APPENDIX B

Condition and ICD-9-CM Code(s)Qualifiers
Congenital syphilis (090)Secondary diagnosis for newborns only
Immunization preventable conditions (033, 037, 045, 320.0,
 390, 391)
Haemophilus meningitis (320.2) for age 1–5 only
Grand mal status and other epileptic convulsions (345)
 Convulsions “A” (780.3)Age 0–5 y
 Convulsions “B” (780.3)Age >5 y
Severe ENT infectionsExclude otitis media cases (382) with myringotomy with insertion
  (382, 462, 463, 465, 472.1) (20.01) of tube
Bacterial pneumoniaExclude case with secondary diagnosis of sickle cell (282.6) and
  (481, 482.2, 482.3, 482.9, 483, 485, 486) patients <2 mo
Asthma (493)
Tuberculosis (011–018)
Cellulitis (681, 682, 683, 686)Exclude cases with a surgical procedure (01-86.99)
Diabetes “A” (250.1, 250.2, 250.3)
Diabetes “B” (250.8, 250.9)
Diabetes “C” (250.0)
Hypoglycemia (251.2)
Gastroenteritis (558.9)
Kidney/urinary infection (590, 599.0, 599.9)
Dehydration-volume depletion (276.5)
Iron deficiency anemia (280.1, 280.8, 280.9)Ages 0–5 y only
Nutritional deficiencies (260, 261, 262, 268.0, 268.1)
Failure to thrive (783.4)Age <1 y

Pediatric Ambulatory Care Sensitive Conditions