Attachment_J-6_Network_Adequacy_Calculations.pdf

Section J Attachment J-6

Network Adequacy Calculations/Exclusions Attachment J-6

The exclusions included in the tabs "Overall", Emergency", and "Preventive" tabs shall apply when the Government performs its analysis in accordance with Section H.6.4 of the Contract.

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Network Adequacy Calculations/Exclusions

Attachment J-6

Category Description

Beneficiary Categories All beneficiary catagories other than ADFMs/ADSMs enrolled in Prime/Prime Remote in Overseas Regions will be excluded

CONUS claims 50 United States and District of Columbia

Point of Service Claims Special Processing = PO or BYPASS-DC = ‘A5’

OHI claims OHI Claims Flag = 1

Remote network waiver locations (if any) (requires TAO approval and notification to TOPO)

(insert city/country location(s) for any approved remote network waiver locations)

TOP Prime Remote-Unspecified Prime Remote enrollees in TOP Prime Remote-Unspecified DMIS locations

Clinical Preventive Services-TRICARE Prime: See TPM C7, Section 2.2

Well-Child Care : See TPM C7, Section 2.5

Immunizations 90281-90586, 90632-90749 (Include Immune Globulins, Vaccines and Toxoids)

Emergency services Diagnosis Code and Place Service comination (refer to Emergency Care Table)

Ambulance, Transport services Place of Service = 41 or 42 Pathology: (TPM C6, section 1.1) 80000 - 89999, 36415, 36416, 96100

Radiology: (TPM C5) 0073T, 70000-79999, 95965-95967, G0204, G0206 (Except for codes with MRI & PET Scan in description)

Pharmaceuticals TYP-OF-SVC=OB or Procedure code is 98800 or 99088

Claims for Professional Services when done in conjunction with an inpatient admission to a network facility

Institutional Outpatient Claim Multiplier=1

DME items not requiring an authorization

TYP-OF-SVC=OA and the billed amount is less than $1,000

Preventive Services

Ancillary Services

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03 SCHOOL 00200 TYPHOID FEVER

04 HOMELESS SHELTER 0050 STAPHYLOCOCCAL FOOD POISONING

05 INDIAN HEALTH SERVICE 0051 BOTULISM

06 INDIAN HEALTH SERVICEFACILITY 0052 FOOD POISONING/CLOSTGRIDIUM PERFRINGES

07 TRIBAL 638 FREESTANDING 0053 FOOD POISONING/OTHER CLOSTRIDIS

08 TRIBAL 638 FACILITY 0054 FOOD POISONING/VIBRO PARAHAEMOLYTICUS

11 OFFICE 0058 OTHER BACTERIAL FOOD POISONING

12 HOME 00581 FOOD POIS; VIB VULNFICUS

13 ASSISTED LIVING FACILITY 00589 OTH BACT FOOD POISONING

14 GROUP HOME 0059 FOOD POISONING, UNSPECIFIED

15 MOBILE UNIT 0092 INFECTIOUS DIARRHEA

19 PHARMACY 02763 ALKALOSIS

20 URGENT CARE FACILITY 0380 SEPTICEMIA

21 INPATIENT FACILITY 0381 SEPTICEMIA

22 OUTPATIENT HOSPITAL 03812 METHICILLIN RESISTANT SEPTICEMIA

EMERG POS FOR AUTH - NO AUTH FOR

EMERG CARE 0382 SEPTICEMIA

24 AMBULATORY SURGERY CENTER 0383 SEPTICEMIA

25 BIRTHING CENTER 03840 SEPTICEMIA

26 MILITARY TREATMENT FACILITY 03841 SEPTICEMIA

31 SKILLED NURSING FACILITY 03842 SEPTICEMIA

32 NURSING FACILITY 03844 SEPTICEMIA

33 CUSTODIAL CARE FACILITY 03849 SEPTICEMIA

34 HOSPICE 0388 SEPTICEMIA

41 AMBULANCE LAND 0389 SEPTICEMIA

42 AMBULANCE AIR/WATER 04041 INFANT BOTULISM

49 INDEPENDENT CLINIC 04042 WOUND BOTULISM

FEDERALLY QUALIFIED HEALTH

CENTER 0479 UNSPECIFIED VIRAL MENINGITIS

51 INDEPENDENT PSYCH FACILITY 0521 VARICELLA (HEMORRHAGIC) PNEUMONIA

52 PARTIAL HOSPITALIZATION FACILITY 0527 CHICKENPOX WITH OTHER SPECIFIED COMPLICATION

53 COMMUNITY MH FACILITY 05821 HUMAN HERPESVIRUS6 ENCEPALITIS

54 INTERMEDIATE CARE FACILITY MH 05829 OTHER HUMAN HERPESVIRUS ENCEPHALITIS

55 RESIDENTIAL SUB ABUSE FACILITY 0650 CRIMEAN HEMORRHAGIC FEVER (CHF CONGO FEVER)

56 PSYCHIATRIC RESIDENTIAL CTR 075 INFECTIOUS MONONUCLEOSIS

57 NON-RESIDENT SUBSTANCE ABUSE CTR 07981 HANTAVIRUS INFECTION

60 MASS IMMUNIZATION CENTER 181 MALIGNANT NEOPLASM/PLACENTA

61 COMPREHENSIVE INPATIENT REHAB 25013 DIABETES WITH KETOACIDOSIS, TYPE I, UNCONTR

62 COMPREHENSIVE OUTPATIENT REHAB 2502 DIABETES WITH HYPEROSMOLAR COMA

65 END STAGE RENAL FACILITY 25020 ADULT ONSET OR UNSPECIFIED

71 PUBLIC HEALTH CLINIC 25021 JUVENILE TYPE

72 RURAL HEALTH CLINIC 25022 DM HYPRSMIRTY TYPE II UNCONTROLLED

81 INDEPENDENT LAB 25023 DM HYPRSMIRTY TYPE I UNCONTROLLED

99 OTHER 2503 DIABETES WITH OTHER COMA

25030 ADULT ONSET OR UNSPECIFIED

25031 JUVENILE TYPE

25032 DM W/COMA TYPE II UNCONTROLLED

25033 DM W/COMA TYPE I UNCONTROLLED

25092 DIABETES WITH UNSPECIFIED COMPLICATIONS, TY

2510 INSULIN COMA

2763 ALKALOSIS

28242 SICKLE-CELL THALASSEMIA W/CRISIS

Emergency Services Table

Place of Service Diagnosis Code

To be excluded from the Network Adequacy Calculation as a part of Emergency Care,the claim must have Place of Service and Diagnosis code from belwo tables.

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28262 SICKLE-CELL ANEMIA, HB-S DISEASE WITH MENTI

28264 SICKLE-CELL/HB-C DISEASE W/CRISIS

2922 PATHOLOGICAL DRUG INTOXICATION

3209 MENINGITIS, DUE TO UNSPECIFIED BACTERIA

3229 MENINGITIS, UNSPECIFIED

3239 UNSPECIFIED CAUSE OF ENCEPHALITIS

3314 OBSTRUCTIVE HYDROCEPHALUS

3373 AUTOMATIC DYSREFLEXIA

33921 ACUTE POST-TRAUMATIC HEADACHE

34510 GEN CONV EPILEPSY;W/O INTRACTABLE EPILEPSY

34511 W/INTRACTABLE EPILEPSY

3453 EPILEPSY, GRAND MAL STATUS

34540 PART EPILEPSY;W/IMPAIR CONSCIOUS,W/O INT EP

34541 W/INTRACTABLE EPILEPSY

34551 PARTIAL EPILEPSY, W/O MENTION OF IMPAIRMENT

34560 INFANTILE SPASMS; W/O INTRACTABLE EPILEPSY

34561 W/INTRACTABLE EPILEPSY

3459 EPILEPSY, UNSPECIFIED

34602 MIGRAINE

34603 MIGRAINE WITH AURA

3483 ENCEPHALOPATHY, UNSPECIFIED

3485 CEREBRAL EDEMA

3570 ACUTE INFECTIVE POLYNEURITIS

35801 MYASTHENIA GAVIS WITH ACUTE EXACERBATION

36050 RETAINED FOREIGN BODY,INTRAOCULAR MAGNETIC

36051 RETAINED FOREIGN BODY,INTRAOCULAR MAGNETIC

36052 RETAINED FOREIGN BODY

36053 RETAINED FOREIGN BODY

36054 RETAINED FOREIGN BODY

36055 RETAINED FOREIGN BODY

36059 RETAINED FOREIGN BODY

36060 RETAINED FOREIGN BODY

36061 RETAINED FOREIGN BODY

36062 RETAINED FOREIGN BODY

36063 RETAINED FOREIGN BODY

36064 RETAINED FOREIGN BODY

36065 RETAINED FOREIGN BODY

36069 RETAINED FOREIGN BODY

36181 TRACTION DETACHMENT OF RETINA

3619 UNSPECIFIED RETINAL DETACHMENT

36230 RETINAL VASCULAR OCCLUSION, UNSPECIFIED

36281 RETINAL HEMORRHAGE

36504 OCULAR HYPERTENSION

36622 TOTAL TRAUMATIC CATARACT

37200 ACUTE CONJUNCTIVITIS

37203 OTHER MUCOPURULENT CONJUNCTIVITIS

37230 OTHER AND UNSPECIFIED CONJUNCTIVITIS

3766 RETAINED FB FOLLOWING PENETRATING ORBIT WOU

37934 POSTERIOR DISLOCATION OF LENS

38200 ACUTE SUPPURATIVE OTITIS MEDIA

38201 ACUTE SUPPURATIVE OTITIS MEDIA WITH SPONTAN

38634 TOXIC LABYRINTHITIS

3910 ACUTE RHEUMATIC PERICARDITIS

3911 ACUTE RHEUMATIC ENDOCARDITIS

3912 ACUTE RHEUMATIC MYOCARDITIS

3918 OTHER ACUTE RHEUMATIC HEART DISEASE

3919 ACUTE RHEUMATIC HEART DISEASE, UNSPECIFIED

3941 RHEUMATIC MITRAL INSUFFICIENCY

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3951 RHEUMATIC AORTIC INSUFFICIENCY

