DRG Expert. (ICD-10 Version) th Edition. The Complete Official Draft MS-DRG Using the ICD-10 Code Set

Transcription

1 DRG Expert (ICD-10 Version) The Complete Official Draft MS-DRG Using the ICD-10 Code Set MS-DRGs based on Version 30.0 Grouper Methodology th Edition

2 Contents Numeric MS-DRG Listing... iii MS-DRG Listing by Major Diagnostic Category... xiii Introduction... xxiii Pre MDC... 1 MDC 1 Diseases and Disorders of the Nervous System...7 MDC 2 Diseases and Disorders of the Eye MDC 3 Diseases and Disorders of the Ear, Nose, Mouth and Throat MDC 4 Diseases and Disorders of the Respiratory System MDC 5 Diseases and Disorders of the Circulatory System MDC 6 Diseases and Disorders of the Digestive System MDC 7 Diseases and Disorders of the Hepatobiliary System and Pancreas MDC 8 Diseases and Disorders of the Musculoskeletal System and Connective Tissue MDC 9 Diseases and Disorders of the Skin, Subcutaneous Tissue and Breast MDC 10 Endocrine, Nutritional and Metabolic Diseases and Disorders MDC 11 Diseases and Disorders of the Kidney and Urinary Tract MDC 12 Diseases and Disorders of the Male Reproductive System MDC 13 Diseases and Disorders of the Female Reproductive System MDC 14 Pregnancy, Childbirth and the Puerperium MDC 15 Newborns and Other Neonates with Conditions Originating in the Perinatal Period MDC 16 Diseases and Disorders of the Blood and Blood-Forming Organs and Immunological Disorders MDC 17 Myeloproliferative Diseases and Disorders and Poorly Differentiated Neoplasms MDC 18 Infectious and Parasitic Diseases MDC 19 Mental Diseases and Disorders MDC 20 Alcohol/Drug Use and Alcohol/Drug-Induced Organic Mental Disorders MDC 21 Injuries, Poisonings and Toxic Effects of Drugs MDC 22 Burns MDC 23 Factors Influencing Health Status and Other Contacts with Health Services MDC 24 Multiple Significant Trauma MDC 25 Human Immunodeficiency Virus Infections DRGs Associated with All MDCs Alphabetic Index to Diseases Numeric Index to Diseases Alphabetic Index to Procedures Numeric Index to Procedures Appendix A Lists of Principal Diagnoses That Are Their Own CC and Their Own MCC Appendix B Alphabetical and Numeric Lists of CCs and MCCs Alphabetic CC List Alphabetic MCC List Numeric CC List Numeric MCC List Appendix C MS-DRG Surgical Hierarchy Table Appendix D National Average Payment Table Appendix E Abbreviations Glossary OptumInsight, Inc. i

3 MDC 5 Diseases and Disorders of the Circulatory System MDC 5: Diseases and Disorders of the Circulatory System SURGICAL SURGICAL DRG 215 Other Heart Assist System Implant GMLOS 8.5 AMLOS 15.0 RW Operating Room Procedures 02HA0RS Insert of Biventricular Ext Heart Assist Sys into Heart, Opn Appr 02HA0RZ Insert of Ext Heart Assist Sys into Heart, Opn Appr 02HA3RS Insert of Biventricular Ext Heart Assist Sys into Heart, Perc Appr 02HA3RZ Insert of Ext Heart Assist Sys into Heart, Perc Appr 02HA4RS Insert of Biventricular Ext Heart Assist Sys into Heart, Perc Endo Appr 02HA4RZ Insert of Ext Heart Assist Sys into Heart, Perc Endo Appr 02WA0JZ Rev of Synth Sub in Heart, Opn Appr 02WA0QZ Rev of Implantable Heart Assist Sys in Heart, Opn Appr 02WA0RZ Rev of Ext Heart Assist Sys in Heart, Opn Appr 02WA3QZ Rev of Implantable Heart Assist Sys in Heart, Perc Appr 02WA3RZ Rev of Ext Heart Assist Sys in Heart, Perc Appr 02WA4QZ Rev of Implantable Heart Assist Sys in Heart, Perc Endo Appr 02WA4RZ Rev of Ext Heart Assist Sys in Heart, Perc Endo Appr DRG 216 Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with MCC GMLOS 13.8 AMLOS 16.4 RW t Operating Room Procedures 027F0[4,D,Z]Z Dilation/Aortic Valve, Opn, [Drug-eluting Intralum Dev, 027G0[4,D,Z]Z Dilation/Mitral Valve, Opn, [Drug-eluting Intralum Dev, 027H0[4,D,Z]Z Dilation/Pulmonary Valve, Opn, [Drug-eluting Intralum Dev, 027J0[4,D,Z]Z Dilation/Tricuspid Valve, Opn, [Drug-eluting Intralum Dev, 02NF0ZZ Release Aortic Valve, Opn Appr 02NG0ZZ Release Mitral Valve, Opn Appr 02NH0ZZ Release Pulmonary Valve, Opn Appr 02NJ0ZZ Release Tricuspid Valve, Opn Appr 02QF* Repair/Aortic Valve 