For HCPCS codes A0425, A0426, A0427, A0428, A0429, A0433 and A0434: Covered for Ambulance Transportation Services to the Site of Medical Care:

Transcription

1 For HCPCS codes A0425, A0426, A0427, A0428, A0429, A0433 and A0434: Covered for Ambulance Transportation Services to the Site of Medical Care: ABDOMINAL OR PELVIC SWELLING MASS OR LUMP OTHER SPECIFIED SITE ABDOMINAL OR PELVIC SWELLING MASS OR LUMP UNSPECIFIED SITE - ABDOMINAL OR PELVIC SWELLING MASS OR LUMP GENERALIZED ABDOMINAL PAIN OTHER SPECIFIED SITE ABDOMINAL PAIN RIGHT UPPER QUADRANT - ABDOMINAL PAIN GENERALIZED ABDOMINAL RIGIDITY OTHER SPECIFIED SITE ABDOMINAL RIGIDITY UNSPECIFIED SITE - ABDOMINAL RIGIDITY GENERALIZED ABDOMINAL TENDERNESS OTHER SPECIFIED SITE ABDOMINAL TENDERNESS UNSPECIFIED SITE - ABDOMINAL TENDERNESS GENERALIZED * ABNORMALITY OF GAIT - TRANSIENT PARALYSIS OF LIMB 436 ACUTE BUT ILL-DEFINED CEREBROVASCULAR DISEASE ACUTE EDEMA OF LUNG UNSPECIFIED ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL SUBSEQUENT EPISODE OF CARE ACUTE MYOCARDIAL INFARCTION OF INFEROLATERAL WALL EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF INFEROLATERAL WALL SUBSEQUENT EPISODE OF CARE ACUTE MYOCARDIAL INFARCTION OF INFEROPOSTERIOR WALL EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF INFEROPOSTERIOR WALL SUBSEQUENT EPISODE OF CARE ACUTE MYOCARDIAL INFARCTION OF OTHER ANTERIOR WALL EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF OTHER ANTERIOR WALL SUBSEQUENT EPISODE OF CARE ACUTE MYOCARDIAL INFARCTION OF OTHER INFERIOR WALL EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF OTHER INFERIOR WALL SUBSEQUENT EPISODE OF CARE ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL SUBSEQUENT EPISODE OF CARE ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES SUBSEQUENT EPISODE OF CARE

2 ACUTE MYOCARDIAL INFARCTION OF UNSPECIFIED SITE EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF UNSPECIFIED SITE SUBSEQUENT EPISODE OF CARE ALCOHOL WITHDRAWAL 291 ALCOHOL WITHDRAWAL DELIRIUM ALLERGY UNSPECIFIED NOT ELSEWHERE CLASSIFIED ALTERATION OF CONSCIOUSNESS OTHER ALTERED MENTAL STATUS APHASIA APPARENT LIFE THREATENING EVENT IN INFANT ASPHYXIA - HYPOXEMIA ASPHYXIATION AND STRANGULATION - ELECTROCUTION AND NONFATAL EFFECTS OF ELECTRIC CURRENT ASTHMA UNSPECIFIED TYPE WITH STATUS ASTHMATICUS - ASTHMA UNSPECIFIED WITH (ACUTE) EXACERBATION ATRIAL FIBRILLATION - ATRIAL FLUTTER 426 ATRIOVENTRICULAR BLOCK COMPLETE BACKACHE UNSPECIFIED 041.9* BACTERIAL INFECTION UNSPECIFIED IN CONDITIONS CLASSIFIED ELSEWHERE AND OF UNSPECIFIED SITE V49.84 BED CONFINEMENT STATUS V V49.76 BELOW KNEE AMPUTATION STATUS - ABOVE KNEE AMPUTATION STATUS BURN OF UNSPECIFIED SITE UNSPECIFIED DEGREE - DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE UNSPECIFIED SITE WITH LOSS OF A BODY PART CARDIAC ARREST

