U. S.

ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL FORT SAM HOUSTON, TEXAS 78234

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MEDICAL RECORDS ADMINISTRATION BRANCH I (BOOK 2 OF 2)

EDITION 101

TABLE OF CONTENTS Page APPENDIX A - Coding Principles...................................................................... APPENDIX B - Excerpts from Volume 1............................................................ APPENDIX C - Excerpts from Volume 2............................................................ APPENDIX D - Excerpts from Volume 3............................................................ APPENDIX E - Excerpts from External Cause of Injury Codes ......................... APPENDIX F - Excerpts from Military Occupational Specialty Codes............... A-1 B-1 C-1 D-1 E-1 F-1

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APPENDIX A - CODING PRINCIPLES EXPLANATION There are specific guidelines for coding diagnoses and surgical procedures. This appendix contains excerpts of coding principles (modified for instructional purposes) from the Individual Patient Data System (IPDS) User's Manual published by the U.S. Army Patient Administration Systems and Biostatistics Activity (PAS&BA). These excerpts provide coding principles for diagnostic and operative coding using the ICD-9-CM. The IPDS User's Manual includes additional principles that are not provided in this appendix. The numbers for each of the principles in this appendix are the same as the corresponding principle in the IPDS User's Manual so you will be able to identify the principles that are not covered in this subcourse. In previous lessons, you have reviewed the preliminary coding guidelines that, for the most part, are applicable generically; i.e., they apply to all coding processes. To provide more specific guidance, this appendix includes 18 principles in short, narrative form. However, each coder should have his/her own copy of the Triservice Disease and Procedure Coding Guidelines ICD-9-CM , which became effective 1 January 1991. Principle I. SUSPECTED CONDITIONS 1. Qualifying adjectives used in the final diagnostic statement imply that a final judgment has not been made. When words such as "suspected," "probable," "questionable," "likely," etc., are used in the diagnosis, code the condition as if it were a confirmed diagnosis. 2. The code assigned to the questionable condition may be used as the principal diagnosis if it was proven to be the condition, after study, that occasioned this admission. 3. Qualifying adjectives such as "Rule Out," "R/O," and "Ruled Out" present special problems for which the following coding rules have been developed. a. Rule Out and R/O. When these words appear in the final diagnostic statement, they have the same meaning as "suspected" and are to be coded as if the condition were confirmed. b. When "Ruled Out," "Not Proven," "Not Confirmed," and "No Evidence Of" appear as part of the diagnosis or the diagnosis is stated in terms which indicate the absence of the condition under investigation, the appropriate code from the Supplementary Classification (V71 category) will be used. The medical record documentation must support the investigation of the suspected condition. Admissions following head trauma where there is no visible evidence of injury and which after observation show no evidence of after effects are coded to V71.4--Ø, the code extender for Observation, head injury, ruled out. (V713-V716 categories require STANAG Cause of Injury Code and Trauma code.) Note that codes from the V71 category may only be used as a principal diagnosis.

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4. Acute and Chronic. When a specific disease is stated as both acute and chronic and the Alphabetic Index provides separate codes for each condition, both will be coded. If the condition described as both acute and chronic was listed as the cause of admission, the acute condition will be indicated as the principal diagnosis. 5. Subacute. If the condition is stated as subacute and the Alphabetic Index does not provide a specific code for the subacute stage, then the code provided for the acute stage of the condition will be used. 6. Acute Upper Respiratory Infection (URI). Occasionally, this diagnosis is written as Acute Respiratory Disease (ARD). Either of the terms used with conditions that are clearly Acute Upper Respiratory Infection should be coded to 465 category. APPLICATION 1. Suspected Conditions. When the final diagnosis is qualified as possible, suspected, probable, etc., it is coded as a confirmed diagnosis. EXAMPLE: DIAGNOSIS: Suspected pneumococcal pneumonia 2. Rule Out, R/O. These terms indicate a suspected condition and are coded as confirmed diagnoses. EXAMPLE: DIAGNOSIS: Rule Out Sepsis. Ø38.9 481

3. Ruled Out. Conditions stated as ruled out, not proven, no evidence of, or other terms indicating the absence of a condition are coded to the Supplementary Classifications Category V71 (observation and evaluation for suspected condition), with the exception of head trauma. EXAMPLES: a. DIAGNOSIS: Pulmonary emboli, ruled out. b. DIAGNOSIS: Questionable concussion, ruled out. V71.8 V71.4--Ø

4. Acute/Subacute and Chronic. If a disease is stated as both acute/subacute and chronic and the Alphabetic Index provides a separate code for each condition, use both codes. EXAMPLE: DIAGNOSIS: Acute and chronic gonococcal salpingitis Ø98.17 Ø98.37

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5. Acute Upper Respiratory Infection (URI). Frequently this diagnosis is written : Acute Respiratory Disease or simply ARD. EXAMPLES: a. DIAGNOSIS: ARD Viral b. DIAGNOSIS: Acute Upper Respiratory Infection URI PRINCIPLE II. MULTIPLE CODING 1. Multiple coding as used throughout these coding guidelines is defined as the assignment of more than one code to fully identify all the component parts of a diagnostic/procedure statement. In the diagnostic classification multiple coding was developed to increase specificity by identifying associated conditions or those which have a cause and effect relationship. Some instances where multiple coding will be used are late effects (cause of) with residuals, etiology (underlying cause) with manifestations and/or complications, adverse effects of medications with drugs (E Codes), and pregnancy related complications (see principle IX). In the procedure, classification multiple coding was developed to identify any additional components of a procedure (if performed) and to identify any synchronous (performed at the same time) procedures. WHEN MULTIPLE CODING IS USED a. Written Instructions: (1) Code also . . . . (a) Further instruction in the Tabular List, Volume 1, to code the underlying cause (etiology) is indicated by "Code also..." It is an instruction to code "first"; therefore, the etiology code is sequenced first. Italicized codes in slanted brackets are used to identify the manifestations. (b) Multiple coding of procedures is indicated by the term "Code also..." to identify adjunct or synchronous procedures done, i.e., those performed or occurring at the same time. "Code also" has a different significance in procedure coding from that in diagnostic coding; there is no implication of sequencing or mandatory multiple coding attached to it. (2) Use additional code . . . .The user should add further information to give a more complete description of the diagnosis or procedure. (3) Note . . . .Some main terms are followed by notes that define terms and give coding instructions. 465.9 465.9

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b. Without Written Instructions: (1) Late effects (cause of) with residual. The residual code is sequenced before the late effect code. (2) Etiology (underlying cause) with manifestations/ complications. Code first the underlying cause, then the manifestation/complication. (3) Adverse effects of medication with drugs (E Codes). This mandates that both codes be used and sequenced with the reaction first followed by the E code. (4) Any other conditions in the main classification that can be more completely identified by the use of multiple coding. NUMBER OF CODES REQUIRED 2. The number of codes to be used depends upon the needs of the user. Avoid indiscriminate coding of all signs and symptoms with their accompanying definitive diagnoses, laboratory test results, social factors and other personal, nonmedical data mentioned in the record. Code only those conditions that require treatment or management during the current episode of hospitalization. DO NOT CODE conditions stated as "history of," "status post," etc., not treated or managed during current hospitalization. EXCEPTION: Personal history of malignant neoplasm V10.00-V10.9 for a previously treated malignant neoplasm with no evidence of recurrence in the primary site. (See principle VIII (Neoplasms.)* 3. Diseases/conditions that are treated in one facility before transfer to another are not coded by the receiving facility unless that disease/condition is still present and being treated. EXCEPTION: When coding underlying cause of death/separation, the receiving facility will code the actual disease/condition that caused the death/separation, even if not treated by that facility. APPLICATION 1. Written Instruction: a. Code also . . . . DIAGNOSIS: Acute myocarditis, secondary to tuberculosis. Code also underlying disease as: myocarditis (acute): influenza (487.8) tuberculosis (017.9)

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EXAMPLES DIAGNOSIS: Acute myocarditis secondary to tuberculosis DIAGNOSIS: Phagolytic glaucoma with hypermature cataract DIAGNOSIS: Temporary colostomy with cecectomy b. Use additional code . . . . The words "if desired" as appears in above should be deleted where found throughout the coding books. All Army MTFs will use additional codes. EXAMPLE: Use additional code, to identify infectious organism. DIAGNOSIS: Acute Pharyngitis, staphylococcal. c. Note . . . . The term "Note" is found in both Diseases and Procedures Indexes and Tabulars. In the Procedures Tabular "Note" may appear at the two- or three-digit level ; and in the Disease Tabular at the category level. Guidance on use of fifth-digit subclassification codes is a "Note" instruction without the actual term. EXAMPLE: DIAGNOSIS: Third degree burn to trunk comprising 20 percent body surface. NOTE: This category is to be used when the site of the burn is unspecified or with categories 940-947 when the site is specified. Third-degree burn to trunk, 20 percent body surface 2. Without Written Instructions: a. Late effect (cause of) with residual. If both the residuals and the cause of the late effect are provided, sequence the code for the residuals first. If the cause of the late effect is specified but not the residuals, code the cause of the late effect. DIAGNOSIS: Hemiplegia secondary to poliomyelitis 12 years ago. (See principle XV for definitions of late effect.) 942.3Ø 948.22 462 Ø41.1 Ø17.9Ø 422.Ø 366.18 365.51 46.11 45.72

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EXAMPLE: Hemiplegia; Late effect of Poliomyelitis b. Etiology with manifestation(s). EXAMPLE: DIAGNOSIS: Cataract, Diabetic. Diabetes Cataract c. Adverse effects of medications. Sequence first the code which identifies the manifestation or the nature of the adverse reaction. An additional code must be used to identify the drug causing the adverse reaction. DIAGNOSIS: Gastritis, secondary to prescribed dosage of aspirin. EXAMPLE: Gastritis, secondary to aspirin 535.4 E935.3 25Ø.5Ø[36641] 342.9 138

3. Use the multiple coding principle for any other conditions in the main classification that can be more completely identified by the use of more than one code. EXAMPLE: DIAGNOSIS: Postoperative thrombophlebitis femoral vein, following hysterectomy Thrombophlebitis during or resulting from a procedure NEC femoral 451.11 PRINCIPLE III. COMBINATIONS AND DOD CODE EXTENDERS 1. Two conditions or a specific diagnosis with an associated secondary process or complication are frequently assigned to the same code. This is referred to as a combination code. Where the coding books provide a single code to fully identify all the conditions described in the diagnostic statement, the one code is sufficient. 2. The combination code may not be so stated in the RUBRIC (Category) title, but may have its own fourth-digit (subcategory) title to identify both disease conditions. EXCEPTION: Where specific instructions in this user's manual direct other -wise; for example, see principle XII (Drug and Alcohol). 997.2 451.11 997.2

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3. There have been a number of codes in the ICD-9-CM code books "modified" to meet the needs of the services. Numeric characters have been added at the seventhdigit level of a coding field. These codes are referred to as DOD Code Extenders. 4. The DOD Code Extenders are found in Appendix A of the Triservice Disease and Procedure Coding Guidelines ICD-9-CM . To ensure that these codes are used when appropriate, all military MTF users of ICD-9-CM code books are responsible for posting all DOD Code Extenders to their books. APPLICATION 1. Combination Codes. Two or more conditions or a specific disease condition with an associated secondary process or complication is frequently assigned one code, a combination code. EXAMPLE: DIAGNOSIS: Acute appendicitis with perforation and peritonitis. 54Ø.Ø

2. DOD Code Extenders. A number of codes in ICD-9-CM have been modified to meet the needs of the Uniformed Services. EXAMPLE: DIAGNOSIS: Lyme Disease PRINCIPLE IV. V CODES 1. The purpose of the V codes is to identify encounters with the health care settings for reasons other than an illness or injury classified to categories ØØ1 -999. The majority of the V codes are oriented toward ambulatory care. Although certain categories of V codes will be used quite frequently for inpatient care, coders should exercise care regarding the extent to which these codes are used on inpatient records. 2. The V code is primarily for use as a supplemental code with the primary code being the current condition which requires hospitalization. However, it may be used as a solo code for inpatients without disease or current injury; for example, a patient who is admitted for surgical or orthopedic aftercare, as an organ or tissue donor, newborn, etc. In these cases, the V code will be the principal diagnosis. 3. The diagnostic statements requiring a V code appear in a variety of terms. The Alphabetic Index does not provide an exhaustive list of terms, but it does provide some key works under which the appropriate V code may be found. Some of the key words are: Admission, Examination, History, Observation, Problem, Status, etc. Ø88.81

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4. Subcategories and Subclassifications V1Ø.Ø-V1Ø.9 are to be used only as additional codes in classifying the primary site of a previously excised or eradicated malignant neoplasm with no evidence of recurrence of the primary site. Subcategory codes V1Ø.6Ø-V1Ø.79 are also used only as additional codes for classifying leukemia and other lymphatic and hematopoietic neoplasms in remission (see principle VIII, Neoplasms). 5. Subcategory code V15.Ø (allergy, other than to medicinal agents) may be used as principal diagnosis, solo code, or it may be used as an additional code as appropriate. For example, it will be used to denote hypersensitivity to insect sting (bite) where that condition results in disability separation/failure to meet medical procurement standards. 6. Subclassification code V15.81 should be used when indicated for patients who do not comply with prescribed medical treatment. This will be used only as an additional code. 7. Subcategory V22.2 (Pregnant State, Incidental) will be used only as an additional code; for example, when the cause of admission is not the pregnancy but an unrelated condition (fractured femur, patient is 3 months pregnant). 8. Subcategory V24.0 (Postpartum Care and Examination Immediately After Delivery) will be used only when patient is admitted immediately following delivery for routine care. Should be used only as principal diagnosis. 9. Subcategory V25.2 (Sterilization). This code is to be used for elective sterilization procedures of both males and females. It is to be used only when the sterilization procedure was performed for the major purpose of contraception rather than for treatment of a disease where sterilization is an incidental result, using the following guidelines: a. If the primary reason for admission is for elective sterilization for contraceptive purposes, use code V25.2 as the cause of admission. If the sterilization is purely elective, code V25.2 will suffice as a solo code for the diagnosis. b. If the sterilization procedure was performed for contraceptive purposes during a current admission for obstetrical delivery, use code V25.2 as an additional code. However, if the sterilization was an end result of a hysterectomy performed because of injury or damage to the uterus during delivery, do not use code V25.2. c. Do not use code V25.2 when the major purpose of the procedure performed was not for contraception; for example, when a hysterectomy is performed for cancer of the uterus. 10. Category V27 (Outcome of Delivery) will be used on the mother's record to denote whether the delivery process resulted in a live -born, stillborn, multiple birth or any combination thereof. The proper use of the V27 category is explained further in Principle IX (OB-GYN Conditions).

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11. Categories V3Ø-V37 (Live-Born Infants According to Type of Birth) will be used for coding of live-born infants. The appropriate fourth digit ".Ø" (Born in Hospital) and ".1" (Born Before Admission to Hospital) will separate hospital births from those born en route or shortly before admission. For inpatient care " .2" (Born Outside Hospital and Not Hospitalized) will not be used on inpatient records. V39 (Unspecified Live Birth) will not be used for inpatient care. (For further details and application of the V30 -V37 categories, see Principle X ( Perinatal Morbidity and Mortality.) 12. Category V42 (Organ or Tissue Replaced by Transplant) may be used, as appropriate, for inpatient care. The subcategory codes are status codes to indicate the presence of a transplanted organ/tissue. These codes will never be used as the cause of admission or principal diagnosis. (For further details and application of this category, see Principle XVI.) 13. Category V44 (Artificial Opening Status) and V45 (Other Post -Surgical Status) are appropriate for inpatient coding to describe a post -surgical status that affects patient care management, for example, V45.1 (Renal dialysis status). These codes will never be used as the cause of admission. 14. Categories V5Ø-V59 (Persons Encountering Health Service for Specific Procedures and Aftercare) will have inpatient utilization as follows: a. Subcategory V5Ø.1 (Other Plastic Surgery for Unacceptable Cosmetic Appearance) will be used as the diagnostic code to support surgery done for purely cosmetic reasons as distinguished from therapeutic indications. A few surgical procedures that can be done for therapeutic reasons but are often done for purely cosmetic purposes are mammary augmentation, facial rhytidectomy (face lift), blepharoplasty, rhinoplasty, and otoplasty. Use of this diagnostic code excludes plastic surgery following healed injury or operation. Category code V51 will be used to support plastic surgery done following previous surgery or injury. b. Categories V51-V58 are for use in indicating a reason for care of patients who have already been treated for some disease or injury not now present. c. Subcategories V54.Ø and V54.8 (Other Orthopedic Aftercare) would be used when a patient is admitted for routine removal of device following "healed fracture" or similar condition. Either code can be a sole diagnostic code used as the cause of admission. d. Subcategories V55.Ø-V55.3 (Attention to Artificial Openings) may be used to classify admission without mention of complication but for the purpose of closing or revising the ostomy site. e. Category V59 (Donors) provides a classification for donor of tissues or organs. (For further details and application of this category, see Principle XVI.) 15. Subcategory V63.2 (Person Awaiting Admission to Adequate Facility Elsewhere) is a possible code for use in those instances where the patient is being held in the hospital pending transfer to another institution. It is to be used as an additional code only.

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16. Subcategories V64.1-V64.3 provide a classification for those patients admitted for a scheduled procedure but discharged with surgery cancelled shortly after admission. These codes will not be used as the cause of admission. 17. Subcategory V65.2 (Person Feigning Illness (Malingerer)) should be used only after the record has been reviewed by either a department chief, the chief of professional services, or a medical care evaluation committee because of the legal implications (Manual of Courts-Martial, 1969, para 194). 18. Category V67 (Follow-up Examination) will be used to include surveillance only following treatment, and will be used for follow-up exams for patients with previously treated neoplasms. 19. V7Ø category will be used for examination and screening for specified circumstances. Code V7Ø.8 will be used for examination of potential organ or tissue donors. (See Principle XVI.) 20. Category V71 will be used for inpatients to classify observations and evaluation for suspected conditions which show no need for further treatment or medical care. Codes from this category can only be used as the principal diagnosis. APPLICATION 1. V Codes are primarily for use as a supplemental code with the primary code being the current condition which requires hospitalization. However, it may be used as a solo code for inpatients without disease or current injury. It may be used as the principal diagnostic code to support surgery done for purely cosmetic purposes. EXAMPLE: DIAGNOSIS: Protruding ears. (Eight-year old is admitted for Otoplasty.)V50.1 744.29 2. A V code denotes hypersensitivity to insect sting (bite) where that condition results in disability separation/failure to meet medical procurement standards. EXAMPLE: DIAGNOSIS: Hypersensitivity to bee sting. (Patient is being separated from the Service.) V15.Ø

3. Sterilization. If the primary reason for admission was for elective sterilization, use code V25.2. Also, use this V code as an additional code if the sterilization procedure was performed for contraceptive purposes during a current obstetrical delivery admission. Do not use this V code when the major purpose of the procedure performed was not for elective sterilization, but to remedy a disease process.

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EXAMPLE: DIAGNOSIS: Admitted for a Laparoscopy with Tubal Ligation. (Patient has five children.) V25.2

4. Category V44 and V45. Appropriate for inpatient coding to describe a postsurgical status that affects patient care management. EXAMPLE: DIAGNOSIS: Acute Pharyngitis: Patient has a temporary Tracheostomy 462 V44.Ø

5. Subcategories V64.1-V64.3 provide a classification for those patients admitted for a scheduled procedure but discharged with surgery cancelled shortly after admission. EXAMPLE: DIAGNOSIS: Chronic Tonsillitis : Patient admitted for Tonsillectomy May 3 1979: Surgery cancelled. Patient is running temperature.

474.Ø 78Ø.6 V64.1

6. Category V71 will be used for inpatients to classify observations and evaluation for suspected conditions which show no need for further treatment or medical care. EXAMPLE: DIAGNOSIS: Observation following auto accident, no injury found. PRINCIPLE V. SURGERY AND PROCEDURES 1. The ICD-9-CM procedure classification is contained in a separate volume 3 which includes the Tabular List and Alphabetic Index. The procedure classification has 16 chapters of which 15 are assigned to anatomical sites (body systems). All surgical procedures on a single body system appear together as follows: CHAPTER CODES Ø1-Ø5 Ø6-Ø7 Ø8-16 18-2Ø V71.4--9

1 Operations on the Nervous System 2 Operations on the Endocrine System 3 Operations on the Eye 4 Operations on the Ear

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5 Operations on the Nose, Mouth, and Pharynx 6 Operations on the Respiratory System 7 Operations on the Cardiovascular System 8 Operations on the Hemic and Lymphatic System 9 Operations on the Digestive System 10 Operations on the Urinary System 11 Operations on the Male Genital System 12 Operations on the Female Genital System 13 Obstetrical Procedures 14 Operations on the Musculoskeletal System 15 Operations on the Integumentary System

21-29 3Ø-34 35-39 4Ø-41 42-54 55-59 6Ø-64 65-71 72-75 76-84 85-86

Chapter sixteen is devoted to miscellaneous diagnostic, therapeutic, and prophylactic nonsurgical procedures on all body systems and include the following: (1) Diagnostic Radiology by anatomical site, distinguishing between Tomography, Contrast Radiology, and Flat X-ray. (2) Diagnostic Ultrasound and Thermography. (3) Nuclear Medicine, both diagnostic and therapeutic. (4) Physical Therapy, Respiratory Therapy, Rehabilitation, and related procedures. (5) Prophylactic vaccination and innoculation. 2. Alphabetic Index a. The Alphabetic Index is organized by "main terms" printed in bold typeface which usually identify the type of procedure performed. The "main terms" represent: Procedures -- Aortogram, audiometry Operations -- Appendectomy, cholecystectomy Nouns -- Operation, procedure Verbs -- Shortening, repair b. Eponyms (procedures named after people) are listed in the Alphabetic Index both as main term entries in alphabetical sequence and under the main term "operation." A description of the procedure or anatomic site usually follows the eponym.

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EXAMPLES: Baldy-Webster operation (uterine suspension) 69.22 Emmet operation (cervix) 67.61 c. A main term may be followed by a series of words (modifiers) in parenthesis. The presence or absence of these modifiers in the procedure do not affect the selection of the code. EXAMPLE: Decortication Lung (Partial) (Total) 34.51 d. A main term may be followed by individual indented line entries ( subterms) which describe a difference in site, surgical technique, approaches, and the extent of the procedure. The presence of these entries do affect the selection of the code. EXAMPLE: Excision lesion (local) skin 86.3 breast 85.21 nose 21.32 radical (wide) . . . 86.4

3. Tabular List The procedure code structure is as follows: a. Two digit section codes which provide a section heading by site and general description of the procedure. EXAMPLE: 32 Excision of lung and bronchus. b. Three digit category codes which specify the procedure. EXAMPLE: 32.0 Local excision or destruction of lesion or tissue of bronchus.

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c. Four digit subcategory codes which provide greater specificity in identifying anatomical sites and defining selected procedures, techniques, or the surgical approach. When a three-digit code is followed by a four-digit code, the four-digit code must be used. The four-digit codes are also used to differentiate between unilateral and bilateral, and between types of conditions such as direct and indirect hernia. EXAMPLE: 32.2 Local excision or destruction of lesion or tissue of lung 32.21 Plication of emphysematous bleb 32.29 Other local excision or destruction of lesion or tissue of lung 4. The two instructions unique to Volume 3 are: a. Omit code. b. Code also any synchronous procedure. 5. The following guidelines are to be used for coding procedures: a. The surgical approach and closure as part of the operation do not require additional codes. Procedures such as laparotomy are not coded if used as an approach for a surgical procedure such as excision or repair. b. When a biopsy is performed as part of a more extensive surgical procedure, code both the biopsy and surgical procedure. c. If a procedure is started and not completed, the approach (incision) is coded. 6. Instructions for Coding Procedures/Use of Alphabetic Index Volume 3 a. Use the Alphabetic Index to locate the main term (procedure): excision, incision, graft, control, etc. b. Read and be guided by any note that appears under the main term such as "see" and "see also." c. Read any terms enclosed in parentheses (modifiers) following the main entry as well as subterms indented under the main entry for selection of the appropriate code. d. Follow any cross-reference instructions. e. Do not code from the Alphabetic Index, important instructions appear in the Tabular List. Verify the code number in the Tabular List.