02QG* Repair/Mitral Valve 02QH* Repair/Pulmonary Valve 02QJ* Repair/Tricuspid Valve 02RF3[7,8,J,K]H Replace/Aortic Valve, Perc, [Auto Tissue Sub, Zooplastic Tissue, Synth Sub, Nonauto Tissue Sub], Transapical 02RF[0,3,4][7,8,J,K]Z Replace/Aortic Valve, [Opn, Perc, Perc Endo], [Auto Tissue Sub, 02RG3[7,8,J,K]H Replace/Mitral Valve, Perc, [Auto Tissue Sub, Zooplastic Tissue, Synth Sub, Nonauto Tissue Sub], Transapical 02RG[0,3,4][7,8,J,K]Z Replace/Mitral Valve, [Opn, Perc, Perc Endo], [Auto Tissue Sub, 02RH3[7,8,J,K]H Replace/Pulmn Valve, Perc, [Auto Tissue Sub, Zooplastic Tissue, Synth Sub, Nonauto Tissue Sub], Transapical 02RH[0,3,4][7,8,J,K]Z Replace/Pulmn Valve, [Opn, Perc, Perc Endo], [Auto Tissue Sub, 02RJ* Replace/Tricuspid Valve 02RP[0,4][7,8,J,K]Z Replace/Pulmn Trunk, [Opn, Perc Endo], [Auto Tissue Sub, 02RQ[0,4][7,8,J,K]Z Replace/Pulmn Artery, Rt, [Opn, Perc Endo], [Auto Tissue Sub, 02RR[0,4][7,8,J,K]Z Replace/Pulmn Artery, Lt, [Opn, Perc Endo], [Auto Tissue Sub, 02RS[0,4][7,8,J,K]Z Replace/Pulmn Vein, Rt, [Opn, Perc Endo], [Auto Tissue Sub, 02RT[0,4][7,8,J,K]Z Replace/Pulmn Vein, Lt, [Opn, Perc Endo], [Auto Tissue Sub, 02RV[0,4][7,8,J,K]Z Replace/Superior Vena Cava, [Opn, Perc Endo], [Auto Tissue Sub, 02RW[0,4][7,8,J,K]Z Replace/Thoracic Aorta, [Opn, Perc Endo], [Auto Tissue Sub, 02UF* Supl/Aortic Valve 02UG* Supl/Mitral Valve 02UH* Supl/Pulmonary Valve 02UJ* Supl/Tricuspid Valve 02UW[3,4]JZ Supl/Thoracic Aorta, [Perc, Perc Endo], Synth Sub, NQ 02VW[0,3,4]DZ Restrict/Thoracic Aorta, [Opn, Perc, Perc Endo], Intralum Dev, NQ 03R0[0,4][7,J,K]Z Replace/Int Mammary Artery, Rt, [Opn, Perc Endo], [Auto Tissue 03R1[0,4][7,J,K]Z Replace/Int Mammary Artery, Lt, [Opn, Perc Endo], [Auto Tissue 03R2[0,4][7,J,K]Z Replace/Innominate Artery, [Opn, Perc Endo], [Auto Tissue 03R3[0,4][7,J,K]Z Replace/Subclavian Artery, Rt, [Opn, Perc Endo], [Auto Tissue 03R4[0,4][7,J,K]Z Replace/Subclavian Artery, Lt, [Opn, Perc Endo], [Auto Tissue 05R0[0,4][7,J,K]Z Replace/Azygos Vein, [Opn, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub], NQ 05R1[0,4][7,J,K]Z Replace/Hemiazygos Vein, [Opn, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub], NQ 05R3[0,4][7,J,K]Z Replace/Innominate Vein, Rt, [Opn, Perc Endo], [Auto Tissue 05R4[0,4][7,J,K]Z Replace/Innominate Vein, Lt, [Opn, Perc Endo], [Auto Tissue 05R5[0,4][7,J,K]Z Replace/Subclavian Vein, Rt, [Opn, Perc Endo], [Auto Tissue 05R6[0,4][7,J,K]Z Replace/Subclavian Vein, Lt, [Opn, Perc Endo], [Auto Tissue 5A02[1,2]1[6,D] Assistance/Cardiac, [Intermittent, Continuous], Output, [Oth Pump, Impeller Pump] Nonoperating Room Procedures 4A023FZ Measurement of Cardiac Rhythm, Perc Appr 4A02[0,3]N[6,7,8] Measurement/Cardiac, [Opn, Perc], Sampling and Pressure, [Rt Heart, Lt Heart, Bilateral] B20* Imaging, Heart, Plain Radiography B210[0,1,Y]ZZ B211[0,1,Y]ZZ B212[0,1,Y]ZZ B213[0,1,Y]ZZ Fluoroscopy/Coronary Artery, Single, [High Osmolar, Low Osmolar, Oth Contrast], None, None Fluoroscopy/Coronary Arteries, Multiple, [High Osmolar, Low Osmolar, Oth Contrast], None, None Fluoroscopy/Coronary Artery Bypass Graft, Single, [High Osmolar, Low Osmolar, Oth Contrast], None, None Fluoroscopy/Coronary Artery Bypass Grafts, Multiple, [High Osmolar, Low Osmolar, Oth Contrast], None, None B214* Fluoroscopy/Heart, Rt B215* Fluoroscopy/Heart, Lt B216* Fluoroscopy/Heart, Rt and Lt B217* Fluoroscopy/Int Mammary Bypass Graft, Rt B218* Fluoroscopy/Int Mammary Bypass Graft, Lt B21F* Fluoroscopy/Bypass Graft, Oth DRG 217 Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with CC GMLOS 9.0 AMLOS 10.2 RW t Select operating room procedures and nonoperating room procedures listed under DRG 216 DRG 218 Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization without CC/MCC GMLOS 6.5 AMLOS 7.4 RW t Select operating room procedures and nonoperating room procedures listed under DRG 216 T Transfer DRG t Special Payment * Code Range 6th and 7th Character of ZZ = No Device, No Qualifier ZX = No Device, Diagnostic 70 MS-DRG Version 30 with I-10 Codes 2014 OptumInsight, Inc.

