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 051.01 200.47 Mantle cell lymph spleen 051.02 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 myelitis 200.52 Primary CNS lymph thorax 058.10 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 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 infect NOS 200.62 Anaplastic lymph thorax 059.01 200.63 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 infect!) NOS 200.68 Anaplastic lymph multip 059.21 200.70 Large cell lymph xtrndl 059.22 Yaba monkey tumor 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 Retinoph prernatr,stage 5 649.30 Coagulation def-unspec 364.81 Floppy iris syndrome 649.31 Coagulation def-dely 364.82 Plateau ids syndrome 649.32 Coagulatn def-del w p/p 364.89 hiskiliary disord NEC 649.33 Coagulation def-antepart 372.06 Ac diem conjunctivitis 649.34 Coagulation def-postpart 414.2 Chr tot ocdus cor artry 649.40 Epilepsy-unspecified 414.3 Cor ath WM rch plaq 649A1 Epilepsy-delivered 415.12 Septic pulmonary embolsm 649.42 Epilepsy-delivered w pip 423.3 Cardiac tamponade 649.43 Epilepsy-antepartvm 429.83 Takotsubo syndrome 649.44 Epilepsy-postpartum 447.70 AORTIC ECTASIA 649.70 Cervical shorteninq-unsp 447.71 THORACIC AORTIC ECTASIA 649.71 Cervical shortening-del 447.72 ABDOMINAL AORTIC ECTASIA 649.73 Cervical shortening-ante THORACOABDOMINAL AORTIC 447,73 ECTASIA 664.60 Anal sphincter tear NOS 449 Septic arterial embolism 664.61 Anal sphincter tear-del 453.82 Ac DVT/embl up ed 664.64 Anal sphinctr tear w p/p 453.83 Ac entIsm up ext NOS 670.10 Pump endometritis-unsp 453.84 Ac emblsm miller/ veins 670.12 Pump endomet del w p/p 453.85 Ac embl subclav veins 670.14 Puerp endomet-postparl 453.86 Ac embl inteml Jug vein 670.20 Puerperal sepsis-unsp 453.87 Ac embl thorac vein NEC 670.22 Puerprl sePsis-del w 1)/e 482.42 Meth res pneu d/t Staph 670.24 Puerped secels-eosteart 488.01 Influenza Due To Identified Avian lnflu 670.30 Puerp septc thromb-unsp 488.02 Influenza Due To Identified Avian Ink 670.32 Prp apt thrmb-del w p/p 488.09 Influenza Due To Identified Avian lnflu 670.34 Prp septc thmt-postpart 488.11 Influenza Due To Identified Novel H1N1 670.80 Maj prp infec NEC-unspec 488.12 Influenza Due To Identified Novel H1N1 670.82 Maj prp inf NEC-d1 w p/p 488.19 Influenza Due To Identified Novel H1N1 670.84 Maj puerp infec NEC-p/p 511.81 Malignant pleural effusn 678.00 Fetal hematologic-unspec 511.89 Effusion NEC exc lb 678.01 Fetal hematologic-deb 518.7 Transfsn rel ac lung inj 678.03 Fetal hernatologic-ante 538 GI mucositis (ulceralve) 678.10 Fetal conjoin twins-unsp 569.79 Corm intest pouch NEC 678.11 Fetal conjoin Mins-del 608.20 Torsion of testis NOS 678.13 Fetal conjoin twins-ante 608.21 Extravag tors sperm cord 679.00 Mat comp in utero-unsp Diagnosis Diagnosis Code Short Description Code Short Description 679.01 MEi comp In utero-del 780.97 Altered mental status 679.02 Mat comp In utro-del-p/p 786.30 Hemo!Airs's 679.03 Mat comp in utero-ante 786.31 Acute idiopathic Pulmonay hemorrhage i 679.04 Mat comp in utero-PIP 786.39 Dther Hemeptysis 679.10 Fetal comp in utero-unsp 787.04 Bilious emesis 679.11 Fetal comp in