TN 12 (01-14)

DI 26510.015 Completing Item 16A and 16B (Primary and Secondary Diagnosis, Body System Code and Impairment Code) on the SSA-831 Disability Determination and Transmittal

A. Citing a diagnosis

Correct diagnosis coding is essential for statistical analysis, case studies, and answering public inquiries. The following principles apply when citing a diagnosis:

  • The diagnosis should identify the underlying cause (i.e., etiology) and disabling manifestation.

  • If the underlying cause is unknown, the diagnosis should identify the disabling manifestation.

  • You must include the codes most relevant to the determination.

  • The electronic claims analysis tool (eCAT) allows for documenting multiple codes as “other” impairment within the case file.

1. Disability examiner (DE) and medical or psychological consultant (MC/PC) team determinations

The reviewing MC/PC and DE team determines the diagnosis and its nomenclature. They provide the diagnosis based on a review of all the medical evidence in file and choose the terminology used on the determination form. The MC/PC completes or reviews the diagnosis. The MC/PC is responsible for diagnosis terminology and accuracy.

2. Non-team determinations

When the DE alone is responsible for the determination, the DE is responsible for diagnosis terminology and accuracy.

B. Description of Block 16

Block 16 contains entries for a:

  • primary and a secondary diagnosis,

  • 2-digit primary body system identifying code, and

  • 4-digit primary and a secondary impairment identifying code – based on a simplified version of the International Classification of Diseases (ICD) full code.

C. Procedure for determining the primary and secondary diagnoses

Complete items 16A and 16B as follows:

1. Introduction

Evaluate all of the medical evidence in the file, and determine diagnoses for the period reviewed. Enter the diagnosis of the claimant's primary and secondary impairment (if any) at the established onset date (EOD) in an allowance or at the alleged onset date (AOD) in a denial. Include other diagnoses present at the time of adjudication in the determination rationale.

2. Primary diagnosis or Item 16A

The primary diagnosis in an allowance refers to the basic condition that rendered the individual disabled, or in a denial, the one which the evidence shows to have the most significant effect on the individual's ability to work.

When the case is a denial, and no diagnosis is established, enter none established. Use impairment code “0000” when there is no medical evidence in the file. Use impairment code “6490” when medical evidence in the file is not sufficient to establish a diagnosis.

a. Drug addiction and alcoholism (DAA) materiality

When the case is a denial because DAA is material, enter the appropriate code for “alcoholism” (3030 – Substance Addiction or Psychoactive Substance Dependence Disorders (Alcohol)) or “drug addiction” (3040 – Substance Addiction or Psychoactive Substance Dependence Disorders (Drugs)) as the primary impairment. When the case is an allowance because DAA is not material, enter the mental or physical impairment that would be disabling, absent the effects of DAA, as the primary diagnosis.

See Also:

DI 90070.050 DAA Material Determinations

b. Statutory blindness

IMPORTANT: A claimant has statutory blindness only if the visual disorder meets Listing 2.02 or 2.03A for adults, or Listing 102.02 or 102.03A for children.

Use the term “Statutory Blindness” as the primary diagnosis.

  1. Enter body system “02” and impairment code “3694” in the blocks provided.

  2. In Item 16B (Secondary Diagnosis), show the underlying cause of the blindness and the corresponding diagnosis code.

  3. Enter “Statutory Blindness” as the secondary diagnosis when the basis of the EOD is a different impairment and that impairment’s onset date is before the onset date of statutory blindness.

3. Secondary diagnosis or Item 16B

If there is no secondary diagnosis, enter “none” in block 16B. The secondary diagnosis in all determinations is the most significant diagnosis following the primary diagnosis in severity, except in the following situations.

a. Symptomatic human immunodeficiency virus (HIV) infection

If the primary diagnosis is symptomatic HIV infection, enter the diagnosis of the most significant HIV-related complication as the secondary diagnosis. If there is no HIV-related complication, enter the most significant diagnosis following the primary diagnosis.

b. DAA is present but not material

When DAA is present but not material, enter “alcoholism” or “drug addiction,” as appropriate, as the secondary diagnosis.

c. Statutory blindness

Enter “Statutory Blindness” as the secondary diagnosis when the basis of the EOD (Item 15A) is not statutory blindness; and the impairment’s onset date is before the onset date of statutory blindness.

  1. In Item 16A (Primary Diagnosis), enter the diagnosis of the other impairment at the established onset date. Enter the related body system code and diagnosis code.

  2. In Item 16B (Secondary Diagnosis), enter “Statutory Blindness” as the secondary diagnosis and show diagnosis code 3694. Because item 16B can only show “Statutory Blindness,” you cannot include the underlying cause on the SSA-831. However, if eCAT is used, show the underlying cause as “Other” impairment.

REMINDER: For additional instructions about completing Item 18 (Case of Blindness), see DI 26510.025.

D. Procedure for body system coding

Body system coding of the primary diagnosis is required for all determinations, favorable or unfavorable.

  • Obtain the appropriate body system code number for the primary diagnosis from DI 26510.015F in this section.

  • Enter the 2-digit body-system code number in the designated space following the primary diagnosis in Item 16A.

E. Procedure for impairment coding

You must code the primary and secondary diagnosis for all determinations, favorable or unfavorable.

  • Select codes, as appropriate, from the predetermined lists in DI 26510.015G.1. through DI 26510.015G.4. in this section.

  • Use the code on List 1, 2, or 3 that most accurately identifies the impairment. For example, on List 1 (Adult listing impairment codes), there are no codes for impairments such as Attention Deficit Hyperactivity Disorder (ADHD) or Eating Disorders. However, there are codes for these impairments on List 2 (Childhood listing impairment codes) and on List 3 (General list of impairment codes). If a claimant has an impairment, such as ADHD, that “equals” an adult listing, use the impairment code for ADHD, even though it does not appear on List 1.

  • Whenever symptomatic HIV (code 0430) is used as the primary diagnosis, use a code from List 4 (also shown on List 5 under “Diagnostic Categories” as “(Secondary Diagnosis for HIV-0430)” for “Body System” 14) as the secondary diagnosis for all favorable or unfavorable determinations, except as noted under DI 26510.015G.4. in this section. Never use these codes as a primary diagnosis. These codes are designated for use as a secondary diagnosis for HIV on Lists 4 and 5, and should only be used as a secondary diagnosis when the primary diagnosis is symptomatic HIV (code 0430).

To complete the impairment code number entry on the SSA-831, enter the appropriate 4-digit impairment code in the designated space following the primary diagnosis in Item 16A and the secondary diagnosis in Item 16B.

The five lists developed for ease of reference are:

List 1 – Adult listing (part A) impairment codes when the adult listings are applicable and impairment severity meets adult listing criteria. Also, use this list in “medical equals” determinations. (See DI 26510.015G.1. in this section.)

List 2 – Childhood listing (part B) impairment codes when childhood listings are applicable and impairment severity meets childhood listing criteria. Also, use this list in “medical equals” determinations. (See DI 26510.015G.2. in this section.)

List 3 – General list of impairment codes when an impairment is less than listing or medical equivalent severity. Use this list in unfavorable adult and childhood determinations; and favorable functional equals or medical and vocational determinations. List 3 also provides codes for special situations described in DI 26510.015G.3. in this section.