3 423.3 CARDIAC TAMPONADE CEREBRAL ARTERY OCCLUSION UNSPECIFIED WITHOUT CEREBRAL INFARCTION - CEREBRAL ARTERY OCCLUSION UNSPECIFIED WITH CEREBRAL INFARCTION CEREBRAL EMBOLISM WITHOUT CEREBRAL INFARCTION - CEREBRAL EMBOLISM WITH CEREBRAL INFARCTION CEREBRAL THROMBOSIS WITHOUT CEREBRAL INFARCTION - CEREBRAL THROMBOSIS WITH CEREBRAL INFARCTION 496* CHRONIC AIRWAY OBSTRUCTION NOT ELSEWHERE CLASSIFIED CLOSED DISLOCATION CERVICAL VERTEBRA UNSPECIFIED - CLOSED DISLOCATION MULTIPLE CERVICAL VERTEBRAE CLOSED DISLOCATION LUMBAR VERTEBRA - CLOSED DISLOCATION THORACIC VERTEBRA CLOSED DISLOCATION MULTIPLE AND ILL-DEFINED SITES - OPEN DISLOCATION MULTIPLE AND ILL-DEFINED SITES CLOSED DISLOCATION OF HIP UNSPECIFIED SITE - OTHER CLOSED ANTERIOR DISLOCATION OF HIP CLOSED DISLOCATION OF KNEE UNSPECIFIED PART - LATERAL DISLOCATION OF TIBIA PROXIMAL END CLOSED CLOSED DISLOCATION OTHER LOCATION CLOSED DISLOCATION SACRUM CLOSED DISLOCATION VERTEBRA UNSPECIFIED SITE CLOSED FRACTURE OF ACETABULUM - OPEN FRACTURE OF PUBIS CLOSED FRACTURE OF C1-C4 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY - CLOSED FRACTURE OF C5-C7 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY CLOSED FRACTURE OF CERVICAL VERTEBRA UNSPECIFIED LEVEL - CLOSED FRACTURE OF MULTIPLE CERVICAL VERTEBRAE CLOSED FRACTURE OF DORSAL (THORACIC) VERTEBRA WITHOUT SPINAL CORD INJURY - OPEN FRACTURE OF UNSPECIFIED PART OF VERTEBRAL COLUMN WITHOUT SPINAL CORD INJURY CLOSED FRACTURE OF ILIUM - MULTIPLE CLOSED PELVIC FRACTURES WITH DISRUPTION OF PELVIC CIRCLE CLOSED FRACTURE OF LUMBAR SPINE WITH SPINAL CORD INJURY - OPEN FRACTURE OF LUMBAR SPINE WITH SPINAL CORD INJURY

4 CLOSED FRACTURE OF OTHER SPECIFIED PART OF PELVIS CLOSED FRACTURE OF SACRUM AND COCCYX WITH OTHER SPINAL CORD INJURY CLOSED FRACTURE OF SACRUM AND COCCYX WITH UNSPECIFIED SPINAL CORD INJURY - CLOSED FRACTURE OF SACRUM AND COCCYX WITH OTHER CAUDA EQUINA INJURY CLOSED FRACTURE OF T1-T6 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY - CLOSED FRACTURE OF T7-T12 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY CLOSED FRACTURE OF UNSPECIFIED VERTEBRA WITH SPINAL CORD INJURY - OPEN FRACTURE OF UNSPECIFIED VERTEBRA WITH SPINAL CORD INJURY CLOSED FRACTURE OF UPPER END OF TIBIA - CLOSED FRACTURE OF UPPER END OF FIBULA WITH TIBIA 438 COGNITIVE DEFICITS COMA - PERSISTENT VEGETATIVE STATE COMPLEX FEBRILE CONVULSIONS CONGESTIVE HEART FAILURE UNSPECIFIED - LEFT HEART FAILURE CONTRACTURE OF JOINT SITE UNSPECIFIED - CONTRACTURE OF JOINT OF MULTIPLE SITES CYANOSIS 293.0* DELIRIUM DUE TO CONDITIONS CLASSIFIED ELSEWHERE V V46.12 DEPENDENCE ON RESPIRATOR, STATUS - ENCOUNTER FOR RESPIRATOR DEPENDENCE DURING POWER FAILURE V46.2* DEPENDENCE ON SUPPLEMENTAL OXYGEN Code Description DIABETES MELLITUS WITHOUT MENTION OF COMPLICATION, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED - DIABETES MELLITUS WITHOUT MENTION OF COMPLICATION, TYPE I [JUVENILE TYPE], UNCONTROLLED DIABETES WITH HYPEROSMOLARITY, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED - DIABETES WITH HYPEROSMOLARITY, TYPE I [JUVENILE TYPE], UNCONTROLLED DIABETES WITH KETOACIDOSIS, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED - DIABETES WITH KETOACIDOSIS, TYPE I [JUVENILE TYPE], UNCONTROLLED

