ln Cond Treatment 1 PREGNANCY (See Guideline Notes 1,2,16,22,64,65,76,85,92) (See Prevention Tables) 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 3,16,64,65,76,79) (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) INTENSIVE NUTRITIONAL/PHYSICAL ACTIVITY COUNSELING AND BEHAVIORAL INTERVENTIONS 9 MAJOR DEPRESSION, RECURRENT; MAJOR DEPRESSION, SINGLE EPISODE, SEVERE (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 64,65,82) 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 64,65,82) MEDICAL/PSYCHOTHERAPY 33 TYPE II DIABETES MELLITUS (See Coding Specification Below) (See Guideline Notes 1,7,8,64,65,76) MEDICAL THERAPY, BARIATRIC SURGERY WITH BMI >= 35 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 1,64,65,84) 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 CONGENITAL AIRWAY OBSTRUCTION WITH OR WITHOUT CLEFT PALATE (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 ACUTE PELVIC INFLAMMATORY DISEASE (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 57 GONOCOCCAL INFECTIONS AND OTHER SEXUALLY TRANSMITTED DISEASES (See Guideline Notes 1,64,65) MEDICAL THERAPY 58 PREVENTIVE DENTAL SERVICES (See Guideline Note 17) CLEANING, FLUORIDE AND SEALANTS 59 HYDATIDIFORM MOLE (See Guideline Notes 64,65,76) D & C, HYSTERECTOMY 60 DENTAL CONDITIONS (EG. INFECTION, PAIN, TRAUMA) EMERGENCY DENTAL SERVICES 61 CHOLELITHIASIS, CHOLECYSTITIS, COMMON BILIARY DUCT STONE (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 62 ULCERS, GASTRITIS, DUODENITIS, AND GI HEMORRHAGE (See Guideline Notes 1,9,64,65,76) MEDICAL AND SURGICAL TREATMENT 63 FLAIL CHEST (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 64 BURN FULL THICKNESS GREATER THAN 10% OF BODY SURFACE (See Guideline Notes 1,6,64,65,76) FREE SKIN GRAFT, MEDICAL THERAPY 65 BRONCHIECTASIS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 66 END STAGE RENAL DISEASE (See Guideline Notes 1,7,64,65,76) MEDICAL THERAPY INCLUDING DIALYSIS 67 METABOLIC DISORDERS INCLUDING HYPERLIPIDEMIA (See Guideline Notes 1,64,65) MEDICAL THERAPY 68 SUBSTANCE-INDUCED DELUSIONAL AND MOOD DISORDERS; INTOXICATION (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 69 SPONTANEOUS ABORTION COMPLICATED BY INFECTION AND/OR HEMORRHAGE, MISSED ABORTION (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 70 SUBSTANCE-INDUCED DELIRIUM (See Guideline Notes 64,65) MEDICAL THERAPY 71 CONGENITAL ANOMALIES OF UPPER ALIMENTARY TRACT, EXCLUDING TONGUE (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 72 CANCRUM ORIS (See Guideline Notes 64,65) MEDICAL THERAPY 73 DISSEMINATED INFECTIONS WITH LOCALIZED SITES (See Guideline Notes 64,65,76) MEDICAL THERAPY 74 VENTRICULAR SEPTAL DEFECT (See Guideline Notes 1,6,64,65,76) CLOSURE 75 ACUTE BACTERIAL MENINGITIS (See Guideline Notes 6,64,65,76) MEDICAL THERAPY 76 ACUTE AND SUBACUTE ISCHEMIC HEART DISEASE, MYOCARDIAL INFARCTION (See Guideline Notes 1,6,13,64,65,76) MEDICAL AND SURGICAL TREATMENT 77 CONGENITAL PULMONARY VALVE STENOSIS (See Guideline Notes 64,65,76) PULMONARY VALVE REPAIR 78 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) 79 AGRANULOCYTOSIS (See Guideline Notes 1,7,11,14,64,65,76) BONE MARROW TRANSPLANTATION 80 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 81 POLYCYTHEMIA NEONATORUM, SYMPTOMATIC (See Guideline Notes 64,65) MEDICAL THERAPY 82 DERMATOMYOSITIS, POLYMYOSITIS (See Guideline Notes 1,64,65) MEDICAL THERAPY 83 ADDISON'S DISEASE (See Guideline Notes 64,65) MEDICAL THERAPY 84 DEEP ABSCESSES, INCLUDING APPENDICITIS AND PERIORBITAL ABSCESS; INTESTINAL PERFORATION (See Guideline Notes 1,36,64,65,76) MEDICAL AND SURGICAL TREATMENT 85 PATENT DUCTUS ARTERIOSUS; AORTIC PULMONARY FISTULA (See Guideline Notes 1,6,64,65,76) LIGATION 86 INJURY TO MAJOR BLOOD VESSELS OF EXTREMITIES (See Guideline Note 76) LIGATION/REPAIR 87 PHLEBITIS AND THROMBOPHLEBITIS, DEEP (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 88 INJURY TO INTERNAL ORGANS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 89 FRACTURE OF HIP, CLOSED (See Guideline Notes 6,15,64,65,76) MEDICAL AND SURGICAL TREATMENT 90 MYOCARDITIS (NONVIRAL), PERICARDITIS (NONVIRAL) AND ENDOCARDITIS (See Guideline Notes 6,64,65,76) MEDICAL AND SURGICAL TREATMENT 91 DEEP OPEN WOUND OF NECK, INCLUDING LARYNX; FRACTURE OF LARYNX OR TRACHEA, OPEN (See Guideline Notes 64,65,76) REPAIR 92 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 93 DISORDERS OF PANCREATIC ENDOCRINE SECRETION (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 94 ENDOCARDIAL CUSHION DEFECTS (See Guideline Notes 1,6,64,65,76) REPAIR 95 CONGENITAL PULMONARY VALVE ATRESIA (See Guideline Notes 6,64,65,76) SHUNT/REPAIR 96 CONGENITAL ANOMALIES OF URINARY SYSTEM (See Guideline Notes 1,64,65,76) RECONSTRUCTION 97 NECROTIZING ENTEROCOLITIS IN FETUS OR NEWBORN (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 98 TRANSPOSITION OF GREAT VESSELS (See Guideline Notes 1,6,64,65,76) REPAIR 99 CONGENITAL MITRAL VALVE STENOSIS/INSUFFICIENCY (See Guideline Notes 6,64,65,76) MITRAL VALVE REPAIR/REPLACEMENT 100 GUILLAIN-BARRE SYNDROME (See Guideline Notes 1,6,64,65,76) MEDICAL THERAPY 101 SEVERE/MODERATE HEAD INJURY: HEMATOMA/EDEMA WITH LOSS OF CONSCIOU0SNESS, COMPOUND/DEPRESSED FRACTURES OF SKULL (See Guideline Notes 1,6,64,65,76,90) MEDICAL AND SURGICAL TREATMENT 102 ACUTE LYMPHOCYTIC LEUKEMIA (CHILD) (See Guideline Notes 1,7,11,12,64,65,76) MEDICAL THERAPY, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 103 ACUTE LEUKEMIAS, MYELODYSPLASTIC SYNDROME (See Guideline Notes 1,7,11,12,14,76) BONE MARROW TRANSPLANT 104 UNDESCENDED TESTICLE (See Guideline Note 76) SURGICAL TREATMENT 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) MEDICAL, SURGICAL AND LASER TREATMENT 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 1,7,11,12,19,64,65,76) 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 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 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 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 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 Notes 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 