DI 26510: Completion of Form SSA-831-C3/U3 -- Title II, Title XVI and Concurrent Claims
TN 15 (01-17)
A. Citing a diagnosis
Correct diagnosis coding is essential for statistical analysis, case studies, and answering public inquiries. The following principles apply when citing a diagnosis:
The diagnosis should identify the underlying cause (i.e., etiology) and disabling manifestation.
If the underlying cause is unknown, the diagnosis should identify the disabling manifestation.
You must include the codes most relevant to the determination.
The electronic claims analysis tool (eCAT) allows for documenting multiple codes as “other” impairment within the case file.
1. Disability examiner (DE) and medical or psychological consultant (MC/PC) team determinations
The reviewing MC/PC and DE team determines the diagnosis and its nomenclature. They provide the diagnosis based on a review of all the medical evidence in file and choose the terminology used on the determination form. The MC/PC completes or reviews the diagnosis. The MC/PC is responsible for diagnosis terminology and accuracy.
2. Non-team determinations
When the DE alone is responsible for the determination, the DE is responsible for diagnosis terminology and accuracy.
B. Block 16A. Primary Diagnosis and Block 16B. Secondary Diagnosis on Form SSA-831
Block 16A. and 16B. on the SSA-831 contain entries for a:
primary and a secondary diagnosis,
2-digit primary body system identifying code, and
4-digit primary and a secondary impairment identifying code – based on a simplified version of the International Classification of Diseases (ICD) full code.
C. Determining the primary and secondary diagnoses
Complete items 16A and 16B as follows:
1. Diagnosis code based on medical evidence
Evaluate all of the medical evidence in the file, and determine diagnoses for the period reviewed. Enter the diagnosis of the claimant's primary and secondary impairment (if any) at the established onset date (EOD) in an allowance or at the alleged onset date (AOD) in a denial. Include other diagnoses present at the time of adjudication in the determination rationale.
2. Primary diagnosis or Item 16A
The primary diagnosis in an allowance refers to the basic condition that rendered the person disabled, or in a denial, the one that the evidence shows to have the most significant effect on the person's ability to work.
When the case is a denial, and no diagnosis is established, enter “none established.” Use impairment code “0000” when there is no medical evidence in the file. Use impairment code “6490” when medical evidence in the file is not sufficient to establish a diagnosis.
a. Drug addiction and alcoholism (DAA) materiality
When the case is a denial because DAA is material, enter the appropriate code for “alcoholism” (3030 – Substance Addiction or Psychoactive Substance Dependence Disorders (Alcohol)) or “drug addiction” (3040 – Substance Addiction or Psychoactive Substance Dependence Disorders (Drugs)) as the primary impairment. When the case is an allowance because DAA is not material, enter the mental or physical impairment that would be disabling, absent the effects of DAA, as the primary diagnosis.
See also:
DI 90070.050 DAA Material Determinations
b. Statutory blindness
IMPORTANT: A claimant has statutory blindness only if the visual disorder meets Listing 2.02 or 2.03A for adults, or Listing 102.02 or 102.03A for children.
Use the term “Statutory Blindness” as the primary diagnosis.
Enter body system “02” and impairment code “3694” in the blocks provided.
In Item 16B (Secondary Diagnosis), show the underlying cause of the blindness and the corresponding diagnosis code.
Enter “Statutory Blindness” as the secondary diagnosis when the basis of the EOD is a different impairment and that impairment’s onset date is before the onset date of statutory blindness.
3. Secondary diagnosis or Item 16B
If there is no secondary diagnosis, enter “none” in block 16B. The secondary diagnosis in all determinations is the most significant diagnosis following the primary diagnosis in severity, except in the following situations.
a. Symptomatic human immunodeficiency virus (HIV) infection
If the primary diagnosis is symptomatic HIV infection, enter the diagnosis of the most significant HIV-related complication as the secondary diagnosis. If there is no HIV-related complication, enter the most significant diagnosis following the primary diagnosis.
b. DAA is present but not material
When DAA is present but not material, enter “alcoholism” or “drug addiction,” as appropriate, as the secondary diagnosis.
c. Statutory blindness
Enter “Statutory Blindness” as the secondary diagnosis when the basis of the EOD (Item 15A) is not statutory blindness and the impairment’s onset date is before the onset date of statutory blindness.
In Item 16A (Primary Diagnosis), enter the diagnosis of the other impairment at the established onset date. Enter the related body system code and diagnosis code.
In Item 16B (Secondary Diagnosis), enter “Statutory Blindness” as the secondary diagnosis and show diagnosis code 3694. Because item 16B can only show “Statutory Blindness,” you cannot include the underlying cause on the. However, if eCAT is used, show the underlying cause as “Other” impairment.
REMINDER: For additional instructions about completing Item 18 (Case of Blindness), see DI 26510.025.
D. Body system coding
Body system coding of the primary diagnosis is required for all determinations, favorable or unfavorable.
Obtain the appropriate body system code number for the primary diagnosis from DI 26510.015F in this section.
Enter the 2-digit body-system code number in the designated space following the primary diagnosis in Item 16A.
E. Impairment coding
You must code the primary and secondary diagnosis for all determinations, favorable or unfavorable.
Select codes, as appropriate, from the predetermined lists in DI 26510.015G.1. through DI 26510.015G.4. in this section.
Use the code on List 1, 2, or 3 that most accurately identifies the impairment.
Whenever symptomatic HIV (code 0430) is used as the primary diagnosis, use a code from List 4 (also shown on List 5 under “Diagnostic Categories” as “(Secondary Diagnosis for HIV-0430)” for “Body System” 14) as the secondary diagnosis for all favorable or unfavorable determinations, except as noted under DI 26510.015G.4. in this section.
Never use a code from List 4 or List 5 as a primary diagnosis. We designated these codes to use as a secondary diagnosis for HIV on Lists 4 and 5. Only use as a secondary diagnosis when the primary diagnosis is symptomatic HIV (code 0430).
To complete the impairment code number entry on the SSA-831, enter the appropriate 4-digit impairment code in the designated space following the primary diagnosis in Item 16A and the secondary diagnosis in Item 16B.
The five lists developed for ease of reference are:
List 1 – Adult listing (part A) impairment codes when the adult listings are applicable and impairment severity meets adult listing criteria. Also, use this list in “medical equals” determinations. (See DI 26510.015G.1. in this section.)
List 2 – Childhood listing (part B) impairment codes when childhood listings are applicable and impairment severity meets childhood listing criteria. Also, use this list in “medical equals” determinations. (See DI 26510.015G.2. in this section.)
List 3 – General list of impairment codes when an impairment is less than listing or medical equivalent severity. Use this list in unfavorable adult and childhood determinations and favorable functional equals or medical and vocational determinations. List 3 also provides codes for special situations described in DI 26510.015G.3. in this section.
List 4 – Impairment codes for symptomatic HIV infection secondary complications. (See DI 26510.015G.4. in this section.)
List 5 – Impairment codes in numeric sequence. Use this list for ease of reference when looking for the diagnosis connected to a particular impairment code. (See DI 26510.015G.5. in this section.)
1. Primary diagnosis impairment codes
Situation |
Reference |
---|---|
Meets, medical equals |
|
Medical and vocational allowances |
2. Secondary diagnosis impairment codes
Situation |
Reference |
---|---|
Meets, medical equals |
|
Medical and vocational allowances |
|
Symptomatic HIV infection |
F. List of body system codes
Code number |
Body System |
---|---|
01 |
Musculoskeletal System |
02 |
Special Senses and Speech |
03 |
Respiratory Disorders |
04 |
Cardiovascular System |
05 |
Digestive System |
06 |
Genitourinary Disorders |
07 |
Hematological Disorders |
08 |
Skin Disorders |
09 |
Endocrine Disorders |
10 |
Congenital Disorders That Affect Multiple Body Systems |
11 |
Neurological Disorders |
12 |
Mental Disorders |
13 |
Cancer |
14 |
Immune System Disorders |
19 |
Low Birth Weight and Failure to Thrive |
20 |
Special/Other |
G. List of impairment codes
1. Adult listing impairment codes
Use this list for any condition that meets or equals a listing in part A of the Listing of Impairments (unless a code from List 2 or List 3 more accurately describes the impairment).
The impairment code should match the diagnosis as closely as possible.
