U. S.

ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL

FORT SAM HOUSTON, TEXAS 78234

MD0753
MEDICAL RECORDS
ADMINISTRATION BRANCH I
(BOOK 2 OF 2)

EDITION 101
 TABLE OF CONTENTS

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

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 APPENDIX A - CODING PRINCIPLES

EXPLANATION

There are specific guidelines for coding diagnoses and surgical procedures. This
appendix contains excerpts of coding principles (modified for instructional purposes)
from the Individual Patient Data System (IPDS) User's Manual published by the U.S.
Army Patient Administration Systems and Biostatistics Activity (PAS&BA). These
excerpts provide coding principles for diagnostic and operative coding using the
ICD-9-CM. The IPDS User's Manual includes additional principles that are not provided
in this appendix. The numbers for each of the principles in this appendix are the same
as the corresponding principle in the IPDS User's Manual so you will be able to identify
the principles that are not covered in this subcourse.

In previous lessons, you have reviewed the preliminary coding guidelines that, for the
most part, are applicable generically; i.e., they apply to all coding processes. To
provide more specific guidance, this appendix includes 18 principles in short, narrative
form. However, each coder should have his/her own copy of the Triservice Disease and
Procedure Coding Guidelines ICD-9-CM , which became effective 1 January 1991.

Principle I. SUSPECTED CONDITIONS

1. Qualifying adjectives used in the final diagnostic statement imply that a final
judgment has not been made. When words such as "suspected," "probable,"
"questionable," "likely," etc., are used in the diagnosis, code the condition as if it were a
confirmed diagnosis.

2. The code assigned to the questionable condition may be used as the principal
diagnosis if it was proven to be the condition, after study, that occasioned this
admission.

3. Qualifying adjectives such as "Rule Out," "R/O," and "Ruled Out" present special
problems for which the following coding rules have been developed.
a. Rule Out and R/O. When these words appear in the final diagnostic statement,
they have the same meaning as "suspected" and are to be coded as if the condition
were confirmed.

b. When "Ruled Out," "Not Proven," "Not Confirmed," and "No Evidence Of" appear
as part of the diagnosis or the diagnosis is stated in terms which indicate the absence of
the condition under investigation, the appropriate code from the Supplementary
Classification (V71 category) will be used. The medical record documentation must
support the investigation of the suspected condition. Admissions following head trauma
where there is no visible evidence of injury and which after observation show no
evidence of after effects are coded to V71.4--Ø, the code extender for Observation,
head injury, ruled out. (V713-V716 categories require STANAG Cause of Injury Code
and Trauma code.) Note that codes from the V71 category may only be used as a
principal diagnosis.

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 4. Acute and Chronic. When a specific disease is stated as both acute and chronic
and the Alphabetic Index provides separate codes for each condition, both will be
coded. If the condition described as both acute and chronic was listed as the cause of
admission, the acute condition will be indicated as the principal diagnosis.

5. Subacute. If the condition is stated as subacute and the Alphabetic Index does not
provide a specific code for the subacute stage, then the code provided for the acute
stage of the condition will be used.

6. Acute Upper Respiratory Infection (URI). Occasionally, this diagnosis is written

as Acute Respiratory Disease (ARD). Either of the terms used with conditions that are
clearly Acute Upper Respiratory Infection should be coded to 465 category.

APPLICATION

1. Suspected Conditions. When the final diagnosis is qualified as possible,

suspected, probable, etc., it is coded as a confirmed diagnosis.

EXAMPLE:

DIAGNOSIS: Suspected pneumococcal pneumonia 481

2. Rule Out, R/O. These terms indicate a suspected condition and are coded as
confirmed diagnoses.

EXAMPLE:

DIAGNOSIS: Rule Out Sepsis. Ø38.9

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

a. DIAGNOSIS: Pulmonary emboli, ruled out. V71.8

b. DIAGNOSIS: Questionable concussion, ruled out. V71.4--Ø

4. Acute/Subacute and Chronic. If a disease is stated as both acute/subacute and

chronic and the Alphabetic Index provides a separate code for each condition, use both
codes.

EXAMPLE:

DIAGNOSIS: Acute and chronic gonococcal salpingitis Ø98.17 Ø98.37

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5. Acute Upper Respiratory Infection (URI). Frequently this diagnosis is written :
Acute Respiratory Disease or simply ARD.

EXAMPLES:

a. DIAGNOSIS: ARD Viral 465.9

b. DIAGNOSIS: Acute Upper Respiratory Infection URI 465.9

PRINCIPLE II. MULTIPLE CODING

1. Multiple coding as used throughout these coding guidelines is defined as the

assignment of more than one code to fully identify all the component parts of a
diagnostic/procedure statement. In the diagnostic classification multiple coding was
developed to increase specificity by identifying associated conditions or those which
have a cause and effect relationship. Some instances where multiple coding will be
used are late effects (cause of) with residuals, etiology (underlying cause) with
manifestations and/or complications, adverse effects of medications with drugs (E
Codes), and pregnancy related complications (see principle IX). In the procedure,
classification multiple coding was developed to identify any additional components of a
procedure (if performed) and to identify any synchronous (performed at the same time)
procedures.

WHEN MULTIPLE CODING IS USED

a. Written Instructions:

(1) Code also . . . .

(a) Further instruction in the Tabular List, Volume 1, to code the underlying
cause (etiology) is indicated by "Code also..." It is an instruction to code "first";
therefore, the etiology code is sequenced first. Italicized codes in slanted brackets are
used to identify the manifestations.

(b) Multiple coding of procedures is indicated by the term "Code also..." to

identify adjunct or synchronous procedures done, i.e., those performed or occurring at
the same time. "Code also" has a different significance in procedure coding from that in
diagnostic coding; there is no implication of sequencing or mandatory multiple coding
attached to it.

(2) Use additional code . . . .The user should add further information to give a
more complete description of the diagnosis or procedure.

(3) Note . . . .Some main terms are followed by notes that define terms and give
coding instructions.

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 b. Without Written Instructions:

(1) Late effects (cause of) with residual. The residual code is sequenced before
the late effect code.

(2) Etiology (underlying cause) with manifestations/ complications. Code first

the underlying cause, then the manifestation/complication.

(3) Adverse effects of medication with drugs (E Codes). This mandates that
both codes be used and sequenced with the reaction first followed by the E code.

(4) Any other conditions in the main classification that can be more completely
identified by the use of multiple coding.

NUMBER OF CODES REQUIRED

2. The number of codes to be used depends upon the needs of the user. Avoid
indiscriminate coding of all signs and symptoms with their accompanying definitive
diagnoses, laboratory test results, social factors and other personal, nonmedical data
mentioned in the record. Code only those conditions that require treatment or
management during the current episode of hospitalization. DO NOT CODE conditions
stated as "history of," "status post," etc., not treated or managed during current
hospitalization.

EXCEPTION: Personal history of malignant neoplasm V10.00-V10.9 for a previously

treated malignant neoplasm with no evidence of recurrence in the primary site. (See
principle VIII (Neoplasms.)*

3. Diseases/conditions that are treated in one facility before transfer to another are not
coded by the receiving facility unless that disease/condition is still present and being
treated.

EXCEPTION: When coding underlying cause of death/separation, the receiving facility

will code the actual disease/condition that caused the death/separation, even if not
treated by that facility.

APPLICATION

1. Written Instruction:

a. Code also . . . .

DIAGNOSIS: Acute myocarditis, secondary to tuberculosis.

Code also underlying disease as:

myocarditis (acute):
influenza (487.8)
tuberculosis (017.9)

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 EXAMPLES

DIAGNOSIS: Acute myocarditis secondary to tuberculosis Ø17.9Ø 422.Ø

DIAGNOSIS: Phagolytic glaucoma with hypermature cataract 366.18 365.51

DIAGNOSIS: Temporary colostomy with cecectomy 46.11 45.72

b. Use additional code . . . .

The words "if desired" as appears in above should be deleted where found throughout
the coding books. All Army MTFs will use additional codes.

EXAMPLE:

Use additional code, to identify infectious organism.

DIAGNOSIS: Acute Pharyngitis, staphylococcal. 462 Ø41.1

c. Note . . . .

The term "Note" is found in both Diseases and Procedures Indexes and Tabulars. In
the Procedures Tabular "Note" may appear at the two- or three-digit level ; and in the
Disease Tabular at the category level. Guidance on use of fifth-digit subclassification
codes is a "Note" instruction without the actual term.

EXAMPLE:

DIAGNOSIS: Third degree burn to trunk comprising 20 percent body surface.

NOTE: This category is to be used when the site of the burn is unspecified or with
categories 940-947 when the site is specified.

Third-degree burn to trunk, 20 percent body surface 942.3Ø 948.22

2. Without Written Instructions:

a. Late effect (cause of) with residual.

If both the residuals and the cause of the late effect are provided, sequence the code for
the residuals first. If the cause of the late effect is specified but not the residuals, code
the cause of the late effect.

DIAGNOSIS: Hemiplegia secondary to poliomyelitis 12 years ago. (See principle XV

for definitions of late effect.)

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 EXAMPLE:

Hemiplegia; Late effect of Poliomyelitis 342.9 138

b. Etiology with manifestation(s).

EXAMPLE:

DIAGNOSIS: Cataract, Diabetic.

Diabetes
Cataract 25Ø.5Ø[36641]

c. Adverse effects of medications.

Sequence first the code which identifies the manifestation or the nature of the adverse
reaction. An additional code must be used to identify the drug causing the adverse
reaction.

DIAGNOSIS: Gastritis, secondary to prescribed dosage of aspirin.

EXAMPLE:

Gastritis, secondary to aspirin 535.4 E935.3

3. Use the multiple coding principle for any other conditions in the main classification
that can be more completely identified by the use of more than one code.

EXAMPLE:

DIAGNOSIS: Postoperative thrombophlebitis femoral vein,

following hysterectomy 997.2 451.11

Thrombophlebitis
during or resulting from a procedure NEC 997.2
femoral 451.11

PRINCIPLE III. COMBINATIONS AND DOD CODE EXTENDERS

1. Two conditions or a specific diagnosis with an associated secondary process or

complication are frequently assigned to the same code. This is referred to as a
combination code. Where the coding books provide a single code to fully identify all the
conditions described in the diagnostic statement, the one code is sufficient.

2. The combination code may not be so stated in the RUBRIC (Category) title, but may
have its own fourth-digit (subcategory) title to identify both disease conditions.

EXCEPTION: Where specific instructions in this user's manual direct other -wise; for
example, see principle XII (Drug and Alcohol).

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3. There have been a number of codes in the ICD-9-CM code books "modified" to
meet the needs of the services. Numeric characters have been added at the seventh-
digit level of a coding field. These codes are referred to as DOD Code Extenders.

4. The DOD Code Extenders are found in Appendix A of the Triservice Disease and
Procedure Coding Guidelines ICD-9-CM . To ensure that these codes are used when
appropriate, all military MTF users of ICD-9-CM code books are responsible for posting
all DOD Code Extenders to their books.

APPLICATION

1. Combination Codes. Two or more conditions or a specific disease condition with

an associated secondary process or complication is frequently assigned one code, a
combination code.

EXAMPLE:

DIAGNOSIS: Acute appendicitis with perforation and peritonitis. 54Ø.Ø

2. DOD Code Extenders. A number of codes in ICD-9-CM have been modified to
meet the needs of the Uniformed Services.

EXAMPLE:

DIAGNOSIS: Lyme Disease Ø88.81

PRINCIPLE IV. V CODES

1. The purpose of the V codes is to identify encounters with the health care settings for
reasons other than an illness or injury classified to categories ØØ1 -999. The majority of
the V codes are oriented toward ambulatory care. Although certain categories of V
codes will be used quite frequently for inpatient care, coders should exercise care
regarding the extent to which these codes are used on inpatient records.
2. The V code is primarily for use as a supplemental code with the primary code being
the current condition which requires hospitalization. However, it may be used as a solo
code for inpatients without disease or current injury; for example, a patient who is
admitted for surgical or orthopedic aftercare, as an organ or tissue donor, newborn, etc.
In these cases, the V code will be the principal diagnosis.

3. The diagnostic statements requiring a V code appear in a variety of terms. The

Alphabetic Index does not provide an exhaustive list of terms, but it does provide some
key works under which the appropriate V code may be found. Some of the key words
are: Admission, Examination, History, Observation, Problem, Status, etc.

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 4. Subcategories and Subclassifications V1Ø.Ø-V1Ø.9 are to be used only as
additional codes in classifying the primary site of a previously excised or eradicated
malignant neoplasm with no evidence of recurrence of the primary site. Subcategory
codes V1Ø.6Ø-V1Ø.79 are also used only as additional codes for classifying leukemia
and other lymphatic and hematopoietic neoplasms in remission (see principle VIII,
Neoplasms).

5. Subcategory code V15.Ø (allergy, other than to medicinal agents) may be used as
principal diagnosis, solo code, or it may be used as an additional code as appropriate.
For example, it will be used to denote hypersensitivity to insect sting (bite) where that
condition results in disability separation/failure to meet medical procurement standards.

6. Subclassification code V15.81 should be used when indicated for patients who do
not comply with prescribed medical treatment. This will be used only as an additional
code.

7. Subcategory V22.2 (Pregnant State, Incidental) will be used only as an additional

code; for example, when the cause of admission is not the pregnancy but an unrelated
condition (fractured femur, patient is 3 months pregnant).

8. Subcategory V24.0 (Postpartum Care and Examination Immediately After Delivery)

will be used only when patient is admitted immediately following delivery for routine
care. Should be used only as principal diagnosis.

9. Subcategory V25.2 (Sterilization). This code is to be used for elective sterilization

procedures of both males and females. It is to be used only when the sterilization
procedure was performed for the major purpose of contraception rather than for
treatment of a disease where sterilization is an incidental result, using the following
guidelines:

a. If the primary reason for admission is for elective sterilization for contraceptive
purposes, use code V25.2 as the cause of admission. If the sterilization is purely
elective, code V25.2 will suffice as a solo code for the diagnosis.

b. If the sterilization procedure was performed for contraceptive purposes during a

current admission for obstetrical delivery, use code V25.2 as an additional code.
However, if the sterilization was an end result of a hysterectomy performed because of
injury or damage to the uterus during delivery, do not use code V25.2.

c. Do not use code V25.2 when the major purpose of the procedure performed was
not for contraception; for example, when a hysterectomy is performed for cancer of the
uterus.

10. Category V27 (Outcome of Delivery) will be used on the mother's record to denote
whether the delivery process resulted in a live -born, stillborn, multiple birth or any
combination thereof. The proper use of the V27 category is explained further in
Principle IX (OB-GYN Conditions).

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11. Categories V3Ø-V37 (Live-Born Infants According to Type of Birth) will be used for
coding of live-born infants. The appropriate fourth digit ".Ø" (Born in Hospital) and ".1"
(Born Before Admission to Hospital) will separate hospital births from those born en
route or shortly before admission. For inpatient care " .2" (Born Outside Hospital and
Not Hospitalized) will not be used on inpatient records. V39 (Unspecified Live Birth) will
not be used for inpatient care. (For further details and application of the V30 -V37
categories, see Principle X ( Perinatal Morbidity and Mortality.)

12. Category V42 (Organ or Tissue Replaced by Transplant) may be used, as

appropriate, for inpatient care. The subcategory codes are status codes to indicate the
presence of a transplanted organ/tissue. These codes will never be used as the cause
of admission or principal diagnosis. (For further details and application of this category,
see Principle XVI.)

13. Category V44 (Artificial Opening Status) and V45 (Other Post -Surgical Status) are
appropriate for inpatient coding to describe a post -surgical status that affects patient
care management, for example, V45.1 (Renal dialysis status). These codes will never
be used as the cause of admission.

14. Categories V5Ø-V59 (Persons Encountering Health Service for Specific

Procedures and Aftercare) will have inpatient utilization as follows:

a. Subcategory V5Ø.1 (Other Plastic Surgery for Unacceptable Cosmetic

Appearance) will be used as the diagnostic code to support surgery done for purely
cosmetic reasons as distinguished from therapeutic indications. A few surgical
procedures that can be done for therapeutic reasons but are often done for purely
cosmetic purposes are mammary augmentation, facial rhytidectomy (face lift),
blepharoplasty, rhinoplasty, and otoplasty. Use of this diagnostic code excludes plastic
surgery following healed injury or operation. Category code V51 will be used to support
plastic surgery done following previous surgery or injury.

b. Categories V51-V58 are for use in indicating a reason for care of patients who
have already been treated for some disease or injury not now present.

c. Subcategories V54.Ø and V54.8 (Other Orthopedic Aftercare) would be used

when a patient is admitted for routine removal of device following "healed fracture" or
similar condition. Either code can be a sole diagnostic code used as the cause of
admission.

d. Subcategories V55.Ø-V55.3 (Attention to Artificial Openings) may be used to

classify admission without mention of complication but for the purpose of closing or
revising the ostomy site.

e. Category V59 (Donors) provides a classification for donor of tissues or organs.

(For further details and application of this category, see Principle XVI.)

15. Subcategory V63.2 (Person Awaiting Admission to Adequate Facility Elsewhere) is

a possible code for use in those instances where the patient is being held in the hospital
pending transfer to another institution. It is to be used as an additional code only.

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16. Subcategories V64.1-V64.3 provide a classification for those patients admitted for a
scheduled procedure but discharged with surgery cancelled shortly after admission.
These codes will not be used as the cause of admission.

17. Subcategory V65.2 (Person Feigning Illness (Malingerer)) should be used only after
the record has been reviewed by either a department chief, the chief of professional
services, or a medical care evaluation committee because of the legal implications
(Manual of Courts-Martial, 1969, para 194).

18. Category V67 (Follow-up Examination) will be used to include surveillance only
following treatment, and will be used for follow-up exams for patients with previously
treated neoplasms.

19. V7Ø category will be used for examination and screening for specified
circumstances. Code V7Ø.8 will be used for examination of potential organ or tissue
donors. (See Principle XVI.)

20. Category V71 will be used for inpatients to classify observations and evaluation for
suspected conditions which show no need for further treatment or medical care. Codes
from this category can only be used as the principal diagnosis.

APPLICATION

1. V Codes are primarily for use as a supplemental code with the primary code being
the current condition which requires hospitalization. However, it may be used as a solo
code for inpatients without disease or current injury. It may be used as the principal
diagnostic code to support surgery done for purely cosmetic purposes.

EXAMPLE:

DIAGNOSIS: Protruding ears. (Eight-year old is admitted for

Otoplasty.)V50.1 744.29
2. A V code denotes hypersensitivity to insect sting (bite) where that condition results
in disability separation/failure to meet medical procurement standards.
EXAMPLE:

DIAGNOSIS: Hypersensitivity to bee sting. (Patient is

being separated from the Service.) V15.Ø

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

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 EXAMPLE:

DIAGNOSIS: Admitted for a Laparoscopy with Tubal Ligation.

(Patient has five children.) V25.2

4. Category V44 and V45. Appropriate for inpatient coding to describe a postsurgical
status that affects patient care management.

EXAMPLE:

DIAGNOSIS: Acute Pharyngitis: Patient has a temporary

Tracheostomy 462 V44.Ø

5. Subcategories V64.1-V64.3 provide a classification for those patients admitted for a

scheduled procedure but discharged with surgery cancelled shortly after admission.

