Category | ICD-10-AM codes | ICD-10-AM description | Additional requirements |
Vaccine-preventable conditions | | | |
Pneumonia and influenza (vaccine-preventable) | J10 | Influenza due to other identified influenza virus | In any diagnosis. Exclude people under 2 months. |
| J11 | Influenza, virus not identified | In any diagnosis. Exclude people under 2 months. |
| J13 | Pneumonia due to Streptococcus pneumoniae | In any diagnosis. Exclude people under 2 months. |
| J14 | Pneumonia due to Haemophilus influenzae | In any diagnosis. Exclude people under 2 months. |
Other vaccine-preventable conditions | A08.0 | Rotaviral enteritis | In any diagnosis. |
| A35 | Other tetanus | In any diagnosis. |
| A36 | Diphtheria | In any diagnosis. |
| A37 | Whooping cough | In any diagnosis. |
| A80 | Acute poliomyelitis | In any diagnosis. |
| B01 | Varicella [chicken pox] | In any diagnosis. |
| B05 | Measles | In any diagnosis. |
| B06 | Rubella [German measles] | In any diagnosis. |
| B16.1 | Acute hepatitis B with delta-agent (coinfection) without hepatic coma | In any diagnosis. |
| B16.9 | Acute hepatitis B without delta-agent and without hepatic coma | In any diagnosis. |
| B18.0 | Chronic viral hepatitis B with delta-agent | In any diagnosis. |
| B18.1 | Chronic viral hepatitis B without delta-agent | In any diagnosis. |
| B26 | Mumps | In any diagnosis. |
| G00.0 | Haemophilus meningitis | In any diagnosis. |
Chronic | | | |
Asthma | J45 | Asthma | As principal diagnosis. Exclude children aged less than 4 years. |
| J46 | Status asthmaticus | As principal diagnosis. Exclude children aged less than 4 years. |
Congestive cardiac failure | I50 | Heart failure | As principal diagnosis. Exclude cases with the following cardiac procedure codes: Blocks [572], [600]–[606], [608]–[650], [653]–[657], [660]–[664], [666], [669]–[682], [684]–[691], [693], [705]–[707], [717] and codes 33172-00[715], 33827-01[733], 34800-00[726], 35412-00[11], 38721-01[733], 90217-02[734], 90215-02[732]. |
| I11.0 | Hypertensive heart disease with (congestive) heart failure | As principal diagnosis. Exclude cases with the following cardiac procedure codes: Blocks [572], [600]–[606], [608]–[650], [653]–[657], [660]–[664], [666], [669]–[682], [684]–[691], [693], [705]–[707], [717 and codes 33172-00[715], 33827-01[733], 34800-00[726], 35412-00[11], 38721-01[733], 90217-02[734], 90215-02[732]. |
| J81 | Pulmonary oedema | As principal diagnosis. Exclude cases with the following cardiac procedure codes: Blocks [572], [600]–[606], [608]–[650], [653]–[657], [660]–[664], [666], [669]–[682], [684]–[691], [693], [705]–[707], [717 and codes 33172-00[715], 33827-01[733], 34800-00[726], 35412-00[11], 38721-01[733], 90217-02[734], 90215-02[732]. |
Diabetes complications | E10.0–E10.9 | Type 1 diabetes mellitus | As principal diagnosis. |
| E11.0–E11.9 | Type 2 diabetes mellitus | As principal diagnosis. |
| E13.0–E13.9 | Other specified diabetes mellitus | As principal diagnosis. |
| E14.0–E14.9 | Unspecified diabetes mellitus | As principal diagnosis. |
COPD | J20 | Acute bronchitis | As principal diagnosis. Only with additional diagnoses of J41, J42, J43, J44. |
| J41 | Simple and mucopurulent chronic bronchitis | As principal diagnosis. |
| J42 | Unspecified chronic bronchitis | As principal diagnosis. |
| J43 | Emphysema | As principal diagnosis. |
| J44 | Other chronic obstructive pulmonary disease | As principal diagnosis. |
Bronchiectasis | J47 | Bronchiectasis | As principal diagnosis. |
| J20 | Acute bronchitis | As principal diagnosis. Only with additional diagnosis of J47. |
