Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter III - Allowances for Services › Section 144-101-III-45 - HOSPITAL SERVICES › Appendix 144-101-III-45-B - NON-EMERGENT USE OF THE EMERGENCY DEPARTMENT

Current through 2024-29, July 17, 2024
The following shall apply to non-emergent use of
						the emergency department (see Sec. 45.03-1(D)(1)(c) and
						45.03-1(D)(2)(b))
ICD-10 codes will be used to identify non-emergent
						use of the emergency department for services delivered beginning October 1,
						2015.
ICD-10
								  Code
ICD-10 Code
								  Description
J02.0
Streptococcal pharyngitis
J03.00
Acute streptococcal tonsillitis,
								  unspecified
J03.01
Acute recurrent streptococcal
								  tonsillitis
B97.10
Unspecified enterovirus as the cause of diseases
								  classified elsewhere
B97.89
Other viral agents as the cause of diseases
								  classified elsewhere
F41.9
Anxiety disorder, unspecified
F41.1
Generalized anxiety disorder
H10.30
Unspecified acute conjunctivitis, unspecified
								  eye
H10.31
Unspecified acute conjunctivitis, right
								  eye
H10.32
Unspecified acute conjunctivitis, left
								  eye
H10.33
Unspecified acute conjunctivitis,
								  bilateral
H10.9
Unspecified conjunctivitis
H60.00
Abscess of external ear, unspecified
								  ear
H60.01
Abscess of right external ear
H60.02
Abscess of left external ear
H60.03
Abscess of external ear, bilateral
H60.10
Cellulitis of external ear, unspecified
								  ear
H60.11
Cellulitis of right external ear
H60.12
Cellulitis of left external ear
H60.13
Cellulitis of external ear, bilateral
H60.311
Diffuse otitis externa, right ear
H60.312
Diffuse otitis externa, left ear
H60.313
Diffuse otitis externa, bilateral
H60.319
Diffuse otitis externa, unspecified
								  ear
H60.321
Hemorrhagic otitis externa, right ear
H60.322
Hemorrhagic otitis externa, left ear
H60.323
Hemorrhagic otitis externa, bilateral
H60.329
Hemorrhagic otitis externa, unspecified
								  ear
H60.391
Other infective otitis externa, right
								  ear
H60.392
Other infective otitis externa, left
								  ear
H60.393
Other infective otitis externa,
								  bilateral
H60.399
Other infective otitis externa, unspecified
								  ear
H65.00
Acute serous otitis media, unspecified
								  ear
H65.01
Acute serous otitis media, right ear
H65.02
Acute serous otitis media, left ear
H65.03
Acute serous otitis media, bilateral
H65.04
Acute serous otitis media recurrent, right
								  ear
H65.05
Acute serous otitis media recurrent, left
								  ear
H65.06
Acute serous otitis media, recurrent,
								  bilateral
H65.07
Acute serous otitis media, recurrent, unspecified
								  ear
H65.90
Unspecified nonsuppurative otitis media,
								  unspecified ear
H65.91
Unspecified nonsuppurative otitis media, right
								  ear
H65.92
Unspecified nonsuppurative otitis media, left
								  ear
H65.93
Unspecified nonsuppurative otitis media,
								  bilateral
H66.001
Acute suppurative otitis media without
								  spontaneous rupture of the ear drum, right ear
H66.002
Acute suppurative otitis media without
								  spontaneous rupture of the ear drum, left ear
H66.003
Acute suppurative otitis media without
								  spontaneous rupture of the ear drum, bilateral
H66.004
Acute suppurative otitis media without
								  spontaneous rupture of the ear drum, recurrent, right ear
H66.005
Acute suppurative otitis media without
								  spontaneous rupture of the ear drum, recurrent, left ear
H66.006
Acute suppurative otitis media without
								  spontaneous rupture of the ear drum, recurrent, bilateral
H66.007
Acute suppurative otitis media without
								  spontaneous rupture of the ear drum, recurrent, unspecified ear
H66.009
Acute suppurative otitis media without
								  spontaneous rupture of the ear drum, unspecified ear
H66.90
Otitis media, unspecified, unspecified
								  ear
H66.91
Otitis media, unspecified. right ear
H66.92
Otitis media, unspecified, left ear
H66.93
Otitis media, unspecified, bilateral
J01.90
Acute sinusitis, unspecified
J01.91
Acute recurrent sinusitis,
								  unspecified
J02.8
Acute pharyngitis due to other specified
								  organisms
J02.9
Acute pharyngitis, unspecified
J06.9
Acute upper respiratory infection,
								  unspecified
J20.0
Acute bronchitis due to Mycoplasma
								  pneumoniae
J20.1
Acute bronchitis due to Hemophilus
								  influenzae
J20.2
Acute bronchitis due to streptococcus
J20.3
Acute bronchitis due to
								  coxsackievirus
J20.4
Acute bronchitis due to parainfluenza
								  virus
J20.5
Acute bronchitis due to respiratory syncytial
								  virus
J20.6
Acute bronchitis due to rhinovirus
J20.7
Acute bronchitis due to echovirus
J20.8
Acute bronchitis due to other specified
								  organisms
J20.9
Acute bronchitis, unspecified
J32.9
Chronic sinusitis, unspecified
J40
Bronchitis, not specified as acute or
								  chronic
J45.20
Mild intermittent asthma,
								  uncomplicated