EXAMPLE:
Intellectual disability, meets Listing 12.05, code 3180;
Arteriosclerotic heart disease with angina pectoris and history of myocardial infarction, meets Listing 4.04, code 4140; and
Alzheimer’s disease meets Listing 12.02, code 2940.
Listing (Body Systems) |
Diagnostic Category |
Impairment Code |
---|---|---|
Musculoskeletal (01) |
||
1.02 |
Other and Unspecified Arthropathies |
7160 |
1.03 |
Osteoarthrosis and Allied Disorders |
7150 |
1.04 |
Disorders of Back (discogenic and degenerative) |
7240 |
1.04B |
Arachnoiditis |
3210 |
1.05 |
Late Effects of Musculoskeletal and Connective Tissue Injuries (amputation) |
9050 |
1.06 |
Fractures of Lower Limb |
8270 |
1.07 |
Fractures of Upper Limb |
8180 |
1.08 |
Open Wound of Upper Limb (Soft Tissue Injury) |
8840 |
1.08 |
Open Wound of Lower Limb (Soft Tissue Injury) |
8940 |
1.08 |
Burns (NOS) |
9490 |
Special Senses and Speech (02) |
||
2.02 |
Retinal Detachments and Defects |
3610 |
2.02 |
Glaucoma |
3650 |
2.02 |
Cataract |
3660 |
2.02 |
Low Vision |
3690 |
2.02 |
Statutory Blindness |
3694 |
2.03 |
Visual Disturbances |
3680 |
2.03A |
Statutory Blindness |
3694 |
2.04 |
Visual Disturbances |
3680 |
2.07 |
Vertiginous Syndromes and Other Disorders of Vestibular System |
3860 |
2.09 |
Loss of Voice |
7840 |
2.10 |
Hearing Loss Not Treated with Cochlear Implantation |
3890 |
2.11 |
Hearing Loss Treated with Cochlear Implantation |
3890 |
Respiratory (03) |
||
3.02 |
Chronic Respiratory Disorders |
4960 |
3.03 |
Asthma |
4930 |
3.04 |
Cystic Fibrosis |
2770 |
3.07 |
Bronchiectasis |
4940 |
3.09 |
Chronic Pulmonary Hypertension Due to Any Cause |
4160 |
3.11 |
Lung Transplant |
3250 |
3.14 |
Respiratory Failure |
5180 |
Cardiovascular (04) |
||
4.02 |
Chronic Heart Failure |
4280 |
4.04 |
Ischemic Heart Disease |
4140 |
4.05 |
Recurrent Arrhythmias |
4270 |
4.06 |
Symptomatic Congenital Heart Disease |
7460 |
4.09 |
Heart Transplant |
3750 |
4.10 |
Aneurysm of Aorta or Major Branches |
4410 |
4.11 |
Chronic Venous Insufficiency |
4590 |
4.12 |
Peripheral Arterial Disease |
4430 |
Digestive (05) |
||
5.02 |
Gastrointestinal Hemorrhaging from any cause |
5780 |
5.05 |
Chronic Liver Disease |
5710 |
5.06 |
Inflammatory Bowel Disease (IBD) |
5550 |
5.07 |
Short Bowel Syndrome (SBS) |
5793 |
5.08 |
Weight Loss due to any digestive disorder |
2630 |
5.09 |
Liver Transplantation |
4750 |
Genitourinary (06) |
||
6.03 |
Chronic Kidney Disease with Dialysis |
5850 |
6.04 |
Kidney Transplant |
9960 |
6.05 |
Chronic Kidney Disease |
5880 |
6.06 |
Nephrotic Syndrome |
5810 |
6.09 |
Complications of Chronic Kidney Disease |
5830 |
Hematological Disorders (07) |
||
7.05 |
Hemolytic Anemias (Including Sickle Cell, Thalassemia, and Variants) |
2820 |
7.08 |
Thrombosis and Hemostasis Disorder (Including Hemophilia) |
2860 |
7.10 |
Bone Marrow Failure (Including Myelofibrosis and Granulocytopenia) |
2890 |
7.17 |
Hematological Disorders with BM/SC Transplantation |
2840 |
7.18 |
Use the Code for the Underlying Hematological Disorder |
|
7.18 |
Hemolytic Anemias (Including Sickle Cell, Thalassemia, and Variants) |
2820 |
7.18 |
Thrombosis and Hemostasis Disorder (Including Hemophilia) |
2860 |
7.18 |
Bone Marrow Failure (Including Myelofibrosis and Granulocytopenia) |
2890 |
Skin Disorders (08) |
||
8.02 |
Ichthyosis |
6950 |
8.03 |
Bullous Disease |
6940 |
8.04 |
Chronic Infections of the Skin or Mucous Membranes |
1170 |
8.05 |
Dermatitis |
6960 |
8.06 |
Hidradenitis Suppurativa |
7050 |
8.07 |
Genetic Photosensitivity Disorders |
7590 |
8.08 |
Burns |
9480 |
Congenital Disorders That Affect Multiple Body Systems (10) |
||
10.06 |
Non-Mosaic Down Syndrome |
7580 |
Neurological Disorders (11) |
||
11.02 |
Epilepsy |
3450 |
11.04 |
Vascular Insult to the Brain |
4380 |
11.05 |
Benign Neoplasm of Brain and Other Parts of Nervous System |
2250 |
11.06 |
Parkinson's Disease |
3320 |
11.07 |
Cerebral Palsy |
3430 |
11.08 |
Spinal Cord Disorders |
3360 |
11.08 |
Fracture of Vertebral Column with Spinal Cord Lesion |
8060 |
11.09 |
Multiple Sclerosis |
3400 |
11.10 |
Amyotrophic Lateral Sclerosis |
3350 |
11.11 |
Post-Polio Syndrome |
1380 |
11.12 |
Myoneural Disorders |
3580 |
11.13 |
Muscular Dystrophies and Other Myopathies |
3590 |
11.14 |
Peripheral Neuropathy |
3570 |
11.17 |
Other Cerebral Degenerations |
3310 |
11.17 |
Huntington Disease |
3330 |
11.18 |
Traumatic Brain Injury |
8540 |
11.20 |
Coma or Persistent Vegetative State |
3480 |
11.22 |
Motor Neuron Disorders other than ALS |
3358 |
Mental Disorders (12) |
||
12.02 |
Neurocognitive Disorders |
2940 |
12.03 |
Schizophrenia Spectrum and Other Psychotic Disorders |
2950 |
12.04 |
Depression, Bipolar and Related Disorders |
2960 |
12.05 |
Intellectual Disorder |
3180 |
12.06 |
Anxiety and Obsessive-Compulsive Disorders |
3000 |
12.07 |
Somatic Symptom and Related Disorders |
3060 |
12.08 |
Personality Disorders |
3010 |
12.08 |
Impulse-Control Disorders |
3120 |
12.10 |
Autism Spectrum Disorders |
2990 |
12.11 |
Attention Deficit/Hyperactivity Disorder |
3140 |
12.11 |
Learning Disorder |
3152 |
12.13 |
Eating Disorders |
3070 |
12.15 |
Trauma- and Stressor-Related Disorders |
3090 |
Cancer (13) |
||
13.02 |
Soft Tissue Tumors of Head and Neck |
1950 |
13.03 |
Malignant Neoplasm of Skin |
1730 |
13.04 |
Malignant Neoplasm of Connective and Other Soft Tissue |
1710 |
13.05 |
Lymphoma |
2020 |
13.06 |
Leukemia |
2070 |
13.07 |
Multiple Myeloma |
2030 |
13.08 |
Malignant Neoplasm of Salivary Glands |
1420 |
13.09 |
Malignant Neoplasm of Thyroid Gland |
1930 |
13.10 |
Malignant Neoplasm of Breast |
1740 |
13.11 |
Malignant Neoplasm of Skeletal System |
1780 |
13.12 |
Malignant Neoplasm of Maxilla, Orbit, or Temporal Fossa |
1700 |
13.13 |
Malignant Neoplasm of Nervous System |
1910 |
13.14 |
Malignant Neoplasm of Trachea, Bronchus, or Lung |
1620 |
13.15 |
Malignant Neoplasm of Pleura |
1630 |
13.15 |
Malignant Neoplasm of Mediastinum) |
1640 |
13.16 |
Malignant Neoplasm of Esophagus |
1500 |
13.16 |
Malignant Neoplasm of Stomach |
1510 |
13.17 |
Malignant Neoplasm of Small Intestine, Including Duodenum |
1520 |
13.18 |
Malignant Neoplasm of Colon, Rectum or Anus |
1530 |
13.19 |
Malignant Neoplasm of Liver and Intrahepatic Bile Ducts |
1550 |
13.19 |
Malignant Neoplasm of Gallbladder and Extrahepatic Bile Ducts |
1560 |
13.20 |
Malignant Neoplasm of Pancreas |
1570 |
13.21 |
Malignant Neoplasm of Kidney, Adrenal Glands, or Ureters |
1890 |
13.22 |
Malignant Neoplasm of Bladder |
1880 |
13.23 |
Malignant Neoplasm of Uterus |
1790 |
13.23 |
Malignant Neoplasm of Vulva or Vagina |
1840 |
13.23 |
Malignant Neoplasm of Ovary and Other Uterine Adnexa |
1830 |
13.24 |
Malignant Neoplasm of Prostate |
1850 |
13.25 |
Malignant Neoplasm of Testis |
1860 |
13.26 |
Malignant Neoplasm of Penis |
1870 |
13.27 |
Malignant Neoplasm of Unspecified Site |
1990 |
13.28 |
Malignant Neoplasm Treated by Bone Marrow or Stem Cell Transplantation |
0420 |
13.29 |
Malignant Melanoma |
1720 |
Immune System Disorders (14) |
||
14.02 |
Systemic Lupus Erythematosus |
7100 |
14.03 |
Systemic Vasculitis |
4460 |
14.04 |
Systemic Sclerosis (Scleroderma ) |
7100 |
14.05 |
Polymyositis and Dermatomyositis |
7100 |
14.06 |
Undifferentiated and Mixed Connective Tissue Disease |
7100 |
14.07 |
Immune Deficiency Disorders, Excluding HIV Infection |
2790 |
14.09 |
Inflammatory Arthritis |
7140 |
14.09C |
Ankylosing Spondylitis or Other Spondyloarthropathies |
7200 |
14.10 |
Sjögren's Syndrome |
7100 |
14.11 |
Symptomatic Human Immunodeficiency Virus (HIV) Infection |
0430 |
2. Childhood listing impairment codes
Use this list for any condition that meets a listing in part B of the listing of impairments. Also use in “medical equals” cases (unless an impairment code from List 1 or List 3 more accurately describes the impairment).
