVE SUBSTANCE ASSAULT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S20301A UNSP SUPERFICIAL INJURIES OF R FRNT WL OF THORAX INIT

T5494XA

TOXIC EFFECT OF UNSP CORROSIVE SUBSTANCE UNDETERMINED INIT

S20302A

UNSP SUPERFICIAL INJURIES OF LEFT FRONT WALL OF THORAX INIT

T550X1A

TOXIC EFFECT OF SOAPS ACCIDENTAL (UNINTENTIONAL) INIT

S20309A

UNSP SUPERFICIAL INJURIES OF UNSP FRONT WALL OF THORAX INIT

T550X2A

TOXIC EFFECT OF SOAPS INTENTIONAL SELF-HARM INIT ENCNTR

S20311A

ABRASION OF RIGHT FRONT WALL OF THORAX INITIAL ENCOUNTER

T550X3A

TOXIC EFFECT OF SOAPS ASSAULT INITIAL ENCOUNTER

S20312A

ABRASION OF LEFT FRONT WALL OF THORAX INITIAL ENCOUNTER

T550X4A

TOXIC EFFECT OF SOAPS UNDETERMINED INITIAL ENCOUNTER

S20319A

ABRASION OF UNSPECIFIED FRONT WALL OF THORAX INIT ENCNTR

T551X1A

TOXIC EFFECT OF DETERGENTS ACCIDENTAL (UNINTENTIONAL) INIT

S20321A

BLISTER (NONTHERMAL) OF RIGHT FRONT WALL OF THORAX INIT

T551X2A

TOXIC EFFECT OF DETERGENTS INTENTIONAL SELF-HARM INIT

S20322A

BLISTER (NONTHERMAL) OF LEFT FRONT WALL OF THORAX INIT

T551X3A

TOXIC EFFECT OF DETERGENTS ASSAULT INITIAL ENCOUNTER

S20329A

BLISTER (NONTHERMAL) OF UNSP FRONT WALL OF THORAX INIT

T551X4A

TOXIC EFFECT OF DETERGENTS UNDETERMINED INITIAL ENCOUNTER

S20341A

EXTERNAL CONSTRICTION OF RIGHT FRONT WALL OF THORAX INIT

T560X1A

TOXIC EFFECT OF LEAD AND ITS COMPOUNDS ACCIDENTAL INIT

S20342A

EXTERNAL CONSTRICTION OF LEFT FRONT WALL OF THORAX INIT

T560X2A

TOXIC EFFECT OF LEAD AND ITS COMPOUNDS SELF-HARM INIT

S20349A

EXTERNAL CONSTRICTION OF UNSP FRONT WALL OF THORAX INIT

T560X3A

TOXIC EFFECT OF LEAD AND ITS COMPOUNDS ASSAULT INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S20351A

SUPERFICIAL FOREIGN BODY OF RIGHT FRONT WALL OF THORAX INIT

T560X4A

TOXIC EFFECT OF LEAD AND ITS COMPOUNDS UNDETERMINED INIT

S20352A

SUPERFICIAL FOREIGN BODY OF LEFT FRONT WALL OF THORAX INIT

T561X1A

TOXIC EFFECT OF MERCURY AND ITS COMPOUNDS ACCIDENTAL INIT

S20359A

SUPERFICIAL FOREIGN BODY OF UNSP FRONT WALL OF THORAX INIT

T561X2A

TOXIC EFFECT OF MERCURY AND ITS COMPOUNDS SELF-HARM INIT

S20361A INSECT BITE (NONVENOMOUS) OF R FRNT WL OF THORAX INIT

T561X3A

TOXIC EFFECT OF MERCURY AND ITS COMPOUNDS ASSAULT INIT

S20362A

INSECT BITE (NONVENOMOUS) OF LEFT FRONT WALL OF THORAX INIT

T561X4A

TOXIC EFFECT OF MERCURY AND ITS COMPOUNDS UNDET INIT

S20369A

INSECT BITE (NONVENOMOUS) OF UNSP FRONT WALL OF THORAX INIT

T562X1A

TOXIC EFFECT OF CHROMIUM AND ITS COMPOUNDS ACC INIT

S20371A

OTH SUPERFICIAL BITE OF RIGHT FRONT WALL OF THORAX INIT

T562X2A

TOXIC EFFECT OF CHROMIUM AND ITS COMPOUNDS SELF-HARM INIT

S20372A OTH SUPERFICIAL BITE OF LEFT FRONT WALL OF THORAX INIT

T562X3A

TOXIC EFFECT OF CHROMIUM AND ITS COMPOUNDS ASSAULT INIT

S20379A OTH SUPERFICIAL BITE OF UNSP FRONT WALL OF THORAX INIT

T562X4A

TOXIC EFFECT OF CHROMIUM AND ITS COMPOUNDS UNDET INIT

S20401A

UNSP SUPERFICIAL INJURIES OF RIGHT BACK WALL OF THORAX INIT

T563X1A

TOXIC EFFECT OF CADMIUM AND ITS COMPOUNDS ACCIDENTAL INIT

S20402A

UNSP SUPERFICIAL INJURIES OF LEFT BACK WALL OF THORAX INIT

T563X2A

TOXIC EFFECT OF CADMIUM AND ITS COMPOUNDS SELF-HARM INIT

S20409A

UNSP SUPERFICIAL INJURIES OF UNSP BACK WALL OF THORAX INIT

T563X3A

TOXIC EFFECT OF CADMIUM AND ITS COMPOUNDS ASSAULT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S20411A

ABRASION OF RIGHT BACK WALL OF THORAX INITIAL ENCOUNTER

T563X4A

TOXIC EFFECT OF CADMIUM AND ITS COMPOUNDS UNDET INIT

S20412A

ABRASION OF LEFT BACK WALL OF THORAX INITIAL ENCOUNTER

T564X1A

TOXIC EFFECT OF COPPER AND ITS COMPOUNDS ACCIDENTAL INIT

S20419A

ABRASION OF UNSPECIFIED BACK WALL OF THORAX INIT ENCNTR

T564X2A

TOXIC EFFECT OF COPPER AND ITS COMPOUNDS SELF-HARM INIT

S20421A

BLISTER (NONTHERMAL) OF RIGHT BACK WALL OF THORAX INIT

T564X3A

TOXIC EFFECT OF COPPER AND ITS COMPOUNDS ASSAULT INIT

S20422A

BLISTER (NONTHERMAL) OF LEFT BACK WALL OF THORAX INIT

T564X4A

TOXIC EFFECT OF COPPER AND ITS COMPOUNDS UNDETERMINED INIT

S20429A

BLISTER (NONTHERMAL) OF UNSP BACK WALL OF THORAX INIT

T565X1A

TOXIC EFFECT OF ZINC AND ITS COMPOUNDS ACCIDENTAL INIT

S20441A

EXTERNAL CONSTRICTION OF RIGHT BACK WALL OF THORAX INIT

T565X2A

TOXIC EFFECT OF ZINC AND ITS COMPOUNDS SELF-HARM INIT

S20442A

EXTERNAL CONSTRICTION OF LEFT BACK WALL OF THORAX INIT

T565X3A

TOXIC EFFECT OF ZINC AND ITS COMPOUNDS ASSAULT INIT ENCNTR

S20449A

EXTERNAL CONSTRICTION OF UNSP BACK WALL OF THORAX INIT

T565X4A

TOXIC EFFECT OF ZINC AND ITS COMPOUNDS UNDETERMINED INIT

S20451A

SUPERFICIAL FOREIGN BODY OF RIGHT BACK WALL OF THORAX INIT

T566X1A

TOXIC EFFECT OF TIN AND ITS COMPOUNDS ACCIDENTAL INIT

S20452A

SUPERFICIAL FOREIGN BODY OF LEFT BACK WALL OF THORAX INIT

T566X2A

TOXIC EFFECT OF TIN AND ITS COMPOUNDS SELF-HARM INIT

S20459A

SUPERFICIAL FOREIGN BODY OF UNSP BACK WALL OF THORAX INIT

T566X3A

TOXIC EFFECT OF TIN AND ITS COMPOUNDS ASSAULT INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S20461A

INSECT BITE (NONVENOMOUS) OF RIGHT BACK WALL OF THORAX INIT

T566X4A

TOXIC EFFECT OF TIN AND ITS COMPOUNDS UNDETERMINED INIT

S20462A

INSECT BITE (NONVENOMOUS) OF LEFT BACK WALL OF THORAX INIT

T567X1A

TOXIC EFFECT OF BERYLLIUM AND ITS COMPOUNDS ACC INIT

S20469A

INSECT BITE (NONVENOMOUS) OF UNSP BACK WALL OF THORAX INIT

T567X2A

TOXIC EFFECT OF BERYLLIUM AND ITS COMPOUNDS SELF-HARM INIT

S20471A

OTH SUPERFICIAL BITE OF RIGHT BACK WALL OF THORAX INIT

T567X3A

TOXIC EFFECT OF BERYLLIUM AND ITS COMPOUNDS ASSAULT INIT

S20472A OTH SUPERFICIAL BITE OF LEFT BACK WALL OF THORAX INIT

T567X4A

TOXIC EFFECT OF BERYLLIUM AND ITS COMPOUNDS UNDET INIT

S20479A OTH SUPERFICIAL BITE OF UNSP BACK WALL OF THORAX INIT

T56811A

TOXIC EFFECT OF THALLIUM ACCIDENTAL (UNINTENTIONAL) INIT

S2090XA

UNSP SUPERFICIAL INJURY OF UNSP PARTS OF THORAX INIT ENCNTR

T56812A

TOXIC EFFECT OF THALLIUM INTENTIONAL SELF-HARM INIT ENCNTR

S2091XA

ABRASION OF UNSPECIFIED PARTS OF THORAX INITIAL ENCOUNTER

T56813A

TOXIC EFFECT OF THALLIUM ASSAULT INITIAL ENCOUNTER

S2092XA

BLISTER (NONTHERMAL) OF UNSP PARTS OF THORAX INIT ENCNTR

T56814A

TOXIC EFFECT OF THALLIUM UNDETERMINED INITIAL ENCOUNTER

S2094XA

EXTERNAL CONSTRICTION OF UNSP PARTS OF THORAX INIT ENCNTR

T56891A

TOXIC EFFECT OF OTH METALS ACCIDENTAL (UNINTENTIONAL) INIT

S2095XA SUPERFICIAL FOREIGN BODY OF UNSP PARTS OF THORAX INIT

T56892A

TOXIC EFFECT OF OTH METALS INTENTIONAL SELF-HARM INIT

S2096XA

INSECT BITE (NONVENOMOUS) OF UNSP PARTS OF THORAX INIT

T56893A

TOXIC EFFECT OF OTHER METALS ASSAULT INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S2097XA

OTHER SUPERFICIAL BITE OF UNSP PARTS OF THORAX INIT ENCNTR

T56894A

TOXIC EFFECT OF OTHER METALS UNDETERMINED INIT ENCNTR

S21001A

UNSPECIFIED OPEN WOUND OF RIGHT BREAST INITIAL ENCOUNTER

T5691XA

TOXIC EFFECT OF UNSP METAL ACCIDENTAL (UNINTENTIONAL) INIT

S21002A

UNSPECIFIED OPEN WOUND OF LEFT BREAST INITIAL ENCOUNTER

T5692XA

TOXIC EFFECT OF UNSP METAL INTENTIONAL SELF-HARM INIT

S21009A

UNSPECIFIED OPEN WOUND OF UNSPECIFIED BREAST INIT ENCNTR

T5693XA

TOXIC EFFECT OF UNSPECIFIED METAL ASSAULT INIT ENCNTR

S21011A

LACERATION WITHOUT FOREIGN BODY OF RIGHT BREAST INIT ENCNTR

T5694XA

TOXIC EFFECT OF UNSPECIFIED METAL UNDETERMINED INIT ENCNTR

S21012A

LACERATION WITHOUT FOREIGN BODY OF LEFT BREAST INIT ENCNTR

T570X1A

TOXIC EFFECT OF ARSENIC AND ITS COMPOUNDS ACCIDENTAL INIT

S21019A

LACERATION WITHOUT FOREIGN BODY OF UNSP BREAST INIT ENCNTR

T570X2A

TOXIC EFFECT OF ARSENIC AND ITS COMPOUNDS SELF-HARM INIT

S21021A

LACERATION WITH FOREIGN BODY OF RIGHT BREAST INIT ENCNTR

T570X3A

TOXIC EFFECT OF ARSENIC AND ITS COMPOUNDS ASSAULT INIT

S21022A

LACERATION WITH FOREIGN BODY OF LEFT BREAST INIT ENCNTR

T570X4A

TOXIC EFFECT OF ARSENIC AND ITS COMPOUNDS UNDET INIT

S21029A

LACERATION WITH FOREIGN BODY OF UNSP BREAST INIT ENCNTR

T571X1A

TOXIC EFFECT OF PHOSPHORUS AND ITS COMPOUNDS ACC INIT

S21031A

PUNCTURE WOUND W/O FOREIGN BODY OF RIGHT BREAST INIT ENCNTR

T571X2A

TOXIC EFFECT OF PHOSPHORUS AND ITS COMPND SELF-HARM INIT

S21032A

PUNCTURE WOUND W/O FOREIGN BODY OF LEFT BREAST INIT ENCNTR

T571X3A

TOXIC EFFECT OF PHOSPHORUS AND ITS COMPOUNDS ASSAULT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S21039A

PUNCTURE WOUND W/O FOREIGN BODY OF UNSP BREAST INIT ENCNTR

T571X4A

TOXIC EFFECT OF PHOSPHORUS AND ITS COMPOUNDS UNDET INIT

S21041A

PUNCTURE WOUND W FOREIGN BODY OF RIGHT BREAST INIT ENCNTR

T572X1A

TOXIC EFFECT OF MANGANESE AND ITS COMPOUNDS ACC INIT

S21042A

PUNCTURE WOUND WITH FOREIGN BODY OF LEFT BREAST INIT ENCNTR

T572X2A

TOXIC EFFECT OF MANGANESE AND ITS COMPOUNDS SELF-HARM INIT

S21049A

PUNCTURE WOUND WITH FOREIGN BODY OF UNSP BREAST INIT ENCNTR

T572X3A

TOXIC EFFECT OF MANGANESE AND ITS COMPOUNDS ASSAULT INIT

S21051A OPEN BITE OF RIGHT BREAST INITIAL ENCOUNTER

T572X4A

TOXIC EFFECT OF MANGANESE AND ITS COMPOUNDS UNDET INIT

S21052A OPEN BITE OF LEFT BREAST INITIAL ENCOUNTER

T573X1A

TOXIC EFFECT OF HYDROGEN CYANIDE ACCIDENTAL INIT

S21059A OPEN BITE OF UNSPECIFIED BREAST INITIAL ENCOUNTER

T573X2A

TOXIC EFFECT OF HYDROGEN CYANIDE SELF-HARM INIT

S21101A

UNSP OPN WND R FRNT WL OF THORAX W/O PENET THOR CAVITY INIT

T573X3A

TOXIC EFFECT OF HYDROGEN CYANIDE ASSAULT INITIAL ENCOUNTER

S21102A

UNSP OPN WND L FRNT WL OF THORAX W/O PENET THOR CAVITY INIT

T573X4A

TOXIC EFFECT OF HYDROGEN CYANIDE UNDETERMINED INIT ENCNTR

S21109A

UNSP OPN WND UNSP FRNT WALL OF THRX W/O PENET THOR CAV INIT

T578X1A

TOXIC EFFECT OF INORGANIC SUBSTANCES ACCIDENTAL INIT

S21111A

LAC W/O FB OF R FRNT WL OF THORAX W/O PENET THOR CAV INIT

T578X2A

TOXIC EFFECT OF INORGANIC SUBSTANCES SELF-HARM INIT

S21112A

LAC W/O FB OF L FRNT WL OF THORAX W/O PENET THOR CAV INIT

T578X3A

TOXIC EFFECT OF OTH INORGANIC SUBSTANCES ASSAULT INIT

S21119A

LAC W/O FB OF UNSP FRNT WL OF THRX W/O PENET THOR CAV INIT

T578X4A

TOXIC EFFECT OF OTH INORGANIC SUBSTANCES UNDETERMINED INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S21121A

LAC W FB OF R FRNT WL OF THORAX W/O PENET THOR CAVITY INIT

T5791XA

TOXIC EFFECT OF UNSP INORGANIC SUBSTANCE ACCIDENTAL INIT

S21122A

LAC W FB OF L FRNT WL OF THORAX W/O PENET THOR CAVITY INIT

T5792XA

TOXIC EFFECT OF UNSP INORGANIC SUBSTANCE SELF-HARM INIT

S21129A

LAC W FB OF UNSP FRONT WALL OF THRX W/O PENET THOR CAV INIT

T5793XA

TOXIC EFFECT OF UNSP INORGANIC SUBSTANCE ASSAULT INIT

S21131A

PNCTR W/O FB OF R FRNT WL OF THORAX W/O PENET THOR CAV INIT

T5794XA

TOXIC EFFECT OF UNSP INORGANIC SUBSTANCE UNDETERMINED INIT

S21132A

PNCTR W/O FB OF L FRNT WL OF THORAX W/O PENET THOR CAV INIT

T5801XA

TOXIC EFFECT OF CARB MONX FROM MTR VEH EXHAUST ACC INIT

S21139A

PNCTR W/O FB OF UNSP FRNT WL OF THRX W/O PENET THOR CAVINIT

T5802XA

TOXIC EFF OF CARB MONX FROM MTR VEH EXHAUST SLF-HRM INIT

S21141A

PNCTR W FB OF R FRNT WL OF THORAX W/O PENET THOR CAV INIT

T5803XA

TOXIC EFFECT OF CARB MONX FROM MTR VEH EXHAUST ASSLT INIT

S21142A

PNCTR W FB OF L FRNT WL OF THORAX W/O PENET THOR CAV INIT

T5804XA

TOXIC EFFECT OF CARB MONX FROM MTR VEH EXHAUST UNDET INIT

S21149A

PNCTR W FB OF UNSP FRNT WL OF THRX W/O PENET THOR CAV INIT

T5811XA

TOXIC EFFECT OF CARB MONX FROM UTILITY GAS ACC INIT

S21151A

OPEN BITE OF R FRNT WL OF THORAX W/O PENET THOR CAVITY INIT

T5812XA

TOXIC EFFECT OF CARB MONX FROM UTILITY GAS SELF-HARM INIT

S21152A

OPEN BITE OF L FRNT WL OF THORAX W/O PENET THOR CAVITY INIT

T5813XA

TOXIC EFFECT OF CARB MONX FROM UTILITY GAS ASSAULT INIT

S21159A

OPEN BITE OF UNSP FRNT WALL OF THRX W/O PENET THOR CAV INIT

T5814XA

TOXIC EFFECT OF CARB MONX FROM UTILITY GAS UNDET INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S21201A

UNSP OPN WND R BK WL OF THORAX W/O PENET THOR CAVITY INIT

T582X1A

TOX EFF OF CARB MONX FR INCMPL COMBST DMST FUEL ACC INIT

S21202A

UNSP OPN WND L BK WL OF THORAX W/O PENET THOR CAVITY INIT

T582X2A

TOX EFF OF CARB MONX FR INCMPL COMBST DMST FUELSLF-HRMINIT

S21209A

UNSP OPN WND UNSP BK WL OF THORAX W/O PENET THOR CAV INIT

T582X3A

TOX EFF OF CARB MONX FR INCMPL COMBST DMST FUEL ASSLT INIT

S21211A

LAC W/O FB OF R BK WL OF THORAX W/O PENET THOR CAVITY INIT

T582X4A

TOX EFF OF CARB MONX FR INCMPL COMBST DMST FUEL UNDET INIT

S21212A

LAC W/O FB OF L BK WL OF THORAX W/O PENET THOR CAVITY INIT

T588X1A

TOXIC EFFECT OF CARB MONX FROM OTH SOURCE ACCIDENTAL INIT

S21219A

LAC W/O FB OF UNSP BK WL OF THORAX W/O PENET THOR CAV INIT

T588X2A

TOXIC EFFECT OF CARB MONX FROM OTH SOURCE SELF-HARM INIT

S21221A

LAC W FB OF R BK WL OF THORAX W/O PENET THOR CAVITY INIT

T588X3A

TOXIC EFFECT OF CARB MONX FROM OTH SOURCE ASSAULT INIT

S21222A

LAC W FB OF L BK WL OF THORAX W/O PENET THOR CAVITY INIT

T588X4A

TOXIC EFFECT OF CARB MONX FROM OTH SOURCE UNDET INIT

S21229A

LAC W FB OF UNSP BK WL OF THORAX W/O PENET THOR CAVITY INIT

T5891XA

TOXIC EFFECT OF CARB MONX FROM UNSP SOURCE ACC INIT

S21231A

PNCTR W/O FB OF R BK WL OF THORAX W/O PENET THOR CAV INIT

T5892XA

TOXIC EFFECT OF CARB MONX FROM UNSP SOURCE SELF-HARM INIT

S21232A

PNCTR W/O FB OF L BK WL OF THORAX W/O PENET THOR CAV INIT

T5893XA

TOXIC EFFECT OF CARB MONX FROM UNSP SOURCE ASSAULT INIT

S21239A

PNCTR W/O FB OF UNSP BK WL OF THRX W/O PENET THOR CAV INIT

T5894XA

TOXIC EFFECT OF CARB MONX FROM UNSP SOURCE UNDET INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S21241A

PNCTR W FB OF R BK WL OF THORAX W/O PENET THOR CAVITY INIT

T590X1A

TOXIC EFFECT OF NITROGEN OXIDES ACCIDENTAL INIT

S21242A

PNCTR W FB OF L BK WL OF THORAX W/O PENET THOR CAVITY INIT

T590X2A

TOXIC EFFECT OF NITROGEN OXIDES INTENTIONAL SELF-HARM INIT

S21249A

PNCTR W FB OF UNSP BK WL OF THORAX W/O PENET THOR CAV INIT

T590X3A

TOXIC EFFECT OF NITROGEN OXIDES ASSAULT INITIAL ENCOUNTER

S21251A

OPEN BITE OF R BK WL OF THORAX W/O PENET THOR CAVITY INIT

T590X4A

TOXIC EFFECT OF NITROGEN OXIDES UNDETERMINED INIT ENCNTR

S21252A

OPEN BITE OF L BK WL OF THORAX W/O PENET THOR CAVITY INIT

T591X1A

TOXIC EFFECT OF SULFUR DIOXIDE ACCIDENTAL INIT

S21259A

OPEN BITE OF UNSP BK WL OF THORAX W/O PENET THOR CAV INIT

T591X2A

TOXIC EFFECT OF SULFUR DIOXIDE INTENTIONAL SELF-HARM INIT

S21301A

UNSP OPN WND R FRNT WL OF THORAX W PENET THOR CAVITY INIT

T591X3A

TOXIC EFFECT OF SULFUR DIOXIDE ASSAULT INITIAL ENCOUNTER

S21302A

UNSP OPN WND L FRNT WL OF THORAX W PENET THOR CAVITY INIT

T591X4A

TOXIC EFFECT OF SULFUR DIOXIDE UNDETERMINED INIT ENCNTR

S21309A

UNSP OPN WND UNSP FRONT WALL OF THRX W PENET THOR CAV INIT

T592X1A

TOXIC EFFECT OF FORMALDEHYDE ACCIDENTAL INIT

S21311A

LAC W/O FB OF R FRNT WL OF THORAX W PENET THOR CAVITY INIT

T592X2A

TOXIC EFFECT OF FORMALDEHYDE INTENTIONAL SELF-HARM INIT

S21312A

LAC W/O FB OF L FRNT WL OF THORAX W PENET THOR CAVITY INIT

T592X3A

TOXIC EFFECT OF FORMALDEHYDE ASSAULT INITIAL ENCOUNTER

S21319A

LAC W/O FB OF UNSP FRONT WALL OF THRX W PENET THOR CAV INIT

T592X4A

TOXIC EFFECT OF FORMALDEHYDE UNDETERMINED INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S21321A

LAC W FB OF R FRNT WL OF THORAX W PENET THOR CAVITY INIT

T593X1A

TOXIC EFFECT OF LACRIMOGENIC GAS ACCIDENTAL INIT

S21322A

LAC W FB OF L FRNT WL OF THORAX W PENET THOR CAVITY INIT

T593X2A

TOXIC EFFECT OF LACRIMOGENIC GAS SELF-HARM INIT

S21329A

LAC W FB OF UNSP FRONT WALL OF THORAX W PENET THOR CAV INIT

T593X3A

TOXIC EFFECT OF LACRIMOGENIC GAS ASSAULT INITIAL ENCOUNTER

S21331A

PNCTR W/O FB OF R FRNT WL OF THORAX W PENET THOR CAV INIT

T593X4A

TOXIC EFFECT OF LACRIMOGENIC GAS UNDETERMINED INIT ENCNTR

S21332A

PNCTR W/O FB OF L FRNT WL OF THORAX W PENET THOR CAV INIT

T594X1A

TOXIC EFFECT OF CHLORINE GAS ACCIDENTAL INIT

S21339A

PNCTR W/O FB OF UNSP FRNT WL OF THRX W PENET THOR CAV INIT

T594X2A

TOXIC EFFECT OF CHLORINE GAS INTENTIONAL SELF-HARM INIT

S21341A

PNCTR W FB OF R FRNT WL OF THORAX W PENET THOR CAVITY INIT

T594X3A

TOXIC EFFECT OF CHLORINE GAS ASSAULT INITIAL ENCOUNTER

S21342A

PNCTR W FB OF L FRNT WL OF THORAX W PENET THOR CAVITY INIT

T594X4A

TOXIC EFFECT OF CHLORINE GAS UNDETERMINED INIT ENCNTR

S21349A

PNCTR W FB OF UNSP FRONT WALL OF THRX W PENET THOR CAV INIT

T595X1A

TOXIC EFF OF FLUORINE GAS AND HYDROGEN FLUORIDE ACC INIT

S21351A

OPEN BITE OF R FRNT WL OF THORAX W PENET THOR CAVITY INIT

T595X2A

TOX EFF OF FLUORINE GAS AND HYDROGEN FLUORIDE SLF-HRM INIT

S21352A

OPEN BITE OF L FRNT WL OF THORAX W PENET THOR CAVITY INIT

T595X3A

TOXIC EFF OF FLUORINE GAS AND HYDROGEN FLUORIDE ASSLT INIT

S21359A

OPEN BITE OF UNSP FRONT WALL OF THRX W PENET THOR CAV INIT

T595X4A

TOXIC EFF OF FLUORINE GAS AND HYDROGEN FLUORIDE UNDET INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S21401A

UNSP OPN WND R BK WL OF THORAX W PENET THORACIC CAVITY INIT

T596X1A

TOXIC EFFECT OF HYDROGEN SULFIDE ACCIDENTAL INIT

S21402A

UNSP OPN WND L BK WL OF THORAX W PENET THORACIC CAVITY INIT

T596X2A

TOXIC EFFECT OF HYDROGEN SULFIDE SELF-HARM INIT

S21409A

UNSP OPN WND UNSP BK WL OF THORAX W PENET THOR CAVITY INIT

T596X3A

TOXIC EFFECT OF HYDROGEN SULFIDE ASSAULT INITIAL ENCOUNTER

S21411A

LAC W/O FB OF R BK WL OF THORAX W PENET THOR CAVITY INIT

T596X4A

TOXIC EFFECT OF HYDROGEN SULFIDE UNDETERMINED INIT ENCNTR

S21412A

LAC W/O FB OF L BK WL OF THORAX W PENET THOR CAVITY INIT

T597X1A

TOXIC EFFECT OF CARBON DIOXIDE ACCIDENTAL INIT

S21419A

LAC W/O FB OF UNSP BK WL OF THORAX W PENET THOR CAVITY INIT

T597X2A

TOXIC EFFECT OF CARBON DIOXIDE INTENTIONAL SELF-HARM INIT

S21421A

LAC W FB OF R BK WL OF THORAX W PENET THORACIC CAVITY INIT

T597X3A

TOXIC EFFECT OF CARBON DIOXIDE ASSAULT INITIAL ENCOUNTER

S21422A

LAC W FB OF L BK WL OF THORAX W PENET THORACIC CAVITY INIT

T597X4A

TOXIC EFFECT OF CARBON DIOXIDE UNDETERMINED INIT ENCNTR

S21429A

LAC W FB OF UNSP BK WL OF THORAX W PENET THOR CAVITY INIT

T59811A

TOXIC EFFECT OF SMOKE ACCIDENTAL (UNINTENTIONAL) INIT

S21431A

PNCTR W/O FB OF R BK WL OF THORAX W PENET THOR CAVITY INIT

T59812A

TOXIC EFFECT OF SMOKE INTENTIONAL SELF-HARM INIT ENCNTR

S21432A

PNCTR W/O FB OF L BK WL OF THORAX W PENET THOR CAVITY INIT

T59813A

TOXIC EFFECT OF SMOKE ASSAULT INITIAL ENCOUNTER

S21439A

PNCTR W/O FB OF UNSP BK WL OF THORAX W PENET THOR CAV INIT

T59814A

TOXIC EFFECT OF SMOKE UNDETERMINED INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S21441A

PNCTR W FB OF R BK WL OF THORAX W PENET THOR CAVITY INIT

T59891A

TOXIC EFFECT OF GASES FUMES AND VAPORS ACCIDENTAL INIT

S21442A

PNCTR W FB OF L BK WL OF THORAX W PENET THOR CAVITY INIT

T59892A

TOXIC EFFECT OF GASES FUMES AND VAPORS SELF-HARM INIT

S21449A

PNCTR W FB OF UNSP BK WL OF THORAX W PENET THOR CAVITY INIT

T59893A

TOXIC EFFECT OF OTH GASES FUMES AND VAPORS ASSAULT INIT

S21451A

OPEN BITE OF R BK WL OF THORAX W PENET THORACIC CAVITY INIT

T59894A

TOXIC EFFECT OF GASES FUMES AND VAPORS UNDETERMINED INIT

S21452A

OPEN BITE OF L BK WL OF THORAX W PENET THORACIC CAVITY INIT

T5991XA

TOXIC EFFECT OF UNSP GASES FUMES AND VAPORS ACC INIT

S21459A

OPEN BITE OF UNSP BK WL OF THORAX W PENET THOR CAVITY INIT

T5992XA

TOXIC EFFECT OF UNSP GASES FUMES AND VAPORS SLF-HRM INIT

S2190XA

UNSP OPEN WOUND OF UNSPECIFIED PART OF THORAX INIT ENCNTR

T5993XA

TOXIC EFFECT OF UNSP GASES FUMES AND VAPORS ASSAULT INIT

S2191XA

LACERATION W/O FOREIGN BODY OF UNSP PART OF THORAX INIT

T5994XA

TOXIC EFFECT OF UNSP GASES FUMES AND VAPORS UNDET INIT

S2192XA LACERATION W FOREIGN BODY OF UNSP PART OF THORAX INIT

T600X1A

TOXIC EFFECT OF ORGANOPHOS AND CARBAMATE INSECT ACC INIT

S2193XA

PUNCTURE WOUND W/O FOREIGN BODY OF UNSP PART OF THORAX INIT

T600X2A

TOXIC EFF OF ORGANOPHOS AND CARBAMATE INSECT SLF-HRM INIT

S2194XA

PUNCTURE WOUND W FOREIGN BODY OF UNSP PART OF THORAX INIT

T600X3A

TOXIC EFFECT OF ORGANOPHOS AND CARBAMATE INSECT ASSLT INIT

S2195XA

OPEN BITE OF UNSPECIFIED PART OF THORAX INITIAL ENCOUNTER

T600X4A

TOXIC EFFECT OF ORGANOPHOS AND CARBAMATE INSECT UNDET INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S22000A

WEDGE COMPRESSION FRACTURE OF UNSP THORACIC VERTEBRA INIT

T601X1A

TOXIC EFFECT OF HALOGENATED INSECTICIDES ACCIDENTAL INIT

S22000B

WEDGE COMPRSN FX UNSP THOR VERTEBRA INIT FOR OPN FX

T601X2A

TOXIC EFFECT OF HALOGENATED INSECTICIDES SELF-HARM INIT

S22001A STABLE BURST FRACTURE OF UNSP THORACIC VERTEBRA INIT

T601X3A

TOXIC EFFECT OF HALOGENATED INSECTICIDES ASSAULT INIT

S22001B

STABLE BURST FRACTURE OF UNSP THOR VERTEBRA INIT FOR OPN FX

T601X4A

TOXIC EFFECT OF HALOGENATED INSECTICIDES UNDETERMINED INIT

S22002A UNSTABLE BURST FRACTURE OF UNSP THORACIC VERTEBRA INIT

T602X1A

TOXIC EFFECT OF INSECTICIDES ACCIDENTAL INIT

S22002B

UNSTABLE BURST FX UNSP THOR VERTEBRA INIT FOR OPN FX

T602X2A

TOXIC EFFECT OF INSECTICIDES INTENTIONAL SELF-HARM INIT

S22008A

OTH FRACTURE OF UNSP THORACIC VERTEBRA INIT FOR CLOS FX

T602X3A

TOXIC EFFECT OF OTHER INSECTICIDES ASSAULT INIT ENCNTR

S22008B

OTH FRACTURE OF UNSP THORACIC VERTEBRA INIT FOR OPN FX

T602X4A

TOXIC EFFECT OF OTH INSECTICIDES UNDETERMINED INIT ENCNTR

S22009A

UNSP FRACTURE OF UNSP THORACIC VERTEBRA INIT FOR CLOS FX

T603X1A

TOXIC EFFECT OF HERBICIDES AND FUNGICIDES ACCIDENTAL INIT

S22009B

UNSP FRACTURE OF UNSP THORACIC VERTEBRA INIT FOR OPN FX

T603X2A

TOXIC EFFECT OF HERBICIDES AND FUNGICIDES SELF-HARM INIT

S22010A

WEDGE COMPRESSION FRACTURE OF FIRST THORACIC VERTEBRA INIT

T603X3A

TOXIC EFFECT OF HERBICIDES AND FUNGICIDES ASSAULT INIT

S22010B

WEDGE COMPRSN FX FIRST THOR VERTEBRA INIT FOR OPN FX

T603X4A

TOXIC EFFECT OF HERBICIDES AND FUNGICIDES UNDET INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S22011A STABLE BURST FRACTURE OF FIRST THORACIC VERTEBRA INIT

T604X1A

TOXIC EFFECT OF RODENTICIDES ACCIDENTAL INIT

S22011B STABLE BURST FX FIRST THOR VERTEBRA INIT FOR OPN FX

T604X2A

TOXIC EFFECT OF RODENTICIDES INTENTIONAL SELF-HARM INIT

S22012A UNSTABLE BURST FRACTURE OF FIRST THORACIC VERTEBRA INIT

T604X3A

TOXIC EFFECT OF RODENTICIDES ASSAULT INITIAL ENCOUNTER

S22012B

UNSTABLE BURST FX FIRST THOR VERTEBRA INIT FOR OPN FX

T604X4A

TOXIC EFFECT OF RODENTICIDES UNDETERMINED INIT ENCNTR

S22018A

OTH FRACTURE OF FIRST THORACIC VERTEBRA INIT FOR CLOS FX

T608X1A

TOXIC EFFECT OF PESTICIDES ACCIDENTAL (UNINTENTIONAL) INIT

S22018B

OTH FRACTURE OF FIRST THORACIC VERTEBRA INIT FOR OPN FX

T608X2A

TOXIC EFFECT OF OTH PESTICIDES INTENTIONAL SELF-HARM INIT

S22019A

UNSP FRACTURE OF FIRST THORACIC VERTEBRA INIT FOR CLOS FX

T608X3A

TOXIC EFFECT OF OTHER PESTICIDES ASSAULT INITIAL ENCOUNTER

S22019B

UNSP FRACTURE OF FIRST THORACIC VERTEBRA INIT FOR OPN FX

T608X4A

TOXIC EFFECT OF OTHER PESTICIDES UNDETERMINED INIT ENCNTR

S22020A

WEDGE COMPRESSION FRACTURE OF SECOND THORACIC VERTEBRA INIT

T6091XA

TOXIC EFFECT OF UNSP PESTICIDE ACCIDENTAL INIT

S22020B

WEDGE COMPRSN FX SECOND THOR VERTEBRA INIT FOR OPN FX

T6092XA

TOXIC EFFECT OF UNSP PESTICIDE INTENTIONAL SELF-HARM INIT

S22021A

STABLE BURST FRACTURE OF SECOND THORACIC VERTEBRA INIT

T6093XA

TOXIC EFFECT OF UNSPECIFIED PESTICIDE ASSAULT INIT ENCNTR

S22021B

STABLE BURST FX SECOND THOR VERTEBRA INIT FOR OPN FX

T6094XA

TOXIC EFFECT OF UNSP PESTICIDE UNDETERMINED INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S22022B

UNSTABLE BURST FX SECOND THOR VERTEBRA INIT FOR OPN FX

T6101XA

CIGUATERA FISH POISONING ACCIDENTAL (UNINTENTIONAL) INIT

S22028A

OTH FRACTURE OF SECOND THORACIC VERTEBRA INIT FOR CLOS FX

T6102XA

CIGUATERA FISH POISONING INTENTIONAL SELF-HARM INIT ENCNTR

S22028B

OTH FRACTURE OF SECOND THORACIC VERTEBRA INIT FOR OPN FX

T6103XA

CIGUATERA FISH POISONING ASSAULT INITIAL ENCOUNTER

S22029A

UNSP FRACTURE OF SECOND THORACIC VERTEBRA INIT FOR CLOS FX

T6104XA

CIGUATERA FISH POISONING UNDETERMINED INITIAL ENCOUNTER

S22029B

UNSP FRACTURE OF SECOND THORACIC VERTEBRA INIT FOR OPN FX

T6111XA

SCOMBROID FISH POISONING ACCIDENTAL (UNINTENTIONAL) INIT

S22030A

WEDGE COMPRESSION FRACTURE OF THIRD THORACIC VERTEBRA INIT

T6112XA

SCOMBROID FISH POISONING INTENTIONAL SELF-HARM INIT ENCNTR

S22030B

WEDGE COMPRSN FX THIRD THOR VERTEBRA INIT FOR OPN FX

T6113XA

SCOMBROID FISH POISONING ASSAULT INITIAL ENCOUNTER

S22031A

STABLE BURST FRACTURE OF THIRD THORACIC VERTEBRA INIT

T6114XA

SCOMBROID FISH POISONING UNDETERMINED INITIAL ENCOUNTER

S22031B STABLE BURST FX THIRD THOR VERTEBRA INIT FOR OPN FX

T61771A

OTH FISH POISONING ACCIDENTAL (UNINTENTIONAL) INIT ENCNTR

S22032A

UNSTABLE BURST FRACTURE OF THIRD THORACIC VERTEBRA INIT

T61772A

OTHER FISH POISONING INTENTIONAL SELF-HARM INIT ENCNTR

S22032B

UNSTABLE BURST FX THIRD THOR VERTEBRA INIT FOR OPN FX

T61773A

OTHER FISH POISONING ASSAULT INITIAL ENCOUNTER

S22038A

OTH FRACTURE OF THIRD THORACIC VERTEBRA INIT FOR CLOS FX

T61774A

OTHER FISH POISONING UNDETERMINED INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S22038B

OTH FRACTURE OF THIRD THORACIC VERTEBRA INIT FOR OPN FX

T61781A

OTH SHELLFISH POISONING ACCIDENTAL (UNINTENTIONAL) INIT

S22039A

UNSP FRACTURE OF THIRD THORACIC VERTEBRA INIT FOR CLOS FX

T61782A

OTH SHELLFISH POISONING INTENTIONAL SELF-HARM INIT ENCNTR

S22039B

UNSP FRACTURE OF THIRD THORACIC VERTEBRA INIT FOR OPN FX

T61783A

OTHER SHELLFISH POISONING ASSAULT INITIAL ENCOUNTER

S22040A

WEDGE COMPRESSION FRACTURE OF FOURTH THORACIC VERTEBRA INIT

T61784A

OTHER SHELLFISH POISONING UNDETERMINED INITIAL ENCOUNTER

S22040B

WEDGE COMPRSN FX FOURTH THOR VERTEBRA INIT FOR OPN FX

T618X1A

TOXIC EFFECT OF SEAFOOD ACCIDENTAL (UNINTENTIONAL) INIT

S22041A

STABLE BURST FRACTURE OF FOURTH THORACIC VERTEBRA INIT

T618X2A

TOXIC EFFECT OF OTH SEAFOOD INTENTIONAL SELF-HARM INIT

S22041B

STABLE BURST FX FOURTH THOR VERTEBRA INIT FOR OPN FX

T618X3A

TOXIC EFFECT OF OTHER SEAFOOD ASSAULT INITIAL ENCOUNTER

S22042A

UNSTABLE BURST FRACTURE OF FOURTH THORACIC VERTEBRA INIT

T618X4A

TOXIC EFFECT OF OTHER SEAFOOD UNDETERMINED INIT ENCNTR

S22042B

UNSTABLE BURST FX FOURTH THOR VERTEBRA INIT FOR OPN FX

T6191XA

TOXIC EFFECT OF UNSP SEAFOOD ACCIDENTAL INIT

S22048A

OTH FRACTURE OF FOURTH THORACIC VERTEBRA INIT FOR CLOS FX

T6192XA

TOXIC EFFECT OF UNSP SEAFOOD INTENTIONAL SELF-HARM INIT

S22048B

OTH FRACTURE OF FOURTH THORACIC VERTEBRA INIT FOR OPN FX

T6193XA

TOXIC EFFECT OF UNSPECIFIED SEAFOOD ASSAULT INIT ENCNTR

S22049A

UNSP FRACTURE OF FOURTH THORACIC VERTEBRA INIT FOR CLOS FX

T6194XA

TOXIC EFFECT OF UNSP SEAFOOD UNDETERMINED INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S22049B

UNSP FRACTURE OF FOURTH THORACIC VERTEBRA INIT FOR OPN FX

T620X1A

TOXIC EFFECT OF INGESTED MUSHROOMS ACCIDENTAL INIT

S22050A

WEDGE COMPRESSION FRACTURE OF T5-T6 VERTEBRA INIT

T620X2A

TOXIC EFFECT OF INGESTED MUSHROOMS SELF-HARM INIT

S22050B

WEDGE COMPRSN FRACTURE OF T5-T6 VERTEBRA INIT FOR OPN FX

T620X3A

TOXIC EFFECT OF INGESTED MUSHROOMS ASSAULT INIT ENCNTR

S22051A

STABLE BURST FRACTURE OF T5-T6 VERTEBRA INIT FOR CLOS FX

T620X4A

TOXIC EFFECT OF INGESTED MUSHROOMS UNDETERMINED INIT

S22051B

STABLE BURST FRACTURE OF T5-T6 VERTEBRA INIT FOR OPN FX

T621X1A

TOXIC EFFECT OF INGESTED BERRIES ACCIDENTAL INIT

S22052A

UNSTABLE BURST FRACTURE OF T5-T6 VERTEBRA INIT FOR CLOS FX

T621X2A

TOXIC EFFECT OF INGESTED BERRIES SELF-HARM INIT

S22052B

UNSTABLE BURST FRACTURE OF T5-T6 VERTEBRA INIT FOR OPN FX

T621X3A

TOXIC EFFECT OF INGESTED BERRIES ASSAULT INITIAL ENCOUNTER

S22058A OTH FRACTURE OF T5-T6 VERTEBRA INIT FOR CLOS FX

T621X4A

TOXIC EFFECT OF INGESTED BERRIES UNDETERMINED INIT ENCNTR

S22058B OTH FRACTURE OF T5-T6 VERTEBRA INIT FOR OPN FX

T622X1A

TOXIC EFFECT OF INGESTED (PARTS OF) PLANT(S) ACC INIT

S22059A UNSP FRACTURE OF T5-T6 VERTEBRA INIT FOR CLOS FX

T622X2A

TOXIC EFFECT OF INGESTED (PARTS OF) PLANT(S) SLF-HRM INIT

S22059B UNSP FRACTURE OF T5-T6 VERTEBRA INIT FOR OPN FX

T622X3A

TOXIC EFFECT OF INGESTED (PARTS OF) PLANT(S) ASSAULT INIT

S22060A

WEDGE COMPRESSION FRACTURE OF T7-T8 VERTEBRA INIT

T622X4A

TOXIC EFFECT OF INGESTED (PARTS OF) PLANT(S) UNDET INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S22060B

WEDGE COMPRSN FRACTURE OF T7-T8 VERTEBRA INIT FOR OPN FX

T628X1A

TOXIC EFFECT OF NOXIOUS SUBSTANCES EATEN AS FOOD ACC INIT

S22061A

STABLE BURST FRACTURE OF T7-T8 VERTEBRA INIT FOR CLOS FX

T628X2A

TOXIC EFFECT OF NOXIOUS SUBSTNC EATEN AS FOOD SLF-HRM INIT

S22061B

STABLE BURST FRACTURE OF T7-T8 VERTEBRA INIT FOR OPN FX

T628X3A

TOXIC EFFECT OF NOXIOUS SUBSTNC EATEN AS FOOD ASSAULT INIT

S22062A

UNSTABLE BURST FRACTURE OF T7-T8 VERTEBRA INIT FOR CLOS FX

T628X4A

TOXIC EFFECT OF NOXIOUS SUBSTNC EATEN AS FOOD UNDET INIT

S22062B

UNSTABLE BURST FRACTURE OF T7-T8 VERTEBRA INIT FOR OPN FX

T6291XA

TOXIC EFFECT OF UNSP NOXIOUS SUB EATEN AS FOOD ACC INIT

S22068A

OTH FRACTURE OF T7-T8 THORACIC VERTEBRA INIT FOR CLOS FX

T6292XA

TOXIC EFF OF UNSP NOXIOUS SUB EATEN AS FOOD SLF-HRM INIT

S22068B

OTH FRACTURE OF T7-T8 THORACIC VERTEBRA INIT FOR OPN FX

T6293XA

TOXIC EFFECT OF UNSP NOXIOUS SUB EATEN AS FOOD ASSLT INIT

S22069A UNSP FRACTURE OF T7-T8 VERTEBRA INIT FOR CLOS FX

T6294XA

TOXIC EFFECT OF UNSP NOXIOUS SUB EATEN AS FOOD UNDET INIT

S22069B UNSP FRACTURE OF T7-T8 VERTEBRA INIT FOR OPN FX

T63001A

TOXIC EFFECT OF UNSP SNAKE VENOM ACCIDENTAL INIT

S22070A

WEDGE COMPRESSION FRACTURE OF T9-T10 VERTEBRA INIT

T63002A

TOXIC EFFECT OF UNSP SNAKE VENOM SELF-HARM INIT

S22070B

WEDGE COMPRSN FRACTURE OF T9-T10 VERTEBRA INIT FOR OPN FX

T63003A

TOXIC EFFECT OF UNSP SNAKE VENOM ASSAULT INIT ENCNTR

S22071A

STABLE BURST FRACTURE OF T9-T10 VERTEBRA INIT FOR CLOS FX

T63004A

TOXIC EFFECT OF UNSP SNAKE VENOM UNDETERMINED INIT ENCNTR

S22071B

STABLE BURST FRACTURE OF T9-T10 VERTEBRA INIT FOR OPN FX

T63011A

TOXIC EFFECT OF RATTLESNAKE VENOM ACCIDENTAL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S22072A

UNSTABLE BURST FRACTURE OF T9-T10 VERTEBRA INIT FOR CLOS FX

T63012A

TOXIC EFFECT OF RATTLESNAKE VENOM SELF-HARM INIT

S22072B

UNSTABLE BURST FRACTURE OF T9-T10 VERTEBRA INIT FOR OPN FX

T63013A

TOXIC EFFECT OF RATTLESNAKE VENOM ASSAULT INIT ENCNTR

S22078A OTH FRACTURE OF T9-T10 VERTEBRA INIT FOR CLOS FX

T63014A

TOXIC EFFECT OF RATTLESNAKE VENOM UNDETERMINED INIT ENCNTR

S22078B OTH FRACTURE OF T9-T10 VERTEBRA INIT FOR OPN FX

T63021A

TOXIC EFFECT OF CORAL SNAKE VENOM ACCIDENTAL INIT

S22079A UNSP FRACTURE OF T9-T10 VERTEBRA INIT FOR CLOS FX

T63022A

TOXIC EFFECT OF CORAL SNAKE VENOM SELF-HARM INIT

S22079B UNSP FRACTURE OF T9-T10 VERTEBRA INIT FOR OPN FX

T63023A

TOXIC EFFECT OF CORAL SNAKE VENOM ASSAULT INIT ENCNTR

S22080A

WEDGE COMPRESSION FRACTURE OF T11-T12 VERTEBRA INIT

T63024A

TOXIC EFFECT OF CORAL SNAKE VENOM UNDETERMINED INIT ENCNTR

S22080B

WEDGE COMPRSN FRACTURE OF T11-T12 VERTEBRA INIT FOR OPN FX

T63031A

TOXIC EFFECT OF TAIPAN VENOM ACCIDENTAL INIT

S22081A

STABLE BURST FRACTURE OF T11-T12 VERTEBRA INIT FOR CLOS FX

T63032A

TOXIC EFFECT OF TAIPAN VENOM INTENTIONAL SELF-HARM INIT

S22081B

STABLE BURST FRACTURE OF T11-T12 VERTEBRA INIT FOR OPN FX

T63033A

TOXIC EFFECT OF TAIPAN VENOM ASSAULT INITIAL ENCOUNTER

S22082A UNSTABLE BURST FRACTURE OF T11-T12 VERTEBRA INIT

T63034A

TOXIC EFFECT OF TAIPAN VENOM UNDETERMINED INIT ENCNTR

S22082B

UNSTABLE BURST FRACTURE OF T11-T12 VERTEBRA INIT FOR OPN FX

T63041A

TOXIC EFFECT OF COBRA VENOM ACCIDENTAL INIT

S22088A OTH FRACTURE OF T11-T12 VERTEBRA INIT FOR CLOS FX

T63042A

TOXIC EFFECT OF COBRA VENOM INTENTIONAL SELF-HARM INIT

S22088B OTH FRACTURE OF T11-T12 VERTEBRA INIT FOR OPN FX

T63043A

TOXIC EFFECT OF COBRA VENOM ASSAULT INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S22089A UNSP FRACTURE OF T11-T12 VERTEBRA INIT FOR CLOS FX

T63044A

TOXIC EFFECT OF COBRA VENOM UNDETERMINED INITIAL ENCOUNTER

S22089B UNSP FRACTURE OF T11-T12 VERTEBRA INIT FOR OPN FX

T63061A

TOXIC EFFECT OF VENOM OF N & S AMERICAN SNAKE ACC INIT

S2220XA

UNSP FRACTURE OF STERNUM INIT ENCNTR FOR CLOSED FRACTURE

T63062A

TOXIC EFFECT OF VENOM OF N & S AMERICAN SNAKE SLF-HRM INIT

S2220XB

UNSP FRACTURE OF STERNUM INIT ENCNTR FOR OPEN FRACTURE

T63063A

TOXIC EFFECT OF VENOM OF N & S AMERICAN SNAKE ASSAULT INIT

S2221XA

FRACTURE OF MANUBRIUM INITIAL ENCOUNTER FOR CLOSED FRACTURE

T63064A

TOXIC EFFECT OF VENOM OF N & S AMERICAN SNAKE UNDET INIT

S2221XB

FRACTURE OF MANUBRIUM INITIAL ENCOUNTER FOR OPEN FRACTURE

T63071A

TOXIC EFFECT OF VENOM OF AUSTRALIAN SNAKE ACCIDENTAL INIT

S2222XA

FRACTURE OF BODY OF STERNUM INIT ENCNTR FOR CLOSED FRACTURE

T63072A

TOXIC EFFECT OF VENOM OF AUSTRALIAN SNAKE SELF-HARM INIT

S2222XB

FRACTURE OF BODY OF STERNUM INIT ENCNTR FOR OPEN FRACTURE

T63073A

TOXIC EFFECT OF VENOM OF OTH AUSTRALIAN SNAKE ASSAULT INIT

S2223XA STERNAL MANUBRIAL DISSOCIATION INIT FOR CLOS FX

T63074A

TOXIC EFFECT OF VENOM OF AUSTRALIAN SNAKE UNDET INIT

S2223XB STERNAL MANUBRIAL DISSOCIATION INIT FOR OPN FX

T63081A

TOXIC EFFECT OF VENOM OF AFRICAN AND ASIAN SNAKE ACC INIT

S2224XA

FRACTURE OF XIPHOID PROCESS INIT ENCNTR FOR CLOSED FRACTURE

T63082A

TOXIC EFF OF VENOM OF AFRICAN AND ASIAN SNAKE SLF-HRM INIT

S2224XB

FRACTURE OF XIPHOID PROCESS INIT ENCNTR FOR OPEN FRACTURE

T63083A

TOXIC EFF OF VENOM OF AFRICAN AND ASIAN SNAKE ASSLT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S2231XA FRACTURE OF ONE RIB RIGHT SIDE INIT FOR CLOS FX

T63084A

TOXIC EFF OF VENOM OF AFRICAN AND ASIAN SNAKE UNDET INIT

S2231XB FRACTURE OF ONE RIB RIGHT SIDE INIT FOR OPN FX

T63091A

TOXIC EFFECT OF VENOM OF SNAKE ACCIDENTAL INIT

S2232XA FRACTURE OF ONE RIB LEFT SIDE INIT FOR CLOS FX

T63092A

TOXIC EFFECT OF VENOM OF SNAKE INTENTIONAL SELF-HARM INIT

S2232XB FRACTURE OF ONE RIB LEFT SIDE INIT FOR OPN FX

T63093A

TOXIC EFFECT OF VENOM OF OTHER SNAKE ASSAULT INIT ENCNTR

S2239XA FRACTURE OF ONE RIB UNSP SIDE INIT FOR CLOS FX

T63094A

TOXIC EFFECT OF VENOM OF OTH SNAKE UNDETERMINED INIT

S2239XB FRACTURE OF ONE RIB UNSP SIDE INIT FOR OPN FX

T63111A

TOXIC EFFECT OF VENOM OF GILA MONSTER ACCIDENTAL INIT

S2241XA MULTIPLE FRACTURES OF RIBS RIGHT SIDE INIT FOR CLOS FX

T63112A

TOXIC EFFECT OF VENOM OF GILA MONSTER SELF-HARM INIT

S2241XB MULTIPLE FRACTURES OF RIBS RIGHT SIDE INIT FOR OPN FX

T63113A

TOXIC EFFECT OF VENOM OF GILA MONSTER ASSAULT INIT ENCNTR

S2242XA MULTIPLE FRACTURES OF RIBS LEFT SIDE INIT FOR CLOS FX

T63114A

TOXIC EFFECT OF VENOM OF GILA MONSTER UNDETERMINED INIT

S2242XB MULTIPLE FRACTURES OF RIBS LEFT SIDE INIT FOR OPN FX

T63121A

TOXIC EFFECT OF VENOM OF VENOMOUS LIZARD ACCIDENTAL INIT

S2243XA MULTIPLE FRACTURES OF RIBS BILATERAL INIT FOR CLOS FX

T63122A

TOXIC EFFECT OF VENOM OF VENOMOUS LIZARD SELF-HARM INIT

S2243XB MULTIPLE FRACTURES OF RIBS BILATERAL INIT FOR OPN FX

T63123A

TOXIC EFFECT OF VENOM OF OTH VENOMOUS LIZARD ASSAULT INIT

S2249XA MULTIPLE FRACTURES OF RIBS UNSP SIDE INIT FOR CLOS FX

T63124A

TOXIC EFFECT OF VENOM OF VENOMOUS LIZARD UNDETERMINED INIT

S2249XB MULTIPLE FRACTURES OF RIBS UNSP SIDE INIT FOR OPN FX

T63191A

TOXIC EFFECT OF VENOM OF REPTILES ACCIDENTAL INIT

S225XXA

FLAIL CHEST INITIAL ENCOUNTER FOR CLOSED FRACTURE

T63192A

TOXIC EFFECT OF VENOM OF REPTILES SELF-HARM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S225XXB

FLAIL CHEST INITIAL ENCOUNTER FOR OPEN FRACTURE

T63193A

TOXIC EFFECT OF VENOM OF OTH REPTILES ASSAULT INIT ENCNTR

S229XXA FRACTURE OF BONY THORAX PART UNSP INIT FOR CLOS FX

T63194A

TOXIC EFFECT OF VENOM OF OTH REPTILES UNDETERMINED INIT

S229XXB FRACTURE OF BONY THORAX PART UNSP INIT FOR OPN FX

T632X1A

TOXIC EFFECT OF VENOM OF SCORPION ACCIDENTAL INIT

S230XXA

TRAUMATIC RUPTURE OF THORACIC INTERVERTEBRAL DISC INIT

T632X2A

TOXIC EFFECT OF VENOM OF SCORPION SELF-HARM INIT

S23100A

SUBLUXATION OF UNSPECIFIED THORACIC VERTEBRA INIT ENCNTR

T632X3A

TOXIC EFFECT OF VENOM OF SCORPION ASSAULT INIT ENCNTR

S23101A

DISLOCATION OF UNSPECIFIED THORACIC VERTEBRA INIT ENCNTR

T632X4A

TOXIC EFFECT OF VENOM OF SCORPION UNDETERMINED INIT ENCNTR

S23110A

SUBLUXATION OF T1/T2 THORACIC VERTEBRA INITIAL ENCOUNTER

T63301A

TOXIC EFFECT OF UNSP SPIDER VENOM ACCIDENTAL INIT

S23111A

DISLOCATION OF T1/T2 THORACIC VERTEBRA INITIAL ENCOUNTER

T63302A

TOXIC EFFECT OF UNSP SPIDER VENOM SELF-HARM INIT

S23120A

SUBLUXATION OF T2/T3 THORACIC VERTEBRA INITIAL ENCOUNTER

T63303A

TOXIC EFFECT OF UNSP SPIDER VENOM ASSAULT INIT ENCNTR

S23121A

DISLOCATION OF T2/T3 THORACIC VERTEBRA INITIAL ENCOUNTER

T63304A

TOXIC EFFECT OF UNSP SPIDER VENOM UNDETERMINED INIT ENCNTR

S23122A

SUBLUXATION OF T3/T4 THORACIC VERTEBRA INITIAL ENCOUNTER

T63311A

TOXIC EFFECT OF VENOM OF BLACK WIDOW SPIDER ACC INIT

S23123A

DISLOCATION OF T3/T4 THORACIC VERTEBRA INITIAL ENCOUNTER

T63312A

TOXIC EFFECT OF VENOM OF BLACK WIDOW SPIDER SELF-HARM INIT

S23130A

SUBLUXATION OF T4/T5 THORACIC VERTEBRA INITIAL ENCOUNTER

T63313A

TOXIC EFFECT OF VENOM OF BLACK WIDOW SPIDER ASSAULT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S23131A

DISLOCATION OF T4/T5 THORACIC VERTEBRA INITIAL ENCOUNTER

T63314A

TOXIC EFFECT OF VENOM OF BLACK WIDOW SPIDER UNDET INIT

S23132A

SUBLUXATION OF T5/T6 THORACIC VERTEBRA INITIAL ENCOUNTER

T63321A

TOXIC EFFECT OF VENOM OF TARANTULA ACCIDENTAL INIT

S23133A

DISLOCATION OF T5/T6 THORACIC VERTEBRA INITIAL ENCOUNTER

T63322A

TOXIC EFFECT OF VENOM OF TARANTULA SELF-HARM INIT

S23140A

SUBLUXATION OF T6/T7 THORACIC VERTEBRA INITIAL ENCOUNTER

T63323A

TOXIC EFFECT OF VENOM OF TARANTULA ASSAULT INIT ENCNTR

S23141A

DISLOCATION OF T6/T7 THORACIC VERTEBRA INITIAL ENCOUNTER

T63324A

TOXIC EFFECT OF VENOM OF TARANTULA UNDETERMINED INIT

S23142A

SUBLUXATION OF T7/T8 THORACIC VERTEBRA INITIAL ENCOUNTER

T63331A

TOXIC EFFECT OF VENOM OF BROWN RECLUSE SPIDER ACC INIT

S23143A

DISLOCATION OF T7/T8 THORACIC VERTEBRA INITIAL ENCOUNTER

T63332A

TOXIC EFFECT OF VENOM OF BROWN RECLUSE SPIDER SLF-HRM INIT

S23150A

SUBLUXATION OF T8/T9 THORACIC VERTEBRA INITIAL ENCOUNTER

T63333A

TOXIC EFFECT OF VENOM OF BROWN RECLUSE SPIDER ASSAULT INIT

S23151A

DISLOCATION OF T8/T9 THORACIC VERTEBRA INITIAL ENCOUNTER

T63334A

TOXIC EFFECT OF VENOM OF BROWN RECLUSE SPIDER UNDET INIT

S23152A

SUBLUXATION OF T9/T10 THORACIC VERTEBRA INITIAL ENCOUNTER

T63391A

TOXIC EFFECT OF VENOM OF SPIDER ACCIDENTAL INIT

S23153A

DISLOCATION OF T9/T10 THORACIC VERTEBRA INITIAL ENCOUNTER

T63392A

TOXIC EFFECT OF VENOM OF SPIDER INTENTIONAL SELF-HARM INIT

S23160A

SUBLUXATION OF T10/T11 THORACIC VERTEBRA INITIAL ENCOUNTER

T63393A

TOXIC EFFECT OF VENOM OF OTHER SPIDER ASSAULT INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S23161A

DISLOCATION OF T10/T11 THORACIC VERTEBRA INITIAL ENCOUNTER

T63394A

TOXIC EFFECT OF VENOM OF OTH SPIDER UNDETERMINED INIT

S23162A

SUBLUXATION OF T11/T12 THORACIC VERTEBRA INITIAL ENCOUNTER

T63411A

TOXIC EFFECT OF VENOM OF CENTIPEDE/MILLIPEDE ACC INIT

S23163A

DISLOCATION OF T11/T12 THORACIC VERTEBRA INITIAL ENCOUNTER

T63412A

TOXIC EFFECT OF VENOM OF CENTIPEDE/MILLIPEDE SLF-HRM INIT

S23170A

SUBLUXATION OF T12/L1 THORACIC VERTEBRA INITIAL ENCOUNTER

T63413A

TOXIC EFFECT OF VENOM OF CENTIPEDE/MILLIPEDE ASSAULT INIT

S23171A

DISLOCATION OF T12/L1 THORACIC VERTEBRA INITIAL ENCOUNTER

T63414A

TOXIC EFFECT OF VENOM OF CENTIPEDE/MILLIPEDE UNDET INIT

S2320XA

DISLOCATION OF UNSPECIFIED PART OF THORAX INITIAL ENCOUNTER

T63421A

TOXIC EFFECT OF VENOM OF ANTS ACCIDENTAL INIT

S2329XA

DISLOCATION OF OTHER PARTS OF THORAX INITIAL ENCOUNTER

T63422A

TOXIC EFFECT OF VENOM OF ANTS INTENTIONAL SELF-HARM INIT

S233XXA

SPRAIN OF LIGAMENTS OF THORACIC SPINE INITIAL ENCOUNTER

T63423A

TOXIC EFFECT OF VENOM OF ANTS ASSAULT INITIAL ENCOUNTER

S2341XA SPRAIN OF RIBS INITIAL ENCOUNTER

T63424A

TOXIC EFFECT OF VENOM OF ANTS UNDETERMINED INIT ENCNTR

S23420A

SPRAIN OF STERNOCLAVICULAR (JOINT) (LIGAMENT) INIT ENCNTR

T63431A

TOXIC EFFECT OF VENOM OF CATERPILLARS ACCIDENTAL INIT

S23421A SPRAIN OF CHONDROSTERNAL JOINT INITIAL ENCOUNTER

T63432A

TOXIC EFFECT OF VENOM OF CATERPILLARS SELF-HARM INIT

S23428A OTHER SPRAIN OF STERNUM INITIAL ENCOUNTER

T63433A

TOXIC EFFECT OF VENOM OF CATERPILLARS ASSAULT INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S23429A UNSPECIFIED SPRAIN OF STERNUM INITIAL ENCOUNTER

T63434A

TOXIC EFFECT OF VENOM OF CATERPILLARS UNDETERMINED INIT

S238XXA

SPRAIN OF OTHER SPECIFIED PARTS OF THORAX INITIAL ENCOUNTER

T63441A

TOXIC EFFECT OF VENOM OF BEES ACCIDENTAL INIT

S239XXA

SPRAIN OF UNSPECIFIED PARTS OF THORAX INITIAL ENCOUNTER

T63442A

TOXIC EFFECT OF VENOM OF BEES INTENTIONAL SELF-HARM INIT

S240XXA

CONCUSSION AND EDEMA OF THORACIC SPINAL CORD INIT ENCNTR

T63443A

TOXIC EFFECT OF VENOM OF BEES ASSAULT INITIAL ENCOUNTER

S24101A

UNSP INJURY AT T1 LEVEL OF THORACIC SPINAL CORD INIT ENCNTR

T63444A

TOXIC EFFECT OF VENOM OF BEES UNDETERMINED INIT ENCNTR

S24102A UNSP INJURY AT T2-T6 LEVEL OF THORACIC SPINAL CORD INIT

T63451A

TOXIC EFFECT OF VENOM OF HORNETS ACCIDENTAL INIT

S24103A UNSP INJURY AT T7-T10 LEVEL OF THORACIC SPINAL CORD INIT

T63452A

TOXIC EFFECT OF VENOM OF HORNETS SELF-HARM INIT

S24104A UNSP INJURY AT T11-T12 LEVEL OF THORACIC SPINAL CORD INIT

T63453A

TOXIC EFFECT OF VENOM OF HORNETS ASSAULT INITIAL ENCOUNTER

S24109A UNSP INJURY AT UNSP LEVEL OF THORACIC SPINAL CORD INIT

T63454A

TOXIC EFFECT OF VENOM OF HORNETS UNDETERMINED INIT ENCNTR

S24111A COMPLETE LESION AT T1 LEVEL OF THORACIC SPINAL CORD INIT

T63461A

TOXIC EFFECT OF VENOM OF WASPS ACCIDENTAL INIT

S24112A

COMPLETE LESION AT T2-T6 LEVEL OF THORACIC SPINAL CORD INIT

T63462A

TOXIC EFFECT OF VENOM OF WASPS INTENTIONAL SELF-HARM INIT

S24113A COMPLETE LESION AT T7-T10 INIT

T63463A

TOXIC EFFECT OF VENOM OF WASPS ASSAULT INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S24114A COMPLETE LESION AT T11-T12 INIT

T63464A

TOXIC EFFECT OF VENOM OF WASPS UNDETERMINED INIT ENCNTR

S24119A

COMPLETE LESION AT UNSP LEVEL OF THORACIC SPINAL CORD INIT

T63481A

TOXIC EFFECT OF VENOM OF ARTHROPOD ACCIDENTAL INIT

S24131A ANTERIOR CORD SYNDROME AT T1 INIT

T63482A

TOXIC EFFECT OF VENOM OF ARTHROPOD SELF-HARM INIT

S24132A ANTERIOR CORD SYNDROME AT T2-T6 INIT

T63483A

TOXIC EFFECT OF VENOM OF OTH ARTHROPOD ASSAULT INIT ENCNTR

S24133A ANTERIOR CORD SYNDROME AT T7-T10 INIT

T63484A

TOXIC EFFECT OF VENOM OF OTH ARTHROPOD UNDETERMINED INIT

S24134A ANTERIOR CORD SYNDROME AT T11-T12 INIT

T63511A

TOXIC EFFECT OF CONTACT W STINGRAY ACCIDENTAL INIT

S24139A

ANT CORD SYNDROME AT UNSP LEVEL OF THOR SPINAL CORD INIT

T63512A

TOXIC EFFECT OF CONTACT W STINGRAY SELF-HARM INIT

S24141A BROWN-SEQUARD SYNDROME AT T1 INIT

T63513A

TOXIC EFFECT OF CONTACT WITH STINGRAY ASSAULT INIT ENCNTR

S24142A BROWN-SEQUARD SYNDROME AT T2-T6 INIT

T63514A

TOXIC EFFECT OF CONTACT W STINGRAY UNDETERMINED INIT

S24143A BROWN-SEQUARD SYNDROME AT T7-T10 INIT

T63591A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS FISH ACC INIT

S24144A BROWN-SEQUARD SYNDROME AT T11-T12 INIT

T63592A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS FISH SELF-HARM INIT

S24149A

BROWN-SEQUARD SYND AT UNSP LEVEL OF THOR SPINAL CORD INIT

T63593A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS FISH ASSAULT INIT

S24151A OTH INCOMPLETE LESION AT T1 INIT

T63594A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS FISH UNDET INIT

S24152A OTH INCOMPLETE LESION AT T2-T6 INIT

T63611A

TOXIC EFFECT OF CONTACT W PORTUGESE MAN-O-WAR ACC INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S24153A OTH INCOMPLETE LESION AT T7-T10 INIT

T63612A

TOXIC EFFECT OF CONTACT W PORTUGESE MAN-O-WAR SLF-HRM INIT

S24154A OTH INCOMPLETE LESION AT T11-T12 INIT

T63613A

TOXIC EFFECT OF CONTACT W PORTUGESE MAN-O-WAR ASSAULT INIT

S24159A

OTH INCMPL LESION AT UNSP LEVEL OF THOR SPINAL CORD INIT

T63614A

TOXIC EFFECT OF CONTACT W PORTUGESE MAN-O-WAR UNDET INIT

S242XXA

INJURY OF NERVE ROOT OF THORACIC SPINE INITIAL ENCOUNTER

T63621A

TOXIC EFFECT OF CONTACT W OTH JELLYFISH ACCIDENTAL INIT

S243XXA

INJURY OF PERIPHERAL NERVES OF THORAX INITIAL ENCOUNTER

T63622A

TOXIC EFFECT OF CONTACT W OTH JELLYFISH SELF-HARM INIT

S244XXA

INJURY OF THORACIC SYMPATHETIC NERVOUS SYSTEM INIT ENCNTR

T63623A

TOXIC EFFECT OF CONTACT W OTH JELLYFISH ASSAULT INIT

S248XXA

INJURY OF OTHER SPECIFIED NERVES OF THORAX INIT ENCNTR

T63624A

TOXIC EFFECT OF CONTACT W OTH JELLYFISH UNDETERMINED INIT

S249XXA

INJURY OF UNSPECIFIED NERVE OF THORAX INITIAL ENCOUNTER

T63631A

TOXIC EFFECT OF CONTACT W SEA ANEMONE ACCIDENTAL INIT

S2500XA

UNSPECIFIED INJURY OF THORACIC AORTA INITIAL ENCOUNTER

T63632A

TOXIC EFFECT OF CONTACT W SEA ANEMONE SELF-HARM INIT

S2501XA

MINOR LACERATION OF THORACIC AORTA INITIAL ENCOUNTER

T63633A

TOXIC EFFECT OF CONTACT W SEA ANEMONE ASSAULT INIT ENCNTR

S2502XA

MAJOR LACERATION OF THORACIC AORTA INITIAL ENCOUNTER

T63634A

TOXIC EFFECT OF CONTACT W SEA ANEMONE UNDETERMINED INIT

S2509XA

OTHER SPECIFIED INJURY OF THORACIC AORTA INITIAL ENCOUNTER

T63691A

TOXIC EFFECT OF CNTCT W OTH VENOM MARINE ANIMALS ACC INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S25101A

UNSP INJURY OF RIGHT INNOMINATE OR SUBCLAVIAN ARTERY INIT

T63692A

TOXIC EFF OF CNTCT W OTH VENOM MARINE ANIMALS SLF-HRM INIT

S25102A

UNSP INJURY OF LEFT INNOMINATE OR SUBCLAVIAN ARTERY INIT

T63693A

TOXIC EFF OF CNTCT W OTH VENOM MARINE ANIMALS ASSLT INIT

S25109A

UNSP INJURY OF UNSP INNOMINATE OR SUBCLAVIAN ARTERY INIT

T63694A

TOXIC EFF OF CNTCT W OTH VENOM MARINE ANIMALS UNDET INIT

S25111A

MINOR LACERATION OF RIGHT INNOMINATE OR SUBCLAV ART INIT

T63711A

TOXIC EFFECT OF CONTACT W VENOMOUS MARINE PLANT ACC INIT

S25112A

MINOR LACERATION OF LEFT INNOMINATE OR SUBCLAV ART INIT

T63712A

TOXIC EFFECT OF CONTACT W VENOM MARINE PLANT SLF-HRM INIT

S25119A

MINOR LACERATION OF UNSP INNOMINATE OR SUBCLAV ART INIT

T63713A

TOXIC EFFECT OF CONTACT W VENOM MARINE PLANT ASSAULT INIT

S25121A

MAJOR LACERATION OF RIGHT INNOMINATE OR SUBCLAV ART INIT

T63714A

TOXIC EFFECT OF CONTACT W VENOMOUS MARINE PLANT UNDET INIT

S25122A

MAJOR LACERATION OF LEFT INNOMINATE OR SUBCLAV ART INIT

T63791A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS PLANT ACC INIT

S25129A

MAJOR LACERATION OF UNSP INNOMINATE OR SUBCLAV ART INIT

T63792A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS PLANT SLF-HRM INIT

S25191A

INJ RIGHT INNOMINATE OR SUBCLAVIAN ARTERY INIT ENCNTR

T63793A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS PLANT ASSAULT INIT

S25192A

INJ LEFT INNOMINATE OR SUBCLAVIAN ARTERY INIT ENCNTR

T63794A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS PLANT UNDET INIT

S25199A

INJ UNSP INNOMINATE OR SUBCLAVIAN ARTERY INIT ENCNTR

T63811A

TOXIC EFFECT OF CONTACT W VENOMOUS FROG ACCIDENTAL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S2520XA

UNSPECIFIED INJURY OF SUPERIOR VENA CAVA INITIAL ENCOUNTER

T63812A

TOXIC EFFECT OF CONTACT W VENOMOUS FROG SELF-HARM INIT

S2521XA

MINOR LACERATION OF SUPERIOR VENA CAVA INITIAL ENCOUNTER

T63813A

TOXIC EFFECT OF CONTACT W VENOMOUS FROG ASSAULT INIT

S2522XA

MAJOR LACERATION OF SUPERIOR VENA CAVA INITIAL ENCOUNTER

T63814A

TOXIC EFFECT OF CONTACT W VENOMOUS FROG UNDETERMINED INIT

S2529XA

OTHER SPECIFIED INJURY OF SUPERIOR VENA CAVA INIT ENCNTR

T63821A

TOXIC EFFECT OF CONTACT W VENOMOUS TOAD ACCIDENTAL INIT

S25301A

UNSP INJURY OF RIGHT INNOMINATE OR SUBCLAVIAN VEIN INIT

T63822A

TOXIC EFFECT OF CONTACT W VENOMOUS TOAD SELF-HARM INIT

S25302A

UNSP INJURY OF LEFT INNOMINATE OR SUBCLAVIAN VEIN INIT

T63823A

TOXIC EFFECT OF CONTACT W VENOMOUS TOAD ASSAULT INIT

S25309A

UNSP INJURY OF UNSP INNOMINATE OR SUBCLAVIAN VEIN INIT

T63824A

TOXIC EFFECT OF CONTACT W VENOMOUS TOAD UNDETERMINED INIT

S25311A

MINOR LACERATION OF RIGHT INNOMINATE OR SUBCLAV VEIN INIT

T63831A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS AMPHIBIAN ACC INIT

S25312A

MINOR LACERATION OF LEFT INNOMINATE OR SUBCLAVIAN VEIN INIT

T63832A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS AMPHIB SLF-HRM INIT

S25319A

MINOR LACERATION OF UNSP INNOMINATE OR SUBCLAVIAN VEIN INIT

T63833A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS AMPHIB ASSAULT INIT

S25321A

MAJOR LACERATION OF RIGHT INNOMINATE OR SUBCLAV VEIN INIT

T63834A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS AMPHIB UNDET INIT

S25322A

MAJOR LACERATION OF LEFT INNOMINATE OR SUBCLAVIAN VEIN INIT

T63891A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS ANIMALS ACC INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S25329A

MAJOR LACERATION OF UNSP INNOMINATE OR SUBCLAVIAN VEIN INIT

T63892A

TOXIC EFFECT OF CONTACT W OTH VENOM ANIMALS SLF-HRM INIT

S25391A INJ RIGHT INNOMINATE OR SUBCLAVIAN VEIN INIT ENCNTR

T63893A

TOXIC EFFECT OF CONTACT W OTH VENOM ANIMALS ASSAULT INIT

S25392A INJ LEFT INNOMINATE OR SUBCLAVIAN VEIN INIT ENCNTR

T63894A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS ANIMALS UNDET INIT

S25399A INJ UNSP INNOMINATE OR SUBCLAVIAN VEIN INIT ENCNTR

T6391XA

TOXIC EFFECT OF CONTACT W UNSP VENOMOUS ANIMAL ACC INIT

S25401A

UNSP INJURY OF RIGHT PULMONARY BLOOD VESSELS INIT ENCNTR

T6392XA

TOXIC EFFECT OF CONTACT W UNSP VENOM ANIMAL SLF-HRM INIT

S25402A

UNSP INJURY OF LEFT PULMONARY BLOOD VESSELS INIT ENCNTR

T6393XA

TOXIC EFFECT OF CONTACT W UNSP VENOM ANIMAL ASSAULT INIT

S25409A

UNSP INJURY OF UNSP PULMONARY BLOOD VESSELS INIT ENCNTR

T6394XA

TOXIC EFFECT OF CONTACT W UNSP VENOMOUS ANIMAL UNDET INIT

S25411A

MINOR LACERATION OF RIGHT PULMONARY BLOOD VESSELS INIT

T6401XA

TOXIC EFFECT OF AFLATOXIN ACCIDENTAL (UNINTENTIONAL) INIT

S25412A

MINOR LACERATION OF LEFT PULMONARY BLOOD VESSELS INIT

T6402XA

TOXIC EFFECT OF AFLATOXIN INTENTIONAL SELF-HARM INIT

S25419A

MINOR LACERATION OF UNSP PULMONARY BLOOD VESSELS INIT

T6403XA

TOXIC EFFECT OF AFLATOXIN ASSAULT INITIAL ENCOUNTER

S25421A

MAJOR LACERATION OF RIGHT PULMONARY BLOOD VESSELS INIT

T6404XA

TOXIC EFFECT OF AFLATOXIN UNDETERMINED INITIAL ENCOUNTER

S25422A

MAJOR LACERATION OF LEFT PULMONARY BLOOD VESSELS INIT

T6481XA

TOXIC EFFECT OF MYCOTOXIN FOOD CONTAMNT ACCIDENTAL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S25429A

MAJOR LACERATION OF UNSP PULMONARY BLOOD VESSELS INIT

T6482XA

TOXIC EFFECT OF MYCOTOXIN FOOD CONTAMINANTS SELF-HARM INIT

S25491A

OTH INJURY OF RIGHT PULMONARY BLOOD VESSELS INIT ENCNTR

T6483XA

TOXIC EFFECT OF MYCOTOXIN FOOD CONTAMINANTS ASSAULT INIT

S25492A

OTH INJURY OF LEFT PULMONARY BLOOD VESSELS INIT ENCNTR

T6484XA

TOXIC EFFECT OF MYCOTOXIN FOOD CONTAMNT UNDETERMINED INIT

S25499A

OTH INJURY OF UNSP PULMONARY BLOOD VESSELS INIT ENCNTR

T650X1A

TOXIC EFFECT OF CYANIDES ACCIDENTAL (UNINTENTIONAL) INIT

S25501A

UNSP INJURY OF INTERCOSTAL BLOOD VESSELS RIGHT SIDE INIT

T650X2A

TOXIC EFFECT OF CYANIDES INTENTIONAL SELF-HARM INIT ENCNTR

S25502A UNSP INJURY OF INTERCOSTAL BLOOD VESSELS LEFT SIDE INIT

T650X3A

TOXIC EFFECT OF CYANIDES ASSAULT INITIAL ENCOUNTER

S25509A UNSP INJURY OF INTERCOSTAL BLOOD VESSELS UNSP SIDE INIT

T650X4A

TOXIC EFFECT OF CYANIDES UNDETERMINED INITIAL ENCOUNTER

S25511A

LACERATION OF INTERCOSTAL BLOOD VESSELS RIGHT SIDE INIT

T651X1A

TOXIC EFFECT OF STRYCHNINE AND ITS SALTS ACCIDENTAL INIT

S25512A LACERATION OF INTERCOSTAL BLOOD VESSELS LEFT SIDE INIT

T651X2A

TOXIC EFFECT OF STRYCHNINE AND ITS SALTS SELF-HARM INIT

S25519A LACERATION OF INTERCOSTAL BLOOD VESSELS UNSP SIDE INIT

T651X3A

TOXIC EFFECT OF STRYCHNINE AND ITS SALTS ASSAULT INIT

S25591A

INJ INTERCOSTAL BLOOD VESSELS RIGHT SIDE INIT ENCNTR

T651X4A

TOXIC EFFECT OF STRYCHNINE AND ITS SALTS UNDETERMINED INIT

S25592A INJ INTERCOSTAL BLOOD VESSELS LEFT SIDE INIT ENCNTR

T65211A

TOXIC EFFECT OF CHEWING TOBACCO ACCIDENTAL INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S25599A

INJ INTERCOSTAL BLOOD VESSELS UNSP SIDE INIT ENCNTR

T65212A

TOXIC EFFECT OF CHEWING TOBACCO INTENTIONAL SELF-HARM INIT

S25801A

UNSP INJURY OF OTH BLOOD VESSELS OF THORAX RIGHT SIDE INIT

T65213A

TOXIC EFFECT OF CHEWING TOBACCO ASSAULT INITIAL ENCOUNTER

S25802A

UNSP INJURY OF OTH BLOOD VESSELS OF THORAX LEFT SIDE INIT

T65214A

TOXIC EFFECT OF CHEWING TOBACCO UNDETERMINED INIT ENCNTR

S25809A

UNSP INJURY OF OTH BLOOD VESSELS OF THORAX UNSP SIDE INIT

T65221A

TOXIC EFFECT OF TOBACCO CIGARETTES ACCIDENTAL INIT

S25811A

LACERATION OF OTH BLOOD VESSELS OF THORAX RIGHT SIDE INIT

T65222A

TOXIC EFFECT OF TOBACCO CIGARETTES SELF-HARM INIT

S25812A

LACERATION OF OTH BLOOD VESSELS OF THORAX LEFT SIDE INIT

T65223A

TOXIC EFFECT OF TOBACCO CIGARETTES ASSAULT INIT ENCNTR

S25819A

LACERATION OF OTH BLOOD VESSELS OF THORAX UNSP SIDE INIT

T65224A

TOXIC EFFECT OF TOBACCO CIGARETTES UNDETERMINED INIT

S25891A

INJ OTH BLOOD VESSELS OF THORAX RIGHT SIDE INIT ENCNTR

T65291A

TOXIC EFFECT OF TOBACCO AND NICOTINE ACCIDENTAL INIT

S25892A INJ OTH BLOOD VESSELS OF THORAX LEFT SIDE INIT ENCNTR

T65292A

TOXIC EFFECT OF TOBACCO AND NICOTINE SELF-HARM INIT

S25899A

INJ OTH BLOOD VESSELS OF THORAX UNSP SIDE INIT ENCNTR

T65293A

TOXIC EFFECT OF OTH TOBACCO AND NICOTINE ASSAULT INIT

S2590XA

UNSP INJURY OF UNSP BLOOD VESSEL OF THORAX INIT ENCNTR

T65294A

TOXIC EFFECT OF OTH TOBACCO AND NICOTINE UNDETERMINED INIT

S2591XA

LACERATION OF UNSP BLOOD VESSEL OF THORAX INIT ENCNTR

T653X1A

TOXIC EFF OF NITRODRV/AMINODRV OF BENZN/HOMOLOG ACC INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S2599XA

OTH INJURY OF UNSP BLOOD VESSEL OF THORAX INIT ENCNTR

T653X2A

TOX EFF OF NITRODRV/AMINODRV OF BENZN/HOMOLOG SLF-HRM INIT

S2600XA

UNSP INJURY OF HEART WITH HEMOPERICARDIUM INIT ENCNTR

T653X3A

TOXIC EFF OF NITRODRV/AMINODRV OF BENZN/HOMOLOG ASSLT INIT

S2601XA

CONTUSION OF HEART WITH HEMOPERICARDIUM INITIAL ENCOUNTER

T653X4A

TOXIC EFF OF NITRODRV/AMINODRV OF BENZN/HOMOLOG UNDET INIT

S26020A

MILD LACERATION OF HEART WITH HEMOPERICARDIUM INIT ENCNTR

T654X1A

TOXIC EFFECT OF CARBON DISULFIDE ACCIDENTAL INIT

S26021A

MODERATE LACERATION OF HEART W HEMOPERICARDIUM INIT ENCNTR

T654X2A

TOXIC EFFECT OF CARBON DISULFIDE SELF-HARM INIT

S26022A

MAJOR LACERATION OF HEART WITH HEMOPERICARDIUM INIT ENCNTR

T654X3A

TOXIC EFFECT OF CARBON DISULFIDE ASSAULT INITIAL ENCOUNTER

S2609XA

OTHER INJURY OF HEART WITH HEMOPERICARDIUM INIT ENCNTR

T654X4A

TOXIC EFFECT OF CARBON DISULFIDE UNDETERMINED INIT ENCNTR

S2610XA

UNSP INJURY OF HEART WITHOUT HEMOPERICARDIUM INIT ENCNTR

T655X1A

TOX EFF OF NITRO AND OTH NITRIC ACIDS AND ESTERS ACC INIT

S2611XA

CONTUSION OF HEART WITHOUT HEMOPERICARDIUM INIT ENCNTR

T655X2A

TOX EFF OF NITRO & OTH NITRIC ACIDS & ESTERS SLF-HRM INIT

S2612XA

LACERATION OF HEART WITHOUT HEMOPERICARDIUM INIT ENCNTR

T655X3A

TOX EFF OF NITRO & OTH NITRIC ACIDS AND ESTERS ASSLT INIT

S2619XA

OTHER INJURY OF HEART WITHOUT HEMOPERICARDIUM INIT ENCNTR

T655X4A

TOX EFF OF NITRO & OTH NITRIC ACIDS AND ESTERS UNDET INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S2690XA

UNSP INJURY OF HEART UNSP W OR W/O HEMOPERICARDIUM INIT

T656X1A

TOXIC EFFECT OF PAINTS AND DYES NEC ACCIDENTAL INIT

S2691XA

CONTUSION OF HEART UNSP W OR W/O HEMOPERICARDIUM INIT

T656X2A

TOXIC EFFECT OF PAINTS AND DYES NEC SELF-HARM INIT

S2692XA

LACERATION OF HEART UNSP W OR W/O HEMOPERICARDIUM INIT

T656X3A

TOXIC EFFECT OF PAINTS AND DYES NEC ASSAULT INIT

S2699XA

INJ HEART UNSP W OR W/O HEMOPERICARDIUM INIT ENCNTR

T656X4A

TOXIC EFFECT OF PAINTS AND DYES NEC UNDETERMINED INIT

S270XXA TRAUMATIC PNEUMOTHORAX INITIAL ENCOUNTER

T65811A

TOXIC EFFECT OF LATEX ACCIDENTAL (UNINTENTIONAL) INIT

S271XXA TRAUMATIC HEMOTHORAX INITIAL ENCOUNTER

T65812A

TOXIC EFFECT OF LATEX INTENTIONAL SELF-HARM INIT ENCNTR

S272XXA

TRAUMATIC HEMOPNEUMOTHORAX INITIAL ENCOUNTER

T65813A

TOXIC EFFECT OF LATEX ASSAULT INITIAL ENCOUNTER

S27301A

UNSPECIFIED INJURY OF LUNG UNILATERAL INITIAL ENCOUNTER

T65814A

TOXIC EFFECT OF LATEX UNDETERMINED INITIAL ENCOUNTER

S27302A UNSPECIFIED INJURY OF LUNG BILATERAL INITIAL ENCOUNTER

T65821A

TOXIC EFFECT OF HARMFUL ALGAE AND ALGAE TOXINS ACC INIT

S27309A

UNSPECIFIED INJURY OF LUNG UNSPECIFIED INITIAL ENCOUNTER

T65822A

TOXIC EFF OF HARMFUL ALGAE AND ALGAE TOXINS SLF-HRM INIT

S27311A

PRIMARY BLAST INJURY OF LUNG UNILATERAL INITIAL ENCOUNTER

T65823A

TOXIC EFFECT OF HARMFUL ALGAE AND ALGAE TOXINS ASSLT INIT

S27312A

PRIMARY BLAST INJURY OF LUNG BILATERAL INITIAL ENCOUNTER

T65824A

TOXIC EFFECT OF HARMFUL ALGAE AND ALGAE TOXINS UNDET INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S27319A

PRIMARY BLAST INJURY OF LUNG UNSPECIFIED INITIAL ENCOUNTER

T65831A

TOXIC EFFECT OF FIBERGLASS ACCIDENTAL (UNINTENTIONAL) INIT

S27321A

CONTUSION OF LUNG UNILATERAL INITIAL ENCOUNTER

T65832A

TOXIC EFFECT OF FIBERGLASS INTENTIONAL SELF-HARM INIT

S27322A CONTUSION OF LUNG BILATERAL INITIAL ENCOUNTER

T65833A

TOXIC EFFECT OF FIBERGLASS ASSAULT INITIAL ENCOUNTER

S27329A

CONTUSION OF LUNG UNSPECIFIED INITIAL ENCOUNTER

T65834A

TOXIC EFFECT OF FIBERGLASS UNDETERMINED INITIAL ENCOUNTER

S27331A

LACERATION OF LUNG UNILATERAL INITIAL ENCOUNTER

T65891A

TOXIC EFFECT OF SUBSTANCES ACCIDENTAL (UNINTENTIONAL) INIT

S27332A LACERATION OF LUNG BILATERAL INITIAL ENCOUNTER

T65892A

TOXIC EFFECT OF OTH SUBSTANCES INTENTIONAL SELF-HARM INIT

S27339A

LACERATION OF LUNG UNSPECIFIED INITIAL ENCOUNTER

T65893A

TOXIC EFFECT OF OTH SUBSTANCES ASSAULT INIT ENCNTR

S27391A

OTHER INJURIES OF LUNG UNILATERAL INITIAL ENCOUNTER

T65894A

TOXIC EFFECT OF OTH SUBSTANCES UNDETERMINED INIT ENCNTR

S27392A OTHER INJURIES OF LUNG BILATERAL INITIAL ENCOUNTER

T6591XA

TOXIC EFFECT OF UNSP SUBSTANCE ACCIDENTAL INIT

S27399A

OTHER INJURIES OF LUNG UNSPECIFIED INITIAL ENCOUNTER

T6592XA

TOXIC EFFECT OF UNSP SUBSTANCE INTENTIONAL SELF-HARM INIT

S27401A

UNSPECIFIED INJURY OF BRONCHUS UNILATERAL INIT ENCNTR

T6593XA

TOXIC EFFECT OF UNSPECIFIED SUBSTANCE ASSAULT INIT ENCNTR

S27402A

UNSPECIFIED INJURY OF BRONCHUS BILATERAL INITIAL ENCOUNTER

T6594XA

TOXIC EFFECT OF UNSP SUBSTANCE UNDETERMINED INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S27409A

UNSPECIFIED INJURY OF BRONCHUS UNSPECIFIED INIT ENCNTR

T66XXXA

RADIATION SICKNESS UNSPECIFIED INITIAL ENCOUNTER

S27411A

PRIMARY BLAST INJURY OF BRONCHUS UNILATERAL INIT ENCNTR

T670XXA

HEATSTROKE AND SUNSTROKE INITIAL ENCOUNTER

S27412A

PRIMARY BLAST INJURY OF BRONCHUS BILATERAL INIT ENCNTR

T671XXA HEAT SYNCOPE INITIAL ENCOUNTER

S27419A

PRIMARY BLAST INJURY OF BRONCHUS UNSPECIFIED INIT ENCNTR

T672XXA HEAT CRAMP INITIAL ENCOUNTER

S27421A

CONTUSION OF BRONCHUS UNILATERAL INITIAL ENCOUNTER

T673XXA

HEAT EXHAUSTION ANHYDROTIC INITIAL ENCOUNTER

S27422A CONTUSION OF BRONCHUS BILATERAL INITIAL ENCOUNTER

T674XXA

HEAT EXHAUSTION DUE TO SALT DEPLETION INITIAL ENCOUNTER

S27429A

CONTUSION OF BRONCHUS UNSPECIFIED INITIAL ENCOUNTER

T675XXA

HEAT EXHAUSTION UNSPECIFIED INITIAL ENCOUNTER

S27431A

LACERATION OF BRONCHUS UNILATERAL INITIAL ENCOUNTER

T676XXA

HEAT FATIGUE TRANSIENT INITIAL ENCOUNTER

S27432A LACERATION OF BRONCHUS BILATERAL INITIAL ENCOUNTER

T677XXA HEAT EDEMA INITIAL ENCOUNTER

S27439A

LACERATION OF BRONCHUS UNSPECIFIED INITIAL ENCOUNTER

T68XXXA HYPOTHERMIA INITIAL ENCOUNTER

S27491A

OTHER INJURY OF BRONCHUS UNILATERAL INITIAL ENCOUNTER

T69011A

IMMERSION HAND RIGHT HAND INITIAL ENCOUNTER

S27492A OTHER INJURY OF BRONCHUS BILATERAL INITIAL ENCOUNTER

T69012A

IMMERSION HAND LEFT HAND INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S27499A

OTHER INJURY OF BRONCHUS UNSPECIFIED INITIAL ENCOUNTER

T69019A

IMMERSION HAND UNSPECIFIED HAND INITIAL ENCOUNTER

S2750XA

UNSPECIFIED INJURY OF THORACIC TRACHEA INITIAL ENCOUNTER

T69021A

IMMERSION FOOT RIGHT FOOT INITIAL ENCOUNTER

S2751XA

PRIMARY BLAST INJURY OF THORACIC TRACHEA INITIAL ENCOUNTER

T69022A

IMMERSION FOOT LEFT FOOT INITIAL ENCOUNTER

S2752XA CONTUSION OF THORACIC TRACHEA INITIAL ENCOUNTER

T69029A

IMMERSION FOOT UNSPECIFIED FOOT INITIAL ENCOUNTER

S2753XA LACERATION OF THORACIC TRACHEA INITIAL ENCOUNTER

T691XXA CHILBLAINS INITIAL ENCOUNTER

S2759XA OTHER INJURY OF THORACIC TRACHEA INITIAL ENCOUNTER

T698XXA

OTHER SPECIFIED EFFECTS OF REDUCED TEMPERATURE INIT ENCNTR

S2760XA UNSPECIFIED INJURY OF PLEURA INITIAL ENCOUNTER

T699XXA

EFFECT OF REDUCED TEMPERATURE UNSPECIFIED INIT ENCNTR

S2763XA LACERATION OF PLEURA INITIAL ENCOUNTER

T700XXA

OTITIC BAROTRAUMA INITIAL ENCOUNTER

S2769XA OTHER INJURY OF PLEURA INITIAL ENCOUNTER

T701XXA

SINUS BAROTRAUMA INITIAL ENCOUNTER

S27802A CONTUSION OF DIAPHRAGM INITIAL ENCOUNTER

T7020XA

UNSPECIFIED EFFECTS OF HIGH ALTITUDE INITIAL ENCOUNTER

S27803A LACERATION OF DIAPHRAGM INITIAL ENCOUNTER

T7029XA

OTHER EFFECTS OF HIGH ALTITUDE INITIAL ENCOUNTER

S27808A OTHER INJURY OF DIAPHRAGM INITIAL ENCOUNTER

T703XXA

CAISSON DISEASE [DECOMPRESSION SICKNESS] INITIAL ENCOUNTER

S27809A

UNSPECIFIED INJURY OF DIAPHRAGM INITIAL ENCOUNTER

T704XXA

EFFECTS OF HIGH-PRESSURE FLUIDS INITIAL ENCOUNTER

S27812A

CONTUSION OF ESOPHAGUS (THORACIC PART) INITIAL ENCOUNTER

T708XXA

OTH EFFECTS OF AIR PRESSURE AND WATER PRESSURE INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S27813A

LACERATION OF ESOPHAGUS (THORACIC PART) INITIAL ENCOUNTER

T709XXA

EFFECT OF AIR PRESSURE AND WATER PRESSURE UNSP INIT ENCNTR

S27818A

OTHER INJURY OF ESOPHAGUS (THORACIC PART) INITIAL ENCOUNTER

T71111A

ASPHYX DUE TO SMOTHERING UNDER PILLOW ACCIDENTAL INIT

S27819A

UNSPECIFIED INJURY OF ESOPHAGUS (THORACIC PART) INIT ENCNTR

T71112A

ASPHYXIATION DUE TO SMOTHERING UNDER PILLOW SELF-HARM INIT

S27892A

CONTUSION OF OTH INTRATHORACIC ORGANS INIT ENCNTR

T71113A

ASPHYXIATION DUE TO SMOTHERING UNDER PILLOW ASSAULT INIT

S27893A

LACERATION OF OTH INTRATHORACIC ORGANS INIT ENCNTR

T71114A

ASPHYX DUE TO SMOTHERING UNDER PILLOW UNDETERMINED INIT

S27898A

OTHER INJURY OF OTH INTRATHORACIC ORGANS INIT ENCNTR

T71121A

ASPHYXIATION DUE TO PLASTIC BAG ACCIDENTAL INIT ENCNTR

S27899A

UNSPECIFIED INJURY OF OTH INTRATHORACIC ORGANS INIT ENCNTR

T71122A

ASPHYXIATION DUE TO PLASTIC BAG INTENTIONAL SELF-HARM INIT

S279XXA

INJURY OF UNSPECIFIED INTRATHORACIC ORGAN INITIAL ENCOUNTER

T71123A

ASPHYXIATION DUE TO PLASTIC BAG ASSAULT INITIAL ENCOUNTER

S280XXA CRUSHED CHEST INITIAL ENCOUNTER

T71124A

ASPHYXIATION DUE TO PLASTIC BAG UNDETERMINED INIT ENCNTR

S281XXA TRAUMATIC AMP OF PART OF THORAX EXCEPT BREAST INIT

T71131A

ASPHYX DUE TO BEING TRAPPED IN BED LINENS ACCIDENTAL INIT

S28211A

COMPLETE TRAUMATIC AMPUTATION OF RIGHT BREAST INIT ENCNTR

T71132A

ASPHYX DUE TO BEING TRAPPED IN BED LINENS SELF-HARM INIT

S28212A

COMPLETE TRAUMATIC AMPUTATION OF LEFT BREAST INIT ENCNTR

T71133A

ASPHYX DUE TO BEING TRAPPED IN BED LINENS ASSAULT INIT

S28219A

COMPLETE TRAUMATIC AMPUTATION OF UNSP BREAST INIT ENCNTR

T71134A

ASPHYX DUE TO BEING TRAPPED IN BED LINENS UNDET INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S28221A

PARTIAL TRAUMATIC AMPUTATION OF RIGHT BREAST INIT ENCNTR

T71141A

ASPHYX DUE TO SMOTHR UNDER ANOTHER PERSON'S BODY ACC INIT

S28222A

PARTIAL TRAUMATIC AMPUTATION OF LEFT BREAST INIT ENCNTR

T71143A

ASPHYX D/T SMOTHR UNDER ANOTHER PERSON'S BODY ASSLT INIT

S28229A

PARTIAL TRAUMATIC AMPUTATION OF UNSP BREAST INIT ENCNTR

T71144A

ASPHYX D/T SMOTHR UNDER ANOTHER PERSON'S BODY UNDET INIT

S29001A UNSP INJURY OF MSL/TND OF FRONT WALL OF THORAX INIT

T71151A

ASPHYX DUE TO SMOTHERING IN FURNITURE ACCIDENTAL INIT

S29002A UNSP INJURY OF MSL/TND OF BACK WALL OF THORAX INIT

T71152A

ASPHYXIATION DUE TO SMOTHERING IN FURNITURE SELF-HARM INIT

S29009A UNSP INJURY OF MSL/TND OF UNSP WALL OF THORAX INIT

T71153A

ASPHYXIATION DUE TO SMOTHERING IN FURNITURE ASSAULT INIT

S29011A

STRAIN OF MUSCLE AND TENDON OF FRONT WALL OF THORAX INIT

T71154A

ASPHYX DUE TO SMOTHERING IN FURNITURE UNDETERMINED INIT

S29012A

STRAIN OF MUSCLE AND TENDON OF BACK WALL OF THORAX INIT

T71161A

ASPHYXIATION DUE TO HANGING ACCIDENTAL INITIAL ENCOUNTER

S29019A

STRAIN OF MUSCLE AND TENDON OF UNSP WALL OF THORAX INIT

T71162A

ASPHYXIATION DUE TO HANGING INTENTIONAL SELF-HARM INIT

S29021A LACERATION OF MSL/TND OF FRONT WALL OF THORAX INIT

T71163A

ASPHYXIATION DUE TO HANGING ASSAULT INITIAL ENCOUNTER

S29022A

LACERATION OF MUSCLE AND TENDON OF BACK WALL OF THORAX INIT

T71164A

ASPHYXIATION DUE TO HANGING UNDETERMINED INITIAL ENCOUNTER

S29029A

LACERATION OF MUSCLE AND TENDON OF UNSP WALL OF THORAX INIT

T71191A

ASPHYX D/T MECH THREAT TO BREATHE D/T OTH CAUSE ACC INIT

S29091A

INJ MUSCLE AND TENDON OF FRONT WALL OF THORAX INIT ENCNTR

T71192A

ASPHYX D/T MECH THRT TO BREATHE D/T OTH CAUSE SLF-HRM INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S29092A

INJ MUSCLE AND TENDON OF BACK WALL OF THORAX INIT ENCNTR

T71193A

ASPHYX D/T MECH THREAT TO BREATHE D/T OTH CAUSE ASSLT INIT

S29099A

INJ MUSCLE AND TENDON OF UNSP WALL OF THORAX INIT ENCNTR

T71194A

ASPHYX D/T MECH THREAT TO BREATHE D/T OTH CAUSE UNDET INIT

S298XXA OTHER SPECIFIED INJURIES OF THORAX INITIAL ENCOUNTER

T7120XA

ASPHYX D/T SYS OXY DEFIC D/T LOW OXY IN AIR UNSP CAUSE INIT

S299XXA UNSPECIFIED INJURY OF THORAX INITIAL ENCOUNTER

T7121XA

ASPHYXIATION DUE TO CAVE-IN OR FALLING EARTH INIT ENCNTR

S300XXA

CONTUSION OF LOWER BACK AND PELVIS INITIAL ENCOUNTER

T71221A

ASPHYX DUE TO BEING TRAPPED IN A CAR TRUNK ACCIDENTAL INIT

S301XXA CONTUSION OF ABDOMINAL WALL INITIAL ENCOUNTER

T71222A

ASPHYX DUE TO BEING TRAPPED IN A CAR TRUNK SELF-HARM INIT

S30201A

CONTUSION OF UNSP EXTERNAL GENITAL ORGAN MALE INIT ENCNTR

T71223A

ASPHYX DUE TO BEING TRAPPED IN A CAR TRUNK ASSAULT INIT

S30202A

CONTUSION OF UNSP EXTERNAL GENITAL ORGAN FEMALE INIT

T71224A

ASPHYX DUE TO BEING TRAPPED IN A CAR TRUNK UNDET INIT

S3021XA CONTUSION OF PENIS INITIAL ENCOUNTER

T71231A

ASPHYX DUE TO BEING TRAP IN A (DISCARDED) REFRIG ACC INIT

S3022XA CONTUSION OF SCROTUM AND TESTES INITIAL ENCOUNTER

T71232A

ASPHYX D/T BEING TRAP IN A (DISCARDED) REFRIG SLF-HRM INIT

S3023XA CONTUSION OF VAGINA AND VULVA INITIAL ENCOUNTER

T71233A

ASPHYX D/T BEING TRAP IN A (DISCARDED) REFRIG ASSLT INIT

S303XXA CONTUSION OF ANUS INITIAL ENCOUNTER

T71234A

ASPHYX D/T BEING TRAP IN A (DISCARDED) REFRIG UNDET INIT

S30810A

ABRASION OF LOWER BACK AND PELVIS INITIAL ENCOUNTER

T7129XA

ASPHYX DUE TO BEING TRAP IN OTH LOW OXYGEN ENVIRONMENT INIT

S30811A ABRASION OF ABDOMINAL WALL INITIAL ENCOUNTER

T719XXA

ASPHYXIATION DUE TO UNSPECIFIED CAUSE INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S30812A ABRASION OF PENIS INITIAL ENCOUNTER

T730XXA STARVATION INITIAL ENCOUNTER

S30813A ABRASION OF SCROTUM AND TESTES INITIAL ENCOUNTER

T731XXA

DEPRIVATION OF WATER INITIAL ENCOUNTER

S30814A ABRASION OF VAGINA AND VULVA INITIAL ENCOUNTER

T732XXA

EXHAUSTION DUE TO EXPOSURE INITIAL ENCOUNTER

S30815A

ABRASION OF UNSP EXTERNAL GENITAL ORGANS MALE INIT ENCNTR

T733XXA

EXHAUSTION DUE TO EXCESSIVE EXERTION INITIAL ENCOUNTER

S30816A ABRASION OF UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T7401XA

ADULT NEGLECT OR ABANDONMENT CONFIRMED INITIAL ENCOUNTER

S30817A ABRASION OF ANUS INITIAL ENCOUNTER

T7402XA

CHILD NEGLECT OR ABANDONMENT CONFIRMED INITIAL ENCOUNTER

S30820A

BLISTER (NONTHERMAL) OF LOWER BACK AND PELVIS INIT ENCNTR

T7411XA

ADULT PHYSICAL ABUSE CONFIRMED INITIAL ENCOUNTER

S30821A

BLISTER (NONTHERMAL) OF ABDOMINAL WALL INITIAL ENCOUNTER

T7412XA

CHILD PHYSICAL ABUSE CONFIRMED INITIAL ENCOUNTER

S30822A BLISTER (NONTHERMAL) OF PENIS INITIAL ENCOUNTER

T7421XA

ADULT SEXUAL ABUSE CONFIRMED INITIAL ENCOUNTER

S30823A

BLISTER (NONTHERMAL) OF SCROTUM AND TESTES INIT ENCNTR

T7422XA

CHILD SEXUAL ABUSE CONFIRMED INITIAL ENCOUNTER

S30824A

BLISTER (NONTHERMAL) OF VAGINA AND VULVA INITIAL ENCOUNTER

T7431XA

ADULT PSYCHOLOGICAL ABUSE CONFIRMED INITIAL ENCOUNTER

S30825A BLISTER OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

T7432XA

CHILD PSYCHOLOGICAL ABUSE CONFIRMED INITIAL ENCOUNTER

S30826A BLISTER OF UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T744XXA

SHAKEN INFANT SYNDROME INITIAL ENCOUNTER

S30827A BLISTER (NONTHERMAL) OF ANUS INITIAL ENCOUNTER

T7500XA

UNSPECIFIED EFFECTS OF LIGHTNING INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S30840A

EXTERNAL CONSTRICTION OF LOWER BACK AND PELVIS INIT ENCNTR

T7501XA

SHOCK DUE TO BEING STRUCK BY LIGHTNING INITIAL ENCOUNTER

S30841A

EXTERNAL CONSTRICTION OF ABDOMINAL WALL INITIAL ENCOUNTER

T7509XA

OTHER EFFECTS OF LIGHTNING INITIAL ENCOUNTER

S30842A EXTERNAL CONSTRICTION OF PENIS INITIAL ENCOUNTER

T751XXA

UNSP EFFECTS OF DROWNING AND NONFATAL SUBMERSION INIT

S30843A

EXTERNAL CONSTRICTION OF SCROTUM AND TESTES INIT ENCNTR

T754XXA ELECTROCUTION INITIAL ENCOUNTER

S30844A

EXTERNAL CONSTRICTION OF VAGINA AND VULVA INITIAL ENCOUNTER

T7601XA

ADULT NEGLECT OR ABANDONMENT SUSPECTED INITIAL ENCOUNTER

S30845A

EXTRN CONSTRICT OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

T7602XA

CHILD NEGLECT OR ABANDONMENT SUSPECTED INITIAL ENCOUNTER

S30846A

EXTRN CONSTRICT OF UNSP EXTRN GENITAL ORGANS FEMALE INIT

T7611XA

ADULT PHYSICAL ABUSE SUSPECTED INITIAL ENCOUNTER

S30850A SUPERFICIAL FOREIGN BODY OF LOWER BACK AND PELVIS INIT

T7612XA

CHILD PHYSICAL ABUSE SUSPECTED INITIAL ENCOUNTER

S30851A SUPERFICIAL FOREIGN BODY OF ABDOMINAL WALL INIT ENCNTR

T7621XA

ADULT SEXUAL ABUSE SUSPECTED INITIAL ENCOUNTER

S30852A SUPERFICIAL FOREIGN BODY OF PENIS INITIAL ENCOUNTER

T7622XA

CHILD SEXUAL ABUSE SUSPECTED INITIAL ENCOUNTER

S30853A

SUPERFICIAL FOREIGN BODY OF SCROTUM AND TESTES INIT ENCNTR

T7631XA

ADULT PSYCHOLOGICAL ABUSE SUSPECTED INITIAL ENCOUNTER

S30854A

SUPERFICIAL FOREIGN BODY OF VAGINA AND VULVA INIT ENCNTR

T7632XA

CHILD PSYCHOLOGICAL ABUSE SUSPECTED INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S30855A

SUPERFICIAL FB OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

T7800XA

ANAPHYLACTIC REACTION DUE TO UNSPECIFIED FOOD INIT ENCNTR

S30856A

SUPERFICIAL FB OF UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T7801XA

ANAPHYLACTIC REACTION DUE TO PEANUTS INITIAL ENCOUNTER

S30857A SUPERFICIAL FOREIGN BODY OF ANUS INITIAL ENCOUNTER

T7802XA

ANAPHYLACTIC REACTION DUE TO SHELLFISH (CRUSTACEANS) INIT

S30860A

INSECT BITE (NONVENOMOUS) OF LOWER BACK AND PELVIS INIT

T7803XA

ANAPHYLACTIC REACTION DUE TO OTHER FISH INITIAL ENCOUNTER

S30861A

INSECT BITE (NONVENOMOUS) OF ABDOMINAL WALL INIT ENCNTR

T7804XA

ANAPHYLACTIC REACTION DUE TO FRUITS AND VEGETABLES INIT

S30862A INSECT BITE (NONVENOMOUS) OF PENIS INITIAL ENCOUNTER

T7805XA

ANAPHYLACTIC REACTION DUE TO TREE NUTS AND SEEDS INIT

S30863A

INSECT BITE (NONVENOMOUS) OF SCROTUM AND TESTES INIT ENCNTR

T7806XA

ANAPHYLACTIC REACTION DUE TO FOOD ADDITIVES INIT ENCNTR

S30864A

INSECT BITE (NONVENOMOUS) OF VAGINA AND VULVA INIT ENCNTR

T7807XA

ANAPHYLACTIC REACTION DUE TO MILK AND DAIRY PRODUCTS INIT

S30865A INSECT BITE OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

T7808XA

ANAPHYLACTIC REACTION DUE TO EGGS INITIAL ENCOUNTER

S30866A INSECT BITE OF UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T7809XA

ANAPHYLACTIC REACTION DUE TO OTH FOOD PRODUCTS INIT ENCNTR

S30867A INSECT BITE (NONVENOMOUS) OF ANUS INITIAL ENCOUNTER

T782XXA

ANAPHYLACTIC SHOCK UNSPECIFIED INITIAL ENCOUNTER

S30870A

OTHER SUPERFICIAL BITE OF LOWER BACK AND PELVIS INIT ENCNTR

T783XXA

ANGIONEUROTIC EDEMA INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S30871A

OTHER SUPERFICIAL BITE OF ABDOMINAL WALL INITIAL ENCOUNTER

T7841XA

ARTHUS PHENOMENON INITIAL ENCOUNTER

S30872A OTHER SUPERFICIAL BITE OF PENIS INITIAL ENCOUNTER

T790XXA

AIR EMBOLISM (TRAUMATIC) INITIAL ENCOUNTER

S30873A

OTHER SUPERFICIAL BITE OF SCROTUM AND TESTES INIT ENCNTR

T791XXA

FAT EMBOLISM (TRAUMATIC) INITIAL ENCOUNTER

S30874A

OTHER SUPERFICIAL BITE OF VAGINA AND VULVA INIT ENCNTR

T792XXA

TRAUMATIC SECONDARY AND RECURRENT HEMOR AND SEROMA INIT

S30875A

OTH SUPERFIC BITE OF UNSP EXTRN GENITAL ORGANS MALE INIT

T794XXA

TRAUMATIC SHOCK INITIAL ENCOUNTER

S30876A

OTH SUPERFIC BITE OF UNSP EXTRN GENITAL ORGANS FEMALE INIT

T795XXA

TRAUMATIC ANURIA INITIAL ENCOUNTER

S30877A OTHER SUPERFICIAL BITE OF ANUS INITIAL ENCOUNTER

T796XXA

TRAUMATIC ISCHEMIA OF MUSCLE INITIAL ENCOUNTER

S3091XA UNSP SUPERFICIAL INJURY OF LOWER BACK AND PELVIS INIT

T797XXA

TRAUMATIC SUBCUTANEOUS EMPHYSEMA INITIAL ENCOUNTER

S3092XA UNSP SUPERFICIAL INJURY OF ABDOMINAL WALL INIT ENCNTR

T798XXA

OTHER EARLY COMPLICATIONS OF TRAUMA INITIAL ENCOUNTER

S3093XA

UNSPECIFIED SUPERFICIAL INJURY OF PENIS INITIAL ENCOUNTER

T799XXA

UNSPECIFIED EARLY COMPLICATION OF TRAUMA INITIAL ENCOUNTER

S3094XA

UNSP SUPERFICIAL INJURY OF SCROTUM AND TESTES INIT ENCNTR

T79A0XA

COMPARTMENT SYNDROME UNSPECIFIED INITIAL ENCOUNTER

S3095XA

UNSP SUPERFICIAL INJURY OF VAGINA AND VULVA INIT ENCNTR

T79A11A

TRAUMATIC COMPARTMENT SYNDROME OF R UP EXTREM INIT

S3096XA

UNSP SUPERFIC INJ UNSP EXTERNAL GENITAL ORGANS MALE INIT

T79A12A

TRAUMATIC COMPARTMENT SYNDROME OF LEFT UPPER EXTREMITY INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S3097XA

UNSP SUPERFIC INJ UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T79A19A

TRAUMATIC COMPARTMENT SYNDROME OF UNSP UPPER EXTREMITY INIT

S3098XA

UNSPECIFIED SUPERFICIAL INJURY OF ANUS INITIAL ENCOUNTER

T79A21A

TRAUMATIC COMPARTMENT SYNDROME OF R LOW EXTREM INIT

S31000A

UNSP OPN WND LOW BACK AND PELV W/O PENET RETROPERITON INIT

T79A22A

TRAUMATIC COMPARTMENT SYNDROME OF LEFT LOWER EXTREMITY INIT

S31001A

UNSP OPN WND LOW BACK AND PELVIS W PENET RETROPERITON INIT

T79A29A

TRAUMATIC COMPARTMENT SYNDROME OF UNSP LOWER EXTREMITY INIT

S31010A

LAC W/O FB OF LOW BACK AND PELV W/O PENET RETROPERITON INIT

T79A3XA

TRAUMATIC COMPARTMENT SYNDROME OF ABDOMEN INITIAL ENCOUNTER

S31011A

LAC W/O FB OF LOW BACK AND PELVIS W PENET RETROPERITON INIT

T79A9XA

TRAUMATIC COMPARTMENT SYNDROME OF OTHER SITES INIT ENCNTR

S31020A

LAC W FB OF LOW BACK AND PELVIS W/O PENET RETROPERITON INIT

T800XXA

AIR EMBOLISM FOL INFUSION TRANFS AND THERAPUTC INJECT INIT

S31021A

LAC W FB OF LOWER BACK AND PELVIS W PENET RETROPERITON INIT

T801XXA

VASCULAR COMP FOL INFUSN TRANFS AND THERAPUTC INJECT INIT

S31030A

PNCTR W/O FB OF LOW BACK & PELV W/O PENET RETROPERITON INIT

T8029XA

INFCT FOL OTH INFUSION TRANSFUSE AND THERAPUTC INJECT INIT

S31031A

PNCTR W/O FB OF LOW BACK AND PELV W PENET RETROPERITON INIT

T8030XA

ABO INCOMPAT REACT DUE TO TRANFS OF BLD/BLD PROD UNSP INIT

S31040A

PNCTR W FB OF LOW BACK AND PELV W/O PENET RETROPERITON INIT

T80310A

ABO INCOMPATIBILITY W ACUTE HEMOLYTIC TRANSFS REACT INIT

S31041A

PNCTR W FB OF LOW BACK AND PELVIS W PENET RETROPERITON INIT

T80311A

ABO INCOMPATIBILITY W DELAYED HEMOLYTIC TRANSFS REACT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31050A

OPEN BITE OF LOW BACK AND PELV W/O PENET RETROPERITON INIT

T80319A

ABO INCOMPATIBILITY W HEMOLYTIC TRANSFS REACT UNSP INIT

S31051A

OPEN BITE OF LOW BACK AND PELVIS W PENET RETROPERITON INIT

T8039XA

OTH ABO INCOMPAT REACT DUE TO TRANFS OF BLD/BLD PROD INIT

S31100A

UNSP OPN WND ABD WALL R UPPER Q W/O PENET PERIT CAV INIT

T8040XA

RH INCOMPAT REACT DUE TO TRANFS OF BLD/BLD PROD UNSP INIT

S31101A

UNSP OPN WND ABD WALL L UPR Q W/O PENET PERIT CAV INIT

T80410A

RH INCOMPATIBILITY W ACUTE HEMOLYTIC TRANSFS REACT INIT

S31102A

UNSP OPN WND ABD WALL EPIGST RGN W/O PENET PERIT CAV INIT

T80411A

RH INCOMPATIBILITY W DELAYED HEMOLYTIC TRANSFS REACT INIT

S31103A

UNSP OPN WND ABD WALL RIGHT LOW Q W/O PENET PERIT CAV INIT

T80419A

RH INCOMPATIBILITY W HEMOLYTIC TRANSFS REACT UNSP INIT

S31104A

UNSP OPN WND ABD WALL LEFT LOW Q W/O PENET PERIT CAV INIT

T8049XA

OTH RH INCOMPAT REACTION DUE TO TRANFS OF BLD/BLD PROD INIT

S31105A

UNSP OPN WND ABD WALL PERIUMB RGN W/O PENET PERIT CAV INIT

T80810A

EXTRAVASATION OF VESICANT ANTINEOPLASTIC CHEMOTHERAPY INIT

S31109A

UNSP OPN WND ABD WALL UNSP Q W/O PENET PERIT CAV INIT

T80818A

EXTRAVASATION OF OTHER VESICANT AGENT INITIAL ENCOUNTER

S31110A

LAC W/O FB OF ABD WALL R UPPER Q W/O PENET PERIT CAV INIT

T80910A

ACUTE HEMOLYTIC TRANSFS REACT UNSP INCOMPATIBILITY INIT

S31111A

LAC W/O FB OF ABD WALL L UPR Q W/O PENET PERIT CAV INIT

T80911A

DELAYED HEMOLYTIC TRANSFS REACT UNSP INCOMPATIBILITY INIT

S31112A

LAC W/O FB OF ABD WALL EPIGST RGN W/O PENET PERIT CAV INIT

T80919A

HEMOLYTIC TRANSFS REACT UNSP INCOMPAT UNSP AC/DELAY INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31113A

LAC W/O FB OF ABD WALL R LOW Q W/O PENET PERIT CAV INIT

T80A0XA

NON-ABO INCOMPAT REACT D/T TRANFS OF BLD/BLD PRODUNSP INIT

S31114A

LAC W/O FB OF ABD WALL LEFT LOW Q W/O PENET PERIT CAV INIT

T80A10A

NON-ABO INCOMPAT W ACUTE HEMOLYTIC TRANSFS REACT INIT

S31115A

LAC W/O FB OF ABD WL PERIUMB RGN W/O PENET PERIT CAV INIT

T80A11A

NON-ABO INCOMPAT W DELAYED HEMOLYTIC TRANSFS REACT INIT

S31119A

LAC W/O FB OF ABD WALL UNSP Q W/O PENET PERIT CAV INIT

T80A19A

NON-ABO INCOMPAT W HEMOLYTIC TRANSFS REACT UNSP INIT

S31120A

LACERAT ABD WALL W FB R UPPER Q W/O PENET PERIT CAV INIT

T80A9XA

OTH NON-ABO INCOMPAT REACT D/T TRANFS OF BLD/BLD PROD INIT

S31121A LACERAT ABD WALL W FB L UPR Q W/O PENET PERIT CAV INIT

T8130XA

DISRUPTION OF WOUND UNSPECIFIED INITIAL ENCOUNTER

S31122A

LACERAT ABD WALL W FB EPIGST RGN W/O PENET PERIT CAV INIT

T8131XA

DISRUPTION OF EXTERNAL OPERATION (SURGICAL) WOUND NEC INIT

S31123A

LACERAT ABD WALL W FB RIGHT LOW Q W/O PENET PERIT CAV INIT

T8132XA

DISRUPTION OF INTERNAL OPERATION (SURGICAL) WOUND NEC INIT

S31124A

LACERAT ABD WALL W FB LEFT LOW Q W/O PENET PERIT CAV INIT

T8133XA

DISRUPTION OF TRAUMATIC INJURY WOUND REPAIR INIT ENCNTR

S31125A

LACERAT ABD WALL W FB PERIUMB RGN W/O PENET PERIT CAV INIT

T814XXA

INFECTION FOLLOWING A PROCEDURE INITIAL ENCOUNTER

S31129A LACERAT ABD WALL W FB UNSP Q W/O PENET PERIT CAV INIT

T81500A

UNSP COMP OF FB ACC LEFT IN BODY FOL SURGICAL OP INIT

S31130A

PNCTR OF ABD WALL W/O FB R UPR Q W/O PENET PERIT CAV INIT

T81501A

UNSP COMP OF FB ACC LEFT IN BODY FOL INFUSN/TRANSFUSN INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31131A

PNCTR OF ABD WALL W/O FB L UPR Q W/O PENET PERIT CAV INIT

T81502A

UNSP COMP OF FB ACC LEFT IN BODY FOL KIDNEY DIALYSIS INIT

S31132A

PNCTR OF ABD WL W/O FB EPIGST RGN W/O PENET PERIT CAV INIT

T81503A

UNSP COMP OF FB ACC LEFT IN BODY FOL INJECT OR IMMUNIZ INIT

S31133A

PNCTR OF ABD WALL W/O FB R LOW Q W/O PENET PERIT CAV INIT

T81504A

UNSP COMP OF FB ACC LEFT IN BODY FOLLOWING ENDO EXAM INIT

S31134A

PNCTR OF ABD WALL W/O FB L LOW Q W/O PENET PERIT CAV INIT

T81505A

UNSP COMP OF FB ACC LEFT IN BODY FOLLOWING HEART CATH INIT

S31135A

PNCTR OF ABD WL W/O FBPERIUMB RGN W/O PENET PERIT CAV INIT

T81506A

UNSP COMP OF FB ACC LEFT IN BODY FOLLOWING PUNCTR/CATH INIT

S31139A

PNCTR OF ABD WALL W/O FB UNSP Q W/O PENET PERIT CAV INIT

T81507A

UNSP COMP OF FB ACC LEFT IN BODY FOL REMOV CATH/PACK INIT

S31140A

PNCTR OF ABD WALL W FB R UPPER Q W/O PENET PERIT CAV INIT

T81508A

UNSP COMP OF FB ACC LEFT IN BODY FOL OTH PROCEDURE INIT

S31141A

PNCTR OF ABD WALL W FB L UPR Q W/O PENET PERIT CAV INIT

T81509A

UNSP COMP OF FB ACC LEFT IN BODY FOL UNSP PROCEDURE INIT

S31142A

PNCTR OF ABD WALL W FB EPIGST RGN W/O PENET PERIT CAV INIT

T81510A

ADHES DUE TO FB ACC LEFT IN BODY FOL SURGICAL OP INIT

S31143A

PNCTR OF ABD WALL W FB R LOW Q W/O PENET PERIT CAV INIT

T81511A

ADHES DUE TO FB ACC LEFT IN BODY FOL INFUSN/TRANSFUSN INIT

S31144A

PNCTR OF ABD WALL W FB LEFT LOW Q W/O PENET PERIT CAV INIT

T81512A

ADHES DUE TO FB ACC LEFT IN BODY FOL KIDNEY DIALYSIS INIT

S31145A

PNCTR OF ABD WL W FB PERIUMB RGN W/O PENET PERIT CAV INIT

T81513A

ADHES DUE TO FB ACC LEFT IN BODY FOL INJECT OR IMMUNIZ INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31149A

PNCTR OF ABD WALL W FB UNSP Q W/O PENET PERIT CAV INIT

T81514A

ADHES DUE TO FB ACC LEFT IN BODY FOLLOWING ENDO EXAM INIT

S31150A

OPEN BITE OF ABD WALL R UPPER Q W/O PENET PERIT CAV INIT

T81515A

ADHES DUE TO FB ACC LEFT IN BODY FOLLOWING HEART CATH INIT

S31151A OPEN BITE OF ABD WALL L UPR Q W/O PENET PERIT CAV INIT

T81516A

ADHES DUE TO FB ACC LEFT IN BODY FOLLOWING PUNCTR/CATH INIT

S31152A

OPEN BITE OF ABD WALL EPIGST RGN W/O PENET PERIT CAV INIT

T81517A

ADHES DUE TO FB ACC LEFT IN BODY FOL REMOV CATH/PACK INIT

S31153A

OPEN BITE OF ABD WALL RIGHT LOW Q W/O PENET PERIT CAV INIT

T81518A

ADHES DUE TO FB ACC LEFT IN BODY FOL OTH PROCEDURE INIT

S31154A

OPEN BITE OF ABD WALL LEFT LOW Q W/O PENET PERIT CAV INIT

T81519A

ADHES DUE TO FB ACC LEFT IN BODY FOL UNSP PROCEDURE INIT

S31155A

OPEN BITE OF ABD WALL PERIUMB RGN W/O PENET PERIT CAV INIT

T81520A

OBST DUE TO FB ACC LEFT IN BODY FOL SURGICAL OPERATION INIT

S31159A OPEN BITE OF ABD WALL UNSP Q W/O PENET PERIT CAV INIT

T81521A

OBST DUE TO FB ACC LEFT IN BODY FOL INFUSN/TRANSFUSN INIT

S3120XA UNSPECIFIED OPEN WOUND OF PENIS INITIAL ENCOUNTER

T81522A

OBST DUE TO FB ACC LEFT IN BODY FOL KIDNEY DIALYSIS INIT

S3121XA

LACERATION WITHOUT FOREIGN BODY OF PENIS INITIAL ENCOUNTER

T81523A

OBST DUE TO FB ACC LEFT IN BODY FOL INJECT OR IMMUNIZ INIT

S3122XA

LACERATION WITH FOREIGN BODY OF PENIS INITIAL ENCOUNTER

T81524A

OBST DUE TO FB ACC LEFT IN BODY FOLLOWING ENDO EXAM INIT

S3123XA

PUNCTURE WOUND WITHOUT FOREIGN BODY OF PENIS INIT ENCNTR

T81525A

OBST DUE TO FB ACC LEFT IN BODY FOLLOWING HEART CATH INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S3124XA

PUNCTURE WOUND WITH FOREIGN BODY OF PENIS INITIAL ENCOUNTER

T81526A

OBST DUE TO FB ACC LEFT IN BODY FOLLOWING PUNCTR/CATH INIT

S3125XA OPEN BITE OF PENIS INITIAL ENCOUNTER

T81527A

OBST DUE TO FB ACC LEFT IN BODY FOL REMOV CATH/PACK INIT

S3130XA

UNSPECIFIED OPEN WOUND OF SCROTUM AND TESTES INIT ENCNTR

T81528A

OBST DUE TO FB ACC LEFT IN BODY FOL OTH PROCEDURE INIT

S3131XA

LACERATION W/O FOREIGN BODY OF SCROTUM AND TESTES INIT

T81529A

OBST DUE TO FB ACC LEFT IN BODY FOL UNSP PROCEDURE INIT

S3132XA

LACERATION W FOREIGN BODY OF SCROTUM AND TESTES INIT ENCNTR

T81530A

PERF DUE TO FB ACC LEFT IN BODY FOL SURGICAL OPERATION INIT

S3133XA

PUNCTURE WOUND W/O FOREIGN BODY OF SCROTUM AND TESTES INIT

T81531A

PERF DUE TO FB ACC LEFT IN BODY FOL INFUSN/TRANSFUSN INIT

S3134XA

PUNCTURE WOUND W FOREIGN BODY OF SCROTUM AND TESTES INIT

T81532A

PERF DUE TO FB ACC LEFT IN BODY FOL KIDNEY DIALYSIS INIT

S3135XA OPEN BITE OF SCROTUM AND TESTES INITIAL ENCOUNTER

T81533A

PERF DUE TO FB ACC LEFT IN BODY FOL INJECT OR IMMUNIZ INIT

S3140XA

UNSPECIFIED OPEN WOUND OF VAGINA AND VULVA INIT ENCNTR

T81534A

PERF DUE TO FB ACC LEFT IN BODY FOLLOWING ENDO EXAM INIT

S3141XA

LACERATION W/O FOREIGN BODY OF VAGINA AND VULVA INIT ENCNTR

T81535A

PERF DUE TO FB ACC LEFT IN BODY FOLLOWING HEART CATH INIT

S3142XA

LACERATION W FOREIGN BODY OF VAGINA AND VULVA INIT ENCNTR

T81536A

PERF DUE TO FB ACC LEFT IN BODY FOLLOWING PUNCTR/CATH INIT

S3143XA

PUNCTURE WOUND W/O FOREIGN BODY OF VAGINA AND VULVA INIT

T81537A

PERF DUE TO FB ACC LEFT IN BODY FOL REMOV CATH/PACK INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S3144XA

PUNCTURE WOUND W FOREIGN BODY OF VAGINA AND VULVA INIT

T81538A

PERF DUE TO FB ACC LEFT IN BODY FOL OTH PROCEDURE INIT

S3145XA OPEN BITE OF VAGINA AND VULVA INITIAL ENCOUNTER

T81539A

PERF DUE TO FB ACC LEFT IN BODY FOL UNSP PROCEDURE INIT

S31501A

UNSP OPEN WOUND OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

T81590A

OTH COMP OF FB ACC LEFT IN BODY FOL SURGICAL OPERATION INIT

S31502A

UNSP OPN WND UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T81591A

OTH COMP OF FB ACC LEFT IN BODY FOL INFUSN/TRANSFUSN INIT

S31511A

LAC W/O FB OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

T81592A

OTH COMP OF FB ACC LEFT IN BODY FOL KIDNEY DIALYSIS INIT

S31512A

LAC W/O FB OF UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T81593A

OTH COMP OF FB ACC LEFT IN BODY FOL INJECT OR IMMUNIZ INIT

S31521A

LACERATION W FB OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

T81594A

OTH COMP OF FB ACC LEFT IN BODY FOLLOWING ENDO EXAM INIT

S31522A LAC W FB OF UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T81595A

OTH COMP OF FB ACC LEFT IN BODY FOLLOWING HEART CATH INIT

S31531A

PNCTR W/O FB OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

T81596A

OTH COMP OF FB ACC LEFT IN BODY FOLLOWING PUNCTR/CATH INIT

S31532A

PNCTR W/O FB OF UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T81597A

OTH COMP OF FB ACC LEFT IN BODY FOL REMOV CATH/PACK INIT

S31541A

PNCTR W FB OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

T81598A

OTH COMP OF FB ACC LEFT IN BODY FOL OTH PROCEDURE INIT

S31542A

PNCTR W FB OF UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T81599A

OTH COMP OF FB ACC LEFT IN BODY FOL UNSP PROCEDURE INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31551A

OPEN BITE OF UNSP EXTERNAL GENITAL ORGANS MALE INIT ENCNTR

T8160XA

UNSP ACUTE REACTION TO FOREIGN SUB ACC LEFT DUR PROC INIT

S31552A OPEN BITE OF UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T8161XA

ASEPTIC PERITONITIS DUE TO FORN SUB ACC LEFT DUR PROC INIT

S31600A

UNSP OPN WND ABD WALL RIGHT UPPER Q W PENET PERIT CAV INIT

T8169XA

OTH ACUTE REACTION TO FOREIGN SUB ACC LEFT DUR PROC INIT

S31601A

UNSP OPEN WOUND OF ABD WALL L UPR Q W PENET PERIT CAV INIT

T81710A

COMPLICATION OF MESENT ART FOLLOWING A PROCEDURE NEC INIT

S31602A

UNSP OPN WND ABD WALL EPIGST RGN W PENET PERIT CAV INIT

T81711A

COMP OF RENAL ARTERY FOLLOWING A PROCEDURE NEC INIT

S31603A

UNSP OPN WND ABD WALL RIGHT LOWER Q W PENET PERIT CAV INIT

T81718A

COMPLICATION OF ARTERY FOLLOWING A PROCEDURE NEC INIT

S31604A

UNSP OPN WND ABD WALL LEFT LOWER Q W PENET PERIT CAV INIT

T81719A

COMPLICATION OF UNSP ARTERY FOLLOWING A PROCEDURE NEC INIT

S31605A

UNSP OPN WND ABD WALL PERIUMB RGN W PENET PERIT CAV INIT

T8172XA

COMPLICATION OF VEIN FOLLOWING A PROCEDURE NEC INIT

S31609A

UNSP OPN WND ABD WALL UNSP QUADRANT W PENET PERIT CAV INIT

T8181XA

COMPLICATION OF INHALATION THERAPY INITIAL ENCOUNTER

S31610A

LAC W/O FB OF ABD WALL R UPPER Q W PENET PERIT CAV INIT

T8182XA

EMPHYSEMA (SUBCUTANEOUS) RESULTING FROM A PROCEDURE INIT

S31611A LAC W/O FB OF ABD WALL L UPR Q W PENET PERIT CAV INIT

T8201XA

BREAKDOWN (MECHANICAL) OF HEART VALVE PROSTHESIS INIT

S31612A

LAC W/O FB OF ABD WALL EPIGST RGN W PENET PERIT CAV INIT

T8202XA

DISPLACEMENT OF HEART VALVE PROSTHESIS INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31613A

LAC W/O FB OF ABD WALL RIGHT LOW Q W PENET PERIT CAV INIT

T8203XA

LEAKAGE OF HEART VALVE PROSTHESIS INITIAL ENCOUNTER

S31614A

LAC W/O FB OF ABD WALL LEFT LOWER Q W PENET PERIT CAV INIT

T8209XA

MECH COMPL OF HEART VALVE PROSTHESIS INITIAL ENCOUNTER

S31615A

LAC W/O FB OF ABD WALL PERIUMB RGN W PENET PERIT CAV INIT

T82110A

BREAKDOWN (MECHANICAL) OF CARDIAC ELECTRODE INIT ENCNTR

S31619A

LAC W/O FB OF ABD WALL UNSP Q W PENET PERIT CAV INIT

T82111A

BREAKDOWN OF CARDIAC PULSE GENERATOR (BATTERY) INIT

S31620A

LAC W FB OF ABD WALL RIGHT UPPER Q W PENET PERIT CAV INIT

T82118A

BREAKDOWN (MECHANICAL) OF CARDIAC ELECTRONIC DEVICE INIT

S31621A

LACERATION W FB OF ABD WALL L UPR Q W PENET PERIT CAV INIT

T82119A

BREAKDOWN OF UNSP CARDIAC ELECTRONIC DEVICE INIT

S31622A LAC W FB OF ABD WALL EPIGST RGN W PENET PERIT CAV INIT

T82120A

DISPLACEMENT OF CARDIAC ELECTRODE INITIAL ENCOUNTER

S31623A

LAC W FB OF ABD WALL RIGHT LOWER Q W PENET PERIT CAV INIT

T82121A

DISPLACEMENT OF CARDIAC PULSE GENERATOR (BATTERY) INIT

S31624A

LAC W FB OF ABD WALL LEFT LOWER Q W PENET PERIT CAV INIT

T82128A

DISPLACEMENT OF OTHER CARDIAC ELECTRONIC DEVICE INIT ENCNTR

S31625A

LAC W FB OF ABD WALL PERIUMB RGN W PENET PERIT CAV INIT

T82129A

DISPLACEMENT OF UNSP CARDIAC ELECTRONIC DEVICE INIT ENCNTR

S31629A

LAC W FB OF ABD WALL UNSP QUADRANT W PENET PERIT CAV INIT

T82190A

MECH COMPL OF CARDIAC ELECTRODE INITIAL ENCOUNTER

S31630A

PNCTR W/O FB OF ABD WALL R UPPER Q W PENET PERIT CAV INIT

T82191A

MECH COMPL OF CARDIAC PULSE GENERATOR (BATTERY) INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31631A PNCTR W/O FB OF ABD WALL L UPR Q W PENET PERIT CAV INIT

T82198A

MECH COMPL OF OTHER CARDIAC ELECTRONIC DEVICE INIT ENCNTR

S31632A

PNCTR W/O FB OF ABD WALL EPIGST RGN W PENET PERIT CAV INIT

T82199A

MECH COMPL OF UNSPECIFIED CARDIAC DEVICE INITIAL ENCOUNTER

S31633A PNCTR W/O FB OF ABD WALL R LOW Q W PENET PERIT CAV INIT

T82211A

BREAKDOWN (MECHANICAL) OF CORONARY ARTERY BYPASS GRAFT INIT

S31634A

PNCTR W/O FB OF ABD WALL LEFT LOW Q W PENET PERIT CAV INIT

T82212A

DISPLACEMENT OF CORONARY ARTERY BYPASS GRAFT INIT ENCNTR

S31635A

PNCTR W/O FB OF ABD WL PERIUMB RGN W PENET PERIT CAV INIT

T82213A

LEAKAGE OF CORONARY ARTERY BYPASS GRAFT INITIAL ENCOUNTER

S31639A

PNCTR W/O FB OF ABD WALL UNSP Q W PENET PERIT CAV INIT

T82218A

MECH COMPL OF CORONARY ARTERY BYPASS GRAFT INIT ENCNTR

S31640A

PNCTR W FB OF ABD WALL R UPPER Q W PENET PERIT CAV INIT

T82221A

BREAKDOWN (MECHANICAL) OF BIOLOGICAL HEART VALVE GRAFT INIT

S31641A PNCTR W FB OF ABD WALL L UPR Q W PENET PERIT CAV INIT

T82222A

DISPLACEMENT OF BIOLOGICAL HEART VALVE GRAFT INIT ENCNTR

S31642A

PNCTR W FB OF ABD WALL EPIGST RGN W PENET PERIT CAV INIT

T82223A

LEAKAGE OF BIOLOGICAL HEART VALVE GRAFT INITIAL ENCOUNTER

S31643A

PNCTR W FB OF ABD WALL RIGHT LOW Q W PENET PERIT CAV INIT

T82228A

MECH COMPL OF BIOLOGICAL HEART VALVE GRAFT INIT ENCNTR

S31644A

PNCTR W FB OF ABD WALL LEFT LOWER Q W PENET PERIT CAV INIT

T82310A

BREAKDOWN (MECHANICAL) OF AORTIC (BIFURCATION) GRAFT INIT

S31645A

PNCTR W FB OF ABD WALL PERIUMB RGN W PENET PERIT CAV INIT

T82311A

BREAKDOWN OF CAROTID ARTERIAL GRAFT (BYPASS) INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31649A

PNCTR W FB OF ABD WALL UNSP Q W PENET PERIT CAV INIT

T82312A

BREAKDOWN OF FEMORAL ARTERIAL GRAFT (BYPASS) INIT

S31650A

OPEN BITE OF ABD WALL RIGHT UPPER Q W PENET PERIT CAV INIT

T82318A

BREAKDOWN (MECHANICAL) OF OTHER VASCULAR GRAFTS INIT ENCNTR

S31651A

OPEN BITE OF ABDOMINAL WALL L UPR Q W PENET PERIT CAV INIT

T82319A

BREAKDOWN (MECHANICAL) OF UNSP VASCULAR GRAFTS INIT ENCNTR

S31652A

OPEN BITE OF ABD WALL EPIGST RGN W PENET PERIT CAV INIT

T82320A

DISPLACEMENT OF AORTIC (BIFURCATION) GRAFT INIT

S31653A

OPEN BITE OF ABD WALL RIGHT LOWER Q W PENET PERIT CAV INIT

T82321A

DISPLACEMENT OF CAROTID ARTERIAL GRAFT (BYPASS) INIT ENCNTR

S31654A

OPEN BITE OF ABD WALL LEFT LOWER Q W PENET PERIT CAV INIT

T82322A

DISPLACEMENT OF FEMORAL ARTERIAL GRAFT (BYPASS) INIT ENCNTR

S31655A

OPEN BITE OF ABD WALL PERIUMB RGN W PENET PERIT CAV INIT

T82328A

DISPLACEMENT OF OTHER VASCULAR GRAFTS INITIAL ENCOUNTER

S31659A

OPEN BITE OF ABD WALL UNSP QUADRANT W PENET PERIT CAV INIT

T82329A

DISPLACEMENT OF UNSPECIFIED VASCULAR GRAFTS INIT ENCNTR

S31801A

LACERATION WITHOUT FOREIGN BODY OF UNSP BUTTOCK INIT ENCNTR

T82330A

LEAKAGE OF AORTIC (BIFURCATION) GRAFT (REPLACEMENT) INIT

S31802A

LACERATION WITH FOREIGN BODY OF UNSP BUTTOCK INIT ENCNTR

T82331A

LEAKAGE OF CAROTID ARTERIAL GRAFT (BYPASS) INIT ENCNTR

S31803A

PUNCTURE WOUND W/O FOREIGN BODY OF UNSP BUTTOCK INIT ENCNTR

T82332A

LEAKAGE OF FEMORAL ARTERIAL GRAFT (BYPASS) INIT ENCNTR

S31804A

PUNCTURE WOUND W FOREIGN BODY OF UNSP BUTTOCK INIT ENCNTR

T82338A

LEAKAGE OF OTHER VASCULAR GRAFTS INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31805A OPEN BITE OF UNSPECIFIED BUTTOCK INITIAL ENCOUNTER

T82339A

LEAKAGE OF UNSPECIFIED VASCULAR GRAFT INITIAL ENCOUNTER

S31809A

UNSPECIFIED OPEN WOUND OF UNSPECIFIED BUTTOCK INIT ENCNTR

T82390A

MECH COMPL OF AORTIC (BIFURCATION) GRAFT (REPLACEMENT) INIT

S31811A

LACERATION W/O FOREIGN BODY OF RIGHT BUTTOCK INIT ENCNTR

T82391A

MECH COMPL OF CAROTID ARTERIAL GRAFT (BYPASS) INIT ENCNTR

S31812A

LACERATION WITH FOREIGN BODY OF RIGHT BUTTOCK INIT ENCNTR

T82392A

MECH COMPL OF FEMORAL ARTERIAL GRAFT (BYPASS) INIT ENCNTR

S31813A

PUNCTURE WOUND W/O FOREIGN BODY OF RIGHT BUTTOCK INIT

T82398A

MECH COMPL OF OTHER VASCULAR GRAFTS INITIAL ENCOUNTER

S31814A

PUNCTURE WOUND W FOREIGN BODY OF RIGHT BUTTOCK INIT ENCNTR

T82399A

MECH COMPL OF UNSPECIFIED VASCULAR GRAFTS INITIAL ENCOUNTER

S31815A OPEN BITE OF RIGHT BUTTOCK INITIAL ENCOUNTER

T8241XA

BREAKDOWN (MECHANICAL) OF VASCULAR DIALYSIS CATHETER INIT

S31819A

UNSPECIFIED OPEN WOUND OF RIGHT BUTTOCK INITIAL ENCOUNTER

T8242XA

DISPLACEMENT OF VASCULAR DIALYSIS CATHETER INIT ENCNTR

S31821A

LACERATION WITHOUT FOREIGN BODY OF LEFT BUTTOCK INIT ENCNTR

T8243XA

LEAKAGE OF VASCULAR DIALYSIS CATHETER INITIAL ENCOUNTER

S31822A

LACERATION WITH FOREIGN BODY OF LEFT BUTTOCK INIT ENCNTR

T8249XA

OTH COMPLICATION OF VASCULAR DIALYSIS CATHETER INIT ENCNTR

S31823A

PUNCTURE WOUND W/O FOREIGN BODY OF LEFT BUTTOCK INIT ENCNTR

T82510A

BREAKDOWN OF SURGICALLY CREATED AV FISTULA INIT

S31824A

PUNCTURE WOUND W FOREIGN BODY OF LEFT BUTTOCK INIT ENCNTR

T82511A

BREAKDOWN (MECHANICAL) OF SURGICALLY CREATED AV SHUNT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31825A OPEN BITE OF LEFT BUTTOCK INITIAL ENCOUNTER

T82512A

BREAKDOWN (MECHANICAL) OF ARTIFICIAL HEART INIT ENCNTR

S31829A

UNSPECIFIED OPEN WOUND OF LEFT BUTTOCK INITIAL ENCOUNTER

T82513A

BREAKDOWN OF BALLOON (COUNTERPULSATION) DEVICE INIT

S31831A

LACERATION WITHOUT FOREIGN BODY OF ANUS INITIAL ENCOUNTER

T82514A

BREAKDOWN (MECHANICAL) OF INFUSION CATHETER INIT ENCNTR

S31832A

LACERATION WITH FOREIGN BODY OF ANUS INITIAL ENCOUNTER

T82515A

BREAKDOWN (MECHANICAL) OF UMBRELLA DEVICE INITIAL ENCOUNTER

S31833A

PUNCTURE WOUND WITHOUT FOREIGN BODY OF ANUS INIT ENCNTR

T82518A

BREAKDOWN OF CARDIAC AND VASCULAR DEVICES AND IMPLANTS INIT

S31834A

PUNCTURE WOUND WITH FOREIGN BODY OF ANUS INITIAL ENCOUNTER

T82519A

BRKDWN UNSP CARDIAC AND VASCULAR DEVICES AND IMPLANTS INIT

S31835A OPEN BITE OF ANUS INITIAL ENCOUNTER

T82520A

DISPLACEMENT OF SURGICALLY CREATED AV FISTULA INIT

S31839A UNSPECIFIED OPEN WOUND OF ANUS INITIAL ENCOUNTER

T82521A

DISPLACEMENT OF SURGICALLY CREATED ARTERIOVENOUS SHUNT INIT

S32000A

WEDGE COMPRESSION FRACTURE OF UNSP LUMBAR VERTEBRA INIT

T82522A

DISPLACEMENT OF ARTIFICIAL HEART INITIAL ENCOUNTER

S32000B

WEDGE COMPRSN FRACTURE OF UNSP LUM VERTEBRA INIT FOR OPN FX

T82523A

DISPLACEMENT OF BALLOON (COUNTERPULSATION) DEVICE INIT

S32001A STABLE BURST FRACTURE OF UNSP LUMBAR VERTEBRA INIT

T82524A

DISPLACEMENT OF INFUSION CATHETER INITIAL ENCOUNTER

S32001B

STABLE BURST FRACTURE OF UNSP LUM VERTEBRA INIT FOR OPN FX

T82525A

DISPLACEMENT OF UMBRELLA DEVICE INITIAL ENCOUNTER

S32002A UNSTABLE BURST FRACTURE OF UNSP LUMBAR VERTEBRA INIT

T82528A

DISPLACMNT OF CARDIAC AND VASCULAR DEVICES AND IMPLNT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32002B UNSTABLE BURST FX UNSP LUM VERTEBRA INIT FOR OPN FX

T82529A

DISPLACMNT OF UNSP CARDIAC AND VASC DEVICES AND IMPLNT INIT

S32008A

OTH FRACTURE OF UNSP LUMBAR VERTEBRA INIT FOR CLOS FX

T82530A

LEAKAGE OF SURGICALLY CREATED ARTERIOVENOUS FISTULA INIT

S32008B

OTH FRACTURE OF UNSP LUMBAR VERTEBRA INIT FOR OPN FX

T82531A

LEAKAGE OF SURGICALLY CREATED ARTERIOVENOUS SHUNT INIT

S32009A

UNSP FRACTURE OF UNSP LUMBAR VERTEBRA INIT FOR CLOS FX

T82532A

LEAKAGE OF ARTIFICIAL HEART INITIAL ENCOUNTER

S32009B

UNSP FRACTURE OF UNSP LUMBAR VERTEBRA INIT FOR OPN FX

T82533A

LEAKAGE OF BALLOON (COUNTERPULSATION) DEVICE INIT ENCNTR

S32010A

WEDGE COMPRESSION FRACTURE OF FIRST LUMBAR VERTEBRA INIT

T82534A

LEAKAGE OF INFUSION CATHETER INITIAL ENCOUNTER

S32010B

WEDGE COMPRSN FX FIRST LUM VERTEBRA INIT FOR OPN FX

T82535A

LEAKAGE OF UMBRELLA DEVICE INITIAL ENCOUNTER

S32011A STABLE BURST FRACTURE OF FIRST LUMBAR VERTEBRA INIT

T82538A

LEAKAGE OF CARDIAC AND VASCULAR DEVICES AND IMPLANTS INIT

S32011B

STABLE BURST FRACTURE OF FIRST LUM VERTEBRA INIT FOR OPN FX

T82539A

LEAKAGE OF UNSP CARDIAC AND VASC DEVICES AND IMPLNT INIT

S32012A UNSTABLE BURST FRACTURE OF FIRST LUMBAR VERTEBRA INIT

T82590A

MECH COMPL OF SURGICALLY CREATED ARTERIOVENOUS FISTULA INIT

S32012B UNSTABLE BURST FX FIRST LUM VERTEBRA INIT FOR OPN FX

T82591A

MECH COMPL OF SURGICALLY CREATED ARTERIOVENOUS SHUNT INIT

S32018A

OTH FRACTURE OF FIRST LUMBAR VERTEBRA INIT FOR CLOS FX

T82592A

MECH COMPL OF ARTIFICIAL HEART INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32018B

OTH FRACTURE OF FIRST LUMBAR VERTEBRA INIT FOR OPN FX

T82593A

MECH COMPL OF BALLOON (COUNTERPULSATION) DEVICE INIT ENCNTR

S32019A

UNSP FRACTURE OF FIRST LUMBAR VERTEBRA INIT FOR CLOS FX

T82594A

MECH COMPL OF INFUSION CATHETER INITIAL ENCOUNTER

S32019B

UNSP FRACTURE OF FIRST LUMBAR VERTEBRA INIT FOR OPN FX

T82595A

MECH COMPL OF UMBRELLA DEVICE INITIAL ENCOUNTER

S32020A

WEDGE COMPRESSION FRACTURE OF SECOND LUMBAR VERTEBRA INIT

T82598A

MECH COMPL OF CARDIAC AND VASCULAR DEVICES AND IMPLNT INIT

S32020B

WEDGE COMPRSN FX SECOND LUM VERTEBRA INIT FOR OPN FX

T82599A

MECH COMPL OF UNSP CARDIAC AND VASC DEVICES AND IMPLNT INIT

S32021A

STABLE BURST FRACTURE OF SECOND LUMBAR VERTEBRA INIT

T826XXA

INFECT/INFLM REACTION DUE TO CARDIAC VALVE PROSTHESIS INIT

S32021B STABLE BURST FX SECOND LUM VERTEBRA INIT FOR OPN FX

T827XXA

INFECT/INFLM REACT D/T OTH CARDI/VASC DEV/IMPLNT/GRFT INIT

S32022A

UNSTABLE BURST FRACTURE OF SECOND LUMBAR VERTEBRA INIT

T82817A

EMBOLISM OF CARDIAC PROSTH DEV/GRFT INIT

S32022B

UNSTABLE BURST FX SECOND LUM VERTEBRA INIT FOR OPN FX

T82818A

EMBOLISM OF VASCULAR PROSTH DEV/GRFT INIT

S32028A

OTH FRACTURE OF SECOND LUMBAR VERTEBRA INIT FOR CLOS FX

T82827A

FIBROSIS OF CARDIAC PROSTH DEV/GRFT INIT

S32028B

OTH FRACTURE OF SECOND LUMBAR VERTEBRA INIT FOR OPN FX

T82828A

FIBROSIS OF VASCULAR PROSTH DEV/GRFT INIT

S32029A

UNSP FRACTURE OF SECOND LUMBAR VERTEBRA INIT FOR CLOS FX

T82837A

HEMORRHAGE OF CARDIAC PROSTH DEV/GRFT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32029B

UNSP FRACTURE OF SECOND LUMBAR VERTEBRA INIT FOR OPN FX

T82838A

HEMORRHAGE OF VASCULAR PROSTH DEV/GRFT INIT

S32030A

WEDGE COMPRESSION FRACTURE OF THIRD LUMBAR VERTEBRA INIT

T82847A

PAIN FROM CARDIAC PROSTH DEV/GRFT INIT

S32030B

WEDGE COMPRSN FX THIRD LUM VERTEBRA INIT FOR OPN FX

T82848A

PAIN FROM VASCULAR PROSTH DEV/GRFT INIT

S32031A STABLE BURST FRACTURE OF THIRD LUMBAR VERTEBRA INIT

T82855A

Stenosis of coronary artery stent initial encounter

S32031B

STABLE BURST FRACTURE OF THIRD LUM VERTEBRA INIT FOR OPN FX

T82855D

Stenosis of coronary artery stent subsequent encounter

S32032A UNSTABLE BURST FRACTURE OF THIRD LUMBAR VERTEBRA INIT

T82855S

Stenosis of coronary artery stent sequela

S32032B

UNSTABLE BURST FX THIRD LUM VERTEBRA INIT FOR OPN FX

T82856A

Stenosis of peripheral vascular stent initial encounter

S32038A

OTH FRACTURE OF THIRD LUMBAR VERTEBRA INIT FOR CLOS FX

T82856D

Stenosis of peripheral vascular stent subsequent encounter

S32038B

OTH FRACTURE OF THIRD LUMBAR VERTEBRA INIT FOR OPN FX

T82856S

Stenosis of peripheral vascular stent sequela

S32039A

UNSP FRACTURE OF THIRD LUMBAR VERTEBRA INIT FOR CLOS FX

T82857A

STENOSIS OF CARDIAC PROSTH DEV/GRFT INIT

S32039B

UNSP FRACTURE OF THIRD LUMBAR VERTEBRA INIT FOR OPN FX

T82858A

STENOSIS OF VASCULAR PROSTH DEV/GRFT INIT

S32040A

WEDGE COMPRESSION FRACTURE OF FOURTH LUMBAR VERTEBRA INIT

T82867A

THROMBOSIS OF CARDIAC PROSTH DEV/GRFT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32040B

WEDGE COMPRSN FX FOURTH LUM VERTEBRA INIT FOR OPN FX

T82868A

THROMBOSIS OF VASCULAR PROSTH DEV/GRFT INIT

S32041A

STABLE BURST FRACTURE OF FOURTH LUMBAR VERTEBRA INIT

T82897A

OTH COMPLICATION OF CARDIAC PROSTH DEV/GRFT INIT

S32041B STABLE BURST FX FOURTH LUM VERTEBRA INIT FOR OPN FX

T82898A

OTH COMPLICATION OF VASCULAR PROSTH DEV/GRFT INIT

S32042A

UNSTABLE BURST FRACTURE OF FOURTH LUMBAR VERTEBRA INIT

T829XXA

UNSP COMP OF CARDIAC AND VASCULAR PROSTH DEV/GRFT INIT

S32042B

UNSTABLE BURST FX FOURTH LUM VERTEBRA INIT FOR OPN FX

T83011A

Breakdown (mechanical) of indwelling urethral catheter initial encounter

S32048A

OTH FRACTURE OF FOURTH LUMBAR VERTEBRA INIT FOR CLOS FX

T83012A

Breakdown (mechanical) of nephrostomy catheter initial encounter

S32048B

OTH FRACTURE OF FOURTH LUMBAR VERTEBRA INIT FOR OPN FX

T83012D

Breakdown (mechanical) of nephrostomy catheter subsequent encounter

S32049A

UNSP FRACTURE OF FOURTH LUMBAR VERTEBRA INIT FOR CLOS FX

T83021A

Displacement of indwelling urethral catheter initial encounter

S32049B

UNSP FRACTURE OF FOURTH LUMBAR VERTEBRA INIT FOR OPN FX

T83022A

Displacement of nephrostomy catheter initial encounter

S32050A

WEDGE COMPRESSION FRACTURE OF FIFTH LUMBAR VERTEBRA INIT

T83022D

Displacement of nephrostomy catheter subsequent encounter

S32050B

WEDGE COMPRSN FX FIFTH LUM VERTEBRA INIT FOR OPN FX

T83032A

Leakage of nephrostomy catheter initial encounter

S32051A STABLE BURST FRACTURE OF FIFTH LUMBAR VERTEBRA INIT

T83032D

Leakage of nephrostomy catheter subsequent encounter

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32051B

STABLE BURST FRACTURE OF FIFTH LUM VERTEBRA INIT FOR OPN FX

T83092A

Other mechanical complication of nephrostomy catheter initial encounter

S32052A UNSTABLE BURST FRACTURE OF FIFTH LUMBAR VERTEBRA INIT

T83092D

Other mechanical complication of nephrostomy catheter subsequent encounter

S32052B UNSTABLE BURST FX FIFTH LUM VERTEBRA INIT FOR OPN FX

T83111A

BREAKDOWN (MECHANICAL) OF URINARY SPHINCTER IMPLANT INIT

S32058A

OTH FRACTURE OF FIFTH LUMBAR VERTEBRA INIT FOR CLOS FX

T83112A

BREAKDOWN (MECHANICAL) OF URINARY STENT INITIAL ENCOUNTER

S32058B

OTH FRACTURE OF FIFTH LUMBAR VERTEBRA INIT FOR OPN FX

T83113A

Breakdown (mechanical) of other urinary stents initial encounter

S32059A

UNSP FRACTURE OF FIFTH LUMBAR VERTEBRA INIT FOR CLOS FX

T83113D

Breakdown (mechanical) of other urinary stents subsequent encounter

S32059B

UNSP FRACTURE OF FIFTH LUMBAR VERTEBRA INIT FOR OPN FX

T83118A

BREAKDOWN (MECHANICAL) OF URINARY DEVICES AND IMPLANTS INIT

S3210XA

UNSP FRACTURE OF SACRUM INIT ENCNTR FOR CLOSED FRACTURE

T83121A

DISPLACEMENT OF URINARY SPHINCTER IMPLANT INITIAL ENCOUNTER

S3210XB

UNSP FRACTURE OF SACRUM INIT ENCNTR FOR OPEN FRACTURE

T83122A

DISPLACEMENT OF URINARY STENT INITIAL ENCOUNTER

S32110A

NONDISPLACED ZONE I FRACTURE OF SACRUM INIT FOR CLOS FX

T83123A

Displacement of other urinary stents initial encounter

S32110B

NONDISPLACED ZONE I FRACTURE OF SACRUM INIT FOR OPN FX

T83123D

Displacement of other urinary stents subsequent encounter

S32111A MINIMALLY DISPLACED ZONE I FRACTURE OF SACRUM INIT

T83128A

DISPLACEMENT OF OTH URINARY DEVICES AND IMPLANTS INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32111B MINIMALLY DISPLACED ZONE I FX SACRUM INIT FOR OPN FX

T83191A

MECH COMPL OF URINARY SPHINCTER IMPLANT INITIAL ENCOUNTER

S32112A SEVERELY DISPLACED ZONE I FRACTURE OF SACRUM INIT

T83192A

MECH COMPL OF URINARY STENT INITIAL ENCOUNTER

S32112B SEVERELY DISPLACED ZONE I FX SACRUM INIT FOR OPN FX

T83193A

Other mechanical complication of other urinary stent initial encounter

S32119A UNSP ZONE I FRACTURE OF SACRUM INIT FOR CLOS FX

T83193D

Other mechanical complication of other urinary stent subsequent encounter

S32119B UNSP ZONE I FRACTURE OF SACRUM INIT FOR OPN FX

T83198A

MECH COMPL OF OTH URINARY DEVICES AND IMPLANTS INIT ENCNTR

S32120A

NONDISPLACED ZONE II FRACTURE OF SACRUM INIT FOR CLOS FX

T8321XA

BREAKDOWN (MECHANICAL) OF GRAFT OF URINARY ORGAN INIT

S32120B

NONDISPLACED ZONE II FRACTURE OF SACRUM INIT FOR OPN FX

T8322XA

DISPLACEMENT OF GRAFT OF URINARY ORGAN INITIAL ENCOUNTER

S32121A MINIMALLY DISPLACED ZONE II FRACTURE OF SACRUM INIT

T8323XA

LEAKAGE OF GRAFT OF URINARY ORGAN INITIAL ENCOUNTER

S32121B MINIMALLY DISPLACED ZONE II FX SACRUM INIT FOR OPN FX

T8324XA

Erosion of graft of urinary organ initial encounter

S32122A SEVERELY DISPLACED ZONE II FRACTURE OF SACRUM INIT

T8324XD

Erosion of graft of urinary organ subsequent encounter

S32122B SEVERELY DISPLACED ZONE II FX SACRUM INIT FOR OPN FX

T8325XA

Exposure of graft of urinary organ initial encounter

S32129A UNSP ZONE II FRACTURE OF SACRUM INIT FOR CLOS FX

T8325XD

Exposure of graft of urinary organ subsequent encounter

S32129B UNSP ZONE II FRACTURE OF SACRUM INIT FOR OPN FX

T8329XA

MECH COMPL OF GRAFT OF URINARY ORGAN INITIAL ENCOUNTER

S32130A

NONDISPLACED ZONE III FRACTURE OF SACRUM INIT FOR CLOS FX

T8331XA

BREAKDOWN (MECHANICAL) OF INTRAUTERINE CONTRACEP DEV INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32130B

NONDISPLACED ZONE III FRACTURE OF SACRUM INIT FOR OPN FX

T8332XA

DISPLACEMENT OF INTRAUTERINE CONTRACEPTIVE DEVICE INIT

S32131A MINIMALLY DISPLACED ZONE III FRACTURE OF SACRUM INIT

T8339XA

MECH COMPL OF INTRAUTERINE CONTRACEPTIVE DEVICE INIT ENCNTR

S32131B MINIMALLY DISPLACED ZONE III FX SACRUM INIT FOR OPN FX

T83411A

Breakdown (mechanical) of implanted testicular prosthesis initial encounter

S32132A SEVERELY DISPLACED ZONE III FRACTURE OF SACRUM INIT

T83411D

Breakdown (mechanical) of implanted testicular prosthesis subsequent encounter

S32132B SEVERELY DISPLACED ZONE III FX SACRUM INIT FOR OPN FX

T83421A

Displacement of implanted testicular prosthesis initial encounter

S32139A UNSP ZONE III FRACTURE OF SACRUM INIT FOR CLOS FX

T83491A

Other mechanical complication of implanted testicular prosthesis initial encounter

S32139B UNSP ZONE III FRACTURE OF SACRUM INIT FOR OPN FX

T83510A

Infection and inflammatory reaction due to cystostomy catheter initial encounter

S3214XA

TYPE 1 FRACTURE OF SACRUM INIT ENCNTR FOR CLOSED FRACTURE

T83511A

Infection and inflammatory reaction due to indwelling urethral catheter initial encounter

S3214XB

TYPE 1 FRACTURE OF SACRUM INIT ENCNTR FOR OPEN FRACTURE

T83512A

Infection and inflammatory reaction due to nephrostomy catheter initial encounter

S3215XA

TYPE 2 FRACTURE OF SACRUM INIT ENCNTR FOR CLOSED FRACTURE

T83518A

Infection and inflammatory reaction due to other urinary catheter initial encounter

S3215XB

TYPE 2 FRACTURE OF SACRUM INIT ENCNTR FOR OPEN FRACTURE

T83590A

Infection and inflammatory reaction due to implanted urinary neurostimulation device initial encounter

S3216XA

TYPE 3 FRACTURE OF SACRUM INIT ENCNTR FOR CLOSED FRACTURE

T83591A

Infection and inflammatory reaction due to implanted urinary sphincter initial encounter

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S3216XB

TYPE 3 FRACTURE OF SACRUM INIT ENCNTR FOR OPEN FRACTURE

T83592A

Infection and inflammatory reaction due to indwelling ureteral stent initial encounter

S3217XA

TYPE 4 FRACTURE OF SACRUM INIT ENCNTR FOR CLOSED FRACTURE

T83593A

Infection and inflammatory reaction due to other urinary stents initial encounter

S3217XB

TYPE 4 FRACTURE OF SACRUM INIT ENCNTR FOR OPEN FRACTURE

T83598A

Infection and inflammatory reaction due to other prosthetic device implant and graft in urinary system initial encounter

S3219XA

OTHER FRACTURE OF SACRUM INIT ENCNTR FOR CLOSED FRACTURE

T8359XA

INFECT/INFLM REACT D/T PROSTH DEV/GRFT IN URINRY SYS INIT

S3219XB

OTHER FRACTURE OF SACRUM INIT ENCNTR FOR OPEN FRACTURE

T8361XA

Infection and inflammatory reaction due to implanted penile prosthesis initial encounter

S322XXA

FRACTURE OF COCCYX INITIAL ENCOUNTER FOR CLOSED FRACTURE

T8362XA

Infection and inflammatory reaction due to implanted testicular prosthesis initial encounter

S322XXB

FRACTURE OF COCCYX INITIAL ENCOUNTER FOR OPEN FRACTURE

T8369XA

Infection and inflammatory reaction due to other prosthetic device implant and graft in genital tract initial encounter

S32301A UNSP FRACTURE OF RIGHT ILIUM INIT FOR CLOS FX

T836XXA

INFECT/INFLM REACT D/T PROSTH DEV/GRFT IN GENITL TRCT INIT

S32301B

UNSP FRACTURE OF RIGHT ILIUM INIT ENCNTR FOR OPEN FRACTURE

T83712A

Erosion of implanted urethral mesh to surrounding organ or tissue initial encounter

S32302A

UNSP FRACTURE OF LEFT ILIUM INIT ENCNTR FOR CLOSED FRACTURE

T83713A

Erosion of implanted urethral bulking agent to surrounding organ or tissue initial encounter

S32302B

UNSP FRACTURE OF LEFT ILIUM INIT ENCNTR FOR OPEN FRACTURE

T83714A

Erosion of implanted ureteral bulking agent to surrounding organ or tissue initial encounter

S32309A

UNSP FRACTURE OF UNSP ILIUM INIT ENCNTR FOR CLOSED FRACTURE

T83719A

Erosion of other prosthetic materials to surrounding organ or tissue initial encounter

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32309B

UNSP FRACTURE OF UNSP ILIUM INIT ENCNTR FOR OPEN FRACTURE

T83722A

Exposure of implanted urethral mesh into urethra initial encounter

S32311A

DISPLACED AVULSION FRACTURE OF RIGHT ILIUM INIT FOR CLOS FX

T83723A

Exposure of implanted urethral bulking agent into urethra initial encounter

S32311B

DISPLACED AVULSION FRACTURE OF RIGHT ILIUM INIT FOR OPN FX

T83724A

Exposure of implanted ureteral bulking agent into ureter initial encounter

S32312A

DISPLACED AVULSION FRACTURE OF LEFT ILIUM INIT FOR CLOS FX

T83729A

Exposure of other prosthetic materials into organ or tissue initial encounter

S32312B

DISPLACED AVULSION FRACTURE OF LEFT ILIUM INIT FOR OPN FX

T8379XA

Other specified complications due to other prosthetic materials initial encounter

S32313A

DISPLACED AVULSION FRACTURE OF UNSP ILIUM INIT FOR CLOS FX

T8381XA

EMBOLISM OF GENITOURINARY PROSTH DEV/GRFT INIT

S32313B

DISPLACED AVULSION FRACTURE OF UNSP ILIUM INIT FOR OPN FX

T8382XA

FIBROSIS OF GENITOURINARY PROSTH DEV/GRFT INIT

S32314A NONDISPLACED AVULSION FRACTURE OF RIGHT ILIUM INIT

T8383XA

HEMORRHAGE OF GENITOURINARY PROSTH DEV/GRFT INIT

S32314B

NONDISP AVULSION FRACTURE OF RIGHT ILIUM INIT FOR OPN FX

T8384XA

PAIN FROM GENITOURINARY PROSTH DEV/GRFT INIT

S32315A NONDISPLACED AVULSION FRACTURE OF LEFT ILIUM INIT

T8385XA

STENOSIS OF GENITOURINARY PROSTH DEV/GRFT INIT

S32315B NONDISP AVULSION FRACTURE OF LEFT ILIUM INIT FOR OPN FX

T8386XA

THROMBOSIS OF GENITOURINARY PROSTH DEV/GRFT INIT

S32316A NONDISPLACED AVULSION FRACTURE OF UNSP ILIUM INIT

T8389XA

OTH COMPLICATION OF GENITOURINARY PROSTH DEV/GRFT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32316B

NONDISP AVULSION FRACTURE OF UNSP ILIUM INIT FOR OPN FX

T839XXA

UNSP COMPLICATION OF GENITOURINARY PROSTH DEV/GRFT INIT

S32391A

OTH FRACTURE OF RIGHT ILIUM INIT ENCNTR FOR CLOSED FRACTURE

T84010A

BROKEN INTERNAL RIGHT HIP PROSTHESIS INITIAL ENCOUNTER

S32391B

OTHER FRACTURE OF RIGHT ILIUM INIT ENCNTR FOR OPEN FRACTURE

T84011A

BROKEN INTERNAL LEFT HIP PROSTHESIS INITIAL ENCOUNTER

S32392A

OTH FRACTURE OF LEFT ILIUM INIT ENCNTR FOR CLOSED FRACTURE

T84012A

BROKEN INTERNAL RIGHT KNEE PROSTHESIS INITIAL ENCOUNTER

S32392B

OTHER FRACTURE OF LEFT ILIUM INIT ENCNTR FOR OPEN FRACTURE

T84013A

BROKEN INTERNAL LEFT KNEE PROSTHESIS INITIAL ENCOUNTER

S32399A

OTH FRACTURE OF UNSP ILIUM INIT ENCNTR FOR CLOSED FRACTURE

T84018A

BROKEN INTERNAL JOINT PROSTHESIS OTHER SITE INIT ENCNTR

S32399B

OTHER FRACTURE OF UNSP ILIUM INIT ENCNTR FOR OPEN FRACTURE

T84019A

BROKEN INTERNAL JOINT PROSTHESIS UNSP SITE INIT ENCNTR

S32401A UNSP FRACTURE OF RIGHT ACETABULUM INIT FOR CLOS FX

T84020A

DISLOCATION OF INTERNAL RIGHT HIP PROSTHESIS INIT ENCNTR

S32401B UNSP FRACTURE OF RIGHT ACETABULUM INIT FOR OPN FX

T84021A

DISLOCATION OF INTERNAL LEFT HIP PROSTHESIS INIT ENCNTR

S32402A UNSP FRACTURE OF LEFT ACETABULUM INIT FOR CLOS FX

T84022A

INSTABILITY OF INTERNAL RIGHT KNEE PROSTHESIS INIT ENCNTR

S32402B UNSP FRACTURE OF LEFT ACETABULUM INIT FOR OPN FX

T84023A

INSTABILITY OF INTERNAL LEFT KNEE PROSTHESIS INIT ENCNTR

S32409A UNSP FRACTURE OF UNSP ACETABULUM INIT FOR CLOS FX

T84028A

DISLOCATION OF OTHER INTERNAL JOINT PROSTHESIS INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32409B UNSP FRACTURE OF UNSP ACETABULUM INIT FOR OPN FX

T84029A

DISLOCATION OF UNSP INTERNAL JOINT PROSTHESIS INIT ENCNTR

S32411A DISP FX OF ANTERIOR WALL OF RIGHT ACETABULUM INIT

T84030A

MECH LOOSENING OF INTERNAL RIGHT HIP PROSTHETIC JOINT INIT

S32411B DISP FX OF ANTERIOR WALL OF RIGHT ACETAB INIT FOR OPN FX

T84031A

MECH LOOSENING OF INTERNAL LEFT HIP PROSTHETIC JOINT INIT

S32412A DISP FX OF ANTERIOR WALL OF LEFT ACETABULUM INIT

T84032A

MECH LOOSENING OF INTERNAL RIGHT KNEE PROSTHETIC JOINT INIT

S32412B

DISP FX OF ANTERIOR WALL OF LEFT ACETABULUM INIT FOR OPN FX

T84033A

MECH LOOSENING OF INTERNAL LEFT KNEE PROSTHETIC JOINT INIT

S32413A DISP FX OF ANTERIOR WALL OF UNSP ACETABULUM INIT

T84038A

MECHANICAL LOOSENING OF OTH INTERNAL PROSTHETIC JOINT INIT

S32413B

DISP FX OF ANTERIOR WALL OF UNSP ACETABULUM INIT FOR OPN FX

T84039A

MECHANICAL LOOSENING OF UNSP INTERNAL PROSTHETIC JOINT INIT

S32414A

NONDISP FX OF ANTERIOR WALL OF RIGHT ACETABULUM INIT

T84040A

PERIPROSTH FRACTURE AROUND INTERNAL PROSTH R HIP JT INIT

S32414B

NONDISP FX OF ANTERIOR WALL OF RIGHT ACETAB INIT FOR OPN FX

T84041A

PERIPROSTH FRACTURE AROUND INTERNAL PROSTH L HIP JT INIT

S32415A

NONDISP FX OF ANTERIOR WALL OF LEFT ACETABULUM INIT

T84042A

PERIPROSTH FRACTURE AROUND INTERNAL PROSTH R KNEE JT INIT

S32415B

NONDISP FX OF ANTERIOR WALL OF LEFT ACETAB INIT FOR OPN FX

T84043A

PERIPROSTH FRACTURE AROUND INTERNAL PROSTH L KNEE JT INIT

S32416A

NONDISP FX OF ANTERIOR WALL OF UNSP ACETABULUM INIT

T84048A

PERIPROSTH FRACTURE AROUND OTH INTERNAL PROSTH JOINT INIT

S32416B

NONDISP FX OF ANTERIOR WALL OF UNSP ACETAB INIT FOR OPN FX

T84049A

PERIPROSTH FRACTURE AROUND UNSP INTERNAL PROSTH JOINT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32421A DISP FX OF POSTERIOR WALL OF RIGHT ACETABULUM INIT

T84050A

PERIPROSTH OSTEOLYSIS OF INTERNAL PROSTHETIC R HIP JT INIT

S32421B DISP FX OF POSTERIOR WALL OF RIGHT ACETAB INIT FOR OPN FX

T84051A

PERIPROSTH OSTEOLYSIS OF INTERNAL PROSTHETIC L HIP JT INIT

S32422A DISP FX OF POSTERIOR WALL OF LEFT ACETABULUM INIT

T84052A

PERIPROSTH OSTEOLYSIS OF INTERNAL PROSTHETIC R KNEE JT INIT

S32422B DISP FX OF POSTERIOR WALL OF LEFT ACETAB INIT FOR OPN FX

T84053A

PERIPROSTH OSTEOLYSIS OF INTERNAL PROSTHETIC L KNEE JT INIT

S32423A DISP FX OF POSTERIOR WALL OF UNSP ACETABULUM INIT

T84058A

PERIPROSTHETIC OSTEOLYSIS OF INTERNAL PROSTHETIC JOINT INIT

S32423B DISP FX OF POSTERIOR WALL OF UNSP ACETAB INIT FOR OPN FX

T84059A

PERIPROSTH OSTEOLYS OF UNSP INTERNAL PROSTHETIC JOINT INIT

S32424A

NONDISP FX OF POSTERIOR WALL OF RIGHT ACETABULUM INIT

T84060A

WEAR OF ARTIC BEARING SURFACE OF INT PROSTH R HIP JT INIT

S32424B NONDISP FX OF POST WALL OF RIGHT ACETAB INIT FOR OPN FX

T84061A

WEAR OF ARTIC BEARING SURFACE OF INT PROSTH L HIP JT INIT

S32425A

NONDISP FX OF POSTERIOR WALL OF LEFT ACETABULUM INIT

T84062A

WEAR OF ARTIC BEARING SURFACE OF INT PROSTH R KNEE JT INIT

S32425B

NONDISP FX OF POSTERIOR WALL OF LEFT ACETAB INIT FOR OPN FX

T84063A

WEAR OF ARTIC BEARING SURFACE OF INT PROSTH L KNEE JT INIT

S32426A

NONDISP FX OF POSTERIOR WALL OF UNSP ACETABULUM INIT

T84068A

WEAR OF ARTIC BEARING SURFACE OF INTERNAL PROSTH JOINT INIT

S32426B

NONDISP FX OF POSTERIOR WALL OF UNSP ACETAB INIT FOR OPN FX

T84069A

WEAR OF ARTIC BEARING SURFACE OF UNSP INT PROSTH JOINT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32431A DISP FX OF ANTERIOR COLUMN OF RIGHT ACETABULUM INIT

T84090A

MECH COMPL OF INTERNAL RIGHT HIP PROSTHESIS INIT ENCNTR

S32431B

DISP FX OF ANTERIOR COLUMN OF RIGHT ACETAB INIT FOR OPN FX

T84091A

MECH COMPL OF INTERNAL LEFT HIP PROSTHESIS INIT ENCNTR

S32432A DISP FX OF ANTERIOR COLUMN OF LEFT ACETABULUM INIT

T84092A

MECH COMPL OF INTERNAL RIGHT KNEE PROSTHESIS INIT ENCNTR

S32432B

DISP FX OF ANTERIOR COLUMN OF LEFT ACETAB INIT FOR OPN FX

T84093A

MECH COMPL OF INTERNAL LEFT KNEE PROSTHESIS INIT ENCNTR

S32433A DISP FX OF ANTERIOR COLUMN OF UNSP ACETABULUM INIT

T84098A

MECH COMPL OF OTHER INTERNAL JOINT PROSTHESIS INIT ENCNTR

S32433B

DISP FX OF ANTERIOR COLUMN OF UNSP ACETAB INIT FOR OPN FX

T84099A

MECH COMPL OF UNSP INTERNAL JOINT PROSTHESIS INIT ENCNTR

S32434A

NONDISP FX OF ANTERIOR COLUMN OF RIGHT ACETABULUM INIT

T84110A

BREAKDOWN (MECHANICAL) OF INT FIX OF RIGHT HUMERUS INIT

S32434B

NONDISP FX OF ANT COLUMN OF RIGHT ACETAB INIT FOR OPN FX

T84111A

BREAKDOWN (MECHANICAL) OF INT FIX OF LEFT HUMERUS INIT

S32435A

NONDISP FX OF ANTERIOR COLUMN OF LEFT ACETABULUM INIT

T84112A

BREAKDOWN (MECHANICAL) OF INT FIX OF BONE OF R FOREARM INIT

S32435B

NONDISP FX OF ANT COLUMN OF LEFT ACETAB INIT FOR OPN FX

T84113A

BREAKDOWN OF INT FIX OF BONE OF LEFT FOREARM INIT

S32436A

NONDISP FX OF ANTERIOR COLUMN OF UNSP ACETABULUM INIT

T84114A

BREAKDOWN (MECHANICAL) OF INT FIX OF RIGHT FEMUR INIT

S32436B

NONDISP FX OF ANT COLUMN OF UNSP ACETAB INIT FOR OPN FX

T84115A

BREAKDOWN (MECHANICAL) OF INT FIX OF LEFT FEMUR INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32441A

DISP FX OF POSTERIOR COLUMN OF RIGHT ACETABULUM INIT

T84116A

BREAKDOWN (MECHANICAL) OF INT FIX OF BONE OF R LOW LEG INIT

S32441B

DISP FX OF POSTERIOR COLUMN OF RIGHT ACETAB INIT FOR OPN FX

T84117A

BREAKDOWN (MECHANICAL) OF INT FIX OF BONE OF L LOW LEG INIT

S32442A

DISP FX OF POSTERIOR COLUMN OF LEFT ACETABULUM INIT

T84119A

BREAKDOWN (MECHANICAL) OF INT FIX OF UNSP BONE OF LIMB INIT

S32442B

DISP FX OF POSTERIOR COLUMN OF LEFT ACETAB INIT FOR OPN FX

T84120A

DISPLACEMENT OF INT FIX OF RIGHT HUMERUS INIT

S32443A

DISP FX OF POSTERIOR COLUMN OF UNSP ACETABULUM INIT

T84121A

DISPLACEMENT OF INT FIX OF LEFT HUMERUS INIT

S32443B

DISP FX OF POSTERIOR COLUMN OF UNSP ACETAB INIT FOR OPN FX

T84122A

DISPLACEMENT OF INT FIX OF BONE OF RIGHT FOREARM INIT

S32444A

NONDISP FX OF POSTERIOR COLUMN OF RIGHT ACETABULUM INIT

T84123A

DISPLACEMENT OF INT FIX OF BONE OF LEFT FOREARM INIT

S32444B

NONDISP FX OF POST COLUMN OF RIGHT ACETAB INIT FOR OPN FX

T84124A

DISPLACEMENT OF INT FIX OF RIGHT FEMUR INIT

S32445A

NONDISP FX OF POSTERIOR COLUMN OF LEFT ACETABULUM INIT

T84125A

DISPLACEMENT OF INTERNAL FIXATION DEVICE OF LEFT FEMUR INIT

S32445B

NONDISP FX OF POST COLUMN OF LEFT ACETAB INIT FOR OPN FX

T84126A

DISPLACEMENT OF INT FIX OF BONE OF RIGHT LOWER LEG INIT

S32446A

NONDISP FX OF POSTERIOR COLUMN OF UNSP ACETABULUM INIT

T84127A

DISPLACEMENT OF INT FIX OF BONE OF LEFT LOWER LEG INIT

S32446B

NONDISP FX OF POST COLUMN OF UNSP ACETAB INIT FOR OPN FX

T84129A

DISPLACEMENT OF INT FIX OF UNSP BONE OF LIMB INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32451A

DISPLACED TRANSVERSE FRACTURE OF RIGHT ACETABULUM INIT

T84190A

MECH COMPL OF INT FIX OF RIGHT HUMERUS INIT

S32451B

DISPLACED TRANSVERSE FX RIGHT ACETABULUM INIT FOR OPN FX

T84191A

MECH COMPL OF INTERNAL FIXATION DEVICE OF LEFT HUMERUS INIT

S32452A

DISPLACED TRANSVERSE FRACTURE OF LEFT ACETABULUM INIT

T84192A

MECH COMPL OF INT FIX OF BONE OF RIGHT FOREARM INIT

S32452B

DISPLACED TRANSVERSE FX LEFT ACETABULUM INIT FOR OPN FX

T84193A

MECH COMPL OF INT FIX OF BONE OF LEFT FOREARM INIT

S32453A

DISPLACED TRANSVERSE FRACTURE OF UNSP ACETABULUM INIT

T84194A

MECH COMPL OF INTERNAL FIXATION DEVICE OF RIGHT FEMUR INIT

S32453B

DISPLACED TRANSVERSE FX UNSP ACETABULUM INIT FOR OPN FX

T84195A

MECH COMPL OF INTERNAL FIXATION DEVICE OF LEFT FEMUR INIT

S32454A

NONDISPLACED TRANSVERSE FRACTURE OF RIGHT ACETABULUM INIT

T84196A

MECH COMPL OF INT FIX OF BONE OF RIGHT LOWER LEG INIT

S32454B

NONDISP TRANSVERSE FX RIGHT ACETABULUM INIT FOR OPN FX

T84197A

MECH COMPL OF INT FIX OF BONE OF LEFT LOWER LEG INIT

S32455A

NONDISPLACED TRANSVERSE FRACTURE OF LEFT ACETABULUM INIT

T84199A

MECH COMPL OF INT FIX OF UNSP BONE OF LIMB INIT

S32455B NONDISP TRANSVERSE FX LEFT ACETABULUM INIT FOR OPN FX

T84210A

BREAKDOWN OF INT FIX OF BONES OF HAND AND FINGERS INIT

S32456A

NONDISPLACED TRANSVERSE FRACTURE OF UNSP ACETABULUM INIT

T84213A

BREAKDOWN OF INT FIX OF BONES OF FOOT AND TOES INIT

S32456B NONDISP TRANSVERSE FX UNSP ACETABULUM INIT FOR OPN FX

T84216A

BREAKDOWN (MECHANICAL) OF INT FIX OF VERTEBRAE INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32461A

DISPLACED ASSOCIATED TRANSV/POST FX RIGHT ACETABULUM INIT

T84218A

BREAKDOWN (MECHANICAL) OF INT FIX OF BONES INIT

S32461B

DISPLACED ASSOC TRANSV/POST FX RIGHT ACETAB INIT FOR OPN FX

T84220A

DISPLACEMENT OF INT FIX OF BONES OF HAND AND FINGERS INIT

S32462A

DISPLACED ASSOCIATED TRANSV/POST FX LEFT ACETABULUM INIT

T84223A

DISPLACEMENT OF INT FIX OF BONES OF FOOT AND TOES INIT

S32462B

DISPLACED ASSOC TRANSV/POST FX LEFT ACETAB INIT FOR OPN FX

T84226A

DISPLACEMENT OF INTERNAL FIXATION DEVICE OF VERTEBRAE INIT

S32463A

DISPLACED ASSOCIATED TRANSV/POST FX UNSP ACETABULUM INIT

T84228A

DISPLACEMENT OF INTERNAL FIXATION DEVICE OF OTH BONES INIT

S32463B

DISPLACED ASSOC TRANSV/POST FX UNSP ACETAB INIT FOR OPN FX

T84290A

MECH COMPL OF INT FIX OF BONES OF HAND AND FINGERS INIT

S32464A

NONDISP ASSOCIATED TRANSV/POST FX RIGHT ACETABULUM INIT

T84293A

MECH COMPL OF INT FIX OF BONES OF FOOT AND TOES INIT

S32464B

NONDISP ASSOC TRANSV/POST FX RIGHT ACETAB INIT FOR OPN FX

T84296A

MECH COMPL OF INTERNAL FIXATION DEVICE OF VERTEBRAE INIT

S32465A

NONDISP ASSOCIATED TRANSV/POST FX LEFT ACETABULUM INIT

T84298A

MECH COMPL OF INTERNAL FIXATION DEVICE OF OTH BONES INIT

S32465B

NONDISP ASSOC TRANSV/POST FX LEFT ACETAB INIT FOR OPN FX

T84310A

BREAKDOWN (MECHANICAL) OF ELECTRONIC BONE STIMULATOR INIT

S32466A

NONDISP ASSOCIATED TRANSV/POST FX UNSP ACETABULUM INIT

T84318A

BREAKDOWN OF BONE DEVICES IMPLANTS AND GRAFTS INIT

S32466B

NONDISP ASSOC TRANSV/POST FX UNSP ACETAB INIT FOR OPN FX

T84320A

DISPLACEMENT OF ELECTRONIC BONE STIMULATOR INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32471A

DISP FX OF MEDIAL WALL OF RIGHT ACETABULUM INIT FOR CLOS FX

T84328A

DISPLACEMENT OF OTH BONE DEVICES IMPLANTS AND GRAFTS INIT

S32471B

DISP FX OF MEDIAL WALL OF RIGHT ACETABULUM INIT FOR OPN FX

T84390A

MECH COMPL OF ELECTRONIC BONE STIMULATOR INITIAL ENCOUNTER

S32472A

DISP FX OF MEDIAL WALL OF LEFT ACETABULUM INIT FOR CLOS FX

T84398A

MECH COMPL OF OTH BONE DEVICES IMPLANTS AND GRAFTS INIT

S32472B

DISP FX OF MEDIAL WALL OF LEFT ACETABULUM INIT FOR OPN FX

T84410A

BREAKDOWN (MECHANICAL) OF MUSCLE AND TENDON GRAFT INIT

S32473A

DISP FX OF MEDIAL WALL OF UNSP ACETABULUM INIT FOR CLOS FX

T84418A

BRKDWN INTERNAL ORTH DEVICES IMPLANTS AND GRAFTS INIT

S32473B

DISP FX OF MEDIAL WALL OF UNSP ACETABULUM INIT FOR OPN FX

T84420A

DISPLACEMENT OF MUSCLE AND TENDON GRAFT INITIAL ENCOUNTER

S32474A NONDISP FX OF MEDIAL WALL OF RIGHT ACETABULUM INIT

T84428A

DISPLACMNT OF INTERNAL ORTH DEVICES IMPLNT AND GRAFTS INIT

S32474B

NONDISP FX OF MEDIAL WALL OF RIGHT ACETAB INIT FOR OPN FX

T84490A

MECH COMPL OF MUSCLE AND TENDON GRAFT INITIAL ENCOUNTER

S32475A NONDISP FX OF MEDIAL WALL OF LEFT ACETABULUM INIT

T84498A

MECH COMPL OF INTERNAL ORTH DEVICES IMPLNT AND GRAFTS INIT

S32475B

NONDISP FX OF MEDIAL WALL OF LEFT ACETAB INIT FOR OPN FX

T8450XA

INFECT/INFLM REACTION DUE TO UNSP INT JOINT PROSTH INIT

S32476A NONDISP FX OF MEDIAL WALL OF UNSP ACETABULUM INIT

T8451XA

INFECT/INFLM REACTION DUE TO INTERNAL RIGHT HIP PROSTH INIT

S32476B

NONDISP FX OF MEDIAL WALL OF UNSP ACETAB INIT FOR OPN FX

T8452XA

INFECT/INFLM REACTION DUE TO INTERNAL LEFT HIP PROSTH INIT

S32481A DISPLACED DOME FRACTURE OF RIGHT ACETABULUM INIT

T8453XA

INFECT/INFLM REACTION DUE TO INTERNAL R KNEE PROSTH INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32481B

DISPLACED DOME FRACTURE OF RIGHT ACETABULUM INIT FOR OPN FX

T8454XA

INFECT/INFLM REACTION DUE TO INTERNAL LEFT KNEE PROSTH INIT

S32482A

DISPLACED DOME FRACTURE OF LEFT ACETABULUM INIT FOR CLOS FX

T8459XA

INFECT/INFLM REACTION DUE TO OTH INTERNAL JOINT PROSTH INIT

S32482B

DISPLACED DOME FRACTURE OF LEFT ACETABULUM INIT FOR OPN FX

T8460XA

INFECT/INFLM REACTION DUE TO INT FIX OF UNSP SITE INIT

S32483A

DISPLACED DOME FRACTURE OF UNSP ACETABULUM INIT FOR CLOS FX

T84610A

INFECT/INFLM REACTION DUE TO INT FIX OF RIGHT HUMERUS INIT

S32483B

DISPLACED DOME FRACTURE OF UNSP ACETABULUM INIT FOR OPN FX

T84611A

INFECT/INFLM REACTION DUE TO INT FIX OF LEFT HUMERUS INIT

S32484A

NONDISPLACED DOME FRACTURE OF RIGHT ACETABULUM INIT

T84612A

INFECT/INFLM REACTION DUE TO INT FIX OF RIGHT RADIUS INIT

S32484B

NONDISP DOME FRACTURE OF RIGHT ACETABULUM INIT FOR OPN FX

T84613A

INFECT/INFLM REACTION DUE TO INT FIX OF LEFT RADIUS INIT

S32485A

NONDISPLACED DOME FRACTURE OF LEFT ACETABULUM INIT

T84614A

INFECT/INFLM REACTION DUE TO INT FIX OF RIGHT ULNA INIT

S32485B

NONDISP DOME FRACTURE OF LEFT ACETABULUM INIT FOR OPN FX

T84615A

INFECT/INFLM REACTION DUE TO INT FIX OF LEFT ULNA INIT

S32486A

NONDISPLACED DOME FRACTURE OF UNSP ACETABULUM INIT

T84619A

INFECT/INFLM REACT DUE TO INT FIX OF UNSP BONE OF ARM INIT

S32486B

NONDISP DOME FRACTURE OF UNSP ACETABULUM INIT FOR OPN FX

T84620A

INFECT/INFLM REACTION DUE TO INT FIX OF RIGHT FEMUR INIT

S32491A OTH FRACTURE OF RIGHT ACETABULUM INIT FOR CLOS FX

T84621A

INFECT/INFLM REACTION DUE TO INT FIX OF LEFT FEMUR INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32491B OTH FRACTURE OF RIGHT ACETABULUM INIT FOR OPN FX

T84622A

INFECT/INFLM REACTION DUE TO INT FIX OF RIGHT TIBIA INIT

S32492A OTH FRACTURE OF LEFT ACETABULUM INIT FOR CLOS FX

T84623A

INFECT/INFLM REACTION DUE TO INT FIX OF LEFT TIBIA INIT

S32492B OTH FRACTURE OF LEFT ACETABULUM INIT FOR OPN FX

T84624A

INFECT/INFLM REACTION DUE TO INT FIX OF RIGHT FIBULA INIT

S32499A OTH FRACTURE OF UNSP ACETABULUM INIT FOR CLOS FX

T84625A

INFECT/INFLM REACTION DUE TO INT FIX OF LEFT FIBULA INIT

S32499B OTH FRACTURE OF UNSP ACETABULUM INIT FOR OPN FX

T84629A

INFECT/INFLM REACT DUE TO INT FIX OF UNSP BONE OF LEG INIT

S32501A UNSP FRACTURE OF RIGHT PUBIS INIT FOR CLOS FX

T8463XA

INFECT/INFLM REACTION DUE TO INT FIX OF SPINE INIT

S32501B

UNSP FRACTURE OF RIGHT PUBIS INIT ENCNTR FOR OPEN FRACTURE

T8469XA

INFECT/INFLM REACTION DUE TO INT FIX OF SITE INIT

S32502A

UNSP FRACTURE OF LEFT PUBIS INIT ENCNTR FOR CLOSED FRACTURE

T847XXA

INFECT/INFLM REACT DUE TO OTH INT ORTH PROSTH DEV/GRFT INIT

S32502B

UNSP FRACTURE OF LEFT PUBIS INIT ENCNTR FOR OPEN FRACTURE

T8481XA

EMBOLISM DUE TO INTERNAL ORTHOPEDIC PROSTH DEV/GRFT INIT

S32509A

UNSP FRACTURE OF UNSP PUBIS INIT ENCNTR FOR CLOSED FRACTURE

T8482XA

FIBROSIS DUE TO INTERNAL ORTHOPEDIC PROSTH DEV/GRFT INIT

S32509B

UNSP FRACTURE OF UNSP PUBIS INIT ENCNTR FOR OPEN FRACTURE

T8483XA

HEMORRHAGE DUE TO INTERNAL ORTHOPEDIC PROSTH DEV/GRFT INIT

S32511A

FRACTURE OF SUPERIOR RIM OF RIGHT PUBIS INIT FOR CLOS FX

T8484XA

PAIN DUE TO INTERNAL ORTHOPEDIC PROSTH DEV/GRFT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32511B

FRACTURE OF SUPERIOR RIM OF RIGHT PUBIS INIT FOR OPN FX

T8485XA

STENOSIS DUE TO INTERNAL ORTHOPEDIC PROSTH DEV/GRFT INIT

S32512A FRACTURE OF SUPERIOR RIM OF LEFT PUBIS INIT FOR CLOS FX

T8486XA

THROMBOSIS DUE TO INTERNAL ORTHOPEDIC PROSTH DEV/GRFT INIT

S32512B FRACTURE OF SUPERIOR RIM OF LEFT PUBIS INIT FOR OPN FX

T8489XA

OTH COMP OF INTERNAL ORTHOPEDIC PROSTH DEV/GRFT INIT

S32519A

FRACTURE OF SUPERIOR RIM OF UNSP PUBIS INIT FOR CLOS FX

T849XXA

UNSP COMP OF INTERNAL ORTHOPEDIC PROSTH DEV/GRFT INIT

S32519B

FRACTURE OF SUPERIOR RIM OF UNSP PUBIS INIT FOR OPN FX

T8501XA

BREAKDOWN OF VENTRICULAR INTRACRANIAL SHUNT INIT

S32591A

OTH FRACTURE OF RIGHT PUBIS INIT ENCNTR FOR CLOSED FRACTURE

T8502XA

DISPLACEMENT OF VENTRICULAR INTRACRANIAL SHUNT INIT

S32591B

OTH FRACTURE OF RIGHT PUBIS INIT ENCNTR FOR OPEN FRACTURE

T8503XA

LEAKAGE OF VENTRICULAR INTRACRANIAL SHUNT INIT

S32592A

OTH FRACTURE OF LEFT PUBIS INIT ENCNTR FOR CLOSED FRACTURE

T8509XA

MECH COMPL OF VENTRICULAR INTRACRANIAL SHUNT INIT

S32592B

OTH FRACTURE OF LEFT PUBIS INIT ENCNTR FOR OPEN FRACTURE

T85110A

BRKDWN IMPLANTED ELECTRONIC NEUROSTIM OF BRAIN INIT

S32599A

OTH FRACTURE OF UNSP PUBIS INIT ENCNTR FOR CLOSED FRACTURE

T85111A

BRKDWN IMPLANTED ELECTRONIC NEUROSTIM OF PERIPH NRV INIT

S32599B

OTH FRACTURE OF UNSP PUBIS INIT ENCNTR FOR OPEN FRACTURE

T85112A

BRKDWN IMPLANTED ELECTRONIC NEUROSTIM OF SPINAL CORD INIT

S32601A UNSP FRACTURE OF RIGHT ISCHIUM INIT FOR CLOS FX

T85113A

Breakdown (mechanical) of implanted electronic neurostimulator generator initial encounter

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32601B UNSP FRACTURE OF RIGHT ISCHIUM INIT FOR OPN FX

T85118A

BRKDWN IMPLANTED ELECTRONIC STIMULATOR OF NERVOUS SYS INIT

S32602A UNSP FRACTURE OF LEFT ISCHIUM INIT FOR CLOS FX

T85120A

DISPLACMNT OF IMPLANTED ELECTRONIC NEUROSTIM OF BRAIN INIT

S32602B

UNSP FRACTURE OF LEFT ISCHIUM INIT ENCNTR FOR OPEN FRACTURE

T85121A

DISPLACMNT OF IMPLNT ELECTRNC NEUROSTIM OF PERIPH NRV INIT

S32609A UNSP FRACTURE OF UNSP ISCHIUM INIT FOR CLOS FX

T85122A

DISPLACMNT OF IMPLNT ELECTRNC NEUROSTIM OF SPINAL CORD INIT

S32609B

UNSP FRACTURE OF UNSP ISCHIUM INIT ENCNTR FOR OPEN FRACTURE

T85123A

Displacement of implanted electronic neurostimulator generator initial encounter

S32611A

DISPLACED AVULSION FRACTURE OF RIGHT ISCHIUM INIT

T85128A

DISPLACMNT OF IMPLNT ELECTRNC STIMULTR OF NERVOUS SYS INIT

S32611B DISPLACED AVULSION FX RIGHT ISCHIUM INIT FOR OPN FX

T85190A

MECH COMPL OF IMPLANTED ELECTRONIC NEUROSTIM OF BRAIN INIT

S32612A

DISPLACED AVULSION FRACTURE OF LEFT ISCHIUM INIT

T85191A

MECH COMPL OF IMPLNT ELECTRNC NEUROSTIM OF PERIPH NRV INIT

S32612B

DISPLACED AVULSION FRACTURE OF LEFT ISCHIUM INIT FOR OPN FX

T85192A

MECH COMPL OF IMPLNT ELECTRNC NEUROSTIM OF SPINAL CORD INIT

S32613A

DISPLACED AVULSION FRACTURE OF UNSP ISCHIUM INIT

T85193A

Other mechanical complication of implanted electronic neurostimulator generator initial encounter

S32613B

DISPLACED AVULSION FRACTURE OF UNSP ISCHIUM INIT FOR OPN FX

T85199A

MECH COMPL OF IMPLNT ELECTRNC STIMULTR OF NERVOUS SYS INIT

S32614A

NONDISPLACED AVULSION FRACTURE OF RIGHT ISCHIUM INIT

T8521XA

BREAKDOWN (MECHANICAL) OF INTRAOCULAR LENS INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32614B

NONDISP AVULSION FRACTURE OF RIGHT ISCHIUM INIT FOR OPN FX

T8522XA

DISPLACEMENT OF INTRAOCULAR LENS INITIAL ENCOUNTER

S32615A

NONDISPLACED AVULSION FRACTURE OF LEFT ISCHIUM INIT

T8529XA

MECH COMPL OF INTRAOCULAR LENS INITIAL ENCOUNTER

S32615B

NONDISP AVULSION FRACTURE OF LEFT ISCHIUM INIT FOR OPN FX

T85310A

BREAKDOWN OF PROSTHETIC ORBIT OF RIGHT EYE INIT

S32616A

NONDISPLACED AVULSION FRACTURE OF UNSP ISCHIUM INIT

T85311A

BREAKDOWN (MECHANICAL) OF PROSTHETIC ORBIT OF LEFT EYE INIT

S32616B

NONDISP AVULSION FRACTURE OF UNSP ISCHIUM INIT FOR OPN FX

T85318A

BREAKDOWN (MECHANICAL) OF OCULAR PROSTH DEV/GRFT INIT

S32691A OTH FRACTURE OF RIGHT ISCHIUM INIT FOR CLOS FX

T85320A

DISPLACEMENT OF PROSTHETIC ORBIT OF RIGHT EYE INIT ENCNTR

S32691B

OTH FRACTURE OF RIGHT ISCHIUM INIT ENCNTR FOR OPEN FRACTURE

T85321A

DISPLACEMENT OF PROSTHETIC ORBIT OF LEFT EYE INIT ENCNTR

S32692A OTH FRACTURE OF LEFT ISCHIUM INIT FOR CLOS FX

T85328A

DISPLACEMENT OF OCULAR PROSTH DEV/GRFT INIT

S32692B

OTH FRACTURE OF LEFT ISCHIUM INIT ENCNTR FOR OPEN FRACTURE

T85390A

MECH COMPL OF PROSTHETIC ORBIT OF RIGHT EYE INIT ENCNTR

S32699A OTH FRACTURE OF UNSP ISCHIUM INIT FOR CLOS FX

T85391A

MECH COMPL OF PROSTHETIC ORBIT OF LEFT EYE INIT ENCNTR

S32699B

OTH FRACTURE OF UNSP ISCHIUM INIT ENCNTR FOR OPEN FRACTURE

T85398A

MECH COMPL OF OCULAR PROSTH DEV/GRFT INIT

S32810A

MULTIPLE FX OF PELVIS W STABLE DISRUPT OF PELVIC RING INIT

T8541XA

BREAKDOWN OF BREAST PROSTHESIS AND IMPLANT INIT

S32810B MULT FX OF PELV W STABLE DISRUPT OF PELV RING 7THB

T8542XA

DISPLACEMENT OF BREAST PROSTHESIS AND IMPLANT INIT ENCNTR

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32811A

MULT FX OF PELVIS W UNSTABLE DISRUPT OF PELVIC RING INIT

T8543XA

LEAKAGE OF BREAST PROSTHESIS AND IMPLANT INITIAL ENCOUNTER

S32811B MULT FX OF PELV W UNSTBL DISRUPT OF PELV RING 7THB

T8544XA

CAPSULAR CONTRACTURE OF BREAST IMPLANT INITIAL ENCOUNTER

S3289XA FRACTURE OF OTH PARTS OF PELVIS INIT FOR CLOS FX

T8549XA

MECH COMPL OF BREAST PROSTHESIS AND IMPLANT INIT ENCNTR

S3289XB FRACTURE OF OTH PARTS OF PELVIS INIT FOR OPN FX

T85510A

BREAKDOWN (MECHANICAL) OF BILE DUCT PROSTHESIS INIT ENCNTR

S329XXA

FRACTURE OF UNSP PARTS OF LUMBOSACRAL SPINE AND PELVIS INIT

T85511A

BREAKDOWN OF ESOPHAGEAL ANTI-REFLUX DEVICE INIT

S329XXB

FX UNSP PARTS OF LUMBOSACRAL SPINE & PELVIS INIT FOR OPN FX

T85518A

BREAKDOWN (MECHANICAL) OF GI PROSTH DEV/GRFT INIT

S330XXA

TRAUMATIC RUPTURE OF LUMBAR INTERVERTEBRAL DISC INIT ENCNTR

T85520A

DISPLACEMENT OF BILE DUCT PROSTHESIS INITIAL ENCOUNTER

S33100A

SUBLUXATION OF UNSPECIFIED LUMBAR VERTEBRA INIT ENCNTR

T85521A

DISPLACEMENT OF ESOPHAGEAL ANTI-REFLUX DEVICE INIT ENCNTR

S33101A

DISLOCATION OF UNSPECIFIED LUMBAR VERTEBRA INIT ENCNTR

T85528A

DISPLACEMENT OF GASTROINTESTINAL PROSTH DEV/GRFT INIT

S33110A

SUBLUXATION OF L1/L2 LUMBAR VERTEBRA INITIAL ENCOUNTER

T85590A

MECH COMPL OF BILE DUCT PROSTHESIS INITIAL ENCOUNTER

S33111A

DISLOCATION OF L1/L2 LUMBAR VERTEBRA INITIAL ENCOUNTER

T85591A

MECH COMPL OF ESOPHAGEAL ANTI-REFLUX DEVICE INIT ENCNTR

S33120A

SUBLUXATION OF L2/L3 LUMBAR VERTEBRA INITIAL ENCOUNTER

T85598A

MECH COMPL OF GASTROINTESTINAL PROSTH DEV/GRFT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S33121A

DISLOCATION OF L2/L3 LUMBAR VERTEBRA INITIAL ENCOUNTER

T85610A

BREAKDOWN OF EPIDURAL AND SUBDURAL INFUSION CATHETER INIT

S33130A

SUBLUXATION OF L3/L4 LUMBAR VERTEBRA INITIAL ENCOUNTER

T85611A

BREAKDOWN OF INTRAPERITONEAL DIALYSIS CATHETER INIT

S33131A

DISLOCATION OF L3/L4 LUMBAR VERTEBRA INITIAL ENCOUNTER

T85612A

BREAKDOWN (MECHANICAL) OF PERMANENT SUTURES INIT ENCNTR

S33140A

SUBLUXATION OF L4/L5 LUMBAR VERTEBRA INITIAL ENCOUNTER

T85613A

BREAKDOWN OF ARTIFICIAL SKIN GRFT /DECELLULAR ALLODERM INIT

S33141A

DISLOCATION OF L4/L5 LUMBAR VERTEBRA INITIAL ENCOUNTER

T85615A

Breakdown (mechanical) of other nervous system device implant or graft initial encounter

S332XXA

DISLOCATION OF SACROILIAC AND SACROCOCCYGEAL JOINT INIT

T85618A

BREAKDOWN (MECHANICAL) OF INTERNAL PROSTH DEV/GRFT INIT

S3330XA

DISLOCATION OF UNSP PARTS OF LUMBAR SPINE AND PELVIS INIT

T85620A

DISPLACMNT OF EPIDURAL AND SUBDURAL INFUSION CATHETER INIT

S3339XA

DISLOCATION OF OTH PRT LUMBAR SPINE AND PELVIS INIT ENCNTR

T85621A

DISPLACEMENT OF INTRAPERITONEAL DIALYSIS CATHETER INIT

S334XXA

TRAUMATIC RUPTURE OF SYMPHYSIS PUBIS INITIAL ENCOUNTER

T85622A

DISPLACEMENT OF PERMANENT SUTURES INITIAL ENCOUNTER

S335XXA

SPRAIN OF LIGAMENTS OF LUMBAR SPINE INITIAL ENCOUNTER

T85623A

DISPLACMNT OF ARTIF SKIN GRFT /DECELLULAR ALLODERM INIT

S336XXA SPRAIN OF SACROILIAC JOINT INITIAL ENCOUNTER

T85625A

Displacement of other nervous system device implant or graft initial encounter

S338XXA

SPRAIN OF OTH PARTS OF LUMBAR SPINE AND PELVIS INIT ENCNTR

T85628A

DISPLACEMENT OF INTERNAL PROSTH DEV/GRFT INIT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S339XXA

SPRAIN OF UNSP PARTS OF LUMBAR SPINE AND PELVIS INIT ENCNTR

T85630A

LEAKAGE OF EPIDURAL AND SUBDURAL INFUSION CATHETER INIT

S3401XA

CONCUSSION AND EDEMA OF LUMBAR SPINAL CORD INIT ENCNTR

T85631A

LEAKAGE OF INTRAPERITONEAL DIALYSIS CATHETER INIT ENCNTR

S3402XA

CONCUSSION AND EDEMA OF SACRAL SPINAL CORD INIT ENCNTR

T85635A

Leakage of other nervous system device implant or graft initial encounter

S34101A

UNSP INJURY TO L1 LEVEL OF LUMBAR SPINAL CORD INIT ENCNTR

T85638A

LEAKAGE OF INTERNAL PROSTH DEV/GRFT INIT

S34102A

UNSP INJURY TO L2 LEVEL OF LUMBAR SPINAL CORD INIT ENCNTR

T85690A

MECH COMPL OF EPIDURAL AND SUBDURAL INFUSION CATHETER INIT

S34103A

UNSP INJURY TO L3 LEVEL OF LUMBAR SPINAL CORD INIT ENCNTR

T85691A

MECH COMPL OF INTRAPERITONEAL DIALYSIS CATHETER INIT ENCNTR

S34104A

UNSP INJURY TO L4 LEVEL OF LUMBAR SPINAL CORD INIT ENCNTR

T85692A

MECH COMPL OF PERMANENT SUTURES INITIAL ENCOUNTER

S34105A

UNSP INJURY TO L5 LEVEL OF LUMBAR SPINAL CORD INIT ENCNTR

T85693A

MECH COMPL OF ARTIF SKIN GRFT /DECELLULAR ALLODERM INIT

S34109A

UNSP INJURY TO UNSP LEVEL OF LUMBAR SPINAL CORD INIT ENCNTR

T85695A

Other mechanical complication of other nervous system device implant or graft initial encounter

S34111A COMPLETE LESION OF L1 LEVEL OF LUMBAR SPINAL CORD INIT

T85698A

MECH COMPL OF INTERNAL PROSTH DEV/GRFT INIT

S34112A COMPLETE LESION OF L2 LEVEL OF LUMBAR SPINAL CORD INIT

T8571XA

INFECT/INFLM REACTION DUE TO PERITON DIALYSIS CATHETER INIT

S34113A COMPLETE LESION OF L3 LEVEL OF LUMBAR SPINAL CORD INIT

T85730A

Infection and inflammatory reaction due to ventricular intracranial (communicating) shunt initial encounter

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S34114A COMPLETE LESION OF L4 LEVEL OF LUMBAR SPINAL CORD INIT

T85731A

Infection and inflammatory reaction due to implanted electronic neurostimulator of brain electrode (lead) initial encounter

S34115A COMPLETE LESION OF L5 LEVEL OF LUMBAR SPINAL CORD INIT

T85732A

Infection and inflammatory reaction due to implanted electronic neurostimulator of peripheral nerve electrode (lead) initial encounter

S34119A

COMPLETE LESION OF UNSP LEVEL OF LUMBAR SPINAL CORD INIT

T85733A

Infection and inflammatory reaction due to implanted electronic neurostimulator of spinal cord electrode (lead) initial encounter

S34121A

INCOMPLETE LESION OF L1 LEVEL OF LUMBAR SPINAL CORD INIT

T85734A

Infection and inflammatory reaction due to implanted electronic neurostimulator generator initial encounter

S34122A

INCOMPLETE LESION OF L2 LEVEL OF LUMBAR SPINAL CORD INIT

T85735A

Infection and inflammatory reaction due to cranial or spinal infusion catheter initial encounter

S34123A

INCOMPLETE LESION OF L3 LEVEL OF LUMBAR SPINAL CORD INIT

T85738A

Infection and inflammatory reaction due to other nervous system device implant or graft initial encounter

S34124A

INCOMPLETE LESION OF L4 LEVEL OF LUMBAR SPINAL CORD INIT

T8579XA

INFECT/INFLM REACTION DUE TO OTH INT PROSTH DEV/GRFT INIT

S34125A

INCOMPLETE LESION OF L5 LEVEL OF LUMBAR SPINAL CORD INIT

T8581XA

EMBOLISM DUE TO INTERNAL PROSTH DEV/GRFT NEC INIT

S34129A

INCOMPLETE LESION OF UNSP LEVEL OF LUMBAR SPINAL CORD INIT

T85810A

Embolism due to nervous system prosthetic devices implants and grafts initial encounter

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S34131A

COMPLETE LESION OF SACRAL SPINAL CORD INITIAL ENCOUNTER

T85818A

Embolism due to other internal prosthetic devices implants and grafts initial encounter

S34132A

INCOMPLETE LESION OF SACRAL SPINAL CORD INITIAL ENCOUNTER

T85820A

Fibrosis due to nervous system prosthetic devices implants and grafts initial encounter

S34139A

UNSPECIFIED INJURY TO SACRAL SPINAL CORD INITIAL ENCOUNTER

T85828A

Fibrosis due to other internal prosthetic devices implants and grafts initial encounter

S3421XA

INJURY OF NERVE ROOT OF LUMBAR SPINE INITIAL ENCOUNTER

T8582XA

FIBROSIS DUE TO INTERNAL PROSTH DEV/GRFT NEC INIT

S3422XA

INJURY OF NERVE ROOT OF SACRAL SPINE INITIAL ENCOUNTER

T85830A

Hemorrhage due to nervous system prosthetic devices implants and grafts initial encounter

S343XXA INJURY OF CAUDA EQUINA INITIAL ENCOUNTER

T85838A

Hemorrhage due to other internal prosthetic devices implants and grafts initial encounter

S344XXA INJURY OF LUMBOSACRAL PLEXUS INITIAL ENCOUNTER

T8583XA

HEMORRHAGE DUE TO INTERNAL PROSTH DEV/GRFT NEC INIT

S345XXA

INJURY OF LUMBAR SACRAL AND PELVIC SYMPATHETIC NERVES INIT

T85840A

Pain due to nervous system prosthetic devices implants and grafts initial encounter

S346XXA INJ PRPH NERVE(S) AT ABD LOW BACK AND PELVIS LEVEL INIT

T85848A

Pain due to other internal prosthetic devices implants and grafts initial encounter

S348XXA

INJURY OF NERVES AT ABDOMEN LOW BACK AND PELVIS LEVEL INIT

T8584XA

PAIN DUE TO INTERNAL PROSTH DEV/GRFT NEC INIT

S349XXA

INJ UNSP NERVES AT ABDOMEN LOW BACK AND PELVIS LEVEL INIT

T85850A

Stenosis due to nervous system prosthetic devices implants and grafts initial encounter

S3500XA

UNSPECIFIED INJURY OF ABDOMINAL AORTA INITIAL ENCOUNTER

T85858A

Stenosis due to other internal prosthetic devices implants and grafts initial encounter

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S3501XA

MINOR LACERATION OF ABDOMINAL AORTA INITIAL ENCOUNTER

T8585XA

STENOSIS DUE TO INTERNAL PROSTH DEV/GRFT NEC INIT

S3502XA

MAJOR LACERATION OF ABDOMINAL AORTA INITIAL ENCOUNTER

T85860A

Thrombosis due to nervous system prosthetic devices implants and grafts initial encounter

S3509XA OTHER INJURY OF ABDOMINAL AORTA INITIAL ENCOUNTER

T85868A

Thrombosis due to other internal prosthetic devices implants and grafts initial encounter

S3510XA

UNSPECIFIED INJURY OF INFERIOR VENA CAVA INITIAL ENCOUNTER

T8586XA

THROMBOSIS DUE TO INTERNAL PROSTH DEV/GRFT NEC INIT

S3511XA

MINOR LACERATION OF INFERIOR VENA CAVA INITIAL ENCOUNTER

T85890A

Other specified complication of nervous system prosthetic devices implants and grafts initial encounter

S3512XA

MAJOR LACERATION OF INFERIOR VENA CAVA INITIAL ENCOUNTER

T85898A

Other specified complication of other internal prosthetic devices implants and grafts initial encounter

S3519XA

OTHER INJURY OF INFERIOR VENA CAVA INITIAL ENCOUNTER

T8589XA

OTH COMPLICATION OF INTERNAL PROSTH DEV/GRFT NEC INIT

S35211A MINOR LACERATION OF CELIAC ARTERY INITIAL ENCOUNTER

T859XXA

UNSP COMPLICATION OF INTERNAL PROSTH DEV/GRFT INIT

S35212A MAJOR LACERATION OF CELIAC ARTERY INITIAL ENCOUNTER

T8600

UNSPECIFIED COMPLICATION OF BONE MARROW TRANSPLANT

S35218A OTHER INJURY OF CELIAC ARTERY INITIAL ENCOUNTER

T8601

BONE MARROW TRANSPLANT REJECTION

S35219A UNSPECIFIED INJURY OF CELIAC ARTERY INITIAL ENCOUNTER

T8602

BONE MARROW TRANSPLANT FAILURE

S35221A

MINOR LACERATION OF SUPERIOR MESENTERIC ARTERY INIT ENCNTR

T8603

BONE MARROW TRANSPLANT INFECTION

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S35222A

MAJOR LACERATION OF SUPERIOR MESENTERIC ARTERY INIT ENCNTR

T8609

OTHER COMPLICATIONS OF BONE MARROW TRANSPLANT

S35228A

OTHER INJURY OF SUPERIOR MESENTERIC ARTERY INIT ENCNTR

T8610

UNSPECIFIED COMPLICATION OF KIDNEY TRANSPLANT

S35229A

UNSP INJURY OF SUPERIOR MESENTERIC ARTERY INIT ENCNTR

T8611 KIDNEY TRANSPLANT REJECTION

S35231A

MINOR LACERATION OF INFERIOR MESENTERIC ARTERY INIT ENCNTR

T8612 KIDNEY TRANSPLANT FAILURE

S35232A

MAJOR LACERATION OF INFERIOR MESENTERIC ARTERY INIT ENCNTR

T8613 KIDNEY TRANSPLANT INFECTION

S35238A

OTHER INJURY OF INFERIOR MESENTERIC ARTERY INIT ENCNTR

T8619

OTHER COMPLICATION OF KIDNEY TRANSPLANT

S35239A

UNSP INJURY OF INFERIOR MESENTERIC ARTERY INIT ENCNTR

T8620

UNSPECIFIED COMPLICATION OF HEART TRANSPLANT

S35291A

MINOR LACERATION OF BRANCHES OF CELIAC AND MESENT ART INIT

T8621 HEART TRANSPLANT REJECTION

S35292A

MAJOR LACERATION OF BRANCHES OF CELIAC AND MESENT ART INIT

T8622 HEART TRANSPLANT FAILURE

S35298A

INJ BRANCHES OF CELIAC AND MESENTERIC ARTERY INIT ENCNTR

T8623 HEART TRANSPLANT INFECTION

S35299A UNSP INJURY OF BRANCHES OF CELIAC AND MESENT ART INIT

T86290 CARDIAC ALLOGRAFT VASCULOPATHY

S35311A LACERATION OF PORTAL VEIN INITIAL ENCOUNTER

T86298

OTHER COMPLICATIONS OF HEART TRANSPLANT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S35318A

OTHER SPECIFIED INJURY OF PORTAL VEIN INITIAL ENCOUNTER

T8630

UNSPECIFIED COMPLICATION OF HEART-LUNG TRANSPLANT

S35319A

UNSPECIFIED INJURY OF PORTAL VEIN INITIAL ENCOUNTER

T8631 HEART-LUNG TRANSPLANT REJECTION

S35321A LACERATION OF SPLENIC VEIN INITIAL ENCOUNTER

T8632 HEART-LUNG TRANSPLANT FAILURE

S35328A

OTHER SPECIFIED INJURY OF SPLENIC VEIN INITIAL ENCOUNTER

T8633 HEART-LUNG TRANSPLANT INFECTION

S35329A

UNSPECIFIED INJURY OF SPLENIC VEIN INITIAL ENCOUNTER

T8639

OTHER COMPLICATIONS OF HEART-LUNG TRANSPLANT

S35331A

LACERATION OF SUPERIOR MESENTERIC VEIN INITIAL ENCOUNTER

T8640

UNSPECIFIED COMPLICATION OF LIVER TRANSPLANT

S35338A OTH INJURY OF SUPERIOR MESENTERIC VEIN INIT ENCNTR

T8641 LIVER TRANSPLANT REJECTION

S35339A

UNSPECIFIED INJURY OF SUPERIOR MESENTERIC VEIN INIT ENCNTR

T8642 LIVER TRANSPLANT FAILURE

S35341A

LACERATION OF INFERIOR MESENTERIC VEIN INITIAL ENCOUNTER

T8643 LIVER TRANSPLANT INFECTION

S35348A OTH INJURY OF INFERIOR MESENTERIC VEIN INIT ENCNTR

T8649

OTHER COMPLICATIONS OF LIVER TRANSPLANT

S35349A

UNSPECIFIED INJURY OF INFERIOR MESENTERIC VEIN INIT ENCNTR

T86810 LUNG TRANSPLANT REJECTION

S35401A

UNSPECIFIED INJURY OF RIGHT RENAL ARTERY INITIAL ENCOUNTER

T86811 LUNG TRANSPLANT FAILURE

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S35402A

UNSPECIFIED INJURY OF LEFT RENAL ARTERY INITIAL ENCOUNTER

T86812 LUNG TRANSPLANT INFECTION

S35403A

UNSPECIFIED INJURY OF UNSPECIFIED RENAL ARTERY INIT ENCNTR

T86818

OTHER COMPLICATIONS OF LUNG TRANSPLANT

S35404A

UNSPECIFIED INJURY OF RIGHT RENAL VEIN INITIAL ENCOUNTER

T86819

UNSPECIFIED COMPLICATION OF LUNG TRANSPLANT

S35405A

UNSPECIFIED INJURY OF LEFT RENAL VEIN INITIAL ENCOUNTER

T86820 SKIN GRAFT (ALLOGRAFT) REJECTION

S35406A

UNSPECIFIED INJURY OF UNSPECIFIED RENAL VEIN INIT ENCNTR

T86821

SKIN GRAFT (ALLOGRAFT) (AUTOGRAFT) FAILURE

S35411A LACERATION OF RIGHT RENAL ARTERY INITIAL ENCOUNTER

T86822

SKIN GRAFT (ALLOGRAFT) (AUTOGRAFT) INFECTION

S35412A LACERATION OF LEFT RENAL ARTERY INITIAL ENCOUNTER

T86828

OTHER COMPLICATIONS OF SKIN GRAFT (ALLOGRAFT) (AUTOGRAFT)

S35413A

LACERATION OF UNSPECIFIED RENAL ARTERY INITIAL ENCOUNTER

T86829

UNSP COMPLICATION OF SKIN GRAFT (ALLOGRAFT) (AUTOGRAFT)

