The Consolidated CMS/PWW
Ambulance Condition Code
ICD Crosswalk
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Consolidated CMS/PWW Ambulance Condition Code ICD Crosswalk
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ICD‐9 Condition Code Examples
ICD‐10 Code Definition
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ICD‐10 Code Definition
Emergency Condition Codes ‐ ALS (Non trauma) K29.70 Gastritis, unspecified, without bleeding
With other signs or symptoms. Nausea,vomiting,fainting, pulsatile mass, distention, rigid, tenderness K29.90 Gastroduodenitis, unspecified, 535.50 Severe abdominal pain on exam, guarding.
without bleeding
Potentially life‐threatening. Bradycardia, junctional and ventricular blocks,non‐sinus tachycardias, PVC’s >6, bi and trigeminy, ventricular tachycardia, ventricular fibrillation, atrial Abnormal Cardiac flutter, PEA, asystole, AICD/AED rhythm/cardiac Fired
I49.9 Cardiac arrhythmia, unspecifed
427.9 dysrhythmia
780.8
Abnormal skin signs Diaphorhesis, cyanosis, delayed cap refill, poor turgor, mottled.
796.4
Abnormal vital signs
With or without symptoms
995.0
Allergic reaction 790.21 Blood glucose R61
Generalized hyperhidrosis
R68.89 Other general symptoms and signs
T78.2XXA Anaphylactic shock, unspecified, initial encounter
K29.70
Gastritis, unspecified, without bleeding
K29.90
Gastroduodenitis, unspecified, without bleeding
R10.9
Unspecified abdominal pain
I49.9
Cardiac arrhythmia, unspecifed
R61
Generalized hyperhidrosis
R23.8
Other skin changes
R68.89
Other general symptoms and signs
T78.2XXA Anaphylactic shock, unspecified, initial encounter
Potentially life‐threatening. Other emergency conditions, rapid T88.6XXA Anaphylactic reaction due to adverse progression of symptoms, prior hx. effect of correct drug or medicament of anaphylaxis, wheezing,
properly administered, initial T78.40XA Allergy, unspecified, initial encounter
difficulty swallowing.
encounter
Abnormal <80 or >250, with R73.01 Impaired fasting glucose
symptoms. Altered mental status, R73.09 Other abnormal blood glucose
R73.01 Impaired fasting glucose
vomiting, signs of dehydration
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799.1
Respiratory arrest ICD‐9 Condition Code Examples
Apnea, hypoventilation requiring ventilatory assistance and airway management.
786.05 Difficulty breathing
427.5
Respiratory arrest R06.02 Shortness of Breath
Cardiac arrest ‐ resuscitation in progress
786.50 Chest pain R09.2
ICD‐10 Code Definition
Dull, severe, crushing, substernal, epigastric, left sided chest pain associated with pain of the jaw, left arm, neck, back, and nausea, vomiting, palpitations, pallor, diaphoresis, decreased LOC.
784.99 Choking episode
991.6
Cold exposure life/limb Temperature < 95F, deep frost bite, other emergency conditions
threatening
Version 1.0
ICD‐10 Code Definition
R09.2
Respiratory arrest R06.02
Shortness of Breath
I46.2
Cardiac arrest due to underlying cardiac condition
I46.8
Cardiac arest due to other underlying condition
I46.9
Cardiac arrest, cause unspecified
I46.9
Cardiac arrest, cause unspecified
R07.9
R06.5
Chest pain, unspecified
Mouth breathing
R07.9
Chest pain, unspecified
R06.7
Sneezing
R06.89 Other abnormalities of breathing
Airway obstructed or partially obstructed
Potentially life or limb threatening
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R19.6
Halitosis
T68.XXXA Hypothermia, initial encounter
Page 2 of 43
T17.200A Unspecified foreign body in pharynx causing asphyxiation, initial encounter
T68.XXXA Hypothermia, initial encounter
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ICD‐9 Condition Code Examples
R41.0
780.97 Altered LOC 780.39 Convulsions/Seizures
Acute condition with Glascow Coma Scale < 15.
Seizing, immediate post‐seizure, postictal, or at risk of seizure and requires medical monitoring/observation.
Disorientation, unspecified
R41.82 Altered mental status, unspecified
R56.9
Unspecified convulsions
437.9
Non‐traumatic headache
With neurologic distress conditions or sudden severe onset
785.1
Cardiac symptoms Palpitations, skipped beats
R00.2
Persistent nausea and vomiting, weakness, hiccups, pleuritic pain, feeling of impending doom, and other emergency conditions.
R11.10
Hot and dry skin, Temp>105, neurologic distress, signs of heat stroke or heat exhaustion, orthostatic vitals, other emergency T67.5XXA
conditions.
Uncontrolled or significant signs of shock or other emergency conditions. Severe, active vaginal, rectal bleeding, hematemesis, hemoptysis, epistaxis, active post‐ R58
surgical bleeding.