The impairment code should match the diagnosis as closely as possible.
For example:
Diabetes mellitus, meets Listing 109.08, code 2500;
Intellectual disability, meets Listing 112.05, code 3180; and
Cystic fibrosis, meets Listing 103.04, code 2770.
Listing (Body System) |
Diagnostic Category |
Impairment Code |
---|---|---|
Musculoskeletal (01) |
||
101.02 |
Other and Unspecified Arthropathies |
7160 |
101.03 |
Osteoarthrosis and Allied Disorders |
7150 |
101.04 |
Fracture of Vertebral Column with Spinal Cord Lesion |
8060 |
101.04 |
Curvature of Spine |
7370 |
101.05 |
Late Effects of Musculoskeletal and Connective Tissue Injuries (amputation) |
9050 |
101.06 |
Fractures of Lower Limb |
8270 |
101.07 |
Fractures of Upper Limb |
8180 |
101.08 |
Open Wound of Upper Limb (Soft Tissue Injury) |
8840 |
101.08 |
Open Wound of Lower Limb (Soft Tissue Injury) |
8940 |
101.08 |
Burns (NOS) |
9490 |
Special Senses (02) |
||
102.02 |
Low Vision |
3690 |
102.02 |
Statutory Blindness |
3694 |
102.03 |
Visual Disturbances |
3680 |
102.03A |
Statutory Blindness |
3694 |
102.04 |
Visual Disturbances |
3680 |
102.10 |
Hearing Loss Not Treated with Cochlear Implantation |
3890 |
102.11 |
Hearing Loss Treated with Cochlear Implantation |
3890 |
Respiratory (03) |
||
103.02 |
Chronic Respiratory Disorders |
4960 |
103.03 |
Asthma |
4930 |
103.04 |
Cystic Fibrosis |
2770 |
103.06 |
Growth Failure Due to Any Chronic Respiratory Disorder |
7860 |
103.11 |
Lung Transplant |
3250 |
103.14 |
Respiratory Failure |
5180 |
Cardiovascular (04) |
||
104.02 |
Chronic Heart Failure |
4280 |
104.02C |
Growth Failure Due to Any Chronic Cardiovascular Disorder |
7850 |
104.05 |
Recurrent Arrhythmias |
4270 |
104.06 |
Congenital Heart Disease |
7460 |
104.09 |
Heart Transplant |
3750 |
104.13 |
Rheumatic Heart Disease |
3910 |
Digestive (05) |
||
105.02 |
Gastrointestinal Hemorrhaging from any cause |
5780 |
105.05 |
Chronic Liver Disease |
5710 |
105.06 |
Inflammatory Bowel Disease (IBD) |
5550 |
105.07 |
Short Bowel Syndrome (SBS) |
5793 |
105.08 |
Growth Failure Due to Any Digestive Disorder |
2630 |
105.09 |
Liver Transplantation |
4750 |
105.10 |
Need for supplemental daily enteral feeding via gastrostomy |
5799 |
Genitourinary (06) |
||
106.03 |
Chronic Kidney Disease with Dialysis |
5850 |
106.04 |
Kidney Transplant |
9960 |
106.05 |
Chronic Kidney Disease |
5880 |
106.06 |
Nephrotic Syndrome |
5810 |
106.07 |
Congenital Anomalies of Urinary System |
7530 |
106.08 |
Growth Failure Due to Any Chronic Renal Disease |
7880 |
106.09 |
Complications of Chronic Kidney Disease |
5830 |
Hematological Disorders (07) |
||
107.05 |
Hemolytic Anemias (Including Sickle Cell, Thalassemia, and Variants) |
2820 |
107.08 |
Thrombosis and Hemostasis Disorder (Including Hemophilia) |
2860 |
107.10 |
Bone Marrow Failure (Including Myelofibrosis and Granulocytopenia) |
2890 |
107.17 |
Hematological Disorders with BM/SC Transplantation |
2840 |
Skin Disorders (08) |
||
108.02 |
Ichthyosis |
6950 |
108.03 |
Bullous Disease |
6940 |
108.04 |
Chronic Infections of the Skin or Mucous Membranes |
1170 |
108.05 |
Dermatitis |
6960 |
108.06 |
Hidradenitis Suppurativa |
7050 |
108.07 |
Genetic Photosensitivity Disorders |
7590 |
108.08 |
Burns |
9480 |
Endocrine (09) |
||
109.08 |
Diabetes Mellitus |
2500 |
Congenital Disorders That Affect Multiple Body Systems (10) |
||
110.06 |
Non-Mosaic Down Syndrome |
7580 |
110.08 |
Anencephalus and Catastrophic Congenital Abnormality or Disease |
7400 |
110.08B |
Cerebral Degeneration Usually Manifest in Childhood |
3300 |
Neurological Disorders (11) |
||
111.02 |
Epilepsy |
3450 |
111.04 |
Vascular Insult to the Brain |
4380 |
111.05 |
Benign Neoplasm of Brain and Other Parts of Nervous System |
2250 |
111.07 |
Cerebral Palsy |
3430 |
111.08 |
Spinal Cord Disorders |
3360 |
111.08 |
Spina Bifida (Meningomyelocele) |
7410 |
111.09 |
Loss of Voice (Communication Impairment) |
7840 |
111.12 |
Myoneural Disorders |
3580 |
111.13 |
Muscular Dystrophies and Other Myopathies |
3590 |
111.14 |
Peripheral Neuropathy |
3570 |
111.17 |
Other Cerebral Degenerations |
3310 |
111.17 |
Huntington Disease |
3330 |
111.18 |
Traumatic Brain Injury |
8540 |
111.20 |
Coma or Persistent Vegetative State |
3480 |
111.21 |
Multiple Sclerosis |
3400 |
111.22 |
Motor Neuron Disorders Other than ALS |
3358 |
Mental Disorders (12) |
||
112.02 |
Neurocognitive Disorders |
2940 |
112.03 |
Schizophrenia Spectrum and Other Psychotic Disorders |
2950 |
112.04 |
Depression, Bipolar and Related Disorders |
2960 |
112.05 |
Intellectual Disorder |
3180 |
112.06 |
Anxiety and Obsessive-Compulsive Disorders |
3000 |
112.07 |
Somatic Symptom and Related Disorders |
3060 |
112.08 |
Personality Disorders |
3010 |
112.08 |
Impulse Control Disorders |
3120 |
112.10 |
Autism Spectrum Disorders |
2990 |
112.11 |
Attention Deficit/Hyperactivity Disorder |
3140 |
112.11 |
Learning Disorder |
3152 |
112.13 |
Eating Disorders |
3070 |
112.14 |
Developmental Disorders in Infants and Toddlers |
3150 |
112.15 |
Trauma- and Stressor-Related Disorders |
3090 |
Cancer (13) |
||
113.03 |
Malignant Neoplasm of Unspecified Site |
1990 |
113.05 |
Lymphoma |
2020 |
113.06 |
Leukemia |
2070 |
113.09 |
Malignant Neoplasm of Thyroid Gland |
1930 |
113.12 |
Malignant Neoplasm of Eye |
1900 |
113.13 |
Malignant Neoplasm of Nervous System |
1910 |
113.21 |
Neuroblastoma |
1920 |
113.29 |
Malignant Melanoma |
1720 |
Immune System Disorders (14) |
||
114.02 |
Systemic Lupus Erythematosus |
7100 |
114.03 |
Systemic Vasculitis |
4460 |
114.04 |
Systemic Sclerosis (Scleroderma) |
7100 |
114.05 |
Polymyositis and Dermatomyositis |
7100 |
114.06 |
Undifferentiated and Mixed Connective Tissue Disease |
7100 |
114.07 |
Immune Deficiency Disorders, Excluding HIV Infection |
2790 |
114.08 |
Human Immunodeficiency Virus (HIV) Infection |
0430 |
114.09 |
Inflammatory Arthritis |
7140 |
114.09C |
Ankylosing Spondylitis or Other Spondyloarthropathies |