1,6,64,65,90) 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 1,64,65,76,93) 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 Notes 1,76) EXCISION OF TUMOR 197 CANCER OF BREAST (See Guideline Notes 1,3,7,11,12,26,64,65,76,79,88) 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; CEREBRAL ANEURYSM; COMPRESSION OF BRAIN (See Guideline Notes 1,6,64,65,76,90) 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 1,6,64,65,86,90) CONSULTATION/MEDICATION MANAGEMENT/LIMITED BEHAVIORAL MODIFICATION 210 SLEEP APNEA AND NARCOLEPSY (See Guideline Notes 1,27,36,64,65,76) MEDICAL AND SURGICAL TREATMENT 211 ERYSIPELAS (See Guideline Notes 64,65) MEDICAL THERAPY 212 DEPRESSION AND OTHER MOOD DISORDERS, MILD OR MODERATE (See Guideline Notes 28,64,65,92) MEDICAL/PSYCHOTHERAPY 213 PNEUMOCOCCAL PNEUMONIA, OTHER BACTERIAL PNEUMONIA, BRONCHOPNEUMONIA (See Guideline Notes 64,65,76) MEDICAL THERAPY 214 SUPERFICIAL ABSCESSES AND CELLULITIS (See Coding Specification Below) (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 215 ZOONOTIC BACTERIAL DISEASES (See Guideline Notes 64,65) MEDICAL THERAPY 216 DEEP OPEN WOUND, WITH OR WITHOUT TENDON OR NERVE INVOLVEMENT (See Guideline Notes 6,64,65,76) MEDICAL AND SURGICAL TREATMENT 217 CHOANAL ATRESIA (See Guideline Notes 64,65,76) REPAIR OF CHOANAL ATRESIA 218 CANCER OF UTERUS (See Guideline Notes 1,7,11,12,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 219 RUPTURE OF LIVER (See Guideline Notes 64,65,76) SUTURE/REPAIR 220 CANCER OF THYROID (See Guideline Notes 1,7,11,12,19,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 221 NON-HODGKIN'S LYMPHOMAS (See Coding Specification Below) (See Guideline Notes 1,7,11,12,19,64,65,76) MEDICAL THERAPY, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 222 PATHOLOGICAL GAMBLING (See Guideline Notes 64,65) (Note: This line is not priced as part of the list as funding comes from non-OHP sources) MEDICAL/PSYCHOTHERAPY 223 BULLOUS DERMATOSES OF THE SKIN (See Guideline Notes 64,65,76) MEDICAL THERAPY 224 ESOPHAGEAL VARICES (See Guideline Notes 1,64,65,76,77) MEDICAL THERAPY/SHUNT/SCLEROTHERAPY 225 TOXIC EPIDERMAL NECROLYSIS AND STAPHYLOCOCCAL SCALDED SKIN SYNDROME; STEVENS-JOHNSON SYNDROME; ERYTHEMA MULTIFORME MAJOR; ECZEMA HERPETICUM (See Guideline Notes 64,65,76) MEDICAL THERAPY 226 ACUTE PULMONARY HEART DISEASE AND PULMONARY EMBOLI (See Guideline Notes 6,64,65,76) MEDICAL AND SURGICAL TREATMENT 227 CANDIDIASIS OF LUNG, DISSEMINATED CANDIDIASIS, CANDIDAL ENDOCARDITIS AND MENINGITIS (See Guideline Notes 1,64,65) MEDICAL THERAPY 228 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 229 CANCER OF STOMACH (See Guideline Notes 1,7,11,12,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 230 PORTAL VEIN THROMBOSIS (See Guideline Notes 64,65,76,77) MEDICAL AND SURGICAL TREATMENT 231 TESTICULAR CANCER (See Guideline Notes 7,11,12,14,30,76) BONE MARROW RESCUE AND TRANSPLANT 232 DENTAL CONDITIONS (EG. PERIODONTAL DISEASE) (See Guideline Note 53) BASIC PERIODONTICS 233 PULMONARY FIBROSIS (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 234 ANAPHYLACTIC SHOCK; EDEMA OF LARYNX (See Guideline Notes 64,65) MEDICAL THERAPY 235 DISORDERS OF FLUID, ELECTROLYTE, AND ACID-BASE BALANCE (See Guideline Notes 1,7,64,65,76) MEDICAL THERAPY, DIALYSIS 236 OCCUPATIONAL LUNG DISEASES (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 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 Coding Specification Below) (See Guideline Notes 64,65) 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, EISENMENGER'S 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 PARKINSON'S 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 Notes 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 1,6,64,65,76,81) 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 Coding Specification Below) (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 DENTAL CONDITIONS (TIME SENSITIVE EVENTS) URGENT DENTAL SERVICES 284 RICKETTSIAL AND OTHER ARTHROPOD-BORNE DISEASES (See Guideline Notes 64,65) MEDICAL THERAPY 285 DIABETES INSIPIDUS (See Guideline Notes 1,64,65) MEDICAL THERAPY 286 SYMPATHETIC UVEITIS AND DEGENERATIVE DISORDERS AND CONDITIONS OF GLOBE (See Guideline Notes 64,65,76) ENUCLEATION 287 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 288 TRAUMATIC AMPUTATION OF FOOT/FEET (COMPLETE)(PARTIAL) WITH AND WITHOUT COMPLICATION (See Guideline Notes 1,6,64,65,76) MEDICAL AND SURGICAL TREATMENT 289 ACUTE POLIOMYELITIS (See Guideline Notes 6,64,65) MEDICAL THERAPY 290 LEPROSY, YAWS, PINTA (See Guideline Notes 1,64,65) MEDICAL THERAPY 291 UROLOGIC INFECTIONS (See Guideline Notes 64,65,76) MEDICAL THERAPY 292 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 293 INJURY TO BLOOD VESSELS OF THE THORACIC CAVITY (See Guideline Notes 1,6,64,65,76) REPAIR 294 RUPTURE OF BLADDER, NONTRAUMATIC (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 295 OTHER PSYCHOTIC DISORDERS (See Guideline Notes 64,65,82) MEDICAL/PSYCHOTHERAPY 296 HYDROPS FETALIS (See Guideline Notes 64,65) MEDICAL THERAPY 297 DEFORMITY/CLOSED DISLOCATION OF JOINT (See Guideline Notes 6,64,65,76) SURGICAL TREATMENT 298 SENSORINEURAL HEARING LOSS - AGE 5 OR UNDER (See Guideline Notes 31,76) COCHLEAR IMPLANT 299 RETINAL DETACHMENT AND OTHER RETINAL DISORDERS (See Guideline Notes 64,65,76) RETINAL REPAIR, VITRECTOMY 300 ARTHROPOD-BORNE VIRAL DISEASES (See Guideline Notes 64,65) MEDICAL THERAPY 301 HYPOPLASIA AND DYSPLASIA OF LUNG (See Guideline Notes 64,65,76) MEDICAL THERAPY 302 CHRONIC RHEUMATIC PERICARDITIS, RHEUMATIC MYOCARDITIS (See Guideline Notes 1,6,64,65) MEDICAL THERAPY 303 BUDD-CHIARI SYNDROME, AND OTHER VENOUS EMBOLISM AND THROMBOSIS (See Guideline Notes 64,65,76,77) THROMBECTOMY/LIGATION 304 LIFE-THREATENING CARDIAC ARRHYTHMIAS (See Guideline Notes 1,6,64,65,76) MEDICAL AND SURGICAL TREATMENT 305 ANOREXIA NERVOSA (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 306 CHRONIC OBSTRUCTIVE PULMONARY DISEASE; CHRONIC RESPIRATORY FAILURE (See Guideline Notes 1,64,65) MEDICAL THERAPY 307 DISSECTING OR RUPTURED AORTIC ANEURYSM (See Guideline Notes 