536.2
992.5
459.0
Cardiac symptoms
Heat exposure ‐ potentially life threatening
Hemorrhage
ICD‐10 Code Definition
I67.9
Cerebrovascular disease, unspecified
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R41.82
R40.241
R40.242
R40.243
R56.9
I67.9
G44.89
R51
Version 1.0
ICD‐10 Code Definition
Altered Mental Status, unspecified
Glasgow coma scale score 13‐15
Glasgow coma scale score 9‐12
Glasgow coma scale score 3‐8
Unspecified convulsions
Cerebrovascular disease, unspecified
Other headache syndrome
Headache
Palpitations
R00.2
Palpitations
Vomiting, unspecified
R11.10
R09.1
I20.0
Vomiting, unspecified
Pleurisy
Unstable angina
T67.5XXA Heat Exhaustion, unspecified, initial encounter
Heat Exhaustion, unspecified, initial encounter
Hemorrhage, Not Elsewhere Classified (NEC)
Page 3 of 43
T67.0XXA Heatstroke and sunstroke, initial encounter
R58
Hemorrhage, Not Elsewhere Classified (NEC)
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T59.811A Toxic effect of smoke, accidental (unintentional), initial encounter
T59.812A Toxic effect of smoke, intentional self‐
harm, initial encounter
T59.813A Toxic effect of smoke, assault,
initial encounter
T59.814A Toxic effect of smoke, undetermined, initial encounter
T59.891A Toxic effect of other specified gases, fumes and vapors, accidental (unintentional), initial encounter
T59.892A Toxic effect of other specified gases, fumes and vapors, intentional self‐
harm, initial encounter
T59.893A Toxic effect of other specified gases, fumes and vapors, assault, initial
encounter
Hazmat
987.9
(Continued on next page) Toxic fume or liquid exposure via inhalation, absorption, oral, radiation, smoke inhalation.
T59.894A Toxic effect of other specified gases, fumes and vapors, undetermined, initial encounter
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T59.91XA Toxic effect of unspecified gases, fumes and vapors, accidental (unintentional), initial encounter
T59.92XA Toxic effect of unspecified gases, fumes and vapors, intentional self‐
harm, initial encounter
T59.93XA Toxic effect of unspecified gases, fumes and vapors, assault, initial encounter
987.9
Hazmat (Continued)
Toxic fume or liquid exposure via inhalation, absorption, oral, radiation, smoke inhalation.
T59.94XA Toxic effect of unspecified gases, fumes and vapors, undetermined, initial encounter
Page 5 of 43
T59.94XA Toxic effect of unspecified gases, fumes and vapors, undetermined, initial encounter
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T82.119A Breakdown (mechanical) of unspecified cardiac electronic device, initial encounter
T82.129A Displacement of unspecified
cardiac electronic device, initial encounter
T82.199A Other mechanical complication of unspecified cardiac device, initial encounter
T82.519A Breakdown (mechanical) of unspecified cardiac and vascular devices and implants, initial encounter
T82.529A Displacement of unspecified cardiac and vascular devices and implants, initial encounter
Life or limb threatening malfunction, failure, or complication. Malfunction of ventilator, internal pacemaker, internal defibrillator, implanted 996.00 Medical device failure drug delivery service.
T82.539A Leakage of unspecified cardiac and vascular devices and implants, initial encounter
T82.599A Other mechanical complication of unspecified cardiac and vascular devices and implants, initial encounter
Page 6 of 43
T82.599A
Other mechanical complication of unspecified cardiac and vascular devices and implants, initial encounter
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436
Neurological distress
ICD‐9 Condition Code Examples
Facial drooping; loss of vision; aphasia; difficulty swallowing; numbness; tingling extremity; stupor, delirium, confusion, hallucinations; paralysis, paresis (focal weakness); abnormal movements; vertigo; unsteady gait/balance; slurred speech, uanble to speak. ICD‐10 Code Definition
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I67.89
Other cerebrovascular disease
I69.920
Aphasia following unspecified cerebrovascular disease
R40.2241 Coma scale, best verbal response, confused conversation in the field [EMT or ambulance]
I67.89
[PWW NOTE: See additional codes related to specific GCS elements under R40]
Other cerebrovascular disease
Acute onset, unable to ambulate or sit due to intensity of pain.
Pain, severe, not 780.96 otherwise specified 724.5
Back pain, non‐
traumatic Pain is the reason for the transport. Use severity scale (7‐10 for severe pain) or patient receiving pharmalogic intervention.
Suspect cardiac or vascular etiology. Other emergency conditions, absence of or decreased leg pulses, pulsatile abdominal mass, severe tearing abdominal pain.
R52
Pain, unspecified
G89.11
Acute pain due to trauma
M54.89 Other dorsalgia
M54.9
Dorsalgia, unspecified
M54.9
M54.89
Other dorsalgia
R52
Pain, unspecified
Dorsalgia, unspecified
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M43.20 Fusion of spine, site unspecified
M43.21 Fusion of spine, occipito‐atlanto‐axial region
M43.22 Fusion of spine, cervical region
M43.23 Fusion of spine, cervicothoracic region
M43.24 Fusion of spine, thoracic region
M43.25 Fusion of spine, thoracolumbar region
M43.26 Fusion of spine, lumbar region
M43.27 Fusion of spine, lumbosacral region
M43.28 Fusion of spine, sacral and sacrococcygeal region
Back pain, non‐
traumatic
724.9
(Continued on next page)
Sudden onset of new neurologic symptoms.
Neurologic distress list.
M43.8X9 Other specified deforming dorsopathies, site unspecified
M53.80 Other specified dorsopathies, site unspecified
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M53.84 Other specified dorsopathies, thoracic region
724.9
Back pain, non‐
traumatic
(Continued)
Sudden onset of new neurologic symptoms.
M53.85 Other specified dorsopathies, thoracolumbar region
Neurologic distress list.
M53.9
Dorsopathy, unspecified
M54.9
Dorsalgia, unspecified
T50.901A Poisoning by unspecified drugs, medicaments and biological substances, accidental (unintentional), initial encounter
T50.902A Poisoning by unspecified drugs, medicaments and biological substances, intentional self‐harm, initial encounter
T50.903A Poisoning by unspecified drugs, medicaments and biological substances, assault, initial encounter
977.9
Poisons ingested, injected, inhaled, absorbed Adverse drug reaction, poison exposure by inhalation, injection, or absorption.