Angina | I20 | Angina pectoris | As principal diagnosis. Exclude cases according to the list of procedures excluded from the Congestive cardiac failure category above. |
| I24.0 | Coronary thrombosis not resulting in myocardial infarction | As principal diagnosis. Exclude cases according to the list of procedures excluded from the Congestive cardiac failure category above. |
| I24.8 | Other forms of acute ischaemic heart disease | As principal diagnosis. Exclude cases according to the list of procedures excluded from the Congestive cardiac failure category above. |
| I24.9 | Acute ischaemic heart disease, unspecified | As principal diagnosis. Exclude cases according to the list of procedures excluded from the Congestive cardiac failure category above. |
Iron deficiency anaemia | D50.1 | Sideropenic dysphagia | As principal diagnosis. |
| D50.8 | Other iron deficiency anaemias | As principal diagnosis. |
| D50.9 | Iron deficiency anaemia, unspecified | As principal diagnosis. |
Hypertension | I10 | Essential (primary) hypertension | As principal diagnosis. Exclude cases with procedure codes according to the list of procedures excluded from the Congestive cardiac failure category above. |
| I11.9 | Hypertensive heart disease without (congestive) heart failure | As principal diagnosis. Exclude cases with procedure codes according to the list of procedures excluded from the Congestive cardiac failure category above. |
Nutritional deficiencies | E40 | Kwashiorkor | As principal diagnosis. |
| E41 | Nutritional marasmus | As principal diagnosis. |
| E42 | Marasmic kwashiorkor | As principal diagnosis. |
| E43 | Unspecified severe protein-energy malnutrition | As principal diagnosis. |
| E55.0 | Rickets, active | As principal diagnosis. |
Rheumatic heart diseases | I00 | Rheumatic fever without mention of heart involvement | As principal diagnosis. |
| I01 | Rheumatic fever with heart involvement | As principal diagnosis. |
| I02 | Rheumatic chorea | As principal diagnosis. |
| I05 | Rheumatic mitral valve diseases | As principal diagnosis. |
| I06 | Rheumatic aortic valve diseases | As principal diagnosis. |
| I07 | Rheumatic tricuspid valve diseases | As principal diagnosis. |
| I08 | Multiple valve diseases | As principal diagnosis. |
| I09 | Other rheumatic heart diseases | As principal diagnosis. |
Acute | | | |
Pneumonia (not vaccine-preventable) | J15.3 | Pneumonia due to streptococcus, group B | In any diagnosis. Exclude people under 2 months. |
| J15.4 | Pneumonia due to other streptococci | In any diagnosis. Exclude people under 2 months. |
| J15.7 | Pneumonia due to Mycoplasma pneumoniae | In any diagnosis. Exclude people under 2 months. |
| J16.0 | Chlamydial pneumonia | In any diagnosis. Exclude people under 2 months. |
Urinary tract infections, including pyelonephritis | N10 | Acute tubulo-interstitial nephritis | As principal diagnosis. |
| N11 | Chronic tubulo-interstitial nephritis | As principal diagnosis. |
| N12 | Tubulo-interstitial nephritis, not specified as acute or chronic | As principal diagnosis. |
| N13.6 | Pyonephrosis | As principal diagnosis. |
| N15.1 | Renal and perinephric abscess | As principal diagnosis. |
| N15.9 | Renal tubulo-interstitial disease, unspecified | As principal diagnosis. |
| N28.9 | Disorder of kidney and ureter, unspecified | As principal diagnosis. |
| N39.0 | Urinary tract infection, site not specified | As principal diagnosis. |
| N39.9 | Disorder of urinary system, unspecified | As principal diagnosis. |
Perforated/bleeding ulcer | K25.0 | Gastric ulcer, acute with haemorrhage | As principal diagnosis. |
| K25.1 | Gastric ulcer, acute with perforation | As principal diagnosis. |
