ICD-10 Special Bulletin, No. 12 October 2017 GENERAL INFORMATION

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ICD-10 Special Bulletin ICD-10 Special Bulletin, No. 12 October 2017 2018 ICD Implementation GENERAL INFORMATION On October 1, 2017, the Texas Medicaid & Healthcare Partnership (TMHP) applied the 2018 annual International Classification of Diseases (ICD) updates that are effective for dates of service on or after October 1, 2017. The annual ICD updates include the following: ICD-10 Clinical Modification (ICD-10-CM) ICD-10 Procedure Coding System (ICD-10-PCS) This combined Special Bulletin includes the ICD updates for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program. This bulletin is intended to notify providers of program and coding changes related to the 2018 updates for ICD and Current Procedural Terminology (CPT ). All providers are encouraged to review the General Information section of this bulletin. Policy updates for a specific program or provider type are discussed in designated sections of the bulletin. Claims Filing The new 2018 ICD diagnosis codes and inpatient hospital surgical procedure codes may be billed beginning October 1, 2017. Important: To avoid fraudulent billing, providers must submit the ICD codes that are most appropriate for the services provided. The ICD-10-PCS procedure codes are inpatient hospital surgical procedure codes and must be submitted, as applicable, only on inpatient hospital claims. Note: For professional and outpatient procedures and services, providers must continue to use the American Medical Association (AMA) Current Procedural Terminology (CPT) Manual and the CMS Health Care Common Procedure Coding System (HCPCS) Manual.

IN THIS ISSUE General Information 1 2018 ICD Implementation... 1 Claims Filing... 1 Medicaid Fee-for-Service and Managed Care Providers 4 Texas Medicaid ICD Updates... 4 Texas Medicaid Benefit Changes... 4 Ambulance Services... 4 Cardiac Rehabilitation... 5 Colony Stimulating Factors... 5 Cytogenetics... 5 Diagnostic Doppler Sonography... 6 Echoencephalography... 7 Evoked Response Tests and Neuromuscular Procedures... 7 Inpatient and Outpatient Behavioral Health... 7 Mental Health Rehabilitative Services... 8 Mental Health Targeted Case Management... 8 Physician Evaluation and Management Services... 8 Pulmonary Function Studies... 9 Substance Use Disorder Services... 9 Vision Services Nonsurgical... 9 Vitamin B12 (Cyanocobalamin) Injections... 10 Home Health and Comprehensive Care Program (CCP) Providers 10 Home Health Services Benefit Changes... 10 Diabetic Equipment and Supplies Home Health... 10 CCP Services Benefit Changes...11 Blood Pressure Devices CCP...11 Nutritional Products - CCP...11

General Information Children With Special Health Care Needs (CSHCN) Services Program Providers 12 CSHCN Services Program Updates... 12 CSHCN Services Program Benefit Changes... 12 Ambulance Services... 12 Ambulatory Blood Pressure Monitoring and Devices... 13 Cytogenetics... 13 Diabetic Equipment and Supplies... 14 Echoencephalography... 14 Evoked Response and Neuromuscular Procedures... 14 Expendable Medical Supplies... 15 Neurostimulators and Neuromuscular Stimulators... 15 Therapeutic Apheresis... 15 Vision Services Nonsurgical... 16 All Code Changes: Added, Revised, and Discontinued 16 2018 ICD Diagnosis Code Additions... 16 Discontinued Diagnosis Codes... 18 Diagnosis Code Description Changes... 18 Inpatient Hospital ICD-10-PCS and DRG 20 Inpatient Hospital ICD-10-PCS Surgical Procedure Code and Diagnosis Related Group (DRG) Updates... 20 Use of the AMA s copyrighted CPT is allowed in this publication with the following disclosure: Current Procedural Terminology (CPT) is copyright 2016 American Medical Association. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable Federal Acquisition Regula tion System/ Defense Federal Acquisition Regulation Supplement (FARS/DFARS) apply. The American Dental Association requires the following copyright notice in all publications containing Current Dental Terminology (CDT) codes: Current Dental Terminology (including procedure codes, nomenclature, descriptors, and other data contained therein) is copyright 2016 American Dental Association. All rights reserved. Applicable FARS/ DFARS apply. ICD-10 Special Bulletin, No. 12 3 2017 Texas Medicaid

Medicaid Fee-For-Service and Managed Care Providers MEDICAID FEE-FOR-SERVICE AND MANAGED CARE PROVIDERS Texas Medicaid ICD Updates The 2018 Internaltional Classification of Diseases (ICD) updates for Texas Medicaid are included in the ICD tables in the All Code Changes: Added, Revised, and Discontinued section of this bulletin beginning on page All Code Changes: Added, Revised, and Discontinued on page 16. The 2018 ICD deletions and replacements are effective October 1, 2017, for dates of service on or after October 1, 2017, for Texas Medicaid. Providers may refer to the General Information section for more information. Texas Medicaid Benefit Changes The following Texas Medicaid benefit changes have been made to support the 2018 ICD-CM diagnosis code updates and are effective for dates of service on or after October 1, 2017. For more information, call the Texas Medicaid & Healthcare Partnership (TMHP) Contact Center at 1-800-925-9126. Note: These changes apply to Texas Medicaid fee-for-service and Medicaid managed care claims and authorization requests that are submitted to TMHP for processing. The policy articles in this bulletin contain the following information: Revised: The description has been revised for these diagnosis codes. Providers may refer to the appropriate copyright holder for the revised descriptions. Discontinued: Discontinued diagnosis codes are no longer reimbursed after September 30, 2017. Added: Added diagnosis codes are new diagnosis codes added by the Centers for Medicare & Medicaid Services (CMS). Ambulance Services The following emergency medical condition codes must be used to identify emergency medical conditions for ambulance transports: R0603 T07XXXA T148XXA T1490XA T1491XA Discontinued Diagnosis Codes T07 T148 An emergency ambulance transport may be reimbursed by Texas Medicaid when it is submitted with modifier ET and one or more emergency medical condition codes. The requesting facility or physician must include with the claim documentation that describes the clients condition which necessitated the ambulance transport. Medicaid recognizes limitations of usual ambulance personnel for establishing a diagnosis, and recognizes coding of a client s condition using International Classification of Diseases, ICD-10 Special Bulletin, No. 12 4 2017 Texas Medicaid

Medicaid Fee-For-Service and Managed Care Providers 10th Revision, Clinical Modification (ICD-10-CM) when reporting ambulance transport services may be less specific than for services reported by other professional providers. Providers who submit ICD-10-CM diagnosis codes should choose the code that best describes the client s condition at the time of transport. Diagnoses that are rule out or suspected diagnoses should not be reported using specific ICD-10-CM diagnosis codes. In such instances where a diagnosis is not confirmed, it is more correct to use a symptom, finding, or injury diagnosis code. Refer to: The current Texas Medicaid Provider Procedures Manual, Ambulance Services Handbook, section 2.2.1 Emergency Ambulance Transport Services, for more information. Cardiac Rehabilitation I219 I21A1 I21A9 I2720 I2721 I2722 I2723 I2724 I2729 I2783 I50810 I50811 I50812 I50813 I50814 I5082 I5083 I5084 I5089 Refer to: The current Texas Medicaid Provider Procedures Manual, Inpatient and Outpatient Hospital Services Handbook, section 4.2.6 Cardiac Rehabilitation, for more information. Colony Stimulating Factors The following diagnosis codes may be reimbursed when submitted with procedure codes J1442, J1447, J2505, J2820, and Q5101: C9620 C9621 C9622 C9629 D4701 D4702 D4709 Discontinued Diagnosis Code C962 Refer to: The current Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, section 9.2.38.38 Colony Stimulating Factors (Filgrastim, Pegfilgrastim, and Sargramostim), for more information. Cytogenetics The following diagnosis codes may be reimbursed when submitted with procedure codes 88230, 88233, 88235, 88237, 88239, 88245, 88248, 88249, 88261, 88262, 88263, 88264, 88271, 88272, 88273, 88274, 88275, 88280, 88283, 88285, 88289, and 88291: P2930 P2938 Q53111 Q53112 Q5313 Q53211 Q53212 ICD-10 Special Bulletin, No. 12 5 2017 Texas Medicaid

Medicaid Fee-For-Service and Managed Care Providers Q5323 Z360 Z361 Z362 Z363 Z364 Z365 Z3681 Z3682 Z3683 Z3684 Z3688 Z3689 Z368A Z369 Discontinued Diagnosis Codes P293 Q5311 Q5321 Z36 Refer to: The current Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, section 9.2.39.6 Cytogenetics Testing, for more information. Diagnostic Doppler Sonography The following diagnosis codes may be reimbursed when submitted with Peripheral Arterial Doppler Studies lower extremity condition procedure codes 93922, 93923, 93924, 93925, and 93926: Section 3: Additional diagnosis codes for lower extremity conditions (Procedure codes 93922, 93923, 93924, 93925, and 93926) L97115 L97116 L97118 L97125 L97126 L97128 L97215 L97216 L97218 L97225 L97226 L97228 L97315 L97316 L97318 L97325 L97326 L97328 L97415 L97416 L97418 L97425 L97426 L97428 L97515 L97516 L97518 L97525 L97526 L97528 L97815 L97816 L97818 L97825 L97826 L97828 L98415 L98416 K98418 L98425 L98426 L98428 The following diagnosis codes may be reimbursed when submitted with Peripheral Venous Doppler Studies procedure codes 93970 and 93971: L97115 L97116 L97118 L97125 L97126 L97128 L97215 L97216 L97218 L97225 L97226 L97228 L97315 L97316 L97318 L97325 L97326 L97328 L97415 L97416 L97418 L97425 L97426 L97428 L97515 L97516 L97518 L97525 L97526 L97528 L97815 L97816 L97818 L97825 L97826 L97828 L98415 L98416 K98418 L98425 L98426 L98428 R0603 Refer to: The current Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, section 9.2.26 Diagnostic Doppler Sonography, for more information. ICD-10 Special Bulletin, No. 12 6 2017 Texas Medicaid