List 4 – Impairment codes for symptomatic HIV infection secondary complications. (See DI 26510.015G.4. in this section.)

List 5 – Impairment codes in numeric sequence. Use this list for ease of reference when looking for the diagnosis connected to a particular impairment code. (See DI 26510.015G.5. in this section.)

1. Primary diagnosis impairment codes

Situation

Reference

Meets, medical equals

DI 26510.015G.1. and DI 26510.015G.2.

Medical and vocational allowances
Functional equals allowances
Denial
Special situations

DI 26510.015G.3.

2. Secondary diagnosis impairment codes

Situation

Reference

Meets, medical equals

DI 26510.015G.1. and DI 26510.015G.2.

Medical and vocational allowances
Functional equals allowances
Denial
Special situations

DI 26510.015G.3.

Symptomatic HIV infection

DI 26510.015G.4.

F. List of body system codes

Code number

Body System

01

Musculoskeletal System

02

Special Senses and Speech

03

Respiratory System

04

Cardiovascular System

05

Digestive System

06

Genitourinary Impairments

07

Hematological Disorders

08

Skin Disorders

09

Endocrine Disorders

10

Congenital Disorders That Affect Multiple Body Systems

11

Neurological

12

Mental Disorders

13

Malignant Neoplastic Diseases

14

Immune System Disorders

19

Growth Impairment

20

Special/Other

G. List of impairment codes

1. Adult listing impairment codes

  1. Use this list for any condition that meets or equals a listing in part A of the Listing of Impairments (unless a code from List 2 or List 3 more accurately describes the impairment).

  2. The impairment code should match the diagnosis as closely as possible.

EXAMPLE:

  • Intellectual disability, meets Listing 12.05, code 3180;

  • Chronic pulmonary insufficiency, meets Listing 3.02, code 4960;

  • Arteriosclerotic heart disease with angina pectoris and history of myocardial infarction, meets Listing 4.04, code 4140; and

  • Alzheimer’s disease meets Listing 12.02, code 2940.

Listing (Body Systems)

Diagnostic Category

Impairment Code

Musculoskeletal (01)

  

1.02

Other and Unspecified Arthropathies

7160

1.03

Osteoarthrosis and Allied Disorders

7150

1.04

Disorders of Back (discogenic and degenerative)

7240

1.04B

Arachnoiditis

3210

1.05

Late Effects of Musculoskeletal and Connective Tissue Injuries (amputation)

9050

1.06

Fractures of Lower Limb

8270

1.07

Fractures of Upper Limb

8180

1.08

Open Wound of Upper Limb (Soft Tissue Injury)

8840

1.08

Open Wound of Lower Limb (Soft Tissue Injury)

8940

1.08

Burns (NOS)

9490

Special Senses and Speech (02)

  

2.02

Retinal Detachments and Defects

3610

2.02

Glaucoma

3650

2.02

Cataract

3660

2.02

Blindness and Low Vision

3690

2.02

Statutory Blindness

3694

2.03

Visual Disturbances

3680

2.03A

Statutory Blindness

3694

2.04

Visual Disturbances

3680

2.07

Vertiginous Syndromes and Other Disorders of Vestibular System

3860

2.09

Loss of Voice

7840

2.10

Hearing Loss Not Treated with Cochlear Implantation

3890

2.11

Hearing Loss Treated with Cochlear Implantation

3890

Respiratory (03)

  

3.02

Chronic Pulmonary Insufficiency

4960

3.03

Asthma

4930

3.04

Cystic Fibrosis

2770

3.06

Pneumoconiosis

5050

3.07

Bronchiectasis

4940

3.08

Mycobacterial, Mycotic, and Other Chronic Persistent Infections of the Lung

1170

3.09

Cor Pulmonale Secondary to Chronic Pulmonary Vascular Hypertension

4160

3.10

Sleep-Related Breathing Disorders

7800

3.11

Lung Transplant

3250

Cardiovascular (04)

  

4.02

Chronic Heart Failure

4280

4.04

Ischemic Heart Disease

4140

4.05

Recurrent Arrhythmias

4270

4.06

Symptomatic Congenital Heart Disease

7460

4.09

Heart Transplant

3750

4.10

Aneurysm of Aorta or Major Branches

4410

4.11

Chronic Venous Insufficiency

4590

4.12

Peripheral Arterial Disease

4430

Digestive (05)

  

5.02

Gastrointestinal Hemorrhaging from any cause

5780

5.05

Chronic Liver Disease

5710

5.06

Inflammatory Bowel Disease (IBD)

5550

5.07

Short Bowel Syndrome (SBS)

5793

5.08

Weight Loss due to any digestive disorder

2630

5.09

Liver Transplantation

4750

Genitourinary (06)

  

6.02

Chronic Renal Failure

5850

6.06

Nephrotic Syndrome

5810

Hematological Disorders (07)

  

7.02

Other Anemias

2850

7.05

Hereditary Hemolytic Anemias (Including all Sickle Cell)

2820

7.06

Purpura and Other Hemorrhagic Conditions

2870

7.07

Disease of Capillaries (Hereditary Telangiectasia)

4480

7.08

Coagulation Defects (Including Hemophilia)

2860

7.09

Polycythemia Vera

2380

7.10

Other Diseases of Blood and Blood-Forming Organs

2890

7.15

Diseases of White Blood Cells

2880

7.17

Aplastic Anemia

2840

Skin Disorders (08)

  

8.02

Ichthyosis

6950

8.03

Bullous Disease

6940

8.04

Chronic Infections of the Skin or Mucous Membranes

1170

8.05

Dermatitis

6960

8.06

Hidradenitis Suppurativa

7050

8.07

Genetic Photosensitivity Disorders

7590

8.08

Burns

9480

Congenital Disorders That Affect Multiple Body Systems (10)

  

10.06

Non-Mosaic Down Syndrome

7580

Neurological (11)

  

11.02

Epilepsy (Major Motor Seizures)

3450

11.03

Epilepsy (Minor Motor Seizures)

3450

11.04

Late Effects of Cerebrovascular Disease

4380

11.05

Benign Neoplasm of Brain and Other Parts of Nervous System

2250

11.06

Parkinson's Disease

3320

11.07

Cerebral Palsy

3430

11.08

Other Diseases of Spinal Cord

3360

11.08

Fracture of Vertebral Column with Spinal Cord Lesion

8060

11.09

Multiple Sclerosis

3400

11.10

Anterior Horn Cell Disease (Amyotrophic Lateral Sclerosis)

3350

11.11

Late Effects of Acute Poliomyelitis

1380

11.12

Myoneural Disorders

3580

11.13

Muscular Dystrophies and Other Myopathies

3590

11.14

Peripheral Neuropathy

3570

11.16

Deficiency Anemias

2810

11.17

Other Cerebral Degenerations

3310

11.17

Huntington Disease

3330

11.18

Late Effects of Injuries to the Nervous System

9070

11.19

Other Diseases of Spinal Cord

3360

Mental Disorders (12)

  

12.02

Organic Mental Disorders

2940

12.03

Schizophrenic, Paranoid and Other Psychotic Disorders

2950

12.04

Affective Disorders

2960

12.05

Intellectual Disability

3180

12.06

Anxiety-Related Disorders

3000

12.07

Somatoform Disorders

3060

12.08

Personality Disorders

3010

12.09

Substance Addiction Disorders (Alcohol)

3030

12.09

Substance Addiction Disorders (Drugs)

3040

12.10

Autistic Disorder and Other Pervasive Developmental Disorders

2990

**

Borderline Intellectual Functioning

*Do not code borderline intellectual functioning as 3180 (under Intellectual Disability).