| K25.2 | Gastric ulcer, acute with both haemorrhage and perforation | As principal diagnosis. |
| K25.4 | Gastric ulcer, chronic or unspecified with haemorrhage | As principal diagnosis. |
| K25.5 | Gastric ulcer, chronic or unspecified with perforation | As principal diagnosis. |
| K25.6 | Gastric ulcer, chronic or unspecified with both haemorrhage and perforation | As principal diagnosis. |
| K26.0 | Duodenal ulcer, acute with haemorrhage | As principal diagnosis. |
| K26.1 | Duodenal ulcer, acute with perforation | As principal diagnosis. |
| K26.2 | Duodenal ulcer, acute with both haemorrhage and perforation | As principal diagnosis. |
| K26.4 | Duodenal ulcer, chronic or unspecified with haemorrhage | As principal diagnosis. |
| K26.5 | Duodenal ulcer, chronic or unspecified with perforation | As principal diagnosis. |
| K26.6 | Duodenal ulcer, chronic or unspecified with both haemorrhage and perforation | As principal diagnosis. |
| K27.0 | Peptic ulcer, site unspecified, acute with haemorrhage | As principal diagnosis. |
| K27.1 | Peptic ulcer, site unspecified, acute with perforation | As principal diagnosis. |
| K27.2 | Peptic ulcer, site unspecified, acute with both haemorrhage and perforation | As principal diagnosis. |
| K27.4 | Peptic ulcer, site unspecified, chronic or unspecified with haemorrhage | As principal diagnosis. |
| K27.5 | Peptic ulcer, site unspecified, chronic or unspecified with perforation | As principal diagnosis. |
| K27.6 | Peptic ulcer, site unspecified, chronic or unspecified with both haemorrhage and perforation | As principal diagnosis. |
| K28.0 | Gastrojejunal ulcer, acute with haemorrhage | As principal diagnosis. |
| K28.1 | Gastrojejunal ulcer, acute with perforation | As principal diagnosis. |
| K28.2 | Gastrojejunal ulcer, acute with both haemorrhage and perforation | As principal diagnosis. |
| K28.4 | Gastrojejunal ulcer, chronic or unspecified with haemorrhage | As principal diagnosis. |
| K28.5 | Gastrojejunal ulcer, chronic or unspecified with perforation | As principal diagnosis. |
| K28.6 | Gastrojejunal ulcer, chronic or unspecified with both haemorrhage and perforation | As principal diagnosis. |
Cellulitis | L02 | Cutaneous abscess, furuncle and carbuncle | As principal diagnosis, AND if the record has: a) No procedures whatever OR b) All procedures for the record are within the blocks [1820] to [2016] OR c) The record has only one procedure and that procedure is one of 30216-00[1604], 30216-01[1604], 30216-02[1604], 30676-00[1659], 30676-02[1659], 30223-01[1606], 30223-02[1606], 30064-00[1605], 90660-00[1602], 90661-00[1608], 96230-00[1659]. |
| L03 | Cellulitis | As principal diagnosis, AND if the record has: a) No procedures whatever OR b) All procedures for the record are within the blocks [1820] to [2016] OR c) The record has only one procedure and that procedure is one of 30216-00[1604], 30216-01[1604], 30216-02[1604], 30676-00[1659], 30676-02[1659], 30223-01[1606], 30223-02[1606], 30064-00[1605], 90660-00[1602], 90661-00[1608], 96230-00[1659] |
| L04 | Acute lymphadenitis | As principal diagnosis, AND if the record has: a) No procedures whatever OR b) All procedures for the record are within the blocks [1820] to [2016] OR c) The record has only one procedure and that procedure is one of 30216-00[1604], 30216-01[1604], 30216-02[1604], 30676-00[1659], 30676-02[1659], 30223-01[1606], 30223-02[1606], 30064-00[1605], 90660-00[1602], 90661-00[1608], 96230-00[1659] |