6,64,65,76) SURGICAL TREATMENT 308 COMPLICATIONS OF A PROCEDURE ALWAYS REQUIRING TREATMENT (See Coding Specification Below) (See Guideline Notes 6,64,65,76,90) MEDICAL AND SURGICAL TREATMENT 309 RUPTURE OF PAPILLARY MUSCLE (See Guideline Notes 6,64,65,76) MEDICAL AND SURGICAL TREATMENT 310 CHRONIC LEUKEMIAS; POLYCYTHEMIA RUBRA VERA (See Guideline Notes 1,7,11,12,64,65,76) MEDICAL THERAPY, WHICH INCLUDES CHEMOTHERAPY, RADIATION AND RADIONUCLEIDE THERAPY 311 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 312 CANCER OF ORAL CAVITY, PHARYNX, NOSE AND LARYNX (See Coding Specification Below) (See Guideline Notes 1,7,11,12,19,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 313 CONSTITUTIONAL APLASTIC ANEMIA (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 314 OSTEOPETROSIS (See Guideline Notes 1,7,11,14,76) BONE MARROW RESCUE AND TRANSPLANT 315 CRUSH INJURIES OF DIGITS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 316 ACUTE STRESS DISORDER (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 317 ADRENAL OR CUTANEOUS HEMORRHAGE OF FETUS OR NEONATE (See Guideline Notes 64,65) MEDICAL THERAPY 318 NEUROLOGICAL DYSFUNCTION IN POSTURE AND MOVEMENT CAUSED BY CHRONIC CONDITIONS (See Coding Specification Below) (See Guideline Notes 6,64,65,76) MEDICAL AND SURGICAL TREATMENT (EG. DURABLE MEDICAL EQUIPMENT AND ORTHOPEDIC PROCEDURE) 319 ANOMALIES OF GALLBLADDER, BILE DUCTS, AND LIVER (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 320 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 321 CATARACT, EXCLUDING CONGENITAL (See Guideline Notes 32,64,65,76) EXTRACTION OF CATARACT 322 AFTER CATARACT (See Guideline Note 76) DISCISSION, LENS CAPSULE 323 FISTULA INVOLVING FEMALE GENITAL TRACT (See Guideline Notes 64,65,76) CLOSURE OF FISTULA 324 VITREOUS DISORDERS (See Guideline Notes 64,65,76) VITRECTOMY 325 CLEFT PALATE AND/OR CLEFT LIP (See Guideline Notes 64,65,76,80) EXCISION AND REPAIR VESTIBULE OF MOUTH, ORTHODONTICS 326 GOUT AND CRYSTAL ARTHROPATHIES (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 327 PERTUSSIS AND DIPTHERIA (See Guideline Notes 64,65) MEDICAL THERAPY 328 THROMBOCYTOPENIA (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 329 DISORDERS OF AMINO-ACID TRANSPORT AND METABOLISM (NON PKU) (See Guideline Notes 64,65) MEDICAL THERAPY 330 PNEUMONIA DUE TO RESPIRATORY SYNCYTIAL VIRUS IN PERSONS UNDER AGE 3 (See Guideline Notes 64,65,76) MEDICAL THERAPY 331 DISORDERS OF ARTERIES, OTHER THAN CAROTID OR CORONARY (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 332 PARALYTIC ILEUS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 333 CIRRHOSIS OF LIVER OR BILIARY TRACT; BUDD-CHIARI SYNDROME; HEPATIC VEIN THROMBOSIS; INTRAHEPATIC VASCULAR MALFORMATIONS; CAROLI'S DISEASE (See Coding Specification Below) (See Guideline Notes 1,76) LIVER TRANSPLANT, LIVER-KIDNEY TRANSPLANT 334 AUTISM SPECTRUM DISORDERS (See Guideline Notes 1,64,65,75) CONSULTATION/MEDICATION MANAGEMENT/LIMITED BEHAVIORAL MODIFICATION 335 CHRONIC INFLAMMATORY DISORDER OF ORBIT (See Guideline Notes 64,65,76) MEDICAL THERAPY 336 CONGENITAL DISLOCATION OF HIP; COXA VARA AND VALGA (See Guideline Notes 6,64,65,76) SURGICAL TREATMENT 337 CORNEAL OPACITY AND OTHER DISORDERS OF CORNEA (See Guideline Notes 64,65,76) KERATOPLASTY 338 DISORDERS INVOLVING THE IMMUNE SYSTEM (See Guideline Notes 1,64,65) MEDICAL THERAPY 339 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 340 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 341 CANCER OF PANCREAS (See Guideline Notes 1,7,11,12,33,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 342 STROKE (See Guideline Notes 1,6,64,65,76,90) MEDICAL THERAPY 343 HEREDITARY ANGIOEDEMA; ANGIONEUROTIC EDEMA (See Guideline Notes 64,65) MEDICAL THERAPY 344 PURULENT ENDOPHTHALMITIS (See Guideline Notes 64,65,76) VITRECTOMY 345 FOREIGN BODY IN CORNEA AND CONJUNCTIVAL SAC (See Guideline Notes 64,65,76) REMOVAL CONJUNCTIVAL FOREIGN BODY 346 OTHER ANEURYSM OF PERIPHERAL ARTERY (See Guideline Note 76) SURGICAL TREATMENT 347 SIALOADENITIS, ABSCESS, FISTULA OF SALIVARY GLANDS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 348 CYSTICERCOSIS, OTHER CESTODE INFECTION, TRICHINOSIS (See Guideline Notes 64,65) MEDICAL THERAPY 349 NON-DISSECTING ANEURYSM WITHOUT RUPTURE (See Guideline Notes 6,64,65,76) SURGICAL TREATMENT 350 ARTERIAL ANEURYSM OF NECK (See Guideline Notes 6,76) REPAIR 351 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 352 ACUTE GLOMERULONEPHRITIS AND OTHER ACUTE RENAL FAILURE (See Guideline Notes 1,7,64,65,76) MEDICAL THERAPY INCLUDING DIALYSIS 353 VESICULAR FISTULA (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 354 COCCIDIOIDOMYCOSIS, HISTOPLASMOSIS, BLASTOMYCOTIC INFECTION, OPPORTUNISTIC AND OTHER MYCOSES (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 355 DISSEMINATED INTRAVASCULAR COAGULATION (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 356 CANCER OF PROSTATE GLAND (See Guideline Notes 1,7,11,12,64,65,76) MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY 357 SYSTEMIC SCLEROSIS (See Guideline Notes 1,64,65) MEDICAL THERAPY 358 ANAEROBIC INFECTIONS REQUIRING HYPERBARIC OXYGEN HYPERBARIC OXYGEN 359 BENIGN CEREBRAL CYSTS (See Guideline Note 76) DRAINAGE 360 ALCOHOLIC FATTY LIVER OR ALCOHOLIC HEPATITIS, CIRRHOSIS OF LIVER (See Guideline Notes 1,64,65,76,77) MEDICAL THERAPY 361 SCLERITIS (See Guideline Notes 64,65,76) MEDICAL THERAPY 362 RUBEOSIS IRIDIS (See Guideline Notes 64,65,76) LASER SURGERY 363 DISEASES OF ENDOCARDIUM (See Guideline Notes 6,64,65,76) MEDICAL THERAPY 364 WOUND OF EYE GLOBE (See Guideline Notes 64,65,76) SURGICAL REPAIR 365 ACUTE NECROSIS OF LIVER (See Guideline Notes 64,65) MEDICAL THERAPY 366 NEPHROTIC SYNDROME AND OTHER RENAL DISORDERS (See Guideline Notes 1,7,64,65,76) MEDICAL THERAPY INCLUDING DIALYSIS 367 IDIOPATHIC OR VIRAL MYOCARDITIS AND PERICARDITIS (See Guideline Notes 6,64,65,76) MEDICAL AND SURGICAL TREATMENT 368 HEREDITARY HEMORRHAGIC TELANGIECTASIA (See Guideline Note 76) EXCISION 369 RHEUMATIC FEVER (See Guideline Notes 6,64,65) MEDICAL THERAPY 370 HEREDITARY FRUCTOSE INTOLERANCE, INTESTINAL