5 DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED - DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE I [JUVENILE TYPE], UNCONTROLLED DIABETES WITH OPHTHALMIC MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED - DIABETES WITH OPHTHALMIC MANIFESTATIONS, TYPE I [JUVENILE TYPE], UNCONTROLLED DIABETES WITH OTHER COMA, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED - DIABETES WITH OTHER COMA, TYPE I [JUVENILE TYPE], UNCONTROLLED DIABETES WITH OTHER SPECIFIED MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED - DIABETES WITH OTHER SPECIFIED MANIFESTATIONS, TYPE I [JUVENILE TYPE], UNCONTROLLED DIABETES WITH PERIPHERAL CIRCULATORY DISORDERS, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED - DIABETES WITH PERIPHERAL CIRCULATORY DISORDERS, TYPE I [JUVENILE TYPE], UNCONTROLLED DISLOCATION OF KNEE UNSPECIFIED PART OPEN - LATERAL DISLOCATION OF TIBIA PROXIMAL END OPEN DISRUPTION OF EXTERNAL OPERATION (SURGICAL) WOUND DISRUPTION OF TRAUMATIC INJURY WOUND REPAIR DISRUPTION OF WOUND, UNSPECIFIED 292 DRUG WITHDRAWAL EFFECTS OF LIGHTNING - DROWNING AND NONFATAL SUBMERSION ELEVATED BLOOD PRESSURE READING WITHOUT DIAGNOSIS OF HYPERTENSION FEVER, UNSPECIFIED - POSTPROCEDURAL FEVER FOREIGN BODY IN LARYNX FOREIGN BODY IN RESPIRATORY TREE UNSPECIFIED FRACTURE OF LOWER END OF FEMUR UNSPECIFIED PART CLOSED - SUPRACONDYLAR FRACTURE OF FEMUR CLOSED FRACTURE OF LOWER END OF FEMUR UNSPECIFIED PART OPEN - SUPRACONDYLAR FRACTURE OF FEMUR OPEN FRACTURE OF UNSPECIFIED INTRACAPSULAR SECTION OF NECK OF FEMUR CLOSED - FRACTURE OF BASE OF NECK OF FEMUR CLOSED FRACTURE OF UNSPECIFIED INTRACAPSULAR SECTION OF NECK OF FEMUR OPEN - FRACTURE OF BASE OF NECK OF FEMUR OPEN

6 FRACTURE OF UNSPECIFIED PART OF FEMUR CLOSED - FRACTURE OF SHAFT OF FEMUR CLOSED FRACTURE OF UNSPECIFIED PART OF FEMUR OPEN - FRACTURE OF SHAFT OF FEMUR OPEN FRACTURE OF UNSPECIFIED PART OF HUMERUS CLOSED - FRACTURE OF SHAFT OF HUMERUS CLOSED FRACTURE OF UNSPECIFIED PART OF HUMERUS OPEN - FRACTURE OF SHAFT OF HUMERUS OPEN FRACTURE OF UNSPECIFIED PART OF LOWER END OF HUMERUS OPEN - FRACTURE OF UNSPECIFIED CONDYLE(S) OF HUMERUS OPEN FRACTURE OF UNSPECIFIED PART OF NECK OF FEMUR CLOSED - FRACTURE OF UNSPECIFIED PART OF NECK OF FEMUR OPEN FRACTURE OF UNSPECIFIED PART OF UPPER END OF HUMERUS OPEN - FRACTURE OF GREATER TUBEROSITY OF HUMERUS OPEN FRACTURE OF UNSPECIFIED TROCHANTERIC SECTION OF FEMUR CLOSED - FRACTURE OF SUBTROCHANTERIC SECTION OF FEMUR CLOSED FRACTURE OF UNSPECIFIED TROCHANTERIC SECTION OF FEMUR OPEN - FRACTURE OF SUBTROCHANTERIC SECTION OF FEMUR OPEN FUNCTIONAL QUADRIPLEGIA GANGRENE HALLUCINATIONS - SYNCOPE AND COLLAPSE 784 HEADACHE 428.9* HEART FAILURE UNSPECIFIED HEMIPLEGIA AFFECTING UNSPECIFIED SIDE - HEMIPLEGIA AFFECTING NONDOMINANT SIDE HEMORRHAGE OF GASTROINTESTINAL TRACT UNSPECIFIED 459 HEMORRHAGE UNSPECIFIED HYPOGLYCEMIC COMA - OTHER SPECIFIED HYPOGLYCEMIA HYPOTENSION UNSPECIFIED