4 Diseases and Disorders of the Circulatory System MDC 5 DRG 219 DRG 222 DRG 219 Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization with MCC GMLOS 10.3 AMLOS 12.5 RW t Operating Room Procedures 027F0[4,D,Z]Z Dilation/Aortic Valve, Opn, [Drug-eluting Intralum Dev, 027G0[4,D,Z]Z Dilation/Mitral Valve, Opn, [Drug-eluting Intralum Dev, 027H0[4,D,Z]Z Dilation/Pulmonary Valve, Opn, [Drug-eluting Intralum Dev, 027J0[4,D,Z]Z Dilation/Tricuspid Valve, Opn, [Drug-eluting Intralum Dev, 02NF0ZZ Release Aortic Valve, Opn Appr 02NG0ZZ Release Mitral Valve, Opn Appr 02NH0ZZ Release Pulmonary Valve, Opn Appr 02NJ0ZZ Release Tricuspid Valve, Opn Appr 02QF* Repair/Aortic Valve 02QG* Repair/Mitral Valve 02QH* Repair/Pulmonary Valve 02QJ* Repair/Tricuspid Valve 02RF3[7,8,J,K]H Replace/Aortic Valve, Perc, [Auto Tissue Sub, Zooplastic Tissue, Synth Sub, Nonauto Tissue Sub], Transapical 02RF[0,3,4][7,8,J,K]Z Replace/Aortic Valve, [Opn, Perc, Perc Endo], [Auto Tissue Sub, 02RG3[7,8,J,K]H Replace/Mitral Valve, Perc, [Auto Tissue Sub, Zooplastic Tissue, Synth Sub, Nonauto Tissue Sub], Transapical 02RG[0,3,4][7,8,J,K]Z Replace/Mitral Valve, [Opn, Perc, Perc Endo], [Auto Tissue Sub, 02RH3[7,8,J,K]H Replace/Pulmonary Valve, Perc, [Auto Tissue Sub, Zooplastic Tissue, Synth Sub, Nonauto Tissue Sub], Transapical 02RH[0,3,4][7,8,J,K]Z Replace/Pulmn Valve, [Opn, Perc, Perc Endo], [Auto Tissue Sub, 02RJ* Replace/Tricuspid Valve 02RP[0,4][7,8,J,K]Z Replace/Pulmn Trunk, [Opn, Perc Endo], [Auto Tissue Sub, 02RQ[0,4][7,8,J,K]Z Replace/Pulmn Artery, Rt, [Opn, Perc Endo], [Auto Tissue Sub, 02RR[0,4][7,8,J,K]Z Replace/Pulmn Artery, Lt, [Opn, Perc Endo], [Auto Tissue Sub, 02RS[0,4][7,8,J,K]Z Replace/Pulmn Vein, Rt, [Opn, Perc Endo], [Auto Tissue Sub, 02RT[0,4][7,8,J,K]Z Replace/Pulmn Vein, Lt, [Opn, Perc Endo], [Auto Tissue Sub, 02RV[0,4][7,8,J,K]Z Replace/Superior Vena Cava, [Opn, Perc Endo], [Auto Tissue Sub, 02RW[0,4][7,8,J,K]Z Replace/Thoracic Aorta, [Opn, Perc Endo], [Auto Tissue Sub, 02UF* Supl/Aortic Valve 02UG* Supl/Mitral Valve 02UH* Supl/Pulmn Valve 02UJ* Supl/Tricuspid Valve 02UW[3,4]JZ Supl/Thoracic Aorta, [Perc, Perc Endo], Synth Sub, NQ 02VW[0,3,4]DZ Restrict/Thoracic Aorta, [Opn, Perc, Perc Endo], Intralum Dev, NQ 03R0[0,4][7,J,K]Z Replace/Int Mammary Artery, Rt, [Opn, Perc Endo], [Auto Tissue 03R1[0,4][7,J,K]Z Replace/Int Mammary Artery, Lt, [Opn, Perc Endo], [Auto Tissue 03R2[0,4][7,J,K]Z Replace/Innominate Artery, [Opn, Perc Endo], [Auto Tissue 03R3[0,4][7,J,K]Z Replace/Subclavian Artery, Rt, [Opn, Perc Endo], [Auto Tissue 03R4[0,4][7,J,K]Z Replace/Subclavian Artery, Lt, [Opn, Perc Endo], [Auto Tissue 05R0[0,4][7,J,K]Z Replace/Azygos Vein, [Opn, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub], NQ 05R1[0,4][7,J,K]Z Replace/Hemiazygos Vein, [Opn, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub], NQ 05R3[0,4][7,J,K]Z Replace/Innominate Vein, Rt, [Opn, Perc Endo], [Auto Tissue 05R4[0,4][7,J,K]Z Replace/Innominate Vein, Lt, [Opn, Perc Endo], [Auto Tissue 05R5[0,4][7,J,K]Z Replace/Subclavian Vein, Rt, [Opn, Perc Endo], [Auto Tissue 05R6[0,4][7,J,K]Z Replace/Subclavian Vein, Lt, [Opn, Perc Endo], [Auto Tissue 5A02[1,2]1[6,D] Assistance/Cardiac, [Intermittent, Continuous], Output, [Oth Pump, Impeller Pump] DRG 220 Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization with CC GMLOS 6.8 AMLOS 7.5 RW t Select operating room procedures listed under DRG 219 DRG 221 Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization without CC/MCC GMLOS 5.1 AMLOS 5.6 RW t Select operating room procedures listed under DRG 219 DRG 222 Cardiac Defibrillator Implant with Cardiac Catheterization with Acute Myocardial Infarction/Heart Failure/Shock with MCC GMLOS 9.9 AMLOS 12.0 RW Principal Diagnosis I09.81 Rheumatic heart failure I11.0 Hypertensive heart dz w/ heart failure I13.0 Hypertensive heart and CKD w/ heart failure and stage 1 through stage 4 CKD, or unsp CKD I13.2 Hypertensive heart and CKD w/ heart failure and w/ stage 5 CKD, or end stage renal dz I21* ST elevation (STEMI) and non-st elevation (NSTEMI) myocardial infarction I22* Subsq ST elevation (STEMI) and non-st elevation (NSTEMI) myocardial infarction I50* Heart failure R57.0 Cardiogenic shock R57.9 Shock, unsp Operating Room Procedures 0JH6[0,3]9Z Insert/SQ Tissue & Fascia, Chest, [Opn, Perc], Cardiac 0JH8[0,3]9Z Insert/SQ Tissue & Fascia, Abd, [Opn, Perc], Cardiac 0JH6[0,3]AZ 0JH8[0,3]AZ 02HL[0,3,4]MZ 0JH6[0,3]8Z 0JH8[0,3]8Z 0JH6[0,3]9Z 0JH8[0,3]9Z 02H40KZ 02H43[J,K,M]Z 02H44KZ Insert/SQ Tissue & Fascia, Chest, [Opn, Perc], Contractility Modulation Dev, NQ Insert/SQ Tissue & Fascia, Abd, [Opn, Perc], Contractility Modulation Dev, NQ NQ Insert/SQ Tissue & Fascia, Chest, [Opn, Perc], Defibrillator Insert/SQ Tissue & Fascia, Abd, [Opn, Perc], Defibrillator Insert/SQ Tissue & Fascia, Chest, [Opn, Perc], Cardiac Insert/SQ Tissue & Fascia, Abd, [Opn, Perc], Cardiac Insert of Defibrillator Lead into Coronary Vein, Opn Appr Insert/Coronary Vein, Perc, [Cardiac Lead, Pacemaker, Cardiac Lead, Defibrillator, Cardiac Lead], NQ Insert of Defibrillator Lead into Coronary Vein, Perc Endo Appr MDC 5: Diseases and Disorders of the Circulatory System SURGICAL Surgical Medical CC Indicator MCC Indicator Procedure Proxy 2014 OptumInsight, Inc. MS-DRG Version 30 with I-10 Codes 71

