01 DRG Numeric Listing

DRG Expert A Comprehensive Reference to the DRG Classiﬁcation System

Twentieth Edition

Changes effective with discharges on or after October 1, 2003

Clinical Technical Editors Anita C. Hart, RHIA, CCS, CCS-P Karen Schmidt, BSN

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Numeric Listing of DRGs

DRG Description MDC Page 001 Craniotomy, Age Greater than 17 with CC...... 1 2 002 Craniotomy, Age Greater than 17 without CC...... 1 2 003 Craniotomy, Age 0-17 ...... 13 004 No Longer Valid...... 1 3 005 No Longer Valid...... 1 3 006 Carpal Tunnel Release...... 13 007 Peripheral and Cranial Nerve and Other Nervous System Procedures with CC ...... 1 3 008 Peripheral and Cranial Nerve and Other Nervous System Procedures without CC ...... 1 6 009 Spinal Disorders and Injuries ...... 1 8 010 Nervous System Neoplasms with CC ...... 1 8 011 Nervous System Neoplasms without CC ...... 1 8 012 Degenerative Nervous System Disorders ...... 1 8 013 Multiple Sclerosis and Cerebellar Ataxia ...... 1 9 014 Intracranial Hemorrhage and Stroke with Infarction ...... 1 9 015 Nonspecific Cerebrovascular and Precerebral Occlusion without Infarction ...... 1 10 016 Nonspecific Cerebrovascular Disorders with CC ...... 1 10 017 Nonspecific Cerebrovascular Disorders without CC ...... 1 10 018 Cranial and Peripheral Nerve Disorders with CC...... 1 10 019 Cranial and Peripheral Nerve Disorders without CC...... 1 12 020 Nervous System Infection Except Viral Meningitis...... 1 12 021 Viral Meningitis ...... 1 13 022 Hypertensive Encephalopathy...... 1 13 023 Nontraumatic Stupor and Coma ...... 1 13 024 Seizure and Headache, Age Greater than 17 with CC ...... 1 13 025 Seizure and Headache, Age Greater than 17 without CC ...... 1 13 026 Seizure and Headache, Age 0-17...... 1 13 027 Traumatic Stupor and Coma, Coma Greater than One Hour...... 1 14

Numeric Listing of DRGs 028 Traumatic Stupor and Coma, Coma Less than One Hour, Age Greater than 17 with CC...... 1 14 029 Traumatic Stupor and Coma, Coma Less than One Hour, Age Greater than 17 without CC...... 1 14 030 Traumatic Stupor and Coma, Coma Less than One Hour, Age 0-17...... 1 14 031 Concussion, Age Greater than 17 with CC ...... 1 14 032 Concussion, Age Greater than 17 without CC ...... 1 14 033 Concussion, Age 0-17...... 114 034 Other Disorders of Nervous System with CC ...... 1 15 035 Other Disorders of Nervous System without CC ...... 1 17 036 Retinal Procedures...... 2 19 037 Orbital Procedures ...... 2 19 038 Primary Iris Procedures...... 2 19 039 Lens Procedures with or without Vitrectomy ...... 2 20 040 Extraocular Procedures Except Orbit, Age Greater than 17...... 2 20 041 Extraocular Procedures Except Orbit, Age 0-17...... 2 21 042 Intraocular Procedures Except Retina, Iris and Lens ...... 2 21 043 Hyphema...... 2 22 044 Acute Major Eye Infections ...... 2 22 045 Neurological Eye Disorders ...... 2 22 046 Other Disorders of the Eye, Age Greater than 17 with CC ...... 2 23 047 Other Disorders of the Eye, Age Greater than 17 without CC ...... 2 28

Numeric Listing of DRGs

DRG Description MDC Page 048 Other Disorders of the Eye, Age 0-17...... 2 28 049 Major Head and Neck Procedures ...... 3 30 050 Sialoadenectomy ...... 3 30 051 Salivary Gland Procedures Except Sialoadenectomy ...... 3 30 052 Cleft Lip and Palate Repair...... 330 053 Sinus and Mastoid Procedurs, Age Greater than 17...... 3 31 054 Sinus and Mastoid Procedures, Age 0-17...... 3 31 055 Miscellaneous Ear, Nose, Mouth and Throat Procedures...... 3 31 056 Rhinoplasty ...... 3 32 057 Tonsillectomy and Adenoidectomy Procedures Except Tonsillectomy and/or Adenoidectomy Only, Age Greater than 17...... 3 32 058 Tonsillectomy and Adenoidectomy Procedures Except Tonsillectomy and/or Adenoidectomy Only, Age 0-17...... 3 32 059 Tonsillectomy and/or Adenoidectomy Only, Age Greater than 17...... 3 32 060 Tonsillectomy and/or Adenoidectomy Only, Age 0-17...... 3 33 061 Myringotomy with Tube Insertion, Age Greater than 17 ...... 3 33 062 Myringotomy with Tube Insertion, Age 0-17 ...... 3 33 063 Other Ear, Nose, Mouth and Throat O.R. Procedures...... 3 33 064 Ear, Nose, Mouth and Throat Malignancy...... 3 37 065 Dysequilibrium ...... 3 37 066 Epistaxis...... 3 37 Numeric Listing of DRGs 067 Epiglottitis ...... 3 38 068 Otitis Media and URI, Age Greater than 17 with CC ...... 3 38 069 Otitis Media and URI, Age Greater than 17 without CC ...... 3 39 070 Otitis Media and URI, Age 0-17...... 3 39 071 Laryngotracheitis ...... 3 39 072 Nasal Trauma and Deformity ...... 3 39 073 Other Ear, Nose, Mouth and Throat Diagnoses, Age Greater than 17 ...... 3 39 074 Other Ear, Nose, Mouth and Throat Diagnoses, Age 0-17 ...... 3 41 075 Major Chest Procedures ...... 4 44 076 Other Respiratory System O.R. Procedures with CC ...... 4 45 077 Other Respiratory System O.R. Procedures without CC ...... 4 46 078 Pulmonary Embolism ...... 447 079 Respiratory Infections and Inflammations, Age Greater than 17 with CC ...... 4 47 080 Respiratory Infections and Inflammations, Age Greater than 17 without CC ...... 4 48 081 Respiratory Infections and Inflammations, Age 0-17...... 4 48 082 Respiratory Neoplasms ...... 4 48 083 Major Chest Trauma with CC ...... 4 49 084 Major Chest Trauma without CC ...... 4 49 085 Pleural Effusion with CC...... 4 49 086 Pleural Effusion without CC...... 449 087 Pulmonary Edema and Respiratory Failure ...... 4 49 088 Chronic Obstructive Pulmonary Disease...... 4 50 089 Simple Pneumonia and Pleurisy, Age Greater than 17 with CC ...... 4 50 090 Simple Pneumonia and Pleurisy, Age Greater than 17 without CC ...... 4 50 091 Simple Pneumonia and Pleurisy, Age 0-17...... 4 50 092 Interstitial Lung Disease with CC...... 4 50 093 Interstitial Lung Disease without CC...... 4 51 094 Pneumothorax with CC ...... 4 51 095 Pneumothorax without CC ...... 4 51 096 Bronchitis and Asthma, Age Greater than 17 with CC ...... 4 51 097 Bronchitis and Asthma, Age Greater than 17 without CC ...... 4 52

DRG Listing by Major Diagnostic Category

MDC 1 DISEASES AND DISORDERS OF THE NERVOUS SYSTEM Surgical DRG DRG Description Page 001 Craniotomy, Age Greater than 17 with CC ...... 2 002 Craniotomy, Age Greater than 17 without CC ...... 2 003 Craniotomy, Age 0-17...... 3 004 No Longer Valid...... 3 005 No Longer Valid...... 3 006 Carpal Tunnel Release ...... 3 007 Peripheral and Cranial Nerve and Other Nervous System Procedures with CC...... 3 008 Peripheral and Cranial Nerve and Other Nervous System Procedures without CC...... 6 l 528 Intracranial Vascular Procedure with Principal Diagnosis of Hemorrhage...... 6 l 529 Ventricular Shunt Procedures with CC ...... 6 l 530 Ventricular Shunt Procedures without CC ...... 6 l 531 Spinal Procedures with CC...... 6 l 532 Spinal Procedures without CC...... 7 l 533 Extracranial Vascular Procedures with CC...... 7 l 534 Extracranial Vascular Procedures without CC...... 7 Medical DRG DRG Description Page 009 Spinal Disorders and Injuries ...... 8 010 Nervous System Neoplasms with CC...... 8 011 Nervous System Neoplasms without CC...... 8 012 Degenerative Nervous System Disorders ...... 8 013 Multiple Sclerosis and Cerebellar Ataxia...... 9 014 Intracranial Hemorrhage and Stroke with Infarction...... 9 015 Nonspecific Cerebrovascular and Precerebral Occlusion without Infarction ...... 10 016 Nonspecific Cerebrovascular Disorders with CC...... 10 017 Nonspecific Cerebrovascular Disorders without CC...... 10 018 Cranial and Peripheral Nerve Disorders with CC ...... 10 019 Cranial and Peripheral Nerve Disorders without CC ...... 12 020 Nervous System Infection Except Viral Meningitis ...... 12 021 Viral Meningitis ...... 13 022 Hypertensive Encephalopathy ...... 13 023 Nontraumatic Stupor and Coma...... 13 024 Seizure and Headache, Age Greater than 17 with CC ...... 13 025 Seizure and Headache, Age Greater than 17 without CC ...... 13 026 Seizure and Headache, Age 0-17 ...... 13 027 Traumatic Stupor and Coma, Coma Greater than One Hour ...... 14 028 Traumatic Stupor and Coma, Coma Less than One Hour, Age Greater than 17? with CC ...... 14 029 Traumatic Stupor and Coma, Coma Less than One Hour, Age Greater than 17 DRG Listing by Major Diagnostic Category without CC ...... 14 030 Traumatic Stupor and Coma, Coma Less than One Hour, Age 0-17 ...... 14 031 Concussion, Age Greater than 17 with CC ...... 14 032 Concussion, Age Greater than 17 without CC ...... 14 033 Concussion, Age 0-17...... 14 034 Other Disorders of Nervous System with CC ...... 15 035 Other Disorders of Nervous System without CC ...... 17 524 Transient Ischemia...... 17

MDC 2 DISEASES AND DISORDERS OF THE EYE Surgical DRG DRG Description Page 036 Retinal Procedures ...... 19 037 Orbital Procedures ...... 19 038 Primary Iris Procedures ...... 19 039 Lens Procedures with or without Vitrectomy...... 20 040 Extraocular Procedures Except Orbit, Age Greater than 17 ...... 20 041 Extraocular Procedures Except Orbit, Age 0-17 ...... 21 042 Intraocular Procedures Except Retina, Iris and Lens...... 21

DRG Listing by Major Diagnostic Category

MDC 2 — Continued Medical DRG DRG Description Page 043 Hyphema...... 22 044 Acute Major Eye Infections ...... 22 045 Neurological Eye Disorders...... 22 046 Other Disorders of the Eye, Age Greater than 17 with CC...... 23 047 Other Disorders of the Eye, Age Greater than 17 without CC...... 28 048 Other Disorders of the Eye, Age 0-17 ...... 28