S35414A LACERATION OF RIGHT RENAL VEIN INITIAL ENCOUNTER

T86830 BONE GRAFT REJECTION

S35415A LACERATION OF LEFT RENAL VEIN INITIAL ENCOUNTER

T86831 BONE GRAFT FAILURE

S35416A

LACERATION OF UNSPECIFIED RENAL VEIN INITIAL ENCOUNTER

T86832 BONE GRAFT INFECTION

S35491A

OTHER SPECIFIED INJURY OF RIGHT RENAL ARTERY INIT ENCNTR

T86838

OTHER COMPLICATIONS OF BONE GRAFT

S35492A

OTHER SPECIFIED INJURY OF LEFT RENAL ARTERY INIT ENCNTR

T86839

UNSPECIFIED COMPLICATION OF BONE GRAFT

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S35493A OTH INJURY OF UNSPECIFIED RENAL ARTERY INIT ENCNTR

T86840 CORNEAL TRANSPLANT REJECTION

S35494A OTHER SPECIFIED INJURY OF RIGHT RENAL VEIN INIT ENCNTR

T86841 CORNEAL TRANSPLANT FAILURE

S35495A

OTHER SPECIFIED INJURY OF LEFT RENAL VEIN INITIAL ENCOUNTER

T86842 CORNEAL TRANSPLANT INFECTION

S35496A OTH INJURY OF UNSPECIFIED RENAL VEIN INIT ENCNTR

T86848

OTHER COMPLICATIONS OF CORNEAL TRANSPLANT

S3550XA INJURY OF UNSPECIFIED ILIAC BLOOD VESSEL(S) INIT ENCNTR

T86849

UNSPECIFIED COMPLICATION OF CORNEAL TRANSPLANT

S35511A INJURY OF RIGHT ILIAC ARTERY INITIAL ENCOUNTER

T86850 INTESTINE TRANSPLANT REJECTION

S35512A INJURY OF LEFT ILIAC ARTERY INITIAL ENCOUNTER

T86851 INTESTINE TRANSPLANT FAILURE

S35513A INJURY OF UNSPECIFIED ILIAC ARTERY INITIAL ENCOUNTER

T86852 INTESTINE TRANSPLANT INFECTION

S35514A INJURY OF RIGHT ILIAC VEIN INITIAL ENCOUNTER

T86858

OTHER COMPLICATIONS OF INTESTINE TRANSPLANT

S35515A INJURY OF LEFT ILIAC VEIN INITIAL ENCOUNTER

T86859

UNSPECIFIED COMPLICATION OF INTESTINE TRANSPLANT

S35516A INJURY OF UNSPECIFIED ILIAC VEIN INITIAL ENCOUNTER

T86890

OTHER TRANSPLANTED TISSUE REJECTION

S35531A INJURY OF RIGHT UTERINE ARTERY INITIAL ENCOUNTER

T86891

OTHER TRANSPLANTED TISSUE FAILURE

S35532A INJURY OF LEFT UTERINE ARTERY INITIAL ENCOUNTER

T86892

OTHER TRANSPLANTED TISSUE INFECTION

S35533A

INJURY OF UNSPECIFIED UTERINE ARTERY INITIAL ENCOUNTER

T86898

OTHER COMPLICATIONS OF OTHER TRANSPLANTED TISSUE

S35534A INJURY OF RIGHT UTERINE VEIN INITIAL ENCOUNTER

T86899

UNSPECIFIED COMPLICATION OF OTHER TRANSPLANTED TISSUE

S35535A INJURY OF LEFT UTERINE VEIN INITIAL ENCOUNTER

T8690

UNSP COMPLICATION OF UNSP TRANSPLANTED ORGAN AND TISSUE

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S35536A

INJURY OF UNSPECIFIED UTERINE VEIN INITIAL ENCOUNTER

T8691

UNSPECIFIED TRANSPLANTED ORGAN AND TISSUE REJECTION

S3559XA INJURY OF OTHER ILIAC BLOOD VESSELS INITIAL ENCOUNTER

T8692

UNSPECIFIED TRANSPLANTED ORGAN AND TISSUE FAILURE

S358X1A

LACERAT BLOOD VESLS AT ABD LOW BACK AND PELVIS LEVEL INIT

T8693

UNSPECIFIED TRANSPLANTED ORGAN AND TISSUE INFECTION

S358X8A

INJ OTH BLOOD VESLS AT ABD LOW BACK AND PELVIS LEVEL INIT

T8699

OTHER COMPLICATIONS OF UNSP TRANSPLANTED ORGAN AND TISSUE

S358X9A

UNSP INJ BLOOD VESLS AT ABD LOW BACK AND PELVIS LEVEL INIT

T870X1

COMPLICATIONS OF REATTACHED (PART OF) RIGHT UPPER EXTREMITY

S3590XA

UNSP INJ UNSP BLD VESS AT ABD LOW BACK AND PELV LEVEL INIT

T870X2

COMPLICATIONS OF REATTACHED (PART OF) LEFT UPPER EXTREMITY

S3591XA

LACERAT UNSP BLD VESS AT ABD LOW BACK AND PELV LEVEL INIT

T870X9

COMPLICATIONS OF REATTACHED (PART OF) UNSP UPPER EXTREMITY

S3599XA

INJ UNSP BLOOD VESS AT ABD LOW BACK AND PELVIS LEVEL INIT

T871X1

COMPLICATIONS OF REATTACHED (PART OF) RIGHT LOWER EXTREMITY

S3600XA UNSPECIFIED INJURY OF SPLEEN INITIAL ENCOUNTER

T871X2

COMPLICATIONS OF REATTACHED (PART OF) LEFT LOWER EXTREMITY

S36020A MINOR CONTUSION OF SPLEEN INITIAL ENCOUNTER

T871X9

COMPLICATIONS OF REATTACHED (PART OF) UNSP LOWER EXTREMITY

S36021A MAJOR CONTUSION OF SPLEEN INITIAL ENCOUNTER

T872

COMPLICATIONS OF OTHER REATTACHED BODY PART

S36029A UNSPECIFIED CONTUSION OF SPLEEN INITIAL ENCOUNTER

T8730

NEUROMA OF AMPUTATION STUMP UNSPECIFIED EXTREMITY

S36030A

SUPERFICIAL (CAPSULAR) LACERATION OF SPLEEN INIT ENCNTR

T8731

NEUROMA OF AMPUTATION STUMP RIGHT UPPER EXTREMITY

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S36031A MODERATE LACERATION OF SPLEEN INITIAL ENCOUNTER

T8732

NEUROMA OF AMPUTATION STUMP LEFT UPPER EXTREMITY

S36032A MAJOR LACERATION OF SPLEEN INITIAL ENCOUNTER

T8733

NEUROMA OF AMPUTATION STUMP RIGHT LOWER EXTREMITY

S36039A UNSPECIFIED LACERATION OF SPLEEN INITIAL ENCOUNTER

T8734

NEUROMA OF AMPUTATION STUMP LEFT LOWER EXTREMITY

S3609XA OTHER INJURY OF SPLEEN INITIAL ENCOUNTER

T8740

INFECTION OF AMPUTATION STUMP UNSPECIFIED EXTREMITY

S36112A CONTUSION OF LIVER INITIAL ENCOUNTER

T8741

INFECTION OF AMPUTATION STUMP RIGHT UPPER EXTREMITY

S36113A

LACERATION OF LIVER UNSPECIFIED DEGREE INITIAL ENCOUNTER

T8742

INFECTION OF AMPUTATION STUMP LEFT UPPER EXTREMITY

S36114A MINOR LACERATION OF LIVER INITIAL ENCOUNTER

T8743

INFECTION OF AMPUTATION STUMP RIGHT LOWER EXTREMITY

S36115A MODERATE LACERATION OF LIVER INITIAL ENCOUNTER

T8744

INFECTION OF AMPUTATION STUMP LEFT LOWER EXTREMITY

S36116A MAJOR LACERATION OF LIVER INITIAL ENCOUNTER

T8750

NECROSIS OF AMPUTATION STUMP UNSPECIFIED EXTREMITY

S36118A OTHER INJURY OF LIVER INITIAL ENCOUNTER

T8751

NECROSIS OF AMPUTATION STUMP RIGHT UPPER EXTREMITY

S36119A UNSPECIFIED INJURY OF LIVER INITIAL ENCOUNTER

T8752

NECROSIS OF AMPUTATION STUMP LEFT UPPER EXTREMITY

S36122A CONTUSION OF GALLBLADDER INITIAL ENCOUNTER

T8753

NECROSIS OF AMPUTATION STUMP RIGHT LOWER EXTREMITY

S36123A LACERATION OF GALLBLADDER INITIAL ENCOUNTER

T8754

NECROSIS OF AMPUTATION STUMP LEFT LOWER EXTREMITY

S36128A

OTHER INJURY OF GALLBLADDER INITIAL ENCOUNTER

T879

UNSPECIFIED COMPLICATIONS OF AMPUTATION STUMP

S36129A

UNSPECIFIED INJURY OF GALLBLADDER INITIAL ENCOUNTER

T882XXA

SHOCK DUE TO ANESTHESIA INITIAL ENCOUNTER

S3613XA INJURY OF BILE DUCT INITIAL ENCOUNTER

T883XXA

MALIGNANT HYPERTHERMIA DUE TO ANESTHESIA INITIAL ENCOUNTER

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S36200A

UNSPECIFIED INJURY OF HEAD OF PANCREAS INITIAL ENCOUNTER

T884XXA

FAILED OR DIFFICULT INTUBATION INITIAL ENCOUNTER

S36201A

UNSPECIFIED INJURY OF BODY OF PANCREAS INITIAL ENCOUNTER

T8851XA

HYPOTHERMIA FOLLOWING ANESTHESIA INITIAL ENCOUNTER

S36202A UNSPECIFIED INJURY OF TAIL OF PANCREAS INITIAL ENCOUNTER

T8852XA

FAILED MODERATE SEDATION DURING PROCEDURE INITIAL ENCOUNTER

S36209A

UNSP INJURY OF UNSPECIFIED PART OF PANCREAS INIT ENCNTR

T8853XA

Unintended awareness under general anesthesia during procedure initial encounter

S36220A CONTUSION OF HEAD OF PANCREAS INITIAL ENCOUNTER

T8859XA

OTHER COMPLICATIONS OF ANESTHESIA INITIAL ENCOUNTER

S36221A CONTUSION OF BODY OF PANCREAS INITIAL ENCOUNTER

T886XXA

ANAPHYL REACTION DUE TO ADVRS EFF DRUG/MED PROP ADMIN INIT

S36222A CONTUSION OF TAIL OF PANCREAS INITIAL ENCOUNTER

T888XXA

OTH COMPLICATIONS OF SURGICAL AND MEDICAL CARE NEC INIT

S36229A

CONTUSION OF UNSPECIFIED PART OF PANCREAS INITIAL ENCOUNTER

T889XXA

COMPLICATION OF SURGICAL AND MEDICAL CARE UNSP INIT ENCNTR

S36230A

LACERATION OF HEAD OF PANCREAS UNSP DEGREE INIT ENCNTR

W268XXA

Contact with other sharp object(s) not elsewhere classified initial encounter

S36231A

LACERATION OF BODY OF PANCREAS UNSP DEGREE INIT ENCNTR

Y901

BLOOD ALCOHOL LEVEL OF 20-39 MG/100 ML

S36232A

LACERATION OF TAIL OF PANCREAS UNSP DEGREE INIT ENCNTR

Y902

BLOOD ALCOHOL LEVEL OF 40-59 MG/100 ML

S36239A LACERATION OF UNSP PART OF PANCREAS UNSP DEGREE INIT

Y903

BLOOD ALCOHOL LEVEL OF 60-79 MG/100 ML

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S36240A

MINOR LACERATION OF HEAD OF PANCREAS INITIAL ENCOUNTER

Y904

BLOOD ALCOHOL LEVEL OF 80-99 MG/100 ML

S36241A

MINOR LACERATION OF BODY OF PANCREAS INITIAL ENCOUNTER

Y905

BLOOD ALCOHOL LEVEL OF 100-119 MG/100 ML

S36242A MINOR LACERATION OF TAIL OF PANCREAS INITIAL ENCOUNTER

Y906

BLOOD ALCOHOL LEVEL OF 120-199 MG/100 ML

S36249A

MINOR LACERATION OF UNSP PART OF PANCREAS INIT ENCNTR

Y907

BLOOD ALCOHOL LEVEL OF 200-239 MG/100 ML

Y908

BLOOD ALCOHOL LEVEL OF 240 MG/100 ML OR MORE

sgaletka
File Attachment
2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List.pdf
Page 4: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A001 CHOLERA DUE TO VIBRIO CHOLERAE 01 BIOVAR ELTOR

S36250A

MODERATE LACERATION OF HEAD OF PANCREAS INITIAL ENCOUNTER

A009 CHOLERA UNSPECIFIED

S36251A MODERATE LACERATION OF BODY OF PANCREAS INITIAL ENCOUNTER

A0100 TYPHOID FEVER UNSPECIFIED

S36252A MODERATE LACERATION OF TAIL OF PANCREAS INITIAL ENCOUNTER

A0101 TYPHOID MENINGITIS

S36259A MODERATE LACERATION OF UNSP PART OF PANCREAS INIT ENCNTR

A0102 TYPHOID FEVER WITH HEART INVOLVEMENT

S36260A

MAJOR LACERATION OF HEAD OF PANCREAS INITIAL ENCOUNTER

A0103 TYPHOID PNEUMONIA

S36261A MAJOR LACERATION OF BODY OF PANCREAS INITIAL ENCOUNTER

A0104 TYPHOID ARTHRITIS

S36262A MAJOR LACERATION OF TAIL OF PANCREAS INITIAL ENCOUNTER

A0105 TYPHOID OSTEOMYELITIS

S36269A MAJOR LACERATION OF UNSP PART OF PANCREAS INIT ENCNTR

A0109 TYPHOID FEVER WITH OTHER COMPLICATIONS

S36290A

OTHER INJURY OF HEAD OF PANCREAS INITIAL ENCOUNTER

A011 PARATYPHOID FEVER A

S36291A OTHER INJURY OF BODY OF PANCREAS INITIAL ENCOUNTER

A012 PARATYPHOID FEVER B

S36292A OTHER INJURY OF TAIL OF PANCREAS INITIAL ENCOUNTER

A013 PARATYPHOID FEVER C

S36299A OTHER INJURY OF UNSPECIFIED PART OF PANCREAS INIT ENCNTR

A014 PARATYPHOID FEVER UNSPECIFIED

S3630XA

UNSPECIFIED INJURY OF STOMACH INITIAL ENCOUNTER

A020 SALMONELLA ENTERITIS

S3632XA CONTUSION OF STOMACH INITIAL ENCOUNTER

A021 SALMONELLA SEPSIS

S3633XA LACERATION OF STOMACH INITIAL ENCOUNTER

A0220 LOCALIZED SALMONELLA INFECTION UNSPECIFIED

S3639XA

OTHER INJURY OF STOMACH INITIAL ENCOUNTER

A0221 SALMONELLA MENINGITIS

S36400A UNSPECIFIED INJURY OF DUODENUM INITIAL ENCOUNTER

Page 5: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A0222 SALMONELLA PNEUMONIA

S36408A UNSP INJURY OF OTHER PART OF SMALL INTESTINE INIT ENCNTR

A0223 SALMONELLA ARTHRITIS

S36409A UNSP INJURY OF UNSP PART OF SMALL INTESTINE INIT ENCNTR

A0224 SALMONELLA OSTEOMYELITIS

S36410A PRIMARY BLAST INJURY OF DUODENUM INITIAL ENCOUNTER

A0225 SALMONELLA PYELONEPHRITIS

S36418A PRIMARY BLAST INJURY OTH PRT SMALL INTESTINE INIT ENCNTR

A0229 SALMONELLA WITH OTHER LOCALIZED INFECTION

S36419A

PRIMARY BLAST INJURY OF UNSP PART OF SMALL INTESTINE INIT

A028 OTHER SPECIFIED SALMONELLA INFECTIONS

S36420A

CONTUSION OF DUODENUM INITIAL ENCOUNTER

A029 SALMONELLA INFECTION UNSPECIFIED

S36428A

CONTUSION OF OTHER PART OF SMALL INTESTINE INIT ENCNTR

A030 SHIGELLOSIS DUE TO SHIGELLA DYSENTERIAE

S36429A

CONTUSION OF UNSP PART OF SMALL INTESTINE INIT ENCNTR

A031 SHIGELLOSIS DUE TO SHIGELLA FLEXNERI

S36430A

LACERATION OF DUODENUM INITIAL ENCOUNTER

A032 SHIGELLOSIS DUE TO SHIGELLA BOYDII

S36438A

LACERATION OF OTHER PART OF SMALL INTESTINE INIT ENCNTR

A033 SHIGELLOSIS DUE TO SHIGELLA SONNEI

S36439A

LACERATION OF UNSP PART OF SMALL INTESTINE INIT ENCNTR

A038 OTHER SHIGELLOSIS

S36490A OTHER INJURY OF DUODENUM INITIAL ENCOUNTER

A039 SHIGELLOSIS UNSPECIFIED

S36498A OTHER INJURY OF OTHER PART OF SMALL INTESTINE INIT ENCNTR

A040 ENTEROPATHOGENIC ESCHERICHIA COLI INFECTION

S36499A

OTHER INJURY OF UNSP PART OF SMALL INTESTINE INIT ENCNTR

A041 ENTEROTOXIGENIC ESCHERICHIA COLI INFECTION

S36500A

UNSPECIFIED INJURY OF ASCENDING COLON INITIAL ENCOUNTER

A042 ENTEROINVASIVE ESCHERICHIA COLI INFECTION

S36501A

UNSPECIFIED INJURY OF TRANSVERSE COLON INITIAL ENCOUNTER

A043 ENTEROHEMORRHAGIC ESCHERICHIA COLI INFECTION

S36502A

UNSPECIFIED INJURY OF DESCENDING COLON INITIAL ENCOUNTER

Page 6: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A044 OTHER INTESTINAL ESCHERICHIA COLI INFECTIONS

S36503A

UNSPECIFIED INJURY OF SIGMOID COLON INITIAL ENCOUNTER

A045 CAMPYLOBACTER ENTERITIS

S36508A UNSPECIFIED INJURY OF OTHER PART OF COLON INITIAL ENCOUNTER

A046 ENTERITIS DUE TO YERSINIA ENTEROCOLITICA

S36509A

UNSPECIFIED INJURY OF UNSPECIFIED PART OF COLON INIT ENCNTR

A047 ENTEROCOLITIS DUE TO CLOSTRIDIUM DIFFICILE

S36510A

PRIMARY BLAST INJURY OF ASCENDING COLON INITIAL ENCOUNTER

A048 OTHER SPECIFIED BACTERIAL INTESTINAL INFECTIONS

S36511A

PRIMARY BLAST INJURY OF TRANSVERSE COLON INITIAL ENCOUNTER

A049 BACTERIAL INTESTINAL INFECTION UNSPECIFIED

S36512A

PRIMARY BLAST INJURY OF DESCENDING COLON INITIAL ENCOUNTER

A050 FOODBORNE STAPHYLOCOCCAL INTOXICATION

S36513A

PRIMARY BLAST INJURY OF SIGMOID COLON INITIAL ENCOUNTER

A051 BOTULISM FOOD POISONING

S36518A PRIMARY BLAST INJURY OF OTHER PART OF COLON INIT ENCNTR

A052 FOODBORNE CLOSTRIDIUM PERFRINGENS INTOXICATION

S36519A

PRIMARY BLAST INJURY OF UNSP PART OF COLON INIT ENCNTR

A053

FOODBORNE VIBRIO PARAHAEMOLYTICUS INTOXICATION

S36520A

CONTUSION OF ASCENDING [RIGHT] COLON INITIAL ENCOUNTER

A054 FOODBORNE BACILLUS CEREUS INTOXICATION

S36521A

CONTUSION OF TRANSVERSE COLON INITIAL ENCOUNTER

A055 FOODBORNE VIBRIO VULNIFICUS INTOXICATION

S36522A

CONTUSION OF DESCENDING [LEFT] COLON INITIAL ENCOUNTER

A058 OTHER SPECIFIED BACTERIAL FOODBORNE INTOXICATIONS

S36523A

CONTUSION OF SIGMOID COLON INITIAL ENCOUNTER

A059 BACTERIAL FOODBORNE INTOXICATION UNSPECIFIED

S36528A

CONTUSION OF OTHER PART OF COLON INITIAL ENCOUNTER

Page 7: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A060 ACUTE AMEBIC DYSENTERY

S36529A CONTUSION OF UNSPECIFIED PART OF COLON INITIAL ENCOUNTER

A061 CHRONIC INTESTINAL AMEBIASIS

S36530A

LACERATION OF ASCENDING [RIGHT] COLON INITIAL ENCOUNTER

A062 AMEBIC NONDYSENTERIC COLITIS

S36531A

LACERATION OF TRANSVERSE COLON INITIAL ENCOUNTER

A063 AMEBOMA OF INTESTINE

S36532A LACERATION OF DESCENDING [LEFT] COLON INITIAL ENCOUNTER

A064 AMEBIC LIVER ABSCESS

S36533A LACERATION OF SIGMOID COLON INITIAL ENCOUNTER

A065 AMEBIC LUNG ABSCESS

S36538A LACERATION OF OTHER PART OF COLON INITIAL ENCOUNTER

A066 AMEBIC BRAIN ABSCESS

S36539A LACERATION OF UNSPECIFIED PART OF COLON INITIAL ENCOUNTER

A067 CUTANEOUS AMEBIASIS

S36590A OTHER INJURY OF ASCENDING [RIGHT] COLON INITIAL ENCOUNTER

A0681 AMEBIC CYSTITIS

S36591A OTHER INJURY OF TRANSVERSE COLON INITIAL ENCOUNTER

A0682 OTHER AMEBIC GENITOURINARY INFECTIONS

S36592A

OTHER INJURY OF DESCENDING [LEFT] COLON INITIAL ENCOUNTER

A0689 OTHER AMEBIC INFECTIONS

S36593A OTHER INJURY OF SIGMOID COLON INITIAL ENCOUNTER

A069 AMEBIASIS UNSPECIFIED

S36598A OTHER INJURY OF OTHER PART OF COLON INITIAL ENCOUNTER

A070 BALANTIDIASIS

S36599A OTHER INJURY OF UNSPECIFIED PART OF COLON INITIAL ENCOUNTER

A071 GIARDIASIS [LAMBLIASIS]

S3660XA UNSPECIFIED INJURY OF RECTUM INITIAL ENCOUNTER

A072 CRYPTOSPORIDIOSIS

S3661XA PRIMARY BLAST INJURY OF RECTUM INITIAL ENCOUNTER

Page 8: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A073 ISOSPORIASIS

S3662XA CONTUSION OF RECTUM INITIAL ENCOUNTER

A074 CYCLOSPORIASIS

S3663XA LACERATION OF RECTUM INITIAL ENCOUNTER

A078 OTHER SPECIFIED PROTOZOAL INTESTINAL DISEASES

S3669XA

OTHER INJURY OF RECTUM INITIAL ENCOUNTER

A079 PROTOZOAL INTESTINAL DISEASE UNSPECIFIED

S3681XA

INJURY OF PERITONEUM INITIAL ENCOUNTER

A080 ROTAVIRAL ENTERITIS

S36892A

CONTUSION OF OTHER INTRA-ABDOMINAL ORGANS INITIAL ENCOUNTER

A0811 ACUTE GASTROENTEROPATHY DUE TO NORWALK AGENT

S36893A

LACERATION OF OTHER INTRA-ABDOMINAL ORGANS INIT ENCNTR

A0819

ACUTE GASTROENTEROPATHY DUE TO OTHER SMALL ROUND VIRUSES

S36898A

OTHER INJURY OF OTHER INTRA-ABDOMINAL ORGANS INIT ENCNTR

A082 ADENOVIRAL ENTERITIS

S36899A UNSP INJURY OF OTHER INTRA-ABDOMINAL ORGANS INIT ENCNTR

A0831 CALICIVIRUS ENTERITIS

S3690XA UNSP INJURY OF UNSP INTRA-ABDOMINAL ORGAN INIT ENCNTR

A0832 ASTROVIRUS ENTERITIS

S3692XA CONTUSION OF UNSPECIFIED INTRA-ABDOMINAL ORGAN INIT ENCNTR

A0839 OTHER VIRAL ENTERITIS

S3693XA LACERATION OF UNSPECIFIED INTRA-ABDOMINAL ORGAN INIT ENCNTR

A084 VIRAL INTESTINAL INFECTION UNSPECIFIED

S3699XA

OTHER INJURY OF UNSP INTRA-ABDOMINAL ORGAN INIT ENCNTR

A088 OTHER SPECIFIED INTESTINAL INFECTIONS

S37001A

UNSPECIFIED INJURY OF RIGHT KIDNEY INITIAL ENCOUNTER

A09 INFECTIOUS GASTROENTERITIS AND COLITIS UNSPECIFIED

S37002A

UNSPECIFIED INJURY OF LEFT KIDNEY INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A150 TUBERCULOSIS OF LUNG

S37009A UNSPECIFIED INJURY OF UNSPECIFIED KIDNEY INITIAL ENCOUNTER

A154 TUBERCULOSIS OF INTRATHORACIC LYMPH NODES

S37011A

MINOR CONTUSION OF RIGHT KIDNEY INITIAL ENCOUNTER

A155 TUBERCULOSIS OF LARYNX TRACHEA AND BRONCHUS

S37012A

MINOR CONTUSION OF LEFT KIDNEY INITIAL ENCOUNTER

A156 TUBERCULOUS PLEURISY

S37019A MINOR CONTUSION OF UNSPECIFIED KIDNEY INITIAL ENCOUNTER

A157 PRIMARY RESPIRATORY TUBERCULOSIS

S37021A

MAJOR CONTUSION OF RIGHT KIDNEY INITIAL ENCOUNTER

A158 OTHER RESPIRATORY TUBERCULOSIS

S37022A

MAJOR CONTUSION OF LEFT KIDNEY INITIAL ENCOUNTER

A159 RESPIRATORY TUBERCULOSIS UNSPECIFIED

S37029A

MAJOR CONTUSION OF UNSPECIFIED KIDNEY INITIAL ENCOUNTER

A170 TUBERCULOUS MENINGITIS

S37031A LACERATION OF RIGHT KIDNEY UNSPECIFIED DEGREE INIT ENCNTR

A171 MENINGEAL TUBERCULOMA

S37032A LACERATION OF LEFT KIDNEY UNSPECIFIED DEGREE INIT ENCNTR

A1781 TUBERCULOMA OF BRAIN AND SPINAL CORD

S37039A

LACERATION OF UNSP KIDNEY UNSPECIFIED DEGREE INIT ENCNTR

A1782 TUBERCULOUS MENINGOENCEPHALITIS

S37041A

MINOR LACERATION OF RIGHT KIDNEY INITIAL ENCOUNTER

A1783 TUBERCULOUS NEURITIS

S37042A MINOR LACERATION OF LEFT KIDNEY INITIAL ENCOUNTER

A1789 OTHER TUBERCULOSIS OF NERVOUS SYSTEM

S37049A

MINOR LACERATION OF UNSPECIFIED KIDNEY INITIAL ENCOUNTER

A179 TUBERCULOSIS OF NERVOUS SYSTEM UNSPECIFIED

S37051A

MODERATE LACERATION OF RIGHT KIDNEY INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A1801 TUBERCULOSIS OF SPINE

S37052A MODERATE LACERATION OF LEFT KIDNEY INITIAL ENCOUNTER

A1802 TUBERCULOUS ARTHRITIS OF OTHER JOINTS

S37059A

MODERATE LACERATION OF UNSPECIFIED KIDNEY INITIAL ENCOUNTER

A1803 TUBERCULOSIS OF OTHER BONES

S37061A

MAJOR LACERATION OF RIGHT KIDNEY INITIAL ENCOUNTER

A1809 OTHER MUSCULOSKELETAL TUBERCULOSIS

S37062A

MAJOR LACERATION OF LEFT KIDNEY INITIAL ENCOUNTER

A1810

TUBERCULOSIS OF GENITOURINARY SYSTEM UNSPECIFIED

S37069A

MAJOR LACERATION OF UNSPECIFIED KIDNEY INITIAL ENCOUNTER

A1811 TUBERCULOSIS OF KIDNEY AND URETER

S37091A

OTHER INJURY OF RIGHT KIDNEY INITIAL ENCOUNTER

A1812 TUBERCULOSIS OF BLADDER

S37092A OTHER INJURY OF LEFT KIDNEY INITIAL ENCOUNTER

A1813 TUBERCULOSIS OF OTHER URINARY ORGANS

S37099A

OTHER INJURY OF UNSPECIFIED KIDNEY INITIAL ENCOUNTER

A1814 TUBERCULOSIS OF PROSTATE

S3710XA UNSPECIFIED INJURY OF URETER INITIAL ENCOUNTER

A1815 TUBERCULOSIS OF OTHER MALE GENITAL ORGANS

S3712XA

CONTUSION OF URETER INITIAL ENCOUNTER

A1816 TUBERCULOSIS OF CERVIX

S3713XA LACERATION OF URETER INITIAL ENCOUNTER

A1817 TUBERCULOUS FEMALE PELVIC INFLAMMATORY DISEASE

S3719XA

OTHER INJURY OF URETER INITIAL ENCOUNTER

A1818 TUBERCULOSIS OF OTHER FEMALE GENITAL ORGANS

S3720XA

UNSPECIFIED INJURY OF BLADDER INITIAL ENCOUNTER

A182 TUBERCULOUS PERIPHERAL LYMPHADENOPATHY

S3722XA

CONTUSION OF BLADDER INITIAL ENCOUNTER

A1831 TUBERCULOUS PERITONITIS

S3723XA LACERATION OF BLADDER INITIAL ENCOUNTER

A1832 TUBERCULOUS ENTERITIS

S3729XA OTHER INJURY OF BLADDER INITIAL ENCOUNTER

A1839 RETROPERITONEAL TUBERCULOSIS

S3730XA

UNSPECIFIED INJURY OF URETHRA INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A184 TUBERCULOSIS OF SKIN AND SUBCUTANEOUS TISSUE

S3732XA

CONTUSION OF URETHRA INITIAL ENCOUNTER

A1850 TUBERCULOSIS OF EYE UNSPECIFIED

S3733XA

LACERATION OF URETHRA INITIAL ENCOUNTER

A1851 TUBERCULOUS EPISCLERITIS

S3739XA OTHER INJURY OF URETHRA INITIAL ENCOUNTER

A1852 TUBERCULOUS KERATITIS

S37401A UNSPECIFIED INJURY OF OVARY UNILATERAL INITIAL ENCOUNTER

A1853 TUBERCULOUS CHORIORETINITIS

S37421A

CONTUSION OF OVARY UNILATERAL INITIAL ENCOUNTER

A1854 TUBERCULOUS IRIDOCYCLITIS

S37421D CONTUSION OF OVARY UNILATERAL SUBSEQUENT ENCOUNTER

A1859 OTHER TUBERCULOSIS OF EYE

S37422A CONTUSION OF OVARY BILATERAL INITIAL ENCOUNTER

A186 TUBERCULOSIS OF (INNER) (MIDDLE) EAR

S37429A

CONTUSION OF OVARY UNSPECIFIED INITIAL ENCOUNTER

A187 TUBERCULOSIS OF ADRENAL GLANDS

S37431A

LACERATION OF OVARY UNILATERAL INITIAL ENCOUNTER

A1881 TUBERCULOSIS OF THYROID GLAND

S37432A

LACERATION OF OVARY BILATERAL INITIAL ENCOUNTER

A1882 TUBERCULOSIS OF OTHER ENDOCRINE GLANDS

S37439A

LACERATION OF OVARY UNSPECIFIED INITIAL ENCOUNTER

A1883 TUBERCULOSIS OF DIGESTIVE TRACT ORGANS NEC

S37491A

OTHER INJURY OF OVARY UNILATERAL INITIAL ENCOUNTER

A1884 TUBERCULOSIS OF HEART

S37492A OTHER INJURY OF OVARY BILATERAL INITIAL ENCOUNTER

A1885 TUBERCULOSIS OF SPLEEN

S37499A OTHER INJURY OF OVARY UNSPECIFIED INITIAL ENCOUNTER

A1889 TUBERCULOSIS OF OTHER SITES

S37501A UNSP INJURY OF FALLOPIAN TUBE UNILATERAL INIT ENCNTR

A190 ACUTE MILIARY TUBERCULOSIS OF A SINGLE SPECIFIED SITE

S37502A

UNSPECIFIED INJURY OF FALLOPIAN TUBE BILATERAL INIT ENCNTR

A191 ACUTE MILIARY TUBERCULOSIS OF MULTIPLE SITES

S37509A

UNSP INJURY OF FALLOPIAN TUBE UNSPECIFIED INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A192 ACUTE MILIARY TUBERCULOSIS UNSPECIFIED

S37511A

PRIMARY BLAST INJURY OF FALLOPIAN TUBE UNILATERAL INIT

A198 OTHER MILIARY TUBERCULOSIS

S37512A PRIMARY BLAST INJURY OF FALLOPIAN TUBE BILATERAL INIT

A199 MILIARY TUBERCULOSIS UNSPECIFIED

S37519A

PRIMARY BLAST INJURY OF FALLOPIAN TUBE UNSP INIT ENCNTR

A200 BUBONIC PLAGUE

S37521A CONTUSION OF FALLOPIAN TUBE UNILATERAL INITIAL ENCOUNTER

A201 CELLULOCUTANEOUS PLAGUE

S37522A CONTUSION OF FALLOPIAN TUBE BILATERAL INITIAL ENCOUNTER

A202 PNEUMONIC PLAGUE

S37529A CONTUSION OF FALLOPIAN TUBE UNSPECIFIED INITIAL ENCOUNTER

A203 PLAGUE MENINGITIS

S37531A LACERATION OF FALLOPIAN TUBE UNILATERAL INITIAL ENCOUNTER

A207 SEPTICEMIC PLAGUE

S37532A LACERATION OF FALLOPIAN TUBE BILATERAL INITIAL ENCOUNTER

A208 OTHER FORMS OF PLAGUE

S37539A LACERATION OF FALLOPIAN TUBE UNSPECIFIED INITIAL ENCOUNTER

A209 PLAGUE UNSPECIFIED

S37591A OTHER INJURY OF FALLOPIAN TUBE UNILATERAL INIT ENCNTR

A210 ULCEROGLANDULAR TULAREMIA

S37592A

OTHER INJURY OF FALLOPIAN TUBE BILATERAL INITIAL ENCOUNTER

A211 OCULOGLANDULAR TULAREMIA

S37599A OTHER INJURY OF FALLOPIAN TUBE UNSPECIFIED INIT ENCNTR

A212 PULMONARY TULAREMIA

S3760XA UNSPECIFIED INJURY OF UTERUS INITIAL ENCOUNTER

A213 GASTROINTESTINAL TULAREMIA

S3762XA

CONTUSION OF UTERUS INITIAL ENCOUNTER

A217 GENERALIZED TULAREMIA

S3763XA LACERATION OF UTERUS INITIAL ENCOUNTER

A218 OTHER FORMS OF TULAREMIA

S3769XA OTHER INJURY OF UTERUS INITIAL ENCOUNTER

A219 TULAREMIA UNSPECIFIED

S37812A CONTUSION OF ADRENAL GLAND INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A220 CUTANEOUS ANTHRAX

S37813A LACERATION OF ADRENAL GLAND INITIAL ENCOUNTER

A221 PULMONARY ANTHRAX

S37818A OTHER INJURY OF ADRENAL GLAND INITIAL ENCOUNTER

A222 GASTROINTESTINAL ANTHRAX

S37819A UNSPECIFIED INJURY OF ADRENAL GLAND INITIAL ENCOUNTER

A227 ANTHRAX SEPSIS

S37822A CONTUSION OF PROSTATE INITIAL ENCOUNTER

A228 OTHER FORMS OF ANTHRAX

S37823A LACERATION OF PROSTATE INITIAL ENCOUNTER

A229 ANTHRAX UNSPECIFIED

S37828A OTHER INJURY OF PROSTATE INITIAL ENCOUNTER

A230 BRUCELLOSIS DUE TO BRUCELLA MELITENSIS

S37829A

UNSPECIFIED INJURY OF PROSTATE INITIAL ENCOUNTER

A231 BRUCELLOSIS DUE TO BRUCELLA ABORTUS

S37892A

CONTUSION OF OTHER URINARY AND PELVIC ORGAN INIT ENCNTR

A232 BRUCELLOSIS DUE TO BRUCELLA SUIS

S37893A

LACERATION OF OTHER URINARY AND PELVIC ORGAN INIT ENCNTR

A233 BRUCELLOSIS DUE TO BRUCELLA CANIS

S37898A

OTHER INJURY OF OTHER URINARY AND PELVIC ORGAN INIT ENCNTR

A238 OTHER BRUCELLOSIS

S37899A UNSP INJURY OF OTHER URINARY AND PELVIC ORGAN INIT ENCNTR

A239 BRUCELLOSIS UNSPECIFIED

S3790XA UNSP INJURY OF UNSP URINARY AND PELVIC ORGAN INIT ENCNTR

A240 GLANDERS

S3792XA CONTUSION OF UNSP URINARY AND PELVIC ORGAN INIT ENCNTR

A241 ACUTE AND FULMINATING MELIOIDOSIS

S3793XA

LACERATION OF UNSP URINARY AND PELVIC ORGAN INIT ENCNTR

A242 SUBACUTE AND CHRONIC MELIOIDOSIS

S3799XA

OTHER INJURY OF UNSP URINARY AND PELVIC ORGAN INIT ENCNTR

A243 OTHER MELIOIDOSIS

S38001A CRUSHING INJURY OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

A249 MELIOIDOSIS UNSPECIFIED

S38002A CRUSHING INJ UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

A250 SPIRILLOSIS

S3801XA CRUSHING INJURY OF PENIS INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A251 STREPTOBACILLOSIS

S3802XA CRUSHING INJURY OF SCROTUM AND TESTIS INITIAL ENCOUNTER

A259 RAT-BITE FEVER UNSPECIFIED

S3803XA CRUSHING INJURY OF VULVA INITIAL ENCOUNTER

A270 LEPTOSPIROSIS ICTEROHEMORRHAGICA

S381XXA

CRUSHING INJURY OF ABDOMEN LOWER BACK AND PELVIS INIT

A2781 ASEPTIC MENINGITIS IN LEPTOSPIROSIS

S38211A

COMPLETE TRAUM AMP OF FEMALE EXTERNAL GENITAL ORGANS INIT

A2789 OTHER FORMS OF LEPTOSPIROSIS

S38212A

PARTIAL TRAUM AMP OF FEMALE EXTERNAL GENITAL ORGANS INIT

A279 LEPTOSPIROSIS UNSPECIFIED

S38221A COMPLETE TRAUMATIC AMPUTATION OF PENIS INITIAL ENCOUNTER

A280 PASTEURELLOSIS

S38222A PARTIAL TRAUMATIC AMPUTATION OF PENIS INITIAL ENCOUNTER

A281 CAT-SCRATCH DISEASE

S38231A COMPLETE TRAUMATIC AMPUTATION OF SCROTUM AND TESTIS INIT

A282 EXTRAINTESTINAL YERSINIOSIS

S38232A PARTIAL TRAUMATIC AMPUTATION OF SCROTUM AND TESTIS INIT

A288

OTH ZOONOTIC BACTERIAL DISEASES NOT ELSEWHERE CLASSIFIED

S383XXA

TRANSECTION (PARTIAL) OF ABDOMEN INITIAL ENCOUNTER

A289 ZOONOTIC BACTERIAL DISEASE UNSPECIFIED

S39001A

UNSP INJURY OF MUSCLE FASCIA AND TENDON OF ABDOMEN INIT

A301 TUBERCULOID LEPROSY

S39002A UNSP INJURY OF MUSCLE FASCIA AND TENDON OF LOWER BACK INIT

A310 PULMONARY MYCOBACTERIAL INFECTION

S39003A

UNSP INJURY OF MUSCLE FASCIA AND TENDON OF PELVIS INIT

A312

DISSEM MYCOBACTERIUM AVIUM-INTRACELLULARE COMPLEX (DMAC)

S39021A

LACERATION OF MUSCLE FASCIA AND TENDON OF ABDOMEN INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A318 OTHER MYCOBACTERIAL INFECTIONS

S39022A

LACERATION OF MUSCLE FASCIA AND TENDON OF LOWER BACK INIT

A319 MYCOBACTERIAL INFECTION UNSPECIFIED

S39023A

LACERATION OF MUSCLE FASCIA AND TENDON OF PELVIS INIT

A3211 LISTERIAL MENINGITIS

S39091A INJ MUSCLE FASCIA AND TENDON OF ABDOMEN INIT ENCNTR

A3212 LISTERIAL MENINGOENCEPHALITIS

S39092A

INJ MUSCLE FASCIA AND TENDON OF LOWER BACK INIT ENCNTR

A327 LISTERIAL SEPSIS

S39093A INJ MUSCLE FASCIA AND TENDON OF PELVIS INIT ENCNTR

A3281 OCULOGLANDULAR LISTERIOSIS

S3981XA OTHER SPECIFIED INJURIES OF ABDOMEN INITIAL ENCOUNTER

A3282 LISTERIAL ENDOCARDITIS

S3983XA OTHER SPECIFIED INJURIES OF PELVIS INITIAL ENCOUNTER

A3289 OTHER FORMS OF LISTERIOSIS

S39840A FRACTURE OF CORPUS CAVERNOSUM PENIS INITIAL ENCOUNTER

A329 LISTERIOSIS UNSPECIFIED

S39848A OTHER SPECIFIED INJURIES OF EXTERNAL GENITALS INIT ENCNTR

A33 TETANUS NEONATORUM

S3991XA UNSPECIFIED INJURY OF ABDOMEN INITIAL ENCOUNTER

A34 OBSTETRICAL TETANUS

S3992XA UNSPECIFIED INJURY OF LOWER BACK INITIAL ENCOUNTER

A35 OTHER TETANUS

S3993XA UNSPECIFIED INJURY OF PELVIS INITIAL ENCOUNTER

A360 PHARYNGEAL DIPHTHERIA

S3994XA UNSPECIFIED INJURY OF EXTERNAL GENITALS INITIAL ENCOUNTER

A361 NASOPHARYNGEAL DIPHTHERIA

S40011A CONTUSION OF RIGHT SHOULDER INITIAL ENCOUNTER

A362 LARYNGEAL DIPHTHERIA

S40012A CONTUSION OF LEFT SHOULDER INITIAL ENCOUNTER

A363 CUTANEOUS DIPHTHERIA

S40019A CONTUSION OF UNSPECIFIED SHOULDER INITIAL ENCOUNTER

A3681 DIPHTHERITIC CARDIOMYOPATHY

S40021A

CONTUSION OF RIGHT UPPER ARM INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A3682 DIPHTHERITIC RADICULOMYELITIS

S40022A

CONTUSION OF LEFT UPPER ARM INITIAL ENCOUNTER

A3683 DIPHTHERITIC POLYNEURITIS

S40029A CONTUSION OF UNSPECIFIED UPPER ARM INITIAL ENCOUNTER

A3684 DIPHTHERITIC TUBULO-INTERSTITIAL NEPHROPATHY

S40241A

EXTERNAL CONSTRICTION OF RIGHT SHOULDER INITIAL ENCOUNTER

A3685 DIPHTHERITIC CYSTITIS

S40242A EXTERNAL CONSTRICTION OF LEFT SHOULDER INITIAL ENCOUNTER

A3686 DIPHTHERITIC CONJUNCTIVITIS

S40249A EXTERNAL CONSTRICTION OF UNSPECIFIED SHOULDER INIT ENCNTR

A3689 OTHER DIPHTHERITIC COMPLICATIONS

S40841A

EXTERNAL CONSTRICTION OF RIGHT UPPER ARM INITIAL ENCOUNTER

A369 DIPHTHERIA UNSPECIFIED

S40842A EXTERNAL CONSTRICTION OF LEFT UPPER ARM INITIAL ENCOUNTER

A3700

WHOOPING COUGH DUE TO BORDETELLA PERTUSSIS WITHOUT PNEUMONIA

S40849A

EXTERNAL CONSTRICTION OF UNSPECIFIED UPPER ARM INIT ENCNTR

A3701

WHOOPING COUGH DUE TO BORDETELLA PERTUSSIS WITH PNEUMONIA

S41001A

UNSPECIFIED OPEN WOUND OF RIGHT SHOULDER INITIAL ENCOUNTER

A3710

WHOOPING COUGH DUE TO BORDETELLA PARAPERTUSSIS W/O PNEUMONIA

S41002A

UNSPECIFIED OPEN WOUND OF LEFT SHOULDER INITIAL ENCOUNTER

A3711

WHOOPING COUGH DUE TO BORDETELLA PARAPERTUSSIS W PNEUMONIA

S41009A

UNSPECIFIED OPEN WOUND OF UNSPECIFIED SHOULDER INIT ENCNTR

A3780

WHOOPING COUGH DUE TO OTHER BORDETELLA SPECIES W/O PNEUMONIA

S41011A

LACERATION W/O FOREIGN BODY OF RIGHT SHOULDER INIT ENCNTR

A3781

WHOOPING COUGH DUE TO OTH BORDETELLA SPECIES WITH PNEUMONIA

S41012A

LACERATION W/O FOREIGN BODY OF LEFT SHOULDER INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A3790

WHOOPING COUGH UNSPECIFIED SPECIES WITHOUT PNEUMONIA

S41019A

LACERATION W/O FOREIGN BODY OF UNSP SHOULDER INIT ENCNTR

A3791

WHOOPING COUGH UNSPECIFIED SPECIES WITH PNEUMONIA

S41021A

LACERATION WITH FOREIGN BODY OF RIGHT SHOULDER INIT ENCNTR

A381 SCARLET FEVER WITH MYOCARDITIS

S41022A

LACERATION WITH FOREIGN BODY OF LEFT SHOULDER INIT ENCNTR

A388 SCARLET FEVER WITH OTHER COMPLICATIONS

S41029A

LACERATION WITH FOREIGN BODY OF UNSP SHOULDER INIT ENCNTR

A390 MENINGOCOCCAL MENINGITIS

S41031A PUNCTURE WOUND W/O FOREIGN BODY OF RIGHT SHOULDER INIT

A391 WATERHOUSE-FRIDERICHSEN SYNDROME

S41032A

PUNCTURE WOUND W/O FOREIGN BODY OF LEFT SHOULDER INIT

A392 ACUTE MENINGOCOCCEMIA

S41039A PUNCTURE WOUND W/O FOREIGN BODY OF UNSP SHOULDER INIT

A393 CHRONIC MENINGOCOCCEMIA

S41041A PUNCTURE WOUND W FOREIGN BODY OF RIGHT SHOULDER INIT ENCNTR

A394 MENINGOCOCCEMIA UNSPECIFIED

S41042A

PUNCTURE WOUND W FOREIGN BODY OF LEFT SHOULDER INIT ENCNTR

A3950 MENINGOCOCCAL CARDITIS UNSPECIFIED

S41049A

PUNCTURE WOUND W FOREIGN BODY OF UNSP SHOULDER INIT ENCNTR

A3951 MENINGOCOCCAL ENDOCARDITIS

S41051A

OPEN BITE OF RIGHT SHOULDER INITIAL ENCOUNTER

A3952 MENINGOCOCCAL MYOCARDITIS

S41052A

OPEN BITE OF LEFT SHOULDER INITIAL ENCOUNTER

A3953 MENINGOCOCCAL PERICARDITIS

S41059A

OPEN BITE OF UNSPECIFIED SHOULDER INITIAL ENCOUNTER

A3981 MENINGOCOCCAL ENCEPHALITIS

S41101A

UNSPECIFIED OPEN WOUND OF RIGHT UPPER ARM INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A3982 MENINGOCOCCAL RETROBULBAR NEURITIS

S41102A

UNSPECIFIED OPEN WOUND OF LEFT UPPER ARM INITIAL ENCOUNTER

A3983 MENINGOCOCCAL ARTHRITIS

S41109A

UNSPECIFIED OPEN WOUND OF UNSPECIFIED UPPER ARM INIT ENCNTR

A3984 POSTMENINGOCOCCAL ARTHRITIS

S41111A

LACERATION W/O FOREIGN BODY OF RIGHT UPPER ARM INIT ENCNTR

A3989 OTHER MENINGOCOCCAL INFECTIONS

S41112A

LACERATION W/O FOREIGN BODY OF LEFT UPPER ARM INIT ENCNTR

A399 MENINGOCOCCAL INFECTION UNSPECIFIED

S41119A

LACERATION W/O FOREIGN BODY OF UNSP UPPER ARM INIT ENCNTR

A400 SEPSIS DUE TO STREPTOCOCCUS GROUP A

S41121A

LACERATION WITH FOREIGN BODY OF RIGHT UPPER ARM INIT ENCNTR

A401 SEPSIS DUE TO STREPTOCOCCUS GROUP B

S41122A

LACERATION WITH FOREIGN BODY OF LEFT UPPER ARM INIT ENCNTR

A403 SEPSIS DUE TO STREPTOCOCCUS PNEUMONIAE

S41129A

LACERATION WITH FOREIGN BODY OF UNSP UPPER ARM INIT ENCNTR

A408 OTHER STREPTOCOCCAL SEPSIS

S41131A PUNCTURE WOUND W/O FOREIGN BODY OF RIGHT UPPER ARM INIT

A409 STREPTOCOCCAL SEPSIS UNSPECIFIED

S41132A

PUNCTURE WOUND W/O FOREIGN BODY OF LEFT UPPER ARM INIT

A411 SEPSIS DUE TO OTHER SPECIFIED STAPHYLOCOCCUS

S41139A

PUNCTURE WOUND W/O FOREIGN BODY OF UNSP UPPER ARM INIT

A412 SEPSIS DUE TO UNSPECIFIED STAPHYLOCOCCUS

S41141A

PUNCTURE WOUND W FOREIGN BODY OF RIGHT UPPER ARM INIT

A413 SEPSIS DUE TO HEMOPHILUS INFLUENZAE

S41142A

PUNCTURE WOUND W FOREIGN BODY OF LEFT UPPER ARM INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A414 SEPSIS DUE TO ANAEROBES

S41149A PUNCTURE WOUND W FOREIGN BODY OF UNSP UPPER ARM INIT ENCNTR

A4150 GRAM-NEGATIVE SEPSIS UNSPECIFIED

S41151A

OPEN BITE OF RIGHT UPPER ARM INITIAL ENCOUNTER

A4151 SEPSIS DUE TO ESCHERICHIA COLI [E. COLI]

S41152A

OPEN BITE OF LEFT UPPER ARM INITIAL ENCOUNTER

A4152 SEPSIS DUE TO PSEUDOMONAS

S41159A OPEN BITE OF UNSPECIFIED UPPER ARM INITIAL ENCOUNTER

A4153 SEPSIS DUE TO SERRATIA

S42001A FRACTURE OF UNSP PART OF RIGHT CLAVICLE INIT FOR CLOS FX

A4159 OTHER GRAM-NEGATIVE SEPSIS

S42001B FRACTURE OF UNSP PART OF RIGHT CLAVICLE INIT FOR OPN FX

A4181 SEPSIS DUE TO ENTEROCOCCUS

S42002A FRACTURE OF UNSP PART OF LEFT CLAVICLE INIT FOR CLOS FX

A4189 OTHER SPECIFIED SEPSIS

S42002B FRACTURE OF UNSP PART OF LEFT CLAVICLE INIT FOR OPN FX

A419 SEPSIS UNSPECIFIED ORGANISM

S42009A FRACTURE OF UNSP PART OF UNSP CLAVICLE INIT FOR CLOS FX

A420 PULMONARY ACTINOMYCOSIS

S42009B FRACTURE OF UNSP PART OF UNSP CLAVICLE INIT FOR OPN FX

A421 ABDOMINAL ACTINOMYCOSIS

S42011A ANTERIOR DISP FX OF STERNAL END OF RIGHT CLAVICLE INIT

A422 CERVICOFACIAL ACTINOMYCOSIS

S42011B

ANT DISP FX OF STERNAL END OF R CLAVICLE INIT FOR OPN FX

A427 ACTINOMYCOTIC SEPSIS

S42012A ANTERIOR DISP FX OF STERNAL END OF LEFT CLAVICLE INIT

A4281 ACTINOMYCOTIC MENINGITIS

S42012B ANT DISP FX OF STERNAL END OF L CLAVICLE INIT FOR OPN FX

A4282 ACTINOMYCOTIC ENCEPHALITIS

S42013A ANTERIOR DISP FX OF STERNAL END OF UNSP CLAVICLE INIT

A4289 OTHER FORMS OF ACTINOMYCOSIS

S42013B

ANT DISP FX OF STERNAL END OF UNSP CLAVICLE INIT FOR OPN FX

A429 ACTINOMYCOSIS UNSPECIFIED

S42014A POSTERIOR DISP FX OF STERNAL END OF RIGHT CLAVICLE INIT

A430 PULMONARY NOCARDIOSIS

S42014B POST DISP FX OF STERNAL END OF R CLAVICLE INIT FOR OPN FX

Page 20: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A431 CUTANEOUS NOCARDIOSIS

S42014S POSTERIOR DISP FX OF STERNAL END OF RIGHT CLAVICLE SEQUELA

A438 OTHER FORMS OF NOCARDIOSIS

S42015A

POSTERIOR DISP FX OF STERNAL END OF LEFT CLAVICLE INIT

A439 NOCARDIOSIS UNSPECIFIED

S42015B POST DISP FX OF STERNAL END OF L CLAVICLE INIT FOR OPN FX

A440 SYSTEMIC BARTONELLOSIS

S42016A POSTERIOR DISP FX OF STERNAL END OF UNSP CLAVICLE INIT

A441

CUTANEOUS AND MUCOCUTANEOUS BARTONELLOSIS

S42016B

POST DISP FX OF STERNAL END UNSP CLAVICLE INIT FOR OPN FX

A448 OTHER FORMS OF BARTONELLOSIS

S42017A

NONDISP FX OF STERNAL END OF RIGHT CLAVICLE INIT

A449 BARTONELLOSIS UNSPECIFIED

S42017B NONDISP FX OF STERNAL END OF RIGHT CLAVICLE INIT FOR OPN FX

A46 ERYSIPELAS

S42018A NONDISP FX OF STERNAL END OF LEFT CLAVICLE INIT FOR CLOS FX

A480 GAS GANGRENE

S42018B NONDISP FX OF STERNAL END OF LEFT CLAVICLE INIT FOR OPN FX

A481 LEGIONNAIRES' DISEASE

S42019A NONDISP FX OF STERNAL END OF UNSP CLAVICLE INIT FOR CLOS FX

A482

NONPNEUMONIC LEGIONNAIRES' DISEASE [PONTIAC FEVER]

S42019B

NONDISP FX OF STERNAL END OF UNSP CLAVICLE INIT FOR OPN FX

A483 TOXIC SHOCK SYNDROME

S42021A DISP FX OF SHAFT OF RIGHT CLAVICLE INIT FOR CLOS FX

A484 BRAZILIAN PURPURIC FEVER

S42021B DISP FX OF SHAFT OF RIGHT CLAVICLE INIT FOR OPN FX

A4851 INFANT BOTULISM

S42022A DISP FX OF SHAFT OF LEFT CLAVICLE INIT FOR CLOS FX

A4852 WOUND BOTULISM

S42022B DISP FX OF SHAFT OF LEFT CLAVICLE INIT FOR OPN FX

A488 OTHER SPECIFIED BACTERIAL DISEASES

S42023A

DISP FX OF SHAFT OF UNSP CLAVICLE INIT FOR CLOS FX

A491 STREPTOCOCCAL INFECTION UNSPECIFIED SITE

S42023B

DISP FX OF SHAFT OF UNSP CLAVICLE INIT FOR OPN FX

Page 21: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A492 HEMOPHILUS INFLUENZAE INFECTION UNSPECIFIED SITE

S42024A

NONDISP FX OF SHAFT OF RIGHT CLAVICLE INIT FOR CLOS FX

A493 MYCOPLASMA INFECTION UNSPECIFIED SITE

S42024B

NONDISP FX OF SHAFT OF RIGHT CLAVICLE INIT FOR OPN FX

A498 OTHER BACTERIAL INFECTIONS OF UNSPECIFIED SITE

S42025A

NONDISP FX OF SHAFT OF LEFT CLAVICLE INIT FOR CLOS FX

A499 BACTERIAL INFECTION UNSPECIFIED

S42025B

NONDISP FX OF SHAFT OF LEFT CLAVICLE INIT FOR OPN FX

A5001 EARLY CONGENITAL SYPHILITIC OCULOPATHY

S42026A

NONDISP FX OF SHAFT OF UNSP CLAVICLE INIT FOR CLOS FX

A5002 EARLY CONGENITAL SYPHILITIC OSTEOCHONDROPATHY

S42026B

NONDISP FX OF SHAFT OF UNSP CLAVICLE INIT FOR OPN FX

A5003 EARLY CONGENITAL SYPHILITIC PHARYNGITIS

S42031A

DISP FX OF LATERAL END OF RIGHT CLAVICLE INIT FOR CLOS FX

A5004 EARLY CONGENITAL SYPHILITIC PNEUMONIA

S42031G

DISP FX OF LATERAL END R CLAVICLE SUBS FOR FX W DELAY HEAL

A5005 EARLY CONGENITAL SYPHILITIC RHINITIS

S42031S

DISPLACED FRACTURE OF LATERAL END OF RIGHT CLAVICLE SEQUELA

A5006 EARLY CUTANEOUS CONGENITAL SYPHILIS

S42032D

DISP FX OF LATERAL END L CLAVICLE SUBS FOR FX W ROUTN HEAL

A5007 EARLY MUCOCUTANEOUS CONGENITAL SYPHILIS

S42032P

DISP FX OF LATERAL END OF L CLAVICLE SUBS FOR FX W MALUNION

A5008 EARLY VISCERAL CONGENITAL SYPHILIS

S42033B

DISP FX OF LATERAL END OF UNSP CLAVICLE INIT FOR OPN FX

A5009 OTHER EARLY CONGENITAL SYPHILIS SYMPTOMATIC

S42033K

DISP FX OF LATERAL END UNSP CLAVICLE SUBS FOR FX W NONUNION

A501 EARLY CONGENITAL SYPHILIS LATENT

S42034A

NONDISP FX OF LATERAL END OF RIGHT CLAVICLE INIT

A502 EARLY CONGENITAL SYPHILIS UNSPECIFIED

S42034G

NONDISP FX OF LATERAL END R CLAVICLE 7THG

Page 22: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A5030 LATE CONGENITAL SYPHILITIC OCULOPATHY UNSPECIFIED

S42034S

NONDISP FX OF LATERAL END OF RIGHT CLAVICLE SEQUELA

A5031 LATE CONGENITAL SYPHILITIC INTERSTITIAL KERATITIS

S42035D

NONDISP FX OF LATERAL END L CLAVICLE 7THD

A5032 LATE CONGENITAL SYPHILITIC CHORIORETINITIS

S42035P

NONDISP FX OF LATERAL END L CLAVICLE SUBS FOR FX W MALUNION

A5039 OTHER LATE CONGENITAL SYPHILITIC OCULOPATHY

S42036A

NONDISP FX OF LATERAL END OF UNSP CLAVICLE INIT FOR CLOS FX

A5040 LATE CONGENITAL NEUROSYPHILIS UNSPECIFIED

S42036B

NONDISP FX OF LATERAL END OF UNSP CLAVICLE INIT FOR OPN FX

A5041 LATE CONGENITAL SYPHILITIC MENINGITIS

S42036K

NONDISP FX OF LATERAL END UNSP CLAVICLE 7THK

A5042 LATE CONGENITAL SYPHILITIC ENCEPHALITIS

S42101A

FRACTURE OF UNSP PART OF SCAPULA RIGHT SHOULDER INIT

A750

EPIDEMIC LOUSE-BORNE TYPHUS FEVER D/T RICKETTSIA PROWAZEKII

S42101G

FX UNSP PART OF SCAPULA R SHLDR SUBS FOR FX W DELAY HEAL

A751 RECRUDESCENT TYPHUS [BRILL'S DISEASE]

S42101S

FRACTURE OF UNSP PART OF SCAPULA RIGHT SHOULDER SEQUELA

A752 TYPHUS FEVER DUE TO RICKETTSIA TYPHI

S42102D

FX UNSP PART OF SCAPULA L SHLDR SUBS FOR FX W ROUTN HEAL

A753 TYPHUS FEVER DUE TO RICKETTSIA TSUTSUGAMUSHI

S42102P

FX UNSP PART OF SCAPULA L SHOULDER SUBS FOR FX W MALUNION

A759 TYPHUS FEVER UNSPECIFIED

S42109B FX UNSP PART OF SCAPULA UNSP SHOULDER INIT FOR OPN FX

A770 SPOTTED FEVER DUE TO RICKETTSIA RICKETTSII

S42109K

FX UNSP PART OF SCAPULA UNSP SHLDR SUBS FOR FX W NONUNION

A771 SPOTTED FEVER DUE TO RICKETTSIA CONORII

S42111A

DISP FX OF BODY OF SCAPULA RIGHT SHOULDER INIT FOR CLOS FX

Page 23: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A772 SPOTTED FEVER DUE TO RICKETTSIA SIBERICA

S42111B

DISP FX OF BODY OF SCAPULA RIGHT SHOULDER INIT FOR OPN FX

A773 SPOTTED FEVER DUE TO RICKETTSIA AUSTRALIS

S42112A

DISP FX OF BODY OF SCAPULA LEFT SHOULDER INIT FOR CLOS FX

A7740 EHRLICHIOSIS UNSPECIFIED

S42112B DISP FX OF BODY OF SCAPULA LEFT SHOULDER INIT FOR OPN FX

A7741 EHRLICHIOSIS CHAFEENSIS [E. CHAFEENSIS]

S42113A

DISP FX OF BODY OF SCAPULA UNSP SHOULDER INIT FOR CLOS FX

A7749 OTHER EHRLICHIOSIS

S42113B DISP FX OF BODY OF SCAPULA UNSP SHOULDER INIT FOR OPN FX

A778 OTHER SPOTTED FEVERS

S42114A NONDISP FX OF BODY OF SCAPULA RIGHT SHOULDER INIT

A779 SPOTTED FEVER UNSPECIFIED

S42114B NONDISP FX OF BODY OF SCAPULA R SHOULDER INIT FOR OPN FX

A78 Q FEVER

S42115A NONDISP FX OF BODY OF SCAPULA LEFT SHOULDER INIT

A790 TRENCH FEVER

S42115B NONDISP FX OF BODY OF SCAPULA L SHOULDER INIT FOR OPN FX

A800

ACUTE PARALYTIC POLIOMYELITIS VACCINE-ASSOCIATED

S42116A

NONDISP FX OF BODY OF SCAPULA UNSP SHOULDER INIT

A801

ACUTE PARALYTIC POLIOMYELITIS WILD VIRUS IMPORTED

S42116B

NONDISP FX OF BODY OF SCAPULA UNSP SHLDR INIT FOR OPN FX

A802

ACUTE PARALYTIC POLIOMYELITIS WILD VIRUS INDIGENOUS

S42121A

DISP FX OF ACROMIAL PROCESS RIGHT SHOULDER INIT

A8030 ACUTE PARALYTIC POLIOMYELITIS UNSPECIFIED

S42121B

DISP FX OF ACROMIAL PROCESS RIGHT SHOULDER INIT FOR OPN FX

A8039 OTHER ACUTE PARALYTIC POLIOMYELITIS

S42122A

DISP FX OF ACROMIAL PROCESS LEFT SHOULDER INIT FOR CLOS FX

Page 24: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A804 ACUTE NONPARALYTIC POLIOMYELITIS

S42122B

DISP FX OF ACROMIAL PROCESS LEFT SHOULDER INIT FOR OPN FX

A809 ACUTE POLIOMYELITIS UNSPECIFIED

S42123A

DISP FX OF ACROMIAL PROCESS UNSP SHOULDER INIT FOR CLOS FX

A8100 CREUTZFELDT-JAKOB DISEASE UNSPECIFIED

S42123B

DISP FX OF ACROMIAL PROCESS UNSP SHOULDER INIT FOR OPN FX

A8101 VARIANT CREUTZFELDT-JAKOB DISEASE

S42124A

NONDISP FX OF ACROMIAL PROCESS RIGHT SHOULDER INIT

A8109 OTHER CREUTZFELDT-JAKOB DISEASE

S42124B

NONDISP FX OF ACROMIAL PROCESS R SHOULDER INIT FOR OPN FX

A811 SUBACUTE SCLEROSING PANENCEPHALITIS

S42125A

NONDISP FX OF ACROMIAL PROCESS LEFT SHOULDER INIT

A812 PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY

S42125B

NONDISP FX OF ACROMIAL PROCESS L SHOULDER INIT FOR OPN FX

A8181 KURU

S42126A NONDISP FX OF ACROMIAL PROCESS UNSP SHOULDER INIT

A8182 GERSTMANN-STRAUSSLER-SCHEINKER SYNDROME

S42126B

NONDISP FX OF ACROMIAL PROCESS UNSP SHLDR INIT FOR OPN FX

A8183 FATAL FAMILIAL INSOMNIA

S42131A DISP FX OF CORACOID PROCESS RIGHT SHOULDER INIT

A8189

OTHER ATYPICAL VIRUS INFECTIONS OF CENTRAL NERVOUS SYSTEM

S42131B

DISP FX OF CORACOID PROCESS RIGHT SHOULDER INIT FOR OPN FX

A819

ATYPICAL VIRUS INFECTION OF CENTRAL NERVOUS SYSTEM UNSP

S42132A

DISP FX OF CORACOID PROCESS LEFT SHOULDER INIT FOR CLOS FX

A820 SYLVATIC RABIES

S42132B DISP FX OF CORACOID PROCESS LEFT SHOULDER INIT FOR OPN FX

A821 URBAN RABIES

S42133A DISP FX OF CORACOID PROCESS UNSP SHOULDER INIT FOR CLOS FX

A829 RABIES UNSPECIFIED

S42133B DISP FX OF CORACOID PROCESS UNSP SHOULDER INIT FOR OPN FX

Page 25: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A830 JAPANESE ENCEPHALITIS

S42134A NONDISP FX OF CORACOID PROCESS RIGHT SHOULDER INIT

A831 WESTERN EQUINE ENCEPHALITIS

S42134B

NONDISP FX OF CORACOID PROCESS R SHOULDER INIT FOR OPN FX

A832 EASTERN EQUINE ENCEPHALITIS

S42135A NONDISP FX OF CORACOID PROCESS LEFT SHOULDER INIT

A833 ST LOUIS ENCEPHALITIS

S42135B NONDISP FX OF CORACOID PROCESS L SHOULDER INIT FOR OPN FX

A834 AUSTRALIAN ENCEPHALITIS

S42136A NONDISP FX OF CORACOID PROCESS UNSP SHOULDER INIT

A835 CALIFORNIA ENCEPHALITIS

S42136B NONDISP FX OF CORACOID PROCESS UNSP SHLDR INIT FOR OPN FX

A836 ROCIO VIRUS DISEASE

S42141A DISP FX OF GLENOID CAVITY OF SCAPULA RIGHT SHOULDER INIT

A838 OTHER MOSQUITO-BORNE VIRAL ENCEPHALITIS

S42141B

DISP FX OF GLENOID CAV OF SCAPULA R SHLDR INIT FOR OPN FX

A839 MOSQUITO-BORNE VIRAL ENCEPHALITIS UNSPECIFIED

S42142A

DISP FX OF GLENOID CAVITY OF SCAPULA LEFT SHOULDER INIT

A840 FAR EASTERN TICK-BORNE ENCEPHALITIS

S42142B

DISP FX OF GLENOID CAV OF SCAPULA L SHLDR INIT FOR OPN FX

A841 CENTRAL EUROPEAN TICK-BORNE ENCEPHALITIS

S42143A

DISP FX OF GLENOID CAVITY OF SCAPULA UNSP SHOULDER INIT

A848 OTHER TICK-BORNE VIRAL ENCEPHALITIS

S42143B

DISP FX OF GLENOID CAV OF SCAPULA UNSP SHLDR 7THB

A849 TICK-BORNE VIRAL ENCEPHALITIS UNSPECIFIED

S42144A

NONDISP FX OF GLENOID CAV OF SCAPULA RIGHT SHOULDER INIT

A850 ENTEROVIRAL ENCEPHALITIS

S42144B NONDISP FX OF GLENOID CAV OF SCAPULA R SHLDR 7THB

A851 ADENOVIRAL ENCEPHALITIS

S42145A NONDISP FX OF GLENOID CAVITY OF SCAPULA LEFT SHOULDER INIT

A852 ARTHROPOD-BORNE VIRAL ENCEPHALITIS UNSPECIFIED

S42145B

NONDISP FX OF GLENOID CAV OF SCAPULA L SHLDR 7THB

Page 26: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A858 OTHER SPECIFIED VIRAL ENCEPHALITIS

S42146A

NONDISP FX OF GLENOID CAVITY OF SCAPULA UNSP SHOULDER INIT

A86 UNSPECIFIED VIRAL ENCEPHALITIS

S42146B

NONDISP FX OF GLENOID CAV OF SCAPULA UNSP SHLDR 7THB

A870 ENTEROVIRAL MENINGITIS

S42151A DISP FX OF NECK OF SCAPULA RIGHT SHOULDER INIT FOR CLOS FX

A871 ADENOVIRAL MENINGITIS

S42151B DISP FX OF NECK OF SCAPULA RIGHT SHOULDER INIT FOR OPN FX

A872 LYMPHOCYTIC CHORIOMENINGITIS

S42152A

DISP FX OF NECK OF SCAPULA LEFT SHOULDER INIT FOR CLOS FX

A878 OTHER VIRAL MENINGITIS

S42152B DISP FX OF NECK OF SCAPULA LEFT SHOULDER INIT FOR OPN FX

A879 VIRAL MENINGITIS UNSPECIFIED

S42153A

DISP FX OF NECK OF SCAPULA UNSP SHOULDER INIT FOR CLOS FX

A888

OTHER SPECIFIED VIRAL INFECTIONS OF CENTRAL NERVOUS SYSTEM

S42153B

DISP FX OF NECK OF SCAPULA UNSP SHOULDER INIT FOR OPN FX

A89 UNSPECIFIED VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM

S42154A

NONDISP FX OF NECK OF SCAPULA RIGHT SHOULDER INIT

A9231 WEST NILE VIRUS INFECTION WITH ENCEPHALITIS

S42154B

NONDISP FX OF NECK OF SCAPULA R SHOULDER INIT FOR OPN FX

A9232

WEST NILE VIRUS INFECTION WITH OTH NEUROLOGIC MANIFESTATION

S42155A

NONDISP FX OF NECK OF SCAPULA LEFT SHOULDER INIT

A9239 WEST NILE VIRUS INFECTION WITH OTHER COMPLICATIONS

S42155B

NONDISP FX OF NECK OF SCAPULA L SHOULDER INIT FOR OPN FX

A924 RIFT VALLEY FEVER

S42156A NONDISP FX OF NECK OF SCAPULA UNSP SHOULDER INIT

A928 OTHER SPECIFIED MOSQUITO-BORNE VIRAL FEVERS

S42156B

NONDISP FX OF NECK OF SCAPULA UNSP SHLDR INIT FOR OPN FX

Page 27: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

A929 MOSQUITO-BORNE VIRAL FEVER UNSPECIFIED

S42191A

FRACTURE OF OTH PART OF SCAPULA RIGHT SHOULDER INIT

A930 OROPOUCHE VIRUS DISEASE

S42191B FRACTURE OTH PRT SCAPULA RIGHT SHOULDER INIT FOR OPN FX

A984 EBOLA VIRUS DISEASE

S42192A FRACTURE OF OTH PART OF SCAPULA LEFT SHOULDER INIT

A985 HEMORRHAGIC FEVER WITH RENAL SYNDROME

S42192B

FRACTURE OTH PRT SCAPULA LEFT SHOULDER INIT FOR OPN FX

A988 OTHER SPECIFIED VIRAL HEMORRHAGIC FEVERS

S42199A

FRACTURE OF OTH PART OF SCAPULA UNSP SHOULDER INIT

A99 UNSPECIFIED VIRAL HEMORRHAGIC FEVER

S42199B

FRACTURE OTH PRT SCAPULA UNSP SHOULDER INIT FOR OPN FX

B003 HERPESVIRAL MENINGITIS

S42201A UNSP FRACTURE OF UPPER END OF RIGHT HUMERUS INIT

B004 HERPESVIRAL ENCEPHALITIS

S42201B UNSP FRACTURE OF UPPER END OF RIGHT HUMERUS INIT FOR OPN FX

B0050 HERPESVIRAL OCULAR DISEASE UNSPECIFIED

S42202A

UNSP FRACTURE OF UPPER END OF LEFT HUMERUS INIT FOR CLOS FX

B0051 HERPESVIRAL IRIDOCYCLITIS

S42202B UNSP FRACTURE OF UPPER END OF LEFT HUMERUS INIT FOR OPN FX

B010 VARICELLA MENINGITIS

S42209A UNSP FRACTURE OF UPPER END OF UNSP HUMERUS INIT FOR CLOS FX

B0111 VARICELLA ENCEPHALITIS AND ENCEPHALOMYELITIS

S42209B

UNSP FRACTURE OF UPPER END OF UNSP HUMERUS INIT FOR OPN FX

B0112 VARICELLA MYELITIS

S42211A UNSP DISP FX OF SURGICAL NECK OF RIGHT HUMERUS INIT

B0189 OTHER VARICELLA COMPLICATIONS

S42211B

UNSP DISP FX OF SURGICAL NECK OF R HUMERUS INIT FOR OPN FX

B020 ZOSTER ENCEPHALITIS

S42212A UNSP DISP FX OF SURGICAL NECK OF LEFT HUMERUS INIT

Page 28: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

B021 ZOSTER MENINGITIS

S42212B UNSP DISP FX OF SURGICAL NECK OF L HUMERUS INIT FOR OPN FX

B0221 POSTHERPETIC GENICULATE GANGLIONITIS

S42213A

UNSP DISP FX OF SURGICAL NECK OF UNSP HUMERUS INIT

B050 MEASLES COMPLICATED BY ENCEPHALITIS

S42213B

UNSP DISP FX OF SURG NECK OF UNSP HUMERUS INIT FOR OPN FX

B051 MEASLES COMPLICATED BY MENINGITIS

S42214A

UNSP NONDISP FX OF SURGICAL NECK OF RIGHT HUMERUS INIT

B052 MEASLES COMPLICATED BY PNEUMONIA

S42214B

UNSP NONDISP FX OF SURG NECK OF R HUMERUS INIT FOR OPN FX

B0601 RUBELLA ENCEPHALITIS

S42215A UNSP NONDISP FX OF SURGICAL NECK OF LEFT HUMERUS INIT

B0602 RUBELLA MENINGITIS

S42215B UNSP NONDISP FX OF SURG NECK OF L HUMERUS INIT FOR OPN FX

B0609 OTHER NEUROLOGICAL COMPLICATIONS OF RUBELLA

S42216A

UNSP NONDISP FX OF SURGICAL NECK OF UNSP HUMERUS INIT

B0681 RUBELLA PNEUMONIA

S42216B UNSP NONDISP FX OF SURG NECK OF UNSP HUMER INIT FOR OPN FX

B0689 OTHER RUBELLA COMPLICATIONS

S42221A

2-PART DISP FX OF SURGICAL NECK OF RIGHT HUMERUS INIT

B08011 VACCINIA NOT FROM VACCINE

S42221B 2-PART DISP FX OF SURG NECK OF R HUMERUS INIT FOR OPN FX

B1009 OTHER HUMAN HERPESVIRUS ENCEPHALITIS

S42222A

2-PART DISP FX OF SURGICAL NECK OF LEFT HUMERUS INIT

B150 HEPATITIS A WITH HEPATIC COMA

S42222B

2-PART DISP FX OF SURG NECK OF L HUMERUS INIT FOR OPN FX

B159 HEPATITIS A WITHOUT HEPATIC COMA

S42223A

2-PART DISP FX OF SURGICAL NECK OF UNSP HUMERUS INIT

B160

ACUTE HEPATITIS B WITH DELTA-AGENT WITH HEPATIC COMA

S42223B

2-PART DISP FX OF SURG NECK OF UNSP HUMERUS INIT FOR OPN FX

B1711 ACUTE HEPATITIS C WITH HEPATIC COMA

S42224A

2-PART NONDISP FX OF SURGICAL NECK OF RIGHT HUMERUS INIT

B190 UNSPECIFIED VIRAL HEPATITIS WITH HEPATIC COMA

S42224B

2-PART NONDISP FX OF SURG NECK OF R HUMERUS INIT FOR OPN FX

Page 29: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

B261 MUMPS MENINGITIS

S42225A 2-PART NONDISP FX OF SURGICAL NECK OF LEFT HUMERUS INIT

B262 MUMPS ENCEPHALITIS

S42225B 2-PART NONDISP FX OF SURG NECK OF L HUMERUS INIT FOR OPN FX

B263 MUMPS PANCREATITIS

S42226A 2-PART NONDISP FX OF SURGICAL NECK OF UNSP HUMERUS INIT

B2701

GAMMAHERPESVIRAL MONONUCLEOSIS WITH POLYNEUROPATHY

S42226B

2-PART NONDISP FX OF SURG NK OF UNSP HUMER INIT FOR OPN FX

B2702

GAMMAHERPESVIRAL MONONUCLEOSIS WITH MENINGITIS

S42231A

3-PART FRACTURE OF SURGICAL NECK OF RIGHT HUMERUS INIT

B2712

CYTOMEGALOVIRAL MONONUCLEOSIS WITH MENINGITIS

S42231B

3-PART FX SURGICAL NECK OF R HUMERUS INIT FOR OPN FX

B2719

CYTOMEGALOVIRAL MONONUCLEOSIS WITH OTHER COMPLICATION

S42232A

3-PART FRACTURE OF SURGICAL NECK OF LEFT HUMERUS INIT

B2781

OTHER INFECTIOUS MONONUCLEOSIS WITH POLYNEUROPATHY

S42232B

3-PART FX SURGICAL NECK OF L HUMERUS INIT FOR OPN FX

B2782

OTHER INFECTIOUS MONONUCLEOSIS WITH MENINGITIS

S42239A

3-PART FRACTURE OF SURGICAL NECK OF UNSP HUMERUS INIT

B2789

OTHER INFECTIOUS MONONUCLEOSIS WITH OTHER COMPLICATION

S42239B

3-PART FX SURGICAL NECK OF UNSP HUMERUS INIT FOR OPN FX

B2792 INFECTIOUS MONONUCLEOSIS UNSPECIFIED WITH MENINGITIS

S42241A

4-PART FRACTURE OF SURGICAL NECK OF RIGHT HUMERUS INIT

B2799

INFECTIOUS MONONUCLEOSIS UNSP WITH OTHER COMPLICATION

S42241B

4-PART FX SURGICAL NECK OF R HUMERUS INIT FOR OPN FX

B3320 VIRAL CARDITIS UNSPECIFIED

S42242A 4-PART FRACTURE OF SURGICAL NECK OF LEFT HUMERUS INIT

Page 30: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

B3321 VIRAL ENDOCARDITIS

S42242B 4-PART FX SURGICAL NECK OF L HUMERUS INIT FOR OPN FX

B3322 VIRAL MYOCARDITIS

S42249A 4-PART FRACTURE OF SURGICAL NECK OF UNSP HUMERUS INIT

B3323 VIRAL PERICARDITIS

S42249B 4-PART FX SURGICAL NECK OF UNSP HUMERUS INIT FOR OPN FX

B3324 VIRAL CARDIOMYOPATHY

S42251A DISP FX OF GREATER TUBEROSITY OF RIGHT HUMERUS INIT

B334

HANTAVIRUS (CARDIO)-PULMONARY SYNDROME [HPS] [HCPS]

S42251B

DISP FX OF GREATER TUBEROSITY OF R HUMERUS INIT FOR OPN FX

B349 VIRAL INFECTION UNSPECIFIED

S42252A DISP FX OF GREATER TUBEROSITY OF LEFT HUMERUS INIT

B375 CANDIDAL MENINGITIS

S42252B DISP FX OF GREATER TUBEROSITY OF L HUMERUS INIT FOR OPN FX

B376 CANDIDAL ENDOCARDITIS

S42253A DISP FX OF GREATER TUBEROSITY OF UNSP HUMERUS INIT

B377 CANDIDAL SEPSIS

S42253B DISP FX OF GREATER TUBEROSITY OF UNSP HUMER INIT FOR OPN FX

B380 ACUTE PULMONARY COCCIDIOIDOMYCOSIS

S42254A

NONDISP FX OF GREATER TUBEROSITY OF RIGHT HUMERUS INIT

B384 COCCIDIOIDOMYCOSIS MENINGITIS

S42254B

NONDISP FX OF GREATER TUBEROSITY OF R HUMER INIT FOR OPN FX

B387 DISSEMINATED COCCIDIOIDOMYCOSIS

S42255A

NONDISP FX OF GREATER TUBEROSITY OF LEFT HUMERUS INIT

B390 ACUTE PULMONARY HISTOPLASMOSIS CAPSULATI

S42255B

NONDISP FX OF GREATER TUBEROSITY OF L HUMER INIT FOR OPN FX

B400 ACUTE PULMONARY BLASTOMYCOSIS

S42256A

NONDISP FX OF GREATER TUBEROSITY OF UNSP HUMERUS INIT

B4081 BLASTOMYCOTIC MENINGOENCEPHALITIS

S42256B

NONDISP FX OF GREATER TUBEROSITY OF UNSP HUMER 7THB

Page 31: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

B4281 CEREBRAL SPOROTRICHOSIS

S42261A DISP FX OF LESSER TUBEROSITY OF RIGHT HUMERUS INIT

B431 PHEOMYCOTIC BRAIN ABSCESS

S42261B DISP FX OF LESSER TUBEROSITY OF R HUMERUS INIT FOR OPN FX

B451 CEREBRAL CRYPTOCOCCOSIS

S42262A DISP FX OF LESSER TUBEROSITY OF LEFT HUMERUS INIT

B5741 MENINGITIS IN CHAGAS' DISEASE

S42262B

DISP FX OF LESSER TUBEROSITY OF L HUMERUS INIT FOR OPN FX

B5742 MENINGOENCEPHALITIS IN CHAGAS' DISEASE

S42263A

DISP FX OF LESSER TUBEROSITY OF UNSP HUMERUS INIT

B582 TOXOPLASMA MENINGOENCEPHALITIS

S42263B

DISP FX OF LESSER TUBEROSITY OF UNSP HUMER INIT FOR OPN FX

B6011

MENINGOENCEPHALITIS DUE TO ACANTHAMOEBA (CULBERTSONI)

S42264A

NONDISP FX OF LESSER TUBEROSITY OF RIGHT HUMERUS INIT

C50011

MALIGNANT NEOPLASM OF NIPPLE AND AREOLA RIGHT FEMALE BREAST

S42264B

NONDISP FX OF LESSER TUBEROSITY OF R HUMER INIT FOR OPN FX

C50012

MALIGNANT NEOPLASM OF NIPPLE AND AREOLA LEFT FEMALE BREAST

S42265A

NONDISP FX OF LESSER TUBEROSITY OF LEFT HUMERUS INIT

C50019

MALIGNANT NEOPLASM OF NIPPLE AND AREOLA UNSP FEMALE BREAST

S42265B

NONDISP FX OF LESSER TUBEROSITY OF L HUMER INIT FOR OPN FX

C50021

MALIGNANT NEOPLASM OF NIPPLE AND AREOLA RIGHT MALE BREAST

S42266A

NONDISP FX OF LESSER TUBEROSITY OF UNSP HUMERUS INIT

C50022

MALIGNANT NEOPLASM OF NIPPLE AND AREOLA LEFT MALE BREAST

S42266B

NONDISP FX OF LESS TUBEROSITY OF UNSP HUMER INIT FOR OPN FX

C50029

MALIGNANT NEOPLASM OF NIPPLE AND AREOLA UNSP MALE BREAST

S42271A

TORUS FRACTURE OF UPPER END OF RIGHT HUMERUS INIT

C50111

MALIGNANT NEOPLASM OF CENTRAL PORTION OF RIGHT FEMALE BREAST

S42272A

TORUS FRACTURE OF UPPER END OF LEFT HUMERUS INIT

Page 32: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

C50112

MALIGNANT NEOPLASM OF CENTRAL PORTION OF LEFT FEMALE BREAST

S42279A

TORUS FRACTURE OF UPPER END OF UNSP HUMERUS INIT

C50119

MALIGNANT NEOPLASM OF CENTRAL PORTION OF UNSP FEMALE BREAST

S42291A

OTH DISP FX OF UPPER END OF RIGHT HUMERUS INIT FOR CLOS FX

C50121

MALIGNANT NEOPLASM OF CENTRAL PORTION OF RIGHT MALE BREAST

S42291B

OTH DISP FX OF UPPER END OF RIGHT HUMERUS INIT FOR OPN FX

C50122

MALIGNANT NEOPLASM OF CENTRAL PORTION OF LEFT MALE BREAST

S42292A

OTH DISP FX OF UPPER END OF LEFT HUMERUS INIT FOR CLOS FX

C50129

MALIGNANT NEOPLASM OF CENTRAL PORTION OF UNSP MALE BREAST

S42292B

OTH DISP FX OF UPPER END OF LEFT HUMERUS INIT FOR OPN FX

C50211

MALIG NEOPLM OF UPPER-INNER QUADRANT OF RIGHT FEMALE BREAST

S42293A

OTH DISP FX OF UPPER END OF UNSP HUMERUS INIT FOR CLOS FX

C50212

MALIG NEOPLASM OF UPPER-INNER QUADRANT OF LEFT FEMALE BREAST

S42293B

OTH DISP FX OF UPPER END OF UNSP HUMERUS INIT FOR OPN FX

C50219

MALIG NEOPLASM OF UPPER-INNER QUADRANT OF UNSP FEMALE BREAST

S42294A

OTH NONDISP FX OF UPPER END OF RIGHT HUMERUS INIT

C50221

MALIG NEOPLASM OF UPPER-INNER QUADRANT OF RIGHT MALE BREAST

S42294B

OTH NONDISP FX OF UPPER END OF R HUMERUS INIT FOR OPN FX

C50222

MALIG NEOPLASM OF UPPER-INNER QUADRANT OF LEFT MALE BREAST

S42295A

OTH NONDISP FX OF UPPER END OF LEFT HUMERUS INIT

C50229

MALIG NEOPLASM OF UPPER-INNER QUADRANT OF UNSP MALE BREAST

S42295B

OTH NONDISP FX OF UPPER END OF LEFT HUMERUS INIT FOR OPN FX

C50311

MALIG NEOPLM OF LOWER-INNER QUADRANT OF RIGHT FEMALE BREAST

S42296A

OTH NONDISP FX OF UPPER END OF UNSP HUMERUS INIT

Page 33: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

C50312

MALIG NEOPLASM OF LOWER-INNER QUADRANT OF LEFT FEMALE BREAST

S42296B

OTH NONDISP FX OF UPPER END OF UNSP HUMERUS INIT FOR OPN FX

C50319

MALIG NEOPLASM OF LOWER-INNER QUADRANT OF UNSP FEMALE BREAST

S42301A

UNSP FRACTURE OF SHAFT OF HUMERUS RIGHT ARM INIT

C50321

MALIG NEOPLASM OF LOWER-INNER QUADRANT OF RIGHT MALE BREAST

S42301B

UNSP FX SHAFT OF HUMERUS RIGHT ARM INIT FOR OPN FX

C50322

MALIG NEOPLASM OF LOWER-INNER QUADRANT OF LEFT MALE BREAST

S42302A

UNSP FRACTURE OF SHAFT OF HUMERUS LEFT ARM INIT

C50329

MALIG NEOPLASM OF LOWER-INNER QUADRANT OF UNSP MALE BREAST

S42302B

UNSP FRACTURE OF SHAFT OF HUMERUS LEFT ARM INIT FOR OPN FX

C50411

MALIG NEOPLM OF UPPER-OUTER QUADRANT OF RIGHT FEMALE BREAST

S42309A

UNSP FRACTURE OF SHAFT OF HUMERUS UNSP ARM INIT

C50412

MALIG NEOPLASM OF UPPER-OUTER QUADRANT OF LEFT FEMALE BREAST

S42309B

UNSP FRACTURE OF SHAFT OF HUMERUS UNSP ARM INIT FOR OPN FX

C50419

MALIG NEOPLASM OF UPPER-OUTER QUADRANT OF UNSP FEMALE BREAST

S42311A

GREENSTICK FRACTURE OF SHAFT OF HUMERUS RIGHT ARM INIT

C50421

MALIG NEOPLASM OF UPPER-OUTER QUADRANT OF RIGHT MALE BREAST

S42312A

GREENSTICK FRACTURE OF SHAFT OF HUMERUS LEFT ARM INIT

C50422

MALIG NEOPLASM OF UPPER-OUTER QUADRANT OF LEFT MALE BREAST

S42319A

GREENSTICK FRACTURE OF SHAFT OF HUMERUS UNSP ARM INIT

C50429

MALIG NEOPLASM OF UPPER-OUTER QUADRANT OF UNSP MALE BREAST

S42321A

DISPLACED TRANSVERSE FX SHAFT OF HUMERUS RIGHT ARM INIT

C50511

MALIG NEOPLM OF LOWER-OUTER QUADRANT OF RIGHT FEMALE BREAST

S42321B

DISPL TRANSVERSE FX SHAFT OF HUMER R ARM INIT FOR OPN FX

Page 34: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

C50512

MALIG NEOPLASM OF LOWER-OUTER QUADRANT OF LEFT FEMALE BREAST

S42322A

DISPLACED TRANSVERSE FX SHAFT OF HUMERUS LEFT ARM INIT

C50519

MALIG NEOPLASM OF LOWER-OUTER QUADRANT OF UNSP FEMALE BREAST

S42322B

DISPL TRANSVERSE FX SHAFT OF HUMER L ARM INIT FOR OPN FX

C50521

MALIG NEOPLASM OF LOWER-OUTER QUADRANT OF RIGHT MALE BREAST

S42323A

DISPLACED TRANSVERSE FX SHAFT OF HUMERUS UNSP ARM INIT

C50522

MALIG NEOPLASM OF LOWER-OUTER QUADRANT OF LEFT MALE BREAST

S42323B

DISPL TRANSVERSE FX SHAFT OF HUMER UNSP ARM 7THB

C50529

MALIG NEOPLASM OF LOWER-OUTER QUADRANT OF UNSP MALE BREAST

S42324A

NONDISP TRANSVERSE FX SHAFT OF HUMERUS RIGHT ARM INIT

C50611

MALIGNANT NEOPLASM OF AXILLARY TAIL OF RIGHT FEMALE BREAST

S42324B

NONDISP TRANSVERSE FX SHAFT OF HUMER R ARM INIT FOR OPN FX

C50612

MALIGNANT NEOPLASM OF AXILLARY TAIL OF LEFT FEMALE BREAST

S42325A

NONDISP TRANSVERSE FX SHAFT OF HUMERUS LEFT ARM INIT

C50619

MALIGNANT NEOPLASM OF AXILLARY TAIL OF UNSP FEMALE BREAST

S42325B

NONDISP TRANSVERSE FX SHAFT OF HUMER L ARM INIT FOR OPN FX

C50621

MALIGNANT NEOPLASM OF AXILLARY TAIL OF RIGHT MALE BREAST

S42326A

NONDISP TRANSVERSE FX SHAFT OF HUMERUS UNSP ARM INIT

C50622

MALIGNANT NEOPLASM OF AXILLARY TAIL OF LEFT MALE BREAST

S42326B

NONDISP TRANSVERSE FX SHAFT OF HUMER UNSP ARM 7THB

C50629

MALIGNANT NEOPLASM OF AXILLARY TAIL OF UNSP MALE BREAST

S42331A

DISPLACED OBLIQUE FX SHAFT OF HUMERUS RIGHT ARM INIT

C50811

MALIGNANT NEOPLASM OF OVRLP SITES OF RIGHT FEMALE BREAST

S42331B

DISPL OBLIQUE FX SHAFT OF HUMER RIGHT ARM INIT FOR OPN FX

Page 35: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

C50812

MALIGNANT NEOPLASM OF OVRLP SITES OF LEFT FEMALE BREAST

S42332A

DISPLACED OBLIQUE FX SHAFT OF HUMERUS LEFT ARM INIT

C50819

MALIGNANT NEOPLASM OF OVRLP SITES OF UNSP FEMALE BREAST

S42332B

DISPL OBLIQUE FX SHAFT OF HUMERUS LEFT ARM INIT FOR OPN FX

C50821

MALIGNANT NEOPLASM OF OVERLAPPING SITES OF RIGHT MALE BREAST

S42333A

DISPLACED OBLIQUE FX SHAFT OF HUMERUS UNSP ARM INIT

C50822

MALIGNANT NEOPLASM OF OVERLAPPING SITES OF LEFT MALE BREAST

S42333B

DISPL OBLIQUE FX SHAFT OF HUMERUS UNSP ARM INIT FOR OPN FX

C50829

MALIGNANT NEOPLASM OF OVERLAPPING SITES OF UNSP MALE BREAST

S42334A

NONDISP OBLIQUE FX SHAFT OF HUMERUS RIGHT ARM INIT

C50911

MALIGNANT NEOPLASM OF UNSP SITE OF RIGHT FEMALE BREAST

S42334B

NONDISP OBLIQUE FX SHAFT OF HUMER R ARM INIT FOR OPN FX

C50912

MALIGNANT NEOPLASM OF UNSPECIFIED SITE OF LEFT FEMALE BREAST

S42335A

NONDISP OBLIQUE FRACTURE OF SHAFT OF HUMERUS LEFT ARM INIT

C50919

MALIGNANT NEOPLASM OF UNSP SITE OF UNSPECIFIED FEMALE BREAST

S42335B

NONDISP OBLIQUE FX SHAFT OF HUMER LEFT ARM INIT FOR OPN FX

C50921

MALIGNANT NEOPLASM OF UNSPECIFIED SITE OF RIGHT MALE BREAST

S42336A

NONDISP OBLIQUE FRACTURE OF SHAFT OF HUMERUS UNSP ARM INIT

C50922

MALIGNANT NEOPLASM OF UNSPECIFIED SITE OF LEFT MALE BREAST

S42336B

NONDISP OBLIQUE FX SHAFT OF HUMER UNSP ARM INIT FOR OPN FX

C50929

MALIGNANT NEOPLASM OF UNSP SITE OF UNSPECIFIED MALE BREAST

S42341A

DISPLACED SPIRAL FX SHAFT OF HUMERUS RIGHT ARM INIT

C7981 SECONDARY MALIGNANT NEOPLASM OF BREAST

S42341B

DISPL SPIRAL FX SHAFT OF HUMERUS RIGHT ARM INIT FOR OPN FX

Page 36: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

C965

MULTIFOCAL AND UNISYSTEMIC LANGERHANS-CELL HISTIOCYTOSIS

S42342A

DISPLACED SPIRAL FX SHAFT OF HUMERUS LEFT ARM INIT

C966 UNIFOCAL LANGERHANS-CELL HISTIOCYTOSIS

S42342B

DISPL SPIRAL FX SHAFT OF HUMERUS LEFT ARM INIT FOR OPN FX

C969

MALIG NEOPLM OF LYMPHOID HEMATPOETC AND REL TISSUE UNSP

S42343A

DISPLACED SPIRAL FX SHAFT OF HUMERUS UNSP ARM INIT

C96Z

OTH MALIG NEOPLM OF LYMPHOID HEMATPOETC AND RELATED TISSUE

S42343B

DISPL SPIRAL FX SHAFT OF HUMERUS UNSP ARM INIT FOR OPN FX

D0500 LOBULAR CARCINOMA IN SITU OF UNSPECIFIED BREAST

S42344A

NONDISP SPIRAL FRACTURE OF SHAFT OF HUMERUS RIGHT ARM INIT

D0501 LOBULAR CARCINOMA IN SITU OF RIGHT BREAST

S42344B

NONDISP SPIRAL FX SHAFT OF HUMER RIGHT ARM INIT FOR OPN FX

D0502 LOBULAR CARCINOMA IN SITU OF LEFT BREAST

S42345A

NONDISP SPIRAL FRACTURE OF SHAFT OF HUMERUS LEFT ARM INIT

D0510 INTRADUCTAL CARCINOMA IN SITU OF UNSPECIFIED BREAST

S42345B

NONDISP SPIRAL FX SHAFT OF HUMER LEFT ARM INIT FOR OPN FX

D0511 INTRADUCTAL CARCINOMA IN SITU OF RIGHT BREAST

S42346A

NONDISP SPIRAL FRACTURE OF SHAFT OF HUMERUS UNSP ARM INIT

D0512 INTRADUCTAL CARCINOMA IN SITU OF LEFT BREAST

S42346B

NONDISP SPIRAL FX SHAFT OF HUMER UNSP ARM INIT FOR OPN FX

D0580 OTH TYPE OF CARCINOMA IN SITU OF UNSPECIFIED BREAST

S42351A

DISPLACED COMMINUTED FX SHAFT OF HUMERUS RIGHT ARM INIT

D0581

OTHER SPECIFIED TYPE OF CARCINOMA IN SITU OF RIGHT BREAST

S42351B

DISPL COMMNT FX SHAFT OF HUMERUS RIGHT ARM INIT FOR OPN FX

Page 37: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

D0582

OTHER SPECIFIED TYPE OF CARCINOMA IN SITU OF LEFT BREAST

S42352A

DISPLACED COMMINUTED FX SHAFT OF HUMERUS LEFT ARM INIT

D0590

UNSPECIFIED TYPE OF CARCINOMA IN SITU OF UNSPECIFIED BREAST

S42352B

DISPL COMMNT FX SHAFT OF HUMERUS LEFT ARM INIT FOR OPN FX

D0591

UNSPECIFIED TYPE OF CARCINOMA IN SITU OF RIGHT BREAST

S42353A

DISPLACED COMMINUTED FX SHAFT OF HUMERUS UNSP ARM INIT

D0592

UNSPECIFIED TYPE OF CARCINOMA IN SITU OF LEFT BREAST

S42353B

DISPL COMMNT FX SHAFT OF HUMERUS UNSP ARM INIT FOR OPN FX

D564 HEREDITARY PERSISTENCE OF FETAL HEMOGLOBIN [HPFH]

S42354A

NONDISP COMMINUTED FX SHAFT OF HUMERUS RIGHT ARM INIT

D568 OTHER THALASSEMIAS

S42354B NONDISP COMMNT FX SHAFT OF HUMER RIGHT ARM INIT FOR OPN FX

D569 THALASSEMIA UNSPECIFIED

S42355A NONDISP COMMINUTED FX SHAFT OF HUMERUS LEFT ARM INIT

D5700 HB-SS DISEASE WITH CRISIS UNSPECIFIED

S42355B

NONDISP COMMNT FX SHAFT OF HUMER LEFT ARM INIT FOR OPN FX

D5701 HB-SS DISEASE WITH ACUTE CHEST SYNDROME

S42356A

NONDISP COMMINUTED FX SHAFT OF HUMERUS UNSP ARM INIT

D5702 HB-SS DISEASE WITH SPLENIC SEQUESTRATION

S42356B

NONDISP COMMNT FX SHAFT OF HUMER UNSP ARM INIT FOR OPN FX

D571 SICKLE-CELL DISEASE WITHOUT CRISIS

S42361A

DISPLACED SEGMENTAL FX SHAFT OF HUMERUS RIGHT ARM INIT

D5720 SICKLE-CELL/HB-C DISEASE WITHOUT CRISIS

S42361B

DISPL SEG FX SHAFT OF HUMERUS RIGHT ARM INIT FOR OPN FX

D57211 SICKLE-CELL/HB-C DISEASE WITH ACUTE CHEST SYNDROME

S42362A

DISPLACED SEGMENTAL FX SHAFT OF HUMERUS LEFT ARM INIT

D57212 SICKLE-CELL/HB-C DISEASE WITH SPLENIC SEQUESTRATION

S42362B

DISPL SEG FX SHAFT OF HUMERUS LEFT ARM INIT FOR OPN FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

D57219 SICKLE-CELL/HB-C DISEASE WITH CRISIS UNSPECIFIED

S42363A

DISPLACED SEGMENTAL FX SHAFT OF HUMERUS UNSP ARM INIT

D573 SICKLE-CELL TRAIT

S42363B DISPL SEG FX SHAFT OF HUMERUS UNSP ARM INIT FOR OPN FX

D5740 SICKLE-CELL THALASSEMIA WITHOUT CRISIS

S42364A

NONDISP SEGMENTAL FX SHAFT OF HUMERUS RIGHT ARM INIT

D57411 SICKLE-CELL THALASSEMIA WITH ACUTE CHEST SYNDROME

S42364B

NONDISP SEG FX SHAFT OF HUMERUS RIGHT ARM INIT FOR OPN FX

D57412 SICKLE-CELL THALASSEMIA WITH SPLENIC SEQUESTRATION

S42365A

NONDISP SEGMENTAL FX SHAFT OF HUMERUS LEFT ARM INIT

D57419 SICKLE-CELL THALASSEMIA WITH CRISIS UNSPECIFIED

S42365B

NONDISP SEG FX SHAFT OF HUMERUS LEFT ARM INIT FOR OPN FX

D5780 OTHER SICKLE-CELL DISORDERS WITHOUT CRISIS

S42366A

NONDISP SEGMENTAL FX SHAFT OF HUMERUS UNSP ARM INIT

D57811 OTHER SICKLE-CELL DISORDERS WITH ACUTE CHEST SYNDROME

S42366B

NONDISP SEG FX SHAFT OF HUMERUS UNSP ARM INIT FOR OPN FX

D57812 OTHER SICKLE-CELL DISORDERS WITH SPLENIC SEQUESTRATION

S42391A

OTH FRACTURE OF SHAFT OF RIGHT HUMERUS INIT FOR CLOS FX

D57819 OTHER SICKLE-CELL DISORDERS WITH CRISIS UNSPECIFIED

S42391B

OTH FRACTURE OF SHAFT OF RIGHT HUMERUS INIT FOR OPN FX

E0800

DIAB D/T UNDRL COND W HYPROSM W/O NONKET HYPRGLY-HYPROS COMA

S42392A

OTH FRACTURE OF SHAFT OF LEFT HUMERUS INIT FOR CLOS FX

E0801

DIABETES DUE TO UNDERLYING CONDITION W HYPROSM W COMA

S42392B

OTH FRACTURE OF SHAFT OF LEFT HUMERUS INIT FOR OPN FX

E0810

DIABETES DUE TO UNDERLYING CONDITION W KETOACIDOSIS W/O COMA

S42399A

OTH FRACTURE OF SHAFT OF UNSP HUMERUS INIT FOR CLOS FX

Page 39: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E0811

DIABETES DUE TO UNDERLYING CONDITION W KETOACIDOSIS W COMA

S42399B

OTH FRACTURE OF SHAFT OF UNSP HUMERUS INIT FOR OPN FX

E0821

DIABETES DUE TO UNDERLYING CONDITION W DIABETIC NEPHROPATHY

S42401A

UNSP FRACTURE OF LOWER END OF RIGHT HUMERUS INIT

E0822

DIABETES DUE TO UNDRL COND W DIABETIC CHRONIC KIDNEY DISEASE

S42401B

UNSP FRACTURE OF LOWER END OF RIGHT HUMERUS INIT FOR OPN FX

E0829

DIABETES DUE TO UNDRL CONDITION W OTH DIABETIC KIDNEY COMP

S42402A

UNSP FRACTURE OF LOWER END OF LEFT HUMERUS INIT FOR CLOS FX

E08311

DIAB DUE TO UNDRL COND W UNSP DIABETIC RTNOP W MACULAR EDEMA

S42402B

UNSP FRACTURE OF LOWER END OF LEFT HUMERUS INIT FOR OPN FX

E08319

DIAB DUE TO UNDRL COND W UNSP DIAB RTNOP W/O MACULAR EDEMA

S42409A

UNSP FRACTURE OF LOWER END OF UNSP HUMERUS INIT FOR CLOS FX

E08321

DIAB D/T UNDRL COND W MILD NONPRLF DIAB RTNOP W MCLR EDEMA

S42409B

UNSP FRACTURE OF LOWER END OF UNSP HUMERUS INIT FOR OPN FX

E083211

Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema right eye

S42411A

DISPL SIMPLE SUPRCNDL FX W/O INTRCNDL FX R HUMERUS INIT

E083212

Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema left eye

S42411B

DISPL SIMP SUPRCNDL FX W/O INTRCNDL FX R HUMER 7THB

E083213

Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema bilateral

S42412A

DISPL SIMPLE SUPRCNDL FX W/O INTRCNDL FX L HUMERUS INIT

E08329

DIAB D/T UNDRL COND W MILD NONPRLF DIAB RTNOP W/O MCLR EDEMA

S42412B

DISPL SIMP SUPRCNDL FX W/O INTRCNDL FX L HUMER 7THB

Page 40: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E08331

DIAB DUE TO UNDRL COND W MOD NONPRLF DIAB RTNOP W MCLR EDEMA

S42413A

DISPL SIMPLE SUPRCNDL FX W/O INTRCNDL FX UNSP HUMERUS INIT

E083311

Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema right eye

S42413B

DISPL SIMP SUPRCNDL FX W/O INTRCNDL FX UNSP HUMER 7THB

E083312

Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema left eye

S42414A

NONDISP SIMPLE SUPRCNDL FX W/O INTRCNDL FX R HUMERUS INIT

E083313

Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema bilateral

S42414B

NONDISP SIMP SUPRCNDL FX W/O INTRCNDL FX R HUMER 7THB

E08339

DIAB D/T UNDRL COND W MOD NONPRLF DIAB RTNOP W/O MCLR EDEMA

S42415A

NONDISP SIMPLE SUPRCNDL FX W/O INTRCNDL FX L HUMERUS INIT

E08341

DIAB D/T UNDRL COND W SEVERE NONPRLF DIAB RTNOP W MCLR EDEMA

S42415B

NONDISP SIMP SUPRCNDL FX W/O INTRCNDL FX L HUMER 7THB

E08.3411

Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema right eye

S42416A

NONDISP SIMPLE SUPRCNDL FX W/O INTRCNDL FX UNSP HUMER INIT

E08.3412

Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema left eye

S42416B

NONDISP SIMP SUPRCNDL FX W/O INTRCNDL FX UNSP HUMER 7THB

E08.3413

Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema bilateral

S42421A

DISPL COMMNT SUPRCNDL FX W/O INTRCNDL FX R HUMERUS INIT

Page 41: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E08349

DIAB D/T UNDRL COND W SEV NONPRLF DIAB RTNOP W/O MCLR EDEMA

S42421B

DISPL COMMNT SUPRCNDL FX W/O INTRCNDL FX R HUMER 7THB

E08351

DIAB DUE TO UNDRL COND W PROLIF DIAB RTNOP W MACULAR EDEMA

S42422A

DISPL COMMNT SUPRCNDL FX W/O INTRCNDL FX L HUMERUS INIT

E08359

DIAB DUE TO UNDRL COND W PROLIF DIAB RTNOP W/O MACULAR EDEMA

S42422B

DISPL COMMNT SUPRCNDL FX W/O INTRCNDL FX L HUMER 7THB

E0836

DIABETES DUE TO UNDERLYING CONDITION W DIABETIC CATARACT

S42423A

DISPL COMMNT SUPRCNDL FX W/O INTRCNDL FX UNSP HUMERUS INIT

E0839

DIABETES DUE TO UNDRL CONDITION W OTH DIABETIC OPTH COMP

S42423B

DISPL COMMNT SUPRCNDL FX W/O INTRCNDL FX UNSP HUMER 7THB

E0840

DIABETES DUE TO UNDERLYING CONDITION W DIABETIC NEUROP UNSP

S42424A

NONDISP COMMNT SUPRCNDL FX W/O INTRCNDL FX R HUMERUS INIT

E0841

DIABETES DUE TO UNDRL CONDITION W DIABETIC MONONEUROPATHY

S42424B

NONDISP COMMNT SUPRCNDL FX W/O INTRCNDL FX R HUMER 7THB

E0842

DIABETES DUE TO UNDERLYING CONDITION W DIABETIC POLYNEUROP

S42425A

NONDISP COMMNT SUPRCNDL FX W/O INTRCNDL FX L HUMERUS INIT

E0843

DIAB DUE TO UNDRL COND W DIABETIC AUTONM (POLY)NEUROPATHY

S42425B

NONDISP COMMNT SUPRCNDL FX W/O INTRCNDL FX L HUMER 7THB

E0844

DIABETES DUE TO UNDERLYING CONDITION W DIABETIC AMYOTROPHY

S42426A

NONDISP COMMNT SUPRCNDL FX W/O INTRCNDL FX UNSP HUMER INIT

E0849

DIABETES DUE TO UNDRL CONDITION W OTH DIABETIC NEURO COMP

S42426B

NONDISP COMMNT SUPRCNDL FX W/O INTRCNDL FX UNSP HUMER 7THB

E0851

DIAB DUE TO UNDRL COND W DIAB PRPH ANGIOPATH W/O GANGRENE

S42431A

DISP FX (AVULSION) OF LATERAL EPICONDYLE OF R HUMERUS INIT

Page 42: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E08.3511

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema right eye

S42431B

DISP FX OF LATERAL EPICONDYLE OF R HUMERUS INIT FOR OPN FX

E08.3512

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema left eye

S42432A

DISP FX (AVULSION) OF LATERAL EPICONDYLE OF L HUMERUS INIT

E08.3513

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema bilateral

S42432B

DISP FX OF LATERAL EPICONDYLE OF L HUMERUS INIT FOR OPN FX

E0852

DIAB DUE TO UNDRL COND W DIABETIC PRPH ANGIOPATH W GANGRENE

S42433A

DISP FX OF LATERAL EPICONDYLE OF UNSP HUMERUS INIT

E083521

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula right eye

S42433B

DISP FX OF LATERAL EPICONDYL OF UNSP HUMER INIT FOR OPN FX

E083522

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula left eye

S42434A

NONDISP FX OF LATERAL EPICONDYLE OF R HUMERUS INIT

E083523

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula bilateral

S42434B

NONDISP FX OF LATERAL EPICONDYL OF R HUMER INIT FOR OPN FX

Page 43: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E08.3531

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula right eye

S42435A

NONDISP FX OF LATERAL EPICONDYLE OF L HUMERUS INIT

E08.3532

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula left eye

S42435B

NONDISP FX OF LATERAL EPICONDYL OF L HUMER INIT FOR OPN FX

E08.3533

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula bilateral

S42436A

NONDISP FX OF LATERAL EPICONDYLE OF UNSP HUMERUS INIT

E08.3541

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment right eye

S42436B

NONDISP FX OF LATERAL EPICONDYL OF UNSP HUMER 7THB

E08.3542

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment left eye

S42441A

DISP FX (AVULSION) OF MEDIAL EPICONDYLE OF R HUMERUS INIT

Page 44: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E08.3543

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment bilateral

S42441B

DISP FX OF MEDIAL EPICONDYLE OF R HUMERUS INIT FOR OPN FX

E08.3551

Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy right eye

S42442A

DISP FX (AVULSION) OF MEDIAL EPICONDYLE OF L HUMERUS INIT

E0859

DIABETES DUE TO UNDERLYING CONDITION W OTH CIRCULATORY COMP

S42442B

DISP FX OF MEDIAL EPICONDYLE OF L HUMERUS INIT FOR OPN FX

E08610

DIABETES DUE TO UNDRL COND W DIABETIC NEUROPATHIC ARTHROP

S42443A

DISP FX OF MEDIAL EPICONDYLE OF UNSP HUMERUS INIT

E08618

DIABETES DUE TO UNDERLYING CONDITION W OTH DIABETIC ARTHROP

S42443B

DISP FX OF MEDIAL EPICONDYL OF UNSP HUMERUS INIT FOR OPN FX

E08620

DIABETES DUE TO UNDERLYING CONDITION W DIABETIC DERMATITIS

S42444A

NONDISP FX OF MEDIAL EPICONDYLE OF R HUMERUS INIT

E08621

DIABETES MELLITUS DUE TO UNDERLYING CONDITION W FOOT ULCER

S42444B

NONDISP FX OF MEDIAL EPICONDYL OF R HUMERUS INIT FOR OPN FX

E08622 DIABETES DUE TO UNDERLYING CONDITION W OTH SKIN ULCER

S42445A

NONDISP FX OF MEDIAL EPICONDYLE OF L HUMERUS INIT

E08628 DIABETES DUE TO UNDERLYING CONDITION W OTH SKIN COMP

S42445B

NONDISP FX OF MEDIAL EPICONDYL OF L HUMERUS INIT FOR OPN FX

E08641

DIABETES DUE TO UNDERLYING CONDITION W HYPOGLYCEMIA W COMA

S42446A

NONDISP FX OF MEDIAL EPICONDYLE OF UNSP HUMERUS INIT

E08649

DIABETES DUE TO UNDERLYING CONDITION W HYPOGLYCEMIA W/O COMA

S42446B

NONDISP FX OF MED EPICONDYL OF UNSP HUMER INIT FOR OPN FX

Page 45: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E0865 DIABETES DUE TO UNDERLYING CONDITION W HYPERGLYCEMIA

S42447A

INCARCERATED FRACTURE OF MEDIAL EPICONDYL OF R HUMERUS INIT

E0869

DIABETES DUE TO UNDERLYING CONDITION W OTH COMPLICATION

S42447B

INCARCERATED FX OF MED EPICONDYL OF R HUMER INIT FOR OPN FX

E088

DIABETES DUE TO UNDERLYING CONDITION W UNSP COMPLICATIONS

S42448A

INCARCERATED FRACTURE OF MEDIAL EPICONDYL OF L HUMERUS INIT

E089

DIABETES DUE TO UNDERLYING CONDITION W/O COMPLICATIONS

S42448B

INCARCERATED FX OF MED EPICONDYL OF L HUMER INIT FOR OPN FX

E0900

DRUG/CHEM DIAB W HYPROSM W/O NONKET HYPRGLY-HYPROS COMA

S42449A

INCARCERATED FX OF MEDIAL EPICONDYL OF UNSP HUMERUS INIT

E0901

DRUG/CHEM DIABETES MELLITUS W HYPEROSMOLARITY W COMA

S42449B

INCARCERATED FX OF MED EPICONDYL OF UNSP HUMER 7THB

E0910

DRUG/CHEM DIABETES MELLITUS W KETOACIDOSIS W/O COMA

S42451A

DISP FX OF LATERAL CONDYLE OF RIGHT HUMERUS INIT

E0911

DRUG/CHEM DIABETES MELLITUS W KETOACIDOSIS W COMA

S42451B

DISP FX OF LATERAL CONDYLE OF RIGHT HUMERUS INIT FOR OPN FX

E0921

DRUG/CHEM DIABETES MELLITUS W DIABETIC NEPHROPATHY

S42452A

DISP FX OF LATERAL CONDYLE OF LEFT HUMERUS INIT FOR CLOS FX

E0922

DRUG/CHEM DIABETES W DIABETIC CHRONIC KIDNEY DISEASE

S42452B

DISP FX OF LATERAL CONDYLE OF LEFT HUMERUS INIT FOR OPN FX

E0929

DRUG/CHEM DIABETES W OTH DIABETIC KIDNEY COMPLICATION

S42453A

DISP FX OF LATERAL CONDYLE OF UNSP HUMERUS INIT FOR CLOS FX

E09311

DRUG/CHEM DIABETES W UNSP DIABETIC RTNOP W MACULAR EDEMA

S42453B

DISP FX OF LATERAL CONDYLE OF UNSP HUMERUS INIT FOR OPN FX

Page 46: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E09319

DRUG/CHEM DIABETES W UNSP DIABETIC RTNOP W/O MACULAR EDEMA

S42454A

NONDISP FX OF LATERAL CONDYLE OF RIGHT HUMERUS INIT

E09321

DRUG/CHEM DIAB W MILD NONPRLF DIABETIC RTNOP W MACULAR EDEMA

S42454B

NONDISP FX OF LATERAL CONDYLE OF R HUMERUS INIT FOR OPN FX

E093211

Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema right eye

S42455A

NONDISP FX OF LATERAL CONDYLE OF LEFT HUMERUS INIT

E093212

Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema left eye

S42455B

NONDISP FX OF LATERAL CONDYLE OF L HUMERUS INIT FOR OPN FX

E093213

Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema bilateral

S42456A

NONDISP FX OF LATERAL CONDYLE OF UNSP HUMERUS INIT

E09329

DRUG/CHEM DIAB W MILD NONPRLF DIAB RTNOP W/O MACULAR EDEMA

S42456B

NONDISP FX OF LATERAL CONDYLE OF UNSP HUMER INIT FOR OPN FX

E09331

DRUG/CHEM DIAB W MODERATE NONPRLF DIAB RTNOP W MACULAR EDEMA

S42461A

DISP FX OF MEDIAL CONDYLE OF RIGHT HUMERUS INIT FOR CLOS FX

E093311

Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema right eye

S42461B

DISP FX OF MEDIAL CONDYLE OF RIGHT HUMERUS INIT FOR OPN FX

E093312

Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema left eye

S42462A

DISP FX OF MEDIAL CONDYLE OF LEFT HUMERUS INIT FOR CLOS FX

Page 47: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E093313

Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema bilateral

S42462B

DISP FX OF MEDIAL CONDYLE OF LEFT HUMERUS INIT FOR OPN FX

E09339

DRUG/CHEM DIAB W MOD NONPRLF DIAB RTNOP W/O MACULAR EDEMA

S42463A

DISP FX OF MEDIAL CONDYLE OF UNSP HUMERUS INIT FOR CLOS FX

E09341

DRUG/CHEM DIAB W SEVERE NONPRLF DIAB RTNOP W MACULAR EDEMA

S42463B

DISP FX OF MEDIAL CONDYLE OF UNSP HUMERUS INIT FOR OPN FX

E093411

Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema right eye

S42464A

NONDISP FX OF MEDIAL CONDYLE OF RIGHT HUMERUS INIT

E093412

Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema left eye

S42464B

NONDISP FX OF MEDIAL CONDYLE OF R HUMERUS INIT FOR OPN FX

E093413

Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema bilateral

S42465A

NONDISP FX OF MEDIAL CONDYLE OF LEFT HUMERUS INIT

E09349

DRUG/CHEM DIAB W SEVERE NONPRLF DIAB RTNOP W/O MACULAR EDEMA

S42465B

NONDISP FX OF MEDIAL CONDYLE OF L HUMERUS INIT FOR OPN FX

E09351

DRUG/CHEM DIABETES W PROLIF DIABETIC RTNOP W MACULAR EDEMA

S42466A

NONDISP FX OF MEDIAL CONDYLE OF UNSP HUMERUS INIT

E093511

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema right eye

S42466B

NONDISP FX OF MEDIAL CONDYLE OF UNSP HUMER INIT FOR OPN FX

Page 48: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E093512

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema left eye

S42471A

DISPLACED TRANSCONDYLAR FRACTURE OF RIGHT HUMERUS INIT

E093513

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema bilateral

S42471B

DISPLACED TRANSCONDY FRACTURE OF R HUMERUS INIT FOR OPN FX

E093521

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula right eye

S42472A

DISPLACED TRANSCONDYLAR FRACTURE OF LEFT HUMERUS INIT

E093522

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula left eye

S42472B

DISPLACED TRANSCONDY FRACTURE OF L HUMERUS INIT FOR OPN FX

E093523

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula bilateral

S42473A

DISPLACED TRANSCONDYLAR FRACTURE OF UNSP HUMERUS INIT

E093531

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula right eye

S42473B

DISPLACED TRANSCONDY FX UNSP HUMERUS INIT FOR OPN FX

Page 49: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E093532

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula left eye

S42474A

NONDISPLACED TRANSCONDYLAR FRACTURE OF RIGHT HUMERUS INIT

E093533

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula bilateral

S42474B

NONDISP TRANSCONDY FRACTURE OF R HUMERUS INIT FOR OPN FX

E093541

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment right eye

S42475A

NONDISPLACED TRANSCONDYLAR FRACTURE OF LEFT HUMERUS INIT

E093542

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment left eye

S42475B

NONDISP TRANSCONDY FRACTURE OF L HUMERUS INIT FOR OPN FX

E093543

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment bilateral

S42476A

NONDISPLACED TRANSCONDYLAR FRACTURE OF UNSP HUMERUS INIT

E09359

DRUG/CHEM DIABETES W PROLIF DIABETIC RTNOP W/O MACULAR EDEMA

S42476B

NONDISP TRANSCONDY FRACTURE OF UNSP HUMERUS INIT FOR OPN FX

Page 50: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E0936

DRUG/CHEM DIABETES MELLITUS W DIABETIC CATARACT

S42481A

TORUS FRACTURE OF LOWER END OF RIGHT HUMERUS INIT

E0937X1

Drug or chemical induced diabetes mellitus with diabetic macular edema resolved following treatment right eye

S42481D

TORUS FX LOWER END OF R HUMERUS SUBS FOR FX W ROUTN HEAL

E0939

DRUG/CHEM DIABETES W OTH DIABETIC OPHTHALMIC COMPLICATION

S42482A

TORUS FRACTURE OF LOWER END OF LEFT HUMERUS INIT

E0940

DRUG/CHEM DIABETES W NEURO COMP W DIABETIC NEUROPATHY UNSP

S42489A

TORUS FRACTURE OF LOWER END OF UNSP HUMERUS INIT

E0941

DRUG/CHEM DIABETES W NEURO COMP W DIABETIC MONONEUROPATHY

S42491A

OTH DISP FX OF LOWER END OF RIGHT HUMERUS INIT FOR CLOS FX

E0942

DRUG/CHEM DIABETES W NEUROLOGICAL COMP W DIABETIC POLYNEUROP

S42491B

OTH DISP FX OF LOWER END OF RIGHT HUMERUS INIT FOR OPN FX

E0943

DRUG/CHEM DIAB W NEURO COMP W DIAB AUTONM (POLY)NEUROPATHY

S42492A

OTH DISP FX OF LOWER END OF LEFT HUMERUS INIT FOR CLOS FX

E0944

DRUG/CHEM DIABETES W NEUROLOGICAL COMP W DIABETIC AMYOTROPHY

S42492B

OTH DISP FX OF LOWER END OF LEFT HUMERUS INIT FOR OPN FX

E0949

DRUG/CHEM DIABETES W NEURO COMP W OTH DIABETIC NEURO COMP

S42493A

OTH DISP FX OF LOWER END OF UNSP HUMERUS INIT FOR CLOS FX

E0951

DRUG/CHEM DIABETES W DIABETIC PRPH ANGIOPATH W/O GANGRENE

S42493B

OTH DISP FX OF LOWER END OF UNSP HUMERUS INIT FOR OPN FX

E0952

DRUG/CHEM DIABETES W DIABETIC PRPH ANGIOPATH W GANGRENE

S42494A

OTH NONDISP FX OF LOWER END OF RIGHT HUMERUS INIT

Page 51: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E0959

DRUG/CHEM DIABETES MELLITUS W OTH CIRCULATORY COMPLICATIONS

S42494B

OTH NONDISP FX OF LOWER END OF R HUMERUS INIT FOR OPN FX

E09610

DRUG/CHEM DIABETES W DIABETIC NEUROPATHIC ARTHROPATHY

S42495A

OTH NONDISP FX OF LOWER END OF LEFT HUMERUS INIT

E09618

DRUG/CHEM DIABETES MELLITUS W OTH DIABETIC ARTHROPATHY

S42495B

OTH NONDISP FX OF LOWER END OF LEFT HUMERUS INIT FOR OPN FX

E09621

DRUG OR CHEMICAL INDUCED DIABETES MELLITUS WITH FOOT ULCER

S42496A

OTH NONDISP FX OF LOWER END OF UNSP HUMERUS INIT

E09622

DRUG OR CHEMICAL INDUCED DIABETES MELLITUS W OTH SKIN ULCER

S42496B

OTH NONDISP FX OF LOWER END OF UNSP HUMERUS INIT FOR OPN FX

E09641

DRUG/CHEM DIABETES MELLITUS W HYPOGLYCEMIA W COMA

S4290XA

FRACTURE OF UNSP SHOULDER GIRDLE PART UNSP INIT

E09649

DRUG/CHEM DIABETES MELLITUS W HYPOGLYCEMIA W/O COMA

S4290XB

FRACTURE OF UNSP SHOULDER GIRDLE PART UNSP INIT FOR OPN FX

E0965

DRUG OR CHEMICAL INDUCED DIABETES MELLITUS W HYPERGLYCEMIA

S4291XA

FRACTURE OF RIGHT SHOULDER GIRDLE PART UNSP INIT

E0969

DRUG/CHEM DIABETES MELLITUS W OTH COMPLICATION

S4291XB

FRACTURE OF R SHOULDER GIRDLE PART UNSP INIT FOR OPN FX

E1010

TYPE 1 DIABETES MELLITUS WITH KETOACIDOSIS WITHOUT COMA

S4292XA

FRACTURE OF LEFT SHOULDER GIRDLE PART UNSP INIT

E1011

TYPE 1 DIABETES MELLITUS WITH KETOACIDOSIS WITH COMA

S4292XB

FRACTURE OF LEFT SHOULDER GIRDLE PART UNSP INIT FOR OPN FX

E1021 TYPE 1 DIABETES MELLITUS WITH DIABETIC NEPHROPATHY

S43001A

UNSPECIFIED SUBLUXATION OF RIGHT SHOULDER JOINT INIT ENCNTR

Page 52: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E1022

TYPE 1 DIABETES MELLITUS W DIABETIC CHRONIC KIDNEY DISEASE

S43003A

UNSP SUBLUXATION OF UNSPECIFIED SHOULDER JOINT INIT ENCNTR

E1029

TYPE 1 DIABETES MELLITUS W OTH DIABETIC KIDNEY COMPLICATION

S43005A

UNSPECIFIED DISLOCATION OF LEFT SHOULDER JOINT INIT ENCNTR

E1049

TYPE 1 DIABETES W OTH DIABETIC NEUROLOGICAL COMPLICATION

S43011A

ANTERIOR SUBLUXATION OF RIGHT HUMERUS INITIAL ENCOUNTER

E1051

TYPE 1 DIABETES W DIABETIC PERIPHERAL ANGIOPATH W/O GANGRENE

S43013A

ANTERIOR SUBLUXATION OF UNSPECIFIED HUMERUS INIT ENCNTR

E1052

TYPE 1 DIABETES W DIABETIC PERIPHERAL ANGIOPATHY W GANGRENE

S43015A

ANTERIOR DISLOCATION OF LEFT HUMERUS INITIAL ENCOUNTER

E1059

TYPE 1 DIABETES MELLITUS WITH OTH CIRCULATORY COMPLICATIONS

S43021A

POSTERIOR SUBLUXATION OF RIGHT HUMERUS INITIAL ENCOUNTER

E10610

TYPE 1 DIABETES MELLITUS W DIABETIC NEUROPATHIC ARTHROPATHY

S43023A

POSTERIOR SUBLUXATION OF UNSPECIFIED HUMERUS INIT ENCNTR

E10618

TYPE 1 DIABETES MELLITUS WITH OTHER DIABETIC ARTHROPATHY

S43025A

POSTERIOR DISLOCATION OF LEFT HUMERUS INITIAL ENCOUNTER

E10621 TYPE 1 DIABETES MELLITUS WITH FOOT ULCER

S43031A

INFERIOR SUBLUXATION OF RIGHT HUMERUS INITIAL ENCOUNTER

E10622 TYPE 1 DIABETES MELLITUS WITH OTHER SKIN ULCER

S43033A

INFERIOR SUBLUXATION OF UNSPECIFIED HUMERUS INIT ENCNTR

E10628

TYPE 1 DIABETES MELLITUS WITH OTHER SKIN COMPLICATIONS

S43035A

INFERIOR DISLOCATION OF LEFT HUMERUS INITIAL ENCOUNTER

E103211

Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema right eye

S43081A

OTHER SUBLUXATION OF RIGHT SHOULDER JOINT INITIAL ENCOUNTER

Page 53: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E103212

Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema left eye

S43082A

OTHER SUBLUXATION OF LEFT SHOULDER JOINT INITIAL ENCOUNTER

E103213

Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema bilateral

S43083A

OTHER SUBLUXATION OF UNSPECIFIED SHOULDER JOINT INIT ENCNTR

E103311

Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema right eye

S43084A

OTHER DISLOCATION OF RIGHT SHOULDER JOINT INITIAL ENCOUNTER

E103312

Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema left eye

S43085A

OTHER DISLOCATION OF LEFT SHOULDER JOINT INITIAL ENCOUNTER

E103313

Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema bilateral

S43086A

OTHER DISLOCATION OF UNSPECIFIED SHOULDER JOINT INIT ENCNTR

E103411

Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema right eye

S43101A

UNSP DISLOCATION OF RIGHT ACROMIOCLAVICULAR JOINT INIT

E103412

Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema left eye

S43102A

UNSP DISLOCATION OF LEFT ACROMIOCLAVICULAR JOINT INIT

E103413

Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema bilateral

S43109A

UNSP DISLOCATION OF UNSP ACROMIOCLAVICULAR JOINT INIT

E103511

Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema right eye

S43111A

SUBLUXATION OF RIGHT ACROMIOCLAVICULAR JOINT INIT ENCNTR

Page 54: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E103512

Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema left eye

S43112A

SUBLUXATION OF LEFT ACROMIOCLAVICULAR JOINT INIT ENCNTR

E103513

Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema bilateral

S43119A

SUBLUXATION OF UNSP ACROMIOCLAVICULAR JOINT INIT ENCNTR

E103521

Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula right eye

S43121A

DISLOCATION OF R ACROMIOCLAV JT 100%-200% DISPLACMNT INIT

E103522

Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula left eye

S43122A

DISLOCATION OF L ACROMIOCLAV JT 100%-200% DISPLACMNT INIT

E103523

Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula bilateral

S43129A

DISLOC OF UNSP ACROMIOCLAV JT 100%-200% DISPLACMNT INIT

E103531

Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula right eye

S43131A

DISLOCATION OF R ACROMIOCLAV JT > 200% DISPLACMNT INIT

E103532

Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula left eye

S43132A

DISLOCATION OF L ACROMIOCLAV JT > 200% DISPLACMNT INIT

Page 55: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E103533

Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula bilateral

S43139A

DISLOCATION OF UNSP ACROMIOCLAV JT > 200% DISPLACMNT INIT

E103541

Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment right eye

S43141A

INFERIOR DISLOCATION OF RIGHT ACROMIOCLAVICULAR JOINT INIT

E103542

Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment left eye

S43142A

INFERIOR DISLOCATION OF LEFT ACROMIOCLAVICULAR JOINT INIT

E10543

Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment bilateral

S43149A

INFERIOR DISLOCATION OF UNSP ACROMIOCLAVICULAR JOINT INIT

E10641

TYPE 1 DIABETES MELLITUS WITH HYPOGLYCEMIA WITH COMA

S43151A

POSTERIOR DISLOCATION OF RIGHT ACROMIOCLAVICULAR JOINT INIT

E10649

TYPE 1 DIABETES MELLITUS WITH HYPOGLYCEMIA WITHOUT COMA

S43152A

POSTERIOR DISLOCATION OF LEFT ACROMIOCLAVICULAR JOINT INIT

E1065 TYPE 1 DIABETES MELLITUS WITH HYPERGLYCEMIA

S43159A

POSTERIOR DISLOCATION OF UNSP ACROMIOCLAVICULAR JOINT INIT

E1069

TYPE 1 DIABETES MELLITUS WITH OTHER SPECIFIED COMPLICATION

S43201A

UNSP SUBLUXATION OF RIGHT STERNOCLAVICULAR JOINT INIT

E1100

TYPE 2 DIAB W HYPROSM W/O NONKET HYPRGLY-HYPROS COMA (NKHHC)

S43202A

UNSP SUBLUXATION OF LEFT STERNOCLAVICULAR JOINT INIT ENCNTR

Page 56: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E1101

TYPE 2 DIABETES MELLITUS WITH HYPEROSMOLARITY WITH COMA

S43203A

UNSP SUBLUXATION OF UNSP STERNOCLAVICULAR JOINT INIT ENCNTR

E1121 TYPE 2 DIABETES MELLITUS WITH DIABETIC NEPHROPATHY

S43204A

UNSP DISLOCATION OF RIGHT STERNOCLAVICULAR JOINT INIT

E1122

TYPE 2 DIABETES MELLITUS W DIABETIC CHRONIC KIDNEY DISEASE

S43205A

UNSP DISLOCATION OF LEFT STERNOCLAVICULAR JOINT INIT ENCNTR

E1129

TYPE 2 DIABETES MELLITUS W OTH DIABETIC KIDNEY COMPLICATION

S43206A

UNSP DISLOCATION OF UNSP STERNOCLAVICULAR JOINT INIT ENCNTR

E1149

TYPE 2 DIABETES W OTH DIABETIC NEUROLOGICAL COMPLICATION

S43211A

ANTERIOR SUBLUXATION OF RIGHT STERNOCLAVICULAR JOINT INIT

E1152

TYPE 2 DIABETES W DIABETIC PERIPHERAL ANGIOPATHY W GANGRENE

S43212A

ANTERIOR SUBLUXATION OF LEFT STERNOCLAVICULAR JOINT INIT

E1159

TYPE 2 DIABETES MELLITUS WITH OTH CIRCULATORY COMPLICATIONS

S43213A

ANTERIOR SUBLUXATION OF UNSP STERNOCLAVICULAR JOINT INIT

E11610

TYPE 2 DIABETES MELLITUS W DIABETIC NEUROPATHIC ARTHROPATHY

S43214A

ANTERIOR DISLOCATION OF RIGHT STERNOCLAVICULAR JOINT INIT

E11621 TYPE 2 DIABETES MELLITUS WITH FOOT ULCER

S43215A

ANTERIOR DISLOCATION OF LEFT STERNOCLAVICULAR JOINT INIT

E11622 TYPE 2 DIABETES MELLITUS WITH OTHER SKIN ULCER

S43216A

ANTERIOR DISLOCATION OF UNSP STERNOCLAVICULAR JOINT INIT

E11641

TYPE 2 DIABETES MELLITUS WITH HYPOGLYCEMIA WITH COMA

S43221A

POSTERIOR SUBLUXATION OF RIGHT STERNOCLAVICULAR JOINT INIT

E11649

TYPE 2 DIABETES MELLITUS WITH HYPOGLYCEMIA WITHOUT COMA

S43222A

POSTERIOR SUBLUXATION OF LEFT STERNOCLAVICULAR JOINT INIT

E1165 TYPE 2 DIABETES MELLITUS WITH HYPERGLYCEMIA

S43223A

POSTERIOR SUBLUXATION OF UNSP STERNOCLAVICULAR JOINT INIT

Page 57: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E1300

OTH DIAB W HYPROSM W/O NONKET HYPRGLY-HYPROS COMA (NKHHC)

S43224A

POSTERIOR DISLOCATION OF RIGHT STERNOCLAVICULAR JOINT INIT

E1301

OTH DIABETES MELLITUS WITH HYPEROSMOLARITY WITH COMA

S43225A

POSTERIOR DISLOCATION OF LEFT STERNOCLAVICULAR JOINT INIT

E1310 OTH DIABETES MELLITUS WITH KETOACIDOSIS WITHOUT COMA

S43226A

POSTERIOR DISLOCATION OF UNSP STERNOCLAVICULAR JOINT INIT

E1311 OTH DIABETES MELLITUS WITH KETOACIDOSIS WITH COMA

S43301A

SUBLUXATION OF UNSP PARTS OF RIGHT SHOULDER GIRDLE INIT

E1322

OTH DIABETES MELLITUS WITH DIABETIC CHRONIC KIDNEY DISEASE

S43302A

SUBLUXATION OF UNSP PARTS OF LEFT SHOULDER GIRDLE INIT

E1329

OTH DIABETES MELLITUS WITH OTH DIABETIC KIDNEY COMPLICATION

S43303A

SUBLUXATION OF UNSP PARTS OF UNSP SHOULDER GIRDLE INIT

E113211

Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema right eye

S43304A

DISLOCATION OF UNSP PARTS OF RIGHT SHOULDER GIRDLE INIT

E113212

Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema left eye

S43305A

DISLOCATION OF UNSP PARTS OF LEFT SHOULDER GIRDLE INIT

E113213

Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema bilateral

S43306A

DISLOCATION OF UNSP PARTS OF UNSP SHOULDER GIRDLE INIT

E113311

Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema right eye

S43311A

SUBLUXATION OF RIGHT SCAPULA INITIAL ENCOUNTER

E113312

Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema left eye

S43312A

SUBLUXATION OF LEFT SCAPULA INITIAL ENCOUNTER

Page 58: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E113313

Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema bilateral

S43313A

SUBLUXATION OF UNSPECIFIED SCAPULA INITIAL ENCOUNTER

E113411

Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema right eye

S43314A

DISLOCATION OF RIGHT SCAPULA INITIAL ENCOUNTER

E113412

Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema left eye

S43315A

DISLOCATION OF LEFT SCAPULA INITIAL ENCOUNTER

E113413

Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema bilateral

S43316A

DISLOCATION OF UNSPECIFIED SCAPULA INITIAL ENCOUNTER

E113511

Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema right eye

S43391A

SUBLUXATION OF OTH PRT RIGHT SHOULDER GIRDLE INIT ENCNTR

E113512

Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema left eye

S43392A

SUBLUXATION OF OTH PRT LEFT SHOULDER GIRDLE INIT ENCNTR

E113513

Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema bilateral

S43393A

SUBLUXATION OF OTH PRT UNSP SHOULDER GIRDLE INIT ENCNTR

E113521

Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula right eye

S43394A

DISLOCATION OF OTH PRT RIGHT SHOULDER GIRDLE INIT ENCNTR

E113522

Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula left eye

S43395A

DISLOCATION OF OTH PRT LEFT SHOULDER GIRDLE INIT ENCNTR

Page 59: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E113523

Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula bilateral

S43396A

DISLOCATION OF OTH PRT UNSP SHOULDER GIRDLE INIT ENCNTR

E113531

Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula right eye

S43401A

UNSPECIFIED SPRAIN OF RIGHT SHOULDER JOINT INIT ENCNTR

E113532

Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula left eye

S43402A

UNSPECIFIED SPRAIN OF LEFT SHOULDER JOINT INITIAL ENCOUNTER

E113533

Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula bilateral

S43409A

UNSP SPRAIN OF UNSPECIFIED SHOULDER JOINT INIT ENCNTR

E113541

Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment right eye

S43411A

SPRAIN OF RIGHT CORACOHUMERAL (LIGAMENT) INITIAL ENCOUNTER

E113542

Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment left eye

S43412A

SPRAIN OF LEFT CORACOHUMERAL (LIGAMENT) INITIAL ENCOUNTER

Page 60: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E113543

Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment bilateral

S43419A

SPRAIN OF UNSPECIFIED CORACOHUMERAL (LIGAMENT) INIT ENCNTR

E133211

Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema right eye

S43421A

SPRAIN OF RIGHT ROTATOR CUFF CAPSULE INITIAL ENCOUNTER

E133212

Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema left eye

S43422A

SPRAIN OF LEFT ROTATOR CUFF CAPSULE INITIAL ENCOUNTER

E133213

Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema bilateral

S43429A

SPRAIN OF UNSPECIFIED ROTATOR CUFF CAPSULE INIT ENCNTR

E133311

Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema right eye

S43431A

SUPERIOR GLENOID LABRUM LESION OF RIGHT SHOULDER INIT

E133312

Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema left eye

S43432A

SUPERIOR GLENOID LABRUM LESION OF LEFT SHOULDER INIT ENCNTR

E133313

Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema bilateral

S43439A

SUPERIOR GLENOID LABRUM LESION OF UNSP SHOULDER INIT ENCNTR

Page 61: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E133411

Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema right eye

S43491A

OTHER SPRAIN OF RIGHT SHOULDER JOINT INITIAL ENCOUNTER

E133412

Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema left eye

S43492A

OTHER SPRAIN OF LEFT SHOULDER JOINT INITIAL ENCOUNTER

E133413

Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema bilateral

S43499A

OTHER SPRAIN OF UNSPECIFIED SHOULDER JOINT INIT ENCNTR

E1349 OTH DIABETES W OTH DIABETIC NEUROLOGICAL COMPLICATION

S4350XA

SPRAIN OF UNSPECIFIED ACROMIOCLAVICULAR JOINT INIT ENCNTR

E1351

OTH DIABETES W DIABETIC PERIPHERAL ANGIOPATHY W/O GANGRENE

S4351XA

SPRAIN OF RIGHT ACROMIOCLAVICULAR JOINT INITIAL ENCOUNTER

E133511

Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema right eye

S4352XA

SPRAIN OF LEFT ACROMIOCLAVICULAR JOINT INITIAL ENCOUNTER

E133512

Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema left eye

S4360XA

SPRAIN OF UNSPECIFIED STERNOCLAVICULAR JOINT INIT ENCNTR

E133513

Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema bilateral

S4361XA

SPRAIN OF RIGHT STERNOCLAVICULAR JOINT INITIAL ENCOUNTER

E1352

OTH DIABETES W DIABETIC PERIPHERAL ANGIOPATHY W GANGRENE

S4362XA

SPRAIN OF LEFT STERNOCLAVICULAR JOINT INITIAL ENCOUNTER

Page 62: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E133521

Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula right eye

S4380XA

SPRAIN OF OTH PARTS OF UNSP SHOULDER GIRDLE INIT ENCNTR

E133522

Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula left eye

S4381XA

SPRAIN OF OTH PARTS OF RIGHT SHOULDER GIRDLE INIT ENCNTR

E133523

Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula bilateral

S4382XA

SPRAIN OF OTH PARTS OF LEFT SHOULDER GIRDLE INIT ENCNTR

E133531

Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula right eye

S4390XA

SPRAIN OF UNSP PARTS OF UNSP SHOULDER GIRDLE INIT ENCNTR

E133532

Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula left eye

S4391XA

SPRAIN OF UNSP PARTS OF RIGHT SHOULDER GIRDLE INIT ENCNTR

E133533

Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula bilateral

S4392XA

SPRAIN OF UNSP PARTS OF LEFT SHOULDER GIRDLE INIT ENCNTR

Page 63: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E133541

Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment right eye

S4400XA

INJURY OF ULNAR NERVE AT UPPER ARM LEVEL UNSP ARM INIT

E133542

Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment left eye

S4401XA

INJURY OF ULNAR NERVE AT UPPER ARM LEVEL RIGHT ARM INIT

E13.3543

Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment bilateral

S4402XA

INJURY OF ULNAR NERVE AT UPPER ARM LEVEL LEFT ARM INIT

E1359

OTH DIABETES MELLITUS WITH OTHER CIRCULATORY COMPLICATIONS

S4410XA

INJURY OF MEDIAN NERVE AT UPPER ARM LEVEL UNSP ARM INIT

E13621 OTHER SPECIFIED DIABETES MELLITUS WITH FOOT ULCER

S4411XA

INJURY OF MEDIAN NERVE AT UPPER ARM LEVEL RIGHT ARM INIT

E13641 OTH DIABETES MELLITUS WITH HYPOGLYCEMIA WITH COMA

S4412XA

INJURY OF MEDIAN NERVE AT UPPER ARM LEVEL LEFT ARM INIT

E13649

OTH DIABETES MELLITUS WITH HYPOGLYCEMIA WITHOUT COMA

S4420XA

INJURY OF RADIAL NERVE AT UPPER ARM LEVEL UNSP ARM INIT

E1365

OTHER SPECIFIED DIABETES MELLITUS WITH HYPERGLYCEMIA

S4421XA

INJURY OF RADIAL NERVE AT UPPER ARM LEVEL RIGHT ARM INIT

E15 NONDIABETIC HYPOGLYCEMIC COMA

S4422XA

INJURY OF RADIAL NERVE AT UPPER ARM LEVEL LEFT ARM INIT

Page 64: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E160

DRUG-INDUCED HYPOGLYCEMIA WITHOUT COMA

S4430XA

INJURY OF AXILLARY NERVE UNSPECIFIED ARM INITIAL ENCOUNTER

E161 OTHER HYPOGLYCEMIA

S4431XA INJURY OF AXILLARY NERVE RIGHT ARM INITIAL ENCOUNTER

E162 HYPOGLYCEMIA UNSPECIFIED

S4432XA INJURY OF AXILLARY NERVE LEFT ARM INITIAL ENCOUNTER

E163 INCREASED SECRETION OF GLUCAGON

S4440XA

INJURY OF MUSCULOCUTANEOUS NERVE UNSP ARM INIT ENCNTR

E164 INCREASED SECRETION OF GASTRIN

S4441XA

INJURY OF MUSCULOCUTANEOUS NERVE RIGHT ARM INIT ENCNTR

E168

OTHER SPECIFIED DISORDERS OF PANCREATIC INTERNAL SECRETION

S4442XA

INJURY OF MUSCULOCUTANEOUS NERVE LEFT ARM INIT ENCNTR

E169

DISORDER OF PANCREATIC INTERNAL SECRETION UNSPECIFIED

S4450XA

INJ CUTAN SENSORY NERVE AT SHLDR/UP ARM UNSP ARM INIT

E200 IDIOPATHIC HYPOPARATHYROIDISM

S4451XA

INJ CUTAN SENSORY NERVE AT SHLDR/UP ARM RIGHT ARM INIT

E201 PSEUDOHYPOPARATHYROIDISM

S4452XA INJ CUTAN SENSORY NERVE AT SHLDR/UP ARM LEFT ARM INIT

E208 OTHER HYPOPARATHYROIDISM

S448X1A INJURY OF NERVES AT SHLDR/UP ARM RIGHT ARM INIT

E209 HYPOPARATHYROIDISM UNSPECIFIED

S448X2A

INJURY OF NERVES AT SHLDR/UP ARM LEFT ARM INIT

E210 PRIMARY HYPERPARATHYROIDISM

S448X9A

INJURY OF NERVES AT SHLDR/UP ARM UNSP ARM INIT

E211

SECONDARY HYPERPARATHYROIDISM NOT ELSEWHERE CLASSIFIED

S4490XA

INJURY OF UNSP NERVE AT SHLDR/UP ARM UNSP ARM INIT

E212 OTHER HYPERPARATHYROIDISM

S4491XA

INJURY OF UNSP NERVE AT SHLDR/UP ARM RIGHT ARM INIT

E213 HYPERPARATHYROIDISM UNSPECIFIED

S4492XA

INJURY OF UNSP NERVE AT SHLDR/UP ARM LEFT ARM INIT

E214 OTHER SPECIFIED DISORDERS OF PARATHYROID GLAND

S45001A

UNSP INJURY OF AXILLARY ARTERY RIGHT SIDE INIT ENCNTR

Page 65: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E215 DISORDER OF PARATHYROID GLAND UNSPECIFIED

S45002A

UNSP INJURY OF AXILLARY ARTERY LEFT SIDE INIT ENCNTR

E220 ACROMEGALY AND PITUITARY GIGANTISM

S45009A

UNSP INJURY OF AXILLARY ARTERY UNSP SIDE INIT ENCNTR

E221 HYPERPROLACTINEMIA

S45011A LACERATION OF AXILLARY ARTERY RIGHT SIDE INITIAL ENCOUNTER

E222

SYNDROME OF INAPPROPRIATE SECRETION OF ANTIDIURETIC HORMONE

S45012A

LACERATION OF AXILLARY ARTERY LEFT SIDE INITIAL ENCOUNTER

E228 OTHER HYPERFUNCTION OF PITUITARY GLAND

S45019A

LACERATION OF AXILLARY ARTERY UNSPECIFIED SIDE INIT ENCNTR

E229 HYPERFUNCTION OF PITUITARY GLAND UNSPECIFIED

S45091A

OTH INJURY OF AXILLARY ARTERY RIGHT SIDE INIT ENCNTR

E230 HYPOPITUITARISM

S45092A OTH INJURY OF AXILLARY ARTERY LEFT SIDE INIT ENCNTR

E231 DRUG-INDUCED HYPOPITUITARISM

S45099A

OTH INJURY OF AXILLARY ARTERY UNSPECIFIED SIDE INIT ENCNTR

E232 DIABETES INSIPIDUS

S45101A UNSP INJURY OF BRACHIAL ARTERY RIGHT SIDE INIT ENCNTR

E233 HYPOTHALAMIC DYSFUNCTION NOT ELSEWHERE CLASSIFIED

S45102A

UNSP INJURY OF BRACHIAL ARTERY LEFT SIDE INIT ENCNTR

E236 OTHER DISORDERS OF PITUITARY GLAND

S45109A

UNSP INJURY OF BRACHIAL ARTERY UNSP SIDE INIT ENCNTR

E237 DISORDER OF PITUITARY GLAND UNSPECIFIED

S45111A

LACERATION OF BRACHIAL ARTERY RIGHT SIDE INITIAL ENCOUNTER

E240 PITUITARY-DEPENDENT CUSHING'S DISEASE

S45112A

LACERATION OF BRACHIAL ARTERY LEFT SIDE INITIAL ENCOUNTER

E241 NELSON'S SYNDROME

S45119A LACERATION OF BRACHIAL ARTERY UNSPECIFIED SIDE INIT ENCNTR

E242 DRUG-INDUCED CUSHING'S SYNDROME

S45191A

OTH INJURY OF BRACHIAL ARTERY RIGHT SIDE INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E243 ECTOPIC ACTH SYNDROME

S45192A OTH INJURY OF BRACHIAL ARTERY LEFT SIDE INIT ENCNTR

E244 ALCOHOL-INDUCED PSEUDO-CUSHING'S SYNDROME

S45199A

OTH INJURY OF BRACHIAL ARTERY UNSPECIFIED SIDE INIT ENCNTR

E248 OTHER CUSHING'S SYNDROME

S45201A UNSP INJURY OF AXILLARY OR BRACHIAL VEIN RIGHT SIDE INIT

E249 CUSHING'S SYNDROME UNSPECIFIED

S45202A

UNSP INJURY OF AXILLARY OR BRACHIAL VEIN LEFT SIDE INIT

E2601 CONN'S SYNDROME

S45209A UNSP INJURY OF AXILLARY OR BRACHIAL VEIN UNSP SIDE INIT

E272 ADDISONIAN CRISIS

S45211A LACERATION OF AXILLARY OR BRACHIAL VEIN RIGHT SIDE INIT

E3120

MULTIPLE ENDOCRINE NEOPLASIA [MEN] SYNDROME UNSPECIFIED

S45212A

LACERATION OF AXILLARY OR BRACHIAL VEIN LEFT SIDE INIT

E3121 MULTIPLE ENDOCRINE NEOPLASIA [MEN] TYPE I

S45219A

LACERATION OF AXILLARY OR BRACHIAL VEIN UNSP SIDE INIT

E3122 MULTIPLE ENDOCRINE NEOPLASIA [MEN] TYPE IIA

S45291A

INJ AXILLARY OR BRACHIAL VEIN RIGHT SIDE INIT ENCNTR

E3123 MULTIPLE ENDOCRINE NEOPLASIA [MEN] TYPE IIB

S45292A

INJ AXILLARY OR BRACHIAL VEIN LEFT SIDE INIT ENCNTR

E320 PERSISTENT HYPERPLASIA OF THYMUS

S45299A

INJ AXILLARY OR BRACHIAL VEIN UNSP SIDE INIT ENCNTR

E321 ABSCESS OF THYMUS

S45301A UNSP INJURY OF SUPERFIC VN AT SHLDR/UP ARM RIGHT ARM INIT

E328 OTHER DISEASES OF THYMUS

S45302A UNSP INJURY OF SUPERFIC VN AT SHLDR/UP ARM LEFT ARM INIT

E340 CARCINOID SYNDROME

S45309A UNSP INJURY OF SUPERFIC VN AT SHLDR/UP ARM UNSP ARM INIT

E3601

INTRAOP HEMOR/HEMTOM OF ENDO SYS ORG COMP AN ENDO SYS PROC

S45311A

LACERATION OF SUPERFIC VN AT SHLDR/UP ARM RIGHT ARM INIT

E3602

INTRAOP HEMOR/HEMTOM OF AN ENDO SYS ORG COMP OTH PROCEDURE

S45312A

LACERATION OF SUPERFIC VN AT SHLDR/UP ARM LEFT ARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E3611

ACC PNCTR & LAC OF AN ENDO SYS ORG DURING AN ENDO SYS PROC

S45319A

LACERATION OF SUPERFIC VN AT SHLDR/UP ARM UNSP ARM INIT

E3612

ACC PNCTR & LAC OF AN ENDO SYS ORG DURING OTH PROCEDURE

S45391A

INJ SUPERFICIAL VEIN AT SHLDR/UP ARM RIGHT ARM INIT

E368

OTHER INTRAOPERATIVE COMPLICATIONS OF ENDOCRINE SYSTEM

S45392A

INJ SUPERFICIAL VEIN AT SHLDR/UP ARM LEFT ARM INIT

E40 KWASHIORKOR

S45399A INJ SUPERFICIAL VEIN AT SHLDR/UP ARM UNSP ARM INIT

E41 NUTRITIONAL MARASMUS

S45801A UNSP INJ BLOOD VESSELS AT SHLDR/UP ARM RIGHT ARM INIT

E42 MARASMIC KWASHIORKOR

S45802A UNSP INJURY OF BLOOD VESSELS AT SHLDR/UP ARM LEFT ARM INIT

E43 UNSPECIFIED SEVERE PROTEIN-CALORIE MALNUTRITION

S45809A

UNSP INJURY OF BLOOD VESSELS AT SHLDR/UP ARM UNSP ARM INIT

E45

RETARDED DEVELOPMENT FOLLOWING PROTEIN-CALORIE MALNUTRITION

S45811A

LACERATION OF BLOOD VESSELS AT SHLDR/UP ARM RIGHT ARM INIT

E46 UNSPECIFIED PROTEIN-CALORIE MALNUTRITION

S45812A

LACERATION OF BLOOD VESSELS AT SHLDR/UP ARM LEFT ARM INIT

E5111 DRY BERIBERI

S45819A LACERATION OF BLOOD VESSELS AT SHLDR/UP ARM UNSP ARM INIT

E5112 WET BERIBERI

S45891A INJ OTH BLOOD VESSELS AT SHLDR/UP ARM RIGHT ARM INIT

E512 WERNICKE'S ENCEPHALOPATHY

S45892A INJ OTH BLOOD VESSELS AT SHLDR/UP ARM LEFT ARM INIT

E518 OTHER MANIFESTATIONS OF THIAMINE DEFICIENCY

S45899A

INJ OTH BLOOD VESSELS AT SHLDR/UP ARM UNSP ARM INIT

E519 THIAMINE DEFICIENCY UNSPECIFIED

S45901A

UNSP INJ UNSP BLOOD VESS AT SHLDR/UP ARM RIGHT ARM INIT

E52 NIACIN DEFICIENCY [PELLAGRA]

S45902A UNSP INJ UNSP BLOOD VESS AT SHLDR/UP ARM LEFT ARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E530 RIBOFLAVIN DEFICIENCY

S45909A UNSP INJ UNSP BLOOD VESS AT SHLDR/UP ARM UNSP ARM INIT

E531 PYRIDOXINE DEFICIENCY

S45911A LACERAT UNSP BLOOD VESSEL AT SHLDR/UP ARM RIGHT ARM INIT

E538 DEFICIENCY OF OTHER SPECIFIED B GROUP VITAMINS

S45912A

LACERAT UNSP BLOOD VESSEL AT SHLDR/UP ARM LEFT ARM INIT

E539 VITAMIN B DEFICIENCY UNSPECIFIED

S45919A

LACERAT UNSP BLOOD VESSEL AT SHLDR/UP ARM UNSP ARM INIT

E54 ASCORBIC ACID DEFICIENCY

S45991A INJ UNSP BLOOD VESSEL AT SHLDR/UP ARM RIGHT ARM INIT

E550 RICKETS ACTIVE

S45992A INJ UNSP BLOOD VESSEL AT SHLDR/UP ARM LEFT ARM INIT

E559 VITAMIN D DEFICIENCY UNSPECIFIED

S45999A

INJ UNSP BLOOD VESSEL AT SHLDR/UP ARM UNSP ARM INIT

E561 DEFICIENCY OF VITAMIN K

S46001A UNSP INJ MUSC/TEND THE ROTATOR CUFF OF R SHOULDER INIT

E662

MORBID (SEVERE) OBESITY WITH ALVEOLAR HYPOVENTILATION

S46002A

UNSP INJ MUSC/TEND THE ROTATOR CUFF OF L SHOULDER INIT

E7021 TYROSINEMIA

S46009A UNSP INJ MUSC/TEND THE ROTATOR CUFF OF UNSP SHOULDER INIT

E70330 CHEDIAK-HIGASHI SYNDROME

S46011A STRAIN OF MUSC/TEND THE ROTATOR CUFF OF RIGHT SHOULDER INIT

E70331 HERMANSKY-PUDLAK SYNDROME

S46012A

STRAIN OF MUSC/TEND THE ROTATOR CUFF OF LEFT SHOULDER INIT

E7041 HISTIDINEMIA

S46019A STRAIN OF MUSC/TEND THE ROTATOR CUFF OF UNSP SHOULDER INIT

E708

OTHER DISORDERS OF AROMATIC AMINO-ACID METABOLISM

S46021A

LACERATION OF MUSC/TEND THE ROTATOR CUFF OF R SHOULDER INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

E709

DISORDER OF AROMATIC AMINO-ACID METABOLISM UNSPECIFIED

S46022A

LACERAT MUSC/TEND THE ROTATOR CUFF OF LEFT SHOULDER INIT

E7871 BARTH SYNDROME

S46029A LACERAT MUSC/TEND THE ROTATOR CUFF OF UNSP SHOULDER INIT

E89820

Postprocedural hematoma of an endocrine system organ or structure following an endocrine system procedure

S46091A

INJ MUSC/TEND THE ROTATOR CUFF OF RIGHT SHOULDER INIT

E89821

Postprocedural hematoma of an endocrine system organ or structure following other procedure

S46092A

INJ MUSC/TEND THE ROTATOR CUFF OF LEFT SHOULDER INIT

E89822

Postprocedural seroma of an endocrine system organ or structure following an endocrine system procedure

S46099A

INJ MUSC/TEND THE ROTATOR CUFF OF UNSP SHOULDER INIT

E89823

Postprocedural seroma of an endocrine system organ or structure following other procedure

S46101A

UNSP INJURY OF MUSC/FASC/TEND LONG HD BICEP RIGHT ARM INIT

F445 CONVERSION DISORDER WITH SEIZURES OR CONVULSIONS

S46102A

UNSP INJURY OF MUSC/FASC/TEND LONG HD BICEP LEFT ARM INIT

G000 HEMOPHILUS MENINGITIS

S46109A UNSP INJURY OF MUSC/FASC/TEND LONG HD BICEP UNSP ARM INIT

G001 PNEUMOCOCCAL MENINGITIS

S46111A STRAIN OF MUSC/FASC/TEND LONG HD BICEP RIGHT ARM INIT

G002 STREPTOCOCCAL MENINGITIS

S46112A STRAIN OF MUSC/FASC/TEND LONG HEAD OF BICEPS LEFT ARM INIT

G003 STAPHYLOCOCCAL MENINGITIS

S46119A STRAIN OF MUSC/FASC/TEND LONG HEAD OF BICEPS UNSP ARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G008 OTHER BACTERIAL MENINGITIS

S46121A LACERATION OF MUSC/FASC/TEND LONG HD BICEP RIGHT ARM INIT

G009 BACTERIAL MENINGITIS UNSPECIFIED

S46122A

LACERATION OF MUSC/FASC/TEND LONG HD BICEP LEFT ARM INIT

G01

MENINGITIS IN BACTERIAL DISEASES CLASSIFIED ELSEWHERE

S46129A

LACERATION OF MUSC/FASC/TEND LONG HD BICEP UNSP ARM INIT

G02

MENINGITIS IN OTH INFEC/PARASTC DISEASES CLASSD ELSWHR

S46191A

INJ MUSC/FASC/TEND LONG HEAD OF BICEPS RIGHT ARM INIT

G030 NONPYOGENIC MENINGITIS

S46192A INJ MUSC/FASC/TEND LONG HEAD OF BICEPS LEFT ARM INIT

G031 CHRONIC MENINGITIS

S46199A INJ MUSC/FASC/TEND LONG HEAD OF BICEPS UNSP ARM INIT

G032 BENIGN RECURRENT MENINGITIS [MOLLARET]

S46201A

UNSP INJURY OF MUSC/FASC/TEND PRT BICEPS RIGHT ARM INIT

G038 MENINGITIS DUE TO OTHER SPECIFIED CAUSES

S46202A

UNSP INJURY OF MUSC/FASC/TEND PRT BICEPS LEFT ARM INIT

G039 MENINGITIS UNSPECIFIED

S46209A UNSP INJURY OF MUSC/FASC/TEND PRT BICEPS UNSP ARM INIT

G0400

ACUTE DISSEMINATED ENCEPHALITIS AND ENCEPHALOMYELITIS UNSP

S46211A

STRAIN OF MUSC/FASC/TEND PRT BICEPS RIGHT ARM INIT

G0401

POSTINFECT ACUTE DISSEM ENCEPHALITIS AND ENCEPHALOMYELITIS

S46212A

STRAIN OF MUSC/FASC/TEND PRT BICEPS LEFT ARM INIT

G042

BACTERIAL MENINGOENCEPHALITIS AND MENINGOMYELITIS NEC

S46219A

STRAIN OF MUSC/FASC/TEND PRT BICEPS UNSP ARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G0430

ACUTE NECROTIZING HEMORRHAGIC ENCEPHALOPATHY UNSPECIFIED

S46221A

LACERATION OF MUSC/FASC/TEND PRT BICEPS RIGHT ARM INIT

G0431

POSTINFECTIOUS ACUTE NECROTIZING HEMORRHAGIC ENCEPHALOPATHY

S46222A

LACERATION OF MUSC/FASC/TEND PRT BICEPS LEFT ARM INIT

G0481 OTHER ENCEPHALITIS AND ENCEPHALOMYELITIS

S46229A

LACERATION OF MUSC/FASC/TEND PRT BICEPS UNSP ARM INIT

G0489 OTHER MYELITIS

S46291A INJ MUSCLE FASCIA AND TENDON OF PRT BICEPS RIGHT ARM INIT

G0490

ENCEPHALITIS AND ENCEPHALOMYELITIS UNSPECIFIED

S46292A

INJ MUSCLE FASCIA AND TENDON OF PRT BICEPS LEFT ARM INIT

G0491 MYELITIS UNSPECIFIED

S46299A INJ MUSCLE FASCIA AND TENDON OF PRT BICEPS UNSP ARM INIT

G053

ENCEPHALITIS AND ENCEPHALOMYELITIS IN DISEASES CLASSD ELSWHR

S46301A

UNSP INJURY OF MUSC/FASC/TEND TRICEPS RIGHT ARM INIT

G054 MYELITIS IN DISEASES CLASSIFIED ELSEWHERE

S46302A

UNSP INJURY OF MUSC/FASC/TEND TRICEPS LEFT ARM INIT

G060 INTRACRANIAL ABSCESS AND GRANULOMA

S46309A

UNSP INJURY OF MUSC/FASC/TEND TRICEPS UNSP ARM INIT

G061 INTRASPINAL ABSCESS AND GRANULOMA

S46311A

STRAIN OF MUSC/FASC/TEND TRICEPS RIGHT ARM INIT

G062 EXTRADURAL AND SUBDURAL ABSCESS UNSPECIFIED

S46312A

STRAIN OF MUSC/FASC/TEND TRICEPS LEFT ARM INIT

G07

INTCRN & INTRASPINAL ABSCS & GRANULOMA IN DIS CLASSD ELSWHR

S46319A

STRAIN OF MUSC/FASC/TEND TRICEPS UNSP ARM INIT

G08

INTRACRANIAL AND INTRASPINAL PHLEBITIS AND THROMBOPHLEBITIS

S46321A

LACERATION OF MUSC/FASC/TEND TRICEPS RIGHT ARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G09

SEQUELAE OF INFLAMMATORY DISEASES OF CENTRAL NERVOUS SYSTEM

S46322A

LACERATION OF MUSC/FASC/TEND TRICEPS LEFT ARM INIT

G20 PARKINSON'S DISEASE

S46329A LACERATION OF MUSC/FASC/TEND TRICEPS UNSP ARM INIT

G210 MALIGNANT NEUROLEPTIC SYNDROME

S46391A

INJ MUSCLE FASCIA AND TENDON OF TRICEPS RIGHT ARM INIT

G2111 NEUROLEPTIC INDUCED PARKINSONISM

S46392A

INJ MUSCLE FASCIA AND TENDON OF TRICEPS LEFT ARM INIT

G254 DRUG-INDUCED CHOREA

S46399A INJ MUSCLE FASCIA AND TENDON OF TRICEPS UNSP ARM INIT

G2570 DRUG INDUCED MOVEMENT DISORDER UNSPECIFIED

S46801A

UNSP INJ MUSC/FASC/TEND AT SHLDR/UP ARM RIGHT ARM INIT

G2571 DRUG INDUCED AKATHISIA

S46802A UNSP INJ MUSC/FASC/TEND AT SHLDR/UP ARM LEFT ARM INIT

G2582 STIFF-MAN SYNDROME

S46809A UNSP INJ MUSC/FASC/TEND AT SHLDR/UP ARM UNSP ARM INIT

G259

EXTRAPYRAMIDAL AND MOVEMENT DISORDER UNSPECIFIED

S46811A

STRAIN OF MUSC/FASC/TEND AT SHLDR/UP ARM RIGHT ARM INIT

G26

EXTRAPYRAMIDAL AND MOVEMENT DISORD IN DISEASES CLASSD ELSWHR

S46812A

STRAIN OF MUSC/FASC/TEND AT SHLDR/UP ARM LEFT ARM INIT

G40211

LOCAL-REL SYMPTC EPI W CMPLX PARTIAL SEIZ NTRCT W STAT EPI

S46819A

STRAIN OF MUSC/FASC/TEND AT SHLDR/UP ARM UNSP ARM INIT

G40219

LOCAL-REL SYMPTC EPI W CMPLX PART SEIZ NTRCT W/O STAT EPI

S46821A

LACERAT MUSC/FASC/TEND AT SHLDR/UP ARM RIGHT ARM INIT

G40301 GEN IDIOPATHIC EPILEPSY NOT INTRACTABLE W STAT EPI

S46822A

LACERATION OF MUSC/FASC/TEND AT SHLDR/UP ARM LEFT ARM INIT

G40309 GEN IDIOPATHIC EPILEPSY NOT INTRACTABLE W/O STAT EPI

S46829A

LACERATION OF MUSC/FASC/TEND AT SHLDR/UP ARM UNSP ARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G40311

GENERALIZED IDIOPATHIC EPILEPSY INTRACTABLE W STAT EPI

S46891A

INJ MUSC/FASC/TEND AT SHLDR/UP ARM RIGHT ARM INIT

G40319

GENERALIZED IDIOPATHIC EPILEPSY INTRACTABLE W/O STAT EPI

S46892A

INJ MUSC/FASC/TEND AT SHLDR/UP ARM LEFT ARM INIT

G40401 OTH GENERALIZED EPILEPSY NOT INTRACTABLE W STAT EPI

S46899A

INJ MUSC/FASC/TEND AT SHLDR/UP ARM UNSP ARM INIT

G40409

OTH GENERALIZED EPILEPSY NOT INTRACTABLE W/O STAT EPI

S46901A

UNSP INJ UNSP MUSC/FASC/TEND AT SHLDR/UP ARM R ARM INIT

G40411

OTH GENERALIZED EPILEPSY INTRACTABLE W STATUS EPILEPTICUS

S46902A

UNSP INJ UNSP MUSC/FASC/TEND AT SHLDR/UP ARM LEFT ARM INIT

G40419 OTH GENERALIZED EPILEPSY INTRACTABLE W/O STAT EPI

S46909A

UNSP INJ UNSP MUSC/FASC/TEND AT SHLDR/UP ARM UNSP ARM INIT

G40501 EPILEPTIC SEIZ REL TO EXTRN CAUSES NOT NTRCT W STAT EPI

S46911A

STRAIN UNSP MUSC/FASC/TEND AT SHLDR/UP ARM RIGHT ARM INIT

G40509

EPILEPTIC SEIZ REL TO EXTRN CAUSES NOT NTRCT W/O STAT EPI

S46912A

STRAIN UNSP MUSC/FASC/TEND AT SHLDR/UP ARM LEFT ARM INIT

G40801

OTHER EPILEPSY NOT INTRACTABLE WITH STATUS EPILEPTICUS

S46919A

STRAIN UNSP MUSC/FASC/TEND AT SHLDR/UP ARM UNSP ARM INIT

G40811 LENNOX-GASTAUT SYNDROME NOT INTRACTABLE W STAT EPI

S46922A

LACERAT UNSP MUSC/FASC/TEND AT SHLDR/UP ARM LEFT ARM INIT

G4089 OTHER SEIZURES

S46929A LACERAT UNSP MUSC/FASC/TEND AT SHLDR/UP ARM UNSP ARM INIT

G40901

EPILEPSY UNSP NOT INTRACTABLE WITH STATUS EPILEPTICUS

S46991A

INJ UNSP MUSC/FASC/TEND AT SHLDR/UP ARM RIGHT ARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G40909

EPILEPSY UNSP NOT INTRACTABLE WITHOUT STATUS EPILEPTICUS

S46992A

INJ UNSP MUSC/FASC/TEND AT SHLDR/UP ARM LEFT ARM INIT

G40911

EPILEPSY UNSPECIFIED INTRACTABLE WITH STATUS EPILEPTICUS

S46999A

INJ UNSP MUSC/FASC/TEND AT SHLDR/UP ARM UNSP ARM INIT

G40919 EPILEPSY UNSP INTRACTABLE WITHOUT STATUS EPILEPTICUS

S471XXA

CRUSHING INJURY OF RIGHT SHOULDER AND UPPER ARM INIT ENCNTR

G43609

PERST MIGRAINE AURA W CEREB INFRC NOT NTRCT W/O STAT MIGR

S472XXA

CRUSHING INJURY OF LEFT SHOULDER AND UPPER ARM INIT ENCNTR

G43611

PERST MIGRAINE AURA W CEREBRAL INFRC NTRCT W STAT MIGR

S479XXA

CRUSHING INJURY OF SHOULDER AND UPPER ARM UNSP ARM INIT

G43619

PERST MIGRAINE AURA W CEREBRAL INFRC NTRCT W/O STAT MIGR

S48011A

COMPLETE TRAUMATIC AMPUTATION AT RIGHT SHOULDER JOINT INIT

G43701

CHRONIC MIGRAINE W/O AURA NOT INTRACTABLE W STAT MIGR

S48012A

COMPLETE TRAUMATIC AMPUTATION AT LEFT SHOULDER JOINT INIT

G450 VERTEBRO-BASILAR ARTERY SYNDROME

S48019A

COMPLETE TRAUMATIC AMPUTATION AT UNSP SHOULDER JOINT INIT

G451 CAROTID ARTERY SYNDROME (HEMISPHERIC)

S48021A

PARTIAL TRAUMATIC AMPUTATION AT RIGHT SHOULDER JOINT INIT

G452

MULTIPLE AND BILATERAL PRECEREBRAL ARTERY SYNDROMES

S48022A

PARTIAL TRAUMATIC AMPUTATION AT LEFT SHOULDER JOINT INIT

G453 AMAUROSIS FUGAX

S48029A PARTIAL TRAUMATIC AMPUTATION AT UNSP SHOULDER JOINT INIT

G454 TRANSIENT GLOBAL AMNESIA

S48111A COMPLETE TRAUM AMP AT LEVEL BETW R SHOULDER AND ELBOW INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G458

OTH TRANSIENT CEREBRAL ISCHEMIC ATTACKS AND RELATED SYND

S48112A

COMPLETE TRAUM AMP AT LEVEL BETW L SHOULDER AND ELBOW INIT

G459 TRANSIENT CEREBRAL ISCHEMIC ATTACK UNSPECIFIED

S48119A

COMPLETE TRAUM AMP AT LEVEL BETW UNSP SHLDR AND ELBOW INIT

G460 MIDDLE CEREBRAL ARTERY SYNDROME

S48121A

PARTIAL TRAUM AMP AT LEVEL BETW R SHOULDER AND ELBOW INIT

G461 ANTERIOR CEREBRAL ARTERY SYNDROME

S48122A

PARTIAL TRAUM AMP AT LEVEL BETW L SHOULDER AND ELBOW INIT

G462 POSTERIOR CEREBRAL ARTERY SYNDROME

S48129A

PARTIAL TRAUM AMP AT LEVEL BETW UNSP SHLDR AND ELBOW INIT

G463 BRAIN STEM STROKE SYNDROME

S48911A

COMPLETE TRAUM AMP OF RIGHT SHLDR/UP ARM LEVEL UNSP INIT

G464 CEREBELLAR STROKE SYNDROME

S48912A

COMPLETE TRAUM AMP OF LEFT SHLDR/UP ARM LEVEL UNSP INIT

G465 PURE MOTOR LACUNAR SYNDROME

S48919A

COMPLETE TRAUM AMP OF UNSP SHLDR/UP ARM LEVEL UNSP INIT

G466 PURE SENSORY LACUNAR SYNDROME

S48921A

PARTIAL TRAUM AMP OF RIGHT SHLDR/UP ARM LEVEL UNSP INIT

G467 OTHER LACUNAR SYNDROMES

S48922A PARTIAL TRAUMATIC AMP OF LEFT SHLDR/UP ARM LEVEL UNSP INIT

G468

OTH VASCULAR SYNDROMES OF BRAIN IN CEREBROVASCULAR DISEASES

S48929A

PARTIAL TRAUMATIC AMP OF UNSP SHLDR/UP ARM LEVEL UNSP INIT

G500 TRIGEMINAL NEURALGIA

S49002A UNSP PHYSEAL FX UPPER END OF HUMERUS LEFT ARM INIT

G501 ATYPICAL FACIAL PAIN

S49009A UNSP PHYSEAL FX UPPER END OF HUMERUS UNSP ARM INIT

G508 OTHER DISORDERS OF TRIGEMINAL NERVE

S49011A

SLTR-HARIS TYPE I PHYSL FX UPPER END HUMER RIGHT ARM INIT

G509 DISORDER OF TRIGEMINAL NERVE UNSPECIFIED

S49012A

SLTR-HARIS TYPE I PHYSL FX UPPER END HUMER LEFT ARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G510 BELL'S PALSY

S49019A SLTR-HARIS TYPE I PHYSL FX UPPER END HUMER UNSP ARM INIT

G511 GENICULATE GANGLIONITIS

S49021A SLTR-HARIS TYPE II PHYSL FX UPPER END HUMER RIGHT ARM INIT

G512 MELKERSSON'S SYNDROME

S49022A SLTR-HARIS TYPE II PHYSL FX UPPER END HUMER LEFT ARM INIT

G513 CLONIC HEMIFACIAL SPASM

S49029A SLTR-HARIS TYPE II PHYSL FX UPPER END HUMER UNSP ARM INIT

G514 FACIAL MYOKYMIA

S49031A SLTR-HARIS TYPE III PHYSL FX UPPER END HUMER R ARM INIT

G518 OTHER DISORDERS OF FACIAL NERVE

S49032A

SLTR-HARIS TYPE III PHYSL FX UPPER END HUMER LEFT ARM INIT

G519 DISORDER OF FACIAL NERVE UNSPECIFIED

S49039A

SLTR-HARIS TYPE III PHYSL FX UPPER END HUMER UNSP ARM INIT

G520 DISORDERS OF OLFACTORY NERVE

S49041A

SLTR-HARIS TYPE IV PHYSL FX UPPER END HUMER RIGHT ARM INIT

G521 DISORDERS OF GLOSSOPHARYNGEAL NERVE

S49042A

SLTR-HARIS TYPE IV PHYSL FX UPPER END HUMER LEFT ARM INIT

G522 DISORDERS OF VAGUS NERVE

S49049A SLTR-HARIS TYPE IV PHYSL FX UPPER END HUMER UNSP ARM INIT

G523 DISORDERS OF HYPOGLOSSAL NERVE

S49091A

OTH PHYSEAL FX UPPER END OF HUMERUS RIGHT ARM INIT

G527 DISORDERS OF MULTIPLE CRANIAL NERVES

S49092A

OTH PHYSEAL FRACTURE OF UPPER END OF HUMERUS LEFT ARM INIT

G528 DISORDERS OF OTHER SPECIFIED CRANIAL NERVES

S49099A

OTH PHYSEAL FRACTURE OF UPPER END OF HUMERUS UNSP ARM INIT

G529 CRANIAL NERVE DISORDER UNSPECIFIED

S49101A

UNSP PHYSEAL FX LOWER END OF HUMERUS RIGHT ARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G53

CRANIAL NERVE DISORDERS IN DISEASES CLASSIFIED ELSEWHERE

S49102A

UNSP PHYSEAL FX LOWER END OF HUMERUS LEFT ARM INIT

G540 BRACHIAL PLEXUS DISORDERS

S49109A UNSP PHYSEAL FX LOWER END OF HUMERUS UNSP ARM INIT

G541 LUMBOSACRAL PLEXUS DISORDERS

S49111A

SLTR-HARIS TYPE I PHYSL FX LOWER END HUMER RIGHT ARM INIT

G542 CERVICAL ROOT DISORDERS NOT ELSEWHERE CLASSIFIED

S49112A

SLTR-HARIS TYPE I PHYSL FX LOWER END HUMER LEFT ARM INIT

G543 THORACIC ROOT DISORDERS NOT ELSEWHERE CLASSIFIED

S49119A

SLTR-HARIS TYPE I PHYSL FX LOWER END HUMER UNSP ARM INIT

G544

LUMBOSACRAL ROOT DISORDERS NOT ELSEWHERE CLASSIFIED

S49121A

SLTR-HARIS TYPE II PHYSL FX LOWER END HUMER RIGHT ARM INIT

G545 NEURALGIC AMYOTROPHY

S49122A SLTR-HARIS TYPE II PHYSL FX LOWER END HUMER LEFT ARM INIT

G546 PHANTOM LIMB SYNDROME WITH PAIN

S49129A

SLTR-HARIS TYPE II PHYSL FX LOWER END HUMER UNSP ARM INIT

G547 PHANTOM LIMB SYNDROME WITHOUT PAIN

S49131A

SLTR-HARIS TYPE III PHYSL FX LOW END HUMER RIGHT ARM INIT

G548 OTHER NERVE ROOT AND PLEXUS DISORDERS

S49132A

SLTR-HARIS TYPE III PHYSL FX LOWER END HUMER LEFT ARM INIT

G549 NERVE ROOT AND PLEXUS DISORDER UNSPECIFIED

S49139A

SLTR-HARIS TYPE III PHYSL FX LOWER END HUMER UNSP ARM INIT

G55

NERVE ROOT AND PLEXUS COMPRESSIONS IN DISEASES CLASSD ELSWHR

S49141A

SLTR-HARIS TYPE IV PHYSL FX LOWER END HUMER RIGHT ARM INIT

G5610

OTHER LESIONS OF MEDIAN NERVE UNSPECIFIED UPPER LIMB

S49142A

SLTR-HARIS TYPE IV PHYSL FX LOWER END HUMER LEFT ARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G5611 OTHER LESIONS OF MEDIAN NERVE RIGHT UPPER LIMB

S49149A

SLTR-HARIS TYPE IV PHYSL FX LOWER END HUMER UNSP ARM INIT

G5612 OTHER LESIONS OF MEDIAN NERVE LEFT UPPER LIMB

S49191A

OTH PHYSEAL FX LOWER END OF HUMERUS RIGHT ARM INIT

G5613 Other lesions of median nerve bilateral upper limbs

S49192A

OTH PHYSEAL FRACTURE OF LOWER END OF HUMERUS LEFT ARM INIT

G5620 LESION OF ULNAR NERVE UNSPECIFIED UPPER LIMB

S49199A

OTH PHYSEAL FRACTURE OF LOWER END OF HUMERUS UNSP ARM INIT

G5621 LESION OF ULNAR NERVE RIGHT UPPER LIMB

S4980XA

OTH INJURIES OF SHOULDER AND UPPER ARM UNSP ARM INIT

G5622 LESION OF ULNAR NERVE LEFT UPPER LIMB

S5000XA

CONTUSION OF UNSPECIFIED ELBOW INITIAL ENCOUNTER

G5623 Lesion of ulnar nerve bilateral upper limbs

S5001XA

CONTUSION OF RIGHT ELBOW INITIAL ENCOUNTER

G5630 LESION OF RADIAL NERVE UNSPECIFIED UPPER LIMB

S5002XA

CONTUSION OF LEFT ELBOW INITIAL ENCOUNTER

G5631 LESION OF RADIAL NERVE RIGHT UPPER LIMB

S5010XA

CONTUSION OF UNSPECIFIED FOREARM INITIAL ENCOUNTER

G5632 LESION OF RADIAL NERVE LEFT UPPER LIMB

S5011XA

CONTUSION OF RIGHT FOREARM INITIAL ENCOUNTER

G5633 Lesion of radial nerve bilateral upper limbs

S5012XA

CONTUSION OF LEFT FOREARM INITIAL ENCOUNTER

G5640 CAUSALGIA OF UNSPECIFIED UPPER LIMB

S50341A

EXTERNAL CONSTRICTION OF RIGHT ELBOW INITIAL ENCOUNTER

G5641 CAUSALGIA OF RIGHT UPPER LIMB

S50342A

EXTERNAL CONSTRICTION OF LEFT ELBOW INITIAL ENCOUNTER

G5642 CAUSALGIA OF LEFT UPPER LIMB

S50349A

EXTERNAL CONSTRICTION OF UNSPECIFIED ELBOW INIT ENCNTR

G5643 Causalgia of bilateral upper limbs

S50351A

SUPERFICIAL FOREIGN BODY OF RIGHT ELBOW INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G5680

OTHER SPECIFIED MONONEUROPATHIES OF UNSPECIFIED UPPER LIMB

S50371A

OTHER SUPERFICIAL BITE OF RIGHT ELBOW INITIAL ENCOUNTER

G5681

OTHER SPECIFIED MONONEUROPATHIES OF RIGHT UPPER LIMB

S50372A

OTHER SUPERFICIAL BITE OF LEFT ELBOW INITIAL ENCOUNTER

G5682

OTHER SPECIFIED MONONEUROPATHIES OF LEFT UPPER LIMB

S50379A

OTHER SUPERFICIAL BITE OF UNSPECIFIED ELBOW INIT ENCNTR

G5683

Other specified mononeuropathies of bilateral upper limbs

S50841A

EXTERNAL CONSTRICTION OF RIGHT FOREARM INITIAL ENCOUNTER

G5690

UNSPECIFIED MONONEUROPATHY OF UNSPECIFIED UPPER LIMB

S50842A

EXTERNAL CONSTRICTION OF LEFT FOREARM INITIAL ENCOUNTER

G5691

UNSPECIFIED MONONEUROPATHY OF RIGHT UPPER LIMB

S50849A

EXTERNAL CONSTRICTION OF UNSPECIFIED FOREARM INIT ENCNTR

G5692

UNSPECIFIED MONONEUROPATHY OF LEFT UPPER LIMB

S50871A

OTHER SUPERFICIAL BITE OF RIGHT FOREARM INITIAL ENCOUNTER

G5693 Unspecified mononeuropathy of bilateral upper limbs

S50872A

OTHER SUPERFICIAL BITE OF LEFT FOREARM INITIAL ENCOUNTER

G5700 LESION OF SCIATIC NERVE UNSPECIFIED LOWER LIMB

S50879A

OTHER SUPERFICIAL BITE OF UNSPECIFIED FOREARM INIT ENCNTR

G5701 LESION OF SCIATIC NERVE RIGHT LOWER LIMB

S51001A

UNSPECIFIED OPEN WOUND OF RIGHT ELBOW INITIAL ENCOUNTER

G5702 LESION OF SCIATIC NERVE LEFT LOWER LIMB

S51002A

UNSPECIFIED OPEN WOUND OF LEFT ELBOW INITIAL ENCOUNTER

G5703 Lesion of sciatic nerve bilateral lower limbs

S51009A

UNSPECIFIED OPEN WOUND OF UNSPECIFIED ELBOW INIT ENCNTR

G5710 MERALGIA PARESTHETICA UNSPECIFIED LOWER LIMB

S51011A

LACERATION WITHOUT FOREIGN BODY OF RIGHT ELBOW INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G5711 MERALGIA PARESTHETICA RIGHT LOWER LIMB

S51012A

LACERATION WITHOUT FOREIGN BODY OF LEFT ELBOW INIT ENCNTR

G5712 MERALGIA PARESTHETICA LEFT LOWER LIMB

S51019A

LACERATION WITHOUT FOREIGN BODY OF UNSP ELBOW INIT ENCNTR

G5713 Meralgia paresthetica bilateral lower limbs

S51021A

LACERATION WITH FOREIGN BODY OF RIGHT ELBOW INIT ENCNTR

G5720 LESION OF FEMORAL NERVE UNSPECIFIED LOWER LIMB

S51022A

LACERATION WITH FOREIGN BODY OF LEFT ELBOW INIT ENCNTR

G5721 LESION OF FEMORAL NERVE RIGHT LOWER LIMB

S51029A

LACERATION WITH FOREIGN BODY OF UNSP ELBOW INIT ENCNTR

G5722 LESION OF FEMORAL NERVE LEFT LOWER LIMB

S51031A

PUNCTURE WOUND W/O FOREIGN BODY OF RIGHT ELBOW INIT ENCNTR

G5723 Lesion of femoral nerve bilateral lower limbs

S51032A

PUNCTURE WOUND W/O FOREIGN BODY OF LEFT ELBOW INIT ENCNTR

G5730

LESION OF LATERAL POPLITEAL NERVE UNSPECIFIED LOWER LIMB

S51039A

PUNCTURE WOUND W/O FOREIGN BODY OF UNSP ELBOW INIT ENCNTR

G5731 LESION OF LATERAL POPLITEAL NERVE RIGHT LOWER LIMB

S51041A

PUNCTURE WOUND WITH FOREIGN BODY OF RIGHT ELBOW INIT ENCNTR

G5732 LESION OF LATERAL POPLITEAL NERVE LEFT LOWER LIMB

S51042A

PUNCTURE WOUND WITH FOREIGN BODY OF LEFT ELBOW INIT ENCNTR

G5733 Lesion of lateral popliteal nerve bilateral lower limbs

S51049A

PUNCTURE WOUND WITH FOREIGN BODY OF UNSP ELBOW INIT ENCNTR

G5740

LESION OF MEDIAL POPLITEAL NERVE UNSPECIFIED LOWER LIMB

S52001A

UNSP FRACTURE OF UPPER END OF RIGHT ULNA INIT FOR CLOS FX

G5741 LESION OF MEDIAL POPLITEAL NERVE RIGHT LOWER LIMB

S52001B

UNSP FX UPPER END OF RIGHT ULNA INIT FOR OPN FX TYPE I/2

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G5742 LESION OF MEDIAL POPLITEAL NERVE LEFT LOWER LIMB

S52001C

UNSP FX UPPER END OF RIGHT ULNA INIT FOR OPN FX TYPE 3A/B/C

G5743 Lesion of medial popliteal nerve bilateral lower limbs

S52002A

UNSP FRACTURE OF UPPER END OF LEFT ULNA INIT FOR CLOS FX

G5750 TARSAL TUNNEL SYNDROME UNSPECIFIED LOWER LIMB

S52002B

UNSP FX UPPER END OF LEFT ULNA INIT FOR OPN FX TYPE I/2

G5751 TARSAL TUNNEL SYNDROME RIGHT LOWER LIMB

S52002C

UNSP FX UPPER END OF LEFT ULNA INIT FOR OPN FX TYPE 3A/B/C

G5752 TARSAL TUNNEL SYNDROME LEFT LOWER LIMB

S52009A

UNSP FRACTURE OF UPPER END OF UNSP ULNA INIT FOR CLOS FX

G5753 Tarsal tunnel syndrome bilateral lower limbs

S52009B

UNSP FX UPPER END OF UNSP ULNA INIT FOR OPN FX TYPE I/2

G5760 LESION OF PLANTAR NERVE UNSPECIFIED LOWER LIMB

S52009C

UNSP FX UPPER END OF UNSP ULNA INIT FOR OPN FX TYPE 3A/B/C

G5761 LESION OF PLANTAR NERVE RIGHT LOWER LIMB

S52022A

DISP FX OF OLECRAN PRO W/O INTARTIC EXTN LEFT ULNA INIT

G5762 LESION OF PLANTAR NERVE LEFT LOWER LIMB

S52022C

DISP FX OF OLECRAN PRO W/O INTARTIC EXTN L ULNA 7THC

G5763 Lesion of plantar nerve bilateral lower limbs

S52023A

DISP FX OF OLECRAN PRO W/O INTARTIC EXTN UNSP ULNA INIT

G5770 CAUSALGIA OF UNSPECIFIED LOWER LIMB

S52023C

DISP FX OF OLECRAN PRO W/O INTARTIC EXTN UNSP ULNA 7THC

G5771 CAUSALGIA OF RIGHT LOWER LIMB

S52024A

NONDISP FX OF OLECRAN PRO W/O INTARTIC EXTN RIGHT ULNA INIT

G5772 CAUSALGIA OF LEFT LOWER LIMB

S52024B

NONDISP FX OF OLECRAN PRO W/O INTARTIC EXTN R ULNA 7THB

G5773 Causalgia of bilateral lower limbs

S52024C

NONDISP FX OF OLECRAN PRO W/O INTARTIC EXTN R ULNA 7THC

G5780

OTHER SPECIFIED MONONEUROPATHIES OF UNSPECIFIED LOWER LIMB

S52025A

NONDISP FX OF OLECRAN PRO W/O INTARTIC EXTN LEFT ULNA INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G5781

OTHER SPECIFIED MONONEUROPATHIES OF RIGHT LOWER LIMB

S52025B

NONDISP FX OF OLECRAN PRO W/O INTARTIC EXTN L ULNA 7THB

G5782

OTHER SPECIFIED MONONEUROPATHIES OF LEFT LOWER LIMB

S52025C

NONDISP FX OF OLECRAN PRO W/O INTARTIC EXTN L ULNA 7THC

G5783

Other specified mononeuropathies of bilateral lower limbs

S52026A

NONDISP FX OF OLECRAN PRO W/O INTARTIC EXTN UNSP ULNA INIT

G5790

UNSPECIFIED MONONEUROPATHY OF UNSPECIFIED LOWER LIMB

S52026B

NONDISP FX OF OLECRAN PRO W/O INTARTIC EXTN UNSP ULNA 7THB

G5791

UNSPECIFIED MONONEUROPATHY OF RIGHT LOWER LIMB

S52026C

NONDISP FX OF OLECRAN PRO W/O INTARTIC EXTN UNSP ULNA 7THC

G5792

UNSPECIFIED MONONEUROPATHY OF LEFT LOWER LIMB

S52031A

DISP FX OF OLECRAN PRO W INTARTIC EXTN RIGHT ULNA INIT

G5793 Unspecified mononeuropathy of bilateral lower limbs

S52031B

DISP FX OF OLECRAN PRO W INTARTIC EXTN R ULNA 7THB

G580 INTERCOSTAL NEUROPATHY

S52031C DISP FX OF OLECRAN PRO W INTARTIC EXTN R ULNA 7THC

G587 MONONEURITIS MULTIPLEX

S52032A DISP FX OF OLECRAN PRO W INTARTIC EXTN LEFT ULNA INIT

G588 OTHER SPECIFIED MONONEUROPATHIES

S52032B

DISP FX OF OLECRAN PRO W INTARTIC EXTN L ULNA 7THB

G589 MONONEUROPATHY UNSPECIFIED

S52032C

DISP FX OF OLECRAN PRO W INTARTIC EXTN L ULNA 7THC

G59

MONONEUROPATHY IN DISEASES CLASSIFIED ELSEWHERE

S52033A

DISP FX OF OLECRAN PRO W INTARTIC EXTN UNSP ULNA INIT

G600 HEREDITARY MOTOR AND SENSORY NEUROPATHY

S52033B

DISP FX OF OLECRAN PRO W INTARTIC EXTN UNSP ULNA 7THB

G601 REFSUM'S DISEASE

S52033C DISP FX OF OLECRAN PRO W INTARTIC EXTN UNSP ULNA 7THC

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G602 NEUROPATHY IN ASSOCIATION WITH HEREDITARY ATAXIA

S52034A

NONDISP FX OF OLECRAN PRO W INTARTIC EXTN RIGHT ULNA INIT

G603 IDIOPATHIC PROGRESSIVE NEUROPATHY

S52034B

NONDISP FX OF OLECRAN PRO W INTARTIC EXTN R ULNA 7THB

G608 OTHER HEREDITARY AND IDIOPATHIC NEUROPATHIES

S52034C

NONDISP FX OF OLECRAN PRO W INTARTIC EXTN R ULNA 7THC

G609 HEREDITARY AND IDIOPATHIC NEUROPATHY UNSPECIFIED

S52035A

NONDISP FX OF OLECRAN PRO W INTARTIC EXTN LEFT ULNA INIT

G610 GUILLAIN-BARRE SYNDROME

S52035B NONDISP FX OF OLECRAN PRO W INTARTIC EXTN L ULNA 7THB

G611 SERUM NEUROPATHY

S52035C NONDISP FX OF OLECRAN PRO W INTARTIC EXTN L ULNA 7THC

G6181 CHRONIC INFLAMMATORY DEMYELINATING POLYNEURITIS

S52036A

NONDISP FX OF OLECRAN PRO W INTARTIC EXTN UNSP ULNA INIT

G6182 Multifocal motor neuropathy

S52036B NONDISP FX OF OLECRAN PRO W INTARTIC EXTN UNSP ULNA 7THB

G6189 OTHER INFLAMMATORY POLYNEUROPATHIES

S52036C

NONDISP FX OF OLECRAN PRO W INTARTIC EXTN UNSP ULNA 7THC

G619

INFLAMMATORY POLYNEUROPATHY UNSPECIFIED

S52041A

DISP FX OF CORONOID PROCESS OF RIGHT ULNA INIT FOR CLOS FX

G620 DRUG-INDUCED POLYNEUROPATHY

S52041B

DISP FX OF CORONOID PRO OF R ULNA INIT FOR OPN FX TYPE I/2

G621 ALCOHOLIC POLYNEUROPATHY

S52041C DISP FX OF CORONOID PRO OF R ULNA 7THC

G622 POLYNEUROPATHY DUE TO OTHER TOXIC AGENTS

S52042A

DISP FX OF CORONOID PROCESS OF LEFT ULNA INIT FOR CLOS FX

G6281 CRITICAL ILLNESS POLYNEUROPATHY

S52042B

DISP FX OF CORONOID PRO OF L ULNA INIT FOR OPN FX TYPE I/2

G6282 RADIATION-INDUCED POLYNEUROPATHY

S52042C

DISP FX OF CORONOID PRO OF L ULNA 7THC

G6289 OTHER SPECIFIED POLYNEUROPATHIES

S52043A

DISP FX OF CORONOID PROCESS OF UNSP ULNA INIT FOR CLOS FX

G629 POLYNEUROPATHY UNSPECIFIED

S52043B

DISP FX OF CORONOID PRO OF UNSP ULNA 7THB

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G63 POLYNEUROPATHY IN DISEASES CLASSIFIED ELSEWHERE

S52043C

DISP FX OF CORONOID PRO OF UNSP ULNA 7THC

G64 OTHER DISORDERS OF PERIPHERAL NERVOUS SYSTEM

S52044A

NONDISP FX OF CORONOID PROCESS OF RIGHT ULNA INIT

G650 SEQUELAE OF GUILLAIN-BARRE SYNDROME

S52044B

NONDISP FX OF CORONOID PRO OF R ULNA 7THB

G651

SEQUELAE OF OTHER INFLAMMATORY POLYNEUROPATHY

S52044C

NONDISP FX OF CORONOID PRO OF R ULNA 7THC

G652 SEQUELAE OF TOXIC POLYNEUROPATHY

S52045A

NONDISP FX OF CORONOID PROCESS OF LEFT ULNA INIT

G7000 MYASTHENIA GRAVIS WITHOUT (ACUTE) EXACERBATION

S52045B

NONDISP FX OF CORONOID PRO OF L ULNA 7THB

G7001 MYASTHENIA GRAVIS WITH (ACUTE) EXACERBATION

S52045C

NONDISP FX OF CORONOID PRO OF L ULNA 7THC

G701 TOXIC MYONEURAL DISORDERS

S52046A NONDISP FX OF CORONOID PROCESS OF UNSP ULNA INIT

G702 CONGENITAL AND DEVELOPMENTAL MYASTHENIA

S52046B

NONDISP FX OF CORONOID PRO OF UNSP ULNA 7THB

G709 MYONEURAL DISORDER UNSPECIFIED

S52046C

NONDISP FX OF CORONOID PRO OF UNSP ULNA 7THC

G710 MUSCULAR DYSTROPHY

S52091A OTH FRACTURE OF UPPER END OF RIGHT ULNA INIT FOR CLOS FX

G7111 MYOTONIC MUSCULAR DYSTROPHY

S52091B

OTH FX UPPER END OF RIGHT ULNA INIT FOR OPN FX TYPE I/2

G7112 MYOTONIA CONGENITA

S52091C OTH FX UPPER END OF RIGHT ULNA INIT FOR OPN FX TYPE 3A/B/C

G7113 MYOTONIC CHONDRODYSTROPHY

S52092A

OTH FRACTURE OF UPPER END OF LEFT ULNA INIT FOR CLOS FX

G7114 DRUG INDUCED MYOTONIA

S52092B OTH FX UPPER END OF LEFT ULNA INIT FOR OPN FX TYPE I/2

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G7119 OTHER SPECIFIED MYOTONIC DISORDERS

S52092C

OTH FX UPPER END OF LEFT ULNA INIT FOR OPN FX TYPE 3A/B/C

G712 CONGENITAL MYOPATHIES

S52099A OTH FRACTURE OF UPPER END OF UNSP ULNA INIT FOR CLOS FX

G713 MITOCHONDRIAL MYOPATHY NOT ELSEWHERE CLASSIFIED

S52099B

OTH FX UPPER END OF UNSP ULNA INIT FOR OPN FX TYPE I/2

G718 OTHER PRIMARY DISORDERS OF MUSCLES

S52099C

OTH FX UPPER END OF UNSP ULNA INIT FOR OPN FX TYPE 3A/B/C

G719 PRIMARY DISORDER OF MUSCLE UNSPECIFIED

S52101A

UNSP FRACTURE OF UPPER END OF RIGHT RADIUS INIT FOR CLOS FX

G720 DRUG-INDUCED MYOPATHY

S52101B UNSP FX UPPER END OF R RADIUS INIT FOR OPN FX TYPE I/2

G721 ALCOHOLIC MYOPATHY

S52101C UNSP FX UPPER END OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

G722 MYOPATHY DUE TO OTHER TOXIC AGENTS

S52102A

UNSP FRACTURE OF UPPER END OF LEFT RADIUS INIT FOR CLOS FX

G723 PERIODIC PARALYSIS

S52102B UNSP FX UPPER END OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

G7241 INCLUSION BODY MYOSITIS [IBM]

S52102C

UNSP FX UPPER END LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

G7249 OTH INFLAMMATORY AND IMMUNE MYOPATHIES NEC

S52109A

UNSP FRACTURE OF UPPER END OF UNSP RADIUS INIT FOR CLOS FX

G7281 CRITICAL ILLNESS MYOPATHY

S52109B UNSP FX UPPER END OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

G7289 OTHER SPECIFIED MYOPATHIES

S52109C UNSP FX UPPER END UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

G729 MYOPATHY UNSPECIFIED

S52111A TORUS FRACTURE OF UPPER END OF RIGHT RADIUS INIT

G731 LAMBERT-EATON SYNDROME IN NEOPLASTIC DISEASE

S52111D

TORUS FX UPPER END OF R RADIUS SUBS FOR FX W ROUTN HEAL

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G733

MYASTHENIC SYNDROMES IN OTHER DISEASES CLASSIFIED ELSEWHERE

S52111G

TORUS FX UPPER END OF R RADIUS SUBS FOR FX W DELAY HEAL

G737 MYOPATHY IN DISEASES CLASSIFIED ELSEWHERE

S52112A

TORUS FRACTURE OF UPPER END OF LEFT RADIUS INIT FOR CLOS FX

G800 SPASTIC QUADRIPLEGIC CEREBRAL PALSY

S52119A

TORUS FRACTURE OF UPPER END OF UNSP RADIUS INIT FOR CLOS FX

G801 SPASTIC DIPLEGIC CEREBRAL PALSY

S52121A

DISP FX OF HEAD OF RIGHT RADIUS INIT FOR CLOS FX

G802 SPASTIC HEMIPLEGIC CEREBRAL PALSY

S52121B

DISP FX OF HEAD OF RIGHT RADIUS INIT FOR OPN FX TYPE I/2

G803 ATHETOID CEREBRAL PALSY

S52121C DISP FX OF HEAD OF RIGHT RADIUS INIT FOR OPN FX TYPE 3A/B/C

G804 ATAXIC CEREBRAL PALSY

S52122A DISP FX OF HEAD OF LEFT RADIUS INIT FOR CLOS FX

G808 OTHER CEREBRAL PALSY

S52122B DISP FX OF HEAD OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

G809 CEREBRAL PALSY UNSPECIFIED

S52122C DISP FX OF HEAD OF LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

G834 CAUDA EQUINA SYNDROME

S52123A DISP FX OF HEAD OF UNSP RADIUS INIT FOR CLOS FX

G8381 BROWN-SEQUARD SYNDROME

S52123B DISP FX OF HEAD OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

G8382 ANTERIOR CORD SYNDROME

S52123C DISP FX OF HEAD OF UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

G8383 POSTERIOR CORD SYNDROME

S52124A NONDISP FX OF HEAD OF RIGHT RADIUS INIT FOR CLOS FX

G8384 TODD'S PARALYSIS (POSTEPILEPTIC)

S52124B

NONDISP FX OF HEAD OF RIGHT RADIUS INIT FOR OPN FX TYPE I/2

G8389 OTHER SPECIFIED PARALYTIC SYNDROMES

S52124C

NONDISP FX OF HEAD OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

G839 PARALYTIC SYNDROME UNSPECIFIED

S52125A

NONDISP FX OF HEAD OF LEFT RADIUS INIT FOR CLOS FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G890 CENTRAL PAIN SYNDROME

S52125B NONDISP FX OF HEAD OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

G8911 ACUTE PAIN DUE TO TRAUMA

S52125C NONDISP FX OF HEAD OF LEFT RAD INIT FOR OPN FX TYPE 3A/B/C

G8912 ACUTE POST-THORACOTOMY PAIN

S52126A

NONDISP FX OF HEAD OF UNSP RADIUS INIT FOR CLOS FX

G8918 OTHER ACUTE POSTPROCEDURAL PAIN

S52126B

NONDISP FX OF HEAD OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

G8921 CHRONIC PAIN DUE TO TRAUMA

S52126C

NONDISP FX OF HEAD OF UNSP RAD INIT FOR OPN FX TYPE 3A/B/C

G8922 CHRONIC POST-THORACOTOMY PAIN

S52131A

DISP FX OF NECK OF RIGHT RADIUS INIT FOR CLOS FX

G8928 OTHER CHRONIC POSTPROCEDURAL PAIN

S52131B

DISP FX OF NECK OF RIGHT RADIUS INIT FOR OPN FX TYPE I/2

G893 NEOPLASM RELATED PAIN (ACUTE) (CHRONIC)

S52131C

DISP FX OF NECK OF RIGHT RADIUS INIT FOR OPN FX TYPE 3A/B/C

G894 CHRONIC PAIN SYNDROME

S52132A DISP FX OF NECK OF LEFT RADIUS INIT FOR CLOS FX

G9001 CAROTID SINUS SYNCOPE

S52132B DISP FX OF NECK OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

G9009 OTHER IDIOPATHIC PERIPHERAL AUTONOMIC NEUROPATHY

S52132C

DISP FX OF NECK OF LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

G901 FAMILIAL DYSAUTONOMIA [RILEY-DAY]

S52133A

DISP FX OF NECK OF UNSP RADIUS INIT FOR CLOS FX

G902 HORNER'S SYNDROME

S52133B DISP FX OF NECK OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

G903

MULTI-SYSTEM DEGENERATION OF THE AUTONOMIC NERVOUS SYSTEM

S52133C

DISP FX OF NECK OF UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

G904 AUTONOMIC DYSREFLEXIA

S52134A NONDISP FX OF NECK OF RIGHT RADIUS INIT FOR CLOS FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G9050 COMPLEX REGIONAL PAIN SYNDROME I UNSPECIFIED

S52134B

NONDISP FX OF NECK OF RIGHT RADIUS INIT FOR OPN FX TYPE I/2

G90511

COMPLEX REGIONAL PAIN SYNDROME I OF RIGHT UPPER LIMB

S52134C

NONDISP FX OF NECK OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

G90512

COMPLEX REGIONAL PAIN SYNDROME I OF LEFT UPPER LIMB

S52135A

NONDISP FX OF NECK OF LEFT RADIUS INIT FOR CLOS FX

G90513

COMPLEX REGIONAL PAIN SYNDROME I OF UPPER LIMB BILATERAL

S52135B

NONDISP FX OF NECK OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

G90519

COMPLEX REGIONAL PAIN SYNDROME I OF UNSPECIFIED UPPER LIMB

S52135C

NONDISP FX OF NECK OF LEFT RAD INIT FOR OPN FX TYPE 3A/B/C

G90521

COMPLEX REGIONAL PAIN SYNDROME I OF RIGHT LOWER LIMB

S52136A

NONDISP FX OF NECK OF UNSP RADIUS INIT FOR CLOS FX

G90522

COMPLEX REGIONAL PAIN SYNDROME I OF LEFT LOWER LIMB

S52136B

NONDISP FX OF NECK OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

G90523

COMPLEX REGIONAL PAIN SYNDROME I OF LOWER LIMB BILATERAL

S52136C

NONDISP FX OF NECK OF UNSP RAD INIT FOR OPN FX TYPE 3A/B/C

G90529

COMPLEX REGIONAL PAIN SYNDROME I OF UNSPECIFIED LOWER LIMB

S52181A

OTH FRACTURE OF UPPER END OF RIGHT RADIUS INIT FOR CLOS FX

G9059

COMPLEX REGIONAL PAIN SYNDROME I OF OTHER SPECIFIED SITE

S52181B

OTH FX UPPER END OF R RADIUS INIT FOR OPN FX TYPE I/2

G908 OTHER DISORDERS OF AUTONOMIC NERVOUS SYSTEM

S52181C

OTH FX UPPER END OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

G909 DISORDER OF THE AUTONOMIC NERVOUS SYSTEM UNSPECIFIED

S52182A

OTH FRACTURE OF UPPER END OF LEFT RADIUS INIT FOR CLOS FX

G910 COMMUNICATING HYDROCEPHALUS

S52182B

OTH FX UPPER END OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

Page 89: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G911 OBSTRUCTIVE HYDROCEPHALUS

S52182C OTH FX UPPER END OF LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

G912 (IDIOPATHIC) NORMAL PRESSURE HYDROCEPHALUS

S52189A

OTH FRACTURE OF UPPER END OF UNSP RADIUS INIT FOR CLOS FX

G913 POST-TRAUMATIC HYDROCEPHALUS UNSPECIFIED

S52189B

OTH FX UPPER END OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

G914 HYDROCEPHALUS IN DISEASES CLASSIFIED ELSEWHERE

S52189C

OTH FX UPPER END OF UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

G918 OTHER HYDROCEPHALUS

S52202A UNSP FRACTURE OF SHAFT OF LEFT ULNA INIT FOR CLOS FX

G919 HYDROCEPHALUS UNSPECIFIED

S52202B UNSP FX SHAFT OF LEFT ULNA INIT FOR OPN FX TYPE I/2

G92 TOXIC ENCEPHALOPATHY

S52202C UNSP FX SHAFT OF LEFT ULNA INIT FOR OPN FX TYPE 3A/B/C

G930 CEREBRAL CYSTS

S52209A UNSP FRACTURE OF SHAFT OF UNSP ULNA INIT FOR CLOS FX

G931 ANOXIC BRAIN DAMAGE NOT ELSEWHERE CLASSIFIED

S52209B

UNSP FX SHAFT OF UNSP ULNA INIT FOR OPN FX TYPE I/2

G932 BENIGN INTRACRANIAL HYPERTENSION

S52209C

UNSP FX SHAFT OF UNSP ULNA INIT FOR OPN FX TYPE 3A/B/C

G933 POSTVIRAL FATIGUE SYNDROME

S52211A

GREENSTICK FRACTURE OF SHAFT OF RIGHT ULNA INIT FOR CLOS FX

G9340 ENCEPHALOPATHY UNSPECIFIED

S52212A

GREENSTICK FRACTURE OF SHAFT OF LEFT ULNA INIT FOR CLOS FX

G9341 METABOLIC ENCEPHALOPATHY

S52219A GREENSTICK FRACTURE OF SHAFT OF UNSP ULNA INIT FOR CLOS FX

G9349 OTHER ENCEPHALOPATHY

S52221A DISPLACED TRANSVERSE FRACTURE OF SHAFT OF RIGHT ULNA INIT

G935 COMPRESSION OF BRAIN

S52221B DISPL TRANSVERSE FX SHAFT OF R ULNA 7THB

G936 CEREBRAL EDEMA

S52221C DISPL TRANSVERSE FX SHAFT OF R ULNA 7THC

Page 90: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G937 REYE'S SYNDROME

S52222A DISPLACED TRANSVERSE FRACTURE OF SHAFT OF LEFT ULNA INIT

G9381 TEMPORAL SCLEROSIS

S52222B DISPL TRANSVERSE FX SHAFT OF L ULNA 7THB

G9389 OTHER SPECIFIED DISORDERS OF BRAIN

S52222C

DISPL TRANSVERSE FX SHAFT OF L ULNA 7THC

G939 DISORDER OF BRAIN UNSPECIFIED

S52223A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF UNSP ULNA INIT

G94

OTHER DISORDERS OF BRAIN IN DISEASES CLASSIFIED ELSEWHERE

S52223B

DISPL TRANSVERSE FX SHAFT OF UNSP ULNA 7THB

G950 SYRINGOMYELIA AND SYRINGOBULBIA

S52223C

DISPL TRANSVERSE FX SHAFT OF UNSP ULNA 7THC

G9511

ACUTE INFARCTION OF SPINAL CORD (EMBOLIC) (NONEMBOLIC)

S52224A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF RIGHT ULNA INIT

G9519 OTHER VASCULAR MYELOPATHIES

S52224B

NONDISP TRANSVERSE FX SHAFT OF R ULNA 7THB

G9520 UNSPECIFIED CORD COMPRESSION

S52224C

NONDISP TRANSVERSE FX SHAFT OF R ULNA 7THC

G9529 OTHER CORD COMPRESSION

S52225A

NONDISPLACED TRANSVERSE FRACTURE OF SHAFT OF LEFT ULNA INIT

G9581 CONUS MEDULLARIS SYNDROME

S52225B

NONDISP TRANSVERSE FX SHAFT OF L ULNA 7THB

G9589 OTHER SPECIFIED DISEASES OF SPINAL CORD

S52225C

NONDISP TRANSVERSE FX SHAFT OF L ULNA 7THC

G959 DISEASE OF SPINAL CORD UNSPECIFIED

S52231A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT ULNA INIT

G960 CEREBROSPINAL FLUID LEAK

S52231B DISPL OBLIQUE FX SHAFT OF R ULNA INIT FOR OPN FX TYPE I/2

G9611 DURAL TEAR

S52231C DISPL OBLIQUE FX SHAFT OF R ULNA 7THC

G9612 MENINGEAL ADHESIONS (CEREBRAL) (SPINAL)

S52232S

DISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT ULNA SEQUELA

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G9619

OTHER DISORDERS OF MENINGES NOT ELSEWHERE CLASSIFIED

S52233A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF UNSP ULNA INIT

G968 OTHER SPECIFIED DISORDERS OF CENTRAL NERVOUS SYSTEM

S52233B

DISPL OBLIQUE FX SHAFT OF UNSP ULNA 7THB

G969 DISORDER OF CENTRAL NERVOUS SYSTEM UNSPECIFIED

S52233C

DISPL OBLIQUE FX SHAFT OF UNSP ULNA 7THC

G970 CEREBROSPINAL FLUID LEAK FROM SPINAL PUNCTURE

S52234A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT ULNA INIT

G971 OTHER REACTION TO SPINAL AND LUMBAR PUNCTURE

S52234B

NONDISP OBLIQUE FX SHAFT OF R ULNA INIT FOR OPN FX TYPE I/2

G972

INTRACRANIAL HYPOTENSION FOLLOWING VENTRICULAR SHUNTING

S52234C

NONDISP OBLIQUE FX SHAFT OF R ULNA 7THC

G9731

INTRAOP HEMOR/HEMTOM OF A NERVOUS SYS ORG COMP NRV SYS PROC

S52235A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT ULNA INIT

G9732

INTRAOP HEMOR/HEMTOM OF A NERVOUS SYS ORG COMP OTH PROCEDURE

S52235B

NONDISP OBLIQUE FX SHAFT OF L ULNA INIT FOR OPN FX TYPE I/2

G9741

ACCIDENTAL PUNCTURE OR LACERATION OF DURA DURING A PROCEDURE

S52235C

NONDISP OBLIQUE FX SHAFT OF L ULNA 7THC

G9748

ACC PNCTR & LAC OF NERVOUS SYS ORG DURING A NERVOUS SYS PROC

S52241A

DISPLACED SPIRAL FRACTURE OF SHAFT OF ULNA RIGHT ARM INIT

G9749

ACC PNCTR & LAC OF NERVOUS SYS ORG DURING OTH PROCEDURE

S52241B

DISPL SPIRAL FX SHAFT OF ULNA R ARM 7THB

G9751

POSTPROC HEMOR/HEMTOM OF A NRV SYS ORG FOL A NRV SYS PROC

S52241C

DISPL SPIRAL FX SHAFT OF ULNA R ARM 7THC

Page 92: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

G9752

POSTPROC HEMOR/HEMTOM OF A NERVOUS SYS ORG FOL OTH PROCEDURE

S52242A

DISPLACED SPIRAL FRACTURE OF SHAFT OF ULNA LEFT ARM INIT

G9761

Postprocedural hematoma of a nervous system organ or structure following a nervous system procedure

S52242B

DISPL SPIRAL FX SHAFT OF ULNA L ARM 7THB

G9762

Postprocedural hematoma of a nervous system organ or structure following other procedure

S52242C

DISPL SPIRAL FX SHAFT OF ULNA L ARM 7THC

G9763

Postprocedural seroma of a nervous system organ or structure following a nervous system procedure

S52243A

DISPLACED SPIRAL FRACTURE OF SHAFT OF ULNA UNSP ARM INIT

G9764

Postprocedural seroma of a nervous system organ or structure following other procedure

S52243B

DISPL SPIRAL FX SHAFT OF ULNA UNSP ARM 7THB

G9781

OTHER INTRAOPERATIVE COMPLICATIONS OF NERVOUS SYSTEM

S52243C

DISPL SPIRAL FX SHAFT OF ULNA UNSP ARM 7THC

G9782

OTH POSTPROC COMPLICATIONS AND DISORDERS OF NERVOUS SYS

S52244A

NONDISP SPIRAL FRACTURE OF SHAFT OF ULNA RIGHT ARM INIT

G980 NEUROGENIC ARTHRITIS NOT ELSEWHERE CLASSIFIED

S52244B

NONDISP SPIRAL FX SHAFT OF ULNA R ARM 7THB

G988 OTHER DISORDERS OF NERVOUS SYSTEM

S52244C

NONDISP SPIRAL FX SHAFT OF ULNA R ARM 7THC

G990

AUTONOMIC NEUROPATHY IN DISEASES CLASSIFIED ELSEWHERE

S52245A

NONDISP SPIRAL FRACTURE OF SHAFT OF ULNA LEFT ARM INIT

G992 MYELOPATHY IN DISEASES CLASSIFIED ELSEWHERE

S52245B

NONDISP SPIRAL FX SHAFT OF ULNA L ARM 7THB

G998

OTH DISRD OF NERVOUS SYSTEM IN DISEASES CLASSIFIED ELSEWHERE

S52245C

NONDISP SPIRAL FX SHAFT OF ULNA L ARM 7THC

Page 93: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H348110 Central retinal vein occlusion right eye with macular edema

S52251A

DISPLACED COMMINUTED FX SHAFT OF ULNA RIGHT ARM INIT

H348111

Central retinal vein occlusion right eye with retinal neovascularization

S52251B

DISPL COMMNT FX SHAFT OF ULNA R ARM 7THB

H348120 Central retinal vein occlusion left eye with macular edema

S52251C

DISPL COMMNT FX SHAFT OF ULNA R ARM 7THC

H348121

Central retinal vein occlusion left eye with retinal neovascularization

S52252A

DISPLACED COMMINUTED FX SHAFT OF ULNA LEFT ARM INIT

H348130 Central retinal vein occlusion bilateral with macular edema

S52252B

DISPL COMMNT FX SHAFT OF ULNA L ARM 7THB

H348131

Central retinal vein occlusion bilateral with retinal neovascularization

S52252C

DISPL COMMNT FX SHAFT OF ULNA L ARM 7THC

H348310

Tributary (branch) retinal vein occlusion right eye with macular edema

S52253A

DISPLACED COMMINUTED FX SHAFT OF ULNA UNSP ARM INIT

H348311

Tributary (branch) retinal vein occlusion right eye with retinal neovascularization

S52253B

DISPL COMMNT FX SHAFT OF ULNA UNSP ARM 7THB

H348320

Tributary (branch) retinal vein occlusion left eye with macular edema

S52253C

DISPL COMMNT FX SHAFT OF ULNA UNSP ARM 7THC

H348321

Tributary (branch) retinal vein occlusion left eye with retinal neovascularization

S52254A

NONDISP COMMINUTED FX SHAFT OF ULNA RIGHT ARM INIT

H348330

Tributary (branch) retinal vein occlusion bilateral with macular edema

S52254B

NONDISP COMMNT FX SHAFT OF ULNA R ARM 7THB

H348331

Tributary (branch) retinal vein occlusion bilateral with retinal neovascularization

S52254C

NONDISP COMMNT FX SHAFT OF ULNA R ARM 7THC

H353110

Nonexudative age-related macular degeneration right eye stage unspecified

S52255A

NONDISP COMMINUTED FRACTURE OF SHAFT OF ULNA LEFT ARM INIT

Page 94: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H59331

Postprocedural hematoma of right eye and adnexa following an ophthalmic procedure

S52255B

NONDISP COMMNT FX SHAFT OF ULNA L ARM 7THB

H59332

Postprocedural hematoma of left eye and adnexa following an ophthalmic procedure

S52255C

NONDISP COMMNT FX SHAFT OF ULNA L ARM 7THC

H59333

Postprocedural hematoma of eye and adnexa following an ophthalmic procedure bilateral

S52256A

NONDISP COMMINUTED FRACTURE OF SHAFT OF ULNA UNSP ARM INIT

H59341

Postprocedural hematoma of right eye and adnexa following other procedure

S52256B

NONDISP COMMNT FX SHAFT OF ULNA UNSP ARM 7THB

H59342

Postprocedural hematoma of left eye and adnexa following other procedure

S52256C

NONDISP COMMNT FX SHAFT OF ULNA UNSP ARM 7THC

H59343

Postprocedural hematoma of eye and adnexa following other procedure bilateral

S52261A

DISPLACED SEGMENTAL FX SHAFT OF ULNA RIGHT ARM INIT

H59351

Postprocedural seroma of right eye and adnexa following an ophthalmic procedure

S52261B

DISPL SEG FX SHAFT OF ULNA R ARM INIT FOR OPN FX TYPE I/2

H59352

Postprocedural seroma of left eye and adnexa following an ophthalmic procedure

S52261C

DISPL SEG FX SHAFT OF ULNA R ARM 7THC

H59353

Postprocedural seroma of eye and adnexa following an ophthalmic procedure bilateral

