Line Condition Treatment 1 PREGNANCY (See Guideline Notes 1,2,16,22,64,65,76) MATERNITY CARE 2 BIRTH OF INFANT (See Guideline Notes 64,65) NEWBORN CARE 3 PREVENTIVE SERVICES, BIRTH TO 10 YEARS OF AGE (See Coding Specification Below) (See Guideline Notes 16,64,65) (See Prevention Tables) MEDICAL THERAPY 4 PREVENTIVE SERVICES, OVER AGE OF 10 (See Guideline Notes 3,16,64,65,76) (See Prevention Tables) MEDICAL THERAPY 5 ABUSE OR DEPENDENCE OF PSYCHOACTIVE SUBSTANCE (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 6 TOBACCO DEPENDENCE (See Guideline Notes 1,4,64,65) MEDICAL THERAPY/BRIEF COUNSELING NOT TO EXCEED 10 FOLLOW-UP VISITS OVER 3 MONTHS 7 REPRODUCTIVE SERVICES (See Guideline Notes 64,65,68,76) CONTRACEPTION MANAGEMENT; STERILIZATION 8 OBESITY (See Guideline Notes 1,5,64,65,73) INTENSIVE NUTRITIONAL/PHYSICAL ACTIVITY COUNSELING AND BEHAVIORAL INTERVENTIONS 9 MAJOR DEPRESSION, RECURRENT (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 10 TYPE I DIABETES MELLITUS (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 11 ASTHMA (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 12 HYPERTENSION AND HYPERTENSIVE DISEASE (See Guideline Notes 1,6,64,65) MEDICAL THERAPY 13 GALACTOSEMIA (See Guideline Notes 1,64,65) MEDICAL THERAPY 14 OTHER RESPIRATORY CONDITIONS OF FETUS AND NEWBORN (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 15 HIV DISEASE (INCLUDING ACQUIRED IMMUNODEFICIENCY SYNDROME) AND RELATED OPPORTUNISTIC INFECTIONS (See Guideline Notes 1,64,65) MEDICAL THERAPY 16 CONGENITAL HYPOTHYROIDISM (See Guideline Notes 1,64,65) MEDICAL THERAPY 17 PHENYLKETONURIA (PKU) (See Guideline Notes 1,64,65) MEDICAL THERAPY 18 CONGENITAL INFECTIOUS DISEASES (See Guideline Notes 1,64,65) MEDICAL THERAPY 19 CONGENITAL SYPHILIS (See Guideline Notes 64,65) MEDICAL THERAPY 20 VERY LOW BIRTH WEIGHT (UNDER 1500 GRAMS) (See Guideline Notes 1,64,65) MEDICAL THERAPY 21 NEONATAL MYASTHENIA GRAVIS (See Guideline Notes 1,64,65) MEDICAL THERAPY 22 HYDROCEPHALUS AND BENIGN INTRACRANIAL HYPERTENSION (See Guideline Notes 1,76) MEDICAL AND SURGICAL TREATMENT 23 SYNDROME OF "INFANT OF A DIABETIC MOTHER" AND NEONATAL HYPOGLYCEMIA (See Guideline Notes 64,65) MEDICAL THERAPY 24 OMPHALITIS OF THE NEWBORN AND NEONATAL INFECTIVE MASTITIS (See Guideline Notes 64,65) MEDICAL THERAPY 25 LOW BIRTH WEIGHT (1500-2500 GRAMS) (See Guideline Notes 1,64,65) MEDICAL THERAPY 26 CYSTIC FIBROSIS (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 27 SCHIZOPHRENIC DISORDERS (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 28 CONVULSIONS AND OTHER CEREBRAL IRRITABILITY IN NEWBORN (See Guideline Notes 1,64,65) MEDICAL THERAPY 29 CEREBRAL DEPRESSION, COMA, AND OTHER ABNORMAL CEREBRAL SIGNS OF NEWBORN (See Guideline Notes 1,64,65) MEDICAL THERAPY 30 VESICOURETERAL REFLUX (See Guideline Notes 64,65,76) MEDICAL THERAPY, REIMPLANTATION 31 DYSPLASIA OF CERVIX AND CERVICAL CARCINOMA IN SITU, CERVICAL CONDYLOMA (See Guideline Notes 64,65,66,76) MEDICAL AND SURGICAL TREATMENT 32 BIPOLAR DISORDERS (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 33 TYPE II DIABETES MELLITUS (See Guideline Notes 1,7,8,64,65,76) MEDICAL THERAPY, BARIATRIC SURGERY WITH BMI ? 35 (See Coding Specification Below) 34 DRUG WITHDRAWAL SYNDROME IN NEWBORN (See Guideline Notes 1,64,65) MEDICAL THERAPY 35 REGIONAL ENTERITIS, IDIOPATHIC PROCTOCOLITIS, ULCERATION OF INTESTINE (See Guideline Notes 1,9,64,65,76) MEDICAL AND SURGICAL TREATMENT 36 EPILEPSY AND FEBRILE CONVULSIONS (See Guideline Notes 1,64,65) MEDICAL THERAPY 37 SEVERE BIRTH TRAUMA FOR BABY (See Guideline Notes 1,64,65) MEDICAL THERAPY 38 NEONATAL THYROTOXICOSIS (See Guideline Notes 64,65) MEDICAL THERAPY 39 HEMATOLOGICAL DISORDERS OF FETUS AND NEWBORN (See Guideline Notes 1,64,65) MEDICAL THERAPY 40 SPINA BIFIDA (See Guideline Notes 1,64,65,76) SURGICAL TREATMENT 41 TERMINATION OF PREGNANCY (See Guideline Notes 1,64,65,76) (Note: This line item is not priced as part of the list.) INDUCED ABORTION 42 ACQUIRED HYPOTHYROIDISM, DYSHORMONOGENIC GOITER (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 43 ECTOPIC PREGNANCY (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 44 PRIMARY, AND SECONDARY SYPHILIS (See Guideline Notes 64,65) MEDICAL THERAPY 45 DISORDERS RELATING TO LONG GESTATION AND HIGH BIRTHWEIGHT (See Guideline Notes 64,65) MEDICAL THERAPY 46 PANHYPOPITUITARISM, IATROGENIC AND OTHER PITUITARY DISORDERS (See Guideline Notes 1,64,65) MEDICAL THERAPY 47 HYPOCALCEMIA, HYPOMAGNESEMIA AND OTHER ENDOCRINE AND METABOLIC DISTURBANCES SPECIFIC TO THE FETUS AND NEWBORN (See Guideline Notes 1,64,65) MEDICAL THERAPY 48 INTUSSCEPTION, VOLVULUS, INTESTINAL OBSTRUCTION, AND FOREIGN BODY IN STOMACH, INTESTINES, COLON, AND RECTUM (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 49 CLEFT PALATE WITH AIRWAY OBSTRUCTION (See Guideline Notes 36,64,65,76) MEDICAL AND SURGICAL TREATMENT, ORTHODONTICS 50 COARCTATION OF THE AORTA (See Guideline Notes 1,6,76) SURGICAL TREATMENT 51 CORONARY ARTERY ANOMALY (See Guideline Notes 6,76) REIMPLANTATION OF CORONARY ARTERY 52 RHEUMATOID ARTHRITIS AND OTHER INFLAMMATORY POLYARTHROPATHIES (See Guideline Notes 1,6,64,65,76) MEDICAL THERAPY, INJECTIONS 53 CHRONIC RESPIRATORY DISEASE ARISING IN THE NEONATAL PERIOD (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 54 CONGENITAL HYDRONEPHROSIS (See Guideline Notes 64,65,76) NEPHRECTOMY/REPAIR 55 TUBERCULOSIS (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 56 GONOCOCCAL INFECTIONS AND OTHER SEXUALLY TRANSMITTED DISEASES (See Guideline Notes 1,64,65) MEDICAL THERAPY 57 ACUTE PELVIC INFLAMMATORY DISEASE (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 58 HYDATIDIFORM MOLE (See Guideline Notes 64,65,76) D & C, HYSTERECTOMY 59 DENTAL CONDITIONS (EG. INFECTIONS) (See Guideline Notes 10,64,65,76) URGENT AND EMERGENT DENTAL SERVICES 60 CHOLELITHIASIS, CHOLECYSTITIS, COMMON BILIARY DUCT STONE (See Guideline Notes 64,65 76) MEDICAL AND SURGICAL TREATMENT 61 ULCERS, GASTRITIS, DUODENITIS, AND GI HEMORRHAGE (See Guideline Notes 1,9,64,65,76) MEDICAL AND SURGICAL TREATMENT 62 FLAIL CHEST (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 63 BURN FULL THICKNESS GREATER THAN 10% OF BODY SURFACE (See Guideline Notes 1,6,64,65, 76) FREE SKIN GRAFT, MEDICAL THERAPY 64 BRONCHIECTASIS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 65 END STAGE RENAL DISEASE (See Guideline Notes 1,7,64,65,76) MEDICAL THERAPY INCLUDING DIALYSIS 66 METABOLIC DISORDERS INCLUDING HYPERLIPIDEMIA (See Guideline Notes 1,64,65) MEDICAL THERAPY 67 SUBSTANCE-INDUCED DELUSIONAL AND MOOD DISORDERS; INTOXICATION (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 68 SPONTANEOUS ABORTION COMPLICATED BY INFECTION AND/OR HEMORRHAGE, MISSED ABORTION (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 69 SUBSTANCE-INDUCED DELIRIUM (See Guideline Notes 64,65) MEDICAL THERAPY 70 CONGENITAL ANOMALIES OF UPPER ALIMENTARY TRACT, EXCLUDING TONGUE (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 71 CANCRUM ORIS (See Guideline Notes 64,65) MEDICAL THERAPY 72 DISSEMINATED INFECTIONS WITH LOCALIZED SITES (See Guideline Notes 64,65,76) MEDICAL THERAPY 73 VENTRICULAR SEPTAL DEFECT (See Guideline Notes 1,6,64,65,76) CLOSURE 74 ACUTE BACTERIAL MENINGITIS (See Guideline Notes 6,64,65,76) MEDICAL THERAPY 75 ACUTE AND SUBACUTE ISCHEMIC HEART DISEASE, MYOCARDIAL INFARCTION (See Guideline Notes 1,6,13,64,65,76) MEDICAL AND SURGICAL TREATMENT 76 CONGENITAL PULMONARY VALVE STENOSIS (See Guideline Notes 64,65,76) PULMONARY VALVE REPAIR 77 NEUROLOGICAL DYSFUNCTION IN BREATHING, EATING, SWALLOWING, BOWEL, OR BLADDER CONTROL CAUSED BY CHRONIC CONDITIONS (See Guideline Notes 6,64,65,76) MEDICAL AND SURGICAL TREATMENT (EG. G-TUBES, J-TUBES, RESPIRATORS, TRACHEOSTOMY, UROLOGICAL PROCEDURES) 78 AGRANULOCYTOSIS (See Guideline Notes 1,7,11,14,64,65,76) BONE MARROW TRANSPLANTATION 79 BURN, PARTIAL THICKNESS GREATER THAN 30% OF BODY SURFACE OR WITH VITAL SITE; FULL THICKNESS WITH VITAL SITE, LESS THAN 10% OF BODY SURFACE (See Guideline Notes 1,6,64,65,76) FREE SKIN GRAFT, MEDICAL THERAPY 80 POLYCYTHEMIA NEONATORUM, SYMPTOMATIC (See Guideline Notes 64,65) MEDICAL THERAPY 81 DERMATOMYOSITIS, POLYMYOSITIS (See Guideline Notes 1,64,65) MEDICAL THERAPY 82 ADDISON'S DISEASE (See Guideline Notes 64,65) MEDICAL THERAPY 83 DEEP ABSCESSES, INCLUDING APPENDICITIS AND PERIORBITAL ABSCESS (See Guideline Notes 1,36,64,65,76) MEDICAL AND SURGICAL TREATMENT 84 PATENT DUCTUS ARTERIOSUS; AORTIC PULMONARY FISTULA (See Guideline Notes 1,6,64,65,76) LIGATION 85 INJURY TO MAJOR BLOOD VESSELS