Developing Medicare and Medicaid Substance Abuse Treatment Spending Estimates. Appendix A: Diagnosis Codes

09/28/2012

TABLE A.1. Alcohol Abuse Diagnosis Codes
  ICD-9-CM   Description   Category of Service  
291 Alcoholic psychoses Core
2910 Delirium tremens Core
2911 Alcohol amnestic syndrome Core
2912 Alcoholic dementia NEC Core
2913 Alcohol hallucinosis Core
2914 Pathologic alcohol intoxication Core
2915 Alcoholic jealousy Core
2918 Alcoholic psychosis NEC Core
2919 Alcoholic psychosis NOS Core
303 Alcohol dependence syndrome Core
3030 Acute alcohol intoxication Core
3039 Alcohol dependency NEC/NOS Core
3050 Alcohol abuse Core
9800 Toxic effects of ethyl alcohol Poisoning
9801 Toxic effects of methyl alcohol Poisoning
E8600 Accidental poisoning by alcoholic beverages   Poisoning
E8601 Accidental poisoning by ethyl alcohol Poisoning
E8602 Accidental poisoning by methyl alcohol Poisoning
E8609 Accidental poisoning by unspecified alcohol Poisoning
7903 Excessive blood level of alcohol Poisoning
3575 Alcoholic polyneuropathy Supplemental
4255 Alcoholic cardiomyopathy Supplemental
5353 Alcoholic gastritis Supplemental
5710 Alcoholic fatty liver Supplemental
5711 Acute alcoholic hepatitis Supplemental
5712 Alcoholic cirrhosis of liver Supplemental
5713 Alcoholic liver damage, unspecified Supplemental
6554 Suspected damage to fetus from alcohol addiction   Fetus
76071 Fetal alcohol syndrome Fetus

TABLE A.2. Drug Abuse Diagnosis Codes
  ICD-9-CM   Description   Category of Service  
292 Drug psychoses Core
2920 Drug withdrawal syndrome Core
2921 Drug paranoid/hallucinosis Core
2922 Pathologic drug intoxication Core
2928 Other drug mental disease Core
2929 Drug mental disorder NOS Core
304 Drug dependence Core
3040 Opioid type dependence Core
3041 Barbiturate dependence Core
3042 Cocaine dependence Core
3043 Cannabis dependence Core
3044 Amphetamine dependence Core
3045 Hallucinogen dependence Core
3046 Drug dependence NEC Core
3047 Opioid/other drug dependence Core
3048 Combinations of drug dependence NEC   Core
3049 Drug dependence NOS Core
305 Non-dependent drug abuse Core
3052 Cannabis abuse Core
3053 Hallucinogen abuse Core
3054 Barbiturate abuse Core
3055 Opioid abuse Core
3056 Cocaine abuse Core
3057 Amphetamine abuse Core
3058 Antidepressant abuse Core
3059 Drug abuse NEC/NOS Core
6483 Drug dependence in pregnancy Fetus
357.6 Polyneuropathy due to drugs Supplemental
6555 Suspected damage to fetus from drugs Fetus
76072 Fetus affected by narcotics Fetus
76073 Fetus affected by hallucinogenic agents Fetus
76075 Fetus affected by cocaine Fetus
7795 Drug withdrawal symptoms in newborns Fetus
965 Poisoning related to narcotics Poisoning
967 Poisoning by sedatives and hypnotics Poisoning
968 Poisoning by central nervous system muscle tone depressants   Poisoning
969 Poisoning by psychotropic agents Poisoning
970 Poisoning by central nervous system stimulants Poisoning
E850-E858 Accidental poisoning by drugs, medicaments, and biologicals Poisoning
E863 Accidental poisoning by agricultural and horticultural chemical and pharmaceutical preparations other than plant food and fertilizer   Poisoning
E950.0-E950.6 Suicide and self-inflicted injury by drugs or medicinal substances Poisoning

