ICD-10 Code Descriptions ICD 9 Codes ICD 10 Codes

SOME FREQUENTLY USED LOUISIANA WIC QUALIFYING MEDICAL CONDITIONS AND ICD-9 & ICD-10 CODES FOR EXEMPT (Special) FORMULAS

The list below includes only a limited number of ICD 9/10 Codes. Please use the web page, or ICD-9-CM International Coding Standard for other ICD-9/10 Codes. A field is now located on the ICD- web page to convert from ICD-9 Codes to ICD-10 Codes.

ICD-10 Code Descriptions

ICD 9 Codes

ICD 10 Codes

WEIGHT RELATED

Failure to Thrive (infant, child) Inadequate Growth (infants < 6 months only) Anorexia Nervosa PREMATURITY

Premature Birth (extremely LBW, unspecified) Low Birth Weight, Unspecified Failure to Thrive Slow Growth and Fetal Malnutrition ALLERGIES

Milk Protein Allergies (Cannot be used as the only qualifying condition for those that do not require an exempt formula. Usually severe and not successfully managed with a Standard Formula) Soy Protein Allergies (Cannot be used as the only qualifying condition for those that do not require an exempt formula. Usually severe and not successfully managed with a Standard Formula) Lactose Intolerance (Cannot be used as the only qualifying condition for those that do not require an exempt formula. Usually severe and not successfully managed with a Standard Formula) Dermatitis Due to Food Taken Internally Allergy, Allergic Reaction, Hypersensitivity

Anaphylactic Shock, Unspecified, Initial Encounter

Rev 08/2021 GP

783.41 783.40 307.1

ICD 9 Codes

765.10 V21.30 783.41 764 - 764.99 (764.1, 764.2, 764.9)

ICD 9 Codes

558.3

R62.51 R62.50 F50.0

ICD 10 Codes

P07.32 P07.00 R62.51 P05.9 (P05.0 ? P05.29, P05.9 ? P05.99)

ICD 10 Codes

Z91.011

NA

None found

271.3

693.1 995.3 995.0

1

E74.39

L27.2 T78.40XA T78.2XXA

SOME FREQUENTLY USED LOUISIANA WIC QUALIFYING MEDICAL CONDITIONS AND ICD-9 & ICD-10 CODES FOR EXEMPT (Special) FORMULAS

The list below includes only a limited number of ICD 9/10 Codes. Please use the web page, or ICD-9-CM International Coding Standard for other ICD-9/10 Codes. A field is now located on the ICD- web page to convert from ICD-9 Codes to ICD-10 Codes.

ICD-9 & ICD-10 Code Descriptions

MALABSORPTION

Pancreatic Steatorrhea Unspecified Intestinal Malabsorption Nausea and Vomiting Vomiting Alone (Cannot be used as the only qualifying condition.)

Celiac Disease Tropical Sprue GASTROINTESTINAL DISORDERS

GERD (Usually severe and not successfully managed with a standard formula) Functional Diarrhea, Inflammatory Irritable Bowel Syndrome Cholecystitis(Unspecified) Biliary Atresia Gastroschesis Gastritis Blood in Stool/Hematochezia Pyloric Stenosis Allergic Dietetic Gastroenteritis, Colitis reaction Enterocolitis Digestive System Disorder of Newborn Eosinophilic Esophagitis

ICD 9 Codes

579.4 579.9 787.07 787.03

579.0 579.1

ICD 9 Codes

530.81

787.91 564.1 575.10 751.61 756.79 535.5 578.1 750.5 558.31 777 NA 530.13

K90.0 K90.0 R11 R11.10

ICD 10 Codes

K90.0 K90.1

ICD 10 Codes

K52.2 , K21.9

R19.7 K58.9 K81.9 Q44.2 Q79.59 , Q79.3 K29.70, K29.90 K92.1 Q 40.0 K52.2 77.9, P77.9 P78, P78.9 K20.0

2 Rev 08/2021 GP

SOME FREQUENTLY USED LOUISIANA WIC QUALIFYING MEDICAL CONDITIONS AND ICD-9 & ICD-10 CODES FOR EXEMPT (Special) FORMULAS

The list below includes only a limited number of ICD 9/10 Codes. Please use the web page, or ICD-9-CM International Coding Standard for other ICD-9/10 Codes. A field is now located on the ICD- web page to convert from ICD-9 Codes to ICD-10 Codes.

ICD-9 & ICD-10 Code Descriptions

METABOLIC DISORDERS

ICD 9 Codes

Cystic Fibrosis Phyenlketonuria(PKU) Galactosemia Endocrine, Nutritional and Metabolic Diseases Disorders of Fatty Acid Oxidation: LCAD, LCHAD, MCAD, VLCAD, SCAD

Congenital, Malformation, Chromosomal Abnormalities

277.0 270.1 271.1 NA 277.85

NA

IMMUNE SYSTEM DISORDERS

ICD 9 Codes

HIV Immunodeficiency Disorders Gluten Enteropathy (Celiac Dz)

042 279.3 569.9

OTHER CONDITIONS

ICD 9 Codes

Pulmonary Atresia Bronchopulmonary Dysplasia Metabolic/Unclassified, Other Specified Congenital Anomalies Pulmonary Hypertension Tuberculosis, Pulmonary Tuberculosis of Lungs Uremia of New Born

747.3 770.7 759.89 416.0 011.9

NA

ICD 10 Codes

E84.8, E84.9, E84.19 E70.0, E70.6 E74.21 E00 - E88 E 71.310-314, 318 Q00 ? Q99

ICD 10 Codes

B20 D84.9 K63.9

ICD 10 Codes

Q25.5 P27.1 Q89.8, Q87.89 I 27.0 A 15.0

P96.0

3 Rev 08/2021 GP

SOME FREQUENTLY USED LOUISIANA WIC QUALIFYING MEDICAL CONDITIONS AND ICD-9 & ICD-10 CODES FOR EXEMPT (Special) FORMULAS

The list below includes only a limited number of ICD 9/10 Codes. Please use the web page, or ICD-9-CM International Coding Standard for other ICD-9/10 Codes. A field is now located on the ICD- web page to convert from ICD-9 Codes to ICD-10 Codes.

ICD-9 & ICD-10 Code Descriptions

OTHER CONDITIONS (Cont'd)

ICD 9 Codes

Acute Renal Failure

Acute Renal Insufficiency Unspecified Renal Disease Chronic Renal Disease Jejunostomy Colostomy Gastrostomy Heart Failure Pulmonary Heart Disease Ischemic Heart Disease Wound Open Other Respiratory Problems of New Born(Apnea, Aspiration, etc) Burn, Body Hirshsprung Disease

584

NA NA NA V44.4 V44.3 V55.1 300- 400s 300- 400s 300- 400s 879.8 770.9 948 751.3

N 17

N28.9 N 19 N 18 Z 93.4 Z 93.3 Z43.1 I 50 I 26 - I 28 I 20 - I 25 531.000A J98.9 T31.0, 32 Q 43.1

ICD 10 Codes

4 Rev 08/2021 GP

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