DISACCHARIDASE AND OTHER DEFICIENCIES (See Guideline Notes 1,64,65) MEDICAL THERAPY 371 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 372 DENTAL CONDITIONS (EG. CARIES, FRACTURED TOOTH) (See Guideline Note 91) BASIC RESTORATIVE (E.G. COMPOSITE RESTORATIONS FOR ANTERIOR TEETH, AMALGAM RESTORATIONS FOR POSTERIOR TEETH) 373 DENTAL CONDITIONS (EG. SEVERE CARIES, INFECTION) (See Guideline Notes 34,48) ORAL SURGERY (I.E. EXTRACTIONS AND OTHER INTRAORAL SURGICAL PROCEDURES) 374 RETROLENTAL FIBROPLASIA (See Guideline Note 76) CRYOSURGERY 375 NEUROLOGICAL DYSFUNCTION IN COMMUNICATION CAUSED BY CHRONIC CONDITIONS (See Guideline Notes 6,64,65,76,90) MEDICAL THERAPY 376 CARDIAC ARRHYTHMIAS (See Guideline Notes 1,6,64,65,76) MEDICAL THERAPY, PACEMAKER 377 MILD/MODERATE BIRTH TRAUMA FOR BABY (See Guideline Notes 1,64,65) MEDICAL THERAPY 378 ATHEROSCLEROSIS, PERIPHERAL (See Guideline Notes 6,64,65,76) SURGICAL TREATMENT 379 URINARY SYSTEM CALCULUS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 380 CONGENITAL ABSENCE OF VAGINA (See Guideline Note 76) ARTIFICIAL VAGINA 381 PENETRATING WOUND OF ORBIT (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 382 CLOSED FRACTURE OF EXTREMITIES (EXCEPT TOES) (See Guideline Notes 6,64,65,76) OPEN OR CLOSED REDUCTION 383 HEARING LOSS - AGE 5 OR UNDER (See Coding Specification Below) (See Guideline Notes 64,65,76) MEDICAL THERAPY INCLUDING HEARING AIDS 384 RHEUMATOID ARTHRITIS, OSTEOARTHRITIS, OSTEOCHONDRITIS DISSECANS, AND ASEPTIC NECROSIS OF BONE (See Guideline Notes 6,15,64,65,71,76,83) ARTHROPLASTY/RECONSTRUCTION 385 ANEURYSM OF PULMONARY ARTERY (See Guideline Notes 6,64,65,76) SURGICAL TREATMENT 386 BODY INFESTATIONS (EG. LICE, SCABIES) (See Guideline Notes 64,65) MEDICAL THERAPY 387 LYME DISEASE AND OTHER ARTHROPOD BORNE DISEASES (See Guideline Notes 1,6,64,65) MEDICAL THERAPY 388 DYSTONIA (UNCONTROLLABLE); LARYNGEAL SPASM AND STENOSIS (See Guideline Notes 64,65,76) MEDICAL THERAPY 389 CYST AND PSEUDOCYST OF PANCREAS (See Guideline Notes 64,65,76) DRAINAGE OF PANCREATIC CYST 390 CONVERSION DISORDER, CHILD (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 391 ACUTE SINUSITIS (See Guideline Notes 35,64,65,76) MEDICAL AND SURGICAL TREATMENT 392 HYPHEMA (See Guideline Note 76) REMOVAL OF BLOOD CLOT 393 ENTROPION (See Guideline Note 76) REPAIR 394 SPONTANEOUS ABORTION (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 395 STREPTOCOCCAL SORE THROAT AND SCARLET FEVER; VINCENT'S DISEASE; ULCER OF TONSIL; UNILATERAL HYPERTROPHY OF TONSIL (See Guideline Notes 36,64,65,76) MEDICAL THERAPY, TONSILLECTOMY/ADENOIDECTOMY 396 GIARDIASIS, INTESTINAL HELMINTHIASIS (See Guideline Notes 64,65) MEDICAL THERAPY 397 AMBLYOPIA (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 398 SOMATIZATION DISORDER; SOMATOFORM PAIN DISORDER (See Guideline Notes 64,65) CONSULTATION/BEHAVIORAL MANAGEMENT 399 TOXIC EFFECT OF GASES, FUMES, AND VAPORS REQUIRING HYPERBARIC OXYGEN HYPERBARIC OXYGEN 400 DISORDERS OF SPINE WITH NEUROLOGIC IMPAIRMENT (See Guideline Notes 1,6,37,64,65,72,76,94) MEDICAL AND SURGICAL TREATMENT 401 ENCEPHALOCELE (See Guideline Note 76) SURGICAL TREATMENT 402 BENIGN NEOPLASM OF RESPIRATORY AND INTRATHORACIC ORGANS (See Guideline Notes 64,65,76) LOBECTOMY, MEDICAL THERAPY, WHICH INCLUDES RADIATION THERAPY 403 IMPERFORATE HYMEN; ABNORMALITIES OF VAGINAL SEPTUM (See Guideline Note 76) SURGICAL TREATMENT 404 RETINAL TEAR (See Guideline Notes 64,65,76) LASER PROPHYLAXIS 405 CHOLESTEATOMA; INFECTIONS OF THE PINNA (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 406 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 407 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 1,6,38,64,65,76,90) MEDICAL THERAPY (SHORT TERM REHABILITATION WITH DEFINED GOALS) 408 ANEMIAS DUE TO DISEASE OR TREATMENT AND OTHER APLASTIC ANEMIAS (See Guideline Notes 64,65) MEDICAL THERAPY 409 ESOPHAGEAL STRICTURE (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 410 CHRONIC ULCER OF SKIN (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 411 ESOPHAGITIS; ESOPHAGEAL AND INTRAESOPHAGEAL HERNIAS (See Guideline Note 76) SURGICAL TREATMENT 412 BULIMIA NERVOSA (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 413 CENTRAL SEROUS RETINOPATHY (See Guideline Note 10) MEDICAL AND SURGICAL TREATMENT 414 DENTAL CONDITIONS (E.G. PULPAL PATHOLOGY, PERMANENT ANTERIOR TOOTH) BASIC ENDODONTICS (I.E. ROOT CANAL THERAPY) 415 SUPERFICIAL INJURIES WITH INFECTION (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 416 PITUITARY DWARFISM (See Guideline Notes 64,65,74) MEDICAL THERAPY 417 SEPARATION ANXIETY DISORDER (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 418 ACUTE OTITIS MEDIA (See Guideline Notes 29,64,65,76) MEDICAL AND SURGICAL TREATMENT 419 PANIC DISORDER; AGORAPHOBIA (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 420 CROUP SYNDROME, EPIGLOTTITIS, ACUTE LARYNGOTRACHEITIS (See Guideline Notes 64,65,76) MEDICAL THERAPY, INTUBATION, TRACHEOTOMY 421 ACHALASIA, NON-NEONATAL (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 422 ENDOMETRIOSIS AND ADENOMYOSIS (See Guideline Notes 1,39,64,65,76) MEDICAL AND SURGICAL TREATMENT 423 ESOPHAGITIS (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 424 INFLUENZA (See Guideline Note 87) MEDICAL THERAPY 425 EATING DISORDER NOS (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 426 ANOGENITAL VIRAL WARTS (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 427 LYMPHADENITIS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 428 UTERINE LEIOMYOMA (See Guideline Notes 40,64,65,76) TOTAL HYSTERECTOMY OR MYOMECTOMY 429 APHAKIA AND OTHER DISORDERS OF LENS (See Guideline Notes 64,65,76) INTRAOCULAR LENS 430 BILATERAL ANOMALIES OF EXTERNAL EAR WITH IMPAIRMENT OF HEARING (See Guideline Notes 64,65,76) RECONSTRUCT OF EAR CANAL 431 DISSOCIATIVE DISORDERS (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 432 EPIDERMOLYSIS BULLOSA (See Guideline Notes 1,64,65,76) MEDICAL THERAPY 433 DELIRIUM DUE TO MEDICAL CAUSES (See Guideline Notes 64,65) MEDICAL THERAPY 434 SPINAL DEFORMITY, CLINICALLY SIGNIFICANT (See