40200 HYPERTENSIVE HEART DISEASE W/O CHF

40201 HYPERTENSIVE HEART DISEASE W/CHF

4040 HYPERTENSIVE HEART & RENAL DISEASE,MALIGNAN

40400 W/O MENTION OF CHF OR RENAL FAILURE

40401 W CHF

40402 W RENAL FAILURE

40403 W CHF AND RENAL FAILURE

4100 ACUTE MI OF ANTEROLATERAL WALL

41000 ACUTE MI,ANTEROLATERAL WALL;UNSPEC EP CARE

41001 INITIAL EPISODE CARE

41002 SUBSEQUENT EPISODE CARE

4101 ACUTE MI OF OTHER ANTERIOR WALL

41010 ACUTE MI,OTHER ANTERIOR WALL;SUBS CARE UNSP

41011 INITIAL EPISODE CARE

41012 SUBSEQUENT EPISODE CARE

4102 ACUTE MI OF INFEROLATERAL WALL

41020 ACUTE MI,INFEROLATERAL;UNSPEC EPISODE CARE

41021 INITIAL EPISODE CARE

41022 SUBSEQUENT EPISODE CARE

4103 ACUTE MI OF INFERPOSTERIOR WALL

41030 ACUTE MI,INFEROPOSTERIOR;UNSPEC EPISODE CAR

41031 INITIAL EPISODE CARE

41032 SUBSEQUENT EPISODE CARE

4104 ACUTE MI OF OTHER INFERIOR WALL

41040 ACUTE MI,OTHER INFERIOR WALL;UNSPEC EP CARE

41041 INITIAL EPISODE CARE

41042 SUBSEQUENT EPISODE CARE

4105 ACUTE MI OF OTHER LATERAL WALL

41050 ACUTE MI,OTHER LATERAL WALL;UNSPEC EP CARE

41051 INITIAL EPISODE CARE

41052 SUBSEQUENT EPISODE CARE

4106 TRUE POSTERIOR WALL INFARCTION

41060 ACUTE MI,TRUE POST WALL INFARCT;UNSP EP CAR

41061 INITIAL EPISODE CARE

41062 SUBSEQUENT EPISODE CARE

4107 SUBENDOCARDIAL INFARCTION

41070 ACUTE MI,SUBENDOCARDIAL INFARCT;UNSP EP CAR

41071 INITIAL EPISODE CARE

41072 SUBSEQUENT EPISODE CARE

4108 ACUTE MI OF OTHER SPECIFIED SITES

41080 ACUTE MI,OTHER SPEC SITE;UNSPEC EPISODE CAR

41081 INITIAL EPISODE CARE

41082 SUBSEQUENT EPISODE CARE

4109 ACUTE MI OF UNSPECIFIED SITE

41090 ACUTE MI,UNSPECFIED SITE;UNSPEC EPISODE CAR

41091 INITIAL EPISODE CARE

41092 SUBSEQUENT EPISODE CARE

4110 POST MI SYNDROME

4111 INTERMEDIATE CORONARY SYNDROME

41181 CORONARY OCCLUSION W/O MYOCARDIAL INFARCTIO

41189 OTHER ACUTE AND SUBACUTE FORMS OF ISCHEMIC

4130 ANGINA PRECTORIS

4131 ANGINA PECTORIS

4139 ANGINA PECTORIS

41406 ARTHROSCLEROSIS OF ARTERY OF TRANSPLANTED H

4141 ANEURYSM OF HEART

41410 ANEURYSM OF HEART WALL

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41411 ANEURYSM OF CORONARY VESSELS

