PCP HRA-ADULT
Page 1 of 9
HEALTHCARE PARTNERS, IPA
Diagnoses Quick Reference Guide
NERVOUS SYSTEM
CVA/Stroke
Parkinson’s/Huntington’s
Disease
V12.54 Personal history of TIA Cerebral Infarction w/o residual deficits
438.11 CVA Late EF Aphasia
438.12 CVA Late EF Dysphasia
438.20 CVA Late EF Hemiplegia (unspec side)
438.30 CVA Late EF Monoplegia Upper Limb (unspec side)
438.40 CVA Late EF Monoplegia Lower Limb (unspec side)
438.50 Other Paralytic Syndrome (unspec side)
438.53 Other Paralytic Syndrome (bilateral)
332.0 Parkinson’s
332.1 Secondary Parkinsonism
333.0 Other Degenerative DZ Basal Ganglia
333 Huntington's Chorea
Peripheral Autonomic
Neuropathy
337.00 Idiopathic Peripheral Auto Neuropathy (unspec)
337.09 Other Idiopathic Periph Auto Neuropathy (unspec)
337.1 Peripheral Autonomic Neuropathy in disorders classified elsewhere
337.20 Reflex Sympathetic Dystrophy (unspec)
337.21 Reflex Sympathetic Dystrophy Upper Limb
337.22 Reflex Sympathetic Dystrophy Low Limb
337.29 Reflex Sympathetic Dystrophy Other Specified Site
337.3 Autonomic Dysreflexia
337.9 Unspec Disorder Autonomic Nervous system
Peripheral Neuropathy
356.0 Hereditary Peripheral Neuropathy
356.1 Peroneal Muscular Atrophy
356.2 Hereditary Sensory Neuropathy
356.3 Refsum's Disease
356.4 Idiopathic Progressive Polyneuropathy
356.8 Other Specified Idiopathic Peripheral Neuropathy
356.9 Other Unspecified Idiopathic Peripheral Neuropathy
Hemiplegia/Hemiparesis
342.00 Flaccid Hemiplegia Unspec Side
342.01 Flaccid Hemiplegia Dominant Side
342.02 Flaccid Hemiplegia Non-dominant Side
342.10 Spastic Hemiplegia Unspec Side
342.11 Spastic Hemiplegia Dominant Side
342.12 Spastic Hemiplegia Non-dominant Side
342.80 Other Spec Hemiplegia Affect Unspec Side
342.81 Other Spec Hemiplegia Affect Dominant Side
342.82 Other Spec Hemiplegia Affect Non-dominant Side
342.90 Unspec Hemiplegia Affect Unspec Side
342.91 Unspec Hemiplegia Affect Dominant Side
342.92 Unspec Hemiplegia Affect Non-dominant Side
Quadriplegia/Paraplegia
344.00 Unspecified Quadriplegia
344.01 Quadriplegia & Quadriparesis C1-C4 Complete
344.02 Quadriplegia & Quadriparesis C1-C4 Incomplete
344.03 Quadriplegia & Quadriparesis C5-C7 Complete
344.04 Quadriplegia & Quadriparesis C5-C7 Incomplete
344.09 Other Quadriplegia & Quadriparesis
344.1 Paraplegia
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PCP HRA-ADULT
Seizures/Epilepsy
PULMONARY
COPD
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345.00 Gen Nonconvuls Epilepsy w/o Intract Sz
345.01 Gen Nonconvuls Epilepsy w/ Intract Sz
345.10 Gen Convuls Epilepsy w/o Intract Sz
345.11 Gen Convuls Epilepsy w/ Intract Sz
345.2 Epileptic Petit Mal Status
345.3 Epileptic Grand Mal Status
345.90 Unspec Epilepsy w/o Intract Epilepsy
345.91 Unspec Epilepsy w/ Intract Epilepsy
496 COPD
Chronic Bronchitis /
Obstructive Bronchitis
491.0 Chronic Bronchitis (smoker's cough)
491.1 Mucopurulent Chronic Bronchitis
491.20 Obstructive Chronic Bronchitis w/o exacerbation
491.21 Obstructive Chronic Bronchitis w/acute exacerbation
491.8 Other Chronic Bronchitis
Emphysema
492.0 Emphysematous Bleb
492.8 Other Emphysema
518.1 Interstitial Emphysema