Medicaid Fee-For-Service and Managed Care Providers Echoencephalography The following diagnosis codes may be reimbursed when submitted with procedure code 76506: P91811 P91819 P9188 Discontinued Diagnosis Codes S061X7D S061X7S S061X8D S061X8S S06307D S06307S S06308D S06308S S06317D S06317S S06318D S06318S S06327D S06327S S06328D S06328S S06337D S06337S S06338D S06338S S06347D S06347S S06348D S06348S S06357D S06357S S06358D S06358S S06367D S06367S S06368D S06368S S06377D S06377S S06378D S06378S S06387D S06387S S06388D S06388S S064X7D S064X7S S064X8D S064X8S S065X7D S065X7S S065X8D S065X8S S066X7D S066X7S S066X8D S066X8S S06897D S06897S S06898D S06898S S069X7D S069X7S S069X8D S069X8S Refer to: The current Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, section 9.2.25.5 Echoencephalography, for more information. Evoked Response Tests and Neuromuscular Procedures The following diagnosis codes may be reimbursed when submitted with electromyography (EMG) and nerve conduction study (NCS) procedure codes: E8581 E8582 E8589 G1223 G1224 G1225 M48062 Discontinued Diagnosis Codes E858 M4806 Refer to: The current Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, section 9.2.27.2 Electromyography and Nerve Conduction Studies, for more information. Inpatient and Outpatient Behavioral Health The following diagnosis codes may be reimbursed for psychotherapy and psychiatric diagnostic evaluation procedure codes 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90846, 90847, and 90853: F1011 F1111 F1211 F1311 F1411 F1511 F1611 F1811 F1911 F5082 ICD-10 Special Bulletin, No. 12 7 2017 Texas Medicaid

Medicaid Fee-For-Service and Managed Care Providers The following diagnosis codes may be reimbursed for psychological, neurological, and neuropsychological testing procedure codes 96101, 96116, and 96118: F1011 F1111 F1211 F1311 F1411 F1511 F1611 F1811 F1911 F5082 Discontinued Diagnosis Codes S065X7D S065X7S S065X8D S065X8S S06897D S06897S Refer to: The current Texas Medicaid Provider Procedures Manual, Behavioral Health and Case Management Services Handbook, section 4.1.12 Services, Benefits, and Limitations, for more information. Mental Health Rehabilitative Services The following diagnosis code may be reimbursed when submitted with mental health rehabilitative services procedure codes H0034, H2012, H2014, and H2017: Added Diagnosis Code F5082 Refer to: The current Texas Medicaid Provider Procedures Manual, Behavioral Health and Case Management Services Handbook, section 5.2.3 Mental Health Rehabilitative Services, for more information. Mental Health Targeted Case Management The following diagnosis code may be reimbursed when submitted with mental health targeted case management procedure code T1017: Added Diagnosis Code F5082 Refer to: The current Texas Medicaid Provider Procedures Manual, Behavioral Health and Case Management Services Handbook, section 5.2.2 Mental Health Targeted Case Management (MHTCM), for more information. Physician Evaluation and Management Services The following diagnosis code may be reimbursed when submitted with procedure code 99078: Added Diagnosis Code E1110 Refer to: The current Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, section 9.2.56 Physician Evaluation and Management (E/M) Services, for more information. ICD-10 Special Bulletin, No. 12 8 2017 Texas Medicaid

Medicaid Fee-For-Service and Managed Care Providers Pulmonary Function Studies The following diagnosis codes may be reimbursed for High Altitude Simulation Test (HAST) procedure codes 94452 and 94453: I2720 I2721 I2722 I2723 I2724 I2729 I2783 Discontinued Diagnosis Code I272 Evidence of hypoxemia must be documented in the client s medical record when billing HAST procedure codes 94452 and 94453 with one of the following diagnosis codes: I2720 I2721 I2722 I2724 I2729 I2783 Discontinued Diagnosis Code I272 Refer to: The current Texas Medicaid Provider Procedures Manual, Inpatient and Outpatient Hospital Handbook, section 4.2.20.4 Pulmonary Function Studies, for more information. Substance Use Disorder Services The following diagnosis codes may be reimbursed when submitted with ambulatory (outpatient) treatment services procedure codes H0004 and H0005: F1011 F1111 F1211 F1311 F1411 F1511 F1611 F1811 F1911 Refer to: The current Texas Medicaid Provider Procedures Manual, Behavioral Health and Case Management Services Handbook, section 8, Substance Use Disorder (SUD) Services (Abuse and Dependence), for more information. Vision Services Nonsurgical The following diagnosis codes may be reimbursed when submitted with polycarbonate lens procedure code V2784: H540X33 H540X34 H540X35 H540X43 H540X44 H540X45 H540X53 H540X54 H541131 H541132 H541141 H541142 H541151 H541152 H541213 H541214 H541215 H541223 H541224 H541225 H542X12 H542X21 H542X22 H54413A H54414A H5442A3 H5442A4 H54512A H5452A2 ICD-10 Special Bulletin, No. 12 9 2017 Texas Medicaid

Home Health and Comprehensive Care Program (CCP) Providers Discontinued Diagnosis Codes H5441 H5442 H5451 H5452 Refer to: The current Texas Medicaid Provider Procedures Manual, Vision and Hearing Services Handbook, section 4.3.6.1 Eyeglass Lens and Frames, for more information. Vitamin B12 (Cyanocobalamin) Injections The following diagnosis code will no longer be covered for Vitamin B12 (Cyanocobalamin) Injections procedure code J3420: Discontinued Diagnosis Code K5660 Refer to: The current Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, section 9.2.38.35 Vitamin B12 (Cyanocobalamin) Injections, for more information. HOME HEALTH AND COMPREHENSIVE CARE PROGRAM (CCP) PROVIDERS Home Health Services Benefit Changes The following Texas Medicaid Home Health Services benefit changes have been made to support the 2018 International Classification of Diseases (ICD) updates and are effective for dates of service on or after October 1, 2017. For more information, call the Texas Medicaid & Healthcare Partnership (TMHP) Contact Center at 1-800-925-9126. Diabetic Equipment and Supplies Home Health The following diagnosis code may be reimbursed without prior authorization when submitted with blood testing and supplies procedure codes to home health durable medical equipment (DME) and medical supplier DME providers: Added Diagnosis Code E1110 Refer to: The current Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, section 2.2.11.3 Glucose Testing Equipment and Other Supplies, for more information. ICD-10 Special Bulletin, No. 12 10 2017 Texas Medicaid

Home Health and Comprehensive Care Program (CCP) Providers CCP Services Benefit Changes The following Texas Medicaid CCP benefit changes have been made to support the 2018 ICD updates and are effective for dates of service on or after October 1, 2017. For more information, call the TMHP Contact Center at 1-800-925-9126. Blood Pressure Devices CCP The following diagnosis codes may be reimbursed when submitted with manual and automated blood pressure devices procedure codes A4660 and A4670: I219 I21A1 I21A9 I2720 I2721 I2722 I2723 I2724 I2729 I2783 I50810 I50811 I50812 I50813 I50814 I5082 I5083 I5084 I5089 Refer to: The current Texas Medicaid Provider Procedures Manual, Children s Services Handbook, section 2.6.4.1.1 Manual and Automated Blood Pressure Devices, for more information. Nutritional Products - CCP Nutritional products may be reimbursed without prior authorization when they are submitted with the following diagnosis codes: E8581 E8589 Discontinued Diagnosis Code E858 Refer to: The current Texas Medicaid Provider Procedures Manual, Children s Services Handbook, section 2.7.10, Nutritional Products, for more information. ICD-10 Special Bulletin, No. 12 11 2017 Texas Medicaid

Children With Special Health Care Needs (CSHCN) Services Program Providers CHILDREN WITH SPECIAL HEALTH CARE NEEDS (CSHCN) SERVICES PROGRAM PROVIDERS CSHCN Services Program Updates The 2018 ICD updates for the CSHCN Services Program are included in the ICD tables in the All Code Changes: Added, Revised, and Discontinued section of this bulletin beginning on page 16. The 2018 ICD deletions are effective October 1, 2017, for dates of service on or after October 1, 2017, for the CSHCN Services Program. Providers may refer to the General Information section for more information. CSHCN Services Program Benefit Changes The following CSHCN Services Program benefit changes have been made to support the 2018 ICD updates and are effective for dates of service on or after October 1, 2017. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-925-9126. The policy articles below contain the following information: Revised: The description has been revised for these diagnosis codes. Providers may refer to the appropriate copyright holder for the revised descriptions. Discontinued: Discontinued diagnosis codes are no longer reimbursed after September 30, 2017. Added: Added diagnosis codes are new procedure codes added by the Centers for Medicare & Medicaid Services (CMS). Ambulance Services The following emergency medical condition codes must be used to identify emergency medical conditions for ambulance transports: R0603 T07XXXA T148XXA T1490XA T1491XA Discontinued Diagnosis Codes T07 T148 An emergency ambulance transport may be reimbursed by the CSHCN Services Program when it is submitted with modifier ET and one or more emergency medical condition codes. The requesting facility or physician must include with the claim documentation that describes the clients condition which necessitated the ambulance transport. Medicaid recognizes limitations of usual ambulance personnel for establishing a diagnosis, and recognizes coding of a client s condition using International Classification of Diseases, ICD-10 Special Bulletin, No. 12 12 2017 Texas Medicaid