41412 DISSECTION OF CORONARY ARTERY

41419 ANEURYSM OF HEART OTHER

4150 ACUTE PULMONARY HEART DISEASE

4151 ACUTE PULMONARY HEART DISEASE

41510 PULMONARY EMBOLISM AND INFARCTION

41511 IATRO PUL EMBOL/INFARCT

41512 SEPTIC PULMONARY EMBOLISM

41519 PUL EMBOLISM/INFARCT NEC

4200 ACUTE PERICARDITIS IN DISEASES CLASS/ELSEWH

4209 ACUTE PERICARDITIS OTHER AND UNSPECIFIED

42090 ACUTE PERICARDITIS INSPECIFIED

42091 ACUTE IDIOPATHIC PERICARDITIS

42099 OTHER/UNSPECIFIED ACUTE PERICARDITIS-OTHER

4210 ACUTE AND SUBACUTE BACTERIAL ENDOCARDITIS

4211 ACUTE PERICARDITISIN DISEASES ELSEWHERE

4219 ACUTE ENDOCARDITIS, UNSPECIFIED

4220 ACUTE MYOCARDITIS IN DISEASES CLASS/ELSEWHE

4229 OTHER AND UNSPEDIFIED ACUTE MYOCARDITIS

42290 ACUTE MYOCARDITIS UNSPECIFIED

42291 IDIOPATHIC MYOCARDITIS

42292 SEPTIC MYOCARDITIS

42293 TOXIC MYOCARDITIS

42299 OTHER/UNSPEC. ACUTE MYOCARDITIS-OTHER

4233 CARDIA TAMPONADE

4260 CONDUCTION DISORDERS

42610 CONDUCTION DISORDERS

42611 CONDUCTION DISORDERS

42612 CONDUCTION DISORDERS

42613 CONDUCTION DISORDERS

4262 CONDUCTION DISORDERS

4263 CONDUCTION DISORDERS

4264 CONDUCTION DISORDERS

42650 CONDUCTION DISORDERS

42651 CONDUCTION DISORDERS

42652 CONDUCTION DISORDERS

42653 CONDUCTION DISORDERS

42654 CONDUCTION DISORDERS

4266 CONDUCTION DISORDERS

4267 CONDUCTION DISORDERS

42681 CONDUCTION DISORDERS

42689 CONDUCTION DISORDERS

4269 CONDUCTION DISORDERS

4270 PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA

4271 PAROXUSMAL VENTRICULAR TACHYCARDIA

4272 PAROXYSMAL TACHYCARDIA UNSPECIFIED

42731 ATRIAL FIBRILLATION

4274 VENTRICULAR FIBRILLATION AND FLUTTER

42741 VENTRICULAR FIBRILLATION

42742 VENTRICULAR FLUTTER

4275 CARDIAC ARREST

4276 PREMATURE BEATS

42760 PREMATURE BEATS, UNSPECIFIED

42761 SUPRAVENTRICULAR PREMATURE BEATS

42769 OTHER

42781 SINOATRIAL NODE DYSFUNCTION

4279 CARDIAC DYSRHYTHMIA UNSPECIFIED

4280 CONGESTIVE HEART FAILURE

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4281 LEFT HEART FAILURE

42820 SYSTOLIC HEART FAILURE NOS

42821 ACUTE SYSTOLIC HEART FAILURE

42822 CHRONIC SYSTOLIC HEART FAILURE

42823 SYSTOLIC HEART FAILURE

42830 DIASTOLIC HEART FAILURE NOS

42831 ACUTE DIASTOLIC HEART FAILURE

42832 CHRONIC DIASTOLIC HEART FAILURE

42833 ACUTE/CHRONIC DIASTOLIC HEART FAILURE

42840 SYST/DIASTOLIC HEART FAILURE NOS

42841 ACUTE SYST/DIASTOLIC HEART FAILURE

42842 CHRONIC SYST/DIASTOLIC HEART FAILURE

42843 AC/CHRON SYST/DIASTOLIC HEART FAILURE

4289 HEART FAILURE, UNSPECIFIED

430 SUBARACHNOID HEMORRHAGE

431 INTRACEREBRAL HEMORRHAGE

4320 NONTRAUMATIC EXTRADURAL HEMORRHAGE

4321 SUBDURAL HEMORRHAGE

4329 UNSPECIFIED INTRACRANIAL HEMORRHAGE

4330 OCCLUSION & STENOSIS OF PRECEREBRAL ARTERIE

43300 BASIL ART OCCL NO INFARC

43301 BASIL ART OCCL W/INFARC

4331 OCCLUSION & STENOSIS OF PRECEREBRAL ARTERIE

43310 OCCLUSION AND STENOSIS OF PRECEREBRAL ARTER

43311 OCCLUSION AND STENOSIS OF PRECEREBRAL ARTER

4332 OCCLUSION & STENOSIS OF PRECEREBRAL ARTERIE

43320 VERTB ART OCC NO INFARC

43321 VERTB ART OCC W/INFARC

4333 OCCLUSION & STENOSIS OF PRECEREBRAL ARTERIE

43330 OCCLUSION AND STENOSIS OF PRECEREBRAL ARTER

43331 OCCLUSION AND STENOSIS OF PRECEREBRAL ARTER

4338 OCCLUSION & STENOSIS OF PRECEREBRAL ARTERIE

43380 OTH PRECER OCC NO INFARC

43381 OTH PRECER OCC W/INFARC

4339 OCCLUSION & STENOSIS OF PRECEREBRAL ARTERIE

43390 PRECERB OCC NO INFARC

43391 PRECERB OCC W/INFARC

43410 CEREBRAL EMBOLISM W/O MENTION OF CERBRAL IN

43411 CEREBRAL EMBOLISM WITH CEREBRAL INFARCHTION

43491 CEREBRAL ARTERY OCCLUSION, UNSPECIFIED, WIT

4358 OTHER SPECIFIED TRANSIENT CEREBRAL ISCHEMIA

4359 UNSPECIFIED TRANSIENT CEREBRAL ISCHEMIA

436 ACUTE BUT ILLDEFINED CV DISEASE(STROKE,CVA)

44021 ATHEROSCLEROSIS OF NATIVE ARTERIES OF EXREM

44022 ATHEROSCLEROSIS OF NATIVE ARTERIES OF EXREM

44100 DISSECTION ANEURYSM, UNSPECIFIED SITE

44101 DISSECTION ANEURYSM, THORATIC

44102 DISSECTION ANEURYSM, ABDOMINAL

44103 DISSECTION ANEURYSM, THORACOABDOMINAL

4411 THORACIC ANEURYSM, RUPTURED

4413 ABDOMINAL ANEURYSM, RUPTURED

44140 ABDOMINAL AORTIC ANEURYSM W/O MENTION OF RU

4415 AORTIC ANEURYSM OF UNSPEC SITE;RUPTURED

4416 RUPT THORAC-ABD ANEURYSM

44290 OTHER ANEURYSM OF UNSPECIFIED SITE

44321 DISSECT CAROTID ARTERY

44322 DISSECT ILIAC ARTERY

44323 DISSECT RENAL ARTERY

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44324 DISSECT VERTEBRAL ARTERY

44329 DISSECT ARTERY NEC

4440 ARTERIAL EMBOLISM AND THROMBOSIS

4441 ARTERIAL EMBOLISM AND THROMBOSIS

44421 ARTERIAL EMBOLISM AND THROMBOSIS

44422 ARTERIAL EMOBLISM AND THROMBOSIS OF LOWER E

44481 ARTERIAL EMBOLISM AND THROMBOSIS OF ILIAC

44489 ARTERIAL EMBOLISM AND THROMBOSIS

4449 ARTERIAL EMBOLISM AND THROMBOSIS

44501 ATHEROEMOLISM UPPER EXT

44502 ATHEROEMBOLISM LOWER EXT

44581 ATHEROEMBOLISM KIDNEY

44589 ATHEROEMBOLISM NEC

4472 RUPTURE OF ARTERY

449 SEPTIC ARTERIAL EMBOLISM

45190 PHLEBITIS AND THOMBOPHLEBITIS OF SPECIFIED

45380 OTHER VENOUS EMBOLISM AND THROMBOSIS OF OTH

45600 ESOPHAGEAL VARICES WITH BLEEDING

4590 OTHER DISORDERS OF CIRC SYS,HEMORRHAGE,UNSP

4803 PNEUMONIA DUE TO SARS

48090 VIRAL PNEUMONIA, UNSPECIFIED

48240 STAPHYLOCOCCAL PNEU NOS

48241 STAPH AUREUS PNEUMONIA

48242 METHICILLIN RESISTANT PNEUMONIA

48249 STAPH PNEUMONIA NEC

48290 BACTERIAL PNEUMONIA, UNSPECIFIED

486 PNEUMONIA, ORGANISM, UNSPECIFIED

49120 OBSTRUCTIVE CHRONIC BRONCHITIS

49300 EXTRINSIC ASTHMA

49320 CHRONIC OBSTRUCTIVE ASTHMA

49321 CHRONIC OBST ASTHMA(W/OPD);W/STATUS ASTHMAT

49391 ASTHMA, UNSPECIFIED, WITH STATUS ASTHMATICU

50630 OTHER ACUTE AND SUBACUTE RESPIRATORY CONDIT

50700 PNEUMONITIS DUE TO INHALATION OF FOOD OR VO

51100 PLEURISY, W/O MENTION OF EFFUSION OR CURREN

51180 OTHER SPECIFIED FORMS OF EFFUSION, EXCEPT

51181 MALIGNANT PLEURAL EFFUSION

51189 OTHER SPECIFIED FORMS OF EFFUSION

51190 UNSPECIFIED PLEURAL EFFUSION

5120 PNEUMOTHORAX,SPONTANEOUS TENSION PREUMOTHOR

51200 SPONTANEOUS TENSION PNEUMOTHORAX

5128 OTHER SPONTANEOUS PNEUMOTHORAX

51280 OTHER SPONTANEOUS PNEUMOTHORAX

51400 PULMONARY CONGESTION AND HYPOSTASIS

51500 POST-INFLAMMATORY PULMONARY FIBROSIS

5168 OTHER SPECIFIED ALVEOLAR AND PARIETOALVEOLA

5180 PULMONARY COLLAPSE

51830 PULMONARY EOSINOPHILIA

5185 PULMONARY INSUFFIC FOLLOWING TRAUMA&SURGERY

51881 RESPIRATORY FAILURE

51882 PULMONARY INSUFFICIENCY

51884 ACUTE & CHRONC RESP FAIL

53021 ULCER OF ESOPHAGUS WITH BLEEDING

53082 ESOPHAGEAL HEMORRHAGE

53084 TRACHEOESOPHAGEAL FISTULA

53100 GASTRIC ULCER, ACUTE WITH HEMORRHAGE, WITH

53501 ACUTE GASTRITIS WITH HEMORRHAGE

53511 ATROPHIC GASTRITIS &HERMORRHAGE

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53521 HYPERTROPHIC GASTRITIS & HEMORRHAGE