T50.904A Poisoning by unspecified drugs, medicaments and biological substances, undetermined, initial encounter
Page 9 of 43
T50.904A Poisoning by unspecified drugs, medicaments and biological substances, undetermined, initial encounter
T65.94XA Toxic effect of unspecified substance, undetermined, initial encounter
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977.3
Severe alcohol intoxication 650
Pregnancy complication / childbirth / labor
Psychiatric
292.9
(Continued on next page)
ICD‐9 Condition Code Examples
ICD‐10 Code Definition
Airway may or may not be at risk. Pharmacological intervention or cardiac monitoring may be T50.991A Poisoning by other drugs, needed. Decreased level of medicaments and biological consciousness resulting or substances, accidental potentially resulting in airway (unintentional), initial encounter
compromise.
O80
F11.19
Opioid abuse with unspecified opioid‐
induced disorder
F11.29
Opioid dependence with unspecified opioid‐induced disorder
F11.99
Opioid use, unspecified with unspecified opioid‐induced disorder
F12.19
Cannabis abuse with unspecified cannabis‐induced disorder
F12.29
Cannabis dependence with unspecified cannabis‐induced disorder
F12.99
Cannabis use, unspecified with unspecified cannabis‐induced disorder
Abnormal mental status; drug withdrawal.
Disoriented, DTs, withdrawal symptoms
Encounter for full‐term uncomplicated delivery
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F10.929 Alcohol use, unspecified with intoxication, unspecified
O80
Encounter for full‐term uncomplicated delivery
O26.90 Pregnancy related conditions, unspecified, unspecified trimester
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Psychiatric
292.9
ICD‐9 Condition Code Examples
Abnormal mental status; drug withdrawal.
(Continued ‐ continues Disoriented, DTs, withdrawal symptoms
on next page)
ICD‐10 Code Definition
F13.19
Sedative, hypnotic or anxiolytic abuse with unspecified sedative, hypnotic or anxiolytic‐induced disorder
F13.29
Sedative, hypnotic or anxiolytic dependence with unspecified sedative, hypnotic or anxiolytic‐
induced disorder
F13.99
Sedative, hypnotic or anxiolytic use, unspecified with unspecified sedative, hypnotic or anxiolytic‐
induced disorder
F14.19
Cocaine abuse with unspecified cocaine‐induced disorder
F14.29
Cocaine dependence with unspecified cocaine‐induced disorder
F14.99
Cocaine use, unspecified with unspecified cocaine‐induced disorder
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Psychiatric
ICD‐9 Condition Code Examples
F15.19
Other stimulant abuse with unspecified stimulant‐induced disorder
F15.29
Other stimulant dependence with
unspecified stimulant‐induced disorder
F15.99
Other stimulant use, unspecified with unspecified stimulant‐induced disorder
F16.19
Hallucinogen abuse with unspecified
hallucinogen‐induced disorder
F16.29
Hallucinogen dependence with unspecified hallucinogen‐induced disorder
F16.99
Hallucinogen use, unspecified with
unspecified hallucinogen‐induced disorder
Abnormal mental status; drug withdrawal.
(Continued ‐ continues Disoriented, DTs, withdrawal symptoms
on next page)
ICD‐10 Code Definition
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F17.209 Nicotine dependence, unspecified, with unspecified nicotine‐induced disorders
F17.219 Nicotine dependence, cigarettes, with unspecified nicotine‐induced disorders
F17.229 Nicotine dependence, chewing
tobacco, with unspecified nicotine‐
induced disorders
F17.299 Nicotine dependence, other tobacco
product, with unspecified nicotine‐
induced disorders
F18.19 Inhalant abuse with unspecified inhalant‐induced disorder
Psychiatric
292.9
Abnormal mental status; drug withdrawal.
(Continued ‐ continues Disoriented, DTs, withdrawal symptoms
on next page)
F18.29 Inhalant dependence with unspecified inhalant‐induced disorder
F18.99 Inhalant use, unspecified with unspecified inhalant‐induced disorder
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ICD‐9 Condition Code Examples
Abnormal mental status; drug withdrawal.
292.9
Psychiatric
(Continued)
787.01 Severe dehydration F19.19
Other psychoactive substance abuse with unspecified psychoactive substance‐induced disorder
F19.29
Other psychoactive substance dependence with unspecified psychoactive substance‐induced disorder
F19.99
Other psychoactive substance use, unspecified with unspecified psychoactive substance‐induced disorder
Disoriented, DTs, withdrawal symptoms
Nausea and vomiting, diarrhea, severe and incapacitating resulting in severe side effects of dehydration.
Unconscious, fainting, Transient unconscious episode or syncope, near sycnope found unconscious. Acute episode 780.02 weakness, dizziness or exacerbation.
ICD‐10 Code Definition
R11.2
R40.4
Nausea with vomiting, unspecified
Transient alteration of awareness
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F19.99
Other psychoactive substance use, unspecified with unspecified psychoactive substance‐induced disorder
R11.2
Nausea with vomiting, unspecified
E86.0
Dehydration
R40.4
Transient alteration of awareness
R55
Syncope and collapse
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Emergency Condition Codes ‐ ALS (Trauma) 959.8
Major trauma
As defined by ACS Field Triage Decision Scheme. Trauma with one of the following: Glascow <14; systolic BP<90; RR<10 or >29; all penetrating injuries to head, neck, torso, extremities proximal to elbow or knee; flail chest; combination of trauma and burns; pelvic fracture; 2 or more long bone fractures; open or depressed skull fracture; paralysis; severe mechanism of injury including: ejection, death of another passenger in same patient compartment, falls >20’’, 20’’ deformity in vehicle or 12’’ deformity of patient compartment, auto pedestrian/bike, pedestrian thrown/run over, motorcycle accident at speeds >20 mph and rider separated from vehicle.