**In the event that borderline intellectual functioning is determined to be of listing level severity, base the appropriate listed impairment category on which to find medical equivalence on consideration of all the cognitive and behavioral manifestations in the particular claim.

3195*

Malignant Neoplastic Diseases (13)

  

13.02

Soft Tissue Tumors of Head and Neck

1950

13.03

Malignant Neoplasm of Skin

1730

13.04

Malignant Neoplasm of Connective and Other Soft Tissue

1710

13.05

Lymphoma

2020

13.06

Leukemia

2070

13.07

Multiple Myeloma

2030

13.08

Malignant Neoplasm of Salivary Glands

1420

13.09

Malignant Neoplasm of Thyroid Gland

1930

13.10

Malignant Neoplasm of Breast

1740

13.11

Malignant Neoplasm of Skeletal System

1780

13.12

Malignant Neoplasm of Maxilla, Orbit, or Temporal Fossa

1700

13.13

Malignant Neoplasm of Nervous System

1910

13.14

Malignant Neoplasm of Trachea, Bronchus, or Lung

1620

13.15

Malignant Neoplasm of Pleura

1630

13.15

Malignant Neoplasm of Mediastinum)

1640

13.16

Malignant Neoplasm of Esophagus

1500

13.16

Malignant Neoplasm of Stomach

1510

13.17

Malignant Neoplasm of Small Intestine, Including Duodenum

1520

13.18

Malignant Neoplasm of Colon, Rectum or Anus

1530

13.19

Malignant Neoplasm of Liver and Intrahepatic Bile Ducts

1550

13.19

Malignant Neoplasm of Gallbladder and Extrahepatic Bile Ducts

1560

13.20

Malignant Neoplasm of Pancreas

1570

13.21

Malignant Neoplasm of Kidney, Adrenal Glands, or Ureters

1890

13.22

Malignant Neoplasm of Bladder

1880

13.23

Malignant Neoplasm of Uterus

1790

13.23

Malignant Neoplasm of Vulva or Vagina

1840

13.23

Malignant Neoplasm of Ovary and Other Uterine Adnexa

1830

13.24

Malignant Neoplasm of Prostate

1850

13.25

Malignant Neoplasm of Testis

1860

13.26

Malignant Neoplasm of Penis

1870

13.27

Malignant Neoplasm of Unspecified Site

1990

13.28

Malignant Neoplasm Treated by Bone Marrow or Stem Cell Transplantation

0420

Immune System Disorders (14)

  

14.02

Systemic Lupus Erythematosus

7100

14.03

Systemic Vasculitis

4460

14.04

Systemic Sclerosis (Scleroderma )

7100

14.05

Polymyositis and Dermatomyositis

7100

14.06

Undifferentiated and Mixed Connective Tissue Disease

7100

14.07

Immune Deficiency Disorders, Excluding HIV Infection

2790

14.08

Human Immunodeficiency Virus (HIV) Infection

0430

14.09

Inflammatory Arthritis

7140

14.09C

Ankylosing Spondylitis or Other Spondyloarthropathies

7200

14.10

Sjögren's Syndrome

7100

2. Childhood listing impairment codes

  1. Use this list for any condition that meets a listing in part B of the Listing of Impairments. Also use in “medical equals” cases (unless an impairment code from List 1 or List 3 more accurately describes the impairment).

  2. The impairment code should match the diagnosis as closely as possible.

For example:

  • Diabetes mellitus, meets Listing 109.08, code 2500;

  • Intellectual disability, meets Listing 112.05, code 3180; and

  • Cystic fibrosis, meets Listing 103.04, code 2770.

Listing (Body System)

Diagnostic Category

Impairment Code

Musculoskeletal (01)

  

101.02

Other and Unspecified Arthropathies

7160

101.03

Osteoarthrosis and Allied Disorders

7150

101.04

Fracture of Vertebral Column with Spinal Cord Lesion

8060

101.04

Curvature of Spine

7370

101.05

Late Effects of Musculoskeletal and Connective Tissue Injuries (amputation)

9050

101.06

Fractures of Lower Limb

8270

101.07

Fractures of Upper Limb

8180

101.08

Open Wound of Upper Limb (Soft Tissue Injury)

8840

101.08

Open Wound of Lower Limb (Soft Tissue Injury)

8940

101.08

Burns (NOS)

9490

Special Senses (02)

  

102.02

Blindness and Low Vision

3690

102.02

Statutory Blindness

3694

102.03

Visual Disturbances

3680

102.03A

Statutory Blindness

3694

102.04

Visual Disturbances

3680

102.10

Hearing Loss Not Treated with Cochlear Implantation

3890

102.11

Hearing Loss Treated with Cochlear Implantation

3890

Respiratory (03)

  

103.02

Chronic Pulmonary Insufficiency

4960

103.03

Asthma

4930

103.04

Cystic Fibrosis

2770

103.05

Lung Transplant

3250

Cardiovascular (04)

  

104.02

Chronic Heart Failure

4280

104.05

Recurrent Arrhythmias

4270

104.06

Congenital Heart Disease

7460

104.09

Heart Transplant

3750

104.13

Rheumatic Heart Disease

3910

Digestive (05)

  

105.02

Gastrointestinal Hemorrhaging from any cause

5780

105.05

Chronic Liver Disease

5710

105.06

Inflammatory Bowel Disease (IBD)

5550

105.07

Short Bowel Syndrome (SBS)

5793

105.08

Malnutrition

2630

105.09

Liver Transplantation

4750

105.10

Need for supplemental daily enteral feeding via gastrostomy

5799

Genitourinary (06)

  

106.02

Chronic Renal Failure

5850

106.06

Nephrotic Syndrome

5810

106.07

Congenital Anomalies of Urinary System

7530

Hematological Disorders (07)

  

107.03

Hereditary Hemolytic Anemias

2820

107.05

Hereditary Hemolytic Anemia (Sickle Cell)

2820

107.06

Purpura and Other Hemorrhagic Conditions

2870

107.08

Coagulation Defects (Including Hemophilia)

2860

Skin Disorders (08)

  

108.02

Ichthyosis

6950

108.03

Bullous Disease

6940

108.04

Chronic Infections of the Skin or Mucous Membranes

1170

108.05

Dermatitis

6960

108.06

Hidradenitis Suppurativa

7050

108.07

Genetic Photosensitivity Disorders

7590

108.08

Burns

9480

Endocrine (09)

  

109.08

Diabetes Mellitus

2500

Congenital Disorders That Affect Multiple Body Systems (10)

  

110.06

Non-Mosaic Down Syndrome

7580

110.08

Anencephalus and Catastrophic Congenital Abnormality or Disease

7400

110.08B

Cerebral Degeneration Usually Manifest in Childhood

3300

Neurological (11)

  

111.02A & B

Epilepsy (Major Motor Seizures)

3450

111.03

Epilepsy (Minor Motor Seizures)

3450

111.05

Benign Neoplasm of Brain and Other Parts of Nervous System

2250

111.06

Other Disorders of Nervous System

3490

111.07

Cerebral Palsy

3430

111.08

Spina Bifida (Meningomyelocele)