53531 ALCOLHOLIC GASTRITIS & HEMORRHAGE

53541 GASTRITIS NEC & HEMORRHAGE

53551 UNSPECIFIED GASTRITIS AND GASTRODUODENITIS

53561 DUODENITIS & HEMORRHAGE

53783 ANGIODYSPLASIA UPPER GI & HEMORRHAGE

5400 ACUTE APPENDICITIS W/GEN.PERITONITIS

5401 ACUTE APPENDICITIS;W/PERITONEAL ABSCESS

5409 W/O MENTION OF PERITONITIS

55010 INGUINAL HERNIA, WITH OBSTRUCTION, W/O MENT

55220 VENTRAL HERNIA, UNSPECIFIED, WITH OBSTRUCTI

5570 ACUTE VASCULAR INSUFFICIENCY OF INTESTINE

560 INTESTIONAL OBSTRUCTION W/O MENTION HERNIA

5600 INTUSSUSCEPTION

5601 PARALYTIC ILEUS

5602 VOLVULUS

5603 IMPACTION OF INTESTINE

5608 OTHER SPECIFIED INTESTINAL OBSTRUCTION

56081 INTESTINAL OR PERITONEAL ADHESIONS WITH OBS

5609 UNSPECIFIED INTESTINAL OBSTRUCTION

56202 DIVRTICULOS-SM CUT/ HEMORRHAGE

56203 DIVRTICULIT-SM CUT/HEMORRHAGE

56212 DIVERTICULOSIS OF COLON WITH HEMORRHAGE

56213 DIVRTICULIT-COLON/HEMORRHAGE

56481 NEUROGENIC BOWEL

5693 HEMORRHAGE OF RECTUM AND ANUS

56985 BOWEL ANGIODYSPLASIA & HEMORRHAGE

5715 CIRRHOSIS OF LIVER W/O MENTION OF ALCOHOL

5722 HERPATIC COMA

57401 CALCULUS OF GALLBLADDER WITH ACUTE CHOLECYS

57411 CALCULUS OF GALLBLADDER WITH OTHER CHOLECYS

57431 CALCULUS OF BILE DUCT WITH ACUTE CHOLECYSTI

57451 CALCULUS OF BILE DUCT W/O MENTION OF CHOLEC

5750 ACUTE CHOLECYSTITIS

57700 ACUTE PANCREATITIS

5780 HEMATEMESIS

5781 MELENA

5789 HEMORRHAGE OF GASTROINTESTINAL TRACT UNSPE

5845 ACUTE RENAL FAILURE

5846 ACUTE RENAL FAILURE

5847 ACUTE RENAL FAILURE

5848 ACUTE RENAL FAILURE

5849 ACUTE RENAL FAILURE

59010 ACUTE PYELONEPHRITIS

5910 HYDRONEPHROSIS

5920 CALCULUS OF KIDNEY

5921 CALCULUS OF URETER

5929 URINARY CALCULUS, UNSPECIFIED

5940 CALCULUS IN DIVERTICULUM OF BLADDER

5941 OTHER CALCULUS IN BLADDER

5942 CALCULUS IN URETHRA

5948 OTHER LOWER URINARY TRACT CALCULUS

5949 CALCULUS OC LOWER URINARY TRACT,UNSPECIFIED

6330 ECTOPIC PREGNANCY ; ABDOMINAL

6331 TOTAL PREGNANCY

6332 OVARIAN PREGNANCY

6338 OTHER PREGNANCY

6339 UNSPECIFIED ECTOPIC PREGNANCY

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63400 SPONTANEOUS ABORTION COMPL. BY INFECT-UNSP

63401 INCOMPLETE

63402 COMPLETE

6341 SPONTANEOUS AB COMP BY DELAY/EXCESS HEMORRH

63410 UNSPECIFIED

63411 INCOMPLETE

63412 COMPLETE

63420 COMPLICATED BY DAMAGE TO PELVIC ORG. UNSPE

63421 INCOMPLETE

63422 COMPLETE

63430 COMPLIC. BY RENAL FAILURE UNSPECIFIED

63431 INCOMPLETE

63432 COMPLETE

63440 COMPLICATED BY METABOLIC DISORDER UNSPEC

63441 INCOMPLETE

63442 COMPLETE

63450 COMPLICATED BY SHOCK UNSPECIFIED

63451 INCOMPLETE

63452 COMPLETE

6346 SPONTANEOUS ABORTION COMP. BY EMBOLISM

63460 UNSPECIFIED

63461 INCOMPLETE

63462 COMPLETE

63470 WITH SPECIFIC COMPLICATIONS UNSPECIFIED

63471 INCOMPLETE

63472 COMPLETE

63480 WITH UNSPECIFIED COMPLCIATION UNSPECIFIED

63481 INCOMPLETE

63482 COMPLETE

63490 WITHOUT MENTION OF COMPLICATIONS UNSPECI

63491 INCOMPLETE

63492 COMPLETE

64000 HEM. IN EARLY PREG.-THREATENED ABORT/UNSPEC

64001 THREATENED ABORTION-DELIV. W/WO ANTE CON

64003 THREAT ABORT-ANTEP COND OR COMPLICATION

64080 OTHER SPEC HEM. EARLY PREG-UNSPECIFIED

64081 OTHER SPEC HEM. EARLY PREG-DEL. W/WO ANTE

64083 OTHER SPEC HEM. EARLY PREG-ANTE COND/COMP

64090 UNSPEC. HEM EARLY PREG- UNSPECIFIED

64091 UNSPEC HEM EARLY PREG-DEL W/WO ANTE COND

64093 UNSP HEM EARLY PREG-ANTE COND/COMPLICATION

641 PLACENTA PREVIA WITHOUT HEMORRHAGE

64100 PLACENTA PREVIA WITHOUT HEMORRHAGE, UNSPEC

6426 ECLAMPSIA

6560 FETAL-MATERNAL HEMORRHAGE

65600 UNSPECIFIED

65601 DELIV. W/WO MENTION ANTEPARTUM CONDITION

65603 ANTEPARTUM CONDITION/COMPLICATION

67450 PERIPARTUM CARDIOMYOPATHY

67451 PERIPARTUM CARDIOMYOPATHY

67452 PERIPARTUM CARDIOMYOPATHY

67453 PERIPARTUM CARDIOMYOPATHY

67454 PERIPARTUM CARDIOMYOPATHY

7100 SYSTEMIC LUPUS ERTHEMATOSUS

72886 NECROTIZING FASCITIS

73345 ASEPTIC NECROSIS OF BONE,JAW

76711 EPICRANIAL SUBAPONEUROTIC HEMORRHAGE MASSIV

77084 RESP FAILURE OF NEWBORN

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77181 SEPTICEMIA OF NEWBORN

77183 BACTEREMIA OF NEWBORN

7790 CONVULSIONS IN NEWBORN

7792 CEREBRAL DEPRESSION,COMA,OTH ABNORMAL SIGNS

77981 NEONATAL BRADYCARDIA

77982 NEONATAL TACHYCARDIA

78001 COMA

78009 ALTERATION OF CONSCIOUSNESS; OTHER (DROWSIN

7802 SYNCOPE AND COLLAPSE

7803 CONVULSIONS

78031 CONVULSIONS

78039 CONVULSIONS

7825 CYANOSIS

78302 CONVULSIONS

78303 CONVULSIONS

7855 SHOCK

78550 SHOCK, UNSPECIFIED

78551 CARDIOGENIC SHOCK

78552 SEPTIC SHOCK

78559 SHOCK W/O MENTION OF TRAUMA; OTHER

78600 RESPIRATORY ABNORMALITY, UNSPECIFIED

7865 CHEST PAIN

78650 CHEST PAIN; UNSPECIFIED

78651 PRECORDIAL PAIN

78652 PAINFUL RESPIRATION

78659 CHEST PAIN; OTHER (DISCOMFORT, PRESSURE, TI

78951 MALIGNANT ASCITES

78959 OTHER ASCITES

79001 DROP,HEMATOCRIT, PRECIP

7903 EXCESSIVE BLOOD LEVEL OF ALCOHOL

798 SUDDEN DEATH,CAUSE UNKNOWN

7980 SUDDEN DEATH, CAUSE UNKNOWN

7981 SUDDEN DEATH, CAUSE UNKNOWN

7982 SUDDEN DEATH, CAUSE UNKNOWN

7989 SUDDEN DEATH, CAUSE UNKNOWN

7990 ASPHYXIA

79901 ASPHYXIA

79902 HYPOXEMIA

7991 RESPIRATORY ARREST

80000 FRACTURE OF VAULT OF SKULL

80001 CLOSED W/OUT MENTION OF INTRACRANIAL INJURY

80002 CLOSED W/OUT MENTION OF INTRACRANIAL INJURY

80003 CLOSED W/OUT MENTION OF INTRACRANIAL INJURY

80004 CLOSED W/OUT MENTION OF INTRACRANIAL INJURY

80005 CLOSED W/OUT MENTION OF INTRACRANIAL INJURY

80006 CLOSED W/OUT MINTION OF INTRACRANIAL INJURY

80009 CLOSED W/OUT MENTION OF INTRACRANIAL INJURY

80010 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80011 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80012 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80013 CLOSED WTIH CEREBRAL LACERATION & CONTUSION

80014 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80015 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80016 CLOSED EITH CEREBRAL LACERATION & CONTUSION

80019 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80020 CLOSED W/SUBARACHNOID,SUBDURAL&EXTRAD. HEMO

80021 CLOSED W/SUBARACHNOID,SUBDURAL&EXTRAD.HEMOR

80022 CLOSED W/SUBARACHNOID,SUBDURAL,&EXTRAD.HEMO

HT940219R0001 Page 11 of 56

80023 CLOSED W/SUBARACHNOID,SUBDURAL,&EXTRAD.HEMO

80024 CLOSED W/SUBARACHNOID,SUBDURAL,&EXTRAD.HEMO

80025 CLOSED W/SUBARACHNOID,SUBDURAL,&EXTRAD.HEMO

80026 CLOSED W/SUBARACHNOID,SUBDURAL,&EXTRAD.HEMO

80029 CLOSED W/SUBARACHNOID,SUBDURAL,&EXTRAD.HEMO

80030 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80031 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80032 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80033 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80034 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80035 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80036 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80039 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80040 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80041 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80042 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80043 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80044 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80045 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80046 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80049 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80050 OPEN WITHOUT MENTION OF INTRACRANIAL INJURY

80051 OPEN WITHOUT MENTION OF INTRACRANIAL INJURY

80052 OPEN WITHOUT MENTION OF INTRACRANIAL INJURY

80053 OPEN WITHOUT MENTION OF INTRACRANIAL INJURY

80054 OPEN WITHOUT MENTION OF INTRACRANIAL INJURY

80055 OPEN WITHOUT MENTION OF INTRACRANIAL INJURY

80056 OPEN WITHOUT MENTION OF INTRACRANIAL INJURY

80059 OPEN WITHOUT MENTION OF INTRACRANIAL INJURY

80060 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80061 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80062 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80063 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80064 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80065 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80066 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80069 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80070 OPEN W/SUBARACHNOID,SUBDURAL&EXTRADURAL HEM

80071 OPEN W/SUBARACHNOID,SUBDURAL&EXTRADURAL HEM

80072 OPEN W/SUBARACHNOID,SUBDURAL&EXTRADURAL HEM

80073 OPEN W/SUBARACHNOID,SUBDURAL&EXTRADURAL HEM

80074 OPEN W/SUBARACHNOID,SUBDURAL&EXTRADURAL HEM

80075 OPEN W/SUBARACHNOID,SUBDURAL&EXTRADURAL HEM

80076 OPEN W/SUBARACHNOID,SUBDURAL&EXTRADURAL HEM

80079 OPEN W/SUBARACHNOID,SUBDURAL&EXTRADURAL HEM

80080 OPEN W/OTHER & UNSPEC.INTRACRANIAL HEMORRHA

80081 OPEN W/OTHER & UNSPEC.INTRACRANIAL HEMORRHA

80082 OPEN W/OTHER & UNSPEC.INTRACRANIAL HEMORRHA

80083 OPEN W/OTHER & UNSPEC.INTRACRANIAL HEMORRHA

80084 OPEN W/OTHER & UNSPEC.INTRACRANIAL HEMORRHA

80085 OPEN W/OTHER & UNSPEC.INTRACRANIAL HEMORRHA

80086 OPEN W/OTHER & UNSPEC.INTRACRANIAL HEMORRHA

80089 OPEN W/OTHER & UNSPEC.INTRACRANIAL HEMORRHA

80090 OPEN W/INTRACRAN.INJURY OF OTHER &UNSPEC.NA

80091 OPEN W/INTRACRAN.INJURY OF OTHER &UNSPEC.NA

80092 OPEN W/INTRACRAN.INJURY OF OTHER &UNSPEC.NA

80093 OPEN W/INTRACRAN.UNJURY OF OTHER &UNSPEC.NA

80094 OPEN W/INTRACRAN.INJURY OF OTHER &UNSPEC.NA

HT940219R0001 Page 12 of 56

80095 OPEN W/INTRACRAN.INJURY OF OTHER &UNSPEC.NA

80096 OPEN W/INTRACRAN.INJURY OF OTHER &UNSPEC.NA

80099 OPEN W/INTRACRAN.INJURY OF OTHER &UNSPEC.NA

80100 FRACTURED OF BASE OF SKULL

80101 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80102 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80103 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80104 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80105 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80106 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80109 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80110 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80111 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80112 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80113 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80114 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80115 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80116 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80119 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80120 CLOSED W/SUBARACHNOID,SUBDURAL&EXTRAD.HEMOR