OF EXTREMITIES (See Guideline Note 76) LIGATION/REPAIR 86 PHLEBITIS AND THROMBOPHLEBITIS, DEEP (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 87 INJURY TO INTERNAL ORGANS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 88 FRACTURE OF HIP, CLOSED (See Guideline Notes 6,15,64,65,76) MEDICAL AND SURGICAL TREATMENT 89 MYOCARDITIS (NONVIRAL), PERICARDITIS (NONVIRAL) AND ENDOCARDITIS (See Guideline Notes 6,64,65,76) MEDICAL AND SURGICAL TREATMENT 90 DEEP OPEN WOUND OF NECK, INCLUDING LARYNX; FRACTURE OF LARYNX OR TRACHEA, OPEN (See Guideline Notes 64,65,76) REPAIR 91 DIABETES MELLITUS WITH END STAGE RENAL DISEASE (See Coding Specification Below) (See Guideline Notes 1,76) SIMULTANEOUS PANCREAS/KIDNEY (SPK) TRANSPLANT, PANCREAS AFTER KIDNEY (PAK) TRANSPLANT 92 DISORDERS OF PANCREATIC ENDOCRINE SECRETION (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 93 ENDOCARDIAL CUSHION DEFECTS (See Guideline Notes 1,6,64,65,76) REPAIR 94 CONGENITAL PULMONARY VALVE ATRESIA (See Guideline Notes 6,64,65,76) SHUNT/REPAIR 95 CONGENITAL ANOMALIES OF URINARY SYSTEM (See Guideline Notes 1,64,65,76) RECONSTRUCTION 96 NECROTIZING ENTEROCOLITIS IN FETUS OR NEWBORN (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 97 TRANSPOSITION OF GREAT VESSELS (See Guideline Notes 1,6,64,65,76) REPAIR 98 CONGENITAL MITRAL VALVE STENOSIS/INSUFFICIENCY (See Guideline Notes 6,64,65,76) MITRAL VALVE REPAIR/REPLACEMENT 99 GUILLAIN-BARRE SYNDROME (See Guideline Notes 1,6,64,65,76) MEDICAL THERAPY 100 SEVERE/MODERATE HEAD INJURY: HEMATOMA/EDEMA WITH LOSS OF CONSCIOU0SNESS, COMPOUND/DEPRESSED FRACTURES OF SKULL (See Guideline Notes 1,6,64,65,76) MEDICAL AND SURGICAL TREATMENT 101 ACUTE LYMPHOCYTIC LEUKEMIA (CHILD) (See Guideline Notes 1,7,11,12,64,65,76) MEDICAL THERAPY, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 102 ACUTE LEUKEMIAS, MYELODYSPLASTIC SYNDROME (See Guideline Notes 1,7,11,12,14,76) BONE MARROW TRANSPLANT 103 UNDESCENDED TESTICLE (See Guideline Note 76) SURGICAL TREATMENT 104 PREVENTIVE DENTAL SERVICES (See Guideline Notes 17,64,65) CLEANING AND FLUORIDE 105 HEREDITARY IMMUNE DEFICIENCIES (See Guideline Notes 1,7,11,14,76) BONE MARROW TRANSPLANT 106 DIABETIC AND OTHER RETINOPATHY (See Guideline Notes 64,65,76) LASER SURGERY 107 BORDERLINE PERSONALITY DISORDER (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 108 HEART FAILURE (See Guideline Notes 1,6,18,64,65,76) MEDICAL THERAPY 109 CARDIOMYOPATHY, HYPERTROPHIC MUSCLE (See Guideline Notes 1,6,64,65,76) MEDICAL AND SURGICAL TREATMENT 110 END STAGE RENAL DISEASE (See Guideline Notes 1,76) RENAL TRANSPLANT 111 CONGENITAL ANOMALIES OF DIGESTIVE SYSTEM AND ABDOMINAL WALL EXCLUDING NECROSIS; CHRONIC INTESTINAL PSEUDO-OBSTRUCTION (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 112 HEMOLYTIC DISEASE DUE TO ISOIMMUNIZATION, ANEMIA DUE TO TRANSPLACENTAL HEMORRHAGE, AND FETAL AND NEONATAL JAUNDICE (See Guideline Notes 64,65) MEDICAL THERAPY 113 POISONING BY INGESTION, INJECTION, AND NON-MEDICINAL AGENTS (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 114 BOTULISM (See Guideline Notes 64,65) MEDICAL THERAPY 115 TETRALOGY OF FALLOT (TOF) (See Guideline Notes 1,6,64,65,76) TOTAL REPAIR TETRALOGY 116 CONGENITAL STENOSIS AND INSUFFICIENCY OF AORTIC VALVE (See Guideline Notes 6,64,65, 76) SURGICAL VALVE REPLACEMENT/VALVULOPLASTY 117 GIANT CELL ARTERITIS, KAWASAKI DISEASE, THROMBOANGIITIS OBLITERANS (See Guideline Notes 64,65) MEDICAL THERAPY 118 FRACTURE OF RIBS AND STERNUM, OPEN (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 119 SUBACUTE MENINGITIS (EG. TUBERCULOSIS, CRYPTOCOCCOSIS) (See Guideline Notes 1,64,65) MEDICAL THERAPY 120 PNEUMOCYSTIS CARINII PNEUMONIA (See Guideline Notes 64,65) MEDICAL THERAPY 121 COAGULATION DEFECTS (See Guideline Notes 64,65) MEDICAL THERAPY 122 CONGENITAL HEART BLOCK; OTHER OBSTRUCTIVE ANOMALIES OF HEART (See Guideline Notes 1,6,64,65,76) MEDICAL THERAPY 123 CANCER OF TESTIS (See Guideline Notes 1,7,11,12,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 124 CANCER OF EYE AND ORBIT (See Guideline Notes 1,7,11,12,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES RADIATION THERAPY 125 HODGKIN'S DISEASE (See Guideline Notes 7,11,12,14,19,76) BONE MARROW TRANSPLANT 126 FOREIGN BODY IN PHARYNX, LARYNX, TRACHEA, BRONCHUS AND ESOPHAGUS (See Guideline Notes 64,65,76) REMOVAL OF FOREIGN BODY 127 IRON DEFICIENCY ANEMIA AND OTHER NUTRITIONAL DEFICIENCIES (See Guideline Notes 64,65) MEDICAL THERAPY 128 PERNICIOUS AND SIDEROBLASTIC ANEMIA (See Guideline Notes 1,64,65) MEDICAL THERAPY 129 ATRIAL SEPTAL DEFECT, SECUNDUM (See Guideline Notes 6,64,65,76) REPAIR SEPTAL DEFECT 130 AMEBIASIS (See Guideline Notes 64,65,76) MEDICAL THERAPY 131 OTHER SPECIFIED APLASTIC ANEMIAS (See Guideline Notes 7,11,14,76) BONE MARROW TRANSPLANT 132 PHYSICAL AND SEXUAL ABUSE INCLUDING RAPE (See Guideline Notes 64,65,76) MEDICAL THERAPY 133 ATTENTION DEFICIT DISORDERS WITH HYPERACTIVITY OR UNDIFFERENTIATED (See Guideline Notes 20,64,65) MEDICAL/PSYCHOTHERAPY 134 PYODERMA; MODERATE/SEVERE PSORIASIS (See Guideline Notes 1,21,64,65) MEDICAL THERAPY 135 MALARIA AND RELAPSING FEVER (See Guideline Notes 1,64,65) MEDICAL THERAPY 136 THYROTOXICOSIS WITH OR WITHOUT GOITER, ENDOCRINE EXOPHTHALMOS; CHRONIC THYROIDITIS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT, INCLUDING RADIATION THERAPY 137 BENIGN NEOPLASM OF THE BRAIN (See Guideline Notes 1,64,65,76) CRANIOTOMY/CRANIECTOMY, LINEAR ACCELERATOR, MEDICAL THERAPY, WHICH INCLUDES RADIATION THERAPY 138 ACUTE GLOMERULONEPHRITIS: WITH LESION OF RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS (See Guideline Notes 1,7,64,65,76) MEDICAL THERAPY INCLUDING DIALYSIS 139 COMMON TRUNCUS (See Guideline Notes 6,64,65,76) TOTAL REPAIR/REPLANT ARTERY 140 WEGENER'S GRANULOMATOSIS (See Guideline Notes 1,64,65) MEDICAL THERAPY AND RADIATION THERAPY 141 TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION (See Guideline Notes 1,6,64,65,76) COMPLETE REPAIR 142 CRUSH INJURIES OTHER THAN DIGITS; COMPARTMENT SYNDROME (See Guideline Notes 6,64,65, 76) MEDICAL AND SURGICAL TREATMENT 143 OPEN FRACTURE/DISLOCATION OF EXTREMITIES (See Guideline Notes 6,64,65,76) MEDICAL AND SURGICAL TREATMENT 144 CANCER OF CERVIX (See Guideline Notes 1,7,11,12,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 145 INTERRUPTED AORTIC ARCH (See Guideline Notes 6,64,65,76) TRANSVERSE ARCH GRAFT 146 TRAUMATIC AMPUTATION OF LEG(S) (COMPLETE)(PARTIAL) WITH AND WITHOUT COMPLICATION (See Guideline Notes 1,6,64,65,76) MEDICAL AND SURGICAL TREATMENT 147 OPPORTUNISTIC INFECTIONS IN IMMUNOCOMPROMISED HOSTS; CANDIDIASIS OF STOMA; PERSONS RECEIVING CONTINUOUS ANTIBIOTIC THERAPY (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 148 EBSTEIN'S ANOMALY (See Guideline Notes 64,65,76) REPAIR SEPTAL DEFECT/VALVULOPLASTY/REPLACEMENT 149 GLAUCOMA, OTHER THAN PRIMARY ANGLE-CLOSURE (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 150 MYASTHENIA GRAVIS (See Guideline Notes 1,64,65,76) MEDICAL THERAPY, THYMECTOMY 151 SYSTEMIC LUPUS ERYTHEMATOSUS, OTHER DIFFUSE DISEASES OF CONNECTIVE TISSUE (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 152 CONDITIONS INVOLVING THE TEMPERATURE REGULATION OF NEWBORNS (See Guideline Notes 64,65) MEDICAL THERAPY 153 PNEUMOTHORAX AND HEMOTHORAX (See Guideline Notes 64,65,76) TUBE THORACOSTOMY/THORACOTOMY, MEDICAL THERAPY 154 HYPOTHERMIA (See Guideline Notes 64,65,76) MEDICAL THERAPY, EXTRACORPOREAL CIRCULATION 155 ANEMIA OF PREMATURITY OR TRANSIENT NEONATAL NEUTROPENIA (See Guideline Notes 64,65) MEDICAL THERAPY 156 ENTERIC INFECTIONS AND OTHER BACTERIAL FOOD POISONING (See Guideline Notes 64,65) MEDICAL THERAPY 157 ACQUIRED HEMOLYTIC ANEMIAS (See Guideline Notes 64,65) MEDICAL THERAPY 158 CERVICAL VERTEBRAL DISLOCATIONS/FRACTURES, OPEN OR CLOSED; OTHER VERTEBRAL DISLOCATIONS/FRACTURES, OPEN; SPINAL CORD INJURIES WITH OR WITHOUT EVIDENCE OF VERTEBRAL INJURY (See Guideline Notes 1,6,64,65,76) MEDICAL AND SURGICAL TREATMENT 159 CHORIOCARCINOMA (See Guideline Notes 1,7,11,12,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 160 DISORDERS OF MINERAL METABOLISM, OTHER THAN CALCIUM (See Guideline Notes 64,65) MEDICAL THERAPY 161 PYOGENIC ARTHRITIS (See Guideline Notes 6,64,65,76) MEDICAL AND SURGICAL TREATMENT 162 BENIGN NEOPLASM OF PITUITARY GLAND (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES RADIATION THERAPY 163 ACUTE VASCULAR INSUFFICIENCY OF INTESTINE (See Guideline Notes 64,65,76) SURGICAL TREATMENT 164 HERPES ZOSTER; HERPES SIMPLEX AND WITH NEUROLOGICAL AND OPHTHALMOLOGICAL COMPLICATIONS (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 165 TRAUMATIC AMPUTATION OF ARM(S), HAND(S), THUMB(S), AND FINGER(S) (COMPLETE)(PARTIAL) WITH AND WITHOUT COMPLICATION (See Guideline Notes 1,6,64,65,76) MEDICAL AND SURGICAL TREATMENT 166 HODGKIN'S DISEASE (See Guideline Notes 1,7,11,12,14,19,64,65,76) MEDICAL THERAPY, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 167 CANCER OF COLON, RECTUM, SMALL INTESTINE AND ANUS (See Guideline Notes 1,7,11,12,19, 23,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 168 CHRONIC GRANULOMATOUS DISEASE (See Guideline Notes 1,7,11,64,65) MEDICAL THERAPY 169 BILIARY ATRESIA (See Guideline Notes 1,76) LIVER TRANSPLANT 170 NON-HODGKIN'S LYMPHOMAS (See Guideline Notes 7,11,12,14,19,76) BONE MARROW TRANSPLANT 171 LEUKOPLAKIA AND CARCINOMA IN SITU OF ORAL MUCOSA, INCLUDING TONGUE (See Guideline Notes 64,65,76) INCISION/EXCISION, MEDICAL THERAPY 172 PREVENTIVE FOOT CARE IN HIGH RISK PATIENTS (See Guideline Note 76) MEDICAL AND SURGICAL TREATMENT OF TOENAILS AND HYPERKERATOSES OF FOOT 173 ANAL, RECTAL AND COLONIC POLYPS (See Guideline Note 1,76) EXCISION OF POLYP 174 GONOCOCCAL AND CHLAMYDIAL INFECTIONS OF THE EYE (See Guideline Notes 64,65) MEDICAL THERAPY 175 COMPLICATED HERNIAS (OTHER THAN DIAPHRAGMATIC HERNIA); UNCOMPLICATED INGUINAL HERNIA IN CHILDREN AGE 18 AND UNDER; PERSISTENT HYDROCELE (See Guideline Notes 24,63,64,65, 76) REPAIR 176 NON-DIABETIC HYPOGLYCEMIC COMA (See Guideline Notes 64,65,76) MEDICAL THERAPY 177 RUPTURED SPLEEN (See Guideline Note 76) REPAIR/SPLENECTOMY/INCISION 178 ACUTE MASTOIDITIS (See Guideline Notes 64,65,76) MASTOIDECTOMY, MEDICAL THERAPY 179 HYPERTENSIVE HEART AND RENAL DISEASE (See Guideline Notes 1,6,64,65) MEDICAL THERAPY 180 POSTTRAUMATIC STRESS DISORDER (See Guideline Notes 25,64,65) MEDICAL/PSYCHOTHERAPY 181 ACUTE NON-LYMPHOCYTIC LEUKEMIAS (See Guideline Notes 1,7,11,12,64,65,76) MEDICAL THERAPY, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 182 GENERALIZED CONVULSIVE OR PARTIAL EPILEPSY WITHOUT MENTION OF IMPAIRMENT OF CONSCIOUSNESS (See Guideline Notes 1,19,76) SINGLE FOCAL SURGERY 183 POLYARTERITIS NODOSA AND ALLIED CONDITIONS (See Guideline Notes 1,64,65) MEDICAL THERAPY 184 COMMON VENTRICLE (See Guideline Notes 6,64,65,76) TOTAL REPAIR 185 INTRACEREBRAL HEMORRHAGE (See Guideline Notes 1,6,64,65) MEDICAL THERAPY 186 URETERAL STRICTURE OR OBSTRUCTION; HYDRONEPHROSIS; HYDROURETER (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 187 CONDITIONS INVOLVING EXPOSURE TO NATURAL ELEMENTS (EG. LIGHTNING STRIKE, HEATSTROKE) (See Guideline Notes 64,65,76) MEDICAL THERAPY, BURN TREATMENT 188 SEPTICEMIA (See Guideline Notes 64,65,76) MEDICAL THERAPY 189 FRACTURE OF PELVIS, OPEN AND CLOSED (See Guideline Notes 6,64,65,76) MEDICAL AND SURGICAL TREATMENT 190 ACUTE OSTEOMYELITIS (See Guideline Notes 1,6,64,65,76) MEDICAL AND SURGICAL TREATMENT 191 DIVERTICULITIS OF COLON (See Guideline Notes 1,64,65,76) COLON RESECTION, MEDICAL THERAPY 192 MULTIPLE VALVULAR DISEASE (See Guideline Notes 6,64,65,76) SURGICAL TREATMENT 193 CUSHING'S SYNDROME; HYPERALDOSTERONISM, OTHER CORTICOADRENAL OVERACTIVITY, MEDULLOADRENAL HYPERFUNCTION (See Guideline Notes 1,64,65,76) MEDICAL THERAPY/ADRENALECTOMY 194 CONGENITAL TRICUSPID ATRESIA AND STENOSIS (See Guideline Notes 6,64,65,76) REPAIR 195 CHRONIC ISCHEMIC HEART DISEASE (See Guideline Notes 1,6,13,64,65,76) MEDICAL AND SURGICAL TREATMENT 196 NEOPLASMS OF ISLETS OF LANGERHANS (See Guideline Note 1,76) EXCISION OF TUMOR 197 CANCER OF BREAST (See Guideline Notes 1,3,7,11,12,26,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY, RADIATION THERAPY AND BREAST RECONSTRUCTION 198 MULTIPLE MYELOMA (See Guideline Notes 7,11,12,14,76) BONE MARROW TRANSPLANT 199 HEREDITARY ANEMIAS, HEMOGLOBINOPATHIES, AND DISORDERS OF THE SPLEEN (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 200 ACUTE PANCREATITIS (See Guideline Notes 64,65,76) MEDICAL THERAPY 201 SUBARACHNOID AND INTRACEREBRAL HEMORRHAGE/HEMATOMA; COMPRESSION OF BRAIN (See Guideline Notes 1,6,64,65,76) BURR HOLES, CRANIECTOMY/CRANIOTOMY 202 BURN, PARTIAL THICKNESS WITHOUT VITAL SITE, 10-30% OF BODY SURFACE (See Guideline Notes 1,6,64,65,76) FREE SKIN GRAFT, MEDICAL THERAPY 203 TETANUS NEONATORUM (See Guideline Notes 64,65) MEDICAL THERAPY 204 CONGENITAL CYSTIC LUNG - MILD AND MODERATE (See Guideline Notes 64,65,76) LUNG RESECTION, MEDICAL THERAPY 205 CHRONIC HEPATITIS; VIRAL HEPATITIS (See Guideline Notes 1,64,65) MEDICAL THERAPY 206 CONSTITUTIONAL APLASTIC ANEMIAS (See Guideline Notes 7,11,14,76) BONE MARROW TRANSPLANT 207 CANCER OF SOFT TISSUE (See Guideline Notes 1,7,11,12,19,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 208 CANCER OF BONES (See Guideline Notes 1,6,7,11,12,19,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 209 CHRONIC ORGANIC MENTAL DISORDERS INCLUDING DEMENTIAS (See Guideline Notes 1,64,65) CONSULTATION/MEDICATION MANAGEMENT/LIMITED BEHAVIORAL MODIFICATION 210 AUTISM SPECTRUM DISORDERS (See Guideline Notes 1,64,65,75) CONSULTATION/MEDICATION MANAGEMENT/LIMITED BEHAVIORAL MODIFICATION 211 SLEEP APNEA (See Guideline Notes 1,27,36,64,65,73,76) MEDICAL AND SURGICAL TREATMENT 212 ERYSIPELAS (See Guideline Notes 64,65) MEDICAL THERAPY 213 DEPRESSION AND OTHER MOOD DISORDERS, MILD OR MODERATE (See Guideline Notes 28,64,65) MEDICAL/PSYCHOTHERAPY 214 PNEUMOCOCCAL PNEUMONIA, OTHER BACTERIAL PNEUMONIA, BRONCHOPNEUMONIA (See Guideline Notes 64,65,76) MEDICAL THERAPY 215 SUPERFICIAL ABSCESSES AND CELLULITIS (See Coding Specification Below) (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 216 ZOONOTIC BACTERIAL DISEASES (See Guideline Notes 64,65) MEDICAL THERAPY 217 DEEP OPEN WOUND, WITH OR WITHOUT TENDON OR NERVE INVOLVEMENT (See Guideline Notes 6,64,65,76) MEDICAL AND SURGICAL TREATMENT 218 CHOANAL ATRESIA (See Guideline Notes 64,65,76) REPAIR OF CHOANAL ATRESIA 219 CANCER OF UTERUS (See Guideline Notes 1,7,11,12,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 220 RUPTURE OF LIVER (See Guideline Notes 64,65,76) SUTURE/REPAIR 221 CANCER OF THYROID (See Guideline Notes 1,7,11,12,19,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 222 NON-HODGKIN'S LYMPHOMAS (See Guideline Notes 1,7,11,12,19,29,64,65,76) MEDICAL THERAPY, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 223 PATHOLOGICAL GAMBLING (Note: This line is not priced as part of the list as funding comes from non-OHP sources.) (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 224 BULLOUS DERMATOSES OF THE SKIN (See Guideline Notes 64,65,76) MEDICAL THERAPY 225 ESOPHAGEAL VARICES (See Guideline Notes 1,64,65,76,77) MEDICAL THERAPY/SHUNT/SCLEROTHERAPY 226 TOXIC EPIDERMAL NECROLYSIS AND STAPHYLOCOCCAL SCALDED SKIN SYNDROME; STEVENS-JOHNSON SYNDROME; ERYTHEMA MULTIFORME MAJOR; ECZEMA HERPETICUM (See Guideline Notes 64,65,76) MEDICAL THERAPY 227 ACUTE PULMONARY HEART DISEASE AND PULMONARY EMBOLI (See Guideline Notes 6,64,65,76) MEDICAL AND SURGICAL TREATMENT 228 CANDIDIASIS OF LUNG, DISSEMINATED CANDIDIASIS, CANDIDAL ENDOCARDITIS AND MENINGITIS (See Guideline Notes 1,64,65) MEDICAL THERAPY 229 CANCER OF KIDNEY AND OTHER URINARY ORGANS (See Guideline Notes 1,7,11,12,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 230 CANCER OF STOMACH (See Guideline Notes 1,7,11,12,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 231 PORTAL VEIN THROMBOSIS (See Guideline Notes 64,65,76,77) MEDICAL AND SURGICAL TREATMENT 232 TESTICULAR CANCER (See Guideline Notes 7,11,12,14,30,76) BONE MARROW RESCUE AND TRANSPLANT 233 PULMONARY FIBROSIS (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 234 OCCUPATIONAL LUNG DISEASES (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 235 ANAPHYLACTIC SHOCK; EDEMA OF LARYNX (See Guideline Notes 64,65) MEDICAL THERAPY 236 DISORDERS OF FLUID, ELECTROLYTE, AND ACID-BASE BALANCE (See Guideline Notes 1,7,64, 76,65) MEDICAL THERAPY, DIALYSIS 237 DISEASES AND DISORDERS OF AORTIC VALVE (See Guideline Notes 1,6,64,65,76) AORTIC VALVE REPLACEMENT, VALVULOPLASTY, MEDICAL THERAPY 238 DISORDERS OF PARATHYROID GLAND; BENIGN NEOPLASM OF PARATHYROID GLAND; DISORDERS OF CALCIUM METABOLISM (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 239 ACUTE INFLAMMATION OF THE HEART DUE TO RHEUMATIC FEVER (See Guideline Notes 6,64,65) MEDICAL THERAPY 240 RUPTURED VISCUS (See Guideline Notes 64,65,76) REPAIR 241 INTESTINAL MALABSORPTION (See Guideline Notes 64,65,69) MEDICAL THERAPY 242 FRACTURE OF FACE BONES; INJURY TO OPTIC AND OTHER CRANIAL NERVES (See Guideline Notes 64,65,76) SURGICAL TREATMENT 243 MALIGNANT MELANOMA OF SKIN (See Guideline Notes 7,11,12,19,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 244 LEPTOSPIROSIS (See Guideline Notes 1,64,65) MEDICAL THERAPY 245 URINARY FISTULA (See Guideline Notes 64,65,76) SURGICAL TREATMENT 246 UNSPECIFIED DISEASES DUE TO MYCOBACTERIA, ACTINOMYCOTIC INFECTIONS, AND TOXOPLASMOSIS (See Guideline Notes 1,64,65) MEDICAL THERAPY 247 HYPOPLASTIC LEFT HEART SYNDROME (See Guideline Note 76) REPAIR 248 ADULT RESPIRATORY DISTRESS SYNDROME; ACUTE RESPIRATORY FAILURE; RESPIRATORY CONDITIONS DUE TO PHYSICAL AND CHEMICAL AGENTS (See Guideline Notes 64,65,76) MEDICAL THERAPY 249 ACUTE LYMPHOCYTIC LEUKEMIAS (ADULT) AND MULTIPLE MYELOMA (See Guideline Notes 1,7, 11,12,64,65,76) MEDICAL THERAPY, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 250 PERIPHERAL VASCULAR DISEASE, LIMB THREATENING INFECTIONS, AND VASCULAR COMPLICATIONS (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 251 TETANUS (See Guideline Notes 64,65) MEDICAL THERAPY 252 CANCER OF OVARY (See Guideline Notes 1,7,11,12,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 253 SHORT BOWEL SYNDROME - AGE 5 OR UNDER (See Guideline Notes 1,76) INTESTINE AND INTESTINE/LIVER TRANSPLANT 254 DEFICIENCIES OF CIRCULATING ENZYMES (ALPHA 1-ANTITRYPSIN DEFICIENCY); CYSTIC FIBROSIS; EMPHYSEMA (See Guideline Notes 1,76) HEART-LUNG AND LUNG TRANSPLANT 255 ACUTE AND SUBACUTE NECROSIS OF LIVER; SPECIFIED INBORN ERRORS OF METABOLISM (EG. MAPLE SYRUP URINE DISEASE, TYROSINEMIA) (See Guideline Notes 1,76) LIVER TRANSPLANT 256 RESPIRATORY FAILURE DUE TO PRIMARY PULMONARY HYPERTENSION, PRIMARY PULMONARY FIBROSIS, LYMPHANGIOLEIOMYOMATOSIS, EISENMENGERĘS DISEASE (See Guideline Notes 1,64, 65,76) HEART-LUNG AND LUNG TRANSPLANTS 257 DERMATOLOGICAL PREMALIGNANT LESIONS AND CARCINOMA IN SITU (See Guideline Notes 64, 65,76) DESTRUCT/EXCISION/MEDICAL THERAPY 258 PRIMARY ANGLE-CLOSURE GLAUCOMA (See Guideline Notes 64,65,76) IRIDECTOMY, LASER SURGERY 259 CORNEAL ULCER; SUPERFICIAL INJURY OF EYE AND ADNEXA (See Guideline Notes 64,65,76) CONJUNCTIVAL FLAP; MEDICAL THERAPY 260 TORSION OF OVARY (See Guideline Notes 64,65,76) OOPHORECTOMY, OVARIAN CYSTECTOMY 261 TORSION OF TESTIS (See Guideline Notes 64,65,76) ORCHIECTOMY, REPAIR 262 LIFE-THREATENING EPISTAXIS (See Guideline Notes 64,65,76) SEPTOPLASTY/REPAIR/CONTROL HEMORRHAGE 263 RETAINED INTRAOCULAR FOREIGN BODY, MAGNETIC AND NONMAGNETIC (See Guideline Notes 64,65,76) FOREIGN BODY REMOVAL 264 GLYCOGENOSIS (See Guideline Notes 64,65) MEDICAL THERAPY 265 METABOLIC BONE DISEASE (See Guideline Notes 1,64,65) MEDICAL THERAPY 266 PARKINSONĘS DISEASE (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 267 CHRONIC PANCREATITIS (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 268 MULTIPLE SCLEROSIS AND OTHER DEMYELINATING DISEASES OF CENTRAL NERVOUS SYSTEM (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 269 PSYCHOLOGICAL FACTORS AGGRAVATING PHYSICAL CONDITION (EG. ASTHMA, CHRONIC GI CONDITIONS, HYPERTENSION) (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 270 ARTERIAL EMBOLISM/THROMBOSIS: ABDOMINAL AORTA, THORACIC AORTA (See Guideline Note 6, 76) SURGICAL TREATMENT 271 CHRONIC OSTEOMYELITIS (See Guideline Notes 1,6,64,65,76) MEDICAL AND SURGICAL TREATMENT 272 MULTIPLE ENDOCRINE NEOPLASIA (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 273 DEFORMITIES OF HEAD (See Guideline Notes 1,6,64,65,76) CRANIOTOMY/CRANIECTOMY 274 DISEASES OF MITRAL AND TRICUSPID VALVES (See Guideline Notes 1,6,64,65,76) VALVULOPLASTY, VALVE REPLACEMENT, MEDICAL THERAPY 275 CANCER OF PENIS AND OTHER MALE GENITAL ORGANS (See Guideline Notes 1,7,11,12,64,65, 76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 276 CANCER OF ENDOCRINE SYSTEM, EXCLUDING THYROID; CARCINOID SYNDROME (See Guideline Notes 1,7,11,12,19,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 277 CANCER OF RETROPERITONEUM, PERITONEUM, OMENTUM AND MESENTERY (See Guideline Notes 1, 7,11,12,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 278 CANCER OF LUNG, BRONCHUS, PLEURA, TRACHEA, MEDIASTINUM AND OTHER RESPIRATORY ORGANS (See Guideline Notes 1,7,11,12,19,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 279 CONGESTIVE HEART FAILURE, CARDIOMYOPATHY, TRANSPOSITION OF GREAT VESSELS, HYPOPLASTIC LEFT HEART SYNDROME (See Guideline Notes 1,6,18,64,65,70,76) CARDIAC TRANSPLANT; HEART/KIDNEY TRANSPLANT 280 CHRONIC NON-LYMPHOCYTIC LEUKEMIA (See Guideline Notes 7,11,12,14,76) BONE MARROW TRANSPLANT 281 TRACHOMA (See Guideline Notes 64,65) MEDICAL THERAPY 282 ACUTE, SUBACUTE, CHRONIC AND OTHER TYPES OF IRIDOCYCLITIS (See Guideline Notes 64, 65,76) MEDICAL THERAPY 283 RICKETTSIAL AND OTHER ARTHROPOD-BORNE DISEASES (See Guideline Notes 64,65) MEDICAL THERAPY 284 DIABETES INSIPIDUS (See Guideline Notes 1,64,65) MEDICAL THERAPY 285 SYMPATHETIC UVEITIS AND DEGENERATIVE DISORDERS AND CONDITIONS OF GLOBE (See Guideline Notes 64,65,76) ENUCLEATION 286 CANCER OF BLADDER AND URETER (See Guideline Notes 1,7,11,12,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 287 TRAUMATIC AMPUTATION OF FOOT/FEET (COMPLETE)(PARTIAL) WITH AND WITHOUT COMPLICATION (See Guideline Notes 1,6,64,65,76) MEDICAL AND SURGICAL TREATMENT 288 ACUTE POLIOMYELITIS (See Guideline Notes 6,64,65) MEDICAL THERAPY 289 LEPROSY, YAWS, PINTA (See Guideline Notes 1,64,65) MEDICAL THERAPY 290 UROLOGIC INFECTIONS (See Guideline Notes 64,65,76) MEDICAL THERAPY 291 CANCER OF SKIN, EXCLUDING MALIGNANT MELANOMA (See Guideline Notes 1,7,11,12,19,64, 65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 292 INJURY TO BLOOD VESSELS OF THE THORACIC CAVITY (See Guideline Notes 1,6,64,65,76) REPAIR 293 RUPTURE OF BLADDER, NONTRAUMATIC (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 294 OTHER PSYCHOTIC DISORDERS (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 295 HYDROPS FETALIS (See Guideline Notes 64,65) MEDICAL THERAPY 296 DEFORMITY/CLOSED DISLOCATION OF JOINT (See Guideline Notes 6,64,65,76) SURGICAL TREATMENT 297 SENSORINEURAL HEARING LOSS - AGE 5 OR UNDER (See Guideline Note 31,76) COCHLEAR IMPLANT 298 RETINAL DETACHMENT AND OTHER RETINAL DISORDERS (See Guideline Notes 64,65,76) RETINAL REPAIR, VITRECTOMY 299 ARTHROPOD-BORNE VIRAL DISEASES (See Guideline Notes 64,65) MEDICAL THERAPY 300 HYPOPLASIA AND DYSPLASIA OF LUNG (See Guideline Notes 64,65,76) MEDICAL THERAPY 301 CHRONIC RHEUMATIC PERICARDITIS, RHEUMATIC MYOCARDITIS (See Guideline Notes 1,6,64,65) MEDICAL THERAPY 302 BUDD-CHIARI SYNDROME, AND OTHER VENOUS EMBOLISM AND THROMBOSIS (See Guideline Notes 64,65,76,77) THROMBECTOMY/LIGATION 303 LIFE-THREATENING CARDIAC ARRHYTHMIAS (See Guideline Notes 1,6,64,65,76) MEDICAL AND SURGICAL TREATMENT 304 ANOREXIA NERVOSA (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 305 CHRONIC OBSTRUCTIVE PULMONARY DISEASE; CHRONIC RESPIRATORY FAILURE (See Guideline Notes 1,64,65) MEDICAL THERAPY 306 DISSECTING OR RUPTURED AORTIC ANEURYSM (See Guideline Notes 6,64,65,76) SURGICAL TREATMENT 307 COMPLICATIONS OF A PROCEDURE ALWAYS REQUIRING TREATMENT (See Guideline Notes 6,64, 65,76; See Coding Specification Below) MEDICAL AND SURGICAL TREATMENT 308 RUPTURE OF PAPILLARY MUSCLE (See Guideline Notes 6,64,65,76) MEDICAL AND SURGICAL TREATMENT 309 CHRONIC LEUKEMIAS; POLYCYTHEMIA RUBRA VERA (See Guideline Notes 1,7,11,12,64,65,76) MEDICAL THERAPY, WHICH INCLUDES CHEMOTHERAPY, RADIATION AND RADIONUCLEIDE THERAPY 310 CANCER OF VAGINA, VULVA AND OTHER FEMALE GENITAL ORGANS (See Guideline Notes 1,7,11, 12,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 311 CANCER OF ORAL CAVITY, PHARYNX, NOSE AND LARYNX (See Guideline Notes 1,7,11,12,19, 64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 312 CONSTITUTIONAL APLASTIC ANEMIA (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 313 OSTEOPETROSIS (See Guideline Notes 1,7,11,14,76) BONE MARROW RESCUE AND TRANSPLANT 314 CRUSH INJURIES OF DIGITS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 315 ACUTE STRESS DISORDER (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 316 ADRENAL OR CUTANEOUS HEMORRHAGE OF FETUS OR NEONATE (See Guideline Notes 64,65) MEDICAL THERAPY 317 NEUROLOGICAL DYSFUNCTION IN POSTURE AND MOVEMENT CAUSED BY CHRONIC CONDITIONS (See Guideline Notes 6,64,65,76; See Coding Specification Below) MEDICAL AND SURGICAL TREATMENT (EG. DURABLE MEDICAL EQUIPMENT AND ORTHOPEDIC PROCEDURE) 318 ANOMALIES OF GALLBLADDER, BILE DUCTS, AND LIVER (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 319 CANCER OF BRAIN AND NERVOUS SYSTEM (See Guideline Notes 1,7,11,12,64,65,76) LINEAR ACCELERATOR, MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 