NDIA Accountability Project

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Impairment categories guide

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The contents of this document are OFFICIAL. Impairment categories guide

Guidance in this document is not approved for use unless you view it in PACE. This article provides guidance for an access delegate to: • understand what impairment categories to select for a person that meets the eligibility requirements.

Recent updates 4 October 2024 New guidance to: • reflect legislation changes from 3 October 2024 • decide what impairment categories to select for a person that meets the eligibility requirements.

Impairments categories guide Impairments are a loss of or damage to a body’s function. When we assess an impairment to meet access, we look at: • the body’s function • the body’s structure • how they think and learn

The following list provides you with information on: • the condition • the ICD 10 Code • the required impairment category for access assessors to select • optional impairment categories to select as relevant, based on evidence provided with access request.

Conditions

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Autism (ASD)

  1. Autism – includes Rett and Asperger Syndrome ICD 10 Codes: F84.0, F84.2, F84.5 Required impairment category: Neurological Optional impairment categories: Intellectual, cognitive, physical, psychosocial

Acquired brain injury

  1. Glioblastoma ICD 10 Code: G71.9 Required impairment category: Neurological Optional impairment categories: Cognitive, physical, psychosocial
  2. Hypoxic brain injury ICD 10 Code: 93.1 Required impairment category: Neurological Optional impairment categories: Physical, psychosocial
  3. Traumatic brain injury – also called head injury and acquired brain damage ICD 10 Code: T90 Required impairment category: Neurological Optional impairment categories: Cognitive, physical, psychosocial

Intellectual disability

  1. Mild intellectual disability ICD 10 Codes: F70 Required impairment category: Intellectual Optional impairment categories: Cognitive
  2. Moderate intellectual disability ICD 10 Codes: F71 Required impairment category: Intellectual Optional impairment categories: Cognitive, physical, psychosocial
  3. Severe intellectual disability

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ICD 10 Codes: F72 Required impairment category: Intellectual Optional impairment categories: Cognitive, physical, psychosocial 4. Profound intellectual disability ICD 10 Codes: F73 Required impairment category: Intellectual Optional impairment categories: Cognitive, physical, psychosocial 5. Unspecified intellectual disability ICD 10 Codes: F79 Required impairment category: Intellectual Optional impairment categories: Cognitive, sensory, physical, psychosocial 6. Pervasive developmental disorder ICD 10 Codes: F84.8 Required impairment category: Intellectual Optional impairment categories: Cognitive, sensory, psychosocial 7. Microcephaly ICD 10 Codes: Q02 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical 8. Other congenital brain conditions – for example, tuberous sclerosis ICD 10 Codes: Q04 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, physical 9. Spina bifida ICD 10 Codes: Q05 Required impairment category: Physical Optional impairment categories: Intellectual, cognitive, sensory, neurological 10. Foetal alcohol syndrome ICD 10 Codes: Q86.0

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Required impairment category: Neurological Optional impairment categories: Intellectual, cognitive, sensory, physical, psychosocial 11. Foetal alcohol spectrum disorder (FASD) ICD 10 Codes: Q86.0D Required impairment category: Neurological Optional impairment categories: Intellectual, cognitive, sensory, physical, psychosocial 12. Cornelia de Lange syndrome ICD 10 Codes: Q87.1 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial 13. Prader Willi syndrome ICD 10 Codes: Q87.1 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, physical, psychosocial 14. Coffin-Lowry syndrome ICD 10 Codes: Q87.8 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial 15. Other congenital conditions (causing intellectual disability) ICD 10 Codes: Q89 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial 16. Edwards syndrome ICD 10 Codes: Q91 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial 17. Patau syndrome ICD 10 Codes: Q91 Required impairment category: Intellectual

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Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial 18. Cri du Chat syndrome ICD 10 Codes: Q93.4 Required impairment category: Intellectual Optional impairment categories: Cognitive, sensory, physical 19. Angelman syndrome ICD 10 Codes: Q93.5 Required impairment category: Intellectual Optional impairment categories: Cognitive, sensory, physical 20. Other chromosomal syndromes (including Kabuki & Williams syndromes) ICD 10 Codes: Q99 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial 21. Fragile X syndrome ICD 10 Codes: Q99.2 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

Cerebral Palsy

  1. Cerebral palsy ICD 10 Codes: G80 Required impairment category: Physical Optional impairment categories: Intellectual, cognitive, neurological, sensory

Down Syndrome

  1. Down syndrome ICD 10 Codes: Q90 Required impairment category: Intellectual Optional impairment categories: Cognitive, physical

Hearing Impairment

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  1. Hearing loss ICD 10 Codes: H90 Required impairment category: Sensory Optional impairment categories: Cognitive
  2. Congenital hearing condition ICD 10 Codes: Q16.9 Required impairment category: Sensory Optional impairment categories: Cognitive