7200 |
114.10 |
Sjögren's Syndrome |
7100 |
114.11 |
Symptomatic Human Immunodeficiency Virus (HIV) Infection |
0430 |
Low Birth Weight (LBW) and Failure to Thrive (FTT) (19) |
||
100.04A |
Low Birth Weight – Weight Under 1200 grams |
7650 |
100.04B |
Low Birth Weight – Weight 1200 - 2000 grams |
7649 |
100.05 |
Failure to Thrive |
7830 |
3. General list of impairment codes
-
Use the following list for any impairment that does not meet or equal a listing in the Listing of Impairments (Part A or B). Some examples are:
Medical and vocational allowances;
Functional equals allowances;
Denials; and
Special situations; e.g., diagnosis is “none established” or diagnosis is established, but no list code of a medical nature is applicable.
Find the body system for the impairment in the listings; determine the diagnostic category most appropriate to the impairment (including special or other), and use the code shown for that category.
Some examples are:
Diabetes mellitus, not severe, code 2500;
Essential hypertension, not severe, code 4010;
Chronic paranoid schizophrenia, severe, code 2950;
Grand mal epilepsy, severe, code 3450; and
Degenerative disc disease, L5-S1, severe, code 7240.
Impairment Codes |
Diagnostic Categories |
---|---|
Musculoskeletal (01) |
|
7150 |
Osteoarthrosis and Allied Disorders |
7160 |
Other and Unspecified Arthropathies |
7240 |
Disorders of Back (Discogenic and Degenerative) |
3210 |
Arachnoiditis |
7280 |
Disorders of Muscle, Ligament and Fascia |
7300 |
Osteomyelitis, Periostitis and Other Infections Involving Bone |
7330 |
Other Disorders of Bone and Cartilage (Osteoporosis) |
7370 |
Curvature of Spine |
8030 |
Fracture of Skull Without Intracranial Injury |
8060 |
Fracture of Vertebral Column with Spinal Cord Lesion |
8180 |
Fractures of Upper Limb |
8270 |
Fractures of Lower Limb |
8290 |
Other Fractures of Bones |
8390 |
Dislocations--All Types |
8480 |
Sprains and Strains--All Types |
8840 |
Open Wound of Upper Limb (Soft Tissue Injury) |
8940 |
Open Wound of Lower Limb (Soft Tissue Injury) |
9050 |
Late Effects of Musculoskeletal and Connective Tissue Injuries (Amputation) |
9490 |
Burns |
Special Senses and Speech (02) |
|
3610 |
Retinal Detachments and Defects |
3620 |
Other Retinal Disorders (Including Diabetic Retinopathy) |
3650 |
Glaucoma |
3660 |
Cataract |
3680 |
Visual Disturbances |
3690 |
Low Vision |
3780 |
Strabismus and Other Disorders of Eye Movements |
3860 |
Vertiginous Syndromes and Other Disorders of Vestibular System |
3880 |
Other Disorders of Ear |
3890 |
Hearing Loss |
7840 |
Loss of Voice |
Respiratory (03) |
|
0110 |
Pulmonary Tuberculosis |
1170 |
Mycotic (Fungus) Infections |
1350 |
Sarcoidosis |
1360 |
Other Infectious and Parasitic Disorders |
2770 |
Disorders of Metabolism (Cystic Fibrosis) |
3250 |
Lung Transplant |
4160 |
Chronic Pulmonary Hypertension Due to Any Cause |
4910 |
Chronic Bronchitis |
4920 |
Emphysema |
4930 |
Asthma |
4940 |
Bronchiectasis |
4960 |
Chronic Respiratory Disorders |
5010 |
Asbestosis |
5050 |
Pneumoconiosis |
5180 |
Respiratory Failure |
5190 |
Other Disorders of the Respiratory System |
7860 |
Growth Failure Due to Any Chronic Respiratory Disorder |
Cardiovascular (04) |
|
0930 |
Cardiovascular Syphilis |
3910 |
Rheumatic Fever with Heart Involvement |
3950 |
Diseases of Aortic Valve |
3980 |
Other Rheumatic Heart Disease |
4010 |
Essential Hypertension |
4020 |
Hypertensive Vascular Disease |
4030 |
Hypertensive Vascular and Renal Disease |
4100 |
Acute Myocardial Infarction |
4130 |
Angina Pectoris Without Ischemic Heart Disease |
4140 |
Chronic Ischemic Heart Disease With or Without Angina |
4160 |
Chronic Pulmonary Heart Disease (Cor Pulmonale) |
4240 |
Valvular Heart Disease or Other Stenotic Defects, or Valvular Regurgitation |
4250 |
Cardiomyopathy |
4270 |
Cardiac Dysrhythmias |
4280 |
Heart Failure |
4410 |
Aortic Aneurysm |
4430 |
Peripheral Vascular (Arterial) Disease |
4510 |
Phlebitis and Thrombophlebitis |
4540 |
Varicose Veins of Lower Extremities |
4590 |
Other Diseases of Circulatory System |
7460 |
Congenital Anomalies of Heart |
7850 |
Growth Failure Due to Any Chronic Respiratory Disorder |
Digestive (05) |
|
1360 |
Other Infectious and Parasitic Disorders |
2630 |
Growth Failure Due to Any Digestive Disorder |
4750 |
Liver Transplantation |
5300 |
Diseases of Esophagus |
5330 |
Peptic Ulcer (Gastric or Duodenal) |
5350 |
Gastritis and Duodenitis |
5530 |
Hernias |
5550 |
Inflammatory Bowel Disease (IBD) |
5690 |
Other Disorders of Gastrointestinal System |
5710 |
Chronic Liver Disease |
5780 |
Gastrointestinal Hemorrhage |
5793 |
Short Bowel Syndrome (SBS) |
5799 |
Need for supplemental daily enteral feeding via a gastrostomy |
7500 |
Congenital Anomalies of Upper Alimentary Tract |
Genitourinary (06) |
|
5810 |
Nephrotic Syndrome |
5830 |
Complications of Chronic Kidney Disease |
5850 |
Chronic Kidney Disease with Dialysis |
5880 |
Chronic Kidney Disease |
5950 |
Interstitial Cystitis |
5990 |
Other Disorders of the Urinary Tract |
6080 |
Disorders of the Male Genital Organs |
6290 |
Disorders of the Female Genital Organs |
7530 |
Congenital Anomalies of Urinary System |
7880 |
Growth Failure Due to Any Chronic Renal Disease |
9960 |
Kidney Transplant |
Hematological Disorders (07) |
|
2820 |
Hemolytic Anemias (Including Sickle Cell, Thalassemia, and Variants) |
2840 |
Hematological Disorders with BM/SC Transplantation |
2860 |
Thrombosis and Hemostasis Disorder (Including Hemophilia) |
2890 |
Bone Marrow Failure (Including Myelofibrosis and Granulocytopenia) |
Skin Disorders (08) |
|
1170 |
Chronic Infections of the Skin or Mucous Membranes |
6940 |
Bullous Disease |
6950 |
Ichthyosis |
6960 |
Dermatitis |
7050 |
Hidradenitis Suppurativa |
7090 |
Other Disorders of the Skin and Subcutaneous Tissues |
7590 |
Genetic Photosensitivity Disorders |
9480 |
Burns |
Endocrine (09) |
|
2460 |
All Disorders of Thyroid (Except Malignant Neoplasm) |
2500 |