320 CATARACT, EXCLUDING CONGENITAL (See Guideline Notes 32,64,65,76) EXTRACTION OF CATARACT 321 AFTER CATARACT (See Guideline Note 76) DISCISSION, LENS CAPSULE 322 FISTULA INVOLVING FEMALE GENITAL TRACT (See Guideline Notes 64,65,76) CLOSURE OF FISTULA 323 VITREOUS DISORDERS (See Guideline Notes 64,65,76) VITRECTOMY 324 CLEFT PALATE AND/OR CLEFT LIP (See Guideline Notes 64,65,76) EXCISION AND REPAIR VESTIBULE OF MOUTH, ORTHODONTICS 325 GOUT AND CRYSTAL ARTHROPATHIES (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 326 PERTUSSIS AND DIPTHERIA (See Guideline Notes 64,65) MEDICAL THERAPY 327 THROMBOCYTOPENIA (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 328 DISORDERS OF AMINO-ACID TRANSPORT AND METABOLISM (NON PKU) (See Guideline Notes 64,65) MEDICAL THERAPY 329 PNEUMONIA DUE TO RESPIRATORY SYNCYTIAL VIRUS IN PERSONS UNDER AGE 3 (See Guideline Notes 64,65,76) MEDICAL THERAPY 330 DISORDERS OF ARTERIES, OTHER THAN CAROTID OR CORONARY (See Guideline Notes 1,64,65, 76) MEDICAL AND SURGICAL TREATMENT 331 PARALYTIC ILEUS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 332 CIRRHOSIS OF LIVER OR BILIARY TRACT; BUDD-CHIARI SYNDROME; HEPATIC VEIN THROMBOSIS; INTRAHEPATIC VASCULAR MALFORMATIONS; CAROLIĘS DISEASE (See Coding Specification Below) (See Guideline Notes 1,76) LIVER TRANSPLANT, LIVER-KIDNEY TRANSPLANT 333 CHRONIC INFLAMMATORY DISORDER OF ORBIT (See Guideline Notes 64,65,76) MEDICAL THERAPY 334 CONGENITAL DISLOCATION OF HIP; COXA VARA AND VALGA (See Guideline Notes 6,64,65,76) SURGICAL TREATMENT 335 CORNEAL OPACITY AND OTHER DISORDERS OF CORNEA (See Guideline Notes 64,65,76) KERATOPLASTY 336 DISORDERS INVOLVING THE IMMUNE SYSTEM (See Guideline Notes 1,64,65) MEDICAL THERAPY 337 CANCER OF ESOPHAGUS (See Guideline Notes 1,7,11,12,19,33,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 338 CANCER OF LIVER (See Guideline Notes 1,7,11,12,33,64,65,76,78) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 339 CANCER OF PANCREAS (See Guideline Notes 1,7,11,12,33,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 340 STROKE (See Guideline Notes 1,6,64,65,76) MEDICAL THERAPY 341 HEREDITARY ANGIOEDEMA; ANGIONEUROTIC EDEMA (See Guideline Notes 64,65) MEDICAL THERAPY 342 PURULENT ENDOPHTHALMITIS (See Guideline Notes 64,65,76) VITRECTOMY 343 FOREIGN BODY IN CORNEA AND CONJUNCTIVAL SAC (See Guideline Notes 64,65,76) REMOVAL CONJUNCTIVAL FOREIGN BODY 344 OTHER ANEURYSM OF PERIPHERAL ARTERY (See Guideline Note 76) SURGICAL TREATMENT 345 SIALOADENITIS, ABSCESS, FISTULA OF SALIVARY GLANDS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 346 CYSTICERCOSIS, OTHER CESTODE INFECTION, TRICHINOSIS (See Guideline Notes 64,65) MEDICAL THERAPY 347 NON-DISSECTING ANEURYSM WITHOUT RUPTURE (See Guideline Notes 6,64,65,76) SURGICAL TREATMENT 348 ARTERIAL ANEURYSM OF NECK (See Guideline Note 6,76) REPAIR 349 FUNCTIONAL AND MECHANICAL DISORDERS OF THE GENITOURINARY SYSTEM INCLUDING BLADDER OUTLET OBSTRUCTION (See Coding Specification Below) (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 350 ACUTE GLOMERULONEPHRITIS AND OTHER ACUTE RENAL FAILURE (See Guideline Notes 1,7,64, 65,76) MEDICAL THERAPY INCLUDING DIALYSIS 351 VESICULAR FISTULA (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 352 COCCIDIOIDOMYCOSIS, HISTOPLASMOSIS, BLASTOMYCOTIC INFECTION, OPPORTUNISTIC AND OTHER MYCOSES (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 353 DISSEMINATED INTRAVASCULAR COAGULATION (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 354 CANCER OF PROSTATE GLAND (See Guideline Notes 1,7,11,12,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 355 SYSTEMIC SCLEROSIS (See Guideline Notes 1,64,65) MEDICAL THERAPY 356 ANAEROBIC INFECTIONS REQUIRING HYPERBARIC OXYGEN HYPERBARIC OXYGEN 357 DENTAL CONDITIONS (EG. DENTAL CARIES, FRACTURED TOOTH) (See Guideline Note 34) BASIC RESTORATIVE 358 BENIGN CEREBRAL CYSTS (See Guideline Note 76) DRAINAGE 359 ALCOHOLIC FATTY LIVER OR ALCOHOLIC HEPATITIS, CIRRHOSIS OF LIVER (See Guideline Notes 1,64,65,76,77) MEDICAL THERAPY 360 SCLERITIS (See Guideline Notes 64,65,76) MEDICAL THERAPY 361 RUBEOSIS IRIDIS (See Guideline Notes 64,65,76) LASER SURGERY 362 DISEASES OF ENDOCARDIUM (See Guideline Notes 6,64,65,76) MEDICAL THERAPY 363 WOUND OF EYE GLOBE (See Guideline Notes 64,65,76) SURGICAL REPAIR 364 ACUTE NECROSIS OF LIVER (See Guideline Notes 64,65) MEDICAL THERAPY 365 NEPHROTIC SYNDROME AND OTHER RENAL DISORDERS (See Guideline Notes 1,7,64,65,76) MEDICAL THERAPY INCLUDING DIALYSIS 366 IDIOPATHIC OR VIRAL MYOCARDITIS AND PERICARDITIS (See Guideline Notes 6,64,65,76) MEDICAL AND SURGICAL TREATMENT 367 HEREDITARY HEMORRHAGIC TELANGIECTASIA (See Guideline Note 76) EXCISION 368 RHEUMATIC FEVER (See Guideline Notes 6,64,65) MEDICAL THERAPY 369 HEREDITARY FRUCTOSE INTOLERANCE, INTESTINAL DISACCHARIDASE AND OTHER DEFICIENCIES (See Guideline Notes 1,64,65) MEDICAL THERAPY 370 ACROMEGALY AND GIGANTISM, OTHER AND UNSPECIFIED ANTERIOR PITUITARY HYPERFUNCTION, BENIGN NEOPLASM OF THYROID GLAND AND OTHER ENDOCRINE GLANDS (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES RADIATION THERAPY 371 RETROLENTAL FIBROPLASIA (See Guideline Note 76) CRYOSURGERY 372 NEUROLOGICAL DYSFUNCTION IN COMMUNICATION CAUSED BY CHRONIC CONDITIONS (See Guideline Notes 6,64,65,76) MEDICAL THERAPY 373 CARDIAC ARRHYTHMIAS (See Guideline Notes 1,6,64,65,76) MEDICAL THERAPY, PACEMAKER 374 MILD/MODERATE BIRTH TRAUMA FOR BABY (See Guideline Notes 1,64,65) MEDICAL THERAPY 375 ATHEROSCLEROSIS, PERIPHERAL (See Guideline Notes 6,64,65,76) SURGICAL TREATMENT 376 URINARY SYSTEM CALCULUS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 377 CONGENITAL ABSENCE OF VAGINA (See Guideline Note 76) ARTIFICIAL VAGINA 378 PENETRATING WOUND OF ORBIT (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 379 CLOSED FRACTURE OF EXTREMITIES (EXCEPT TOES) (See Guideline Notes 6,64,65,76) OPEN OR CLOSED REDUCTION 380 HEARING LOSS - AGE 5 OR UNDER (See Guideline Notes 64,65,76) MEDICAL THERAPY INCLUDING HEARING AIDS 381 RHEUMATOID ARTHRITIS, OSTEOARTHRITIS, OSTEOCHONDRITIS DISSECANS, AND ASEPTIC NECROSIS OF BONE (See Guideline Notes 6,15,64,65,71,76) ARTHROPLASTY/RECONSTRUCTION 382 ANEURYSM OF PULMONARY ARTERY (See Guideline Notes 6,64,65,76) SURGICAL TREATMENT 383 BODY INFESTATIONS (EG. LICE, SCABIES) (See Guideline Notes 64,65) MEDICAL THERAPY 384 LYME DISEASE AND OTHER ARTHROPOD BORNE DISEASES (See Guideline Notes 1,6,64,65) MEDICAL THERAPY 385 DYSTONIA (UNCONTROLLABLE); LARYNGEAL SPASM AND STENOSIS (See Guideline Notes 64,65, 76) MEDICAL THERAPY 386 CYST AND PSEUDOCYST OF PANCREAS (See Guideline Notes 64,65,76) DRAINAGE OF PANCREATIC CYST 387 CONVERSION DISORDER, CHILD (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 388 ACUTE SINUSITIS (See Guideline Notes 35,64,65,76) MEDICAL AND SURGICAL TREATMENT 389 HYPHEMA (See Guideline Note 76) REMOVAL OF BLOOD CLOT 390 ENTROPION (See Guideline Note 76) REPAIR 391 SPONTANEOUS ABORTION (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 392 STREPTOCOCCAL SORE THROAT AND SCARLET FEVER; VINCENTĘS DISEASE; ULCER OF TONSIL; UNILATERAL HYPERTROPHY OF TONSIL (See Guideline Notes 36,64,65,76) MEDICAL THERAPY, TONSILLECTOMY/ADENOIDECTOMY 393 GIARDIASIS, INTESTINAL HELMINTHIASIS (See Guideline Notes 64,65) MEDICAL THERAPY 394 AMBLYOPIA (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 395 SOMATIZATION DISORDER; SOMATOFORM PAIN DISORDER (See Guideline Notes 64,65) CONSULTATION/BEHAVIORAL MANAGEMENT 396 TOXIC EFFECT OF GASES, FUMES, AND VAPORS REQUIRING HYPERBARIC OXYGEN HYPERBARIC OXYGEN 397 DISORDERS OF SPINE WITH NEUROLOGIC IMPAIRMENT (See Guideline Notes 1,6,37,64,65,72, 76) MEDICAL AND SURGICAL TREATMENT 398 ENCEPHALOCELE (See Guideline Note 76) SURGICAL TREATMENT 399 BENIGN NEOPLASM OF RESPIRATORY AND INTRATHORACIC ORGANS (See Guideline Notes 64,65, 76) LOBECTOMY, MEDICAL THERAPY, WHICH INCLUDES RADIATION THERAPY 400 IMPERFORATE HYMEN; ABNORMALITIES OF VAGINAL SEPTUM (See Guideline Note 76) SURGICAL TREATMENT 401 RETINAL TEAR (See Guideline Notes 64,65,76) LASER PROPHYLAXIS 402 CHOLESTEATOMA; INFECTIONS OF THE PINNA (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 403 DISRUPTIONS OF THE LIGAMENTS AND TENDONS OF THE ARMS AND LEGS, EXCLUDING THE KNEE, GRADE II AND III (See Guideline Notes 6,64,65,76) REPAIR 404 DYSFUNCTION RESULTING IN LOSS OF ABILITY TO MAXIMIZE LEVEL OF INDEPENDENCE IN SELF- DIRECTED CARE CAUSED BY CHRONIC CONDITIONS THAT CAUSE NEUROLOGICAL DYSFUNCTION (See Guideline Notes 1,6,38,64,65,76) MEDICAL THERAPY (SHORT TERM REHABILITATION