IHCP bulletinprovider.indianamedicaid.com/ihcp/Bulletins/BT202077.pdf048-3 Peripheral, cranial &...

IHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT202077 JUNE 25, 2020

of 2

IHCP announces changes to DRG grouper and inpatient hospital reimbursement rates The Indiana Health Coverage Programs (IHCP) has selected the 3M All-Patient Refined (APR) Diagnosis-Related Group (DRG), version 36, as announced in IHCP Bulletin BT202059.

All inpatient reimbursement rates and DRG weights communicated in this bulletin are effective for inpatient stays with discharge dates on or after August 1, 2020. The current APR-DRG grouper, version 30, will remain in place for inpatient stays with discharge dates before August 1, 2020. Billing procedures for inpatient hospital services have not changed. See the Inpatient Hospital Services provider reference module and IHCP provider bulletins and banner pages for specific billing instructions.

For information about the APR-DRG software, contact 3M at 1-800-367-2447 or visit 3M Health Information Systems page on the 3M website at 3m.com.

Policy reminders

The following sections are reminders of IHCP policies in place for inpatient hospital services.

Hospital Assessment Fee program The Hospital Assessment Fee (HAF) program remains in effect, as detailed in IHCP Bulletin BT201939.

Inpatient stays of less than 24 hours Providers should continue to bill any inpatient stay that is less than 24 hours as an outpatient service. For exceptions to the 24-hour policy, follow the guidance published in the Inpatient Hospital Services provider reference module.

Updated rates and relative weights

The following sections provide information about the rates and relative weights for the new APR-DRG grouper, version 36.

DRG base rate The DRG base rate will be $3,624.35 for acute care hospital services. The DRG base rate for eligible children’s hospitals will be $4,349.22. Providers eligible for the children’s hospital base rate will be notified individually of their eligibility.

Outlier threshold and cost-to-charge ratios The threshold used to determine outlier payments will be updated to $59,175. Myers and Stauffer LC, the IHCP’s hospital rate-setting contractor, will notify hospitals individually of their new global cost-to-charge ratio that is used to calculate outlier payments. Low-volume IHCP providers, new IHCP providers, and most out-of-state providers will receive the statewide median cost-to-charge ratio of 0.3362.

http://provider.indianamedicaid.com/ihcp/Bulletins/BT202059.pdf

https://www.in.gov/medicaid/files/inpatient%20hospital%20services.pdf

https://www.3m.com/3M/en_US/health-information-systems-us/


https://www.in.gov/medicaid/files/inpatient%20hospital%20services.pdf



IHCP bulletin BT202077 JUNE 25, 2020

of 2

Level-of-care rates Table 1 provides the level-of-care (LOC) per diem rates effective for inpatient stays with discharge dates on or after August 1, 2020.

Table 1 – LOC per diem rates effective for inpatient stays with discharge dates on or after August 1, 2020

Please note that DRG 757 will be paid at the psychiatric LOC rate unless billed with ICD-10 diagnosis codes F70–F79. Claims that group to DRG 757, when billed with diagnosis codes F70-F79, will pay using the DRG payment methodology, rather than the LOC per diem methodology.

Provider-specific per diem rates for providers classified as hospital provider specialty 013 – Long-Term Acute Care (LTAC) will be communicated to qualifying providers individually by Myers & Stauffer.

Capital per diem rates The capital per diem rate remains unchanged at $64.50.

Medical education rates Myers and Stauffer will notify qualifying hospitals individually of their new medical education per diem rates.

Relative weights and average lengths of stay A complete list of new relative weights and average lengths of stay (ALOS) associated with the new APR-DRG grouper, version 36, are listed in Table 2, attached to this bulletin. Please note that each DRG has four severity levels (1 – Minor, 2 – Moderate, 3 – Major, and 4 – Extreme), which allow for more detailed coding of the patient’s status.

If you have questions about this publication, please contact Customer Assistance at 1-800-457-4584.

QUESTIONS?

To receive email notices of IHCP publications, subscribe by clicking the blue subscription envelope or sign up from the IHCP provider website at in.gov/medicaid/providers.

SIGN UP FOR IHCP EMAIL NOTIFICATIONS

If you need additional copies of this publication, please download them from the Bulletins page of the IHCP provider website at in.gov/medicaid/providers.

COPIES OF THIS PUBLICATION

A printer-friendly version of this publication, in black and white and without photos, is available for your convenience.

TO PRINT

Service Per Diem Rate Psychiatric LOC $408.50 Rehabilitation LOC $667.00 Burn/1 LOC $3,750.00 Burn/2 LOC $1,125.00

https://www.in.gov/medicaid/providers/index.html

https://public.govdelivery.com/accounts/INFSSA/subscriber/new?topic_id=INFSSA_29%5d

https://www.in.gov/medicaid/providers/829.htm

http://provider.indianamedicaid.com/ihcp/Bulletins/BT202077_PF.pdf


APR-DRG Version 36 and Inpatient Hospital Reimbursement 1 of 27

Table 2 – Relative weights and ALOS associated with APR-DRG grouper, version 36, effective for inpatient stays with discharge dates on or after August 1, 2020

DRG Description Relative weight ALOS

001-1 Liver transplant &/or intestinal transplant 6.5564 7.0 001-2 Liver transplant &/or intestinal transplant 6.5564 7.3 001-3 Liver transplant &/or intestinal transplant 6.5564 11.7 001-4 Liver transplant &/or intestinal transplant 20.4270 23.6 002-1 Heart &/or lung transplant 16.1645 13.0 002-2 Heart &/or lung transplant 16.1645 15.6 002-3 Heart &/or lung transplant 16.1645 23.1 002-4 Heart &/or lung transplant 28.0178 35.3 004-1 Tracheostomy w mv 96+ hours w extensive procedure 9.1088 11.0 004-2 Tracheostomy w mv 96+ hours w extensive procedure 9.1088 14.3 004-3 Tracheostomy w mv 96+ hours w extensive procedure 9.1088 21.3 004-4 Tracheostomy w mv 96+ hours w extensive procedure 18.5510 41.1 005-1 Tracheostomy w mv 96+ hours w/o extensive procedure 4.9141 13.9 005-2 Tracheostomy w mv 96+ hours w/o extensive procedure 4.9141 15.9 005-3 Tracheostomy w mv 96+ hours w/o extensive procedure 7.4898 23.3 005-4 Tracheostomy w mv 96+ hours w/o extensive procedure 12.0511 32.1 006-1 Pancreas transplant 8.9991 6.5 006-2 Pancreas transplant 8.9991 7.0 006-3 Pancreas transplant 8.9991 8.5 006-4 Pancreas transplant 13.1237 8.5 007-1 Allogeneic bone marrow transplant 11.4151 26.4 007-2 Allogeneic bone marrow transplant 11.4151 26.4 007-3 Allogeneic bone marrow transplant 11.4151 26.4 007-4 Allogeneic bone marrow transplant 18.9129 39.5 008-1 Autologous bone marrow transplant 5.5709 14.3 008-2 Autologous bone marrow transplant 5.5709 16.1 008-3 Autologous bone marrow transplant 5.5709 17.7 008-4 Autologous bone marrow transplant 8.3500 22.2 009-1 Extracorporeal membrane oxygenation (ECMO) 10.6465 12.0 009-2 Extracorporeal membrane oxygenation (ECMO) 10.6465 12.0 009-3 Extracorporeal membrane oxygenation (ECMO) 10.6465 12.0 009-4 Extracorporeal membrane oxygenation (ECMO) 18.4485 12.0 010-1 Head trauma with deep coma 7.7351 19.9 010-2 Head trauma with deep coma 7.7351 19.9 010-3 Head trauma with deep coma 7.7351 19.9 010-4 Head trauma with deep coma 8.3337 19.9 020-1 Craniotomy for trauma 1.9134 4.0 020-2 Craniotomy for trauma 2.2745 5.4 020-3 Craniotomy for trauma 2.9812 7.8 020-4 Craniotomy for trauma 4.9376 9.6 021-1 Craniotomy except for trauma 1.9928 3.2 021-2 Craniotomy except for trauma 2.2792 3.3 021-3 Craniotomy except for trauma 4.5116 9.4 021-4 Craniotomy except for trauma 6.0100 11.1 022-1 Ventricular shunt procedures 1.5747 1.9 022-2 Ventricular shunt procedures 1.5962 2.1 022-3 Ventricular shunt procedures 2.5106 4.2 022-4 Ventricular shunt procedures 3.9690 9.7 023-1 Spinal procedures 1.6245 2.4 023-2 Spinal procedures 1.9126 3.3 023-3 Spinal procedures 3.1395 7.2 023-4 Spinal procedures 5.2647 13.6 024-1 Extracranial vascular procedures 1.5598 1.5 024-2 Extracranial vascular procedures 2.2787 2.4




024-3 Extracranial vascular procedures 2.7315 4.9 024-4 Extracranial vascular procedures 4.7169 7.9 026-1 Other nervous system & related procedures 1.3333 2.0 026-2 Other nervous system & related procedures 1.9950 4.0 026-3 Other nervous system & related procedures 2.1108 6.3 026-4 Other nervous system & related procedures 3.5635 10.5 040-1 Spinal disorders & injuries 0.9537 4.0 040-2 Spinal disorders & injuries 1.2222 5.6 040-3 Spinal disorders & injuries 1.8371 9.7 040-4 Spinal disorders & injuries 3.9471 16.5 041-1 Nervous system malignancy 0.7163 2.2 041-2 Nervous system malignancy 1.4956 4.1 041-3 Nervous system malignancy 1.4956 4.7 041-4 Nervous system malignancy 1.4956 4.7 042-1 Degenerative nervous system disorders exc mult sclerosis 0.5782 4.6 042-2 Degenerative nervous system disorders exc mult sclerosis 1.1466 5.9 042-3 Degenerative nervous system disorders exc mult sclerosis 1.8234 7.4 042-4 Degenerative nervous system disorders exc mult sclerosis 2.0403 8.3 043-1 Multiple sclerosis & other demyelinating diseases 1.0560 3.7 043-2 Multiple sclerosis & other demyelinating diseases 1.0560 4.0 043-3 Multiple sclerosis & other demyelinating diseases 1.4797 7.6 043-4 Multiple sclerosis & other demyelinating diseases 1.8047 20.4 044-1 Intracranial hemorrhage 0.7614 2.7 044-2 Intracranial hemorrhage 1.0323 2.9 044-3 Intracranial hemorrhage 1.4035 4.2 044-4 Intracranial hemorrhage 1.7482 4.2 045-1 CVA & precerebral occlusion w infarct 0.7912 2.3 045-2 CVA & precerebral occlusion w infarct 0.9649 3.0 045-3 CVA & precerebral occlusion w infarct 1.4045 4.2 045-4 CVA & precerebral occlusion w infarct 3.2032 9.1 046-1 Nonspecific CVA & precerebral occlusion w/o infarct 0.8617 1.5 046-2 Nonspecific CVA & precerebral occlusion w/o infarct 0.8617 2.3 046-3 Nonspecific CVA & precerebral occlusion w/o infarct 0.8617 2.9 046-4 Nonspecific CVA & precerebral occlusion w/o infarct 0.8617 16.0 047-1 Transient ischemia 0.7056 2.0 047-2 Transient ischemia 0.8215 2.4 047-3 Transient ischemia 0.8215 3.1 047-4 Transient ischemia 0.8215 11.8 048-1 Peripheral, cranial & autonomic nerve disorders 0.7631 2.8 048-2 Peripheral, cranial & autonomic nerve disorders 0.8788 3.4 048-3 Peripheral, cranial & autonomic nerve disorders 1.1802 4.5 048-4 Peripheral, cranial & autonomic nerve disorders 1.9093 8.2 049-1 Bacterial & tuberculous infections of nervous system 1.5673 5.1 049-2 Bacterial & tuberculous infections of nervous system 1.7200 5.6 049-3 Bacterial & tuberculous infections of nervous system 1.9331 7.9 049-4 Bacterial & tuberculous infections of nervous system 3.7083 11.7 050-1 Non-bacterial infections of nervous system exc viral

meningitis 0.7900 2.8

050-2 Non-bacterial infections of nervous system exc viral meningitis

1.2315 4.1


1.7411 7.0


3.5260 11.5

051-1 Viral meningitis 0.4636 2.1 051-2 Viral meningitis 0.6323 2.9 051-3 Viral meningitis 1.1705 5.3




