Group 1 OR Group 2
- E2603
- E2604
- E2622
- E2623
Group 2 OR Group 3
- E0953
- E0955
- E0956
- E0957
- E0960
- E2605
- E2606
- E2613
- E2614
- E2615
- E2616
- E2617
- E2620
- E2621
One code from Group 1 and Group 3 | OR | One code from Group 2
- E2607
- E2608
- E2624
- E2625
Group 1 Codes:
| Code | Description | GROUP |
|---|---|---|
| L89.130 | Pressure ulcer of right lower back, unstageable | 1 |
| L89.131 | Pressure ulcer of right lower back, stage 1 | 1 |
| L89.132 | Pressure ulcer of right lower back, stage 2 | 1 |
| L89.133 | Pressure ulcer of right lower back, stage 3 | 1 |
| L89.134 | Pressure ulcer of right lower back, stage 4 | 1 |
| L89.140 | Pressure ulcer of left lower back, unstageable | 1 |
| L89.141 | Pressure ulcer of left lower back, stage 1 | 1 |
| L89.142 | Pressure ulcer of left lower back, stage 2 | 1 |
| L89.143 | Pressure ulcer of left lower back, stage 3 | 1 |
| L89.144 | Pressure ulcer of left lower back, stage 4 | 1 |
| L89.150 | Pressure ulcer of sacral region, unstageable | 1 |
| L89.151 | Pressure ulcer of sacral region, stage 1 | 1 |
| L89.152 | Pressure ulcer of sacral region, stage 2 | 1 |
| L89.153 | Pressure ulcer of sacral region, stage 3 | 1 |
| L89.154 | Pressure ulcer of sacral region, stage 4 | 1 |
| L89.200 | Pressure ulcer of unspecified hip, unstageable | 1 |
| L89.201 | Pressure ulcer of unspecified hip, stage 1 | 1 |
| L89.202 | Pressure ulcer of unspecified hip, stage 2 | 1 |
| L89.203 | Pressure ulcer of unspecified hip, stage 3 | 1 |
| L89.204 | Pressure ulcer of unspecified hip, stage 4 | 1 |
| L89.210 | Pressure ulcer of right hip, unstageable | 1 |
| L89.211 | Pressure ulcer of right hip, stage 1 | 1 |
| L89.212 | Pressure ulcer of right hip, stage 2 | 1 |
| L89.213 | Pressure ulcer of right hip, stage 3 | 1 |
| L89.214 | Pressure ulcer of right hip, stage 4 | 1 |
| L89.220 | Pressure ulcer of left hip, unstageable | 1 |
| L89.221 | Pressure ulcer of left hip, stage 1 | 1 |
| L89.222 | Pressure ulcer of left hip, stage 2 | 1 |
| L89.223 | Pressure ulcer of left hip, stage 3 | 1 |
| L89.224 | Pressure ulcer of left hip, stage 4 | 1 |
| L89.300 | Pressure ulcer of unspecified buttock, unstageable | 1 |
| L89.301 | Pressure ulcer of unspecified buttock, stage 1 | 1 |
| L89.302 | Pressure ulcer of unspecified buttock, stage 2 | 1 |
| L89.303 | Pressure ulcer of unspecified buttock, stage 3 | 1 |
| L89.304 | Pressure ulcer of unspecified buttock, stage 4 | 1 |
| L89.310 | Pressure ulcer of right buttock, unstageable | 1 |
| L89.311 | Pressure ulcer of right buttock, stage 1 | 1 |
| L89.312 | Pressure ulcer of right buttock, stage 2 | 1 |
| L89.313 | Pressure ulcer of right buttock, stage 3 | 1 |
| L89.314 | Pressure ulcer of right buttock, stage 4 | 1 |
| L89.320 | Pressure ulcer of left buttock, unstageable | 1 |
| L89.321 | Pressure ulcer of left buttock, stage 1 | 1 |
| L89.322 | Pressure ulcer of left buttock, stage 2 | 1 |
| L89.323 | Pressure ulcer of left buttock, stage 3 | 1 |
| L89.324 | Pressure ulcer of left buttock, stage 4 | 1 |
| L89.41 | Pressure ulcer of contiguous site of back, buttock and hip, stage 1 | 1 |
| L89.42 | Pressure ulcer of contiguous site of back, buttock and hip, stage 2 | 1 |
| L89.43 | Pressure ulcer of contiguous site of back, buttock and hip, stage 3 | 1 |
| L89.44 | Pressure ulcer of contiguous site of back, buttock and hip, stage 4 | 1 |
| L89.45 | Pressure ulcer of contiguous site of back, buttock and hip, unstageable | 1 |
| Z87.2 | Personal history of diseases of the skin and subcutaneous tissue | 1 |
Group 2 Codes
| Code | Description | GROUP |
|---|---|---|
| B91 | Sequelae of poliomyelitis | 2 |
| E75.00 | GM2 gangliosidosis, unspecified | 2 |
| E75.01 | Sandhoff disease | 2 |
| E75.02 | Tay-Sachs disease | 2 |
| E75.09 | Other GM2 gangliosidosis | 2 |
| E75.10 | Unspecified gangliosidosis | 2 |
| E75.11 | Mucolipidosis IV | 2 |
| E75.19 | Other gangliosidosis | 2 |
| E75.23 | Krabbe disease | 2 |
| E75.25 | Metachromatic leukodystrophy | 2 |