T07
Unspecified multiple injuries
Page 15 of 43
T07
Unspecified multiple injuries
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J95.821 Acute postprocedural respiratory failure
J96.00
Acute respiratory failure, unspecified whether with hypoxia or hypercapnia
J96.01
Acute respiratory failure with hypoxia
J96.00
518.51 Other trauma 958.2
Other trauma ‐ bleeding Need to monitor or maintain airway. Decreased LOC, bleeding into airway, trauma to head, face or neck.
Major bleeding. Uncontrolled or significant bleeding.
Acute respiratory failure with hypercapnia
T79.2XXA Traumatic secondary and recurrent hemorrhage and seroma, initial encounter
J96.02
Page 16 of 43
Acute respiratory failure, unspecified whether with hypoxia or hypercapnia
S09.90XA Unspecified injury of head, initial encounter
T79.2XXA Traumatic secondary and recurrent hemorrhage and seroma, initial encounter
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S48.911A Complete traumatic amputation of right shoulder and upper arm, level unspecified, initial encounter
S48.912A Complete traumatic amputation of left shoulder and upper arm, level unspecified, initial encounter
S48.919A Complete traumatic amputation of unspecified shoulder and upper arm, level unspecified, initial encounter
S48.921A Partial traumatic amputation of right S48.919A Complete traumatic amputation of unspecified shoulder and upper arm, shoulder and upper arm, level level unspecified, initial encounter
unspecified, initial encounter
S48.922A Partial traumatic amputation of left shoulder and upper arm, level unspecified, initial encounter
887.4
Other trauma ‐ amputation Amputation – arm or Hand
S58.919A Complete traumatic amputation of unspecified forearm, level unspecified, initial encounter
S68.419A Complete traumatic amputation of S48.929A Partial traumatic amputation of unspecified shoulder and upper arm, unspecified hand at wrist level, initial level unspecified, initial encounter
encounter
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S78.911A Complete traumatic amputation of right hip and thigh, level unspecified, initial encounter
S78.912A Complete traumatic amputation of left hip and thigh, level unspecified, initial encounter
S78.921A Partial traumatic amputation of right hip and thigh, level unspecified, initial encounter
Other trauma ‐ amputation
897.4
(Continued on next page)
Amputation – leg or foot
S78.922A Partial traumatic amputation of left hip and thigh, level unspecified, initial encounter
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Version 1.0
ICD‐10 Code Definition
S88.911A Complete traumatic amputation of right lower leg, level unspecified, initial encounter
S88.912A Complete traumatic amputation of left lower leg, level unspecified, initial encounter
S88.919A Complete traumatic amputation of unspecified lower leg, level unspecified, initial encounter
S88.921A Partial traumatic amputation of right S78.919A Complete traumatic amputation of lower leg, level unspecified, initial unspecified hip and thigh, level unspecified, initial encounter
encounter
Other trauma ‐ amputation
897.4
(Continued)
Amputation – leg or foot
S88.922A Partial traumatic amputation of left lower leg, level unspecified, initial encounter
S88.919A Complete traumatic amputation of unspecified lower leg, level unspecified, initial encounter
S88.929A Partial traumatic amputation of unspecified lower leg, level unspecified, initial encounter
S98.019A Complete traumatic amputation of unspecified foot at ankle level, initial encounter
Page 19 of 43
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S36.90XA Unspecified injury of unspecified intra‐
abdominal organ, initial encounter
S36.92XA Contusion of unspecified intra‐
abdominal organ, initial encounter
S36.93XA Laceration of unspecified intra‐
abdominal organ, initial encounter
S36.99XA Other injury of unspecified intra‐
abdominal organ, initial encounter
S37.90XA Unspecified injury of unspecified urinary and pelvic organ, initial encounter
869.0
Other trauma ‐ closed
S02.91XA Unspecified fracture of skull, initial encounter for closed fracture
S27.9XXA Injury of unspecified intrathoracic Suspected internal, head, chest, or organ, initial encounter
abdominal injuries.
S37.92XA Contusion of unspecified urinary and pelvic organ, initial encounter
Signs of closed head injury, open S36.90XA Unspecified injury of unspecified intra‐
head injury, pneumothorax, abdominal organ, initial encounter
S37.93XA Laceration of unspecified urinary and pelvic organ, initial encounter
hemothorax, abdominal bruising, positive abdominal signs on exam, S37.90XA Unspecified injury of unspecified internal bleeding criteria, urinary and pelvic organ, initial S37.99XA Other injury of unspecified urinary evisceration
encounter
and pelvic organ, initial encounter
Page 20 of 43
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S01.90XA Unspecified open wound of unspecified part of head, initial encounter
S21.90XA Unspecified open wound of unspecified part of thorax, initial encounter
Suspected internal, head, chest, or abdominal injuries.
869.1
949.3
Other trauma ‐ open Burns ‐ major CMS Crosswalk Document simply states: Cluster 869.1
Signs of closed head injury, open head injury, pneumothorax, hemothorax, abdominal bruising, positive abdominal signs on exam, internal bleeding criteria, evisceration
Major – per American Burn Association (ABA)
Partial thickness burns > 10% total body surface area (TBSA); involvement of face, hands, feet, genitalia, perineum, or major joints; third degree burns; electrical; chemical; inhalation; burns with preexisting medical disorders; burns and trauma
S31.609A Unspecified open wound of abdominal wall, unspecified quadrant with penetration into peritoneal cavity, initial encounter
S31.001A Unspecified open wound of lower back and pelvis with penetration into retroperitoneum, initial encounter
T31.10
T30.0
Burn of unspecified body region, unspecified degree
Page 21 of 43
Burns involving 10‐19% of body surface with 0% to 9% third degree burns
[PWW NOTE: See additional body surface ranges under T31]
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Potentially life or limb‐threatening.