7 991.6 HYPOTHERMIA * HYPOTHERMIA NOT ASSOCIATED WITH LOW ENVIRONMENTAL TEMPERATURE IATROGENIC PULMONARY EMBOLISM AND INFARCTION ILL-DEFINED OPEN FRACTURES OF UPPER LIMB INTESTINAL OR PERITONEAL ADHESIONS WITH OBSTRUCTION (POSTOPERATIVE) (POSTINFECTION) 431 INTRACEREBRAL HEMORRHAGE INTRACRANIAL INJURY OF OTHER AND UNSPECIFIED NATURE WITH OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED INTRACRANIAL INJURY OF OTHER AND UNSPECIFIED NATURE WITH OPEN INTRACRANIAL WOUND WITH STATE OF CONSCIOUSNESS UNSPECIFIED - INTRACRANIAL INJURY OF OTHER AND UNSPECIFIED NATURE WITH OPEN INTRACRANIAL WOUND WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION INTRACRANIAL INJURY OF OTHER AND UNSPECIFIED NATURE WITHOUT OPEN INTRACRANIAL WOUND WITH CONCUSSION UNSPECIFIED INTRACRANIAL INJURY OF OTHER AND UNSPECIFIED NATURE WITHOUT OPEN INTRACRANIAL WOUND WITH STATE OF CONSCIOUSNESS UNSPECIFIED - INTRACRANIAL INJURY OF OTHER AND UNSPECIFIED NATURE WITHOUT OPEN INTRACRANIAL WOUND WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION LACERATION OF EYELID FULL-THICKNESS NOT INVOLVING LACRIMAL PASSAGES - PENETRATING WOUND OF ORBIT WITH FOREIGN BODY 907.2* LATE EFFECT OF SPINAL CORD INJURY LUMBAGO MALIGNANT NEOPLASM OF BRAIN UNSPECIFIED SITE V46.14 MECHANICAL COMPLICATION OF RESPIRATOR [VENTILATOR] MENINGISMUS MONOPLEGIA OF LOWER LIMB AFFECTING UNSPECIFIED SIDE - MONOPLEGIA OF LOWER LIMB AFFECTING NONDOMINANT SIDE MULTIPLE CLOSED FRACTURES INVOLVING BOTH UPPER LIMBS AND UPPER LIMB WITH RIB(S) AND STERNUM - MULTIPLE OPEN FRACTURES INVOLVING BOTH UPPER LIMBS AND UPPER LIMB WITH RIB(S) AND STERNUM

8 NAUSEA WITH VOMITING V07.0 NEED FOR ISOLATION NONDEPENDENT ALCOHOL ABUSE UNSPECIFIED DRINKING BEHAVIOR - NONDEPENDENT OTHER MIXED OR UNSPECIFIED DRUG ABUSE EPISODIC USE OCULAR LACERATION WITHOUT PROLAPSE OF INTRAOCULAR TISSUE - UNSPECIFIED OCULAR PENETRATION OPEN DISLOCATION CERVICAL VERTEBRA UNSPECIFIED - OPEN DISLOCATION MULTIPLE CERVICAL VERTEBRAE OPEN DISLOCATION LUMBAR VERTEBRA - OPEN DISLOCATION THORACIC VERTEBRA OPEN DISLOCATION OF HIP UNSPECIFIED SITE - OTHER OPEN ANTERIOR DISLOCATION OF HIP OPEN DISLOCATION OTHER LOCATION OPEN DISLOCATION STERNUM OPEN DISLOCATION VERTEBRA UNSPECIFIED SITE - OPEN DISLOCATION SACRUM OPEN FRACTURE OF C1-C4 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY - OPEN FRACTURE OF C5-C7 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY OPEN FRACTURE OF CERVICAL VERTEBRA UNSPECIFIED LEVEL - OPEN FRACTURE OF MULTIPLE CERVICAL VERTEBRAE OPEN FRACTURE OF CLAVICLE UNSPECIFIED PART - OPEN FRACTURE OF ACROMIAL END OF CLAVICLE OPEN FRACTURE OF ILIUM - MULTIPLE OPEN PELVIC FRACTURES WITH DISRUPTION OF PELVIC CIRCLE OPEN FRACTURE OF OTHER SPECIFIED PART OF PELVIS OPEN FRACTURE OF PATELLA OPEN FRACTURE OF SACRUM AND COCCYX WITH OTHER SPINAL CORD INJURY OPEN FRACTURE OF SACRUM AND COCCYX WITH UNSPECIFIED SPINAL CORD INJURY - OPEN FRACTURE OF SACRUM AND COCCYX WITH OTHER CAUDA EQUINA INJURY