TABLE A.3. MH Diagnosis Codes
  ICD-9-CM   Description   Analytical Classification  
295 Schizophrenic disorders Schizophrenia
2950 Simple schizophrenia Schizophrenia
2951 Hebephrenia Schizophrenia
2952 Catatonic schizophrenia Schizophrenia
2953 Paranoid schizophrenia Schizophrenia
2954 Acute schizophrenic episode Schizophrenia
2955 Latent schizophrenia Schizophrenia
2956 Residual schizophrenia Schizophrenia
2957 Schizoaffective type Schizophrenia
2958 Schizophrenia NEC Schizophrenia
2959 Schizophrenia NOS Schizophrenia
296 Affective psychoses Other affective disorder
2960 Manic disorder, single episode Bipolar I
2961 Manic disorder, recurrent episode Bipolar I
2962x (x = 3 or 4) Depressive psychosis, single episode, severe Major depression, severe
2962x (x ne 3 or 4)   Depressive psychosis, single episode, non-severe   Major depression, non-severe
2963x (x = 3 or 4) Depressive psychosis, recurrent episode, severe Major depression, severe
2963x (x ne 3 or 4) Depressive psychosis, recurrent episode, non-severe   Major depression, non-severe
2964 Bipolar affective, manic Bipolar I
2965 Bipolar affective, depressive Bipolar I
2966 Bipolar affective, mixed Bipolar I
2967 Bipolar affective NOS Bipolar I
2968 Manic-depressive NEC/NOS Other or unspecified bipolar
2969 Affective psychoses NEC/NOS Other affective disorder
297 Paranoid states Delusional disorder
2970 Paranoid state, simple Delusional disorder
2971 Paranoia Delusional disorder
2972 Paraphrenia Delusional disorder
2973 Shared paranoid disorder Delusional disorder
2978 Paranoid states NEC Delusional disorder
2979 Paranoid state NOS Delusional disorder
298 Other non-organic psychoses Other MH diagnosis
2980 Reactive depressive psychosis Other MH diagnosis
2981 Excitative-type psychosis Other MH diagnosis
2982 Reactive confusion Other MH diagnosis
2983 Acute paranoid reaction Other MH diagnosis
2984 Psychogenic paranoid psychosis Other MH diagnosis
2988 Reactive psychosis NEC/NOS Other MH diagnosis
2989 Psychosis NOS Other MH diagnosis
299 Psychoses of childhood Other MH diagnosis
2990 Infantile autism Other MH diagnosis
2991 Disintegrative psychosis Other MH diagnosis
2998 Early childhood psychoses NEC   Other MH diagnosis
2999 Early childhood psychosis NOS Other MH diagnosis
300 Neurotic disorders Anxiety disorder
3000 Anxiety states Anxiety disorder
3001 Hysteria Anxiety disorder
3002 Phobic disorders Anxiety disorder
3003 Obsessive-compulsive disorder Anxiety disorder
3004 Neurotic depression Anxiety disorder
3005 Neurasthenia Anxiety disorder
3006 Depersonalization syndrome Anxiety disorder
3007 Hypochondriasis Anxiety disorder
3008 Neurotic disorders NEC Anxiety disorder
3009 Neurotic disorder NOS Anxiety disorder
301 Personality disorders Other personality disorder
3010 Paranoid personality Other personality disorder
3011 Affective personality Other personality disorder
3012 Schizoid personality Other personality disorder
3013 Explosive personality Other personality disorder
3014 Compulsive personality Other personality disorder
3015 Histrionic personality Other personality disorder
3016 Dependent personality Other personality disorder
3017 Antisocial personality Antisocial personality disorder
3018 Other personality disorder Other personality disorder
3019 Personality disorder NOS Other personality disorder
302 Sexual disorders Other MH diagnosis
3020 Egodystonic homosexuality Other MH diagnosis
3021 Zoophilia Other MH diagnosis
3022 Pedophilia Other MH diagnosis
3023 Transvestism Other MH diagnosis
3024 Exhibitionism Other MH diagnosis
3025 Transsexualism Other MH diagnosis
3026 Psychosexual identity disorder Other MH diagnosis
3027 Psychosexual dysfunction Other MH diagnosis
3028 Psychosexual disorder NEC Other MH diagnosis
3029 Psychosexual disorder NOS Other MH diagnosis
306 Psychophysiologic disease Other MH diagnosis
3060 Psychogenic musculoskeletal disease   Other MH diagnosis
3061 Psychogenic respiratory disease Other MH diagnosis
3062 Psychogenic cardiovascular disease Other MH diagnosis
3063 Psychogenic skin disease Other MH diagnosis
3064 Psychogenic GI disease Other MH diagnosis
3065 Psychogenic GU disease Other MH diagnosis
3066 Psychogenic endocrine disease   Other MH diagnosis
3067 Psychogenic sensory disease Other MH diagnosis
3068 Psychogenic disorder NEC Other MH diagnosis
3069 Psychogenic disorder NOS Other MH diagnosis
307 Special symptom NEC Other MH diagnosis
3070 Stammering and stuttering Other MH diagnosis
3071 Anorexia nervosa Other MH diagnosis
3072 Tics Other MH diagnosis
3073 Stereotyped movements Other MH diagnosis
3074 Non-organic sleep disorder Other MH diagnosis
3075 Eating disorders NEC/NOS Other MH diagnosis
3076 Enuresis Other MH diagnosis
3077 Encopresis Other MH diagnosis
3078 Psychalgia Other MH diagnosis
3079 Special symptom NEC/NOS Other MH diagnosis
308 Acute reaction to stress Acute reaction to stress
3080 Stress reaction, emotional Acute reaction to stress
3081 Stress reaction, fugue Acute reaction to stress
3082 Stress reaction, psychomotor Acute reaction to stress
3083 Acute stress reaction NEC Acute reaction to stress
3084 Stress reaction, mixed disorder Acute reaction to stress
3089 Acute stress reaction NOS Acute reaction to stress
309 Adjustment reaction Adjustment reaction
3090 Brief depressive reaction Adjustment reaction
3091 Prolonged depressive reaction Adjustment reaction
3092 Adjustment reaction/other emotion Adjustment reaction
3093 Adjustment reaction -- conduct disorder   Adjustment reaction
3094 Adjustment reaction -- emotion/conduct Adjustment reaction
3098 Other adjustment reaction Adjustment reaction
3099 Adjustment reaction NOS Adjustment reaction
310 Non-psychotic brain syndrome Other MH diagnosis
3100 Frontal lobe syndrome Other MH diagnosis
3101 Organic personality syndrome Other MH diagnosis
3102 Postconcussion syndrome Other MH diagnosis
3108 Non-psychotic brain syndrome NEC Other MH diagnosis
3109 Non-psychotic brain syndrome NOS Other MH diagnosis
311 Depressive disorder NEC Other depressive disorder
312 Conduct disturbance NEC Conduct disorder
3120 Unsocialized aggression Conduct disorder
3121 Unsocialized, unaggressive Conduct disorder
3122 Socialized conduct disorder Conduct disorder
3123 Impulse control disorder NEC Conduct disorder
3124 Mixed disturbance conduct/emotion Conduct disorder
3128 Other conduct disturbance Conduct disorder
3129 Conduct disturbance NOS Conduct disorder
313 Emotional disorder child/adolescent Other MH diagnosis
3130 Overanxious disorder Other MH diagnosis
3131 Misery and unhappiness disorder Other MH diagnosis
3132 Sensitivity and withdrawal Other MH diagnosis
3133 Relationship problems Other MH diagnosis
3138 Other emotional disturbance, child Other MH diagnosis
3139 Emotional disturbance, child, NOS Other MH diagnosis
314 Hyperkinetic syndrome Other MH diagnosis
3140 Attention deficit disorder Other MH diagnosis
3141 Hyperkinetic with developmental delay   Other MH diagnosis
3142 Hyperkinetic conduct disorder Other MH diagnosis
3148 Other hyperkinetic syndrome Other MH diagnosis
3149 Hyperkinetic syndrome NOS Other MH diagnosis
6484 Mental disorders in pregnancy Other MH diagnosis
V402 Mental problems NEC MH V-code
V403 Behavioral problems NEC MH V-code
V409 Mental/behavior problems NOS MH V-code
V61 Other family circumstances MH V-code
V610 Family disruption MH V-code
V611 Marital problems MH V-code
V612 Parentchild problems MH V-code
V613 Problem with aged parent MH V-code
V614 Health problem in family MH V-code
V615 Multi-parity MH V-code
V616 Illegitimate pregnancy MH V-code
V617 Unwanted pregnancy NEC MH V-code
V618 Family circumstances NEC MH V-code
V619 Family circumstance NOS MH V-code
V663 Mental disorder convalescence MH V-code
V673 Psychiatric followup MH V-code
V701 Psychiatric exam -- authority required MH V-code
V702 General psychiatric exam NEC MH V-code
V710 Observation for mental conditions MH V-code
E950.7-E950.9, E951-E959 Suicide and self-inflicted injury by cause other than drugs or medicinal substances   Suicide and self-inflicted injury
MH = Mental Health.
ne = not equal.