MDC 3 DISEASES AND DISORDERS OF THE EAR, NOSE, MOUTH AND THROAT Surgical DRG DRG Description Page 049 Major Head and Neck Procedures...... 30 050 Sialoadenectomy...... 30 051 Salivary Gland Procedures Except Sialoadenectomy...... 30 052 Cleft Lip and Palate Repair ...... 30 053 Sinus and Mastoid Procedures, Age Greater than 17 ...... 31 054 Sinus and Mastoid Procedures, Age 0-17 ...... 31 055 Miscellaneous Ear, Nose, Mouth and Throat Procedures ...... 31 056 Rhinoplasty...... 32

057 Tonsillectomy and Adenoidectomy Procedures Except Tonsillectomy and/or DRG Listing by Major Diagnostic Category Adenoidectomy Only, Age Greater than 17 ...... 32 058 Tonsillectomy and Adenoidectomy Procedures Except Tonsillectomy and/or Adenoidectomy Only, Age 0-17 ...... 32 059 Tonsillectomy and/or Adenoidectomy Only, Age Greater than 17 ...... 32 060 Tonsillectomy and/or Adenoidectomy Only, Age 0-17 ...... 33 061 Myringotomy with Tube Insertion, Age Greater than 17...... 33 062 Myringotomy with Tube Insertion, Age 0-17...... 33 063 Other Ear, Nose, Mouth and Throat O.R. Procedures ...... 33 168 Mouth Procedures with CC ...... 35 169 Mouth Procedures without CC ...... 36 Medical DRG DRG Description Page 064 Ear, Nose, Mouth and Throat Malignancy ...... 37 065 Dysequilibrium ...... 37 066 Epistaxis ...... 37 067 Epiglottitis...... 38 068 Otitis Media and URI, Age Greater than 17 with CC...... 38 069 Otitis Media and URI, Age Greater than 17 without CC...... 39 070 Otitis Media and URI, Age 0-17 ...... 39 071 Laryngotracheitis...... 39 072 Nasal Trauma and Deformity...... 39 073 Other Ear, Nose, Mouth and Throat Diagnoses, Age Greater than 17...... 39 074 Other Ear, Nose, Mouth and Throat Diagnoses, Age 0-17...... 41 185 Dental and Oral Diseases Except Extractions and Restorations, Age Greater than 17 ...... 41 186 Dental and Oral Diseases Except Extractions and Restorations, Age 0-17 ...... 42 187 Dental Extractions and Restorations ...... 42

MDC 4 DISEASES AND DISORDERS OF THE RESPIRATORY SYSTEM Surgical DRG DRG Description Page 075 Major Chest Procedures...... 44 076 Other Respiratory System O.R. Procedures with CC...... 45 077 Other Respiratory System O.R. Procedures without CC...... 46 474 No Longer Valid...... 46 Medical DRG DRG Description Page 078 Pulmonary Embolism...... 47 079 Respiratory Infections and Inflammations, Age Greater than 17 with CC ...... 47 080 Respiratory Infections and Inflammations, Age Greater than 17 without CC ...... 48 081 Respiratory Infections and Inflammations, Age 0-17 ...... 48 082 Respiratory Neoplasms...... 48 083 Major Chest Trauma with CC...... 49 084 Major Chest Trauma without CC...... 49 085 Pleural Effusion with CC ...... 49 086 Pleural Effusion without CC ...... 49 087 Pulmonary Edema and Respiratory Failure...... 49

Introduction

The diagnosis-related group (DRG) system organizes analysis can be launched using the DRG clinical ICD-9-CM diagnosis and procedure codes into a framework, and quality reviews can be performed to complex, comprehensive system based on a few simple assess coding practices and physician documentation. principles. Ongoing education of physicians, coders, nurses, and utilization review personnel can be guided by the Understanding how the DRG system works enables results of DRG analysis. providers to recover the appropriate payment for inpatient services rendered in an acute ca0re hospital Second, DRGs assist in evaluating utilization of facility, which is consistent with the intent of the services. Each DRG represents the average resources federal government when it devised the DRG system. needed to treat patients grouped to that DRG relative The DRG Expert helps providers understand DRGs, to the national average of resources used to treat all thus ensuring appropriate payment. Medicare patients. The DRG assigned to each hospital inpatient stay also relates to the hospital case mix (i.e., Note: For information concerning the DRG the types of patients the hospital treats). The hospital classification system for long-term acute care hospitals case-mix index (CMI) is determined by dividing the (LTCHs), refer to the section titled “Long Term Acute sum of all DRG relative weights for every DRG used by Care Hospital Prospective Payment System (LTCH Medicare patients (counting each patient populating PPS)” on page Introduction — 4. the DRG separately) by the total number of Medicare inpatient cases for the hospital. SOURCE OF INFORMATION Medicare computes the case-mix adjustment for each Information in the book is taken from the official data fiscal year for all hospitals based upon the case-mix published by the Centers for Medicare and Medicaid

data received. This CMI is then used to adjust the Introduction Services (CMS) in the Federal Register, vol. 68, no. 148, hospital base rate, which is a factor in computing the dated August 1, 2003, pages 45346-45672 (“Medicare total hospital payment under PPS. Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2004 The formula for computing the hospital payment for Rates; Final Rule”). The information presented is each DRG is as follows: consistent with the fiscal 2004 Grouper version 21.0. DRG Relative Weight x Hospital Base Rate = Hospital BASIC CHARACTERISTICS OF Payment DRG CLASSIFICATION The hospital case mix complexity includes the A DRG is one of 518 currently valid groups that following patient attributes: classify patients into clinically cohesive groups that demonstrate similar consumption of hospital • Severity of illness — the level of loss of function resources and length-of-stay patterns. In 1983, or mortality associated with disease Congress mandated a national hospital prospective •Prognosis — defined as probable outcome of payment system (PPS) for all Medicare inpatients. The illness following types of hospitals are excluded from the PPS: •Treatment difficulty — patient management • Psychiatric hospitals and units problems • Rehabilitation hospitals and units • Need for intervention — severity of illness that would result due to lack of immediate or • Children’s hospitals continuing care • Long-term care hospitals • Resource intensity — volume and types of • Cancer hospitals services required for patient management

This PPS uses DRGs to determine hospital The DRG system was developed to relate case mix to reimbursement. CMS administers the PPS and issues resource utilization. Reimbursement is adjusted to all rules and changes with regard to DRGs. reflect the resource utilization and does not take into consideration severity of illness, prognosis, treatment In addition to calculating reimbursement, DRGs have difficulty, or need for intervention. two major functions. The first is to help evaluate the quality of care. Not only are critical pathways designed Case mix and complexity can be analyzed and around DRGs, but benchmarking and outcomes monitored in relation to cost and utilization of services.

DRG Expert

In addition, high-volume conditions and services can The pre-MDC DRG group includes bone marrow and be identified and monitored, and DRG trend analysis organ transplant cases as well as tracheostomy cases. can aid in forecasting future staff and facility requirements. One important operating parameter is Further sorting of medical classifications is performed the CMI, which measures the cost of a hospital’s by principal diagnosis type and/or surgical Medicare patient mix in relation to the cost of all classifications by type of surgery. Finally, the case is Medicare patients. A low case mix may indicate analyzed for age and/or the presence of CCs as unnecessary revenue loss. indicated by ICD-9-CM diagnosis codes, and a DRG is assigned.

DRG ASSIGNMENT PROCESS Each year, effective October 1 through September 30, DRGs are assigned using the principal diagnosis; up to DRG assignments are adjusted based on relative eight additional diagnoses; the principal procedure weight (RW), arithmetic mean length of stay (AMLOS), and up to five additional procedure codes; and age, and geometric mean length of stay (GMLOS). Annually, sex, and discharge status. One DRG is assigned to new ICD-9-CM codes are also incorporated into the each inpatient stay. Diagnoses and procedures are existing DRGs or new DRGs are added for the next designated by ICD-9-CM codes. The following fiscal year. describes the typical decision process used to assign a DRG to a case. The information contained in this manual reflects the DRG classification system for fiscal 2004, Grouper A case is assigned to one of 25 major diagnostic version 21.0. categories (MDCs), which are mutually exclusive groups based on principal diagnosis. DRG assignment Grouper Version Effective Time Period is based upon the following considerations: CMS 21.0 10/01/2003 – 09/30/2004 CMS 20.0 10/01/2002– 09/30/2003 • Principal and secondary diagnosis and procedure codes CMS 19.0 10/01/2001 – 09/30/2002 • Sex CMS 18.0 10/01/2000 – 09/30/2001 • Age CMS 17.0 10/01/1999 – 09/30/2000 • Discharge status CMS 16.0 10/01/1998 – 09/30/1999 •Presence or absence of complications and CMS 15.0 10/01/1997 – 09/30/1998 comorbidities (CCs) CMS 14.0 10/01/1996 – 09/30/1997 Introduction • Birth weight for neonates CMS 13.0 10/01/1995 – 09/30/1996 CMS 12.0 10/01/1994 – 09/30/1995 Each MDC is organized into one of two sections — CMS 11.0 10/01/1993 – 09/30/1994 surgical or medical. The surgical section classifies all surgical conditions based upon operating room CMS 10.0 10/01/1992 – 09/30/1993 procedures. The medical section classifies all CMS 9.0 10/01/1991 – 09/30/1992 diagnostic conditions based upon diagnosis codes. The CMS 8.0 10/01/1990 – 09/30/1991 majority of MDCs are organized by major body system CMS 7.0 10/01/1989 – 09/30/1990 and/or are associated with a particular medical CMS 6.0 10/01/1988 – 09/30/1989 specialty. CMS 5.0 10/01/1987 – 09/30/1988 There are two groups of DRGs that are not assigned to CMS 4.0 10/01/1986 – 09/30/1987 MDCs. First, there is the group that may be associated CMS 3.0 05/01/1986 – 09/30/1986 with all MDCs. This group includes DRGs created CMS 2.0 10/01/1983 – 04/30/1986 specifically to report admissions into a facility that have been assigned invalid principal diagnoses (DRG 469), have O.R. procedures unrelated to a principal COMPLICATIONS AND diagnosis (DRGs 468, 476, and 477), or are COMORBIDITIES ungroupable principal diagnoses (DRG 470). Although CMS developed a standard list of diagnoses that are the scope is too broad for clinical analysis, the DRGs recognized as CCs for DRGs. When a CC is present as encompass clinically coherent cases. a secondary diagnosis, it may affect DRG assignment.