EXAMPLE:

DIAGNOSIS: Chronic Tonsillitis : Patient admitted for

Tonsillectomy May 3 1979: Surgery cancelled.
Patient is running temperature. 474.Ø 78Ø.6 V64.1

6. Category V71 will be used for inpatients to classify observations and evaluation for
suspected conditions which show no need for further treatment or medical care.

EXAMPLE:

DIAGNOSIS: Observation following auto accident,

no injury found. V71.4--9

PRINCIPLE V. SURGERY AND PROCEDURES

1. The ICD-9-CM procedure classification is contained in a separate volume 3 which

includes the Tabular List and Alphabetic Index. The procedure classification has 16
chapters of which 15 are assigned to anatomical sites (body systems). All surgical
procedures on a single body system appear together as follows:

CHAPTER CODES

1 Operations on the Nervous System Ø1-Ø5

2 Operations on the Endocrine System Ø6-Ø7

3 Operations on the Eye Ø8-16

4 Operations on the Ear 18-2Ø

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 5 Operations on the Nose, Mouth, and Pharynx 21-29

6 Operations on the Respiratory System 3Ø-34

7 Operations on the Cardiovascular System 35-39

8 Operations on the Hemic and Lymphatic System 4Ø-41

9 Operations on the Digestive System 42-54

10 Operations on the Urinary System 55-59

11 Operations on the Male Genital System 6Ø-64

12 Operations on the Female Genital System 65-71

13 Obstetrical Procedures 72-75

14 Operations on the Musculoskeletal System 76-84

15 Operations on the Integumentary System 85-86

Chapter sixteen is devoted to miscellaneous diagnostic, therapeutic, and prophylactic

nonsurgical procedures on all body systems and include the following:

(1) Diagnostic Radiology by anatomical site, distinguishing between

Tomography, Contrast Radiology, and Flat X-ray.

(2) Diagnostic Ultrasound and Thermography.

(3) Nuclear Medicine, both diagnostic and therapeutic.

(4) Physical Therapy, Respiratory Therapy, Rehabilitation, and

related procedures.

(5) Prophylactic vaccination and innoculation.

2. Alphabetic Index

a. The Alphabetic Index is organized by "main terms" printed in bold typeface

which usually identify the type of procedure performed. The "main terms" represent:

Procedures -- Aortogram, audiometry

Operations -- Appendectomy, cholecystectomy
Nouns -- Operation, procedure
Verbs -- Shortening, repair

b. Eponyms (procedures named after people) are listed in the Alphabetic Index
both as main term entries in alphabetical sequence and under the main term
"operation." A description of the procedure or anatomic site usually follows the eponym.

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 EXAMPLES:

Baldy-Webster operation (uterine suspension) 69.22

Emmet operation (cervix) 67.61

c. A main term may be followed by a series of words (modifiers) in parenthesis.

The presence or absence of these modifiers in the procedure do not affect the selection
of the code.

EXAMPLE:

Decortication
Lung (Partial) (Total) 34.51

d. A main term may be followed by individual indented line entries ( subterms)

which describe a difference in site, surgical technique, approaches, and the extent of
the procedure. The presence of these entries do affect the selection of the code.

EXAMPLE:

Excision
lesion (local)
skin 86.3
breast 85.21
nose 21.32
radical (wide) . . . 86.4

3. Tabular List

The procedure code structure is as follows:

a. Two digit section codes which provide a section heading by site and general
description of the procedure.

EXAMPLE:

32 Excision of lung and bronchus.

b. Three digit category codes which specify the procedure.

EXAMPLE:

32.0 Local excision or destruction of lesion or tissue of bronchus.

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 c. Four digit subcategory codes which provide greater specificity in identifying
anatomical sites and defining selected procedures, techniques, or the surgical
approach. When a three-digit code is followed by a four-digit code, the four-digit code
must be used. The four-digit codes are also used to differentiate between unilateral and
bilateral, and between types of conditions such as direct and indirect hernia.

EXAMPLE:

32.2 Local excision or destruction of lesion or tissue

of lung

32.21 Plication of emphysematous bleb

32.29 Other local excision or destruction of

lesion or tissue of lung

4. The two instructions unique to Volume 3 are:

a. Omit code.

b. Code also any synchronous procedure.

5. The following guidelines are to be used for coding procedures:

a. The surgical approach and closure as part of the operation do not require
additional codes. Procedures such as laparotomy are not coded if used as an approach
for a surgical procedure such as excision or repair.

b. When a biopsy is performed as part of a more extensive surgical procedure,

code both the biopsy and surgical procedure.

c. If a procedure is started and not completed, the approach (incision) is coded.

6. Instructions for Coding Procedures/Use of Alphabetic Index Volume 3

a. Use the Alphabetic Index to locate the main term (procedure): excision, incision,
graft, control, etc.

b. Read and be guided by any note that appears under the main term such as
"see" and "see also."

c. Read any terms enclosed in parentheses (modifiers) following the main entry as
well as subterms indented under the main entry for selection of the appropriate code.

d. Follow any cross-reference instructions.

e. Do not code from the Alphabetic Index, important instructions appear in the
Tabular List. Verify the code number in the Tabular List.

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7. Instructions for Coding Procedures/Use of Tabular List

a. Refer to the Tabular List to verify that the code selected is in accordance with
the desired classification of the procedure.

b. Read and be guided by the inclusion or exclusion notes that may appear not
only under the particular code but also under the category code or section title for that
particular code.

c. Use as many codes as necessary to adequately classify a surgical procedure,

unless instructed otherwise by the term "omit code."

8. Sequencing Guidelines

a. Report all significant procedures. A significant procedure is one which carries

an operative or anesthetic risk, or requires highly trained personnel, and requires
special facilities or equipment. Verify procedures were performed and not just
scheduled. To increase accuracy and specificity of coding, examine the discharge
summary, operative reports, x-rays, pathology reports, notes, and orders for additional
procedures not listed on the Inpatient Treatment Record Coversheet (ITRCS) by the
physician.

b. The principal procedure is listed as the first procedure statement on the ITRCS.
The principal procedure is that procedure most related to the principal diagnosis. A
principal procedure is one which was performed for definitive treatment (therapeutic)
rather than one performed for diagnostic or exploratory purposes.

c. When a diagnostic procedure is relat ed to the principal diagnosis and a

therapeutic procedure is related to a secondary diagnosis, then the principal procedure
is the therapeutic procedure.

d. When two or more therapeutic procedures are performed and all or none are
related to the principal diagnosis, then the procedure during which tissue was removed
or the procedure which subjected the patient to the greatest risk is selected as the
principal procedure.

e. If diagnostic procedures are performed and all or none of them relate to the
principal diagnosis, select the procedure which impacts most dramatically on resource
usage.

f. An incidental appendectomy (47.1) should not be coded as a principal procedure.

g. If there is a disagreement between the ITRCS and the operation/tissue report,

refer the record back to the supervisor and/or physician for clarification.

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9. Conventions and Instructional Terms

Conventions, abbreviations, and instructional terms used in the procedure classification

are similar to those in the diagnostic classification.

Includes: Inclusions are separate terms entered under a two or three digit code.
These inclusion terms represent only the most frequently used terms and
serve as a guide to examples of the procedures included in the code and title.
Other terms also classified to that code and title are found in the Index. The
location of the term "includes" indicates which codes are included. "Includes"
at section level applies to all codes in that section.

85 Operation on the Breast

Includes: Operations on skin of:

Breast Female or
Previous Mastectomy Site Male }
"Includes" at category level applies to all codes in that category.

09.4 Manipulation of lacrimal passage

Includes: removal of calculus

that will dilation

Exclusions are italicized terms prefaced by a box, indicating that the

Excludes: code and title do not include these terms. The position of the exclusion
terms is the same as the inclusions and have the same significance as
the inclusion terms with the same application. When both inclusion and
exclusion terms appear together, the inclusion terms are listed first.

Note: Notes appear in the Index and Tabular List.

See: This instruction tells the coder to look elsewhere for the code.

Excision

fallopian tube - see salpingectomy

See Also: This instruction is a suggestion to look further if the main term or subterm(s)
for that entry is insufficient for coding the procedure.

Angioplasty - see also repair, blood vessel

coronary 36.0

MD0753 A-16
See Category: This term is infrequently used. It refers the coder to a section of
code numbers rather than one code.

Lysis
Adhesions
Bone - see category 78.9

§ The section mark symbol preceding a code denotes the placement of a footnote at
the bottom of the page which is applicable to all subdivision in the code.

Code also: This instruction in the Tabular List is a guide to determining the number of
codes necessary. It is a reminder to code the individual components of
a procedure when they are accomplished at the same time. "Code also"
is also used as an instruction to code the use of special adjunctive
procedures or equipment. "Code also" often includes the word
"synchronous" (performed at the same time).

46.1 Colostomy

Code also any synchronous resection

(45.49, 45.71-45.79, 45.8)

The instruction "Code also" may appear under two-digit, three-digit, or

four-digit codes.

Omit Code: The surgical approach and closure are a part of the operation and do not
require codes in addition to the code for the operation unless they are
unusual or required by the statement "code also." Procedures such as
laparotomy are not coded if used as an approach for a surgical
procedure such as excision or repair. The surgical approach code is
used when there is no further operative procedure, e.g., exploratory
laparotomy with biopsy. Both the laparotomy and the biopsy are coded.
Exception: If a procedure is started and not completed, the approach
(incision) is coded. The instruction "omit code" is the guide in both the
Tabular List and Alphabetic Index.

APPLICATION

1. When an endoscopy is performed and the endoscope is passed through more than
one cavity, the code for the endoscopy will identify the farthest site.

Esophagoscopy NEC 42.23

Esophagogastroscopy NEC (Other gastroscopy) 44.13
Duodenoscopy (Other endoscopy of small intestine) 45.13
Esophagogastroduodenoscopy 45.13

MD0753 A-17
2. There are some codes in the classification which identify endoscopic biopsies.

Bronchoscopy with biopsy (Endoscopic bronchial biopsy) 33.24

3. If there is no code which includes both procedures, code each procedure

separately.

Laryngoscopy with biopsy (Laryngoscopy) 31.42

(Biopsy of Larynx) 31.43

4. If an endoscopy is performed and another procedure such as excision of lesion is

performed, code both the endoscopy and the other procedure - unless instructed
otherwise in the Alphabetic Index or the Tabular List.

PROCEDURE: Cystoscopy with transurethral resection of prostate

Cystoscopy (transurethral) 57.32

Resection
prostate -- see also Prostatectomy
transurethral (punch) 60.2

Transurethral resection of prostate 60.2

5. A principal procedure is one which was performed for definitive (therapeutic)

treatment rather than one performed for diagnostic purposes.

DIAGNOSIS: Torn medial meniscus 836.Ø

PROCEDURE: Arthroscopy with meniscectomy 8Ø.6 8Ø.26

The meniscectomy is the principal procedure for it was performed for therapeutic
treatment, the arthroscopy is a diagnostic procedure.

6. When a diagnostic procedure is related to the principal diagnosis and a therapeutic

procedure is related to a secondary diagnosis, then the principal procedure is the
therapeutic procedure.

PRINCIPAL DIAGNOSIS: Gastritis

SECONDARY DIAGNOSIS: Left indirect inguinal hernia

PROCEDURES: Gastroscopy (diagnostic)

Left inguinal herniorrhaphy (therapeutic)

The herniorrhaphy is the principal procedure.

MD0753 A-18
 PRINCIPLE VI. SYMPTOMS, INCONCLUSIVE DIAGNOSES, COPD

1. Signs and symptoms that point rather definitely to a particular diagnosis are
assigned to the appropriate chapter of ICD-9-CM rather than chapter 16; for example,
hematuria is assigned to the chapter for Genitourinary System (Code 5997). Chapter
16 includes ill-defined conditions and symptoms that could be the result of two or more
conditions, or may involve two or more systems of the body, and are used in cases
where the necessary studies to determine a definitive diagnosis were not completed
prior to disposition; for example, transfer and death cases without an autopsy.

2. Chapter 16 includes Category Codes 780-799. The paragraph on page 707 of

Volume 1, ICD-9-CM should be reviewed carefully prior to assigning codes from this
chapter.

3. Diagnostic statements that may require use of codes from chapter 16 are:

a. When a specific diagnosis cannot be made at time of disposition.

b. Transient signs and symptoms whose etiology could not be determined.

c. Provisional diagnosis made for dispositioned patients (e.g., patients that are
transferred).

d. A more precise diagnosis cannot be made for other reasons.

e. Certain signs and symptoms are important in rendering appropriate medical

care; therefore, the appropriate code from chapter 16 will be used as an additional code
when the etiology is known.

4. The signs and symptoms found in Chapter 16 (Categories 780-799) of ICD-9-CM

may be used as the principal diagnosis only when:

a. No definite cause is identified.

b. The signs and symptoms are followed by comparative contrasting diagnoses.

c. The signs and symptoms are a residual of late effect.

d. The signs and symptoms are the result of an adverse reaction to medication.

5. Comparative/Contrasting Diagnoses:

a. If the differential diseases/conditions have a symptom(s) stated, the symptom

may be used as the principal diagnosis.

b. If the differential diseases/conditions have no symptom stated, assign codes for

the stated conditions and assign the first listed as the principal diagnosis.

MD0753 A-19
 6. Chronic Obstructive Pulmonary Disease (COPD) Category Code 496. This code is
to be used only when COPD is reported without mention of a more specific chronic
obstructive pulmonary disease. COPD with other diagnoses (such as emphysema,
chronic bronchitis, allergic alveolitis, asthma, and bronchiectasis) is classified to the
specific condition rather than category 496.

APPLICATION

1. Diagnostic statement that requires assigning codes from chapter 16.

EXAMPLE:

DIAGNOSIS: Dysuria, etiology undetermined 7881

2. COPD is coded to category 496. This category will be used only when there is no
mention of a specific chronic obstructive pulmonary disease. Also, assign the
symptom(s) code as additional codes.

EXAMPLE:

DIAGNOSIS: Pneumothorax, spontaneous, left. Chronic

Obstructive Pulmonary Disease. 5128 496Ø
DIAGNOSIS: Chronic Obstructive Pulmonary Disease
Emphysema, Compensatory` 5182

PRINCIPLE VII. COMPLICATIONS OF CARE

1. Surgical and Postoperative Complications.

a. Accurate coding of complications as a result of surgical procedures is very

important. In some hospitals, the Quality Assurance personnel rely on correct coding of
complications to alert them of a potential problem. To code a surgical complication
proceed as follows in the stated order until the appropriate code is located.

(1) Look up an entry for the complication (such as infection) and the indented
modifier "postoperative."

(2) Look up "Complication" and an indented modified to describe the

complication.

(3) Look up "Complication, surgical procedure" and identify the body system to
which the complication is assigned.

MD0753 A-20
 b. Postoperative complications affecting a specific anatomical site or body system
are classified to categories 001-799 in the main classification. Complications affecting
more than one site or body system are classified to categories 996-999 of the chapter
on injury and poisoning. Of particular significance are the last three lines of the
exclusion note which state: "any condition classified elsewhere in the Alphabetic Index
when described as due to a procedure." An additional code, when possible, will be
used to specifically identify the anatomical site or the manifestation of the postoperative
complication. When multiple coding is used, sequencing of codes is important. A
postoperative complication may be principal diagnosis if it is the cause for readmission.
The codes from categories 996-999 take precedence in sequencing, when an additional
code is used for specificity.

c. Subcategories/subclassifications codes 996.0-996.5 are specific for mechanical

complications resulting form various prosthetic devices or implants. They include
mechanical breakdown or obstruction, leakage, displacement, perforation, or protrusion
of the devices. Complications of a mechanical nature of internal prosthetic devices and
implants are classified to 996.0-996.5. Complications involving implants and internal
devices are classified to 996.7. The remaining codes in category 996 are for
physiological complications; for example, complications or rejections following organ or
tissue transplants with an accompanying code from category V42 to identify the specific
organ or tissue involved. (See principle XVI (Organ and Tissue Transplants) for correct
sequencing of codes.)

2. Medical Care Complications.

a. Subcategory codes 999.0 through 999.9 will be used when the diagnostic
statement specifies that condition as a complication resulting from medical care.
Carefully read the inclusion and exclusion terms.

b. Subcategory code 999.9 may be used alone to indicate a complication of

medical care when the specific condition is not mentioned by the responsible physician.
When possible, an additional code will be used for specificity to completely describe the
condition.

3. Complications vs. Aftercare.

a. Coding personnel should thoroughly review the record to ascertain whether the
condition requiring hospitalization was in fact a complication or aftercare.

b. An admission for aftercare is usually scheduled, whereas an admission for

complication of surgical or medical care occurs at the time the complication develops.

APPLICATION

1. Read carefully the "excludes" note, Page 867 in Volume 1, ICD-9-CM.

EXAMPLE:

DIAGNOSIS: Infection of surgical wound (Cesarean section 3 weeks ago) 674.34

MD0753 A-21
 2. A condition specified as a complication of surgical care or postoperative, which does
not have a specific subentry in the Alphabetic Index will be multiple coded, when
possible.

EXAMPLE:

DIAGNOSIS: Pneumothorax due to accidental puncture

during cardiac catherization. 9982/5128

3. Category 996 provides codes at the fourth- and fifth-digit level to distinguish
between mechanical and physiological complications.

EXAMPLES:

DIAGNOSIS: Migration of breast prosthesis. 99654

DIAGNOSIS: Infected breast implant following mastectomy. 9966

4. Complications or rejection of organ or tissue transplant.

EXAMPLE:

DIAGNOSIS: Cadaveric renal transplant X3,

rejection episode. 99681 V42Ø

PRINCIPLE VIII. NEOPLASMS

1. Instructions on how to use Chapter 2, Neoplasms (140-239) are provided on page

81, Volume 1 of ICD-9-CM. All neoplasms whether functionally active or not are
classified to Chapter 2. If the neoplasm is functionally active, an additional code should
be used to identify the functional activity.

a. Table of neoplasms.
(1) The Table of Neoplasms gives the code numbers for neoplasms by
anatomical site. For each site, there are six possible code numbers according to
whether the neoplasm in question is malignant, primary, secondary, benign, in situ, of
uncertain behavior, or of unspecified nature.

(2) The description of the neoplasm will often indicate which of the six columns
is appropriate; for example, malignant melanoma of skin, benign fibroadenoma of
breast, or carcinoma in situ of cervix uteri. Where such descriptors are not present, the
remainder of the index should be consulted.

(3) Sites marked with the sign "*"; for example, face NEC*, should be classified
to malignant neoplasm of skin of these sites if the variety of neoplasm is a
squamous-cell carcinoma or an epidermoid carcinoma and to benign neoplasm of skin
of these sites if the variety of neoplasm is a papilloma (any type).

MD0753 A-22
 (4) The term "cancer" when modified by an adjective or adjectival phrase
indicating a morphological type should be coded in the same manner as "carcinoma"
with that adjective or phrase. Thus, "squamous cell cancer" should be coded in the
same manner as "squamous-cell carcinoma."

b. Morphology codes (Volume 1, pages 1055 -1076).

(1) ICD-9-CM provides an optional set of four-digit codes preceded by the letter
"M" for identifying the morphology of neoplasms. An additional set of single digits is
provided to identify the behavior of the neoplasm, such as "/3" for malignant, primary
site. Morphology codes are not used in the inpatient record.