051-4 Viral meningitis 1.3531 5.3 052-1 Alteration in consciousness 0.4990 1.6 052-2 Alteration in consciousness 0.8650 3.1 052-3 Alteration in consciousness 1.1126 4.0 052-4 Alteration in consciousness 2.3232 5.9 053-1 Seizure 0.5860 2.2 053-2 Seizure 0.7464 2.5 053-3 Seizure 0.9764 2.9 053-4 Seizure 2.2307 5.2 054-1 Migraine & other headaches 0.7127 2.7 054-2 Migraine & other headaches 0.8237 3.1 054-3 Migraine & other headaches 0.9490 3.4 054-4 Migraine & other headaches 0.9490 3.5 055-1 Head trauma w coma >1 hr or hemorrhage 0.6068 1.9 055-2 Head trauma w coma >1 hr or hemorrhage 1.0501 3.2 055-3 Head trauma w coma >1 hr or hemorrhage 1.5848 4.5 055-4 Head trauma w coma >1 hr or hemorrhage 2.9941 6.2 056-1 Brain contusion/laceration & complicated skull fx, coma < 1 hr

or no coma 0.5050 1.3

056-2 Brain contusion/laceration & complicated skull fx, coma < 1 hr or no coma

0.7656 2.4


0.7656 2.4


0.7656 7.0

057-1 Concussion, closed skull fx nos, uncomplicated intracranial injury, coma < 1 hr or no coma

0.5549 2.3


0.8939 3.1


1.0152 3.2


1.7686 4.6

058-1 Other disorders of nervous system 1.1860 4.4 058-2 Other disorders of nervous system 1.7143 6.8 058-3 Other disorders of nervous system 2.1362 9.9 058-4 Other disorders of nervous system 3.3205 11.2 059-1 Anoxic & other severe brain damage 1.2100 2.4 059-2 Anoxic & other severe brain damage 1.2100 4.3 059-3 Anoxic & other severe brain damage 1.2100 4.7 059-4 Anoxic & other severe brain damage 1.7566 4.7 073-1 Orbit and eye procedures 1.0126 2.1 073-2 Orbit and eye procedures 1.1888 2.8 073-3 Orbit and eye procedures 1.8779 4.1 073-4 Orbit and eye procedures 1.8779 22.7 082-1 Eye infections and other eye disorders 0.6119 2.6 082-2 Eye infections and other eye disorders 0.7375 2.7 082-3 Eye infections and other eye disorders 0.8979 3.2 082-4 Eye infections and other eye disorders 1.1980 8.3 089-1 Major cranial/facial bone procedures 1.5309 1.8 089-2 Major cranial/facial bone procedures 4.0160 4.0 089-3 Major cranial/facial bone procedures 4.7610 5.7 089-4 Major cranial/facial bone procedures 6.3480 11.2 091-1 Other major head & neck procedures 1.8701 2.8 091-2 Other major head & neck procedures 2.0425 3.7 091-3 Other major head & neck procedures 2.8928 6.9 091-4 Other major head & neck procedures 5.0555 11.2




092-1 Facial bone procedures except major cranial/facial bone procedures

1.5444 1.7


1.5444 2.1


2.6758 4.8


5.0778 11.0

095-1 Cleft lip & palate repair 0.6933 1.2 095-2 Cleft lip & palate repair 0.7904 1.3 095-3 Cleft lip & palate repair 1.0208 3.8 095-4 Cleft lip & palate repair 1.0208 3.8 097-1 Tonsil & adenoid procedures 0.6582 1.6 097-2 Tonsil & adenoid procedures 0.9185 2.1 097-3 Tonsil & adenoid procedures 1.1292 2.8 097-4 Tonsil & adenoid procedures 1.4207 9.8 098-1 Other ear, nose, mouth & throat procedures 0.9182 2.0 098-2 Other ear, nose, mouth & throat procedures 1.1865 3.0 098-3 Other ear, nose, mouth & throat procedures 2.1004 5.7 098-4 Other ear, nose, mouth & throat procedures 3.7630 9.7 110-1 Ear, nose, mouth, throat, cranial/facial malignancies 0.6180 2.0 110-2 Ear, nose, mouth, throat, cranial/facial malignancies 0.7620 2.8 110-3 Ear, nose, mouth, throat, cranial/facial malignancies 1.1499 4.6 110-4 Ear, nose, mouth, throat, cranial/facial malignancies 1.9626 7.1 111-1 Vertigo & other labyrinth disorders 0.4853 1.7 111-2 Vertigo & other labyrinth disorders 0.7159 2.8 111-3 Vertigo & other labyrinth disorders 0.7159 2.8 111-4 Vertigo & other labyrinth disorders 0.7159 3.1 113-1 Infections of upper respiratory tract 0.4467 2.1 113-2 Infections of upper respiratory tract 0.5451 2.4 113-3 Infections of upper respiratory tract 1.0163 3.4 113-4 Infections of upper respiratory tract 1.1907 4.5 114-1 Dental diseases and disorders 0.5656 2.3 114-2 Dental diseases and disorders 0.6154 2.5 114-3 Dental diseases and disorders 0.9231 3.3 114-4 Dental diseases and disorders 1.1314 12.3 115-1 Other ear, nose, mouth, throat & cranial/facial diagnoses 0.9220 2.5 115-2 Other ear, nose, mouth, throat & cranial/facial diagnoses 0.9220 3.0 115-3 Other ear, nose, mouth, throat & cranial/facial diagnoses 1.5885 4.9 115-4 Other ear, nose, mouth, throat & cranial/facial diagnoses 1.8893 6.1 120-1 Major respiratory & chest procedures 2.1611 4.1 120-2 Major respiratory & chest procedures 2.5768 5.5 120-3 Major respiratory & chest procedures 3.5941 9.2 120-4 Major respiratory & chest procedures 6.7537 16.8 121-1 Other respiratory & chest procedures 1.7347 4.1 121-2 Other respiratory & chest procedures 1.9368 4.7 121-3 Other respiratory & chest procedures 2.8889 7.8 121-4 Other respiratory & chest procedures 5.6875 13.0 130-1 Respiratory system diagnosis w ventilator support 96+ hours 4.1090 12.6 130-2 Respiratory system diagnosis w ventilator support 96+ hours 4.1090 12.6 130-3 Respiratory system diagnosis w ventilator support 96+ hours 4.1090 12.6 130-4 Respiratory system diagnosis w ventilator support 96+ hours 5.3797 12.6 131-1 Cystic fibrosis - pulmonary disease 2.5607 7.9 131-2 Cystic fibrosis - pulmonary disease 2.5607 8.4 131-3 Cystic fibrosis - pulmonary disease 2.5607 10.2 131-4 Cystic fibrosis - pulmonary disease 3.3035 11.1




132-1 BPD & oth chronic respiratory diseases arising in perinatal period

0.6867 2.2


1.0362 3.7


1.0362 3.7


5.9525 14.4

133-1 Respiratory failure 0.6166 2.2 133-2 Respiratory failure 0.9049 3.1 133-3 Respiratory failure 1.3115 4.0 133-4 Respiratory failure 2.1886 5.4 134-1 Pulmonary embolism 0.8890 2.8 134-2 Pulmonary embolism 0.8947 2.9 134-3 Pulmonary embolism 1.2835 4.0 134-4 Pulmonary embolism 2.2245 5.7 135-1 Major chest & respiratory trauma 0.6129 2.4 135-2 Major chest & respiratory trauma 0.8883 3.1 135-3 Major chest & respiratory trauma 1.0793 4.0 135-4 Major chest & respiratory trauma 1.6837 6.2 136-1 Respiratory malignancy 0.5715 2.4 136-2 Respiratory malignancy 0.9479 3.3 136-3 Respiratory malignancy 1.2916 4.7 136-4 Respiratory malignancy 1.5919 5.9 137-1 Major respiratory infections & inflammations 0.7069 3.2 137-2 Major respiratory infections & inflammations 1.0458 4.1 137-3 Major respiratory infections & inflammations 1.3667 4.6 137-4 Major respiratory infections & inflammations 2.4223 7.0 138-1 Bronchiolitis & RSV pneumonia 0.4867 2.5 138-2 Bronchiolitis & RSV pneumonia 0.6764 3.1 138-3 Bronchiolitis & RSV pneumonia 0.9508 4.1 138-4 Bronchiolitis & RSV pneumonia 1.9057 6.3 139-1 Other pneumonia 0.4890 2.3 139-2 Other pneumonia 0.6950 2.8 139-3 Other pneumonia 1.0537 3.8 139-4 Other pneumonia 1.8883 5.6 140-1 Chronic obstructive pulmonary disease 0.6668 2.7 140-2 Chronic obstructive pulmonary disease 0.7754 3.0 140-3 Chronic obstructive pulmonary disease 0.9411 3.3 140-4 Chronic obstructive pulmonary disease 1.3183 4.3 141-1 Asthma 0.5232 2.2 141-2 Asthma 0.6805 2.5 141-3 Asthma 0.8930 3.1 141-4 Asthma 1.4314 4.0 142-1 Interstitial & alveolar lung diseases 0.6303 2.4 142-2 Interstitial & alveolar lung diseases 0.6521 2.9 142-3 Interstitial & alveolar lung diseases 0.8748 4.0 142-4 Interstitial & alveolar lung diseases 1.5234 6.5 143-1 Other respiratory diagnoses except signs, symptoms & minor