S52262A

DISPLACED SEGMENTAL FX SHAFT OF ULNA LEFT ARM INIT

H59361

Postprocedural seroma of right eye and adnexa following other procedure

S52262B

DISPL SEG FX SHAFT OF ULNA L ARM INIT FOR OPN FX TYPE I/2

H59362

Postprocedural seroma of left eye and adnexa following other procedure

S52262C

DISPL SEG FX SHAFT OF ULNA L ARM 7THC

Page 95: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H59363

Postprocedural seroma of eye and adnexa following other procedure bilateral

S52263A

DISPLACED SEGMENTAL FX SHAFT OF ULNA UNSP ARM INIT

H6120 IMPACTED CERUMEN UNSPECIFIED EAR

S52263B

DISPL SEG FX SHAFT OF ULNA UNSP ARM 7THB

H6121 IMPACTED CERUMEN RIGHT EAR

S52263C

DISPL SEG FX SHAFT OF ULNA UNSP ARM 7THC

H6122 IMPACTED CERUMEN LEFT EAR

S52264A NONDISP SEGMENTAL FRACTURE OF SHAFT OF ULNA RIGHT ARM INIT

H6123 IMPACTED CERUMEN BILATERAL

S52264B

NONDISP SEG FX SHAFT OF ULNA R ARM 7THB

H61301

ACQUIRED STENOSIS OF RIGHT EXTERNAL EAR CANAL UNSPECIFIED

S52264C

NONDISP SEG FX SHAFT OF ULNA R ARM 7THC

H61302

ACQUIRED STENOSIS OF LEFT EXTERNAL EAR CANAL UNSPECIFIED

S52265A

NONDISP SEGMENTAL FRACTURE OF SHAFT OF ULNA LEFT ARM INIT

H61303

ACQUIRED STENOSIS OF EXTERNAL EAR CANAL UNSP BILATERAL

S52265B

NONDISP SEG FX SHAFT OF ULNA L ARM 7THB

H61309

ACQUIRED STENOSIS OF EXTERNAL EAR CANAL UNSP UNSP EAR

S52265C

NONDISP SEG FX SHAFT OF ULNA L ARM 7THC

H61311

ACQUIRED STENOSIS OF R EXT EAR CANAL SECONDARY TO TRAUMA

S52266A

NONDISP SEGMENTAL FRACTURE OF SHAFT OF ULNA UNSP ARM INIT

H61312

ACQUIRED STENOSIS OF L EXT EAR CANAL SECONDARY TO TRAUMA

S52266B

NONDISP SEG FX SHAFT OF ULNA UNSP ARM 7THB

H61313

ACQUIRED STENOSIS OF EXT EAR CANAL SECONDARY TO TRAUMA BI

S52266C

NONDISP SEG FX SHAFT OF ULNA UNSP ARM 7THC

H61319

ACQUIRED STENOSIS OF EXT EAR CANAL SEC TO TRAUMA UNSP EAR

S52271A

MONTEGGIA'S FRACTURE OF RIGHT ULNA INIT FOR CLOS FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H61321

ACQUIRED STENOSIS OF R EXT EAR CANAL SEC TO INFLAM AND INFCT

S52271B

MONTEGGIA'S FRACTURE OF RIGHT ULNA INIT FOR OPN FX TYPE I/2

H61322

ACQUIRED STENOSIS OF L EXT EAR CANAL SEC TO INFLAM AND INFCT

S52271C

MONTEGGIA'S FX RIGHT ULNA INIT FOR OPN FX TYPE 3A/B/C

H61323

ACQ STENOSIS OF EXT EAR CANAL SEC TO INFLAM AND INFCT BI

S52272A

MONTEGGIA'S FRACTURE OF LEFT ULNA INIT FOR CLOS FX

H61329

ACQ STENOS OF EXT EAR CANAL SEC TO INFLAM & INFCT UNSP EAR

S52272B

MONTEGGIA'S FRACTURE OF LEFT ULNA INIT FOR OPN FX TYPE I/2

H61391 OTHER ACQUIRED STENOSIS OF RIGHT EXTERNAL EAR CANAL

S52272C

MONTEGGIA'S FX LEFT ULNA INIT FOR OPN FX TYPE 3A/B/C

H61392 OTHER ACQUIRED STENOSIS OF LEFT EXTERNAL EAR CANAL

S52279A

MONTEGGIA'S FRACTURE OF UNSP ULNA INIT FOR CLOS FX

H61393

OTHER ACQUIRED STENOSIS OF EXTERNAL EAR CANAL BILATERAL

S52279B

MONTEGGIA'S FRACTURE OF UNSP ULNA INIT FOR OPN FX TYPE I/2

H61399

OTHER ACQUIRED STENOSIS OF EXTERNAL EAR CANAL UNSP EAR

S52279C

MONTEGGIA'S FX UNSP ULNA INIT FOR OPN FX TYPE 3A/B/C

H61811 EXOSTOSIS OF RIGHT EXTERNAL CANAL

S52281A

BENT BONE OF RIGHT ULNA INIT ENCNTR FOR CLOSED FRACTURE

H61812 EXOSTOSIS OF LEFT EXTERNAL CANAL

S52281B

BENT BONE OF RIGHT ULNA INIT FOR OPN FX TYPE I/2

H61813 EXOSTOSIS OF EXTERNAL CANAL BILATERAL

S52281C

BENT BONE OF RIGHT ULNA INIT FOR OPN FX TYPE 3A/B/C

H61819 EXOSTOSIS OF EXTERNAL CANAL UNSPECIFIED EAR

S52282A

BENT BONE OF LEFT ULNA INIT ENCNTR FOR CLOSED FRACTURE

H61891 OTHER SPECIFIED DISORDERS OF RIGHT EXTERNAL EAR

S52282B

BENT BONE OF LEFT ULNA INIT FOR OPN FX TYPE I/2

H61892 OTHER SPECIFIED DISORDERS OF LEFT EXTERNAL EAR

S52282C

BENT BONE OF LEFT ULNA INIT FOR OPN FX TYPE 3A/B/C

H61893 OTHER SPECIFIED DISORDERS OF EXTERNAL EAR BILATERAL

S52283A

BENT BONE OF UNSP ULNA INIT ENCNTR FOR CLOSED FRACTURE

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H61899

OTHER SPECIFIED DISORDERS OF EXTERNAL EAR UNSPECIFIED EAR

S52283B

BENT BONE OF UNSP ULNA INIT FOR OPN FX TYPE I/2

H6190 DISORDER OF EXTERNAL EAR UNSPECIFIED UNSPECIFIED EAR

S52283C

BENT BONE OF UNSP ULNA INIT FOR OPN FX TYPE 3A/B/C

H6191 DISORDER OF RIGHT EXTERNAL EAR UNSPECIFIED

S52291A

OTH FRACTURE OF SHAFT OF RIGHT ULNA INIT FOR CLOS FX

H6192 DISORDER OF LEFT EXTERNAL EAR UNSPECIFIED

S52291B

OTH FX SHAFT OF RIGHT ULNA INIT FOR OPN FX TYPE I/2

H6193 DISORDER OF EXTERNAL EAR UNSPECIFIED BILATERAL

S52291C

OTH FX SHAFT OF RIGHT ULNA INIT FOR OPN FX TYPE 3A/B/C

H6240

OTITIS EXTERNA IN OTH DISEASES CLASSD ELSWHR UNSP EAR

S52292A

OTH FRACTURE OF SHAFT OF LEFT ULNA INIT FOR CLOS FX

H6241

OTITIS EXTERNA IN OTH DISEASES CLASSD ELSWHR RIGHT EAR

S52292B

OTH FRACTURE OF SHAFT OF LEFT ULNA INIT FOR OPN FX TYPE I/2

H6242

OTITIS EXTERNA IN OTH DISEASES CLASSD ELSWHR LEFT EAR

S52292C

OTH FX SHAFT OF LEFT ULNA INIT FOR OPN FX TYPE 3A/B/C

H6243

OTITIS EXTERNA IN OTH DISEASES CLASSD ELSWHR BILATERAL

S52299A

OTH FRACTURE OF SHAFT OF UNSP ULNA INIT FOR CLOS FX

H628X1 OTH DISORDERS OF R EXT EAR IN DISEASES CLASSD ELSWHR

S52299B

OTH FRACTURE OF SHAFT OF UNSP ULNA INIT FOR OPN FX TYPE I/2

H628X2

OTH DISORDERS OF LEFT EXTERNAL EAR IN DISEASES CLASSD ELSWHR

S52299C

OTH FX SHAFT OF UNSP ULNA INIT FOR OPN FX TYPE 3A/B/C

H628X3 OTH DISORDERS OF EXT EAR IN DISEASES CLASSD ELSWHR BI

S52301A

UNSP FRACTURE OF SHAFT OF RIGHT RADIUS INIT FOR CLOS FX

H628X9

OTH DISORDERS OF EXT EAR IN DISEASES CLASSD ELSWHR UNSP EAR

S52301B

UNSP FRACTURE OF SHAFT OF R RADIUS INIT FOR OPN FX TYPE I/2

Page 98: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H6500 ACUTE SEROUS OTITIS MEDIA UNSPECIFIED EAR

S52301C

UNSP FX SHAFT OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

H6501 ACUTE SEROUS OTITIS MEDIA RIGHT EAR

S52302A

UNSP FRACTURE OF SHAFT OF LEFT RADIUS INIT FOR CLOS FX

H6502 ACUTE SEROUS OTITIS MEDIA LEFT EAR

S52302B

UNSP FX SHAFT OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

H6503 ACUTE SEROUS OTITIS MEDIA BILATERAL

S52302C

UNSP FX SHAFT OF LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

H6504 ACUTE SEROUS OTITIS MEDIA RECURRENT RIGHT EAR

S52309A

UNSP FRACTURE OF SHAFT OF UNSP RADIUS INIT FOR CLOS FX

H6505 ACUTE SEROUS OTITIS MEDIA RECURRENT LEFT EAR

S52309B

UNSP FX SHAFT OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

H6506 ACUTE SEROUS OTITIS MEDIA RECURRENT BILATERAL

S52309C

UNSP FX SHAFT OF UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

H6507 ACUTE SEROUS OTITIS MEDIA RECURRENT UNSPECIFIED EAR

S52311A

GREENSTICK FRACTURE OF SHAFT OF RADIUS RIGHT ARM INIT

H65111

ACUTE AND SUBACUTE ALLERGIC OTITIS MEDIA (SEROUS) R EAR

S52311S

GREENSTICK FRACTURE OF SHAFT OF RADIUS RIGHT ARM SEQUELA

H65112

ACUTE AND SUBACUTE ALLERGIC OTITIS MEDIA (SEROUS) LEFT EAR

S52312A

GREENSTICK FRACTURE OF SHAFT OF RADIUS LEFT ARM INIT

H65113

ACUTE AND SUBACUTE ALLERGIC OTITIS MEDIA (SEROUS) BI

S52319A

GREENSTICK FRACTURE OF SHAFT OF RADIUS UNSP ARM INIT

H65114

ACUTE AND SUBACUTE ALLERGIC OTITIS MEDIA RECUR R EAR

S52321A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF RIGHT RADIUS INIT

H65115

ACUTE AND SUBACUTE ALLERGIC OTITIS MEDIA RECUR LEFT EAR

S52321B

DISPL TRANSVERSE FX SHAFT OF R RAD INIT FOR OPN FX TYPE I/2

H65116

ACUTE AND SUBACUTE ALLERGIC OTITIS MEDIA (SEROUS) RECUR BI

S52321C

DISPL TRANSVERSE FX SHAFT OF R RAD 7THC

H65117

ACUTE AND SUBACUTE ALLERGIC OTITIS MEDIA RECUR UNSP EAR

S52322A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF LEFT RADIUS INIT

Page 99: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H65119

ACUTE AND SUBACUTE ALLERGIC OTITIS MEDIA (SEROUS) UNSP EAR

S52322B

DISPL TRANSVERSE FX SHAFT OF L RAD INIT FOR OPN FX TYPE I/2

H65191

OTHER ACUTE NONSUPPURATIVE OTITIS MEDIA RIGHT EAR

S52322C

DISPL TRANSVERSE FX SHAFT OF L RAD 7THC

H65192

OTHER ACUTE NONSUPPURATIVE OTITIS MEDIA LEFT EAR

S52323A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF UNSP RADIUS INIT

H65193

OTHER ACUTE NONSUPPURATIVE OTITIS MEDIA BILATERAL

S52323B

DISPL TRANSVERSE FX SHAFT OF UNSP RAD 7THB

H65194

OTH ACUTE NONSUPPURATIVE OTITIS MEDIA RECURRENT RIGHT EAR

S52323C

DISPL TRANSVERSE FX SHAFT OF UNSP RAD 7THC

H65195

OTHER ACUTE NONSUPPURATIVE OTITIS MEDIA RECURRENT LEFT EAR

S52324A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF RIGHT RADIUS INIT

H65196

OTH ACUTE NONSUPPURATIVE OTITIS MEDIA RECURRENT BILATERAL

S52324B

NONDISP TRANSVERSE FX SHAFT OF R RAD 7THB

H65197

OTHER ACUTE NONSUPPURATIVE OTITIS MEDIA RECURRENT UNSP EAR

S52324C

NONDISP TRANSVERSE FX SHAFT OF R RAD 7THC

H65199

OTHER ACUTE NONSUPPURATIVE OTITIS MEDIA UNSPECIFIED EAR

S52325A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF LEFT RADIUS INIT

H6520 CHRONIC SEROUS OTITIS MEDIA UNSPECIFIED EAR

S52325B

NONDISP TRANSVERSE FX SHAFT OF L RAD 7THB

H6521 CHRONIC SEROUS OTITIS MEDIA RIGHT EAR

S52325C

NONDISP TRANSVERSE FX SHAFT OF L RAD 7THC

H6522 CHRONIC SEROUS OTITIS MEDIA LEFT EAR

S52326A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF UNSP RADIUS INIT

H6523 CHRONIC SEROUS OTITIS MEDIA BILATERAL

S52326B

NONDISP TRANSVERSE FX SHAFT OF UNSP RAD 7THB

H6530 CHRONIC MUCOID OTITIS MEDIA UNSPECIFIED EAR

S52326C

NONDISP TRANSVERSE FX SHAFT OF UNSP RAD 7THC

Page 100: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H6531 CHRONIC MUCOID OTITIS MEDIA RIGHT EAR

S52331A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT RADIUS INIT

H6532 CHRONIC MUCOID OTITIS MEDIA LEFT EAR

S52331B

DISPL OBLIQUE FX SHAFT OF R RADIUS INIT FOR OPN FX TYPE I/2

H6533 CHRONIC MUCOID OTITIS MEDIA BILATERAL

S52331C

DISPL OBLIQUE FX SHAFT OF R RAD INIT FOR OPN FX TYPE 3A/B/C

H65411 CHRONIC ALLERGIC OTITIS MEDIA RIGHT EAR

S52332A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT RADIUS INIT

H65412 CHRONIC ALLERGIC OTITIS MEDIA LEFT EAR

S52332B

DISPL OBLIQUE FX SHAFT OF LEFT RAD INIT FOR OPN FX TYPE I/2

H65413 CHRONIC ALLERGIC OTITIS MEDIA BILATERAL

S52332C

DISPL OBLIQUE FX SHAFT OF L RAD INIT FOR OPN FX TYPE 3A/B/C

H65419 CHRONIC ALLERGIC OTITIS MEDIA UNSPECIFIED EAR

S52333A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF UNSP RADIUS INIT

H65491

OTHER CHRONIC NONSUPPURATIVE OTITIS MEDIA RIGHT EAR

S52333B

DISPL OBLIQUE FX SHAFT OF UNSP RAD INIT FOR OPN FX TYPE I/2

H65492

OTHER CHRONIC NONSUPPURATIVE OTITIS MEDIA LEFT EAR

S52333C

DISPL OBLIQUE FX SHAFT OF UNSP RAD 7THC

H65493

OTHER CHRONIC NONSUPPURATIVE OTITIS MEDIA BILATERAL

S52334A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT RADIUS INIT

H65499

OTHER CHRONIC NONSUPPURATIVE OTITIS MEDIA UNSPECIFIED EAR

S52334B

NONDISP OBLIQUE FX SHAFT OF R RAD INIT FOR OPN FX TYPE I/2

H6590

UNSPECIFIED NONSUPPURATIVE OTITIS MEDIA UNSPECIFIED EAR

S52334C

NONDISP OBLIQUE FX SHAFT OF R RAD 7THC

H6591

UNSPECIFIED NONSUPPURATIVE OTITIS MEDIA RIGHT EAR

S52335A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT RADIUS INIT

H6592

UNSPECIFIED NONSUPPURATIVE OTITIS MEDIA LEFT EAR

S52335B

NONDISP OBLIQUE FX SHAFT OF L RAD INIT FOR OPN FX TYPE I/2

Page 101: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H6593

UNSPECIFIED NONSUPPURATIVE OTITIS MEDIA BILATERAL

S52335C

NONDISP OBLIQUE FX SHAFT OF L RAD 7THC

H66001

ACUTE SUPPR OTITIS MEDIA W/O SPON RUPT EAR DRUM RIGHT EAR

S52336A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF UNSP RADIUS INIT

H66002

ACUTE SUPPR OTITIS MEDIA W/O SPON RUPT EAR DRUM LEFT EAR

S52336B

NONDISP OBLIQUE FX SHAFT OF UNSP RAD 7THB

H66003

ACUTE SUPPR OTITIS MEDIA W/O SPON RUPT EAR DRUM BILATERAL

S52336C

NONDISP OBLIQUE FX SHAFT OF UNSP RAD 7THC

H66004

AC SUPPR OTITIS MEDIA W/O SPON RUPT EAR DRUM RECUR R EAR

S52341A

DISPLACED SPIRAL FX SHAFT OF RADIUS RIGHT ARM INIT

H66005

AC SUPPR OTITIS MEDIA W/O SPON RUPT EAR DRUM RECUR L EAR

S52341B

DISPL SPIRAL FX SHAFT OF RAD R ARM 7THB

H66006

ACUTE SUPPR OTITIS MEDIA W/O SPON RUPT EAR DRUM RECUR BI

S52341C

DISPL SPIRAL FX SHAFT OF RAD R ARM 7THC

H66007

AC SUPPR OTITIS MEDIA W/O SPON RUPT EAR DRUMRECUR UNSP EAR

S52342A

DISPLACED SPIRAL FRACTURE OF SHAFT OF RADIUS LEFT ARM INIT

H66009

ACUTE SUPPR OTITIS MEDIA W/O SPON RUPT EAR DRUM UNSP EAR

S52342B

DISPL SPIRAL FX SHAFT OF RAD L ARM 7THB

H66011

ACUTE SUPPR OTITIS MEDIA W SPON RUPT EAR DRUM RIGHT EAR

S52342C

DISPL SPIRAL FX SHAFT OF RAD L ARM 7THC

H66012

ACUTE SUPPR OTITIS MEDIA W SPON RUPT EAR DRUM LEFT EAR

S52343A

DISPLACED SPIRAL FRACTURE OF SHAFT OF RADIUS UNSP ARM INIT

H66013

ACUTE SUPPR OTITIS MEDIA W SPON RUPT EAR DRUM BILATERAL

S52343B

DISPL SPIRAL FX SHAFT OF RAD UNSP ARM 7THB

Page 102: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H66014

ACUTE SUPPR OTITIS MEDIA W SPON RUPT EAR DRUM RECUR R EAR

S52343C

DISPL SPIRAL FX SHAFT OF RAD UNSP ARM 7THC

H66015

ACUTE SUPPR OTITIS MEDIA W SPON RUPT EAR DRUM RECUR L EAR

S52344A

NONDISP SPIRAL FRACTURE OF SHAFT OF RADIUS RIGHT ARM INIT

H66016

ACUTE SUPPR OTITIS MEDIA W SPON RUPT EAR DRUM RECURRENT BI

S52344B

NONDISP SPIRAL FX SHAFT OF RAD R ARM 7THB

H66017

AC SUPPR OTITIS MEDIA W SPON RUPT EAR DRUM RECUR UNSP EAR

S52344C

NONDISP SPIRAL FX SHAFT OF RAD R ARM 7THC

H66019

ACUTE SUPPR OTITIS MEDIA W SPON RUPT EAR DRUM UNSP EAR

S52345A

NONDISP SPIRAL FRACTURE OF SHAFT OF RADIUS LEFT ARM INIT

H6610

CHRONIC TUBOTYMPANIC SUPPURATIVE OTITIS MEDIA UNSPECIFIED

S52345B

NONDISP SPIRAL FX SHAFT OF RAD L ARM 7THB

H6611

CHRONIC TUBOTYMPANIC SUPPURATIVE OTITIS MEDIA RIGHT EAR

S52345C

NONDISP SPIRAL FX SHAFT OF RAD L ARM 7THC

H6612

CHRONIC TUBOTYMPANIC SUPPURATIVE OTITIS MEDIA LEFT EAR

S52346A

NONDISP SPIRAL FRACTURE OF SHAFT OF RADIUS UNSP ARM INIT

H6613

CHRONIC TUBOTYMPANIC SUPPURATIVE OTITIS MEDIA BILATERAL

S52346B

NONDISP SPIRAL FX SHAFT OF RAD UNSP ARM 7THB

H6620

CHRONIC ATTICOANTRAL SUPPURATIVE OTITIS MEDIA UNSP EAR

S52346C

NONDISP SPIRAL FX SHAFT OF RAD UNSP ARM 7THC

H6621

CHRONIC ATTICOANTRAL SUPPURATIVE OTITIS MEDIA RIGHT EAR

S52351A

DISPLACED COMMINUTED FX SHAFT OF RADIUS RIGHT ARM INIT

H6622

CHRONIC ATTICOANTRAL SUPPURATIVE OTITIS MEDIA LEFT EAR

S52351B

DISPL COMMNT FX SHAFT OF RAD R ARM 7THB

Page 103: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H6623

CHRONIC ATTICOANTRAL SUPPURATIVE OTITIS MEDIA BILATERAL

S52351C

DISPL COMMNT FX SHAFT OF RAD R ARM 7THC

H663X1 OTHER CHRONIC SUPPURATIVE OTITIS MEDIA RIGHT EAR

S52352A

DISPLACED COMMINUTED FX SHAFT OF RADIUS LEFT ARM INIT

H663X2 OTHER CHRONIC SUPPURATIVE OTITIS MEDIA LEFT EAR

S52352B

DISPL COMMNT FX SHAFT OF RAD L ARM 7THB

H663X3 OTHER CHRONIC SUPPURATIVE OTITIS MEDIA BILATERAL

S52352C

DISPL COMMNT FX SHAFT OF RAD L ARM 7THC

H663X9 OTHER CHRONIC SUPPURATIVE OTITIS MEDIA UNSPECIFIED EAR

S52353A

DISPLACED COMMINUTED FX SHAFT OF RADIUS UNSP ARM INIT

H6640 SUPPURATIVE OTITIS MEDIA UNSPECIFIED UNSPECIFIED EAR

S52353B

DISPL COMMNT FX SHAFT OF RAD UNSP ARM 7THB

H6641 SUPPURATIVE OTITIS MEDIA UNSPECIFIED RIGHT EAR

S52353C

DISPL COMMNT FX SHAFT OF RAD UNSP ARM 7THC

H6642 SUPPURATIVE OTITIS MEDIA UNSPECIFIED LEFT EAR

S52354A

NONDISP COMMINUTED FX SHAFT OF RADIUS RIGHT ARM INIT

H6643 SUPPURATIVE OTITIS MEDIA UNSPECIFIED BILATERAL

S52354B

NONDISP COMMNT FX SHAFT OF RAD R ARM 7THB

H6690 OTITIS MEDIA UNSPECIFIED UNSPECIFIED EAR

S52354C

NONDISP COMMNT FX SHAFT OF RAD R ARM 7THC

H6691 OTITIS MEDIA UNSPECIFIED RIGHT EAR

S52355A

NONDISP COMMINUTED FX SHAFT OF RADIUS LEFT ARM INIT

H6692 OTITIS MEDIA UNSPECIFIED LEFT EAR

S52355B

NONDISP COMMNT FX SHAFT OF RAD L ARM 7THB

H6693 OTITIS MEDIA UNSPECIFIED BILATERAL

S52355C

NONDISP COMMNT FX SHAFT OF RAD L ARM 7THC

H671

OTITIS MEDIA IN DISEASES CLASSIFIED ELSEWHERE RIGHT EAR

S52356A

NONDISP COMMINUTED FX SHAFT OF RADIUS UNSP ARM INIT

Page 104: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H672

OTITIS MEDIA IN DISEASES CLASSIFIED ELSEWHERE LEFT EAR

S52356B

NONDISP COMMNT FX SHAFT OF RAD UNSP ARM 7THB

H673

OTITIS MEDIA IN DISEASES CLASSIFIED ELSEWHERE BILATERAL

S52356C

NONDISP COMMNT FX SHAFT OF RAD UNSP ARM 7THC

H679

OTITIS MEDIA IN DISEASES CLASSIFIED ELSEWHERE UNSP EAR

S52361A

DISPLACED SEGMENTAL FX SHAFT OF RADIUS RIGHT ARM INIT

H68001 UNSPECIFIED EUSTACHIAN SALPINGITIS RIGHT EAR

S52361B

DISPL SEG FX SHAFT OF RAD R ARM INIT FOR OPN FX TYPE I/2

H68002 UNSPECIFIED EUSTACHIAN SALPINGITIS LEFT EAR

S52361C

DISPL SEG FX SHAFT OF RAD R ARM 7THC

H68003 UNSPECIFIED EUSTACHIAN SALPINGITIS BILATERAL

S52362A

DISPLACED SEGMENTAL FX SHAFT OF RADIUS LEFT ARM INIT

H68009 UNSPECIFIED EUSTACHIAN SALPINGITIS UNSPECIFIED EAR

S52362B

DISPL SEG FX SHAFT OF RAD L ARM INIT FOR OPN FX TYPE I/2

H68011 ACUTE EUSTACHIAN SALPINGITIS RIGHT EAR

S52362C

DISPL SEG FX SHAFT OF RAD L ARM 7THC

H68012 ACUTE EUSTACHIAN SALPINGITIS LEFT EAR

S52363A

DISPLACED SEGMENTAL FX SHAFT OF RADIUS UNSP ARM INIT

H68013 ACUTE EUSTACHIAN SALPINGITIS BILATERAL

S52363B

DISPL SEG FX SHAFT OF RAD UNSP ARM 7THB

H68019 ACUTE EUSTACHIAN SALPINGITIS UNSPECIFIED EAR

S52363C

DISPL SEG FX SHAFT OF RAD UNSP ARM 7THC

H68021 CHRONIC EUSTACHIAN SALPINGITIS RIGHT EAR

S52364A

NONDISP SEGMENTAL FX SHAFT OF RADIUS RIGHT ARM INIT

H68022 CHRONIC EUSTACHIAN SALPINGITIS LEFT EAR

S52364B

NONDISP SEG FX SHAFT OF RAD R ARM INIT FOR OPN FX TYPE I/2

H68023 CHRONIC EUSTACHIAN SALPINGITIS BILATERAL

S52364C

NONDISP SEG FX SHAFT OF RAD R ARM 7THC

H68029 CHRONIC EUSTACHIAN SALPINGITIS UNSPECIFIED EAR

S52365A

NONDISP SEGMENTAL FX SHAFT OF RADIUS LEFT ARM INIT

Page 105: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H68101 UNSPECIFIED OBSTRUCTION OF EUSTACHIAN TUBE RIGHT EAR

S52365B

NONDISP SEG FX SHAFT OF RAD L ARM INIT FOR OPN FX TYPE I/2

H68102 UNSPECIFIED OBSTRUCTION OF EUSTACHIAN TUBE LEFT EAR

S52365C

NONDISP SEG FX SHAFT OF RAD L ARM 7THC

H68103 UNSPECIFIED OBSTRUCTION OF EUSTACHIAN TUBE BILATERAL

S52366A

NONDISP SEGMENTAL FX SHAFT OF RADIUS UNSP ARM INIT

H68109

UNSPECIFIED OBSTRUCTION OF EUSTACHIAN TUBE UNSPECIFIED EAR

S52366B

NONDISP SEG FX SHAFT OF RAD UNSP ARM 7THB

H68111 OSSEOUS OBSTRUCTION OF EUSTACHIAN TUBE RIGHT EAR

S52366C

NONDISP SEG FX SHAFT OF RAD UNSP ARM 7THC

H68112 OSSEOUS OBSTRUCTION OF EUSTACHIAN TUBE LEFT EAR

S52371A

GALEAZZI'S FRACTURE OF RIGHT RADIUS INIT FOR CLOS FX

H68113 OSSEOUS OBSTRUCTION OF EUSTACHIAN TUBE BILATERAL

S52371B

GALEAZZI'S FRACTURE OF R RADIUS INIT FOR OPN FX TYPE I/2

H68119

OSSEOUS OBSTRUCTION OF EUSTACHIAN TUBE UNSPECIFIED EAR

S52371C

GALEAZZI'S FRACTURE OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

H68121

INTRINSIC CARTILAGENOUS OBST OF EUSTACH TUBE RIGHT EAR

S52372A

GALEAZZI'S FRACTURE OF LEFT RADIUS INIT FOR CLOS FX

H68122

INTRINSIC CARTILAGENOUS OBST OF EUSTACH TUBE LEFT EAR

S52372B

GALEAZZI'S FRACTURE OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

H68123

INTRINSIC CARTILAGENOUS OBST OF EUSTACH TUBE BILATERAL

S52372C

GALEAZZI'S FX LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

H68129

INTRINSIC CARTILAGENOUS OBST OF EUSTACH TUBE UNSP EAR

S52379A

GALEAZZI'S FRACTURE OF UNSP RADIUS INIT FOR CLOS FX

H68131

EXTRINSIC CARTILAGENOUS OBST OF EUSTACH TUBE RIGHT EAR

S52379B

GALEAZZI'S FRACTURE OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

Page 106: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H68132

EXTRINSIC CARTILAGENOUS OBST OF EUSTACH TUBE LEFT EAR

S52379C

GALEAZZI'S FX UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

H68133

EXTRINSIC CARTILAGENOUS OBST OF EUSTACH TUBE BILATERAL

S52381A

BENT BONE OF RIGHT RADIUS INIT ENCNTR FOR CLOSED FRACTURE

H68139

EXTRINSIC CARTILAGENOUS OBST OF EUSTACH TUBE UNSP EAR

S52381B

BENT BONE OF RIGHT RADIUS INIT FOR OPN FX TYPE I/2

H6900 PATULOUS EUSTACHIAN TUBE UNSPECIFIED EAR

S52381C

BENT BONE OF RIGHT RADIUS INIT FOR OPN FX TYPE 3A/B/C

H6901 PATULOUS EUSTACHIAN TUBE RIGHT EAR

S52382A

BENT BONE OF LEFT RADIUS INIT ENCNTR FOR CLOSED FRACTURE

H6902 PATULOUS EUSTACHIAN TUBE LEFT EAR

S52382B

BENT BONE OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

H6903 PATULOUS EUSTACHIAN TUBE BILATERAL

S52382C

BENT BONE OF LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

H6980 OTH DISRD OF EUSTACHIAN TUBE UNSPECIFIED EAR

S52389A

BENT BONE OF UNSP RADIUS INIT ENCNTR FOR CLOSED FRACTURE

H6981

OTHER SPECIFIED DISORDERS OF EUSTACHIAN TUBE RIGHT EAR

S52389B

BENT BONE OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

H6982 OTHER SPECIFIED DISORDERS OF EUSTACHIAN TUBE LEFT EAR

S52389C

BENT BONE OF UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

H6983

OTHER SPECIFIED DISORDERS OF EUSTACHIAN TUBE BILATERAL

S52391A

OTH FRACTURE OF SHAFT OF RADIUS RIGHT ARM INIT FOR CLOS FX

H6990

UNSPECIFIED EUSTACHIAN TUBE DISORDER UNSPECIFIED EAR

S52391B

OTH FX SHAFT OF RADIUS RIGHT ARM INIT FOR OPN FX TYPE I/2

H6991 UNSPECIFIED EUSTACHIAN TUBE DISORDER RIGHT EAR

S52391C

OTH FX SHAFT OF RAD RIGHT ARM INIT FOR OPN FX TYPE 3A/B/C

H6992 UNSPECIFIED EUSTACHIAN TUBE DISORDER LEFT EAR

S52392A

OTH FRACTURE OF SHAFT OF RADIUS LEFT ARM INIT FOR CLOS FX

Page 107: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H6993 UNSPECIFIED EUSTACHIAN TUBE DISORDER BILATERAL

S52392B

OTH FX SHAFT OF RADIUS LEFT ARM INIT FOR OPN FX TYPE I/2

H70001 ACUTE MASTOIDITIS WITHOUT COMPLICATIONS RIGHT EAR

S52392C

OTH FX SHAFT OF RAD LEFT ARM INIT FOR OPN FX TYPE 3A/B/C

H70002 ACUTE MASTOIDITIS WITHOUT COMPLICATIONS LEFT EAR

S52399A

OTH FRACTURE OF SHAFT OF RADIUS UNSP ARM INIT FOR CLOS FX

H70003 ACUTE MASTOIDITIS WITHOUT COMPLICATIONS BILATERAL

S52399B

OTH FX SHAFT OF RADIUS UNSP ARM INIT FOR OPN FX TYPE I/2

H70009

ACUTE MASTOIDITIS WITHOUT COMPLICATIONS UNSPECIFIED EAR

S52399C

OTH FX SHAFT OF RAD UNSP ARM INIT FOR OPN FX TYPE 3A/B/C

H70011 SUBPERIOSTEAL ABSCESS OF MASTOID RIGHT EAR

S52501A

UNSP FRACTURE OF THE LOWER END OF RIGHT RADIUS INIT

H70012 SUBPERIOSTEAL ABSCESS OF MASTOID LEFT EAR

S52501B

UNSP FX THE LOWER END OF R RADIUS INIT FOR OPN FX TYPE I/2

H70013 SUBPERIOSTEAL ABSCESS OF MASTOID BILATERAL

S52501C

UNSP FX THE LOWER END R RADIUS INIT FOR OPN FX TYPE 3A/B/C

H70019 SUBPERIOSTEAL ABSCESS OF MASTOID UNSPECIFIED EAR

S52502A

UNSP FRACTURE OF THE LOWER END OF LEFT RADIUS INIT

H70091

ACUTE MASTOIDITIS WITH OTHER COMPLICATIONS RIGHT EAR

S52502B

UNSP FX THE LOWER END LEFT RADIUS INIT FOR OPN FX TYPE I/2

H70092

ACUTE MASTOIDITIS WITH OTHER COMPLICATIONS LEFT EAR

S52502C

UNSP FX THE LOWER END LEFT RAD INIT FOR OPN FX TYPE 3A/B/C

H70093

ACUTE MASTOIDITIS WITH OTHER COMPLICATIONS BILATERAL

S52509A

UNSP FRACTURE OF THE LOWER END OF UNSP RADIUS INIT

H70099

ACUTE MASTOIDITIS WITH OTHER COMPLICATIONS UNSPECIFIED EAR

S52509B

UNSP FX THE LOWER END UNSP RADIUS INIT FOR OPN FX TYPE I/2

Page 108: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H7010 CHRONIC MASTOIDITIS UNSPECIFIED EAR

S52509C

UNSP FX THE LOWER END UNSP RAD INIT FOR OPN FX TYPE 3A/B/C

H7011 CHRONIC MASTOIDITIS RIGHT EAR

S52511A

DISP FX OF RIGHT RADIAL STYLOID PROCESS INIT FOR CLOS FX

H7012 CHRONIC MASTOIDITIS LEFT EAR

S52511B

DISP FX OF R RADIAL STYLOID PRO INIT FOR OPN FX TYPE I/2

H7013 CHRONIC MASTOIDITIS BILATERAL

S52511C

DISP FX OF R RADIAL STYLOID PRO INIT FOR OPN FX TYPE 3A/B/C

H70201 UNSPECIFIED PETROSITIS RIGHT EAR

S52512A

DISP FX OF LEFT RADIAL STYLOID PROCESS INIT FOR CLOS FX

H70202 UNSPECIFIED PETROSITIS LEFT EAR

S52512B

DISP FX OF LEFT RADIAL STYLOID PRO INIT FOR OPN FX TYPE I/2

H70203 UNSPECIFIED PETROSITIS BILATERAL

S52512C

DISP FX OF L RADIAL STYLOID PRO INIT FOR OPN FX TYPE 3A/B/C

H70209 UNSPECIFIED PETROSITIS UNSPECIFIED EAR

S52512S

DISPLACED FRACTURE OF LEFT RADIAL STYLOID PROCESS SEQUELA

H70211 ACUTE PETROSITIS RIGHT EAR

S52513A DISP FX OF UNSP RADIAL STYLOID PROCESS INIT FOR CLOS FX

H70212 ACUTE PETROSITIS LEFT EAR

S52513B DISP FX OF UNSP RADIAL STYLOID PRO INIT FOR OPN FX TYPE I/2

H70213 ACUTE PETROSITIS BILATERAL

S52513C DISP FX OF UNSP RADIAL STYLOID PRO 7THC

H70219 ACUTE PETROSITIS UNSPECIFIED EAR

S52514A

NONDISP FX OF RIGHT RADIAL STYLOID PROCESS INIT FOR CLOS FX

H70221 CHRONIC PETROSITIS RIGHT EAR

S52514B

NONDISP FX OF R RADIAL STYLOID PRO INIT FOR OPN FX TYPE I/2

H70222 CHRONIC PETROSITIS LEFT EAR

S52514C NONDISP FX OF R RADIAL STYLOID PRO 7THC

H70223 CHRONIC PETROSITIS BILATERAL

S52515A

NONDISP FX OF LEFT RADIAL STYLOID PROCESS INIT FOR CLOS FX

H70229 CHRONIC PETROSITIS UNSPECIFIED EAR

S52515B

NONDISP FX OF L RADIAL STYLOID PRO INIT FOR OPN FX TYPE I/2

Page 109: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H70811 POSTAURICULAR FISTULA RIGHT EAR

S52515C

NONDISP FX OF L RADIAL STYLOID PRO 7THC

H70812 POSTAURICULAR FISTULA LEFT EAR

S52516A

NONDISP FX OF UNSP RADIAL STYLOID PROCESS INIT FOR CLOS FX

H70813 POSTAURICULAR FISTULA BILATERAL

S52516B

NONDISP FX OF UNSP RADIAL STYLOID PRO 7THB

H70819 POSTAURICULAR FISTULA UNSPECIFIED EAR

S52516C

NONDISP FX OF UNSP RADIAL STYLOID PRO 7THC

H70891

OTHER MASTOIDITIS AND RELATED CONDITIONS RIGHT EAR

S52521A

TORUS FRACTURE OF LOWER END OF RIGHT RADIUS INIT

H70892 OTHER MASTOIDITIS AND RELATED CONDITIONS LEFT EAR

S52522A

TORUS FRACTURE OF LOWER END OF LEFT RADIUS INIT FOR CLOS FX

H70893

OTHER MASTOIDITIS AND RELATED CONDITIONS BILATERAL

S52529A

TORUS FRACTURE OF LOWER END OF UNSP RADIUS INIT FOR CLOS FX

H70899

OTHER MASTOIDITIS AND RELATED CONDITIONS UNSPECIFIED EAR

S52531A

COLLES' FRACTURE OF RIGHT RADIUS INIT FOR CLOS FX

H7090 UNSPECIFIED MASTOIDITIS UNSPECIFIED EAR

S52531B

COLLES' FRACTURE OF RIGHT RADIUS INIT FOR OPN FX TYPE I/2

H7091 UNSPECIFIED MASTOIDITIS RIGHT EAR

S52531C

COLLES' FRACTURE OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

H7092 UNSPECIFIED MASTOIDITIS LEFT EAR

S52532A

COLLES' FRACTURE OF LEFT RADIUS INIT FOR CLOS FX

H7093 UNSPECIFIED MASTOIDITIS BILATERAL

S52532B

COLLES' FRACTURE OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

H7100 CHOLESTEATOMA OF ATTIC UNSPECIFIED EAR

S52532C

COLLES' FRACTURE OF LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

H7101 CHOLESTEATOMA OF ATTIC RIGHT EAR

S52539A

COLLES' FRACTURE OF UNSP RADIUS INIT FOR CLOS FX

H7102 CHOLESTEATOMA OF ATTIC LEFT EAR

S52539B

COLLES' FRACTURE OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

Page 110: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H7103 CHOLESTEATOMA OF ATTIC BILATERAL

S52539C

COLLES' FRACTURE OF UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

H7110 CHOLESTEATOMA OF TYMPANUM UNSPECIFIED EAR

S52541A

SMITH'S FRACTURE OF RIGHT RADIUS INIT FOR CLOS FX

H7111 CHOLESTEATOMA OF TYMPANUM RIGHT EAR

S52541B

SMITH'S FRACTURE OF RIGHT RADIUS INIT FOR OPN FX TYPE I/2

H7112 CHOLESTEATOMA OF TYMPANUM LEFT EAR

S52541C

SMITH'S FRACTURE OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

H7113 CHOLESTEATOMA OF TYMPANUM BILATERAL

S52542A

SMITH'S FRACTURE OF LEFT RADIUS INIT FOR CLOS FX

H7120 CHOLESTEATOMA OF MASTOID UNSPECIFIED EAR

S52542B

SMITH'S FRACTURE OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

H7121 CHOLESTEATOMA OF MASTOID RIGHT EAR

S52542C

SMITH'S FRACTURE OF LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

H7122 CHOLESTEATOMA OF MASTOID LEFT EAR

S52549A

SMITH'S FRACTURE OF UNSP RADIUS INIT FOR CLOS FX

H7123 CHOLESTEATOMA OF MASTOID BILATERAL

S52549B

SMITH'S FRACTURE OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

H7130 DIFFUSE CHOLESTEATOSIS UNSPECIFIED EAR

S52549C

SMITH'S FRACTURE OF UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

H7131 DIFFUSE CHOLESTEATOSIS RIGHT EAR

S52551A

OTH EXTRARTIC FRACTURE OF LOWER END OF RIGHT RADIUS INIT

H7132 DIFFUSE CHOLESTEATOSIS LEFT EAR

S52551B

OTH EXTRARTIC FX LOWER END R RAD INIT FOR OPN FX TYPE I/2

H7133 DIFFUSE CHOLESTEATOSIS BILATERAL

S52551C

OTH EXTRARTIC FX LOW END R RAD INIT FOR OPN FX TYPE 3A/B/C

H7190 UNSPECIFIED CHOLESTEATOMA UNSPECIFIED EAR

S52552A

OTH EXTRARTIC FRACTURE OF LOWER END OF LEFT RADIUS INIT

H7191 UNSPECIFIED CHOLESTEATOMA RIGHT EAR

S52552B

OTH EXTRARTIC FX LOW END LEFT RAD INIT FOR OPN FX TYPE I/2

Page 111: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H7192 UNSPECIFIED CHOLESTEATOMA LEFT EAR

S52552C

OTH EXTRARTIC FX LOW END L RAD INIT FOR OPN FX TYPE 3A/B/C

H7193 UNSPECIFIED CHOLESTEATOMA BILATERAL

S52559A

OTH EXTRARTIC FRACTURE OF LOWER END OF UNSP RADIUS INIT

H7200

CENTRAL PERFORATION OF TYMPANIC MEMBRANE UNSPECIFIED EAR

S52559B

OTH EXTRARTIC FX LOW END UNSP RAD INIT FOR OPN FX TYPE I/2

H7201

CENTRAL PERFORATION OF TYMPANIC MEMBRANE RIGHT EAR

S52559C

OTH EXTRARTIC FX LOW END UNSP RAD 7THC

H7202

CENTRAL PERFORATION OF TYMPANIC MEMBRANE LEFT EAR

S52561A

BARTON'S FRACTURE OF RIGHT RADIUS INIT FOR CLOS FX

H7203

CENTRAL PERFORATION OF TYMPANIC MEMBRANE BILATERAL

S52561B

BARTON'S FRACTURE OF RIGHT RADIUS INIT FOR OPN FX TYPE I/2

H7210

ATTIC PERFORATION OF TYMPANIC MEMBRANE UNSPECIFIED EAR

S52561C

BARTON'S FRACTURE OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

H7211

ATTIC PERFORATION OF TYMPANIC MEMBRANE RIGHT EAR

S52562A

BARTON'S FRACTURE OF LEFT RADIUS INIT FOR CLOS FX

H7212

ATTIC PERFORATION OF TYMPANIC MEMBRANE LEFT EAR

S52562B

BARTON'S FRACTURE OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

H7213

ATTIC PERFORATION OF TYMPANIC MEMBRANE BILATERAL

S52562C

BARTON'S FX LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

H722X1

OTHER MARGINAL PERFORATIONS OF TYMPANIC MEMBRANE RIGHT EAR

S52569A

BARTON'S FRACTURE OF UNSP RADIUS INIT FOR CLOS FX

H722X2

OTHER MARGINAL PERFORATIONS OF TYMPANIC MEMBRANE LEFT EAR

S52569B

BARTON'S FRACTURE OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

Page 112: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H722X3

OTHER MARGINAL PERFORATIONS OF TYMPANIC MEMBRANE BILATERAL

S52569C

BARTON'S FX UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

H722X9

OTHER MARGINAL PERFORATIONS OF TYMPANIC MEMBRANE UNSP EAR

S52571A

OTH INTARTIC FRACTURE OF LOWER END OF RIGHT RADIUS INIT

H72811

MULTIPLE PERFORATIONS OF TYMPANIC MEMBRANE RIGHT EAR

S52571B

OTH INTARTIC FX LOWER END R RADIUS INIT FOR OPN FX TYPE I/2

H72812

MULTIPLE PERFORATIONS OF TYMPANIC MEMBRANE LEFT EAR

S52571C

OTH INTARTIC FX LOWER END R RAD INIT FOR OPN FX TYPE 3A/B/C

H72813

MULTIPLE PERFORATIONS OF TYMPANIC MEMBRANE BILATERAL

S52572A

OTH INTARTIC FRACTURE OF LOWER END OF LEFT RADIUS INIT

H72819

MULTIPLE PERFORATIONS OF TYMPANIC MEMBRANE UNSPECIFIED EAR

S52572B

OTH INTARTIC FX LOWER END LEFT RAD INIT FOR OPN FX TYPE I/2

H72821

TOTAL PERFORATIONS OF TYMPANIC MEMBRANE RIGHT EAR

S52572C

OTH INTARTIC FX LOW END L RAD INIT FOR OPN FX TYPE 3A/B/C

H72822

TOTAL PERFORATIONS OF TYMPANIC MEMBRANE LEFT EAR

S52579A

OTH INTARTIC FRACTURE OF LOWER END OF UNSP RADIUS INIT

H72823

TOTAL PERFORATIONS OF TYMPANIC MEMBRANE BILATERAL

S52579B

OTH INTARTIC FX LOWER END UNSP RAD INIT FOR OPN FX TYPE I/2

H72829

TOTAL PERFORATIONS OF TYMPANIC MEMBRANE UNSPECIFIED EAR

S52579C

OTH INTARTIC FX LOW END UNSP RAD 7THC

H7290

UNSP PERFORATION OF TYMPANIC MEMBRANE UNSPECIFIED EAR

S52591A

OTH FRACTURES OF LOWER END OF RIGHT RADIUS INIT FOR CLOS FX

H7291

UNSPECIFIED PERFORATION OF TYMPANIC MEMBRANE RIGHT EAR

S52591B

OTH FX OF LOWER END OF R RADIUS INIT FOR OPN FX TYPE I/2

Page 113: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H7292

UNSPECIFIED PERFORATION OF TYMPANIC MEMBRANE LEFT EAR

S52591C

OTH FX OF LOWER END OF R RADIUS INIT FOR OPN FX TYPE 3A/B/C

H7293

UNSPECIFIED PERFORATION OF TYMPANIC MEMBRANE BILATERAL

S52592A

OTH FRACTURES OF LOWER END OF LEFT RADIUS INIT FOR CLOS FX

H73001 ACUTE MYRINGITIS RIGHT EAR

S52592B OTH FX OF LOWER END OF LEFT RADIUS INIT FOR OPN FX TYPE I/2

H73002 ACUTE MYRINGITIS LEFT EAR

S52592C OTH FX OF LOWER END LEFT RADIUS INIT FOR OPN FX TYPE 3A/B/C

H73003 ACUTE MYRINGITIS BILATERAL

S52599A OTH FRACTURES OF LOWER END OF UNSP RADIUS INIT FOR CLOS FX

H73009 ACUTE MYRINGITIS UNSPECIFIED EAR

S52599B

OTH FX OF LOWER END OF UNSP RADIUS INIT FOR OPN FX TYPE I/2

H73011 BULLOUS MYRINGITIS RIGHT EAR

S52599C

OTH FX OF LOWER END UNSP RADIUS INIT FOR OPN FX TYPE 3A/B/C

H73012 BULLOUS MYRINGITIS LEFT EAR

S52601A UNSP FRACTURE OF LOWER END OF RIGHT ULNA INIT FOR CLOS FX

H73013 BULLOUS MYRINGITIS BILATERAL

S52601B

UNSP FX LOWER END OF RIGHT ULNA INIT FOR OPN FX TYPE I/2

H73019 BULLOUS MYRINGITIS UNSPECIFIED EAR

S52601C

UNSP FX LOWER END OF RIGHT ULNA INIT FOR OPN FX TYPE 3A/B/C

H73091 OTHER ACUTE MYRINGITIS RIGHT EAR

S52602A

UNSP FRACTURE OF LOWER END OF LEFT ULNA INIT FOR CLOS FX

H73092 OTHER ACUTE MYRINGITIS LEFT EAR

S52602B

UNSP FX LOWER END OF LEFT ULNA INIT FOR OPN FX TYPE I/2

H73093 OTHER ACUTE MYRINGITIS BILATERAL

S52602C

UNSP FX LOWER END OF LEFT ULNA INIT FOR OPN FX TYPE 3A/B/C

H73099 OTHER ACUTE MYRINGITIS UNSPECIFIED EAR

S52609A

UNSP FRACTURE OF LOWER END OF UNSP ULNA INIT FOR CLOS FX

H7310 CHRONIC MYRINGITIS UNSPECIFIED EAR

S52609B

UNSP FX LOWER END OF UNSP ULNA INIT FOR OPN FX TYPE I/2

Page 114: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H7311 CHRONIC MYRINGITIS RIGHT EAR

S52609C

UNSP FX LOWER END OF UNSP ULNA INIT FOR OPN FX TYPE 3A/B/C

H7312 CHRONIC MYRINGITIS LEFT EAR

S52611A DISP FX OF RIGHT ULNA STYLOID PROCESS INIT FOR CLOS FX

H7313 CHRONIC MYRINGITIS BILATERAL

S52611B

DISP FX OF R ULNA STYLOID PROCESS INIT FOR OPN FX TYPE I/2

H7320 UNSPECIFIED MYRINGITIS UNSPECIFIED EAR

S52611C

DISP FX OF R ULNA STYLOID PRO INIT FOR OPN FX TYPE 3A/B/C

H7321 UNSPECIFIED MYRINGITIS RIGHT EAR

S52612A

DISP FX OF LEFT ULNA STYLOID PROCESS INIT FOR CLOS FX

H7322 UNSPECIFIED MYRINGITIS LEFT EAR

S52612B

DISP FX OF L ULNA STYLOID PROCESS INIT FOR OPN FX TYPE I/2

H7323 UNSPECIFIED MYRINGITIS BILATERAL

S52612C

DISP FX OF L ULNA STYLOID PRO INIT FOR OPN FX TYPE 3A/B/C

H73811 ATROPHIC FLACCID TYMPANIC MEMBRANE RIGHT EAR

S52613A

DISP FX OF UNSP ULNA STYLOID PROCESS INIT FOR CLOS FX

H73812 ATROPHIC FLACCID TYMPANIC MEMBRANE LEFT EAR

S52613B

DISP FX OF UNSP ULNA STYLOID PRO INIT FOR OPN FX TYPE I/2

H73813 ATROPHIC FLACCID TYMPANIC MEMBRANE BILATERAL

S52613C

DISP FX OF UNSP ULNA STYLOID PRO 7THC

H73819 ATROPHIC FLACCID TYMPANIC MEMBRANE UNSPECIFIED EAR

S52614A

NONDISP FX OF RIGHT ULNA STYLOID PROCESS INIT FOR CLOS FX

H73821

ATROPHIC NONFLACCID TYMPANIC MEMBRANE RIGHT EAR

S52614B

NONDISP FX OF R ULNA STYLOID PRO INIT FOR OPN FX TYPE I/2

H73822

ATROPHIC NONFLACCID TYMPANIC MEMBRANE LEFT EAR

S52614C

NONDISP FX OF R ULNA STYLOID PRO 7THC

Page 115: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H73823

ATROPHIC NONFLACCID TYMPANIC MEMBRANE BILATERAL

S52615A

NONDISP FX OF LEFT ULNA STYLOID PROCESS INIT FOR CLOS FX

H73829

ATROPHIC NONFLACCID TYMPANIC MEMBRANE UNSPECIFIED EAR

S52615B

NONDISP FX OF L ULNA STYLOID PRO INIT FOR OPN FX TYPE I/2

H73891

OTHER SPECIFIED DISORDERS OF TYMPANIC MEMBRANE RIGHT EAR

S52615C

NONDISP FX OF L ULNA STYLOID PRO 7THC

H73892

OTHER SPECIFIED DISORDERS OF TYMPANIC MEMBRANE LEFT EAR

S52616A

NONDISP FX OF UNSP ULNA STYLOID PROCESS INIT FOR CLOS FX

H73893

OTHER SPECIFIED DISORDERS OF TYMPANIC MEMBRANE BILATERAL

S52616B

NONDISP FX OF UNSP ULNA STYLOID PRO 7THB

H73899 OTH DISRD OF TYMPANIC MEMBRANE UNSPECIFIED EAR

S52616C

NONDISP FX OF UNSP ULNA STYLOID PRO 7THC

H7390

UNSPECIFIED DISORDER OF TYMPANIC MEMBRANE UNSPECIFIED EAR

S52621A

TORUS FRACTURE OF LOWER END OF RIGHT ULNA INIT FOR CLOS FX

H7391

UNSPECIFIED DISORDER OF TYMPANIC MEMBRANE RIGHT EAR

S52622A

TORUS FRACTURE OF LOWER END OF LEFT ULNA INIT FOR CLOS FX

H7392

UNSPECIFIED DISORDER OF TYMPANIC MEMBRANE LEFT EAR

S52629A

TORUS FRACTURE OF LOWER END OF UNSP ULNA INIT FOR CLOS FX

H7393

UNSPECIFIED DISORDER OF TYMPANIC MEMBRANE BILATERAL

S52691A

OTH FRACTURE OF LOWER END OF RIGHT ULNA INIT FOR CLOS FX

H7401 TYMPANOSCLEROSIS RIGHT EAR

S52691B OTH FX LOWER END OF RIGHT ULNA INIT FOR OPN FX TYPE I/2

H7402 TYMPANOSCLEROSIS LEFT EAR

S52691C OTH FX LOWER END OF RIGHT ULNA INIT FOR OPN FX TYPE 3A/B/C

H7403 TYMPANOSCLEROSIS BILATERAL

S52692A OTH FRACTURE OF LOWER END OF LEFT ULNA INIT FOR CLOS FX

Page 116: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H7409 TYMPANOSCLEROSIS UNSPECIFIED EAR

S52692B

OTH FX LOWER END OF LEFT ULNA INIT FOR OPN FX TYPE I/2

H7411 ADHESIVE RIGHT MIDDLE EAR DISEASE

S52692C

OTH FX LOWER END OF LEFT ULNA INIT FOR OPN FX TYPE 3A/B/C

H7412 ADHESIVE LEFT MIDDLE EAR DISEASE

S52699A

OTH FRACTURE OF LOWER END OF UNSP ULNA INIT FOR CLOS FX

H7413 ADHESIVE MIDDLE EAR DISEASE BILATERAL

S52699B

OTH FX LOWER END OF UNSP ULNA INIT FOR OPN FX TYPE I/2

H7419 ADHESIVE MIDDLE EAR DISEASE UNSPECIFIED EAR

S52699C

OTH FX LOWER END OF UNSP ULNA INIT FOR OPN FX TYPE 3A/B/C

H7420

DISCONTINUITY AND DISLOCATION OF EAR OSSICLES UNSP EAR

S5290XA

UNSP FRACTURE OF UNSP FOREARM INIT FOR CLOS FX

H7421

DISCONTINUITY AND DISLOCATION OF RIGHT EAR OSSICLES

S5290XB

UNSP FRACTURE OF UNSP FOREARM INIT FOR OPN FX TYPE I/2

H7422

DISCONTINUITY AND DISLOCATION OF LEFT EAR OSSICLES

S5290XC

UNSP FRACTURE OF UNSP FOREARM INIT FOR OPN FX TYPE 3A/B/C

H7423

DISCONTINUITY AND DISLOCATION OF EAR OSSICLES BILATERAL

S5291XA

UNSP FRACTURE OF RIGHT FOREARM INIT FOR CLOS FX

H74311 ANKYLOSIS OF EAR OSSICLES RIGHT EAR

S5291XB

UNSP FRACTURE OF RIGHT FOREARM INIT FOR OPN FX TYPE I/2

H74312 ANKYLOSIS OF EAR OSSICLES LEFT EAR

S5291XC

UNSP FRACTURE OF RIGHT FOREARM INIT FOR OPN FX TYPE 3A/B/C

H74313 ANKYLOSIS OF EAR OSSICLES BILATERAL

S5292XA

UNSP FRACTURE OF LEFT FOREARM INIT FOR CLOS FX

H74319 ANKYLOSIS OF EAR OSSICLES UNSPECIFIED EAR

S5292XB

UNSP FRACTURE OF LEFT FOREARM INIT FOR OPN FX TYPE I/2

H74321 PARTIAL LOSS OF EAR OSSICLES RIGHT EAR

S5292XC

UNSP FRACTURE OF LEFT FOREARM INIT FOR OPN FX TYPE 3A/B/C

Page 117: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H74322 PARTIAL LOSS OF EAR OSSICLES LEFT EAR

S53001A

UNSPECIFIED SUBLUXATION OF RIGHT RADIAL HEAD INIT ENCNTR

H74323 PARTIAL LOSS OF EAR OSSICLES BILATERAL

S53002A

UNSPECIFIED SUBLUXATION OF LEFT RADIAL HEAD INIT ENCNTR

H74329 PARTIAL LOSS OF EAR OSSICLES UNSPECIFIED EAR

S53004A

UNSPECIFIED DISLOCATION OF RIGHT RADIAL HEAD INIT ENCNTR

H74391

OTHER ACQUIRED ABNORMALITIES OF RIGHT EAR OSSICLES

S53005A

UNSPECIFIED DISLOCATION OF LEFT RADIAL HEAD INIT ENCNTR

H74392

OTHER ACQUIRED ABNORMALITIES OF LEFT EAR OSSICLES

S53006A

UNSP DISLOCATION OF UNSPECIFIED RADIAL HEAD INIT ENCNTR

H74393

OTHER ACQUIRED ABNORMALITIES OF EAR OSSICLES BILATERAL

S53011A

ANTERIOR SUBLUXATION OF RIGHT RADIAL HEAD INITIAL ENCOUNTER

H74399

OTHER ACQUIRED ABNORMALITIES OF EAR OSSICLES UNSP EAR

S53012A

ANTERIOR SUBLUXATION OF LEFT RADIAL HEAD INITIAL ENCOUNTER

H7440 POLYP OF MIDDLE EAR UNSPECIFIED EAR

S53013A

ANTERIOR SUBLUXATION OF UNSPECIFIED RADIAL HEAD INIT ENCNTR

H7441 POLYP OF RIGHT MIDDLE EAR

S53014A ANTERIOR DISLOCATION OF RIGHT RADIAL HEAD INITIAL ENCOUNTER

H7442 POLYP OF LEFT MIDDLE EAR

S53015A ANTERIOR DISLOCATION OF LEFT RADIAL HEAD INITIAL ENCOUNTER

H7443 POLYP OF MIDDLE EAR BILATERAL

S53016A

ANTERIOR DISLOCATION OF UNSPECIFIED RADIAL HEAD INIT ENCNTR

H748X1

OTHER SPECIFIED DISORDERS OF RIGHT MIDDLE EAR AND MASTOID

S53021A

POSTERIOR SUBLUXATION OF RIGHT RADIAL HEAD INIT ENCNTR

H748X2

OTHER SPECIFIED DISORDERS OF LEFT MIDDLE EAR AND MASTOID

S53022A

POSTERIOR SUBLUXATION OF LEFT RADIAL HEAD INITIAL ENCOUNTER

H748X3 OTH DISRD OF MIDDLE EAR AND MASTOID BILATERAL

S53023A

POSTERIOR SUBLUXATION OF UNSP RADIAL HEAD INIT ENCNTR

Page 118: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H748X9

OTH DISRD OF MIDDLE EAR AND MASTOID UNSPECIFIED EAR

S53024A

POSTERIOR DISLOCATION OF RIGHT RADIAL HEAD INIT ENCNTR

H7490

UNSP DISORDER OF MIDDLE EAR AND MASTOID UNSPECIFIED EAR

S53025A

POSTERIOR DISLOCATION OF LEFT RADIAL HEAD INITIAL ENCOUNTER

H7491

UNSPECIFIED DISORDER OF RIGHT MIDDLE EAR AND MASTOID

S53026A

POSTERIOR DISLOCATION OF UNSP RADIAL HEAD INIT ENCNTR

H7492

UNSPECIFIED DISORDER OF LEFT MIDDLE EAR AND MASTOID

S53031A

NURSEMAID'S ELBOW RIGHT ELBOW INITIAL ENCOUNTER

H7493

UNSPECIFIED DISORDER OF MIDDLE EAR AND MASTOID BILATERAL

S53032A

NURSEMAID'S ELBOW LEFT ELBOW INITIAL ENCOUNTER

H7500

MASTOIDITIS IN INFEC/PARASTC DIS CLASSD ELSWHR UNSP EAR

S53033A

NURSEMAID'S ELBOW UNSPECIFIED ELBOW INITIAL ENCOUNTER

H7501

MASTOIDITIS IN INFEC/PARASTC DISEASES CLASSD ELSWHR R EAR

S53091A

OTHER SUBLUXATION OF RIGHT RADIAL HEAD INITIAL ENCOUNTER

H7502

MASTOIDITIS IN INFEC/PARASTC DIS CLASSD ELSWHR LEFT EAR

S53092A

OTHER SUBLUXATION OF LEFT RADIAL HEAD INITIAL ENCOUNTER

H7503

MASTOIDITIS IN INFEC/PARASTC DISEASES CLASSD ELSWHR BI

S53093A

OTHER SUBLUXATION OF UNSPECIFIED RADIAL HEAD INIT ENCNTR

H7580

OTH DISRD OF MID EAR AND MAST IN DIS CLASSD ELSWHR UNSP EAR

S53094A

OTHER DISLOCATION OF RIGHT RADIAL HEAD INITIAL ENCOUNTER

H7581

OTH DISRD OF R MID EAR AND MASTOID IN DISEASES CLASSD ELSWHR

S53095A

OTHER DISLOCATION OF LEFT RADIAL HEAD INITIAL ENCOUNTER

H7582

OTH DISRD OF L MID EAR AND MASTOID IN DISEASES CLASSD ELSWHR

S53096A

OTHER DISLOCATION OF UNSPECIFIED RADIAL HEAD INIT ENCNTR

Page 119: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H7583

OTH DISRD OF MID EAR AND MASTOID IN DIS CLASSD ELSWHR BI

S53101A

UNSP SUBLUXATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8000

OTOSCLEROSIS W OVAL WINDOW NONOBLITERATIVE UNSP EAR

S53102A

UNSP SUBLUXATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8001

OTOSCLEROSIS W OVAL WINDOW NONOBLITERATIVE RIGHT EAR

S53103A

UNSP SUBLUXATION OF UNSP ULNOHUMERAL JOINT INIT ENCNTR

H8002

OTOSCLEROSIS W OVAL WINDOW NONOBLITERATIVE LEFT EAR

S53104A

UNSP DISLOCATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8003

OTOSCLEROSIS INVOLVING OVAL WINDOW NONOBLITERATIVE BI

S53105A

UNSP DISLOCATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8010

OTOSCLEROSIS INVOLVING OVAL WINDOW OBLITERATIVE UNSP EAR

S53106A

UNSP DISLOCATION OF UNSP ULNOHUMERAL JOINT INIT ENCNTR

H8011

OTOSCLEROSIS INVOLVING OVAL WINDOW OBLITERATIVE RIGHT EAR

S53111A

ANTERIOR SUBLUXATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8012

OTOSCLEROSIS INVOLVING OVAL WINDOW OBLITERATIVE LEFT EAR

S53112A

ANTERIOR SUBLUXATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8013

OTOSCLEROSIS INVOLVING OVAL WINDOW OBLITERATIVE BILATERAL

S53114A

ANTERIOR DISLOCATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8020 COCHLEAR OTOSCLEROSIS UNSPECIFIED EAR

S53115A

ANTERIOR DISLOCATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8021 COCHLEAR OTOSCLEROSIS RIGHT EAR

S53116A

ANTERIOR DISLOCATION OF UNSP ULNOHUMERAL JOINT INIT ENCNTR

H8022 COCHLEAR OTOSCLEROSIS LEFT EAR

S53121A

POSTERIOR SUBLUXATION OF RIGHT ULNOHUMERAL JOINT INIT

Page 120: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H8023 COCHLEAR OTOSCLEROSIS BILATERAL

S53122A

POSTERIOR SUBLUXATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8080 OTHER OTOSCLEROSIS UNSPECIFIED EAR

S53123A

POSTERIOR SUBLUXATION OF UNSP ULNOHUMERAL JOINT INIT ENCNTR

H8081 OTHER OTOSCLEROSIS RIGHT EAR

S53124A

POSTERIOR DISLOCATION OF RIGHT ULNOHUMERAL JOINT INIT

H8082 OTHER OTOSCLEROSIS LEFT EAR

S53125A POSTERIOR DISLOCATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8083 OTHER OTOSCLEROSIS BILATERAL

S53131A

MEDIAL SUBLUXATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8090 UNSPECIFIED OTOSCLEROSIS UNSPECIFIED EAR

S53132A

MEDIAL SUBLUXATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8091 UNSPECIFIED OTOSCLEROSIS RIGHT EAR

S53133A

MEDIAL SUBLUXATION OF UNSP ULNOHUMERAL JOINT INIT ENCNTR

H8092 UNSPECIFIED OTOSCLEROSIS LEFT EAR

S53134A

MEDIAL DISLOCATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8093 UNSPECIFIED OTOSCLEROSIS BILATERAL

S53135A

MEDIAL DISLOCATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8101 MENIERE'S DISEASE RIGHT EAR

S53136A MEDIAL DISLOCATION OF UNSP ULNOHUMERAL JOINT INIT ENCNTR

H8102 MENIERE'S DISEASE LEFT EAR

S53141A LATERAL SUBLUXATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8103 MENIERE'S DISEASE BILATERAL

S53142A LATERAL SUBLUXATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H8109 MENIERE'S DISEASE UNSPECIFIED EAR

S53143A

LATERAL SUBLUXATION OF UNSP ULNOHUMERAL JOINT INIT ENCNTR

H8110 BENIGN PAROXYSMAL VERTIGO UNSPECIFIED EAR

S53144A

LATERAL DISLOCATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8111 BENIGN PAROXYSMAL VERTIGO RIGHT EAR

S53145A

LATERAL DISLOCATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8112 BENIGN PAROXYSMAL VERTIGO LEFT EAR

S53146A

LATERAL DISLOCATION OF UNSP ULNOHUMERAL JOINT INIT ENCNTR

H8113 BENIGN PAROXYSMAL VERTIGO BILATERAL

S53191A

OTHER SUBLUXATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8120 VESTIBULAR NEURONITIS UNSPECIFIED EAR

S53192A

OTHER SUBLUXATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8121 VESTIBULAR NEURONITIS RIGHT EAR

S53194A

OTHER DISLOCATION OF RIGHT ULNOHUMERAL JOINT INIT ENCNTR

H8122 VESTIBULAR NEURONITIS LEFT EAR

S53195A

OTHER DISLOCATION OF LEFT ULNOHUMERAL JOINT INIT ENCNTR

H8123 VESTIBULAR NEURONITIS BILATERAL

S53196A

OTHER DISLOCATION OF UNSP ULNOHUMERAL JOINT INIT ENCNTR

H81311 AURAL VERTIGO RIGHT EAR

S5320XA TRAUMATIC RUPTURE OF UNSP RADIAL COLLATERAL LIGAMENT INIT

H81312 AURAL VERTIGO LEFT EAR

S5321XA TRAUMATIC RUPTURE OF RIGHT RADIAL COLLATERAL LIGAMENT INIT

H81313 AURAL VERTIGO BILATERAL

S5322XA TRAUMATIC RUPTURE OF LEFT RADIAL COLLATERAL LIGAMENT INIT

Page 122: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H81319 AURAL VERTIGO UNSPECIFIED EAR

S5330XA

TRAUMATIC RUPTURE OF UNSP ULNAR COLLATERAL LIGAMENT INIT

H81391 OTHER PERIPHERAL VERTIGO RIGHT EAR

S5331XA

TRAUMATIC RUPTURE OF RIGHT ULNAR COLLATERAL LIGAMENT INIT

H81392 OTHER PERIPHERAL VERTIGO LEFT EAR

S53401A

UNSPECIFIED SPRAIN OF RIGHT ELBOW INITIAL ENCOUNTER

H81393 OTHER PERIPHERAL VERTIGO BILATERAL

S53402A

UNSPECIFIED SPRAIN OF LEFT ELBOW INITIAL ENCOUNTER

H81399 OTHER PERIPHERAL VERTIGO UNSPECIFIED EAR

S53411A

RADIOHUMERAL (JOINT) SPRAIN OF RIGHT ELBOW INIT ENCNTR

H8141 VERTIGO OF CENTRAL ORIGIN RIGHT EAR

S53412A

RADIOHUMERAL (JOINT) SPRAIN OF LEFT ELBOW INITIAL ENCOUNTER

H8142 VERTIGO OF CENTRAL ORIGIN LEFT EAR

S53419A

RADIOHUMERAL (JOINT) SPRAIN OF UNSP ELBOW INIT ENCNTR

H8143 VERTIGO OF CENTRAL ORIGIN BILATERAL

S53421A

ULNOHUMERAL (JOINT) SPRAIN OF RIGHT ELBOW INITIAL ENCOUNTER

H8149 VERTIGO OF CENTRAL ORIGIN UNSPECIFIED EAR

S53422A

ULNOHUMERAL (JOINT) SPRAIN OF LEFT ELBOW INITIAL ENCOUNTER

H818X1

OTHER DISORDERS OF VESTIBULAR FUNCTION RIGHT EAR

S53431A

RADIAL COLLATERAL LIGAMENT SPRAIN OF RIGHT ELBOW INIT

H818X2

OTHER DISORDERS OF VESTIBULAR FUNCTION LEFT EAR

S53432A

RADIAL COLLATERAL LIGAMENT SPRAIN OF LEFT ELBOW INIT ENCNTR

H818X3

OTHER DISORDERS OF VESTIBULAR FUNCTION BILATERAL

S53441A

ULNAR COLLATERAL LIGAMENT SPRAIN OF RIGHT ELBOW INIT ENCNTR

H818X9

OTHER DISORDERS OF VESTIBULAR FUNCTION UNSPECIFIED EAR

S53442A

ULNAR COLLATERAL LIGAMENT SPRAIN OF LEFT ELBOW INIT ENCNTR

Page 123: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H8190

UNSPECIFIED DISORDER OF VESTIBULAR FUNCTION UNSPECIFIED EAR

S53491A

OTHER SPRAIN OF RIGHT ELBOW INITIAL ENCOUNTER

H8191

UNSPECIFIED DISORDER OF VESTIBULAR FUNCTION RIGHT EAR

S53492A

OTHER SPRAIN OF LEFT ELBOW INITIAL ENCOUNTER

H8192

UNSPECIFIED DISORDER OF VESTIBULAR FUNCTION LEFT EAR

S5400XA

INJURY OF ULNAR NERVE AT FOREARM LEVEL UNSP ARM INIT

H8193

UNSPECIFIED DISORDER OF VESTIBULAR FUNCTION BILATERAL

S5400XD

INJURY OF ULNAR NERVE AT FOREARM LEVEL UNSP ARM SUBS

H821

VERTIGINOUS SYNDROMES IN DISEASES CLASSD ELSWHR RIGHT EAR

S5400XS

INJURY OF ULNAR NERVE AT FOREARM LEVEL UNSP ARM SEQUELA

H822

VERTIGINOUS SYNDROMES IN DISEASES CLASSD ELSWHR LEFT EAR

S5401XA

INJURY OF ULNAR NERVE AT FOREARM LEVEL RIGHT ARM INIT

H823

VERTIGINOUS SYNDROMES IN DISEASES CLASSD ELSWHR BILATERAL

S5401XD

INJURY OF ULNAR NERVE AT FOREARM LEVEL RIGHT ARM SUBS

H829

VERTIGINOUS SYNDROMES IN DISEASES CLASSD ELSWHR UNSP EAR

S5401XS

INJURY OF ULNAR NERVE AT FOREARM LEVEL RIGHT ARM SEQUELA

H8301 LABYRINTHITIS RIGHT EAR

S5402XA INJURY OF ULNAR NERVE AT FOREARM LEVEL LEFT ARM INIT

H8302 LABYRINTHITIS LEFT EAR

S5402XD INJURY OF ULNAR NERVE AT FOREARM LEVEL LEFT ARM SUBS

H8303 LABYRINTHITIS BILATERAL

S5402XS INJURY OF ULNAR NERVE AT FOREARM LEVEL LEFT ARM SEQUELA

H8309 LABYRINTHITIS UNSPECIFIED EAR

S5410XA

INJURY OF MEDIAN NERVE AT FOREARM LEVEL UNSP ARM INIT

H8311 LABYRINTHINE FISTULA RIGHT EAR

S5410XD

INJURY OF MEDIAN NERVE AT FOREARM LEVEL UNSP ARM SUBS

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H8312 LABYRINTHINE FISTULA LEFT EAR

S5410XS

INJURY OF MEDIAN NERVE AT FOREARM LEVEL UNSP ARM SEQUELA

H8313 LABYRINTHINE FISTULA BILATERAL

S5411XA

INJURY OF MEDIAN NERVE AT FOREARM LEVEL RIGHT ARM INIT

H8319 LABYRINTHINE FISTULA UNSPECIFIED EAR

S5411XD

INJURY OF MEDIAN NERVE AT FOREARM LEVEL RIGHT ARM SUBS

H832X1 LABYRINTHINE DYSFUNCTION RIGHT EAR

S5411XS

INJURY OF MEDIAN NERVE AT FOREARM LEVEL RIGHT ARM SEQUELA

H832X2 LABYRINTHINE DYSFUNCTION LEFT EAR

S5412XA

INJURY OF MEDIAN NERVE AT FOREARM LEVEL LEFT ARM INIT

H832X3 LABYRINTHINE DYSFUNCTION BILATERAL

S5412XD

INJURY OF MEDIAN NERVE AT FOREARM LEVEL LEFT ARM SUBS

H832X9 LABYRINTHINE DYSFUNCTION UNSPECIFIED EAR

S5412XS

INJURY OF MEDIAN NERVE AT FOREARM LEVEL LEFT ARM SEQUELA

H833X1 NOISE EFFECTS ON RIGHT INNER EAR

S5420XA

INJURY OF RADIAL NERVE AT FOREARM LEVEL UNSP ARM INIT

H833X2 NOISE EFFECTS ON LEFT INNER EAR

S5420XD

INJURY OF RADIAL NERVE AT FOREARM LEVEL UNSP ARM SUBS

H833X3 NOISE EFFECTS ON INNER EAR BILATERAL

S5420XS

INJURY OF RADIAL NERVE AT FOREARM LEVEL UNSP ARM SEQUELA

H833X9 NOISE EFFECTS ON INNER EAR UNSPECIFIED EAR

S5421XA

INJURY OF RADIAL NERVE AT FOREARM LEVEL RIGHT ARM INIT

H838X1 OTHER SPECIFIED DISEASES OF RIGHT INNER EAR

S5421XD

INJURY OF RADIAL NERVE AT FOREARM LEVEL RIGHT ARM SUBS

H838X2 OTHER SPECIFIED DISEASES OF LEFT INNER EAR

S5421XS

INJURY OF RADIAL NERVE AT FOREARM LEVEL RIGHT ARM SEQUELA

H838X3 OTHER SPECIFIED DISEASES OF INNER EAR BILATERAL

S5422XA

INJURY OF RADIAL NERVE AT FOREARM LEVEL LEFT ARM INIT

H838X9 OTHER SPECIFIED DISEASES OF INNER EAR UNSPECIFIED EAR

S5422XD

INJURY OF RADIAL NERVE AT FOREARM LEVEL LEFT ARM SUBS

Page 125: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H8390 UNSPECIFIED DISEASE OF INNER EAR UNSPECIFIED EAR

S5422XS

INJURY OF RADIAL NERVE AT FOREARM LEVEL LEFT ARM SEQUELA

H8391 UNSPECIFIED DISEASE OF RIGHT INNER EAR

S5430XA

INJURY OF CUTAN SENSORY NERVE AT FORARM LV UNSP ARM INIT

H8392 UNSPECIFIED DISEASE OF LEFT INNER EAR

S5430XD

INJURY OF CUTAN SENSORY NERVE AT FORARM LV UNSP ARM SUBS

H8393 UNSPECIFIED DISEASE OF INNER EAR BILATERAL

S5430XS

INJ CUTAN SENSORY NERVE AT FORARM LV UNSP ARM SEQUELA

H900 CONDUCTIVE HEARING LOSS BILATERAL

S5431XA

INJURY OF CUTAN SENSORY NERVE AT FORARM LV RIGHT ARM INIT

H9011

CONDCTV HEAR LOSS UNI RIGHT EAR W UNRESTR HEAR CNTRA SIDE

S5431XD

INJURY OF CUTAN SENSORY NERVE AT FORARM LV RIGHT ARM SUBS

H9012

CONDCTV HEAR LOSS UNI LEFT EAR W UNRESTR HEAR CNTRA SIDE

S5431XS

INJ CUTAN SENSORY NERVE AT FORARM LV RIGHT ARM SEQUELA

H902 CONDUCTIVE HEARING LOSS UNSPECIFIED

S5432XA

INJURY OF CUTAN SENSORY NERVE AT FORARM LV LEFT ARM INIT

H903 SENSORINEURAL HEARING LOSS BILATERAL

S5432XD

INJURY OF CUTAN SENSORY NERVE AT FORARM LV LEFT ARM SUBS

H9041

SNSRNRL HEAR LOSS UNI RIGHT EAR W UNRESTR HEAR CNTRA SIDE

S5432XS

INJ CUTAN SENSORY NERVE AT FORARM LV LEFT ARM SEQUELA

H9042

SNSRNRL HEAR LOSS UNI LEFT EAR W UNRESTR HEAR CNTRA SIDE

S548X1A

UNSP INJURY OF OTH NERVES AT FOREARM LEVEL RIGHT ARM INIT

H905 UNSPECIFIED SENSORINEURAL HEARING LOSS

S548X1D

UNSP INJURY OF OTH NERVES AT FOREARM LEVEL RIGHT ARM SUBS

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H906

MIXED CONDUCTIVE AND SENSORINEURAL HEARING LOSS BILATERAL

S548X1S

UNSP INJURY OF NERVES AT FOREARM LEVEL RIGHT ARM SEQUELA

H9071

MIX CNDCT/SNRL HEAR LOSSUNIR EARW UNRESTR HEAR CNTRA SIDE

S548X2A

UNSP INJURY OF OTH NERVES AT FOREARM LEVEL LEFT ARM INIT

H9072

MIX CNDCT/SNRL HEAR LOSSUNIL EARW UNRESTR HEAR CNTRA SIDE

S548X2D

UNSP INJURY OF OTH NERVES AT FOREARM LEVEL LEFT ARM SUBS

H908

MIXED CONDUCTIVE AND SENSORINEURAL HEARING LOSS UNSPECIFIED

S548X2S

UNSP INJURY OF NERVES AT FOREARM LEVEL LEFT ARM SEQUELA

H9101 OTOTOXIC HEARING LOSS RIGHT EAR

S548X9A

UNSP INJURY OF OTH NERVES AT FOREARM LEVEL UNSP ARM INIT

H9102 OTOTOXIC HEARING LOSS LEFT EAR

S548X9D

UNSP INJURY OF OTH NERVES AT FOREARM LEVEL UNSP ARM SUBS

H9103 OTOTOXIC HEARING LOSS BILATERAL

S548X9S

UNSP INJURY OF NERVES AT FOREARM LEVEL UNSP ARM SEQUELA

H9109 OTOTOXIC HEARING LOSS UNSPECIFIED EAR

S5490XA

INJURY OF UNSP NERVE AT FOREARM LEVEL UNSP ARM INIT ENCNTR

H9110 PRESBYCUSIS UNSPECIFIED EAR

S5490XD INJURY OF UNSP NERVE AT FOREARM LEVEL UNSP ARM SUBS ENCNTR

H9111 PRESBYCUSIS RIGHT EAR

S5490XS INJURY OF UNSP NERVE AT FOREARM LEVEL UNSP ARM SEQUELA

H9112 PRESBYCUSIS LEFT EAR

S5491XA INJURY OF UNSP NERVE AT FOREARM LEVEL RIGHT ARM INIT

H9113 PRESBYCUSIS BILATERAL

S5491XD INJURY OF UNSP NERVE AT FOREARM LEVEL RIGHT ARM SUBS

H9120 SUDDEN IDIOPATHIC HEARING LOSS UNSPECIFIED EAR

S5491XS

INJURY OF UNSP NERVE AT FOREARM LEVEL RIGHT ARM SEQUELA

Page 127: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H9121 SUDDEN IDIOPATHIC HEARING LOSS RIGHT EAR

S5492XA

INJURY OF UNSP NERVE AT FOREARM LEVEL LEFT ARM INIT ENCNTR

H9122 SUDDEN IDIOPATHIC HEARING LOSS LEFT EAR

S5492XD

INJURY OF UNSP NERVE AT FOREARM LEVEL LEFT ARM SUBS ENCNTR

H9123 SUDDEN IDIOPATHIC HEARING LOSS BILATERAL

S5492XS

INJURY OF UNSP NERVE AT FOREARM LEVEL LEFT ARM SEQUELA

H913 DEAF NONSPEAKING NOT ELSEWHERE CLASSIFIED

S55001A

UNSP INJURY OF ULNAR ARTERY AT FORARM LV RIGHT ARM INIT

H918X1 OTHER SPECIFIED HEARING LOSS RIGHT EAR

S55002A

UNSP INJURY OF ULNAR ARTERY AT FOREARM LEVEL LEFT ARM INIT

H918X2 OTHER SPECIFIED HEARING LOSS LEFT EAR

S55011A

LACERATION OF ULNAR ARTERY AT FOREARM LEVEL RIGHT ARM INIT

H918X3 OTHER SPECIFIED HEARING LOSS BILATERAL

S55012A

LACERATION OF ULNAR ARTERY AT FOREARM LEVEL LEFT ARM INIT

H918X9 OTHER SPECIFIED HEARING LOSS UNSPECIFIED EAR

S55091A

INJ ULNAR ARTERY AT FOREARM LEVEL RIGHT ARM INIT ENCNTR

H9190 UNSPECIFIED HEARING LOSS UNSPECIFIED EAR

S55092A

INJ ULNAR ARTERY AT FOREARM LEVEL LEFT ARM INIT ENCNTR

H9191 UNSPECIFIED HEARING LOSS RIGHT EAR

S55101A

UNSP INJURY OF RADIAL ARTERY AT FORARM LV RIGHT ARM INIT

H9192 UNSPECIFIED HEARING LOSS LEFT EAR

S55102A

UNSP INJURY OF RADIAL ARTERY AT FORARM LV LEFT ARM INIT

H9193 UNSPECIFIED HEARING LOSS BILATERAL

S55111A

LACERATION OF RADIAL ARTERY AT FORARM LV RIGHT ARM INIT

H9201 OTALGIA RIGHT EAR

S55112A LACERATION OF RADIAL ARTERY AT FOREARM LEVEL LEFT ARM INIT

H9202 OTALGIA LEFT EAR

S55191A INJ RADIAL ARTERY AT FOREARM LEVEL RIGHT ARM INIT ENCNTR

H9203 OTALGIA BILATERAL

S55192A INJ RADIAL ARTERY AT FOREARM LEVEL LEFT ARM INIT ENCNTR

H9209 OTALGIA UNSPECIFIED EAR

S55201A UNSP INJURY OF VEIN AT FOREARM LEVEL RIGHT ARM INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H9210 OTORRHEA UNSPECIFIED EAR

S55202A UNSP INJURY OF VEIN AT FOREARM LEVEL LEFT ARM INIT ENCNTR

H9211 OTORRHEA RIGHT EAR

S55211A LACERATION OF VEIN AT FOREARM LEVEL RIGHT ARM INIT ENCNTR

H9212 OTORRHEA LEFT EAR

S55212A LACERATION OF VEIN AT FOREARM LEVEL LEFT ARM INIT ENCNTR

H9213 OTORRHEA BILATERAL

S55291A OTH INJURY OF VEIN AT FOREARM LEVEL RIGHT ARM INIT ENCNTR

H9220 OTORRHAGIA UNSPECIFIED EAR

S55292A OTH INJURY OF VEIN AT FOREARM LEVEL LEFT ARM INIT ENCNTR

H9221 OTORRHAGIA RIGHT EAR

S55801A UNSP INJURY OF BLOOD VESSELS AT FORARM LV RIGHT ARM INIT

H9222 OTORRHAGIA LEFT EAR

S55802A UNSP INJURY OF BLOOD VESSELS AT FORARM LV LEFT ARM INIT

H9223 OTORRHAGIA BILATERAL

S55811A LACERATION OF BLOOD VESSELS AT FORARM LV RIGHT ARM INIT

H93011 TRANSIENT ISCHEMIC DEAFNESS RIGHT EAR

S55812A

LACERATION OF BLOOD VESSELS AT FOREARM LEVEL LEFT ARM INIT

H93012 TRANSIENT ISCHEMIC DEAFNESS LEFT EAR

S55891A

INJ OTH BLOOD VESSELS AT FOREARM LEVEL RIGHT ARM INIT

H93013 TRANSIENT ISCHEMIC DEAFNESS BILATERAL

S55892A

INJ OTH BLOOD VESSELS AT FOREARM LEVEL LEFT ARM INIT

H93019 TRANSIENT ISCHEMIC DEAFNESS UNSPECIFIED EAR

S55901A

UNSP INJURY OF UNSP BLOOD VESS AT FORARM LV RIGHT ARM INIT

H93091

UNSPECIFIED DEGENERATIVE AND VASCULAR DISORDERS OF RIGHT EAR

S55902A

UNSP INJURY OF UNSP BLOOD VESS AT FORARM LV LEFT ARM INIT

H93092

UNSPECIFIED DEGENERATIVE AND VASCULAR DISORDERS OF LEFT EAR

S55911A

LACERAT UNSP BLOOD VESSEL AT FORARM LV RIGHT ARM INIT

H93093

UNSP DEGENERATIVE AND VASCULAR DISORDERS OF EAR BILATERAL

S55912A

LACERATION OF UNSP BLOOD VESSEL AT FORARM LV LEFT ARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H93099

UNSP DEGENERATIVE AND VASCULAR DISORDERS OF UNSPECIFIED EAR

S55991A

INJ UNSP BLOOD VESSEL AT FOREARM LEVEL RIGHT ARM INIT

H9311 TINNITUS RIGHT EAR

S55992A INJ UNSP BLOOD VESSEL AT FOREARM LEVEL LEFT ARM INIT

H9312 TINNITUS LEFT EAR

S56001A UNSP INJ FLEXOR MUSC/FASC/TEND R THM AT FORARM LV INIT

H9313 TINNITUS BILATERAL

S56002A UNSP INJ FLEXOR MUSC/FASC/TEND L THM AT FORARM LV INIT

H9319 TINNITUS UNSPECIFIED EAR

S56009A

UNSP INJURY OF FLEXOR MUSC/FASC/TEND THMB AT FORARM LV INIT

H93211 AUDITORY RECRUITMENT RIGHT EAR

S56011A

STRAIN OF FLEXOR MUSC/FASC/TEND R THM AT FORARM LV INIT

H93212 AUDITORY RECRUITMENT LEFT EAR

S56012A

STRAIN OF FLEXOR MUSC/FASC/TEND L THM AT FORARM LV INIT

H93213 AUDITORY RECRUITMENT BILATERAL

S56019A

STRAIN OF FLEXOR MUSC/FASC/TEND THMB AT FOREARM LEVEL INIT

H93219 AUDITORY RECRUITMENT UNSPECIFIED EAR

S56021A

LACERAT FLEXOR MUSC/FASC/TEND RIGHT THUMB AT FORARM LV INIT

H93221 DIPLACUSIS RIGHT EAR

S56022A LACERAT FLEXOR MUSC/FASC/TEND LEFT THUMB AT FORARM LV INIT

H93222 DIPLACUSIS LEFT EAR

S56029A

LACERATION OF FLEXOR MUSC/FASC/TEND THMB AT FORARM LV INIT

H93223 DIPLACUSIS BILATERAL

S56091A INJ FLEXOR MUSC/FASC/TEND RIGHT THUMB AT FOREARM LEVEL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H93229 DIPLACUSIS UNSPECIFIED EAR

S56092D INJ FLEXOR MUSC/FASC/TEND LEFT THUMB AT FOREARM LEVEL SUBS

H93231 HYPERACUSIS RIGHT EAR

S56099A INJ FLEXOR MUSC/FASC/TEND THMB AT FOREARM LEVEL INIT

H93232 HYPERACUSIS LEFT EAR

S56101A UNSP INJ FLEXOR MUSC/FASC/TEND R IDX FNGR AT FORARM LV INIT

H93233 HYPERACUSIS BILATERAL

S56102A UNSP INJ FLEXOR MUSC/FASC/TEND L IDX FNGR AT FORARM LV INIT

H93239 HYPERACUSIS UNSPECIFIED EAR

S56103A UNSP INJ FLEXOR MUSC/FASC/TEND R MID FNGR AT FORARM LV INIT

H93241 TEMPORARY AUDITORY THRESHOLD SHIFT RIGHT EAR

S56104A

UNSP INJ FLEXOR MUSC/FASC/TEND L MID FNGR AT FORARM LV INIT

H93242 TEMPORARY AUDITORY THRESHOLD SHIFT LEFT EAR

S56105A

UNSP INJ FLEXOR MUSC/FASC/TEND R RNG FNGR AT FORARM LV INIT

H93243 TEMPORARY AUDITORY THRESHOLD SHIFT BILATERAL

S56106A

UNSP INJ FLEXOR MUSC/FASC/TEND L RNG FNGR AT FORARM LV INIT

H93249

TEMPORARY AUDITORY THRESHOLD SHIFT UNSPECIFIED EAR

S56107A

UNSP INJ FLXR MUSC/FASC/TEND R LIT FNGR AT FORARM LV INIT

H9325 CENTRAL AUDITORY PROCESSING DISORDER

S56108A

UNSP INJ FLXR MUSC/FASC/TEND L LIT FNGR AT FORARM LV INIT

H93291 OTHER ABNORMAL AUDITORY PERCEPTIONS RIGHT EAR

S56109A

UNSP INJ FLEXOR MUSC/FASC/TEND UNSP FNGR AT FORARM LV INIT

H93292 OTHER ABNORMAL AUDITORY PERCEPTIONS LEFT EAR

S56111A

STRAIN FLEXOR MUSC/FASC/TEND R IDX FNGR AT FORARM LV INIT

H93293 OTHER ABNORMAL AUDITORY PERCEPTIONS BILATERAL

S56112D

STRAIN FLEXOR MUSC/FASC/TEND L IDX FNGR AT FORARM LV SUBS

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H93299 OTHER ABNORMAL AUDITORY PERCEPTIONS UNSPECIFIED EAR

S56113A

STRAIN FLEXOR MUSC/FASC/TEND R MID FINGER AT FORARM LV INIT

H933X1 DISORDERS OF RIGHT ACOUSTIC NERVE

S56114A

STRAIN FLEXOR MUSC/FASC/TEND L MID FINGER AT FORARM LV INIT

H933X2 DISORDERS OF LEFT ACOUSTIC NERVE

S56115A

STRAIN FLEXOR MUSC/FASC/TEND R RNG FNGR AT FORARM LV INIT

H933X3 DISORDERS OF BILATERAL ACOUSTIC NERVES

S56116A

STRAIN FLEXOR MUSC/FASC/TEND L RNG FNGR AT FORARM LV INIT

H933X9 DISORDERS OF UNSPECIFIED ACOUSTIC NERVE

S56117A

STRAIN FLXR MUSC/FASC/TEND R LITTLE FNGR AT FORARM LV INIT

H938X1 OTHER SPECIFIED DISORDERS OF RIGHT EAR

S56118A

STRAIN FLXR MUSC/FASC/TEND L LITTLE FNGR AT FORARM LV INIT

H938X2 OTHER SPECIFIED DISORDERS OF LEFT EAR

S56119A

STRAIN FLEXOR MUSC/FASC/TEND OF UNSP FNGR AT FORARM LV INIT

H938X3 OTHER SPECIFIED DISORDERS OF EAR BILATERAL

S56121A

LACERAT FLEXOR MUSC/FASC/TEND R IDX FNGR AT FORARM LV INIT

H938X9 OTHER SPECIFIED DISORDERS OF EAR UNSPECIFIED EAR

S56122A

LACERAT FLEXOR MUSC/FASC/TEND L IDX FNGR AT FORARM LV INIT

H9390 UNSPECIFIED DISORDER OF EAR UNSPECIFIED EAR

S56123A

LACERAT FLEXOR MUSC/FASC/TEND R MID FNGR AT FORARM LV INIT

H9391 UNSPECIFIED DISORDER OF RIGHT EAR

S56124A

LACERAT FLEXOR MUSC/FASC/TEND L MID FNGR AT FORARM LV INIT

H9392 UNSPECIFIED DISORDER OF LEFT EAR

S56125A

LACERAT FLEXOR MUSC/FASC/TEND R RNG FNGR AT FORARM LV INIT

H9393 UNSPECIFIED DISORDER OF EAR BILATERAL

S56126A

LACERAT FLEXOR MUSC/FASC/TEND L RNG FNGR AT FORARM LV INIT

H93A1 Pulsatile tinnitus right ear

S56127A LACERAT FLXR MUSC/FASC/TEND R LITTLE FNGR AT FORARM LV INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H93A2 Pulsatile tinnitus left ear

S56128A LACERAT FLXR MUSC/FASC/TEND L LITTLE FNGR AT FORARM LV INIT

H93A3 Pulsatile tinnitus bilateral

S56129A LACERAT FLEXOR MUSC/FASC/TEND UNSP FINGER AT FORARM LV INIT

H93A9 Pulsatile tinnitus unspecified ear

S56191A

INJ FLEXOR MUSC/FASC/TEND R IDX FNGR AT FOREARM LEVEL INIT

H9400

ACUSTC NEURITIS IN INFEC/PARASTC DIS CLASSD ELSWHR UNSP EAR

S56192A

INJ FLEXOR MUSC/FASC/TEND L IDX FNGR AT FOREARM LEVEL INIT

H9401

ACUSTC NEURITIS IN INFEC/PARASTC DIS CLASSD ELSWHR R EAR

S56193A

INJ FLEXOR MUSC/FASC/TEND R MID FINGER AT FORARM LV INIT

H9402

ACUSTC NEURITIS IN INFEC/PARASTC DIS CLASSD ELSWHR LEFT EAR

S56194A

INJ FLEXOR MUSC/FASC/TEND L MID FINGER AT FORARM LV INIT

H9403

ACUSTC NEURITIS IN INFEC/PARASTC DISEASES CLASSD ELSWHR BI

S56195A

INJ FLEXOR MUSC/FASC/TEND R RNG FNGR AT FOREARM LEVEL INIT

H9480

OTH DISRD OF EAR IN DISEASES CLASSIFIED ELSEWHERE UNSP EAR

S56196A

INJ FLEXOR MUSC/FASC/TEND L RNG FNGR AT FOREARM LEVEL INIT

H9481

OTH DISRD OF RIGHT EAR IN DISEASES CLASSIFIED ELSEWHERE

S56197A

INJ FLEXOR MUSC/FASC/TEND R LITTLE FINGER AT FORARM LV INIT

H9482

OTH DISRD OF LEFT EAR IN DISEASES CLASSIFIED ELSEWHERE

S56198A

INJ FLEXOR MUSC/FASC/TEND L LITTLE FINGER AT FORARM LV INIT

H9483

OTH DISRD OF EAR IN DISEASES CLASSIFIED ELSEWHERE BILATERAL

S56199A

INJ FLEXOR MUSC/FASC/TEND UNSP FINGER AT FOREARM LEVEL INIT

H9500

RECUR CHOLESTEATOMA OF POSTMASTOIDECTOMY CAVITY UNSP EAR

S56201A

UNSP INJ FLEXOR MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

H9501

RECUR CHOLESTEATOMA OF POSTMASTOIDECTOMY CAVITY RIGHT EAR

S56202A

UNSP INJ FLEXOR MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H9502

RECUR CHOLESTEATOMA OF POSTMASTOIDECTOMY CAVITY LEFT EAR

S56209A

UNSP INJ FLEXOR MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

H9503

RECURRENT CHOLESTEATOMA OF POSTMASTOIDECTOMY CAVITY BI EARS

S56211A

STRAIN FLEXOR MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

H95111

CHRONIC INFLAMMATION OF POSTMASTOIDECTOMY CAVITY RIGHT EAR

S56212A

STRAIN OF FLEXOR MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

H95112

CHRONIC INFLAMMATION OF POSTMASTOIDECTOMY CAVITY LEFT EAR

S56219A

STRAIN OF FLEXOR MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

H95113

CHRONIC INFLAM OF POSTMASTOIDECTOMY CAVITY BILATERAL EARS

S56221A

LACERAT FLEXOR MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

H95119

CHRONIC INFLAMMATION OF POSTMASTOIDECTOMY CAVITY UNSP EAR

S56222A

LACERAT FLEXOR MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

H95121

GRANULATION OF POSTMASTOIDECTOMY CAVITY RIGHT EAR

S56229A

LACERAT FLEXOR MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

H95122

GRANULATION OF POSTMASTOIDECTOMY CAVITY LEFT EAR

S56291A

INJ OTH FLEXOR MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

H95123

GRANULATION OF POSTMASTOIDECTOMY CAVITY BILATERAL EARS

S56292A

INJ OTH FLEXOR MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

H95129

GRANULATION OF POSTMASTOIDECTOMY CAVITY UNSPECIFIED EAR

S56299A

INJ OTH FLEXOR MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

H95131

MUCOSAL CYST OF POSTMASTOIDECTOMY CAVITY RIGHT EAR

S56301A

UNSP INJ EXTN/ABDR MUSC/FASC/TEND OF R THM AT FORARM LVINIT

H95132

MUCOSAL CYST OF POSTMASTOIDECTOMY CAVITY LEFT EAR

S56302A

UNSP INJ EXTN/ABDR MUSC/FASC/TEND OF L THM AT FORARM LVINIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H95133

MUCOSAL CYST OF POSTMASTOIDECTOMY CAVITY BILATERAL EARS

S56309A

UNSP INJ EXTN/ABDR MUSC/FASC/TEND OF THMB AT FORARM LV INIT

H95139

MUCOSAL CYST OF POSTMASTOIDECTOMY CAVITY UNSPECIFIED EAR

S56311A

STRAIN EXTN/ABDR MUSC/FASC/TEND OF R THM AT FORARM LV INIT

H95191 OTHER DISORDERS FOLLOWING MASTOIDECTOMY RIGHT EAR

S56312A

STRAIN EXTN/ABDR MUSC/FASC/TEND OF L THM AT FORARM LV INIT

H95192 OTHER DISORDERS FOLLOWING MASTOIDECTOMY LEFT EAR

S56319A

STRAIN EXTN/ABDR MUSC/FASC/TEND OF THMB AT FORARM LV INIT

H95193

OTHER DISORDERS FOLLOWING MASTOIDECTOMY BILATERAL EARS

S56321A

LACERAT EXTN/ABDR MUSC/FASC/TEND OF R THM AT FORARM LV INIT

H95199

OTHER DISORDERS FOLLOWING MASTOIDECTOMY UNSPECIFIED EAR

S56322A

LACERAT EXTN/ABDR MUSC/FASC/TEND OF L THM AT FORARM LV INIT

H9521

INTRAOP HEMOR/HEMTOM OF EAR/MASTD COMP A PROC ON EAR/MASTD

S56329A

LACERAT EXTN/ABDR MUSC/FASC/TEND OF THMB AT FORARM LV INIT

H9522

INTRAOP HEMOR/HEMTOM OF EAR/MASTD COMPLICATING OTH PROCEDURE

S56391A

INJ EXTN/ABDR MUSC/FASC/TEND OF R THM AT FORARM LV INIT

H9531

ACC PNCTR & LAC OF THE EAR/MASTD DUR PROC ON THE EAR/MASTD

S56392A

INJ EXTN/ABDR MUSC/FASC/TEND OF L THM AT FORARM LV INIT

H9532

ACCIDENTAL PNCTR & LAC OF THE EAR/MASTD DURING OTH PROCEDURE

S56399A

INJ EXTN/ABDR MUSC/FASC/TEND OF THMB AT FOREARM LEVEL INIT

H9541

POSTPROC HEMOR/HEMTOM OF EAR/MASTD FOL PROC ON EAR/MASTD

S56401A

UNSP INJ EXTN MUSC/FASC/TEND R IDX FNGR AT FORARM LV INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

H9542

POSTPROC HEMOR/HEMTOM OF EAR/MASTD FOLLOWING OTH PROCEDURE

S56402A

UNSP INJ EXTN MUSC/FASC/TEND L IDX FNGR AT FORARM LV INIT

H9551

Postprocedural hematoma of ear and mastoid process following a procedure on the ear and mastoid process

S56403A

UNSP INJ EXTN MUSC/FASC/TEND R MID FINGER AT FORARM LV INIT

H9552

Postprocedural hematoma of ear and mastoid process following other procedure

S56404A

UNSP INJ EXTN MUSC/FASC/TEND L MID FINGER AT FORARM LV INIT

H9553

Postprocedural seroma of ear and mastoid process following a procedure on the ear and mastoid process

S56405A

UNSP INJ EXTN MUSC/FASC/TEND R RNG FNGR AT FORARM LV INIT

H9554

Postprocedural seroma of ear and mastoid process following other procedure

S56406A

UNSP INJ EXTN MUSC/FASC/TEND L RNG FNGR AT FORARM LV INIT

H95811 POSTPROCEDURAL STENOSIS OF RIGHT EXTERNAL EAR CANAL

S56407A

UNSP INJ EXTN MUSC/FASC/TEND R LIT FNGR AT FORARM LV INIT

H95812 POSTPROCEDURAL STENOSIS OF LEFT EXTERNAL EAR CANAL

S56408A

UNSP INJ EXTN MUSC/FASC/TEND L LIT FNGR AT FORARM LV INIT

H95813

POSTPROCEDURAL STENOSIS OF EXTERNAL EAR CANAL BILATERAL

S56409A

UNSP INJ EXTN MUSC/FASC/TEND UNSP FINGER AT FORARM LV INIT

H95819

POSTPROCEDURAL STENOSIS OF UNSPECIFIED EXTERNAL EAR CANAL

S56411A

STRAIN EXTENSOR MUSC/FASC/TEND R IDX FNGR AT FORARM LV INIT

H9588

OTH INTRAOP COMP AND DISORDERS OF THE EAR/MASTD NEC

S56412A

STRAIN EXTENSOR MUSC/FASC/TEND L IDX FNGR AT FORARM LV INIT

H9589

OTH POSTPROC COMP AND DISORDERS OF THE EAR/MASTD NEC

S56413A

STRAIN EXTN MUSC/FASC/TEND R MID FINGER AT FORARM LV INIT

I160 Hypertensive urgency

S56414A STRAIN EXTN MUSC/FASC/TEND L MID FINGER AT FORARM LV INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I161 Hypertensive emergency

S56415A STRAIN EXTENSOR MUSC/FASC/TEND R RNG FNGR AT FORARM LV INIT

I169 Hypertensive crisis unspecified

S56416A STRAIN EXTENSOR MUSC/FASC/TEND L RNG FNGR AT FORARM LV INIT

I209 ANGINA PECTORIS UNSPECIFIED

S56417A STRAIN EXTN MUSC/FASC/TEND R LITTLE FNGR AT FORARM LV INIT

I2101 STEMI INVOLVING LEFT MAIN CORONARY ARTERY

S56418A

STRAIN EXTN MUSC/FASC/TEND L LITTLE FNGR AT FORARM LV INIT

I2102

STEMI INVOLVING LEFT ANTERIOR DESCENDING CORONARY ARTERY

S56419A

STRAIN EXTN MUSC/FASC/TEND FNGRUNSP FNGR AT FORARM LV INIT

I2109

STEMI INVOLVING OTH CORONARY ARTERY OF ANTERIOR WALL

S56421A

LACERAT EXTN MUSC/FASC/TEND R IDX FNGR AT FORARM LV INIT

I2111 STEMI INVOLVING RIGHT CORONARY ARTERY

S56422A

LACERAT EXTN MUSC/FASC/TEND L IDX FNGR AT FORARM LV INIT

I2119

STEMI INVOLVING OTH CORONARY ARTERY OF INFERIOR WALL

S56423A

LACERAT EXTN MUSC/FASC/TEND R MID FINGER AT FORARM LV INIT

I2121

STEMI INVOLVING LEFT CIRCUMFLEX CORONARY ARTERY

S56424A

LACERAT EXTN MUSC/FASC/TEND L MID FINGER AT FORARM LV INIT

I2129 STEMI INVOLVING OTH SITES

S56425A LACERAT EXTN MUSC/FASC/TEND R RNG FNGR AT FORARM LV INIT

I213

ST ELEVATION (STEMI) MYOCARDIAL INFARCTION OF UNSP SITE

S56426A

LACERAT EXTN MUSC/FASC/TEND L RNG FNGR AT FORARM LV INIT

I214 NON-ST ELEVATION (NSTEMI) MYOCARDIAL INFARCTION

S56427A

LACERAT EXTN MUSC/FASC/TEND R LITTLE FNGR AT FORARM LV INIT

I220 SUBSEQUENT STEMI OF ANTERIOR WALL

S56428A

LACERAT EXTN MUSC/FASC/TEND L LITTLE FNGR AT FORARM LV INIT

I221 SUBSEQUENT STEMI OF INFERIOR WALL

S56429A

LACERAT EXTN MUSC/FASC/TEND UNSP FINGER AT FORARM LV INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I222

SUBSEQUENT NON-ST ELEVATION (NSTEMI) MYOCARDIAL INFARCTION

S56491A

INJ EXTENSOR MUSC/FASC/TEND R IDX FNGR AT FORARM LV INIT

I228 SUBSEQUENT STEMI OF SITES

S56492A INJ EXTENSOR MUSC/FASC/TEND L IDX FNGR AT FORARM LV INIT

I229 SUBSEQUENT STEMI OF UNSP SITE

S56493A

INJ EXTENSOR MUSC/FASC/TEND R MID FINGER AT FORARM LV INIT

I230

HEMOPERICARDIUM AS CURRENT COMPLICATION FOLLOWING AMI

S56494A

INJ EXTENSOR MUSC/FASC/TEND L MID FINGER AT FORARM LV INIT

I231

ATRIAL SEPTAL DEFECT AS CURRENT COMPLICATION FOLLOWING AMI

S56495A

INJ EXTENSOR MUSC/FASC/TEND R RNG FNGR AT FORARM LV INIT

I232

VENTRICULAR SEPTAL DEFECT AS CURRENT COMP FOLLOWING AMI

S56496A

INJ EXTENSOR MUSC/FASC/TEND L RNG FNGR AT FORARM LV INIT

I233

RUPTURE OF CARD WALL W/O HEMOPERIC AS CURRENT COMP FOL AMI

S56497A

INJ EXTN MUSC/FASC/TEND R LITTLE FINGER AT FORARM LV INIT

I234

RUPTURE OF CHORD TENDNE AS CURRENT COMP FOLLOWING AMI

S56498A

INJ EXTN MUSC/FASC/TEND L LITTLE FINGER AT FORARM LV INIT

I235

RUPTURE OF PAPILLARY MUSCLE AS CURRENT COMP FOLLOWING AMI

S56499A

INJ EXTENSOR MUSC/FASC/TEND UNSP FINGER AT FORARM LV INIT

I236

THOMBOS OF ATRIUM/AURIC APPEND/VENTR AS CURRENT COMP FOL AMI

S56501A

UNSP INJ EXTN MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

I237 POSTINFARCTION ANGINA

S56502A UNSP INJ EXTN MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

I238 OTH CURRENT COMPLICATIONS FOLLOWING AMI

S56509A

UNSP INJ EXTN MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

I240

ACUTE CORONARY THROMBOSIS NOT RESULTING IN MYOCARDIAL INFRC

S56511A

STRAIN OF EXTN MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I241 DRESSLER'S SYNDROME

S56512A STRAIN OF EXTN MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

I248 OTHER FORMS OF ACUTE ISCHEMIC HEART DISEASE

S56519A

STRAIN OF EXTN MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

I249 ACUTE ISCHEMIC HEART DISEASE UNSPECIFIED

S56521A

LACERAT EXTN MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

I2510

ATHSCL HEART DISEASE OF NATIVE CORONARY ARTERY W/O ANG PCTRS

S56522A

LACERAT EXTN MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

I25110

ATHSCL HEART DISEASE OF NATIVE COR ART W UNSTABLE ANG PCTRS

S56529A

LACERAT EXTN MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

I25111

ATHSCL HEART DISEASE OF NATIVE COR ART W ANG PCTRS W SPASM

S56591A

INJ EXTN MUSC/FASC/TEND AT FOREARM LEVEL RIGHT ARM INIT

I25118

ATHSCL HEART DISEASE OF NATIVE COR ART W OTH ANG PCTRS

S56592A

INJ EXTN MUSC/FASC/TEND AT FOREARM LEVEL LEFT ARM INIT

I25119

ATHSCL HEART DISEASE OF NATIVE COR ART W UNSP ANG PCTRS

S56599A

INJ EXTN MUSC/FASC/TEND AT FOREARM LEVEL UNSP ARM INIT

I252 OLD MYOCARDIAL INFARCTION

S56801A UNSP INJURY OF MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

I253 ANEURYSM OF HEART

S56802A UNSP INJURY OF MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

I2541 CORONARY ARTERY ANEURYSM

S56809A UNSP INJURY OF MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

I2542 CORONARY ARTERY DISSECTION

S56811A STRAIN OF MUSC/FASC/TEND AT FOREARM LEVEL RIGHT ARM INIT

I255 ISCHEMIC CARDIOMYOPATHY

S56812A STRAIN OF MUSC/FASC/TEND AT FOREARM LEVEL LEFT ARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I256 SILENT MYOCARDIAL ISCHEMIA

S56819A STRAIN OF MUSC/FASC/TEND AT FOREARM LEVEL UNSP ARM INIT

I25700

ATHEROSCLEROSIS OF CABG UNSP W UNSTABLE ANGINA PECTORIS

S56821A

LACERATION OF MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

I25701

ATHSCL CABG UNSP W ANGINA PECTORIS W DOCUMENTED SPASM

S56822A

LACERATION OF MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

I25708 ATHEROSCLEROSIS OF CABG UNSP W OTH ANGINA PECTORIS

S56829A

LACERATION OF MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

I25709

ATHEROSCLEROSIS OF CABG UNSP W UNSP ANGINA PECTORIS

S56891A

INJ MUSC/FASC/TEND AT FOREARM LEVEL RIGHT ARM INIT ENCNTR

I25710

ATHSCL AUTOLOGOUS VEIN CABG W UNSTABLE ANGINA PECTORIS

S56892A

INJ MUSC/FASC/TEND AT FOREARM LEVEL LEFT ARM INIT ENCNTR

I25711

ATHSCL AUTOLOGOUS VEIN CABG W ANG PCTRS W DOCUMENTED SPASM

S56899A

INJ MUSC/FASC/TEND AT FOREARM LEVEL UNSP ARM INIT ENCNTR

I25718 ATHSCL AUTOLOGOUS VEIN CABG W OTH ANGINA PECTORIS

S56901A

UNSP INJ UNSP MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

I25719

ATHSCL AUTOLOGOUS VEIN CABG W UNSP ANGINA PECTORIS

S56902A

UNSP INJ UNSP MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

I25720

ATHSCL AUTOLOGOUS ARTERY CABG W UNSTABLE ANGINA PECTORIS

S56909A

UNSP INJ UNSP MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

I25721

ATHSCL AUTOLOGOUS ARTERY CABG W ANG PCTRS W DOCUMENTED SPASM

S56911A

STRAIN OF UNSP MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

I25728 ATHSCL AUTOLOGOUS ARTERY CABG W OTH ANGINA PECTORIS

S56912A

STRAIN OF UNSP MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I25729

ATHSCL AUTOLOGOUS ARTERY CABG W UNSP ANGINA PECTORIS

S56919A

STRAIN OF UNSP MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

I25730

ATHSCL NONAUTOLOGOUS BIOLOGICAL CABG W UNSTABLE ANG PCTRS

S56921A

LACERAT UNSP MUSC/FASC/TEND AT FORARM LV RIGHT ARM INIT

I25731

ATHSCL NONAUT BIOLOGICAL CABG W ANG PCTRS W DOCUMENTED SPASM

S56922A

LACERAT UNSP MUSC/FASC/TEND AT FORARM LV LEFT ARM INIT

I25738

ATHSCL NONAUTOLOGOUS BIOLOGICAL CABG W OTH ANGINA PECTORIS

S56929A

LACERAT UNSP MUSC/FASC/TEND AT FORARM LV UNSP ARM INIT

I25739

ATHSCL NONAUTOLOGOUS BIOLOGICAL CABG W UNSP ANGINA PECTORIS

S56991A

INJ UNSP MUSC/FASC/TEND AT FOREARM LEVEL RIGHT ARM INIT

I25750

ATHSCL NATIVE COR ART OF TXPLT HEART W UNSTABLE ANGINA

S56992A

INJ UNSP MUSC/FASC/TEND AT FOREARM LEVEL LEFT ARM INIT

I25751

ATHSCL NATIVE COR ART OF TXPLT HEART W ANG PCTRS W SPASM

S56999A

INJ UNSP MUSC/FASC/TEND AT FOREARM LEVEL UNSP ARM INIT

I25758

ATHSCL NATIVE COR ART OF TRANSPLANTED HEART W OTH ANG PCTRS

S5700XA

CRUSHING INJURY OF UNSPECIFIED ELBOW INITIAL ENCOUNTER

I25759

ATHSCL NATIVE COR ART OF TRANSPLANTED HEART W UNSP ANG PCTRS

S5701XA

CRUSHING INJURY OF RIGHT ELBOW INITIAL ENCOUNTER

I25760

ATHSCL BYPASS OF COR ART OF TXPLT HEART W UNSTABLE ANGINA

S5702XA

CRUSHING INJURY OF LEFT ELBOW INITIAL ENCOUNTER

I25761

ATHSCL BYPASS OF COR ART OF TXPLT HEART W ANG PCTRS W SPASM

S5781XA

CRUSHING INJURY OF RIGHT FOREARM INITIAL ENCOUNTER

I25768

ATHSCL BYPASS OF COR ART OF TXPLT HEART W OTH ANG PCTRS

S5782XA

CRUSHING INJURY OF LEFT FOREARM INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I25769

ATHSCL BYPASS OF COR ART OF TXPLT HEART W UNSP ANG PCTRS

S58011A

COMPLETE TRAUMATIC AMP AT ELBOW LEVEL RIGHT ARM INIT

I25790 ATHEROSCLEROSIS OF CABG W UNSTABLE ANGINA PECTORIS

S58012A

COMPLETE TRAUMATIC AMPUTATION AT ELBOW LEVEL LEFT ARM INIT

I25791

ATHEROSCLEROSIS OF CABG W ANGINA PECTORIS W DOCUMENTED SPASM

S58021A

PARTIAL TRAUMATIC AMPUTATION AT ELBOW LEVEL RIGHT ARM INIT

I25798 ATHEROSCLEROSIS OF CABG W OTH ANGINA PECTORIS

S58022A

PARTIAL TRAUMATIC AMPUTATION AT ELBOW LEVEL LEFT ARM INIT

I25799 ATHEROSCLEROSIS OF CABG W UNSP ANGINA PECTORIS

S58111A

COMPLETE TRAUM AMP AT LEV BETW ELBOW AND WRIST R ARM INIT

I25810 ATHEROSCLEROSIS OF CABG W/O ANGINA PECTORIS

S58112A

COMPLETE TRAUM AMP AT LEV BETW ELBOW AND WRS LEFT ARM INIT

I25811

ATHSCL NATIVE COR ART OF TRANSPLANTED HEART W/O ANG PCTRS

S58121A

PART TRAUM AMP AT LEV BETW ELBOW AND WRIST RIGHT ARM INIT

I25812

ATHSCL BYPASS OF COR ART OF TRANSPLANTED HEART W/O ANG PCTRS

S58122A

PART TRAUM AMP AT LEVEL BETW ELBOW AND WRIST LEFT ARM INIT

I2582 CHRONIC TOTAL OCCLUSION OF CORONARY ARTERY

S58911A

COMPLETE TRAUMATIC AMPUTATION OF R FOREARM LEVEL UNSP INIT

I2583 CORONARY ATHEROSCLEROSIS DUE TO LIPID RICH PLAQUE

S58912A

COMPLETE TRAUMATIC AMPUTATION OF L FOREARM LEVEL UNSP INIT

I2589 OTHER FORMS OF CHRONIC ISCHEMIC HEART DISEASE

S58921A

PARTIAL TRAUMATIC AMPUTATION OF R FOREARM LEVEL UNSP INIT

I259 CHRONIC ISCHEMIC HEART DISEASE UNSPECIFIED

S58922A

PARTIAL TRAUMATIC AMPUTATION OF L FOREARM LEVEL UNSP INIT

Page 142: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I2601 SEPTIC PULMONARY EMBOLISM WITH ACUTE COR PULMONALE

S59001A

UNSP PHYSEAL FRACTURE OF LOWER END OF ULNA RIGHT ARM INIT

I2609

OTHER PULMONARY EMBOLISM WITH ACUTE COR PULMONALE

S59002A

UNSP PHYSEAL FRACTURE OF LOWER END OF ULNA LEFT ARM INIT

I2690

SEPTIC PULMONARY EMBOLISM WITHOUT ACUTE COR PULMONALE

S59009A

UNSP PHYSEAL FRACTURE OF LOWER END OF ULNA UNSP ARM INIT

I2699

OTHER PULMONARY EMBOLISM WITHOUT ACUTE COR PULMONALE

S59011A

SLTR-HARIS TYPE I PHYSL FX LOWER END ULNA RIGHT ARM INIT

I270 PRIMARY PULMONARY HYPERTENSION

S59012A

SLTR-HARIS TYPE I PHYSL FX LOWER END OF ULNA LEFT ARM INIT

I271 KYPHOSCOLIOTIC HEART DISEASE

S59021A

SLTR-HARIS TYPE II PHYSL FX LOWER END ULNA RIGHT ARM INIT

I272 OTHER SECONDARY PULMONARY HYPERTENSION

S59022A

SLTR-HARIS TYPE II PHYSL FX LOWER END ULNA LEFT ARM INIT

I2781 COR PULMONALE (CHRONIC)

S59029A SLTR-HARIS TYPE II PHYSL FX LOWER END ULNA UNSP ARM INIT

I2782 CHRONIC PULMONARY EMBOLISM

S59031A

SLTR-HARIS TYPE III PHYSL FX LOWER END ULNA RIGHT ARM INIT

I2789 OTHER SPECIFIED PULMONARY HEART DISEASES

S59032A

SLTR-HARIS TYPE III PHYSL FX LOWER END ULNA LEFT ARM INIT

I279 PULMONARY HEART DISEASE UNSPECIFIED

S59041A

SLTR-HARIS TYPE IV PHYSL FX LOWER END ULNA RIGHT ARM INIT

I280 ARTERIOVENOUS FISTULA OF PULMONARY VESSELS

S59042A

SLTR-HARIS TYPE IV PHYSL FX LOWER END ULNA LEFT ARM INIT

I281 ANEURYSM OF PULMONARY ARTERY

S59091A

OTH PHYSEAL FRACTURE OF LOWER END OF ULNA RIGHT ARM INIT

Page 143: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I288 OTHER DISEASES OF PULMONARY VESSELS

S59092A

OTH PHYSEAL FRACTURE OF LOWER END OF ULNA LEFT ARM INIT

I289 DISEASE OF PULMONARY VESSELS UNSPECIFIED

S59101A

UNSP PHYSEAL FRACTURE OF UPPER END RADIUS RIGHT ARM INIT

I300 ACUTE NONSPECIFIC IDIOPATHIC PERICARDITIS

S59102A

UNSP PHYSEAL FRACTURE OF UPPER END OF RADIUS LEFT ARM INIT

I301 INFECTIVE PERICARDITIS

S59111A SLTR-HARIS TYPE I PHYSL FX UPPER END RADIUS RIGHT ARM INIT

I308 OTHER FORMS OF ACUTE PERICARDITIS

S59112A

SLTR-HARIS TYPE I PHYSL FX UPPER END RADIUS LEFT ARM INIT

I309 ACUTE PERICARDITIS UNSPECIFIED

S59121A

SLTR-HARIS TYPE II PHYSL FX UPPER END RAD RIGHT ARM INIT

I310 CHRONIC ADHESIVE PERICARDITIS

S59122A

SLTR-HARIS TYPE II PHYSL FX UPPER END RADIUS LEFT ARM INIT

I311 CHRONIC CONSTRICTIVE PERICARDITIS

S59131A

SLTR-HARIS TYPE III PHYSL FX UPPER END RAD RIGHT ARM INIT

I312 HEMOPERICARDIUM NOT ELSEWHERE CLASSIFIED

S59132A

SLTR-HARIS TYPE III PHYSL FX UPPER END RAD LEFT ARM INIT

I313 PERICARDIAL EFFUSION (NONINFLAMMATORY)

S59141A

SLTR-HARIS TYPE IV PHYSL FX UPPER END RAD RIGHT ARM INIT

I314 CARDIAC TAMPONADE

S59142A SLTR-HARIS TYPE IV PHYSL FX UPPER END RADIUS LEFT ARM INIT

I318 OTHER SPECIFIED DISEASES OF PERICARDIUM

S59191A

OTH PHYSEAL FRACTURE OF UPPER END OF RADIUS RIGHT ARM INIT

I319 DISEASE OF PERICARDIUM UNSPECIFIED

S59192A

OTH PHYSEAL FRACTURE OF UPPER END OF RADIUS LEFT ARM INIT

I32 PERICARDITIS IN DISEASES CLASSIFIED ELSEWHERE

S59201A

UNSP PHYSEAL FRACTURE OF LOWER END RADIUS RIGHT ARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I330 ACUTE AND SUBACUTE INFECTIVE ENDOCARDITIS

S59202A

UNSP PHYSEAL FRACTURE OF LOWER END OF RADIUS LEFT ARM INIT

I339 ACUTE AND SUBACUTE ENDOCARDITIS UNSPECIFIED

S59801A

OTHER SPECIFIED INJURIES OF RIGHT ELBOW INITIAL ENCOUNTER

I340 NONRHEUMATIC MITRAL (VALVE) INSUFFICIENCY

S59802A

OTHER SPECIFIED INJURIES OF LEFT ELBOW INITIAL ENCOUNTER

I341 NONRHEUMATIC MITRAL (VALVE) PROLAPSE

S59811A

OTHER SPECIFIED INJURIES RIGHT FOREARM INITIAL ENCOUNTER

I342 NONRHEUMATIC MITRAL (VALVE) STENOSIS

S59812A

OTHER SPECIFIED INJURIES LEFT FOREARM INITIAL ENCOUNTER

I348 OTHER NONRHEUMATIC MITRAL VALVE DISORDERS

S59901A

UNSPECIFIED INJURY OF RIGHT ELBOW INITIAL ENCOUNTER

I349 NONRHEUMATIC MITRAL VALVE DISORDER UNSPECIFIED

S59902A

UNSPECIFIED INJURY OF LEFT ELBOW INITIAL ENCOUNTER

I350 NONRHEUMATIC AORTIC (VALVE) STENOSIS

S59911A

UNSPECIFIED INJURY OF RIGHT FOREARM INITIAL ENCOUNTER

I351 NONRHEUMATIC AORTIC (VALVE) INSUFFICIENCY

S59912A

UNSPECIFIED INJURY OF LEFT FOREARM INITIAL ENCOUNTER

I352

NONRHEUMATIC AORTIC (VALVE) STENOSIS WITH INSUFFICIENCY

S60011A

CONTUSION OF RIGHT THUMB WITHOUT DAMAGE TO NAIL INIT ENCNTR

I358 OTHER NONRHEUMATIC AORTIC VALVE DISORDERS

S60012A

CONTUSION OF LEFT THUMB WITHOUT DAMAGE TO NAIL INIT ENCNTR

I359 NONRHEUMATIC AORTIC VALVE DISORDER UNSPECIFIED

S60021A

CONTUSION OF RIGHT INDEX FINGER W/O DAMAGE TO NAIL INIT

I360 NONRHEUMATIC TRICUSPID (VALVE) STENOSIS

S60022A

CONTUSION OF LEFT INDEX FINGER W/O DAMAGE TO NAIL INIT

I361 NONRHEUMATIC TRICUSPID (VALVE) INSUFFICIENCY

S60031A

CONTUSION OF RIGHT MIDDLE FINGER W/O DAMAGE TO NAIL INIT

Page 145: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I362

NONRHEUMATIC TRICUSPID (VALVE) STENOSIS WITH INSUFFICIENCY

S60032A

CONTUSION OF LEFT MIDDLE FINGER W/O DAMAGE TO NAIL INIT

I368 OTHER NONRHEUMATIC TRICUSPID VALVE DISORDERS

S60041A

CONTUSION OF RIGHT RING FINGER W/O DAMAGE TO NAIL INIT

I369 NONRHEUMATIC TRICUSPID VALVE DISORDER UNSPECIFIED

S60042A

CONTUSION OF LEFT RING FINGER W/O DAMAGE TO NAIL INIT

I370 NONRHEUMATIC PULMONARY VALVE STENOSIS

S60051A

CONTUSION OF RIGHT LITTLE FINGER W/O DAMAGE TO NAIL INIT

I371 NONRHEUMATIC PULMONARY VALVE INSUFFICIENCY

S60052A

CONTUSION OF LEFT LITTLE FINGER W/O DAMAGE TO NAIL INIT

I372

NONRHEUMATIC PULMONARY VALVE STENOSIS WITH INSUFFICIENCY

S60111A

CONTUSION OF RIGHT THUMB WITH DAMAGE TO NAIL INIT ENCNTR

I378 OTHER NONRHEUMATIC PULMONARY VALVE DISORDERS

S60112A

CONTUSION OF LEFT THUMB WITH DAMAGE TO NAIL INIT ENCNTR

I379 NONRHEUMATIC PULMONARY VALVE DISORDER UNSPECIFIED

S60121A

CONTUSION OF RIGHT INDEX FINGER W DAMAGE TO NAIL INIT

I38 ENDOCARDITIS VALVE UNSPECIFIED

S60122A

CONTUSION OF LEFT INDEX FINGER W DAMAGE TO NAIL INIT ENCNTR

I39

ENDOCARDITIS AND HEART VALVE DISORD IN DIS CLASSD ELSWHR

S60131A

CONTUSION OF RIGHT MIDDLE FINGER W DAMAGE TO NAIL INIT

I400 INFECTIVE MYOCARDITIS

S60132A CONTUSION OF LEFT MIDDLE FINGER W DAMAGE TO NAIL INIT

I401 ISOLATED MYOCARDITIS

S60141A CONTUSION OF RIGHT RING FINGER W DAMAGE TO NAIL INIT ENCNTR

I408 OTHER ACUTE MYOCARDITIS

S60142A CONTUSION OF LEFT RING FINGER W DAMAGE TO NAIL INIT ENCNTR

Page 146: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I409 ACUTE MYOCARDITIS UNSPECIFIED

S60151A

CONTUSION OF RIGHT LITTLE FINGER W DAMAGE TO NAIL INIT

I41 MYOCARDITIS IN DISEASES CLASSIFIED ELSEWHERE

S60152A

CONTUSION OF LEFT LITTLE FINGER W DAMAGE TO NAIL INIT

I420 DILATED CARDIOMYOPATHY

S60211A CONTUSION OF RIGHT WRIST INITIAL ENCOUNTER

I421 OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY

S60212A

CONTUSION OF LEFT WRIST INITIAL ENCOUNTER

I422 OTHER HYPERTROPHIC CARDIOMYOPATHY

S60219A

CONTUSION OF UNSPECIFIED WRIST INITIAL ENCOUNTER

I423 ENDOMYOCARDIAL (EOSINOPHILIC) DISEASE

S60221A

CONTUSION OF RIGHT HAND INITIAL ENCOUNTER

I424 ENDOCARDIAL FIBROELASTOSIS

S60222A CONTUSION OF LEFT HAND INITIAL ENCOUNTER

I425 OTHER RESTRICTIVE CARDIOMYOPATHY

S60311A

ABRASION OF RIGHT THUMB INITIAL ENCOUNTER

I426 ALCOHOLIC CARDIOMYOPATHY

S60312A ABRASION OF LEFT THUMB INITIAL ENCOUNTER

I427 CARDIOMYOPATHY DUE TO DRUG AND EXTERNAL AGENT

S60341A

EXTERNAL CONSTRICTION OF RIGHT THUMB INITIAL ENCOUNTER

I428 OTHER CARDIOMYOPATHIES

S60342A EXTERNAL CONSTRICTION OF LEFT THUMB INITIAL ENCOUNTER

I429 CARDIOMYOPATHY UNSPECIFIED

S60351A

SUPERFICIAL FOREIGN BODY OF RIGHT THUMB INITIAL ENCOUNTER

I43 CARDIOMYOPATHY IN DISEASES CLASSIFIED ELSEWHERE

S60352A

SUPERFICIAL FOREIGN BODY OF LEFT THUMB INITIAL ENCOUNTER

I440 ATRIOVENTRICULAR BLOCK FIRST DEGREE

S60361A

INSECT BITE (NONVENOMOUS) OF RIGHT THUMB INITIAL ENCOUNTER

I441 ATRIOVENTRICULAR BLOCK SECOND DEGREE

S60362A

INSECT BITE (NONVENOMOUS) OF LEFT THUMB INITIAL ENCOUNTER

I442 ATRIOVENTRICULAR BLOCK COMPLETE

S60371A

OTHER SUPERFICIAL BITE OF RIGHT THUMB INITIAL ENCOUNTER

Page 147: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I4430 UNSPECIFIED ATRIOVENTRICULAR BLOCK

S60372A

OTHER SUPERFICIAL BITE OF LEFT THUMB INITIAL ENCOUNTER

I4439 OTHER ATRIOVENTRICULAR BLOCK

S60391A

OTHER SUPERFICIAL INJURIES OF RIGHT THUMB INITIAL ENCOUNTER

I444 LEFT ANTERIOR FASCICULAR BLOCK

S60392A

OTHER SUPERFICIAL INJURIES OF LEFT THUMB INITIAL ENCOUNTER

I445 LEFT POSTERIOR FASCICULAR BLOCK

S60410A

ABRASION OF RIGHT INDEX FINGER INITIAL ENCOUNTER

I4460 UNSPECIFIED FASCICULAR BLOCK

S60411A

ABRASION OF LEFT INDEX FINGER INITIAL ENCOUNTER

I4469 OTHER FASCICULAR BLOCK

S60412A ABRASION OF RIGHT MIDDLE FINGER INITIAL ENCOUNTER

I447 LEFT BUNDLE-BRANCH BLOCK UNSPECIFIED

S60413A

ABRASION OF LEFT MIDDLE FINGER INITIAL ENCOUNTER

I450 RIGHT FASCICULAR BLOCK

S60414A ABRASION OF RIGHT RING FINGER INITIAL ENCOUNTER

I4510 UNSPECIFIED RIGHT BUNDLE-BRANCH BLOCK

S60415A

ABRASION OF LEFT RING FINGER INITIAL ENCOUNTER

I4519 OTHER RIGHT BUNDLE-BRANCH BLOCK

S60416A

ABRASION OF RIGHT LITTLE FINGER INITIAL ENCOUNTER

I452 BIFASCICULAR BLOCK

S60417A ABRASION OF LEFT LITTLE FINGER INITIAL ENCOUNTER

I453 TRIFASCICULAR BLOCK

S60420A BLISTER (NONTHERMAL) OF RIGHT INDEX FINGER INIT ENCNTR

I454 NONSPECIFIC INTRAVENTRICULAR BLOCK

S60421A

BLISTER (NONTHERMAL) OF LEFT INDEX FINGER INITIAL ENCOUNTER

I455 OTHER SPECIFIED HEART BLOCK

S60422A BLISTER (NONTHERMAL) OF RIGHT MIDDLE FINGER INIT ENCNTR

I456 PRE-EXCITATION SYNDROME

S60423A BLISTER (NONTHERMAL) OF LEFT MIDDLE FINGER INIT ENCNTR

I4581 LONG QT SYNDROME

S60424A BLISTER (NONTHERMAL) OF RIGHT RING FINGER INITIAL ENCOUNTER

I4589 OTHER SPECIFIED CONDUCTION DISORDERS

S60425A

BLISTER (NONTHERMAL) OF LEFT RING FINGER INITIAL ENCOUNTER

Page 148: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I459 CONDUCTION DISORDER UNSPECIFIED

S60426A

BLISTER (NONTHERMAL) OF RIGHT LITTLE FINGER INIT ENCNTR

I462

CARDIAC ARREST DUE TO UNDERLYING CARDIAC CONDITION

S60427A

BLISTER (NONTHERMAL) OF LEFT LITTLE FINGER INIT ENCNTR

I468

CARDIAC ARREST DUE TO OTHER UNDERLYING CONDITION

S60440A

EXTERNAL CONSTRICTION OF RIGHT INDEX FINGER INIT ENCNTR

I469 CARDIAC ARREST CAUSE UNSPECIFIED

S60441A

EXTERNAL CONSTRICTION OF LEFT INDEX FINGER INIT ENCNTR

I470 RE-ENTRY VENTRICULAR ARRHYTHMIA

S60442A

EXTERNAL CONSTRICTION OF RIGHT MIDDLE FINGER INIT ENCNTR

I471 SUPRAVENTRICULAR TACHYCARDIA

S60443A

EXTERNAL CONSTRICTION OF LEFT MIDDLE FINGER INIT ENCNTR

I472 VENTRICULAR TACHYCARDIA

S60444A EXTERNAL CONSTRICTION OF RIGHT RING FINGER INIT ENCNTR

I479 PAROXYSMAL TACHYCARDIA UNSPECIFIED

S60445A

EXTERNAL CONSTRICTION OF LEFT RING FINGER INITIAL ENCOUNTER

I480 PAROXYSMAL ATRIAL FIBRILLATION

S60446A

EXTERNAL CONSTRICTION OF RIGHT LITTLE FINGER INIT ENCNTR

I481 PERSISTENT ATRIAL FIBRILLATION

S60447A

EXTERNAL CONSTRICTION OF LEFT LITTLE FINGER INIT ENCNTR

I4901 VENTRICULAR FIBRILLATION

S60450A SUPERFICIAL FOREIGN BODY OF RIGHT INDEX FINGER INIT ENCNTR

I4902 VENTRICULAR FLUTTER

S60451A SUPERFICIAL FOREIGN BODY OF LEFT INDEX FINGER INIT ENCNTR

I491 ATRIAL PREMATURE DEPOLARIZATION

S60452A

SUPERFICIAL FOREIGN BODY OF RIGHT MIDDLE FINGER INIT ENCNTR

I492 JUNCTIONAL PREMATURE DEPOLARIZATION

S60453A

SUPERFICIAL FOREIGN BODY OF LEFT MIDDLE FINGER INIT ENCNTR

I493 VENTRICULAR PREMATURE DEPOLARIZATION

S60454A

SUPERFICIAL FOREIGN BODY OF RIGHT RING FINGER INIT ENCNTR

I4940 UNSPECIFIED PREMATURE DEPOLARIZATION

S60455A

SUPERFICIAL FOREIGN BODY OF LEFT RING FINGER INIT ENCNTR

Page 149: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I4949 OTHER PREMATURE DEPOLARIZATION

S60456A

SUPERFICIAL FOREIGN BODY OF RIGHT LITTLE FINGER INIT ENCNTR

I495 SICK SINUS SYNDROME

S60457A SUPERFICIAL FOREIGN BODY OF LEFT LITTLE FINGER INIT ENCNTR

I498 OTHER SPECIFIED CARDIAC ARRHYTHMIAS

S60460A

INSECT BITE (NONVENOMOUS) OF RIGHT INDEX FINGER INIT ENCNTR

I499 CARDIAC ARRHYTHMIA UNSPECIFIED

S60461A

INSECT BITE (NONVENOMOUS) OF LEFT INDEX FINGER INIT ENCNTR

I501 LEFT VENTRICULAR FAILURE

S60462A INSECT BITE (NONVENOMOUS) OF RIGHT MIDDLE FINGER INIT

I5020 UNSPECIFIED SYSTOLIC (CONGESTIVE) HEART FAILURE

S60463A

INSECT BITE (NONVENOMOUS) OF LEFT MIDDLE FINGER INIT ENCNTR

I5021 ACUTE SYSTOLIC (CONGESTIVE) HEART FAILURE

S60464A

INSECT BITE (NONVENOMOUS) OF RIGHT RING FINGER INIT ENCNTR

I5022 CHRONIC SYSTOLIC (CONGESTIVE) HEART FAILURE

S60465A

INSECT BITE (NONVENOMOUS) OF LEFT RING FINGER INIT ENCNTR

I5023 ACUTE ON CHRONIC SYSTOLIC (CONGESTIVE) HEART FAILURE

S60466A

INSECT BITE (NONVENOMOUS) OF RIGHT LITTLE FINGER INIT

I5030 UNSPECIFIED DIASTOLIC (CONGESTIVE) HEART FAILURE

S60467A

INSECT BITE (NONVENOMOUS) OF LEFT LITTLE FINGER INIT ENCNTR

I5031 ACUTE DIASTOLIC (CONGESTIVE) HEART FAILURE

S60468A

INSECT BITE (NONVENOMOUS) OF OTHER FINGER INITIAL ENCOUNTER

I5032 CHRONIC DIASTOLIC (CONGESTIVE) HEART FAILURE

S60470A

OTHER SUPERFICIAL BITE OF RIGHT INDEX FINGER INIT ENCNTR

I5033 ACUTE ON CHRONIC DIASTOLIC (CONGESTIVE) HEART FAILURE

S60471A

OTHER SUPERFICIAL BITE OF LEFT INDEX FINGER INIT ENCNTR

I5040

UNSP COMBINED SYSTOLIC AND DIASTOLIC (CONGESTIVE) HRT FAIL

S60472A

OTHER SUPERFICIAL BITE OF RIGHT MIDDLE FINGER INIT ENCNTR

I5041

ACUTE COMBINED SYSTOLIC AND DIASTOLIC (CONGESTIVE) HRT FAIL

S60473A

OTHER SUPERFICIAL BITE OF LEFT MIDDLE FINGER INIT ENCNTR

I5042 CHRONIC COMBINED SYSTOLIC AND DIASTOLIC HRT FAIL

S60474A

OTHER SUPERFICIAL BITE OF RIGHT RING FINGER INIT ENCNTR

Page 150: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I5043

ACUTE ON CHRONIC COMBINED SYSTOLIC AND DIASTOLIC HRT FAIL

S60475A

OTHER SUPERFICIAL BITE OF LEFT RING FINGER INIT ENCNTR

I509 HEART FAILURE UNSPECIFIED

S60476A OTHER SUPERFICIAL BITE OF RIGHT LITTLE FINGER INIT ENCNTR

I510 CARDIAC SEPTAL DEFECT ACQUIRED

S60477A

OTHER SUPERFICIAL BITE OF LEFT LITTLE FINGER INIT ENCNTR

I511

RUPTURE OF CHORDAE TENDINEAE NOT ELSEWHERE CLASSIFIED

S60511A

ABRASION OF RIGHT HAND INITIAL ENCOUNTER

I512

RUPTURE OF PAPILLARY MUSCLE NOT ELSEWHERE CLASSIFIED

S60512A

ABRASION OF LEFT HAND INITIAL ENCOUNTER

I513 INTRACARDIAC THROMBOSIS NOT ELSEWHERE CLASSIFIED

S60521A

BLISTER (NONTHERMAL) OF RIGHT HAND INITIAL ENCOUNTER

I514 MYOCARDITIS UNSPECIFIED

S60522A BLISTER (NONTHERMAL) OF LEFT HAND INITIAL ENCOUNTER

I515 MYOCARDIAL DEGENERATION

S60541A EXTERNAL CONSTRICTION OF RIGHT HAND INITIAL ENCOUNTER

I517 CARDIOMEGALY

S60542A EXTERNAL CONSTRICTION OF LEFT HAND INITIAL ENCOUNTER

I5181 TAKOTSUBO SYNDROME

S60551A SUPERFICIAL FOREIGN BODY OF RIGHT HAND INITIAL ENCOUNTER

I5189 OTHER ILL-DEFINED HEART DISEASES

S60552A

SUPERFICIAL FOREIGN BODY OF LEFT HAND INITIAL ENCOUNTER

I519 HEART DISEASE UNSPECIFIED

S60561A INSECT BITE (NONVENOMOUS) OF RIGHT HAND INITIAL ENCOUNTER

I52

OTHER HEART DISORDERS IN DISEASES CLASSIFIED ELSEWHERE

S60562A

INSECT BITE (NONVENOMOUS) OF LEFT HAND INITIAL ENCOUNTER

I6000

NTRM SUBARACH HEMORRHAGE FROM UNSP CAROTID SIPHON AND BIFURC

S60571A

OTHER SUPERFICIAL BITE OF HAND OF RIGHT HAND INIT ENCNTR

I6001

NTRM SUBARACH HEMOR FROM RIGHT CAROTID SIPHON AND BIFURC

S60572A

OTHER SUPERFICIAL BITE OF HAND OF LEFT HAND INIT ENCNTR

Page 151: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I6002

NTRM SUBARACH HEMORRHAGE FROM LEFT CAROTID SIPHON AND BIFURC

S60811A

ABRASION OF RIGHT WRIST INITIAL ENCOUNTER

I6010

NTRM SUBARACH HEMORRHAGE FROM UNSP MIDDLE CEREBRAL ARTERY

S60812A

ABRASION OF LEFT WRIST INITIAL ENCOUNTER

I6011

NTRM SUBARACH HEMORRHAGE FROM RIGHT MIDDLE CEREBRAL ARTERY

S60821A

BLISTER (NONTHERMAL) OF RIGHT WRIST INITIAL ENCOUNTER

I6012

NTRM SUBARACH HEMORRHAGE FROM LEFT MIDDLE CEREBRAL ARTERY

S60822A

BLISTER (NONTHERMAL) OF LEFT WRIST INITIAL ENCOUNTER

I602

Nontraumatic subarachnoid hemorrhage from anterior communicating artery

S60829A

BLISTER (NONTHERMAL) OF UNSPECIFIED WRIST INITIAL ENCOUNTER

I6020

NTRM SUBARACH HEMOR FROM UNSP ANTERIOR COMMUNICATING ARTERY

S60841A

EXTERNAL CONSTRICTION OF RIGHT WRIST INITIAL ENCOUNTER

I6021

NTRM SUBARACH HEMOR FROM RIGHT ANTERIOR COMMUNICATING ARTERY

S60842A

EXTERNAL CONSTRICTION OF LEFT WRIST INITIAL ENCOUNTER

I6022

NTRM SUBARACH HEMOR FROM LEFT ANTERIOR COMMUNICATING ARTERY

S60851A

SUPERFICIAL FOREIGN BODY OF RIGHT WRIST INITIAL ENCOUNTER

I6030

NTRM SUBARACH HEMOR FROM UNSP POSTERIOR COMMUNICATING ARTERY

S60852A

SUPERFICIAL FOREIGN BODY OF LEFT WRIST INITIAL ENCOUNTER

I6031

NTRM SUBARACH HEMOR FROM RIGHT POST COMMUNICATING ARTERY

S60861A

INSECT BITE (NONVENOMOUS) OF RIGHT WRIST INITIAL ENCOUNTER

I6032

NTRM SUBARACH HEMOR FROM LEFT POSTERIOR COMMUNICATING ARTERY

S60862A

INSECT BITE (NONVENOMOUS) OF LEFT WRIST INITIAL ENCOUNTER

I604

NONTRAUMATIC SUBARACHNOID HEMORRHAGE FROM BASILAR ARTERY

S60871A

OTHER SUPERFICIAL BITE OF RIGHT WRIST INITIAL ENCOUNTER

Page 152: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I6050

NONTRAUMATIC SUBARACHNOID HEMORRHAGE FROM UNSP VERTEB ART

S60872A

OTHER SUPERFICIAL BITE OF LEFT WRIST INITIAL ENCOUNTER

I6051

NONTRAUMATIC SUBARACHNOID HEMORRHAGE FROM R VERTEB ART

S60911A

UNSPECIFIED SUPERFICIAL INJURY OF RIGHT WRIST INIT ENCNTR

I6052

NONTRAUMATIC SUBARACHNOID HEMORRHAGE FROM L VERTEB ART

S60912A

UNSPECIFIED SUPERFICIAL INJURY OF LEFT WRIST INIT ENCNTR

I606

NONTRAUMATIC SUBARACHNOID HEMORRHAGE FROM OTH INTRACRAN ART

S60921A

UNSPECIFIED SUPERFICIAL INJURY OF RIGHT HAND INIT ENCNTR

I607

NONTRAUMATIC SUBARACHNOID HEMORRHAGE FROM UNSP INTRACRAN ART

S60922A

UNSPECIFIED SUPERFICIAL INJURY OF LEFT HAND INIT ENCNTR

I608 OTHER NONTRAUMATIC SUBARACHNOID HEMORRHAGE

S60931A

UNSPECIFIED SUPERFICIAL INJURY OF RIGHT THUMB INIT ENCNTR

I609

NONTRAUMATIC SUBARACHNOID HEMORRHAGE UNSPECIFIED

S60932A

UNSPECIFIED SUPERFICIAL INJURY OF LEFT THUMB INIT ENCNTR

I610

NONTRAUMATIC INTCRBL HEMORRHAGE IN HEMISPHERE SUBCORTICAL

S60940A

UNSP SUPERFICIAL INJURY OF RIGHT INDEX FINGER INIT ENCNTR

I611

NONTRAUMATIC INTCRBL HEMORRHAGE IN HEMISPHERE CORTICAL

S60941A

UNSP SUPERFICIAL INJURY OF LEFT INDEX FINGER INIT ENCNTR

I612

NONTRAUMATIC INTRACEREBRAL HEMORRHAGE IN HEMISPHERE UNSP

S60942A

UNSP SUPERFICIAL INJURY OF RIGHT MIDDLE FINGER INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I613

NONTRAUMATIC INTRACEREBRAL HEMORRHAGE IN BRAIN STEM

S60943A

UNSP SUPERFICIAL INJURY OF LEFT MIDDLE FINGER INIT ENCNTR

I614

NONTRAUMATIC INTRACEREBRAL HEMORRHAGE IN CEREBELLUM

S60944A

UNSP SUPERFICIAL INJURY OF RIGHT RING FINGER INIT ENCNTR

I615

NONTRAUMATIC INTRACEREBRAL HEMORRHAGE INTRAVENTRICULAR

S60945A

UNSP SUPERFICIAL INJURY OF LEFT RING FINGER INIT ENCNTR

I616

NONTRAUMATIC INTRACEREBRAL HEMORRHAGE MULTIPLE LOCALIZED

S60946A

UNSP SUPERFICIAL INJURY OF RIGHT LITTLE FINGER INIT ENCNTR

I618 OTHER NONTRAUMATIC INTRACEREBRAL HEMORRHAGE

S60947A

UNSP SUPERFICIAL INJURY OF LEFT LITTLE FINGER INIT ENCNTR

I619

NONTRAUMATIC INTRACEREBRAL HEMORRHAGE UNSPECIFIED

S60948A

UNSPECIFIED SUPERFICIAL INJURY OF OTHER FINGER INIT ENCNTR

I6200 NONTRAUMATIC SUBDURAL HEMORRHAGE UNSPECIFIED

S61001A

UNSP OPEN WOUND OF RIGHT THUMB W/O DAMAGE TO NAIL INIT

I6201 NONTRAUMATIC ACUTE SUBDURAL HEMORRHAGE

S61002A

UNSP OPEN WOUND OF LEFT THUMB W/O DAMAGE TO NAIL INIT

I6202 NONTRAUMATIC SUBACUTE SUBDURAL HEMORRHAGE

S61011A

LACERATION W/O FB OF RIGHT THUMB W/O DAMAGE TO NAIL INIT

I6203 NONTRAUMATIC CHRONIC SUBDURAL HEMORRHAGE

S61012A

LACERATION W/O FB OF LEFT THUMB W/O DAMAGE TO NAIL INIT

I621 NONTRAUMATIC EXTRADURAL HEMORRHAGE

S61021A

LACERATION W FB OF RIGHT THUMB W/O DAMAGE TO NAIL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I629

NONTRAUMATIC INTRACRANIAL HEMORRHAGE UNSPECIFIED

S61022A

LACERATION W FB OF LEFT THUMB W/O DAMAGE TO NAIL INIT

I6300

CEREBRAL INFARCTION DUE TO THOMBOS UNSP PRECEREBRAL ARTERY

S61031A

PNCTR W/O FB OF RIGHT THUMB W/O DAMAGE TO NAIL INIT

I63011 CEREBRAL INFARCTION DUE TO THROMBOSIS OF R VERTEB ART

S61032A

PNCTR W/O FB OF LEFT THUMB W/O DAMAGE TO NAIL INIT

I63012 CEREBRAL INFARCTION DUE TO THROMBOSIS OF L VERTEB ART

S61041A

PNCTR W FOREIGN BODY OF RIGHT THUMB W/O DAMAGE TO NAIL INIT

I63013

Cerebral infarction due to thrombosis of bilateral vertebral arteries

S61042A

PNCTR W FOREIGN BODY OF LEFT THUMB W/O DAMAGE TO NAIL INIT

I63019

CEREBRAL INFARCTION DUE TO THOMBOS UNSP VERTEBRAL ARTERY

S61051A

OPEN BITE OF RIGHT THUMB WITHOUT DAMAGE TO NAIL INIT ENCNTR

I6302

CEREBRAL INFARCTION DUE TO THROMBOSIS OF BASILAR ARTERY

S61052A

OPEN BITE OF LEFT THUMB WITHOUT DAMAGE TO NAIL INIT ENCNTR

I63031

CEREBRAL INFRC DUE TO THROMBOSIS OF RIGHT CAROTID ARTERY

S61101A

UNSP OPEN WOUND OF RIGHT THUMB W DAMAGE TO NAIL INIT ENCNTR

I63032

CEREBRAL INFARCTION DUE TO THROMBOSIS OF LEFT CAROTID ARTERY

S61102A

UNSP OPEN WOUND OF LEFT THUMB W DAMAGE TO NAIL INIT ENCNTR

I63033

Cerebral infarction due to thrombosis of bilateral carotid arteries

S61111A

LACERATION W/O FB OF RIGHT THUMB W DAMAGE TO NAIL INIT

I63039

CEREBRAL INFARCTION DUE TO THROMBOSIS OF UNSP CAROTID ARTERY

S61112A

LACERATION W/O FB OF LEFT THUMB W DAMAGE TO NAIL INIT

I6309

CEREBRAL INFARCTION DUE TO THROMBOSIS OF PRECEREBRAL ARTERY

S61121A

LACERATION W FB OF RIGHT THUMB W DAMAGE TO NAIL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I6310

CEREBRAL INFARCTION DUE TO EMBOLISM OF UNSP PRECERB ARTERY

S61122A

LACERATION W FB OF LEFT THUMB W DAMAGE TO NAIL INIT

I63111 CEREBRAL INFARCTION DUE TO EMBOLISM OF R VERTEB ART

S61131A

PNCTR W/O FOREIGN BODY OF RIGHT THUMB W DAMAGE TO NAIL INIT

I63112

CEREBRAL INFARCTION DUE TO EMBOLISM OF LEFT VERTEBRAL ARTERY

S61132A

PNCTR W/O FOREIGN BODY OF LEFT THUMB W DAMAGE TO NAIL INIT

I63113

Cerebral infarction due to embolism of bilateral vertebral arteries

S61141A

PNCTR W FOREIGN BODY OF RIGHT THUMB W DAMAGE TO NAIL INIT

I63119

CEREBRAL INFARCTION DUE TO EMBOLISM OF UNSP VERTEBRAL ARTERY

S61142A

PNCTR W FOREIGN BODY OF LEFT THUMB W DAMAGE TO NAIL INIT

I6312 CEREBRAL INFARCTION DUE TO EMBOLISM OF BASILAR ARTERY

S61151A

OPEN BITE OF RIGHT THUMB WITH DAMAGE TO NAIL INIT ENCNTR

I63131

CEREBRAL INFARCTION DUE TO EMBOLISM OF RIGHT CAROTID ARTERY

S61152A

OPEN BITE OF LEFT THUMB WITH DAMAGE TO NAIL INIT ENCNTR

I63132

CEREBRAL INFARCTION DUE TO EMBOLISM OF LEFT CAROTID ARTERY

S61200A

UNSP OPEN WOUND OF R IDX FNGR W/O DAMAGE TO NAIL INIT

I63133

Cerebral infarction due to embolism of bilateral carotid arteries

S61201A

UNSP OPEN WOUND OF L IDX FNGR W/O DAMAGE TO NAIL INIT

I63139

CEREBRAL INFARCTION DUE TO EMBOLISM OF UNSP CAROTID ARTERY

S61202A

UNSP OPEN WOUND OF R MID FINGER W/O DAMAGE TO NAIL INIT

I6319

CEREBRAL INFARCTION DUE TO EMBOLISM OF PRECEREBRAL ARTERY

S61203A

UNSP OPEN WOUND OF L MID FINGER W/O DAMAGE TO NAIL INIT

I6320

CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF UNSP PRECERB ART

S61204A

UNSP OPEN WOUND OF R RNG FNGR W/O DAMAGE TO NAIL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I63211

CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF RIGHT VERTEB ART

S61205A

UNSP OPEN WOUND OF LEFT RING FINGER W/O DAMAGE TO NAIL INIT

I63212

CEREB INFRC DUE TO UNSP OCCLS OR STENOSIS OF LEFT VERTEB ART

S61206A

UNSP OPEN WOUND OF R LITTLE FINGER W/O DAMAGE TO NAIL INIT

I63213

Cerebral infarction due to unspecified occlusion or stenosis of bilateral vertebral arteries

S61207A

UNSP OPEN WOUND OF L LITTLE FINGER W/O DAMAGE TO NAIL INIT

I63219

CEREB INFRC DUE TO UNSP OCCLS OR STENOSIS OF UNSP VERTEB ART

S61210A

LACERATION W/O FB OF R IDX FNGR W/O DAMAGE TO NAIL INIT

I6322

CEREBRAL INFRC DUE TO UNSP OCCLS OR STENOSIS OF BASILAR ART

S61211A

LACERATION W/O FB OF L IDX FNGR W/O DAMAGE TO NAIL INIT

I63231

CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF RIGHT CAROTID ART

S61212A

LACERATION W/O FB OF R MID FINGER W/O DAMAGE TO NAIL INIT

I63232

CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF LEFT CAROTID ART

S61213A

LACERATION W/O FB OF L MID FINGER W/O DAMAGE TO NAIL INIT

I63233

Cerebral infarction due to unspecified occlusion or stenosis of bilateral carotid arteries

S61214A

LACERATION W/O FB OF R RNG FNGR W/O DAMAGE TO NAIL INIT

I63239

CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF UNSP CAROTID ART

S61215A

LACERATION W/O FB OF L RNG FNGR W/O DAMAGE TO NAIL INIT

I6329

CEREBRAL INFRC DUE TO UNSP OCCLS OR STENOSIS OF PRECERB ART

S61216A

LAC W/O FB OF R LITTLE FINGER W/O DAMAGE TO NAIL INIT

I6330

CEREBRAL INFARCTION DUE TO THOMBOS UNSP CEREBRAL ARTERY

S61217A

LAC W/O FB OF L LITTLE FINGER W/O DAMAGE TO NAIL INIT

I63311

CEREB INFRC DUE TO THOMBOS OF RIGHT MIDDLE CEREBRAL ARTERY

S61218A

LACERATION W/O FB OF FINGER W/O DAMAGE TO NAIL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I63312

CEREBRAL INFRC DUE TO THOMBOS OF LEFT MIDDLE CEREBRAL ARTERY

S61220A

LACERATION W FB OF R IDX FNGR W/O DAMAGE TO NAIL INIT

I63313

Cerebral infarction due to thrombosis of bilateral middle cerebral arteries

S61221A

LACERATION W FB OF L IDX FNGR W/O DAMAGE TO NAIL INIT

I63319

CEREBRAL INFRC DUE TO THOMBOS UNSP MIDDLE CEREBRAL ARTERY

S61222A

LACERATION W FB OF R MID FINGER W/O DAMAGE TO NAIL INIT

I63321

CEREBRAL INFRC DUE TO THOMBOS OF RIGHT ANT CEREBRAL ARTERY

S61223A

LACERATION W FB OF L MID FINGER W/O DAMAGE TO NAIL INIT

I63322

CEREBRAL INFRC DUE TO THOMBOS OF LEFT ANT CEREBRAL ARTERY

S61224A

LACERATION W FB OF R RNG FNGR W/O DAMAGE TO NAIL INIT

I63323

Cerebral infarction due to thrombosis of bilateral anterior arteries

S61225A

LACERATION W FB OF L RNG FNGR W/O DAMAGE TO NAIL INIT

I63329

CEREBRAL INFRC DUE TO THOMBOS UNSP ANTERIOR CEREBRAL ARTERY

S61226A

LACERATION W FB OF R LITTLE FINGER W/O DAMAGE TO NAIL INIT

I63331

CEREBRAL INFRC DUE TO THOMBOS OF RIGHT POST CEREBRAL ARTERY

S61227A

LACERATION W FB OF L LITTLE FINGER W/O DAMAGE TO NAIL INIT

I63332

CEREBRAL INFRC DUE TO THOMBOS OF LEFT POST CEREBRAL ARTERY

S61230A

PNCTR W/O FB OF R IDX FNGR W/O DAMAGE TO NAIL INIT

I63333

Cerebral infarction to thrombosis of bilateral posterior arteries

S61231A

PNCTR W/O FB OF L IDX FNGR W/O DAMAGE TO NAIL INIT

I63343

Cerebral infarction to thrombosis of bilateral cerebellar arteries

S61232A

PNCTR W/O FB OF R MID FINGER W/O DAMAGE TO NAIL INIT

I63339

CEREBRAL INFRC DUE TO THOMBOS UNSP POSTERIOR CEREBRAL ARTERY

S61233A

PNCTR W/O FB OF L MID FINGER W/O DAMAGE TO NAIL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I63341

CEREBRAL INFRC DUE TO THROMBOSIS OF RIGHT CEREBLR ARTERY

S61234A

PNCTR W/O FB OF R RNG FNGR W/O DAMAGE TO NAIL INIT

I63342

CEREBRAL INFARCTION DUE TO THROMBOSIS OF LEFT CEREBLR ARTERY

S61235A

PNCTR W/O FB OF L RNG FNGR W/O DAMAGE TO NAIL INIT

I63349

CEREBRAL INFARCTION DUE TO THOMBOS UNSP CEREBELLAR ARTERY

S61236A

PNCTR W/O FB OF R LITTLE FINGER W/O DAMAGE TO NAIL INIT

I6339

CEREBRAL INFARCTION DUE TO THROMBOSIS OF OTH CEREBRAL ARTERY

S61237A

PNCTR W/O FB OF L LITTLE FINGER W/O DAMAGE TO NAIL INIT

I6340

CEREBRAL INFARCTION DUE TO EMBOLISM OF UNSP CEREBRAL ARTERY

S61238A

PNCTR W/O FOREIGN BODY OF FINGER W/O DAMAGE TO NAIL INIT

I63411

CEREB INFRC DUE TO EMBOLISM OF RIGHT MIDDLE CEREBRAL ARTERY

S61240A

PNCTR W FOREIGN BODY OF R IDX FNGR W/O DAMAGE TO NAIL INIT

I63412

CEREB INFRC DUE TO EMBOLISM OF LEFT MIDDLE CEREBRAL ARTERY

S61241A

PNCTR W FOREIGN BODY OF L IDX FNGR W/O DAMAGE TO NAIL INIT

I63413

Cerebral infarction due to embolism of bilateral middle cerebral arteries

S61242A

PNCTR W FB OF R MID FINGER W/O DAMAGE TO NAIL INIT

I63419

CEREB INFRC DUE TO EMBOLISM OF UNSP MIDDLE CEREBRAL ARTERY

S61243A

PNCTR W FB OF L MID FINGER W/O DAMAGE TO NAIL INIT

I63421

CEREBRAL INFRC DUE TO EMBOLISM OF RIGHT ANT CEREBRAL ARTERY

S61244A

PNCTR W FOREIGN BODY OF R RNG FNGR W/O DAMAGE TO NAIL INIT

I63422

CEREBRAL INFRC DUE TO EMBOLISM OF LEFT ANT CEREBRAL ARTERY

S61245A

PNCTR W FOREIGN BODY OF L RNG FNGR W/O DAMAGE TO NAIL INIT

I63423

Cerebral infarction due to embolism of bilateral anterior cerebral arteries

S61246A

PNCTR W FB OF R LITTLE FINGER W/O DAMAGE TO NAIL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I63429

CEREBRAL INFRC DUE TO EMBOLISM OF UNSP ANT CEREBRAL ARTERY

S61247A

PNCTR W FB OF L LITTLE FINGER W/O DAMAGE TO NAIL INIT

I63431

CEREBRAL INFRC DUE TO EMBOLISM OF RIGHT POST CEREBRAL ARTERY

S61250A

OPEN BITE OF RIGHT INDEX FINGER W/O DAMAGE TO NAIL INIT

I63432

CEREBRAL INFRC DUE TO EMBOLISM OF LEFT POST CEREBRAL ARTERY

S61251A

OPEN BITE OF LEFT INDEX FINGER W/O DAMAGE TO NAIL INIT

I63433

Cerebral infarction due to embolism of bilateral posterior cerebral arteries

S61252A

OPEN BITE OF RIGHT MIDDLE FINGER W/O DAMAGE TO NAIL INIT

I63439

CEREBRAL INFRC DUE TO EMBOLISM OF UNSP POST CEREBRAL ARTERY

S61253A

OPEN BITE OF LEFT MIDDLE FINGER W/O DAMAGE TO NAIL INIT

I63441

CEREBRAL INFARCTION DUE TO EMBOLISM OF RIGHT CEREBLR ARTERY

S61254A

OPEN BITE OF RIGHT RING FINGER W/O DAMAGE TO NAIL INIT

I63442

CEREBRAL INFARCTION DUE TO EMBOLISM OF LEFT CEREBLR ARTERY

S61255A

OPEN BITE OF LEFT RING FINGER W/O DAMAGE TO NAIL INIT

I63443

Cerebral infarction due to embolism of bilateral cerebellar arteries

S61256A

OPEN BITE OF RIGHT LITTLE FINGER W/O DAMAGE TO NAIL INIT

I63449

CEREBRAL INFARCTION DUE TO EMBOLISM OF UNSP CEREBLR ARTERY

S61257A

OPEN BITE OF LEFT LITTLE FINGER W/O DAMAGE TO NAIL INIT

I6349

CEREBRAL INFARCTION DUE TO EMBOLISM OF OTHER CEREBRAL ARTERY

S61258A

OPEN BITE OF OTHER FINGER W/O DAMAGE TO NAIL INIT ENCNTR

I6350

CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF UNSP CEREB ARTERY

S61300A

UNSP OPEN WOUND OF RIGHT INDEX FINGER W DAMAGE TO NAIL INIT

I63511

CEREB INFRC D/T UNSP OCCLS OR STENOS OF RIGHT MID CEREB ART

S61301A

UNSP OPEN WOUND OF LEFT INDEX FINGER W DAMAGE TO NAIL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I63512

CEREB INFRC D/T UNSP OCCLS OR STENOS OF LEFT MID CEREB ART

S61302A

UNSP OPEN WOUND OF R MID FINGER W DAMAGE TO NAIL INIT

I63513

Cerebral infarction due to unspecified occlusion or stenosis of bilateral middle arteries

S61303A

UNSP OPEN WOUND OF LEFT MIDDLE FINGER W DAMAGE TO NAIL INIT

I63519

CEREB INFRC D/T UNSP OCCLS OR STENOS OF UNSP MID CEREB ART

S61304A

UNSP OPEN WOUND OF RIGHT RING FINGER W DAMAGE TO NAIL INIT

I63521

CEREB INFRC D/T UNSP OCCLS OR STENOS OF RIGHT ANT CEREB ART

S61305A

UNSP OPEN WOUND OF LEFT RING FINGER W DAMAGE TO NAIL INIT

I63522

CEREB INFRC D/T UNSP OCCLS OR STENOS OF LEFT ANT CEREB ART

S61306A

UNSP OPEN WOUND OF R LITTLE FINGER W DAMAGE TO NAIL INIT

I63523

Cerebral infarction due to unspecified occlusion or stenosis of bilateral anterior arteries

S61307A

UNSP OPEN WOUND OF LEFT LITTLE FINGER W DAMAGE TO NAIL INIT

I63529

CEREB INFRC D/T UNSP OCCLS OR STENOS OF UNSP ANT CEREB ART

S61310A

LACERATION W/O FB OF R IDX FNGR W DAMAGE TO NAIL INIT

I63531

CEREB INFRC D/T UNSP OCCLS OR STENOS OF RIGHT POST CEREB ART

S61311A

LACERATION W/O FB OF L IDX FNGR W DAMAGE TO NAIL INIT

I63532

CEREB INFRC D/T UNSP OCCLS OR STENOS OF LEFT POST CEREB ART

S61312A

LACERATION W/O FB OF R MID FINGER W DAMAGE TO NAIL INIT

I63533

Cerebral infarction due to unspecified occlusion or stenosis of bilateral posterior arteries

S61313A

LACERATION W/O FB OF L MID FINGER W DAMAGE TO NAIL INIT

I63539

CEREB INFRC D/T UNSP OCCLS OR STENOS OF UNSP POST CEREB ART

S61314A

LACERATION W/O FB OF R RNG FNGR W DAMAGE TO NAIL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I63541

CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF RIGHT CEREBLR ART

S61315A

LACERATION W/O FB OF L RNG FNGR W DAMAGE TO NAIL INIT

I63542

CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF LEFT CEREBLR ART

S61316A

LACERATION W/O FB OF R LITTLE FINGER W DAMAGE TO NAIL INIT

I63543

Cerebral infarction due to unspecified occlusion or stenosis of bilateral cerebellar arteries

S61317A

LACERATION W/O FB OF L LITTLE FINGER W DAMAGE TO NAIL INIT

I63549

CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF UNSP CEREBLR ART

S61320A

LACERATION W FB OF R IDX FNGR W DAMAGE TO NAIL INIT

I6359

CEREB INFRC DUE TO UNSP OCCLS OR STENOSIS OF CEREBRAL ARTERY

S61321A

LACERATION W FB OF L IDX FNGR W DAMAGE TO NAIL INIT

I636

CEREBRAL INFRC DUE TO CEREBRAL VENOUS THOMBOS NONPYOGENIC

S61322A

LACERATION W FB OF R MID FINGER W DAMAGE TO NAIL INIT

I638 OTHER CEREBRAL INFARCTION

S61323A LACERATION W FB OF L MID FINGER W DAMAGE TO NAIL INIT

I639 CEREBRAL INFARCTION UNSPECIFIED

S61324A

LACERATION W FB OF R RNG FNGR W DAMAGE TO NAIL INIT

I6501 OCCLUSION AND STENOSIS OF RIGHT VERTEBRAL ARTERY

S61325A

LACERATION W FB OF L RNG FNGR W DAMAGE TO NAIL INIT

I6502 OCCLUSION AND STENOSIS OF LEFT VERTEBRAL ARTERY

S61326A

LACERATION W FB OF R LITTLE FINGER W DAMAGE TO NAIL INIT

I6503

OCCLUSION AND STENOSIS OF BILATERAL VERTEBRAL ARTERIES

S61327A

LACERATION W FB OF L LITTLE FINGER W DAMAGE TO NAIL INIT

I6509

OCCLUSION AND STENOSIS OF UNSPECIFIED VERTEBRAL ARTERY

S61328A

LACERATION W FOREIGN BODY OF FINGER W DAMAGE TO NAIL INIT

I651 OCCLUSION AND STENOSIS OF BASILAR ARTERY

S61330A

PNCTR W/O FOREIGN BODY OF R IDX FNGR W DAMAGE TO NAIL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I6521 OCCLUSION AND STENOSIS OF RIGHT CAROTID ARTERY

S61331A

PNCTR W/O FOREIGN BODY OF L IDX FNGR W DAMAGE TO NAIL INIT

I6522 OCCLUSION AND STENOSIS OF LEFT CAROTID ARTERY

S61332A

PNCTR W/O FB OF R MID FINGER W DAMAGE TO NAIL INIT

I6523 OCCLUSION AND STENOSIS OF BILATERAL CAROTID ARTERIES

S61333A

PNCTR W/O FB OF L MID FINGER W DAMAGE TO NAIL INIT

I6529 OCCLUSION AND STENOSIS OF UNSPECIFIED CAROTID ARTERY

S61334A

PNCTR W/O FOREIGN BODY OF R RNG FNGR W DAMAGE TO NAIL INIT

I658 OCCLUSION AND STENOSIS OF OTHER PRECEREBRAL ARTERIES

S61335A

PNCTR W/O FOREIGN BODY OF L RNG FNGR W DAMAGE TO NAIL INIT

I659

OCCLUSION AND STENOSIS OF UNSPECIFIED PRECEREBRAL ARTERY

S61336A

PNCTR W/O FB OF R LITTLE FINGER W DAMAGE TO NAIL INIT

I6601

OCCLUSION AND STENOSIS OF RIGHT MIDDLE CEREBRAL ARTERY

S61337A

PNCTR W/O FB OF L LITTLE FINGER W DAMAGE TO NAIL INIT

I6602 OCCLUSION AND STENOSIS OF LEFT MIDDLE CEREBRAL ARTERY

S61340A

PNCTR W FOREIGN BODY OF R IDX FNGR W DAMAGE TO NAIL INIT

I6603

OCCLUSION AND STENOSIS OF BILATERAL MIDDLE CEREBRAL ARTERIES

S61341A

PNCTR W FOREIGN BODY OF L IDX FNGR W DAMAGE TO NAIL INIT

I6609

OCCLUSION AND STENOSIS OF UNSPECIFIED MIDDLE CEREBRAL ARTERY

S61342A

PNCTR W FOREIGN BODY OF R MID FINGER W DAMAGE TO NAIL INIT

I6611

OCCLUSION AND STENOSIS OF RIGHT ANTERIOR CEREBRAL ARTERY

S61343A

PNCTR W FOREIGN BODY OF L MID FINGER W DAMAGE TO NAIL INIT

I6612

OCCLUSION AND STENOSIS OF LEFT ANTERIOR CEREBRAL ARTERY

S61344A

PNCTR W FOREIGN BODY OF R RNG FNGR W DAMAGE TO NAIL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I6613

OCCLUSION AND STENOSIS OF BI ANTERIOR CEREBRAL ARTERIES

S61345A

PNCTR W FOREIGN BODY OF L RNG FNGR W DAMAGE TO NAIL INIT

I6619

OCCLUSION AND STENOSIS OF UNSP ANTERIOR CEREBRAL ARTERY

S61346A

PNCTR W FB OF R LITTLE FINGER W DAMAGE TO NAIL INIT

I6621

OCCLUSION AND STENOSIS OF RIGHT POSTERIOR CEREBRAL ARTERY

S61347A

PNCTR W FB OF L LITTLE FINGER W DAMAGE TO NAIL INIT

I6622

OCCLUSION AND STENOSIS OF LEFT POSTERIOR CEREBRAL ARTERY

S61350A

OPEN BITE OF RIGHT INDEX FINGER W DAMAGE TO NAIL INIT

I6623

OCCLUSION AND STENOSIS OF BI POSTERIOR CEREBRAL ARTERIES

S61351A

OPEN BITE OF LEFT INDEX FINGER W DAMAGE TO NAIL INIT ENCNTR

I6629

OCCLUSION AND STENOSIS OF UNSP POSTERIOR CEREBRAL ARTERY

S61352A

OPEN BITE OF RIGHT MIDDLE FINGER W DAMAGE TO NAIL INIT

I663 OCCLUSION AND STENOSIS OF CEREBELLAR ARTERIES

S61353A

OPEN BITE OF LEFT MIDDLE FINGER W DAMAGE TO NAIL INIT

I668 OCCLUSION AND STENOSIS OF OTHER CEREBRAL ARTERIES

S61354A

OPEN BITE OF RIGHT RING FINGER W DAMAGE TO NAIL INIT ENCNTR

I669 OCCLUSION AND STENOSIS OF UNSPECIFIED CEREBRAL ARTERY

S61355A

OPEN BITE OF LEFT RING FINGER W DAMAGE TO NAIL INIT ENCNTR

I670 DISSECTION OF CEREBRAL ARTERIES NONRUPTURED

S61356A

OPEN BITE OF RIGHT LITTLE FINGER W DAMAGE TO NAIL INIT

I671 CEREBRAL ANEURYSM NONRUPTURED

S61357A

OPEN BITE OF LEFT LITTLE FINGER W DAMAGE TO NAIL INIT

I672 CEREBRAL ATHEROSCLEROSIS

S61358A OPEN BITE OF OTHER FINGER WITH DAMAGE TO NAIL INIT ENCNTR

I673 PROGRESSIVE VASCULAR LEUKOENCEPHALOPATHY

S61401A

UNSPECIFIED OPEN WOUND OF RIGHT HAND INITIAL ENCOUNTER

I674 HYPERTENSIVE ENCEPHALOPATHY

S61402A

UNSPECIFIED OPEN WOUND OF LEFT HAND INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I675 MOYAMOYA DISEASE

S61411A LACERATION WITHOUT FOREIGN BODY OF RIGHT HAND INIT ENCNTR

I676

NONPYOGENIC THROMBOSIS OF INTRACRANIAL VENOUS SYSTEM

S61412A

LACERATION WITHOUT FOREIGN BODY OF LEFT HAND INIT ENCNTR

I677 CEREBRAL ARTERITIS NOT ELSEWHERE CLASSIFIED

S61421A

LACERATION WITH FOREIGN BODY OF RIGHT HAND INIT ENCNTR

I679 CEREBROVASCULAR DISEASE UNSPECIFIED

S61422A

LACERATION WITH FOREIGN BODY OF LEFT HAND INITIAL ENCOUNTER

I680 CEREBRAL AMYLOID ANGIOPATHY

S61431A

PUNCTURE WOUND W/O FOREIGN BODY OF RIGHT HAND INIT ENCNTR

I682

CEREBRAL ARTERITIS IN OTHER DISEASES CLASSIFIED ELSEWHERE

S61432A

PUNCTURE WOUND W/O FOREIGN BODY OF LEFT HAND INIT ENCNTR

I688

OTH CEREBROVASCULAR DISORDERS IN DISEASES CLASSD ELSWHR

S61441A

PUNCTURE WOUND WITH FOREIGN BODY OF RIGHT HAND INIT ENCNTR

I6900

UNSPECIFIED SEQUELAE OF NONTRAUMATIC SUBARACHNOID HEMORRHAGE

S61442A

PUNCTURE WOUND WITH FOREIGN BODY OF LEFT HAND INIT ENCNTR

I6901

COGNITIVE DEFICITS FOLLOWING NTRM SUBARACHNOID HEMORRHAGE

S61451A

OPEN BITE OF RIGHT HAND INITIAL ENCOUNTER

I69010

Attention and concentration deficit following nontraumatic subarachnoid hemorrhage

S61452A

OPEN BITE OF LEFT HAND INITIAL ENCOUNTER

I69011

Memory deficit following nontraumatic subarachnoid hemorrhage

S61501A

UNSPECIFIED OPEN WOUND OF RIGHT WRIST INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69012

Visuospatial deficit and spatial neglect following nontraumatic subarachnoid hemorrhage

S61502A

UNSPECIFIED OPEN WOUND OF LEFT WRIST INITIAL ENCOUNTER

I69013

Psychomotor deficit following nontraumatic subarachnoid hemorrhage

S61511A

LACERATION WITHOUT FOREIGN BODY OF RIGHT WRIST INIT ENCNTR

I69014

Frontal lobe and executive function deficit following nontraumatic subarachnoid hemorrhage

S61512A

LACERATION WITHOUT FOREIGN BODY OF LEFT WRIST INIT ENCNTR

I69015

Cognitive social or emotional deficit following nontraumatic subarachnoid hemorrhage

S61521A

LACERATION WITH FOREIGN BODY OF RIGHT WRIST INIT ENCNTR

I69018

Other symptoms and signs involving cognitive functions following nontraumatic subarachnoid hemorrhage

S61522A

LACERATION WITH FOREIGN BODY OF LEFT WRIST INIT ENCNTR

I69019

Unspecified symptoms and signs involving cognitive functions following nontraumatic subarachnoid hemorrhage

S61531A

PUNCTURE WOUND W/O FOREIGN BODY OF RIGHT WRIST INIT ENCNTR

I69021

DYSPHASIA FOLLOWING NONTRAUMATIC SUBARACHNOID HEMORRHAGE

S61532A

PUNCTURE WOUND W/O FOREIGN BODY OF LEFT WRIST INIT ENCNTR

I69022

DYSARTHRIA FOLLOWING NONTRAUMATIC SUBARACHNOID HEMORRHAGE

S61541A

PUNCTURE WOUND WITH FOREIGN BODY OF RIGHT WRIST INIT ENCNTR

I69023

FLUENCY DISORDER FOLLOWING NTRM SUBARACHNOID HEMORRHAGE

S61542A

PUNCTURE WOUND WITH FOREIGN BODY OF LEFT WRIST INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69028

OTH SPEECH/LANG DEFICITS FOLLOWING NTRM SUBARACH HEMORRHAGE

S61551A

OPEN BITE OF RIGHT WRIST INITIAL ENCOUNTER

I69031

MONOPLG UPR LMB FOL NTRM SUBARACH HEMOR AFF RIGHT DOM SIDE

S61552A

OPEN BITE OF LEFT WRIST INITIAL ENCOUNTER

I69032

MONOPLG UPR LMB FOL NTRM SUBARACH HEMOR AFF LEFT DOM SIDE

S62001A

UNSP FRACTURE OF NAVICULAR BONE OF RIGHT WRIST INIT

I69033

MONOPLG UPR LMB FOL NTRM SUBARACH HEMOR AFF R NONDOM SIDE

S62001B

UNSP FX NAVICULAR BONE OF RIGHT WRIST INIT FOR OPN FX

I69034

MONOPLG UPR LMB FOL NTRM SUBARACH HEMOR AFF LEFT NONDOM SIDE

S62002A

UNSP FRACTURE OF NAVICULAR BONE OF LEFT WRIST INIT

I69039

MONOPLG UPR LMB FOLLOWING NTRM SUBARACH HEMOR AFF UNSP SIDE

S62002B

UNSP FX NAVICULAR BONE OF LEFT WRIST INIT FOR OPN FX

I69041

MONOPLG LOW LMB FOL NTRM SUBARACH HEMOR AFF RIGHT DOM SIDE

S62011A

DISP FX OF DISTAL POLE OF NAVICULAR BONE OF R WRIST INIT

I69042

MONOPLG LOW LMB FOL NTRM SUBARACH HEMOR AFF LEFT DOM SIDE

S62011B

DISP FX OF DIST POLE OF NAVIC BONE OF R WRS INIT FOR OPN FX

I69043

MONOPLG LOW LMB FOL NTRM SUBARACH HEMOR AFF R NONDOM SIDE

S62012A

DISP FX OF DISTAL POLE OF NAVICULAR BONE OF LEFT WRIST INIT

I69044

MONOPLG LOW LMB FOL NTRM SUBARACH HEMOR AFF LEFT NONDOM SIDE

S62012B

DISP FX OF DIST POLE OF NAVIC BONE OF L WRS INIT FOR OPN FX

I69049

MONOPLG LOW LMB FOLLOWING NTRM SUBARACH HEMOR AFF UNSP SIDE

S62014A

NONDISP FX OF DISTAL POLE OF NAVICULAR BONE OF R WRIST INIT

I69051

HEMIPLGA FOL NTRM SUBARACH HEMOR AFF RIGHT DOMINANT SIDE

S62014B

NONDISP FX OF DIST POLE OF NAVIC BONE OF R WRS 7THB

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69052

HEMIPLGA FOL NTRM SUBARACH HEMOR AFF LEFT DOMINANT SIDE

S62015A

NONDISP FX OF DISTAL POLE OF NAVICULAR BONE OF L WRIST INIT

I69053

HEMIPLGA FOLLOWING NTRM SUBARACH HEMOR AFF RIGHT NONDOM SIDE

S62015B

NONDISP FX OF DIST POLE OF NAVIC BONE OF L WRS 7THB

I69054

HEMIPLGA FOLLOWING NTRM SUBARACH HEMOR AFF LEFT NONDOM SIDE

S62021A

DISP FX OF MIDDLE THIRD OF NAVICULAR BONE OF R WRIST INIT

I69059

HEMIPLGA FOLLOWING NTRM SUBARACH HEMOR AFFECTING UNSP SIDE

S62021B

DISP FX OF MID 3RD OF NAVIC BONE OF R WRIST INIT FOR OPN FX

I69061

OTH PARLYT SYND FOL NTRM SUBARACH HEMOR AFF RIGHT DOM SIDE

S62022A

DISP FX OF MIDDLE THIRD OF NAVICULAR BONE OF L WRIST INIT

I69062

OTH PARLYT SYND FOL NTRM SUBARACH HEMOR AFF LEFT DOM SIDE

S62022B

DISP FX OF MID 3RD OF NAVIC BONE OF L WRIST INIT FOR OPN FX

I69063

OTH PARLYT SYND FOL NTRM SUBARACH HEMOR AFF R NONDOM SIDE

S62024A

NONDISP FX OF MIDDLE THIRD OF NAVIC BONE OF R WRIST INIT

I69064

OTH PARLYT SYND FOL NTRM SUBARACH HEMOR AFF LEFT NONDOM SIDE

S62024B

NONDISP FX OF MID 3RD OF NAVIC BONE OF R WRS 7THB

I69065

OTH PARALYTIC SYNDROME FOLLOWING NTRM SUBARACH HEMOR BI

S62025A

NONDISP FX OF MIDDLE THIRD OF NAVIC BONE OF L WRIST INIT

I69069

OTH PARALYTIC SYNDROME FOL NTRM SUBARACH HEMOR AFF UNSP SIDE

S62025B

NONDISP FX OF MID 3RD OF NAVIC BONE OF L WRS 7THB

I69090

APRAXIA FOLLOWING NONTRAUMATIC SUBARACHNOID HEMORRHAGE

S62031A

DISP FX OF PROXIMAL THIRD OF NAVICULAR BONE OF R WRIST INIT

I69091

DYSPHAGIA FOLLOWING NONTRAUMATIC SUBARACHNOID HEMORRHAGE

S62031B

DISP FX OF PROX 3RD OF NAVIC BONE OF R WRS INIT FOR OPN FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69092

FACIAL WEAKNESS FOLLOWING NTRM SUBARACHNOID HEMORRHAGE

S62032A

DISP FX OF PROXIMAL THIRD OF NAVICULAR BONE OF L WRIST INIT

I69093

ATAXIA FOLLOWING NONTRAUMATIC SUBARACHNOID HEMORRHAGE

S62032B

DISP FX OF PROX 3RD OF NAVIC BONE OF L WRS INIT FOR OPN FX

I69098

OTH SEQUELAE FOLLOWING NONTRAUMATIC SUBARACHNOID HEMORRHAGE

S62034A

NONDISP FX OF PROXIMAL THIRD OF NAVIC BONE OF R WRIST INIT

I6910

UNSP SEQUELAE OF NONTRAUMATIC INTRACEREBRAL HEMORRHAGE

S62034B

NONDISP FX OF PROX 3RD OF NAVIC BONE OF R WRS 7THB

I6911

COGNITIVE DEFICITS FOLLOWING NONTRAUMATIC INTCRBL HEMORRHAGE

S62035A

NONDISP FX OF PROXIMAL THIRD OF NAVIC BONE OF L WRIST INIT

I69110

Attention and concentration deficit following nontraumatic intracerebral hemorrhage

S62035B

NONDISP FX OF PROX 3RD OF NAVIC BONE OF L WRS 7THB

I69111

Memory deficit following nontraumatic intracerebral hemorrhage

S62101A

FRACTURE OF UNSP CARPAL BONE RIGHT WRIST INIT FOR CLOS FX

I69112

Visuospatial deficit and spatial neglect following nontraumatic intracerebral hemorrhage

S62101B

FRACTURE OF UNSP CARPAL BONE RIGHT WRIST INIT FOR OPN FX

I69113

Psychomotor deficit following nontraumatic intracerebral hemorrhage

S62102A

FRACTURE OF UNSP CARPAL BONE LEFT WRIST INIT FOR CLOS FX

I69114

Frontal lobe and executive function deficit following nontraumatic intracerebral hemorrhage

S62102B

FRACTURE OF UNSP CARPAL BONE LEFT WRIST INIT FOR OPN FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69115

Cognitive social or emotional deficit following nontraumatic intracerebral hemorrhage

S62111A

DISP FX OF TRIQUETRUM BONE RIGHT WRIST INIT FOR CLOS FX

I69118

Other symptoms and signs involving cognitive functions following nontraumatic intracerebral hemorrhage

S62111B

DISP FX OF TRIQUETRUM BONE RIGHT WRIST INIT FOR OPN FX

I69119

Unspecified symptoms and signs involving cognitive functions following nontraumatic intracerebral hemorrhage

S62112A

DISP FX OF TRIQUETRUM BONE LEFT WRIST INIT FOR CLOS FX

I69120

APHASIA FOLLOWING NONTRAUMATIC INTRACEREBRAL HEMORRHAGE

S62112B

DISP FX OF TRIQUETRUM BONE LEFT WRIST INIT FOR OPN FX

I69121

DYSPHASIA FOLLOWING NONTRAUMATIC INTRACEREBRAL HEMORRHAGE

S62114A

NONDISP FX OF TRIQUETRUM BONE RIGHT WRIST INIT FOR CLOS FX

I69122

DYSARTHRIA FOLLOWING NONTRAUMATIC INTRACEREBRAL HEMORRHAGE

S62114B

NONDISP FX OF TRIQUETRUM BONE RIGHT WRIST INIT FOR OPN FX

I69123

FLUENCY DISORDER FOLLOWING NONTRAUMATIC INTCRBL HEMORRHAGE

S62115A

NONDISP FX OF TRIQUETRUM BONE LEFT WRIST INIT FOR CLOS FX

I69128

OTH SPEECH/LANG DEFICITS FOLLOWING NTRM INTCRBL HEMORRHAGE

S62115B

NONDISP FX OF TRIQUETRUM BONE LEFT WRIST INIT FOR OPN FX

I69131

MONOPLG UPR LMB FOL NTRM INTCRBL HEMOR AFF RIGHT DOM SIDE

S62121A

DISP FX OF LUNATE RIGHT WRIST INIT FOR CLOS FX

I69132

MONOPLG UPR LMB FOL NTRM INTCRBL HEMOR AFF LEFT DOM SIDE

S62121B

DISP FX OF LUNATE RIGHT WRIST INIT FOR OPN FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69133

MONOPLG UPR LMB FOL NTRM INTCRBL HEMOR AFF RIGHT NONDOM SIDE

S62164A

NONDISP FX OF PISIFORM RIGHT WRIST INIT FOR CLOS FX

I69134

MONOPLG UPR LMB FOL NTRM INTCRBL HEMOR AFF LEFT NONDOM SIDE

S62164B

NONDISP FX OF PISIFORM RIGHT WRIST INIT FOR OPN FX

I69139

MONOPLG UPR LMB FOLLOWING NTRM INTCRBL HEMOR AFF UNSP SIDE

S62165A

NONDISP FX OF PISIFORM LEFT WRIST INIT FOR CLOS FX

I69141

MONOPLG LOW LMB FOL NTRM INTCRBL HEMOR AFF RIGHT DOM SIDE

S62165B

NONDISP FX OF PISIFORM LEFT WRIST INIT FOR OPN FX

I69142

MONOPLG LOW LMB FOL NTRM INTCRBL HEMOR AFF LEFT DOM SIDE

S62171A

DISP FX OF TRAPEZIUM RIGHT WRIST INIT FOR CLOS FX

I69143

MONOPLG LOW LMB FOL NTRM INTCRBL HEMOR AFF RIGHT NONDOM SIDE

S62171B

DISP FX OF TRAPEZIUM RIGHT WRIST INIT FOR OPN FX

I69144

MONOPLG LOW LMB FOL NTRM INTCRBL HEMOR AFF LEFT NONDOM SIDE

S62172A

DISP FX OF TRAPEZIUM LEFT WRIST INIT FOR CLOS FX

I69149

MONOPLG LOW LMB FOLLOWING NTRM INTCRBL HEMOR AFF UNSP SIDE

S62172B

DISP FX OF TRAPEZIUM LEFT WRIST INIT FOR OPN FX

I69151

HEMIPLGA FOL NTRM INTCRBL HEMOR AFF RIGHT DOMINANT SIDE

S62174A

NONDISP FX OF TRAPEZIUM RIGHT WRIST INIT FOR CLOS FX

I69152

HEMIPLGA FOLLOWING NTRM INTCRBL HEMOR AFF LEFT DOMINANT SIDE

S62174B

NONDISP FX OF TRAPEZIUM RIGHT WRIST INIT FOR OPN FX

I69153

HEMIPLGA FOLLOWING NTRM INTCRBL HEMOR AFF RIGHT NONDOM SIDE

S62175A

NONDISP FX OF TRAPEZIUM LEFT WRIST INIT FOR CLOS FX

I69154

HEMIPLGA FOLLOWING NTRM INTCRBL HEMOR AFF LEFT NONDOM SIDE

S62175B

NONDISP FX OF TRAPEZIUM LEFT WRIST INIT FOR OPN FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69159

HEMIPLGA FOLLOWING NTRM INTCRBL HEMOR AFFECTING UNSP SIDE

S62181A

DISP FX OF TRAPEZOID RIGHT WRIST INIT FOR CLOS FX

I69161

OTH PARLYT SYND FOL NTRM INTCRBL HEMOR AFF RIGHT DOM SIDE

S62181B

DISP FX OF TRAPEZOID RIGHT WRIST INIT FOR OPN FX

I69162

OTH PARLYT SYNDROME FOL NTRM INTCRBL HEMOR AFF LEFT DOM SIDE

S62182A

DISP FX OF TRAPEZOID LEFT WRIST INIT FOR CLOS FX

I69163

OTH PARLYT SYND FOL NTRM INTCRBL HEMOR AFF RIGHT NONDOM SIDE

S62182B

DISP FX OF TRAPEZOID LEFT WRIST INIT FOR OPN FX

I69164

OTH PARLYT SYND FOL NTRM INTCRBL HEMOR AFF LEFT NONDOM SIDE

S62184A

NONDISP FX OF TRAPEZOID RIGHT WRIST INIT FOR CLOS FX

I69165

OTH PARALYTIC SYNDROME FOLLOWING NTRM INTCRBL HEMOR BI

S62184B

NONDISP FX OF TRAPEZOID RIGHT WRIST INIT FOR OPN FX

I69169

OTH PARALYTIC SYNDROME FOL NTRM INTCRBL HEMOR AFF UNSP SIDE

S62185A

NONDISP FX OF TRAPEZOID LEFT WRIST INIT FOR CLOS FX

I69190

APRAXIA FOLLOWING NONTRAUMATIC INTRACEREBRAL HEMORRHAGE

S62185B

NONDISP FX OF TRAPEZOID LEFT WRIST INIT FOR OPN FX

I69191

DYSPHAGIA FOLLOWING NONTRAUMATIC INTRACEREBRAL HEMORRHAGE

S62201A

UNSP FRACTURE OF FIRST METACARPAL BONE RIGHT HAND INIT

I69192

FACIAL WEAKNESS FOLLOWING NONTRAUMATIC INTCRBL HEMORRHAGE

S62201B

UNSP FX FIRST METACARPAL BONE RIGHT HAND INIT FOR OPN FX

I69193

ATAXIA FOLLOWING NONTRAUMATIC INTRACEREBRAL HEMORRHAGE

S62202A

UNSP FRACTURE OF FIRST METACARPAL BONE LEFT HAND INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69198

OTHER SEQUELAE OF NONTRAUMATIC INTRACEREBRAL HEMORRHAGE

S62202B

UNSP FX FIRST METACARPAL BONE LEFT HAND INIT FOR OPN FX

I6920

UNSP SEQUELAE OF OTHER NONTRAUMATIC INTRACRANIAL HEMORRHAGE

S62211A

BENNETT'S FRACTURE RIGHT HAND INIT FOR CLOS FX

I6921

COGNITIVE DEFICITS FOLLOWING OTH NTRM INTCRN HEMORRHAGE

S62211B

BENNETT'S FRACTURE RIGHT HAND INIT FOR OPN FX

I69210

Attention and concentration deficit following other nontraumatic intracranial hemorrhage

S62212A

BENNETT'S FRACTURE LEFT HAND INIT FOR CLOS FX

I69211

Memory deficit following other nontraumatic intracranial hemorrhage

S62212B

BENNETT'S FRACTURE LEFT HAND INIT ENCNTR FOR OPEN FRACTURE

I69212

Visuospatial deficit and spatial neglect following other nontraumatic intracranial hemorrhage

S62221A

DISPLACED ROLANDO'S FRACTURE RIGHT HAND INIT FOR CLOS FX

I69213

Psychomotor deficit following other nontraumatic intracranial hemorrhage

S62221B

DISPLACED ROLANDO'S FRACTURE RIGHT HAND INIT FOR OPN FX

I69214

Frontal lobe and executive function deficit following other nontraumatic intracranial hemorrhage

S62222A

DISPLACED ROLANDO'S FRACTURE LEFT HAND INIT FOR CLOS FX

I69215

Cognitive social or emotional deficit following other nontraumatic intracranial hemorrhage

S62222B

DISPLACED ROLANDO'S FRACTURE LEFT HAND INIT FOR OPN FX

I69218

Other symptoms and signs involving cognitive functions following other nontraumatic intracranial hemorrhage

S62224A

NONDISPLACED ROLANDO'S FRACTURE RIGHT HAND INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69219

Unspecified symptoms and signs involving cognitive functions following other nontraumatic intracranial hemorrhage

S62224B

NONDISPLACED ROLANDO'S FRACTURE RIGHT HAND INIT FOR OPN FX

I69220

APHASIA FOLLOWING OTHER NONTRAUMATIC INTRACRANIAL HEMORRHAGE

S62225A

NONDISPLACED ROLANDO'S FRACTURE LEFT HAND INIT FOR CLOS FX

I69221

DYSPHASIA FOLLOWING OTH NONTRAUMATIC INTRACRANIAL HEMORRHAGE

S62225B

NONDISPLACED ROLANDO'S FRACTURE LEFT HAND INIT FOR OPN FX

I69222

DYSARTHRIA FOLLOWING OTH NONTRAUMATIC INTCRN HEMORRHAGE

S62231A

OTH DISP FX OF BASE OF FIRST MC BONE RIGHT HAND INIT

I69223

FLUENCY DISORDER FOLLOWING OTH NTRM INTCRN HEMORRHAGE

S62231B

OTH DISP FX OF BASE OF 1ST MC BONE R HAND INIT FOR OPN FX

I69228

OTH SPEECH/LANG DEFICITS FOLLOWING OTH NTRM INTCRN HEMOR

S62232A

OTH DISP FX OF BASE OF FIRST MC BONE LEFT HAND INIT

I69231

MONOPLG UPR LMB FOL OTH NTRM INTCRN HEMOR AFF RIGHT DOM SIDE

S62232B

OTH DISP FX OF BASE OF 1ST MC BONE L HAND INIT FOR OPN FX

I69232

MONOPLG UPR LMB FOL OTH NTRM INTCRN HEMOR AFF LEFT DOM SIDE

S62233A

OTH DISP FX OF BASE OF FIRST MC BONE UNSP HAND INIT

I69233

MONOPLG UPR LMB FOL OTH NTRM INTCRN HEMOR AFF R NONDOM SIDE

S62233B

OTH DISP FX OF BASE OF 1ST MC BONE UNSP HAND 7THB

I69234

MONOPLG UPR LMB FOL OTH NTRM INTCRN HEMOR AFF L NONDOM SIDE

S62234A

OTH NONDISP FX OF BASE OF FIRST MC BONE RIGHT HAND INIT

I69239

MONOPLG UPR LMB FOL OTH NTRM INTCRN HEMOR AFF UNSP SIDE

S62234B

OTH NONDISP FX OF BASE OF 1ST MC BONE R HAND 7THB

I69241

MONOPLG LOW LMB FOL OTH NTRM INTCRN HEMOR AFF RIGHT DOM SIDE

S62235A

OTH NONDISP FX OF BASE OF FIRST MC BONE LEFT HAND INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69242

MONOPLG LOW LMB FOL OTH NTRM INTCRN HEMOR AFF LEFT DOM SIDE

S62235B

OTH NONDISP FX OF BASE OF 1ST MC BONE L HAND 7THB

I69243

MONOPLG LOW LMB FOL OTH NTRM INTCRN HEMOR AFF R NONDOM SIDE

S62241A

DISP FX OF SHAFT OF FIRST METACARPAL BONE RIGHT HAND INIT

I69244

MONOPLG LOW LMB FOL OTH NTRM INTCRN HEMOR AFF L NONDOM SIDE

S62241B

DISP FX OF SHAFT OF FIRST MC BONE R HAND INIT FOR OPN FX

I69249

MONOPLG LOW LMB FOL OTH NTRM INTCRN HEMOR AFF UNSP SIDE

S62242A

DISP FX OF SHAFT OF FIRST METACARPAL BONE LEFT HAND INIT

I69251

HEMIPLGA FOL OTH NTRM INTCRN HEMOR AFF RIGHT DOMINANT SIDE

S62242B

DISP FX OF SHAFT OF FIRST MC BONE L HAND INIT FOR OPN FX

I69252

HEMIPLGA FOL OTH NTRM INTCRN HEMOR AFF LEFT DOMINANT SIDE

S62244A

NONDISP FX OF SHAFT OF FIRST MC BONE RIGHT HAND INIT

I69253

HEMIPLGA FOL OTH NTRM INTCRN HEMOR AFF RIGHT NONDOM SIDE

S62244B

NONDISP FX OF SHAFT OF 1ST MC BONE R HAND INIT FOR OPN FX

I69254

HEMIPLGA FOL OTH NTRM INTCRN HEMOR AFF LEFT NONDOM SIDE

S62245A

NONDISP FX OF SHAFT OF FIRST MC BONE LEFT HAND INIT

I69259

HEMIPLGA FOLLOWING OTH NTRM INTCRN HEMOR AFFECTING UNSP SIDE

S62245B

NONDISP FX OF SHAFT OF 1ST MC BONE L HAND INIT FOR OPN FX

I69261

OTH PARLYT SYND FOL OTH NTRM INTCRN HEMOR AFF RIGHT DOM SIDE

S62251A

DISP FX OF NECK OF FIRST METACARPAL BONE RIGHT HAND INIT

I69262

OTH PARLYT SYND FOL OTH NTRM INTCRN HEMOR AFF LEFT DOM SIDE

S62251B

DISP FX OF NECK OF FIRST MC BONE R HAND INIT FOR OPN FX

I69263

OTH PARLYT SYND FOL OTH NTRM INTCRN HEMOR AFF R NONDOM SIDE

S62252A

DISP FX OF NECK OF FIRST METACARPAL BONE LEFT HAND INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69264

OTH PARLYT SYND FOL OTH NTRM INTCRN HEMOR AFF L NONDOM SIDE

S62252B

DISP FX OF NECK OF FIRST MC BONE LEFT HAND INIT FOR OPN FX

I69265

OTH PARALYTIC SYNDROME FOLLOWING OTH NTRM INTCRN HEMOR BI

S62253A

DISP FX OF NECK OF FIRST METACARPAL BONE UNSP HAND INIT

I69269

OTH PARLYT SYNDROME FOL OTH NTRM INTCRN HEMOR AFF UNSP SIDE

S62254A

NONDISP FX OF NECK OF FIRST MC BONE RIGHT HAND INIT

I69290

APRAXIA FOLLOWING OTHER NONTRAUMATIC INTRACRANIAL HEMORRHAGE

S62254B

NONDISP FX OF NECK OF FIRST MC BONE R HAND INIT FOR OPN FX

I69291

DYSPHAGIA FOLLOWING OTH NONTRAUMATIC INTRACRANIAL HEMORRHAGE

S62255A

NONDISP FX OF NECK OF FIRST METACARPAL BONE LEFT HAND INIT

I69292

FACIAL WEAKNESS FOLLOWING OTH NONTRAUMATIC INTCRN HEMORRHAGE

S62255B

NONDISP FX OF NECK OF FIRST MC BONE L HAND INIT FOR OPN FX

I69293

ATAXIA FOLLOWING OTHER NONTRAUMATIC INTRACRANIAL HEMORRHAGE

S62291A

OTH FRACTURE OF FIRST METACARPAL BONE RIGHT HAND INIT

I69298

OTHER SEQUELAE OF OTHER NONTRAUMATIC INTRACRANIAL HEMORRHAGE

S62291B

OTH FX FIRST METACARPAL BONE RIGHT HAND INIT FOR OPN FX

I6930 UNSPECIFIED SEQUELAE OF CEREBRAL INFARCTION

S62292A

OTH FRACTURE OF FIRST METACARPAL BONE LEFT HAND INIT

I6931

COGNITIVE DEFICITS FOLLOWING CEREBRAL INFARCTION

S62292B

OTH FX FIRST METACARPAL BONE LEFT HAND INIT FOR OPN FX

I69310

Attention and concentration deficit following cerebral infarction

S62300A

UNSP FRACTURE OF SECOND METACARPAL BONE RIGHT HAND INIT

I69311 Memory deficit following cerebral infarction

S62300B

UNSP FX SECOND METACARPAL BONE RIGHT HAND INIT FOR OPN FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69312

Visuospatial deficit and spatial neglect following cerebral infarction

S62301A

UNSP FRACTURE OF SECOND METACARPAL BONE LEFT HAND INIT

I69313 Psychomotor deficit following cerebral infarction

S62301B

UNSP FX SECOND METACARPAL BONE LEFT HAND INIT FOR OPN FX

I69314

Frontal lobe and executive function deficit following cerebral infarction

S62302A

UNSP FRACTURE OF THIRD METACARPAL BONE RIGHT HAND INIT

I69315

Cognitive social or emotional deficit following cerebral infarction

S62302B

UNSP FX THIRD METACARPAL BONE RIGHT HAND INIT FOR OPN FX

I69318

Other symptoms and signs involving cognitive functions following cerebral infarction

S62303A

UNSP FRACTURE OF THIRD METACARPAL BONE LEFT HAND INIT

I69319

Unspecified symptoms and signs involving cognitive functions following cerebral infarction

S62303B

UNSP FX THIRD METACARPAL BONE LEFT HAND INIT FOR OPN FX

I69320 APHASIA FOLLOWING CEREBRAL INFARCTION

S62304A

UNSP FRACTURE OF FOURTH METACARPAL BONE RIGHT HAND INIT

I69321 DYSPHASIA FOLLOWING CEREBRAL INFARCTION

S62304B

UNSP FX FOURTH METACARPAL BONE RIGHT HAND INIT FOR OPN FX

I69322 DYSARTHRIA FOLLOWING CEREBRAL INFARCTION

S62305A

UNSP FRACTURE OF FOURTH METACARPAL BONE LEFT HAND INIT

I69323

FLUENCY DISORDER FOLLOWING CEREBRAL INFARCTION

S62305B

UNSP FX FOURTH METACARPAL BONE LEFT HAND INIT FOR OPN FX

I69328

OTH SPEECH/LANG DEFICITS FOLLOWING CEREBRAL INFARCTION

S62306A

UNSP FRACTURE OF FIFTH METACARPAL BONE RIGHT HAND INIT

I69331

MONOPLG UPR LMB FOL CEREBRAL INFRC AFF RIGHT DOMINANT SIDE

S62306B

UNSP FX FIFTH METACARPAL BONE RIGHT HAND INIT FOR OPN FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69332

MONOPLG UPR LMB FOL CEREBRAL INFRC AFF LEFT DOMINANT SIDE

S62307A

UNSP FRACTURE OF FIFTH METACARPAL BONE LEFT HAND INIT

I69333

MONOPLG UPR LMB FOL CEREBRAL INFRC AFF RIGHT NONDOM SIDE

S62307B

UNSP FX FIFTH METACARPAL BONE LEFT HAND INIT FOR OPN FX

I69334

MONOPLG UPR LMB FOL CEREBRAL INFRC AFF LEFT NONDOM SIDE

S62310A

DISP FX OF BASE OF SECOND METACARPAL BONE RIGHT HAND INIT

I69339

MONOPLG UPR LMB FOLLOWING CEREBRAL INFRC AFFECTING UNSP SIDE

S62310B

DISP FX OF BASE OF SECOND MC BONE R HAND INIT FOR OPN FX

I69341

MONOPLG LOW LMB FOL CEREBRAL INFRC AFF RIGHT DOMINANT SIDE

S62311A

DISP FX OF BASE OF SECOND METACARPAL BONE. LEFT HAND INIT

I69342

MONOPLG LOW LMB FOL CEREBRAL INFRC AFF LEFT DOMINANT SIDE

S62311B

DISP FX OF BASE OF SECOND MC BONE. L HAND INIT FOR OPN FX

I69343

MONOPLG LOW LMB FOL CEREBRAL INFRC AFF RIGHT NONDOM SIDE

S62312A

DISP FX OF BASE OF THIRD METACARPAL BONE RIGHT HAND INIT

I69344

MONOPLG LOW LMB FOL CEREBRAL INFRC AFF LEFT NONDOM SIDE

S62312B

DISP FX OF BASE OF THIRD MC BONE R HAND INIT FOR OPN FX

I69349

MONOPLG LOW LMB FOLLOWING CEREBRAL INFRC AFFECTING UNSP SIDE

S62313A

DISP FX OF BASE OF THIRD METACARPAL BONE LEFT HAND INIT

I69351

HEMIPLGA FOLLOWING CEREBRAL INFRC AFF RIGHT DOMINANT SIDE

S62313B

DISP FX OF BASE OF THIRD MC BONE LEFT HAND INIT FOR OPN FX

I69352

HEMIPLGA FOLLOWING CEREBRAL INFRC AFF LEFT DOMINANT SIDE

S62314A

DISP FX OF BASE OF FOURTH METACARPAL BONE RIGHT HAND INIT

I69353

HEMIPLGA FOLLOWING CEREBRAL INFRC AFF RIGHT NONDOM SIDE

S62314B

DISP FX OF BASE OF FOURTH MC BONE R HAND INIT FOR OPN FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69354

HEMIPLGA FOLLOWING CEREBRAL INFRC AFFECTING LEFT NONDOM SIDE

S62315A

DISP FX OF BASE OF FOURTH METACARPAL BONE LEFT HAND INIT

I69359

HEMIPLGA FOLLOWING CEREBRAL INFARCTION AFFECTING UNSP SIDE

S62315B

DISP FX OF BASE OF FOURTH MC BONE L HAND INIT FOR OPN FX

I69361

OTH PARLYT SYNDROME FOL CEREB INFRC AFF RIGHT DOMINANT SIDE

S62316A

DISP FX OF BASE OF FIFTH METACARPAL BONE RIGHT HAND INIT

I69362

OTH PARLYT SYNDROME FOL CEREB INFRC AFF LEFT DOMINANT SIDE

S62316B

DISP FX OF BASE OF FIFTH MC BONE R HAND INIT FOR OPN FX

I69363

OTH PARLYT SYNDROME FOL CEREBRAL INFRC AFF RIGHT NONDOM SIDE

S62317A

DISP FX OF BASE OF FIFTH METACARPAL BONE. LEFT HAND INIT

I69364

OTH PARLYT SYNDROME FOL CEREBRAL INFRC AFF LEFT NONDOM SIDE

S62317B

DISP FX OF BASE OF FIFTH MC BONE. LEFT HAND INIT FOR OPN FX

I69365

OTH PARALYTIC SYNDROME FOLLOWING CEREBRAL INFRC BILATERAL

S62320A

DISP FX OF SHAFT OF SECOND METACARPAL BONE RIGHT HAND INIT

I69369

OTH PARALYTIC SYNDROME FOL CEREBRAL INFRC AFF UNSP SIDE

S62320B

DISP FX OF SHAFT OF SECOND MC BONE R HAND INIT FOR OPN FX

I69390 APRAXIA FOLLOWING CEREBRAL INFARCTION

S62321A

DISP FX OF SHAFT OF SECOND METACARPAL BONE LEFT HAND INIT

I69391 DYSPHAGIA FOLLOWING CEREBRAL INFARCTION

S62321B

DISP FX OF SHAFT OF SECOND MC BONE L HAND INIT FOR OPN FX

I69392 FACIAL WEAKNESS FOLLOWING CEREBRAL INFARCTION

S62322A

DISP FX OF SHAFT OF THIRD METACARPAL BONE RIGHT HAND INIT

I69393 ATAXIA FOLLOWING CEREBRAL INFARCTION

S62322B

DISP FX OF SHAFT OF THIRD MC BONE R HAND INIT FOR OPN FX

I69398 OTHER SEQUELAE OF CEREBRAL INFARCTION

S62323A

DISP FX OF SHAFT OF THIRD METACARPAL BONE LEFT HAND INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I6980

UNSPECIFIED SEQUELAE OF OTHER CEREBROVASCULAR DISEASE

S62323B

DISP FX OF SHAFT OF THIRD MC BONE L HAND INIT FOR OPN FX

I6981

COGNITIVE DEFICITS FOLLOWING OTHER CEREBROVASCULAR DISEASE

S62324A

DISP FX OF SHAFT OF FOURTH METACARPAL BONE RIGHT HAND INIT

I69810

Attention and concentration deficit following other cerebrovascular disease

S62324B

DISP FX OF SHAFT OF FOURTH MC BONE R HAND INIT FOR OPN FX

I69811 Memory deficit following other cerebrovascular disease

S62325A

DISP FX OF SHAFT OF FOURTH METACARPAL BONE LEFT HAND INIT

I69812

Visuospatial deficit and spatial neglect following other cerebrovascular disease

S62325B

DISP FX OF SHAFT OF FOURTH MC BONE L HAND INIT FOR OPN FX

I69813 Psychomotor deficit following other cerebrovascular disease

S62326A

DISP FX OF SHAFT OF FIFTH METACARPAL BONE RIGHT HAND INIT

I69814

Frontal lobe and executive function deficit following other cerebrovascular disease

S62326B

DISP FX OF SHAFT OF FIFTH MC BONE R HAND INIT FOR OPN FX

I69815

Cognitive social or emotional deficit following other cerebrovascular disease

S62327A

DISP FX OF SHAFT OF FIFTH METACARPAL BONE LEFT HAND INIT

I69818

Other symptoms and signs involving cognitive functions following other cerebrovascular disease

S62327B

DISP FX OF SHAFT OF FIFTH MC BONE L HAND INIT FOR OPN FX

I69819

Unspecified symptoms and signs involving cognitive functions following other cerebrovascular disease

S62330A

DISP FX OF NECK OF SECOND METACARPAL BONE RIGHT HAND INIT

I69820 APHASIA FOLLOWING OTHER CEREBROVASCULAR DISEASE

S62330B

DISP FX OF NECK OF SECOND MC BONE R HAND INIT FOR OPN FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69821 DYSPHASIA FOLLOWING OTHER CEREBROVASCULAR DISEASE

S62331A

DISP FX OF NECK OF SECOND METACARPAL BONE LEFT HAND INIT

I69822

DYSARTHRIA FOLLOWING OTHER CEREBROVASCULAR DISEASE

S62331B

DISP FX OF NECK OF SECOND MC BONE L HAND INIT FOR OPN FX

I69823

FLUENCY DISORDER FOLLOWING OTHER CEREBROVASCULAR DISEASE

S62332A

DISP FX OF NECK OF THIRD METACARPAL BONE RIGHT HAND INIT

I69828

OTH SPEECH/LANG DEFICITS FOLLOWING OTH CEREBVASC DISEASE

S62332B

DISP FX OF NECK OF THIRD MC BONE R HAND INIT FOR OPN FX

I69831

MONOPLG UPR LMB FOL OTH CEREBVASC DISEASE AFF RIGHT DOM SIDE

S62333A

DISP FX OF NECK OF THIRD METACARPAL BONE LEFT HAND INIT

I69832

MONOPLG UPR LMB FOL OTH CEREBVASC DISEASE AFF LEFT DOM SIDE

S62333B

DISP FX OF NECK OF THIRD MC BONE LEFT HAND INIT FOR OPN FX

I69833

MONOPLG UPR LMB FOL OTH CEREBVASC DIS AFF RIGHT NONDOM SIDE

S62334A

DISP FX OF NECK OF FOURTH METACARPAL BONE RIGHT HAND INIT

I69834

MONOPLG UPR LMB FOL OTH CEREBVASC DIS AFF LEFT NONDOM SIDE

S62334B

DISP FX OF NECK OF FOURTH MC BONE R HAND INIT FOR OPN FX

I69839

MONOPLG UPR LMB FOL OTH CEREBVASC DISEASE AFF UNSP SIDE

S62335A

DISP FX OF NECK OF FOURTH METACARPAL BONE LEFT HAND INIT

I69841

MONOPLG LOW LMB FOL OTH CEREBVASC DISEASE AFF RIGHT DOM SIDE

S62335B

DISP FX OF NECK OF FOURTH MC BONE L HAND INIT FOR OPN FX

I69842

MONOPLG LOW LMB FOL OTH CEREBVASC DISEASE AFF LEFT DOM SIDE

S62336A

DISP FX OF NECK OF FIFTH METACARPAL BONE RIGHT HAND INIT

I69843

MONOPLG LOW LMB FOL OTH CEREBVASC DIS AFF RIGHT NONDOM SIDE

S62336B

DISP FX OF NECK OF FIFTH MC BONE R HAND INIT FOR OPN FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69844

MONOPLG LOW LMB FOL OTH CEREBVASC DIS AFF LEFT NONDOM SIDE

S62337A

DISP FX OF NECK OF FIFTH METACARPAL BONE LEFT HAND INIT

I69849

MONOPLG LOW LMB FOL OTH CEREBVASC DISEASE AFF UNSP SIDE

S62337B

DISP FX OF NECK OF FIFTH MC BONE LEFT HAND INIT FOR OPN FX

I69851

HEMIPLGA FOL OTH CEREBVASC DISEASE AFF RIGHT DOMINANT SIDE

S62340A

NONDISP FX OF BASE OF SECOND MC BONE RIGHT HAND INIT

I69852

HEMIPLGA FOL OTH CEREBVASC DISEASE AFF LEFT DOMINANT SIDE

S62340B

NONDISP FX OF BASE OF 2ND MC BONE R HAND INIT FOR OPN FX

I69853

HEMIPLGA FOL OTH CEREBVASC DISEASE AFF RIGHT NONDOM SIDE

S62341A

NONDISP FX OF BASE OF SECOND MC BONE. LEFT HAND INIT

I69854

HEMIPLGA FOL OTH CEREBVASC DISEASE AFF LEFT NONDOM SIDE

S62341B

NONDISP FX OF BASE OF 2ND MC BONE. L HAND INIT FOR OPN FX

I69859

HEMIPLGA FOLLOWING OTH CEREBVASC DISEASE AFFECTING UNSP SIDE

S62342A

NONDISP FX OF BASE OF THIRD MC BONE RIGHT HAND INIT

I69861

OTH PARLYT SYND FOL OTH CEREBVASC DISEASE AFF RIGHT DOM SIDE

S62342B

NONDISP FX OF BASE OF THIRD MC BONE R HAND INIT FOR OPN FX

I69862

OTH PARLYT SYND FOL OTH CEREBVASC DISEASE AFF LEFT DOM SIDE

S62343A

NONDISP FX OF BASE OF THIRD METACARPAL BONE LEFT HAND INIT

I69863

OTH PARLYT SYND FOL OTH CEREBVASC DIS AFF RIGHT NONDOM SIDE

S62343B

NONDISP FX OF BASE OF THIRD MC BONE L HAND INIT FOR OPN FX

I69864

OTH PARLYT SYND FOL OTH CEREBVASC DIS AFF LEFT NONDOM SIDE

S62344A

NONDISP FX OF BASE OF FOURTH MC BONE RIGHT HAND INIT

I69865

OTH PARALYTIC SYNDROME FOLLOWING OTH CEREBVASC DISEASE BI

S62344B

NONDISP FX OF BASE OF 4TH MC BONE R HAND INIT FOR OPN FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69869

OTH PARLYT SYNDROME FOL OTH CEREBVASC DISEASE AFF UNSP SIDE

S62345A

NONDISP FX OF BASE OF FOURTH MC BONE LEFT HAND INIT

I69890 APRAXIA FOLLOWING OTHER CEREBROVASCULAR DISEASE

S62345B

NONDISP FX OF BASE OF 4TH MC BONE L HAND INIT FOR OPN FX

I69891 DYSPHAGIA FOLLOWING OTHER CEREBROVASCULAR DISEASE

S62346A

NONDISP FX OF BASE OF FIFTH MC BONE RIGHT HAND INIT

I69892

FACIAL WEAKNESS FOLLOWING OTHER CEREBROVASCULAR DISEASE

S62346B

NONDISP FX OF BASE OF FIFTH MC BONE R HAND INIT FOR OPN FX

I69893 ATAXIA FOLLOWING OTHER CEREBROVASCULAR DISEASE

S62347A

NONDISP FX OF BASE OF FIFTH METACARPAL BONE. LEFT HAND INIT

I69898 OTHER SEQUELAE OF OTHER CEREBROVASCULAR DISEASE

S62347B

NONDISP FX OF BASE OF FIFTH MC BONE. L HAND INIT FOR OPN FX

I6990

UNSPECIFIED SEQUELAE OF UNSPECIFIED CEREBROVASCULAR DISEASE

S62350A

NONDISP FX OF SHAFT OF SECOND MC BONE RIGHT HAND INIT

I6991

COGNITIVE DEFICITS FOLLOWING UNSP CEREBROVASCULAR DISEASE

S62350B

NONDISP FX OF SHAFT OF 2ND MC BONE R HAND INIT FOR OPN FX

I69910

Attention and concentration deficit following unspecified cerebrovascular disease

S62351A

NONDISP FX OF SHAFT OF SECOND MC BONE LEFT HAND INIT

I69911

Memory deficit following unspecified cerebrovascular disease

S62351B

NONDISP FX OF SHAFT OF 2ND MC BONE L HAND INIT FOR OPN FX

I69912

Visuospatial deficit and spatial neglect following unspecified cerebrovascular disease

S62352A

NONDISP FX OF SHAFT OF THIRD MC BONE RIGHT HAND INIT

I69913

Psychomotor deficit following unspecified cerebrovascular disease

S62352B

NONDISP FX OF SHAFT OF 3RD MC BONE R HAND INIT FOR OPN FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69914

Frontal lobe and executive function deficit following unspecified cerebrovascular disease

S62353A

NONDISP FX OF SHAFT OF THIRD MC BONE LEFT HAND INIT

I69915

Cognitive social or emotional deficit following unspecified cerebrovascular disease

S62353B

NONDISP FX OF SHAFT OF 3RD MC BONE L HAND INIT FOR OPN FX

I69918

Other symptoms and signs involving cognitive functions following unspecified cerebrovascular disease

S62354A

NONDISP FX OF SHAFT OF FOURTH MC BONE RIGHT HAND INIT

I69919

Unspecified symptoms and signs involving cognitive functions following unspecified cerebrovascular disease

S62354B

NONDISP FX OF SHAFT OF 4TH MC BONE R HAND INIT FOR OPN FX

I69920

APHASIA FOLLOWING UNSPECIFIED CEREBROVASCULAR DISEASE

S62355A

NONDISP FX OF SHAFT OF FOURTH MC BONE LEFT HAND INIT

I69921

DYSPHASIA FOLLOWING UNSPECIFIED CEREBROVASCULAR DISEASE

S62355B

NONDISP FX OF SHAFT OF 4TH MC BONE L HAND INIT FOR OPN FX

I69922

DYSARTHRIA FOLLOWING UNSPECIFIED CEREBROVASCULAR DISEASE

S62356A

NONDISP FX OF SHAFT OF FIFTH MC BONE RIGHT HAND INIT

I69923

FLUENCY DISORDER FOLLOWING UNSP CEREBROVASCULAR DISEASE

S62356B

NONDISP FX OF SHAFT OF 5TH MC BONE R HAND INIT FOR OPN FX

I69928

OTH SPEECH/LANG DEFICITS FOLLOWING UNSP CEREBVASC DISEASE

S62357A

NONDISP FX OF SHAFT OF FIFTH MC BONE LEFT HAND INIT

I69931

MONOPLG UPR LMB FOL UNSP CEREBVASC DIS AFF RIGHT DOM SIDE

S62357B

NONDISP FX OF SHAFT OF 5TH MC BONE L HAND INIT FOR OPN FX

I69932

MONOPLG UPR LMB FOL UNSP CEREBVASC DISEASE AFF LEFT DOM SIDE

S62360A

NONDISP FX OF NECK OF SECOND MC BONE RIGHT HAND INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69933

MONOPLG UPR LMB FOL UNSP CEREBVASC DIS AFF RIGHT NONDOM SIDE

S62360B

NONDISP FX OF NECK OF 2ND MC BONE R HAND INIT FOR OPN FX

I69934

MONOPLG UPR LMB FOL UNSP CEREBVASC DIS AFF LEFT NONDOM SIDE

S62361A

NONDISP FX OF NECK OF SECOND MC BONE LEFT HAND INIT

I69939

MONOPLG UPR LMB FOL UNSP CEREBVASC DISEASE AFF UNSP SIDE

S62361B

NONDISP FX OF NECK OF 2ND MC BONE L HAND INIT FOR OPN FX

I69941

MONOPLG LOW LMB FOL UNSP CEREBVASC DIS AFF RIGHT DOM SIDE

S62362A

NONDISP FX OF NECK OF THIRD MC BONE RIGHT HAND INIT

I69942

MONOPLG LOW LMB FOL UNSP CEREBVASC DISEASE AFF LEFT DOM SIDE

S62362B

NONDISP FX OF NECK OF THIRD MC BONE R HAND INIT FOR OPN FX

I69943

MONOPLG LOW LMB FOL UNSP CEREBVASC DIS AFF RIGHT NONDOM SIDE

S62363A

NONDISP FX OF NECK OF THIRD METACARPAL BONE LEFT HAND INIT

I69944

MONOPLG LOW LMB FOL UNSP CEREBVASC DIS AFF LEFT NONDOM SIDE

S62363B

NONDISP FX OF NECK OF THIRD MC BONE L HAND INIT FOR OPN FX

I69949

MONOPLG LOW LMB FOL UNSP CEREBVASC DISEASE AFF UNSP SIDE

S62364A

NONDISP FX OF NECK OF FOURTH MC BONE RIGHT HAND INIT

I69951

HEMIPLGA FOL UNSP CEREBVASC DISEASE AFF RIGHT DOMINANT SIDE

S62364B

NONDISP FX OF NECK OF 4TH MC BONE R HAND INIT FOR OPN FX

I69952

HEMIPLGA FOL UNSP CEREBVASC DISEASE AFF LEFT DOMINANT SIDE

S62365A

NONDISP FX OF NECK OF FOURTH MC BONE LEFT HAND INIT

I69953

HEMIPLGA FOL UNSP CEREBVASC DISEASE AFF RIGHT NONDOM SIDE

S62365B

NONDISP FX OF NECK OF 4TH MC BONE L HAND INIT FOR OPN FX

I69954

HEMIPLGA FOL UNSP CEREBVASC DISEASE AFF LEFT NONDOM SIDE

S62366A

NONDISP FX OF NECK OF FIFTH MC BONE RIGHT HAND INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I69959

HEMIPLGA FOLLOWING UNSP CEREBVASC DISEASE AFF UNSP SIDE

S62366B

NONDISP FX OF NECK OF FIFTH MC BONE R HAND INIT FOR OPN FX

I69961

OTH PARLYT SYND FOL UNSP CEREBVASC DIS AFF RIGHT DOM SIDE

S62367A

NONDISP FX OF NECK OF FIFTH METACARPAL BONE LEFT HAND INIT

I69962

OTH PARLYT SYND FOL UNSP CEREBVASC DISEASE AFF LEFT DOM SIDE

S62367B

NONDISP FX OF NECK OF FIFTH MC BONE L HAND INIT FOR OPN FX

I69963

OTH PARLYT SYND FOL UNSP CEREBVASC DIS AFF RIGHT NONDOM SIDE

S62390A

OTH FRACTURE OF SECOND METACARPAL BONE RIGHT HAND INIT

I69964

OTH PARLYT SYND FOL UNSP CEREBVASC DIS AFF LEFT NONDOM SIDE

S62390B

OTH FX SECOND METACARPAL BONE RIGHT HAND INIT FOR OPN FX

I69965

OTH PARALYTIC SYNDROME FOLLOWING UNSP CEREBVASC DISEASE BI

S62391A

OTH FRACTURE OF SECOND METACARPAL BONE LEFT HAND INIT

I69969

OTH PARLYT SYNDROME FOL UNSP CEREBVASC DISEASE AFF UNSP SIDE

S62391B

OTH FX SECOND METACARPAL BONE LEFT HAND INIT FOR OPN FX

I69990

APRAXIA FOLLOWING UNSPECIFIED CEREBROVASCULAR DISEASE

S62392A

OTH FRACTURE OF THIRD METACARPAL BONE RIGHT HAND INIT

I69991

DYSPHAGIA FOLLOWING UNSPECIFIED CEREBROVASCULAR DISEASE

S62392B

OTH FX THIRD METACARPAL BONE RIGHT HAND INIT FOR OPN FX

I69992

FACIAL WEAKNESS FOLLOWING UNSP CEREBROVASCULAR DISEASE

S62393A

OTH FRACTURE OF THIRD METACARPAL BONE LEFT HAND INIT

I69993

ATAXIA FOLLOWING UNSPECIFIED CEREBROVASCULAR DISEASE

S62393B

OTH FX THIRD METACARPAL BONE LEFT HAND INIT FOR OPN FX

I69998

OTHER SEQUELAE FOLLOWING UNSPECIFIED CEREBROVASCULAR DISEASE

S62394A

OTH FRACTURE OF FOURTH METACARPAL BONE RIGHT HAND INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I7092 CHRONIC TOTAL OCCLUSION OF ARTERY OF THE EXTREMITIES