| E75.27 | Pelizaeus-Merzbacher disease | 2 |
| E75.28 | Canavan disease | 2 |
| E75.29 | Other sphingolipidosis | 2 |
| E75.4 | Neuronal ceroid lipofuscinosis | 2 |
| F03.90 | Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | 2 |
| F03.911 | Unspecified dementia, unspecified severity, with agitation | 2 |
| F03.918 | Unspecified dementia, unspecified severity, with other behavioral disturbance | 2 |
| F03.92 | Unspecified dementia, unspecified severity, with psychotic disturbance | 2 |
| F03.93 | Unspecified dementia, unspecified severity, with mood disturbance | 2 |
| F03.94 | Unspecified dementia, unspecified severity, with anxiety | 2 |
| F03.A11 | Unspecified dementia, mild, with agitation | 2 |
| F03.A18 | Unspecified dementia, mild, with other behavioral disturbance | 2 |
| F03.A2 | Unspecified dementia, mild, with psychotic disturbance | 2 |
| F03.A3 | Unspecified dementia, mild, with mood disturbance | 2 |
| F03.A4 | Unspecified dementia, mild, with anxiety | 2 |
| F03.B11 | Unspecified dementia, moderate, with agitation | 2 |
| F03.B18 | Unspecified dementia, moderate, with other behavioral disturbance | 2 |
| F03.B2 | Unspecified dementia, moderate, with psychotic disturbance | 2 |
| F03.B3 | Unspecified dementia, moderate, with mood disturbance | 2 |
| F03.B4 | Unspecified dementia, moderate, with anxiety | 2 |
| F03.C11 | Unspecified dementia, severe, with agitation | 2 |
| F03.C18 | Unspecified dementia, severe, with other behavioral disturbance | 2 |
| F03.C2 | Unspecified dementia, severe, with psychotic disturbance | 2 |
| F03.C3 | Unspecified dementia, severe, with mood disturbance | 2 |
| F03.C4 | Unspecified dementia, severe, with anxiety | 2 |
| F84.2 | Rett’s syndrome | 2 |
| G04.1 | Tropical spastic paraplegia | 2 |
| G04.82 | Acute flaccid myelitis | 2 |
| G04.89 | Other myelitis | 2 |
| G10 | Huntington’s disease | 2 |
| G11.0 | Congenital nonprogressive ataxia | 2 |
| G11.10 | Early-onset cerebellar ataxia, unspecified | 2 |
| G11.11 | Friedreich ataxia | 2 |
| G11.19 | Other early-onset cerebellar ataxia | 2 |
| G11.2 | Late-onset cerebellar ataxia | 2 |
| G11.3 | Cerebellar ataxia with defective DNA repair | 2 |
| G11.4 | Hereditary spastic paraplegia | 2 |
| G11.8 | Other hereditary ataxias | 2 |
| G11.9 | Hereditary ataxia, unspecified | 2 |
| G12.0 | Infantile spinal muscular atrophy, type I [Werdnig-Hoffman] | 2 |
| G12.1 | Other inherited spinal muscular atrophy | 2 |
| G12.20 | Motor neuron disease, unspecified | 2 |
| G12.21 | Amyotrophic lateral sclerosis | 2 |
| G12.23 | Primary lateral sclerosis | 2 |
| G12.24 | Familial motor neuron disease | 2 |
| G12.25 | Progressive spinal muscle atrophy | 2 |
| G12.29 | Other motor neuron disease | 2 |
| G12.8 | Other spinal muscular atrophies and related syndromes | 2 |
| G12.9 | Spinal muscular atrophy, unspecified | 2 |
| G14 | Postpolio syndrome | 2 |
| G20.A1 | Parkinson’s disease without dyskinesia, without mention of fluctuations | 2 |
| G20.A2 | Parkinson’s disease without dyskinesia, with fluctuations | 2 |
| G20.B1 | Parkinson’s disease with dyskinesia, without mention of fluctuations | 2 |
| G20.B2 | Parkinson’s disease with dyskinesia, with fluctuations | 2 |
| G20.C | Parkinsonism, unspecified | 2 |
| G21.4 | Vascular parkinsonism | 2 |
| G24.1 | Genetic torsion dystonia | 2 |
| G30.0 | Alzheimer’s disease with early onset | 2 |
| G30.1 | Alzheimer’s disease with late onset | 2 |
| G30.8 | Other Alzheimer’s disease | 2 |
| G30.9 | Alzheimer’s disease, unspecified | 2 |
| G31.80 | Leukodystrophy, unspecified | 2 |
| G31.81 | Alpers disease | 2 |
| G31.82 | Leigh’s disease | 2 |
| G31.83 | Neurocognitive disorder with Lewy bodies | 2 |
| G31.86 | Alexander disease | 2 |
| G31.89 | Other specified degenerative diseases of nervous system | 2 |
| G32.0 | Subacute combined degeneration of spinal cord in diseases classified elsewhere | 2 |
| G32.81 | Cerebellar ataxia in diseases classified elsewhere | 2 |
| G32.89 | Other specified degenerative disorders of nervous system in diseases classified elsewhere | 2 |