diagnoses 0.8274 3.2

143-2 Other respiratory diagnoses except signs, symptoms & minor diagnoses

1.0233 3.5


1.2467 3.9


2.3973 6.0

144-1 Respiratory signs, symptoms & minor diagnoses 0.7493 2.8




144-2 Respiratory signs, symptoms & minor diagnoses 0.8211 2.9 144-3 Respiratory signs, symptoms & minor diagnoses 0.8211 3.3 144-4 Respiratory signs, symptoms & minor diagnoses 1.3193 4.7 145-1 Acute bronchitis and related symptoms 0.5611 2.1 145-2 Acute bronchitis and related symptoms 0.6538 2.4 145-3 Acute bronchitis and related symptoms 0.9213 3.0 145-4 Acute bronchitis and related symptoms 1.2773 4.4 160-1 Major cardiothoracic repair of heart anomaly 2.8295 3.9 160-2 Major cardiothoracic repair of heart anomaly 3.3397 4.7 160-3 Major cardiothoracic repair of heart anomaly 4.3601 8.3 160-4 Major cardiothoracic repair of heart anomaly 9.8894 14.4 161-1 Cardiac defibrillator & heart assist implant 4.4533 4.0 161-2 Cardiac defibrillator & heart assist implant 5.4591 6.0 161-3 Cardiac defibrillator & heart assist implant 6.4107 9.4 161-4 Cardiac defibrillator & heart assist implant 27.0879 23.3 162-1 Cardiac valve procedures w AMI or complex PDX 3.7095 6.2 162-2 Cardiac valve procedures w AMI or complex PDX 4.3154 6.8 162-3 Cardiac valve procedures w AMI or complex PDX 6.5763 11.7 162-4 Cardiac valve procedures w AMI or complex PDX 9.1512 16.0 163-1 Cardiac valve procedures w/o AMI or complex PDX 3.1583 4.4 163-2 Cardiac valve procedures w/o AMI or complex PDX 4.1852 6.0 163-3 Cardiac valve procedures w/o AMI or complex PDX 4.6334 7.7 163-4 Cardiac valve procedures w/o AMI or complex PDX 8.0102 14.0 165-1 Coronary bypass w AMI or complex PDX 2.7867 6.0 165-2 Coronary bypass w AMI or complex PDX 4.0766 8.4 165-3 Coronary bypass w AMI or complex PDX 4.8207 9.5 165-4 Coronary bypass w AMI or complex PDX 8.1940 14.8 166-1 Coronary bypass w/o AMI or complex PDX 2.7678 5.8 166-2 Coronary bypass w/o AMI or complex PDX 3.1596 6.2 166-3 Coronary bypass w/o AMI or complex PDX 4.1706 7.0 166-4 Coronary bypass w/o AMI or complex PDX 6.4933 11.9 167-1 Other cardiothoracic & thoracic vascular procedures 2.2588 3.8 167-2 Other cardiothoracic & thoracic vascular procedures 2.9382 3.8 167-3 Other cardiothoracic & thoracic vascular procedures 3.7248 7.6 167-4 Other cardiothoracic & thoracic vascular procedures 5.9409 11.0 169-1 Major abdominal vascular procedures 2.1860 4.3 169-2 Major abdominal vascular procedures 2.8194 5.5 169-3 Major abdominal vascular procedures 3.8379 6.3 169-4 Major abdominal vascular procedures 6.4020 8.9 170-1 Permanent cardiac pacemaker implant w AMI, heart failure or

shock 2.8262 2.0

170-2 Permanent cardiac pacemaker implant w AMI, heart failure or shock

2.8262 4.6


2.8262 7.1


4.1249 10.1

171-1 Perm cardiac pacemaker implant w/o AMI, heart failure or shock

2.0277 2.0


2.2892 3.4


2.6703 4.6


3.1679 8.2

174-1 Percutaneous coronary intervention w AMI 1.7656 2.1 174-2 Percutaneous coronary intervention w AMI 1.8857 2.4




174-3 Percutaneous coronary intervention w AMI 2.3781 3.6 174-4 Percutaneous coronary intervention w AMI 4.2605 6.7 175-1 Percutaneous coronary intervention w/o AMI 1.9094 2.1 175-2 Percutaneous coronary intervention w/o AMI 2.2172 2.7 175-3 Percutaneous coronary intervention w/o AMI 2.6066 3.8 175-4 Percutaneous coronary intervention w/o AMI 5.1904 8.6 176-1 Cardiac pacemaker & defibrillator device replacement 1.8445 2.3 176-2 Cardiac pacemaker & defibrillator device replacement 1.8608 3.0 176-3 Cardiac pacemaker & defibrillator device replacement 5.3813 6.2 176-4 Cardiac pacemaker & defibrillator device replacement 5.3813 8.7 177-1 Cardiac pacemaker & defibrillator revision except device

replacement 1.0785 2.4

177-2 Cardiac pacemaker & defibrillator revision except device replacement

1.7484 3.6


2.9561 5.2


2.9561 12.4

180-1 Other circulatory system procedures 1.2087 2.4 180-2 Other circulatory system procedures 1.4880 3.6 180-3 Other circulatory system procedures 2.3795 6.3 180-4 Other circulatory system procedures 3.1354 9.5 181-1 Lower extremity arterial procedures 1.9054 2.5 181-2 Lower extremity arterial procedures 2.5339 3.9 181-3 Lower extremity arterial procedures 4.0225 6.9 181-4 Lower extremity arterial procedures 6.0704 9.7 182-1 Other peripheral vascular procedures 2.4308 1.4 182-2 Other peripheral vascular procedures 3.0589 3.8 182-3 Other peripheral vascular procedures 3.0589 5.2 182-4 Other peripheral vascular procedures 4.1168 8.7 190-1 Acute myocardial infarction 0.8348 2.0 190-2 Acute myocardial infarction 0.9274 2.3 190-3 Acute myocardial infarction 1.1632 3.4 190-4 Acute myocardial infarction 2.2431 5.0 191-1 Cardiac catheterization for coronary artery disease 0.8874 2.1 191-2 Cardiac catheterization for coronary artery disease 1.0535 2.6 191-3 Cardiac catheterization for coronary artery disease 1.1944 3.2 191-4 Cardiac catheterization for coronary artery disease 2.1785 6.6 192-1 Cardiac catheterization for other non-coronary conditions 0.8241 2.0 192-2 Cardiac catheterization for other non-coronary conditions 1.0757 3.1 192-3 Cardiac catheterization for other non-coronary conditions 1.6141 4.5 192-4 Cardiac catheterization for other non-coronary conditions 2.9112 6.2 193-1 Acute & subacute endocarditis 0.7119 2.8 193-2 Acute & subacute endocarditis 0.9049 4.7 193-3 Acute & subacute endocarditis 1.2336 7.0 193-4 Acute & subacute endocarditis 2.0409 8.0 194-1 Heart failure 0.6801 2.4 194-2 Heart failure 0.8344 3.1 194-3 Heart failure 1.1686 4.1 194-4 Heart failure 1.8640 5.9 196-1 Cardiac arrest & shock 0.5338 2.2 196-2 Cardiac arrest & shock 0.5338 2.2 196-3 Cardiac arrest & shock 0.8500 2.2 196-4 Cardiac arrest & shock 2.1736 3.7 197-1 Peripheral & other vascular disorders 0.8765 2.6 197-2 Peripheral & other vascular disorders 1.0940 3.3 197-3 Peripheral & other vascular disorders 1.3374 4.1




197-4 Peripheral & other vascular disorders 1.7467 6.1 198-1 Angina pectoris & coronary atherosclerosis 0.4376 1.5 198-2 Angina pectoris & coronary atherosclerosis 0.7322 2.2 198-3 Angina pectoris & coronary atherosclerosis 0.7322 2.5 198-4 Angina pectoris & coronary atherosclerosis 1.2235 4.3 199-1 Hypertension 0.5892 2.0 199-2 Hypertension 0.7431 2.8 199-3 Hypertension 1.1090 3.4 199-4 Hypertension 1.3117 4.7 200-1 Cardiac structural & valvular disorders 1.6250 2.6 200-2 Cardiac structural & valvular disorders 1.6250 2.6 200-3 Cardiac structural & valvular disorders 1.6250 5.4 200-4 Cardiac structural & valvular disorders 1.6250 5.4 201-1 Cardiac arrhythmia & conduction disorders 0.6149 2.1 201-2 Cardiac arrhythmia & conduction disorders 0.7107 2.4 201-3 Cardiac arrhythmia & conduction disorders 1.1050 3.5 201-4 Cardiac arrhythmia & conduction disorders 1.3993 5.4 203-1 Chest pain 0.5380 1.8 203-2 Chest pain 0.6354 1.9 203-3 Chest pain 0.8428 3.0 203-4 Chest pain 0.8428 3.1 204-1 Syncope & collapse 0.6741 2.4 204-2 Syncope & collapse 0.6868 2.4 204-3 Syncope & collapse 1.0811 3.4 204-4 Syncope & collapse 1.3501 5.4 205-1 Cardiomyopathy 0.5277 1.6 205-2 Cardiomyopathy 0.5293 2.4 205-3 Cardiomyopathy 0.8404 4.2 205-4 Cardiomyopathy 1.3743 7.4 206-1 Malfunction, reaction, complication of cardiac/vasc device or

procedure 0.6314 1.9

206-2 Malfunction, reaction, complication of cardiac/vasc device or procedure

0.7144 2.6


1.1815 4.1


1.9332 6.2

207-1 Other circulatory system diagnoses 0.6231 2.5 207-2 Other circulatory system diagnoses 0.9452 2.9 207-3 Other circulatory system diagnoses 1.6057 4.6 207-4 Other circulatory system diagnoses 1.6057 5.5 220-1 Major stomach, esophageal & duodenal procedures 1.6455 3.0 220-2 Major stomach, esophageal & duodenal procedures 2.1223 5.1 220-3 Major stomach, esophageal & duodenal procedures 3.9389 10.6 220-4 Major stomach, esophageal & duodenal procedures 5.6184 14.8 222-1 Other stomach, esophageal & duodenal procedures 0.5355 2.0 222-2 Other stomach, esophageal & duodenal procedures 1.3932 4.4 222-3 Other stomach, esophageal & duodenal procedures 2.0720 6.8 222-4 Other stomach, esophageal & duodenal procedures 3.2667 10.1 223-1 Other small & large bowel procedures 1.3986 4.0 223-2 Other small & large bowel procedures 1.7573 4.6 223-3 Other small & large bowel procedures 1.8416 6.6 223-4 Other small & large bowel procedures 3.0870 10.2 224-1 Peritoneal adhesiolysis 1.7897 4.9 224-2 Peritoneal adhesiolysis 2.3829 8.0 224-3 Peritoneal adhesiolysis 2.6872 8.5 224-4 Peritoneal adhesiolysis 4.0239 16.0