(2) The morphology codes may be located in the Alphabetical Index (Volume 2)
in alphabetical sequence under the main term entry for the specific neoplasm.

(3) The word morphology is defined as the study of the form and structure of
the cells and tissues from which the neoplasms arise.

(a) The properties of a particular neoplasm is determined by the tissue of

origin as opposed to the organ of origin.

(b) The type of cells that a malignant neoplasm is comprised of often

determines the rate of growth, degree of malignancy, and the particular type of
treatment rendered.

(4) Metastatic neoplasms are identified at the metastatic site by their

morphology, which is different from that of the normal tissue at the metastatic site and
the same as the morphology of the tissue and cells at the primary site. This is important
to remember when coding neoplasms and determining primary versus secondary sites.

(a) Classification of neoplasms by the tissue from which they arise are:

1. Epithelial tissue--adenoma, papilloma, carcinoma, and

adenocarcinoma.

2. Connective tissue--fibroma, leiomyoma, fibrosarcoma, and

leiomyosarcoma.

3. Nervous tissue--meningioma and glioma.

(b) Classifications of neoplasms by cells from which they arise are:

1. Clear cell adenoma.

2. Acinar cell adenoma.

3. Basal cell carcinoma.

4. Squamous cell carcinoma.

MD0753 A-23
 c. Personal History of Malignant Neoplasm. In addition to the categories for
malignant neoplasm provided in chapter 2, ICD-9-CM contains codes in the
supplementary classification for describing history of (primary) malignant neoplasm
(codes V1Ø.ØØ-V1Ø.9), and for describing the purpose of an encounter as for
radiotherapy (code V58.Ø) and for maintenance chemotherapy (code V58.1).

d. Categories 150 and 201 contain a departure from the usual princi ples of
classification in that the fourth-digit subdivisions in each case are not mutually
exclusive. In each instance, the dual axis is provided to account for differing
terminology encountered on source documents; for example, one surgeon may describe
the location of an esophageal malignancy as cervical portion, while another may say
upper third.

e. Neoplasms with Overlapping Site Boundaries. Categories 140-195 are for

the classification of primary malignant neoplasms according to their point of origin. A
primary malignant neoplasm whose point of origin cannot be determined but whose
stated sites overlaps two or more subcategories within a three -digit category should be
classified to the four-digit subcategory .8 (other). For certain malignant neoplasms
whose point of origin cannot be determined but whose stated sites overlap two or more
three-digit categories, codes for contiguous sites are provided. These codes are 149.8,
159.8, and 165.8. Overlapping malignant neoplasms that cannot be classified as
indicated above should be assigned to the appropriate subdivision of category 195
(Malignant neoplasm of other and ill-defined sites).

2. Coding Principles.

a. Primary Site is Still Present (Solid Tumors). For example, the hospital
admission during which the malignancy is diagnosed or during which the primary
treatment took place. Code the primary site using codes from chapter 2 (codes
14Ø.Ø-195.9). If present, code also secondary sites which may be present using
categories 196-199.

b. Primary Site Previously Treated (Solid Tumors). The primary site was
previously excised or eradicated with no recurrence of original primary site. If a
neoplasm is eradicated on a previous admission, regardless of the length of time since
eradication, the neoplasm should not be coded as being present unless there has been
a recurrence. An eradicated neoplasm is one that has been removed by surgical
procedure or otherwise destroyed through other treatment. To note the eradicated
neoplasm in the present record, code a personal history of a malignant neoplasm.

(1) Code the primary site using codes from the supplementary classification
(codes V1Ø.ØØ-V1Ø.9). These codes will never appear as the cause of admission
diagnosis.

(2) If the patient has secondary sites present, code these using categories
196-199. Also code the previous primary site code (V1Ø.ØØ-V1Ø.9).

(3) If the patient has no secondary malignancy, and if the reason for admission
is follow-up of the malignancy, code to V67. Also code the previous primary site
(V1Ø.ØØ-V1Ø.9).

MD0753 A-24
 c. Primary Malignancy of Hematopoietic and Lymphatic Tissue.

(1) Malignancy of hematopoietic and lymphatic tissue is always coded to

2ØØ.Ø-2Ø8.9 series with appropriate fifth digit where required, unless it is st ated to be
"in remission."

(2) For malignancy of hematopoietic and lymphatic tissue "in remission", a V67
with an additional code from categories V1Ø.6-V1Ø.7, as applicable, will be used.

d. Patient Admitted Solely and Specifically for Radiotherapy Session or for

Maintenance Chemotherapy.

(1) Patients admitted solely and specifically for radiotherapy and no other
treatment, use code V58.Ø as principal diagnosis.

(2) Patients admitted solely for chemotherapy and no other treatment, use code
V58.1 as principal diagnosis.

(3) The present primary and any secondary malignancies should be classified
supplementally. If either or both neoplasms have been eradicated, the personal history
of malignancy should be coded.

e. Metastatic Cancer.

(1) If the primary malignancy is no longer present, identify the previous primary
site using the proper code within the V1Ø category. In such cases, do not assign the
code for "primary site unknown."

EXAMPLE: Metastatic carcinoma to lung from breast. Bilateral radical mastectomy

performed 6 months ago.

Code to: Secondary neoplasm of lung (197.Ø) and personal history of malignant
neoplasm of breast (V1Ø.3).

(2) Cancer described as "metastatic from" a site should be interpreted as

primary of that site.

EXAMPLE: Metastatic carcinoma from breast.

Code to: Primary malignant neoplasm of breast (174.9). Secondary neoplasm of

unspecified site (199.1).

(3) Primary site unknown. When the primary site is unknown, code to the
unspecified site for the morphological type involved; for example, carcinoma (199.1),
melanoma (172.9), adenocarcinoma (199.1), osteosarcoma (17Ø.9), and fibrosarcoma
(171.9).

MD0753 A-25
 (4) Cancer described as "metastatic to" a site should be interpreted as a
secondary of that site. Also, assign the appropriate code for the primary malignant
neoplasm of specified site if the primary site is identified or code to the unspecified site
(as stated in e(3) above).

EXAMPLE: Metastatic carcinoma to lung.

Code to: Secondary neoplasm of lung (197.Ø) and primary malignant neoplasm of
unspecified site (199.1).

EXAMPLE: Metastatic carcinoma from liver to lung.

Code to: Primary malignant neoplasm of liver (155.Ø) and secondary neoplasm of lung
(197.Ø).

(5) If two or more sites are stated in the diagnosis and all are qualified as
metastatic code as for primary site unknown, code the stated sites as secondary
neoplasm of those sites.

EXAMPLE: Metastatic melanoma of lung and liver.

Code to: Secondary neoplasm of lung (197.Ø) and liver (197.7) and primary malignant
melanoma of unspecified site (172.9).

EXAMPLE: Metastatic carcinoma of brain and lung.

Code to: Secondary neoplasm of brain (198.3) and lung (197.Ø) and primary
carcinoma of unspecified site (199.1).

(6) If only one site is stated in the diagnosis and this is qualified as metastatic,
proceed as follows:

(a) Code as for primary site unknown; however, if this code is 199.Ø or
199.1, follow rule (6)(b) below.

(b) If the code arrived at in (6)(a) above is 199.Ø or 199.1, code instead as
for primary malignant neoplasm of the stated site except for the following sites, which
should be coded to the secondary neoplasm of that site.

bone (198.5) meninges (198.4)

brain (198.3) peritoneum (197.6)
diaphragm (198.8) pleura (197.2)
heart (198.8) retroperitoneum (197.6)
liver (197.7) spinal cord (198.3)
lymph nodes (196.9) site classifiable to 195
mediastinum (197.1) (198.89)

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

MD0753 A-26
EXAMPLE: Metastatic lung cancer.

Code to: Primary malignant neoplasm of lung (162.9), and secondary malignant
neoplasm, unspecified site 199.1.

EXAMPLE: Metastatic cancer of brain.

Code to: Secondary neoplasm of brain (198.3) and primary malignant neoplasm of
unspecified site (199.1).

(7) If no site is stated in the diagnosis, but the morphological type is qualified as
"metastatic," code as primary site unknown.

EXAMPLE: Metastatic apocrine adenocarcinoma.

Code to: Primary malignant apocrine adenocarcinoma of unspecified site (173.9), and
secondary malignant neoplasm, unspecified site 199.1.

f. When Neoplasm is the Underlying Cause of Death.

(1) Code to primary site when known or as "primary site unknown" when
undetermined.

(2) Categories 196, 197, and 198 are not to be used for underlying cause of
death coding. Secondary neoplasm of specified sites, of unspecified site, or without
mention of primary site, will be coded as "primary site unknown."

EXAMPLE: Metastatic carcinoma to colon.

Code to: Morphological type involved (carcinoma - 199.1) for underlying cause of
death.

3. Sequencing.

a. The patient is admitted with a suspected malignant neoplasm:

(1) If confirmed, the neoplasm is sequenced first.

(2) If not confirmed, list as admission for suspected neoplasm.

b. The patient is admitted with a confirmed malignant neoplasm:

(1) If the neoplasm is treated (e.g., surgically), the neoplasm is sequenced first.

(2) If only a condition caused by the neoplasm is treated, the condition (not the
neoplasm) is sequenced first (e.g., dehydration). An exception to this is if the condition
is coded in Chapter 16 of ICD-9-CM.

MD0753 A-27
 (3) If the patient is admitted specifically for chemotherapy or radiotherapy,
principal diagnosis is admission for chemotherapy or radiotherapy.

c. The patient is admitted for restaging:

(1) If a new neoplasm is found, the neoplasm is principal.

(2) If known neoplasm has grown, the neoplasm is principal.

(3) If nothing new is found, admission for follow-up examination is principal.

APPLICATION

1. The Table of Neoplasms give the code numbers for neoplasms by anatomical site.
For each site there are five possible code numbers according to whether the neoplasm
in question is malignant, benign, in situ, of uncertain behavior, or of unspecified nature.

EXAMPLE:

DIAGNOSIS: Carcinoma in situ, rectum 23Ø.4

2. Primary site is still prese nt (solid tumors). Code the primary site using codes from
chapter 2 (codes 14Ø.ØØ-195.8). Code, also, any secondary sites which may be
present, using codes 196.Ø-199.1.

EXAMPLE:

DIAGNOSIS: Adenocarcinoma of prostate gland

metastatic cancer to urinary bladder. 185.Ø 198.1

3. Primary site previously treated (solid tumors). The primary site was previously
excised or eradicated with no recurrence of original primary site. (See coding principles
in paragraphs 2a and 2b above.)

EXAMPLE:
DIAGNOSIS: Bladder tumor examination; surgery
performed 6 months ago for malignancy
of bladder. No evidence of recurrence. V67.Ø V1Ø.51

4. A primarily malignant neoplasm that overlaps two or more subcategories within a

three-digit rubric and whose poi nt of origin cannot be determined should be classified to
the subcategory ".8" (Other).

EXAMPLE:

DIAGNOSIS: Glioma of left parieto-occipital area. 191.8

MD0753 A-28
 5. Patients admitted solely for radiotherapy session or for maintenance chemotherapy,
code to proper V58 category.

EXAMPLE:

DIAGNOSIS: Carcinoma of cervix, hysterectomy

2 months ago. Admitted for
maintenance chemotherapy. V58.1 V1Ø.41

PRINCIPLE IX. OB-GYN CONDITIONS

1. Abortion Category Codes.

a. For DOD purposes, abortions will be classified by type, in the following

categories:

(1) Missed abortion, ectopic and molar pregnancy - 63Ø to 633.

(2) Spontaneous - 634.

(3) Legally induced (therapeutic, elective) - 635.

(4) Illegally induced - 636.

(5) Unspecified abortion - 637.

(6) Failed attempted abortion - 638.

(7) Complications following abortion and ectopic and molar pregnancies - 639.

b. The subcategory levels (fourth digits) identify the presence or absence of

complications. They identify complications resulting from the abortion, not the reasons
for performing the abortion. Use of the fifth digit Ø, unspecified stage, is strongly
discouraged and will be questioned.
c. Fifth digit codes listed at the bottom of pages 531, 532, and 533 are for use with
abortion categories 634 through 637 to indicate the stage of the abortion as complete,
incomplete, or unspecified.

d. When abortion procedures are done for therapeutic reasons, or if the MTF is
allowed to perform elective abortions, the procedures frequently used are:

(1) Hysterotomy or hysterectomy to terminate pregnancy - 74.91.

(2) Amniotic or saline injection for termination of pregnancy - 75.Ø.

(3) Vacuum aspiration for termination of pregnancy - 69.51.

(4) D & C to terminate pregnancy - 69.Ø1.

MD0753 A-29
 e. Legally induced abortion, Category 635, includes both elective and therapeutic
abortions. A therapeutic abortion is one induced for medical indications which would be
life threatening to the mother if the pregnancy were carried to term. An elective abortion
is one performed at the request of the patient. To distinguish between therapeutic and
elective abortions, code extenders have been provided to meet DOD statistical
requirements. The code extenders will be used in the seventh position of the diagnostic
field. The use of 9 (unspecified) will be questioned. The code extenders are as listed
below.

Elective 635.XX - Ø
Therapeutic 635.XX - 1
Unspecified 635.XX - 9

f. When a therapeutic abortion is performed, the reason (diagnosis) for this legally
induced abortion must also be coded. Codes from categories 640-648 will be used to
reflect the complication(s) of pregnancy leading to the therapeutic abortion; the fifth digit
Ø will indicate abortive outcome. The reason for the abortion will be selected from other
ICD-9-CM categories and will be used as an additional code. Sequence the abortion
code first.

g. An abortion resulting in a live-born fetus is coded as an abortion by type, with a

code from category V27 as appropriate.

h. Complications following abortion, ectopic, or molar pregnancy are classified to

category 639. This category is to be used as an additional code when there are
immediate complications during the same admission as treatment for the ectopic or
molar pregnancy. For example, Pelvic Peritonitis due to ruptured tubal pregnancy is
coded to 633.1 and 639.Ø Codes 634-638 are never used in combination with category
code 639 during the same admission. However, a code from 639 category is the
principal diagnostic code for complications stemming from an abortion done during a
previous episode of care.

i. The subcategory codes for 634, Spontaneous Abortions, identify the presence or
absence of any complications arising during the same admission or encounter as that
for the abortion. For example, the diagnosis "incomplete spontaneous abortion with
delayed hemorrhage" is coded 634.11. The use of this code indicates that the delayed
hemorrhage occurred during the same admission as that for the spontaneous abortion.
Another example is "Spontaneous abortion with urinary tract infection" which is coded to
634.7Ø. Additional codes specific for the complication are not required.

MD0753 A-30
 APPLICATION

Abortion Codes

1. When coding a therapeutic abortion, code also the reason why the abortion was
performed.

EXAMPLE:

DIAGNOSIS: Therapeutic abortion, complete, 635.92 - 1

due to severe maternal rheumatic
heart disease 648.6Ø 398.9Ø
D&C 69.Ø1

2. An admission for complication(s) after an abortion is coded to category 639.

EXAMPLE:

DIAGNOSIS: Excessive hemorrhage following 693.1

elective abortion at Cypress
Community Hospital

2. Pregnancy and Puerperium Category Codes.

a. Categories 64Ø-676 have fifth-digit codes to provide more specificity regarding

the outcome of current hospitalization. Specifically, the fifth digits have the following
meanings: (See Volume 1, page 537).

Ø - Unspecified as to the episode of care or not applicable. (The fifth digit "Ø"
will be used only to denote abortive outcome.)

1 - Delivery with or without mention of antepartum condition.

2 - Delivery with mention of postpartum complication during present episode of

care.
3 - Antepartum condition or complication (undelivered).

4 - Postpartum condition or complication following delivery that occurred during

previous episode of care or outside hospital with subsequent admission.

b. Puerperal complications are those occurring after delivery until 6 weeks

following termination of pregnancy. Fifth digits "2" and "4" will distinguish between
immediate (during present episode of care) and delayed puerperal
complications/conditions.

c. The ICD-9-CM index will often direct coder to the same fourth-digit code for
complications that are related to pregnancy, childbirth (delivery) and the puerperium.
The fifth digits for these categories will indicate the specific status of patient at
disposition.

MD0753 A-31
 d. Categories 647 and 648 are combination codes for nonobstetrical conditions in
obstetrical patients. These conditions are classified elsewhere but will be recorded as
complication of pregnancy, childbirth, or the puerperium. When these codes are used,
an additional code is required to denote the specific condition. With one exception,
code 648.8 does not require an additional code. The code from categories 647 or 648
will take precedence in sequencing.

e. Categories V22 (Normal Pregnancy) and V23 (Supervision of High Risk

Pregnancy) will be used most often for outpatient care. Codes in V22, Normal
pregnancy, are not to accompany any codes in Chapter 11, Complications of
Pregnancy, Childbirth, and the Puerperium. The use of V22.2, Pregnant state
incidental, is used for a patient whose principal diagnosis is unrelated to and is not
complicating the pregnancy. V23 subcategory codes will be used primarily for
outpatient care to identify patients whose pregnancy is of a high risk status; for
example, teenage pregnancies and pregnancies in women over 40 years old are
considered to be high risk in nature and often require close monitoring, even on an
inpatient basis.

APPLICATION

Pregnancy and Puerperium Codes

1. Use an additional code with categories 647 and 648 to further describe the
conditions complicating the pregnancy or the puerperium. Any conditions listed in 647
or 648 categories will require multiple coding, but 647 and 648 codes will be sequenced
prior to the code for the specified condition. (Note exception to dual coding ( para 2d,
above) 648.8 .
EXAMPLE:

DIAGNOSIS: Pregnancy complicated by Sickle-cell 648.23 282.6Ø

Anemia

2. Use fifth digit "4" to identify a postpartum condition or complication following delivery
that occurred during previous episode of care or outside hospital with subsequent
admission.

EXAMPLE:

DIAGNOSIS: Purulent Mastitis, 3 weeks 675.14

following delivery

3. Use V22.2 (Pregnant state, incidental) when patient's cause of admission is not the
pregnancy.

EXAMPLE:

DIAGNOSIS: Meniere's Syndrome, Pregnancy, 16 weeks 386.ØØ V22.2

MD0753 A-32
3. Deliveries.

a. A large portion of the military services inpatient workload is comprised of

conditions relating to pregnancy, labor, delivery, and the puerperium. Coding personnel
should be thoroughly familiar with the sections in chapter 11 used in classifying specific
conditions associated with obstetrics; for example:

(1) Categories 64Ø-648 complications mainly related to pregnancy.

(2) Categories 65Ø-659 normal delivery, and other indications of care in

pregnancy, labor and delivery.

(3) Categories 66Ø-669 complications occurring mainly in the course of labor

and delivery.