| G35 | Multiple sclerosis | 2 |
| G36.0 | Neuromyelitis optica [Devic] | 2 |
| G36.1 | Acute and subacute hemorrhagic leukoencephalitis [Hurst] | 2 |
| G36.8 | Other specified acute disseminated demyelination | 2 |
| G36.9 | Acute disseminated demyelination, unspecified | 2 |
| G37.0 | Diffuse sclerosis of central nervous system | 2 |
| G37.1 | Central demyelination of corpus callosum | 2 |
| G37.2 | Central pontine myelinolysis | 2 |
| G37.3 | Acute transverse myelitis in demyelinating disease of central nervous system | 2 |
| G37.4 | Subacute necrotizing myelitis of central nervous system | 2 |
| G37.5 | Concentric sclerosis [Balo] of central nervous system | 2 |
| G37.81 | Myelin oligodendrocyte glycoprotein antibody disease | 2 |
| G37.89 | Other specified demyelinating diseases of central nervous system | 2 |
| G37.9 | Demyelinating disease of central nervous system, unspecified | 2 |
| G60.0 | Hereditary motor and sensory neuropathy | 2 |
| G61.0 | Guillain-Barre syndrome | 2 |
| G70.00 | Myasthenia gravis without (acute) exacerbation | 2 |
| G70.01 | Myasthenia gravis with (acute) exacerbation | 2 |
| G71.00 | Muscular dystrophy, unspecified | 2 |
| G71.01 | Duchenne or Becker muscular dystrophy | 2 |
| G71.02 | Facioscapulohumeral muscular dystrophy | 2 |
| G71.031 | Autosomal dominant limb girdle muscular dystrophy | 2 |
| G71.032 | Autosomal recessive limb girdle muscular dystrophy due to calpain-3 dysfunction | 2 |
| G71.033 | Limb girdle muscular dystrophy due to dysferlin dysfunction | 2 |
| G71.0340 | Limb girdle muscular dystrophy due to sarcoglycan dysfunction, unspecified | 2 |
| G71.0341 | Limb girdle muscular dystrophy due to alpha sarcoglycan dysfunction | 2 |
| G71.0342 | Limb girdle muscular dystrophy due to beta sarcoglycan dysfunction | 2 |
| G71.0349 | Limb girdle muscular dystrophy due to other sarcoglycan dysfunction | 2 |
| G71.035 | Limb girdle muscular dystrophy due to anoctamin-5 dysfunction | 2 |
| G71.038 | Other limb girdle muscular dystrophy | 2 |
| G71.039 | Limb girdle muscular dystrophy, unspecified | 2 |
| G71.09 | Other specified muscular dystrophies | 2 |
| G71.11 | Myotonic muscular dystrophy | 2 |
| G71.20 | Congenital myopathy, unspecified | 2 |
| G71.21 | Nemaline myopathy | 2 |
| G71.220 | X-linked myotubular myopathy | 2 |
| G71.228 | Other centronuclear myopathy | 2 |
| G71.29 | Other congenital myopathy | 2 |
| G72.41 | Inclusion body myositis [IBM] | 2 |
| G80.0 | Spastic quadriplegic cerebral palsy | 2 |
| G80.1 | Spastic diplegic cerebral palsy | 2 |
| G80.2 | Spastic hemiplegic cerebral palsy | 2 |
| G80.3 | Athetoid cerebral palsy | 2 |
| G80.4 | Ataxic cerebral palsy | 2 |
| G80.8 | Other cerebral palsy | 2 |
| G80.9 | Cerebral palsy, unspecified | 2 |
| G81.00 | Flaccid hemiplegia affecting unspecified side | 2 |
| G81.01 | Flaccid hemiplegia affecting right dominant side | 2 |
| G81.02 | Flaccid hemiplegia affecting left dominant side | 2 |
| G81.03 | Flaccid hemiplegia affecting right nondominant side | 2 |
| G81.04 | Flaccid hemiplegia affecting left nondominant side | 2 |
| G81.10 | Spastic hemiplegia affecting unspecified side | 2 |
| G81.11 | Spastic hemiplegia affecting right dominant side | 2 |
| G81.12 | Spastic hemiplegia affecting left dominant side | 2 |
| G81.13 | Spastic hemiplegia affecting right nondominant side | 2 |
| G81.14 | Spastic hemiplegia affecting left nondominant side | 2 |
| G81.90 | Hemiplegia, unspecified affecting unspecified side | 2 |
| G81.91 | Hemiplegia, unspecified affecting right dominant side | 2 |
| G81.92 | Hemiplegia, unspecified affecting left dominant side | 2 |
| G81.93 | Hemiplegia, unspecified affecting right nondominant side | 2 |
| G81.94 | Hemiplegia, unspecified affecting left nondominant side | 2 |
| G82.20 | Paraplegia, unspecified | 2 |
| G82.21 | Paraplegia, complete | 2 |
| G82.22 | Paraplegia, incomplete | 2 |
| G82.50 | Quadriplegia, unspecified | 2 |
| G82.51 | Quadriplegia, C1-C4 complete | 2 |
| G82.52 | Quadriplegia, C1-C4 incomplete | 2 |