Visual Impairment

  1. Albinism ICD 10 Codes: E70.3 Required impairment category: Sensory Optional impairment categories: Not applicable
  2. Visual impairment (including blindness) ICD 10 Codes: H54 Required impairment category: Sensory Optional impairment categories: Not applicable
  3. Congenital eye conditions ICD 10 Codes: Q15.9 Required impairment category: Sensory Optional impairment categories: Not applicable

Other Sensory - Speech

  1. Other sensory - speech ICD 10 Codes: R47 Required impairment category: Sensory Optional impairment categories: Physical

Multiple Sclerosis

  1. Multiple Sclerosis

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ICD 10 Codes: G35 Required impairment category: Neurological Optional impairment categories: Cognitive, physical, psychosocial

Other Neurological

  1. Alzheimer’s disease ICD 10 Codes: F00 Required impairment category: Cognitive Optional impairment categories: Neurological, physical, psychosocial
  2. Unspecified dementia ICD 10 Codes: F03 Required impairment category: Cognitive Optional impairment categories: Neurological, physical, psychosocial
  3. Huntington disease ICD 10 Codes: G10 Required impairment category: Physical Optional impairment categories: Cognitive, neurological, psychosocial
  4. Motor neurone disease ICD 10 Codes: G12.2 Required impairment category: Physical Optional impairment categories: Cognitive, neurological, sensory, psychosocial
  5. Parkinson’s disease ICD 10 Codes: G20 Required impairment category: Neurological Optional impairment categories: Cognitive, physical, psychosocial
  6. Epilepsy – Mandatory TAPIB ICD 10 Codes: G40 Required impairment category: Neurological Optional impairment categories: Intellectual, cognitive, psychosocial
  7. Muscular dystrophy

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ICD 10 Codes: G71.0 Required impairment category: Physical Optional impairment categories: Neurological 8. Other Neurological – List A and List C ICD 10 Codes: G99 Required impairment category: Neurological Optional impairment categories: Cognitive, sensory, physical

Stroke

  1. Stroke ICD 10 Codes: I69 Required impairment category: Physical Optional impairment categories: Cognitive, neurological, sensory, psychosocial

Other Physical

  1. Rheumatoid arthritis ICD 10 Codes: M05 Required impairment category: Physical Optional impairment categories: Not applicable
  2. Other arthritis – mandatory TAPIB ICD 10 Codes: M12 Required impairment category: Physical Optional impairment categories: Not applicable
  3. Other physical ICD 10 Codes: M95 Required impairment category: Physical Optional impairment categories: Psychosocial
  4. Multiple traumatic amputations ICD 10 Codes: T05 Required impairment category: Physical

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Optional impairment categories: Psychosocial 5. Myopathy ICD 10 Codes: G72.9 Required impairment category: Physical Optional impairment categories: Not applicable

Psychosocial disability

  1. Schizophrenia ICD 10 Codes: F20 Required impairment category: Psychosocial Optional impairment categories: Cognitive
  2. Schizoaffective disorder ICD 10 Codes: F25.9 Required impairment category: Psychosocial Optional impairment categories: Cognitive
  3. Bipolar affective disorder ICD 10 Codes: F31 Required impairment category: Psychosocial Optional impairment categories: Cognitive
  4. Major depressive illness ICD 10 Codes: F32 Required impairment category: Psychosocial Optional impairment categories: Cognitive
  5. Other anxiety disorders ICD 10 Codes: F41 Required impairment category: Psychosocial Optional impairment categories: Cognitive
  6. Obsessive-compulsive disorder ICD 10 Codes: F42 Required impairment category: Psychosocial

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Optional impairment categories: Not applicable 7. Post traumatic stress disorder ICD 10 Codes: F43 Required impairment category: Psychosocial Optional impairment categories: Cognitive 8. Borderline personality disorder ICD 10 Codes: F60.3 Required impairment category: Psychosocial Optional impairment categories: Not applicable 9. Tourette syndrome ICD 10 Codes: F95.2 Required impairment category: Neurological Optional impairment categories: Cognitive, physical, psychosocial 10. Other psychosocial disorders ICD 10 Codes: F99 Required impairment category: Psychosocial Optional impairment categories: Cognitive 11. Anorexia ICD 10 Codes: R63 Required impairment category: Psychosocial Optional impairment categories: Cognitive, physical

Spinal Cord Injury

  1. Malignant neoplasm of spinal cord complete and incomplete ICD 10 Codes: C72.5, C72.7 Required impairment category: Physical Optional impairment categories: Neurological, sensory
  2. Spinal cord injury (complete) ICD 10 Codes: T09.5 Required impairment category: Physical

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Optional impairment categories: Neurological, sensory, psychosocial 3. Spinal cord injury (incomplete) ICD 10 Codes: T09.7 Required impairment category: Physical Optional impairment categories: Neurological, sensory, psychosocial