989.5
Animal bites, stings Symptoms of specific envenomation, significant face, neck, trunk, and extremity involvement; other emergency conditions.
76 codes from
T63.001A through T63.414A
T63.94XA Toxic effect of contact with unspecified venomous animal
76 codes from
T63.421A through T63.94XA
T63.484A Toxic effect of venom of other arthropod, undetermined, initial encounter
T75.00XA Unspecified effects of lightning, initial encounter
994.0
Lightning 994.8
Electrocution 994.1
Near drowning T75.01XA Shock due to being struck by lightning, initial encounter
T75.00XA Unspecified effects of lightning, initial encounter
T75.09XA Other effects of lightning, initial
encounter
T75.01XA Shock due to being struck by lightning, initial encounter
T75.4XXA Electrocution, initial encounter
T75.1XXA Unspecified effects of drowning and Airway compromised during near nonfatal submersion, initial drowning event
encounter
T75.4XXA Electrocution, initial encounter
T75.1XXA Unspecified effects of drowning and nonfatal submersion, initial encounter
T74.21XA Adult sexual abuse, confirmed, initial T76.21XA Adult sexual abuse, suspected, initial encounter
encounter
995.83 Sexual assault
With major injuries
T76.21XA Adult sexual abuse, suspected, initial T76.22XA Child sexual abuse, suspected, initial encounter
encounter
Page 22 of 43
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ICD‐9 Condition Code Examples
ICD‐10 Code Definition
Emergency Condition Codes ‐ BLS (Non‐traumatic)
R10.0 Acute abdomen
789.00 Abdominal pain 692.9
Without other signs or symptoms
Allergies reaction ‐ non Hives, itching, rash, slow onset, life threatening local swelling, redness, erythema.
R10.9
Unspecified abdominal pain
L23.9
Allergic contact dermatitis, unspecified cause
L24.9
Irritant contact dermatitis, unspecified cause
L25.9
Unspecified contact dermatitis, unspecified cause
L30.0
Nummular dermatitis
L30.2
Cutaneous autosensitization
L30.8
Other specified dermatitis
L30.9
Dermatitis, unspecified
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R10.84
Generalized abdominal pain
R10.9
Unspecified abdominal pain
T78.49XA Other allergy, initial encounter
With symptoms
991.9
Cold exposure 379.90 Eye symptoms 992.2
Heat exposure Shivering, superficial frost bite, and other emergency conditions
Acute vision loss and/or severe pain
With symptoms. Muscle cramps, profuse sweating, fatigue.
T69.9XXA Effect of reduced temperature, unspecified, initial encounter
H57.9 Unspecified disorder of eye and adnexa
T69.9XXA Effect of reduced temperature, unspecified, initial encounter
H57.9 Unspecified disorder of eye and adnexa
T67.2XXA Heat cramp, initial encounter
T67.2XXA Heat cramp, initial encounter
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038.9
ICD‐9 Condition Code Examples
Infectious disease requiring isolation procedures / public health risk
A41.9
Sepsis, unspecified organism
Health maintenance device failures T83.498A
that cannot be resolved on location. Oxygen system supply malfunction, orthopedic device 996.30 Medical device failure failure.
F10.10
F10.120
Unable to care for self and unable F10.129
to ambulate. No airway 305.00 Alcohol intoxication compromise.
Major wound dehiscence, evisceration, or requires special Post‐operative handling for transport. Non‐life T81.9XXA
procedure threatening
998.9 complications 298.9
036.9
Threat to self or others, acute episode or exacerbation of paranoia, or disruptive behavior. Psychiatric/behavioral Suicidal, homicidal, or violent.
Fever with associated symptoms (headache, stiff neck, etc.). Neurological changes. Suspected spinal meningitis.
Sick person ‐ fever ICD‐10 Code Definition
Other mechanical complication of other prosthetic devices, implants and grafts of genital tract, initial encounter
Alcohol abuse, uncomplicated
Alcohol abuse with intoxication, uncomplicated
Alcohol abuse with intoxication, unspecified
Unspecified complication of procedure, initial encounter
F28
Other psychotic disorder not due to a substance or known physiological condition
F29
Unspecified psychosis not due to a substance or known physiological condition
A39.9
Meningococcal infection, unspecified
Page 24 of 43
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A41.9
Sepsis, unspecified organism
B99.9
Unspecified infectious disease
Y82.8
Other medical devices associated with adverse incidents
F10.10
Alcohol abuse, uncomplicated
T81.9XXA Unspecified complication of procedure, initial encounter
F29
Unspecified psychosis not due to a substance or known physiological condition
F68.8
Other specified disorders of adult personality and behavior
A39.9
Meningococcal infection, unspecified
R50.9
Fever, unspecified
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Emergency Condition Codes ‐ BLS (Trauma) Suspected fracture/dislocation requiring splinting/immobilization for transport.
829.0
Other trauma ‐ suspected fracture Spinal, long bones, and joints including shoulder elbow, wrist, hip, knee and ankle, deformity of bone or joint.