| G82.53 | Quadriplegia, C5-C7 complete | 2 |
| G82.54 | Quadriplegia, C5-C7 incomplete | 2 |
| G93.89 | Other specified disorders of brain | 2 |
| G93.9 | Disorder of brain, unspecified | 2 |
| G94 | Other disorders of brain in diseases classified elsewhere | 2 |
| G95.0 | Syringomyelia and syringobulbia | 2 |
| G95.11 | Acute infarction of spinal cord (embolic) (nonembolic) | 2 |
| G95.19 | Other vascular myelopathies | 2 |
| G99.2 | Myelopathy in diseases classified elsewhere | 2 |
| I69.051 | Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage affecting right dominant side | 2 |
| I69.052 | Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage affecting left dominant side | 2 |
| I69.053 | Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage affecting right non-dominant side | 2 |
| I69.054 | Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage affecting left non-dominant side | 2 |
| I69.059 | Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage affecting unspecified side | 2 |
| I69.151 | Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting right dominant side | 2 |
| I69.152 | Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting left dominant side | 2 |
| I69.153 | Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting right non-dominant side | 2 |
| I69.154 | Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting left non-dominant side | 2 |
| I69.159 | Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting unspecified side | 2 |
| I69.251 | Hemiplegia and hemiparesis following other nontraumatic intracranial hemorrhage affecting right dominant side | 2 |
| I69.252 | Hemiplegia and hemiparesis following other nontraumatic intracranial hemorrhage affecting left dominant side | 2 |
| I69.253 | Hemiplegia and hemiparesis following other nontraumatic intracranial hemorrhage affecting right non-dominant side | 2 |
| I69.254 | Hemiplegia and hemiparesis following other nontraumatic intracranial hemorrhage affecting left non-dominant side | 2 |
| I69.259 | Hemiplegia and hemiparesis following other nontraumatic intracranial hemorrhage affecting unspecified side | 2 |
| I69.351 | Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side | 2 |
| I69.352 | Hemiplegia and hemiparesis following cerebral infarction affecting left dominant side | 2 |
| I69.353 | Hemiplegia and hemiparesis following cerebral infarction affecting right non-dominant side | 2 |
| I69.354 | Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side | 2 |
| I69.359 | Hemiplegia and hemiparesis following cerebral infarction affecting unspecified side | 2 |
| I69.851 | Hemiplegia and hemiparesis following other cerebrovascular disease affecting right dominant side | 2 |
| I69.852 | Hemiplegia and hemiparesis following other cerebrovascular disease affecting left dominant side | 2 |
| I69.853 | Hemiplegia and hemiparesis following other cerebrovascular disease affecting right non-dominant side | 2 |
| I69.854 | Hemiplegia and hemiparesis following other cerebrovascular disease affecting left non-dominant side | 2 |
| I69.859 | Hemiplegia and hemiparesis following other cerebrovascular disease affecting unspecified side | 2 |
| I69.951 | Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting right dominant side | 2 |
| I69.952 | Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting left dominant side | 2 |
| I69.953 | Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting right non-dominant side | 2 |
| I69.954 | Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting left non-dominant side | 2 |
| I69.959 | Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting unspecified side | 2 |
| M48.00 | Spinal stenosis, site unspecified | 2 |
| M48.01 | Spinal stenosis, occipito-atlanto-axial region | 2 |
| M48.02 | Spinal stenosis, cervical region | 2 |
| M48.03 | Spinal stenosis, cervicothoracic region | 2 |
| M48.04 | Spinal stenosis, thoracic region | 2 |
| M48.05 | Spinal stenosis, thoracolumbar region | 2 |