9 OPEN FRACTURE OF SHAFT OF TIBIA - OPEN FRACTURE OF SHAFT OF FIBULA WITH TIBIA OPEN FRACTURE OF T1-T6 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY - OPEN FRACTURE OF T7-T12 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY OPEN FRACTURE OF UNSPECIFIED PART OF TIBIA - OPEN FRACTURE OF UNSPECIFIED PART OF FIBULA WITH TIBIA OPEN FRACTURE OF UPPER END OF TIBIA - OPEN FRACTURE OF UPPER END OF FIBULA WITH TIBIA 995 OTHER ANAPHYLACTIC REACTION OTHER AND UNSPECIFIED INJURY OF OTHER SITES OF TRUNK OTHER AND UNSPECIFIED INJURY TO FACE AND NECK OTHER AND UNSPECIFIED INJURY TO HEAD * OTHER AND UNSPECIFIED INJURY TO HIP AND THIGH - OTHER AND UNSPECIFIED INJURY TO UNSPECIFIED SITE 298.8* OTHER AND UNSPECIFIED REACTIVE PSYCHOSIS OTHER CLOSED SKULL FRACTURE WITH CEREBRAL LACERATION AND CONTUSION WITH CONCUSSION UNSPECIFIED OTHER CLOSED SKULL FRACTURE WITH CEREBRAL LACERATION AND CONTUSION WITH STATE OF CONSCIOUSNESS UNSPECIFIED - OTHER CLOSED SKULL FRACTURE WITH CEREBRAL LACERATION AND CONTUSION WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION OTHER CLOSED SKULL FRACTURE WITH INTRACRANIAL INJURY OF OTHER AND UNSPECIFIED NATURE WITH STATE OF CONSCIOUSNESS UNSPECIFIED - OTHER SITE OF CLOSED SKULL FRACTURE WITH INTRACRANIAL INJURY OF OTHER AND UNSPECIFIED NATURE WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION OTHER CLOSED SKULL FRACTURE WITH OTHER AND UNSPECIFIED INTRACRANIAL HEMORRHAGE WITH CONCUSSION UNSPECIFIED OTHER CLOSED SKULL FRACTURE WITH OTHER AND UNSPECIFIED INTRACRANIAL HEMORRHAGE WITH STATE OF UNCONSCIOUSNESS UNSPECIFIED - OTHER CLOSED SKULL FRACTURE WITH OTHER AND UNSPECIFIED INTRACRANIAL HEMORRHAGE WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION OTHER CLOSED SKULL FRACTURE WITH SUBARACHNOID SUBDURAL AND EXTRADURAL HEMORRHAGE WITH CONCUSSION UNSPECIFIED OTHER CLOSED SKULL FRACTURE WITH SUBARACHNOID SUBDURAL AND EXTRADURAL HEMORRHAGE WITH STATE OF CONSCIOUSNESS UNSPECIFIED - OTHER CLOSED SKULL FRACTURE WITH SUBARACHNOID SUBDURAL AND EXTRADURAL HEMORRHAGE WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION OTHER CLOSED SKULL FRACTURE WITHOUT INTRACRANIAL INJURY WITH CONCUSSION UNSPECIFIED OTHER CLOSED SKULL FRACTURE WITHOUT INTRACRANIAL INJURY WITH STATE OF CONSCIOUSNESS UNSPECIFIED - OTHER CLOSED SKULL FRACTURE WITHOUT INTRACRANIAL INJURY WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION

10 OTHER CONVULSIONS OTHER DISLOCATION OF KNEE CLOSED OTHER DISLOCATION OF KNEE OPEN * OTHER DISORDERS OF IMPULSE CONTROL OTHER DRUG ALLERGY OTHER FRACTURE OF LOWER END OF FEMUR CLOSED OTHER FRACTURE OF LOWER END OF FEMUR OPEN OTHER FRACTURE OF LOWER END OF HUMERUS OPEN OTHER INJURY OF CHEST WALL - OTHER INJURY OF ABDOMEN OTHER LEFT BUNDLE BRANCH BLOCK OTHER MALIGNANT NEOPLASM OF UNSPECIFIED SITE - MALIGNANT NEOPLASM ASSOCIATED WITH TRANSPLANT ORGAN OTHER OPEN FRACTURE OF UPPER END OF HUMERUS OTHER OPEN SKULL FRACTURE WITH CEREBRAL LACERATION AND CONTUSION WITH CONCUSSION UNSPECIFIED OTHER OPEN SKULL FRACTURE WITH CEREBRAL LACERATION AND CONTUSION WITH STATE OF CONSCIOUSNESS UNSPECIFIED - OTHER OPEN SKULL FRACTURE WITH CEREBRAL LACERATION AND CONTUSION WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION OTHER OPEN SKULL FRACTURE WITH INTRACRANIAL INJURY OF OTHER AND UNSPECIFIED NATURE WITH CONCUSSION UNSPECIFIED OTHER OPEN SKULL FRACTURE WITH INTRACRANIAL INJURY OF OTHER AND UNSPECIFIED NATURE WITH STATE OF CONSCIOUSNESS UNSPECIFIED - OTHER OPEN SKULL FRACTURE WITH INTRACRANIAL INJURY OF OTHER AND UNSPECIFIED NATURE WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION OTHER OPEN SKULL FRACTURE WITH OTHER AND UNSPECIFIED INTRACRANIAL HEMORRHAGE WITH CONCUSSION UNSPECIFIED OTHER OPEN SKULL FRACTURE WITH OTHER AND UNSPECIFIED INTRACRANIAL HEMORRHAGE WITH STATE OF CONSCIOUSNESS UNSPECIFIED - OTHER OPEN SKULL FRACTURE WITH OTHER AND UNSPECIFIED INTRACRANIAL HEMORRHAGE WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION OTHER OPEN SKULL FRACTURE WITH SUBARACHNOID SUBDURAL AND EXTRADURAL HEMORRHAGE WITH CONCUSSION UNSPECIFIED

11 OTHER OPEN SKULL FRACTURE WITH SUBARACHNOID SUBDURAL AND EXTRADURAL HEMORRHAGE WITH STATE OF CONSCIOUSNESS UNSPECIFIED - OTHER OPEN SKULL FRACTURE WITH SUBARACHNOID SUBDURAL AND EXTRADURAL HEMORRHAGE WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION OTHER OPEN SKULL FRACTURE WITHOUT INJURY WITH STATE OF CONSCIOUSNESS UNSPECIFIED - OTHER OPEN SKULL FRACTURE WITHOUT INTRACRANIAL INJURY WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION OTHER OPEN SKULL FRACTURE WITHOUT INTRACRANIAL INJURY WITH CONCUSSION UNSPECIFIED OTHER PREMATURE BEATS OTHER PULMONARY EMBOLISM AND INFARCTION OTHER SHOCK WITHOUT TRAUMA OTHER SITE OF CLOSED SKULL FRACTURE WITH INTRACRANIAL INJURY OF OTHER AND UNSPECIFIED NATURE WITH CONCUSSION UNSPECIFIED OTHER SPECIFIED COMPLICATIONS OF PREGNANCY UNSPECIFIED AS TO EPISODE OF CARE OTHER SPECIFIED INTESTINAL OBSTRUCTION V15.89 OTHER SPECIFIED PERSONAL HISTORY PRESENTING HAZARDS TO HEALTH OTHER TRANSCERVICAL FRACTURE OF FEMUR CLOSED OTHER TRANSCERVICAL FRACTURE OF FEMUR OPEN * PAIN IN JOINT INVOLVING MULTIPLE SITES PAIN IN THORACIC SPINE PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA - PAROXYSMAL VENTRICULAR TACHYCARDIA PATHOLOGICAL DRUG INTOXICATION V15.6 PERSONAL HISTORY OF POISONING PRESENTING HAZARDS TO HEALTH PHLEBITIS AND THROMBOPHLEBITIS OF FEMORAL VEIN (DEEP) (SUPERFICIAL) PHLEBITIS AND THROMBOPHLEBITIS OF OTHER