Children With Special Health Care Needs (CSHCN) Services Program Providers 10th Revision, Clinical Modification (ICD-10-CM) when reporting ambulance transport services may be less specific than for services reported by other professional providers. Providers who submit ICD-10-CM diagnosis codes should choose the code that best describes the client s condition at the time of transport. Diagnoses that are rule out or suspected diagnoses should not be reported using specific ICD-10-CM diagnosis codes. In such instances where a diagnosis is not confirmed, it is more correct to use a symptom, finding, or injury diagnosis code. Refer to: The current CSHCN Services Program Provider Manual, section 9.3, Emergency Ambulance Transports, for more information. Ambulatory Blood Pressure Monitoring and Devices The following diagnosis codes may be reimbursed when submitted with procedure codes A4660 and A4670: I219 I21A1 I21A9 I2720 I2721 I2722 I2723 I2724 I2729 I2783 I50810 I50811 I50812 I50813 I50814 I5082 I5083 I5084 I5089 Revised Diagnosis Code I501 Refer to: The current CSHCN Services Program Provider Manual, section 11.2.1.2 Manual and Automated Blood Pressure Devices, for more information. Cytogenetics The following diagnosis codes may be reimbursed when submitted with procedure codes 88230, 88233, 88235, 88237, 88239, 88245, 88248, 88249, 88261, 88262, 88263, 88264, 88271, 88272, 88273, 88274, 88275, 88280, 88283, 88285, 88289, and 88291: P2930 P2938 Q53111 Q53112 Q5313 Q53211 Q53212 Q5323 Discontinued Diagnosis Codes P293 Q5311 Q5321 Revised Diagnosis Codes Q6412 Q822 Z315 Refer to: The current CSHCN Services Program Provider Manual, section 25.2.5.2 Cytogenetics Testing, for more information. ICD-10 Special Bulletin, No. 12 13 2017 Texas Medicaid

Children With Special Health Care Needs (CSHCN) Services Program Providers Diabetic Equipment and Supplies The following diagnosis codes may be reimbursed without prior authorization when submitted with blood testing and supplies procedure codes: Added Diagnosis Code E1110 Refer to: The current CSHCN Services Program Provider Manual, section 15.2.1 Glucose Monitor and Supplies, for more information. Echoencephalography The following diagnosis codes may be reimbursed when submitted with procedure code 76505: P91811 P91819 P9188 Discontinued Diagnosis Codes S061X7D S061X7S S061X8D S061X8S S06307D S06307S S06308D S06308S S06317D S06317S S06318D S06318S S06327D S06327S S06328D S06328S S06337D S06337S S06338D S06338S S06347D S06347S S06348D S06348S S06357D S06357S S06358D S06358S S06367D S06367S S06368D S06368S S06377D S06377S S06378D S06378S S06387D S06387S S06388D S06388S S064X7D S064X7S S064X8D S064X8S S065X7D S065X7S S065X8D S065X8S S066X7D S066X7S S066X8D S066X8S S06897D S06897S S06898D S06898S S069X7D S069X7S S069X8D S069X8S Refer to: The current CSHCN Services Program Provider Manual, section 31.2.17 Echoencephalography, for more information. Evoked Response and Neuromuscular Procedures The following diagnosis codes may be reimbursed when submitted with electromyography (EMG) and nerve conduction study (NCS) procedure codes: E8581 E8582 E8589 G1223 G1224 G1225 M48062 Discontinued Diagnosis Codes E858 M4806 Revised Diagnosis Codes M3300 M3301 M3302 M3309 M3310 M3311 M3312 M3319 ICD-10 Special Bulletin, No. 12 14 2017 Texas Medicaid

Children With Special Health Care Needs (CSHCN) Services Program Providers Refer to: The current CSHCN Services Program Provider Manual, section 31.2.19 Evoked Response and Neuromuscular Procedures, for more information. Expendable Medical Supplies The following diagnosis codes may be reimbursed when submitted with the appropriate diapers, briefs, pull-ups, or liners procedure codes: Revised Diagnosis Codes N35112 N35113 N35114 N99111 N99112 N99113 Q6412 Refer to: The current CSHCN Services Program Provider Manual, section 18.2.4 Diapers, Briefs, Pull-ups, and Liners, for more information. Neurostimulators and Neuromuscular Stimulators The following diagnosis codes may be considered for prior authorization when submitted with appropriate dorsal column neurostimulation (DCN), intracranial neurostimulation (ICN), or percutaneous electrical nerve stimulation (PENS) device procedure codes: G1223 G1224 G1225 M48061 M48062 Discontinued Diagnosis Code M4806 Refer to: The current CSHCN Services Program Provider Manual, section 27.2.1 Dorsal Column Neurostimulation (DCN), section 27.2.2 Intracranial Neurostimulation (ICN), and section 27.2.4 Percutaneous Electrical Nerve Stimulation (PENS), for more information. Therapeutic Apheresis The following diagnosis codes may be reimbursed when submitted with procedure codes 36511, 36512, 36513, 36514, 36515, and 36516: Revised Diagnosis Codes M3300 M3301 M3302 M3309 M3310 M3311 M3312 M3319 Refer to: The current CSHCN Services Program Provider Manual section 31.2.40 Therapeutic Apheresis, for more information. ICD-10 Special Bulletin, No. 12 15 2017 Texas Medicaid

All Code Changes: Added, Revised, and Discontinued Vision Services Nonsurgical The following diagnosis codes may be reimbursed when submitted with the appropriate contact lenses and their prescription and fitting procedure codes: H442A1 H442A2 H442A3 H442A9 H442B1 H442B2 H442B3 H442B9 H442C1 H442C2 H442C3 H442C9 H442D1 H442D2 H442D3 H442D9 H442E1 H442E2 H442E3 H442E9 Refer to: The current CSHCN Services Program Provider Manual, section 40.2.1.4 Contact Lenses, for more information. ALL CODE CHANGES: ADDED, REVISED, AND DISCONTINUED 2018 ICD Diagnosis Code Additions The following is a list of new International Classification of Diseases (ICD) diagnosis codes: Diagnosis Codes A0471 A0472 C9620 C9621 C9622 C9629 D4701 D4702 D4709 E1110 E1111 E8581 E8582 E8589 F1011 F1111 F1211 F1311 F1411 F1511 F1611 F1811 F1911 F5082 G1223 G1224 G1225 H442A1 H442A2 H442A3 H442A9 H442B1 H442B2 H442B3 H442B9 H442C1 H442C2 H442C3 H442C9 H442D1 H442D2 H442D3 H442D9 H442E1 H442E2 H442E3 H442E9 H540X33 H540X34 H540X35 H540X43 H540X44 H540X45 H540X53 H540X54 H540X55 H541131 H541132 H541141 H541142 H541151 H541152 H541213 H541214 H541215 H541223 H541224 H541225 H542X11 H542X12 H542X21 H542X22 H54413A H54414A H54415A H5442A3 H5442A4 H5442A5 H54511A H54512A H5452A1 H5452A2 I219 I21A1 I21A9 I2720 I2721 I2722 I2723 I2724 I2729 I2783 150810 I50811 I50812 I50813 I50814 I5082 I5083 I5084 I5089 K06010 K06011 K06012 K06013 K06020 K06021 K06022 K06023 K5650 K5651 K5652 K56600 K56601 K56609 K56690 K56691 K56699 K9130 K9131 K9132 L97105 L97106 L97108 L97115 L97116 L97118 L97125 L97126 L97128 L97205 L97206 L97208 L97215 L97216 L97218 L97225 L97226 L97228 L97305 ICD-10 Special Bulletin, No. 12 16 2017 Texas Medicaid