| L08 | Other local infections of skin and subcutaneous tissue | As principal diagnosis, AND if the record has: a) No procedures whatever OR b) All procedures for the record are within the blocks [1820] to [2016] OR c) The record has only one procedure and that procedure is one of 30216-00[1604], 30216-01[1604], 30216-02[1604], 30676-00[1659], 30676-02[1659], 30223-01[1606], 30223-02[1606], 30064-00[1605], 90660-00[1602], 90661-00[1608], 96230-00[1659] . |
| L88 | Pyoderma gangrenosum | As principal diagnosis, AND if the record has: a) No procedures whatever OR b) All procedures for the record are within the blocks [1820] to [2016] OR c) The record has only one procedure and that procedure is one of 30216-00[1604], 30216-01[1604], 30216-02[1604], 30676-00[1659], 30676-02[1659], 30223-01[1606], 30223-02[1606], 30064-00[1605], 90660-00[1602], 90661-00[1608], 96230-00[1659] |
| L98.0 | Pyogenic granuloma | As principal diagnosis, AND if the record has: a) No procedures whatever OR b) All procedures for the record are within the blocks [1820] to [2016] OR c) The record has only one procedure and that procedure is one of 30216-00[1604], 30216-01[1604], 30216-02[1604], 30676-00[1659], 30676-02[1659], 30223-01[1606], 30223-02[1606], 30064-00[1605], 90660-00[1602], 90661-00[1608], 96230-00[1659] |
| L98.3 | Eosinophilic cellulitis [Wells] | As principal diagnosis, AND if the record has: a) No procedures whatever OR b) All procedures for the record are within the blocks [1820] to [2016] OR c) The record has only one procedure and that procedure is one of 30216-00[1604], 30216-01[1604], 30216-02[1604], 30676-00[1659], 30676-02[1659], 30223-01[1606], 30223-02[1606], 30064-00[1605], 90660-00[1602], 90661-00[1608], 96230-00[1659] |
Pelvic inflammatory disease | N70 | Salpingitis and oophoritis | As principal diagnosis. |
| N73 | Other female pelvic inflammatory diseases | As principal diagnosis. |
| N74 | Female pelvic inflammatory disorders in diseases classified elsewhere | As principal diagnosis. |
Ear, nose and throat infections | H66 | Suppurative and unspecified otitis media | As principal diagnosis. |
| J02 | Acute pharyngitis | As principal diagnosis. |
| J03 | Acute tonsillitis | As principal diagnosis. |
| J06 | Acute upper respiratory infections of multiple and unspecified sites | As principal diagnosis. |
| J31.2 | Chronic pharyngitis | As principal diagnosis. |
Dental conditions | K02 | Dental caries | As principal diagnosis. |
| K03 | Other diseases of hard tissues of teeth | As principal diagnosis. |
| K04 | Diseases of pulp and periapical tissues | As principal diagnosis. |
| K05 | Gingivitis and periodontal diseases | As principal diagnosis. |
| K06 | Other disorders of gingiva and edentulous alveolar ridge | As principal diagnosis. |
| K08 | Other disorders of teeth and supporting structures | As principal diagnosis. |
| K09.8 | Other cysts of oral region, not elsewhere classified | As principal diagnosis. |
| K09.9 | Cyst of oral region, unspecified | As principal diagnosis. |
| K12 | Stomatitis and related lesions | As principal diagnosis. |
| K13 | Other diseases of lip and oral mucosa | As principal diagnosis. |
| K14.0 | Glossitis | As principal diagnosis. |
Convulsions and epilepsy | G40 | Epilepsy | As principal diagnosis. |
| G41 | Status epilepticus | As principal diagnosis. |
| R56 | Convulsions, not elsewhere classified | As principal diagnosis. |
Eclampsia | O15 | Eclampsia | As principal diagnosis. |
Gangrene | R02 | Gangrene, not elsewhere classified | In any diagnosis. |
| I70.24 | Atherosclerosis of arteries of extremities with gangrene | As principal diagnosis. |
| E09.52 | Intermediate hyperglycaemia with peripheral angiopathy, with gangrene | As principal diagnosis. |