5 MDC 5: Diseases and Disorders of the Circulatory System SURGICAL DRG 223 DRG HN[0,3,4][J,K,M]Z Insert/Pericardium, [Opn, Perc, Perc Endo], [Cardiac Lead, Pacemaker, Cardiac Lead, Defibrillator, Cardiac Lead], NQ 0JH6[0,3]8Z 0JH8[0,3]8Z 02H4[0,4]KZ Insert/SQ Tissue & Fascia, Chest, [Opn, Perc], Defibrillator Insert/SQ Tissue & Fascia, Abd, [Opn, Perc], Defibrillator Insert/Coronary Vein, [Opn, Perc Endo], Cardiac Lead, 02HN[0,3,4][J,K,M]ZInsert/Pericardium, [Opn, Perc, Perc Endo], [Cardiac Lead, Pacemaker, Cardiac Lead, Defibrillator, Cardiac Lead], NQ Nonoperating Room Procedures 4A02[0,3]N[6,7,8] Measurement/Cardiac, [Opn, Perc], Sampling and Pressure, [Rt Heart, Lt Heart, Bilateral] B20* Imaging, Heart, Plain Radiography B210[0,1,Y]ZZ Fluoroscopy/Coronary Artery, Single, [High Osmolar, Low Osmolar, Oth Contrast], None, None B211[0,1,Y]ZZ Fluoroscopy/Coronary Arteries, Multiple, [High Osmolar, Low Osmolar, Oth Contrast], None, None B212[0,1,Y]ZZ Fluoroscopy/Coronary Artery Bypass Graft, Single, [High B213[0,1,Y]ZZ Osmolar, Low Osmolar, Oth Contrast], None, None Fluoroscopy/Coronary Artery Bypass Grafts, Multiple, [High Osmolar, Low Osmolar, Oth Contrast], None, None B214* Fluoroscopy/Heart, Rt B215* Fluoroscopy/Heart, Lt B216* Fluoroscopy/Heart, Rt and Lt B217* Fluoroscopy/Int Mammary Bypass Graft, Rt B218* Fluoroscopy/Int Mammary Bypass Graft, Lt B21F* Fluoroscopy/Bypass Graft, Oth DRG 223 Cardiac Defibrillator Implant with Cardiac Catheterization with Acute Myocardial Infarction/Heart Failure/Shock without MCC GMLOS 4.4 AMLOS 5.9 RW Select principal diagnosis operating room procedure combinations nonoperating room procedures listed under DRG 222 DRG 224 Cardiac Defibrillator Implant with Cardiac Catheterization without Acute Myocardial Infarction/Heart Failure/Shock with MCC GMLOS 8.1 AMLOS 10.0 RW Select any principal diagnosis listed under MDC 5 excluding acute myocardial infarction, heart failure and shock Select operating room procedure combinations nonoperating room procedures listed under DRG 222 DRG 225 Cardiac Defibrillator Implant with Cardiac Catheterization without Acute Myocardial Infarction/Heart Failure/Shock without MCC GMLOS 4.0 AMLOS 5.0 RW Select any principal diagnosis listed under MDC 5 excluding acute myocardial infarction, heart failure and shock Select operating room procedure combinations nonoperating room procedures listed under DRG 222 DRG Expert (ICD-10 Version) DRG 226 Cardiac Defibrillator Implant without Cardiac Catheterization with MCC GMLOS 6.1 AMLOS 8.7 RW Operating Room Procedures 0JH6[0,3]9Z Insert/SQ Tissue & Fascia, Chest, [Opn, Perc], Cardiac 0JH8[0,3]9Z Insert/SQ Tissue & Fascia, Abd, [Opn, Perc], Cardiac 0JH6[0,3]AZ Insert/SQ Tissue & Fascia, Chest, [Opn, Perc], Contractility Modulation Dev, NQ 0JH8[0,3]AZ Insert/SQ Tissue & Fascia, Abd, [Opn, Perc], Contractility Modulation Dev, NQ 02HL[0,3,4]MZ NQ 0JH6[0,3]8Z Insert/SQ Tissue & Fascia, Chest, [Opn, Perc], Defibrillator 0JH8[0,3]8Z Insert/SQ Tissue & Fascia, Abd, [Opn, Perc], Defibrillator 0JH6[0,3]9Z 0JH8[0,3]9Z 02H40KZ 02H43[J,K,M]Z 02H44KZ Insert/SQ Tissue & Fascia, Chest, [Opn, Perc], Cardiac Insert/SQ Tissue & Fascia, Abd, [Opn, Perc], Cardiac Insert of Defibrillator Lead into Coronary Vein, Opn Appr Insert/Coronary Vein, Perc, [Cardiac Lead, Pacemaker, Cardiac Lead, Defibrillator, Cardiac Lead], NQ Insert of Defibrillator Lead into Coronary Vein, Perc Endo Appr 02HN[0,3,4][J,K,M]Z Insert/Pericardium, [Opn, Perc, Perc Endo], [Cardiac Lead, Pacemaker, Cardiac Lead, Defibrillator, Cardiac Lead], NQ 0JH6[0,3]8Z 0JH8[0,3]8Z 02H4[0,4]KZ Insert/SQ Tissue & Fascia, Chest, [Opn, Perc], Defibrillator Insert/SQ Tissue & Fascia, Abd, [Opn, Perc], Defibrillator Insert/Coronary Vein, [Opn, Perc Endo], Cardiac Lead, 02HN[0,3,4][J,K,M]Z Insert/Pericardium, [Opn, Perc, Perc Endo], [Cardiac Lead, Pacemaker, Cardiac Lead, Defibrillator, Cardiac Lead], NQ T Transfer DRG t Special Payment * Code Range 6th and 7th Character of ZZ = No Device, No Qualifier ZX = No Device, Diagnostic 72 MS-DRG Version 30 with I-10 Codes 2014 OptumInsight, Inc.