7410

111.09

Loss of Voice (Communication Impairment)

7840

Mental Disorders (12)

  

112.02

Organic Mental Disorders

2940

112.03

Schizophrenic, Delusional (Paranoid), Schizo-Affective, and Other Psychotic Disorders

2950

112.04

Mood Disorders

2960

112.05

Intellectual Disability

3180

112.06

Anxiety Disorders

3000

112.07

Somatoform Disorders

3060

112.07

Eating and Tic Disorders

3070

112.08

Personality Disorders

3010

112.08

Conduct Disorder

3120

112.08

Oppositional/Defiant Disorder

3138

112.09

Psychoactive Substance Dependence Disorders (Alcohol)

3030

112.09

Psychoactive Substance Dependence Disorders (Drugs)

3040

112.10

Autistic Disorder and Other Pervasive Developmental Disorders

2990

112.11

Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder

3140

112.12

Developmental and Emotional Disorders of Newborn and Younger Infants

3150

*

Learning Disorder (LD)

*In the event that an LD is of listing level severity, base the appropriate listing to equal on consideration of all the cognitive and behavioral manifestations in the particular case.

3152

112.12

Speech and Language Delays

3153

***

Borderline Intellectual Functioning

**Borderline intellectual functioning must not be coded as 3180 (under Intellectual Disability).

***In the event that borderline intellectual functioning is determined to be of listing level severity, base the appropriate listed impairment category on which to find medical equivalence on consideration of all the cognitive and behavioral manifestations in the particular case.

NOTE: Listing codes for some childhood mental impairments above show listings that might be appropriate if the impairment is of listing level severity. Because there is no listing specifically written for these mental diagnoses, they cannot meet a listing.

3195**

Malignant Neoplastic Diseases (13)

  

113.03

Malignant Neoplasm of Unspecified Site

1990

113.05

Lymphoma

2020

113.06

Leukemia

2070

113.09

Malignant Neoplasm of Thyroid Gland

1930

113.12

Malignant Neoplasm of Eye

1900

113.13

Malignant Neoplasm of Nervous System

1910

113.21

Neuroblastoma

1920

Immune System Disorders (14)

  

114.02

Systemic Lupus Erythematosus

7100

114.03

Systemic Vasculitis

4460

114.04

Systemic Sclerosis (Scleroderma)

7100

114.05

Polymyositis and Dermatomyositis

7100

114.06

Undifferentiated and Mixed Connective Tissue Disease

7100

114.07

Immune Deficiency Disorders, Excluding HIV Infection

2790

114.08

Human Immunodeficiency Virus (HIV) Infection

0430

114.09

Inflammatory Arthritis

7140

114.09C

Ankylosing Spondylitis or Other Spondyloarthropathies

7200

114.10

Sjögren's Syndrome

7100

Growth Impairment (19)

  

100.02

Malnutrition, Marasmus, Failure to Thrive

7830

100.03

Malnutrition, Marasmus, Failure to Thrive

7830

3. General list of impairment codes

  1. Use the following list for any impairment that does not meet or equal a listing in the Listing of Impairments (Part A or B). Some examples are:

    • Medical and vocational allowances;

    • Functional equals allowances;

    • Denials; and

    • Special situations; e.g., diagnosis is “none established” or diagnosis is established, but no list code of a medical nature is applicable.

  2. Find the body system for the impairment in the listings; determine the diagnostic category most appropriate to the impairment (including special or other), and use the code shown for that category.

Some examples are:

  • Diabetes mellitus, not severe, code 2500;

  • Chronic pulmonary insufficiency, severe, code 4920;

  • Essential hypertension, not severe, code 4010;

  • Chronic paranoid schizophrenia, severe, code 2950;

  • Grand mal epilepsy, severe, code 3450; and

  • Degenerative disc disease, L5-S1, severe, code 7240.

Impairment Codes

Diagnostic Categories

Musculoskeletal (01)

 

7150

Osteoarthrosis and Allied Disorders

7160

Other and Unspecified Arthropathies

7240

Disorders of Back (Discogenic and Degenerative)

3210

Arachnoiditis

7280

Disorders of Muscle, Ligament and Fascia

7300

Osteomyelitis, Periostitis and Other Infections Involving Bone

7330

Other Disorders of Bone and Cartilage (Osteoporosis)

7370

Curvature of Spine

8030

Fracture of Skull Without Intracranial Injury

8060

Fracture of Vertebral Column with Spinal Cord Lesion

8180

Fractures of Upper Limb

8270

Fractures of Lower Limb

8290

Other Fractures of Bones

8390

Dislocations--All Types

8480

Sprains and Strains--All Types

8840

Open Wound of Upper Limb (Soft Tissue Injury)

8940

Open Wound of Lower Limb (Soft Tissue Injury)

9050

Late Effects of Musculoskeletal and Connective Tissue Injuries (Amputation)

9490

Burns

Special Senses and Speech (02)

 

3610

Retinal Detachments and Defects

3620

Other Retinal Disorders (Including Diabetic Retinopathy)

3650

Glaucoma

3660

Cataract

3680

Visual Disturbances

3690

Blindness and Low Vision

3780

Strabismus and Other Disorders of Eye Movements

3860

Vertiginous Syndromes and Other Disorders of Vestibular System

3880

Other Disorders of Ear

3890

Hearing Loss

7840

Loss of Voice

Respiratory (03)

 

0110

Pulmonary Tuberculosis

1170

Mycotic (Fungus) Infections

1350

Sarcoidosis

1360

Other Infectious and Parasitic Disorders

2770

Disorders of Metabolism (Cystic Fibrosis)

4160

Chronic Pulmonary Heart Disease

4910

Chronic Bronchitis

4920

Emphysema

4930

Asthma

4940

Bronchiectasis

4960

Chronic Pulmonary Insufficiency (COPD)

5010

Asbestosis

5050

Pneumoconiosis

5190

Other Disorders of the Respiratory System

Cardiovascular (04)

 

0930

Cardiovascular Syphilis

3910

Rheumatic Fever with Heart Involvement

3950

Diseases of Aortic Valve

3980

Other Rheumatic Heart Disease

4010

Essential Hypertension

4020

Hypertensive Vascular Disease

4030

Hypertensive Vascular and Renal Disease

4100

Acute Myocardial Infarction

4130

Angina Pectoris Without Ischemic Heart Disease

4140

Chronic Ischemic Heart Disease With or Without Angina

4160

Chronic Pulmonary Heart Disease (Cor Pulmonale)

4240

Valvular Heart Disease or Other Stenotic Defects, or Valvular Regurgitation

4250

Cardiomyopathy

4270

Cardiac Dysrhythmias

4280

Heart Failure

4410

Aortic Aneurysm

4430

Peripheral Vascular (Arterial) Disease

4510

Phlebitis and Thrombophlebitis

4540

Varicose Veins of Lower Extremities

4590

Other Diseases of Circulatory System

7460

Congenital Anomalies of Heart

Digestive (05)

 

1360

Other Infectious and Parasitic Disorders

2630

Malnutrition (Weight Loss)

4750

Liver Transplantation

5300

Diseases of Esophagus

5330

Peptic Ulcer (Gastric or Duodenal)

5350

Gastritis and Duodenitis

5530

Hernias

5550

Inflammatory Bowel Disease (IBD)