12 V49.87 PHYSICAL RESTRAINTS STATUS POISONING BY UNSPECIFIED DRUG OR MEDICINAL SUBSTANCE POST TRAUMATIC SEIZURES PRESSURE ULCER, LOWER BACK - PRESSURE ULCER, BUTTOCK PRESSURE ULCER, STAGE III - PRESSURE ULCER, STAGE IV PRINZMETAL ANGINA 514 PULMONARY CONGESTION AND HYPOSTASIS * RESPIRATORY ABNORMALITY OTHER RESPIRATORY ARREST RIGHT BUNDLE BRANCH BLOCK RIGHT BUNDLE BRANCH BLOCK AND LEFT POSTERIOR FASCICULAR BLOCK - TRIFASCICULAR BLOCK SADDLE EMBOLUS OF PULMONARY ARTERY SHOCK UNSPECIFIED - SEPTIC SHOCK SINOATRIAL NODE DYSFUNCTION V45.88 STATUS POST ADMINISTRATION OF TPA (RTPA) IN A DIFFERENT FACILITY WITHIN THE LAST 24 HOURS PRIOR TO ADMISSION TO CURRENT FACILITY STRICTURE AND STENOSIS OF ESOPHAGUS 293.1* SUBACUTE DELIRIUM SUBENDOCARDIAL INFARCTION EPISODE OF CARE UNSPECIFIED - SUBENDOCARDIAL INFARCTION SUBSEQUENT EPISODE OF CARE SWELLING OF LIMB

13 TACHYCARDIA UNSPECIFIED - PALPITATIONS TRANSFUSION RELATED ACUTE LUNG INJURY (TRALI) TRUE POSTERIOR WALL INFARCTION EPISODE OF CARE UNSPECIFIED - TRUE POSTERIOR WALL INFARCTION SUBSEQUENT EPISODE OF CARE UNSPECIFIED ADULT MALTREATMENT UNSPECIFIED ADVERSE EFFECT OF OTHER DRUG, MEDICINAL AND BIOLOGICAL SUBSTANCE UNSPECIFIED CHEST PAIN - PAINFUL RESPIRATION UNSPECIFIED CLOSED FRACTURE OF PELVIS - UNSPECIFIED OPEN FRACTURE OF PELVIS UNSPECIFIED COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE - ACUTE ON CHRONIC COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE UNSPECIFIED DIASTOLIC HEART FAILURE - ACUTE ON CHRONIC DIASTOLIC HEART FAILURE UNSPECIFIED OPEN WOUND OF EYEBALL UNSPECIFIED SYSTOLIC HEART FAILURE - ACUTE ON CHRONIC SYSTOLIC HEART FAILURE UNSPECIFIED TRANSIENT CEREBRAL ISCHEMIA VENTRICULAR FIBRILLATION - VENTRICULAR FLUTTER VOLUME DEPLETION, UNSPECIFIED - HYPOVOLEMIA VOMITING ALONE *Notes: Use code to denote special handling in route - isolation. Use code to denote chemical restraint. Use code to denote patient safety: danger to self and others monitoring other and unspecified reactive Use code to denote patient safety: danger to self and others seclusion (flight risk). Use code if behavior is such that restraints were required to ensure patient safety. Use code to denote cardiac/hemodynamic monitoring required en route. Use code 496 to denote suctioning required en route or need for titrated oxygen therapy. Use code to denote specialized handling en route position requires specialized handling.

14 Use code to denote airway control/positioning required en route. Use code to denote special handling en route to reduce pain. Use code to report a fall with injuries and other multiple injury conditions such as injuries sustained in motor Use code V46.2 to indicate that transportation was necessary due to administration of medically necessary oxygen