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.
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.
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
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
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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