TABLE A.4. Prescription Drug Codes
Drug Name NDC Code
Alcoholism Medications
Campral 0456-3330
Naltrexone HCl (Revia) 51285-275, 0555-0902, 52152-105, 185-39, 406-1170, 16590-897, 16729-81, 47335-326, 60793-430, 60793-431, 60793-433, 60793-434, 60793-435, 60793-437
Vivitrol 63459-300, 65757-300, 65757-301
Disulfiram (Antabuse) 51285-523, 51285-524, 64980-171, 64980-172, 65473-706
Opiate and Heroin Addition Medications
Subutex 12496-1310, 12496-1278
Suboxone 12496-1202, 12496-1208, 54868-5707, 54868-5750, 63629-4028, 63629-4034
Vivitrol 65757-300, 65757-301
Naltrexone HCl (Revia) See above
Nalmefene Hydrochloride (Revex)   10019-315, 10019-311, 11098-311
Other Drug Abuse Medications
Naloxone Hydrochloride (Narcan) 63481-365, 63481-368, 63481-359, 0409-1212, 0409-1215, 0409-1219, 63481-358, 63481-3771, 52584-469, 52584-782, 16590-556, 63739-463, 54868-2062,54868-6259, 60429-570, 68387-531, 548-1469, 548-3369, 43063-142, 43386-680, 52584-212, 52584-215, 409-1782
SOURCE: FDA's NDC database.
NOTE: NDCs are for the listed drug and for any generic equivalent.