518.2 Compensatory Emphysema
Asthma
493.01 Extrinsic Asthma w/status asthmaticus
493.02 Extrinsic Asthma w/acute exacerbation
493.11 Intrinsic Asthma w/status asthmaticus
493.12 Intrinsic Asthma w/acute exacerbation
493.21 Chronic Obstructive Asthma w/status asthmaticus
493.22 Chronic Obstructive Asthma w/acute exacerbation
Chronic Respiratory Failure
518.83 Chronic Respiratory Failure
518.84 Acute & Chronic Respiratory Failure
CARDIOVASCULAR
Angina
413.9 Other & Unspec Angina Pectoris
413.0 Angina decubitus (nocturnal angina)
413.1 Prinzmetal Angina (variant angina)
Old Myocardial Infarction
412 Old Myocardial Infarction
Congestive Heart Failure
428.0 Congestive Heart Failure (unspecified)
428.1 Lt Heart Failure
428.20 Unspec Systolic Ht Failure
428.21 Acute Systolic Ht Failure
428.22 Chronic Systolic Ht Failure
428.23 Acute on Chronic Systolic Ht Failure
428.30 Unspec Diastolic Ht Failure
428.31 Acute Diastolic Ht Failure
428.32 Chronic Diastolic Ht Failure
428.33 Acute on Chronic Diastolic Ht Failure
428.40 Unspec Combined S&D Ht Failure
428.41 Acute Combined S&D Ht Failure
428.42 Chronic Combined S&D Ht Failure
428.43 Acute on Chronic Combined S&D Ht Failure
428.9 Heart Failure (unspecified)
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PCP HRA-ADULT
Arrhythmia/PSVT
Long Term Anticoagulation
Pulmonary HTN
Cardiomyopathy
Valvular Heart Disease
Atherosclerosis
Carotid Artery Disease
PVD
Hyperlipidemia
HTN
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427.0 Paroxysmal Supraventricular Tachycardia
427.1 Paroxysmal Ventricular Tachycardia
427.2 Paroxysmal Tachycardia (unspecified)
427.31 Atrial Fibrillation
427.32 Atrial Flutter
427.41 Ventricular Fibrillation
427.42 Ventricular Flutter
427.60 Premature Beats (unspecified)
427.61 Supraventricular Premature Beats
427.81 Sick Sinus Syndrome
427.9 Arrhythmia (unspecified)
V58.61 Long-Term (current) use of anticoagulants
V58.63 Long-term (current) use of antiplatelet/antithrombotic
V58.64 Long-term (current) use of nonsteroidal anti-inflammatories (NSAID)
416.0 Primary Pulmonary HTN
416.8 Other Pulmonary Dz (Secondary Pulmonary HTN)
416.9 Unspec Dz of Pulmonary Artery
425.0 Endomyocardial Fibrosis
425.11 Hypertrophic Obstructive Cardiomyopathy
425.18 Other Hypertrophic Cardiomyopathy
425.2 Obscure Cardiomyopathy of Africa (Becker's)
425.3 Endocardial Fibroelastosis
425.4 Other Primary Cardiomyopathies
425.5 Alcoholic Cardiomyopathy
425.7 Nutritional and Metabolic Cardiomyopathy
425.9 Secondary Cardiomyopathy
394.0 Rheumatic Mitral Valve Stenosis
394.1 Rheumatic Mitral Insufficiency (regurg)
394.9 Rheumatic Mitral Valve Disease (unspecified)
395.0 Rheumatic Aortic Stenosis
395.1 Rheumatic Aortic Insufficiency
395.9 Rheumatic Aortic Disease (unspecified)
397.0 Tricuspid Valve Disease
424.0 Mitral Valve Disorder
424.1 Aortic valve disorders
424.2 Tricuspid valve disorders, specified as non-rheumatic
424.3 Pulmonary Valve Disorder
440.0 Atherosclerosis of Aorta
440.1 Atherosclerosis of Renal Artery
440.20 Atherosclerosis of Native Arteries Extremities Unspec
440.21 Atherosclerosis of Native Arteries Extremities w/Intermittent Claudication