All Code Changes: Added, Revised, and Discontinued Diagnosis Codes L97306 L97308 L97315 L97316 L97318 L97325 L97326 L97328 L97405 L97406 L97408 L97415 L97416 L97418 L97425 L97426 L97428 L97505 L97506 L97508 L07515 L97516 L97518 L97525 L97526 L97528 L97805 L97806 L97808 L97815 L97816 L97818 L97825 L97826 L97828 L97905 L97906 L97908 L97915 L97916 L97918 L97925 L97926 L97928 L98415 L98416 L98418 L98425 L98426 L98428 L98495 L98496 L98498 M3303 M3313 M3393 M48061 M48062 N630 N6310 N6311 N6312 N6313 N6314 N6320 N6321 N6322 N6323 N6324 N6331 N6332 N6341 N6342 O00101 O00102 O00109 O00111 O00112 O00119 O00201 O00202 O00209 O00211 O00212 O00219 O368310 O368311 O368312 O368313 O368314 O368315 O368319 O368320 O368321 O368322 O368323 O368324 O368325 O368329 O368330 O368331 O368332 O368333 O368334 O368335 O368339 O368390 O368391 O368392 O368393 O368394 O368395 O368399 P2930 P2938 P7884 P8381 P8388 P91811 P91819 P9188 Q53111 Q53112 Q5313 Q53211 Q53212 Q5323 R0603 R3983 R3984 T07XXXA T07XXXD T07XXXS T148XXA T148XXD T148XXS T1490XA T1490XD T1490XS T1491XA T1491XD T1491XS V8605XA V8605XD V8605XS V8606XA V8606XD V8606XS V8615XA V8615XD V8615XS V8616XA V8616XD V8616XS V8625XA V8625XD V8625XS V8626XA V8626XD V8626XS V8635XA V8635XD V8635XS V8636XA V8636XD V8636XS V8645XA V8645XD V8645XS V8646XA V8646XD V8646XS V8655XA V8655XD V8655XS V8656XA V8656XD V8656XS V8665XA V8665XD V8665XS V8666XA V8666XD V8666XS V8675XA V8675XD V8675XS V8676XA V8676XD V8676XS V8695XA V8695XD V8695XS V8696XA V8696XD V8696XS Z360 Z361 Z362 Z363 Z364 Z365 Z3681 Z3682 Z3683 Z3684 Z3685 Z3686 Z3687 Z3688 Z3689 Z368A Z369 Z4003 Z7182 Z7183 Z91841 Z91842 Z91843 Z91849 For more information, call the Texas Medicaid & Healthcare Partnership (TMHP) Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. ICD-10 Special Bulletin, No. 12 17 2017 Texas Medicaid

All Code Changes: Added, Revised, and Discontinued Discontinued Diagnosis Codes The 2018 ICD discontinued diagnosis codes are no longer valid for claims submitted with dates of service on or after October 1, 2017. The following is a list of diagnosis codes that have been discontinued: Diagnosis Codes A047 C962 D470 E858 H540 H5411 H5412 H542 H5441 H5442 H5451 H5452 I272 K060 K565 K5660 K5669 K913 M4806 N63 O0010 O0011 O0020 O0021 P293 P838 P918 Q5311 Q5321 S061X7D S061X7S S061X8D S061X8S S062X7D S062X7S S062X8D S062X8S S06307D S06307S S06308D S06308S S06317D S06317S S06318D S06318S S06327D S06327S S06328D S06328S S06337D S06337S S06338D S06338S S06347D S06347S S06348D S06348S S06357D S06357S S06358D S06358S S06367D S06367S S06368D S06368S S06377D S06377S S06378D S06378S S06387D S06387S S06388D S06388S S064X7D S064X7S S064X8D S064X8S S065X7D S065X7S S065X8D S065X8S S066X7D S066X7S S066X8D S066X8S S06817D S06817S S06818D S06818S S06827D S06827S S06828D S06828S S06897D S06897S S06898D S06898S S069X7D S069X7S S069X8D S069X8S S63131A S63131D S63131S S63132A S63132D S63132S S63133A S63133D S63133S S63134A S63134D S63134S S63135A S63135D S63135S S63136A S63136D S63136S S63141A S63141D S63141S S63142A S63142D S63142S S63143A S63143D S63143S S63144A S63144D S63144S S63145A S63145D S63145S S63146A S63146D S63146S T07 T148 T1490 T1491 Z36 For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP- CSHCN Services Program Contact Center at 1-800-568-2413. Diagnosis Code Description Changes Effective for dates of service on or after October 1, 2017, the following diagnosis code descriptions have changed: Diagnosis Codes F410 H02051 H02052 H02053 H02054 H02055 H02056 H02059 I501 I63211 I63212 I6322 I63323 I63333 I63513 I63523 I63533 I82811 I82812 I82819 I83811 ICD-10 Special Bulletin, No. 12 18 2017 Texas Medicaid

All Code Changes: Added, Revised, and Discontinued Diagnosis Codes I83812 I83819 I83891 I83892 I83899 J156 M3300 M3301 M3302 M3309 M3310 M3311 M3312 M3319 N35112 N35113 N35114 N99111 N99112 N99113 Q6412 Q822 S04031A S04031D S04031S S04032A S04032D S04032S S04039A S04039D S04039S S04041A S04041D S04041S S04042A S04042D S04042S S04049A S04049D S04049S S62311A S62311B S62311D S62311G S62311K S62311P S62311S S62317A S62317B S62317D S62317G S62317K S62317P S62317S S62341A S62341B S62341D S62341G S62341K S62341P S62341S S62347A S62347B S62347D S62347G S62347K S62347P S62347S S62620A S62620B S62620D S62620G S62620K S62620P S62620S S62621A S62621B S62621D S62621G S62621K S62621P S62621S S62622A S62622B S62622D S62622G S62622K S62622P S62622S S62623A S62623B S62623D S62623G S62623K S62623P S62623S S62624A S62624B S62624D S62624G S62624K S62624P S62624S S62625A S62625B S62625D S62625G S62625K S62625P S62625S S62650A S62650B S62650D S62650G S62650K S62650P S62650S S62651A S62651B S62651D S62651G S62651K S62651P S62651S S62652A S62652B S62652D S62652G S62652K S62652P S62652S S62653A S62653B S62653D S62653G S62653K S62653P S62653S S63121A S63121D S63121S S63122A S63122D S63122S S63123A S63123D S63123S S63124A S63124D S63124S S63125A S63125D S63125S S63126A S63126D S63126S S92521A S92521B S92521D S92521G S92521K S92521P S92521S S92522A S92522B S92522D S92522G S92522K S92522P S92522S S92523A S92523B S92523D S92523G S92523K S92523P S92523S S92524A S92524B S92524D S92524G S92524K S92524P S92524S S92525A S92525B S92525D S92525G S92525K S92525P S92525S S92526A S92526B S92526D S92526G S92526K S92526P S92526S W298XXA W298XXD W298XXS Z315 Z4002 Z681 Z79890 For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP- CSHCN Services Program Contact Center at 1-800-568-2413. ICD-10 Special Bulletin, No. 12 19 2017 Texas Medicaid

INPATIENT HOSPITAL ICD-10-PCS AND DRG Inpatient Hospital ICD-10-PCS Surgical Procedure Code and Diagnosis Related Group (DRG) Updates The ICD-10-PCS procedure codes are inpatient hospital surgical procedure codes and must be submitted, as applicable, only on inpatient hospital claims. Note: For professional and outpatient procedures and services, providers must continue to use the American Medical Association (AMA) Current Procedural Terminology (CPT) manual and the CMS Health Care Common Procedure Coding System (HCPCS) manual. This section lists the ICD-10-PCS inpatient hospital surgical procedure code changes for inpatient hospital providers. Providers should refer to the appropriate copyright holder s code listing for the new, discontinued, and revised descriptions for the procedure codes indicated below. All discontinued codes will not be reimbursed for dates of service on or after October 1, 2017. The following table lists all of the new surgical procedure codes: Note: These procedure codes are surgical codes used to assign the proper DRG for an inpatient hospital stay and are processed as informational only. Added Procedure Codes 00160ZB 00163ZB 0016470 0016471 0016472 0016473 0016474 0016475 0016476 0016477 0016478 001647B 00164J0 00164J1 00164J2 00164J3 00164J4 00164J5 00164J6 00164J7 00164J8 00164JB 00164K0 00164K1 00164K2 00164K3 00164K4 00164K5 00164K6 00164K7 00164K8 00164KB 00164ZB 00760ZZ 00763ZZ 00764ZZ 00CU0ZZ 00CU3ZZ 00CU4ZZ 00H004Z 00H00YZ 00H03YZ 00H04YZ 00H60YZ 00H63YZ 00H64YZ 00HE0YZ 00HE3YZ 00HE4YZ 00HU0YZ 00HU3YZ 00HU4YZ 00HV0YZ 00HV3YZ 00HV4YZ 00P00YZ 00P03YZ 00P04YZ 00P60YZ 00P63YZ 00P64YZ 00PE0YZ 00PE3YZ 00PE4YZ 00PU0YZ 00PU3YZ 00PU4YZ 00PV0YZ 00PV3YZ 00PV4YZ 00R107Z 00R10JZ 00R10KZ 00R147Z 00R14JZ 00R14KZ 00R207Z 00R20JZ 00R20KZ 00R247Z 00R24JZ 00R24KZ 00R607Z 00R60JZ 00R60KZ 00R647Z 00R64JZ 00R64KZ 00RF07Z 00RF0JZ 00RF0KZ 00RF47Z 00RF4JZ 00RF4KZ 00RG07Z 00RG0JZ 00RG0KZ 00RG47Z 00RG4JZ 00RG4KZ 00RH07Z 00RH0JZ 00RH0KZ 00RH47Z 00RH4JZ 00RH4KZ 00RJ07Z 00RJ0JZ 00RJ0KZ 00RJ47Z 00RJ4JZ 00RJ4KZ 00RK07Z 00RK0JZ 00RK0KZ 00RK47Z 00RK4JZ 00RK4KZ 00RL07Z 00RL0JZ 00RL0KZ 00RL47Z 00RL4JZ 00RL4KZ 00RM07Z 00RM0JZ 00RM0KZ 00RM47Z 00RM4JZ 00RM4KZ 00RN07Z 00RN0JZ 00RN0KZ ICD-10 Special Bulletin, No. 12 20 2017 Texas Medicaid

