Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter III - Allowances for Services
Section 144-101-III-45 - HOSPITAL SERVICES
Appendix 144-101-III-45-B - NON-EMERGENT USE OF THE EMERGENCY DEPARTMENT
The following shall apply to non-emergent use of the emergency department (see Sec. 45.03-1(D)(1)(c) and 45.03-1(D)(2)(b))
ICD-10 codes will be used to identify non-emergent use of the emergency department for services delivered beginning October 1, 2015.
|
ICD-10 Code |
ICD-10 Code Description |
|
J02.0 |
Streptococcal pharyngitis |
|
J03.00 |
Acute streptococcal tonsillitis, unspecified |
|
J03.01 |
Acute recurrent streptococcal tonsillitis |
|
B97.10 |
Unspecified enterovirus as the cause of diseases classified elsewhere |
|
B97.89 |
Other viral agents as the cause of diseases classified elsewhere |
|
F41.9 |
Anxiety disorder, unspecified |
|
F41.1 |
Generalized anxiety disorder |
|
H10.30 |
Unspecified acute conjunctivitis, unspecified eye |
|
H10.31 |
Unspecified acute conjunctivitis, right eye |
|
H10.32 |
Unspecified acute conjunctivitis, left eye |
|
H10.33 |
Unspecified acute conjunctivitis, bilateral |
|
H10.9 |
Unspecified conjunctivitis |
|
H60.00 |
Abscess of external ear, unspecified ear |
|
H60.01 |
Abscess of right external ear |
|
H60.02 |
Abscess of left external ear |
|
H60.03 |
Abscess of external ear, bilateral |
|
H60.10 |
Cellulitis of external ear, unspecified ear |
|
H60.11 |
Cellulitis of right external ear |
|
H60.12 |
Cellulitis of left external ear |
|
H60.13 |
Cellulitis of external ear, bilateral |
|
H60.311 |
Diffuse otitis externa, right ear |
|
H60.312 |
Diffuse otitis externa, left ear |
|
H60.313 |
Diffuse otitis externa, bilateral |
|
H60.319 |
Diffuse otitis externa, unspecified ear |
|
H60.321 |
Hemorrhagic otitis externa, right ear |
|
H60.322 |
Hemorrhagic otitis externa, left ear |
|
H60.323 |
Hemorrhagic otitis externa, bilateral |
|
H60.329 |
Hemorrhagic otitis externa, unspecified ear |
|
H60.391 |
Other infective otitis externa, right ear |
|
H60.392 |
Other infective otitis externa, left ear |
|
H60.393 |
Other infective otitis externa, bilateral |
|
H60.399 |
Other infective otitis externa, unspecified ear |
|
H65.00 |
Acute serous otitis media, unspecified ear |
|
H65.01 |
Acute serous otitis media, right ear |
|
H65.02 |
Acute serous otitis media, left ear |
|
H65.03 |
Acute serous otitis media, bilateral |
|
H65.04 |
Acute serous otitis media recurrent, right ear |
|
H65.05 |
Acute serous otitis media recurrent, left ear |
|
H65.06 |
Acute serous otitis media, recurrent, bilateral |
|
H65.07 |
Acute serous otitis media, recurrent, unspecified ear |
|
H65.90 |
Unspecified nonsuppurative otitis media, unspecified ear |
|
H65.91 |
Unspecified nonsuppurative otitis media, right ear |
|
H65.92 |
Unspecified nonsuppurative otitis media, left ear |
|
H65.93 |
Unspecified nonsuppurative otitis media, bilateral |
|
H66.001 |
Acute suppurative otitis media without spontaneous rupture of the ear drum, right ear |
|
H66.002 |
Acute suppurative otitis media without spontaneous rupture of the ear drum, left ear |
|
H66.003 |
Acute suppurative otitis media without spontaneous rupture of the ear drum, bilateral |
|
H66.004 |
Acute suppurative otitis media without spontaneous rupture of the ear drum, recurrent, right ear |
|
H66.005 |
Acute suppurative otitis media without spontaneous rupture of the ear drum, recurrent, left ear |
|
H66.006 |
