T6a

Reporting Period: January 1, 2014 through December 31, 2014

TABLE 6A – SELECTED DIAGNOSES AND SERVICES RENDERED

Diagnostic Category		Applicable ICD-9-CM Code	Number of Visits by Diagnosis regardless of primacy (A)	Number of Patients with Diagnosis regardless of primacy (B)
Selected Infectious and Parasitic Diseases
1-2.	Symptomatic HIV , Asymptomatic HIV	042 , 079.53, V08
1-2(a)	Initial HIV Diagnosis: Persons diagnosed for the first time ever in the life of the patient (see manual)	042 , 079.53, V08
3.	Tuberculosis	010.xx – 018.xx
4.	Syphilis and other sexually transmitted diseases	090.xx – 099.xx
4a.	Hepatitis B	070.20, 070.22, 070.30, 070.32
4b.	Hepatitis C	070.41, 070.44, 070.51, 070.54, 070.70, 070.71
Selected Diseases of the Respiratory System
5.	Asthma	493.xx
6.	Chronic bronchitis and emphysema	490.xx – 492.xx
Selected Other Medical Conditions
7.	Abnormal breast findings, female	174.xx; 198.81; 233.0x; 238.3 793.8x
8.	Abnormal cervical findings	180.xx; 198.82; 233.1x; 795.0x
9.	Diabetes mellitus	250.xx; 648.0x; 775.1x
10.	Heart disease (selected)	391.xx – 392.0x 410.xx – 429.xx
11.	Hypertension	401.xx – 405.xx;
12.	Contact dermatitis and other eczema	692.xx
13.	Dehydration	276.5x
14.	Exposure to heat or cold	991.xx – 992.xx
14a.	Overweight and obesity	ICD-9 : 278.0 – 278.02 or V85.xx excluding V85.0, V85.1, V85.51 V85.52
Selected Childhood Conditions
15.	Otitis media and eustachian tube disorders	381.xx – 382.xx
16.	Selected perinatal medical conditions	770.xx; 771.xx; 773.xx; 774.xx – 779.xx (excluding 779.3x)

17.

Lack of expected normal physiological development (such as delayed milestone; failure to gain weight; failure to thrive); Does not Include Sexual or Mental Development; Nutritional deficiencies

260.xx – 269.xx; 779.3x; 783.3x – 783.4x;

TABLE 6A – SELECTED DIAGNOSES AND SERVICES RENDERED

Diagnostic Category			Applicable ICD-9-CM Code	Number of Visits by Diagnosis regardless of primacy (A)	Number of Patients with Diagnosis regardless of primacy (B)
Selected Mental Health and Substance Abuse Conditions
18.	Alcohol related disorders	291.xx, 303.xx; 305.0x 357.5x
19.	Other substance related disorders (excluding tobacco use disorders)	292.1x – 292.8x 304.xx, 305.2x – 305.9x 357.6x, 648.3x
19a.	Tobacco use disorder	305.1
20a.	Depression and other mood disorders	296.xx, 300.4 301.13, 311.xx
20b.	Anxiety disorders including PTSD	300.0x, 300.2x, 300.3, 308.3, 309.81
20c.	Attention deficit and disruptive behavior disorders	312.8x, 312.9x, 313.81, 314.xx
20d.	Other mental disorders, excluding drug or alcohol dependence (includes mental retardation)	290.xx 293.xx – 302.xx (excluding 296.xx, 300.0x, 300.2x, 300.3, 300.4, 301.13);  306.xx - 319.xx (excluding 308.3, 309.81, 311.xx, 312.8x, 312.9x,313.81,314.xx)

TABLE 6A – SELECTED SERVICES RENDERED      

Service Category		Applicable ICD-9-CM or CPT-4 Code	Number of Visits (A)	Number of Patients (B)
Selected Diagnostic Tests/Screening/Preventive Services
21.	HIV test	CPT-4: 86689; 86701-86703; 87390-87391
21a.	Hepatitis B test	CPT-4: 86704, 86706, 87515-17
21b.	Hepatitis C test	CPT-4: 86803-04, 87520-22
22.	Mammogram	CPT-4: 77052, 77057 OR ICD-9: V76.11; V76.12
23.	Pap test	CPT-4: 88141-88155; 88164-88167, 88174-88175 OR ICD-9: V72.3; V72.31; V76.2
24.	Selected Immunizations: Hepatitis A, Hemophilus Influenza B (HiB), Pneumococcal, Diptheria, Tetanus, Pertussis (DTaP) (DTP) (DT), Mumps, Measles, Rubella, Poliovirus, Varicella, Hepatitis B Child)	CPT-4: 90633-90634, 90645 – 90648; 90670; 90696 – 90702; 90704 – 90716; 90718 - 90723; 90743 – 90744; 90748
24a.	Seasonal Flu vaccine	CPT-4: 90655 - 90662
25.	Contraceptive management	ICD-9: V25.xx
26.	Health supervision of infant or child (ages 0 through 11)	CPT-4: 99391-99393; 99381-99383;
26a.	Childhood lead test screening (9 to 72 months)	CPT-4: 83655
26b.	Screening, Brief Intervention, and Referral to Treatment (SBIRT)	CPT-4: 99408-99409
26c.	Smoke and tobacco use cessation counseling	CPT-4:  99406 and 99407; S9075
26d.	Comprehensive and intermediate eye exams	CPT-4: 92002, 92004, 92012, 92014
Service Category		Applicable ADA Code	Number of Visits (A)	Number of Patients (B)
Selected Dental Services
27.	I. Emergency Services	ADA : D9110
28.	II. Oral Exams	ADA : D0120, D0140, DO145, D0150, D0160, D0170, D0180
29.	Prophylaxis – adult or child	ADA : D1110, D1120,
30.	Sealants	ADA : D1351
31.	Fluoride treatment – adult or child	ADA : D1203, D1204, D1206
32.	III. Restorative Services	ADA : D21xx – D29xx
33.	IV. Oral Surgery (extractions and other surgical procedures)	ADA : D7111, D7140, D7210, D7220, D7230, D7240, D7241, D7250, D7260, D7261, D7270, D7272, D7280
34.	V. Rehabilitative services (Endo, Perio, Prostho, Ortho)	ADA : D3xxx, D4xxx, D5xxx , D6xxx, D8xxx

Sources of codes:

• International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), Volumes 1 and 2, 2010/2012. American Medical Association.

• Current Procedural Terminology, (CPT) 2010/2012. American Medical Association.
  Current Dental Terminology, (CDT) 2010/2011. American Dental Association.
  
  

NOTE: x in a code denotes any number including the absence of a number in that place.