Added Procedure Codes 00RN47Z 00RN4JZ 00RN4KZ 00RP07Z 00RP0JZ 00RP0KZ 00RP47Z 00RP4JZ 00RP4KZ 00RQ07Z 00RQ0JZ 00RQ0KZ 00RQ47Z 00RQ4JZ 00RQ4KZ 00RR07Z 00RR0JZ 00RR0KZ 00RR47Z 00RR4JZ 00RR4KZ 00RS07Z 00RS0JZ 00RS0KZ 00RS47Z 00RS4JZ 00RS4KZ 00RT07Z 00RT0JZ 00RT0KZ 00RT47Z 00RT4JZ 00RT4KZ 00U607Z 00U60JZ 00U60KZ 00U637Z 00U63JZ 00U63KZ 00U647Z 00U64JZ 00U64KZ 00UF0JZ 00UF0KZ 00UF3JZ 00UF3KZ 00UF4JZ 00UF4KZ 00UG0JZ 00UG0KZ 00UG3JZ 00UG3KZ 00UG4JZ 00UG4KZ 00UH0JZ 00UH0KZ 00UH3JZ 00UH3KZ 00UH4JZ 00UH4KZ 00UJ0JZ 00UJ0KZ 00UJ3JZ 00UJ3KZ 00UJ4JZ 00UJ4KZ 00UK0JZ 00UK0KZ 00UK3JZ 00UK3KZ 00UK4JZ 00UK4KZ 00UL0JZ 00UL0KZ 00UL3JZ 00UL3KZ 00UL4JZ 00UL4KZ 00UM0JZ 00UM0KZ 00UM3JZ 00UM3KZ 00UM4JZ 00UM4KZ 00UN0JZ 00UN0KZ 00UN3JZ 00UN3KZ 00UN4JZ 00UN4KZ 00UP0JZ 00UP0KZ 00UP3JZ 00UP3KZ 00UP4JZ 00UP4KZ 00UQ0JZ 00UQ0KZ 00UQ3JZ 00UQ3KZ 00UQ4JZ 00UQ4KZ 00UR0JZ 00UR0KZ 00UR3JZ 00UR3KZ 00UR4JZ 00UR4KZ 00US0JZ 00US0KZ 00US3JZ 00US3KZ 00US4JZ 00US4KZ 00W00YZ 00W03YZ 00W04YZ 00W60YZ 00W63YZ 00W64YZ 00WE0YZ 00WE3YZ 00WE4YZ 00WU0YZ 00WU3YZ 00WU4YZ 00WV0YZ 00WV3YZ 00WV4YZ 01HY0YZ 01HY3YZ 01HY4YZ 01PY0YZ 01PY3YZ 01PY4YZ 01R107Z 01R10JZ 01R10KZ 01R147Z 01R14JZ 01R14KZ 01R207Z 01R20JZ 01R20KZ 01R247Z 01R24JZ 01R24KZ 01R407Z 01R40JZ 01R40KZ 01R447Z 01R44JZ 01R44KZ 01R507Z 01R50JZ 01R50KZ 01R547Z 01R54JZ 01R54KZ 01R607Z 01R60JZ 01R60KZ 01R647Z 01R64JZ 01R64KZ 01R807Z 01R80JZ 01R80KZ 01R847Z 01R84JZ 01R84KZ 01RB07Z 01RB0JZ 01RB0KZ 01RB47Z 01RB4JZ 01RB4KZ 01RC07Z 01RC0JZ 01RC0KZ 01RC47Z 01RC4JZ 01RC4KZ 01RD07Z 01RD0JZ 01RD0KZ 01RD47Z 01RD4JZ 01RD4KZ 01RF07Z 01RF0JZ 01RF0KZ 01RF47Z 01RF4JZ 01RF4KZ 01RG07Z 01RG0JZ 01RG0KZ 01RG47Z 01RG4JZ 01RG4KZ 01RH07Z 01RH0JZ 01RH0KZ 01RH47Z 01RH4JZ 01RH4KZ 01RR07Z 01RR0JZ 01RR0KZ 01RR47Z 01RR4JZ 01RR4KZ 01U10JZ 01U10KZ 01U13JZ 01U13KZ 01U14JZ 01U14KZ 01U20JZ 01U20KZ 01U23JZ 01U23KZ 01U24JZ 01U24KZ 01U40JZ 01U40KZ 01U43JZ 01U43KZ 01U44JZ 01U44KZ 01U50JZ 01U50KZ 01U53JZ 01U53KZ 01U54JZ 01U54KZ 01U60JZ 01U60KZ 01U63JZ 01U63KZ 01U64JZ 01U64KZ 01U80JZ 01U80KZ ICD-10 Special Bulletin, No. 12 21 2017 Texas Medicaid

Added Procedure Codes 01U83JZ 01U83KZ 01U84JZ 01U84KZ 01UB0JZ 01UB0KZ 01UB3JZ 01UB3KZ 01UB4JZ 01UB4KZ 01UC0JZ 01UC0KZ 01UC3JZ 01UC3KZ 01UC4JZ 01UC4KZ 01UD0JZ 01UD0KZ 01UD3JZ 01UD3KZ 01UD4JZ 01UD4KZ 01UF0JZ 01UF0KZ 01UF3JZ 01UF3KZ 01UF4JZ 01UF4KZ 01UG0JZ 01UG0KZ 01UG3JZ 01UG3KZ 01UG4JZ 01UG4KZ 01UH0JZ 01UH0KZ 01UH3JZ 01UH3KZ 01UH4JZ 01UH4KZ 01UR0JZ 01UR0KZ 01UR3JZ 01UR3KZ 01UR4JZ 01UR4KZ 01WY0YZ 01WY3YZ 01WY4YZ 02163Z7 021W0JG 021W0JH 021W0KG 021W0KH 027L04Z 027L0DZ 027L0ZZ 027L34Z 027L3DZ 027L3ZZ 027L44Z 027L4DZ 027L4ZZ 02H40YZ 02H43YZ 02H44YZ 02H60YZ 02H63YZ 02H64YZ 02H70YZ 02H73YZ 02H74YZ 02HA0RJ 02HA0YZ 02HA3RJ 02HA3YZ 02HA4RJ 02HA4YZ 02HK0YZ 02HK3YZ 02HK4YZ 02HL0YZ 02HL3YZ 02HL4YZ 02HN0YZ 02HN3YZ 02HN4YZ 02HP0YZ 02HP3YZ 02HP4YZ 02HQ0YZ 02HQ3YZ 02HQ4YZ 02HR0YZ 02HR3YZ 02HR4YZ 02HS0YZ 02HS3YZ 02HS4YZ 02HT0YZ 02HT3YZ 02HT4YZ 02HV0YZ 02HV3YZ 02HV4YZ 02HW0YZ 02HW3YZ 02HW4YZ 02LP0CZ 02LP0DZ 02LP0ZZ 02LP3CZ 02LP3DZ 02LP3ZZ 02LP4CZ 02LP4DZ 02LP4ZZ 02LQ0CZ 02LQ0DZ 02LQ0ZZ 02LQ3CZ 02LQ3DZ 02LQ3ZZ 02LQ4CZ 02LQ4DZ 02LQ4ZZ 02LR0CZ 02LR0DZ 02LR0ZZ 02LR3CZ 02LR3DZ 02LR3ZZ 02LR4CZ 02LR4DZ 02LR4ZZ 02LW3DJ 02N00ZZ 02N03ZZ 02N04ZZ 02N10ZZ 02N13ZZ 02N14ZZ 02N20ZZ 02N23ZZ 02N24ZZ 02N30ZZ 02N33ZZ 02N34ZZ 02PA0RS 02PA0YZ 02PA3RS 02PA3YZ 02PA4RS 02PA4YZ 02PY0YZ 02PY3YZ 02PY4YZ 02RJ37H 02RJ37Z 02RJ38H 02RJ38Z 02RJ3JH 02RJ3JZ 02RJ3KH 02RJ3KZ 02VG0ZZ 02VG3ZZ 02VG4ZZ 02WA0RS 02WA0YZ 02WA3RS 02WA3YZ 02WA4RS 02WA4YZ 02WAXRS 02WF37Z 02WF38Z 02WF3JZ 02WF3KZ 02WG37Z 02WG38Z 02WG3JZ 02WG3KZ 02WH37Z 02WH38Z 02WH3JZ 02WH3KZ 02WJ37Z 02WJ38Z 02WJ3JZ 02WJ3KZ 02WY0YZ 02WY3YZ 02WY4YZ 031509V 03150AV 03150JV 03150KV 03150ZV 031609V 03160AV 03160JV 03160KV 03160ZV 031709V 03170AV 03170JV 03170KV 03170ZV 031809V 03180AV 03180JV 03180KV 03180ZV 031H09K 031H0AK 031H0JK 031H0KK 031H0ZK 031J09J 031J0AJ 031J0JJ 031J0KJ 031J0ZJ 031K09K 031K0AK 031K0JK 031K0KK 031K0ZK 031L09J 031L0AJ 031L0JJ 031L0KJ 031L0ZJ 031M09K 031M0AK 031M0JK 031M0KK 031M0ZK 031N09J 031N0AJ 031N0JJ 031N0KJ 031N0ZJ 03HY0YZ ICD-10 Special Bulletin, No. 12 22 2017 Texas Medicaid