T14.8
Other injury of unspecified body region
T14.8
Other injury of unspecified body region
S41.001A Unspecified open wound of right shoulder, initial encounter
S41.002A Unspecified open wound of left shoulder, initial encounter
S41.009A Unspecified open wound of
unspecified shoulder, initial encounter
S41.011A Laceration without foreign body of right shoulder, initial encounter
Other trauma ‐ penetrating
(Continued on next 880.00 page)
S41.012A Laceration without foreign body of
left shoulder, initial encounter
Penetrating extremity injuries. S41.019A Laceration without foreign body of Isolated with bleeding stopped and unspecified shoulder, initial good CSM.
encounter
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S41.031A Puncture wound without foreign
body of right shoulder, initial encounter
S41.032A Puncture wound without foreign body of left shoulder, initial encounter
S41.039A Puncture wound without foreign
body of unspecified shoulder, initial encounter
S41.051A Open bite of right shoulder, initial encounter
Other trauma ‐ penetrating
880.00 (Continued)
S41.052A Open bite of left shoulder, initial
encounter
Penetrating extremity injuries. Isolated with bleeding stopped and S41.059A Open bite of unspecified shoulder, good CSM.
initial encounter
Page 26 of 43
S41.009A Unspecified open wound of unspecified shoulder, initial encounter
T14.90
Injury, unspecified
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S68.110A Complete traumatic metacarpophalangeal amputation of right index finger, initial encounter
S68.111A Complete traumatic metacarpophalangeal amputation of left index finger, initial encounter
S68.112A Complete traumatic metacarpophalangeal amputation of right middle finger, initial encounter
S68.113A Complete traumatic metacarpophalangeal amputation of left middle finger, initial encounter
Other trauma ‐ amputation
886.0
(Continued ‐ continues on next page)
Amputation – digits ‐ fingers
S68.114A Complete traumatic metacarpophalangeal amputation of right ring finger, initial encounter
S68.115A Complete traumatic metacarpophalangeal amputation of left ring finger, initial encounter
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S68.116A Complete traumatic metacarpophalangeal amputation of right little finger, initial encounter
S68.117A Complete traumatic metacarpophalangeal amputation of left little finger, initial encounter
Other trauma ‐ amputation
886.0
(Continued ‐ continues on next page)
Amputation – digits ‐ fingers
S68.118A Complete traumatic metacarpophalangeal amputation of other finger, initial encounter
S68.119A Complete traumatic metacarpophalangeal amputation of unspecified finger, initial encounter
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S68.120A Partial traumatic metacarpophalangeal amputation of right index finger, initial encounter
S68.121A Partial traumatic metacarpophalangeal amputation of left index finger, initial encounter
S68.122A Partial traumatic metacarpophalangeal amputation of right middle finger, initial encounter
S68.123A Partial traumatic metacarpophalangeal amputation of left middle finger, initial encounter
Other trauma ‐ amputation
886.0
(Continued ‐ continues on next page)
Amputation – digits ‐ fingers
S68.124A Partial traumatic metacarpophalangeal amputation of right ring finger, initial encounter
S68.125A Partial traumatic metacarpophalangeal amputation of left ring finger, initial encounter
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S68.126A Partial traumatic metacarpophalangeal amputation of right little finger, initial encounter
S68.127A Partial traumatic metacarpophalangeal amputation of left little finger, initial encounter
Other trauma ‐ amputation
886.0
(Continued ‐ continues on next page)
Amputation – digits ‐ fingers
S68.128A Partial traumatic metacarpophalangeal amputation of other finger, initial encounter
S68.129A Partial traumatic metacarpophalangeal amputation of unspecified finger, initial encounter
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S68.610A Complete traumatic transphalangeal amputation of right index finger, initial encounter
S68.611A Complete traumatic transphalangeal amputation of left index finger, initial encounter
S68.612A Complete traumatic transphalangeal amputation of right middle finger, initial encounter
S68.613A Complete traumatic
transphalangeal amputation of left middle finger, initial encounter
Other trauma ‐ amputation
886.0
(Continued ‐ continues on next page)
Amputation – digits ‐ fingers
S68.614A Complete traumatic
transphalangeal amputation of right ring finger, initial encounter
S68.615A Complete traumatic transphalangeal amputation of left ring finger, initial encounter
Page 31 of 43
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S68.616A Complete traumatic transphalangeal amputation of right little finger, initial encounter
S68.617A Complete traumatic transphalangeal amputation of left little finger, initial encounter
Other trauma ‐ amputation
886.0
(Continued ‐ continues on next page)
Amputation – digits ‐ fingers
S68.618A Complete traumatic transphalangeal amputation of other finger, initial encounter
S68.619A Complete traumatic transphalangeal amputation of unspecified finger, initial encounter
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S68.620A Partial traumatic transphalangeal amputation of right index finger, initial encounter
S68.621A Partial traumatic transphalangeal amputation of left index finger, initial encounter
S68.622A Partial traumatic transphalangeal amputation of right middle finger, initial encounter
S68.623A Partial traumatic transphalangeal amputation of left middle finger, initial encounter
Other trauma ‐ amputation
886.0
(Continued ‐ continues on next page)
Amputation – digits ‐ fingers
S68.624A Partial traumatic transphalangeal amputation of right ring finger, initial encounter
S68.625A Partial traumatic transphalangeal amputation of left ring finger, initial encounter
Page 33 of 43
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S68.626A Partial traumatic transphalangeal amputation of right little finger, initial encounter
S68.627A Partial traumatic transphalangeal amputation of left little finger, initial encounter
Other trauma ‐ amputation
886.0
(Continued)