J45.30
Mild persistent asthma, uncomplicated
J45.40
Moderate persistent asthma,
								  uncomplicated
J45.50
Severe persistent asthma,
								  uncomplicated
J45.21
Mild intermittent asthma w/ (acute)
								  exacerbation
J45.31
Mild persistent asthma w/ (acute)
								  exacerbation
J45.41
Moderate persist asthma w/ (acute)
								  exacerbation
J45.51
Severe persist asthma w/ (acute)
								  exacerbation
J45.20
Mild intermittent asthma,
								  uncomplicated
J45.30
Mild persistent asthma, uncomplicated
J45.40
Moderate persistent asthma,
								  uncomplicated
J45.50
Severe persistent asthma,
								  uncomplicated
J45.21
Mild intermittent asthma w/ (acute)
								  exacerbation
J45.31
Mild persistent asthma w/ (acute)
								  exacerbations
J45.41
Moderate persist asthma w/ (acute)
								  exacerbation
J45.51
Severe persist asthma w/ (acute)
								  exacerbation
J44.9
Chronic obstructive pulmonary disease,
								  unspecified
J44.1
Chronic obstructive pulmonary disease w/ (acute)
								  exacerbation
J45.990
Exercise induced bronchospasm
J45.991
Cough variant asthma
J45.909
Unspecified asthma, uncomplicated
J45.998
Other asthma
J45.901
Unspecified asthma with (acute)
								  exacerbation
L22
Diaper dermatitis
L20.0
Besnier's prurigo
L20.81
Atopic neurodermatitis
L20.82
Flexural eczema
L20.84
Intrinsic (allergic) eczema
L20.89
Other atopic dermatitis
L20.9
Atopic dermatitis, unspecified
L23.7
Allergic contact dermatitis due to plants, except
								  food
L24.7
Irritant contact dermatitis due to plants, except
								  food
L25.5
Unspecified contact dermatitis due to plants,
								  except food
L23.9
Allergic contact dermatitis, unspecified
								  cause
L24.9
Irritant contact dermatitis, unspecified
								  cause
L25.9
Unspecified contact dermatitis, unspecified
								  cause
L30.0
Nummular dermatitis
L30.2
Cutaneous autosensitization
L30.8
Other specified dermatitis
L30.9
Dermatitis, unspecified
M25.512
Pain in left shoulder
M25.519
Pain in unspecified shoulder
M25.521
Pain in right elbow
M25.522
Pain in left elbow
M25.529
Pain in unspecified elbow
M25.531
Pain in right wrist
M25.532
Pain in left wrist
M25.539
Pain in unspecified wrist
M79.643
Pain in unspecified hand
M79.646
Pain in unspecified finger(s)
M25.551
Pain in right hip
M25.552
Pain in left hip
M25.559
Pain in unspecified hip
M25.561
Pain in right knee
M25.562
Pain in left knee
M25.569
Pain in unspecified knee
M25.571
Pain in right ankle and joints of right
								  foot
M25.572
Pain in left ankle and joints of left
								  foot
M25.579
Pain in unspecified ankle and joints of
								  unspecified foot
M54.5
Low back pain
M54.89
Other dorsalgia
M54.9
Dorsalgia, unspecified
M60.80
Other myositis, unspecified site
M60.811
Other myositis, right shoulder
M60.812
Other myositis, left shoulder
M60.819
Other myositis, unspecified shoulder
M60.821
Other myositis, right upper arm
M60.822
Other myositis, left upper arm
M60.829
Other myositis, unspecified upper arm
M60.831
Other myositis, right forearm
M60.832
Other myositis, left forearm
M60.839
Other myositis, unspecified forearm
M60.841
Other myositis, right hand
M60.842
Other myositis, left hand
M60.849
Other myositis, unspecified hand
M60.851
Other myositis, right thigh
M60.852
Other myositis, left thigh
M60.859
Other myositis, unspecified thigh
M60.861
Other myositis, right lower leg
M60.862
Other myositis, left lower leg
M60.869
Other myositis, unspecified lower leg
M60.871
Other myositis, right ankle and foot
M60.872
Other myositis, left ankle and foot
M60.879
Other myositis, unspecified ankle and
								  foot
M60.88
Other myositis, other site
M60.89
Other myositis, multiple sites
M60.9
Myositis, unspecified
M79.1
Myalgia
M79.7
Fibromyalgia
M79.601
Pain in right arm
M79.602
Pain in left arm
M79.603
Pain in arm, unspecified
M79.604
Pain in right leg
M79.605
Pain in left leg
M79.606
Pain in leg, unspecified
M79.609
Pain in unspecified limb
M79.621
Pain in right upper arm
M79.622
Pain in left upper arm
M79.629
Pain in unspecified upper arm
M79.631
Pain in right forearm
M79.632
Pain in left forearm
M79.639
Pain in unspecified forearm
M79.641
Pain in right hand
M79.642
Pain in left hand
M79.643
Pain in unspecified hand
M79.644
Pain in right finger(s)
M79.645
Pain in left finger(s)
M79.646
Pain in unspecified finger(s)
M79.651
Pain in right thigh
M79.652
Pain in left thigh
M79.659
Pain in unspecified thigh
M79.661
Pain in right lower leg
M79.662
Pain in left lower leg
M79.669
Pain in unspecified lower leg
M79.671
Pain in right foot
M79.672
Pain in left foot
M79.673
Pain in unspecified foot
M79.674
Pain in right toe(s)
M79.675
Pain in left toe(s)
M79.676
Pain in unspecified toe(s)
G93.3
Postviral fatigue syndrome
R53.0
Neoplastic (malignant) related
								  fatigue
R53.1
Weakness
R53.81
Other malaise
R58.83
Other fatigue
R21
Rash and other nonspecific skin
								  eruption
G44.1
Vascular headache, not elsewhere
								  classified
R51
Headache
R05
Cough