80121 CLOSED W/SUBARACHNOID,SUBDURAL&EXTRAD.HEMOR

80122 CLOSED W/SUBARACHNOID,SUBDURAL&EXTRAD.HEMOR

80123 CLOSED W/SUBARACHNOID,SUBDURAL&EXTRAD.HEMOR

80124 CLOSED W/SUBARACHNOID,SUBDURAL&EXTRAD.HEMOR

80125 CLOSED W/SUBARACHNOID,SUBDURAL&EXTRAD.HEMOR

80126 CLOSED W/SUBARACHNOID,SUBDURAL&EXTRAD.HEMOR

80129 CLOSED W/SUBARACHNOID,SUBDURAL&EXTRAD.HEMOR

80130 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80131 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80132 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80133 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80134 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80135 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80136 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80139 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80140 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80141 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80142 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80143 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80144 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80145 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80146 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80149 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80150 OPEN W/O MENTION OF INTRACRANIAL INJURY

80151 OPEN WITHOUT MENTION OF INTRACRANIAL INJURY

80152 OPEN WITHOUT MENTION OF INTRACRANIAL INJURY

80153 OPEN WITHOUT MENTION OF INTRACRANIAL INJURY

80154 OPEN WITHOUT MENTION OF INTRACRANIAL INJURY

80155 OPEN WITHOUT MENTION OF INTRACRANIAL INJURY

80156 OPEN WITHOUT MENTION OF INTRACRANIAL INJURY

80159 OPEN WITHOUT MENTION OF INTRACRANIAL INJURY

80160 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80161 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80162 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80163 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80164 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80165 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80166 OPEN WITH CEREBRAL LACERATION AND CONTUSION

HT940219R0001 Page 13 of 56

80169 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80170 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80171 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80172 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80173 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80174 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80175 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80176 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80179 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80180 OPEN W/OTHER & UNSPEC.INTRACRANIAL HEMORRHA

80181 OPEN W/OTHER & UNSPEC.INTRACRANIAL HEMORRHA

80182 OPEN W/OTHER & UNSPEC. INTRACRANIAL HEMORRH

80183 OPEN W/OTHER & UNSPEC. INTRACRANIAL HEMORRH

80184 OPEN W/OTHER & UNSPEC.INTRACRANIAL HEMORRHA

80185 OPEN W/OTHER & UNSPEC. INTRACRANIAL HEMORRH

80186 OPEN W/OTHER AND UNSPEC. INTRACRANIAL HEMOR

80189 OPEN W/OTHER UNSPECIFIED INTRACRANIAL HEMOR

80190 OPEN W/INTRAC.INJURY OF OTHER & UNSPEC. NAT

80191 OPEN W/INTRAC.INJURY OF OTHER & UNSPEC. NAT

80192 OPEN W/INTRAC.INJURY OF OTHER & UNSPEC. NAT

80193 OPEN W/INTRAC.INJURY OF OTHER & UNSPEC. NAT

80194 OPEN W/INTRAC.INJURY OF OTHER & UNSPEC. NAT

80195 OPEN W/INTRAC.INJURY OF OTHER & UNSPEC. NAT

80196 OPEN W/INTRAC.INJURY OF OTHER & UNSPEC. NAT

80199 OPEN W/INTRAC.INJURY OF OTHER & UNSPEC. NAT

8020 MANDIBLE,FRACT.OF FACEBONES-NASAL BONES-CLO

8021 MANDIBLE, NASAL BONES OPEN

80220 MANDIBLE, UNSPECIFIED SITE

80221 CONDYLAR PROCESS

80222 SUBCONDYLAR

80223 CORONOID PROCESS

80224 RAMUS, UNSPECIFIED

80225 ANGLE OF JAW

80226 SYMPHYS IS OF BODY

80227 ALVEOLAR BORDER OF BODY

80228 BODY, OTHER AND UNSPECIFIED

80229 MULTIPLE SITES

80230 MANDIBLE, OPEN UNSPECIFIED SITE

80231 CONDYLAR PROCESS

80232 SUBCONDYLAR

80233 CORONOID PROCESS

80234 RAMUS, UNSPECIFIED

80235 ANGLE OF JAW

80236 SYMPHYSIS OF BODY

80237 ALVEOLAR BORDER OF BODY

80238 BODY, OTHER AND UNSPECIFIED

80239 MULTIPLE SITES

8024 MALAR AND MAXILLARY BONES, CLOSED

8025 MALAR AND MAXILLARY BONES, OPEN

8026 ORBITAL FLOOR (BLOW-OUT), CLOSED

8027 ORBITAL FLOOR (BLOW-OUT), OPEN

8028 OTHER FACIAL BONES, CLOSED

8029 OTHER FACIAL BONES, OPEN

80300 OTHER AND UNQUALIFIED SKULL FRACTURES,

80301 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80302 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80303 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80304 CLOSED W/O MENTION OF INTRACRANIAL INJURY

HT940219R0001 Page 14 of 56

80305 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80306 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80309 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80310 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80311 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80312 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80313 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80314 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80315 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80316 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80319 CLOSED WITH CEREBRAL LACERATION & CONTUSION

80320 CLOSED W/SUBARACHNOID,SUBDURAL & EXTRAD HEM

80321 CLOSED,W/SUBARACHNOID,SUBDURAL & EXTRAD.HEM

80322 CLOSED,W/SUBARACHNOID,SUBDURAL & EXTRAD.HEM

80323 CLOSED,W/SUBARACHNOID,SUBDURAL & EXTRAD.HEM

80324 CLOSED W/SUBARACHNOID,SUBDURAL & EXTRAD.HEM

80325 CLOSED W/SUBARACHNOID,SUBDURAL & EXTRAD.HEM

80326 CLOSED W/SUBARACHNOID,SUBDURAL & EXTRAD.HEM

80329 CLOSED W/SUBARACHNOID,SUBDURAL & EXTRAD.HEM

80330 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80331 CLOSED W/OTHER & UNSPEC.INTRACRACIAL HEMORR

80332 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80333 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80334 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80335 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80336 CLOSED W/OTHER & UNSPEC.INTRACRACIAL HEMORR

80339 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80340 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80341 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80342 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80343 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80344 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80345 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80346 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80349 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80350 OPEN W/OUT MENTION OF INTRACRANIAL INJURY

80351 OPEN W/OUT MENTION OF INTRACRANIAL INJURY

80352 OPEN W/OUT MENTION OF INTRACRANIAL INJURY

80353 OPEN W/OUT MENTION OF INTRACRANIAL INJURY

80354 OPEN W/OUT MENTION OF INTRACRANIAL INJURY

80355 OPEN W/OUT MENTION OF INTRACRANIAL INJURY

80356 OPEN W/OUT MENTION OF INTRACRANIAL INJURY

80359 OPEN W/OUT MENTION OF INTRACRANIAL INJURY

80360 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80361 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80362 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80363 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80364 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80365 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80366 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80369 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80370 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80371 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80372 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80373 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80374 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80375 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80376 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

HT940219R0001 Page 15 of 56

80379 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80380 OPEN W/OTHER & UNSPEC. INTRACRANIAL HEMOR

80381 OPEN W/OTHER & UNSPEC. INTRACRANIAL HEMORR

80382 OPEN W/OTHER & UNSPEC. INTRACRANIAL HEMORR

80383 OPEN W/OTHER & UNSPEC. INTRACRANIAL HEMORR

80384 OPEN W/OTHER & UNSPEC. INTRACRANIAL HEMORR

80385 OPEN W/OTHER & UNSPEC. INTRACRANIAL HEMORR

80386 OPEN W/OTHER & UNSPEC. INTRACRANIAL HEMORR

80389 OPEN W/OTHER & UNSPEC. INTRACRANIAL HEMORR

80390 OPEN W/INTRACRAN.INJURY OF OTHER & UNSPEC N

80391 OPEN W/INTRACRAN.INJURY OF OTHER & UNSPEC.N

80392 OPEN W/INTRACRAN.INJURY OF OTHER & UNSPEC.N

80393 OPEN W/INTRACRAN.INJURY OF OTHER & UNSPEC.N

80394 OPEN W/INTRACRAN.INJURY OF OTHER & UNSPEC.N

80395 OPEN W/INTRACRAN.INJURY OF OTHER & UNSPEC.N

80396 OPEN W/INTRACRAN.INJURY OF OTHER & UNSPEC.N

80399 OPEN W/INTRACRAN.INJURY OF OTHER & UNSPEC.N

80400 MULT.FRACT.INVOLV.SKULL/FACE W/OTHER BONES

80401 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80402 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80403 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80404 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80405 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80406 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80409 CLOSED W/O MENTION OF INTRACRANIAL INJURY

80410 CLOSED W/CEREBRAL LACERATION AND CONTUSION

80411 CLOSED W/CEREBRAL LACERATION AND CONTUSION

80412 CLOSED W/CEREBRAL LACERATION AND CONTUSION

80413 CLOSED W/CEREBRAL LACERATION AND CONTUSION

80414 CLOSED W/CEREBRAL LACERATION AND CONTUSION

80415 CLOSED W/CEREBRAL LACERATION AND CONTUSION

80416 CLOSED W/CEREBRAL LACERATION AND CONTUSION

80419 CLOSED W/CEREBRAL LACERATION AND CONTUSION

80420 CLOSED W/SUBARACHNOID,SUBDURAL & EXTRAD.HEM

80421 CLOSED W/SUBARACHNOID,SUBDURAL & EXTRAD.HEM

80422 CLOSED W/SUBARACHNOID,SUBDURAL & EXTRAD.HEM

80423 CLOSED W/SUBARACHNOID,SUBDURAL & EXTRAD.HEM

80424 CLOSED W/SUBARACHNOID,SUBDURAL & EXTRAD.HEM

80425 CLOSED W/SUBARACHNOID,SUBDURAL & EXTRAD.HEM

80426 CLOSED W/SUBARACHNOID,SUBDURAL & EXTRAD.HEM

80429 CLOSED W/SUBARACHNOID,SUBDURAL & EXTRAD.HEM

80430 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80431 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80432 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80433 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80434 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80435 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80436 CLOSED W/OTHER 3 UNSPEC.INTRACRANIAL HEMORR