5690

Other Disorders of Gastrointestinal System

5710

Chronic Liver Disease

5780

Gastrointestinal Hemorrhage

5793

Short Bowel Syndrome (SBS)

5799

Need for supplemental daily enteral feeding via a gastrostomy

7500

Congenital Anomalies of Upper Alimentary Tract

Genitourinary (06)

 

5810

Nephrotic Syndrome

5850

Chronic Renal Failure

5950

Interstitial Cystitis

5990

Other Disorders of the Urinary Tract

6080

Disorders of the Male Genital Organs

6290

Disorders of the Female Genital Organs

7530

Congenital Anomalies of Urinary System

Hematological Disorders (07)

 

2380

Polycythemia Vera

2790

Immune Deficiency Disorders, Excluding HIV infection

2810

Deficiency Anemias

2820

Hereditary Hemolytic Anemias (Including All Sickle Cell)

2840

Aplastic Anemia

2850

Other Anemias

2860

Coagulation Defects (Including Hemophilia)

2870

Purpura and Other Hemorrhagic Conditions

2880

Diseases of White Blood Cells

2890

Other Diseases of Blood and Blood-Forming Organs

4480

Diseases of Capillaries (Hereditary Telangiectasia)

Skin Disorders (08)

 

1170

Chronic Infections of the Skin or Mucous Membranes

6940

Bullous Disease

6950

Ichthyosis

6960

Dermatitis

7050

Hidradenitis Suppurativa

7090

Other Disorders of the Skin and Subcutaneous Tissues

7590

Genetic Photosensitivity Disorders

9480

Burns

Endocrine (09)

 

2460

All Disorders of Thyroid (Except Malignant Neoplasm)

2500

Diabetes Mellitus

2520

All Disorders of Parathyroid Gland (Except Malignant Neoplasm)

2530

All Disorders of Pituitary Gland (Except Malignant Neoplasm)

2550

All Disorders of Adrenal Glands (Except Malignant Neoplasm)

Congenital Disorders That Affect Multiple Body Systems (10)

 

3300

Cerebral Degenerations Usually Manifest in Childhood

7400

Anencephalus and Catastrophic Congenital Abnormality or Disease

7580

Non-Mosaic Down Syndrome)

Neurological (11)

 

0940

Neurosyphilis (Tabes Dorsalis)

1380

Late Effects of Acute Poliomyelitis

2250

Benign Neoplasm of Brain and Other Parts of Nervous System

2810

Deficiency Anemias

3300

Cerebral Degenerations Usually Manifest in Childhood

3310

Other Cerebral Degenerations

3320

Parkinson's Disease

3330

Huntington Disease

3350

Anterior Horn Cell Disease (Including Amyotrophic Lateral Sclerosis)

3360

Other Diseases of Spinal Cord

3370

Disorders of Autonomic Nervous System

3400

Multiple Sclerosis

3430

Cerebral Palsy

3450

Epilepsy

3460

Migraine

3490

Other Disorders of the Nervous System

3540

Carpal Tunnel Syndrome

3570

Diabetic and Other Peripheral Neuropathy

3580

Myoneural Disorders

3590

Muscular Dystrophies and Other Myopathies

4380

Late Effects of Cerebrovascular Disease

7410

Spina Bifida

7840

Loss of Voice

8060

Fracture of Vertebral Column with Spinal Cord Lesion

8540

Intracranial Injury

9070

Late Effects of Injuries to the Nervous System

Mental Disorders (12)

 

2940

Organic Mental Disorders

2950

Schizophrenic, Paranoid and Other Psychotic Disorders

2960

Affective Disorders/Mood Disorders

2990

Autistic Disorder and Other Pervasive Developmental Disorders

3000

Anxiety Disorders

3010

Personality Disorders

3030

Substance Addiction or Psychoactive Substance Dependence Disorders (Alcohol)

3040

Substance Addiction or Psychoactive Substance Dependence Disorders (Drugs)

3060

Somatoform Disorders

3070

Eating and Tic Disorders

3120

Conduct Disorder

3138

Oppositional/Defiant Disorder

3140

Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder

3150

Developmental and Emotional Disorders of Newborn and Younger Infants

3152

Learning Disorder

3153

Speech and Language Delays

3180

Intellectual Disability

3195*

Borderline Intellectual Functioning

*Do not code borderline intellectual functioning as 3180 (under Intellectual Disability).

Malignant Neoplastic Diseases (13)

 

0420

Malignant Neoplasm Treated by Bone Marrow or Stem Cell Transplantation

1410

Malignant Neoplasm of Tongue

1420

Malignant Neoplasm of Salivary Glands

1500

Malignant Neoplasm of Esophagus

1510

Malignant Neoplasm of Stomach

1520

Malignant Neoplasm of Small Intestine, Including Duodenum

1530

Malignant Neoplasm of Colon, Rectum or Anus

1550

Malignant Neoplasm of Liver and Intrahepatic Bile Ducts

1560

Malignant Neoplasm of Gallbladder and Extrahepatic Bile Ducts

1570

Malignant Neoplasm of Pancreas

1590

Malignant Neoplasm of Other and Ill-Defined Sites Within the Digestive Organs and Peritoneum (Abdomen)

1620

Malignant Neoplasm of Trachea, Bronchus, or Lung

1630

Malignant Neoplasm of Pleura

1640

Malignant Neoplasm of Mediastinum

1700

Malignant Neoplasm of Maxilla, Orbit, or Temporal Fossa

1710

Malignant Neoplasm of Connective and Other Soft Tissue

1720

Malignant Melanoma of Skin

1730

Malignant Neoplasm of Skin

1740

Malignant Neoplasm of Breast

1780

Malignant Neoplasm of Skeletal System

1790

Malignant Neoplasm of Uterus

1830

Malignant Neoplasm of Ovary and Other Uterine Adnexa

1840

Malignant Neoplasm of Vulva or Vagina

1850

Malignant Neoplasm of Prostate

1860

Malignant Neoplasm of Testis

1870

Malignant Neoplasm of Penis

1880

Malignant Neoplasm of Bladder

1890

Malignant Neoplasm of Kidney, Adrenal Glands, or Ureters

1900

Malignant Neoplasm of Eye

1910

Malignant Neoplasm of Nervous System

1920

Neuroblastoma

1930

Malignant Neoplasm of Thyroid Gland

1940

Malignant Neoplasm of Other Endocrine Glands and Related Structures

1950

Soft Tissue Tumors of Head and Neck

1980

Secondary Malignant Neoplasms (Metastatic Neoplasms of Distant Sites Other Than Regional Lymph Nodes)

1990

Malignant Neoplasms of Unspecified Site

2020

Lymphoma

2030

Multiple Myeloma

2070

Leukemia

2390

Neoplasm of Unspecified or Unknown Nature

2730

Macroglobulinemia or Heavy Chain Disease

Immune System (14)

 

2790

Immune Deficiency Disorders, Excluding HIV Infection)

4460

Periarteritis Nodosa and Allied Conditions (Systemic Vasculitis)

7100

Diffuse Diseases of Connective Tissue (Including Systemic Lupus Erythematosus, Systemic Sclerosis (Scleroderma), Polymyositis and Dermatomyositis, Undifferentiated and Mixed Connective Tissue Disease, Sjögren’s Syndrome)