(4) Categories 67Ø-676 complications of the puerperium.

b. Category 65Ø (Delivery in a completely normal case) includes only normal,

spontaneous delivery, cephalic (vertex) presentation, of a single full -term live-born
infant. An episiotomy or amniotomy may be performed. This code excludes application
of forceps or any manipulation to assist delivery. This code excludes stillbirth or
multiple births. This code cannot be used in combination with other codes in chapter
11.

c. In assigning codes from the V27 category in conjunction with the 65Ø code,
V27.Ø is the only valid outcome of delivery code which can be used.

d. Subcategory 669.5 (Forceps or Ventouse Delivery without mention of indication)

includes normal delivery of a live fetus, cephalic presentation, with application of low or
outlet forceps or vacuum extraction without mention of any complication of labor or
delivery. 669.5 is used with mid or high forceps only if the complication necessitating
the use of mid or high forceps is not stated.

e. Subcategory 656.4 (Intrauterine Death) includes delivery of a fetal death

(stillbirth) after completion of 20 weeks gestation. The key word in the Alphabetic Index
is Intrauterine Death, not stillbirth.

f. Subcategory 644.2 (Early Onset of Delivery) includes premature delivery,

premature labor with onset of delivery and spontaneous delivery of premature infant.

g. Category 651 (Multiple Gestation Delivery). This code is for use in denoting
multiple gestation, either during pregnancy or for delivery.

h. Outcome of Delivery. The V27 category is to be used to record the outcome of

delivery on the mother's cover sheet. In the Alphabetic Index look for "Outcome of
Delivery," which will lead to the V27 category. This V27 category has subcategories to
denote live-born and stillborn.

i. In the case of a stillbirth, the appropriate V27 code will be recorded on the
mother's cover sheet, and there will be no separate record made for the stillbirth.

MD0753 A-33
 j. When a delivery is complicated, use as many codes as is necessary to
completely describe the complications.

k. For a spontaneous delivery occurring in the hospital, in addition t o the diagnostic

code(s), a procedure (delivery) code will be used. Procedure code 73.59 (other
manually assisted delivery) will only be assigned if no other delivery code from category
73-74 is used.

APPLICATION

Delivery Codes

1. Use subcategory 669.5 with mid or high forceps only if the complication
necessitating the mid or high forceps is not stated.

EXAMPLE:

DIAGNOSIS: Delivery, full-term: Live-born infant: 669.51 V27.Ø

Vertex presentation: Low forceps.

2. Use as many codes as necessary to completely describe a complicated delivery.

Record the outcome of delivery.

EXAMPLE:

DIAGNOSIS: Pregnancy, uterine, delivered,male 652.21 664.Ø1 664.51 V27.Ø

infant, frank breech presentation:
first degree perineal laceration (with
hematoma of vulva).

3. Category 651 will be used with deliveries of multiple births. If, during the same
episode of care, a complication of delivery or an antepartum condition occurs in addition
to a postpartum complication, assign fifth digits 1 and 2 respectively, to the codes
identifying the complications.
EXAMPLE:

DIAGNOSIS: Intrauterine pregnancy, full-term 651.Ø1 671.42 V27.2

delivered twins, live -born male
infants, postpartum
phlebothrombosis, deep

PRINCIPLE X. PERINATAL MORBIDITY AND MORTALITY

1. The perinatal period is defined as that period occurring before, during, and up to 28
days following birth.

MD0753 A-34
 2. Conditions specifically classified to Chapter 15 when originating in the perinatal
period must be qualified by such terms as "neonatal" or "of newborn" or transitory in
nature.

3. If the same condition occurs in a permanent state in the newborn, it will be coded to
the appropriate category in the main classification.

4. The conditions classified to Chapter 15 include:

a. Conditions in the newborn infant or in an infant in the perinatal period

b. Conditions in any age group that originated in the perinatal period.

5. Categories 76Ø-763 are used to identify maternal conditions that are found to be the
cause of morbidity or mortality in the newborn.

6. Although many of the category titles in Chapter 15 contain the term "maternal" and
appear to refer to the maternal conditions, all the codes in Chapter 15 pertain to the
infant identifying the maternal conditions affecting the infant.

7. There are codes in this perinatal category to show gestational maturity. These
codes can be located under terms as immaturity, prematurity, post-term, light-for-dates,
and heavy-for-dates.

8. Categories 765 and 766 are not to be used as underlying cause of death if any other
cause of perinatal mortality is reported.

9. Respiratory distress syndrome of newborn may be coded in one of two ways.

Respiratory distress syndrome which is referred to as mild and recovery occurs within
72 hours of birth is coded to 77Ø.6. If respiratory distress syndrome is more severe and
recovery is not apparent within the first 72 hours of life, then code to 769.

APPLICATION

1. Use codes from categories 76Ø-763 to identify maternal conditions on the infant's
record that have caused morbidity or mortality in the newborn.

EXAMPLE

DIAGNOSIS: Single, full-term, live-born, male infant V3Ø.Ø 76Ø.2 743.39

Congenital cataracts resulting from antenatal
exposure to maternal rubella

2. Conditions originating in the perinatal period qualified as "neonatal" or "of newborn"

are usually transitory and will be coded with the appropriate perinatal code. If the
disease occurs in the permanent state in the newborn, code the condition from the main
classification.

MD0753 A-35
 EXAMPLE

DIAGNOSIS: Neonatal single, full-term, live-born female V3Ø.Ø 775.1

infant, transient diabetes mellitus.

PRINCIPLE XI. POISONING AND ADVERSE EFFECTS OF DRUGS AND E CODES

1. ICD-9-CM provides codes to differentiate between poisoning and an adverse

reaction to a correct substance properly prescribed and administered correctly. (See
principle XIV for poisoning.)

2. The World Health Organization has proposed a definition of an adverse drug

reaction as any response to a drug "which is noxious and unintended and which occurs
at doses used in man for prophylaxis, diagnosis, or therapy".

3. Terms frequently used in diagnostic statements to identify adverse drug reaction to

a correct substance properly administered are: accumulative effect, allergic reaction,
idiosyncratic reaction, hypersensitivity, paradoxical reaction, and side effects,
synergistic reaction and antagonistic drug interactions.

4. Categories E93Ø-E949 provide means to identify the drug responsible for a n

adverse reaction to a substance correctly administered. These E Code subcategories
provide the same specificity in identifying the drug involved in causing the adverse
reaction as do categories 96Ø-979 in identifying the drug involved in poisoning. Not e
that codes 96Ø-979 cannot be used in combination with codes E93Ø-E949. One
identifies a substance causing poison, and the other identifies a substance causing an
adverse reaction in therapeutic use.

5. The adverse reaction to a correct substance properly administered is classified to

the manifestation or the nature of the adverse reaction, such as gastritis, lymphadenitis,
urticaria, psychosis, etc.

6. Two codes are required to code an adverse reaction to a correct substance properly
administered. First code the adverse reaction using a code from ØØ1-799 categories;
second, code the drug or substance which caused it, using an E code from the
Therapeutic column of the Table of Drugs and Chemicals. If the reaction is unknown,
use code 995.2 and the E code.

7. Codes E93Ø-E949 can never be used as a solo code. The adverse reaction code is
always sequenced first. The E code can never be the principal diagnosis.

8. Code 995.2 will be used for unspecified nature of allergic or idiosyncratic reactions
to a correct substance properly administered (drug allergy, NOS). It is provided for
those cases in which a code from ØØ1-799 cannot be assigned because the nature of
the reaction is not known/stated. In these cases 995.2 is sequenced first, and the E
code is an additional code.

MD0753 A-36
9. The code 9Ø9.9 entitled "Late effect of other and unspecified external causes" is
provided to code the late effects of a previous adverse reaction the nature of which is
not stated. In essence 9Ø9.9 is used to code a late effect in a case which would have
been coded to 995.2 if it had been described as a current effect.

10. Chronic effects and delayed effects of drugs. Long-term, chronic effects of
drugs, such as the accumulative effect of digitalis, are coded as an adverse reaction to
a correct substance properly administered. Delayed chronic effects of drugs that occur
or are present a long time after the administration of the drug to which the patient
developed a reaction are coded as late effects of either poisoning or adverse reaction to
correct substance properly administered, depending on the circumstances.

11. Poisoning due to drugs, medicinal substances, and biologicals is defined as

conditions resulting from overdose of these substances or from the wrong substance
given or taken in error. Prior to using the table of drugs and chemicals, all coding
personnel should read the introduction in volume 2, page 763. Note also the table
beginning on page 765. The military hospitals will use only the first column "Poisoning"
and the third column "Therapeutic Use" in assigning codes from this table.

a. The column heading "Poisoning" provides codes 96Ø-979 for poisoning,

overdose, wrong drug given or taken, and wrong dosage given or taken, and codes
98Ø-989 for toxic effects of substances chiefly nonmedicinal as to source.

b. The adverse effect in "Therapeutic Use" column is intended to provide the

E Codes for external cause of adverse reactions to a correct substance (drugs,
medicinal, and biological substances) properly administered.

12. Categories 96Ø-979 identify the drugs, medicinal substances, and biologicals
causing the poisoning. These codes are found in Volume 2 (Table of Drugs and
Chemicals), pages 765-861.

13. If unable to locate the specific drug that caused the poisoning in the table, consult
the index of the American Hospital Formulary Service (AHFS). The numbers assigned
the drugs by the AHFS correlate to the code numbers for poisoning in ICD-9-CM (see
volume 2, pages 796-802).
14. Physicians use various terms when describing poisoning such as : overdose,
poisoning, toxic effect, wrong dosage given or taken, and wrong drug given or taken.
Interactions between any drug and alcohol or between prescribed and over-the-counter
drugs are classified as poisonings.

15. To code a poisoning, select a code from the poisoning column of the table of Drugs
and Chemicals. If known, code the reaction/manifestation as an additional code. If a
secondary code is used, the code for the poisoning must be sequenced first. Unlike
coding an adverse effect, there is no code for an unknown reaction to a poisoning.

MD0753 A-37
 APPLICATION

1. Chronic or long-term effect of drug:

EXAMPLE:

DIAGNOSIS: Cardiac arrhythmia secondary to digitalis 427.9 E942.1

intoxication.

2. Delayed or late effect of drug with previous manifestations specified:

EXAMPLE:

DIAGNOSIS: Brain damage secondary to cerebral anoxia 348.1 E93Ø.Ø

1 year ago, resulting from severe allergic
reaction to penicillin.

3. Delayed or late effect of adverse reaction without specifying the previous adverse
reaction.

EXAMPLE:

DIAGNOSIS: Brain damage, due to allergic reaction to 348.9 909.9 E93Ø.Ø

penicillin 1 year ago.

NOTE: Code 9Ø9.9 is used to denote the cause of the late effect of a previous adverse
reaction to a drug only when the nature or manifestation of the previous allergic reaction
is not specified.

4. Categories 96Ø-979 identify drugs, medicinal and biological substances causing the
poisoning.

EXAMPLE:
DIAGNOSIS: Overdose, seconal 967.Ø

PRINCIPLE XII. DRUG AND ALCOHOL

1. Definitions of Dependency and Abuse. It is the responsibility of the physician to

clearly indicate in the diagnostic statement whether the individual is abusing or
dependent on the specific substance. To assist coding personnel in determining the
correct classification for specific diagnostic statements, the following definitions are
provided:

MD0753 A-38
 a. Alcohol dependence syndrome (Alcoholism). A state, psychic and usually
also physical, resulting from taking alcohol, characterized by behavioral and other
responses that always include a compulsion to take alcohol on a continuous or periodic
basis in order to experience its psychic effects, and sometimes to avoid the discomfort
of its absence. Tolerance may or may not be present.

b. Nondependent abuse of alcohol. Includes individuals whose use of alcohol

has brought them to medical attention. Nondependent abuse of alcohol is applicable to
individuals formerly diagnosed as simple drunkenness cases. It also applies to
individuals not suffering from alcoholism whether or not they are intoxicated when seen
by a physician, after being referred to him in connection with driving-while-intoxicated
charges, altercations involving alcohol, AWOL or absences from work due to overuse of
alcohol, or for similar reasons when these individuals may benefit from available
rehabilitative services.

c. Drug dependence. A state, psychic and sometimes also physical, resulting

from taking a drug, characterized by behavioral and other responses that always include
a compulsion to take a drug on a continuous or periodic basis in order to experience its
psychic effects, and sometimes to avoid the discomfort of its absence. Tolerance may
or may not be present. A person may be dependent on more than one drug.

d. Nondependent abuse of drugs. Includes cases where a person, for whom no

other diagnosis is possible, has come under medical care because of the maladaptive
effect of a drug on which he is not dependent and that he has taken on his own initiative
to the detriment of his health or social functioning.

2. Overdoses. Overdose cases must include sufficient information so that the

following coding principles may be applied:

a. Drug abuse overdoses. These are usually cases in which an individual

abusing drugs inadvertently takes a dose larger than he can tolerate physiologically.
This may happen, for example, when the purity of his usual dose has been increased by
the supplier's inclusion of a smaller proportion of cutting material in the product. Or an
individual may take his previously accustomed dose after his physiological tolerance
has been lowered by a period of abstinence from the drug. The term "overdose" may
also be applied to cases of severe reaction, including sudden deaths, when the drug
abuser may not have exceeded his usual dose.

b. The cause of admission code in drug abuse overdose cases will be the
appropriate poisoning code from the Poisoning by Drugs, Medicaments, and Biological
Substances section of ICD-9-CM (categories 96Ø-979). The appropriate code for drug
abuse will be selected from the drug dependence categories (3Ø4) or the
Nondependent Abuse of Drugs category (3Ø5) and added as an additional code. The
cause of injury code will be 7Ø-, with third digit from Appendix B of the DOD coding
guidelines manual (STANAG 2Ø5Ø). This code is defined as "Poisoning by ingestion of
toxic substance ..." It should also be used for cases in which the toxic substance was
taken by methods other than ingestion.

MD0753 A-39
 3. For diagnosis qualified as "due to" or "secondary to" alcoholism, both the disease
condition and alcohol use (category (3Ø3) will be coded; for example, pancreatitis due
to alcoholism will be coded 577.Ø and 3Ø3.9Ø. Use the same principle if disease
condition is "due to" or "secondary to" drug abuse. As appropriate also code 9Ø9.Ø
(Late effects, poisoning). For some conditions, a combined diagnosis code points to
alcoholism as the cause of the disorder or physical complication. In such instances, the
use of the one code is sufficient; for example, alcoholic psychosis (category 291) ;
alcoholic cirrhosis of liver (571.2) and acute alcohol hepatitis (571.1). However, if
alcohol dependence or abuse is associated with the disorder or physical complication,
both will be coded.

APPLICATION

Drug and Alcohol

When admission is for both drug abuse and drug dependency, the drug dependency will
be the principal diagnosis:

EXAMPLE:

DIAGNOSIS: Cocaine dependence, Marijuana, abuse. 3Ø4.2Ø 3Ø5.2Ø

PRINCIPLE XIII. HEART CONDITIONS AND HYPERTENSION

1. Diseases relating to the circulatory system are difficult to code due to the many
synonymous terms and phrases used by physicians in writing the narrative description
of the disease process. The code(s) assigned depends on the words used in the
diagnostic statement. Carefully read and adhere to all written codes. The use of codes
which classify conditions to "other" or "unspecified" is discouraged.

2. ICD-9-CM provides fourth and fifth digits in many categories specifically relating to
the circulatory system. It is very important to follow the basic coding rule to always
locate the condition in the Alphabetic Index and verify in the Tabular List.
3. The alphabetic Index provides a table to classify hypertension whether as a sole
condition or in combination with other disease conditions.

a. To code hypertensive disease, refer to the table on pages 375-377 in Volume 2.

Specificity is provided by the terms malignant, benign, or unspecified.

b. Hypertension when associated with specific heart and renal conditions in a

cause-and-effect linkage are coded to categories 4Ø2, 4Ø3, or 4Ø4 as appropriate.
When using specific combination codes involving hypertension with heart and/or renal
conditions, the type of hypertension will determine the assignment of the fourth or fifth
digit.

MD0753 A-40
 c. Heart conditions listed in 428, 429.Ø-429.3, 429.8, and 429.9 described as due
to hypertension or hypertensive are coded to the 4Ø2 category. It is important to alert
the medical staff of the need to differentiate between (1) hypertensive heart disease and
(2) heart disease with nonrelated hypertension.

d. Renal conditions classified to categories 585, 586, or 587 with any condition
classified to category 4Ø1 or described as hypertensive renal disease is coded to the
4Ø3 category.

e. A supplemental code for hypertension is used in addition to the principal code to

completely classify a diagnosis specified as "with hypertension" or "and hypertension."

4. A separate three-digit category 412 is provided to classify the diagnosis "old

myocardial infarction." "Old" is defined as healed, old, or past, as evidenced by history,
or diagnosed as a result of an abnormal EKG or other special investigation and
currently asymptomatic. This code will never be used as principal diagnosis, but is to
be used when appropriate as an additional code.

5. A repeat myocardial infarction occurring during the same period of hospitalization as

that for the acute myocardial infarction is coded to the specific site involved provided the
site is different from the previous site; for example, patient admitted with diagnosis of
acute myocardial infarction of anterolateral wall (code 41Ø.) and while recovering in the
hospital, patient experiences a "repeat myocardial infarction of inferoposterior wall"
(code 41Ø.3). Both codes would be used and in the correct sequence as they occurred.

6. The best rule to follow in assigning codes relating to cerebrovascular diseases is

use as many codes as necessary to identify all the component parts of a complex
diagnostic statement unless the Alphabetic Index or Tabular List directs otherwise.

a. Conditions classifiable to cerebrovascular disease, codes 43Ø-438, include

those with mention of hypertension. An additional code should be used to identify the
hypertension and will follow the CVA-related codes.

b. If the cause for a cerebrovascular accident (CVA) is known, code 436 should not
be used as the principal diagnosis. Review the record, especially CT brain scan reports
for causes such as thrombosis, embolism.

c. Conditions resulting from the acute cerebrovascular disease stated as residuals

will be coded as additional codes. If the condition is still present at the time of
discharge, it will also be coded as an additional code. If conditions are stated as
transient and result from the cerebrovascular disease, omit coding.

d. When coding late effects of cerebrovascular disease, sequence the residual

code first followed by code 438.

7. ICD-9-CM differentiates between the conditions specified as high blood pressure

(hypertension) and elevated blood pressure
without a diagnosis of hypertension.

MD0753 A-41
 a. The diagnosis of "high blood pressure" is classified to category 4Ø1 (Ess ential
hypertension).

b. The diagnosis of "elevated blood pressure" without the term "hypertension" is

classified to code 796.2 (elevated blood pressure reading without diagnosis of
hypertension).

8. Most cases of chronic valvular heart disease are acquired and due to a previous
attack of acute rheumatic fever (usually unrecognized) resulting in stenosis or
incompetence of the valves. The mitral valves are the most commonly affected. In
ICD-9-CM, some of these resultant disorders of the mitral valve are classified to the
section on rheumatic diseases, while others are not, unless the diagnosis specifies the
condition as rheumatic. Disorders of the aortic valve must be specified as rheumatic in
order to be classified to section 396. When both the mitral and aortic valves are
involved, whether specified or not, the condition is classified to code 396, the section on
rheumatic diseases.

9. Ischemic heart disease occurs as a result of the lack of blood flow to the heart due
to partial or complete obstruction of the coronary artery. This disease may be identified
by such terms as arteriosclerotic heart disease, coronary ischemia, or coronary artery
disease. Sequencing of this disease depends on the reason for admission. When
hypertension is present as a secondary condition to ischemic heart disease, sequence
the ischemic heart disease before the hypertension code.

10. The diagnosis arteriosclerotic cardiovascular disease (ASCVD) requires two codes.
Code 429.2 identifies the cardiovascular disease but does not identify it as being due to
arteriosclerosis (code 44Ø.9). The correct codes for ASCVD are 429.2 and 44Ø.9. The
exclusion note under 44Ø.9. should be interpreted as "use additional code" to identify
the site of the arteriosclerosis (cardiovascular). It is not specified in code 44Ø.9.