226-1 Anal procedures 1.1331 3.5 226-2 Anal procedures 1.1331 3.5 226-3 Anal procedures 1.2519 4.7 226-4 Anal procedures 1.5114 8.7 227-1 Hernia procedures except inguinal, femoral & umbilical 1.3926 3.0 227-2 Hernia procedures except inguinal, femoral & umbilical 1.8524 4.2 227-3 Hernia procedures except inguinal, femoral & umbilical 2.2434 5.5 227-4 Hernia procedures except inguinal, femoral & umbilical 3.8033 10.6 228-1 Inguinal, femoral & umbilical hernia procedures 0.9558 2.3 228-2 Inguinal, femoral & umbilical hernia procedures 1.3701 3.6 228-3 Inguinal, femoral & umbilical hernia procedures 1.4091 4.3 228-4 Inguinal, femoral & umbilical hernia procedures 2.9373 7.6 229-1 Other digestive system & abdominal procedures 1.1734 3.0 229-2 Other digestive system & abdominal procedures 1.2986 3.4 229-3 Other digestive system & abdominal procedures 2.0555 6.0 229-4 Other digestive system & abdominal procedures 3.7580 8.5 230-1 Major small bowel procedures 1.6578 4.3 230-2 Major small bowel procedures 2.1444 5.8 230-3 Major small bowel procedures 3.7268 10.7 230-4 Major small bowel procedures 6.0256 14.7 231-1 Major large bowel procedures 1.7241 4.2 231-2 Major large bowel procedures 1.9623 5.4 231-3 Major large bowel procedures 2.7549 8.5 231-4 Major large bowel procedures 4.1761 12.4 232-1 Gastric fundoplication 1.0960 1.9 232-2 Gastric fundoplication 1.3544 2.4 232-3 Gastric fundoplication 1.4569 4.3 232-4 Gastric fundoplication 2.9772 13.3 233-1 Appendectomy with complex principal diagnosis 1.1954 3.3 233-2 Appendectomy with complex principal diagnosis 1.6552 5.1 233-3 Appendectomy with complex principal diagnosis 1.6552 5.4 233-4 Appendectomy with complex principal diagnosis 3.0046 10.2 234-1 Appendectomy without complex principal diagnosis 0.8620 1.8 234-2 Appendectomy without complex principal diagnosis 1.0115 1.9 234-3 Appendectomy without complex principal diagnosis 1.5257 3.8 234-4 Appendectomy without complex principal diagnosis 1.5257 7.0 240-1 Digestive malignancy 1.2827 3.7 240-2 Digestive malignancy 1.2827 4.1 240-3 Digestive malignancy 1.4326 5.4 240-4 Digestive malignancy 2.3218 8.1 241-1 Peptic ulcer & gastritis 0.7111 2.7 241-2 Peptic ulcer & gastritis 0.8278 3.0 241-3 Peptic ulcer & gastritis 1.2891 4.2 241-4 Peptic ulcer & gastritis 2.4342 8.3 242-1 Major esophageal disorders 0.4698 1.8 242-2 Major esophageal disorders 0.8606 3.1 242-3 Major esophageal disorders 1.0432 3.4 242-4 Major esophageal disorders 2.1106 6.9 243-1 Other esophageal disorders 0.4967 2.3 243-2 Other esophageal disorders 0.8217 3.1 243-3 Other esophageal disorders 1.1711 4.2 243-4 Other esophageal disorders 1.7883 6.5 244-1 Diverticulitis & diverticulosis 0.7987 3.3 244-2 Diverticulitis & diverticulosis 0.8420 3.5 244-3 Diverticulitis & diverticulosis 0.8483 4.1 244-4 Diverticulitis & diverticulosis 4.3260 16.6 245-1 Inflammatory bowel disease 0.6899 3.0




245-2 Inflammatory bowel disease 0.9105 3.6 245-3 Inflammatory bowel disease 1.2572 5.1 245-4 Inflammatory bowel disease 1.7370 7.5 246-1 Gastrointestinal vascular insufficiency 0.6800 2.6 246-2 Gastrointestinal vascular insufficiency 0.8582 3.5 246-3 Gastrointestinal vascular insufficiency 0.9492 4.4 246-4 Gastrointestinal vascular insufficiency 1.8934 6.7 247-1 Intestinal obstruction 0.6499 2.9 247-2 Intestinal obstruction 0.8768 3.5 247-3 Intestinal obstruction 1.2376 4.8 247-4 Intestinal obstruction 1.5084 6.4 248-1 Major gastrointestinal & peritoneal infections 0.6232 3.0 248-2 Major gastrointestinal & peritoneal infections 1.0409 4.0 248-3 Major gastrointestinal & peritoneal infections 1.1752 4.6 248-4 Major gastrointestinal & peritoneal infections 1.8270 8.0 249-1 Other gastroenteritis, nausea & vomiting 0.5212 2.4 249-2 Other gastroenteritis, nausea & vomiting 0.6986 2.7 249-3 Other gastroenteritis, nausea & vomiting 0.9423 3.6 249-4 Other gastroenteritis, nausea & vomiting 1.4559 5.9 251-1 Abdominal pain 0.6450 2.4 251-2 Abdominal pain 0.7360 3.1 251-3 Abdominal pain 0.9157 3.7 251-4 Abdominal pain 0.9157 6.1 252-1 Malfunction, reaction & complication of GI device or


252-2 Malfunction, reaction & complication of GI device or procedure

0.9539 3.4


1.3513 4.3


1.8597 6.7

253-1 Other & unspecified gastrointestinal hemorrhage 0.7137 2.3 253-2 Other & unspecified gastrointestinal hemorrhage 0.8103 2.9 253-3 Other & unspecified gastrointestinal hemorrhage 1.1654 3.8 253-4 Other & unspecified gastrointestinal hemorrhage 2.0536 6.5 254-1 Other digestive system diagnoses 0.8727 2.8 254-2 Other digestive system diagnoses 1.0062 3.4 254-3 Other digestive system diagnoses 1.3835 4.5 254-4 Other digestive system diagnoses 2.7006 7.2 260-1 Major pancreas, liver & shunt procedures 2.1793 5.0 260-2 Major pancreas, liver & shunt procedures 2.3162 5.5 260-3 Major pancreas, liver & shunt procedures 3.4716 8.9 260-4 Major pancreas, liver & shunt procedures 6.5347 16.5 261-1 Major biliary tract procedures 1.3706 3.7 261-2 Major biliary tract procedures 2.0154 5.8 261-3 Major biliary tract procedures 2.4934 7.5 261-4 Major biliary tract procedures 3.8173 16.9 263-1 Cholecystectomy 1.1660 2.6 263-2 Cholecystectomy 1.4590 3.7 263-3 Cholecystectomy 1.6300 4.5 263-4 Cholecystectomy 4.0560 16.5 264-1 Other hepatobiliary, pancreas & abdominal procedures 1.3161 3.8 264-2 Other hepatobiliary, pancreas & abdominal procedures 1.3529 3.8 264-3 Other hepatobiliary, pancreas & abdominal procedures 2.1942 6.8 264-4 Other hepatobiliary, pancreas & abdominal procedures 5.2432 11.0 279-1 Hepatic coma & other major acute liver disorders 0.4106 2.3 279-2 Hepatic coma & other major acute liver disorders 0.8475 3.3




279-3 Hepatic coma & other major acute liver disorders 1.1494 4.2 279-4 Hepatic coma & other major acute liver disorders 2.4907 7.1 280-1 Alcoholic liver disease 0.5721 2.7 280-2 Alcoholic liver disease 0.8251 3.2 280-3 Alcoholic liver disease 1.4143 5.1 280-4 Alcoholic liver disease 2.8512 7.8 281-1 Malignancy of hepatobiliary system & pancreas 0.5511 2.6 281-2 Malignancy of hepatobiliary system & pancreas 0.9991 4.0 281-3 Malignancy of hepatobiliary system & pancreas 1.1631 4.6 281-4 Malignancy of hepatobiliary system & pancreas 2.1355 8.7 282-1 Disorders of pancreas except malignancy 0.6661 3.0 282-2 Disorders of pancreas except malignancy 0.8159 3.4 282-3 Disorders of pancreas except malignancy 1.3427 4.7 282-4 Disorders of pancreas except malignancy 3.3913 9.0 283-1 Other disorders of the liver 0.6188 2.8 283-2 Other disorders of the liver 0.8590 3.2 283-3 Other disorders of the liver 1.1236 4.1 283-4 Other disorders of the liver 1.7979 6.5 284-1 Disorders of gallbladder & biliary tract 0.9175 2.5 284-2 Disorders of gallbladder & biliary tract 1.0871 3.1 284-3 Disorders of gallbladder & biliary tract 1.2024 4.1 284-4 Disorders of gallbladder & biliary tract 1.7199 6.6 301-1 Hip joint replacement 2.1952 2.3 301-2 Hip joint replacement 2.3879 2.5 301-3 Hip joint replacement 2.6082 3.7 301-4 Hip joint replacement 2.8223 8.0 302-1 Knee joint replacement 2.1119 2.2 302-2 Knee joint replacement 2.1470 2.4 302-3 Knee joint replacement 3.0357 2.7 302-4 Knee joint replacement 3.0359 6.7 303-1 Dorsal & lumbar fusion proc for curvature of back 7.9883 3.9 303-2 Dorsal & lumbar fusion proc for curvature of back 7.9883 4.9 303-3 Dorsal & lumbar fusion proc for curvature of back 7.9883 6.6 303-4 Dorsal & lumbar fusion proc for curvature of back 9.8492 10.6 304-1 Dorsal & lumbar fusion proc except for curvature of back 3.6888 2.4 304-2 Dorsal & lumbar fusion proc except for curvature of back 4.3629 3.1 304-3 Dorsal & lumbar fusion proc except for curvature of back 5.8063 5.2 304-4 Dorsal & lumbar fusion proc except for curvature of back 6.6129 10.8 305-1 Amputation of lower limb except toes 1.3020 3.1 305-2 Amputation of lower limb except toes 1.6231 5.0 305-3 Amputation of lower limb except toes 2.5640 8.3 305-4 Amputation of lower limb except toes 3.2370 9.7 308-1 Hip & femur fracture repair 1.2957 2.1 308-2 Hip & femur fracture repair 1.9381 4.0 308-3 Hip & femur fracture repair 2.4390 5.7 308-4 Hip & femur fracture repair 2.8169 7.1 309-1 Other significant hip & femur surgery 1.4251 2.1 309-2 Other significant hip & femur surgery 2.0841 3.2 309-3 Other significant hip & femur surgery 2.3886 5.1 309-4 Other significant hip & femur surgery 3.8065 10.5 310-1 Intervertebral disc excision & decompression 0.8848 1.9 310-2 Intervertebral disc excision & decompression 1.2556 2.4 310-3 Intervertebral disc excision & decompression 1.7807 4.9 310-4 Intervertebral disc excision & decompression 2.7134 9.3 312-1 Skin graft, except hand, for musculoskeletal & connective

tissue diagnoses 1.3446 2.9




312-2 Skin graft, except hand, for musculoskeletal & connective tissue diagnoses

1.3446 4.2


2.5520 8.5


7.0106 22.7

313-1 Knee & lower leg procedures except foot 1.5174 2.5 313-2 Knee & lower leg procedures except foot 2.0291 3.6 313-3 Knee & lower leg procedures except foot 2.9460 6.3 313-4 Knee & lower leg procedures except foot 3.7765 11.2 314-1 Foot & toe procedures 1.1135 2.2 314-2 Foot & toe procedures 1.4884 4.7 314-3 Foot & toe procedures 1.8211 5.8 314-4 Foot & toe procedures 2.5693 8.8 315-1 Shoulder, upper arm & forearm procedures except joint

replacement 1.3402 2.2

315-2 Shoulder, upper arm & forearm procedures except joint replacement

1.4539 2.6


2.6520 6.0


3.1337 8.7

316-1 Hand & wrist procedures 0.8369 2.8 316-2 Hand & wrist procedures 1.1852 2.9 316-3 Hand & wrist procedures 1.5727 5.3 316-4 Hand & wrist procedures 2.6436 9.8 317-1 Tendon, muscle & other soft tissue procedures 0.9395 2.4 317-2 Tendon, muscle & other soft tissue procedures 1.5608 5.6 317-3 Tendon, muscle & other soft tissue procedures 2.1817 7.2 317-4 Tendon, muscle & other soft tissue procedures 4.8505 13.7 320-1 Other musculoskeletal system & connective tissue

procedures 1.4547 2.1

320-2 Other musculoskeletal system & connective tissue procedures

1.9016 3.9


1.9016 5.7


3.0052 9.4

321-1 Cervical spinal fusion & other back/neck proc exc disc excis/decomp

1.7760 1.3


2.2631 2.0


3.4785 4.9


4.4684 9.9

322-1 Shoulder & elbow joint replacement 2.4796 1.6 322-2 Shoulder & elbow joint replacement 2.4796 2.0 322-3 Shoulder & elbow joint replacement 2.4796 2.9 322-4 Shoulder & elbow joint replacement 2.7989 6.8 340-1 Fracture of femur 1.5498 2.4 340-2 Fracture of femur 1.5498 3.2 340-3 Fracture of femur 1.5498 5.8 340-4 Fracture of femur 1.5498 5.8 341-1 Fracture of pelvis or dislocation of hip 0.4223 2.6 341-2 Fracture of pelvis or dislocation of hip 0.4868 3.1 341-3 Fracture of pelvis or dislocation of hip 0.6298 3.6 341-4 Fracture of pelvis or dislocation of hip 0.7979 4.5