6 Alphabetic Index to Diseases, S42.22[1,2,3,4, 5,6][A,B] 2-part [disp, Nondisp] fx of surgical neck of [rt, lt, unsp] humerus, init enc for [clsd, opn] fx 424 S42.23[1,2,9] [A,B] 3-part fx of surgical neck of [rt, lt, unsp] humerus, init enc for [clsd, opn] fx 181, 424 H49.0* 3rd [oculomotor] nerve palsy 45 O72.0 3rd-stage hemor 271, 272, 273 S42.24[1,2,9] [A,B] 4-part fx of surgical neck of [rt, lt, unsp] humerus, init enc for [clsd, opn] fx 181, 424 Q , XX true hermaphrodite 258, 262, 267 H49.1* 4th [trochlear] nerve palsy 45 H49.2* 6th [abducent] nerve palsy 45 S19.8 A Oth spec inj of [unsp part of neck, larynx, cervical trachea, vocal [0,1,2,3,4,5,9]X cord, thyroid gland, pharynx & cervical esophagus, oth spec part of neck], init enc 422 R10* Abd & pelvic pain 113 A42.1 Abd actinomycosis 111 R19.3* Abd rigidity 114 R92* Abnormal & inconclusive findings on dx imaging of breast 220 R Abnormal auditory function study 58, 287 R03* Abnormal bld-pressure reading, w/o diagnosis 101 R19.1* Abnormal bowel sounds 113 R85.61* Abnormal cytologic smear of anus 114 R85.69 Abnormal cytological findings in specimens from oth digestive organs & abd cavity 386 R87.69 Abnormal cytological findings in specimens from oth female genital organs 387 R89.6 Abnormal cytological findings in specimens from oth organs, systems & tissues 387 R90.81 Abnormal echoencephalogram 39 R Abnormal electro-oculogram [EOG] 46 R Abnormal electromyogram [EMG] 191 R Abnormal electroretinogram [ERG] 46 R83* Abnormal findings in cerebrospinal fluid 39 R88* Abnormal findings in oth body fluids & substances 387 R86* Abnormal findings in specimens from male genital organs 258 R84* Abnormal findings in specimens from respiratory organs & thorax 386 O28* Abnormal findings on antenatal screening of mother 275, 277 R82.8 Abnormal findings on cytological & histological exam of urine 252 R93.[6,7] Abnormal findings on dx imaging of [limbs, oth parts of musculoskeletal sys] 191 R93.1 Abnormal findings on dx imaging of heart & coronary circulation 99 R93.2 Abnormal findings on dx imaging of liver & biliary tract 121 R93.5 Abnormal findings on dx imaging of oth abd regions, including retroperitoneum 113 R93.3 Abnormal findings on dx imaging of oth parts of digestive tract 113 R93.8 Abnormal findings on dx imaging of oth spec body structures 99 R93.0 Abnormal findings on dx imaging of skull & head, NEC 39 R93.4 Abnormal findings on dx imaging of urinary organs 252 R82.7 Abnormal findings on microbiological exam of urine 252 P09 Abnormal findings on neonatal screening 386 O Abnormal glucose comp preg 275, 277 O Abnormal glucose comp the puerperium 274 O99.8[1,2,3,4]4 [Abnormal glucose, Streptococcus B carrier state, Oth infxn carrier state, Bariatric surgery status] comp childbirth 271, 273 O99.8[1,2,3,4]5 [Abnormal glucose, Streptococcus B carrier state, Oth infxn carrier state, Bariatric surgery status] comp the puerperium 270 K04.3 Abnormal hard tissue formation in pulp 4 R85.7 Abnormal histological findings in specimens from digestive organs & abd cavity 386 R87.7 Abnormal histological findings in specimens from female genital organs 387 R89.7 Abnormal histological findings in specimens from oth organs, systems & tissues 287, 387 R76.9 Abnormal immunological finding in serum, unsp 292 R85.4 Abnormal immunological findings in specimens from digestive organs & abd cavity 386 R87.4 Abnormal immunological findings in specimens from female genital organs 387 R89.4 Abnormal immunological findings in specimens from oth organs, systems & tissues 387 H02.51* Abnormal innervation synd 45 R25* Abnormal involuntary movements 39 R85.0 Abnormal lvl of enzymes in specimens from digestive organs & abd cavity 386 R87.0 Abnormal lvl of enzymes in specimens from female genital organs 387 R89.0 Abnormal lvl of enzymes in specimens from oth organs, systems & tissues 387 R85.1 Abnormal lvl of hormones in specimens from digestive organs & abd cavity 386 R87.1 Abnormal lvl of hormones in specimens from female genital organs 387 R89.1 Abnormal lvl of hormones in specimens from oth organs, systems & tissues 387 R85.2 Abnormal lvl of oth drugs, medicaments & biological substances in specimens from digestive organs & abd cavity 386 R87.2 Abnormal lvl of oth drugs, medicaments & biological substances in specimens from female genital organs 387 R89.2 Abnormal lvl of oth drugs, medicaments & biological substances in specimens from oth organs, systems & tissues 387 R85.3 Abnormal lvl of substances chiefly nonmedicinal as to source in specimens from digestive organs & abd cavity 386 R87.3 Abnormal lvl of substances chiefly nonmedicinal as to source in specimens from female genital organs 387 R89.3 Abnormal lvl of substances chiefly nonmedicinal as to source in specimens