Pediatric diagnoses - ICD-10-CM Medicare Code Edits

The Medicare Code Editor detects inconsistencies in pediatric cases by checking a patient's age and any diagnosis on the patient's record. The pediatric code edits apply to patients age range is 0–17 years inclusive (e.g., Reye's syndrome, routine child health exam).

The following 122 ICD-10-CM codes are intended for pediatric diagnoses

ICD CodeDescriptionCategory
A48.51Infant botulismOther bacterial diseases, not elsewhere classified (A48)
B08.20Exanthema subitum [sixth disease], unspecifiedOth viral infect with skin and mucous membrane lesions, NEC (B08)
B08.21Exanthema subitum [sixth disease] due to human herpesvirus 6Oth viral infect with skin and mucous membrane lesions, NEC (B08)
B08.22Exanthema subitum [sixth disease] due to human herpesvirus 7Oth viral infect with skin and mucous membrane lesions, NEC (B08)
C93.30Juvenile myelomonocytic leukemia, not having achieved remissionMonocytic leukemia (C93)
C93.31Juvenile myelomonocytic leukemia, in remissionMonocytic leukemia (C93)
C93.32Juvenile myelomonocytic leukemia, in relapseMonocytic leukemia (C93)
E30.1Precocious pubertyDisorders of puberty, not elsewhere classified (E30)
E30.8Other disorders of pubertyDisorders of puberty, not elsewhere classified (E30)
F64.2Gender identity disorder of childhoodGender identity disorders (F64)
F84.3Other childhood disintegrative disorderPervasive developmental disorders (F84)
G93.7Reye's syndromeOther disorders of brain (G93)
H26.001Unspecified infantile and juvenile cataract, right eyeOther cataract (H26)
H26.002Unspecified infantile and juvenile cataract, left eyeOther cataract (H26)
H26.003Unspecified infantile and juvenile cataract, bilateralOther cataract (H26)
H26.009Unspecified infantile and juvenile cataract, unspecified eyeOther cataract (H26)
H26.011Infantile and juvenile cortical, lamellar, or zonular cataract, right eyeOther cataract (H26)
H26.012Infantile and juvenile cortical, lamellar, or zonular cataract, left eyeOther cataract (H26)
H26.013Infantile and juvenile cortical, lamellar, or zonular cataract, bilateralOther cataract (H26)
H26.019Infantile and juvenile cortical, lamellar, or zonular cataract, unspecified eyeOther cataract (H26)
H26.031Infantile and juvenile nuclear cataract, right eyeOther cataract (H26)
H26.032Infantile and juvenile nuclear cataract, left eyeOther cataract (H26)
H26.033Infantile and juvenile nuclear cataract, bilateralOther cataract (H26)
H26.039Infantile and juvenile nuclear cataract, unspecified eyeOther cataract (H26)
H26.041Anterior subcapsular polar infantile and juvenile cataract, right eyeOther cataract (H26)
H26.042Anterior subcapsular polar infantile and juvenile cataract, left eyeOther cataract (H26)
H26.043Anterior subcapsular polar infantile and juvenile cataract, bilateralOther cataract (H26)
H26.049Anterior subcapsular polar infantile and juvenile cataract, unspecified eyeOther cataract (H26)
H26.051Posterior subcapsular polar infantile and juvenile cataract, right eyeOther cataract (H26)
H26.052Posterior subcapsular polar infantile and juvenile cataract, left eyeOther cataract (H26)
H26.053Posterior subcapsular polar infantile and juvenile cataract, bilateralOther cataract (H26)
H26.059Posterior subcapsular polar infantile and juvenile cataract, unspecified eyeOther cataract (H26)
H26.061Combined forms of infantile and juvenile cataract, right eyeOther cataract (H26)
H26.062Combined forms of infantile and juvenile cataract, left eyeOther cataract (H26)
H26.063Combined forms of infantile and juvenile cataract, bilateralOther cataract (H26)
H26.069Combined forms of infantile and juvenile cataract, unspecified eyeOther cataract (H26)
H26.09Other infantile and juvenile cataractOther cataract (H26)
L12.2Chronic bullous disease of childhoodPemphigoid (L12)
L20.83Infantile (acute) (chronic) eczemaAtopic dermatitis (L20)
L21.1Seborrheic infantile dermatitisSeborrheic dermatitis (L21)
L44.4Infantile papular acrodermatitis [Gianotti-Crosti]Other papulosquamous disorders (L44)
L70.4Infantile acneAcne (L70)
N92.2Excessive menstruation at pubertyExcessive, frequent and irregular menstruation (N92)
R04.81Acute idiopathic pulmonary hemorrhage in infantsHemorrhage from respiratory passages (R04)
R10.83ColicAbdominal and pelvic pain (R10)
R62.0Delayed milestone in childhoodLack of expected normal physiol dev in childhood and adults (R62)
R62.51Failure to thrive (child)Lack of expected normal physiol dev in childhood and adults (R62)
R63.31Pediatric feeding disorder, acuteSymptoms and signs concerning food and fluid intake (R63)
R63.32Pediatric feeding disorder, chronicSymptoms and signs concerning food and fluid intake (R63)
R68.11Excessive crying of infant (baby)Other general symptoms and signs (R68)
R68.12Fussy infant (baby)Other general symptoms and signs (R68)
R68.13Apparent life threatening event in infant (ALTE)Other general symptoms and signs (R68)
R68.19Other nonspecific symptoms peculiar to infancyOther general symptoms and signs (R68)
T74.02XAChild neglect or abandonment, confirmed, initial encounterAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.02XDChild neglect or abandonment, confirmed, subsequent encounterAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.02XSChild neglect or abandonment, confirmed, sequelaAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.12XAChild physical abuse, confirmed, initial encounterAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.12XDChild physical abuse, confirmed, subsequent encounterAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.12XSChild physical abuse, confirmed, sequelaAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.22XAChild sexual abuse, confirmed, initial encounterAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.22XDChild sexual abuse, confirmed, subsequent encounterAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.22XSChild sexual abuse, confirmed, sequelaAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.32XAChild psychological abuse, confirmed, initial encounterAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.32XDChild psychological abuse, confirmed, subsequent encounterAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.32XSChild psychological abuse, confirmed, sequelaAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.4XXAShaken infant syndrome, initial encounterAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.4XXDShaken infant syndrome, subsequent encounterAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.4XXSShaken infant syndrome, sequelaAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.52XAChild sexual exploitation, confirmed, initial encounterAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.52XDChild sexual exploitation, confirmed, subsequent encounterAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.52XSChild sexual exploitation, confirmed, sequelaAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.62XAChild forced labor exploitation, confirmed, initial encounterAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.62XDChild forced labor exploitation, confirmed, subsequent encounterAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.62XSChild forced labor exploitation, confirmed, sequelaAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.92XAUnspecified child maltreatment, confirmed, initial encounterAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.92XDUnspecified child maltreatment, confirmed, subsequent encounterAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.92XSUnspecified child maltreatment, confirmed, sequelaAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.A2XAChild financial abuse, confirmed, initial encounterAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.A2XDChild financial abuse, confirmed, subsequent encounterAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T74.A2XSChild financial abuse, confirmed, sequelaAdult and child abuse, neglect and oth maltreat, confirmed (T74)
T76.02XAChild neglect or abandonment, suspected, initial encounterAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.02XDChild neglect or abandonment, suspected, subsequent encounterAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.02XSChild neglect or abandonment, suspected, sequelaAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.12XAChild physical abuse, suspected, initial encounterAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.12XDChild physical abuse, suspected, subsequent encounterAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.12XSChild physical abuse, suspected, sequelaAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.22XAChild sexual abuse, suspected, initial encounterAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.22XDChild sexual abuse, suspected, subsequent encounterAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.22XSChild sexual abuse, suspected, sequelaAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.32XAChild psychological abuse, suspected, initial encounterAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.32XDChild psychological abuse, suspected, subsequent encounterAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.32XSChild psychological abuse, suspected, sequelaAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.52XAChild sexual exploitation, suspected, initial encounterAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.52XDChild sexual exploitation, suspected, subsequent encounterAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.52XSChild sexual exploitation, suspected, sequelaAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.62XAChild forced labor exploitation, suspected, initial encounterAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.62XDChild forced labor exploitation, suspected, subsequent encounterAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.62XSChild forced labor exploitation, suspected, sequelaAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.92XAUnspecified child maltreatment, suspected, initial encounterAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.92XDUnspecified child maltreatment, suspected, subsequent encounterAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.92XSUnspecified child maltreatment, suspected, sequelaAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.A2XAChild financial abuse, suspected, initial encounterAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.A2XDChild financial abuse, suspected, subsequent encounterAdult and child abuse, neglect and oth maltreat, suspected (T76)
T76.A2XSChild financial abuse, suspected, sequelaAdult and child abuse, neglect and oth maltreat, suspected (T76)
Z00.121Encounter for routine child health examination with abnormal findingsEncntr for general exam w/o complaint, susp or reprtd dx (Z00)
Z00.129Encounter for routine child health examination without abnormal findingsEncntr for general exam w/o complaint, susp or reprtd dx (Z00)
Z00.2Encounter for examination for period of rapid growth in childhoodEncntr for general exam w/o complaint, susp or reprtd dx (Z00)
Z00.3Encounter for examination for adolescent development stateEncntr for general exam w/o complaint, susp or reprtd dx (Z00)
Z00.70Encounter for examination for period of delayed growth in childhood without abnormal findingsEncntr for general exam w/o complaint, susp or reprtd dx (Z00)
Z00.71Encounter for examination for period of delayed growth in childhood with abnormal findingsEncntr for general exam w/o complaint, susp or reprtd dx (Z00)
Z04.42Encounter for examination and observation following alleged child rapeEncounter for examination and observation for other reasons (Z04)
Z04.72Encounter for examination and observation following alleged child physical abuseEncounter for examination and observation for other reasons (Z04)
Z62.21Child in welfare custodyProblems related to upbringing (Z62)
Z62.3Hostility towards and scapegoating of childProblems related to upbringing (Z62)
Z69.010Encounter for mental health services for victim of parental child abuseEncntr for mental health serv for victim and perp of abuse (Z69)
Z69.020Encounter for mental health services for victim of non-parental child abuseEncntr for mental health serv for victim and perp of abuse (Z69)
Z72.810Child and adolescent antisocial behaviorProblems related to lifestyle (Z72)
Z73.810Behavioral insomnia of childhood, sleep-onset association typeProblems related to life management difficulty (Z73)
Z73.811Behavioral insomnia of childhood, limit setting typeProblems related to life management difficulty (Z73)
Z73.812Behavioral insomnia of childhood, combined typeProblems related to life management difficulty (Z73)
Z73.819Behavioral insomnia of childhood, unspecified typeProblems related to life management difficulty (Z73)
Z76.2Encounter for health supervision and care of other healthy infant and childPersons encountering health services in other circumstances (Z76)