Added Procedure Codes 03HY3YZ 03HY4YZ 03PY0YZ 03PY3YZ 03PY4YZ 03WY0YZ 03WY3YZ 03WY4YZ 0413093 0413094 0413095 04130A3 04130A4 04130A5 04130J3 04130J4 04130J5 04130K3 04130K4 04130K5 04130Z3 04130Z4 04130Z5 0413493 0413494 0413495 04134A3 04134A4 04134A5 04134J3 04134J4 04134J5 04134K3 04134K4 04134K5 04134Z3 04134Z4 04134Z5 041T09P 041T09Q 041T09S 041T0AP 041T0AQ 041T0AS 041T0JP 041T0JQ 041T0JS 041T0KP 041T0KQ 041T0KS 041T0ZP 041T0ZQ 041T0ZS 041T49P 041T49Q 041T49S 041T4AP 041T4AQ 041T4AS 041T4JP 041T4JQ 041T4JS 041T4KP 041T4KQ 041T4KS 041T4ZP 041T4ZQ 041T4ZS 041U09P 041U09Q 041U09S 041U0AP 041U0AQ 041U0AS 041U0JP 041U0JQ 041U0JS 041U0KP 041U0KQ 041U0KS 041U0ZP 041U0ZQ 041U0ZS 041U49P 041U49Q 041U49S 041U4AP 041U4AQ 041U4AS 041U4JP 041U4JQ 041U4JS 041U4KP 041U4KQ 041U4KS 041U4ZP 041U4ZQ 041U4ZS 041V09P 041V09Q 041V09S 041V0AP 041V0AQ 041V0AS 041V0JP 041V0JQ 041V0JS 041V0KP 041V0KQ 041V0KS 041V0ZP 041V0ZQ 041V0ZS 041V49P 041V49Q 041V49S 041V4AP 041V4AQ 041V4AS 041V4JP 041V4JQ 041V4JS 041V4KP 041V4KQ 041V4KS 041V4ZP 041V4ZQ 041V4ZS 041W09P 041W09Q 041W09S 041W0AP 041W0AQ 041W0AS 041W0JP 041W0JQ 041W0JS 041W0KP 041W0KQ 041W0KS 041W0ZP 041W0ZQ 041W0ZS 041W49P 041W49Q 041W49S 041W4AP 041W4AQ 041W4AS 041W4JP 041W4JQ 041W4JS 041W4KP 041W4KQ 041W4KS 041W4ZP 041W4ZQ 041W4ZS 0470041 04700D1 04700Z1 0470341 04703D1 04703Z1 0470441 04704D1 04704Z1 0471041 04710D1 04710Z1 0471341 04713D1 04713Z1 0471441 04714D1 04714Z1 0472041 04720D1 04720Z1 0472341 04723D1 04723Z1 0472441 04724D1 04724Z1 0473041 04730D1 04730Z1 0473341 04733D1 04733Z1 0473441 04734D1 04734Z1 0474041 04740D1 04740Z1 0474341 04743D1 04743Z1 0474441 04744D1 04744Z1 0475041 04750D1 04750Z1 0475341 04753D1 04753Z1 0475441 04754D1 04754Z1 0476041 04760D1 04760Z1 0476341 04763D1 04763Z1 0476441 04764D1 04764Z1 0477041 04770D1 04770Z1 0477341 04773D1 04773Z1 0477441 04774D1 04774Z1 0478041 04780D1 04780Z1 0478341 04783D1 04783Z1 0478441 04784D1 04784Z1 0479041 04790D1 04790Z1 0479341 04793D1 04793Z1 ICD-10 Special Bulletin, No. 12 23 2017 Texas Medicaid

Added Procedure Codes 0479441 04794D1 04794Z1 047A041 047A0D1 047A0Z1 047A341 047A3D1 047A3Z1 047A441 047A4D1 047A4Z1 047B041 047B0D1 047B0Z1 047B341 047B3D1 047B3Z1 047B441 047B4D1 047B4Z1 047C041 047C0D1 047C0Z1 047C341 047C3D1 047C3Z1 047C441 047C4D1 047C4Z1 047D041 047D0D1 047D0Z1 047D341 047D3D1 047D3Z1 047D441 047D4D1 047D4Z1 047E041 047E0D1 047E0Z1 047E341 047E3D1 047E3Z1 047E441 047E4D1 047E4Z1 047F041 047F0D1 047F0Z1 047F341 047F3D1 047F3Z1 047F441 047F4D1 047F4Z1 047H041 047H0D1 047H0Z1 047H341 047H3D1 047H3Z1 047H441 047H4D1 047H4Z1 047J041 047J0D1 047J0Z1 047J341 047J3D1 047J3Z1 047J441 047J4D1 047J4Z1 047P041 047P0D1 047P0Z1 047P341 047P3D1 047P3Z1 047P441 047P4D1 047P4Z1 047Q041 047Q0D1 047Q0Z1 047Q341 047Q3D1 047Q3Z1 047Q441 047Q4D1 047Q4Z1 047R041 047R0D1 047R0Z1 047R341 047R3D1 047R3Z1 047R441 047R4D1 047R4Z1 047S041 047S0D1 047S0Z1 047S341 047S3D1 047S3Z1 047S441 047S4D1 047S4Z1 047T041 047T0D1 047T0Z1 047T341 047T3D1 047T3Z1 047T441 047T4D1 047T4Z1 047U041 047U0D1 047U0Z1 047U341 047U3D1 047U3Z1 047U441 047U4D1 047U4Z1 047V041 047V0D1 047V0Z1 047V341 047V3D1 047V3Z1 047V441 047V4D1 047V4Z1 047W041 047W0D1 047W0Z1 047W341 047W3D1 047W3Z1 047W441 047W4D1 047W4Z1 047Y041 047Y0D1 047Y0Z1 047Y341 047Y3D1 047Y3Z1 047Y441 047Y4D1 047Y4Z1 04HY0YZ 04HY3YZ 04HY4YZ 04L03DJ 04PY0YZ 04PY3YZ 04PY4YZ 04WY0YZ 04WY3YZ 04WY4YZ 05HY0YZ 05HY3YZ 05HY4YZ 05PY0YZ 05PY3YZ 05PY4YZ 05WY0YZ 05WY3YZ 05WY4YZ 061007P 061007Q 061007R 061009P 061009Q 061009R 06100AP 06100AQ 06100AR 06100JP 06100JQ 06100JR 06100KP 06100KQ 06100KR 06100ZP 06100ZQ 06100ZR 061047P 061047Q 061047R 061049P 061049Q 061049R 06104AP 06104AQ 06104AR 06104JP 06104JQ 06104JR 06104KP 06104KQ 06104KR 06104ZP 06104ZQ 06104ZR 06183J4 06183JY 06184J4 06HY0YZ 06HY3YZ 06HY4YZ 06L37CZ 06L37DZ 06L37ZZ 06L38CZ 06L38DZ 06L38ZZ 06PY0YZ 06PY3YZ 06PY4YZ 06WY0YZ 06WY3YZ 06WY4YZ 079080Z 07908ZX 07908ZZ 079180Z 07918ZX 07918ZZ 079280Z 07928ZX 07928ZZ 079380Z 07938ZX 07938ZZ 079480Z 07948ZX 07948ZZ 079580Z ICD-10 Special Bulletin, No. 12 24 2017 Texas Medicaid