from oth organs, systems & tissues 387 R85.5 Abnormal microbiological findings in specimens from digestive organs & abd cavity 386 R87.5 Abnormal microbiological findings in specimens from female genital organs 387 R89.5 Abnormal microbiological findings in specimens from oth organs, systems & tissues 387 R Abnormal oculomotor study 46 R29.3 Abnormal posture 39 O02.9 Abnormal product of conception, unsp 275, 277 R29.2 Abnormal reflex 39 R Abnormal response to nerve stimulation, unsp 39 R94.3* Abnormal results of cardiovascular function studies 101 R94.0* Abnormal results of function studies of central nervous sys 39 R94.8 Abnormal results of function studies of oth organs & systems 252 R94.4 Abnormal results of kidney function studies 252 R94.5 Abnormal results of liver function studies 121 R94.7 Abnormal results of oth endocrine function studies 244 R94.1[1,2,3]8 Abnormal results of oth function studies of [eye, ear & oth special senses, peripheral nervous sys] 39 R94.2 Abnormal results of pulmonary function studies 69 R94.6 Abnormal results of thyroid function studies 244 R74* Abnormal serum enzyme lvls 386 R09.3 Abnormal sputum 68 R97* Abnormal tumor markers 387 R82.6 Abnormal urine lvls of substances chiefly nonmedicinal as to source 252 R Abnormal vestibular function study 58 R Abnormal visually evoked potential [VEP] 46 O62* Abnormalities of forces of labor 276, 278 K00.2 Abnormalities of size & form of teeth 4 O76 Abnormality in fetal heart rate & rhythm comp labor & delivery 276, 278 R71* Abnormality of red bld cells 291 T80.30XA ABO incompatibility reaction d/t transfusion of bld or bld products, unsp, init enc 286, 291 T80.30XS ABO incompatibility reaction d/t transfusion of bld or bld products, unsp, seq 374 T80.30XD ABO incompatibility reaction d/t transfusion of bld or bld products, unsp, subsq enc 412 Alphabetic Index to Diseases 2014 OptumInsight, Inc. 467

7 Numeric Index to Diseases Code Page A00* 111 A01* 307 A A , 440 A02.2* 440 A A , 15, 41 A A A A A A , 440 A , 440 A03* 111 A04* 111 A A A A A A A A A A A A A A A , 15, 41 A A06.8* 307 A A A07* 111 A08* 113 A A15* 66, 440 A , 15, 41 A , 15, 41 A17.8* 10, 15, 41 A A17* 440 A18.0[1,3] 159 A A A A18.1[0,1,2,3] 251 A18.1[4,5] 258 A18.1[6,7,8] 261, 266 A A18.3* 111 A A18.5* 45 A A A18.8[2,4,9] 307 A A A A18* 440 A19* 307, 440 A A A Code Page A A A A A21.[0,1,7,8,9] 307 A A A A A A A A A23* 307 A24* 307 A25* 307 A A A A A A27.8* 10, 15, 41 A A A A A A A30* 307 A A A , 440 A , 440 A , 440 A A32.1* 307 A A32.8* 307 A A34 270, 273 A35 280, 307 A36.0 2, 58 A36.1 2, 58 A36.2 2, 58 A A36.8[2,3,4] 307 A A A A A A37* 68 A38* 307 A , 15, 41 A , 308 A A A A39.5* 280 A39.5[0,2,3] 100 A A39.8[3,4] 160, 280 A , 15, 41 A , 280 A A Code Page A , 440 A40* 308 A41* 280, 308, 440 A A A A , 308 A42.8* 307 A A42* 440 A A A A A43* 440 A44* 307 A A , 307 A , 280, 440 A A A A48.5* 307 A A A49* 307 A50.0* 307 A A A A A A A50.4[0,1,2,3] 41 A A A A50.5* 307 A A A A , 261, 266 A A A51.3* 229 A , 15, 41 A A A A A A A A A A A A A A A A A A A A , 15, 41 Code Page A , 15, 41 A A A A A A A A A A A A A A A A A A53* 307 A54.0[0,2,3,9] 261, 266 A54.0[0,9] 258 A A , 261, 266 A54.2[1,2,3,9] 258 A54.2[1,4,9] 261, 266 A54.3* 45 A54.4[0,2,3,9] 160 A A54.5 2, 57 A A , 15, 41 A A A A A A A A55 258, 261, 266 A56.0* 261, 266 A56.0[0,1,9] 258 A56.1* 251 A , 261, 266 A A56.4 2, 57 A , 261, 266 A57 258, 261, 266 A58 258, 261, 266 A59.0[0,1,3,9] 261, 267 A59.0[0,2,3,9] 258 A A A60.0[0,1,2,9] 258 A60.0[0,1,4,9] 440 A60.0[0,3,4,9] 261, 267 A , 261, 267, 440 A , 261, 267, 440 A A , 261, 267 A64 258, 261, 267 A A66.[0,1,2,3,4] 229 A66.5 2, 58 A A A Numeric Index to Diseases 2014 OptumInsight, Inc. 633

8 Alphabetic Index to Procedures S42.22[1,2,3]B 2-part disp fx of surgical neck of [rt, lt, unsp] humerus, init enc for opn fx 435 S42.22[4,5,6]B 2-part Nondisp fx of surgical neck of [rt, lt, unsp] humerus, init enc for opn fx 435 S42.23[1,2,9]B 3-part fx of surgical neck of [rt, lt, unsp] humerus, init enc for opn fx 435 S42.24[1,2,9]B 4-part fx of surgical neck of [rt, lt, unsp] humerus, init enc for opn fx A07Z6 Abortion of Products of Conception, Vacuum, Via Natrl or Artfcl Opng 269, 271, A0[0,3,4,7,8]ZZ Abortion/Products of Conception, [Opn, Perc, Perc Endo, Via Natrl or Artfcl Opng, Via Natrl or Artfcl Opng Endo] A0[7,8]ZZ Abortion/Products of Conception, [Via Natrl or Artfcl Opng, Via Natrl or Artfcl Opng Endo] 464 S90.41[1,2,3]A Abrasion, [rt, lt, unsp] great toe, init enc 430 S90.41[4,5,6]A Abrasion, [rt, lt, unsp] lesser toe(s), init enc 430 S90.5[1,2,4,5,6,7] [Abrasion, Blister (nonthermal), Ext constriction, Superf FB, [1,2,9]A Insect bite (nonvenomous), Oth superf bite], [rt, lt, unsp] ankle, init enc 430 S90.8[1,2,4,5,6,7] [1,2,9]A F0DZ9[E,F,U,Z]Z [Abrasion, Blister (nonthermal), Ext constriction, Superf FB, Insect bite (nonvenomous), Oth superf bite], [rt, lt, unsp] foot, init enc 430 Adaptive,Supportive or Protective Devices Dev Fitting using [Orthosis, Assistive, Adaptive, Supportive or Protective Equipment, Prosthesis, No Dev] 157, 356 T79.