0430

Symptomatic Human Immunodeficiency Virus (HIV) Infection

0440

Asymptomatic Human Immunodeficiency Virus (HIV) Infection

2740

Gout

7140

Inflammatory Arthritis

7200

Ankylosing Spondylitis and Other Inflammatory Spondyloarthropathies

Growth Impairment (19)

 

7649

Birth Weight Between 1200 and 2000 Grams and Small for Gestational Age

7650

Birth Weight Under 1200 Grams

7830

Malnutrition, Marasmus, Failure to Thrive

Special/Other (20)

 

0000

None Established

(No Medical Evidence in File)

6490

None Established

(Medical Evidence in File But Insufficient to Establish Diagnosis)

2480

Diagnosis Established--No Predetermined List Code of Medical Nature Applicable

2780

Obesity and Other Hyperalimenation

7290

Fibromyalgia

7590

Other Congenital Anomalies

8690

Internal Injury

8790

Other Open Wounds, Except Limbs

9330

Chronic Fatigue Syndrome (CFS)

4. Symptomatic HIV infection and secondary diagnosis impairment codes

Whenever symptomatic HIV (code 0430) is the primary diagnosis, the secondary diagnosis should be the manifestation of HIV. First, try to select the most appropriate code from the following list as the secondary diagnosis code. Only if the manifestation of HIV is not included in this list, should you select the most appropriate code from the General List of Impairment Codes:

Diagnosis

Impairment Code

Anemia

2850

Aspergillosis

1170

Bacterial infections, multiple or recurrent

0410

Bone infection

7300

Brain atrophy

3310

Candidiasis

1120

Carcinoma of the Cervix

1800

Cardiomyopathy

4250

Coccidioidomycosis

1140

Condyloma caused by the human papillomavirus

0780

Cryptococcosis

1170

Cryptosporidiosis

0070

Cytomegalovirus Disease

0780

Diarrhea

5580

Eczema

6920

Endocarditis

4240

Genital ulcerative disease, female

6290

Genital ulcerative disease, male

6080

Granulocytopenia

2880

Growth disturbance

7830

Hepatitis

5730

Herpes Simplex

0540

Herpes Zoster

0530

Histoplasmosis

1150

HIV encephalopathy

3480

HIV wasting syndrome

2630

Impaired brain growth

7420

Isosporiasis

0070

Joint infection

7110

Kaposi's Sarcoma

1760

Leukoencephalopathy

0460

Lymphoid interstital pneumonia (LIP)

5160

Lymphoma

2000

Meningitis

3220

Microcephaly

7420

Microsporidiosis

1360

Mucormycosis

1170

Mycobacterial infection, avium intracellulare, caused by M. Kansasii,

or M. tuberculosis (except pulmonary tuberculosis)

0310

Nephropathy

5830

Neurological conditions

3490

Neurosyphilis

0940

Nocardiosis

0390

Pancreatitis

5770

Pelvic inflammatory disease

6140

Peripheral neuropathy

3560

Pneumocystis infection, extrapulmonary

1360

Pneumocystis Pneumonia (PCP)

1360

Pneumonia (non-PCP)

4860

Psoriasis

6960

Pulmonary Lymphoid Hyperplasia (PLH)

2850

Pulmonary Tuberculosis

0110

Salmonella Bacteremia

0030

Sepsis

0380

Septic Arthritis

7110

Sinusitis

4730

Squamous Cell Carcinoma of the Anal Canal or Anal Margin

1540

Strongyloidiasis

1270

Syphilis

0970

Thrombocytopenia

2870

Toxoplasmosis

1300

Vulvovaginal Candida

1120

5. Impairment codes in numeric sequence

Use the following list when looking for the diagnosis connected to a particular impairment code.

Impairment Code

Body System

Diagnostic Categories

0000

20

None Established (No Medical Evidence in File)

0030

14

Salmonella Bacteremia (Secondary Diagnosis for HIV-0430)

0070

14

Cryptosporidiosis (Secondary Diagnosis for HIV-0430)

0070

14

Isosporiasis (Secondary Diagnosis for HIV-0430)

0110

03

Pulmonary Tuberculosis

0310

14

Mycobacterium infection avium intracellulare, caused by M. Kansasii, or

M. tuberculosis (except pulmonary tuberculosis) (Secondary Diagnosis for HIV-0430)

0380

14

Sepsis (Secondary Diagnosis for HIV-0430)

0390

14

Nocardiasis (Secondary Diagnosis for HIV-0430)

0410

14

Bacterial Infections, Multiple or Recurrent

(Secondary Diagnosis for HIV-0430)

0420

13

Malignant Neoplasm Treated by Bone Marrow or Stem Cell Transplantation

0430

14

Symptomatic Human Immunodeficiency Virus (HIV) Infection

0440

14

Asymptomatic Human Immunodeficiency Virus (HIV) Infection

0460

14

Leukoencephalopathy (Secondary Diagnosis for HIV-0430)

0530

14

Herpes Zoster (Secondary Diagnosis for HIV-0430)

0540

14

Herpes Simplex (Secondary Diagnosis for HIV-0430)

0780

14

Condyloma Caused by the Human Papillomavirus

(Secondary Diagnosis for HIV-0430)

0780

14

Cytomegalovirus Disease (Secondary Diagnosis for HIV-0430)

0930

04

Cardiovascular Syphilis

0940

11

Neurosyphilis (Tabes Dorsalis)

0940

14

Neurosyphilis (Secondary Diagnosis for HIV-0430)

0970

14

Syphilis (Secondary Diagnosis for HIV-0430)

1120

14

Candidiasis (Secondary Diagnosis for HIV-0430)

1120

14

Vulvovaginal Candida (Secondary Diagnosis for HIV-0430)

1140

14

Coccidiodomycosis (Secondary Diagnosis for HIV-0430)

1150

14

Histoplasmosis (Secondary Diagnosis for HIV-0430)

1170

03

Mycobacterial, Mycotic and Other Chronic Infections of the Lung

1170

08

Chronic Infections of the Skin or Mucous Membranes

1170

14

Aspergillosis (Secondary Diagnosis for HIV-0430)

1170

14

Cryptococcosis (Secondary Diagnosis for HIV-0430)

1170

14

Mucormycosis (Secondary Diagnosis for HIV-0430)

1270

14

Strongyloidiasis (Secondary Diagnosis for HIV-0430)

1300

14

Toxoplasmosis (Secondary Diagnosis for HIV-0430)

1350

03

Sarcoidosis

1360

05

Other Infectious and Parasitic Disorders

1360

14

Micro-Sporidiosis (Secondary Diagnosis for HIV-0430)

1360

14

Pneumocystis Infection, extra-pulmonary

(Secondary Diagnosis for HIV-0430)

1360

14

Pneumocystis Pneumonia (PCP)

(Secondary Diagnosis for HIV-0430)

1380

11

Late Effects of Acute Poliomyelitis

1410

13

Malignant Neoplasm of Tongue

1420

13

Malignant Neoplasm of Salivary Glands

1500

13

Malignant Neoplasm of Esophagus

1510

13

Malignant Neoplasm of Stomach

1520

13

Malignant Neoplasm of Small Intestine, Including Duodenum

1530

13

Malignant Neoplasm of Colon, Rectum or Anus

1540

14

Squamous Cell Carcinoma of the Anal Canal or

Anal Margin (Secondary Diagnosis for HIV-0430)