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7. Instructions for Coding Procedures/Use of Tabular List a. Refer to the Tabular List to verify that the code selected is in accordance with the desired classification of the procedure. b. Read and be guided by the inclusion or exclusion notes that may appear not only under the particular code but also under the category code or section title for that particular code. c. Use as many codes as necessary to adequately classify a surgical procedure, unless instructed otherwise by the term "omit code." 8. Sequencing Guidelines a. Report all significant procedures. A significant procedure is one which carries an operative or anesthetic risk, or requires highly trained personnel, and requires special facilities or equipment. Verify procedures were performed and not just scheduled. To increase accuracy and specificity of coding, examine the discharge summary, operative reports, x-rays, pathology reports, notes, and orders for additional procedures not listed on the Inpatient Treatment Record Coversheet (ITRCS) by the physician. b. The principal procedure is listed as the first procedure statement on the ITRCS. The principal procedure is that procedure most related to the principal diagnosis. A principal procedure is one which was performed for definitive treatment (therapeutic) rather than one performed for diagnostic or exploratory purposes. c. When a diagnostic procedure is relat ed to the principal diagnosis and a therapeutic procedure is related to a secondary diagnosis, then the principal procedure is the therapeutic procedure. d. When two or more therapeutic procedures are performed and all or none are related to the principal diagnosis, then the procedure during which tissue was removed or the procedure which subjected the patient to the greatest risk is selected as the principal procedure. e. If diagnostic procedures are performed and all or none of them relate to the principal diagnosis, select the procedure which impacts most dramatically on resource usage. f. An incidental appendectomy (47.1) should not be coded as a principal procedure. g. If there is a disagreement between the ITRCS and the operation/tissue report, refer the record back to the supervisor and/or physician for clarification.

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9. Conventions and Instructional Terms Conventions, abbreviations, and instructional terms used in the procedure classification are similar to those in the diagnostic classification. Includes: Inclusions are separate terms entered under a two or three digit code. These inclusion terms represent only the most frequently used terms and serve as a guide to examples of the procedures included in the code and title. Other terms also classified to that code and title are found in the Index. The location of the term "includes" indicates which codes are included. "Includes" at section level applies to all codes in that section. 85 Operation on the Breast Includes: Operations on skin of: Breast Female or Previous Mastectomy Site Male

}

"Includes" at category level applies to all codes in that category. 09.4 Manipulation of lacrimal passage Includes: removal of calculus that will dilation Excludes: Exclusions are italicized terms prefaced by a box, indicating that the code and title do not include these terms. The position of the exclusion terms is the same as the inclusions and have the same significance as the inclusion terms with the same application. When both inclusion and exclusion terms appear together, the inclusion terms are listed first.

Note: Notes appear in the Index and Tabular List. See: This instruction tells the coder to look elsewhere for the code.

Excision fallopian tube - see salpingectomy See Also: This instruction is a suggestion to look further if the main term or subterm(s) for that entry is insufficient for coding the procedure. Angioplasty - see also repair, blood vessel coronary 36.0

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See Category: This term is infrequently used. It refers the coder to a section of code numbers rather than one code. Lysis Adhesions Bone - see category 78.9 § The section mark symbol preceding a code denotes the placement of a footnote at the bottom of the page which is applicable to all subdivision in the code.

Code also: This instruction in the Tabular List is a guide to determining the number of codes necessary. It is a reminder to code the individual components of a procedure when they are accomplished at the same time. "Code also" is also used as an instruction to code the use of special adjunctive procedures or equipment. "Code also" often includes the word "synchronous" (performed at the same time). 46.1 Colostomy Code also any synchronous resection (45.49, 45.71-45.79, 45.8) The instruction "Code also" may appear under two-digit, three-digit, or four-digit codes. Omit Code: The surgical approach and closure are a part of the operation and do not require codes in addition to the code for the operation unless they are unusual or required by the statement "code also." Procedures such as laparotomy are not coded if used as an approach for a surgical procedure such as excision or repair. The surgical approach code is used when there is no further operative procedure, e.g., exploratory laparotomy with biopsy. Both the laparotomy and the biopsy are coded. Exception: If a procedure is started and not completed, the approach (incision) is coded. The instruction "omit code" is the guide in both the Tabular List and Alphabetic Index. APPLICATION 1. When an endoscopy is performed and the endoscope is passed through more than one cavity, the code for the endoscopy will identify the farthest site. Esophagoscopy NEC Esophagogastroscopy NEC (Other gastroscopy) 44.13 Duodenoscopy (Other endoscopy of small intestine) Esophagogastroduodenoscopy 42.23 45.13 45.13

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2. There are some codes in the classification which identify endoscopic biopsies. Bronchoscopy with biopsy (Endoscopic bronchial biopsy) 3. If there is no code which includes both procedures, code each procedure separately. Laryngoscopy with biopsy (Laryngoscopy) (Biopsy of Larynx) 31.42 31.43 33.24

4. If an endoscopy is performed and another procedure such as excision of lesion is performed, code both the endoscopy and the other procedure - unless instructed otherwise in the Alphabetic Index or the Tabular List. PROCEDURE: Cystoscopy with transurethral resection of prostate Cystoscopy (transurethral) Resection prostate -- see also Prostatectomy transurethral (punch) Transurethral resection of prostate 57.32

60.2 60.2

5. A principal procedure is one which was performed for definitive (therapeutic) treatment rather than one performed for diagnostic purposes. DIAGNOSIS: Torn medial meniscus PROCEDURE: Arthroscopy with meniscectomy 836.Ø 8Ø.6 8Ø.26

The meniscectomy is the principal procedure for it was performed for therapeutic treatment, the arthroscopy is a diagnostic procedure. 6. When a diagnostic procedure is related to the principal diagnosis and a therapeutic procedure is related to a secondary diagnosis, then the principal procedure is the therapeutic procedure. PRINCIPAL DIAGNOSIS: Gastritis SECONDARY DIAGNOSIS: Left indirect inguinal hernia PROCEDURES: Gastroscopy (diagnostic) Left inguinal herniorrhaphy (therapeutic) The herniorrhaphy is the principal procedure.

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PRINCIPLE VI. SYMPTOMS, INCONCLUSIVE DIAGNOSES, COPD 1. Signs and symptoms that point rather definitely to a particular diagnosis are assigned to the appropriate chapter of ICD-9-CM rather than chapter 16; for example, hematuria is assigned to the chapter for Genitourinary System (Code 5997). Chapter 16 includes ill-defined conditions and symptoms that could be the result of two or more conditions, or may involve two or more systems of the body, and are used in cases where the necessary studies to determine a definitive diagnosis were not completed prior to disposition; for example, transfer and death cases without an autopsy. 2. Chapter 16 includes Category Codes 780-799. The paragraph on page 707 of Volume 1, ICD-9-CM should be reviewed carefully prior to assigning codes from this chapter. 3. Diagnostic statements that may require use of codes from chapter 16 are: a. When a specific diagnosis cannot be made at time of disposition. b. Transient signs and symptoms whose etiology could not be determined. c. Provisional diagnosis made for dispositioned patients (e.g., patients that are transferred). d. A more precise diagnosis cannot be made for other reasons. e. Certain signs and symptoms are important in rendering appropriate medical care; therefore, the appropriate code from chapter 16 will be used as an additional code when the etiology is known. 4. The signs and symptoms found in Chapter 16 (Categories 780-799) of ICD-9-CM may be used as the principal diagnosis only when: a. No definite cause is identified. b. The signs and symptoms are followed by comparative contrasting diagnoses. c. The signs and symptoms are a residual of late effect. d. The signs and symptoms are the result of an adverse reaction to medication. 5. Comparative/Contrasting Diagnoses: a. If the differential diseases/conditions have a symptom(s) stated, the symptom may be used as the principal diagnosis. b. If the differential diseases/conditions have no symptom stated, assign codes for the stated conditions and assign the first listed as the principal diagnosis.

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6. Chronic Obstructive Pulmonary Disease (COPD) Category Code 496. This code is to be used only when COPD is reported without mention of a more specific chronic obstructive pulmonary disease. COPD with other diagnoses (such as emphysema, chronic bronchitis, allergic alveolitis, asthma, and bronchiectasis) is classified to the specific condition rather than category 496. APPLICATION 1. Diagnostic statement that requires assigning codes from chapter 16. EXAMPLE: DIAGNOSIS: Dysuria, etiology undetermined 7881

2. COPD is coded to category 496. This category will be used only when there is no mention of a specific chronic obstructive pulmonary disease. Also, assign the symptom(s) code as additional codes. EXAMPLE: DIAGNOSIS: Pneumothorax, spontaneous, left. Chronic Obstructive Pulmonary Disease. DIAGNOSIS: Chronic Obstructive Pulmonary Disease Emphysema, Compensatory` PRINCIPLE VII. COMPLICATIONS OF CARE 1. Surgical and Postoperative Complications. a. Accurate coding of complications as a result of surgical procedures is very important. In some hospitals, the Quality Assurance personnel rely on correct coding of complications to alert them of a potential problem. To code a surgical complication proceed as follows in the stated order until the appropriate code is located. (1) Look up an entry for the complication (such as infection) and the indented modifier "postoperative." (2) Look up "Complication" and an indented modified to describe the complication. (3) Look up "Complication, surgical procedure" and identify the body system to which the complication is assigned. 5128 496Ø 5182

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b. Postoperative complications affecting a specific anatomical site or body system are classified to categories 001-799 in the main classification. Complications affecting more than one site or body system are classified to categories 996-999 of the chapter on injury and poisoning. Of particular significance are the last three lines of the exclusion note which state: "any condition classified elsewhere in the Alphabetic Index when described as due to a procedure." An additional code, when possible, will be used to specifically identify the anatomical site or the manifestation of the postoperative complication. When multiple coding is used, sequencing of codes is important. A postoperative complication may be principal diagnosis if it is the cause for readmission. The codes from categories 996-999 take precedence in sequencing, when an additional code is used for specificity. c. Subcategories/subclassifications codes 996.0-996.5 are specific for mechanical complications resulting form various prosthetic devices or implants. They include mechanical breakdown or obstruction, leakage, displacement, perforation, or protrusion of the devices. Complications of a mechanical nature of internal prosthetic devices and implants are classified to 996.0-996.5. Complications involving implants and internal devices are classified to 996.7. The remaining codes in category 996 are for physiological complications; for example, complications or rejections following organ or tissue transplants with an accompanying code from category V42 to identify the specific organ or tissue involved. (See principle XVI (Organ and Tissue Transplants) for correct sequencing of codes.) 2. Medical Care Complications. a. Subcategory codes 999.0 through 999.9 will be used when the diagnostic statement specifies that condition as a complication resulting from medical care. Carefully read the inclusion and exclusion terms. b. Subcategory code 999.9 may be used alone to indicate a complication of medical care when the specific condition is not mentioned by the responsible physician. When possible, an additional code will be used for specificity to completely describe the condition. 3. Complications vs. Aftercare. a. Coding personnel should thoroughly review the record to ascertain whether the condition requiring hospitalization was in fact a complication or aftercare. b. An admission for aftercare is usually scheduled, whereas an admission for complication of surgical or medical care occurs at the time the complication develops. APPLICATION 1. Read carefully the "excludes" note, Page 867 in Volume 1, ICD-9-CM. EXAMPLE: DIAGNOSIS: Infection of surgical wound (Cesarean section 3 weeks ago) 674.34

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2. A condition specified as a complication of surgical care or postoperative, which does not have a specific subentry in the Alphabetic Index will be multiple coded, when possible. EXAMPLE: DIAGNOSIS: Pneumothorax due to accidental puncture during cardiac catherization. 9982/5128

3. Category 996 provides codes at the fourth- and fifth-digit level to distinguish between mechanical and physiological complications. EXAMPLES: DIAGNOSIS: Migration of breast prosthesis. DIAGNOSIS: Infected breast implant following mastectomy. 4. Complications or rejection of organ or tissue transplant. EXAMPLE: DIAGNOSIS: Cadaveric renal transplant X3, rejection episode. PRINCIPLE VIII. NEOPLASMS 1. Instructions on how to use Chapter 2, Neoplasms (140-239) are provided on page 81, Volume 1 of ICD-9-CM. All neoplasms whether functionally active or not are classified to Chapter 2. If the neoplasm is functionally active, an additional code should be used to identify the functional activity. a. Table of neoplasms. (1) The Table of Neoplasms gives the code numbers for neoplasms by anatomical site. For each site, there are six possible code numbers according to whether the neoplasm in question is malignant, primary, secondary, benign, in situ, of uncertain behavior, or of unspecified nature. (2) The description of the neoplasm will often indicate which of the six columns is appropriate; for example, malignant melanoma of skin, benign fibroadenoma of breast, or carcinoma in situ of cervix uteri. Where such descriptors are not present, the remainder of the index should be consulted. (3) Sites marked with the sign "*"; for example, face NEC*, should be classified to malignant neoplasm of skin of these sites if the variety of neoplasm is a squamous-cell carcinoma or an epidermoid carcinoma and to benign neoplasm of skin of these sites if the variety of neoplasm is a papilloma (any type). 99681 V42Ø 99654 9966

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(4) The term "cancer" when modified by an adjective or adjectival phrase indicating a morphological type should be coded in the same manner as "carcinoma" with that adjective or phrase. Thus, "squamous cell cancer" should be coded in the same manner as "squamous-cell carcinoma." b. Morphology codes (Volume 1, pages 1055 -1076). (1) ICD-9-CM provides an optional set of four-digit codes preceded by the letter "M" for identifying the morphology of neoplasms. An additional set of single digits is provided to identify the behavior of the neoplasm, such as "/3" for malignant, primary site. Morphology codes are not used in the inpatient record. (2) The morphology codes may be located in the Alphabetical Index (Volume 2) in alphabetical sequence under the main term entry for the specific neoplasm. (3) The word morphology is defined as the study of the form and structure of the cells and tissues from which the neoplasms arise. (a) The properties of a particular neoplasm is determined by the tissue of origin as opposed to the organ of origin. (b) The type of cells that a malignant neoplasm is comprised of often determines the rate of growth, degree of malignancy, and the particular type of treatment rendered. (4) Metastatic neoplasms are identified at the metastatic site by their morphology, which is different from that of the normal tissue at the metastatic site and the same as the morphology of the tissue and cells at the primary site. This is important to remember when coding neoplasms and determining primary versus secondary sites. (a) Classification of neoplasms by the tissue from which they arise are: 1. Epithelial tissue--adenoma, papilloma, carcinoma, and adenocarcinoma. 2. Connective tissue--fibroma, leiomyoma, fibrosarcoma, and leiomyosarcoma. 3. Nervous tissue--meningioma and glioma. (b) Classifications of neoplasms by cells from which they arise are: 1. Clear cell adenoma. 2. Acinar cell adenoma. 3. Basal cell carcinoma. 4. Squamous cell carcinoma.

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c. Personal History of Malignant Neoplasm. In addition to the categories for malignant neoplasm provided in chapter 2, ICD-9-CM contains codes in the supplementary classification for describing history of (primary) malignant neoplasm (codes V1Ø.ØØ-V1Ø.9), and for describing the purpose of an encounter as for radiotherapy (code V58.Ø) and for maintenance chemotherapy (code V58.1). d. Categories 150 and 201 contain a departure from the usual princi ples of classification in that the fourth-digit subdivisions in each case are not mutually exclusive. In each instance, the dual axis is provided to account for differing terminology encountered on source documents; for example, one surgeon may describe the location of an esophageal malignancy as cervical portion, while another may say upper third. e. Neoplasms with Overlapping Site Boundaries. Categories 140-195 are for the classification of primary malignant neoplasms according to their point of origin. A primary malignant neoplasm whose point of origin cannot be determined but whose stated sites overlaps two or more subcategories within a three -digit category should be classified to the four-digit subcategory .8 (other). For certain malignant neoplasms whose point of origin cannot be determined but whose stated sites overlap two or more three-digit categories, codes for contiguous sites are provided. These codes are 149.8, 159.8, and 165.8. Overlapping malignant neoplasms that cannot be classified as indicated above should be assigned to the appropriate subdivision of category 195 (Malignant neoplasm of other and ill-defined sites). 2. Coding Principles. a. Primary Site is Still Present (Solid Tumors). For example, the hospital admission during which the malignancy is diagnosed or during which the primary treatment took place. Code the primary site using codes from chapter 2 (codes 14Ø.Ø-195.9). If present, code also secondary sites which may be present using categories 196-199. b. Primary Site Previously Treated (Solid Tumors). The primary site was previously excised or eradicated with no recurrence of original primary site. If a neoplasm is eradicated on a previous admission, regardless of the length of time since eradication, the neoplasm should not be coded as being present unless there has been a recurrence. An eradicated neoplasm is one that has been removed by surgical procedure or otherwise destroyed through other treatment. To note the eradicated neoplasm in the present record, code a personal history of a malignant neoplasm. (1) Code the primary site using codes from the supplementary classification (codes V1Ø.ØØ-V1Ø.9). These codes will never appear as the cause of admission diagnosis. (2) If the patient has secondary sites present, code these using categories 196-199. Also code the previous primary site code (V1Ø.ØØ-V1Ø.9). (3) If the patient has no secondary malignancy, and if the reason for admission is follow-up of the malignancy, code to V67. Also code the previous primary site (V1Ø.ØØ-V1Ø.9).

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c. Primary Malignancy of Hematopoietic and Lymphatic Tissue. (1) Malignancy of hematopoietic and lymphatic tissue is always coded to 2ØØ.Ø-2Ø8.9 series with appropriate fifth digit where required, unless it is st ated to be "in remission." (2) For malignancy of hematopoietic and lymphatic tissue "in remission", a V67 with an additional code from categories V1Ø.6-V1Ø.7, as applicable, will be used. d. Patient Admitted Solely and Specifically for Radiotherapy Session or for Maintenance Chemotherapy. (1) Patients admitted solely and specifically for radiotherapy and no other treatment, use code V58.Ø as principal diagnosis. (2) Patients admitted solely for chemotherapy and no other treatment, use code V58.1 as principal diagnosis. (3) The present primary and any secondary malignancies should be classified supplementally. If either or both neoplasms have been eradicated, the personal history of malignancy should be coded. e. Metastatic Cancer. (1) If the primary malignancy is no longer present, identify the previous primary site using the proper code within the V1Ø category. In such cases, do not assign the code for "primary site unknown." EXAMPLE: Metastatic carcinoma to lung from breast. Bilateral radical mastectomy performed 6 months ago. Code to: Secondary neoplasm of lung (197.Ø) and personal history of malignant neoplasm of breast (V1Ø.3). (2) Cancer described as "metastatic from" a site should be interpreted as primary of that site. EXAMPLE: Metastatic carcinoma from breast. Code to: Primary malignant neoplasm of breast (174.9). Secondary neoplasm of unspecified site (199.1). (3) Primary site unknown. When the primary site is unknown, code to the unspecified site for the morphological type involved; for example, carcinoma (199.1), melanoma (172.9), adenocarcinoma (199.1), osteosarcoma (17Ø.9), and fibrosarcoma (171.9).

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(4) Cancer described as "metastatic to" a site should be interpreted as a secondary of that site. Also, assign the appropriate code for the primary malignant neoplasm of specified site if the primary site is identified or code to the unspecified site (as stated in e(3) above). EXAMPLE: Metastatic carcinoma to lung. Code to: Secondary neoplasm of lung (197.Ø) and primary malignant neoplasm of unspecified site (199.1). EXAMPLE: Metastatic carcinoma from liver to lung. Code to: Primary malignant neoplasm of liver (155.Ø) and secondary neoplasm of lung (197.Ø). (5) If two or more sites are stated in the diagnosis and all are qualified as metastatic code as for primary site unknown, code the stated sites as secondary neoplasm of those sites. EXAMPLE: Metastatic melanoma of lung and liver. Code to: Secondary neoplasm of lung (197.Ø) and liver (197.7) and primary malignant melanoma of unspecified site (172.9). EXAMPLE: Metastatic carcinoma of brain and lung. Code to: Secondary neoplasm of brain (198.3) and lung (197.Ø) and primary carcinoma of unspecified site (199.1). (6) If only one site is stated in the diagnosis and this is qualified as metastatic, proceed as follows: (a) Code as for primary site unknown; however, if this code is 199.Ø or 199.1, follow rule (6)(b) below. (b) If the code arrived at in (6)(a) above is 199.Ø or 199.1, code instead as for primary malignant neoplasm of the stated site except for the following sites, which should be coded to the secondary neoplasm of that site. bone (198.5) brain (198.3) diaphragm (198.8) heart (198.8) liver (197.7) lymph nodes (196.9) mediastinum (197.1) meninges (198.4) peritoneum (197.6) pleura (197.2) retroperitoneum (197.6) spinal cord (198.3) site classifiable to 195 (198.89)

Also assign the appropriate code for primary or secondary malignant neoplasm of specified or unspecified site, depending on the diagnostic statement being coded.

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EXAMPLE: Metastatic lung cancer. Code to: Primary malignant neoplasm of lung (162.9), and secondary malignant neoplasm, unspecified site 199.1. EXAMPLE: Metastatic cancer of brain. Code to: Secondary neoplasm of brain (198.3) and primary malignant neoplasm of unspecified site (199.1). (7) If no site is stated in the diagnosis, but the morphological type is qualified as "metastatic," code as primary site unknown. EXAMPLE: Metastatic apocrine adenocarcinoma. Code to: Primary malignant apocrine adenocarcinoma of unspecified site (173.9), and secondary malignant neoplasm, unspecified site 199.1. f. When Neoplasm is the Underlying Cause of Death. (1) Code to primary site when known or as "primary site unknown" when undetermined. (2) Categories 196, 197, and 198 are not to be used for underlying cause of death coding. Secondary neoplasm of specified sites, of unspecified site, or without mention of primary site, will be coded as "primary site unknown." EXAMPLE: Metastatic carcinoma to colon. Code to: Morphological type involved (carcinoma - 199.1) for underlying cause of death. 3. Sequencing. a. The patient is admitted with a suspected malignant neoplasm: (1) If confirmed, the neoplasm is sequenced first. (2) If not confirmed, list as admission for suspected neoplasm. b. The patient is admitted with a confirmed malignant neoplasm: (1) If the neoplasm is treated (e.g., surgically), the neoplasm is sequenced first. (2) If only a condition caused by the neoplasm is treated, the condition (not the neoplasm) is sequenced first (e.g., dehydration). An exception to this is if the condition is coded in Chapter 16 of ICD-9-CM.

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(3) If the patient is admitted specifically for chemotherapy or radiotherapy, principal diagnosis is admission for chemotherapy or radiotherapy. c. The patient is admitted for restaging: (1) If a new neoplasm is found, the neoplasm is principal. (2) If known neoplasm has grown, the neoplasm is principal. (3) If nothing new is found, admission for follow-up examination is principal. APPLICATION 1. The Table of Neoplasms give the code numbers for neoplasms by anatomical site. For each site there are five possible code numbers according to whether the neoplasm in question is malignant, benign, in situ, of uncertain behavior, or of unspecified nature. EXAMPLE: DIAGNOSIS: Carcinoma in situ, rectum 23Ø.4

2. Primary site is still prese nt (solid tumors). Code the primary site using codes from chapter 2 (codes 14Ø.ØØ-195.8). Code, also, any secondary sites which may be present, using codes 196.Ø-199.1. EXAMPLE: DIAGNOSIS: Adenocarcinoma of prostate gland metastatic cancer to urinary bladder. 185.Ø 198.1

3. Primary site previously treated (solid tumors). The primary site was previously excised or eradicated with no recurrence of original primary site. (See coding principles in paragraphs 2a and 2b above.) EXAMPLE: DIAGNOSIS: Bladder tumor examination; surgery performed 6 months ago for malignancy of bladder. No evidence of recurrence.