| M48.061 | Spinal stenosis, lumbar region without neurogenic claudication | 2 |
| M48.062 | Spinal stenosis, lumbar region with neurogenic claudication | 2 |
| M48.07 | Spinal stenosis, lumbosacral region | 2 |
| M48.08 | Spinal stenosis, sacral and sacrococcygeal region | 2 |
| M62.3 | Immobility syndrome (paraplegic) | 2 |
| M62.85 | Dysfunction of the multifidus muscles, lumbar region | 2 |
| M62.89 | Other specified disorders of muscle | 2 |
| Q03.0 | Malformations of aqueduct of Sylvius | 2 |
| Q03.1 | Atresia of foramina of Magendie and Luschka | 2 |
| Q03.8 | Other congenital hydrocephalus | 2 |
| Q03.9 | Congenital hydrocephalus, unspecified | 2 |
| Q05.0 | Cervical spina bifida with hydrocephalus | 2 |
| Q05.1 | Thoracic spina bifida with hydrocephalus | 2 |
| Q05.2 | Lumbar spina bifida with hydrocephalus | 2 |
| Q05.3 | Sacral spina bifida with hydrocephalus | 2 |
| Q05.4 | Unspecified spina bifida with hydrocephalus | 2 |
| Q05.5 | Cervical spina bifida without hydrocephalus | 2 |
| Q05.6 | Thoracic spina bifida without hydrocephalus | 2 |
| Q05.7 | Lumbar spina bifida without hydrocephalus | 2 |
| Q05.8 | Sacral spina bifida without hydrocephalus | 2 |
| Q05.9 | Spina bifida, unspecified | 2 |
| Q07.00 | Arnold-Chiari syndrome without spina bifida or hydrocephalus | 2 |
| Q07.01 | Arnold-Chiari syndrome with spina bifida | 2 |
| Q07.02 | Arnold-Chiari syndrome with hydrocephalus | 2 |
| Q07.03 | Arnold-Chiari syndrome with spina bifida and hydrocephalus | 2 |
| Q67.8 | Other congenital deformities of chest | 2 |
| Q68.1 | Congenital deformity of finger(s) and hand | 2 |
| Q74.3 | Arthrogryposis multiplex congenita | 2 |
| Q78.0 | Osteogenesis imperfecta | 2 |
| Q79.60 | Ehlers-Danlos syndrome, unspecified | 2 |
| Q79.61 | Classical Ehlers-Danlos syndrome | 2 |
| Q79.62 | Hypermobile Ehlers-Danlos syndrome | 2 |
| Q79.63 | Vascular Ehlers-Danlos syndrome | 2 |
| Q79.69 | Other Ehlers-Danlos syndromes | 2 |
| Q90.0 | Trisomy 21, nonmosaicism (meiotic nondisjunction) | 2 |
| Q90.1 | Trisomy 21, mosaicism (mitotic nondisjunction) | 2 |
| Q90.2 | Trisomy 21, translocation | 2 |
| Q90.9 | Down syndrome, unspecified | 2 |
Group 3 Codes
| Code | Description | GROUP |
|---|---|---|
| G83.10 | Monoplegia of lower limb affecting unspecified side | 3 |
| G83.11 | Monoplegia of lower limb affecting right dominant side | 3 |
| G83.12 | Monoplegia of lower limb affecting left dominant side | 3 |
| G83.13 | Monoplegia of lower limb affecting right nondominant side | 3 |
| G83.14 | Monoplegia of lower limb affecting left nondominant side | 3 |
| I69.041 | Monoplegia of lower limb following nontraumatic subarachnoid hemorrhage affecting right dominant side | 3 |
| I69.042 | Monoplegia of lower limb following nontraumatic subarachnoid hemorrhage affecting left dominant side | 3 |
| I69.043 | Monoplegia of lower limb following nontraumatic subarachnoid hemorrhage affecting right non-dominant side | 3 |
| I69.044 | Monoplegia of lower limb following nontraumatic subarachnoid hemorrhage affecting left non-dominant side | 3 |
| I69.049 | Monoplegia of lower limb following nontraumatic subarachnoid hemorrhage affecting unspecified side | 3 |
| I69.141 | Monoplegia of lower limb following nontraumatic intracerebral hemorrhage affecting right dominant side | 3 |
| I69.142 | Monoplegia of lower limb following nontraumatic intracerebral hemorrhage affecting left dominant side | 3 |
| I69.143 | Monoplegia of lower limb following nontraumatic intracerebral hemorrhage affecting right non-dominant side | 3 |
| I69.144 | Monoplegia of lower limb following nontraumatic intracerebral hemorrhage affecting left non-dominant side | 3 |
| I69.149 | Monoplegia of lower limb following nontraumatic intracerebral hemorrhage affecting unspecified side | 3 |
| I69.241 | Monoplegia of lower limb following other nontraumatic intracranial hemorrhage affecting right dominant side | 3 |
| I69.242 | Monoplegia of lower limb following other nontraumatic intracranial hemorrhage affecting left dominant side | 3 |