Diabetes Mellitus |
2520 |
All Disorders of Parathyroid Gland (Except Malignant Neoplasm) |
2530 |
All Disorders of Pituitary Gland (Except Malignant Neoplasm) |
2550 |
All Disorders of Adrenal Glands (Except Malignant Neoplasm) |
Congenital Disorders That Affect Multiple Body Systems (10) |
|
3300 |
Cerebral Degenerations Usually Manifest in Childhood |
7400 |
Anencephalus and Catastrophic Congenital Abnormality or Disease |
7580 |
Non-Mosaic Down Syndrome |
Neurological Disorders (11) |
|
1380 |
Post-Polio Syndrome |
2250 |
Benign Neoplasm of Brain and Other Parts of Nervous System |
3300 |
Cerebral Degenerations Usually Manifest in Childhood |
3310 |
Other Cerebral Degenerations |
3320 |
Parkinson's Disease |
3330 |
Huntington Disease |
3350 |
Amyotrophic Lateral Sclerosis |
3358 |
Motor Neuron Disorders Other than ALS |
3360 |
Spinal Cord Disorders |
3370 |
Disorders of Autonomic Nervous System |
3400 |
Multiple Sclerosis |
3430 |
Cerebral Palsy |
3450 |
Epilepsy |
3460 |
Migraine |
3480 |
Coma or Persistent Vegetative State |
3490 |
Other Disorders of the Nervous System |
3540 |
Carpal Tunnel Syndrome |
3570 |
Peripheral Neuropathy |
3580 |
Myoneural Disorders |
3590 |
Muscular Dystrophies and Other Myopathies |
4380 |
Vascular Insult to the Brain |
7410 |
Spina Bifida (Meningomyelocele) |
7840 |
Loss of Voice (Communication Impairment) |
8060 |
Fracture of Vertebral Column with Spinal Cord Lesion |
8540 |
Traumatic Brain Injury |
9070 |
Late Effects of Injuries to the Nervous System |
Mental Disorders (12) |
|
2940 |
Neurocognitive Disorders |
2950 |
Schizophrenia Spectrum and Other Psychotic Disorders |
2960 |
Depression, Bipolar and Related Disorders |
2990 |
Autism Spectrum Disorders |
3000 |
Anxiety and Obsessive-Compulsive Disorders |
3010 |
Personality Disorders |
3030 |
Substance Addiction Disorders (Alcohol) |
3040 |
Substance Addiction Disorders (Drugs) |
3060 |
Somatic Symptom and Related Disorders |
3070 |
Eating Disorders |
3090 |
Trauma- and Stressor-Related Disorders |
3120 |
Impulse Control Disorders |
3138 |
Oppositional/Defiant Disorder |
3140 |
Attention Deficit/Hyperactivity Disorder |
3150 |
Developmental Disorders in Infants and Toddlers |
3152 |
Learning Disorder |
3153 |
Speech and Language Impairment |
3180 |
Intellectual Disorder |
3195 |
Borderline Intellectual Functioning |
7810 |
Tic Disorders |
Malignant Neoplastic Diseases (13) |
|
0420 |
Malignant Neoplasm Treated by Bone Marrow or Stem Cell Transplantation |
1410 |
Malignant Neoplasm of Tongue |
1420 |
Malignant Neoplasm of Salivary Glands |
1500 |
Malignant Neoplasm of Esophagus |
1510 |
Malignant Neoplasm of Stomach |
1520 |
Malignant Neoplasm of Small Intestine, Including Duodenum |
1530 |
Malignant Neoplasm of Colon, Rectum or Anus |
1550 |
Malignant Neoplasm of Liver and Intrahepatic Bile Ducts |
1560 |
Malignant Neoplasm of Gallbladder and Extrahepatic Bile Ducts |
1570 |
Malignant Neoplasm of Pancreas |
1590 |
Malignant Neoplasm of Other and Ill-Defined Sites Within the Digestive Organs and Peritoneum (Abdomen) |
1620 |
Malignant Neoplasm of Trachea, Bronchus, or Lung |
1630 |
Malignant Neoplasm of Pleura |
1640 |
Malignant Neoplasm of Mediastinum |
1700 |
Malignant Neoplasm of Maxilla, Orbit, or Temporal Fossa |
1710 |
Malignant Neoplasm of Connective and Other Soft Tissue |
1720 |
Malignant Melanoma |
1730 |
Malignant Neoplasm of Skin |
1740 |
Malignant Neoplasm of Breast |
1780 |
Malignant Neoplasm of Skeletal System |
1790 |
Malignant Neoplasm of Uterus |
1830 |
Malignant Neoplasm of Ovary and Other Uterine Adnexa |
1840 |
Malignant Neoplasm of Vulva or Vagina |
1850 |
Malignant Neoplasm of Prostate |
1860 |
Malignant Neoplasm of Testis |
1870 |
Malignant Neoplasm of Penis |
1880 |
Malignant Neoplasm of Bladder |
1890 |
Malignant Neoplasm of Kidney, Adrenal Glands, or Ureters |
1900 |
Malignant Neoplasm of Eye |
1910 |
Malignant Neoplasm of Nervous System |
1920 |
Neuroblastoma |
1930 |
Malignant Neoplasm of Thyroid Gland |
1940 |
Malignant Neoplasm of Other Endocrine Glands and Related Structures |
1950 |
Soft Tissue Tumors of Head and Neck |
1980 |
Secondary Malignant Neoplasms (Metastatic Neoplasms of Distant Sites Other Than Regional Lymph Nodes) |
1990 |
Malignant Neoplasms of Unspecified Site |
2020 |
Lymphoma |
2030 |
Multiple Myeloma |
2070 |
Leukemia |
2390 |
Neoplasm of Unspecified or Unknown Nature |
2730 |
Macroglobulinemia or Heavy Chain Disease |
Immune System (14) |
|
2790 |
Immune Deficiency Disorders, Excluding HIV Infection) |
4460 |
Periarteritis Nodosa and Allied Conditions (Systemic Vasculitis) |
7100 |
Diffuse Diseases of Connective Tissue (Including Systemic Lupus Erythematosus, Systemic Sclerosis (Scleroderma), Polymyositis and Dermatomyositis, Undifferentiated and Mixed Connective Tissue Disease, Sjögren’s Syndrome) |
0430 |
Symptomatic Human Immunodeficiency Virus (HIV) Infection |
0440 |
Asymptomatic Human Immunodeficiency Virus (HIV) Infection |
2740 |
Gout |
7140 |
Inflammatory Arthritis |
7200 |
Ankylosing Spondylitis and Other Inflammatory Spondyloarthropathies |
Low Birth Weight (LBW) and Failure to Thrive (FTT) (19) |
|
7649 |
Low Birth Weight – Weight 1200 - 2000 grams. |
7650 |
Low Birth Weight – Weight Under 1200 grams. |
7830 |
Failure to Thrive |
Special/Other (20) |
|
0000 |
None Established (No Medical Evidence in File) |
6490 |
None Established (Medical Evidence in File But Insufficient to Establish Diagnosis) |
2480 |
Diagnosis Established--No Predetermined List Code of Medical Nature Applicable |
2780 |
Obesity and Other Hyperalimentation |
7290 |
Fibromyalgia |
7590 |
Other Congenital Anomalies |
8690 |
Internal Injury |
8790 |
Other Open Wounds, Except Limbs |
9330 |
Chronic Fatigue Syndrome (CFS) |
4. Symptomatic HIV infection and secondary diagnosis impairment codes