V67.Ø V1Ø.51

4. A primarily malignant neoplasm that overlaps two or more subcategories within a three-digit rubric and whose poi nt of origin cannot be determined should be classified to the subcategory ".8" (Other). EXAMPLE: DIAGNOSIS: Glioma of left parieto-occipital area. 191.8

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5. Patients admitted solely for radiotherapy session or for maintenance chemotherapy, code to proper V58 category. EXAMPLE: DIAGNOSIS: Carcinoma of cervix, hysterectomy 2 months ago. Admitted for maintenance chemotherapy. PRINCIPLE IX. OB-GYN CONDITIONS 1. Abortion Category Codes. a. For DOD purposes, abortions will be classified by type, in the following categories: (1) Missed abortion, ectopic and molar pregnancy - 63Ø to 633. (2) Spontaneous - 634. (3) Legally induced (therapeutic, elective) - 635. (4) Illegally induced - 636. (5) Unspecified abortion - 637. (6) Failed attempted abortion - 638. (7) Complications following abortion and ectopic and molar pregnancies - 639. b. The subcategory levels (fourth digits) identify the presence or absence of complications. They identify complications resulting from the abortion, not the reasons for performing the abortion. Use of the fifth digit Ø, unspecified stage, is strongly discouraged and will be questioned. c. Fifth digit codes listed at the bottom of pages 531, 532, and 533 are for use with abortion categories 634 through 637 to indicate the stage of the abortion as complete, incomplete, or unspecified. d. When abortion procedures are done for therapeutic reasons, or if the MTF is allowed to perform elective abortions, the procedures frequently used are: (1) Hysterotomy or hysterectomy to terminate pregnancy - 74.91. (2) Amniotic or saline injection for termination of pregnancy - 75.Ø. (3) Vacuum aspiration for termination of pregnancy - 69.51. (4) D & C to terminate pregnancy - 69.Ø1.

V58.1 V1Ø.41

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e. Legally induced abortion, Category 635, includes both elective and therapeutic abortions. A therapeutic abortion is one induced for medical indications which would be life threatening to the mother if the pregnancy were carried to term. An elective abortion is one performed at the request of the patient. To distinguish between therapeutic and elective abortions, code extenders have been provided to meet DOD statistical requirements. The code extenders will be used in the seventh position of the diagnostic field. The use of 9 (unspecified) will be questioned. The code extenders are as listed below. Elective Therapeutic Unspecified 635.XX - Ø 635.XX - 1 635.XX - 9

f. When a therapeutic abortion is performed, the reason (diagnosis) for this legally induced abortion must also be coded. Codes from categories 640-648 will be used to reflect the complication(s) of pregnancy leading to the therapeutic abortion; the fifth digit Ø will indicate abortive outcome. The reason for the abortion will be selected from other ICD-9-CM categories and will be used as an additional code. Sequence the abortion code first. g. An abortion resulting in a live-born fetus is coded as an abortion by type, with a code from category V27 as appropriate. h. Complications following abortion, ectopic, or molar pregnancy are classified to category 639. This category is to be used as an additional code when there are immediate complications during the same admission as treatment for the ectopic or molar pregnancy. For example, Pelvic Peritonitis due to ruptured tubal pregnancy is coded to 633.1 and 639.Ø Codes 634-638 are never used in combination with category code 639 during the same admission. However, a code from 639 category is the principal diagnostic code for complications stemming from an abortion done during a previous episode of care. i. The subcategory codes for 634, Spontaneous Abortions, identify the presence or absence of any complications arising during the same admission or encounter as that for the abortion. For example, the diagnosis "incomplete spontaneous abortion with delayed hemorrhage" is coded 634.11. The use of this code indicates that the delayed hemorrhage occurred during the same admission as that for the spontaneous abortion. Another example is "Spontaneous abortion with urinary tract infection" which is coded to 634.7Ø. Additional codes specific for the complication are not required.

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APPLICATION Abortion Codes 1. When coding a therapeutic abortion, code also the reason why the abortion was performed. EXAMPLE: DIAGNOSIS: Therapeutic abortion, complete, due to severe maternal rheumatic heart disease 648.6Ø 398.9Ø D&C 69.Ø1 635.92 - 1

2. An admission for complication(s) after an abortion is coded to category 639. EXAMPLE: DIAGNOSIS: Excessive hemorrhage following elective abortion at Cypress Community Hospital 2. Pregnancy and Puerperium Category Codes. a. Categories 64Ø-676 have fifth-digit codes to provide more specificity regarding the outcome of current hospitalization. Specifically, the fifth digits have the following meanings: (See Volume 1, page 537). Ø - Unspecified as to the episode of care or not applicable. (The fifth digit "Ø" will be used only to denote abortive outcome.) 1 - Delivery with or without mention of antepartum condition. 2 - Delivery with mention of postpartum complication during present episode of care. 3 - Antepartum condition or complication (undelivered). 4 - Postpartum condition or complication following delivery that occurred during previous episode of care or outside hospital with subsequent admission. b. Puerperal complications are those occurring after delivery until 6 weeks following termination of pregnancy. Fifth digits "2" and "4" will distinguish between immediate (during present episode of care) and delayed puerperal complications/conditions. c. The ICD-9-CM index will often direct coder to the same fourth-digit code for complications that are related to pregnancy, childbirth (delivery) and the puerperium. The fifth digits for these categories will indicate the specific status of patient at disposition. 693.1

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d. Categories 647 and 648 are combination codes for nonobstetrical conditions in obstetrical patients. These conditions are classified elsewhere but will be recorded as complication of pregnancy, childbirth, or the puerperium. When these codes are used, an additional code is required to denote the specific condition. With one exception, code 648.8 does not require an additional code. The code from categories 647 or 648 will take precedence in sequencing. e. Categories V22 (Normal Pregnancy) and V23 (Supervision of High Risk Pregnancy) will be used most often for outpatient care. Codes in V22, Normal pregnancy, are not to accompany any codes in Chapter 11, Complications of Pregnancy, Childbirth, and the Puerperium. The use of V22.2, Pregnant state incidental, is used for a patient whose principal diagnosis is unrelated to and is not complicating the pregnancy. V23 subcategory codes will be used primarily for outpatient care to identify patients whose pregnancy is of a high risk status; for example, teenage pregnancies and pregnancies in women over 40 years old are considered to be high risk in nature and often require close monitoring, even on an inpatient basis. APPLICATION Pregnancy and Puerperium Codes 1. Use an additional code with categories 647 and 648 to further describe the conditions complicating the pregnancy or the puerperium. Any conditions listed in 647 or 648 categories will require multiple coding, but 647 and 648 codes will be sequenced prior to the code for the specified condition. (Note exception to dual coding ( para 2d, above) 648.8 . EXAMPLE: DIAGNOSIS: Pregnancy complicated by Sickle-cell Anemia 648.23 282.6Ø

2. Use fifth digit "4" to identify a postpartum condition or complication following delivery that occurred during previous episode of care or outside hospital with subsequent admission. EXAMPLE: DIAGNOSIS: Purulent Mastitis, 3 weeks following delivery 675.14

3. Use V22.2 (Pregnant state, incidental) when patient's cause of admission is not the pregnancy. EXAMPLE: DIAGNOSIS: Meniere's Syndrome, Pregnancy, 16 weeks 386.ØØ V22.2

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3. Deliveries. a. A large portion of the military services inpatient workload is comprised of conditions relating to pregnancy, labor, delivery, and the puerperium. Coding personnel should be thoroughly familiar with the sections in chapter 11 used in classifying specific conditions associated with obstetrics; for example: (1) Categories 64Ø-648 complications mainly related to pregnancy. (2) Categories 65Ø-659 normal delivery, and other indications of care in pregnancy, labor and delivery. (3) Categories 66Ø-669 complications occurring mainly in the course of labor and delivery. (4) Categories 67Ø-676 complications of the puerperium. b. Category 65Ø (Delivery in a completely normal case) includes only normal, spontaneous delivery, cephalic (vertex) presentation, of a single full -term live-born infant. An episiotomy or amniotomy may be performed. This code excludes application of forceps or any manipulation to assist delivery. This code excludes stillbirth or multiple births. This code cannot be used in combination with other codes in chapter 11. c. In assigning codes from the V27 category in conjunction with the 65Ø code, V27.Ø is the only valid outcome of delivery code which can be used. d. Subcategory 669.5 (Forceps or Ventouse Delivery without mention of indication) includes normal delivery of a live fetus, cephalic presentation, with application of low or outlet forceps or vacuum extraction without mention of any complication of labor or delivery. 669.5 is used with mid or high forceps only if the complication necessitating the use of mid or high forceps is not stated. e. Subcategory 656.4 (Intrauterine Death) includes delivery of a fetal death (stillbirth) after completion of 20 weeks gestation. The key word in the Alphabetic Index is Intrauterine Death, not stillbirth. f. Subcategory 644.2 (Early Onset of Delivery) includes premature delivery, premature labor with onset of delivery and spontaneous delivery of premature infant. g. Category 651 (Multiple Gestation Delivery). This code is for use in denoting multiple gestation, either during pregnancy or for delivery. h. Outcome of Delivery. The V27 category is to be used to record the outcome of delivery on the mother's cover sheet. In the Alphabetic Index look for "Outcome of Delivery," which will lead to the V27 category. This V27 category has subcategories to denote live-born and stillborn. i. In the case of a stillbirth, the appropriate V27 code will be recorded on the mother's cover sheet, and there will be no separate record made for the stillbirth.

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j. When a delivery is complicated, use as many codes as is necessary to completely describe the complications. k. For a spontaneous delivery occurring in the hospital, in addition t o the diagnostic code(s), a procedure (delivery) code will be used. Procedure code 73.59 (other manually assisted delivery) will only be assigned if no other delivery code from category 73-74 is used. APPLICATION Delivery Codes 1. Use subcategory 669.5 with mid or high forceps only if the complication necessitating the mid or high forceps is not stated. EXAMPLE: DIAGNOSIS: Delivery, full-term: Live-born infant: Vertex presentation: Low forceps. 669.51 V27.Ø

2. Use as many codes as necessary to completely describe a complicated delivery. Record the outcome of delivery. EXAMPLE: DIAGNOSIS: Pregnancy, uterine, delivered,male infant, frank breech presentation: first degree perineal laceration (with hematoma of vulva). 652.21 664.Ø1 664.51 V27.Ø

3. Category 651 will be used with deliveries of multiple births. If, during the same episode of care, a complication of delivery or an antepartum condition occurs in addition to a postpartum complication, assign fifth digits 1 and 2 respectively, to the codes identifying the complications. EXAMPLE: DIAGNOSIS: Intrauterine pregnancy, full-term delivered twins, live -born male infants, postpartum phlebothrombosis, deep 651.Ø1 671.42 V27.2

PRINCIPLE X. PERINATAL MORBIDITY AND MORTALITY 1. The perinatal period is defined as that period occurring before, during, and up to 28 days following birth.

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2. Conditions specifically classified to Chapter 15 when originating in the perinatal period must be qualified by such terms as "neonatal" or "of newborn" or transitory in nature. 3. If the same condition occurs in a permanent state in the newborn, it will be coded to the appropriate category in the main classification. 4. The conditions classified to Chapter 15 include: a. Conditions in the newborn infant or in an infant in the perinatal period b. Conditions in any age group that originated in the perinatal period. 5. Categories 76Ø-763 are used to identify maternal conditions that are found to be the cause of morbidity or mortality in the newborn. 6. Although many of the category titles in Chapter 15 contain the term "maternal" and appear to refer to the maternal conditions, all the codes in Chapter 15 pertain to the infant identifying the maternal conditions affecting the infant. 7. There are codes in this perinatal category to show gestational maturity. These codes can be located under terms as immaturity, prematurity, post-term, light-for-dates, and heavy-for-dates. 8. Categories 765 and 766 are not to be used as underlying cause of death if any other cause of perinatal mortality is reported. 9. Respiratory distress syndrome of newborn may be coded in one of two ways. Respiratory distress syndrome which is referred to as mild and recovery occurs within 72 hours of birth is coded to 77Ø.6. If respiratory distress syndrome is more severe and recovery is not apparent within the first 72 hours of life, then code to 769. APPLICATION 1. Use codes from categories 76Ø-763 to identify maternal conditions on the infant's record that have caused morbidity or mortality in the newborn. EXAMPLE DIAGNOSIS: Single, full-term, live-born, male infant Congenital cataracts resulting from antenatal exposure to maternal rubella V3Ø.Ø 76Ø.2 743.39

2. Conditions originating in the perinatal period qualified as "neonatal" or "of newborn" are usually transitory and will be coded with the appropriate perinatal code. If the disease occurs in the permanent state in the newborn, code the condition from the main classification.

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EXAMPLE DIAGNOSIS: Neonatal single, full-term, live-born female infant, transient diabetes mellitus. V3Ø.Ø 775.1

PRINCIPLE XI. POISONING AND ADVERSE EFFECTS OF DRUGS AND E CODES 1. ICD-9-CM provides codes to differentiate between poisoning and an adverse reaction to a correct substance properly prescribed and administered correctly. (See principle XIV for poisoning.) 2. The World Health Organization has proposed a definition of an adverse drug reaction as any response to a drug "which is noxious and unintended and which occurs at doses used in man for prophylaxis, diagnosis, or therapy". 3. Terms frequently used in diagnostic statements to identify adverse drug reaction to a correct substance properly administered are: accumulative effect, allergic reaction, idiosyncratic reaction, hypersensitivity, paradoxical reaction, and side effects, synergistic reaction and antagonistic drug interactions. 4. Categories E93Ø-E949 provide means to identify the drug responsible for a n adverse reaction to a substance correctly administered. These E Code subcategories provide the same specificity in identifying the drug involved in causing the adverse reaction as do categories 96Ø-979 in identifying the drug involved in poisoning. Not e that codes 96Ø-979 cannot be used in combination with codes E93Ø-E949. One identifies a substance causing poison, and the other identifies a substance causing an adverse reaction in therapeutic use. 5. The adverse reaction to a correct substance properly administered is classified to the manifestation or the nature of the adverse reaction, such as gastritis, lymphadenitis, urticaria, psychosis, etc. 6. Two codes are required to code an adverse reaction to a correct substance properly administered. First code the adverse reaction using a code from ØØ1-799 categories; second, code the drug or substance which caused it, using an E code from the Therapeutic column of the Table of Drugs and Chemicals. If the reaction is unknown, use code 995.2 and the E code. 7. Codes E93Ø-E949 can never be used as a solo code. The adverse reaction code is always sequenced first. The E code can never be the principal diagnosis. 8. Code 995.2 will be used for unspecified nature of allergic or idiosyncratic reactions to a correct substance properly administered (drug allergy, NOS). It is provided for those cases in which a code from ØØ1-799 cannot be assigned because the nature of the reaction is not known/stated. In these cases 995.2 is sequenced first, and the E code is an additional code.

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9. The code 9Ø9.9 entitled "Late effect of other and unspecified external causes" is provided to code the late effects of a previous adverse reaction the nature of which is not stated. In essence 9Ø9.9 is used to code a late effect in a case which would have been coded to 995.2 if it had been described as a current effect. 10. Chronic effects and delayed effects of drugs. Long-term, chronic effects of drugs, such as the accumulative effect of digitalis, are coded as an adverse reaction to a correct substance properly administered. Delayed chronic effects of drugs that occur or are present a long time after the administration of the drug to which the patient developed a reaction are coded as late effects of either poisoning or adverse reaction to correct substance properly administered, depending on the circumstances. 11. Poisoning due to drugs, medicinal substances, and biologicals is defined as conditions resulting from overdose of these substances or from the wrong substance given or taken in error. Prior to using the table of drugs and chemicals, all coding personnel should read the introduction in volume 2, page 763. Note also the table beginning on page 765. The military hospitals will use only the first column "Poisoning" and the third column "Therapeutic Use" in assigning codes from this table. a. The column heading "Poisoning" provides codes 96Ø-979 for poisoning, overdose, wrong drug given or taken, and wrong dosage given or taken, and codes 98Ø-989 for toxic effects of substances chiefly nonmedicinal as to source. b. The adverse effect in "Therapeutic Use" column is intended to provide the E Codes for external cause of adverse reactions to a correct substance (drugs, medicinal, and biological substances) properly administered. 12. Categories 96Ø-979 identify the drugs, medicinal substances, and biologicals causing the poisoning. These codes are found in Volume 2 (Table of Drugs and Chemicals), pages 765-861. 13. If unable to locate the specific drug that caused the poisoning in the table, consult the index of the American Hospital Formulary Service (AHFS). The numbers assigned the drugs by the AHFS correlate to the code numbers for poisoning in ICD-9-CM (see volume 2, pages 796-802). 14. Physicians use various terms when describing poisoning such as : overdose, poisoning, toxic effect, wrong dosage given or taken, and wrong drug given or taken. Interactions between any drug and alcohol or between prescribed and over-the-counter drugs are classified as poisonings. 15. To code a poisoning, select a code from the poisoning column of the table of Drugs and Chemicals. If known, code the reaction/manifestation as an additional code. If a secondary code is used, the code for the poisoning must be sequenced first. Unlike coding an adverse effect, there is no code for an unknown reaction to a poisoning.

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APPLICATION 1. Chronic or long-term effect of drug: EXAMPLE: DIAGNOSIS: Cardiac arrhythmia secondary to digitalis intoxication. 2. Delayed or late effect of drug with previous manifestations specified: EXAMPLE: DIAGNOSIS: Brain damage secondary to cerebral anoxia 1 year ago, resulting from severe allergic reaction to penicillin. 348.1 E93Ø.Ø 427.9 E942.1

3. Delayed or late effect of adverse reaction without specifying the previous adverse reaction. EXAMPLE: DIAGNOSIS: Brain damage, due to allergic reaction to penicillin 1 year ago. 348.9 909.9 E93Ø.Ø

NOTE: Code 9Ø9.9 is used to denote the cause of the late effect of a previous adverse reaction to a drug only when the nature or manifestation of the previous allergic reaction is not specified. 4. Categories 96Ø-979 identify drugs, medicinal and biological substances causing the poisoning. EXAMPLE: DIAGNOSIS: Overdose, seconal PRINCIPLE XII. DRUG AND ALCOHOL 1. Definitions of Dependency and Abuse. It is the responsibility of the physician to clearly indicate in the diagnostic statement whether the individual is abusing or dependent on the specific substance. To assist coding personnel in determining the correct classification for specific diagnostic statements, the following definitions are provided: 967.Ø

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a. Alcohol dependence syndrome (Alcoholism). A state, psychic and usually also physical, resulting from taking alcohol, characterized by behavioral and other responses that always include a compulsion to take alcohol on a continuous or periodic basis in order to experience its psychic effects, and sometimes to avoid the discomfort of its absence. Tolerance may or may not be present. b. Nondependent abuse of alcohol. Includes individuals whose use of alcohol has brought them to medical attention. Nondependent abuse of alcohol is applicable to individuals formerly diagnosed as simple drunkenness cases. It also applies to individuals not suffering from alcoholism whether or not they are intoxicated when seen by a physician, after being referred to him in connection with driving-while-intoxicated charges, altercations involving alcohol, AWOL or absences from work due to overuse of alcohol, or for similar reasons when these individuals may benefit from available rehabilitative services. c. Drug dependence. A state, psychic and sometimes also physical, resulting from taking a drug, characterized by behavioral and other responses that always include a compulsion to take a drug on a continuous or periodic basis in order to experience its psychic effects, and sometimes to avoid the discomfort of its absence. Tolerance may or may not be present. A person may be dependent on more than one drug. d. Nondependent abuse of drugs. Includes cases where a person, for whom no other diagnosis is possible, has come under medical care because of the maladaptive effect of a drug on which he is not dependent and that he has taken on his own initiative to the detriment of his health or social functioning. 2. Overdoses. Overdose cases must include sufficient information so that the following coding principles may be applied: a. Drug abuse overdoses. These are usually cases in which an individual abusing drugs inadvertently takes a dose larger than he can tolerate physiologically. This may happen, for example, when the purity of his usual dose has been increased by the supplier's inclusion of a smaller proportion of cutting material in the product. Or an individual may take his previously accustomed dose after his physiological tolerance has been lowered by a period of abstinence from the drug. The term "overdose" may also be applied to cases of severe reaction, including sudden deaths, when the drug abuser may not have exceeded his usual dose. b. The cause of admission code in drug abuse overdose cases will be the appropriate poisoning code from the Poisoning by Drugs, Medicaments, and Biological Substances section of ICD-9-CM (categories 96Ø-979). The appropriate code for drug abuse will be selected from the drug dependence categories (3Ø4) or the Nondependent Abuse of Drugs category (3Ø5) and added as an additional code. The cause of injury code will be 7Ø-, with third digit from Appendix B of the DOD coding guidelines manual (STANAG 2Ø5Ø). This code is defined as "Poisoning by ingestion of toxic substance ..." It should also be used for cases in which the toxic substance was taken by methods other than ingestion.

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3. For diagnosis qualified as "due to" or "secondary to" alcoholism, both the disease condition and alcohol use (category (3Ø3) will be coded; for example, pancreatitis due to alcoholism will be coded 577.Ø and 3Ø3.9Ø. Use the same principle if disease condition is "due to" or "secondary to" drug abuse. As appropriate also code 9Ø9.Ø (Late effects, poisoning). For some conditions, a combined diagnosis code points to alcoholism as the cause of the disorder or physical complication. In such instances, the use of the one code is sufficient; for example, alcoholic psychosis (category 291) ; alcoholic cirrhosis of liver (571.2) and acute alcohol hepatitis (571.1). However, if alcohol dependence or abuse is associated with the disorder or physical complication, both will be coded. APPLICATION Drug and Alcohol When admission is for both drug abuse and drug dependency, the drug dependency will be the principal diagnosis: EXAMPLE: DIAGNOSIS: Cocaine dependence, Marijuana, abuse. 3Ø4.2Ø 3Ø5.2Ø

PRINCIPLE XIII. HEART CONDITIONS AND HYPERTENSION 1. Diseases relating to the circulatory system are difficult to code due to the many synonymous terms and phrases used by physicians in writing the narrative description of the disease process. The code(s) assigned depends on the words used in the diagnostic statement. Carefully read and adhere to all written codes. The use of codes which classify conditions to "other" or "unspecified" is discouraged. 2. ICD-9-CM provides fourth and fifth digits in many categories specifically relating to the circulatory system. It is very important to follow the basic coding rule to always locate the condition in the Alphabetic Index and verify in the Tabular List. 3. The alphabetic Index provides a table to classify hypertension whether as a sole condition or in combination with other disease conditions. a. To code hypertensive disease, refer to the table on pages 375-377 in Volume 2. Specificity is provided by the terms malignant, benign, or unspecified. b. Hypertension when associated with specific heart and renal conditions in a cause-and-effect linkage are coded to categories 4Ø2, 4Ø3, or 4Ø4 as appropriate. When using specific combination codes involving hypertension with heart and/or renal conditions, the type of hypertension will determine the assignment of the fourth or fifth digit.

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c. Heart conditions listed in 428, 429.Ø-429.3, 429.8, and 429.9 described as due to hypertension or hypertensive are coded to the 4Ø2 category. It is important to alert the medical staff of the need to differentiate between (1) hypertensive heart disease and (2) heart disease with nonrelated hypertension. d. Renal conditions classified to categories 585, 586, or 587 with any condition classified to category 4Ø1 or described as hypertensive renal disease is coded to the 4Ø3 category. e. A supplemental code for hypertension is used in addition to the principal code to completely classify a diagnosis specified as "with hypertension" or "and hypertension." 4. A separate three-digit category 412 is provided to classify the diagnosis "old myocardial infarction." "Old" is defined as healed, old, or past, as evidenced by history, or diagnosed as a result of an abnormal EKG or other special investigation and currently asymptomatic. This code will never be used as principal diagnosis, but is to be used when appropriate as an additional code. 5. A repeat myocardial infarction occurring during the same period of hospitalization as that for the acute myocardial infarction is coded to the specific site involved provided the site is different from the previous site; for example, patient admitted with diagnosis of acute myocardial infarction of anterolateral wall (code 41Ø.) and while recovering in the hospital, patient experiences a "repeat myocardial infarction of inferoposterior wall" (code 41Ø.3). Both codes would be used and in the correct sequence as they occurred. 6. The best rule to follow in assigning codes relating to cerebrovascular diseases is use as many codes as necessary to identify all the component parts of a complex diagnostic statement unless the Alphabetic Index or Tabular List directs otherwise. a. Conditions classifiable to cerebrovascular disease, codes 43Ø-438, include those with mention of hypertension. An additional code should be used to identify the hypertension and will follow the CVA-related codes. b. If the cause for a cerebrovascular accident (CVA) is known, code 436 should not be used as the principal diagnosis. Review the record, especially CT brain scan reports for causes such as thrombosis, embolism. c. Conditions resulting from the acute cerebrovascular disease stated as residuals will be coded as additional codes. If the condition is still present at the time of discharge, it will also be coded as an additional code. If conditions are stated as transient and result from the cerebrovascular disease, omit coding. d. When coding late effects of cerebrovascular disease, sequence the residual code first followed by code 438. 7. ICD-9-CM differentiates between the conditions specified as high blood pressure (hypertension) and elevated blood pressure without a diagnosis of hypertension.