| I69.243 | Monoplegia of lower limb following other nontraumatic intracranial hemorrhage affecting right non-dominant side | 3 |
| I69.244 | Monoplegia of lower limb following other nontraumatic intracranial hemorrhage affecting left non-dominant side | 3 |
| I69.249 | Monoplegia of lower limb following other nontraumatic intracranial hemorrhage affecting unspecified side | 3 |
| I69.341 | Monoplegia of lower limb following cerebral infarction affecting right dominant side | 3 |
| I69.342 | Monoplegia of lower limb following cerebral infarction affecting left dominant side | 3 |
| I69.343 | Monoplegia of lower limb following cerebral infarction affecting right non-dominant side | 3 |
| I69.344 | Monoplegia of lower limb following cerebral infarction affecting left non-dominant side | 3 |
| I69.349 | Monoplegia of lower limb following cerebral infarction affecting unspecified side | 3 |
| I69.841 | Monoplegia of lower limb following other cerebrovascular disease affecting right dominant side | 3 |
| I69.842 | Monoplegia of lower limb following other cerebrovascular disease affecting left dominant side | 3 |
| I69.843 | Monoplegia of lower limb following other cerebrovascular disease affecting right non-dominant side | 3 |
| I69.844 | Monoplegia of lower limb following other cerebrovascular disease affecting left non-dominant side | 3 |
| I69.849 | Monoplegia of lower limb following other cerebrovascular disease affecting unspecified side | 3 |
| I69.941 | Monoplegia of lower limb following unspecified cerebrovascular disease affecting right dominant side | 3 |
| I69.942 | Monoplegia of lower limb following unspecified cerebrovascular disease affecting left dominant side | 3 |
| I69.943 | Monoplegia of lower limb following unspecified cerebrovascular disease affecting right non-dominant side | 3 |
| I69.944 | Monoplegia of lower limb following unspecified cerebrovascular disease affecting left non-dominant side | 3 |
| I69.949 | Monoplegia of lower limb following unspecified cerebrovascular disease affecting unspecified side | 3 |
| Q72.01 | Congenital complete absence of right lower limb | 3 |
| Q72.02 | Congenital complete absence of left lower limb | 3 |
| Q72.03 | Congenital complete absence of lower limb, bilateral | 3 |
| Q72.11 | Congenital absence of right thigh and lower leg with foot present | 3 |
| Q72.12 | Congenital absence of left thigh and lower leg with foot present | 3 |
| Q72.13 | Congenital absence of thigh and lower leg with foot present, bilateral | 3 |
| Q78.0 | Osteogenesis imperfecta | 3 |
| S78.011A | Complete traumatic amputation at right hip joint, initial encounter | 3 |
| S78.011D | Complete traumatic amputation at right hip joint, subsequent encounter | 3 |
| S78.011S | Complete traumatic amputation at right hip joint, sequela | 3 |
| S78.012A | Complete traumatic amputation at left hip joint, initial encounter | 3 |
| S78.012D | Complete traumatic amputation at left hip joint, subsequent encounter | 3 |
| S78.012S | Complete traumatic amputation at left hip joint, sequela | 3 |
| S78.019A | Complete traumatic amputation at unspecified hip joint, initial encounter | 3 |
| S78.019D | Complete traumatic amputation at unspecified hip joint, subsequent encounter | 3 |
| S78.019S | Complete traumatic amputation at unspecified hip joint, sequela | 3 |
| S78.021A | Partial traumatic amputation at right hip joint, initial encounter | 3 |
| S78.021D | Partial traumatic amputation at right hip joint, subsequent encounter | 3 |
| S78.021S | Partial traumatic amputation at right hip joint, sequela | 3 |
| S78.022A | Partial traumatic amputation at left hip joint, initial encounter | 3 |
| S78.022D | Partial traumatic amputation at left hip joint, subsequent encounter | 3 |
| S78.022S | Partial traumatic amputation at left hip joint, sequela | 3 |
| S78.029A | Partial traumatic amputation at unspecified hip joint, initial encounter | 3 |
| S78.029D | Partial traumatic amputation at unspecified hip joint, subsequent encounter | 3 |