Guideline Notes 1,6,41,64,65,76) MEDICAL AND SURGICAL TREATMENT 435 MIGRAINE HEADACHES (See Guideline Notes 1,64,65,92) MEDICAL THERAPY 436 DENTAL CONDITIONS (EG. PULPAL PATHOLOGY, PERMANENT BICUSPID/PREMOLAR TOOTH) BASIC ENDODONTICS (I.E. ROOT CANAL THERAPY) 437 SCHIZOTYPAL PERSONALITY DISORDERS (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 438 BALANOPOSTHITIS AND OTHER DISORDERS OF PENIS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 439 SICCA SYNDROME; POLYMYALGIA RHEUMATICA (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 440 TRANSIENT CEREBRAL ISCHEMIA; OCCLUSION/STENOSIS OF PRECEREBRAL ARTERIES WITHOUT OCCLUSION (See Guideline Notes 64,65,76) MEDICAL THERAPY; THROMBOENDARTERECTOMY 441 PERIPHERAL NERVE ENTRAPMENT (See Guideline Notes 6,64,65,76) MEDICAL AND SURGICAL TREATMENT 442 MENIERE'S DISEASE (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 443 DISORDERS OF SHOULDER, INCLUDING SPRAINS/STRAINS GRADE 3 THROUGH 6 (See Guideline Notes 6,64,65,76) REPAIR/RECONSTRUCTION, MEDICAL THERAPY 444 INCONTINENCE OF FECES (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 445 OPPOSITIONAL DEFIANT DISORDER (See Guideline Notes 42,64,65) MEDICAL/PSYCHOTHERAPY 446 MENSTRUAL BLEEDING DISORDERS (See Guideline Notes 1,44,64,65,76,88) MEDICAL AND SURGICAL TREATMENT 447 SARCOIDOSIS (See Guideline Notes 1,64,65) MEDICAL THERAPY 448 COMPLICATIONS OF A PROCEDURE USUALLY REQUIRING TREATMENT (See Guideline Notes 6,43,64,65,76) MEDICAL AND SURGICAL TREATMENT 449 ADRENOGENITAL DISORDERS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 450 NON-MALIGNANT OTITIS EXTERNA (See Guideline Notes 64,65,76) MEDICAL THERAPY 451 VAGINITIS, TRICHOMONIASIS (See Guideline Notes 64,65) MEDICAL THERAPY 452 STRABISMUS WITHOUT AMBLYOPIA AND OTHER DISORDERS OF BINOCULAR EYE MOVEMENTS; CONGENITAL ANOMALIES OF EYE (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 453 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 454 URETHRAL FISTULA (See Guideline Notes 64,65,76) EXCISION, MEDICAL THERAPY 455 INTERNAL DERANGEMENT OF KNEE AND LIGAMENTOUS DISRUPTIONS OF THE KNEE, GRADE II AND III (See Guideline Notes 6,64,65,76) REPAIR, MEDICAL THERAPY 456 OPEN WOUND OF EAR DRUM (See Guideline Note 76) TYMPANOPLASTY 457 CHRONIC DEPRESSION (DYSTHYMIA) (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 458 HYPOSPADIAS AND EPISPADIAS (See Guideline Notes 64,65,73,76,89) REPAIR 459 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 460 DYSTROPHY OF VULVA (See Guideline Notes 64,65,76) MEDICAL THERAPY 461 RECURRENT EROSION OF THE CORNEA (See Guideline Notes 64,65,76) CORNEAL TATTOO, REMOVAL OF CORNEAL EPITHELIUM; WITH OR WITHOUT CHEMOCAUTERIZATION 462 STEREOTYPY/HABIT DISORDER AND SELF-ABUSIVE BEHAVIOR DUE TO NEUROLOGICAL DYSFUNCTION (See Guideline Notes 1,64,65) CONSULTATION/MEDICATION MANAGEMENT/LIMITED BEHAVIORAL MODIFICATION 463 FOREIGN BODY IN UTERUS, VULVA AND VAGINA (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 464 RESIDUAL FOREIGN BODY IN SOFT TISSUE (See Guideline Note 76) REMOVAL 465 VENOUS TRIBUTARY (BRANCH) OCCLUSION; CENTRAL RETINAL VEIN OCCLUSION (See Guideline Notes 64,65,76) LASER SURGERY 466 TRIGEMINAL AND OTHER NERVE DISORDERS (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT, RADIATION THERAPY 467 MALUNION AND NONUNION OF FRACTURE (See Guideline Notes 6,64,65,76) SURGICAL TREATMENT 468 DENTAL CONDITIONS (EG. PULPAL PATHOLOGY, PERMANENT MOLAR TOOTH) BASIC ENDODONTICS (I.E. ROOT CANAL THERAPY) 469 ADJUSTMENT DISORDERS (See Coding Specification Below) (See Guideline Notes 45,64,65) MEDICAL/PSYCHOTHERAPY 470 HEARING LOSS - OVER AGE OF FIVE (See Guideline Notes 1,64,65,76) MEDICAL THERAPY INCLUDING HEARING AIDS 471 TOURETTE'S DISORDER AND TIC DISORDERS (See Guideline Notes 1,64,65) MEDICAL/PSYCHOTHERAPY 472 ATHEROSCLEROSIS, AORTIC AND RENAL (See Guideline Notes 1,64,65,76) MEDICAL AND SURGICAL TREATMENT 473 DEGENERATION OF MACULA AND POSTERIOR POLE (See Guideline Notes 46,64,65,76) VITRECTOMY, LASER SURGERY 474 REACTIVE ATTACHMENT DISORDER OF INFANCY OR EARLY CHILDHOOD (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 475 DISORDERS OF REFRACTION AND ACCOMMODATION (See Guideline Notes 64,65) MEDICAL THERAPY 476 EXOPHTHALMOS AND CYSTS OF THE EYE AND ORBIT (See Guideline Notes 64,65,76) SURGICAL TREATMENT 477 DENTAL CONDITIONS (EG. MISSING TEETH, PROSTHESIS FAILURE) (See Guideline Note 62) REMOVABLE PROSTHODONTICS (E.G. FULL AND PARTIAL DENTURES, RELINES) 478 URINARY INCONTINENCE (See Guideline Notes 1,6,47,64,65,76) MEDICAL AND SURGICAL TREATMENT 479 DISORDERS OF PLASMA PROTEIN METABOLISM (See Guideline Notes 64,65) MEDICAL THERAPY 480 DENTAL CONDITIONS (E.G. PULPAL PATHOLOGY, PERMANENT ANTERIOR TOOTH) ADVANCED ENDODONTICS (E.G. RETREATMENT OF PREVIOUS ROOT CANAL THERAPY) 481 FACTITIOUS DISORDERS (See Guideline Notes 64,65) CONSULTATION 482 NEONATAL CONJUNCTIVITIS, DACRYOCYSTITIS AND CANDIDA INFECTION (See Guideline Notes 64,65) MEDICAL THERAPY 483 SIMPLE AND SOCIAL PHOBIAS (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 484 ACUTE BRONCHITIS AND BRONCHIOLITIS (See Guideline Notes 64,65,76) MEDICAL THERAPY 485 CENTRAL PTERYGIUM (See Guideline Notes 64,65,76) EXCISION OR TRANSPOSITION OF PTERYGIUM WITHOUT GRAFT, RADIATION THERAPY 486 BRANCHIAL CLEFT CYST; THYROGLOSSAL DUCT CYST; CYST OF PHARYNX OR NASOPHARYNX (See Guideline Notes 64,65,76) EXCISION, MEDICAL THERAPY 487 OBSESSIVE-COMPULSIVE DISORDERS (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 488 OVERANXIOUS DISORDER; GENERALIZED ANXIETY DISORDER; ANXIETY DISORDER, UNSPECIFIED (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 489 OSTEOARTHRITIS AND ALLIED DISORDERS (See Guideline Notes 1,6,64,65,76) MEDICAL THERAPY, INJECTIONS 490 ATELECTASIS (COLLAPSE OF LUNG) (See Guideline Notes 64,65,76) MEDICAL THERAPY 491 SENSORINEURAL HEARING LOSS - OVER AGE OF FIVE (See Guideline Notes 1,49,76) COCHLEAR IMPLANT 492 UTERINE PROLAPSE; CYSTOCELE (See Guideline Notes 50,64,65,76) SURGICAL REPAIR 493 BRACHIAL PLEXUS LESIONS (See Guideline Notes 64,65,76) MEDICAL THERAPY 494 DENTAL CONDITIONS (EG. CARIES, FRACTURED