S62394B

OTH FX FOURTH METACARPAL BONE RIGHT HAND INIT FOR OPN FX

I7100 DISSECTION OF UNSPECIFIED SITE OF AORTA

S62395A

OTH FRACTURE OF FOURTH METACARPAL BONE LEFT HAND INIT

I7101 DISSECTION OF THORACIC AORTA

S62395B

OTH FX FOURTH METACARPAL BONE LEFT HAND INIT FOR OPN FX

I7102 DISSECTION OF ABDOMINAL AORTA

S62396A

OTH FRACTURE OF FIFTH METACARPAL BONE RIGHT HAND INIT

I7103 DISSECTION OF THORACOABDOMINAL AORTA

S62396B

OTH FX FIFTH METACARPAL BONE RIGHT HAND INIT FOR OPN FX

I711 THORACIC AORTIC ANEURYSM RUPTURED

S62397A

OTH FRACTURE OF FIFTH METACARPAL BONE LEFT HAND INIT

I713 ABDOMINAL AORTIC ANEURYSM RUPTURED

S62397B

OTH FX FIFTH METACARPAL BONE LEFT HAND INIT FOR OPN FX

I715 THORACOABDOMINAL AORTIC ANEURYSM RUPTURED

S62501A

FRACTURE OF UNSP PHALANX OF RIGHT THUMB INIT FOR CLOS FX

I718 AORTIC ANEURYSM OF UNSPECIFIED SITE RUPTURED

S62501B

FRACTURE OF UNSP PHALANX OF RIGHT THUMB INIT FOR OPN FX

I719

AORTIC ANEURYSM OF UNSPECIFIED SITE WITHOUT RUPTURE

S62502A

FRACTURE OF UNSP PHALANX OF LEFT THUMB INIT FOR CLOS FX

I720 ANEURYSM OF CAROTID ARTERY

S62502B

FRACTURE OF UNSP PHALANX OF LEFT THUMB INIT FOR OPN FX

I721 ANEURYSM OF ARTERY OF UPPER EXTREMITY

S62511A

DISP FX OF PROXIMAL PHALANX OF RIGHT THUMB INIT FOR CLOS FX

I722 ANEURYSM OF RENAL ARTERY

S62511B DISP FX OF PROXIMAL PHALANX OF RIGHT THUMB INIT FOR OPN FX

I723 ANEURYSM OF ILIAC ARTERY

S62512A DISP FX OF PROXIMAL PHALANX OF LEFT THUMB INIT FOR CLOS FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I724 ANEURYSM OF ARTERY OF LOWER EXTREMITY

S62512B

DISP FX OF PROXIMAL PHALANX OF LEFT THUMB INIT FOR OPN FX

I725 Aneurysm of other precerebral arteries

S62514A

NONDISP FX OF PROXIMAL PHALANX OF RIGHT THUMB INIT

I726 Aneurysm of vertebral artery

S62514B NONDISP FX OF PROXIMAL PHALANX OF R THM INIT FOR OPN FX

I728 ANEURYSM OF OTHER SPECIFIED ARTERIES

S62515A

NONDISP FX OF PROXIMAL PHALANX OF LEFT THUMB INIT

I729 ANEURYSM OF UNSPECIFIED SITE

S62515B

NONDISP FX OF PROXIMAL PHALANX OF L THM INIT FOR OPN FX

I7300 RAYNAUD'S SYNDROME WITHOUT GANGRENE

S62521A

DISP FX OF DISTAL PHALANX OF RIGHT THUMB INIT FOR CLOS FX

I7301 RAYNAUD'S SYNDROME WITH GANGRENE

S62521B

DISP FX OF DISTAL PHALANX OF RIGHT THUMB INIT FOR OPN FX

I731

THROMBOANGIITIS OBLITERANS [BUERGER'S DISEASE]

S62522A

DISP FX OF DISTAL PHALANX OF LEFT THUMB INIT FOR CLOS FX

I7381 ERYTHROMELALGIA

S62522B DISP FX OF DISTAL PHALANX OF LEFT THUMB INIT FOR OPN FX

I7389 OTHER SPECIFIED PERIPHERAL VASCULAR DISEASES

S62524A

NONDISP FX OF DISTAL PHALANX OF RIGHT THUMB INIT

I739 PERIPHERAL VASCULAR DISEASE UNSPECIFIED

S62524B

NONDISP FX OF DISTAL PHALANX OF RIGHT THUMB INIT FOR OPN FX

I7410

EMBOLISM AND THROMBOSIS OF UNSPECIFIED PARTS OF AORTA

S62525A

NONDISP FX OF DISTAL PHALANX OF LEFT THUMB INIT FOR CLOS FX

I7411 EMBOLISM AND THROMBOSIS OF THORACIC AORTA

S62525B

NONDISP FX OF DISTAL PHALANX OF LEFT THUMB INIT FOR OPN FX

I7419 EMBOLISM AND THROMBOSIS OF OTHER PARTS OF AORTA

S62600A

FRACTURE OF UNSP PHALANX OF RIGHT INDEX FINGER INIT

I742

EMBOLISM AND THROMBOSIS OF ARTERIES OF THE UPPER EXTREMITIES

S62600B

FRACTURE OF UNSP PHALANX OF R IDX FNGR INIT FOR OPN FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I743

EMBOLISM AND THROMBOSIS OF ARTERIES OF THE LOWER EXTREMITIES

S62601A

FRACTURE OF UNSP PHALANX OF LEFT INDEX FINGER INIT

I744

EMBOLISM AND THROMBOSIS OF ARTERIES OF EXTREMITIES UNSP

S62601B

FRACTURE OF UNSP PHALANX OF L IDX FNGR INIT FOR OPN FX

I745 EMBOLISM AND THROMBOSIS OF ILIAC ARTERY

S62602A

FRACTURE OF UNSP PHALANX OF RIGHT MIDDLE FINGER INIT

I748 EMBOLISM AND THROMBOSIS OF OTHER ARTERIES

S62602B

FRACTURE OF UNSP PHALANX OF R MID FINGER INIT FOR OPN FX

I749 EMBOLISM AND THROMBOSIS OF UNSPECIFIED ARTERY

S62603A

FRACTURE OF UNSP PHALANX OF LEFT MIDDLE FINGER INIT

I75011 ATHEROEMBOLISM OF RIGHT UPPER EXTREMITY

S62603B

FRACTURE OF UNSP PHALANX OF L MID FINGER INIT FOR OPN FX

I75012 ATHEROEMBOLISM OF LEFT UPPER EXTREMITY

S62604A

FRACTURE OF UNSP PHALANX OF RIGHT RING FINGER INIT

I75013 ATHEROEMBOLISM OF BILATERAL UPPER EXTREMITIES

S62604B

FRACTURE OF UNSP PHALANX OF R RNG FNGR INIT FOR OPN FX

I75019 ATHEROEMBOLISM OF UNSPECIFIED UPPER EXTREMITY

S62605A

FRACTURE OF UNSP PHALANX OF LEFT RING FINGER INIT

I75021 ATHEROEMBOLISM OF RIGHT LOWER EXTREMITY

S62605B

FRACTURE OF UNSP PHALANX OF L RNG FNGR INIT FOR OPN FX

I75022 ATHEROEMBOLISM OF LEFT LOWER EXTREMITY

S62606A

FRACTURE OF UNSP PHALANX OF RIGHT LITTLE FINGER INIT

I75023 ATHEROEMBOLISM OF BILATERAL LOWER EXTREMITIES

S62606B

FRACTURE OF UNSP PHALANX OF R LITTLE FINGER INIT FOR OPN FX

I75029

ATHEROEMBOLISM OF UNSPECIFIED LOWER EXTREMITY

S62607A

FRACTURE OF UNSP PHALANX OF LEFT LITTLE FINGER INIT

I7581 ATHEROEMBOLISM OF KIDNEY

S62607B FRACTURE OF UNSP PHALANX OF L LITTLE FINGER INIT FOR OPN FX

I7589 ATHEROEMBOLISM OF OTHER SITE

S62610A

DISP FX OF PROXIMAL PHALANX OF RIGHT INDEX FINGER INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I76 SEPTIC ARTERIAL EMBOLISM

S62610B DISP FX OF PROXIMAL PHALANX OF R IDX FNGR INIT FOR OPN FX

I770 ARTERIOVENOUS FISTULA ACQUIRED

S62611A

DISP FX OF PROXIMAL PHALANX OF LEFT INDEX FINGER INIT

I771 STRICTURE OF ARTERY

S62611B DISP FX OF PROXIMAL PHALANX OF L IDX FNGR INIT FOR OPN FX

I772 RUPTURE OF ARTERY

S62612A DISP FX OF PROXIMAL PHALANX OF RIGHT MIDDLE FINGER INIT

I773 ARTERIAL FIBROMUSCULAR DYSPLASIA

S62612B

DISP FX OF PROXIMAL PHALANX OF R MID FINGER INIT FOR OPN FX

I774 CELIAC ARTERY COMPRESSION SYNDROME

S62613A

DISP FX OF PROXIMAL PHALANX OF LEFT MIDDLE FINGER INIT

I775 NECROSIS OF ARTERY

S62613B DISP FX OF PROXIMAL PHALANX OF L MID FINGER INIT FOR OPN FX

I776 ARTERITIS UNSPECIFIED

S62614A DISP FX OF PROXIMAL PHALANX OF RIGHT RING FINGER INIT

I7770 Dissection of unspecified artery

S62614B DISP FX OF PROXIMAL PHALANX OF R RNG FNGR INIT FOR OPN FX

I7771 DISSECTION OF CAROTID ARTERY

S62615A

DISP FX OF PROXIMAL PHALANX OF LEFT RING FINGER INIT

I7772 DISSECTION OF ILIAC ARTERY

S62615B DISP FX OF PROXIMAL PHALANX OF L RNG FNGR INIT FOR OPN FX

I7773 DISSECTION OF RENAL ARTERY

S62616A DISP FX OF PROXIMAL PHALANX OF RIGHT LITTLE FINGER INIT

I7774 DISSECTION OF VERTEBRAL ARTERY

S62616B

DISP FX OF PROX PHALANX OF R LITTLE FINGER INIT FOR OPN FX

I7775 Dissection of other precerebral arteries

S62617A

DISP FX OF PROXIMAL PHALANX OF LEFT LITTLE FINGER INIT

I7776 Dissection of artery of upper extremity

S62617B

DISP FX OF PROX PHALANX OF L LITTLE FINGER INIT FOR OPN FX

I7777 Dissection of artery of lower extremity

S62620A

DISP FX OF MEDIAL PHALANX OF RIGHT INDEX FINGER INIT

I7779 DISSECTION OF OTHER ARTERY

S62620B DISP FX OF MEDIAL PHALANX OF R IDX FNGR INIT FOR OPN FX

I77810 THORACIC AORTIC ECTASIA

S62621A DISP FX OF MEDIAL PHALANX OF LEFT INDEX FINGER INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I77811 ABDOMINAL AORTIC ECTASIA

S62621B DISP FX OF MEDIAL PHALANX OF L IDX FNGR INIT FOR OPN FX

I77812 THORACOABDOMINAL AORTIC ECTASIA

S62622A

DISP FX OF MEDIAL PHALANX OF RIGHT MIDDLE FINGER INIT

I77819 AORTIC ECTASIA UNSPECIFIED SITE

S62622B

DISP FX OF MEDIAL PHALANX OF R MID FINGER INIT FOR OPN FX

I7789 OTHER SPECIFIED DISORDERS OF ARTERIES AND ARTERIOLES

S62623A

DISP FX OF MEDIAL PHALANX OF LEFT MIDDLE FINGER INIT

I779 DISORDER OF ARTERIES AND ARTERIOLES UNSPECIFIED

S62623B

DISP FX OF MEDIAL PHALANX OF L MID FINGER INIT FOR OPN FX

I780 HEREDITARY HEMORRHAGIC TELANGIECTASIA

S62624A

DISP FX OF MEDIAL PHALANX OF RIGHT RING FINGER INIT

I781 NEVUS NON-NEOPLASTIC

S62624B DISP FX OF MEDIAL PHALANX OF R RNG FNGR INIT FOR OPN FX

I788 OTHER DISEASES OF CAPILLARIES

S62625A

DISP FX OF MEDIAL PHALANX OF LEFT RING FINGER INIT

I789 DISEASE OF CAPILLARIES UNSPECIFIED

S62625B

DISP FX OF MEDIAL PHALANX OF L RNG FNGR INIT FOR OPN FX

I790

ANEURYSM OF AORTA IN DISEASES CLASSIFIED ELSEWHERE

S62626A

DISP FX OF MEDIAL PHALANX OF RIGHT LITTLE FINGER INIT

I791 AORTITIS IN DISEASES CLASSIFIED ELSEWHERE

S62626B

DISP FX OF MEDIAL PHALANX OF R LITTLE FNGR INIT FOR OPN FX

I798

OTH DISORD OF ARTARTERIOLES & CAPILARE IN DIS CLASSD ELSWHR

S62627A

DISP FX OF MEDIAL PHALANX OF LEFT LITTLE FINGER INIT

I8000

PHLBTS AND THOMBOPHLB OF SUPERFIC VESSELS OF UNSP LOW EXTRM

S62627B

DISP FX OF MEDIAL PHALANX OF L LITTLE FNGR INIT FOR OPN FX

I8001

PHLEBITIS AND THOMBOPHLB OF SUPERFIC VESSELS OF R LOW EXTREM

S62630A

DISP FX OF DISTAL PHALANX OF RIGHT INDEX FINGER INIT

I8002

PHLEBITIS AND THOMBOPHLB OF SUPERFIC VESSELS OF L LOW EXTREM

S62630B

DISP FX OF DISTAL PHALANX OF R IDX FNGR INIT FOR OPN FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I8003

PHLBTS AND THOMBOPHLB OF SUPERFIC VESSELS OF LOW EXTRM BI

S62631A

DISP FX OF DISTAL PHALANX OF LEFT INDEX FINGER INIT

I8010

PHLEBITIS AND THROMBOPHLEBITIS OF UNSPECIFIED FEMORAL VEIN

S62631B

DISP FX OF DISTAL PHALANX OF L IDX FNGR INIT FOR OPN FX

I8011

PHLEBITIS AND THROMBOPHLEBITIS OF RIGHT FEMORAL VEIN

S62632A

DISP FX OF DISTAL PHALANX OF RIGHT MIDDLE FINGER INIT

I8012

PHLEBITIS AND THROMBOPHLEBITIS OF LEFT FEMORAL VEIN

S62632B

DISP FX OF DISTAL PHALANX OF R MID FINGER INIT FOR OPN FX

I8013

PHLEBITIS AND THROMBOPHLEBITIS OF FEMORAL VEIN BILATERAL

S62633A

DISP FX OF DISTAL PHALANX OF LEFT MIDDLE FINGER INIT

I80201

PHLBTS AND THOMBOPHLB OF UNSP DEEP VESSELS OF R LOW EXTREM

S62633B

DISP FX OF DISTAL PHALANX OF L MID FINGER INIT FOR OPN FX

I80202

PHLBTS AND THOMBOPHLB OF UNSP DEEP VESSELS OF L LOW EXTREM

S62634A

DISP FX OF DISTAL PHALANX OF RIGHT RING FINGER INIT

I80203

PHLBTS AND THOMBOPHLB OF UNSP DEEP VESSELS OF LOW EXTRM BI

S62634B

DISP FX OF DISTAL PHALANX OF R RNG FNGR INIT FOR OPN FX

I80209

PHLBTS AND THOMBOPHLB OF UNSP DEEP VESSELS OF UNSP LOW EXTRM

S62635A

DISP FX OF DISTAL PHALANX OF LEFT RING FINGER INIT

I80211

PHLEBITIS AND THROMBOPHLEBITIS OF RIGHT ILIAC VEIN

S62635B

DISP FX OF DISTAL PHALANX OF L RNG FNGR INIT FOR OPN FX

I80212

PHLEBITIS AND THROMBOPHLEBITIS OF LEFT ILIAC VEIN

S62636A

DISP FX OF DISTAL PHALANX OF RIGHT LITTLE FINGER INIT

I80213

PHLEBITIS AND THROMBOPHLEBITIS OF ILIAC VEIN BILATERAL

S62636B

DISP FX OF DIST PHALANX OF R LITTLE FINGER INIT FOR OPN FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I80219

PHLEBITIS AND THROMBOPHLEBITIS OF UNSPECIFIED ILIAC VEIN

S62637A

DISP FX OF DISTAL PHALANX OF LEFT LITTLE FINGER INIT

I80221

PHLEBITIS AND THROMBOPHLEBITIS OF RIGHT POPLITEAL VEIN

S62637B

DISP FX OF DIST PHALANX OF L LITTLE FINGER INIT FOR OPN FX

I80222

PHLEBITIS AND THROMBOPHLEBITIS OF LEFT POPLITEAL VEIN

S62640A

NONDISP FX OF PROXIMAL PHALANX OF RIGHT INDEX FINGER INIT

I80223

PHLEBITIS AND THROMBOPHLEBITIS OF POPLITEAL VEIN BILATERAL

S62640B

NONDISP FX OF PROX PHALANX OF R IDX FNGR INIT FOR OPN FX

I80229

PHLEBITIS AND THROMBOPHLEBITIS OF UNSPECIFIED POPLITEAL VEIN

S62641A

NONDISP FX OF PROXIMAL PHALANX OF LEFT INDEX FINGER INIT

I80231

PHLEBITIS AND THROMBOPHLEBITIS OF RIGHT TIBIAL VEIN

S62641B

NONDISP FX OF PROX PHALANX OF L IDX FNGR INIT FOR OPN FX

I80232

PHLEBITIS AND THROMBOPHLEBITIS OF LEFT TIBIAL VEIN

S62642A

NONDISP FX OF PROXIMAL PHALANX OF RIGHT MIDDLE FINGER INIT

I80233

PHLEBITIS AND THROMBOPHLEBITIS OF TIBIAL VEIN BILATERAL

S62642B

NONDISP FX OF PROX PHALANX OF R MID FINGER INIT FOR OPN FX

I80239

PHLEBITIS AND THROMBOPHLEBITIS OF UNSPECIFIED TIBIAL VEIN

S62643A

NONDISP FX OF PROXIMAL PHALANX OF LEFT MIDDLE FINGER INIT

I80291

PHLEBITIS AND THOMBOPHLB OF DEEP VESSELS OF R LOW EXTREM

S62643B

NONDISP FX OF PROX PHALANX OF L MID FINGER INIT FOR OPN FX

I80292

PHLEBITIS AND THOMBOPHLB OF DEEP VESSELS OF L LOW EXTREM

S62644A

NONDISP FX OF PROXIMAL PHALANX OF RIGHT RING FINGER INIT

I80293

PHLEBITIS AND THOMBOPHLB OF DEEP VESSELS OF LOW EXTRM BI

S62644B

NONDISP FX OF PROX PHALANX OF R RNG FNGR INIT FOR OPN FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I80299

PHLEBITIS AND THOMBOPHLB OF DEEP VESSELS OF UNSP LOW EXTRM

S62645A

NONDISP FX OF PROXIMAL PHALANX OF LEFT RING FINGER INIT

I803

PHLEBITIS AND THROMBOPHLEBITIS OF LOWER EXTREMITIES UNSP

S62645B

NONDISP FX OF PROX PHALANX OF L RNG FNGR INIT FOR OPN FX

I808

PHLEBITIS AND THROMBOPHLEBITIS OF OTHER SITES

S62646A

NONDISP FX OF PROXIMAL PHALANX OF RIGHT LITTLE FINGER INIT

I809

PHLEBITIS AND THROMBOPHLEBITIS OF UNSPECIFIED SITE

S62646B

NONDISP FX OF PROX PHALANX OF R LITTLE FNGR INIT FOR OPN FX

I81 PORTAL VEIN THROMBOSIS

S62647A NONDISP FX OF PROXIMAL PHALANX OF LEFT LITTLE FINGER INIT

I820 BUDD-CHIARI SYNDROME

S62647B NONDISP FX OF PROX PHALANX OF L LITTLE FNGR INIT FOR OPN FX

I821 THROMBOPHLEBITIS MIGRANS

S62650A NONDISP FX OF MEDIAL PHALANX OF RIGHT INDEX FINGER INIT

I82210

ACUTE EMBOLISM AND THROMBOSIS OF SUPERIOR VENA CAVA

S62650B

NONDISP FX OF MEDIAL PHALANX OF R IDX FNGR INIT FOR OPN FX

I82211

CHRONIC EMBOLISM AND THROMBOSIS OF SUPERIOR VENA CAVA

S62651A

NONDISP FX OF MEDIAL PHALANX OF LEFT INDEX FINGER INIT

I82220

ACUTE EMBOLISM AND THROMBOSIS OF INFERIOR VENA CAVA

S62651B

NONDISP FX OF MEDIAL PHALANX OF L IDX FNGR INIT FOR OPN FX

I82221

CHRONIC EMBOLISM AND THROMBOSIS OF INFERIOR VENA CAVA

S62652A

NONDISP FX OF MEDIAL PHALANX OF RIGHT MIDDLE FINGER INIT

I82290

ACUTE EMBOLISM AND THROMBOSIS OF OTHER THORACIC VEINS

S62652B

NONDISP FX OF MEDIAL PHALANX OF R MID FNGR INIT FOR OPN FX

I82291

CHRONIC EMBOLISM AND THROMBOSIS OF OTHER THORACIC VEINS

S62653A

NONDISP FX OF MEDIAL PHALANX OF LEFT MIDDLE FINGER INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I823 EMBOLISM AND THROMBOSIS OF RENAL VEIN

S62653B

NONDISP FX OF MEDIAL PHALANX OF L MID FNGR INIT FOR OPN FX

I82401

ACUTE EMBOLISM AND THOMBOS UNSP DEEP VEINS OF R LOW EXTREM

S62654A

NONDISP FX OF MEDIAL PHALANX OF RIGHT RING FINGER INIT

I82402

ACUTE EMBOLISM AND THOMBOS UNSP DEEP VEINS OF L LOW EXTREM

S62654B

NONDISP FX OF MEDIAL PHALANX OF R RNG FNGR INIT FOR OPN FX

I82403

ACUTE EMBOLISM AND THOMBOS UNSP DEEP VEINS OF LOW EXTRM BI

S62655A

NONDISP FX OF MEDIAL PHALANX OF LEFT RING FINGER INIT

I82409

ACUTE EMBOLISM AND THOMBOS UNSP DEEP VN UNSP LOWER EXTREMITY

S62655B

NONDISP FX OF MEDIAL PHALANX OF L RNG FNGR INIT FOR OPN FX

I82411

ACUTE EMBOLISM AND THROMBOSIS OF RIGHT FEMORAL VEIN

S62656A

NONDISP FX OF MEDIAL PHALANX OF RIGHT LITTLE FINGER INIT

I82412

ACUTE EMBOLISM AND THROMBOSIS OF LEFT FEMORAL VEIN

S62656B

NONDISP FX OF MEDIAL PHALANX OF R LIT FNGR INIT FOR OPN FX

I82413

ACUTE EMBOLISM AND THROMBOSIS OF FEMORAL VEIN BILATERAL

S62657A

NONDISP FX OF MEDIAL PHALANX OF LEFT LITTLE FINGER INIT

I82419

ACUTE EMBOLISM AND THROMBOSIS OF UNSPECIFIED FEMORAL VEIN

S62657B

NONDISP FX OF MEDIAL PHALANX OF L LIT FNGR INIT FOR OPN FX

I82421

ACUTE EMBOLISM AND THROMBOSIS OF RIGHT ILIAC VEIN

S62660A

NONDISP FX OF DISTAL PHALANX OF RIGHT INDEX FINGER INIT

I82422

ACUTE EMBOLISM AND THROMBOSIS OF LEFT ILIAC VEIN

S62660B

NONDISP FX OF DISTAL PHALANX OF R IDX FNGR INIT FOR OPN FX

I82423

ACUTE EMBOLISM AND THROMBOSIS OF ILIAC VEIN BILATERAL

S62661A

NONDISP FX OF DISTAL PHALANX OF LEFT INDEX FINGER INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I82429

ACUTE EMBOLISM AND THROMBOSIS OF UNSPECIFIED ILIAC VEIN

S62661B

NONDISP FX OF DISTAL PHALANX OF L IDX FNGR INIT FOR OPN FX

I82431

ACUTE EMBOLISM AND THROMBOSIS OF RIGHT POPLITEAL VEIN

S62662A

NONDISP FX OF DISTAL PHALANX OF RIGHT MIDDLE FINGER INIT

I82432

ACUTE EMBOLISM AND THROMBOSIS OF LEFT POPLITEAL VEIN

S62662B

NONDISP FX OF DIST PHALANX OF R MID FINGER INIT FOR OPN FX

I82433

ACUTE EMBOLISM AND THROMBOSIS OF POPLITEAL VEIN BILATERAL

S62663A

NONDISP FX OF DISTAL PHALANX OF LEFT MIDDLE FINGER INIT

I82439

ACUTE EMBOLISM AND THROMBOSIS OF UNSPECIFIED POPLITEAL VEIN

S62663B

NONDISP FX OF DIST PHALANX OF L MID FINGER INIT FOR OPN FX

I82441

ACUTE EMBOLISM AND THROMBOSIS OF RIGHT TIBIAL VEIN

S62664A

NONDISP FX OF DISTAL PHALANX OF RIGHT RING FINGER INIT

I82442

ACUTE EMBOLISM AND THROMBOSIS OF LEFT TIBIAL VEIN

S62664B

NONDISP FX OF DISTAL PHALANX OF R RNG FNGR INIT FOR OPN FX

I82443

ACUTE EMBOLISM AND THROMBOSIS OF TIBIAL VEIN BILATERAL

S62665A

NONDISP FX OF DISTAL PHALANX OF LEFT RING FINGER INIT

I82449

ACUTE EMBOLISM AND THROMBOSIS OF UNSPECIFIED TIBIAL VEIN

S62665B

NONDISP FX OF DISTAL PHALANX OF L RNG FNGR INIT FOR OPN FX

I82491

ACUTE EMBOLISM AND THROMBOSIS OF DEEP VEIN OF R LOW EXTREM

S62666A

NONDISP FX OF DISTAL PHALANX OF RIGHT LITTLE FINGER INIT

I82492

ACUTE EMBOLISM AND THROMBOSIS OF DEEP VEIN OF L LOW EXTREM

S62666B

NONDISP FX OF DIST PHALANX OF R LITTLE FNGR INIT FOR OPN FX

I82493

ACUTE EMBOLISM AND THOMBOS OF DEEP VEIN OF LOW EXTRM BI

S62667A

NONDISP FX OF DISTAL PHALANX OF LEFT LITTLE FINGER INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I82499

ACUTE EMBOLISM AND THROMBOSIS OF DEEP VEIN OF UNSP LOW EXTRM

S62667B

NONDISP FX OF DIST PHALANX OF L LITTLE FNGR INIT FOR OPN FX

I824Y1

AC EMBLSM AND THOMBOS UNSP DEEP VEINS OF R PROX LOW EXTRM

S6290XA

UNSP FRACTURE OF UNSP WRIST AND HAND INIT FOR CLOS FX

I824Y2

AC EMBLSM AND THOMBOS UNSP DEEP VEINS OF LEFT PROX LOW EXTRM

S6290XB

UNSP FRACTURE OF UNSP WRIST AND HAND INIT FOR OPN FX

I824Y3

AC EMBLSM AND THOMBOS UNSP DEEP VEINS OF PROX LOW EXTRM BI

S6291XA

UNSP FRACTURE OF RIGHT WRIST AND HAND INIT FOR CLOS FX

I824Y9

ACUTE EMBLSM AND THOMBOS UNSP DEEP VN UNSP PROX LOW EXTRM

S6291XB

UNSP FRACTURE OF RIGHT WRIST AND HAND INIT FOR OPN FX

I824Z1

AC EMBLSM AND THOMBOS UNSP DEEP VEINS OF R DIST LOW EXTRM

S6292XA

UNSP FRACTURE OF LEFT WRIST AND HAND INIT FOR CLOS FX

I824Z2

AC EMBLSM AND THOMBOS UNSP DEEP VEINS OF LEFT DIST LOW EXTRM

S63001A

UNSPECIFIED SUBLUXATION OF RIGHT WRIST AND HAND INIT ENCNTR

I824Z3

AC EMBLSM AND THOMBOS UNSP DEEP VEINS OF DIST LOW EXTRM BI

S63003A

UNSP SUBLUXATION OF UNSPECIFIED WRIST AND HAND INIT ENCNTR

I824Z9

ACUTE EMBLSM AND THOMBOS UNSP DEEP VN UNSP DISTAL LOW EXTRM

S63004A

UNSPECIFIED DISLOCATION OF RIGHT WRIST AND HAND INIT ENCNTR

I82501

CHRONIC EMBOLISM AND THOMBOS UNSP DEEP VEINS OF R LOW EXTREM

S63005A

UNSPECIFIED DISLOCATION OF LEFT WRIST AND HAND INIT ENCNTR

I82502

CHRONIC EMBOLISM AND THOMBOS UNSP DEEP VEINS OF L LOW EXTREM

S63012A

SUBLUXATION OF DISTAL RADIOULNAR JOINT OF LEFT WRIST INIT

I82503

CHRONIC EMBLSM AND THOMBOS UNSP DEEP VEINS OF LOW EXTRM BI

S63015A

DISLOCATION OF DISTAL RADIOULNAR JOINT OF LEFT WRIST INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I82509

CHRONIC EMBOLISM AND THOMBOS UNSP DEEP VN UNSP LOW EXTRM

S63016A

DISLOCATION OF DISTAL RADIOULNAR JOINT OF UNSP WRIST INIT

I82511

CHRONIC EMBOLISM AND THROMBOSIS OF RIGHT FEMORAL VEIN

S63021A

SUBLUXATION OF RADIOCARPAL JOINT OF RIGHT WRIST INIT ENCNTR

I82512

CHRONIC EMBOLISM AND THROMBOSIS OF LEFT FEMORAL VEIN

S63022A

SUBLUXATION OF RADIOCARPAL JOINT OF LEFT WRIST INIT ENCNTR

I82513

CHRONIC EMBOLISM AND THROMBOSIS OF FEMORAL VEIN BILATERAL

S63023A

SUBLUXATION OF RADIOCARPAL JOINT OF UNSP WRIST INIT ENCNTR

I82519

CHRONIC EMBOLISM AND THROMBOSIS OF UNSPECIFIED FEMORAL VEIN

S63025A

DISLOCATION OF RADIOCARPAL JOINT OF LEFT WRIST INIT ENCNTR

I82521

CHRONIC EMBOLISM AND THROMBOSIS OF RIGHT ILIAC VEIN

S63031A

SUBLUXATION OF MIDCARPAL JOINT OF RIGHT WRIST INIT ENCNTR

I82522

CHRONIC EMBOLISM AND THROMBOSIS OF LEFT ILIAC VEIN

S63032A

SUBLUXATION OF MIDCARPAL JOINT OF LEFT WRIST INIT ENCNTR

I82523

CHRONIC EMBOLISM AND THROMBOSIS OF ILIAC VEIN BILATERAL

S63033A

SUBLUXATION OF MIDCARPAL JOINT OF UNSP WRIST INIT ENCNTR

I82529

CHRONIC EMBOLISM AND THROMBOSIS OF UNSPECIFIED ILIAC VEIN

S63034A

DISLOCATION OF MIDCARPAL JOINT OF RIGHT WRIST INIT ENCNTR

I82531

CHRONIC EMBOLISM AND THROMBOSIS OF RIGHT POPLITEAL VEIN

S63035A

DISLOCATION OF MIDCARPAL JOINT OF LEFT WRIST INIT ENCNTR

I82532

CHRONIC EMBOLISM AND THROMBOSIS OF LEFT POPLITEAL VEIN

S63036A

DISLOCATION OF MIDCARPAL JOINT OF UNSP WRIST INIT ENCNTR

I82533

CHRONIC EMBOLISM AND THROMBOSIS OF POPLITEAL VEIN BILATERAL

S63041A

SUBLUXATION OF CARPOMETACARPAL JOINT OF RIGHT THUMB INIT

Page 198: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I82539

CHRONIC EMBOLISM AND THROMBOSIS OF UNSP POPLITEAL VEIN

S63042A

SUBLUXATION OF CARPOMETACARPAL JOINT OF LEFT THUMB INIT

I82541

CHRONIC EMBOLISM AND THROMBOSIS OF RIGHT TIBIAL VEIN

S63043A

SUBLUXATION OF CARPOMETACARPAL JOINT OF UNSP THUMB INIT

I82542

CHRONIC EMBOLISM AND THROMBOSIS OF LEFT TIBIAL VEIN

S63044A

DISLOCATION OF CARPOMETACARPAL JOINT OF RIGHT THUMB INIT

I82543

CHRONIC EMBOLISM AND THROMBOSIS OF TIBIAL VEIN BILATERAL

S63045A

DISLOCATION OF CARPOMETACARPAL JOINT OF LEFT THUMB INIT

I82549

CHRONIC EMBOLISM AND THROMBOSIS OF UNSPECIFIED TIBIAL VEIN

S63045S

DISLOCATION OF CARPOMETACARPAL JOINT OF LEFT THUMB SEQUELA

I82591

CHRONIC EMBOLISM AND THROMBOSIS OF DEEP VEIN OF R LOW EXTREM

S63052A

SUBLUXATION OF OTH CARPOMETACARPAL JOINT OF LEFT HAND INIT

I82592

CHRONIC EMBOLISM AND THROMBOSIS OF DEEP VEIN OF L LOW EXTREM

S63053A

SUBLUXATION OF OTH CARPOMETACARPAL JOINT OF UNSP HAND INIT

I82593

CHRONIC EMBOLISM AND THOMBOS OF DEEP VEIN OF LOW EXTRM BI

S63054A

DISLOCATION OF OTH CARPOMETACARPAL JOINT OF RIGHT HAND INIT

I82599

CHRONIC EMBOLISM AND THOMBOS OF DEEP VEIN OF UNSP LOW EXTRM

S63055A

DISLOCATION OF OTH CARPOMETACARPAL JOINT OF LEFT HAND INIT

I825Y1

CHR EMBLSM AND THOMBOS UNSP DEEP VEINS OF R PROX LOW EXTRM

S63056A

DISLOCATION OF OTH CARPOMETACARPAL JOINT OF UNSP HAND INIT

I825Y2

CHR EMBLSM AND THOMBOS UNSP DEEP VN OF LEFT PROX LOW EXTRM

S63061A

SUBLUX OF MC (BONE) PROXIMAL END OF RIGHT HAND INIT

I825Y3

CHR EMBLSM AND THOMBOS UNSP DEEP VEINS OF PROX LOW EXTRM BI

S63062A

SUBLUX OF METACARPAL (BONE) PROXIMAL END OF LEFT HAND INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I825Y9

CHRONIC EMBLSM AND THOMBOS UNSP DEEP VN UNSP PROX LOW EXTRM

S63063A

SUBLUX OF METACARPAL (BONE) PROXIMAL END OF UNSP HAND INIT

I825Z1

CHR EMBLSM AND THOMBOS UNSP DEEP VEINS OF R DIST LOW EXTRM

S63064A

DISLOC OF MC (BONE) PROXIMAL END OF RIGHT HAND INIT

I825Z2

CHR EMBLSM AND THOMBOS UNSP DEEP VN OF LEFT DIST LOW EXTRM

S63065A

DISLOC OF METACARPAL (BONE) PROXIMAL END OF LEFT HAND INIT

I825Z3

CHR EMBLSM AND THOMBOS UNSP DEEP VEINS OF DIST LOW EXTRM BI

S63066A

DISLOC OF METACARPAL (BONE) PROXIMAL END OF UNSP HAND INIT

I825Z9

CHR EMBLSM AND THOMBOS UNSP DEEP VN UNSP DISTAL LOW EXTRM

S63072A

SUBLUXATION OF DISTAL END OF LEFT ULNA INITIAL ENCOUNTER

I82601

ACUTE EMBOLISM AND THOMBOS UNSP VEINS OF R UP EXTREM

S63073A

SUBLUXATION OF DISTAL END OF UNSPECIFIED ULNA INIT ENCNTR

I82602

ACUTE EMBOLISM AND THOMBOS UNSP VEINS OF L UP EXTREM

S63074A

DISLOCATION OF DISTAL END OF RIGHT ULNA INITIAL ENCOUNTER

I82603

ACUTE EMBOLISM AND THOMBOS UNSP VEINS OF UP EXTREM BI

S63075A

DISLOCATION OF DISTAL END OF LEFT ULNA INITIAL ENCOUNTER

I82609

ACUTE EMBOLISM AND THOMBOS UNSP VN UNSP UPPER EXTREMITY

S63076A

DISLOCATION OF DISTAL END OF UNSPECIFIED ULNA INIT ENCNTR

I82611

ACUTE EMBOLISM AND THOMBOS OF SUPERFIC VEINS OF R UP EXTREM

S63091A

OTHER SUBLUXATION OF RIGHT WRIST AND HAND INITIAL ENCOUNTER

I82612

ACUTE EMBOLISM AND THOMBOS OF SUPERFIC VEINS OF L UP EXTREM

S63092A

OTHER SUBLUXATION OF LEFT WRIST AND HAND INITIAL ENCOUNTER

I82613

ACUTE EMBLSM AND THOMBOS OF SUPERFIC VEINS OF UP EXTREM BI

S63093A

OTHER SUBLUXATION OF UNSPECIFIED WRIST AND HAND INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I82619

ACUTE EMBOLISM AND THROMBOSIS OF SUPERFIC VN UNSP UP EXTREM

S63094A

OTHER DISLOCATION OF RIGHT WRIST AND HAND INITIAL ENCOUNTER

I82621

ACUTE EMBOLISM AND THROMBOSIS OF DEEP VEINS OF R UP EXTREM

S63095A

OTHER DISLOCATION OF LEFT WRIST AND HAND INITIAL ENCOUNTER

I82622

ACUTE EMBOLISM AND THROMBOSIS OF DEEP VEINS OF L UP EXTREM

S63096A

OTHER DISLOCATION OF UNSPECIFIED WRIST AND HAND INIT ENCNTR

I82623

ACUTE EMBOLISM AND THOMBOS OF DEEP VEINS OF UP EXTREM BI

S63101A

UNSPECIFIED SUBLUXATION OF RIGHT THUMB INITIAL ENCOUNTER

I82629

ACUTE EMBOLISM AND THROMBOSIS OF DEEP VN UNSP UP EXTREM

S63102A

UNSPECIFIED SUBLUXATION OF LEFT THUMB INITIAL ENCOUNTER

I82701

CHRONIC EMBOLISM AND THOMBOS UNSP VEINS OF R UP EXTREM

S63103A

UNSPECIFIED SUBLUXATION OF UNSPECIFIED THUMB INIT ENCNTR

I82702

CHRONIC EMBOLISM AND THOMBOS UNSP VEINS OF L UP EXTREM

S63104A

UNSPECIFIED DISLOCATION OF RIGHT THUMB INITIAL ENCOUNTER

I82703

CHRONIC EMBOLISM AND THOMBOS UNSP VEINS OF UP EXTREM BI

S63105A

UNSPECIFIED DISLOCATION OF LEFT THUMB INITIAL ENCOUNTER

I82709

CHRONIC EMBOLISM AND THOMBOS UNSP VN UNSP UPPER EXTREMITY

S63106A

UNSPECIFIED DISLOCATION OF UNSPECIFIED THUMB INIT ENCNTR

I82711

CHRONIC EMBLSM AND THOMBOS OF SUPERFIC VEINS OF R UP EXTREM

S63111A

SUBLUXATION OF MCP JOINT OF RIGHT THUMB INIT

I82712

CHRONIC EMBLSM AND THOMBOS OF SUPERFIC VEINS OF L UP EXTREM

S63112A

SUBLUXATION OF METACARPOPHALANGEAL JOINT OF LEFT THUMB INIT

I82713

CHR EMBLSM AND THOMBOS OF SUPERFIC VEINS OF UP EXTREM BI

S63113A

SUBLUXATION OF METACARPOPHALANGEAL JOINT OF UNSP THUMB INIT

Page 201: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I82719

CHRONIC EMBOLISM AND THOMBOS OF SUPERFIC VN UNSP UP EXTREM

S63114A

DISLOCATION OF MCP JOINT OF RIGHT THUMB INIT

I82721

CHRONIC EMBOLISM AND THROMBOSIS OF DEEP VEINS OF R UP EXTREM

S63115A

DISLOCATION OF METACARPOPHALANGEAL JOINT OF LEFT THUMB INIT

I82722

CHRONIC EMBOLISM AND THROMBOSIS OF DEEP VEINS OF L UP EXTREM

S63116A

DISLOCATION OF METACARPOPHALANGEAL JOINT OF UNSP THUMB INIT

I82723

CHRONIC EMBOLISM AND THOMBOS OF DEEP VEINS OF UP EXTREM BI

S63121A

SUBLUXATION OF UNSP INTERPHALN JOINT OF RIGHT THUMB INIT

I82729

CHRONIC EMBOLISM AND THROMBOSIS OF DEEP VN UNSP UP EXTREM

S63122A

SUBLUXATION OF UNSP INTERPHALN JOINT OF LEFT THUMB INIT

I82811

EMBOLISM AND THROMBOSIS OF SUPERFIC VEINS OF RIGHT LOW EXTRM

S63123A

SUBLUXATION OF UNSP INTERPHALANGEAL JOINT OF THMB INIT

I82812

EMBOLISM AND THROMBOSIS OF SUPERFIC VEINS OF LEFT LOW EXTRM

S63124A

DISLOCATION OF UNSP INTERPHALN JOINT OF RIGHT THUMB INIT

I82813

EMBOLISM AND THOMBOS OF SUPERFIC VEINS OF LOW EXTRM BI

S63125A

DISLOCATION OF UNSP INTERPHALN JOINT OF LEFT THUMB INIT

I82819

EMBOLISM AND THROMBOSIS OF SUPERFICIAL VN UNSP LOW EXTRM

S63126A

DISLOCATION OF UNSP INTERPHALANGEAL JOINT OF THMB INIT

I82890

ACUTE EMBOLISM AND THROMBOSIS OF OTHER SPECIFIED VEINS

S63131A

SUBLUXATION OF PROXIMAL INTERPHALN JOINT OF R THM INIT

I82891

CHRONIC EMBOLISM AND THROMBOSIS OF OTHER SPECIFIED VEINS

S63132A

SUBLUXATION OF PROXIMAL INTERPHALN JOINT OF LEFT THUMB INIT

I8290

ACUTE EMBOLISM AND THROMBOSIS OF UNSPECIFIED VEIN

S63133A

SUBLUXATION OF PROXIMAL INTERPHALANGEAL JOINT OF THMB INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I8291

CHRONIC EMBOLISM AND THROMBOSIS OF UNSPECIFIED VEIN

S63134A

DISLOC OF PROXIMAL INTERPHALN JOINT OF RIGHT THUMB INIT

I82A11

ACUTE EMBOLISM AND THROMBOSIS OF RIGHT AXILLARY VEIN

S63135A

DISLOCATION OF PROXIMAL INTERPHALN JOINT OF LEFT THUMB INIT

I82A12

ACUTE EMBOLISM AND THROMBOSIS OF LEFT AXILLARY VEIN

S63136A

DISLOCATION OF PROXIMAL INTERPHALANGEAL JOINT OF THMB INIT

I82A13

ACUTE EMBOLISM AND THROMBOSIS OF AXILLARY VEIN BILATERAL

S63141A

SUBLUXATION OF DISTAL INTERPHALN JOINT OF RIGHT THUMB INIT

I82A19

ACUTE EMBOLISM AND THROMBOSIS OF UNSPECIFIED AXILLARY VEIN

S63142A

SUBLUXATION OF DISTAL INTERPHALN JOINT OF LEFT THUMB INIT

I82A21

CHRONIC EMBOLISM AND THROMBOSIS OF RIGHT AXILLARY VEIN

S63143A

SUBLUXATION OF DISTAL INTERPHALANGEAL JOINT OF THMB INIT

I82A22

CHRONIC EMBOLISM AND THROMBOSIS OF LEFT AXILLARY VEIN

S63144A

DISLOCATION OF DISTAL INTERPHALN JOINT OF RIGHT THUMB INIT

I82A23

CHRONIC EMBOLISM AND THROMBOSIS OF AXILLARY VEIN BILATERAL

S63145A

DISLOCATION OF DISTAL INTERPHALN JOINT OF LEFT THUMB INIT

I82A29

CHRONIC EMBOLISM AND THROMBOSIS OF UNSPECIFIED AXILLARY VEIN

S63146A

DISLOCATION OF DISTAL INTERPHALANGEAL JOINT OF THMB INIT

I82B11

ACUTE EMBOLISM AND THROMBOSIS OF RIGHT SUBCLAVIAN VEIN

S63200A

UNSPECIFIED SUBLUXATION OF RIGHT INDEX FINGER INIT ENCNTR

I82B12

ACUTE EMBOLISM AND THROMBOSIS OF LEFT SUBCLAVIAN VEIN

S63201A

UNSPECIFIED SUBLUXATION OF LEFT INDEX FINGER INIT ENCNTR

I82B13

ACUTE EMBOLISM AND THROMBOSIS OF SUBCLAVIAN VEIN BILATERAL

S63202A

UNSPECIFIED SUBLUXATION OF RIGHT MIDDLE FINGER INIT ENCNTR

Page 203: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I82B19

ACUTE EMBOLISM AND THROMBOSIS OF UNSPECIFIED SUBCLAVIAN VEIN

S63203A

UNSPECIFIED SUBLUXATION OF LEFT MIDDLE FINGER INIT ENCNTR

I82B21

CHRONIC EMBOLISM AND THROMBOSIS OF RIGHT SUBCLAVIAN VEIN

S63204A

UNSPECIFIED SUBLUXATION OF RIGHT RING FINGER INIT ENCNTR

I82B22

CHRONIC EMBOLISM AND THROMBOSIS OF LEFT SUBCLAVIAN VEIN

S63205A

UNSPECIFIED SUBLUXATION OF LEFT RING FINGER INIT ENCNTR

I82B23

CHRONIC EMBOLISM AND THROMBOSIS OF SUBCLAV VEIN BILATERAL

S63206A

UNSPECIFIED SUBLUXATION OF RIGHT LITTLE FINGER INIT ENCNTR

I82B29

CHRONIC EMBOLISM AND THROMBOSIS OF UNSP SUBCLAVIAN VEIN

S63207A

UNSPECIFIED SUBLUXATION OF LEFT LITTLE FINGER INIT ENCNTR

I82C11

ACUTE EMBOLISM AND THROMBOSIS OF RIGHT INTERNAL JUGULAR VEIN

S63208A

UNSPECIFIED SUBLUXATION OF OTHER FINGER INITIAL ENCOUNTER

I82C12

ACUTE EMBOLISM AND THROMBOSIS OF LEFT INTERNAL JUGULAR VEIN

S63209A

UNSPECIFIED SUBLUXATION OF UNSPECIFIED FINGER INIT ENCNTR

I82C13

ACUTE EMBOLISM AND THROMBOSIS OF INT JUGULAR VEIN BILATERAL

S63210A

SUBLUXATION OF MCP JOINT OF RIGHT INDEX FINGER INIT

I82C19

ACUTE EMBOLISM AND THROMBOSIS OF UNSP INTERNAL JUGULAR VEIN

S63211A

SUBLUXATION OF MCP JOINT OF LEFT INDEX FINGER INIT

I82C21

CHRONIC EMBOLISM AND THROMBOSIS OF R INT JUGULAR VEIN

S63212A

SUBLUXATION OF MCP JOINT OF RIGHT MIDDLE FINGER INIT

I82C22

CHRONIC EMBOLISM AND THROMBOSIS OF L INT JUGULAR VEIN

S63213A

SUBLUXATION OF MCP JOINT OF LEFT MIDDLE FINGER INIT

I82C23

CHRONIC EMBOLISM AND THOMBOS OF INT JUGULAR VEIN BILATERAL

S63214A

SUBLUXATION OF MCP JOINT OF RIGHT RING FINGER INIT

Page 204: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I82C29

CHRONIC EMBOLISM AND THOMBOS UNSP INTERNAL JUGULAR VEIN

S63215A

SUBLUXATION OF MCP JOINT OF LEFT RING FINGER INIT

I83001

VARICOSE VEINS OF UNSP LOWER EXTREMITY WITH ULCER OF THIGH

S63216A

SUBLUXATION OF MCP JOINT OF RIGHT LITTLE FINGER INIT

I83002

VARICOSE VEINS OF UNSP LOWER EXTREMITY WITH ULCER OF CALF

S63217A

SUBLUXATION OF MCP JOINT OF LEFT LITTLE FINGER INIT

I83003

VARICOSE VEINS OF UNSP LOWER EXTREMITY WITH ULCER OF ANKLE

S63218A

SUBLUXATION OF METACARPOPHALANGEAL JOINT OF OTH FINGER INIT

I83004

VARICOS VN UNSP LOWER EXTREMITY W ULCER OF HEEL AND MIDFOOT

S63219A

SUBLUXATION OF MCP JOINT OF UNSP FINGER INIT

I83005

VARICOS VN UNSP LOWER EXTREMITY W ULCER OTH PART OF FOOT

S63220A

SUBLUXATION OF UNSP INTERPHALN JOINT OF R IDX FNGR INIT

I83008

VARICOS VN UNSP LOW EXTRM W ULCER OTH PART OF LOWER LEG

S63221A

SUBLUXATION OF UNSP INTERPHALN JOINT OF L IDX FNGR INIT

I83009

VARICOSE VEINS OF UNSP LOWER EXTREMITY W ULCER OF UNSP SITE

S63222A

SUBLUXATION OF UNSP INTERPHALN JOINT OF R MID FINGER INIT

I83011

VARICOSE VEINS OF RIGHT LOWER EXTREMITY WITH ULCER OF THIGH

S63223A

SUBLUXATION OF UNSP INTERPHALN JOINT OF L MID FINGER INIT

I83012

VARICOSE VEINS OF RIGHT LOWER EXTREMITY WITH ULCER OF CALF

S63224A

SUBLUXATION OF UNSP INTERPHALN JOINT OF R RNG FNGR INIT

I83013

VARICOSE VEINS OF RIGHT LOWER EXTREMITY WITH ULCER OF ANKLE

S63225A

SUBLUXATION OF UNSP INTERPHALN JOINT OF L RNG FNGR INIT

I83014

VARICOSE VEINS OF R LOW EXTREM W ULCER OF HEEL AND MIDFOOT

S63226A

SUBLUX OF UNSP INTERPHALN JOINT OF R LITTLE FINGER INIT

Page 205: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I83015

VARICOSE VEINS OF R LOW EXTREM W ULCER OTH PART OF FOOT

S63227A

SUBLUX OF UNSP INTERPHALN JOINT OF L LITTLE FINGER INIT

I83018

VARICOSE VEINS OF R LOW EXTREM W ULCER OTH PART OF LOWER LEG

S63228A

SUBLUXATION OF UNSP INTERPHALANGEAL JOINT OF FINGER INIT

I83019

VARICOSE VEINS OF RIGHT LOWER EXTREMITY W ULCER OF UNSP SITE

S63229A

SUBLUXATION OF UNSP INTERPHALN JOINT OF UNSP FINGER INIT

I83021

VARICOSE VEINS OF LEFT LOWER EXTREMITY WITH ULCER OF THIGH

S63230A

SUBLUXATION OF PROXIMAL INTERPHALN JOINT OF R IDX FNGR INIT

I83022

VARICOSE VEINS OF LEFT LOWER EXTREMITY WITH ULCER OF CALF

S63231A

SUBLUXATION OF PROXIMAL INTERPHALN JOINT OF L IDX FNGR INIT

I83023

VARICOSE VEINS OF LEFT LOWER EXTREMITY WITH ULCER OF ANKLE

S63232A

SUBLUX OF PROXIMAL INTERPHALN JOINT OF R MID FINGER INIT

I83024

VARICOSE VEINS OF L LOW EXTREM W ULCER OF HEEL AND MIDFOOT

S63233A

SUBLUX OF PROXIMAL INTERPHALN JOINT OF L MID FINGER INIT

I83025

VARICOSE VEINS OF L LOW EXTREM W ULCER OTH PART OF FOOT

S63234A

SUBLUXATION OF PROXIMAL INTERPHALN JOINT OF R RNG FNGR INIT

I83028

VARICOSE VEINS OF L LOW EXTREM W ULCER OTH PART OF LOWER LEG

S63235A

SUBLUXATION OF PROXIMAL INTERPHALN JOINT OF L RNG FNGR INIT

I83029

VARICOSE VEINS OF LEFT LOWER EXTREMITY W ULCER OF UNSP SITE

S63236A

SUBLUX OF PROXIMAL INTERPHALN JOINT OF R LITTLE FINGER INIT

I8310

VARICOSE VEINS OF UNSP LOWER EXTREMITY WITH INFLAMMATION

S63237A

SUBLUX OF PROXIMAL INTERPHALN JOINT OF L LITTLE FINGER INIT

I8311

VARICOSE VEINS OF RIGHT LOWER EXTREMITY WITH INFLAMMATION

S63238A

SUBLUXATION OF PROXIMAL INTERPHALN JOINT OF FINGER INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I8312

VARICOSE VEINS OF LEFT LOWER EXTREMITY WITH INFLAMMATION

S63239A

SUBLUX OF PROXIMAL INTERPHALN JOINT OF UNSP FINGER INIT

I83201

VARICOS VN UNSP LOW EXTRM W ULC OF THIGH AND INFLAMMATION

S63240A

SUBLUXATION OF DISTAL INTERPHALN JOINT OF R IDX FNGR INIT

I83202

VARICOS VN UNSP LOW EXTRM W ULC OF CALF AND INFLAMMATION

S63241A

SUBLUXATION OF DISTAL INTERPHALN JOINT OF L IDX FNGR INIT

I83203

VARICOS VN UNSP LOW EXTRM W ULC OF ANKLE AND INFLAMMATION

S63242A

SUBLUXATION OF DISTAL INTERPHALN JOINT OF R MID FINGER INIT

I83204

VARICOS VN UNSP LOW EXTRM W ULC OF HEEL AND MIDFT AND INFLAM

S63243A

SUBLUXATION OF DISTAL INTERPHALN JOINT OF L MID FINGER INIT

I83205

VARICOS VN UNSP LOW EXTRM W ULC OTH PART OF FOOT AND INFLAM

S63244A

SUBLUXATION OF DISTAL INTERPHALN JOINT OF R RNG FNGR INIT

I83208

VARICOS VN UNSP LOW EXTRM W ULC OTH PRT LOW EXTRM AND INFLAM

S63245A

SUBLUXATION OF DISTAL INTERPHALN JOINT OF L RNG FNGR INIT

I83209

VARICOS VN UNSP LOW EXTRM W ULC OF UNSP SITE AND INFLAM

S63246A

SUBLUX OF DISTAL INTERPHALN JOINT OF R LITTLE FINGER INIT

I83211

VARICOS VN OF R LOW EXTREM W ULC OF THIGH AND INFLAMMATION

S63247A

SUBLUX OF DISTAL INTERPHALN JOINT OF L LITTLE FINGER INIT

I83212

VARICOS VN OF R LOW EXTREM W ULC OF CALF AND INFLAMMATION

S63248A

SUBLUXATION OF DISTAL INTERPHALANGEAL JOINT OF FINGER INIT

I83213

VARICOS VN OF R LOW EXTREM W ULC OF ANKLE AND INFLAMMATION

S63249A

SUBLUXATION OF DISTAL INTERPHALN JOINT OF UNSP FINGER INIT

I83214

VARICOS VN OF R LOW EXTREM W ULC OF HEEL & MIDFT AND INFLAM

S63250A

UNSPECIFIED DISLOCATION OF RIGHT INDEX FINGER INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I83215

VARICOS VN OF R LOW EXTREM W ULC OTH PART OF FOOT AND INFLAM

S63251A

UNSPECIFIED DISLOCATION OF LEFT INDEX FINGER INIT ENCNTR

I83218

VARICOS VN OF R LOW EXTREM W ULC OTH PRT LOW EXTRM & INFLAM

S63252A

UNSPECIFIED DISLOCATION OF RIGHT MIDDLE FINGER INIT ENCNTR

I83219

VARICOS VN OF R LOW EXTREM W ULC OF UNSP SITE AND INFLAM

S63253A

UNSPECIFIED DISLOCATION OF LEFT MIDDLE FINGER INIT ENCNTR

I83221

VARICOS VN OF L LOW EXTREM W ULC OF THIGH AND INFLAMMATION

S63254A

UNSPECIFIED DISLOCATION OF RIGHT RING FINGER INIT ENCNTR

I83222

VARICOS VN OF L LOW EXTREM W ULC OF CALF AND INFLAMMATION

S63255A

UNSPECIFIED DISLOCATION OF LEFT RING FINGER INIT ENCNTR

I83223

VARICOS VN OF L LOW EXTREM W ULC OF ANKLE AND INFLAMMATION

S63256A

UNSPECIFIED DISLOCATION OF RIGHT LITTLE FINGER INIT ENCNTR

I83224

VARICOS VN OF L LOW EXTREM W ULC OF HEEL & MIDFT AND INFLAM

S63257A

UNSPECIFIED DISLOCATION OF LEFT LITTLE FINGER INIT ENCNTR

I83225

VARICOS VN OF L LOW EXTREM W ULC OTH PART OF FOOT AND INFLAM

S63258A

UNSPECIFIED DISLOCATION OF OTHER FINGER INITIAL ENCOUNTER

I83228

VARICOS VN OF L LOW EXTREM W ULC OTH PRT LOW EXTRM & INFLAM

S63259A

UNSPECIFIED DISLOCATION OF UNSPECIFIED FINGER INIT ENCNTR

I83229

VARICOS VN OF L LOW EXTREM W ULC OF UNSP SITE AND INFLAM

S63260A

DISLOCATION OF MCP JOINT OF RIGHT INDEX FINGER INIT

I83811

VARICOSE VEINS OF RIGHT LOWER EXTREMITIES WITH PAIN

S63261A

DISLOCATION OF MCP JOINT OF LEFT INDEX FINGER INIT

I83812

VARICOSE VEINS OF LEFT LOWER EXTREMITIES WITH PAIN

S63262A

DISLOCATION OF MCP JOINT OF RIGHT MIDDLE FINGER INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I83813

VARICOSE VEINS OF BILATERAL LOWER EXTREMITIES WITH PAIN

S63263A

DISLOCATION OF MCP JOINT OF LEFT MIDDLE FINGER INIT

I83819

VARICOSE VEINS OF UNSPECIFIED LOWER EXTREMITIES WITH PAIN

S63264A

DISLOCATION OF MCP JOINT OF RIGHT RING FINGER INIT

I83891 VARICOSE VEINS OF RIGHT LOW EXTRM W OTH COMPLICATIONS

S63265A

DISLOCATION OF MCP JOINT OF LEFT RING FINGER INIT

I83892

VARICOSE VEINS OF LEFT LOWER EXTREMITIES W OTH COMPLICATIONS

S63266A

DISLOCATION OF MCP JOINT OF RIGHT LITTLE FINGER INIT

I83893

VARICOSE VEINS OF BI LOW EXTREM W OTH COMPLICATIONS

S63267A

DISLOCATION OF MCP JOINT OF LEFT LITTLE FINGER INIT

I83899

VARICOSE VEINS OF UNSP LOWER EXTREMITIES W OTH COMPLICATIONS

S63268A

DISLOCATION OF METACARPOPHALANGEAL JOINT OF OTH FINGER INIT

I8390

ASYMPTOMATIC VARICOSE VEINS OF UNSPECIFIED LOWER EXTREMITY

S63269A

DISLOCATION OF MCP JOINT OF UNSP FINGER INIT

I8391

ASYMPTOMATIC VARICOSE VEINS OF RIGHT LOWER EXTREMITY

S63270A

DISLOCATION OF UNSP INTERPHALN JOINT OF R IDX FNGR INIT

I8392

ASYMPTOMATIC VARICOSE VEINS OF LEFT LOWER EXTREMITY

S63271A

DISLOCATION OF UNSP INTERPHALN JOINT OF L IDX FNGR INIT

I8393

ASYMPTOMATIC VARICOSE VEINS OF BILATERAL LOWER EXTREMITIES

S63272A

DISLOCATION OF UNSP INTERPHALN JOINT OF R MID FINGER INIT

I8500 ESOPHAGEAL VARICES WITHOUT BLEEDING

S63273A

DISLOCATION OF UNSP INTERPHALN JOINT OF L MID FINGER INIT

I8501 ESOPHAGEAL VARICES WITH BLEEDING

S63274A

DISLOCATION OF UNSP INTERPHALN JOINT OF R RNG FNGR INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I8510 SECONDARY ESOPHAGEAL VARICES WITHOUT BLEEDING

S63275A

DISLOCATION OF UNSP INTERPHALN JOINT OF L RNG FNGR INIT

I8511 SECONDARY ESOPHAGEAL VARICES WITH BLEEDING

S63276A

DISLOC OF UNSP INTERPHALN JOINT OF R LITTLE FINGER INIT

I860 SUBLINGUAL VARICES

S63277A DISLOC OF UNSP INTERPHALN JOINT OF L LITTLE FINGER INIT

I861 SCROTAL VARICES

S63278A

DISLOCATION OF UNSP INTERPHALANGEAL JOINT OF FINGER INIT

I862 PELVIC VARICES

S63279A DISLOCATION OF UNSP INTERPHALN JOINT OF UNSP FINGER INIT

I863 VULVAL VARICES

S63280A

DISLOCATION OF PROXIMAL INTERPHALN JOINT OF R IDX FNGR INIT

I864 GASTRIC VARICES

S63281A DISLOCATION OF PROXIMAL INTERPHALN JOINT OF L IDX FNGR INIT

I868 VARICOSE VEINS OF OTHER SPECIFIED SITES

S63282A

DISLOC OF PROXIMAL INTERPHALN JOINT OF R MID FINGER INIT

I87001

POSTTHROMBOTIC SYNDROME W/O COMPLICATIONS OF R LOW EXTREM

S63283A

DISLOC OF PROXIMAL INTERPHALN JOINT OF L MID FINGER INIT

I87002

POSTTHROMBOTIC SYNDROME W/O COMPLICATIONS OF L LOW EXTREM

S63284A

DISLOCATION OF PROXIMAL INTERPHALN JOINT OF R RNG FNGR INIT

I87003

POSTTHROM SYNDROME W/O COMPLICATIONS OF BILATERAL LOW EXTRM

S63285A

DISLOCATION OF PROXIMAL INTERPHALN JOINT OF L RNG FNGR INIT

I87009

POSTTHROMBOTIC SYNDROME W/O COMPLICATIONS OF UNSP EXTREMITY

S63286A

DISLOC OF PROXIMAL INTERPHALN JOINT OF R LITTLE FINGER INIT

Page 210: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I87011

POSTTHROMBOTIC SYNDROME WITH ULCER OF RIGHT LOWER EXTREMITY

S63287A

DISLOC OF PROXIMAL INTERPHALN JOINT OF L LITTLE FINGER INIT

I87012

POSTTHROMBOTIC SYNDROME WITH ULCER OF LEFT LOWER EXTREMITY

S63288A

DISLOCATION OF PROXIMAL INTERPHALN JOINT OF FINGER INIT

I87013

POSTTHROMBOTIC SYNDROME W ULCER OF BILATERAL LOWER EXTREMITY

S63289A

DISLOC OF PROXIMAL INTERPHALN JOINT OF UNSP FINGER INIT

I87019

POSTTHROMBOTIC SYNDROME WITH ULCER OF UNSP LOWER EXTREMITY

S63290A

DISLOCATION OF DISTAL INTERPHALN JOINT OF R IDX FNGR INIT

I87021

POSTTHROMBOTIC SYNDROME W INFLAMMATION OF R LOW EXTREM

S63291A

DISLOCATION OF DISTAL INTERPHALN JOINT OF L IDX FNGR INIT

I87022

POSTTHROMBOTIC SYNDROME W INFLAMMATION OF L LOW EXTREM

S63292A

DISLOCATION OF DISTAL INTERPHALN JOINT OF R MID FINGER INIT

I87023

POSTTHROM SYNDROME W INFLAMMATION OF BILATERAL LOW EXTRM

S63293A

DISLOCATION OF DISTAL INTERPHALN JOINT OF L MID FINGER INIT

I87029

POSTTHROMBOTIC SYNDROME W INFLAMMATION OF UNSP LOW EXTRM

S63294A

DISLOCATION OF DISTAL INTERPHALN JOINT OF R RNG FNGR INIT

I87031

POSTTHROM SYNDROME W ULCER AND INFLAMMATION OF R LOW EXTREM

S63295A

DISLOCATION OF DISTAL INTERPHALN JOINT OF L RNG FNGR INIT

I87032

POSTTHROM SYNDROME W ULCER AND INFLAMMATION OF L LOW EXTREM

S63296A

DISLOC OF DISTAL INTERPHALN JOINT OF R LITTLE FINGER INIT

I87033

POSTTHROM SYNDROME W ULCER AND INFLAM OF BILATERAL LOW EXTRM

S63297A

DISLOC OF DISTAL INTERPHALN JOINT OF L LITTLE FINGER INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I87039

POSTTHROM SYNDROME W ULCER AND INFLAM OF UNSP LOW EXTRM

S63298A

DISLOCATION OF DISTAL INTERPHALANGEAL JOINT OF FINGER INIT

I87091

POSTTHROMBOTIC SYNDROME W OTH COMPLICATIONS OF R LOW EXTREM

S63299A

DISLOCATION OF DISTAL INTERPHALN JOINT OF UNSP FINGER INIT

I87092

POSTTHROMBOTIC SYNDROME W OTH COMPLICATIONS OF L LOW EXTREM

S63301A

TRAUMATIC RUPTURE OF UNSP LIGAMENT OF RIGHT WRIST INIT

I87093

POSTTHROM SYNDROME W OTH COMP OF BILATERAL LOW EXTRM

S63302A

TRAUMATIC RUPTURE OF UNSP LIGAMENT OF LEFT WRIST INIT

I87099

POSTTHROM SYNDROME W OTH COMPLICATIONS OF UNSP LOW EXTRM

S63309A

TRAUMATIC RUPTURE OF UNSP LIGAMENT OF UNSP WRIST INIT

I871 COMPRESSION OF VEIN

S63311A TRAUMATIC RUPTURE OF COLLATERAL LIGAMENT OF R WRIST INIT

I872 VENOUS INSUFFICIENCY (CHRONIC) (PERIPHERAL)

S63312A

TRAUMATIC RUPTURE OF COLLATERAL LIGAMENT OF LEFT WRIST INIT

I87301

CHRONIC VENOUS HYPERTENSION W/O COMP OF R LOW EXTREM

S63319A

TRAUMATIC RUPTURE OF COLLATERAL LIGAMENT OF UNSP WRIST INIT

I87302

CHRONIC VENOUS HYPERTENSION W/O COMP OF L LOW EXTREM

S63321A

TRAUMATIC RUPTURE OF RIGHT RADIOCARPAL LIGAMENT INIT ENCNTR

I87303

CHRONIC VENOUS HYPERTENSION W/O COMP OF BILATERAL LOW EXTRM

S63322A

TRAUMATIC RUPTURE OF LEFT RADIOCARPAL LIGAMENT INIT ENCNTR

I87309

CHRONIC VENOUS HYPERTENSION W/O COMP OF UNSP LOW EXTRM

S63329A

TRAUMATIC RUPTURE OF UNSP RADIOCARPAL LIGAMENT INIT ENCNTR

I87311

CHRONIC VENOUS HYPERTENSION W ULCER OF R LOW EXTREM

S63331A

TRAUM RUPTURE OF RIGHT ULNOCARPAL (PALMAR) LIGAMENT INIT

Page 212: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I87312

CHRONIC VENOUS HYPERTENSION W ULCER OF L LOW EXTREM

S63332A

TRAUMATIC RUPTURE OF LEFT ULNOCARPAL (PALMAR) LIGAMENT INIT

I87313

CHRONIC VENOUS HYPERTENSION W ULCER OF BILATERAL LOW EXTRM

S63339A

TRAUMATIC RUPTURE OF UNSP ULNOCARPAL (PALMAR) LIGAMENT INIT

I87319

CHRONIC VENOUS HYPERTENSION W ULCER OF UNSP LOW EXTRM

S63391A

TRAUMATIC RUPTURE OF OTH LIGAMENT OF RIGHT WRIST INIT

I87321

CHRONIC VENOUS HYPERTENSION W INFLAMMATION OF R LOW EXTREM

S63392A

TRAUMATIC RUPTURE OF OTH LIGAMENT OF LEFT WRIST INIT ENCNTR

I87322

CHRONIC VENOUS HYPERTENSION W INFLAMMATION OF L LOW EXTREM

S63399A

TRAUMATIC RUPTURE OF OTH LIGAMENT OF UNSP WRIST INIT ENCNTR

I87323

CHRONIC VENOUS HTN W INFLAMMATION OF BILATERAL LOW EXTRM

S63400A

TRAUM RUPTURE OF UNSP LIGMT OF R IDX FNGR AT MCP/IP JT INIT

I87329

CHRONIC VENOUS HYPERTENSION W INFLAMMATION OF UNSP LOW EXTRM

S63401A

TRAUM RUPTURE OF UNSP LIGMT OF L IDX FNGR AT MCP/IP JT INIT

I87331

CHRONIC VENOUS HTN W ULCER AND INFLAMMATION OF R LOW EXTREM

S63402A

TRAUM RUPT OF UNSP LIGMT OF R MID FINGER AT MCP/IP JT INIT

I87332

CHRONIC VENOUS HTN W ULCER AND INFLAMMATION OF L LOW EXTREM

S63403A

TRAUM RUPT OF UNSP LIGMT OF L MID FINGER AT MCP/IP JT INIT

I87333

CHRONIC VENOUS HTN W ULCER AND INFLAM OF BILATERAL LOW EXTRM

S63404A

TRAUM RUPTURE OF UNSP LIGMT OF R RNG FNGR AT MCP/IP JT INIT

I87339

CHRONIC VENOUS HTN W ULCER AND INFLAM OF UNSP LOW EXTRM

S63405A

TRAUM RUPTURE OF UNSP LIGMT OF L RNG FNGR AT MCP/IP JT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I87391

CHRONIC VENOUS HYPERTENSION W OTH COMP OF R LOW EXTREM

S63406A

TRAUM RUPT OF UNSP LIGMT OF R LITTLE FNGR AT MCP/IP JT INIT

I87392

CHRONIC VENOUS HYPERTENSION W OTH COMP OF L LOW EXTREM

S63407A

TRAUM RUPT OF UNSP LIGMT OF L LITTLE FNGR AT MCP/IP JT INIT

I87393

CHRONIC VENOUS HTN W OTH COMP OF BILATERAL LOW EXTRM

S63408A

TRAUM RUPTURE OF UNSP LIGAMENT OF FINGER AT MCP/IP JT INIT

I87399

CHRONIC VENOUS HYPERTENSION W OTH COMP OF UNSP LOW EXTRM

S63409A

TRAUM RUPT OF UNSP LIGMT OF UNSP FINGER AT MCP/IP JT INIT

I878 OTHER SPECIFIED DISORDERS OF VEINS

S63410A

TRAUM RUPT OF COLLAT LIGMT OF R IDX FNGR AT MCP/IP JT INIT

I879 DISORDER OF VEIN UNSPECIFIED

S63411A

TRAUM RUPT OF COLLAT LIGMT OF L IDX FNGR AT MCP/IP JT INIT

I880 NONSPECIFIC MESENTERIC LYMPHADENITIS

S63412A

TRAUM RUPT OF COLLAT LIGMT OF R MID FNGR AT MCP/IP JT INIT

I881 CHRONIC LYMPHADENITIS EXCEPT MESENTERIC

S63413A

TRAUM RUPT OF COLLAT LIGMT OF L MID FNGR AT MCP/IP JT INIT

I888 OTHER NONSPECIFIC LYMPHADENITIS

S63414A

TRAUM RUPT OF COLLAT LIGMT OF R RNG FNGR AT MCP/IP JT INIT

I889 NONSPECIFIC LYMPHADENITIS UNSPECIFIED

S63415A

TRAUM RUPT OF COLLAT LIGMT OF L RNG FNGR AT MCP/IP JT INIT

I890 LYMPHEDEMA NOT ELSEWHERE CLASSIFIED

S63416A

TRAUM RUPT OF COLLAT LIGMT OF R LIT FNGR AT MCP/IP JT INIT

I891 LYMPHANGITIS

S63417A TRAUM RUPT OF COLLAT LIGMT OF L LIT FNGR AT MCP/IP JT INIT

I898

OTH NONINFECTIVE DISORDERS OF LYMPHATIC VESSELS AND NODES

S63418A

TRAUM RUPTURE OF COLLAT LIGMT OF FINGER AT MCP/IP JT INIT

I899

NONINFECTIVE DISORDER OF LYMPHATIC VESSELS AND NODES UNSP

S63419A

TRAUM RUPT OF COLLAT LIGMT OF UNSP FINGER AT MCP/IP JT INIT

I950 IDIOPATHIC HYPOTENSION

S63420A TRAUM RUPT OF PALMAR LIGMT OF R IDX FNGR AT MCP/IP JT INIT

Page 214: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I951 ORTHOSTATIC HYPOTENSION

S63421A TRAUM RUPT OF PALMAR LIGMT OF L IDX FNGR AT MCP/IP JT INIT

I952 HYPOTENSION DUE TO DRUGS

S63422A TRAUM RUPT OF PALMAR LIGMT OF R MID FNGR AT MCP/IP JT INIT

I953 HYPOTENSION OF HEMODIALYSIS

S63423A

TRAUM RUPT OF PALMAR LIGMT OF L MID FNGR AT MCP/IP JT INIT

I9581 POSTPROCEDURAL HYPOTENSION

S63424A

TRAUM RUPT OF PALMAR LIGMT OF R RNG FNGR AT MCP/IP JT INIT

I9589 OTHER HYPOTENSION

S63425A TRAUM RUPT OF PALMAR LIGMT OF L RNG FNGR AT MCP/IP JT INIT

I959 HYPOTENSION UNSPECIFIED

S63426A TRAUM RUPT OF PALMAR LIGMT OF R LIT FNGR AT MCP/IP JT INIT

I96 GANGRENE NOT ELSEWHERE CLASSIFIED

S63427A

TRAUM RUPT OF PALMAR LIGMT OF L LIT FNGR AT MCP/IP JT INIT

I970 POSTCARDIOTOMY SYNDROME

S63428A TRAUM RUPTURE OF PALMAR LIGMT OF FINGER AT MCP/IP JT INIT

I97110

POSTPROC CARDIAC INSUFFICIENCY FOLLOWING CARDIAC SURGERY

S63429A

TRAUM RUPT OF PALMAR LIGMT OF UNSP FINGER AT MCP/IP JT INIT

I97111

POSTPROCEDURAL CARDIAC INSUFFICIENCY FOLLOWING OTHER SURGERY

S63430A

TRAUM RUPT OF VOLAR PLATE OF R IDX FNGR AT MCP/IP JT INIT

I97120

POSTPROCEDURAL CARDIAC ARREST FOLLOWING CARDIAC SURGERY

S63431A

TRAUM RUPT OF VOLAR PLATE OF L IDX FNGR AT MCP/IP JT INIT

I97121

POSTPROCEDURAL CARDIAC ARREST FOLLOWING OTHER SURGERY

S63433A

TRAUM RUPT OF VOLAR PLATE OF L MID FINGER AT MCP/IP JT INIT

I97130

POSTPROCEDURAL HEART FAILURE FOLLOWING CARDIAC SURGERY

S63434A

TRAUM RUPT OF VOLAR PLATE OF R RNG FNGR AT MCP/IP JT INIT

I97131

POSTPROCEDURAL HEART FAILURE FOLLOWING OTHER SURGERY

S63435A

TRAUM RUPT OF VOLAR PLATE OF L RNG FNGR AT MCP/IP JT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I97190

OTH POSTPROC CARDIAC FUNCTN DISTURB FOL CARDIAC SURGERY

S63437A

TRAUM RUPT OF VOLAR PLATE OF L LIT FNGR AT MCP/IP JT INIT

I97191

OTH POSTPROC CARDIAC FUNCTN DISTURB FOLLOWING OTH SURGERY

S63438A

TRAUM RUPTURE OF VOLAR PLATE OF FINGER AT MCP/IP JT INIT

I972 POSTMASTECTOMY LYMPHEDEMA SYNDROME

S63439A

TRAUM RUPT OF VOLAR PLATE OF UNSP FINGER AT MCP/IP JT INIT

I973 POSTPROCEDURAL HYPERTENSION

S63490A

TRAUM RUPTURE OF LIGAMENT OF R IDX FNGR AT MCP/IP JT INIT

I97410

INTRAOPERATIVE HEMOR/HEMTOM OF A CIRC SYS ORG COMP CARD CATH

S63491A

TRAUM RUPTURE OF LIGAMENT OF L IDX FNGR AT MCP/IP JT INIT

I97411

INTRAOP HEMOR/HEMTOM OF A CIRC SYS ORG COMP CARD BYPASS

S63492A

TRAUM RUPTURE OF LIGAMENT OF R MID FINGER AT MCP/IP JT INIT

I97418

INTRAOP HEMOR/HEMTOM OF CIRC SYS ORG COMP OTH CIRC SYS PROC

S63493A

TRAUM RUPTURE OF LIGAMENT OF L MID FINGER AT MCP/IP JT INIT

I9742

INTRAOP HEMOR/HEMTOM OF A CIRC SYS ORG COMP OTH PROCEDURE

S63494A

TRAUM RUPTURE OF LIGAMENT OF R RNG FNGR AT MCP/IP JT INIT

I9751

ACC PNCTR & LAC OF A CIRC SYS ORG DURING A CIRC SYS PROC

S63495A

TRAUM RUPTURE OF LIGAMENT OF L RNG FNGR AT MCP/IP JT INIT

I9752

ACC PNCTR & LAC OF A CIRC SYS ORG DURING OTH PROCEDURE

S63496A

TRAUM RUPTURE OF LIGMT OF R LITTLE FINGER AT MCP/IP JT INIT

I97610

POSTPROC HEMOR/HEMTOM OF A CIRC SYS ORG FOL A CARDIAC CATH

S63497A

TRAUM RUPTURE OF LIGMT OF L LITTLE FINGER AT MCP/IP JT INIT

I97611

POSTPROC HEMOR/HEMTOM OF A CIRC SYS ORG FOL CARDIAC BYPASS

S63498A

TRAUMATIC RUPTURE OF LIGAMENT OF FINGER AT MCP/IP JT INIT

I97618

POSTPROC HEMOR/HEMTOM OF CIRC SYS ORG FOL OTH CIRC SYS PROC

S63499A

TRAUM RUPTURE OF LIGAMENT OF UNSP FINGER AT MCP/IP JT INIT

Page 216: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I9762

POSTPROC HEMOR/HEMTOM OF A CIRC SYS ORG FOL OTH PROCEDURE

S63501A

UNSPECIFIED SPRAIN OF RIGHT WRIST INITIAL ENCOUNTER

I97620

Postprocedural hemorrhage of a circulatory system organ or structure following other procedure

S63502A

UNSPECIFIED SPRAIN OF LEFT WRIST INITIAL ENCOUNTER

I97621

Postprocedural hematoma of a circulatory system organ or structure following other procedure

S63509A

UNSPECIFIED SPRAIN OF UNSPECIFIED WRIST INITIAL ENCOUNTER

I97622

Postprocedural seroma of a circulatory system organ or structure following other procedure

S63511A

SPRAIN OF CARPAL JOINT OF RIGHT WRIST INITIAL ENCOUNTER

I97630

Postprocedural hematoma of a circulatory system organ or structure following a cardiac catheterization

S63512A

SPRAIN OF CARPAL JOINT OF LEFT WRIST INITIAL ENCOUNTER

I97631

Postprocedural hematoma of a circulatory system organ or structure following cardiac bypass

S63521A

SPRAIN OF RADIOCARPAL JOINT OF RIGHT WRIST INIT ENCNTR

I97638

Postprocedural hematoma of a circulatory system organ or structure following other circulatory system procedure

S63522A

SPRAIN OF RADIOCARPAL JOINT OF LEFT WRIST INITIAL ENCOUNTER

I97640

Postprocedural seroma of a circulatory system organ or structure following a cardiac catheterization

S63591A

OTHER SPECIFIED SPRAIN OF RIGHT WRIST INITIAL ENCOUNTER

I97641

Postprocedural seroma of a circulatory system organ or structure following cardiac bypass

S63592A

OTHER SPECIFIED SPRAIN OF LEFT WRIST INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I97648

Postprocedural seroma of a circulatory system organ or structure following other circulatory system procedure

S63601A

UNSPECIFIED SPRAIN OF RIGHT THUMB INITIAL ENCOUNTER

I97710

INTRAOPERATIVE CARDIAC ARREST DURING CARDIAC SURGERY

S63602D

UNSPECIFIED SPRAIN OF LEFT THUMB SUBSEQUENT ENCOUNTER

I97711

INTRAOPERATIVE CARDIAC ARREST DURING OTHER SURGERY

S63609A

UNSPECIFIED SPRAIN OF UNSPECIFIED THUMB INITIAL ENCOUNTER

I97790

OTH INTRAOP CARDIAC FUNCTN DISTURB DURING CARDIAC SURGERY

S63610A

UNSPECIFIED SPRAIN OF RIGHT INDEX FINGER INITIAL ENCOUNTER

I97791

OTH INTRAOP CARDIAC FUNCTIONAL DISTURB DURING OTH SURGERY

S63611A

UNSPECIFIED SPRAIN OF LEFT INDEX FINGER INITIAL ENCOUNTER

I97810

INTRAOPERATIVE CEREBVASC INFARCTION DURING CARDIAC SURGERY

S63612A

UNSPECIFIED SPRAIN OF RIGHT MIDDLE FINGER INITIAL ENCOUNTER

I97811

INTRAOPERATIVE CEREBROVASCULAR INFARCTION DURING OTH SURGERY

S63613A

UNSPECIFIED SPRAIN OF LEFT MIDDLE FINGER INITIAL ENCOUNTER

I97820

POSTPROCEDURAL CEREBVASC INFARCTION DURING CARDIAC SURGERY

S63614A

UNSPECIFIED SPRAIN OF RIGHT RING FINGER INITIAL ENCOUNTER

I97821

POSTPROCEDURAL CEREBROVASCULAR INFARCTION DURING OTH SURGERY

S63615A

UNSPECIFIED SPRAIN OF LEFT RING FINGER INITIAL ENCOUNTER

I9788

OTH INTRAOPERATIVE COMPLICATIONS OF THE CIRC SYS NEC

S63616A

UNSPECIFIED SPRAIN OF RIGHT LITTLE FINGER INITIAL ENCOUNTER

I9789

OTH POSTPROC COMP AND DISORDERS OF THE CIRC SYS NEC

S63617A

UNSPECIFIED SPRAIN OF LEFT LITTLE FINGER INITIAL ENCOUNTER

I998 OTHER DISORDER OF CIRCULATORY SYSTEM

S63618A

UNSPECIFIED SPRAIN OF OTHER FINGER INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

I999 UNSPECIFIED DISORDER OF CIRCULATORY SYSTEM

S63619A

UNSPECIFIED SPRAIN OF UNSPECIFIED FINGER INITIAL ENCOUNTER

J00 ACUTE NASOPHARYNGITIS [COMMON COLD]

S63621A

SPRAIN OF INTERPHALANGEAL JOINT OF RIGHT THUMB INIT ENCNTR

J0100 ACUTE MAXILLARY SINUSITIS UNSPECIFIED

S63622A

SPRAIN OF INTERPHALANGEAL JOINT OF LEFT THUMB INIT ENCNTR

J0101 ACUTE RECURRENT MAXILLARY SINUSITIS

S63630A

SPRAIN OF INTERPHALANGEAL JOINT OF RIGHT INDEX FINGER INIT

J0110 ACUTE FRONTAL SINUSITIS UNSPECIFIED

S63631A

SPRAIN OF INTERPHALANGEAL JOINT OF LEFT INDEX FINGER INIT

J0111 ACUTE RECURRENT FRONTAL SINUSITIS

S63632A

SPRAIN OF INTERPHALANGEAL JOINT OF RIGHT MIDDLE FINGER INIT

J0120 ACUTE ETHMOIDAL SINUSITIS UNSPECIFIED

S63633A

SPRAIN OF INTERPHALANGEAL JOINT OF LEFT MIDDLE FINGER INIT

J0121 ACUTE RECURRENT ETHMOIDAL SINUSITIS

S63634A

SPRAIN OF INTERPHALANGEAL JOINT OF RIGHT RING FINGER INIT

J0130 ACUTE SPHENOIDAL SINUSITIS UNSPECIFIED

S63635A

SPRAIN OF INTERPHALANGEAL JOINT OF LEFT RING FINGER INIT

J0131 ACUTE RECURRENT SPHENOIDAL SINUSITIS

S63636A

SPRAIN OF INTERPHALANGEAL JOINT OF RIGHT LITTLE FINGER INIT

J0140 ACUTE PANSINUSITIS UNSPECIFIED

S63637A

SPRAIN OF INTERPHALANGEAL JOINT OF LEFT LITTLE FINGER INIT

J0141 ACUTE RECURRENT PANSINUSITIS

S63638A

SPRAIN OF INTERPHALANGEAL JOINT OF OTHER FINGER INIT ENCNTR

J0180 OTHER ACUTE SINUSITIS

S63641A SPRAIN OF METACARPOPHALANGEAL JOINT OF RIGHT THUMB INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J0181 OTHER ACUTE RECURRENT SINUSITIS

S63642A

SPRAIN OF METACARPOPHALANGEAL JOINT OF LEFT THUMB INIT

J0190 ACUTE SINUSITIS UNSPECIFIED

S63650A SPRAIN OF MCP JOINT OF RIGHT INDEX FINGER INIT

J0191 ACUTE RECURRENT SINUSITIS UNSPECIFIED

S63651A

SPRAIN OF MCP JOINT OF LEFT INDEX FINGER INIT

J020 STREPTOCOCCAL PHARYNGITIS

S63652A SPRAIN OF MCP JOINT OF RIGHT MIDDLE FINGER INIT

J0410 ACUTE TRACHEITIS WITHOUT OBSTRUCTION

S63653A

SPRAIN OF MCP JOINT OF LEFT MIDDLE FINGER INIT

J0411 ACUTE TRACHEITIS WITH OBSTRUCTION

S63654A

SPRAIN OF MCP JOINT OF RIGHT RING FINGER INIT

J042 ACUTE LARYNGOTRACHEITIS

S63655A SPRAIN OF MCP JOINT OF LEFT RING FINGER INIT

J0430 SUPRAGLOTTITIS UNSPECIFIED WITHOUT OBSTRUCTION

S63656A

SPRAIN OF MCP JOINT OF RIGHT LITTLE FINGER INIT

J0431 SUPRAGLOTTITIS UNSPECIFIED WITH OBSTRUCTION

S63657A

SPRAIN OF MCP JOINT OF LEFT LITTLE FINGER INIT

J050 ACUTE OBSTRUCTIVE LARYNGITIS [CROUP]

S63658A

SPRAIN OF METACARPOPHALANGEAL JOINT OF OTH FINGER INIT

J0510 ACUTE EPIGLOTTITIS WITHOUT OBSTRUCTION

S63681A

OTHER SPRAIN OF RIGHT THUMB INITIAL ENCOUNTER

J0511 ACUTE EPIGLOTTITIS WITH OBSTRUCTION

S63682A

OTHER SPRAIN OF LEFT THUMB INITIAL ENCOUNTER

J060 ACUTE LARYNGOPHARYNGITIS

S63690A OTHER SPRAIN OF RIGHT INDEX FINGER INITIAL ENCOUNTER

J069 ACUTE UPPER RESPIRATORY INFECTION UNSPECIFIED

S63691A

OTHER SPRAIN OF LEFT INDEX FINGER INITIAL ENCOUNTER

J102

INFLUENZA DUE TO OTH IDENT INFLUENZA VIRUS W GI MANIFEST

S63692A

OTHER SPRAIN OF RIGHT MIDDLE FINGER INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J1081

INFLUENZA DUE TO OTH IDENT INFLUENZA VIRUS W ENCEPHALOPATHY

S63693A

OTHER SPRAIN OF LEFT MIDDLE FINGER INITIAL ENCOUNTER

J1082

INFLUENZA DUE TO OTH IDENT INFLUENZA VIRUS W MYOCARDITIS

S63694A

OTHER SPRAIN OF RIGHT RING FINGER INITIAL ENCOUNTER

J1083

INFLUENZA DUE TO OTH IDENT INFLUENZA VIRUS W OTITIS MEDIA

S63695A

OTHER SPRAIN OF LEFT RING FINGER INITIAL ENCOUNTER

J1089

INFLUENZA DUE TO OTH IDENT INFLUENZA VIRUS W OTH MANIFEST

S63696A

OTHER SPRAIN OF RIGHT LITTLE FINGER INITIAL ENCOUNTER

J1100

FLU DUE TO UNIDENTIFIED FLU VIRUS W UNSP TYPE OF PNEUMONIA

S63697A

OTHER SPRAIN OF LEFT LITTLE FINGER INITIAL ENCOUNTER

J1108

FLU DUE TO UNIDENTIFIED FLU VIRUS W SPECIFIED PNEUMONIA

S63698A

OTHER SPRAIN OF OTHER FINGER INITIAL ENCOUNTER

J111

FLU DUE TO UNIDENTIFIED INFLUENZA VIRUS W OTH RESP MANIFEST

S638X1A

SPRAIN OF OTHER PART OF RIGHT WRIST AND HAND INIT ENCNTR

J112

INFLUENZA DUE TO UNIDENTIFIED INFLUENZA VIRUS W GI MANIFEST

S638X2A

SPRAIN OF OTHER PART OF LEFT WRIST AND HAND INIT ENCNTR

J1181

FLU DUE TO UNIDENTIFIED INFLUENZA VIRUS W ENCEPHALOPATHY

S6391XA

SPRAIN OF UNSP PART OF RIGHT WRIST AND HAND INIT ENCNTR

J1182

INFLUENZA DUE TO UNIDENTIFIED INFLUENZA VIRUS W MYOCARDITIS

S6392XA

SPRAIN OF UNSP PART OF LEFT WRIST AND HAND INIT ENCNTR

J1183

INFLUENZA DUE TO UNIDENTIFIED INFLUENZA VIRUS W OTITIS MEDIA

S6400XA

INJURY OF ULNAR NERVE AT WRS/HND LV OF UNSP ARM INIT

J1189

INFLUENZA DUE TO UNIDENTIFIED INFLUENZA VIRUS W OTH MANIFEST

S6401XA

INJURY OF ULNAR NERVE AT WRS/HND LV OF RIGHT ARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J120 ADENOVIRAL PNEUMONIA

S6402XA INJURY OF ULNAR NERVE AT WRS/HND LV OF LEFT ARM INIT

J121 RESPIRATORY SYNCYTIAL VIRUS PNEUMONIA

S6411XD

INJURY OF MEDIAN NERVE AT WRS/HND LV OF RIGHT ARM SUBS

J122 PARAINFLUENZA VIRUS PNEUMONIA

S6412XA

INJURY OF MEDIAN NERVE AT WRS/HND LV OF LEFT ARM INIT

J123 HUMAN METAPNEUMOVIRUS PNEUMONIA

S6421XA

INJURY OF RADIAL NERVE AT WRS/HND LV OF RIGHT ARM INIT

J1281 PNEUMONIA DUE TO SARS-ASSOCIATED CORONAVIRUS

S6422XA

INJURY OF RADIAL NERVE AT WRS/HND LV OF LEFT ARM INIT

J1289 OTHER VIRAL PNEUMONIA

S6430XA INJURY OF DIGITAL NERVE OF UNSPECIFIED THUMB INIT ENCNTR

J129 VIRAL PNEUMONIA UNSPECIFIED

S6431XA

INJURY OF DIGITAL NERVE OF RIGHT THUMB INITIAL ENCOUNTER

J13 PNEUMONIA DUE TO STREPTOCOCCUS PNEUMONIAE

S6432XA

INJURY OF DIGITAL NERVE OF LEFT THUMB INITIAL ENCOUNTER

J14 PNEUMONIA DUE TO HEMOPHILUS INFLUENZAE

S64490A

INJURY OF DIGITAL NERVE OF RIGHT INDEX FINGER INIT ENCNTR

J150 PNEUMONIA DUE TO KLEBSIELLA PNEUMONIAE

S64491D

INJURY OF DIGITAL NERVE OF LEFT INDEX FINGER SUBS ENCNTR

J151 PNEUMONIA DUE TO PSEUDOMONAS

S64492A

INJURY OF DIGITAL NERVE OF RIGHT MIDDLE FINGER INIT ENCNTR

J1520

PNEUMONIA DUE TO STAPHYLOCOCCUS UNSPECIFIED

S64493A

INJURY OF DIGITAL NERVE OF LEFT MIDDLE FINGER INIT ENCNTR

J1529 PNEUMONIA DUE TO OTHER STAPHYLOCOCCUS

S64494A

INJURY OF DIGITAL NERVE OF RIGHT RING FINGER INIT ENCNTR

J153 PNEUMONIA DUE TO STREPTOCOCCUS GROUP B

S64495A

INJURY OF DIGITAL NERVE OF LEFT RING FINGER INIT ENCNTR

J154 PNEUMONIA DUE TO OTHER STREPTOCOCCI

S64496A

INJURY OF DIGITAL NERVE OF RIGHT LITTLE FINGER INIT ENCNTR

J155 PNEUMONIA DUE TO ESCHERICHIA COLI

S64497A

INJURY OF DIGITAL NERVE OF LEFT LITTLE FINGER INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J156

PNEUMONIA DUE TO OTHER AEROBIC GRAM-NEGATIVE BACTERIA

S64498A

INJURY OF DIGITAL NERVE OF OTHER FINGER INITIAL ENCOUNTER

J157 PNEUMONIA DUE TO MYCOPLASMA PNEUMONIAE

S648X1A

INJURY OF NERVES AT WRIST AND HAND LEVEL OF RIGHT ARM INIT

J158 PNEUMONIA DUE TO OTHER SPECIFIED BACTERIA

S648X2A

INJURY OF NERVES AT WRIST AND HAND LEVEL OF LEFT ARM INIT

J159 UNSPECIFIED BACTERIAL PNEUMONIA

S6491XA

INJURY OF UNSP NERVE AT WRS/HND LV OF RIGHT ARM INIT

J160 CHLAMYDIAL PNEUMONIA

S6492XA INJURY OF UNSP NERVE AT WRS/HND LV OF LEFT ARM INIT

J168

PNEUMONIA DUE TO OTHER SPECIFIED INFECTIOUS ORGANISMS

S65011A

LACERATION OF ULNAR ARTERY AT WRS/HND LV OF RIGHT ARM INIT

J17 PNEUMONIA IN DISEASES CLASSIFIED ELSEWHERE

S65012A

LACERATION OF ULNAR ARTERY AT WRS/HND LV OF LEFT ARM INIT

J180 BRONCHOPNEUMONIA UNSPECIFIED ORGANISM

S65019A

LACERATION OF ULNAR ARTERY AT WRS/HND LV OF UNSP ARM INIT

J181 LOBAR PNEUMONIA UNSPECIFIED ORGANISM

S65111A

LACERATION OF RADIAL ARTERY AT WRS/HND LV OF RIGHT ARM INIT

J182 HYPOSTATIC PNEUMONIA UNSPECIFIED ORGANISM

S65112A

LACERATION OF RADIAL ARTERY AT WRS/HND LV OF LEFT ARM INIT

J188 OTHER PNEUMONIA UNSPECIFIED ORGANISM

S65119A

LACERATION OF RADIAL ARTERY AT WRS/HND LV OF UNSP ARM INIT

J189 PNEUMONIA UNSPECIFIED ORGANISM

S65211A

LACERATION OF SUPERFICIAL PALMAR ARCH OF RIGHT HAND INIT

J200 ACUTE BRONCHITIS DUE TO MYCOPLASMA PNEUMONIAE

S65212A

LACERATION OF SUPERFICIAL PALMAR ARCH OF LEFT HAND INIT

J201 ACUTE BRONCHITIS DUE TO HEMOPHILUS INFLUENZAE

S65219A

LACERATION OF SUPERFICIAL PALMAR ARCH OF UNSP HAND INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J202 ACUTE BRONCHITIS DUE TO STREPTOCOCCUS

S65311A

LACERATION OF DEEP PALMAR ARCH OF RIGHT HAND INIT ENCNTR

J203 ACUTE BRONCHITIS DUE TO COXSACKIEVIRUS

S65312A

LACERATION OF DEEP PALMAR ARCH OF LEFT HAND INIT ENCNTR

J204 ACUTE BRONCHITIS DUE TO PARAINFLUENZA VIRUS

S65319A

LACERATION OF DEEP PALMAR ARCH OF UNSP HAND INIT ENCNTR

J205 ACUTE BRONCHITIS DUE TO RESPIRATORY SYNCYTIAL VIRUS

S65411A

LACERATION OF BLOOD VESSEL OF RIGHT THUMB INITIAL ENCOUNTER

J206 ACUTE BRONCHITIS DUE TO RHINOVIRUS

S65412A

LACERATION OF BLOOD VESSEL OF LEFT THUMB INITIAL ENCOUNTER

J207 ACUTE BRONCHITIS DUE TO ECHOVIRUS

S65419A

LACERATION OF BLOOD VESSEL OF UNSPECIFIED THUMB INIT ENCNTR

J208 ACUTE BRONCHITIS DUE TO OTHER SPECIFIED ORGANISMS

S65510A

LACERATION OF BLOOD VESSEL OF RIGHT INDEX FINGER INIT

J209 ACUTE BRONCHITIS UNSPECIFIED

S65511A

LACERATION OF BLOOD VESSEL OF LEFT INDEX FINGER INIT ENCNTR

J210 ACUTE BRONCHIOLITIS DUE TO RESPIRATORY SYNCYTIAL VIRUS

S65512A

LACERATION OF BLOOD VESSEL OF RIGHT MIDDLE FINGER INIT

J211 ACUTE BRONCHIOLITIS DUE TO HUMAN METAPNEUMOVIRUS

S65513A

LACERATION OF BLOOD VESSEL OF LEFT MIDDLE FINGER INIT

J218 ACUTE BRONCHIOLITIS DUE TO OTHER SPECIFIED ORGANISMS

S65514A

LACERATION OF BLOOD VESSEL OF RIGHT RING FINGER INIT ENCNTR

J219 ACUTE BRONCHIOLITIS UNSPECIFIED

S65515A

LACERATION OF BLOOD VESSEL OF LEFT RING FINGER INIT ENCNTR

J22 UNSPECIFIED ACUTE LOWER RESPIRATORY INFECTION

S65516A

LACERATION OF BLOOD VESSEL OF RIGHT LITTLE FINGER INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J300 VASOMOTOR RHINITIS

S65517A LACERATION OF BLOOD VESSEL OF LEFT LITTLE FINGER INIT

J301 ALLERGIC RHINITIS DUE TO POLLEN

S65518A

LACERATION OF BLOOD VESSEL OF OTHER FINGER INIT ENCNTR

J302 OTHER SEASONAL ALLERGIC RHINITIS

S65519A

LACERATION OF BLOOD VESSEL OF UNSP FINGER INIT ENCNTR

J305 ALLERGIC RHINITIS DUE TO FOOD

S65811A

LACERATION OF BLOOD VESSELS AT WRS/HND LV OF RIGHT ARM INIT

J3081

ALLERGIC RHINITIS DUE TO ANIMAL (CAT) (DOG) HAIR AND DANDER

S65812A

LACERATION OF BLOOD VESSELS AT WRS/HND LV OF LEFT ARM INIT

J3501 CHRONIC TONSILLITIS

S65819A LACERATION OF BLOOD VESSELS AT WRS/HND LV OF UNSP ARM INIT

J3502 CHRONIC ADENOIDITIS

S65911A LACERAT UNSP BLOOD VESSEL AT WRS/HND LV OF RIGHT ARM INIT

J3503 CHRONIC TONSILLITIS AND ADENOIDITIS

S65912A

LACERAT UNSP BLOOD VESSEL AT WRS/HND LV OF LEFT ARM INIT

J351 HYPERTROPHY OF TONSILS

S65919A LACERAT UNSP BLOOD VESSEL AT WRS/HND LV OF UNSP ARM INIT

J352 HYPERTROPHY OF ADENOIDS

S66011A

STRAIN LONG FLEXOR MUSC/FASC/TEND R THM AT WRS/HND LV INIT

J353

HYPERTROPHY OF TONSILS WITH HYPERTROPHY OF ADENOIDS

S66012A

STRAIN LONG FLEXOR MUSC/FASC/TEND L THM AT WRS/HND LV INIT

J358 OTHER CHRONIC DISEASES OF TONSILS AND ADENOIDS

S66019A

STRAIN LONG FLEXOR MUSC/FASC/TEND THMB AT WRS/HND LV INIT

J359 CHRONIC DISEASE OF TONSILS AND ADENOIDS UNSPECIFIED

S66021A

LACERAT LONG FLEXOR MUSC/FASC/TEND R THM AT WRS/HND LV INIT

J36 PERITONSILLAR ABSCESS

S66022A

LACERAT LONG FLEXOR MUSC/FASC/TEND L THM AT WRS/HND LV INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J370 CHRONIC LARYNGITIS

S66029A

LACERAT LONG FLEXOR MUSC/FASC/TEND THMB AT WRS/HND LV INIT

J371 CHRONIC LARYNGOTRACHEITIS

S66110A STRAIN FLEXOR MUSC/FASC/TEND R IDX FNGR AT WRS/HND LV INIT

J3800 PARALYSIS OF VOCAL CORDS AND LARYNX UNSPECIFIED

S66111A

STRAIN FLEXOR MUSC/FASC/TEND L IDX FNGR AT WRS/HND LV INIT

J3801 PARALYSIS OF VOCAL CORDS AND LARYNX UNILATERAL

S66112A

STRAIN FLEXOR MUSC/FASC/TEND R MID FNGR AT WRS/HND LV INIT

J3802 PARALYSIS OF VOCAL CORDS AND LARYNX BILATERAL

S66113A

STRAIN FLEXOR MUSC/FASC/TEND L MID FNGR AT WRS/HND LV INIT

J381 POLYP OF VOCAL CORD AND LARYNX

S66114A

STRAIN FLEXOR MUSC/FASC/TEND R RNG FNGR AT WRS/HND LV INIT

J382 NODULES OF VOCAL CORDS

S66115A STRAIN FLEXOR MUSC/FASC/TEND L RNG FNGR AT WRS/HND LV INIT

J383 OTHER DISEASES OF VOCAL CORDS

S66116A

STRAIN FLXR MUSC/FASC/TEND R LITTLE FNGR AT WRS/HND LV INIT

J385 LARYNGEAL SPASM

S66117A STRAIN FLXR MUSC/FASC/TEND L LITTLE FNGR AT WRS/HND LV INIT

J386 STENOSIS OF LARYNX

S66118A STRAIN OF FLEXOR MUSC/FASC/TEND FINGER AT WRS/HND LV INIT

J387 OTHER DISEASES OF LARYNX

S66119A STRAIN FLEXOR MUSC/FASC/TEND UNSP FINGER AT WRS/HND LV INIT

J390 RETROPHARYNGEAL AND PARAPHARYNGEAL ABSCESS

S66120A

LACERAT FLEXOR MUSC/FASC/TEND R IDX FNGR AT WRS/HND LV INIT

J391 OTHER ABSCESS OF PHARYNX

S66121A LACERAT FLEXOR MUSC/FASC/TEND L IDX FNGR AT WRS/HND LV INIT

J392 OTHER DISEASES OF PHARYNX

S66122A LACERAT FLEXOR MUSC/FASC/TEND R MID FNGR AT WRS/HND LV INIT

J393

UPPER RESPIRATORY TRACT HYPERSENSITIVITY REACTION SITE UNSP

S66123A

LACERAT FLEXOR MUSC/FASC/TEND L MID FNGR AT WRS/HND LV INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J398 OTHER SPECIFIED DISEASES OF UPPER RESPIRATORY TRACT

S66124A

LACERAT FLEXOR MUSC/FASC/TEND R RNG FNGR AT WRS/HND LV INIT

J399

DISEASE OF UPPER RESPIRATORY TRACT UNSPECIFIED

S66125A

LACERAT FLEXOR MUSC/FASC/TEND L RNG FNGR AT WRS/HND LV INIT

J40 BRONCHITIS NOT SPECIFIED AS ACUTE OR CHRONIC

S66126A

LACERAT FLXR MUSC/FASC/TEND R LIT FNGR AT WRS/HND LV INIT

J410 SIMPLE CHRONIC BRONCHITIS

S66127A LACERAT FLXR MUSC/FASC/TEND L LIT FNGR AT WRS/HND LV INIT

J411 MUCOPURULENT CHRONIC BRONCHITIS

S66128A

LACERAT FLEXOR MUSC/FASC/TEND FINGER AT WRS/HND LV INIT

J418

MIXED SIMPLE AND MUCOPURULENT CHRONIC BRONCHITIS

S66129A

LACERAT FLEXOR MUSC/FASC/TEND UNSP FNGR AT WRS/HND LV INIT

J42 UNSPECIFIED CHRONIC BRONCHITIS

S66211A

STRAIN OF EXTENSOR MUSC/FASC/TEND R THM AT WRS/HND LV INIT

J430

UNILATERAL PULMONARY EMPHYSEMA [MACLEOD'S SYNDROME]

S66212A

STRAIN OF EXTENSOR MUSC/FASC/TEND L THM AT WRS/HND LV INIT

J4522 MILD INTERMITTENT ASTHMA WITH STATUS ASTHMATICUS

S66219A

STRAIN OF EXTENSOR MUSC/FASC/TEND THMB AT WRS/HND LV INIT

J4532 MILD PERSISTENT ASTHMA WITH STATUS ASTHMATICUS

S66221A

LACERAT EXTENSOR MUSC/FASC/TEND R THM AT WRS/HND LV INIT

J4542

MODERATE PERSISTENT ASTHMA WITH STATUS ASTHMATICUS

S66222A

LACERAT EXTENSOR MUSC/FASC/TEND L THM AT WRS/HND LV INIT

J4552 SEVERE PERSISTENT ASTHMA WITH STATUS ASTHMATICUS

S66229A

LACERAT EXTENSOR MUSC/FASC/TEND THMB AT WRS/HND LV INIT

J45902 UNSPECIFIED ASTHMA WITH STATUS ASTHMATICUS

S66310A

STRAIN EXTN MUSC/FASC/TEND R IDX FNGR AT WRS/HND LV INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J45909 UNSPECIFIED ASTHMA UNCOMPLICATED

S66311A

STRAIN EXTN MUSC/FASC/TEND L IDX FNGR AT WRS/HND LV INIT

J45990 EXERCISE INDUCED BRONCHOSPASM

S66312A

STRAIN EXTN MUSC/FASC/TEND R MID FINGER AT WRS/HND LV INIT

J45991 COUGH VARIANT ASTHMA

S66313A STRAIN EXTN MUSC/FASC/TEND L MID FINGER AT WRS/HND LV INIT

J45998 OTHER ASTHMA

S66314A STRAIN EXTN MUSC/FASC/TEND R RNG FNGR AT WRS/HND LV INIT

J470

BRONCHIECTASIS WITH ACUTE LOWER RESPIRATORY INFECTION

S66315A

STRAIN EXTN MUSC/FASC/TEND L RNG FNGR AT WRS/HND LV INIT

J471 BRONCHIECTASIS WITH (ACUTE) EXACERBATION

S66316A

STRAIN EXTN MUSC/FASC/TEND R LITTLE FNGR AT WRS/HND LV INIT

J479 BRONCHIECTASIS UNCOMPLICATED

S66317A

STRAIN EXTN MUSC/FASC/TEND L LITTLE FNGR AT WRS/HND LV INIT

J60 COALWORKER'S PNEUMOCONIOSIS

S66318A

STRAIN OF EXTENSOR MUSC/FASC/TEND FINGER AT WRS/HND LV INIT

J61

PNEUMOCONIOSIS DUE TO ASBESTOS AND OTHER MINERAL FIBERS

S66319A

STRAIN EXTN MUSC/FASC/TEND UNSP FINGER AT WRS/HND LV INIT

J620 PNEUMOCONIOSIS DUE TO TALC DUST

S66320A

LACERAT EXTN MUSC/FASC/TEND R IDX FNGR AT WRS/HND LV INIT

J628

PNEUMOCONIOSIS DUE TO OTHER DUST CONTAINING SILICA

S66321A

LACERAT EXTN MUSC/FASC/TEND L IDX FNGR AT WRS/HND LV INIT

J630 ALUMINOSIS (OF LUNG)

S66322A LACERAT EXTN MUSC/FASC/TEND R MID FINGER AT WRS/HND LV INIT

J631 BAUXITE FIBROSIS (OF LUNG)

S66323A LACERAT EXTN MUSC/FASC/TEND L MID FINGER AT WRS/HND LV INIT

J632 BERYLLIOSIS

S66324A LACERAT EXTN MUSC/FASC/TEND R RNG FNGR AT WRS/HND LV INIT

J633 GRAPHITE FIBROSIS (OF LUNG)

S66325A LACERAT EXTN MUSC/FASC/TEND L RNG FNGR AT WRS/HND LV INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J634 SIDEROSIS

S66326A LACERAT EXTN MUSC/FASC/TEND R LIT FNGR AT WRS/HND LV INIT

J635 STANNOSIS

S66327A LACERAT EXTN MUSC/FASC/TEND L LIT FNGR AT WRS/HND LV INIT

J636

PNEUMOCONIOSIS DUE TO OTHER SPECIFIED INORGANIC DUSTS

S66328A

LACERAT EXTENSOR MUSC/FASC/TEND FINGER AT WRS/HND LV INIT

J64 UNSPECIFIED PNEUMOCONIOSIS

S66329A

LACERAT EXTN MUSC/FASC/TEND UNSP FINGER AT WRS/HND LV INIT

J65 PNEUMOCONIOSIS ASSOCIATED WITH TUBERCULOSIS

S66411A

STRAIN OF INTRINSIC MUSC/FASC/TEND R THM AT WRS/HND LV INIT

J660 BYSSINOSIS

S66412A

STRAIN OF INTRINSIC MUSC/FASC/TEND L THM AT WRS/HND LV INIT

J661 FLAX-DRESSERS' DISEASE

S66419A

STRAIN OF INTRINSIC MUSC/FASC/TEND THMB AT WRS/HND LV INIT

J662 CANNABINOSIS

S66421A LACERAT INTRINSIC MUSC/FASC/TEND R THM AT WRS/HND LV INIT

J668

AIRWAY DISEASE DUE TO OTHER SPECIFIC ORGANIC DUSTS

S66422A

LACERAT INTRINSIC MUSC/FASC/TEND L THM AT WRS/HND LV INIT

J670 FARMER'S LUNG

S66429A LACERAT INTRINSIC MUSC/FASC/TEND THMB AT WRS/HND LV INIT

J671 BAGASSOSIS

S66510A STRAIN INTRNS MUSC/FASC/TEND R IDX FNGR AT WRS/HND LV INIT

J672 BIRD FANCIER'S LUNG

S66511A STRAIN INTRNS MUSC/FASC/TEND L IDX FNGR AT WRS/HND LV INIT

J673 SUBEROSIS

S66512A STRAIN INTRNS MUSC/FASC/TEND R MID FNGR AT WRS/HND LV INIT

J674 MALTWORKER'S LUNG

S66513A STRAIN INTRNS MUSC/FASC/TEND L MID FNGR AT WRS/HND LV INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J675 MUSHROOM-WORKER'S LUNG

S66514A STRAIN INTRNS MUSC/FASC/TEND R RNG FNGR AT WRS/HND LV INIT

J676 MAPLE-BARK-STRIPPER'S LUNG

S66515A STRAIN INTRNS MUSC/FASC/TEND L RNG FNGR AT WRS/HND LV INIT

J677 AIR CONDITIONER AND HUMIDIFIER LUNG

S66516A

STRAIN INTRNS MUSC/FASC/TEND R LIT FNGR AT WRS/HND LV INIT

J678

HYPERSENSITIVITY PNEUMONITIS DUE TO OTHER ORGANIC DUSTS

S66517A

STRAIN INTRNS MUSC/FASC/TEND L LIT FNGR AT WRS/HND LV INIT

J679

HYPERSENSITIVITY PNEUMONITIS DUE TO UNSPECIFIED ORGANIC DUST

S66518A

STRAIN OF INTRNS MUSC/FASC/TEND FINGER AT WRS/HND LV INIT

J680

BRONCHITIS & PNEUMONITIS D/T CHEMICALS GAS FUMES & VAPORS

S66519A

STRAIN INTRNS MUSC/FASC/TEND UNSP FINGER AT WRS/HND LV INIT

J681

PULMONARY EDEMA DUE TO CHEMICALS GASES FUMES AND VAPORS

S66520A

LACERAT INTRNS MUSC/FASC/TEND R IDX FNGR AT WRS/HND LV INIT

J682

UPPER RESP INFLAM D/T CHEMICALS GAS FUMES AND VAPORS NEC

S66521A

LACERAT INTRNS MUSC/FASC/TEND L IDX FNGR AT WRS/HND LV INIT

J683

OTH AC & SUBAC RESP COND D/T CHEMICALS GAS FUMES & VAPORS

S66522A

LACERAT INTRNS MUSC/FASC/TEND R MID FNGR AT WRS/HND LV INIT

J684

CHRONIC RESP COND DUE TO CHEMICALS GASES FUMES AND VAPORS

S66523A

LACERAT INTRNS MUSC/FASC/TEND L MID FNGR AT WRS/HND LV INIT

J688

OTH RESP COND DUE TO CHEMICALS GASES FUMES AND VAPORS

S66524A

LACERAT INTRNS MUSC/FASC/TEND R RNG FNGR AT WRS/HND LV INIT

J689

UNSP RESP COND DUE TO CHEMICALS GASES FUMES AND VAPORS

S66525A

LACERAT INTRNS MUSC/FASC/TEND L RNG FNGR AT WRS/HND LV INIT

J690

PNEUMONITIS DUE TO INHALATION OF FOOD AND VOMIT

S66526A

LACERAT INTRNS MUSC/FASC/TEND R LIT FNGR AT WRS/HND LV INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J691

PNEUMONITIS DUE TO INHALATION OF OILS AND ESSENCES

S66527A

LACERAT INTRNS MUSC/FASC/TEND L LIT FNGR AT WRS/HND LV INIT

J698

PNEUMONITIS DUE TO INHALATION OF OTHER SOLIDS AND LIQUIDS

S66528A

LACERAT INTRINSIC MUSC/FASC/TEND FINGER AT WRS/HND LV INIT

J700

ACUTE PULMONARY MANIFESTATIONS DUE TO RADIATION

S66529A

LACERAT INTRNS MUSC/FASC/TEND UNSP FNGR AT WRS/HND LV INIT

J701

CHRONIC AND OTHER PULMONARY MANIFESTATIONS DUE TO RADIATION

S66811A

STRAIN OF MUSC/FASC/TEND AT WRS/HND LV RIGHT HAND INIT

J702 ACUTE DRUG-INDUCED INTERSTITIAL LUNG DISORDERS

S66812A

STRAIN OF MUSC/FASC/TEND AT WRS/HND LV LEFT HAND INIT

J703 CHRONIC DRUG-INDUCED INTERSTITIAL LUNG DISORDERS

S66819A

STRAIN OF MUSC/FASC/TEND AT WRS/HND LV UNSP HAND INIT

J704 DRUG-INDUCED INTERSTITIAL LUNG DISORDERS UNSPECIFIED

S66821A

LACERATION OF MUSC/FASC/TEND AT WRS/HND LV RIGHT HAND INIT

J708 RESPIRATORY CONDITIONS DUE TO OTH EXTERNAL AGENTS

S66822A

LACERATION OF MUSC/FASC/TEND AT WRS/HND LV LEFT HAND INIT

J709

RESPIRATORY CONDITIONS DUE TO UNSPECIFIED EXTERNAL AGENT

S66829A

LACERATION OF MUSC/FASC/TEND AT WRS/HND LV UNSP HAND INIT

J80 ACUTE RESPIRATORY DISTRESS SYNDROME

S66911A

STRAIN OF UNSP MUSC/FASC/TEND AT WRS/HND LV R HAND INIT

J810 ACUTE PULMONARY EDEMA

S66912A STRAIN OF UNSP MUSC/FASC/TEND AT WRS/HND LV LEFT HAND INIT

J811 CHRONIC PULMONARY EDEMA

S66919A STRAIN OF UNSP MUSC/FASC/TEND AT WRS/HND LV UNSP HAND INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J82 PULMONARY EOSINOPHILIA NOT ELSEWHERE CLASSIFIED

S66921A

LACERAT UNSP MUSC/FASC/TEND AT WRS/HND LV RIGHT HAND INIT

J842 LYMPHOID INTERSTITIAL PNEUMONIA

S66922A

LACERAT UNSP MUSC/FASC/TEND AT WRS/HND LV LEFT HAND INIT

J849 INTERSTITIAL PULMONARY DISEASE UNSPECIFIED

S66929A

LACERAT UNSP MUSC/FASC/TEND AT WRS/HND LV UNSP HAND INIT

J850 GANGRENE AND NECROSIS OF LUNG

S6700XA

CRUSHING INJURY OF UNSPECIFIED THUMB INITIAL ENCOUNTER

J851 ABSCESS OF LUNG WITH PNEUMONIA

S6701XA

CRUSHING INJURY OF RIGHT THUMB INITIAL ENCOUNTER

J852 ABSCESS OF LUNG WITHOUT PNEUMONIA

S6702XA

CRUSHING INJURY OF LEFT THUMB INITIAL ENCOUNTER

J853 ABSCESS OF MEDIASTINUM

S6710XA CRUSHING INJURY OF UNSPECIFIED FINGER(S) INITIAL ENCOUNTER

J860 PYOTHORAX WITH FISTULA

S67190A CRUSHING INJURY OF RIGHT INDEX FINGER INITIAL ENCOUNTER

J869 PYOTHORAX WITHOUT FISTULA

S67191A CRUSHING INJURY OF LEFT INDEX FINGER INITIAL ENCOUNTER

J90 PLEURAL EFFUSION NOT ELSEWHERE CLASSIFIED

S67192A

CRUSHING INJURY OF RIGHT MIDDLE FINGER INITIAL ENCOUNTER

J910 MALIGNANT PLEURAL EFFUSION

S67193A

CRUSHING INJURY OF LEFT MIDDLE FINGER INITIAL ENCOUNTER

J918

PLEURAL EFFUSION IN OTHER CONDITIONS CLASSIFIED ELSEWHERE

S67194A

CRUSHING INJURY OF RIGHT RING FINGER INITIAL ENCOUNTER

J920 PLEURAL PLAQUE WITH PRESENCE OF ASBESTOS

S67195A

CRUSHING INJURY OF LEFT RING FINGER INITIAL ENCOUNTER

J929 PLEURAL PLAQUE WITHOUT ASBESTOS

S67196A

CRUSHING INJURY OF RIGHT LITTLE FINGER INITIAL ENCOUNTER

J930 SPONTANEOUS TENSION PNEUMOTHORAX

S67197A

CRUSHING INJURY OF LEFT LITTLE FINGER INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J939 PNEUMOTHORAX UNSPECIFIED

S67198A CRUSHING INJURY OF OTHER FINGER INITIAL ENCOUNTER

J940 CHYLOUS EFFUSION

S6720XA CRUSHING INJURY OF UNSPECIFIED HAND INITIAL ENCOUNTER

J941 FIBROTHORAX

S6721XA CRUSHING INJURY OF RIGHT HAND INITIAL ENCOUNTER

J942 HEMOTHORAX

S6722XA CRUSHING INJURY OF LEFT HAND INITIAL ENCOUNTER

J948 OTHER SPECIFIED PLEURAL CONDITIONS

S6730XA

CRUSHING INJURY OF UNSPECIFIED WRIST INITIAL ENCOUNTER

J949 PLEURAL CONDITION UNSPECIFIED

S6731XA

CRUSHING INJURY OF RIGHT WRIST INITIAL ENCOUNTER

J9500 UNSPECIFIED TRACHEOSTOMY COMPLICATION

S6732XA

CRUSHING INJURY OF LEFT WRIST INITIAL ENCOUNTER

J9501 HEMORRHAGE FROM TRACHEOSTOMY STOMA

S6740XA

CRUSHING INJURY OF UNSPECIFIED WRIST AND HAND INIT ENCNTR

J9503 MALFUNCTION OF TRACHEOSTOMY STOMA

S6741XA

CRUSHING INJURY OF RIGHT WRIST AND HAND INITIAL ENCOUNTER

J9504

TRACHEO-ESOPHAGEAL FISTULA FOLLOWING TRACHEOSTOMY

S6742XA

CRUSHING INJURY OF LEFT WRIST AND HAND INITIAL ENCOUNTER

J9509 OTHER TRACHEOSTOMY COMPLICATION

S6790XA

CRUSH INJ UNSP PART(S) OF UNSP WRIST HAND AND FINGERS INIT

J951

ACUTE PULMONARY INSUFFICIENCY FOLLOWING THORACIC SURGERY

S6791XA

CRUSHING INJ UNSP PART(S) OF R WRIST HAND AND FINGERS INIT

J952

ACUTE PULMONARY INSUFFICIENCY FOLLOWING NONTHORACIC SURGERY

S6792XA

CRUSHING INJ UNSP PART(S) OF L WRIST HAND AND FINGERS INIT

J953

CHRONIC PULMONARY INSUFFICIENCY FOLLOWING SURGERY

S68011A

COMPLETE TRAUMATIC MCP AMPUTATION OF RIGHT THUMB INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J954 CHEMICAL PNEUMONITIS DUE TO ANESTHESIA

S68012A

COMPLETE TRAUMATIC MCP AMPUTATION OF LEFT THUMB INIT

J955 POSTPROCEDURAL SUBGLOTTIC STENOSIS

S68019A

COMPLETE TRAUMATIC MCP AMPUTATION OF THMB INIT

J9561

INTRAOP HEMOR/HEMTOM OF A RESP SYS ORG COMP RESP SYS PROC

S68021A

PARTIAL TRAUMATIC MCP AMPUTATION OF RIGHT THUMB INIT

J9562

INTRAOP HEMOR/HEMTOM OF A RESP SYS ORG COMP OTH PROCEDURE

S68022A

PARTIAL TRAUMATIC MCP AMPUTATION OF LEFT THUMB INIT

J9571

ACCIDENTAL PNCTR & LAC OF A RESP SYS ORG DUR RESP SYS PROC

S68029A

PARTIAL TRAUMATIC MCP AMPUTATION OF THMB INIT

J9572

ACC PNCTR & LAC OF A RESP SYS ORG DURING OTH PROCEDURE

S68110A

COMPLETE TRAUMATIC MCP AMPUTATION OF R IDX FNGR INIT

J95830

POSTPROC HEMOR/HEMTOM OF A RESP SYS ORG FOL A RESP SYS PROC

S68111A

COMPLETE TRAUMATIC MCP AMPUTATION OF LEFT INDEX FINGER INIT

J95831

POSTPROC HEMOR/HEMTOM OF A RESP SYS ORG FOL OTH PROCEDURE

S68112A

COMPLETE TRAUMATIC MCP AMPUTATION OF R MID FINGER INIT

J9584 TRANSFUSION-RELATED ACUTE LUNG INJURY (TRALI)

S68113A

COMPLETE TRAUMATIC MCP AMPUTATION OF L MID FINGER INIT

J95850 MECHANICAL COMPLICATION OF RESPIRATOR

S68114A

COMPLETE TRAUMATIC MCP AMPUTATION OF RIGHT RING FINGER INIT

J95851 VENTILATOR ASSOCIATED PNEUMONIA

S68115A

COMPLETE TRAUMATIC MCP AMPUTATION OF LEFT RING FINGER INIT

J95859 OTHER COMPLICATION OF RESPIRATOR [VENTILATOR]

S68116A

COMPLETE TRAUMATIC MCP AMPUTATION OF R LITTLE FINGER INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J95860

Postprocedural hematoma of a respiratory system organ or structure following a respiratory system procedure

S68117A

COMPLETE TRAUMATIC MCP AMPUTATION OF L LITTLE FINGER INIT

J95861

Postprocedural hematoma of a respiratory system organ or structure following other procedure

S68118A

COMPLETE TRAUMATIC MCP AMPUTATION OF FINGER INIT

J95862

Postprocedural seroma of a respiratory system organ or structure following a respiratory system procedure

S68119A

COMPLETE TRAUMATIC MCP AMPUTATION OF UNSP FINGER INIT

J95863

Postprocedural seroma of a respiratory system organ or structure following other procedure

S68120A

PARTIAL TRAUMATIC MCP AMPUTATION OF RIGHT INDEX FINGER INIT

J9588

OTH INTRAOPERATIVE COMPLICATIONS OF RESPIRATORY SYSTEM NEC

S68121A

PARTIAL TRAUMATIC MCP AMPUTATION OF LEFT INDEX FINGER INIT

J9589

OTH POSTPROC COMPLICATIONS AND DISORDERS OF RESP SYS NEC

S68122A

PARTIAL TRAUMATIC MCP AMPUTATION OF R MID FINGER INIT

J9600

ACUTE RESPIRATORY FAILURE UNSP W HYPOXIA OR HYPERCAPNIA

S68123A

PARTIAL TRAUMATIC MCP AMPUTATION OF LEFT MIDDLE FINGER INIT

J9601 ACUTE RESPIRATORY FAILURE WITH HYPOXIA

S68124A

PARTIAL TRAUMATIC MCP AMPUTATION OF RIGHT RING FINGER INIT

J9602 ACUTE RESPIRATORY FAILURE WITH HYPERCAPNIA

S68125A

PARTIAL TRAUMATIC MCP AMPUTATION OF LEFT RING FINGER INIT

J9610

CHRONIC RESPIRATORY FAILURE UNSP W HYPOXIA OR HYPERCAPNIA

S68126A

PARTIAL TRAUMATIC MCP AMPUTATION OF R LITTLE FINGER INIT

J9611 CHRONIC RESPIRATORY FAILURE WITH HYPOXIA

S68127A

PARTIAL TRAUMATIC MCP AMPUTATION OF LEFT LITTLE FINGER INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J9612 CHRONIC RESPIRATORY FAILURE WITH HYPERCAPNIA

S68128A

PARTIAL TRAUMATIC MCP AMPUTATION OF FINGER INIT

J9620

ACUTE AND CHR RESP FAILURE UNSP W HYPOXIA OR HYPERCAPNIA

S68129A

PARTIAL TRAUMATIC MCP AMPUTATION OF UNSP FINGER INIT

J9621

ACUTE AND CHRONIC RESPIRATORY FAILURE WITH HYPOXIA

S68411A

COMPLETE TRAUMATIC AMP OF RIGHT HAND AT WRIST LEVEL INIT

J9622

ACUTE AND CHRONIC RESPIRATORY FAILURE WITH HYPERCAPNIA

S68412A

COMPLETE TRAUMATIC AMP OF LEFT HAND AT WRIST LEVEL INIT

J9690

RESPIRATORY FAILURE UNSP UNSP W HYPOXIA OR HYPERCAPNIA

S68419A

COMPLETE TRAUMATIC AMP OF UNSP HAND AT WRIST LEVEL INIT

J9691 RESPIRATORY FAILURE UNSPECIFIED WITH HYPOXIA

S68421A

PARTIAL TRAUMATIC AMP OF RIGHT HAND AT WRIST LEVEL INIT

J9692

RESPIRATORY FAILURE UNSPECIFIED WITH HYPERCAPNIA

S68422A

PARTIAL TRAUMATIC AMP OF LEFT HAND AT WRIST LEVEL INIT

J9801 ACUTE BRONCHOSPASM

S68429A PARTIAL TRAUMATIC AMP OF UNSP HAND AT WRIST LEVEL INIT

J9809 OTHER DISEASES OF BRONCHUS NOT ELSEWHERE CLASSIFIED

S68511A

COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF RIGHT THUMB INIT

J9811 ATELECTASIS

S68512A COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF LEFT THUMB INIT

J9819 OTHER PULMONARY COLLAPSE

S68519A

COMPLETE TRAUMATIC TRANSPHALANGEAL AMPUTATION OF THMB INIT

J982 INTERSTITIAL EMPHYSEMA

S68521A PARTIAL TRAUMATIC TRNSPHAL AMPUTATION OF RIGHT THUMB INIT

J983 COMPENSATORY EMPHYSEMA

S68522A PARTIAL TRAUMATIC TRNSPHAL AMPUTATION OF LEFT THUMB INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

J984 OTHER DISORDERS OF LUNG

S68529A

PARTIAL TRAUMATIC TRANSPHALANGEAL AMPUTATION OF THMB INIT

J985 DISEASES OF MEDIASTINUM NOT ELSEWHERE CLASSIFIED

S68610A

COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF R IDX FNGR INIT

J9851 Mediastinitis

S68611A COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF L IDX FNGR INIT

J9859 Other diseases of mediastinum not elsewhere classified

S68612A

COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF R MID FINGER INIT

J986 DISORDERS OF DIAPHRAGM

S68613A COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF L MID FINGER INIT

J988 OTHER SPECIFIED RESPIRATORY DISORDERS

S68614A

COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF R RNG FNGR INIT

J989 RESPIRATORY DISORDER UNSPECIFIED

S68615A

COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF L RNG FNGR INIT

J99

RESPIRATORY DISORDERS IN DISEASES CLASSIFIED ELSEWHERE

S68616A

COMPLETE TRAUMATIC TRNSPHAL AMP OF R LITTLE FINGER INIT

K200 EOSINOPHILIC ESOPHAGITIS

S68617A COMPLETE TRAUMATIC TRNSPHAL AMP OF L LITTLE FINGER INIT

K208 OTHER ESOPHAGITIS

S68618A COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF FINGER INIT

K209 ESOPHAGITIS UNSPECIFIED

S68619A COMPLETE TRAUMATIC TRNSPHAL AMPUTATION OF UNSP FINGER INIT

K210 GASTRO-ESOPHAGEAL REFLUX DISEASE WITH ESOPHAGITIS

S68620A

PARTIAL TRAUMATIC TRNSPHAL AMPUTATION OF R IDX FNGR INIT

K219

GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS

S68621A

PARTIAL TRAUMATIC TRNSPHAL AMPUTATION OF L IDX FNGR INIT

K220 ACHALASIA OF CARDIA

S68622A PARTIAL TRAUMATIC TRNSPHAL AMPUTATION OF R MID FINGER INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K2210 ULCER OF ESOPHAGUS WITHOUT BLEEDING

S68623A

PARTIAL TRAUMATIC TRNSPHAL AMPUTATION OF L MID FINGER INIT

K2211 ULCER OF ESOPHAGUS WITH BLEEDING

S68624A

PARTIAL TRAUMATIC TRNSPHAL AMPUTATION OF R RNG FNGR INIT

K222 ESOPHAGEAL OBSTRUCTION

S68625A PARTIAL TRAUMATIC TRNSPHAL AMPUTATION OF L RNG FNGR INIT

K223 PERFORATION OF ESOPHAGUS

S68626A PARTIAL TRAUMATIC TRNSPHAL AMP OF R LITTLE FINGER INIT

K224 DYSKINESIA OF ESOPHAGUS

S68627A PARTIAL TRAUMATIC TRNSPHAL AMP OF L LITTLE FINGER INIT

K225 DIVERTICULUM OF ESOPHAGUS ACQUIRED

S68628A

PARTIAL TRAUMATIC TRANSPHALANGEAL AMPUTATION OF FINGER INIT

K226

GASTRO-ESOPHAGEAL LACERATION-HEMORRHAGE SYNDROME

S68629A

PARTIAL TRAUMATIC TRNSPHAL AMPUTATION OF UNSP FINGER INIT

K2270 BARRETT'S ESOPHAGUS WITHOUT DYSPLASIA

S68711A

COMPLETE TRAUMATIC TRANSMETCRPL AMP OF RIGHT HAND INIT

K22710 BARRETT'S ESOPHAGUS WITH LOW GRADE DYSPLASIA

S68712A

COMPLETE TRAUMATIC TRANSMETCRPL AMP OF LEFT HAND INIT

K22711 BARRETT'S ESOPHAGUS WITH HIGH GRADE DYSPLASIA

S68719A

COMPLETE TRAUMATIC TRANSMETCRPL AMP OF UNSP HAND INIT

K22719 BARRETT'S ESOPHAGUS WITH DYSPLASIA UNSPECIFIED

S68721A

PARTIAL TRAUMATIC TRANSMETCRPL AMP OF RIGHT HAND INIT

K228 OTHER SPECIFIED DISEASES OF ESOPHAGUS

S68722A

PARTIAL TRAUMATIC TRANSMETCRPL AMPUTATION OF LEFT HAND INIT

K229 DISEASE OF ESOPHAGUS UNSPECIFIED

S68729A

PARTIAL TRAUMATIC TRANSMETCRPL AMPUTATION OF UNSP HAND INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K23

DISORDERS OF ESOPHAGUS IN DISEASES CLASSIFIED ELSEWHERE

S7000XA

CONTUSION OF UNSPECIFIED HIP INITIAL ENCOUNTER

K250 ACUTE GASTRIC ULCER WITH HEMORRHAGE

S7001XA

CONTUSION OF RIGHT HIP INITIAL ENCOUNTER

K251 ACUTE GASTRIC ULCER WITH PERFORATION

S7002XA

CONTUSION OF LEFT HIP INITIAL ENCOUNTER

K252

ACUTE GASTRIC ULCER WITH BOTH HEMORRHAGE AND PERFORATION

S7010XA

CONTUSION OF UNSPECIFIED THIGH INITIAL ENCOUNTER

K253

ACUTE GASTRIC ULCER WITHOUT HEMORRHAGE OR PERFORATION

S7011XA

CONTUSION OF RIGHT THIGH INITIAL ENCOUNTER

K254

CHRONIC OR UNSPECIFIED GASTRIC ULCER WITH HEMORRHAGE

S7012XA

CONTUSION OF LEFT THIGH INITIAL ENCOUNTER

K255

CHRONIC OR UNSPECIFIED GASTRIC ULCER WITH PERFORATION

S70211A

ABRASION RIGHT HIP INITIAL ENCOUNTER

K256

CHRONIC OR UNSP GASTRIC ULCER W BOTH HEMORRHAGE AND PERF

S70212A

ABRASION LEFT HIP INITIAL ENCOUNTER

K257

CHRONIC GASTRIC ULCER WITHOUT HEMORRHAGE OR PERFORATION

S70219A

ABRASION UNSPECIFIED HIP INITIAL ENCOUNTER

K259

GASTRIC ULCER UNSP AS ACUTE OR CHRONIC W/O HEMOR OR PERF

S70221A

BLISTER (NONTHERMAL) RIGHT HIP INITIAL ENCOUNTER

K260 ACUTE DUODENAL ULCER WITH HEMORRHAGE

S70222A

BLISTER (NONTHERMAL) LEFT HIP INITIAL ENCOUNTER

K261 ACUTE DUODENAL ULCER WITH PERFORATION

S70229A

BLISTER (NONTHERMAL) UNSPECIFIED HIP INITIAL ENCOUNTER

K262

ACUTE DUODENAL ULCER WITH BOTH HEMORRHAGE AND PERFORATION

S70241A

EXTERNAL CONSTRICTION RIGHT HIP INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K263

ACUTE DUODENAL ULCER WITHOUT HEMORRHAGE OR PERFORATION

S70242A

EXTERNAL CONSTRICTION LEFT HIP INITIAL ENCOUNTER

K264

CHRONIC OR UNSPECIFIED DUODENAL ULCER WITH HEMORRHAGE

S70249A

EXTERNAL CONSTRICTION UNSPECIFIED HIP INITIAL ENCOUNTER

K265

CHRONIC OR UNSPECIFIED DUODENAL ULCER WITH PERFORATION

S70341A

EXTERNAL CONSTRICTION RIGHT THIGH INITIAL ENCOUNTER

K266

CHRONIC OR UNSP DUODENAL ULCER W BOTH HEMORRHAGE AND PERF

S70342A

EXTERNAL CONSTRICTION LEFT THIGH INITIAL ENCOUNTER

K267

CHRONIC DUODENAL ULCER WITHOUT HEMORRHAGE OR PERFORATION

S70349A

EXTERNAL CONSTRICTION UNSPECIFIED THIGH INITIAL ENCOUNTER

K269

DUODENAL ULCER UNSP AS ACUTE OR CHRONIC W/O HEMOR OR PERF

S71001A

UNSPECIFIED OPEN WOUND RIGHT HIP INITIAL ENCOUNTER

K270

ACUTE PEPTIC ULCER SITE UNSPECIFIED WITH HEMORRHAGE

S71002A

UNSPECIFIED OPEN WOUND LEFT HIP INITIAL ENCOUNTER

K271

ACUTE PEPTIC ULCER SITE UNSPECIFIED WITH PERFORATION

S71009A

UNSPECIFIED OPEN WOUND UNSPECIFIED HIP INITIAL ENCOUNTER

K272

ACUTE PEPTIC ULCER SITE UNSP W BOTH HEMORRHAGE AND PERF

S71011A

LACERATION WITHOUT FOREIGN BODY RIGHT HIP INIT ENCNTR

K273

ACUTE PEPTIC ULCER SITE UNSP W/O HEMORRHAGE OR PERFORATION

S71012A

LACERATION WITHOUT FOREIGN BODY LEFT HIP INITIAL ENCOUNTER

K274

CHRONIC OR UNSP PEPTIC ULCER SITE UNSP WITH HEMORRHAGE

S71019A

LACERATION WITHOUT FOREIGN BODY UNSP HIP INIT ENCNTR

K275

CHRONIC OR UNSP PEPTIC ULCER SITE UNSP WITH PERFORATION

S71021A

LACERATION WITH FOREIGN BODY RIGHT HIP INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K276

CHR OR UNSP PEPTIC ULCER SITE UNSP W BOTH HEMOR AND PERF

S71022A

LACERATION WITH FOREIGN BODY LEFT HIP INITIAL ENCOUNTER

K277

CHRONIC PEPTIC ULCER SITE UNSP W/O HEMORRHAGE OR PERF

S71029A

LACERATION WITH FOREIGN BODY UNSPECIFIED HIP INIT ENCNTR

K279

PEPTIC ULC SITE UNSP UNSP AS AC OR CHR W/O HEMOR OR PERF

S71031A

PUNCTURE WOUND WITHOUT FOREIGN BODY RIGHT HIP INIT ENCNTR

K280 ACUTE GASTROJEJUNAL ULCER WITH HEMORRHAGE

S71032A

PUNCTURE WOUND WITHOUT FOREIGN BODY LEFT HIP INIT ENCNTR

K281 ACUTE GASTROJEJUNAL ULCER WITH PERFORATION

S71039A

PUNCTURE WOUND WITHOUT FOREIGN BODY UNSP HIP INIT ENCNTR

K282

ACUTE GASTROJEJUNAL ULCER W BOTH HEMORRHAGE AND PERFORATION

S71041A

PUNCTURE WOUND WITH FOREIGN BODY RIGHT HIP INIT ENCNTR

K283

ACUTE GASTROJEJUNAL ULCER WITHOUT HEMORRHAGE OR PERFORATION

S71042A

PUNCTURE WOUND WITH FOREIGN BODY LEFT HIP INIT ENCNTR

K284

CHRONIC OR UNSPECIFIED GASTROJEJUNAL ULCER WITH HEMORRHAGE

S71049A

PUNCTURE WOUND WITH FOREIGN BODY UNSP HIP INIT ENCNTR

K285

CHRONIC OR UNSPECIFIED GASTROJEJUNAL ULCER WITH PERFORATION

S71051A

OPEN BITE RIGHT HIP INITIAL ENCOUNTER

K286

CHRONIC OR UNSP GASTROJEJUNAL ULCER W BOTH HEMOR AND PERF

S71052A

OPEN BITE LEFT HIP INITIAL ENCOUNTER

K287

CHRONIC GASTROJEJUNAL ULCER W/O HEMORRHAGE OR PERFORATION

S71059A

OPEN BITE UNSPECIFIED HIP INITIAL ENCOUNTER

K4100

BI FEMORAL HERNIA W OBST W/O GANGRENE NOT SPCF AS RECUR

S71101A

UNSPECIFIED OPEN WOUND RIGHT THIGH INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K4101

BILATERAL FEMORAL HERNIA W OBST W/O GANGRENE RECURRENT

S71102A

UNSPECIFIED OPEN WOUND LEFT THIGH INITIAL ENCOUNTER

K4110

BI FEMORAL HERNIA W GANGRENE NOT SPECIFIED AS RECURRENT

S71109A

UNSPECIFIED OPEN WOUND UNSPECIFIED THIGH INITIAL ENCOUNTER

K4111 BILATERAL FEMORAL HERNIA WITH GANGRENE RECURRENT

S71111A

LACERATION WITHOUT FOREIGN BODY RIGHT THIGH INIT ENCNTR

K4120

BI FEMORAL HERNIA W/O OBST OR GANGRENE NOT SPCF AS RECUR

S71112A

LACERATION WITHOUT FOREIGN BODY LEFT THIGH INIT ENCNTR

K4121

BILATERAL FEMORAL HERNIA W/O OBST OR GANGRENE RECURRENT

S71119A

LACERATION WITHOUT FOREIGN BODY UNSP THIGH INIT ENCNTR

K4130

UNIL FEMORAL HERNIA W OBST W/O GANGRENE NOT SPCF AS RECUR

S71121A

LACERATION WITH FOREIGN BODY RIGHT THIGH INITIAL ENCOUNTER

K4131

UNILATERAL FEMORAL HERNIA W OBST W/O GANGRENE RECURRENT

S71122A

LACERATION WITH FOREIGN BODY LEFT THIGH INITIAL ENCOUNTER

K4140

UNIL FEMORAL HERNIA W GANGRENE NOT SPECIFIED AS RECURRENT

S71129A

LACERATION WITH FOREIGN BODY UNSPECIFIED THIGH INIT ENCNTR

K4141 UNILATERAL FEMORAL HERNIA WITH GANGRENE RECURRENT

S71131A

PUNCTURE WOUND W/O FOREIGN BODY RIGHT THIGH INIT ENCNTR

K4190

UNIL FEMORAL HERNIA W/O OBST OR GANGRENE NOT SPCF AS RECUR

S71132A

PUNCTURE WOUND WITHOUT FOREIGN BODY LEFT THIGH INIT ENCNTR

K4191

UNILATERAL FEMORAL HERNIA W/O OBST OR GANGRENE RECURRENT

S71139A

PUNCTURE WOUND WITHOUT FOREIGN BODY UNSP THIGH INIT ENCNTR

K420

UMBILICAL HERNIA WITH OBSTRUCTION WITHOUT GANGRENE

S71141A

PUNCTURE WOUND WITH FOREIGN BODY RIGHT THIGH INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K421 UMBILICAL HERNIA WITH GANGRENE

S71142A

PUNCTURE WOUND WITH FOREIGN BODY LEFT THIGH INIT ENCNTR

K429 UMBILICAL HERNIA WITHOUT OBSTRUCTION OR GANGRENE

S71149A

PUNCTURE WOUND WITH FOREIGN BODY UNSP THIGH INIT ENCNTR

K440

DIAPHRAGMATIC HERNIA WITH OBSTRUCTION WITHOUT GANGRENE

S71151A

OPEN BITE RIGHT THIGH INITIAL ENCOUNTER

K441 DIAPHRAGMATIC HERNIA WITH GANGRENE

S71152A

OPEN BITE LEFT THIGH INITIAL ENCOUNTER

K449

DIAPHRAGMATIC HERNIA WITHOUT OBSTRUCTION OR GANGRENE

S71159A

OPEN BITE UNSPECIFIED THIGH INITIAL ENCOUNTER

K450

OTH ABDOMINAL HERNIA WITH OBSTRUCTION WITHOUT GANGRENE

S72001A

FRACTURE OF UNSP PART OF NECK OF RIGHT FEMUR INIT

K451 OTHER SPECIFIED ABDOMINAL HERNIA WITH GANGRENE

S72001B

FX UNSP PART OF NECK OF R FEMUR INIT FOR OPN FX TYPE I/2

K458

OTH ABDOMINAL HERNIA WITHOUT OBSTRUCTION OR GANGRENE

S72001C

FX UNSP PART OF NECK OF R FEMUR INIT FOR OPN FX TYPE 3A/B/C

K460

UNSP ABDOMINAL HERNIA WITH OBSTRUCTION WITHOUT GANGRENE

S72002A

FRACTURE OF UNSP PART OF NECK OF LEFT FEMUR INIT

K461 UNSPECIFIED ABDOMINAL HERNIA WITH GANGRENE

S72002B

FX UNSP PART OF NECK OF LEFT FEMUR INIT FOR OPN FX TYPE I/2

K469

UNSPECIFIED ABDOMINAL HERNIA WITHOUT OBSTRUCTION OR GANGRENE

S72002C

FX UNSP PART OF NECK OF L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K5221 Food protein-induced enterocolitis syndrome

S72009A

FRACTURE OF UNSP PART OF NECK OF UNSP FEMUR INIT

K5222 Food protein-induced enteropathy

S72009B

FX UNSP PART OF NECK OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K5229 Other allergic and dietetic gastroenteritis and colitis

S72009C

FX UNSP PART OF NK OF UNSP FEMR INIT FOR OPN FX TYPE 3A/B/C

K523 Indeterminate colitis

S72011A UNSP INTRACAPSULAR FRACTURE OF RIGHT FEMUR INIT FOR CLOS FX

K52831 Collagenous colitis

S72011B UNSP INTRACAP FX RIGHT FEMUR INIT FOR OPN FX TYPE I/2

K52832 Lymphocytic colitis

S72011C UNSP INTRACAP FX RIGHT FEMUR INIT FOR OPN FX TYPE 3A/B/C

K52838 Other microscopic colitis

S72012A UNSP INTRACAPSULAR FRACTURE OF LEFT FEMUR INIT FOR CLOS FX

K55011

Focal (segmental) acute (reversible) ischemia of small intestine

S72012B

UNSP INTRACAP FX LEFT FEMUR INIT FOR OPN FX TYPE I/2

K55012 Diffuse acute (reversible) ischemia of small intestine

S72012C

UNSP INTRACAP FX LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

K55019

Acute (reversible) ischemia of small intestine extent unspecified

S72019A

UNSP INTRACAPSULAR FRACTURE OF UNSP FEMUR INIT FOR CLOS FX

K55021 Focal (segmental) acute infarction of small intestine

S72019B

UNSP INTRACAP FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

K55022 Diffuse acute infarction of small intestine

S72019C

UNSP INTRACAP FX UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

K55029 Acute infarction of small intestine extent unspecified

S72021A

DISP FX OF EPIPHYSIS (SEPARATION) (UPPER) OF R FEMUR INIT

K55031

Focal (segmental) acute (reversible) ischemia of large intestine

S72021B

DISP FX OF EPIPHY (SEPARATION) (UPPER) OF R FEMR 7THB

K55032 Diffuse acute (reversible) ischemia of large intestine

S72021C

DISP FX OF EPIPHY (SEPARATION) (UPPER) OF R FEMR 7THC

K55039

Acute (reversible) ischemia of large intestine extent unspecified

S72022A

DISP FX OF EPIPHYSIS (SEPARATION) (UPPER) OF L FEMUR INIT

K55041 Focal (segmental) acute infarction of large intestine

S72022B

DISP FX OF EPIPHY (SEPARATION) (UPPER) OF L FEMR 7THB

Page 244: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K55042 Diffuse acute infarction of large intestine

S72022C

DISP FX OF EPIPHY (SEPARATION) (UPPER) OF L FEMR 7THC

K55049 Acute infarction of large intestine extent unspecified

S72023A

DISP FX OF EPIPHY (SEPARATION) (UPPER) OF UNSP FEMUR INIT

K55051

Focal (segmental) acute (reversible) ischemia of intestine part unspecified

S72023B

DISP FX OF EPIPHY (SEPARATION) (UPPER) OF UNSP FEMR 7THB

K55052

Diffuse acute (reversible) ischemia of intestine part unspecified

S72023C

DISP FX OF EPIPHY (SEPARATION) (UPPER) OF UNSP FEMR 7THC

K55059

Acute (reversible) ischemia of intestine part and extent unspecified

S72024A

NONDISP FX OF EPIPHY (SEPARATION) (UPPER) OF R FEMUR INIT

K55061

Focal (segmental) acute infarction of intestine part unspecified

S72024B

NONDISP FX OF EPIPHY (SEPARATION) (UPPER) OF R FEMR 7THB

K55062 Diffuse acute infarction of intestine part unspecified

S72024C

NONDISP FX OF EPIPHY (SEPARATION) (UPPER) OF R FEMR 7THC

K55069 Acute infarction of intestine part and extent unspecified

S72025A

NONDISP FX OF EPIPHY (SEPARATION) (UPPER) OF L FEMUR INIT

K5530 Necrotizing enterocolitis unspecified

S72025B

NONDISP FX OF EPIPHY (SEPARATION) (UPPER) OF L FEMR 7THB

K5531 Stage 1 necrotizing enterocolitis

S72025C NONDISP FX OF EPIPHY (SEPARATION) (UPPER) OF L FEMR 7THC

K5532 Stage 2 necrotizing enterocolitis

S72026A NONDISP FX OF EPIPHY (SEPARATION) (UPPER) OF UNSP FEMR INIT

K5533 Stage 3 necrotizing enterocolitis

S72026B NONDISP FX OF EPIPHY (SEPARATION) (UPPER) OF UNSP FEMR 7THB

K5931 Toxic megacolon

S72026C NONDISP FX OF EPIPHY (SEPARATION) (UPPER) OF UNSP FEMR 7THC

Page 245: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K5939 Other megacolon

S72031A DISPLACED MIDCERVICAL FRACTURE OF RIGHT FEMUR INIT

K625 HEMORRHAGE OF ANUS AND RECTUM

S72031B

DISPLACED MIDCERVICAL FX R FEMUR INIT FOR OPN FX TYPE I/2

K630 ABSCESS OF INTESTINE

S72031C DISPL MIDCERVICAL FX R FEMUR INIT FOR OPN FX TYPE 3A/B/C

K631 PERFORATION OF INTESTINE (NONTRAUMATIC)

S72032A

DISPLACED MIDCERVICAL FRACTURE OF LEFT FEMUR INIT

K632 FISTULA OF INTESTINE

S72032B DISPLACED MIDCERVICAL FX L FEMUR INIT FOR OPN FX TYPE I/2

K633 ULCER OF INTESTINE

S72032C DISPL MIDCERVICAL FX L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K634 ENTEROPTOSIS

S72033A DISPLACED MIDCERVICAL FRACTURE OF UNSP FEMUR INIT

K635 POLYP OF COLON

S72033B DISPL MIDCERVICAL FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

K639 DISEASE OF INTESTINE UNSPECIFIED

S72033C

DISPL MIDCERVICAL FX UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

K650 GENERALIZED (ACUTE) PERITONITIS

S72034A

NONDISPLACED MIDCERVICAL FRACTURE OF RIGHT FEMUR INIT

K651 PERITONEAL ABSCESS

S72034B NONDISP MIDCERVICAL FX RIGHT FEMUR INIT FOR OPN FX TYPE I/2

K652 SPONTANEOUS BACTERIAL PERITONITIS

S72034C

NONDISP MIDCERVICAL FX R FEMUR INIT FOR OPN FX TYPE 3A/B/C

K653 CHOLEPERITONITIS

S72035A NONDISPLACED MIDCERVICAL FRACTURE OF LEFT FEMUR INIT

K654 SCLEROSING MESENTERITIS

S72035B NONDISP MIDCERVICAL FX LEFT FEMUR INIT FOR OPN FX TYPE I/2

K658 OTHER PERITONITIS

S72035C NONDISP MIDCERVICAL FX L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K659 PERITONITIS UNSPECIFIED

S72036A NONDISPLACED MIDCERVICAL FRACTURE OF UNSP FEMUR INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K660

PERITONEAL ADHESIONS (POSTPROCEDURAL) (POSTINFECTION)

S72036B

NONDISP MIDCERVICAL FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

K661 HEMOPERITONEUM

S72036C NONDISP MIDCERVICAL FX UNSP FEMR 7THC

K668 OTHER SPECIFIED DISORDERS OF PERITONEUM

S72041A

DISP FX OF BASE OF NECK OF RIGHT FEMUR INIT FOR CLOS FX

K669 DISORDER OF PERITONEUM UNSPECIFIED

S72041B

DISP FX OF BASE OF NECK OF R FEMUR INIT FOR OPN FX TYPE I/2

K67

DISORDERS OF PERITONEUM IN INFECTIOUS DISEASES CLASSD ELSWHR

S72041C

DISP FX OF BASE OF NK OF R FEMR INIT FOR OPN FX TYPE 3A/B/C

K6811 POSTPROCEDURAL RETROPERITONEAL ABSCESS

S72042A

DISP FX OF BASE OF NECK OF LEFT FEMUR INIT FOR CLOS FX

K6812 PSOAS MUSCLE ABSCESS

S72042B DISP FX OF BASE OF NECK OF L FEMUR INIT FOR OPN FX TYPE I/2

K6819 OTHER RETROPERITONEAL ABSCESS

S72042C

DISP FX OF BASE OF NK OF L FEMR INIT FOR OPN FX TYPE 3A/B/C

K689 OTHER DISORDERS OF RETROPERITONEUM

S72043A

DISP FX OF BASE OF NECK OF UNSP FEMUR INIT FOR CLOS FX

K700 ALCOHOLIC FATTY LIVER

S72043B DISP FX OF BASE OF NK OF UNSP FEMR INIT FOR OPN FX TYPE I/2

K7010 ALCOHOLIC HEPATITIS WITHOUT ASCITES

S72043C

DISP FX OF BASE OF NK OF UNSP FEMR 7THC

K7011 ALCOHOLIC HEPATITIS WITH ASCITES

S72044A

NONDISP FX OF BASE OF NECK OF RIGHT FEMUR INIT FOR CLOS FX

K702 ALCOHOLIC FIBROSIS AND SCLEROSIS OF LIVER

S72044B

NONDISP FX OF BASE OF NK OF R FEMR INIT FOR OPN FX TYPE I/2

K7030 ALCOHOLIC CIRRHOSIS OF LIVER WITHOUT ASCITES

S72044C

NONDISP FX OF BASE OF NK OF R FEMR 7THC

K7031 ALCOHOLIC CIRRHOSIS OF LIVER WITH ASCITES

S72045A

NONDISP FX OF BASE OF NECK OF LEFT FEMUR INIT FOR CLOS FX

K7040 ALCOHOLIC HEPATIC FAILURE WITHOUT COMA

S72045B

NONDISP FX OF BASE OF NK OF L FEMR INIT FOR OPN FX TYPE I/2

K7041 ALCOHOLIC HEPATIC FAILURE WITH COMA

S72045C

NONDISP FX OF BASE OF NK OF L FEMR 7THC

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K709 ALCOHOLIC LIVER DISEASE UNSPECIFIED

S72046A

NONDISP FX OF BASE OF NECK OF UNSP FEMUR INIT FOR CLOS FX

K710 TOXIC LIVER DISEASE WITH CHOLESTASIS

S72046B

NONDISP FX OF BASE OF NK OF UNSP FEMR 7THB

K7110

TOXIC LIVER DISEASE WITH HEPATIC NECROSIS WITHOUT COMA

S72046C

NONDISP FX OF BASE OF NK OF UNSP FEMR 7THC

K7111 TOXIC LIVER DISEASE WITH HEPATIC NECROSIS WITH COMA

S72051A

UNSP FRACTURE OF HEAD OF RIGHT FEMUR INIT FOR CLOS FX

K712 TOXIC LIVER DISEASE WITH ACUTE HEPATITIS

S72051B

UNSP FX HEAD OF RIGHT FEMUR INIT FOR OPN FX TYPE I/2

K713

TOXIC LIVER DISEASE WITH CHRONIC PERSISTENT HEPATITIS

S72051C

UNSP FX HEAD OF RIGHT FEMUR INIT FOR OPN FX TYPE 3A/B/C

K714 TOXIC LIVER DISEASE WITH CHRONIC LOBULAR HEPATITIS

S72052A

UNSP FRACTURE OF HEAD OF LEFT FEMUR INIT FOR CLOS FX

K7150

TOXIC LIVER DISEASE W CHRONIC ACTIVE HEPATITIS W/O ASCITES

S72052B

UNSP FX HEAD OF LEFT FEMUR INIT FOR OPN FX TYPE I/2

K7151

TOXIC LIVER DISEASE W CHRONIC ACTIVE HEPATITIS WITH ASCITES

S72052C

UNSP FX HEAD OF LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

K716

TOXIC LIVER DISEASE WITH HEPATITIS NOT ELSEWHERE CLASSIFIED

S72059A

UNSP FRACTURE OF HEAD OF UNSP FEMUR INIT FOR CLOS FX

K717

TOXIC LIVER DISEASE WITH FIBROSIS AND CIRRHOSIS OF LIVER

S72059B

UNSP FX HEAD OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

K718 TOXIC LIVER DISEASE WITH OTHER DISORDERS OF LIVER

S72059C

UNSP FX HEAD OF UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

K719 TOXIC LIVER DISEASE UNSPECIFIED

S72061A

DISPLACED ARTICULAR FRACTURE OF HEAD OF RIGHT FEMUR INIT

K7200 ACUTE AND SUBACUTE HEPATIC FAILURE WITHOUT COMA

S72061B

DISPLACED ARTIC FX HEAD OF R FEMUR INIT FOR OPN FX TYPE I/2

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K7201 ACUTE AND SUBACUTE HEPATIC FAILURE WITH COMA

S72061C

DISPL ARTIC FX HEAD OF R FEMUR INIT FOR OPN FX TYPE 3A/B/C

K7210 CHRONIC HEPATIC FAILURE WITHOUT COMA

S72062A

DISPLACED ARTICULAR FRACTURE OF HEAD OF LEFT FEMUR INIT

K7211 CHRONIC HEPATIC FAILURE WITH COMA

S72062B

DISPLACED ARTIC FX HEAD OF L FEMUR INIT FOR OPN FX TYPE I/2

K7290 HEPATIC FAILURE UNSPECIFIED WITHOUT COMA

S72062C

DISPL ARTIC FX HEAD OF L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K7291 HEPATIC FAILURE UNSPECIFIED WITH COMA

S72063A

DISPLACED ARTICULAR FRACTURE OF HEAD OF UNSP FEMUR INIT

K730

CHRONIC PERSISTENT HEPATITIS NOT ELSEWHERE CLASSIFIED

S72063B

DISPL ARTIC FX HEAD OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

K731 CHRONIC LOBULAR HEPATITIS NOT ELSEWHERE CLASSIFIED

S72063C

DISPL ARTIC FX HEAD OF UNSP FEMR 7THC

K732 CHRONIC ACTIVE HEPATITIS NOT ELSEWHERE CLASSIFIED

S72064A

NONDISPLACED ARTICULAR FRACTURE OF HEAD OF RIGHT FEMUR INIT

K738 OTHER CHRONIC HEPATITIS NOT ELSEWHERE CLASSIFIED

S72064B

NONDISP ARTIC FX HEAD OF R FEMUR INIT FOR OPN FX TYPE I/2

K739 CHRONIC HEPATITIS UNSPECIFIED

S72064C

NONDISP ARTIC FX HEAD OF R FEMR INIT FOR OPN FX TYPE 3A/B/C

K740 HEPATIC FIBROSIS

S72065A NONDISPLACED ARTICULAR FRACTURE OF HEAD OF LEFT FEMUR INIT

K741 HEPATIC SCLEROSIS

S72065B NONDISP ARTIC FX HEAD OF L FEMUR INIT FOR OPN FX TYPE I/2

K742 HEPATIC FIBROSIS WITH HEPATIC SCLEROSIS

S72065C

NONDISP ARTIC FX HEAD OF L FEMR INIT FOR OPN FX TYPE 3A/B/C

K743 PRIMARY BILIARY CIRRHOSIS

S72066A NONDISPLACED ARTICULAR FRACTURE OF HEAD OF UNSP FEMUR INIT

K744 SECONDARY BILIARY CIRRHOSIS

S72066B NONDISP ARTIC FX HEAD OF UNSP FEMR INIT FOR OPN FX TYPE I/2

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K745 BILIARY CIRRHOSIS UNSPECIFIED

S72066C

NONDISP ARTIC FX HEAD OF UNSP FEMR 7THC

K7460 UNSPECIFIED CIRRHOSIS OF LIVER

S72091A

OTH FRACTURE OF HEAD AND NECK OF RIGHT FEMUR INIT

K7469 OTHER CIRRHOSIS OF LIVER

S72091B OTH FX HEAD/NECK OF RIGHT FEMUR INIT FOR OPN FX TYPE I/2

K750 ABSCESS OF LIVER

S72091C OTH FX HEAD/NECK OF RIGHT FEMUR INIT FOR OPN FX TYPE 3A/B/C

K751 PHLEBITIS OF PORTAL VEIN

S72092A OTH FRACTURE OF HEAD AND NECK OF LEFT FEMUR INIT

K752 NONSPECIFIC REACTIVE HEPATITIS

S72092B

OTH FX HEAD/NECK OF LEFT FEMUR INIT FOR OPN FX TYPE I/2

K753 GRANULOMATOUS HEPATITIS NOT ELSEWHERE CLASSIFIED

S72092C

OTH FX HEAD/NECK OF LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

K754 AUTOIMMUNE HEPATITIS

S72099A OTH FRACTURE OF HEAD AND NECK OF UNSP FEMUR INIT

K7581 NONALCOHOLIC STEATOHEPATITIS (NASH)

S72099B

OTH FX HEAD/NECK OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

K7589

OTHER SPECIFIED INFLAMMATORY LIVER DISEASES

S72099C

OTH FX HEAD/NECK OF UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

K759 INFLAMMATORY LIVER DISEASE UNSPECIFIED

S72101A

UNSP TROCHANTERIC FRACTURE OF RIGHT FEMUR INIT FOR CLOS FX

K760 FATTY (CHANGE OF) LIVER NOT ELSEWHERE CLASSIFIED

S72101B

UNSP TROCHAN FX RIGHT FEMUR INIT FOR OPN FX TYPE I/2

K761 CHRONIC PASSIVE CONGESTION OF LIVER

S72101C

UNSP TROCHAN FX RIGHT FEMUR INIT FOR OPN FX TYPE 3A/B/C

K762 CENTRAL HEMORRHAGIC NECROSIS OF LIVER

S72102A

UNSP TROCHANTERIC FRACTURE OF LEFT FEMUR INIT FOR CLOS FX

K763 INFARCTION OF LIVER

S72102B UNSP TROCHAN FX LEFT FEMUR INIT FOR OPN FX TYPE I/2

K764 PELIOSIS HEPATIS

S72102C UNSP TROCHAN FX LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K765 HEPATIC VENO-OCCLUSIVE DISEASE

S72109A

UNSP TROCHANTERIC FRACTURE OF UNSP FEMUR INIT FOR CLOS FX

K766 PORTAL HYPERTENSION

S72109B UNSP TROCHAN FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

K767 HEPATORENAL SYNDROME

S72109C UNSP TROCHAN FX UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

K769 LIVER DISEASE UNSPECIFIED

S72111A DISP FX OF GREATER TROCHANTER OF RIGHT FEMUR INIT

K77 LIVER DISORDERS IN DISEASES CLASSIFIED ELSEWHERE

S72111B

DISP FX OF GREATER TROCHANTER OF R FEMR 7THB

K8000

CALCULUS OF GALLBLADDER W ACUTE CHOLECYST W/O OBSTRUCTION

S72111C

DISP FX OF GREATER TROCHANTER OF R FEMR 7THC

K8001

CALCULUS OF GALLBLADDER W ACUTE CHOLECYSTITIS W OBSTRUCTION

S72112A

DISP FX OF GREATER TROCHANTER OF LEFT FEMUR INIT

K8010

CALCULUS OF GALLBLADDER W CHRONIC CHOLECYST W/O OBSTRUCTION

S72112B

DISP FX OF GREATER TROCHANTER OF L FEMR 7THB

K8011

CALCULUS OF GALLBLADDER W CHRONIC CHOLECYST W OBSTRUCTION

S72112C

DISP FX OF GREATER TROCHANTER OF L FEMR 7THC

K8012

CALCULUS OF GB W ACUTE AND CHRONIC CHOLECYST W/O OBSTRUCTION

S72113A

DISP FX OF GREATER TROCHANTER OF UNSP FEMUR INIT

K8013

CALCULUS OF GB W ACUTE AND CHRONIC CHOLECYST W OBSTRUCTION

S72113B

DISP FX OF GREATER TROCHANTER OF UNSP FEMR 7THB

K8018

CALCULUS OF GALLBLADDER W OTH CHOLECYSTITIS W/O OBSTRUCTION

S72113C

DISP FX OF GREATER TROCHANTER OF UNSP FEMR 7THC

K8019

CALCULUS OF GALLBLADDER W OTH CHOLECYSTITIS WITH OBSTRUCTION

S72114A

NONDISP FX OF GREATER TROCHANTER OF RIGHT FEMUR INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K8020

CALCULUS OF GALLBLADDER W/O CHOLECYSTITIS W/O OBSTRUCTION

S72114B

NONDISP FX OF GREATER TROCHANTER OF R FEMR 7THB

K8021

CALCULUS OF GALLBLADDER W/O CHOLECYSTITIS WITH OBSTRUCTION

S72114C

NONDISP FX OF GREATER TROCHANTER OF R FEMR 7THC

K8030

CALCULUS OF BILE DUCT W CHOLANGITIS UNSP W/O OBSTRUCTION

S72115A

NONDISP FX OF GREATER TROCHANTER OF LEFT FEMUR INIT

K8031

CALCULUS OF BILE DUCT W CHOLANGITIS UNSP WITH OBSTRUCTION

S72115B

NONDISP FX OF GREATER TROCHANTER OF L FEMR 7THB

K8032

CALCULUS OF BILE DUCT WITH ACUTE CHOLANGITIS W/O OBSTRUCTION

S72115C

NONDISP FX OF GREATER TROCHANTER OF L FEMR 7THC

K8033

CALCULUS OF BILE DUCT W ACUTE CHOLANGITIS WITH OBSTRUCTION

S72116A

NONDISP FX OF GREATER TROCHANTER OF UNSP FEMUR INIT

K8034

CALCULUS OF BILE DUCT W CHRONIC CHOLANGITIS W/O OBSTRUCTION

S72116B

NONDISP FX OF GREATER TROCHANTER OF UNSP FEMR 7THB

K8035

CALCULUS OF BILE DUCT W CHRONIC CHOLANGITIS WITH OBSTRUCTION

S72116C

NONDISP FX OF GREATER TROCHANTER OF UNSP FEMR 7THC

K8036

CALCULUS OF BILE DUCT W ACUTE AND CHR CHOLANGITIS W/O OBST

S72121A

DISP FX OF LESSER TROCHANTER OF RIGHT FEMUR INIT

K8037

CALCULUS OF BILE DUCT W ACUTE AND CHRONIC CHOLANGITIS W OBST

S72121B

DISP FX OF LESS TROCHANTER OF R FEMR 7THB

K8040

CALCULUS OF BILE DUCT W CHOLECYSTITIS UNSP W/O OBSTRUCTION

S72121C

DISP FX OF LESS TROCHANTER OF R FEMR 7THC

K8041

CALCULUS OF BILE DUCT W CHOLECYSTITIS UNSP W OBSTRUCTION

S72122A

DISP FX OF LESSER TROCHANTER OF LEFT FEMUR INIT FOR CLOS FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K8042

CALCULUS OF BILE DUCT W ACUTE CHOLECYSTITIS W/O OBSTRUCTION

S72122B

DISP FX OF LESS TROCHANTER OF L FEMR 7THB

K8043

CALCULUS OF BILE DUCT W ACUTE CHOLECYSTITIS WITH OBSTRUCTION

S72122C

DISP FX OF LESS TROCHANTER OF L FEMR 7THC

K8044

CALCULUS OF BILE DUCT W CHRONIC CHOLECYST W/O OBSTRUCTION

S72123A

DISP FX OF LESSER TROCHANTER OF UNSP FEMUR INIT FOR CLOS FX

K8045

CALCULUS OF BILE DUCT W CHRONIC CHOLECYSTITIS W OBSTRUCTION

S72123B

DISP FX OF LESS TROCHANTER OF UNSP FEMR 7THB

K8046

CALCULUS OF BILE DUCT W ACUTE AND CHRONIC CHOLECYST W/O OBST

S72123C

DISP FX OF LESS TROCHANTER OF UNSP FEMR 7THC

K8047

CALCULUS OF BILE DUCT W ACUTE AND CHRONIC CHOLECYST W OBST

S72124A

NONDISP FX OF LESSER TROCHANTER OF RIGHT FEMUR INIT

K8050

CALCULUS OF BILE DUCT W/O CHOLANGITIS OR CHOLECYST W/O OBST

S72124B

NONDISP FX OF LESS TROCHANTER OF R FEMR 7THB

K8051

CALCULUS OF BILE DUCT W/O CHOLANGITIS OR CHOLECYST W OBST

S72124C

NONDISP FX OF LESS TROCHANTER OF R FEMR 7THC

K8060

CALCULUS OF GB AND BILE DUCT W CHOLECYST UNSP W/O OBST

S72125A

NONDISP FX OF LESSER TROCHANTER OF LEFT FEMUR INIT

K8061

CALCULUS OF GB AND BILE DUCT W CHOLECYST UNSP W OBST

S72125B

NONDISP FX OF LESS TROCHANTER OF L FEMR 7THB

K8062

CALCULUS OF GB AND BILE DUCT W ACUTE CHOLECYST W/O OBST

S72125C

NONDISP FX OF LESS TROCHANTER OF L FEMR 7THC

K8063

CALCULUS OF GB AND BILE DUCT W ACUTE CHOLECYST W OBSTRUCTION

S72126A

NONDISP FX OF LESSER TROCHANTER OF UNSP FEMUR INIT

Page 253: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K8064

CALCULUS OF GB AND BILE DUCT W CHRONIC CHOLECYST W/O OBST

S72126B

NONDISP FX OF LESS TROCHANTER OF UNSP FEMR 7THB

K8065

CALCULUS OF GB AND BILE DUCT W CHRONIC CHOLECYST W OBST

S72126C

NONDISP FX OF LESS TROCHANTER OF UNSP FEMR 7THC

K8066

CALCULUS OF GB AND BILE DUCT W AC AND CHR CHOLECYST W/O OBST

S72131A

DISPLACED APOPHYSEAL FRACTURE OF RIGHT FEMUR INIT

K8067

CALCULUS OF GB AND BILE DUCT W AC AND CHR CHOLECYST W OBST

S72131B

DISPLACED APOPHYSEAL FX R FEMUR INIT FOR OPN FX TYPE I/2

K8070

CALCULUS OF GB AND BILE DUCT W/O CHOLECYST W/O OBSTRUCTION

S72131C

DISPLACED APOPHYSEAL FX R FEMUR INIT FOR OPN FX TYPE 3A/B/C

K8071

CALCULUS OF GB AND BILE DUCT W/O CHOLECYST W OBSTRUCTION

S72132A

DISPLACED APOPHYSEAL FRACTURE OF LEFT FEMUR INIT

K8080 OTHER CHOLELITHIASIS WITHOUT OBSTRUCTION

S72132B

DISPLACED APOPHYSEAL FX LEFT FEMUR INIT FOR OPN FX TYPE I/2

K8081 OTHER CHOLELITHIASIS WITH OBSTRUCTION

S72132C

DISPLACED APOPHYSEAL FX L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K810 ACUTE CHOLECYSTITIS

S72133A DISPLACED APOPHYSEAL FRACTURE OF UNSP FEMUR INIT

K811 CHRONIC CHOLECYSTITIS

S72133B DISPLACED APOPHYSEAL FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

K812 ACUTE CHOLECYSTITIS WITH CHRONIC CHOLECYSTITIS

S72133C

DISPL APOPHYSEAL FX UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

K819 CHOLECYSTITIS UNSPECIFIED

S72134A NONDISPLACED APOPHYSEAL FRACTURE OF RIGHT FEMUR INIT

K820 OBSTRUCTION OF GALLBLADDER

S72134B

NONDISP APOPHYSEAL FX RIGHT FEMUR INIT FOR OPN FX TYPE I/2

K821 HYDROPS OF GALLBLADDER

S72134C NONDISP APOPHYSEAL FX R FEMUR INIT FOR OPN FX TYPE 3A/B/C

Page 254: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K822 PERFORATION OF GALLBLADDER

S72135A

NONDISPLACED APOPHYSEAL FRACTURE OF LEFT FEMUR INIT

K823 FISTULA OF GALLBLADDER

S72135B NONDISP APOPHYSEAL FX LEFT FEMUR INIT FOR OPN FX TYPE I/2

K824 CHOLESTEROLOSIS OF GALLBLADDER

S72135C

NONDISP APOPHYSEAL FX L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K828 OTHER SPECIFIED DISEASES OF GALLBLADDER

S72136A

NONDISPLACED APOPHYSEAL FRACTURE OF UNSP FEMUR INIT

K829 DISEASE OF GALLBLADDER UNSPECIFIED

S72136B

NONDISP APOPHYSEAL FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

K830 CHOLANGITIS

S72136C NONDISP APOPHYSEAL FX UNSP FEMR INIT FOR OPN FX TYPE 3A/B/C

K831 OBSTRUCTION OF BILE DUCT

S72141A DISPLACED INTERTROCHANTERIC FRACTURE OF RIGHT FEMUR INIT

K832 PERFORATION OF BILE DUCT

S72141B DISPLACED INTERTROCH FX R FEMUR INIT FOR OPN FX TYPE I/2

K833 FISTULA OF BILE DUCT

S72141C DISPLACED INTERTROCH FX R FEMUR INIT FOR OPN FX TYPE 3A/B/C

K834 SPASM OF SPHINCTER OF ODDI

S72142A DISPLACED INTERTROCHANTERIC FRACTURE OF LEFT FEMUR INIT

K835 BILIARY CYST

S72142B DISPLACED INTERTROCH FX LEFT FEMUR INIT FOR OPN FX TYPE I/2

K838 OTHER SPECIFIED DISEASES OF BILIARY TRACT

S72142C

DISPLACED INTERTROCH FX L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K839 DISEASE OF BILIARY TRACT UNSPECIFIED

S72143A

DISPLACED INTERTROCHANTERIC FRACTURE OF UNSP FEMUR INIT

K850 IDIOPATHIC ACUTE PANCREATITIS

S72143B

DISPLACED INTERTROCH FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

K8500 Idiopathic acute pancreatitis without necrosis or infection

S72143C

DISPL INTERTROCH FX UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K8501 Idiopathic acute pancreatitis with uninfected necrosis

S72144A

NONDISPLACED INTERTROCHANTERIC FRACTURE OF RIGHT FEMUR INIT

K8502 Idiopathic acute pancreatitis with infected necrosis

S72144B

NONDISP INTERTROCH FX RIGHT FEMUR INIT FOR OPN FX TYPE I/2

K851 BILIARY ACUTE PANCREATITIS

S72144C NONDISP INTERTROCH FX R FEMUR INIT FOR OPN FX TYPE 3A/B/C

K8510 Biliary acute pancreatitis without necrosis or infection

S72145A

NONDISPLACED INTERTROCHANTERIC FRACTURE OF LEFT FEMUR INIT

K8511 Biliary acute pancreatitis with uninfected necrosis

S72145B

NONDISP INTERTROCH FX LEFT FEMUR INIT FOR OPN FX TYPE I/2

K8512 Biliary acute pancreatitis with infected necrosis

S72145C

NONDISP INTERTROCH FX L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K852 ALCOHOL INDUCED ACUTE PANCREATITIS

S72146A

NONDISPLACED INTERTROCHANTERIC FRACTURE OF UNSP FEMUR INIT

K8520

Alcohol induced acute pancreatitis without necrosis or infection

S72146B

NONDISP INTERTROCH FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

K8521

Alcohol induced acute pancreatitis with uninfected necrosis

S72146C

NONDISP INTERTROCH FX UNSP FEMR INIT FOR OPN FX TYPE 3A/B/C

K8522

Alcohol induced acute pancreatitis with infected necrosis

S7221XA

DISPLACED SUBTROCHANTERIC FRACTURE OF RIGHT FEMUR INIT

K853 DRUG INDUCED ACUTE PANCREATITIS

S7221XB

DISPLACED SUBTROCHNT FX R FEMUR INIT FOR OPN FX TYPE I/2

K8530 Drug induced acute pancreatitis without necrosis or infection

S7221XC

DISPLACED SUBTROCHNT FX R FEMUR INIT FOR OPN FX TYPE 3A/B/C

K8531 Drug induced acute pancreatitis with uninfected necrosis

S7222XA

DISPLACED SUBTROCHANTERIC FRACTURE OF LEFT FEMUR INIT

Page 256: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K8532 Drug induced acute pancreatitis with infected necrosis

S7222XB

DISPLACED SUBTROCHNT FX LEFT FEMUR INIT FOR OPN FX TYPE I/2

K858 OTHER ACUTE PANCREATITIS

S7222XC DISPLACED SUBTROCHNT FX L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K8580 Other acute pancreatitis without necrosis or infection

S7223XA

DISPLACED SUBTROCHANTERIC FRACTURE OF UNSP FEMUR INIT

K8581 Other acute pancreatitis with uninfected necrosis

S7223XB

DISPLACED SUBTROCHNT FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

K8582 Other acute pancreatitis with infected necrosis

S7223XC

DISPL SUBTROCHNT FX UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

K859 ACUTE PANCREATITIS UNSPECIFIED

S7224XA

NONDISPLACED SUBTROCHANTERIC FRACTURE OF RIGHT FEMUR INIT

K8590

Acute pancreatitis without necrosis or infection unspecified

S7224XB

NONDISP SUBTROCHNT FX RIGHT FEMUR INIT FOR OPN FX TYPE I/2

K8591 Acute pancreatitis with uninfected necrosis unspecified

S7224XC

NONDISP SUBTROCHNT FX R FEMUR INIT FOR OPN FX TYPE 3A/B/C

K8592 Acute pancreatitis with infected necrosis unspecified

S7225XA

NONDISPLACED SUBTROCHANTERIC FRACTURE OF LEFT FEMUR INIT

K860 ALCOHOL-INDUCED CHRONIC PANCREATITIS

S7225XB

NONDISP SUBTROCHNT FX LEFT FEMUR INIT FOR OPN FX TYPE I/2

K861 OTHER CHRONIC PANCREATITIS

S7225XC NONDISP SUBTROCHNT FX L FEMUR INIT FOR OPN FX TYPE 3A/B/C

K862 CYST OF PANCREAS

S7226XA NONDISPLACED SUBTROCHANTERIC FRACTURE OF UNSP FEMUR INIT

K863 PSEUDOCYST OF PANCREAS

S7226XB NONDISP SUBTROCHNT FX UNSP FEMUR INIT FOR OPN FX TYPE I/2

Page 257: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K868 OTHER SPECIFIED DISEASES OF PANCREAS

S7226XC

NONDISP SUBTROCHNT FX UNSP FEMR INIT FOR OPN FX TYPE 3A/B/C

K8681 Exocrine pancreatic insufficiency

S72301A

UNSP FRACTURE OF SHAFT OF RIGHT FEMUR INIT FOR CLOS FX

K8689 Other specified diseases of pancreas

S72301B

UNSP FX SHAFT OF RIGHT FEMUR INIT FOR OPN FX TYPE I/2

K869 DISEASE OF PANCREAS UNSPECIFIED

S72301C

UNSP FX SHAFT OF RIGHT FEMUR INIT FOR OPN FX TYPE 3A/B/C

K87

DISORD OF GB BILIARY TRAC AND PANCREAS IN DIS CLASSD ELSWHR

S72302A

UNSP FRACTURE OF SHAFT OF LEFT FEMUR INIT FOR CLOS FX

K902 BLIND LOOP SYNDROME NOT ELSEWHERE CLASSIFIED

S72302B

UNSP FX SHAFT OF LEFT FEMUR INIT FOR OPN FX TYPE I/2

K903 PANCREATIC STEATORRHEA

S72302C UNSP FX SHAFT OF LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

K904

MALABSORPTION DUE TO INTOLERANCE NOT ELSEWHERE CLASSIFIED

S72309A

UNSP FRACTURE OF SHAFT OF UNSP FEMUR INIT FOR CLOS FX

K9081 WHIPPLE'S DISEASE

S72309B UNSP FX SHAFT OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

K9089 OTHER INTESTINAL MALABSORPTION

S72309C

UNSP FX SHAFT OF UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

K909 INTESTINAL MALABSORPTION UNSPECIFIED

S72321A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF RIGHT FEMUR INIT

K910 VOMITING FOLLOWING GASTROINTESTINAL SURGERY

S72321B

DISPL TRANSVERSE FX SHAFT OF R FEMR 7THB

K911 POSTGASTRIC SURGERY SYNDROMES

S72321C

DISPL TRANSVERSE FX SHAFT OF R FEMR 7THC

K912

POSTSURGICAL MALABSORPTION NOT ELSEWHERE CLASSIFIED

S72322A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF LEFT FEMUR INIT

K913 POSTPROCEDURAL INTESTINAL OBSTRUCTION

S72322B

DISPL TRANSVERSE FX SHAFT OF L FEMR 7THB

K915 POSTCHOLECYSTECTOMY SYNDROME

S72322C

DISPL TRANSVERSE FX SHAFT OF L FEMR 7THC

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K9161

INTRAOP HEMOR/HEMTOM OF DGSTV SYS ORG COMP A DGSTV SYS PROC

S72323A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF UNSP FEMUR INIT

K9162

INTRAOP HEMOR/HEMTOM OF A DGSTV SYS ORG COMP OTH PROCEDURE

S72323B

DISPL TRANSVERSE FX SHAFT OF UNSP FEMR 7THB

K9171

ACCIDENTAL PNCTR & LAC OF A DGSTV SYS ORG DUR DGSTV SYS PROC

S72323C

DISPL TRANSVERSE FX SHAFT OF UNSP FEMR 7THC

K9172

ACC PNCTR & LAC OF A DGSTV SYS ORG DURING OTH PROCEDURE

S72324A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF RIGHT FEMUR INIT

K9181

OTHER INTRAOPERATIVE COMPLICATIONS OF DIGESTIVE SYSTEM

S72324B

NONDISP TRANSVERSE FX SHAFT OF R FEMR 7THB

K9182 POSTPROCEDURAL HEPATIC FAILURE

S72324C

NONDISP TRANSVERSE FX SHAFT OF R FEMR 7THC

K9183 POSTPROCEDURAL HEPATORENAL SYNDROME

S72325A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF LEFT FEMUR INIT

K91840

POSTPROC HEMOR/HEMTOM OF DGSTV SYS ORG FOL A DGSTV SYS PROC

S72325B

NONDISP TRANSVERSE FX SHAFT OF L FEMR 7THB

K91841

POSTPROC HEMOR/HEMTOM OF A DGSTV SYS ORG FOL OTH PROCEDURE

S72325C

NONDISP TRANSVERSE FX SHAFT OF L FEMR 7THC

K91850 POUCHITIS

S72326A NONDISP TRANSVERSE FRACTURE OF SHAFT OF UNSP FEMUR INIT

K91858 OTHER COMPLICATIONS OF INTESTINAL POUCH

S72326B

NONDISP TRANSVERSE FX SHAFT OF UNSP FEMR 7THB

K91870

Postprocedural hematoma of a digestive system organ or structure following a digestive system procedure

S72326C

NONDISP TRANSVERSE FX SHAFT OF UNSP FEMR 7THC

K91871

Postprocedural hematoma of a digestive system organ or structure following other procedure

S72331A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT FEMUR INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K91872

Postprocedural seroma of a digestive system organ or structure following a digestive system procedure

S72331B

DISPL OBLIQUE FX SHAFT OF R FEMUR INIT FOR OPN FX TYPE I/2

K91873

Postprocedural seroma of a digestive system organ or structure following other procedure

S72331C

DISPL OBLIQUE FX SHAFT OF R FEMR 7THC

K9189

OTH POSTPROCEDURAL COMPLICATIONS AND DISORDERS OF DGSTV SYS

S72332A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT FEMUR INIT

K920 HEMATEMESIS

S72332B DISPL OBLIQUE FX SHAFT OF L FEMUR INIT FOR OPN FX TYPE I/2

K921 MELENA

S72332C DISPL OBLIQUE FX SHAFT OF L FEMR 7THC

K922 GASTROINTESTINAL HEMORRHAGE UNSPECIFIED

S72333A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF UNSP FEMUR INIT

K9281 GASTROINTESTINAL MUCOSITIS (ULCERATIVE)

S72333B

DISPL OBLIQUE FX SHAFT OF UNSP FEMR 7THB

K9289 OTHER SPECIFIED DISEASES OF THE DIGESTIVE SYSTEM

S72333C

DISPL OBLIQUE FX SHAFT OF UNSP FEMR 7THC

K929 DISEASE OF DIGESTIVE SYSTEM UNSPECIFIED

S72334A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT FEMUR INIT

K9400 COLOSTOMY COMPLICATION UNSPECIFIED

S72334B

NONDISP OBLIQUE FX SHAFT OF R FEMR INIT FOR OPN FX TYPE I/2

K9401 COLOSTOMY HEMORRHAGE

S72334C NONDISP OBLIQUE FX SHAFT OF R FEMR 7THC

K9402 COLOSTOMY INFECTION

S72335A NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT FEMUR INIT

K9403 COLOSTOMY MALFUNCTION

S72335B NONDISP OBLIQUE FX SHAFT OF L FEMR INIT FOR OPN FX TYPE I/2

K9409 OTHER COMPLICATIONS OF COLOSTOMY

S72335C

NONDISP OBLIQUE FX SHAFT OF L FEMR 7THC

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

K9410 ENTEROSTOMY COMPLICATION UNSPECIFIED

S72336A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF UNSP FEMUR INIT

K9411 ENTEROSTOMY HEMORRHAGE

S72336B NONDISP OBLIQUE FX SHAFT OF UNSP FEMR 7THB

K9412 ENTEROSTOMY INFECTION

S72336C NONDISP OBLIQUE FX SHAFT OF UNSP FEMR 7THC

K9413 ENTEROSTOMY MALFUNCTION

S72341A DISPLACED SPIRAL FRACTURE OF SHAFT OF RIGHT FEMUR INIT

K9419 OTHER COMPLICATIONS OF ENTEROSTOMY

S72341B

DISPL SPIRAL FX SHAFT OF R FEMUR INIT FOR OPN FX TYPE I/2

K9420 GASTROSTOMY COMPLICATION UNSPECIFIED

S72341C

DISPL SPIRAL FX SHAFT OF R FEMR INIT FOR OPN FX TYPE 3A/B/C

K9421 GASTROSTOMY HEMORRHAGE

S72342A DISPLACED SPIRAL FRACTURE OF SHAFT OF LEFT FEMUR INIT

K9422 GASTROSTOMY INFECTION

S72342B DISPL SPIRAL FX SHAFT OF L FEMUR INIT FOR OPN FX TYPE I/2

K9423 GASTROSTOMY MALFUNCTION

S72342C DISPL SPIRAL FX SHAFT OF L FEMR INIT FOR OPN FX TYPE 3A/B/C

K9429 OTHER COMPLICATIONS OF GASTROSTOMY

S72343A

DISPLACED SPIRAL FRACTURE OF SHAFT OF UNSP FEMUR INIT

K9430 ESOPHAGOSTOMY COMPLICATIONS UNSPECIFIED

S72343B

DISPL SPIRAL FX SHAFT OF UNSP FEMR INIT FOR OPN FX TYPE I/2

K9431 ESOPHAGOSTOMY HEMORRHAGE

S72343C

DISPL SPIRAL FX SHAFT OF UNSP FEMR 7THC

K9432 ESOPHAGOSTOMY INFECTION

S72344A NONDISPLACED SPIRAL FRACTURE OF SHAFT OF RIGHT FEMUR INIT

K9433 ESOPHAGOSTOMY MALFUNCTION

S72344B

NONDISP SPIRAL FX SHAFT OF R FEMUR INIT FOR OPN FX TYPE I/2

K9439 OTHER COMPLICATIONS OF ESOPHAGOSTOMY

S72344C

NONDISP SPIRAL FX SHAFT OF R FEMR 7THC

L00 STAPHYLOCOCCAL SCALDED SKIN SYNDROME

S72345A

NONDISPLACED SPIRAL FRACTURE OF SHAFT OF LEFT FEMUR INIT

L03211 CELLULITIS OF FACE

S72345B NONDISP SPIRAL FX SHAFT OF L FEMUR INIT FOR OPN FX TYPE I/2

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

L03212 ACUTE LYMPHANGITIS OF FACE

S72345C NONDISP SPIRAL FX SHAFT OF L FEMR 7THC

L03213 Periorbital cellulitis

S72346A NONDISPLACED SPIRAL FRACTURE OF SHAFT OF UNSP FEMUR INIT

L03221 CELLULITIS OF NECK

S72346B NONDISP SPIRAL FX SHAFT OF UNSP FEMR 7THB

L03222 ACUTE LYMPHANGITIS OF NECK

S72346C NONDISP SPIRAL FX SHAFT OF UNSP FEMR 7THC

L121 CICATRICIAL PEMPHIGOID

S72351A DISPLACED COMMINUTED FRACTURE OF SHAFT OF RIGHT FEMUR INIT

L490

EXFOLIATN DUE TO ERYTHEMAT COND W < 10 PCT OF BODY SURFACE

S72351B

DISPL COMMNT FX SHAFT OF R FEMUR INIT FOR OPN FX TYPE I/2

L491

EXFOLIATN DUE TO ERYTHEMAT COND W 10-19 PCT OF BODY SURFACE

S72351C

DISPL COMMNT FX SHAFT OF R FEMR INIT FOR OPN FX TYPE 3A/B/C

L492

EXFOLIATN DUE TO ERYTHEMAT COND W 20-29 PCT OF BODY SURFACE

S72352A

DISPLACED COMMINUTED FRACTURE OF SHAFT OF LEFT FEMUR INIT

L493

EXFOLIATN DUE TO ERYTHEMAT COND W 30-39 PCT OF BODY SURFACE

S72352B

DISPL COMMNT FX SHAFT OF L FEMUR INIT FOR OPN FX TYPE I/2

L494

EXFOLIATN DUE TO ERYTHEMAT COND W 40-49 PCT OF BODY SURFACE

S72352C

DISPL COMMNT FX SHAFT OF L FEMR INIT FOR OPN FX TYPE 3A/B/C

L495

EXFOLIATN DUE TO ERYTHEMAT COND W 50-59 PCT OF BODY SURFACE

S72353A

DISPLACED COMMINUTED FRACTURE OF SHAFT OF UNSP FEMUR INIT

L496

EXFOLIATN DUE TO ERYTHEMAT COND W 60-69 PCT OF BODY SURFACE

S72353B

DISPL COMMNT FX SHAFT OF UNSP FEMR INIT FOR OPN FX TYPE I/2

L497

EXFOLIATN DUE TO ERYTHEMAT COND W 70-79 PCT OF BODY SURFACE

S72353C

DISPL COMMNT FX SHAFT OF UNSP FEMR 7THC

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

L498

EXFOLIATN DUE TO ERYTHEMAT COND W 80-89 PCT OF BODY SURFACE

S72354A

NONDISP COMMINUTED FRACTURE OF SHAFT OF RIGHT FEMUR INIT

L499

EXFOLIATN D/T ERYTHEMAT COND W 90 OR MORE PCT OF BODY SURFC

S72354B

NONDISP COMMNT FX SHAFT OF R FEMUR INIT FOR OPN FX TYPE I/2

L500 ALLERGIC URTICARIA

S72354C NONDISP COMMNT FX SHAFT OF R FEMR 7THC

L501 IDIOPATHIC URTICARIA

S72355A NONDISP COMMINUTED FRACTURE OF SHAFT OF LEFT FEMUR INIT

L502 URTICARIA DUE TO COLD AND HEAT

S72355B

NONDISP COMMNT FX SHAFT OF L FEMUR INIT FOR OPN FX TYPE I/2

L503 DERMATOGRAPHIC URTICARIA

S72355C NONDISP COMMNT FX SHAFT OF L FEMR 7THC

L504 VIBRATORY URTICARIA

S72356A NONDISP COMMINUTED FRACTURE OF SHAFT OF UNSP FEMUR INIT

L505 CHOLINERGIC URTICARIA

S72356B NONDISP COMMNT FX SHAFT OF UNSP FEMR 7THB

L506 CONTACT URTICARIA

S72356C NONDISP COMMNT FX SHAFT OF UNSP FEMR 7THC

L508 OTHER URTICARIA

S72361A DISPLACED SEGMENTAL FRACTURE OF SHAFT OF RIGHT FEMUR INIT

L509 URTICARIA UNSPECIFIED

S72361B DISPL SEG FX SHAFT OF R FEMUR INIT FOR OPN FX TYPE I/2

L510 NONBULLOUS ERYTHEMA MULTIFORME

S72361C

DISPL SEG FX SHAFT OF R FEMUR INIT FOR OPN FX TYPE 3A/B/C

L511 STEVENS-JOHNSON SYNDROME

S72362A DISPLACED SEGMENTAL FRACTURE OF SHAFT OF LEFT FEMUR INIT

L512 TOXIC EPIDERMAL NECROLYSIS [LYELL]

S72362B

DISPL SEG FX SHAFT OF L FEMUR INIT FOR OPN FX TYPE I/2

L513

STEVENS-JOHNSON SYND-TOX EPDRML NECROLYSIS OVERLAP SYNDROME

S72362C

DISPL SEG FX SHAFT OF L FEMUR INIT FOR OPN FX TYPE 3A/B/C

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

L518 OTHER ERYTHEMA MULTIFORME

S72363A

DISPLACED SEGMENTAL FRACTURE OF SHAFT OF UNSP FEMUR INIT

L519 ERYTHEMA MULTIFORME UNSPECIFIED

S72363B

DISPL SEG FX SHAFT OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

L52 ERYTHEMA NODOSUM

S72363C DISPL SEG FX SHAFT OF UNSP FEMR INIT FOR OPN FX TYPE 3A/B/C

L530 TOXIC ERYTHEMA

S72364A NONDISP SEGMENTAL FRACTURE OF SHAFT OF RIGHT FEMUR INIT

L531 ERYTHEMA ANNULARE CENTRIFUGUM

S72364B

NONDISP SEG FX SHAFT OF R FEMUR INIT FOR OPN FX TYPE I/2

L532 ERYTHEMA MARGINATUM

S72364C NONDISP SEG FX SHAFT OF R FEMUR INIT FOR OPN FX TYPE 3A/B/C

L533 OTHER CHRONIC FIGURATE ERYTHEMA

S72365A

NONDISPLACED SEGMENTAL FRACTURE OF SHAFT OF LEFT FEMUR INIT

L538 OTHER SPECIFIED ERYTHEMATOUS CONDITIONS

S72365B

NONDISP SEG FX SHAFT OF L FEMUR INIT FOR OPN FX TYPE I/2

L539 ERYTHEMATOUS CONDITION UNSPECIFIED

S72365C

NONDISP SEG FX SHAFT OF L FEMUR INIT FOR OPN FX TYPE 3A/B/C

L54 ERYTHEMA IN DISEASES CLASSIFIED ELSEWHERE

S72366A

NONDISPLACED SEGMENTAL FRACTURE OF SHAFT OF UNSP FEMUR INIT

L550 SUNBURN OF FIRST DEGREE

S72366B NONDISP SEG FX SHAFT OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

L551 SUNBURN OF SECOND DEGREE

S72366C NONDISP SEG FX SHAFT OF UNSP FEMR 7THC

L552 SUNBURN OF THIRD DEGREE

S72391A OTH FRACTURE OF SHAFT OF RIGHT FEMUR INIT FOR CLOS FX

L559 SUNBURN UNSPECIFIED

S72391B OTH FX SHAFT OF RIGHT FEMUR INIT FOR OPN FX TYPE I/2

L560 DRUG PHOTOTOXIC RESPONSE

S72391C OTH FX SHAFT OF RIGHT FEMUR INIT FOR OPN FX TYPE 3A/B/C

Page 264: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

L561 DRUG PHOTOALLERGIC RESPONSE

S72392A

OTH FRACTURE OF SHAFT OF LEFT FEMUR INIT FOR CLOS FX

L562 PHOTOCONTACT DERMATITIS [BERLOQUE DERMATITIS]

S72392B

OTH FX SHAFT OF LEFT FEMUR INIT FOR OPN FX TYPE I/2

L563 SOLAR URTICARIA

S72392C OTH FX SHAFT OF LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

L564 POLYMORPHOUS LIGHT ERUPTION

S72399A

OTH FRACTURE OF SHAFT OF UNSP FEMUR INIT FOR CLOS FX

L565

DISSEMINATED SUPERFICIAL ACTINIC POROKERATOSIS (DSAP)

S72399B

OTH FX SHAFT OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

L568 OTH ACUTE SKIN CHANGES DUE TO ULTRAVIOLET RADIATION

S72399C

OTH FX SHAFT OF UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

L569

ACUTE SKIN CHANGE DUE TO ULTRAVIOLET RADIATION UNSPECIFIED

S72401A

UNSP FRACTURE OF LOWER END OF RIGHT FEMUR INIT FOR CLOS FX

L570 ACTINIC KERATOSIS

S72401B UNSP FX LOWER END OF RIGHT FEMUR INIT FOR OPN FX TYPE I/2

L571 ACTINIC RETICULOID

S72401C UNSP FX LOWER END OF R FEMUR INIT FOR OPN FX TYPE 3A/B/C

L572 CUTIS RHOMBOIDALIS NUCHAE

S72402A UNSP FRACTURE OF LOWER END OF LEFT FEMUR INIT FOR CLOS FX

L573 POIKILODERMA OF CIVATTE

S72402B UNSP FX LOWER END OF LEFT FEMUR INIT FOR OPN FX TYPE I/2

L574 CUTIS LAXA SENILIS

S72402C UNSP FX LOWER END OF LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

L575 ACTINIC GRANULOMA

S72409A UNSP FRACTURE OF LOWER END OF UNSP FEMUR INIT FOR CLOS FX

L578

OTH SKIN CHANGES DUE TO CHR EXPSR TO NONIONIZING RADIATION

S72409B

UNSP FX LOWER END OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

L579

SKIN CHANGES DUE TO CHR EXPSR TO NONIONIZING RADIATION UNSP

S72409C

UNSP FX LOWER END OF UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

L580 ACUTE RADIODERMATITIS

S72411A DISPLACED UNSP CONDYLE FX LOWER END OF RIGHT FEMUR INIT

L581 CHRONIC RADIODERMATITIS

S72411B DISPL UNSP CONDYLE FX LOW END R FEMR 7THB

L589 RADIODERMATITIS UNSPECIFIED

S72411C

DISPL UNSP CONDYLE FX LOW END R FEMR 7THC

L590 ERYTHEMA AB IGNE [DERMATITIS AB IGNE]

S72412A

DISPLACED UNSP CONDYLE FX LOWER END OF LEFT FEMUR INIT

L598 OTH DISRD OF THE SKIN SUBCU RELATED TO RADIATION

S72412B

DISPL UNSP CONDYLE FX LOW END L FEMR 7THB

L599 DISORDER OF THE SKIN SUBCU RELATED TO RADIATION UNSP

S72412C

DISPL UNSP CONDYLE FX LOW END L FEMR 7THC

L7601

INTRAOP HEMOR/HEMTOM OF SKIN SUBCU COMP A DERMATOLOGIC PROC

S72413A

DISPLACED UNSP CONDYLE FX LOWER END OF UNSP FEMUR INIT

L7602

INTRAOP HEMOR/HEMTOM OF SKIN SUBCU COMP OTH PROCEDURE

S72413B

DISPL UNSP CONDYLE FX LOW END UNSP FEMR 7THB

L7611

ACC PNCTR & LAC OF SKIN SUBCU DURING A DERMATOLOGIC PROC

S72413C

DISPL UNSP CONDYLE FX LOW END UNSP FEMR 7THC

L7612

ACCIDENTAL PNCTR & LAC OF SKIN SUBCU DURING OTH PROCEDURE

S72414A

NONDISP UNSP CONDYLE FX LOWER END OF RIGHT FEMUR INIT

L7621

POSTPROC HEMOR/HEMTOM OF SKIN SUBCU FOL A DERMATOLOGIC PROC

S72414B

NONDISP UNSP CONDYLE FX LOW END R FEMR 7THB

L7622

POSTPROC HEMOR/HEMTOM OF SKIN SUBCU FOLLOWING OTH PROCEDURE

S72414C

NONDISP UNSP CONDYLE FX LOW END R FEMR 7THC

L7681

OTH INTRAOPERATIVE COMPLICATIONS OF SKIN SUBCU

S72415A

NONDISP UNSP CONDYLE FX LOWER END OF LEFT FEMUR INIT

L7682

OTH POSTPROCEDURAL COMPLICATIONS OF SKIN SUBCU

S72415B

NONDISP UNSP CONDYLE FX LOW END L FEMR 7THB

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

L88 PYODERMA GANGRENOSUM

S72415C NONDISP UNSP CONDYLE FX LOW END L FEMR 7THC

L97413

NON-PRS CHR ULCER OF RIGHT HEEL AND MIDFOOT W NECROS MUSCLE

S72416A

NONDISP UNSP CONDYLE FX LOWER END OF UNSP FEMUR INIT

L97414

NON-PRS CHR ULCER OF RIGHT HEEL AND MIDFOOT W NECROS BONE

S72416B

NONDISP UNSP CONDYLE FX LOW END UNSP FEMR 7THB

L97419

NON-PRS CHR ULCER OF RIGHT HEEL AND MIDFOOT W UNSP SEVERT

S72416C

NONDISP UNSP CONDYLE FX LOW END UNSP FEMR 7THC

L97423

NON-PRS CHR ULCER OF LEFT HEEL AND MIDFOOT W NECROS MUSCLE

S72421A

DISP FX OF LATERAL CONDYLE OF RIGHT FEMUR INIT FOR CLOS FX

L97424

NON-PRS CHRONIC ULCER OF LEFT HEEL AND MIDFOOT W NECROS BONE

S72421B

DISP FX OF LATERAL CONDYLE OF R FEMR 7THB

L97429

NON-PRS CHRONIC ULCER OF LEFT HEEL AND MIDFOOT W UNSP SEVERT

S72421C

DISP FX OF LATERAL CONDYLE OF R FEMR 7THC

L97503

NON-PRS CHRONIC ULCER OTH PRT UNSP FOOT W NECROSIS OF MUSCLE

S72422A

DISP FX OF LATERAL CONDYLE OF LEFT FEMUR INIT FOR CLOS FX

L97504

NON-PRS CHRONIC ULCER OTH PRT UNSP FOOT W NECROSIS OF BONE

S72422B

DISP FX OF LATERAL CONDYLE OF L FEMR 7THB

L97509

NON-PRESSURE CHRONIC ULCER OTH PRT UNSP FOOT W UNSP SEVERITY

S72422C

DISP FX OF LATERAL CONDYLE OF L FEMR 7THC

L97513

NON-PRS CHRONIC ULCER OTH PRT RIGHT FOOT W NECROS MUSCLE

S72423A

DISP FX OF LATERAL CONDYLE OF UNSP FEMUR INIT FOR CLOS FX

L97514

NON-PRS CHRONIC ULCER OTH PRT RIGHT FOOT W NECROSIS OF BONE

S72423B

DISP FX OF LATERAL CONDYLE OF UNSP FEMR 7THB

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

L97519

NON-PRS CHRONIC ULCER OTH PRT RIGHT FOOT W UNSP SEVERITY

S72423C

DISP FX OF LATERAL CONDYLE OF UNSP FEMR 7THC

L97523

NON-PRS CHRONIC ULCER OTH PRT LEFT FOOT W NECROSIS OF MUSCLE

S72424A

NONDISP FX OF LATERAL CONDYLE OF RIGHT FEMUR INIT

L97524

NON-PRS CHRONIC ULCER OTH PRT LEFT FOOT W NECROSIS OF BONE

S72424B

NONDISP FX OF LATERAL CONDYLE OF R FEMR 7THB

L97529

NON-PRESSURE CHRONIC ULCER OTH PRT LEFT FOOT W UNSP SEVERITY

S72424C

NONDISP FX OF LATERAL CONDYLE OF R FEMR 7THC

L97803

NON-PRS CHRONIC ULCER OTH PRT UNSP LOWER LEG W NECROS MUSCLE

S72425A

NONDISP FX OF LATERAL CONDYLE OF LEFT FEMUR INIT

L97804

NON-PRS CHRONIC ULCER OTH PRT UNSP LOWER LEG W NECROS BONE

S72425B

NONDISP FX OF LATERAL CONDYLE OF L FEMR 7THB

L97809

NON-PRS CHRONIC ULCER OTH PRT UNSP LOWER LEG W UNSP SEVERITY

S72425C

NONDISP FX OF LATERAL CONDYLE OF L FEMR 7THC

L97813

NON-PRS CHRONIC ULCER OTH PRT R LOW LEG W NECROSIS OF MUSCLE

S72426A

NONDISP FX OF LATERAL CONDYLE OF UNSP FEMUR INIT

L97814

NON-PRS CHRONIC ULCER OTH PRT R LOW LEG W NECROSIS OF BONE

S72426B

NONDISP FX OF LATERAL CONDYLE OF UNSP FEMR 7THB

L97823

NON-PRS CHRONIC ULCER OTH PRT L LOW LEG W NECROSIS OF MUSCLE

S72426C

NONDISP FX OF LATERAL CONDYLE OF UNSP FEMR 7THC

L97824

NON-PRS CHRONIC ULCER OTH PRT L LOW LEG W NECROSIS OF BONE

S72431A

DISP FX OF MEDIAL CONDYLE OF RIGHT FEMUR INIT FOR CLOS FX

L97903

NON-PRS CHRONIC ULC UNSP PRT OF UNSP LOW LEG W NECROS MUSCLE

S72431B

DISP FX OF MED CONDYLE OF R FEMUR INIT FOR OPN FX TYPE I/2

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

L97904

NON-PRS CHRONIC ULC UNSP PRT OF UNSP LOWER LEG W NECROS BONE

S72431C

DISP FX OF MED CONDYLE OF R FEMR 7THC

L97913

NON-PRS CHRONIC ULC UNSP PRT OF R LOW LEG W NECROS MUSCLE

S72432A

DISP FX OF MEDIAL CONDYLE OF LEFT FEMUR INIT FOR CLOS FX

L97914

NON-PRS CHRONIC ULC UNSP PRT OF R LOW LEG W NECROSIS OF BONE

S72432B

DISP FX OF MED CONDYLE OF L FEMUR INIT FOR OPN FX TYPE I/2

L97923

NON-PRS CHRONIC ULC UNSP PRT OF L LOW LEG W NECROS MUSCLE

S72432C

DISP FX OF MED CONDYLE OF L FEMR 7THC

L97924

NON-PRS CHRONIC ULC UNSP PRT OF L LOW LEG W NECROSIS OF BONE

S72433A

DISP FX OF MEDIAL CONDYLE OF UNSP FEMUR INIT FOR CLOS FX

L98413

NON-PRESSURE CHRONIC ULCER OF BUTTOCK W NECROSIS OF MUSCLE

S72433B

DISP FX OF MED CONDYLE OF UNSP FEMR 7THB

L98414

NON-PRESSURE CHRONIC ULCER OF BUTTOCK WITH NECROSIS OF BONE

S72433C

DISP FX OF MED CONDYLE OF UNSP FEMR 7THC

L98423

NON-PRESSURE CHRONIC ULCER OF BACK WITH NECROSIS OF MUSCLE

S72434A

NONDISP FX OF MEDIAL CONDYLE OF RIGHT FEMUR INIT

L98424

NON-PRESSURE CHRONIC ULCER OF BACK WITH NECROSIS OF BONE

S72434B

NONDISP FX OF MED CONDYLE OF R FEMR 7THB

L98494

NON-PRS CHRONIC ULCER OF SKIN OF SITES W NECROSIS OF BONE

S72434C

NONDISP FX OF MED CONDYLE OF R FEMR 7THC

M2430 PATHOLOGICAL DISLOCATION OF UNSP JOINT NEC

S72435A

NONDISP FX OF MEDIAL CONDYLE OF LEFT FEMUR INIT FOR CLOS FX

M24311 PATHOLOGICAL DISLOCATION OF RIGHT SHOULDER NEC

S72435B

NONDISP FX OF MED CONDYLE OF L FEMR 7THB

M24312 PATHOLOGICAL DISLOCATION OF LEFT SHOULDER NEC

S72435C

NONDISP FX OF MED CONDYLE OF L FEMR 7THC

Page 269: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M24319 PATHOLOGICAL DISLOCATION OF UNSP SHOULDER NEC

S72436A

NONDISP FX OF MEDIAL CONDYLE OF UNSP FEMUR INIT FOR CLOS FX

M24321 PATHOLOGICAL DISLOCATION OF RIGHT ELBOW NEC

S72436B

NONDISP FX OF MED CONDYLE OF UNSP FEMR 7THB

M24322 PATHOLOGICAL DISLOCATION OF LEFT ELBOW NEC

S72436C

NONDISP FX OF MED CONDYLE OF UNSP FEMR 7THC

M24329 PATHOLOGICAL DISLOCATION OF UNSP ELBOW NEC

S72441A

DISP FX OF LOWER EPIPHYSIS (SEPARATION) OF RIGHT FEMUR INIT

M24331 PATHOLOGICAL DISLOCATION OF RIGHT WRIST NEC

S72441B

DISP FX OF LOW EPIPHY (SEPARATION) OF R FEMR 7THB

M24332 PATHOLOGICAL DISLOCATION OF LEFT WRIST NEC

S72441C

DISP FX OF LOW EPIPHY (SEPARATION) OF R FEMR 7THC

M24339 PATHOLOGICAL DISLOCATION OF UNSP WRIST NEC

S72442A

DISP FX OF LOWER EPIPHYSIS (SEPARATION) OF LEFT FEMUR INIT

M24341 PATHOLOGICAL DISLOCATION OF RIGHT HAND NEC

S72442B

DISP FX OF LOW EPIPHY (SEPARATION) OF L FEMR 7THB

M24342 PATHOLOGICAL DISLOCATION OF LEFT HAND NEC

S72442C

DISP FX OF LOW EPIPHY (SEPARATION) OF L FEMR 7THC

M24349 PATHOLOGICAL DISLOCATION OF UNSP HAND NEC

S72443A

DISP FX OF LOWER EPIPHYSIS (SEPARATION) OF UNSP FEMUR INIT

M24351 PATHOLOGICAL DISLOCATION OF RIGHT HIP NEC

S72443B

DISP FX OF LOW EPIPHY (SEPARATION) OF UNSP FEMR 7THB

M24352 PATHOLOGICAL DISLOCATION OF LEFT HIP NEC

S72443C

DISP FX OF LOW EPIPHY (SEPARATION) OF UNSP FEMR 7THC

M24359 PATHOLOGICAL DISLOCATION OF UNSP HIP NEC

S72444A

NONDISP FX OF LOWER EPIPHYSIS (SEPARATION) OF R FEMUR INIT

M24361 PATHOLOGICAL DISLOCATION OF RIGHT KNEE NEC

S72444B

NONDISP FX OF LOW EPIPHY (SEPARATION) OF R FEMR 7THB

M24362 PATHOLOGICAL DISLOCATION OF LEFT KNEE NEC

S72444C

NONDISP FX OF LOW EPIPHY (SEPARATION) OF R FEMR 7THC

M24369 PATHOLOGICAL DISLOCATION OF UNSP KNEE NEC

S72445A

NONDISP FX OF LOWER EPIPHYSIS (SEPARATION) OF L FEMUR INIT

Page 270: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M24371 PATHOLOGICAL DISLOCATION OF RIGHT ANKLE NEC

S72445B

NONDISP FX OF LOW EPIPHY (SEPARATION) OF L FEMR 7THB

M24372 PATHOLOGICAL DISLOCATION OF LEFT ANKLE NEC

S72445C

NONDISP FX OF LOW EPIPHY (SEPARATION) OF L FEMR 7THC

M24373 PATHOLOGICAL DISLOCATION OF UNSP ANKLE NEC

S72446A

NONDISP FX OF LOWER EPIPHY (SEPARATION) OF UNSP FEMUR INIT

M24374 PATHOLOGICAL DISLOCATION OF RIGHT FOOT NEC

S72446B

NONDISP FX OF LOW EPIPHY (SEPARATION) OF UNSP FEMR 7THB

M24375 PATHOLOGICAL DISLOCATION OF LEFT FOOT NEC

S72446C

NONDISP FX OF LOW EPIPHY (SEPARATION) OF UNSP FEMR 7THC

M24376 PATHOLOGICAL DISLOCATION OF UNSP FOOT NEC

S72451A

DISPL SUPRCNDL FX W/O INTRCNDL EXTN LOWER END R FEMUR INIT

M310 HYPERSENSITIVITY ANGIITIS

S72451B DISPL SUPRCNDL FX W/O INTRCNDL EXTN LOW END R FEMR 7THB

M311 THROMBOTIC MICROANGIOPATHY

S72451C

DISPL SUPRCNDL FX W/O INTRCNDL EXTN LOW END R FEMR 7THC

M312 LETHAL MIDLINE GRANULOMA

S72452A DISPL SUPRCNDL FX W/O INTRCNDL EXTN LOWER END L FEMUR INIT

M314 AORTIC ARCH SYNDROME [TAKAYASU]

S72452B

DISPL SUPRCNDL FX W/O INTRCNDL EXTN LOW END L FEMR 7THB

M318 OTHER SPECIFIED NECROTIZING VASCULOPATHIES

S72452C

DISPL SUPRCNDL FX W/O INTRCNDL EXTN LOW END L FEMR 7THC

M319 NECROTIZING VASCULOPATHY UNSPECIFIED

S72453A

DISPL SUPRCNDL FX W/O INTRCNDL EXTN LOW END UNSP FEMR INIT

M3211 ENDOCARDITIS IN SYSTEMIC LUPUS ERYTHEMATOSUS

S72453B

DISPL SUPRCNDL FX W/O INTRCNDL EXTN LOW END UNSP FEMR 7THB

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M3212 PERICARDITIS IN SYSTEMIC LUPUS ERYTHEMATOSUS

S72453C

DISPL SUPRCNDL FX W/O INTRCNDL EXTN LOW END UNSP FEMR 7THC

M3213

LUNG INVOLVEMENT IN SYSTEMIC LUPUS ERYTHEMATOSUS

S72454A

NONDISP SUPRCNDL FX W/O INTRCNDL EXTN LOWER END R FEMR INIT

M3214

GLOMERULAR DISEASE IN SYSTEMIC LUPUS ERYTHEMATOSUS

S72454B

NONDISP SUPRCNDL FX W/O INTRCNDL EXTN LOW END R FEMR 7THB

M3215

TUBULO-INTERSTITIAL NEUROPATH IN SYS LUPUS ERYTHEMATOSUS

S72454C

NONDISP SUPRCNDL FX W/O INTRCNDL EXTN LOW END R FEMR 7THC

M3219

OTH ORGAN OR SYSTEM INVOLV IN SYSTEMIC LUPUS ERYTHEMATOSUS

S72455A

NONDISP SUPRCNDL FX W/O INTRCNDL EXTN LOWER END L FEMR INIT

M328 OTHER FORMS OF SYSTEMIC LUPUS ERYTHEMATOSUS

S72455B

NONDISP SUPRCNDL FX W/O INTRCNDL EXTN LOW END L FEMR 7THB

M329 SYSTEMIC LUPUS ERYTHEMATOSUS UNSPECIFIED

S72455C

NONDISP SUPRCNDL FX W/O INTRCNDL EXTN LOW END L FEMR 7THC

M4830 TRAUMATIC SPONDYLOPATHY SITE UNSPECIFIED

S72456A

NONDISP SUPRCNDL FX W/O INTRCNDL EXTN LOW END UNSP FEMRINIT

M4831

TRAUMATIC SPONDYLOPATHY OCCIPITO-ATLANTO-AXIAL REGION

S72456B

NONDISP SUPRCNDL FX W/O INTRCNDL EXTN LOW END UNSP FEMR7THB

M4832 TRAUMATIC SPONDYLOPATHY CERVICAL REGION

S72456C

NONDISP SUPRCNDL FX W/O INTRCNDL EXTN LOW END UNSP FEMR7THC

M4833 TRAUMATIC SPONDYLOPATHY CERVICOTHORACIC REGION

S72461A

DISPL SUPRCNDL FX W INTRCNDL EXTN LOWER END OF R FEMUR INIT

M4834 TRAUMATIC SPONDYLOPATHY THORACIC REGION

S72461B

DISPL SUPRCNDL FX W INTRCNDL EXTN LOW END R FEMR 7THB

M4835 TRAUMATIC SPONDYLOPATHY THORACOLUMBAR REGION

S72461C

DISPL SUPRCNDL FX W INTRCNDL EXTN LOW END R FEMR 7THC

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M4836 TRAUMATIC SPONDYLOPATHY LUMBAR REGION

S72462A

DISPL SUPRCNDL FX W INTRCNDL EXTN LOWER END OF L FEMUR INIT

M4837 TRAUMATIC SPONDYLOPATHY LUMBOSACRAL REGION

S72462B

DISPL SUPRCNDL FX W INTRCNDL EXTN LOW END L FEMR 7THB

M4838

TRAUMATIC SPONDYLOPATHY SACRAL AND SACROCOCCYGEAL REGION

S72462C

DISPL SUPRCNDL FX W INTRCNDL EXTN LOW END L FEMR 7THC

M4840XA

FATIGUE FRACTURE OF VERTEBRA SITE UNSP INIT FOR FX

S72463A

DISPL SUPRCNDL FX W INTRCNDL EXTN LOWER END UNSP FEMUR INIT

M4841XA

FATIGUE FRACTURE OF VERTEBRA OCCIPT-ATLAN-AX REGION INIT

S72463B

DISPL SUPRCNDL FX W INTRCNDL EXTN LOW END UNSP FEMR 7THB

M4842XA

FATIGUE FRACTURE OF VERTEBRA CERVICAL REGION INIT FOR FX

S72463C

DISPL SUPRCNDL FX W INTRCNDL EXTN LOW END UNSP FEMR 7THC

M4843XA

FATIGUE FRACTURE OF VERTEBRA CERVICOTHORACIC REGION INIT

S72464A

NONDISP SUPRCNDL FX W INTRCNDL EXTN LOWER END R FEMUR INIT

M4844XA

FATIGUE FRACTURE OF VERTEBRA THORACIC REGION INIT FOR FX

S72464B

NONDISP SUPRCNDL FX W INTRCNDL EXTN LOW END R FEMR 7THB

M4845XA

FATIGUE FRACTURE OF VERTEBRA THORACOLUMBAR REGION INIT

S72464C

NONDISP SUPRCNDL FX W INTRCNDL EXTN LOW END R FEMR 7THC

M4846XA

FATIGUE FRACTURE OF VERTEBRA LUMBAR REGION INIT FOR FX

S72465A

NONDISP SUPRCNDL FX W INTRCNDL EXTN LOWER END L FEMUR INIT

M4847XA

FATIGUE FRACTURE OF VERTEBRA LUMBOSACRAL REGION INIT

S72465B

NONDISP SUPRCNDL FX W INTRCNDL EXTN LOW END L FEMR 7THB

M4848XA

FATIGUE FRACTURE OF VERTEBRA SACR/SACROCYGL REGION INIT

S72465C

NONDISP SUPRCNDL FX W INTRCNDL EXTN LOW END L FEMR 7THC

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M4850XA COLLAPSED VERTEBRA NEC SITE UNSP INIT