| S78.029S | Partial traumatic amputation at unspecified hip joint, sequela | 3 |
| S78.111A | Complete traumatic amputation at level between right hip and knee, initial encounter | 3 |
| S78.111D | Complete traumatic amputation at level between right hip and knee, subsequent encounter | 3 |
| S78.111S | Complete traumatic amputation at level between right hip and knee, sequela | 3 |
| S78.112A | Complete traumatic amputation at level between left hip and knee, initial encounter | 3 |
| S78.112D | Complete traumatic amputation at level between left hip and knee, subsequent encounter | 3 |
| S78.112S | Complete traumatic amputation at level between left hip and knee, sequela | 3 |
| S78.119A | Complete traumatic amputation at level between unspecified hip and knee, initial encounter | 3 |
| S78.119D | Complete traumatic amputation at level between unspecified hip and knee, subsequent encounter | 3 |
| S78.119S | Complete traumatic amputation at level between unspecified hip and knee, sequela | 3 |
| S78.121A | Partial traumatic amputation at level between right hip and knee, initial encounter | 3 |
| S78.121D | Partial traumatic amputation at level between right hip and knee, subsequent encounter | 3 |
| S78.121S | Partial traumatic amputation at level between right hip and knee, sequela | 3 |
| S78.122A | Partial traumatic amputation at level between left hip and knee, initial encounter | 3 |
| S78.122D | Partial traumatic amputation at level between left hip and knee, subsequent encounter | 3 |
| S78.122S | Partial traumatic amputation at level between left hip and knee, sequela | 3 |
| S78.129A | Partial traumatic amputation at level between unspecified hip and knee, initial encounter | 3 |
| S78.129D | Partial traumatic amputation at level between unspecified hip and knee, subsequent encounter | 3 |
| S78.129S | Partial traumatic amputation at level between unspecified hip and knee, sequela | 3 |
| S78.911A | Complete traumatic amputation of right hip and thigh, level unspecified, initial encounter | 3 |
| S78.911D | Complete traumatic amputation of right hip and thigh, level unspecified, subsequent encounter | 3 |
| S78.911S | Complete traumatic amputation of right hip and thigh, level unspecified, sequela | 3 |
| S78.912A | Complete traumatic amputation of left hip and thigh, level unspecified, initial encounter | 3 |
| S78.912D | Complete traumatic amputation of left hip and thigh, level unspecified, subsequent encounter | 3 |
| S78.912S | Complete traumatic amputation of left hip and thigh, level unspecified, sequela | 3 |
| S78.919A | Complete traumatic amputation of unspecified hip and thigh, level unspecified, initial encounter | 3 |
| S78.919D | Complete traumatic amputation of unspecified hip and thigh, level unspecified, subsequent encounter | 3 |
| S78.919S | Complete traumatic amputation of unspecified hip and thigh, level unspecified, sequela | 3 |
| S78.921A | Partial traumatic amputation of right hip and thigh, level unspecified, initial encounter | 3 |
| S78.921D | Partial traumatic amputation of right hip and thigh, level unspecified, subsequent encounter | 3 |
| S78.921S | Partial traumatic amputation of right hip and thigh, level unspecified, sequela | 3 |
| S78.922A | Partial traumatic amputation of left hip and thigh, level unspecified, initial encounter | 3 |
| S78.922D | Partial traumatic amputation of left hip and thigh, level unspecified, subsequent encounter | 3 |
| S78.922S | Partial traumatic amputation of left hip and thigh, level unspecified, sequela | 3 |
| S78.929A | Partial traumatic amputation of unspecified hip and thigh, level unspecified, initial encounter | 3 |
| S78.929D | Partial traumatic amputation of unspecified hip and thigh, level unspecified, subsequent encounter | 3 |
| S78.929S | Partial traumatic amputation of unspecified hip and thigh, level unspecified, sequela | 3 |
| S88.011A | Complete traumatic amputation at knee level, right lower leg, initial encounter | 3 |