Another group not assigned to MDCs are called pre- Examples of the most commonly missed CCs are: MDC DRGs, which consist of cases that are grouped by surgical procedure rather than principal diagnosis. • Alcoholism • Anemia due to blood loss, acute/chronic

Nervous System — MDC 1 MDC 1 DISEASES AND DISORDERS OF THE NERVOUS SYSTEM Assignment of ICD-9-CM Codes 003.21 130.0 333.0 349.0 433.31 784.0 006.5 137.1 333.1 349.1 433.80 784.3 *013 138 333.2 349.2 433.81 784.5 036.0 139.0 333.3 349.81 433.90 792.0 036.1 *191 333.4 349.82 433.91 793.0 *045.0 *192 333.5 349.89 434.00 *794.0 *045.1 194.4 333.6 349.9 434.01 794.10 *045.9 194.5 333.7 *350 434.10 794.19 *046 194.6 333.82 *351 434.11 796.1 *047 198.3 333.83 *352 434.90 798.0 048 198.4 333.84 *353 434.91 *800 049.0 *225 333.89 *354 *435 *801 049.1 227.4 333.90 *355 436 *803 049.8 227.5 333.91 356.0 437.0 *804 049.9 227.6 333.92 356.1 437.1 *806 052.0 228.02 333.93 356.2 437.2 *850 053.0 237.1 333.99 356.3 437.3 *851

053.10 237.3 *334 356.4 437.4 *852 MDC 1: Nervous System — Dx List 053.11 237.5 *335 356.8 437.5 *853 053.12 237.6 336.0 356.9 437.6 *854 053.13 237.70 336.1 357.0 437.7 905.0 053.19 237.71 336.2 357.1 437.8 907.0 054.3 237.72 336.3 357.2 437.9 907.1 054.72 237.9 336.8 357.3 *438 907.2 055.0 239.6 336.9 357.4 723.2 907.3 056.00 *250.6 *337 357.5 723.3 907.4 056.01 *307.2 340 357.6 723.4 907.5 056.09 307.81 *341 357.7 729.2 907.9 *062 310.2 *342 *357.8 736.05 950.1 *063 *320 343.0 357.9 736.06 950.2 064 *321 343.1 *358.0 736.07 950.3 066.2 *322 343.2 358.1 736.74 950.9 071 323.0 343.3 358.2 *740 951.0 072.1 323.1 343.4 358.8 *741 951.1 072.2 323.2 343.8 358.9 *742 951.2 072.72 323.4 343.9 *359 747.81 951.3 078.81 323.5 *344.0 377.00 747.82 951.4 *090.4 323.6 344.1 377.01 756.17 951.6 091.81 323.7 344.2 377.04 759.5 951.7 094.0 323.8 *344.3 *377.5 779.7 951.8 094.1 323.9 *344.4 *377.6 780.01 951.9 094.2 *324 344.5 *377.7 780.03 *952 094.3 325 344.60 377.9 780.09 *953 094.81 326 *344.8 378.86 *780.3 *954 094.82 *330 344.9 379.45 780.51 *955 094.85 331.0 *345 388.61 780.53 *956 094.87 *331.1 *346 430 780.57 *957 094.89 331.2 347 431 781.0 996.2 094.9 331.3 348.0 *432 781.1 996.63 098.82 331.4 348.1 433.00 781.2 996.75 *100.8 331.7 348.2 433.01 781.3 *997.0 112.83 331.81 *348.3 433.10 781.4 *V53.0 114.2 331.82 *348.4 433.11 781.6 115.01 331.89 348.5 433.20 781.8 115.11 331.9 348.8 433.21 *781.9 115.91 *332 348.9 433.30 782.0

DRG Expert MDC 1 DISEASES AND DISORDERS OF THE NERVOUS SYSTEM

SURGICAL

<∫>DRG 001 Craniotomy, <¥Age> Greater than 17 <©with> CC GMLOS 8.0 AMLOS 10.9 RW 3.6186 4 Operating Room Procedures 01.12 Biopsy, open, cerebral meninges 01.14 Biopsy, open, brain 01.15 Biopsy, skull 01.18 Procedure, diagnostic, other, brain and cerebral meninges 01.19 Procedure, diagnostic, other, skull *01.2 Craniotomy and craniectomy *01.3 Incision, brain and cerebral meninges *01.4 Operation, thalamus and globus pallidus *01.5 Excision or destruction, other, brain and meninges 01.6 Excision, lesion, skull *02.0 Cranioplasty *02.1 Repair, cerebral meninges 02.2 Ventriculostomy 02.91 Lysis, adhesions, cortical 02.92 Repair, brain 02.93 Implantation, intracranial neurostimulator 02.94 Insertion or replacement, skull tongs or halo traction device 02.99 Operation, other, skull, brain and cerebral meninges 04.01 Neurotomy, acoustic 04.41 Decompression, trigeminal nerve root 07.13 Biopsy, pituitary gland, transfrontal approach 07.14 Biopsy, pituitary gland, transphenoidal approach 07.15 Biopsy, pituitary gland, unspeciﬁed approach 07.17 Biopsy, pineal gland *07.5 Operation, pineal gland *07.6 Hypophysectomy

MDC 1: Nervous System — Surgical *07.7 Operation, other, hypophysis 29.92 Division, nerve, glossopharyngeal 38.01 Incision, intracranial vessels 38.11 Endarterectomy, intracranial vessels 38.31 Phlebectomy, with anastomosis, intracranial vessels 38.41 Phlebectomy, with graft replacement, intracranial vessels 38.51 Ligation and stripping, varicose veins, intracranial vessel 38.61 Excision, lesion, other, intracranial vessels 38.81 Ligation, division, other, intracranial vessels 39.28 Bypass, vascular, extracranial-intracranial (EC-IC) 39.51 Clipping, aneurysm 39.52 Repair, other, aneurysm 39.53 Repair, ﬁstula, arteriovenous 39.72 Repair or occlusion, endovascular, head and neck vessels 39.79 Repair, endovascular, other (of aneurysm), other vessels

<∫>DRG 002 Craniotomy, <¥>Age Greater than 17 <©>without CC GMLOS 4.1 AMLOS 5.3 RW 2.0850 4 Select operating room procedures listed under DRG 001

Alphabetic Index to Diseases

Code Narrative Page Code Narrative Page *388.4 Abnormal, auditory perception 40 796.4 Abnormal, findings, other 280, 350 786.7 Abnormal chest sounds 52 nonspecific, clinical 791.7 Abnormal, findings, cells and 176 796.1 Abnormal, findings, other 16 casts, urine nonspecific, reflex 792.5 Abnormal, findings, cloudy dialysis 350 796.0 Abnormal, findings, other 337 effluent nonspecific, toxicological *795.3 Abnormal, findings, culture, 304 791.9 Abnormal, findings, other 176 nonspecific positive nonspecific, urine 792.3 Abnormal, findings, nonspecific, 251 648.80 Abnormal, glucose tolerance, 256 amniotic fluid maternal, complicating pregnancy, childbirth, or the puerperium, 792.0 Abnormal, findings, nonspecific, 16 unspecified as to episode of care cerebrospinal fluid 648.81 Abnormal, glucose tolerance, 206, 228 793.0 Abnormal, findings, nonspecific, 16 maternal, complicating pregnancy, radiological and other examination, childbirth, or the puerperium, skull and head delivered, with or without mention 793.1 Abnormal, findings, nonspecific, 52 of antepartum condition radiological and other examination, 648.82 Abnormal, glucose tolerance, 206, 228 lung field maternal, complicating pregnancy, 793.2 Abnormal, findings, nonspecific, 63, 82 childbirth, or the puerperium, Alphabetic Index to Diseases radiological and other examination, delivered, with mention of intrathoracic organ postpartum complication 793.3 Abnormal, findings, nonspecific, 112 648.83 Abnormal, glucose tolerance, 246, 253 radiological and other examination, maternal, complicating pregnancy, biliary tract childbirth, or the puerperium, 793.4 Abnormal, findings, nonspecific, 102 antepartum condition or radiological and other examination, complication gastrointestinal tract 648.84 Abnormal, glucose tolerance, 240 793.5 Abnormal, findings, nonspecific, 176 maternal, complicating pregnancy, radiological and other examination, childbirth, or the puerperium, genitourinary organs postpartum condition or 793.6 Abnormal, findings, nonspecific, 102 complication radiological and other examination, 781.0 Abnormal involuntary movements 16 abdominal area, including 793.80 Abnormal, mammogram, 151 retroperitoneum unspecified 793.7 Abnormal, findings, nonspecific, 141 795.2 Abnormal, nonspecific, findings, 351 radiological and other examination, chromosomal analysis musculoskeletal system 794.31 Abnormal, nonspecific, findings, 86 793.89 Abnormal, findings, nonspecific, 151 electrocardiogram [ECG] [EKG] radiological and other examination, 794.17 Abnormal, nonspecific, findings, 141 breast electromyogram [EMG] 793.9 Abnormal, findings, nonspecific, 350 794.12 Abnormal, nonspecific, findings, 27 radiological and other examination, electrooculogram other body site 794.15 Abnormal, nonspecific, findings, 41, 280 792.4 Abnormal, findings, nonspecific, 41 function studies, auditory saliva 794.7 Abnormal, nonspecific, findings, 167 792.2 Abnormal, findings, nonspecific, 187 function studies, basal metabolic semen rate 792.1 Abnormal, findings, nonspecific, 102 *794.3 Abnormal, nonspecific, findings, 63 stool contents function studies, cardiovascular 796.9 Abnormal, findings, other 350 794.6 Abnormal, nonspecific, findings, 167 nonspecific function studies, endocrine 796.5 Abnormal, findings, other 251 794.4 Abnormal, nonspecific, findings, 176 nonspecific, antenatal screening function studies, kidney 796.2 Abnormal, findings, other 63, 87 794.8 Abnormal, nonspecific, findings, 112 nonspecific, blood pressure, function studies, liver elevated without diagnosis of hypertension 794.19 Abnormal, nonspecific, findings, 16 function studies, nervous system, 796.3 Abnormal, findings, other 63, 87 peripheral nonspecific, blood pressure, low

DRG Expert

Code Narrative Page Code Narrative Page 794.9 Abnormal, nonspecific, findings, 176 654.04 Abnormalities, congenital, uterus, 240 function studies, not elsewhere complicating pregnancy, childbirth, classified or the puerperium, postpartum 794.14 Abnormal, nonspecific, findings, 27 condition or complication function studies, oculomotor 654.40 Abnormalities, other, shape or 257 794.39 Abnormal, nonspecific, findings, 86 position, gravis uterus and function studies, other, neighboring structures, cardiovascular unspecified as to episode of care 794.2 Abnormal, nonspecific, findings, 53 654.41 Abnormalities, other, shape or 208, 229 function studies, pulmonary position, gravis uterus and neighboring structures, delivered, 794.11 Abnormal, nonspecific, findings, 27 with or without mention of function studies, retinal antepartum condition 794.5 Abnormal, nonspecific, findings, 167 654.42 Abnormalities, other, shape or 208, 229 function studies, thyroid position, gravis uterus and 794.30 Abnormal, nonspecific, findings, 86 neighboring structures, delivered, function studies, unspecified, with mention of postpartum cardiovascular complication 794.16 Abnormal, nonspecific, findings, 41 654.43 Abnormalities, other, shape or 247 function studies, vestibular position, gravis uterus and 795.4 Abnormal, nonspecific, findings, 280, 350 neighboring structures, histological, other antepartum condition or *795.0 Abnormal, nonspecific, findings, 193, 200 complication pap smear, cervix 654.44 Abnormalities, other, shape or 240 795.1 Abnormal, nonspecific, findings, 49 position, gravis uterus and pap smear, other site neighboring structures, postpartum condition or 794.13 Abnormal, nonspecific, findings, 27 complication visually evoked potential 655.10 Abnormality, chromosomal, fetus, 257 794.10 Abnormal, nonspecific, response 16 affecting management of mother, to nerve stimulation, unspecified unspecified as to episode of care *794.0 Abnormal, nonspecific, results, 16 655.11 Abnormality, chromosomal, fetus, 208, 230 function studies, brain and central affecting management of mother, nervous system delivered, with or without mention 792.9 Abnormal, other findings, 350 of antepartum condition nonspecific, body substances 655.13 Abnormality, chromosomal, fetus, 247 785.3 Abnormal, other, heart sounds 63, 86 affecting management of mother, 631 Abnormal, other, product of 244 antepartum condition or conception complication 781.92 Abnormal posture 16 659.73 Abnormality, fetal heart rate or 248 rhythm, antepartum condition or Alphabetic Index to Diseases 379.40 Abnormal, pupillary function, 23 unspecified complication 786.4 Abnormal, sputum 52 659.71 Abnormality, fetal heart rate or 210, 232 rhythm, delivered, with or without *783.2 Abnormal, weight loss and 381 mention of antepartum condition underweight 659.70 Abnormality, fetal heart rate or 210, 232 654.00 Abnormalities, congenital, uterus, 257 rhythm, unspecified as to episode complicating pregnancy, childbirth, of care or not applicable or the puerperium, unspecified as to episode of care 655.80 Abnormality, fetal, other known or 257 suspected, not elsewhere 654.01 Abnormalities, congenital, uterus, 207, 229 classified, affecting management complicating pregnancy, childbirth, of mother, unspecified as to or the puerperium, delivered, with episode of care or without mention of antepartum condition 655.81 Abnormality, fetal, other known or 209, 230 suspected, not elsewhere 654.02 Abnormalities, congenital, uterus, 207, 229 classified, affecting management complicating pregnancy, childbirth, of mother, delivered, with or or the puerperium, delivered, with without mention of antepartum mention of postpartum condition complication 655.83 Abnormality, fetal, other known or 247 654.03 Abnormalities, congenital, uterus, 247 suspected, not elsewhere complicating pregnancy, childbirth, classified, affecting management or the puerperium, antepartum of mother, antepartum condition or condition or complication complication 655.90 Abnormality, fetal, unspecified, 257 affecting management of mother, unspecified as to episode of care