342-1 Fractures & dislocations except femur, pelvis & back 1.2138 2.3 342-2 Fractures & dislocations except femur, pelvis & back 1.2138 3.1 342-3 Fractures & dislocations except femur, pelvis & back 1.2138 3.8 342-4 Fractures & dislocations except femur, pelvis & back 1.4910 5.7 343-1 Musculoskeletal malignancy & pathol fracture d/t muscskel

malig 0.9250 3.4

343-2 Musculoskeletal malignancy & pathol fracture d/t muscskel malig

0.9250 3.6


1.6516 6.6


2.6214 9.2

344-1 Osteomyelitis, septic arthritis & other musculoskeletal infections

0.9765 3.7


1.1807 4.2


1.7593 6.7


3.0378 12.2

346-1 Connective tissue disorders 0.7651 2.9 346-2 Connective tissue disorders 1.0721 3.9 346-3 Connective tissue disorders 1.2619 4.6 346-4 Connective tissue disorders 2.7516 8.6 347-1 Other back & neck disorders, fractures & injuries 1.5489 2.6 347-2 Other back & neck disorders, fractures & injuries 1.8042 3.5 347-3 Other back & neck disorders, fractures & injuries 1.8042 4.2 347-4 Other back & neck disorders, fractures & injuries 1.8042 6.6 349-1 Malfunction, reaction, complic of orthopedic device or


349-2 Malfunction, reaction, complic of orthopedic device or procedure

1.5272 3.5


1.9010 6.4


1.9010 7.1

351-1 Other musculoskeletal system & connective tissue diagnoses 1.6484 2.0 351-2 Other musculoskeletal system & connective tissue diagnoses 1.6484 2.5 351-3 Other musculoskeletal system & connective tissue diagnoses 1.6484 3.9 351-4 Other musculoskeletal system & connective tissue diagnoses 1.6484 7.4 361-1 Skin graft for skin & subcutaneous tissue diagnoses 1.1819 3.3 361-2 Skin graft for skin & subcutaneous tissue diagnoses 1.6343 5.1 361-3 Skin graft for skin & subcutaneous tissue diagnoses 2.0522 7.4 361-4 Skin graft for skin & subcutaneous tissue diagnoses 3.0515 11.1 362-1 Mastectomy procedures 1.2832 1.5 362-2 Mastectomy procedures 1.8174 2.2 362-3 Mastectomy procedures 2.0266 4.1 362-4 Mastectomy procedures 2.0266 4.8 363-1 Breast procedures except mastectomy 1.2349 3.5 363-2 Breast procedures except mastectomy 2.2340 3.5 363-3 Breast procedures except mastectomy 2.6927 4.0 363-4 Breast procedures except mastectomy 3.0804 15.7 364-1 Other skin, subcutaneous tissue & related procedures 0.9069 3.0 364-2 Other skin, subcutaneous tissue & related procedures 1.3459 4.8 364-3 Other skin, subcutaneous tissue & related procedures 1.9073 6.6 364-4 Other skin, subcutaneous tissue & related procedures 2.8951 9.8 380-1 Skin ulcers 0.4259 2.7 380-2 Skin ulcers 0.8683 3.7




380-3 Skin ulcers 1.4048 5.3 380-4 Skin ulcers 1.4230 6.2 381-1 Major skin disorders 0.3608 2.4 381-2 Major skin disorders 0.6053 3.4 381-3 Major skin disorders 0.9722 4.6 381-4 Major skin disorders 1.1768 8.2 382-1 Malignant breast disorders 0.9412 3.2 382-2 Malignant breast disorders 0.9412 3.2 382-3 Malignant breast disorders 0.9412 4.1 382-4 Malignant breast disorders 1.3660 5.1 383-1 Cellulitis & other skin infections 0.6215 2.6 383-2 Cellulitis & other skin infections 0.8181 3.4 383-3 Cellulitis & other skin infections 1.1382 4.3 383-4 Cellulitis & other skin infections 1.3666 6.6 384-1 Contusion, open wound & other trauma to skin &

subcutaneous tissue 0.7031 2.3

384-2 Contusion, open wound & other trauma to skin & subcutaneous tissue

0.8325 2.8


1.1733 3.1


1.6233 5.4

385-1 Other skin, subcutaneous tissue & breast disorders 0.6324 2.6 385-2 Other skin, subcutaneous tissue & breast disorders 0.8710 3.4 385-3 Other skin, subcutaneous tissue & breast disorders 0.8710 4.0 385-4 Other skin, subcutaneous tissue & breast disorders 1.1218 10.9 401-1 Adrenal procedures 1.3915 2.2 401-2 Adrenal procedures 1.9471 3.3 401-3 Adrenal procedures 1.9471 6.4 401-4 Adrenal procedures 1.9471 8.9 403-1 Procedures for obesity 1.6413 2.0 403-2 Procedures for obesity 1.8736 2.2 403-3 Procedures for obesity 1.8930 2.6 403-4 Procedures for obesity 4.9374 10.6 404-1 Thyroid, parathyroid & thyroglossal procedures 0.9302 1.3 404-2 Thyroid, parathyroid & thyroglossal procedures 1.3877 2.4 404-3 Thyroid, parathyroid & thyroglossal procedures 2.0989 3.7 404-4 Thyroid, parathyroid & thyroglossal procedures 2.7491 18.5 405-1 Other procedures for endocrine, nutritional & metabolic

disorders 1.2393 2.4

405-2 Other procedures for endocrine, nutritional & metabolic disorders

1.4300 3.8


2.1330 6.3


4.7365 16.1

420-1 Diabetes 0.5875 2.2 420-2 Diabetes 0.6796 2.4 420-3 Diabetes 0.9930 3.5 420-4 Diabetes 1.8837 5.5 421-1 Malnutrition, failure to thrive & other nutritional disorders 1.1405 2.4 421-2 Malnutrition, failure to thrive & other nutritional disorders 1.1405 4.1 421-3 Malnutrition, failure to thrive & other nutritional disorders 1.1405 5.6 421-4 Malnutrition, failure to thrive & other nutritional disorders 1.4878 7.0 422-1 Hypovolemia & related electrolyte disorders 0.3563 1.8 422-2 Hypovolemia & related electrolyte disorders 0.5883 2.5 422-3 Hypovolemia & related electrolyte disorders 0.9654 3.5




422-4 Hypovolemia & related electrolyte disorders 1.2620 5.5 423-1 Inborn errors of metabolism 1.1681 1.9 423-2 Inborn errors of metabolism 1.1681 3.0 423-3 Inborn errors of metabolism 1.1681 3.4 423-4 Inborn errors of metabolism 1.5521 17.2 424-1 Other endocrine disorders 0.7932 2.5 424-2 Other endocrine disorders 0.9122 2.9 424-3 Other endocrine disorders 1.5166 5.7 424-4 Other endocrine disorders 1.5883 6.0 425-1 Other non-hypovolemic electrolyte disorders 0.4909 1.3 425-2 Other non-hypovolemic electrolyte disorders 0.4989 1.3 425-3 Other non-hypovolemic electrolyte disorders 0.8105 2.1 425-4 Other non-hypovolemic electrolyte disorders 1.2705 4.2 426-1 Non-hypovolemic sodium disorders 0.6637 2.7 426-2 Non-hypovolemic sodium disorders 0.6637 2.8 426-3 Non-hypovolemic sodium disorders 1.0860 4.0 426-4 Non-hypovolemic sodium disorders 1.5095 6.6 427-1 Thyroid disorders 0.4395 1.9 427-2 Thyroid disorders 0.8152 3.2 427-3 Thyroid disorders 1.0053 4.2 427-4 Thyroid disorders 1.0554 9.1 440-1 Kidney transplant 5.1645 4.1 440-2 Kidney transplant 5.2893 4.6 440-3 Kidney transplant 6.1027 6.1 440-4 Kidney transplant 10.3645 10.1 441-1 Major bladder procedures 1.7772 4.8 441-2 Major bladder procedures 1.9783 4.8 441-3 Major bladder procedures 3.1089 7.9 441-4 Major bladder procedures 6.3029 16.0 442-1 Kidney & urinary tract procedures for malignancy 1.5450 3.2 442-2 Kidney & urinary tract procedures for malignancy 1.7727 3.7 442-3 Kidney & urinary tract procedures for malignancy 2.2815 4.9 442-4 Kidney & urinary tract procedures for malignancy 3.9077 9.7 443-1 Kidney & urinary tract procedures for nonmalignancy 1.0205 1.9 443-2 Kidney & urinary tract procedures for nonmalignancy 1.4870 2.8 443-3 Kidney & urinary tract procedures for nonmalignancy 1.9396 4.6 443-4 Kidney & urinary tract procedures for nonmalignancy 3.2196 9.2 444-1 Renal dialysis access device and vessel repair 1.5128 2.0 444-2 Renal dialysis access device and vessel repair 1.6537 3.8 444-3 Renal dialysis access device and vessel repair 2.5158 7.4 444-4 Renal dialysis access device and vessel repair 3.2119 11.3 445-1 Other bladder procedures 0.8815 1.8 445-2 Other bladder procedures 0.9041 2.5 445-3 Other bladder procedures 1.5848 5.8 445-4 Other bladder procedures 2.1197 36.7 446-1 Urethral & transurethral procedures 1.0226 2.4 446-2 Urethral & transurethral procedures 1.0958 2.9 446-3 Urethral & transurethral procedures 1.2404 4.2 446-4 Urethral & transurethral procedures 2.5567 8.5 447-1 Other kidney, urinary tract & related procedures 1.4747 3.0 447-2 Other kidney, urinary tract & related procedures 1.6306 3.8 447-3 Other kidney, urinary tract & related procedures 2.2026 6.4 447-4 Other kidney, urinary tract & related procedures 2.4919 10.8 461-1 Kidney & urinary tract malignancy 0.9596 2.7 461-2 Kidney & urinary tract malignancy 0.9596 2.7 461-3 Kidney & urinary tract malignancy 0.9596 4.3 461-4 Kidney & urinary tract malignancy 1.4760 7.1