1550

13

Malignant Neoplasm of Liver and Intrahepatic Bile Ducts

1560

13

Malignant Neoplasm of Gallbladder and Extrahepatic Bile Ducts

1570

13

Malignant Neoplasm of Pancreas

1590

13

Malignant Neoplasm of Other and Ill-Defined Sites Within the Digestive Organs and Peritoneum (Abdomen)

1620

13

Malignant Neoplasm of Trachea, Bronchus, or Lung

1630

13

Malignant Neoplasm of Pleura

1640

13

Malignant Neoplasm of Mediastinum

1700

13

Malignant Neoplasm of Maxilla, Orbit, or Temporal Fossa

1710

13

Malignant Neoplasm of Connective and Other Soft Tissue

1720

13

Malignant Melanoma of Skin

1730

13

Malignant Neoplasm of Skin

1740

13

Malignant Neoplasm of Breast

1760

14

Kaposi’s Sarcoma (Secondary Diagnosis for HIV-0430)

1780

13

Malignant Neoplasm of Skeletal System

1790

13

Malignant Neoplasm of Uterus

1800

14

Carcinoma of the Cervix (Secondary Diagnosis for HIV-0430)

1830

13

Malignant Neoplasm of Ovary and Other Uterine Adnexa

1840

13

Malignant Neoplasm of Vulva or Vagina

1850

13

Malignant Neoplasm of Prostate

1860

13

Malignant Neoplasm of Testis

1870

13

Malignant Neoplasm of Penis

1880

13

Malignant Neoplasm of Bladder

1890

13

Malignant Neoplasm of Kidney, Adrenal Glands, or Ureters

1900

13

Malignant Neoplasm of Eye

1910

13

Malignant Neoplasm of Nervous System

1920

13

Neuroblastoma

1930

13

Malignant Neoplasm of Thyroid Gland

1940

13

Malignant Neoplasm of Other Endocrine Glands and Related Structures

1950

13

Soft Tissue Tumors of Head and Neck

1980

13

Secondary Malignant Neoplasms (Metastatic Neoplasms of Distant Sites Other Than Regional Lymph Nodes)

1990

13

Malignant Neoplasm of Unspecified Site

2000

14

Lymphoma (Secondary Diagnosis for HIV-0430)

2020

13

Lymphoma

2030

13

Multiple Myeloma

2070

13

Leukemia

2250

11

Benign Neoplasm of Brain and Other Parts of Nervous System

2380

07

Neoplasm of Uncertain Behavior of Other Sites and Tissues

(Polycythemia Vera)

2390

13

Neoplasm of Unspecified or Unknown Nature

2460

09

All Disorders of Thyroid Gland (Except Malignant Neoplasm)

2480

20

Diagnosis Established--No Predetermined List Code of Medical Nature Applicable

2500

09

Diabetes Mellitus

2520

09

All Disorders of Parathyroid Gland (Except Malignant Neoplasm)

2530

09

All Disorders of the Pituitary Gland (Except Malignant Neoplasm)

2550

09

All Disorders of Adrenal Glands (Except Malignant Neoplasm)

2630

05

Malnutrition (Weight Loss)

2630

14

HIV Wasting Syndrome (Secondary Diagnosis for HIV-0430)

2720

04

Hyperlipidemia

2730

13

Macroglobulinemia or Heavy Chain Disease

2740

14

Gout

2770

03

Cystic Fibrosis

2780

20

Obesity

2790

07

Immune Deficiency Disorders, Excluding HIV Infection

2790

14

Immune Deficiency Disorders, Excluding HIV Infection)

2810

07

Deficiency Anemias

2810

11

Deficiency Anemias

2820

07

Hereditary Hemolytic Anemias (Including All Sickle Cell)

2840

07

Aplastic Anemia

2850

07

Other Anemias

2850

14

Anemia (Secondary Diagnosis for HIV-0430

2850

14

Pulmonary Lymphoid Hyperplasia (PLH) (Secondary Diagnosis for HIV-0430)

2860

07

Coagulation Defects (Including Hemophilia)

2870

07

Purpura and Other Hemorrhagic Conditions

2870

14

Thrombocytopenia (Secondary Diagnosis for HIV-0430)

2880

07

Diseases of White Blood Cells

2880

14

Granulocytopenia (Secondary Diagnosis for HIV-0430)

2890

07

Other Diseases of Blood and Blood-Forming Organs

2940

12

Organic Mental Disorders

2950

12

Schizophrenic, Paranoid and Other Psychotic Disorders

2960

12

Affective/Mood Disorders

2990

12

Autistic Disorder and Other Pervasive Developmental Disorders

3000

12

Anxiety Disorders

3010

12

Personality Disorders

3030

12

Substance Addiction or Psychoactive Substance Dependence Disorders (Alcohol)

3040

12

Substance Addiction or Psychoactive Substance Dependence Disorders (Drugs)

3060

12

Somatoform Disorders

3070

12

Eating and Tic Disorders

3120

12

Conduct Disorder

3138

12

Oppositional/Defiant Disorder

3140

12

Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder

3150

12

Development and Emotional Disorders of Newborn and Younger Infants

3152

12

Learning Disorder

3153

12

Speech and Language Delays

3180

12

Intellectual Disability

3195*

12

Borderline Intellectual Functioning

*Do not code borderline intellectual functioning as 3180 (under Intellectual Disability).

3210

01

Arachnoiditis

3220

14

Meningitis (Secondary Diagnosis for HIV-0430)

3250

03

Lung Transplant

3300

10

Cerebral Degenerations Usually Manifest in Childhood

3300

11

Cerebral Degenerations Usually Manifest in Childhood

3310

11

Other Cerebral Degenerations

3310

14

Brain Atrophy (Secondary Diagnosis for HIV-0430)

3320

11

Parkinson’s Disease

3330

11

Huntington Disease

3350

11

Anterior Horn Cell Disease

(Including Amyotrophic Lateral Sclerosis)

3360

11

Other Diseases of Spinal Cord

3370

11

Disorders of Autonomic Nervous System

3400

11

Multiple Sclerosis

3430

11

Cerebral Palsy

3450

11

Epilepsy

3460

11

Migraine

3480

14

HIV Encephalopathy (Secondary Diagnosis for HIV-0430)

3490

11

Other Disorders of the Nervous System

 

14

Neurological Conditions (Secondary Diagnosis for HIV-0430)

3540

11

Carpal Tunnel Syndrome

3560

14

Peripheral Neuropathy (Secondary Diagnosis for HIV-0430)

3570

11

Peripheral Neuropathy

3580

11

Myoneural Disorders

3590

11

Muscular Dystrophies and Other Myopathies

3610

02

Retinal Detachments and Defects

3620

02

Other Retinal Disorders (Including Diabetic Retinopathy)