Amputation – digits ‐ fingers
S68.628A Partial traumatic transphalangeal amputation of other finger, initial encounter
S68.519A Complete traumatic transphalangeal amputation of unspecified thumb, initial encounter
S68.629A Partial traumatic transphalangeal amputation of unspecified finger, initial encounter
S68.619A Complete traumatic transphalangeal amputation of unspecified finger, initial encounter
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S98.111A Complete traumatic amputation of right great toe, initial encounter
S98.112A Complete traumatic amputation of left great toe, initial encounter
S98.119A Complete traumatic amputation of unspecified great toe, initial encounter
S98.121A Partial traumatic amputation of
right great toe, initial encounter
S98.122A Partial traumatic amputation of left great toe, initial encounter
Other trauma ‐ amputation
895.0
(Continued on next page)
Amputation – digits ‐ toes
S98.129A Partial traumatic amputation of
unspecified great toe, initial encounter
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S98.131A Complete traumatic amputation of one right lesser toe, initial encounter
S98.132A Complete traumatic amputation of
one left lesser toe, initial encounter
S98.139A Complete traumatic amputation of one unspecified lesser toe, initial encounter
S98.141A Partial traumatic amputation of one
right lesser toe, initial encounter
Other trauma ‐ amputation
895.0
(Continued ‐ continues on next page)
Amputation – digits ‐ toes
S98.142A Partial traumatic amputation of one left lesser toe, initial encounter
S98.149A Partial traumatic amputation of one
unspecified lesser toe, initial encounter
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S98.211A Complete traumatic amputation of two or more right lesser toes, initial encounter
S98.212A Complete traumatic amputation of
two or more left lesser toes, initial encounter
S98.219A Complete traumatic amputation of two or more unspecified lesser toes, initial encounter
Other trauma ‐ amputation
895.0
(Continued)
Amputation – digits ‐ toes
Minor – per ABA
S98.221A Partial traumatic amputation of two
or more right lesser toes, initial encounter
S98.119A Complete traumatic amputation of unspecified great toe, initial encounter
S98.222A Partial traumatic amputation of two or more left lesser toes, initial encounter
S98.139A Complete traumatic amputation of one unspecified lesser toe, initial encounter
S98.229A Partial traumatic amputation of two or more unspecified lesser toes, initial encounter
S98.219A Complete traumatic amputation of two or more unspecified lesser toes, initial encounter
T30.0
949.2
Burns ‐ minor Other burns than listed above.
Burn of unspecified body region, unspecified degree
Page 37 of 43
T30.0
Burn of unspecified body region, unspecified degree
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S31.010A Laceration without foreign body of lower back and pelvis without penetration into retroperitoneum, initial encounter
S31.030A Puncture wound without foreign body of lower back and pelvis without penetration into retroperitoneum, initial encounter
879.8
921.9
S31.050A Open bite of lower back and pelvis without penetration into retroperitoneum, initial encounter
S81.859A Open bite, unspecified lower leg, initial encounter
S51.859A Open bite of unspecified forearm, initial encounter
Animal bites/stings Local pain and swelling or special handling considerations (not related to obesity) and patient monitoring required.
Eye injuries Acute vision loss or blurring, severe pain or chemical exposure, S05.90XA Unspecified injury of unspecified eye S05.90XA Unspecified injury of unspecified eye penetrating, severe lid lacerations.
and orbit, initial encounter
and orbit, initial encounter
995.80 Sexual assault
With minor or no injuries
S38.3XXA Transection (partial) of abdomen, initial encounter
W57.XXXA Bitten or stung by nonvenomous insect and other nonvenomous arthropods, initial encounter
T74.91XA
Unspecified adult maltreatment, confirmed, initial encounter
T76.91XA Unspecified adult maltreatment, suspected, initial encounter
T76.91XA
Unspecified adult maltreatment, suspected, initial encounter
T76.92XA Unspecified child maltreatment, suspected, initial encounter
Page 38 of 43
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Non‐emergency Condition Codes ‐ ALS 428.9
Cardiac monitoring 518.81 Airway management Expectation monitoring is needed before and after transport.
Ventilator dependent, apnea monitor, possible intubation needed, deep suctioning.
I50.9
Heart failure, unspecified
J96.00
Acute respiratory failure, unspecified whether with hypoxia or hypercapnia
J96.01
Acute respiratory failure with hypoxia
J96.02
Acute respiratory failure with hypercapnia
J96.90
Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia
J96.91
Respiratory failure, unspecified with hypoxia
J96.92
Respiratory failure, unspecified with hypercapnia
Y71.0
Diagnostic and monitoring cardiovascular devices associated with adverse incidents
I49.8
Other specified cardiac arrhythmias
J96.90
Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia
Z99.11
Dependence on respirator/ventilator status
Delirium due to known physiological condition
F05
F05
293.0
Chemical restraint Delirium due to known physiological condition
Page 39 of 43
F91.9
Conduct disorder, unspecified
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Non‐emergency Condition Codes ‐ BLS J44.9
496
Suctioning required en route, need for O2 therapy J44.9
Chronic obstructive pulmonary disease, unspecified
R06.00 Dyspnea, unspecified
Z99.89
Chronic obstructive pulmonary disease, unspecified
Dependence on other enabling machines and devices
R06.09 Other forms of dyspnea
R06.83 Snoring
R06.89 Other abnormalities of breathing
786.09 Airway control 492.8
298.9
Third party assistance/attendant required to apply, administer, or regulate or adjust oxygen en route.
J43.0
Unilateral pulmonary emphysema [MacLeod's syndrome]
J43.1
Panlobular emphysema
R06.89
J43.9
Does not apply to patient capable of self‐administration of portable or home O2. Patient must require oxygen therapy and be so frail as to require assistance.
Patient safety: Danger to self or others – in Refer to definition in 42 CFR restraints.
Section 482.13(e).
