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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 125 ICD-10-CM codes are intended for pediatric diagnoses

  • Other bacterial diseases, not elsewhere classified (A48)

  • Other viral infections characterized by skin and mucous membrane lesions, not elsewhere classified (B08)

    • B08.20 - Exanthema subitum [sixth disease], unspecified

    • B08.21 - Exanthema subitum [sixth disease] due to human herpesvirus 6

    • B08.22 - Exanthema subitum [sixth disease] due to human herpesvirus 7

  • Monocytic leukemia (C93)

    • C93.30 - Juvenile myelomonocytic leukemia, not having achieved remission

    • C93.31 - Juvenile myelomonocytic leukemia, in remission

    • C93.32 - Juvenile myelomonocytic leukemia, in relapse

  • Disorders of puberty, not elsewhere classified (E30)

    • E30.1 - Precocious puberty

    • E30.8 - Other disorders of puberty

  • Gender identity disorders (F64)

    • F64.2 - Gender identity disorder of childhood

  • Pervasive developmental disorders (F84)

    • F84.3 - Other childhood disintegrative disorder

  • Other disorders of brain (G93)

    • G93.7 - Reye's syndrome

  • Other cataract (H26)

    • H26.001 - Unspecified infantile and juvenile cataract, right eye

    • H26.002 - Unspecified infantile and juvenile cataract, left eye

    • H26.003 - Unspecified infantile and juvenile cataract, bilateral

    • H26.009 - Unspecified infantile and juvenile cataract, unspecified eye

    • H26.011 - Infantile and juvenile cortical, lamellar, or zonular cataract, right eye

    • H26.012 - Infantile and juvenile cortical, lamellar, or zonular cataract, left eye

    • H26.013 - Infantile and juvenile cortical, lamellar, or zonular cataract, bilateral

    • H26.019 - Infantile and juvenile cortical, lamellar, or zonular cataract, unspecified eye

    • H26.031 - Infantile and juvenile nuclear cataract, right eye

    • H26.032 - Infantile and juvenile nuclear cataract, left eye

    • H26.033 - Infantile and juvenile nuclear cataract, bilateral

    • H26.039 - Infantile and juvenile nuclear cataract, unspecified eye

    • H26.041 - Anterior subcapsular polar infantile and juvenile cataract, right eye

    • H26.042 - Anterior subcapsular polar infantile and juvenile cataract, left eye

    • H26.043 - Anterior subcapsular polar infantile and juvenile cataract, bilateral

    • H26.049 - Anterior subcapsular polar infantile and juvenile cataract, unspecified eye

    • H26.051 - Posterior subcapsular polar infantile and juvenile cataract, right eye

    • H26.052 - Posterior subcapsular polar infantile and juvenile cataract, left eye

    • H26.053 - Posterior subcapsular polar infantile and juvenile cataract, bilateral

    • H26.059 - Posterior subcapsular polar infantile and juvenile cataract, unspecified eye

    • H26.061 - Combined forms of infantile and juvenile cataract, right eye

    • H26.062 - Combined forms of infantile and juvenile cataract, left eye

    • H26.063 - Combined forms of infantile and juvenile cataract, bilateral

    • H26.069 - Combined forms of infantile and juvenile cataract, unspecified eye

    • H26.09 - Other infantile and juvenile cataract

  • Pemphigoid (L12)

    • L12.2 - Chronic bullous disease of childhood

  • Atopic dermatitis (L20)

    • L20.83 - Infantile (acute) (chronic) eczema

  • Seborrheic dermatitis (L21)

    • L21.1 - Seborrheic infantile dermatitis

  • Other papulosquamous disorders (L44)

    • L44.4 - Infantile papular acrodermatitis [Gianotti-Crosti]

  • Acne (L70)

  • Excessive, frequent and irregular menstruation (N92)

    • N92.2 - Excessive menstruation at puberty

  • Hemorrhage from respiratory passages (R04)

    • R04.81 - Acute idiopathic pulmonary hemorrhage in infants

  • Abdominal and pelvic pain (R10)

  • Lack of expected normal physiological development in childhood and adults (R62)

    • R62.0 - Delayed milestone in childhood

    • R62.51 - Failure to thrive (child)

  • Symptoms and signs concerning food and fluid intake (R63)

    • R63.31 - Pediatric feeding disorder, acute

    • R63.32 - Pediatric feeding disorder, chronic

  • Other general symptoms and signs (R68)

    • R68.11 - Excessive crying of infant (baby)

    • R68.12 - Fussy infant (baby)

    • R68.13 - Apparent life threatening event in infant (ALTE)

    • R68.19 - Other nonspecific symptoms peculiar to infancy

  • Adult and child abuse, neglect and other maltreatment, confirmed (T74)