440.22 Atherosclerosis of Native Arteries Extremities w/Rest Pain
440.23 Atherosclerosis of Native Arteries Extremities w/Ulceration
440.24 Atherosclerosis of Native Arteries Extremities w/Gangrene
433.10 Occlusion and stenosis of carotid artery without mention of cerebral infarction
433.11 Occlusion and stenosis of carotid artery with cerebral infarction
443.9 Peripheral Vascular Disease (unspecified)
443.0 Raynaud's Syndrome
272.0 Pure Hypercholesterolemia
272.2 Mixed Hyperlipidemia
272.4 Other & Unspec Hyperlipidemia
401.0 Essential HTN (malignant)
401.1 Essential HTN (benign)
401.9 Essential HTN (unspecified)
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PCP HRA-ADULT
HTN w/Chronic Kidney Dz
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403.00 Malig HTN Chronic Kidney Dz Stage I-IV
403.01 Malig HTN Chronic Kidney Dz Stage V or ESRD
403.10 Benign HTN Chronic Kidney Dz Stage I-IV
403.11 Benign HTN Chronic Kidney Dz Stage V or ESRD
403.90 Unspec HTN Chronic Kidney Dz Stage I-IV
403.91 Unspec HTN Chronic Kidney Dz Stage V or ESRD
404.00 Malig HTN Heart w/CKD Stage I-IV or Unspec w/o HT Failure
404.01 Malig HTN Heart w/CKD Stage I-IV or Unspec w/HT Failure
404.02 Malig HTN Heart w/CKD Stage V or ESRD w/o HT Failure
404.03 Malig HTN Heart w/CKD Stage V or ESRD w/HT Failure
404.10 Benign HTN Heart w/CKD Stage I-IV or Unspec w/o HT Failure
404.11 Benign HTN Heart w/CKD Stage I-IV or Unspec w/HT Failure
404.12 Benign HTN Heart w/CKD Stage V or ESRD w/o HT Failure
404.13 Benign HTN Heart w/CKD Stage V or ESRD w/HT Failure
404.90 Unsp HTN Heart w/CKD Stage I-IV or Unspec w/o HT Failure
404.91 Unsp HTN Heart w/CKD Stage I-IV or Unspec w/HT Failure
404.92 Unsp HTN Heart w/CKD Stage V or ESRD w/o HT Failure
404.93 Unsp HTN Heart w/CKD Stage V or ESRD w/HT Fail
V45.11 Renal Dialysis Status
V45.12 Noncompliance with renal dialysis
Skin Ulcers, Lower Limbs
(except pressure ulcer)
707.10 Ulcer of lower limb, unspecified
707.11 Ulcer of Thigh
707.12 Ulcer of Calf
707.13 Ulcer of Ankle
717.14 Ulcer of Heel & Midfoot
717.15 Ulcer of Other Part of Foot
717.19 Ulcer of Other Part of Lower Limb
Pressure Ulcer
(Use additional code to
identify stage of pressure
ulcer)
707.01 Pressure Ulcer Elbow
707.02 Pressure Ulcer Upper Back
707.03 Pressure Ulcer Lower Back (coccyx/sacrum)
707.04 Pressure Ulcer Hip
707.05 Pressure Ulcer Buttock
707.06 Pressure Ulcer Ankle
707.07 Pressure Ulcer Heel
707.09 Pressure Ulcer Other Site
Stage of Pressure Ulcer
707.21 Stage I (non-blanching erythema)
707.22 Stage II (abrasion, blister, partial thick)
707.23 Stage III (full thickness, subq tissues)
707.24 Stage IV (through to muscle, tendon or bone)
707.25 Unstageable Pressure Ulcer
CHRONIC KIDNEY DISEASE
Chronic Kidney Disease/
Nephritis
585.1 Chronic Kidney Dz Stage I
585.2 Chronic Kidney Dz Stage II (mild)
585.3 Chronic Kidney Dz Stage III (moderate)
585.4 Chronic Kidney Dz Stage IV (severe)
585.5 Chronic Kidney Dz Stage V (kidney failure)
585.9 Chronic Kidney Dz (unspecified)
592.0 Calculus of Kidney
592.1 Calculus of Ureter
582.0 Glomerulonephritis Chronic w/lesion prolif