utero-del 799.82 Appar life threat-infant 679.12 Ftlanp In utro-del-pth 813.46 Torus fx ulna-closed 679.13 Fetal cony in utero-ante 813.47 Torus fx radius/ulna-do 679.14 Fetal comp in utero-pip 832.2 Nursemaid's elbow 695.12 Erythema multifonne maj 958.90 Compartment syndrome NOS 695.13 Stevens-Johnson syndrome 958.91 Trauma comp synd up ext 695.14 Stevens-Johnson-TEN syn 958.92 Trauma ccrith synd low ext 685.15 Toxic epidrrnl necrolysis 958.93 Trauma compart synd abd 685.52 EA dit myth 20-29 bdy 958.99 Trauma compart synd NEC 695.53 Ed clit eryth 30-39 bdy 969.00 Poisai-antidepresnt NOS 695.54 Ed d/t myth 40-49 bdy 969.01 Pols monoamine oxidase 695.55 Exit &I myth 50-59 bdy 969.02 Pols seroln/norepinephm 695.56 Exit ctit eryth 60-69 bdy 9E4).03 Pois serolinin reuptake 695.57 Exit oft eryth 70-79 bdy 9E8.04 Pois tetracycle andepres 695.58 Exfl cllt eryth 80-89 bdy 969.05 Pois bicycle antidepres 695.59 bdi d/t eryth >=90% bdy 969.09 Pois antidepressants NEC 724.03 SPINAL STENOSIS 969.70 Pois Psychostimulant NOS 729.71 Nontraum comp syn-up ext 969.71 Poisoning by caffeine 729.72 Natraum comp syn-low ex 969.72 Poisoning by amphetamine 729.73 Nontrauma comp syn-abd 969.73 Poison by methylphendate 729.79 Natrauma comp syn NEC 969.79 Poison by psychostim NEC 760.61 Amniocentesis affect NB 970.81 Poisoning By Cocaine 760.62 In utero proc NEC aff NB 970.89 Poisoning By Other Central Nenrcus Syst 760.63 Mat surg dur preg aff NB 995.20 Adv eff med/biol sub NOS 760.64 Prey rnatem sum aff NB 995.21 Arthus phenomenon 768.70 Hypoxe-ischem enceph NOS 995.22 Adv eff anesthesia NOS 768.71 loIld hypox-ischem enceph 995.23 Adverse eff insulin NOS 768.72 Mod hypox-ischem enceph 995.24 Fail mod sedate dur proc 768.73 Sev hypox-iptem enathh 995.27 Drug allergy NEC 770.87 NB respiratory arrest 995.29 Adv eff riled/bid NECMOS 770.88 NB hypoxia 997.31 Venthr asscc pieumonia 777.50 Nec enterocoltis NB NOS 997.39 Ftespiratory comp NEC 777.51 Stq I nec enterccol NB 998.30 Wound disruption NOS 777.52 Stg II nec enterocol NB 999.60 Atm Incompatibility Reaction 777.53 Stg III nee enterocol NB 999.61 Abo Incompatibility With Hemolytic Tran 779.32 NB bilious vomiting 999.62 Abo Incompatibility With Acute Hernolyti 779.85 NB cardiac arrest 999.63 Abo Incanpatiblity With Delayed Nemoly 780.32 Complx felxtie convulsns 999.69 Other Abo Incompatibility Reaction 780.33 Post Traumatic Seizures 999.70 Rh Incompatibility Reaction Diagnosis Code Short Description 999.71 Rh Incompabbility With Hemolytic Trans 999.72 Fth Incompatibitity With Acute Hemolytic Rh Incompatibility Wilh Delayed 999.73 Hemolyt 999.74 Other Rh Incanpatibility Reaction 999.75 Non-Abo Incompatibility Reaction 990.76 Non-Abo Incompatibility VVith Hemolytic Non-Abo Incompatiblibir With Acute 999.77 Hemo Non-Abo Incompatibility With Delayed 999.78 He 999.79 Other Non-Abo Incompatibility Reaction 999.80 Transfusion Reaction 999.81 Extravstn Vesicant Chemo 999.82 Bdravasn Vesicant NEC 999.83 Hernalytic Transfusion Reaction 999.84 Acute Hemolytic Transfusion Reaction Delayed Hemolytic Transfusion 999.85 Reacti3n 999.88 Infusion reaction NEC 999.89 Transfusion reaction NEC