| S88.011D | Complete traumatic amputation at knee level, right lower leg, subsequent encounter | 3 |
| S88.011S | Complete traumatic amputation at knee level, right lower leg, sequela | 3 |
| S88.012A | Complete traumatic amputation at knee level, left lower leg, initial encounter | 3 |
| S88.012D | Complete traumatic amputation at knee level, left lower leg, subsequent encounter | 3 |
| S88.012S | Complete traumatic amputation at knee level, left lower leg, sequela | 3 |
| S88.019A | Complete traumatic amputation at knee level, unspecified lower leg, initial encounter | 3 |
| S88.019D | Complete traumatic amputation at knee level, unspecified lower leg, subsequent encounter | 3 |
| S88.019S | Complete traumatic amputation at knee level, unspecified lower leg, sequela | 3 |
| S88.021A | Partial traumatic amputation at knee level, right lower leg, initial encounter | 3 |
| S88.021D | Partial traumatic amputation at knee level, right lower leg, subsequent encounter | 3 |
| S88.021S | Partial traumatic amputation at knee level, right lower leg, sequela | 3 |
| S88.022A | Partial traumatic amputation at knee level, left lower leg, initial encounter | 3 |
| S88.022D | Partial traumatic amputation at knee level, left lower leg, subsequent encounter | 3 |
| S88.022S | Partial traumatic amputation at knee level, left lower leg, sequela | 3 |
| S88.029A | Partial traumatic amputation at knee level, unspecified lower leg, initial encounter | 3 |
| S88.029D | Partial traumatic amputation at knee level, unspecified lower leg, subsequent encounter | 3 |
| S88.029S | Partial traumatic amputation at knee level, unspecified lower leg, sequela | 3 |
| S88.911A | Complete traumatic amputation of right lower leg, level unspecified, initial encounter | 3 |
| S88.911D | Complete traumatic amputation of right lower leg, level unspecified, subsequent encounter | 3 |
| S88.911S | Complete traumatic amputation of right lower leg, level unspecified, sequela | 3 |
| S88.912A | Complete traumatic amputation of left lower leg, level unspecified, initial encounter | 3 |
| S88.912D | Complete traumatic amputation of left lower leg, level unspecified, subsequent encounter | 3 |
| S88.912S | Complete traumatic amputation of left lower leg, level unspecified, sequela | 3 |
| S88.919A | Complete traumatic amputation of unspecified lower leg, level unspecified, initial encounter | 3 |
| S88.919D | Complete traumatic amputation of unspecified lower leg, level unspecified, subsequent encounter | 3 |
| S88.919S | Complete traumatic amputation of unspecified lower leg, level unspecified, sequela | 3 |
| S88.921A | Partial traumatic amputation of right lower leg, level unspecified, initial encounter | 3 |
| S88.921D | Partial traumatic amputation of right lower leg, level unspecified, subsequent encounter | 3 |
| S88.921S | Partial traumatic amputation of right lower leg, level unspecified, sequela | 3 |
| S88.922A | Partial traumatic amputation of left lower leg, level unspecified, initial encounter | 3 |
| S88.922D | Partial traumatic amputation of left lower leg, level unspecified, subsequent encounter | 3 |
| S88.922S | Partial traumatic amputation of left lower leg, level unspecified, sequela | 3 |
| S88.929A | Partial traumatic amputation of unspecified lower leg, level unspecified, initial encounter | 3 |
| S88.929D | Partial traumatic amputation of unspecified lower leg, level unspecified, subsequent encounter | 3 |
| S88.929S | Partial traumatic amputation of unspecified lower leg, level unspecified, sequela | 3 |
| Z89.511 | Acquired absence of right leg below knee | 3 |
| Z89.512 | Acquired absence of left leg below knee | 3 |
| Z89.519 | Acquired absence of unspecified leg below knee | 3 |
| Z89.611 | Acquired absence of right leg above knee | 3 |
| Z89.612 | Acquired absence of left leg above knee | 3 |
| Z89.619 | Acquired absence of unspecified leg above knee | 3 |
| Z89.621 | Acquired absence of right hip joint | 3 |
| Z89.622 | Acquired absence of left hip joint | 3 |
| Z89.629 | Acquired absence of unspecified hip joint | 3 |