TOOTH) ADVANCED RESTORATIVE (I.E. BASIC CROWNS) 495 OVARIAN DYSFUNCTION, GONADAL DYSGENISIS, MENOPAUSAL MANAGEMENT (See Guideline Notes 64,65,74,76,88) OOPHORECTOMY, ORCHIECTOMY, HORMONAL REPLACEMENT FOR PURPOSES OTHER THAN INFERTILITY 496 FUNCTIONAL ENCOPRESIS (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 497 PTOSIS (ACQUIRED) WITH VISION IMPAIRMENT (See Guideline Notes 64,65,76) PTOSIS REPAIR 498 CHRONIC SINUSITIS (See Guideline Notes 35,64,65,76) MEDICAL AND SURGICAL TREATMENT 499 KERATOCONJUNCTIVITS AND CORNEAL NEOVASCULARIZATION (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 500 SELECTIVE MUTISM (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 501 THROMBOSED AND COMPLICATED HEMORRHOIDS (See Guideline Notes 64,65,76) HEMORRHOIDECTOMY, INCISION 502 CHRONIC OTITIS MEDIA (See Guideline Notes 51,64,65,76) PE TUBES/ADENOIDECTOMY/TYMPANOPLASTY, MEDICAL THERAPY 503 RECTAL PROLAPSE (See Guideline Notes 64,65,76) SURGICAL TREATMENT 504 OTOSCLEROSIS (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 505 FOREIGN BODY IN EAR AND NOSE (See Guideline Notes 64,65,76) REMOVAL OF FOREIGN BODY 506 ANAL FISTULA; CHRONIC ANAL FISSURE (See Guideline Notes 1,52,64,65,76) SPHINCTEROTOMY, FISSURECTOMY, FISTULECTOMY, MEDICAL THERAPY 507 CLOSED DISLOCATIONS/FRACTURES OF NON-CERVICAL VERTEBRAL COLUMN WITHOUT SPINAL CORD INJURY (See Guideline Notes 6,64,65,76) MEDICAL AND SURGICAL TREATMENT 508 CONDUCT DISORDER, AGE 18 OR UNDER (See Guideline Notes 54,64,65) MEDICAL/PSYCHOTHERAPY 509 BREAST CYSTS AND OTHER DISORDERS OF THE BREAST (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 510 CERVICITIS, ENDOCERVICITIS, HEMATOMA OF VULVA, AND NONINFLAMMATORY DISORDERS OF THE VAGINA (See Guideline Notes 64,65,76) MEDICAL AND SURGICAL TREATMENT 511 CYSTS OF BARTHOLIN'S GLAND AND VULVA (See Guideline Notes 64,65,76) INCISION AND DRAINAGE, MEDICAL THERAPY 512 LICHEN PLANUS (See Guideline Notes 64,65) MEDICAL THERAPY 513 RUPTURE OF SYNOVIUM REMOVAL OF BAKER'S CYST 514 ENOPHTHALMOS (See Guideline Notes 64,65) ORBITAL IMPLANT 515 BELL'S PALSY, EXPOSURE KERATOCONJUNCTIVITIS (See Guideline Notes 64,65) TARSORRHAPHY 516 PERIPHERAL ENTHESOPATHIES (See Guideline Notes 6,64,65) MEDICAL THERAPY 517 DERMATOPHYTOSIS OF NAIL, GROIN, AND FOOT AND OTHER DERMATOMYCOSIS (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 518 CONVERSION DISORDER, ADULT (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 519 CLOSED FRACTURES OF RIBS, STERNUM AND COCCYX (See Guideline Notes 64,65) MEDICAL THERAPY 520 SPASTIC DIPLEGIA RHIZOTOMY 521 GENDER IDENTIFICATION DISORDER, PARAPHILIAS AND OTHER PSYCHOSEXUAL DISORDERS (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 522 DENTAL CONDITIONS (EG. PERIODONTAL DISEASE) ADVANCED PERIODONTICS (E.G. SURGICAL PROCEDURES AND SPLINTING) 523 HEPATORENAL SYNDROME (See Guideline Notes 64,65) MEDICAL THERAPY 524 ECTROPION, TRICHIASIS OF EYELID, BENIGN NEOPLASM OF EYELID ECTROPION REPAIR 525 PHIMOSIS SURGICAL TREATMENT 526 CERUMEN IMPACTION (See Guideline Notes 64,65) REMOVAL OF EAR WAX 527 SIALOLITHIASIS, MUCOCELE, DISTURBANCE OF SALIVARY SECRETION, OTHER AND UNSPECIFIED DISEASES OF SALIVARY GLANDS (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 528 CHRONIC CONJUNCTIVITIS, BLEPHAROCONJUNCTIVITIS (See Guideline Notes 64,65) MEDICAL THERAPY 529 OTHER DISORDERS OF SYNOVIUM, TENDON AND BURSA, COSTOCHONDRITIS, AND CHONDRODYSTROPHY (See Guideline Notes 64,65) MEDICAL THERAPY 530 TOXIC ERYTHEMA, ACNE ROSACEA, DISCOID LUPUS (See Guideline Notes 64,65) MEDICAL THERAPY 531 PERIPHERAL ENTHESOPATHIES SURGICAL TREATMENT 532 NASAL POLYPS, OTHER DISORDERS OF NASAL CAVITY AND SINUSES (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 533 DENTAL CONDITIONS (E.G. PULPAL PATHOLOGY, PERMANENT BICUSPID/PREMOLAR TOOTH) ADVANCED ENDODONTICS (E.G. RETREATMENT OF PREVIOUS ROOT CANAL THERAPY) 534 CIRCUMSCRIBED SCLERODERMA (See Guideline Notes 64,65) MEDICAL THERAPY 535 PERIPHERAL NERVE DISORDERS (See Guideline Notes 64,65) MEDICAL THERAPY 536 CLOSED FRACTURE OF GREAT TOE (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 537 DYSFUNCTION OF NASOLACRIMAL SYSTEM; LACRIMAL SYSTEM LACERATION (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 538 BENIGN NEOPLASM OF KIDNEY AND OTHER URINARY ORGANS (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 539 VERTIGINOUS SYNDROMES AND OTHER DISORDERS OF VESTIBULAR SYSTEM (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 540 CLOSED FRACTURE OF ONE OR MORE PHALANGES OF THE FOOT, NOT INCLUDING THE GREAT TOE MEDICAL AND SURGICAL TREATMENT 541 PHLEBITIS AND THROMBOPHLEBITIS, SUPERFICIAL (See Guideline Notes 64,65) MEDICAL THERAPY 542 DISORDERS OF SWEAT GLANDS (See Guideline Notes 64,65) MEDICAL THERAPY 543 PARALYSIS OF VOCAL CORDS OR LARYNX (See Guideline Notes 64,65) INCISION/EXCISION/ENDOSCOPY 544 DELUSIONAL DISORDER (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 545 CYSTIC ACNE (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 546 SEXUAL DYSFUNCTION (See Guideline Notes 64,65) PSYCHOTHERAPY, MEDICAL AND SURGICAL TREATMENT 547 UNCOMPLICATED HERNIA (OTHER THAN INGUINAL HERNIA IN CHILDREN AGE 18 AND UNDER OR DIAPHRAGMATIC HERNIA) (See Guideline Notes 64,65) REPAIR 548 BENIGN NEOPLASM OF NASAL CAVITIES, MIDDLE EAR AND ACCESSORY SINUSES EXCISION, RECONSTRUCTION 549 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 550 DEFORMITIES OF UPPER BODY AND ALL LIMBS (See Guideline Notes 64,65) REPAIR/REVISION/RECONSTRUCTION/RELOCATION/MEDICAL THERAPY 551 DISORDERS OF FUNCTION OF STOMACH AND OTHER FUNCTIONAL DIGESTIVE DISORDERS (See Guideline Notes 64,65) MEDICAL THERAPY 552 PELVIC PAIN SYNDROME, DYSPAREUNIA (See Guideline Notes 55,64,65) MEDICAL AND SURGICAL TREATMENT 553 ATOPIC DERMATITIS (See Guideline Notes 64,65) MEDICAL THERAPY 554 CONTACT DERMATITIS AND OTHER ECZEMA (See Guideline Notes 64,65) MEDICAL THERAPY 555 HYPOTENSION (See Guideline Notes 64,65) MEDICAL THERAPY 556 VIRAL, SELF-LIMITING ENCEPHALITIS, MYELITIS AND ENCEPHALOMYELITIS (See Guideline Notes 61,64,65) MEDICAL THERAPY 557 PERIPHERAL NERVE DISORDERS SURGICAL TREATMENT 558 DENTAL