Numeric Index to Diseases

Code Narrative Page Code Narrative Page *001 Cholera 100 *013 Tuberculosis, meninges and 12, 379 *002 Typhoid and parathyphoid fevers 302 central nervous system 003.0 Gastroenteritis, Salmonella 100 *014 Tuberculosis, intestines, 102, 379 peritoneum and mesenteric glands 003.1 Septicemia, Salmonella 300, 379 *015 Tuberculosis, bones and joints 379 *003.2 Infection, Salmonella, localized 379 *015.0 Tuberculosis, vertebral column 132 003.20 Infection, Salmonella, localized, 302 unspecified *015.1 Tuberculosis, hip 133 003.21 Meningitis, Salmonella 12 *015.2 Tuberculosis, knee 133 003.22 Pneumonia, Salmonella 47 *015.5 Tuberculosis, limb bones 132 003.23 Arthritis, Salmonella 133 *015.6 Tuberculosis, mastoid 39 003.24 Osteomyelitis, Salmonella 132 *015.7 Tuberculosis, bone, other specified 132 003.29 Infection, Salmonella, localized, 302 *015.8 Tuberculosis, joint, other specified 133 other *015.9 Tuberculosis, bones and joints, 133 003.8 Infection, Salmonella, other 302, 379 unspecified 003.9 Infection, Salmonella, unspecified 302, 379 *016 Tuberculosis, genitourinary system 379 *004 Shigellosis 100 *016.0 Tuberculosis, kidney 175 005.0 Poisoning, food, staphylococcal 100 *016.1 Tuberculosis, bladder 175

005.1 Botulism 302 *016.2 Tuberculosis, ureter 175 Numeric Index to Diseases 005.2 Poisoning, food, due to Clostridium 100 *016.3 Tuberculosis, urinary organs, other 175 perfringens [C Welchii] *016.4 Tuberculosis, epididymis 185 005.3 Poisoning, food, due to other 100 *016.5 Tuberculosis, genital organs, male, 185 Clostridia other 005.4 Poisoning, food, due to Vibrio 100 *016.6 Tuberculous oophoritis and 191, 198 parahaemolyticus salpingitis *005.8 Poisoning, food, other bacteria 100 *016.7 Tuberculosis, other, female genital 191, 198 005.9 Poisoning, food, unspecified 100 organs 006.0 Dysentery, amebic, acute, without 100 *016.9 Tuberculosis, genitourinary, 175 mention of abscess unspecified 006.1 Amebiasis, intestinal, chronic, 100 *017 Tuberculosis, other organs 379 without mention of abscess *017.0 Tuberculosis, skin and 155 006.2 Colitis, amebic, nondysenteric 100 subcutaneous cellular tissue 006.3 Abscess, amebic, liver 111 *017.1 Tuberculosis, erythema nodosum 150 with hypersensitivity reaction 006.4 Abscess, amebic, lung 47 *017.2 Tuberculosis, peripheral lymph 285 006.5 Abscess, amebic, brain 12 nodes 006.6 Ulceration, amebic, skin 155 *017.3 Tuberculosis, eye 23 006.8 Infection, amebic, other sites 302 *017.4 Tuberculosis, ear 39 006.9 Amebiasis, unspecified 302 *017.5 Tuberculosis, thyroid gland 166 *007 Disease, intestinal, protozoal, 100 *017.6 Tuberculosis, adrenal gland 166 other *017.7 Tuberculosis, spleen 285 007.2 Coccidiosis 379 *017.8 Tuberculosis, esophagus 102 *008 Infection, intestinal, due to other 100 organisms *017.9 Tuberculosis, organs, other 302 specified *009 Infection, intestinal, ill-defined 100, 380 *018 Tuberculosis, miliary 379 *010 Tuberculosis, primary 47, 379 *018.0 Tuberculosis, miliary, acute 302 *011 Tuberculosis, pulmonary 47, 379 *018.8 Tuberculosis, miliary, other 302 *012 Tuberculosis, respiratory, other 379 specified *012.0 Tuberculosis, pleurisy 47 *018.9 Tuberculosis, miliary, unspecified 302 *012.1 Tuberculosis, intrathoracic lymph 47 020.0 Plague, bubonic 302 nodes 020.1 Plague, cellulocutaneous 302 *012.2 Tuberculosis, tracheobronchial, 47 isolated 020.2 Septicemia, plague 300 *012.3 Tuberculosis, laryngitis 39, 390 020.3 Plague, pneumonic, primary 47 *012.8 Tuberculosis, respiratory, other 47 020.4 Plague, pneumonic, secondary 47 specified 020.5 Plague, pneumonic, unspecified 47 020.8 Plague, other specified types 302

DRG Expert

Code Narrative Page Code Narrative Page 020.9 Plague, unspecified 302 036.81 Neuritis, meningococcal, optic 22, 263, 021.0 Tularemia, ulceroglandular 302 271 021.1 Tularemia, enteric 102 036.82 Arthropathy, meningococcal 133, 263, 271 021.2 Tularemia, pulmonary 47 036.89 Infection, meningococcal, other, 300 021.3 Tularemia, oculoglandular 302 specified 021.8 Tularemia, other specified 302 036.9 Infection, meningococcal, 300 021.9 Tularemia, unspecified 302 unspecified 022.0 Anthrax, cutaneous 155 037 Tetanus 263, 271, 022.1 Anthrax, pulmonary 47 302 022.2 Anthrax, gastrointestinal 102 *038 Septicemia 263, 271, 022.3 Anthrax, septicemia, 300 300, 379 022.8 Anthrax, other specified 302 *039 Infection, actinomycotic 379 manifestations 039.0 Infection, actinomycotic, 155 022.9 Anthrax, unspecified 302 cutaneous *023 Brucellosis 302 039.1 Infection, actinomycotic, 47 pulmonary 024 Glanders 302 039.2 Infection, actinomycotic, 102 025 Melioidosis 302 abdominal *026 Rat-bite fever 302 039.3 Infection, actinomycotic, 155 *027 Disease, zoonotic bacterial, other 302 cervicofacial *030 Leprosy 302 039.4 Madura foot 155 031.0 Disease, pulmonary, due to 47 039.8 Infection, actinomycotic, other 302 Mycobacterium avium, specified sites intracellulare, kansasii 039.9 Infection, actinomycotic, 302 031.1 Disease, cutaneous, due to other 155 unspecified site mycobacteria 040.0 Gangrene, gas 263, 271, 031.2 Disease, due to disseminated 302, 379 302 mycobacterium avium- 040.1 Rhinoscleroma 302 intracellulare complex (DMAC) 040.2 Disease, Whipple’s 102 031.8 Disease, mycobacterial, other 302, 379 040.3 Necrobacillosis 302 031.9 Disease, due to mycobacteria, 302, 379 unspecified 040.81 Pyomyositis, tropical 136 032.0 Diphtheria, faucial 39 040.82 Syndrome, toxic shock 302 032.1 Diphtheria, nasopharyngeal 390 040.89 Disease, bacterial, other 302 032.2 Diphtheria, anterior nasal 39 *041 Infection, bacterial, in conditions 302 classified elsewhere 032.3 Diphtheria, laryngeal 390 042 Disease, human immunodeficiency 378, 379, Numeric Index to Diseases 032.81 Diphtheria, conjunctival 23 virus (HIV) 380, 381 032.82 Diphtheria, myocarditis 60, 85 *045.0 Poliomyelitis, acute paralytic, 12 032.83 Diphtheria, peritonitis 102 specified as bulbar 032.84 Diphtheria, cystitis 175 *045.1 Poliomyelitis, acute, with other 12 032.85 Diphtheria, cutaneous 155 paralysis 032.89 Diphtheria, other 302 *045.2 Poliomyelitis, acute, nonparalytic 300 032.9 Diphtheria, unspecified 302 *045.9 Poliomyelitis, acute, unspecified 12 *033 Whooping cough 51 *046 Infection, slow virus, central 8 034.0 Sore throat, streptococcal 38, 390 nervous system 034.1 Scarlet fever 302 046.2 Panencephalitis, subacute, 263, 271 sclerosing 035 Erysipelas 151 046.3 Leukoencephalopathy, multifocal, 379 036.0 Meningitis, meningococcal 12 progressive 036.1 Encephalitis, meningococcal 12 046.8 Infection, viral, slow, central 379 036.2 Meningococcemia 300 nervous system, other specified 036.3 Syndrome, Waterhouse- 263, 271, 046.9 Infection, viral, slow, central 379 Friderichsen, meningococcal 300 nervous system, unspecified *036.4 Carditis, meningococcal 60, 263, *047 Meningitis, due to enterovirus 13 271 047.9 Meningitis,viral, unspecified 380 036.40 Carditis, meningococcal, 85 048 Disease, enterovirus, other, central 13 unspecified nervous system 036.41 Pericarditis, meningococcal 85 049.0 Choriomeningitis, lymphocytic 13 036.42 Endocarditis, meningococcal 79 049.1 Meningitis, due to adenovirus 13 036.43 Myocarditis, meningococcal 85