80439 CLOSED W/OTHER & UNSPEC.INTRACRANIAL HEMORR

80440 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80441 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80442 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80443 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80444 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80445 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80446 CLOSED W/INTRACRAN.INJURY OF OTHER & UNSPEC

80449 CLOSED W/INTRACRAN.INJURY OF OTHER & INSPEC

80450 OPEN W/O MENTION OF INTRACRANIAL INJURY

HT940219R0001 Page 16 of 56

80451 OPEN W/O MENTION OF INTRACRANIAL INJURY

80452 OPEN W/O MENTION OF INTRACRANIAL INJURY

80453 OPEN W/O MENTION OF INTRACRANIAL INJURY

80454 OPEN W/O MENTION OF INTRACRANIAL INJURY

80455 OPEN W/O MENTION OF INTRACRANIAL INJURY

80456 OPEN W/O MENTION OF INTRACRANIAL INJURY

80459 OPEN W/O MENTION OF INTRACRANIAL INJURY

80460 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80461 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80462 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80463 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80464 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80465 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80466 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80469 OPEN WITH CEREBRAL LACERATION AND CONTUSION

80470 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80471 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80472 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80473 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80474 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80475 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80476 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80479 OPEN W/SUBARACHNOID,SUBDURAL & EXTRAD.HEMOR