WITH DEFINED GOALS) 405 ANEMIAS DUE TO DISEASE OR TREATMENT AND OTHER APLASTIC ANEMIAS (See Guideline Notes 64,65) MEDICAL THERAPY 406 ESOPHAGEAL STRICTURE (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 407 CHRONIC ULCER OF SKIN (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 408 ESOPHAGITIS; ESOPHAGEAL AND INTRAESOPHAGEAL HERNIAS (See Guideline Note 76) SURGICAL TREATMENT 409 BULIMIA NERVOSA (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 410 SUPERFICIAL INJURIES WITH INFECTION (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 411 PITUITARY DWARFISM (See Guideline Notes 64,65,74) MEDICAL THERAPY 412 SEPARATION ANXIETY DISORDER (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 413 ACUTE OTITIS MEDIA (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 414 PANIC DISORDER; AGORAPHOBIA (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 415 CROUP SYNDROME, EPIGLOTTITIS, ACUTE LARYNGOTRACHEITIS (See Guideline Notes 64,65,76) MEDICAL THERAPY, INTUBATION, TRACHEOTOMY 416 ACHALASIA, NON-NEONATAL (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 417 ENDOMETRIOSIS AND ADENOMYOSIS (See Guideline Notes 1,39,64,65,76) MEDICAL AND SURGICAL TREATMENT 418 ESOPHAGITIS (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 419 ANOGENITAL VIRAL WARTS (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 420 EATING DISORDER NOS (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 421 LYMPHADENITIS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 422 UTERINE LEIOMYOMA (See Guideline Notes 40,64,65,76) TOTAL HYSTERECTOMY OR MYOMECTOMY 423 APHAKIA AND OTHER DISORDERS OF LENS (See Guideline Notes 64,65,76) INTRAOCULAR LENS 424 BILATERAL ANOMALIES OF EXTERNAL EAR WITH IMPAIRMENT OF HEARING (See Guideline Notes 64,65,76) RECONSTRUCT OF EAR CANAL 425 DISSOCIATIVE DISORDERS (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 426 EPIDERMOLYSIS BULLOSA (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 427 DELIRIUM DUE TO MEDICAL CAUSES (See Guideline Notes 64,65) MEDICAL THERAPY 428 SPINAL DEFORMITY, CLINICALLY SIGNIFICANT (See Guideline Notes 1,6,41,64,65,76) MEDICAL AND SURGICAL TREATMENT 429 MIGRAINE HEADACHES (See Guideline Notes 1,64,65) MEDICAL THERAPY 430 SCHIZOTYPAL PERSONALITY DISORDERS (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 431 BALANOPOSTHITIS AND OTHER DISORDERS OF PENIS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 432 SICCA SYNDROME; POLYMYALGIA RHEUMATICA (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 433 TRANSIENT CEREBRAL ISCHEMIA; OCCLUSION/STENOSIS OF PRECEREBRAL ARTERIES WITHOUT OCCLUSION (See Guideline Notes 64,65,76) MEDICAL THERAPY; THROMBOENDARTERECTOMY 434 PERIPHERAL NERVE ENTRAPMENT (See Guideline Notes 6,64,65,76) MEDICAL AND SURGICAL TREATMENT 435 MENIEREĘS DISEASE (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 436 DISORDERS OF SHOULDER, INCLUDING SPRAINS/STRAINS GRADE 3 THROUGH 6 (See Guideline Notes 6,64,65,76) REPAIR/RECONSTRUCTION, MEDICAL THERAPY 437 INCONTINENCE OF FECES (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 438 OPPOSITIONAL DEFIANT DISORDER (See Guideline Notes 42,64,65) MEDICAL/PSYCHOTHERAPY 439 SARCOIDOSIS (See Guideline Notes 1,64,65) MEDICAL THERAPY 440 COMPLICATIONS OF A PROCEDURE USUALLY REQUIRING TREATMENT (See Guideline Notes 6,43,64,65,76) MEDICAL AND SURGICAL TREATMENT 441 MENSTRUAL BLEEDING DISORDERS (See Guideline Notes 1,44,64,65,76) MEDICAL AND SURGICAL TREATMENT 442 ADRENOGENITAL DISORDERS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 443 NON-MALIGNANT OTITIS EXTERNA (See Guideline Notes 64,65,76) MEDICAL THERAPY 444 VAGINITIS, TRICHOMONIASIS (See Guideline Notes 64,65) MEDICAL THERAPY 445 STRABISMUS WITHOUT AMBLYOPIA AND OTHER DISORDERS OF BINOCULAR EYE MOVEMENTS; CONGENITAL ANOMALIES OF EYE (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 446 NONINFLAMMATORY DISORDERS AND BENIGN NEOPLASMS OF OVARY, FALLOPIAN TUBES AND UTERUS; OVARIAN CYSTS; STREAK OVARIES (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 447 URETHRAL FISTULA (See Guideline Notes 64,65,76) EXCISION, MEDICAL THERAPY 448 INTERNAL DERANGEMENT OF KNEE AND LIGAMENTOUS DISRUPTIONS OF THE KNEE, GRADE II AND III (See Guideline Notes 6,64,65,76) REPAIR, MEDICAL THERAPY 449 OPEN WOUND OF EAR DRUM (See Guideline Note 76) TYMPANOPLASTY 450 CHRONIC DEPRESSION (DYSTHYMIA) (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 451 HYPOSPADIAS AND EPISPADIAS (See Guideline Notes 64,65,76) REPAIR 452 CANCER OF GALLBLADDER AND OTHER BILIARY (See Guideline Notes 1,7,11,12,33,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 453 DYSTROPHY OF VULVA (See Guideline Notes 64,65,76) MEDICAL THERAPY 454 RECURRENT EROSION OF THE CORNEA (See Guideline Notes 64,65,76) CORNEAL TATTOO, REMOVAL OF CORNEAL EPITHELIUM; WITH OR WITHOUT CHEMOCAUTERIZATION 455 STEREOTYPY/HABIT DISORDER AND SELF-ABUSIVE BEHAVIOR DUE TO NEUROLOGICAL DYSFUNCTION (See Guideline Notes 1,64,65) CONSULTATION/MEDICATION MANAGEMENT/LIMITED BEHAVIORAL MODIFICATION 456 FOREIGN BODY IN UTERUS, VULVA AND VAGINA (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 457 RESIDUAL FOREIGN BODY IN SOFT TISSUE (See Guideline Note 76) REMOVAL 458 VENOUS TRIBUTARY (BRANCH) OCCLUSION; CENTRAL RETINAL VEIN OCCLUSION (See Guideline Notes 64,65,76) LASER SURGERY 459 TRIGEMINAL AND OTHER NERVE DISORDERS (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT, RADIATION THERAPY 460 MALUNION AND NONUNION OF FRACTURE (See Guideline Notes 6,64,65,76) SURGICAL TREATMENT 461 ADJUSTMENT DISORDERS (See Coding Specification Below) (See Guideline Notes 45,64,65) MEDICAL/PSYCHOTHERAPY 462 HEARING LOSS - OVER AGE OF FIVE (See Guideline Notes 1,64,65,76) MEDICAL THERAPY INCLUDING HEARING AIDS 463 TOURETTE'S DISORDER AND TIC DISORDERS (See Guideline Notes 1,64,65) MEDICAL/PSYCHOTHERAPY 464 ATHEROSCLEROSIS, AORTIC AND RENAL (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 465 DEGENERATION OF MACULA AND POSTERIOR POLE (See Guideline Notes 46,64,65,76) VITRECTOMY, LASER SURGERY 466 REACTIVE ATTACHMENT DISORDER OF INFANCY OR EARLY CHILDHOOD (See Guideline Notes 64, 65) MEDICAL/PSYCHOTHERAPY 467 DISORDERS OF REFRACTION AND ACCOMMODATION (See Guideline Notes 64,65) MEDICAL THERAPY 468 EXOPHTHALMOS AND CYSTS OF THE EYE AND ORBIT (See Guideline Notes 64,65,76) SURGICAL TREATMENT 469 URINARY INCONTINENCE (See Guideline Notes 1,47,64,65,76) MEDICAL AND SURGICAL TREATMENT 470 DISORDERS OF PLASMA PROTEIN METABOLISM (See Guideline Notes 64,65) MEDICAL THERAPY 471 FACTITIOUS DISORDERS (See Guideline Notes 64,65) CONSULTATION 472 NEONATAL CONJUNCTIVITIS, DACRYOCYSTITIS AND CANDIDA INFECTION (See Guideline Notes 64,65) MEDICAL THERAPY 473 DENTAL CONDITIONS (EG. TOOTH LOSS) (See Guideline Note 48) SPACE MAINTENANCE AND PERIODONTAL MAINTENANCE 474 SIMPLE AND SOCIAL PHOBIAS (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 475 ACUTE BRONCHITIS AND BRONCHIOLITIS (See Guideline Notes 64,65,76) MEDICAL THERAPY 476 CENTRAL PTERYGIUM (See Guideline Notes 64,65,76) EXCISION OR TRANSPOSITION OF PTERYGIUM WITHOUT GRAFT, RADIATION THERAPY 477 BRANCHIAL CLEFT CYST; THYROGLOSSAL DUCT CYST; CYST OF PHARYNX OR NASOPHARYNX (See Guideline Notes 64,65,76) EXCISION, MEDICAL THERAPY 478 OBSESSIVE-COMPULSIVE DISORDERS (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 479 OVERANXIOUS DISORDER; GENERALIZED ANXIETY DISORDER; ANXIETY DISORDER, UNSPECIFIED See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 480 OSTEOARTHRITIS AND ALLIED DISORDERS (See Guideline Notes 1,6,64,65,76) MEDICAL THERAPY, INJECTIONS 481 ATELECTASIS (COLLAPSE OF LUNG) (See Guideline Notes 64,65,76) MEDICAL THERAPY 482 SENSORINEURAL HEARING LOSS - OVER AGE OF FIVE (See Guideline Notes 1,49,76) COCHLEAR IMPLANT 483 BRACHIAL PLEXUS LESIONS (See Guideline Notes 64,65,76) MEDICAL THERAPY 484 UTERINE PROLAPSE; CYSTOCELE (See Guideline Notes 50,64,65,76) SURGICAL REPAIR 485 OVARIAN DYSFUNCTION, GONADAL DYSGENISIS, MENOPAUSAL MANAGEMENT (See Guideline Notes 64,65,74,76) OOPHORECTOMY, ORCHIECTOMY, HORMONAL REPLACEMENT FOR PURPOSES OTHER THAN INFERTILITY 486 FUNCTIONAL ENCOPRESIS (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 487 PTOSIS (ACQUIRED) WITH VISION IMPAIRMENT (See Guideline Notes 64,65,76) PTOSIS REPAIR 488 CHRONIC SINUSITIS (See Guideline Notes 35,64,65,76) MEDICAL AND SURGICAL TREATMENT 489 KERATOCONJUNCTIVITS, CORNEAL ABSCESS AND NEOVASCULARIZATION (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 490 SELECTIVE MUTISM (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 491 THROMBOSED AND COMPLICATED