462-1 Nephritis & nephrosis 0.4761 2.8 462-2 Nephritis & nephrosis 0.6394 3.4 462-3 Nephritis & nephrosis 1.1008 4.6 462-4 Nephritis & nephrosis 1.3793 11.7 463-1 Kidney & urinary tract infections 0.5258 2.4 463-2 Kidney & urinary tract infections 0.6386 2.7 463-3 Kidney & urinary tract infections 0.9635 3.7 463-4 Kidney & urinary tract infections 1.1204 5.5 465-1 Urinary stones & acquired upper urinary tract obstruction 0.6802 2.3 465-2 Urinary stones & acquired upper urinary tract obstruction 0.7569 2.3 465-3 Urinary stones & acquired upper urinary tract obstruction 0.8652 2.3 465-4 Urinary stones & acquired upper urinary tract obstruction 1.4666 6.3 466-1 Malfunction, reaction, complic of genitourinary device or proc 0.4497 2.3 466-2 Malfunction, reaction, complic of genitourinary device or proc 0.8513 3.4 466-3 Malfunction, reaction, complic of genitourinary device or proc 1.1882 4.0 466-4 Malfunction, reaction, complic of genitourinary device or proc 1.9786 5.6 468-1 Other kidney & urinary tract diagnoses, signs & symptoms 0.7206 2.5 468-2 Other kidney & urinary tract diagnoses, signs & symptoms 1.1359 3.4 468-3 Other kidney & urinary tract diagnoses, signs & symptoms 1.2949 4.8 468-4 Other kidney & urinary tract diagnoses, signs & symptoms 1.5520 6.4 469-1 Acute kidney injury 0.5739 2.3 469-2 Acute kidney injury 0.7679 2.9 469-3 Acute kidney injury 1.1766 4.2 469-4 Acute kidney injury 2.6479 7.9 470-1 Chronic kidney disease 0.3424 1.8 470-2 Chronic kidney disease 0.8064 2.5 470-3 Chronic kidney disease 1.3762 4.1 470-4 Chronic kidney disease 1.5285 5.2 480-1 Major male pelvic procedures 1.2388 2.5 480-2 Major male pelvic procedures 1.5868 2.6 480-3 Major male pelvic procedures 2.1020 3.2 480-4 Major male pelvic procedures 2.1020 15.0 482-1 Transurethral prostatectomy 0.7491 1.6 482-2 Transurethral prostatectomy 0.8345 2.3 482-3 Transurethral prostatectomy 1.2110 4.4 482-4 Transurethral prostatectomy 1.2110 9.3 483-1 Penis, testes & scrotal procedures 1.0999 3.3 483-2 Penis, testes & scrotal procedures 1.2692 3.3 483-3 Penis, testes & scrotal procedures 1.6850 6.5 483-4 Penis, testes & scrotal procedures 2.1890 7.0 484-1 Other male reproductive system & related procedures 0.9103 1.6 484-2 Other male reproductive system & related procedures 1.0914 1.6 484-3 Other male reproductive system & related procedures 1.6407 1.6 484-4 Other male reproductive system & related procedures 3.5213 9.7 500-1 Malignancy, male reproductive system 0.8830 2.8 500-2 Malignancy, male reproductive system 0.8830 2.9 500-3 Malignancy, male reproductive system 0.8830 4.2 500-4 Malignancy, male reproductive system 1.0448 8.0 501-1 Male reproductive system diagnoses except malignancy 0.6377 2.8 501-2 Male reproductive system diagnoses except malignancy 0.7588 2.8 501-3 Male reproductive system diagnoses except malignancy 0.7588 3.5 501-4 Male reproductive system diagnoses except malignancy 1.6628 7.9 510-1 Pelvic evisceration, radical hysterectomy & other radical gyn

procs 1.3265 1.6

510-2 Pelvic evisceration, radical hysterectomy & other radical gyn procs

1.4942 3.6





1.4942 4.0


1.4942 4.0

511-1 Uterine & adnexa procedures for ovarian & adnexal malignancy

1.3265 3.2


1.6539 4.5


2.2121 6.6


4.1135 11.8

512-1 Uterine & adnexa procedures for non-ovarian & non-adnexal malig

1.5328 2.6


1.5328 3.4


1.9295 4.3


2.8406 9.4

513-1 Uterine & adnexa procedures for non-malignancy except leiomyoma

0.9314 2.1


1.1862 2.7


1.7416 4.9


1.8858 11.1

514-1 Female reproductive system reconstructive procedures 1.1146 1.9 514-2 Female reproductive system reconstructive procedures 1.1913 1.9 514-3 Female reproductive system reconstructive procedures 1.2080 2.5 514-4 Female reproductive system reconstructive procedures 1.2080 2.5 517-1 Dilation & curettage for non-obstetric diagnoses 0.7369 1.8 517-2 Dilation & curettage for non-obstetric diagnoses 0.8155 2.0 517-3 Dilation & curettage for non-obstetric diagnoses 2.0448 5.9 517-4 Dilation & curettage for non-obstetric diagnoses 2.5496 7.6 518-1 Other female reproductive system & related procedures 1.0265 1.8 518-2 Other female reproductive system & related procedures 1.3390 3.9 518-3 Other female reproductive system & related procedures 2.1198 5.8 518-4 Other female reproductive system & related procedures 2.4245 15.6 519-1 Uterine & adnexa procedures for leiomyoma 1.0077 2.2 519-2 Uterine & adnexa procedures for leiomyoma 1.1017 2.4 519-3 Uterine & adnexa procedures for leiomyoma 1.8917 4.9 519-4 Uterine & adnexa procedures for leiomyoma 1.8917 24.5 530-1 Female reproductive system malignancy 0.4342 2.2 530-2 Female reproductive system malignancy 0.7176 2.9 530-3 Female reproductive system malignancy 0.9511 4.1 530-4 Female reproductive system malignancy 1.7836 7.8 531-1 Female reproductive system infections 0.5684 2.4 531-2 Female reproductive system infections 0.7199 2.9 531-3 Female reproductive system infections 0.8189 3.8 531-4 Female reproductive system infections 1.0284 8.2 532-1 Menstrual & other female reproductive system disorders 0.7350 2.3 532-2 Menstrual & other female reproductive system disorders 0.7350 2.5 532-3 Menstrual & other female reproductive system disorders 0.7350 3.1 532-4 Menstrual & other female reproductive system disorders 0.9431 9.7 540-1 Cesarean delivery 0.7377 2.7 540-2 Cesarean delivery 0.9446 3.3




540-3 Cesarean delivery 1.2067 4.2 540-4 Cesarean delivery 2.3996 6.6 541-1 Vaginal delivery w sterilization &/or D&C 0.7472 2.2 541-2 Vaginal delivery w sterilization &/or D&C 0.8145 2.4 541-3 Vaginal delivery w sterilization &/or D&C 1.2002 3.2 541-4 Vaginal delivery w sterilization &/or D&C 1.8579 4.5 542-1 Vaginal delivery w complicating procedures exc sterilization

&/or D&C 0.6390 2.3

542-2 Vaginal delivery w complicating procedures exc sterilization &/or D&C

0.7248 2.6


0.7843 2.7


0.9659 4.0

544-1 D&C, aspiration curettage or hysterotomy for obstetric diagnoses

0.6046 2.1


0.7336 2.1


1.0393 3.1


2.2336 5.9

545-1 Ectopic pregnancy procedure 0.8515 2.1 545-2 Ectopic pregnancy procedure 0.8553 2.4 545-3 Ectopic pregnancy procedure 1.2115 2.4 545-4 Ectopic pregnancy procedure 1.2115 14.0 546-1 Other O.R. proc for obstetric diagnoses except delivery

diagnoses 0.7190 2.4

546-2 Other O.R. proc for obstetric diagnoses except delivery diagnoses

0.7190 2.4


2.0658 4.3


2.0658 9.3

560-1 Vaginal delivery 0.5717 2.2 560-2 Vaginal delivery 0.6515 2.4 560-3 Vaginal delivery 0.8864 3.1 560-4 Vaginal delivery 1.5552 4.5 561-1 Postpartum & post abortion diagnoses w/o procedure 0.4895 2.0 561-2 Postpartum & post abortion diagnoses w/o procedure 0.6240 2.7 561-3 Postpartum & post abortion diagnoses w/o procedure 0.9444 3.8 561-4 Postpartum & post abortion diagnoses w/o procedure 1.3181 4.4 563-1 Preterm labor 0.4486 2.1 563-2 Preterm labor 0.7633 3.0 563-3 Preterm labor 0.7633 3.0 563-4 Preterm labor 0.7633 3.1 564-1 Abortion w/o D&C, aspiration curettage or hysterotomy 0.3090 1.2 564-2 Abortion w/o D&C, aspiration curettage or hysterotomy 0.6648 1.6 564-3 Abortion w/o D&C, aspiration curettage or hysterotomy 0.6648 1.8 564-4 Abortion w/o D&C, aspiration curettage or hysterotomy 0.6648 9.0 565-1 False labor 0.1509 1.2 565-2 False labor 0.5791 2.6 565-3 False labor 0.5791 2.6 565-4 False labor 0.5791 2.6 566-1 Other antepartum diagnoses 0.4967 2.1 566-2 Other antepartum diagnoses 0.6586 2.7 566-3 Other antepartum diagnoses 0.7532 3.2 566-4 Other antepartum diagnoses 1.3309 5.2




580-1 Neonate, transferred <5 days old, not born here 0.2558 1.4 580-2 Neonate, transferred <5 days old, not born here 0.3244 1.4 580-3 Neonate, transferred <5 days old, not born here 0.5568 1.4 580-4 Neonate, transferred <5 days old, not born here 0.5568 1.5 581-1 Neonate, transferred < 5 days old, born here 0.2025 1.3 581-2 Neonate, transferred < 5 days old, born here 0.2749 1.3 581-3 Neonate, transferred < 5 days old, born here 0.3337 1.3 581-4 Neonate, transferred < 5 days old, born here 0.6586 1.3 583-1 Neonate w ECMO 15.3123 13.0 583-2 Neonate w ECMO 15.3123 36.9 583-3 Neonate w ECMO 15.3123 36.9 583-4 Neonate w ECMO 15.3123 36.9 588-1 Neonate bwt <1500g w major procedure 13.5926 55.4 588-2 Neonate bwt <1500g w major procedure 13.5926 55.4 588-3 Neonate bwt <1500g w major procedure 13.5926 66.6 588-4 Neonate bwt <1500g w major procedure 31.0476 96.5 589-1 Neonate bwt <500g or GA <24 weeks 5.2380 24.6 589-2 Neonate bwt <500g or GA <24 weeks 5.2380 24.6 589-3 Neonate bwt <500g or GA <24 weeks 5.2380 24.6 589-4 Neonate bwt <500g or GA <24 weeks 5.2380 24.6 591-1 Neonate birthwt 500-749g w/o major procedure 8.2595 29.0 591-2 Neonate birthwt 500-749g w/o major procedure 8.2595 47.5 591-3 Neonate birthwt 500-749g w/o major procedure 8.2595 47.5 591-4 Neonate birthwt 500-749g w/o major procedure 18.0576 47.5 593-1 Neonate birthwt 750-999g w/o major procedure 8.0675 6.0 593-2 Neonate birthwt 750-999g w/o major procedure 8.0675 37.0 593-3 Neonate birthwt 750-999g w/o major procedure 12.8038 53.5 593-4 Neonate birthwt 750-999g w/o major procedure 16.1409 60.1 602-1 Neonate bwt 1000-1249g w resp dist synd/oth maj resp or

maj anom 7.5653 29.1

602-2 Neonate bwt 1000-1249g w resp dist synd/oth maj resp or maj anom

7.5653 45.7


10.6637 56.9


11.5401 56.9

603-1 Neonate birthwt 1000-1249g w or w/o other significant condition

5.8817 14.8


6.6402 39.9


6.7356 42.4


6.7356 70.0


3.9096 25.7


7.5073 41.4


8.1399 41.4


11.2326 55.1

608-1 Neonate bwt 1250-1499g w or w/o other significant condition 3.2927 20.6 608-2 Neonate bwt 1250-1499g w or w/o other significant condition 4.9775 28.4 608-3 Neonate bwt 1250-1499g w or w/o other significant condition 6.9123 40.3 608-4 Neonate bwt 1250-1499g w or w/o other significant condition 6.9123 48.0 609-1 Neonate bwt 1500-2499g w major procedure 9.0024 29.7 609-2 Neonate bwt 1500-2499g w major procedure 9.0024 29.7




