Wis. Admin. Code Department of Health Services DHS 115.04 - Congenital disorders
Pursuant to s. 253.13(1), Stats., blood samples taken from each newborn shall be tested for all of the following conditions:
(1)
(a) Phenylketonuria (PKU),
ICD-10-CM-E70.0.
(b)
Hyperphenylalaninemia, ICD-10-CM-E70.1.
(2) Galactosemia, ICD-10-CM-E74.21.
(3) Congenital hypothyroidism,
ICD-10-CM-E03.1.
(4)
Hemoglobinopathies, including all of the following:
(a) Sickle cell disease,
ICD-10-CM-D57.1.
(b) Hemoglobin
S-beta Thalassemia, ICD-10-CM-D57.40.
(c) Hemoglobin SC disease,
ICD-10-CM-D57.20.
(d) Hemoglobin
disease other, ICD-10-CM-D58.2.
(5) Biotinidase deficiency,
ICD-10-CM-D81.810.
(6) Congenital
adrenal hyperplasia, ICD-10-CM-E25.0.
(7) Cystic fibrosis,
ICD-10-CM-E84.9.
(8) Fatty acid
oxidation disorders, including all of the following:
(a) Medium-chain acyl-CoA dehydrogenase
deficiency, ICD-10-CM-E71.311.
(b)
Long-chain L-3-Hydroxy acyl-CoA dehydrogenase deficiency,
ICD-10-CM-E71.318.
(c) Very
long-chain acyl-CoA dehydrogenase deficiency, ICD-10-CM-E71.310.
(cm) Carnitine palmitoyltransferase IA
deficiency, ICD-10-CM-E71.318.
(d)
Carnitine palmitoyltransferase II deficiency, ICD-10-CM-E71.318.
(e) Carnitine-acylcarnitine translocase
deficiency, ICD-10-CM-E71.318.
(f)
Glutaric acidemia type II, ICD-10-CM-E71.313.
(g) 2, 4-Dienoyl-CoA reductase deficiency,
ICD-10-CM-E71.318.
(h) Carnitine
uptake defect, ICD-10-CM-E71.41.
(i) Medium/short-chain hydroxy CoA
dehydrogenase deficiency, ICD-10-CM-E71.318.
(j) Medium-chain ketoacyl-CoA thiolase
deficiency, ICD-10-CM-E71.318.
(9) Maple Syrup Urine Disease,
ICD-10-CM-E71.0.
(10)
Homocystinuria, ICD-10-CM-E72.11.
(11) Tyrosinemia types I, II, and III,
ICD-10-CM-E70.21.
(12)
Citrullinemia types I and II, ICD-10-CM-E72.23.
(13) Argininosuccinic acidura,
ICD-10-CM-E72.22.
(14) Severe
Combined Immunodeficiency and related conditions of immunodeficiency,
ICD-10-CM-D81.9.
(15) Organic
acidemias, including all of the following:
(a)
Glutaric acidemia type I, ICD-10-CM-E72.3.
(b) Propionic acidemia,
ICD-10-CM-E71.121.
(c)
Methylmalonic acidemia (CBL A, B, C, D; MUT), ICD-10-CM-E71.120.
(d) Isovaleric acidemia,
ICD-10-CM-E71.110.
(e)
3-Methylcrotony1-CoA carboxylase deficiency, ICD-10-CM-E71.19.
(f) Multiple carboxylase deficiency,
ICD-10-CM-D81.818.
(g)
3-Methylglutaconic aciduria, ICD-10-CM-E71.111.
(h) beta-Ketothiolase deficiency,
ICD-10-CM-E71.19.
(i)
2-Methyl-3-hydroxbutyric aciduria, ICD-10-CM- E71.19.
(j) 3-Hydroxy-3-methylglutaric aciduria,
ICD-10-CM- E71.118.
(15m) Spinal muscular atrophy,
ICD-10-CM-G12.9.
(16) Critical
congenital heart disease, including all of the following:
(a)
1.
Coarctation of the aorta, ICD-10-CM-Q25.1.
2. Atresia of aorta,
ICD-10-CM-Q25.2.
3. Stenosis of
aorta, ICD-10-CM-Q25.3.
(b)
1.
Double outlet right ventricle, ICD-10-CM-Q20.1.
2. Double outlet left ventricle,
ICD-10-CM-Q20.2.
(c)
Ebstein's anomaly, ICD-10-CM-Q22.5.
(d)
1.
Hypoplastic left heart syndrome ICD-10-CM-Q23.4.
2. Congenital mitral stenosis or atresia,
ICD-10-CM-Q23.2.
(e)
1. Interrupted aortic arch,
ICD-10-CM-Q25.4.
2. Atresia of
aorta, ICD-10-CM-Q25.2.
3. Stenosis
of aorta, ICD-10-CM-Q25.3.
(f)
1.
Pulmonary valve atresia, ICD-10-CM-Q22.0.
2. Other congenital malformations of the
pulmonary valve, ICD-10-CM-Q22.3.
3. Atresia of pulmonary artery,
ICD-10-CM-Q25.5.
(g)
Single ventricle heart disease variants other than HLHS, including all of the
following:
1. Hypoplastic right heart
syndrome, ICD-10-CM-Q22.6.
2. Other
congenital malformations of the tricuspid valve ICD-10-CM-Q22.8.
3. Congenital malformations of the tricuspid
valve unspecified, ICD-10-CM-Q22.9.
4. Double inlet ventricle,
ICD-10-CM-Q20.4.
(h)
Tetralogy of fallot, ICD-10-CM-Q21.3.
(i)
1.
Total anomalous pulmonary venous return, ICD-10-CM-Q26.2.
2. Anomalous pulmonary venous connection,
unspecified, ICD-10-CM-Q26.4.
3.
Partial anomalous pulmonary venous connection, ICD-10-CM-Q26.3.
(j) Transposition of the great
vessels, ICD-10-CM-Q20.3.
(k)
Tricuspid atresia and stenosis, ICD-10-CM-Q22.4.
(l) Truncus arteriosus,
ICD-10-CM-Q20.0.
(17)
Pompe Disease, ICD-10-CM-E74.02.
Notes
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