80480 OPEN W/OTHER & UNSPEC. INTRACRANIAL HEMORRH

80481 OPEN W/OTHER & UNSPEC. INTRACRANIAL HEMORRH

80482 OPEN W/OTHER & UNSPEC. INTRACRANIAL HEMORRH

80483 OPEN W/OTHER & UNSPEC. INTRACRANIAL HEMORRH

80484 OPEN W/OTHER & UNSPEC. INTRACRANIAL HEMORRH

80485 OPEN W/OTHER & UNSPEC. INTRACRANIAL HEMORRH

80486 OPEN W/OTHER & UNSPEC. INTRACRANIAL HEMORRH

80489 OPEN W/OTHER & UNSPEC. INTRACRANIAL HEMORRH

80490 OPEN W/INTRACRAN.INJURY OF OTHER & UNSPEC.N

80491 OPEN W/INTRACRAN.INJURY OF OTHER & UNSPEC.N

80492 OPEN W/INTRACRAN.INJURY OF OTHER & UNSPEC.N

80493 OPEN W/INTRACRAN.INJURY OF OTHER & UNSPEC.N

80494 OPEN W/INTRACRAN.INJURY OF OTHER & UNSPEC.N

80495 OPEN W/INTRACRAN.INJURY OF OTHER & UNSPEC.N

80496 OPEN W/INTRACRAN.INJURY OF OTHER & UNSPEC.N

80499 OPEN W/INTRACRAN.INJURY OF OTHER & UNSPEC.N

80500 FRACT.VERT.CD-W/O MEN.OF SP.CORD INJY.UNSPC

80501 CERVICAL-CLOSED, FIRST CERVICAL VERTEBRA

80502 CERVICAL-CLOSED, SECOND CERVICAL VERTRBRA

80503 CERVICAL-CLOSED, THIRD CERVICAL VERTEBRA

80504 CERVICAL-CLOSED, FOURTH CERVICAL VERTEBRA

80505 CERVICAL-CLOSED, FIFTH CERVICAL VERTEBRA

80506 CERVICAL-CLOSED, SIXTH CERVICAL VERTEBRA

80507 CERVICAL-CLOSED, SEVENTH CERVICAL VERTEBRA

80508 CERVICAL-CLOSED, MULTIPLE CERVICAL VERTEBRA

80510 CERVICAL-OPEN, CERVICAL VERTEBRAL LEVEL

80511 CERVICAL-OPEN, FIRST CERVICAL VERTEBRA

80512 CERVICAL-OPEN, SECOND CERVICAL VERTEBRA

80513 CERVICAL-OPEN, THIRD CERVICAL VERTEBRA

80514 CERVICAL-OPEN, FOURTH CERVICAL VERTEBRA

80515 CERVICAL-OPEN, FIFTH CERVICAL VERTEBRA LEVE

80516 CERVICAL-OPEN, SIXTH CERVICAL VERTEBRA LEVE

80517 CERVICAL-OPEN, SEVENTH CERVICAL VERTEBRA LE

80518 CERVICAL-OPEN, MULTIPLE CERVICAL VERTEBRA

8052 FRAC CERVICAL COLUMN/DORSAL CLOSE WO MENT I

HT940219R0001 Page 17 of 56

8053 DORSAL OPENED

8054 LUMBAR CLOSED

8055 LUMBAR OPEN

8056 SACRUM/COCCYX CLOSED

8057 SACRUM/COCCYX OPEN

8058 UNSPECIFIED CLOSED

8059 UNSPECIFIED OPEN

80600 CERV.CLOSED-C1-C4 LEVEL W/UNSPEC.SPIN.CD.IN

80601 C1-C4 LEVEL WITH COMPLETE LESION OF CORD

80602 C1-C4 LEVEL WITH ANTERIOR CORD SYNDROME

80603 C1-C4 LEVEL WITH CENTRAL CORD SYNDROME

80604 C1-C4 LEVEL WITH OTHER SPEC.SPINAL CORD INJ

80605 C5-C7 LEVEL WITH UNSPEC. SPINAL CORD INJURY

80606 C5-C7 LEVEL WITH COMPLETE LESION OF CORD

80607 CERV-CLSD.C5-C7 LEVEL W/ANTERIOR CORD SYNDR

80608 C5-C7 LEVEL WITH CENTRAL CORD SYNDROME

80609 C5-C7 LEVEL WITH OTHER SPEC. SPINAL CORD IN

80610 CERV-OPEN,C1-C4 LEVEL W/UNSPEC.SPINAL CD IN

80611 C1-C4 LEVEL WITH COMPLETE LESION OF CORD

80612 C1-C4 LEVEL WITH ANTERIOR CORD SYNDROME

80613 C1-C4 LEVEL WITH CENTRAL CORD SYNDROME

80614 C1-C4 LEVEL WITH OTHER SPEC. SPENAL CD. INJ

80615 C5-C7 LEVEL WITH UNSPEC. SPINAL CORD INJURY

80616 C5-C7 LEVEL WITH COMPLETE LESION OF CORD

80617 C5-C7 LEVEL WITH ANTERIOR CORD SYNDROME

80618 C5-C7 LEVEL WITH CENTRAL CORD SYNDROME

80619 C5-C7 LEVEL WITH OTHER SPEC. SPINAL CORD IN

80620 DORSAL (THOR) CLSD.T1-T6 LEVEL W/UNSPEC.SPI

80621 T1-T6 LEVEL WITH COMPLETE LESION OF CORD

80622 T1-T6 LEVEL WITH ANTERIOR CORD SYNDROME

80623 T1-T6 LEVEL WITH CENTRAL CORD SYNDROME

80624 T1-T6 LEVEL WITH OTHER SPEC. SPINAL CORD IN

80625 T7-T12 LEVEL WITH UNSPECIFIED SPINAL CD.INJ

80626 T7-T12 LEVEL WITH COMPLETE LESION OF CORD

80627 T7-T12 LEVEL WITH ANTERIOR CORD SYNDROME

80628 T7-T12 LEVEL WITH CENTRAL CORD SYNDROME

80629 T7-T12 LEVEL WITH OTHER SPEC.SPINAL CD. INJ

80630 DORSAL(THOR)OPEN T1-T6 LEVEL W/UNSPEC.SPINA

80631 T1-T6 LEVEL WITH COMPLETE LESION OF CORD

80632 T1-T6 LEVEL WITH ANTERIOR CORD SYNDROME

80633 T1-T6 LEVEL WITH CENTRAL CORD SYNDROME

80634 T1-T6 LEVEL WITH OTHER SPEC.SPINAL CORD INJ

80635 T7-T12 LEVEL WITH UNSPEC.SPINAL CORD INJURY

80636 T7-T12 LEVEL WITH COMPLETE LESION OF CORD

80637 T7-T12 LEVEL WITH ANTERIOR CORD SYNDROME

80638 T7-T12 LEVEL WITH CENTRAL CORD SYNDROME

80639 T7-T12 LEVEL WITH OTHER SPEC.SPINAL CORD IN

8064 FRACT. VERTE COLUM WITH INJURY LUMBAR CLOSE

8065 LUMBAR OPEN

80660 SACRUM & COCCYX,CLSD.W/UNSPEC.SPINAL CD.INJ

80661 CLOSED, WITH COMPLETE CAUDA EQUINA LESION

80662 CLOSED, WITH OTHER CAUDA EQUINA INJURY

80669 CLOSED, WITH OTHER SPINAL CORD INJURY

80670 SACRUM & COCCYX,OPEN W/UNSPEC.SPINAL CD.INJ

80671 OPEN, WITH COMPLETE CAUDA EQUINA LESION

80672 OPEN, WITH OTHER CAUDA EQUINA INJURY

80679 OPEN, WITH OTHER SPINAL CORD INJURY

8068 UNSPECIFIED CLOSED

HT940219R0001 Page 18 of 56

8069 UNSPECIFIED OPEN

80700 FRACT.RIB(S),STERNUM,LARYNX & TRACHEA, UNSP

80701 RIB(S), CLOSED

80702 RIB(S), CLOSED

80703 RIB(S), CLOSED

80704 RIB(S), CLOSED

80705 RIB(S), CLOSED

80706 RIB(S), CLOSED

80707 RIB(S), CLOSED

80708 RIB(S),CLOSED

80709 RIB(S), CLOSED

80710 FRACT.RIB(S),STERNUM,LARYNX,TRACHEA OPEN

80711 RIB(S), OPEN

80712 RIB(S), OPEN

80713 RIB(S), OPEN

80714 RIB(S), OPEN

80715 RIB(S), OPEN

80716 RIB(S), OPEN

80717 RIB(S), OPEN

80718 RIB(S), OPEN

80719 RIB(S), OPEN

8072 FRACTURE OF STERNUM CLOSED

8073 OPEN

8074 FLAIL CHEST

8075 LARYNX AND TRACHEA CLOSED

8076 OPEN

8080 FRACTURE PELVIS ACETABULUM CLOSED

8081 OPEN

8082 FRACTURE PUBIS CLOSED

8083 OPEN

80841 OTHER SPECIFIED PART, CLOSED- ILIUM

80842 ISCHIUM

80843 MULTIPLE PELVIC FRACT. W/DISRUPT.OF PEL.CIR

80849 OTHER

8085 OTHER,SPECIFIED PART, OPEN

80851 OTHER SPECIFIED PART, OPEN- ILIUM

80852 ISCHIUM

80853 MULTIPLE PELVIC FRACT.W/DISRUPT.OF PELV.CIR

80859 OTHER

8088 FRACTURE PELVIS UNSPECIFIED CLOSED

8089 OPEN

8090 ILL DEFINED FRACTURE OF BONES OF TRUNK CLOS

8091 OPEN

81000 FRACT.OF CLAVICLE,UNSPEC. PART- CLOSED

81001 FRACT. OF CLAVICLE, STERNAL END OF CLAVICLE

81002 FRACT. OF CLAVICLE, SHAFT OF CLAVICLE

81003 FRACT. OF CLAVICLE,ACROMIAL END OF CLAVICLE

81010 FRACT.OF CLAVICLE UNSPEC. PART- OPEN

81011 FRACT.OF CLAVICLE-STERNAL END OF CLAVICLE

81012 FRACT.OF CLAVICLE-SHAFT OF CLAVICLE

81013 FRACT.OF CLAVICLE-ACROMIAL END OF CLAVICLE

81100 FRACT.OF SCAPULA UNSPEC. PART-CLOSED

81101 FRACT.OF SCAPULA-ACROMIAL PROCESS, CLOSED

81102 FRACT.OF SCAPULA-CORACOID PROCESS, CLOSED

81103 FRACT.OF SCAPULA-GLENOID CAV.& NECK OF SCAP

81109 FRACT. OF SCAPULA-OTHER, CLOSED

81110 FRACT.OF SCAPULA-UNSPEC. PART, OPEN

81111 FRACT.OF SCAPULA-ACROMIAL PROCESS, OPEN

HT940219R0001 Page 19 of 56

81112 FRACT.OF SCAPULA- CORACOID PROCESS, OPEN

81113 FRACT.OF SCAPULA-GLENOID CAV.& NECK OF SCAP

81119 FRACT.OF SCAPULA- OTHER, OPEN

81200 FRACT.OF HUMERUS-UPPER END,CLOSED,UNSPEC.PA

81201 FRACT.OF HUMERUS-CLOSED, SURGICAL NECK

81202 FRACT.OF HUMERUS-CLOSED, ANATOMICAL NECK

81203 FRACT.OF HUMERUS-CLOSED, GREATER TUBEROSITY

81209 FRACT.OF HUMERUS-CLOSED, OTHER

81210 FRACT.OF HUMERUS-UPPER END,OPEN UNSPEC.PART

81211 FRACT.OF HUMERUS-OPEN, SURGICAL NECK

81212 FRACT.OF HUMERUS-OPEN, ANATOMICAL NECK

81213 FRACT.OF HUMERUS-OPEN, GREATER TUBEROSITY

81219 FRACT.OF HUMERUS-OPEN, OTHER

81220 SHAFT OR UNSPEC.PART OF HUMERUS, CLOSED

81221 SHAFT OF HUMERUS OR UNSPEC. PART, CLOSED

81230 SHAFT OR UNSPEC. PART OF HUMERUS, OPEN

81231 SHAFT OF HUMERUS OR UNSPEC. PART, OPEN

81240 LOWER END, CLOSED, UNSPECIFIED PART

81241 LOWER END,CLOSED-SUPRACONDYLAR FRACT.OF HUM

81242 LOWER END-CLOSED, LATERAL CONDYLE

81243 LOWER END-CLOSED, MEDIAL CONDYLE

81244 LOWER END-CLOSED, CONDYLE(S), UNSPEC.

81249 FRACTURE HUMERUS LOWER END CLOSED OTHER

81250 LOWER END-OPEN, UNSPECIFIED PART

81251 LOWER END-OPEN, SUPRACONDYLAR FRACT OF HUME

81252 LOWER END,-OPEN, LATERAL CONDYLE

81253 LOWER END-OPEN, MEDIAL CONDYLE

81254 LOWER END-OPEN, CONDYLE(S), UNSPECIFIED

81259 LOWER END-OPEN, OTHER

81300 FRACT.OF RAD.& ULNA,UPER-END,FOREARM,UN.CLO

81301 UPPER END-CLOSED, OLECRANON PROCESS OF ULNA

81302 UPPER END-CLOSED, CORONOID PROCESS OF ULNA

81303 UPPER END-CLOSED, MONTEGGIA'S FRACTURE

81304 OTHER & UNSPEC.FRACT.OF PROXIMAL END OF ULN

81305 HEAD OF RADIUS

81306 NECK OF RADIUS

81307 OTHER & UNSPEC.FRACT.OF PROXIMAL END OF RAD

81308 RADIUS WITH ULNA, UPPER END (ANY PART)