609-3 Neonate bwt 1500-2499g w major procedure 9.0024 29.7 609-4 Neonate bwt 1500-2499g w major procedure 17.1121 52.9 611-1 Neonate birthwt 1500-1999g w major anomaly 1.8326 13.3 611-2 Neonate birthwt 1500-1999g w major anomaly 5.6967 28.9 611-3 Neonate birthwt 1500-1999g w major anomaly 6.6628 30.8 611-4 Neonate birthwt 1500-1999g w major anomaly 13.0510 46.4 612-1 Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond 3.3154 18.5 612-2 Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond 4.8166 25.4 612-3 Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond 6.3430 31.7 612-4 Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond 7.1197 34.1 613-1 Neonate birthwt 1500-1999g w congenital/perinatal infection 2.6743 9.7 613-2 Neonate birthwt 1500-1999g w congenital/perinatal infection 2.6743 17.6 613-3 Neonate birthwt 1500-1999g w congenital/perinatal infection 3.7670 26.4 613-4 Neonate birthwt 1500-1999g w congenital/perinatal infection 3.7670 26.4 614-1 Neonate bwt 1500-1999g w or w/o other significant condition 1.9508 9.7 614-2 Neonate bwt 1500-1999g w or w/o other significant condition 3.3795 18.1 614-3 Neonate bwt 1500-1999g w or w/o other significant condition 4.8604 26.2 614-4 Neonate bwt 1500-1999g w or w/o other significant condition 4.8604 34.3 621-1 Neonate bwt 2000-2499g w major anomaly 1.2977 6.8 621-2 Neonate bwt 2000-2499g w major anomaly 2.0105 12.1 621-3 Neonate bwt 2000-2499g w major anomaly 4.2376 16.5 621-4 Neonate bwt 2000-2499g w major anomaly 10.7063 34.0 622-1 Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond 2.4614 12.2 622-2 Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond 3.3691 17.3 622-3 Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond 3.7640 17.3 622-4 Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond 5.7609 22.9 623-1 Neonate bwt 2000-2499g w congenital/perinatal infection 1.0269 7.9 623-2 Neonate bwt 2000-2499g w congenital/perinatal infection 2.0144 11.9 623-3 Neonate bwt 2000-2499g w congenital/perinatal infection 2.0144 17.7 623-4 Neonate bwt 2000-2499g w congenital/perinatal infection 2.0144 38.0 625-1 Neonate bwt 2000-2499g w other significant condition 2.8227 11.7 625-2 Neonate bwt 2000-2499g w other significant condition 2.8227 16.2 625-3 Neonate bwt 2000-2499g w other significant condition 2.8227 21.2 625-4 Neonate bwt 2000-2499g w other significant condition 2.8227 21.2 626-1 Neonate bwt 2000-2499g, normal newborn or neonate w

other problem 0.4585 2.9

626-2 Neonate bwt 2000-2499g, normal newborn or neonate w other problem

0.4585 2.9


1.2739 5.5


1.2739 17.0

630-1 Neonate birthwt >2499g w major cardiovascular procedure 3.9052 3.8 630-2 Neonate birthwt >2499g w major cardiovascular procedure 3.9052 5.6 630-3 Neonate birthwt >2499g w major cardiovascular procedure 3.9052 7.9 630-4 Neonate birthwt >2499g w major cardiovascular procedure 14.5085 21.8 631-1 Neonate birthwt >2499g w other major procedure 1.2826 2.2 631-2 Neonate birthwt >2499g w other major procedure 3.5029 11.4 631-3 Neonate birthwt >2499g w other major procedure 3.7378 11.4 631-4 Neonate birthwt >2499g w other major procedure 14.6676 30.1 633-1 Neonate birthwt >2499g w major anomaly 0.5078 2.7 633-2 Neonate birthwt >2499g w major anomaly 1.9897 6.6 633-3 Neonate birthwt >2499g w major anomaly 3.8271 13.3 633-4 Neonate birthwt >2499g w major anomaly 7.3783 21.3 634-1 Neonate, birthwt >2499g w resp dist synd/oth maj resp cond 1.0187 4.8 634-2 Neonate, birthwt >2499g w resp dist synd/oth maj resp cond 2.0814 8.8 634-3 Neonate, birthwt >2499g w resp dist synd/oth maj resp cond 2.8496 9.5




634-4 Neonate, birthwt >2499g w resp dist synd/oth maj resp cond 5.3951 14.1 636-1 Neonate birthwt >2499g w congenital/perinatal infection 1.1649 5.7 636-2 Neonate birthwt >2499g w congenital/perinatal infection 1.1649 5.7 636-3 Neonate birthwt >2499g w congenital/perinatal infection 1.1649 5.7 636-4 Neonate birthwt >2499g w congenital/perinatal infection 1.1649 5.7 639-1 Neonate birthwt >2499g w other significant condition 1.4698 5.9 639-2 Neonate birthwt >2499g w other significant condition 2.3308 10.0 639-3 Neonate birthwt >2499g w other significant condition 3.2374 10.0 639-4 Neonate birthwt >2499g w other significant condition 3.2374 10.0 640-1 Neonate birthwt >2499g, normal newborn or neonate w other

problem 0.2505 2.1

640-2 Neonate birthwt >2499g, normal newborn or neonate w other problem

0.3245 2.4


0.6536 3.3


0.6536 3.3

650-1 Splenectomy 1.5573 3.1 650-2 Splenectomy 1.5573 3.5 650-3 Splenectomy 2.9376 6.7 650-4 Splenectomy 3.1219 13.6 651-1 Other procedures of blood & blood-forming organs 1.2638 4.4 651-2 Other procedures of blood & blood-forming organs 1.4142 4.4 651-3 Other procedures of blood & blood-forming organs 1.8745 5.4 651-4 Other procedures of blood & blood-forming organs 2.0650 16.5 660-1 Major hematologic/immunologic diag exc sickle cell crisis &

coagul 0.6738 2.5

660-2 Major hematologic/immunologic diag exc sickle cell crisis & coagul

1.0724 4.1


1.7417 5.8


3.1851 8.2

661-1 Coagulation & platelet disorders 0.7759 2.2 661-2 Coagulation & platelet disorders 0.9598 2.5 661-3 Coagulation & platelet disorders 1.2191 4.2 661-4 Coagulation & platelet disorders 3.2207 8.1 662-1 Sickle cell anemia crisis 0.8281 3.9 662-2 Sickle cell anemia crisis 1.0231 4.6 662-3 Sickle cell anemia crisis 1.6234 6.5 662-4 Sickle cell anemia crisis 2.0963 7.9 663-1 Other anemia & disorders of blood & blood-forming organs 0.6916 2.3 663-2 Other anemia & disorders of blood & blood-forming organs 0.8769 3.0 663-3 Other anemia & disorders of blood & blood-forming organs 1.0335 3.5 663-4 Other anemia & disorders of blood & blood-forming organs 1.3548 5.1 680-1 Major O.R. procedures for lymphatic/hematopoietic/other

neoplasms 1.5467 3.3

680-2 Major O.R. procedures for lymphatic/hematopoietic/other neoplasms

2.8242 8.0


3.6665 8.8


5.2899 13.4

681-1 Other O.R. procedures for lymphatic/hematopoietic/other neoplasms

1.1698 2.0


1.5402 5.4





4.1543 13.8


5.5718 14.4

690-1 Acute leukemia 0.9464 5.3 690-2 Acute leukemia 2.8732 6.6 690-3 Acute leukemia 5.9321 16.6 690-4 Acute leukemia 6.1405 16.6 691-1 Lymphoma, myeloma & non-acute leukemia 1.2801 2.8 691-2 Lymphoma, myeloma & non-acute leukemia 1.7259 5.2 691-3 Lymphoma, myeloma & non-acute leukemia 1.7259 5.5 691-4 Lymphoma, myeloma & non-acute leukemia 3.3808 8.9 692-1 Radiotherapy 1.1197 11.0 692-2 Radiotherapy 1.9801 11.0 692-3 Radiotherapy 1.9801 11.0 692-4 Radiotherapy 3.3649 11.0 694-1 Lymphatic & other malignancies & neoplasms of uncertain

behavior 0.8880 3.2

694-2 Lymphatic & other malignancies & neoplasms of uncertain behavior

1.1695 3.9


1.1695 4.3


1.9893 7.1

695-1 Chemotherapy for acute leukemia 1.0055 4.1 695-2 Chemotherapy for acute leukemia 1.0055 4.1 695-3 Chemotherapy for acute leukemia 2.8937 8.8 695-4 Chemotherapy for acute leukemia 6.3189 19.1 696-1 Other chemotherapy 0.6977 2.4 696-2 Other chemotherapy 0.9691 2.9 696-3 Other chemotherapy 1.5116 4.0 696-4 Other chemotherapy 2.7406 7.4 710-1 Infectious & parasitic diseases including HIV w O.R.


710-2 Infectious & parasitic diseases including HIV w O.R. procedure

1.8007 5.6


2.9090 9.0


5.5282 14.3

711-1 Post-op, post-trauma, other device infections w O.R. procedure

1.3805 4.1


1.6460 5.6


3.0013 9.3


4.8139 12.6

720-1 Septicemia & disseminated infections 0.6926 2.8 720-2 Septicemia & disseminated infections 0.8829 3.4 720-3 Septicemia & disseminated infections 1.3171 4.5 720-4 Septicemia & disseminated infections 3.0335 7.7 721-1 Post-operative, post-traumatic, other device infections 0.7333 3.1 721-2 Post-operative, post-traumatic, other device infections 0.9794 3.8 721-3 Post-operative, post-traumatic, other device infections 1.6260 6.1 721-4 Post-operative, post-traumatic, other device infections 2.7899 8.3 722-1 Fever 0.4456 2.2 722-2 Fever 0.6543 3.0




722-3 Fever 0.7305 3.0 722-4 Fever 1.0624 4.3 723-1 Viral illness 0.3703 2.0 723-2 Viral illness 0.5330 2.1 723-3 Viral illness 0.9418 3.7 723-4 Viral illness 1.7772 5.5 724-1 Other infectious & parasitic diseases 0.7963 3.1 724-2 Other infectious & parasitic diseases 0.8973 3.7 724-3 Other infectious & parasitic diseases 1.8597 6.5 724-4 Other infectious & parasitic diseases 2.3487 8.2 740-1 Mental illness diagnosis w O.R. procedure LOC LOC 740-2 Mental illness diagnosis w O.R. procedure LOC LOC 740-3 Mental illness diagnosis w O.R. procedure LOC LOC 740-4 Mental illness diagnosis w O.R. procedure LOC LOC 750-1 Schizophrenia LOC LOC 750-2 Schizophrenia LOC LOC 750-3 Schizophrenia LOC LOC 750-4 Schizophrenia LOC LOC 751-1 Major depressive disorders & other/unspecified psychoses LOC LOC 751-2 Major depressive disorders & other/unspecified psychoses LOC LOC 751-3 Major depressive disorders & other/unspecified psychoses LOC LOC 751-4 Major depressive disorders & other/unspecified psychoses LOC LOC 752-1 Disorders of personality & impulse control LOC LOC 752-2 Disorders of personality & impulse control LOC LOC 752-3 Disorders of personality & impulse control LOC LOC 752-4 Disorders of personality & impulse control LOC LOC 753-1 Bipolar disorders LOC LOC 753-2 Bipolar disorders LOC LOC 753-3 Bipolar disorders LOC LOC 753-4 Bipolar disorders LOC LOC 754-1 Depression except major depressive disorder LOC LOC 754-2 Depression except major depressive disorder LOC LOC 754-3 Depression except major depressive disorder LOC LOC 754-4 Depression except major depressive disorder LOC LOC 755-1 Adjustment disorders & neuroses except depressive

diagnoses LOC LOC

755-2 Adjustment disorders & neuroses except depressive diagnoses

LOC LOC


LOC LOC


LOC LOC

756-1 Acute anxiety & delirium states LOC LOC 756-2 Acute anxiety & delirium states LOC LOC 756-3 Acute anxiety & delirium states LOC LOC 756-4 Acute anxiety & delirium states LOC LOC 757-1 Organic mental health disturbances 0.4443 4.2 757-2 Organic mental health disturbances 0.5680 5.6 757-3 Organic mental health disturbances 0.7201 7.4 757-4 Organic mental health disturbances 1.9267 9.0 758-1 Behavioral disorders LOC LOC 758-2 Behavioral disorders LOC LOC 758-3 Behavioral disorders LOC LOC 758-4 Behavioral disorders LOC LOC 759-1 Eating disorders LOC LOC 759-2 Eating disorders LOC LOC 759-3 Eating disorders LOC LOC