Acute suppurative otitis media without spontaneous rupture of the ear drum, recurrent, bilateral |
|
H66.007 |
Acute suppurative otitis media without spontaneous rupture of the ear drum, recurrent, unspecified ear |
|
H66.009 |
Acute suppurative otitis media without spontaneous rupture of the ear drum, unspecified ear |
|
H66.90 |
Otitis media, unspecified, unspecified ear |
|
H66.91 |
Otitis media, unspecified. right ear |
|
H66.92 |
Otitis media, unspecified, left ear |
|
H66.93 |
Otitis media, unspecified, bilateral |
|
J01.90 |
Acute sinusitis, unspecified |
|
J01.91 |
Acute recurrent sinusitis, unspecified |
|
J02.8 |
Acute pharyngitis due to other specified organisms |
|
J02.9 |
Acute pharyngitis, unspecified |
|
J06.9 |
Acute upper respiratory infection, unspecified |
|
J20.0 |
Acute bronchitis due to Mycoplasma pneumoniae |
|
J20.1 |
Acute bronchitis due to Hemophilus influenzae |
|
J20.2 |
Acute bronchitis due to streptococcus |
|
J20.3 |
Acute bronchitis due to coxsackievirus |
|
J20.4 |
Acute bronchitis due to parainfluenza virus |
|
J20.5 |
Acute bronchitis due to respiratory syncytial virus |
|
J20.6 |
Acute bronchitis due to rhinovirus |
|
J20.7 |
Acute bronchitis due to echovirus |
|
J20.8 |
Acute bronchitis due to other specified organisms |
|
J20.9 |
Acute bronchitis, unspecified |
|
J32.9 |
Chronic sinusitis, unspecified |
|
J40 |
Bronchitis, not specified as acute or chronic |
|
J45.20 |
Mild intermittent asthma, uncomplicated |
|
J45.30 |
Mild persistent asthma, uncomplicated |
|
J45.40 |
Moderate persistent asthma, uncomplicated |
|
J45.50 |
Severe persistent asthma, uncomplicated |
|
J45.21 |
Mild intermittent asthma w/ (acute) exacerbation |
|
J45.31 |
Mild persistent asthma w/ (acute) exacerbation |
|
J45.41 |
Moderate persist asthma w/ (acute) exacerbation |
|
J45.51 |
Severe persist asthma w/ (acute) exacerbation |
|
J45.20 |
Mild intermittent asthma, uncomplicated |
|
J45.30 |
Mild persistent asthma, uncomplicated |
|
J45.40 |
Moderate persistent asthma, uncomplicated |
|
J45.50 |
Severe persistent asthma, uncomplicated |
|
J45.21 |
Mild intermittent asthma w/ (acute) exacerbation |
|
J45.31 |
Mild persistent asthma w/ (acute) exacerbations |
|
J45.41 |
Moderate persist asthma w/ (acute) exacerbation |
|
J45.51 |
Severe persist asthma w/ (acute) exacerbation |
|
J44.9 |
Chronic obstructive pulmonary disease, unspecified |
|
J44.1 |
Chronic obstructive pulmonary disease w/ (acute) exacerbation |
|
J45.990 |
Exercise induced bronchospasm |
|
J45.991 |
Cough variant asthma |
|
J45.909 |
Unspecified asthma, uncomplicated |
|
J45.998 |
Other asthma |
|
J45.901 |
Unspecified asthma with (acute) exacerbation |
|
L22 |
Diaper dermatitis |
|
L20.0 |
Besnier's prurigo |
|
L20.81 |
Atopic neurodermatitis |
|
L20.82 |
Flexural eczema |
|
L20.84 |
Intrinsic (allergic) eczema |
|
L20.89 |
Other atopic dermatitis |
|
L20.9 |
Atopic dermatitis, unspecified |
|
L23.7 |
Allergic contact dermatitis due to plants, except food |
|
L24.7 |
Irritant contact dermatitis due to plants, except food |
|
L25.5 |
Unspecified contact dermatitis due to plants, except food |
|
L23.9 |
Allergic contact dermatitis, unspecified cause |
|
L24.9 |
Irritant contact dermatitis, unspecified cause |
|
L25.9 |
Unspecified contact dermatitis, unspecified cause |
|
L30.0 |
Nummular dermatitis |
|
L30.2 |
Cutaneous autosensitization |
|
L30.8 |
Other specified dermatitis |
|
L30.9 |
Dermatitis, unspecified |
|
M25.512 |
Pain in left shoulder |