3650

02

Glaucoma

3660

02

Cataract

3680

02

Visual Disturbances

3690

02

Blindness and Low Vision

3694

02

Statutory Blindness

3750

04

Cardiac Transplantation

3780

02

Strabismus and Other Disorders of Eye Movements

3860

02

Vertiginous Syndromes and Other Disorders of Vestibular System

3880

02

Other Disorders of Ear

3890

02

Hearing Loss

3910

04

Rheumatic Fever with Heart Involvement

3950

04

Diseases of Aortic Valve

3980

04

Other Rheumatic Heart Disease

4010

04

Essential Hypertension

4020

04

Hypertensive Cardiovascular Disease

4030

04

Hypertensive Vascular and Renal Disease

4100

04

Acute Myocardial Infarction

4130

04

Angina Pectoris Without Ischemic Heart Disease

4140

04

Chronic Ischemic Heart Disease With or Without Angina

4160

03

Cor Pulmonale Secondary to Chronic Pulmonary Vascular Hypertension

4160

04

Chronic Pulmonary Heart Disease (Cor Pulmonale)

4240

04

Valvular Heart Disease or Other Stenotic Defects or Valvular Regurgitation

4240

14

Endocarditis (Secondary Diagnosis for HIV-0430)

4250

04

Cardiomyopathy

4270

04

Cardiac Dysrhythmias (Arrhythmias)

4280

04

Heart Failure

4380

11

Late Effects of Cerebrovascular Disease

4410

04

Aneurysm of Aorta or Major Branches

4430

04

Peripheral Vascular (Arterial) Disease

4460

04

Kawasaki Syndrome

4460

14

Periarteritis Nodosa and Allied Conditions (Systemic Vasculitis)

4480

07

Diseases of Capillaries (Hereditary Telangiectasia)

4510

04

Phlebitis and Thrombophlebitis

4540

04

Varicose Veins of Lower Extremities

4590

04

Other Diseases of Circulatory System (Venous Insufficiency)

4730

14

Sinusitis (Secondary Diagnosis for HIV-0430)

4750

05

Liver Transplant

4860

14

Pneumonia (non-PCP) (Secondary Diagnosis for HIV-0430)

4910

03

Chronic Bronchitis

4920

03

Emphysema

4930

03

Asthma

4940

03

Bronchiectasis

4960

03

Chronic Pulmonary Insufficiency (COPD)

5010

03

Asbestosis

5050

03

Pneumoconiosis

5160

14

Lymphoid Interstitial Pneumonia (LIP) (Secondary Diagnosis for HIV-0430)

5190

03

Other Disorders of the Respiratory System

5300

05

Diseases of Esophagus

5330

05

Peptic Ulcer (Gastric or Duodenal)

5350

05

Gastritis and Duodenitis

5530

05

Hernias

5550

05

Inflammatory Bowel Disease (IBD)

5580

14

Diarrhea (Secondary Diagnosis for HIV-0430)

5690

05

Other Disorders of Gastrointestinal System

5710

05

Chronic Liver Disease

5730

14

Hepatitis (Secondary Diagnosis for HIV-0430)

5770

14

Pancreatitis (Secondary Diagnosis for HIV-0430)

5780

05

Gastrointestinal hemorrhaging from any cause

5793

05

Short Bowel Syndrome (SBS)

5799

05

Need for supplemental daily enteral feeding via gastrostomy

5810

06

Nephrotic Syndrome

5830

14

Nephropathy (Secondary Diagnosis for HIV-0430)

5850

06

Chronic Renal Failure

5950

06

Interstitial Cystitis

5990

06

Other Disorders of the Urinary Tract

6080

06

Disorders of the Male Genital Organs

6080

14

Genital Ulcerative Disease, Male (Secondary Diagnosis for HIV-0430)

6140

14

Pelvic Inflammatory Disease (Secondary Diagnosis for HIV-0430)

6290

06

Disorders of the Female Genital Organs

6290

14

Genital Ulcerative Disease, Female (Secondary Diagnosis for HIV-0430)

6490

20

None Established

(Medical Evidence in File But Insufficient to Establish Diagnosis)

6920

14

Eczema (Secondary Diagnosis for HIV-0430)

6940

08

Bullous Disease

6950

08

Ichthyosis

6960

08

Dermatitis

6960

14

Psoriasis (Secondary Diagnosis for HIV-0430)

7050

08

Hidradenitis Suppurativa

7090

08

Other Disorders of the Skin and Subcutaneous Tissues

7100

14

Diffuse Diseases of Connective Tissue (including Systemic Lupus Erythematosus, Systemic Sclerosis (Scleroderma), Polymyositis and Dermatomyositis, Undifferentiated and Mixed Connective Tissue Disease, Sjögren's Syndrome)

7110

14

Joint Infection (Secondary Diagnosis for HIV-0430)

7110

14

Septic Arthritis (Secondary Diagnosis for HIV-0430)

7140

14

Inflammatory Arthritis

7150

01

Osteoarthrosis and Allied Disorders

7160

01

Other and Unspecified Arthropathies

7200

14

Ankylosing Spondylitis or Other Spondyloarthropathies

7240

01

Disorders of Back (Discogenic and Degenerative)

7280

01

Disorders of Muscle, Ligament and Fascia

7290

20

Fibromyalgia

7300

01

Osteomyelitis, Periostitis and Other Infections Involving Bone

7300

14

Bone Infection (Secondary Diagnosis for HIV-0430)

7330

01

Other Disorders of Bone and Cartilage (Osteoporosis)

7370

01

Curvature of Spine

7400

10

Anencephalus and Catastrophic Congenital Abnormality or Disease

7410

11

Spina Bifida (Meningomyelocele)

7420

14

Impaired Brain Growth (Secondary Diagnosis for HIV-0430)

7420

14

Microcephaly (Secondary Diagnosis for HIV-0430)

7460

04

Congenital Heart Disease

7500

05

Congenital Anomalies of Upper Alimentary Tract

7530

06

Congenital Anomalies of Urinary System

7580

10

Down Syndrome (Excluding Mosaic Down Syndrome)

7590

08

Genetic Photosensitivity Disorders

7590

20

Other Congenital Anomalies

7649

19

Birth Weight Between 1200 and 2000 Grams and Small For Gestational Age

7650

19

Birth Weight Under 1200 Grams

7800

03

Sleep-Related Breathing Disorders

7830

14

Growth Disturbance (Secondary Diagnosis for HIV-0430)

7830

19

Malnutrition, Marasmus, Failure to Thrive (Growth Impairment)

7840

02

Loss of Voice

7840

11

Loss of Voice

8030

01

Fracture of Skull Without Intracranial Injury

8060

01

Fracture of Vertebral Column with Spinal Cord Lesion

8060

11

Fracture of Vertebral Column with Spinal Cord Lesion

8180

01

Fractures of Upper Limb

8270

01

Fractures of Lower Limb

8290

01

Other Fractures of Bones

8390

01

Dislocations--All Types

8480

01

Sprains and Strains--All Types

8540

11

Intracranial Injury

8690

20

Internal Injury

8790

20

Other Open Wounds, Except Limbs

8840

01

Open Wound of Upper Limb (Soft Tissue Injury)

8940

01

Open Wound of Lower Limb (Soft Tissue Injury)

9050

01

Late Effects of Musculoskeletal and Connective Tissue Injuries (Amputation)

9070

11

Late Effects of Injuries to the Nervous System

9330

20

Chronic Fatigue Syndrome (CFS)

9480

08

Burns

9490

01

Burns (NOS)


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0426510015
DI 26510.015 - Completing Item 16A and 16B (Primary and Secondary Diagnosis, Body System Code and Impairment Code) on the SSA-831 Disability Determination and Transmittal - 01/14/2014
Batch run: 01/14/2014
Rev:01/14/2014