Alphabetic Index to Procedures

Code Narriative Page Code Narriative Page 68.23 Ablation, endometrial 190, 191, 04.72 Anastomosis, face, accessory 33 194 04.71 Anastomosis, face, hypoglossal 33 83.11 Achillotenotomy 121 *51.3 Anastomosis, gallbladder or bile 95, 107, 28.6 Adenoidectomy, without 32 duct 292, 324 tonsillectomy *45.9 Anastomosis, intestinal 89, 323 *08.5 Adjstment, other, lid position 3, 20, 146, 45.90 Anastomosis, intestinal, 161, 292 318, 383 unspeciﬁed 07.3 Adrenalectomy, bilateral 147, 160 45.95 Anastomosis, intestine, large-to- 292 *07.2 Adrenalectomy, partial 160 anus 07.22 Adrenalectomy, unilateral 147 45.94 Anastomosis, intestine, large-to- 163, 292 86.72 Advancement, pedicle graft 5, 35, 66, large 96, 117, 45.93 Anastomosis, intestine, small-to- 66, 163, 160, 315 large, other 292 83.71 Advancement, tendon, except 149 45.92 Anastomosis, intestine, small-to- 292 hand rectal stump 24.5 Alveoloplasty 35, 320, 45.91 Anastomosis, intestine, small-to- 161, 292 385 small

84.19 Amputation, abdominopelvic 58, 116, 55.86 Anastomosis, kidney 325 Alphabetic Index to Procedures 332 *56.7 Anastomosis or bypass, other, 170, 325 84.17 Amputation above knee 5, 58, 116, ureter 160, 332 04.74 Anastomosis, other, cranial or 33 84.01 Amputation and disarticulation, 123, 317, peripheral nerve finger 389 52.96 Anastomosis, pancreas 107, 324 84.02 Amputation and disarticulation, 123, 317 58.44 Anastomosis, urethra 325 thumb 39.1 Anastomosis, venous, 57, 91, 107 84.14 Amputation, ankle, through 5, 58, 116, intraabdominal malleoli tibia and fibula 160, 332 88.53 Angiocardiogram, left heart 55, 56, 73, 67.4 Amputation, cervix 194 79 84.09 Amputation, interthoracoscapular 116, 332 88.54 Angiocardiogram, right and left 55, 56, 73, *84.1 Amputation, lower limb 149 heart 79 84.10 Amputation, lower limb, 58, 116, 88.52 Angiocardiogram, right heart 55, 56, 73, unspecified 160, 332 79 84.15 Amputation, other, below knee 5, 58, 116, 36.03 Angioplasty, coronary, chest, open 56 160, 332 39.50 Angioplasty or atherectomy, 7, 45, 67, 64.3 Amputation, penis 182 vessel, noncoronary 95, 109, 84.12 Amputation, through foot 5, 58, 116, 124, 148, 160, 332 162, 172, 322 84.05 Amputation, through forearm 116, 332 35.33 Annuloplasty 55 84.03 Amputation, through hand 116, 332 49.21 Anoscopy 295 84.07 Amputation, through humerus 116, 332 88.55 Anteriogram, coronary, one 55, 56, 73, 84.11 Amputation, toe 5, 58, 121, catheter 79 160, 332 88.57 Anteriogram, coronary, other 55, 56, 73, 84.91 Amputation, unspecified 58, 116, 79 149, 332 88.56 Anteriogram, coronary, two 55, 56, 73, *84.0 Amputation, upper limb 58, 149 catheters 79 84.00 Amputation, upper limb, 116, 332 *22.3 Antrotomy, external maxillary 31 unspecified *47.0 Appendectomy 94 04.73 Anastomosis, accessory, 33 hypoglossal *47.1 Appendectomy, incidental 196, 323 *42.6 Anastomosis, antesternal, 34, 91, 47.09 Appendectomy, other 66 esophagus 291, 322 47.91 Appendicostomy 90 57.88 Anastomosis, bladder, other 171, 183, 78.14 Application, external fixation 122, 315 293 device, carpals and metacarpals 39.21 Anastomosis, cavalpulmonary 57 78.15 Application, external fixation 115, 327, artery device, femur 357 *42.5 Anastomosis, esophagus, 34, 91, 78.12 Application, external fixation 117, 327 intrathoracic 291, 322 device, humerus

DRG Expert

Code Narriative Page Code Narriative Page 78.19 Application, external fixation 125, 327 80.04 Arthrotomy, for removal of 131, 316 device, other prosthesis, hand and finger 78.16 Application, external fixation 129, 327 80.05 Arthrotomy, for removal of 115, 330, device, patella prosthesis, hip 357 78.13 Application, external fixation 119, 327 80.06 Arthrotomy, for removal of 131, 330 device, radius and ulna prosthesis, knee 78.11 Application, external fixation 46, 125, 80.09 Arthrotomy, for removal of 131, 330 device, scapula, clavicle and 327 prosthesis, other thorax 80.01 Arthrotomy, for removal of 130, 330 78.18 Application, external fixation 120, 327 prosthesis, shoulder device, tarsals and metatarsals 80.00 Arthrotomy, for removal of 130, 330 78.17 Application, external fixation 117, 327 prosthesis, unspecified site device, tibia and fibula 80.03 Arthrotomy, for removal of 131, 316 78.10 Application, external fixation 125, 327 prosthesis, wrist device, unspecified site 80.17 Arthrotomy, other, ankle 118, 330 39.27 Arteriovenostomy, for renal dialysis 65, 95, 80.12 Arthrotomy, other, elbow 119, 163, 162, 172, 330 322 80.18 Arthrotomy, other, foot and toe 120, 330, 81.25 Arthrodesis, carporadial 122, 316 388 81.24 Arthrodesis, elbow 119, 331 80.14 Arthrotomy, other, hand and finger 123, 316 *81.1 Arthrodesis, foot and ankle 331 80.15 Arthrotomy, other, hip 115, 330, 81.21 Arthrodesis, hip 116, 331, 357 357 80.16 Arthrotomy, other, knee 129, 163, 81.28 Arthrodesis, interphalangeal 122, 316 330, 388 81.22 Arthrodesis, knee 129, 331 80.19 Arthrotomy, other, other specified 126, 330 81.26 Arthrodesis, metacarpocarpal 122, 316 sites 81.27 Arthrodesis, metacarpophalangeal 122, 316 80.11 Arthrotomy, other, shoulder 119, 330 81.29 Arthrodesis, other specified joints 126, 331 80.10 Arthrotomy, other, unspecified site 126, 163, 330 81.23 Arthrodesis, shoulder 119, 164, 331 80.13 Arthrotomy, other, wrist 123, 316 81.12 Arthrodesis, triple 118 69.52 Aspiration curettage, following 219, 220, delivery or abortion 387 81.20 Arthrodesis, unspecified joints 126, 331 69.51 Aspiration curettage, uterus, for 220, 387 *81.7 Arthroplasty, hand, fingers, and 123 termination of pregnancy wrist 12.21 Aspiration, diagnostic, eye, 21 81.85 Arthroplasty, other, elbow 119, 331 anterior chamber, 81.83 Arthroplasty, other, shoulder 119, 331, 16.22 Aspiration, diagnostic, orbit 19, 384 388 36.05 Atherectomy, coronary, PTCA, 55, 69, 70, 81.82 Arthroplasty, shoulder, recurrent 119, 331 Alphabetic Index to Procedures multiple-vessel, with or without 71 dislocation thrombolytic agent 76.5 Arthroplasty, temporomandibular 34, 125, 36.02 Atherectomy, coronary, PTCA, 55, 69, 70, 327 single-vessel, with thrombolytic 71 81.74 Arthroplasty, with implant, 4, 316 agent carpocarpal or carpometacarpal 36.01 Atherectomy, coronary, PTCA, 55, 69, 70, joint, with implant single-vessel, without mention of 71 81.71 Arthroplasty, with implant, 4, 316 thrombolytic agent metacarpophalangeal and 86.73 Attachment, pedicle or flap graft to 123, 317 interphalangeal joint, with implant hand 81.75 Arthroplasty, without implant, 4, 316 27.57 Attachment, pedicle or flap graft, to 36, 147, carpocarpal or carpometacarpal lip and mouth 320, 385 joint, without implant 86.74 Attachment, pedicle or flap graft, to 5, 35, 66, 81.72 Arthroplasty, without implant, 4, 316 other sites 96, 117, metacarpophalangeal and 160, 315 interphalangeal joint, without implant 55.61 Autotransplantation, kidney 169, 325 *80.2 Arthroscopy 123, 330 54.22 Biopsy, abdominal wall or 95, 148, umbilicus 292, 324, 80.26 Arthroscopy, knee 163, 388 386 80.07 Arthrotomy, for removal of 131, 330 07.12 Biopsy, adrenal gland, open 160 prosthesis, ankle 38.21 Biopsy, blood vessel 4, 20, 34, 80.02 Arthrotomy, for removal of 131, 330 45, 67, prosthesis, elbow 124, 162, 80.08 Arthrotomy, for removal of 131, 330 172, 386 prosthesis, foot and toe *77.4 Biopsy, bone 117

Numeric Index to Procedures

Code Narriative Page Code Narriative Page 00.15 Injection or infusion, high-dose 297 02.01 Craniectomy, linear 356 infusion interleukin-2 (IL-2) 02.02 Elevation, fragments, fracture, 356 00.50 Implantation, cardiac 59, 64 skull resynchronization pacemaker, 02.03 Formation, flap, cranial 356 without mention of defibrillation, total system [CRT-P] 02.04 Graft, bone, skull 356 00.51 Implantation, cardiac 68, 73 02.05 Insertion, plate, skull 356 resynchronization defibrillator, total 02.06 Osteoplasty, other, cranial 356 system [CRT-D] *02.1 Repair, cerebral meninges 2 00.52 Implantation or replacement, 59, 60, 68, 02.11 Suture, simple, dura mater, brain 317, 356 transvenous lead (electrode) into 73 02.12 Repair, other, cerebral meninges 317, 356 left ventricular coronary venous system 02.13 Ligation, meningeal vessel 6, 317, 356 00.53 Implantation or replacement, 59, 64 02.14 Plexectomy, choroid 356 cardiac resynchronization 02.2 Ventriculostomy 2, 290, pacemaker, pulse generator only 317, 356 [CRT-P] *02.3 Shunt, ventricular, extracranial 6, 290, 317 00.54 Implantation or replacement, 60, 68, 73 02.42 Replacement, ventricular shunt 6, 290, 317 cardiac resynchronization 02.43 Removal, ventricular shunt 6, 317 defibrillator, pulse generator only Numeric Index to Procedures [CRT-D] 02.91 Lysis, adhesions, cortical 2, 290, 317 01.12 Biopsy, open, cerebral meninges 2, 290 02.92 Repair, brain 2, 317, 356 01.14 Biopsy, open, brain 2, 290 02.93 Implantation, intracranial 2, 290, 317 neurostimulator 01.15 Biopsy, skull 2, 116, 161 02.94 Insertion or replacement, skull 2, 124, 01.18 Procedure, diagnostic, other, brain 2, 290, 317 tongs or halo traction device 317, 356 and cerebral meninges 02.99 Operation, other, skull, brain and 2, 124, 01.19 Procedure, diagnostic, other, skull 2, 116, 317 cerebral meninges 290, 317, *01.2 Craniotomy and craniectomy 2 356 01.21 Incision and drainage, cranial 356 *03.0 Exploration and decompression, 6, 317 sinus spinal canal structures 01.22 Removal, intracranial 290 03.02 Reopening, laminectomy site 128, 290 neurostimulator 03.09 Exploration and decompression, 128, 290 01.23 Reopening, craniotomy site 290, 317, other, spinal canal 356 03.1 Division, intraspinal nerve root 6, 128, 01.24 Craniotomy, other 290, 317, 290, 317 356 *03.2 Chordotomy 6, 109, 01.25 Craniectomy, other 124, 290, 290, 317 317, 356 03.32 Biopsy, spinal cord or spinal 6, 128, 290 *01.3 Incision, brain and cerebral 2, 317 meninges meninges 03.39 Procedure, diagnostic, other, 6, 128, 290 01.31 Incision, cerebral meninges 290, 356 spinal cord and spinal canal 01.32 Lobotomy and tractotomy 290, 356 structures 01.39 Incision, other, brain 290, 356 03.4 Excision or destruction, lesion, 6, 128, 290 *01.4 Operation, thalamus and globus 2, 290 spinal cord or spinal meninges pallidus *03.5 Repair, spinal cord structures 6 01.41 Operation, thalamus 317, 356 03.53 Repair, vertebral fracture 128, 290, 01.42 Operation, globus pallidus 356 317 *01.5 Excision or destruction, other, 2, 290 03.59 Repair and plastic operation, other, 128, 290, brain and meninges spinal cord structures 317 01.51 Excision or destruction, other, 356 03.6 Lysis, adhesions, spinal cord and 6, 128, lesion or tissue, cerebral meninges nerve roots 290, 317 01.52 Hemispherectomy 317, 356 *03.7 Shunt, spinal theca 6, 290 01.53 Lobectomy, brain 317, 356 03.93 Insertion or replacement, spinal 7, 128, neurostimulator 172, 182, 01.59 Excision or destruction, other, 317, 356 196, 290, lesion or tissue, brain 317 01.6 Excision, lesion, skull 2, 130, 03.94 Removal, spinal neurostimulator 7, 128, 290, 356 172, 182, *02.0 Cranioplasty 2, 124, 317 196, 317