S72466A

NONDISP SUPRCNDL FX W INTRCNDL EXTN LOW END UNSP FEMR INIT

M4851XA

COLLAPSED VERTEBRA NEC OCCIPITO-ATLANTO-AXIAL REGION INIT

S72466B

NONDISP SUPRCNDL FX W INTRCNDL EXTN LOW END UNSP FEMR 7THB

M4852XA COLLAPSED VERTEBRA NEC CERVICAL REGION INIT

S72466C

NONDISP SUPRCNDL FX W INTRCNDL EXTN LOW END UNSP FEMR 7THC

M4853XA COLLAPSED VERTEBRA NEC CERVICOTHORACIC REGION INIT

S72471A

TORUS FRACTURE OF LOWER END OF RIGHT FEMUR INIT FOR CLOS FX

M4854XA COLLAPSED VERTEBRA NEC THORACIC REGION INIT

S72472A

TORUS FRACTURE OF LOWER END OF LEFT FEMUR INIT FOR CLOS FX

M4855XA COLLAPSED VERTEBRA NEC THORACOLUMBAR REGION INIT

S72479A

TORUS FRACTURE OF LOWER END OF UNSP FEMUR INIT FOR CLOS FX

M4856XA COLLAPSED VERTEBRA NEC LUMBAR REGION INIT

S72491A

OTH FRACTURE OF LOWER END OF RIGHT FEMUR INIT FOR CLOS FX

M4857XA COLLAPSED VERTEBRA NEC LUMBOSACRAL REGION INIT

S72491B

OTH FX LOWER END OF RIGHT FEMUR INIT FOR OPN FX TYPE I/2

M4858XA COLLAPSED VERTEBRA NEC SACR/SACROCYGL REGION INIT

S72491C

OTH FX LOWER END OF RIGHT FEMUR INIT FOR OPN FX TYPE 3A/B/C

M5001

CERVICAL DISC DISORDER W MYELOPATHY HIGH CERVICAL REGION

S72492A

OTH FRACTURE OF LOWER END OF LEFT FEMUR INIT FOR CLOS FX

M5002

CERVICAL DISC DISORDER WITH MYELOPATHY MID-CERVICAL REGION

S72492B

OTH FX LOWER END OF LEFT FEMUR INIT FOR OPN FX TYPE I/2

M50020

Cervical disc disorder with myelopathy mid-cervical region unspecified level

S72492C

OTH FX LOWER END OF LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

M50021 Cervical disc disorder at C4-C5 level with myelopathy

S72499A

OTH FRACTURE OF LOWER END OF UNSP FEMUR INIT FOR CLOS FX

M50022 Cervical disc disorder at C5-C6 level with myelopathy

S72499B

OTH FX LOWER END OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

Page 274: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M50023 Cervical disc disorder at C6-C7 level with myelopathy

S72499C

OTH FX LOWER END OF UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

M5003

CERVICAL DISC DISORDER W MYELOPATHY CERVICOTHORACIC REGION

S728X1A

OTH FRACTURE OF RIGHT FEMUR INIT ENCNTR FOR CLOSED FRACTURE

M5010

CERVICAL DISC DISORDER W RADICULOPATHY UNSP CERVICAL REGION

S728X1B

OTH FRACTURE OF RIGHT FEMUR INIT FOR OPN FX TYPE I/2

M5011

CERV DISC DISORDER W RADICULOPATHY HIGH CERVICAL REGION

S728X1C

OTH FRACTURE OF RIGHT FEMUR INIT FOR OPN FX TYPE 3A/B/C

M5012

CERVICAL DISC DISORDER W RADICULOPATHY MID-CERVICAL REGION

S728X2A

OTH FRACTURE OF LEFT FEMUR INIT ENCNTR FOR CLOSED FRACTURE

M50120 Mid-cervical disc disorder unspecified

S728X2B

OTH FRACTURE OF LEFT FEMUR INIT FOR OPN FX TYPE I/2

M50121 Cervical disc disorder at C4-C5 level with radiculopathy

S728X2C

OTH FRACTURE OF LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

M50122 Cervical disc disorder at C5-C6 level with radiculopathy

S728X9A

OTH FRACTURE OF UNSP FEMUR INIT ENCNTR FOR CLOSED FRACTURE

M50123 Cervical disc disorder at C6-C7 level with radiculopathy

S728X9B

OTH FRACTURE OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

M5013

CERVICAL DISC DISORDER W RADICULOPATHY CERVICOTHOR REGION

S728X9C

OTH FRACTURE OF UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

M5020

OTHER CERVICAL DISC DISPLACEMENT UNSP CERVICAL REGION

S7290XA

UNSP FRACTURE OF UNSP FEMUR INIT ENCNTR FOR CLOSED FRACTURE

M5021

OTHER CERVICAL DISC DISPLACEMENT HIGH CERVICAL REGION

S7290XB

UNSP FRACTURE OF UNSP FEMUR INIT FOR OPN FX TYPE I/2

M5022

OTHER CERVICAL DISC DISPLACEMENT MID-CERVICAL REGION

S7290XC

UNSP FRACTURE OF UNSP FEMUR INIT FOR OPN FX TYPE 3A/B/C

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M50220

Other cervical disc displacement mid-cervical region unspecified level

S7291XA

UNSP FRACTURE OF RIGHT FEMUR INIT FOR CLOS FX

M50221 Other cervical disc displacement at C4-C5 level

S7291XB

UNSP FRACTURE OF RIGHT FEMUR INIT FOR OPN FX TYPE I/2

M50222 Other cervical disc displacement at C5-C6 level

S7291XC

UNSP FRACTURE OF RIGHT FEMUR INIT FOR OPN FX TYPE 3A/B/C

M50223 Other cervical disc displacement at C6-C7 level

S7292XA

UNSP FRACTURE OF LEFT FEMUR INIT ENCNTR FOR CLOSED FRACTURE

M5023

OTHER CERVICAL DISC DISPLACEMENT CERVICOTHORACIC REGION

S7292XB

UNSP FRACTURE OF LEFT FEMUR INIT FOR OPN FX TYPE I/2

M5030

OTHER CERVICAL DISC DEGENERATION UNSP CERVICAL REGION

S7292XC

UNSP FRACTURE OF LEFT FEMUR INIT FOR OPN FX TYPE 3A/B/C

M5031

OTHER CERVICAL DISC DEGENERATION HIGH CERVICAL REGION

S73001A

UNSPECIFIED SUBLUXATION OF RIGHT HIP INITIAL ENCOUNTER

M5032

OTHER CERVICAL DISC DEGENERATION MID-CERVICAL REGION

S73002A

UNSPECIFIED SUBLUXATION OF LEFT HIP INITIAL ENCOUNTER

M50320

Other cervical disc degeneration mid-cervical region unspecified level

S73003A

UNSPECIFIED SUBLUXATION OF UNSPECIFIED HIP INIT ENCNTR

M50321 Other cervical disc degeneration at C4-C5 level

S73004A

UNSPECIFIED DISLOCATION OF RIGHT HIP INITIAL ENCOUNTER

M50322 Other cervical disc degeneration at C5-C6 level

S73005A

UNSPECIFIED DISLOCATION OF LEFT HIP INITIAL ENCOUNTER

M50323 Other cervical disc degeneration at C6-C7 level

S73006A

UNSPECIFIED DISLOCATION OF UNSPECIFIED HIP INIT ENCNTR

M5033

OTHER CERVICAL DISC DEGENERATION CERVICOTHORACIC REGION

S73011A

POSTERIOR SUBLUXATION OF RIGHT HIP INITIAL ENCOUNTER

M5080

OTHER CERVICAL DISC DISORDERS UNSPECIFIED CERVICAL REGION

S73012A

POSTERIOR SUBLUXATION OF LEFT HIP INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M5081

OTHER CERVICAL DISC DISORDERS HIGH CERVICAL REGION

S73013A

POSTERIOR SUBLUXATION OF UNSPECIFIED HIP INITIAL ENCOUNTER

M5082

OTHER CERVICAL DISC DISORDERS MID-CERVICAL REGION

S73014A

POSTERIOR DISLOCATION OF RIGHT HIP INITIAL ENCOUNTER

M50820

Other cervical disc disorders mid-cervical region unspecified level

S73015A

POSTERIOR DISLOCATION OF LEFT HIP INITIAL ENCOUNTER

M50821 Other cervical disc disorders at C4-C5 level

S73016A

POSTERIOR DISLOCATION OF UNSPECIFIED HIP INITIAL ENCOUNTER

M50822 Other cervical disc disorders at C5-C6 level

S73021A

OBTURATOR SUBLUXATION OF RIGHT HIP INITIAL ENCOUNTER

M50823 Other cervical disc disorders at C6-C7 level

S73022A

OBTURATOR SUBLUXATION OF LEFT HIP INITIAL ENCOUNTER

M5083

OTHER CERVICAL DISC DISORDERS CERVICOTHORACIC REGION

S73023A

OBTURATOR SUBLUXATION OF UNSPECIFIED HIP INITIAL ENCOUNTER

M5090 CERVICAL DISC DISORDER UNSP UNSPECIFIED CERVICAL REGION

S73024A

OBTURATOR DISLOCATION OF RIGHT HIP INITIAL ENCOUNTER

M5091

CERVICAL DISC DISORDER UNSPECIFIED HIGH CERVICAL REGION

S73025A

OBTURATOR DISLOCATION OF LEFT HIP INITIAL ENCOUNTER

M5092

CERVICAL DISC DISORDER UNSPECIFIED MID-CERVICAL REGION

S73026A

OBTURATOR DISLOCATION OF UNSPECIFIED HIP INITIAL ENCOUNTER

M50920

Unspecified cervical disc disorder mid-cervical region unspecified level

S73031A

OTHER ANTERIOR SUBLUXATION OF RIGHT HIP INITIAL ENCOUNTER

M50921 Unspecified cervical disc disorder at C4-C5 level

S73032A

OTHER ANTERIOR SUBLUXATION OF LEFT HIP INITIAL ENCOUNTER

M50922 Unspecified cervical disc disorder at C5-C6 level

S73033A

OTHER ANTERIOR SUBLUXATION OF UNSPECIFIED HIP INIT ENCNTR

M50923 Unspecified cervical disc disorder at C6-C7 level

S73034A

OTHER ANTERIOR DISLOCATION OF RIGHT HIP INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M5093

CERVICAL DISC DISORDER UNSPECIFIED CERVICOTHORACIC REGION

S73035A

OTHER ANTERIOR DISLOCATION OF LEFT HIP INITIAL ENCOUNTER

M5104

INTERVERTEBRAL DISC DISORDERS W MYELOPATHY THORACIC REGION

S73036A

OTHER ANTERIOR DISLOCATION OF UNSPECIFIED HIP INIT ENCNTR

M5105

INTVRT DISC DISORDERS W MYELOPATHY THORACOLUMBAR REGION

S73041A

CENTRAL SUBLUXATION OF RIGHT HIP INITIAL ENCOUNTER

M5106

INTERVERTEBRAL DISC DISORDERS WITH MYELOPATHY LUMBAR REGION

S73042A

CENTRAL SUBLUXATION OF LEFT HIP INITIAL ENCOUNTER

M5114

INTVRT DISC DISORDERS W RADICULOPATHY THORACIC REGION

S73043A

CENTRAL SUBLUXATION OF UNSPECIFIED HIP INITIAL ENCOUNTER

M5115

INTVRT DISC DISORDERS W RADICULOPATHY THORACOLUMBAR REGION

S73044A

CENTRAL DISLOCATION OF RIGHT HIP INITIAL ENCOUNTER

M5116

INTERVERTEBRAL DISC DISORDERS W RADICULOPATHY LUMBAR REGION

S73045A

CENTRAL DISLOCATION OF LEFT HIP INITIAL ENCOUNTER

M5117

INTVRT DISC DISORDERS W RADICULOPATHY LUMBOSACRAL REGION

S73046A

CENTRAL DISLOCATION OF UNSPECIFIED HIP INITIAL ENCOUNTER

M5124

OTHER INTERVERTEBRAL DISC DISPLACEMENT THORACIC REGION

S73111A

ILIOFEMORAL LIGAMENT SPRAIN OF RIGHT HIP INITIAL ENCOUNTER

M5125

OTHER INTERVERTEBRAL DISC DISPLACEMENT THORACOLUMBAR REGION

S73112A

ILIOFEMORAL LIGAMENT SPRAIN OF LEFT HIP INITIAL ENCOUNTER

M5126

OTHER INTERVERTEBRAL DISC DISPLACEMENT LUMBAR REGION

S73119A

ILIOFEMORAL LIGAMENT SPRAIN OF UNSPECIFIED HIP INIT ENCNTR

M5127

OTHER INTERVERTEBRAL DISC DISPLACEMENT LUMBOSACRAL REGION

S73121A

ISCHIOCAPSULAR LIGAMENT SPRAIN OF RIGHT HIP INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M5134

OTHER INTERVERTEBRAL DISC DEGENERATION THORACIC REGION

S73122A

ISCHIOCAPSULAR LIGAMENT SPRAIN OF LEFT HIP INIT ENCNTR

M5135

OTHER INTERVERTEBRAL DISC DEGENERATION THORACOLUMBAR REGION

S73129A

ISCHIOCAPSULAR LIGAMENT SPRAIN OF UNSP HIP INIT ENCNTR

M5136

OTHER INTERVERTEBRAL DISC DEGENERATION LUMBAR REGION

S73191A

OTHER SPRAIN OF RIGHT HIP INITIAL ENCOUNTER

M5137

OTHER INTERVERTEBRAL DISC DEGENERATION LUMBOSACRAL REGION

S73192A

OTHER SPRAIN OF LEFT HIP INITIAL ENCOUNTER

M5144 SCHMORL'S NODES THORACIC REGION

S73199A

OTHER SPRAIN OF UNSPECIFIED HIP INITIAL ENCOUNTER

M5145 SCHMORL'S NODES THORACOLUMBAR REGION

S7400XA

INJURY OF SCIATIC NRV AT HIP AND THIGH LEVEL UNSP LEG INIT

M5146 SCHMORL'S NODES LUMBAR REGION

S7401XA

INJURY OF SCIATIC NRV AT HIP AND THI LEV RIGHT LEG INIT

M5147 SCHMORL'S NODES LUMBOSACRAL REGION

S7402XA

INJURY OF SCIATIC NRV AT HIP AND THIGH LEVEL LEFT LEG INIT

M5184 OTHER INTERVERTEBRAL DISC DISORDERS THORACIC REGION

S7410XA

INJURY OF FEMORAL NRV AT HIP AND THIGH LEVEL UNSP LEG INIT

M5185

OTHER INTERVERTEBRAL DISC DISORDERS THORACOLUMBAR REGION

S7411XA

INJURY OF FEMORAL NRV AT HIP AND THI LEV RIGHT LEG INIT

M5186 OTHER INTERVERTEBRAL DISC DISORDERS LUMBAR REGION

S7412XA

INJURY OF FEMORAL NRV AT HIP AND THIGH LEVEL LEFT LEG INIT

M5187

OTHER INTERVERTEBRAL DISC DISORDERS LUMBOSACRAL REGION

S7420XA

INJ CUTAN SENSORY NERVE AT HIP AND THI LEV UNSP LEG INIT

M519

UNSP THORACIC THORACOLUM AND LUMBOSACR INTVRT DISC DISORDER

S7421XA

INJ CUTAN SENS NERVE AT HIP AND HIGH LEVEL RIGHT LEG INIT

M530 CERVICOCRANIAL SYNDROME

S7422XA INJ CUTAN SENSORY NERVE AT HIP AND THI LEV LEFT LEG INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M531 CERVICOBRACHIAL SYNDROME

S748X1A INJURY OF OTH NERVES AT HIP AND THIGH LEVEL RIGHT LEG INIT

M532X1 SPINAL INSTABILITIES OCCIPITO-ATLANTO-AXIAL REGION

S748X2A

INJURY OF OTH NERVES AT HIP AND THIGH LEVEL LEFT LEG INIT

M532X2 SPINAL INSTABILITIES CERVICAL REGION

S748X9A

INJURY OF OTH NERVES AT HIP AND THIGH LEVEL UNSP LEG INIT

M532X3 SPINAL INSTABILITIES CERVICOTHORACIC REGION

S7490XA

INJURY OF UNSP NERVE AT HIP AND THIGH LEVEL UNSP LEG INIT

M532X4 SPINAL INSTABILITIES THORACIC REGION

S7491XA

INJURY OF UNSP NERVE AT HIP AND THIGH LEVEL RIGHT LEG INIT

M532X5 SPINAL INSTABILITIES THORACOLUMBAR REGION

S7492XA

INJURY OF UNSP NERVE AT HIP AND THIGH LEVEL LEFT LEG INIT

M532X6 SPINAL INSTABILITIES LUMBAR REGION

S75011A

MINOR LACERATION OF FEMORAL ARTERY RIGHT LEG INIT ENCNTR

M532X7 SPINAL INSTABILITIES LUMBOSACRAL REGION

S75012A

MINOR LACERATION OF FEMORAL ARTERY LEFT LEG INIT ENCNTR

M532X8

SPINAL INSTABILITIES SACRAL AND SACROCOCCYGEAL REGION

S75019A

MINOR LACERATION OF FEMORAL ARTERY UNSP LEG INIT ENCNTR

M532X9 SPINAL INSTABILITIES SITE UNSPECIFIED

S75021A

MAJOR LACERATION OF FEMORAL ARTERY RIGHT LEG INIT ENCNTR

M533 SACROCOCCYGEAL DISORDERS NOT ELSEWHERE CLASSIFIED

S75022A

MAJOR LACERATION OF FEMORAL ARTERY LEFT LEG INIT ENCNTR

M5380

OTHER SPECIFIED DORSOPATHIES SITE UNSPECIFIED

S75029A

MAJOR LACERATION OF FEMORAL ARTERY UNSP LEG INIT ENCNTR

M5381

OTHER SPECIFIED DORSOPATHIES OCCIPITO-ATLANTO-AXIAL REGION

S75111A

MINOR LACERAT FEMOR VEIN AT HIP AND THI LEV RIGHT LEG INIT

M5382

OTHER SPECIFIED DORSOPATHIES CERVICAL REGION

S75112A

MINOR LACERAT FEMOR VEIN AT HIP AND THI LEV LEFT LEG INIT

M5383

OTHER SPECIFIED DORSOPATHIES CERVICOTHORACIC REGION

S75119A

MINOR LACERAT FEMOR VEIN AT HIP AND THI LEV UNSP LEG INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M5384

OTHER SPECIFIED DORSOPATHIES THORACIC REGION

S75121A

MAJOR LACERAT FEMOR VEIN AT HIP AND THI LEV RIGHT LEG INIT

M5385

OTHER SPECIFIED DORSOPATHIES THORACOLUMBAR REGION

S75122A

MAJOR LACERAT FEMOR VEIN AT HIP AND THI LEV LEFT LEG INIT

M5386

OTHER SPECIFIED DORSOPATHIES LUMBAR REGION

S75129A

MAJOR LACERAT FEMOR VEIN AT HIP AND THI LEV UNSP LEG INIT

M5387

OTHER SPECIFIED DORSOPATHIES LUMBOSACRAL REGION

S75211A

MINOR LACERAT GREAT SAPH AT HIP AND THI LEV RIGHT LEG INIT

M5388

OTH DORSOPATHIES SACRAL AND SACROCOCCYGEAL REGION

S75212A

MINOR LACERAT GREAT SAPH AT HIP AND THI LEV LEFT LEG INIT

M539 DORSOPATHY UNSPECIFIED

S75219A MINOR LACERAT GREAT SAPH AT HIP AND THI LEV UNSP LEG INIT

M62212

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE LEFT SHOULDER

S75221A

MAJOR LACERAT GREAT SAPH AT HIP AND THI LEV RIGHT LEG INIT

M62219

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE UNSP SHOULDER

S75222A

MAJOR LACERAT GREAT SAPH AT HIP AND THI LEV LEFT LEG INIT

M62221

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE RIGHT UPPER ARM

S75229A

MAJOR LACERAT GREAT SAPH AT HIP AND THI LEV UNSP LEG INIT

M62222

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE LEFT UPPER ARM

S75811A

LACERAT BLOOD VESSELS AT HIP AND THI LEV RIGHT LEG INIT

M62229

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE UNSP UPPER ARM

S75812A

LACERAT BLOOD VESSELS AT HIP AND THIGH LEVEL LEFT LEG INIT

M62231

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE RIGHT FOREARM

S75819A

LACERAT BLOOD VESSELS AT HIP AND THIGH LEVEL UNSP LEG INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M62232

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE LEFT FOREARM

S75911A

LACERAT UNSP BLOOD VESS AT HIP AND THI LEV RIGHT LEG INIT

M62239

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE UNSP FOREARM

S75912A

LACERAT UNSP BLOOD VESS AT HIP AND THI LEV LEFT LEG INIT

M62241

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE RIGHT HAND

S75919A

LACERAT UNSP BLOOD VESS AT HIP AND THI LEV UNSP LEG INIT

M62242

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE LEFT HAND

S76011A

STRAIN OF MUSCLE FASCIA AND TENDON OF RIGHT HIP INIT

M62249

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE UNSPECIFIED HAND

S76012A

STRAIN OF MUSCLE FASCIA AND TENDON OF LEFT HIP INIT ENCNTR

M62251

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE RIGHT THIGH

S76019A

STRAIN OF MUSCLE FASCIA AND TENDON OF UNSP HIP INIT ENCNTR

M62252

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE LEFT THIGH

S76021A

LACERATION OF MUSCLE FASCIA AND TENDON OF RIGHT HIP INIT

M62259

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE UNSP THIGH

S76022A

LACERATION OF MUSCLE FASCIA AND TENDON OF LEFT HIP INIT

M62261

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE RIGHT LOWER LEG

S76029A

LACERATION OF MUSCLE FASCIA AND TENDON OF UNSP HIP INIT

M62262

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE LEFT LOWER LEG

S76111A

STRAIN OF RIGHT QUADRICEPS MUSCLE FASCIA AND TENDON INIT

M62269

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE UNSP LOWER LEG

S76112A

STRAIN OF LEFT QUADRICEPS MUSCLE FASCIA AND TENDON INIT

M62271

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE RIGHT ANK/FT

S76119A

STRAIN OF UNSP QUADRICEPS MUSCLE FASCIA AND TENDON INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M62272

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE LEFT ANK/FT

S76121A

LACERATION OF RIGHT QUADRICEPS MUSC/FASC/TEND INIT

M62279

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE UNSP ANK/FT

S76122A

LACERATION OF LEFT QUADRICEPS MUSC/FASC/TEND INIT

M6228

NONTRAUMATIC ISCHEMIC INFARCTION OF MUSCLE OTHER SITE

S76129A

LACERATION OF UNSP QUADRICEPS MUSC/FASC/TEND INIT

M660 RUPTURE OF POPLITEAL CYST

S76211A STRAIN OF ADDUCTOR MUSC/FASC/TEND RIGHT THIGH INIT

M6610 RUPTURE OF SYNOVIUM UNSPECIFIED JOINT

S76212A

STRAIN OF ADDUCTOR MUSC/FASC/TEND LEFT THIGH INIT

M66111 RUPTURE OF SYNOVIUM RIGHT SHOULDER

S76219A

STRAIN OF ADDUCTOR MUSC/FASC/TEND UNSP THIGH INIT

M66112 RUPTURE OF SYNOVIUM LEFT SHOULDER

S76221A

LACERATION OF ADDUCTOR MUSC/FASC/TEND RIGHT THIGH INIT

M66119 RUPTURE OF SYNOVIUM UNSPECIFIED SHOULDER

S76222A

LACERATION OF ADDUCTOR MUSC/FASC/TEND LEFT THIGH INIT

M66121 RUPTURE OF SYNOVIUM RIGHT ELBOW

S76229A

LACERATION OF ADDUCTOR MUSC/FASC/TEND UNSP THIGH INIT

M66122 RUPTURE OF SYNOVIUM LEFT ELBOW

S76311A

STRAIN MSL/FASC/TND POST GRP AT THI LEV RIGHT THIGH INIT

M66129 RUPTURE OF SYNOVIUM UNSPECIFIED ELBOW

S76312A

STRAIN OF MSL/FASC/TND POST GRP AT THI LEV LEFT THIGH INIT

M66131 RUPTURE OF SYNOVIUM RIGHT WRIST

S76319A

STRAIN OF MSL/FASC/TND POST GRP AT THI LEV UNSP THIGH INIT

M66132 RUPTURE OF SYNOVIUM LEFT WRIST

S76321A

LACERAT MSL/FASC/TND POST GRP AT THI LEV RIGHT THIGH INIT

M66139 RUPTURE OF SYNOVIUM UNSPECIFIED WRIST

S76322A

LACERAT MSL/FASC/TND POST GRP AT THI LEV LEFT THIGH INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M66141 RUPTURE OF SYNOVIUM RIGHT HAND

S76329A

LACERAT MSL/FASC/TND POST GRP AT THI LEV UNSP THIGH INIT

M66142 RUPTURE OF SYNOVIUM LEFT HAND

S76811A

STRAIN OF MUSC/FASC/TEND AT THIGH LEVEL RIGHT THIGH INIT

M66143 RUPTURE OF SYNOVIUM UNSPECIFIED HAND

S76812A

STRAIN OF MUSC/FASC/TEND AT THIGH LEVEL LEFT THIGH INIT

M66144 RUPTURE OF SYNOVIUM RIGHT FINGER(S)

S76819A

STRAIN OF MUSC/FASC/TEND AT THIGH LEVEL UNSP THIGH INIT

M66145 RUPTURE OF SYNOVIUM LEFT FINGER(S)

S76821A

LACERAT MUSC/FASC/TEND AT THIGH LEVEL RIGHT THIGH INIT

M66146 RUPTURE OF SYNOVIUM UNSPECIFIED FINGER(S)

S76822A

LACERAT MUSC/FASC/TEND AT THIGH LEVEL LEFT THIGH INIT

M66151 RUPTURE OF SYNOVIUM RIGHT HIP

S76829A

LACERAT MUSC/FASC/TEND AT THIGH LEVEL UNSP THIGH INIT

M66152 RUPTURE OF SYNOVIUM LEFT HIP

S76911A

STRAIN OF UNSP MUSC/FASC/TEND AT THI LEV RIGHT THIGH INIT

M66159 RUPTURE OF SYNOVIUM UNSPECIFIED HIP

S76912A

STRAIN OF UNSP MUSC/FASC/TEND AT THI LEV LEFT THIGH INIT

M66171 RUPTURE OF SYNOVIUM RIGHT ANKLE

S76919A

STRAIN OF UNSP MUSC/FASC/TEND AT THI LEV UNSP THIGH INIT

M66172 RUPTURE OF SYNOVIUM LEFT ANKLE

S76921A

LACERAT UNSP MUSC/FASC/TEND AT THI LEV RIGHT THIGH INIT

M66173 RUPTURE OF SYNOVIUM UNSPECIFIED ANKLE

S76922A

LACERAT UNSP MUSC/FASC/TEND AT THIGH LEVEL LEFT THIGH INIT

M66174 RUPTURE OF SYNOVIUM RIGHT FOOT

S76929A

LACERAT UNSP MUSC/FASC/TEND AT THIGH LEVEL UNSP THIGH INIT

M66175 RUPTURE OF SYNOVIUM LEFT FOOT

S7700XA

CRUSHING INJURY OF UNSPECIFIED HIP INITIAL ENCOUNTER

M66176 RUPTURE OF SYNOVIUM UNSPECIFIED FOOT

S7701XA

CRUSHING INJURY OF RIGHT HIP INITIAL ENCOUNTER

M66177 RUPTURE OF SYNOVIUM RIGHT TOE(S)

S7702XA

CRUSHING INJURY OF LEFT HIP INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M66178 RUPTURE OF SYNOVIUM LEFT TOE(S)

S7710XA

CRUSHING INJURY OF UNSPECIFIED THIGH INITIAL ENCOUNTER

M66179 RUPTURE OF SYNOVIUM UNSPECIFIED TOE(S)

S7711XA

CRUSHING INJURY OF RIGHT THIGH INITIAL ENCOUNTER

M6618 RUPTURE OF SYNOVIUM OTHER SITE

S7712XA

CRUSHING INJURY OF LEFT THIGH INITIAL ENCOUNTER

M6620

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS UNSPECIFIED SITE

S7720XA

CRUSHING INJURY OF UNSPECIFIED HIP WITH THIGH INIT ENCNTR

M66211

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS RIGHT SHOULDER

S7721XA

CRUSHING INJURY OF RIGHT HIP WITH THIGH INITIAL ENCOUNTER

M66212

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS LEFT SHOULDER

S7722XA

CRUSHING INJURY OF LEFT HIP WITH THIGH INITIAL ENCOUNTER

M66219

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS UNSP SHOULDER

S78011A

COMPLETE TRAUMATIC AMPUTATION AT RIGHT HIP JOINT INIT

M66221

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS RIGHT UPPER ARM

S78012A

COMPLETE TRAUMATIC AMPUTATION AT LEFT HIP JOINT INIT ENCNTR

M66222

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS LEFT UPPER ARM

S78019A

COMPLETE TRAUMATIC AMPUTATION AT UNSP HIP JOINT INIT ENCNTR

M66229

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS UNSP UPPER ARM

S78021A

PARTIAL TRAUMATIC AMPUTATION AT RIGHT HIP JOINT INIT ENCNTR

M66231

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS RIGHT FOREARM

S78022A

PARTIAL TRAUMATIC AMPUTATION AT LEFT HIP JOINT INIT ENCNTR

M66232

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS LEFT FOREARM

S78029A

PARTIAL TRAUMATIC AMPUTATION AT UNSP HIP JOINT INIT ENCNTR

M66239

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS UNSPECIFIED FOREARM

S78111A

COMPLETE TRAUMATIC AMP AT LEVEL BETW R HIP AND KNEE INIT

Page 285: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M66241

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS RIGHT HAND

S78112A

COMPLETE TRAUMATIC AMP AT LEVEL BETW LEFT HIP AND KNEE INIT

M66242

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS LEFT HAND

S78119A

COMPLETE TRAUMATIC AMP AT LEVEL BETW UNSP HIP AND KNEE INIT

M66249

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS UNSPECIFIED HAND

S78121A

PARTIAL TRAUMATIC AMP AT LEVEL BETW RIGHT HIP AND KNEE INIT

M66251

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS RIGHT THIGH

S78122A

PARTIAL TRAUMATIC AMP AT LEVEL BETW LEFT HIP AND KNEE INIT

M66252

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS LEFT THIGH

S78129A

PARTIAL TRAUMATIC AMP AT LEVEL BETW UNSP HIP AND KNEE INIT

M66259

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS UNSPECIFIED THIGH

S78911A

COMPLETE TRAUMATIC AMP OF R HIP AND THIGH LEVEL UNSP INIT

M66261

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS RIGHT LOWER LEG

S78912A

COMPLETE TRAUM AMP OF LEFT HIP AND THIGH LEVEL UNSP INIT

M66262

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS LEFT LOWER LEG

S78919A

COMPLETE TRAUM AMP OF UNSP HIP AND THIGH LEVEL UNSP INIT

M66269

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS UNSP LOWER LEG

S78921A

PARTIAL TRAUMATIC AMP OF R HIP AND THIGH LEVEL UNSP INIT

M66271

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS RIGHT ANK/FT

S78922A

PARTIAL TRAUM AMP OF LEFT HIP AND THIGH LEVEL UNSP INIT

M66272

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS LEFT ANKLE AND FOOT

S78929A

PARTIAL TRAUM AMP OF UNSP HIP AND THIGH LEVEL UNSP INIT

M66279

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS UNSP ANKLE AND FOOT

S79001A

UNSP PHYSEAL FRACTURE OF UPPER END OF RIGHT FEMUR INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M6628

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS OTHER SITE

S79002A

UNSP PHYSEAL FRACTURE OF UPPER END OF LEFT FEMUR INIT

M6629

SPONTANEOUS RUPTURE OF EXTENSOR TENDONS MULTIPLE SITES

S79009A

UNSP PHYSEAL FRACTURE OF UPPER END OF UNSP FEMUR INIT

M6630

SPONTANEOUS RUPTURE OF FLEXOR TENDONS UNSPECIFIED SITE

S79011A

SLTR-HARIS TYPE I PHYSEAL FX UPPER END OF RIGHT FEMUR INIT

M66311

SPONTANEOUS RUPTURE OF FLEXOR TENDONS RIGHT SHOULDER

S79012A

SLTR-HARIS TYPE I PHYSEAL FX UPPER END OF LEFT FEMUR INIT

M66312

SPONTANEOUS RUPTURE OF FLEXOR TENDONS LEFT SHOULDER

S79019A

SLTR-HARIS TYPE I PHYSEAL FX UPPER END OF UNSP FEMUR INIT

M66319

SPONTANEOUS RUPTURE OF FLEXOR TENDONS UNSPECIFIED SHOULDER

S79091A

OTH PHYSEAL FRACTURE OF UPPER END OF RIGHT FEMUR INIT

M66321

SPONTANEOUS RUPTURE OF FLEXOR TENDONS RIGHT UPPER ARM

S79092A

OTH PHYSEAL FRACTURE OF UPPER END OF LEFT FEMUR INIT

M66322

SPONTANEOUS RUPTURE OF FLEXOR TENDONS LEFT UPPER ARM

S79099A

OTH PHYSEAL FRACTURE OF UPPER END OF UNSP FEMUR INIT

M66329

SPONTANEOUS RUPTURE OF FLEXOR TENDONS UNSPECIFIED UPPER ARM

S79101A

UNSP PHYSEAL FRACTURE OF LOWER END OF RIGHT FEMUR INIT

M66331

SPONTANEOUS RUPTURE OF FLEXOR TENDONS RIGHT FOREARM

S79102A

UNSP PHYSEAL FRACTURE OF LOWER END OF LEFT FEMUR INIT

M66332

SPONTANEOUS RUPTURE OF FLEXOR TENDONS LEFT FOREARM

S79109A

UNSP PHYSEAL FRACTURE OF LOWER END OF UNSP FEMUR INIT

M66339

SPONTANEOUS RUPTURE OF FLEXOR TENDONS UNSPECIFIED FOREARM

S79111A

SLTR-HARIS TYPE I PHYSEAL FX LOWER END OF RIGHT FEMUR INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M66341 SPONTANEOUS RUPTURE OF FLEXOR TENDONS RIGHT HAND

S79112A

SLTR-HARIS TYPE I PHYSEAL FX LOWER END OF LEFT FEMUR INIT

M66342 SPONTANEOUS RUPTURE OF FLEXOR TENDONS LEFT HAND

S79119A

SLTR-HARIS TYPE I PHYSEAL FX LOWER END OF UNSP FEMUR INIT

M66349

SPONTANEOUS RUPTURE OF FLEXOR TENDONS UNSPECIFIED HAND

S79121A

SLTR-HARIS TYPE II PHYSEAL FX LOWER END OF RIGHT FEMUR INIT

M66351 SPONTANEOUS RUPTURE OF FLEXOR TENDONS RIGHT THIGH

S79122A

SLTR-HARIS TYPE II PHYSEAL FX LOWER END OF LEFT FEMUR INIT

M66352 SPONTANEOUS RUPTURE OF FLEXOR TENDONS LEFT THIGH

S79129A

SLTR-HARIS TYPE II PHYSEAL FX LOWER END OF UNSP FEMUR INIT

M66359

SPONTANEOUS RUPTURE OF FLEXOR TENDONS UNSPECIFIED THIGH

S79131A

SLTR-HARIS TYPE III PHYSEAL FX LOWER END OF R FEMUR INIT

M66361

SPONTANEOUS RUPTURE OF FLEXOR TENDONS RIGHT LOWER LEG

S79132A

SLTR-HARIS TYPE III PHYSEAL FX LOWER END OF LEFT FEMUR INIT

M66362

SPONTANEOUS RUPTURE OF FLEXOR TENDONS LEFT LOWER LEG

S79139A

SLTR-HARIS TYPE III PHYSEAL FX LOWER END OF UNSP FEMUR INIT

M66369

SPONTANEOUS RUPTURE OF FLEXOR TENDONS UNSPECIFIED LOWER LEG

S79141A

SLTR-HARIS TYPE IV PHYSEAL FX LOWER END OF RIGHT FEMUR INIT

M66371

SPONTANEOUS RUPTURE OF FLEXOR TENDONS RIGHT ANKLE AND FOOT

S79142A

SLTR-HARIS TYPE IV PHYSEAL FX LOWER END OF LEFT FEMUR INIT

M66372

SPONTANEOUS RUPTURE OF FLEXOR TENDONS LEFT ANKLE AND FOOT

S79149A

SLTR-HARIS TYPE IV PHYSEAL FX LOWER END OF UNSP FEMUR INIT

M66379

SPONTANEOUS RUPTURE OF FLEXOR TENDONS UNSP ANKLE AND FOOT

S79191A

OTH PHYSEAL FRACTURE OF LOWER END OF RIGHT FEMUR INIT

M6638 SPONTANEOUS RUPTURE OF FLEXOR TENDONS OTHER SITE

S79192A

OTH PHYSEAL FRACTURE OF LOWER END OF LEFT FEMUR INIT

Page 288: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M6639

SPONTANEOUS RUPTURE OF FLEXOR TENDONS MULTIPLE SITES

S79199A

OTH PHYSEAL FRACTURE OF LOWER END OF UNSP FEMUR INIT

M6680

SPONTANEOUS RUPTURE OF OTHER TENDONS UNSPECIFIED SITE

S80241A

EXTERNAL CONSTRICTION RIGHT KNEE INITIAL ENCOUNTER

M66811

SPONTANEOUS RUPTURE OF OTHER TENDONS RIGHT SHOULDER

S80242A

EXTERNAL CONSTRICTION LEFT KNEE INITIAL ENCOUNTER

M66812

SPONTANEOUS RUPTURE OF OTHER TENDONS LEFT SHOULDER

S80249A

EXTERNAL CONSTRICTION UNSPECIFIED KNEE INITIAL ENCOUNTER

M66819

SPONTANEOUS RUPTURE OF OTHER TENDONS UNSPECIFIED SHOULDER

S80841A

EXTERNAL CONSTRICTION RIGHT LOWER LEG INITIAL ENCOUNTER

M66821

SPONTANEOUS RUPTURE OF OTHER TENDONS RIGHT UPPER ARM

S80842A

EXTERNAL CONSTRICTION LEFT LOWER LEG INITIAL ENCOUNTER

M66822

SPONTANEOUS RUPTURE OF OTHER TENDONS LEFT UPPER ARM

S80849A

EXTERNAL CONSTRICTION UNSPECIFIED LOWER LEG INIT ENCNTR

M66829

SPONTANEOUS RUPTURE OF OTHER TENDONS UNSPECIFIED UPPER ARM

S81001A

UNSPECIFIED OPEN WOUND RIGHT KNEE INITIAL ENCOUNTER

M66831

SPONTANEOUS RUPTURE OF OTHER TENDONS RIGHT FOREARM

S81002A

UNSPECIFIED OPEN WOUND LEFT KNEE INITIAL ENCOUNTER

M66832

SPONTANEOUS RUPTURE OF OTHER TENDONS LEFT FOREARM

S81009A

UNSPECIFIED OPEN WOUND UNSPECIFIED KNEE INITIAL ENCOUNTER

M66839

SPONTANEOUS RUPTURE OF OTHER TENDONS UNSPECIFIED FOREARM

S81011A

LACERATION WITHOUT FOREIGN BODY RIGHT KNEE INIT ENCNTR

M66841 SPONTANEOUS RUPTURE OF OTHER TENDONS RIGHT HAND

S81012A

LACERATION WITHOUT FOREIGN BODY LEFT KNEE INIT ENCNTR

M66842 SPONTANEOUS RUPTURE OF OTHER TENDONS LEFT HAND

S81019A

LACERATION WITHOUT FOREIGN BODY UNSP KNEE INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M66849

SPONTANEOUS RUPTURE OF OTHER TENDONS UNSPECIFIED HAND

S81021A

LACERATION WITH FOREIGN BODY RIGHT KNEE INITIAL ENCOUNTER

M66851 SPONTANEOUS RUPTURE OF OTHER TENDONS RIGHT THIGH

S81022A

LACERATION WITH FOREIGN BODY LEFT KNEE INITIAL ENCOUNTER

M66852 SPONTANEOUS RUPTURE OF OTHER TENDONS LEFT THIGH

S81029A

LACERATION WITH FOREIGN BODY UNSPECIFIED KNEE INIT ENCNTR

M66859

SPONTANEOUS RUPTURE OF OTHER TENDONS UNSPECIFIED THIGH

S81031A

PUNCTURE WOUND WITHOUT FOREIGN BODY RIGHT KNEE INIT ENCNTR

M66861

SPONTANEOUS RUPTURE OF OTHER TENDONS RIGHT LOWER LEG

S81032A

PUNCTURE WOUND WITHOUT FOREIGN BODY LEFT KNEE INIT ENCNTR

M66862

SPONTANEOUS RUPTURE OF OTHER TENDONS LEFT LOWER LEG

S81039A

PUNCTURE WOUND WITHOUT FOREIGN BODY UNSP KNEE INIT ENCNTR

M66869

SPONTANEOUS RUPTURE OF OTHER TENDONS UNSPECIFIED LOWER LEG

S81041A

PUNCTURE WOUND WITH FOREIGN BODY RIGHT KNEE INIT ENCNTR

M66871

SPONTANEOUS RUPTURE OF OTHER TENDONS RIGHT ANKLE AND FOOT

S81042A

PUNCTURE WOUND WITH FOREIGN BODY LEFT KNEE INIT ENCNTR

M66872

SPONTANEOUS RUPTURE OF OTHER TENDONS LEFT ANKLE AND FOOT

S81049A

PUNCTURE WOUND WITH FOREIGN BODY UNSP KNEE INIT ENCNTR

M66879

SPONTANEOUS RUPTURE OF OTHER TENDONS UNSP ANKLE AND FOOT

S81051A

OPEN BITE RIGHT KNEE INITIAL ENCOUNTER

M6688 SPONTANEOUS RUPTURE OF OTHER TENDONS OTHER

S81052A

OPEN BITE LEFT KNEE INITIAL ENCOUNTER

M6689

SPONTANEOUS RUPTURE OF OTHER TENDONS MULTIPLE SITES

S81059A

OPEN BITE UNSPECIFIED KNEE INITIAL ENCOUNTER

M669 SPONTANEOUS RUPTURE OF UNSPECIFIED TENDON

S81801A

UNSPECIFIED OPEN WOUND RIGHT LOWER LEG INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M726 NECROTIZING FASCIITIS

S81802A UNSPECIFIED OPEN WOUND LEFT LOWER LEG INITIAL ENCOUNTER

M729 FIBROBLASTIC DISORDER UNSPECIFIED

S81809A

UNSPECIFIED OPEN WOUND UNSPECIFIED LOWER LEG INIT ENCNTR

M7500 ADHESIVE CAPSULITIS OF UNSPECIFIED SHOULDER

S81811A

LACERATION W/O FOREIGN BODY RIGHT LOWER LEG INIT ENCNTR

M7501 ADHESIVE CAPSULITIS OF RIGHT SHOULDER

S81812A

LACERATION WITHOUT FOREIGN BODY LEFT LOWER LEG INIT ENCNTR

M7502 ADHESIVE CAPSULITIS OF LEFT SHOULDER

S81819A

LACERATION WITHOUT FOREIGN BODY UNSP LOWER LEG INIT ENCNTR

M7520 BICIPITAL TENDINITIS UNSPECIFIED SHOULDER

S81821A

LACERATION WITH FOREIGN BODY RIGHT LOWER LEG INIT ENCNTR

M7521 BICIPITAL TENDINITIS RIGHT SHOULDER

S81822A

LACERATION WITH FOREIGN BODY LEFT LOWER LEG INIT ENCNTR

M7522 BICIPITAL TENDINITIS LEFT SHOULDER

S81829A

LACERATION WITH FOREIGN BODY UNSP LOWER LEG INIT ENCNTR

M7530 CALCIFIC TENDINITIS OF UNSPECIFIED SHOULDER

S81831A

PUNCTURE WOUND W/O FOREIGN BODY RIGHT LOWER LEG INIT

M7531 CALCIFIC TENDINITIS OF RIGHT SHOULDER

S81832A

PUNCTURE WOUND W/O FOREIGN BODY LEFT LOWER LEG INIT ENCNTR

M7532 CALCIFIC TENDINITIS OF LEFT SHOULDER

S81839A

PUNCTURE WOUND W/O FOREIGN BODY UNSP LOWER LEG INIT ENCNTR

M7540 IMPINGEMENT SYNDROME OF UNSPECIFIED SHOULDER

S81841A

PUNCTURE WOUND W FOREIGN BODY RIGHT LOWER LEG INIT ENCNTR

M7541 IMPINGEMENT SYNDROME OF RIGHT SHOULDER

S81842A

PUNCTURE WOUND W FOREIGN BODY LEFT LOWER LEG INIT ENCNTR

M7542 IMPINGEMENT SYNDROME OF LEFT SHOULDER

S81849A

PUNCTURE WOUND W FOREIGN BODY UNSP LOWER LEG INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M7550 BURSITIS OF UNSPECIFIED SHOULDER

S81851A

OPEN BITE RIGHT LOWER LEG INITIAL ENCOUNTER

M7551 BURSITIS OF RIGHT SHOULDER

S81852A OPEN BITE LEFT LOWER LEG INITIAL ENCOUNTER

M7552 BURSITIS OF LEFT SHOULDER

S81859A OPEN BITE UNSPECIFIED LOWER LEG INITIAL ENCOUNTER

M7580 OTHER SHOULDER LESIONS UNSPECIFIED SHOULDER

S82001A

UNSP FRACTURE OF RIGHT PATELLA INIT FOR CLOS FX

M7581 OTHER SHOULDER LESIONS RIGHT SHOULDER

S82001B

UNSP FRACTURE OF RIGHT PATELLA INIT FOR OPN FX TYPE I/2

M7582 OTHER SHOULDER LESIONS LEFT SHOULDER

S82001C

UNSP FRACTURE OF RIGHT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7590

SHOULDER LESION UNSPECIFIED UNSPECIFIED SHOULDER

S82002A

UNSP FRACTURE OF LEFT PATELLA INIT FOR CLOS FX

M7591 SHOULDER LESION UNSPECIFIED RIGHT SHOULDER

S82002B

UNSP FRACTURE OF LEFT PATELLA INIT FOR OPN FX TYPE I/2

M7592 SHOULDER LESION UNSPECIFIED LEFT SHOULDER

S82002C

UNSP FRACTURE OF LEFT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7600 GLUTEAL TENDINITIS UNSPECIFIED HIP

S82009A

UNSP FRACTURE OF UNSP PATELLA INIT FOR CLOS FX

M7601 GLUTEAL TENDINITIS RIGHT HIP

S82009B UNSP FRACTURE OF UNSP PATELLA INIT FOR OPN FX TYPE I/2

M7602 GLUTEAL TENDINITIS LEFT HIP

S82009C UNSP FRACTURE OF UNSP PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7610 PSOAS TENDINITIS UNSPECIFIED HIP

S82011A

DISPLACED OSTEOCHONDRAL FRACTURE OF RIGHT PATELLA INIT

M7611 PSOAS TENDINITIS RIGHT HIP

S82011B DISPL OSTEOCHON FX RIGHT PATELLA INIT FOR OPN FX TYPE I/2

M7612 PSOAS TENDINITIS LEFT HIP

S82011C DISPL OSTEOCHON FX R PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7620 ILIAC CREST SPUR UNSPECIFIED HIP

S82012A

DISPLACED OSTEOCHONDRAL FRACTURE OF LEFT PATELLA INIT

Page 292: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M7621 ILIAC CREST SPUR RIGHT HIP

S82012B DISPL OSTEOCHON FX LEFT PATELLA INIT FOR OPN FX TYPE I/2

M7622 ILIAC CREST SPUR LEFT HIP

S82012C DISPL OSTEOCHON FX LEFT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7630 ILIOTIBIAL BAND SYNDROME UNSPECIFIED LEG

S82013A

DISPLACED OSTEOCHONDRAL FRACTURE OF UNSP PATELLA INIT

M7631 ILIOTIBIAL BAND SYNDROME RIGHT LEG

S82013B

DISPL OSTEOCHON FX UNSP PATELLA INIT FOR OPN FX TYPE I/2

M7632 ILIOTIBIAL BAND SYNDROME LEFT LEG

S82013C

DISPL OSTEOCHON FX UNSP PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7640 TIBIAL COLLATERAL BURSITIS UNSPECIFIED LEG

S82014A

NONDISPLACED OSTEOCHONDRAL FRACTURE OF RIGHT PATELLA INIT

M7641 TIBIAL COLLATERAL BURSITIS [PELLEGRINI-STIEDA] RIGHT LEG

S82014B

NONDISP OSTEOCHON FX RIGHT PATELLA INIT FOR OPN FX TYPE I/2

M7642 TIBIAL COLLATERAL BURSITIS [PELLEGRINI-STIEDA] LEFT LEG

S82014C

NONDISP OSTEOCHON FX R PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7650 PATELLAR TENDINITIS UNSPECIFIED KNEE

S82015A

NONDISPLACED OSTEOCHONDRAL FRACTURE OF LEFT PATELLA INIT

M7651 PATELLAR TENDINITIS RIGHT KNEE

S82015B

NONDISP OSTEOCHON FX LEFT PATELLA INIT FOR OPN FX TYPE I/2

M7652 PATELLAR TENDINITIS LEFT KNEE

S82015C

NONDISP OSTEOCHON FX L PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7660 ACHILLES TENDINITIS UNSPECIFIED LEG

S82016A

NONDISPLACED OSTEOCHONDRAL FRACTURE OF UNSP PATELLA INIT

M7661 ACHILLES TENDINITIS RIGHT LEG

S82016B NONDISP OSTEOCHON FX UNSP PATELLA INIT FOR OPN FX TYPE I/2

M7662 ACHILLES TENDINITIS LEFT LEG

S82016C NONDISP OSTEOCHON FX UNSP PATELLA 7THC

Page 293: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M7670 PERONEAL TENDINITIS UNSPECIFIED LEG

S82021A

DISPLACED LONGITUDINAL FRACTURE OF RIGHT PATELLA INIT

M7671 PERONEAL TENDINITIS RIGHT LEG

S82021B

DISPL LONGITUD FX RIGHT PATELLA INIT FOR OPN FX TYPE I/2

M7672 PERONEAL TENDINITIS LEFT LEG

S82021C DISPL LONGITUD FX RIGHT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M76811 ANTERIOR TIBIAL SYNDROME RIGHT LEG

S82022A

DISPLACED LONGITUDINAL FRACTURE OF LEFT PATELLA INIT

M76812 ANTERIOR TIBIAL SYNDROME LEFT LEG

S82022B

DISPLACED LONGITUD FX LEFT PATELLA INIT FOR OPN FX TYPE I/2

M76819 ANTERIOR TIBIAL SYNDROME UNSPECIFIED LEG

S82022C

DISPL LONGITUD FX LEFT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M76821 POSTERIOR TIBIAL TENDINITIS RIGHT LEG

S82023A

DISPLACED LONGITUDINAL FRACTURE OF UNSP PATELLA INIT

M76822 POSTERIOR TIBIAL TENDINITIS LEFT LEG

S82023B

DISPLACED LONGITUD FX UNSP PATELLA INIT FOR OPN FX TYPE I/2

M76829 POSTERIOR TIBIAL TENDINITIS UNSPECIFIED LEG

S82023C

DISPL LONGITUD FX UNSP PATELLA INIT FOR OPN FX TYPE 3A/B/C

M76891

OTH ENTHESOPATHIES OF RIGHT LOWER LIMB EXCLUDING FOOT

S82024A

NONDISPLACED LONGITUDINAL FRACTURE OF RIGHT PATELLA INIT

M76892 OTH ENTHESOPATHIES OF LEFT LOWER LIMB EXCLUDING FOOT

S82024B

NONDISP LONGITUD FX RIGHT PATELLA INIT FOR OPN FX TYPE I/2

M76899

OTH ENTHESOPATHIES OF UNSPECIFIED LOWER LIMB EXCLUDING FOOT

S82024C

NONDISP LONGITUD FX R PATELLA INIT FOR OPN FX TYPE 3A/B/C

M769 UNSPECIFIED ENTHESOPATHY LOWER LIMB EXCLUDING FOOT

S82025A

NONDISPLACED LONGITUDINAL FRACTURE OF LEFT PATELLA INIT

M7700 MEDIAL EPICONDYLITIS UNSPECIFIED ELBOW

S82025B

NONDISP LONGITUD FX LEFT PATELLA INIT FOR OPN FX TYPE I/2

M7701 MEDIAL EPICONDYLITIS RIGHT ELBOW

S82025C

NONDISP LONGITUD FX L PATELLA INIT FOR OPN FX TYPE 3A/B/C

Page 294: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M7702 MEDIAL EPICONDYLITIS LEFT ELBOW

S82026A

NONDISPLACED LONGITUDINAL FRACTURE OF UNSP PATELLA INIT

M7710 LATERAL EPICONDYLITIS UNSPECIFIED ELBOW

S82026B

NONDISP LONGITUD FX UNSP PATELLA INIT FOR OPN FX TYPE I/2

M7711 LATERAL EPICONDYLITIS RIGHT ELBOW

S82026C

NONDISP LONGITUD FX UNSP PATELLA 7THC

M7712 LATERAL EPICONDYLITIS LEFT ELBOW

S82031A

DISPLACED TRANSVERSE FRACTURE OF RIGHT PATELLA INIT

M7720 PERIARTHRITIS UNSPECIFIED WRIST

S82031B

DISPL TRANSVERSE FX RIGHT PATELLA INIT FOR OPN FX TYPE I/2

M7721 PERIARTHRITIS RIGHT WRIST

S82031C DISPL TRANSVERSE FX R PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7722 PERIARTHRITIS LEFT WRIST

S82032A DISPLACED TRANSVERSE FRACTURE OF LEFT PATELLA INIT

M7730 CALCANEAL SPUR UNSPECIFIED FOOT

S82032B

DISPL TRANSVERSE FX LEFT PATELLA INIT FOR OPN FX TYPE I/2

M7731 CALCANEAL SPUR RIGHT FOOT

S82032C DISPL TRANSVERSE FX L PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7732 CALCANEAL SPUR LEFT FOOT

S82033A DISPLACED TRANSVERSE FRACTURE OF UNSP PATELLA INIT

M7740 METATARSALGIA UNSPECIFIED FOOT

S82033B

DISPL TRANSVERSE FX UNSP PATELLA INIT FOR OPN FX TYPE I/2

M7741 METATARSALGIA RIGHT FOOT

S82033C DISPL TRANSVERSE FX UNSP PATELLA 7THC

M7742 METATARSALGIA LEFT FOOT

S82034A NONDISPLACED TRANSVERSE FRACTURE OF RIGHT PATELLA INIT

M7750 OTHER ENTHESOPATHY OF UNSPECIFIED FOOT

S82034B

NONDISP TRANSVERSE FX R PATELLA INIT FOR OPN FX TYPE I/2

M7751 OTHER ENTHESOPATHY OF RIGHT FOOT

S82034C

NONDISP TRANSVERSE FX R PATELLA INIT FOR OPN FX TYPE 3A/B/C

M7752 OTHER ENTHESOPATHY OF LEFT FOOT

S82035A

NONDISPLACED TRANSVERSE FRACTURE OF LEFT PATELLA INIT

M778 OTHER ENTHESOPATHIES NOT ELSEWHERE CLASSIFIED

S82035B

NONDISP TRANSVERSE FX LEFT PATELLA INIT FOR OPN FX TYPE I/2

Page 295: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M779 ENTHESOPATHY UNSPECIFIED

S82035C NONDISP TRANSVERSE FX L PATELLA INIT FOR OPN FX TYPE 3A/B/C

M790 RHEUMATISM UNSPECIFIED

S82036A NONDISPLACED TRANSVERSE FRACTURE OF UNSP PATELLA INIT

M791 MYALGIA

S82036B NONDISP TRANSVERSE FX UNSP PATELLA INIT FOR OPN FX TYPE I/2

M792 NEURALGIA AND NEURITIS UNSPECIFIED

S82036C

NONDISP TRANSVERSE FX UNSP PATELLA 7THC

M793 PANNICULITIS UNSPECIFIED

S82041A DISPLACED COMMINUTED FRACTURE OF RIGHT PATELLA INIT

M794 HYPERTROPHY OF (INFRAPATELLAR) FAT PAD

S82041B

DISPLACED COMMNT FX RIGHT PATELLA INIT FOR OPN FX TYPE I/2

M795 RESIDUAL FOREIGN BODY IN SOFT TISSUE

S82041C

DISPL COMMNT FX RIGHT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M79A11

NONTRAUMATIC COMPARTMENT SYNDROME OF RIGHT UPPER EXTREMITY

S82042A

DISPLACED COMMINUTED FRACTURE OF LEFT PATELLA INIT

M79A12

NONTRAUMATIC COMPARTMENT SYNDROME OF LEFT UPPER EXTREMITY

S82042B

DISPLACED COMMNT FX LEFT PATELLA INIT FOR OPN FX TYPE I/2

M79A19

NONTRAUMATIC COMPARTMENT SYNDROME OF UNSP UPPER EXTREMITY

S82042C

DISPL COMMNT FX LEFT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M79A21

NONTRAUMATIC COMPARTMENT SYNDROME OF RIGHT LOWER EXTREMITY

S82043A

DISPLACED COMMINUTED FRACTURE OF UNSP PATELLA INIT

M79A22

NONTRAUMATIC COMPARTMENT SYNDROME OF LEFT LOWER EXTREMITY

S82043B

DISPLACED COMMNT FX UNSP PATELLA INIT FOR OPN FX TYPE I/2

M79A29

NONTRAUMATIC COMPARTMENT SYNDROME OF UNSP LOWER EXTREMITY

S82043C

DISPL COMMNT FX UNSP PATELLA INIT FOR OPN FX TYPE 3A/B/C

M79A3

NONTRAUMATIC COMPARTMENT SYNDROME OF ABDOMEN

S82044A

NONDISPLACED COMMINUTED FRACTURE OF RIGHT PATELLA INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M79A9

NONTRAUMATIC COMPARTMENT SYNDROME OF OTHER SITES

S82044B

NONDISP COMMNT FX RIGHT PATELLA INIT FOR OPN FX TYPE I/2

M8000XA

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE UNSP SITE INIT

S82044C

NONDISP COMMNT FX RIGHT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M80011A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE R SHOULDER INIT

S82045A

NONDISPLACED COMMINUTED FRACTURE OF LEFT PATELLA INIT

M80012A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE L SHOULDER INIT

S82045B

NONDISP COMMINUTED FX LEFT PATELLA INIT FOR OPN FX TYPE I/2

M80019A

AGE-REL OSTEOPOR W CURRENT PATH FX UNSP SHOULDER INIT

S82045C

NONDISP COMMNT FX LEFT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M80021A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE R HUMERUS INIT

S82046A

NONDISPLACED COMMINUTED FRACTURE OF UNSP PATELLA INIT

M80022A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE L HUMERUS INIT

S82046B

NONDISP COMMINUTED FX UNSP PATELLA INIT FOR OPN FX TYPE I/2

M80029A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE UNSP HUMERUS INIT

S82046C

NONDISP COMMNT FX UNSP PATELLA INIT FOR OPN FX TYPE 3A/B/C

M80031A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE R FOREARM INIT

S82091A

OTH FRACTURE OF RIGHT PATELLA INIT FOR CLOS FX

M80032A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE L FOREARM INIT

S82091B

OTH FRACTURE OF RIGHT PATELLA INIT FOR OPN FX TYPE I/2

M80039A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE UNSP FOREARM INIT

S82091C

OTH FRACTURE OF RIGHT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M80041A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE RIGHT HAND INIT

S82092A

OTH FRACTURE OF LEFT PATELLA INIT FOR CLOS FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M80042A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE LEFT HAND INIT

S82092B

OTH FRACTURE OF LEFT PATELLA INIT FOR OPN FX TYPE I/2

M80049A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE UNSP HAND INIT

S82092C

OTH FRACTURE OF LEFT PATELLA INIT FOR OPN FX TYPE 3A/B/C

M80051A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE RIGHT FEMUR INIT

S82099A

OTH FRACTURE OF UNSP PATELLA INIT FOR CLOS FX

M80052A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE LEFT FEMUR INIT

S82099B

OTH FRACTURE OF UNSP PATELLA INIT FOR OPN FX TYPE I/2

M80059A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE UNSP FEMUR INIT

S82099C

OTH FRACTURE OF UNSP PATELLA INIT FOR OPN FX TYPE 3A/B/C

M80061A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE R LOW LEG INIT

S82101A

UNSP FRACTURE OF UPPER END OF RIGHT TIBIA INIT FOR CLOS FX

M80062A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE L LOW LEG INIT

S82101B

UNSP FX UPPER END OF RIGHT TIBIA INIT FOR OPN FX TYPE I/2

M80069A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE UNSP LOW LEG INIT

S82101C

UNSP FX UPPER END OF R TIBIA INIT FOR OPN FX TYPE 3A/B/C

M80071A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE RIGHT ANK/FT INIT

S82102A

UNSP FRACTURE OF UPPER END OF LEFT TIBIA INIT FOR CLOS FX

M80072A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE LEFT ANK/FT INIT

S82102B

UNSP FX UPPER END OF LEFT TIBIA INIT FOR OPN FX TYPE I/2

M80079A

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE UNSP ANK/FT INIT

S82102C

UNSP FX UPPER END OF LEFT TIBIA INIT FOR OPN FX TYPE 3A/B/C

M8008XA

AGE-REL OSTEOPOR W CURRENT PATH FRACTURE VERTEBRA(E) INIT

S82109A

UNSP FRACTURE OF UPPER END OF UNSP TIBIA INIT FOR CLOS FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M8080XA OTH OSTEOPOR W CURRENT PATH FRACTURE UNSP SITE INIT

S82109B

UNSP FX UPPER END OF UNSP TIBIA INIT FOR OPN FX TYPE I/2

M80811A

OTH OSTEOPOR W CURRENT PATH FRACTURE R SHOULDER INIT

S82109C

UNSP FX UPPER END OF UNSP TIBIA INIT FOR OPN FX TYPE 3A/B/C

M80812A

OTH OSTEOPOR W CURRENT PATH FRACTURE L SHOULDER INIT

S82111A

DISP FX OF RIGHT TIBIAL SPINE INIT FOR CLOS FX

M80819A

OTH OSTEOPOR W CURRENT PATH FRACTURE UNSP SHOULDER INIT

S82111B

DISP FX OF RIGHT TIBIAL SPINE INIT FOR OPN FX TYPE I/2

M80821A

OTH OSTEOPOR W CURRENT PATH FRACTURE R HUMERUS INIT

S82111C

DISP FX OF RIGHT TIBIAL SPINE INIT FOR OPN FX TYPE 3A/B/C

M80822A

OTH OSTEOPOR W CURRENT PATH FRACTURE L HUMERUS INIT

S82112A

DISP FX OF LEFT TIBIAL SPINE INIT FOR CLOS FX

M80829A

OTH OSTEOPOR W CURRENT PATH FRACTURE UNSP HUMERUS INIT

S82112B

DISP FX OF LEFT TIBIAL SPINE INIT FOR OPN FX TYPE I/2

M80831A

OTH OSTEOPOR W CURRENT PATH FRACTURE R FOREARM INIT

S82112C

DISP FX OF LEFT TIBIAL SPINE INIT FOR OPN FX TYPE 3A/B/C

M80832A

OTH OSTEOPOR W CURRENT PATH FRACTURE L FOREARM INIT

S82113A

DISP FX OF UNSP TIBIAL SPINE INIT FOR CLOS FX

M80839A

OTH OSTEOPOR W CURRENT PATH FRACTURE UNSP FOREARM INIT

S82113B

DISP FX OF UNSP TIBIAL SPINE INIT FOR OPN FX TYPE I/2

M80841A

OTH OSTEOPOR W CURRENT PATH FRACTURE RIGHT HAND INIT

S82113C

DISP FX OF UNSP TIBIAL SPINE INIT FOR OPN FX TYPE 3A/B/C

M80842A

OTH OSTEOPOR W CURRENT PATH FRACTURE LEFT HAND INIT

S82114A

NONDISP FX OF RIGHT TIBIAL SPINE INIT FOR CLOS FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M80849A

OTH OSTEOPOR W CURRENT PATH FRACTURE UNSP HAND INIT

S82114B

NONDISP FX OF RIGHT TIBIAL SPINE INIT FOR OPN FX TYPE I/2

M80851A

OTH OSTEOPOR W CURRENT PATH FRACTURE RIGHT FEMUR INIT

S82114C

NONDISP FX OF R TIBIAL SPINE INIT FOR OPN FX TYPE 3A/B/C

M80852A

OTH OSTEOPOR W CURRENT PATH FRACTURE LEFT FEMUR INIT

S82115A

NONDISP FX OF LEFT TIBIAL SPINE INIT FOR CLOS FX

M80859A

OTH OSTEOPOR W CURRENT PATH FRACTURE UNSP FEMUR INIT

S82115B

NONDISP FX OF LEFT TIBIAL SPINE INIT FOR OPN FX TYPE I/2

M80861A

OTH OSTEOPOR W CURRENT PATH FRACTURE R LOW LEG INIT

S82115C

NONDISP FX OF LEFT TIBIAL SPINE INIT FOR OPN FX TYPE 3A/B/C

M80862A

OTH OSTEOPOR W CURRENT PATH FRACTURE L LOW LEG INIT

S82116A

NONDISP FX OF UNSP TIBIAL SPINE INIT FOR CLOS FX

M80869A

OTH OSTEOPOR W CURRENT PATH FRACTURE UNSP LOWER LEG INIT

S82116B

NONDISP FX OF UNSP TIBIAL SPINE INIT FOR OPN FX TYPE I/2

M80871A

OTH OSTEOPOR W CURRENT PATH FRACTURE RIGHT ANK/FT INIT

S82116C

NONDISP FX OF UNSP TIBIAL SPINE INIT FOR OPN FX TYPE 3A/B/C

M80872A

OTH OSTEOPOR W CURRENT PATH FRACTURE LEFT ANK/FT INIT

S82121A

DISP FX OF LATERAL CONDYLE OF RIGHT TIBIA INIT FOR CLOS FX

M80879A

OTH OSTEOPOR W CURRENT PATH FRACTURE UNSP ANK/FT INIT

S82121B

DISP FX OF LATERAL CONDYLE OF R TIBIA 7THB

M8088XA

OTH OSTEOPOR W CURRENT PATH FRACTURE VERTEBRA(E) INIT

S82121C

DISP FX OF LATERAL CONDYLE OF R TIBIA 7THC

M8430XA

STRESS FRACTURE UNSPECIFIED SITE INIT ENCNTR FOR FRACTURE

S82122A

DISP FX OF LATERAL CONDYLE OF LEFT TIBIA INIT FOR CLOS FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84311A

STRESS FRACTURE RIGHT SHOULDER INIT ENCNTR FOR FRACTURE

S82122B

DISP FX OF LATERAL CONDYLE OF L TIBIA 7THB

M84312A

STRESS FRACTURE LEFT SHOULDER INIT ENCNTR FOR FRACTURE

S82122C

DISP FX OF LATERAL CONDYLE OF L TIBIA 7THC

M84319A

STRESS FRACTURE UNSP SHOULDER INIT ENCNTR FOR FRACTURE

S82123A

DISP FX OF LATERAL CONDYLE OF UNSP TIBIA INIT FOR CLOS FX

M84321A

STRESS FRACTURE RIGHT HUMERUS INIT ENCNTR FOR FRACTURE

S82123B

DISP FX OF LATERAL CONDYLE OF UNSP TIBIA 7THB

M84322A

STRESS FRACTURE LEFT HUMERUS INIT ENCNTR FOR FRACTURE

S82123C

DISP FX OF LATERAL CONDYLE OF UNSP TIBIA 7THC

M84329A

STRESS FRACTURE UNSP HUMERUS INIT ENCNTR FOR FRACTURE

S82124A

NONDISP FX OF LATERAL CONDYLE OF RIGHT TIBIA INIT

M84331A

STRESS FRACTURE RIGHT ULNA INITIAL ENCOUNTER FOR FRACTURE

S82124B

NONDISP FX OF LATERAL CONDYLE OF R TIBIA 7THB

M84332A

STRESS FRACTURE LEFT ULNA INITIAL ENCOUNTER FOR FRACTURE

S82124C

NONDISP FX OF LATERAL CONDYLE OF R TIBIA 7THC

M84333A

STRESS FRACTURE RIGHT RADIUS INIT ENCNTR FOR FRACTURE

S82125A

NONDISP FX OF LATERAL CONDYLE OF LEFT TIBIA INIT

M84334A

STRESS FRACTURE LEFT RADIUS INITIAL ENCOUNTER FOR FRACTURE

S82125B

NONDISP FX OF LATERAL CONDYLE OF L TIBIA 7THB

M84339A STRESS FRACTURE UNSP ULNA AND RADIUS INIT FOR FX

S82125C

NONDISP FX OF LATERAL CONDYLE OF L TIBIA 7THC

M84341A

STRESS FRACTURE RIGHT HAND INITIAL ENCOUNTER FOR FRACTURE

S82126A

NONDISP FX OF LATERAL CONDYLE OF UNSP TIBIA INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84342A

STRESS FRACTURE LEFT HAND INITIAL ENCOUNTER FOR FRACTURE

S82126B

NONDISP FX OF LATERAL CONDYLE OF UNSP TIBIA 7THB

M84343A

STRESS FRACTURE UNSPECIFIED HAND INIT ENCNTR FOR FRACTURE

S82126C

NONDISP FX OF LATERAL CONDYLE OF UNSP TIBIA 7THC

M84344A

STRESS FRACTURE RIGHT FINGER(S) INIT ENCNTR FOR FRACTURE

S82131A

DISP FX OF MEDIAL CONDYLE OF RIGHT TIBIA INIT FOR CLOS FX

M84345A

STRESS FRACTURE LEFT FINGER(S) INIT ENCNTR FOR FRACTURE

S82131B

DISP FX OF MED CONDYLE OF R TIBIA INIT FOR OPN FX TYPE I/2

M84346A

STRESS FRACTURE UNSP FINGER(S) INIT ENCNTR FOR FRACTURE

S82131C

DISP FX OF MED CONDYLE OF R TIBIA 7THC

M84350A

STRESS FRACTURE PELVIS INITIAL ENCOUNTER FOR FRACTURE

S82132A

DISP FX OF MEDIAL CONDYLE OF LEFT TIBIA INIT FOR CLOS FX

M84351A

STRESS FRACTURE RIGHT FEMUR INITIAL ENCOUNTER FOR FRACTURE

S82132B

DISP FX OF MED CONDYLE OF L TIBIA INIT FOR OPN FX TYPE I/2

M84352A

STRESS FRACTURE LEFT FEMUR INITIAL ENCOUNTER FOR FRACTURE

S82132C

DISP FX OF MED CONDYLE OF L TIBIA 7THC

M84353A

STRESS FRACTURE UNSPECIFIED FEMUR INIT ENCNTR FOR FRACTURE

S82133A

DISP FX OF MEDIAL CONDYLE OF UNSP TIBIA INIT FOR CLOS FX

M84359A

STRESS FRACTURE HIP UNSPECIFIED INIT ENCNTR FOR FRACTURE

S82133B

DISP FX OF MED CONDYLE OF UNSP TIBIA 7THB

M84361A

STRESS FRACTURE RIGHT TIBIA INITIAL ENCOUNTER FOR FRACTURE

S82133C

DISP FX OF MED CONDYLE OF UNSP TIBIA 7THC

M84362A

STRESS FRACTURE LEFT TIBIA INITIAL ENCOUNTER FOR FRACTURE

S82134A

NONDISP FX OF MEDIAL CONDYLE OF RIGHT TIBIA INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84363A

STRESS FRACTURE RIGHT FIBULA INIT ENCNTR FOR FRACTURE

S82134B

NONDISP FX OF MED CONDYLE OF R TIBIA 7THB

M84364A

STRESS FRACTURE LEFT FIBULA INITIAL ENCOUNTER FOR FRACTURE

S82134C

NONDISP FX OF MED CONDYLE OF R TIBIA 7THC

M84369A STRESS FRACTURE UNSP TIBIA AND FIBULA INIT FOR FX

S82135A

NONDISP FX OF MEDIAL CONDYLE OF LEFT TIBIA INIT FOR CLOS FX

M84371A

STRESS FRACTURE RIGHT ANKLE INITIAL ENCOUNTER FOR FRACTURE

S82135B

NONDISP FX OF MED CONDYLE OF L TIBIA 7THB

M84372A

STRESS FRACTURE LEFT ANKLE INITIAL ENCOUNTER FOR FRACTURE

S82135C

NONDISP FX OF MED CONDYLE OF L TIBIA 7THC

M84373A

STRESS FRACTURE UNSPECIFIED ANKLE INIT ENCNTR FOR FRACTURE

S82136A

NONDISP FX OF MEDIAL CONDYLE OF UNSP TIBIA INIT FOR CLOS FX

M84374A

STRESS FRACTURE RIGHT FOOT INITIAL ENCOUNTER FOR FRACTURE

S82136B

NONDISP FX OF MED CONDYLE OF UNSP TIBIA 7THB

M84375A

STRESS FRACTURE LEFT FOOT INITIAL ENCOUNTER FOR FRACTURE

S82136C

NONDISP FX OF MED CONDYLE OF UNSP TIBIA 7THC

M84376A

STRESS FRACTURE UNSPECIFIED FOOT INIT ENCNTR FOR FRACTURE

S82141A

DISPLACED BICONDYLAR FRACTURE OF RIGHT TIBIA INIT

M84377A STRESS FRACTURE RIGHT TOE(S) INIT ENCNTR FOR FRACTURE

S82141B

DISPLACED BICONDYLAR FX R TIBIA INIT FOR OPN FX TYPE I/2

M84378A

STRESS FRACTURE LEFT TOE(S) INITIAL ENCOUNTER FOR FRACTURE

S82141C

DISPLACED BICONDYLAR FX R TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84379A STRESS FRACTURE UNSP TOE(S) INIT ENCNTR FOR FRACTURE

S82142A

DISPLACED BICONDYLAR FRACTURE OF LEFT TIBIA INIT

Page 303: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M8438XA

STRESS FRACTURE OTHER SITE INITIAL ENCOUNTER FOR FRACTURE

S82142B

DISPLACED BICONDYLAR FX LEFT TIBIA INIT FOR OPN FX TYPE I/2

M8440XA

PATHOLOGICAL FRACTURE UNSP SITE INIT ENCNTR FOR FRACTURE

S82142C

DISPLACED BICONDYLAR FX L TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84411A PATHOLOGICAL FRACTURE RIGHT SHOULDER INIT FOR FX

S82143A

DISPLACED BICONDYLAR FRACTURE OF UNSP TIBIA INIT

M84412A PATHOLOGICAL FRACTURE LEFT SHOULDER INIT FOR FX

S82143B

DISPLACED BICONDYLAR FX UNSP TIBIA INIT FOR OPN FX TYPE I/2

M84419A PATHOLOGICAL FRACTURE UNSP SHOULDER INIT FOR FX

S82143C

DISPL BICONDYLAR FX UNSP TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84421A PATHOLOGICAL FRACTURE RIGHT HUMERUS INIT FOR FX

S82144A

NONDISPLACED BICONDYLAR FRACTURE OF RIGHT TIBIA INIT

M84422A PATHOLOGICAL FRACTURE LEFT HUMERUS INIT FOR FX

S82144B

NONDISP BICONDYLAR FX RIGHT TIBIA INIT FOR OPN FX TYPE I/2

M84429A PATHOLOGICAL FRACTURE UNSP HUMERUS INIT FOR FX

S82144C

NONDISP BICONDYLAR FX R TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84431A

PATHOLOGICAL FRACTURE RIGHT ULNA INIT ENCNTR FOR FRACTURE

S82145A

NONDISPLACED BICONDYLAR FRACTURE OF LEFT TIBIA INIT

M84432A

PATHOLOGICAL FRACTURE LEFT ULNA INIT ENCNTR FOR FRACTURE

S82145B

NONDISP BICONDYLAR FX LEFT TIBIA INIT FOR OPN FX TYPE I/2

M84433A PATHOLOGICAL FRACTURE RIGHT RADIUS INIT FOR FX

S82145C

NONDISP BICONDYLAR FX L TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84434A

PATHOLOGICAL FRACTURE LEFT RADIUS INIT ENCNTR FOR FRACTURE

S82146A

NONDISPLACED BICONDYLAR FRACTURE OF UNSP TIBIA INIT

M84439A

PATHOLOGICAL FRACTURE UNSP ULNA AND RADIUS INIT FOR FX

S82146B

NONDISP BICONDYLAR FX UNSP TIBIA INIT FOR OPN FX TYPE I/2

M84441A

PATHOLOGICAL FRACTURE RIGHT HAND INIT ENCNTR FOR FRACTURE

S82146C

NONDISP BICONDYLAR FX UNSP TIBIA 7THC

Page 304: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84442A

PATHOLOGICAL FRACTURE LEFT HAND INIT ENCNTR FOR FRACTURE

S82151A

DISP FX OF RIGHT TIBIAL TUBEROSITY INIT FOR CLOS FX

M84443A

PATHOLOGICAL FRACTURE UNSP HAND INIT ENCNTR FOR FRACTURE

S82151B

DISP FX OF RIGHT TIBIAL TUBEROSITY INIT FOR OPN FX TYPE I/2

M84444A PATHOLOGICAL FRACTURE RIGHT FINGER(S) INIT FOR FX

S82151C

DISP FX OF R TIBIAL TUBEROSITY INIT FOR OPN FX TYPE 3A/B/C

M84445A PATHOLOGICAL FRACTURE LEFT FINGER(S) INIT FOR FX

S82152A

DISP FX OF LEFT TIBIAL TUBEROSITY INIT FOR CLOS FX

M84446A PATHOLOGICAL FRACTURE UNSP FINGER(S) INIT FOR FX

S82152B

DISP FX OF LEFT TIBIAL TUBEROSITY INIT FOR OPN FX TYPE I/2

M84451A

PATHOLOGICAL FRACTURE RIGHT FEMUR INIT ENCNTR FOR FRACTURE

S82152C

DISP FX OF L TIBIAL TUBEROSITY INIT FOR OPN FX TYPE 3A/B/C

M84452A

PATHOLOGICAL FRACTURE LEFT FEMUR INIT ENCNTR FOR FRACTURE

S82153A

DISP FX OF UNSP TIBIAL TUBEROSITY INIT FOR CLOS FX

M84453A

PATHOLOGICAL FRACTURE UNSP FEMUR INIT ENCNTR FOR FRACTURE

S82153B

DISP FX OF UNSP TIBIAL TUBEROSITY INIT FOR OPN FX TYPE I/2

M84454A

PATHOLOGICAL FRACTURE PELVIS INIT ENCNTR FOR FRACTURE

S82153C

DISP FX OF UNSP TIBIAL TUBEROSITY 7THC

M84459A

PATHOLOGICAL FRACTURE HIP UNSP INIT ENCNTR FOR FRACTURE

S82154A

NONDISP FX OF RIGHT TIBIAL TUBEROSITY INIT FOR CLOS FX

M84461A

PATHOLOGICAL FRACTURE RIGHT TIBIA INIT ENCNTR FOR FRACTURE

S82154B

NONDISP FX OF R TIBIAL TUBEROSITY INIT FOR OPN FX TYPE I/2

M84462A

PATHOLOGICAL FRACTURE LEFT TIBIA INIT ENCNTR FOR FRACTURE

S82154C

NONDISP FX OF R TIBIAL TUBEROSITY 7THC

M84463A PATHOLOGICAL FRACTURE RIGHT FIBULA INIT FOR FX

S82155A

NONDISP FX OF LEFT TIBIAL TUBEROSITY INIT FOR CLOS FX

Page 305: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84464A

PATHOLOGICAL FRACTURE LEFT FIBULA INIT ENCNTR FOR FRACTURE

S82155B

NONDISP FX OF L TIBIAL TUBEROSITY INIT FOR OPN FX TYPE I/2

M84469A

PATHOLOGICAL FRACTURE UNSP TIBIA AND FIBULA INIT FOR FX

S82155C

NONDISP FX OF L TIBIAL TUBEROSITY 7THC

M84471A

PATHOLOGICAL FRACTURE RIGHT ANKLE INIT ENCNTR FOR FRACTURE

S82156A

NONDISP FX OF UNSP TIBIAL TUBEROSITY INIT FOR CLOS FX

M84472A

PATHOLOGICAL FRACTURE LEFT ANKLE INIT ENCNTR FOR FRACTURE

S82156B

NONDISP FX OF UNSP TIBIAL TUBEROSITY 7THB

M84473A

PATHOLOGICAL FRACTURE UNSP ANKLE INIT ENCNTR FOR FRACTURE

S82156C

NONDISP FX OF UNSP TIBIAL TUBEROSITY 7THC

M84474A

PATHOLOGICAL FRACTURE RIGHT FOOT INIT ENCNTR FOR FRACTURE

S82161A

TORUS FRACTURE OF UPPER END OF RIGHT TIBIA INIT FOR CLOS FX

M84475A

PATHOLOGICAL FRACTURE LEFT FOOT INIT ENCNTR FOR FRACTURE

S82162A

TORUS FRACTURE OF UPPER END OF LEFT TIBIA INIT FOR CLOS FX

M84476A

PATHOLOGICAL FRACTURE UNSP FOOT INIT ENCNTR FOR FRACTURE

S82169A

TORUS FRACTURE OF UPPER END OF UNSP TIBIA INIT FOR CLOS FX

M84477A PATHOLOGICAL FRACTURE RIGHT TOE(S) INIT FOR FX

S82191A

OTH FRACTURE OF UPPER END OF RIGHT TIBIA INIT FOR CLOS FX

M84478A

PATHOLOGICAL FRACTURE LEFT TOE(S) INIT ENCNTR FOR FRACTURE

S82191B

OTH FX UPPER END OF RIGHT TIBIA INIT FOR OPN FX TYPE I/2

M84479A

PATHOLOGICAL FRACTURE UNSP TOE(S) INIT ENCNTR FOR FRACTURE

S82191C

OTH FX UPPER END OF RIGHT TIBIA INIT FOR OPN FX TYPE 3A/B/C

M8448XA

PATHOLOGICAL FRACTURE OTHER SITE INIT ENCNTR FOR FRACTURE

S82192A

OTH FRACTURE OF UPPER END OF LEFT TIBIA INIT FOR CLOS FX

Page 306: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M8450XA

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE UNSP SITE INIT

S82192B

OTH FX UPPER END OF LEFT TIBIA INIT FOR OPN FX TYPE I/2

M84511A PATH FRACTURE IN NEOPLASTIC DISEASE R SHOULDER INIT

S82192C

OTH FX UPPER END OF LEFT TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84512A PATH FRACTURE IN NEOPLASTIC DISEASE L SHOULDER INIT

S82199A

OTH FRACTURE OF UPPER END OF UNSP TIBIA INIT FOR CLOS FX

M84519A PATH FRACTURE IN NEOPLASTIC DISEASE UNSP SHOULDER INIT

S82199B

OTH FX UPPER END OF UNSP TIBIA INIT FOR OPN FX TYPE I/2

M84521A

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE R HUMERUS INIT

S82199C

OTH FX UPPER END OF UNSP TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84522A

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE L HUMERUS INIT

S82201A

UNSP FRACTURE OF SHAFT OF RIGHT TIBIA INIT FOR CLOS FX

M84529A PATH FRACTURE IN NEOPLASTIC DISEASE UNSP HUMERUS INIT

S82201B

UNSP FX SHAFT OF RIGHT TIBIA INIT FOR OPN FX TYPE I/2

M84531A PATH FRACTURE IN NEOPLASTIC DISEASE RIGHT ULNA INIT

S82201C

UNSP FX SHAFT OF RIGHT TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84532A

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE LEFT ULNA INIT

S82202A

UNSP FRACTURE OF SHAFT OF LEFT TIBIA INIT FOR CLOS FX

M84533A PATH FRACTURE IN NEOPLASTIC DISEASE RIGHT RADIUS INIT

S82202B

UNSP FX SHAFT OF LEFT TIBIA INIT FOR OPN FX TYPE I/2

M84534A PATH FRACTURE IN NEOPLASTIC DISEASE LEFT RADIUS INIT

S82202C

UNSP FX SHAFT OF LEFT TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84539A

PATH FRACTURE IN NEOPLTC DISEASE UNSP ULNA AND RADIUS INIT

S82209A

UNSP FRACTURE OF SHAFT OF UNSP TIBIA INIT FOR CLOS FX

Page 307: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84541A PATH FRACTURE IN NEOPLASTIC DISEASE RIGHT HAND INIT

S82209B

UNSP FX SHAFT OF UNSP TIBIA INIT FOR OPN FX TYPE I/2

M84542A

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE LEFT HAND INIT

S82209C

UNSP FX SHAFT OF UNSP TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84549A

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE UNSP HAND INIT

S82221A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF RIGHT TIBIA INIT

M84550A

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE PELVIS INIT

S82221B

DISPL TRANSVERSE FX SHAFT OF R TIBIA 7THB

M84551A PATH FRACTURE IN NEOPLASTIC DISEASE RIGHT FEMUR INIT

S82221C

DISPL TRANSVERSE FX SHAFT OF R TIBIA 7THC

M84552A PATH FRACTURE IN NEOPLASTIC DISEASE LEFT FEMUR INIT

S82222A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF LEFT TIBIA INIT

M84553A PATH FRACTURE IN NEOPLASTIC DISEASE UNSP FEMUR INIT

S82222B

DISPL TRANSVERSE FX SHAFT OF L TIBIA 7THB

M84559A

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE HIP UNSP INIT

S82222C

DISPL TRANSVERSE FX SHAFT OF L TIBIA 7THC

M84561A PATH FRACTURE IN NEOPLASTIC DISEASE RIGHT TIBIA INIT

S82223A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF UNSP TIBIA INIT

M84562A PATH FRACTURE IN NEOPLASTIC DISEASE LEFT TIBIA INIT

S82223B

DISPL TRANSVERSE FX SHAFT OF UNSP TIBIA 7THB

M84563A PATH FRACTURE IN NEOPLASTIC DISEASE RIGHT FIBULA INIT

S82223C

DISPL TRANSVERSE FX SHAFT OF UNSP TIBIA 7THC

M84564A PATH FRACTURE IN NEOPLASTIC DISEASE LEFT FIBULA INIT

S82224A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF RIGHT TIBIA INIT

Page 308: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84569A PATH FX IN NEOPLTC DISEASE UNSP TIBIA AND FIBULA INIT

S82224B

NONDISP TRANSVERSE FX SHAFT OF R TIBIA 7THB

M84571A PATH FRACTURE IN NEOPLASTIC DISEASE RIGHT ANKLE INIT

S82224C

NONDISP TRANSVERSE FX SHAFT OF R TIBIA 7THC

M84572A PATH FRACTURE IN NEOPLASTIC DISEASE LEFT ANKLE INIT

S82225A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF LEFT TIBIA INIT

M84573A PATH FRACTURE IN NEOPLASTIC DISEASE UNSP ANKLE INIT

S82225B

NONDISP TRANSVERSE FX SHAFT OF L TIBIA 7THB

M84574A PATH FRACTURE IN NEOPLASTIC DISEASE RIGHT FOOT INIT

S82225C

NONDISP TRANSVERSE FX SHAFT OF L TIBIA 7THC

M84575A

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE LEFT FOOT INIT

S82226A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF UNSP TIBIA INIT

M84576A

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE UNSP FOOT INIT

S82226B

NONDISP TRANSVERSE FX SHAFT OF UNSP TIBIA 7THB

M8458XA

PATHOLOGICAL FRACTURE IN NEOPLASTIC DISEASE OTH SITE INIT

S82226C

NONDISP TRANSVERSE FX SHAFT OF UNSP TIBIA 7THC

M8460XA

PATHOLOGICAL FRACTURE IN OTH DISEASE UNSP SITE INIT FOR FX

S82231A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT TIBIA INIT

M84611A

PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT SHOULDER INIT

S82231B

DISPL OBLIQUE FX SHAFT OF R TIBIA INIT FOR OPN FX TYPE I/2

M84612A

PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT SHOULDER INIT

S82231C

DISPL OBLIQUE FX SHAFT OF R TIBIA 7THC

M84619A

PATHOLOGICAL FRACTURE IN OTH DISEASE UNSP SHOULDER INIT

S82232A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT TIBIA INIT

Page 309: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84621A

PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT HUMERUS INIT

S82232B

DISPL OBLIQUE FX SHAFT OF L TIBIA INIT FOR OPN FX TYPE I/2

M84622A

PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT HUMERUS INIT

S82232C

DISPL OBLIQUE FX SHAFT OF L TIBIA 7THC

M84629A

PATHOLOGICAL FRACTURE IN OTH DISEASE UNSP HUMERUS INIT

S82233A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF UNSP TIBIA INIT

M84631A PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT ULNA INIT

S82233B

DISPL OBLIQUE FX SHAFT OF UNSP TIBIA 7THB

M84632A

PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT ULNA INIT FOR FX

S82233C

DISPL OBLIQUE FX SHAFT OF UNSP TIBIA 7THC

M84633A

PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT RADIUS INIT

S82234A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT TIBIA INIT

M84634A PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT RADIUS INIT

S82234B

NONDISP OBLIQUE FX SHAFT OF R TIBIA 7THB

M84639A

PATH FRACTURE IN OTH DISEASE UNSP ULNA AND RADIUS INIT

S82234C

NONDISP OBLIQUE FX SHAFT OF R TIBIA 7THC

M84641A PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT HAND INIT

S82235A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT TIBIA INIT

M84642A

PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT HAND INIT FOR FX

S82235B

NONDISP OBLIQUE FX SHAFT OF L TIBIA 7THB

M84649A

PATHOLOGICAL FRACTURE IN OTH DISEASE UNSP HAND INIT FOR FX

S82235C

NONDISP OBLIQUE FX SHAFT OF L TIBIA 7THC

M84650A

PATHOLOGICAL FRACTURE IN OTH DISEASE PELVIS INIT FOR FX

S82236A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF UNSP TIBIA INIT

Page 310: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84651A

PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT FEMUR INIT

S82236B

NONDISP OBLIQUE FX SHAFT OF UNSP TIBIA 7THB

M84652A PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT FEMUR INIT

S82236C

NONDISP OBLIQUE FX SHAFT OF UNSP TIBIA 7THC

M84653A PATHOLOGICAL FRACTURE IN OTH DISEASE UNSP FEMUR INIT

S82241A

DISPLACED SPIRAL FRACTURE OF SHAFT OF RIGHT TIBIA INIT

M84659A

PATHOLOGICAL FRACTURE IN OTH DISEASE HIP UNSP INIT FOR FX

S82241B

DISPL SPIRAL FX SHAFT OF R TIBIA INIT FOR OPN FX TYPE I/2

M84661A PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT TIBIA INIT

S82241C

DISPL SPIRAL FX SHAFT OF R TIBIA 7THC

M84662A PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT TIBIA INIT

S82242A

DISPLACED SPIRAL FRACTURE OF SHAFT OF LEFT TIBIA INIT

M84663A PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT FIBULA INIT

S82242B

DISPL SPIRAL FX SHAFT OF L TIBIA INIT FOR OPN FX TYPE I/2

M84664A PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT FIBULA INIT

S82242C

DISPL SPIRAL FX SHAFT OF L TIBIA 7THC

M84669A

PATH FRACTURE IN OTH DISEASE UNSP TIBIA AND FIBULA INIT

S82243A

DISPLACED SPIRAL FRACTURE OF SHAFT OF UNSP TIBIA INIT

M84671A PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT ANKLE INIT

S82243B

DISPL SPIRAL FX SHAFT OF UNSP TIBIA 7THB

M84672A PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT ANKLE INIT

S82243C

DISPL SPIRAL FX SHAFT OF UNSP TIBIA 7THC

M84673A PATHOLOGICAL FRACTURE IN OTH DISEASE UNSP ANKLE INIT

S82244A

NONDISPLACED SPIRAL FRACTURE OF SHAFT OF RIGHT TIBIA INIT

M84674A PATHOLOGICAL FRACTURE IN OTH DISEASE RIGHT FOOT INIT

S82244B

NONDISP SPIRAL FX SHAFT OF R TIBIA INIT FOR OPN FX TYPE I/2

M84675A

PATHOLOGICAL FRACTURE IN OTH DISEASE LEFT FOOT INIT FOR FX

S82244C

NONDISP SPIRAL FX SHAFT OF R TIBIA 7THC

Page 311: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84676A

PATHOLOGICAL FRACTURE IN OTH DISEASE UNSP FOOT INIT FOR FX

S82245A

NONDISPLACED SPIRAL FRACTURE OF SHAFT OF LEFT TIBIA INIT

M8468XA

PATHOLOGICAL FRACTURE IN OTH DISEASE OTH SITE INIT FOR FX

S82245B

NONDISP SPIRAL FX SHAFT OF L TIBIA INIT FOR OPN FX TYPE I/2

M84750A

Atypical femoral fracture unspecified initial encounter for fracture

S82245C

NONDISP SPIRAL FX SHAFT OF L TIBIA 7THC

M84751A

Incomplete atypical femoral fracture right leg initial encounter for fracture

S82246A

NONDISPLACED SPIRAL FRACTURE OF SHAFT OF UNSP TIBIA INIT

M84752A

Incomplete atypical femoral fracture left leg initial encounter for fracture

S82246B

NONDISP SPIRAL FX SHAFT OF UNSP TIBIA 7THB

M84753A

Incomplete atypical femoral fracture unspecified leg initial encounter for fracture

S82246C

NONDISP SPIRAL FX SHAFT OF UNSP TIBIA 7THC

M84754A

Complete transverse atypical femoral fracture right leg initial encounter for fracture

S82251A

DISPLACED COMMINUTED FRACTURE OF SHAFT OF RIGHT TIBIA INIT

M84755A

Complete transverse atypical femoral fracture left leg initial encounter for fracture

S82251B

DISPL COMMNT FX SHAFT OF R TIBIA INIT FOR OPN FX TYPE I/2

M84756A

Complete transverse atypical femoral fracture unspecified leg initial encounter for fracture

S82251C

DISPL COMMNT FX SHAFT OF R TIBIA 7THC

M84757A

Complete oblique atypical femoral fracture right leg initial encounter for fracture

S82252A

DISPLACED COMMINUTED FRACTURE OF SHAFT OF LEFT TIBIA INIT

M84758A

Complete oblique atypical femoral fracture, left leg, initial encounter for fracture

S82252B

DISPL COMMNT FX SHAFT OF L TIBIA INIT FOR OPN FX TYPE I/2

M84759A

Complete oblique atypical femoral fracture unspecified leg initial encounter for fracture

S82252C

DISPL COMMNT FX SHAFT OF L TIBIA 7THC

Page 312: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M8480

OTHER DISORDERS OF CONTINUITY OF BONE UNSPECIFIED SITE

S82253A

DISPLACED COMMINUTED FRACTURE OF SHAFT OF UNSP TIBIA INIT

M84811

OTHER DISORDERS OF CONTINUITY OF BONE RIGHT SHOULDER

S82253B

DISPL COMMNT FX SHAFT OF UNSP TIBIA 7THB

M84812

OTHER DISORDERS OF CONTINUITY OF BONE LEFT SHOULDER

S82253C

DISPL COMMNT FX SHAFT OF UNSP TIBIA 7THC

M84819

OTHER DISORDERS OF CONTINUITY OF BONE UNSPECIFIED SHOULDER

S82254A

NONDISP COMMINUTED FRACTURE OF SHAFT OF RIGHT TIBIA INIT

M84821

OTHER DISORDERS OF CONTINUITY OF BONE RIGHT HUMERUS

S82254B

NONDISP COMMNT FX SHAFT OF R TIBIA INIT FOR OPN FX TYPE I/2

M84822

OTHER DISORDERS OF CONTINUITY OF BONE LEFT HUMERUS

S82254C

NONDISP COMMNT FX SHAFT OF R TIBIA 7THC

M84829

OTHER DISORDERS OF CONTINUITY OF BONE UNSPECIFIED HUMERUS

S82255A

NONDISP COMMINUTED FRACTURE OF SHAFT OF LEFT TIBIA INIT

M84831

OTHER DISORDERS OF CONTINUITY OF BONE RIGHT ULNA

S82255B

NONDISP COMMNT FX SHAFT OF L TIBIA INIT FOR OPN FX TYPE I/2

M84832

OTHER DISORDERS OF CONTINUITY OF BONE LEFT ULNA

S82255C

NONDISP COMMNT FX SHAFT OF L TIBIA 7THC

M84833

OTHER DISORDERS OF CONTINUITY OF BONE RIGHT RADIUS

S82256A

NONDISP COMMINUTED FRACTURE OF SHAFT OF UNSP TIBIA INIT

M84834

OTHER DISORDERS OF CONTINUITY OF BONE LEFT RADIUS

S82256B

NONDISP COMMNT FX SHAFT OF UNSP TIBIA 7THB

M84839

OTHER DISORDERS OF CONTINUITY OF BONE UNSP ULNA AND RADIUS

S82256C

NONDISP COMMNT FX SHAFT OF UNSP TIBIA 7THC

Page 313: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84841

OTHER DISORDERS OF CONTINUITY OF BONE RIGHT HAND

S82261A

DISPLACED SEGMENTAL FRACTURE OF SHAFT OF RIGHT TIBIA INIT

M84842

OTHER DISORDERS OF CONTINUITY OF BONE LEFT HAND

S82261B

DISPL SEG FX SHAFT OF R TIBIA INIT FOR OPN FX TYPE I/2

M84849

OTHER DISORDERS OF CONTINUITY OF BONE UNSPECIFIED HAND

S82261C

DISPL SEG FX SHAFT OF R TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84851

OTH DISORD OF CONTINUITY OF BONE RIGHT PELV RGN AND THIGH

S82262A

DISPLACED SEGMENTAL FRACTURE OF SHAFT OF LEFT TIBIA INIT

M84852

OTH DISORD OF CONTINUITY OF BONE LEFT PELV REGION AND THIGH

S82262B

DISPL SEG FX SHAFT OF L TIBIA INIT FOR OPN FX TYPE I/2

M84859

OTH DISORD OF CONTINUITY OF BONE UNSP PELV REGION AND THIGH

S82262C

DISPL SEG FX SHAFT OF L TIBIA INIT FOR OPN FX TYPE 3A/B/C

M84861

OTHER DISORDERS OF CONTINUITY OF BONE RIGHT TIBIA

S82263A

DISPLACED SEGMENTAL FRACTURE OF SHAFT OF UNSP TIBIA INIT

M84862

OTHER DISORDERS OF CONTINUITY OF BONE LEFT TIBIA

S82263B

DISPL SEG FX SHAFT OF UNSP TIBIA INIT FOR OPN FX TYPE I/2

M84863

OTHER DISORDERS OF CONTINUITY OF BONE RIGHT FIBULA

S82263C

DISPL SEG FX SHAFT OF UNSP TIBIA 7THC

M84864

OTHER DISORDERS OF CONTINUITY OF BONE LEFT FIBULA

S82264A

NONDISP SEGMENTAL FRACTURE OF SHAFT OF RIGHT TIBIA INIT

M84869

OTHER DISORDERS OF CONTINUITY OF BONE UNSP TIBIA AND FIBULA

S82264B

NONDISP SEG FX SHAFT OF R TIBIA INIT FOR OPN FX TYPE I/2

M84871

OTHER DISORDERS OF CONTINUITY OF BONE RIGHT ANKLE AND FOOT

S82264C

NONDISP SEG FX SHAFT OF R TIBIA INIT FOR OPN FX TYPE 3A/B/C

Page 314: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M84872

OTHER DISORDERS OF CONTINUITY OF BONE LEFT ANKLE AND FOOT

S82265A

NONDISPLACED SEGMENTAL FRACTURE OF SHAFT OF LEFT TIBIA INIT

M84879

OTHER DISORDERS OF CONTINUITY OF BONE UNSP ANKLE AND FOOT

S82265B

NONDISP SEG FX SHAFT OF L TIBIA INIT FOR OPN FX TYPE I/2

M8488

OTHER DISORDERS OF CONTINUITY OF BONE OTHER SITE

S82265C

NONDISP SEG FX SHAFT OF L TIBIA INIT FOR OPN FX TYPE 3A/B/C

M849 DISORDER OF CONTINUITY OF BONE UNSPECIFIED

S82266A

NONDISPLACED SEGMENTAL FRACTURE OF SHAFT OF UNSP TIBIA INIT

M8600

ACUTE HEMATOGENOUS OSTEOMYELITIS UNSPECIFIED SITE

S82266B

NONDISP SEG FX SHAFT OF UNSP TIBIA INIT FOR OPN FX TYPE I/2

M86011

ACUTE HEMATOGENOUS OSTEOMYELITIS RIGHT SHOULDER

S82266C

NONDISP SEG FX SHAFT OF UNSP TIBIA 7THC

M86012

ACUTE HEMATOGENOUS OSTEOMYELITIS LEFT SHOULDER

S82291A

OTH FRACTURE OF SHAFT OF RIGHT TIBIA INIT FOR CLOS FX

M86019

ACUTE HEMATOGENOUS OSTEOMYELITIS UNSPECIFIED SHOULDER

S82291B

OTH FX SHAFT OF RIGHT TIBIA INIT FOR OPN FX TYPE I/2

M86021

ACUTE HEMATOGENOUS OSTEOMYELITIS RIGHT HUMERUS

S82291C

OTH FX SHAFT OF RIGHT TIBIA INIT FOR OPN FX TYPE 3A/B/C

M86022 ACUTE HEMATOGENOUS OSTEOMYELITIS LEFT HUMERUS

S82292A

OTH FRACTURE OF SHAFT OF LEFT TIBIA INIT FOR CLOS FX

M86029

ACUTE HEMATOGENOUS OSTEOMYELITIS UNSPECIFIED HUMERUS

S82292B

OTH FX SHAFT OF LEFT TIBIA INIT FOR OPN FX TYPE I/2

M86031

ACUTE HEMATOGENOUS OSTEOMYELITIS RIGHT RADIUS AND ULNA

S82292C

OTH FX SHAFT OF LEFT TIBIA INIT FOR OPN FX TYPE 3A/B/C

Page 315: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M86032

ACUTE HEMATOGENOUS OSTEOMYELITIS LEFT RADIUS AND ULNA

S82299A

OTH FRACTURE OF SHAFT OF UNSP TIBIA INIT FOR CLOS FX

M86039

ACUTE HEMATOGENOUS OSTEOMYELITIS UNSP RADIUS AND ULNA

S82299B

OTH FX SHAFT OF UNSP TIBIA INIT FOR OPN FX TYPE I/2

M86041 ACUTE HEMATOGENOUS OSTEOMYELITIS RIGHT HAND

S82299C

OTH FX SHAFT OF UNSP TIBIA INIT FOR OPN FX TYPE 3A/B/C

M86042 ACUTE HEMATOGENOUS OSTEOMYELITIS LEFT HAND

S82301A

UNSP FRACTURE OF LOWER END OF RIGHT TIBIA INIT FOR CLOS FX

M86049

ACUTE HEMATOGENOUS OSTEOMYELITIS UNSPECIFIED HAND

S82301B

UNSP FX LOWER END OF RIGHT TIBIA INIT FOR OPN FX TYPE I/2

M86051 ACUTE HEMATOGENOUS OSTEOMYELITIS RIGHT FEMUR

S82301C

UNSP FX LOWER END OF R TIBIA INIT FOR OPN FX TYPE 3A/B/C

M86052 ACUTE HEMATOGENOUS OSTEOMYELITIS LEFT FEMUR

S82302A

UNSP FRACTURE OF LOWER END OF LEFT TIBIA INIT FOR CLOS FX

M86059

ACUTE HEMATOGENOUS OSTEOMYELITIS UNSPECIFIED FEMUR

S82302B

UNSP FX LOWER END OF LEFT TIBIA INIT FOR OPN FX TYPE I/2

M86061

ACUTE HEMATOGENOUS OSTEOMYELITIS RIGHT TIBIA AND FIBULA

S82302C

UNSP FX LOWER END OF LEFT TIBIA INIT FOR OPN FX TYPE 3A/B/C

M86062

ACUTE HEMATOGENOUS OSTEOMYELITIS LEFT TIBIA AND FIBULA

S82309A

UNSP FRACTURE OF LOWER END OF UNSP TIBIA INIT FOR CLOS FX

M86069

ACUTE HEMATOGENOUS OSTEOMYELITIS UNSP TIBIA AND FIBULA

S82309B

UNSP FX LOWER END OF UNSP TIBIA INIT FOR OPN FX TYPE I/2

M86071

ACUTE HEMATOGENOUS OSTEOMYELITIS RIGHT ANKLE AND FOOT

S82309C

UNSP FX LOWER END OF UNSP TIBIA INIT FOR OPN FX TYPE 3A/B/C

M86072

ACUTE HEMATOGENOUS OSTEOMYELITIS LEFT ANKLE AND FOOT

S82311A

TORUS FRACTURE OF LOWER END OF RIGHT TIBIA INIT FOR CLOS FX

Page 316: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M86079

ACUTE HEMATOGENOUS OSTEOMYELITIS UNSPECIFIED ANKLE AND FOOT

S82312A

TORUS FRACTURE OF LOWER END OF LEFT TIBIA INIT FOR CLOS FX

M8608 ACUTE HEMATOGENOUS OSTEOMYELITIS OTHER SITES

S82319A

TORUS FRACTURE OF LOWER END OF UNSP TIBIA INIT FOR CLOS FX

M8609

ACUTE HEMATOGENOUS OSTEOMYELITIS MULTIPLE SITES

S82391A

OTH FRACTURE OF LOWER END OF RIGHT TIBIA INIT FOR CLOS FX

M8610 OTHER ACUTE OSTEOMYELITIS UNSPECIFIED SITE

S82391B

OTH FX LOWER END OF RIGHT TIBIA INIT FOR OPN FX TYPE I/2

M86111 OTHER ACUTE OSTEOMYELITIS RIGHT SHOULDER

S82391C

OTH FX LOWER END OF RIGHT TIBIA INIT FOR OPN FX TYPE 3A/B/C

M86112 OTHER ACUTE OSTEOMYELITIS LEFT SHOULDER

S82392A

OTH FRACTURE OF LOWER END OF LEFT TIBIA INIT FOR CLOS FX

M86119 OTHER ACUTE OSTEOMYELITIS UNSPECIFIED SHOULDER

S82392B

OTH FX LOWER END OF LEFT TIBIA INIT FOR OPN FX TYPE I/2

M86121 OTHER ACUTE OSTEOMYELITIS RIGHT HUMERUS

S82392C

OTH FX LOWER END OF LEFT TIBIA INIT FOR OPN FX TYPE 3A/B/C

M86122 OTHER ACUTE OSTEOMYELITIS LEFT HUMERUS

S82399A

OTH FRACTURE OF LOWER END OF UNSP TIBIA INIT FOR CLOS FX

M86129 OTHER ACUTE OSTEOMYELITIS UNSPECIFIED HUMERUS

S82399B

OTH FX LOWER END OF UNSP TIBIA INIT FOR OPN FX TYPE I/2

M86131 OTHER ACUTE OSTEOMYELITIS RIGHT RADIUS AND ULNA

S82399C

OTH FX LOWER END OF UNSP TIBIA INIT FOR OPN FX TYPE 3A/B/C

M86132 OTHER ACUTE OSTEOMYELITIS LEFT RADIUS AND ULNA

S82401A

UNSP FRACTURE OF SHAFT OF RIGHT FIBULA INIT FOR CLOS FX

M86139

OTHER ACUTE OSTEOMYELITIS UNSPECIFIED RADIUS AND ULNA

S82401B

UNSP FRACTURE OF SHAFT OF R FIBULA INIT FOR OPN FX TYPE I/2

M86141 OTHER ACUTE OSTEOMYELITIS RIGHT HAND

S82401C

UNSP FX SHAFT OF R FIBULA INIT FOR OPN FX TYPE 3A/B/C

M86142 OTHER ACUTE OSTEOMYELITIS LEFT HAND

S82402A

UNSP FRACTURE OF SHAFT OF LEFT FIBULA INIT FOR CLOS FX

M86149 OTHER ACUTE OSTEOMYELITIS UNSPECIFIED HAND

S82402B

UNSP FX SHAFT OF LEFT FIBULA INIT FOR OPN FX TYPE I/2

Page 317: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M86151 OTHER ACUTE OSTEOMYELITIS RIGHT FEMUR

S82402C

UNSP FX SHAFT OF LEFT FIBULA INIT FOR OPN FX TYPE 3A/B/C

M86152 OTHER ACUTE OSTEOMYELITIS LEFT FEMUR

S82409A

UNSP FRACTURE OF SHAFT OF UNSP FIBULA INIT FOR CLOS FX

M86159 OTHER ACUTE OSTEOMYELITIS UNSPECIFIED FEMUR

S82409B

UNSP FX SHAFT OF UNSP FIBULA INIT FOR OPN FX TYPE I/2

M86161 OTHER ACUTE OSTEOMYELITIS RIGHT TIBIA AND FIBULA

S82409C

UNSP FX SHAFT OF UNSP FIBULA INIT FOR OPN FX TYPE 3A/B/C

M86162 OTHER ACUTE OSTEOMYELITIS LEFT TIBIA AND FIBULA

S82421A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF RIGHT FIBULA INIT

M86169 OTHER ACUTE OSTEOMYELITIS UNSPECIFIED TIBIA AND FIBULA

S82421B

DISPL TRANSVERSE FX SHAFT OF R FIBULA 7THB

M86171 OTHER ACUTE OSTEOMYELITIS RIGHT ANKLE AND FOOT

S82421C

DISPL TRANSVERSE FX SHAFT OF R FIBULA 7THC

M86172 OTHER ACUTE OSTEOMYELITIS LEFT ANKLE AND FOOT

S82422A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF LEFT FIBULA INIT

M86179 OTHER ACUTE OSTEOMYELITIS UNSPECIFIED ANKLE AND FOOT

S82422B

DISPL TRANSVERSE FX SHAFT OF L FIBULA 7THB

M8618 OTHER ACUTE OSTEOMYELITIS OTHER SITE

S82422C

DISPL TRANSVERSE FX SHAFT OF L FIBULA 7THC

M8619 OTHER ACUTE OSTEOMYELITIS MULTIPLE SITES

S82423A

DISPLACED TRANSVERSE FRACTURE OF SHAFT OF UNSP FIBULA INIT

M93011 ACUTE SLIPPED UPPER FEMORAL EPIPHYSIS RIGHT HIP

S82423B

DISPL TRANSVERSE FX SHAFT OF UNSP FIBULA 7THB

M93012 ACUTE SLIPPED UPPER FEMORAL EPIPHYSIS LEFT HIP

S82423C

DISPL TRANSVERSE FX SHAFT OF UNSP FIBULA 7THC

M93013 ACUTE SLIPPED UPPER FEMORAL EPIPHYSIS UNSP HIP

S82424A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF RIGHT FIBULA INIT

M93031

ACUTE ON CHRONIC SLIPPED UPPER FEMORAL EPIPHYSIS RIGHT HIP

S82424B

NONDISP TRANSVERSE FX SHAFT OF R FIBULA 7THB

Page 318: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M93032

ACUTE ON CHRONIC SLIPPED UPPER FEMORAL EPIPHYSIS LEFT HIP

S82424C

NONDISP TRANSVERSE FX SHAFT OF R FIBULA 7THC

M93033

ACUTE ON CHRONIC SLIPPED UPPER FEMORAL EPIPHYSIS UNSP HIP

S82425A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF LEFT FIBULA INIT

M96621

FX HUMERUS FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT RIGHT ARM

S82425B

NONDISP TRANSVERSE FX SHAFT OF L FIBULA 7THB

M96622

FX HUMERUS FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT LEFT ARM

S82425C

NONDISP TRANSVERSE FX SHAFT OF L FIBULA 7THC

M96629

FX HUMERUS FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT UNSP ARM

S82426A

NONDISP TRANSVERSE FRACTURE OF SHAFT OF UNSP FIBULA INIT

M96631

FX RAD/ULNA FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT R ARM

S82426B

NONDISP TRANSVERSE FX SHAFT OF UNSP FIBULA 7THB

M96632

FX RAD/ULNA FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT LEFT ARM

S82426C

NONDISP TRANSVERSE FX SHAFT OF UNSP FIBULA 7THC

M96639

FX RAD/ULNA FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT UNSP ARM

S82431A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT FIBULA INIT

M9665

FX PELVIS FOLLOWING INSRT ORTHO IMPLNT/PROSTH/BONE PLT

S82431B

DISPL OBLIQUE FX SHAFT OF R FIBULA INIT FOR OPN FX TYPE I/2

M96661

FX FEMUR FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT RIGHT LEG

S82431C

DISPL OBLIQUE FX SHAFT OF R FIBULA 7THC

Page 319: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M96662

FX FEMUR FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT LEFT LEG

S82432A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT FIBULA INIT

M96669

FX FEMUR FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT UNSP LEG

S82432B

DISPL OBLIQUE FX SHAFT OF L FIBULA INIT FOR OPN FX TYPE I/2

M96671

FX TIB/FIB FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT RIGHT LEG

S82432C

DISPL OBLIQUE FX SHAFT OF L FIBULA 7THC

M96672

FX TIB/FIB FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT LEFT LEG

S82433A

DISPLACED OBLIQUE FRACTURE OF SHAFT OF UNSP FIBULA INIT

M96679

FX TIB/FIB FOL INSRT ORTHO IMPLNT/PROSTH/BONE PLT UNSP LEG

S82433B

DISPL OBLIQUE FX SHAFT OF UNSP FIBULA 7THB

M96840

Postprocedural hematoma of a musculoskeletal structure following a musculoskeletal system procedure

S82433C

DISPL OBLIQUE FX SHAFT OF UNSP FIBULA 7THC

M96841

Postprocedural hematoma of a musculoskeletal structure following other procedure

S82434A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF RIGHT FIBULA INIT

M96842

Postprocedural seroma of a musculoskeletal structure following a musculoskeletal system procedure

S82434B

NONDISP OBLIQUE FX SHAFT OF R FIBULA 7THB

M96843

Postprocedural seroma of a musculoskeletal structure following other procedure

S82434C

NONDISP OBLIQUE FX SHAFT OF R FIBULA 7THC

M9701XA

Periprosthetic fracture around internal prosthetic right hip joint initial encounter

S82435A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF LEFT FIBULA INIT

M9702XA

Periprosthetic fracture around internal prosthetic left hip joint initial encounter

S82435B

NONDISP OBLIQUE FX SHAFT OF L FIBULA 7THB

Page 320: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M9711XA

Periprosthetic fracture around internal prosthetic right knee joint initial encounter

S82435C

NONDISP OBLIQUE FX SHAFT OF L FIBULA 7THC

M9712XA

Periprosthetic fracture around internal prosthetic left knee joint initial encounter

S82436A

NONDISPLACED OBLIQUE FRACTURE OF SHAFT OF UNSP FIBULA INIT

M9721XA

Periprosthetic fracture around internal prosthetic right ankle joint initial encounter

S82436B

NONDISP OBLIQUE FX SHAFT OF UNSP FIBULA 7THB

M9722XA

Periprosthetic fracture around internal prosthetic left ankle joint initial encounter

S82436C

NONDISP OBLIQUE FX SHAFT OF UNSP FIBULA 7THC

M9731XA

Periprosthetic fracture around internal prosthetic right shoulder joint initial encounter

S82441A

DISPLACED SPIRAL FRACTURE OF SHAFT OF RIGHT FIBULA INIT

M9732XA

Periprosthetic fracture around internal prosthetic left shoulder joint initial encounter

S82441B

DISPL SPIRAL FX SHAFT OF R FIBULA INIT FOR OPN FX TYPE I/2

M9741XA

Periprosthetic fracture around internal prosthetic right elbow joint initial encounter

S82441C

DISPL SPIRAL FX SHAFT OF R FIBULA 7THC

M9742XA

Periprosthetic fracture around internal prosthetic left elbow joint initial encounter

S82442A

DISPLACED SPIRAL FRACTURE OF SHAFT OF LEFT FIBULA INIT

M978XXA

Periprosthetic fracture around other internal prosthetic joint initial encounter

S82442B

DISPL SPIRAL FX SHAFT OF L FIBULA INIT FOR OPN FX TYPE I/2

Page 321: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

M979XXA

Periprosthetic fracture around unspecified internal prosthetic joint initial encounter

S82442C

DISPL SPIRAL FX SHAFT OF L FIBULA 7THC

N130

Hydronephrosis with ureteropelvic junction obstruction

S82443A

DISPLACED SPIRAL FRACTURE OF SHAFT OF UNSP FIBULA INIT

N170 ACUTE KIDNEY FAILURE WITH TUBULAR NECROSIS

S82443B

DISPL SPIRAL FX SHAFT OF UNSP FIBULA 7THB

N171 ACUTE KIDNEY FAILURE WITH ACUTE CORTICAL NECROSIS

S82443C

DISPL SPIRAL FX SHAFT OF UNSP FIBULA 7THC

N172 ACUTE KIDNEY FAILURE WITH MEDULLARY NECROSIS

S82444A

NONDISPLACED SPIRAL FRACTURE OF SHAFT OF RIGHT FIBULA INIT

N178 OTHER ACUTE KIDNEY FAILURE

S82444B NONDISP SPIRAL FX SHAFT OF R FIBULA 7THB

N179 ACUTE KIDNEY FAILURE UNSPECIFIED

S82444C

NONDISP SPIRAL FX SHAFT OF R FIBULA 7THC

N181 CHRONIC KIDNEY DISEASE STAGE 1

S82445A

NONDISPLACED SPIRAL FRACTURE OF SHAFT OF LEFT FIBULA INIT

N182 CHRONIC KIDNEY DISEASE STAGE 2 (MILD)

S82445B

NONDISP SPIRAL FX SHAFT OF L FIBULA 7THB

N183 CHRONIC KIDNEY DISEASE STAGE 3 (MODERATE)

S82445C

NONDISP SPIRAL FX SHAFT OF L FIBULA 7THC

N184 CHRONIC KIDNEY DISEASE STAGE 4 (SEVERE)

S82446A

NONDISPLACED SPIRAL FRACTURE OF SHAFT OF UNSP FIBULA INIT

N185 CHRONIC KIDNEY DISEASE STAGE 5

S82446B

NONDISP SPIRAL FX SHAFT OF UNSP FIBULA 7THB

N186 END STAGE RENAL DISEASE

S82446C NONDISP SPIRAL FX SHAFT OF UNSP FIBULA 7THC

N189 CHRONIC KIDNEY DISEASE UNSPECIFIED

S82451A

DISPLACED COMMINUTED FRACTURE OF SHAFT OF RIGHT FIBULA INIT

N19 UNSPECIFIED KIDNEY FAILURE

S82451B DISPL COMMNT FX SHAFT OF R FIBULA INIT FOR OPN FX TYPE I/2

N200 CALCULUS OF KIDNEY

S82451C DISPL COMMNT FX SHAFT OF R FIBULA 7THC

Page 322: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N201 CALCULUS OF URETER

S82452A DISPLACED COMMINUTED FRACTURE OF SHAFT OF LEFT FIBULA INIT

N202 CALCULUS OF KIDNEY WITH CALCULUS OF URETER

S82452B

DISPL COMMNT FX SHAFT OF L FIBULA INIT FOR OPN FX TYPE I/2

N209 URINARY CALCULUS UNSPECIFIED

S82452C

DISPL COMMNT FX SHAFT OF L FIBULA 7THC

N210 CALCULUS IN BLADDER

S82453A DISPLACED COMMINUTED FRACTURE OF SHAFT OF UNSP FIBULA INIT

N211 CALCULUS IN URETHRA

S82453B DISPL COMMNT FX SHAFT OF UNSP FIBULA 7THB

N218 OTHER LOWER URINARY TRACT CALCULUS

S82453C

DISPL COMMNT FX SHAFT OF UNSP FIBULA 7THC

N219 CALCULUS OF LOWER URINARY TRACT UNSPECIFIED

S82454A

NONDISP COMMINUTED FRACTURE OF SHAFT OF RIGHT FIBULA INIT

N22

CALCULUS OF URINARY TRACT IN DISEASES CLASSIFIED ELSEWHERE

S82454B

NONDISP COMMNT FX SHAFT OF R FIBULA 7THB

N23 UNSPECIFIED RENAL COLIC

S82454C NONDISP COMMNT FX SHAFT OF R FIBULA 7THC

N250 RENAL OSTEODYSTROPHY

S82455A NONDISP COMMINUTED FRACTURE OF SHAFT OF LEFT FIBULA INIT

N251 NEPHROGENIC DIABETES INSIPIDUS

S82455B

NONDISP COMMNT FX SHAFT OF L FIBULA 7THB

N2581

SECONDARY HYPERPARATHYROIDISM OF RENAL ORIGIN

S82455C

NONDISP COMMNT FX SHAFT OF L FIBULA 7THC

N2589

OTH DISORDERS RESULTING FROM IMPAIRED RENAL TUBULAR FUNCTION

S82456A

NONDISP COMMINUTED FRACTURE OF SHAFT OF UNSP FIBULA INIT

N259

DISORDER RSLT FROM IMPAIRED RENAL TUBULAR FUNCTION UNSP

S82456B

NONDISP COMMNT FX SHAFT OF UNSP FIBULA 7THB

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N261 ATROPHY OF KIDNEY (TERMINAL)

S82456C

NONDISP COMMNT FX SHAFT OF UNSP FIBULA 7THC

N262 PAGE KIDNEY

S82461A DISPLACED SEGMENTAL FRACTURE OF SHAFT OF RIGHT FIBULA INIT

N269 RENAL SCLEROSIS UNSPECIFIED

S82461B DISPL SEG FX SHAFT OF R FIBULA INIT FOR OPN FX TYPE I/2

N270 SMALL KIDNEY UNILATERAL

S82461C DISPL SEG FX SHAFT OF R FIBULA INIT FOR OPN FX TYPE 3A/B/C

N271 SMALL KIDNEY BILATERAL

S82462A DISPLACED SEGMENTAL FRACTURE OF SHAFT OF LEFT FIBULA INIT

N279 SMALL KIDNEY UNSPECIFIED

S82462B DISPL SEG FX SHAFT OF L FIBULA INIT FOR OPN FX TYPE I/2

N280 ISCHEMIA AND INFARCTION OF KIDNEY

S82462C

DISPL SEG FX SHAFT OF L FIBULA INIT FOR OPN FX TYPE 3A/B/C

N281 CYST OF KIDNEY ACQUIRED

S82463A DISPLACED SEGMENTAL FRACTURE OF SHAFT OF UNSP FIBULA INIT

N2881 HYPERTROPHY OF KIDNEY

S82463B DISPL SEG FX SHAFT OF UNSP FIBULA INIT FOR OPN FX TYPE I/2

N2882 MEGALOURETER

S82463C DISPL SEG FX SHAFT OF UNSP FIBULA 7THC

N2883 NEPHROPTOSIS

S82464A NONDISP SEGMENTAL FRACTURE OF SHAFT OF RIGHT FIBULA INIT

N2884 PYELITIS CYSTICA

S82464B NONDISP SEG FX SHAFT OF R FIBULA INIT FOR OPN FX TYPE I/2

N2885 PYELOURETERITIS CYSTICA

S82464C NONDISP SEG FX SHAFT OF R FIBULA 7THC

N2886 URETERITIS CYSTICA

S82465A NONDISP SEGMENTAL FRACTURE OF SHAFT OF LEFT FIBULA INIT

N2889 OTHER SPECIFIED DISORDERS OF KIDNEY AND URETER

S82465B

NONDISP SEG FX SHAFT OF L FIBULA INIT FOR OPN FX TYPE I/2

N289 DISORDER OF KIDNEY AND URETER UNSPECIFIED

S82465C

NONDISP SEG FX SHAFT OF L FIBULA 7THC

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N29

OTH DISORDERS OF KIDNEY AND URETER IN DISEASES CLASSD ELSWHR

S82466A

NONDISP SEGMENTAL FRACTURE OF SHAFT OF UNSP FIBULA INIT

N3000 ACUTE CYSTITIS WITHOUT HEMATURIA

S82466B

NONDISP SEG FX SHAFT OF UNSP FIBULA 7THB

N3001 ACUTE CYSTITIS WITH HEMATURIA

S82466C

NONDISP SEG FX SHAFT OF UNSP FIBULA 7THC

N3010

INTERSTITIAL CYSTITIS (CHRONIC) WITHOUT HEMATURIA

S82491A

OTH FRACTURE OF SHAFT OF RIGHT FIBULA INIT FOR CLOS FX

N3011 INTERSTITIAL CYSTITIS (CHRONIC) WITH HEMATURIA

S82491B

OTH FRACTURE OF SHAFT OF R FIBULA INIT FOR OPN FX TYPE I/2

N3020 OTHER CHRONIC CYSTITIS WITHOUT HEMATURIA

S82491C

OTH FX SHAFT OF R FIBULA INIT FOR OPN FX TYPE 3A/B/C

N3021 OTHER CHRONIC CYSTITIS WITH HEMATURIA

S82492A

OTH FRACTURE OF SHAFT OF LEFT FIBULA INIT FOR CLOS FX

N3030 TRIGONITIS WITHOUT HEMATURIA

S82492B

OTH FX SHAFT OF LEFT FIBULA INIT FOR OPN FX TYPE I/2

N3031 TRIGONITIS WITH HEMATURIA

S82492C OTH FX SHAFT OF LEFT FIBULA INIT FOR OPN FX TYPE 3A/B/C

N3040 IRRADIATION CYSTITIS WITHOUT HEMATURIA

S82499A

OTH FRACTURE OF SHAFT OF UNSP FIBULA INIT FOR CLOS FX

N3041 IRRADIATION CYSTITIS WITH HEMATURIA

S82499B

OTH FX SHAFT OF UNSP FIBULA INIT FOR OPN FX TYPE I/2

N3080 OTHER CYSTITIS WITHOUT HEMATURIA

S82499C

OTH FX SHAFT OF UNSP FIBULA INIT FOR OPN FX TYPE 3A/B/C

N3081 OTHER CYSTITIS WITH HEMATURIA

S8251XA

DISP FX OF MEDIAL MALLEOLUS OF RIGHT TIBIA INIT FOR CLOS FX

N3090 CYSTITIS UNSPECIFIED WITHOUT HEMATURIA

S8251XB

DISP FX OF MED MALLEOLUS OF R TIBIA 7THB

N3091 CYSTITIS UNSPECIFIED WITH HEMATURIA

S8251XC

DISP FX OF MED MALLEOLUS OF R TIBIA 7THC

N310

UNINHIBITED NEUROPATHIC BLADDER NOT ELSEWHERE CLASSIFIED

S8252XA

DISP FX OF MEDIAL MALLEOLUS OF LEFT TIBIA INIT FOR CLOS FX

Page 325: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N311

REFLEX NEUROPATHIC BLADDER NOT ELSEWHERE CLASSIFIED

S8252XB

DISP FX OF MED MALLEOLUS OF L TIBIA 7THB

N312

FLACCID NEUROPATHIC BLADDER NOT ELSEWHERE CLASSIFIED

S8252XC

DISP FX OF MED MALLEOLUS OF L TIBIA 7THC

N318 OTHER NEUROMUSCULAR DYSFUNCTION OF BLADDER

S8253XA

DISP FX OF MEDIAL MALLEOLUS OF UNSP TIBIA INIT FOR CLOS FX

N319

NEUROMUSCULAR DYSFUNCTION OF BLADDER UNSPECIFIED

S8253XB

DISP FX OF MED MALLEOLUS OF UNSP TIBIA 7THB

N320 BLADDER-NECK OBSTRUCTION

S8253XC DISP FX OF MED MALLEOLUS OF UNSP TIBIA 7THC

N321 VESICOINTESTINAL FISTULA

S8254XA NONDISP FX OF MEDIAL MALLEOLUS OF RIGHT TIBIA INIT

N322 VESICAL FISTULA NOT ELSEWHERE CLASSIFIED

S8254XB

NONDISP FX OF MED MALLEOLUS OF R TIBIA 7THB

N323 DIVERTICULUM OF BLADDER

S8254XC NONDISP FX OF MED MALLEOLUS OF R TIBIA 7THC

N3281 OVERACTIVE BLADDER

S8255XA NONDISP FX OF MEDIAL MALLEOLUS OF LEFT TIBIA INIT

N3289 OTHER SPECIFIED DISORDERS OF BLADDER

S8255XB

NONDISP FX OF MED MALLEOLUS OF L TIBIA 7THB

N329 BLADDER DISORDER UNSPECIFIED

S8255XC

NONDISP FX OF MED MALLEOLUS OF L TIBIA 7THC

N33

BLADDER DISORDERS IN DISEASES CLASSIFIED ELSEWHERE

S8256XA

NONDISP FX OF MEDIAL MALLEOLUS OF UNSP TIBIA INIT

N340 URETHRAL ABSCESS

S8256XB NONDISP FX OF MED MALLEOLUS OF UNSP TIBIA 7THB

N341 NONSPECIFIC URETHRITIS

S8256XC NONDISP FX OF MED MALLEOLUS OF UNSP TIBIA 7THC

N342 OTHER URETHRITIS

S8261XA DISP FX OF LATERAL MALLEOLUS OF RIGHT FIBULA INIT

N343 URETHRAL SYNDROME UNSPECIFIED

S8261XB

DISP FX OF LATERAL MALLEOLUS OF R FIBULA 7THB

Page 326: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N35010 POST-TRAUMATIC URETHRAL STRICTURE MALE MEATAL

S8261XC

DISP FX OF LATERAL MALLEOLUS OF R FIBULA 7THC

N35011 POST-TRAUMATIC BULBOUS URETHRAL STRICTURE

S8262XA

DISP FX OF LATERAL MALLEOLUS OF LEFT FIBULA INIT

N35012

POST-TRAUMATIC MEMBRANOUS URETHRAL STRICTURE

S8262XB

DISP FX OF LATERAL MALLEOLUS OF L FIBULA 7THB

N35013 POST-TRAUMATIC ANTERIOR URETHRAL STRICTURE

S8262XC

DISP FX OF LATERAL MALLEOLUS OF L FIBULA 7THC

N35014 POST-TRAUMATIC URETHRAL STRICTURE MALE UNSPECIFIED

S8263XA

DISP FX OF LATERAL MALLEOLUS OF UNSP FIBULA INIT

N35021 URETHRAL STRICTURE DUE TO CHILDBIRTH

S8263XB

DISP FX OF LATERAL MALLEOLUS OF UNSP FIBULA 7THB

N35028 OTHER POST-TRAUMATIC URETHRAL STRICTURE FEMALE

S8263XC

DISP FX OF LATERAL MALLEOLUS OF UNSP FIBULA 7THC

N35111 POSTINFECTIVE URETHRAL STRICTURE NEC MALE MEATAL

S8264XA

NONDISP FX OF LATERAL MALLEOLUS OF RIGHT FIBULA INIT

N35112 POSTINFECTIVE BULBOUS URETHRAL STRICTURE NEC

S8264XB

NONDISP FX OF LATERAL MALLEOLUS OF R FIBULA 7THB

N35113 POSTINFECTIVE MEMBRANOUS URETHRAL STRICTURE NEC

S8264XC

NONDISP FX OF LATERAL MALLEOLUS OF R FIBULA 7THC

N35114 POSTINFECTIVE ANTERIOR URETHRAL STRICTURE NEC

S8265XA

NONDISP FX OF LATERAL MALLEOLUS OF LEFT FIBULA INIT

N35119 POSTINFECTIVE URETHRAL STRICTURE NEC MALE UNSP

S8265XB

NONDISP FX OF LATERAL MALLEOLUS OF L FIBULA 7THB

N3512 POSTINFECTIVE URETHRAL STRICTURE NEC FEMALE

S8265XC

NONDISP FX OF LATERAL MALLEOLUS OF L FIBULA 7THC

N358 OTHER URETHRAL STRICTURE

S8266XA NONDISP FX OF LATERAL MALLEOLUS OF UNSP FIBULA INIT

N359 URETHRAL STRICTURE UNSPECIFIED

S8266XB

NONDISP FX OF LATERAL MALLEOLUS OF UNSP FIBULA 7THB

N360 URETHRAL FISTULA

S8266XC NONDISP FX OF LATERAL MALLEOLUS OF UNSP FIBULA 7THC

N361 URETHRAL DIVERTICULUM

S82811A TORUS FRACTURE OF UPPER END OF RIGHT FIBULA INIT

Page 327: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N362 URETHRAL CARUNCLE

S82812A TORUS FRACTURE OF UPPER END OF LEFT FIBULA INIT FOR CLOS FX

N3641 HYPERMOBILITY OF URETHRA

S82819A TORUS FRACTURE OF UPPER END OF UNSP FIBULA INIT FOR CLOS FX

N3642 INTRINSIC SPHINCTER DEFICIENCY (ISD)

S82821A

TORUS FRACTURE OF LOWER END OF RIGHT FIBULA INIT

N401

ENLARGED PROSTATE WITH LOWER URINARY TRACT SYMPTOMS

S82822A

TORUS FRACTURE OF LOWER END OF LEFT FIBULA INIT FOR CLOS FX

N413 PROSTATOCYSTITIS

S82829A TORUS FRACTURE OF LOWER END OF UNSP FIBULA INIT FOR CLOS FX

N414 GRANULOMATOUS PROSTATITIS

S82831A

OTH FRACTURE OF UPPER AND LOWER END OF RIGHT FIBULA INIT

N4281 PROSTATODYNIA SYNDROME

S82831B OTH FX UPPER AND LOW END R FIBULA INIT FOR OPN FX TYPE I/2

N4400 TORSION OF TESTIS UNSPECIFIED

S82831C

OTH FX UPR AND LOW END R FIBULA INIT FOR OPN FX TYPE 3A/B/C

N4401 EXTRAVAGINAL TORSION OF SPERMATIC CORD

S82832A

OTH FRACTURE OF UPPER AND LOWER END OF LEFT FIBULA INIT

N4402 INTRAVAGINAL TORSION OF SPERMATIC CORD

S82832B

OTH FX UPPER AND LOW END L FIBULA INIT FOR OPN FX TYPE I/2

N4403 TORSION OF APPENDIX TESTIS

S82832C OTH FX UPR AND LOW END L FIBULA INIT FOR OPN FX TYPE 3A/B/C

N4404 TORSION OF APPENDIX EPIDIDYMIS

S82839A

OTH FRACTURE OF UPPER AND LOWER END OF UNSP FIBULA INIT

N451 EPIDIDYMITIS

S82839B OTH FX UPR AND LOW END UNSP FIBULA INIT FOR OPN FX TYPE I/2

N452 ORCHITIS

S82839C OTH FX UPR & LOW END UNSP FIBULA 7THC

N493 FOURNIER GANGRENE

S82841A DISPLACED BIMALLEOLAR FRACTURE OF RIGHT LOWER LEG INIT

N50811 Right testicular pain

S82841B DISPLACED BIMALLEOL FX R LOW LEG INIT FOR OPN FX TYPE I/2

Page 328: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N50812 Left testicular pain

S82841C DISPL BIMALLEOL FX R LOW LEG INIT FOR OPN FX TYPE 3A/B/C

N50819 Testicular pain unspecified

S82842A DISPLACED BIMALLEOLAR FRACTURE OF LEFT LOWER LEG INIT

N5082 Scrotal pain

S82842B DISPLACED BIMALLEOL FX L LOW LEG INIT FOR OPN FX TYPE I/2

N6001 SOLITARY CYST OF RIGHT BREAST

S82842C

DISPL BIMALLEOL FX L LOW LEG INIT FOR OPN FX TYPE 3A/B/C

N6002 SOLITARY CYST OF LEFT BREAST

S82843A DISPLACED BIMALLEOLAR FRACTURE OF UNSP LOWER LEG INIT

N6009 SOLITARY CYST OF UNSPECIFIED BREAST

S82843B

DISPL BIMALLEOL FX UNSP LOWER LEG INIT FOR OPN FX TYPE I/2

N6011 DIFFUSE CYSTIC MASTOPATHY OF RIGHT BREAST

S82843C

DISPL BIMALLEOL FX UNSP LOW LEG INIT FOR OPN FX TYPE 3A/B/C

N6012 DIFFUSE CYSTIC MASTOPATHY OF LEFT BREAST

S82844A

NONDISPLACED BIMALLEOLAR FRACTURE OF RIGHT LOWER LEG INIT

N6019 DIFFUSE CYSTIC MASTOPATHY OF UNSPECIFIED BREAST

S82844B

NONDISP BIMALLEOL FX R LOW LEG INIT FOR OPN FX TYPE I/2

N6021 FIBROADENOSIS OF RIGHT BREAST

S82844C

NONDISP BIMALLEOL FX R LOW LEG INIT FOR OPN FX TYPE 3A/B/C

N6022 FIBROADENOSIS OF LEFT BREAST

S82845A

NONDISPLACED BIMALLEOLAR FRACTURE OF LEFT LOWER LEG INIT

N6029 FIBROADENOSIS OF UNSPECIFIED BREAST

S82845B

NONDISP BIMALLEOL FX L LOW LEG INIT FOR OPN FX TYPE I/2

N6031 FIBROSCLEROSIS OF RIGHT BREAST

S82845C

NONDISP BIMALLEOL FX L LOW LEG INIT FOR OPN FX TYPE 3A/B/C

N6032 FIBROSCLEROSIS OF LEFT BREAST

S82846A

NONDISPLACED BIMALLEOLAR FRACTURE OF UNSP LOWER LEG INIT

N6039 FIBROSCLEROSIS OF UNSPECIFIED BREAST

S82846B

NONDISP BIMALLEOL FX UNSP LOW LEG INIT FOR OPN FX TYPE I/2

Page 329: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N6041 MAMMARY DUCT ECTASIA OF RIGHT BREAST

S82846C

NONDISP BIMALLEOL FX UNSP LOW LEG 7THC

N6042 MAMMARY DUCT ECTASIA OF LEFT BREAST

S82851A

DISPLACED TRIMALLEOLAR FRACTURE OF RIGHT LOWER LEG INIT

N6049 MAMMARY DUCT ECTASIA OF UNSPECIFIED BREAST

S82851B

DISPLACED TRIMALLEOL FX R LOW LEG INIT FOR OPN FX TYPE I/2

N6081 OTHER BENIGN MAMMARY DYSPLASIAS OF RIGHT BREAST

S82851C

DISPL TRIMALLEOL FX R LOW LEG INIT FOR OPN FX TYPE 3A/B/C

N6082 OTHER BENIGN MAMMARY DYSPLASIAS OF LEFT BREAST

S82852A

DISPLACED TRIMALLEOLAR FRACTURE OF LEFT LOWER LEG INIT

N6089

OTHER BENIGN MAMMARY DYSPLASIAS OF UNSPECIFIED BREAST

S82852B

DISPLACED TRIMALLEOL FX L LOW LEG INIT FOR OPN FX TYPE I/2

N6091

UNSPECIFIED BENIGN MAMMARY DYSPLASIA OF RIGHT BREAST

S82852C

DISPL TRIMALLEOL FX L LOW LEG INIT FOR OPN FX TYPE 3A/B/C

N6092

UNSPECIFIED BENIGN MAMMARY DYSPLASIA OF LEFT BREAST

S82853A

DISPLACED TRIMALLEOLAR FRACTURE OF UNSP LOWER LEG INIT

N6099

UNSPECIFIED BENIGN MAMMARY DYSPLASIA OF UNSPECIFIED BREAST

S82853B

DISPL TRIMALLEOL FX UNSP LOWER LEG INIT FOR OPN FX TYPE I/2

N61 INFLAMMATORY DISORDERS OF BREAST

S82853C

DISPL TRIMALLEOL FX UNSP LOW LEG 7THC

N610 Mastitis without abscess

S82854A NONDISPLACED TRIMALLEOLAR FRACTURE OF RIGHT LOWER LEG INIT

N611 Abscess of the breast and nipple

S82854B

NONDISP TRIMALLEOL FX R LOW LEG INIT FOR OPN FX TYPE I/2

N62 HYPERTROPHY OF BREAST

S82854C NONDISP TRIMALLEOL FX R LOW LEG INIT FOR OPN FX TYPE 3A/B/C

N63 UNSPECIFIED LUMP IN BREAST

S82855A NONDISPLACED TRIMALLEOLAR FRACTURE OF LEFT LOWER LEG INIT

Page 330: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N641 FAT NECROSIS OF BREAST

S82855B NONDISP TRIMALLEOL FX L LOW LEG INIT FOR OPN FX TYPE I/2

N642 ATROPHY OF BREAST

S82855C NONDISP TRIMALLEOL FX L LOW LEG INIT FOR OPN FX TYPE 3A/B/C

N8341 Prolapse and hernia of right ovary and fallopian tube

S82856A

NONDISPLACED TRIMALLEOLAR FRACTURE OF UNSP LOWER LEG INIT

N8342 Prolapse and hernia of left ovary and fallopian tube

S82856B

NONDISP TRIMALLEOL FX UNSP LOW LEG INIT FOR OPN FX TYPE I/2

N83511 Torsion of right ovary and ovarian pedicle

S82856C

NONDISP TRIMALLEOL FX UNSP LOW LEG 7THC

N83512 Torsion of left ovary and ovarian pedicle

S82861A

DISPLACED MAISONNEUVE'S FRACTURE OF RIGHT LEG INIT

N83521 Torsion of right fallopian tube

S82861B DISPL MAISONNEUVE'S FX RIGHT LEG INIT FOR OPN FX TYPE I/2

N83522 Torsion of left fallopian tube

S82861C DISPL MAISONNEUVE'S FX R LEG INIT FOR OPN FX TYPE 3A/B/C

N990 POSTPROCEDURAL (ACUTE) (CHRONIC) KIDNEY FAILURE

S82862A

DISPLACED MAISONNEUVE'S FRACTURE OF LEFT LEG INIT

N99110 POSTPROCEDURAL URETHRAL STRICTURE MALE MEATAL

S82862B

DISPL MAISONNEUVE'S FX LEFT LEG INIT FOR OPN FX TYPE I/2

N99111 POSTPROCEDURAL BULBOUS URETHRAL STRICTURE

S82862C

DISPL MAISONNEUVE'S FX LEFT LEG INIT FOR OPN FX TYPE 3A/B/C

N99112

POSTPROCEDURAL MEMBRANOUS URETHRAL STRICTURE

S82863A

DISPLACED MAISONNEUVE'S FRACTURE OF UNSP LEG INIT

N99113 POSTPROCEDURAL ANTERIOR URETHRAL STRICTURE

S82863B

DISPL MAISONNEUVE'S FX UNSP LEG INIT FOR OPN FX TYPE I/2

N99114 POSTPROCEDURAL URETHRAL STRICTURE MALE UNSPECIFIED

S82863C

DISPL MAISONNEUVE'S FX UNSP LEG INIT FOR OPN FX TYPE 3A/B/C

N99115 Postprocedural fossa navicularis urethral stricture

S82864A

NONDISPLACED MAISONNEUVE'S FRACTURE OF RIGHT LEG INIT

N9912 POSTPROCEDURAL URETHRAL STRICTURE FEMALE

S82864B

NONDISP MAISONNEUVE'S FX RIGHT LEG INIT FOR OPN FX TYPE I/2

Page 331: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

N99510 CYSTOSTOMY HEMORRHAGE

S82864C NONDISP MAISONNEUVE'S FX R LEG INIT FOR OPN FX TYPE 3A/B/C

N99520

HEMORRHAGE OF OTHER EXTERNAL STOMA OF URINARY TRACT

S82865A

NONDISPLACED MAISONNEUVE'S FRACTURE OF LEFT LEG INIT

N99524 Stenosis of incontinent stoma of urinary tract

S82865B

NONDISP MAISONNEUVE'S FX LEFT LEG INIT FOR OPN FX TYPE I/2

N99530 HEMORRHAGE OF OTHER STOMA OF URINARY TRACT

S82865C

NONDISP MAISONNEUVE'S FX L LEG INIT FOR OPN FX TYPE 3A/B/C

N99533 Herniation of continent stoma of urinary tract

S82866A

NONDISPLACED MAISONNEUVE'S FRACTURE OF UNSP LEG INIT

N99534 Stenosis of continent stoma of urinary tract

S82866B

NONDISP MAISONNEUVE'S FX UNSP LEG INIT FOR OPN FX TYPE I/2

N9961

INTRAOP HEMOR/HEMTOM OF A GU SYS ORG COMP A GU SYS PROCEDURE

S82866C

NONDISP MAISONNEUVE'S FX UNSP LEG 7THC

N99840

Postprocedural hematoma of a genitourinary system organ or structure following a genitourinary system procedure

S82871A

DISPLACED PILON FRACTURE OF RIGHT TIBIA INIT FOR CLOS FX

N99841

Postprocedural hematoma of a genitourinary system organ or structure following other procedure

S82871B

DISPLACED PILON FX RIGHT TIBIA INIT FOR OPN FX TYPE I/2

N99842

Postprocedural seroma of a genitourinary system organ or structure following a genitourinary system procedure

S82871C

DISPLACED PILON FX RIGHT TIBIA INIT FOR OPN FX TYPE 3A/B/C

N99843

Postprocedural seroma of a genitourinary system organ or structure following other procedure

S82872A

DISPLACED PILON FRACTURE OF LEFT TIBIA INIT FOR CLOS FX

O000 ABDOMINAL PREGNANCY

S82872B DISPLACED PILON FX LEFT TIBIA INIT FOR OPN FX TYPE I/2

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O0000 Abdominal pregnancy without intrauterine pregnancy

S82872C

DISPLACED PILON FX LEFT TIBIA INIT FOR OPN FX TYPE 3A/B/C

O0001 Abdominal pregnancy with intrauterine pregnancy

S82873A

DISPLACED PILON FRACTURE OF UNSP TIBIA INIT FOR CLOS FX

O001 TUBAL PREGNANCY

S82873B DISPLACED PILON FX UNSP TIBIA INIT FOR OPN FX TYPE I/2

O0010 Tubal pregnancy without intrauterine pregnancy

S82873C

DISPLACED PILON FX UNSP TIBIA INIT FOR OPN FX TYPE 3A/B/C

O0011 Tubal pregnancy with intrauterine pregnancy

S82874A

NONDISPLACED PILON FRACTURE OF RIGHT TIBIA INIT FOR CLOS FX

O002 OVARIAN PREGNANCY

S82874B NONDISP PILON FX RIGHT TIBIA INIT FOR OPN FX TYPE I/2

O0020 Ovarian pregnancy without intrauterine pregnancy

S82874C

NONDISP PILON FX RIGHT TIBIA INIT FOR OPN FX TYPE 3A/B/C

O0021 Ovarian pregnancy with intrauterine pregnancy

S82875A

NONDISPLACED PILON FRACTURE OF LEFT TIBIA INIT FOR CLOS FX

O008 OTHER ECTOPIC PREGNANCY

S82875B NONDISP PILON FX LEFT TIBIA INIT FOR OPN FX TYPE I/2

O0080 Other ectopic pregnancy without intrauterine pregnancy

S82875C

NONDISP PILON FX LEFT TIBIA INIT FOR OPN FX TYPE 3A/B/C

O0081 Other ectopic pregnancy with intrauterine pregnancy

S82876A

NONDISPLACED PILON FRACTURE OF UNSP TIBIA INIT FOR CLOS FX

O009 ECTOPIC PREGNANCY UNSPECIFIED

S82876B

NONDISP PILON FX UNSP TIBIA INIT FOR OPN FX TYPE I/2

O0090 Unspecified ectopic pregnancy without intrauterine pregnancy

S82876C

NONDISP PILON FX UNSP TIBIA INIT FOR OPN FX TYPE 3A/B/C

O0091 Unspecified ectopic pregnancy with intrauterine pregnancy

S82891A

OTH FRACTURE OF RIGHT LOWER LEG INIT FOR CLOS FX

O010 CLASSICAL HYDATIDIFORM MOLE

S82891B

OTH FRACTURE OF RIGHT LOWER LEG INIT FOR OPN FX TYPE I/2

O011 INCOMPLETE AND PARTIAL HYDATIDIFORM MOLE

S82891C

OTH FRACTURE OF RIGHT LOWER LEG INIT FOR OPN FX TYPE 3A/B/C

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O019 HYDATIDIFORM MOLE UNSPECIFIED

S82892A

OTH FRACTURE OF LEFT LOWER LEG INIT FOR CLOS FX

O020 BLIGHTED OVUM AND NONHYDATIDIFORM MOLE

S82892B

OTH FRACTURE OF LEFT LOWER LEG INIT FOR OPN FX TYPE I/2

O021 MISSED ABORTION

S82892C OTH FRACTURE OF LEFT LOWER LEG INIT FOR OPN FX TYPE 3A/B/C

O029 ABNORMAL PRODUCT OF CONCEPTION UNSPECIFIED

S82899A

OTH FRACTURE OF UNSP LOWER LEG INIT FOR CLOS FX

O031

DELAYED OR EXCESSIVE HEMOR FOLLOWING INCMPL SPON ABORTION

S82899B

OTH FRACTURE OF UNSP LOWER LEG INIT FOR OPN FX TYPE I/2

O032

EMBOLISM FOLLOWING INCOMPLETE SPONTANEOUS ABORTION

S82899C

OTH FRACTURE OF UNSP LOWER LEG INIT FOR OPN FX TYPE 3A/B/C

O0331

SHOCK FOLLOWING INCOMPLETE SPONTANEOUS ABORTION

S8290XA

UNSP FRACTURE OF UNSP LOWER LEG INIT FOR CLOS FX

O0336

CARDIAC ARREST FOLLOWING INCOMPLETE SPONTANEOUS ABORTION

S8290XB

UNSP FRACTURE OF UNSP LOWER LEG INIT FOR OPN FX TYPE I/2

O0337

SEPSIS FOLLOWING INCOMPLETE SPONTANEOUS ABORTION

S8290XC

UNSP FRACTURE OF UNSP LOWER LEG INIT FOR OPN FX TYPE 3A/B/C

O036

DELAYED OR EXCESS HEMOR FOL COMPLETE OR UNSP SPON ABORTION

S8291XA

UNSP FRACTURE OF RIGHT LOWER LEG INIT FOR CLOS FX

O037

EMBOLISM FOLLOWING COMPLETE OR UNSP SPONTANEOUS ABORTION

S8291XB

UNSP FRACTURE OF RIGHT LOWER LEG INIT FOR OPN FX TYPE I/2

O0381

SHOCK FOLLOWING COMPLETE OR UNSPECIFIED SPONTANEOUS ABORTION

S8291XC

UNSP FRACTURE OF R LOW LEG INIT FOR OPN FX TYPE 3A/B/C

O0382

RENAL FAILURE FOLLOWING COMPLETE OR UNSP SPON ABORTION

S8292XA

UNSP FRACTURE OF LEFT LOWER LEG INIT FOR CLOS FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O0383

METABOLIC DISORDER FOLLOWING COMPLETE OR UNSP SPON ABORTION

S8292XB

UNSP FRACTURE OF LEFT LOWER LEG INIT FOR OPN FX TYPE I/2

O0386

CARDIAC ARREST FOLLOWING COMPLETE OR UNSP SPON ABORTION

S8292XC

UNSP FRACTURE OF LEFT LOWER LEG INIT FOR OPN FX TYPE 3A/B/C

O0387

SEPSIS FOLLOWING COMPLETE OR UNSP SPONTANEOUS ABORTION

S83001A

UNSPECIFIED SUBLUXATION OF RIGHT PATELLA INITIAL ENCOUNTER

O046

DELAYED OR EXCESS HEMOR FOL (INDUCED) TERM OF PREGNANCY

S83002A

UNSPECIFIED SUBLUXATION OF LEFT PATELLA INITIAL ENCOUNTER

O047

EMBOLISM FOLLOWING (INDUCED) TERMINATION OF PREGNANCY

S83003A

UNSPECIFIED SUBLUXATION OF UNSPECIFIED PATELLA INIT ENCNTR

O0481 SHOCK FOLLOWING (INDUCED) TERMINATION OF PREGNANCY

S83004A

UNSPECIFIED DISLOCATION OF RIGHT PATELLA INITIAL ENCOUNTER

O0482

RENAL FAILURE FOLLOWING (INDUCED) TERMINATION OF PREGNANCY

S83005A

UNSPECIFIED DISLOCATION OF LEFT PATELLA INITIAL ENCOUNTER

O0483

METABOLIC DISORDER FOLLOWING (INDUCED) TERM OF PREGNANCY

S83006A

UNSPECIFIED DISLOCATION OF UNSPECIFIED PATELLA INIT ENCNTR

O0485

OTH VENOUS COMP FOLLOWING (INDUCED) TERMINATION OF PREGNANCY

S83011A

LATERAL SUBLUXATION OF RIGHT PATELLA INITIAL ENCOUNTER

O0486

CARDIAC ARREST FOLLOWING (INDUCED) TERMINATION OF PREGNANCY

S83012A

LATERAL SUBLUXATION OF LEFT PATELLA INITIAL ENCOUNTER

O0487 SEPSIS FOLLOWING (INDUCED) TERMINATION OF PREGNANCY

S83013A

LATERAL SUBLUXATION OF UNSPECIFIED PATELLA INIT ENCNTR

O071

DELAYED OR EXCESS HEMOR FOL FAILED ATTEMPT TERM OF PREGNANCY

S83014A

LATERAL DISLOCATION OF RIGHT PATELLA INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O072

EMBOLISM FOLLOWING FAILED ATTEMPTED TERMINATION OF PREGNANCY

S83015A

LATERAL DISLOCATION OF LEFT PATELLA INITIAL ENCOUNTER

O0731

SHOCK FOLLOWING FAILED ATTEMPTED TERMINATION OF PREGNANCY

S83016A

LATERAL DISLOCATION OF UNSPECIFIED PATELLA INIT ENCNTR

O0732

RENAL FAILURE FOLLOWING FAILED ATTEMPTED TERM OF PREGNANCY

S83091A

OTHER SUBLUXATION OF RIGHT PATELLA INITIAL ENCOUNTER

O0733

METABOLIC DISORDER FOL FAILED ATTEMPT TERM OF PREGNANCY

S83092A

OTHER SUBLUXATION OF LEFT PATELLA INITIAL ENCOUNTER

O0735

OTH VENOUS COMP FOLLOWING FAILED ATTEMPTED TERM OF PREGNANCY

S83093A

OTHER SUBLUXATION OF UNSPECIFIED PATELLA INITIAL ENCOUNTER

O0736

CARDIAC ARREST FOLLOWING FAILED ATTEMPTED TERM OF PREGNANCY

S83094A

OTHER DISLOCATION OF RIGHT PATELLA INITIAL ENCOUNTER

O0737

SEPSIS FOLLOWING FAILED ATTEMPTED TERMINATION OF PREGNANCY

S83095A

OTHER DISLOCATION OF LEFT PATELLA INITIAL ENCOUNTER

O081

DELAYED OR EXCESS HEMOR FOL ECTOPIC AND MOLAR PREGNANCY

S83096A

OTHER DISLOCATION OF UNSPECIFIED PATELLA INITIAL ENCOUNTER

O082

EMBOLISM FOLLOWING ECTOPIC AND MOLAR PREGNANCY

S83101A

UNSPECIFIED SUBLUXATION OF RIGHT KNEE INITIAL ENCOUNTER

O083 SHOCK FOLLOWING ECTOPIC AND MOLAR PREGNANCY

S83102A

UNSPECIFIED SUBLUXATION OF LEFT KNEE INITIAL ENCOUNTER

O084

RENAL FAILURE FOLLOWING ECTOPIC AND MOLAR PREGNANCY

S83103A

UNSPECIFIED SUBLUXATION OF UNSPECIFIED KNEE INIT ENCNTR

O085

METABOLIC DISORDERS FOLLOWING AN ECTOPIC AND MOLAR PREGNANCY

S83104A

UNSPECIFIED DISLOCATION OF RIGHT KNEE INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O086

DAMAGE TO PELVIC ORGANS AND TISS FOL AN ECT AND MOLAR PREG

S83105A

UNSPECIFIED DISLOCATION OF LEFT KNEE INITIAL ENCOUNTER

O087

OTH VENOUS COMP FOLLOWING AN ECTOPIC AND MOLAR PREGNANCY

S83106A

UNSPECIFIED DISLOCATION OF UNSPECIFIED KNEE INIT ENCNTR

O0881

CARDIAC ARREST FOLLOWING AN ECTOPIC AND MOLAR PREGNANCY

S83111A

ANTERIOR SUBLUX OF PROXIMAL END OF TIBIA RIGHT KNEE INIT

O0882 SEPSIS FOLLOWING ECTOPIC AND MOLAR PREGNANCY

S83112A

ANTERIOR SUBLUX OF PROXIMAL END OF TIBIA LEFT KNEE INIT

O10011

PRE-EXISTING ESSENTIAL HTN COMP PREGNANCY FIRST TRIMESTER

S83113A

ANTERIOR SUBLUX OF PROXIMAL END OF TIBIA UNSP KNEE INIT

O10012

PRE-EXISTING ESSENTIAL HTN COMP PREGNANCY SECOND TRIMESTER

S83114A

ANTERIOR DISLOC OF PROXIMAL END OF TIBIA RIGHT KNEE INIT

O10013

PRE-EXISTING ESSENTIAL HTN COMP PREGNANCY THIRD TRIMESTER

S83115A

ANTERIOR DISLOC OF PROXIMAL END OF TIBIA LEFT KNEE INIT

O10019

PRE-EXISTING ESSENTIAL HTN COMP PREGNANCY UNSP TRIMESTER

S83116A

ANTERIOR DISLOC OF PROXIMAL END OF TIBIA UNSP KNEE INIT

O1002

PRE-EXISTING ESSENTIAL HYPERTENSION COMPLICATING CHILDBIRTH

S83121A

POSTERIOR SUBLUX OF PROXIMAL END OF TIBIA RIGHT KNEE INIT

O1003

PRE-EXISTING ESSENTIAL HYPERTENSION COMP THE PUERPERIUM

S83122A

POSTERIOR SUBLUX OF PROXIMAL END OF TIBIA LEFT KNEE INIT

O10111

PRE-EXIST HYP HEART DISEASE COMP PREGNANCY FIRST TRIMESTER

S83123A

POSTERIOR SUBLUX OF PROXIMAL END OF TIBIA UNSP KNEE INIT

O10112

PRE-EXIST HYP HEART DISEASE COMP PREGNANCY SECOND TRIMESTER

S83124A

POSTERIOR DISLOC OF PROXIMAL END OF TIBIA RIGHT KNEE INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O10113

PRE-EXIST HYP HEART DISEASE COMP PREGNANCY THIRD TRIMESTER

S83125A

POSTERIOR DISLOC OF PROXIMAL END OF TIBIA LEFT KNEE INIT

O10119

PRE-EXIST HYP HEART DISEASE COMP PREGNANCY UNSP TRIMESTER

S83126A

POSTERIOR DISLOC OF PROXIMAL END OF TIBIA UNSP KNEE INIT

O1012

PRE-EXISTING HYPERTENSIVE HEART DISEASE COMP CHILDBIRTH

S83131A

MEDIAL SUBLUX OF PROXIMAL END OF TIBIA RIGHT KNEE INIT

O1013

PRE-EXISTING HYPERTENSIVE HEART DISEASE COMP THE PUERPERIUM

S83132A

MEDIAL SUBLUXATION OF PROXIMAL END OF TIBIA LEFT KNEE INIT

O10211

PRE-EXIST HYP CHRONIC KIDNEY DISEASE COMP PREG FIRST TRI

S83133A

MEDIAL SUBLUXATION OF PROXIMAL END OF TIBIA UNSP KNEE INIT

O10212

PRE-EXIST HYP CHRONIC KIDNEY DISEASE COMP PREG SECOND TRI

S83134A

MEDIAL DISLOC OF PROXIMAL END OF TIBIA RIGHT KNEE INIT

O10213

PRE-EXIST HYP CHRONIC KIDNEY DISEASE COMP PREG THIRD TRI

S83135A

MEDIAL DISLOCATION OF PROXIMAL END OF TIBIA LEFT KNEE INIT

O10219

PRE-EXIST HYP CHRONIC KIDNEY DISEASE COMP PREG UNSP TRI

S83136A

MEDIAL DISLOCATION OF PROXIMAL END OF TIBIA UNSP KNEE INIT

O1022

PRE-EXISTING HYP CHRONIC KIDNEY DISEASE COMP CHILDBIRTH

S83141A

LATERAL SUBLUX OF PROXIMAL END OF TIBIA RIGHT KNEE INIT

O1023

PRE-EXISTING HYP CHRONIC KIDNEY DISEASE COMP THE PUERPERIUM

S83142A

LATERAL SUBLUX OF PROXIMAL END OF TIBIA LEFT KNEE INIT

O10311

PRE-EXIST HYP HEART AND CHR KIDNEY DIS COMP PREG FIRST TRI

S83143A

LATERAL SUBLUX OF PROXIMAL END OF TIBIA UNSP KNEE INIT

O10312

PRE-EXIST HYP HEART AND CHR KIDNEY DIS COMP PREG SECOND TRI

S83144A

LATERAL DISLOC OF PROXIMAL END OF TIBIA RIGHT KNEE INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O10313

PRE-EXIST HYP HEART AND CHR KIDNEY DIS COMP PREG THIRD TRI

S83145A

LATERAL DISLOC OF PROXIMAL END OF TIBIA LEFT KNEE INIT

O10319

PRE-EXIST HYP HEART AND CHR KIDNEY DIS COMP PREG UNSP TRI

S83146A

LATERAL DISLOC OF PROXIMAL END OF TIBIA UNSP KNEE INIT

O1032

PRE-EXIST HYP HEART AND CHRONIC KIDNEY DISEASE COMP CHLDBRTH

S83191A

OTHER SUBLUXATION OF RIGHT KNEE INITIAL ENCOUNTER

O1033

PRE-EXIST HYP HEART AND CHR KIDNEY DISEASE COMP THE PUERP

S83192A

OTHER SUBLUXATION OF LEFT KNEE INITIAL ENCOUNTER

O10411

PRE-EXISTING SECONDARY HTN COMP PREGNANCY FIRST TRIMESTER

S83193A

OTHER SUBLUXATION OF UNSPECIFIED KNEE INITIAL ENCOUNTER

O10412

PRE-EXISTING SECONDARY HTN COMP PREGNANCY SECOND TRIMESTER

S83194A

OTHER DISLOCATION OF RIGHT KNEE INITIAL ENCOUNTER

O10413

PRE-EXISTING SECONDARY HTN COMP PREGNANCY THIRD TRIMESTER

S83195A

OTHER DISLOCATION OF LEFT KNEE INITIAL ENCOUNTER

O10419

PRE-EXISTING SECONDARY HTN COMP PREGNANCY UNSP TRIMESTER

S83196A

OTHER DISLOCATION OF UNSPECIFIED KNEE INITIAL ENCOUNTER

O1042

PRE-EXISTING SECONDARY HYPERTENSION COMPLICATING CHILDBIRTH

S83200A

BUCKET-HNDL TEAR OF UNSP MENSC CURRENT INJURY R KNEE INIT

O1043

PRE-EXISTING SECONDARY HYPERTENSION COMP THE PUERPERIUM

S83201A

BUCKET-HNDL TEAR OF UNSP MENSC CURRENT INJURY L KNEE INIT

O10911 UNSP PRE-EXISTING HTN COMP PREGNANCY FIRST TRIMESTER

S83202A

BUCKET-HNDL TEAR OF UNSP MENSC CRNT INJURY UNSP KNEE INIT

O10912

UNSP PRE-EXISTING HTN COMP PREGNANCY SECOND TRIMESTER

S83211A

BUCKET-HNDL TEAR OF MEDIAL MENSC CRNT INJURY R KNEE INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O10913 UNSP PRE-EXISTING HTN COMP PREGNANCY THIRD TRIMESTER

S83212A

BUCKET-HNDL TEAR OF MEDIAL MENSC CRNT INJURY L KNEE INIT

O10919 UNSP PRE-EXISTING HTN COMP PREGNANCY UNSP TRIMESTER

S83219A

BUCKET-HNDL TEAR OF MEDIAL MENSC CRNT INJ UNSP KNEE INIT

O1092

UNSP PRE-EXISTING HYPERTENSION COMPLICATING CHILDBIRTH

S83221A

PRPH TEAR OF MEDIAL MENISCUS CURRENT INJURY R KNEE INIT

O1093

UNSP PRE-EXISTING HYPERTENSION COMPLICATING THE PUERPERIUM

S83222A

PRPH TEAR OF MEDIAL MENISCUS CURRENT INJURY L KNEE INIT

O111

PRE-EXISTING HYPERTENSION W PRE-ECLAMPSIA FIRST TRIMESTER

S83229A

PRPH TEAR OF MEDIAL MENSC CURRENT INJURY UNSP KNEE INIT

O112

PRE-EXISTING HYPERTENSION W PRE-ECLAMPSIA SECOND TRIMESTER

S83231A

COMPLEX TEAR OF MEDIAL MENSC CURRENT INJURY R KNEE INIT

O113

PRE-EXISTING HYPERTENSION W PRE-ECLAMPSIA THIRD TRIMESTER

S83232A

COMPLEX TEAR OF MEDIAL MENSC CURRENT INJURY L KNEE INIT

O114

Pre-existing hypertension with pre-eclampsia complicating childbirth

S83239A

CMPLX TEAR OF MEDIAL MENSC CURRENT INJURY UNSP KNEE INIT

O115

Pre-existing hypertension with pre-eclampsia complicating the puerperium

S83241A

OTH TEAR OF MEDIAL MENISCUS CURRENT INJURY R KNEE INIT

O119

PRE-EXISTING HYPERTENSION WITH PRE-ECLAMPSIA UNSP TRIMESTER

S83242A

OTH TEAR OF MEDIAL MENISCUS CURRENT INJURY LEFT KNEE INIT

O1200 GESTATIONAL EDEMA UNSPECIFIED TRIMESTER

S83249A

OTH TEAR OF MEDIAL MENISCUS CURRENT INJURY UNSP KNEE INIT

O1201 GESTATIONAL EDEMA FIRST TRIMESTER

S83251A

BUCKET-HNDL TEAR OF LAT MENSC CURRENT INJURY R KNEE INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O1202 GESTATIONAL EDEMA SECOND TRIMESTER

S83252A

BUCKET-HNDL TEAR OF LAT MENSC CURRENT INJURY L KNEE INIT

O1203 GESTATIONAL EDEMA THIRD TRIMESTER

S83259A

BUCKET-HNDL TEAR OF LAT MENSC CRNT INJURY UNSP KNEE INIT

O1204 Gestational edema complicating childbirth

S83261A

PRPH TEAR OF LAT MENSC CURRENT INJURY RIGHT KNEE INIT

O1205 Gestational edema complicating the puerperium

S83262A

PRPH TEAR OF LAT MENSC CURRENT INJURY LEFT KNEE INIT

O1210 GESTATIONAL PROTEINURIA UNSPECIFIED TRIMESTER

S83269A

PRPH TEAR OF LAT MENSC CURRENT INJURY UNSP KNEE INIT

O1211 GESTATIONAL PROTEINURIA FIRST TRIMESTER

S83271A

COMPLEX TEAR OF LAT MENSC CURRENT INJURY RIGHT KNEE INIT

O1212 GESTATIONAL PROTEINURIA SECOND TRIMESTER

S83272A

COMPLEX TEAR OF LAT MENSC CURRENT INJURY LEFT KNEE INIT

O1213 GESTATIONAL PROTEINURIA THIRD TRIMESTER

S83279A

COMPLEX TEAR OF LAT MENSC CURRENT INJURY UNSP KNEE INIT

O1214 Gestational proteinuria complicating childbirth

S83281A

OTH TEAR OF LAT MENSC CURRENT INJURY RIGHT KNEE INIT

O1215 Gestational proteinuria complicating the puerperium

S83282A

OTH TEAR OF LAT MENSC CURRENT INJURY LEFT KNEE INIT

O1220

GESTATIONAL EDEMA WITH PROTEINURIA UNSPECIFIED TRIMESTER

S83289A

OTH TEAR OF LAT MENSC CURRENT INJURY UNSP KNEE INIT

O1221 GESTATIONAL EDEMA WITH PROTEINURIA FIRST TRIMESTER

S8330XA

TEAR OF ARTICULAR CARTILAGE OF UNSP KNEE CURRENT INIT

O1222

GESTATIONAL EDEMA WITH PROTEINURIA SECOND TRIMESTER

S8331XA

TEAR OF ARTICULAR CARTILAGE OF RIGHT KNEE CURRENT INIT

O1223

GESTATIONAL EDEMA WITH PROTEINURIA THIRD TRIMESTER

S8332XA

TEAR OF ARTICULAR CARTILAGE OF LEFT KNEE CURRENT INIT

O1224

Gestational edema with proteinuria complicating childbirth

S83401A

SPRAIN OF UNSP COLLATERAL LIGAMENT OF RIGHT KNEE INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O1225

Gestational edema with proteinuria complicating the puerperium

S83402A

SPRAIN OF UNSP COLLATERAL LIGAMENT OF LEFT KNEE INIT ENCNTR

O131

GESTATIONAL HTN W/O SIGNIFICANT PROTEINURIA FIRST TRIMESTER

S83409A

SPRAIN OF UNSP COLLATERAL LIGAMENT OF UNSP KNEE INIT ENCNTR

O132

GESTATNL HTN W/O SIGNIFICANT PROTEINURIA SECOND TRIMESTER

S83411A

SPRAIN OF MEDIAL COLLATERAL LIGAMENT OF RIGHT KNEE INIT

O133

GESTATIONAL HTN W/O SIGNIFICANT PROTEINURIA THIRD TRIMESTER

S83412A

SPRAIN OF MEDIAL COLLATERAL LIGAMENT OF LEFT KNEE INIT

O134

Gestational [pregnancy-induced] hypertension without significant proteinuria complicating childbirth

S83419A

SPRAIN OF MEDIAL COLLATERAL LIGAMENT OF UNSP KNEE INIT

O135

Gestational [pregnancy-induced] hypertension without significant proteinuria complicating the puerperium

S83421A

SPRAIN OF LATERAL COLLATERAL LIGAMENT OF RIGHT KNEE INIT

O139

GESTATIONAL HTN W/O SIGNIFICANT PROTEINURIA UNSP TRIMESTER

S83422A

SPRAIN OF LATERAL COLLATERAL LIGAMENT OF LEFT KNEE INIT

O1400

MILD TO MODERATE PRE-ECLAMPSIA UNSPECIFIED TRIMESTER

S83429A

SPRAIN OF LATERAL COLLATERAL LIGAMENT OF UNSP KNEE INIT

O1402

MILD TO MODERATE PRE-ECLAMPSIA SECOND TRIMESTER

S83501A

SPRAIN OF UNSP CRUCIATE LIGAMENT OF RIGHT KNEE INIT ENCNTR

O1403 MILD TO MODERATE PRE-ECLAMPSIA THIRD TRIMESTER

S83502A

SPRAIN OF UNSP CRUCIATE LIGAMENT OF LEFT KNEE INIT ENCNTR

O1404 Mild to moderate pre-eclampsia complicating childbirth

S83509A

SPRAIN OF UNSP CRUCIATE LIGAMENT OF UNSP KNEE INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O1405 Mild to moderate pre-eclampsia complicating the puerperium

S83511A

SPRAIN OF ANTERIOR CRUCIATE LIGAMENT OF RIGHT KNEE INIT

O1410 SEVERE PRE-ECLAMPSIA UNSPECIFIED TRIMESTER

S83512A

SPRAIN OF ANTERIOR CRUCIATE LIGAMENT OF LEFT KNEE INIT

O1412 SEVERE PRE-ECLAMPSIA SECOND TRIMESTER

S83519A

SPRAIN OF ANTERIOR CRUCIATE LIGAMENT OF UNSP KNEE INIT

O1413 SEVERE PRE-ECLAMPSIA THIRD TRIMESTER

S83521A

SPRAIN OF POSTERIOR CRUCIATE LIGAMENT OF RIGHT KNEE INIT

O1414 Severe pre-eclampsia complicating childbirth

S83522A

SPRAIN OF POSTERIOR CRUCIATE LIGAMENT OF LEFT KNEE INIT

O1415 Severe pre-eclampsia complicating the puerperium

S83529A

SPRAIN OF POSTERIOR CRUCIATE LIGAMENT OF UNSP KNEE INIT

O1420 HELLP SYNDROME (HELLP) UNSPECIFIED TRIMESTER

S8360XA

SPRAIN OF SUPER TIBIOFIBUL JOINT AND LIGMT UNSP KNEE INIT

O1422 HELLP SYNDROME (HELLP) SECOND TRIMESTER

S8361XA

SPRAIN OF THE SUPER TIBIOFIBUL JOINT AND LIGMT R KNEE INIT

O1423 HELLP SYNDROME (HELLP) THIRD TRIMESTER

S8362XA

SPRAIN OF THE SUPER TIBIOFIBUL JOINT AND LIGMT L KNEE INIT

O1424 HELLP syndrome complicating childbirth

S838X1A

SPRAIN OF OTHER SPECIFIED PARTS OF RIGHT KNEE INIT ENCNTR

O1425 HELLP syndrome complicating the puerperium

S838X2A

SPRAIN OF OTHER SPECIFIED PARTS OF LEFT KNEE INIT ENCNTR

O1490 UNSPECIFIED PRE-ECLAMPSIA UNSPECIFIED TRIMESTER

S838X9A

SPRAIN OF OTH PARTS OF UNSPECIFIED KNEE INIT ENCNTR

O1492 UNSPECIFIED PRE-ECLAMPSIA SECOND TRIMESTER

S8390XA

SPRAIN OF UNSPECIFIED SITE OF UNSPECIFIED KNEE INIT ENCNTR

O1493 UNSPECIFIED PRE-ECLAMPSIA THIRD TRIMESTER

S8391XA

SPRAIN OF UNSPECIFIED SITE OF RIGHT KNEE INITIAL ENCOUNTER

O1494 Unspecified pre-eclampsia complicating childbirth

S8392XA

SPRAIN OF UNSPECIFIED SITE OF LEFT KNEE INITIAL ENCOUNTER

O1495 Unspecified pre-eclampsia complicating the puerperium

S8400XA

INJURY OF TIBIAL NERVE AT LOWER LEG LEVEL UNSP LEG INIT

O1500 ECLAMPSIA IN PREGNANCY UNSPECIFIED TRIMESTER

S8401XA

INJURY OF TIBIAL NERVE AT LOWER LEG LEVEL RIGHT LEG INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O1502 ECLAMPSIA IN PREGNANCY SECOND TRIMESTER

S8402XA

INJURY OF TIBIAL NERVE AT LOWER LEG LEVEL LEFT LEG INIT

O1503 ECLAMPSIA IN PREGNANCY THIRD TRIMESTER

S8410XA

INJURY OF PERONEAL NERVE AT LOWER LEG LEVEL UNSP LEG INIT

O151 ECLAMPSIA IN LABOR

S8411XA INJURY OF PERONEAL NERVE AT LOWER LEG LEVEL RIGHT LEG INIT

O152 ECLAMPSIA IN THE PUERPERIUM

S8412XA

INJURY OF PERONEAL NERVE AT LOWER LEG LEVEL LEFT LEG INIT

O159 ECLAMPSIA UNSPECIFIED AS TO TIME PERIOD

S8420XA

INJ CUTAN SENSORY NERVE AT LOWER LEG LEVEL UNSP LEG INIT

O161

UNSPECIFIED MATERNAL HYPERTENSION FIRST TRIMESTER

S8421XA

INJ CUTAN SENSORY NERVE AT LOWER LEG LEVEL RIGHT LEG INIT

O162

UNSPECIFIED MATERNAL HYPERTENSION SECOND TRIMESTER

S8422XA

INJ CUTAN SENSORY NERVE AT LOWER LEG LEVEL LEFT LEG INIT

O163

UNSPECIFIED MATERNAL HYPERTENSION THIRD TRIMESTER

S84801A

INJURY OF OTH NERVES AT LOWER LEG LEVEL RIGHT LEG INIT

O164

Unspecified maternal hypertension complicating childbirth

S84802A

INJURY OF OTH NERVES AT LOWER LEG LEVEL LEFT LEG INIT

O165

Unspecified maternal hypertension complicating the puerperium

S84809A

INJURY OF OTH NERVES AT LOWER LEG LEVEL UNSP LEG INIT

O169

UNSPECIFIED MATERNAL HYPERTENSION UNSPECIFIED TRIMESTER

S8490XA

INJURY OF UNSP NERVE AT LOWER LEG LEVEL UNSP LEG INIT

O200 THREATENED ABORTION

S8491XA INJURY OF UNSP NERVE AT LOWER LEG LEVEL RIGHT LEG INIT

O208 OTHER HEMORRHAGE IN EARLY PREGNANCY

S8492XA

INJURY OF UNSP NERVE AT LOWER LEG LEVEL LEFT LEG INIT

O209 HEMORRHAGE IN EARLY PREGNANCY UNSPECIFIED

S85011A

LACERATION OF POPLITEAL ARTERY RIGHT LEG INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O210 MILD HYPEREMESIS GRAVIDARUM

S85012A

LACERATION OF POPLITEAL ARTERY LEFT LEG INITIAL ENCOUNTER

O2230

DEEP PHLEBOTHROMBOSIS IN PREGNANCY UNSPECIFIED TRIMESTER

S85019A

LACERATION OF POPLITEAL ARTERY UNSPECIFIED LEG INIT ENCNTR

O2231 DEEP PHLEBOTHROMBOSIS IN PREGNANCY FIRST TRIMESTER

S85111A

LACERATION OF UNSP TIBIAL ARTERY RIGHT LEG INIT ENCNTR

O2232

DEEP PHLEBOTHROMBOSIS IN PREGNANCY SECOND TRIMESTER

S85112A

LACERATION OF UNSP TIBIAL ARTERY LEFT LEG INIT ENCNTR

O2233 DEEP PHLEBOTHROMBOSIS IN PREGNANCY THIRD TRIMESTER

S85119A

LACERATION OF UNSP TIBIAL ARTERY UNSP LEG INIT ENCNTR

O2250

CEREBRAL VENOUS THROMBOSIS IN PREGNANCY UNSP TRIMESTER

S85141A

LACERATION OF ANTERIOR TIBIAL ARTERY RIGHT LEG INIT ENCNTR

O2251

CEREBRAL VENOUS THROMBOSIS IN PREGNANCY FIRST TRIMESTER

S85142A

LACERATION OF ANTERIOR TIBIAL ARTERY LEFT LEG INIT ENCNTR

O2252

CEREBRAL VENOUS THROMBOSIS IN PREGNANCY SECOND TRIMESTER

S85149A

LACERATION OF ANTERIOR TIBIAL ARTERY UNSP LEG INIT ENCNTR

O2253

CEREBRAL VENOUS THROMBOSIS IN PREGNANCY THIRD TRIMESTER

S85171A

LACERATION OF POSTERIOR TIBIAL ARTERY RIGHT LEG INIT

O228X1

OTHER VENOUS COMPLICATIONS IN PREGNANCY FIRST TRIMESTER

S85172A

LACERATION OF POSTERIOR TIBIAL ARTERY LEFT LEG INIT ENCNTR

O228X2

OTHER VENOUS COMPLICATIONS IN PREGNANCY SECOND TRIMESTER

S85179A

LACERATION OF POSTERIOR TIBIAL ARTERY UNSP LEG INIT ENCNTR

O228X3

OTHER VENOUS COMPLICATIONS IN PREGNANCY THIRD TRIMESTER

S85211A

LACERATION OF PERONEAL ARTERY RIGHT LEG INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O228X9

OTHER VENOUS COMPLICATIONS IN PREGNANCY UNSP TRIMESTER

S85212A

LACERATION OF PERONEAL ARTERY LEFT LEG INITIAL ENCOUNTER

O2290

VENOUS COMPLICATION IN PREGNANCY UNSP UNSP TRIMESTER

S85219A

LACERATION OF PERONEAL ARTERY UNSPECIFIED LEG INIT ENCNTR

O2291

VENOUS COMPLICATION IN PREGNANCY UNSP FIRST TRIMESTER

S85311A

LACERAT GREAT SAPHENOUS AT LOWER LEG LEVEL RIGHT LEG INIT

O2292

VENOUS COMPLICATION IN PREGNANCY UNSP SECOND TRIMESTER

S85312A

LACERAT GREAT SAPHENOUS AT LOWER LEG LEVEL LEFT LEG INIT

O2293

VENOUS COMPLICATION IN PREGNANCY UNSP THIRD TRIMESTER

S85319A

LACERAT GREAT SAPHENOUS AT LOWER LEG LEVEL UNSP LEG INIT

O26851 SPOTTING COMPLICATING PREGNANCY FIRST TRIMESTER

S85411A

LACERAT LESS SAPHENOUS AT LOWER LEG LEVEL RIGHT LEG INIT

O26852

SPOTTING COMPLICATING PREGNANCY SECOND TRIMESTER

S85412A

LACERAT LESS SAPHENOUS AT LOWER LEG LEVEL LEFT LEG INIT

O26853 SPOTTING COMPLICATING PREGNANCY THIRD TRIMESTER

S85419A

LACERAT LESS SAPHENOUS AT LOWER LEG LEVEL UNSP LEG INIT

O26859

SPOTTING COMPLICATING PREGNANCY UNSPECIFIED TRIMESTER

S85511A

LACERATION OF POPLITEAL VEIN RIGHT LEG INITIAL ENCOUNTER

O283

ABNORMAL ULTRASONIC FINDING ON ANTENATAL SCREENING OF MOTHER

S85512A

LACERATION OF POPLITEAL VEIN LEFT LEG INITIAL ENCOUNTER

O29011

ASPIRAT PNEUMONITIS DUE TO ANESTH DURING PREG FIRST TRI

S85519A

LACERATION OF POPLITEAL VEIN UNSPECIFIED LEG INIT ENCNTR

O29012

ASPIRAT PNEUMONITIS DUE TO ANESTH DURING PREG SECOND TRI

S85811A

LACERAT BLOOD VESSELS AT LOWER LEG LEVEL RIGHT LEG INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O29013

ASPIRAT PNEUMONITIS DUE TO ANESTH DURING PREG THIRD TRI

S85812A

LACERAT BLOOD VESSELS AT LOWER LEG LEVEL LEFT LEG INIT

O29019

ASPIRAT PNEUMONITIS DUE TO ANESTH DURING PREG UNSP TRI

S85819A

LACERAT BLOOD VESSELS AT LOWER LEG LEVEL UNSP LEG INIT

O29021

PRESSR COLLAPSE OF LUNG DUE TO ANESTH DURING PREG FIRST TRI

S85911A

LACERAT UNSP BLOOD VESS AT LOWER LEG LEVEL RIGHT LEG INIT

O29022

PRESSR COLLAPSE OF LUNG D/T ANESTH DURING PREG SECOND TRI

S85912A

LACERAT UNSP BLOOD VESSEL AT LOWER LEG LEVEL LEFT LEG INIT

O29023

PRESSR COLLAPSE OF LUNG DUE TO ANESTH DURING PREG THIRD TRI

S85919A

LACERAT UNSP BLOOD VESSEL AT LOWER LEG LEVEL UNSP LEG INIT

O29029

PRESSR COLLAPSE OF LUNG DUE TO ANESTH DURING PREG UNSP TRI

S86011A

STRAIN OF RIGHT ACHILLES TENDON INITIAL ENCOUNTER

O29091

OTH PULMONARY COMP OF ANESTH DURING PREG FIRST TRIMESTER

S86012A

STRAIN OF LEFT ACHILLES TENDON INITIAL ENCOUNTER

O29092

OTH PULMONARY COMP OF ANESTH DURING PREG SECOND TRIMESTER

S86019A

STRAIN OF UNSPECIFIED ACHILLES TENDON INITIAL ENCOUNTER

O29093

OTH PULMONARY COMP OF ANESTH DURING PREG THIRD TRIMESTER

S86021A

LACERATION OF RIGHT ACHILLES TENDON INITIAL ENCOUNTER

O29099

OTH PULMONARY COMP OF ANESTH DURING PREG UNSP TRIMESTER

S86022A

LACERATION OF LEFT ACHILLES TENDON INITIAL ENCOUNTER

O29111

CARDIAC ARREST DUE TO ANESTH DURING PREG FIRST TRIMESTER

S86029A

LACERATION OF UNSPECIFIED ACHILLES TENDON INITIAL ENCOUNTER

O29112

CARDIAC ARREST DUE TO ANESTH DURING PREG SECOND TRIMESTER

S86111A

STRAIN MUSC/TEND POST GRP AT LOW LEG LEVEL RIGHT LEG INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O29113

CARDIAC ARREST DUE TO ANESTH DURING PREG THIRD TRIMESTER

S86112A

STRAIN MUSC/TEND POST GRP AT LOW LEG LEVEL LEFT LEG INIT

O29119

CARDIAC ARREST DUE TO ANESTH DURING PREG UNSP TRIMESTER

S86119A

STRAIN MUSC/TEND POST GRP AT LOW LEG LEVEL UNSP LEG INIT

O29121

CARDIAC FAILURE DUE TO ANESTH DURING PREG FIRST TRIMESTER

S86121A

LACERAT MUSC/TEND POST GRP AT LOW LEG LEVEL RIGHT LEG INIT

O29122

CARDIAC FAILURE DUE TO ANESTH DURING PREG SECOND TRIMESTER

S86122A

LACERAT MUSC/TEND POST GRP AT LOW LEG LEVEL LEFT LEG INIT

O29123

CARDIAC FAILURE DUE TO ANESTH DURING PREG THIRD TRIMESTER

S86129A

LACERAT MUSC/TEND POST GRP AT LOW LEG LEVEL UNSP LEG INIT

O29129

CARDIAC FAILURE DUE TO ANESTH DURING PREG UNSP TRIMESTER

S86211A

STRAIN MUSC/TEND ANT GRP AT LOW LEG LEVEL RIGHT LEG INIT

O29191

OTH CARDIAC COMP OF ANESTH DURING PREGNANCY FIRST TRIMESTER

S86212A

STRAIN MUSC/TEND ANT GRP AT LOW LEG LEVEL LEFT LEG INIT

O29192

OTH CARDIAC COMP OF ANESTH DURING PREG SECOND TRIMESTER

S86219A

STRAIN MUSC/TEND ANT GRP AT LOW LEG LEVEL UNSP LEG INIT

O29193

OTH CARDIAC COMP OF ANESTH DURING PREGNANCY THIRD TRIMESTER

S86221A

LACERAT MUSC/TEND ANT GRP AT LOW LEG LEVEL RIGHT LEG INIT

O29199

OTH CARDIAC COMP OF ANESTH DURING PREGNANCY UNSP TRIMESTER

S86222A

LACERAT MUSC/TEND ANT GRP AT LOW LEG LEVEL LEFT LEG INIT

O29211

CEREBRAL ANOXIA DUE TO ANESTH DURING PREG FIRST TRIMESTER

S86229A

LACERAT MUSC/TEND ANT GRP AT LOW LEG LEVEL UNSP LEG INIT

O29212

CEREBRAL ANOXIA DUE TO ANESTH DURING PREG SECOND TRIMESTER

S86311A

STRAIN MUSC/TEND PERONEAL GRP AT LOW LEG LEV R LEG INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O29213

CEREBRAL ANOXIA DUE TO ANESTH DURING PREG THIRD TRIMESTER

S86312A

STRAIN MUSC/TEND PERONEAL GRP AT LOW LEG LEV LEFT LEG INIT

O29219

CEREBRAL ANOXIA DUE TO ANESTH DURING PREG UNSP TRIMESTER

S86319A

STRAIN MUSC/TEND PERONEAL GRP AT LOW LEG LEV UNSP LEG INIT

O29291

OTH CNSL COMP OF ANESTH DURING PREGNANCY FIRST TRIMESTER

S86321A

LACERAT MUSC/TEND PERONEAL GRP AT LOW LEG LEV R LEG INIT

O29292

OTH CNSL COMP OF ANESTH DURING PREGNANCY SECOND TRIMESTER

S86322A

LACERAT MUSC/TEND PERONEAL GRP AT LOW LEG LEV L LEG INIT

O29293

OTH CNSL COMP OF ANESTH DURING PREGNANCY THIRD TRIMESTER

S86329A

LACERAT MUSC/TEND PERONEAL GRP AT LOW LEG LEVUNSP LEG INIT

O29299

OTH CNSL COMP OF ANESTHESIA DURING PREGNANCY UNSP TRIMESTER

S86811A

STRAIN OF MUSC/TEND AT LOWER LEG LEVEL RIGHT LEG INIT

O293X1

TOXIC REACTION TO LOCAL ANESTH DURING PREG FIRST TRIMESTER

S86812A

STRAIN OF MUSC/TEND AT LOWER LEG LEVEL LEFT LEG INIT

O293X2

TOXIC REACTION TO LOCAL ANESTH DURING PREG SECOND TRIMESTER

S86819A

STRAIN OF MUSC/TEND AT LOWER LEG LEVEL UNSP LEG INIT

O293X3

TOXIC REACTION TO LOCAL ANESTH DURING PREG THIRD TRIMESTER

S86821A

LACERATION OF MUSC/TEND AT LOWER LEG LEVEL RIGHT LEG INIT

O293X9

TOXIC REACTION TO LOCAL ANESTH DURING PREG UNSP TRIMESTER

S86822A

LACERATION OF MUSC/TEND AT LOWER LEG LEVEL LEFT LEG INIT

O2960

FAILED OR DIFFICULT INTUBATION FOR ANESTH DUR PREG UNSP TRI

S86829A

LACERATION OF MUSC/TEND AT LOWER LEG LEVEL UNSP LEG INIT

O2961

FAIL OR DIFFICULT INTUBATION FOR ANESTH DUR PREG FIRST TRI

S86911A

STRAIN OF UNSP MUSC/TEND AT LOWER LEG LEVEL RIGHT LEG INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O2962

FAIL OR DIFFICULT INTUBATION FOR ANESTH DUR PREG SECOND TRI

S86912A

STRAIN OF UNSP MUSC/TEND AT LOWER LEG LEVEL LEFT LEG INIT

O2963

FAIL OR DIFFICULT INTUBATION FOR ANESTH DUR PREG THIRD TRI

S86919A

STRAIN OF UNSP MUSC/TEND AT LOWER LEG LEVEL UNSP LEG INIT

O298X1

OTH COMP OF ANESTHESIA DURING PREGNANCY FIRST TRIMESTER

S86921A

LACERAT UNSP MUSC/TEND AT LOWER LEG LEVEL RIGHT LEG INIT

O298X2

OTH COMP OF ANESTHESIA DURING PREGNANCY SECOND TRIMESTER

S86922A

LACERAT UNSP MUSC/TEND AT LOWER LEG LEVEL LEFT LEG INIT

O298X3

OTH COMP OF ANESTHESIA DURING PREGNANCY THIRD TRIMESTER

S86929A

LACERAT UNSP MUSC/TEND AT LOWER LEG LEVEL UNSP LEG INIT

O298X9

OTH COMP OF ANESTHESIA DURING PREGNANCY UNSP TRIMESTER

S8700XA

CRUSHING INJURY OF UNSPECIFIED KNEE INITIAL ENCOUNTER

O2990

UNSP COMP OF ANESTHESIA DURING PREGNANCY UNSP TRIMESTER

S8701XA

CRUSHING INJURY OF RIGHT KNEE INITIAL ENCOUNTER

O2991

UNSP COMP OF ANESTHESIA DURING PREGNANCY FIRST TRIMESTER

S8702XA

CRUSHING INJURY OF LEFT KNEE INITIAL ENCOUNTER

O2992

UNSP COMP OF ANESTHESIA DURING PREGNANCY SECOND TRIMESTER

S8780XA

CRUSHING INJURY OF UNSPECIFIED LOWER LEG INITIAL ENCOUNTER

O2993

UNSP COMP OF ANESTHESIA DURING PREGNANCY THIRD TRIMESTER

S8781XA

CRUSHING INJURY OF RIGHT LOWER LEG INITIAL ENCOUNTER

O320XX0

MATERNAL CARE FOR UNSTABLE LIE NOT APPLICABLE OR UNSP

S8782XA

CRUSHING INJURY OF LEFT LOWER LEG INITIAL ENCOUNTER

O320XX1 MATERNAL CARE FOR UNSTABLE LIE FETUS 1

S88011A

COMPLETE TRAUMATIC AMPUTATION AT KNEE LEVEL R LOW LEG INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O320XX2 MATERNAL CARE FOR UNSTABLE LIE FETUS 2

S88012A

COMPLETE TRAUMATIC AMPUTATION AT KNEE LEVEL L LOW LEG INIT

O320XX3 MATERNAL CARE FOR UNSTABLE LIE FETUS 3

S88019A

COMPLETE TRAUMATIC AMP AT KNEE LEVEL UNSP LOWER LEG INIT

O320XX4 MATERNAL CARE FOR UNSTABLE LIE FETUS 4

S88021A

PARTIAL TRAUMATIC AMPUTATION AT KNEE LEVEL R LOW LEG INIT

O320XX5 MATERNAL CARE FOR UNSTABLE LIE FETUS 5

S88022A

PARTIAL TRAUMATIC AMPUTATION AT KNEE LEVEL L LOW LEG INIT

O320XX9 MATERNAL CARE FOR UNSTABLE LIE OTHER FETUS

S88029A

PARTIAL TRAUMATIC AMP AT KNEE LEVEL UNSP LOWER LEG INIT

O321XX0 MATERNAL CARE FOR BREECH PRESENTATION UNSP

S88111A

COMPLETE TRAUM AMP AT LEV BETW KN AND ANKL R LOW LEG INIT

O321XX1 MATERNAL CARE FOR BREECH PRESENTATION FETUS 1

S88112A

COMPLETE TRAUM AMP AT LEV BETW KN AND ANKL L LOW LEG INIT

O321XX2 MATERNAL CARE FOR BREECH PRESENTATION FETUS 2

S88119A

COMPLETE TRAUM AMP AT LEV BETW KN & ANKL UNSP LOW LEG INIT

O321XX3 MATERNAL CARE FOR BREECH PRESENTATION FETUS 3

S88121A

PART TRAUM AMP AT LEVEL BETW KNEE AND ANKLE R LOW LEG INIT

O321XX4 MATERNAL CARE FOR BREECH PRESENTATION FETUS 4

S88122A

PART TRAUM AMP AT LEVEL BETW KNEE AND ANKLE L LOW LEG INIT

O321XX5 MATERNAL CARE FOR BREECH PRESENTATION FETUS 5

S88129A

PART TRAUM AMP AT LEV BETW KNEE AND ANKL UNSP LOW LEG INIT

O321XX9 MATERNAL CARE FOR BREECH PRESENTATION OTHER FETUS

S88911A

COMPLETE TRAUMATIC AMPUTATION OF R LOW LEG LEVEL UNSP INIT

O322XX0

MATERNAL CARE FOR TRANSVERSE AND OBLIQUE LIE UNSP

S88912A

COMPLETE TRAUMATIC AMPUTATION OF L LOW LEG LEVEL UNSP INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O322XX1

MATERNAL CARE FOR TRANSVERSE AND OBLIQUE LIE FETUS 1

S88919A

COMPLETE TRAUMATIC AMP OF UNSP LOWER LEG LEVEL UNSP INIT

O322XX2

MATERNAL CARE FOR TRANSVERSE AND OBLIQUE LIE FETUS 2

S88921A

PARTIAL TRAUMATIC AMPUTATION OF R LOW LEG LEVEL UNSP INIT

O322XX3

MATERNAL CARE FOR TRANSVERSE AND OBLIQUE LIE FETUS 3

S88929A

PARTIAL TRAUMATIC AMP OF UNSP LOWER LEG LEVEL UNSP INIT

O322XX4

MATERNAL CARE FOR TRANSVERSE AND OBLIQUE LIE FETUS 4

S89001A

UNSP PHYSEAL FRACTURE OF UPPER END OF RIGHT TIBIA INIT

O322XX5

MATERNAL CARE FOR TRANSVERSE AND OBLIQUE LIE FETUS 5

S89002A

UNSP PHYSEAL FRACTURE OF UPPER END OF LEFT TIBIA INIT

O322XX9

MATERNAL CARE FOR TRANSVERSE AND OBLIQUE LIE OTHER FETUS

S89009A

UNSP PHYSEAL FRACTURE OF UPPER END OF UNSP TIBIA INIT

O323XX0

MATERNAL CARE FOR FACE BROW AND CHIN PRESENTATION UNSP

S89011A

SLTR-HARIS TYPE I PHYSEAL FX UPPER END OF RIGHT TIBIA INIT

O323XX1

MATERNAL CARE FOR FACE BROW AND CHIN PRESENTATION FETUS 1

S89012A

SLTR-HARIS TYPE I PHYSEAL FX UPPER END OF LEFT TIBIA INIT

O323XX2

MATERNAL CARE FOR FACE BROW AND CHIN PRESENTATION FETUS 2

S89019A

SLTR-HARIS TYPE I PHYSEAL FX UPPER END OF UNSP TIBIA INIT

O323XX3

MATERNAL CARE FOR FACE BROW AND CHIN PRESENTATION FETUS 3

S89021A

SLTR-HARIS TYPE II PHYSEAL FX UPPER END OF RIGHT TIBIA INIT

O323XX4

MATERNAL CARE FOR FACE BROW AND CHIN PRESENTATION FETUS 4

S89022A

SLTR-HARIS TYPE II PHYSEAL FX UPPER END OF LEFT TIBIA INIT

O323XX5

MATERNAL CARE FOR FACE BROW AND CHIN PRESENTATION FETUS 5

S89029A

SLTR-HARIS TYPE II PHYSEAL FX UPPER END OF UNSP TIBIA INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O323XX9

MATERNAL CARE FOR FACE BROW AND CHIN PRESENTATION OTH

S89031A

SLTR-HARIS TYPE III PHYSEAL FX UPPER END OF R TIBIA INIT

O324XX0

MATERNAL CARE FOR HIGH HEAD AT TERM NOT APPLICABLE OR UNSP

S89032A

SLTR-HARIS TYPE III PHYSEAL FX UPPER END OF LEFT TIBIA INIT

O324XX1 MATERNAL CARE FOR HIGH HEAD AT TERM FETUS 1

S89039A

SLTR-HARIS TYPE III PHYSEAL FX UPPER END OF UNSP TIBIA INIT

O324XX2 MATERNAL CARE FOR HIGH HEAD AT TERM FETUS 2

S89041A

SLTR-HARIS TYPE IV PHYSEAL FX UPPER END OF RIGHT TIBIA INIT

O324XX3 MATERNAL CARE FOR HIGH HEAD AT TERM FETUS 3

S89042A

SLTR-HARIS TYPE IV PHYSEAL FX UPPER END OF LEFT TIBIA INIT

O324XX4 MATERNAL CARE FOR HIGH HEAD AT TERM FETUS 4

S89049A

SLTR-HARIS TYPE IV PHYSEAL FX UPPER END OF UNSP TIBIA INIT

O324XX5 MATERNAL CARE FOR HIGH HEAD AT TERM FETUS 5

S89091A

OTH PHYSEAL FRACTURE OF UPPER END OF RIGHT TIBIA INIT

O324XX9 MATERNAL CARE FOR HIGH HEAD AT TERM OTHER FETUS

S89092A

OTH PHYSEAL FRACTURE OF UPPER END OF LEFT TIBIA INIT

O326XX0

MATERNAL CARE FOR COMPOUND PRESENTATION UNSP

S89099A

OTH PHYSEAL FRACTURE OF UPPER END OF UNSP TIBIA INIT

O326XX1

MATERNAL CARE FOR COMPOUND PRESENTATION FETUS 1

S89101A

UNSP PHYSEAL FRACTURE OF LOWER END OF RIGHT TIBIA INIT

O326XX2

MATERNAL CARE FOR COMPOUND PRESENTATION FETUS 2

S89102A

UNSP PHYSEAL FRACTURE OF LOWER END OF LEFT TIBIA INIT

O326XX3

MATERNAL CARE FOR COMPOUND PRESENTATION FETUS 3

S89109A

UNSP PHYSEAL FRACTURE OF LOWER END OF UNSP TIBIA INIT

O326XX4

MATERNAL CARE FOR COMPOUND PRESENTATION FETUS 4

S89111A

SLTR-HARIS TYPE I PHYSEAL FX LOWER END OF RIGHT TIBIA INIT

O326XX5

MATERNAL CARE FOR COMPOUND PRESENTATION FETUS 5

S89112A

SLTR-HARIS TYPE I PHYSEAL FX LOWER END OF LEFT TIBIA INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O326XX9

MATERNAL CARE FOR COMPOUND PRESENTATION OTHER FETUS

S89119A

SLTR-HARIS TYPE I PHYSEAL FX LOWER END OF UNSP TIBIA INIT

O328XX0

MATERNAL CARE FOR OTH MALPRESENTATION OF FETUS UNSP

S89121A

SLTR-HARIS TYPE II PHYSEAL FX LOWER END OF RIGHT TIBIA INIT

O328XX1

MATERNAL CARE FOR OTHER MALPRESENTATION OF FETUS FETUS 1

S89122A

SLTR-HARIS TYPE II PHYSEAL FX LOWER END OF LEFT TIBIA INIT

O328XX2

MATERNAL CARE FOR OTHER MALPRESENTATION OF FETUS FETUS 2

S89129A

SLTR-HARIS TYPE II PHYSEAL FX LOWER END OF UNSP TIBIA INIT

O328XX3

MATERNAL CARE FOR OTHER MALPRESENTATION OF FETUS FETUS 3

S89131A

SLTR-HARIS TYPE III PHYSEAL FX LOWER END OF R TIBIA INIT

O328XX4

MATERNAL CARE FOR OTHER MALPRESENTATION OF FETUS FETUS 4

S89132A

SLTR-HARIS TYPE III PHYSEAL FX LOWER END OF LEFT TIBIA INIT

O328XX5

MATERNAL CARE FOR OTHER MALPRESENTATION OF FETUS FETUS 5

S89139A

SLTR-HARIS TYPE III PHYSEAL FX LOWER END OF UNSP TIBIA INIT

O328XX9

MATERNAL CARE FOR OTH MALPRESENTATION OF FETUS OTHER FETUS

S89141A

SLTR-HARIS TYPE IV PHYSEAL FX LOWER END OF RIGHT TIBIA INIT

O329XX1

MATERNAL CARE FOR MALPRESENTATION OF FETUS UNSP FETUS 1

S89142A

SLTR-HARIS TYPE IV PHYSEAL FX LOWER END OF LEFT TIBIA INIT

O329XX2

MATERNAL CARE FOR MALPRESENTATION OF FETUS UNSP FETUS 2

S89149A

SLTR-HARIS TYPE IV PHYSEAL FX LOWER END OF UNSP TIBIA INIT

O329XX3

MATERNAL CARE FOR MALPRESENTATION OF FETUS UNSP FETUS 3

S89191A

OTH PHYSEAL FRACTURE OF LOWER END OF RIGHT TIBIA INIT

O329XX4

MATERNAL CARE FOR MALPRESENTATION OF FETUS UNSP FETUS 4

S89192A

OTH PHYSEAL FRACTURE OF LOWER END OF LEFT TIBIA INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O329XX5

MATERNAL CARE FOR MALPRESENTATION OF FETUS UNSP FETUS 5

S89199A

OTH PHYSEAL FRACTURE OF LOWER END OF UNSP TIBIA INIT

O329XX9

MATERNAL CARE FOR MALPRESENTATION OF FETUS UNSP OTH FETUS

S89201A

UNSP PHYSEAL FRACTURE OF UPPER END OF RIGHT FIBULA INIT

O330

MATERN CARE FOR DISPROPRTN D/T DEFORMITY OF MATERN PELV BONE

S89202A

UNSP PHYSEAL FRACTURE OF UPPER END OF LEFT FIBULA INIT

O331

MATERN CARE FOR DISPROPRTN D/T GENERALLY CONTRACTED PELVIS

S89209A

UNSP PHYSEAL FRACTURE OF UPPER END OF UNSP FIBULA INIT

O332

MATERNAL CARE FOR DISPROPRTN DUE TO INLET CONTRCTN OF PELVIS

S89211A

SLTR-HARIS TYPE I PHYSEAL FX UPPER END OF R FIBULA INIT

O333XX0

MATERN CARE FOR DISPROPRTN D/T OUTLET CONTRCTN OF PELV UNSP

S89212A

SLTR-HARIS TYPE I PHYSEAL FX UPPER END OF LEFT FIBULA INIT

O333XX1

MATERN CARE FOR DISPROPRTN D/T OUTLET CONTRCTN OF PELV FTS1

S89219A

SLTR-HARIS TYPE I PHYSEAL FX UPPER END OF UNSP FIBULA INIT

O333XX2

MATERN CARE FOR DISPROPRTN D/T OUTLET CONTRCTN OF PELV FTS2

S89221A

SLTR-HARIS TYPE II PHYSEAL FX UPPER END OF R FIBULA INIT

O333XX3

MATERN CARE FOR DISPROPRTN D/T OUTLET CONTRCTN OF PELV FTS3

S89222A

SLTR-HARIS TYPE II PHYSEAL FX UPPER END OF LEFT FIBULA INIT

O333XX4

MATERN CARE FOR DISPROPRTN D/T OUTLET CONTRCTN OF PELV FTS4

S89229A

SLTR-HARIS TYPE II PHYSEAL FX UPPER END OF UNSP FIBULA INIT

O333XX5

MATERN CARE FOR DISPROPRTN D/T OUTLET CONTRCTN OF PELV FTS5

S89291A

OTH PHYSEAL FRACTURE OF UPPER END OF RIGHT FIBULA INIT

O333XX9

MATERN CARE FOR DISPROPRTN D/T OUTLET CONTRCTN OF PELV OTH

S89292A

OTH PHYSEAL FRACTURE OF UPPER END OF LEFT FIBULA INIT

Page 355: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O334XX1

MATERN CARE FOR DISPROPRTN OF MIX MATERN & FETL ORIGIN FTS1

S89299A

OTH PHYSEAL FRACTURE OF UPPER END OF UNSP FIBULA INIT

O334XX2

MATERN CARE FOR DISPROPRTN OF MIX MATERN & FETL ORIGIN FTS2

S89301A

UNSP PHYSEAL FRACTURE OF LOWER END OF RIGHT FIBULA INIT

O334XX3

MATERN CARE FOR DISPROPRTN OF MIX MATERN & FETL ORIGIN FTS3

S89302A

UNSP PHYSEAL FRACTURE OF LOWER END OF LEFT FIBULA INIT

O334XX4

MATERN CARE FOR DISPROPRTN OF MIX MATERN & FETL ORIGIN FTS4

S89309A

UNSP PHYSEAL FRACTURE OF LOWER END OF UNSP FIBULA INIT

O334XX5

MATERN CARE FOR DISPROPRTN OF MIX MATERN & FETL ORIGIN FTS5

S89311A

SLTR-HARIS TYPE I PHYSEAL FX LOWER END OF R FIBULA INIT

O334XX9

MATERN CARE FOR DISPROPRTN OF MIX MATERN & FETL ORIGIN OTH

S89312A

SLTR-HARIS TYPE I PHYSEAL FX LOWER END OF LEFT FIBULA INIT

O335XX1

MATERN CARE FOR DISPROPRTN D/T UNUSUALLY LARGE FETUS FTS1

S89319A

SLTR-HARIS TYPE I PHYSEAL FX LOWER END OF UNSP FIBULA INIT

O335XX2

MATERN CARE FOR DISPROPRTN D/T UNUSUALLY LARGE FETUS FTS2

S89321A

SLTR-HARIS TYPE II PHYSEAL FX LOWER END OF R FIBULA INIT

O335XX3

MATERN CARE FOR DISPROPRTN D/T UNUSUALLY LARGE FETUS FTS3

S89322A

SLTR-HARIS TYPE II PHYSEAL FX LOWER END OF LEFT FIBULA INIT

O335XX4

MATERN CARE FOR DISPROPRTN D/T UNUSUALLY LARGE FETUS FTS4

S89329A

SLTR-HARIS TYPE II PHYSEAL FX LOWER END OF UNSP FIBULA INIT

O335XX5

MATERN CARE FOR DISPROPRTN D/T UNUSUALLY LARGE FETUS FTS5

S89391A

OTH PHYSEAL FRACTURE OF LOWER END OF RIGHT FIBULA INIT

O335XX9

MATERN CARE FOR DISPROPRTN DUE TO UNUSUALLY LARGE FETUS OTH

S89392A

OTH PHYSEAL FRACTURE OF LOWER END OF LEFT FIBULA INIT

Page 356: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O336XX1

MATERN CARE FOR DISPROPRTN DUE TO HYDROCEPHALIC FETUS FTS1

S89399A

OTH PHYSEAL FRACTURE OF LOWER END OF UNSP FIBULA INIT

O336XX2

MATERN CARE FOR DISPROPRTN DUE TO HYDROCEPHALIC FETUS FTS2

S91011A

LACERATION WITHOUT FOREIGN BODY RIGHT ANKLE INIT ENCNTR

O336XX3

MATERN CARE FOR DISPROPRTN DUE TO HYDROCEPHALIC FETUS FTS3

S91012A

LACERATION WITHOUT FOREIGN BODY LEFT ANKLE INIT ENCNTR

O336XX4

MATERN CARE FOR DISPROPRTN DUE TO HYDROCEPHALIC FETUS FTS4

S91019A

LACERATION WITHOUT FOREIGN BODY UNSP ANKLE INIT ENCNTR

O336XX5

MATERN CARE FOR DISPROPRTN DUE TO HYDROCEPHALIC FETUS FTS5

S91021A

LACERATION WITH FOREIGN BODY RIGHT ANKLE INITIAL ENCOUNTER

O336XX9

MATERNAL CARE FOR DISPROPRTN DUE TO HYDROCEPHALIC FETUS OTH

S91022A

LACERATION WITH FOREIGN BODY LEFT ANKLE INITIAL ENCOUNTER

O337

MATERNAL CARE FOR DISPROPORTION DUE TO OTH FETAL DEFORMITIES

S91029A

LACERATION WITH FOREIGN BODY UNSPECIFIED ANKLE INIT ENCNTR

O338

MATERNAL CARE FOR DISPROPORTION OF OTHER ORIGIN

S91031A

PUNCTURE WOUND W/O FOREIGN BODY RIGHT ANKLE INIT ENCNTR

O3401

MATERNAL CARE FOR UNSP CONGEN MALFORM OF UTERUS FIRST TRI

S91032A

PUNCTURE WOUND WITHOUT FOREIGN BODY LEFT ANKLE INIT ENCNTR

O3402

MATERNAL CARE FOR UNSP CONGEN MALFORM OF UTERUS SECOND TRI

S91039A

PUNCTURE WOUND WITHOUT FOREIGN BODY UNSP ANKLE INIT ENCNTR

O3403

MATERNAL CARE FOR UNSP CONGEN MALFORM OF UTERUS THIRD TRI

S91041A

PUNCTURE WOUND WITH FOREIGN BODY RIGHT ANKLE INIT ENCNTR

O3411

MATERNAL CARE FOR BENIGN TUMOR OF CORPUS UTERI FIRST TRI

S91042A

PUNCTURE WOUND WITH FOREIGN BODY LEFT ANKLE INIT ENCNTR

Page 357: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O3412

MATERNAL CARE FOR BENIGN TUMOR OF CORPUS UTERI SECOND TRI

S91049A

PUNCTURE WOUND WITH FOREIGN BODY UNSP ANKLE INIT ENCNTR

O3413

MATERNAL CARE FOR BENIGN TUMOR OF CORPUS UTERI THIRD TRI

S91051A

OPEN BITE RIGHT ANKLE INITIAL ENCOUNTER

O3421

MATERNAL CARE FOR SCAR FROM PREVIOUS CESAREAN DELIVERY

S91052A

OPEN BITE LEFT ANKLE INITIAL ENCOUNTER

O3429

MATERNAL CARE DUE TO UTERINE SCAR FROM OTH PREVIOUS SURGERY

S91059A

OPEN BITE UNSPECIFIED ANKLE INITIAL ENCOUNTER

O3431

MATERNAL CARE FOR CERVICAL INCOMPETENCE FIRST TRIMESTER

S91111A

LAC W/O FB OF RIGHT GREAT TOE W/O DAMAGE TO NAIL INIT

O3432

MATERNAL CARE FOR CERVICAL INCOMPETENCE SECOND TRIMESTER

S91112A

LACERATION W/O FB OF LEFT GREAT TOE W/O DAMAGE TO NAIL INIT

O3433

MATERNAL CARE FOR CERVICAL INCOMPETENCE THIRD TRIMESTER

S91113A

LACERATION W/O FB OF UNSP GREAT TOE W/O DAMAGE TO NAIL INIT

O3441

MATERNAL CARE FOR OTH ABNLT OF CERVIX FIRST TRIMESTER

S91114A

LAC W/O FB OF RIGHT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O3442

MATERNAL CARE FOR OTH ABNLT OF CERVIX SECOND TRIMESTER

S91115A

LAC W/O FB OF LEFT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O3443

MATERNAL CARE FOR OTH ABNLT OF CERVIX THIRD TRIMESTER

S91116A

LAC W/O FB OF UNSP LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O34511

MATERNAL CARE FOR INCARCERATION OF GRAVID UTERUS FIRST TRI

S91119A

LACERATION W/O FB OF UNSP TOE W/O DAMAGE TO NAIL INIT

O34512

MATERNAL CARE FOR INCARCERATION OF GRAVID UTERUS SECOND TRI

S91121A

LACERATION W FB OF RIGHT GREAT TOE W/O DAMAGE TO NAIL INIT

Page 358: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O34513

MATERNAL CARE FOR INCARCERATION OF GRAVID UTERUS THIRD TRI

S91122A

LACERATION W FB OF LEFT GREAT TOE W/O DAMAGE TO NAIL INIT

O34521

MATERNAL CARE FOR PROLAPSE OF GRAVID UTERUS FIRST TRIMESTER

S91123A

LACERATION W FB OF UNSP GREAT TOE W/O DAMAGE TO NAIL INIT

O34522

MATERNAL CARE FOR PROLAPSE OF GRAVID UTERUS SECOND TRI

S91124A

LAC W FB OF RIGHT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O34523

MATERNAL CARE FOR PROLAPSE OF GRAVID UTERUS THIRD TRIMESTER

S91125A

LAC W FB OF LEFT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O34531

MATERNAL CARE FOR RETROVERSION OF GRAVID UTERUS FIRST TRI

S91126A

LAC W FB OF UNSP LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O34532

MATERNAL CARE FOR RETROVERSION OF GRAVID UTERUS SECOND TRI

S91129A

LACERATION W FB OF UNSP TOE(S) W/O DAMAGE TO NAIL INIT

O34533

MATERNAL CARE FOR RETROVERSION OF GRAVID UTERUS THIRD TRI

S91131A

PNCTR W/O FB OF RIGHT GREAT TOE W/O DAMAGE TO NAIL INIT

O34591

MATERNAL CARE FOR OTH ABNLT OF GRAVID UTERUS FIRST TRI

S91132A

PNCTR W/O FB OF LEFT GREAT TOE W/O DAMAGE TO NAIL INIT

O34592

MATERNAL CARE FOR OTH ABNLT OF GRAVID UTERUS SECOND TRI

S91133A

PNCTR W/O FB OF UNSP GREAT TOE W/O DAMAGE TO NAIL INIT

O34593

MATERNAL CARE FOR OTH ABNLT OF GRAVID UTERUS THIRD TRI

S91134A

PNCTR W/O FB OF RIGHT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O3481

MATERNAL CARE FOR OTH ABNLT OF PELVIC ORGANS FIRST TRI

S91135A

PNCTR W/O FB OF LEFT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O3482

MATERNAL CARE FOR OTH ABNLT OF PELVIC ORGANS SECOND TRI

S91136A

PNCTR W/O FB OF UNSP LESSER TOE(S) W/O DAMAGE TO NAIL INIT

Page 359: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O3483

MATERNAL CARE FOR OTH ABNLT OF PELVIC ORGANS THIRD TRI

S91139A

PNCTR W/O FB OF UNSP TOE(S) W/O DAMAGE TO NAIL INIT

O3491 MATERNAL CARE FOR ABNLT OF PELVIC ORGAN UNSP FIRST TRI

S91141A

PNCTR W FB OF RIGHT GREAT TOE W/O DAMAGE TO NAIL INIT

O3492

MATERNAL CARE FOR ABNLT OF PELVIC ORGAN UNSP SECOND TRI

S91142A

PNCTR W FB OF LEFT GREAT TOE W/O DAMAGE TO NAIL INIT

O3493 MATERNAL CARE FOR ABNLT OF PELVIC ORGAN UNSP THIRD TRI

S91143A

PNCTR W FB OF UNSP GREAT TOE W/O DAMAGE TO NAIL INIT

O353XX1

MATERN CARE FOR DAMAG TO FTS FROM VIRAL DIS IN MOTHER FTS1

S91144A

PNCTR W FB OF RIGHT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O353XX2

MATERN CARE FOR DAMAG TO FTS FROM VIRAL DIS IN MOTHER FTS2

S91145A

PNCTR W FB OF LEFT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O353XX3

MATERN CARE FOR DAMAG TO FTS FROM VIRAL DIS IN MOTHER FTS3

S91146A

PNCTR W FB OF UNSP LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O353XX4

MATERN CARE FOR DAMAG TO FTS FROM VIRAL DIS IN MOTHER FTS4

S91149A

PNCTR W FOREIGN BODY OF UNSP TOE(S) W/O DAMAGE TO NAIL INIT

O353XX5

MATERN CARE FOR DAMAG TO FTS FROM VIRAL DIS IN MOTHER FTS5

S91151A

OPEN BITE OF RIGHT GREAT TOE W/O DAMAGE TO NAIL INIT ENCNTR

O353XX9

MATERN CARE FOR DAMAG TO FETUS FROM VIRAL DIS IN MOTHER OTH

S91152A

OPEN BITE OF LEFT GREAT TOE W/O DAMAGE TO NAIL INIT ENCNTR

O3621X1

MATERNAL CARE FOR HYDROPS FETALIS FIRST TRIMESTER FETUS 1

S91153A

OPEN BITE OF UNSP GREAT TOE W/O DAMAGE TO NAIL INIT ENCNTR

O3621X2

MATERNAL CARE FOR HYDROPS FETALIS FIRST TRIMESTER FETUS 2

S91154A

OPEN BITE OF RIGHT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O3621X3

MATERNAL CARE FOR HYDROPS FETALIS FIRST TRIMESTER FETUS 3

S91155A

OPEN BITE OF LEFT LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O3621X4

MATERNAL CARE FOR HYDROPS FETALIS FIRST TRIMESTER FETUS 4

S91156A

OPEN BITE OF UNSP LESSER TOE(S) W/O DAMAGE TO NAIL INIT

O3621X5

MATERNAL CARE FOR HYDROPS FETALIS FIRST TRIMESTER FETUS 5

S91159A

OPEN BITE OF UNSP TOE(S) WITHOUT DAMAGE TO NAIL INIT ENCNTR

O3621X9 MATERNAL CARE FOR HYDROPS FETALIS FIRST TRIMESTER OTH

S91211A

LACERATION W/O FB OF RIGHT GREAT TOE W DAMAGE TO NAIL INIT

O3622X1

MATERNAL CARE FOR HYDROPS FETALIS SECOND TRIMESTER FETUS 1

S91212A

LACERATION W/O FB OF LEFT GREAT TOE W DAMAGE TO NAIL INIT

O3622X2

MATERNAL CARE FOR HYDROPS FETALIS SECOND TRIMESTER FETUS 2

S91213A

LACERATION W/O FB OF UNSP GREAT TOE W DAMAGE TO NAIL INIT

O3622X3

MATERNAL CARE FOR HYDROPS FETALIS SECOND TRIMESTER FETUS 3

S91214A

LAC W/O FB OF RIGHT LESSER TOE(S) W DAMAGE TO NAIL INIT

O3622X4

MATERNAL CARE FOR HYDROPS FETALIS SECOND TRIMESTER FETUS 4

S91215A

LAC W/O FB OF LEFT LESSER TOE(S) W DAMAGE TO NAIL INIT

O3622X5

MATERNAL CARE FOR HYDROPS FETALIS SECOND TRIMESTER FETUS 5

S91216A

LAC W/O FB OF UNSP LESSER TOE(S) W DAMAGE TO NAIL INIT

O3622X9

MATERNAL CARE FOR HYDROPS FETALIS SECOND TRIMESTER OTH

S91219A

LACERATION W/O FB OF UNSP TOE(S) W DAMAGE TO NAIL INIT

O3623X1

MATERNAL CARE FOR HYDROPS FETALIS THIRD TRIMESTER FETUS 1

S91221A

LACERATION W FB OF RIGHT GREAT TOE W DAMAGE TO NAIL INIT

O3623X2

MATERNAL CARE FOR HYDROPS FETALIS THIRD TRIMESTER FETUS 2

S91222A

LACERATION W FB OF LEFT GREAT TOE W DAMAGE TO NAIL INIT

Page 361: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O3623X3

MATERNAL CARE FOR HYDROPS FETALIS THIRD TRIMESTER FETUS 3

S91223A

LACERATION W FB OF UNSP GREAT TOE W DAMAGE TO NAIL INIT

O3623X4

MATERNAL CARE FOR HYDROPS FETALIS THIRD TRIMESTER FETUS 4

S91224A

LAC W FB OF RIGHT LESSER TOE(S) W DAMAGE TO NAIL INIT

O3623X5

MATERNAL CARE FOR HYDROPS FETALIS THIRD TRIMESTER FETUS 5

S91225A

LACERATION W FB OF LEFT LESSER TOE(S) W DAMAGE TO NAIL INIT

O3623X9 MATERNAL CARE FOR HYDROPS FETALIS THIRD TRIMESTER OTH

S91226A

LACERATION W FB OF UNSP LESSER TOE(S) W DAMAGE TO NAIL INIT

O364XX1 MATERNAL CARE FOR INTRAUTERINE DEATH FETUS 1

S91229A

LACERATION W FB OF UNSP TOE(S) W DAMAGE TO NAIL INIT

O364XX2 MATERNAL CARE FOR INTRAUTERINE DEATH FETUS 2

S91231A

PNCTR W/O FB OF RIGHT GREAT TOE W DAMAGE TO NAIL INIT

O364XX3 MATERNAL CARE FOR INTRAUTERINE DEATH FETUS 3

S91232A

PNCTR W/O FB OF LEFT GREAT TOE W DAMAGE TO NAIL INIT

O364XX4 MATERNAL CARE FOR INTRAUTERINE DEATH FETUS 4

S91233A

PNCTR W/O FB OF UNSP GREAT TOE W DAMAGE TO NAIL INIT

O364XX5 MATERNAL CARE FOR INTRAUTERINE DEATH FETUS 5

S91234A

PNCTR W/O FB OF RIGHT LESSER TOE(S) W DAMAGE TO NAIL INIT

O364XX9

MATERNAL CARE FOR INTRAUTERINE DEATH OTHER FETUS

S91235A

PNCTR W/O FB OF LEFT LESSER TOE(S) W DAMAGE TO NAIL INIT

O365111

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 1ST TRI FTS1

S91236A

PNCTR W/O FB OF UNSP LESSER TOE(S) W DAMAGE TO NAIL INIT

O365112

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 1ST TRI FTS2

S91239A

PNCTR W/O FOREIGN BODY OF UNSP TOE(S) W DAMAGE TO NAIL INIT

O365113

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 1ST TRI FTS3

S91241A

PNCTR W FB OF RIGHT GREAT TOE W DAMAGE TO NAIL INIT

O365114

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 1ST TRI FTS4

S91242A

PNCTR W FB OF LEFT GREAT TOE W DAMAGE TO NAIL INIT

Page 362: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O365115

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 1ST TRI FTS5

S91243A

PNCTR W FB OF UNSP GREAT TOE W DAMAGE TO NAIL INIT

O365119

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF FIRST TRI OTH

S91244A

PNCTR W FB OF RIGHT LESSER TOE(S) W DAMAGE TO NAIL INIT

O365121

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 2ND TRI FTS1

S91245A

PNCTR W FB OF LEFT LESSER TOE(S) W DAMAGE TO NAIL INIT

O365122

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 2ND TRI FTS2

S91246A

PNCTR W FB OF UNSP LESSER TOE(S) W DAMAGE TO NAIL INIT

O365123

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 2ND TRI FTS3

S91249A

PNCTR W FOREIGN BODY OF UNSP TOE(S) W DAMAGE TO NAIL INIT

O365124

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 2ND TRI FTS4

S91251A

OPEN BITE OF RIGHT GREAT TOE W DAMAGE TO NAIL INIT ENCNTR

O365125

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 2ND TRI FTS5

S91252A

OPEN BITE OF LEFT GREAT TOE WITH DAMAGE TO NAIL INIT ENCNTR

O365129

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF 2ND TRI OTH

S91253A

OPEN BITE OF UNSP GREAT TOE WITH DAMAGE TO NAIL INIT ENCNTR

O365131

MATERN CARE FOR OR SUSP PLACNTL INSUFF THIRD TRI FTS1

S91254A

OPEN BITE OF RIGHT LESSER TOE(S) W DAMAGE TO NAIL INIT

O365132

MATERN CARE FOR OR SUSP PLACNTL INSUFF THIRD TRI FTS2

S91255A

OPEN BITE OF LEFT LESSER TOE(S) W DAMAGE TO NAIL INIT

O365133

MATERN CARE FOR OR SUSP PLACNTL INSUFF THIRD TRI FTS3

S91256A

OPEN BITE OF UNSP LESSER TOE(S) W DAMAGE TO NAIL INIT

O365134

MATERN CARE FOR OR SUSP PLACNTL INSUFF THIRD TRI FTS4

S91259A

OPEN BITE OF UNSP TOE(S) WITH DAMAGE TO NAIL INIT ENCNTR

Page 363: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O365135

MATERN CARE FOR OR SUSP PLACNTL INSUFF THIRD TRI FTS5

S91311A

LACERATION WITHOUT FOREIGN BODY RIGHT FOOT INIT ENCNTR

O365139

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF THIRD TRI OTH

S91312A

LACERATION WITHOUT FOREIGN BODY LEFT FOOT INIT ENCNTR

O365191

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF UNSP TRI FTS1

S91319A

LACERATION WITHOUT FOREIGN BODY UNSP FOOT INIT ENCNTR

O365192

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF UNSP TRI FTS2

S91321A

LACERATION WITH FOREIGN BODY RIGHT FOOT INITIAL ENCOUNTER

O365193

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF UNSP TRI FTS3

S91322A

LACERATION WITH FOREIGN BODY LEFT FOOT INITIAL ENCOUNTER

O365194

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF UNSP TRI FTS4

S91329A

LACERATION WITH FOREIGN BODY UNSPECIFIED FOOT INIT ENCNTR

O365195

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF UNSP TRI FTS5

S91331A

PUNCTURE WOUND WITHOUT FOREIGN BODY RIGHT FOOT INIT ENCNTR

O365199

MATERN CARE FOR KNOWN OR SUSP PLACNTL INSUFF UNSP TRI OTH

S91332A

PUNCTURE WOUND WITHOUT FOREIGN BODY LEFT FOOT INIT ENCNTR

O368121

DECREASED FETAL MOVEMENTS SECOND TRIMESTER FETUS 1

S91339A

PUNCTURE WOUND WITHOUT FOREIGN BODY UNSP FOOT INIT ENCNTR

O368122

DECREASED FETAL MOVEMENTS SECOND TRIMESTER FETUS 2

S91341A

PUNCTURE WOUND WITH FOREIGN BODY RIGHT FOOT INIT ENCNTR

O368123

DECREASED FETAL MOVEMENTS SECOND TRIMESTER FETUS 3

S91342A

PUNCTURE WOUND WITH FOREIGN BODY LEFT FOOT INIT ENCNTR

O368124

DECREASED FETAL MOVEMENTS SECOND TRIMESTER FETUS 4

S91349A

PUNCTURE WOUND WITH FOREIGN BODY UNSP FOOT INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O368125

DECREASED FETAL MOVEMENTS SECOND TRIMESTER FETUS 5

S91351A

OPEN BITE RIGHT FOOT INITIAL ENCOUNTER

O368129

DECREASED FETAL MOVEMENTS SECOND TRIMESTER OTHER FETUS

S91352A

OPEN BITE LEFT FOOT INITIAL ENCOUNTER

O368131

DECREASED FETAL MOVEMENTS THIRD TRIMESTER FETUS 1

S92001A

UNSP FRACTURE OF RIGHT CALCANEUS INIT FOR CLOS FX

O368132

DECREASED FETAL MOVEMENTS THIRD TRIMESTER FETUS 2

S92001B

UNSP FRACTURE OF RIGHT CALCANEUS INIT FOR OPN FX

O368133

DECREASED FETAL MOVEMENTS THIRD TRIMESTER FETUS 3

S92002A

UNSP FRACTURE OF LEFT CALCANEUS INIT FOR CLOS FX

O368134

DECREASED FETAL MOVEMENTS THIRD TRIMESTER FETUS 4

S92002B

UNSP FRACTURE OF LEFT CALCANEUS INIT FOR OPN FX

O368135

DECREASED FETAL MOVEMENTS THIRD TRIMESTER FETUS 5

S92009A

UNSP FRACTURE OF UNSP CALCANEUS INIT FOR CLOS FX

O368139

DECREASED FETAL MOVEMENTS THIRD TRIMESTER OTHER FETUS

S92009B

UNSP FRACTURE OF UNSP CALCANEUS INIT FOR OPN FX

O368191

DECREASED FETAL MOVEMENTS UNSPECIFIED TRIMESTER FETUS 1

S92011A

DISP FX OF BODY OF RIGHT CALCANEUS INIT FOR CLOS FX

O368192

DECREASED FETAL MOVEMENTS UNSPECIFIED TRIMESTER FETUS 2

S92011B

DISP FX OF BODY OF RIGHT CALCANEUS INIT FOR OPN FX

O368193

DECREASED FETAL MOVEMENTS UNSPECIFIED TRIMESTER FETUS 3

S92012A

DISP FX OF BODY OF LEFT CALCANEUS INIT FOR CLOS FX

O368194

DECREASED FETAL MOVEMENTS UNSPECIFIED TRIMESTER FETUS 4

S92012B

DISP FX OF BODY OF LEFT CALCANEUS INIT FOR OPN FX

Page 365: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O368195

DECREASED FETAL MOVEMENTS UNSPECIFIED TRIMESTER FETUS 5

S92013A

DISP FX OF BODY OF UNSP CALCANEUS INIT FOR CLOS FX

O368199

DECREASED FETAL MOVEMENTS UNSP TRIMESTER OTHER FETUS

S92013B

DISP FX OF BODY OF UNSP CALCANEUS INIT FOR OPN FX

O368910

MATERNAL CARE FOR OTH FETAL PROBLEMS FIRST TRIMESTER UNSP

S92014A

NONDISP FX OF BODY OF RIGHT CALCANEUS INIT FOR CLOS FX

O368911

MATERNAL CARE FOR OTH FETAL PROBLEMS FIRST TRI FETUS 1

S92014B

NONDISP FX OF BODY OF RIGHT CALCANEUS INIT FOR OPN FX

O368912

MATERNAL CARE FOR OTH FETAL PROBLEMS FIRST TRI FETUS 2

S92015A

NONDISP FX OF BODY OF LEFT CALCANEUS INIT FOR CLOS FX

O368913

MATERNAL CARE FOR OTH FETAL PROBLEMS FIRST TRI FETUS 3

S92015B

NONDISP FX OF BODY OF LEFT CALCANEUS INIT FOR OPN FX

O368914

MATERNAL CARE FOR OTH FETAL PROBLEMS FIRST TRI FETUS 4

S92016A

NONDISP FX OF BODY OF UNSP CALCANEUS INIT FOR CLOS FX

O368915

MATERNAL CARE FOR OTH FETAL PROBLEMS FIRST TRI FETUS 5

S92016B

NONDISP FX OF BODY OF UNSP CALCANEUS INIT FOR OPN FX

O368919

MATERNAL CARE FOR OTH FETAL PROBLEMS FIRST TRIMESTER OTH

S92021A

DISP FX OF ANTERIOR PROCESS OF RIGHT CALCANEUS INIT

O368921

MATERNAL CARE FOR OTH FETAL PROBLEMS SECOND TRI FETUS 1

S92021B

DISP FX OF ANTERIOR PROCESS OF R CALCANEUS INIT FOR OPN FX

O368922

MATERNAL CARE FOR OTH FETAL PROBLEMS SECOND TRI FETUS 2

S92022A

DISP FX OF ANTERIOR PROCESS OF LEFT CALCANEUS INIT

O368923

MATERNAL CARE FOR OTH FETAL PROBLEMS SECOND TRI FETUS 3

S92022B

DISP FX OF ANTERIOR PROCESS OF L CALCANEUS INIT FOR OPN FX

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O368924

MATERNAL CARE FOR OTH FETAL PROBLEMS SECOND TRI FETUS 4

S92023A

DISP FX OF ANTERIOR PROCESS OF UNSP CALCANEUS INIT

O368925

MATERNAL CARE FOR OTH FETAL PROBLEMS SECOND TRI FETUS 5

S92023B

DISP FX OF ANT PROCESS OF UNSP CALCANEUS INIT FOR OPN FX

O368929

MATERNAL CARE FOR OTH FETAL PROBLEMS SECOND TRIMESTER OTH

S92024A

NONDISP FX OF ANTERIOR PROCESS OF RIGHT CALCANEUS INIT

O368931

MATERNAL CARE FOR OTH FETAL PROBLEMS THIRD TRI FETUS 1

S92024B

NONDISP FX OF ANT PROCESS OF R CALCANEUS INIT FOR OPN FX

O368932

MATERNAL CARE FOR OTH FETAL PROBLEMS THIRD TRI FETUS 2

S92025A

NONDISP FX OF ANTERIOR PROCESS OF LEFT CALCANEUS INIT

O368933

MATERNAL CARE FOR OTH FETAL PROBLEMS THIRD TRI FETUS 3

S92025B

NONDISP FX OF ANT PROCESS OF L CALCANEUS INIT FOR OPN FX

O368934

MATERNAL CARE FOR OTH FETAL PROBLEMS THIRD TRI FETUS 4

S92026A

NONDISP FX OF ANTERIOR PROCESS OF UNSP CALCANEUS INIT

O368935

MATERNAL CARE FOR OTH FETAL PROBLEMS THIRD TRI FETUS 5

S92026B

NONDISP FX OF ANT PROCESS OF UNSP CALCANEUS INIT FOR OPN FX

O368939

MATERNAL CARE FOR OTH FETAL PROBLEMS THIRD TRIMESTER OTH

S92031A

DISPLACED AVULSION FX TUBEROSITY OF R CALCANEUS INIT

O368991

MATERNAL CARE FOR OTH FETAL PROBLEMS UNSP TRI FETUS 1

S92031B

DISPL AVULSION FX TUBEROSITY OF R CALCANEUS INIT FOR OPN FX

O368992

MATERNAL CARE FOR OTH FETAL PROBLEMS UNSP TRI FETUS 2

S92032A

DISPLACED AVULSION FX TUBEROSITY OF L CALCANEUS INIT

O368993

MATERNAL CARE FOR OTH FETAL PROBLEMS UNSP TRI FETUS 3

S92032B

DISPL AVULSION FX TUBEROSITY OF L CALCANEUS INIT FOR OPN FX

Page 367: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O368994

MATERNAL CARE FOR OTH FETAL PROBLEMS UNSP TRI FETUS 4

S92033A

DISPLACED AVULSION FX TUBEROSITY OF UNSP CALCANEUS INIT

O368995

MATERNAL CARE FOR OTH FETAL PROBLEMS UNSP TRI FETUS 5

S92033B

DISPL AVULS FX TUBEROSITY OF UNSP CALCANEUS INIT FOR OPN FX

O368999

MATERNAL CARE FOR OTH FETAL PROBLEMS UNSP TRIMESTER OTH

S92034A

NONDISP AVULSION FRACTURE OF TUBEROSITY OF R CALCANEUS INIT

O3690X1

MATERNAL CARE FOR FETAL PROBLEM UNSP UNSP TRI FETUS 1

S92034B

NONDISP AVULS FX TUBEROSITY OF R CALCANEUS INIT FOR OPN FX

O3690X2

MATERNAL CARE FOR FETAL PROBLEM UNSP UNSP TRI FETUS 2

S92035A

NONDISP AVULSION FRACTURE OF TUBEROSITY OF L CALCANEUS INIT

O3690X3

MATERNAL CARE FOR FETAL PROBLEM UNSP UNSP TRI FETUS 3

S92035B

NONDISP AVULS FX TUBEROSITY OF L CALCANEUS INIT FOR OPN FX

O3690X4

MATERNAL CARE FOR FETAL PROBLEM UNSP UNSP TRI FETUS 4

S92036A

NONDISP AVULSION FX TUBEROSITY OF UNSP CALCANEUS INIT

O3690X5

MATERNAL CARE FOR FETAL PROBLEM UNSP UNSP TRI FETUS 5

S92036B

NONDISP AVULS FX TUBEROSITY OF UNSP CALCANEUS 7THB

O3690X9

MATERNAL CARE FOR FETAL PROBLEM UNSP UNSP TRIMESTER OTH

S92041A

DISPLACED OTH FRACTURE OF TUBEROSITY OF R CALCANEUS INIT

O3691X1

MATERNAL CARE FOR FETAL PROBLEM UNSP FIRST TRI FETUS 1

S92041B

DISPLACED OTH FX TUBEROSITY OF R CALCANEUS INIT FOR OPN FX

O3691X2

MATERNAL CARE FOR FETAL PROBLEM UNSP FIRST TRI FETUS 2

S92042A

DISPLACED OTH FRACTURE OF TUBEROSITY OF LEFT CALCANEUS INIT

O3691X3

MATERNAL CARE FOR FETAL PROBLEM UNSP FIRST TRI FETUS 3

S92042B

DISPLACED OTH FX TUBEROSITY OF L CALCANEUS INIT FOR OPN FX

Page 368: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O3691X4

MATERNAL CARE FOR FETAL PROBLEM UNSP FIRST TRI FETUS 4

S92043A

DISPLACED OTH FRACTURE OF TUBEROSITY OF UNSP CALCANEUS INIT

O3691X5

MATERNAL CARE FOR FETAL PROBLEM UNSP FIRST TRI FETUS 5

S92043B

DISPL OTH FX TUBEROSITY OF UNSP CALCANEUS INIT FOR OPN FX

O3691X9

MATERNAL CARE FOR FETAL PROBLEM UNSP FIRST TRIMESTER OTH

S92044A

NONDISPLACED OTH FRACTURE OF TUBEROSITY OF R CALCANEUS INIT

O3692X0

MATERNAL CARE FOR FETAL PROBLEM UNSP SECOND TRI UNSP

S92044B

NONDISP OTH FX TUBEROSITY OF R CALCANEUS INIT FOR OPN FX

O3692X1

MATERNAL CARE FOR FETAL PROBLEM UNSP SECOND TRI FETUS 1

S92045A

NONDISPLACED OTH FRACTURE OF TUBEROSITY OF L CALCANEUS INIT

O3692X2

MATERNAL CARE FOR FETAL PROBLEM UNSP SECOND TRI FETUS 2

S92045B

NONDISP OTH FX TUBEROSITY OF L CALCANEUS INIT FOR OPN FX

O3692X3

MATERNAL CARE FOR FETAL PROBLEM UNSP SECOND TRI FETUS 3

S92046A

NONDISP OTH FRACTURE OF TUBEROSITY OF UNSP CALCANEUS INIT

O3692X4

MATERNAL CARE FOR FETAL PROBLEM UNSP SECOND TRI FETUS 4

S92046B

NONDISP OTH FX TUBEROSITY OF UNSP CALCANEUS INIT FOR OPN FX

O3692X5

MATERNAL CARE FOR FETAL PROBLEM UNSP SECOND TRI FETUS 5

S92051A

DISPLACED OTH EXTRAARTICULAR FRACTURE OF R CALCANEUS INIT

O3692X9

MATERNAL CARE FOR FETAL PROBLEM UNSP SECOND TRIMESTER OTH

S92051B

DISPLACED OTH EXTRARTIC FX R CALCANEUS INIT FOR OPN FX

O3693X1

MATERNAL CARE FOR FETAL PROBLEM UNSP THIRD TRI FETUS 1

S92052A

DISPLACED OTH EXTRARTIC FRACTURE OF LEFT CALCANEUS INIT

O3693X2

MATERNAL CARE FOR FETAL PROBLEM UNSP THIRD TRI FETUS 2

S92052B

DISPLACED OTH EXTRARTIC FX L CALCANEUS INIT FOR OPN FX

Page 369: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O3693X3

MATERNAL CARE FOR FETAL PROBLEM UNSP THIRD TRI FETUS 3

S92053A

DISPLACED OTH EXTRARTIC FRACTURE OF UNSP CALCANEUS INIT

O3693X4

MATERNAL CARE FOR FETAL PROBLEM UNSP THIRD TRI FETUS 4

S92053B

DISPLACED OTH EXTRARTIC FX UNSP CALCANEUS INIT FOR OPN FX

O3693X5

MATERNAL CARE FOR FETAL PROBLEM UNSP THIRD TRI FETUS 5

S92054A

NONDISPLACED OTH EXTRARTIC FRACTURE OF R CALCANEUS INIT

O3693X9

MATERNAL CARE FOR FETAL PROBLEM UNSP THIRD TRIMESTER OTH

S92054B

NONDISP OTH EXTRARTIC FX R CALCANEUS INIT FOR OPN FX

O401XX1 POLYHYDRAMNIOS FIRST TRIMESTER FETUS 1

S92055A

NONDISPLACED OTH EXTRARTIC FRACTURE OF LEFT CALCANEUS INIT

O401XX2 POLYHYDRAMNIOS FIRST TRIMESTER FETUS 2

S92055B

NONDISP OTH EXTRARTIC FX L CALCANEUS INIT FOR OPN FX

O401XX3 POLYHYDRAMNIOS FIRST TRIMESTER FETUS 3

S92056A

NONDISPLACED OTH EXTRARTIC FRACTURE OF UNSP CALCANEUS INIT

O401XX4 POLYHYDRAMNIOS FIRST TRIMESTER FETUS 4

S92056B

NONDISP OTH EXTRARTIC FX UNSP CALCANEUS INIT FOR OPN FX

O401XX5 POLYHYDRAMNIOS FIRST TRIMESTER FETUS 5

S92061A

DISPLACED INTRAARTICULAR FRACTURE OF RIGHT CALCANEUS INIT

O401XX9 POLYHYDRAMNIOS FIRST TRIMESTER OTHER FETUS

S92061B

DISPLACED INTARTIC FRACTURE OF R CALCANEUS INIT FOR OPN FX

O402XX1 POLYHYDRAMNIOS SECOND TRIMESTER FETUS 1

S92062A

DISPLACED INTRAARTICULAR FRACTURE OF LEFT CALCANEUS INIT

O402XX2 POLYHYDRAMNIOS SECOND TRIMESTER FETUS 2

S92062B

DISPLACED INTARTIC FRACTURE OF L CALCANEUS INIT FOR OPN FX

O402XX3 POLYHYDRAMNIOS SECOND TRIMESTER FETUS 3

S92063A

DISPLACED INTRAARTICULAR FRACTURE OF UNSP CALCANEUS INIT

Page 370: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O402XX4 POLYHYDRAMNIOS SECOND TRIMESTER FETUS 4