CONDITIONS (E.G. PULPAL PATHOLOGY, PERMANENT MOLAR TOOTH) ADVANCED ENDODONTICS (E.G. RETREATMENT OF PREVIOUS ROOT CANAL THERAPY) 559 ICHTHYOSIS (See Guideline Notes 64,65) MEDICAL THERAPY 560 RAYNAUD'S SYNDROME (See Guideline Notes 64,65) MEDICAL THERAPY 561 LESION OF PLANTAR NERVE; PLANTAR FASCIAL FIBROMATOSIS (See Guideline Notes 64,65) MEDICAL THERAPY, EXCISION 562 ACUTE AND CHRONIC DISORDERS OF SPINE WITHOUT NEUROLOGIC IMPAIRMENT (See Guideline Notes 6,56,64,65,72,94) MEDICAL AND SURGICAL TREATMENT 563 TENSION HEADACHES (See Guideline Notes 64,65,92) MEDICAL THERAPY 564 MILD PSORIASIS ; DERMATOPHYTOSIS: SCALP, HAND, BODY, DEEP-SEATED (See Guideline Notes 57,64,65) MEDICAL THERAPY 565 DEFORMITIES OF FOOT (See Guideline Notes 64,65) FASCIOTOMY/INCISION/REPAIR/ARTHRODESIS 566 GRANULOMA OF MUSCLE, GRANULOMA OF SKIN AND SUBCUTANEOUS TISSUE (See Guideline Notes 64,65,76) REMOVAL OF GRANULOMA 567 HYDROCELE (See Guideline Notes 64,65) MEDICAL THERAPY, EXCISION 568 SYMPTOMATIC URTICARIA (See Guideline Notes 64,65) MEDICAL THERAPY 569 IMPULSE DISORDERS EXCLUDING PATHOLOGICAL GAMBLING (See Guideline Notes 58,64,65) MEDICAL/PSYCHOTHERAPY 570 SUBLINGUAL, SCROTAL, AND PELVIC VARICES (See Guideline Notes 64,65) VENOUS INJECTION, VASCULAR SURGERY 571 ASEPTIC MENINGITIS (See Guideline Notes 61,64,65) MEDICAL THERAPY 572 TMJ DISORDER (See Guideline Notes 64,65) TMJ SPLINTS 573 XEROSIS (See Guideline Notes 64,65) MEDICAL THERAPY 574 CHRONIC DISEASE OF TONSILS AND ADENOIDS (See Guideline Notes 36,64,65) TONSILLECTOMY AND ADENOIDECTOMY 575 OTHER NONINFECTIOUS GASTROENTERITIS AND COLITIS (See Guideline Notes 61,64,65) MEDICAL THERAPY 576 SHYNESS DISORDER OF CHILDHOOD OR ADOLESCENCE (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 577 HEMATOMA OF AURICLE OR PINNA AND HEMATOMA OF EXTERNAL EAR (See Guideline Notes 64,65) DRAINAGE 578 KERATODERMA, ACANTHOSIS NIGRICANS, STRIAE ATROPHICAE, AND OTHER HYPERTROPHIC OR ATROPHIC CONDITIONS OF SKIN (See Guideline Notes 64,65) MEDICAL THERAPY 579 CHRONIC PROSTATITIS, OTHER DISORDERS OF PROSTATE (See Guideline Notes 64,65) MEDICAL THERAPY 580 CHONDROMALACIA (See Guideline Notes 6,64,65) MEDICAL THERAPY 581 DYSMENORRHEA (See Guideline Notes 59,64,65) MEDICAL AND SURGICAL TREATMENT 582 OPEN WOUND OF EAR DRUM (See Guideline Notes 64,65) MEDICAL THERAPY 583 SPASTIC DYSPHONIA (See Guideline Notes 64,65) MEDICAL THERAPY 584 MACROMASTIA BREAST REDUCTION 585 ALLERGIC RHINITIS AND CONJUNCTIVITIS, CHRONIC RHINITIS (See Guideline Notes 64,65) MEDICAL THERAPY 586 CANCER OF LIVER AND INTRAHEPATIC BILE DUCTS (See Guideline Note 12) LIVER TRANSPLANT 587 BENIGN NEOPLASM OF EXTERNAL FEMALE GENITAL ORGANS EXCISION 588 RUMINATION DISORDER OF INFANCY (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 589 HORDEOLUM AND OTHER DEEP INFLAMMATION OF EYELID; CHALAZION (See Guideline Notes 64,65) INCISION AND DRAINAGE, MEDICAL THERAPY 590 CONDUCTIVE HEARING LOSS AUDIANT BONE CONDUCTORS 591 ACUTE ANAL FISSURE (See Guideline Notes 64,65) FISSURECTOMY, MEDICAL THERAPY 592 PLEURISY (See Guideline Notes 64,65) MEDICAL THERAPY 593 PERITONEAL ADHESION SURGICAL TREATMENT 594 DERMATITIS DUE TO SUBSTANCES TAKEN INTERNALLY (See Guideline Notes 64,65) MEDICAL THERAPY 595 BLEPHARITIS (See Guideline Notes 64,65) MEDICAL THERAPY 596 UNSPECIFIED URINARY OBSTRUCTION AND BENIGN PROSTATIC HYPERPLASIA WITHOUT OBSTRUCTION (See Guideline Notes 64,65) MEDICAL THERAPY 597 OTHER COMPLICATIONS OF A PROCEDURE (See Guideline Notes 6,43,64,65) MEDICAL AND SURGICAL TREATMENT 598 LYMPHEDEMA (See Guideline Notes 43,64,65) MEDICAL THERAPY, OTHER OPERATION ON LYMPH CHANNEL 599 ACUTE NON-SUPPURATIVE LABYRINTHITIS (See Guideline Notes 64,65) MEDICAL THERAPY 600 DEVIATED NASAL SEPTUM, ACQUIRED DEFORMITY OF NOSE, OTHER DISEASES OF UPPER RESPIRATORY TRACT (See Guideline Notes 64,65) EXCISION OF CYST/RHINECTOMY/PROSTHESIS 601 STOMATITIS AND OTHER DISEASES OF ORAL SOFT TISSUES (See Guideline Notes 64,65) INCISION AND DRAINAGE, MEDICAL THERAPY 602 CAVUS DEFORMITY OF FOOT; FLAT FOOT; POLYDACTYLY AND SYNDACTYLY OF TOES (See Guideline Notes 64,65) MEDICAL THERAPY, ORTHOTIC 603 ERYTHEMA MULTIFORME MINOR (See Guideline Notes 64,65) MEDICAL THERAPY 604 INFECTIOUS MONONUCLEOSIS (See Guideline Notes 64,65) MEDICAL THERAPY 605 URETHRITIS, NON-SEXUALLY TRANSMITTED (See Guideline Notes 64,65) MEDICAL THERAPY 606 CONGENITAL ANOMALIES OF FEMALE GENITAL ORGANS EXCLUDING VAGINA (See Guideline Notes 64,65) SURGICAL TREATMENT 607 SPINAL DEFORMITY, NOT CLINICALLY SIGNIFICANT (See Guideline Notes 60,64,65) ARTHRODESIS/REPAIR/RECONSTRUCTION, MEDICAL THERAPY 608 ANTI-SOCIAL PERSONALITY DISORDER (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 609 PERSONALITY DISORDERS EXCLUDING BORDERLINE, SCHIZOTYPAL AND ANTI-SOCIAL (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 610 CANDIDIASIS OF MOUTH, SKIN AND NAILS (See Guideline Notes 64,65) MEDICAL THERAPY 611 BENIGN NEOPLASM OF MALE GENITAL ORGANS: TESTIS, PROSTATE, EPIDIDYMIS (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 612 ATROPHY OF EDENTULOUS ALVEOLAR RIDGE VESTIBULOPLASTY, GRAFTS, IMPLANTS 613 OLD LACERATION OF CERVIX AND VAGINA (See Guideline Notes 64,65) MEDICAL THERAPY 614 VULVAL VARICES (See Guideline Notes 64,65) VASCULAR SURGERY 615 DISEASE OF NAILS, HAIR AND HAIR FOLLICLES (See Guideline Notes 64,65) MEDICAL THERAPY 616 OBESITY (See Guideline Notes 8,64,65) NON-INTENSIVE NUTRITIONAL/PHYSICAL ACTIVITY COUNSELING AND BEHAVIORAL INTERVENTIONS; BARIATRIC SURGERY FOR OBESITY WITH A SIGNIFICANT COMORBIDITY OTHER THAN TYPE II DIABETES & BMI >=35 OR BMI>=40 WITHOUT A SIGNIFICANT COMORBIDITY 617 ACUTE TONSILLITIS OTHER THAN BETA-STREPTOCOCCAL (See Guideline Notes 64,65) MEDICAL THERAPY 618 CORNS AND CALLUSES (See Guideline Notes 64,65) MEDICAL THERAPY 619 SYNOVITIS AND TENOSYNOVITIS (See Guideline Notes 6,64,65) MEDICAL THERAPY 620 PROLAPSED URETHRAL MUCOSA (See Guideline Notes 64,65) SURGICAL TREATMENT 621 DENTAL CONDITIONS (EG. CARIES, FRACTURED TOOTH) ADVANCED RESTORATIVE-ELECTIVE (INLAYS,ONLAYS,GOLD FOIL AND HIGH NOBLE METAL RESTORATIONS) 622 SECONDARY AND ILL-DEFINED MALIGNANT