DRG Expert

Code Narriative Page Code Narriative Page 03.97 Revision, spinal thecal shunt 7, 128, 05.0 Division, sympathetic nerve or 3, 65 290, 317 ganglion 03.98 Removal, spinal thecal shunt 7, 128, 317 *05.1 Procedure, diagnostic, 3 03.99 Operation, other, spinal cord and 7, 128, sympathetic nerves or ganglia spinal canal structures 290, 317 *05.2 Sympathectomy 3, 65 *04.0 Incision, division and excision, 33 05.21 Ganglionectomy, sphenopalatine 33 cranial and peripheral nerves 05.22 Sympathectomy, cervical 33 04.01 Neurotomy, acoustic 2 05.23 Sympathectomy, lumbar 382 04.02 Division, trigeminal nerve 3, 317 05.24 Sympathectomy, presacral 196 04.03 Division or crushing, other, cranial 3, 124, 317 *05.8 Operation, other, sympathetic 3 and peripheral nerves nerves or ganglia 04.04 Incision, other, cranial and 3, 124, 317 05.89 Operation, other, sympathetic 65 peripheral nerves nerves or ganglia 04.05 Ganglionectomy, gasserian 3, 317 05.9 Operation, other, nervous system 3, 318 04.06 Ganglionectomy, other, cranial or 3, 124, 317 06.02 Reopening, wound, thyroid field 161, 318, peripheral 382 04.07 Excision or avulsion, other, cranial 3, 124, 06.09 Incision, other, thyroid field 31, 147, and peripheral nerve 317, 382 161, 318 04.12 Biopsy, open, cranial or peripheral 3, 33, 124, 06.12 Biopsy, thyroid gland, open 161 nerve or ganglion 318 06.13 Biopsy, parathyroid gland 124, 161 04.19 Procedure, diagnostic, other, 3, 33, 124, 06.19 Procedure, diagnostic, other, 124, 161 cranial and peripheral nerves and 318 thyroid and parathyroid gland ganglia 06.2 Lobectomy, unilateral, thyroid 161 04.3 Suture, cranial and peripheral 3, 318 nerves *06.3 Thyroidectomy, other, partial 161 *04.4 Lysis, adhesions and 382 06.4 Thyroidectomy, complete 161 decompression, cranial and *06.5 Thyroidectomy, substernal 161 peripheral nerves 06.6 Excision, lingual thyroid 33, 161 04.41 Decompression, trigeminal nerve 2, 33, 318, 06.7 Excision, thyroglossal duct or tract 33, 161 root 356 *06.8 Parathyroidectomy 161, 172 04.42 Decompression, other, cranial 3, 33, 318 06.91 Division, thyroid isthmus 161 nerve 06.92 Ligation, thyroid vessels 161, 318 04.43 Release, carpal tunnel 3, 122, 315 06.93 Suture, thyroid gland 161, 318 04.44 Release, tarsal tunnel 3, 120, 318 06.94 Reimplantation, thyroid tissue 161 04.49 Lysis, adhesions and 3, 33, 124, decompression, other, peripheral 318 06.95 Reimplantation, parathyroid tissue 161 nerve or ganglion 06.98 Operation, other, thyroid glands 161 04.5 Graft, nerve, cranial or peripheral 3, 318 06.99 Operation, other, parathyroid 161 Numeric Index to Procedures 04.6 Transposition, cranial and 3, 318 glands peripheral nerves *07.0 Exploration, adrenal gland 160 *04.7 Neuroplasty, other, cranial or 3, 318 07.12 Biopsy, adrenal gland, open 160 peripheral 07.13 Biopsy, pituitary gland, transfrontal 2, 160 04.71 Anastomosis, face, hypoglossal 33 approach 04.72 Anastomosis, face, accessory 33 07.14 Biopsy, pituitary gland, 2, 160 04.73 Anastomosis, accessory, 33 transphenoidal approach hypoglossal 07.15 Biopsy, pituitary gland, unspecified 2, 160 04.74 Anastomosis, other, cranial or 33 approach peripheral nerve 07.16 Biopsy, thymus 44, 162, 04.75 Revision, previous repair, cranial 33 284, 290 and peripheral nerves 07.17 Biopsy, pineal gland 2, 160 04.76 Repair, old traumatic injury, cranial 33 07.19 Procedure, diagnostic, other, 3, 160 and peripheral nerves adrenal gland, pineal gland and *04.9 Operation, other, cranial and 3, 318 thymus peripheral nerves *07.2 Adrenalectomy, partial 160 04.92 Implantation or replacement, 33, 124, 07.22 Adrenalectomy, unilateral 147 peripheral neurostimulator 172, 182, 07.3 Adrenalectomy, bilateral 147, 160 196 *07.4 Operation, other, adrenal glands, 160 04.93 Removal, peripheral 33, 124, nerves and vessels neurostimulator 182, 196 07.43 Ligation, adrenal vessel 318 04.99 Operation, other, cranial and 33, 124 07.44 Repair, adrenal gland 318 peripheral nerves 07.45 Reimplantation, adrenal tissue 318

Appendix A — Invalid DRG Conversion Table

According to section 1886(d) (4) (C) of the Social Security Act, the Secretary of Health and Human Services is required to periodically adjust DRG classiﬁcations to account for changes in resource consumption, treatment patterns, technology and other factors that may change the relative use of hospital resources. These adjustments may require reclassiﬁcation and resultant invalidation of some DRGs.

The following table lists the DRGs that have become invalid and provides information concerning the new DRG assignment for the procedures and diagnoses due to the reclassification. The first section of the table is sorted by procedure ICD-9-CM codes. The information sorted by diagnosis codes follows that first procedure section.

INVL NEW Effec- Code DRG DRG Title DRG DRG Title tive 00.51 & 514†† Card Defib Impl W Card Cath 535 Cardiac Defibrillator Implant W 2003 37.94 Cardiac Catheterization W Acute 00.52 & MI, Heart Failure or Shock 00.54 536 Cardiac Defibrillator Implant W Cardiac Catheterization W/O Acute Appendix A — Invalid DRG Conversion Table MI, Heart Failure or Shock 01.12 400 Lymphoma & Leukemia W Major 539 Lymphoma & Leukemia W Major 2003 01.14 O.R. Procedures O.R. Procedures W CC 01.18 540 Lymphoma & Leukemia W Major 01.22- O.R. Procedures W/O CC 01.25 01.31 01.32 01.39 *01.4 *01.5 01.6 231 Local Excision & Removal of Int Fix 537 Local Excision & Removal of Int Fix 2003 Devices, Except Hip & Femur Devices, Except Hip & Femur W CC 538 Local Excision & Removal of Int Fix Devices, Except Hip & Femur W/O CC 01.6 400 Lymphoma & Leukemia W Major 539 Lymphoma & Leukemia W Major 2003 O.R. Procedures O.R. Procedures W CC 540 Lymphoma & Leukemia W Major O.R. Procedures W/O CC 02.2 400 Lymphoma & Leukemia W Major 539 Lymphoma & Leukemia W Major 2003 *02.3 O.R. Procedures O.R. Procedures W CC 02.42 540 Lymphoma & Leukemia W Major 02.91 O.R. Procedures W/O CC 02.93 02.99 *03.0 004 Spinal Procedures 531 Spinal Procedures W CC 2003 532 Spinal Procedures W/O CC 03.02 214 Back/Neck Procs W CC 499 Back/Neck Procs Exc Spin Fus W 1997 215 Back/Neck Procs W/O CC CC 500 Back/Neck Procs Exc Spin Fus W/O CC 03.02 400 Lymphoma & Leukemia W Major 539 Lymphoma & Leukemia W Major 2003 03.09 O.R. Procedures O.R. Procedures W CC 540 Lymphoma & Leukemia W Major O.R. Procedures W/O CC 03.1 004 Spinal Procedures 531 Spinal Procedures W CC 2003 532 Spinal Procedures W/O CC

† DRG 109 was reactivated in October 1998 as Coronary Bypass without Cardiac Catheterization †† DRG 514 became invalid effective 2003 ††† DRG assignment October 1, 1984, through September 30, 2001, only

DRG Expert

INVL NEW Effec- Code DRG DRG Title DRG DRG Title tive 03.1 214 Back/Neck Procs W CC 499 Back/Neck Procs Exc Spin Fus W 1997 215 Back/Neck Procs W/O CC CC 500 Back/Neck Procs Exc Spin Fus W/O CC 03.1 400 Lymphoma & Leukemia W Major 539 Lymphoma & Leukemia W Major 2003 O.R. Procedures O.R. Procedures W CC 540 Lymphoma & Leukemia W Major O.R. Procedures W/O CC *03.2 004 Spinal Procedures 531 Spinal Procedures W CC 2003 532 Spinal Procedures W/O CC *03.2 400 Lymphoma & Leukemia W Major 539 Lymphoma & Leukemia W Major 2003 O.R. Procedures O.R. Procedures W CC 540 Lymphoma & Leukemia W Major O.R. Procedures W/O CC 03.32 004 Spinal Procedures 531 Spinal Procedures W CC 2003 532 Spinal Procedures W/O CC 03.32 214 Back/Neck Procs W CC 499 Back/Neck Procs Exc Spin Fus W 1997 215 Back/Neck Procs W/O CC CC 500 Back/Neck Procs Exc Spin Fus W/O CC 03.32 400 Lymphoma & Leukemia W Major 539 Lymphoma & Leukemia W Major 2003 O.R. Procedures O.R. Procedures W CC 540 Lymphoma & Leukemia W Major O.R. Procedures W/O CC 03.39 004 Spinal Procedures 531 Spinal Procedures W CC 2003 532 Spinal Procedures W/O CC 03.39 214 Back/Neck Procs W CC 499 Back/Neck Procs Exc Spin Fus W 1997 215 Back/Neck Procs W/O CC CC 500 Back/Neck Procs Exc Spin Fus W/O CC 03.39 400 Lymphoma & Leukemia W Major 539 Lymphoma & Leukemia W Major 2003 O.R. Procedures O.R. Procedures W CC 540 Lymphoma & Leukemia W Major O.R. Procedures W/O CC 03.4 004 Spinal Procedures 531 Spinal Procedures W CC 2003 532 Spinal Procedures W/O CC 03.4 214 Back/Neck Procs W CC 499 Back/Neck Procs Exc Spin Fus W 1997 215 Back/Neck Procs W/O CC CC 500 Back/Neck Procs Exc Spin Fus W/O CC 03.4 400 Lymphoma & Leukemia W Major 539 Lymphoma & Leukemia W Major 2003 O.R. Procedures O.R. Procedures W CC