|
M25.519 |
Pain in unspecified shoulder |
|
M25.521 |
Pain in right elbow |
|
M25.522 |
Pain in left elbow |
|
M25.529 |
Pain in unspecified elbow |
|
M25.531 |
Pain in right wrist |
|
M25.532 |
Pain in left wrist |
|
M25.539 |
Pain in unspecified wrist |
|
M79.643 |
Pain in unspecified hand |
|
M79.646 |
Pain in unspecified finger(s) |
|
M25.551 |
Pain in right hip |
|
M25.552 |
Pain in left hip |
|
M25.559 |
Pain in unspecified hip |
|
M25.561 |
Pain in right knee |
|
M25.562 |
Pain in left knee |
|
M25.569 |
Pain in unspecified knee |
|
M25.571 |
Pain in right ankle and joints of right foot |
|
M25.572 |
Pain in left ankle and joints of left foot |
|
M25.579 |
Pain in unspecified ankle and joints of unspecified foot |
|
M54.5 |
Low back pain |
|
M54.89 |
Other dorsalgia |
|
M54.9 |
Dorsalgia, unspecified |
|
M60.80 |
Other myositis, unspecified site |
|
M60.811 |
Other myositis, right shoulder |
|
M60.812 |
Other myositis, left shoulder |
|
M60.819 |
Other myositis, unspecified shoulder |
|
M60.821 |
Other myositis, right upper arm |
|
M60.822 |
Other myositis, left upper arm |
|
M60.829 |
Other myositis, unspecified upper arm |
|
M60.831 |
Other myositis, right forearm |
|
M60.832 |
Other myositis, left forearm |
|
M60.839 |
Other myositis, unspecified forearm |
|
M60.841 |
Other myositis, right hand |
|
M60.842 |
Other myositis, left hand |
|
M60.849 |
Other myositis, unspecified hand |
|
M60.851 |
Other myositis, right thigh |
|
M60.852 |
Other myositis, left thigh |
|
M60.859 |
Other myositis, unspecified thigh |
|
M60.861 |
Other myositis, right lower leg |
|
M60.862 |
Other myositis, left lower leg |
|
M60.869 |
Other myositis, unspecified lower leg |
|
M60.871 |
Other myositis, right ankle and foot |
|
M60.872 |
Other myositis, left ankle and foot |
|
M60.879 |
Other myositis, unspecified ankle and foot |
|
M60.88 |
Other myositis, other site |
|
M60.89 |
Other myositis, multiple sites |
|
M60.9 |
Myositis, unspecified |
|
M79.1 |
Myalgia |
|
M79.7 |
Fibromyalgia |
|
M79.601 |
Pain in right arm |
|
M79.602 |
Pain in left arm |
|
M79.603 |
Pain in arm, unspecified |
|
M79.604 |
Pain in right leg |
|
M79.605 |
Pain in left leg |
|
M79.606 |
Pain in leg, unspecified |
|
M79.609 |
Pain in unspecified limb |
|
M79.621 |
Pain in right upper arm |
|
M79.622 |
Pain in left upper arm |
|
M79.629 |
Pain in unspecified upper arm |
|
M79.631 |
Pain in right forearm |
|
M79.632 |
Pain in left forearm |
|
M79.639 |
Pain in unspecified forearm |
|
M79.641 |
Pain in right hand |
|
M79.642 |
Pain in left hand |
|
M79.643 |
Pain in unspecified hand |
|
M79.644 |
Pain in right finger(s) |
|
M79.645 |
Pain in left finger(s) |
|
M79.646 |
Pain in unspecified finger(s) |
|
M79.651 |
Pain in right thigh |
|
M79.652 |
Pain in left thigh |
|
M79.659 |
Pain in unspecified thigh |
|
M79.661 |
Pain in right lower leg |
|
M79.662 |
Pain in left lower leg |
|
M79.669 |
Pain in unspecified lower leg |
|
M79.671 |
Pain in right foot |
|
M79.672 |
Pain in left foot |
|
M79.673 |
Pain in unspecified foot |
|
M79.674 |
Pain in right toe(s) |
|
M79.675 |
Pain in left toe(s) |
|
M79.676 |
Pain in unspecified toe(s) |
|
G93.3 |
Postviral fatigue syndrome |
|
R53.0 |
Neoplastic (malignant) related fatigue |
|
R53.1 |
Weakness |
|
R53.81 |
Other malaise |
|
R58.83 |
Other fatigue |
|
R21 |
Rash and other nonspecific skin eruption |
|
G44.1 |
Vascular headache, not elsewhere classified |
|
R51 |
Headache |
|
R05 |
Cough |