81310 FRACT.OF RAD.& ULNA,UPPER-END OF FOREARM,OP

81311 UPPER END-OPEN, OLECRANON PROCESS OF ULNA

81312 UPPER END-OPEN, CORONOID PROCESS OF ULNA

81313 MONTEGGIA'S FRACTURE

81314 OTHER & UNSPEC.FRACT. OF PROXIMAL END OF UL

81315 HEAD OF RADIUS

81316 NECK OF RADIUS

81317 OTHER & UNSPEC.FRACT. OF PROX.END OF RADIUS

81318 RADIUS WITH ULNA,UPPER END (ANY PART)

81320 SHAFT, CLOSED, UNSPECIFIED

81321 SHAFT, CLOSED, RADIUS (ALONE)

81322 SHAFT, CLOSED, ULNA (ALONE)

81323 SHAFT, CLOSED, RADIUS WITH ULNA

81330 SHAFT- OPEN, UNSPECIFIED

81331 SHAFT- OPEN, RADIUS (ALONE)

81332 SHAFT- OPEN, ULNA (ALONE)

81333 SHAFT- OPEN, RADIUS WITH ULNA

81340 LOWER END OF FOREARM,CLOSED UNSPECIFIED

81341 LOWER END,CLOSED-COLLES' FRACTURE

81342 CLOSED,OTHER FRACT.OF DISTAL END OF RADIUS

HT940219R0001 Page 20 of 56

81343 CLOSED, DISTAL END OF ULNA (ALONE)

81344 CLOSED,RADIUS WITH ULNA, LOWER END

81345 TORUS FX RADIUS-CLOSED

81350 LOWER END OF FOREARM-OPEN, UNSPECIFIED

81351 LOWER END-OPEN, COLLES' FRACTURE

81352 OTHER FRACT.OF DISTAL END OF RADIUS (ALONE)

81353 LOWER END-OPEN, DISTAL END OF ULNA (ALONE)

81354 RADIUS WITH ULNA, LOWER END-OPEN

81380 UNSPEC. PART, CLOSED- FOREARM, UNSPEC.

81381 UNSPEC. PART-CLOSED, RADIUS (ALONE)

81382 UNSPEC. PART-CLOSED, ULNA (ALONE)

81383 UNSPEC. PART-CLOSED, RADIUS WITH ULNA

81390 UNSPEC. PART-OPEN, FOREARM, UNSPEC.

81391 UNSPEC. PART-OPEN, RADIUS (ALONE)

81392 UNSPEC. PART-OPEN, ULNA (ALONE)

81393 UNSPEC. PART-OPEN, RADIUS WITH ULNA

81400 FRACT.OF CARPAL BONES-CLOSED, UNSPECIFIED

81401 NAVICULAR (SCAPHOID) OF WRIST

81402 LUNATE(SEMILUNAR) BONE OF WRIST-CLOSED

81403 TRIQUETRAL (CUNEIFORM) BONE OF WRIST-CLOSED

81404 PISIFORM- CLOSED

81405 TRAPEZIUM BONE (LARGER MULTANGULAR)-CLOSED

81406 TRAPEZOID BONE (SMALLER MULTANGULAR)-CLOSED

81407 CAPITATE BONE (OS MAGNUM)- CLOSED

81408 HAMATE (UNCIFORM) BONE- CLOSED

81409 OTHER- CLOSED

81410 FRACT. OF CARPAL BONE(S), UNSPEC.

81411 NAVICULAR (SCAPHOID) OF WRIST-OPEN

81412 LUNATE (SEMILUNAR) BONE OF WRIST-OPEN

81413 TRIGUETRAL OPEN

81414 PISISFORM OPEN

81415 TRAPEZIUM BONE (LARGER MULTANGULAR)-OPEN

81416 TRAPEZOID BONE (SMALLER MULTANGULAR)- OPEN

81417 CAPITATE BONE (OS MAGNUM)- OPEN

81418 HAMATE (UNCIFORM) BONE- OPEN

81419 OTHER- OPEN

81500 FRACT.OF METACARPAL BONE(S)-CLSD- SITE UNSP

81501 FRACT.-BASE OF THUMB (FIRST) METACARPAL CLS

81502 BASE OF OTHER METACARPAL BONE(S)-CLOSED

81503 SHAFT OF METACARPAL BONE(S)-CLOSED

81504 NECK OF METACARPAL BONE(S)- CLOSED

81509 MULTIPLE SITES OF METACARPUS-CLOSED

81510 FRACT.OF METACARPAL BONE(S)-OPEN, SITE UNSP

81511 BASE OF THUMB (FIRST) METACARPAL-OPEN

81512 BASE OF OTHER METACARPAL BONE(S)-OPEN

81513 SHAFT OF METACARPAL BONE(S)-OPEN

81514 NECK OF METACARPAL BONE OPEN

81519 MULTIPLE SITES OF METACARPUS-OPEN

81600 FRACT.OF ONE/MORE PHALANGES OF HAND,UNSP.CL

81601 MIDDLE/PROXIMAL PHALANX OR PHALANGES-CLOSED

81602 DISTAL PHALANX OR PHALANGES-CLOSED

81603 MULTIPLE SITES- CLOSED

81610 FRACT.OF ONE/MORE PHALANGES, UNSPEC.-OPEN

81611 MIDDLE/PROXIMAL PHALANX OR PHALANGES-OPEN

81612 DISTAL PHALANX OR PHALANGES- OPEN

81613 MULTIPLE SITES- OPEN

8170 MULTIPLE FRACT. HAND BONES CLOSED

8171 OPEN

HT940219R0001 Page 21 of 56

8180 ILL DEFINED FRACT. OF UPPER LIMB CLOSED

8181 OPEN

8190 MULTIPLE FRACT. INVOLV. BOTH UPPER LIMB CLO

8191 OPEN

82000 TRANS.FRACT.-CLOSED INTRACAPSULAR SECT.UNSP

82001 EPIPHYSIS (SEPARATION)(UPPER)

82002 MIDCERVICAL SECTION

82003 BASE OF NECK

82009 OTHER

82010 TRANSCERVICAL FRACT.-OPEN INTRAC.SECT.OP.UN

82011 EPIPHYSIS (SEPARATION)(UPPER)-OPEN

82012 MIDCERVICAL SECTION- OPEN

82019 OTHER- OPEN

82020 PERTROCHANTERIC FRACT.CLSD.TROCHAN.SCT.UNSP

82021 INTERTROCHANTERIC SECTION- CLOSED

82022 SUBTROCHANTERIC SECTION- CLOSED

82030 PERTROCH.FRACT.OPEN-TROCHANTERIC SECT.UNSPE

82031 INTERTROCHANTERIC SECTION, OPEN

82032 SUBTROCHANTERIC SECTION, OPEN

8208 FRACTURE OF NECK OF FEMUR UNSPEC. CLOSED

8209 OPEN

82100 FRACT.OF OTHER/UNSPEC.PART OF FEMUR,CLOSED

82101 SHAFT, CLOSED

82110 SHAFT/UNSPEC. PART OF FEMUR, OPEN

82111 SHAFT, OPEN

82120 LOWER END, CLOSED

82121 CONDYLE, FEMORAL, CLOSED

82122 EPIPHYSIS, LOWER (SEPARATION) CLOSED

82123 SUPRACONDYLAR FRACTURE OF FEMUR, CLOSED

82129 OTHER, CLOSED

82130 LOWER END-OPEN, UNSPECIFIED PART

82131 CONDYLE, FEMORAL- OPEN

82132 EPIPHYSIS, LOWER (SEPARATION)- OPEN

82133 SUPRACONDYLAR FRACTURE OF FEMUR- OPEN

82139 OTHER- OPEN

8220 FRACTURE OF PATELLA CLOSED

8221 OPEN

82300 FRACT.OF TIB & FIB-TIBIA ALONE-UPPER END,CL

82301 UPPER END-CLOSED, FIBULA ALONE

82302 UPPER END-CLOSED, FIBULA WITH TIBIA

82310 UPPER END-OPEN, TIBIA ALONE

82311 UPPER END-OPEN, FIBULA ALONE

82312 UPPER END-OPEN, FIBULA WITH TIBIA

82320 SHAFT, CLOSED- TIBIA ALONE

82321 SHAFT, OPEN- FIBULA ALONE

82322 SHAFT-CLOSED, FIBULA WITH TIBIA

82330 SHAFT-OPEN, TIBIA ALONE

82331 SHAFT-OPEN, FIBULA ALONE

82332 SHAFT-OPEN, FIBULA WITH TIBIA

82340 TORUS FX OF TIBIA

82380 UNSPEC. PART-CLOSED, TIBIA ALONE

82381 UNSPEC. PART-CLOSED, FIBULA ALONE

82382 UNSPEC. PART-CLOSED, FIBULA WITH TIBIA

82390 UNSPEC. PART-OPEN, TIBIA ALONE

82391 UNSPEC. PART-OPEN, FIBULA ALONE

82392 UNSPEC. PART-OPEN, FIBULA WITH TIBIA

8240 FRACTURE OF ANKLE MEDIAL MALLEOLUS CLOSED

8241 OPEN

HT940219R0001 Page 22 of 56

8242 LATERAL MALLEOLOUS CLOSED

8243 OPEN

8244 BIMALLEOLAR CLOSED

8245 OPEN

8246 TRIMALLEOLAR CLOSED

8247 OPEN

8248 UNSPECIFIED CLOSED

8249 OPEN

8250 FRACTURE OF TARSAL/MATATARSAL BONES CALC. C

8251 OPEN

82520 FT.OTH.TARS.&MET.BON.CL.UNSP.BN.OF FT.EX.TO

82521 ASTRAGALUS,CLOSED

82522 NAVICULAR (SCAPHOID), FOOT- CLOSED

82523 CUBOID, CLOSED

82524 CUNEIFORM, FOOT- CLOSED

82525 METATARSAL BONE(S), CLOSED

82529 OTHER- CLOSED

82530 FT.OTH.TARS.&MET.BN.CL.UNSP.BN.OF FT.EX.TOE

82531 ASTRAGALUS

82532 NAVICULAR (SCAPHOID), FOOT

82533 CUBOID

82534 CUNEIFORM, FOOT

82535 METATARSAL BONES

82539 FRAC OF OTH TAR & META BONS, OP OTHER

8260 FRACTURE ONE/MORE PHALANGES OF FOOT CLOSED

8261 OPEN

8270 OTHER MULT/ILL DEFINED FRACT LOW LIMB CLOSE

8271 OPEN

8280 MULT. FRACTURE INVOLV. BOTH LOW LIMBS CLOSE

8281 OPEN

8290 FRACTURE IMSPECIFIED BONES CLOSED

8291 OPEN

8300 DISLOCATION OF JAW CLOSED

8301 OPEN

83100 DISLOCATION OF SHOULDER, CLOSED;UNSPECIFIED

83101 ANTERIOR DISLOCATION OF HUMERUS

83102 POSTERIOR DISLOCATION OF HUMERUS

83103 INFERIOR DISLOCATION OF HUMERUS

83104 ACROMIOCLAVICULAR (JOINT)

83109 OTHER

83110 DISLOCATION OF SHOULDER,OPEN; UNSPECIFIED

83111 ANTERIOR DISLOCATION OF HUMERUS

83112 POSTERIOR DISLOCATION OF HUMERUS

83113 INFERIOR DISLOCATION OF HUMERUS

83114 ACROMIOCLAVICULAR (JOINT)

83119 OTHER

83200 DISLOCATION OF ELBOW, CLOSED; UNSPECIFIED

83201 ANTERIOR DISLOCATION OF ELBOW

83202 POSTERIOR DISLOCATION OF ELBOW

83203 MEDIAL DISLOCATION OF ELBOW

83204 LATERAL DISLOCATION OF ELBOW

83209 OTHER

83210 DISLOCATION OF ELBOW, OPEN; UNSPECIFIED

83211 ANTERIOR DISLOCATION OF ELBOW

83212 POSTERIOR DISLOCATION OF ELBOW

83213 MEDIAL DISLOCATION OF ELBOW

83214 LATERAL DISLOCATION OF ELBOW

83219 OTHER

HT940219R0001 Page 23 of 56

83300 DISLOCATION OF WRIST, CLOSED; UNSPECIFIED

83301 RADIOULNAR (JOINT), DISTAL

83302 RADIOCARPAL (JOINT)

83303 MIDCARPAL (JOINT)

83304 CARPOMETACARPAL (JOINT)

83305 METACARPAL (BONE), PROXIMAL END

83309 OTHER

83310 DISLOCATION OF WRIST, OPEN; UNSPECIFIED

83311 RADIOULNAR (JOINT), DISTAL

83312 RADIOCARPAL (JOINT)

83313 MIDCARPAL (JOINT)

83314 CARPOMETACARPAL (JOINT)

83315 METACARPAL (BONE), PROXIMAL END

83319 OTHER

83400 DISLOCATION OF FINGER, CLOSED;UNSPECIFIED

83401 METACARPOPHALANGEAL (JOINT)

83402 INTERPHALANGEAL (JOINT), HAND

83410 DISLOCATION OF FINGER, OPEN;UNSPECIFIED

83411 METACARPOPHALANGEAL (JOINT)

83412 INTERPHALANGEAL (JOINT), HAND

83500 DISLOCATION OF HIP, CLOSED; UNSPECIFIED

83501 POSTERIOR DISLOCATION

83502…