Appendix A — Invalid DRG Conversion Table 540 Lymphoma & Leukemia W Major O.R. Procedures W/O CC *03.5 004 Spinal Procedures 531 Spinal Procedures W CC 2003 532 Spinal Procedures W/O CC 03.53 214 Back/Neck Procs W CC 499 Back/Neck Procs Exc Spin Fus W 1997 215 Back/Neck Procs W/O CC CC 500 Back/Neck Procs Exc Spin Fus W/O CC 03.53 400 Lymphoma & Leukemia W Major 539 Lymphoma & Leukemia W Major 2003 O.R. Procedures O.R. Procedures W CC 540 Lymphoma & Leukemia W Major O.R. Procedures W/O CC 03.59 214 Back/Neck Procs W CC 499 Back/Neck Procs Exc Spin Fus W 1997 215 Back/Neck Procs W/O CC CC 500 Back/Neck Procs Exc Spin Fus W/O CC

Appendix B — DRG Surgical Hierarchy Table

The surgical hierarchy reﬂects the relative resources requirement of the various surgical procedures of each major diagnostic category (MDC). The hierarchy is based upon variables such as principal diagnosis, surgical class, age, complications and comorbidities.

Arranging the surgical DRGs in this manner allows for the assignment of patients with multiple procedures related to the principal diagnosis to a surgical DRG that best reﬂects the resources used in the care of that patient. Since patients can be assigned to only one surgical class for each inpatient stay, patients with multiple procedures related to the principal diagnosis are assigned to the highest surgical DRG in the MDC assigned according to principal diagnosis. (Federal Register, August 1, 2003).

Pre MDC

Heart transplant 103 Tracheostomy/mechanical ventilation 96+ hours exc for face, mouth & neck diagnoses 483 Appendix B — DRG Surgical Hierarchy Table Liver transplant 480 Lung transplant 495 Simultaneous pancreas/kidney transplant 512 Pancreas transplant 513 Bone marrow transplant 481 Tracheostomy for face, mouth & neck diagnoses 482 MDC 1 DISEASES & DISORDERS OF THE NERVOUS SYSTEM

Craniotomy age 0-17 003 Intracranial vascular procedures w PDx hemorrhage 528 Craniotomy age >17 w CC 001 Craniotomy age >17 w/o CC 002 Ventricular shunt procedure w CC 529 Ventricular shunt procedure w/o CC 530 Spinal procedure w CC 531 Spinal procedure w/o CC 532 Extacranial Procedures w CC 533 Extacranial Procedures w/o CC 534 Carpal tunnel release 006 Peripheral & cranial nerve and other O.R. nervous system proc w CC 007 Peripheral & cranial nerve and other O.R. nervous system proc w/o CC 008 MDC 2 DISEASES & DISORDERS OF THE EYE

Orbital proc 037 Extraocular proc exc orbit age >17 040 Extraocular proc exc orbit age 0-17 041 Retinal proc 036 Intraocular proc exc retina, iris & lens 042 Lens proc 039 Primary iris proc 038

DRG Expert

MDC 3 DISEASES & DISORDERS OF THE EAR, NOSE, MOUTH & THROAT

Major head & neck proc 049 Myringotomy w tube insertion age >17 061 Myringotomy w tube insertion age 0-17 062 Sinus & mastoid proc age >17 053 Sinus & mastoid proc age 0-17 054 Tonsil & adenoid proc exc tonsillectomy &/or adenoidectomy age >17 057 Tonsil & adenoid proc exc tonsillectomy &/or adenoidectomy age 0-17 058 Cleft lip & palate repair 052 Mouth proc w CC 168 Mouth proc w/o CC 169 Rhinoplasty 056 Sialoadenectomy 050 Salivary gland proc exc sialoadenectomy 051 Miscellaneous ear, nose, mouth & throat proc 055 Tonsillectomy &/or adenoidectomy only age >17 059 Tonsillectomy &/or adenoidectomy only age 0-17 060 Other ear, nose, mouth & throat O.R. proc 063 MDC 4 DISEASES & DISORDERS OF THE RESPIRATORY SYSTEM

Major chest proc 075 Other respiratory system O.R. proc w CC 076 Other respiratory system O.R. proc w/o CC 077 MDC 5 DISEASES & DISORDERS OF THE CIRCULATORY SYSTEM

Heart assist system implant 525 Cardiac valve proc w cardiac cath 104 Cardiac valve proc w/o cardiac cath 105 Cardiac defibrillator implnt w cardiac cath w AMI, heart failure, or shock 535 Cardiac defibrillator implnt w cardiac cath w/o AMI, heart failure, or shock 536 Cardiac defibrillator implnt w/o cardiac cath 515 Other cardiothoracic proc 108 Coronary bypass w ptca 106 Coronary bypass w cardiac cath 107 Coronary bypass w/o cardiaac cath 109 Cardiovascular proc w CC 110

Appendix B — DRG Surgical Hierarchy Table Cardiovascular proc w/o CC 111 Amputation exc upper limb & toe 113 Permanent cardiac pacemaker implantation w AMI, hrt fail or shock 115 Other permanent cardiac pacemaker implantation w coronary art stent implnt 116 Percutaneous cardiovascular proc w AMI 516 Percutaneous cardiovascular proc w/o AMI w coronary art stent implnt 517 Percutaneous cardiovascular proc w/o AMI w/o coronary art stent implnt 518 Percutaneous cardiovascular proc w drug-eluting stent w AMI 526 Percutaneous cardiovascular proc w drug-eluting stent w/o AMI 527 Other vascular proc w CC 478 Other vascular proc w/o CC 479 Amputation upper limb & toe for circ system disord 114 Cardiac pacemaker replacement &/or revision exc device replacement 117 Cardiac pacemaker device replacement 118 Vein ligation & stripping 119 Other circulatory system O.R. proc 120

Appendix C — LTC-DRG Crosswalk

The Centers for Medicare and Medicaid Services (CMS) modiﬁed the DRGs for the LTCH prospective payment system by developing LTCH-speciﬁc relative weights to account for the fact that LTCHs generally treat patients with multiple medical problems. Therefore, CMS developed a crosswalk of IPPS DRG to LTC DRG data including relative weight (RW), geometric mean length of stay (GMLOS), and 5/6 GMLOS for short stay outlier payment adjustment.

Since LTCHs generally do not treat the full range of diagnoses that make up the inpatient DRG system, the low volume DRGs were grouped into quintiles for setting the relative weights and length of stay data. The following footnotes provide the information concerning the grouping of the individual DRGs.

1 Relative weights for these LTC-DRGs were determined by assigning the cases to low volume quintile 1. 2 Relative weights for these LTC-DRGs were determined by assigning the cases to low volume quintile 2. 3 Relative weights for these LTC-DRGs were determined by assigning the cases to low volume quintile 3. 4 Relative weights for these LTC-DRGs were determined by assigning the cases to low volume quintile 4. 5 Relative weights for these LTC-DRGs were determined by assigning the cases to low volume quintile 5. 6 Relative weights for these LTC-DRGs were assigned a value of 0.0.

7 Relative weights for these LTC-DRGs were determined after adjusting to account for nonmonotonically. Appendix C — LTC-DRG Crosswalk 8 Relative weights for these LTC-DRGs were determined by assigning these cases to the appropriate low volume quintile because they had no LTCH cases in the FY 2002 MedPAR

LTC- 5/6 DRG Description RW GMLOS GMLOS

001 CRANIOTOMY AGE >17 W CC 5 2.0841 40.0 33.3 002 CRANIOTOMY AGE > 17 W/O CC 8 2.0841 40.0 33.3 003 CRANIOTOMY AGE 0-17 8 2.0841 40.0 33.3 006 CARPAL TUNNEL RELEASE 8 0.4964 18.5 15.4 007 PERIPH & CRANIAL NERVE & OTHER NERV SYST 1.5754 41.0 34.1 PROC W CC 7 008 PERIPH & CRANIAL NERVE & OTHER NERV SYST 1.5754 41.0 34.1 PROC W/O CC 7 009 SPINAL DISORDERS & INJURIES 1.5025 32.9 27.4 010 NERVOUS SYSTEM NEOPLASMS W CC 0.7549 23.4 19.5 011 NERVOUS SYSTEM NEOPLASMS W/O CC 0.7281 22.0 18.3 012 DEGENERATIVE NERVOUS SYSTEM DISORDERS 0.7485 25.8 21.5 013 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA 0.7530 25.9 21.5 014 INTRACRANIAL HEMORRHAGE & STROKE W INFARCT 0.9196 27.4 22.8 015 NONSPECIFIC CVA & PRECEREBRAL OCCULUSION 0.8714 28.8 24.0 W/O INFARCT 016 NONSPECIFIC CEREBROVASCULAR DISORDERS W CC 0.9125 23.9 19.9 017 NONSPECIFIC CEREBROVASCULAR DISORDERS 0.5262 20.4 17.0 W/O CC 018 CRANIAL & PERIPHERAL NERVE DISORDERS W CC 0.8225 23.9 19.9 019 CRANIAL & PERIPHERAL NERVE DISORDERS W/O CC 0.6236 22.7 18.9 020 NERVOUS SYSTEM INFECTION EXCEPT VIRAL 1.0097 24.8 20.6 MENINGITIS 021 VIRAL MENINGITIS 2 0.7372 23.5 19.5 022 HYPERTENSIVE ENCEPHALOPATHY 2 0.7372 23.5 19.5 023 NONTRAUMATIC STUPOR & COMA 0.9033 28.8 24.0 024 SEIZURE & HEADACHE AGE >17 W CC 0.8527 26.2 21.8