582.1 Glomerulonephritis Chronic w/lesion memb
582.4 Glomerulonephritis Chronic w/lesion rapid pg
582.89 Glomerulonephritis Chronic Other
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PCP HRA-ADULT
ESRD
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585.6 ESRD
V45.11 Renal Dialysis Status
ONCOLOGY
Primary Malignant Neoplasm
X = requires additional digit
V45.12 Noncompliance with renal dialysis
140.X-149.X Specify: Lip/Oral Cavity/Pharynx
150.X -159.X Specify: Digestive Organs/Peritoneum
160.X -165.X Specify: Resp/Intrathoracic Organs
170.X -172.X, 173.XX, 174.X-176.X Specify: Bone, Connective Tissue, Skin, Breast
179, 180.X -184.X, 185, 186.X-189.X Specify: Genitourinary Organs
190.X-192.X, 193, 194.X – 195X Specify: Other and Unspec Sites
(Eye, Brain, Nervous System, Endocrine, Head, Neck, Abd, Pelvis, Limbs)
200-208 Specify: Lymphatic & Hematopoietic Tissue
Secondary Malignant
Neoplasm
196.0-196.9 Specify: Secondary Lymph Nodes
197.0-197.8 Specify: Secondary Respiratory & Digestive
198.0 Secondary Kidney
198.1 Secondary Other Urinary Organ
198.2 Secondary Skin of Breast
198.3 Secondary Brain & Spinal Cord
198.4 Secondary Other Nervous System
198.5 Secondary Bone & Bone Marrow
198.6 Secondary Ovary
198.7 Secondary Adrenal Gland
198.81 Secondary Breast
198.82 Secondary Genital Organs
198.89 Secondary Other
Personal History of Malignant
Neoplasm
V10.0X Hx Gastrointestinal Tract
V10.11 Hx Bronchus & Lung
V10.12 Hx Trachea,
V10.2X Hx Other Respiratory & Intrathoracic Organs
V10.3 Hx Breast
V10.4X Hx Genital Organs
V10.5X Hx Urinary Organs
V10.6X Hx Leukemia
V10.7X Hx Other Lymphatic & Hematopoietic Neoplasms
V10.81 Hx Bone
V10.82 Hx Melanoma of Skin
V10.83 Hx Other Neoplasm of Skin
V10.84 Hx Eye
V10.85 Hx Brain
V10.86 Hx Parts of Nervous System
V10.87 Hx Thyroid
V10.88 Hx Endocrine Gland & Related Structures
V10.89 Hx Other
V10.90 Hx Unspec Malignant Neoplasm
V10.91 Hx Neuroendocrine Tumor
X = requires additional digit
Benign Neoplasm of Brain and
Nervous System
225.0 Benign Neoplasm of Brain
225.1 Benign Neoplasm Cranial Nerves
225.2 Benign Neoplasm Cerebral Meninges
225.3 Benign Neoplasm Spinal Cord
225.4 Benign Neoplasm of Spinal Meninges
225.8 Benign Neoplasm Nervous System, Other Spec Site Nervous Sys
225.9 Benign Neoplasm Nervous System, Unspec
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Copyright 2012
Revised 6-5-2015
PCP HRA-ADULT
TRANSPLANT
Organ/Stem Cell Transplant
GI/HEPATOLOGY
GERD/GI Ulcer
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V42.0 Kidney
V42.1 Heart
V42.6 Lung
V42.7 Liver
V42.81 Bone Marrow
V42.82 Periph Stem Cells
V42.83 Pancreas
V42.84 Organ/Tissue Intestine
V43.21 HRT Assist Device
V43.22 Implanted Artificial HRT
531.50 Chronic or Unsp Gastric Ulcer w/Perforation without Obstruction
531.51 Chronic or Unsp Gastric Ulcer w/Perforation w/Obstruction
532.50 Chronic or Unsp Duod Ulcer w/Perforation without Obstruction
532.51 Chronic or Unsp Duod Ulcer w/Perforation w/Obstruction
533.50 Chronic or Unsp Peptic Ulcer w/Perforation without Obstruction
533.51 Chronic or Unsp Peptic Ulcer w/Perforation w/Obstruction
Hepatitis/Cirrhosis
571.2 Cirrhosis, Alcoholic