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a. The diagnosis of "high blood pressure" is classified to category 4Ø1 (Ess ential hypertension). b. The diagnosis of "elevated blood pressure" without the term "hypertension" is classified to code 796.2 (elevated blood pressure reading without diagnosis of hypertension). 8. Most cases of chronic valvular heart disease are acquired and due to a previous attack of acute rheumatic fever (usually unrecognized) resulting in stenosis or incompetence of the valves. The mitral valves are the most commonly affected. In ICD-9-CM, some of these resultant disorders of the mitral valve are classified to the section on rheumatic diseases, while others are not, unless the diagnosis specifies the condition as rheumatic. Disorders of the aortic valve must be specified as rheumatic in order to be classified to section 396. When both the mitral and aortic valves are involved, whether specified or not, the condition is classified to code 396, the section on rheumatic diseases. 9. Ischemic heart disease occurs as a result of the lack of blood flow to the heart due to partial or complete obstruction of the coronary artery. This disease may be identified by such terms as arteriosclerotic heart disease, coronary ischemia, or coronary artery disease. Sequencing of this disease depends on the reason for admission. When hypertension is present as a secondary condition to ischemic heart disease, sequence the ischemic heart disease before the hypertension code. 10. The diagnosis arteriosclerotic cardiovascular disease (ASCVD) requires two codes. Code 429.2 identifies the cardiovascular disease but does not identify it as being due to arteriosclerosis (code 44Ø.9). The correct codes for ASCVD are 429.2 and 44Ø.9. The exclusion note under 44Ø.9. should be interpreted as "use additional code" to identify the site of the arteriosclerosis (cardiovascular). It is not specified in code 44Ø.9. 11. When assigning codes to complications of surgical care resulting from surgery, the "excludes" note under code 997.1 needs clarification of the term "long-term." a. Subcategory 997.1 classifies cardiac complications that occur during the immediate postoperative period or during the continuous period of hospitalization in which the surgery was performed. b. Subcategory 429.4 classifies "long-term" cardiac complications resulting from cardiac surgery performed during a previous episode of care, regardless of the timespan between the surgery and the complications. c. Subcategory 997.1 is used also to classify immediate cardiac complications resulting from any type of procedure. Subcategory 429.4 is used to classify "long-term" cardiac complications resulting from cardiac surgery only. The surgery must have been performed during a previous episode of care. d. Subcategory 996.4Ø3 is used to classify occlusion of coronary artery bypass grafts over a period of time (no specific time limits.).

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APPLICATION Heart Conditions and Hypertension 1. Code the condition(s) resulting from the acute cerebrovascular disease only if stated to be a residual and is still present at discharge. If conditions are stated to be transient, do not code. EXAMPLE: DIAGNOSIS: Left common carotid artery occlusion. Transient ischemic attack 433.1

2. Certain disease conditions classified to the circulatory system are assigned combination codes (heart, renal, and hypertension) when diagnostic statements clearly indicate a cause-and-effect relationship between the condition(s) and hypertension. EXAMPLES: DIAGNOSIS: Congestive heart failure due to hypertensive heart disease DIAGNOSIS: Congestive heart failure with hypertension, essential, benign PRINCIPLE XIV. INJURIES 1. Chapter 17, entitled Injuries and Poisoning, comprise a major section of ICD-9-CM. Categories 8ØØ-999 include fractures, dislocations, sprains, burns, poisoning, complications of surgical and medical care, and various other types of trauma. 2. Although a number of combination codes are provided for classifying multiple injuries of the same type (that is, fractures involving more than one anatomical location and burns of multiple sites, etc), the basic coding rule should be followed when possible. The basic coding rule states: "Multiple coding is not used if the classification provides a combination code that fully describes all of the elements of the diagnostic or procedure statement." Injuries classifiable to more than one subcategory should be coded separately whenever possible. 3. ICD-9-CM provides subcategory codes to identify injuries considered to be complicated for categories 872-897. Burns classified to categories 94Ø-949 do not provide codes at fourth or fifth-digit level to identify complications. Diagnostic statements specifying burns as infected will also use code 958.3 as an additional code. 4. Late Effects of Injuries. Late effects of diseases and injuries are classified to the condition identifying the residual. An additional code is used to identify the cause of the late effect. (See principle XV.) 4Ø2.91 428.Ø 4Ø1.1

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5. Fractures are classified as open or closed. Coding personnel should review the descriptions in Volume 1, page 735, that are frequently used in diagnostic statements that identify fractures as open or closed. Fractures not specified as open or closed are coded as closed. 6. Categories 94Ø-949 are provided for coding burns whether from chemicals or other causes. Burns of the same anatomical site but of different degrees should be coded to the appropriate subcategory identifying the most severe degree. If a burn is stated to be infected, in addition to the code(s) used to identify the burn, also use code 958.3 to identify the infection. a. Category 948 is used to classify burns according to percent of body surface involved. This category is primarily designed for use as an additional code with categories 94Ø-947 to indicate the percent of body surface involved. It may be used as a solo code when the site of the burn is not specified, but the percentage of body surface involvement is specified. b. Category 948 is unique in the coding structure. This category is designed to be used as a subcategory fourth-digit code or as a subclassification fifth-digit code whichever is applicable. The fourth digit will be used to indicate total percent of body surface burn. The fifth digit is for percent of body surface of third -degree burn. The military coders will always assign a fifth digit when using this category. If the total percent of body surface is specified and there is no percentage for third -degree burn or the percent for third-degree burn is less than 10 percent, use the fifth digit "Ø." 7. Cause of injury codes for any condition coded with codes 692.71, 8ØØ-999, V713V716, and E93Ø-E949 codes will be taken from STANAG 2050. See Appendix B of Triservice Disease and Procedure Coding Guidelines, ICD--9-CM , dated 1 January 1991. 8. Sequencing of Injuries. a. Multiple injuries: the most severe or life-threatening injury is the principal diagnosis. b. If injuries are of equal importance, the principal diagnosis is the one for which a definitive surgical or nonsurgical procedure is performed. APPLICATION 1. Multiple coding is not used if the classification provides a combination code fully describing all elements of the diagnostic or procedure narrative. EXAMPLE: DIAGNOSIS: Closed fracture of right radius and ulna 813.83

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2. CD-9-CM provides subcategory codes to identify injuries considered to be complicated for categories 872-879. Burns classified to categories 94Ø-949 do not provide codes at fourth- or fifth-digit level to identify complications; therefore, diagnostic statements specifying burns as infected will require two or more codes. EXAMPLES: DIAGNOSIS: Laceration of right upper arm with delayed healing DIAGNOSIS: Third-degree burn, left forearm, infected 88Ø.13 943.31 958.3

3. Category 948 is used to classify burns according to percent of body surface involved. Military coders will use the fifth digit "Ø" for percent of body surface with no third-degree burn or third-degree burn of less than 10 percent. EXAMPLES: DIAGNOSIS: Third-degree burn to face, neck, and chest, 23 percent of body surface DIAGNOSIS: Second-degree burn to face, neck, and chest, 23 percent of body surface PRINCIPLE XV. LATE EFFECTS 1. Late effects are those inactive residual effects of indefinite duration after termination of the acute phase of the illness or injury. The term "late effect" includes those conditions/residuals specified as: a. Late. b. Due to an old injury. c. Due to a previous illness or injury. d. Due to an injury or illness that occurred 1 year or more ago. NOTE: The 1 year or more is not a hard, fast rule. If sufficient time has elapsed between the acute phase of the illness or injury and the development of a residual, then disregard the 1-year rule. 2. Late effects are classified by the residuals and by the cause of the late effect. The late-effect code can never be used as the principal diagnosis. Also the late -effect code can never be the cause for disability separation or failure to meet entrance standards. 3. Categories to identify the cause of the late effect are 137, 138, 139, 268.1, 326, 438, and 905 through 909. As previously stated, these codes can never be used as principal diagnosis or as medical reasons for disability separation. They will always be used as additional codes when applicable. 946.3 948.22 946.2 948.2Ø

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4. Conditions frequently described in diagnostic statements as residuals and late effects are: a. Malunion fracture. b. Traumatic arthritis following fracture. c. Hemiplegia, cerebrovascular thrombosis 1 year ago. d. Scarring due to third-degree burn. e. Contracture tendons due to poliomyelitis. f. Sterility due to mumps. 5. When coding a late effect of an illness or injury and a code for both the residual and the late effect are provided, the code for the residual must be sequenced first with the appropriate code to show cause (late effect) as an additional code. APPLICATION Both the residual and the late effect must be coded. The code for the residual is sequenced first. EXAMPLE: DIAGNOSIS: Nonunion of left ulna due to fracture 8 months ago 733.82 905.2

PRINCIPLE XVI. ORGAN AND TISSUE TRANSPLANTS 1. Potential Donor. Patients are sometimes admitted for predonation examination to determine tissue compatibility prior to organ/tissue donation. These patients are potential organ/tissue donors and are coded with the diagnostic code V7Ø.8 (Examination of potential donor). This code indicates the patient is not serving as a donor during the current episode of hospitalization, and therefore, the record would not have a procedure code for organ/ tissue removal. 2. Donor. Category V59 (Donor) is to be used for patients who serve as organ/tissue donor during the current continuous period of hospitalization. The admission diagnosis is Organ/Tissue Donor (specific type) and requires an appropriate subcategory code from the V59 category. Use of any V59 subcategory code indicates the patient did serve as an organ/tissue donor and therefore, the record requires a surgical procedure code indicating organ/ tissue removal.

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3. The V7Ø.8 (Examination of potential donor) code will not be used on the same record as the V59 (Donor) category code. 4. Initial Transplant Recipient. Patients admitted for an injury or chronic disease process necessitating an initial organ/tissue transplant will have that condition coded as the principal diagnosis. An additional subcategory code from the V42 (Organ or tissue replaced by transplant) category will be used as an additional code to indicate the specific organ/tissue transplanted. The recipient's surgical procedure indicating the organ/tissue transplanted will always be indicated and coded as the principle procedure. 5. Recipient Complications and/or Rejections. When an admission occurs due to a complication and/or rejection of a previously transplanted organ/tissue, the cause of admission code is selected from the 996.8 through 996.99 subcategories and used as the principal diagnosis. An additional code from category V42 (Organ or tissue replaced by transplant) is required to denote the specific organ involved. 6. Follow-up. At specified intervals transplant patients are admitted solely for examination and testing. When the admission is solely for follow -up care (status post with no complication) code V67Ø will be the principal diagnostic code. A code from the V42 category is selected to indicate the organ or tissue replaced by transplant. The disease process (or injury) which led to the initial transplant will not be coded. 7. All subcategory codes in the V42 (Organ or tissue replaced by transplant) category are status codes to indicate the presence of a transplanted organ/tissue. APPLICATION 1. A surgical procedure for organ/tissue removal is not appropriate with the predonation examination for tissue compatibility diagnosis. EXAMPLE: DIAGNOSIS: Examination of potential kidney donor V7Ø.8

2. The organ donor requires a diagnostic code to indicate the specific organ donated and a surgical procedure code for the specific organ/tissue removed. EXAMPLE: DIAGNOSIS: Kidney donor PROCEDURE: Total nephrectomy, right V59.4 55.51

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3. An initial transplant recipient requires the diagnosis necessitating the transplant be coded as the principal diagnosis and an additional diagnostic code from category V42 to denote the specific organ/tissue transplanted. The principal surgical procedure will be the specific organ/tissue transplanted. EXAMPLE: DIAGNOSIS: End state renal disease PROCEDURE: Renal transplant 585.Ø V42.Ø 55.69

4. Use a subcategory code from 996 category to show cause of admission for rejection and/or complication of organ transplant, and an additional code from V42 category to show specific organ transplanted and now causing rejection. EXAMPLE: DIAGNOSIS: Rejection of cadaver kidney transplant 996.8 V42.Ø

5. An admission solely for follow-up of organ/tissue transplant will have code V67.0 as the principle diagnosis. EXAMPLE: DIAGNOSIS: Status post renal transplant follow-up PROCEDURE: Transplant done 6 months ago for end stage renal disease PRINCIPLE XVII. AIDS AND HIV INFECTIONS 1. AIDS AND HIV. AIDS is an acronym for Acquired Immunodeficiency Syndrome. HIV is an acronym for Human Immunodeficiency Virus. The spectrum of HIV infections can be divided into three categories: a. Ø42 - HIV infection with specified secondary infections and malignant neoplasms. b. Ø43 - HIV infection with other specified manifestations in the absence of either specified secondary infections or malignant neoplasms. c. Ø44 - Other HIV infections not classifiable above. 2. Code Category. The selection of the appropriate Ø42-Ø44 code is determined solely by the terminology used for the HIV infection. Codes Ø42, Ø43, and Ø44 are mutually exclusive and only one code from the Ø42-Ø44 series should be used on the same record. This code may change on subsequent admissions. Priority is given to Ø42 over Ø43 and Ø44; Ø43 is given priority over Ø44. V67.Ø V42.Ø

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3. Manifestations. The manifestations of the HIV infection should be clearly identified in order to select the appropriate code. Use the alphabetical table provided in the ICD9-CM addendum as an index to assist in the selection of the most appropriate code for the infection and any associated manifestation(s). a. The term "with" implies that the condition or manifestation of HIV infection need only be listed on the record. Terms such as "and" and "in association with" will be considered in the same manner as "with." EXAMPLES: DIAGNOSES: Acute lymphadenitis with AIDS, Stage 3 Kaposi's sarcoma associated with AIDS, Stage 6 Burkitt's tumor, Stage 6 AIDS-like disease, Stage 4 683, Ø42.9, 795.8--3 173, Ø42,2, 795.8--6 2ØØ.2, Ø42.2, 795.8--6 Ø43.9, 795.8--4

b. The term "due to" denotes a causal relationship. The physician must state the relationship between HIV infections and other conditions. EXAMPLES: DIAGNOSES: Dementia due to HIV infection, Stage 5 Acquired immunodeficiency syndrome, Stage 6 Disseminated candidiases caused by AIDS, Stage 6 298.9, Ø43.1, 795.8--5

Ø42.9, 795.8--6 112.5, Ø42.1, 795.8--6

4. HIV Code Extenders. To accommodate the DRG groupers and still retain the specificity required by DOD to identify the progressive stage of an HIV infection, the following "stage" code extenders are available: 795.8— 1 Positive serological or viral culture findings for human immunodeficiency virus (HIV), stage 1. 795.8— 2 Positive serological or viral culture findings for human immunodeficiency virus (HIV), stage 2. 795.8— 3 Positive serological or viral culture findings for human immunodeficiency virus (HIV), stage 3. 795.8— 4 Positive serological or viral culture findings for human immunodeficiency virus (HIV), stage 4.

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795.8— 5 Positive serological or viral culture findings for human immunodeficiency virus (HIV), stage 5. 795.8— 6 Positive serological or viral culture findings for human immunodeficiency virus (HIV), stage 6. 795.8— 9 Positive serological or viral culture findings for human immunodeficiency virus (HIV), stage unspecified or unknown. 5. Sequencing. a. The principal diagnosis would be selected based on the individual discharge. The HIV infection codes can be used as either a principal or other diagnosis. The note "with" and "due to HIV infection" do not imply sequencing. b. A manifestation associated with an HIV infection, when found after study to have been chiefly responsible for the hospitalization, is coded as the principal diagnosis. This is followed than by one of the Ø4 . subcategory codes and appropriate stage code. (NOTE: Except for Stage 1 and unspecified, Stage 9). c. When there is no manifestation, code the HIV infection using as principal diagnosis one of the Ø4 . codes with the appropriate stage code. The Ø4 . code will be the principal diagnosis. d. Follow-up Examination. Patients with positive HIV are seen at regular intervals for follow-up examination; these cases should be coded as follows: (1) For patients who have an identified manifestation at the end of the hospital stay, code the manifestation and appropriate Ø4 . subcategory code. The manifestation is selected as the principal diagnosis. The V67. code for follow-up is unnecessary. Code also the appropriate stage code. (2) For patients who demonstrate no obvious manifestation, code V67. with the appropriate stage code and the appropriate Ø4 .Ø code. The follow-up V67. will be the principal diagnosis. e. HIV stage codes are usually additional codes. They may be the principal diagnosis or sole diagnosis only in the following circumstances: (1) HIV Stage Unspecified (795.8--9) can be used when the patient has been identified as HIV positive serology, and is en route for evaluation and staging. It may occasionally represent a nonmilitary inpatient for whom no staging has been done. (2) HIV Stage 1 (795.8--1) can be used when the patient has been so staged and demonstrates no manifestations. f. Laboratory examination. Previous codes in this category are no longer used. (1) The V72.6- serology codes (four DOD-unique) are for use only; for outpatients. We have deleted the V72.6- for inpatients but must leave the system intact for the outpatient US active duty data base. That system collects negative as well as positive serologies to accommodate the complete formula for rates and percentages.

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(2) There should be no code for false positive on inpatient records . Because we require two Elisa and a Western Blot before a diagnosis is made, the chances of a false positive are negligible. (3) For hospital inpatients, there will be no need for a diagnosis or code on the medical record face sheet to reflect "negative serology - HIV." We do not diagnose or code other negative laboratory findings; there is no need to do so with HIV. APPLICATION 1. The manifestation chiefly responsible for the hospitalization is the principal diagnosis and is sequenced first, followed by the Ø4 . HIV infection code. Code also all other manifestations and the stage code. EXAMPLE: DIAGNOSES: HIV Dementia AIDS, Stage 6 Candida Esophagitis Ø42.9 112.8Ø 298.9

2. When a patient is admitted for a follow-up examination, code to V67.59 and code the stage of infection. EXAMPLE: DIAGNOSES: Follow-up exam HIV Antibody Positive, Stage 2 V67.59 795.8--2

3. When hospitalization is for a condition unrelated to the HIV infection, that condition is the principal diagnosis. EXAMPLE: DIAGNOSES: Closed Head Injury, MV Bladder Contusion Fracture, Closed, Right Acetabulum HIV Infection Ø44.9 795.8--1 867.Ø 8Ø8.Ø 854.Ø

HIV Positive, Stage 1 of Infection

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PRINCIPLE XVIII. SPECIAL DIAGNOSIS 1. Viral (Infectious) Hepatitis. a. The code numbers in ICD-9-CM for viral hepatitis will be used. However, to provide greater specificity for DOD use, this category has been expanded by use of DOD code extenders, which are included in Appendix A of the Triservice Disease and Procedure Coding Guidelines, dated 1 January 1991. b. There is no longer a requirement to denote drug use/nonuse when coding hepatitis conditions. c. Post-transfusion hepatitis will be coded 999.8 and Ø7Ø.3--1. d. Post-vaccination hepatitis will be coded 999.9 and Ø7Ø.3--1. 2. Diabetes Mellitus. a. Category 25Ø is used to classify diabetes mellitus. Fourth-digit classifications are used to identify the presence of coma or systemic manifestations. The fifth-digit subclassifica-tion will specify the type of diabetes. When the physician does not specify the type of diabetes, a fifth digit of "Ø" is assigned. Fifth-digit subclassifications: Ø -- Adult onset and NOS (AODM) Noninsulin Dependent Diabetes (NIDDM) Maturity Onset Diabetes (MODM) Type II Diabetes 1 -- Juvenile type (JODM) Insulin Dependent Diabetes (IDDM) Adult Onset with Insulin Dependence Type I Diabetes b. To use the fifth digit of "1," insulin dependent must be noted somewhere in the medical record or as part of the stated final diagnosis. Do not assume a patient has insulin dependent diabetes simply because the patient is receiving insulin. Sometimes Type II diabetics require temporary use of insulin when they are hospitalized for surgery or other illness. Consult the physician for clarification in such cases. c. System Manifestations. (1) Categories 25Ø.4-25Ø.8 are used to classify diabetes with systemic manifestations, which represent a cause and effect relationship with the diabetes. These codes are presented together as an inseparable pair in the Alphabetic Index. These paired codes are sequenced so that the underlying cause (diabetes) is always positioned first and followed by the manifestation code.

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(2) The physician should specify in the diagnosis that the condition is diabetic or due to diabetes; otherwise, it is presumed not to be caused by diabetes. NOTE: An exception is diabetic gangrene or diabetes with gangrene leads the coder to the code denoting diabetes as the underlying cause of the gangrene, 25Ø.7Ø [785.4]. d. Uncontrolled diabetes. Diabetes described as brittle or uncontrolled is to be interpreted as diabetes mellitus, complicated. Brittle diabetes mellitus is difficult to control because of rapid fluctuation in the blood sugar. Brittle diabetes mellitus may occur in either the juvenile or the adult-onset type. ICD-9-CM CODE EXTENDERS Add these codes to the indicated categories in ICD-9-CM, Volume 1. These codes are to be used with records having a date of disposition on or after 1 January 1989. Ø4Ø89— Ø Toxic shock syndrome Ø4Ø89— 9 Other specified bacterial diseases, excluding toxic shock syndrome Ø7ØØ— Ø Viral hepatitis A with hepatic coma, lab test confirmed Ø7ØØ— 1 Viral hepatitis A with hepatic coma, lab test not reported or negative Ø7ØØ— 2 Viral hepatitis A with hepatic coma, lab test notperformed Ø7Ø1— Ø Viral hepatitis A without mention of hepatic coma, lab test confirmed Ø7Ø1— 1 Viral hepatitis A without mention of hepatic coma, lab test not reported or negative Ø7Ø1— 2 Viral hepatitis A without mention of hepatic coma, lab test not performed Ø7Ø2— Ø Viral hepatitis B with hepatic coma, lab test confirmed Ø7Ø2— 1 Viral hepatitis B with hepatic coma, lab test not reported or negative Ø7Ø2— 2 Viral hepatitis B with hepatic coma, lab test not performed Ø7Ø3— Ø Viral hepatitis B without mention of hepatic coma, lab test confirmed Ø7Ø3— 1 Viral hepatitis B without mention of hepatic coma, lab test not reported or negative Ø7Ø3— 2 Viral hepatitis B without mention of hepatic coma, lab test not performed Ø7Ø4— 3 Ø7Ø4— 9 Ø7Ø5— 3 Ø7Ø5— 9 Ø888— Ø Ø888— 9 Non A, Non-B hepatitis with hepatic coma Other specified viral hepatitis, excluding Non-A, Non-B hepatitis, with hepatic coma Non A, Non-B hepatitis without mention of hepatic coma Other specified viral hepatitis, excluding Non-A, Non-B hepatitis, without mention of hepatic coma Lyme disease Other specified arthropod-borne diseases, excluding Lyme's disease

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4461— Ø 4461— 9

Kawasaki disease Acute febrile mucocutaneous lymph node syndrome (MCLS), excluding Kawasaki disease

635xx— Ø Legally induced abortion, elective 635xx— 1 Legally induced abortion, therapeutic 635xx— 9 Legally induced abortion, unspecified 638x— Ø 638x— 1 638x— 9 6542— Ø 6542— 9 7958— 1 Failed attempted abortion, elective Failed attempted abortion, therapeutic Failed attempted abortion, unspecified Uterine scar from previous cesarean section Uterine scar from previous surgery, excluding previous cesarean section Positive serological or viral cu lture findings for human immunodeficiency virus (HIV), stage 1 Positive serological or viral culture findings for human immunodeficiency virus (HIV), stage 2 Positive serological or viral culture findings for human immunodeficiency virus (HIV), stage 3 Positive serological or viral culture findings for human immunodeficiency virus (HIV), stage 4 Positive serological or viral culture findings for human immunodeficiency virus (HIV), stage 5 Positive serological or viral culture findings for human immunodeficiency virus (HIV), stage 6 Positive serological or viral culture findings for human immunodeficiency virus (HIV), stage unspecified or unknown Observation following other accident, head injury ruled out Observation following other accident, excluding head injury Observation following other inflicted injury, head injury ruled out Observation following other inflicted injury, excluding head injury Positive serological or viral culture findings for human immunodeficiency virus (HIV), stage 2