J43.2
Centrilobular emphysema
J43.8
Other emphysema
J43.9
Emphysema, unspecified
F28
Other psychotic disorder not due to a substance or known physiological condition
F29
Unspecified psychosis not due to a substance or known physiological condition
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Z99.81
F29
Z78.1
Other abnormalities of breathing
Emphysema, unspecified
Dependence on supplemental oxygen
Unspecified psychosis not due to a substance or known physiological condition
Physical restraint status
Prepared by PWW Media, Inc. ‐ October 2015
This is an educational tool only and does not constitute legal advice.
User bears all responsibility for use and for compliance with all applicable laws and regulations.
ICD‐9 Condition Code Examples
ICD‐10 Code Definition
abc QuikGuide
ICD‐10 Codes
CMS ICD‐9 Condition Code Definition
CMS ICD‐10 Condition Codes
CMS ICD‐9 Condition Code Consolidated CMS/PWW Ambulance Condition Code ICD Crosswalk
F05
293.1
Patient safety: Danger Behavioral or cognitive risk such to self or others – that patient requires monitoring monitoring.
for safety.
298.8
Behavioral or cognitive risk such that patient requires attendant to assure patient does not try to exit Patient safety: Danger the ambulance prematurely. Refer to 42 CFR Section 482.13(f) for to self or others – seclusion (flight risk). definition.
781.3
Patient safety: Risk of falling off wheelchair or stretcher while in motion (not related to obesity).
041.9
Special handling en route – isolation.
Patient’s physical condition is such that patient risks injury during vehicle movement despite restraints. Indirect indicators include MDS criteria.
Includes patients w/communicable diseases or hazardous material exposure who must be isolated from public or whose medical condition must be protected from public exposure; surgical drainage complications.
F05
F23
Delirium due to known physiological condition
Ataxia, unspecified
R27.8
Other lack of coordination
R27.9
Unspecified lack of coordination
A49.9
Bacterial infection, unspecified
Page 41 of 43
ICD‐10 Code Definition
Delirium due to known physiological condition
F91.8
Other conduct disorders
Z74.3
Need for continuous supervision
F23
Brief psychotic disorder
F69
Unspecified disorder of adult personality and behavior
Brief psychotic disorder
R27.0
Version 1.0
R27.9
R27.0
R27.8
Z91.81
Z74.01
Z74.09
Unspecified lack of coordination
Ataxia, unspecified
Other lack of coordination
History of falling
Bed confinement status
Other reduced mobility
B96.89
Other specified bacterial agents as the cause of diseases classified elsewhere
B99.9
Unspecified infectious disease
Z51.89
Encounter for other specified aftercare
Prepared by PWW Media, Inc. ‐ October 2015
This is an educational tool only and does not constitute legal advice.
User bears all responsibility for use and for compliance with all applicable laws and regulations.
ICD‐9 Condition Code Examples
ICD‐10 Code Definition
abc QuikGuide
ICD‐10 Codes
CMS ICD‐9 Condition Code Definition
CMS ICD‐10 Condition Codes
CMS ICD‐9 Condition Code Consolidated CMS/PWW Ambulance Condition Code ICD Crosswalk
Version 1.0
ICD‐10 Code Definition
S14.109S Unspecified injury at unspecified level of cervical spinal cord, sequela
52 codes from
S14.0XXS through S14.156S
Special handling en route to reduce pain – orthopedic device.
907.2
52 codes from
S14.157S through S34.139S
S24.109S Unspecified injury at unspecified level of thoracic spinal cord, sequela
S34.109S Unspecified injury to unspecified level of lumbar spinal cord, sequela
S34.139S Unspecified injury to sacral spinal cord, sequela
T84.84XA Pain due to internal orthopedic prosthetic devices, implants and grafts, initial encounter
M25.559 Pain in unspecified hip
Backboard, halotraction, use of Special handling en route to reduce pain – pins and traction etc. Pain may be present.
orthopedic device.
M24.50
719.45
Special handling en route – positioning or
requires specialized 719.49 handling.
Requires special handling to avoid further injury (such as with > grade 2 decubiti on buttocks). Generally does not apply to shorter transfers of < 1 hour. Positioning in wheelchair or standard car seat inappropriate due to contractures or recent extremity fractures – post‐op hip as an example.
M25.551 Pain in right hip
Contracture, unspecified joint
L89.109 Pressure ulcer of unspecified part of back, unspecified stage
L89.209 Pressure ulcer of unspecified hip, unspecified stage
L89.309 Pressure ulcer of unspecified buttock, unspecified stage
M25.552 Pain in left hip
L89.90
Pressure ulcer of unspecified site, unspecified stage
M25.50
Pain in unspecified joint
M25.559 Pain in unspecified hip
M25.50 Pain in unspecified joint
Page 42 of 43
Prepared by PWW Media, Inc. ‐ October 2015
This is an educational tool only and does not constitute legal advice.
User bears all responsibility for use and for compliance with all applicable laws and regulations.
NEW
Bed Confined
ICD‐9 Condition Code Examples
Patient is: (1) unable to get up from bed without assistance, (2) unable to ambulate, and (3) unable to sit in a chair or wheelchair. All three must be true for this condition to apply
ICD‐10 Code Definition
abc QuikGuide
ICD‐10 Codes
CMS ICD‐9 Condition Code Definition
CMS ICD‐10 Condition Codes
CMS ICD‐9 Condition Code Consolidated CMS/PWW Ambulance Condition Code ICD Crosswalk
Version 1.0
ICD‐10 Code Definition
Was not included on the original Condition Code list.
Therefore, CMS did not provide a crosswalk for this condition.
Z74.01
Page 43 of 43
Bed confinement status
Prepared by PWW Media, Inc. ‐ October 2015
This is an educational tool only and does not constitute legal advice.
User bears all responsibility for use and for compliance with all applicable laws and regulations.