S92063B

DISPLACED INTARTIC FX UNSP CALCANEUS INIT FOR OPN FX

O402XX5 POLYHYDRAMNIOS SECOND TRIMESTER FETUS 5

S92064A

NONDISPLACED INTRAARTICULAR FRACTURE OF R CALCANEUS INIT

O402XX9 POLYHYDRAMNIOS SECOND TRIMESTER OTHER FETUS

S92064B

NONDISP INTARTIC FRACTURE OF R CALCANEUS INIT FOR OPN FX

O403XX1 POLYHYDRAMNIOS THIRD TRIMESTER FETUS 1

S92065A

NONDISPLACED INTRAARTICULAR FRACTURE OF LEFT CALCANEUS INIT

O403XX2 POLYHYDRAMNIOS THIRD TRIMESTER FETUS 2

S92065B

NONDISP INTARTIC FRACTURE OF L CALCANEUS INIT FOR OPN FX

O403XX3 POLYHYDRAMNIOS THIRD TRIMESTER FETUS 3

S92066A

NONDISPLACED INTRAARTICULAR FRACTURE OF UNSP CALCANEUS INIT

O403XX4 POLYHYDRAMNIOS THIRD TRIMESTER FETUS 4

S92066B

NONDISP INTARTIC FRACTURE OF UNSP CALCANEUS INIT FOR OPN FX

O403XX5 POLYHYDRAMNIOS THIRD TRIMESTER FETUS 5

S92101A

UNSP FRACTURE OF RIGHT TALUS INIT FOR CLOS FX

O403XX9 POLYHYDRAMNIOS THIRD TRIMESTER OTHER FETUS

S92101B

UNSP FRACTURE OF RIGHT TALUS INIT ENCNTR FOR OPEN FRACTURE

O409XX1

POLYHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 1

S92102A

UNSP FRACTURE OF LEFT TALUS INIT ENCNTR FOR CLOSED FRACTURE

O409XX2

POLYHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 2

S92102B

UNSP FRACTURE OF LEFT TALUS INIT ENCNTR FOR OPEN FRACTURE

O409XX3

POLYHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 3

S92109A

UNSP FRACTURE OF UNSP TALUS INIT ENCNTR FOR CLOSED FRACTURE

O409XX4

POLYHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 4

S92109B

UNSP FRACTURE OF UNSP TALUS INIT ENCNTR FOR OPEN FRACTURE

O409XX5

POLYHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 5

S92111A

DISP FX OF NECK OF RIGHT TALUS INIT FOR CLOS FX

Page 371: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O409XX9

POLYHYDRAMNIOS UNSPECIFIED TRIMESTER OTHER FETUS

S92111B

DISP FX OF NECK OF RIGHT TALUS INIT FOR OPN FX

O4100X1

OLIGOHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 1

S92112A

DISP FX OF NECK OF LEFT TALUS INIT FOR CLOS FX

O4100X2

OLIGOHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 2

S92112B

DISP FX OF NECK OF LEFT TALUS INIT ENCNTR FOR OPEN FRACTURE

O4100X3

OLIGOHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 3

S92113A

DISP FX OF NECK OF UNSP TALUS INIT FOR CLOS FX

O4100X4

OLIGOHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 4

S92113B

DISP FX OF NECK OF UNSP TALUS INIT ENCNTR FOR OPEN FRACTURE

O4100X5

OLIGOHYDRAMNIOS UNSPECIFIED TRIMESTER FETUS 5

S92114A

NONDISP FX OF NECK OF RIGHT TALUS INIT FOR CLOS FX

O4100X9

OLIGOHYDRAMNIOS UNSPECIFIED TRIMESTER OTHER FETUS

S92114B

NONDISP FX OF NECK OF RIGHT TALUS INIT FOR OPN FX

O4101X1 OLIGOHYDRAMNIOS FIRST TRIMESTER FETUS 1

S92115A

NONDISP FX OF NECK OF LEFT TALUS INIT FOR CLOS FX

O4101X2 OLIGOHYDRAMNIOS FIRST TRIMESTER FETUS 2

S92115B

NONDISP FX OF NECK OF LEFT TALUS INIT FOR OPN FX

O4101X3 OLIGOHYDRAMNIOS FIRST TRIMESTER FETUS 3

S92116A

NONDISP FX OF NECK OF UNSP TALUS INIT FOR CLOS FX

O4101X4 OLIGOHYDRAMNIOS FIRST TRIMESTER FETUS 4

S92116B

NONDISP FX OF NECK OF UNSP TALUS INIT FOR OPN FX

O4101X5 OLIGOHYDRAMNIOS FIRST TRIMESTER FETUS 5

S92121A

DISP FX OF BODY OF RIGHT TALUS INIT FOR CLOS FX

O4101X9 OLIGOHYDRAMNIOS FIRST TRIMESTER OTHER FETUS

S92121B

DISP FX OF BODY OF RIGHT TALUS INIT FOR OPN FX

O4102X1 OLIGOHYDRAMNIOS SECOND TRIMESTER FETUS 1

S92122A

DISP FX OF BODY OF LEFT TALUS INIT FOR CLOS FX

Page 372: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O4102X2 OLIGOHYDRAMNIOS SECOND TRIMESTER FETUS 2

S92122B

DISP FX OF BODY OF LEFT TALUS INIT ENCNTR FOR OPEN FRACTURE

O4102X3 OLIGOHYDRAMNIOS SECOND TRIMESTER FETUS 3

S92123A

DISP FX OF BODY OF UNSP TALUS INIT FOR CLOS FX

O4102X4 OLIGOHYDRAMNIOS SECOND TRIMESTER FETUS 4

S92123B

DISP FX OF BODY OF UNSP TALUS INIT ENCNTR FOR OPEN FRACTURE

O4102X5 OLIGOHYDRAMNIOS SECOND TRIMESTER FETUS 5

S92124A

NONDISP FX OF BODY OF RIGHT TALUS INIT FOR CLOS FX

O4102X9 OLIGOHYDRAMNIOS SECOND TRIMESTER OTHER FETUS

S92124B

NONDISP FX OF BODY OF RIGHT TALUS INIT FOR OPN FX

O4103X1 OLIGOHYDRAMNIOS THIRD TRIMESTER FETUS 1

S92125A

NONDISP FX OF BODY OF LEFT TALUS INIT FOR CLOS FX

O4103X2 OLIGOHYDRAMNIOS THIRD TRIMESTER FETUS 2

S92125B

NONDISP FX OF BODY OF LEFT TALUS INIT FOR OPN FX

O4103X3 OLIGOHYDRAMNIOS THIRD TRIMESTER FETUS 3

S92126A

NONDISP FX OF BODY OF UNSP TALUS INIT FOR CLOS FX

O4103X4 OLIGOHYDRAMNIOS THIRD TRIMESTER FETUS 4

S92126B

NONDISP FX OF BODY OF UNSP TALUS INIT FOR OPN FX

O4103X5 OLIGOHYDRAMNIOS THIRD TRIMESTER FETUS 5

S92131A

DISP FX OF POSTERIOR PROCESS OF RIGHT TALUS INIT

O4103X9 OLIGOHYDRAMNIOS THIRD TRIMESTER OTHER FETUS

S92131B

DISP FX OF POSTERIOR PROCESS OF RIGHT TALUS INIT FOR OPN FX

O411010

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP FIRST TRI UNSP

S92132A

DISP FX OF POSTERIOR PROCESS OF LEFT TALUS INIT FOR CLOS FX

O411011

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP FIRST TRI FETUS 1

S92132B

DISP FX OF POSTERIOR PROCESS OF LEFT TALUS INIT FOR OPN FX

O411012

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP FIRST TRI FETUS 2

S92133A

DISP FX OF POSTERIOR PROCESS OF UNSP TALUS INIT FOR CLOS FX

O411013

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP FIRST TRI FETUS 3

S92133B

DISP FX OF POSTERIOR PROCESS OF UNSP TALUS INIT FOR OPN FX

Page 373: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O411014

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP FIRST TRI FETUS 4

S92134A

NONDISP FX OF POSTERIOR PROCESS OF RIGHT TALUS INIT

O411015

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP FIRST TRI FETUS 5

S92134B

NONDISP FX OF POST PROCESS OF RIGHT TALUS INIT FOR OPN FX

O411019 INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP FIRST TRI OTH

S92135A

NONDISP FX OF POSTERIOR PROCESS OF LEFT TALUS INIT

O411021

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP SECOND TRI FETUS 1

S92135B

NONDISP FX OF POST PROCESS OF LEFT TALUS INIT FOR OPN FX

O411022

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP SECOND TRI FETUS 2

S92136A

NONDISP FX OF POSTERIOR PROCESS OF UNSP TALUS INIT

O411023

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP SECOND TRI FETUS 3

S92136B

NONDISP FX OF POST PROCESS OF UNSP TALUS INIT FOR OPN FX

O411024

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP SECOND TRI FETUS 4

S92141A

DISPLACED DOME FRACTURE OF RIGHT TALUS INIT FOR CLOS FX

O411025

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP SECOND TRI FETUS 5

S92141B

DISPLACED DOME FRACTURE OF RIGHT TALUS INIT FOR OPN FX

O411029

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP SECOND TRI OTH

S92142A

DISPLACED DOME FRACTURE OF LEFT TALUS INIT FOR CLOS FX

O411031

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP THIRD TRI FETUS 1

S92142B

DISPLACED DOME FRACTURE OF LEFT TALUS INIT FOR OPN FX

O411032

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP THIRD TRI FETUS 2

S92143A

DISPLACED DOME FRACTURE OF UNSP TALUS INIT FOR CLOS FX

O411033

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP THIRD TRI FETUS 3

S92143B

DISPLACED DOME FRACTURE OF UNSP TALUS INIT FOR OPN FX

Page 374: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O411034

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP THIRD TRI FETUS 4

S92144A

NONDISPLACED DOME FRACTURE OF RIGHT TALUS INIT FOR CLOS FX

O411035

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP THIRD TRI FETUS 5

S92144B

NONDISPLACED DOME FRACTURE OF RIGHT TALUS INIT FOR OPN FX

O411039

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP THIRD TRI OTH

S92145A

NONDISPLACED DOME FRACTURE OF LEFT TALUS INIT FOR CLOS FX

O411091

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP UNSP TRI FETUS 1

S92145B

NONDISPLACED DOME FRACTURE OF LEFT TALUS INIT FOR OPN FX

O411092

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP UNSP TRI FETUS 2

S92146A

NONDISPLACED DOME FRACTURE OF UNSP TALUS INIT FOR CLOS FX

O411093

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP UNSP TRI FETUS 3

S92146B

NONDISPLACED DOME FRACTURE OF UNSP TALUS INIT FOR OPN FX

O411094

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP UNSP TRI FETUS 4

S92151A

DISPL AVULSION FRACTURE (CHIP FRACTURE) OF RIGHT TALUS INIT

O411095

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP UNSP TRI FETUS 5

S92151B

DISPL AVULS FX (CHIP FRACTURE) OF R TALUS INIT FOR OPN FX

O411099

INFCT OF AMNIOTIC SAC AND MEMBRNS UNSP UNSP TRIMESTER OTH

S92152A

DISPL AVULSION FRACTURE (CHIP FRACTURE) OF LEFT TALUS INIT

O411210

CHORIOAMNIONITIS FIRST TRIMESTER NOT APPLICABLE OR UNSP

S92152B

DISPL AVULS FX (CHIP FRACTURE) OF L TALUS INIT FOR OPN FX

O411211 CHORIOAMNIONITIS FIRST TRIMESTER FETUS 1

S92153A

DISPL AVULSION FRACTURE (CHIP FRACTURE) OF UNSP TALUS INIT

O411212 CHORIOAMNIONITIS FIRST TRIMESTER FETUS 2

S92153B

DISPL AVULS FX (CHIP FRACTURE) OF UNSP TALUS 7THB

O411213 CHORIOAMNIONITIS FIRST TRIMESTER FETUS 3

S92154A

NONDISP AVULS FRACTURE (CHIP FRACTURE) OF RIGHT TALUS INIT

Page 375: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O411214 CHORIOAMNIONITIS FIRST TRIMESTER FETUS 4

S92154B

NONDISP AVULS FX (CHIP FRACTURE) OF R TALUS INIT FOR OPN FX

O411215 CHORIOAMNIONITIS FIRST TRIMESTER FETUS 5

S92155A

NONDISP AVULS FRACTURE (CHIP FRACTURE) OF LEFT TALUS INIT

O411219 CHORIOAMNIONITIS FIRST TRIMESTER OTHER FETUS

S92155B

NONDISP AVULS FX (CHIP FRACTURE) OF L TALUS INIT FOR OPN FX

O411220

CHORIOAMNIONITIS SECOND TRIMESTER NOT APPLICABLE OR UNSP

S92156A

NONDISP AVULS FRACTURE (CHIP FRACTURE) OF UNSP TALUS INIT

O411221 CHORIOAMNIONITIS SECOND TRIMESTER FETUS 1

S92156B

NONDISP AVULS FX (CHIP FRACTURE) OF UNSP TALUS 7THB

O411222 CHORIOAMNIONITIS SECOND TRIMESTER FETUS 2

S92191A

OTH FRACTURE OF RIGHT TALUS INIT ENCNTR FOR CLOSED FRACTURE

O411223 CHORIOAMNIONITIS SECOND TRIMESTER FETUS 3

S92191B

OTHER FRACTURE OF RIGHT TALUS INIT ENCNTR FOR OPEN FRACTURE

O411224 CHORIOAMNIONITIS SECOND TRIMESTER FETUS 4

S92192A

OTH FRACTURE OF LEFT TALUS INIT ENCNTR FOR CLOSED FRACTURE

O411225 CHORIOAMNIONITIS SECOND TRIMESTER FETUS 5

S92192B

OTHER FRACTURE OF LEFT TALUS INIT ENCNTR FOR OPEN FRACTURE

O411229 CHORIOAMNIONITIS SECOND TRIMESTER OTHER FETUS

S92199A

OTH FRACTURE OF UNSP TALUS INIT ENCNTR FOR CLOSED FRACTURE

O411230

CHORIOAMNIONITIS THIRD TRIMESTER NOT APPLICABLE OR UNSP

S92199B

OTHER FRACTURE OF UNSP TALUS INIT ENCNTR FOR OPEN FRACTURE

O411231 CHORIOAMNIONITIS THIRD TRIMESTER FETUS 1

S92201A

FRACTURE OF UNSP TARSAL BONE(S) OF RIGHT FOOT INIT

O411232 CHORIOAMNIONITIS THIRD TRIMESTER FETUS 2

S92201B

FX UNSP TARSAL BONE(S) OF RIGHT FOOT INIT FOR OPN FX

O411233 CHORIOAMNIONITIS THIRD TRIMESTER FETUS 3

S92202A

FRACTURE OF UNSP TARSAL BONE(S) OF LEFT FOOT INIT

Page 376: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O411234 CHORIOAMNIONITIS THIRD TRIMESTER FETUS 4

S92202B

FX UNSP TARSAL BONE(S) OF LEFT FOOT INIT FOR OPN FX

O411235 CHORIOAMNIONITIS THIRD TRIMESTER FETUS 5

S92209A

FRACTURE OF UNSP TARSAL BONE(S) OF UNSP FOOT INIT

O411239 CHORIOAMNIONITIS THIRD TRIMESTER OTHER FETUS

S92209B

FX UNSP TARSAL BONE(S) OF UNSP FOOT INIT FOR OPN FX

O411290

CHORIOAMNIONITIS UNSP TRIMESTER NOT APPLICABLE OR UNSP

S92211A

DISP FX OF CUBOID BONE OF RIGHT FOOT INIT FOR CLOS FX

O411291

CHORIOAMNIONITIS UNSPECIFIED TRIMESTER FETUS 1

S92211B

DISP FX OF CUBOID BONE OF RIGHT FOOT INIT FOR OPN FX

O411292

CHORIOAMNIONITIS UNSPECIFIED TRIMESTER FETUS 2

S92212A

DISP FX OF CUBOID BONE OF LEFT FOOT INIT FOR CLOS FX

O411293

CHORIOAMNIONITIS UNSPECIFIED TRIMESTER FETUS 3

S92212B

DISP FX OF CUBOID BONE OF LEFT FOOT INIT FOR OPN FX

O411294

CHORIOAMNIONITIS UNSPECIFIED TRIMESTER FETUS 4

S92213A

DISP FX OF CUBOID BONE OF UNSP FOOT INIT FOR CLOS FX

O411295

CHORIOAMNIONITIS UNSPECIFIED TRIMESTER FETUS 5

S92213B

DISP FX OF CUBOID BONE OF UNSP FOOT INIT FOR OPN FX

O411299

CHORIOAMNIONITIS UNSPECIFIED TRIMESTER OTHER FETUS

S92214A

NONDISP FX OF CUBOID BONE OF RIGHT FOOT INIT FOR CLOS FX

O411410

PLACENTITIS FIRST TRIMESTER NOT APPLICABLE OR UNSPECIFIED

S92214B

NONDISP FX OF CUBOID BONE OF RIGHT FOOT INIT FOR OPN FX

O411411 PLACENTITIS FIRST TRIMESTER FETUS 1

S92215A

NONDISP FX OF CUBOID BONE OF LEFT FOOT INIT FOR CLOS FX

O411412 PLACENTITIS FIRST TRIMESTER FETUS 2

S92215B

NONDISP FX OF CUBOID BONE OF LEFT FOOT INIT FOR OPN FX

O411413 PLACENTITIS FIRST TRIMESTER FETUS 3

S92216A

NONDISP FX OF CUBOID BONE OF UNSP FOOT INIT FOR CLOS FX

Page 377: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O411414 PLACENTITIS FIRST TRIMESTER FETUS 4

S92216B

NONDISP FX OF CUBOID BONE OF UNSP FOOT INIT FOR OPN FX

O411415 PLACENTITIS FIRST TRIMESTER FETUS 5

S92221A

DISP FX OF LATERAL CUNEIFORM OF RIGHT FOOT INIT FOR CLOS FX

O411419 PLACENTITIS FIRST TRIMESTER OTHER FETUS

S92221B

DISP FX OF LATERAL CUNEIFORM OF RIGHT FOOT INIT FOR OPN FX

O411420

PLACENTITIS SECOND TRIMESTER NOT APPLICABLE OR UNSPECIFIED

S92222A

DISP FX OF LATERAL CUNEIFORM OF LEFT FOOT INIT FOR CLOS FX

O411421 PLACENTITIS SECOND TRIMESTER FETUS 1

S92222B

DISP FX OF LATERAL CUNEIFORM OF LEFT FOOT INIT FOR OPN FX

O411422 PLACENTITIS SECOND TRIMESTER FETUS 2

S92223A

DISP FX OF LATERAL CUNEIFORM OF UNSP FOOT INIT FOR CLOS FX

O411423 PLACENTITIS SECOND TRIMESTER FETUS 3

S92223B

DISP FX OF LATERAL CUNEIFORM OF UNSP FOOT INIT FOR OPN FX

O411424 PLACENTITIS SECOND TRIMESTER FETUS 4

S92224A

NONDISP FX OF LATERAL CUNEIFORM OF RIGHT FOOT INIT

O411425 PLACENTITIS SECOND TRIMESTER FETUS 5

S92224B

NONDISP FX OF LATERAL CUNEIFORM OF R FOOT INIT FOR OPN FX

O411429 PLACENTITIS SECOND TRIMESTER OTHER FETUS

S92225A

NONDISP FX OF LATERAL CUNEIFORM OF LEFT FOOT INIT

O411430

PLACENTITIS THIRD TRIMESTER NOT APPLICABLE OR UNSPECIFIED

S92225B

NONDISP FX OF LATERAL CUNEIFORM OF L FOOT INIT FOR OPN FX

O411431 PLACENTITIS THIRD TRIMESTER FETUS 1

S92226A

NONDISP FX OF LATERAL CUNEIFORM OF UNSP FOOT INIT

O411432 PLACENTITIS THIRD TRIMESTER FETUS 2

S92226B

NONDISP FX OF LATERAL CUNEIFORM OF UNSP FT INIT FOR OPN FX

O411433 PLACENTITIS THIRD TRIMESTER FETUS 3

S92231A

DISP FX OF INTERMEDIATE CUNEIFORM OF RIGHT FOOT INIT

O411434 PLACENTITIS THIRD TRIMESTER FETUS 4

S92231B

DISP FX OF INTERMED CUNEIFORM OF RIGHT FOOT INIT FOR OPN FX

O411435 PLACENTITIS THIRD TRIMESTER FETUS 5

S92232A

DISP FX OF INTERMEDIATE CUNEIFORM OF LEFT FOOT INIT

Page 378: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O411439 PLACENTITIS THIRD TRIMESTER OTHER FETUS

S92232B

DISP FX OF INTERMED CUNEIFORM OF LEFT FOOT INIT FOR OPN FX

O411490

PLACENTITIS UNSP TRIMESTER NOT APPLICABLE OR UNSPECIFIED

S92233A

DISP FX OF INTERMEDIATE CUNEIFORM OF UNSP FOOT INIT

O411491 PLACENTITIS UNSPECIFIED TRIMESTER FETUS 1

S92233B

DISP FX OF INTERMED CUNEIFORM OF UNSP FOOT INIT FOR OPN FX

O411492 PLACENTITIS UNSPECIFIED TRIMESTER FETUS 2

S92234A

NONDISP FX OF INTERMEDIATE CUNEIFORM OF RIGHT FOOT INIT

O411493 PLACENTITIS UNSPECIFIED TRIMESTER FETUS 3

S92234B

NONDISP FX OF INTERMED CUNEIFORM OF R FOOT INIT FOR OPN FX

O411494 PLACENTITIS UNSPECIFIED TRIMESTER FETUS 4

S92235A

NONDISP FX OF INTERMEDIATE CUNEIFORM OF LEFT FOOT INIT

O411495 PLACENTITIS UNSPECIFIED TRIMESTER FETUS 5

S92235B

NONDISP FX OF INTERMED CUNEIFORM OF L FOOT INIT FOR OPN FX

O411499 PLACENTITIS UNSPECIFIED TRIMESTER OTHER FETUS

S92236A

NONDISP FX OF INTERMEDIATE CUNEIFORM OF UNSP FOOT INIT

O418X10 OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS FIRST TRI UNSP

S92236B

NONDISP FX OF INTERMED CUNEIFORM OF UNSP FT INIT FOR OPN FX

O418X11

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS FIRST TRI FETUS 1

S92241A

DISP FX OF MEDIAL CUNEIFORM OF RIGHT FOOT INIT FOR CLOS FX

O418X12

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS FIRST TRI FETUS 2

S92241B

DISP FX OF MEDIAL CUNEIFORM OF RIGHT FOOT INIT FOR OPN FX

O418X13

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS FIRST TRI FETUS 3

S92242A

DISP FX OF MEDIAL CUNEIFORM OF LEFT FOOT INIT FOR CLOS FX

O418X14

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS FIRST TRI FETUS 4

S92242B

DISP FX OF MEDIAL CUNEIFORM OF LEFT FOOT INIT FOR OPN FX

Page 379: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O418X15

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS FIRST TRI FETUS 5

S92243A

DISP FX OF MEDIAL CUNEIFORM OF UNSP FOOT INIT FOR CLOS FX

O418X19 OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS FIRST TRI OTH

S92243B

DISP FX OF MEDIAL CUNEIFORM OF UNSP FOOT INIT FOR OPN FX

O418X20

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS SECOND TRI UNSP

S92244A

NONDISP FX OF MEDIAL CUNEIFORM OF RIGHT FOOT INIT

O418X21

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS SECOND TRI FETUS 1

S92244B

NONDISP FX OF MEDIAL CUNEIFORM OF R FOOT INIT FOR OPN FX

O418X22

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS SECOND TRI FETUS 2

S92245A

NONDISP FX OF MEDIAL CUNEIFORM OF LEFT FOOT INIT

O418X23

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS SECOND TRI FETUS 3

S92245B

NONDISP FX OF MEDIAL CUNEIFORM OF LEFT FOOT INIT FOR OPN FX

O418X24

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS SECOND TRI FETUS 4

S92246A

NONDISP FX OF MEDIAL CUNEIFORM OF UNSP FOOT INIT

O418X25

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS SECOND TRI FETUS 5

S92246B

NONDISP FX OF MEDIAL CUNEIFORM OF UNSP FOOT INIT FOR OPN FX

O418X29

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS SECOND TRI OTH

S92251A

DISP FX OF NAVICULAR OF RIGHT FOOT INIT FOR CLOS FX

O418X30

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS THIRD TRI UNSP

S92251B

DISP FX OF NAVICULAR OF RIGHT FOOT INIT FOR OPN FX

O418X31

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS THIRD TRI FETUS 1

S92252A

DISP FX OF NAVICULAR OF LEFT FOOT INIT FOR CLOS FX

O418X32

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS THIRD TRI FETUS 2

S92252B

DISP FX OF NAVICULAR OF LEFT FOOT INIT FOR OPN FX

Page 380: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O418X33

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS THIRD TRI FETUS 3

S92253A

DISP FX OF NAVICULAR OF UNSP FOOT INIT FOR CLOS FX

O418X34

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS THIRD TRI FETUS 4

S92253B

DISP FX OF NAVICULAR OF UNSP FOOT INIT FOR OPN FX

O418X35

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS THIRD TRI FETUS 5

S92254A

NONDISP FX OF NAVICULAR OF RIGHT FOOT INIT FOR CLOS FX

O418X39 OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS THIRD TRI OTH

S92254B

NONDISP FX OF NAVICULAR OF RIGHT FOOT INIT FOR OPN FX

O418X90 OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS UNSP TRI UNSP

S92255A

NONDISP FX OF NAVICULAR OF LEFT FOOT INIT FOR CLOS FX

O418X91

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS UNSP TRI FETUS 1

S92255B

NONDISP FX OF NAVICULAR OF LEFT FOOT INIT FOR OPN FX

O418X92

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS UNSP TRI FETUS 2

S92256A

NONDISP FX OF NAVICULAR OF UNSP FOOT INIT FOR CLOS FX

O418X93

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS UNSP TRI FETUS 3

S92256B

NONDISP FX OF NAVICULAR OF UNSP FOOT INIT FOR OPN FX

O418X94

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS UNSP TRI FETUS 4

S92301A

FRACTURE OF UNSP METATARSAL BONE(S) RIGHT FOOT INIT

O418X95

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS UNSP TRI FETUS 5

S92301B

FX UNSP METATARSAL BONE(S) RIGHT FOOT INIT FOR OPN FX

O418X99

OTH DISRD OF AMNIOTIC FLUID AND MEMBRNS UNSP TRIMESTER OTH

S92302A

FRACTURE OF UNSP METATARSAL BONE(S) LEFT FOOT INIT

O4190X0

DISORDER OF AMNIOTIC FLUID AND MEMBRNS UNSP UNSP TRI UNSP

S92302B

FX UNSP METATARSAL BONE(S) LEFT FOOT INIT FOR OPN FX

Page 381: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O4190X1

DISORDER OF AMNIO FLUID AND MEMBRNS UNSP UNSP TRI FETUS 1

S92309A

FRACTURE OF UNSP METATARSAL BONE(S) UNSP FOOT INIT

O4190X2

DISORDER OF AMNIO FLUID AND MEMBRNS UNSP UNSP TRI FETUS 2

S92309B

FX UNSP METATARSAL BONE(S) UNSP FOOT INIT FOR OPN FX

O4190X3

DISORDER OF AMNIO FLUID AND MEMBRNS UNSP UNSP TRI FETUS 3

S92311A

DISP FX OF FIRST METATARSAL BONE RIGHT FOOT INIT

O4190X4

DISORDER OF AMNIO FLUID AND MEMBRNS UNSP UNSP TRI FETUS 4

S92311B

DISP FX OF FIRST METATARSAL BONE R FOOT INIT FOR OPN FX

O4190X5

DISORDER OF AMNIO FLUID AND MEMBRNS UNSP UNSP TRI FETUS 5

S92312A

DISP FX OF FIRST METATARSAL BONE LEFT FOOT INIT

O4190X9

DISORDER OF AMNIOTIC FLUID AND MEMBRNS UNSP UNSP TRI OTH

S92312B

DISP FX OF FIRST METATARSAL BONE LEFT FOOT INIT FOR OPN FX

O4191X0

DISORDER OF AMNIO FLUID AND MEMBRNS UNSP FIRST TRI UNSP

S92313A

DISP FX OF FIRST METATARSAL BONE UNSP FOOT INIT

O4191X1

DISORD OF AMNIO FLUID AND MEMBRNS UNSP FIRST TRI FETUS 1

S92313B

DISP FX OF FIRST METATARSAL BONE UNSP FOOT INIT FOR OPN FX

O4191X2

DISORD OF AMNIO FLUID AND MEMBRNS UNSP FIRST TRI FETUS 2

S92314A

NONDISP FX OF FIRST METATARSAL BONE RIGHT FOOT INIT

O4191X3

DISORD OF AMNIO FLUID AND MEMBRNS UNSP FIRST TRI FETUS 3

S92314B

NONDISP FX OF FIRST METATARSAL BONE R FOOT INIT FOR OPN FX

O4191X4

DISORD OF AMNIO FLUID AND MEMBRNS UNSP FIRST TRI FETUS 4

S92315A

NONDISP FX OF FIRST METATARSAL BONE LEFT FOOT INIT

O4191X5

DISORD OF AMNIO FLUID AND MEMBRNS UNSP FIRST TRI FETUS 5

S92315B

NONDISP FX OF FIRST METATARSAL BONE L FOOT INIT FOR OPN FX

Page 382: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O4191X9

DISORDER OF AMNIOTIC FLUID AND MEMBRNS UNSP FIRST TRI OTH

S92316A

NONDISP FX OF FIRST METATARSAL BONE UNSP FOOT INIT

O4192X0

DISORDER OF AMNIO FLUID AND MEMBRNS UNSP SECOND TRI UNSP

S92316B

NONDISP FX OF 1ST METATARSAL BONE UNSP FT INIT FOR OPN FX

O4192X1

DISORD OF AMNIO FLUID AND MEMBRNS UNSP SECOND TRI FETUS 1

S92321A

DISP FX OF SECOND METATARSAL BONE RIGHT FOOT INIT

O4192X2

DISORD OF AMNIO FLUID AND MEMBRNS UNSP SECOND TRI FETUS 2

S92321B

DISP FX OF SECOND METATARSAL BONE R FOOT INIT FOR OPN FX

O4192X3

DISORD OF AMNIO FLUID AND MEMBRNS UNSP SECOND TRI FETUS 3

S92322A

DISP FX OF SECOND METATARSAL BONE LEFT FOOT INIT

O4192X4

DISORD OF AMNIO FLUID AND MEMBRNS UNSP SECOND TRI FETUS 4

S92322B

DISP FX OF SECOND METATARSAL BONE L FOOT INIT FOR OPN FX

O4192X5

DISORD OF AMNIO FLUID AND MEMBRNS UNSP SECOND TRI FETUS 5

S92323A

DISP FX OF SECOND METATARSAL BONE UNSP FOOT INIT

O4192X9

DISORDER OF AMNIO FLUID AND MEMBRNS UNSP SECOND TRI OTH

S92323B

DISP FX OF 2ND METATARSAL BONE UNSP FOOT INIT FOR OPN FX

O4193X0

DISORDER OF AMNIO FLUID AND MEMBRNS UNSP THIRD TRI UNSP

S92324A

NONDISP FX OF SECOND METATARSAL BONE RIGHT FOOT INIT

O4193X1

DISORD OF AMNIO FLUID AND MEMBRNS UNSP THIRD TRI FETUS 1

S92324B

NONDISP FX OF 2ND METATARSAL BONE R FOOT INIT FOR OPN FX

O4193X2

DISORD OF AMNIO FLUID AND MEMBRNS UNSP THIRD TRI FETUS 2

S92325A

NONDISP FX OF SECOND METATARSAL BONE LEFT FOOT INIT

O4193X3

DISORD OF AMNIO FLUID AND MEMBRNS UNSP THIRD TRI FETUS 3

S92325B

NONDISP FX OF 2ND METATARSAL BONE L FOOT INIT FOR OPN FX

Page 383: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O4193X4

DISORD OF AMNIO FLUID AND MEMBRNS UNSP THIRD TRI FETUS 4

S92326A

NONDISP FX OF SECOND METATARSAL BONE UNSP FOOT INIT

O4193X5

DISORD OF AMNIO FLUID AND MEMBRNS UNSP THIRD TRI FETUS 5

S92326B

NONDISP FX OF 2ND METATARSAL BONE UNSP FT INIT FOR OPN FX

O4193X9

DISORDER OF AMNIOTIC FLUID AND MEMBRNS UNSP THIRD TRI OTH

S92331A

DISP FX OF THIRD METATARSAL BONE RIGHT FOOT INIT

O4200

PREM ROM ONSET LABOR W/N 24 HR OF RUPT UNSP WEEKS OF GEST

S92331B

DISP FX OF THIRD METATARSAL BONE R FOOT INIT FOR OPN FX

O42011

PRETRM PREM ROM ONSET LABOR W/N 24 HOURS OF RUPT FIRST TRI

S92332A

DISP FX OF THIRD METATARSAL BONE LEFT FOOT INIT

O42012

PRETRM PREM ROM ONSET LABOR W/N 24 HOURS OF RUPT 2ND TRI

S92332B

DISP FX OF THIRD METATARSAL BONE LEFT FOOT INIT FOR OPN FX

O42013

PRETRM PREM ROM ONSET LABOR W/N 24 HOURS OF RUPT THIRD TRI

S92333A

DISP FX OF THIRD METATARSAL BONE UNSP FOOT INIT

O42019

PRETRM PREM ROM ONSET LABOR W/N 24 HOURS OF RUPT UNSP TRI

S92333B

DISP FX OF THIRD METATARSAL BONE UNSP FOOT INIT FOR OPN FX

O4202

FULL-TERM PREM ROM ONSET LABOR WITHIN 24 HOURS OF RUPTURE

S92334A

NONDISP FX OF THIRD METATARSAL BONE RIGHT FOOT INIT

O4210

PREM ROM ONSET LABOR > 24 HR FOL RUPT UNSP WEEKS OF GEST

S92334B

NONDISP FX OF THIRD METATARSAL BONE R FOOT INIT FOR OPN FX

O42111

PRETRM PREM ROM ONSET LABOR > 24 HOURS FOL RUPT FIRST TRI

S92335A

NONDISP FX OF THIRD METATARSAL BONE LEFT FOOT INIT

O42112

PRETRM PREM ROM ONSET LABOR > 24 HOURS FOL RUPT SECOND TRI

S92335B

NONDISP FX OF THIRD METATARSAL BONE L FOOT INIT FOR OPN FX

Page 384: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O42113

PRETRM PREM ROM ONSET LABOR > 24 HOURS FOL RUPT THIRD TRI

S92336A

NONDISP FX OF THIRD METATARSAL BONE UNSP FOOT INIT

O42119

PRETRM PREM ROM ONSET LABOR > 24 HOURS FOL RUPT UNSP TRI

S92336B

NONDISP FX OF 3RD METATARSAL BONE UNSP FT INIT FOR OPN FX

O4212

FULL-TERM PREMATURE ROM ONSET LABOR > 24 HOURS FOL RUPTURE

S92341A

DISP FX OF FOURTH METATARSAL BONE RIGHT FOOT INIT

O4290

PREM ROM 7TH0 BETW RUPT & ONST LABR UNSP WEEKS OF GEST

S92341B

DISP FX OF FOURTH METATARSAL BONE R FOOT INIT FOR OPN FX

O42911

PRETRM PREM ROM UNSP TIME BETW RUPT AND ONSET LABR 1ST TRI

S92342A

DISP FX OF FOURTH METATARSAL BONE LEFT FOOT INIT

O42912

PRETRM PREM ROM UNSP TIME BETW RUPT AND ONSET LABR 2ND TRI

S92342B

DISP FX OF FOURTH METATARSAL BONE L FOOT INIT FOR OPN FX

O42913

PRETRM PREM ROM UNSP TIME BETW RUPT AND ONST LABR 3RD TRI

S92343A

DISP FX OF FOURTH METATARSAL BONE UNSP FOOT INIT

O42919

PRETRM PREM ROM UNSP TIME BETW RUPT AND ONST LABR UNSP TRI

S92343B

DISP FX OF 4TH METATARSAL BONE UNSP FOOT INIT FOR OPN FX

O4292

FULL-TERM PREM ROM UNSP TIME BETW RUPTURE AND ONSET LABOR

S92344A

NONDISP FX OF FOURTH METATARSAL BONE RIGHT FOOT INIT

O43013

FETOMATERNAL PLACENTAL TRANSFUSION SYNDROME THIRD TRIMESTER

S92344B

NONDISP FX OF 4TH METATARSAL BONE R FOOT INIT FOR OPN FX

O43022

FETUS-TO-FETUS PLACNTL TRANSFUSE SYNDROME SECOND TRIMESTER

S92345A

NONDISP FX OF FOURTH METATARSAL BONE LEFT FOOT INIT

O43101 MALFORMATION OF PLACENTA UNSPECIFIED FIRST TRIMESTER

S92345B

NONDISP FX OF 4TH METATARSAL BONE L FOOT INIT FOR OPN FX

Page 385: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O43109

MALFORMATION OF PLACENTA UNSPECIFIED UNSPECIFIED TRIMESTER

S92346A

NONDISP FX OF FOURTH METATARSAL BONE UNSP FOOT INIT

O43113 CIRCUMVALLATE PLACENTA THIRD TRIMESTER

S92346B

NONDISP FX OF 4TH METATARSAL BONE UNSP FT INIT FOR OPN FX

O4420

Partial placenta previa NOS or without hemorrhage unspecified trimester

S92351A

DISP FX OF FIFTH METATARSAL BONE RIGHT FOOT INIT

O4421

Partial placenta previa NOS or without hemorrhage first trimester

S92351B

DISP FX OF FIFTH METATARSAL BONE R FOOT INIT FOR OPN FX

O4422

Partial placenta previa NOS or without hemorrhage second trimester

S92352A

DISP FX OF FIFTH METATARSAL BONE LEFT FOOT INIT

O4423

Partial placenta previa NOS or without hemorrhage third trimester

S92352B

DISP FX OF FIFTH METATARSAL BONE LEFT FOOT INIT FOR OPN FX

O4430

Partial placenta previa with hemorrhage unspecified trimester

S92353A

DISP FX OF FIFTH METATARSAL BONE UNSP FOOT INIT

O4431 Partial placenta previa with hemorrhage first trimester

S92353B

DISP FX OF FIFTH METATARSAL BONE UNSP FOOT INIT FOR OPN FX

O4432 Partial placenta previa with hemorrhage second trimester

S92354A

NONDISP FX OF FIFTH METATARSAL BONE RIGHT FOOT INIT

O4433 Partial placenta previa with hemorrhage third trimester

S92354B

NONDISP FX OF FIFTH METATARSAL BONE R FOOT INIT FOR OPN FX

O4450

Low lying placenta with hemorrhage unspecified trimester

S92355A

NONDISP FX OF FIFTH METATARSAL BONE LEFT FOOT INIT

O4451 Low lying placenta with hemorrhage first trimester

S92355B

NONDISP FX OF FIFTH METATARSAL BONE L FOOT INIT FOR OPN FX

Page 386: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O4452 Low lying placenta with hemorrhage second trimester

S92356A

NONDISP FX OF FIFTH METATARSAL BONE UNSP FOOT INIT

O4453 Low lying placenta with hemorrhage third trimester

S92356B

NONDISP FX OF 5TH METATARSAL BONE UNSP FT INIT FOR OPN FX

O6000

PRETERM LABOR WITHOUT DELIVERY UNSPECIFIED TRIMESTER

S92401A

DISPLACED UNSP FRACTURE OF RIGHT GREAT TOE INIT FOR CLOS FX

O6002 PRETERM LABOR WITHOUT DELIVERY SECOND TRIMESTER

S92401B

DISPLACED UNSP FRACTURE OF RIGHT GREAT TOE INIT FOR OPN FX

O6003 PRETERM LABOR WITHOUT DELIVERY THIRD TRIMESTER

S92402A

DISPLACED UNSP FRACTURE OF LEFT GREAT TOE INIT FOR CLOS FX

O6010X0

PRETERM LABOR W PRETERM DELIVERY UNSP TRIMESTER UNSP

S92402B

DISPLACED UNSP FRACTURE OF LEFT GREAT TOE INIT FOR OPN FX

O6010X1

PRETERM LABOR WITH PRETERM DELIVERY UNSP TRIMESTER FETUS 1

S92403A

DISPLACED UNSP FRACTURE OF UNSP GREAT TOE INIT FOR CLOS FX

O6010X2

PRETERM LABOR WITH PRETERM DELIVERY UNSP TRIMESTER FETUS 2

S92403B

DISPLACED UNSP FRACTURE OF UNSP GREAT TOE INIT FOR OPN FX

O6010X3

PRETERM LABOR WITH PRETERM DELIVERY UNSP TRIMESTER FETUS 3

S92404A

NONDISPLACED UNSP FRACTURE OF RIGHT GREAT TOE INIT

O6010X4

PRETERM LABOR WITH PRETERM DELIVERY UNSP TRIMESTER FETUS 4

S92404B

NONDISP UNSP FRACTURE OF RIGHT GREAT TOE INIT FOR OPN FX

O6010X5

PRETERM LABOR WITH PRETERM DELIVERY UNSP TRIMESTER FETUS 5

S92405A

NONDISPLACED UNSP FRACTURE OF LEFT GREAT TOE INIT

O6010X9

PRETERM LABOR W PRETERM DELIVERY UNSP TRIMESTER OTH FETUS

S92405B

NONDISP UNSP FRACTURE OF LEFT GREAT TOE INIT FOR OPN FX

O6012X0

PRETERM LABOR SECOND TRI W PRETERM DELIVERY SECOND TRI UNSP

S92406A

NONDISPLACED UNSP FRACTURE OF UNSP GREAT TOE INIT

Page 387: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O6012X1

PRETERM LABOR SECOND TRI W PRETERM DEL SECOND TRI FETUS 1

S92406B

NONDISP UNSP FRACTURE OF UNSP GREAT TOE INIT FOR OPN FX

O6012X2

PRETERM LABOR SECOND TRI W PRETERM DEL SECOND TRI FETUS 2

S92411A

DISP FX OF PROXIMAL PHALANX OF RIGHT GREAT TOE INIT

O6012X3

PRETERM LABOR SECOND TRI W PRETERM DEL SECOND TRI FETUS 3

S92411B

DISP FX OF PROX PHALANX OF RIGHT GREAT TOE INIT FOR OPN FX

O6012X4

PRETERM LABOR SECOND TRI W PRETERM DEL SECOND TRI FETUS 4

S92412A

DISP FX OF PROXIMAL PHALANX OF LEFT GREAT TOE INIT

O6012X5

PRETERM LABOR SECOND TRI W PRETERM DEL SECOND TRI FETUS 5

S92412B

DISP FX OF PROX PHALANX OF LEFT GREAT TOE INIT FOR OPN FX

O6012X9

PRETERM LABOR SECOND TRI W PRETERM DELIVERY SECOND TRI OTH

S92413A

DISP FX OF PROXIMAL PHALANX OF UNSP GREAT TOE INIT

O6013X1

PRETERM LABOR SECOND TRI W PRETERM DEL THIRD TRI FETUS 1

S92413B

DISP FX OF PROX PHALANX OF UNSP GREAT TOE INIT FOR OPN FX

O6013X2

PRETERM LABOR SECOND TRI W PRETERM DEL THIRD TRI FETUS 2

S92414A

NONDISP FX OF PROXIMAL PHALANX OF RIGHT GREAT TOE INIT

O6013X3

PRETERM LABOR SECOND TRI W PRETERM DEL THIRD TRI FETUS 3

S92414B

NONDISP FX OF PROX PHALANX OF R GREAT TOE INIT FOR OPN FX

O6013X4

PRETERM LABOR SECOND TRI W PRETERM DEL THIRD TRI FETUS 4

S92415A

NONDISP FX OF PROXIMAL PHALANX OF LEFT GREAT TOE INIT

O6013X5

PRETERM LABOR SECOND TRI W PRETERM DEL THIRD TRI FETUS 5

S92415B

NONDISP FX OF PROX PHALANX OF L GREAT TOE INIT FOR OPN FX

O6013X9

PRETERM LABOR SECOND TRI W PRETERM DELIVERY THIRD TRI OTH

S92416A

NONDISP FX OF PROXIMAL PHALANX OF UNSP GREAT TOE INIT

Page 388: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O6014X1

PRETERM LABOR THIRD TRI W PRETERM DEL THIRD TRI FETUS 1

S92416B

NONDISP FX OF PROX PHALANX OF UNSP GREAT TOE 7THB

O6014X2

PRETERM LABOR THIRD TRI W PRETERM DEL THIRD TRI FETUS 2

S92421A

DISP FX OF DISTAL PHALANX OF RIGHT GREAT TOE INIT

O6014X3

PRETERM LABOR THIRD TRI W PRETERM DEL THIRD TRI FETUS 3

S92421B

DISP FX OF DIST PHALANX OF RIGHT GREAT TOE INIT FOR OPN FX

O6014X4

PRETERM LABOR THIRD TRI W PRETERM DEL THIRD TRI FETUS 4

S92422A

DISP FX OF DISTAL PHALANX OF LEFT GREAT TOE INIT

O6014X5

PRETERM LABOR THIRD TRI W PRETERM DEL THIRD TRI FETUS 5

S92422B

DISP FX OF DISTAL PHALANX OF LEFT GREAT TOE INIT FOR OPN FX

O6014X9

PRETERM LABOR THIRD TRI W PRETERM DELIVERY THIRD TRI OTH

S92423A

DISP FX OF DISTAL PHALANX OF UNSP GREAT TOE INIT

O6020X0 TERM DELIVERY W PRETERM LABOR UNSP TRIMESTER UNSP

S92423B

DISP FX OF DISTAL PHALANX OF UNSP GREAT TOE INIT FOR OPN FX

O6020X1

TERM DELIVERY WITH PRETERM LABOR UNSP TRIMESTER FETUS 1

S92424A

NONDISP FX OF DISTAL PHALANX OF RIGHT GREAT TOE INIT

O6020X2

TERM DELIVERY WITH PRETERM LABOR UNSP TRIMESTER FETUS 2

S92424B

NONDISP FX OF DIST PHALANX OF R GREAT TOE INIT FOR OPN FX

O6020X3

TERM DELIVERY WITH PRETERM LABOR UNSP TRIMESTER FETUS 3

S92425A

NONDISP FX OF DISTAL PHALANX OF LEFT GREAT TOE INIT

O6020X4

TERM DELIVERY WITH PRETERM LABOR UNSP TRIMESTER FETUS 4

S92425B

NONDISP FX OF DIST PHALANX OF L GREAT TOE INIT FOR OPN FX

O6020X5

TERM DELIVERY WITH PRETERM LABOR UNSP TRIMESTER FETUS 5

S92426A

NONDISP FX OF DISTAL PHALANX OF UNSP GREAT TOE INIT

Page 389: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O6020X9

TERM DELIVERY WITH PRETERM LABOR UNSP TRIMESTER OTH FETUS

S92426B

NONDISP FX OF DIST PHALANX OF UNSP GREAT TOE 7THB

O6022X0

TERM DELIVERY W PRETERM LABOR SECOND TRIMESTER UNSP

S92491A

OTH FRACTURE OF RIGHT GREAT TOE INIT FOR CLOS FX

O6022X1

TERM DELIVERY WITH PRETERM LABOR SECOND TRIMESTER FETUS 1

S92491B

OTH FRACTURE OF RIGHT GREAT TOE INIT FOR OPN FX

O6022X2

TERM DELIVERY WITH PRETERM LABOR SECOND TRIMESTER FETUS 2

S92492A

OTH FRACTURE OF LEFT GREAT TOE INIT FOR CLOS FX

O6022X3

TERM DELIVERY WITH PRETERM LABOR SECOND TRIMESTER FETUS 3

S92492B

OTH FRACTURE OF LEFT GREAT TOE INIT FOR OPN FX

O6022X4

TERM DELIVERY WITH PRETERM LABOR SECOND TRIMESTER FETUS 4

S92499A

OTH FRACTURE OF UNSP GREAT TOE INIT FOR CLOS FX

O6022X5

TERM DELIVERY WITH PRETERM LABOR SECOND TRIMESTER FETUS 5

S92499B

OTH FRACTURE OF UNSP GREAT TOE INIT FOR OPN FX

O6022X9

TERM DELIVERY W PRETERM LABOR SECOND TRIMESTER OTH FETUS

S92501A

DISPLACED UNSP FRACTURE OF RIGHT LESSER TOE(S) INIT

O6023X0 TERM DELIVERY W PRETERM LABOR THIRD TRIMESTER UNSP

S92501B

DISPLACED UNSP FX RIGHT LESSER TOE(S) INIT FOR OPN FX

O6023X1

TERM DELIVERY WITH PRETERM LABOR THIRD TRIMESTER FETUS 1

S92502A

DISPLACED UNSP FRACTURE OF LEFT LESSER TOE(S) INIT

O6023X2

TERM DELIVERY WITH PRETERM LABOR THIRD TRIMESTER FETUS 2

S92502B

DISPLACED UNSP FX LEFT LESSER TOE(S) INIT FOR OPN FX

O6023X3

TERM DELIVERY WITH PRETERM LABOR THIRD TRIMESTER FETUS 3

S92503A

DISPLACED UNSP FRACTURE OF UNSP LESSER TOE(S) INIT

Page 390: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O6023X4

TERM DELIVERY WITH PRETERM LABOR THIRD TRIMESTER FETUS 4

S92503B

DISPLACED UNSP FX UNSP LESSER TOE(S) INIT FOR OPN FX

O6023X5

TERM DELIVERY WITH PRETERM LABOR THIRD TRIMESTER FETUS 5

S92504A

NONDISPLACED UNSP FRACTURE OF RIGHT LESSER TOE(S) INIT

O6023X9

TERM DELIVERY WITH PRETERM LABOR THIRD TRIMESTER OTH FETUS

S92504B

NONDISP UNSP FX RIGHT LESSER TOE(S) INIT FOR OPN FX

O610 FAILED MEDICAL INDUCTION OF LABOR

S92505A

NONDISPLACED UNSP FRACTURE OF LEFT LESSER TOE(S) INIT

O611 FAILED INSTRUMENTAL INDUCTION OF LABOR

S92505B

NONDISP UNSP FRACTURE OF LEFT LESSER TOE(S) INIT FOR OPN FX

O618 OTHER FAILED INDUCTION OF LABOR

S92506A

NONDISPLACED UNSP FRACTURE OF UNSP LESSER TOE(S) INIT

O619 FAILED INDUCTION OF LABOR UNSPECIFIED

S92506B

NONDISP UNSP FRACTURE OF UNSP LESSER TOE(S) INIT FOR OPN FX

O620 PRIMARY INADEQUATE CONTRACTIONS

S92511A

DISP FX OF PROXIMAL PHALANX OF RIGHT LESSER TOE(S) INIT

O621 SECONDARY UTERINE INERTIA

S92511B DISP FX OF PROX PHALANX OF R LESS TOE(S) INIT FOR OPN FX

O622 OTHER UTERINE INERTIA

S92512A DISP FX OF PROXIMAL PHALANX OF LEFT LESSER TOE(S) INIT

O623 PRECIPITATE LABOR

S92512B DISP FX OF PROX PHALANX OF LEFT LESS TOE(S) INIT FOR OPN FX

O624

HYPERTONIC INCOORDINATE AND PROLONGED UTERINE CONTRACTIONS

S92513A

DISP FX OF PROXIMAL PHALANX OF UNSP LESSER TOE(S) INIT

O628 OTHER ABNORMALITIES OF FORCES OF LABOR

S92513B

DISP FX OF PROX PHALANX OF UNSP LESS TOE(S) INIT FOR OPN FX

O629 ABNORMALITY OF FORCES OF LABOR UNSPECIFIED

S92514A

NONDISP FX OF PROXIMAL PHALANX OF RIGHT LESSER TOE(S) INIT

Page 391: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O630 PROLONGED FIRST STAGE (OF LABOR)

S92514B

NONDISP FX OF PROX PHALANX OF R LESS TOE(S) INIT FOR OPN FX

O631 PROLONGED SECOND STAGE (OF LABOR)

S92515A

NONDISP FX OF PROXIMAL PHALANX OF LEFT LESSER TOE(S) INIT

O632 DELAYED DELIVERY OF SECOND TWIN TRIPLET ETC.

S92515B

NONDISP FX OF PROX PHALANX OF L LESS TOE(S) INIT FOR OPN FX

O639 LONG LABOR UNSPECIFIED

S92516A NONDISP FX OF PROXIMAL PHALANX OF UNSP LESSER TOE(S) INIT

O640XX0

OBSTRUCTED LABOR DUE TO INCMPL ROTATION OF FETAL HEAD UNSP

S92516B

NONDISP FX OF PROX PHALANX OF UNSP LESS TOE(S) 7THB

O640XX1

OBST LABOR DUE TO INCMPL ROTATION OF FETAL HEAD FETUS 1

S92521A

DISP FX OF MEDIAL PHALANX OF RIGHT LESSER TOE(S) INIT

O640XX2

OBST LABOR DUE TO INCMPL ROTATION OF FETAL HEAD FETUS 2

S92521B

DISP FX OF MED PHALANX OF RIGHT LESS TOE(S) INIT FOR OPN FX

O640XX3

OBST LABOR DUE TO INCMPL ROTATION OF FETAL HEAD FETUS 3

S92522A

DISP FX OF MEDIAL PHALANX OF LEFT LESSER TOE(S) INIT

O640XX4

OBST LABOR DUE TO INCMPL ROTATION OF FETAL HEAD FETUS 4

S92522B

DISP FX OF MED PHALANX OF LEFT LESS TOE(S) INIT FOR OPN FX

O640XX5

OBST LABOR DUE TO INCMPL ROTATION OF FETAL HEAD FETUS 5

S92523A

DISP FX OF MEDIAL PHALANX OF UNSP LESSER TOE(S) INIT

O640XX9

OBSTRUCTED LABOR DUE TO INCMPL ROTATION OF FETAL HEAD OTH

S92523B

DISP FX OF MED PHALANX OF UNSP LESS TOE(S) INIT FOR OPN FX

O641XX0 OBSTRUCTED LABOR DUE TO BREECH PRESENTATION UNSP

S92524A

NONDISP FX OF MEDIAL PHALANX OF RIGHT LESSER TOE(S) INIT

O641XX1

OBSTRUCTED LABOR DUE TO BREECH PRESENTATION FETUS 1

S92524B

NONDISP FX OF MED PHALANX OF R LESS TOE(S) INIT FOR OPN FX

Page 392: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O641XX2

OBSTRUCTED LABOR DUE TO BREECH PRESENTATION FETUS 2

S92525A

NONDISP FX OF MEDIAL PHALANX OF LEFT LESSER TOE(S) INIT

O641XX3

OBSTRUCTED LABOR DUE TO BREECH PRESENTATION FETUS 3

S92525B

NONDISP FX OF MED PHALANX OF L LESS TOE(S) INIT FOR OPN FX

O641XX4

OBSTRUCTED LABOR DUE TO BREECH PRESENTATION FETUS 4

S92526A

NONDISP FX OF MEDIAL PHALANX OF UNSP LESSER TOE(S) INIT

O641XX5

OBSTRUCTED LABOR DUE TO BREECH PRESENTATION FETUS 5

S92526B

NONDISP FX OF MED PHALANX OF UNSP LESS TOE(S) 7THB

O641XX9

OBSTRUCTED LABOR DUE TO BREECH PRESENTATION OTHER FETUS

S92531A

DISP FX OF DISTAL PHALANX OF RIGHT LESSER TOE(S) INIT

O642XX1 OBSTRUCTED LABOR DUE TO FACE PRESENTATION FETUS 1

S92531B

DISP FX OF DIST PHALANX OF R LESS TOE(S) INIT FOR OPN FX

O642XX2 OBSTRUCTED LABOR DUE TO FACE PRESENTATION FETUS 2

S92532A

DISP FX OF DISTAL PHALANX OF LEFT LESSER TOE(S) INIT

O642XX3 OBSTRUCTED LABOR DUE TO FACE PRESENTATION FETUS 3

S92532B

DISP FX OF DIST PHALANX OF LEFT LESS TOE(S) INIT FOR OPN FX

O642XX4 OBSTRUCTED LABOR DUE TO FACE PRESENTATION FETUS 4

S92533A

DISP FX OF DISTAL PHALANX OF UNSP LESSER TOE(S) INIT

O642XX5 OBSTRUCTED LABOR DUE TO FACE PRESENTATION FETUS 5

S92533B

DISP FX OF DIST PHALANX OF UNSP LESS TOE(S) INIT FOR OPN FX

O642XX9

OBSTRUCTED LABOR DUE TO FACE PRESENTATION OTHER FETUS

S92534A

NONDISP FX OF DISTAL PHALANX OF RIGHT LESSER TOE(S) INIT

O643XX1 OBSTRUCTED LABOR DUE TO BROW PRESENTATION FETUS 1

S92534B

NONDISP FX OF DIST PHALANX OF R LESS TOE(S) INIT FOR OPN FX

O643XX2 OBSTRUCTED LABOR DUE TO BROW PRESENTATION FETUS 2

S92535A

NONDISP FX OF DISTAL PHALANX OF LEFT LESSER TOE(S) INIT

Page 393: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O643XX3 OBSTRUCTED LABOR DUE TO BROW PRESENTATION FETUS 3

S92535B

NONDISP FX OF DIST PHALANX OF L LESS TOE(S) INIT FOR OPN FX

O643XX4 OBSTRUCTED LABOR DUE TO BROW PRESENTATION FETUS 4

S92536A

NONDISP FX OF DISTAL PHALANX OF UNSP LESSER TOE(S) INIT

O643XX5 OBSTRUCTED LABOR DUE TO BROW PRESENTATION FETUS 5

S92536B

NONDISP FX OF DIST PHALANX OF UNSP LESS TOE(S) 7THB

O643XX9

OBSTRUCTED LABOR DUE TO BROW PRESENTATION OTHER FETUS

S92591A

OTH FRACTURE OF RIGHT LESSER TOE(S) INIT FOR CLOS FX

O644XX1

OBSTRUCTED LABOR DUE TO SHOULDER PRESENTATION FETUS 1

S92591B

OTH FRACTURE OF RIGHT LESSER TOE(S) INIT FOR OPN FX

O644XX2

OBSTRUCTED LABOR DUE TO SHOULDER PRESENTATION FETUS 2

S92592A

OTH FRACTURE OF LEFT LESSER TOE(S) INIT FOR CLOS FX

O644XX3

OBSTRUCTED LABOR DUE TO SHOULDER PRESENTATION FETUS 3

S92592B

OTH FRACTURE OF LEFT LESSER TOE(S) INIT FOR OPN FX

O644XX4

OBSTRUCTED LABOR DUE TO SHOULDER PRESENTATION FETUS 4

S92599A

OTH FRACTURE OF UNSP LESSER TOE(S) INIT FOR CLOS FX

O644XX5

OBSTRUCTED LABOR DUE TO SHOULDER PRESENTATION FETUS 5

S92599B

OTH FRACTURE OF UNSP LESSER TOE(S) INIT FOR OPN FX

O644XX9

OBSTRUCTED LABOR DUE TO SHOULDER PRESENTATION OTHER FETUS

S92811A

Other fracture of right foot initial encounter for closed fracture

O645XX1

OBSTRUCTED LABOR DUE TO COMPOUND PRESENTATION FETUS 1

S92811B

Other fracture of right foot initial encounter for open fracture

O645XX2

OBSTRUCTED LABOR DUE TO COMPOUND PRESENTATION FETUS 2

S92812A

Other fracture of left foot initial encounter for closed fracture

Page 394: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O645XX3

OBSTRUCTED LABOR DUE TO COMPOUND PRESENTATION FETUS 3

S92812B

Other fracture of left foot initial encounter for open fracture

O645XX4

OBSTRUCTED LABOR DUE TO COMPOUND PRESENTATION FETUS 4

S92819A

Other fracture of unspecified foot initial encounter for closed fracture

O645XX5

OBSTRUCTED LABOR DUE TO COMPOUND PRESENTATION FETUS 5

S92819B

Other fracture of unspecified foot initial encounter for open fracture

O645XX9

OBSTRUCTED LABOR DUE TO COMPOUND PRESENTATION OTHER FETUS

S92901A

UNSP FRACTURE OF RIGHT FOOT INIT ENCNTR FOR CLOSED FRACTURE

O648XX1

OBSTRUCTED LABOR DUE TO OTH MALPOS AND MALPRESENT FETUS 1

S92901B

UNSP FRACTURE OF RIGHT FOOT INIT ENCNTR FOR OPEN FRACTURE

O648XX2

OBSTRUCTED LABOR DUE TO OTH MALPOS AND MALPRESENT FETUS 2

S92902A

UNSP FRACTURE OF LEFT FOOT INIT ENCNTR FOR CLOSED FRACTURE

O648XX3

OBSTRUCTED LABOR DUE TO OTH MALPOS AND MALPRESENT FETUS 3

S92902B

UNSP FRACTURE OF LEFT FOOT INIT ENCNTR FOR OPEN FRACTURE

O648XX4

OBSTRUCTED LABOR DUE TO OTH MALPOS AND MALPRESENT FETUS 4

S92909A

UNSP FRACTURE OF UNSP FOOT INIT ENCNTR FOR CLOSED FRACTURE

O648XX5

OBSTRUCTED LABOR DUE TO OTH MALPOS AND MALPRESENT FETUS 5

S92909B

UNSP FRACTURE OF UNSP FOOT INIT ENCNTR FOR OPEN FRACTURE

O648XX9

OBSTRUCTED LABOR DUE TO OTH MALPOSITION AND MALPRESENT OTH

S92911A

UNSP FRACTURE OF RIGHT TOE(S) INIT FOR CLOS FX

O649XX1

OBSTRUCTED LABOR DUE TO MALPOS AND MALPRESENT UNSP FETUS 1

S92911B

UNSP FRACTURE OF RIGHT TOE(S) INIT ENCNTR FOR OPEN FRACTURE

O649XX2

OBSTRUCTED LABOR DUE TO MALPOS AND MALPRESENT UNSP FETUS 2

S92912A

UNSP FRACTURE OF LEFT TOE(S) INIT FOR CLOS FX

Page 395: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O649XX3

OBSTRUCTED LABOR DUE TO MALPOS AND MALPRESENT UNSP FETUS 3

S92912B

UNSP FRACTURE OF LEFT TOE(S) INIT ENCNTR FOR OPEN FRACTURE

O649XX4

OBSTRUCTED LABOR DUE TO MALPOS AND MALPRESENT UNSP FETUS 4

S92919A

UNSP FRACTURE OF UNSP TOE(S) INIT FOR CLOS FX

O649XX5

OBSTRUCTED LABOR DUE TO MALPOS AND MALPRESENT UNSP FETUS 5

S92919B

UNSP FRACTURE OF UNSP TOE(S) INIT ENCNTR FOR OPEN FRACTURE

O649XX9

OBSTRUCTED LABOR DUE TO MALPOS AND MALPRESENT UNSP OTH

S9301XA

SUBLUXATION OF RIGHT ANKLE JOINT INITIAL ENCOUNTER

O650 OBSTRUCTED LABOR DUE TO DEFORMED PELVIS

S9302XA

SUBLUXATION OF LEFT ANKLE JOINT INITIAL ENCOUNTER

O651

OBSTRUCTED LABOR DUE TO GENERALLY CONTRACTED PELVIS

S9303XA

SUBLUXATION OF UNSPECIFIED ANKLE JOINT INITIAL ENCOUNTER

O652 OBSTRUCTED LABOR DUE TO PELVIC INLET CONTRACTION

S9304XA

DISLOCATION OF RIGHT ANKLE JOINT INITIAL ENCOUNTER

O653

OBST LABOR DUE TO PELVIC OUTLET AND MID-CAVITY CONTRCTN

S9305XA

DISLOCATION OF LEFT ANKLE JOINT INITIAL ENCOUNTER

O654

OBSTRUCTED LABOR DUE TO FETOPELVIC DISPROPORTION UNSP

S93111A

DISLOCATION OF INTERPHALN JOINT OF RIGHT GREAT TOE INIT

O655

OBSTRUCTED LABOR DUE TO ABNLT OF MATERNAL PELVIC ORGANS

S93112A

DISLOCATION OF INTERPHALANGEAL JOINT OF LEFT GREAT TOE INIT

O658

OBSTRUCTED LABOR DUE TO OTHER MATERNAL PELVIC ABNORMALITIES

S93113A

DISLOCATION OF INTERPHALANGEAL JOINT OF UNSP GREAT TOE INIT

O659

OBSTRUCTED LABOR DUE TO MATERNAL PELVIC ABNORMALITY UNSP

S93114A

DISLOCATION OF INTERPHALN JOINT OF RIGHT LESSER TOE(S) INIT

O660 OBSTRUCTED LABOR DUE TO SHOULDER DYSTOCIA

S93115A

DISLOCATION OF INTERPHALN JOINT OF LEFT LESSER TOE(S) INIT

Page 396: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O661 OBSTRUCTED LABOR DUE TO LOCKED TWINS

S93116A

DISLOCATION OF INTERPHALN JOINT OF UNSP LESSER TOE(S) INIT

O662 OBSTRUCTED LABOR DUE TO UNUSUALLY LARGE FETUS

S93119A

DISLOCATION OF INTERPHALANGEAL JOINT OF UNSP TOE(S) INIT

O663

OBSTRUCTED LABOR DUE TO OTHER ABNORMALITIES OF FETUS

S93121A

DISLOCATION OF MTP JOINT OF RIGHT GREAT TOE INIT

O6640 FAILED TRIAL OF LABOR UNSPECIFIED

S93122A

DISLOCATION OF MTP JOINT OF LEFT GREAT TOE INIT

O6641

FAILED ATTEMPT VAGINAL BIRTH AFTER PREVIOUS CESAREAN DEL

S93123A

DISLOCATION OF MTP JOINT OF UNSP GREAT TOE INIT

O665

ATTEMPTED APPLICATION OF VACUUM EXTRACTOR AND FORCEPS

S93124A

DISLOCATION OF MTP JOINT OF RIGHT LESSER TOE(S) INIT

O666 OBSTRUCTED LABOR DUE TO OTHER MULTIPLE FETUSES

S93125A

DISLOCATION OF MTP JOINT OF LEFT LESSER TOE(S) INIT

O668 OTHER SPECIFIED OBSTRUCTED LABOR

S93126A

DISLOCATION OF MTP JOINT OF UNSP LESSER TOE(S) INIT

O669 OBSTRUCTED LABOR UNSPECIFIED

S93129A

DISLOCATION OF MTP JOINT OF UNSP TOE(S) INIT

O670 INTRAPARTUM HEMORRHAGE WITH COAGULATION DEFECT

S93131A

SUBLUXATION OF INTERPHALN JOINT OF RIGHT GREAT TOE INIT

O678 OTHER INTRAPARTUM HEMORRHAGE

S93132A

SUBLUXATION OF INTERPHALANGEAL JOINT OF LEFT GREAT TOE INIT

O679 INTRAPARTUM HEMORRHAGE UNSPECIFIED

S93133A

SUBLUXATION OF INTERPHALANGEAL JOINT OF UNSP GREAT TOE INIT

O68

LABOR AND DELIVERY COMP BY ABNLT OF FETAL ACID-BASE BALANCE

S93134A

SUBLUXATION OF INTERPHALN JOINT OF RIGHT LESSER TOE(S) INIT

O690XX0

LABOR AND DELIVERY COMPLICATED BY PROLAPSE OF CORD UNSP

S93135A

SUBLUXATION OF INTERPHALN JOINT OF LEFT LESSER TOE(S) INIT

Page 397: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O690XX1

LABOR AND DELIVERY COMPLICATED BY PROLAPSE OF CORD FETUS 1

S93136A

SUBLUXATION OF INTERPHALN JOINT OF UNSP LESSER TOE(S) INIT

O690XX2

LABOR AND DELIVERY COMPLICATED BY PROLAPSE OF CORD FETUS 2

S93139A

SUBLUXATION OF INTERPHALANGEAL JOINT OF UNSP TOE(S) INIT

O690XX3

LABOR AND DELIVERY COMPLICATED BY PROLAPSE OF CORD FETUS 3

S93141A

SUBLUXATION OF MTP JOINT OF RIGHT GREAT TOE INIT

O690XX4

LABOR AND DELIVERY COMPLICATED BY PROLAPSE OF CORD FETUS 4

S93142A

SUBLUXATION OF MTP JOINT OF LEFT GREAT TOE INIT

O690XX5

LABOR AND DELIVERY COMPLICATED BY PROLAPSE OF CORD FETUS 5

S93143A

SUBLUXATION OF MTP JOINT OF UNSP GREAT TOE INIT

O690XX9

LABOR AND DELIVERY COMPLICATED BY PROLAPSE OF CORD OTH

S93144A

SUBLUXATION OF MTP JOINT OF RIGHT LESSER TOE(S) INIT

O691XX0

LABOR AND DELIVERY COMP BY CORD AROUND NECK W COMPRSN UNSP

S93145A

SUBLUXATION OF MTP JOINT OF LEFT LESSER TOE(S) INIT

O691XX1

LABOR AND DEL COMP BY CORD AROUND NECK W COMPRSN FETUS 1

S93146A

SUBLUXATION OF MTP JOINT OF UNSP LESSER TOE(S) INIT

O691XX2

LABOR AND DEL COMP BY CORD AROUND NECK W COMPRSN FETUS 2

S93149A

SUBLUXATION OF MTP JOINT OF UNSP TOE(S) INIT

O691XX3

LABOR AND DEL COMP BY CORD AROUND NECK W COMPRSN FETUS 3

S93311A

SUBLUXATION OF TARSAL JOINT OF RIGHT FOOT INITIAL ENCOUNTER

O691XX4

LABOR AND DEL COMP BY CORD AROUND NECK W COMPRSN FETUS 4

S93312A

SUBLUXATION OF TARSAL JOINT OF LEFT FOOT INITIAL ENCOUNTER

O691XX5

LABOR AND DEL COMP BY CORD AROUND NECK W COMPRSN FETUS 5

S93313A

SUBLUXATION OF TARSAL JOINT OF UNSPECIFIED FOOT INIT ENCNTR

Page 398: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O691XX9

LABOR AND DELIVERY COMP BY CORD AROUND NECK W COMPRSN OTH

S93314A

DISLOCATION OF TARSAL JOINT OF RIGHT FOOT INITIAL ENCOUNTER

O692XX0

LABOR AND DEL COMP BY OTH CORD ENTANGLE W COMPRSN UNSP

S93315A

DISLOCATION OF TARSAL JOINT OF LEFT FOOT INITIAL ENCOUNTER

O692XX1

LABOR AND DEL COMP BY OTH CORD ENTANGLE W COMPRSN FETUS 1

S93316A

DISLOCATION OF TARSAL JOINT OF UNSPECIFIED FOOT INIT ENCNTR

O692XX2

LABOR AND DEL COMP BY OTH CORD ENTANGLE W COMPRSN FETUS 2

S93321A

SUBLUXATION OF TARSOMETATARSAL JOINT OF RIGHT FOOT INIT

O692XX3

LABOR AND DEL COMP BY OTH CORD ENTANGLE W COMPRSN FETUS 3

S93322A

SUBLUXATION OF TARSOMETATARSAL JOINT OF LEFT FOOT INIT

O692XX4

LABOR AND DEL COMP BY OTH CORD ENTANGLE W COMPRSN FETUS 4

S93323A

SUBLUXATION OF TARSOMETATARSAL JOINT OF UNSP FOOT INIT

O692XX5

LABOR AND DEL COMP BY OTH CORD ENTANGLE W COMPRSN FETUS 5

S93324A

DISLOCATION OF TARSOMETATARSAL JOINT OF RIGHT FOOT INIT

O692XX9

LABOR AND DELIVERY COMP BY OTH CORD ENTANGLE W COMPRSN OTH

S93325A

DISLOCATION OF TARSOMETATARSAL JOINT OF LEFT FOOT INIT

O693XX0

LABOR AND DELIVERY COMPLICATED BY SHORT CORD UNSP

S93326A

DISLOCATION OF TARSOMETATARSAL JOINT OF UNSP FOOT INIT

O693XX1

LABOR AND DELIVERY COMPLICATED BY SHORT CORD FETUS 1

S93401A

SPRAIN OF UNSPECIFIED LIGAMENT OF RIGHT ANKLE INIT ENCNTR

O693XX2

LABOR AND DELIVERY COMPLICATED BY SHORT CORD FETUS 2

S93402A

SPRAIN OF UNSPECIFIED LIGAMENT OF LEFT ANKLE INIT ENCNTR

O693XX3

LABOR AND DELIVERY COMPLICATED BY SHORT CORD FETUS 3

S93409A

SPRAIN OF UNSP LIGAMENT OF UNSPECIFIED ANKLE INIT ENCNTR

Page 399: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O693XX4

LABOR AND DELIVERY COMPLICATED BY SHORT CORD FETUS 4

S93411A

SPRAIN OF CALCANEOFIBULAR LIGAMENT OF RIGHT ANKLE INIT

O693XX5

LABOR AND DELIVERY COMPLICATED BY SHORT CORD FETUS 5

S93412A

SPRAIN OF CALCANEOFIBULAR LIGAMENT OF LEFT ANKLE INIT

O693XX9

LABOR AND DELIVERY COMPLICATED BY SHORT CORD OTHER FETUS

S93419A

SPRAIN OF CALCANEOFIBULAR LIGAMENT OF UNSP ANKLE INIT

O694XX0

LABOR AND DELIVERY COMPLICATED BY VASA PREVIA UNSP

S93421A

SPRAIN OF DELTOID LIGAMENT OF RIGHT ANKLE INITIAL ENCOUNTER

O694XX1

LABOR AND DELIVERY COMPLICATED BY VASA PREVIA FETUS 1

S93422A

SPRAIN OF DELTOID LIGAMENT OF LEFT ANKLE INITIAL ENCOUNTER

O694XX2

LABOR AND DELIVERY COMPLICATED BY VASA PREVIA FETUS 2

S93429A

SPRAIN OF DELTOID LIGAMENT OF UNSPECIFIED ANKLE INIT ENCNTR

O694XX3

LABOR AND DELIVERY COMPLICATED BY VASA PREVIA FETUS 3

S93431A

SPRAIN OF TIBIOFIBULAR LIGAMENT OF RIGHT ANKLE INIT ENCNTR

O694XX4

LABOR AND DELIVERY COMPLICATED BY VASA PREVIA FETUS 4

S93432A

SPRAIN OF TIBIOFIBULAR LIGAMENT OF LEFT ANKLE INIT ENCNTR

O694XX5

LABOR AND DELIVERY COMPLICATED BY VASA PREVIA FETUS 5

S93439A

SPRAIN OF TIBIOFIBULAR LIGAMENT OF UNSP ANKLE INIT ENCNTR

O694XX9

LABOR AND DELIVERY COMPLICATED BY VASA PREVIA OTHER FETUS

S93491A

SPRAIN OF OTHER LIGAMENT OF RIGHT ANKLE INITIAL ENCOUNTER

O695XX0

LABOR AND DELIVERY COMP BY VASCULAR LESION OF CORD UNSP

S93492A

SPRAIN OF OTHER LIGAMENT OF LEFT ANKLE INITIAL ENCOUNTER

O695XX1

LABOR AND DELIVERY COMP BY VASCULAR LESION OF CORD FETUS 1

S93499A

SPRAIN OF OTHER LIGAMENT OF UNSPECIFIED ANKLE INIT ENCNTR

Page 400: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O695XX2

LABOR AND DELIVERY COMP BY VASCULAR LESION OF CORD FETUS 2

S93511A

SPRAIN OF INTERPHALANGEAL JOINT OF RIGHT GREAT TOE INIT

O695XX3

LABOR AND DELIVERY COMP BY VASCULAR LESION OF CORD FETUS 3

S93512A

SPRAIN OF INTERPHALANGEAL JOINT OF LEFT GREAT TOE INIT

O695XX4

LABOR AND DELIVERY COMP BY VASCULAR LESION OF CORD FETUS 4

S93513A

SPRAIN OF INTERPHALANGEAL JOINT OF UNSP GREAT TOE INIT

O695XX5

LABOR AND DELIVERY COMP BY VASCULAR LESION OF CORD FETUS 5

S93514A

SPRAIN OF INTERPHALANGEAL JOINT OF RIGHT LESSER TOE(S) INIT

O695XX9

LABOR AND DELIVERY COMP BY VASCULAR LESION OF CORD OTH

S93515A

SPRAIN OF INTERPHALANGEAL JOINT OF LEFT LESSER TOE(S) INIT

O6981X0

LABOR AND DEL COMP BY CORD AROUND NECK W/O COMPRSN UNSP

S93516A

SPRAIN OF INTERPHALANGEAL JOINT OF UNSP LESSER TOE(S) INIT

O6981X1

LABOR AND DEL COMP BY CORD AROUND NECK W/O COMPRSN FETUS 1

S93519A

SPRAIN OF INTERPHALANGEAL JOINT OF UNSP TOE(S) INIT ENCNTR

O6981X2

LABOR AND DEL COMP BY CORD AROUND NECK W/O COMPRSN FETUS 2

S93521A

SPRAIN OF METATARSOPHALANGEAL JOINT OF RIGHT GREAT TOE INIT

O6981X3

LABOR AND DEL COMP BY CORD AROUND NECK W/O COMPRSN FETUS 3

S93522A

SPRAIN OF METATARSOPHALANGEAL JOINT OF LEFT GREAT TOE INIT

O6981X4

LABOR AND DEL COMP BY CORD AROUND NECK W/O COMPRSN FETUS 4

S93523A

SPRAIN OF METATARSOPHALANGEAL JOINT OF UNSP GREAT TOE INIT

O6981X5

LABOR AND DEL COMP BY CORD AROUND NECK W/O COMPRSN FETUS 5

S93524A

SPRAIN OF MTP JOINT OF RIGHT LESSER TOE(S) INIT

O6981X9

LABOR AND DEL COMP BY CORD AROUND NECK W/O COMPRSN OTH

S93525A

SPRAIN OF MTP JOINT OF LEFT LESSER TOE(S) INIT

Page 401: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O6982X0

LABOR AND DEL COMP BY OTH CORD ENTANGLE W/O COMPRSN UNSP

S93526A

SPRAIN OF MTP JOINT OF UNSP LESSER TOE(S) INIT

O6982X1

LABOR AND DEL COMP BY OTH CORD ENTANGLE W/O COMPRSN FTS1

S93529A

SPRAIN OF METATARSOPHALANGEAL JOINT OF UNSP TOE(S) INIT

O6982X2

LABOR AND DEL COMP BY OTH CORD ENTANGLE W/O COMPRSN FTS2

S93611A

SPRAIN OF TARSAL LIGAMENT OF RIGHT FOOT INITIAL ENCOUNTER

O6982X3

LABOR AND DEL COMP BY OTH CORD ENTANGLE W/O COMPRSN FTS3

S93612A

SPRAIN OF TARSAL LIGAMENT OF LEFT FOOT INITIAL ENCOUNTER

O6982X4

LABOR AND DEL COMP BY OTH CORD ENTANGLE W/O COMPRSN FTS4

S93619A

SPRAIN OF TARSAL LIGAMENT OF UNSPECIFIED FOOT INIT ENCNTR

O6982X5

LABOR AND DEL COMP BY OTH CORD ENTANGLE W/O COMPRSN FTS5

S93621A

SPRAIN OF TARSOMETATARSAL LIGAMENT OF RIGHT FOOT INIT

O6982X9

LABOR AND DEL COMP BY OTH CORD ENTANGLE W/O COMPRSN OTH

S93622A

SPRAIN OF TARSOMETATARSAL LIGAMENT OF LEFT FOOT INIT ENCNTR

O6989X0

LABOR AND DELIVERY COMPLICATED BY OTH CORD COMP UNSP

S93629A

SPRAIN OF TARSOMETATARSAL LIGAMENT OF UNSP FOOT INIT ENCNTR

O6989X1

LABOR AND DELIVERY COMPLICATED BY OTH CORD COMP FETUS 1

S93691A

OTHER SPRAIN OF RIGHT FOOT INITIAL ENCOUNTER

O6989X2

LABOR AND DELIVERY COMPLICATED BY OTH CORD COMP FETUS 2

S93692A

OTHER SPRAIN OF LEFT FOOT INITIAL ENCOUNTER

O6989X3

LABOR AND DELIVERY COMPLICATED BY OTH CORD COMP FETUS 3

S93699A

OTHER SPRAIN OF UNSPECIFIED FOOT INITIAL ENCOUNTER

O6989X4

LABOR AND DELIVERY COMPLICATED BY OTH CORD COMP FETUS 4

S95011A

LACERATION OF DORSAL ARTERY OF RIGHT FOOT INITIAL ENCOUNTER

Page 402: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O6989X5

LABOR AND DELIVERY COMPLICATED BY OTH CORD COMP FETUS 5

S95012A

LACERATION OF DORSAL ARTERY OF LEFT FOOT INITIAL ENCOUNTER

O6989X9

LABOR AND DELIVERY COMPLICATED BY OTH CORD COMP OTH

S95019A

LACERATION OF DORSAL ARTERY OF UNSPECIFIED FOOT INIT ENCNTR

O699XX0

LABOR AND DELIVERY COMPLICATED BY CORD COMP UNSP UNSP

S95111A

LACERATION OF PLANTAR ARTERY OF RIGHT FOOT INIT ENCNTR

O699XX1

LABOR AND DELIVERY COMPLICATED BY CORD COMP UNSP FETUS 1

S95112A

LACERATION OF PLANTAR ARTERY OF LEFT FOOT INITIAL ENCOUNTER

O699XX2

LABOR AND DELIVERY COMPLICATED BY CORD COMP UNSP FETUS 2

S95119A

LACERATION OF PLANTAR ARTERY OF UNSP FOOT INIT ENCNTR

O699XX3

LABOR AND DELIVERY COMPLICATED BY CORD COMP UNSP FETUS 3

S95211A

LACERATION OF DORSAL VEIN OF RIGHT FOOT INITIAL ENCOUNTER

O699XX4

LABOR AND DELIVERY COMPLICATED BY CORD COMP UNSP FETUS 4

S95212A

LACERATION OF DORSAL VEIN OF LEFT FOOT INITIAL ENCOUNTER

O699XX5

LABOR AND DELIVERY COMPLICATED BY CORD COMP UNSP FETUS 5

S95219A

LACERATION OF DORSAL VEIN OF UNSPECIFIED FOOT INIT ENCNTR

O699XX9

LABOR AND DELIVERY COMPLICATED BY CORD COMP UNSP OTH

S95811A

LACERATION OF BLOOD VESSELS AT ANK/FT LEVEL RIGHT LEG INIT

O7100

RUPTURE OF UTERUS BEFORE ONSET OF LABOR UNSP TRIMESTER

S95812A

LACERATION OF BLOOD VESSELS AT ANK/FT LEVEL LEFT LEG INIT

O7102

RUPTURE OF UTERUS BEFORE ONSET OF LABOR SECOND TRIMESTER

S95819A

LACERATION OF BLOOD VESSELS AT ANK/FT LEVEL UNSP LEG INIT

O7103

RUPTURE OF UTERUS BEFORE ONSET OF LABOR THIRD TRIMESTER

S95911A

LACERAT UNSP BLOOD VESSEL AT ANK/FT LEVEL RIGHT LEG INIT

Page 403: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O711 RUPTURE OF UTERUS DURING LABOR

S95912A

LACERAT UNSP BLOOD VESSEL AT ANK/FT LEVEL LEFT LEG INIT

O712 POSTPARTUM INVERSION OF UTERUS

S95919A

LACERAT UNSP BLOOD VESSEL AT ANK/FT LEVEL UNSP LEG INIT

O715 OTHER OBSTETRIC INJURY TO PELVIC ORGANS

S96011A

STRAIN MSL/TND LNG FLXR MSL TOE AT ANK/FT LEV R FOOT INIT

O716 OBSTETRIC DAMAGE TO PELVIC JOINTS AND LIGAMENTS

S96012A

STRAIN MSL/TND LNG FLXR MSL TOE AT ANK/FT LEV L FOOT INIT

O717 OBSTETRIC HEMATOMA OF PELVIS

S96019A

STRAIN MSL/TND LNG FLXR MSL TOE AT ANK/FT LEV UNSP FT INIT

O7181 LACERATION OF UTERUS NOT ELSEWHERE CLASSIFIED

S96021A

LACERAT MSL/TND LNG FLXR MSL TOE AT ANK/FT LEV R FOOT INIT

O7182 OTHER SPECIFIED TRAUMA TO PERINEUM AND VULVA

S96022A

LACERAT MSL/TND LNG FLXR MSL TOE AT ANK/FT LEV L FOOT INIT

O7189 OTHER SPECIFIED OBSTETRIC TRAUMA

S96029A

LACERAT MSL/TND LNG FLXR MSL TOE AT ANK/FT LEVUNSP FT INIT

O719 OBSTETRIC TRAUMA UNSPECIFIED

S96111A

STRAIN MSL/TND LNG EXTN MSL TOE AT ANK/FT LEV R FOOT INIT

O720 THIRD-STAGE HEMORRHAGE

S96112A STRAIN MSL/TND LNG EXTN MSL TOE AT ANK/FT LEV L FOOT INIT

O721 OTHER IMMEDIATE POSTPARTUM HEMORRHAGE

S96119A

STRAIN MSL/TND LNG EXTN MSL TOE AT ANK/FT LEV UNSP FT INIT

O722 DELAYED AND SECONDARY POSTPARTUM HEMORRHAGE

S96121A

LACERAT MSL/TND LNG EXTN MSL TOE AT ANK/FT LEV R FOOT INIT

O723 POSTPARTUM COAGULATION DEFECTS

S96122A

LACERAT MSL/TND LNG EXTN MSL TOE AT ANK/FT LEV L FOOT INIT

O730 RETAINED PLACENTA WITHOUT HEMORRHAGE

S96129A

LACERAT MSL/TND LNG EXTN MSL TOE AT ANK/FT LEVUNSP FT INIT

O731

RETAINED PORTIONS OF PLACENTA AND MEMBRANES W/O HEMORRHAGE

S96211A

STRAIN OF INTRINSIC MSL/TND AT ANK/FT LEVEL R FOOT INIT

O740

ASPIRAT PNEUMONITIS DUE TO ANESTH DURING LABOR AND DELIVERY

S96212A

STRAIN OF INTRINSIC MSL/TND AT ANK/FT LEVEL LEFT FOOT INIT

Page 404: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O741

OTH PULMONARY COMP OF ANESTHESIA DURING LABOR AND DELIVERY

S96219A

STRAIN OF INTRINSIC MSL/TND AT ANK/FT LEVEL UNSP FOOT INIT

O742 CARDIAC COMP OF ANESTHESIA DURING LABOR AND DELIVERY

S96221A

LACERAT INTRINSIC MSL/TND AT ANK/FT LEVEL RIGHT FOOT INIT

O743

CNSL COMPLICATIONS OF ANESTHESIA DURING LABOR AND DELIVERY

S96222A

LACERAT INTRINSIC MSL/TND AT ANK/FT LEVEL LEFT FOOT INIT

O744

TOXIC REACTION TO LOCAL ANESTHESIA DURING LABOR AND DELIVERY

S96229A

LACERAT INTRINSIC MSL/TND AT ANK/FT LEVEL UNSP FOOT INIT

O747

FAILED OR DIFFICULT INTUBATION FOR ANESTH DUR LABOR AND DEL

S96811A

STRAIN OF MUSCLES AND TENDONS AT ANK/FT LEVEL R FOOT INIT

O748

OTHER COMPLICATIONS OF ANESTHESIA DURING LABOR AND DELIVERY

S96812A

STRAIN OF MUSCLES AND TENDONS AT ANK/FT LEVEL L FOOT INIT

O749

COMPLICATION OF ANESTHESIA DURING LABOR AND DELIVERY UNSP

S96819A

STRAIN MUSCLES AND TENDONS AT ANK/FT LEVEL UNSP FOOT INIT

O750 MATERNAL DISTRESS DURING LABOR AND DELIVERY

S96821A

LACERAT MUSCLES AND TENDONS AT ANK/FT LEVEL R FOOT INIT

O751 SHOCK DURING OR FOLLOWING LABOR AND DELIVERY

S96822A

LACERAT MUSCLES AND TENDONS AT ANK/FT LEVEL LEFT FOOT INIT

O752 PYREXIA DURING LABOR NOT ELSEWHERE CLASSIFIED

S96829A

LACERAT MUSCLES AND TENDONS AT ANK/FT LEVEL UNSP FOOT INIT

O753 OTHER INFECTION DURING LABOR

S96911A

STRAIN OF UNSP MSL/TND AT ANK/FT LEVEL RIGHT FOOT INIT

O754

OTHER COMPLICATIONS OF OBSTETRIC SURGERY AND PROCEDURES

S96912A

STRAIN OF UNSP MSL/TND AT ANK/FT LEVEL LEFT FOOT INIT

O755

DELAYED DELIVERY AFTER ARTIFICIAL RUPTURE OF MEMBRANES

S96919A

STRAIN OF UNSP MSL/TND AT ANK/FT LEVEL UNSP FOOT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O7581

MATERNAL EXHAUSTION COMPLICATING LABOR AND DELIVERY

S96921A

LACERATION OF UNSP MSL/TND AT ANK/FT LEVEL RIGHT FOOT INIT

O7589

OTHER SPECIFIED COMPLICATIONS OF LABOR AND DELIVERY

S96922A

LACERATION OF UNSP MSL/TND AT ANK/FT LEVEL LEFT FOOT INIT

O759 COMPLICATION OF LABOR AND DELIVERY UNSPECIFIED

S96929A

LACERATION OF UNSP MSL/TND AT ANK/FT LEVEL UNSP FOOT INIT

O76

ABNLT IN FETAL HEART RATE AND RHYTHM COMP LABOR AND DELIVERY

S9700XA

CRUSHING INJURY OF UNSPECIFIED ANKLE INITIAL ENCOUNTER

O770

LABOR AND DELIVERY COMPLICATED BY MECONIUM IN AMNIOTIC FLUID

S9701XA

CRUSHING INJURY OF RIGHT ANKLE INITIAL ENCOUNTER

O771

FETAL STRESS IN LABOR OR DELIVERY DUE TO DRUG ADMINISTRATION

S9702XA

CRUSHING INJURY OF LEFT ANKLE INITIAL ENCOUNTER

O778

LABOR AND DELIVERY COMP BY OTH EVIDENCE OF FETAL STRESS

S97101A

CRUSHING INJURY OF UNSPECIFIED RIGHT TOE(S) INIT ENCNTR

O779

LABOR AND DELIVERY COMPLICATED BY FETAL STRESS UNSPECIFIED

S97102A

CRUSHING INJURY OF UNSPECIFIED LEFT TOE(S) INIT ENCNTR

O873

CEREBRAL VENOUS THROMBOSIS IN THE PUERPERIUM

S97109A

CRUSHING INJURY OF UNSPECIFIED TOE(S) INITIAL ENCOUNTER

O88011 AIR EMBOLISM IN PREGNANCY FIRST TRIMESTER

S97111A

CRUSHING INJURY OF RIGHT GREAT TOE INITIAL ENCOUNTER

O88012 AIR EMBOLISM IN PREGNANCY SECOND TRIMESTER

S97112A

CRUSHING INJURY OF LEFT GREAT TOE INITIAL ENCOUNTER

O88013 AIR EMBOLISM IN PREGNANCY THIRD TRIMESTER

S97119A

CRUSHING INJURY OF UNSPECIFIED GREAT TOE INITIAL ENCOUNTER

O88019 AIR EMBOLISM IN PREGNANCY UNSPECIFIED TRIMESTER

S97121A

CRUSHING INJURY OF RIGHT LESSER TOE(S) INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O8802 AIR EMBOLISM IN CHILDBIRTH

S97122A CRUSHING INJURY OF LEFT LESSER TOE(S) INITIAL ENCOUNTER

O8803 AIR EMBOLISM IN THE PUERPERIUM

S97129A

CRUSHING INJURY OF UNSPECIFIED LESSER TOE(S) INIT ENCNTR

O88111 AMNIOTIC FLUID EMBOLISM IN PREGNANCY FIRST TRIMESTER

S9780XA

CRUSHING INJURY OF UNSPECIFIED FOOT INITIAL ENCOUNTER

O88112

AMNIOTIC FLUID EMBOLISM IN PREGNANCY SECOND TRIMESTER

S9781XA

CRUSHING INJURY OF RIGHT FOOT INITIAL ENCOUNTER

O88113 AMNIOTIC FLUID EMBOLISM IN PREGNANCY THIRD TRIMESTER

S9782XA

CRUSHING INJURY OF LEFT FOOT INITIAL ENCOUNTER

O88119

AMNIOTIC FLUID EMBOLISM IN PREGNANCY UNSPECIFIED TRIMESTER

S98011A

COMPLETE TRAUMATIC AMP OF RIGHT FOOT AT ANKLE LEVEL INIT

O8812 AMNIOTIC FLUID EMBOLISM IN CHILDBIRTH

S98012A

COMPLETE TRAUMATIC AMP OF LEFT FOOT AT ANKLE LEVEL INIT

O8813 AMNIOTIC FLUID EMBOLISM IN THE PUERPERIUM

S98019A

COMPLETE TRAUMATIC AMP OF UNSP FOOT AT ANKLE LEVEL INIT

O88211 THROMBOEMBOLISM IN PREGNANCY FIRST TRIMESTER

S98021A

PARTIAL TRAUMATIC AMP OF RIGHT FOOT AT ANKLE LEVEL INIT

O88212

THROMBOEMBOLISM IN PREGNANCY SECOND TRIMESTER

S98022A

PARTIAL TRAUMATIC AMP OF LEFT FOOT AT ANKLE LEVEL INIT

O88213 THROMBOEMBOLISM IN PREGNANCY THIRD TRIMESTER

S98029A

PARTIAL TRAUMATIC AMP OF UNSP FOOT AT ANKLE LEVEL INIT

O88219

THROMBOEMBOLISM IN PREGNANCY UNSPECIFIED TRIMESTER

S98111A

COMPLETE TRAUMATIC AMPUTATION OF RIGHT GREAT TOE INIT

O8822 THROMBOEMBOLISM IN CHILDBIRTH

S98112A

COMPLETE TRAUMATIC AMPUTATION OF LEFT GREAT TOE INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O8823 THROMBOEMBOLISM IN THE PUERPERIUM

S98119A

COMPLETE TRAUMATIC AMPUTATION OF UNSP GREAT TOE INIT ENCNTR

O88311

PYEMIC AND SEPTIC EMBOLISM IN PREGNANCY FIRST TRIMESTER

S98121A

PARTIAL TRAUMATIC AMPUTATION OF RIGHT GREAT TOE INIT ENCNTR

O88312

PYEMIC AND SEPTIC EMBOLISM IN PREGNANCY SECOND TRIMESTER

S98122A

PARTIAL TRAUMATIC AMPUTATION OF LEFT GREAT TOE INIT ENCNTR

O88313

PYEMIC AND SEPTIC EMBOLISM IN PREGNANCY THIRD TRIMESTER

S98129A

PARTIAL TRAUMATIC AMPUTATION OF UNSP GREAT TOE INIT ENCNTR

O88319

PYEMIC AND SEPTIC EMBOLISM IN PREGNANCY UNSP TRIMESTER

S98131A

COMPLETE TRAUMATIC AMPUTATION OF ONE RIGHT LESSER TOE INIT

O8832 PYEMIC AND SEPTIC EMBOLISM IN CHILDBIRTH

S98132A

COMPLETE TRAUMATIC AMPUTATION OF ONE LEFT LESSER TOE INIT

O8833 PYEMIC AND SEPTIC EMBOLISM IN THE PUERPERIUM

S98139A

COMPLETE TRAUMATIC AMPUTATION OF ONE UNSP LESSER TOE INIT

O88811 OTHER EMBOLISM IN PREGNANCY FIRST TRIMESTER

S98141A

PARTIAL TRAUMATIC AMPUTATION OF ONE RIGHT LESSER TOE INIT

O88812

OTHER EMBOLISM IN PREGNANCY SECOND TRIMESTER

S98142A

PARTIAL TRAUMATIC AMPUTATION OF ONE LEFT LESSER TOE INIT

O88813 OTHER EMBOLISM IN PREGNANCY THIRD TRIMESTER

S98149A

PARTIAL TRAUMATIC AMPUTATION OF ONE UNSP LESSER TOE INIT

O88819

OTHER EMBOLISM IN PREGNANCY UNSPECIFIED TRIMESTER

S98211A

COMPLETE TRAUM AMP OF TWO OR MORE RIGHT LESSER TOES INIT

O8882 OTHER EMBOLISM IN CHILDBIRTH

S98212A

COMPLETE TRAUMATIC AMP OF TWO OR MORE LEFT LESSER TOES INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O8883 OTHER EMBOLISM IN THE PUERPERIUM

S98219A

COMPLETE TRAUMATIC AMP OF TWO OR MORE UNSP LESSER TOES INIT

O8901

ASPIRATION PNEUMONITIS DUE TO ANESTH DURING THE PUERPERIUM

S98221A

PARTIAL TRAUMATIC AMP OF TWO OR MORE RIGHT LESSER TOES INIT

O8909

OTH PULMONARY COMP OF ANESTHESIA DURING THE PUERPERIUM

S98222A

PARTIAL TRAUMATIC AMP OF TWO OR MORE LEFT LESSER TOES INIT

O891

CARDIAC COMPLICATIONS OF ANESTHESIA DURING THE PUERPERIUM

S98229A

PARTIAL TRAUMATIC AMP OF TWO OR MORE UNSP LESSER TOES INIT

O892

CNSL COMPLICATIONS OF ANESTHESIA DURING THE PUERPERIUM

S98311A

COMPLETE TRAUMATIC AMPUTATION OF RIGHT MIDFOOT INIT ENCNTR

O893

TOXIC REACTION TO LOCAL ANESTHESIA DURING THE PUERPERIUM

S98312A

COMPLETE TRAUMATIC AMPUTATION OF LEFT MIDFOOT INIT ENCNTR

O894

SPINAL AND EPIDUR ANESTHESIA-INDUCED HDACHE DURING THE PUERP

S98319A

COMPLETE TRAUMATIC AMPUTATION OF UNSP MIDFOOT INIT ENCNTR

O895

OTH COMP OF SPINAL AND EPIDURAL ANESTH DURING THE PUERPERIUM

S98321A

PARTIAL TRAUMATIC AMPUTATION OF RIGHT MIDFOOT INIT ENCNTR

O896

FAILED OR DIFFICULT INTUBATION FOR ANESTH DURING THE PUERP

S98322A

PARTIAL TRAUMATIC AMPUTATION OF LEFT MIDFOOT INIT ENCNTR

O898

OTHER COMPLICATIONS OF ANESTHESIA DURING THE PUERPERIUM

S98329A

PARTIAL TRAUMATIC AMPUTATION OF UNSP MIDFOOT INIT ENCNTR

O903 PERIPARTUM CARDIOMYOPATHY

S98911A

COMPLETE TRAUMATIC AMP OF RIGHT FOOT LEVEL UNSP INIT

O904 POSTPARTUM ACUTE KIDNEY FAILURE

S98912A

COMPLETE TRAUMATIC AMPUTATION OF LEFT FOOT LEVEL UNSP INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O905 POSTPARTUM THYROIDITIS

S98919A COMPLETE TRAUMATIC AMPUTATION OF UNSP FOOT LEVEL UNSP INIT

O99820

STREPTOCOCCUS B CARRIER STATE COMPLICATING PREGNANCY

S98921A

PARTIAL TRAUMATIC AMPUTATION OF RIGHT FOOT LEVEL UNSP INIT

O99824

STREPTOCOCCUS B CARRIER STATE COMPLICATING CHILDBIRTH

S98922A

PARTIAL TRAUMATIC AMPUTATION OF LEFT FOOT LEVEL UNSP INIT

O99825

STREPTOCOCCUS B CARRIER STATE COMPLICATING THE PUERPERIUM

S98929A

PARTIAL TRAUMATIC AMPUTATION OF UNSP FOOT LEVEL UNSP INIT

O9A311

PHYSICAL ABUSE COMPLICATING PREGNANCY FIRST TRIMESTER

S99001A

Unspecified physeal fracture of right calcaneus initial encounter for closed fracture

O9A312

PHYSICAL ABUSE COMPLICATING PREGNANCY SECOND TRIMESTER

S99001B

Unspecified physeal fracture of right calcaneus initial encounter for open fracture

O9A313

PHYSICAL ABUSE COMPLICATING PREGNANCY THIRD TRIMESTER

S99002A

Unspecified physeal fracture of left calcaneus initial encounter for closed fracture

O9A319

PHYSICAL ABUSE COMPLICATING PREGNANCY UNSPECIFIED TRIMESTER

S99002B

Unspecified physeal fracture of left calcaneus initial encounter for open fracture

O9A32 PHYSICAL ABUSE COMPLICATING CHILDBIRTH

S99009A

Unspecified physeal fracture of unspecified calcaneus initial encounter for closed fracture

O9A33

PHYSICAL ABUSE COMPLICATING THE PUERPERIUM

S99009B

Unspecified physeal fracture of unspecified calcaneus initial encounter for open fracture

O9A411 SEXUAL ABUSE COMPLICATING PREGNANCY FIRST TRIMESTER

S99011A

Salter-Harris Type I physeal fracture of right calcaneus initial encounter for closed fracture

O9A412

SEXUAL ABUSE COMPLICATING PREGNANCY SECOND TRIMESTER

S99011B

Salter-Harris Type I physeal fracture of right calcaneus initial encounter for open fracture

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

O9A413 SEXUAL ABUSE COMPLICATING PREGNANCY THIRD TRIMESTER

S99012A

Salter-Harris Type I physeal fracture of left calcaneus initial encounter for closed fracture

O9A419

SEXUAL ABUSE COMPLICATING PREGNANCY UNSPECIFIED TRIMESTER

S99012B

Salter-Harris Type I physeal fracture of left calcaneus initial encounter for open fracture

O9A42 SEXUAL ABUSE COMPLICATING CHILDBIRTH

S99019A

Salter-Harris Type I physeal fracture of unspecified calcaneus initial encounter for closed fracture

O9A43 SEXUAL ABUSE COMPLICATING THE PUERPERIUM

S99019B

Salter-Harris Type I physeal fracture of unspecified calcaneus initial encounter for open fracture

P0382 MECONIUM PASSAGE DURING DELIVERY

S99021A

Salter-Harris Type II physeal fracture of right calcaneus initial encounter for closed fracture

P043 NEWBORN AFFECTED BY MATERNAL USE OF ALCOHOL

S99021B

Salter-Harris Type II physeal fracture of right calcaneus initial encounter for open fracture

P0441 NEWBORN AFFECTED BY MATERNAL USE OF COCAINE

S99022A

Salter-Harris Type II physeal fracture of left calcaneus initial encounter for closed fracture

P0449

NEWBORN AFFECTED BY MATERNAL USE OF DRUGS OF ADDICTION

S99022B

Salter-Harris Type II physeal fracture of left calcaneus initial encounter for open fracture

P048

NEWBORN AFFECTED BY OTH MATERNAL NOXIOUS SUBSTANCES

S99029A

Salter-Harris Type II physeal fracture of unspecified calcaneus initial encounter for closed fracture

P049

NEWBORN AFFECTED BY MATERNAL NOXIOUS SUBSTANCE UNSP

S99029B

Salter-Harris Type II physeal fracture of unspecified calcaneus initial encounter for open fracture

P0500

NEWBORN LIGHT FOR GESTATIONAL AGE UNSPECIFIED WEIGHT

S99031A

Salter-Harris Type III physeal fracture of right calcaneus initial encounter for closed fracture

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P0501

NEWBORN LIGHT FOR GESTATIONAL AGE LESS THAN 500 GRAMS

S99031B

Salter-Harris Type III physeal fracture of right calcaneus initial encounter for open fracture

P0502

NEWBORN LIGHT FOR GESTATIONAL AGE 500-749 GRAMS

S99032A

Salter-Harris Type III physeal fracture of left calcaneus initial encounter for closed fracture

P0503

NEWBORN LIGHT FOR GESTATIONAL AGE 750-999 GRAMS

S99032B

Salter-Harris Type III physeal fracture of left calcaneus initial encounter for open fracture

P0504

NEWBORN LIGHT FOR GESTATIONAL AGE 1000-1249 GRAMS

S99039A

Salter-Harris Type III physeal fracture of unspecified calcaneus initial encounter for closed fracture

P0505

NEWBORN LIGHT FOR GESTATIONAL AGE 1250-1499 GRAMS

S99039B

Salter-Harris Type III physeal fracture of unspecified calcaneus initial encounter for open fracture

P0506

NEWBORN LIGHT FOR GESTATIONAL AGE 1500-1749 GRAMS

S99041A

Salter-Harris Type IV physeal fracture of right calcaneus initial encounter for closed fracture

P0507

NEWBORN LIGHT FOR GESTATIONAL AGE 1750-1999 GRAMS

S99041B

Salter-Harris Type IV physeal fracture of right calcaneus initial encounter for open fracture

P0508

NEWBORN LIGHT FOR GESTATIONAL AGE 2000-2499 GRAMS

S99042A

Salter-Harris Type IV physeal fracture of left calcaneus initial encounter for closed fracture

P0509 Newborn light for gestational age 2500 grams and over

S99042B

Salter-Harris Type IV physeal fracture of left calcaneus initial encounter for open fracture

P0510

NEWBORN SMALL FOR GESTATIONAL AGE UNSPECIFIED WEIGHT

S99049A

Salter-Harris Type IV physeal fracture of unspecified calcaneus initial encounter for closed fracture

P0511

NEWBORN SMALL FOR GESTATIONAL AGE LESS THAN 500 GRAMS

S99049B

Salter-Harris Type IV physeal fracture of unspecified calcaneus initial encounter for open fracture

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P0512

NEWBORN SMALL FOR GESTATIONAL AGE 500-749 GRAMS

S99091A

Other physeal fracture of right calcaneus initial encounter for closed fracture

P0513

NEWBORN SMALL FOR GESTATIONAL AGE 750-999 GRAMS

S99091B

Other physeal fracture of right calcaneus initial encounter for open fracture

P0514

NEWBORN SMALL FOR GESTATIONAL AGE 1000-1249 GRAMS

S99092A

Other physeal fracture of left calcaneus initial encounter for closed fracture

P0515

NEWBORN SMALL FOR GESTATIONAL AGE 1250-1499 GRAMS

S99092B

Other physeal fracture of left calcaneus initial encounter for open fracture

P0516

NEWBORN SMALL FOR GESTATIONAL AGE 1500-1749 GRAMS

S99099A

Other physeal fracture of unspecified calcaneus initial encounter for closed fracture

P0517

NEWBORN SMALL FOR GESTATIONAL AGE 1750-1999 GRAMS

S99099B

Other physeal fracture of unspecified calcaneus initial encounter for open fracture

P0518

NEWBORN SMALL FOR GESTATIONAL AGE 2000-2499 GRAMS

S99101A

Unspecified physeal fracture of right metatarsal initial encounter for closed fracture

P0519 Newborn small for gestational age other

S99101B

Unspecified physeal fracture of right metatarsal initial encounter for open fracture

P052

NB AFF BY FETAL MALNUT NOT LIGHT OR SMALL FOR GESTATNL AGE

S99102A

Unspecified physeal fracture of left metatarsal initial encounter for closed fracture

P0700

EXTREMELY LOW BIRTH WEIGHT NEWBORN UNSPECIFIED WEIGHT

S99102B

Unspecified physeal fracture of left metatarsal initial encounter for open fracture

P0701

EXTREMELY LOW BIRTH WEIGHT NEWBORN LESS THAN 500 GRAMS

S99109A

Unspecified physeal fracture of unspecified metatarsal initial encounter for closed fracture

P0702

EXTREMELY LOW BIRTH WEIGHT NEWBORN 500-749 GRAMS

S99109B

Unspecified physeal fracture of unspecified metatarsal initial encounter for open fracture

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P0703

EXTREMELY LOW BIRTH WEIGHT NEWBORN 750-999 GRAMS

S99111A

Salter-Harris Type I physeal fracture of right metatarsal initial encounter for closed fracture

P0710

OTHER LOW BIRTH WEIGHT NEWBORN UNSPECIFIED WEIGHT

S99111B

Salter-Harris Type I physeal fracture of right metatarsal initial encounter for open fracture

P0714 OTHER LOW BIRTH WEIGHT NEWBORN 1000-1249 GRAMS

S99112A

Salter-Harris Type I physeal fracture of left metatarsal initial encounter for closed fracture

P0715 OTHER LOW BIRTH WEIGHT NEWBORN 1250-1499 GRAMS

S99112B

Salter-Harris Type I physeal fracture of left metatarsal initial encounter for open fracture

P0716 OTHER LOW BIRTH WEIGHT NEWBORN 1500-1749 GRAMS

S99119A

Salter-Harris Type I physeal fracture of unspecified metatarsal initial encounter for closed fracture

P0717 OTHER LOW BIRTH WEIGHT NEWBORN 1750-1999 GRAMS

S99119B

Salter-Harris Type I physeal fracture of unspecified metatarsal initial encounter for open fracture

P0718 OTHER LOW BIRTH WEIGHT NEWBORN 2000-2499 GRAMS

S99121A

Salter-Harris Type II physeal fracture of right metatarsal initial encounter for closed fracture

P0720

EXTREME IMMATURITY OF NEWBORN UNSP WEEKS OF GESTATION

S99121B

Salter-Harris Type II physeal fracture of right metatarsal initial encounter for open fracture

P0721

EXTREME IMMATURITY OF NB GESTATNL AGE < 23 COMPLETED WEEKS

S99122A

Salter-Harris Type II physeal fracture of left metatarsal initial encounter for closed fracture

P0722

EXTREME IMMATURITY OF NB GESTATNL AGE 23 COMPLETED WEEKS

S99122B

Salter-Harris Type II physeal fracture of left metatarsal initial encounter for open fracture

P0723

EXTREME IMMATURITY OF NB GESTATNL AGE 24 COMPLETED WEEKS

S99129A

Salter-Harris Type II physeal fracture of unspecified metatarsal initial encounter for closed fracture

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P0730

PRETERM NEWBORN UNSPECIFIED WEEKS OF GESTATION

S99129B

Salter-Harris Type II physeal fracture of unspecified metatarsal initial encounter for open fracture

P0731

PRETERM NEWBORN GESTATIONAL AGE 28 COMPLETED WEEKS

S99131A

Salter-Harris Type III physeal fracture of right metatarsal initial encounter for closed fracture

P0732

PRETERM NEWBORN GESTATIONAL AGE 29 COMPLETED WEEKS

S99131B

Salter-Harris Type III physeal fracture of right metatarsal initial encounter for open fracture

P100 SUBDURAL HEMORRHAGE DUE TO BIRTH INJURY

S99132A

Salter-Harris Type III physeal fracture of left metatarsal initial encounter for closed fracture

P101 CEREBRAL HEMORRHAGE DUE TO BIRTH INJURY

S99132B

Salter-Harris Type III physeal fracture of left metatarsal initial encounter for open fracture

P102

INTRAVENTRICULAR HEMORRHAGE DUE TO BIRTH INJURY

S99139A

Salter-Harris Type III physeal fracture of unspecified metatarsal initial encounter for closed fracture

P103 SUBARACHNOID HEMORRHAGE DUE TO BIRTH INJURY

S99139B

Salter-Harris Type III physeal fracture of unspecified metatarsal initial encounter for open fracture

P104 TENTORIAL TEAR DUE TO BIRTH INJURY

S99141A

Salter-Harris Type IV physeal fracture of right metatarsal initial encounter for closed fracture

P108

OTH INTCRN LACERATIONS AND HEMORRHAGES DUE TO BIRTH INJURY

S99141B

Salter-Harris Type IV physeal fracture of right metatarsal initial encounter for open fracture

P109

UNSP INTCRN LACERATION AND HEMORRHAGE DUE TO BIRTH INJURY

S99142A

Salter-Harris Type IV physeal fracture of left metatarsal initial encounter for closed fracture

P110 CEREBRAL EDEMA DUE TO BIRTH INJURY

S99142B

Salter-Harris Type IV physeal fracture of left metatarsal initial encounter for open fracture

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P111 OTHER SPECIFIED BRAIN DAMAGE DUE TO BIRTH INJURY

S99149A

Salter-Harris Type IV physeal fracture of unspecified metatarsal initial encounter for closed fracture

P112 UNSPECIFIED BRAIN DAMAGE DUE TO BIRTH INJURY

S99149B

Salter-Harris Type IV physeal fracture of unspecified metatarsal initial encounter for open fracture

P113 BIRTH INJURY TO FACIAL NERVE

S99191A

Other physeal fracture of right metatarsal initial encounter for closed fracture

P114 BIRTH INJURY TO OTHER CRANIAL NERVES

S99191B

Other physeal fracture of right metatarsal initial encounter for open fracture

P115 BIRTH INJURY TO SPINE AND SPINAL CORD

S99192A

Other physeal fracture of left metatarsal initial encounter for closed fracture

P119 BIRTH INJURY TO CENTRAL NERVOUS SYSTEM UNSPECIFIED

S99192B

Other physeal fracture of left metatarsal initial encounter for open fracture

P120 CEPHALHEMATOMA DUE TO BIRTH INJURY

S99199A

Other physeal fracture of unspecified metatarsal initial encounter for closed fracture

P121

CHIGNON (FROM VACUUM EXTRACTION) DUE TO BIRTH INJURY

S99199B

Other physeal fracture of unspecified metatarsal initial encounter for open fracture

P122

EPICRANIAL SUBAPONEUROTIC HEMORRHAGE DUE TO BIRTH INJURY

S99201A

Unspecified physeal fracture of phalanx of right toe initial encounter for closed fracture

P130 FRACTURE OF SKULL DUE TO BIRTH INJURY

S99201B

Unspecified physeal fracture of phalanx of right toe initial encounter for open fracture

P131 OTHER BIRTH INJURIES TO SKULL

S99202A

Unspecified physeal fracture of phalanx of left toe initial encounter for closed fracture

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P150 BIRTH INJURY TO LIVER

S99202B

Unspecified physeal fracture of phalanx of left toe initial encounter for open fracture

P151 BIRTH INJURY TO SPLEEN

S99209A

Unspecified physeal fracture of phalanx of unspecified toe initial encounter for closed fracture

P190

METABOLIC ACIDEMIA IN NEWBORN FIRST NOTED BEFORE ONSET LABOR

S99209B

Unspecified physeal fracture of phalanx of unspecified toe initial encounter for open fracture

P191

METABOLIC ACIDEMIA IN NEWBORN FIRST NOTED DURING LABOR

S99211A

Salter-Harris Type I physeal fracture of phalanx of right toe initial encounter for closed fracture

P192 METABOLIC ACIDEMIA NOTED AT BIRTH

S99211B

Salter-Harris Type I physeal fracture of phalanx of right toe initial encounter for open fracture

P199 METABOLIC ACIDEMIA UNSPECIFIED

S99212A

Salter-Harris Type I physeal fracture of phalanx of left toe initial encounter for closed fracture

P220 RESPIRATORY DISTRESS SYNDROME OF NEWBORN

S99212B

Salter-Harris Type I physeal fracture of phalanx of left toe initial encounter for open fracture

P221 TRANSIENT TACHYPNEA OF NEWBORN

S99219A

Salter-Harris Type I physeal fracture of phalanx of unspecified toe initial encounter for closed fracture

P228 OTHER RESPIRATORY DISTRESS OF NEWBORN

S99219B

Salter-Harris Type I physeal fracture of phalanx of unspecified toe initial encounter for open fracture

P229 RESPIRATORY DISTRESS OF NEWBORN UNSPECIFIED

S99221A

Salter-Harris Type II physeal fracture of phalanx of right toe initial encounter for closed fracture

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P230 CONGENITAL PNEUMONIA DUE TO VIRAL AGENT

S99221B

Salter-Harris Type II physeal fracture of phalanx of right toe initial encounter for open fracture

P231 CONGENITAL PNEUMONIA DUE TO CHLAMYDIA

S99222A

Salter-Harris Type II physeal fracture of phalanx of left toe initial encounter for closed fracture

P232 CONGENITAL PNEUMONIA DUE TO STAPHYLOCOCCUS

S99222B

Salter-Harris Type II physeal fracture of phalanx of left toe initial encounter for open fracture

P233 CONGENITAL PNEUMONIA DUE TO STREPTOCOCCUS GROUP B

S99229A

Salter-Harris Type II physeal fracture of phalanx of unspecified toe initial encounter for closed fracture

P234 CONGENITAL PNEUMONIA DUE TO ESCHERICHIA COLI

S99229B

Salter-Harris Type II physeal fracture of phalanx of unspecified toe initial encounter for open fracture

P235 CONGENITAL PNEUMONIA DUE TO PSEUDOMONAS

S99231A

Salter-Harris Type III physeal fracture of phalanx of right toe initial encounter for closed fracture

P236 CONGENITAL PNEUMONIA DUE TO OTHER BACTERIAL AGENTS

S99231B

Salter-Harris Type III physeal fracture of phalanx of right toe initial encounter for open fracture

P238 CONGENITAL PNEUMONIA DUE TO OTHER ORGANISMS

S99232A

Salter-Harris Type III physeal fracture of phalanx of left toe initial encounter for closed fracture

P239 CONGENITAL PNEUMONIA UNSPECIFIED

S99232B

Salter-Harris Type III physeal fracture of phalanx of left toe initial encounter for open fracture

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P2400

MECONIUM ASPIRATION WITHOUT RESPIRATORY SYMPTOMS

S99239A

Salter-Harris Type III physeal fracture of phalanx of unspecified toe initial encounter for closed fracture

P2401 MECONIUM ASPIRATION WITH RESPIRATORY SYMPTOMS

S99239B

Salter-Harris Type III physeal fracture of phalanx of unspecified toe initial encounter for open fracture

P2410

NEONATAL ASPIRAT OF AMNIO FLUID AND MUCUS W/O RESP SYMP

S99241A

Salter-Harris Type IV physeal fracture of phalanx of right toe initial encounter for closed fracture

P2411

NEONATAL ASPIRAT OF AMNIO FLUID AND MUCUS W RESP SYMP

S99241B

Salter-Harris Type IV physeal fracture of phalanx of right toe initial encounter for open fracture

P2420

NEONATAL ASPIRATION OF BLOOD WITHOUT RESPIRATORY SYMPTOMS

S99242A

Salter-Harris Type IV physeal fracture of phalanx of left toe initial encounter for closed fracture

P2421

NEONATAL ASPIRATION OF BLOOD WITH RESPIRATORY SYMPTOMS

S99242B

Salter-Harris Type IV physeal fracture of phalanx of left toe initial encounter for open fracture

P2430

NEONATAL ASPIRAT OF MILK AND REGURGITATED FOOD W/O RESP SYMP

S99249A

Salter-Harris Type IV physeal fracture of phalanx of unspecified toe initial encounter for closed fracture

P2431

NEONATAL ASPIRAT OF MILK AND REGURGITATED FOOD W RESP SYMP

S99249B

Salter-Harris Type IV physeal fracture of phalanx of unspecified toe initial encounter for open fracture

P2480

OTHER NEONATAL ASPIRATION WITHOUT RESPIRATORY SYMPTOMS

S99291A

Other physeal fracture of phalanx of right toe initial encounter for closed fracture

P2481 OTHER NEONATAL ASPIRATION WITH RESPIRATORY SYMPTOMS

S99291B

Other physeal fracture of phalanx of right toe initial encounter for open fracture

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P249 NEONATAL ASPIRATION UNSPECIFIED

S99292A

Other physeal fracture of phalanx of left toe initial encounter for closed fracture

P250

INTERSTITIAL EMPHYSEMA ORIGINATING IN THE PERINATAL PERIOD

S99292B

Other physeal fracture of phalanx of left toe initial encounter for open fracture

P251 PNEUMOTHORAX ORIGINATING IN THE PERINATAL PERIOD

S99299A

Other physeal fracture of phalanx of unspecified toe initial encounter for closed fracture

P252

PNEUMOMEDIASTINUM ORIGINATING IN THE PERINATAL PERIOD

S99299B

Other physeal fracture of phalanx of unspecified toe initial encounter for open fracture

P253

PNEUMOPERICARDIUM ORIGINATING IN THE PERINATAL PERIOD

T1491 SUICIDE ATTEMPT

P258

OTH COND REL TO INTERSTIT EMPHYSEMA ORIGIN IN PERINAT PERIOD

T1500XA

FOREIGN BODY IN CORNEA UNSPECIFIED EYE INITIAL ENCOUNTER

P260

TRACHEOBRONCHIAL HEMORRHAGE ORIGIN IN THE PERINATAL PERIOD

T1501XA

FOREIGN BODY IN CORNEA RIGHT EYE INITIAL ENCOUNTER

P261

MASSIVE PULMONARY HEMORRHAGE ORIGIN IN THE PERINATAL PERIOD

T1502XA

FOREIGN BODY IN CORNEA LEFT EYE INITIAL ENCOUNTER

P268

OTH PULMONARY HEMORRHAGES ORIGIN IN THE PERINATAL PERIOD

T1510XA

FOREIGN BODY IN CONJUNCTIVAL SAC UNSP EYE INIT ENCNTR

P269

UNSP PULMONARY HEMORRHAGE ORIGIN IN THE PERINATAL PERIOD

T1511XA

FOREIGN BODY IN CONJUNCTIVAL SAC RIGHT EYE INIT ENCNTR

P270 WILSON-MIKITY SYNDROME

T1512XA FOREIGN BODY IN CONJUNCTIVAL SAC LEFT EYE INIT ENCNTR

P271

BRONCHOPULMONARY DYSPLASIA ORIGIN IN THE PERINATAL PERIOD

T1580XA

FB IN OTH AND MULTIPLE PARTS OF EXTERNAL EYE UNSP EYE INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P278

OTH CHRONIC RESP DISEASES ORIGIN IN THE PERINATAL PERIOD

T1581XA

FB IN OTH AND MULTIPLE PARTS OF EXTERNAL EYE R EYE INIT

P279

UNSP CHRONIC RESP DISEASE ORIGIN IN THE PERINATAL PERIOD

T1582XA

FB IN OTH AND MULTIPLE PARTS OF EXTERNAL EYE LEFT EYE INIT

P280 PRIMARY ATELECTASIS OF NEWBORN

T1590XA

FOREIGN BODY ON EXTERNAL EYE PART UNSP UNSP EYE INIT

P2810 UNSPECIFIED ATELECTASIS OF NEWBORN

T1591XA

FOREIGN BODY ON EXTERNAL EYE PART UNSP RIGHT EYE INIT

P2811

RESORPTION ATELECTASIS WITHOUT RESPIRATORY DISTRESS SYNDROME

T1592XA

FOREIGN BODY ON EXTERNAL EYE PART UNSP LEFT EYE INIT

P2819 OTHER ATELECTASIS OF NEWBORN

T161XXA

FOREIGN BODY IN RIGHT EAR INITIAL ENCOUNTER

P282 CYANOTIC ATTACKS OF NEWBORN

T162XXA

FOREIGN BODY IN LEFT EAR INITIAL ENCOUNTER

P283 PRIMARY SLEEP APNEA OF NEWBORN

T169XXA

FOREIGN BODY IN EAR UNSPECIFIED EAR INITIAL ENCOUNTER

P284 OTHER APNEA OF NEWBORN

T170XXA FOREIGN BODY IN NASAL SINUS INITIAL ENCOUNTER

P285 RESPIRATORY FAILURE OF NEWBORN

T171XXA

FOREIGN BODY IN NOSTRIL INITIAL ENCOUNTER

P2881 RESPIRATORY ARREST OF NEWBORN

T17200A

UNSP FOREIGN BODY IN PHARYNX CAUSING ASPHYXIATION INIT

P2889 OTHER SPECIFIED RESPIRATORY CONDITIONS OF NEWBORN

T17208A

UNSP FOREIGN BODY IN PHARYNX CAUSING OTH INJURY INIT ENCNTR

P289 RESPIRATORY CONDITION OF NEWBORN UNSPECIFIED

T17210A

GASTRIC CONTENTS IN PHARYNX CAUSING ASPHYXIATION INIT

P290 NEONATAL CARDIAC FAILURE

T17218A GASTRIC CONTENTS IN PHARYNX CAUSING OTH INJURY INIT ENCNTR

P2911 NEONATAL TACHYCARDIA

T17220A FOOD IN PHARYNX CAUSING ASPHYXIATION INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P2912 NEONATAL BRADYCARDIA

T17228A FOOD IN PHARYNX CAUSING OTHER INJURY INITIAL ENCOUNTER

P292 NEONATAL HYPERTENSION

T17290A OTH FOREIGN OBJECT IN PHARYNX CAUSING ASPHYXIATION INIT

P293 PERSISTENT FETAL CIRCULATION

T17298A

OTH FOREIGN OBJECT IN PHARYNX CAUSING OTH INJURY INIT

P294 TRANSIENT MYOCARDIAL ISCHEMIA IN NEWBORN

T17300A

UNSP FOREIGN BODY IN LARYNX CAUSING ASPHYXIATION INIT

P2981 CARDIAC ARREST OF NEWBORN

T17308A UNSP FOREIGN BODY IN LARYNX CAUSING OTH INJURY INIT ENCNTR

P2989

OTH CARDIOVASC DISORDERS ORIGINATING IN THE PERINATAL PERIOD

T17310A

GASTRIC CONTENTS IN LARYNX CAUSING ASPHYXIATION INIT ENCNTR

P299

CARDIOVASC DISORDER ORIGIN IN THE PERINATAL PERIOD UNSP

T17318A

GASTRIC CONTENTS IN LARYNX CAUSING OTHER INJURY INIT ENCNTR

P350 CONGENITAL RUBELLA SYNDROME

T17320A

FOOD IN LARYNX CAUSING ASPHYXIATION INITIAL ENCOUNTER

P351 CONGENITAL CYTOMEGALOVIRUS INFECTION

T17328A

FOOD IN LARYNX CAUSING OTHER INJURY INITIAL ENCOUNTER

P352 CONGENITAL HERPESVIRAL [HERPES SIMPLEX] INFECTION

T17390A

OTH FOREIGN OBJECT IN LARYNX CAUSING ASPHYXIATION INIT

P353 CONGENITAL VIRAL HEPATITIS

T17398A OTH FOREIGN OBJECT IN LARYNX CAUSING OTH INJURY INIT ENCNTR

P358 OTHER CONGENITAL VIRAL DISEASES

T17400A

UNSP FOREIGN BODY IN TRACHEA CAUSING ASPHYXIATION INIT

P359 CONGENITAL VIRAL DISEASE UNSPECIFIED

T17408A

UNSP FOREIGN BODY IN TRACHEA CAUSING OTH INJURY INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P360 SEPSIS OF NEWBORN DUE TO STREPTOCOCCUS GROUP B

T17410A

GASTRIC CONTENTS IN TRACHEA CAUSING ASPHYXIATION INIT

P3610 SEPSIS OF NEWBORN DUE TO UNSPECIFIED STREPTOCOCCI

T17418A

GASTRIC CONTENTS IN TRACHEA CAUSING OTH INJURY INIT ENCNTR

P3619 SEPSIS OF NEWBORN DUE TO OTHER STREPTOCOCCI

T17420A

FOOD IN TRACHEA CAUSING ASPHYXIATION INITIAL ENCOUNTER

P362 SEPSIS OF NEWBORN DUE TO STAPHYLOCOCCUS AUREUS

T17428A

FOOD IN TRACHEA CAUSING OTHER INJURY INITIAL ENCOUNTER

P3630 SEPSIS OF NEWBORN DUE TO UNSPECIFIED STAPHYLOCOCCI

T17490A

OTH FOREIGN OBJECT IN TRACHEA CAUSING ASPHYXIATION INIT

P3639 SEPSIS OF NEWBORN DUE TO OTHER STAPHYLOCOCCI

T17498A

OTH FOREIGN OBJECT IN TRACHEA CAUSING OTH INJURY INIT

P364 SEPSIS OF NEWBORN DUE TO ESCHERICHIA COLI

T17500A

UNSP FOREIGN BODY IN BRONCHUS CAUSING ASPHYXIATION INIT

P365 SEPSIS OF NEWBORN DUE TO ANAEROBES

T17508A

UNSP FOREIGN BODY IN BRONCHUS CAUSING OTH INJURY INIT

P368 OTHER BACTERIAL SEPSIS OF NEWBORN

T17510A

GASTRIC CONTENTS IN BRONCHUS CAUSING ASPHYXIATION INIT

P369 BACTERIAL SEPSIS OF NEWBORN UNSPECIFIED

T17518A

GASTRIC CONTENTS IN BRONCHUS CAUSING OTH INJURY INIT ENCNTR

P370 CONGENITAL TUBERCULOSIS

T17520A FOOD IN BRONCHUS CAUSING ASPHYXIATION INITIAL ENCOUNTER

P371 CONGENITAL TOXOPLASMOSIS

T17528A FOOD IN BRONCHUS CAUSING OTHER INJURY INITIAL ENCOUNTER

P372 NEONATAL (DISSEMINATED) LISTERIOSIS

T17590A

OTH FOREIGN OBJECT IN BRONCHUS CAUSING ASPHYXIATION INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P373 CONGENITAL FALCIPARUM MALARIA

T17598A

OTH FOREIGN OBJECT IN BRONCHUS CAUSING OTH INJURY INIT

P374 OTHER CONGENITAL MALARIA

T17800A UNSP FOREIGN BODY IN OTH PRT RESP TRACT CAUSING ASPHYX INIT

P375 NEONATAL CANDIDIASIS

T17808A UNSP FB IN OTH PRT RESP TRACT CAUSING OTH INJURY INIT

P378

OTHER SPECIFIED CONGENITAL INFECTIOUS AND PARASITIC DISEASES

T17810A

GASTRIC CONTENTS IN OTH PRT RESP TRACT CAUSING ASPHYX INIT

P379

CONGENITAL INFECTIOUS OR PARASITIC DISEASE UNSPECIFIED

T17818A

GASTR CONTENTS IN OTH PRT RESP TRACT CAUSE OTH INJURY INIT

P381 OMPHALITIS WITH MILD HEMORRHAGE

T17820A

FOOD IN OTH PRT RESPIRATORY TRACT CAUSING ASPHYXIATION INIT

P389 OMPHALITIS WITHOUT HEMORRHAGE

T17828A

FOOD IN OTH PRT RESPIRATORY TRACT CAUSING OTH INJURY INIT

P390 NEONATAL INFECTIVE MASTITIS

T17890A OTH FOREIGN OBJECT IN OTH PRT RESP TRACT CAUSE ASPHYX INIT

P391 NEONATAL CONJUNCTIVITIS AND DACRYOCYSTITIS

T17898A

OTH FORN OBJECT IN OTH PRT RESP TRACT CAUSE OTH INJURY INIT

P392 INTRA-AMNIOTIC INFECTION AFFECTING NEWBORN NEC

T17900A

UNSP FB IN RESP TRACT PART UNSP CAUSING ASPHYX INIT

P393 NEONATAL URINARY TRACT INFECTION

T17908A

UNSP FB IN RESP TRACT PART UNSP CAUSING OTH INJURY INIT

P394 NEONATAL SKIN INFECTION

T17910A GASTRIC CONTENTS IN RESP TRACT PART UNSP CAUSE ASPHYX INIT

P398

OTHER SPECIFIED INFECTIONS SPECIFIC TO THE PERINATAL PERIOD

T17918A

GASTR CONTENTS IN RESP TRACT PART UNSP CAUSE OTH INJ INIT

P399

INFECTION SPECIFIC TO THE PERINATAL PERIOD UNSPECIFIED

T17920A

FOOD IN RESP TRACT PART UNSP CAUSING ASPHYXIATION INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P500

NEWBORN AFF BY UTERIN (FETAL) BLOOD LOSS FROM VASA PREVIA

T17928A

FOOD IN RESP TRACT PART UNSP CAUSING OTH INJURY INIT

P501

NEWBORN AFF BY UTERIN (FETAL) BLOOD LOSS FROM RUPTURED CORD

T17990A

OTH FORN OBJ IN RESP TRACT PART UNSP IN CAUSE ASPHYX INIT

P502

NEWBORN AFFECTED BY UTERIN (FETAL) BLOOD LOSS FROM PLACENTA

T17998A

OTH FORN OBJECT IN RESP TRACT PART UNSP CAUSE OTH INJ INIT

P503 NEWBORN AFFECTED BY HEMORRHAGE INTO CO-TWIN

T180XXA

FOREIGN BODY IN MOUTH INITIAL ENCOUNTER

P504

NEWBORN AFFECTED BY HEMORRHAGE INTO MATERNAL CIRCULATION

T18100A

UNSP FB IN ESOPHAGUS CAUSING COMPRESSION OF TRACHEA INIT

P505

NB AFF BY UTERIN BLOOD LOSS FROM CUT END OF CO-TWIN'S CORD

T18108A

UNSP FOREIGN BODY IN ESOPHAGUS CAUSING OTH INJURY INIT

P508

NEWBORN AFFECTED BY OTHER INTRAUTERINE (FETAL) BLOOD LOSS

T18110A

GASTRIC CONTENTS IN ESOPH CAUSING COMPRSN OF TRACHEA INIT

P509

NEWBORN AFFECTED BY INTRAUTERINE (FETAL) BLOOD LOSS UNSP

T18118A

GASTRIC CONTENTS IN ESOPHAGUS CAUSING OTH INJURY INIT

P510 MASSIVE UMBILICAL HEMORRHAGE OF NEWBORN

T18120A

FOOD IN ESOPHAGUS CAUSING COMPRESSION OF TRACHEA INIT

P518 OTHER UMBILICAL HEMORRHAGES OF NEWBORN

T18128A

FOOD IN ESOPHAGUS CAUSING OTHER INJURY INITIAL ENCOUNTER

P519 UMBILICAL HEMORRHAGE OF NEWBORN UNSPECIFIED

T18190A

OTH FOREIGN OBJECT IN ESOPH CAUSING COMPRSN OF TRACHEA INIT

P520

INTRAVENTRICULAR HEMORRHAGE GRADE 1 OF NEWBORN

T18198A

OTH FOREIGN OBJECT IN ESOPHAGUS CAUSING OTH INJURY INIT

P521

INTRAVENTRICULAR HEMORRHAGE GRADE 2 OF NEWBORN

T182XXA

FOREIGN BODY IN STOMACH INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P5221

INTRAVENTRICULAR HEMORRHAGE GRADE 3 OF NEWBORN

T183XXA

FOREIGN BODY IN SMALL INTESTINE INITIAL ENCOUNTER

P5222

INTRAVENTRICULAR HEMORRHAGE GRADE 4 OF NEWBORN

T184XXA

FOREIGN BODY IN COLON INITIAL ENCOUNTER

P523

UNSP INTRAVENTRICULAR (NONTRAUMATIC) HEMORRHAGE OF NEWBORN

T185XXA

FOREIGN BODY IN ANUS AND RECTUM INITIAL ENCOUNTER

P524

INTRACEREBRAL (NONTRAUMATIC) HEMORRHAGE OF NEWBORN

T188XXA

FOREIGN BODY IN OTHER PARTS OF ALIMENTARY TRACT INIT ENCNTR

P525

SUBARACHNOID (NONTRAUMATIC) HEMORRHAGE OF NEWBORN

T189XXA

FOREIGN BODY OF ALIMENTARY TRACT PART UNSP INIT ENCNTR

P526

CEREBELLAR AND POSTERIOR FOSSA HEMORRHAGE OF NEWBORN

T190XXA

FOREIGN BODY IN URETHRA INITIAL ENCOUNTER

P528

OTHER INTRACRANIAL (NONTRAUMATIC) HEMORRHAGES OF NEWBORN

T191XXA

FOREIGN BODY IN BLADDER INITIAL ENCOUNTER

P529

INTRACRANIAL (NONTRAUMATIC) HEMORRHAGE OF NEWBORN UNSP

T192XXA

FOREIGN BODY IN VULVA AND VAGINA INITIAL ENCOUNTER

P53 HEMORRHAGIC DISEASE OF NEWBORN

T193XXA

FOREIGN BODY IN UTERUS INITIAL ENCOUNTER

P540 NEONATAL HEMATEMESIS

T194XXA FOREIGN BODY IN PENIS INITIAL ENCOUNTER

P541 NEONATAL MELENA

T198XXA FOREIGN BODY IN OTH PRT GENITOURINARY TRACT INIT ENCNTR

P542 NEONATAL RECTAL HEMORRHAGE

T199XXA

FOREIGN BODY IN GENITOURINARY TRACT PART UNSP INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P543

OTHER NEONATAL GASTROINTESTINAL HEMORRHAGE

T2020XA

BURN SECOND DEGREE OF HEAD FACE AND NECK UNSP SITE INIT

P544 NEONATAL ADRENAL HEMORRHAGE

T20211A

BURN OF SECOND DEGREE OF RIGHT EAR INITIAL ENCOUNTER

P545 NEONATAL CUTANEOUS HEMORRHAGE

T20212A

BURN OF SECOND DEGREE OF LEFT EAR INITIAL ENCOUNTER

P546 NEONATAL VAGINAL HEMORRHAGE

T20219A

BURN OF SECOND DEGREE OF UNSPECIFIED EAR INITIAL ENCOUNTER

P548 OTHER SPECIFIED NEONATAL HEMORRHAGES

T2022XA

BURN OF SECOND DEGREE OF LIP(S) INITIAL ENCOUNTER

P549 NEONATAL HEMORRHAGE UNSPECIFIED

T2023XA

BURN OF SECOND DEGREE OF CHIN INITIAL ENCOUNTER

P550 RH ISOIMMUNIZATION OF NEWBORN

T2024XA

BURN OF SECOND DEGREE OF NOSE (SEPTUM) INITIAL ENCOUNTER

P551 ABO ISOIMMUNIZATION OF NEWBORN

T2025XA

BURN OF SECOND DEGREE OF SCALP [ANY PART] INITIAL ENCOUNTER

P558 OTHER HEMOLYTIC DISEASES OF NEWBORN

T2026XA

BURN OF SECOND DEGREE OF FOREHEAD AND CHEEK INIT ENCNTR

P559 HEMOLYTIC DISEASE OF NEWBORN UNSPECIFIED

T2027XA

BURN OF SECOND DEGREE OF NECK INITIAL ENCOUNTER

P560 HYDROPS FETALIS DUE TO ISOIMMUNIZATION

T2029XA

BURN OF 2ND DEG MUL SITES OF HEAD FACE AND NECK INIT

P5690

HYDROPS FETALIS DUE TO UNSPECIFIED HEMOLYTIC DISEASE

T2030XA

BURN THIRD DEGREE OF HEAD FACE AND NECK UNSP SITE INIT

P5699 HYDROPS FETALIS DUE TO OTHER HEMOLYTIC DISEASE

T20311A

BURN OF THIRD DEGREE OF RIGHT EAR INITIAL ENCOUNTER

P570 KERNICTERUS DUE TO ISOIMMUNIZATION

T20312A

BURN OF THIRD DEGREE OF LEFT EAR INITIAL ENCOUNTER

P578 OTHER SPECIFIED KERNICTERUS

T20319A BURN OF THIRD DEGREE OF UNSPECIFIED EAR INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P579 KERNICTERUS UNSPECIFIED

T2032XA BURN OF THIRD DEGREE OF LIP(S) INITIAL ENCOUNTER

P580 NEONATAL JAUNDICE DUE TO BRUISING

T2033XA

BURN OF THIRD DEGREE OF CHIN INITIAL ENCOUNTER

P581 NEONATAL JAUNDICE DUE TO BLEEDING

T2034XA

BURN OF THIRD DEGREE OF NOSE (SEPTUM) INITIAL ENCOUNTER

P582 NEONATAL JAUNDICE DUE TO INFECTION

T2035XA

BURN OF THIRD DEGREE OF SCALP [ANY PART] INITIAL ENCOUNTER

P583 NEONATAL JAUNDICE DUE TO POLYCYTHEMIA

T2036XA

BURN OF THIRD DEGREE OF FOREHEAD AND CHEEK INIT ENCNTR

P5841

NB JAUND DUE TO DRUGS OR TOXINS TRANSMITTED FROM MOTHER

T2037XA

BURN OF THIRD DEGREE OF NECK INITIAL ENCOUNTER

P5842

NEONATAL JAUNDICE DUE TO DRUGS OR TOXINS GIVEN TO NEWBORN

T2039XA

BURN OF 3RD DEG MU SITES OF HEAD FACE AND NECK INIT

P585

NEONATAL JAUNDICE DUE TO SWALLOWED MATERNAL BLOOD

T2060XA

CORROS SECOND DEG OF HEAD FACE AND NECK UNSP SITE INIT

P588

NEONATAL JAUNDICE DUE TO OTHER SPECIFIED EXCESSIVE HEMOLYSIS

T20611A

CORROSION OF SECOND DEGREE OF RIGHT EAR INITIAL ENCOUNTER

P589

NEONATAL JAUNDICE DUE TO EXCESSIVE HEMOLYSIS UNSPECIFIED

T20612A

CORROSION OF SECOND DEGREE OF LEFT EAR INITIAL ENCOUNTER

P590

NEONATAL JAUNDICE ASSOCIATED WITH PRETERM DELIVERY

T20619A

CORROSION OF SECOND DEGREE OF UNSPECIFIED EAR INIT ENCNTR

P591 INSPISSATED BILE SYNDROME

T2062XA CORROSION OF SECOND DEGREE OF LIP(S) INITIAL ENCOUNTER

P5920

NEONATAL JAUNDICE FROM UNSPECIFIED HEPATOCELLULAR DAMAGE

T2063XA

CORROSION OF SECOND DEGREE OF CHIN INITIAL ENCOUNTER

P5929

NEONATAL JAUNDICE FROM OTHER HEPATOCELLULAR DAMAGE

T2064XA

CORROSION OF SECOND DEGREE OF NOSE (SEPTUM) INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P593 NEONATAL JAUNDICE FROM BREAST MILK INHIBITOR

T2065XA

CORROSION OF SECOND DEGREE OF SCALP INITIAL ENCOUNTER

P598 NEONATAL JAUNDICE FROM OTHER SPECIFIED CAUSES

T2066XA

CORROSION OF SECOND DEGREE OF FOREHEAD AND CHEEK INIT

P599 NEONATAL JAUNDICE UNSPECIFIED

T2067XA

CORROSION OF SECOND DEGREE OF NECK INITIAL ENCOUNTER

P60

DISSEMINATED INTRAVASCULAR COAGULATION OF NEWBORN

T2069XA

CORROSION OF 2ND DEG MUL SITES OF HEAD FACE AND NECK INIT

P610 TRANSIENT NEONATAL THROMBOCYTOPENIA

T2070XA

CORROS THIRD DEGREE OF HEAD FACE AND NECK UNSP SITE INIT

P611 POLYCYTHEMIA NEONATORUM

T20711A CORROSION OF THIRD DEGREE OF RIGHT EAR INITIAL ENCOUNTER

P612 ANEMIA OF PREMATURITY

T20712A CORROSION OF THIRD DEGREE OF LEFT EAR INITIAL ENCOUNTER

P613 CONGENITAL ANEMIA FROM FETAL BLOOD LOSS

T20719A

CORROSION OF THIRD DEGREE OF UNSPECIFIED EAR INIT ENCNTR

P614 OTHER CONGENITAL ANEMIAS NOT ELSEWHERE CLASSIFIED

T2072XA

CORROSION OF THIRD DEGREE OF LIP(S) INITIAL ENCOUNTER

P615 TRANSIENT NEONATAL NEUTROPENIA

T2073XA

CORROSION OF THIRD DEGREE OF CHIN INITIAL ENCOUNTER

P616 OTHER TRANSIENT NEONATAL DISORDERS OF COAGULATION

T2074XA

CORROSION OF THIRD DEGREE OF NOSE (SEPTUM) INIT ENCNTR

P618 OTHER SPECIFIED PERINATAL HEMATOLOGICAL DISORDERS

T2075XA

CORROSION OF THIRD DEGREE OF SCALP INITIAL ENCOUNTER

P619 PERINATAL HEMATOLOGICAL DISORDER UNSPECIFIED

T2076XA

CORROSION OF THIRD DEGREE OF FOREHEAD AND CHEEK INIT ENCNTR

P700

SYNDROME OF INFANT OF MOTHER WITH GESTATIONAL DIABETES

T2077XA

CORROSION OF THIRD DEGREE OF NECK INITIAL ENCOUNTER

P701 SYNDROME OF INFANT OF A DIABETIC MOTHER

T2079XA

CORROSION OF 3RD DEG MU SITES OF HEAD FACE AND NECK INIT

P702 NEONATAL DIABETES MELLITUS

T2120XA BURN OF SECOND DEGREE OF TRUNK UNSP SITE INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P703 IATROGENIC NEONATAL HYPOGLYCEMIA

T2121XA

BURN OF SECOND DEGREE OF CHEST WALL INITIAL ENCOUNTER

P704 OTHER NEONATAL HYPOGLYCEMIA

T2122XA

BURN OF SECOND DEGREE OF ABDOMINAL WALL INITIAL ENCOUNTER

P708

OTH TRANSITORY DISORDERS OF CARBOHYDRATE METAB OF NEWBORN

T2123XA

BURN OF SECOND DEGREE OF UPPER BACK INITIAL ENCOUNTER

P709

TRANSITORY DISORDER OF CARBOHYDRATE METAB OF NEWBORN UNSP

T2124XA

BURN OF SECOND DEGREE OF LOWER BACK INITIAL ENCOUNTER

P710 COW'S MILK HYPOCALCEMIA IN NEWBORN

T2125XA

BURN OF SECOND DEGREE OF BUTTOCK INITIAL ENCOUNTER

P711 OTHER NEONATAL HYPOCALCEMIA

T2126XA

BURN OF SECOND DEGREE OF MALE GENITAL REGION INIT ENCNTR

P712 NEONATAL HYPOMAGNESEMIA

T2127XA BURN OF SECOND DEGREE OF FEMALE GENITAL REGION INIT ENCNTR

P713

NEONATAL TETANY WITHOUT CALCIUM OR MAGNESIUM DEFICIENCY

T2129XA

BURN OF SECOND DEGREE OF OTHER SITE OF TRUNK INIT ENCNTR

P714 TRANSITORY NEONATAL HYPOPARATHYROIDISM

T2130XA

BURN OF THIRD DEGREE OF TRUNK UNSPECIFIED SITE INIT ENCNTR

P718

OTH TRANSITORY NEONATAL DISORD OF CALCIUM & MAGNESIUM METAB

T2131XA

BURN OF THIRD DEGREE OF CHEST WALL INITIAL ENCOUNTER

P719

TRANSITORY NEONATAL DISORD OF CALCIUM & MAGNESIUM METABUNSP

T2132XA

BURN OF THIRD DEGREE OF ABDOMINAL WALL INITIAL ENCOUNTER

P720 NEONATAL GOITER NOT ELSEWHERE CLASSIFIED

T2133XA

BURN OF THIRD DEGREE OF UPPER BACK INITIAL ENCOUNTER

P721 TRANSITORY NEONATAL HYPERTHYROIDISM

T2134XA

BURN OF THIRD DEGREE OF LOWER BACK INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P722

OTH TRANSITORY NEONATAL DISORDERS OF THYROID FUNCTION NEC

T2135XA

BURN OF THIRD DEGREE OF BUTTOCK INITIAL ENCOUNTER

P728

OTHER SPECIFIED TRANSITORY NEONATAL ENDOCRINE DISORDERS

T2136XA

BURN OF THIRD DEGREE OF MALE GENITAL REGION INIT ENCNTR

P729

TRANSITORY NEONATAL ENDOCRINE DISORDER UNSPECIFIED

T2137XA

BURN OF THIRD DEGREE OF FEMALE GENITAL REGION INIT ENCNTR

P740 LATE METABOLIC ACIDOSIS OF NEWBORN

T2139XA

BURN OF THIRD DEGREE OF OTHER SITE OF TRUNK INIT ENCNTR

P741 DEHYDRATION OF NEWBORN

T2160XA CORROSION OF SECOND DEGREE OF TRUNK UNSP SITE INIT ENCNTR

P742 DISTURBANCES OF SODIUM BALANCE OF NEWBORN

T2161XA

CORROSION OF SECOND DEGREE OF CHEST WALL INITIAL ENCOUNTER

P743 DISTURBANCES OF POTASSIUM BALANCE OF NEWBORN

T2162XA

CORROSION OF SECOND DEGREE OF ABDOMINAL WALL INIT ENCNTR

P744

OTHER TRANSITORY ELECTROLYTE DISTURBANCES OF NEWBORN

T2163XA

CORROSION OF SECOND DEGREE OF UPPER BACK INITIAL ENCOUNTER

P745 TRANSITORY TYROSINEMIA OF NEWBORN

T2164XA

CORROSION OF SECOND DEGREE OF LOWER BACK INITIAL ENCOUNTER

P746

TRANSITORY HYPERAMMONEMIA OF NEWBORN

T2165XA

CORROSION OF SECOND DEGREE OF BUTTOCK INITIAL ENCOUNTER

P748

OTHER TRANSITORY METABOLIC DISTURBANCES OF NEWBORN

T2166XA

CORROSION OF SECOND DEGREE OF MALE GENITAL REGION INIT

P749

TRANSITORY METABOLIC DISTURBANCE OF NEWBORN UNSPECIFIED

T2167XA

CORROSION OF SECOND DEGREE OF FEMALE GENITAL REGION INIT

P760 MECONIUM PLUG SYNDROME

T2169XA CORROSION OF SECOND DEGREE OF OTH SITE OF TRUNK INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P761 TRANSITORY ILEUS OF NEWBORN

T2170XA

CORROSION OF THIRD DEGREE OF TRUNK UNSP SITE INIT ENCNTR

P762 INTESTINAL OBSTRUCTION DUE TO INSPISSATED MILK

T2171XA

CORROSION OF THIRD DEGREE OF CHEST WALL INITIAL ENCOUNTER

P768 OTHER SPECIFIED INTESTINAL OBSTRUCTION OF NEWBORN

T2172XA

CORROSION OF THIRD DEGREE OF ABDOMINAL WALL INIT ENCNTR

P769 INTESTINAL OBSTRUCTION OF NEWBORN UNSPECIFIED

T2173XA

CORROSION OF THIRD DEGREE OF UPPER BACK INITIAL ENCOUNTER

P771 STAGE 1 NECROTIZING ENTEROCOLITIS IN NEWBORN

T2174XA

CORROSION OF THIRD DEGREE OF LOWER BACK INITIAL ENCOUNTER

P772 STAGE 2 NECROTIZING ENTEROCOLITIS IN NEWBORN

T2175XA

CORROSION OF THIRD DEGREE OF BUTTOCK INITIAL ENCOUNTER

P773 STAGE 3 NECROTIZING ENTEROCOLITIS IN NEWBORN

T2176XA

CORROSION OF THIRD DEGREE OF MALE GENITAL REGION INIT

P779 NECROTIZING ENTEROCOLITIS IN NEWBORN UNSPECIFIED

T2177XA

CORROSION OF THIRD DEGREE OF FEMALE GENITAL REGION INIT

P780 PERINATAL INTESTINAL PERFORATION

T2179XA

CORROSION OF THIRD DEGREE OF OTH SITE OF TRUNK INIT ENCNTR

P781 OTHER NEONATAL PERITONITIS

T2220XA BURN SECOND DEG OF SHLDR/UP LMB EX WRS/HND UNSP SITE INIT

P782

NEONATAL HEMATEMESIS AND MELENA D/T SWALLOWED MATERN BLOOD

T22211A

BURN OF SECOND DEGREE OF RIGHT FOREARM INITIAL ENCOUNTER

P783 NONINFECTIVE NEONATAL DIARRHEA

T22212A

BURN OF SECOND DEGREE OF LEFT FOREARM INITIAL ENCOUNTER

P7881 CONGENITAL CIRRHOSIS (OF LIVER)

T22219A

BURN OF SECOND DEGREE OF UNSPECIFIED FOREARM INIT ENCNTR

P7882 PEPTIC ULCER OF NEWBORN

T22221A BURN OF SECOND DEGREE OF RIGHT ELBOW INITIAL ENCOUNTER

P7883 NEWBORN ESOPHAGEAL REFLUX

T22222A

BURN OF SECOND DEGREE OF LEFT ELBOW INITIAL ENCOUNTER

P7889 OTHER SPECIFIED PERINATAL DIGESTIVE SYSTEM DISORDERS

T22229A

BURN OF SECOND DEGREE OF UNSPECIFIED ELBOW INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P789 PERINATAL DIGESTIVE SYSTEM DISORDER UNSPECIFIED

T22231A

BURN OF SECOND DEGREE OF RIGHT UPPER ARM INITIAL ENCOUNTER

P800 COLD INJURY SYNDROME

T22232A BURN OF SECOND DEGREE OF LEFT UPPER ARM INITIAL ENCOUNTER

P808 OTHER HYPOTHERMIA OF NEWBORN

T22239A

BURN OF SECOND DEGREE OF UNSPECIFIED UPPER ARM INIT ENCNTR

P809 HYPOTHERMIA OF NEWBORN UNSPECIFIED

T22241A

BURN OF SECOND DEGREE OF RIGHT AXILLA INITIAL ENCOUNTER

P810 ENVIRONMENTAL HYPERTHERMIA OF NEWBORN

T22242A

BURN OF SECOND DEGREE OF LEFT AXILLA INITIAL ENCOUNTER

P818

OTH DISTURBANCES OF TEMPERATURE REGULATION OF NEWBORN

T22249A

BURN OF SECOND DEGREE OF UNSPECIFIED AXILLA INIT ENCNTR

P819

DISTURBANCE OF TEMPERATURE REGULATION OF NEWBORN UNSP

T22251A

BURN OF SECOND DEGREE OF RIGHT SHOULDER INITIAL ENCOUNTER

P830 SCLEREMA NEONATORUM

T22252A BURN OF SECOND DEGREE OF LEFT SHOULDER INITIAL ENCOUNTER

P831 NEONATAL ERYTHEMA TOXICUM

T22259A

BURN OF SECOND DEGREE OF UNSPECIFIED SHOULDER INIT ENCNTR

P832 HYDROPS FETALIS NOT DUE TO HEMOLYTIC DISEASE

T22261A

BURN OF SECOND DEGREE OF RIGHT SCAPULAR REGION INIT ENCNTR

P8330 UNSPECIFIED EDEMA SPECIFIC TO NEWBORN

T22262A

BURN OF SECOND DEGREE OF LEFT SCAPULAR REGION INIT ENCNTR

P8339 OTHER EDEMA SPECIFIC TO NEWBORN

T22269A

BURN OF SECOND DEGREE OF UNSP SCAPULAR REGION INIT ENCNTR

P834 BREAST ENGORGEMENT OF NEWBORN

T22291A

BURN 2ND DEG MUL SITES OF R SHLDR/UP LMB EX WRS/HND INIT

P835 CONGENITAL HYDROCELE

T22292A BURN 2ND DEG MUL SITE OF LEFT SHLDR/UP LMB EX WRS/HND INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P836 UMBILICAL POLYP OF NEWBORN

T22299A

BURN 2ND DEG MUL SITES OF SHLDR/UP LMB EXCEPT WRS/HND INIT

P838

OTHER SPECIFIED CONDITIONS OF INTEGUMENT SPECIFIC TO NEWBORN

T2230XA

BURN THIRD DEG OF SHLDR/UP LMB EX WRS/HND UNSP SITE INIT

P839

CONDITION OF THE INTEGUMENT SPECIFIC TO NEWBORN UNSPECIFIED

T22311A

BURN OF THIRD DEGREE OF RIGHT FOREARM INITIAL ENCOUNTER

P84 OTHER PROBLEMS WITH NEWBORN

T22312A

BURN OF THIRD DEGREE OF LEFT FOREARM INITIAL ENCOUNTER

P90 CONVULSIONS OF NEWBORN

T22319A BURN OF THIRD DEGREE OF UNSPECIFIED FOREARM INIT ENCNTR

P910 NEONATAL CEREBRAL ISCHEMIA

T22321A

BURN OF THIRD DEGREE OF RIGHT ELBOW INITIAL ENCOUNTER

P911 ACQUIRED PERIVENTRICULAR CYSTS OF NEWBORN

T22322A

BURN OF THIRD DEGREE OF LEFT ELBOW INITIAL ENCOUNTER

P912 NEONATAL CEREBRAL LEUKOMALACIA

T22329A

BURN OF THIRD DEGREE OF UNSPECIFIED ELBOW INITIAL ENCOUNTER

P913 NEONATAL CEREBRAL IRRITABILITY

T22331A

BURN OF THIRD DEGREE OF RIGHT UPPER ARM INITIAL ENCOUNTER

P914 NEONATAL CEREBRAL DEPRESSION

T22332A

BURN OF THIRD DEGREE OF LEFT UPPER ARM INITIAL ENCOUNTER

P915 NEONATAL COMA

T22339A

BURN OF THIRD DEGREE OF UNSPECIFIED UPPER ARM INIT ENCNTR

P9160

HYPOXIC ISCHEMIC ENCEPHALOPATHY [HIE] UNSPECIFIED

T22341A

BURN OF THIRD DEGREE OF RIGHT AXILLA INITIAL ENCOUNTER

P9161 MILD HYPOXIC ISCHEMIC ENCEPHALOPATHY [HIE]

T22342A

BURN OF THIRD DEGREE OF LEFT AXILLA INITIAL ENCOUNTER

P9162 MODERATE HYPOXIC ISCHEMIC ENCEPHALOPATHY [HIE]

T22349A

BURN OF THIRD DEGREE OF UNSPECIFIED AXILLA INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P9163 SEVERE HYPOXIC ISCHEMIC ENCEPHALOPATHY [HIE]

T22351A

BURN OF THIRD DEGREE OF RIGHT SHOULDER INITIAL ENCOUNTER

P918

OTHER SPECIFIED DISTURBANCES OF CEREBRAL STATUS OF NEWBORN

T22352A

BURN OF THIRD DEGREE OF LEFT SHOULDER INITIAL ENCOUNTER

P919

DISTURBANCE OF CEREBRAL STATUS OF NEWBORN UNSPECIFIED

T22359A

BURN OF THIRD DEGREE OF UNSPECIFIED SHOULDER INIT ENCNTR

P9201 BILIOUS VOMITING OF NEWBORN

T22361A

BURN OF THIRD DEGREE OF RIGHT SCAPULAR REGION INIT ENCNTR

P9209 OTHER VOMITING OF NEWBORN

T22362A

BURN OF THIRD DEGREE OF LEFT SCAPULAR REGION INIT ENCNTR

P921 REGURGITATION AND RUMINATION OF NEWBORN

T22369A

BURN OF THIRD DEGREE OF UNSP SCAPULAR REGION INIT ENCNTR

P922 SLOW FEEDING OF NEWBORN

T22391A BURN 3RD DEG MU SITES OF R SHLDR/UP LMB EX WRS/HND INIT

P923 UNDERFEEDING OF NEWBORN

T22392A BURN 3RD DEG MU SITES OF LEFT SHLDR/UP LMB EX WRS/HND INIT

P924 OVERFEEDING OF NEWBORN

T22399A BURN 3RD DEG MU SITES OF SHLDR/UP LMB EXCEPT WRS/HND INIT

P925 NEONATAL DIFFICULTY IN FEEDING AT BREAST

T2260XA

CORROS 2ND DEG OF SHLDR/UP LMB EX WRS/HND UNSP SITE INIT

P926 FAILURE TO THRIVE IN NEWBORN

T22611A

CORROSION OF SECOND DEGREE OF RIGHT FOREARM INIT ENCNTR

P928 OTHER FEEDING PROBLEMS OF NEWBORN

T22612A

CORROSION OF SECOND DEGREE OF LEFT FOREARM INIT ENCNTR

P929 FEEDING PROBLEM OF NEWBORN UNSPECIFIED

T22619A

CORROSION OF SECOND DEGREE OF UNSP FOREARM INIT ENCNTR

P930 GREY BABY SYNDROME

T22621A CORROSION OF SECOND DEGREE OF RIGHT ELBOW INITIAL ENCOUNTER

P938

OTH REACTIONS AND INTOXICATIONS D/T DRUGS ADMINISTERED TO NB

T22622A

CORROSION OF SECOND DEGREE OF LEFT ELBOW INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P940 TRANSIENT NEONATAL MYASTHENIA GRAVIS

T22629A

CORROSION OF SECOND DEGREE OF UNSPECIFIED ELBOW INIT ENCNTR

P941 CONGENITAL HYPERTONIA

T22631A CORROSION OF SECOND DEGREE OF RIGHT UPPER ARM INIT ENCNTR

P942 CONGENITAL HYPOTONIA

T22632A CORROSION OF SECOND DEGREE OF LEFT UPPER ARM INIT ENCNTR

P948 OTHER DISORDERS OF MUSCLE TONE OF NEWBORN

T22639A

CORROSION OF SECOND DEGREE OF UNSP UPPER ARM INIT ENCNTR

P949 DISORDER OF MUSCLE TONE OF NEWBORN UNSPECIFIED

T22641A

CORROSION OF SECOND DEGREE OF RIGHT AXILLA INIT ENCNTR

P95 STILLBIRTH

T22642A CORROSION OF SECOND DEGREE OF LEFT AXILLA INITIAL ENCOUNTER

P960 CONGENITAL RENAL FAILURE

T22649A CORROSION OF SECOND DEGREE OF UNSP AXILLA INIT ENCNTR

P961

NEONATAL W/DRAWAL SYMP FROM MATERN USE OF DRUGS OF ADDICTION

T22651A

CORROSION OF SECOND DEGREE OF RIGHT SHOULDER INIT ENCNTR

P962

WITHDRAWAL SYMPTOMS FROM THERAPEUTIC USE OF DRUGS IN NEWBORN

T22652A

CORROSION OF SECOND DEGREE OF LEFT SHOULDER INIT ENCNTR

P963 WIDE CRANIAL SUTURES OF NEWBORN

T22659A

CORROSION OF SECOND DEGREE OF UNSP SHOULDER INIT ENCNTR

P965

COMP TO NEWBORN DUE TO (FETAL) INTRAUTERINE PROCEDURE

T22661A

CORROSION OF SECOND DEGREE OF RIGHT SCAPULAR REGION INIT

P9681

EXPSR TO (ENVIRONMENTAL) TOBACCO SMOKE IN THE PERINAT PERIOD

T22662A

CORROSION OF SECOND DEGREE OF LEFT SCAPULAR REGION INIT

P9682 DELAYED SEPARATION OF UMBILICAL CORD

T22669A

CORROSION OF SECOND DEGREE OF UNSP SCAPULAR REGION INIT

P9683 MECONIUM STAINING

T22691A CORROS 2ND DEG MUL SITES OF R SHLDR/UP LMB EX WRS/HND INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

P9689 OTH CONDITIONS ORIGINATING IN THE PERINATAL PERIOD

T22692A

CORROS 2ND DEG MUL SITE OF L SHLDR/UP LMB EX WRS/HND INIT

P969

CONDITION ORIGINATING IN THE PERINATAL PERIOD UNSPECIFIED

T22699A

CORROS 2ND DEG MUL SITES OF SHLDR/UP LMB EX WRS/HND INIT

Q000 ANENCEPHALY

T2270XA CORROS 3RD DEG OF SHLDR/UP LMB EX WRS/HND UNSP SITE INIT

Q001 CRANIORACHISCHISIS

T22711A CORROSION OF THIRD DEGREE OF RIGHT FOREARM INIT ENCNTR

Q002 INIENCEPHALY

T22712A CORROSION OF THIRD DEGREE OF LEFT FOREARM INITIAL ENCOUNTER

Q010 FRONTAL ENCEPHALOCELE

T22719A CORROSION OF THIRD DEGREE OF UNSP FOREARM INIT ENCNTR

Q011 NASOFRONTAL ENCEPHALOCELE

T22721A

CORROSION OF THIRD DEGREE OF RIGHT ELBOW INITIAL ENCOUNTER

Q012 OCCIPITAL ENCEPHALOCELE

T22722A CORROSION OF THIRD DEGREE OF LEFT ELBOW INITIAL ENCOUNTER

Q018 ENCEPHALOCELE OF OTHER SITES

T22729A

CORROSION OF THIRD DEGREE OF UNSPECIFIED ELBOW INIT ENCNTR

Q019 ENCEPHALOCELE UNSPECIFIED

T22731A CORROSION OF THIRD DEGREE OF RIGHT UPPER ARM INIT ENCNTR

Q02 MICROCEPHALY

T22732A CORROSION OF THIRD DEGREE OF LEFT UPPER ARM INIT ENCNTR

Q030 MALFORMATIONS OF AQUEDUCT OF SYLVIUS

T22739A

CORROSION OF THIRD DEGREE OF UNSP UPPER ARM INIT ENCNTR

Q031 ATRESIA OF FORAMINA OF MAGENDIE AND LUSCHKA

T22741A

CORROSION OF THIRD DEGREE OF RIGHT AXILLA INITIAL ENCOUNTER

Q038 OTHER CONGENITAL HYDROCEPHALUS

T22742A

CORROSION OF THIRD DEGREE OF LEFT AXILLA INITIAL ENCOUNTER

Q039 CONGENITAL HYDROCEPHALUS UNSPECIFIED

T22749A

CORROSION OF THIRD DEGREE OF UNSPECIFIED AXILLA INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

Q040 CONGENITAL MALFORMATIONS OF CORPUS CALLOSUM

T22751A

CORROSION OF THIRD DEGREE OF RIGHT SHOULDER INIT ENCNTR

Q041 ARHINENCEPHALY

T22752A CORROSION OF THIRD DEGREE OF LEFT SHOULDER INIT ENCNTR

Q042 HOLOPROSENCEPHALY

T22759A CORROSION OF THIRD DEGREE OF UNSP SHOULDER INIT ENCNTR

Q043 OTHER REDUCTION DEFORMITIES OF BRAIN

T22761A

CORROSION OF THIRD DEGREE OF RIGHT SCAPULAR REGION INIT

Q044 SEPTO-OPTIC DYSPLASIA OF BRAIN

T22762A

CORROSION OF THIRD DEGREE OF LEFT SCAPULAR REGION INIT

Q045 MEGALENCEPHALY

T22769A CORROSION OF THIRD DEGREE OF UNSP SCAPULAR REGION INIT

Q046 CONGENITAL CEREBRAL CYSTS

T22791A CORROS 3RD DEG MU SITES OF R SHLDR/UP LMB EX WRS/HND INIT

Q048 OTHER SPECIFIED CONGENITAL MALFORMATIONS OF BRAIN

T22792A

CORROS 3RD DEG MU SITE OF L SHLDR/UP LMB EX WRS/HND INIT

Q049 CONGENITAL MALFORMATION OF BRAIN UNSPECIFIED

T22799A

CORROS 3RD DEG MU SITES OF SHLDR/UP LMB EX WRS/HND INIT

Q050 CERVICAL SPINA BIFIDA WITH HYDROCEPHALUS

T23201A

BURN OF SECOND DEGREE OF RIGHT HAND UNSP SITE INIT ENCNTR

Q051 THORACIC SPINA BIFIDA WITH HYDROCEPHALUS

T23202A

BURN OF SECOND DEGREE OF LEFT HAND UNSP SITE INIT ENCNTR

Q052 LUMBAR SPINA BIFIDA WITH HYDROCEPHALUS

T23209A

BURN OF SECOND DEGREE OF UNSP HAND UNSP SITE INIT ENCNTR

Q053 SACRAL SPINA BIFIDA WITH HYDROCEPHALUS

T23211A

BURN OF SECOND DEGREE OF RIGHT THUMB (NAIL) INIT ENCNTR

Q054 UNSPECIFIED SPINA BIFIDA WITH HYDROCEPHALUS

T23212A

BURN OF SECOND DEGREE OF LEFT THUMB (NAIL) INIT ENCNTR

Q055 CERVICAL SPINA BIFIDA WITHOUT HYDROCEPHALUS

T23219A

BURN OF SECOND DEGREE OF UNSP THUMB (NAIL) INIT ENCNTR

Q056 THORACIC SPINA BIFIDA WITHOUT HYDROCEPHALUS

T23221A

BURN SECOND DEGREE OF SINGLE R FINGER EXCEPT THUMB INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

Q057 LUMBAR SPINA BIFIDA WITHOUT HYDROCEPHALUS

T23222A

BURN SECOND DEGREE OF SINGLE L FINGER EXCEPT THUMB INIT

Q058 SACRAL SPINA BIFIDA WITHOUT HYDROCEPHALUS

T23229A

BURN SECOND DEGREE OF UNSP SINGLE FINGER EXCEPT THUMB INIT

Q059 SPINA BIFIDA UNSPECIFIED

T23231A BURN 2ND DEG MUL RIGHT FINGERS (NAIL) NOT INC THUMB INIT

Q060 AMYELIA

T23232A BURN OF 2ND DEG MUL LEFT FINGERS (NAIL) NOT INC THUMB INIT

Q061 HYPOPLASIA AND DYSPLASIA OF SPINAL CORD

T23239A

BURN SECOND DEGREE OF UNSP MULT FNGR NOT INC THUMB INIT

Q062 DIASTEMATOMYELIA

T23241A BURN OF 2ND DEG MUL RIGHT FINGERS (NAIL) INC THUMB INIT

Q063 OTHER CONGENITAL CAUDA EQUINA MALFORMATIONS

T23242A

BURN OF 2ND DEG MUL LEFT FINGERS (NAIL) INC THUMB INIT

Q064 HYDROMYELIA

T23249A BURN SECOND DEGREE OF UNSP MULT FNGR (NAIL) INC THUMB INIT

Q068

OTHER SPECIFIED CONGENITAL MALFORMATIONS OF SPINAL CORD

T23251A

BURN OF SECOND DEGREE OF RIGHT PALM INITIAL ENCOUNTER

Q069 CONGENITAL MALFORMATION OF SPINAL CORD UNSPECIFIED

T23252A

BURN OF SECOND DEGREE OF LEFT PALM INITIAL ENCOUNTER

Q0700

ARNOLD-CHIARI SYNDROME WITHOUT SPINA BIFIDA OR HYDROCEPHALUS

T23259A

BURN OF SECOND DEGREE OF UNSPECIFIED PALM INITIAL ENCOUNTER

Q0701 ARNOLD-CHIARI SYNDROME WITH SPINA BIFIDA

T23261A

BURN OF SECOND DEGREE OF BACK OF RIGHT HAND INIT ENCNTR

Q0702 ARNOLD-CHIARI SYNDROME WITH HYDROCEPHALUS

T23262A

BURN OF SECOND DEGREE OF BACK OF LEFT HAND INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

Q0703

ARNOLD-CHIARI SYNDROME WITH SPINA BIFIDA AND HYDROCEPHALUS

T23269A

BURN OF SECOND DEGREE OF BACK OF UNSP HAND INIT ENCNTR

Q078

OTHER SPECIFIED CONGENITAL MALFORMATIONS OF NERVOUS SYSTEM

T23271A

BURN OF SECOND DEGREE OF RIGHT WRIST INITIAL ENCOUNTER

Q079

CONGENITAL MALFORMATION OF NERVOUS SYSTEM UNSPECIFIED

T23272A

BURN OF SECOND DEGREE OF LEFT WRIST INITIAL ENCOUNTER

Q100 CONGENITAL PTOSIS

T23279A BURN OF SECOND DEGREE OF UNSPECIFIED WRIST INIT ENCNTR

Q101 CONGENITAL ECTROPION

T23291A BURN OF 2ND DEG MUL SITES OF RIGHT WRIST AND HAND INIT

Q102 CONGENITAL ENTROPION

T23292A BURN OF 2ND DEG MUL SITES OF LEFT WRIST AND HAND INIT

Q103 OTHER CONGENITAL MALFORMATIONS OF EYELID

T23299A

BURN OF 2ND DEG MUL SITES OF UNSP WRIST AND HAND INIT

Q104 ABSENCE AND AGENESIS OF LACRIMAL APPARATUS

T23301A

BURN OF THIRD DEGREE OF RIGHT HAND UNSP SITE INIT ENCNTR

Q105 CONGENITAL STENOSIS AND STRICTURE OF LACRIMAL DUCT

T23302A

BURN OF THIRD DEGREE OF LEFT HAND UNSP SITE INIT ENCNTR

Q106

OTHER CONGENITAL MALFORMATIONS OF LACRIMAL APPARATUS

T23309A

BURN OF THIRD DEGREE OF UNSP HAND UNSP SITE INIT ENCNTR

Q107 CONGENITAL MALFORMATION OF ORBIT

T23311A

BURN OF THIRD DEGREE OF RIGHT THUMB (NAIL) INIT ENCNTR

Q110 CYSTIC EYEBALL

T23312A BURN OF THIRD DEGREE OF LEFT THUMB (NAIL) INITIAL ENCOUNTER

Q111 OTHER ANOPHTHALMOS

T23319A BURN OF THIRD DEGREE OF UNSP THUMB (NAIL) INIT ENCNTR

Q112 MICROPHTHALMOS

T23321A BURN THIRD DEGREE OF SINGLE R FINGER EXCEPT THUMB INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

Q113 MACROPHTHALMOS

T23322A BURN THIRD DEGREE OF SINGLE L FINGER EXCEPT THUMB INIT

Q120 CONGENITAL CATARACT

T23329A BURN THIRD DEGREE OF UNSP SINGLE FINGER EXCEPT THUMB INIT

Q121 CONGENITAL DISPLACED LENS

T23331A BURN OF 3RD DEG MU RIGHT FINGERS (NAIL) NOT INC THUMB INIT

Q122 COLOBOMA OF LENS

T23332A BURN OF 3RD DEG MU LEFT FINGERS (NAIL) NOT INC THUMB INIT

Q123 CONGENITAL APHAKIA

T23339A BURN THIRD DEGREE OF UNSP MULT FNGR NOT INC THUMB INIT

Q124 SPHEROPHAKIA

T23341A BURN OF 3RD DEG MU RIGHT FINGERS (NAIL) INC THUMB INIT

Q128 OTHER CONGENITAL LENS MALFORMATIONS

T23342A

BURN OF 3RD DEG MU LEFT FINGERS (NAIL) INC THUMB INIT

Q129 CONGENITAL LENS MALFORMATION UNSPECIFIED

T23349A

BURN THIRD DEGREE OF UNSP MULT FNGR (NAIL) INC THUMB INIT

Q130 COLOBOMA OF IRIS

T23351A BURN OF THIRD DEGREE OF RIGHT PALM INITIAL ENCOUNTER

Q131 ABSENCE OF IRIS

T23352A BURN OF THIRD DEGREE OF LEFT PALM INITIAL ENCOUNTER

Q132 OTHER CONGENITAL MALFORMATIONS OF IRIS

T23359A

BURN OF THIRD DEGREE OF UNSPECIFIED PALM INITIAL ENCOUNTER

Q133 CONGENITAL CORNEAL OPACITY

T23361A

BURN OF THIRD DEGREE OF BACK OF RIGHT HAND INIT ENCNTR

Q134 OTHER CONGENITAL CORNEAL MALFORMATIONS

T23362A

BURN OF THIRD DEGREE OF BACK OF LEFT HAND INITIAL ENCOUNTER

Q135 BLUE SCLERA

T23369A BURN OF THIRD DEGREE OF BACK OF UNSP HAND INIT ENCNTR

Q1381 RIEGER'S ANOMALY

T23371A BURN OF THIRD DEGREE OF RIGHT WRIST INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

Q2521 Interruption of aortic arch

T23372A BURN OF THIRD DEGREE OF LEFT WRIST INITIAL ENCOUNTER

Q2529 Other atresia of aorta

T23379A

BURN OF THIRD DEGREE OF UNSPECIFIED WRIST INITIAL ENCOUNTER

Q2540 Congenital malformation of aorta unspecified

T23391A

BURN OF 3RD DEG MU SITES OF RIGHT WRIST AND HAND INIT

Q2541 Absence and aplasia of aorta

T23392A BURN OF 3RD DEG MU SITES OF LEFT WRIST AND HAND INIT

Q2542 Hypoplasia of aorta

T23399A BURN OF 3RD DEG MU SITES OF UNSP WRIST AND HAND INIT

Q2543 Congenital aneurysm of aorta

T23601A CORROSION OF SECOND DEGREE OF RIGHT HAND UNSP SITE INIT

Q2544 Congenital dilation of aorta

T23602A CORROSION OF SECOND DEGREE OF LEFT HAND UNSP SITE INIT

Q2545 Double aortic arch

T23609A CORROSION OF SECOND DEGREE OF UNSP HAND UNSP SITE INIT

Q2546 Tortuous aortic arch

T23611A CORROSION OF SECOND DEGREE OF RIGHT THUMB (NAIL) INIT

Q2547 Right aortic arch

T23612A CORROSION OF SECOND DEGREE OF LEFT THUMB (NAIL) INIT ENCNTR

Q2548 Anomalous origin of subclavian artery

T23619A

CORROSION OF SECOND DEGREE OF UNSP THUMB (NAIL) INIT ENCNTR

Q2549 Other congenital malformations of aorta

T23621A

CORROS SECOND DEGREE OF SINGLE R FINGER EXCEPT THUMB INIT

Q822 MASTOCYTOSIS

T23622A CORROS SECOND DEGREE OF SINGLE L FINGER EXCEPT THUMB INIT

Q8740 MARFAN'S SYNDROME UNSPECIFIED

T23629A

CORROS SECOND DEG OF UNSP SINGLE FINGER EXCEPT THUMB INIT

Q87410 MARFAN'S SYNDROME WITH AORTIC DILATION

T23631A

CORROS 2ND DEG MUL RIGHT FINGERS (NAIL) NOT INC THUMB INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

Q87418

MARFAN'S SYNDROME WITH OTHER CARDIOVASCULAR MANIFESTATIONS

T23632A

CORROS 2ND DEG MUL LEFT FINGERS (NAIL) NOT INC THUMB INIT

Q8742 MARFAN'S SYNDROME WITH OCULAR MANIFESTATIONS

T23639A

CORROS SECOND DEGREE OF UNSP MULT FNGR NOT INC THUMB INIT

Q8743 MARFAN'S SYNDROME WITH SKELETAL MANIFESTATION

T23641A

CORROS 2ND DEG MUL RIGHT FINGERS (NAIL) INC THUMB INIT

Q875

OTH CONGENITAL MALFORMATION SYNDROMES W OTH SKELETAL CHANGES

T23642A

CORROS 2ND DEG MUL LEFT FINGERS (NAIL) INC THUMB INIT

Q8782 Arterial tortuosity syndrome

T23649A CORROS SECOND DEGREE OF UNSP MULT FNGR INC THUMB INIT

R000 TACHYCARDIA UNSPECIFIED

T23651A CORROSION OF SECOND DEGREE OF RIGHT PALM INITIAL ENCOUNTER

R001 BRADYCARDIA UNSPECIFIED

T23652A CORROSION OF SECOND DEGREE OF LEFT PALM INITIAL ENCOUNTER

R002 PALPITATIONS

T23659A CORROSION OF SECOND DEGREE OF UNSPECIFIED PALM INIT ENCNTR

R008 OTHER ABNORMALITIES OF HEART BEAT

T23661A

CORROSION OF SECOND DEGREE BACK OF RIGHT HAND INIT ENCNTR

R009 UNSPECIFIED ABNORMALITIES OF HEART BEAT

T23662A

CORROSION OF SECOND DEGREE BACK OF LEFT HAND INIT ENCNTR

R010 BENIGN AND INNOCENT CARDIAC MURMURS

T23669A

CORROSION OF SECOND DEGREE BACK OF UNSP HAND INIT ENCNTR

R011 CARDIAC MURMUR UNSPECIFIED

T23671A

CORROSION OF SECOND DEGREE OF RIGHT WRIST INITIAL ENCOUNTER

R030

ELEVATED BLOOD-PRESSURE READING W/O DIAGNOSIS OF HTN

T23672A

CORROSION OF SECOND DEGREE OF LEFT WRIST INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R031 NONSPECIFIC LOW BLOOD-PRESSURE READING

T23679A

CORROSION OF SECOND DEGREE OF UNSPECIFIED WRIST INIT ENCNTR

R040 EPISTAXIS

T23691A CORROSION OF 2ND DEG MUL SITES OF RIGHT WRIST AND HAND INIT

R041 HEMORRHAGE FROM THROAT

T23692A CORROSION OF 2ND DEG MUL SITES OF LEFT WRIST AND HAND INIT

R042 HEMOPTYSIS

T23699A CORROSION OF 2ND DEG MUL SITES OF UNSP WRIST AND HAND INIT

R0481

ACUTE IDIOPATHIC PULMONARY HEMORRHAGE IN INFANTS

T23701A

CORROSION OF THIRD DEGREE OF RIGHT HAND UNSP SITE INIT

R0489

HEMORRHAGE FROM OTHER SITES IN RESPIRATORY PASSAGES

T23702A

CORROSION OF THIRD DEGREE OF LEFT HAND UNSP SITE INIT

R049

HEMORRHAGE FROM RESPIRATORY PASSAGES UNSPECIFIED

T23709A

CORROSION OF THIRD DEGREE OF UNSP HAND UNSP SITE INIT

R0600 DYSPNEA UNSPECIFIED

T23711A CORROSION OF THIRD DEGREE OF RIGHT THUMB (NAIL) INIT ENCNTR

R0601 ORTHOPNEA

T23712A CORROSION OF THIRD DEGREE OF LEFT THUMB (NAIL) INIT ENCNTR

R0602 SHORTNESS OF BREATH

T23719A CORROSION OF THIRD DEGREE OF UNSP THUMB (NAIL) INIT ENCNTR

R0609 OTHER FORMS OF DYSPNEA

T23721A CORROS THIRD DEGREE OF SINGLE R FINGER EXCEPT THUMB INIT

R061 STRIDOR

T23722A CORROS THIRD DEGREE OF SINGLE L FINGER EXCEPT THUMB INIT

R062 WHEEZING

T23729A CORROS THIRD DEGREE OF UNSP SINGLE FINGER EXCEPT THUMB INIT

R063 PERIODIC BREATHING

T23731A CORROS 3RD DEG MU RIGHT FINGERS (NAIL) NOT INC THUMB INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R071 CHEST PAIN ON BREATHING

T23732A CORROS 3RD DEG MU LEFT FINGERS (NAIL) NOT INC THUMB INIT

R0782 INTERCOSTAL PAIN

T23739A CORROS THIRD DEGREE OF UNSP MULT FNGR NOT INC THUMB INIT

R0789 OTHER CHEST PAIN

T23741A CORROS 3RD DEG MU RIGHT FINGERS (NAIL) INC THUMB INIT

R0901 ASPHYXIA

T23742A CORROS 3RD DEG MU LEFT FINGERS (NAIL) INCLUDING THUMB INIT

R0902 HYPOXEMIA

T23749A CORROS THIRD DEGREE OF UNSP MULT FNGR INC THUMB INIT

R092 RESPIRATORY ARREST

T23751A CORROSION OF THIRD DEGREE OF RIGHT PALM INITIAL ENCOUNTER

R0989

OTH SYMPTOMS AND SIGNS INVOLVING THE CIRC AND RESP SYSTEMS

T23752A

CORROSION OF THIRD DEGREE OF LEFT PALM INITIAL ENCOUNTER

R100 ACUTE ABDOMEN

T23759A CORROSION OF THIRD DEGREE OF UNSPECIFIED PALM INIT ENCNTR

R1114 BILIOUS VOMITING

T23761A CORROSION OF THIRD DEGREE OF BACK OF RIGHT HAND INIT ENCNTR

R130 APHAGIA

T23762A CORROSION OF THIRD DEGREE OF BACK OF LEFT HAND INIT ENCNTR

R1312 DYSPHAGIA OROPHARYNGEAL PHASE

T23769A

CORROSION OF THIRD DEGREE BACK OF UNSP HAND INIT ENCNTR

R1313 DYSPHAGIA PHARYNGEAL PHASE

T23771A

CORROSION OF THIRD DEGREE OF RIGHT WRIST INITIAL ENCOUNTER

R1314 DYSPHAGIA PHARYNGOESOPHAGEAL PHASE

T23772A

CORROSION OF THIRD DEGREE OF LEFT WRIST INITIAL ENCOUNTER

R221 LOCALIZED SWELLING MASS AND LUMP NECK

T23779A

CORROSION OF THIRD DEGREE OF UNSPECIFIED WRIST INIT ENCNTR

R230 CYANOSIS

T23791A CORROSION OF 3RD DEG MU SITES OF RIGHT WRIST AND HAND INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R231 PALLOR

T23792A CORROSION OF 3RD DEG MU SITES OF LEFT WRIST AND HAND INIT

R232 FLUSHING

T23799A CORROSION OF 3RD DEG MU SITES OF UNSP WRIST AND HAND INIT

R233 SPONTANEOUS ECCHYMOSES

T24201A BURN 2ND DEG OF UNSP SITE RIGHT LOWER LIMB EX ANK/FT INIT

R234 CHANGES IN SKIN TEXTURE

T24202A BURN 2ND DEG OF UNSP SITE LEFT LOWER LIMB EX ANK/FT INIT

R238 OTHER SKIN CHANGES

T24209A BURN 2ND DEG OF UNSP SITE UNSP LOWER LIMB EX ANK/FT INIT

R239 UNSPECIFIED SKIN CHANGES

T24211A BURN OF SECOND DEGREE OF RIGHT THIGH INITIAL ENCOUNTER

R250 ABNORMAL HEAD MOVEMENTS

T24212A BURN OF SECOND DEGREE OF LEFT THIGH INITIAL ENCOUNTER

R251 TREMOR UNSPECIFIED

T24219A BURN OF SECOND DEGREE OF UNSPECIFIED THIGH INIT ENCNTR

R290 TETANY

T24221A BURN OF SECOND DEGREE OF RIGHT KNEE INITIAL ENCOUNTER

R291 MENINGISMUS

T24222A BURN OF SECOND DEGREE OF LEFT KNEE INITIAL ENCOUNTER

R295 TRANSIENT PARALYSIS

T24229A

BURN OF SECOND DEGREE OF UNSPECIFIED KNEE INITIAL ENCOUNTER

R29700 NIHSS score 0

T24231A BURN OF SECOND DEGREE OF RIGHT LOWER LEG INITIAL ENCOUNTER

R29701 NIHSS score 1

T24232A BURN OF SECOND DEGREE OF LEFT LOWER LEG INITIAL ENCOUNTER

R29702 NIHSS score 2

T24239A BURN OF SECOND DEGREE OF UNSPECIFIED LOWER LEG INIT ENCNTR

R29703 NIHSS score 3

T24291A BURN 2ND DEG MUL SITES OF RIGHT LOWER LIMB EX ANK/FT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R29704 NIHSS score 4

T24292A BURN 2ND DEG MUL SITES OF LEFT LOWER LIMB EX ANK/FT INIT

R29705 NIHSS score 5

T24299A BURN 2ND DEG MUL SITES OF UNSP LOWER LIMB EX ANK/FT INIT

R29706 NIHSS score 6

T24301A BURN THIRD DEG OF UNSP SITE RIGHT LOW LIMB EX ANK/FT INIT

R29707 NIHSS score 7

T24302A BURN THIRD DEG OF UNSP SITE LEFT LOWER LIMB EX ANK/FT INIT

R29708 NIHSS score 8

T24309A BURN THIRD DEG OF UNSP SITE UNSP LOWER LIMB EX ANK/FT INIT

R29709 NIHSS score 9

T24311A BURN OF THIRD DEGREE OF RIGHT THIGH INITIAL ENCOUNTER

R29710 NIHSS score 10

T24312A BURN OF THIRD DEGREE OF LEFT THIGH INITIAL ENCOUNTER

R29711 NIHSS score 11

T24319A

BURN OF THIRD DEGREE OF UNSPECIFIED THIGH INITIAL ENCOUNTER

R29712 NIHSS score 12

T24321A BURN OF THIRD DEGREE OF RIGHT KNEE INITIAL ENCOUNTER

R29713 NIHSS score 13

T24322A BURN OF THIRD DEGREE OF LEFT KNEE INITIAL ENCOUNTER

R29714 NIHSS score 14

T24329A

BURN OF THIRD DEGREE OF UNSPECIFIED KNEE INITIAL ENCOUNTER

R29715 NIHSS score 15

T24331A BURN OF THIRD DEGREE OF RIGHT LOWER LEG INITIAL ENCOUNTER

R29716 NIHSS score 16

T24332A BURN OF THIRD DEGREE OF LEFT LOWER LEG INITIAL ENCOUNTER

R29717 NIHSS score 17

T24339A BURN OF THIRD DEGREE OF UNSPECIFIED LOWER LEG INIT ENCNTR

R29718 NIHSS score 18

T24391A BURN 3RD DEG MU SITES OF RIGHT LOWER LIMB EX ANK/FT INIT

R29719 NIHSS score 19

T24392A BURN 3RD DEG MU SITES OF LEFT LOWER LIMB EX ANK/FT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R29720 NIHSS score 20

T24399A BURN 3RD DEG MU SITES OF UNSP LOWER LIMB EX ANK/FT INIT

R29721 NIHSS score 21

T24601A CORROS 2ND DEG OF UNSP SITE RIGHT LOW LIMB EX ANK/FT INIT

R29722 NIHSS score 22

T24602A CORROS 2ND DEG OF UNSP SITE LEFT LOWER LIMB EX ANK/FT INIT

R29723 NIHSS score 23

T24609A CORROS 2ND DEG OF UNSP SITE UNSP LOWER LIMB EX ANK/FT INIT

R29724 NIHSS score 24

T24611A CORROSION OF SECOND DEGREE OF RIGHT THIGH INITIAL ENCOUNTER

R29725 NIHSS score 25

T24612A CORROSION OF SECOND DEGREE OF LEFT THIGH INITIAL ENCOUNTER

R29726 NIHSS score 26

T24619A CORROSION OF SECOND DEGREE OF UNSPECIFIED THIGH INIT ENCNTR

R29727 NIHSS score 27

T24621A CORROSION OF SECOND DEGREE OF RIGHT KNEE INITIAL ENCOUNTER

R29728 NIHSS score 28

T24622A CORROSION OF SECOND DEGREE OF LEFT KNEE INITIAL ENCOUNTER

R29729 NIHSS score 29

T24629A CORROSION OF SECOND DEGREE OF UNSPECIFIED KNEE INIT ENCNTR

R29730 NIHSS score 30

T24631A CORROSION OF SECOND DEGREE OF RIGHT LOWER LEG INIT ENCNTR

R29731 NIHSS score 31

T24632A CORROSION OF SECOND DEGREE OF LEFT LOWER LEG INIT ENCNTR

R29732 NIHSS score 32

T24639A CORROSION OF SECOND DEGREE OF UNSP LOWER LEG INIT ENCNTR

R29733 NIHSS score 33

T24691A CORROS 2ND DEG MUL SITES OF RIGHT LOW LIMB EX ANK/FT INIT

R29734 NIHSS score 34

T24692A CORROS 2ND DEG MUL SITES OF LEFT LOWER LIMB EX ANK/FT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R29735 NIHSS score 35

T24699A CORROS 2ND DEG MUL SITES OF UNSP LOWER LIMB EX ANK/FT INIT

R29736 NIHSS score 36

T24701A CORROS THIRD DEG OF UNSP SITE R LOW LIMB EX ANK/FT INIT

R29737 NIHSS score 37

T24702A CORROS THIRD DEG OF UNSP SITE LEFT LOW LIMB EX ANK/FT INIT

R29738 NIHSS score 38

T24709A CORROS THIRD DEG OF UNSP SITE UNSP LOW LIMB EX ANK/FT INIT

R29739 NIHSS score 39

T24711A CORROSION OF THIRD DEGREE OF RIGHT THIGH INITIAL ENCOUNTER

R29740 NIHSS score 40

T24712A CORROSION OF THIRD DEGREE OF LEFT THIGH INITIAL ENCOUNTER

R29741 NIHSS score 41

T24719A CORROSION OF THIRD DEGREE OF UNSPECIFIED THIGH INIT ENCNTR

R29742 NIHSS score 42

T24721A CORROSION OF THIRD DEGREE OF RIGHT KNEE INITIAL ENCOUNTER

R29810 FACIAL WEAKNESS

T24722A CORROSION OF THIRD DEGREE OF LEFT KNEE INITIAL ENCOUNTER

R29891 OCULAR TORTICOLLIS

T24729A CORROSION OF THIRD DEGREE OF UNSPECIFIED KNEE INIT ENCNTR

R301 VESICAL TENESMUS

T24731A CORROSION OF THIRD DEGREE OF RIGHT LOWER LEG INIT ENCNTR

R309 PAINFUL MICTURITION UNSPECIFIED

T24732A

CORROSION OF THIRD DEGREE OF LEFT LOWER LEG INIT ENCNTR

R310 GROSS HEMATURIA

T24739A CORROSION OF THIRD DEGREE OF UNSP LOWER LEG INIT ENCNTR

R360 URETHRAL DISCHARGE WITHOUT BLOOD

T24791A

CORROS 3RD DEG MU SITES OF RIGHT LOWER LIMB EX ANK/FT INIT

R361 HEMATOSPERMIA

T24792A CORROS 3RD DEG MU SITES OF LEFT LOWER LIMB EX ANK/FT INIT

R369 URETHRAL DISCHARGE UNSPECIFIED

T24799A

CORROS 3RD DEG MU SITES OF UNSP LOWER LIMB EX ANK/FT INIT

R3912 POOR URINARY STREAM

T25211A BURN OF SECOND DEGREE OF RIGHT ANKLE INITIAL ENCOUNTER

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ICD-10 Code Description

ICD-10 Code Description

R3913 SPLITTING OF URINARY STREAM

T25212A BURN OF SECOND DEGREE OF LEFT ANKLE INITIAL ENCOUNTER

R3919 OTHER DIFFICULTIES WITH MICTURITION

T25219A

BURN OF SECOND DEGREE OF UNSPECIFIED ANKLE INIT ENCNTR

R392 EXTRARENAL UREMIA

T25221A BURN OF SECOND DEGREE OF RIGHT FOOT INITIAL ENCOUNTER

R3989

OTHER SYMPTOMS AND SIGNS INVOLVING THE GENITOURINARY SYSTEM

T25222A

BURN OF SECOND DEGREE OF LEFT FOOT INITIAL ENCOUNTER

R399

UNSP SYMPTOMS AND SIGNS INVOLVING THE GENITOURINARY SYSTEM

T25229A

BURN OF SECOND DEGREE OF UNSPECIFIED FOOT INITIAL ENCOUNTER

R4020 UNSPECIFIED COMA

T25231A BURN OF SECOND DEGREE OF RIGHT TOE(S) (NAIL) INIT ENCNTR

R402110 COMA SCALE EYES OPEN NEVER UNSPECIFIED TIME

T25232A

BURN OF SECOND DEGREE OF LEFT TOE(S) (NAIL) INIT ENCNTR

R402111 COMA SCALE EYES OPEN NEVER IN THE FIELD

T25239A

BURN OF SECOND DEGREE OF UNSP TOE(S) (NAIL) INIT ENCNTR

R402112 COMA SCALE EYES OPEN NEVER EMR

T25291A

BURN OF 2ND DEG MUL SITES OF RIGHT ANKLE AND FOOT INIT

R402113 COMA SCALE EYES OPEN NEVER AT HOSPITAL ADMISSION

T25292A

BURN OF 2ND DEG MUL SITES OF LEFT ANKLE AND FOOT INIT

R402114 COMA SCALE EYES OPEN NEVER 24+HRS

T25299A

BURN OF 2ND DEG MUL SITES OF UNSP ANKLE AND FOOT INIT

R402120 COMA SCALE EYES OPEN TO PAIN UNSPECIFIED TIME

T25311A

BURN OF THIRD DEGREE OF RIGHT ANKLE INITIAL ENCOUNTER

R402121 COMA SCALE EYES OPEN TO PAIN IN THE FIELD

T25312A

BURN OF THIRD DEGREE OF LEFT ANKLE INITIAL ENCOUNTER

R402122 COMA SCALE EYES OPEN TO PAIN EMR

T25319A

BURN OF THIRD DEGREE OF UNSPECIFIED ANKLE INITIAL ENCOUNTER

R402123 COMA SCALE EYES OPEN TO PAIN AT HOSPITAL ADMISSION

T25321A

BURN OF THIRD DEGREE OF RIGHT FOOT INITIAL ENCOUNTER

R402124 COMA SCALE EYES OPEN TO PAIN 24+HRS

T25322A

BURN OF THIRD DEGREE OF LEFT FOOT INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R402130 COMA SCALE EYES OPEN TO SOUND UNSPECIFIED TIME

T25329A

BURN OF THIRD DEGREE OF UNSPECIFIED FOOT INITIAL ENCOUNTER

R402131 COMA SCALE EYES OPEN TO SOUND IN THE FIELD

T25331A

BURN OF THIRD DEGREE OF RIGHT TOE(S) (NAIL) INIT ENCNTR

R402132 COMA SCALE EYES OPEN TO SOUND EMR

T25332A

BURN OF THIRD DEGREE OF LEFT TOE(S) (NAIL) INIT ENCNTR

R402133

COMA SCALE EYES OPEN TO SOUND AT HOSPITAL ADMISSION

T25339A

BURN OF THIRD DEGREE OF UNSP TOE(S) (NAIL) INIT ENCNTR

R402134 COMA SCALE EYES OPEN TO SOUND 24+HRS

T25391A

BURN OF 3RD DEG MU SITES OF RIGHT ANKLE AND FOOT INIT

R402140

COMA SCALE EYES OPEN SPONTANEOUS UNSPECIFIED TIME

T25392A

BURN OF 3RD DEG MU SITES OF LEFT ANKLE AND FOOT INIT

R402141 COMA SCALE EYES OPEN SPONTANEOUS IN THE FIELD

T25399A

BURN OF 3RD DEG MU SITES OF UNSP ANKLE AND FOOT INIT

R402142 COMA SCALE EYES OPEN SPONTANEOUS EMR

T25611A

CORROSION OF SECOND DEGREE OF RIGHT ANKLE INITIAL ENCOUNTER

R402143

COMA SCALE EYES OPEN SPONTANEOUS AT HOSPITAL ADMISSION

T25612A

CORROSION OF SECOND DEGREE OF LEFT ANKLE INITIAL ENCOUNTER

R402144 COMA SCALE EYES OPEN SPONTANEOUS 24+HRS

T25619A

CORROSION OF SECOND DEGREE OF UNSPECIFIED ANKLE INIT ENCNTR

R402210

COMA SCALE BEST VERBAL RESPONSE NONE UNSPECIFIED TIME

T25621A

CORROSION OF SECOND DEGREE OF RIGHT FOOT INITIAL ENCOUNTER

R402211 COMA SCALE BEST VERBAL RESPONSE NONE IN THE FIELD

T25622A

CORROSION OF SECOND DEGREE OF LEFT FOOT INITIAL ENCOUNTER

R402212 COMA SCALE BEST VERBAL RESPONSE NONE EMR

T25629A

CORROSION OF SECOND DEGREE OF UNSPECIFIED FOOT INIT ENCNTR

R402213 COMA SCALE BEST VERBAL RESPONSE NONE ADMIT

T25631A

CORROSION OF SECOND DEGREE OF RIGHT TOE(S) (NAIL) INIT

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ICD-10 Code Description

ICD-10 Code Description

R402214 COMA SCALE BEST VERBAL RESPONSE NONE 24+HRS

T25632A

CORROSION OF SECOND DEGREE OF LEFT TOE(S) (NAIL) INIT

R402220

COMA SCALE BEST VERB INCOMPREHENSIBLE WORDS UNSP TIME

T25639A

CORROSION OF SECOND DEGREE OF UNSP TOE(S) (NAIL) INIT

R402221

COMA SCALE BEST VERB INCOMPREHENSIBLE WORDS IN THE FIELD

T25691A

CORROSION OF SECOND DEGREE OF RIGHT ANKLE AND FOOT INIT

R402222

COMA SCALE BEST VERB INCOMPREHENSIBLE WORDS EMR

T25692A

CORROSION OF SECOND DEGREE OF LEFT ANKLE AND FOOT INIT

R402223

COMA SCALE BEST VERB INCOMPREHENSIBLE WORDS ADMIT

T25699A

CORROSION OF SECOND DEGREE OF UNSP ANKLE AND FOOT INIT

R402224

COMA SCALE BEST VERB INCOMPREHENSIBLE WORDS 24+HRS

T25711A

CORROSION OF THIRD DEGREE OF RIGHT ANKLE INITIAL ENCOUNTER

R402230

COMA SCALE BEST VERB INAPPROPRIATE WORDS UNSP TIME

T25712A

CORROSION OF THIRD DEGREE OF LEFT ANKLE INITIAL ENCOUNTER

R402231

COMA SCALE BEST VERB INAPPROPRIATE WORDS IN THE FIELD

T25719A

CORROSION OF THIRD DEGREE OF UNSPECIFIED ANKLE INIT ENCNTR

R402232

COMA SCALE BEST VERBAL RESPONSE INAPPROPRIATE WORDS EMR

T25721A

CORROSION OF THIRD DEGREE OF RIGHT FOOT INITIAL ENCOUNTER

R402233

COMA SCALE BEST VERBAL RESPONSE INAPPROPRIATE WORDS ADMIT

T25722A

CORROSION OF THIRD DEGREE OF LEFT FOOT INITIAL ENCOUNTER

R402234

COMA SCALE BEST VERB INAPPROPRIATE WORDS 24+HRS

T25729A

CORROSION OF THIRD DEGREE OF UNSPECIFIED FOOT INIT ENCNTR

R402240

COMA SCALE BEST VERB CONFUSED CONVERSATION UNSP TIME

T25731A

CORROSION OF THIRD DEGREE OF RIGHT TOE(S) (NAIL) INIT

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ICD-10 Code Description

ICD-10 Code Description

R402241

COMA SCALE BEST VERB CONFUSED CONVERSATION IN THE FIELD

T25732A

CORROSION OF THIRD DEGREE OF LEFT TOE(S) (NAIL) INIT ENCNTR

R402242

COMA SCALE BEST VERBAL RESPONSE CONFUSED CONVERSATION EMR

T25739A

CORROSION OF THIRD DEGREE OF UNSP TOE(S) (NAIL) INIT ENCNTR

R402243

COMA SCALE BEST VERB CONFUSED CONVERSATION ADMIT

T25791A

CORROSION OF 3RD DEG MU SITES OF RIGHT ANKLE AND FOOT INIT

R402244

COMA SCALE BEST VERB CONFUSED CONVERSATION 24+HRS

T25792A

CORROSION OF 3RD DEG MU SITES OF LEFT ANKLE AND FOOT INIT

R402250

COMA SCALE BEST VERBAL RESPONSE ORIENTED UNSPECIFIED TIME

T25799A

CORROSION OF 3RD DEG MU SITES OF UNSP ANKLE AND FOOT INIT

R402251

COMA SCALE BEST VERBAL RESPONSE ORIENTED IN THE FIELD

T2600XA

BURN OF UNSPECIFIED EYELID AND PERIOCULAR AREA INIT ENCNTR

R402252 COMA SCALE BEST VERBAL RESPONSE ORIENTED EMR

T2601XA

BURN OF RIGHT EYELID AND PERIOCULAR AREA INITIAL ENCOUNTER

R402253 COMA SCALE BEST VERBAL RESPONSE ORIENTED ADMIT

T2602XA

BURN OF LEFT EYELID AND PERIOCULAR AREA INITIAL ENCOUNTER

R402254 COMA SCALE BEST VERBAL RESPONSE ORIENTED 24+HRS

T2610XA

BURN OF CORNEA AND CONJUNCTIVAL SAC UNSP EYE INIT ENCNTR

R402310

COMA SCALE BEST MOTOR RESPONSE NONE UNSPECIFIED TIME

T2611XA

BURN OF CORNEA AND CONJUNCTIVAL SAC RIGHT EYE INIT ENCNTR

R402311 COMA SCALE BEST MOTOR RESPONSE NONE IN THE FIELD

T2612XA

BURN OF CORNEA AND CONJUNCTIVAL SAC LEFT EYE INIT ENCNTR

R402312 COMA SCALE BEST MOTOR RESPONSE NONE EMR

T2620XA

BURN W RESULTING RUPTURE AND DEST OF UNSP EYEBALL INIT

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ICD-10 Code Description

ICD-10 Code Description

R402313

COMA SCALE BEST MOTOR RESPONSE NONE AT HOSPITAL ADMISSION

T2621XA

BURN W RESULTING RUPTURE AND DEST OF RIGHT EYEBALL INIT

R402314 COMA SCALE BEST MOTOR RESPONSE NONE 24+HRS

T2622XA

BURN W RESULTING RUPTURE AND DEST OF LEFT EYEBALL INIT

R402320

COMA SCALE BEST MOTOR RESPONSE EXTENSION UNSPECIFIED TIME

T2630XA

BURNS OF OTH PARTS OF UNSP EYE AND ADNEXA INIT ENCNTR

R402321

COMA SCALE BEST MOTOR RESPONSE EXTENSION IN THE FIELD

T2631XA

BURNS OF OTH PARTS OF RIGHT EYE AND ADNEXA INIT ENCNTR

R402322 COMA SCALE BEST MOTOR RESPONSE EXTENSION EMR

T2632XA

BURNS OF OTH PARTS OF LEFT EYE AND ADNEXA INIT ENCNTR

R402323 COMA SCALE BEST MOTOR RESPONSE EXTENSION ADMIT

T2640XA

BURN OF UNSP EYE AND ADNEXA PART UNSPECIFIED INIT ENCNTR

R402324 COMA SCALE BEST MOTOR RESPONSE EXTENSION 24+HRS

T2641XA

BURN OF RIGHT EYE AND ADNEXA PART UNSPECIFIED INIT ENCNTR

R402330

COMA SCALE BEST MOTOR RESPONSE ABNORMAL UNSPECIFIED TIME

T2642XA

BURN OF LEFT EYE AND ADNEXA PART UNSPECIFIED INIT ENCNTR

R402331

COMA SCALE BEST MOTOR RESPONSE ABNORMAL IN THE FIELD

T2650XA

CORROSION OF UNSP EYELID AND PERIOCULAR AREA INIT ENCNTR

R402332 COMA SCALE BEST MOTOR RESPONSE ABNORMAL EMR

T2651XA

CORROSION OF RIGHT EYELID AND PERIOCULAR AREA INIT ENCNTR

R402333 COMA SCALE BEST MOTOR RESPONSE ABNORMAL ADMIT

T2652XA

CORROSION OF LEFT EYELID AND PERIOCULAR AREA INIT ENCNTR

R402334 COMA SCALE BEST MOTOR RESPONSE ABNORMAL 24+HRS

T2660XA

CORROSION OF CORNEA AND CONJUNCTIVAL SAC UNSP EYE INIT

R402340

COMA SCALE BEST MOTOR FLEXION WITHDRAWAL UNSP TIME

T2661XA

CORROSION OF CORNEA AND CONJUNCTIVAL SAC RIGHT EYE INIT

R402341

COMA SCALE BEST MOTOR FLEXION WITHDRAWAL IN THE FIELD

T2662XA

CORROSION OF CORNEA AND CONJUNCTIVAL SAC LEFT EYE INIT

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ICD-10 Code Description

ICD-10 Code Description

R402342

COMA SCALE BEST MOTOR RESPONSE FLEXION WITHDRAWAL EMR

T2670XA

CORROSION W RESULTING RUPTURE AND DEST OF UNSP EYEBALL INIT

R402343

COMA SCALE BEST MOTOR RESPONSE FLEXION WITHDRAWAL ADMIT

T2671XA

CORROS W RESULTING RUPTURE AND DEST OF RIGHT EYEBALL INIT

R402344

COMA SCALE BEST MOTOR RESPONSE FLEXION WITHDRAWAL 24+HRS

T2672XA

CORROSION W RESULTING RUPTURE AND DEST OF LEFT EYEBALL INIT

R402350

COMA SCALE BEST MOTOR RESPONSE LOCALIZES PAIN UNSP TIME

T2680XA

CORROSIONS OF OTH PARTS OF UNSP EYE AND ADNEXA INIT ENCNTR

R402351 COMA SCALE BEST MOTOR LOCALIZES PAIN IN THE FIELD

T2681XA

CORROSIONS OF OTH PARTS OF RIGHT EYE AND ADNEXA INIT ENCNTR

R402352 COMA SCALE BEST MOTOR RESPONSE LOCALIZES PAIN EMR

T2682XA

CORROSIONS OF OTH PARTS OF LEFT EYE AND ADNEXA INIT ENCNTR

R402353

COMA SCALE BEST MOTOR RESPONSE LOCALIZES PAIN ADMIT

T2690XA

CORROSION OF UNSP EYE AND ADNEXA PART UNSP INIT ENCNTR

R402354

COMA SCALE BEST MOTOR RESPONSE LOCALIZES PAIN 24+HRS

T2691XA

CORROSION OF RIGHT EYE AND ADNEXA PART UNSP INIT ENCNTR

R402360

COMA SCALE BEST MOTOR RESPONSE OBEYS COMMANDS UNSP TIME

T2692XA

CORROSION OF LEFT EYE AND ADNEXA PART UNSP INIT ENCNTR

R402361

COMA SCALE BEST MOTOR OBEYS COMMANDS IN THE FIELD

T270XXA

BURN OF LARYNX AND TRACHEA INITIAL ENCOUNTER

R402362

COMA SCALE BEST MOTOR RESPONSE OBEYS COMMANDS EMR

T271XXA

BURN INVOLVING LARYNX AND TRACHEA WITH LUNG INIT ENCNTR

R402363

COMA SCALE BEST MOTOR RESPONSE OBEYS COMMANDS ADMIT

T272XXA

BURN OF OTHER PARTS OF RESPIRATORY TRACT INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R402364

COMA SCALE BEST MOTOR RESPONSE OBEYS COMMANDS 24+HRS

T273XXA

BURN OF RESPIRATORY TRACT PART UNSPECIFIED INIT ENCNTR

R402410 Glasgow coma scale score 13-15 unspecified time

T274XXA

CORROSION OF LARYNX AND TRACHEA INITIAL ENCOUNTER

R402411 Glasgow coma scale score 13-15 in the field [EMT or ambulance]