Added Procedure Codes 07958ZX 07958ZZ 079680Z 07968ZX 07968ZZ 079780Z 07978ZX 07978ZZ 079880Z 07988ZX 07988ZZ 079980Z 07998ZX 07998ZZ 079B80Z 079B8ZX 079B8ZZ 079C80Z 079C8ZX 079C8ZZ 079D80Z 079D8ZX 079D8ZZ 079F80Z 079F8ZX 079F8ZZ 079G80Z 079G8ZX 079G8ZZ 079H80Z 079H8ZX 079H8ZZ 079J80Z 079J8ZX 079J8ZZ 079K80Z 079K8ZX 079K8ZZ 079L80Z 079L8ZX 079L8ZZ 07D03ZX 07D04ZX 07D08ZX 07D13ZX 07D14ZX 07D18ZX 07D23ZX 07D24ZX 07D28ZX 07D33ZX 07D34ZX 07D38ZX 07D43ZX 07D44ZX 07D48ZX 07D53ZX 07D54ZX 07D58ZX 07D63ZX 07D64ZX 07D68ZX 07D73ZX 07D74ZX 07D78ZX 07D83ZX 07D84ZX 07D88ZX 07D93ZX 07D94ZX 07D98ZX 07DB3ZX 07DB4ZX 07DB8ZX 07DC3ZX 07DC4ZX 07DC8ZX 07DD3ZX 07DD4ZX 07DD8ZX 07DF3ZX 07DF4ZX 07DF8ZX 07DG3ZX 07DG4ZX 07DG8ZX 07DH3ZX 07DH4ZX 07DH8ZX 07DJ3ZX 07DJ4ZX 07DJ8ZX 07DK3ZX 07DK4ZX 07DK8ZX 07DL3ZX 07DL4ZX 07DL8ZX 07DM3ZX 07DM4ZX 07DP3ZX 07DP4ZX 07HK0YZ 07HK3YZ 07HK4YZ 07HL0YZ 07HL3YZ 07HL4YZ 07HM0YZ 07HM3YZ 07HM4YZ 07HN0YZ 07HN3YZ 07HN4YZ 07HP0YZ 07HP3YZ 07HP4YZ 07JN8ZZ 07PK0YZ 07PK3YZ 07PK4YZ 07PL0YZ 07PL3YZ 07PL4YZ 07PM0YZ 07PM3YZ 07PM4YZ 07PN0YZ 07PN3YZ 07PN4YZ 07PP0YZ 07PP3YZ 07PP4YZ 07Q08ZZ 07Q18ZZ 07Q28ZZ 07Q38ZZ 07Q48ZZ 07Q58ZZ 07Q68ZZ 07Q78ZZ 07Q88ZZ 07Q98ZZ 07QB8ZZ 07QC8ZZ 07QD8ZZ 07QF8ZZ 07QG8ZZ 07QH8ZZ 07QJ8ZZ 07QK8ZZ 07QL8ZZ 07WK0YZ 07WK3YZ 07WK4YZ 07WL0YZ 07WL3YZ 07WL4YZ 07WM0YZ 07WM3YZ 07WM4YZ 07WN0YZ 07WN3YZ 07WN4YZ 07WP0YZ 07WP3YZ 07WP4YZ 08H00YZ 08H03YZ 08H07YZ 08H08YZ 08H10YZ 08H13YZ 08H17YZ 08H18YZ 08P00YZ 08P03YZ 08P07YZ 08P08YZ 08P10YZ 08P13YZ 08P17YZ 08P18YZ 08PJ3YZ 08PK3YZ 08PL0YZ 08PL3YZ 08PM0YZ 08PM3YZ 08W00YZ 08W03YZ 08W07YZ 08W08YZ 08W10YZ 08W13YZ 08W17YZ 08W18YZ 08WJ3YZ 08WK3YZ 08WL0YZ 08WL3YZ 08WM0YZ 08WM3YZ 09558ZZ 09568ZZ 09598ZZ 095A8ZZ 095B8ZZ 095C8ZZ 095D8ZZ 095E8ZZ 095K8ZZ 095M8ZZ 095P8ZZ 095Q8ZZ 095R8ZZ 095S8ZZ 095T8ZZ 095U8ZZ 095V8ZZ 095W8ZZ 095X8ZZ 099570Z 09957ZX 09957ZZ 099580Z 09958ZX 09958ZZ 099670Z 09967ZX 09967ZZ 099680Z 09968ZX 09968ZZ 099970Z 09997ZX 09997ZZ 099980Z 09998ZX 09998ZZ 099A70Z 099A7ZX 099A7ZZ 099A80Z 099A8ZX ICD-10 Special Bulletin, No. 12 25 2017 Texas Medicaid

Added Procedure Codes 099A8ZZ 099B70Z 099B7ZX 099B7ZZ 099B80Z 099B8ZX 099B8ZZ 099C70Z 099C7ZX 099C7ZZ 099C80Z 099C8ZX 099C8ZZ 099D70Z 099D7ZX 099D7ZZ 099D80Z 099D8ZX 099D8ZZ 099E70Z 099E7ZX 099E7ZZ 099E80Z 099E8ZX 099E8ZZ 099K70Z 099K7ZX 099K7ZZ 099K80Z 099K8ZX 099K8ZZ 099M70Z 099M7ZX 099M7ZZ 099M80Z 099M8ZX 099M8ZZ 099P70Z 099P7ZX 099P7ZZ 099P80Z 099P8ZX 099P8ZZ 099Q70Z 099Q7ZX 099Q7ZZ 099Q80Z 099Q8ZX 099Q8ZZ 099R70Z 099R7ZX 099R7ZZ 099R80Z 099R8ZX 099R8ZZ 099S70Z 099S7ZX 099S7ZZ 099S80Z 099S8ZX 099S8ZZ 099T70Z 099T7ZX 099T7ZZ 099T80Z 099T8ZX 099T8ZZ 099U70Z 099U7ZX 099U7ZZ 099U80Z 099U8ZX 099U8ZZ 099V70Z 099V7ZX 099V7ZZ 099V80Z 099V8ZX 099V8ZZ 099W70Z 099W7ZX 099W7ZZ 099W80Z 099W8ZX 099W8ZZ 099X70Z 099X7ZX 099X7ZZ 099X80Z 099X8ZX 099X8ZZ 09B58ZX 09B58ZZ 09B68ZX 09B68ZZ 09B98ZX 09B98ZZ 09BA8ZX 09BA8ZZ 09BB8ZX 09BB8ZZ 09BC8ZX 09BC8ZZ 09BD8ZX 09BD8ZZ 09BE8ZX 09BE8ZZ 09BK8ZX 09BK8ZZ 09BM8ZX 09BM8ZZ 09BP8ZX 09BP8ZZ 09BQ8ZX 09BQ8ZZ 09BR8ZX 09BR8ZZ 09BS8ZX 09BS8ZZ 09BT8ZX 09BT8ZZ 09BU8ZX 09BU8ZZ 09BV8ZX 09BV8ZZ 09BW8ZX 09BW8ZZ 09BX8ZX 09BX8ZZ 09C58ZZ 09C68ZZ 09C98ZZ 09CA8ZZ 09CB8ZZ 09CC8ZZ 09CD8ZZ 09CE8ZZ 09CK8ZZ 09CM8ZZ 09CP8ZZ 09CQ8ZZ 09CR8ZZ 09CS8ZZ 09CT8ZZ 09CU8ZZ 09CV8ZZ 09CW8ZZ 09CX8ZZ 09HH0YZ 09HH3YZ 09HH4YZ 09HH7YZ 09HH8YZ 09HJ0YZ 09HJ3YZ 09HJ4YZ 09HJ7YZ 09HJ8YZ 09HK0YZ 09HK3YZ 09HK4YZ 09HK7YZ 09HK8YZ 09HY0YZ 09HY3YZ 09HY4YZ 09HY7YZ 09HY8YZ 09JD8ZZ 09JE8ZZ 09JK8ZZ 09JY8ZZ 09N58ZZ 09N68ZZ 09N98ZZ 09NA8ZZ 09NB8ZZ 09NC8ZZ 09ND8ZZ 09NE8ZZ 09NK8ZZ 09NM8ZZ 09NP8ZZ 09NQ8ZZ 09NR8ZZ 09NS8ZZ 09NT8ZZ 09NU8ZZ 09NV8ZZ 09NW8ZZ 09NX8ZZ 09PH0YZ 09PH3YZ 09PH4YZ 09PH7YZ 09PH8YZ 09PJ0YZ 09PJ3YZ 09PJ4YZ 09PJ7YZ 09PJ8YZ 09PK0YZ 09PK3YZ 09PK4YZ 09PK7YZ 09PK8YZ 09PY0YZ 09PY3YZ 09PY4YZ 09PY7YZ 09PY8YZ 09Q58ZZ 09Q68ZZ 09Q98ZZ 09QA8ZZ 09QB8ZZ 09QC8ZZ 09QD8ZZ 09QE8ZZ 09QK8ZZ 09QM8ZZ 09QP8ZZ 09QQ8ZZ 09QR8ZZ 09QS8ZZ 09QT8ZZ 09QU8ZZ 09QV8ZZ 09QW8ZZ 09QX8ZZ 09T58ZZ 09T68ZZ 09T98ZZ 09TA8ZZ 09TB8ZZ 09TC8ZZ 09TD8ZZ 09TE8ZZ 09TK8ZZ 09TM8ZZ 09TP8ZZ 09TQ8ZZ 09TR8ZZ 09TS8ZZ 09TT8ZZ ICD-10 Special Bulletin, No. 12 26 2017 Texas Medicaid