HEMORRHOIDS (See Guideline Notes 64,65,76) HEMORRHOIDECTOMY, INCISION 492 CHRONIC OTITIS MEDIA (See Guideline Notes 51,64,65,76) PE TUBES/ADENOIDECTOMY/TYMPANOPLASTY, MEDICAL THERAPY 493 RECTAL PROLAPSE (See Guideline Notes 64,65,76) SURGICAL TREATMENT 494 OTOSCLEROSIS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 495 FOREIGN BODY IN EAR AND NOSE (See Guideline Notes 64,65,76) REMOVAL OF FOREIGN BODY 496 ANAL FISTULA; CHRONIC ANAL FISSURE (See Guideline Notes 1,52,64,65,76) SPHINCTEROTOMY, FISSURECTOMY, FISTULECTOMY, MEDICAL THERAPY 497 CLOSED DISLOCATIONS/FRACTURES OF NON-CERVICAL VERTEBRAL COLUMN WITHOUT SPINAL CORD INJURY (See Guideline Notes 6,64,65,76) MEDICAL AND SURGICAL TREATMENT 498 DENTAL CONDITIONS (EG. SEVERE TOOTH DECAY) (See Guideline Note 53,76) STABILIZATION OF PERIODONTAL HEALTH, COMPLEX RESTORATIVE, AND REMOVABLE PROSTHODONTICS 499 CONDUCT DISORDER, AGE 18 OR UNDER (See Guideline Note 54,64,65) MEDICAL/PSYCHOTHERAPY 500 BREAST CYSTS AND OTHER DISORDERS OF THE BREAST (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 501 CERVICITIS, ENDOCERVICITIS, HEMATOMA OF VULVA, AND NONINFLAMMATORY DISORDERS OF THE VAGINA (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 502 CYSTS OF BARTHOLIN'S GLAND AND VULVA (See Guideline Notes 64,65,76) INCISION AND DRAINAGE, MEDICAL THERAPY 503 LICHEN PLANUS (See Guideline Notes 64,65) MEDICAL THERAPY 504 DENTAL CONDITIONS (EG. BROKEN APPLIANCES) (See Guideline Notes 64,65) PERIODONTICS AND COMPLEX PROSTHETICS 505 RUPTURE OF SYNOVIUM REMOVAL OF BAKER'S CYST 506 ENOPHTHALMOS (See Guideline Notes 64,65) ORBITAL IMPLANT 507 BELL'S PALSY, EXPOSURE KERATOCONJUNCTIVITIS (See Guideline Notes 64,65) TARSORRHAPHY 508 PERIPHERAL ENTHESOPATHIES (See Guideline Notes 6,64,65) MEDICAL THERAPY 509 DERMATOPHYTOSIS OF NAIL, GROIN, AND FOOT AND OTHER DERMATOMYCOSIS (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 510 CONVERSION DISORDER, ADULT (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 511 CLOSED FRACTURES OF RIBS, STERNUM AND COCCYX (See Guideline Notes 64,65) MEDICAL THERAPY 512 SPASTIC DIPLEGIA RHIZOTOMY 513 GENDER IDENTIFICATION DISORDER, PARAPHILIAS AND OTHER PSYCHOSEXUAL DISORDERS (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 514 HEPATORENAL SYNDROME (See Guideline Notes 64,65) MEDICAL THERAPY 515 ECTROPION, TRICHIASIS OF EYELID, BENIGN NEOPLASM OF EYELID ECTROPION REPAIR 516 PHIMOSIS SURGICAL TREATMENT 517 CERUMEN IMPACTION (See Guideline Notes 64,65) REMOVAL OF EAR WAX 518 SIALOLITHIASIS, MUCOCELE, DISTURBANCE OF SALIVARY SECRETION, OTHER AND UNSPECIFIED DISEASES OF SALIVARY GLANDS (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 519 CHRONIC CONJUNCTIVITIS, BLEPHAROCONJUNCTIVITIS (See Guideline Notes 64,65) MEDICAL THERAPY 520 OTHER DISORDERS OF SYNOVIUM, TENDON AND BURSA, COSTOCHONDRITIS, AND CHONDRODYSTROPHY (See Guideline Notes 64,65) MEDICAL THERAPY 521 TOXIC ERYTHEMA, ACNE ROSACEA, DISCOID LUPUS (See Guideline Notes 64,65) MEDICAL THERAPY 522 PERIPHERAL ENTHESOPATHIES SURGICAL TREATMENT 523 NASAL POLYPS, OTHER DISORDERS OF NASAL CAVITY AND SINUSES (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 524 CIRCUMSCRIBED SCLERODERMA (See Guideline Notes 64,65) MEDICAL THERAPY 525 PERIPHERAL NERVE DISORDERS (See Guideline Notes 64,65) MEDICAL THERAPY 526 CLOSED FRACTURE OF GREAT TOE (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 527 DYSFUNCTION OF NASOLACRIMAL SYSTEM; LACRIMAL SYSTEM LACERATION (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 528 BENIGN NEOPLASM OF KIDNEY AND OTHER URINARY ORGANS (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 529 VERTIGINOUS SYNDROMES AND OTHER DISORDERS OF VESTIBULAR SYSTEM (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 530 CLOSED FRACTURE OF ONE OR MORE PHALANGES OF THE FOOT, NOT INCLUDING THE GREAT TOE MEDICAL AND SURGICAL TREATMENT 531 PHLEBITIS AND THROMBOPHLEBITIS, SUPERFICIAL (See Guideline Notes 64,65) MEDICAL THERAPY 532 DISORDERS OF SWEAT GLANDS (See Guideline Notes 64,65) MEDICAL THERAPY 533 SEXUAL DYSFUNCTION (See Guideline Notes 64,65) PSYCHOTHERAPY, MEDICAL AND SURGICAL TREATMENT 534 PARALYSIS OF VOCAL CORDS OR LARYNX (See Guideline Notes 64,65) INCISION/EXCISION/ENDOSCOPY 535 DELUSIONAL DISORDER (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 536 CYSTIC ACNE (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 537 UNCOMPLICATED HERNIA (OTHER THAN INGUINAL HERNIA IN CHILDREN AGE 18 AND UNDER OR DIAPHRAGMATIC HERNIA) (See Guideline Notes 64,65) REPAIR 538 BENIGN NEOPLASM OF NASAL CAVITIES, MIDDLE EAR AND ACCESSORY SINUSES EXCISION, RECONSTRUCTION 539 BENIGN NEOPLASM BONE AND ARTICULAR CARTILAGE INCLUDING OSTEOID OSTEOMAS; BENIGN NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE (See Guideline Notes 6,64,65) MEDICAL AND SURGICAL TREATMENT, RADIATION THERAPY 540 OTHER NONINFECTIOUS GASTROENTERITIS AND COLITIS (See Guideline Notes 61,64,65) MEDICAL THERAPY 541 DEFORMITIES OF UPPER BODY AND ALL LIMBS (See Guideline Notes 64,65) REPAIR/REVISION/RECONSTRUCTION/RELOCATION/MEDICAL THERAPY 542 DISORDERS OF FUNCTION OF STOMACH AND OTHER FUNCTIONAL DIGESTIVE DISORDERS (See Guideline Notes 64,65) MEDICAL THERAPY 543 PELVIC PAIN SYNDROME, DYSPAREUNIA (See Guideline Notes 55,64,65) MEDICAL AND SURGICAL TREATMENT 544 ATOPIC DERMATITIS (See Guideline Notes 64,65) MEDICAL THERAPY 545 CONTACT DERMATITIS AND OTHER ECZEMA (See Guideline Notes 64,65) MEDICAL THERAPY 546 HYPOTENSION (See Guideline Notes 64,65) MEDICAL THERAPY 547 VIRAL, SELF-LIMITING ENCEPHALITIS, MYELITIS AND ENCEPHALOMYELITIS (See Guideline Notes 61,64,65) MEDICAL THERAPY 548 PERIPHERAL NERVE DISORDERS SURGICAL TREATMENT 549 ICHTHYOSIS (See Guideline Notes 64,65) MEDICAL THERAPY 550 LESION OF PLANTAR NERVE; PLANTAR FASCIAL FIBROMATOSIS (See Guideline Notes 64,65) MEDICAL THERAPY, EXCISION 551 ACUTE AND CHRONIC DISORDERS OF SPINE WITHOUT NEUROLOGIC IMPAIRMENT (See Guideline Notes 6,56,64,65,72) MEDICAL AND SURGICAL TREATMENT 552 RAYNAUD'S SYNDROME (See Guideline Notes 64,65) MEDICAL THERAPY 553 TENSION HEADACHES (See Guideline Notes 64,65) MEDICAL THERAPY 554 MILD PSORIASIS (See Guideline Notes 57,64,65); DERMATOPHYTOSIS: SCALP, HAND, BODY, DEEP-SEATED MEDICAL THERAPY 555 DEFORMITIES OF FOOT (See Guideline Notes 64,65) FASCIOTOMY/INCISION/REPAIR/ARTHRODESIS 556 GRANULOMA OF MUSCLE, GRANULOMA OF SKIN AND SUBCUTANEOUS TISSUE (See Guideline Notes 64,65,76) REMOVAL OF GRANULOMA 557 HYDROCELE (See Guideline Notes 64,65) MEDICAL THERAPY, EXCISION 558 SYMPTOMATIC URTICARIA (See Guideline Notes 64,65) MEDICAL THERAPY 559 IMPULSE DISORDERS EXCLUDING PATHOLOGICAL GAMBLING (See Guideline Notes 58,64,65) MEDICAL/PSYCHOTHERAPY 560 SUBLINGUAL, SCROTAL, AND PELVIC VARICES (See Guideline Notes 64,65) VENOUS INJECTION, VASCULAR SURGERY 561 ASEPTIC MENINGITIS (See Guideline Notes 61,64,65) MEDICAL THERAPY 562 TMJ DISORDER (See Guideline Notes 64,65) TMJ SPLINTS 563 XEROSIS (See Guideline Notes 64,65) MEDICAL THERAPY 564 CHRONIC DISEASE OF TONSILS AND ADENOIDS (See Guideline Notes 36,64,65) TONSILLECTOMY AND ADENOIDECTOMY 565 SHYNESS DISORDER OF CHILDHOOD OR ADOLESCENCE (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 566 HEMATOMA OF AURICLE OR PINNA AND HEMATOMA OF EXTERNAL EAR (See Guideline Notes 64,65) DRAINAGE 567 KERATODERMA, ACANTHOSIS NIGRICANS, STRIAE ATROPHICAE, AND OTHER HYPERTROPHIC OR ATROPHIC CONDITIONS OF SKIN (See Guideline Notes 64,65) MEDICAL THERAPY 568 CHRONIC PROSTATITIS, OTHER DISORDERS OF PROSTATE (See Guideline Notes 64,65) MEDICAL THERAPY 569 CHONDROMALACIA (See Guideline Notes 6,64,65) MEDICAL THERAPY 570 MACROMASTIA BREAST REDUCTION 571 DYSMENORRHEA (See Guideline Notes 59,64,65) MEDICAL AND SURGICAL TREATMENT 572 OPEN WOUND OF EAR DRUM (See Guideline Notes 64,65) MEDICAL THERAPY 573 ALLERGIC RHINITIS AND CONJUNCTIVITIS, CHRONIC RHINITIS (See Guideline Notes 64,65) MEDICAL THERAPY 574 CANCER OF LIVER AND INTRAHEPATIC BILE DUCTS (See Guideline Note 12) LIVER TRANSPLANT 575 POSTCONCUSSION SYNDROME (See Guideline Notes 64,65) MEDICAL THERAPY 576 BENIGN NEOPLASM OF EXTERNAL FEMALE GENITAL ORGANS EXCISION 577 RUMINATION DISORDER OF INFANCY (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 578 HORDEOLUM AND OTHER DEEP INFLAMMATION OF EYELID; CHALAZION (See Guideline Notes 64,65) INCISION AND DRAINAGE, MEDICAL THERAPY 579 CONDUCTIVE HEARING LOSS AUDIANT BONE CONDUCTORS 580 ACUTE ANAL FISSURE (See Guideline Notes 64,65) FISSURECTOMY, MEDICAL THERAPY 581 PLEURISY (See Guideline Notes 64,65) MEDICAL THERAPY 582 CENTRAL SEROUS RETINOPATHY LASER SURGERY 583 PERITONEAL ADHESION