11. When assigning codes to complications of surgical care resulting from surgery, the
"excludes" note under code 997.1 needs clarification of the term "long-term."

a. Subcategory 997.1 classifies cardiac complications that occur during the

immediate postoperative period or during the continuous period of hospitalization in
which the surgery was performed.

b. Subcategory 429.4 classifies "long-term" cardiac complications resulting from

cardiac surgery performed during a previous episode of care, regardless of the time-
span between the surgery and the complications.

c. Subcategory 997.1 is used also to classify immediate cardiac complications

resulting from any type of procedure. Subcategory 429.4 is used to classify "long-term"
cardiac complications resulting from cardiac surgery only. The surgery must have been
performed during a previous episode of care.

d. Subcategory 996.4Ø3 is used to classify occlusion of coronary artery bypass

grafts over a period of time (no specific time limits.).

MD0753 A-42
 APPLICATION

Heart Conditions and Hypertension

1. Code the condition(s) resulting from the acute cerebrovascular disease only if stated
to be a residual and is still present at discharge. If conditions are stated to be transient,
do not code.

EXAMPLE:

DIAGNOSIS: Left common carotid artery occlusion. Transient 433.1

ischemic attack

2. Certain disease conditions classified to the circulatory system are assigned

combination codes (heart, renal, and hypertension) when diagnostic statements clearly
indicate a cause-and-effect relationship between the condition(s) and hypertension.

EXAMPLES:

DIAGNOSIS: Congestive heart failure due to hypertensive 4Ø2.91

heart disease

DIAGNOSIS: Congestive heart failure with hypertension, 428.Ø 4Ø1.1

essential, benign

PRINCIPLE XIV. INJURIES

1. Chapter 17, entitled Injuries and Poisoning, comprise a major section of ICD-9-CM.
Categories 8ØØ-999 include fractures, dislocations, sprains, burns, poisoning,
complications of surgical and medical care, and various other types of trauma.

2. Although a number of combination codes are provided for classifying multiple

injuries of the same type (that is, fractures involving more than one anatomical location
and burns of multiple sites, etc), the basic coding rule should be followed when
possible. The basic coding rule states: "Multiple coding is not used if the classification
provides a combination code that fully describes all of the elements of the diagnostic or
procedure statement." Injuries classifiable to more than one subcategory should be
coded separately whenever possible.

3. ICD-9-CM provides subcategory codes to identify injuries considered to be

complicated for categories 872-897. Burns classified to categories 94Ø-949 do not
provide codes at fourth or fifth-digit level to identify complications. Diagnostic
statements specifying burns as infected will also use code 958.3 as an additional code.

4. Late Effects of Injuries. Late effects of diseases and injuries are classified to the
condition identifying the residual. An additional code is used to identify the cause of the
late effect. (See principle XV.)

MD0753 A-43
 5. Fractures are classified as open or closed. Coding personnel should review the
descriptions in Volume 1, page 735, that are frequently used in diagnostic statements
that identify fractures as open or closed. Fractures not specified as open or closed are
coded as closed.

6. Categories 94Ø-949 are provided for coding burns whether from chemicals or other
causes. Burns of the same anatomical site but of different degrees should be coded to
the appropriate subcategory identifying the most severe degree. If a burn is stated to
be infected, in addition to the code(s) used to identify the burn, also use code 958.3 to
identify the infection.

a. Category 948 is used to classify burns according to percent of body surface

involved. This category is primarily designed for use as an additional code with
categories 94Ø-947 to indicate the percent of body surface involved. It may be used as
a solo code when the site of the burn is not specified, but the percentage of body
surface involvement is specified.

b. Category 948 is unique in the coding structure. This category is designed to be

used as a subcategory fourth-digit code or as a subclassification fifth-digit code
whichever is applicable. The fourth digit will be used to indicate total percent of body
surface burn. The fifth digit is for percent of body surface of third -degree burn. The
military coders will always assign a fifth digit when using this category. If the total
percent of body surface is specified and there is no percentage for third -degree burn or
the percent for third-degree burn is less than 10 percent, use the fifth digit "Ø."

7. Cause of injury codes for any condition coded with codes 692.71, 8ØØ-999, V713-
V716, and E93Ø-E949 codes will be taken from STANAG 2050. See Appendix B of
Triservice Disease and Procedure Coding Guidelines, ICD--9-CM , dated 1 January
1991.

8. Sequencing of Injuries.

a. Multiple injuries: the most severe or life-threatening injury is the principal

diagnosis.

b. If injuries are of equal importance, the principal diagnosis is the one for which a
definitive surgical or nonsurgical procedure is performed.

APPLICATION

1. Multiple coding is not used if the classification provides a combination code fully
describing all elements of the diagnostic or procedure narrative.

EXAMPLE:

DIAGNOSIS: Closed fracture of right radius and ulna 813.83

MD0753 A-44
 2. CD-9-CM provides subcategory codes to identify injuries considered to be
complicated for categories 872-879. Burns classified to categories 94Ø-949 do not
provide codes at fourth- or fifth-digit level to identify complications; therefore, diagnostic
statements specifying burns as infected will require two or more codes.

EXAMPLES:

DIAGNOSIS: Laceration of right upper arm with delayed 88Ø.13

healing

DIAGNOSIS: Third-degree burn, left forearm, infected 943.31 958.3

3. Category 948 is used to classify burns according to percent of body surface

involved. Military coders will use the fifth digit "Ø" for percent of body surface with no
third-degree burn or third-degree burn of less than 10 percent.

EXAMPLES:

DIAGNOSIS: Third-degree burn to face, neck, and chest, 946.3 948.22

23 percent of body surface

DIAGNOSIS: Second-degree burn to face, neck, and chest, 946.2 948.2Ø

23 percent of body surface

PRINCIPLE XV. LATE EFFECTS

1. Late effects are those inactive residual effects of indefinite duration after termination
of the acute phase of the illness or injury. The term "late effect" includes those
conditions/residuals specified as:

a. Late.

b. Due to an old injury.

c. Due to a previous illness or injury.

d. Due to an injury or illness that occurred 1 year or more ago.

NOTE: The 1 year or more is not a hard, fast rule. If sufficient time has elapsed
between the acute phase of the illness or injury and the development of a residual, then
disregard the 1-year rule.

2. Late effects are classified by the residuals and by the cause of the late effect. The
late-effect code can never be used as the principal diagnosis. Also the late -effect code
can never be the cause for disability separation or failure to meet entrance standards.

3. Categories to identify the cause of the late effect are 137, 138, 139, 268.1, 326, 438,
and 905 through 909. As previously stated, these codes can never be used as principal
diagnosis or as medical reasons for disability separation. They will always be used as
additional codes when applicable.

MD0753 A-45
4. Conditions frequently described in diagnostic statements as residuals and late
effects are:

a. Malunion fracture.

b. Traumatic arthritis following fracture.

c. Hemiplegia, cerebrovascular thrombosis 1 year ago.

d. Scarring due to third-degree burn.

e. Contracture tendons due to poliomyelitis.

f. Sterility due to mumps.

5. When coding a late effect of an illness or injury and a code for both the residual and
the late effect are provided, the code for the residual must be sequenced first with the
appropriate code to show cause (late effect) as an additional code.

APPLICATION

Both the residual and the late effect must be coded. The code for the residual is
sequenced first.

EXAMPLE:

DIAGNOSIS: Nonunion of left ulna due to fracture 733.82 905.2

8 months ago

PRINCIPLE XVI. ORGAN AND TISSUE TRANSPLANTS

1. Potential Donor. Patients are sometimes admitted for predonation examination to

determine tissue compatibility prior to organ/tissue donation. These patients are
potential organ/tissue donors and are coded with the diagnostic code V7Ø.8
(Examination of potential donor). This code indicates the patient is not serving as a
donor during the current episode of hospitalization, and therefore, the record would not
have a procedure code for organ/ tissue removal.

2. Donor. Category V59 (Donor) is to be used for patients who serve as organ/tissue
donor during the current continuous period of hospitalization. The admission diagnosis
is Organ/Tissue Donor (specific type) and requires an appropriate subcategory code
from the V59 category. Use of any V59 subcategory code indicates the patient did
serve as an organ/tissue donor and therefore, the record requires a surgical procedure
code indicating organ/ tissue removal.

MD0753 A-46
 3. The V7Ø.8 (Examination of potential donor) code will not be used on the same
record as the V59 (Donor) category code.

4. Initial Transplant Recipient. Patients admitted for an injury or chronic disease

process necessitating an initial organ/tissue transplant will have that condition coded as
the principal diagnosis. An additional subcategory code from the V42 (Organ or tissue
replaced by transplant) category will be used as an additional code to indicate the
specific organ/tissue transplanted. The recipient's surgical procedure indicating the
organ/tissue transplanted will always be indicated and coded as the principle procedure.

5. Recipient Complications and/or Rejections. When an admission occurs due to a

complication and/or rejection of a previously transplanted organ/tissue, the cause of
admission code is selected from the 996.8 through 996.99 subcategories and used as
the principal diagnosis. An additional code from category V42 (Organ or tissue replaced
by transplant) is required to denote the specific organ involved.

6. Follow-up. At specified intervals transplant patients are admitted solely for

examination and testing. When the admission is solely for follow -up care (status post
with no complication) code V67Ø will be the principal diagnostic code. A code from the
V42 category is selected to indicate the organ or tissue replaced by transplant. The
disease process (or injury) which led to the initial transplant will not be coded.
7. All subcategory codes in the V42 (Organ or tissue replaced by transplant) category
are status codes to indicate the presence of a transplanted organ/tissue.

APPLICATION

1. A surgical procedure for organ/tissue removal is not appropriate with the

predonation examination for tissue compatibility diagnosis.

EXAMPLE:

DIAGNOSIS: Examination of potential kidney donor V7Ø.8

2. The organ donor requires a diagnostic code to indicate the specific organ donated
and a surgical procedure code for the specific organ/tissue removed.

EXAMPLE:

DIAGNOSIS: Kidney donor V59.4

PROCEDURE: Total nephrectomy, right 55.51

MD0753 A-47
 3. An initial transplant recipient requires the diagnosis necessitating the transplant be
coded as the principal diagnosis and an additional diagnostic code from category V42 to
denote the specific organ/tissue transplanted. The principal surgical procedure will be
the specific organ/tissue transplanted.

EXAMPLE:

DIAGNOSIS: End state renal disease 585.Ø V42.Ø

PROCEDURE: Renal transplant 55.69

4. Use a subcategory code from 996 category to show cause of admission for rejection
and/or complication of organ transplant, and an additional code from V42 category to
show specific organ transplanted and now causing rejection.

EXAMPLE:

DIAGNOSIS: Rejection of cadaver kidney transplant 996.8 V42.Ø

5. An admission solely for follow-up of organ/tissue transplant will have code V67.0 as
the principle diagnosis.

EXAMPLE:

DIAGNOSIS: Status post renal transplant follow-up V67.Ø V42.Ø

PROCEDURE: Transplant done 6 months ago for end
stage renal disease

PRINCIPLE XVII. AIDS AND HIV INFECTIONS

1. AIDS AND HIV. AIDS is an acronym for Acquired Immunodeficiency Syndrome.

HIV is an acronym for Human Immunodeficiency Virus. The spectrum of HIV infections
can be divided into three categories:
a. Ø42 - HIV infection with specified secondary infections and malignant
neoplasms.

b. Ø43 - HIV infection with other specified manifestations in the absence of either
specified secondary infections or malignant neoplasms.

c. Ø44 - Other HIV infections not classifiable above.

2. Code Category. The selection of the appropriate Ø42-Ø44 code is determined

solely by the terminology used for the HIV infection. Codes Ø42, Ø43, and Ø44 are
mutually exclusive and only one code from the Ø42-Ø44 series should be used on the
same record. This code may change on subsequent admissions. Priority is given to
Ø42 over Ø43 and Ø44; Ø43 is given priority over Ø44.

MD0753 A-48
 3. Manifestations. The manifestations of the HIV infection should be clearly identified
in order to select the appropriate code. Use the alphabetical table provided in the ICD-
9-CM addendum as an index to assist in the selection of the most appropriate code for
the infection and any associated manifestation(s).

a. The term "with" implies that the condition or manifestation of HIV infection need
only be listed on the record. Terms such as "and" and "in association with" will be
considered in the same manner as "with."

EXAMPLES:

DIAGNOSES: Acute lymphadenitis with AIDS, Stage 3 683, Ø42.9, 795.8--3

Kaposi's sarcoma associated 173, Ø42,2, 795.8--6

with AIDS, Stage 6

Burkitt's tumor, Stage 6 2ØØ.2, Ø42.2, 795.8--6

AIDS-like disease, Stage 4 Ø43.9, 795.8--4

b. The term "due to" denotes a causal relationship. The physician must state the
relationship between HIV infections and other conditions.

EXAMPLES:

DIAGNOSES: Dementia due to HIV infection, Stage 5 298.9, Ø43.1, 795.8--5

Acquired immunodeficiency syndrome, Ø42.9, 795.8--6

Stage 6

Disseminated candidiases caused 112.5, Ø42.1, 795.8--6

by AIDS, Stage 6

4. HIV Code Extenders. To accommodate the DRG groupers and still retain the
specificity required by DOD to identify the progressive stage of an HIV infection, the
following "stage" code extenders are available:

795.8— 1 Positive serological or viral culture findings for human immunodeficiency

virus (HIV), stage 1.

795.8— 2 Positive serological or viral culture findings for human immunodeficiency

virus (HIV), stage 2.

795.8— 3 Positive serological or viral culture findings for human immunodeficiency

virus (HIV), stage 3.

795.8— 4 Positive serological or viral culture findings for human immunodeficiency

virus (HIV), stage 4.

MD0753 A-49
 795.8— 5 Positive serological or viral culture findings for human immunodeficiency
virus (HIV), stage 5.

795.8— 6 Positive serological or viral culture findings for human immunodeficiency

virus (HIV), stage 6.

795.8— 9 Positive serological or viral culture findings for human immunodeficiency

virus (HIV), stage unspecified or unknown.

5. Sequencing.

a. The principal diagnosis would be selected based on the individual discharge.

The HIV infection codes can be used as either a principal or other diagnosis. The note
"with" and "due to HIV infection" do not imply sequencing.

b. A manifestation associated with an HIV infection, when found after study to have
been chiefly responsible for the hospitalization, is coded as the principal diagnosis. This
is followed than by one of the Ø4 . subcategory codes and appropriate stage code.
(NOTE: Except for Stage 1 and unspecified, Stage 9).

c. When there is no manifestation, code the HIV infection using as principal

diagnosis one of the Ø4 . codes with the appropriate stage code. The Ø4 . code will
be the principal diagnosis.

d. Follow-up Examination. Patients with positive HIV are seen at regular intervals
for follow-up examination; these cases should be coded as follows:

(1) For patients who have an identified manifestation at the end of the hospital
stay, code the manifestation and appropriate Ø4 . subcategory code. The
manifestation is selected as the principal diagnosis. The V67. code for follow-up is
unnecessary. Code also the appropriate stage code.

(2) For patients who demonstrate no obvious manifestation, code V67. with the
appropriate stage code and the appropriate Ø4 .Ø code. The follow-up V67. will be the
principal diagnosis.
e. HIV stage codes are usually additional codes. They may be the principal
diagnosis or sole diagnosis only in the following circumstances:

(1) HIV Stage Unspecified (795.8--9) can be used when the patient has been
identified as HIV positive serology, and is en route for evaluation and staging. It may
occasionally represent a nonmilitary inpatient for whom no staging has been done.

(2) HIV Stage 1 (795.8--1) can be used when the patient has been so staged
and demonstrates no manifestations.

f. Laboratory examination. Previous codes in this category are no longer used.

(1) The V72.6- serology codes (four DOD-unique) are for use only; for
outpatients. We have deleted the V72.6- for inpatients but must leave the system intact
for the outpatient US active duty data base. That system collects negative as well as
positive serologies to accommodate the complete formula for rates and percentages.

MD0753 A-50
 (2) There should be no code for false positive on inpatient records . Because
we require two Elisa and a Western Blot before a diagnosis is made, the chances of a
false positive are negligible.

(3) For hospital inpatients, there will be no need for a diagnosis or code on the
medical record face sheet to reflect "negative serology - HIV." We do not diagnose or
code other negative laboratory findings; there is no need to do so with HIV.

APPLICATION

1. The manifestation chiefly responsible for the hospitalization is the principal

diagnosis and is sequenced first, followed by the Ø4 . HIV infection code. Code also all
other manifestations and the stage code.

EXAMPLE:

DIAGNOSES: HIV Dementia 298.9

AIDS, Stage 6 Ø42.9

Candida Esophagitis 112.8Ø

2. When a patient is admitted for a follow-up examination, code to V67.59 and code
the stage of infection.

EXAMPLE:

DIAGNOSES: Follow-up exam V67.59

HIV Antibody Positive, Stage 2 795.8--2

3. When hospitalization is for a condition unrelated to the HIV infection, that condition
is the principal diagnosis.

EXAMPLE:
DIAGNOSES: Closed Head Injury, MV 854.Ø

Bladder Contusion 867.Ø

Fracture, Closed, Right Acetabulum 8Ø8.Ø

HIV Infection Ø44.9

HIV Positive, Stage 1 of Infection 795.8--1

MD0753 A-51
 PRINCIPLE XVIII. SPECIAL DIAGNOSIS

1. Viral (Infectious) Hepatitis.

a. The code numbers in ICD-9-CM for viral hepatitis will be used. However, to
provide greater specificity for DOD use, this category has been expanded by use of
DOD code extenders, which are included in Appendix A of the Triservice Disease and
Procedure Coding Guidelines, dated 1 January 1991.

b. There is no longer a requirement to denote drug use/nonuse when coding

hepatitis conditions.

c. Post-transfusion hepatitis will be coded 999.8 and Ø7Ø.3--1.

d. Post-vaccination hepatitis will be coded 999.9 and Ø7Ø.3--1.

2. Diabetes Mellitus.

a. Category 25Ø is used to classify diabetes mellitus. Fourth-digit classifications

are used to identify the presence of coma or systemic manifestations. The fifth-digit
subclassifica-tion will specify the type of diabetes. When the physician does not specify
the type of diabetes, a fifth digit of "Ø" is assigned.

Fifth-digit subclassifications:

Ø -- Adult onset and NOS (AODM)

Noninsulin Dependent Diabetes (NIDDM)
Maturity Onset Diabetes (MODM)
Type II Diabetes

1 -- Juvenile type (JODM)

Insulin Dependent Diabetes (IDDM)
Adult Onset with Insulin Dependence
Type I Diabetes

b. To use the fifth digit of "1," insulin dependent must be noted somewhere in the
medical record or as part of the stated final diagnosis. Do not assume a patient has
insulin dependent diabetes simply because the patient is receiving insulin. Sometimes
Type II diabetics require temporary use of insulin when they are hospitalized for surgery
or other illness. Consult the physician for clarification in such cases.

c. System Manifestations.