Added Procedure Codes 09TU8ZZ 09TV8ZZ 09TW8ZZ 09TX8ZZ 09U587Z 09U58JZ 09U58KZ 09U687Z 09U68JZ 09U68KZ 09U987Z 09U98JZ 09U98KZ 09UA87Z 09UA8JZ 09UA8KZ 09UD87Z 09UD8JZ 09UD8KZ 09UE87Z 09UE8JZ 09UE8KZ 09UK87Z 09UK8JZ 09UK8KZ 09UM87Z 09UM8JZ 09UM8KZ 09WH0YZ 09WH3YZ 09WH4YZ 09WH7YZ 09WH8YZ 09WJ0YZ 09WJ3YZ 09WJ4YZ 09WJ7YZ 09WJ8YZ 09WK0YZ 09WK3YZ 09WK4YZ 09WK7YZ 09WK8YZ 09WY0YZ 09WY3YZ 09WY4YZ 09WY7YZ 09WY8YZ 0B5T0ZZ 0B5T3ZZ 0B5T4ZZ 0B9N80Z 0B9N8ZX 0B9N8ZZ 0B9P80Z 0B9P8ZX 0B9P8ZZ 0B9T00Z 0B9T0ZX 0B9T0ZZ 0B9T30Z 0B9T3ZX 0B9T3ZZ 0B9T40Z 0B9T4ZX 0B9T4ZZ 0BBN8ZX 0BBN8ZZ 0BBP8ZX 0BBP8ZZ 0BBT0ZX 0BBT0ZZ 0BBT3ZX 0BBT3ZZ 0BBT4ZX 0BBT4ZZ 0BCT0ZZ 0BCT3ZZ 0BCT4ZZ 0BD14ZX 0BD18ZX 0BD24ZX 0BD28ZX 0BD34ZX 0BD38ZX 0BD44ZX 0BD48ZX 0BD54ZX 0BD58ZX 0BD64ZX 0BD68ZX 0BD74ZX 0BD78ZX 0BD84ZX 0BD88ZX 0BD94ZX 0BD98ZX 0BDB4ZX 0BDB8ZX 0BDC4ZX 0BDC8ZX 0BDD4ZX 0BDD8ZX 0BDF4ZX 0BDF8ZX 0BDG4ZX 0BDG8ZX 0BDH4ZX 0BDH8ZX 0BDJ4ZX 0BDJ8ZX 0BDK4ZX 0BDK8ZX 0BDL4ZX 0BDL8ZX 0BDM4ZX 0BDM8ZX 0BH00YZ 0BH03YZ 0BH04YZ 0BH07YZ 0BH08YZ 0BH10YZ 0BH13YZ 0BH14YZ 0BH17YZ 0BH18YZ 0BHK0YZ 0BHK3YZ 0BHK4YZ 0BHK7YZ 0BHK8YZ 0BHL0YZ 0BHL3YZ 0BHL4YZ 0BHL7YZ 0BHL8YZ 0BHQ0YZ 0BHQ3YZ 0BHQ4YZ 0BHQ7YZ 0BHQ8YZ 0BHT02Z 0BHT0MZ 0BHT0YZ 0BHT32Z 0BHT3MZ 0BHT3YZ 0BHT42Z 0BHT4MZ 0BHT4YZ 0BHT7YZ 0BHT8YZ 0BMT0ZZ 0BNT0ZZ 0BNT3ZZ 0BNT4ZZ 0BP00YZ 0BP03YZ 0BP04YZ 0BP07YZ 0BP08YZ 0BPK0YZ 0BPK3YZ 0BPK4YZ 0BPK7YZ 0BPK8YZ 0BPL0YZ 0BPL3YZ 0BPL4YZ 0BPL7YZ 0BPL8YZ 0BPQ0YZ 0BPQ3YZ 0BPQ4YZ 0BPQ7YZ 0BPQ8YZ 0BPT0YZ 0BPT3YZ 0BPT4YZ 0BPT7YZ 0BPT8YZ 0BQT0ZZ 0BQT3ZZ 0BQT4ZZ 0BR107Z 0BR10JZ 0BR10KZ 0BR147Z 0BR14JZ 0BR14KZ 0BR207Z 0BR20JZ 0BR20KZ 0BR247Z 0BR24JZ 0BR24KZ 0BR307Z 0BR30JZ 0BR30KZ 0BR347Z 0BR34JZ 0BR34KZ 0BR407Z 0BR40JZ 0BR40KZ 0BR447Z 0BR44JZ 0BR44KZ 0BR507Z 0BR50JZ 0BR50KZ 0BR547Z 0BR54JZ 0BR54KZ 0BR607Z 0BR60JZ 0BR60KZ 0BR647Z 0BR64JZ 0BR64KZ 0BR707Z 0BR70JZ 0BR70KZ 0BR747Z 0BR74JZ 0BR74KZ 0BR807Z 0BR80JZ 0BR80KZ 0BR847Z 0BR84JZ 0BR84KZ 0BR907Z 0BR90JZ 0BR90KZ 0BR947Z 0BR94JZ 0BR94KZ 0BRB07Z 0BRB0JZ 0BRB0KZ 0BRB47Z 0BRB4JZ 0BRB4KZ ICD-10 Special Bulletin, No. 12 27 2017 Texas Medicaid

Added Procedure Codes 0BRT07Z 0BRT0JZ 0BRT0KZ 0BRT47Z 0BRT4JZ 0BRT4KZ 0BST0ZZ 0BTT0ZZ 0BTT4ZZ 0BU187Z 0BU18JZ 0BU18KZ 0BU287Z 0BU28JZ 0BU28KZ 0BU387Z 0BU38JZ 0BU38KZ 0BU487Z 0BU48JZ 0BU48KZ 0BU587Z 0BU58JZ 0BU58KZ 0BU687Z 0BU68JZ 0BU68KZ 0BU787Z 0BU78JZ 0BU78KZ 0BU887Z 0BU88JZ 0BU88KZ 0BU987Z 0BU98JZ 0BU98KZ 0BUB87Z 0BUB8JZ 0BUB8KZ 0BUT07Z 0BUT0JZ 0BUT0KZ 0BUT47Z 0BUT4JZ 0BUT4KZ 0BW00YZ 0BW03YZ 0BW04YZ 0BW07YZ 0BW08YZ 0BWK0YZ 0BWK3YZ 0BWK4YZ 0BWK7YZ 0BWK8YZ 0BWL0YZ 0BWL3YZ 0BWL4YZ 0BWL7YZ 0BWL8YZ 0BWQ0YZ 0BWQ3YZ 0BWQ4YZ 0BWQ7YZ 0BWQ8YZ 0BWT0YZ 0BWT3YZ 0BWT4YZ 0BWT7YZ 0BWT8YZ 0CHA0YZ 0CHA3YZ 0CHA7YZ 0CHA8YZ 0CHS0YZ 0CHS3YZ 0CHS7YZ 0CHS8YZ 0CHY0YZ 0CHY3YZ 0CHY7YZ 0CHY8YZ 0CPA0YZ 0CPA3YZ 0CPA7YZ 0CPA8YZ 0CPS0YZ 0CPS3YZ 0CPS7YZ 0CPS8YZ 0CPY0YZ 0CPY3YZ 0CPY7YZ 0CPY8YZ 0CWA0YZ 0CWA3YZ 0CWA7YZ 0CWA8YZ 0CWS0YZ 0CWS3YZ 0CWS7YZ 0CWS8YZ 0CWY0YZ 0CWY3YZ 0CWY7YZ 0CWY8YZ 0D5U0ZZ 0D5U3ZZ 0D5U4ZZ 0D9U00Z 0D9U0ZX 0D9U0ZZ 0D9U30Z 0D9U3ZX 0D9U3ZZ 0D9U40Z 0D9U4ZX 0D9U4ZZ 0DBGFZZ 0DBLFZZ 0DBMFZZ 0DBNFZZ 0DBU0ZX 0DBU0ZZ 0DBU3ZX 0DBU3ZZ 0DBU4ZX 0DBU4ZZ 0DCU0ZZ 0DCU3ZZ 0DCU4ZZ 0DD13ZX 0DD14ZX 0DD18ZX 0DD23ZX 0DD24ZX 0DD28ZX 0DD33ZX 0DD34ZX 0DD38ZX 0DD43ZX 0DD44ZX 0DD48ZX 0DD53ZX 0DD54ZX 0DD58ZX 0DD63ZX 0DD64ZX 0DD68ZX 0DD73ZX 0DD74ZX 0DD78ZX 0DD83ZX 0DD84ZX 0DD88ZX 0DD93ZX 0DD94ZX 0DD98ZX 0DDA3ZX 0DDA4ZX 0DDA8ZX 0DDB3ZX 0DDB4ZX 0DDB8ZX 0DDC3ZX 0DDC4ZX 0DDC8ZX 0DDE3ZX 0DDE4ZX 0DDE8ZX 0DDF3ZX 0DDF4ZX 0DDF8ZX 0DDG3ZX 0DDG4ZX 0DDG8ZX 0DDH3ZX 0DDH4ZX 0DDH8ZX 0DDJ3ZX 0DDJ4ZX 0DDJ8ZX 0DDK3ZX 0DDK4ZX 0DDK8ZX 0DDL3ZX 0DDL4ZX 0DDL8ZX 0DDM3ZX 0DDM4ZX 0DDM8ZX 0DDN3ZX 0DDN4ZX 0DDN8ZX 0DDP3ZX 0DDP4ZX 0DDP8ZX 0DDQ3ZX 0DDQ4ZX 0DDQ8ZX 0DDQXZX 0DH00YZ 0DH03YZ 0DH04YZ 0DH07YZ 0DH08YZ 0DH50YZ 0DH53YZ 0DH54YZ 0DH57YZ 0DH58YZ 0DH60YZ 0DH63YZ 0DH64YZ 0DH67YZ 0DH68YZ 0DHD0YZ 0DHD3YZ 0DHD4YZ 0DHD7YZ 0DHD8YZ 0DNU0ZZ 0DNU3ZZ 0DNU4ZZ 0DP00YZ 0DP03YZ 0DP04YZ 0DP07YZ 0DP08YZ 0DP50YZ 0DP53YZ 0DP54YZ 0DP57YZ 0DP58YZ 0DP60YZ 0DP63YZ 0DP64YZ 0DP67YZ 0DP68YZ 0DPD0YZ 0DPD3YZ 0DPD4YZ 0DPD7YZ 0DPD8YZ 0DQU0ZZ ICD-10 Special Bulletin, No. 12 28 2017 Texas Medicaid