T275XXA

CORROSION INVOLVING LARYNX AND TRACHEA W LUNG INIT ENCNTR

R402412

Glasgow coma scale score 13-15 at arrival to emergency department

T276XXA

CORROSION OF OTHER PARTS OF RESPIRATORY TRACT INIT ENCNTR

R402420 Glasgow coma scale score 9-12 unspecified time

T277XXA

CORROSION OF RESPIRATORY TRACT PART UNSP INIT ENCNTR

R402421 Glasgow coma scale score 9-12 in the field [EMT or ambulance]

T280XXA

BURN OF MOUTH AND PHARYNX INITIAL ENCOUNTER

R402422

Glasgow coma scale score 9-12 at arrival to emergency department

T281XXA

BURN OF ESOPHAGUS INITIAL ENCOUNTER

R402430 Glasgow coma scale score 3-8 unspecified time

T282XXA

BURN OF OTHER PARTS OF ALIMENTARY TRACT INITIAL ENCOUNTER

R402431 Glasgow coma scale score 3-8 in the field [EMT or ambulance]

T283XXA

BURN OF INTERNAL GENITOURINARY ORGANS INITIAL ENCOUNTER

R402432

Glasgow coma scale score 3-8 at arrival to emergency department

T2840XA

BURN OF UNSPECIFIED INTERNAL ORGAN INITIAL ENCOUNTER

R402440

Other coma without documented Glasgow coma scale score or with partial score reported unspecified time

T28411A

BURN OF RIGHT EAR DRUM INITIAL ENCOUNTER

R402441

Other coma without documented Glasgow coma scale score or with partial score reported in the field [EMT or ambulance]

T28412A

BURN OF LEFT EAR DRUM INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

R402442

Other coma without documented Glasgow coma scale score or with partial score reported at arrival to emergency department

T28419A

BURN OF UNSPECIFIED EAR DRUM INITIAL ENCOUNTER

R403 PERSISTENT VEGETATIVE STATE

T2849XA BURN OF OTHER INTERNAL ORGAN INITIAL ENCOUNTER

R404 TRANSIENT ALTERATION OF AWARENESS

T285XXA

CORROSION OF MOUTH AND PHARYNX INITIAL ENCOUNTER

R410 DISORIENTATION UNSPECIFIED

T286XXA CORROSION OF ESOPHAGUS INITIAL ENCOUNTER

R411 ANTEROGRADE AMNESIA

T287XXA CORROSION OF OTHER PARTS OF ALIMENTARY TRACT INIT ENCNTR

R412 RETROGRADE AMNESIA

T288XXA

CORROSION OF INTERNAL GENITOURINARY ORGANS INIT ENCNTR

R413 OTHER AMNESIA

T2890XA

CORROSIONS OF UNSPECIFIED INTERNAL ORGANS INITIAL ENCOUNTER

R414 NEUROLOGIC NEGLECT SYNDROME

T28911A

CORROSIONS OF RIGHT EAR DRUM INITIAL ENCOUNTER

R4182 ALTERED MENTAL STATUS UNSPECIFIED

T28912A

CORROSIONS OF LEFT EAR DRUM INITIAL ENCOUNTER

R41841 COGNITIVE COMMUNICATION DEFICIT

T28919A

CORROSIONS OF UNSPECIFIED EAR DRUM INITIAL ENCOUNTER

R41842 VISUOSPATIAL DEFICIT

T2899XA CORROSIONS OF OTHER INTERNAL ORGANS INITIAL ENCOUNTER

R41843 PSYCHOMOTOR DEFICIT

T3110 BURNS OF 10-19% OF BODY SURFC W 0% TO 9% THIRD DEGREE BURNS

R41844 FRONTAL LOBE AND EXECUTIVE FUNCTION DEFICIT

T3111

BURNS OF 10-19% OF BODY SURFACE W 10-19% THIRD DEGREE BURNS

R4189

OTH SYMPTOMS AND SIGNS W COGNITIVE FUNCTIONS AND AWARENESS

T3120

BURNS OF 20-29% OF BODY SURFC W 0% TO 9% THIRD DEGREE BURNS

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ICD-10 Code Description

ICD-10 Code Description

R419

UNSP SYMPTOMS AND SIGNS W COGNITIVE FUNCTIONS AND AWARENESS

T3121

BURNS OF 20-29% OF BODY SURFACE W 10-19% THIRD DEGREE BURNS

R454 IRRITABILITY AND ANGER

T3122 BURNS OF 20-29% OF BODY SURFACE W 20-29% THIRD DEGREE BURNS

R455 HOSTILITY

T3130 BURNS OF 30-39% OF BODY SURFC W 0% TO 9% THIRD DEGREE BURNS

R456 VIOLENT BEHAVIOR

T3131 BURNS OF 30-39% OF BODY SURFACE W 10-19% THIRD DEGREE BURNS

R45850 HOMICIDAL IDEATIONS

T3132 BURNS OF 30-39% OF BODY SURFACE W 20-29% THIRD DEGREE BURNS

R45851 SUICIDAL IDEATIONS

T3133 BURNS OF 30-39% OF BODY SURFACE W 30-39% THIRD DEGREE BURNS

R4587 IMPULSIVENESS

T3140 BURNS OF 40-49% OF BODY SURFC W 0% TO 9% THIRD DEGREE BURNS

R4589 OTHER SYMPTOMS AND SIGNS INVOLVING EMOTIONAL STATE

T3141

BURNS OF 40-49% OF BODY SURFACE W 10-19% THIRD DEGREE BURNS

R4701 APHASIA

T3142 BURNS OF 40-49% OF BODY SURFACE W 20-29% THIRD DEGREE BURNS

R4781 SLURRED SPEECH

T3143 BURNS OF 40-49% OF BODY SURFACE W 30-39% THIRD DEGREE BURNS

R5081

FEVER PRESENTING WITH CONDITIONS CLASSIFIED ELSEWHERE

T3144

BURNS OF 40-49% OF BODY SURFACE W 40-49% THIRD DEGREE BURNS

R5082 POSTPROCEDURAL FEVER

T3150 BURNS OF 50-59% OF BODY SURFC W 0% TO 9% THIRD DEGREE BURNS

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ICD-10 Code Description

ICD-10 Code Description

R5084 FEBRILE NONHEMOLYTIC TRANSFUSION REACTION

T3151

BURNS OF 50-59% OF BODY SURFACE W 10-19% THIRD DEGREE BURNS

R530 NEOPLASTIC (MALIGNANT) RELATED FATIGUE

T3152

BURNS OF 50-59% OF BODY SURFACE W 20-29% THIRD DEGREE BURNS

R55 SYNCOPE AND COLLAPSE

T3153 BURNS OF 50-59% OF BODY SURFACE W 30-39% THIRD DEGREE BURNS

R5600 SIMPLE FEBRILE CONVULSIONS

T3154 BURNS OF 50-59% OF BODY SURFACE W 40-49% THIRD DEGREE BURNS

R5601 COMPLEX FEBRILE CONVULSIONS

T3155

BURNS OF 50-59% OF BODY SURFACE W 50-59% THIRD DEGREE BURNS

R561 POST TRAUMATIC SEIZURES

T3160 BURNS OF 60-69% OF BODY SURFC W 0% TO 9% THIRD DEGREE BURNS

R569 UNSPECIFIED CONVULSIONS

T3161 BURNS OF 60-69% OF BODY SURFACE W 10-19% THIRD DEGREE BURNS

R570 CARDIOGENIC SHOCK

T3162 BURNS OF 60-69% OF BODY SURFACE W 20-29% THIRD DEGREE BURNS

R571 HYPOVOLEMIC SHOCK

T3163 BURNS OF 60-69% OF BODY SURFACE W 30-39% THIRD DEGREE BURNS

R578 OTHER SHOCK

T3164 BURNS OF 60-69% OF BODY SURFACE W 40-49% THIRD DEGREE BURNS

R579 SHOCK UNSPECIFIED

T3165 BURNS OF 60-69% OF BODY SURFACE W 50-59% THIRD DEGREE BURNS

R58 HEMORRHAGE NOT ELSEWHERE CLASSIFIED

T3166

BURNS OF 60-69% OF BODY SURFACE W 60-69% THIRD DEGREE BURNS

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ICD-10 Code Description

ICD-10 Code Description

R590 LOCALIZED ENLARGED LYMPH NODES

T3170

BURNS OF 70-79% OF BODY SURFC W 0% TO 9% THIRD DEGREE BURNS

R591 GENERALIZED ENLARGED LYMPH NODES

T3171

BURNS OF 70-79% OF BODY SURFACE W 10-19% THIRD DEGREE BURNS

R599 ENLARGED LYMPH NODES UNSPECIFIED

T3172

BURNS OF 70-79% OF BODY SURFACE W 20-29% THIRD DEGREE BURNS

R609 EDEMA UNSPECIFIED

T3173 BURNS OF 70-79% OF BODY SURFACE W 30-39% THIRD DEGREE BURNS

R61 GENERALIZED HYPERHIDROSIS

T3174 BURNS OF 70-79% OF BODY SURFACE W 40-49% THIRD DEGREE BURNS

R6251 FAILURE TO THRIVE (CHILD)

T3175 BURNS OF 70-79% OF BODY SURFACE W 50-59% THIRD DEGREE BURNS

R627 ADULT FAILURE TO THRIVE

T3176 BURNS OF 70-79% OF BODY SURFACE W 60-69% THIRD DEGREE BURNS

R630 ANOREXIA

T3177 BURNS OF 70-79% OF BODY SURFACE W 70-79% THIRD DEGREE BURNS

R6520 SEVERE SEPSIS WITHOUT SEPTIC SHOCK

T3180

BURNS OF 80-89% OF BODY SURFC W 0% TO 9% THIRD DEGREE BURNS

R6521 SEVERE SEPSIS WITH SEPTIC SHOCK

T3181

BURNS OF 80-89% OF BODY SURFACE W 10-19% THIRD DEGREE BURNS

R6813 APPARENT LIFE THREATENING EVENT IN INFANT (ALTE)

T3182

BURNS OF 80-89% OF BODY SURFACE W 20-29% THIRD DEGREE BURNS

R920

MAMMOGRAPHIC MICROCALCIFICATION FOUND ON DX IMAGING OF BRST

T3183

BURNS OF 80-89% OF BODY SURFACE W 30-39% THIRD DEGREE BURNS

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ICD-10 Code Description

ICD-10 Code Description

R921

MAMMOGRAPHIC CALCIFCN FOUND ON DIAGNOSTIC IMAGING OF BREAST

T3184

BURNS OF 80-89% OF BODY SURFACE W 40-49% THIRD DEGREE BURNS

R922 INCONCLUSIVE MAMMOGRAM

T3185 BURNS OF 80-89% OF BODY SURFACE W 50-59% THIRD DEGREE BURNS

R928

OTH ABN AND INCONCLUSIVE FINDINGS ON DX IMAGING OF BREAST

T3186

BURNS OF 80-89% OF BODY SURFACE W 60-69% THIRD DEGREE BURNS

S0000XA

UNSPECIFIED SUPERFICIAL INJURY OF SCALP INITIAL ENCOUNTER

T3187

BURNS OF 80-89% OF BODY SURFACE W 70-79% THIRD DEGREE BURNS

S0001XA ABRASION OF SCALP INITIAL ENCOUNTER

T3188

BURNS OF 80-89% OF BODY SURFACE W 80-89% THIRD DEGREE BURNS

S0001XS ABRASION OF SCALP SEQUELA

T3190 BURNS OF 90%/MORE OF BODY SURFC W 0% TO 9% THIRD DEG BURNS

S0002XS BLISTER (NONTHERMAL) OF SCALP SEQUELA

T3191

BURNS OF 90%/MORE OF BODY SURFC W 10-19% THIRD DEGREE BURNS

S0004XA

EXTERNAL CONSTRICTION OF PART OF SCALP INITIAL ENCOUNTER

T3192

BURNS OF 90%/MORE OF BODY SURFC W 20-29% THIRD DEGREE BURNS

S0005XA SUPERFICIAL FOREIGN BODY OF SCALP INITIAL ENCOUNTER

T3193

BURNS OF 90%/MORE OF BODY SURFC W 30-39% THIRD DEGREE BURNS

S0006XA INSECT BITE (NONVENOMOUS) OF SCALP INITIAL ENCOUNTER

T3194

BURNS OF 90%/MORE OF BODY SURFC W 40-49% THIRD DEGREE BURNS

S0007XA OTHER SUPERFICIAL BITE OF SCALP INITIAL ENCOUNTER

T3195

BURNS OF 90%/MORE OF BODY SURFC W 50-59% THIRD DEGREE BURNS

S0010XA

CONTUSION OF UNSP EYELID AND PERIOCULAR AREA INIT ENCNTR

T3196

BURNS OF 90%/MORE OF BODY SURFC W 60-69% THIRD DEGREE BURNS

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ICD-10 Code Description

ICD-10 Code Description

S0011XA

CONTUSION OF RIGHT EYELID AND PERIOCULAR AREA INIT ENCNTR

T3197

BURNS OF 90%/MORE OF BODY SURFC W 70-79% THIRD DEGREE BURNS

S0012XA

CONTUSION OF LEFT EYELID AND PERIOCULAR AREA INIT ENCNTR

T3198

BURNS OF 90%/MORE OF BODY SURFC W 80-89% THIRD DEGREE BURNS

S00201A

UNSP SUPERFIC INJ RIGHT EYELID AND PERIOCULR AREA INIT

T3199

BURNS OF 90%/MORE OF BODY SURFC W 90%/MORE THIRD DEG BURNS

S00202A

UNSP SUPERFIC INJURY OF LEFT EYELID AND PERIOCULR AREA INIT

T320

CORROSIONS INVOLVING LESS THAN 10% OF BODY SURFACE

S00209A

UNSP SUPERFIC INJURY OF UNSP EYELID AND PERIOCULR AREA INIT

T3210

CORROS 10-19% OF BODY SURFACE W 0% TO 9% THIRD DEGREE CORROS

S00211A

ABRASION OF RIGHT EYELID AND PERIOCULAR AREA INIT ENCNTR

T3211

CORROS 10-19% OF BODY SURFACE W 10-19% THIRD DEGREE CORROS

S00212A ABRASION OF LEFT EYELID AND PERIOCULAR AREA INIT ENCNTR

T3220

CORROS 20-29% OF BODY SURFACE W 0% TO 9% THIRD DEGREE CORROS

S00219A

ABRASION OF UNSP EYELID AND PERIOCULAR AREA INIT ENCNTR

T3221

CORROS 20-29% OF BODY SURFACE W 10-19% THIRD DEGREE CORROS

S00221A BLISTER OF RIGHT EYELID AND PERIOCULAR AREA INIT

T3222

CORROS 20-29% OF BODY SURFACE W 20-29% THIRD DEGREE CORROS

S00222A BLISTER OF LEFT EYELID AND PERIOCULAR AREA INIT

T3230

CORROS 30-39% OF BODY SURFACE W 0% TO 9% THIRD DEGREE CORROS

S00229A BLISTER OF UNSP EYELID AND PERIOCULAR AREA INIT

T3231

CORROS 30-39% OF BODY SURFACE W 10-19% THIRD DEGREE CORROS

S00241A

EXTERNAL CONSTRICT OF RIGHT EYELID AND PERIOCULAR AREA INIT

T3232

CORROS 30-39% OF BODY SURFACE W 20-29% THIRD DEGREE CORROS

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S00242A

EXTERNAL CONSTRICT OF LEFT EYELID AND PERIOCULAR AREA INIT

T3233

CORROS 30-39% OF BODY SURFACE W 30-39% THIRD DEGREE CORROS

S00249A

EXTERNAL CONSTRICT OF UNSP EYELID AND PERIOCULAR AREA INIT

T3240

CORROS 40-49% OF BODY SURFACE W 0% TO 9% THIRD DEGREE CORROS

S00251A

SUPERFICIAL FB OF RIGHT EYELID AND PERIOCULAR AREA INIT

T3241

CORROS 40-49% OF BODY SURFACE W 10-19% THIRD DEGREE CORROS

S00252A SUPERFICIAL FB OF LEFT EYELID AND PERIOCULAR AREA INIT

T3242

CORROS 40-49% OF BODY SURFACE W 20-29% THIRD DEGREE CORROS

S00259A

SUPERFICIAL FB OF UNSP EYELID AND PERIOCULAR AREA INIT

T3243

CORROS 40-49% OF BODY SURFACE W 30-39% THIRD DEGREE CORROS

S00261A INSECT BITE OF RIGHT EYELID AND PERIOCULAR AREA INIT

T3244

CORROS 40-49% OF BODY SURFACE W 40-49% THIRD DEGREE CORROS

S00262A INSECT BITE OF LEFT EYELID AND PERIOCULAR AREA INIT

T3250

CORROS 50-59% OF BODY SURFACE W 0% TO 9% THIRD DEGREE CORROS

S00269A INSECT BITE OF UNSP EYELID AND PERIOCULAR AREA INIT

T3251

CORROS 50-59% OF BODY SURFACE W 10-19% THIRD DEGREE CORROS

S00271A

OTH SUPERFIC BITE OF RIGHT EYELID AND PERIOCULAR AREA INIT

T3252

CORROS 50-59% OF BODY SURFACE W 20-29% THIRD DEGREE CORROS

S00272A

OTH SUPERFIC BITE OF LEFT EYELID AND PERIOCULAR AREA INIT

T3253

CORROS 50-59% OF BODY SURFACE W 30-39% THIRD DEGREE CORROS

S0093XA

CONTUSION OF UNSPECIFIED PART OF HEAD INITIAL ENCOUNTER

T3254

CORROS 50-59% OF BODY SURFACE W 40-49% THIRD DEGREE CORROS

S0100XA UNSPECIFIED OPEN WOUND OF SCALP INITIAL ENCOUNTER

T3255

CORROS 50-59% OF BODY SURFACE W 50-59% THIRD DEGREE CORROS

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0103XA

PUNCTURE WOUND WITHOUT FOREIGN BODY OF SCALP INIT ENCNTR

T3260

CORROS 60-69% OF BODY SURFACE W 0% TO 9% THIRD DEGREE CORROS

S0104XA

PUNCTURE WOUND WITH FOREIGN BODY OF SCALP INITIAL ENCOUNTER

T3261

CORROS 60-69% OF BODY SURFACE W 10-19% THIRD DEGREE CORROS

S020XXA

FRACTURE OF VAULT OF SKULL INIT ENCNTR FOR CLOSED FRACTURE

T3262

CORROS 60-69% OF BODY SURFACE W 20-29% THIRD DEGREE CORROS

S020XXB

FRACTURE OF VAULT OF SKULL INIT ENCNTR FOR OPEN FRACTURE

T3263

CORROS 60-69% OF BODY SURFACE W 30-39% THIRD DEGREE CORROS

S020XXD FRACTURE OF VAULT OF SKULL SUBS FOR FX W ROUTN HEAL

T3264

CORROS 60-69% OF BODY SURFACE W 40-49% THIRD DEGREE CORROS

S020XXG FRACTURE OF VAULT OF SKULL SUBS FOR FX W DELAY HEAL

T3265

CORROS 60-69% OF BODY SURFACE W 50-59% THIRD DEGREE CORROS

S020XXK FRACTURE OF VAULT OF SKULL SUBS FOR FX W NONUNION

T3266

CORROS 60-69% OF BODY SURFACE W 60-69% THIRD DEGREE CORROS

S020XXS FRACTURE OF VAULT OF SKULL SEQUELA

T3270

CORROS 70-79% OF BODY SURFACE W 0% TO 9% THIRD DEGREE CORROS

S0210XA UNSP FRACTURE OF BASE OF SKULL INIT FOR CLOS FX

T3271

CORROS 70-79% OF BODY SURFACE W 10-19% THIRD DEGREE CORROS

S0210XB UNSP FRACTURE OF BASE OF SKULL INIT FOR OPN FX

T3272

CORROS 70-79% OF BODY SURFACE W 20-29% THIRD DEGREE CORROS

S0210XD

UNSP FRACTURE OF BASE OF SKULL SUBS FOR FX W ROUTN HEAL

T3273

CORROS 70-79% OF BODY SURFACE W 30-39% THIRD DEGREE CORROS

S0210XG

UNSP FRACTURE OF BASE OF SKULL SUBS FOR FX W DELAY HEAL

T3274

CORROS 70-79% OF BODY SURFACE W 40-49% THIRD DEGREE CORROS

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0210XK

UNSP FRACTURE OF BASE OF SKULL SUBS FOR FX W NONUNION

T3275

CORROS 70-79% OF BODY SURFACE W 50-59% THIRD DEGREE CORROS

S0210XS UNSPECIFIED FRACTURE OF BASE OF SKULL SEQUELA

T3276

CORROS 70-79% OF BODY SURFACE W 60-69% THIRD DEGREE CORROS

S02101A

Fracture of base of skull right side initial encounter for closed fracture

T3277

CORROS 70-79% OF BODY SURFACE W 70-79% THIRD DEGREE CORROS

S02101B

Fracture of base of skull right side initial encounter for open fracture

T3280

CORROS 80-89% OF BODY SURFACE W 0% TO 9% THIRD DEGREE CORROS

S02102A

Fracture of base of skull left side initial encounter for closed fracture

T3281

CORROS 80-89% OF BODY SURFACE W 10-19% THIRD DEGREE CORROS

S02102B

Fracture of base of skull left side initial encounter for open fracture

T3282

CORROS 80-89% OF BODY SURFACE W 20-29% THIRD DEGREE CORROS

S02102D Fracture of base of skull left side sequela

T3283

CORROS 80-89% OF BODY SURFACE W 30-39% THIRD DEGREE CORROS

S02102G

Fracture of base of skull left side subsequent encounter for fracture with delayed healing

T3284

CORROS 80-89% OF BODY SURFACE W 40-49% THIRD DEGREE CORROS

S02102K

Fracture of base of skull left side subsequent encounter for fracture with nonunion

T3285

CORROS 80-89% OF BODY SURFACE W 50-59% THIRD DEGREE CORROS

S02102S

Fracture of base of skull left side subsequent encounter for fracture with routine healing

T3286

CORROS 80-89% OF BODY SURFACE W 60-69% THIRD DEGREE CORROS

S02109A

Fracture of base of skull unspecified side initial encounter for closed fracture

T3287

CORROS 80-89% OF BODY SURFACE W 70-79% THIRD DEGREE CORROS

S02109B

Fracture of base of skull unspecified side initial encounter for open fracture

T3288

CORROS 80-89% OF BODY SURFACE W 80-89% THIRD DEGREE CORROS

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S02109S Fracture of base of skull unspecified side sequela

T3290

CORROS 90%/MORE OF BODY SURFC W 0% TO 9% THIRD DEGREE CORROS

S02110A TYPE I OCCIPITAL CONDYLE FRACTURE INIT FOR CLOS FX

T3291

CORROS 90%/MORE OF BODY SURFACE W 10-19% THIRD DEGREE CORROS

S02110B TYPE I OCCIPITAL CONDYLE FRACTURE INIT FOR OPN FX

T3292

CORROS 90%/MORE OF BODY SURFACE W 20-29% THIRD DEGREE CORROS

S02110D

TYPE I OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W ROUTN HEAL

T3293

CORROS 90%/MORE OF BODY SURFACE W 30-39% THIRD DEGREE CORROS

S02110G

TYPE I OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W DELAY HEAL

T3294

CORROS 90%/MORE OF BODY SURFACE W 40-49% THIRD DEGREE CORROS

S02110K

TYPE I OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W NONUNION

T3295

CORROS 90%/MORE OF BODY SURFACE W 50-59% THIRD DEGREE CORROS

S02110S TYPE I OCCIPITAL CONDYLE FRACTURE SEQUELA

T3296

CORROS 90%/MORE OF BODY SURFACE W 60-69% THIRD DEGREE CORROS

S02111A TYPE II OCCIPITAL CONDYLE FRACTURE INIT FOR CLOS FX

T3297

CORROS 90%/MORE OF BODY SURFACE W 70-79% THIRD DEGREE CORROS

S02111B TYPE II OCCIPITAL CONDYLE FRACTURE INIT FOR OPN FX

T3298

CORROS 90%/MORE OF BODY SURFACE W 80-89% THIRD DEGREE CORROS

S02111D

TYPE II OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W ROUTN HEAL

T3299

CORROS 90%/MORE OF BODY SURFC W 90%/MORE THIRD DEGREE CORROS

S02111G

TYPE II OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W DELAY HEAL

T33011A

SUPERFICIAL FROSTBITE OF RIGHT EAR INITIAL ENCOUNTER

S02111K

TYPE II OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W NONUNION

T33012A

SUPERFICIAL FROSTBITE OF LEFT EAR INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S02111S TYPE II OCCIPITAL CONDYLE FRACTURE SEQUELA

T33019A

SUPERFICIAL FROSTBITE OF UNSPECIFIED EAR INITIAL ENCOUNTER

S02112A TYPE III OCCIPITAL CONDYLE FRACTURE INIT FOR CLOS FX

T3302XA

SUPERFICIAL FROSTBITE OF NOSE INITIAL ENCOUNTER

S02112B TYPE III OCCIPITAL CONDYLE FRACTURE INIT FOR OPN FX

T3309XA

SUPERFICIAL FROSTBITE OF OTHER PART OF HEAD INIT ENCNTR

S02112D TYPE III OCCIPITAL CONDYLE FX SUBS FOR FX W ROUTN HEAL

T331XXA

SUPERFICIAL FROSTBITE OF NECK INITIAL ENCOUNTER

S02112G TYPE III OCCIPITAL CONDYLE FX SUBS FOR FX W DELAY HEAL

T332XXA

SUPERFICIAL FROSTBITE OF THORAX INITIAL ENCOUNTER

S02112K

TYPE III OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W NONUNION

T333XXA

SUPERFIC FROSTBITE OF ABD WALL LOWER BACK AND PELVIS INIT

S02112S TYPE III OCCIPITAL CONDYLE FRACTURE SEQUELA

T3340XA

SUPERFICIAL FROSTBITE OF UNSPECIFIED ARM INITIAL ENCOUNTER

S02113A UNSP OCCIPITAL CONDYLE FRACTURE INIT FOR CLOS FX

T3341XA

SUPERFICIAL FROSTBITE OF RIGHT ARM INITIAL ENCOUNTER

S02113B UNSP OCCIPITAL CONDYLE FRACTURE INIT FOR OPN FX

T3342XA

SUPERFICIAL FROSTBITE OF LEFT ARM INITIAL ENCOUNTER

S02113D

UNSP OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W ROUTN HEAL

T33511A

SUPERFICIAL FROSTBITE OF RIGHT WRIST INITIAL ENCOUNTER

S02113G

UNSP OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W DELAY HEAL

T33512A

SUPERFICIAL FROSTBITE OF LEFT WRIST INITIAL ENCOUNTER

S02113K

UNSP OCCIPITAL CONDYLE FRACTURE SUBS FOR FX W NONUNION

T33519A

SUPERFICIAL FROSTBITE OF UNSPECIFIED WRIST INIT ENCNTR

S02113S UNSPECIFIED OCCIPITAL CONDYLE FRACTURE SEQUELA

T33521A

SUPERFICIAL FROSTBITE OF RIGHT HAND INITIAL ENCOUNTER

S02118A

OTHER FRACTURE OF OCCIPUT INIT ENCNTR FOR CLOSED FRACTURE

T33522A

SUPERFICIAL FROSTBITE OF LEFT HAND INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S02118B

OTHER FRACTURE OF OCCIPUT INIT ENCNTR FOR OPEN FRACTURE

T33529A

SUPERFICIAL FROSTBITE OF UNSPECIFIED HAND INITIAL ENCOUNTER

S02119A

UNSP FRACTURE OF OCCIPUT INIT ENCNTR FOR CLOSED FRACTURE

T33531A

SUPERFICIAL FROSTBITE OF RIGHT FINGER(S) INITIAL ENCOUNTER

S02119B

UNSP FRACTURE OF OCCIPUT INIT ENCNTR FOR OPEN FRACTURE

T33532A

SUPERFICIAL FROSTBITE OF LEFT FINGER(S) INITIAL ENCOUNTER

S0211AA

Type I occipital condyle fracture right side initial encounter for closed fracture

T33539A

SUPERFICIAL FROSTBITE OF UNSPECIFIED FINGER(S) INIT ENCNTR

S0211AB

Type I occipital condyle fracture right side initial encounter for open fracture

T3360XA

SUPERFICIAL FROSTBITE OF UNSP HIP AND THIGH INIT ENCNTR

S0211BA

Type I occipital condyle fracture left side initial encounter for closed fracture

T3361XA

SUPERFICIAL FROSTBITE OF RIGHT HIP AND THIGH INIT ENCNTR

S0211BB

Type I occipital condyle fracture left side initial encounter for open fracture

T3362XA

SUPERFICIAL FROSTBITE OF LEFT HIP AND THIGH INIT ENCNTR

S0211CA

Type II occipital condyle fracture right side initial encounter for closed fracture

T3370XA

SUPERFICIAL FROSTBITE OF UNSP KNEE AND LOWER LEG INIT

S0211CB

Type II occipital condyle fracture right side initial encounter for open fracture

T3371XA

SUPERFICIAL FROSTBITE OF RIGHT KNEE AND LOWER LEG INIT

S0211DA

Type II occipital condyle fracture left side initial encounter for closed fracture

T3372XA

SUPERFICIAL FROSTBITE OF LEFT KNEE AND LOWER LEG INIT

S0211DB

Type II occipital condyle fracture left side initial encounter for open fracture

T33811A

SUPERFICIAL FROSTBITE OF RIGHT ANKLE INITIAL ENCOUNTER

S0211EA

Type III occipital condyle fracture right side initial encounter for closed fracture

T33812A

SUPERFICIAL FROSTBITE OF LEFT ANKLE INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0211EB

Type III occipital condyle fracture right side initial encounter for open fracture

T33819A

SUPERFICIAL FROSTBITE OF UNSPECIFIED ANKLE INIT ENCNTR

S0211ED

Type III occipital condyle fracture right side subsequent encounter for fracture with routine healing

T33821A

SUPERFICIAL FROSTBITE OF RIGHT FOOT INITIAL ENCOUNTER

S0211FA

Type III occipital condyle fracture left side initial encounter for closed fracture

T33822A

SUPERFICIAL FROSTBITE OF LEFT FOOT INITIAL ENCOUNTER

S0211FB

Type III occipital condyle fracture left side initial encounter for open fracture

T33829A

SUPERFICIAL FROSTBITE OF UNSPECIFIED FOOT INITIAL ENCOUNTER

S0211GA

Other fracture or occiput right side initial encounter for closed fracture

T33831A

SUPERFICIAL FROSTBITE OF RIGHT TOE(S) INITIAL ENCOUNTER

S0211GB

Other fracture or occiput right side initial encounter for open fracture

T33832A

SUPERFICIAL FROSTBITE OF LEFT TOE(S) INITIAL ENCOUNTER

S0211HA

Other fracture or occiput left side initial encounter for closed fracture

T33839A

SUPERFICIAL FROSTBITE OF UNSPECIFIED TOE(S) INIT ENCNTR

S0211HB

Other fracture or occiput left side initial encounter for open fracture

T3390XA

SUPERFICIAL FROSTBITE OF UNSPECIFIED SITES INIT ENCNTR

S0219XA OTH FRACTURE OF BASE OF SKULL INIT FOR CLOS FX

T3399XA

SUPERFICIAL FROSTBITE OF OTHER SITES INITIAL ENCOUNTER

S0219XB

OTH FRACTURE OF BASE OF SKULL INIT ENCNTR FOR OPEN FRACTURE

T34011A

FROSTBITE WITH TISSUE NECROSIS OF RIGHT EAR INIT ENCNTR

S022XXA

FRACTURE OF NASAL BONES INIT ENCNTR FOR CLOSED FRACTURE

T34012A

FROSTBITE WITH TISSUE NECROSIS OF LEFT EAR INIT ENCNTR

S022XXB

FRACTURE OF NASAL BONES INITIAL ENCOUNTER FOR OPEN FRACTURE

T34019A

FROSTBITE WITH TISSUE NECROSIS OF UNSP EAR INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0230XA

Fracture of orbital floor unspecified side initial encounter for closed fracture

T3402XA

FROSTBITE WITH TISSUE NECROSIS OF NOSE INITIAL ENCOUNTER

S0230XB

Fracture of orbital floor unspecified side initial encounter for open fracture

T3409XA

FROSTBITE W TISSUE NECROSIS OF OTH PART OF HEAD INIT ENCNTR

S0231XA

Fracture of orbital floor right side initial encounter for closed fracture

T341XXA

FROSTBITE WITH TISSUE NECROSIS OF NECK INITIAL ENCOUNTER

S0231XB

Fracture of orbital floor right side initial encounter for open fracture

T342XXA

FROSTBITE WITH TISSUE NECROSIS OF THORAX INITIAL ENCOUNTER

S0232XA

Fracture of orbital floor left side initial encounter for closed fracture

T343XXA

FRSTBTE W TISSUE NECROS ABD WALL LOW BACK AND PELVIS INIT

S0232XB

Fracture of orbital floor left side initial encounter for open fracture

T3440XA

FROSTBITE WITH TISSUE NECROSIS OF UNSP ARM INIT ENCNTR

S023XXA

FRACTURE OF ORBITAL FLOOR INIT ENCNTR FOR CLOSED FRACTURE

T3441XA

FROSTBITE WITH TISSUE NECROSIS OF RIGHT ARM INIT ENCNTR

S023XXB

FRACTURE OF ORBITAL FLOOR INIT ENCNTR FOR OPEN FRACTURE

T3442XA

FROSTBITE WITH TISSUE NECROSIS OF LEFT ARM INIT ENCNTR

S02400A

MALAR FRACTURE UNSPECIFIED INIT ENCNTR FOR CLOSED FRACTURE

T34511A

FROSTBITE WITH TISSUE NECROSIS OF RIGHT WRIST INIT ENCNTR

S02400B

MALAR FRACTURE UNSPECIFIED INIT ENCNTR FOR OPEN FRACTURE

T34512A

FROSTBITE WITH TISSUE NECROSIS OF LEFT WRIST INIT ENCNTR

S02401A

MAXILLARY FRACTURE UNSP INIT ENCNTR FOR CLOSED FRACTURE

T34519A

FROSTBITE WITH TISSUE NECROSIS OF UNSP WRIST INIT ENCNTR

S02401B

MAXILLARY FRACTURE UNSP INIT ENCNTR FOR OPEN FRACTURE

T34521A

FROSTBITE WITH TISSUE NECROSIS OF RIGHT HAND INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S02402A

ZYGOMATIC FRACTURE UNSP INIT ENCNTR FOR CLOSED FRACTURE

T34522A

FROSTBITE WITH TISSUE NECROSIS OF LEFT HAND INIT ENCNTR

S02402B

ZYGOMATIC FRACTURE UNSP INIT ENCNTR FOR OPEN FRACTURE

T34529A

FROSTBITE WITH TISSUE NECROSIS OF UNSP HAND INIT ENCNTR

S0240AA Malar fracture right side initial encounter for closed fracture

T34531A

FROSTBITE W TISSUE NECROSIS OF RIGHT FINGER(S) INIT ENCNTR

S0240AB Malar fracture right side initial encounter for open fracture

T34532A

FROSTBITE W TISSUE NECROSIS OF LEFT FINGER(S) INIT ENCNTR

S0240BA Malar fracture left side initial encounter for closed fracture

T34539A

FROSTBITE W TISSUE NECROSIS OF UNSP FINGER(S) INIT ENCNTR

S0240BB Malar fracture left side initial encounter for open fracture

T3460XA

FROSTBITE W TISSUE NECROSIS OF UNSP HIP AND THIGH INIT

S0240CA

Maxillary fracture right side initial encounter for closed fracture

T3461XA

FROSTBITE W TISSUE NECROSIS OF RIGHT HIP AND THIGH INIT

S0240CB

Maxillary fracture right side initial encounter for open fracture

T3462XA

FROSTBITE W TISSUE NECROSIS OF LEFT HIP AND THIGH INIT

S0240DA

Maxillary fracture left side initial encounter for closed fracture

T3470XA

FROSTBITE W TISSUE NECROSIS OF UNSP KNEE AND LOWER LEG INIT

S0240DB

Maxillary fracture left side initial encounter for open fracture

T3471XA

FROSTBITE W TISSUE NECROS RIGHT KNEE AND LOWER LEG INIT

S0240EA

Zygomatic fracture right side initial encounter for closed fracture

T3472XA

FROSTBITE W TISSUE NECROSIS OF LEFT KNEE AND LOWER LEG INIT

S0240EB

Zygomatic fracture right side initial encounter for open fracture

T34811A

FROSTBITE WITH TISSUE NECROSIS OF RIGHT ANKLE INIT ENCNTR

S0240FA

Zygomatic fracture left side initial encounter for closed fracture

T34812A

FROSTBITE WITH TISSUE NECROSIS OF LEFT ANKLE INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0240FB

Zygomatic fracture left side initial encounter for open fracture

T34819A

FROSTBITE WITH TISSUE NECROSIS OF UNSP ANKLE INIT ENCNTR

S02411A

LEFORT I FRACTURE INITIAL ENCOUNTER FOR CLOSED FRACTURE

T34821A

FROSTBITE WITH TISSUE NECROSIS OF RIGHT FOOT INIT ENCNTR

S02411B

LEFORT I FRACTURE INITIAL ENCOUNTER FOR OPEN FRACTURE

T34822A

FROSTBITE WITH TISSUE NECROSIS OF LEFT FOOT INIT ENCNTR

S02412A

LEFORT II FRACTURE INITIAL ENCOUNTER FOR CLOSED FRACTURE

T34829A

FROSTBITE WITH TISSUE NECROSIS OF UNSP FOOT INIT ENCNTR

S02412B

LEFORT II FRACTURE INITIAL ENCOUNTER FOR OPEN FRACTURE

T34831A

FROSTBITE WITH TISSUE NECROSIS OF RIGHT TOE(S) INIT ENCNTR

S02413A

LEFORT III FRACTURE INITIAL ENCOUNTER FOR CLOSED FRACTURE

T34832A

FROSTBITE WITH TISSUE NECROSIS OF LEFT TOE(S) INIT ENCNTR

S02413B

LEFORT III FRACTURE INITIAL ENCOUNTER FOR OPEN FRACTURE

T34839A

FROSTBITE WITH TISSUE NECROSIS OF UNSP TOE(S) INIT ENCNTR

S0242XA FRACTURE OF ALVEOLUS OF MAXILLA INIT FOR CLOS FX

T3490XA

FROSTBITE WITH TISSUE NECROSIS OF UNSP SITES INIT ENCNTR

S0242XB FRACTURE OF ALVEOLUS OF MAXILLA INIT FOR OPN FX

T3499XA

FROSTBITE WITH TISSUE NECROSIS OF OTHER SITES INIT ENCNTR

S02600A

FRACTURE OF UNSP PART OF BODY OF MANDIBLE INIT FOR CLOS FX

T360X1A

POISONING BY PENICILLINS ACCIDENTAL (UNINTENTIONAL) INIT

S02600B

FRACTURE OF UNSP PART OF BODY OF MANDIBLE INIT FOR OPN FX

T360X2A

POISONING BY PENICILLINS INTENTIONAL SELF-HARM INIT ENCNTR

S02600D

FX UNSP PART OF BODY OF MANDIBLE SUBS FOR FX W ROUTN HEAL

T360X3A

POISONING BY PENICILLINS ASSAULT INITIAL ENCOUNTER

S02600G

FX UNSP PART OF BODY OF MANDIBLE SUBS FOR FX W DELAY HEAL

T360X4A

POISONING BY PENICILLINS UNDETERMINED INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S02600K

FX UNSP PART OF BODY OF MANDIBLE SUBS FOR FX W NONUNION

T361X1A

POISONING BY CEPHALOSPOR/OTH BETA-LACTM ANTIBIOT ACC INIT

S02600S

FRACTURE OF UNSPECIFIED PART OF BODY OF MANDIBLE SEQUELA

T361X2A

POISN BY CEPHALOSPOR/OTH BETA-LACTM ANTIBIOT SLF-HRM INIT

S02601A

Fracture of unspecified part of body of right mandible initial encounter for closed fracture

T361X3A

POISN BY CEPHALOSPOR/OTH BETA-LACTM ANTIBIOT ASSAULT INIT

S02601B

Fracture of unspecified part of body of right mandible initial encounter for open fracture

T361X4A

POISN BY CEPHALOSPOR/OTH BETA-LACTM ANTIBIOT UNDET INIT

S02602A

Fracture of unspecified part of body of left mandible initial encounter for closed fracture

T362X1A

POISONING BY CHLORAMPHENICOL GROUP ACCIDENTAL INIT

S02602B

Fracture of unspecified part of body of left mandible initial encounter for open fracture

T362X2A

POISONING BY CHLORAMPHENICOL GROUP SELF-HARM INIT

S02609A

FRACTURE OF MANDIBLE UNSP INIT ENCNTR FOR CLOSED FRACTURE

T362X3A

POISONING BY CHLORAMPHENICOL GROUP ASSAULT INIT ENCNTR

S02609B

FRACTURE OF MANDIBLE UNSP INIT ENCNTR FOR OPEN FRACTURE

T362X4A

POISONING BY CHLORAMPHENICOL GROUP UNDETERMINED INIT

S02609D FRACTURE OF MANDIBLE UNSP SUBS FOR FX W ROUTN HEAL

T363X1A

POISONING BY MACROLIDES ACCIDENTAL (UNINTENTIONAL) INIT

S02609G FRACTURE OF MANDIBLE UNSP SUBS FOR FX W DELAY HEAL

T363X2A

POISONING BY MACROLIDES INTENTIONAL SELF-HARM INIT ENCNTR

S02609K FRACTURE OF MANDIBLE UNSP SUBS FOR FX W NONUNION

T363X3A

POISONING BY MACROLIDES ASSAULT INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S02609S FRACTURE OF MANDIBLE UNSPECIFIED SEQUELA

T363X4A

POISONING BY MACROLIDES UNDETERMINED INITIAL ENCOUNTER

S02610A

Fracture of condylar process of mandible unspecified side initial encounter for closed fracture

T364X1A

POISONING BY TETRACYCLINES ACCIDENTAL (UNINTENTIONAL) INIT

S02610B

Fracture of condylar process of mandible unspecified side initial encounter for open fracture

T364X2A

POISONING BY TETRACYCLINES INTENTIONAL SELF-HARM INIT

S02611A

Fracture of condylar process of right mandible initial encounter for closed fracture

T364X3A

POISONING BY TETRACYCLINES ASSAULT INITIAL ENCOUNTER

S02611B

Fracture of condylar process of right mandible initial encounter for open fracture

T364X4A

POISONING BY TETRACYCLINES UNDETERMINED INITIAL ENCOUNTER

S02612A

Fracture of condylar process of left mandible initial encounter for closed fracture

T365X1A

POISONING BY AMINOGLYCOSIDES ACCIDENTAL INIT

S02612B

Fracture of condylar process of left mandible initial encounter for open fracture

T365X2A

POISONING BY AMINOGLYCOSIDES INTENTIONAL SELF-HARM INIT

S0261XA

FRACTURE OF CONDYLAR PROCESS OF MANDIBLE INIT FOR CLOS FX

T365X3A

POISONING BY AMINOGLYCOSIDES ASSAULT INITIAL ENCOUNTER

S0261XB

FRACTURE OF CONDYLAR PROCESS OF MANDIBLE INIT FOR OPN FX

T365X4A

POISONING BY AMINOGLYCOSIDES UNDETERMINED INIT ENCNTR

S0261XD

FX CONDYLAR PROCESS OF MANDIBLE SUBS FOR FX W ROUTN HEAL

T366X1A

POISONING BY RIFAMPICINS ACCIDENTAL (UNINTENTIONAL) INIT

S0261XG

FX CONDYLAR PROCESS OF MANDIBLE SUBS FOR FX W DELAY HEAL

T366X2A

POISONING BY RIFAMPICINS INTENTIONAL SELF-HARM INIT ENCNTR

S0261XK

FX CONDYLAR PROCESS OF MANDIBLE SUBS FOR FX W NONUNION

T366X3A

POISONING BY RIFAMPICINS ASSAULT INITIAL ENCOUNTER

Page 474: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0261XS

FRACTURE OF CONDYLAR PROCESS OF MANDIBLE SEQUELA

T366X4A

POISONING BY RIFAMPICINS UNDETERMINED INITIAL ENCOUNTER

S02620A

Fracture of subcondylar process of mandible unspecified side initial encounter for closed fracture

T367X1A

POISONING BY ANTIFUNGAL ANTIBIOT SYS USED ACC INIT

S02620B

Fracture of subcondylar process of mandible unspecified side initial encounter for open fracture

T367X2A

POISONING BY ANTIFUNGAL ANTIBIOT SYS USED SELF-HARM INIT

S02621A

Fracture of subcondylar process of right mandible initial encounter for closed fracture

T367X3A

POISONING BY ANTIFUNGAL ANTIBIOTICS SYS USED ASSAULT INIT

S02621B

Fracture of subcondylar process of right mandible initial encounter for open fracture

T367X4A

POISONING BY ANTIFUNGAL ANTIBIOTICS SYS USED UNDET INIT

S02622A

Fracture of subcondylar process of left mandible initial encounter for closed fracture

T368X1A

POISONING BY OTH SYSTEMIC ANTIBIOTICS ACCIDENTAL INIT

S02622B

Fracture of subcondylar process of left mandible initial encounter for open fracture

T368X2A

POISONING BY OTH SYSTEMIC ANTIBIOTICS SELF-HARM INIT

S0262XA FRACTURE OF SUBCONDYLAR PROCESS OF MANDIBLE INIT

T368X3A

POISONING BY OTH SYSTEMIC ANTIBIOTICS ASSAULT INIT ENCNTR

S0262XB

FRACTURE OF SUBCONDYLAR PROCESS OF MANDIBLE INIT FOR OPN FX

T368X4A

POISONING BY OTH SYSTEMIC ANTIBIOTICS UNDETERMINED INIT

S0262XD

FX SUBCONDYLAR PROCESS OF MANDIBLE SUBS FOR FX W ROUTN HEAL

T3691XA

POISONING BY UNSP SYSTEMIC ANTIBIOTIC ACCIDENTAL INIT

Page 475: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0262XG

FX SUBCONDYLAR PROCESS OF MANDIBLE SUBS FOR FX W DELAY HEAL

T3692XA

POISONING BY UNSP SYSTEMIC ANTIBIOTIC SELF-HARM INIT

S0262XK

FX SUBCONDYLAR PROCESS OF MANDIBLE SUBS FOR FX W NONUNION

T3693XA

POISONING BY UNSP SYSTEMIC ANTIBIOTIC ASSAULT INIT ENCNTR

S0262XS

FRACTURE OF SUBCONDYLAR PROCESS OF MANDIBLE SEQUELA

T3694XA

POISONING BY UNSP SYSTEMIC ANTIBIOTIC UNDETERMINED INIT

S02630A

Fracture of coronoid process of mandible unspecified side initial encounter for closed fracture

T370X1A

POISONING BY SULFONAMIDES ACCIDENTAL (UNINTENTIONAL) INIT

S02630B

Fracture of coronoid process of mandible unspecified side initial encounter for open fracture

T370X2A

POISONING BY SULFONAMIDES INTENTIONAL SELF-HARM INIT

S02631A

Fracture of coronoid process of right mandible initial encounter for closed fracture

T370X3A

POISONING BY SULFONAMIDES ASSAULT INITIAL ENCOUNTER

S02631B

Fracture of coronoid process of right mandible initial encounter for open fracture

T370X4A

POISONING BY SULFONAMIDES UNDETERMINED INITIAL ENCOUNTER

S02632A

Fracture of coronoid process of left mandible initial encounter for closed fracture

T371X1A

POISONING BY ANTIMYCOBAC DRUGS ACCIDENTAL INIT

S02632B

Fracture of coronoid process of left mandible initial encounter for open fracture

T371X2A

POISONING BY ANTIMYCOBACTERIAL DRUGS SELF-HARM INIT

S0263XA

FRACTURE OF CORONOID PROCESS OF MANDIBLE INIT FOR CLOS FX

T371X3A

POISONING BY ANTIMYCOBACTERIAL DRUGS ASSAULT INIT ENCNTR

S0263XB

FRACTURE OF CORONOID PROCESS OF MANDIBLE INIT FOR OPN FX

T371X4A

POISONING BY ANTIMYCOBACTERIAL DRUGS UNDETERMINED INIT

S0263XD

FX CORONOID PROCESS OF MANDIBLE SUBS FOR FX W ROUTN HEAL

T372X1A

POISN BY ANTIMALARI/DRUGS ACTING ON BLD PROTZOA ACC INIT

Page 476: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0263XG

FX CORONOID PROCESS OF MANDIBLE SUBS FOR FX W DELAY HEAL

T372X2A

POISN BY ANTIMALARI/DRUGS ACT ON BLD PROTZOA SLF-HRM INIT

S0263XK

FX CORONOID PROCESS OF MANDIBLE SUBS FOR FX W NONUNION

T372X3A

POISN BY ANTIMALARI/DRUGS ACTING ON BLD PROTZOA ASSLT INIT

S0263XS

FRACTURE OF CORONOID PROCESS OF MANDIBLE SEQUELA

T372X4A

POISN BY ANTIMALARI/DRUGS ACTING ON BLD PROTZOA UNDET INIT

S02640A

Fracture of ramus of mandible unspecified side initial encounter for closed fracture

T373X1A

POISONING BY OTH ANTIPROTOZOAL DRUGS ACCIDENTAL INIT

S02640B

Fracture of ramus of mandible unspecified side initial encounter for open fracture

T373X2A

POISONING BY OTH ANTIPROTOZOAL DRUGS SELF-HARM INIT

S02641A

Fracture of ramus of right mandible initial encounter for closed fracture

T373X3A

POISONING BY OTHER ANTIPROTOZOAL DRUGS ASSAULT INIT ENCNTR

S02641B

Fracture of ramus of right mandible initial encounter for open fracture

T373X4A

POISONING BY OTH ANTIPROTOZOAL DRUGS UNDETERMINED INIT

S02642A

Fracture of ramus of left mandible initial encounter for closed fracture

T374X1A

POISONING BY ANTHELMINTHICS ACCIDENTAL INIT

S02642B

Fracture of ramus of left mandible initial encounter for open fracture

T374X2A

POISONING BY ANTHELMINTHICS INTENTIONAL SELF-HARM INIT

S0264XA FRACTURE OF RAMUS OF MANDIBLE INIT FOR CLOS FX

T374X3A

POISONING BY ANTHELMINTHICS ASSAULT INITIAL ENCOUNTER

S0264XB

FRACTURE OF RAMUS OF MANDIBLE INIT ENCNTR FOR OPEN FRACTURE

T374X4A

POISONING BY ANTHELMINTHICS UNDETERMINED INITIAL ENCOUNTER

S0264XD

FRACTURE OF RAMUS OF MANDIBLE SUBS FOR FX W ROUTN HEAL

T375X1A

POISONING BY ANTIVIRAL DRUGS ACCIDENTAL INIT

Page 477: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0264XG

FRACTURE OF RAMUS OF MANDIBLE SUBS FOR FX W DELAY HEAL

T375X2A

POISONING BY ANTIVIRAL DRUGS INTENTIONAL SELF-HARM INIT

S0264XK

FRACTURE OF RAMUS OF MANDIBLE SUBS FOR FX W NONUNION

T375X3A

POISONING BY ANTIVIRAL DRUGS ASSAULT INITIAL ENCOUNTER

S0264XS FRACTURE OF RAMUS OF MANDIBLE SEQUELA

T375X4A

POISONING BY ANTIVIRAL DRUGS UNDETERMINED INIT ENCNTR

S02650A

Fracture of angle of mandible unspecified side initial encounter for closed fracture

T378X1A

POISONING BY OTH SYSTEMIC ANTI-INFECT/PARASIT ACC INIT

S02650B

Fracture of angle of mandible unspecified side initial encounter for open fracture

T378X2A

POISN BY OTH SYSTEMIC ANTI-INFECT/PARASIT SELF-HARM INIT

S02651A

Fracture of angle of right mandible initial encounter for closed fracture

T378X3A

POISONING BY OTH SYSTEMIC ANTI-INFECT/PARASIT ASSAULT INIT

S02651B

Fracture of angle of right mandible initial encounter for open fracture

T378X4A

POISONING BY OTH SYSTEMIC ANTI-INFECT/PARASIT UNDET INIT

S02652A

Fracture of angle of left mandible initial encounter for closed fracture

T3791XA

POISN BY UNSP SYS ANTI-INFECT AND ANTIPARASTC ACC INIT

S02652B

Fracture of angle of left mandible initial encounter for open fracture

T3792XA

POISN BY UNSP SYS ANTI-INFECT AND ANTIPARASTC SLF-HRM INIT

S0265XA FRACTURE OF ANGLE OF MANDIBLE INIT FOR CLOS FX

T3793XA

POISN BY UNSP SYS ANTI-INFECT AND ANTIPARASTC ASSAULT INIT

S0265XB

FRACTURE OF ANGLE OF MANDIBLE INIT ENCNTR FOR OPEN FRACTURE

T3794XA

POISN BY UNSP SYS ANTI-INFECT AND ANTIPARASTC UNDET INIT

S0265XD

FRACTURE OF ANGLE OF MANDIBLE SUBS FOR FX W ROUTN HEAL

T380X1A

POISONING BY GLUCOCORT/SYNTH ANALOG ACCIDENTAL INIT

S0265XG

FRACTURE OF ANGLE OF MANDIBLE SUBS FOR FX W DELAY HEAL

T380X2A

POISONING BY GLUCOCORT/SYNTH ANALOG SELF-HARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0265XK

FRACTURE OF ANGLE OF MANDIBLE SUBS FOR FX W NONUNION

T380X3A

POISONING BY GLUCOCORT/SYNTH ANALOG ASSAULT INIT

S0265XS FRACTURE OF ANGLE OF MANDIBLE SEQUELA

T380X4A

POISONING BY GLUCOCORT/SYNTH ANALOG UNDETERMINED INIT

S0266XA FRACTURE OF SYMPHYSIS OF MANDIBLE INIT FOR CLOS FX

T381X1A

POISONING BY THYROID HORMONES AND SUB ACCIDENTAL INIT

S0266XB FRACTURE OF SYMPHYSIS OF MANDIBLE INIT FOR OPN FX

T381X2A

POISONING BY THYROID HORMONES AND SUB SELF-HARM INIT

S0266XD

FRACTURE OF SYMPHYSIS OF MANDIBLE SUBS FOR FX W ROUTN HEAL

T381X3A

POISONING BY THYROID HORMONES AND SUBSTITUTES ASSAULT INIT

S0266XG

FRACTURE OF SYMPHYSIS OF MANDIBLE SUBS FOR FX W DELAY HEAL

T381X4A

POISONING BY THYROID HORMONES AND SUBSTITUTES UNDET INIT

S0266XK

FRACTURE OF SYMPHYSIS OF MANDIBLE SUBS FOR FX W NONUNION

T382X1A

POISONING BY ANTITHYROID DRUGS ACCIDENTAL INIT

S0266XS FRACTURE OF SYMPHYSIS OF MANDIBLE SEQUELA

T382X2A

POISONING BY ANTITHYROID DRUGS INTENTIONAL SELF-HARM INIT

S02670A

Fracture of alveolus of mandible unspecified side initial encounter for closed fracture

T382X3A

POISONING BY ANTITHYROID DRUGS ASSAULT INITIAL ENCOUNTER

S02670B

Fracture of alveolus of mandible unspecified side initial encounter for open fracture

T382X4A

POISONING BY ANTITHYROID DRUGS UNDETERMINED INIT ENCNTR

S02671A

Fracture of alveolus of right mandible initial encounter for closed fracture

T383X1A

POISONING BY INSULIN AND ORAL HYPOGLYCEMIC DRUGS ACC INIT

S02671B

Fracture of alveolus of right mandible initial encounter for open fracture

T383X2A

POISN BY INSULIN AND ORAL HYPOGLYCEMIC DRUGS SLF-HRM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S02672A

Fracture of alveolus of left mandible initial encounter for closed fracture

T383X3A

POISN BY INSULIN AND ORAL HYPOGLYCEMIC DRUGS ASSAULT INIT

S02672B

Fracture of alveolus of left mandible initial encounter for open fracture

T383X4A

POISN BY INSULIN AND ORAL HYPOGLYCEMIC DRUGS UNDET INIT

S0267XA FRACTURE OF ALVEOLUS OF MANDIBLE INIT FOR CLOS FX

T384X1A

POISONING BY ORAL CONTRACEPTIVES ACCIDENTAL INIT

S0267XB FRACTURE OF ALVEOLUS OF MANDIBLE INIT FOR OPN FX

T384X2A

POISONING BY ORAL CONTRACEPTIVES SELF-HARM INIT

S0267XD

FRACTURE OF ALVEOLUS OF MANDIBLE SUBS FOR FX W ROUTN HEAL

T384X3A

POISONING BY ORAL CONTRACEPTIVES ASSAULT INITIAL ENCOUNTER

S0267XG

FRACTURE OF ALVEOLUS OF MANDIBLE SUBS FOR FX W DELAY HEAL

T384X4A

POISONING BY ORAL CONTRACEPTIVES UNDETERMINED INIT ENCNTR

S0267XK

FRACTURE OF ALVEOLUS OF MANDIBLE SUBS FOR FX W NONUNION

T385X1A

POISONING BY OTH ESTROGENS AND PROGSTRN ACCIDENTAL INIT

S0267XS FRACTURE OF ALVEOLUS OF MANDIBLE SEQUELA

T385X2A

POISONING BY OTH ESTROGENS AND PROGESTOGENS SELF-HARM INIT

S0269XA FRACTURE OF MANDIBLE OF OTH SITE INIT FOR CLOS FX

T385X3A

POISONING BY OTH ESTROGENS AND PROGESTOGENS ASSAULT INIT

S0269XB FRACTURE OF MANDIBLE OF OTH SITE INIT FOR OPN FX

T385X4A

POISONING BY OTH ESTROGENS AND PROGSTRN UNDETERMINED INIT

S0269XD

FRACTURE OF MANDIBLE OF OTH SITE SUBS FOR FX W ROUTN HEAL

T386X1A

POISONING BY ANTIGONADTR/ANTIESTR/ANTIANDRG NEC ACC INIT

S0269XG

FRACTURE OF MANDIBLE OF OTH SITE SUBS FOR FX W DELAY HEAL

T386X2A

POISN BY ANTIGONADTR/ANTIESTR/ANTIANDRG NEC SLF-HRM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0269XK

FRACTURE OF MANDIBLE OF OTH SITE SUBS FOR FX W NONUNION

T386X3A

POISN BY ANTIGONADTR/ANTIESTR/ANTIANDRG NEC ASSAULT INIT

S0269XS FRACTURE OF MANDIBLE OF OTHER SPECIFIED SITE SEQUELA

T386X4A

POISN BY ANTIGONADTR/ANTIESTR/ANTIANDRG NEC UNDET INIT

S0280XA

Fracture of other specified skull and facial bones unspecified side initial encounter for closed fracture

T387X1A

POISONING BY ANDROGENS AND ANABOLIC CONGENERS ACC INIT

S0280XB

Fracture of other specified skull and facial bones unspecified side initial encounter for open fracture

T387X2A

POISN BY ANDROGENS AND ANABOLIC CONGENERS SELF-HARM INIT

S0281XA

Fracture of other specified skull and facial bones right side initial encounter for closed fracture

T387X3A

POISONING BY ANDROGENS AND ANABOLIC CONGENERS ASSAULT INIT

S0281XB

Fracture of other specified skull and facial bones right side initial encounter for open fracture

T387X4A

POISONING BY ANDROGENS AND ANABOLIC CONGENERS UNDET INIT

S0282XA

Fracture of other specified skull and facial bones left side initial encounter for closed fracture

T38801A

POISONING BY UNSP HORMONES AND SYNTHETIC SUB ACC INIT

S0282XB

Fracture of other specified skull and facial bones left side initial encounter for open fracture

T38802A

POISN BY UNSP HORMONES AND SYNTHETIC SUB SELF-HARM INIT

S028XXA FRACTURES OF OTH SKULL AND FACIAL BONES INIT FOR CLOS FX

T38803A

POISONING BY UNSP HORMONES AND SYNTHETIC SUB ASSAULT INIT

S028XXB FRACTURES OF OTH SKULL AND FACIAL BONES INIT FOR OPN FX

T38804A

POISONING BY UNSP HORMONES AND SYNTHETIC SUB UNDET INIT

Page 481: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0291XA

UNSP FRACTURE OF SKULL INIT ENCNTR FOR CLOSED FRACTURE

T38811A

POISONING BY ANTERIOR PITUITARY HORMONES ACCIDENTAL INIT

S0291XB

UNSPECIFIED FRACTURE OF SKULL INIT ENCNTR FOR OPEN FRACTURE

T38812A

POISONING BY ANTERIOR PITUITARY HORMONES SELF-HARM INIT

S0292XA UNSP FRACTURE OF FACIAL BONES INIT FOR CLOS FX

T38813A

POISONING BY ANTERIOR PITUITARY HORMONES ASSAULT INIT

S0292XB

UNSP FRACTURE OF FACIAL BONES INIT ENCNTR FOR OPEN FRACTURE

T38814A

POISONING BY ANTERIOR PITUITARY HORMONES UNDETERMINED INIT

S0300XA Dislocation of jaw unspecified side initial encounter

T38891A

POISONING BY OTH HORMONES AND SYNTHETIC SUB ACC INIT

S0301XA Dislocation of jaw right side initial encounter

T38892A

POISONING BY OTH HORMONES AND SYNTHETIC SUB SELF-HARM INIT

S0302XA Dislocation of jaw left side initial encounter

T38893A

POISONING BY OTH HORMONES AND SYNTHETIC SUB ASSAULT INIT

S0303XA Dislocation of jaw bilateral initial encounter

T38894A

POISONING BY OTH HORMONES AND SYNTHETIC SUB UNDET INIT

S030XXA DISLOCATION OF JAW INITIAL ENCOUNTER

T38901A

POISONING BY UNSP HORMONE ANTAGONISTS ACCIDENTAL INIT

S031XXA

DISLOCATION OF SEPTAL CARTILAGE OF NOSE INITIAL ENCOUNTER

T38902A

POISONING BY UNSP HORMONE ANTAGONISTS SELF-HARM INIT

S032XXA DISLOCATION OF TOOTH INITIAL ENCOUNTER

T38903A

POISONING BY UNSP HORMONE ANTAGONISTS ASSAULT INIT ENCNTR

S0340XA Sprain of jaw unspecified side initial encounter

T38904A

POISONING BY UNSP HORMONE ANTAGONISTS UNDETERMINED INIT

S0341XA Sprain of jaw right side initial encounter

T38991A

POISONING BY OTH HORMONE ANTAGONISTS ACCIDENTAL INIT

S0342XA Sprain of jaw left side initial encounter

T38992A

POISONING BY OTH HORMONE ANTAGONISTS SELF-HARM INIT

Page 482: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0343XA Sprain of jaw bilateral initial encounter

T38993A

POISONING BY OTHER HORMONE ANTAGONISTS ASSAULT INIT ENCNTR

S034XXA SPRAIN OF JAW INITIAL ENCOUNTER

T38994A

POISONING BY OTH HORMONE ANTAGONISTS UNDETERMINED INIT

S038XXA

SPRAIN OF JOINTS AND LIGAMENTS OF OTH PRT HEAD INIT ENCNTR

T39011A

POISONING BY ASPIRIN ACCIDENTAL (UNINTENTIONAL) INIT

S039XXA

SPRAIN OF JOINTS AND LIGAMENTS OF UNSP PARTS OF HEAD INIT

T39012A

POISONING BY ASPIRIN INTENTIONAL SELF-HARM INIT ENCNTR

S04011A INJURY OF OPTIC NERVE RIGHT EYE INITIAL ENCOUNTER

T39013A

POISONING BY ASPIRIN ASSAULT INITIAL ENCOUNTER

S04012A INJURY OF OPTIC NERVE LEFT EYE INITIAL ENCOUNTER

T39014A

POISONING BY ASPIRIN UNDETERMINED INITIAL ENCOUNTER

S04019A

INJURY OF OPTIC NERVE UNSPECIFIED EYE INITIAL ENCOUNTER

T39091A

POISONING BY SALICYLATES ACCIDENTAL (UNINTENTIONAL) INIT

S0402XA INJURY OF OPTIC CHIASM INITIAL ENCOUNTER

T39092A

POISONING BY SALICYLATES INTENTIONAL SELF-HARM INIT ENCNTR

S04031A

INJURY OF OPTIC TRACT AND PATHWAYS RIGHT EYE INIT ENCNTR

T39093A

POISONING BY SALICYLATES ASSAULT INITIAL ENCOUNTER

S04032A

INJURY OF OPTIC TRACT AND PATHWAYS LEFT EYE INIT ENCNTR

T39094A

POISONING BY SALICYLATES UNDETERMINED INITIAL ENCOUNTER

S04039A

INJURY OF OPTIC TRACT AND PATHWAYS UNSP EYE INIT ENCNTR

T391X1A

POISONING BY 4-AMINOPHENOL DERIVATIVES ACCIDENTAL INIT

S04041A INJURY OF VISUAL CORTEX RIGHT EYE INITIAL ENCOUNTER

T391X2A

POISONING BY 4-AMINOPHENOL DERIVATIVES SELF-HARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S04042A INJURY OF VISUAL CORTEX LEFT EYE INITIAL ENCOUNTER

T391X3A

POISONING BY 4-AMINOPHENOL DERIVATIVES ASSAULT INIT ENCNTR

S0410XA

INJURY OF OCULOMOTOR NERVE UNSPECIFIED SIDE INIT ENCNTR

T391X4A

POISONING BY 4-AMINOPHENOL DERIVATIVES UNDETERMINED INIT

S0411XA

INJURY OF OCULOMOTOR NERVE RIGHT SIDE INITIAL ENCOUNTER

T392X1A

POISONING BY PYRAZOLONE DERIVATIVES ACCIDENTAL INIT

S0412XA

INJURY OF OCULOMOTOR NERVE LEFT SIDE INITIAL ENCOUNTER

T392X2A

POISONING BY PYRAZOLONE DERIVATIVES SELF-HARM INIT

S0421XA INJURY OF TROCHLEAR NERVE RIGHT SIDE INITIAL ENCOUNTER

T392X3A

POISONING BY PYRAZOLONE DERIVATIVES ASSAULT INIT ENCNTR

S0422XA INJURY OF TROCHLEAR NERVE LEFT SIDE INITIAL ENCOUNTER

T392X4A

POISONING BY PYRAZOLONE DERIVATIVES UNDETERMINED INIT

S0431XA INJURY OF TRIGEMINAL NERVE RIGHT SIDE INITIAL ENCOUNTER

T39311A

POISONING BY PROPIONIC ACID DERIVATIVES ACCIDENTAL INIT

S0432XA INJURY OF TRIGEMINAL NERVE LEFT SIDE INITIAL ENCOUNTER

T39312A

POISONING BY PROPIONIC ACID DERIVATIVES SELF-HARM INIT

S0441XA INJURY OF ABDUCENT NERVE RIGHT SIDE INITIAL ENCOUNTER

T39313A

POISONING BY PROPIONIC ACID DERIVATIVES ASSAULT INIT

S0442XA INJURY OF ABDUCENT NERVE LEFT SIDE INITIAL ENCOUNTER

T39314A

POISONING BY PROPIONIC ACID DERIVATIVES UNDETERMINED INIT

S0451XA INJURY OF FACIAL NERVE RIGHT SIDE INITIAL ENCOUNTER

T39391A

POISONING BY OTH NONSTEROID ANTI-INFLAM DRUGS ACC INIT

S0452XA INJURY OF FACIAL NERVE LEFT SIDE INITIAL ENCOUNTER

T39392A

POISN BY OTH NONSTEROID ANTI-INFLAM DRUGS SELF-HARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0461XA INJURY OF ACOUSTIC NERVE RIGHT SIDE INITIAL ENCOUNTER

T39393A

POISONING BY OTH NONSTEROID ANTI-INFLAM DRUGS ASSAULT INIT

S0462XA INJURY OF ACOUSTIC NERVE LEFT SIDE INITIAL ENCOUNTER

T39394A

POISONING BY OTH NONSTEROID ANTI-INFLAM DRUGS UNDET INIT

S0471XA INJURY OF ACCESSORY NERVE RIGHT SIDE INITIAL ENCOUNTER

T394X1A

POISONING BY ANTIRHEUMATICS NEC ACCIDENTAL INIT

S0472XA INJURY OF ACCESSORY NERVE LEFT SIDE INITIAL ENCOUNTER

T394X2A

POISONING BY ANTIRHEUMATICS NEC SELF-HARM INIT

S04811A INJURY OF OLFACTORY NERVE RIGHT SIDE INITIAL ENCOUNTER

T394X3A

POISONING BY ANTIRHEUMATICS NEC ASSAULT INIT

S04812A INJURY OF OLFACTORY NERVE LEFT SIDE INITIAL ENCOUNTER

T394X4A

POISONING BY ANTIRHEUMATICS NEC UNDETERMINED INIT

S04891A

INJURY OF OTHER CRANIAL NERVES RIGHT SIDE INIT ENCNTR

T398X1A

POISONING BY OTH NONOPIO ANALGES/ANTIPYRET NEC ACC INIT

S04892A

INJURY OF OTHER CRANIAL NERVES LEFT SIDE INITIAL ENCOUNTER

T398X2A

POISN BY OTH NONOPIO ANALGES/ANTIPYRET NEC SELF-HARM INIT

S04899A

INJURY OF OTHER CRANIAL NERVES UNSP SIDE INIT ENCNTR

T398X3A

POISN BY OTH NONOPIO ANALGES/ANTIPYRET NEC ASSAULT INIT

S049XXA

INJURY OF UNSPECIFIED CRANIAL NERVE INITIAL ENCOUNTER

T398X4A

POISONING BY OTH NONOPIO ANALGES/ANTIPYRET NEC UNDET INIT

S0500XA

INJ CONJUNCTIVA AND CORNEAL ABRASION W/O FB UNSP EYE INIT

T3991XA

POISONING BY UNSP NONOPI ANALGS/ANTIPYR/ANTIRHEU ACC INIT

S0501XA

INJ CONJUNCTIVA AND CORNEAL ABRASION W/O FB RIGHT EYE INIT

T3992XA

POISN BY UNSP NONOPI ANALGS/ANTIPYR/ANTIRHEU SLF-HRM INIT

S0502XA

INJ CONJUNCTIVA AND CORNEAL ABRASION W/O FB LEFT EYE INIT

T3993XA

POISN BY UNSP NONOPI ANALGS/ANTIPYR/ANTIRHEU ASSAULT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0510XA CONTUSION OF EYEBALL AND ORBITAL TISSUES UNSP EYE INIT

T3994XA

POISN BY UNSP NONOPI ANALGS/ANTIPYR/ANTIRHEU UNDET INIT

S0511XA

CONTUSION OF EYEBALL AND ORBITAL TISSUES RIGHT EYE INIT

T400X1A

POISONING BY OPIUM ACCIDENTAL (UNINTENTIONAL) INIT ENCNTR

S0512XA CONTUSION OF EYEBALL AND ORBITAL TISSUES LEFT EYE INIT

T400X2A

POISONING BY OPIUM INTENTIONAL SELF-HARM INITIAL ENCOUNTER

S0520XA

OCLR LAC/RUPT W PROLAPS/LOSS OF INTRAOC TISS UNSP EYE INIT

T400X3A

POISONING BY OPIUM ASSAULT INITIAL ENCOUNTER

S0521XA

OCLR LAC/RUPT W PROLAPS/LOSS OF INTRAOC TISSUE R EYE INIT

T400X4A

POISONING BY OPIUM UNDETERMINED INITIAL ENCOUNTER

S0522XA

OCLR LAC/RUPT W PROLAPS/LOSS OF INTRAOC TISSUE L EYE INIT

T401X1A

POISONING BY HEROIN ACCIDENTAL (UNINTENTIONAL) INIT ENCNTR

S0530XA

OCLR LAC W/O PROLAPS/LOSS OF INTRAOC TISSUE UNSP EYE INIT

T401X2A

POISONING BY HEROIN INTENTIONAL SELF-HARM INIT ENCNTR

S0531XA

OCULAR LAC W/O PROLAPS/LOSS OF INTRAOC TISSUE R EYE INIT

T401X3A

POISONING BY HEROIN ASSAULT INITIAL ENCOUNTER

S0532XA

OCULAR LAC W/O PROLAPS/LOSS OF INTRAOC TISSUE L EYE INIT

T401X4A

POISONING BY HEROIN UNDETERMINED INITIAL ENCOUNTER

S0540XA

PENETRATING WOUND OF ORBIT W OR W/O FB UNSP EYE INIT

T402X1A

POISONING BY OTH OPIOIDS ACCIDENTAL (UNINTENTIONAL) INIT

S0541XA

PENETRATING WOUND OF ORBIT W OR W/O FB RIGHT EYE INIT

T402X2A

POISONING BY OTH OPIOIDS INTENTIONAL SELF-HARM INIT ENCNTR

S0542XA

PENETRATING WOUND OF ORBIT W OR W/O FB LEFT EYE INIT

T402X3A

POISONING BY OTHER OPIOIDS ASSAULT INITIAL ENCOUNTER

Page 486: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0551XA

PENETRATING WOUND W FOREIGN BODY OF RIGHT EYEBALL INIT

T402X4A

POISONING BY OTHER OPIOIDS UNDETERMINED INITIAL ENCOUNTER

S0552XA

PENETRATING WOUND W FOREIGN BODY OF LEFT EYEBALL INIT

T403X1A

POISONING BY METHADONE ACCIDENTAL (UNINTENTIONAL) INIT

S0560XA

PENETRATING WOUND W/O FOREIGN BODY OF UNSP EYEBALL INIT

T403X2A

POISONING BY METHADONE INTENTIONAL SELF-HARM INIT ENCNTR

S0561XA

PENETRATING WOUND W/O FOREIGN BODY OF RIGHT EYEBALL INIT

T403X3A

POISONING BY METHADONE ASSAULT INITIAL ENCOUNTER

S0562XA

PENETRATING WOUND W/O FOREIGN BODY OF LEFT EYEBALL INIT

T403X4A

POISONING BY METHADONE UNDETERMINED INITIAL ENCOUNTER

S0570XA AVULSION OF UNSPECIFIED EYE INITIAL ENCOUNTER

T404X1A

POISONING BY OTH SYNTHETIC NARCOTICS ACCIDENTAL INIT

S0571XA AVULSION OF RIGHT EYE INITIAL ENCOUNTER

T404X2A

POISONING BY OTH SYNTHETIC NARCOTICS SELF-HARM INIT

S0572XA AVULSION OF LEFT EYE INITIAL ENCOUNTER

T404X3A

POISONING BY OTHER SYNTHETIC NARCOTICS ASSAULT INIT ENCNTR

S058X1A OTHER INJURIES OF RIGHT EYE AND ORBIT INITIAL ENCOUNTER

T404X4A

POISONING BY OTH SYNTHETIC NARCOTICS UNDETERMINED INIT

S058X2A OTHER INJURIES OF LEFT EYE AND ORBIT INITIAL ENCOUNTER

T405X1A

POISONING BY COCAINE ACCIDENTAL (UNINTENTIONAL) INIT

S058X9A

OTHER INJURIES OF UNSPECIFIED EYE AND ORBIT INIT ENCNTR

T405X2A

POISONING BY COCAINE INTENTIONAL SELF-HARM INIT ENCNTR

S0590XA

UNSPECIFIED INJURY OF UNSPECIFIED EYE AND ORBIT INIT ENCNTR

T405X3A

POISONING BY COCAINE ASSAULT INITIAL ENCOUNTER

S0591XA

UNSPECIFIED INJURY OF RIGHT EYE AND ORBIT INITIAL ENCOUNTER

T405X4A

POISONING BY COCAINE UNDETERMINED INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0592XA

UNSPECIFIED INJURY OF LEFT EYE AND ORBIT INITIAL ENCOUNTER

T40601A

POISONING BY UNSP NARCOTICS ACCIDENTAL INIT

S060X0A

CONCUSSION WITHOUT LOSS OF CONSCIOUSNESS INITIAL ENCOUNTER

T40602A

POISONING BY UNSP NARCOTICS INTENTIONAL SELF-HARM INIT

S060X1A CONCUSSION W LOC OF 30 MINUTES OR LESS INIT

T40603A

POISONING BY UNSPECIFIED NARCOTICS ASSAULT INIT ENCNTR

S060X2A

CONCUSSION W LOSS OF CONSCIOUSNESS OF 31-59 MIN INIT

T40604A

POISONING BY UNSP NARCOTICS UNDETERMINED INIT ENCNTR

S060X3A

CONCUSSION W LOSS OF CONSCIOUSNESS OF 1-5 HRS 59 MIN INIT

T40691A

POISONING BY OTH NARCOTICS ACCIDENTAL (UNINTENTIONAL) INIT

S060X4A CONCUSSION W LOC OF 6 HOURS TO 24 HOURS INIT

T40692A

POISONING BY OTH NARCOTICS INTENTIONAL SELF-HARM INIT

S060X5A CONCUSSION W LOC >24 HR W RET CONSC LEV INIT

T40693A

POISONING BY OTHER NARCOTICS ASSAULT INITIAL ENCOUNTER

S060X6A CONCUSSION W LOC >24 HR W/O RET CONSC W SURV INIT

T40694A

POISONING BY OTHER NARCOTICS UNDETERMINED INIT ENCNTR

S060X7A

CONCUSSION W LOC W DEATH DUE TO BRAIN INJURY BF CONSC INIT

T407X1A

POISONING BY CANNABIS (DERIVATIVES) ACCIDENTAL INIT

S060X8A

CONCUSSION W LOC W DEATH DUE TO OTH CAUSE BF CONSC INIT

T407X2A

POISONING BY CANNABIS (DERIVATIVES) SELF-HARM INIT

S060X9A

CONCUSSION W LOSS OF CONSCIOUSNESS OF UNSP DURATION INIT

T407X3A

POISONING BY CANNABIS (DERIVATIVES) ASSAULT INIT ENCNTR

S061X0A

TRAUMATIC CEREBRAL EDEMA W/O LOSS OF CONSCIOUSNESS INIT

T407X4A

POISONING BY CANNABIS (DERIVATIVES) UNDETERMINED INIT

S061X1A

TRAUMATIC CEREBRAL EDEMA W LOC OF 30 MINUTES OR LESS INIT

T408X1A

POISONING BY LYSERGIDE ACCIDENTAL (UNINTENTIONAL) INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S061X2A TRAUMATIC CEREBRAL EDEMA W LOC OF 31-59 MIN INIT

T408X2A

POISONING BY LYSERGIDE INTENTIONAL SELF-HARM INIT ENCNTR

S061X3A TRAUMATIC CEREBRAL EDEMA W LOC OF 1-5 HRS 59 MIN INIT

T408X3A

POISONING BY LYSERGIDE [LSD] ASSAULT INITIAL ENCOUNTER

S061X4A

TRAUMATIC CEREBRAL EDEMA W LOC OF 6 HOURS TO 24 HOURS INIT

T408X4A

POISONING BY LYSERGIDE UNDETERMINED INITIAL ENCOUNTER

S061X5A

TRAUMATIC CEREBRAL EDEMA W LOC >24 HR W RET CONSC LEV INIT

T40901A

POISONING BY UNSP PSYCHODYSLEPT ACCIDENTAL INIT

S061X6A

TRAUM CEREBRAL EDEMA W LOC >24 HR W/O RET CONSC W SURV INIT

T40902A

POISONING BY UNSP PSYCHODYSLEPTICS SELF-HARM INIT

S061X7A

TRAUM CEREB EDEMA W LOC W DEATH D/T BRAIN INJ BF CONSC INIT

T40903A

POISONING BY UNSP PSYCHODYSLEPTICS ASSAULT INIT ENCNTR

S061X8A

TRAUM CEREB EDEMA W LOC W DEATH D/T OTH CAUSE BF CONSC INIT

T40904A

POISONING BY UNSP PSYCHODYSLEPTICS UNDETERMINED INIT

S061X9A TRAUMATIC CEREBRAL EDEMA W LOC OF UNSP DURATION INIT

T40991A

POISONING BY OTH PSYCHODYSLEPT ACCIDENTAL INIT

S062X0A DIFFUSE TBI W/O LOSS OF CONSCIOUSNESS INIT

T40992A

POISONING BY OTH PSYCHODYSLEPTICS SELF-HARM INIT

S062X1A DIFFUSE TBI W LOC OF 30 MINUTES OR LESS INIT

T40993A

POISONING BY OTHER PSYCHODYSLEPTICS ASSAULT INIT ENCNTR

S062X2A

DIFFUSE TBI W LOSS OF CONSCIOUSNESS OF 31-59 MIN INIT

T40994A

POISONING BY OTH PSYCHODYSLEPTICS UNDETERMINED INIT ENCNTR

S062X3A

DIFFUSE TBI W LOSS OF CONSCIOUSNESS OF 1-5 HRS 59 MIN INIT

T410X1A

POISONING BY INHALED ANESTHETICS ACCIDENTAL INIT

S062X4A DIFFUSE TBI W LOC OF 6 HOURS TO 24 HOURS INIT

T410X2A

POISONING BY INHALED ANESTHETICS SELF-HARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S062X5A

DIFFUSE TBI W LOC >24 HR W RETURN TO CONSCIOUS LEVELS INIT

T410X3A

POISONING BY INHALED ANESTHETICS ASSAULT INITIAL ENCOUNTER

S062X6A DIFFUSE TBI W LOC >24 HR W/O RET CONSC W SURV INIT

T410X4A

POISONING BY INHALED ANESTHETICS UNDETERMINED INIT ENCNTR

S062X7A

DIFFUSE TBI W LOC W DEATH DUE TO BRAIN INJURY BF CONSC INIT

T411X1A

POISONING BY INTRAVENOUS ANESTHETICS ACCIDENTAL INIT

S062X8A

DIFFUSE TBI W LOC W DEATH DUE TO OTH CAUSE BF CONSC INIT

T411X2A

POISONING BY INTRAVENOUS ANESTHETICS SELF-HARM INIT

S062X9A

DIFFUSE TBI W LOSS OF CONSCIOUSNESS OF UNSP DURATION INIT

T411X3A

POISONING BY INTRAVENOUS ANESTHETICS ASSAULT INIT ENCNTR

S06300A UNSP FOCAL TBI W/O LOSS OF CONSCIOUSNESS INIT

T411X4A

POISONING BY INTRAVENOUS ANESTHETICS UNDETERMINED INIT

S06301A UNSP FOCAL TBI W LOC OF 30 MINUTES OR LESS INIT

T41201A

POISONING BY UNSP GENERAL ANESTHETICS ACCIDENTAL INIT

S06302A

UNSP FOCAL TBI W LOSS OF CONSCIOUSNESS OF 31-59 MIN INIT

T41202A

POISONING BY UNSP GENERAL ANESTHETICS SELF-HARM INIT

S06303A UNSP FOCAL TBI W LOC OF 1-5 HRS 59 MIN INIT

T41203A

POISONING BY UNSP GENERAL ANESTHETICS ASSAULT INIT ENCNTR

S06304A UNSP FOCAL TBI W LOC OF 6 HOURS TO 24 HOURS INIT

T41204A

POISONING BY UNSP GENERAL ANESTHETICS UNDETERMINED INIT

S06305A UNSP FOCAL TBI W LOC >24 HR W RET CONSC LEV INIT

T41291A

POISONING BY OTH GENERAL ANESTHETICS ACCIDENTAL INIT

S06306A UNSP FOCAL TBI W LOC >24 HR W/O RET CONSC W SURV INIT

T41292A

POISONING BY OTH GENERAL ANESTHETICS SELF-HARM INIT

S06307A

UNSP FOCAL TBI W LOC W DEATH D/T BRAIN INJURY BF CONSC INIT

T41293A

POISONING BY OTHER GENERAL ANESTHETICS ASSAULT INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S06307S

UNSP FOCAL TBI W LOC W DEATH D/T BRAIN INJURY BF CONSC SQLA

T41294A

POISONING BY OTH GENERAL ANESTHETICS UNDETERMINED INIT

S06308A

UNSP FOCAL TBI W LOC W DEATH DUE TO OTH CAUSE BF CONSC INIT

T413X1A

POISONING BY LOCAL ANESTHETICS ACCIDENTAL INIT

S06308S

UNSP FOCAL TBI W LOC W DEATH DUE TO OTH CAUSE BF CONSC SQLA

T413X2A

POISONING BY LOCAL ANESTHETICS INTENTIONAL SELF-HARM INIT

S06309A UNSP FOCAL TBI W LOC OF UNSP DURATION INIT

T413X3A

POISONING BY LOCAL ANESTHETICS ASSAULT INITIAL ENCOUNTER

S06310A

CONTUS/LAC RIGHT CEREBRUM W/O LOSS OF CONSCIOUSNESS INIT

T413X4A

POISONING BY LOCAL ANESTHETICS UNDETERMINED INIT ENCNTR

S06311A

CONTUS/LAC RIGHT CEREBRUM W LOC OF 30 MINUTES OR LESS INIT

T4141XA

POISONING BY UNSP ANESTHETIC ACCIDENTAL INIT

S06312A CONTUS/LAC RIGHT CEREBRUM W LOC OF 31-59 MIN INIT

T4142XA

POISONING BY UNSP ANESTHETIC INTENTIONAL SELF-HARM INIT

S06313A CONTUS/LAC RIGHT CEREBRUM W LOC OF 1-5 HRS 59 MIN INIT

T4143XA

POISONING BY UNSPECIFIED ANESTHETIC ASSAULT INIT ENCNTR

S06314A

CONTUS/LAC RIGHT CEREBRUM W LOC OF 6 HOURS TO 24 HOURS INIT

T4144XA

POISONING BY UNSP ANESTHETIC UNDETERMINED INIT ENCNTR

S06315A

CONTUS/LAC RIGHT CEREBRUM W LOC >24 HR W RET CONSC LEV INIT

T415X1A

POISONING BY THERAPEUTIC GASES ACCIDENTAL INIT

S06316A

CONTUS/LAC R CEREB W LOC >24 HR W/O RET CONSC W SURV INIT

T415X2A

POISONING BY THERAPEUTIC GASES INTENTIONAL SELF-HARM INIT

S06317A

CONTUS/LAC R CEREB W LOC W DTH D/T BRAIN INJ BF CONSC INIT

T415X3A

POISONING BY THERAPEUTIC GASES ASSAULT INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S06318A

CONTUS/LAC R CEREB W LOC W DTH D/T OTH CAUSE BF CONSC INIT

T415X4A

POISONING BY THERAPEUTIC GASES UNDETERMINED INIT ENCNTR

S06319A CONTUS/LAC RIGHT CEREBRUM W LOC OF UNSP DURATION INIT

T420X1A

POISONING BY HYDANTOIN DERIVATIVES ACCIDENTAL INIT

S06320A

CONTUS/LAC LEFT CEREBRUM W/O LOSS OF CONSCIOUSNESS INIT

T420X2A

POISONING BY HYDANTOIN DERIVATIVES SELF-HARM INIT

S06321A

CONTUS/LAC LEFT CEREBRUM W LOC OF 30 MINUTES OR LESS INIT

T420X3A

POISONING BY HYDANTOIN DERIVATIVES ASSAULT INIT ENCNTR

S06322A CONTUS/LAC LEFT CEREBRUM W LOC OF 31-59 MIN INIT

T420X4A

POISONING BY HYDANTOIN DERIVATIVES UNDETERMINED INIT

S06323A CONTUS/LAC LEFT CEREBRUM W LOC OF 1-5 HRS 59 MIN INIT

T421X1A

POISONING BY IMINOSTILBENES ACCIDENTAL INIT

S06324A

CONTUS/LAC LEFT CEREBRUM W LOC OF 6 HOURS TO 24 HOURS INIT

T421X2A

POISONING BY IMINOSTILBENES INTENTIONAL SELF-HARM INIT

S06325A

CONTUS/LAC LEFT CEREBRUM W LOC >24 HR W RET CONSC LEV INIT

T421X3A

POISONING BY IMINOSTILBENES ASSAULT INITIAL ENCOUNTER

S06326A

CONTUS/LAC L CEREB W LOC >24 HR W/O RET CONSC W SURV INIT

T421X4A

POISONING BY IMINOSTILBENES UNDETERMINED INITIAL ENCOUNTER

S06327A

CONTUS/LAC L CEREB W LOC W DTH D/T BRAIN INJ BF CONSC INIT

T422X1A

POISONING BY SUCCINIMIDES AND OXAZOLIDINEDIONES ACC INIT

S06328A

CONTUS/LAC L CEREB W LOC W DTH D/T OTH CAUSE BF CONSC INIT

T422X2A

POISN BY SUCCINIMIDES AND OXAZOLIDINEDIONES SELF-HARM INIT

S06329A CONTUS/LAC LEFT CEREBRUM W LOC OF UNSP DURATION INIT

T422X3A

POISN BY SUCCINIMIDES AND OXAZOLIDINEDIONES ASSAULT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S06330A CONTUS/LAC CEREB W/O LOSS OF CONSCIOUSNESS INIT

T422X4A

POISONING BY SUCCINIMIDES AND OXAZOLIDINEDIONES UNDET INIT

S06331A CONTUS/LAC CEREB W LOC OF 30 MINUTES OR LESS INIT

T423X1A

POISONING BY BARBITURATES ACCIDENTAL (UNINTENTIONAL) INIT

S06332A

CONTUS/LAC CEREB W LOSS OF CONSCIOUSNESS OF 31-59 MIN INIT

T423X2A

POISONING BY BARBITURATES INTENTIONAL SELF-HARM INIT

S06333A CONTUS/LAC CEREB W LOC OF 1-5 HRS 59 MIN INIT

T423X3A

POISONING BY BARBITURATES ASSAULT INITIAL ENCOUNTER

S06334A CONTUS/LAC CEREB W LOC OF 6 HOURS TO 24 HOURS INIT

T423X4A

POISONING BY BARBITURATES UNDETERMINED INITIAL ENCOUNTER

S06335A CONTUS/LAC CEREB W LOC >24 HR W RET CONSC LEV INIT

T424X1A

POISONING BY BENZODIAZEPINES ACCIDENTAL INIT

S06336A

CONTUS/LAC CEREB W LOC >24 HR W/O RET CONSC W SURV INIT

T424X2A

POISONING BY BENZODIAZEPINES INTENTIONAL SELF-HARM INIT

S06337A

CONTUS/LAC CEREB W LOC W DEATH D/T BRAIN INJ BF CONSC INIT

T424X3A

POISONING BY BENZODIAZEPINES ASSAULT INITIAL ENCOUNTER

S06338A

CONTUS/LAC CEREB W LOC W DEATH D/T OTH CAUSE BF CONSC INIT

T424X4A

POISONING BY BENZODIAZEPINES UNDETERMINED INIT ENCNTR

S06339A CONTUS/LAC CEREB W LOC OF UNSP DURATION INIT

T425X1A

POISONING BY MIXED ANTIEPILEPTICS ACCIDENTAL INIT

S06340A

TRAUM HEMOR RIGHT CEREBRUM W/O LOSS OF CONSCIOUSNESS INIT

T425X2A

POISONING BY MIXED ANTIEPILEPTICS SELF-HARM INIT

S06341A

TRAUM HEMOR RIGHT CEREBRUM W LOC OF 30 MINUTES OR LESS INIT

T425X3A

POISONING BY MIXED ANTIEPILEPTICS ASSAULT INIT ENCNTR

S06342A

TRAUM HEMOR RIGHT CEREBRUM W LOC OF 31-59 MIN INIT

T425X4A

POISONING BY MIXED ANTIEPILEPTICS UNDETERMINED INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S06343A

TRAUM HEMOR RIGHT CEREBRUM W LOC OF 1-5 HRS 59 MINUTES INIT

T426X1A

POISONING BY OTH ANTIEPLPTC AND SED-HYPNTC DRUGS ACC INIT

S06344A

TRAUM HEMOR RIGHT CEREBRUM W LOC OF 6-24 HRS INIT

T426X2A

POISN BY OTH ANTIEPLPTC AND SED-HYPNTC DRUGS SLF-HRM INIT

S06345A TRAUM HEMOR R CEREB W LOC >24 HR W RET CONSC LEV INIT

T426X3A

POISN BY OTH ANTIEPLPTC AND SED-HYPNTC DRUGS ASSAULT INIT

S06346A

TRAUM HEMOR R CEREB W LOC >24 HR W/O RET CONSC W SURV INIT

T426X4A

POISN BY OTH ANTIEPLPTC AND SED-HYPNTC DRUGS UNDET INIT

S06347A

TRAUM HEMOR R CEREB W LOC W DTH D/T BRAIN INJ BF CONSC INIT

T4271XA

POISN BY UNSP ANTIEPLPTC AND SED-HYPNTC DRUGS ACC INIT

S06348A

TRAUM HEMOR R CEREB W LOC W DTH D/T OTH CAUSE BF CONSC INIT

T4272XA

POISN BY UNSP ANTIEPLPTC AND SED-HYPNTC DRUGS SLF-HRM INIT

S06349A

TRAUM HEMOR RIGHT CEREBRUM W LOC OF UNSP DURATION INIT

T4273XA

POISN BY UNSP ANTIEPLPTC AND SED-HYPNTC DRUGS ASSAULT INIT

S06350A

TRAUM HEMOR LEFT CEREBRUM W/O LOSS OF CONSCIOUSNESS INIT

T4274XA

POISN BY UNSP ANTIEPLPTC AND SED-HYPNTC DRUGS UNDET INIT

S06351A

TRAUM HEMOR LEFT CEREBRUM W LOC OF 30 MINUTES OR LESS INIT

T428X1A

POISN BY ANTIPARKNS DRUG/CENTR MUSC-TONE DEPR ACC INIT

S06352A

TRAUM HEMOR LEFT CEREBRUM W LOC OF 31-59 MIN INIT

T428X2A

POISN BY ANTIPARKNS DRUG/CENTR MUSC-TONE DEPR SLF-HRM INIT

S06353A

TRAUM HEMOR LEFT CEREBRUM W LOC OF 1-5 HRS 59 MINUTES INIT

T428X3A

POISN BY ANTIPARKNS DRUG/CENTR MUSC-TONE DEPR ASSAULT INIT

S06354A

TRAUM HEMOR LEFT CEREBRUM W LOC OF 6 HOURS TO 24 HOURS INIT

T428X4A

POISN BY ANTIPARKNS DRUG/CENTR MUSC-TONE DEPR UNDET INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S06355A

TRAUM HEMOR LEFT CEREBRUM W LOC >24 HR W RET CONSC LEV INIT

T43011A

POISONING BY TRICYCLIC ANTIDEPRESSANTS ACCIDENTAL INIT

S06356A

TRAUM HEMOR L CEREB W LOC >24 HR W/O RET CONSC W SURV INIT

T43012A

POISONING BY TRICYCLIC ANTIDEPRESSANTS SELF-HARM INIT

S06357A

TRAUM HEMOR L CEREB W LOC W DTH D/T BRAIN INJ BF CONSC INIT

T43013A

POISONING BY TRICYCLIC ANTIDEPRESSANTS ASSAULT INIT ENCNTR

S06358A

TRAUM HEMOR L CEREB W LOC W DTH D/T OTH CAUSE BF CONSC INIT

T43014A

POISONING BY TRICYCLIC ANTIDEPRESSANTS UNDETERMINED INIT

S06359A

TRAUM HEMOR LEFT CEREBRUM W LOC OF UNSP DURATION INIT

T43021A

POISONING BY TETRACYCLIC ANTIDEPRESSANTS ACCIDENTAL INIT

S06360A TRAUM HEMOR CEREB W/O LOSS OF CONSCIOUSNESS INIT

T43022A

POISONING BY TETRACYCLIC ANTIDEPRESSANTS SELF-HARM INIT

S06361A TRAUM HEMOR CEREB W LOC OF 30 MINUTES OR LESS INIT

T43023A

POISONING BY TETRACYCLIC ANTIDEPRESSANTS ASSAULT INIT

S06362A TRAUM HEMOR CEREB W LOC OF 31-59 MIN INIT

T43024A

POISONING BY TETRACYCLIC ANTIDEPRESSANTS UNDETERMINED INIT

S06363A TRAUM HEMOR CEREB W LOC OF 1-5 HRS 59 MINUTES INIT

T431X1A

POISONING BY MAO INHIB ANTIDEPRESSANTS ACCIDENTAL INIT

S06364A TRAUM HEMOR CEREB W LOC OF 6 HOURS TO 24 HOURS INIT

T431X2A

POISONING BY MAO INHIB ANTIDEPRESSANTS SELF-HARM INIT

S06365A TRAUM HEMOR CEREB W LOC >24 HR W RET CONSC LEV INIT

T431X3A

POISONING BY MAO INHIB ANTIDEPRESSANTS ASSAULT INIT

S06366A

TRAUM HEMOR CEREB W LOC >24 HR W/O RET CONSC W SURV INIT

T431X4A

POISONING BY MAO INHIB ANTIDEPRESSANTS UNDETERMINED INIT

S06367A

TRAUM HEMOR CEREB W LOC W DTH D/T BRAIN INJ BF CONSC INIT

T43201A

POISONING BY UNSP ANTIDEPRESSANTS ACCIDENTAL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S06368A

TRAUM HEMOR CEREB W LOC W DTH D/T OTH CAUSE BF CONSC INIT

T43202A

POISONING BY UNSP ANTIDEPRESSANTS SELF-HARM INIT

S06369A TRAUM HEMOR CEREB W LOC OF UNSP DURATION INIT

T43203A

POISONING BY UNSP ANTIDEPRESSANTS ASSAULT INIT ENCNTR

S06370A CONTUS/LAC/HEM CRBLM W/O LOSS OF CONSCIOUSNESS INIT

T43204A

POISONING BY UNSP ANTIDEPRESSANTS UNDETERMINED INIT ENCNTR

S06371A

CONTUS/LAC/HEM CRBLM W LOC OF 30 MINUTES OR LESS INIT

T43211A

POISN BY SLCTV SEROTON/NOREPINEPH REUP INHIBTR ACC INIT

S06372A CONTUS/LAC/HEM CRBLM W LOC OF 31-59 MIN INIT

T43212A

POISN BY SLCTV SEROTON/NOREPINEPH REUP INHIBTRSLF-HRM INIT

S06373A CONTUS/LAC/HEM CRBLM W LOC OF 1-5 HRS 59 MIN INIT

T43213A

POISN BY SLCTV SEROTON/NOREPINEPH REUP INHIBTR ASSLT INIT

S06374A

CONTUS/LAC/HEM CRBLM W LOC OF 6 HOURS TO 24 HOURS INIT

T43214A

POISN BY SLCTV SEROTON/NOREPINEPH REUP INHIBTR UNDET INIT

S06375A

CONTUS/LAC/HEM CRBLM W LOC >24 HR W RET CONSC LEV INIT

T43221A

POISN BY SELECTIVE SEROTONIN REUPTAKE INHIBTR ACC INIT

S06376A

CONTUS/LAC/HEM CRBLM W LOC >24 HR W/O RET CONSC W SURV INIT

T43222A

POISN BY SLCTV SEROTONIN REUPTAKE INHIBTR SELF-HARM INIT

S06377A

CONTUS/LAC/HEM CRBLM W LOC W DTH D/T BRAIN INJ BF CONSCINIT

T43223A

POISN BY SELECTIVE SEROTONIN REUPTAKE INHIBTR ASSAULT INIT

S06378A

CONTUS/LAC/HEM CRBLM W LOC W DTH D/T OTH CAUSE BF CONSCINIT

T43224A

POISN BY SELECTIVE SEROTONIN REUPTAKE INHIBTR UNDET INIT

S06379A CONTUS/LAC/HEM CRBLM W LOC OF UNSP DURATION INIT

T43291A

POISONING BY OTH ANTIDEPRESSANTS ACCIDENTAL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S06380A

CONTUS/LAC/HEM BRAINSTEM W/O LOSS OF CONSCIOUSNESS INIT

T43292A

POISONING BY OTH ANTIDEPRESSANTS SELF-HARM INIT

S06381A

CONTUS/LAC/HEM BRAINSTEM W LOC OF 30 MINUTES OR LESS INIT

T43293A

POISONING BY OTHER ANTIDEPRESSANTS ASSAULT INIT ENCNTR

S06382A CONTUS/LAC/HEM BRAINSTEM W LOC OF 31-59 MIN INIT

T43294A

POISONING BY OTH ANTIDEPRESSANTS UNDETERMINED INIT ENCNTR

S06383A CONTUS/LAC/HEM BRAINSTEM W LOC OF 1-5 HRS 59 MIN INIT

T433X1A

POISONING BY PHENOTHIAZ ANTIPSYCHOT/NEUROLEPT ACC INIT

S06384A

CONTUS/LAC/HEM BRAINSTEM W LOC OF 6 HOURS TO 24 HOURS INIT

T433X2A

POISN BY PHENOTHIAZ ANTIPSYCHOT/NEUROLEPT SELF-HARM INIT

S06385A

CONTUS/LAC/HEM BRAINSTEM W LOC >24 HR W RET CONSC LEV INIT

T433X3A

POISONING BY PHENOTHIAZ ANTIPSYCHOT/NEUROLEPT ASSAULT INIT

S06386A

CONTUS/LAC/HEM BRNST W LOC >24 HR W/O RET CONSC W SURV INIT

T433X4A

POISONING BY PHENOTHIAZ ANTIPSYCHOT/NEUROLEPT UNDET INIT

S06387A

CONTUS/LAC/HEM BRNST W LOC W DTH D/T BRAIN INJ BF CONSCINIT

T434X1A

POISONING BY BUTYROPHEN/THIOTHIXEN NEUROLEPTC ACC INIT

S06388A

CONTUS/LAC/HEM BRNST W LOC W DTH D/T OTH CAUSE BF CONSCINIT

T434X2A

POISN BY BUTYROPHEN/THIOTHIXEN NEUROLEPTC SELF-HARM INIT

S06389A CONTUS/LAC/HEM BRAINSTEM W LOC OF UNSP DURATION INIT

T434X3A

POISONING BY BUTYROPHEN/THIOTHIXEN NEUROLEPTC ASSAULT INIT

S064X0A

EPIDURAL HEMORRHAGE W/O LOSS OF CONSCIOUSNESS INIT ENCNTR

T434X4A

POISONING BY BUTYROPHEN/THIOTHIXEN NEUROLEPTC UNDET INIT

S064X1A

EPIDURAL HEMORRHAGE W LOC OF 30 MINUTES OR LESS INIT

T43501A

POISONING BY UNSP ANTIPSYCHOT/NEUROLEPT ACCIDENTAL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S064X2A EPIDURAL HEMORRHAGE W LOC OF 31-59 MIN INIT

T43502A

POISONING BY UNSP ANTIPSYCHOT/NEUROLEPT SELF-HARM INIT

S064X3A EPIDURAL HEMORRHAGE W LOC OF 1-5 HRS 59 MIN INIT

T43503A

POISONING BY UNSP ANTIPSYCHOT/NEUROLEPT ASSAULT INIT

S064X4A

EPIDURAL HEMORRHAGE W LOC OF 6 HOURS TO 24 HOURS INIT

T43504A

POISONING BY UNSP ANTIPSYCHOT/NEUROLEPT UNDETERMINED INIT

S064X5A

EPIDURAL HEMORRHAGE W LOC >24 HR W RET CONSC LEV INIT

T43591A

POISONING BY OTH ANTIPSYCHOT/NEUROLEPT ACCIDENTAL INIT

S064X6A

EPIDURAL HEMORRHAGE W LOC >24 HR W/O RET CONSC W SURV INIT

T43592A

POISONING BY OTH ANTIPSYCHOT/NEUROLEPT SELF-HARM INIT

S064X7A

EPIDUR HEMOR W LOC W DEATH D/T BRAIN INJURY BF CONSC INIT

T43593A

POISONING BY OTH ANTIPSYCHOT/NEUROLEPT ASSAULT INIT

S064X8A

EPIDUR HEMOR W LOC W DEATH DUE TO OTH CAUSES BF CONSC INIT

T43594A

POISONING BY OTH ANTIPSYCHOT/NEUROLEPT UNDETERMINED INIT

S064X9A EPIDURAL HEMORRHAGE W LOC OF UNSP DURATION INIT

T43601A

POISONING BY UNSP PSYCHOSTIM ACCIDENTAL INIT

S065X0A TRAUM SUBDR HEM W/O LOSS OF CONSCIOUSNESS INIT

T43602A

POISONING BY UNSP PSYCHOSTIMULANTS SELF-HARM INIT

S065X1A TRAUM SUBDR HEM W LOC OF 30 MINUTES OR LESS INIT

T43603A

POISONING BY UNSP PSYCHOSTIMULANTS ASSAULT INIT ENCNTR

S065X2A

TRAUM SUBDR HEM W LOSS OF CONSCIOUSNESS OF 31-59 MIN INIT

T43604A

POISONING BY UNSP PSYCHOSTIMULANTS UNDETERMINED INIT

S065X3A TRAUM SUBDR HEM W LOC OF 1-5 HRS 59 MIN INIT

T43611A

POISONING BY CAFFEINE ACCIDENTAL (UNINTENTIONAL) INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S065X4A TRAUM SUBDR HEM W LOC OF 6 HOURS TO 24 HOURS INIT

T43612A

POISONING BY CAFFEINE INTENTIONAL SELF-HARM INIT ENCNTR

S065X5A TRAUM SUBDR HEM W LOC >24 HR W RET CONSC LEV INIT

T43613A

POISONING BY CAFFEINE ASSAULT INITIAL ENCOUNTER

S065X6A

TRAUM SUBDR HEM W LOC >24 HR W/O RET CONSC W SURV INIT

T43614A

POISONING BY CAFFEINE UNDETERMINED INITIAL ENCOUNTER

S065X7A

TRAUM SUBDR HEM W LOC W DTH D/T BRAIN INJ BEF REG CONSCINIT

T43621A

POISONING BY AMPHETAMINES ACCIDENTAL (UNINTENTIONAL) INIT

S065X8A

TRAUM SUBDR HEM W LOC W DTH D/T OTH CAUSE BEF REG CONSCINIT

T43622A

POISONING BY AMPHETAMINES INTENTIONAL SELF-HARM INIT

S065X9A TRAUM SUBDR HEM W LOC OF UNSP DURATION INIT

T43623A

POISONING BY AMPHETAMINES ASSAULT INITIAL ENCOUNTER

S066X0A TRAUM SUBRAC HEM W/O LOSS OF CONSCIOUSNESS INIT

T43624A

POISONING BY AMPHETAMINES UNDETERMINED INITIAL ENCOUNTER

S066X1A TRAUM SUBRAC HEM W LOC OF 30 MINUTES OR LESS INIT

T43631A

POISONING BY METHYLPHENIDATE ACCIDENTAL INIT

S066X2A

TRAUM SUBRAC HEM W LOSS OF CONSCIOUSNESS OF 31-59 MIN INIT

T43632A

POISONING BY METHYLPHENIDATE INTENTIONAL SELF-HARM INIT

S066X3A TRAUM SUBRAC HEM W LOC OF 1-5 HRS 59 MIN INIT

T43633A

POISONING BY METHYLPHENIDATE ASSAULT INITIAL ENCOUNTER

S066X4A TRAUM SUBRAC HEM W LOC OF 6 HOURS TO 24 HOURS INIT

T43634A

POISONING BY METHYLPHENIDATE UNDETERMINED INIT ENCNTR

S066X5A TRAUM SUBRAC HEM W LOC >24 HR W RET CONSC LEV INIT

T43691A

POISONING BY OTH PSYCHOSTIM ACCIDENTAL INIT

S066X6A

TRAUM SUBRAC HEM W LOC >24 HR W/O RET CONSC W SURV INIT

T43692A

POISONING BY OTH PSYCHOSTIMULANTS SELF-HARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S066X7A

TRAUM SUBRAC HEM W LOC W DEATH D/T BRAIN INJ BF CONSC INIT

T43693A

POISONING BY OTHER PSYCHOSTIMULANTS ASSAULT INIT ENCNTR

S066X8A

TRAUM SUBRAC HEM W LOC W DEATH D/T OTH CAUSE BF CONSC INIT

T43694A

POISONING BY OTH PSYCHOSTIMULANTS UNDETERMINED INIT ENCNTR

S066X9A TRAUM SUBRAC HEM W LOC OF UNSP DURATION INIT

T438X1A

POISONING BY OTH PSYCHOTROPIC DRUGS ACCIDENTAL INIT

S06810A INJURY OF R INT CAROTID INTCR W/O LOC INIT

T438X2A

POISONING BY OTH PSYCHOTROPIC DRUGS SELF-HARM INIT

S06811A

INJ R INT CAROTID INTCR W LOC OF 30 MINUTES OR LESS INIT

T438X3A

POISONING BY OTHER PSYCHOTROPIC DRUGS ASSAULT INIT ENCNTR

S06812A

INJURY OF R INT CAROTID INTCR W LOC OF 31-59 MIN INIT

T438X4A

POISONING BY OTH PSYCHOTROPIC DRUGS UNDETERMINED INIT

S06813A

INJURY OF R INT CAROTID INTCR W LOC OF 1-5 HRS 59 MIN INIT

T4391XA

POISONING BY UNSP PSYCHOTROPIC DRUG ACCIDENTAL INIT

S06814A INJURY OF R INT CAROTID INTCR W LOC OF 6-24 HRS INIT

T4392XA

POISONING BY UNSP PSYCHOTROPIC DRUG SELF-HARM INIT

S06815A

INJ R INT CAROTID INTCR W LOC >24 HR W RET CONSC LEV INIT

T4393XA

POISONING BY UNSP PSYCHOTROPIC DRUG ASSAULT INIT ENCNTR

S06816A

INJ R INT CRTDINTCR W LOC >24 HR W/O RET CONSC W SURV INIT

T4394XA

POISONING BY UNSP PSYCHOTROPIC DRUG UNDETERMINED INIT

S06817A

INJ R INT CRTDINTCR W LOC W DTH D/T BRAIN INJ BF CONSCINIT

T440X1A

POISONING BY ANTICHOLIN AGENTS ACCIDENTAL INIT

S06818A

INJ R INT CRTDINTCR W LOC W DTH D/T OTH CAUSE BF CONSCINIT

T440X2A

POISONING BY ANTICHOLINESTERASE AGENTS SELF-HARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S06819A

INJURY OF R INT CAROTID INTCR W LOC OF UNSP DURATION INIT

T440X3A

POISONING BY ANTICHOLINESTERASE AGENTS ASSAULT INIT ENCNTR

S06820A INJURY OF L INT CAROTID INTCR W/O LOC INIT

T440X4A

POISONING BY ANTICHOLINESTERASE AGENTS UNDETERMINED INIT

S06821A INJ L INT CAROTID INTCR W LOC OF 30 MINUTES OR LESS INIT

T441X1A

POISONING BY OTH PARASYMPATH ACCIDENTAL INIT

S06822A INJURY OF L INT CAROTID INTCR W LOC OF 31-59 MIN INIT

T441X2A

POISONING BY OTH PARASYMPATHOMIMETICS SELF-HARM INIT

S06823A INJURY OF L INT CAROTID INTCR W LOC OF 1-5 HRS 59 MIN INIT

T441X3A

POISONING BY OTH PARASYMPATHOMIMETICS ASSAULT INIT ENCNTR

S06824A INJURY OF L INT CAROTID INTCR W LOC OF 6-24 HRS INIT

T441X4A

POISONING BY OTH PARASYMPATHOMIMETICS UNDETERMINED INIT

S06825A INJ L INT CAROTID INTCR W LOC >24 HR W RET CONSC LEV INIT

T442X1A

POISONING BY GANGLIONIC BLOCKING DRUGS ACCIDENTAL INIT

S06826A

INJ L INT CRTDINTCR W LOC >24 HR W/O RET CONSC W SURV INIT

T442X2A

POISONING BY GANGLIONIC BLOCKING DRUGS SELF-HARM INIT

S06827A

INJ L INT CRTDINTCR W LOC W DTH D/T BRAIN INJ BF CONSCINIT

T442X3A

POISONING BY GANGLIONIC BLOCKING DRUGS ASSAULT INIT ENCNTR

S06828A

INJ L INT CRTDINTCR W LOC W DTH D/T OTH CAUSE BF CONSCINIT

T442X4A

POISONING BY GANGLIONIC BLOCKING DRUGS UNDETERMINED INIT

S06829A INJURY OF L INT CAROTID INTCR W LOC OF UNSP DURATION INIT

T443X1A

POISONING BY OTH PARASYMPATH AND SPASMOLYTICS ACC INIT

S06890A INTCRAN INJ W/O LOSS OF CONSCIOUSNESS INIT ENCNTR

T443X2A

POISN BY OTH PARASYMPATH AND SPASMOLYTICS SELF-HARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S06891A INTCRAN INJ W LOC OF 30 MINUTES OR LESS INIT

T443X3A

POISONING BY OTH PARASYMPATH AND SPASMOLYTICS ASSAULT INIT

S06892A

INTCRAN INJ W LOSS OF CONSCIOUSNESS OF 31-59 MIN INIT

T443X4A

POISONING BY OTH PARASYMPATH AND SPASMOLYTICS UNDET INIT

S06893A

INTCRAN INJ W LOSS OF CONSCIOUSNESS OF 1-5 HRS 59 MIN INIT

T444X1A

POISONING BY PREDOM ALPHA-ADRENOCPT AGONISTS ACC INIT

S06894A INTCRAN INJ W LOC OF 6 HOURS TO 24 HOURS INIT

T444X2A

POISN BY PREDOM ALPHA-ADRENOCPT AGONISTS SELF-HARM INIT

S06895A INTCRAN INJ W LOC >24 HR W RET CONSC LEV INIT

T444X3A

POISONING BY PREDOM ALPHA-ADRENOCPT AGONISTS ASSAULT INIT

S06896A INTCRAN INJ W LOC >24 HR W/O RET CONSC W SURV INIT

T444X4A

POISONING BY PREDOM ALPHA-ADRENOCPT AGONISTS UNDET INIT

S06897A

INTCRAN INJ W LOC W DEATH DUE TO BRAIN INJURY BF CONSC INIT

T445X1A

POISONING BY PREDOM BETA-ADRENOCPT AGONISTS ACC INIT

S06898A

INTCRAN INJ W LOC W DEATH DUE TO OTH CAUSE BF CONSC INIT

T445X2A

POISONING BY PREDOM BETA-ADRENOCPT AGONISTS SELF-HARM INIT

S06899A

INTCRAN INJ W LOSS OF CONSCIOUSNESS OF UNSP DURATION INIT

T445X3A

POISONING BY PREDOM BETA-ADRENOCPT AGONISTS ASSAULT INIT

S069X0A

UNSP INTRACRANIAL INJURY W/O LOSS OF CONSCIOUSNESS INIT

T445X4A

POISONING BY PREDOM BETA-ADRENOCPT AGONISTS UNDET INIT

S069X1A

UNSP INTRACRANIAL INJURY W LOC OF 30 MINUTES OR LESS INIT

T446X1A

POISONING BY ALPHA-ADRENOCPT ANTAGONISTS ACCIDENTAL INIT

S069X2A UNSP INTRACRANIAL INJURY W LOC OF 31-59 MIN INIT

T446X2A

POISONING BY ALPHA-ADRENOCPT ANTAGONISTS SELF-HARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S069X3A UNSP INTRACRANIAL INJURY W LOC OF 1-5 HRS 59 MIN INIT

T446X3A

POISONING BY ALPHA-ADRENORECEPTOR ANTAGONISTS ASSAULT INIT

S069X4A

UNSP INTRACRANIAL INJURY W LOC OF 6 HOURS TO 24 HOURS INIT

T446X4A

POISONING BY ALPHA-ADRENOCPT ANTAGONISTS UNDETERMINED INIT

S069X5A

UNSP INTRACRANIAL INJURY W LOC >24 HR W RET CONSC LEV INIT

T447X1A

POISONING BY BETA-ADRENOCPT ANTAGONISTS ACCIDENTAL INIT

S069X6A

UNSP INTCRN INJURY W LOC >24 HR W/O RET CONSC W SURV INIT

T447X2A

POISONING BY BETA-ADRENOCPT ANTAGONISTS SELF-HARM INIT

S069X7A

UNSP INTCRN INJ W LOC W DEATH D/T BRAIN INJ BF CONSC INIT

T447X3A

POISONING BY BETA-ADRENORECEPTOR ANTAGONISTS ASSAULT INIT

S069X8A

UNSP INTCRN INJ W LOC W DEATH D/T OTH CAUSE BF CONSC INIT

T447X4A

POISONING BY BETA-ADRENOCPT ANTAGONISTS UNDETERMINED INIT

S070XXA CRUSHING INJURY OF FACE INITIAL ENCOUNTER

T448X1A

POISONING BY CENTR-ACTING/ADREN-NEURN-BLOCK AGNT ACC INIT

S071XXA CRUSHING INJURY OF SKULL INITIAL ENCOUNTER

T448X2A

POISN BY CENTR-ACTING/ADREN-NEURN-BLOCK AGNT SLF-HRM INIT

S078XXA

CRUSHING INJURY OF OTHER PARTS OF HEAD INITIAL ENCOUNTER

T448X3A

POISN BY CENTR-ACTING/ADREN-NEURN-BLOCK AGNT ASSAULT INIT

S079XXA

CRUSHING INJURY OF HEAD PART UNSPECIFIED INITIAL ENCOUNTER

T448X4A

POISN BY CENTR-ACTING/ADREN-NEURN-BLOCK AGNT UNDET INIT

S080XXA AVULSION OF SCALP INITIAL ENCOUNTER

T44901A

POISN BY UNSP DRUGS AFF THE AUTONM NERVOUS SYS ACC INIT

S08111A

COMPLETE TRAUMATIC AMPUTATION OF RIGHT EAR INIT ENCNTR

T44902A

POISN BY UNSP DRUGS AFF THE AUTONM NRV SYS SLF-HRM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S08112A

COMPLETE TRAUMATIC AMPUTATION OF LEFT EAR INITIAL ENCOUNTER

T44903A

POISN BY UNSP DRUGS AFF THE AUTONM NERVOUS SYS ASSLT INIT

S08119A

COMPLETE TRAUMATIC AMPUTATION OF UNSP EAR INIT ENCNTR

T44904A

POISN BY UNSP DRUGS AFF THE AUTONM NERVOUS SYS UNDET INIT

S08121A

PARTIAL TRAUMATIC AMPUTATION OF RIGHT EAR INITIAL ENCOUNTER

T44991A

POISONING BY OTH DRUG AFF THE AUTONM NERVOUS SYS ACC INIT

S08122A

PARTIAL TRAUMATIC AMPUTATION OF LEFT EAR INITIAL ENCOUNTER

T44992A

POISN BY OTH DRUG AFF THE AUTONM NERVOUS SYS SLF-HRM INIT

S08129A

PARTIAL TRAUMATIC AMPUTATION OF UNSPECIFIED EAR INIT ENCNTR

T44993A

POISN BY OTH DRUG AFF THE AUTONM NERVOUS SYS ASSAULT INIT

S08811A

COMPLETE TRAUMATIC AMPUTATION OF NOSE INITIAL ENCOUNTER

T44994A

POISN BY OTH DRUG AFF THE AUTONM NERVOUS SYS UNDET INIT

S08812A

PARTIAL TRAUMATIC AMPUTATION OF NOSE INITIAL ENCOUNTER

T450X1A

POISONING BY ANTIALLERG/ANTIEMETIC ACCIDENTAL INIT

S0889XA

TRAUMATIC AMPUTATION OF OTHER PARTS OF HEAD INIT ENCNTR

T450X2A

POISONING BY ANTIALLERG/ANTIEMETIC SELF-HARM INIT

S090XXA INJURY OF BLOOD VESSELS OF HEAD NEC INIT

T450X3A

POISONING BY ANTIALLERG/ANTIEMETIC ASSAULT INIT

S0910XA

UNSPECIFIED INJURY OF MUSCLE AND TENDON OF HEAD INIT ENCNTR

T450X4A

POISONING BY ANTIALLERG/ANTIEMETIC UNDETERMINED INIT

S0911XA

STRAIN OF MUSCLE AND TENDON OF HEAD INITIAL ENCOUNTER

T451X1A

POISONING BY ANTINEOPL AND IMMUNOSUP DRUGS ACC INIT

S0912XA

LACERATION OF MUSCLE AND TENDON OF HEAD INITIAL ENCOUNTER

T451X2A

POISONING BY ANTINEOPL AND IMMUNOSUP DRUGS SELF-HARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S0919XA OTH INJURY OF MUSCLE AND TENDON OF HEAD INIT ENCNTR

T451X3A

POISONING BY ANTINEOPL AND IMMUNOSUP DRUGS ASSAULT INIT

S0920XA

TRAUMATIC RUPTURE OF UNSPECIFIED EAR DRUM INITIAL ENCOUNTER

T451X4A

POISONING BY ANTINEOPL AND IMMUNOSUP DRUGS UNDET INIT

S0921XA

TRAUMATIC RUPTURE OF RIGHT EAR DRUM INITIAL ENCOUNTER

T452X1A

POISONING BY VITAMINS ACCIDENTAL (UNINTENTIONAL) INIT

S0922XA TRAUMATIC RUPTURE OF LEFT EAR DRUM INITIAL ENCOUNTER

T452X2A

POISONING BY VITAMINS INTENTIONAL SELF-HARM INIT ENCNTR

S09301A UNSP INJURY OF RIGHT MIDDLE AND INNER EAR INIT ENCNTR

T452X3A

POISONING BY VITAMINS ASSAULT INITIAL ENCOUNTER

S09302A

UNSPECIFIED INJURY OF LEFT MIDDLE AND INNER EAR INIT ENCNTR

T452X4A

POISONING BY VITAMINS UNDETERMINED INITIAL ENCOUNTER

S09309A

UNSP INJURY OF UNSPECIFIED MIDDLE AND INNER EAR INIT ENCNTR

T453X1A

POISONING BY ENZYMES ACCIDENTAL (UNINTENTIONAL) INIT

S09311A PRIMARY BLAST INJURY OF RIGHT EAR INITIAL ENCOUNTER

T453X2A

POISONING BY ENZYMES INTENTIONAL SELF-HARM INIT ENCNTR

S09312A PRIMARY BLAST INJURY OF LEFT EAR INITIAL ENCOUNTER

T453X3A

POISONING BY ENZYMES ASSAULT INITIAL ENCOUNTER

S09313A PRIMARY BLAST INJURY OF EAR BILATERAL INITIAL ENCOUNTER

T453X4A

POISONING BY ENZYMES UNDETERMINED INITIAL ENCOUNTER

S09319A

PRIMARY BLAST INJURY OF UNSPECIFIED EAR INITIAL ENCOUNTER

T454X1A

POISONING BY IRON AND ITS COMPOUNDS ACCIDENTAL INIT

S09391A OTH INJURY OF RIGHT MIDDLE AND INNER EAR INIT ENCNTR

T454X2A

POISONING BY IRON AND ITS COMPOUNDS SELF-HARM INIT

S09392A OTH INJURY OF LEFT MIDDLE AND INNER EAR INIT ENCNTR

T454X3A

POISONING BY IRON AND ITS COMPOUNDS ASSAULT INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S09399A

OTH INJURY OF UNSPECIFIED MIDDLE AND INNER EAR INIT ENCNTR

T454X4A

POISONING BY IRON AND ITS COMPOUNDS UNDETERMINED INIT

S098XXA OTHER SPECIFIED INJURIES OF HEAD INITIAL ENCOUNTER

T45511A

POISONING BY ANTICOAGULANTS ACCIDENTAL INIT

S100XXA CONTUSION OF THROAT INITIAL ENCOUNTER

T45512A

POISONING BY ANTICOAGULANTS INTENTIONAL SELF-HARM INIT

S1010XA

UNSPECIFIED SUPERFICIAL INJURIES OF THROAT INIT ENCNTR

T45513A

POISONING BY ANTICOAGULANTS ASSAULT INITIAL ENCOUNTER

S1011XA ABRASION OF THROAT INITIAL ENCOUNTER

T45514A

POISONING BY ANTICOAGULANTS UNDETERMINED INITIAL ENCOUNTER

S1012XA BLISTER (NONTHERMAL) OF THROAT INITIAL ENCOUNTER

T45521A

POISONING BY ANTITHROMBOTIC DRUGS ACCIDENTAL INIT

S1014XA

EXTERNAL CONSTRICTION OF PART OF THROAT INITIAL ENCOUNTER

T45522A

POISONING BY ANTITHROMBOTIC DRUGS SELF-HARM INIT

S1015XA SUPERFICIAL FOREIGN BODY OF THROAT INITIAL ENCOUNTER

T45523A

POISONING BY ANTITHROMBOTIC DRUGS ASSAULT INIT ENCNTR

S1016XA

INSECT BITE (NONVENOMOUS) OF THROAT INITIAL ENCOUNTER

T45524A

POISONING BY ANTITHROMBOTIC DRUGS UNDETERMINED INIT ENCNTR

S1017XA OTHER SUPERFICIAL BITE OF THROAT INITIAL ENCOUNTER

T45601A

POISONING BY UNSP FIBRIN-AFFCT DRUGS ACCIDENTAL INIT

S1080XA

UNSP SUPERFICIAL INJURY OF OTH PART OF NECK INIT ENCNTR

T45602A

POISONING BY UNSP FIBRIN-AFFCT DRUGS SELF-HARM INIT

S1081XA

ABRASION OF OTHER SPECIFIED PART OF NECK INITIAL ENCOUNTER

T45603A

POISONING BY UNSP FIBRIN-AFFCT DRUGS ASSAULT INIT

S1082XA

BLISTER (NONTHERMAL) OF OTH PART OF NECK INIT ENCNTR

T45604A

POISONING BY UNSP FIBRIN-AFFCT DRUGS UNDETERMINED INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S1083XA

CONTUSION OF OTHER SPECIFIED PART OF NECK INITIAL ENCOUNTER

T45611A

POISONING BY THROMBOLYTIC DRUG ACCIDENTAL INIT

S1084XA

EXTERNAL CONSTRICTION OF OTH PART OF NECK INIT ENCNTR

T45612A

POISONING BY THROMBOLYTIC DRUG INTENTIONAL SELF-HARM INIT

S1085XA

SUPERFICIAL FOREIGN BODY OF OTH PART OF NECK INIT ENCNTR

T45613A

POISONING BY THROMBOLYTIC DRUG ASSAULT INITIAL ENCOUNTER

S1086XA

INSECT BITE OF OTHER SPECIFIED PART OF NECK INIT ENCNTR

T45614A

POISONING BY THROMBOLYTIC DRUG UNDETERMINED INIT ENCNTR

S1087XA

OTHER SUPERFICIAL BITE OF OTH PART OF NECK INIT ENCNTR

T45621A

POISONING BY HEMOSTATIC DRUG ACCIDENTAL INIT

S1090XA

UNSP SUPERFICIAL INJURY OF UNSP PART OF NECK INIT ENCNTR

T45622A

POISONING BY HEMOSTATIC DRUG INTENTIONAL SELF-HARM INIT

S1091XA

ABRASION OF UNSPECIFIED PART OF NECK INITIAL ENCOUNTER

T45623A

POISONING BY HEMOSTATIC DRUG ASSAULT INITIAL ENCOUNTER

S1092XA

BLISTER (NONTHERMAL) OF UNSP PART OF NECK INIT ENCNTR

T45624A

POISONING BY HEMOSTATIC DRUG UNDETERMINED INIT ENCNTR

S1093XA

CONTUSION OF UNSPECIFIED PART OF NECK INITIAL ENCOUNTER

T45691A

POISONING BY OTH FIBRIN-AFFCT DRUGS ACCIDENTAL INIT

S1094XA

EXTERNAL CONSTRICTION OF UNSP PART OF NECK INIT ENCNTR

T45692A

POISONING BY OTH FIBRIN-AFFCT DRUGS SELF-HARM INIT

S1095XA

SUPERFICIAL FOREIGN BODY OF UNSP PART OF NECK INIT ENCNTR

T45693A

POISONING BY OTH FIBRINOLYSIS-AFFECTING DRUGS ASSAULT INIT

S1096XA

INSECT BITE OF UNSPECIFIED PART OF NECK INITIAL ENCOUNTER

T45694A

POISONING BY OTH FIBRIN-AFFCT DRUGS UNDETERMINED INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S1097XA

OTHER SUPERFICIAL BITE OF UNSP PART OF NECK INIT ENCNTR

T457X1A

POISN BY ANTICOAG ANTAG VITAMIN K AND OTH COAG ACC INIT

S11011A

LACERATION WITHOUT FOREIGN BODY OF LARYNX INITIAL ENCOUNTER

T457X2A

POISN BY ANTICOAG ANTAG VIT K AND OTH COAG SLF-HRM INIT

S11012A

LACERATION WITH FOREIGN BODY OF LARYNX INITIAL ENCOUNTER

T457X3A

POISN BY ANTICOAG ANTAG VIT K AND OTH COAG ASSAULT INIT

S11013A

PUNCTURE WOUND WITHOUT FOREIGN BODY OF LARYNX INIT ENCNTR

T457X4A

POISN BY ANTICOAG ANTAG VITAMIN K AND OTH COAG UNDET INIT

S11014A

PUNCTURE WOUND WITH FOREIGN BODY OF LARYNX INIT ENCNTR

T458X1A

POISN BY OTH PRIM SYSTEMIC AND HEMATOLOG AGENTS ACC INIT

S11015A OPEN BITE OF LARYNX INITIAL ENCOUNTER

T458X2A

POISN BY OTH PRIM SYS AND HEMATOLOG AGENTS SLF-HRM INIT

S11019A UNSPECIFIED OPEN WOUND OF LARYNX INITIAL ENCOUNTER

T458X3A

POISN BY OTH PRIM SYS AND HEMATOLOG AGENTS ASSAULT INIT

S11021A

LACERATION WITHOUT FOREIGN BODY OF TRACHEA INIT ENCNTR

T458X4A

POISN BY OTH PRIM SYSTEMIC AND HEMATOLOG AGENTS UNDET INIT

S11022A

LACERATION WITH FOREIGN BODY OF TRACHEA INITIAL ENCOUNTER

T4591XA

POISN BY UNSP PRIM SYSTEMIC AND HEMATOLOG AGENT ACC INIT

S11023A

PUNCTURE WOUND WITHOUT FOREIGN BODY OF TRACHEA INIT ENCNTR

T4592XA

POISN BY UNSP PRIM SYS AND HEMATOLOG AGENT SLF-HRM INIT

S11024A

PUNCTURE WOUND WITH FOREIGN BODY OF TRACHEA INIT ENCNTR

T4593XA

POISN BY UNSP PRIM SYS AND HEMATOLOG AGENT ASSAULT INIT

S11025A OPEN BITE OF TRACHEA INITIAL ENCOUNTER

T4594XA

POISN BY UNSP PRIM SYSTEMIC AND HEMATOLOG AGENT UNDET INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S11029A UNSPECIFIED OPEN WOUND OF TRACHEA INITIAL ENCOUNTER

T460X1A

POISONING BY CARDI-STIM GLYCOS/DRUG SIMLAR ACT ACC INIT

S11031A

LACERATION WITHOUT FOREIGN BODY OF VOCAL CORD INIT ENCNTR

T460X2A

POISN BY CARDI-STIM GLYCOS/DRUG SIMLAR ACT SELF-HARM INIT

S11032A

LACERATION WITH FOREIGN BODY OF VOCAL CORD INIT ENCNTR

T460X3A

POISN BY CARDI-STIM GLYCOS/DRUG SIMLAR ACT ASSAULT INIT

S11033A

PUNCTURE WOUND W/O FOREIGN BODY OF VOCAL CORD INIT ENCNTR

T460X4A

POISONING BY CARDI-STIM GLYCOS/DRUG SIMLAR ACT UNDET INIT

S11034A

PUNCTURE WOUND WITH FOREIGN BODY OF VOCAL CORD INIT ENCNTR

T461X1A

POISONING BY CALCIUM-CHANNEL BLOCKERS ACCIDENTAL INIT

S1122XA

LACERATION W FB OF PHARYNX AND CERVICAL ESOPHAGUS INIT

T461X2A

POISONING BY CALCIUM-CHANNEL BLOCKERS SELF-HARM INIT

S1123XA

PNCTR W/O FB OF PHARYNX AND CERVICAL ESOPHAGUS INIT

T461X3A

POISONING BY CALCIUM-CHANNEL BLOCKERS ASSAULT INIT ENCNTR

S1124XA

PNCTR W FOREIGN BODY OF PHARYNX AND CERVICAL ESOPHAGUS INIT

T461X4A

POISONING BY CALCIUM-CHANNEL BLOCKERS UNDETERMINED INIT

S1125XA

OPEN BITE OF PHARYNX AND CERVICAL ESOPHAGUS INIT ENCNTR

T462X1A

POISONING BY OTH ANTIDYSRHYTHMIC DRUGS ACCIDENTAL INIT

S1180XA

UNSPECIFIED OPEN WOUND OF OTH PART OF NECK INIT ENCNTR

T462X2A

POISONING BY OTH ANTIDYSRHYTHMIC DRUGS SELF-HARM INIT

S1181XA

LACERATION W/O FOREIGN BODY OF OTH PART OF NECK INIT ENCNTR

T462X3A

POISONING BY OTH ANTIDYSRHYTHMIC DRUGS ASSAULT INIT ENCNTR

S1182XA

LACERATION W FOREIGN BODY OF OTH PART OF NECK INIT ENCNTR

T462X4A

POISONING BY OTH ANTIDYSRHYTHMIC DRUGS UNDETERMINED INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S1183XA

PUNCTURE WOUND W/O FOREIGN BODY OTH PRT NECK INIT ENCNTR

T463X1A

POISONING BY CORONARY VASODILATORS ACCIDENTAL INIT

S1184XA

PUNCTURE WOUND W FOREIGN BODY OTH PRT NECK INIT ENCNTR

T463X2A

POISONING BY CORONARY VASODILATORS SELF-HARM INIT

S1185XA

OPEN BITE OF OTHER SPECIFIED PART OF NECK INITIAL ENCOUNTER

T463X3A

POISONING BY CORONARY VASODILATORS ASSAULT INIT ENCNTR

S1189XA OTHER OPEN WOUND OF OTH PART OF NECK INIT ENCNTR

T463X4A

POISONING BY CORONARY VASODILATORS UNDETERMINED INIT

S1190XA

UNSP OPEN WOUND OF UNSPECIFIED PART OF NECK INIT ENCNTR

T464X1A

POISONING BY ANGIOTENS-CONVERT-ENZYME INHIBITORS ACC INIT

S1191XA

LACERATION W/O FOREIGN BODY OF UNSP PART OF NECK INIT

T464X2A

POISN BY ANGIOTENS-CONVERT-ENZYME INHIBTR SELF-HARM INIT

S1192XA

LACERATION W FOREIGN BODY OF UNSP PART OF NECK INIT ENCNTR

T464X3A

POISONING BY ANGIOTENS-CONVERT-ENZYME INHIBTR ASSAULT INIT

S1193XA

PUNCTURE WOUND W/O FOREIGN BODY OF UNSP PART OF NECK INIT

T464X4A

POISONING BY ANGIOTENS-CONVERT-ENZYME INHIBTR UNDET INIT

S1194XA

PUNCTURE WOUND W FOREIGN BODY OF UNSP PART OF NECK INIT

T465X1A

POISONING BY OTH ANTIHYPERTN DRUGS ACCIDENTAL INIT

S1195XA

OPEN BITE OF UNSPECIFIED PART OF NECK INITIAL ENCOUNTER

T465X2A

POISONING BY OTH ANTIHYPERTENSIVE DRUGS SELF-HARM INIT

S12000A

UNSP DISP FX OF FIRST CERVICAL VERTEBRA INIT FOR CLOS FX

T465X3A

POISONING BY OTH ANTIHYPERTENSIVE DRUGS ASSAULT INIT

S12001A

UNSP NONDISP FX OF FIRST CERVICAL VERTEBRA INIT FOR CLOS FX

T465X4A

POISONING BY OTH ANTIHYPERTENSIVE DRUGS UNDETERMINED INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12001B

UNSP NONDISP FX OF FIRST CERVICAL VERTEBRA INIT FOR OPN FX

T466X1A

POISONING BY ANTIHYPERLIP AND ANTIARTERIO DRUGS ACC INIT

S1201XA STABLE BURST FRACTURE OF FIRST CERVICAL VERTEBRA INIT

T466X2A

POISN BY ANTIHYPERLIP AND ANTIARTERIO DRUGS SELF-HARM INIT

S1201XB

STABLE BURST FX FIRST CERVCAL VERTEBRA INIT FOR OPN FX

T466X3A

POISN BY ANTIHYPERLIP AND ANTIARTERIO DRUGS ASSAULT INIT

S1202XA UNSTABLE BURST FRACTURE OF FIRST CERVICAL VERTEBRA INIT

T466X4A

POISONING BY ANTIHYPERLIP AND ANTIARTERIO DRUGS UNDET INIT

S1202XB

UNSTABLE BURST FX FIRST CERVCAL VERTEBRA INIT FOR OPN FX

T467X1A

POISONING BY PERIPHERAL VASODILATORS ACCIDENTAL INIT

S12030A DISPLACED POSTERIOR ARCH FX FIRST CERVCAL VERTEBRA INIT

T467X2A

POISONING BY PERIPHERAL VASODILATORS SELF-HARM INIT

S12030B

DISPL POST ARCH FX FIRST CERVCAL VERTEBRA INIT FOR OPN FX

T467X3A

POISONING BY PERIPHERAL VASODILATORS ASSAULT INIT ENCNTR

S12031A NONDISP POSTERIOR ARCH FX FIRST CERVCAL VERTEBRA INIT

T467X4A

POISONING BY PERIPHERAL VASODILATORS UNDETERMINED INIT

S12031B

NONDISP POST ARCH FX FIRST CERVCAL VERTEBRA INIT FOR OPN FX

T468X1A

POISONING BY ANTIVARIC DRUGS INC SCLER AGENTS ACC INIT

S12040A DISPLACED LATERAL MASS FX FIRST CERVCAL VERTEBRA INIT

T468X2A

POISN BY ANTIVARIC DRUGS INC SCLER AGENTS SELF-HARM INIT

S12040B DISPL LATERAL MASS FX FIRST CERVCAL VERT INIT FOR OPN FX

T468X3A

POISN BY ANTIVARIC DRUGS INC SCLER AGENTS ASSAULT INIT

S12041A NONDISP LATERAL MASS FX FIRST CERVCAL VERTEBRA INIT

T468X4A

POISONING BY ANTIVARIC DRUGS INC SCLER AGENTS UNDET INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12041B

NONDISP LATERAL MASS FX FIRST CERVCAL VERT INIT FOR OPN FX

T46901A

POISONING BY UNSP AGENTS AFF THE CARDIOVASC SYS ACC INIT

S12090A OTH DISP FX OF FIRST CERVICAL VERTEBRA INIT FOR CLOS FX

T46902A

POISN BY UNSP AGENTS AFF THE CARDIOVASC SYS SELF-HARM INIT

S12090B OTH DISP FX OF FIRST CERVICAL VERTEBRA INIT FOR OPN FX

T46903A

POISN BY UNSP AGENTS AFF THE CARDIOVASC SYS ASSAULT INIT

S12091A

OTH NONDISP FX OF FIRST CERVICAL VERTEBRA INIT FOR CLOS FX

T46904A

POISONING BY UNSP AGENTS AFF THE CARDIOVASC SYS UNDET INIT

S12091B

OTH NONDISP FX OF FIRST CERVICAL VERTEBRA INIT FOR OPN FX

T46991A

POISONING BY OTH AGENTS AFF THE CARDIOVASC SYS ACC INIT

S12100A

UNSP DISP FX OF SECOND CERVICAL VERTEBRA INIT FOR CLOS FX

T46992A

POISN BY OTH AGENTS AFF THE CARDIOVASC SYS SELF-HARM INIT

S12100B

UNSP DISP FX OF SECOND CERVICAL VERTEBRA INIT FOR OPN FX

T46993A

POISN BY OTH AGENTS AFF THE CARDIOVASC SYS ASSAULT INIT

S12101A UNSP NONDISP FX OF SECOND CERVICAL VERTEBRA INIT

T46994A

POISONING BY OTH AGENTS AFF THE CARDIOVASC SYS UNDET INIT

S12101B

UNSP NONDISP FX OF SECOND CERVICAL VERTEBRA INIT FOR OPN FX

T470X1A

POISONING BY HISTAMINE H2-RECEPTOR BLOCKERS ACC INIT

S12110A

ANTERIOR DISPLACED TYPE II DENS FRACTURE INIT FOR CLOS FX

T470X2A

POISONING BY HISTAMINE H2-RECEPTOR BLOCKERS SELF-HARM INIT

S12110B

ANTERIOR DISPLACED TYPE II DENS FRACTURE INIT FOR OPN FX

T470X3A

POISONING BY HISTAMINE H2-RECEPTOR BLOCKERS ASSAULT INIT

S12111A

POSTERIOR DISPLACED TYPE II DENS FRACTURE INIT FOR CLOS FX

T470X4A

POISONING BY HISTAMINE H2-RECEPTOR BLOCKERS UNDET INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12111B

POSTERIOR DISPLACED TYPE II DENS FRACTURE INIT FOR OPN FX

T471X1A

POISN BY OTH ANTACIDS AND ANTI-GSTRC-SEC DRUGS ACC INIT

S12112A NONDISPLACED TYPE II DENS FRACTURE INIT FOR CLOS FX

T471X2A

POISN BY OTH ANTACIDS & ANTI-GSTRC-SEC DRUGS SLF-HRM INIT

S12112B NONDISPLACED TYPE II DENS FRACTURE INIT FOR OPN FX

T471X3A

POISN BY OTH ANTACIDS AND ANTI-GSTRC-SEC DRUGS ASSLT INIT

S12120A

OTH DISPLACED DENS FRACTURE INIT ENCNTR FOR CLOSED FRACTURE

T471X4A

POISN BY OTH ANTACIDS AND ANTI-GSTRC-SEC DRUGS UNDET INIT

S12120B

OTHER DISPLACED DENS FRACTURE INIT ENCNTR FOR OPEN FRACTURE

T472X1A

POISONING BY STIMULANT LAXATIVES ACCIDENTAL INIT

S12121A OTH NONDISPLACED DENS FRACTURE INIT FOR CLOS FX

T472X2A

POISONING BY STIMULANT LAXATIVES SELF-HARM INIT

S12121B OTH NONDISPLACED DENS FRACTURE INIT FOR OPN FX

T472X3A

POISONING BY STIMULANT LAXATIVES ASSAULT INITIAL ENCOUNTER

S12130A

UNSP TRAUM DISPL SPONDYLOLYSIS OF SECOND CERVCAL VERT INIT

T472X4A

POISONING BY STIMULANT LAXATIVES UNDETERMINED INIT ENCNTR

S12130B

UNSP TRAUM DISPL SPONDYLOLYSIS OF 2ND CERVCAL VERT 7THB

T473X1A

POISONING BY SALINE AND OSMOTIC LAXATIVES ACCIDENTAL INIT

S12131A

UNSP TRAUM NONDISP SPONDYLOLYSIS OF 2ND CERVCAL VERT INIT

T473X2A

POISONING BY SALINE AND OSMOTIC LAXATIVES SELF-HARM INIT

S12131B

UNSP TRAUM NONDISP SPONDYLOLYSIS OF 2ND CERVCAL VERT 7THB

T473X3A

POISONING BY SALINE AND OSMOTIC LAXATIVES ASSAULT INIT

S1214XA TYPE III TRAUM SPONDYLOLYSIS OF SECOND CERVCAL VERT INIT

T473X4A

POISONING BY SALINE AND OSMOTIC LAXATIVES UNDET INIT

S1214XB TYPE III TRAUM SPONDYLOLYSIS OF 2ND CERVCAL VERT 7THB

T474X1A

POISONING BY OTH LAXATIVES ACCIDENTAL (UNINTENTIONAL) INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12150A

OTH TRAUM DISPL SPONDYLOLYSIS OF SECOND CERVCAL VERT INIT

T474X2A

POISONING BY OTH LAXATIVES INTENTIONAL SELF-HARM INIT

S12150B

OTH TRAUM DISPL SPONDYLOLYSIS OF 2ND CERVCAL VERT 7THB

T474X3A

POISONING BY OTHER LAXATIVES ASSAULT INITIAL ENCOUNTER

S12151A

OTH TRAUM NONDISP SPONDYLOLYSIS OF SECOND CERVCAL VERT INIT

T474X4A

POISONING BY OTHER LAXATIVES UNDETERMINED INIT ENCNTR

S12151B

OTH TRAUM NONDISP SPONDYLOLYSIS OF 2ND CERVCAL VERT 7THB

T475X1A

POISONING BY DIGESTANTS ACCIDENTAL (UNINTENTIONAL) INIT

S12190A

OTH DISP FX OF SECOND CERVICAL VERTEBRA INIT FOR CLOS FX

T475X2A

POISONING BY DIGESTANTS INTENTIONAL SELF-HARM INIT ENCNTR

S12190B

OTH DISP FX OF SECOND CERVICAL VERTEBRA INIT FOR OPN FX

T475X3A

POISONING BY DIGESTANTS ASSAULT INITIAL ENCOUNTER

S12191A

OTH NONDISP FX OF SECOND CERVICAL VERTEBRA INIT FOR CLOS FX

T475X4A

POISONING BY DIGESTANTS UNDETERMINED INITIAL ENCOUNTER

S12191B

OTH NONDISP FX OF SECOND CERVICAL VERTEBRA INIT FOR OPN FX

T476X1A

POISONING BY ANTIDIARRHEAL DRUGS ACCIDENTAL INIT

S12200A

UNSP DISP FX OF THIRD CERVICAL VERTEBRA INIT FOR CLOS FX

T476X2A

POISONING BY ANTIDIARRHEAL DRUGS SELF-HARM INIT

S12200B

UNSP DISP FX OF THIRD CERVICAL VERTEBRA INIT FOR OPN FX

T476X3A

POISONING BY ANTIDIARRHEAL DRUGS ASSAULT INITIAL ENCOUNTER

S12201A

UNSP NONDISP FX OF THIRD CERVICAL VERTEBRA INIT FOR CLOS FX

T476X4A

POISONING BY ANTIDIARRHEAL DRUGS UNDETERMINED INIT ENCNTR

S12201B

UNSP NONDISP FX OF THIRD CERVICAL VERTEBRA INIT FOR OPN FX

T477X1A

POISONING BY EMETICS ACCIDENTAL (UNINTENTIONAL) INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12230A

UNSP TRAUM DISPL SPONDYLOLYSIS OF THIRD CERVCAL VERT INIT

T477X2A

POISONING BY EMETICS INTENTIONAL SELF-HARM INIT ENCNTR

S12230B

UNSP TRAUM DISPL SPONDYLOLYSIS OF 3RD CERVCAL VERT 7THB

T477X3A

POISONING BY EMETICS ASSAULT INITIAL ENCOUNTER

S12231A

UNSP TRAUM NONDISP SPONDYLOLYSIS OF THIRD CERVCAL VERT INIT

T477X4A

POISONING BY EMETICS UNDETERMINED INITIAL ENCOUNTER

S12231B

UNSP TRAUM NONDISP SPONDYLOLYSIS OF 3RD CERVCAL VERT 7THB

T478X1A

POISONING BY OTH AGENTS AFF GI SYS ACCIDENTAL INIT

S1224XA

TYPE III TRAUM SPONDYLOLYSIS OF THIRD CERVCAL VERTEBRA INIT

T478X2A

POISONING BY OTH AGENTS AFF GI SYS SELF-HARM INIT

S1224XB TYPE III TRAUM SPONDYLOLYSIS OF 3RD CERVCAL VERT 7THB

T478X3A

POISONING BY OTH AGENTS AFF GI SYS ASSAULT INIT

S12250A

OTH TRAUM DISPL SPONDYLOLYSIS OF THIRD CERVCAL VERT INIT

T478X4A

POISONING BY OTH AGENTS AFF GI SYS UNDETERMINED INIT

S12250B

OTH TRAUM DISPL SPONDYLOLYSIS OF 3RD CERVCAL VERT 7THB

T4791XA

POISONING BY UNSP AGENTS AFF THE GI SYS ACCIDENTAL INIT

S12251A

OTH TRAUM NONDISP SPONDYLOLYSIS OF THIRD CERVCAL VERT INIT

T4792XA

POISONING BY UNSP AGENTS AFF THE GI SYS SELF-HARM INIT

S12251B

OTH TRAUM NONDISP SPONDYLOLYSIS OF 3RD CERVCAL VERT 7THB

T4793XA

POISONING BY UNSP AGENTS AFF THE GI SYS ASSAULT INIT

S12290A

OTH DISP FX OF THIRD CERVICAL VERTEBRA INIT FOR CLOS FX

T4794XA

POISONING BY UNSP AGENTS AFF THE GI SYS UNDETERMINED INIT

S12290B

OTH DISP FX OF THIRD CERVICAL VERTEBRA INIT FOR OPN FX

T480X1A

POISONING BY OXYTOCIC DRUGS ACCIDENTAL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12291A

OTH NONDISP FX OF THIRD CERVICAL VERTEBRA INIT FOR CLOS FX

T480X2A

POISONING BY OXYTOCIC DRUGS INTENTIONAL SELF-HARM INIT

S12291B

OTH NONDISP FX OF THIRD CERVICAL VERTEBRA INIT FOR OPN FX

T480X3A

POISONING BY OXYTOCIC DRUGS ASSAULT INITIAL ENCOUNTER

S12300A

UNSP DISP FX OF FOURTH CERVICAL VERTEBRA INIT FOR CLOS FX

T480X4A

POISONING BY OXYTOCIC DRUGS UNDETERMINED INITIAL ENCOUNTER

S12300B

UNSP DISP FX OF FOURTH CERVICAL VERTEBRA INIT FOR OPN FX

T481X1A

POISONING BY SKELETAL MUSCLE RELAXANTS ACCIDENTAL INIT

S12301A UNSP NONDISP FX OF FOURTH CERVICAL VERTEBRA INIT

T481X2A

POISONING BY SKELETAL MUSCLE RELAXANTS SELF-HARM INIT

S12301B

UNSP NONDISP FX OF FOURTH CERVICAL VERTEBRA INIT FOR OPN FX

T481X3A

POISONING BY SKELETAL MUSCLE RELAXANTS ASSAULT INIT ENCNTR

S12330A

UNSP TRAUM DISPL SPONDYLOLYSIS OF FOURTH CERVCAL VERT INIT

T481X4A

POISONING BY SKELETAL MUSCLE RELAXANTS UNDETERMINED INIT

S12330B

UNSP TRAUM DISPL SPONDYLOLYSIS OF 4TH CERVCAL VERT 7THB

T48201A

POISONING BY UNSP DRUGS ACTING ON MUSCLES ACCIDENTAL INIT

S12331A

UNSP TRAUM NONDISP SPONDYLOLYSIS OF 4TH CERVCAL VERT INIT

T48202A

POISONING BY UNSP DRUGS ACTING ON MUSCLES SELF-HARM INIT

S12331B

UNSP TRAUM NONDISP SPONDYLOLYSIS OF 4TH CERVCAL VERT 7THB

T48203A

POISONING BY UNSP DRUGS ACTING ON MUSCLES ASSAULT INIT

S1234XA TYPE III TRAUM SPONDYLOLYSIS OF FOURTH CERVCAL VERT INIT

T48204A

POISONING BY UNSP DRUGS ACTING ON MUSCLES UNDET INIT

S1234XB TYPE III TRAUM SPONDYLOLYSIS OF 4TH CERVCAL VERT 7THB

T48291A

POISONING BY OTH DRUGS ACTING ON MUSCLES ACCIDENTAL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12350A

OTH TRAUM DISPL SPONDYLOLYSIS OF FOURTH CERVCAL VERT INIT

T48292A

POISONING BY OTH DRUGS ACTING ON MUSCLES SELF-HARM INIT

S12350B

OTH TRAUM DISPL SPONDYLOLYSIS OF 4TH CERVCAL VERT 7THB

T48293A

POISONING BY OTH DRUGS ACTING ON MUSCLES ASSAULT INIT

S12351A

OTH TRAUM NONDISP SPONDYLOLYSIS OF FOURTH CERVCAL VERT INIT

T48294A

POISONING BY OTH DRUGS ACTING ON MUSCLES UNDETERMINED INIT

S12351B

OTH TRAUM NONDISP SPONDYLOLYSIS OF 4TH CERVCAL VERT 7THB

T483X1A

POISONING BY ANTITUSSIVES ACCIDENTAL (UNINTENTIONAL) INIT

S12390A

OTH DISP FX OF FOURTH CERVICAL VERTEBRA INIT FOR CLOS FX

T483X2A

POISONING BY ANTITUSSIVES INTENTIONAL SELF-HARM INIT

S12390B

OTH DISP FX OF FOURTH CERVICAL VERTEBRA INIT FOR OPN FX

T483X3A

POISONING BY ANTITUSSIVES ASSAULT INITIAL ENCOUNTER

S12391A

OTH NONDISP FX OF FOURTH CERVICAL VERTEBRA INIT FOR CLOS FX

T483X4A

POISONING BY ANTITUSSIVES UNDETERMINED INITIAL ENCOUNTER

S12391B

OTH NONDISP FX OF FOURTH CERVICAL VERTEBRA INIT FOR OPN FX

T484X1A

POISONING BY EXPECTORANTS ACCIDENTAL (UNINTENTIONAL) INIT

S12400A

UNSP DISP FX OF FIFTH CERVICAL VERTEBRA INIT FOR CLOS FX

T484X2A

POISONING BY EXPECTORANTS INTENTIONAL SELF-HARM INIT

S12400B

UNSP DISP FX OF FIFTH CERVICAL VERTEBRA INIT FOR OPN FX

T484X3A

POISONING BY EXPECTORANTS ASSAULT INITIAL ENCOUNTER

S12401A

UNSP NONDISP FX OF FIFTH CERVICAL VERTEBRA INIT FOR CLOS FX

T484X4A

POISONING BY EXPECTORANTS UNDETERMINED INITIAL ENCOUNTER

S12401B

UNSP NONDISP FX OF FIFTH CERVICAL VERTEBRA INIT FOR OPN FX

T485X1A

POISONING BY OTH ANTI-CMN-COLD DRUGS ACCIDENTAL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12430A

UNSP TRAUM DISPL SPONDYLOLYSIS OF FIFTH CERVCAL VERT INIT

T485X2A

POISONING BY OTH ANTI-COMMON-COLD DRUGS SELF-HARM INIT

S12430B

UNSP TRAUM DISPL SPONDYLOLYSIS OF 5TH CERVCAL VERT 7THB

T485X3A

POISONING BY OTH ANTI-COMMON-COLD DRUGS ASSAULT INIT

S12431A

UNSP TRAUM NONDISP SPONDYLOLYSIS OF FIFTH CERVCAL VERT INIT

T485X4A

POISONING BY OTH ANTI-COMMON-COLD DRUGS UNDETERMINED INIT

S12431B

UNSP TRAUM NONDISP SPONDYLOLYSIS OF 5TH CERVCAL VERT 7THB

T486X1A

POISONING BY ANTIASTHMATICS ACCIDENTAL INIT

S1244XA

TYPE III TRAUM SPONDYLOLYSIS OF FIFTH CERVCAL VERTEBRA INIT

T486X2A

POISONING BY ANTIASTHMATICS INTENTIONAL SELF-HARM INIT

S1244XB TYPE III TRAUM SPONDYLOLYSIS OF 5TH CERVCAL VERT 7THB

T486X3A

POISONING BY ANTIASTHMATICS ASSAULT INITIAL ENCOUNTER

S12450A

OTH TRAUM DISPL SPONDYLOLYSIS OF FIFTH CERVCAL VERT INIT

T486X4A

POISONING BY ANTIASTHMATICS UNDETERMINED INITIAL ENCOUNTER

S12450B

OTH TRAUM DISPL SPONDYLOLYSIS OF 5TH CERVCAL VERT 7THB

T48901A

POISN BY UNSP AGENTS PRIM ACTING ON THE RESP SYS ACC INIT

S12451A

OTH TRAUM NONDISP SPONDYLOLYSIS OF FIFTH CERVCAL VERT INIT

T48902A

POISN BY UNSP AGENTS PRIM ACT ON THE RESP SYS SLF-HRM INIT

S12451B

OTH TRAUM NONDISP SPONDYLOLYSIS OF 5TH CERVCAL VERT 7THB

T48903A

POISN BY UNSP AGENTS PRIM ACT ON THE RESP SYS ASSLT INIT

S12490A OTH DISP FX OF FIFTH CERVICAL VERTEBRA INIT FOR CLOS FX

T48904A

POISN BY UNSP AGENTS PRIM ACT ON THE RESP SYS UNDET INIT

S12490B OTH DISP FX OF FIFTH CERVICAL VERTEBRA INIT FOR OPN FX

T48991A

POISN BY OTH AGENTS PRIM ACTING ON THE RESP SYS ACC INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12491A

OTH NONDISP FX OF FIFTH CERVICAL VERTEBRA INIT FOR CLOS FX

T48992A

POISN BY OTH AGENTS PRIM ACT ON THE RESP SYS SLF-HRM INIT

S12491B

OTH NONDISP FX OF FIFTH CERVICAL VERTEBRA INIT FOR OPN FX

T48993A

POISN BY OTH AGENTS PRIM ACTING ON THE RESP SYS ASSLT INIT

S12500A

UNSP DISP FX OF SIXTH CERVICAL VERTEBRA INIT FOR CLOS FX

T48994A

POISN BY OTH AGENTS PRIM ACTING ON THE RESP SYS UNDET INIT

S12500B

UNSP DISP FX OF SIXTH CERVICAL VERTEBRA INIT FOR OPN FX

T490X1A

POISONING BY LOCAL ANTIFUNG/INFECT/INFLAMM DRUGS ACC INIT

S12501A

UNSP NONDISP FX OF SIXTH CERVICAL VERTEBRA INIT FOR CLOS FX

T490X2A

POISN BY LOCAL ANTIFUNG/INFECT/INFLAMM DRUGS SLF-HRM INIT

S12501B

UNSP NONDISP FX OF SIXTH CERVICAL VERTEBRA INIT FOR OPN FX

T490X3A

POISN BY LOCAL ANTIFUNG/INFECT/INFLAMM DRUGS ASSAULT INIT

S12530A

UNSP TRAUM DISPL SPONDYLOLYSIS OF SIXTH CERVCAL VERT INIT

T490X4A

POISN BY LOCAL ANTIFUNG/INFECT/INFLAMM DRUGS UNDET INIT

S12530B

UNSP TRAUM DISPL SPONDYLOLYSIS OF SIXTH CERVCAL VERT 7THB

T491X1A

POISONING BY ANTIPRURITICS ACCIDENTAL (UNINTENTIONAL) INIT

S12531A

UNSP TRAUM NONDISP SPONDYLOLYSIS OF SIXTH CERVCAL VERT INIT

T491X2A

POISONING BY ANTIPRURITICS INTENTIONAL SELF-HARM INIT

S12531B

UNSP TRAUM NONDISP SPONDYLOLYSIS OF SIXTH CERVCAL VERT 7THB

T491X3A

POISONING BY ANTIPRURITICS ASSAULT INITIAL ENCOUNTER

S1254XA

TYPE III TRAUM SPONDYLOLYSIS OF SIXTH CERVCAL VERTEBRA INIT

T491X4A

POISONING BY ANTIPRURITICS UNDETERMINED INITIAL ENCOUNTER

S1254XB TYPE III TRAUM SPONDYLOLYSIS OF SIXTH CERVCAL VERT 7THB

T492X1A

POISONING BY LOCAL ASTRINGENTS/DETERGENTS ACCIDENTAL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12550A

OTH TRAUM DISPL SPONDYLOLYSIS OF SIXTH CERVCAL VERT INIT

T492X2A

POISONING BY LOCAL ASTRINGENTS/DETERGENTS SELF-HARM INIT

S12550B

OTH TRAUM DISPL SPONDYLOLYSIS OF SIXTH CERVCAL VERT 7THB

T492X3A

POISONING BY LOCAL ASTRINGENTS/DETERGENTS ASSAULT INIT

S12551A

OTH TRAUM NONDISP SPONDYLOLYSIS OF SIXTH CERVCAL VERT INIT

T492X4A

POISONING BY LOCAL ASTRINGENTS/DETERGENTS UNDET INIT

S12551B

OTH TRAUM NONDISP SPONDYLOLYSIS OF SIXTH CERVCAL VERT 7THB

T493X1A

POISONING BY EMOLLIENTS DEMULCENTS AND PROTECT ACC INIT

S12590A OTH DISP FX OF SIXTH CERVICAL VERTEBRA INIT FOR CLOS FX

T493X2A

POISN BY EMOLLIENTS DEMULCENTS AND PROTECT SELF-HARM INIT

S12590B OTH DISP FX OF SIXTH CERVICAL VERTEBRA INIT FOR OPN FX

T493X3A

POISN BY EMOLLIENTS DEMULCENTS AND PROTECT ASSAULT INIT

S12591A

OTH NONDISP FX OF SIXTH CERVICAL VERTEBRA INIT FOR CLOS FX

T493X4A

POISONING BY EMOLLIENTS DEMULCENTS AND PROTECT UNDET INIT

S12591B

OTH NONDISP FX OF SIXTH CERVICAL VERTEBRA INIT FOR OPN FX

T494X1A

POISONING BY KERATOLYT/KERATPLST/HAIR TRMT DRUG ACC INIT

S12600A

UNSP DISP FX OF SEVENTH CERVICAL VERTEBRA INIT FOR CLOS FX

T494X2A

POISN BY KERATOLYT/KERATPLST/HAIR TRMT DRUG SELF-HARM INIT

S12600B

UNSP DISP FX OF SEVENTH CERVICAL VERTEBRA INIT FOR OPN FX

T494X3A

POISN BY KERATOLYT/KERATPLST/HAIR TRMT DRUG ASSAULT INIT

S12601A UNSP NONDISP FX OF SEVENTH CERVICAL VERTEBRA INIT

T494X4A

POISONING BY KERATOLYT/KERATPLST/HAIR TRMT DRUG UNDET INIT

S12601B

UNSP NONDISP FX OF SEVENTH CERVCAL VERTEBRA INIT FOR OPN FX

T495X1A

POISONING BY OPTH DRUGS AND PREPARATIONS ACCIDENTAL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12630A

UNSP TRAUM DISPL SPONDYLOLYSIS OF SEVENTH CERVCAL VERT INIT

T495X2A

POISONING BY OPTH DRUGS AND PREPARATIONS SELF-HARM INIT

S12630B

UNSP TRAUM DISPL SPONDYLOLYSIS OF 7TH CERVCAL VERT 7THB

T495X3A

POISONING BY OPTH DRUGS AND PREPARATIONS ASSAULT INIT

S12631A

UNSP TRAUM NONDISP SPONDYLOLYSIS OF 7TH CERVCAL VERT INIT

T495X4A

POISONING BY OPTH DRUGS AND PREPARATIONS UNDETERMINED INIT

S12631B

UNSP TRAUM NONDISP SPONDYLOLYSIS OF 7TH CERVCAL VERT 7THB

T496X1A

POISONING BY OTORHINO DRUGS AND PREP ACCIDENTAL INIT

S1264XA

TYPE III TRAUM SPONDYLOLYSIS OF SEVENTH CERVCAL VERT INIT

T496X2A

POISONING BY OTORHINO DRUGS AND PREP SELF-HARM INIT

S1264XB TYPE III TRAUM SPONDYLOLYSIS OF 7TH CERVCAL VERT 7THB

T496X3A

POISONING BY OTORHINO DRUGS AND PREPARATIONS ASSAULT INIT

S12650A

OTH TRAUM DISPL SPONDYLOLYSIS OF SEVENTH CERVCAL VERT INIT

T496X4A

POISONING BY OTORHINO DRUGS AND PREP UNDETERMINED INIT

S12650B

OTH TRAUM DISPL SPONDYLOLYSIS OF 7TH CERVCAL VERT 7THB

T497X1A

POISONING BY DENTAL DRUGS TOPICALLY APPLIED ACC INIT

S12651A

OTH TRAUM NONDISP SPONDYLOLYSIS OF 7TH CERVCAL VERT INIT

T497X2A

POISN BY DENTAL DRUGS TOPICALLY APPLIED SELF-HARM INIT

S12651B

OTH TRAUM NONDISP SPONDYLOLYSIS OF 7TH CERVCAL VERT 7THB

T497X3A

POISONING BY DENTAL DRUGS TOPICALLY APPLIED ASSAULT INIT

S12690A

OTH DISP FX OF SEVENTH CERVICAL VERTEBRA INIT FOR CLOS FX

T497X4A

POISONING BY DENTAL DRUGS TOPICALLY APPLIED UNDET INIT

S12690B

OTH DISP FX OF SEVENTH CERVICAL VERTEBRA INIT FOR OPN FX

T498X1A

POISONING BY OTH TOPICAL AGENTS ACCIDENTAL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S12691A OTH NONDISP FX OF SEVENTH CERVICAL VERTEBRA INIT

T498X2A

POISONING BY OTH TOPICAL AGENTS INTENTIONAL SELF-HARM INIT

S12691B

OTH NONDISP FX OF SEVENTH CERVICAL VERTEBRA INIT FOR OPN FX

T498X3A

POISONING BY OTHER TOPICAL AGENTS ASSAULT INIT ENCNTR

S128XXA FRACTURE OF OTHER PARTS OF NECK INITIAL ENCOUNTER

T498X4A

POISONING BY OTHER TOPICAL AGENTS UNDETERMINED INIT ENCNTR

S129XXA

FRACTURE OF NECK UNSPECIFIED INITIAL ENCOUNTER

T4991XA

POISONING BY UNSP TOPICAL AGENT ACCIDENTAL INIT

S130XXA

TRAUMATIC RUPTURE OF CERVICAL INTERVERTEBRAL DISC INIT

T4992XA

POISONING BY UNSP TOPICAL AGENT INTENTIONAL SELF-HARM INIT

S13100A

SUBLUXATION OF UNSPECIFIED CERVICAL VERTEBRAE INIT ENCNTR

T4993XA

POISONING BY UNSPECIFIED TOPICAL AGENT ASSAULT INIT ENCNTR

S13101A

DISLOCATION OF UNSPECIFIED CERVICAL VERTEBRAE INIT ENCNTR

T4994XA

POISONING BY UNSP TOPICAL AGENT UNDETERMINED INIT ENCNTR

S13110A

SUBLUXATION OF C0/C1 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T500X1A

POISONING BY MINERALOCORTICOIDS AND THEIR ANTAG ACC INIT

S13111A

DISLOCATION OF C0/C1 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T500X2A

POISONING BY MINERALOCORTICOIDS AND ANTAG SELF-HARM INIT

S13120A

SUBLUXATION OF C1/C2 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T500X3A

POISONING BY MINERALOCORTICOIDS AND ANTAG ASSAULT INIT

S13121A

DISLOCATION OF C1/C2 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T500X4A

POISONING BY MINERALOCORTICOIDS AND THEIR ANTAG UNDET INIT

S13130A

SUBLUXATION OF C2/C3 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T501X1A

POISONING BY LOOP DIURETICS ACCIDENTAL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S13131A

DISLOCATION OF C2/C3 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T501X2A

POISONING BY LOOP DIURETICS INTENTIONAL SELF-HARM INIT

S13140A

SUBLUXATION OF C3/C4 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T501X3A

POISONING BY LOOP DIURETICS ASSAULT INITIAL ENCOUNTER

S13141A

DISLOCATION OF C3/C4 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T501X4A

POISONING BY LOOP DIURETICS UNDETERMINED INITIAL ENCOUNTER

S13150A

SUBLUXATION OF C4/C5 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T502X1A

POISN BY CRBNC-ANHYDR INHIBTR BENZO/OTH DIURETC ACC INIT

S13151A

DISLOCATION OF C4/C5 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T502X2A

POISN BY CRBNC-ANHYDR INHIBTRBENZO/OTH DIURETCSLF-HRMINIT

S13160A

SUBLUXATION OF C5/C6 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T502X3A

POISN BY CRBNC-ANHYDR INHIBTRBENZO/OTH DIURETC ASSLT INIT

S13161A

DISLOCATION OF C5/C6 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T502X4A

POISN BY CRBNC-ANHYDR INHIBTRBENZO/OTH DIURETC UNDET INIT

S13170A

SUBLUXATION OF C6/C7 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T503X1A

POISONING BY ELECTROLYTIC/CALORIC/WTR-BAL AGNT ACC INIT

S13171A

DISLOCATION OF C6/C7 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T503X2A

POISN BY ELECTROLYTIC/CALORIC/WTR-BAL AGNT SELF-HARM INIT

S13180A

SUBLUXATION OF C7/T1 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T503X3A

POISN BY ELECTROLYTIC/CALORIC/WTR-BAL AGNT ASSAULT INIT

S13181A

DISLOCATION OF C7/T1 CERVICAL VERTEBRAE INITIAL ENCOUNTER

T503X4A

POISONING BY ELECTROLYTIC/CALORIC/WTR-BAL AGNT UNDET INIT

S1320XA

DISLOCATION OF UNSPECIFIED PARTS OF NECK INITIAL ENCOUNTER

T504X1A

POISONING BY DRUGS AFFECTING URIC ACID METAB ACC INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S1329XA DISLOCATION OF OTHER PARTS OF NECK INITIAL ENCOUNTER

T504X2A

POISONING BY DRUGS AFF URIC ACID METAB SELF-HARM INIT

S134XXA

SPRAIN OF LIGAMENTS OF CERVICAL SPINE INITIAL ENCOUNTER

T504X3A

POISONING BY DRUGS AFFECTING URIC ACID METAB ASSAULT INIT

S135XXA SPRAIN OF THYROID REGION INITIAL ENCOUNTER

T504X4A

POISONING BY DRUGS AFFECTING URIC ACID METAB UNDET INIT

S138XXA

SPRAIN OF JOINTS AND LIGAMENTS OF OTH PRT NECK INIT ENCNTR

T505X1A

POISONING BY APPETITE DEPRESSANTS ACCIDENTAL INIT

S139XXA

SPRAIN OF JOINTS AND LIGAMENTS OF UNSP PARTS OF NECK INIT

T505X2A

POISONING BY APPETITE DEPRESSANTS SELF-HARM INIT

S140XXA

CONCUSSION AND EDEMA OF CERVICAL SPINAL CORD INIT ENCNTR

T505X3A

POISONING BY APPETITE DEPRESSANTS ASSAULT INIT ENCNTR

S14101A

UNSP INJURY AT C1 LEVEL OF CERVICAL SPINAL CORD INIT ENCNTR

T505X4A

POISONING BY APPETITE DEPRESSANTS UNDETERMINED INIT ENCNTR

S14102A

UNSP INJURY AT C2 LEVEL OF CERVICAL SPINAL CORD INIT ENCNTR

T506X1A

POISONING BY ANTIDOTES AND CHELATING AGENTS ACC INIT

S14103A

UNSP INJURY AT C3 LEVEL OF CERVICAL SPINAL CORD INIT ENCNTR

T506X2A

POISONING BY ANTIDOTES AND CHELATING AGENTS SELF-HARM INIT

S14104A

UNSP INJURY AT C4 LEVEL OF CERVICAL SPINAL CORD INIT ENCNTR

T506X3A

POISONING BY ANTIDOTES AND CHELATING AGENTS ASSAULT INIT

S14105A

UNSP INJURY AT C5 LEVEL OF CERVICAL SPINAL CORD INIT ENCNTR

T506X4A

POISONING BY ANTIDOTES AND CHELATING AGENTS UNDET INIT

S14106A

UNSP INJURY AT C6 LEVEL OF CERVICAL SPINAL CORD INIT ENCNTR

T507X1A

POISN BY ANALEPTICS AND OPIOID RECEPTOR ANTAG ACC INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S14107A

UNSP INJURY AT C7 LEVEL OF CERVICAL SPINAL CORD INIT ENCNTR

T507X2A

POISN BY ANALEPTICS AND OPIOID RECEPTOR ANTAG SLF-HRM INIT

S14108A

UNSP INJURY AT C8 LEVEL OF CERVICAL SPINAL CORD INIT ENCNTR

T507X3A

POISN BY ANALEPTICS AND OPIOID RECEPTOR ANTAG ASSAULT INIT

S14109A UNSP INJURY AT UNSP LEVEL OF CERVICAL SPINAL CORD INIT

T507X4A

POISN BY ANALEPTICS AND OPIOID RECEPTOR ANTAG UNDET INIT

S14111A COMPLETE LESION AT C1 LEVEL OF CERVICAL SPINAL CORD INIT

T508X1A

POISONING BY DIAGNOSTIC AGENTS ACCIDENTAL INIT

S14112A COMPLETE LESION AT C2 LEVEL OF CERVICAL SPINAL CORD INIT

T508X2A

POISONING BY DIAGNOSTIC AGENTS INTENTIONAL SELF-HARM INIT

S14113A COMPLETE LESION AT C3 LEVEL OF CERVICAL SPINAL CORD INIT

T508X3A

POISONING BY DIAGNOSTIC AGENTS ASSAULT INITIAL ENCOUNTER

S14114A COMPLETE LESION AT C4 LEVEL OF CERVICAL SPINAL CORD INIT

T508X4A

POISONING BY DIAGNOSTIC AGENTS UNDETERMINED INIT ENCNTR

S14115A COMPLETE LESION AT C5 LEVEL OF CERVICAL SPINAL CORD INIT

T50901A

POISONING BY UNSP DRUG/MEDS/BIOL SUBST ACCIDENTAL INIT

S14116A COMPLETE LESION AT C6 LEVEL OF CERVICAL SPINAL CORD INIT

T50902A

POISONING BY UNSP DRUG/MEDS/BIOL SUBST SELF-HARM INIT

S14117A COMPLETE LESION AT C7 LEVEL OF CERVICAL SPINAL CORD INIT

T50903A

POISONING BY UNSP DRUG/MEDS/BIOL SUBST ASSAULT INIT

S14118A COMPLETE LESION AT C8 LEVEL OF CERVICAL SPINAL CORD INIT

T50904A

POISONING BY UNSP DRUG/MEDS/BIOL SUBST UNDETERMINED INIT

S14119A

COMPLETE LESION AT UNSP LEVEL OF CERVICAL SPINAL CORD INIT

T50991A

POISONING BY OTH DRUG/MEDS/BIOL SUBST ACCIDENTAL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S14121A CENTRAL CORD SYNDROME AT C1 INIT

T50992A

POISONING BY OTH DRUG/MEDS/BIOL SUBST SELF-HARM INIT

S14122A CENTRAL CORD SYNDROME AT C2 INIT

T50993A

POISONING BY OTH DRUG/MEDS/BIOL SUBST ASSAULT INIT

S14123A CENTRAL CORD SYNDROME AT C3 INIT

T50994A

POISONING BY OTH DRUG/MEDS/BIOL SUBST UNDETERMINED INIT

S14124A CENTRAL CORD SYNDROME AT C4 INIT

T50A11A

POISN BY PERTUSS VACCINE INC COMBIN W PERTUSS ACC INIT

S14125A CENTRAL CORD SYNDROME AT C5 INIT

T50A12A

POISN BY PERTUSS VACCN INC COMBIN W PERTUSS SLF-HRM INIT

S14126A CENTRAL CORD SYNDROME AT C6 INIT

T50A13A

POISN BY PERTUSS VACCINE INC COMBIN W PERTUSS ASSLT INIT

S14127A CENTRAL CORD SYNDROME AT C7 INIT

T50A14A

POISN BY PERTUSS VACCINE INC COMBIN W PERTUSS UNDET INIT

S14128A CENTRAL CORD SYNDROME AT C8 INIT

T50A21A

POISONING BY MIXED BACT VACCINES W/O A PERTUSS ACC INIT

S14129A

CENTRAL CORD SYND AT UNSP LEVEL OF CERV SPINAL CORD INIT

T50A22A

POISN BY MIXED BACT VACCINES W/O A PERTUSS SELF-HARM INIT

S14131A ANTERIOR CORD SYNDROME AT C1 INIT

T50A23A

POISN BY MIXED BACT VACCINES W/O A PERTUSS ASSAULT INIT

S14132A ANTERIOR CORD SYNDROME AT C2 INIT

T50A24A

POISONING BY MIXED BACT VACCINES W/O A PERTUSS UNDET INIT

S14133A ANTERIOR CORD SYNDROME AT C3 INIT

T50A91A

POISONING BY OTH BACTERIAL VACCINES ACCIDENTAL INIT

S14134A ANTERIOR CORD SYNDROME AT C4 INIT

T50A92A

POISONING BY OTH BACTERIAL VACCINES SELF-HARM INIT

S14135A ANTERIOR CORD SYNDROME AT C5 INIT

T50A93A

POISONING BY OTHER BACTERIAL VACCINES ASSAULT INIT ENCNTR

S14136A ANTERIOR CORD SYNDROME AT C6 INIT

T50A94A

POISONING BY OTH BACTERIAL VACCINES UNDETERMINED INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S14137A ANTERIOR CORD SYNDROME AT C7 INIT

T50B11A

POISONING BY SMALLPOX VACCINES ACCIDENTAL INIT

S14138A ANTERIOR CORD SYNDROME AT C8 INIT

T50B12A

POISONING BY SMALLPOX VACCINES INTENTIONAL SELF-HARM INIT

S14139A

ANT CORD SYNDROME AT UNSP LEVEL OF CERV SPINAL CORD INIT

T50B13A

POISONING BY SMALLPOX VACCINES ASSAULT INITIAL ENCOUNTER

S14141A BROWN-SEQUARD SYNDROME AT C1 INIT

T50B14A

POISONING BY SMALLPOX VACCINES UNDETERMINED INIT ENCNTR

S14142A BROWN-SEQUARD SYNDROME AT C2 INIT

T50B91A

POISONING BY OTH VIRAL VACCINES ACCIDENTAL INIT

S14143A BROWN-SEQUARD SYNDROME AT C3 INIT

T50B92A

POISONING BY OTH VIRAL VACCINES INTENTIONAL SELF-HARM INIT

S14144A BROWN-SEQUARD SYNDROME AT C4 INIT

T50B93A

POISONING BY OTHER VIRAL VACCINES ASSAULT INIT ENCNTR

S14145A BROWN-SEQUARD SYNDROME AT C5 INIT

T50B94A

POISONING BY OTHER VIRAL VACCINES UNDETERMINED INIT ENCNTR

S14146A BROWN-SEQUARD SYNDROME AT C6 INIT

T50Z11A

POISONING BY IMMUNOGLOBULIN ACCIDENTAL INIT

S14147A BROWN-SEQUARD SYNDROME AT C7 INIT

T50Z12A

POISONING BY IMMUNOGLOBULIN INTENTIONAL SELF-HARM INIT

S14148A BROWN-SEQUARD SYNDROME AT C8 INIT

T50Z13A

POISONING BY IMMUNOGLOBULIN ASSAULT INITIAL ENCOUNTER

S14149A

BROWN-SEQUARD SYND AT UNSP LEVEL OF CERV SPINAL CORD INIT

T50Z14A

POISONING BY IMMUNOGLOBULIN UNDETERMINED INITIAL ENCOUNTER

S14151A OTH INCOMPLETE LESION AT C1 INIT

T50Z91A

POISONING BY OTH VACCINES AND BIOLG SUBSTANCES ACC INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S14152A OTH INCOMPLETE LESION AT C2 INIT

T50Z92A

POISONING BY OTH VACCINES AND BIOLG SUBSTNC SELF-HARM INIT

S14153A OTH INCOMPLETE LESION AT C3 INIT

T50Z93A

POISONING BY OTH VACCINES AND BIOLG SUBSTNC ASSAULT INIT

S14154A OTH INCOMPLETE LESION AT C4 INIT

T50Z94A

POISONING BY OTH VACCINES AND BIOLG SUBSTANCES UNDET INIT

S14155A OTH INCOMPLETE LESION AT C5 INIT

T510X1A

TOXIC EFFECT OF ETHANOL ACCIDENTAL (UNINTENTIONAL) INIT

S14156A OTH INCOMPLETE LESION AT C6 INIT

T510X2A

TOXIC EFFECT OF ETHANOL INTENTIONAL SELF-HARM INIT ENCNTR

S14157A OTH INCOMPLETE LESION AT C7 INIT

T510X3A

TOXIC EFFECT OF ETHANOL ASSAULT INITIAL ENCOUNTER

S14158A OTH INCOMPLETE LESION AT C8 INIT

T510X4A

TOXIC EFFECT OF ETHANOL UNDETERMINED INITIAL ENCOUNTER

S14159A

OTH INCMPL LESION AT UNSP LEVEL OF CERV SPINAL CORD INIT

T511X1A

TOXIC EFFECT OF METHANOL ACCIDENTAL (UNINTENTIONAL) INIT

S142XXA

INJURY OF NERVE ROOT OF CERVICAL SPINE INITIAL ENCOUNTER

T511X2A

TOXIC EFFECT OF METHANOL INTENTIONAL SELF-HARM INIT ENCNTR

S143XXA INJURY OF BRACHIAL PLEXUS INITIAL ENCOUNTER

T511X3A

TOXIC EFFECT OF METHANOL ASSAULT INITIAL ENCOUNTER

S144XXA INJURY OF PERIPHERAL NERVES OF NECK INITIAL ENCOUNTER

T511X4A

TOXIC EFFECT OF METHANOL UNDETERMINED INITIAL ENCOUNTER

S145XXA

INJURY OF CERVICAL SYMPATHETIC NERVES INITIAL ENCOUNTER

T512X1A

TOXIC EFFECT OF 2-PROPANOL ACCIDENTAL (UNINTENTIONAL) INIT

S148XXA

INJURY OF OTHER SPECIFIED NERVES OF NECK INITIAL ENCOUNTER

T512X2A

TOXIC EFFECT OF 2-PROPANOL INTENTIONAL SELF-HARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S149XXA

INJURY OF UNSPECIFIED NERVES OF NECK INITIAL ENCOUNTER

T512X3A

TOXIC EFFECT OF 2-PROPANOL ASSAULT INITIAL ENCOUNTER

S15001A UNSPECIFIED INJURY OF RIGHT CAROTID ARTERY INIT ENCNTR

T512X4A

TOXIC EFFECT OF 2-PROPANOL UNDETERMINED INITIAL ENCOUNTER

S15002A

UNSPECIFIED INJURY OF LEFT CAROTID ARTERY INITIAL ENCOUNTER

T513X1A

TOXIC EFFECT OF FUSEL OIL ACCIDENTAL (UNINTENTIONAL) INIT

S15009A UNSP INJURY OF UNSPECIFIED CAROTID ARTERY INIT ENCNTR

T513X2A

TOXIC EFFECT OF FUSEL OIL INTENTIONAL SELF-HARM INIT

S15011A

MINOR LACERATION OF RIGHT CAROTID ARTERY INITIAL ENCOUNTER

T513X3A

TOXIC EFFECT OF FUSEL OIL ASSAULT INITIAL ENCOUNTER

S15012A

MINOR LACERATION OF LEFT CAROTID ARTERY INITIAL ENCOUNTER

T513X4A

TOXIC EFFECT OF FUSEL OIL UNDETERMINED INITIAL ENCOUNTER

S15019A

MINOR LACERATION OF UNSPECIFIED CAROTID ARTERY INIT ENCNTR

T518X1A

TOXIC EFFECT OF ALCOHOLS ACCIDENTAL (UNINTENTIONAL) INIT

S15021A

MAJOR LACERATION OF RIGHT CAROTID ARTERY INITIAL ENCOUNTER

T518X2A

TOXIC EFFECT OF OTH ALCOHOLS INTENTIONAL SELF-HARM INIT

S15022A

MAJOR LACERATION OF LEFT CAROTID ARTERY INITIAL ENCOUNTER

T518X3A

TOXIC EFFECT OF OTHER ALCOHOLS ASSAULT INITIAL ENCOUNTER

S15029A

MAJOR LACERATION OF UNSPECIFIED CAROTID ARTERY INIT ENCNTR

T518X4A

TOXIC EFFECT OF OTHER ALCOHOLS UNDETERMINED INIT ENCNTR

S15091A

OTHER SPECIFIED INJURY OF RIGHT CAROTID ARTERY INIT ENCNTR

T5191XA

TOXIC EFFECT OF UNSP ALCOHOL ACCIDENTAL INIT

S15092A

OTHER SPECIFIED INJURY OF LEFT CAROTID ARTERY INIT ENCNTR

T5192XA

TOXIC EFFECT OF UNSP ALCOHOL INTENTIONAL SELF-HARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S15099A OTH INJURY OF UNSPECIFIED CAROTID ARTERY INIT ENCNTR

T5193XA

TOXIC EFFECT OF UNSPECIFIED ALCOHOL ASSAULT INIT ENCNTR

S15101A

UNSPECIFIED INJURY OF RIGHT VERTEBRAL ARTERY INIT ENCNTR

T5194XA

TOXIC EFFECT OF UNSP ALCOHOL UNDETERMINED INIT ENCNTR

S15102A

UNSPECIFIED INJURY OF LEFT VERTEBRAL ARTERY INIT ENCNTR

T520X1A

TOXIC EFFECT OF PETROLEUM PRODUCTS ACCIDENTAL INIT

S15109A

UNSP INJURY OF UNSPECIFIED VERTEBRAL ARTERY INIT ENCNTR

T520X2A

TOXIC EFFECT OF PETROLEUM PRODUCTS SELF-HARM INIT

S15111A

MINOR LACERATION OF RIGHT VERTEBRAL ARTERY INIT ENCNTR

T520X3A

TOXIC EFFECT OF PETROLEUM PRODUCTS ASSAULT INIT ENCNTR

S15112A

MINOR LACERATION OF LEFT VERTEBRAL ARTERY INITIAL ENCOUNTER

T520X4A

TOXIC EFFECT OF PETROLEUM PRODUCTS UNDETERMINED INIT

S15119A

MINOR LACERATION OF UNSP VERTEBRAL ARTERY INIT ENCNTR

T521X1A

TOXIC EFFECT OF BENZENE ACCIDENTAL (UNINTENTIONAL) INIT

S15121A

MAJOR LACERATION OF RIGHT VERTEBRAL ARTERY INIT ENCNTR

T521X2A

TOXIC EFFECT OF BENZENE INTENTIONAL SELF-HARM INIT ENCNTR

S15122A

MAJOR LACERATION OF LEFT VERTEBRAL ARTERY INITIAL ENCOUNTER

T521X3A

TOXIC EFFECT OF BENZENE ASSAULT INITIAL ENCOUNTER

S15129A

MAJOR LACERATION OF UNSP VERTEBRAL ARTERY INIT ENCNTR

T521X4A

TOXIC EFFECT OF BENZENE UNDETERMINED INITIAL ENCOUNTER

S15191A

OTH INJURY OF RIGHT VERTEBRAL ARTERY INIT ENCNTR

T522X1A

TOXIC EFFECT OF HOMOLOGUES OF BENZENE ACCIDENTAL INIT

S15192A

OTHER SPECIFIED INJURY OF LEFT VERTEBRAL ARTERY INIT ENCNTR

T522X2A

TOXIC EFFECT OF HOMOLOGUES OF BENZENE SELF-HARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S15199A

OTH INJURY OF UNSPECIFIED VERTEBRAL ARTERY INIT ENCNTR

T522X3A

TOXIC EFFECT OF HOMOLOGUES OF BENZENE ASSAULT INIT ENCNTR

S15201A

UNSP INJURY OF RIGHT EXTERNAL JUGULAR VEIN INIT ENCNTR

T522X4A

TOXIC EFFECT OF HOMOLOGUES OF BENZENE UNDETERMINED INIT

S15202A

UNSP INJURY OF LEFT EXTERNAL JUGULAR VEIN INIT ENCNTR

T523X1A

TOXIC EFFECT OF GLYCOLS ACCIDENTAL (UNINTENTIONAL) INIT

S15209A

UNSP INJURY OF UNSP EXTERNAL JUGULAR VEIN INIT ENCNTR

T523X2A

TOXIC EFFECT OF GLYCOLS INTENTIONAL SELF-HARM INIT ENCNTR

S15211A

MINOR LACERATION OF RIGHT EXTERNAL JUGULAR VEIN INIT ENCNTR

T523X3A

TOXIC EFFECT OF GLYCOLS ASSAULT INITIAL ENCOUNTER

S15212A

MINOR LACERATION OF LEFT EXTERNAL JUGULAR VEIN INIT ENCNTR

T523X4A

TOXIC EFFECT OF GLYCOLS UNDETERMINED INITIAL ENCOUNTER

S15219A

MINOR LACERATION OF UNSP EXTERNAL JUGULAR VEIN INIT ENCNTR

T524X1A

TOXIC EFFECT OF KETONES ACCIDENTAL (UNINTENTIONAL) INIT

S15221A

MAJOR LACERATION OF RIGHT EXTERNAL JUGULAR VEIN INIT ENCNTR

T524X2A

TOXIC EFFECT OF KETONES INTENTIONAL SELF-HARM INIT ENCNTR

S15222A

MAJOR LACERATION OF LEFT EXTERNAL JUGULAR VEIN INIT ENCNTR

T524X3A

TOXIC EFFECT OF KETONES ASSAULT INITIAL ENCOUNTER

S15229A

MAJOR LACERATION OF UNSP EXTERNAL JUGULAR VEIN INIT ENCNTR

T524X4A

TOXIC EFFECT OF KETONES UNDETERMINED INITIAL ENCOUNTER

S15291A

OTH INJURY OF RIGHT EXTERNAL JUGULAR VEIN INIT ENCNTR

T528X1A

TOXIC EFFECT OF ORGANIC SOLVENTS ACCIDENTAL INIT

S15292A OTH INJURY OF LEFT EXTERNAL JUGULAR VEIN INIT ENCNTR

T528X2A

TOXIC EFFECT OF ORGANIC SOLVENTS SELF-HARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S15299A

OTH INJURY OF UNSPECIFIED EXTERNAL JUGULAR VEIN INIT ENCNTR

T528X3A

TOXIC EFFECT OF OTHER ORGANIC SOLVENTS ASSAULT INIT ENCNTR

S15301A

UNSP INJURY OF RIGHT INTERNAL JUGULAR VEIN INIT ENCNTR

T528X4A

TOXIC EFFECT OF OTH ORGANIC SOLVENTS UNDETERMINED INIT

S15302A UNSP INJURY OF LEFT INTERNAL JUGULAR VEIN INIT ENCNTR

T5291XA

TOXIC EFFECT OF UNSP ORGANIC SOLVENT ACCIDENTAL INIT

S15309A

UNSP INJURY OF UNSP INTERNAL JUGULAR VEIN INIT ENCNTR

T5292XA

TOXIC EFFECT OF UNSP ORGANIC SOLVENT SELF-HARM INIT

S15311A

MINOR LACERATION OF RIGHT INTERNAL JUGULAR VEIN INIT ENCNTR

T5293XA

TOXIC EFFECT OF UNSP ORGANIC SOLVENT ASSAULT INIT ENCNTR

S15312A

MINOR LACERATION OF LEFT INTERNAL JUGULAR VEIN INIT ENCNTR

T5294XA

TOXIC EFFECT OF UNSP ORGANIC SOLVENT UNDETERMINED INIT

S15319A

MINOR LACERATION OF UNSP INTERNAL JUGULAR VEIN INIT ENCNTR

T530X1A

TOXIC EFFECT OF CARBON TETRACHLORIDE ACCIDENTAL INIT

S15321A

MAJOR LACERATION OF RIGHT INTERNAL JUGULAR VEIN INIT ENCNTR

T530X2A

TOXIC EFFECT OF CARBON TETRACHLORIDE SELF-HARM INIT

S15322A

MAJOR LACERATION OF LEFT INTERNAL JUGULAR VEIN INIT ENCNTR

T530X3A

TOXIC EFFECT OF CARBON TETRACHLORIDE ASSAULT INIT ENCNTR

S15329A

MAJOR LACERATION OF UNSP INTERNAL JUGULAR VEIN INIT ENCNTR

T530X4A

TOXIC EFFECT OF CARBON TETRACHLORIDE UNDETERMINED INIT

S15391A

OTH INJURY OF RIGHT INTERNAL JUGULAR VEIN INIT ENCNTR

T531X1A

TOXIC EFFECT OF CHLOROFORM ACCIDENTAL (UNINTENTIONAL) INIT

S15392A OTH INJURY OF LEFT INTERNAL JUGULAR VEIN INIT ENCNTR

T531X2A

TOXIC EFFECT OF CHLOROFORM INTENTIONAL SELF-HARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S15399A

OTH INJURY OF UNSPECIFIED INTERNAL JUGULAR VEIN INIT ENCNTR

T531X3A

TOXIC EFFECT OF CHLOROFORM ASSAULT INITIAL ENCOUNTER

S158XXA INJURY OF OTH BLOOD VESSELS AT NECK LEVEL INIT ENCNTR

T531X4A

TOXIC EFFECT OF CHLOROFORM UNDETERMINED INITIAL ENCOUNTER

S159XXA INJURY OF UNSP BLOOD VESSEL AT NECK LEVEL INIT ENCNTR

T532X1A

TOXIC EFFECT OF TRICHLOROETHYLENE ACCIDENTAL INIT

S161XXA STRAIN OF MUSCLE FASCIA AND TENDON AT NECK LEVEL INIT

T532X2A

TOXIC EFFECT OF TRICHLOROETHYLENE SELF-HARM INIT

S162XXA

LACERATION OF MUSCLE FASCIA AND TENDON AT NECK LEVEL INIT

T532X3A

TOXIC EFFECT OF TRICHLOROETHYLENE ASSAULT INIT ENCNTR

S168XXA

INJ MUSCLE FASCIA AND TENDON AT NECK LEVEL INIT ENCNTR

T532X4A

TOXIC EFFECT OF TRICHLOROETHYLENE UNDETERMINED INIT ENCNTR

S169XXA

UNSP INJURY OF MUSCLE FASCIA AND TENDON AT NECK LEVEL INIT

T533X1A

TOXIC EFFECT OF TETRACHLOROETHYLENE ACCIDENTAL INIT

S170XXA

CRUSHING INJURY OF LARYNX AND TRACHEA INITIAL ENCOUNTER

T533X2A

TOXIC EFFECT OF TETRACHLOROETHYLENE SELF-HARM INIT

S178XXA CRUSHING INJURY OF OTH PARTS OF NECK INIT ENCNTR

T533X3A

TOXIC EFFECT OF TETRACHLOROETHYLENE ASSAULT INIT ENCNTR

S179XXA

CRUSHING INJURY OF NECK PART UNSPECIFIED INITIAL ENCOUNTER

T533X4A

TOXIC EFFECT OF TETRACHLOROETHYLENE UNDETERMINED INIT

S1980XA OTH INJURIES OF UNSPECIFIED PART OF NECK INIT ENCNTR

T534X1A

TOXIC EFFECT OF DICHLOROMETHANE ACCIDENTAL INIT

S1981XA OTHER SPECIFIED INJURIES OF LARYNX INITIAL ENCOUNTER

T534X2A

TOXIC EFFECT OF DICHLOROMETHANE INTENTIONAL SELF-HARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S1982XA

OTHER SPECIFIED INJURIES OF CERVICAL TRACHEA INIT ENCNTR

T534X3A

TOXIC EFFECT OF DICHLOROMETHANE ASSAULT INITIAL ENCOUNTER

S1983XA

OTHER SPECIFIED INJURIES OF VOCAL CORD INITIAL ENCOUNTER

T534X4A

TOXIC EFFECT OF DICHLOROMETHANE UNDETERMINED INIT ENCNTR

S1984XA

OTHER SPECIFIED INJURIES OF THYROID GLAND INITIAL ENCOUNTER

T535X1A

TOXIC EFFECT OF CHLOROFLUOROCARBONS ACCIDENTAL INIT

S1985XA

OTH INJURIES OF PHARYNX AND CERVICAL ESOPHAGUS INIT ENCNTR

T535X2A

TOXIC EFFECT OF CHLOROFLUOROCARBONS SELF-HARM INIT

S1989XA

OTH INJURIES OF OTHER SPECIFIED PART OF NECK INIT ENCNTR

T535X3A

TOXIC EFFECT OF CHLOROFLUOROCARBONS ASSAULT INIT ENCNTR

S199XXA UNSPECIFIED INJURY OF NECK INITIAL ENCOUNTER

T535X4A

TOXIC EFFECT OF CHLOROFLUOROCARBONS UNDETERMINED INIT

S2000XA

CONTUSION OF BREAST UNSPECIFIED BREAST INITIAL ENCOUNTER

T536X1A

TOXIC EFF OF HALGN DERIV OF ALIPHATIC HYDROCRB ACC INIT

S2001XA CONTUSION OF RIGHT BREAST INITIAL ENCOUNTER

T536X2A

TOX EFF OF HALGN DERIV OF ALIPHATIC HYDROCRB SLF-HRM INIT

S2002XA CONTUSION OF LEFT BREAST INITIAL ENCOUNTER

T536X3A

TOXIC EFF OF HALGN DERIV OF ALIPHATIC HYDROCRB ASSLT INIT

S20101A UNSP SUPERFICIAL INJURIES OF BREAST RIGHT BREAST INIT

T536X4A

TOXIC EFF OF HALGN DERIV OF ALIPHATIC HYDROCRB UNDET INIT

S20102A UNSP SUPERFICIAL INJURIES OF BREAST LEFT BREAST INIT

T537X1A

TOXIC EFFECT OF HALGN DERIV OF AROMATIC HYDROCRB ACC INIT

S20109A UNSP SUPERFICIAL INJURIES OF BREAST UNSP BREAST INIT

T537X2A

TOXIC EFF OF HALGN DERIV OF AROMATIC HYDROCRB SLF-HRM INIT

S20111A ABRASION OF BREAST RIGHT BREAST INITIAL ENCOUNTER

T537X3A

TOXIC EFF OF HALGN DERIV OF AROMATIC HYDROCRB ASSLT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S20112A ABRASION OF BREAST LEFT BREAST INITIAL ENCOUNTER

T537X4A

TOXIC EFF OF HALGN DERIV OF AROMATIC HYDROCRB UNDET INIT

S20119A

ABRASION OF BREAST UNSPECIFIED BREAST INITIAL ENCOUNTER

T5391XA

TOXIC EFF OF UNSP HALGN DERIV OF AROMAT HYDROCRB ACC INIT

S20121A

BLISTER (NONTHERMAL) OF BREAST RIGHT BREAST INIT ENCNTR

T5392XA

TOX EFF OF UNSP HALGN DERIV OF AROMAT HYDROCRBSLF-HRM INIT

S20122A

BLISTER (NONTHERMAL) OF BREAST LEFT BREAST INIT ENCNTR

T5393XA

TOX EFF OF UNSP HALGN DERIV OF AROMAT HYDROCRB ASSLT INIT

S20129A

BLISTER (NONTHERMAL) OF BREAST UNSP BREAST INIT ENCNTR

T5394XA

TOX EFF OF UNSP HALGN DERIV OF AROMAT HYDROCRB UNDET INIT

S20141A

EXTERNAL CONSTRICTION OF PART OF BREAST RIGHT BREAST INIT

T540X1A

TOXIC EFFECT OF PHENOL AND PHENOL HOMOLOGUES ACC INIT

S20142A

EXTERNAL CONSTRICTION OF PART OF BREAST LEFT BREAST INIT

T540X2A

TOXIC EFFECT OF PHENOL AND PHENOL HOMOLOG SELF-HARM INIT

S20149A

EXTERNAL CONSTRICTION OF PART OF BREAST UNSP BREAST INIT

T540X3A

TOXIC EFFECT OF PHENOL AND PHENOL HOMOLOGUES ASSAULT INIT

S20151A SUPERFICIAL FOREIGN BODY OF BREAST RIGHT BREAST INIT

T540X4A

TOXIC EFFECT OF PHENOL AND PHENOL HOMOLOGUES UNDET INIT

S20152A

SUPERFICIAL FOREIGN BODY OF BREAST LEFT BREAST INIT ENCNTR

T541X1A

TOXIC EFFECT OF CORROSIVE ORGANIC COMPOUNDS ACC INIT

S20159A

SUPERFICIAL FOREIGN BODY OF BREAST UNSP BREAST INIT ENCNTR

T541X2A

TOXIC EFFECT OF CORROSIVE ORGANIC COMPOUNDS SELF-HARM INIT

S20161A INSECT BITE (NONVENOMOUS) OF BREAST RIGHT BREAST INIT

T541X3A

TOXIC EFFECT OF CORROSIVE ORGANIC COMPOUNDS ASSAULT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S20162A INSECT BITE (NONVENOMOUS) OF BREAST LEFT BREAST INIT

T541X4A

TOXIC EFFECT OF CORROSIVE ORGANIC COMPOUNDS UNDET INIT

S20169A INSECT BITE (NONVENOMOUS) OF BREAST UNSP BREAST INIT

T542X1A

TOXIC EFF OF CORROSV ACIDS AND ACID-LIKE SUBSTNC ACC INIT

S20171A

OTHER SUPERFICIAL BITE OF BREAST RIGHT BREAST INIT ENCNTR

T542X2A

TOX EFF OF CORROSV ACIDS & ACID-LIKE SUBSTNC SLF-HRM INIT

S20172A

OTHER SUPERFICIAL BITE OF BREAST LEFT BREAST INIT ENCNTR

T542X3A

TOX EFF OF CORROSV ACIDS AND ACID-LIKE SUBSTNC ASSLT INIT

S20179A

OTHER SUPERFICIAL BITE OF BREAST UNSP BREAST INIT ENCNTR

T542X4A

TOX EFF OF CORROSV ACIDS AND ACID-LIKE SUBSTNC UNDET INIT

S2020XA

CONTUSION OF THORAX UNSPECIFIED INITIAL ENCOUNTER

T543X1A

TOX EFF OF CORROSV ALKALIS AND ALK-LIKE SUBSTNC ACC INIT

S20211A

CONTUSION OF RIGHT FRONT WALL OF THORAX INITIAL ENCOUNTER

T543X2A

TOX EFF OF CORROSV ALKALIS & ALK-LIKE SUBSTNC SLF-HRM INIT

S20212A

CONTUSION OF LEFT FRONT WALL OF THORAX INITIAL ENCOUNTER

T543X3A

TOX EFF OF CORROSV ALKALIS AND ALK-LIKE SUBSTNC ASSLT INIT

S20219A

CONTUSION OF UNSPECIFIED FRONT WALL OF THORAX INIT ENCNTR

T543X4A

TOX EFF OF CORROSV ALKALIS AND ALK-LIKE SUBSTNC UNDET INIT

S20221A

CONTUSION OF RIGHT BACK WALL OF THORAX INITIAL ENCOUNTER

T5491XA

TOXIC EFFECT OF UNSP CORROSIVE SUBSTANCE ACCIDENTAL INIT

S20222A

CONTUSION OF LEFT BACK WALL OF THORAX INITIAL ENCOUNTER

T5492XA

TOXIC EFFECT OF UNSP CORROSIVE SUBSTANCE SELF-HARM INIT

S20229A

CONTUSION OF UNSPECIFIED BACK WALL OF THORAX INIT ENCNTR

T5493XA

TOXIC EFFECT OF UNSP CORROSIVE SUBSTANCE ASSAULT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S20301A UNSP SUPERFICIAL INJURIES OF R FRNT WL OF THORAX INIT