DRG Expert

LTC- 5/6 DRG Description RW GMLOS GMLOS

025 SEIZURE & HEADACHE AGE >17 W/O CC 0.7727 24.1 20.0 026 SEIZURE & HEADACHE AGE 0-17 8 0.7372 23.5 19.5 027 TRAUMATIC STUPOR & COMA, COMA >1 HR 1.1929 30.4 25.3 028 TRAUMATIC STUPOR & COMA, COMA <1 HR AGE >17 1.0211 29.0 24.1 W CC 029 TRAUMATIC STUPOR & COMA, COMA <1 HR AGE >17 0.9056 26.6 22.1 W/O CC 030 TRAUMATIC STUPOR & COMA, COMA <1 HR AGE 0-17 8 0.9562 26.1 21.7 031 CONCUSSION AGE >17 W CC 7 0.9562 26.1 21.7 032 CONCUSSION AGE >17 W/O CC 7 0.9562 26.1 21.7 033 CONCUSSION AGE 0-17 8 0.7372 23.5 19.5 034 OTHER DISORDERS OF NERVOUS SYSTEM W CC 0.9140 27.8 23.1 035 OTHER DISORDERS OF NERVOUS SYSTEM W/O CC 0.6651 24.5 20.4 036 RETINAL PROCEDURES 8 0.4964 18.5 15.4 037 ORBITAL PROCEDURES 8 0.4964 18.5 15.4 038 PRIMARY IRIS PROCEDURES 8 0.4964 18.5 15.4 039 LENS PROCEDURES WITH OR WITHOUT 0.4964 18.5 15.4 VITRECTOMY 8 040 EXTRAOCULAR PROCEDURES EXCEPT ORBIT 2.0841 40.0 33.3 AGE >17 5 041 EXTRAOCULAR PROCEDURES EXCEPT ORBIT 0.4964 18.5 15.4 AGE 0-17 8 042 INTRAOCULAR PROCEDURES EXCEPT RETINA, 0.4964 18.5 15.4 IRIS & LENS 8 043 HYPHEMA 8 0.4964 18.5 15.4 044 ACUTE MAJOR EYE INFECTIONS 1 0.4964 18.5 15.4 045 NEUROLOGICAL EYE DISORDERS 8 0.4964 18.5 15.4 046 OTHER DISORDERS OF THE EYE AGE >17 W CC 1 0.4964 18.5 15.4 047 OTHER DISORDERS OF THE EYE AGE >17 W/O CC 1 0.4964 18.5 15.4 048 OTHER DISORDERS OF THE EYE AGE 0-17 8 0.4964 18.5 15.4 Appendix C — LTC-DRG Crosswalk Appendix C — LTC-DRG 049 MAJOR HEAD & NECK PROCEDURES 8 1.3569 32.5 27.0 050 SIALOADENECTOMY 8 0.9562 26.1 21.7 051 SALIVARY GLAND PROCEDURES EXCEPT 0.9562 26.1 21.7 SIALOADENECTOMY 8 052 CLEFT LIP & PALATE REPAIR 8 0.9562 26.1 21.7 053 SINUS & MASTOID PROCEDURES AGE >17 2 0.7372 23.5 19.5 054 SINUS & MASTOID PROCEDURES AGE 0-17 8 0.9562 26.1 21.7 055 MISCELLANEOUS EAR, NOSE, MOUTH & THROAT 0.9562 26.1 21.7 PROCEDURES 8 056 RHINOPLASTY 8 0.7372 23.5 19.5 057 T&A PROC, EXCEPT TONSILLECTOMY &/OR 0.9562 26.1 21.7 ADENOIDECTOMY ONLY, AGE >17 8 058 T&A PROC, EXCEPT TONSILLECTOMY &/OR 0.9562 26.1 21.7 ADENOIDECTOMY ONLY, AGE 0-17 8 059 TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, 0.9562 26.1 21.7 AGE >17 8 060 TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, 0.9562 26.1 21.7 AGE 0-17 8

Appendix D — National Average Payment Table

The national average payment for each DRG is calculated by multiplying the current relative weight of the DRG by the ESTIMATED national average hospital Medicare base rate. That estimated average hospital base rate is adjusted annually using information gathered by Ingenix, Inc. and the information published in the Federal Register (“Medicare Program: Changes to the Inpatient Prospective Payment Systems and Fiscal Year 2004 Rates; Final Rule”). This information is provided as a benchmark reference only. There is no ofﬁcial publication of the average hospital base rate, therefore the national average payments provide in this table are approximate.

Nat’l Avg DRG Description MDC Payment 001 Craniotomy, Age Greater than 17 with CC...... 1 $15,885.65 002 Craniotomy, Age Greater than 17 without CC...... 1 $9,153.15 003 Craniotomy, Age 0-17 ...... 1 $8,671.57 004 No Longer Valid...... 1 $0.00 Appendix D — National Average Payment Table 005 No Longer Valid...... 1 $0.00 006 Carpal Tunnel Release ...... 1 $3,552.39 007 Peripheral and Cranial Nerve and Other Nervous System Procedures with CC ...... 1 $11,641.84 008 Peripheral and Cranial Nerve and Other Nervous System Procedures without CC ...... 1 $6,783.87 009 Spinal Disorders and Injuries ...... 1 $6,239.95 010 Nervous System Neoplasms with CC ...... 1 $5,464.67 011 Nervous System Neoplasms without CC ...... 1 $3,762.67 012 Degenerative Nervous System Disorders ...... 1 $4,064.70 013 Multiple Sclerosis and Cerebellar Ataxia ...... 1 $3,589.26 014 Intracranial Hemorrhage and Stroke with Infarction ...... 1 $5,567.40 015 Nonspecific Cerebrovascular and Precerebral Occlusion without Infarction ...... 1 $4,248.20 016 Nonspecific Cerebrovascular Disorders with CC ...... 1 $5,539.30 017 Nonspecific Cerebrovascular Disorders without CC ...... 1 $3,069.05 018 Cranial and Peripheral Nerve Disorders with CC...... 1 $4,401.41 019 Cranial and Peripheral Nerve Disorders without CC...... 1 $3,091.00 020 Nervous System Infection Except Viral Meningitis...... 1 $12,025.97 021 Viral Meningitis ...... 1 $6,645.58 022 Hypertensive Encephalopathy...... 1 $4,713.54 023 Nontraumatic Stupor and Coma ...... 1 $3,616.92 024 Seizure and Headache, Age Greater than 17 with CC ...... 1 $4,443.12 025 Seizure and Headache, Age Greater than 17 without CC ...... 1 $2,681.85 026 Seizure and Headache, Age 0-17...... 1 $6,027.47 027 Traumatic Stupor and Coma, Coma Greater than One Hour...... 1 $5,869.43 028 Traumatic Stupor and Coma, Coma Less than One Hour, Age Greater than 17 with CC...... 1 $5,876.45 029 Traumatic Stupor and Coma, Coma Less than One Hour, Age Greater than 17 without CC...... 1 $3,111.19 030 Traumatic Stupor and Coma, Coma Less than One Hour, Age 0-17...... 1 $1,466.70 031 Concussion, Age Greater than 17 with CC ...... 1 $4,002.36 032 Concussion, Age Greater than 17 without CC ...... 1 $2,495.28 033 Concussion, Age 0-17...... 1 $921.02 034 Other Disorders of Nervous System with CC ...... 1 $4,359.71 035 Other Disorders of Nervous System without CC ...... 1 $2,789.85 036 Retinal Procedures...... 2 $2,764.82 037 Orbital Procedures ...... 2 $4,642.43 038 Primary Iris Procedures...... 2 $2,049.69

DRG Expert

Nat’l Avg DRG Description MDC Payment 039 Lens Procedures with or without Vitrectomy...... 2 $2,759.12 040 Extraocular Procedures Except Orbit, Age Greater than 17 ...... 2 $3,923.34 041 Extraocular Procedures Except Orbit, Age 0-17 ...... 2 $1,493.04 042 Intraocular Procedures Except Retina, Iris and Lens...... 2 $3,101.10 043 Hyphema ...... 2 $2,362.70 044 Acute Major Eye Infections...... 2 $2,896.08 045 Neurological Eye Disorders...... 2 $3,182.75 046 Other Disorders of the Eye, Age Greater than 17 with CC...... 2 $3,483.90 047 Other Disorders of the Eye, Age Greater than 17 without CC...... 2 $2,334.16 048 Other Disorders of the Eye, Age 0-17 ...... 2 $1,315.24 049 Major Head and Neck Procedures...... 3 $7,584.60 050 Sialoadenectomy...... 3 $3,651.16 051 Salivary Gland Procedures Except Sialoadenectomy...... 3 $3,691.99 052 Cleft Lip and Palate Repair ...... 3 $3,519.90 053 Sinus and Mastoid Procedures, Age Greater than 17...... 3 $5,496.28 054 Sinus and Mastoid Procedures, Age 0-17...... 3 $2,131.78 055 Miscellaneous Ear, Nose, Mouth and Throat Procedures ...... 3 $4,059.43 056 Rhinoplasty...... 3 $4,053.29 057 Tonsillectomy and Adenoidectomy Procedures Except Tonsillectomy and/or Adenoidectomy Only, Age Greater than 17 ...... 3 $4,841.73 058 Tonsillectomy and Adenoidectomy Procedures Except Tonsillectomy and/or Adenoidectomy Only, Age 0-17 ...... 3 $1,210.32 059 Tonsillectomy and/or Adenoidectomy Only, Age Greater than 17 ...... 3 $4,195.52 060 Tonsillectomy and/or Adenoidectomy Only, Age 0-17 ...... 3 $921.46 061 Myringotomy with Tube Insertion, Age Greater than 17 ...... 3 $5,414.63 062 Myringotomy with Tube Insertion, Age 0-17...... 3 $1,305.15 063 Other Ear, Nose, Mouth and Throat O.R. Procedures ...... 3 $6,040.20 064 Ear, Nose, Mouth and Throat Malignancy ...... 3 $5,746.07 065 Dysequilibrium...... 3 $2,523.37 066 Epistaxis ...... 3 $2,551.03 067 Epiglottitis ...... 3 $3,415.42 068 Otitis Media and URI, Age Greater than 17 with CC...... 3 $2,867.11 069 Otitis Media and URI, Age Greater than 17 without CC...... 3 $2,189.29 070 Otitis Media and URI, Age 0-17 ...... 3 $1,399.53 071 Laryngotracheitis...... 3 $3,101.54 072 Nasal Trauma and Deformity...... 3 $3,052.81 Appendix D — National Average Payment Table Appendix D — National Average 073 Other Ear, Nose, Mouth and Throat Diagnoses, Age Greater than 17...... 3 $3,592.78 074 Other Ear, Nose, Mouth and Throat Diagnoses, Age 0-17...... 3 $1,483.82 075 Major Chest Procedures...... 4 $13,361.84 076 Other Respiratory System O.R. Procedures with CC ...... 4 $12,372.78 077 Other Respiratory System O.R. Procedures without CC ...... 4 $5,433.94 078 Pulmonary Embolism...... 4 $5,588.91 079 Respiratory Infections and Inflammations, Age Greater than 17 with CC...... 4 $7,012.59 080 Respiratory Infections and Inflammations, Age Greater than 17 without CC...... 4 $3,687.60 081 Respiratory Infections and Inflammations, Age 0-17 ...... 4 $6,716.70 082 Respiratory Neoplasms ...... 4 $6,024.84 083 Major Chest Trauma with CC...... 4 $4,223.18 084 Major Chest Trauma without CC...... 4 $2,357.87 085 Pleural Effusion with CC ...... 4 $5,235.95 086 Pleural Effusion without CC ...... 4 $3,013.30 087 Pulmonary Edema and Respiratory Failure...... 4 $5,895.77