7958— 2 7958— 3 7958— 4 7958— 5 7958— 6 7958— 9 V714— Ø V714— 9 V716— Ø V716— 9 7958— 2

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APPLICATION 1. Use the DOD code extenders when coding hepatitis conditions. EXAMPLE: DIAGNOSIS: Hepatitis B, no lab confirmation and no coma Ø7Ø.3--1

2. Diabetes mellitus. Use fifth digits to denote insulin dependent or noninsulin depending; use the fourth digits to denote complications and/or manifestations. EXAMPLES: DIAGNOSIS: Diabetes mellitus, juvenile, brittle DIAGNOSIS: Diabetic nephropathy 25Ø.41 583.81

3. When diabetes mellitus is specified as brittle on uncontrolled, assign the code identifying the specific complication present ; if any is stated. Otherwise, assign 25Ø.9with the appropriate fifth-digit code. EXAMPLES: DIAGNOSIS: Diabetes mellitus, uncontrolled; ketoacidosis DIAGNOSIS: Diabetes mellitus, brittle 25Ø.1Ø 25Ø.9Ø

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APPENDIX B - EXCERPTS FROM VOLUME I International Classification of Diseases, 9th Revision, Clinical Modification TABULAR LIST

117.8 Infection by dematiacious fungi, [ Phaehyphomyocsis] Infection by dematiacious fungi, such as Cladosporium trichoides [bantianum], Dreschlera hawaiiensis, Phialophora gougerotii, Phialophora jeanselmi 117.9 Other and unspecified mycoses 118 Opportunistic mycoses Infection of skin, subcutaneous tissues, and/or organs by a wide variety of fungi generally considered to be pathogenic to compromised hosts only (e.g., infection by species of Alternaria, Dreschlera, Fusarium)

HELMINTHIASES (120-129)

120 Schistosomiasis [bilharziasis] 120.0 Schistosoma haematobium Vesical schistosomiasis NOS 120.1 Schistosoma mansoni Intestinal schistosomiasis NOS 120.2 Schistosoma japonicum Asiatic schistosomiasis NOS Katayama disease or fever 120.3 Cutaneous Cercarial dermatitis Infection by cercariae of Schistosoma 120.8 Other specified schistosomiasis Infection by Schistosoma: bovis intercalatum mattheii

Schistosome dermatitis Swimmers' itch

Infection by Schistosoma spindale Schistosomiasis chestermani

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NEOPLASMS

154.3 Anus, unspecified

Excludes:

anus: margin (172.5, 173.5) skin (172.5, 173.5) perianal skin (172.5, 173.5)

154.8 Other Anorectum Cloacogenic zone Malignant neoplasm of contiguous or overlapping sites of rectum, rectosigmoid junction, and anus whose point of origin cannot be determined

155 Malignant neoplasm of liver and intrahepatic bile ducts 155.0 Liver, primary Carcinoma: liver, specified as primary hepatocellular liver cell Hepatoblastoma 155.1 Intrahepatic bile ducts Canaliculi biliferi Interlobular: bile ducts biliary canals

Intrahepatic biliary passages canaliculi gall duct

Excludes:

hepatic duct (156.1)

155.2 Liver, not specified as primary or secondary 156 Malignant neoplasm of gallbladder and extrahepatic bile ducts 156.0 Gallbladder 156.1 Extrahepatic bile ducts Biliary duct or passage NOS Common bile duct

Cystic duct Hepatic duct Sphincter of Oddi

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NERVOUS SYSTEM AND SENSE ORGANS

380.4 Impacted cerumen Wax in ear 380.5 Acquired stenosis of external ear canal Collapse of external ear canal 380.50 Acquired stenosis of external ear canal, unspecified as to cause 380.51 Secondary to trauma 380.52 Secondary to surgery 380.53 Secondary to inflammation 380.8 Other disorders of external ear 380.81 Exostosis of external ear canal 380.89 Other 380.9 Unspecified disorder of external ear 381 Nonsuppurative otitis media and Eustachian tube disorders 381.0 Acute nonsuppurative otitis media Acute tubotympanic catarrh Otitis media, acute or subacute: catarrhal exudative transudative with effusion Excludes: otitic barotrauma (993.0)

381.00 Acute nonsuppurative otitis media, unspecified 381.01 Acute serous otitis media Acute or subacute secretory otitis media 381.02 Acute mucoid otitis media Acute or subacute seromucinous otitis media Blue drum syndrome

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RESPIRATORY SYSTEM

485 Bronchopneumonia, organism unspecified Bronchopneumonia: hemorrhagic terminal Pleurobronchopneumonia Excludes: Pneumonia: lobular segmental

bronchiolitis (acute) (466.1) chronic (491.8) lipoid pneumonia (507.1)

486 Pneumonia, organism unspecified

Excludes:

hypostatic or passive pneumonia (514) influenza with pneumonia, any form (487.0) inhalation or aspiration pneumonia due to foreign materials (507.0-507.8) pneumonitis due to fumes and vapors (506.0)

487 Influenza

Excludes:

hemophilus influenzae [H.influenzae]: infection NOS (041.5) larygitis (464.0) meningitis (320.0) pneumonia (482.2)

487.0 With pneumonia Influenza with pneumonia, any form Influenzal: bronchopneumonia pneumonia 487.1 With other respiratory manifestations Influenza NOS Influenzal: laryngitis pharyngitis respiratory infection (upper) (acute) 487.8 With other manifestations Encephalopathy due to influenza Influenza with involvement of gastrointestinal tract Excludes: "intestinal flu" [viral gastroenteritis] (008.8)

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CONDITIONS IN THE PERINATAL PERIOD

773.3 Hydrops fetalis due to isoimmunization Use additional code, if desired, to identify type of isoimmunization (773.0-773.2)

773.4 Kernicterus due to isoimmunization Use additional code, if desired, to identify type of isoimmunization (773.0-773.2)

773.5 Late anemia due to isoimmunization

774 Other perinatal jaundice

774.0 Perinatal jaundice from hereditary hemolytic anemias Code also underlying disease (282.0-282.9)

774.1 Perinatal jaundice from other excessive hemolysis Fetal or neonatal jaundice from: brusing drugs or toxins transmitted from mother infection polycythermia swallowed maternal blood Use additional code, if desired, to identify cause

Excludes:

jaundice due to isoimmunization (773.0-773.2)

774.2 Neonatal jaundice associated with preterm delivery Hyperbilirubinemia or prematurity Jaundice due to delayed conjugation associated with preterm delivery

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SYMPTOMS, SIGNS, AND ILL-DEFINED CONDITIONS

782.6 Pallor and flushing 782.61 Pallor 782.62 Flushing Excessive blushing 782.7 Spontaneous ecchymoses Petechiae

Excludes:

ecchymosis in fetus or newborn (772.6) purpura (287.0-287.9)

782.8 Changes in skin texture Induration of skin Thickening

}

782.9 Other symptoms involving skin and integumentary tissues 783 Symptoms concerning nutrition, metabolism, and development 783.0 Anorexia Loss of appetite

Excludes:

anorexia nervosa (307.1) loss of appetite of nonorganic origin (307.59)

783.1 Abnormal weight gain

Excludes:

excessive weight gain in pregnancy (646.1) obesity (278.0)

783.2 Abnormal loss of weight 783.3 Feeding difficulties and mismanagement Feeding problem (elderly) (infant)

Excludes:

feeding disturbance or problems: in newborn (779.3) of nonorganic origin (307.50-307.59)

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TABULAR LIST

783.4 Lack of expected normal physiological development Delayed milestone Lack of growth Failure to gain weight Physical retardation Failure to thrive Short stature Excludes:

delay in sexual development and puberty (259.0) specific delays in mental development (315.0-315.9)

783.5 Polydipsia Excessive thirst 783.6 Polyphagia Excessive eating Hyperalimentation NOS

Excludes:

disorders of eating of nonorganic origin (307.50-307.59)

783.9 Other symptoms concerning nutrition, metabolism, and development Hypometabolism

Excludes:

abnormal basal metabolic rate (794.7) dehydration (276.5) other disorders of fluid, electrolyte and acid-base balance (276.0-276.9)

784 Symptoms involving head and neck

Excludes:

encephalopathy NOS (348.3) specific symptoms involving neck classifiable to 723 (723.0-723.9)

784.0 Headache Facial pain

Pain in head NOS

Excludes:

atypical face pain (350.2) migraine (346.0-346.9) tension headache (307.81)

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SYMPTOMS, SIGNS, AND ILL-DEFINED CONDITIONS

784.1 Throat pain Excludes: dysphagia (787.2) neck pain (723.1) sore throat (462) chronic (472.1)

784.2 Swelling, mass, or lump in head and neck Space-occupying lesion, intracranial NOS 784.3 Aphasia

Excludes: 784.4 Voice disturbance

developmental aphasia (315.31)

784.40 Voice distubrance, unspecified 784.41 Aphonia Loss of voice 784.49 Other Change in voice Dysphonia Hoarseness 784.5 Other speech distubance Dysarthria Dysphasia

Hypernasality Hyponasality

Slurred speech

Excludes:

stammering and stuttering (307.0) that of nonorganic origin (307.0, 307.9)

784.6 Other symbolic dysfunction

Excludes:

developmental learning delays (315.0-315.9)

784.60 Symbolic dysfunction, unspecified 784.61 Alexia and dyslexia Alexia (with agraphia) 784.69 Other Acalculia Agnosia

Agraphia NOS Apraxia

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APPENDIX C – EXCERPTS FROM VOLUME 2 International Classification of Diseases, 9 th Revision, Clinical Modification
INDEX TO DISEASES
Anomaly, anomalous (congenital) (unspecified type) – continued vitreous humor 743.9 specified type NEC 743.51 vulva 752.40 wrist (joint) 755.50 Anomia 784.69 Anonychia 757.5 Acquired 703.8 Anophthalmos, anophthalmus (clinical) (congenital) (globe) 743.00 acquired 360.89 Anopsia (altitudinal) (quadrant ) 368.46 Anorchia 752.8 Anorchism, anorchidism 752.8 Anorexia 783.0 hysterical 300.11 nervosa 307.1 Anosmia (see also Disturbance, sensation) 781.1 hysterical 300.11 postinfectional 478.9 psychogenic 306.7 traumatic 951.8 Anosognosia 780.9 Anosphrasia 781.1 Anosteoplasia 756.50 Anotia 744.09 Anovulatory cycle 638.0 Anoxemia 799.0 newborn 770.8 Anoxia 799.0 altitude 993.2 cerebral 348.1 with abortion – see Abortion, by type, with specified complication NEC ectopic pregnancy (see also categories 633.0-633.9) 639.8 molar pregnancy (see also categories 630-632) 639.8 complicating delivery (cesarean) (instrumental) 669.4 ectopic or molar pregnancy 639.8 obstetric anesthesia or sedation 668.2 during or resulting from a procedure 997.0 following abortion 639.8 ectopic or molar pregnancy 639.8 newborn (see also Distress, fetal, liveborn infant) 768.9 due to drowning 994.1 heart – see Insufficiency, coronary high altitude 993.2 intrauterine fetal death (before onset of labor) 768.0 during labor 768.1

Anthropophobia

Anoxia –continued intrauterine – continued liveborn infant – see Distress, fetal, liveborn infant myocardial – see Insufficiency, coronary, newborn 768.9 mild or moderate (Apgar score 4-7) 768.6 severe (Apgar score 0-3) 768.5 pathological 799.0 Anteflexion – see Anteversion Antenatal care, normal pregnancy V22.1 first V22.0 screening (for) V28.9 based on amniocentesis NEC V28.2 chromosomal anomalies V28.0 raised alphafetoprotein levels V28.1 chromosomal anomalies V28.0 fetal growth retardation using ultrasonics V28.4 isoimmunization V28.5 malformations using ultrasonics V28.3 raised alphafetoprotein levels in amniotic fluid V28.1 specified condition NEC V28.8 Antepartum.--.see condition Anterior – see also condition spinal artery compression syndrome 721.1 Antero-occlusion 524.2 Anteversion cervix (see also Anteversion, uterus) 621.6 femur (neck), congenital 755.63 uterus, uterine (cervix) (postinfectional) (postpartal, old) 621.6 congenital 752.3 in pregnancy or childbirth 654.4 affecting fetus or newborn 763.8 causing obstructed labor 660.2 affecting fetus or newborn 763.1 Anthracosilicosis (occupational) 500 Anthracosis (lung) (occupational) 500 lingua 529.3 Anthrax 022.9 with pneumonia 022.1 [484.5] colitis 022.2 cutaneous 022.0 gastrointestinal 022.2 intestinal 022.2 pulmonary 022.1 respiratory 022.1 septicemia 022.3 specified manifestation NEC 022.8 Anthropoid pelvis 755.69 with disproportion (fetopelvic) 653.2 affecting fetus or newborn 763.1 causing obstructed labor 660.1 affecting fetus or newborn 763.1 Anthropophobia 300.29

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INDEX TO DISEASES Jaundice ____________________________________________________________________________________
J Jaccoud's nodular fibrositis, chronic (Jaccoud's syndrome) 714.4 Jackson's membrane 751.4 paralysis or syndrome 344.8 veil 751.4 Jacksonian epilepsy 345.5 seizures (focal) 345.5 Jacob's ulcer (M8090/3)--see Neoplasm, skin, malignant, by site Jacquet's dermatitis (diaper dermatitis) 691.0 Jadassohn's blue nevus (M8780/0--see Neoplasm, skin, benign disease (maculopapular erythroderma) 696.2 intraepidermal epithelioma (M8096/0) -- see Neoplasm, skin, benign Jadassohn-Lewandowski syndrome (pachyonychia congenita) 757.5 Jadassohn-Pellizari's disease (anetoderma).701.3 Jadassohn-Tieche nevus (M8780/0— see Neoplasm, skin, benign Jaffe-Lichtenstein (-Uehlinger) syndrome 252.0 Jahnke's syndrome (encephalocutaneous angiomnatosis) 759.6 Jakob-Creutzfeldt disease or syndrome 046.1 with dementia 290.10 Jaksch (-Luzet) disease or syndrome (pseudoleukemia infantum) 285.8 Jamaican neuropathy 349.82 paraplegic tropical ataxic-spastic syndrome 349.82 Janet's disease (psychasthenia) 300.89 Janiceps 759.4 Jansky-Bielschowsky amaurotic familial idiocy 330.1 Japanese B type encephalitis 062.0 river fever 081.2 seven-day fever 100.89 Jaundice (yellow) 782.4 acholuric (familial) ( splenomegalic) (see also Spherocytosis) 282.0 acquired 283.9 breast milk 774.39 catarrhal (acute) 070.1 with hepatic coma 070.0 Jaundice (yellow)--continued catarrhal (acute)--continued chronic 571.9 epidemic--see Jaundice, epidemic cholestatic (benign) 782.4 chronic idiopathic 277.4 epidemic (catarrhal) 070.1 with hepatic coma 070.0 leptospiral 100.0 spirochetal 100.0 febrile (acute) 070.1 with hepatic coma 070.0 leptospiral 100.0 spirochetal 100.0 fetus or newborn 774.6 due to or associated with ABO antibodies 773.1 incompatibility, maternal/fetal 773.1 isoimmunization 773.1 absence or deficiency of enzyme system for bilirubin conjugation (congential) 774.39 blood group incompatibility NEC 773.2 breast milk inhibitors to conjugation 774.39 associated with preterm delivery 774.2 bruising 774.1 Crigler-Najjar syndrome 277.4 [774.31] delayed conjugation 774.30 associated with preterm delivery 774.2 development 774.39 drugs or toxins transmitted from mother 774.1 G-6-PD deficiency 282.2 [774.0] galactosemia 271.1 [774.5] Gilbert's syndrome 277.4 [774.31] hepatocellular damage 774.4 hereditary hemolytic anemia (see also Anemia, hemolytic) 282.9 [774.0] hypothyroidism, congential 243 [774.31] incompatibility, maternal/fetal NEC 773.2 infection 774.1 inspissated bile syndrome 774.4 isoimmunization NEC 773.2 mucoviscidosis 277.01 [774.5]

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INDEX TO DISEASES Lambliasis ____________________________________________________________________________________
Lacertation--continued uterus--continued with--continued molar pregnancy (see categories 630-632) 639.2 following abortion 639.2 ectopic or molar pregnancy 639.2 nonpuerperal, nontraumatic 621.8 obstetrical trauma NEC 665.1 old (postpartal) 62.18 vagina with abortion--see Abortion, by type, with damage to pelvic organs ectopic pregancy (see categories 633.0-633.9) 639.2 molar pregnancy (see categories 630-632) 639.2 perineal involvement, complicating delivery 664.0 complicating delivery 665.4 first degree 664.0 second degree 664.1 third degree 664.2 fourth degree 664.3 high 665.4 muscles 664.1 sulcus 665.4 wall 665.4 following abortion 639.2 ectopic or molar pregnancy 639.2 nonpuerperal, nontraumatic 623.4 old (postpartal) 623.4 valve, heart--see Endocarditis vulva with abortion--see Abortion, by type, with damage to pelvic organs ectopic pregnancy (see categories 633.0-633.9) 639.2 molar pregnancy (see also categories 630-632) 639.2 complicating delivery 664.0 following abortion 639.2 ectopic or molar pregnancy 639.2 nonpuerperal, nontraumatic 624.4 old (postpartal) 624.4 Lachrymal--see condition Lachrymonasal duct --see condition Lack of appetite (see also Anorexia) 783.0 care in home V60.4 of infant (at or after birth) 995.5 affecting parent or family V61.21 specified person NEC 995.81 coordination 781.3 Lack of --- continued development--see also Hypoplasia physiological 783.4 education V62.3 energy 780.6 financial resources V60.2 food 994.2 in environment V60.8 growth 783.4 heating V60.1 housing (permanent) (temporary) V60.0 adequate V60.1 material resources V60.2 medical attention 799.8 memory (see also Amnesia) 780.9 mild, following organic brain damage 310.1 ovlation 628.0 person able to render necessary care V60.4 physiologic development 783.4 shelter V60.0 water 994.3 Lacrimal--see condition Lacrimation, abnormal (see also Epiphora) 375.20 Lacrimonasal duct--see condition Lactation, lactating (breast) (puerperal) (postpartum) defective 676.4 disorder 676.9 specified type NEC 676.8 excessive 676.6 failed 676.4 mastitis NEC 675.2 mother (care and/or examination) V24.1 nonpuerperal 611.6 suppressed 676.5 Lacticemia 271.3 excessive 276.2 Lactosuria 271.3 Lacunar skull 756.0 Laennec;s cirrhosis (alcoholic) 571.2 nonalcoholic 571.5 Lafora's disease 333.2 Lag, lid (nervous) 374.41 Lagleyze-von Hippel disease (retinocerebral) angiomatosis) 759.6 Lagophthalmos (eyelid) (nervous ) 374.20 cicatrical 374.23 keratitis (see also Keratitis) 370.34 mechanical 374.22 paralytic 374.21 La grippe--see Influenza Lahore sore 085.1 Lakes, venous (cerebral) 437.8 Laki-Lorand factor deficiency (see also Defect, coagulation) 286.3 Lalling 307.39 Lambliasis 007.1

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Lame INDEX TO DISEASES ____________________________________________________________________________________
Lame back 724.5 Lancereaux's diabetes (diabetes mellitus with marked emaciation) 250.8 [261] Landouzy-Dejerine dystrophy (fascioscapulohumeral atrophy) 359.1 Landry's diease or paralysis 357.0 Landry-Guillain-Barre syndrome 357.0 Lane's band 751.4 disease 569.89 kink (see also Obstruction, intestine) 560.9 Langdon Down's syndrome (mongolism) 758.0 Language abolition 784.69 Lanugo (persistent) 757.4 Lardaceous degeneration (any site) 277.3 disease 277.3 kidney 277.3 [583.81] liver 277.3 Large baby (regardless of gestational age) 766.1 exceptionally (weight of 45 grams or more) 766.0 of diabetic mother 775.0 ear 744.22 fetus--see also Oversize, fetus causing disproportion 653.5 with obstructed labor 660.1 for dates fetus or newborn (regardless of gestational age) 766.1 affecting management of pregnancy 656.6 exceptionally (weight of 45 grams or more) 766.0 pysiological cup 743.57 waxy liver 277.3 white kidney--see Nephrosis Larsen's syndrome (flattened facies and multiple congential dislocations) 755.8 Larsen-Johansson disease (juvenile osteopathia patellae) 732.4) Larva migrans cutaneous NEC 126.9 ancylostoma 126.9 of Diptera in viterous 128.0 visceral NEC 128.0 Larygeal--see also condition syncope 786.2 Laryngismus (acute) (infectious) (stridulous) 478.75 congential 748.3 diphtheritic 032.3 Laryngitis (acute) (edematous) (fibrinous) (gangrenous) (infective) (infiltrative)( malignant) (membranous) (phlegmonous) (pneumococcal) (pseudomembranous) (septic) (subglottic) (suppurative) (ulcerative) (viral) 464.0 with influenza, flu, or grippe 487.1 tracheitis (see also Laryngotracheitis) 464.20 with obstruction 464.21 acute 464.20 with obstruction 464.21 chronic 476.1 atrophic 476.0 Borrelia vincentii 101 catarrhal 476.0 chronic 476.0 with tracheitis (chronic) 476.1 due to external agent--see Condition, respiratory, chronic, due to diphtheritic (membranous) 032.3 due to external agent--see Infammation, respiratory, upper, due to H. influenzae 464.0 Hemophilus influenzae 464.0 influenzal 487.1 pachydermic 478.79 sicca 476.0 spasmodic 478.75 acute 464.0 streptococcal 034.0 stridulous 478.75 syphilitic 095.8 congential 090.5 tuberculous (see also Tuberculosis, larynx) 012.3 Vincent's 101 Laryngocele (congential) (ventricular ) 748.3 Laryngofissure 478.79 congenital 748.3 Laryngomalacia (congenital) 748.3 Laryngopharyngitis (acute) 465.0 chronic 478.9 due to external agent--see Condition, respiratory, chronic, due to due to external agent--see Inflammation, respiratory, upper, due to septic 034.0 Laryngoplegia (see also Paralysis, vocal cord) 478.30 Laryngoptosis 478.79 Laryngospasm 478.75 due to external agent--see Condition, respiratory, acute, due to Laryngostenosis 478.74 congential 748.3

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INDEX TO DISEASES
Uncertain Behavior Malignant

Neoplasm

Neoplasm, neoplastic – continued ligament – continued Uterosacral … … … … … … … … … … … … … … … … … . limb* … … … … … … … … … … … … … … … … … … … … ... lower* … … … … … … … … … … … … … … … … … … … .. upper* … … … … … … … … … … … … … … … … … … … .. limbus of cornea … … … … … … … … … … … … … … … .. lingual NEC (see also Neoplasm, tongue) … … … … .. lingula, lung … … … … … … … … … … … … … … … … … .. lip (external) (lipstick area) ( vermillion border) … … … buccal aspect – see Neoplasm, lip, internal commissure… … … … … … … … … … … … … … … … … . contiguous sites … … … … … … … … … … … … … … … . with oral cavity or pharynx … … … … … … … … … … . frenulum – see Neoplasm, lip, internal inner aspect – see Neoplasm, lip, internal internal (buccal) (frenulum) (mucosa) (oral) … … … .. lower… … … … … … … … … … … … … … … … … … … ... upper … … … … … … … … … … … … … … … … … … … . lower … … … … … … … … … … … … … … … … … … … … internal (buccal) (frenulum) (mucosa) (oral)… … … . mucosa – see Neoplasm, lip, internal oral aspect – see Neoplasm, lip, internal skin (commissure) (lower) (upper) … … … … … … … .. upper … … … … … … … … … … … … … … … … … … … … internal (buccal) (frenulum) (mucosa) (oral) … … … liver … … … … … … … … … … … … … … … … … … … … … . primary … … … … … … … … … … … … … … … … … … … lobe azygos … … … … … … … … … … … … … … … … … … … frontal … … … … … … … … … … … … … … … … … … … .. lower … … … … … … … … … … … … … … … … … … … … middle … … … … … … … … … … … … … … … … … … … . occipital … … … … … … … … … … … … … … … … … … .. parietal … … … … … … … … … … … … … … … … … … … temporal … … … … … … … … … … … … … … … … … … . upper … … … … … … … … … … … … … … … … … … … … lumbrosacral plexus … … … … … … … … … … … … … … lung … … … … … … … … … … … … … … … … … … … … … azgos lobe … … … … … … … … … … … … … … … … … .. carina … … … … … … … … … … … … … … … … … … … .. contiguous sites with bronchus or trachea … … … … hilus … … … … … … … … … … … … … … … … … … … … . lingula … … … … … … … … … … … … … … … … … … … .. lobe NEC … … … … … … … … … … … … … … … … … … . lower lobe … … … … … … … … … … … … … … … … … … main bronchus … … … … … … … … … … … … … … … … middle lobe … … … … … … … … … … … … … … … … … . upper lobe … … … … … … … … … … … … … … … … … ...