Whenever symptomatic HIV (code 0430) is the primary diagnosis, the secondary diagnosis should be the manifestation of HIV. First, try to select the most appropriate code from the following list as the secondary diagnosis code. Only if the manifestation of HIV is not included in this list, should you select the most appropriate code from the General List of Impairment Codes:
Diagnosis |
Impairment Code |
---|---|
Absolute CD4 Count 50 or Less |
7950 |
Anemia |
2850 |
Aspergillosis |
1170 |
Bacterial infections, multiple or recurrent |
0410 |
Bone infection |
7300 |
Brain atrophy |
3310 |
Candidiasis |
1120 |
Carcinoma of the Cervix |
1800 |
Cardiomyopathy |
4250 |
Coccidioidomycosis |
1140 |
Condyloma caused by the human papillomavirus |
0780 |
1170 |
|
Cryptosporidiosis |
0070 |
Cytomegalovirus Disease |
0780 |
Diarrhea |
5580 |
Eczema |
6920 |
Endocarditis |
4240 |
Genital ulcerative disease, female |
6290 |
Genital ulcerative disease, male |
6080 |
Granulocytopenia |
2880 |
Immune Suppression and Growth Failure |
7830 |
Hepatitis |
5730 |
Herpes Simplex |
0540 |
Herpes Zoster |
0530 |
Histoplasmosis |
1150 |
HIV encephalopathy |
3480 |
HIV wasting syndrome |
2630 |
Impaired brain growth |
7420 |
Isosporiasis |
0070 |
Joint infection |
7110 |
Kaposi Sarcoma |
1760 |
Leukoencephalopathy |
0460 |
Lymphoid interstitial pneumonia (LIP) |
5160 |
Lymphoma |
2000 |
Meningitis |
3220 |
Microcephaly |
7420 |
Microsporidiosis |
1360 |
Mucormycosis |
1170 |
Multicentric Castleman Disease |
2380 |
Mycobacterial infection, avium intracellulare, caused by M. Kansasii, or M. tuberculosis (except pulmonary tuberculosis) |
0310 |
Nephropathy |
5830 |
Neurological conditions |
3490 |
Neurosyphilis |
0940 |
Nocardiosis |
0390 |
Pancreatitis |
5770 |
Pelvic inflammatory disease |
6140 |
Peripheral neuropathy |
3560 |
Pneumocystis infection, extrapulmonary |
1360 |
Pneumocystis Pneumonia (PCP) |
1360 |
Pneumonia (non-PCP) |
4860 |
Psoriasis |
6960 |
Pulmonary Lymphoid Hyperplasia (PLH) |
2850 |
Pulmonary Tuberculosis |
0110 |
Salmonella Bacteremia |
0030 |
Sepsis |
0380 |
Septic Arthritis |
7110 |
Sinusitis |
4730 |
Squamous Cell Carcinoma of the Anal Canal or Anal Margin |
1540 |
Strongyloidiasis |
1270 |
Syphilis |
0970 |
Thrombocytopenia |
2870 |
Toxoplasmosis |
1300 |
Vulvovaginal Candida |
1120 |
5. Impairment codes in numeric sequence
Use the following list when looking for the diagnosis connected to a particular impairment code.
Impairment Code |
Body System |
Diagnostic Categories |
---|---|---|
0000 |
20 |
None Established (No Medical Evidence in File) |
0030 |
14 |
Salmonella Bacteremia (Secondary Diagnosis for HIV-0430) |
0070 |
14 |
Cryptosporidiosis (Secondary Diagnosis for HIV-0430) |
0070 |
14 |
Isosporiasis (Secondary Diagnosis for HIV-0430) |
0110 |
03 |
Pulmonary Tuberculosis |
0310 |
14 |
Mycobacterium infection avium intracellulare, caused by M. Kansasii, or M. tuberculosis (except pulmonary tuberculosis) (Secondary Diagnosis for HIV-0430) |
0380 |
14 |
Sepsis (Secondary Diagnosis for HIV-0430) |
0390 |
14 |
Nocardiasis (Secondary Diagnosis for HIV-0430) |
0410 |
14 |
Bacterial Infections, Multiple or Recurrent (Secondary Diagnosis for HIV-0430) |
0420 |
13 |
Malignant Neoplasm Treated by Bone Marrow or Stem Cell Transplantation |
0430 |
14 |
Symptomatic Human Immunodeficiency Virus (HIV) Infection |
0440 |
14 |
Asymptomatic Human Immunodeficiency Virus (HIV) Infection |
0460 |
14 |
Leukoencephalopathy (Secondary Diagnosis for HIV-0430) |
0530 |
14 |
Herpes Zoster (Secondary Diagnosis for HIV-0430) |
0540 |
14 |
Herpes Simplex (Secondary Diagnosis for HIV-0430) |
0780 |
14 |
Condyloma Caused by the Human Papillomavirus (Secondary Diagnosis for HIV-0430) |
0780 |
14 |
Cytomegalovirus Disease (Secondary Diagnosis for HIV-0430) |
0930 |
04 |
Cardiovascular Syphilis |
0940 |
14 |
Neurosyphilis (Secondary Diagnosis for HIV-0430) |
0970 |
14 |
Syphilis (Secondary Diagnosis for HIV-0430) |
1120 |
14 |
Candidiasis (Secondary Diagnosis for HIV-0430) |
1120 |
14 |
Vulvovaginal Candida (Secondary Diagnosis for HIV-0430) |
1140 |
14 |
Coccidiodomycosis (Secondary Diagnosis for HIV-0430) |
1150 |
14 |
Histoplasmosis (Secondary Diagnosis for HIV-0430) |
1170 |
03 |
Mycobacterial, Mycotic and Other Chronic Infections of the Lung |
1170 |
08 |
Chronic Infections of the Skin or Mucous Membranes |
1170 |
14 |
Aspergillosis (Secondary Diagnosis for HIV-0430) |
1170 |
14 |
Cryptococcosis (Secondary Diagnosis for HIV-0430) |
1170 |
14 |
Mucormycosis (Secondary Diagnosis for HIV-0430) |
1270 |
14 |
Strongyloidiasis (Secondary Diagnosis for HIV-0430) |
1300 |
14 |
Toxoplasmosis (Secondary Diagnosis for HIV-0430) |
1350 |
03 |
Sarcoidosis |
1360 |
05 |
Other Infectious and Parasitic Disorders |
1360 |
14 |
Micro-Sporidiosis (Secondary Diagnosis for HIV-0430) |
1360 |
14 |
Pneumocystis Infection, extra-pulmonary (Secondary Diagnosis for HIV-0430) |
1360 |
14 |
Pneumocystis Pneumonia (PCP) (Secondary Diagnosis for HIV-0430) |
1380 |
11 |
Post-Polio Syndrome |
1410 |
13 |
Malignant Neoplasm of Tongue |
1420 |
13 |
Malignant Neoplasm of Salivary Glands |
1500 |
13 |
Malignant Neoplasm of Esophagus |
1510 |
13 |
Malignant Neoplasm of Stomach |
1520 |
13 |
Malignant Neoplasm of Small Intestine, Including Duodenum |
1530 |
13 |
Malignant Neoplasm of Colon, Rectum or Anus |
1540 |
14 |
Squamous Cell Carcinoma of the Anal Canal or Anal Margin (Secondary Diagnosis for HIV-0430) |
1550 |
13 |
Malignant Neoplasm of Liver and Intrahepatic Bile Ducts |
1560 |
13 |
Malignant Neoplasm of Gallbladder and Extrahepatic Bile Ducts |
1570 |
13 |
Malignant Neoplasm of Pancreas |
1590 |
13 |
Malignant Neoplasm of Other and Ill-Defined Sites Within the Digestive Organs and Peritoneum (Abdomen) |
1620 |
13 |
Malignant Neoplasm of Trachea, Bronchus, or Lung |
1630 |
13 |
Malignant Neoplasm of Pleura |
1640 |
13 |
Malignant Neoplasm of Mediastinum |
1700 |
13 |
Malignant Neoplasm of Maxilla, Orbit, or Temporal Fossa |
1710 |
13 |
Malignant Neoplasm of Connective and Other Soft Tissue |
1720 |
13 |
Malignant Melanoma |
1730 |
13 |
Malignant Neoplasm of Skin |
1740 |