571.3 Unspec Alcoholic Liver Damage
571.40 Chronic Hepatitis (unspecified)
571.41 Chronic Persistent Hepatitis
571.42 Autoimmune Hepatitis
571.5 Cirrhosis, Non-alcoholic
571.6 Biliary Cirrhosis
070.32 Chronic Viral Hepatitis B w/o Hepatic Coma (w/o Delta)
070.33 Chronic Viral Hepatitis B w/o Hepatic Coma (w/Delta)
070.54 Chronic Hepatitis C w/o Hepatic Coma
GI/IBD (UC; Crohn’s)
555.0 Regional Enteritis of Small Intestine (Ileitis/Crohn’s Dz)
555.1 Regional Enteritis of Large Intestine (Colitis/Regional Enteritis/Crohn’s Dz)
555.2 Regional Enteritis of Small Intestine w/Large Intestine (Regional Ileocolitis)
555.9 Regional Enteritis of unspecified site (Crohn’s Disease)
556.0 Ulcerative Enterocolitis (Chronic)
556.1 Ulcerative Ileocolitis (Chronic)
556.2 Ulcerative Proctitis (Chronic)
556.3 Ulcerative Proctosigmoiditis (Chronic)
556.4 Pseudopolyposis of Colon
556.9 Ulcerative Colitis Unspec (Inflammatory Bowel Disease)
579.0 Celiac Disease
579.9 Unspec Intestinal Malabsorption
Malnutrition
261 Nutritional Marasmus (Malnutrition Sever)
262 Other Sever, Protein-Calorie Malnutrition
(nutritional edema w/o dyspigmentation of skin & hair)
263.0 Malnutrition Moderate Degree
263.1 Malnutrition Mild Degree
263.8 Other Protein-Calorie Malnutrition
263.9 Unspec Protein-Calorie Malnutrition
799.4 Cachexia (advanced malnutrition w/wasting)
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PCP HRA-ADULT
DIABETES/ENDOCRINE
Diabetes
X = requires additional digit
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250.0X Diabetes Mellitus w/o Complication
250.4X Diabetes w/Renal Manifestations
250.5X Diabetes w/Ophthalmic Manifestation
250.6X Diabetes w/Neurologic Manifestation
250.7X Diabetes w/Peripheral Circulatory Disorder
250.8X Diabetes w/Other Spec Manifestation
Add Applicable 5th Digit:
0 Type II or unspecified type, not stated as uncontrolled
1 Type I (juvenile Type), not stated as uncontrolled
2 Type II or unspecified type, uncontrolled
3 Type I (juvenile Type) , uncontrolled
Diabetes w/Manifestations (complications) require TWO Diagnosis Codes
Renal Manifestaions
585.1 CKD Stage I
585.3 CKD Stage III (mod)
585.5 CKD Stage V (GRF <15)
585.9 CKD (unspecified)
583.1 Nephropathy
V45.11 Renal Dialysis Status
585.2 CKD Stage II (mild)
585.4 CKD Stage IV (severe)
585.6 ESRD w/Dialysis
Ophthalmic Manifestations
366.41 Diabetic Cataract
362.07 Macular Edema
379.23 Vitreous hemorrhage
365.44 Glaucoma
369.0 Profound Impair OU
369.1 Mod/Sever Impair OS/OD
369.2 Mod/Sever Impair OU
369.3 Unsp Visual Loss OU
362.01 Background diabetic retinopathy
362.02 Proliferative diabetic retinopathy
362.03 Nonproliferative diabetic retinopathy NOS
369.4 Legal Blindness
369.6 Profound Impairment One Eye
369.7 Mod/Severe Impair One Eye
369.8 Unsp V Loss One Eye
369.9 Unspec Visual Loss
Neurologic Manifestation
357.2 Polyneuropathy
354 Mononeurities Upper Limb
536.3 Gastroparalysis
713.5 Neurogenic Arthropathy
337.1 Periph Auto Neuropathy
355 Mononeuritis Lower Limb
353.5 Amyotrophy
Peripheral Circulatory
Disorder
785.4 Gangrene
443.81 Peripheral Angiopathy
581.1 Nephrosis
V45.12 Noncompliance with renal dialysis