TABLE A.5. Classification of SA/MH Treatment Services by Type
Types of SA Treatment Services SA-Specific Codes Other Behavioral Health Codes* Other Types of Identifiers
Emergency room care NA NA OT file claim with place of service code = 23
Inpatient care H0008, H0009    
Residential treatment H0010, H0011 H0017, H0018, H0019, S5145, S5146, T2048  
Intensive treatment program H0015, S9475, H2036, S9480, S9485, H0035, T2034  
Treatment program service H2035, S0201 H2012  
Individual/group psychotherapy   90804, 90805, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90816, 90817, 90818, 90819, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90875, 90876, 90846, 90847, 90849, 90853, 90857, G0410, G0411  
Other assessment/ screening/ intervention/ evaluation/ prevention/ treatment planning H0001, H0003, H0022, H0028, H0049, H0050, H0007, H0048, H0026, G0396, G0397, T1007, 99408 H0030, H2011, S9484, 90801, S9083, H0002, H1011, 96150, 96151, 90802, H0031, T1001, H1000, 90889, 90801, 90885, 96101, 96102, 96103, 96100, 96125, 99456, S9446, H1003, H0023, H0032, 00100, G8405 G8404, 96115, 96116, 96117, T2010, T2011, T1023, 96105, 96111, 96110, 96125  
Other medication management H0020, J0592, J1230, J3490, J2315, J8499, S0109 90862, H0034, H2010, H0033, M0064, T1502  
Other counseling/ therapy H0005, T1006 H0004, 90806, 90845, 90870, 90871, 90880, 96152, 99510, H2032, G0176, 96153, 96154, 96155  
Other case management or community supports H0006, T1007, T1012, T1009 T1016, T1017, H0037, H2015, H2016, H2021, G0177, S5110, H5111, T1027, H2014, H2017, H2018, H2027, H0025, H2023, H2024, H2025, H2026, H2019, H2020, S0280, S0281, 90882, H0039, H0040, T1024, H1004, H0036, H2022, S9482, H2033 H0038, T2040, T2041, G0409  
Detoxification H0012, H0013, H0014    
Housing (including halfway house) H2034 H0043, H0044  
Other H0016, H0047, T1010, T1011, T1013, T2025, H2037 90899  
* These behavioral health codes will be classified as SA treatments when they are associated with a primary SA diagnosis.
NA = not available.

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