(1) Categories 25Ø.4-25Ø.8 are used to classify diabetes with systemic

manifestations, which represent a cause and effect relationship with the diabetes.
These codes are presented together as an inseparable pair in the Alphabetic Index.
These paired codes are sequenced so that the underlying cause (diabetes) is always
positioned first and followed by the manifestation code.

MD0753 A-52
 (2) The physician should specify in the diagnosis that the condition is diabetic or
due to diabetes; otherwise, it is presumed not to be caused by diabetes.

NOTE: An exception is diabetic gangrene or diabetes with gangrene leads the coder to
the code denoting diabetes as the underlying cause of the gangrene, 25Ø.7Ø [785.4].

d. Uncontrolled diabetes. Diabetes described as brittle or uncontrolled is to be

interpreted as diabetes mellitus, complicated. Brittle diabetes mellitus is difficult to
control because of rapid fluctuation in the blood sugar. Brittle diabetes mellitus may
occur in either the juvenile or the adult-onset type.

ICD-9-CM CODE EXTENDERS

Add these codes to the indicated categories in ICD-9-CM, Volume 1. These codes are
to be used with records having a date of disposition on or after 1 January 1989.

Ø4Ø89— Ø Toxic shock syndrome

Ø4Ø89— 9 Other specified bacterial diseases, excluding toxic shock syndrome

Ø7ØØ— Ø Viral hepatitis A with hepatic coma, lab test confirmed

Ø7ØØ— 1 Viral hepatitis A with hepatic coma, lab test not reported or negative
Ø7ØØ— 2 Viral hepatitis A with hepatic coma, lab test notperformed

Ø7Ø1— Ø Viral hepatitis A without mention of hepatic coma, lab test confirmed
Ø7Ø1— 1 Viral hepatitis A without mention of hepatic coma, lab test not reported or
negative
Ø7Ø1— 2 Viral hepatitis A without mention of hepatic coma, lab test not performed

Ø7Ø2— Ø Viral hepatitis B with hepatic coma, lab test confirmed

Ø7Ø2— 1 Viral hepatitis B with hepatic coma, lab test not reported or negative
Ø7Ø2— 2 Viral hepatitis B with hepatic coma, lab test not performed

Ø7Ø3— Ø Viral hepatitis B without mention of hepatic coma, lab test confirmed
Ø7Ø3— 1 Viral hepatitis B without mention of hepatic coma, lab test not reported or
negative
Ø7Ø3— 2 Viral hepatitis B without mention of hepatic coma, lab test not performed

Ø7Ø4— 3 Non A, Non-B hepatitis with hepatic coma

Ø7Ø4— 9 Other specified viral hepatitis, excluding Non-A, Non-B hepatitis, with
hepatic coma

Ø7Ø5— 3 Non A, Non-B hepatitis without mention of hepatic coma

Ø7Ø5— 9 Other specified viral hepatitis, excluding Non-A, Non-B hepatitis, without
mention of hepatic coma

Ø888— Ø Lyme disease

Ø888— 9 Other specified arthropod-borne diseases, excluding Lyme's disease

MD0753 A-53
4461— Ø Kawasaki disease
4461— 9 Acute febrile mucocutaneous lymph node syndrome (MCLS), excluding
Kawasaki disease

635xx— Ø Legally induced abortion, elective

635xx— 1 Legally induced abortion, therapeutic
635xx— 9 Legally induced abortion, unspecified

638x— Ø Failed attempted abortion, elective

638x— 1 Failed attempted abortion, therapeutic
638x— 9 Failed attempted abortion, unspecified

6542— Ø Uterine scar from previous cesarean section

6542— 9 Uterine scar from previous surgery, excluding previous cesarean section

7958— 1 Positive serological or viral cu lture findings for human immunodeficiency

virus (HIV), stage 1

7958— 2 Positive serological or viral culture findings for human immunodeficiency

virus (HIV), stage 2

7958— 3 Positive serological or viral culture findings for human immunodeficiency

virus (HIV), stage 3

7958— 4 Positive serological or viral culture findings for human immunodeficiency

virus (HIV), stage 4

7958— 5 Positive serological or viral culture findings for human immunodeficiency

virus (HIV), stage 5

7958— 6 Positive serological or viral culture findings for human immunodeficiency

virus (HIV), stage 6

7958— 9 Positive serological or viral culture findings for human immunodeficiency

virus (HIV), stage unspecified or unknown

V714— Ø Observation following other accident, head injury ruled out

V714— 9 Observation following other accident, excluding head injury

V716— Ø Observation following other inflicted injury, head injury ruled out

V716— 9 Observation following other inflicted injury, excluding head injury

7958— 2 Positive serological or viral culture findings for human immunodeficiency

virus (HIV), stage 2

MD0753 A-54
 APPLICATION

1. Use the DOD code extenders when coding hepatitis conditions.

EXAMPLE:

DIAGNOSIS: Hepatitis B, no lab confirmation and no coma Ø7Ø.3--1

2. Diabetes mellitus. Use fifth digits to denote insulin dependent or noninsulin

depending; use the fourth digits to denote complications and/or manifestations.

EXAMPLES:

DIAGNOSIS: Diabetes mellitus, juvenile, brittle 25Ø.41

DIAGNOSIS: Diabetic nephropathy 583.81

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

EXAMPLES:

DIAGNOSIS: Diabetes mellitus, uncontrolled; ketoacidosis 25Ø.1Ø

DIAGNOSIS: Diabetes mellitus, brittle 25Ø.9Ø

MD0753 A-55
 APPENDIX B - EXCERPTS FROM VOLUME I
International Classification of Diseases, 9th Revision, Clinical Modification

TABULAR LIST

117.8 Infection by dematiacious fungi, [ Phaehyphomyocsis]

Infection by dematiacious fungi, such as
Cladosporium trichoides [bantianum],
Dreschlera hawaiiensis, Phialophora
gougerotii, Phialophora jeanselmi

117.9 Other and unspecified mycoses

118 Opportunistic mycoses

Infection of skin, subcutaneous tissues, and/or
organs by a wide variety of fungi generally
considered to be pathogenic to compromised
hosts only (e.g., infection by species of
Alternaria, Dreschlera, Fusarium)

HELMINTHIASES (120-129)

120 Schistosomiasis [bilharziasis]

120.0 Schistosoma haematobium

Vesical schistosomiasis NOS

120.1 Schistosoma mansoni

Intestinal schistosomiasis NOS

120.2 Schistosoma japonicum

Asiatic schistosomiasis NOS
Katayama disease or fever

120.3 Cutaneous
Cercarial dermatitis Schistosome dermatitis
Infection by cercariae of Swimmers' itch
Schistosoma

120.8 Other specified schistosomiasis

Infection by Schistosoma: Infection by Schistosoma
bovis spindale
intercalatum Schistosomiasis
mattheii chestermani

MD0753 B-1
 NEOPLASMS

154.3 Anus, unspecified

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

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

155 Malignant neoplasm of liver and intrahepatic bile ducts

155.0 Liver, primary

Carcinoma:
liver, specified as primary
hepatocellular
liver cell
Hepatoblastoma

155.1 Intrahepatic bile ducts

Canaliculi biliferi Intrahepatic
Interlobular: biliary passages
bile ducts canaliculi
biliary canals gall duct

Excludes: hepatic duct (156.1)

155.2 Liver, not specified as primary or secondary

156 Malignant neoplasm of gallbladder and extrahepatic bile ducts

156.0 Gallbladder

156.1 Extrahepatic bile ducts

Biliary duct or passage Cystic duct
NOS Hepatic duct
Common bile duct Sphincter of Oddi

MD0753 B-2
 NERVOUS SYSTEM AND SENSE ORGANS

380.4 Impacted cerumen

Wax in ear

380.5 Acquired stenosis of external ear canal

Collapse of external ear canal

380.50 Acquired stenosis of external ear canal, unspecified

as to cause

380.51 Secondary to trauma

380.52 Secondary to surgery

380.53 Secondary to inflammation

380.8 Other disorders of external ear

380.81 Exostosis of external ear canal

380.89 Other

380.9 Unspecified disorder of external ear

381 Nonsuppurative otitis media and Eustachian tube disorders

381.0 Acute nonsuppurative otitis media

Acute tubotympanic catarrh
Otitis media, acute or subacute:
catarrhal
exudative
transudative
with effusion

Excludes: otitic barotrauma (993.0)

381.00 Acute nonsuppurative otitis media, unspecified

381.01 Acute serous otitis media

Acute or subacute secretory otitis media

381.02 Acute mucoid otitis media

Acute or subacute seromucinous otitis media
Blue drum syndrome

MD0753 B-3
 RESPIRATORY SYSTEM

485 Bronchopneumonia, organism unspecified

Bronchopneumonia: Pneumonia:
hemorrhagic lobular
terminal segmental
Pleurobronchopneumonia

Excludes: bronchiolitis (acute) (466.1)

chronic (491.8)
lipoid pneumonia (507.1)

486 Pneumonia, organism unspecified

Excludes: hypostatic or passive pneumonia (514)

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

487 Influenza

Excludes: hemophilus influenzae [H.influenzae]:

infection NOS (041.5)
larygitis (464.0)
meningitis (320.0)
pneumonia (482.2)

487.0 With pneumonia

Influenza with pneumonia, any form
Influenzal:
bronchopneumonia
pneumonia

487.1 With other respiratory manifestations

Influenza NOS
Influenzal:
laryngitis
pharyngitis
respiratory infection (upper) (acute)

487.8 With other manifestations

Encephalopathy due to influenza
Influenza with involvement of gastrointestinal tract

Excludes: "intestinal flu" [viral gastroenteritis] (008.8)

MD0753 B-4
 CONDITIONS IN THE PERINATAL PERIOD

773.3 Hydrops fetalis due to isoimmunization

Use additional code, if desired, to identify type

of isoimmunization (773.0-773.2)

773.4 Kernicterus due to isoimmunization

Use additional code, if desired, to identify type

of isoimmunization (773.0-773.2)

773.5 Late anemia due to isoimmunization

774 Other perinatal jaundice

774.0 Perinatal jaundice from hereditary hemolytic anemias

Code also underlying disease (282.0-282.9)

774.1 Perinatal jaundice from other excessive hemolysis

Fetal or neonatal jaundice from:
brusing
drugs or toxins transmitted from mother
infection
polycythermia
swallowed maternal blood

Use additional code, if desired, to identify cause

Excludes: jaundice due to isoimmunization (773.0-773.2)

774.2 Neonatal jaundice associated with preterm delivery

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

MD0753 B-5
 SYMPTOMS, SIGNS, AND ILL-DEFINED CONDITIONS

782.6 Pallor and flushing

782.61 Pallor

782.62 Flushing
Excessive blushing

782.7 Spontaneous ecchymoses

Petechiae

Excludes: ecchymosis in fetus or newborn (772.6)

purpura (287.0-287.9)

782.8 Changes in skin texture

Induration of skin
Thickening }
782.9 Other symptoms involving skin and integumentary tissues

783 Symptoms concerning nutrition, metabolism, and development

783.0 Anorexia
Loss of appetite

Excludes: anorexia nervosa (307.1)

loss of appetite of nonorganic origin (307.59)

783.1 Abnormal weight gain

Excludes: excessive weight gain in pregnancy (646.1)

obesity (278.0)

783.2 Abnormal loss of weight

783.3 Feeding difficulties and mismanagement

Feeding problem (elderly) (infant)

Excludes: feeding disturbance or problems:

in newborn (779.3)
of nonorganic origin (307.50-307.59)

MD0753 B-6
 TABULAR LIST

783.4 Lack of expected normal physiological development

Delayed milestone Lack of growth
Failure to gain weight Physical retardation
Failure to thrive Short stature

Excludes: delay in sexual development and puberty

(259.0)
specific delays in mental development
(315.0-315.9)

783.5 Polydipsia
Excessive thirst

783.6 Polyphagia
Excessive eating
Hyperalimentation NOS

Excludes: disorders of eating of nonorganic

origin (307.50-307.59)

783.9 Other symptoms concerning nutrition, metabolism, and

development
Hypometabolism

Excludes: abnormal basal metabolic rate (794.7)

dehydration (276.5)
other disorders of fluid, electrolyte
and acid-base balance (276.0-276.9)

784 Symptoms involving head and neck

Excludes: encephalopathy NOS (348.3)

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

784.0 Headache
Facial pain Pain in head NOS

Excludes: atypical face pain (350.2)

migraine (346.0-346.9)
tension headache (307.81)

MD0753 B-7
 SYMPTOMS, SIGNS, AND ILL-DEFINED CONDITIONS

784.1 Throat pain

Excludes: dysphagia (787.2)

neck pain (723.1)
sore throat (462)
chronic (472.1)

784.2 Swelling, mass, or lump in head and neck

Space-occupying lesion, intracranial NOS

784.3 Aphasia

Excludes: developmental aphasia (315.31)

784.4 Voice disturbance

784.40 Voice distubrance, unspecified

784.41 Aphonia
Loss of voice

784.49 Other
Change in voice Hypernasality
Dysphonia Hyponasality
Hoarseness

784.5 Other speech distubance

Dysarthria Slurred speech
Dysphasia

Excludes: stammering and stuttering (307.0)

that of nonorganic origin (307.0, 307.9)

784.6 Other symbolic dysfunction

Excludes: developmental learning delays (315.0-315.9)

784.60 Symbolic dysfunction, unspecified

784.61 Alexia and dyslexia

Alexia (with agraphia)

784.69 Other
Acalculia Agraphia NOS
Agnosia Apraxia

MD0753 B-8
 APPENDIX C – EXCERPTS FROM VOLUME 2
International Classification of Diseases, 9 th Revision, Clinical Modification

INDEX TO DISEASES
Anthropophobia
Anomaly, anomalous (congenital)
(unspecified type) – continued Anoxia –continued
vitreous humor 743.9 intrauterine – continued
specified type NEC 743.51 liveborn infant – see Distress, fetal,
vulva 752.40 liveborn infant
wrist (joint) 755.50 myocardial – see Insufficiency, coronary,
Anomia 784.69 newborn 768.9
Anonychia 757.5 mild or moderate (Apgar score 4-7)
Acquired 703.8 768.6
Anophthalmos, anophthalmus (clinical) severe (Apgar score 0-3) 768.5
(congenital) (globe) 743.00 pathological 799.0
acquired 360.89 Anteflexion – see Anteversion
Anopsia (altitudinal) (quadrant ) 368.46 Antenatal
Anorchia 752.8 care, normal pregnancy V22.1
Anorchism, anorchidism 752.8 first V22.0
Anorexia 783.0 screening (for) V28.9
hysterical 300.11 based on amniocentesis NEC V28.2
nervosa 307.1 chromosomal anomalies V28.0
Anosmia (see also Disturbance, sensation) raised alphafetoprotein levels V28.1
781.1 chromosomal anomalies V28.0
hysterical 300.11 fetal growth retardation using
postinfectional 478.9 ultrasonics V28.4
psychogenic 306.7 isoimmunization V28.5
traumatic 951.8 malformations using ultrasonics V28.3
Anosognosia 780.9 raised alphafetoprotein levels in
Anosphrasia 781.1 amniotic fluid V28.1
Anosteoplasia 756.50 specified condition NEC V28.8
Anotia 744.09 Antepartum.--.see condition
Anovulatory cycle 638.0 Anterior – see also condition
Anoxemia 799.0 spinal artery compression syndrome 721.1
newborn 770.8 Antero-occlusion 524.2
Anoxia 799.0 Anteversion
altitude 993.2 cervix (see also Anteversion, uterus)
cerebral 348.1 621.6
with femur (neck), congenital 755.63
abortion – see Abortion, by type, uterus, uterine (cervix) (postinfectional)
with specified complication NEC (postpartal, old) 621.6
ectopic pregnancy (see also categories congenital 752.3
633.0-633.9) 639.8 in pregnancy or childbirth 654.4
molar pregnancy (see also categories affecting fetus or newborn 763.8
630-632) 639.8 causing obstructed labor 660.2
complicating affecting fetus or newborn 763.1
delivery (cesarean) (instrumental) Anthracosilicosis (occupational) 500
669.4 Anthracosis (lung) (occupational) 500
ectopic or molar pregnancy 639.8 lingua 529.3
obstetric anesthesia or sedation 668.2 Anthrax 022.9
during or resulting from a procedure with pneumonia 022.1 [484.5]
997.0 colitis 022.2
following cutaneous 022.0
abortion 639.8 gastrointestinal 022.2
ectopic or molar pregnancy 639.8 intestinal 022.2
newborn (see also Distress, fetal, pulmonary 022.1
liveborn infant) 768.9 respiratory 022.1
due to drowning 994.1 septicemia 022.3
heart – see Insufficiency, coronary specified manifestation NEC 022.8
high altitude 993.2 Anthropoid pelvis 755.69
intrauterine with disproportion (fetopelvic) 653.2
fetal death (before onset of labor) 768.0 affecting fetus or newborn 763.1
during labor 768.1 causing obstructed labor 660.1
affecting fetus or newborn 763.1
Anthropophobia 300.29

MD0753 C-1
 INDEX TO DISEASES Jaundice
____________________________________________________________________________________

Jaccoud's nodular fibrositis, chronic Jaundice (yellow)--continued

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

MD0753 C-2
 INDEX TO DISEASES Lambliasis
____________________________________________________________________________________