NEOPLASMS (See Guideline Notes 7,11,12,64,65) MEDICAL AND SURGICAL TREATMENT 623 GANGLION (See Guideline Notes 64,65) EXCISION 624 EPISCLERITIS (See Guideline Notes 64,65) MEDICAL THERAPY 625 DIAPER RASH (See Guideline Notes 64,65) MEDICAL THERAPY 626 TONGUE TIE AND OTHER ANOMALIES OF TONGUE FRENOTOMY, TONGUE TIE 627 CYSTS OF ORAL SOFT TISSUES (See Guideline Notes 64,65) INCISION AND DRAINAGE 628 CONGENITAL DEFORMITIES OF KNEE (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 629 CHRONIC PANCREATITIS SURGICAL TREATMENT 630 HERPES SIMPLEX WITHOUT COMPLICATIONS, EXCLUDING GENITAL HERPES (See Guideline Notes 64,65) MEDICAL THERAPY 631 DENTAL CONDITIONS (EG. MISSING TEETH) COMPLEX PROSTHODONTICS (I.E. FIXED BRIDGES, OVERDENTURES) 632 CONGENITAL ANOMALIES OF THE EAR WITHOUT IMPAIRMENT OF HEARING; UNILATERAL ANOMALIES OF THE EAR OTOPLASTY, REPAIR AND AMPUTATION 633 KELOID SCAR; OTHER ABNORMAL GRANULATION TISSUE INTRALESIONAL INJECTIONS/DESTRUCTION/EXCISION, RADIATION THERAPY 634 DISORDERS OF SOFT TISSUE (See Guideline Notes 64,65,72) MEDICAL THERAPY 635 MINOR BURNS (See Guideline Notes 64,65) MEDICAL THERAPY 636 DISORDERS OF SLEEP WITHOUT SLEEP APNEA (See Guideline Notes 64,65) MEDICAL THERAPY 637 ORAL APHTHAE (See Guideline Notes 64,65) MEDICAL THERAPY 638 SPRAINS AND STRAINS OF ADJACENT MUSCLES AND JOINTS, MINOR (See Guideline Notes 6,64,65) MEDICAL THERAPY 639 ASYMPTOMATIC URTICARIA (See Guideline Notes 64,65) MEDICAL THERAPY 640 FINGERTIP AVULSION REPAIR WITHOUT PEDICLE GRAFT 641 MINOR HEAD INJURY: HEMATOMA/EDEMA WITH NO LOSS OF CONSCIOUSNESS (See Guideline Notes 64,65) MEDICAL THERAPY 642 VIRAL WARTS EXCLUDING VENEREAL WARTS (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT, CRYOSURGERY 643 ACUTE UPPER RESPIRATORY INFECTIONS AND COMMON COLD (See Guideline Notes 64,65) MEDICAL THERAPY 644 OTHER VIRAL INFECTIONS, EXCLUDING PNEUMONIA DUE TO RESPIRATORY SYNCYTIAL VIRUS IN PERSONS UNDER AGE 3 (See Guideline Notes 61,64,65,69) MEDICAL THERAPY 645 PHARYNGITIS AND LARYNGITIS AND OTHER DISEASES OF VOCAL CORDS (See Guideline Notes 64,65) MEDICAL THERAPY 646 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 647 DENTAL CONDITIONS (EG. MALOCCLUSION) ORTHODONTIA (I.E. FIXED AND REMOVABLE APPLIANCES AND ASSOCIATED SURGICAL PROCEDURES) 648 DENTAL CONDITIONS (EG. MISSING TEETH) IMPLANTS (I.E. IMPLANT PLACEMENT AND ASSOCIATED CROWN OR PROSTHESIS) 649 UNCOMPLICATED HEMORRHOIDS (See Guideline Notes 64,65) HEMORRHOIDECTOMY, MEDICAL THERAPY 650 OPEN WOUND OF INTERNAL STRUCTURES OF MOUTH WITHOUT COMPLICATION (See Guideline Notes 64,65) REPAIR SOFT TISSUES 651 SEBACEOUS CYST (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 652 SEBORRHEIC KERATOSIS, DYSCHROMIA, AND VASCULAR DISORDERS, SCAR CONDITIONS, AND FIBROSIS OF SKIN (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 653 REDUNDANT PREPUCE (See Guideline Notes 64,65) ELECTIVE CIRCUMCISION 654 STENOSIS OF NASOLACRIMAL DUCT (ACQUIRED) DACRYOCYSTORHINOSTOMY 655 CONJUNCTIVAL CYST (See Guideline Notes 64,65) EXCISION OF CONJUNCTIVAL CYST 656 BENIGN NEOPLASMS OF SKIN AND OTHER SOFT TISSUES (See Guideline Notes 64,65) MEDICAL THERAPY 657 DISEASE OF CAPILLARIES EXCISION 658 NONINFLAMMATORY DISORDERS OF CERVIX; HYPERTROPHY OF LABIA (See Guideline Notes 64,65) MEDICAL THERAPY 659 CYST, HEMORRHAGE, AND INFARCTION OF THYROID (See Guideline Notes 64,65) SURGICAL TREATMENT 660 PICA (See Guideline Notes 64,65) MEDICAL/PSYCHOTHERAPY 661 ACUTE VIRAL CONJUNCTIVITIS (See Guideline Notes 64,65) MEDICAL THERAPY 662 MUSCULAR CALCIFICATION AND OSSIFICATION (See Guideline Notes 64,65) MEDICAL THERAPY 663 SUPERFICIAL WOUNDS WITHOUT INFECTION AND CONTUSIONS (See Guideline Notes 64,65) MEDICAL THERAPY 664 CHRONIC BRONCHITIS (See Guideline Notes 64,65) MEDICAL THERAPY 665 GALACTORRHEA, MASTODYNIA, ATROPHY, BENIGN NEOPLASMS AND UNSPECIFIED DISORDERS OF THE BREAST (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 666 BENIGN POLYPS OF VOCAL CORDS (See Guideline Notes 64,65) MEDICAL THERAPY, STRIPPING 667 BENIGN NEOPLASMS OF DIGESTIVE SYSTEM (See Guideline Notes 64,65) SURGICAL TREATMENT 668 VARICOSE VEINS OF LOWER EXTREMITIES WITHOUT ULCER OR INFLAMMATION (See Guideline Notes 64,65) STRIPPING/SCLEROTHERAPY, MEDICAL THERAPY 669 CYST OF KIDNEY, ACQUIRED (See Guideline Notes 64,65) MEDICAL AND SURGICAL TREATMENT 670 HYPERTELORISM OF ORBIT (See Guideline Notes 64,65) ORBITOTOMY 671 GALLSTONES WITHOUT CHOLECYSTITIS (See Guideline Notes 64,65) MEDICAL THERAPY, CHOLECYSTECTOMY 672 GYNECOMASTIA MASTECTOMY 673 TMJ DISORDERS (See Guideline Notes 64,65) TMJ SURGERY 674 EDEMA AND OTHER CONDITIONS INVOLVING THE INTEGUMENT OF THE FETUS AND NEWBORN (See Guideline Notes 64,65) MEDICAL THERAPY 675 DENTAL CONDITIONS WHERE TREATMENT IS CHOSEN PRIMARILY FOR AESTHETIC CONSIDERATIONS COSMETIC DENTAL SERVICES 676 DENTAL CONDITIONS WHERE TREATMENT RESULTS IN MARGINAL IMPROVEMENT ELECTIVE DENTAL SERVICES 677 CONGENITAL CYSTIC LUNG - SEVERE LUNG RESECTION 678 AGENESIS OF LUNG (See Guideline Notes 64,65) MEDICAL THERAPY 679 CENTRAL RETINAL ARTERY OCCLUSION PARACENTESIS OF AQUEOUS 680 BENIGN LESIONS OF TONGUE (See Guideline Notes 64,65) EXCISION 681 MENTAL DISORDERS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION 682 INTRACRANIAL CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION 683 INFECTIOUS DISEASES WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION 684 ENDOCRINE AND METABOLIC CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65,67) EVALUATION 685 CARDIOVASCULAR CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION 686 SENSORY ORGAN CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION 687 NEUROLOGIC CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION 688 DERMATOLOGICAL CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION 689 RESPIRATORY CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION 690 GENITOURINARY CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65,73) EVALUATION 691 MUSCULOSKELETAL CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION 692 GASTROINTESTINAL CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65) EVALUATION