183.4 195.8 195.5 195.4 190.4 141.9 162.3 140.9 140.6 140.8 149.8

198.82 198.89 198.89 198.89 198.4 198.89 197.0 198.89 198.89 ---

-232.8 232.7 232.6 234.0 230.0 231.2 230.0 230.0 ---

221.0 229.8 229.8 229.8 224.4 210.1 212.3 210.0 210.4 ---

236.3 238.8 238.8 238.8 238.8 235.1 235.7 235.1 235.1 ---

140.5 140.4 140.3 140.1 140.4

198.89 198.89 198.89 198.89 198.89

230.0 230.0 230.0 230.0 230.0

210.0 210.0 210.0 210.0 210.0

235.1 235.1 235.1 235.1 235.1

173.0 140.0 140.3 155.2 155.0 162.3 191.1 162.5 162.4 191.4 191.3 191.2 162.3 171.6 162.9 162.3 162.2 162.8 162.2 162.3 162.9 162.5 162.2 162.4 162.3

198.2 198.89 198.89 197.7 -197.0 198.3 197.0 197.0 198.3 198.3 198.3 197.0 198.4 197.0 197.0 197.0 -197.0 197.0 197.0 197.0 197.0 197.0 197.0

232.0 230.0 230.0 230.8 -231.2 -231.2 231.2 ---231.2 -231.2 231.2 231.2 -231.2 231.2 231.2 231.2 231.2 231.2 231.2

216.0 210.0 210.0 211.5 -212.3 225.0 212.3 212.3 225.0 225.0 225.0 212.3 215.6 212.3 212.3 212.3 -212.3 212.3 212.3 212.3 212.3 212.3 212.3

238.2 235.1 235.1 235.3 -235.7 237.5 235.7 235.7 237.5 237.5 237.5 235.7 238.1 235.7 235.7 235.7 -235.7 235.7 235.7 235.7 235.7 235.7 235.7

MD0753

C-5

Unspecified 239.5 239.8 239.8 239.8 239.8 239.0 239.1 239.0 239.0 --239.0 239.0 239.0 239.0 239.0 239.0 239.0 239.0 239.0 -239.1 239.6 239.1 239.1 239.6 239.6 239.6 239.1 239.2 239.1 239.1 239.1 -239.1 239.1 239.1 239.1 239.1 239.1 239.1

Secondary

Ca In situ

Primary

Benign

INDEX TO DISEASES Swelling ____________________________________________________________________________________
Suppuration suppurative--continued wound--see also Wound, open, by site, complicated dislocation--see Dislocation, by site, compound fracture--see Fracture, by, site, open scratch or other superficial injury--see Injury, superficial, by site Suprapubic drainage 596.8 Suprarenal (gland)--see condition Suprascapular nerve--see condition Suprasellar--see condition Supraspinatus syndrome 726.10 Surfer knots 919.8 infected 919.9 Surgery cosmetic NEC V50.1 following healed injury or operation V51 hair transplant V50.0 elective V50.9 breast augmentation or reduction V50.1 circumcision, ritual or routine (in absence of medical indication) V50.2 cosmetic NEC V50.1 ear piercing V50.3 face-lift V50.1 following healed injury or operation V51 hair transplant V50.0 not done because of contraindication V64.1 patient's decision V64.2 specified reason NEC V64.3 plastic breast augmentation or reduction V50.1 cosmetic V50.1 face-lift V50.1 following healed injury or operation V51 repair of scarred tissue (following healed injury or operation) V51 specified type NEC V50.8 previous, in pregnancy or childbirth cervix 654.6 affecting fetus or newborn 763.8 causing obstructed labor 660.2 affecting fetus or newborn 763.1 pelvic soft tissues NEC 654.9 affecting fetus or newborn 763.8 causing obstructed labor 660.2 affecting fetus or newborn 763.1 perineum or vulva 654.8 uterus 654.2 affecting fetus or newborn 763.8 causing obstructed labor 660.2 affecting fetus or newborn 763.1 Surgery--continued previous, in pregnancy or childbirth-- continued vagina 654.7 Surgical abortion--see Abortion, legal emphysema 998.8 kidney (see also Pyelitis) 590.80 operation NEC 799.9 procedures, complication or misadventure --see Complications, surgical procedure shock 998.0 Suspected condition, ruled out (see also Observation, suspected) V71.9 specified condition NEC V71.8 Suspended uterus, in pregnancy or childbirth 654.4 affecting fetus or newborn 763.8 causing obstructed labor 660.2 affecting fetus or newborn 763.1 Sutton's disease 709.0 Sutton and Gull's disease (arteriolar nephrosclerosis) (see also Hypertension, kidney) 403.9 Suture burst (in operation wound) 998.3 inadvertently left in operation wound 998.4 removal V58.3 Shirodkar, in pregnancy (with or without cervical incompetence) 654.5 Swab inadvertently left in operation wound 998.4 Swallowed, swallowing difficulty (see also Dysphagia) 787.2 foreign body NEC (see also Foreign body) 938 Swamp fever 100.89 Swan neck hand (intrinsic) 736.09 Sweat(s), sweating disease or sickness 078.2 excessive 780.8 fetid 705.89 fever 078.2 gland disease 705.9 specified type NEC 705.89 military 078.2 night 780.8 Sweeley-Kllonsky disease (angiokeratoma corporis diffusum) 272.7 Sweet's syndrome (acute febrilc neutrophilic dermatosis) 695.89 Swelling abdominal (not referable to specific organ) 789.3 adrenal gland, cloudy 255.8 ankle 719.07 anus 787.9 arm 729.81

MD0753

C-6

Swelling INDEX TO DISEASES ____________________________________________________________________________________
Swelling--continued breast 611.72 Calabar 125.2 cervical gland 785.6 cheek 784.2 chest 786.6 ear 388.8 epigastric 789.3 extermity (lower) (upper) 729.81 eye 379.92 female genital organ 625.8 finger 729.81 foot 729.81 glands 785.6 gum 784.2 hand 729.81 head 784.2 inflammatory--see Inflammation joint (see also Effusion, joint) 719.0 tuberculous--see Tuberculosis, joint kidney, cloudy 593.89 leg 729.81 limb 729.81 liver 573.8 lung 786.6 lymph nodes 785.6 mediastinal 786.6 mouth 784.2 muscle (limb) 729.81 neck 784.2 nose or sinus 784.2 palate 784.2 pelvis 789.3 penis 607.83 perineum 625.8 rectum 787.9 scrotum 608.86 skin 782.2 splenic (see also Splenomegaly) 789.2 substernal 786.6 superifical, localized (skin) 782.2 testicle 608.86 throat 784.2 toe 729.81 tongue 784.2 tubular (see also Disease, renal) 593.9 umbilicus 789.3 uterus 625.8 vagina 625.8 vulva 625.8 wandering, due to Gnathostoma (spinigerum) 128.1 white--see Tuberculosis, arthritis Swift's disease 985.0 Swimmers' ear (acute) 380.12 itch 120.3 Swimming in the head 780.4 Swollen--see also Swelling glands 785.6 Swyer's syndrome (XY pure gonadal dysgenesis) 752.7 Sycosis 704.8 barbae (not parasitic) 704.8 contagiosa 110.0 lupoid 704.8 mycotic 110.0 parasitic 110.0 vulgaris 704.8 Sydenham's chorea--see Chorea, Sydenham's Sylvatic yellow fever 060.0 Sylvest's disease (epidermic pleurodynia) 074.1 Symblepharon 372.63 congential 743.62 Symond;s syndrome 348.2 Sympsthetic--see condition Sympatheticotonia (see also Neuropathy, peripheral, autonomic) 337.9 Sympathicoblastoma (M9500/3) specified site--see Neoplasm, by site, malignant unspecified site 194.0 Sympathicogonioma (M9500/3)— see Sympathicoblastoma Sympathoblastoma (M9500/3)— see Sympathicoblastoma Sympathogonioma (M9500/3)— see Sympathicoblastoma Sympalangy (see also Syndactiylism) 755.10 Symptoms, specified (general) NEC 780.9 abdomen NEC 789.9 bone NEC 733.90 breast NEC 611.79 cardiac NEC 785.9 cardiovascular NEC 785.9 chest NEC 786.9 development NEC 783.9 digestive system NEC 787.9 eye NEC 379.99 gastrointestinal tract NEC 787.9 genital organs NEC female 625.9 male 608.9 head and neck NEC 784.9 heart NEC 785.9 joint NEC 719.60 ankle 719.67 elbow 719.62 foot 719.67 hand 719.64 hip 719.65 knee 719.66 multiple sites 719.69 pelvic region 719.65

MD0753

C-7

INDEX TO DISEASES Vulvovaginitis ____________________________________________________________________________________
von Eulenburg's disease (congenital) paramyotonia) 359.2 von Gierke's disease (glycogenosis I) 271.0 von Gies' joint 095.8 von Graefe's disease or syndrome 378.72 von Hippel (-Lindau) disease or syndrome (retinocerebral angiomatosis) 759.6 von Jaksch's anemia or disease (pseudoleukemia infantum) 285.8 von recklinghausen's disease or syndrome (nerves) (skin) (M9540/1) 237.7 bones (ostetis fibrosa cystica) 252.0 tumor (M9540/1) 237.7 von Recklinghausen-Applebaum disease (hemochromatosis) 275.0 von Schroetter's syndrome (intermittent venous claudication) 453.8 von Willebrand (-Jurgens) (-Minot) diease or syndrome (angiohemophilia) 286.4 von Zambusch's disease (lichen sclerosus et atrophicus) 701.0 Voorhoeve's disease or dyschondroplasia 756.4 Vossius' ring 921.3 late effect 366.21 Voyeurism 302.82 Vrolik's disease (osteogenesis imperfecta) 756.51 Vulva--see condition Vulvismus 625.1 Vulvitis (acute) allergic) ( aphthous) (chornic) (gangrenous) (hypertrophic) (intertriginous) 616.10 with abortion--see Abortion, by type, with sepsis ectopic pregnancy (see also categories 633.0-633.9) 639.0 molar pregnancy (see also categories 630-632) 639.0 adhesive, congential 752.49 blennorrhagic (acute) 098.0 chronic or duration of 2 months or over 098.2 complicating pregnancy or puerperium 646.6 due to Ducrey's bacillus 099.0 following abortion 639.0 ectopic or molar pregnancy 639.0 gonococcal (acute) 098.0 chronic or duration of 2 months or over 098.2 herpetic 054.11 leukoplakic 624.0 monilial 112.1 puerperal, postpartum, childbirth 646.6 syphilitic (early) 091.0 late 095.8 Vulvitis (acute) (allergic) ( aphthous) (chronic) (gangernous) (hypertrophic) (intertriginous)-- continued trichomonal 131.01 Vulvorectal--see condition Vulvovaginitis ( see also Vulvitis) 616.10 amebic 006.8 gonococcal (acute) 098.0 chronic or duration of 2 months or over 098.2 herpetic 054.11 monilial 112.1 trichomonal (Trichomonas vaginalis) 131.01

MD0753

C-8

Waardenburg's INDEX TO DISEASES ____________________________________________________________________________________

W
Waardenburg's syndrome 756.89 meaning ptosis-epicanthus 270.2 Waardenburg-Klein syndrome (ptosis-epicanthus) 270.2 Wagner's disease (colloid millium) 709.3 Wagner (-Unverricht) syndrome (dermatomyositis) 710.3 Waiting list, person on V63.2 undergoing social agency investigation V63.8 Wakefulness disorder (see also Hypersomnia) 780.54 nonorganic origin 307.43 Waldenstrom's disease (osteochondorsis, capital femoral) 732.1 hepatitis (lupoid hepatitis) 571.49 hypergammaglobulinemia 273.0 macroglobulinernia 273.3 purpura, hypergammaglobulinemic 273.0 syndrome (macroglobulinemia) 273.3 Waldenstrom-Kjellberg syndrome (sideropenic dysphagia) 280.8 Walking difficulty 719.7 psychogenic 307.9 sleep 307.46 hysterical 300.13 Wall, abdominal--see condition Wallenberg's syndrome (posterior inferior cerebellar artery) ( see also Disease, cerebrovascular, acute) 436 Walgren's disease (obstruction of splenic vein with collateral circulation) 459.89 meningitis (see also Meningitis, aspetic) 047.9 Wandering acetabulum 736.39 gallbladder 751.69 kidney, congential 753.3 organ or site, congential NEC--see Malposition, congential pacemarker (atrial) (heart) 427.89 spleen 289.59 Wardrop's disease (with lymphangitis) 681.9 finger 681.02 toe 681.11 War neurosis 300.16 Wart (common) (digitate) (filiform) (infectious) (juvenile) (plantar) (viral) 078.1 external genital organs (venereal) 078.1 Wart (common) (digitate) (filiform) (infectious) (junvenile) (plantar) (viral)--continued fig 078.1 Hassall-Henle's (of cornea ) 371.41 Henle's (of cornea) 371.41 moist 078.1 Peruvian 088.0 prosector (see also Tuberculosis) 017.0 seborrheic 702 senile 702 syphilitic 091.3 tuberculous (see also Tuberculosis) 017.0 veneral (female) (male) 078.1 Warthin's tumor (salivary gland) (M8561/0 ) 210.2 Washerwoman's itch 692.4 Wasilieff's disease (leptospiral jaundice) 100.0 Wasting disease 799.4 due to malnutrition 261 extreme (due to mainutrition) 261 muscular NEC 728.2 palsy, paralysis 335.21 Water clefts 366.12 deprivation of 994.3 in joint (see also Effusion, joint) 719.0 intoxication 276.6 itch 120.3 lack of 994.3 loading 276.6 on brain--see Hydrocephalus chest 511.8 poisoning 276.6 Waterbrash 787.1 Water-hammer pulse (see also Insufficiency, aortic) 424.1 Waterhouse (-Friderichsen) disease or syndrome 036.3 Water-losing nephritis 588.8 Wax in ear 380.4 Waxy degeneration, any site 277.3 disease 277.3 kidney 277.3 [583.81] liver (large) 277.3 spleen 277.3 Weak, weakness (generalized) 780.7 arches (acquired) 734 congenital 754.61 bladder sphincter 788.3

MD0753

C-9

APPENDIX D, EXCERPTS FROM VOLUME 3 International Classification of Diseases, 9th Revision, Clinical Modification TABULAR LIST

11.32 Excision of pterygium with corneal graft 11.39 Other excision of ptergium 11.4 Excision or destruction of tissue or other lesion of cornea 11.41 Mechanical removal of corneal epithelium That by chemocauterization Excludes: that for smear or culture (11.21)

11.42 Thermocauterization of corneal lesion 11.43 Cryotherapy of corneal lesion 11.49 Other removal of destruction of corneal lesion Excision of cornea NOS Excludes: 11.5 Repair of cornea 11.51 Suture of corneal laceration 11.52 Repair of postoperative wound dehiscence of cornea 11.53 Repair of corneal laceration or wound with conjunctival flap 11.59 Other repair of cornea 11.6 Corneal transplant Excludes: excision of pteryhium with corneal graft (11.32) biopsy of cornea (11.22)

11.60 Corneal transplant, not otherwise specified Keratoplasty NOS 11.61 Lamellar keratoplasty with autograft 11.62 Other lamellar keratoplasty 11.63 Penetrating keratoplasty with autograft Perforating keratoplasty with autograft

MD0753

D-1

TABULAR LIST

22.9 Other operations on nasal sinuses Exterioization of maxillary sinus Fistuilzation of sinus Excludes: 23 Removal and restoration of teeth 23.0 Forceps extraction of tooth 23.01 Extraction of deciduous tooth 23.09 Extraction of other tooth Extraction of tooth NOS 23.1 Surgical removal of tooth 23.11 Removal of residual root 23.19 Other surgical extractions of tooth Odontectomy NOS Removal of impacted tooth Tooth extraction with elevation of mucoperiosteal flap 23.2 Resoration of tooth by filling 23.3 Restoration of tooth by inlay 23.4 Other dental restoration 23.41 Application of crown 23.42 Insertion of fixed bridge 23.43 Insertion of removable bridge 23.49 Other 23.5 Implantation of tooth 23.6 Prosthetic dental implant Endosseous dental implant dilation of frontonasal duct (96.21)

MD0753

D-2

OPERATIONS ON CARDIOVASCULAR SYSTEM 38 Incision, excision, and occlusion of vessels Code also cardiopulmonary bypass [extracorporeal circulation] [hear-lung machine] (39.61)

Excludes:

that of coronary vessels (36.0-36.99)

The following fourth-digit subclassifcation is for use with appropriate categories in section 38, marked with a symbol (§), to identify the site: 0 unspecified site 1 intracranial vessels Cerebral (anterior) (middle) Circle or Willis Posterior communicating artery 2 other vessels of head and neck Carotid artery (common) (external) (internal) Jugular vein (external) (internal) 3 upper limb vessels Axillary Radial Brachial Ulnar 4 aorta 5 other thoracic vessels Innominate Subclavian Pulmonary (artery) Vena cava, superior (vein) 6 abdominal arteries Celiac Mesenteric Gastric Renal Hepatic Splenic Iliac Umbilical Excludes: abdominal aora (4) 7 abdominal veins Iliac Splenic Portal Vena cava (inferior) Renal 8 lower limb arteries Femoral (common) (superficial) Popliteal Tibial 9 lower limb veins Femoral Saphenous Popliteal Tibial

MD0753

D-3

OPERATIONS ON CARDIOVASCULAR SYSTEM § 38.5 Ligation and stripping of varicose veins [0-3,5,7-9 ligation of varices: Excludes: esophageal (42.91) gastric (44.91) § 38.6 Other excision of vessels [0-9] Excision of blood vessel (lesion) NOS Excludes: excision of vessel for aortocoronary bypass (36.10-36.14) excision with: anastomosis (38.30-38.39) graft replacement (38.40-38.49) implant (38.40-38.49)

38.7 Plication of vena cava Insertion of implant or sieve in vena cava Ligation of vena cava (inferior) (superior) § 38.8 Other surgical occlusion of vessels [0-9] Clamping Division of blood vessel Ligation Occlusion

}

Excludes:

adrenal vessels (07.43) esophageal varices gastric or duodenal vessel for ulcer (44.4044.42) gastric varices (44.91) meningeal vessel (02.13) spermatic vein for varicocele (63.1) that for control of (postoperative) hemorrhage: anus (49.95) bladder (57.93) following vascular procedure (39.41) nose (21.00-21.09) prostate (60.94) tonsil (28.7) thyroid vessel (06.92)

§ Requires fourth-digit; valid digits are in [brackets] under each code. See page 99 for definitions.

MD0753

D-4

OPERATIONS ON DIGESTIVE SYSTEM

45.93 Other small-to-large intestinal anastomosis 45.94 Large-to-large intestinal anastomosis Excludes: 46 Other operations intestine rectorectostomy (48.74)

46.0 Exterioization of intestine Includes: loop enterostomy multiple stage resection of intestine

46.01 Exteriorization of small intestine Loop ileostomy 46.02 Resection of exteriorized segment of small intestine 46.03 Exteriorization of large intestine Exteriorization of intestine NOS First stage Mikulicz exteriorization of intestine Loop colostomy 46.04 Resection of exteriorized segment of large intestine Resection of exteriorized segment of intestine NOS Second stage Mikulicz operation 46.1 Colostomy Code also any synchronous resection (45.49, 45.71-45.79, 45.8)

Excludes:

loop colostomy (46.03) that with synchronous anterior rectal resection (48.62)

46.10 Colostomy, not otherwise specified 46.11 Temporary colostomy 46.12 Permanent magnetic colostomy 46.13 Other permanent colostomy

MD0753

D-5

OPERATIONS ON MUSCULOSKELETAL SYSTEM 81.01 Atlas-axis spinal fusion Craniocervical fusion Excludes: that for pseudoarthrosis (81.08)

81.02 Other cervical spinal fusion Excludes: that for pseudoarthrosis (81.08)

81.03 Dorsal spinal fusion Excludes: that for pseudoarthrosis (81.08)

81.04 Dorsolumbar spinal fusion with Harrington rod Excludes: that for pseudoarthrosis (81.08)

81.05 Other dorsolumbar spinal fusion Excludes: that for pseudoarthrosis (81.08)

81.06 Lumbar spinal fusion Excludes: that for pseudoarthrosis (81.08)

81.07 Lumbosacral spinal fusion Excludes: that for pseudoarthrosis (81.08)

81.08 Refusion of spine Correction of pseudoarthrosis of spine 81.09 Other spinal fusion 81.1 Arthrodesis of foot and ankle Includes: arthrodesis of foot and ankle with: bone graft external fixation device 81.11 Ankle fusion Tibiotalar fusion 81.12 Triple arthrodesis Talus to calcaneus and calcaneus to cuboid and navicular 81.13 Subtatlar fusion 81.14 Midtarsal fusion

MD0753

D-6

Coffey

INDEX TO PROCEDURES

Coffey operation (uterine suspension) Meig's modification) 69.22 Cole operation (anterior tarsal wedgeosteotomy) 77.28 Colectomy (partial) (segmental) (subtotal) 45.79 cecum (with terminal ileum) 45.72 left (lower) (radical) 45.75 multiple segmental 45.71 right (radical) 45.73 sigmoid 45.76 terminal ileum with cecum 45.72 total 45.8 transverse 45.74 Collapse, lung, surgical 33.39 by destruction of phrenic nerve 33.31 pneumoperitoneum 33.33 pneumothorax, artificially-induced 33.32 thoracoplasty 33.34 Collection, sperm for artificial insemination 99.96 Collis-Nissen operation (hiatal hernia repair) with esophagogastroplasty) 53.80 Colocentesis 45.03 Colocolostomy 45.94 proximal to distal segment 45.79 Colocystoplasty 57.87 [45.52] Colofixation 46.64 Coloileotomy 45.00 Colonna operation adductor tenotomy (first stage) 83.12 hip arthroplasty (second stage) 81.69 reconstruction of hip (second stage) 81.69 Colonoscopy 45.24 fiberoptic (flexible) 45.23 intraoperative 45.21 through stoma (artificial) 45.22 transabdominal 45.21 Colopexy 46.63 Coloplication 46.64 Coloproctostomy 45.94 Colorectosigmoidostomy 45.94 Colorectostomy 45.94 Colorrhaphy 46.75 Coloscopy--see Colonoscopy Colosigmoidostomy 45.94 Colostomy (ileo-ascending) (ileotransverse) (perineal) (transverse) 46.10 with anterior rectal resection 48.62 delayed opening 46.14 loop 46.03 permanent 46.13 magnetic 46.12 temporary 46.11 Colotomy 45.03 Colpectomy 70.4 Colpoceliocentesis 70.0 Colpocentesis 70.0

Colopocleisis (complete) (partial) 70.4 Colpohysterectomy 68.5 Colpoperineoplasty 70.79 with repair of urethrocele 70.50 Colpoperineorrhaphy 70.71 following delivery 75.69 Colpopexy 70.77 Colpoplasty 70.79 Colpopoiesis 70.61 Colporrhaphy 70.71 anterior (cystocele repair) 70.51 for repair of cystocele 70.51 with rectocele 70.50 enterocele 70.8 rectocele 70.52 with cystocele 70.50 urethrocele 70.51 posterior (rectocele repair) 70.52 Colposcopy 70.21 Colpotomy 70.14 for pelvic peritoneal drainage 70.12 Commando operation (radical glossectomy) 25.4 Commissurotomy closed heart technique--see Valvulotomy, heart open heart technique--see Valvuloplasty, heart Compression, trigeminal nerve 04.02 Conchectomy 21.69 Conchotomy 21.1 Conduction study, nerve 89.15 Conduitogram, ileum 87.78 Condylectomy (see also Arthrectomy) 80.90 mandible 76.5 Condylotomy NEC (see also Division, joint capsule) 80.40 mandible (open) 76.62 closed 76.61 Conization cervix (knife) (sharp) (biopsy) 67.2 by cryosurgery 67.33 electroconization 67.32 Conjunctivocystorhinostomy 09.82 with insertion of tube or stent 09.83 Conjunctivodacryocystorhinostomy (CDCR) 09.82 with insertion of tube or stent 09.83 Conjunctiovdacryocystostomy 09.82 with insertion of tube or stent 09.83 Conjunctivoplasty 10.49 Conjunctivorhinostomy 09.82 with insertion of tube or stent 09.83 Constriction of globe, for scleral buckling (see also Buckling, scleral) 14.49 Construction auricle, ear (with graft) with implant) 1 18.71

MD0753

D-7

INDEX TO PROCEDURES

Graft

Girdlestone operation --continued laminectomy with spinal fusion 81.00 muscle transfer for claw toe repair 83.77 resection of femoral head and neck 77.85 Girdlestone-Taylor operation (muscle transfer for claw toe repair) 83.77 Glenn operation (anastomosis of superior venn cava to right pulmonary artery) 39.21 Glenoplasty, shoulder 81.83 with synthetic joint prosthesis 81.81 for recurrent dislocation 81.82 Glomectomy carotid 39.8 jugulare 20.51 Glossectomy (complete) (total) 25.3 partial or subtotal 25.2 radical 25.4 Glossopexy 25.59 Glossoplasty NEC 25.59 Glossorrhaphy 25.51 Glossotomy NEC 25.94 for tongue tie 25.91 Goebel-Frangenheim-Stoeckel operation (urethrovesical suspension) 59.4 Goldner operation (clubfoot release)80.48 Goldthwaite operation ankle stabilization 81.11 patellar stabilization 81.44 tendon transfer for stabilization of patella 81.44 Gonadectomy ovary 65.3 testis 62.3 Goniopuncture 12.51 with goniotomy 12.53 Gonioscopy 12.29 Goniospasis 12.59 Goniotomy (Barkan's) 12.52 with goniopuncture 12.53 Goodal-Power operation (vagina) 70.4 Gordon-Taylor operation (hindquarter amputation) 84.19 Graber-Duvernay operation (drilling of femoral head) 77.15 Graft, grafting aneurysm 39.52 artery, arterial (patch) 39.58 with excision or resection of vessel--see Arteriectomy, with graft replacement synthetic path (Dacron) (Teflon) 39.57 tissue path (vein) (autogenous) (homograft) 39.56 blood vessel (patch) 39.58 with

Graft, grafting--continued blood vessel (patch)--continued with--continued excision or resection of vessel--see Angiectomy, with graft replacement synthetic patch (Dacron) (Teflon) 39.57 tissue patch (vein) (autogenous) (homograft) 39.56 bone (autogenous) (bone bank) (dual onlay) (heterogenous) (inlay) (massive onlay) (multiple)(osteoperiosteal) (peg) (subperiosteal) (with metallic fixation) 78.00 with arthrodesis--see Arthrodesis arthroplasty--see Arthroplasty lengthening--see Lengthening, bone carpals, metacrapals 78.04 clavicle 78.01 facial NEC 76.91 with total ostectomy 76.44 femur 78.05 fibula 78.07 humerus 78.02 joint--see Arthroplasty mandible 76.91 with total mandibulectomy 76.41 nose--see Graft, nose patella 78.06 pelvic 78.09 pericranial 02.04 phalanges (foot) (hand) 78.09 radius 78.03 scapula 78.01 skull 02.04 specified site NEC 78.09 spine 78.09 with fusion--see Fusion, spinal tarsal, metatarsal 78.08 thorax (ribs) (sternum) 78.01 thumb (with transfer of skin flap) 82.69 tibia 78.07 ulna 78.03 vertebrae 78.09 with fusion--see Fusion, spinal breast (see also Mammoplasty) 85.89 buccal sulcus 27.99 cartilage (joint)--see also Arthroplasty nose--see Graft, nose chest wall (mesh) (silastic) 34.79 conjunctiva (free) (mucosa) 10.44 for symblepharon repair 10.41 corena (see also Keratoplasty) 11.60 dermal-fat 86.69 dura 02.12 ear auricle 18.79

MD0753

D-8

Kader

INDEX TO PROCEDURES

K
Kader operation (temporary gastrostomy) 43.1 Kaufman operation (for urinary stress incontinence) 59.79 Kazanjiian operation (buccal vestibular sulcus extension) 24.91 Kehr operation (hepatopexy) 50.69 Keller operation (bunionectomy) 77.59 Kelly (-Kennedy) operation (urethrovesical plication) 59.3 Kelly-Stoeckel operation (urethrovesical plication) 59.3 Kelotomy 53.9 Keratectomy (complete)(partial) (superficial) 11.49 for pterygium 11.39 with corneal graft 11.32 Keratocentesis (for hyphema) 12.91 Keratomeleusis 11.71 Keratophakia 11.72 Keratoplasty (tectonic) (with autograft) (with homograft) 11.60 lamellar (nonpenetrating) (with homograft) 11.62 with autograft 11.61 penetrating (full-thickness) (with homograft) 11.64 with autograft 11.63 perforating--see Keratoplasty, penetrating refractive 11.71 specified type NEC 11.49 Keratoprosthesis 11.73 Keratotomy (delimiting) (posterior ) 11.1 Kerr operation (low cervical cesarean section) 74.1 Kessler operation (arthroplasty, carpometacarpal joint) 81.71 Kidner operation (excision of accessory navicular bone) (with tendon transfer) 77.98 Killian operation (frontal sinusotomy) 22.41 Kineplasty--see Cineplasty King-Steelquist operation (hindquarter amputation) 84.19 Kirk operation (amputation through thigh) 84.17 Kondoleon operation (correction of lymphedema) 40.9 Krause operation (sympathetic denervation) 05.29 Kroener operation (partial salpingectomy) 66.69 Kroenlein operation (lateral orbitotomy) 16.01 Kronig operation (low cervical cesarean section) 74.1 Krukenberg operation (reconstruction of below-elbow amputation) 82.89 Kuhnt-Szymanowski operation (ectropion repair with lid reconstruction) 08.44

MD0753

D-9

Reduction

INDEX TO PROCEDURES

Reduction--continued size--continued abdominal wall (adipose) (pendulous) 86.83 arms (adipose) (batwing) 86.83 breast (bilateral) 85.22 unilateral 85.31 buttocks (adipose) 86.83 finger (macrodactyly repair) 82.83 skin 86.83 subcutaneous tissue 86.83 thighs (adipose) 86.83 torsion intestine (manual) (surgical) 46.80 large 46.82 small 46.81 kidney pedicle 55.84 omentum 54.74 spermatic cord 63.52 with orchiopexy 62.5 testis 63.52 with orchiopexy 62.5 volvulus intestine 46.80 large 46.82 small 46.81 stomach 44.92 Reefing, joint capsule (see also Arthroplasty) 81.96 Re-entry operation (aorta ) 39.54 Re-establishment, continuity --see also Anastomosis bowel 46.50 fallopian tube 66.79 vas deferens 63.82 Referral (for) psychiatric aftercare (halfway house) (outpatient clinic) 94.52 psychotherapy 94.51 rehabilitation alcoholism 94.53 drug addiction 94.54 psychologic NEC 94.59 vocational 94.55 Reformation, chamber of eye 12.99 Refracture bone (for faulty union) (see also Osteoclasis) 78.70 nasal bones 21.88 Refusion, spine 81.08 Regional blood flow study 92.05 Regulation, menstrual 69.6 Rehabilitation programs NEC 93.89 sheltered employment 93.85 vocational 93.85 Reimplantation adrenal tissue (heterotopic) (orthotopic) 07.45 artery 39.59 renal, aberrant 39.55

Reimplantation--continued bile ducts following excision of ampulla of Vater 51.62 extremity--see Reattachment, extremity fallopian tube into uterus 66.74 kidney 55.61 lung 33.5 ovary 65.72 pancreatic tissue 52.81 parathyroid tissue (heterotopic) (orthotopic) 06.95 pulmonary artery for hemitruncus repair 35.83 renal vessel, aberrant 39.55 testis in scrotum 62.5 thyroid tissue (heterotopic) (orthotopic) 06.94 tooth 23.5 ureter into bladder 56.74 Reinforcement--see also Repair, by site sclera NEC 12.88 with graft 12.87 Reinsertion--see also Insertion cardiac pacemaker battery 37.85 cystostomy tube 59.94 fixation device (internal) ( see also Fixation, bone, internal) 78.50 heart valve (prosthetic) 35.95 Holter (-Spitz) valve 02.42 implant (expelled) (extruded) eyeball (with conjunctival graft) 16.62 orbital 16.62 nephrostomy tube 55.93 pacemaker (battery) cardiac 37.85 pyelostomy tube 55.94 ureteral stent, by incision 56.2 ureterostomy tube 59.93 valve heart (prosthetic) 35.95 ventricular (cererbal) 02.42 Relaxation--see also Release training 94.33 Release carpal tunnel (for nerve decompression) 04.43 celiac artery axis 39.91 central slip, extensor tendon hand (mallet finger repair) 82.84 chordee 64.42 clubfoot NEC 83.84 de Quervain's tenosynovitis 82.01 Dupuytren's contracture (by palmar fascictomy) 82.35 by fasciotomy (subcutaneous) 82.12 with excision 82.35 Fowler (mallet finger repair) 82.84 joint (capsule) (adherent) (constrictive) (see also Division, joint capsule) 80.40 laryngeal 31.92

MD0753

D-10

Transection

INDEX TO DISEASES

Transection--continued artery (with ligation)--continued renal, aberrant (with reimplantation) 39.55 bone (see also Osteotomy) 77.30 fallopian tube (bilateral) (remaining) (solitary) 66.39 by endoscopy 66.22 unilateral 66.92 isthmus, thyroid 06.91 muscle 83.19 eye 15.13 multiple (two or more muscles) 15.3 hand 82.19 nerve (cranial) (peripheral) NEC 04.03 acoustic 04.01 root (spinal) 03.1 sympathetic 05.0 tracts in spinal cord 03.29 trigeminal 04.02 vagus (transabdominal) (see also Vagotomy) 44.00 pylorus (with wedge resection) 43.3 renal vessel, aberrant (with reimplantation) 39.55 spinal cord tracts 03.29 nerve root 03.1 tendon 83.13 hand 82.11 uvula 27.71 vas deferens 63.71 vein (with ligation) (see also Division, vein) 38.80 renal, aberrant (with reimplantation) 39.55 varicose (lower limb) 38.59 Transfer, transference bone shaft, fibula into tibia 78.47 digital (to replace absent thumb) 82.69 finger (to thumb) (same hand) 82.61 to finger, except thumb 82.81 opposite hand (with amputation) 82.69 [84.01] toe (to thumb) (with amputation) 82.69 [84.11] to finger, except thumb 82.81 [84.11] finger (to replace absent thumb) (same hand) 82.61 to finger, except thumb 82.81 opposite hand (with amputation) 82.69 [84.01] muscle origin 83.77 hand 82.58 nerve (cranial) (peripheral) (radial anterior) (ulnar) 04.6 pedicle graft 86.74

Transfer, transerence--continued pes anserinus (tendon) (repair of knee) 81.47 tarsoconjunctival flap, from opposing lid 08.64 tendon 83.75 hand 82.56 pes anserinus (repair of knee) 81.47 toe-to-thumb (free) (pedicle) (with amputation) 82.69 [84.11] Transfixion--see also Fixation iris ( bombe) 12.11 Transfusion (of) 99.03 antihemophilic factor 99.06 antivenin 99.16 blood (whole) 99.03 expander 99.08 surrogate 99.09 bone marrow 41.0 coagulation factors 99.06 Dextran 99.08 exchange 99.01 intraperitoneal 75.2 in utero (with hysterotomy) 75.2 exsanguination 99.01 gamma globulin 99.14 granulocytes 99.09 intrauterine 75.2 packed cells 99.04 plasma 99.07 platelets 99.05 replacement, total 99.01 serum NEC 99.07 substitution 99.01 thrombocytes 99.05 Transillumination nasal sinuses 89.35 skull (newborn) 89.16 Translumbar aortogram 88.42 Transplant, transplantation artery 39.59 renal, aberrant 39.55 autotransplant--see Reimplantation blood vessel 39.59 renal, aberrant 39.55 bone (see also Graft, bone) 78.00 marrow 41.0 conjunctiva, for pterygium 11.39 corneal (see also Keratoplasty) 11.60 dura 02.12 fascia 83.82 hand 82.72 finger (replacing absent thumb) (same hand) 82.61 to finger, except thumb 82.81 opposite hand (with amputation) 82.69 [84.01] gracilis muscle (for) 83.77 anal incontinence 49.74

MD0753

D-11

Suture

INDEX TO DISEASES

Suture (laceration)--continued aponeurosis (see also Suture, tendon) 83.64 arteriovenous fistula 39.53 artery 39.31 bile duct 51.79 bladder 57.81 obstetric laceration (current) 75.61 blood vessel NEC 39.30 artery 39.31 vein 39.32 breast (skin) 85.81 bronchus 33.41 bursa 83.99 hand 82.99 canaliculus 09.73 cecum 46.75 cerebral menings 02.11 cervix (traumatic laceration) 67.61 internal os, encirclement 67.5 obstetric laceration (current) 75.51 old 67.69 chest wall 34.71 cleft palate 27.62 clitoris 71.4 colon 46.75 common duct 51.71 conjunctiva 10.6 cornea 11.51 with conjunctival flap 11.53 corneoscleral 11.51 with conjunctival flap 11.53 diaphragm 34.82 duodenum 46.71 dura mater (cerebral) 02.11 spinal 03.59 ear, external 18.4 enterocele 70.8 entropion 08.42 epididymis (and) spermatic cord 63.51 vas deferens 63.81 episiotomy--see Episiotomy esophagus 42.82 eyeball 16.89 eyebrow 08.81 eyelid 08.81 with entropion or ectropion repair 08.42 fallopian tube 66.71 fascia 83.65 hand 82.46 to skeletal attachment 83.89 hand 82.89 gallbladder 51.91 ganglion, sympathetic 05.81 gingiva 24.32 great vessel 39.30

Suture (laceration)--continued gum 24.32 heart 37.4 hepatic duct 51.79 hymen 70.76 ileum 46.73 intestine 46.79 large 46.75 small 46.73 jejunum 46.73 joint capsule 81.96 with arthroplasty--see Arthroplasty ankle 81.94 foot 81.94 lower extremity NEC 81.95 upper extremity 81.93 kidney 55.81 labia 71.71 laceration--see Suture, by site larynx 31.61 ligament 81.96 with arthroplasty--see Arthroplasty ankle 81.94 broad 69.29 Cooper's 54.64 foot and toes 81.94 gastrocolic 54.73 knee 81.95 lower extremity NEC 81.95 sacrouteine 69.29 upper extremity 81.93 uterine 69.29 ligation--see Ligation lip 27.51 liver 50.61 lung 33.43 meninges (cerebral) 02.11 spinal 03.59 mesentery 54.75 mouth 27.52 muscle 83.65 hand 82.46 ocular (oblique) (rectus) 15.7 nerve (cranial) (peripheral) 04.3 sympathetic 05.81 nose (external) (internal) 21.81 for epistaxis 21.09 obstetric laceration NEC 75.69 bladder 75.61 cervix 75.51 corpus uteri 75.52 pelvic floor 75.69 perineum 75.69 rectum 75.62 sphincter ani 75.62 urethra 75.61

MD0753

D-12

APPENDIX E - EXCERPTS FROM EXTERNAL CAUSE OF INJURY CODES as used by the NATO Forces NATO Standardization Agreement (NATO 2050) Place of Occurrence of Injury Third-Digit Code

On board aircraft or spacecraft or in the air or in space .......................................................................................................................Ø On board ship or other water transport or in water/sea, river, lake, etc ..............................................................................................................1 On land and at an airfield ......................................................................................................2 On land and at a dock............................................................................................................3 On land and at an industrial plant (e.g., ordnance factory, supply warehouse, repair shop) .......................................................................4 On land and on firing range or drill field .................................................................................5 On land and on obstacle course .............................................................................................6 On land and in kitchen (other than home), mess hall, or bakery .....................................................................................................................7 On land and in the home, quarters, or barracks .....................................................................8 On land, other, or unspecified ................................................................................................9 Data Code Group ØØØ-Ø29 ØØØ-ØØ9

Data Items and Explanations

Data Codes

ACCIDENTS IN AIR TRANSPORT, INVOLVING MILITARY AIRCRAFT Injured person was in (or boarding,etc.) powered heavier-than-air fixed-wing military aircraft, and the accident involved: Boarding or alighting .....................................................................ØØØ Taxiing, takeoff from, or landing on aircraft carrier ...........................................................................ØØ1 Taxiing other or unspecified (includes collision while taxiing) ...............................................................ØØ2 Takeoff, other or unspecified (includes crash on take-off) .....................................................................ØØ3 ♦♦♦

Ø3Ø-Ø39

ACCIDENTS IN AIR TRANSPORT INVOLVING NON-MILITARY AND UNSPECIFIED AIRCRAFT Injured person was boarding, or alighting from: Commercial transport aircraft (fixed-wing or other) ........................................................................................Ø34 Other nonmilitary aircraft (fixed-wing or other) ........................................................................................Ø35

Ø34-Ø35

MD0753

E-1

Data Code Group Ø36-Ø39

Data Items and Explanations

Data Codes

Injured person was not making flight but was injured incident to a flight involving: Commercial transport aircraft (fixed-wing or other) ......................................................................................Ø36 Other nonmilitary aircraft (fixed-wing or other) ..........................................................................................Ø37 Parachuting from nonmilitary aircraft due to causes other than aircraft damage or failure ..........................................................................................Ø38 Unspecified aircraft accident involving nonmilitary aircraft ......................................................................Ø39

Ø4Ø-Ø49 Ø4Ø-Ø46

ACCIDENTS INVOLVING SPACECRAFT Injured astronaut was in spacecraft and was involved in: Blast-off accident (explosion, fire, etc) no escape ...................................................................................Ø4Ø Blast-off accident (explosion, fire, etc) and astronaut was ejected ...........................................................Ø41 Accident during ascent ..................................................................Ø42 Accident while in orbit ...................................................................Ø43 Accident during re-entry ................................................................Ø44 Accident on impact after re-entry - no escape .......................................................................................Ø45 Accident on impact after re-entry and astronaut did escape ...................................................................Ø46 ♦♦♦

1ØØ-149 1ØØ-119 1ØØ-1Ø9

ACCIDENTS IN LAND TRANSPORT MOTOR VEHICLE TRAFFIC ACCIDENTS Accident not involving military-owned (or unspecified as to ownership) vehicle: Injury is to driver of motor vehicle (except codes 1Ø6 and 1Ø7) ........................................................1ØØ Injury is to passenger (not driver) of motor vehicle (except codes 1Ø6 and 1Ø7) ............................................1Ø1 Injury is to unspecified occupant of motor vehicle ..........................................................................................1Ø2 Injury occurred in boarding or alighting from vehicle ..................................................................................1Ø3 Injury is to pedestrian ......................................................................1Ø4 Injury is to pedal cyclist (driver or other rider) .............................................................................................1Ø5

MD0753

E-2

Data Code Group

Data Items and Explanations

Data Codes

Injury is to motorcyclist (driver or other rider) .............................................................................................1Ø6 Injury is to driver or other rider on tracked or semi-tracked vehicle ....................................................1Ø7 Injury is to other or unspecified person ............................................1Ø9 ♦♦♦ 11Ø-119 Accident involving military-owned vehicle: Injury is to driver of motor vehicle (except codes 116 and 117) ..........................................................11Ø Injury is to passenger (not driver) of motor vehicle (except codes 116 and 117) ..............................................111 Injury is to unspecified occupant of motor vehicle ..........................................................................................112 Injury occurred in boarding or alighting from vehicle ..................................................................................113 Injury is to pedestrian… … … … … … … … … … … … … … … 114 Injury is to pedal cyclist (driver or other rider) .............................................................................................115 Injury is to motorcyclist (driver or other rider) .............................................................................................116 Injury is to occupant of tracked or semitracked vehicle (tank, self-propelled gun, etc.) ......................................................................................117 Injury is to other or unspecified person ............................................119 LAND TRANSPORT ACCIDENTS, EXCEPT MOTOR VEHICLE TRAFFIC ACCIDENTS Motor vehicle nontraffic accident: Injury (nontraffic) is to driver of nonmilitary motor vehicle, except codes 126 and 127..................................................................................12Ø Injury (nontraffic) is to passenger (not driver) of nonmilitary motor vehicle, except codes 126 and 127 ............................................................121 ♦♦♦ 14Ø-149 Other land transport accident: Railway accident .............................................................................14Ø Other specified land transport accident ...........................................149 ♦♦♦

12Ø-149

12Ø-13Ø

MD0753

E-3

Data Code Group

Data Items and Explanations

Data Codes

2ØØ-249

ATHLETICS AND SPORTS, INCLUDING PHYSICAL TRAINING Athletics and sports accident, other (includes unspecified place of occurrence): Baseball .........................................................................................22Ø Basketball ......................................................................................221 Boating (sailboat, powerboat, and other recreational small craft) ................................................................222 Boxing ...........................................................................................223 Calisthenics and gymnastic ("PT") .................................................224 Cricket ...........................................................................................225 Football (American) .......................................................................226 Handball, fives, squash, and jai alai ...............................................227 Hockey ..........................................................................................228 Mountaineering, rock climbing, skiing, and tobogganing ...........................................................................229 Rugger ...........................................................................................23Ø Soccer and football unspecified .....................................................231 Softball and rounders .....................................................................232 Swimming and diving, including water polo233 Tennis and badminton ...................................................................234 Track and field events (jumps, etc.) ...............................................235 Wrestling, judo, and unarmed combat training ..........................................................................................236 Horsemanship ................................................................................237 Other athletics and sports (excludes obstacle course) ............................................................................239

22Ø-239

25Ø-299

REACTIONS, COMPLICATIONS, AND MISADVENTURES IN MEDICAL OR SURGICAL PROCEDURES AND LATE COMPLICATIONS OR LATE EFFECTS Complications of prophylactic inoculation: Postvaccinal encephalitis ................................................................25Ø Smallpox vaccination reaction other than encephalitis ....................................................................................251 Reaction to: Typhoid and/or paratyphoid vaccine ................................................252 Tetanus toxin-antitoxin ....................................................................253 Tetanus toxoid ................................................................................254 Diphth2eria antitoxin or diphtheria toxoid ........................................255 BCG ..............................................................................................256

25Ø-269

MD0753

E-4

Data Code Group

Data Items and Explanations

Data Codes

Prophylactic use of antibiotics .........................................................257 Other specified vaccine (except combinations) ................................................................................265 Other specified toxoid or antitoxin (except combinations) ....................................................................266 Unspecified vaccine, toxoid, or antitoxin .........................................267 Combination of two or more of above .............................................268 Other biological substances, including immune serum...............................................................................269 ♦♦♦ 320-339 AGENTS OF CHEMICAL WARFARE, EXCLUDING INCENDIARIES; Lung irritants and irritant smokes ..........................................................32Ø Vesicants (including mustard gas) ........................................................321 Nerve gases .........................................................................................322 Lacrimators and screening smokes.......................................................33Ø Other chemical warfare agents (excluding incendiaries) ...................................................................................339 34Ø-359 AGENTS OF BIOLOGICAL WARFARE Biological warfare agents .....................................................................359 ♦♦♦ 44Ø-459 CONVENTIONAL WEAPONS INJURY TO PERSON ON LAND OR IN UNSPECIFIED LOCATION Fragment-producing conventional weapon: Artillery shell ...................................................................................44Ø Rocket ............................................................................................441 Ballistic missile ...............................................................................442 Bomb, free-falling ...........................................................................443 Mortar .............................................................................................444 Bazooka .........................................................................................445 Antipersonnel mine, boobytrap,etc ..................................................446 Mine, other or unspecified (includes antitank, etc.) ................................................................................447 Grenade .........................................................................................448 Shell fragment, other and unspecified .............................................449

44Ø-449

MD0753

E-5

Data Code Group 45Ø-459

Data Items and Explanations

Data Codes

Other conventional weapons: Bullet, nonexplosive, nonincendiary or unspecified (includes bullets not reported as explosive or incendiary, whether rifle or machine gun, etc.) .................................................45Ø Bullet, explosive .............................................................................451 Bullet, incendiary ............................................................................452 Flame thrower.................................................................................453 Other incendiaries (includes incendiary bomb) ............................................................................................454 Bayonet, etc....................................................................................455 Other specified conventional weapon ..............................................458 Unspecified weapon, presumably conventional (excludes unspecified bullet or shell fragment) .......................................................................................459 ♦♦♦

*Use one-digit "place of occurrence of injury" code as third digit for the following data code groups. See the table at beginning of this appendix.

7Ø-*-79-*

POISONS, FIRE, HOT OR CORROSIVE SUBSTANCES Poisoning by ingestion of toxic substance (excludes chemical warfare agents and reactions to drugs or other therapeutic misadventure; includes intentional or accidental overdose or improper use of drug or other therapeutic agent not under professional direction) ...........................................................7Ø-* Poisoning by inhalation of toxic substance (excludes chemical warfare agents, specifically defined transport accidents, and reactions to drugs or other therapeutic misadventure; includes intentional or accidental exposure to toxic substance) ..........................................71-*

MD0753

E-6

Data Code Group

Data Items and Explanations

Data Codes

Adverse systemic or skin reaction by contact with a toxic substance (excludes chemical burns of external parts 77-*; also excludes reactions due to chemical warfare agents and reactions to drugs or other therapeutic misadventures; includes intentional or accidental exposure to the toxic substance) .....................................................72-* Sting or bite of venomous reptile (poisonous snake) ...........................................................................73-* Sting or bite of venomous arthropod (venomous spider, wasp, etc.) ........................................................74-* Fire, explosion with fire, conflagration ..................................................75-* Hot liquids or steam (includes molten metal) .............................................................................................76-* Corrosive substances, external chemical burns only .......................................................................................77-* Hot solids or other hot objects (includes stoves) ............................................................................................78-* ♦♦♦ 8Ø-*89-* SPECIFIED ENVIRONMENTAL FACTORS (Includes natural or artificial environment) Excessive heat or insolation (includes heat stroke, sunburn, etc.; excludes specifically defined transport accidents) ..........................................8Ø-* Excessive cold .....................................................................................81-* High or low pressure (atmospheric or artificial) including hypoxia and barotrauma .....................................................................................82-* Excessive noise; for example, acoustic trauma ............................................................................................83-* Hunger, thirst, or exposure ...................................................................84-* Lightning or cataclysm (includes tornado, flood, etc.) ......................................................................................85-* Drowning or submersion, not elsewhere classified (excludes specifically defined water transport accidents) ...............................................................86-* Motion: travel (includes air sickness, sea sickness, motion sickness) .......................................................87-* Animals, not elsewhere classified .........................................................88-*

MD0753

E-7

Data Code Group 9Ø-*-99-*

Data Items and Explanations

Data Codes

FALLS AND MISCELLANEOUS OTHER OR UNSPECIFIED AGENTS (Excludes transport accidents -- See data code ØØØ-199) Fall on or jump from stairs or ladder .....................................................9Ø-* Other fall or jump from one level to another ...........................................................................................91-* Falls or jumps on same level, including unspecified falls ..............................................................................92-* Marching or drilling, not elsewhere classified 93-* Twisting, turning, slipping, running, etc ., not elsewhere classified,without fall ................................................94-* Lifting, pushing, pulling .........................................................................95-* Hanging, suffocation, or strangulation ...................................................96-* Fighting, not elsewhere classified, including horseplay/ jeu brutal (code specific agent if specified ................................................................97-* Other specified agents not classifiable elsewhere above .............................................................................98-* Unspecified causative agent; unknown .................................................99-*

MD0753

E-8

APPENDIX F - EXCERPTS FROM MILITARY OCCUPATIONAL SPECIALTY CODES DATA CODE NAVY AEROGRAPHER'S MATE........................................................................................................... AG AIR TRAFFIC CONTROLLER ..................................................................................................... AC AIRCREW SURVIVAL EQUIP-MAN ............................................................................................ PR AIRMAN ................................................................................................................................ AN AIRMAN APPRENTICE............................................................................................................... AA AIRMAN RECRUIT...................................................................................................................... AR AVIATION ANTISUB WARFARE OP .......................................................................................... AW AVIATION ANTISUB WARFARE TECH ...................................................................................... AX AVIATION BOATSWAIN'S MATE ............................................................................................... AB AVIATION BOATSWAIN'S MATE (AIRCRAFT HANDLING) ....................................................... ABH AVIATION BOATSWAIN'S MATE (FUELS)................................................................................. ABF AVIATION BOATSWAIN'S MATE (LAUNCHING & RECOVERY EQUIPMENT).......................... ABE AVIATION ELECTRICIAN'S MATE ............................................................................................. AE AVIATION ELECTRONICS TECH ............................................................................................... AT AVIATION FIRE CONTROL TECH.............................................................................................. AQ AVIATION MACHINIST'S MATE ................................................................................................. AD AVIATION MAINTENANCE ADMIN............................................................................................. AZ AVIATION ORDNANCEMAN....................................................................................................... AO AVIATION STOREKEEPER ........................................................................................................ AK AVIATION STRUCTURAL MECHANIC ....................................................................................... AM AVIATION STRUCTURAL MECHANIC (HYDRAULIC)................................................................ AMH AVIATION STRUCTURAL MECHANIC (SAFETY EQUIPMENT) ................................................ AME AVIATION STRUCTURAL MECHANIC (STRUCTURES) ............................................................ AMS AVIATION SUPPORT EQUIP TECH ........................................................................................... AS AVIATION SUPPORT EQUIP TECH (ELECTRICAL) .................................................................. ASE AVIATION SUPPORT EQUIP TECH (MECHANICAL)................................................................. ASM BOATSWAIN'S MATE................................................................................................................. BM BOILER TECHNICIAN................................................................................................................. BT BUILDER ................................................................................................................................ BU CONSTRUCTION ELECTRICIAN ............................................................................................... CE CONSTRUCTION MECHANIC .................................................................................................... CM CRYPTOLOGIC TECHNICIAN (ADMINISTRATIVE) ................................................................... CTA CRYPTOLOGIC TECHNICIAN (COLLECTION) .......................................................................... CTR CRYPTOLOGIC TECHNICIAN (COMMUNICATIONS) ................................................................ CTO CRYPTOLOGIC TECHNICIAN (INTERPRETIVE) ....................................................................... CTI CRYPTOLOGIC TECHNICIAN (MAINTENANCE) ....................................................................... CTM CRYPTOLOGIC TECHNICIAN (TECHNICAL) ............................................................................. CTT DAMAGE CONTROLMAN........................................................................................................... DC

DESCRIPTION

MD0753

F-1

DESCRIPTION NAVY (CONTINUED)

DATA CODE

DATA PROCESSING TECHNICIAN............................................................................................ DP DATA SYSTEMS TECHNICIAN .................................................................................................. DS DENTAL TECHNICIAN................................................................................................................ DT DENTAL TECHNICIAN................................................................................................................ DN DENTAL TECHNICIAN APPRENTICE ........................................................................................ DA DENTAL TECHNICIAN RECRUIT ............................................................................................... DR DISBURSING CLERK ................................................................................................................. DK ELECTRICIAN'S MATE ............................................................................................................... EM ELECTRICIAN'S TECHNICIAN ................................................................................................... ET ELECTRONICS WARFARE TECHNICIAN .................................................................................. EW ENGINEERING AND BASIC ....................................................................................................... EA ENGINEMAN............................................................................................................................... EN EQUIPMENT OPERATOR .......................................................................................................... EO FIRE CONTROL TECHNICIAN ................................................................................................... FT FIRE CONTROL TECHNICIAN (BALLISTIC MISSILE FIRE CONTROL)..................................... FTB FIRE CONTROL TECHNICIAN (GUN FIRE CONTROL) ............................................................. FTG FIRE CONTROLMAN .................................................................................................................. FC FIREMAN ................................................................................................................................ FN FIREMAN APPRENTICE............................................................................................................. FA FIREMAN RECRUIT ................................................................................................................... FR GAS TURBINE SYSTEMS TECHNICIAN.................................................................................... GS GAS TURBINE SYSTEMS TECHNICIAN (ELECTRICAL)........................................................... GSE GUNNER'S MATE ....................................................................................................................... GM GUNNER'S MATE (GUNS) ......................................................................................................... GMG HOSPITAL CORPSMAN ............................................................................................................. HM HOSPITAL CORPSMAN RECRUIT............................................................................................. HR HULL MAINTENANCE TECHNICIAN .......................................................................................... HT ILLUSTRATOR DRAFTSMAN BASIC ......................................................................................... DM INSTRUMENTMAN ..................................................................................................................... IM INTELLIGENCE SPECIALIST ..................................................................................................... IS INTERIOR COMM ELECTRICIAN............................................................................................... IC JOURNALIST .............................................................................................................................. JO LEGALMAN ................................................................................................................................ LN LITHOGRAPHER ........................................................................................................................ LI MACHINERY REPAIRMAN ......................................................................................................... MR MACHINIST'S MATE................................................................................................................... MM MASTER AT ARMS..................................................................................................................... MA MESS MANAGEMENT SPECIALIST .......................................................................................... MS MINEMAN ................................................................................................................................ MN

MD0753

F-2

DESCRIPTION ARMY

DATA CODE

AMMUNITION SUPERVISOR ..................................................................................................... 55Z AMMUNITION TECH................................................................................................................... 91ØA AN/TSQ-73 OPERATOR/REPAIRER .......................................................................................... 25L ANATOMICAL PATHOLOGIST OFFICER................................................................................... 61T ANESTHESIOLOGIST OFFICER................................................................................................ 6ØN ANIMAL CARE SPECIALIST....................................................................................................... 91T ARMY INTELLIGENCE TECH ..................................................................................................... 351C ARMAMENT/FIRE CONT MAINT SUP........................................................................................ 45Z ARMAMENT REPAIR TECH ....................................................................................................... 913A ARMOR/CAVALRY SYSTEMS MAINTENANCE TECH............................................................... 915D ARMOR OFFICER, GENERAL.................................................................................................... 12A ARMOR SENIOR SERGEANT .................................................................................................... 19Z ARNG ATTENDING NON-ROTC COLLEGES FOR STATE OCS ............................................... Ø9T ARTILLERY REPAIRER .............................................................................................................. 45L ATOMIC DEMO MUNITION SPEC.............................................................................................. 12E ATTACHE TECH ......................................................................................................................... 35ØL ATTACK HELICOPTER REPAIRER............................................................................................ 67Y AUDIO/TV SPECIALIST.............................................................................................................. 84F AUDIO-VISUAL CHIEF................................................................................................................ 25Z AUDIO-VISUAL EQUIP REPAIRER ............................................................................................ 41E AUTOMATIC DATA TELECOMMUNICATIONS CENTER OPERATOR ...................................... 72G AUTOMATIC DIGITAL MESSAGE SWITCH EQUIPMENT REPAIRER ...................................... 29H AUTOMATIC TEST EQUIPMENT OPERATOR........................................................................... 39B AUTOMATION MGT OFFICER ................................................................................................... 53C AVIATION LOGISTICS OFFICER ............................................................................................... 15T AVIATION MAINTENANCE TECH .............................................................................................. 151A AVIATION OFFICER, GENERAL ................................................................................................ 15A AVIONIC COMM EQUIP REPAIRER .......................................................................................... 35L AVIONIC EQUIP MAINT SUPERVISOR...................................................................................... 35P AVIONIC MECHANIC.................................................................................................................. 35K AVIONIC NAV/FLT CONT EQUIP REP....................................................................................... 35M AVIONIC SPECIAL EQUIP REPAIRER....................................................................................... 35R BANDMASTER (WØO) ............................................................................................................... 42ØC BANDS SENIOR SERGEANT ..................................................................................................... Ø2Z BANDSPERSON ......................................................................................................................... Ø2S BARITONE/EUPHONIUM PLAYER............................................................................................. Ø2C BASSOON PLAYER.................................................................................................................... Ø2K BEHAVIORAL SCIENCE SPEC .................................................................................................. 91G BIOCHEMIST OFFICER ............................................................................................................. 68C

MD0753

F-3

DESCRIPTION ARMY (CONTINUED)

DATA CODE

BIOLOGICAL SCIENCES ASSIGNMENT ................................................................................... Ø1H BIOMED EQUIP SPEC, ADVANCED .......................................................................................... 35U BIOMED EQUIP SPEC, BASIC/SIGNALS INTELL & EW OFFICER ........................................... 35G BIOMED INFO SYS OFFICER .................................................................................................... 67D BIOMEDICAL EQUIPMENT REPAIR TECH................................................................................ 67ØA BRADLEY FIGHTING VEHICLE SYSTEM MECHANIC............................................................... 63T BRADLEY FIGHTING VEHICLE SYSTEM TURRET MECH........................................................ 45T BRANCH IMMATERIAL, OFFICER ............................................................................................. Ø1A BRIDGE CREWMAN/CAVALRY UNIT OFFICER ........................................................................ 12C BROADCAST JOURNALIST ....................................................................................................... 71R BROADCAST OFFICER.............................................................................................................. 46B C-12 PILOT ................................................................................................................................ 155E CALIBRATION SPEC .................................................................................................................. 35H CANNON CREWMAN/LIGHT MSL FLD ART OFFICER.............................................................. 13B CANNON FIRE DIRECTION SPEC/CANNON FLD ART OFFICER............................................. 13E CARDIAC SPEC.......................................................................................................................... 91N CARDIOLOGIST OFFICER ......................................................................................................... 6ØH CARGO SPECIALIST.................................................................................................................. 88H CARPENTRY-MASONARY SPEC/TEST AND EVALUATION OFFICER..................................... 51B CARTOGRAPHER ...................................................................................................................... 81C CAVALRY SCOUT ...................................................................................................................... 19D CH-47A/B/C PILOT ..................................................................................................................... 154B CH-47D PILOT ............................................................................................................................ 154C CH-54 PILOT............................................................................................................................... 154A CHAPARRAL CREWMEMBER ................................................................................................... 16P CHAPARRAL/RED EYE REPAIRER ........................................................................................... 27G CHAPARRAL SYS MECHANIC................................................................................................... 24N CHAPARRAL-VULCAN SYSTEMS TECH................................................................................... 14ØB CHAPLAIN ASSISTANT.............................................................................................................. 71M CHEMICAL, GENERAL OFFICER............................................................................................... 74A CHEMICAL MUNITIONS & MATERIEL MGT OFFICER.............................................................. 74C CHEMICAL OPERATIONS SPEC ............................................................................................... 54B CHEMICAL OPNS & TRNG OFFICER ........................................................................................ 74B CHILD NEUROLOGIST OFFICER .............................................................................................. 6ØR CHILD PSYCHIATRIST OFFICER .............................................................................................. 6ØU CHINA OFFICER ........................................................................................................................ 48F CID SPECIAL AGENT ................................................................................................................. 95D CID SPECIAL AGENT (WO) ....................................................................................................... 311A CIVIL AFFAIRS, GENERAL (RES) .............................................................................................. 38A

MD0753

F-4

DESCRIPTION ARMY (CONTINUED)

DATA CODE

ENGINEER EQUIPMENT REPAIR TECH ................................................................................... 213A ENGINEER OFF, GENERAL....................................................................................................... 21A ENT SPEC ................................................................................................................................ 91U ENVIRONMENTAL SCIENCE OFF ............................................................................................. 68N EQUAL OPPORTUNITY NCO ..................................................................................................... ØØU EQUIP RECORDS/PARTS SPEC ............................................................................................... 76C EW/INTERCEPT AERIAL SENSOR REPAIRER......................................................................... 33V EW/INTERCEPT AVIATION SYSTEMS REPAIRER................................................................... 33R EW/INTERCEPT STRAT SYS ANAL & CMD/CONT SYBSYS REPAIRER ................................. 33M EW/INTERCEPT STRATEGIC PROCESSING & STORAGE SUBSYS REPAIRER .............................................................................................................. 33Q EW/INTERCEPT STRATEGIC RECEIVING SUBSYSTEMS REPAIRER.................................... 33P EQ/INTERCEPT SYSTEMS MAINTENENCE SUPERVISOR...................................................... 33Z EW/INTERCEPT TACTICAL SYSTEMS REPAIRER................................................................... 33T EW/SIGINT ANALYST ................................................................................................................ 98C EW/SIGINT CHIEF...................................................................................................................... 98Z EW/SIGINT EMITTER ID/LOC .................................................................................................... Ø5D EW/SIGINT MORSE INTERCEPTOR ......................................................................................... Ø5H EW/SIGINT N/MORSE INTERCEPTOR...................................................................................... Ø5K EW/SIGINT NONCOMM INTERCEPTOR ................................................................................... 98J EW/SIGINT VOICE INTERCEPTOR ........................................................................................... 98G EXECUTIVE ADMINISTRATIVE ASSISTANT............................................................................. 71C EXECUTIVE DENTAL OFFICER................................................................................................. 63R EXPLOSIVE ORDNANCE DISP SPEC........................................................................................ 55D EYE SPEC ................................................................................................................................ 91Y FABRIC REPAIR SPEC .............................................................................................................. 43M FACILITIES/CONTRACT CONSTRUCTION MGT ENG (FCCME) OFFICER .............................. 21D FAMILY PHYSICIAN OFFICER ................................................................................................... 61H FIELD ARTILLERY DIGITAL SYSTEMS REPAIRER................................................................... 39L FIELD ARTILLERY METEOROLOGICAL CREW ........................................................................ 93F FIELD ARTILLERY OFF, GEN .................................................................................................... 13A FIELD ARTILLERY SYSTEMS MAINTENANCE TECH ............................................................... 915C FIELD ARTILLERY TACTICAL FIRE DIRECTION SYS REPAIRER............................................ 39Y FIELD COMMUNICATIONS SECURITY EQUIPMENT REPAIRER............................................. 29S FIELD MEDICAL ASSISTANT OFFICER .................................................................................... 67B FIGHTING VEHICLE INFANTRYMAN ........................................................................................ 11M FINANCE OFFICER, GENERAL ................................................................................................. 44A FINANCE SENIOR SERGEANT.................................................................................................. 73Z FINANCE SPEC .......................................................................................................................... 73C

MD0753

F-5

DESCRIPTION ARMY (CONTINUED)

DATA CODE

FIRE CONTROL INST REPAIRER.............................................................................................. 41C FIRE CONTROL SYSTEM REPAIRER ....................................................................................... 45G FIRE SUPPORT SPEC ............................................................................................................... 13F FIREFIGHTER ............................................................................................................................ 51M FIXED COMMUNICATIONS SECURITY EQUIPMENT REPAIRER ............................................ 29F FIXED WING AVIATOR (WO) ..................................................................................................... 155A FLD ART RADAR CREW MEMBER............................................................................................ 17B FLD ART TARGET ACQUIS OFF ............................................................................................... 13D FLD ARTILLERY FIREFINDER RADAR OPERATOR ................................................................ 13R FLD ARTILLERY SENIOR SGT .................................................................................................. 13Z FLD ARTILLERY SURVEYOR..................................................................................................... 82C FLIGHT OPERATIONS COORDINATOR .................................................................................... 93P FLIGHT SURGEON OFFICER .................................................................................................... 61N FLUTE/PICCOLO PLAYER ......................................................................................................... Ø2G FOOD SERVICE SPEC............................................................................................................... 94B FOOD SERVICE TECH............................................................................................................... 922A FORCE DEVELOPMENT OFFICER............................................................................................ 50A FOREIGN AREA, GENERAL....................................................................................................... 48A FORWARD AREA ALERTING RADAR (FAAR) REPAIRER........................................................ 27N FRENCH HORN PLAYER ........................................................................................................... Ø2D FUEL-ELEC SYS REPAIRER/PROSTHODONTIST, REMOVABLE OFFICER.......................................................................................... 63G GASTROENTEROLOGIST OFFICER ......................................................................................... 6ØG GEN CONSTRUCTION EQUIP OPER ........................................................................................ 62J GEN ENGINEERING SUPERVISOR........................................................................................... 51Z GENERAL MED OFFICER .......................................................................................................... 6ØE GENERAL SURGEON OFFICER ................................................................................................ 61J GRAVES REGISTRATION SPEC ............................................................................................... 57F GROUND SURVEILLANCE SYSTEMS OPERATOR .................................................................. 96R GUITAR PLAYER........................................................................................................................ Ø2T HARDWARE ENG OFFICER ...................................................................................................... 53B HAWK CONT WAVE RADAR REP ............................................................................................. 24K HAWK FIRE CONT CREW MEMBER ......................................................................................... 16E HAWK FIRE CONT MECH (RES) ............................................................................................... 24E HAWK FIRE CONT REPAIRER .................................................................................................. 24H HAWK FIRING SEC MECH......................................................................................................... 24C HAWK INFO COOD GEN MECH ................................................................................................ 24G HAWK LAUNCH/MECH SYS REP .............................................................................................. 24L HAWK MAINT CHIEF.................................................................................................................. 24V HAWK MASTER MECH .............................................................................................................. 24R

MD0753

F-6

DESCRIPTION ARMY (CONTINUED)

DATA CODE

HAWK MISSILE CREW MEMBER .............................................................................................. 16D HAWK MISSILE SYSTEM TECH ................................................................................................ 14ØD HAWK MSL AIR DEF OFF .......................................................................................................... 14D HAWK PULSE RADAR REPAIRER............................................................................................. 24J HEALTH CARE ADMINISTRATOR OFFICER............................................................................. 67A HEALTH FAC PLANNING OFF ................................................................................................... 67L HEALTH PHYSICS SPEC ........................................................................................................... 91X HEALTH SERVICES COMPTROLLER OFFICER ....................................................................... 67C HEALTH SVCS MATERIEL OFF................................................................................................. 67K HEALTH SVCS PERS MGR OFFICER ....................................................................................... 67F HEAVY ANTI-ARMOR WEAP INFANTRYMAN ........................................................................... 11H HEAVY CONSTRUCTION EQUIP OPER.................................................................................... 62E HEAVY LIFT HELICOPTER REP ................................................................................................ 67X HEAVY LIFT HELICOPTER TECHNICAL INSPECTOR .............................................................. 66X HEAVY WHEEL VEHICLE MECH ............................................................................................... 63S HEMATOLOGIST OFFICER ....................................................................................................... 6ØZ HOSPITAL DIETICIAN OFFICER................................................................................................ 65C HOSPITAL FOOD SERVICE SPEC ............................................................................................ 94F HUMAN INTELLIGENCE OFFICER ............................................................................................ 35F IBM AUTOMATIC DATA PROCESSING SYSTEMS REPAIRER................................................. 39K IEW EQUIPMENT TECH............................................................................................................. 353A ILLUSTRATOR............................................................................................................................ 81E IMAGERY ANALYST................................................................................................................... 96D IMAGERY INTELLIGENCE TECH............................................................................................... 35ØD IIMMUNOLOGIST ....................................................................................................................... 68E INDIRECT FIRE INFANTRYMAN/MECH INFANTRY OFFICER .................................................. 11C INDUSTRIAL MGT OFFICER...................................................................................................... 97C INFANTRY OFFICER, GENERAL ............................................................................................... 11A INFANTRY SENIOR SERGEANT................................................................................................ 11Z INFANTRYMAN/LIGHT INFANTRY OFF..................................................................................... 11B INFECTIOUS DIS OFFICER ....................................................................................................... 61G INTELL OFFICER ....................................................................................................................... 35C INTELLIGENCE ANALYST.......................................................................................................... 96B INTELLIGENCE SENIOR SERGEANT........................................................................................ 96Z INTERNIST OFFICER ................................................................................................................. 61F INTERROGATION TECH ............................................................................................................ 351E INTERROGATOR ....................................................................................................................... 97E JOURNALIST .............................................................................................................................. 71Q JUDGE ADVOCATE OFFICER ................................................................................................... 55A

MD0753

F-7

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