Other

  1. Malignant neoplasm of brain ICD 10 Codes: C71 Required impairment category: Neurological Optional impairment categories: Cognitive, psychosocial
  2. Metastatic cancer ICD 10 Codes: C79.9 Required impairment category: Physical Optional impairment categories: Cognitive
  3. Malignant neoplasm of blood or immune disease ICD 10 Codes: C96 Required impairment category: Physical Optional impairment categories: Cognitive
  4. Autoimmune disorders ICD 10 Codes: D89.9 Required impairment category: Physical Optional impairment categories: Cognitive
  5. Obesity – mandatory TAPIB ICD 10 Codes: E66 Required impairment category: Physical Optional impairment categories: Psychosocial
  6. Classical phenylketonuria ICD 10 Codes: E70.0 Required impairment category: Cognitive

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Optional impairment categories: Psychosocial 7. Disorders of pyruvate metabolism and gluconeogenesis ICD 10 Codes: E74.4 Required impairment category: Intellectual Optional impairment categories: Neurological, physical 8. Other metabolic disorders ICD 10 Codes: E88 Required impairment category: Intellectual Optional impairment categories: Neurological, physical 9. Dementia – rapidly progressing ICD 10 Codes: F03.9 Required impairment category: Cognitive Optional impairment categories: Not applicable 10. Functional neurological disorder (FND) – mandatory TAPIB ICD 10 Codes: F44.4 Required impairment category: Neurological Optional impairment categories: Cognitive, sensory, physical 11. Other language disorder ICD 10 Codes: F80 Required impairment category: Cognitive Optional impairment categories: Not applicable 12. Peripheral neuropathy – does NOT require TAPIB ICD 10 Codes: F90.0 Required impairment category: Neurological Optional impairment categories: Sensory, physical 13. Oppositional defiant disorder (ODD) ICD 10 Codes: F91.3 Required impairment category: Cognitive Optional impairment categories: Psychosocial

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  1. Other hereditary ataxias ICD 10 Codes: G11.8 Required impairment category: Neurological Optional impairment categories: Cognitive, sensory, physical
  2. Dementia – early onset ICD 10 Codes: G30.0 Required impairment category: Cognitive Optional impairment categories: Not applicable
  3. Plegia ICD 10 Codes: G83.1 Required impairment category: Physical Optional impairment categories: Neurological
  4. Chronic pain – mandatory TAPIB ICD 10 Codes: G89.4 Required impairment category: Physical Optional impairment categories: Sensory, psychosocial
  5. Postural Orthostatic Tachycardia Syndrome (POTS) – mandatory TAPIB ICD 10 Codes: I49.8 Required impairment category: Neurological Optional impairment categories: Physical
  6. Lymphoedema – mandatory TAPIB ICD 10 Codes: I89.0 Required impairment category: Physical Optional impairment categories: Not applicable
  7. Chronic lung disease ICD 10 Codes: J44.9 Required impairment category: Physical Optional impairment categories:
  8. Chronic Obstructive Pulmonary Disease (COPD) – mandatory TAPIB

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ICD 10 Codes: J44.9A Required impairment category: Physical Optional impairment categories: Not applicable 22. Osteoarthritis – mandatory TAPIB ICD 10 Codes: M19.9 Required impairment category: Physical Optional impairment categories: Not applicable 23. Systemic lupus erythematosus ICD 10 Codes: M32 Required impairment category: Physical Optional impairment categories: Not applicable 24. Ankylosing spondylitis ICD 10 Codes: M45 Required impairment category: Physical Optional impairment categories: Not applicable 25. Fibromyalgia ICD 10 Codes: M79.7 Required impairment category: Physical Optional impairment categories: Sensory 26. Renal failure ICD 10 Codes: N18 Required impairment category: Physical Optional impairment categories: 27. Ehlers Danlos – does NOT require TAPIB ICD 10 Codes: Q79.6 Required impairment category: Physical Optional impairment categories: Not applicable 28. Dyslexia ICD 10 Codes: R48

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Required impairment category: Cognitive Optional impairment categories: Psychosocial 29. Childhood apraxia of speech ICD 10 Codes: R48.2 Required impairment category: Neurological Optional impairment categories: Cognitive 30. Short stature ICD 10 Codes: R62.5 Required impairment category: Physical Optional impairment categories: Not applicable 31. Amputation – single limb or upper/lower limb ICD 10 Codes: Z89 Required impairment category: Physical Optional impairment categories: Cognitive, sensory, psychosocial 32. Amputation – multiple ICD 10 Codes: Z89.1 Required impairment category: Physical Optional impairment categories: Cognitive, sensory, psychosocial

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Version control

Version Amended Brief Description of Change Status

by

0.1 VFK746 |Draft transfer of endorsed Attachment A DRAFT 2024-10-03 — Descriptions of impairment categories to KA — required for legislation updates

0.2 TCM150 |Peer review DRAFT 2024-10-03 0.3 VFK746_ |Implementation of Peer Review DRAFT 2024-10-03 0.4 JM0122 |EL1 review and approval DRAFT 2024-10-07 0.5 VFK746 |Class 1 endorsement — progress to BM DRAFT 2024-10-08

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