T5494XA

TOXIC EFFECT OF UNSP CORROSIVE SUBSTANCE UNDETERMINED INIT

S20302A

UNSP SUPERFICIAL INJURIES OF LEFT FRONT WALL OF THORAX INIT

T550X1A

TOXIC EFFECT OF SOAPS ACCIDENTAL (UNINTENTIONAL) INIT

S20309A

UNSP SUPERFICIAL INJURIES OF UNSP FRONT WALL OF THORAX INIT

T550X2A

TOXIC EFFECT OF SOAPS INTENTIONAL SELF-HARM INIT ENCNTR

S20311A

ABRASION OF RIGHT FRONT WALL OF THORAX INITIAL ENCOUNTER

T550X3A

TOXIC EFFECT OF SOAPS ASSAULT INITIAL ENCOUNTER

S20312A

ABRASION OF LEFT FRONT WALL OF THORAX INITIAL ENCOUNTER

T550X4A

TOXIC EFFECT OF SOAPS UNDETERMINED INITIAL ENCOUNTER

S20319A

ABRASION OF UNSPECIFIED FRONT WALL OF THORAX INIT ENCNTR

T551X1A

TOXIC EFFECT OF DETERGENTS ACCIDENTAL (UNINTENTIONAL) INIT

S20321A

BLISTER (NONTHERMAL) OF RIGHT FRONT WALL OF THORAX INIT

T551X2A

TOXIC EFFECT OF DETERGENTS INTENTIONAL SELF-HARM INIT

S20322A

BLISTER (NONTHERMAL) OF LEFT FRONT WALL OF THORAX INIT

T551X3A

TOXIC EFFECT OF DETERGENTS ASSAULT INITIAL ENCOUNTER

S20329A

BLISTER (NONTHERMAL) OF UNSP FRONT WALL OF THORAX INIT

T551X4A

TOXIC EFFECT OF DETERGENTS UNDETERMINED INITIAL ENCOUNTER

S20341A

EXTERNAL CONSTRICTION OF RIGHT FRONT WALL OF THORAX INIT

T560X1A

TOXIC EFFECT OF LEAD AND ITS COMPOUNDS ACCIDENTAL INIT

S20342A

EXTERNAL CONSTRICTION OF LEFT FRONT WALL OF THORAX INIT

T560X2A

TOXIC EFFECT OF LEAD AND ITS COMPOUNDS SELF-HARM INIT

S20349A

EXTERNAL CONSTRICTION OF UNSP FRONT WALL OF THORAX INIT

T560X3A

TOXIC EFFECT OF LEAD AND ITS COMPOUNDS ASSAULT INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S20351A

SUPERFICIAL FOREIGN BODY OF RIGHT FRONT WALL OF THORAX INIT

T560X4A

TOXIC EFFECT OF LEAD AND ITS COMPOUNDS UNDETERMINED INIT

S20352A

SUPERFICIAL FOREIGN BODY OF LEFT FRONT WALL OF THORAX INIT

T561X1A

TOXIC EFFECT OF MERCURY AND ITS COMPOUNDS ACCIDENTAL INIT

S20359A

SUPERFICIAL FOREIGN BODY OF UNSP FRONT WALL OF THORAX INIT

T561X2A

TOXIC EFFECT OF MERCURY AND ITS COMPOUNDS SELF-HARM INIT

S20361A INSECT BITE (NONVENOMOUS) OF R FRNT WL OF THORAX INIT

T561X3A

TOXIC EFFECT OF MERCURY AND ITS COMPOUNDS ASSAULT INIT

S20362A

INSECT BITE (NONVENOMOUS) OF LEFT FRONT WALL OF THORAX INIT

T561X4A

TOXIC EFFECT OF MERCURY AND ITS COMPOUNDS UNDET INIT

S20369A

INSECT BITE (NONVENOMOUS) OF UNSP FRONT WALL OF THORAX INIT

T562X1A

TOXIC EFFECT OF CHROMIUM AND ITS COMPOUNDS ACC INIT

S20371A

OTH SUPERFICIAL BITE OF RIGHT FRONT WALL OF THORAX INIT

T562X2A

TOXIC EFFECT OF CHROMIUM AND ITS COMPOUNDS SELF-HARM INIT

S20372A OTH SUPERFICIAL BITE OF LEFT FRONT WALL OF THORAX INIT

T562X3A

TOXIC EFFECT OF CHROMIUM AND ITS COMPOUNDS ASSAULT INIT

S20379A OTH SUPERFICIAL BITE OF UNSP FRONT WALL OF THORAX INIT

T562X4A

TOXIC EFFECT OF CHROMIUM AND ITS COMPOUNDS UNDET INIT

S20401A

UNSP SUPERFICIAL INJURIES OF RIGHT BACK WALL OF THORAX INIT

T563X1A

TOXIC EFFECT OF CADMIUM AND ITS COMPOUNDS ACCIDENTAL INIT

S20402A

UNSP SUPERFICIAL INJURIES OF LEFT BACK WALL OF THORAX INIT

T563X2A

TOXIC EFFECT OF CADMIUM AND ITS COMPOUNDS SELF-HARM INIT

S20409A

UNSP SUPERFICIAL INJURIES OF UNSP BACK WALL OF THORAX INIT

T563X3A

TOXIC EFFECT OF CADMIUM AND ITS COMPOUNDS ASSAULT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S20411A

ABRASION OF RIGHT BACK WALL OF THORAX INITIAL ENCOUNTER

T563X4A

TOXIC EFFECT OF CADMIUM AND ITS COMPOUNDS UNDET INIT

S20412A

ABRASION OF LEFT BACK WALL OF THORAX INITIAL ENCOUNTER

T564X1A

TOXIC EFFECT OF COPPER AND ITS COMPOUNDS ACCIDENTAL INIT

S20419A

ABRASION OF UNSPECIFIED BACK WALL OF THORAX INIT ENCNTR

T564X2A

TOXIC EFFECT OF COPPER AND ITS COMPOUNDS SELF-HARM INIT

S20421A

BLISTER (NONTHERMAL) OF RIGHT BACK WALL OF THORAX INIT

T564X3A

TOXIC EFFECT OF COPPER AND ITS COMPOUNDS ASSAULT INIT

S20422A

BLISTER (NONTHERMAL) OF LEFT BACK WALL OF THORAX INIT

T564X4A

TOXIC EFFECT OF COPPER AND ITS COMPOUNDS UNDETERMINED INIT

S20429A

BLISTER (NONTHERMAL) OF UNSP BACK WALL OF THORAX INIT

T565X1A

TOXIC EFFECT OF ZINC AND ITS COMPOUNDS ACCIDENTAL INIT

S20441A

EXTERNAL CONSTRICTION OF RIGHT BACK WALL OF THORAX INIT

T565X2A

TOXIC EFFECT OF ZINC AND ITS COMPOUNDS SELF-HARM INIT

S20442A

EXTERNAL CONSTRICTION OF LEFT BACK WALL OF THORAX INIT

T565X3A

TOXIC EFFECT OF ZINC AND ITS COMPOUNDS ASSAULT INIT ENCNTR

S20449A

EXTERNAL CONSTRICTION OF UNSP BACK WALL OF THORAX INIT

T565X4A

TOXIC EFFECT OF ZINC AND ITS COMPOUNDS UNDETERMINED INIT

S20451A

SUPERFICIAL FOREIGN BODY OF RIGHT BACK WALL OF THORAX INIT

T566X1A

TOXIC EFFECT OF TIN AND ITS COMPOUNDS ACCIDENTAL INIT

S20452A

SUPERFICIAL FOREIGN BODY OF LEFT BACK WALL OF THORAX INIT

T566X2A

TOXIC EFFECT OF TIN AND ITS COMPOUNDS SELF-HARM INIT

S20459A

SUPERFICIAL FOREIGN BODY OF UNSP BACK WALL OF THORAX INIT

T566X3A

TOXIC EFFECT OF TIN AND ITS COMPOUNDS ASSAULT INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S20461A

INSECT BITE (NONVENOMOUS) OF RIGHT BACK WALL OF THORAX INIT

T566X4A

TOXIC EFFECT OF TIN AND ITS COMPOUNDS UNDETERMINED INIT

S20462A

INSECT BITE (NONVENOMOUS) OF LEFT BACK WALL OF THORAX INIT

T567X1A

TOXIC EFFECT OF BERYLLIUM AND ITS COMPOUNDS ACC INIT

S20469A

INSECT BITE (NONVENOMOUS) OF UNSP BACK WALL OF THORAX INIT

T567X2A

TOXIC EFFECT OF BERYLLIUM AND ITS COMPOUNDS SELF-HARM INIT

S20471A

OTH SUPERFICIAL BITE OF RIGHT BACK WALL OF THORAX INIT

T567X3A

TOXIC EFFECT OF BERYLLIUM AND ITS COMPOUNDS ASSAULT INIT

S20472A OTH SUPERFICIAL BITE OF LEFT BACK WALL OF THORAX INIT

T567X4A

TOXIC EFFECT OF BERYLLIUM AND ITS COMPOUNDS UNDET INIT

S20479A OTH SUPERFICIAL BITE OF UNSP BACK WALL OF THORAX INIT

T56811A

TOXIC EFFECT OF THALLIUM ACCIDENTAL (UNINTENTIONAL) INIT

S2090XA

UNSP SUPERFICIAL INJURY OF UNSP PARTS OF THORAX INIT ENCNTR

T56812A

TOXIC EFFECT OF THALLIUM INTENTIONAL SELF-HARM INIT ENCNTR

S2091XA

ABRASION OF UNSPECIFIED PARTS OF THORAX INITIAL ENCOUNTER

T56813A

TOXIC EFFECT OF THALLIUM ASSAULT INITIAL ENCOUNTER

S2092XA

BLISTER (NONTHERMAL) OF UNSP PARTS OF THORAX INIT ENCNTR

T56814A

TOXIC EFFECT OF THALLIUM UNDETERMINED INITIAL ENCOUNTER

S2094XA

EXTERNAL CONSTRICTION OF UNSP PARTS OF THORAX INIT ENCNTR

T56891A

TOXIC EFFECT OF OTH METALS ACCIDENTAL (UNINTENTIONAL) INIT

S2095XA SUPERFICIAL FOREIGN BODY OF UNSP PARTS OF THORAX INIT

T56892A

TOXIC EFFECT OF OTH METALS INTENTIONAL SELF-HARM INIT

S2096XA

INSECT BITE (NONVENOMOUS) OF UNSP PARTS OF THORAX INIT

T56893A

TOXIC EFFECT OF OTHER METALS ASSAULT INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S2097XA

OTHER SUPERFICIAL BITE OF UNSP PARTS OF THORAX INIT ENCNTR

T56894A

TOXIC EFFECT OF OTHER METALS UNDETERMINED INIT ENCNTR

S21001A

UNSPECIFIED OPEN WOUND OF RIGHT BREAST INITIAL ENCOUNTER

T5691XA

TOXIC EFFECT OF UNSP METAL ACCIDENTAL (UNINTENTIONAL) INIT

S21002A

UNSPECIFIED OPEN WOUND OF LEFT BREAST INITIAL ENCOUNTER

T5692XA

TOXIC EFFECT OF UNSP METAL INTENTIONAL SELF-HARM INIT

S21009A

UNSPECIFIED OPEN WOUND OF UNSPECIFIED BREAST INIT ENCNTR

T5693XA

TOXIC EFFECT OF UNSPECIFIED METAL ASSAULT INIT ENCNTR

S21011A

LACERATION WITHOUT FOREIGN BODY OF RIGHT BREAST INIT ENCNTR

T5694XA

TOXIC EFFECT OF UNSPECIFIED METAL UNDETERMINED INIT ENCNTR

S21012A

LACERATION WITHOUT FOREIGN BODY OF LEFT BREAST INIT ENCNTR

T570X1A

TOXIC EFFECT OF ARSENIC AND ITS COMPOUNDS ACCIDENTAL INIT

S21019A

LACERATION WITHOUT FOREIGN BODY OF UNSP BREAST INIT ENCNTR

T570X2A

TOXIC EFFECT OF ARSENIC AND ITS COMPOUNDS SELF-HARM INIT

S21021A

LACERATION WITH FOREIGN BODY OF RIGHT BREAST INIT ENCNTR

T570X3A

TOXIC EFFECT OF ARSENIC AND ITS COMPOUNDS ASSAULT INIT

S21022A

LACERATION WITH FOREIGN BODY OF LEFT BREAST INIT ENCNTR

T570X4A

TOXIC EFFECT OF ARSENIC AND ITS COMPOUNDS UNDET INIT

S21029A

LACERATION WITH FOREIGN BODY OF UNSP BREAST INIT ENCNTR

T571X1A

TOXIC EFFECT OF PHOSPHORUS AND ITS COMPOUNDS ACC INIT

S21031A

PUNCTURE WOUND W/O FOREIGN BODY OF RIGHT BREAST INIT ENCNTR

T571X2A

TOXIC EFFECT OF PHOSPHORUS AND ITS COMPND SELF-HARM INIT

S21032A

PUNCTURE WOUND W/O FOREIGN BODY OF LEFT BREAST INIT ENCNTR

T571X3A

TOXIC EFFECT OF PHOSPHORUS AND ITS COMPOUNDS ASSAULT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S21039A

PUNCTURE WOUND W/O FOREIGN BODY OF UNSP BREAST INIT ENCNTR

T571X4A

TOXIC EFFECT OF PHOSPHORUS AND ITS COMPOUNDS UNDET INIT

S21041A

PUNCTURE WOUND W FOREIGN BODY OF RIGHT BREAST INIT ENCNTR

T572X1A

TOXIC EFFECT OF MANGANESE AND ITS COMPOUNDS ACC INIT

S21042A

PUNCTURE WOUND WITH FOREIGN BODY OF LEFT BREAST INIT ENCNTR

T572X2A

TOXIC EFFECT OF MANGANESE AND ITS COMPOUNDS SELF-HARM INIT

S21049A

PUNCTURE WOUND WITH FOREIGN BODY OF UNSP BREAST INIT ENCNTR

T572X3A

TOXIC EFFECT OF MANGANESE AND ITS COMPOUNDS ASSAULT INIT

S21051A OPEN BITE OF RIGHT BREAST INITIAL ENCOUNTER

T572X4A

TOXIC EFFECT OF MANGANESE AND ITS COMPOUNDS UNDET INIT

S21052A OPEN BITE OF LEFT BREAST INITIAL ENCOUNTER

T573X1A

TOXIC EFFECT OF HYDROGEN CYANIDE ACCIDENTAL INIT

S21059A OPEN BITE OF UNSPECIFIED BREAST INITIAL ENCOUNTER

T573X2A

TOXIC EFFECT OF HYDROGEN CYANIDE SELF-HARM INIT

S21101A

UNSP OPN WND R FRNT WL OF THORAX W/O PENET THOR CAVITY INIT

T573X3A

TOXIC EFFECT OF HYDROGEN CYANIDE ASSAULT INITIAL ENCOUNTER

S21102A

UNSP OPN WND L FRNT WL OF THORAX W/O PENET THOR CAVITY INIT

T573X4A

TOXIC EFFECT OF HYDROGEN CYANIDE UNDETERMINED INIT ENCNTR

S21109A

UNSP OPN WND UNSP FRNT WALL OF THRX W/O PENET THOR CAV INIT

T578X1A

TOXIC EFFECT OF INORGANIC SUBSTANCES ACCIDENTAL INIT

S21111A

LAC W/O FB OF R FRNT WL OF THORAX W/O PENET THOR CAV INIT

T578X2A

TOXIC EFFECT OF INORGANIC SUBSTANCES SELF-HARM INIT

S21112A

LAC W/O FB OF L FRNT WL OF THORAX W/O PENET THOR CAV INIT

T578X3A

TOXIC EFFECT OF OTH INORGANIC SUBSTANCES ASSAULT INIT

S21119A

LAC W/O FB OF UNSP FRNT WL OF THRX W/O PENET THOR CAV INIT

T578X4A

TOXIC EFFECT OF OTH INORGANIC SUBSTANCES UNDETERMINED INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S21121A

LAC W FB OF R FRNT WL OF THORAX W/O PENET THOR CAVITY INIT

T5791XA

TOXIC EFFECT OF UNSP INORGANIC SUBSTANCE ACCIDENTAL INIT

S21122A

LAC W FB OF L FRNT WL OF THORAX W/O PENET THOR CAVITY INIT

T5792XA

TOXIC EFFECT OF UNSP INORGANIC SUBSTANCE SELF-HARM INIT

S21129A

LAC W FB OF UNSP FRONT WALL OF THRX W/O PENET THOR CAV INIT

T5793XA

TOXIC EFFECT OF UNSP INORGANIC SUBSTANCE ASSAULT INIT

S21131A

PNCTR W/O FB OF R FRNT WL OF THORAX W/O PENET THOR CAV INIT

T5794XA

TOXIC EFFECT OF UNSP INORGANIC SUBSTANCE UNDETERMINED INIT

S21132A

PNCTR W/O FB OF L FRNT WL OF THORAX W/O PENET THOR CAV INIT

T5801XA

TOXIC EFFECT OF CARB MONX FROM MTR VEH EXHAUST ACC INIT

S21139A

PNCTR W/O FB OF UNSP FRNT WL OF THRX W/O PENET THOR CAVINIT

T5802XA

TOXIC EFF OF CARB MONX FROM MTR VEH EXHAUST SLF-HRM INIT

S21141A

PNCTR W FB OF R FRNT WL OF THORAX W/O PENET THOR CAV INIT

T5803XA

TOXIC EFFECT OF CARB MONX FROM MTR VEH EXHAUST ASSLT INIT

S21142A

PNCTR W FB OF L FRNT WL OF THORAX W/O PENET THOR CAV INIT

T5804XA

TOXIC EFFECT OF CARB MONX FROM MTR VEH EXHAUST UNDET INIT

S21149A

PNCTR W FB OF UNSP FRNT WL OF THRX W/O PENET THOR CAV INIT

T5811XA

TOXIC EFFECT OF CARB MONX FROM UTILITY GAS ACC INIT

S21151A

OPEN BITE OF R FRNT WL OF THORAX W/O PENET THOR CAVITY INIT

T5812XA

TOXIC EFFECT OF CARB MONX FROM UTILITY GAS SELF-HARM INIT

S21152A

OPEN BITE OF L FRNT WL OF THORAX W/O PENET THOR CAVITY INIT

T5813XA

TOXIC EFFECT OF CARB MONX FROM UTILITY GAS ASSAULT INIT

S21159A

OPEN BITE OF UNSP FRNT WALL OF THRX W/O PENET THOR CAV INIT

T5814XA

TOXIC EFFECT OF CARB MONX FROM UTILITY GAS UNDET INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S21201A

UNSP OPN WND R BK WL OF THORAX W/O PENET THOR CAVITY INIT

T582X1A

TOX EFF OF CARB MONX FR INCMPL COMBST DMST FUEL ACC INIT

S21202A

UNSP OPN WND L BK WL OF THORAX W/O PENET THOR CAVITY INIT

T582X2A

TOX EFF OF CARB MONX FR INCMPL COMBST DMST FUELSLF-HRMINIT

S21209A

UNSP OPN WND UNSP BK WL OF THORAX W/O PENET THOR CAV INIT

T582X3A

TOX EFF OF CARB MONX FR INCMPL COMBST DMST FUEL ASSLT INIT

S21211A

LAC W/O FB OF R BK WL OF THORAX W/O PENET THOR CAVITY INIT

T582X4A

TOX EFF OF CARB MONX FR INCMPL COMBST DMST FUEL UNDET INIT

S21212A

LAC W/O FB OF L BK WL OF THORAX W/O PENET THOR CAVITY INIT

T588X1A

TOXIC EFFECT OF CARB MONX FROM OTH SOURCE ACCIDENTAL INIT

S21219A

LAC W/O FB OF UNSP BK WL OF THORAX W/O PENET THOR CAV INIT

T588X2A

TOXIC EFFECT OF CARB MONX FROM OTH SOURCE SELF-HARM INIT

S21221A

LAC W FB OF R BK WL OF THORAX W/O PENET THOR CAVITY INIT

T588X3A

TOXIC EFFECT OF CARB MONX FROM OTH SOURCE ASSAULT INIT

S21222A

LAC W FB OF L BK WL OF THORAX W/O PENET THOR CAVITY INIT

T588X4A

TOXIC EFFECT OF CARB MONX FROM OTH SOURCE UNDET INIT

S21229A

LAC W FB OF UNSP BK WL OF THORAX W/O PENET THOR CAVITY INIT

T5891XA

TOXIC EFFECT OF CARB MONX FROM UNSP SOURCE ACC INIT

S21231A

PNCTR W/O FB OF R BK WL OF THORAX W/O PENET THOR CAV INIT

T5892XA

TOXIC EFFECT OF CARB MONX FROM UNSP SOURCE SELF-HARM INIT

S21232A

PNCTR W/O FB OF L BK WL OF THORAX W/O PENET THOR CAV INIT

T5893XA

TOXIC EFFECT OF CARB MONX FROM UNSP SOURCE ASSAULT INIT

S21239A

PNCTR W/O FB OF UNSP BK WL OF THRX W/O PENET THOR CAV INIT

T5894XA

TOXIC EFFECT OF CARB MONX FROM UNSP SOURCE UNDET INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S21241A

PNCTR W FB OF R BK WL OF THORAX W/O PENET THOR CAVITY INIT

T590X1A

TOXIC EFFECT OF NITROGEN OXIDES ACCIDENTAL INIT

S21242A

PNCTR W FB OF L BK WL OF THORAX W/O PENET THOR CAVITY INIT

T590X2A

TOXIC EFFECT OF NITROGEN OXIDES INTENTIONAL SELF-HARM INIT

S21249A

PNCTR W FB OF UNSP BK WL OF THORAX W/O PENET THOR CAV INIT

T590X3A

TOXIC EFFECT OF NITROGEN OXIDES ASSAULT INITIAL ENCOUNTER

S21251A

OPEN BITE OF R BK WL OF THORAX W/O PENET THOR CAVITY INIT

T590X4A

TOXIC EFFECT OF NITROGEN OXIDES UNDETERMINED INIT ENCNTR

S21252A

OPEN BITE OF L BK WL OF THORAX W/O PENET THOR CAVITY INIT

T591X1A

TOXIC EFFECT OF SULFUR DIOXIDE ACCIDENTAL INIT

S21259A

OPEN BITE OF UNSP BK WL OF THORAX W/O PENET THOR CAV INIT

T591X2A

TOXIC EFFECT OF SULFUR DIOXIDE INTENTIONAL SELF-HARM INIT

S21301A

UNSP OPN WND R FRNT WL OF THORAX W PENET THOR CAVITY INIT

T591X3A

TOXIC EFFECT OF SULFUR DIOXIDE ASSAULT INITIAL ENCOUNTER

S21302A

UNSP OPN WND L FRNT WL OF THORAX W PENET THOR CAVITY INIT

T591X4A

TOXIC EFFECT OF SULFUR DIOXIDE UNDETERMINED INIT ENCNTR

S21309A

UNSP OPN WND UNSP FRONT WALL OF THRX W PENET THOR CAV INIT

T592X1A

TOXIC EFFECT OF FORMALDEHYDE ACCIDENTAL INIT

S21311A

LAC W/O FB OF R FRNT WL OF THORAX W PENET THOR CAVITY INIT

T592X2A

TOXIC EFFECT OF FORMALDEHYDE INTENTIONAL SELF-HARM INIT

S21312A

LAC W/O FB OF L FRNT WL OF THORAX W PENET THOR CAVITY INIT

T592X3A

TOXIC EFFECT OF FORMALDEHYDE ASSAULT INITIAL ENCOUNTER

S21319A

LAC W/O FB OF UNSP FRONT WALL OF THRX W PENET THOR CAV INIT

T592X4A

TOXIC EFFECT OF FORMALDEHYDE UNDETERMINED INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S21321A

LAC W FB OF R FRNT WL OF THORAX W PENET THOR CAVITY INIT

T593X1A

TOXIC EFFECT OF LACRIMOGENIC GAS ACCIDENTAL INIT

S21322A

LAC W FB OF L FRNT WL OF THORAX W PENET THOR CAVITY INIT

T593X2A

TOXIC EFFECT OF LACRIMOGENIC GAS SELF-HARM INIT

S21329A

LAC W FB OF UNSP FRONT WALL OF THORAX W PENET THOR CAV INIT

T593X3A

TOXIC EFFECT OF LACRIMOGENIC GAS ASSAULT INITIAL ENCOUNTER

S21331A

PNCTR W/O FB OF R FRNT WL OF THORAX W PENET THOR CAV INIT

T593X4A

TOXIC EFFECT OF LACRIMOGENIC GAS UNDETERMINED INIT ENCNTR

S21332A

PNCTR W/O FB OF L FRNT WL OF THORAX W PENET THOR CAV INIT

T594X1A

TOXIC EFFECT OF CHLORINE GAS ACCIDENTAL INIT

S21339A

PNCTR W/O FB OF UNSP FRNT WL OF THRX W PENET THOR CAV INIT

T594X2A

TOXIC EFFECT OF CHLORINE GAS INTENTIONAL SELF-HARM INIT

S21341A

PNCTR W FB OF R FRNT WL OF THORAX W PENET THOR CAVITY INIT

T594X3A

TOXIC EFFECT OF CHLORINE GAS ASSAULT INITIAL ENCOUNTER

S21342A

PNCTR W FB OF L FRNT WL OF THORAX W PENET THOR CAVITY INIT

T594X4A

TOXIC EFFECT OF CHLORINE GAS UNDETERMINED INIT ENCNTR

S21349A

PNCTR W FB OF UNSP FRONT WALL OF THRX W PENET THOR CAV INIT

T595X1A

TOXIC EFF OF FLUORINE GAS AND HYDROGEN FLUORIDE ACC INIT

S21351A

OPEN BITE OF R FRNT WL OF THORAX W PENET THOR CAVITY INIT

T595X2A

TOX EFF OF FLUORINE GAS AND HYDROGEN FLUORIDE SLF-HRM INIT

S21352A

OPEN BITE OF L FRNT WL OF THORAX W PENET THOR CAVITY INIT

T595X3A

TOXIC EFF OF FLUORINE GAS AND HYDROGEN FLUORIDE ASSLT INIT

S21359A

OPEN BITE OF UNSP FRONT WALL OF THRX W PENET THOR CAV INIT

T595X4A

TOXIC EFF OF FLUORINE GAS AND HYDROGEN FLUORIDE UNDET INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S21401A

UNSP OPN WND R BK WL OF THORAX W PENET THORACIC CAVITY INIT

T596X1A

TOXIC EFFECT OF HYDROGEN SULFIDE ACCIDENTAL INIT

S21402A

UNSP OPN WND L BK WL OF THORAX W PENET THORACIC CAVITY INIT

T596X2A

TOXIC EFFECT OF HYDROGEN SULFIDE SELF-HARM INIT

S21409A

UNSP OPN WND UNSP BK WL OF THORAX W PENET THOR CAVITY INIT

T596X3A

TOXIC EFFECT OF HYDROGEN SULFIDE ASSAULT INITIAL ENCOUNTER

S21411A

LAC W/O FB OF R BK WL OF THORAX W PENET THOR CAVITY INIT

T596X4A

TOXIC EFFECT OF HYDROGEN SULFIDE UNDETERMINED INIT ENCNTR

S21412A

LAC W/O FB OF L BK WL OF THORAX W PENET THOR CAVITY INIT

T597X1A

TOXIC EFFECT OF CARBON DIOXIDE ACCIDENTAL INIT

S21419A

LAC W/O FB OF UNSP BK WL OF THORAX W PENET THOR CAVITY INIT

T597X2A

TOXIC EFFECT OF CARBON DIOXIDE INTENTIONAL SELF-HARM INIT

S21421A

LAC W FB OF R BK WL OF THORAX W PENET THORACIC CAVITY INIT

T597X3A

TOXIC EFFECT OF CARBON DIOXIDE ASSAULT INITIAL ENCOUNTER

S21422A

LAC W FB OF L BK WL OF THORAX W PENET THORACIC CAVITY INIT

T597X4A

TOXIC EFFECT OF CARBON DIOXIDE UNDETERMINED INIT ENCNTR

S21429A

LAC W FB OF UNSP BK WL OF THORAX W PENET THOR CAVITY INIT

T59811A

TOXIC EFFECT OF SMOKE ACCIDENTAL (UNINTENTIONAL) INIT

S21431A

PNCTR W/O FB OF R BK WL OF THORAX W PENET THOR CAVITY INIT

T59812A

TOXIC EFFECT OF SMOKE INTENTIONAL SELF-HARM INIT ENCNTR

S21432A

PNCTR W/O FB OF L BK WL OF THORAX W PENET THOR CAVITY INIT

T59813A

TOXIC EFFECT OF SMOKE ASSAULT INITIAL ENCOUNTER

S21439A

PNCTR W/O FB OF UNSP BK WL OF THORAX W PENET THOR CAV INIT

T59814A

TOXIC EFFECT OF SMOKE UNDETERMINED INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S21441A

PNCTR W FB OF R BK WL OF THORAX W PENET THOR CAVITY INIT

T59891A

TOXIC EFFECT OF GASES FUMES AND VAPORS ACCIDENTAL INIT

S21442A

PNCTR W FB OF L BK WL OF THORAX W PENET THOR CAVITY INIT

T59892A

TOXIC EFFECT OF GASES FUMES AND VAPORS SELF-HARM INIT

S21449A

PNCTR W FB OF UNSP BK WL OF THORAX W PENET THOR CAVITY INIT

T59893A

TOXIC EFFECT OF OTH GASES FUMES AND VAPORS ASSAULT INIT

S21451A

OPEN BITE OF R BK WL OF THORAX W PENET THORACIC CAVITY INIT

T59894A

TOXIC EFFECT OF GASES FUMES AND VAPORS UNDETERMINED INIT

S21452A

OPEN BITE OF L BK WL OF THORAX W PENET THORACIC CAVITY INIT

T5991XA

TOXIC EFFECT OF UNSP GASES FUMES AND VAPORS ACC INIT

S21459A

OPEN BITE OF UNSP BK WL OF THORAX W PENET THOR CAVITY INIT

T5992XA

TOXIC EFFECT OF UNSP GASES FUMES AND VAPORS SLF-HRM INIT

S2190XA

UNSP OPEN WOUND OF UNSPECIFIED PART OF THORAX INIT ENCNTR

T5993XA

TOXIC EFFECT OF UNSP GASES FUMES AND VAPORS ASSAULT INIT

S2191XA

LACERATION W/O FOREIGN BODY OF UNSP PART OF THORAX INIT

T5994XA

TOXIC EFFECT OF UNSP GASES FUMES AND VAPORS UNDET INIT

S2192XA LACERATION W FOREIGN BODY OF UNSP PART OF THORAX INIT

T600X1A

TOXIC EFFECT OF ORGANOPHOS AND CARBAMATE INSECT ACC INIT

S2193XA

PUNCTURE WOUND W/O FOREIGN BODY OF UNSP PART OF THORAX INIT

T600X2A

TOXIC EFF OF ORGANOPHOS AND CARBAMATE INSECT SLF-HRM INIT

S2194XA

PUNCTURE WOUND W FOREIGN BODY OF UNSP PART OF THORAX INIT

T600X3A

TOXIC EFFECT OF ORGANOPHOS AND CARBAMATE INSECT ASSLT INIT

S2195XA

OPEN BITE OF UNSPECIFIED PART OF THORAX INITIAL ENCOUNTER

T600X4A

TOXIC EFFECT OF ORGANOPHOS AND CARBAMATE INSECT UNDET INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S22000A

WEDGE COMPRESSION FRACTURE OF UNSP THORACIC VERTEBRA INIT

T601X1A

TOXIC EFFECT OF HALOGENATED INSECTICIDES ACCIDENTAL INIT

S22000B

WEDGE COMPRSN FX UNSP THOR VERTEBRA INIT FOR OPN FX

T601X2A

TOXIC EFFECT OF HALOGENATED INSECTICIDES SELF-HARM INIT

S22001A STABLE BURST FRACTURE OF UNSP THORACIC VERTEBRA INIT

T601X3A

TOXIC EFFECT OF HALOGENATED INSECTICIDES ASSAULT INIT

S22001B

STABLE BURST FRACTURE OF UNSP THOR VERTEBRA INIT FOR OPN FX

T601X4A

TOXIC EFFECT OF HALOGENATED INSECTICIDES UNDETERMINED INIT

S22002A UNSTABLE BURST FRACTURE OF UNSP THORACIC VERTEBRA INIT

T602X1A

TOXIC EFFECT OF INSECTICIDES ACCIDENTAL INIT

S22002B

UNSTABLE BURST FX UNSP THOR VERTEBRA INIT FOR OPN FX

T602X2A

TOXIC EFFECT OF INSECTICIDES INTENTIONAL SELF-HARM INIT

S22008A

OTH FRACTURE OF UNSP THORACIC VERTEBRA INIT FOR CLOS FX

T602X3A

TOXIC EFFECT OF OTHER INSECTICIDES ASSAULT INIT ENCNTR

S22008B

OTH FRACTURE OF UNSP THORACIC VERTEBRA INIT FOR OPN FX

T602X4A

TOXIC EFFECT OF OTH INSECTICIDES UNDETERMINED INIT ENCNTR

S22009A

UNSP FRACTURE OF UNSP THORACIC VERTEBRA INIT FOR CLOS FX

T603X1A

TOXIC EFFECT OF HERBICIDES AND FUNGICIDES ACCIDENTAL INIT

S22009B

UNSP FRACTURE OF UNSP THORACIC VERTEBRA INIT FOR OPN FX

T603X2A

TOXIC EFFECT OF HERBICIDES AND FUNGICIDES SELF-HARM INIT

S22010A

WEDGE COMPRESSION FRACTURE OF FIRST THORACIC VERTEBRA INIT

T603X3A

TOXIC EFFECT OF HERBICIDES AND FUNGICIDES ASSAULT INIT

S22010B

WEDGE COMPRSN FX FIRST THOR VERTEBRA INIT FOR OPN FX

T603X4A

TOXIC EFFECT OF HERBICIDES AND FUNGICIDES UNDET INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S22011A STABLE BURST FRACTURE OF FIRST THORACIC VERTEBRA INIT

T604X1A

TOXIC EFFECT OF RODENTICIDES ACCIDENTAL INIT

S22011B STABLE BURST FX FIRST THOR VERTEBRA INIT FOR OPN FX

T604X2A

TOXIC EFFECT OF RODENTICIDES INTENTIONAL SELF-HARM INIT

S22012A UNSTABLE BURST FRACTURE OF FIRST THORACIC VERTEBRA INIT

T604X3A

TOXIC EFFECT OF RODENTICIDES ASSAULT INITIAL ENCOUNTER

S22012B

UNSTABLE BURST FX FIRST THOR VERTEBRA INIT FOR OPN FX

T604X4A

TOXIC EFFECT OF RODENTICIDES UNDETERMINED INIT ENCNTR

S22018A

OTH FRACTURE OF FIRST THORACIC VERTEBRA INIT FOR CLOS FX

T608X1A

TOXIC EFFECT OF PESTICIDES ACCIDENTAL (UNINTENTIONAL) INIT

S22018B

OTH FRACTURE OF FIRST THORACIC VERTEBRA INIT FOR OPN FX

T608X2A

TOXIC EFFECT OF OTH PESTICIDES INTENTIONAL SELF-HARM INIT

S22019A

UNSP FRACTURE OF FIRST THORACIC VERTEBRA INIT FOR CLOS FX

T608X3A

TOXIC EFFECT OF OTHER PESTICIDES ASSAULT INITIAL ENCOUNTER

S22019B

UNSP FRACTURE OF FIRST THORACIC VERTEBRA INIT FOR OPN FX

T608X4A

TOXIC EFFECT OF OTHER PESTICIDES UNDETERMINED INIT ENCNTR

S22020A

WEDGE COMPRESSION FRACTURE OF SECOND THORACIC VERTEBRA INIT

T6091XA

TOXIC EFFECT OF UNSP PESTICIDE ACCIDENTAL INIT

S22020B

WEDGE COMPRSN FX SECOND THOR VERTEBRA INIT FOR OPN FX

T6092XA

TOXIC EFFECT OF UNSP PESTICIDE INTENTIONAL SELF-HARM INIT

S22021A

STABLE BURST FRACTURE OF SECOND THORACIC VERTEBRA INIT

T6093XA

TOXIC EFFECT OF UNSPECIFIED PESTICIDE ASSAULT INIT ENCNTR

S22021B

STABLE BURST FX SECOND THOR VERTEBRA INIT FOR OPN FX

T6094XA

TOXIC EFFECT OF UNSP PESTICIDE UNDETERMINED INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S22022B

UNSTABLE BURST FX SECOND THOR VERTEBRA INIT FOR OPN FX

T6101XA

CIGUATERA FISH POISONING ACCIDENTAL (UNINTENTIONAL) INIT

S22028A

OTH FRACTURE OF SECOND THORACIC VERTEBRA INIT FOR CLOS FX

T6102XA

CIGUATERA FISH POISONING INTENTIONAL SELF-HARM INIT ENCNTR

S22028B

OTH FRACTURE OF SECOND THORACIC VERTEBRA INIT FOR OPN FX

T6103XA

CIGUATERA FISH POISONING ASSAULT INITIAL ENCOUNTER

S22029A

UNSP FRACTURE OF SECOND THORACIC VERTEBRA INIT FOR CLOS FX

T6104XA

CIGUATERA FISH POISONING UNDETERMINED INITIAL ENCOUNTER

S22029B

UNSP FRACTURE OF SECOND THORACIC VERTEBRA INIT FOR OPN FX

T6111XA

SCOMBROID FISH POISONING ACCIDENTAL (UNINTENTIONAL) INIT

S22030A

WEDGE COMPRESSION FRACTURE OF THIRD THORACIC VERTEBRA INIT

T6112XA

SCOMBROID FISH POISONING INTENTIONAL SELF-HARM INIT ENCNTR

S22030B

WEDGE COMPRSN FX THIRD THOR VERTEBRA INIT FOR OPN FX

T6113XA

SCOMBROID FISH POISONING ASSAULT INITIAL ENCOUNTER

S22031A

STABLE BURST FRACTURE OF THIRD THORACIC VERTEBRA INIT

T6114XA

SCOMBROID FISH POISONING UNDETERMINED INITIAL ENCOUNTER

S22031B STABLE BURST FX THIRD THOR VERTEBRA INIT FOR OPN FX

T61771A

OTH FISH POISONING ACCIDENTAL (UNINTENTIONAL) INIT ENCNTR

S22032A

UNSTABLE BURST FRACTURE OF THIRD THORACIC VERTEBRA INIT

T61772A

OTHER FISH POISONING INTENTIONAL SELF-HARM INIT ENCNTR

S22032B

UNSTABLE BURST FX THIRD THOR VERTEBRA INIT FOR OPN FX

T61773A

OTHER FISH POISONING ASSAULT INITIAL ENCOUNTER

S22038A

OTH FRACTURE OF THIRD THORACIC VERTEBRA INIT FOR CLOS FX

T61774A

OTHER FISH POISONING UNDETERMINED INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S22038B

OTH FRACTURE OF THIRD THORACIC VERTEBRA INIT FOR OPN FX

T61781A

OTH SHELLFISH POISONING ACCIDENTAL (UNINTENTIONAL) INIT

S22039A

UNSP FRACTURE OF THIRD THORACIC VERTEBRA INIT FOR CLOS FX

T61782A

OTH SHELLFISH POISONING INTENTIONAL SELF-HARM INIT ENCNTR

S22039B

UNSP FRACTURE OF THIRD THORACIC VERTEBRA INIT FOR OPN FX

T61783A

OTHER SHELLFISH POISONING ASSAULT INITIAL ENCOUNTER

S22040A

WEDGE COMPRESSION FRACTURE OF FOURTH THORACIC VERTEBRA INIT

T61784A

OTHER SHELLFISH POISONING UNDETERMINED INITIAL ENCOUNTER

S22040B

WEDGE COMPRSN FX FOURTH THOR VERTEBRA INIT FOR OPN FX

T618X1A

TOXIC EFFECT OF SEAFOOD ACCIDENTAL (UNINTENTIONAL) INIT

S22041A

STABLE BURST FRACTURE OF FOURTH THORACIC VERTEBRA INIT

T618X2A

TOXIC EFFECT OF OTH SEAFOOD INTENTIONAL SELF-HARM INIT

S22041B

STABLE BURST FX FOURTH THOR VERTEBRA INIT FOR OPN FX

T618X3A

TOXIC EFFECT OF OTHER SEAFOOD ASSAULT INITIAL ENCOUNTER

S22042A

UNSTABLE BURST FRACTURE OF FOURTH THORACIC VERTEBRA INIT

T618X4A

TOXIC EFFECT OF OTHER SEAFOOD UNDETERMINED INIT ENCNTR

S22042B

UNSTABLE BURST FX FOURTH THOR VERTEBRA INIT FOR OPN FX

T6191XA

TOXIC EFFECT OF UNSP SEAFOOD ACCIDENTAL INIT

S22048A

OTH FRACTURE OF FOURTH THORACIC VERTEBRA INIT FOR CLOS FX

T6192XA

TOXIC EFFECT OF UNSP SEAFOOD INTENTIONAL SELF-HARM INIT

S22048B

OTH FRACTURE OF FOURTH THORACIC VERTEBRA INIT FOR OPN FX

T6193XA

TOXIC EFFECT OF UNSPECIFIED SEAFOOD ASSAULT INIT ENCNTR

S22049A

UNSP FRACTURE OF FOURTH THORACIC VERTEBRA INIT FOR CLOS FX

T6194XA

TOXIC EFFECT OF UNSP SEAFOOD UNDETERMINED INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S22049B

UNSP FRACTURE OF FOURTH THORACIC VERTEBRA INIT FOR OPN FX

T620X1A

TOXIC EFFECT OF INGESTED MUSHROOMS ACCIDENTAL INIT

S22050A

WEDGE COMPRESSION FRACTURE OF T5-T6 VERTEBRA INIT

T620X2A

TOXIC EFFECT OF INGESTED MUSHROOMS SELF-HARM INIT

S22050B

WEDGE COMPRSN FRACTURE OF T5-T6 VERTEBRA INIT FOR OPN FX

T620X3A

TOXIC EFFECT OF INGESTED MUSHROOMS ASSAULT INIT ENCNTR

S22051A

STABLE BURST FRACTURE OF T5-T6 VERTEBRA INIT FOR CLOS FX

T620X4A

TOXIC EFFECT OF INGESTED MUSHROOMS UNDETERMINED INIT

S22051B

STABLE BURST FRACTURE OF T5-T6 VERTEBRA INIT FOR OPN FX

T621X1A

TOXIC EFFECT OF INGESTED BERRIES ACCIDENTAL INIT

S22052A

UNSTABLE BURST FRACTURE OF T5-T6 VERTEBRA INIT FOR CLOS FX

T621X2A

TOXIC EFFECT OF INGESTED BERRIES SELF-HARM INIT

S22052B

UNSTABLE BURST FRACTURE OF T5-T6 VERTEBRA INIT FOR OPN FX

T621X3A

TOXIC EFFECT OF INGESTED BERRIES ASSAULT INITIAL ENCOUNTER

S22058A OTH FRACTURE OF T5-T6 VERTEBRA INIT FOR CLOS FX

T621X4A

TOXIC EFFECT OF INGESTED BERRIES UNDETERMINED INIT ENCNTR

S22058B OTH FRACTURE OF T5-T6 VERTEBRA INIT FOR OPN FX

T622X1A

TOXIC EFFECT OF INGESTED (PARTS OF) PLANT(S) ACC INIT

S22059A UNSP FRACTURE OF T5-T6 VERTEBRA INIT FOR CLOS FX

T622X2A

TOXIC EFFECT OF INGESTED (PARTS OF) PLANT(S) SLF-HRM INIT

S22059B UNSP FRACTURE OF T5-T6 VERTEBRA INIT FOR OPN FX

T622X3A

TOXIC EFFECT OF INGESTED (PARTS OF) PLANT(S) ASSAULT INIT

S22060A

WEDGE COMPRESSION FRACTURE OF T7-T8 VERTEBRA INIT

T622X4A

TOXIC EFFECT OF INGESTED (PARTS OF) PLANT(S) UNDET INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S22060B

WEDGE COMPRSN FRACTURE OF T7-T8 VERTEBRA INIT FOR OPN FX

T628X1A

TOXIC EFFECT OF NOXIOUS SUBSTANCES EATEN AS FOOD ACC INIT

S22061A

STABLE BURST FRACTURE OF T7-T8 VERTEBRA INIT FOR CLOS FX

T628X2A

TOXIC EFFECT OF NOXIOUS SUBSTNC EATEN AS FOOD SLF-HRM INIT

S22061B

STABLE BURST FRACTURE OF T7-T8 VERTEBRA INIT FOR OPN FX

T628X3A

TOXIC EFFECT OF NOXIOUS SUBSTNC EATEN AS FOOD ASSAULT INIT

S22062A

UNSTABLE BURST FRACTURE OF T7-T8 VERTEBRA INIT FOR CLOS FX

T628X4A

TOXIC EFFECT OF NOXIOUS SUBSTNC EATEN AS FOOD UNDET INIT

S22062B

UNSTABLE BURST FRACTURE OF T7-T8 VERTEBRA INIT FOR OPN FX

T6291XA

TOXIC EFFECT OF UNSP NOXIOUS SUB EATEN AS FOOD ACC INIT

S22068A

OTH FRACTURE OF T7-T8 THORACIC VERTEBRA INIT FOR CLOS FX

T6292XA

TOXIC EFF OF UNSP NOXIOUS SUB EATEN AS FOOD SLF-HRM INIT

S22068B

OTH FRACTURE OF T7-T8 THORACIC VERTEBRA INIT FOR OPN FX

T6293XA

TOXIC EFFECT OF UNSP NOXIOUS SUB EATEN AS FOOD ASSLT INIT

S22069A UNSP FRACTURE OF T7-T8 VERTEBRA INIT FOR CLOS FX

T6294XA

TOXIC EFFECT OF UNSP NOXIOUS SUB EATEN AS FOOD UNDET INIT

S22069B UNSP FRACTURE OF T7-T8 VERTEBRA INIT FOR OPN FX

T63001A

TOXIC EFFECT OF UNSP SNAKE VENOM ACCIDENTAL INIT

S22070A

WEDGE COMPRESSION FRACTURE OF T9-T10 VERTEBRA INIT

T63002A

TOXIC EFFECT OF UNSP SNAKE VENOM SELF-HARM INIT

S22070B

WEDGE COMPRSN FRACTURE OF T9-T10 VERTEBRA INIT FOR OPN FX

T63003A

TOXIC EFFECT OF UNSP SNAKE VENOM ASSAULT INIT ENCNTR

S22071A

STABLE BURST FRACTURE OF T9-T10 VERTEBRA INIT FOR CLOS FX

T63004A

TOXIC EFFECT OF UNSP SNAKE VENOM UNDETERMINED INIT ENCNTR

S22071B

STABLE BURST FRACTURE OF T9-T10 VERTEBRA INIT FOR OPN FX

T63011A

TOXIC EFFECT OF RATTLESNAKE VENOM ACCIDENTAL INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S22072A

UNSTABLE BURST FRACTURE OF T9-T10 VERTEBRA INIT FOR CLOS FX

T63012A

TOXIC EFFECT OF RATTLESNAKE VENOM SELF-HARM INIT

S22072B

UNSTABLE BURST FRACTURE OF T9-T10 VERTEBRA INIT FOR OPN FX

T63013A

TOXIC EFFECT OF RATTLESNAKE VENOM ASSAULT INIT ENCNTR

S22078A OTH FRACTURE OF T9-T10 VERTEBRA INIT FOR CLOS FX

T63014A

TOXIC EFFECT OF RATTLESNAKE VENOM UNDETERMINED INIT ENCNTR

S22078B OTH FRACTURE OF T9-T10 VERTEBRA INIT FOR OPN FX

T63021A

TOXIC EFFECT OF CORAL SNAKE VENOM ACCIDENTAL INIT

S22079A UNSP FRACTURE OF T9-T10 VERTEBRA INIT FOR CLOS FX

T63022A

TOXIC EFFECT OF CORAL SNAKE VENOM SELF-HARM INIT

S22079B UNSP FRACTURE OF T9-T10 VERTEBRA INIT FOR OPN FX

T63023A

TOXIC EFFECT OF CORAL SNAKE VENOM ASSAULT INIT ENCNTR

S22080A

WEDGE COMPRESSION FRACTURE OF T11-T12 VERTEBRA INIT

T63024A

TOXIC EFFECT OF CORAL SNAKE VENOM UNDETERMINED INIT ENCNTR

S22080B

WEDGE COMPRSN FRACTURE OF T11-T12 VERTEBRA INIT FOR OPN FX

T63031A

TOXIC EFFECT OF TAIPAN VENOM ACCIDENTAL INIT

S22081A

STABLE BURST FRACTURE OF T11-T12 VERTEBRA INIT FOR CLOS FX

T63032A

TOXIC EFFECT OF TAIPAN VENOM INTENTIONAL SELF-HARM INIT

S22081B

STABLE BURST FRACTURE OF T11-T12 VERTEBRA INIT FOR OPN FX

T63033A

TOXIC EFFECT OF TAIPAN VENOM ASSAULT INITIAL ENCOUNTER

S22082A UNSTABLE BURST FRACTURE OF T11-T12 VERTEBRA INIT

T63034A

TOXIC EFFECT OF TAIPAN VENOM UNDETERMINED INIT ENCNTR

S22082B

UNSTABLE BURST FRACTURE OF T11-T12 VERTEBRA INIT FOR OPN FX

T63041A

TOXIC EFFECT OF COBRA VENOM ACCIDENTAL INIT

S22088A OTH FRACTURE OF T11-T12 VERTEBRA INIT FOR CLOS FX

T63042A

TOXIC EFFECT OF COBRA VENOM INTENTIONAL SELF-HARM INIT

S22088B OTH FRACTURE OF T11-T12 VERTEBRA INIT FOR OPN FX

T63043A

TOXIC EFFECT OF COBRA VENOM ASSAULT INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S22089A UNSP FRACTURE OF T11-T12 VERTEBRA INIT FOR CLOS FX

T63044A

TOXIC EFFECT OF COBRA VENOM UNDETERMINED INITIAL ENCOUNTER

S22089B UNSP FRACTURE OF T11-T12 VERTEBRA INIT FOR OPN FX

T63061A

TOXIC EFFECT OF VENOM OF N & S AMERICAN SNAKE ACC INIT

S2220XA

UNSP FRACTURE OF STERNUM INIT ENCNTR FOR CLOSED FRACTURE

T63062A

TOXIC EFFECT OF VENOM OF N & S AMERICAN SNAKE SLF-HRM INIT

S2220XB

UNSP FRACTURE OF STERNUM INIT ENCNTR FOR OPEN FRACTURE

T63063A

TOXIC EFFECT OF VENOM OF N & S AMERICAN SNAKE ASSAULT INIT

S2221XA

FRACTURE OF MANUBRIUM INITIAL ENCOUNTER FOR CLOSED FRACTURE

T63064A

TOXIC EFFECT OF VENOM OF N & S AMERICAN SNAKE UNDET INIT

S2221XB

FRACTURE OF MANUBRIUM INITIAL ENCOUNTER FOR OPEN FRACTURE

T63071A

TOXIC EFFECT OF VENOM OF AUSTRALIAN SNAKE ACCIDENTAL INIT

S2222XA

FRACTURE OF BODY OF STERNUM INIT ENCNTR FOR CLOSED FRACTURE

T63072A

TOXIC EFFECT OF VENOM OF AUSTRALIAN SNAKE SELF-HARM INIT

S2222XB

FRACTURE OF BODY OF STERNUM INIT ENCNTR FOR OPEN FRACTURE

T63073A

TOXIC EFFECT OF VENOM OF OTH AUSTRALIAN SNAKE ASSAULT INIT

S2223XA STERNAL MANUBRIAL DISSOCIATION INIT FOR CLOS FX

T63074A

TOXIC EFFECT OF VENOM OF AUSTRALIAN SNAKE UNDET INIT

S2223XB STERNAL MANUBRIAL DISSOCIATION INIT FOR OPN FX

T63081A

TOXIC EFFECT OF VENOM OF AFRICAN AND ASIAN SNAKE ACC INIT

S2224XA

FRACTURE OF XIPHOID PROCESS INIT ENCNTR FOR CLOSED FRACTURE

T63082A

TOXIC EFF OF VENOM OF AFRICAN AND ASIAN SNAKE SLF-HRM INIT

S2224XB

FRACTURE OF XIPHOID PROCESS INIT ENCNTR FOR OPEN FRACTURE

T63083A

TOXIC EFF OF VENOM OF AFRICAN AND ASIAN SNAKE ASSLT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S2231XA FRACTURE OF ONE RIB RIGHT SIDE INIT FOR CLOS FX

T63084A

TOXIC EFF OF VENOM OF AFRICAN AND ASIAN SNAKE UNDET INIT

S2231XB FRACTURE OF ONE RIB RIGHT SIDE INIT FOR OPN FX

T63091A

TOXIC EFFECT OF VENOM OF SNAKE ACCIDENTAL INIT

S2232XA FRACTURE OF ONE RIB LEFT SIDE INIT FOR CLOS FX

T63092A

TOXIC EFFECT OF VENOM OF SNAKE INTENTIONAL SELF-HARM INIT

S2232XB FRACTURE OF ONE RIB LEFT SIDE INIT FOR OPN FX

T63093A

TOXIC EFFECT OF VENOM OF OTHER SNAKE ASSAULT INIT ENCNTR

S2239XA FRACTURE OF ONE RIB UNSP SIDE INIT FOR CLOS FX

T63094A

TOXIC EFFECT OF VENOM OF OTH SNAKE UNDETERMINED INIT

S2239XB FRACTURE OF ONE RIB UNSP SIDE INIT FOR OPN FX

T63111A

TOXIC EFFECT OF VENOM OF GILA MONSTER ACCIDENTAL INIT

S2241XA MULTIPLE FRACTURES OF RIBS RIGHT SIDE INIT FOR CLOS FX

T63112A

TOXIC EFFECT OF VENOM OF GILA MONSTER SELF-HARM INIT

S2241XB MULTIPLE FRACTURES OF RIBS RIGHT SIDE INIT FOR OPN FX

T63113A

TOXIC EFFECT OF VENOM OF GILA MONSTER ASSAULT INIT ENCNTR

S2242XA MULTIPLE FRACTURES OF RIBS LEFT SIDE INIT FOR CLOS FX

T63114A

TOXIC EFFECT OF VENOM OF GILA MONSTER UNDETERMINED INIT

S2242XB MULTIPLE FRACTURES OF RIBS LEFT SIDE INIT FOR OPN FX

T63121A

TOXIC EFFECT OF VENOM OF VENOMOUS LIZARD ACCIDENTAL INIT

S2243XA MULTIPLE FRACTURES OF RIBS BILATERAL INIT FOR CLOS FX

T63122A

TOXIC EFFECT OF VENOM OF VENOMOUS LIZARD SELF-HARM INIT

S2243XB MULTIPLE FRACTURES OF RIBS BILATERAL INIT FOR OPN FX

T63123A

TOXIC EFFECT OF VENOM OF OTH VENOMOUS LIZARD ASSAULT INIT

S2249XA MULTIPLE FRACTURES OF RIBS UNSP SIDE INIT FOR CLOS FX

T63124A

TOXIC EFFECT OF VENOM OF VENOMOUS LIZARD UNDETERMINED INIT

S2249XB MULTIPLE FRACTURES OF RIBS UNSP SIDE INIT FOR OPN FX

T63191A

TOXIC EFFECT OF VENOM OF REPTILES ACCIDENTAL INIT

S225XXA

FLAIL CHEST INITIAL ENCOUNTER FOR CLOSED FRACTURE

T63192A

TOXIC EFFECT OF VENOM OF REPTILES SELF-HARM INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S225XXB

FLAIL CHEST INITIAL ENCOUNTER FOR OPEN FRACTURE

T63193A

TOXIC EFFECT OF VENOM OF OTH REPTILES ASSAULT INIT ENCNTR

S229XXA FRACTURE OF BONY THORAX PART UNSP INIT FOR CLOS FX

T63194A

TOXIC EFFECT OF VENOM OF OTH REPTILES UNDETERMINED INIT

S229XXB FRACTURE OF BONY THORAX PART UNSP INIT FOR OPN FX

T632X1A

TOXIC EFFECT OF VENOM OF SCORPION ACCIDENTAL INIT

S230XXA

TRAUMATIC RUPTURE OF THORACIC INTERVERTEBRAL DISC INIT

T632X2A

TOXIC EFFECT OF VENOM OF SCORPION SELF-HARM INIT

S23100A

SUBLUXATION OF UNSPECIFIED THORACIC VERTEBRA INIT ENCNTR

T632X3A

TOXIC EFFECT OF VENOM OF SCORPION ASSAULT INIT ENCNTR

S23101A

DISLOCATION OF UNSPECIFIED THORACIC VERTEBRA INIT ENCNTR

T632X4A

TOXIC EFFECT OF VENOM OF SCORPION UNDETERMINED INIT ENCNTR

S23110A

SUBLUXATION OF T1/T2 THORACIC VERTEBRA INITIAL ENCOUNTER

T63301A

TOXIC EFFECT OF UNSP SPIDER VENOM ACCIDENTAL INIT

S23111A

DISLOCATION OF T1/T2 THORACIC VERTEBRA INITIAL ENCOUNTER

T63302A

TOXIC EFFECT OF UNSP SPIDER VENOM SELF-HARM INIT

S23120A

SUBLUXATION OF T2/T3 THORACIC VERTEBRA INITIAL ENCOUNTER

T63303A

TOXIC EFFECT OF UNSP SPIDER VENOM ASSAULT INIT ENCNTR

S23121A

DISLOCATION OF T2/T3 THORACIC VERTEBRA INITIAL ENCOUNTER

T63304A

TOXIC EFFECT OF UNSP SPIDER VENOM UNDETERMINED INIT ENCNTR

S23122A

SUBLUXATION OF T3/T4 THORACIC VERTEBRA INITIAL ENCOUNTER

T63311A

TOXIC EFFECT OF VENOM OF BLACK WIDOW SPIDER ACC INIT

S23123A

DISLOCATION OF T3/T4 THORACIC VERTEBRA INITIAL ENCOUNTER

T63312A

TOXIC EFFECT OF VENOM OF BLACK WIDOW SPIDER SELF-HARM INIT

S23130A

SUBLUXATION OF T4/T5 THORACIC VERTEBRA INITIAL ENCOUNTER

T63313A

TOXIC EFFECT OF VENOM OF BLACK WIDOW SPIDER ASSAULT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S23131A

DISLOCATION OF T4/T5 THORACIC VERTEBRA INITIAL ENCOUNTER

T63314A

TOXIC EFFECT OF VENOM OF BLACK WIDOW SPIDER UNDET INIT

S23132A

SUBLUXATION OF T5/T6 THORACIC VERTEBRA INITIAL ENCOUNTER

T63321A

TOXIC EFFECT OF VENOM OF TARANTULA ACCIDENTAL INIT

S23133A

DISLOCATION OF T5/T6 THORACIC VERTEBRA INITIAL ENCOUNTER

T63322A

TOXIC EFFECT OF VENOM OF TARANTULA SELF-HARM INIT

S23140A

SUBLUXATION OF T6/T7 THORACIC VERTEBRA INITIAL ENCOUNTER

T63323A

TOXIC EFFECT OF VENOM OF TARANTULA ASSAULT INIT ENCNTR

S23141A

DISLOCATION OF T6/T7 THORACIC VERTEBRA INITIAL ENCOUNTER

T63324A

TOXIC EFFECT OF VENOM OF TARANTULA UNDETERMINED INIT

S23142A

SUBLUXATION OF T7/T8 THORACIC VERTEBRA INITIAL ENCOUNTER

T63331A

TOXIC EFFECT OF VENOM OF BROWN RECLUSE SPIDER ACC INIT

S23143A

DISLOCATION OF T7/T8 THORACIC VERTEBRA INITIAL ENCOUNTER

T63332A

TOXIC EFFECT OF VENOM OF BROWN RECLUSE SPIDER SLF-HRM INIT

S23150A

SUBLUXATION OF T8/T9 THORACIC VERTEBRA INITIAL ENCOUNTER

T63333A

TOXIC EFFECT OF VENOM OF BROWN RECLUSE SPIDER ASSAULT INIT

S23151A

DISLOCATION OF T8/T9 THORACIC VERTEBRA INITIAL ENCOUNTER

T63334A

TOXIC EFFECT OF VENOM OF BROWN RECLUSE SPIDER UNDET INIT

S23152A

SUBLUXATION OF T9/T10 THORACIC VERTEBRA INITIAL ENCOUNTER

T63391A

TOXIC EFFECT OF VENOM OF SPIDER ACCIDENTAL INIT

S23153A

DISLOCATION OF T9/T10 THORACIC VERTEBRA INITIAL ENCOUNTER

T63392A

TOXIC EFFECT OF VENOM OF SPIDER INTENTIONAL SELF-HARM INIT

S23160A

SUBLUXATION OF T10/T11 THORACIC VERTEBRA INITIAL ENCOUNTER

T63393A

TOXIC EFFECT OF VENOM OF OTHER SPIDER ASSAULT INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S23161A

DISLOCATION OF T10/T11 THORACIC VERTEBRA INITIAL ENCOUNTER

T63394A

TOXIC EFFECT OF VENOM OF OTH SPIDER UNDETERMINED INIT

S23162A

SUBLUXATION OF T11/T12 THORACIC VERTEBRA INITIAL ENCOUNTER

T63411A

TOXIC EFFECT OF VENOM OF CENTIPEDE/MILLIPEDE ACC INIT

S23163A

DISLOCATION OF T11/T12 THORACIC VERTEBRA INITIAL ENCOUNTER

T63412A

TOXIC EFFECT OF VENOM OF CENTIPEDE/MILLIPEDE SLF-HRM INIT

S23170A

SUBLUXATION OF T12/L1 THORACIC VERTEBRA INITIAL ENCOUNTER

T63413A

TOXIC EFFECT OF VENOM OF CENTIPEDE/MILLIPEDE ASSAULT INIT

S23171A

DISLOCATION OF T12/L1 THORACIC VERTEBRA INITIAL ENCOUNTER

T63414A

TOXIC EFFECT OF VENOM OF CENTIPEDE/MILLIPEDE UNDET INIT

S2320XA

DISLOCATION OF UNSPECIFIED PART OF THORAX INITIAL ENCOUNTER

T63421A

TOXIC EFFECT OF VENOM OF ANTS ACCIDENTAL INIT

S2329XA

DISLOCATION OF OTHER PARTS OF THORAX INITIAL ENCOUNTER

T63422A

TOXIC EFFECT OF VENOM OF ANTS INTENTIONAL SELF-HARM INIT

S233XXA

SPRAIN OF LIGAMENTS OF THORACIC SPINE INITIAL ENCOUNTER

T63423A

TOXIC EFFECT OF VENOM OF ANTS ASSAULT INITIAL ENCOUNTER

S2341XA SPRAIN OF RIBS INITIAL ENCOUNTER

T63424A

TOXIC EFFECT OF VENOM OF ANTS UNDETERMINED INIT ENCNTR

S23420A

SPRAIN OF STERNOCLAVICULAR (JOINT) (LIGAMENT) INIT ENCNTR

T63431A

TOXIC EFFECT OF VENOM OF CATERPILLARS ACCIDENTAL INIT

S23421A SPRAIN OF CHONDROSTERNAL JOINT INITIAL ENCOUNTER

T63432A

TOXIC EFFECT OF VENOM OF CATERPILLARS SELF-HARM INIT

S23428A OTHER SPRAIN OF STERNUM INITIAL ENCOUNTER

T63433A

TOXIC EFFECT OF VENOM OF CATERPILLARS ASSAULT INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S23429A UNSPECIFIED SPRAIN OF STERNUM INITIAL ENCOUNTER

T63434A

TOXIC EFFECT OF VENOM OF CATERPILLARS UNDETERMINED INIT

S238XXA

SPRAIN OF OTHER SPECIFIED PARTS OF THORAX INITIAL ENCOUNTER

T63441A

TOXIC EFFECT OF VENOM OF BEES ACCIDENTAL INIT

S239XXA

SPRAIN OF UNSPECIFIED PARTS OF THORAX INITIAL ENCOUNTER

T63442A

TOXIC EFFECT OF VENOM OF BEES INTENTIONAL SELF-HARM INIT

S240XXA

CONCUSSION AND EDEMA OF THORACIC SPINAL CORD INIT ENCNTR

T63443A

TOXIC EFFECT OF VENOM OF BEES ASSAULT INITIAL ENCOUNTER

S24101A

UNSP INJURY AT T1 LEVEL OF THORACIC SPINAL CORD INIT ENCNTR

T63444A

TOXIC EFFECT OF VENOM OF BEES UNDETERMINED INIT ENCNTR

S24102A UNSP INJURY AT T2-T6 LEVEL OF THORACIC SPINAL CORD INIT

T63451A

TOXIC EFFECT OF VENOM OF HORNETS ACCIDENTAL INIT

S24103A UNSP INJURY AT T7-T10 LEVEL OF THORACIC SPINAL CORD INIT

T63452A

TOXIC EFFECT OF VENOM OF HORNETS SELF-HARM INIT

S24104A UNSP INJURY AT T11-T12 LEVEL OF THORACIC SPINAL CORD INIT

T63453A

TOXIC EFFECT OF VENOM OF HORNETS ASSAULT INITIAL ENCOUNTER

S24109A UNSP INJURY AT UNSP LEVEL OF THORACIC SPINAL CORD INIT

T63454A

TOXIC EFFECT OF VENOM OF HORNETS UNDETERMINED INIT ENCNTR

S24111A COMPLETE LESION AT T1 LEVEL OF THORACIC SPINAL CORD INIT

T63461A

TOXIC EFFECT OF VENOM OF WASPS ACCIDENTAL INIT

S24112A

COMPLETE LESION AT T2-T6 LEVEL OF THORACIC SPINAL CORD INIT

T63462A

TOXIC EFFECT OF VENOM OF WASPS INTENTIONAL SELF-HARM INIT

S24113A COMPLETE LESION AT T7-T10 INIT

T63463A

TOXIC EFFECT OF VENOM OF WASPS ASSAULT INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S24114A COMPLETE LESION AT T11-T12 INIT

T63464A

TOXIC EFFECT OF VENOM OF WASPS UNDETERMINED INIT ENCNTR

S24119A

COMPLETE LESION AT UNSP LEVEL OF THORACIC SPINAL CORD INIT

T63481A

TOXIC EFFECT OF VENOM OF ARTHROPOD ACCIDENTAL INIT

S24131A ANTERIOR CORD SYNDROME AT T1 INIT

T63482A

TOXIC EFFECT OF VENOM OF ARTHROPOD SELF-HARM INIT

S24132A ANTERIOR CORD SYNDROME AT T2-T6 INIT

T63483A

TOXIC EFFECT OF VENOM OF OTH ARTHROPOD ASSAULT INIT ENCNTR

S24133A ANTERIOR CORD SYNDROME AT T7-T10 INIT

T63484A

TOXIC EFFECT OF VENOM OF OTH ARTHROPOD UNDETERMINED INIT

S24134A ANTERIOR CORD SYNDROME AT T11-T12 INIT

T63511A

TOXIC EFFECT OF CONTACT W STINGRAY ACCIDENTAL INIT

S24139A

ANT CORD SYNDROME AT UNSP LEVEL OF THOR SPINAL CORD INIT

T63512A

TOXIC EFFECT OF CONTACT W STINGRAY SELF-HARM INIT

S24141A BROWN-SEQUARD SYNDROME AT T1 INIT

T63513A

TOXIC EFFECT OF CONTACT WITH STINGRAY ASSAULT INIT ENCNTR

S24142A BROWN-SEQUARD SYNDROME AT T2-T6 INIT

T63514A

TOXIC EFFECT OF CONTACT W STINGRAY UNDETERMINED INIT

S24143A BROWN-SEQUARD SYNDROME AT T7-T10 INIT

T63591A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS FISH ACC INIT

S24144A BROWN-SEQUARD SYNDROME AT T11-T12 INIT

T63592A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS FISH SELF-HARM INIT

S24149A

BROWN-SEQUARD SYND AT UNSP LEVEL OF THOR SPINAL CORD INIT

T63593A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS FISH ASSAULT INIT

S24151A OTH INCOMPLETE LESION AT T1 INIT

T63594A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS FISH UNDET INIT

S24152A OTH INCOMPLETE LESION AT T2-T6 INIT

T63611A

TOXIC EFFECT OF CONTACT W PORTUGESE MAN-O-WAR ACC INIT

Page 562: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S24153A OTH INCOMPLETE LESION AT T7-T10 INIT

T63612A

TOXIC EFFECT OF CONTACT W PORTUGESE MAN-O-WAR SLF-HRM INIT

S24154A OTH INCOMPLETE LESION AT T11-T12 INIT

T63613A

TOXIC EFFECT OF CONTACT W PORTUGESE MAN-O-WAR ASSAULT INIT

S24159A

OTH INCMPL LESION AT UNSP LEVEL OF THOR SPINAL CORD INIT

T63614A

TOXIC EFFECT OF CONTACT W PORTUGESE MAN-O-WAR UNDET INIT

S242XXA

INJURY OF NERVE ROOT OF THORACIC SPINE INITIAL ENCOUNTER

T63621A

TOXIC EFFECT OF CONTACT W OTH JELLYFISH ACCIDENTAL INIT

S243XXA

INJURY OF PERIPHERAL NERVES OF THORAX INITIAL ENCOUNTER

T63622A

TOXIC EFFECT OF CONTACT W OTH JELLYFISH SELF-HARM INIT

S244XXA

INJURY OF THORACIC SYMPATHETIC NERVOUS SYSTEM INIT ENCNTR

T63623A

TOXIC EFFECT OF CONTACT W OTH JELLYFISH ASSAULT INIT

S248XXA

INJURY OF OTHER SPECIFIED NERVES OF THORAX INIT ENCNTR

T63624A

TOXIC EFFECT OF CONTACT W OTH JELLYFISH UNDETERMINED INIT

S249XXA

INJURY OF UNSPECIFIED NERVE OF THORAX INITIAL ENCOUNTER

T63631A

TOXIC EFFECT OF CONTACT W SEA ANEMONE ACCIDENTAL INIT

S2500XA

UNSPECIFIED INJURY OF THORACIC AORTA INITIAL ENCOUNTER

T63632A

TOXIC EFFECT OF CONTACT W SEA ANEMONE SELF-HARM INIT

S2501XA

MINOR LACERATION OF THORACIC AORTA INITIAL ENCOUNTER

T63633A

TOXIC EFFECT OF CONTACT W SEA ANEMONE ASSAULT INIT ENCNTR

S2502XA

MAJOR LACERATION OF THORACIC AORTA INITIAL ENCOUNTER

T63634A

TOXIC EFFECT OF CONTACT W SEA ANEMONE UNDETERMINED INIT

S2509XA

OTHER SPECIFIED INJURY OF THORACIC AORTA INITIAL ENCOUNTER

T63691A

TOXIC EFFECT OF CNTCT W OTH VENOM MARINE ANIMALS ACC INIT

Page 563: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S25101A

UNSP INJURY OF RIGHT INNOMINATE OR SUBCLAVIAN ARTERY INIT

T63692A

TOXIC EFF OF CNTCT W OTH VENOM MARINE ANIMALS SLF-HRM INIT

S25102A

UNSP INJURY OF LEFT INNOMINATE OR SUBCLAVIAN ARTERY INIT

T63693A

TOXIC EFF OF CNTCT W OTH VENOM MARINE ANIMALS ASSLT INIT

S25109A

UNSP INJURY OF UNSP INNOMINATE OR SUBCLAVIAN ARTERY INIT

T63694A

TOXIC EFF OF CNTCT W OTH VENOM MARINE ANIMALS UNDET INIT

S25111A

MINOR LACERATION OF RIGHT INNOMINATE OR SUBCLAV ART INIT

T63711A

TOXIC EFFECT OF CONTACT W VENOMOUS MARINE PLANT ACC INIT

S25112A

MINOR LACERATION OF LEFT INNOMINATE OR SUBCLAV ART INIT

T63712A

TOXIC EFFECT OF CONTACT W VENOM MARINE PLANT SLF-HRM INIT

S25119A

MINOR LACERATION OF UNSP INNOMINATE OR SUBCLAV ART INIT

T63713A

TOXIC EFFECT OF CONTACT W VENOM MARINE PLANT ASSAULT INIT

S25121A

MAJOR LACERATION OF RIGHT INNOMINATE OR SUBCLAV ART INIT

T63714A

TOXIC EFFECT OF CONTACT W VENOMOUS MARINE PLANT UNDET INIT

S25122A

MAJOR LACERATION OF LEFT INNOMINATE OR SUBCLAV ART INIT

T63791A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS PLANT ACC INIT

S25129A

MAJOR LACERATION OF UNSP INNOMINATE OR SUBCLAV ART INIT

T63792A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS PLANT SLF-HRM INIT

S25191A

INJ RIGHT INNOMINATE OR SUBCLAVIAN ARTERY INIT ENCNTR

T63793A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS PLANT ASSAULT INIT

S25192A

INJ LEFT INNOMINATE OR SUBCLAVIAN ARTERY INIT ENCNTR

T63794A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS PLANT UNDET INIT

S25199A

INJ UNSP INNOMINATE OR SUBCLAVIAN ARTERY INIT ENCNTR

T63811A

TOXIC EFFECT OF CONTACT W VENOMOUS FROG ACCIDENTAL INIT

Page 564: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S2520XA

UNSPECIFIED INJURY OF SUPERIOR VENA CAVA INITIAL ENCOUNTER

T63812A

TOXIC EFFECT OF CONTACT W VENOMOUS FROG SELF-HARM INIT

S2521XA

MINOR LACERATION OF SUPERIOR VENA CAVA INITIAL ENCOUNTER

T63813A

TOXIC EFFECT OF CONTACT W VENOMOUS FROG ASSAULT INIT

S2522XA

MAJOR LACERATION OF SUPERIOR VENA CAVA INITIAL ENCOUNTER

T63814A

TOXIC EFFECT OF CONTACT W VENOMOUS FROG UNDETERMINED INIT

S2529XA

OTHER SPECIFIED INJURY OF SUPERIOR VENA CAVA INIT ENCNTR

T63821A

TOXIC EFFECT OF CONTACT W VENOMOUS TOAD ACCIDENTAL INIT

S25301A

UNSP INJURY OF RIGHT INNOMINATE OR SUBCLAVIAN VEIN INIT

T63822A

TOXIC EFFECT OF CONTACT W VENOMOUS TOAD SELF-HARM INIT

S25302A

UNSP INJURY OF LEFT INNOMINATE OR SUBCLAVIAN VEIN INIT

T63823A

TOXIC EFFECT OF CONTACT W VENOMOUS TOAD ASSAULT INIT

S25309A

UNSP INJURY OF UNSP INNOMINATE OR SUBCLAVIAN VEIN INIT

T63824A

TOXIC EFFECT OF CONTACT W VENOMOUS TOAD UNDETERMINED INIT

S25311A

MINOR LACERATION OF RIGHT INNOMINATE OR SUBCLAV VEIN INIT

T63831A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS AMPHIBIAN ACC INIT

S25312A

MINOR LACERATION OF LEFT INNOMINATE OR SUBCLAVIAN VEIN INIT

T63832A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS AMPHIB SLF-HRM INIT

S25319A

MINOR LACERATION OF UNSP INNOMINATE OR SUBCLAVIAN VEIN INIT

T63833A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS AMPHIB ASSAULT INIT

S25321A

MAJOR LACERATION OF RIGHT INNOMINATE OR SUBCLAV VEIN INIT

T63834A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS AMPHIB UNDET INIT

S25322A

MAJOR LACERATION OF LEFT INNOMINATE OR SUBCLAVIAN VEIN INIT

T63891A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS ANIMALS ACC INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S25329A

MAJOR LACERATION OF UNSP INNOMINATE OR SUBCLAVIAN VEIN INIT

T63892A

TOXIC EFFECT OF CONTACT W OTH VENOM ANIMALS SLF-HRM INIT

S25391A INJ RIGHT INNOMINATE OR SUBCLAVIAN VEIN INIT ENCNTR

T63893A

TOXIC EFFECT OF CONTACT W OTH VENOM ANIMALS ASSAULT INIT

S25392A INJ LEFT INNOMINATE OR SUBCLAVIAN VEIN INIT ENCNTR

T63894A

TOXIC EFFECT OF CONTACT W OTH VENOMOUS ANIMALS UNDET INIT

S25399A INJ UNSP INNOMINATE OR SUBCLAVIAN VEIN INIT ENCNTR

T6391XA

TOXIC EFFECT OF CONTACT W UNSP VENOMOUS ANIMAL ACC INIT

S25401A

UNSP INJURY OF RIGHT PULMONARY BLOOD VESSELS INIT ENCNTR

T6392XA

TOXIC EFFECT OF CONTACT W UNSP VENOM ANIMAL SLF-HRM INIT

S25402A

UNSP INJURY OF LEFT PULMONARY BLOOD VESSELS INIT ENCNTR

T6393XA

TOXIC EFFECT OF CONTACT W UNSP VENOM ANIMAL ASSAULT INIT

S25409A

UNSP INJURY OF UNSP PULMONARY BLOOD VESSELS INIT ENCNTR

T6394XA

TOXIC EFFECT OF CONTACT W UNSP VENOMOUS ANIMAL UNDET INIT

S25411A

MINOR LACERATION OF RIGHT PULMONARY BLOOD VESSELS INIT

T6401XA

TOXIC EFFECT OF AFLATOXIN ACCIDENTAL (UNINTENTIONAL) INIT

S25412A

MINOR LACERATION OF LEFT PULMONARY BLOOD VESSELS INIT

T6402XA

TOXIC EFFECT OF AFLATOXIN INTENTIONAL SELF-HARM INIT

S25419A

MINOR LACERATION OF UNSP PULMONARY BLOOD VESSELS INIT

T6403XA

TOXIC EFFECT OF AFLATOXIN ASSAULT INITIAL ENCOUNTER

S25421A

MAJOR LACERATION OF RIGHT PULMONARY BLOOD VESSELS INIT

T6404XA

TOXIC EFFECT OF AFLATOXIN UNDETERMINED INITIAL ENCOUNTER

S25422A

MAJOR LACERATION OF LEFT PULMONARY BLOOD VESSELS INIT

T6481XA

TOXIC EFFECT OF MYCOTOXIN FOOD CONTAMNT ACCIDENTAL INIT

Page 566: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S25429A

MAJOR LACERATION OF UNSP PULMONARY BLOOD VESSELS INIT

T6482XA

TOXIC EFFECT OF MYCOTOXIN FOOD CONTAMINANTS SELF-HARM INIT

S25491A

OTH INJURY OF RIGHT PULMONARY BLOOD VESSELS INIT ENCNTR

T6483XA

TOXIC EFFECT OF MYCOTOXIN FOOD CONTAMINANTS ASSAULT INIT

S25492A

OTH INJURY OF LEFT PULMONARY BLOOD VESSELS INIT ENCNTR

T6484XA

TOXIC EFFECT OF MYCOTOXIN FOOD CONTAMNT UNDETERMINED INIT

S25499A

OTH INJURY OF UNSP PULMONARY BLOOD VESSELS INIT ENCNTR

T650X1A

TOXIC EFFECT OF CYANIDES ACCIDENTAL (UNINTENTIONAL) INIT

S25501A

UNSP INJURY OF INTERCOSTAL BLOOD VESSELS RIGHT SIDE INIT

T650X2A

TOXIC EFFECT OF CYANIDES INTENTIONAL SELF-HARM INIT ENCNTR

S25502A UNSP INJURY OF INTERCOSTAL BLOOD VESSELS LEFT SIDE INIT

T650X3A

TOXIC EFFECT OF CYANIDES ASSAULT INITIAL ENCOUNTER

S25509A UNSP INJURY OF INTERCOSTAL BLOOD VESSELS UNSP SIDE INIT

T650X4A

TOXIC EFFECT OF CYANIDES UNDETERMINED INITIAL ENCOUNTER

S25511A

LACERATION OF INTERCOSTAL BLOOD VESSELS RIGHT SIDE INIT

T651X1A

TOXIC EFFECT OF STRYCHNINE AND ITS SALTS ACCIDENTAL INIT

S25512A LACERATION OF INTERCOSTAL BLOOD VESSELS LEFT SIDE INIT

T651X2A

TOXIC EFFECT OF STRYCHNINE AND ITS SALTS SELF-HARM INIT

S25519A LACERATION OF INTERCOSTAL BLOOD VESSELS UNSP SIDE INIT

T651X3A

TOXIC EFFECT OF STRYCHNINE AND ITS SALTS ASSAULT INIT

S25591A

INJ INTERCOSTAL BLOOD VESSELS RIGHT SIDE INIT ENCNTR

T651X4A

TOXIC EFFECT OF STRYCHNINE AND ITS SALTS UNDETERMINED INIT

S25592A INJ INTERCOSTAL BLOOD VESSELS LEFT SIDE INIT ENCNTR

T65211A

TOXIC EFFECT OF CHEWING TOBACCO ACCIDENTAL INIT

Page 567: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S25599A

INJ INTERCOSTAL BLOOD VESSELS UNSP SIDE INIT ENCNTR

T65212A

TOXIC EFFECT OF CHEWING TOBACCO INTENTIONAL SELF-HARM INIT

S25801A

UNSP INJURY OF OTH BLOOD VESSELS OF THORAX RIGHT SIDE INIT

T65213A

TOXIC EFFECT OF CHEWING TOBACCO ASSAULT INITIAL ENCOUNTER

S25802A

UNSP INJURY OF OTH BLOOD VESSELS OF THORAX LEFT SIDE INIT

T65214A

TOXIC EFFECT OF CHEWING TOBACCO UNDETERMINED INIT ENCNTR

S25809A

UNSP INJURY OF OTH BLOOD VESSELS OF THORAX UNSP SIDE INIT

T65221A

TOXIC EFFECT OF TOBACCO CIGARETTES ACCIDENTAL INIT

S25811A

LACERATION OF OTH BLOOD VESSELS OF THORAX RIGHT SIDE INIT

T65222A

TOXIC EFFECT OF TOBACCO CIGARETTES SELF-HARM INIT

S25812A

LACERATION OF OTH BLOOD VESSELS OF THORAX LEFT SIDE INIT

T65223A

TOXIC EFFECT OF TOBACCO CIGARETTES ASSAULT INIT ENCNTR

S25819A

LACERATION OF OTH BLOOD VESSELS OF THORAX UNSP SIDE INIT

T65224A

TOXIC EFFECT OF TOBACCO CIGARETTES UNDETERMINED INIT

S25891A

INJ OTH BLOOD VESSELS OF THORAX RIGHT SIDE INIT ENCNTR

T65291A

TOXIC EFFECT OF TOBACCO AND NICOTINE ACCIDENTAL INIT

S25892A INJ OTH BLOOD VESSELS OF THORAX LEFT SIDE INIT ENCNTR

T65292A

TOXIC EFFECT OF TOBACCO AND NICOTINE SELF-HARM INIT

S25899A

INJ OTH BLOOD VESSELS OF THORAX UNSP SIDE INIT ENCNTR

T65293A

TOXIC EFFECT OF OTH TOBACCO AND NICOTINE ASSAULT INIT

S2590XA

UNSP INJURY OF UNSP BLOOD VESSEL OF THORAX INIT ENCNTR

T65294A

TOXIC EFFECT OF OTH TOBACCO AND NICOTINE UNDETERMINED INIT

S2591XA

LACERATION OF UNSP BLOOD VESSEL OF THORAX INIT ENCNTR

T653X1A

TOXIC EFF OF NITRODRV/AMINODRV OF BENZN/HOMOLOG ACC INIT

Page 568: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S2599XA

OTH INJURY OF UNSP BLOOD VESSEL OF THORAX INIT ENCNTR

T653X2A

TOX EFF OF NITRODRV/AMINODRV OF BENZN/HOMOLOG SLF-HRM INIT

S2600XA

UNSP INJURY OF HEART WITH HEMOPERICARDIUM INIT ENCNTR

T653X3A

TOXIC EFF OF NITRODRV/AMINODRV OF BENZN/HOMOLOG ASSLT INIT

S2601XA

CONTUSION OF HEART WITH HEMOPERICARDIUM INITIAL ENCOUNTER

T653X4A

TOXIC EFF OF NITRODRV/AMINODRV OF BENZN/HOMOLOG UNDET INIT

S26020A

MILD LACERATION OF HEART WITH HEMOPERICARDIUM INIT ENCNTR

T654X1A

TOXIC EFFECT OF CARBON DISULFIDE ACCIDENTAL INIT

S26021A

MODERATE LACERATION OF HEART W HEMOPERICARDIUM INIT ENCNTR

T654X2A

TOXIC EFFECT OF CARBON DISULFIDE SELF-HARM INIT

S26022A

MAJOR LACERATION OF HEART WITH HEMOPERICARDIUM INIT ENCNTR

T654X3A

TOXIC EFFECT OF CARBON DISULFIDE ASSAULT INITIAL ENCOUNTER

S2609XA

OTHER INJURY OF HEART WITH HEMOPERICARDIUM INIT ENCNTR

T654X4A

TOXIC EFFECT OF CARBON DISULFIDE UNDETERMINED INIT ENCNTR

S2610XA

UNSP INJURY OF HEART WITHOUT HEMOPERICARDIUM INIT ENCNTR

T655X1A

TOX EFF OF NITRO AND OTH NITRIC ACIDS AND ESTERS ACC INIT

S2611XA

CONTUSION OF HEART WITHOUT HEMOPERICARDIUM INIT ENCNTR

T655X2A

TOX EFF OF NITRO & OTH NITRIC ACIDS & ESTERS SLF-HRM INIT

S2612XA

LACERATION OF HEART WITHOUT HEMOPERICARDIUM INIT ENCNTR

T655X3A

TOX EFF OF NITRO & OTH NITRIC ACIDS AND ESTERS ASSLT INIT

S2619XA

OTHER INJURY OF HEART WITHOUT HEMOPERICARDIUM INIT ENCNTR

T655X4A

TOX EFF OF NITRO & OTH NITRIC ACIDS AND ESTERS UNDET INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S2690XA

UNSP INJURY OF HEART UNSP W OR W/O HEMOPERICARDIUM INIT

T656X1A

TOXIC EFFECT OF PAINTS AND DYES NEC ACCIDENTAL INIT

S2691XA

CONTUSION OF HEART UNSP W OR W/O HEMOPERICARDIUM INIT

T656X2A

TOXIC EFFECT OF PAINTS AND DYES NEC SELF-HARM INIT

S2692XA

LACERATION OF HEART UNSP W OR W/O HEMOPERICARDIUM INIT

T656X3A

TOXIC EFFECT OF PAINTS AND DYES NEC ASSAULT INIT

S2699XA

INJ HEART UNSP W OR W/O HEMOPERICARDIUM INIT ENCNTR

T656X4A

TOXIC EFFECT OF PAINTS AND DYES NEC UNDETERMINED INIT

S270XXA TRAUMATIC PNEUMOTHORAX INITIAL ENCOUNTER

T65811A

TOXIC EFFECT OF LATEX ACCIDENTAL (UNINTENTIONAL) INIT

S271XXA TRAUMATIC HEMOTHORAX INITIAL ENCOUNTER

T65812A

TOXIC EFFECT OF LATEX INTENTIONAL SELF-HARM INIT ENCNTR

S272XXA

TRAUMATIC HEMOPNEUMOTHORAX INITIAL ENCOUNTER

T65813A

TOXIC EFFECT OF LATEX ASSAULT INITIAL ENCOUNTER

S27301A

UNSPECIFIED INJURY OF LUNG UNILATERAL INITIAL ENCOUNTER

T65814A

TOXIC EFFECT OF LATEX UNDETERMINED INITIAL ENCOUNTER

S27302A UNSPECIFIED INJURY OF LUNG BILATERAL INITIAL ENCOUNTER

T65821A

TOXIC EFFECT OF HARMFUL ALGAE AND ALGAE TOXINS ACC INIT

S27309A

UNSPECIFIED INJURY OF LUNG UNSPECIFIED INITIAL ENCOUNTER

T65822A

TOXIC EFF OF HARMFUL ALGAE AND ALGAE TOXINS SLF-HRM INIT

S27311A

PRIMARY BLAST INJURY OF LUNG UNILATERAL INITIAL ENCOUNTER

T65823A

TOXIC EFFECT OF HARMFUL ALGAE AND ALGAE TOXINS ASSLT INIT

S27312A

PRIMARY BLAST INJURY OF LUNG BILATERAL INITIAL ENCOUNTER

T65824A

TOXIC EFFECT OF HARMFUL ALGAE AND ALGAE TOXINS UNDET INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S27319A

PRIMARY BLAST INJURY OF LUNG UNSPECIFIED INITIAL ENCOUNTER

T65831A

TOXIC EFFECT OF FIBERGLASS ACCIDENTAL (UNINTENTIONAL) INIT

S27321A

CONTUSION OF LUNG UNILATERAL INITIAL ENCOUNTER

T65832A

TOXIC EFFECT OF FIBERGLASS INTENTIONAL SELF-HARM INIT

S27322A CONTUSION OF LUNG BILATERAL INITIAL ENCOUNTER

T65833A

TOXIC EFFECT OF FIBERGLASS ASSAULT INITIAL ENCOUNTER

S27329A

CONTUSION OF LUNG UNSPECIFIED INITIAL ENCOUNTER

T65834A

TOXIC EFFECT OF FIBERGLASS UNDETERMINED INITIAL ENCOUNTER

S27331A

LACERATION OF LUNG UNILATERAL INITIAL ENCOUNTER

T65891A

TOXIC EFFECT OF SUBSTANCES ACCIDENTAL (UNINTENTIONAL) INIT

S27332A LACERATION OF LUNG BILATERAL INITIAL ENCOUNTER

T65892A

TOXIC EFFECT OF OTH SUBSTANCES INTENTIONAL SELF-HARM INIT

S27339A

LACERATION OF LUNG UNSPECIFIED INITIAL ENCOUNTER

T65893A

TOXIC EFFECT OF OTH SUBSTANCES ASSAULT INIT ENCNTR

S27391A

OTHER INJURIES OF LUNG UNILATERAL INITIAL ENCOUNTER

T65894A

TOXIC EFFECT OF OTH SUBSTANCES UNDETERMINED INIT ENCNTR

S27392A OTHER INJURIES OF LUNG BILATERAL INITIAL ENCOUNTER

T6591XA

TOXIC EFFECT OF UNSP SUBSTANCE ACCIDENTAL INIT

S27399A

OTHER INJURIES OF LUNG UNSPECIFIED INITIAL ENCOUNTER

T6592XA

TOXIC EFFECT OF UNSP SUBSTANCE INTENTIONAL SELF-HARM INIT

S27401A

UNSPECIFIED INJURY OF BRONCHUS UNILATERAL INIT ENCNTR

T6593XA

TOXIC EFFECT OF UNSPECIFIED SUBSTANCE ASSAULT INIT ENCNTR

S27402A

UNSPECIFIED INJURY OF BRONCHUS BILATERAL INITIAL ENCOUNTER

T6594XA

TOXIC EFFECT OF UNSP SUBSTANCE UNDETERMINED INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S27409A

UNSPECIFIED INJURY OF BRONCHUS UNSPECIFIED INIT ENCNTR

T66XXXA

RADIATION SICKNESS UNSPECIFIED INITIAL ENCOUNTER

S27411A

PRIMARY BLAST INJURY OF BRONCHUS UNILATERAL INIT ENCNTR

T670XXA

HEATSTROKE AND SUNSTROKE INITIAL ENCOUNTER

S27412A

PRIMARY BLAST INJURY OF BRONCHUS BILATERAL INIT ENCNTR

T671XXA HEAT SYNCOPE INITIAL ENCOUNTER

S27419A

PRIMARY BLAST INJURY OF BRONCHUS UNSPECIFIED INIT ENCNTR

T672XXA HEAT CRAMP INITIAL ENCOUNTER

S27421A

CONTUSION OF BRONCHUS UNILATERAL INITIAL ENCOUNTER

T673XXA

HEAT EXHAUSTION ANHYDROTIC INITIAL ENCOUNTER

S27422A CONTUSION OF BRONCHUS BILATERAL INITIAL ENCOUNTER

T674XXA

HEAT EXHAUSTION DUE TO SALT DEPLETION INITIAL ENCOUNTER

S27429A

CONTUSION OF BRONCHUS UNSPECIFIED INITIAL ENCOUNTER

T675XXA

HEAT EXHAUSTION UNSPECIFIED INITIAL ENCOUNTER

S27431A

LACERATION OF BRONCHUS UNILATERAL INITIAL ENCOUNTER

T676XXA

HEAT FATIGUE TRANSIENT INITIAL ENCOUNTER

S27432A LACERATION OF BRONCHUS BILATERAL INITIAL ENCOUNTER

T677XXA HEAT EDEMA INITIAL ENCOUNTER

S27439A

LACERATION OF BRONCHUS UNSPECIFIED INITIAL ENCOUNTER

T68XXXA HYPOTHERMIA INITIAL ENCOUNTER

S27491A

OTHER INJURY OF BRONCHUS UNILATERAL INITIAL ENCOUNTER

T69011A

IMMERSION HAND RIGHT HAND INITIAL ENCOUNTER

S27492A OTHER INJURY OF BRONCHUS BILATERAL INITIAL ENCOUNTER

T69012A

IMMERSION HAND LEFT HAND INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S27499A

OTHER INJURY OF BRONCHUS UNSPECIFIED INITIAL ENCOUNTER

T69019A

IMMERSION HAND UNSPECIFIED HAND INITIAL ENCOUNTER

S2750XA

UNSPECIFIED INJURY OF THORACIC TRACHEA INITIAL ENCOUNTER

T69021A

IMMERSION FOOT RIGHT FOOT INITIAL ENCOUNTER

S2751XA

PRIMARY BLAST INJURY OF THORACIC TRACHEA INITIAL ENCOUNTER

T69022A

IMMERSION FOOT LEFT FOOT INITIAL ENCOUNTER

S2752XA CONTUSION OF THORACIC TRACHEA INITIAL ENCOUNTER

T69029A

IMMERSION FOOT UNSPECIFIED FOOT INITIAL ENCOUNTER

S2753XA LACERATION OF THORACIC TRACHEA INITIAL ENCOUNTER

T691XXA CHILBLAINS INITIAL ENCOUNTER

S2759XA OTHER INJURY OF THORACIC TRACHEA INITIAL ENCOUNTER

T698XXA

OTHER SPECIFIED EFFECTS OF REDUCED TEMPERATURE INIT ENCNTR

S2760XA UNSPECIFIED INJURY OF PLEURA INITIAL ENCOUNTER

T699XXA

EFFECT OF REDUCED TEMPERATURE UNSPECIFIED INIT ENCNTR

S2763XA LACERATION OF PLEURA INITIAL ENCOUNTER

T700XXA

OTITIC BAROTRAUMA INITIAL ENCOUNTER

S2769XA OTHER INJURY OF PLEURA INITIAL ENCOUNTER

T701XXA

SINUS BAROTRAUMA INITIAL ENCOUNTER

S27802A CONTUSION OF DIAPHRAGM INITIAL ENCOUNTER

T7020XA

UNSPECIFIED EFFECTS OF HIGH ALTITUDE INITIAL ENCOUNTER

S27803A LACERATION OF DIAPHRAGM INITIAL ENCOUNTER

T7029XA

OTHER EFFECTS OF HIGH ALTITUDE INITIAL ENCOUNTER

S27808A OTHER INJURY OF DIAPHRAGM INITIAL ENCOUNTER

T703XXA

CAISSON DISEASE [DECOMPRESSION SICKNESS] INITIAL ENCOUNTER

S27809A

UNSPECIFIED INJURY OF DIAPHRAGM INITIAL ENCOUNTER

T704XXA

EFFECTS OF HIGH-PRESSURE FLUIDS INITIAL ENCOUNTER

S27812A

CONTUSION OF ESOPHAGUS (THORACIC PART) INITIAL ENCOUNTER

T708XXA

OTH EFFECTS OF AIR PRESSURE AND WATER PRESSURE INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S27813A

LACERATION OF ESOPHAGUS (THORACIC PART) INITIAL ENCOUNTER

T709XXA

EFFECT OF AIR PRESSURE AND WATER PRESSURE UNSP INIT ENCNTR

S27818A

OTHER INJURY OF ESOPHAGUS (THORACIC PART) INITIAL ENCOUNTER

T71111A

ASPHYX DUE TO SMOTHERING UNDER PILLOW ACCIDENTAL INIT

S27819A

UNSPECIFIED INJURY OF ESOPHAGUS (THORACIC PART) INIT ENCNTR

T71112A

ASPHYXIATION DUE TO SMOTHERING UNDER PILLOW SELF-HARM INIT

S27892A

CONTUSION OF OTH INTRATHORACIC ORGANS INIT ENCNTR

T71113A

ASPHYXIATION DUE TO SMOTHERING UNDER PILLOW ASSAULT INIT

S27893A

LACERATION OF OTH INTRATHORACIC ORGANS INIT ENCNTR

T71114A

ASPHYX DUE TO SMOTHERING UNDER PILLOW UNDETERMINED INIT

S27898A

OTHER INJURY OF OTH INTRATHORACIC ORGANS INIT ENCNTR

T71121A

ASPHYXIATION DUE TO PLASTIC BAG ACCIDENTAL INIT ENCNTR

S27899A

UNSPECIFIED INJURY OF OTH INTRATHORACIC ORGANS INIT ENCNTR

T71122A

ASPHYXIATION DUE TO PLASTIC BAG INTENTIONAL SELF-HARM INIT

S279XXA

INJURY OF UNSPECIFIED INTRATHORACIC ORGAN INITIAL ENCOUNTER

T71123A

ASPHYXIATION DUE TO PLASTIC BAG ASSAULT INITIAL ENCOUNTER

S280XXA CRUSHED CHEST INITIAL ENCOUNTER

T71124A

ASPHYXIATION DUE TO PLASTIC BAG UNDETERMINED INIT ENCNTR

S281XXA TRAUMATIC AMP OF PART OF THORAX EXCEPT BREAST INIT

T71131A

ASPHYX DUE TO BEING TRAPPED IN BED LINENS ACCIDENTAL INIT

S28211A

COMPLETE TRAUMATIC AMPUTATION OF RIGHT BREAST INIT ENCNTR

T71132A

ASPHYX DUE TO BEING TRAPPED IN BED LINENS SELF-HARM INIT

S28212A

COMPLETE TRAUMATIC AMPUTATION OF LEFT BREAST INIT ENCNTR

T71133A

ASPHYX DUE TO BEING TRAPPED IN BED LINENS ASSAULT INIT

S28219A

COMPLETE TRAUMATIC AMPUTATION OF UNSP BREAST INIT ENCNTR

T71134A

ASPHYX DUE TO BEING TRAPPED IN BED LINENS UNDET INIT

Page 574: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S28221A

PARTIAL TRAUMATIC AMPUTATION OF RIGHT BREAST INIT ENCNTR

T71141A

ASPHYX DUE TO SMOTHR UNDER ANOTHER PERSON'S BODY ACC INIT

S28222A

PARTIAL TRAUMATIC AMPUTATION OF LEFT BREAST INIT ENCNTR

T71143A

ASPHYX D/T SMOTHR UNDER ANOTHER PERSON'S BODY ASSLT INIT

S28229A

PARTIAL TRAUMATIC AMPUTATION OF UNSP BREAST INIT ENCNTR

T71144A

ASPHYX D/T SMOTHR UNDER ANOTHER PERSON'S BODY UNDET INIT

S29001A UNSP INJURY OF MSL/TND OF FRONT WALL OF THORAX INIT

T71151A

ASPHYX DUE TO SMOTHERING IN FURNITURE ACCIDENTAL INIT

S29002A UNSP INJURY OF MSL/TND OF BACK WALL OF THORAX INIT

T71152A

ASPHYXIATION DUE TO SMOTHERING IN FURNITURE SELF-HARM INIT

S29009A UNSP INJURY OF MSL/TND OF UNSP WALL OF THORAX INIT

T71153A

ASPHYXIATION DUE TO SMOTHERING IN FURNITURE ASSAULT INIT

S29011A

STRAIN OF MUSCLE AND TENDON OF FRONT WALL OF THORAX INIT

T71154A

ASPHYX DUE TO SMOTHERING IN FURNITURE UNDETERMINED INIT

S29012A

STRAIN OF MUSCLE AND TENDON OF BACK WALL OF THORAX INIT

T71161A

ASPHYXIATION DUE TO HANGING ACCIDENTAL INITIAL ENCOUNTER

S29019A

STRAIN OF MUSCLE AND TENDON OF UNSP WALL OF THORAX INIT

T71162A

ASPHYXIATION DUE TO HANGING INTENTIONAL SELF-HARM INIT

S29021A LACERATION OF MSL/TND OF FRONT WALL OF THORAX INIT

T71163A

ASPHYXIATION DUE TO HANGING ASSAULT INITIAL ENCOUNTER

S29022A

LACERATION OF MUSCLE AND TENDON OF BACK WALL OF THORAX INIT

T71164A

ASPHYXIATION DUE TO HANGING UNDETERMINED INITIAL ENCOUNTER

S29029A

LACERATION OF MUSCLE AND TENDON OF UNSP WALL OF THORAX INIT

T71191A

ASPHYX D/T MECH THREAT TO BREATHE D/T OTH CAUSE ACC INIT

S29091A

INJ MUSCLE AND TENDON OF FRONT WALL OF THORAX INIT ENCNTR

T71192A

ASPHYX D/T MECH THRT TO BREATHE D/T OTH CAUSE SLF-HRM INIT

Page 575: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S29092A

INJ MUSCLE AND TENDON OF BACK WALL OF THORAX INIT ENCNTR

T71193A

ASPHYX D/T MECH THREAT TO BREATHE D/T OTH CAUSE ASSLT INIT

S29099A

INJ MUSCLE AND TENDON OF UNSP WALL OF THORAX INIT ENCNTR

T71194A

ASPHYX D/T MECH THREAT TO BREATHE D/T OTH CAUSE UNDET INIT

S298XXA OTHER SPECIFIED INJURIES OF THORAX INITIAL ENCOUNTER

T7120XA

ASPHYX D/T SYS OXY DEFIC D/T LOW OXY IN AIR UNSP CAUSE INIT

S299XXA UNSPECIFIED INJURY OF THORAX INITIAL ENCOUNTER

T7121XA

ASPHYXIATION DUE TO CAVE-IN OR FALLING EARTH INIT ENCNTR

S300XXA

CONTUSION OF LOWER BACK AND PELVIS INITIAL ENCOUNTER

T71221A

ASPHYX DUE TO BEING TRAPPED IN A CAR TRUNK ACCIDENTAL INIT

S301XXA CONTUSION OF ABDOMINAL WALL INITIAL ENCOUNTER

T71222A

ASPHYX DUE TO BEING TRAPPED IN A CAR TRUNK SELF-HARM INIT

S30201A

CONTUSION OF UNSP EXTERNAL GENITAL ORGAN MALE INIT ENCNTR

T71223A

ASPHYX DUE TO BEING TRAPPED IN A CAR TRUNK ASSAULT INIT

S30202A

CONTUSION OF UNSP EXTERNAL GENITAL ORGAN FEMALE INIT

T71224A

ASPHYX DUE TO BEING TRAPPED IN A CAR TRUNK UNDET INIT

S3021XA CONTUSION OF PENIS INITIAL ENCOUNTER

T71231A

ASPHYX DUE TO BEING TRAP IN A (DISCARDED) REFRIG ACC INIT

S3022XA CONTUSION OF SCROTUM AND TESTES INITIAL ENCOUNTER

T71232A

ASPHYX D/T BEING TRAP IN A (DISCARDED) REFRIG SLF-HRM INIT

S3023XA CONTUSION OF VAGINA AND VULVA INITIAL ENCOUNTER

T71233A

ASPHYX D/T BEING TRAP IN A (DISCARDED) REFRIG ASSLT INIT

S303XXA CONTUSION OF ANUS INITIAL ENCOUNTER

T71234A

ASPHYX D/T BEING TRAP IN A (DISCARDED) REFRIG UNDET INIT

S30810A

ABRASION OF LOWER BACK AND PELVIS INITIAL ENCOUNTER

T7129XA

ASPHYX DUE TO BEING TRAP IN OTH LOW OXYGEN ENVIRONMENT INIT

S30811A ABRASION OF ABDOMINAL WALL INITIAL ENCOUNTER

T719XXA

ASPHYXIATION DUE TO UNSPECIFIED CAUSE INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S30812A ABRASION OF PENIS INITIAL ENCOUNTER

T730XXA STARVATION INITIAL ENCOUNTER

S30813A ABRASION OF SCROTUM AND TESTES INITIAL ENCOUNTER

T731XXA

DEPRIVATION OF WATER INITIAL ENCOUNTER

S30814A ABRASION OF VAGINA AND VULVA INITIAL ENCOUNTER

T732XXA

EXHAUSTION DUE TO EXPOSURE INITIAL ENCOUNTER

S30815A

ABRASION OF UNSP EXTERNAL GENITAL ORGANS MALE INIT ENCNTR

T733XXA

EXHAUSTION DUE TO EXCESSIVE EXERTION INITIAL ENCOUNTER

S30816A ABRASION OF UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T7401XA

ADULT NEGLECT OR ABANDONMENT CONFIRMED INITIAL ENCOUNTER

S30817A ABRASION OF ANUS INITIAL ENCOUNTER

T7402XA

CHILD NEGLECT OR ABANDONMENT CONFIRMED INITIAL ENCOUNTER

S30820A

BLISTER (NONTHERMAL) OF LOWER BACK AND PELVIS INIT ENCNTR

T7411XA

ADULT PHYSICAL ABUSE CONFIRMED INITIAL ENCOUNTER

S30821A

BLISTER (NONTHERMAL) OF ABDOMINAL WALL INITIAL ENCOUNTER

T7412XA

CHILD PHYSICAL ABUSE CONFIRMED INITIAL ENCOUNTER

S30822A BLISTER (NONTHERMAL) OF PENIS INITIAL ENCOUNTER

T7421XA

ADULT SEXUAL ABUSE CONFIRMED INITIAL ENCOUNTER

S30823A

BLISTER (NONTHERMAL) OF SCROTUM AND TESTES INIT ENCNTR

T7422XA

CHILD SEXUAL ABUSE CONFIRMED INITIAL ENCOUNTER

S30824A

BLISTER (NONTHERMAL) OF VAGINA AND VULVA INITIAL ENCOUNTER

T7431XA

ADULT PSYCHOLOGICAL ABUSE CONFIRMED INITIAL ENCOUNTER

S30825A BLISTER OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

T7432XA

CHILD PSYCHOLOGICAL ABUSE CONFIRMED INITIAL ENCOUNTER

S30826A BLISTER OF UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T744XXA

SHAKEN INFANT SYNDROME INITIAL ENCOUNTER

S30827A BLISTER (NONTHERMAL) OF ANUS INITIAL ENCOUNTER

T7500XA

UNSPECIFIED EFFECTS OF LIGHTNING INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S30840A

EXTERNAL CONSTRICTION OF LOWER BACK AND PELVIS INIT ENCNTR

T7501XA

SHOCK DUE TO BEING STRUCK BY LIGHTNING INITIAL ENCOUNTER

S30841A

EXTERNAL CONSTRICTION OF ABDOMINAL WALL INITIAL ENCOUNTER

T7509XA

OTHER EFFECTS OF LIGHTNING INITIAL ENCOUNTER

S30842A EXTERNAL CONSTRICTION OF PENIS INITIAL ENCOUNTER

T751XXA

UNSP EFFECTS OF DROWNING AND NONFATAL SUBMERSION INIT

S30843A

EXTERNAL CONSTRICTION OF SCROTUM AND TESTES INIT ENCNTR

T754XXA ELECTROCUTION INITIAL ENCOUNTER

S30844A

EXTERNAL CONSTRICTION OF VAGINA AND VULVA INITIAL ENCOUNTER

T7601XA

ADULT NEGLECT OR ABANDONMENT SUSPECTED INITIAL ENCOUNTER

S30845A

EXTRN CONSTRICT OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

T7602XA

CHILD NEGLECT OR ABANDONMENT SUSPECTED INITIAL ENCOUNTER

S30846A

EXTRN CONSTRICT OF UNSP EXTRN GENITAL ORGANS FEMALE INIT

T7611XA

ADULT PHYSICAL ABUSE SUSPECTED INITIAL ENCOUNTER

S30850A SUPERFICIAL FOREIGN BODY OF LOWER BACK AND PELVIS INIT

T7612XA

CHILD PHYSICAL ABUSE SUSPECTED INITIAL ENCOUNTER

S30851A SUPERFICIAL FOREIGN BODY OF ABDOMINAL WALL INIT ENCNTR

T7621XA

ADULT SEXUAL ABUSE SUSPECTED INITIAL ENCOUNTER

S30852A SUPERFICIAL FOREIGN BODY OF PENIS INITIAL ENCOUNTER

T7622XA

CHILD SEXUAL ABUSE SUSPECTED INITIAL ENCOUNTER

S30853A

SUPERFICIAL FOREIGN BODY OF SCROTUM AND TESTES INIT ENCNTR

T7631XA

ADULT PSYCHOLOGICAL ABUSE SUSPECTED INITIAL ENCOUNTER

S30854A

SUPERFICIAL FOREIGN BODY OF VAGINA AND VULVA INIT ENCNTR

T7632XA

CHILD PSYCHOLOGICAL ABUSE SUSPECTED INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S30855A

SUPERFICIAL FB OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

T7800XA

ANAPHYLACTIC REACTION DUE TO UNSPECIFIED FOOD INIT ENCNTR

S30856A

SUPERFICIAL FB OF UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T7801XA

ANAPHYLACTIC REACTION DUE TO PEANUTS INITIAL ENCOUNTER

S30857A SUPERFICIAL FOREIGN BODY OF ANUS INITIAL ENCOUNTER

T7802XA

ANAPHYLACTIC REACTION DUE TO SHELLFISH (CRUSTACEANS) INIT

S30860A

INSECT BITE (NONVENOMOUS) OF LOWER BACK AND PELVIS INIT

T7803XA

ANAPHYLACTIC REACTION DUE TO OTHER FISH INITIAL ENCOUNTER

S30861A

INSECT BITE (NONVENOMOUS) OF ABDOMINAL WALL INIT ENCNTR

T7804XA

ANAPHYLACTIC REACTION DUE TO FRUITS AND VEGETABLES INIT

S30862A INSECT BITE (NONVENOMOUS) OF PENIS INITIAL ENCOUNTER

T7805XA

ANAPHYLACTIC REACTION DUE TO TREE NUTS AND SEEDS INIT

S30863A

INSECT BITE (NONVENOMOUS) OF SCROTUM AND TESTES INIT ENCNTR

T7806XA

ANAPHYLACTIC REACTION DUE TO FOOD ADDITIVES INIT ENCNTR

S30864A

INSECT BITE (NONVENOMOUS) OF VAGINA AND VULVA INIT ENCNTR

T7807XA

ANAPHYLACTIC REACTION DUE TO MILK AND DAIRY PRODUCTS INIT

S30865A INSECT BITE OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

T7808XA

ANAPHYLACTIC REACTION DUE TO EGGS INITIAL ENCOUNTER

S30866A INSECT BITE OF UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T7809XA

ANAPHYLACTIC REACTION DUE TO OTH FOOD PRODUCTS INIT ENCNTR

S30867A INSECT BITE (NONVENOMOUS) OF ANUS INITIAL ENCOUNTER

T782XXA

ANAPHYLACTIC SHOCK UNSPECIFIED INITIAL ENCOUNTER

S30870A

OTHER SUPERFICIAL BITE OF LOWER BACK AND PELVIS INIT ENCNTR

T783XXA

ANGIONEUROTIC EDEMA INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S30871A

OTHER SUPERFICIAL BITE OF ABDOMINAL WALL INITIAL ENCOUNTER

T7841XA

ARTHUS PHENOMENON INITIAL ENCOUNTER

S30872A OTHER SUPERFICIAL BITE OF PENIS INITIAL ENCOUNTER

T790XXA

AIR EMBOLISM (TRAUMATIC) INITIAL ENCOUNTER

S30873A

OTHER SUPERFICIAL BITE OF SCROTUM AND TESTES INIT ENCNTR

T791XXA

FAT EMBOLISM (TRAUMATIC) INITIAL ENCOUNTER

S30874A

OTHER SUPERFICIAL BITE OF VAGINA AND VULVA INIT ENCNTR

T792XXA

TRAUMATIC SECONDARY AND RECURRENT HEMOR AND SEROMA INIT

S30875A

OTH SUPERFIC BITE OF UNSP EXTRN GENITAL ORGANS MALE INIT

T794XXA

TRAUMATIC SHOCK INITIAL ENCOUNTER

S30876A

OTH SUPERFIC BITE OF UNSP EXTRN GENITAL ORGANS FEMALE INIT

T795XXA

TRAUMATIC ANURIA INITIAL ENCOUNTER

S30877A OTHER SUPERFICIAL BITE OF ANUS INITIAL ENCOUNTER

T796XXA

TRAUMATIC ISCHEMIA OF MUSCLE INITIAL ENCOUNTER

S3091XA UNSP SUPERFICIAL INJURY OF LOWER BACK AND PELVIS INIT

T797XXA

TRAUMATIC SUBCUTANEOUS EMPHYSEMA INITIAL ENCOUNTER

S3092XA UNSP SUPERFICIAL INJURY OF ABDOMINAL WALL INIT ENCNTR

T798XXA

OTHER EARLY COMPLICATIONS OF TRAUMA INITIAL ENCOUNTER

S3093XA

UNSPECIFIED SUPERFICIAL INJURY OF PENIS INITIAL ENCOUNTER

T799XXA

UNSPECIFIED EARLY COMPLICATION OF TRAUMA INITIAL ENCOUNTER

S3094XA

UNSP SUPERFICIAL INJURY OF SCROTUM AND TESTES INIT ENCNTR

T79A0XA

COMPARTMENT SYNDROME UNSPECIFIED INITIAL ENCOUNTER

S3095XA

UNSP SUPERFICIAL INJURY OF VAGINA AND VULVA INIT ENCNTR

T79A11A

TRAUMATIC COMPARTMENT SYNDROME OF R UP EXTREM INIT

S3096XA

UNSP SUPERFIC INJ UNSP EXTERNAL GENITAL ORGANS MALE INIT

T79A12A

TRAUMATIC COMPARTMENT SYNDROME OF LEFT UPPER EXTREMITY INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S3097XA

UNSP SUPERFIC INJ UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T79A19A

TRAUMATIC COMPARTMENT SYNDROME OF UNSP UPPER EXTREMITY INIT

S3098XA

UNSPECIFIED SUPERFICIAL INJURY OF ANUS INITIAL ENCOUNTER

T79A21A

TRAUMATIC COMPARTMENT SYNDROME OF R LOW EXTREM INIT

S31000A

UNSP OPN WND LOW BACK AND PELV W/O PENET RETROPERITON INIT

T79A22A

TRAUMATIC COMPARTMENT SYNDROME OF LEFT LOWER EXTREMITY INIT

S31001A

UNSP OPN WND LOW BACK AND PELVIS W PENET RETROPERITON INIT

T79A29A

TRAUMATIC COMPARTMENT SYNDROME OF UNSP LOWER EXTREMITY INIT

S31010A

LAC W/O FB OF LOW BACK AND PELV W/O PENET RETROPERITON INIT

T79A3XA

TRAUMATIC COMPARTMENT SYNDROME OF ABDOMEN INITIAL ENCOUNTER

S31011A

LAC W/O FB OF LOW BACK AND PELVIS W PENET RETROPERITON INIT

T79A9XA

TRAUMATIC COMPARTMENT SYNDROME OF OTHER SITES INIT ENCNTR

S31020A

LAC W FB OF LOW BACK AND PELVIS W/O PENET RETROPERITON INIT

T800XXA

AIR EMBOLISM FOL INFUSION TRANFS AND THERAPUTC INJECT INIT

S31021A

LAC W FB OF LOWER BACK AND PELVIS W PENET RETROPERITON INIT

T801XXA

VASCULAR COMP FOL INFUSN TRANFS AND THERAPUTC INJECT INIT

S31030A

PNCTR W/O FB OF LOW BACK & PELV W/O PENET RETROPERITON INIT

T8029XA

INFCT FOL OTH INFUSION TRANSFUSE AND THERAPUTC INJECT INIT

S31031A

PNCTR W/O FB OF LOW BACK AND PELV W PENET RETROPERITON INIT

T8030XA

ABO INCOMPAT REACT DUE TO TRANFS OF BLD/BLD PROD UNSP INIT

S31040A

PNCTR W FB OF LOW BACK AND PELV W/O PENET RETROPERITON INIT

T80310A

ABO INCOMPATIBILITY W ACUTE HEMOLYTIC TRANSFS REACT INIT

S31041A

PNCTR W FB OF LOW BACK AND PELVIS W PENET RETROPERITON INIT

T80311A

ABO INCOMPATIBILITY W DELAYED HEMOLYTIC TRANSFS REACT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31050A

OPEN BITE OF LOW BACK AND PELV W/O PENET RETROPERITON INIT

T80319A

ABO INCOMPATIBILITY W HEMOLYTIC TRANSFS REACT UNSP INIT

S31051A

OPEN BITE OF LOW BACK AND PELVIS W PENET RETROPERITON INIT

T8039XA

OTH ABO INCOMPAT REACT DUE TO TRANFS OF BLD/BLD PROD INIT

S31100A

UNSP OPN WND ABD WALL R UPPER Q W/O PENET PERIT CAV INIT

T8040XA

RH INCOMPAT REACT DUE TO TRANFS OF BLD/BLD PROD UNSP INIT

S31101A

UNSP OPN WND ABD WALL L UPR Q W/O PENET PERIT CAV INIT

T80410A

RH INCOMPATIBILITY W ACUTE HEMOLYTIC TRANSFS REACT INIT

S31102A

UNSP OPN WND ABD WALL EPIGST RGN W/O PENET PERIT CAV INIT

T80411A

RH INCOMPATIBILITY W DELAYED HEMOLYTIC TRANSFS REACT INIT

S31103A

UNSP OPN WND ABD WALL RIGHT LOW Q W/O PENET PERIT CAV INIT

T80419A

RH INCOMPATIBILITY W HEMOLYTIC TRANSFS REACT UNSP INIT

S31104A

UNSP OPN WND ABD WALL LEFT LOW Q W/O PENET PERIT CAV INIT

T8049XA

OTH RH INCOMPAT REACTION DUE TO TRANFS OF BLD/BLD PROD INIT

S31105A

UNSP OPN WND ABD WALL PERIUMB RGN W/O PENET PERIT CAV INIT

T80810A

EXTRAVASATION OF VESICANT ANTINEOPLASTIC CHEMOTHERAPY INIT

S31109A

UNSP OPN WND ABD WALL UNSP Q W/O PENET PERIT CAV INIT

T80818A

EXTRAVASATION OF OTHER VESICANT AGENT INITIAL ENCOUNTER

S31110A

LAC W/O FB OF ABD WALL R UPPER Q W/O PENET PERIT CAV INIT

T80910A

ACUTE HEMOLYTIC TRANSFS REACT UNSP INCOMPATIBILITY INIT

S31111A

LAC W/O FB OF ABD WALL L UPR Q W/O PENET PERIT CAV INIT

T80911A

DELAYED HEMOLYTIC TRANSFS REACT UNSP INCOMPATIBILITY INIT

S31112A

LAC W/O FB OF ABD WALL EPIGST RGN W/O PENET PERIT CAV INIT

T80919A

HEMOLYTIC TRANSFS REACT UNSP INCOMPAT UNSP AC/DELAY INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31113A

LAC W/O FB OF ABD WALL R LOW Q W/O PENET PERIT CAV INIT

T80A0XA

NON-ABO INCOMPAT REACT D/T TRANFS OF BLD/BLD PRODUNSP INIT

S31114A

LAC W/O FB OF ABD WALL LEFT LOW Q W/O PENET PERIT CAV INIT

T80A10A

NON-ABO INCOMPAT W ACUTE HEMOLYTIC TRANSFS REACT INIT

S31115A

LAC W/O FB OF ABD WL PERIUMB RGN W/O PENET PERIT CAV INIT

T80A11A

NON-ABO INCOMPAT W DELAYED HEMOLYTIC TRANSFS REACT INIT

S31119A

LAC W/O FB OF ABD WALL UNSP Q W/O PENET PERIT CAV INIT

T80A19A

NON-ABO INCOMPAT W HEMOLYTIC TRANSFS REACT UNSP INIT

S31120A

LACERAT ABD WALL W FB R UPPER Q W/O PENET PERIT CAV INIT

T80A9XA

OTH NON-ABO INCOMPAT REACT D/T TRANFS OF BLD/BLD PROD INIT

S31121A LACERAT ABD WALL W FB L UPR Q W/O PENET PERIT CAV INIT

T8130XA

DISRUPTION OF WOUND UNSPECIFIED INITIAL ENCOUNTER

S31122A

LACERAT ABD WALL W FB EPIGST RGN W/O PENET PERIT CAV INIT

T8131XA

DISRUPTION OF EXTERNAL OPERATION (SURGICAL) WOUND NEC INIT

S31123A

LACERAT ABD WALL W FB RIGHT LOW Q W/O PENET PERIT CAV INIT

T8132XA

DISRUPTION OF INTERNAL OPERATION (SURGICAL) WOUND NEC INIT

S31124A

LACERAT ABD WALL W FB LEFT LOW Q W/O PENET PERIT CAV INIT

T8133XA

DISRUPTION OF TRAUMATIC INJURY WOUND REPAIR INIT ENCNTR

S31125A

LACERAT ABD WALL W FB PERIUMB RGN W/O PENET PERIT CAV INIT

T814XXA

INFECTION FOLLOWING A PROCEDURE INITIAL ENCOUNTER

S31129A LACERAT ABD WALL W FB UNSP Q W/O PENET PERIT CAV INIT

T81500A

UNSP COMP OF FB ACC LEFT IN BODY FOL SURGICAL OP INIT

S31130A

PNCTR OF ABD WALL W/O FB R UPR Q W/O PENET PERIT CAV INIT

T81501A

UNSP COMP OF FB ACC LEFT IN BODY FOL INFUSN/TRANSFUSN INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31131A

PNCTR OF ABD WALL W/O FB L UPR Q W/O PENET PERIT CAV INIT

T81502A

UNSP COMP OF FB ACC LEFT IN BODY FOL KIDNEY DIALYSIS INIT

S31132A

PNCTR OF ABD WL W/O FB EPIGST RGN W/O PENET PERIT CAV INIT

T81503A

UNSP COMP OF FB ACC LEFT IN BODY FOL INJECT OR IMMUNIZ INIT

S31133A

PNCTR OF ABD WALL W/O FB R LOW Q W/O PENET PERIT CAV INIT

T81504A

UNSP COMP OF FB ACC LEFT IN BODY FOLLOWING ENDO EXAM INIT

S31134A

PNCTR OF ABD WALL W/O FB L LOW Q W/O PENET PERIT CAV INIT

T81505A

UNSP COMP OF FB ACC LEFT IN BODY FOLLOWING HEART CATH INIT

S31135A

PNCTR OF ABD WL W/O FBPERIUMB RGN W/O PENET PERIT CAV INIT

T81506A

UNSP COMP OF FB ACC LEFT IN BODY FOLLOWING PUNCTR/CATH INIT

S31139A

PNCTR OF ABD WALL W/O FB UNSP Q W/O PENET PERIT CAV INIT

T81507A

UNSP COMP OF FB ACC LEFT IN BODY FOL REMOV CATH/PACK INIT

S31140A

PNCTR OF ABD WALL W FB R UPPER Q W/O PENET PERIT CAV INIT

T81508A

UNSP COMP OF FB ACC LEFT IN BODY FOL OTH PROCEDURE INIT

S31141A

PNCTR OF ABD WALL W FB L UPR Q W/O PENET PERIT CAV INIT

T81509A

UNSP COMP OF FB ACC LEFT IN BODY FOL UNSP PROCEDURE INIT

S31142A

PNCTR OF ABD WALL W FB EPIGST RGN W/O PENET PERIT CAV INIT

T81510A

ADHES DUE TO FB ACC LEFT IN BODY FOL SURGICAL OP INIT

S31143A

PNCTR OF ABD WALL W FB R LOW Q W/O PENET PERIT CAV INIT

T81511A

ADHES DUE TO FB ACC LEFT IN BODY FOL INFUSN/TRANSFUSN INIT

S31144A

PNCTR OF ABD WALL W FB LEFT LOW Q W/O PENET PERIT CAV INIT

T81512A

ADHES DUE TO FB ACC LEFT IN BODY FOL KIDNEY DIALYSIS INIT

S31145A

PNCTR OF ABD WL W FB PERIUMB RGN W/O PENET PERIT CAV INIT

T81513A

ADHES DUE TO FB ACC LEFT IN BODY FOL INJECT OR IMMUNIZ INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31149A

PNCTR OF ABD WALL W FB UNSP Q W/O PENET PERIT CAV INIT

T81514A

ADHES DUE TO FB ACC LEFT IN BODY FOLLOWING ENDO EXAM INIT

S31150A

OPEN BITE OF ABD WALL R UPPER Q W/O PENET PERIT CAV INIT

T81515A

ADHES DUE TO FB ACC LEFT IN BODY FOLLOWING HEART CATH INIT

S31151A OPEN BITE OF ABD WALL L UPR Q W/O PENET PERIT CAV INIT

T81516A

ADHES DUE TO FB ACC LEFT IN BODY FOLLOWING PUNCTR/CATH INIT

S31152A

OPEN BITE OF ABD WALL EPIGST RGN W/O PENET PERIT CAV INIT

T81517A

ADHES DUE TO FB ACC LEFT IN BODY FOL REMOV CATH/PACK INIT

S31153A

OPEN BITE OF ABD WALL RIGHT LOW Q W/O PENET PERIT CAV INIT

T81518A

ADHES DUE TO FB ACC LEFT IN BODY FOL OTH PROCEDURE INIT

S31154A

OPEN BITE OF ABD WALL LEFT LOW Q W/O PENET PERIT CAV INIT

T81519A

ADHES DUE TO FB ACC LEFT IN BODY FOL UNSP PROCEDURE INIT

S31155A

OPEN BITE OF ABD WALL PERIUMB RGN W/O PENET PERIT CAV INIT

T81520A

OBST DUE TO FB ACC LEFT IN BODY FOL SURGICAL OPERATION INIT

S31159A OPEN BITE OF ABD WALL UNSP Q W/O PENET PERIT CAV INIT

T81521A

OBST DUE TO FB ACC LEFT IN BODY FOL INFUSN/TRANSFUSN INIT

S3120XA UNSPECIFIED OPEN WOUND OF PENIS INITIAL ENCOUNTER

T81522A

OBST DUE TO FB ACC LEFT IN BODY FOL KIDNEY DIALYSIS INIT

S3121XA

LACERATION WITHOUT FOREIGN BODY OF PENIS INITIAL ENCOUNTER

T81523A

OBST DUE TO FB ACC LEFT IN BODY FOL INJECT OR IMMUNIZ INIT

S3122XA

LACERATION WITH FOREIGN BODY OF PENIS INITIAL ENCOUNTER

T81524A

OBST DUE TO FB ACC LEFT IN BODY FOLLOWING ENDO EXAM INIT

S3123XA

PUNCTURE WOUND WITHOUT FOREIGN BODY OF PENIS INIT ENCNTR

T81525A

OBST DUE TO FB ACC LEFT IN BODY FOLLOWING HEART CATH INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S3124XA

PUNCTURE WOUND WITH FOREIGN BODY OF PENIS INITIAL ENCOUNTER

T81526A

OBST DUE TO FB ACC LEFT IN BODY FOLLOWING PUNCTR/CATH INIT

S3125XA OPEN BITE OF PENIS INITIAL ENCOUNTER

T81527A

OBST DUE TO FB ACC LEFT IN BODY FOL REMOV CATH/PACK INIT

S3130XA

UNSPECIFIED OPEN WOUND OF SCROTUM AND TESTES INIT ENCNTR

T81528A

OBST DUE TO FB ACC LEFT IN BODY FOL OTH PROCEDURE INIT

S3131XA

LACERATION W/O FOREIGN BODY OF SCROTUM AND TESTES INIT

T81529A

OBST DUE TO FB ACC LEFT IN BODY FOL UNSP PROCEDURE INIT

S3132XA

LACERATION W FOREIGN BODY OF SCROTUM AND TESTES INIT ENCNTR

T81530A

PERF DUE TO FB ACC LEFT IN BODY FOL SURGICAL OPERATION INIT

S3133XA

PUNCTURE WOUND W/O FOREIGN BODY OF SCROTUM AND TESTES INIT

T81531A

PERF DUE TO FB ACC LEFT IN BODY FOL INFUSN/TRANSFUSN INIT

S3134XA

PUNCTURE WOUND W FOREIGN BODY OF SCROTUM AND TESTES INIT

T81532A

PERF DUE TO FB ACC LEFT IN BODY FOL KIDNEY DIALYSIS INIT

S3135XA OPEN BITE OF SCROTUM AND TESTES INITIAL ENCOUNTER

T81533A

PERF DUE TO FB ACC LEFT IN BODY FOL INJECT OR IMMUNIZ INIT

S3140XA

UNSPECIFIED OPEN WOUND OF VAGINA AND VULVA INIT ENCNTR

T81534A

PERF DUE TO FB ACC LEFT IN BODY FOLLOWING ENDO EXAM INIT

S3141XA

LACERATION W/O FOREIGN BODY OF VAGINA AND VULVA INIT ENCNTR

T81535A

PERF DUE TO FB ACC LEFT IN BODY FOLLOWING HEART CATH INIT

S3142XA

LACERATION W FOREIGN BODY OF VAGINA AND VULVA INIT ENCNTR

T81536A

PERF DUE TO FB ACC LEFT IN BODY FOLLOWING PUNCTR/CATH INIT

S3143XA

PUNCTURE WOUND W/O FOREIGN BODY OF VAGINA AND VULVA INIT

T81537A

PERF DUE TO FB ACC LEFT IN BODY FOL REMOV CATH/PACK INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S3144XA

PUNCTURE WOUND W FOREIGN BODY OF VAGINA AND VULVA INIT

T81538A

PERF DUE TO FB ACC LEFT IN BODY FOL OTH PROCEDURE INIT

S3145XA OPEN BITE OF VAGINA AND VULVA INITIAL ENCOUNTER

T81539A

PERF DUE TO FB ACC LEFT IN BODY FOL UNSP PROCEDURE INIT

S31501A

UNSP OPEN WOUND OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

T81590A

OTH COMP OF FB ACC LEFT IN BODY FOL SURGICAL OPERATION INIT

S31502A

UNSP OPN WND UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T81591A

OTH COMP OF FB ACC LEFT IN BODY FOL INFUSN/TRANSFUSN INIT

S31511A

LAC W/O FB OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

T81592A

OTH COMP OF FB ACC LEFT IN BODY FOL KIDNEY DIALYSIS INIT

S31512A

LAC W/O FB OF UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T81593A

OTH COMP OF FB ACC LEFT IN BODY FOL INJECT OR IMMUNIZ INIT

S31521A

LACERATION W FB OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

T81594A

OTH COMP OF FB ACC LEFT IN BODY FOLLOWING ENDO EXAM INIT

S31522A LAC W FB OF UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T81595A

OTH COMP OF FB ACC LEFT IN BODY FOLLOWING HEART CATH INIT

S31531A

PNCTR W/O FB OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

T81596A

OTH COMP OF FB ACC LEFT IN BODY FOLLOWING PUNCTR/CATH INIT

S31532A

PNCTR W/O FB OF UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T81597A

OTH COMP OF FB ACC LEFT IN BODY FOL REMOV CATH/PACK INIT

S31541A

PNCTR W FB OF UNSP EXTERNAL GENITAL ORGANS MALE INIT

T81598A

OTH COMP OF FB ACC LEFT IN BODY FOL OTH PROCEDURE INIT

S31542A

PNCTR W FB OF UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T81599A

OTH COMP OF FB ACC LEFT IN BODY FOL UNSP PROCEDURE INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31551A

OPEN BITE OF UNSP EXTERNAL GENITAL ORGANS MALE INIT ENCNTR

T8160XA

UNSP ACUTE REACTION TO FOREIGN SUB ACC LEFT DUR PROC INIT

S31552A OPEN BITE OF UNSP EXTERNAL GENITAL ORGANS FEMALE INIT

T8161XA

ASEPTIC PERITONITIS DUE TO FORN SUB ACC LEFT DUR PROC INIT

S31600A

UNSP OPN WND ABD WALL RIGHT UPPER Q W PENET PERIT CAV INIT

T8169XA

OTH ACUTE REACTION TO FOREIGN SUB ACC LEFT DUR PROC INIT

S31601A

UNSP OPEN WOUND OF ABD WALL L UPR Q W PENET PERIT CAV INIT

T81710A

COMPLICATION OF MESENT ART FOLLOWING A PROCEDURE NEC INIT

S31602A

UNSP OPN WND ABD WALL EPIGST RGN W PENET PERIT CAV INIT

T81711A

COMP OF RENAL ARTERY FOLLOWING A PROCEDURE NEC INIT

S31603A

UNSP OPN WND ABD WALL RIGHT LOWER Q W PENET PERIT CAV INIT

T81718A

COMPLICATION OF ARTERY FOLLOWING A PROCEDURE NEC INIT

S31604A

UNSP OPN WND ABD WALL LEFT LOWER Q W PENET PERIT CAV INIT

T81719A

COMPLICATION OF UNSP ARTERY FOLLOWING A PROCEDURE NEC INIT

S31605A

UNSP OPN WND ABD WALL PERIUMB RGN W PENET PERIT CAV INIT

T8172XA

COMPLICATION OF VEIN FOLLOWING A PROCEDURE NEC INIT

S31609A

UNSP OPN WND ABD WALL UNSP QUADRANT W PENET PERIT CAV INIT

T8181XA

COMPLICATION OF INHALATION THERAPY INITIAL ENCOUNTER

S31610A

LAC W/O FB OF ABD WALL R UPPER Q W PENET PERIT CAV INIT

T8182XA

EMPHYSEMA (SUBCUTANEOUS) RESULTING FROM A PROCEDURE INIT

S31611A LAC W/O FB OF ABD WALL L UPR Q W PENET PERIT CAV INIT

T8201XA

BREAKDOWN (MECHANICAL) OF HEART VALVE PROSTHESIS INIT

S31612A

LAC W/O FB OF ABD WALL EPIGST RGN W PENET PERIT CAV INIT

T8202XA

DISPLACEMENT OF HEART VALVE PROSTHESIS INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31613A

LAC W/O FB OF ABD WALL RIGHT LOW Q W PENET PERIT CAV INIT

T8203XA

LEAKAGE OF HEART VALVE PROSTHESIS INITIAL ENCOUNTER

S31614A

LAC W/O FB OF ABD WALL LEFT LOWER Q W PENET PERIT CAV INIT

T8209XA

MECH COMPL OF HEART VALVE PROSTHESIS INITIAL ENCOUNTER

S31615A

LAC W/O FB OF ABD WALL PERIUMB RGN W PENET PERIT CAV INIT

T82110A

BREAKDOWN (MECHANICAL) OF CARDIAC ELECTRODE INIT ENCNTR

S31619A

LAC W/O FB OF ABD WALL UNSP Q W PENET PERIT CAV INIT

T82111A

BREAKDOWN OF CARDIAC PULSE GENERATOR (BATTERY) INIT

S31620A

LAC W FB OF ABD WALL RIGHT UPPER Q W PENET PERIT CAV INIT

T82118A

BREAKDOWN (MECHANICAL) OF CARDIAC ELECTRONIC DEVICE INIT

S31621A

LACERATION W FB OF ABD WALL L UPR Q W PENET PERIT CAV INIT

T82119A

BREAKDOWN OF UNSP CARDIAC ELECTRONIC DEVICE INIT

S31622A LAC W FB OF ABD WALL EPIGST RGN W PENET PERIT CAV INIT

T82120A

DISPLACEMENT OF CARDIAC ELECTRODE INITIAL ENCOUNTER

S31623A

LAC W FB OF ABD WALL RIGHT LOWER Q W PENET PERIT CAV INIT

T82121A

DISPLACEMENT OF CARDIAC PULSE GENERATOR (BATTERY) INIT

S31624A

LAC W FB OF ABD WALL LEFT LOWER Q W PENET PERIT CAV INIT

T82128A

DISPLACEMENT OF OTHER CARDIAC ELECTRONIC DEVICE INIT ENCNTR

S31625A

LAC W FB OF ABD WALL PERIUMB RGN W PENET PERIT CAV INIT

T82129A

DISPLACEMENT OF UNSP CARDIAC ELECTRONIC DEVICE INIT ENCNTR

S31629A

LAC W FB OF ABD WALL UNSP QUADRANT W PENET PERIT CAV INIT

T82190A

MECH COMPL OF CARDIAC ELECTRODE INITIAL ENCOUNTER

S31630A

PNCTR W/O FB OF ABD WALL R UPPER Q W PENET PERIT CAV INIT

T82191A

MECH COMPL OF CARDIAC PULSE GENERATOR (BATTERY) INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31631A PNCTR W/O FB OF ABD WALL L UPR Q W PENET PERIT CAV INIT

T82198A

MECH COMPL OF OTHER CARDIAC ELECTRONIC DEVICE INIT ENCNTR

S31632A

PNCTR W/O FB OF ABD WALL EPIGST RGN W PENET PERIT CAV INIT

T82199A

MECH COMPL OF UNSPECIFIED CARDIAC DEVICE INITIAL ENCOUNTER

S31633A PNCTR W/O FB OF ABD WALL R LOW Q W PENET PERIT CAV INIT

T82211A

BREAKDOWN (MECHANICAL) OF CORONARY ARTERY BYPASS GRAFT INIT

S31634A

PNCTR W/O FB OF ABD WALL LEFT LOW Q W PENET PERIT CAV INIT

T82212A

DISPLACEMENT OF CORONARY ARTERY BYPASS GRAFT INIT ENCNTR

S31635A

PNCTR W/O FB OF ABD WL PERIUMB RGN W PENET PERIT CAV INIT

T82213A

LEAKAGE OF CORONARY ARTERY BYPASS GRAFT INITIAL ENCOUNTER

S31639A

PNCTR W/O FB OF ABD WALL UNSP Q W PENET PERIT CAV INIT

T82218A

MECH COMPL OF CORONARY ARTERY BYPASS GRAFT INIT ENCNTR

S31640A

PNCTR W FB OF ABD WALL R UPPER Q W PENET PERIT CAV INIT

T82221A

BREAKDOWN (MECHANICAL) OF BIOLOGICAL HEART VALVE GRAFT INIT

S31641A PNCTR W FB OF ABD WALL L UPR Q W PENET PERIT CAV INIT

T82222A

DISPLACEMENT OF BIOLOGICAL HEART VALVE GRAFT INIT ENCNTR

S31642A

PNCTR W FB OF ABD WALL EPIGST RGN W PENET PERIT CAV INIT

T82223A

LEAKAGE OF BIOLOGICAL HEART VALVE GRAFT INITIAL ENCOUNTER

S31643A

PNCTR W FB OF ABD WALL RIGHT LOW Q W PENET PERIT CAV INIT

T82228A

MECH COMPL OF BIOLOGICAL HEART VALVE GRAFT INIT ENCNTR

S31644A

PNCTR W FB OF ABD WALL LEFT LOWER Q W PENET PERIT CAV INIT

T82310A

BREAKDOWN (MECHANICAL) OF AORTIC (BIFURCATION) GRAFT INIT

S31645A

PNCTR W FB OF ABD WALL PERIUMB RGN W PENET PERIT CAV INIT

T82311A

BREAKDOWN OF CAROTID ARTERIAL GRAFT (BYPASS) INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31649A

PNCTR W FB OF ABD WALL UNSP Q W PENET PERIT CAV INIT

T82312A

BREAKDOWN OF FEMORAL ARTERIAL GRAFT (BYPASS) INIT

S31650A

OPEN BITE OF ABD WALL RIGHT UPPER Q W PENET PERIT CAV INIT

T82318A

BREAKDOWN (MECHANICAL) OF OTHER VASCULAR GRAFTS INIT ENCNTR

S31651A

OPEN BITE OF ABDOMINAL WALL L UPR Q W PENET PERIT CAV INIT

T82319A

BREAKDOWN (MECHANICAL) OF UNSP VASCULAR GRAFTS INIT ENCNTR

S31652A

OPEN BITE OF ABD WALL EPIGST RGN W PENET PERIT CAV INIT

T82320A

DISPLACEMENT OF AORTIC (BIFURCATION) GRAFT INIT

S31653A

OPEN BITE OF ABD WALL RIGHT LOWER Q W PENET PERIT CAV INIT

T82321A

DISPLACEMENT OF CAROTID ARTERIAL GRAFT (BYPASS) INIT ENCNTR

S31654A

OPEN BITE OF ABD WALL LEFT LOWER Q W PENET PERIT CAV INIT

T82322A

DISPLACEMENT OF FEMORAL ARTERIAL GRAFT (BYPASS) INIT ENCNTR

S31655A

OPEN BITE OF ABD WALL PERIUMB RGN W PENET PERIT CAV INIT

T82328A

DISPLACEMENT OF OTHER VASCULAR GRAFTS INITIAL ENCOUNTER

S31659A

OPEN BITE OF ABD WALL UNSP QUADRANT W PENET PERIT CAV INIT

T82329A

DISPLACEMENT OF UNSPECIFIED VASCULAR GRAFTS INIT ENCNTR

S31801A

LACERATION WITHOUT FOREIGN BODY OF UNSP BUTTOCK INIT ENCNTR

T82330A

LEAKAGE OF AORTIC (BIFURCATION) GRAFT (REPLACEMENT) INIT

S31802A

LACERATION WITH FOREIGN BODY OF UNSP BUTTOCK INIT ENCNTR

T82331A

LEAKAGE OF CAROTID ARTERIAL GRAFT (BYPASS) INIT ENCNTR

S31803A

PUNCTURE WOUND W/O FOREIGN BODY OF UNSP BUTTOCK INIT ENCNTR

T82332A

LEAKAGE OF FEMORAL ARTERIAL GRAFT (BYPASS) INIT ENCNTR

S31804A

PUNCTURE WOUND W FOREIGN BODY OF UNSP BUTTOCK INIT ENCNTR

T82338A

LEAKAGE OF OTHER VASCULAR GRAFTS INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31805A OPEN BITE OF UNSPECIFIED BUTTOCK INITIAL ENCOUNTER

T82339A

LEAKAGE OF UNSPECIFIED VASCULAR GRAFT INITIAL ENCOUNTER

S31809A

UNSPECIFIED OPEN WOUND OF UNSPECIFIED BUTTOCK INIT ENCNTR

T82390A

MECH COMPL OF AORTIC (BIFURCATION) GRAFT (REPLACEMENT) INIT

S31811A

LACERATION W/O FOREIGN BODY OF RIGHT BUTTOCK INIT ENCNTR

T82391A

MECH COMPL OF CAROTID ARTERIAL GRAFT (BYPASS) INIT ENCNTR

S31812A

LACERATION WITH FOREIGN BODY OF RIGHT BUTTOCK INIT ENCNTR

T82392A

MECH COMPL OF FEMORAL ARTERIAL GRAFT (BYPASS) INIT ENCNTR

S31813A

PUNCTURE WOUND W/O FOREIGN BODY OF RIGHT BUTTOCK INIT

T82398A

MECH COMPL OF OTHER VASCULAR GRAFTS INITIAL ENCOUNTER

S31814A

PUNCTURE WOUND W FOREIGN BODY OF RIGHT BUTTOCK INIT ENCNTR

T82399A

MECH COMPL OF UNSPECIFIED VASCULAR GRAFTS INITIAL ENCOUNTER

S31815A OPEN BITE OF RIGHT BUTTOCK INITIAL ENCOUNTER

T8241XA

BREAKDOWN (MECHANICAL) OF VASCULAR DIALYSIS CATHETER INIT

S31819A

UNSPECIFIED OPEN WOUND OF RIGHT BUTTOCK INITIAL ENCOUNTER

T8242XA

DISPLACEMENT OF VASCULAR DIALYSIS CATHETER INIT ENCNTR

S31821A

LACERATION WITHOUT FOREIGN BODY OF LEFT BUTTOCK INIT ENCNTR

T8243XA

LEAKAGE OF VASCULAR DIALYSIS CATHETER INITIAL ENCOUNTER

S31822A

LACERATION WITH FOREIGN BODY OF LEFT BUTTOCK INIT ENCNTR

T8249XA

OTH COMPLICATION OF VASCULAR DIALYSIS CATHETER INIT ENCNTR

S31823A

PUNCTURE WOUND W/O FOREIGN BODY OF LEFT BUTTOCK INIT ENCNTR

T82510A

BREAKDOWN OF SURGICALLY CREATED AV FISTULA INIT

S31824A

PUNCTURE WOUND W FOREIGN BODY OF LEFT BUTTOCK INIT ENCNTR

T82511A

BREAKDOWN (MECHANICAL) OF SURGICALLY CREATED AV SHUNT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S31825A OPEN BITE OF LEFT BUTTOCK INITIAL ENCOUNTER

T82512A

BREAKDOWN (MECHANICAL) OF ARTIFICIAL HEART INIT ENCNTR

S31829A

UNSPECIFIED OPEN WOUND OF LEFT BUTTOCK INITIAL ENCOUNTER

T82513A

BREAKDOWN OF BALLOON (COUNTERPULSATION) DEVICE INIT

S31831A

LACERATION WITHOUT FOREIGN BODY OF ANUS INITIAL ENCOUNTER

T82514A

BREAKDOWN (MECHANICAL) OF INFUSION CATHETER INIT ENCNTR

S31832A

LACERATION WITH FOREIGN BODY OF ANUS INITIAL ENCOUNTER

T82515A

BREAKDOWN (MECHANICAL) OF UMBRELLA DEVICE INITIAL ENCOUNTER

S31833A

PUNCTURE WOUND WITHOUT FOREIGN BODY OF ANUS INIT ENCNTR

T82518A

BREAKDOWN OF CARDIAC AND VASCULAR DEVICES AND IMPLANTS INIT

S31834A

PUNCTURE WOUND WITH FOREIGN BODY OF ANUS INITIAL ENCOUNTER

T82519A

BRKDWN UNSP CARDIAC AND VASCULAR DEVICES AND IMPLANTS INIT

S31835A OPEN BITE OF ANUS INITIAL ENCOUNTER

T82520A

DISPLACEMENT OF SURGICALLY CREATED AV FISTULA INIT

S31839A UNSPECIFIED OPEN WOUND OF ANUS INITIAL ENCOUNTER

T82521A

DISPLACEMENT OF SURGICALLY CREATED ARTERIOVENOUS SHUNT INIT

S32000A

WEDGE COMPRESSION FRACTURE OF UNSP LUMBAR VERTEBRA INIT

T82522A

DISPLACEMENT OF ARTIFICIAL HEART INITIAL ENCOUNTER

S32000B

WEDGE COMPRSN FRACTURE OF UNSP LUM VERTEBRA INIT FOR OPN FX

T82523A

DISPLACEMENT OF BALLOON (COUNTERPULSATION) DEVICE INIT

S32001A STABLE BURST FRACTURE OF UNSP LUMBAR VERTEBRA INIT

T82524A

DISPLACEMENT OF INFUSION CATHETER INITIAL ENCOUNTER

S32001B

STABLE BURST FRACTURE OF UNSP LUM VERTEBRA INIT FOR OPN FX

T82525A

DISPLACEMENT OF UMBRELLA DEVICE INITIAL ENCOUNTER

S32002A UNSTABLE BURST FRACTURE OF UNSP LUMBAR VERTEBRA INIT

T82528A

DISPLACMNT OF CARDIAC AND VASCULAR DEVICES AND IMPLNT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32002B UNSTABLE BURST FX UNSP LUM VERTEBRA INIT FOR OPN FX

T82529A

DISPLACMNT OF UNSP CARDIAC AND VASC DEVICES AND IMPLNT INIT

S32008A

OTH FRACTURE OF UNSP LUMBAR VERTEBRA INIT FOR CLOS FX

T82530A

LEAKAGE OF SURGICALLY CREATED ARTERIOVENOUS FISTULA INIT

S32008B

OTH FRACTURE OF UNSP LUMBAR VERTEBRA INIT FOR OPN FX

T82531A

LEAKAGE OF SURGICALLY CREATED ARTERIOVENOUS SHUNT INIT

S32009A

UNSP FRACTURE OF UNSP LUMBAR VERTEBRA INIT FOR CLOS FX

T82532A

LEAKAGE OF ARTIFICIAL HEART INITIAL ENCOUNTER

S32009B

UNSP FRACTURE OF UNSP LUMBAR VERTEBRA INIT FOR OPN FX

T82533A

LEAKAGE OF BALLOON (COUNTERPULSATION) DEVICE INIT ENCNTR

S32010A

WEDGE COMPRESSION FRACTURE OF FIRST LUMBAR VERTEBRA INIT

T82534A

LEAKAGE OF INFUSION CATHETER INITIAL ENCOUNTER

S32010B

WEDGE COMPRSN FX FIRST LUM VERTEBRA INIT FOR OPN FX

T82535A

LEAKAGE OF UMBRELLA DEVICE INITIAL ENCOUNTER

S32011A STABLE BURST FRACTURE OF FIRST LUMBAR VERTEBRA INIT

T82538A

LEAKAGE OF CARDIAC AND VASCULAR DEVICES AND IMPLANTS INIT

S32011B

STABLE BURST FRACTURE OF FIRST LUM VERTEBRA INIT FOR OPN FX

T82539A

LEAKAGE OF UNSP CARDIAC AND VASC DEVICES AND IMPLNT INIT

S32012A UNSTABLE BURST FRACTURE OF FIRST LUMBAR VERTEBRA INIT

T82590A

MECH COMPL OF SURGICALLY CREATED ARTERIOVENOUS FISTULA INIT

S32012B UNSTABLE BURST FX FIRST LUM VERTEBRA INIT FOR OPN FX

T82591A

MECH COMPL OF SURGICALLY CREATED ARTERIOVENOUS SHUNT INIT

S32018A

OTH FRACTURE OF FIRST LUMBAR VERTEBRA INIT FOR CLOS FX

T82592A

MECH COMPL OF ARTIFICIAL HEART INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32018B

OTH FRACTURE OF FIRST LUMBAR VERTEBRA INIT FOR OPN FX

T82593A

MECH COMPL OF BALLOON (COUNTERPULSATION) DEVICE INIT ENCNTR

S32019A

UNSP FRACTURE OF FIRST LUMBAR VERTEBRA INIT FOR CLOS FX

T82594A

MECH COMPL OF INFUSION CATHETER INITIAL ENCOUNTER

S32019B

UNSP FRACTURE OF FIRST LUMBAR VERTEBRA INIT FOR OPN FX

T82595A

MECH COMPL OF UMBRELLA DEVICE INITIAL ENCOUNTER

S32020A

WEDGE COMPRESSION FRACTURE OF SECOND LUMBAR VERTEBRA INIT

T82598A

MECH COMPL OF CARDIAC AND VASCULAR DEVICES AND IMPLNT INIT

S32020B

WEDGE COMPRSN FX SECOND LUM VERTEBRA INIT FOR OPN FX

T82599A

MECH COMPL OF UNSP CARDIAC AND VASC DEVICES AND IMPLNT INIT

S32021A

STABLE BURST FRACTURE OF SECOND LUMBAR VERTEBRA INIT

T826XXA

INFECT/INFLM REACTION DUE TO CARDIAC VALVE PROSTHESIS INIT

S32021B STABLE BURST FX SECOND LUM VERTEBRA INIT FOR OPN FX

T827XXA

INFECT/INFLM REACT D/T OTH CARDI/VASC DEV/IMPLNT/GRFT INIT

S32022A

UNSTABLE BURST FRACTURE OF SECOND LUMBAR VERTEBRA INIT

T82817A

EMBOLISM OF CARDIAC PROSTH DEV/GRFT INIT

S32022B

UNSTABLE BURST FX SECOND LUM VERTEBRA INIT FOR OPN FX

T82818A

EMBOLISM OF VASCULAR PROSTH DEV/GRFT INIT

S32028A

OTH FRACTURE OF SECOND LUMBAR VERTEBRA INIT FOR CLOS FX

T82827A

FIBROSIS OF CARDIAC PROSTH DEV/GRFT INIT

S32028B

OTH FRACTURE OF SECOND LUMBAR VERTEBRA INIT FOR OPN FX

T82828A

FIBROSIS OF VASCULAR PROSTH DEV/GRFT INIT

S32029A

UNSP FRACTURE OF SECOND LUMBAR VERTEBRA INIT FOR CLOS FX

T82837A

HEMORRHAGE OF CARDIAC PROSTH DEV/GRFT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32029B

UNSP FRACTURE OF SECOND LUMBAR VERTEBRA INIT FOR OPN FX

T82838A

HEMORRHAGE OF VASCULAR PROSTH DEV/GRFT INIT

S32030A

WEDGE COMPRESSION FRACTURE OF THIRD LUMBAR VERTEBRA INIT

T82847A

PAIN FROM CARDIAC PROSTH DEV/GRFT INIT

S32030B

WEDGE COMPRSN FX THIRD LUM VERTEBRA INIT FOR OPN FX

T82848A

PAIN FROM VASCULAR PROSTH DEV/GRFT INIT

S32031A STABLE BURST FRACTURE OF THIRD LUMBAR VERTEBRA INIT

T82855A

Stenosis of coronary artery stent initial encounter

S32031B

STABLE BURST FRACTURE OF THIRD LUM VERTEBRA INIT FOR OPN FX

T82855D

Stenosis of coronary artery stent subsequent encounter

S32032A UNSTABLE BURST FRACTURE OF THIRD LUMBAR VERTEBRA INIT

T82855S

Stenosis of coronary artery stent sequela

S32032B

UNSTABLE BURST FX THIRD LUM VERTEBRA INIT FOR OPN FX

T82856A

Stenosis of peripheral vascular stent initial encounter

S32038A

OTH FRACTURE OF THIRD LUMBAR VERTEBRA INIT FOR CLOS FX

T82856D

Stenosis of peripheral vascular stent subsequent encounter

S32038B

OTH FRACTURE OF THIRD LUMBAR VERTEBRA INIT FOR OPN FX

T82856S

Stenosis of peripheral vascular stent sequela

S32039A

UNSP FRACTURE OF THIRD LUMBAR VERTEBRA INIT FOR CLOS FX

T82857A

STENOSIS OF CARDIAC PROSTH DEV/GRFT INIT

S32039B

UNSP FRACTURE OF THIRD LUMBAR VERTEBRA INIT FOR OPN FX

T82858A

STENOSIS OF VASCULAR PROSTH DEV/GRFT INIT

S32040A

WEDGE COMPRESSION FRACTURE OF FOURTH LUMBAR VERTEBRA INIT

T82867A

THROMBOSIS OF CARDIAC PROSTH DEV/GRFT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32040B

WEDGE COMPRSN FX FOURTH LUM VERTEBRA INIT FOR OPN FX

T82868A

THROMBOSIS OF VASCULAR PROSTH DEV/GRFT INIT

S32041A

STABLE BURST FRACTURE OF FOURTH LUMBAR VERTEBRA INIT

T82897A

OTH COMPLICATION OF CARDIAC PROSTH DEV/GRFT INIT

S32041B STABLE BURST FX FOURTH LUM VERTEBRA INIT FOR OPN FX

T82898A

OTH COMPLICATION OF VASCULAR PROSTH DEV/GRFT INIT

S32042A

UNSTABLE BURST FRACTURE OF FOURTH LUMBAR VERTEBRA INIT

T829XXA

UNSP COMP OF CARDIAC AND VASCULAR PROSTH DEV/GRFT INIT

S32042B

UNSTABLE BURST FX FOURTH LUM VERTEBRA INIT FOR OPN FX

T83011A

Breakdown (mechanical) of indwelling urethral catheter initial encounter

S32048A

OTH FRACTURE OF FOURTH LUMBAR VERTEBRA INIT FOR CLOS FX

T83012A

Breakdown (mechanical) of nephrostomy catheter initial encounter

S32048B

OTH FRACTURE OF FOURTH LUMBAR VERTEBRA INIT FOR OPN FX

T83012D

Breakdown (mechanical) of nephrostomy catheter subsequent encounter

S32049A

UNSP FRACTURE OF FOURTH LUMBAR VERTEBRA INIT FOR CLOS FX

T83021A

Displacement of indwelling urethral catheter initial encounter

S32049B

UNSP FRACTURE OF FOURTH LUMBAR VERTEBRA INIT FOR OPN FX

T83022A

Displacement of nephrostomy catheter initial encounter

S32050A

WEDGE COMPRESSION FRACTURE OF FIFTH LUMBAR VERTEBRA INIT

T83022D

Displacement of nephrostomy catheter subsequent encounter

S32050B

WEDGE COMPRSN FX FIFTH LUM VERTEBRA INIT FOR OPN FX

T83032A

Leakage of nephrostomy catheter initial encounter

S32051A STABLE BURST FRACTURE OF FIFTH LUMBAR VERTEBRA INIT

T83032D

Leakage of nephrostomy catheter subsequent encounter

Page 597: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32051B

STABLE BURST FRACTURE OF FIFTH LUM VERTEBRA INIT FOR OPN FX

T83092A

Other mechanical complication of nephrostomy catheter initial encounter

S32052A UNSTABLE BURST FRACTURE OF FIFTH LUMBAR VERTEBRA INIT

T83092D

Other mechanical complication of nephrostomy catheter subsequent encounter

S32052B UNSTABLE BURST FX FIFTH LUM VERTEBRA INIT FOR OPN FX

T83111A

BREAKDOWN (MECHANICAL) OF URINARY SPHINCTER IMPLANT INIT

S32058A

OTH FRACTURE OF FIFTH LUMBAR VERTEBRA INIT FOR CLOS FX

T83112A

BREAKDOWN (MECHANICAL) OF URINARY STENT INITIAL ENCOUNTER

S32058B

OTH FRACTURE OF FIFTH LUMBAR VERTEBRA INIT FOR OPN FX

T83113A

Breakdown (mechanical) of other urinary stents initial encounter

S32059A

UNSP FRACTURE OF FIFTH LUMBAR VERTEBRA INIT FOR CLOS FX

T83113D

Breakdown (mechanical) of other urinary stents subsequent encounter

S32059B

UNSP FRACTURE OF FIFTH LUMBAR VERTEBRA INIT FOR OPN FX

T83118A

BREAKDOWN (MECHANICAL) OF URINARY DEVICES AND IMPLANTS INIT

S3210XA

UNSP FRACTURE OF SACRUM INIT ENCNTR FOR CLOSED FRACTURE

T83121A

DISPLACEMENT OF URINARY SPHINCTER IMPLANT INITIAL ENCOUNTER

S3210XB

UNSP FRACTURE OF SACRUM INIT ENCNTR FOR OPEN FRACTURE

T83122A

DISPLACEMENT OF URINARY STENT INITIAL ENCOUNTER

S32110A

NONDISPLACED ZONE I FRACTURE OF SACRUM INIT FOR CLOS FX

T83123A

Displacement of other urinary stents initial encounter

S32110B

NONDISPLACED ZONE I FRACTURE OF SACRUM INIT FOR OPN FX

T83123D

Displacement of other urinary stents subsequent encounter

S32111A MINIMALLY DISPLACED ZONE I FRACTURE OF SACRUM INIT

T83128A

DISPLACEMENT OF OTH URINARY DEVICES AND IMPLANTS INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32111B MINIMALLY DISPLACED ZONE I FX SACRUM INIT FOR OPN FX

T83191A

MECH COMPL OF URINARY SPHINCTER IMPLANT INITIAL ENCOUNTER

S32112A SEVERELY DISPLACED ZONE I FRACTURE OF SACRUM INIT

T83192A

MECH COMPL OF URINARY STENT INITIAL ENCOUNTER

S32112B SEVERELY DISPLACED ZONE I FX SACRUM INIT FOR OPN FX

T83193A

Other mechanical complication of other urinary stent initial encounter

S32119A UNSP ZONE I FRACTURE OF SACRUM INIT FOR CLOS FX

T83193D

Other mechanical complication of other urinary stent subsequent encounter

S32119B UNSP ZONE I FRACTURE OF SACRUM INIT FOR OPN FX

T83198A

MECH COMPL OF OTH URINARY DEVICES AND IMPLANTS INIT ENCNTR

S32120A

NONDISPLACED ZONE II FRACTURE OF SACRUM INIT FOR CLOS FX

T8321XA

BREAKDOWN (MECHANICAL) OF GRAFT OF URINARY ORGAN INIT

S32120B

NONDISPLACED ZONE II FRACTURE OF SACRUM INIT FOR OPN FX

T8322XA

DISPLACEMENT OF GRAFT OF URINARY ORGAN INITIAL ENCOUNTER

S32121A MINIMALLY DISPLACED ZONE II FRACTURE OF SACRUM INIT

T8323XA

LEAKAGE OF GRAFT OF URINARY ORGAN INITIAL ENCOUNTER

S32121B MINIMALLY DISPLACED ZONE II FX SACRUM INIT FOR OPN FX

T8324XA

Erosion of graft of urinary organ initial encounter

S32122A SEVERELY DISPLACED ZONE II FRACTURE OF SACRUM INIT

T8324XD

Erosion of graft of urinary organ subsequent encounter

S32122B SEVERELY DISPLACED ZONE II FX SACRUM INIT FOR OPN FX

T8325XA

Exposure of graft of urinary organ initial encounter

S32129A UNSP ZONE II FRACTURE OF SACRUM INIT FOR CLOS FX

T8325XD

Exposure of graft of urinary organ subsequent encounter

S32129B UNSP ZONE II FRACTURE OF SACRUM INIT FOR OPN FX

T8329XA

MECH COMPL OF GRAFT OF URINARY ORGAN INITIAL ENCOUNTER

S32130A

NONDISPLACED ZONE III FRACTURE OF SACRUM INIT FOR CLOS FX

T8331XA

BREAKDOWN (MECHANICAL) OF INTRAUTERINE CONTRACEP DEV INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32130B

NONDISPLACED ZONE III FRACTURE OF SACRUM INIT FOR OPN FX

T8332XA

DISPLACEMENT OF INTRAUTERINE CONTRACEPTIVE DEVICE INIT

S32131A MINIMALLY DISPLACED ZONE III FRACTURE OF SACRUM INIT

T8339XA

MECH COMPL OF INTRAUTERINE CONTRACEPTIVE DEVICE INIT ENCNTR

S32131B MINIMALLY DISPLACED ZONE III FX SACRUM INIT FOR OPN FX

T83411A

Breakdown (mechanical) of implanted testicular prosthesis initial encounter

S32132A SEVERELY DISPLACED ZONE III FRACTURE OF SACRUM INIT

T83411D

Breakdown (mechanical) of implanted testicular prosthesis subsequent encounter

S32132B SEVERELY DISPLACED ZONE III FX SACRUM INIT FOR OPN FX

T83421A

Displacement of implanted testicular prosthesis initial encounter

S32139A UNSP ZONE III FRACTURE OF SACRUM INIT FOR CLOS FX

T83491A

Other mechanical complication of implanted testicular prosthesis initial encounter

S32139B UNSP ZONE III FRACTURE OF SACRUM INIT FOR OPN FX

T83510A

Infection and inflammatory reaction due to cystostomy catheter initial encounter

S3214XA

TYPE 1 FRACTURE OF SACRUM INIT ENCNTR FOR CLOSED FRACTURE

T83511A

Infection and inflammatory reaction due to indwelling urethral catheter initial encounter

S3214XB

TYPE 1 FRACTURE OF SACRUM INIT ENCNTR FOR OPEN FRACTURE

T83512A

Infection and inflammatory reaction due to nephrostomy catheter initial encounter

S3215XA

TYPE 2 FRACTURE OF SACRUM INIT ENCNTR FOR CLOSED FRACTURE

T83518A

Infection and inflammatory reaction due to other urinary catheter initial encounter

S3215XB

TYPE 2 FRACTURE OF SACRUM INIT ENCNTR FOR OPEN FRACTURE

T83590A

Infection and inflammatory reaction due to implanted urinary neurostimulation device initial encounter

S3216XA

TYPE 3 FRACTURE OF SACRUM INIT ENCNTR FOR CLOSED FRACTURE

T83591A

Infection and inflammatory reaction due to implanted urinary sphincter initial encounter

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S3216XB

TYPE 3 FRACTURE OF SACRUM INIT ENCNTR FOR OPEN FRACTURE

T83592A

Infection and inflammatory reaction due to indwelling ureteral stent initial encounter

S3217XA

TYPE 4 FRACTURE OF SACRUM INIT ENCNTR FOR CLOSED FRACTURE

T83593A

Infection and inflammatory reaction due to other urinary stents initial encounter

S3217XB

TYPE 4 FRACTURE OF SACRUM INIT ENCNTR FOR OPEN FRACTURE

T83598A

Infection and inflammatory reaction due to other prosthetic device implant and graft in urinary system initial encounter

S3219XA

OTHER FRACTURE OF SACRUM INIT ENCNTR FOR CLOSED FRACTURE

T8359XA

INFECT/INFLM REACT D/T PROSTH DEV/GRFT IN URINRY SYS INIT

S3219XB

OTHER FRACTURE OF SACRUM INIT ENCNTR FOR OPEN FRACTURE

T8361XA

Infection and inflammatory reaction due to implanted penile prosthesis initial encounter

S322XXA

FRACTURE OF COCCYX INITIAL ENCOUNTER FOR CLOSED FRACTURE

T8362XA

Infection and inflammatory reaction due to implanted testicular prosthesis initial encounter

S322XXB

FRACTURE OF COCCYX INITIAL ENCOUNTER FOR OPEN FRACTURE

T8369XA

Infection and inflammatory reaction due to other prosthetic device implant and graft in genital tract initial encounter

S32301A UNSP FRACTURE OF RIGHT ILIUM INIT FOR CLOS FX

T836XXA

INFECT/INFLM REACT D/T PROSTH DEV/GRFT IN GENITL TRCT INIT

S32301B

UNSP FRACTURE OF RIGHT ILIUM INIT ENCNTR FOR OPEN FRACTURE

T83712A

Erosion of implanted urethral mesh to surrounding organ or tissue initial encounter

S32302A

UNSP FRACTURE OF LEFT ILIUM INIT ENCNTR FOR CLOSED FRACTURE

T83713A

Erosion of implanted urethral bulking agent to surrounding organ or tissue initial encounter

S32302B

UNSP FRACTURE OF LEFT ILIUM INIT ENCNTR FOR OPEN FRACTURE

T83714A

Erosion of implanted ureteral bulking agent to surrounding organ or tissue initial encounter

S32309A

UNSP FRACTURE OF UNSP ILIUM INIT ENCNTR FOR CLOSED FRACTURE

T83719A

Erosion of other prosthetic materials to surrounding organ or tissue initial encounter

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32309B

UNSP FRACTURE OF UNSP ILIUM INIT ENCNTR FOR OPEN FRACTURE

T83722A

Exposure of implanted urethral mesh into urethra initial encounter

S32311A

DISPLACED AVULSION FRACTURE OF RIGHT ILIUM INIT FOR CLOS FX

T83723A

Exposure of implanted urethral bulking agent into urethra initial encounter

S32311B

DISPLACED AVULSION FRACTURE OF RIGHT ILIUM INIT FOR OPN FX

T83724A

Exposure of implanted ureteral bulking agent into ureter initial encounter

S32312A

DISPLACED AVULSION FRACTURE OF LEFT ILIUM INIT FOR CLOS FX

T83729A

Exposure of other prosthetic materials into organ or tissue initial encounter

S32312B

DISPLACED AVULSION FRACTURE OF LEFT ILIUM INIT FOR OPN FX

T8379XA

Other specified complications due to other prosthetic materials initial encounter

S32313A

DISPLACED AVULSION FRACTURE OF UNSP ILIUM INIT FOR CLOS FX

T8381XA

EMBOLISM OF GENITOURINARY PROSTH DEV/GRFT INIT

S32313B

DISPLACED AVULSION FRACTURE OF UNSP ILIUM INIT FOR OPN FX

T8382XA

FIBROSIS OF GENITOURINARY PROSTH DEV/GRFT INIT

S32314A NONDISPLACED AVULSION FRACTURE OF RIGHT ILIUM INIT

T8383XA

HEMORRHAGE OF GENITOURINARY PROSTH DEV/GRFT INIT

S32314B

NONDISP AVULSION FRACTURE OF RIGHT ILIUM INIT FOR OPN FX

T8384XA

PAIN FROM GENITOURINARY PROSTH DEV/GRFT INIT

S32315A NONDISPLACED AVULSION FRACTURE OF LEFT ILIUM INIT

T8385XA

STENOSIS OF GENITOURINARY PROSTH DEV/GRFT INIT

S32315B NONDISP AVULSION FRACTURE OF LEFT ILIUM INIT FOR OPN FX

T8386XA

THROMBOSIS OF GENITOURINARY PROSTH DEV/GRFT INIT

S32316A NONDISPLACED AVULSION FRACTURE OF UNSP ILIUM INIT

T8389XA

OTH COMPLICATION OF GENITOURINARY PROSTH DEV/GRFT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32316B

NONDISP AVULSION FRACTURE OF UNSP ILIUM INIT FOR OPN FX

T839XXA

UNSP COMPLICATION OF GENITOURINARY PROSTH DEV/GRFT INIT

S32391A

OTH FRACTURE OF RIGHT ILIUM INIT ENCNTR FOR CLOSED FRACTURE

T84010A

BROKEN INTERNAL RIGHT HIP PROSTHESIS INITIAL ENCOUNTER

S32391B

OTHER FRACTURE OF RIGHT ILIUM INIT ENCNTR FOR OPEN FRACTURE

T84011A

BROKEN INTERNAL LEFT HIP PROSTHESIS INITIAL ENCOUNTER

S32392A

OTH FRACTURE OF LEFT ILIUM INIT ENCNTR FOR CLOSED FRACTURE

T84012A

BROKEN INTERNAL RIGHT KNEE PROSTHESIS INITIAL ENCOUNTER

S32392B

OTHER FRACTURE OF LEFT ILIUM INIT ENCNTR FOR OPEN FRACTURE

T84013A

BROKEN INTERNAL LEFT KNEE PROSTHESIS INITIAL ENCOUNTER

S32399A

OTH FRACTURE OF UNSP ILIUM INIT ENCNTR FOR CLOSED FRACTURE

T84018A

BROKEN INTERNAL JOINT PROSTHESIS OTHER SITE INIT ENCNTR

S32399B

OTHER FRACTURE OF UNSP ILIUM INIT ENCNTR FOR OPEN FRACTURE

T84019A

BROKEN INTERNAL JOINT PROSTHESIS UNSP SITE INIT ENCNTR

S32401A UNSP FRACTURE OF RIGHT ACETABULUM INIT FOR CLOS FX

T84020A

DISLOCATION OF INTERNAL RIGHT HIP PROSTHESIS INIT ENCNTR

S32401B UNSP FRACTURE OF RIGHT ACETABULUM INIT FOR OPN FX

T84021A

DISLOCATION OF INTERNAL LEFT HIP PROSTHESIS INIT ENCNTR

S32402A UNSP FRACTURE OF LEFT ACETABULUM INIT FOR CLOS FX

T84022A

INSTABILITY OF INTERNAL RIGHT KNEE PROSTHESIS INIT ENCNTR

S32402B UNSP FRACTURE OF LEFT ACETABULUM INIT FOR OPN FX

T84023A

INSTABILITY OF INTERNAL LEFT KNEE PROSTHESIS INIT ENCNTR

S32409A UNSP FRACTURE OF UNSP ACETABULUM INIT FOR CLOS FX

T84028A

DISLOCATION OF OTHER INTERNAL JOINT PROSTHESIS INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32409B UNSP FRACTURE OF UNSP ACETABULUM INIT FOR OPN FX

T84029A

DISLOCATION OF UNSP INTERNAL JOINT PROSTHESIS INIT ENCNTR

S32411A DISP FX OF ANTERIOR WALL OF RIGHT ACETABULUM INIT

T84030A

MECH LOOSENING OF INTERNAL RIGHT HIP PROSTHETIC JOINT INIT

S32411B DISP FX OF ANTERIOR WALL OF RIGHT ACETAB INIT FOR OPN FX

T84031A

MECH LOOSENING OF INTERNAL LEFT HIP PROSTHETIC JOINT INIT

S32412A DISP FX OF ANTERIOR WALL OF LEFT ACETABULUM INIT

T84032A

MECH LOOSENING OF INTERNAL RIGHT KNEE PROSTHETIC JOINT INIT

S32412B

DISP FX OF ANTERIOR WALL OF LEFT ACETABULUM INIT FOR OPN FX

T84033A

MECH LOOSENING OF INTERNAL LEFT KNEE PROSTHETIC JOINT INIT

S32413A DISP FX OF ANTERIOR WALL OF UNSP ACETABULUM INIT

T84038A

MECHANICAL LOOSENING OF OTH INTERNAL PROSTHETIC JOINT INIT

S32413B

DISP FX OF ANTERIOR WALL OF UNSP ACETABULUM INIT FOR OPN FX

T84039A

MECHANICAL LOOSENING OF UNSP INTERNAL PROSTHETIC JOINT INIT

S32414A

NONDISP FX OF ANTERIOR WALL OF RIGHT ACETABULUM INIT

T84040A

PERIPROSTH FRACTURE AROUND INTERNAL PROSTH R HIP JT INIT

S32414B

NONDISP FX OF ANTERIOR WALL OF RIGHT ACETAB INIT FOR OPN FX

T84041A

PERIPROSTH FRACTURE AROUND INTERNAL PROSTH L HIP JT INIT

S32415A

NONDISP FX OF ANTERIOR WALL OF LEFT ACETABULUM INIT

T84042A

PERIPROSTH FRACTURE AROUND INTERNAL PROSTH R KNEE JT INIT

S32415B

NONDISP FX OF ANTERIOR WALL OF LEFT ACETAB INIT FOR OPN FX

T84043A

PERIPROSTH FRACTURE AROUND INTERNAL PROSTH L KNEE JT INIT

S32416A

NONDISP FX OF ANTERIOR WALL OF UNSP ACETABULUM INIT

T84048A

PERIPROSTH FRACTURE AROUND OTH INTERNAL PROSTH JOINT INIT

S32416B

NONDISP FX OF ANTERIOR WALL OF UNSP ACETAB INIT FOR OPN FX

T84049A

PERIPROSTH FRACTURE AROUND UNSP INTERNAL PROSTH JOINT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32421A DISP FX OF POSTERIOR WALL OF RIGHT ACETABULUM INIT

T84050A

PERIPROSTH OSTEOLYSIS OF INTERNAL PROSTHETIC R HIP JT INIT

S32421B DISP FX OF POSTERIOR WALL OF RIGHT ACETAB INIT FOR OPN FX

T84051A

PERIPROSTH OSTEOLYSIS OF INTERNAL PROSTHETIC L HIP JT INIT

S32422A DISP FX OF POSTERIOR WALL OF LEFT ACETABULUM INIT

T84052A

PERIPROSTH OSTEOLYSIS OF INTERNAL PROSTHETIC R KNEE JT INIT

S32422B DISP FX OF POSTERIOR WALL OF LEFT ACETAB INIT FOR OPN FX

T84053A

PERIPROSTH OSTEOLYSIS OF INTERNAL PROSTHETIC L KNEE JT INIT

S32423A DISP FX OF POSTERIOR WALL OF UNSP ACETABULUM INIT

T84058A

PERIPROSTHETIC OSTEOLYSIS OF INTERNAL PROSTHETIC JOINT INIT

S32423B DISP FX OF POSTERIOR WALL OF UNSP ACETAB INIT FOR OPN FX

T84059A

PERIPROSTH OSTEOLYS OF UNSP INTERNAL PROSTHETIC JOINT INIT

S32424A

NONDISP FX OF POSTERIOR WALL OF RIGHT ACETABULUM INIT

T84060A

WEAR OF ARTIC BEARING SURFACE OF INT PROSTH R HIP JT INIT

S32424B NONDISP FX OF POST WALL OF RIGHT ACETAB INIT FOR OPN FX

T84061A

WEAR OF ARTIC BEARING SURFACE OF INT PROSTH L HIP JT INIT

S32425A

NONDISP FX OF POSTERIOR WALL OF LEFT ACETABULUM INIT

T84062A

WEAR OF ARTIC BEARING SURFACE OF INT PROSTH R KNEE JT INIT

S32425B

NONDISP FX OF POSTERIOR WALL OF LEFT ACETAB INIT FOR OPN FX

T84063A

WEAR OF ARTIC BEARING SURFACE OF INT PROSTH L KNEE JT INIT

S32426A

NONDISP FX OF POSTERIOR WALL OF UNSP ACETABULUM INIT

T84068A

WEAR OF ARTIC BEARING SURFACE OF INTERNAL PROSTH JOINT INIT

S32426B

NONDISP FX OF POSTERIOR WALL OF UNSP ACETAB INIT FOR OPN FX

T84069A

WEAR OF ARTIC BEARING SURFACE OF UNSP INT PROSTH JOINT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32431A DISP FX OF ANTERIOR COLUMN OF RIGHT ACETABULUM INIT

T84090A

MECH COMPL OF INTERNAL RIGHT HIP PROSTHESIS INIT ENCNTR

S32431B

DISP FX OF ANTERIOR COLUMN OF RIGHT ACETAB INIT FOR OPN FX

T84091A

MECH COMPL OF INTERNAL LEFT HIP PROSTHESIS INIT ENCNTR

S32432A DISP FX OF ANTERIOR COLUMN OF LEFT ACETABULUM INIT

T84092A

MECH COMPL OF INTERNAL RIGHT KNEE PROSTHESIS INIT ENCNTR

S32432B

DISP FX OF ANTERIOR COLUMN OF LEFT ACETAB INIT FOR OPN FX

T84093A

MECH COMPL OF INTERNAL LEFT KNEE PROSTHESIS INIT ENCNTR

S32433A DISP FX OF ANTERIOR COLUMN OF UNSP ACETABULUM INIT

T84098A

MECH COMPL OF OTHER INTERNAL JOINT PROSTHESIS INIT ENCNTR

S32433B

DISP FX OF ANTERIOR COLUMN OF UNSP ACETAB INIT FOR OPN FX

T84099A

MECH COMPL OF UNSP INTERNAL JOINT PROSTHESIS INIT ENCNTR

S32434A

NONDISP FX OF ANTERIOR COLUMN OF RIGHT ACETABULUM INIT

T84110A

BREAKDOWN (MECHANICAL) OF INT FIX OF RIGHT HUMERUS INIT

S32434B

NONDISP FX OF ANT COLUMN OF RIGHT ACETAB INIT FOR OPN FX

T84111A

BREAKDOWN (MECHANICAL) OF INT FIX OF LEFT HUMERUS INIT

S32435A

NONDISP FX OF ANTERIOR COLUMN OF LEFT ACETABULUM INIT

T84112A

BREAKDOWN (MECHANICAL) OF INT FIX OF BONE OF R FOREARM INIT

S32435B

NONDISP FX OF ANT COLUMN OF LEFT ACETAB INIT FOR OPN FX

T84113A

BREAKDOWN OF INT FIX OF BONE OF LEFT FOREARM INIT

S32436A

NONDISP FX OF ANTERIOR COLUMN OF UNSP ACETABULUM INIT

T84114A

BREAKDOWN (MECHANICAL) OF INT FIX OF RIGHT FEMUR INIT

S32436B

NONDISP FX OF ANT COLUMN OF UNSP ACETAB INIT FOR OPN FX

T84115A

BREAKDOWN (MECHANICAL) OF INT FIX OF LEFT FEMUR INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32441A

DISP FX OF POSTERIOR COLUMN OF RIGHT ACETABULUM INIT

T84116A

BREAKDOWN (MECHANICAL) OF INT FIX OF BONE OF R LOW LEG INIT

S32441B

DISP FX OF POSTERIOR COLUMN OF RIGHT ACETAB INIT FOR OPN FX

T84117A

BREAKDOWN (MECHANICAL) OF INT FIX OF BONE OF L LOW LEG INIT

S32442A

DISP FX OF POSTERIOR COLUMN OF LEFT ACETABULUM INIT

T84119A

BREAKDOWN (MECHANICAL) OF INT FIX OF UNSP BONE OF LIMB INIT

S32442B

DISP FX OF POSTERIOR COLUMN OF LEFT ACETAB INIT FOR OPN FX

T84120A

DISPLACEMENT OF INT FIX OF RIGHT HUMERUS INIT

S32443A

DISP FX OF POSTERIOR COLUMN OF UNSP ACETABULUM INIT

T84121A

DISPLACEMENT OF INT FIX OF LEFT HUMERUS INIT

S32443B

DISP FX OF POSTERIOR COLUMN OF UNSP ACETAB INIT FOR OPN FX

T84122A

DISPLACEMENT OF INT FIX OF BONE OF RIGHT FOREARM INIT

S32444A

NONDISP FX OF POSTERIOR COLUMN OF RIGHT ACETABULUM INIT

T84123A

DISPLACEMENT OF INT FIX OF BONE OF LEFT FOREARM INIT

S32444B

NONDISP FX OF POST COLUMN OF RIGHT ACETAB INIT FOR OPN FX

T84124A

DISPLACEMENT OF INT FIX OF RIGHT FEMUR INIT

S32445A

NONDISP FX OF POSTERIOR COLUMN OF LEFT ACETABULUM INIT

T84125A

DISPLACEMENT OF INTERNAL FIXATION DEVICE OF LEFT FEMUR INIT

S32445B

NONDISP FX OF POST COLUMN OF LEFT ACETAB INIT FOR OPN FX

T84126A

DISPLACEMENT OF INT FIX OF BONE OF RIGHT LOWER LEG INIT

S32446A

NONDISP FX OF POSTERIOR COLUMN OF UNSP ACETABULUM INIT

T84127A

DISPLACEMENT OF INT FIX OF BONE OF LEFT LOWER LEG INIT

S32446B

NONDISP FX OF POST COLUMN OF UNSP ACETAB INIT FOR OPN FX

T84129A

DISPLACEMENT OF INT FIX OF UNSP BONE OF LIMB INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32451A

DISPLACED TRANSVERSE FRACTURE OF RIGHT ACETABULUM INIT

T84190A

MECH COMPL OF INT FIX OF RIGHT HUMERUS INIT

S32451B

DISPLACED TRANSVERSE FX RIGHT ACETABULUM INIT FOR OPN FX

T84191A

MECH COMPL OF INTERNAL FIXATION DEVICE OF LEFT HUMERUS INIT

S32452A

DISPLACED TRANSVERSE FRACTURE OF LEFT ACETABULUM INIT

T84192A

MECH COMPL OF INT FIX OF BONE OF RIGHT FOREARM INIT

S32452B

DISPLACED TRANSVERSE FX LEFT ACETABULUM INIT FOR OPN FX

T84193A

MECH COMPL OF INT FIX OF BONE OF LEFT FOREARM INIT

S32453A

DISPLACED TRANSVERSE FRACTURE OF UNSP ACETABULUM INIT

T84194A

MECH COMPL OF INTERNAL FIXATION DEVICE OF RIGHT FEMUR INIT

S32453B

DISPLACED TRANSVERSE FX UNSP ACETABULUM INIT FOR OPN FX

T84195A

MECH COMPL OF INTERNAL FIXATION DEVICE OF LEFT FEMUR INIT

S32454A

NONDISPLACED TRANSVERSE FRACTURE OF RIGHT ACETABULUM INIT

T84196A

MECH COMPL OF INT FIX OF BONE OF RIGHT LOWER LEG INIT

S32454B

NONDISP TRANSVERSE FX RIGHT ACETABULUM INIT FOR OPN FX

T84197A

MECH COMPL OF INT FIX OF BONE OF LEFT LOWER LEG INIT

S32455A

NONDISPLACED TRANSVERSE FRACTURE OF LEFT ACETABULUM INIT

T84199A

MECH COMPL OF INT FIX OF UNSP BONE OF LIMB INIT

S32455B NONDISP TRANSVERSE FX LEFT ACETABULUM INIT FOR OPN FX

T84210A

BREAKDOWN OF INT FIX OF BONES OF HAND AND FINGERS INIT

S32456A

NONDISPLACED TRANSVERSE FRACTURE OF UNSP ACETABULUM INIT

T84213A

BREAKDOWN OF INT FIX OF BONES OF FOOT AND TOES INIT

S32456B NONDISP TRANSVERSE FX UNSP ACETABULUM INIT FOR OPN FX

T84216A

BREAKDOWN (MECHANICAL) OF INT FIX OF VERTEBRAE INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32461A

DISPLACED ASSOCIATED TRANSV/POST FX RIGHT ACETABULUM INIT

T84218A

BREAKDOWN (MECHANICAL) OF INT FIX OF BONES INIT

S32461B

DISPLACED ASSOC TRANSV/POST FX RIGHT ACETAB INIT FOR OPN FX

T84220A

DISPLACEMENT OF INT FIX OF BONES OF HAND AND FINGERS INIT

S32462A

DISPLACED ASSOCIATED TRANSV/POST FX LEFT ACETABULUM INIT

T84223A

DISPLACEMENT OF INT FIX OF BONES OF FOOT AND TOES INIT

S32462B

DISPLACED ASSOC TRANSV/POST FX LEFT ACETAB INIT FOR OPN FX

T84226A

DISPLACEMENT OF INTERNAL FIXATION DEVICE OF VERTEBRAE INIT

S32463A

DISPLACED ASSOCIATED TRANSV/POST FX UNSP ACETABULUM INIT

T84228A

DISPLACEMENT OF INTERNAL FIXATION DEVICE OF OTH BONES INIT

S32463B

DISPLACED ASSOC TRANSV/POST FX UNSP ACETAB INIT FOR OPN FX

T84290A

MECH COMPL OF INT FIX OF BONES OF HAND AND FINGERS INIT

S32464A

NONDISP ASSOCIATED TRANSV/POST FX RIGHT ACETABULUM INIT

T84293A

MECH COMPL OF INT FIX OF BONES OF FOOT AND TOES INIT

S32464B

NONDISP ASSOC TRANSV/POST FX RIGHT ACETAB INIT FOR OPN FX

T84296A

MECH COMPL OF INTERNAL FIXATION DEVICE OF VERTEBRAE INIT

S32465A

NONDISP ASSOCIATED TRANSV/POST FX LEFT ACETABULUM INIT

T84298A

MECH COMPL OF INTERNAL FIXATION DEVICE OF OTH BONES INIT

S32465B

NONDISP ASSOC TRANSV/POST FX LEFT ACETAB INIT FOR OPN FX

T84310A

BREAKDOWN (MECHANICAL) OF ELECTRONIC BONE STIMULATOR INIT

S32466A

NONDISP ASSOCIATED TRANSV/POST FX UNSP ACETABULUM INIT

T84318A

BREAKDOWN OF BONE DEVICES IMPLANTS AND GRAFTS INIT

S32466B

NONDISP ASSOC TRANSV/POST FX UNSP ACETAB INIT FOR OPN FX

T84320A

DISPLACEMENT OF ELECTRONIC BONE STIMULATOR INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32471A

DISP FX OF MEDIAL WALL OF RIGHT ACETABULUM INIT FOR CLOS FX

T84328A

DISPLACEMENT OF OTH BONE DEVICES IMPLANTS AND GRAFTS INIT

S32471B

DISP FX OF MEDIAL WALL OF RIGHT ACETABULUM INIT FOR OPN FX

T84390A

MECH COMPL OF ELECTRONIC BONE STIMULATOR INITIAL ENCOUNTER

S32472A

DISP FX OF MEDIAL WALL OF LEFT ACETABULUM INIT FOR CLOS FX

T84398A

MECH COMPL OF OTH BONE DEVICES IMPLANTS AND GRAFTS INIT

S32472B

DISP FX OF MEDIAL WALL OF LEFT ACETABULUM INIT FOR OPN FX

T84410A

BREAKDOWN (MECHANICAL) OF MUSCLE AND TENDON GRAFT INIT

S32473A

DISP FX OF MEDIAL WALL OF UNSP ACETABULUM INIT FOR CLOS FX

T84418A

BRKDWN INTERNAL ORTH DEVICES IMPLANTS AND GRAFTS INIT

S32473B

DISP FX OF MEDIAL WALL OF UNSP ACETABULUM INIT FOR OPN FX

T84420A

DISPLACEMENT OF MUSCLE AND TENDON GRAFT INITIAL ENCOUNTER

S32474A NONDISP FX OF MEDIAL WALL OF RIGHT ACETABULUM INIT

T84428A

DISPLACMNT OF INTERNAL ORTH DEVICES IMPLNT AND GRAFTS INIT

S32474B

NONDISP FX OF MEDIAL WALL OF RIGHT ACETAB INIT FOR OPN FX

T84490A

MECH COMPL OF MUSCLE AND TENDON GRAFT INITIAL ENCOUNTER

S32475A NONDISP FX OF MEDIAL WALL OF LEFT ACETABULUM INIT

T84498A

MECH COMPL OF INTERNAL ORTH DEVICES IMPLNT AND GRAFTS INIT

S32475B

NONDISP FX OF MEDIAL WALL OF LEFT ACETAB INIT FOR OPN FX

T8450XA

INFECT/INFLM REACTION DUE TO UNSP INT JOINT PROSTH INIT

S32476A NONDISP FX OF MEDIAL WALL OF UNSP ACETABULUM INIT

T8451XA

INFECT/INFLM REACTION DUE TO INTERNAL RIGHT HIP PROSTH INIT

S32476B

NONDISP FX OF MEDIAL WALL OF UNSP ACETAB INIT FOR OPN FX

T8452XA

INFECT/INFLM REACTION DUE TO INTERNAL LEFT HIP PROSTH INIT

S32481A DISPLACED DOME FRACTURE OF RIGHT ACETABULUM INIT

T8453XA

INFECT/INFLM REACTION DUE TO INTERNAL R KNEE PROSTH INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32481B

DISPLACED DOME FRACTURE OF RIGHT ACETABULUM INIT FOR OPN FX

T8454XA

INFECT/INFLM REACTION DUE TO INTERNAL LEFT KNEE PROSTH INIT

S32482A

DISPLACED DOME FRACTURE OF LEFT ACETABULUM INIT FOR CLOS FX

T8459XA

INFECT/INFLM REACTION DUE TO OTH INTERNAL JOINT PROSTH INIT

S32482B

DISPLACED DOME FRACTURE OF LEFT ACETABULUM INIT FOR OPN FX

T8460XA

INFECT/INFLM REACTION DUE TO INT FIX OF UNSP SITE INIT

S32483A

DISPLACED DOME FRACTURE OF UNSP ACETABULUM INIT FOR CLOS FX

T84610A

INFECT/INFLM REACTION DUE TO INT FIX OF RIGHT HUMERUS INIT

S32483B

DISPLACED DOME FRACTURE OF UNSP ACETABULUM INIT FOR OPN FX

T84611A

INFECT/INFLM REACTION DUE TO INT FIX OF LEFT HUMERUS INIT

S32484A

NONDISPLACED DOME FRACTURE OF RIGHT ACETABULUM INIT

T84612A

INFECT/INFLM REACTION DUE TO INT FIX OF RIGHT RADIUS INIT

S32484B

NONDISP DOME FRACTURE OF RIGHT ACETABULUM INIT FOR OPN FX

T84613A

INFECT/INFLM REACTION DUE TO INT FIX OF LEFT RADIUS INIT

S32485A

NONDISPLACED DOME FRACTURE OF LEFT ACETABULUM INIT

T84614A

INFECT/INFLM REACTION DUE TO INT FIX OF RIGHT ULNA INIT

S32485B

NONDISP DOME FRACTURE OF LEFT ACETABULUM INIT FOR OPN FX

T84615A

INFECT/INFLM REACTION DUE TO INT FIX OF LEFT ULNA INIT

S32486A

NONDISPLACED DOME FRACTURE OF UNSP ACETABULUM INIT

T84619A

INFECT/INFLM REACT DUE TO INT FIX OF UNSP BONE OF ARM INIT

S32486B

NONDISP DOME FRACTURE OF UNSP ACETABULUM INIT FOR OPN FX

T84620A

INFECT/INFLM REACTION DUE TO INT FIX OF RIGHT FEMUR INIT

S32491A OTH FRACTURE OF RIGHT ACETABULUM INIT FOR CLOS FX

T84621A

INFECT/INFLM REACTION DUE TO INT FIX OF LEFT FEMUR INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32491B OTH FRACTURE OF RIGHT ACETABULUM INIT FOR OPN FX

T84622A

INFECT/INFLM REACTION DUE TO INT FIX OF RIGHT TIBIA INIT

S32492A OTH FRACTURE OF LEFT ACETABULUM INIT FOR CLOS FX

T84623A

INFECT/INFLM REACTION DUE TO INT FIX OF LEFT TIBIA INIT

S32492B OTH FRACTURE OF LEFT ACETABULUM INIT FOR OPN FX

T84624A

INFECT/INFLM REACTION DUE TO INT FIX OF RIGHT FIBULA INIT

S32499A OTH FRACTURE OF UNSP ACETABULUM INIT FOR CLOS FX

T84625A

INFECT/INFLM REACTION DUE TO INT FIX OF LEFT FIBULA INIT

S32499B OTH FRACTURE OF UNSP ACETABULUM INIT FOR OPN FX

T84629A

INFECT/INFLM REACT DUE TO INT FIX OF UNSP BONE OF LEG INIT

S32501A UNSP FRACTURE OF RIGHT PUBIS INIT FOR CLOS FX

T8463XA

INFECT/INFLM REACTION DUE TO INT FIX OF SPINE INIT

S32501B

UNSP FRACTURE OF RIGHT PUBIS INIT ENCNTR FOR OPEN FRACTURE

T8469XA

INFECT/INFLM REACTION DUE TO INT FIX OF SITE INIT

S32502A

UNSP FRACTURE OF LEFT PUBIS INIT ENCNTR FOR CLOSED FRACTURE

T847XXA

INFECT/INFLM REACT DUE TO OTH INT ORTH PROSTH DEV/GRFT INIT

S32502B

UNSP FRACTURE OF LEFT PUBIS INIT ENCNTR FOR OPEN FRACTURE

T8481XA

EMBOLISM DUE TO INTERNAL ORTHOPEDIC PROSTH DEV/GRFT INIT

S32509A

UNSP FRACTURE OF UNSP PUBIS INIT ENCNTR FOR CLOSED FRACTURE

T8482XA

FIBROSIS DUE TO INTERNAL ORTHOPEDIC PROSTH DEV/GRFT INIT

S32509B

UNSP FRACTURE OF UNSP PUBIS INIT ENCNTR FOR OPEN FRACTURE

T8483XA

HEMORRHAGE DUE TO INTERNAL ORTHOPEDIC PROSTH DEV/GRFT INIT

S32511A

FRACTURE OF SUPERIOR RIM OF RIGHT PUBIS INIT FOR CLOS FX

T8484XA

PAIN DUE TO INTERNAL ORTHOPEDIC PROSTH DEV/GRFT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32511B

FRACTURE OF SUPERIOR RIM OF RIGHT PUBIS INIT FOR OPN FX

T8485XA

STENOSIS DUE TO INTERNAL ORTHOPEDIC PROSTH DEV/GRFT INIT

S32512A FRACTURE OF SUPERIOR RIM OF LEFT PUBIS INIT FOR CLOS FX

T8486XA

THROMBOSIS DUE TO INTERNAL ORTHOPEDIC PROSTH DEV/GRFT INIT

S32512B FRACTURE OF SUPERIOR RIM OF LEFT PUBIS INIT FOR OPN FX

T8489XA

OTH COMP OF INTERNAL ORTHOPEDIC PROSTH DEV/GRFT INIT

S32519A

FRACTURE OF SUPERIOR RIM OF UNSP PUBIS INIT FOR CLOS FX

T849XXA

UNSP COMP OF INTERNAL ORTHOPEDIC PROSTH DEV/GRFT INIT

S32519B

FRACTURE OF SUPERIOR RIM OF UNSP PUBIS INIT FOR OPN FX

T8501XA

BREAKDOWN OF VENTRICULAR INTRACRANIAL SHUNT INIT

S32591A

OTH FRACTURE OF RIGHT PUBIS INIT ENCNTR FOR CLOSED FRACTURE

T8502XA

DISPLACEMENT OF VENTRICULAR INTRACRANIAL SHUNT INIT

S32591B

OTH FRACTURE OF RIGHT PUBIS INIT ENCNTR FOR OPEN FRACTURE

T8503XA

LEAKAGE OF VENTRICULAR INTRACRANIAL SHUNT INIT

S32592A

OTH FRACTURE OF LEFT PUBIS INIT ENCNTR FOR CLOSED FRACTURE

T8509XA

MECH COMPL OF VENTRICULAR INTRACRANIAL SHUNT INIT

S32592B

OTH FRACTURE OF LEFT PUBIS INIT ENCNTR FOR OPEN FRACTURE

T85110A

BRKDWN IMPLANTED ELECTRONIC NEUROSTIM OF BRAIN INIT

S32599A

OTH FRACTURE OF UNSP PUBIS INIT ENCNTR FOR CLOSED FRACTURE

T85111A

BRKDWN IMPLANTED ELECTRONIC NEUROSTIM OF PERIPH NRV INIT

S32599B

OTH FRACTURE OF UNSP PUBIS INIT ENCNTR FOR OPEN FRACTURE

T85112A

BRKDWN IMPLANTED ELECTRONIC NEUROSTIM OF SPINAL CORD INIT

S32601A UNSP FRACTURE OF RIGHT ISCHIUM INIT FOR CLOS FX

T85113A

Breakdown (mechanical) of implanted electronic neurostimulator generator initial encounter

Page 613: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32601B UNSP FRACTURE OF RIGHT ISCHIUM INIT FOR OPN FX

T85118A

BRKDWN IMPLANTED ELECTRONIC STIMULATOR OF NERVOUS SYS INIT

S32602A UNSP FRACTURE OF LEFT ISCHIUM INIT FOR CLOS FX

T85120A

DISPLACMNT OF IMPLANTED ELECTRONIC NEUROSTIM OF BRAIN INIT

S32602B

UNSP FRACTURE OF LEFT ISCHIUM INIT ENCNTR FOR OPEN FRACTURE

T85121A

DISPLACMNT OF IMPLNT ELECTRNC NEUROSTIM OF PERIPH NRV INIT

S32609A UNSP FRACTURE OF UNSP ISCHIUM INIT FOR CLOS FX

T85122A

DISPLACMNT OF IMPLNT ELECTRNC NEUROSTIM OF SPINAL CORD INIT

S32609B

UNSP FRACTURE OF UNSP ISCHIUM INIT ENCNTR FOR OPEN FRACTURE

T85123A

Displacement of implanted electronic neurostimulator generator initial encounter

S32611A

DISPLACED AVULSION FRACTURE OF RIGHT ISCHIUM INIT

T85128A

DISPLACMNT OF IMPLNT ELECTRNC STIMULTR OF NERVOUS SYS INIT

S32611B DISPLACED AVULSION FX RIGHT ISCHIUM INIT FOR OPN FX

T85190A

MECH COMPL OF IMPLANTED ELECTRONIC NEUROSTIM OF BRAIN INIT

S32612A

DISPLACED AVULSION FRACTURE OF LEFT ISCHIUM INIT

T85191A

MECH COMPL OF IMPLNT ELECTRNC NEUROSTIM OF PERIPH NRV INIT

S32612B

DISPLACED AVULSION FRACTURE OF LEFT ISCHIUM INIT FOR OPN FX

T85192A

MECH COMPL OF IMPLNT ELECTRNC NEUROSTIM OF SPINAL CORD INIT

S32613A

DISPLACED AVULSION FRACTURE OF UNSP ISCHIUM INIT

T85193A

Other mechanical complication of implanted electronic neurostimulator generator initial encounter

S32613B

DISPLACED AVULSION FRACTURE OF UNSP ISCHIUM INIT FOR OPN FX

T85199A

MECH COMPL OF IMPLNT ELECTRNC STIMULTR OF NERVOUS SYS INIT

S32614A

NONDISPLACED AVULSION FRACTURE OF RIGHT ISCHIUM INIT

T8521XA

BREAKDOWN (MECHANICAL) OF INTRAOCULAR LENS INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32614B

NONDISP AVULSION FRACTURE OF RIGHT ISCHIUM INIT FOR OPN FX

T8522XA

DISPLACEMENT OF INTRAOCULAR LENS INITIAL ENCOUNTER

S32615A

NONDISPLACED AVULSION FRACTURE OF LEFT ISCHIUM INIT

T8529XA

MECH COMPL OF INTRAOCULAR LENS INITIAL ENCOUNTER

S32615B

NONDISP AVULSION FRACTURE OF LEFT ISCHIUM INIT FOR OPN FX

T85310A

BREAKDOWN OF PROSTHETIC ORBIT OF RIGHT EYE INIT

S32616A

NONDISPLACED AVULSION FRACTURE OF UNSP ISCHIUM INIT

T85311A

BREAKDOWN (MECHANICAL) OF PROSTHETIC ORBIT OF LEFT EYE INIT

S32616B

NONDISP AVULSION FRACTURE OF UNSP ISCHIUM INIT FOR OPN FX

T85318A

BREAKDOWN (MECHANICAL) OF OCULAR PROSTH DEV/GRFT INIT

S32691A OTH FRACTURE OF RIGHT ISCHIUM INIT FOR CLOS FX

T85320A

DISPLACEMENT OF PROSTHETIC ORBIT OF RIGHT EYE INIT ENCNTR

S32691B

OTH FRACTURE OF RIGHT ISCHIUM INIT ENCNTR FOR OPEN FRACTURE

T85321A

DISPLACEMENT OF PROSTHETIC ORBIT OF LEFT EYE INIT ENCNTR

S32692A OTH FRACTURE OF LEFT ISCHIUM INIT FOR CLOS FX

T85328A

DISPLACEMENT OF OCULAR PROSTH DEV/GRFT INIT

S32692B

OTH FRACTURE OF LEFT ISCHIUM INIT ENCNTR FOR OPEN FRACTURE

T85390A

MECH COMPL OF PROSTHETIC ORBIT OF RIGHT EYE INIT ENCNTR

S32699A OTH FRACTURE OF UNSP ISCHIUM INIT FOR CLOS FX

T85391A

MECH COMPL OF PROSTHETIC ORBIT OF LEFT EYE INIT ENCNTR

S32699B

OTH FRACTURE OF UNSP ISCHIUM INIT ENCNTR FOR OPEN FRACTURE

T85398A

MECH COMPL OF OCULAR PROSTH DEV/GRFT INIT

S32810A

MULTIPLE FX OF PELVIS W STABLE DISRUPT OF PELVIC RING INIT

T8541XA

BREAKDOWN OF BREAST PROSTHESIS AND IMPLANT INIT

S32810B MULT FX OF PELV W STABLE DISRUPT OF PELV RING 7THB

T8542XA

DISPLACEMENT OF BREAST PROSTHESIS AND IMPLANT INIT ENCNTR

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S32811A

MULT FX OF PELVIS W UNSTABLE DISRUPT OF PELVIC RING INIT

T8543XA

LEAKAGE OF BREAST PROSTHESIS AND IMPLANT INITIAL ENCOUNTER

S32811B MULT FX OF PELV W UNSTBL DISRUPT OF PELV RING 7THB

T8544XA

CAPSULAR CONTRACTURE OF BREAST IMPLANT INITIAL ENCOUNTER

S3289XA FRACTURE OF OTH PARTS OF PELVIS INIT FOR CLOS FX

T8549XA

MECH COMPL OF BREAST PROSTHESIS AND IMPLANT INIT ENCNTR

S3289XB FRACTURE OF OTH PARTS OF PELVIS INIT FOR OPN FX

T85510A

BREAKDOWN (MECHANICAL) OF BILE DUCT PROSTHESIS INIT ENCNTR

S329XXA

FRACTURE OF UNSP PARTS OF LUMBOSACRAL SPINE AND PELVIS INIT

T85511A

BREAKDOWN OF ESOPHAGEAL ANTI-REFLUX DEVICE INIT

S329XXB

FX UNSP PARTS OF LUMBOSACRAL SPINE & PELVIS INIT FOR OPN FX

T85518A

BREAKDOWN (MECHANICAL) OF GI PROSTH DEV/GRFT INIT

S330XXA

TRAUMATIC RUPTURE OF LUMBAR INTERVERTEBRAL DISC INIT ENCNTR

T85520A

DISPLACEMENT OF BILE DUCT PROSTHESIS INITIAL ENCOUNTER

S33100A

SUBLUXATION OF UNSPECIFIED LUMBAR VERTEBRA INIT ENCNTR

T85521A

DISPLACEMENT OF ESOPHAGEAL ANTI-REFLUX DEVICE INIT ENCNTR

S33101A

DISLOCATION OF UNSPECIFIED LUMBAR VERTEBRA INIT ENCNTR

T85528A

DISPLACEMENT OF GASTROINTESTINAL PROSTH DEV/GRFT INIT

S33110A

SUBLUXATION OF L1/L2 LUMBAR VERTEBRA INITIAL ENCOUNTER

T85590A

MECH COMPL OF BILE DUCT PROSTHESIS INITIAL ENCOUNTER

S33111A

DISLOCATION OF L1/L2 LUMBAR VERTEBRA INITIAL ENCOUNTER

T85591A

MECH COMPL OF ESOPHAGEAL ANTI-REFLUX DEVICE INIT ENCNTR

S33120A

SUBLUXATION OF L2/L3 LUMBAR VERTEBRA INITIAL ENCOUNTER

T85598A

MECH COMPL OF GASTROINTESTINAL PROSTH DEV/GRFT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S33121A

DISLOCATION OF L2/L3 LUMBAR VERTEBRA INITIAL ENCOUNTER

T85610A

BREAKDOWN OF EPIDURAL AND SUBDURAL INFUSION CATHETER INIT

S33130A

SUBLUXATION OF L3/L4 LUMBAR VERTEBRA INITIAL ENCOUNTER

T85611A

BREAKDOWN OF INTRAPERITONEAL DIALYSIS CATHETER INIT

S33131A

DISLOCATION OF L3/L4 LUMBAR VERTEBRA INITIAL ENCOUNTER

T85612A

BREAKDOWN (MECHANICAL) OF PERMANENT SUTURES INIT ENCNTR

S33140A

SUBLUXATION OF L4/L5 LUMBAR VERTEBRA INITIAL ENCOUNTER

T85613A

BREAKDOWN OF ARTIFICIAL SKIN GRFT /DECELLULAR ALLODERM INIT

S33141A

DISLOCATION OF L4/L5 LUMBAR VERTEBRA INITIAL ENCOUNTER

T85615A

Breakdown (mechanical) of other nervous system device implant or graft initial encounter

S332XXA

DISLOCATION OF SACROILIAC AND SACROCOCCYGEAL JOINT INIT

T85618A

BREAKDOWN (MECHANICAL) OF INTERNAL PROSTH DEV/GRFT INIT

S3330XA

DISLOCATION OF UNSP PARTS OF LUMBAR SPINE AND PELVIS INIT

T85620A

DISPLACMNT OF EPIDURAL AND SUBDURAL INFUSION CATHETER INIT

S3339XA

DISLOCATION OF OTH PRT LUMBAR SPINE AND PELVIS INIT ENCNTR

T85621A

DISPLACEMENT OF INTRAPERITONEAL DIALYSIS CATHETER INIT

S334XXA

TRAUMATIC RUPTURE OF SYMPHYSIS PUBIS INITIAL ENCOUNTER

T85622A

DISPLACEMENT OF PERMANENT SUTURES INITIAL ENCOUNTER

S335XXA

SPRAIN OF LIGAMENTS OF LUMBAR SPINE INITIAL ENCOUNTER

T85623A

DISPLACMNT OF ARTIF SKIN GRFT /DECELLULAR ALLODERM INIT

S336XXA SPRAIN OF SACROILIAC JOINT INITIAL ENCOUNTER

T85625A

Displacement of other nervous system device implant or graft initial encounter

S338XXA

SPRAIN OF OTH PARTS OF LUMBAR SPINE AND PELVIS INIT ENCNTR

T85628A

DISPLACEMENT OF INTERNAL PROSTH DEV/GRFT INIT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S339XXA

SPRAIN OF UNSP PARTS OF LUMBAR SPINE AND PELVIS INIT ENCNTR

T85630A

LEAKAGE OF EPIDURAL AND SUBDURAL INFUSION CATHETER INIT

S3401XA

CONCUSSION AND EDEMA OF LUMBAR SPINAL CORD INIT ENCNTR

T85631A

LEAKAGE OF INTRAPERITONEAL DIALYSIS CATHETER INIT ENCNTR

S3402XA

CONCUSSION AND EDEMA OF SACRAL SPINAL CORD INIT ENCNTR

T85635A

Leakage of other nervous system device implant or graft initial encounter

S34101A

UNSP INJURY TO L1 LEVEL OF LUMBAR SPINAL CORD INIT ENCNTR

T85638A

LEAKAGE OF INTERNAL PROSTH DEV/GRFT INIT

S34102A

UNSP INJURY TO L2 LEVEL OF LUMBAR SPINAL CORD INIT ENCNTR

T85690A

MECH COMPL OF EPIDURAL AND SUBDURAL INFUSION CATHETER INIT

S34103A

UNSP INJURY TO L3 LEVEL OF LUMBAR SPINAL CORD INIT ENCNTR

T85691A

MECH COMPL OF INTRAPERITONEAL DIALYSIS CATHETER INIT ENCNTR

S34104A

UNSP INJURY TO L4 LEVEL OF LUMBAR SPINAL CORD INIT ENCNTR

T85692A

MECH COMPL OF PERMANENT SUTURES INITIAL ENCOUNTER

S34105A

UNSP INJURY TO L5 LEVEL OF LUMBAR SPINAL CORD INIT ENCNTR

T85693A

MECH COMPL OF ARTIF SKIN GRFT /DECELLULAR ALLODERM INIT

S34109A

UNSP INJURY TO UNSP LEVEL OF LUMBAR SPINAL CORD INIT ENCNTR

T85695A

Other mechanical complication of other nervous system device implant or graft initial encounter

S34111A COMPLETE LESION OF L1 LEVEL OF LUMBAR SPINAL CORD INIT

T85698A

MECH COMPL OF INTERNAL PROSTH DEV/GRFT INIT

S34112A COMPLETE LESION OF L2 LEVEL OF LUMBAR SPINAL CORD INIT

T8571XA

INFECT/INFLM REACTION DUE TO PERITON DIALYSIS CATHETER INIT

S34113A COMPLETE LESION OF L3 LEVEL OF LUMBAR SPINAL CORD INIT

T85730A

Infection and inflammatory reaction due to ventricular intracranial (communicating) shunt initial encounter

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S34114A COMPLETE LESION OF L4 LEVEL OF LUMBAR SPINAL CORD INIT

T85731A

Infection and inflammatory reaction due to implanted electronic neurostimulator of brain electrode (lead) initial encounter

S34115A COMPLETE LESION OF L5 LEVEL OF LUMBAR SPINAL CORD INIT

T85732A

Infection and inflammatory reaction due to implanted electronic neurostimulator of peripheral nerve electrode (lead) initial encounter

S34119A

COMPLETE LESION OF UNSP LEVEL OF LUMBAR SPINAL CORD INIT

T85733A

Infection and inflammatory reaction due to implanted electronic neurostimulator of spinal cord electrode (lead) initial encounter

S34121A

INCOMPLETE LESION OF L1 LEVEL OF LUMBAR SPINAL CORD INIT

T85734A

Infection and inflammatory reaction due to implanted electronic neurostimulator generator initial encounter

S34122A

INCOMPLETE LESION OF L2 LEVEL OF LUMBAR SPINAL CORD INIT

T85735A

Infection and inflammatory reaction due to cranial or spinal infusion catheter initial encounter

S34123A

INCOMPLETE LESION OF L3 LEVEL OF LUMBAR SPINAL CORD INIT

T85738A

Infection and inflammatory reaction due to other nervous system device implant or graft initial encounter

S34124A

INCOMPLETE LESION OF L4 LEVEL OF LUMBAR SPINAL CORD INIT

T8579XA

INFECT/INFLM REACTION DUE TO OTH INT PROSTH DEV/GRFT INIT

S34125A

INCOMPLETE LESION OF L5 LEVEL OF LUMBAR SPINAL CORD INIT

T8581XA

EMBOLISM DUE TO INTERNAL PROSTH DEV/GRFT NEC INIT

S34129A

INCOMPLETE LESION OF UNSP LEVEL OF LUMBAR SPINAL CORD INIT

T85810A

Embolism due to nervous system prosthetic devices implants and grafts initial encounter

Page 619: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S34131A

COMPLETE LESION OF SACRAL SPINAL CORD INITIAL ENCOUNTER

T85818A

Embolism due to other internal prosthetic devices implants and grafts initial encounter

S34132A

INCOMPLETE LESION OF SACRAL SPINAL CORD INITIAL ENCOUNTER

T85820A

Fibrosis due to nervous system prosthetic devices implants and grafts initial encounter

S34139A

UNSPECIFIED INJURY TO SACRAL SPINAL CORD INITIAL ENCOUNTER

T85828A

Fibrosis due to other internal prosthetic devices implants and grafts initial encounter

S3421XA

INJURY OF NERVE ROOT OF LUMBAR SPINE INITIAL ENCOUNTER

T8582XA

FIBROSIS DUE TO INTERNAL PROSTH DEV/GRFT NEC INIT

S3422XA

INJURY OF NERVE ROOT OF SACRAL SPINE INITIAL ENCOUNTER

T85830A

Hemorrhage due to nervous system prosthetic devices implants and grafts initial encounter

S343XXA INJURY OF CAUDA EQUINA INITIAL ENCOUNTER

T85838A

Hemorrhage due to other internal prosthetic devices implants and grafts initial encounter

S344XXA INJURY OF LUMBOSACRAL PLEXUS INITIAL ENCOUNTER

T8583XA

HEMORRHAGE DUE TO INTERNAL PROSTH DEV/GRFT NEC INIT

S345XXA

INJURY OF LUMBAR SACRAL AND PELVIC SYMPATHETIC NERVES INIT

T85840A

Pain due to nervous system prosthetic devices implants and grafts initial encounter

S346XXA INJ PRPH NERVE(S) AT ABD LOW BACK AND PELVIS LEVEL INIT

T85848A

Pain due to other internal prosthetic devices implants and grafts initial encounter

S348XXA

INJURY OF NERVES AT ABDOMEN LOW BACK AND PELVIS LEVEL INIT

T8584XA

PAIN DUE TO INTERNAL PROSTH DEV/GRFT NEC INIT

S349XXA

INJ UNSP NERVES AT ABDOMEN LOW BACK AND PELVIS LEVEL INIT

T85850A

Stenosis due to nervous system prosthetic devices implants and grafts initial encounter

S3500XA

UNSPECIFIED INJURY OF ABDOMINAL AORTA INITIAL ENCOUNTER

T85858A

Stenosis due to other internal prosthetic devices implants and grafts initial encounter

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S3501XA

MINOR LACERATION OF ABDOMINAL AORTA INITIAL ENCOUNTER

T8585XA

STENOSIS DUE TO INTERNAL PROSTH DEV/GRFT NEC INIT

S3502XA

MAJOR LACERATION OF ABDOMINAL AORTA INITIAL ENCOUNTER

T85860A

Thrombosis due to nervous system prosthetic devices implants and grafts initial encounter

S3509XA OTHER INJURY OF ABDOMINAL AORTA INITIAL ENCOUNTER

T85868A

Thrombosis due to other internal prosthetic devices implants and grafts initial encounter

S3510XA

UNSPECIFIED INJURY OF INFERIOR VENA CAVA INITIAL ENCOUNTER

T8586XA

THROMBOSIS DUE TO INTERNAL PROSTH DEV/GRFT NEC INIT

S3511XA

MINOR LACERATION OF INFERIOR VENA CAVA INITIAL ENCOUNTER

T85890A

Other specified complication of nervous system prosthetic devices implants and grafts initial encounter

S3512XA

MAJOR LACERATION OF INFERIOR VENA CAVA INITIAL ENCOUNTER

T85898A

Other specified complication of other internal prosthetic devices implants and grafts initial encounter

S3519XA

OTHER INJURY OF INFERIOR VENA CAVA INITIAL ENCOUNTER

T8589XA

OTH COMPLICATION OF INTERNAL PROSTH DEV/GRFT NEC INIT

S35211A MINOR LACERATION OF CELIAC ARTERY INITIAL ENCOUNTER

T859XXA

UNSP COMPLICATION OF INTERNAL PROSTH DEV/GRFT INIT

S35212A MAJOR LACERATION OF CELIAC ARTERY INITIAL ENCOUNTER

T8600

UNSPECIFIED COMPLICATION OF BONE MARROW TRANSPLANT

S35218A OTHER INJURY OF CELIAC ARTERY INITIAL ENCOUNTER

T8601

BONE MARROW TRANSPLANT REJECTION

S35219A UNSPECIFIED INJURY OF CELIAC ARTERY INITIAL ENCOUNTER

T8602

BONE MARROW TRANSPLANT FAILURE

S35221A

MINOR LACERATION OF SUPERIOR MESENTERIC ARTERY INIT ENCNTR

T8603

BONE MARROW TRANSPLANT INFECTION

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S35222A

MAJOR LACERATION OF SUPERIOR MESENTERIC ARTERY INIT ENCNTR

T8609

OTHER COMPLICATIONS OF BONE MARROW TRANSPLANT

S35228A

OTHER INJURY OF SUPERIOR MESENTERIC ARTERY INIT ENCNTR

T8610

UNSPECIFIED COMPLICATION OF KIDNEY TRANSPLANT

S35229A

UNSP INJURY OF SUPERIOR MESENTERIC ARTERY INIT ENCNTR

T8611 KIDNEY TRANSPLANT REJECTION

S35231A

MINOR LACERATION OF INFERIOR MESENTERIC ARTERY INIT ENCNTR

T8612 KIDNEY TRANSPLANT FAILURE

S35232A

MAJOR LACERATION OF INFERIOR MESENTERIC ARTERY INIT ENCNTR

T8613 KIDNEY TRANSPLANT INFECTION

S35238A

OTHER INJURY OF INFERIOR MESENTERIC ARTERY INIT ENCNTR

T8619

OTHER COMPLICATION OF KIDNEY TRANSPLANT

S35239A

UNSP INJURY OF INFERIOR MESENTERIC ARTERY INIT ENCNTR

T8620

UNSPECIFIED COMPLICATION OF HEART TRANSPLANT

S35291A

MINOR LACERATION OF BRANCHES OF CELIAC AND MESENT ART INIT

T8621 HEART TRANSPLANT REJECTION

S35292A

MAJOR LACERATION OF BRANCHES OF CELIAC AND MESENT ART INIT

T8622 HEART TRANSPLANT FAILURE

S35298A

INJ BRANCHES OF CELIAC AND MESENTERIC ARTERY INIT ENCNTR

T8623 HEART TRANSPLANT INFECTION

S35299A UNSP INJURY OF BRANCHES OF CELIAC AND MESENT ART INIT

T86290 CARDIAC ALLOGRAFT VASCULOPATHY

S35311A LACERATION OF PORTAL VEIN INITIAL ENCOUNTER

T86298

OTHER COMPLICATIONS OF HEART TRANSPLANT

Page 622: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S35318A

OTHER SPECIFIED INJURY OF PORTAL VEIN INITIAL ENCOUNTER

T8630

UNSPECIFIED COMPLICATION OF HEART-LUNG TRANSPLANT

S35319A

UNSPECIFIED INJURY OF PORTAL VEIN INITIAL ENCOUNTER

T8631 HEART-LUNG TRANSPLANT REJECTION

S35321A LACERATION OF SPLENIC VEIN INITIAL ENCOUNTER

T8632 HEART-LUNG TRANSPLANT FAILURE

S35328A

OTHER SPECIFIED INJURY OF SPLENIC VEIN INITIAL ENCOUNTER

T8633 HEART-LUNG TRANSPLANT INFECTION

S35329A

UNSPECIFIED INJURY OF SPLENIC VEIN INITIAL ENCOUNTER

T8639

OTHER COMPLICATIONS OF HEART-LUNG TRANSPLANT

S35331A

LACERATION OF SUPERIOR MESENTERIC VEIN INITIAL ENCOUNTER

T8640

UNSPECIFIED COMPLICATION OF LIVER TRANSPLANT

S35338A OTH INJURY OF SUPERIOR MESENTERIC VEIN INIT ENCNTR

T8641 LIVER TRANSPLANT REJECTION

S35339A

UNSPECIFIED INJURY OF SUPERIOR MESENTERIC VEIN INIT ENCNTR

T8642 LIVER TRANSPLANT FAILURE

S35341A

LACERATION OF INFERIOR MESENTERIC VEIN INITIAL ENCOUNTER

T8643 LIVER TRANSPLANT INFECTION

S35348A OTH INJURY OF INFERIOR MESENTERIC VEIN INIT ENCNTR

T8649

OTHER COMPLICATIONS OF LIVER TRANSPLANT

S35349A

UNSPECIFIED INJURY OF INFERIOR MESENTERIC VEIN INIT ENCNTR

T86810 LUNG TRANSPLANT REJECTION

S35401A

UNSPECIFIED INJURY OF RIGHT RENAL ARTERY INITIAL ENCOUNTER

T86811 LUNG TRANSPLANT FAILURE

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S35402A

UNSPECIFIED INJURY OF LEFT RENAL ARTERY INITIAL ENCOUNTER

T86812 LUNG TRANSPLANT INFECTION

S35403A

UNSPECIFIED INJURY OF UNSPECIFIED RENAL ARTERY INIT ENCNTR

T86818

OTHER COMPLICATIONS OF LUNG TRANSPLANT

S35404A

UNSPECIFIED INJURY OF RIGHT RENAL VEIN INITIAL ENCOUNTER

T86819

UNSPECIFIED COMPLICATION OF LUNG TRANSPLANT

S35405A

UNSPECIFIED INJURY OF LEFT RENAL VEIN INITIAL ENCOUNTER

T86820 SKIN GRAFT (ALLOGRAFT) REJECTION

S35406A

UNSPECIFIED INJURY OF UNSPECIFIED RENAL VEIN INIT ENCNTR

T86821

SKIN GRAFT (ALLOGRAFT) (AUTOGRAFT) FAILURE

S35411A LACERATION OF RIGHT RENAL ARTERY INITIAL ENCOUNTER

T86822

SKIN GRAFT (ALLOGRAFT) (AUTOGRAFT) INFECTION

S35412A LACERATION OF LEFT RENAL ARTERY INITIAL ENCOUNTER

T86828

OTHER COMPLICATIONS OF SKIN GRAFT (ALLOGRAFT) (AUTOGRAFT)

S35413A

LACERATION OF UNSPECIFIED RENAL ARTERY INITIAL ENCOUNTER

T86829

UNSP COMPLICATION OF SKIN GRAFT (ALLOGRAFT) (AUTOGRAFT)

S35414A LACERATION OF RIGHT RENAL VEIN INITIAL ENCOUNTER

T86830 BONE GRAFT REJECTION

S35415A LACERATION OF LEFT RENAL VEIN INITIAL ENCOUNTER

T86831 BONE GRAFT FAILURE

S35416A

LACERATION OF UNSPECIFIED RENAL VEIN INITIAL ENCOUNTER

T86832 BONE GRAFT INFECTION

S35491A

OTHER SPECIFIED INJURY OF RIGHT RENAL ARTERY INIT ENCNTR

T86838

OTHER COMPLICATIONS OF BONE GRAFT

S35492A

OTHER SPECIFIED INJURY OF LEFT RENAL ARTERY INIT ENCNTR

T86839

UNSPECIFIED COMPLICATION OF BONE GRAFT

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S35493A OTH INJURY OF UNSPECIFIED RENAL ARTERY INIT ENCNTR

T86840 CORNEAL TRANSPLANT REJECTION

S35494A OTHER SPECIFIED INJURY OF RIGHT RENAL VEIN INIT ENCNTR

T86841 CORNEAL TRANSPLANT FAILURE

S35495A

OTHER SPECIFIED INJURY OF LEFT RENAL VEIN INITIAL ENCOUNTER

T86842 CORNEAL TRANSPLANT INFECTION

S35496A OTH INJURY OF UNSPECIFIED RENAL VEIN INIT ENCNTR

T86848

OTHER COMPLICATIONS OF CORNEAL TRANSPLANT

S3550XA INJURY OF UNSPECIFIED ILIAC BLOOD VESSEL(S) INIT ENCNTR

T86849

UNSPECIFIED COMPLICATION OF CORNEAL TRANSPLANT

S35511A INJURY OF RIGHT ILIAC ARTERY INITIAL ENCOUNTER

T86850 INTESTINE TRANSPLANT REJECTION

S35512A INJURY OF LEFT ILIAC ARTERY INITIAL ENCOUNTER

T86851 INTESTINE TRANSPLANT FAILURE

S35513A INJURY OF UNSPECIFIED ILIAC ARTERY INITIAL ENCOUNTER

T86852 INTESTINE TRANSPLANT INFECTION

S35514A INJURY OF RIGHT ILIAC VEIN INITIAL ENCOUNTER

T86858

OTHER COMPLICATIONS OF INTESTINE TRANSPLANT

S35515A INJURY OF LEFT ILIAC VEIN INITIAL ENCOUNTER

T86859

UNSPECIFIED COMPLICATION OF INTESTINE TRANSPLANT

S35516A INJURY OF UNSPECIFIED ILIAC VEIN INITIAL ENCOUNTER

T86890

OTHER TRANSPLANTED TISSUE REJECTION

S35531A INJURY OF RIGHT UTERINE ARTERY INITIAL ENCOUNTER

T86891

OTHER TRANSPLANTED TISSUE FAILURE

S35532A INJURY OF LEFT UTERINE ARTERY INITIAL ENCOUNTER

T86892

OTHER TRANSPLANTED TISSUE INFECTION

S35533A

INJURY OF UNSPECIFIED UTERINE ARTERY INITIAL ENCOUNTER

T86898

OTHER COMPLICATIONS OF OTHER TRANSPLANTED TISSUE

S35534A INJURY OF RIGHT UTERINE VEIN INITIAL ENCOUNTER

T86899

UNSPECIFIED COMPLICATION OF OTHER TRANSPLANTED TISSUE

S35535A INJURY OF LEFT UTERINE VEIN INITIAL ENCOUNTER

T8690

UNSP COMPLICATION OF UNSP TRANSPLANTED ORGAN AND TISSUE

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S35536A

INJURY OF UNSPECIFIED UTERINE VEIN INITIAL ENCOUNTER

T8691

UNSPECIFIED TRANSPLANTED ORGAN AND TISSUE REJECTION

S3559XA INJURY OF OTHER ILIAC BLOOD VESSELS INITIAL ENCOUNTER

T8692

UNSPECIFIED TRANSPLANTED ORGAN AND TISSUE FAILURE

S358X1A

LACERAT BLOOD VESLS AT ABD LOW BACK AND PELVIS LEVEL INIT

T8693

UNSPECIFIED TRANSPLANTED ORGAN AND TISSUE INFECTION

S358X8A

INJ OTH BLOOD VESLS AT ABD LOW BACK AND PELVIS LEVEL INIT

T8699

OTHER COMPLICATIONS OF UNSP TRANSPLANTED ORGAN AND TISSUE

S358X9A

UNSP INJ BLOOD VESLS AT ABD LOW BACK AND PELVIS LEVEL INIT

T870X1

COMPLICATIONS OF REATTACHED (PART OF) RIGHT UPPER EXTREMITY

S3590XA

UNSP INJ UNSP BLD VESS AT ABD LOW BACK AND PELV LEVEL INIT

T870X2

COMPLICATIONS OF REATTACHED (PART OF) LEFT UPPER EXTREMITY

S3591XA

LACERAT UNSP BLD VESS AT ABD LOW BACK AND PELV LEVEL INIT

T870X9

COMPLICATIONS OF REATTACHED (PART OF) UNSP UPPER EXTREMITY

S3599XA

INJ UNSP BLOOD VESS AT ABD LOW BACK AND PELVIS LEVEL INIT

T871X1

COMPLICATIONS OF REATTACHED (PART OF) RIGHT LOWER EXTREMITY

S3600XA UNSPECIFIED INJURY OF SPLEEN INITIAL ENCOUNTER

T871X2

COMPLICATIONS OF REATTACHED (PART OF) LEFT LOWER EXTREMITY

S36020A MINOR CONTUSION OF SPLEEN INITIAL ENCOUNTER

T871X9

COMPLICATIONS OF REATTACHED (PART OF) UNSP LOWER EXTREMITY

S36021A MAJOR CONTUSION OF SPLEEN INITIAL ENCOUNTER

T872

COMPLICATIONS OF OTHER REATTACHED BODY PART

S36029A UNSPECIFIED CONTUSION OF SPLEEN INITIAL ENCOUNTER

T8730

NEUROMA OF AMPUTATION STUMP UNSPECIFIED EXTREMITY

S36030A

SUPERFICIAL (CAPSULAR) LACERATION OF SPLEEN INIT ENCNTR

T8731

NEUROMA OF AMPUTATION STUMP RIGHT UPPER EXTREMITY

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S36031A MODERATE LACERATION OF SPLEEN INITIAL ENCOUNTER

T8732

NEUROMA OF AMPUTATION STUMP LEFT UPPER EXTREMITY

S36032A MAJOR LACERATION OF SPLEEN INITIAL ENCOUNTER

T8733

NEUROMA OF AMPUTATION STUMP RIGHT LOWER EXTREMITY

S36039A UNSPECIFIED LACERATION OF SPLEEN INITIAL ENCOUNTER

T8734

NEUROMA OF AMPUTATION STUMP LEFT LOWER EXTREMITY

S3609XA OTHER INJURY OF SPLEEN INITIAL ENCOUNTER

T8740

INFECTION OF AMPUTATION STUMP UNSPECIFIED EXTREMITY

S36112A CONTUSION OF LIVER INITIAL ENCOUNTER

T8741

INFECTION OF AMPUTATION STUMP RIGHT UPPER EXTREMITY

S36113A

LACERATION OF LIVER UNSPECIFIED DEGREE INITIAL ENCOUNTER

T8742

INFECTION OF AMPUTATION STUMP LEFT UPPER EXTREMITY

S36114A MINOR LACERATION OF LIVER INITIAL ENCOUNTER

T8743

INFECTION OF AMPUTATION STUMP RIGHT LOWER EXTREMITY

S36115A MODERATE LACERATION OF LIVER INITIAL ENCOUNTER

T8744

INFECTION OF AMPUTATION STUMP LEFT LOWER EXTREMITY

S36116A MAJOR LACERATION OF LIVER INITIAL ENCOUNTER

T8750

NECROSIS OF AMPUTATION STUMP UNSPECIFIED EXTREMITY

S36118A OTHER INJURY OF LIVER INITIAL ENCOUNTER

T8751

NECROSIS OF AMPUTATION STUMP RIGHT UPPER EXTREMITY

S36119A UNSPECIFIED INJURY OF LIVER INITIAL ENCOUNTER

T8752

NECROSIS OF AMPUTATION STUMP LEFT UPPER EXTREMITY

S36122A CONTUSION OF GALLBLADDER INITIAL ENCOUNTER

T8753

NECROSIS OF AMPUTATION STUMP RIGHT LOWER EXTREMITY

S36123A LACERATION OF GALLBLADDER INITIAL ENCOUNTER

T8754

NECROSIS OF AMPUTATION STUMP LEFT LOWER EXTREMITY

S36128A

OTHER INJURY OF GALLBLADDER INITIAL ENCOUNTER

T879

UNSPECIFIED COMPLICATIONS OF AMPUTATION STUMP

S36129A

UNSPECIFIED INJURY OF GALLBLADDER INITIAL ENCOUNTER

T882XXA

SHOCK DUE TO ANESTHESIA INITIAL ENCOUNTER

S3613XA INJURY OF BILE DUCT INITIAL ENCOUNTER

T883XXA

MALIGNANT HYPERTHERMIA DUE TO ANESTHESIA INITIAL ENCOUNTER

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S36200A

UNSPECIFIED INJURY OF HEAD OF PANCREAS INITIAL ENCOUNTER

T884XXA

FAILED OR DIFFICULT INTUBATION INITIAL ENCOUNTER

S36201A

UNSPECIFIED INJURY OF BODY OF PANCREAS INITIAL ENCOUNTER

T8851XA

HYPOTHERMIA FOLLOWING ANESTHESIA INITIAL ENCOUNTER

S36202A UNSPECIFIED INJURY OF TAIL OF PANCREAS INITIAL ENCOUNTER

T8852XA

FAILED MODERATE SEDATION DURING PROCEDURE INITIAL ENCOUNTER

S36209A

UNSP INJURY OF UNSPECIFIED PART OF PANCREAS INIT ENCNTR

T8853XA

Unintended awareness under general anesthesia during procedure initial encounter

S36220A CONTUSION OF HEAD OF PANCREAS INITIAL ENCOUNTER

T8859XA

OTHER COMPLICATIONS OF ANESTHESIA INITIAL ENCOUNTER

S36221A CONTUSION OF BODY OF PANCREAS INITIAL ENCOUNTER

T886XXA

ANAPHYL REACTION DUE TO ADVRS EFF DRUG/MED PROP ADMIN INIT

S36222A CONTUSION OF TAIL OF PANCREAS INITIAL ENCOUNTER

T888XXA

OTH COMPLICATIONS OF SURGICAL AND MEDICAL CARE NEC INIT

S36229A

CONTUSION OF UNSPECIFIED PART OF PANCREAS INITIAL ENCOUNTER

T889XXA

COMPLICATION OF SURGICAL AND MEDICAL CARE UNSP INIT ENCNTR

S36230A

LACERATION OF HEAD OF PANCREAS UNSP DEGREE INIT ENCNTR

W268XXA

Contact with other sharp object(s) not elsewhere classified initial encounter

S36231A

LACERATION OF BODY OF PANCREAS UNSP DEGREE INIT ENCNTR

Y901

BLOOD ALCOHOL LEVEL OF 20-39 MG/100 ML

S36232A

LACERATION OF TAIL OF PANCREAS UNSP DEGREE INIT ENCNTR

Y902

BLOOD ALCOHOL LEVEL OF 40-59 MG/100 ML

S36239A LACERATION OF UNSP PART OF PANCREAS UNSP DEGREE INIT

Y903

BLOOD ALCOHOL LEVEL OF 60-79 MG/100 ML

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2017A UnitedHealthcare Community Plan Kansas ER Policy ICD 10 Diagnosis List

ICD-10 Code Description

ICD-10 Code Description

S36240A

MINOR LACERATION OF HEAD OF PANCREAS INITIAL ENCOUNTER

Y904

BLOOD ALCOHOL LEVEL OF 80-99 MG/100 ML

S36241A

MINOR LACERATION OF BODY OF PANCREAS INITIAL ENCOUNTER

Y905

BLOOD ALCOHOL LEVEL OF 100-119 MG/100 ML

S36242A MINOR LACERATION OF TAIL OF PANCREAS INITIAL ENCOUNTER

Y906

BLOOD ALCOHOL LEVEL OF 120-199 MG/100 ML

S36249A

MINOR LACERATION OF UNSP PART OF PANCREAS INIT ENCNTR

Y907

BLOOD ALCOHOL LEVEL OF 200-239 MG/100 ML

Y908

BLOOD ALCOHOL LEVEL OF 240 MG/100 ML OR MORE

Page 629: Emergency Room Services; Kansas, Professional · 2. If the professional emergency room provider bills CPT codes 99281-99285, 99291, or 99292 and it fails to meet ER criteria (based

REIMBURSEMENT POLICY

CMS-1500

Proprietary information of UnitedHealthcare Community Plan. Copyright 2017 United HealthCare Services, Inc. 2017R7115B

1/27/2014 Annual renewal of policy approved by United HealthCare Community & State Payment Policy Committee

1/1/2014 Annual Version Change Policy Verbiage Change: Provider Appeals Process section updated

3/25/2013 Policy implemented by UnitedHealthcare Community & State

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