    • T74.02XA - Child neglect or abandonment, confirmed, initial encounter

    • T74.02XD - Child neglect or abandonment, confirmed, subsequent encounter

    • T74.02XS - Child neglect or abandonment, confirmed, sequela

    • T74.12XA - Child physical abuse, confirmed, initial encounter

    • T74.12XD - Child physical abuse, confirmed, subsequent encounter

    • T74.12XS - Child physical abuse, confirmed, sequela

    • T74.22XA - Child sexual abuse, confirmed, initial encounter

    • T74.22XD - Child sexual abuse, confirmed, subsequent encounter

    • T74.22XS - Child sexual abuse, confirmed, sequela

    • T74.32XA - Child psychological abuse, confirmed, initial encounter

    • T74.32XD - Child psychological abuse, confirmed, subsequent encounter

    • T74.32XS - Child psychological abuse, confirmed, sequela

    • T74.4XXA - Shaken infant syndrome, initial encounter

    • T74.4XXD - Shaken infant syndrome, subsequent encounter

    • T74.4XXS - Shaken infant syndrome, sequela

    • T74.52XA - Child sexual exploitation, confirmed, initial encounter

    • T74.52XD - Child sexual exploitation, confirmed, subsequent encounter

    • T74.52XS - Child sexual exploitation, confirmed, sequela

    • T74.62XA - Child forced labor exploitation, confirmed, initial encounter

    • T74.62XD - Child forced labor exploitation, confirmed, subsequent encounter

    • T74.62XS - Child forced labor exploitation, confirmed, sequela

    • T74.92XA - Unspecified child maltreatment, confirmed, initial encounter

    • T74.92XD - Unspecified child maltreatment, confirmed, subsequent encounter

    • T74.92XS - Unspecified child maltreatment, confirmed, sequela

    • T74.A2XA - Child financial abuse, confirmed, initial encounter

    • T74.A2XD - Child financial abuse, confirmed, subsequent encounter

    • T74.A2XS - Child financial abuse, confirmed, sequela

  • Adult and child abuse, neglect and other maltreatment, suspected (T76)

    • T76.02XA - Child neglect or abandonment, suspected, initial encounter

    • T76.02XD - Child neglect or abandonment, suspected, subsequent encounter

    • T76.02XS - Child neglect or abandonment, suspected, sequela

    • T76.12XA - Child physical abuse, suspected, initial encounter

    • T76.12XD - Child physical abuse, suspected, subsequent encounter

    • T76.12XS - Child physical abuse, suspected, sequela

    • T76.22XA - Child sexual abuse, suspected, initial encounter

    • T76.22XD - Child sexual abuse, suspected, subsequent encounter

    • T76.22XS - Child sexual abuse, suspected, sequela

    • T76.32XA - Child psychological abuse, suspected, initial encounter

    • T76.32XD - Child psychological abuse, suspected, subsequent encounter

    • T76.32XS - Child psychological abuse, suspected, sequela

    • T76.52XA - Child sexual exploitation, suspected, initial encounter

    • T76.52XD - Child sexual exploitation, suspected, subsequent encounter

    • T76.52XS - Child sexual exploitation, suspected, sequela

    • T76.62XA - Child forced labor exploitation, suspected, initial encounter

    • T76.62XD - Child forced labor exploitation, suspected, subsequent encounter

    • T76.62XS - Child forced labor exploitation, suspected, sequela

    • T76.92XA - Unspecified child maltreatment, suspected, initial encounter

    • T76.92XD - Unspecified child maltreatment, suspected, subsequent encounter

    • T76.92XS - Unspecified child maltreatment, suspected, sequela

    • T76.A2XA - Child financial abuse, suspected, initial encounter

    • T76.A2XD - Child financial abuse, suspected, subsequent encounter

    • T76.A2XS - Child financial abuse, suspected, sequela

  • Encounter for general examination without complaint, suspected or reported diagnosis (Z00)

    • Z00.121 - Encounter for routine child health examination with abnormal findings

    • Z00.129 - Encounter for routine child health examination without abnormal findings

    • Z00.2 - Encounter for examination for period of rapid growth in childhood

    • Z00.3 - Encounter for examination for adolescent development state

    • Z00.70 - Encounter for examination for period of delayed growth in childhood without abnormal findings

    • Z00.71 - Encounter for examination for period of delayed growth in childhood with abnormal findings

  • Encounter for administrative examination (Z02)

    • Z02.84 - Encounter for child welfare exam

  • Encounter for examination and observation for other reasons (Z04)

    • Z04.42 - Encounter for examination and observation following alleged child rape

    • Z04.72 - Encounter for examination and observation following alleged child physical abuse

  • Encounter for mental health services for victim and perpetrator of abuse (Z69)

    • Z69.010 - Encounter for mental health services for victim of parental child abuse

    • Z69.020 - Encounter for mental health services for victim of non-parental child abuse

  • Persons encountering health services in other circumstances (Z76)

    • Z76.2 - Encounter for health supervision and care of other healthy infant and child