13 |
Malignant Neoplasm of Breast |
1760 |
14 |
Kaposi’s Sarcoma (Secondary Diagnosis for HIV-0430) |
1780 |
13 |
Malignant Neoplasm of Skeletal System |
1790 |
13 |
Malignant Neoplasm of Uterus |
1800 |
14 |
Carcinoma of the Cervix (Secondary Diagnosis for HIV-0430) |
1830 |
13 |
Malignant Neoplasm of Ovary and Other Uterine Adnexa |
1840 |
13 |
Malignant Neoplasm of Vulva or Vagina |
1850 |
13 |
Malignant Neoplasm of Prostate |
1860 |
13 |
Malignant Neoplasm of Testis |
1870 |
13 |
Malignant Neoplasm of Penis |
1880 |
13 |
Malignant Neoplasm of Bladder |
1890 |
13 |
Malignant Neoplasm of Kidney, Adrenal Glands, or Ureters |
1900 |
13 |
Malignant Neoplasm of Eye |
1910 |
13 |
Malignant Neoplasm of Nervous System |
1920 |
13 |
Neuroblastoma |
1930 |
13 |
Malignant Neoplasm of Thyroid Gland |
1940 |
13 |
Malignant Neoplasm of Other Endocrine Glands and Related Structures |
1950 |
13 |
Soft Tissue Tumors of Head and Neck |
1980 |
13 |
Secondary Malignant Neoplasms (Metastatic Neoplasms of Distant Sites Other Than Regional Lymph Nodes) |
1990 |
13 |
Malignant Neoplasm of Unspecified Site |
2000 |
14 |
Lymphoma (Secondary Diagnosis for HIV-0430) |
2020 |
13 |
Lymphoma |
2030 |
13 |
Multiple Myeloma |
2070 |
13 |
Leukemia |
2250 |
11 |
Benign Neoplasm of Brain and Other Parts of Nervous System |
2380 |
14 |
Multicentric Castleman Disease (Secondary Diagnosis for HIV-0430) |
2390 |
13 |
Neoplasm of Unspecified or Unknown Nature |
2460 |
09 |
All Disorders of Thyroid Gland (Except Malignant Neoplasm) |
2480 |
20 |
Diagnosis Established--No Predetermined List Code of Medical Nature Applicable |
2500 |
09 |
Diabetes Mellitus |
2520 |
09 |
All Disorders of Parathyroid Gland (Except Malignant Neoplasm) |
2530 |
09 |
All Disorders of the Pituitary Gland (Except Malignant Neoplasm) |
2550 |
09 |
All Disorders of Adrenal Glands (Except Malignant Neoplasm) |
2630 |
05 |
Growth Failure Due to Any Digestive Disorder. |
2630 |
14 |
HIV Wasting Syndrome (Secondary Diagnosis for HIV-0430) |
2720 |
04 |
Hyperlipidemia |
2730 |
13 |
Macroglobulinemia or Heavy Chain Disease |
2740 |
14 |
Gout |
2770 |
03 |
Cystic Fibrosis |
2780 |
20 |
Obesity |
2820 |
07 |
Hemolytic Anemias (Including Sickle Cell Thalassemia, and Variants) |
2840 |
07 |
Hematological Disorders with BM/SC Transplantation. |
2850 |
14 |
Anemia (Secondary Diagnosis for HIV-0430) |
2850 |
14 |
Pulmonary Lymphoid Hyperplasia (PLH) (Secondary Diagnosis for HIV-0430) |
2860 |
07 |
Thrombosis and Hemostasis Disorder (Including Hemophilia) |
2870 |
14 |
Thrombocytopenia (Secondary Diagnosis for HIV-0430) |
2880 |
14 |
Granulocytopenia (Secondary Diagnosis for HIV-0430) |
2890 |
07 |
Bone Marrow Failure (Including Myelofibrosis and Granulocytopenia) |
2940 |
12 |
Neurocognitive Disorders |
2950 |
12 |
Schizophrenia Spectrum and Other Psychotic Disorders |
2960 |
12 |
Depression, Bipolar and Related Disorders |
2990 |
12 |
Autism Spectrum Disorders |
3000 |
12 |
Anxiety and Obsessive-Compulsive Disorders |
3010 |
12 |
Personality Disorders |
3030 |
12 |
Substance Addiction Disorders (Alcohol) |
3040 |
12 |
Substance Addiction Disorders (Drugs) |
3060 |
12 |
Somatic Symptom and Related Disorders |
3070 |
12 |
Eating Disorders |
3090 |
12 |
Trauma- and Stressor-Related Disorders |
3120 |
12 |
Impulse Control Disorders |
3138 |
12 |
Oppositional/Defiant Disorder |
3140 |
12 |
Attention Deficit/Hyperactivity Disorder |
3150 |
12 |
Developmental Disorders in Infants and Toddlers |
3152 |
12 |
Learning Disorder |
3153 |
12 |
Speech and Language Impairment |
3180 |
12 |
Intellectual Disorder |
3195 |
12 |
Borderline Intellectual Functioning |
3210 |
01 |
Arachnoiditis |
3220 |
14 |
Meningitis (Secondary Diagnosis for HIV-0430) |
3250 |
03 |
Lung Transplant |
3300 |
10 |
Cerebral Degenerations Usually Manifest in Childhood |
3300 |
11 |
Cerebral Degenerations Usually Manifest in Childhood |
3310 |
11 |
Other Cerebral Degenerations |
3310 |
14 |
Brain Atrophy (Secondary Diagnosis for HIV-0430) |
3320 |
11 |
Parkinson’s Disease |
3330 |
11 |
Huntington Disease |
3350 |
11 |
Amyotrophic Lateral Sclerosis |
3358 |
11 |
Motor Neuron Disorders Other than ALS |
3360 |
11 |
Spinal Cord Disorders |
3370 |
11 |
Disorders of Autonomic Nervous System |
3400 |
11 |
Multiple Sclerosis |
3430 |
11 |
Cerebral Palsy |
3450 |
11 |
Epilepsy |
3460 |
11 |
Migraine |
3480 |
11 |
Coma or Persistent Vegetative State |
3480 |
14 |
HIV Encephalopathy (Secondary Diagnosis for HIV-0430) |
3490 |
11 |
Other Disorders of the Nervous System |
14 |
Neurological Conditions (Secondary Diagnosis for HIV-0430) |
|
3540 |
11 |
Carpal Tunnel Syndrome |
3560 |
14 |
Peripheral Neuropathy (Secondary Diagnosis for HIV-0430) |
3570 |
11 |
Peripheral Neuropathy |
3580 |
11 |
Myoneural Disorders |
3590 |
11 |
Muscular Dystrophies and Other Myopathies |
3610 |
02 |
Retinal Detachments and Defects |
3620 |
02 |
Other Retinal Disorders (Including Diabetic Retinopathy) |
3650 |
02 |
Glaucoma |
3660 |
02 |
Cataract |
3680 |
02 |
Visual Disturbances |
3690 |
02 |
Low Vision |
3694 |
02 |
Statutory Blindness |
3750 |
04 |
Cardiac Transplantation |
3780 |
02 |
Strabismus and Other Disorders of Eye Movements |
3860 |
02 |
Vertiginous Syndromes and Other Disorders of Vestibular System |
3880 |
02 |
Other Disorders of Ear |
3890 |
02 |
Hearing Loss |
3910 |
04 |
Rheumatic Fever with Heart Involvement |
3950 |
04 |
Diseases of Aortic Valve |
3980 |
04 |
Other Rheumatic Heart Disease |
4010 |
04 |
Essential Hypertension |
4020 |
04 |
Hypertensive Cardiovascular Disease |
4030 |
04 |
Hypertensive Vascular and Renal Disease |
4100 |
04 |
Acute Myocardial Infarction |
4130 |
04 |
Angina Pectoris Without Ischemic Heart Disease |
4140 |
04 |
Chronic Ischemic Heart Disease With or Without Angina |
4160 |
03 |
Chronic Pulmonary Hypertension Due to Any Cause |
4160 |
04 |
Chronic Pulmonary Heart Disease (Cor Pulmonale) |
4240 |
04 |
Valvular Heart Disease or Other Stenotic Defects or Valvular Regurgitation |