SURGICAL TREATMENT 584 DERMATITIS DUE TO SUBSTANCES TAKEN INTERNALLY (See Guideline Notes 64,65) MEDICAL THERAPY 585 BLEPHARITIS (See Guideline Notes 64,65) MEDICAL THERAPY 586 UNSPECIFIED URINARY OBSTRUCTION AND BENIGN PROSTATIC HYPERPLASIA WITHOUT OBSTRUCTION (See Guideline Notes 64,65) MEDICAL THERAPY 587 OTHER COMPLICATIONS OF A PROCEDURE (See Guideline Notes 6,64,65) MEDICAL AND SURGICAL TREATMENT 588 LYMPHEDEMA (See Guideline Notes 43,64,65) MEDICAL THERAPY, OTHER OPERATION ON LYMPH CHANNEL 589 ACUTE NON-SUPPURATIVE LABYRINTHITIS (See Guideline Notes 64,65) MEDICAL THERAPY 590 DEVIATED NASAL SEPTUM, ACQUIRED DEFORMITY OF NOSE, OTHER DISEASES OF UPPER RESPIRATORY TRACT (See Guideline Notes 64,65) EXCISION OF CYST/RHINECTOMY/PROSTHESIS 591 STOMATITIS AND OTHER DISEASES OF ORAL SOFT TISSUES (See Guideline Notes 64,65) INCISION AND DRAINAGE, MEDICAL THERAPY 592 CAVUS DEFORMITY OF FOOT; FLAT FOOT; POLYDACTYLY AND SYNDACTYLY OF TOES (See Guideline Notes 64,65) MEDICAL THERAPY, ORTHOTIC 593 ERYTHEMA MULTIFORME MINOR (See Guideline Notes 64,65) MEDICAL THERAPY 594 INFECTIOUS MONONUCLEOSIS (See Guideline Notes 64,65) MEDICAL THERAPY 595 CONGENITAL ANOMALIES OF FEMALE GENITAL ORGANS EXCLUDING VAGINA (See Guideline Notes 64,65) SURGICAL TREATMENT 596 SPINAL DEFORMITY, NOT CLINICALLY SIGNIFICANT (See Guideline Notes 60,64,65) ARTHRODESIS/REPAIR/RECONSTRUCTION, MEDICAL THERAPY 597 ANTI-SOCIAL PERSONALITY DISORDER (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 598 SPASTIC DYSPHONIA (See Guideline Notes 64,65) MEDICAL THERAPY 599 URETHRITIS, NON-SEXUALLY TRANSMITTED (See Guideline Notes 64,65) MEDICAL THERAPY 600 PERSONALITY DISORDERS EXCLUDING BORDERLINE, SCHIZOTYPAL AND ANTI-SOCIAL (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 601 CANDIDIASIS OF MOUTH, SKIN AND NAILS (See Guideline Notes 64,65) MEDICAL THERAPY 602 BENIGN NEOPLASM OF MALE GENITAL ORGANS: TESTIS, PROSTATE, EPIDIDYMIS (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 603 ATROPHY OF EDENTULOUS ALVEOLAR RIDGE VESTIBULOPLASTY, GRAFTS, IMPLANTS 604 OLD LACERATION OF CERVIX AND VAGINA (See Guideline Notes 64,65) MEDICAL THERAPY 605 VULVAL VARICES (See Guideline Notes 64,65) VASCULAR SURGERY 606 DISEASE OF NAILS, HAIR AND HAIR FOLLICLES (See Guideline Notes 64,65) MEDICAL THERAPY 607 ACUTE TONSILLITIS OTHER THAN BETA-STREPTOCOCCAL (See Guideline Notes 64,65) MEDICAL THERAPY 608 CORNS AND CALLUSES (See Guideline Notes 64,65) MEDICAL THERAPY 609 SYNOVITIS AND TENOSYNOVITIS (See Guideline Notes 6,64,65) MEDICAL THERAPY 610 PROLAPSED URETHRAL MUCOSA (See Guideline Notes 64,65) SURGICAL TREATMENT 611 SECONDARY AND ILL-DEFINED MALIGNANT NEOPLASMS (See Guideline Notes 7,11,12,64,65) MEDICAL AND SURGICAL TREATMENT 612 GANGLION (See Guideline Notes 64,65) EXCISION 613 EPISCLERITIS (See Guideline Notes 64,65) MEDICAL THERAPY 614 DIAPER RASH (See Guideline Notes 64,65) MEDICAL THERAPY 615 TONGUE TIE AND OTHER ANOMALIES OF TONGUE FRENOTOMY, TONGUE TIE 616 CYSTS OF ORAL SOFT TISSUES (See Guideline Notes 64,65) INCISION AND DRAINAGE 617 CONGENITAL DEFORMITIES OF KNEE (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 618 CHRONIC PANCREATITIS SURGICAL TREATMENT 619 HERPES SIMPLEX WITHOUT COMPLICATIONS, EXCLUDING GENITAL HERPES (See Guideline Notes 64,65) MEDICAL THERAPY 620 CONGENITAL ANOMALIES OF THE EAR WITHOUT IMPAIRMENT OF HEARING; UNILATERAL ANOMALIES OF THE EAR OTOPLASTY, REPAIR AND AMPUTATION 621 KELOID SCAR; OTHER ABNORMAL GRANULATION TISSUE INTRALESIONAL INJECTIONS/DESTRUCTION/EXCISION, RADIATION THERAPY 622 DISORDERS OF SOFT TISSUE (See Guideline Notes 64,65,72) MEDICAL THERAPY 623 MINOR BURNS (See Guideline Notes 64,65) MEDICAL THERAPY 624 DISORDERS OF SLEEP WITHOUT SLEEP APNEA (See Guideline Notes 64,65) MEDICAL THERAPY 625 ORAL APHTHAE (See Guideline Notes 64,65) MEDICAL THERAPY 626 SPRAINS AND STRAINS OF ADJACENT MUSCLES AND JOINTS, MINOR (See Guideline Notes 6,64,65) MEDICAL THERAPY 627 ASYMPTOMATIC URTICARIA (See Guideline Notes 64,65) MEDICAL THERAPY 628 DENTAL CONDITIONS (EG. ORTHODONTICS) (See Guideline Notes 64,65) COSMETIC DENTAL SERVICES 629 FINGERTIP AVULSION REPAIR WITHOUT PEDICLE GRAFT 630 MINOR HEAD INJURY: HEMATOMA/EDEMA WITH NO LOSS OF CONSCIOUSNESS (See Guideline Notes 64,65) MEDICAL THERAPY 631 VIRAL WARTS EXCLUDING VENEREAL WARTS (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT, CRYOSURGERY 632 ACUTE UPPER RESPIRATORY INFECTIONS AND COMMON COLD (See Guideline Notes 64,65) MEDICAL THERAPY 633 OTHER VIRAL INFECTIONS, EXCLUDING PNEUMONIA DUE TO RESPIRATORY SYNCYTIAL VIRUS IN PERSONS UNDER AGE 3 (See Guideline Notes 61,64,65) MEDICAL THERAPY 634 PHARYNGITIS AND LARYNGITIS AND OTHER DISEASES OF VOCAL CORDS (See Guideline Notes 64,65) MEDICAL THERAPY 635 ANOMALIES OF RELATIONSHIP OF JAW TO CRANIAL BASE, MAJOR ANOMALIES OF JAW SIZE, OTHER SPECIFIED AND UNSPECIFIED DENTOFACIAL ANOMALIES (See Guideline Notes 64,65) OSTEOPLASTY, MAXILLA/MANDIBLE 636 GALACTORRHEA, MASTODYNIA, ATROPHY, BENIGN NEOPLASMS AND UNSPECIFIED DISORDERS OF THE BREAST (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 637 HYPERTELORISM OF ORBIT (See Guideline Notes 64,65) ORBITOTOMY 638 OPEN WOUND OF INTERNAL STRUCTURES OF MOUTH WITHOUT COMPLICATION (See Guideline Notes 64,65) REPAIR SOFT TISSUES 639 SEBACEOUS CYST (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 640 SEBORRHEIC KERATOSIS, DYSCHROMIA, AND VASCULAR DISORDERS, SCAR CONDITIONS, AND FIBROSIS OF SKIN (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 641 REDUNDANT PREPUCE (See Guideline Notes 64,65) ELECTIVE CIRCUMCISION 642 STENOSIS OF NASOLACRIMAL DUCT (ACQUIRED) DACRYOCYSTORHINOSTOMY 643 CONJUNCTIVAL CYST (See Guideline Notes 64,65) EXCISION OF CONJUNCTIVAL CYST 644 BENIGN NEOPLASMS OF SKIN AND OTHER SOFT TISSUES (See Guideline Notes 64,65) MEDICAL THERAPY 645 DISEASE OF CAPILLARIES EXCISION 646 NONINFLAMMATORY DISORDERS OF CERVIX; HYPERTROPHY OF LABIA (See Guideline Notes 64,65) MEDICAL THERAPY 647 CYST, HEMORRHAGE, AND INFARCTION OF THYROID (See Guideline Notes 64,65) SURGICAL TREATMENT 648 PICA (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 649 ACUTE VIRAL CONJUNCTIVITIS (See Guideline Notes 64,65) MEDICAL THERAPY 650 MUSCULAR CALCIFICATION AND OSSIFICATION (See Guideline Notes 64,65) MEDICAL THERAPY 651 SUPERFICIAL WOUNDS WITHOUT INFECTION AND CONTUSIONS (See Guideline Notes 64,65) MEDICAL THERAPY 652 CHRONIC BRONCHITIS (See Guideline Notes 64,65) MEDICAL THERAPY 653 BENIGN POLYPS OF VOCAL CORDS (See Guideline Notes 64,65) MEDICAL THERAPY, STRIPPING 654 BENIGN NEOPLASMS OF DIGESTIVE SYSTEM (See Guideline Notes 64,65) SURGICAL TREATMENT 655 VARICOSE VEINS OF LOWER EXTREMITIES WITHOUT ULCER OR INFLAMMATION (See Guideline Notes 64,65) STRIPPING/SCLEROTHERAPY, MEDICAL THERAPY 656 CYST OF KIDNEY, ACQUIRED (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 657 GALLSTONES WITHOUT CHOLECYSTITIS (See Guideline Notes 64,65) MEDICAL THERAPY, CHOLECYSTECTOMY 658 DENTAL CONDITIONS WHERE TREATMENT RESULTS IN MARGINAL IMPROVEMENT (See Guideline Notes 62,64,65) ELECTIVE DENTAL SERVICES 659 GYNECOMASTIA MASTECTOMY 660 TMJ DISORDERS (See Guideline Notes 64,65) TMJ SURGERY 661 EDEMA AND OTHER CONDITIONS INVOLVING THE INTEGUMENT OF THE FETUS AND NEWBORN (See Guideline Notes 64,65) MEDICAL THERAPY 662 CONGENITAL CYSTIC LUNG - SEVERE LUNG RESECTION 663 AGENESIS OF LUNG (See Guideline Notes 64,65) MEDICAL THERAPY 664 CENTRAL RETINAL ARTERY OCCLUSION PARACENTESIS OF AQUEOUS 665 BENIGN LESIONS OF TONGUE (See Guideline Notes 64,65) EXCISION 666 UNCOMPLICATED HEMORRHOIDS (See Guideline Notes 64,65) HEMORRHOIDECTOMY, MEDICAL THERAPY 667 MENTAL DISORDERS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION 668 INTRACRANIAL CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION 669 INFECTIOUS DISEASES WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION 670 ENDOCRINE AND METABOLIC CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65,67) EVALUATION 671 CARDIOVASCULAR CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION 672 SENSORY ORGAN CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION 673 NEUROLOGIC CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION 674 DERMATOLOGICAL CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 29,64,65) EVALUATION 675 RESPIRATORY CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION 676 GENITOURINARY CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION 677 MUSCULOSKELETAL CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION 678 GASTROINTESTINAL CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION