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GOVE1RNMENT of the DISTRICT of COLUMBIA Department of Health Care Finance * * * GOVE1RNMENT OF THE DISTRICT OF COLUMBIA Department of Health Care Finance * * * Office of the Deputy Director DHCF Transmittal #11-36 TO: Hospital Providers FR: Linda Elam, Ph.D., MP Deputy Director - Medi id Director DT: December 19, 2011 RE: Hospital Room (ER) Diagnosis Indicators The purpose of this Transmittal is to provide notice of updated emergency room (ER) code indicators, effective January 1, 2012. DHCF's analysis of ER indicator codes encompasses codes from 10/1/2006 forward. ICD-9-CM diagnosis codes that will be eligible for payment at the increased payment rate for emergency services are listed in the attached table. For more information, please contact Benjamin Finder, Director of the Division of Research, Analysis and Rate Setting at 202-724-4029 or email: [email protected]. Attaclunent 825 North Capitol Street, N.E., Washington, D.C. 20002 (202) 442-5988 Fax (202) 442-4790 Diagnosis Diagnosis Code Short Description Code Short Description 038.12 MRSA septicemia 200.37 Margin zone lymph spleen 040.41 Infant botulism 200.38 Margin zone lymph muttip 040.42 Wound botulism 200.40 Mantle cell lyrn xtrrndl 041.12 MRSA elsewhere/NOS 200A1 Mantle cell hrmph head 046.11 Varnt Creutzfeldt-Jakob 200.42 Mantle cell lymph thorax 046.19 Creutztidt-Jalcob NEC/NOS 200A3 Mantle cell lymph abdom 046.71 Gerstmn-Straus-Schnk syn 200.44 Mantle cell lymph axilla 046.72 Fatal Jambi insomnia 200A5 Mantle cell lymph inguin 046.79 Non dis of CNS NEC/NOS 200.46 Mantle cell lymph petec 051.01 Cowpox 200.47 Mantle cell lymph spleen 051.02 Vaccinia MIvaccination 200.48 Mantle cell lymph multip 052.2 Postvaricella myelitis 200.50 Prirnary CNS lymph xtindi 053.14 Herpes zoster myektis 200.51 Primary CNS lymph head 054.74 Herpes simplex myelitis 200.52 Primary CNS lymph thorax 058.10 Roseola infantum NOS 200.53 Primary CNS lymph abdom 058.11 Roseola infant NI HHV-6 200.54 Primay CNS lymph axilla 058.12 Roseola infant di HHV-7 200.55 Pdrnary CNS lym inguin 058.21 Human herpes* 6 enteph 200.56 Piimary CNS lymph pelvic 058.29 Human herpesvr encph NEC 200.57 Primary CNS lymph spleen 058.81 Human herpesvirus 6 Info 200.58 Primay CNS lymph multip 058.82 Human herpesvirus 7 infc 200.60 Ananias* lymph ictrndl 058.89 Humat herpesvirs inf NEC 200.61 Anaplastic lymph head 059.00 Orthopoxvirus infect NOS 200.62 Anaplastic lymph thorax 059.01 Monkeypox 200.63 Anaplastic lymph abdom 059.10 Parapoinrirus infectn NOS 200.64 Anaplastic lymph axilla 059.11 Bovine stomatitis 200.65 Anaplastic himph inguin 059.12 Sealpox 200.66 Anaplastic lymph pelvic 059.19 Parapoxviius infect, NEC 200.67 Artaplastic lymph spleen 059.20 Yatapoxvirus infect!) NOS 200.68 Anaplastic lymph multip 059.21 Tanapox 200.70 Large cell lymph xtrndl 059.22 Yaba monkey tumor virus 200.71 Large cell lymphoma head 059.8 Poxvirus infections NEC 200.72 Large cell lymph thorax 059.9 Poxvims infection NOS 200.73 Large cell lymph abdom 079.83 Parvovins B19 200.74 Large cell lymph aella 136.21 Infectn rift acanthamoeba 200.75 Lame cell lymph inguin 136.29 Int free-liv arnebae NEC 200.76 Large cell lymph pelvic 199.2 Malig neopl-transp organ 200.77 Large cell lymph sPleen 200.30 Magni zone lym xtrndl 200.78 Large cell lymph multip 200.31 Margin zwe hcrn head 202.70 Path T cell lym xlmdl 200.32 Margin zone lym thorax 202.71 Periph T cell lymph head 200.33 Margin zone tyrn abdom 202.72 Periph T cell lym thorax 200.34 Margin zone lyrn axiRa 202.73 Periph T cell lym abdom 200.35 Margin zone lym inguin 202.74 Pedph T cell lyrn axilla 200.36 Margin zone lym pelvic 202.75 Periph T cell lyrn inguin Diagnosis Diagnosis Code Short Description Code Short Description 202.76 Periph T cell lym pelvic 209.24 Malig carcinoid kidney 202.77 Periph T cell lym spleen 209.25 Mal carcnoid forequt NOS 202.78 Periph T cell lym muffle 209.26 Mal carcinoid midgut NOS 204.02 Act lymp leuk in relapse 209.27 Mal carcnoid hindgut NOS 204.12 Chr lymp leuk in relapse 209.29 Makg carcinoid oth site 204.22 Sbac lym leuk in relapse 209.30 Mary neurcendo ca NOS 204.82 Oth lym leuk in relapse 209.31 Merkel cell ca-face 204.92 Lyrnp leuk NOS relapse 209.32 Melte! cell ca-sclpineck 205.02 Act myel leuk in relapse 209.33 Merkel cell ca-up limb 205.12 Chr myel leuk in relmse 209.34 Merkel cell ca-lovi limb 205.22 Sbac myi leuk in relapse 209.35 Merkel cell ca-trunk 205.32 Myel sarccima In relapse 209.36 Merkel cell ca-oth sites 205.82 Oth myel leuk in relapse 209.40 Ben crcnoid sm intst NOS 205.92 Myel leuk NOS in relapse 209.41 Ben carcinoid duodenum 206.02 Act mono leuk in relapse 209.42 Benign carcinoid jejunum 206.12 Chr mono leuk in relapse 209.43 Benign carcinoid ileum 206.22 Sbac mato leu in relapse 209.50 Ben crcnoid Ig intst NOS 206.82 Oth mono leuk in relapse 209.51 Ben carcinoid appendix 206.92 Mono leuk NOS relapse 209.52 Benign cardnoid cecum 207.02 Ac erlh/erylk in !elapse 209.53 Ben carcinoid asc colon 207.12 Chr erythrmia in relapse 209.54 Ben crcinoid trans colon 207.22 Mgluycyt leuk in relapse 209.55 Ben carcinoid desc colon 207.82 Oth spf leuk in relapse 209.56 Ben carcinoid sig colon 208.02 Ac leuk uns d relapse 209.57 Etenign carcinoid rectum 208.12 Ch leu uns d in relapse 209.60 Ben crcnd prim site unkn 208.22 Sbac leu uns cl-relapse 209.61 Ben carcinoid bronc/lung 208.82 Oth leuk uns d-relapse 209.62 Benign carcinoid thymus 20822 Leukemia NOS in relapse 209.63 Benign carcinold stomach 209.00 Mal crcndd sm intst NOS 209.64 Benign carcinoid kidney 209.01 Malta carcinoid duodenum 209.65 Ben crcinoid forequt NOS 209.02 Malt) carcinoid jejunum 209.66 Ben crcinoid midgut NOS 209.03 Maki carcinoid Neum 209.67 Ben crcnoid hindqut NOS 209.10 Mal crcridd lq intst NOS 209.69 Bengn cardnoid oth site 209.11 Malig carcinoid appendN 209.70 Sec neuroendo tumor NOS 209.12 Maliq carcinoid cecum 209.71 Sec neuroend tu dist lym 209.13 Mal crcnoid ascend colon 209.72 Sec neuroend tumor-liver W9.14 Mal crcnoid transv colon 209.73 Sec neuroendo tumor-bone 209.15 Mal cardnoid desc colon 2t)9.74 Sec neuroendo tu-periton 209.16 Mal carcinoid siq colon 209.75 Secondary Merkel cell ca 209.17 Maliq carcinoid rectum 209.79 Sec neuroend tu oth site 209.20 MS crcnd prim site unkn 233.30 Ca in situ fem gen NOS 209.21 Mal carcinoid broncilun9 233.31 Carcinoma in situ vagina 209.22 Malig carcinoid thymus 233.32 Carcinoma in situ vuhra 209.23 Malg carcinoid stomach 233.39 Ca in situ fem gen NEC Diagnosis Diagnosis Code Short Description Code Short Description 237.73 Schwannomatosis 288.4 Hemophagocylic syndromes 238.71 Essnfial thrombocythemia 289.83 Myelofibrosis 238.75 Myelodysplastic synd NOS 289.84 Heparin-indu thrombocyto 238.76 Myebfi w myeb metaplas 323.01 Enceph/encephmye oth dis 238.77 Post tp lymphprolif dis 323.02 Myelifis-oth viral dis 239.81 Neo retinakhoroid NOS 323.41 Encephtmyelitis-oth inf 249.00 Sec DM wo cmp nt st uncn 323.42 Myelitis WI oth infect 249.01 Sec DM wo comp uncontrld 323.51 EncephAnyel folwg immune 249.10 Sec DM keto nt st uncntr 323.52 Myelitis tollwg immune 249.11 Sec DM keb3acd uncntrli 323.61 Int ac dis encephalomyel 249.20 Sec DM hpros nt st uncnr 323.62 Postint encephaktis NEC 249.21 Sec DM hprosnir uncntrld 323.63 Postinfectious myelitis 249.30 Sec DM ot cma nt st uncn 323.71 Toxic encph & encephlorny 249.31 Sec DM oth coma uncntrkl 323.72 Rode myelitis 249.40 Sec DM rent nt st uncntr 323.81 Enceph & encephlalo NEC 249.41 Sec DM renal uncontrld 323.82 Myelitis cause NEC 249.51 Sec DM ophth uncontrld 331.5 Nomil pressure hydroceph 249.61 Sec DM neuro uncontrld 333.72 Acute dystonia elk drugs 249.70 Sec DM circ nt st unagr 337.01 Carotid sinus syndrome 249.71 Sec DM elk uncontrkl 338.11 Acute pain due to trauma 249.80 Sec DM oth nt st uncontr 338.12 Acute post4horacet pain 249.81 Sec DM other uncontrld 339.21 Ac post-trauma headathe 249.90 Sec DM unsp nt st uncon 339.89 Headache syndrome NEC 249.91 Sec DM unsp uncontrold 341.20 Acute myelitis NOS 258.01 Muk endo neoplas type I 341.21 Acute myelitis oth cond 258.02 Muk endo neop type IIA 341.22 ldiopalhc trans myelitis 258.03 Mult endo neoP tYPe 118 346.02 Mom w aur wo ntrc mgm 274.01 Acute gouty alhropathy 346.03 Nom w aura w ntrc mgm 275.01 Hereditary Hemochromatosis 346.12 Mem wo aura va ntzt mgr 275.5 Humpy Bone Syndrome 346.13 Mem wo aura w ntrc mqm Transfusion Associated Circulatory 276.61 Over 346.22 Var mgr NEC wo ntc mqr 277.30 Amyloidosis NOS 346.23 Var mgm NEC w ntrc mgr 277.88 Tumor lysis syndrome 346.30 Hmplq mqr va ntrc wo st 279.50 Graft-versus-host NOS 346.31 Hmplg mgm w ntrc wo st 279.51 Ac graft-versus-host dis 346.32 Hemplg mgr we ntrc w st 279.52 Chronc graft-vs-host dis 346.33 Hmplq mgm w ntrc w st 279.53 Ac on chm grft-vs-host 346.42 Menstl minim ntrc w st 284.01 Constitution RBC aplasia 346,43 Menstl mgm w ntrc w st 284.09 Const Waste anemia NEC 346.51 Prs era w ntr w3 infist 284.1 Pancytopenia 346.53 Prs ara wo Inf w ntrist 287.41 Posttranslusion Purpura 346.61 Prs ara w/Intintr wo st 288.03 Drug induced neutropenia 346.62 Prs ara wo ntr w infrst 288.04 Neutropenia dit infect!) 346.63 Prst ara w inf w ntrist Diagnosis Diagnosis Code Short Description Code Short Description 346.83 Oth mgr w ntrc w st mgr 608.22 Intravac tors spew cord 346.92 Mgr NOS wo ntrc w st mgr 608.23 Torsion appendix testis 346.93 Mgm NOS w ntrc w st mgr 608.24 Torsion appy epididymis 349.31 Amid pundop lac dura 649.10 Obesity-unspecified 349.39 Dural tear NEC 649.11 Obesity-delivered 359.24 Drug induced myotonia 649.12 Obesity-delivered w p/p 362.25 Relinoph prematr,stage 3 649.13 Obesity-antepartum 362.26 Retinoph prematutage 4 649.14 Obesity-postpartum 362.27
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