Lacertation--continued Lack of --- continued

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

MD0753 C-3
Lame INDEX TO DISEASES
____________________________________________________________________________________

Lame back 724.5 with

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

MD0753 C-4
 INDEX TO DISEASES Neoplasm

Malignant

Uncertain Behavior

Unspecified
Secondary

Ca In situ
Primary

Benign
Neoplasm, neoplastic – continued
ligament – continued
Uterosacral … … … … … … … … … … … … … … … … … . 183.4 198.82 -- 221.0 236.3 239.5
limb* … … … … … … … … … … … … … … … … … … … … ... 195.8 198.89 232.8 229.8 238.8 239.8
lower* … … … … … … … … … … … … … … … … … … … .. 195.5 198.89 232.7 229.8 238.8 239.8
upper* … … … … … … … … … … … … … … … … … … … .. 195.4 198.89 232.6 229.8 238.8 239.8
limbus of cornea … … … … … … … … … … … … … … … .. 190.4 198.4 234.0 224.4 238.8 239.8
lingual NEC (see also Neoplasm, tongue) … … … … .. 141.9 198.89 230.0 210.1 235.1 239.0
lingula, lung … … … … … … … … … … … … … … … … … .. 162.3 197.0 231.2 212.3 235.7 239.1
lip (external) (lipstick area) ( vermillion border) … … … 140.9 198.89 230.0 210.0 235.1 239.0
buccal aspect – see Neoplasm, lip, internal
commissure… … … … … … … … … … … … … … … … … . 140.6 198.89 230.0 210.4 235.1 239.0
contiguous sites … … … … … … … … … … … … … … … . 140.8 -- -- -- -- --
with oral cavity or pharynx … … … … … … … … … … . 149.8 -- -- -- -- --
frenulum – see Neoplasm, lip, internal
inner aspect – see Neoplasm, lip, internal
internal (buccal) (frenulum) (mucosa) (oral) … … … .. 140.5 198.89 230.0 210.0 235.1 239.0
lower… … … … … … … … … … … … … … … … … … … ... 140.4 198.89 230.0 210.0 235.1 239.0
upper … … … … … … … … … … … … … … … … … … … . 140.3 198.89 230.0 210.0 235.1 239.0
lower … … … … … … … … … … … … … … … … … … … … 140.1 198.89 230.0 210.0 235.1 239.0
internal (buccal) (frenulum) (mucosa) (oral)… … … . 140.4 198.89 230.0 210.0 235.1 239.0
mucosa – see Neoplasm, lip, internal
oral aspect – see Neoplasm, lip, internal
skin (commissure) (lower) (upper) … … … … … … … .. 173.0 198.2 232.0 216.0 238.2 239.0
upper … … … … … … … … … … … … … … … … … … … … 140.0 198.89 230.0 210.0 235.1 239.0
internal (buccal) (frenulum) (mucosa) (oral) … … … 140.3 198.89 230.0 210.0 235.1 239.0
liver … … … … … … … … … … … … … … … … … … … … … . 155.2 197.7 230.8 211.5 235.3 239.0
primary … … … … … … … … … … … … … … … … … … … 155.0 -- -- -- -- --
lobe
azygos … … … … … … … … … … … … … … … … … … … 162.3 197.0 231.2 212.3 235.7 239.1
frontal … … … … … … … … … … … … … … … … … … … .. 191.1 198.3 -- 225.0 237.5 239.6
lower … … … … … … … … … … … … … … … … … … … … 162.5 197.0 231.2 212.3 235.7 239.1
middle … … … … … … … … … … … … … … … … … … … . 162.4 197.0 231.2 212.3 235.7 239.1
occipital … … … … … … … … … … … … … … … … … … .. 191.4 198.3 -- 225.0 237.5 239.6
parietal … … … … … … … … … … … … … … … … … … … 191.3 198.3 -- 225.0 237.5 239.6
temporal … … … … … … … … … … … … … … … … … … . 191.2 198.3 -- 225.0 237.5 239.6
upper … … … … … … … … … … … … … … … … … … … … 162.3 197.0 231.2 212.3 235.7 239.1
lumbrosacral plexus … … … … … … … … … … … … … … 171.6 198.4 -- 215.6 238.1 239.2
lung … … … … … … … … … … … … … … … … … … … … … 162.9 197.0 231.2 212.3 235.7 239.1
azgos lobe … … … … … … … … … … … … … … … … … .. 162.3 197.0 231.2 212.3 235.7 239.1
carina … … … … … … … … … … … … … … … … … … … .. 162.2 197.0 231.2 212.3 235.7 239.1
contiguous sites with bronchus or trachea … … … … 162.8 -- -- -- -- --
hilus … … … … … … … … … … … … … … … … … … … … . 162.2 197.0 231.2 212.3 235.7 239.1
lingula … … … … … … … … … … … … … … … … … … … .. 162.3 197.0 231.2 212.3 235.7 239.1
lobe NEC … … … … … … … … … … … … … … … … … … . 162.9 197.0 231.2 212.3 235.7 239.1
lower lobe … … … … … … … … … … … … … … … … … … 162.5 197.0 231.2 212.3 235.7 239.1
main bronchus … … … … … … … … … … … … … … … … 162.2 197.0 231.2 212.3 235.7 239.1
middle lobe … … … … … … … … … … … … … … … … … . 162.4 197.0 231.2 212.3 235.7 239.1
upper lobe … … … … … … … … … … … … … … … … … ... 162.3 197.0 231.2 212.3 235.7 239.1

MD0753 C-5
 INDEX TO DISEASES Swelling
____________________________________________________________________________________

Suppuration suppurative--continued Surgery--continued

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

MD0753 C-6
Swelling INDEX TO DISEASES
____________________________________________________________________________________

Swelling--continued glands 785.6

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

MD0753 C-7
 INDEX TO DISEASES Vulvovaginitis
____________________________________________________________________________________

von Eulenburg's disease (congenital) syphilitic (early) 091.0

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

MD0753 C-8
Waardenburg's INDEX TO DISEASES
____________________________________________________________________________________

Waardenburg's syndrome 756.89

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

MD0753 C-9
 APPENDIX D, EXCERPTS FROM VOLUME 3
International Classification of Diseases, 9th Revision, Clinical Modification

TABULAR LIST

11.32 Excision of pterygium with corneal graft

11.39 Other excision of ptergium

11.4 Excision or destruction of tissue or other lesion of cornea

11.41 Mechanical removal of corneal epithelium

That by chemocauterization

Excludes: that for smear or culture (11.21)

11.42 Thermocauterization of corneal lesion

11.43 Cryotherapy of corneal lesion

11.49 Other removal of destruction of corneal lesion

Excision of cornea NOS

Excludes: biopsy of cornea (11.22)

11.5 Repair of cornea

11.51 Suture of corneal laceration

11.52 Repair of postoperative wound dehiscence of cornea

11.53 Repair of corneal laceration or wound with conjunctival flap

11.59 Other repair of cornea

11.6 Corneal transplant

Excludes: excision of pteryhium with corneal

graft (11.32)

11.60 Corneal transplant, not otherwise specified

Keratoplasty NOS

11.61 Lamellar keratoplasty with autograft

11.62 Other lamellar keratoplasty

11.63 Penetrating keratoplasty with autograft

Perforating keratoplasty with autograft

MD0753 D-1
 TABULAR LIST

22.9 Other operations on nasal sinuses

Exterioization of maxillary sinus
Fistuilzation of sinus

Excludes: dilation of frontonasal duct (96.21)

23 Removal and restoration of teeth

23.0 Forceps extraction of tooth

23.01 Extraction of deciduous tooth

23.09 Extraction of other tooth

Extraction of tooth NOS

23.1 Surgical removal of tooth

23.11 Removal of residual root

23.19 Other surgical extractions of tooth

Odontectomy NOS
Removal of impacted tooth
Tooth extraction with elevation of
mucoperiosteal flap

23.2 Resoration of tooth by filling

23.3 Restoration of tooth by inlay

23.4 Other dental restoration

23.41 Application of crown

23.42 Insertion of fixed bridge

23.43 Insertion of removable bridge

23.49 Other

23.5 Implantation of tooth

23.6 Prosthetic dental implant

Endosseous dental implant

MD0753 D-2
 OPERATIONS ON CARDIOVASCULAR SYSTEM

38 Incision, excision, and occlusion of vessels

Code also cardiopulmonary bypass [extracorporeal

circulation] [hear-lung machine] (39.61)

Excludes: that of coronary vessels (36.0-36.99)

The following fourth-digit subclassifcation is for use

with appropriate categories in section 38, marked with a
symbol (§), to identify the site:

0 unspecified site
1 intracranial vessels
Cerebral (anterior) (middle)
Circle or Willis
Posterior communicating artery
2 other vessels of head and neck
Carotid artery (common) (external) (internal)
Jugular vein (external) (internal)
3 upper limb vessels
Axillary Radial
Brachial Ulnar
4 aorta
5 other thoracic vessels
Innominate Subclavian
Pulmonary (artery) Vena cava, superior
(vein)
6 abdominal arteries
Celiac Mesenteric
Gastric Renal
Hepatic Splenic
Iliac Umbilical

Excludes: abdominal aora (4)

7 abdominal veins
Iliac Splenic
Portal Vena cava (inferior)
Renal
8 lower limb arteries
Femoral (common) (superficial)
Popliteal
Tibial
9 lower limb veins
Femoral Saphenous
Popliteal Tibial

MD0753 D-3
 OPERATIONS ON CARDIOVASCULAR SYSTEM

§ 38.5 Ligation and stripping of varicose veins

[0-3,5,7-9
Excludes: ligation of varices:
esophageal (42.91)
gastric (44.91)

§ 38.6 Other excision of vessels

[0-9] Excision of blood vessel (lesion) NOS

Excludes: excision of vessel for aortocoronary bypass

(36.10-36.14)
excision with:
anastomosis (38.30-38.39)
graft replacement (38.40-38.49)
implant (38.40-38.49)

38.7 Plication of vena cava

Insertion of implant or sieve in vena cava
Ligation of vena cava (inferior) (superior)

§ 38.8 Other surgical occlusion of vessels

}
[0-9] Clamping
Division of blood vessel
Ligation
Occlusion

Excludes: adrenal vessels (07.43)

esophageal varices
gastric or duodenal vessel for ulcer (44.40-
44.42)
gastric varices (44.91)
meningeal vessel (02.13)
spermatic vein for varicocele (63.1)
that for control of (postoperative) hemorrhage:
anus (49.95)
bladder (57.93)
following vascular procedure (39.41)
nose (21.00-21.09)
prostate (60.94)
tonsil (28.7)
thyroid vessel (06.92)

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

MD0753 D-4
 OPERATIONS ON DIGESTIVE SYSTEM

45.93 Other small-to-large intestinal anastomosis

45.94 Large-to-large intestinal anastomosis

Excludes: rectorectostomy (48.74)

46 Other operations intestine

46.0 Exterioization of intestine

Includes: loop enterostomy

multiple stage resection of intestine

46.01 Exteriorization of small intestine

Loop ileostomy

46.02 Resection of exteriorized segment of small intestine

46.03 Exteriorization of large intestine

Exteriorization of intestine NOS
First stage Mikulicz exteriorization of intestine
Loop colostomy

46.04 Resection of exteriorized segment of large intestine

Resection of exteriorized segment of
intestine NOS
Second stage Mikulicz operation

46.1 Colostomy

Code also any synchronous resection

(45.49, 45.71-45.79, 45.8)

Excludes: loop colostomy (46.03)

that with synchronous anterior
rectal resection (48.62)

46.10 Colostomy, not otherwise specified

46.11 Temporary colostomy

46.12 Permanent magnetic colostomy

46.13 Other permanent colostomy

MD0753 D-5
 OPERATIONS ON MUSCULOSKELETAL SYSTEM

81.01 Atlas-axis spinal fusion

Craniocervical fusion

Excludes: that for pseudoarthrosis (81.08)

81.02 Other cervical spinal fusion

Excludes: that for pseudoarthrosis (81.08)

81.03 Dorsal spinal fusion

Excludes: that for pseudoarthrosis (81.08)

81.04 Dorsolumbar spinal fusion with Harrington rod

Excludes: that for pseudoarthrosis (81.08)

81.05 Other dorsolumbar spinal fusion

Excludes: that for pseudoarthrosis (81.08)

81.06 Lumbar spinal fusion

Excludes: that for pseudoarthrosis (81.08)

81.07 Lumbosacral spinal fusion

Excludes: that for pseudoarthrosis (81.08)

81.08 Refusion of spine

Correction of pseudoarthrosis of spine

81.09 Other spinal fusion

81.1 Arthrodesis of foot and ankle

Includes: arthrodesis of foot and ankle with:

bone graft
external fixation device

81.11 Ankle fusion

Tibiotalar fusion

81.12 Triple arthrodesis

Talus to calcaneus and calcaneus to cuboid
and navicular

81.13 Subtatlar fusion

81.14 Midtarsal fusion

MD0753 D-6
Coffey INDEX TO PROCEDURES

Coffey operation (uterine suspension) Meig's Colopocleisis (complete) (partial) 70.4

modification) 69.22 Colpohysterectomy 68.5
Cole operation (anterior tarsal wedgeosteotomy) 77.28 Colpoperineoplasty 70.79
Colectomy (partial) (segmental) (subtotal) 45.79 with repair of urethrocele 70.50
cecum (with terminal ileum) 45.72 Colpoperineorrhaphy 70.71
left (lower) (radical) 45.75 following delivery 75.69
multiple segmental 45.71 Colpopexy 70.77
right (radical) 45.73 Colpoplasty 70.79
sigmoid 45.76 Colpopoiesis 70.61
terminal ileum with cecum 45.72 Colporrhaphy 70.71
total 45.8 anterior (cystocele repair) 70.51
transverse 45.74 for repair of cystocele 70.51
Collapse, lung, surgical 33.39 with rectocele 70.50
by enterocele 70.8
destruction of phrenic nerve 33.31 rectocele 70.52
pneumoperitoneum 33.33 with cystocele 70.50
pneumothorax, artificially-induced 33.32 urethrocele 70.51
thoracoplasty 33.34 posterior (rectocele repair) 70.52
Collection, sperm for artificial insemination 99.96 Colposcopy 70.21
Collis-Nissen operation (hiatal hernia repair) Colpotomy 70.14
with esophagogastroplasty) 53.80 for pelvic peritoneal drainage 70.12
Colocentesis 45.03 Commando operation (radical glossectomy) 25.4
Colocolostomy 45.94 Commissurotomy
proximal to distal segment 45.79 closed heart technique--see Valvulotomy, heart
Colocystoplasty 57.87 [45.52] open heart technique--see Valvuloplasty, heart
Colofixation 46.64 Compression, trigeminal nerve 04.02
Coloileotomy 45.00 Conchectomy 21.69
Colonna operation Conchotomy 21.1
adductor tenotomy (first stage) 83.12 Conduction study, nerve 89.15
hip arthroplasty (second stage) 81.69 Conduitogram, ileum 87.78
reconstruction of hip (second stage) 81.69 Condylectomy (see also Arthrectomy) 80.90
Colonoscopy 45.24 mandible 76.5
fiberoptic (flexible) 45.23 Condylotomy NEC (see also Division, joint capsule) 80.40
intraoperative 45.21 mandible (open) 76.62
through stoma (artificial) 45.22 closed 76.61
transabdominal 45.21 Conization
Colopexy 46.63 cervix (knife) (sharp) (biopsy) 67.2
Coloplication 46.64 by
Coloproctostomy 45.94 cryosurgery 67.33
Colorectosigmoidostomy 45.94 electroconization 67.32
Colorectostomy 45.94 Conjunctivocystorhinostomy 09.82
Colorrhaphy 46.75 with insertion of tube or stent 09.83
Coloscopy--see Colonoscopy Conjunctivodacryocystorhinostomy (CDCR) 09.82
Colosigmoidostomy 45.94 with insertion of tube or stent 09.83
Colostomy (ileo-ascending) (ileotransverse) Conjunctiovdacryocystostomy 09.82
(perineal) (transverse) 46.10 with insertion of tube or stent 09.83
with anterior rectal resection 48.62 Conjunctivoplasty 10.49
delayed opening 46.14 Conjunctivorhinostomy 09.82
loop 46.03 with insertion of tube or stent 09.83
permanent 46.13 Constriction of globe, for scleral buckling
magnetic 46.12 (see also Buckling, scleral) 14.49
temporary 46.11 Construction
Colotomy 45.03 auricle, ear (with graft) with implant) 1
Colpectomy 70.4 18.71
Colpoceliocentesis 70.0
Colpocentesis 70.0

MD0753 D-7
 INDEX TO PROCEDURES Graft

Girdlestone operation --continued Graft, grafting--continued

laminectomy with spinal fusion 81.00 blood vessel (patch)--continued
muscle transfer for claw toe repair 83.77 with--continued
resection of femoral head and neck 77.85 excision or resection of vessel--see
Girdlestone-Taylor operation (muscle Angiectomy, with graft replacement
transfer for claw toe repair) 83.77 synthetic patch (Dacron) (Teflon) 39.57
Glenn operation (anastomosis of superior tissue patch (vein) (autogenous) (homograft) 39.56
venn cava to right pulmonary artery) 39.21 bone (autogenous) (bone bank) (dual onlay)
Glenoplasty, shoulder 81.83 (heterogenous) (inlay) (massive onlay)
with synthetic joint prosthesis 81.81 (multiple)(osteoperiosteal) (peg) (subperiosteal) (with
for recurrent dislocation 81.82 metallic fixation) 78.00
Glomectomy with
carotid 39.8 arthrodesis--see Arthrodesis
jugulare 20.51 arthroplasty--see Arthroplasty
Glossectomy (complete) (total) 25.3 lengthening--see Lengthening, bone
partial or subtotal 25.2 carpals, metacrapals 78.04
radical 25.4 clavicle 78.01
Glossopexy 25.59 facial NEC 76.91
Glossoplasty NEC 25.59 with total ostectomy 76.44
Glossorrhaphy 25.51 femur 78.05
Glossotomy NEC 25.94 fibula 78.07
for tongue tie 25.91 humerus 78.02
Goebel-Frangenheim-Stoeckel operation joint--see Arthroplasty
(urethrovesical suspension) 59.4 mandible 76.91
Goldner operation (clubfoot release)80.48 with total mandibulectomy 76.41
Goldthwaite operation nose--see Graft, nose
ankle stabilization 81.11 patella 78.06
patellar stabilization 81.44 pelvic 78.09
tendon transfer for stabilization of patella 81.44 pericranial 02.04
Gonadectomy phalanges (foot) (hand) 78.09
ovary 65.3 radius 78.03
testis 62.3 scapula 78.01
Goniopuncture 12.51 skull 02.04
with goniotomy 12.53 specified site NEC 78.09
Gonioscopy 12.29 spine 78.09
Goniospasis 12.59 with fusion--see Fusion, spinal
Goniotomy (Barkan's) 12.52 tarsal, metatarsal 78.08
with goniopuncture 12.53 thorax (ribs) (sternum) 78.01
Goodal-Power operation (vagina) 70.4 thumb (with transfer of skin flap) 82.69
Gordon-Taylor operation (hindquarter tibia 78.07
amputation) 84.19 ulna 78.03
Graber-Duvernay operation (drilling of vertebrae 78.09
femoral head) 77.15 with fusion--see Fusion, spinal
Graft, grafting breast (see also Mammoplasty) 85.89
aneurysm 39.52 buccal sulcus 27.99
artery, arterial (patch) 39.58 cartilage (joint)--see also Arthroplasty
with nose--see Graft, nose
excision or resection of vessel--see chest wall (mesh) (silastic) 34.79
Arteriectomy, with graft conjunctiva (free) (mucosa) 10.44
replacement for symblepharon repair 10.41
synthetic path (Dacron) (Teflon) corena (see also Keratoplasty) 11.60
39.57 dermal-fat 86.69
tissue path (vein) (autogenous) dura 02.12
(homograft) 39.56 ear
blood vessel (patch) 39.58 auricle 18.79
with

MD0753 D-8
 Kader INDEX TO PROCEDURES

Kader operation (temporary gastrostomy) Kroenlein operation (lateral orbitotomy) 16.01