759-4 Eating disorders LOC LOC 760-1 Other mental health disorders LOC LOC 760-2 Other mental health disorders LOC LOC 760-3 Other mental health disorders LOC LOC 760-4 Other mental health disorders LOC LOC 770-1 Drug & alcohol abuse or dependence, left against medical

advice 0.2000 2.2

770-2 Drug & alcohol abuse or dependence, left against medical advice

0.3000 2.2


0.5000 2.2


0.7000 5.5

772-1 Alcohol & drug dependence w rehab or rehab/detox therapy 0.3000 4.7 772-2 Alcohol & drug dependence w rehab or rehab/detox therapy 0.3000 4.7 772-3 Alcohol & drug dependence w rehab or rehab/detox therapy 0.3000 4.7 772-4 Alcohol & drug dependence w rehab or rehab/detox therapy 0.3000 4.7 773-1 Opioid abuse & dependence 0.4000 3.8 773-2 Opioid abuse & dependence 0.5000 4.6 773-3 Opioid abuse & dependence 0.7000 4.6 773-4 Opioid abuse & dependence 1.5000 5.9 774-1 Cocaine abuse & dependence 0.3000 2.4 774-2 Cocaine abuse & dependence 0.5000 3.7 774-3 Cocaine abuse & dependence 1.1000 4.1 774-4 Cocaine abuse & dependence 1.6000 5.8 775-1 Alcohol abuse & dependence 0.5000 3.4 775-2 Alcohol abuse & dependence 0.6000 3.7 775-3 Alcohol abuse & dependence 1.1000 4.4 775-4 Alcohol abuse & dependence 2.3000 6.0 776-1 Other drug abuse & dependence 0.5000 3.7 776-2 Other drug abuse & dependence 0.5000 3.7 776-3 Other drug abuse & dependence 0.6000 3.7 776-4 Other drug abuse & dependence 1.1000 7.6 792-1 Extensive or procedures for other complications of treatment 1.4000 2.6 792-2 Extensive or procedures for other complications of treatment 1.8000 3.7 792-3 Extensive or procedures for other complications of treatment 2.4000 6.5 792-4 Extensive or procedures for other complications of treatment 4.9000 10.9 793-1 Moderately extensive or procedures for other complications

of treatment 1.1000 2.9

793-2 Moderately extensive or procedures for other complications of treatment

1.3000 3.9


1.8000 5.0


3.5000 9.3

794-1 Non-extensive or procedures for other complications of treatment

0.8086 2.0


0.9659 2.7


1.4147 4.9


1.7619 13.5

810-1 Hemorrhage or hematoma due to complication 0.6000 2.3 810-2 Hemorrhage or hematoma due to complication 0.8000 2.3 810-3 Hemorrhage or hematoma due to complication 1.0000 3.4 810-4 Hemorrhage or hematoma due to complication 1.7000 5.6 811-1 Allergic reactions 0.4000 1.5




811-2 Allergic reactions 0.7000 2.5 811-3 Allergic reactions 1.2000 3.2 811-4 Allergic reactions 1.5000 4.8 812-1 Poisoning of medicinal agents 0.6000 1.9 812-2 Poisoning of medicinal agents 0.7000 2.4 812-3 Poisoning of medicinal agents 0.8000 2.5 812-4 Poisoning of medicinal agents 1.4000 3.4 813-1 Other complications of treatment 0.5145 2.2 813-2 Other complications of treatment 0.9598 3.3 813-3 Other complications of treatment 1.1401 3.3 813-4 Other complications of treatment 1.7896 6.8 815-1 Other injury, poisoning & toxic effect diagnoses 0.4403 1.6 815-2 Other injury, poisoning & toxic effect diagnoses 0.6194 2.6 815-3 Other injury, poisoning & toxic effect diagnoses 0.7777 3.3 815-4 Other injury, poisoning & toxic effect diagnoses 1.9171 4.6 816-1 Toxic effects of non-medicinal substances 0.5369 1.6 816-2 Toxic effects of non-medicinal substances 0.6869 2.4 816-3 Toxic effects of non-medicinal substances 0.8122 2.5 816-4 Toxic effects of non-medicinal substances 1.7864 3.9 817-1 Overdose 0.5305 2.3 817-2 Overdose 0.6544 2.3 817-3 Overdose 0.7455 2.7 817-4 Overdose 1.7060 4.2 841-1 Extensive 3rd degree burns w skin graft LOC LOC 841-2 Extensive 3rd degree burns w skin graft LOC LOC 841-3 Extensive 3rd degree burns w skin graft LOC LOC 841-4 Extensive 3rd degree burns w skin graft LOC LOC 842-1 Burns with skin graft except extensive 3rd degree burns LOC LOC 842-2 Burns with skin graft except extensive 3rd degree burns LOC LOC 842-3 Burns with skin graft except extensive 3rd degree burns LOC LOC 842-4 Burns with skin graft except extensive 3rd degree burns LOC LOC 843-1 Extensive 3rd degree or full thickness burns w/o skin graft LOC LOC 843-2 Extensive 3rd degree or full thickness burns w/o skin graft LOC LOC 843-3 Extensive 3rd degree or full thickness burns w/o skin graft LOC LOC 843-4 Extensive 3rd degree or full thickness burns w/o skin graft LOC LOC 844-1 Partial thickness burns w/o skin graft LOC LOC 844-2 Partial thickness burns w/o skin graft LOC LOC 844-3 Partial thickness burns w/o skin graft LOC LOC 844-4 Partial thickness burns w/o skin graft LOC LOC 850-1 Procedure w diag of rehab, aftercare or oth contact w health

service 1.9996 2.5

850-2 Procedure w diag of rehab, aftercare or oth contact w health service

2.2806 3.1


2.7420 5.0


3.3883 9.4

860-1 Rehabilitation LOC LOC 860-2 Rehabilitation LOC LOC 860-3 Rehabilitation LOC LOC 860-4 Rehabilitation LOC LOC 861-1 Signs, symptoms & other factors influencing health status 0.7569 2.8 861-2 Signs, symptoms & other factors influencing health status 0.9371 3.5 861-3 Signs, symptoms & other factors influencing health status 1.4504 5.0 861-4 Signs, symptoms & other factors influencing health status 1.4504 6.8 862-1 Other aftercare & convalescence 1.2970 7.1 862-2 Other aftercare & convalescence 1.6712 8.1




862-3 Other aftercare & convalescence 2.3787 10.4 862-4 Other aftercare & convalescence 3.2857 13.0 863-1 Neonatal aftercare 1.4382 8.8 863-2 Neonatal aftercare 3.6223 18.3 863-3 Neonatal aftercare 7.2491 27.8 863-4 Neonatal aftercare 9.6208 27.8 890-1 HIV w multiple major HIV related conditions 1.2551 4.6 890-2 HIV w multiple major HIV related conditions 1.2551 4.6 890-3 HIV w multiple major HIV related conditions 1.2551 4.6 890-4 HIV w multiple major HIV related conditions 3.2493 8.3 892-1 HIV w major HIV related condition 0.7081 2.5 892-2 HIV w major HIV related condition 0.7081 2.9 892-3 HIV w major HIV related condition 0.9728 4.2 892-4 HIV w major HIV related condition 2.0837 6.2 893-1 HIV w multiple significant HIV related conditions 0.7316 3.4 893-2 HIV w multiple significant HIV related conditions 0.7316 3.4 893-3 HIV w multiple significant HIV related conditions 0.7316 3.4 893-4 HIV w multiple significant HIV related conditions 1.2117 37.0 894-1 HIV w one signif HIV cond or w/o signif related cond 0.7791 2.6 894-2 HIV w one signif HIV cond or w/o signif related cond 0.7791 2.6 894-3 HIV w one signif HIV cond or w/o signif related cond 0.7791 2.6 894-4 HIV w one signif HIV cond or w/o signif related cond 1.1417 5.1 910-1 Craniotomy for multiple significant trauma 4.2000 3.0 910-2 Craniotomy for multiple significant trauma 4.2000 3.0 910-3 Craniotomy for multiple significant trauma 4.2000 8.6 910-4 Craniotomy for multiple significant trauma 6.5000 8.6 911-1 Extensive abdominal/thoracic procedures for mult significant

trauma 1.9000 4.9

911-2 Extensive abdominal/thoracic procedures for mult significant trauma

2.0000 4.9


2.9000 7.8


5.9000 11.1

912-1 Musculoskeletal & other procedures for multiple significant trauma

2.2000 5.0


2.5000 5.8


4.3000 7.0


6.7000 10.2

930-1 Multiple significant trauma w/o O.R. procedure 0.8000 2.3 930-2 Multiple significant trauma w/o O.R. procedure 1.1000 3.1 930-3 Multiple significant trauma w/o O.R. procedure 1.5000 4.1 930-4 Multiple significant trauma w/o O.R. procedure 2.5000 5.2 950-1 Extensive procedure unrelated to principal diagnosis 1.5625 3.1 950-2 Extensive procedure unrelated to principal diagnosis 2.2919 5.1 950-3 Extensive procedure unrelated to principal diagnosis 2.4165 5.8 950-4 Extensive procedure unrelated to principal diagnosis 5.2834 11.3 951-1 Moderately extensive procedure unrelated to principal

diagnosis 1.3000 2.8

951-2 Moderately extensive procedure unrelated to principal diagnosis

1.7000 4.2


2.8000 6.8


4.3000 10.7




952-1 Nonextensive procedure unrelated to principal diagnosis 0.8576 2.5 952-2 Nonextensive procedure unrelated to principal diagnosis 1.2737 4.1 952-3 Nonextensive procedure unrelated to principal diagnosis 1.8981 5.9 952-4 Nonextensive procedure unrelated to principal diagnosis 3.0879 9.4 955-0 Principal diagnosis invalid as discharge diagnosis 0.0000 0.0 956-0 Ungroupable 0.0000 0.0

IHCP bulletinprovider.indianamedicaid.com/ihcp/Bulletins/BT202077.pdf048-3 Peripheral, cranial &...

Documents

Transcript of IHCP bulletinprovider.indianamedicaid.com/ihcp/Bulletins/BT202077.pdf048-3 Peripheral, cranial &...