Long-Term (current) Use of Insulin: V58.67
Thyroid Gland Disorder
X = requires additional digit
Acquired Hypothyroidism
240.9 Goiter (unspec)
242.9X Hyperthyroidism
Add Applicable 5th Digit:
0 without mention of thyrotoxic crisis or storm
1 with mention of thyrotoxic crisis or storm
244.0 Postsurgical Hypothyroidism
244.1 Other post-ablative hypothyroidism
244.9 Unspec Disorder of Thyroid
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Revised 6-5-2015
PCP HRA-ADULT
IMMUNODEFICIENCY
HIV/AIDS
Page 8 of 9
042 HIV (all manifestations)
V08 HIV (asymptomatic)
MENTAL, BEHAVIORAL & NEURODEVELOPMENTAL DISORDERS
Dependency
303.0X Acute Alcoholic Intoxication
303.9X
304.0X
304.1X
304.2X
304.3X
304.4X
304.5X
304.6X
304.7X
304.9X
Alcohol Dependence (chronic alcoholism)
Opioid Type Dependence
Sedative, Hypnotic or Anxiolytic Dependence
Cocaine Dependence
Cannabis Dependence
Amphetamine & Other Psychostimulant Dependence
Hallucinogen Dependence
Other Specified Drug Dependence
Combinations of Opioid Type Drug w/Any Other
Unspecified drug dependence
Add Applicable 5th Digit:
0 Unspecified
1 Continuous
2 Episodic
3 In Remission
Dementia
290.0 Senile Dementia (uncomplicated)
290.21 Senile Dementia w/Depression
290.20 Senile Dementia w/Psychosis
331.0 Alzheimer's Dz
Anxiety
300.00 Anxiety States (unspec)
300.01 Panic Disorder
300.02 Generalized Anxiety Disorder
Depression
296.0X Bipolar I disorder (single manic episode)
296.1X Manic disorder, (recurrent episode)
296.2X Major depressive disorder (single episode)
296.3X Major depressive disorder (recurrent episode)
Add Applicable 5th Digit:
0 Unspecified
1 Mild
2 Moderate
3 Severe, w/o mention of psychotic behavior
4 Severe, specified as w/psychotic behavior
5 In partial or unspecified remission
6 In full remission
296.80 Bipolar disorder, unspecified
296.90 Unspecified Episodic Mood Disorder
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PCP HRA-ADULT
Psychosis/Schizophrenia
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295.0X Schizophrenia Simple Type
295.1X Schizophrenia Disorganized Type
295.2X Schizophrenia Catatonic Type
295.3X Schizophrenia Paranoid Type
295.4X Schizophreniform Disorder
295.5X Latent Schizophrenia
295.6X Schizophrenia Residual Type
295.9X Unspecified Schizophrenia
Add Applicable 5th Digit:
0 Unspecified
1 Sub chronic
2 Chronic
3 Sub chronic w/Acute Exacerbation
4 Chronic w/Acute Exacerbation
5 In remission
OTHER
Osteoporosis
733.00 Osteoporosis Unspecified
733.01 Senile Osteoporosis
733.02 Idiopathic Osteoporosis
733.03 Disuse Osteoporosis
733.09 Other Osteoporosis (Drug-Induced)
Amputation(s)
V49.60 Upper Limb Amputation (unspecified)
V49.63 Hand Amputation
V49.65 Below Elbow Amputation
V49.66 Above Elbow Amputation
V49.70 Lower Limb Amputation (unspecified)
V49.71 Great Toe Amputation
V49.72 Other Toe(s) Amputation
V49.73 Foot Amputation
V49.74 Ankle (disarticulation of ankle)
V49.75 Below Knee Amputation
V49.76 Above Knee Amputation (disarticulation of knee)
*Diagnosis codes in blue indicate Risk Adjusted Diagnoses
HealthCare Partners, IPA 092812
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