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

MD0753 D-9
Reduction INDEX TO PROCEDURES

Reduction--continued Reimplantation--continued
size--continued bile ducts following excision of ampulla of
abdominal wall (adipose) (pendulous) 86.83 Vater 51.62
arms (adipose) (batwing) 86.83 extremity--see Reattachment, extremity
breast (bilateral) 85.22 fallopian tube into uterus 66.74
unilateral 85.31 kidney 55.61
buttocks (adipose) 86.83 lung 33.5
finger (macrodactyly repair) 82.83 ovary 65.72
skin 86.83 pancreatic tissue 52.81
subcutaneous tissue 86.83 parathyroid tissue (heterotopic) (orthotopic) 06.95
thighs (adipose) 86.83 pulmonary artery for hemitruncus repair 35.83
torsion renal vessel, aberrant 39.55
intestine (manual) (surgical) 46.80 testis in scrotum 62.5
large 46.82 thyroid tissue (heterotopic) (orthotopic) 06.94
small 46.81 tooth 23.5
kidney pedicle 55.84 ureter into bladder 56.74
omentum 54.74 Reinforcement--see also Repair, by site
spermatic cord 63.52 sclera NEC 12.88
with orchiopexy 62.5 with graft 12.87
testis 63.52 Reinsertion--see also Insertion
with orchiopexy 62.5 cardiac pacemaker battery 37.85
volvulus cystostomy tube 59.94
intestine 46.80 fixation device (internal) ( see also
large 46.82 Fixation, bone, internal) 78.50
small 46.81 heart valve (prosthetic) 35.95
stomach 44.92 Holter (-Spitz) valve 02.42
Reefing, joint capsule (see also implant (expelled) (extruded)
Arthroplasty) 81.96 eyeball (with conjunctival graft) 16.62
Re-entry operation (aorta ) 39.54 orbital 16.62
Re-establishment, continuity --see also Anastomosis nephrostomy tube 55.93
bowel 46.50 pacemaker (battery) cardiac 37.85
fallopian tube 66.79 pyelostomy tube 55.94
vas deferens 63.82 ureteral stent, by incision 56.2
Referral (for) ureterostomy tube 59.93
psychiatric aftercare (halfway house) (outpatient clinic) valve
94.52 heart (prosthetic) 35.95
psychotherapy 94.51 ventricular (cererbal) 02.42
rehabilitation Relaxation--see also Release
alcoholism 94.53 training 94.33
drug addiction 94.54 Release
psychologic NEC 94.59 carpal tunnel (for nerve decompression) 04.43
vocational 94.55 celiac artery axis 39.91
Reformation, chamber of eye 12.99 central slip, extensor tendon hand (mallet
Refracture finger repair) 82.84
bone (for faulty union) (see also Osteoclasis) 78.70 chordee 64.42
nasal bones 21.88 clubfoot NEC 83.84
Refusion, spine 81.08 de Quervain's tenosynovitis 82.01
Regional blood flow study 92.05 Dupuytren's contracture (by palmar
Regulation, menstrual 69.6 fascictomy) 82.35
Rehabilitation programs NEC 93.89 by fasciotomy (subcutaneous) 82.12
sheltered employment 93.85 with excision 82.35
vocational 93.85 Fowler (mallet finger repair) 82.84
Reimplantation joint (capsule) (adherent) (constrictive)
adrenal tissue (heterotopic) (orthotopic) 07.45 (see also Division, joint capsule)
artery 39.59 80.40
renal, aberrant 39.55 laryngeal 31.92

MD0753 D-10
Transection INDEX TO DISEASES

Transection--continued Transfer, transerence--continued

artery (with ligation)--continued pes anserinus (tendon) (repair of knee) 81.47
renal, aberrant (with reimplantation) tarsoconjunctival flap, from opposing lid 08.64
39.55 tendon 83.75
bone (see also Osteotomy) 77.30 hand 82.56
fallopian tube (bilateral) (remaining) (solitary) 66.39 pes anserinus (repair of knee) 81.47
by endoscopy 66.22 toe-to-thumb (free) (pedicle) (with
unilateral 66.92 amputation) 82.69 [84.11]
isthmus, thyroid 06.91 Transfixion--see also Fixation iris ( bombe) 12.11
muscle 83.19 Transfusion (of) 99.03
eye 15.13 antihemophilic factor 99.06
multiple (two or more muscles) 15.3 antivenin 99.16
hand 82.19 blood (whole) 99.03
nerve (cranial) (peripheral) NEC 04.03 expander 99.08
acoustic 04.01 surrogate 99.09
root (spinal) 03.1 bone marrow 41.0
sympathetic 05.0 coagulation factors 99.06
tracts in spinal cord 03.29 Dextran 99.08
trigeminal 04.02 exchange 99.01
vagus (transabdominal) (see also Vagotomy) 44.00 intraperitoneal 75.2
pylorus (with wedge resection) 43.3 in utero (with hysterotomy) 75.2
renal vessel, aberrant (with reimplantation) exsanguination 99.01
39.55 gamma globulin 99.14
spinal granulocytes 99.09
cord tracts 03.29 intrauterine 75.2
nerve root 03.1 packed cells 99.04
tendon 83.13 plasma 99.07
hand 82.11 platelets 99.05
uvula 27.71 replacement, total 99.01
vas deferens 63.71 serum NEC 99.07
vein (with ligation) (see also Division, vein) 38.80 substitution 99.01
renal, aberrant (with reimplantation) 39.55 thrombocytes 99.05
varicose (lower limb) 38.59 Transillumination
Transfer, transference nasal sinuses 89.35
bone shaft, fibula into tibia 78.47 skull (newborn) 89.16
digital (to replace absent thumb) 82.69 Translumbar aortogram 88.42
finger (to thumb) (same hand) 82.61 Transplant, transplantation
to artery 39.59
finger, except thumb 82.81 renal, aberrant 39.55
opposite hand (with amputation) autotransplant--see Reimplantation
82.69 [84.01] blood vessel 39.59
toe (to thumb) (with amputation) 82.69 [84.11] renal, aberrant 39.55
to finger, except thumb 82.81 bone (see also Graft, bone) 78.00
[84.11] marrow 41.0
finger (to replace absent thumb) (same conjunctiva, for pterygium 11.39
hand) 82.61 corneal (see also Keratoplasty) 11.60
to dura 02.12
finger, except thumb 82.81 fascia 83.82
opposite hand (with amputation) hand 82.72
82.69 [84.01] finger (replacing absent thumb) (same hand) 82.61
muscle origin 83.77 to
hand 82.58 finger, except thumb 82.81
nerve (cranial) (peripheral) (radial opposite hand (with amputation) 82.69 [84.01]
anterior) (ulnar) 04.6 gracilis muscle (for) 83.77
pedicle graft 86.74 anal incontinence 49.74

MD0753 D-11
Suture INDEX TO DISEASES

Suture (laceration)--continued Suture (laceration)--continued

aponeurosis (see also Suture, tendon) 83.64 gum 24.32
arteriovenous fistula 39.53 heart 37.4
artery 39.31 hepatic duct 51.79
bile duct 51.79 hymen 70.76
bladder 57.81 ileum 46.73
obstetric laceration (current) 75.61 intestine 46.79
blood vessel NEC 39.30 large 46.75
artery 39.31 small 46.73
vein 39.32 jejunum 46.73
breast (skin) 85.81 joint capsule 81.96
bronchus 33.41 with arthroplasty--see Arthroplasty
bursa 83.99 ankle 81.94
hand 82.99 foot 81.94
canaliculus 09.73 lower extremity NEC 81.95
cecum 46.75 upper extremity 81.93
cerebral menings 02.11 kidney 55.81
cervix (traumatic laceration) 67.61 labia 71.71
internal os, encirclement 67.5 laceration--see Suture, by site
obstetric laceration (current) 75.51 larynx 31.61
old 67.69 ligament 81.96
chest wall 34.71 with arthroplasty--see Arthroplasty
cleft palate 27.62 ankle 81.94
clitoris 71.4 broad 69.29
colon 46.75 Cooper's 54.64
common duct 51.71 foot and toes 81.94
conjunctiva 10.6 gastrocolic 54.73
cornea 11.51 knee 81.95
with conjunctival flap 11.53 lower extremity NEC 81.95
corneoscleral 11.51 sacrouteine 69.29
with conjunctival flap 11.53 upper extremity 81.93
diaphragm 34.82 uterine 69.29
duodenum 46.71 ligation--see Ligation
dura mater (cerebral) 02.11 lip 27.51
spinal 03.59 liver 50.61
ear, external 18.4 lung 33.43
enterocele 70.8 meninges (cerebral) 02.11
entropion 08.42 spinal 03.59
epididymis (and) mesentery 54.75
spermatic cord 63.51 mouth 27.52
vas deferens 63.81 muscle 83.65
episiotomy--see Episiotomy hand 82.46
esophagus 42.82 ocular (oblique) (rectus) 15.7
eyeball 16.89 nerve (cranial) (peripheral) 04.3
eyebrow 08.81 sympathetic 05.81
eyelid 08.81 nose (external) (internal) 21.81
with entropion or ectropion repair 08.42 for epistaxis 21.09
fallopian tube 66.71 obstetric laceration NEC 75.69
fascia 83.65 bladder 75.61
hand 82.46 cervix 75.51
to skeletal attachment 83.89 corpus uteri 75.52
hand 82.89 pelvic floor 75.69
gallbladder 51.91 perineum 75.69
ganglion, sympathetic 05.81 rectum 75.62
gingiva 24.32 sphincter ani 75.62
great vessel 39.30 urethra 75.61

MD0753 D-12
 APPENDIX E - EXCERPTS FROM EXTERNAL CAUSE OF INJURY CODES
as used by the NATO Forces
NATO Standardization Agreement (NATO 2050)

Place of Occurrence of Injury Third-Digit Code

On board aircraft or spacecraft or in the air or

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

Data
Code Group Data Items and Explanations Data Codes

ØØØ-Ø29 ACCIDENTS IN AIR TRANSPORT, INVOLVING MILITARY AIRCRAFT

ØØØ-ØØ9 Injured person was in (or boarding,etc.)

powered heavier-than-air fixed-wing
military aircraft, and the accident
involved:
Boarding or alighting .....................................................................ØØØ
Taxiing, takeoff from, or landing on
aircraft carrier ...........................................................................ØØ1
Taxiing other or unspecified (includes
collision while taxiing) ...............................................................ØØ2
Takeoff, other or unspecified (includes
crash on take-off) .....................................................................ØØ3

♦♦♦

Ø3Ø-Ø39 ACCIDENTS IN AIR TRANSPORT INVOLVING NON-MILITARY AND

UNSPECIFIED AIRCRAFT

Ø34-Ø35 Injured person was boarding, or alighting from:

Commercial transport aircraft (fixed-wing
or other) ........................................................................................Ø34
Other nonmilitary aircraft (fixed-wing
or other) ........................................................................................Ø35

MD0753 E-1
 Data
Code Group Data Items and Explanations Data Codes

Ø36-Ø39 Injured person was not making flight but was

injured incident to a flight involving:
Commercial transport aircraft (fixed-wing
or other) ......................................................................................Ø36

Other nonmilitary aircraft (fixed-wing or

other) ..........................................................................................Ø37
Parachuting from nonmilitary aircraft due
to causes other than aircraft damage or
failure ..........................................................................................Ø38
Unspecified aircraft accident involving
nonmilitary aircraft ......................................................................Ø39

Ø4Ø-Ø49 ACCIDENTS INVOLVING SPACECRAFT

Ø4Ø-Ø46 Injured astronaut was in spacecraft and was

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

♦♦♦

1ØØ-149 ACCIDENTS IN LAND TRANSPORT

1ØØ-119 MOTOR VEHICLE TRAFFIC ACCIDENTS

1ØØ-1Ø9 Accident not involving military-owned

(or unspecified as to ownership)
vehicle:
Injury is to driver of motor vehicle
(except codes 1Ø6 and 1Ø7) ........................................................1ØØ
Injury is to passenger (not driver) of motor
vehicle (except codes 1Ø6 and 1Ø7) ............................................1Ø1
Injury is to unspecified occupant of motor
vehicle ..........................................................................................1Ø2
Injury occurred in boarding or alighting
from vehicle ..................................................................................1Ø3
Injury is to pedestrian ......................................................................1Ø4
Injury is to pedal cyclist (driver or other
rider) .............................................................................................1Ø5

MD0753 E-2
 Data
Code Group Data Items and Explanations Data Codes

Injury is to motorcyclist (driver or other

rider) .............................................................................................1Ø6
Injury is to driver or other rider on
tracked or semi-tracked vehicle ....................................................1Ø7
Injury is to other or unspecified person ............................................1Ø9

♦♦♦

11Ø-119 Accident involving military-owned vehicle:

Injury is to driver of motor vehicle
(except codes 116 and 117) ..........................................................11Ø
Injury is to passenger (not driver) of motor
vehicle (except codes 116 and 117) ..............................................111
Injury is to unspecified occupant of motor
vehicle ..........................................................................................112
Injury occurred in boarding or alighting
from vehicle ..................................................................................113
Injury is to pedestrian… … … … … … … … … … … … … … … 114
Injury is to pedal cyclist (driver or other
rider) .............................................................................................115
Injury is to motorcyclist (driver or other
rider) .............................................................................................116
Injury is to occupant of tracked or semi-
tracked vehicle (tank, self-propelled
gun, etc.) ......................................................................................117
Injury is to other or unspecified person ............................................119

12Ø-149 LAND TRANSPORT ACCIDENTS, EXCEPT MOTOR VEHICLE TRAFFIC

ACCIDENTS

12Ø-13Ø Motor vehicle nontraffic accident:

Injury (nontraffic) is to driver of
nonmilitary motor vehicle, except codes
126 and 127..................................................................................12Ø
Injury (nontraffic) is to passenger (not
driver) of nonmilitary motor vehicle,
except codes 126 and 127 ............................................................121

♦♦♦

14Ø-149 Other land transport accident:

Railway accident .............................................................................14Ø
Other specified land transport accident ...........................................149

♦♦♦

MD0753 E-3
 Data
Code Group Data Items and Explanations Data Codes

2ØØ-249 ATHLETICS AND SPORTS, INCLUDING PHYSICAL

TRAINING

22Ø-239 Athletics and sports accident, other (includes

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

25Ø-299 REACTIONS, COMPLICATIONS, AND MISADVENTURES IN MEDICAL OR

SURGICAL PROCEDURES AND LATE COMPLICATIONS OR LATE EFFECTS

25Ø-269 Complications of prophylactic inoculation:

Postvaccinal encephalitis ................................................................25Ø
Smallpox vaccination reaction other than
encephalitis ....................................................................................251
Reaction to:
Typhoid and/or paratyphoid vaccine ................................................252
Tetanus toxin-antitoxin ....................................................................253
Tetanus toxoid ................................................................................254
Diphth2eria antitoxin or diphtheria toxoid ........................................255
BCG ..............................................................................................256

MD0753 E-4
 Data
Code Group Data Items and Explanations Data Codes

Prophylactic use of antibiotics .........................................................257

Other specified vaccine (except
combinations) ................................................................................265
Other specified toxoid or antitoxin
(except combinations) ....................................................................266
Unspecified vaccine, toxoid, or antitoxin .........................................267
Combination of two or more of above .............................................268
Other biological substances, including
immune serum...............................................................................269

♦♦♦

320-339 AGENTS OF CHEMICAL WARFARE, EXCLUDING INCENDIARIES;

Lung irritants and irritant smokes ..........................................................32Ø

Vesicants (including mustard gas) ........................................................321
Nerve gases .........................................................................................322
Lacrimators and screening smokes.......................................................33Ø
Other chemical warfare agents (excluding
incendiaries) ...................................................................................339

34Ø-359 AGENTS OF BIOLOGICAL WARFARE

Biological warfare agents .....................................................................359

♦♦♦

44Ø-459 CONVENTIONAL WEAPONS INJURY TO PERSON ON LAND OR IN

UNSPECIFIED LOCATION

44Ø-449 Fragment-producing conventional weapon:

Artillery shell ...................................................................................44Ø
Rocket ............................................................................................441
Ballistic missile ...............................................................................442
Bomb, free-falling ...........................................................................443
Mortar .............................................................................................444
Bazooka .........................................................................................445
Antipersonnel mine, boobytrap,etc ..................................................446
Mine, other or unspecified (includes
antitank, etc.) ................................................................................447
Grenade .........................................................................................448
Shell fragment, other and unspecified .............................................449

MD0753 E-5
 Data
Code Group Data Items and Explanations Data Codes

45Ø-459 Other conventional weapons:

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

♦♦♦

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

7Ø-*-79-* POISONS, FIRE, HOT OR CORROSIVE SUBSTANCES

Poisoning by ingestion of toxic substance

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

MD0753 E-6
 Data
Code Group Data Items and Explanations Data Codes

Adverse systemic or skin reaction by

contact with a toxic substance (excludes
chemical burns of external parts 77-*;
also excludes reactions due to chemical
warfare agents and reactions to drugs
or other therapeutic misadventures;
includes intentional or accidental
exposure to the toxic substance) .....................................................72-*
Sting or bite of venomous reptile
(poisonous snake) ...........................................................................73-*
Sting or bite of venomous arthropod
(venomous spider, wasp, etc.) ........................................................74-*
Fire, explosion with fire, conflagration ..................................................75-*
Hot liquids or steam (includes molten
metal) .............................................................................................76-*
Corrosive substances, external chemical
burns only .......................................................................................77-*
Hot solids or other hot objects (includes
stoves) ............................................................................................78-*

♦♦♦

8Ø-*89-* SPECIFIED ENVIRONMENTAL FACTORS (Includes natural or artificial

environment)

Excessive heat or insolation (includes

heat stroke, sunburn, etc.; excludes
specifically defined transport accidents) ..........................................8Ø-*
Excessive cold .....................................................................................81-*
High or low pressure (atmospheric or
artificial) including hypoxia and
barotrauma .....................................................................................82-*
Excessive noise; for example, acoustic
trauma ............................................................................................83-*
Hunger, thirst, or exposure ...................................................................84-*
Lightning or cataclysm (includes tornado,
flood, etc.) ......................................................................................85-*
Drowning or submersion, not elsewhere
classified (excludes specifically defined
water transport accidents) ...............................................................86-*
Motion: travel (includes air sickness,
sea sickness, motion sickness) .......................................................87-*
Animals, not elsewhere classified .........................................................88-*

MD0753 E-7
 Data
Code Group Data Items and Explanations Data Codes

9Ø-*-99-* FALLS AND MISCELLANEOUS OTHER OR UNSPECIFIED AGENTS

(Excludes transport accidents -- See data code ØØØ-199)

Fall on or jump from stairs or ladder .....................................................9Ø-*

Other fall or jump from one level to
another ...........................................................................................91-*
Falls or jumps on same level, including
unspecified falls ..............................................................................92-*
Marching or drilling, not elsewhere
classified 93-*
Twisting, turning, slipping, running, etc .,
not elsewhere classified,without fall ................................................94-*
Lifting, pushing, pulling .........................................................................95-*
Hanging, suffocation, or strangulation ...................................................96-*
Fighting, not elsewhere classified,
including horseplay/ jeu brutal (code
specific agent if specified ................................................................97-*
Other specified agents not classifiable
elsewhere above .............................................................................98-*
Unspecified causative agent; unknown .................................................99-*

MD0753 E-8
 APPENDIX F - EXCERPTS FROM MILITARY OCCUPATIONAL SPECIALTY CODES

DATA
DESCRIPTION CODE

NAVY

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

MD0753 F-1
 DATA
DESCRIPTION CODE

NAVY (CONTINUED)

DATA PROCESSING TECHNICIAN............................................................................................ DP

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

MD0753 F-2
 DATA
DESCRIPTION CODE

ARMY

AMMUNITION SUPERVISOR ..................................................................................................... 55Z

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

MD0753 F-3
 DATA
DESCRIPTION CODE

ARMY (CONTINUED)

BIOLOGICAL SCIENCES ASSIGNMENT ................................................................................... Ø1H

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

MD0753 F-4
 DATA
DESCRIPTION CODE

ARMY (CONTINUED)

ENGINEER EQUIPMENT REPAIR TECH ................................................................................... 213A

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

MD0753 F-5
 DATA
DESCRIPTION CODE

ARMY (CONTINUED)

FIRE CONTROL INST REPAIRER.............................................................................................. 41C

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

MD0753 F-6
 DATA
DESCRIPTION CODE

ARMY (CONTINUED)

HAWK MISSILE CREW MEMBER .............................................................................................. 16D

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

MD0753 F-7