4240 |
14 |
Endocarditis (Secondary Diagnosis for HIV-0430) |
4250 |
04 |
Cardiomyopathy |
4270 |
04 |
Cardiac Dysrhythmias (Arrhythmias) |
4280 |
04 |
Heart Failure |
4380 |
11 |
Vascular Insult to the Brain |
4410 |
04 |
Aneurysm of Aorta or Major Branches |
4430 |
04 |
Peripheral Vascular (Arterial) Disease |
4460 |
04 |
Kawasaki Syndrome |
4460 |
14 |
Periarteritis Nodosa and Allied Conditions (Systemic Vasculitis) |
4510 |
04 |
Phlebitis and Thrombophlebitis |
4540 |
04 |
Varicose Veins of Lower Extremities |
4590 |
04 |
Other Diseases of Circulatory System (Venous Insufficiency) |
4730 |
14 |
Sinusitis (Secondary Diagnosis for HIV-0430) |
4750 |
05 |
Liver Transplant |
4860 |
14 |
Pneumonia (non-PCP) (Secondary Diagnosis for HIV-0430) |
4910 |
03 |
Chronic Bronchitis |
4920 |
03 |
Emphysema |
4930 |
03 |
Asthma |
4940 |
03 |
Bronchiectasis |
4960 |
03 |
Chronic Respiratory Disorders |
5010 |
03 |
Asbestosis |
5050 |
03 |
Pneumoconiosis |
5160 |
14 |
Lymphoid Interstitial Pneumonia (LIP) (Secondary Diagnosis for HIV-0430) |
5180 |
03 |
Respiratory Failure |
5190 |
03 |
Other Disorders of the Respiratory System |
5300 |
05 |
Diseases of Esophagus |
5330 |
05 |
Peptic Ulcer (Gastric or Duodenal) |
5350 |
05 |
Gastritis and Duodenitis |
5530 |
05 |
Hernias |
5550 |
05 |
Inflammatory Bowel Disease (IBD) |
5580 |
14 |
Diarrhea (Secondary Diagnosis for HIV-0430) |
5690 |
05 |
Other Disorders of Gastrointestinal System |
5710 |
05 |
Chronic Liver Disease |
5730 |
14 |
Hepatitis (Secondary Diagnosis for HIV-0430) |
5770 |
14 |
Pancreatitis (Secondary Diagnosis for HIV-0430) |
5780 |
05 |
Gastrointestinal hemorrhaging from any cause |
5793 |
05 |
Short Bowel Syndrome (SBS) |
5799 |
05 |
Need for supplemental daily enteral feeding via gastrostomy |
5810 |
06 |
Nephrotic Syndrome |
5830 |
14 |
Nephropathy (Secondary Diagnosis for HIV-0430) |
5830 |
06 |
Complications of Chronic Kidney Disease |
5850 |
06 |
Chronic Kidney Disease with Dialysis |
5880 |
06 |
Chronic Kidney Disease |
5950 |
06 |
Interstitial Cystitis |
5990 |
06 |
Other Disorders of the Urinary Tract |
6080 |
06 |
Disorders of the Male Genital Organs |
6080 |
14 |
Genital Ulcerative Disease, Male (Secondary Diagnosis for HIV-0430) |
6140 |
14 |
Pelvic Inflammatory Disease (Secondary Diagnosis for HIV-0430) |
6290 |
06 |
Disorders of the Female Genital Organs |
6290 |
14 |
Genital Ulcerative Disease, Female (Secondary Diagnosis for HIV-0430) |
6490 |
20 |
None Established (Medical Evidence in File But Insufficient to Establish Diagnosis) |
6920 |
14 |
Eczema (Secondary Diagnosis for HIV-0430) |
6940 |
08 |
Bullous Disease |
6950 |
08 |
Ichthyosis |
6960 |
08 |
Dermatitis |
6960 |
14 |
Psoriasis (Secondary Diagnosis for HIV-0430) |
7050 |
08 |
Hidradenitis Suppurativa |
7090 |
08 |
Other Disorders of the Skin and Subcutaneous Tissues |
7100 |
14 |
Diffuse Diseases of Connective Tissue (including Systemic Lupus Erythematosus, Systemic Sclerosis (Scleroderma), Polymyositis and Dermatomyositis, Undifferentiated and Mixed Connective Tissue Disease, Sjögren's Syndrome) |
7110 |
14 |
Joint Infection (Secondary Diagnosis for HIV-0430) |
7110 |
14 |
Septic Arthritis (Secondary Diagnosis for HIV-0430) |
7140 |
14 |
Inflammatory Arthritis |
7150 |
01 |
Osteoarthrosis and Allied Disorders |
7160 |
01 |
Other and Unspecified Arthropathies |
7200 |
14 |
Ankylosing Spondylitis or Other Spondyloarthropathies |
7240 |
01 |
Disorders of Back (Discogenic and Degenerative) |
7280 |
01 |
Disorders of Muscle, Ligament and Fascia |
7290 |
20 |
Fibromyalgia |
7300 |
01 |
Osteomyelitis, Periostitis and Other Infections Involving Bone |
7300 |
14 |
Bone Infection (Secondary Diagnosis for HIV-0430) |
7330 |
01 |
Other Disorders of Bone and Cartilage (Osteoporosis) |
7370 |
01 |
Curvature of Spine |
7400 |
10 |
Anencephalus and Catastrophic Congenital Abnormality or Disease |
7410 |
11 |
Spina Bifida (Meningomyelocele) |
7420 |
14 |
Impaired Brain Growth (Secondary Diagnosis for HIV-0430) |
7420 |
14 |
Microcephaly (Secondary Diagnosis for HIV-0430) |
7460 |
04 |
Congenital Heart Disease |
7500 |
05 |
Congenital Anomalies of Upper Alimentary Tract |
7530 |
06 |
Congenital Anomalies of Urinary System |
7580 |
10 |
Down Syndrome (Excluding Mosaic Down Syndrome) |
7590 |
08 |
Genetic Photosensitivity Disorders |
7590 |
20 |
Other Congenital Anomalies |
7649 |
19 |
Low Birth Weight - Weight 1200 - 2000 grams |
7650 |
19 |
Low Birth Weight – Weight Under 1200 grams |
7800 |
03 |
Sleep-Related Breathing Disorders |
7810 |
12 |
Tic Disorders |
7830 |
14 |
Immune Suppression and Growth Failure (Secondary Diagnosis for HIV-0430) |
7830 |
19 |
Failure to Thrive (Growth Disorders) |
7840 |
02 |
Loss of Voice |
7840 |
11 |
Loss of Voice (Communication Impairment) |
7850 |
04 |
Growth Failure Due to Any Chronic Cardiovascular Disorder |
7860 |
03 |
Growth Failure Due to Any Chronic Respiratory Disorder |
7880 |
06 |
Growth Failure Due to Any Chronic Renal Disease |
7950 |
14 |
Absolute CD4 Count 50 or Less (Secondary Diagnosis for HIV-0430 |
8030 |
01 |
Fracture of Skull Without Intracranial Injury |
8060 |
01 |
Fracture of Vertebral Column with Spinal Cord Lesion |
8060 |
11 |
Fracture of Vertebral Column with Spinal Cord Lesion |
8180 |
01 |
Fractures of Upper Limb |
8270 |
01 |
Fractures of Lower Limb |
8290 |
01 |
Other Fractures of Bones |
8390 |
01 |
Dislocations--All Types |
8480 |
01 |
Sprains and Strains--All Types |
8540 |
11 |
Traumatic Brain Injury |
8690 |
20 |
Internal Injury |
8790 |
20 |
Other Open Wounds, Except Limbs |
8840 |
01 |
Open Wound of Upper Limb (Soft Tissue Injury) |
8940 |
01 |
Open Wound of Lower Limb (Soft Tissue Injury) |
9050 |
01 |
Late Effects of Musculoskeletal and Connective Tissue Injuries (Amputation) |
9070 |
11 |
Late Effects of Injuries to the Nervous System |
9330 |
20 |
Chronic Fatigue Syndrome (CFS) |
9480 |
08 |
Burns |
9490 |
01 |
Burns (NOS) |
9960 |
06 |
Kidney Transplant |
—