[0,1]XXA [Air, Fat] embolism (traum), init enc 434 T79.[0,1]XXS [Air, Fat] embolism (traum), seq 360 0W0F* Alter/Abd Wall 233 0W0F[0,3,4] Alter/Abd Wall, [Opn, Perc, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 213, 462 0Y0L[0,3,4] Alter/Ankle Region, Lt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, 0Y0K[0,3,4] Alter/Ankle Region, Rt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, 0X05[0,3,4] Alter/Axilla, Lt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 213, 463 0X04[0,3,4] Alter/Axilla, Rt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 213, 463 0H0V[0,3,X][7,J,K]Z Alter/Breast, Bilateral, [Opn, Perc, Ext], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub], NQ 335, 452 0H0V[0,3]JZ Alter/Breast, Bilateral, [Opn, Perc], Synth Sub, NQ 217 0H0U[0,3,X][7,J,K]Z Alter/Breast, Lt, [Opn, Perc, Ext], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub] NQ 452 0H0UX[7,J,K]Z Alter/Breast, Lt, Ext, [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub], NQ 335 0H0T[0,3,X][7,J,K]Z Alter/Breast, Rt, [Opn, Perc, Ext], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub] NQ 452 0H0TX[7,J,K]Z Alter/Breast, Rt, Ext, [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub], NQ 335 0Y01[0,3,4] Alter/Buttock, Lt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, 0Y00[0,3,4] Alter/Buttock, Rt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, 0W08[0,3,4]Alter/Chest Wall, [Opn, Perc, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 213, 462 0X0C[0,3,4] Alter/Elbow Region, Lt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 214, 463 0X0B[0,3,4] Alter/Elbow Region, Rt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 214, [0,3,4,X] Alter/Ext Ear, Bilateral, [Opn, Perc, Perc Endo, Ext], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 206, [0,3,4,X] Alter/Ext Ear, Lt, [Opn, Perc, Perc Endo, Ext], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 206, [0,3,4,X] Alter/Ext Ear, Rt, [Opn, Perc, Perc Endo, Ext], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev] NQ 206, 448 0W02* Alter/Face 55 0W02[0,3,4]Alter/Face, [Opn, Perc, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 213, 462 0W00[0,3,4]Alter/Head, [Opn, Perc, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 213, 462 0Y0G[0,3,4] Alter/Knee Region, Lt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, 0Y0F[0,3,4] Alter/Knee Region, Rt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, 0X0F[0,3,4] Alter/Lwr Arm, Lt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 214, 463 0X0D[0,3,4] Alter/Lwr Arm, Rt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 214, 463 0W0L[0,3,4] Alter/Lwr Back, [Opn, Perc, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 213, 462 0Y0B[0,3,4] Alter/Lwr Extr, Lt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, 0Y09[0,3,4] Alter/Lwr Extr, Rt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, 0W05* Alter/Lwr Jaw 49, 157 0Y0J[0,3,4] Alter/Lwr Leg, Lt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, 0Y0H[0,3,4] Alter/Lwr Leg, Rt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, 0C01X Alter/Lwr Lip, Ext, [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 206, 450 0W06* Alter/Neck 55 0W06[0,3,4]Alter/Neck, [Opn, Perc, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 213, K* Alter/Nose K[0,3,4,X] Alter/Nose, [Opn, Perc, Perc Endo, Ext], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 206, 448 0W0N* Alter/Perineum, Female 264, 273 0W0N[0,3,4] Alter/Perineum, Female, [Opn, Perc, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev] NQ 462 0W0M[0,3,4] Alter/Perineum, Male, [Opn, Perc, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 213, 462 0X03[0,3,4] Alter/Shldr Region, Lt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 213, 463 0X02[0,3,4] Alter/Shldr Region, Rt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 213, 463 0J08* Alter/SQ Tissue & Fascia, Abd 233 0J08[0,3]ZZ Alter/SQ Tissue & Fascia, Abd, [Opn, Perc] 208, 452 0J04* Alter/SQ Tissue & Fascia, Ant Neck 233 0J04[0,3]ZZ Alter/SQ Tissue & Fascia, Ant Neck, [Opn, Perc] 208, 452 0J07* Alter/SQ Tissue & Fascia, Back 233 0J07[0,3]ZZ Alter/SQ Tissue & Fascia, Back, [Opn, Perc] 208, 452 0J09* Alter/SQ Tissue & Fascia, Buttock 233 0J09[0,3]ZZ Alter/SQ Tissue & Fascia, Buttock, [Opn, Perc] 208, 452 0J06* Alter/SQ Tissue & Fascia, Chest 233 0J06[0,3]ZZ Alter/SQ Tissue & Fascia, Chest, [Opn, Perc] 208, 452 0J01* Alter/SQ Tissue & Fascia, Face 53 0J01[0,3]ZZ Alter/SQ Tissue & Fascia, Face, [Opn, Perc] 208, 452 0J0H* Alter/SQ Tissue & Fascia, Lt Lwr Arm 233 0J0H[0,3]ZZ Alter/SQ Tissue & Fascia, Lt Lwr Arm, [Opn, Perc] 208, 452 0J0P* Alter/SQ Tissue & Fascia, Lt Lwr Leg 233 0J0P[0,3]ZZ Alter/SQ Tissue & Fascia, Lt Lwr Leg, [Opn, Perc] 208, 452 0J0F* Alter/SQ Tissue & Fascia, Lt Upr Arm 233 0J0F[0,3]ZZ Alter/SQ Tissue & Fascia, Lt Upr Arm, [Opn, Perc] 208, 452 0J0M* Alter/SQ Tissue & Fascia, Lt Upr Leg 233 0J0M[0,3]ZZ Alter/SQ Tissue & Fascia, Lt Upr Leg, [Opn, Perc] 208, 452 0J05* Alter/SQ Tissue & Fascia, Posterior Neck 233 0J05[0,3]ZZ Alter/SQ Tissue & Fascia, Posterior Neck, [Opn, Perc] 208, 452 0J0G* Alter/SQ Tissue & Fascia, Rt Lwr Arm 233 0J0G[0,3]ZZ Alter/SQ Tissue & Fascia, Rt Lwr Arm, [Opn, Perc] 208, 452 0J0N* Alter/SQ Tissue & Fascia, Rt Lwr Leg 233 0J0N[0,3]ZZ Alter/SQ Tissue & Fascia, Rt Lwr Leg, [Opn, Perc] 208, 452 0J0D* Alter/SQ Tissue & Fascia, Rt Upr Arm 233 0J0D[0,3]ZZ Alter/SQ Tissue & Fascia, Rt Upr Arm, [Opn, Perc] 208, 452 0J0L* Alter/SQ Tissue & Fascia, Rt Upr Leg 233 0J0L[0,3]ZZ Alter/SQ Tissue & Fascia, Rt Upr Leg, [Opn, Perc] 208, 452 0X09[0,3,4] Alter/Upr Arm, Lt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 214, 463 0X08[0,3,4] Alter/Upr Arm, Rt, [Opn, Perc, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 214, 463 0W0K[0,3,4]Alter/Upr Back, [Opn, Perc, Perc Endo], [Auto Tissue Sub, Synth Sub, Nonauto Tissue Sub, No Dev], NQ 213, 462 Alphabetic Index to Procedures 2014 OptumInsight, Inc. 689

9 Numeric Index to Procedures 001* [0,3][7,J,K][0,1,2,3,4,5,6,7,8] [0,3][7,J,K]B * [7,J,K]B 8, 12, [7,J,K]B 8, 12, U[0,3][7,J,K][4,6,7,9] [0,3,4]ZZ 12, 16, * 8, 316, [0,3,4]ZZ 12, 16, * 8, [0,3,4]ZZ 12, 16, * 8, [0,3,4]ZZ 12, * 8, [0,3,4]ZZ 12, 16, * 8, 316, [0,3,4]ZZ 12, 16, * 8, [0,3,4]ZZ 12, 16, * 8, 316, A[0,3,4]ZZ 12, 16, A* 8, 316, B[0,3,4]ZZ 12, 16, B* 8, 316, C[0,3,4]ZZ 12, 16, C* 8, 316, D[0,3,4]ZZ 12, 16, D* 8, 316, T[0,3,4]ZZ 19, T* 129, W[0,3,4]ZZ 19, W* 129, X[0,3,4]ZZ 19, X* 129, Y[0,3,4]ZZ 19, Y* 129, [0,3,4]ZZ 12, 16, * 8, 316, [0,3,4]ZZ 12, 16, * 8, 316, [0,3,4]ZZ 12, 16, * 8, F* 23, 50, 150, G* 23, 50, 150, H* 23, 50, 150, J* 23, 50, 150, K* 23, 50, L* 23, 50, 150, M* 23, 50, 150, N* 23, 50, 150, P[0,3,4]ZZ 12, P* 8, Q* 23, 50, 63, R* 23, 50, 150, S* 23, 50, 150, W[0,3,4]ZZ 19, W* 118, X[0,3,4]ZZ 19, X* 118, Y[0,3,4]ZZ 19, Y* 118, [F,G,H,J]0ZX 50, [K,L,M,N]0ZX 50, [P,Q,R,S]0ZX 50, [0,3,4][0,Z]Z 8, 12, 16, 316, ZX 8, 12, 16, [0,Z]Z 8, 12, 16, 294, 316, ZX 8, 12, 16, [0,Z]Z 8, 12, 16, 294, 316, ZX 8, 12, 16, [0,3,4][0,Z]Z 8, 12, 16, 316, ZX 8, 12, 16, [0,Z]Z 8, 12, 16, 294, 316, ZX 8, 12, 16, [0,Z]Z 8, 12, 16, 294, 316, ZX 8, 12, 16, [0,3,4]0Z 8, 294, 316, [0,Z]Z 12, ZX 8, 12, 16, ZZ 8, 316, [0,3,4][0,Z]Z 8, 12, 17, 316, ZX 8, 12, 17, [0,3,4][0,Z]Z 8, 12, 17, 294, ZX 8, 12, 17, [0,3,4][0,Z]Z 8, 12, 17, 294, 316, ZX 8, 12, 17, A[0,3,4][0,Z]Z 8, 12, 17, 294, 317, A0ZX 8, 12, 17, B[0,3,4][0,Z]Z 8, 12, 17, 317, B0ZX 8, 12, 17, C[0,3,4][0,Z]Z 8, 12, 17, 317, C0ZX 8, 12, 17, D[0,3,4][0,Z]Z 8, 12, 17, 317, D0ZX 8, 12, 17, F[0,3,4][0,Z]Z F0ZX 23, G[0,3,4][0,Z]Z G0ZX 23, H[0,3,4][0,Z]Z H0ZX 23, J[0,3,4][0,Z]Z J0ZX 23, K[0,3,4][0,Z]Z K0ZX 23, L[0,3,4][0,Z]Z L0ZX 23, M[0,3,4][0,Z]Z M0ZX 23, N[0,3,4][0,Z]Z N0ZX 23, P[0,3,4][0,Z]Z P0ZX 23, Q[0,3,4][0,Z]Z Q0ZX 23, R[0,3,4][0,Z]Z R0ZX 23, S[0,3,4][0,Z]Z S0ZX 23, T[0,3,4][0,Z]Z 19, 294, T[0,3,4]ZX 19, T* 129, U[0,3,4]ZX 19, 129, 130, U0[0,Z]Z U00Z 19, 129, 130, U0ZZ 19, 129, 130, W[0,3,4][0,Z]Z 19, 294, W[0,3,4]ZX 19, W* 129, X[0,3,4][0,Z]Z 19, 294, X[0,3,4]ZX 19, X* 129, Y[0,3,4][0,Z]Z 19, 294, Y[0,3,4]ZX 19, Y* 129, B0[0,3,4]ZZ 8, 12, 17, 294, 317, B00ZX 8, 12, 17, B1[0,3,4]ZZ 8, 12, 17, 294, B10ZX 8, 12, 17, B2[0,3,4]ZZ 8, 12, 17, 294, B20ZX 8, 12, 17, B6[0,3,4]ZZ 8, 12, 17, 294, 317, B60ZX 8, 12, 17, B7[0,3,4]ZZ 8, 12, 17, 294, 317, B70ZX 8, 12, 17, B8[0,3,4]ZZ 8, 12, 17, 294, B80ZX 8, 12, 17, B9[0,3,4]ZZ 8, 12, 17, 294, 317, B90ZX 8, 12, 17, BA[0,3,4]ZZ 8, 12, 17, 294, 317, BA0ZX 8, 12, 17, BB[0,3,4]ZZ 8, 12, 17, 294, 317, BB0ZX 8, 12, 17, BC[0,3,4]ZZ 8, 12, 17, 294, 317, BC0ZX 8, 12, 17, BD[0,3,4]ZZ 8, 12, 17, 294, 317, BD0ZX 8, 12, 17, BF[0,3,4]ZZ 23, 50, 150, 317, BF0ZX 23, 50, 150, BG[0,3,4]ZZ 23, 50, 150, 317, BG0ZX 23, 50, 150, BH[0,3,4]ZZ 23, 50, 150, 317, BH0ZX 23, 50, 150, BJ[0,3,4]ZZ 23, 50, 150, 317, BJ0ZX 23, 50, 150, BK[0,3,4]ZZ 23, 50, 150, 317, BK0ZX 23, 50, 150, BL[0,3,4]ZZ 23, 50, 150, 317, BL0ZX 23, 50, 150, BM[0,3,4]ZZ 23, 50, 150, 317, BM0ZX 23, 50, 150, BN[0,3,4]ZZ 50 00BN[3,4]ZZ 23, 150, 317, BN0ZX 23, 50, 150, BN0ZZ 8, 12, 17 00BP[0,3,4]ZZ 23, 50, 150, 317, BP0ZX 23, 50, 150, BQ[0,3,4]ZZ 23, 50, 150, 317, BQ0ZX 23, 50, 150, BR[0,3,4]ZZ 23, 50, 150, 317, BR0ZX 23, 50, 150, BS[0,3,4]ZZ 23, 50, 150, 317, BS0ZX 23, 50, 150, BT[0,3,4]Z[X,Z] 19, BT* 129, BW[0,3,4]Z[X,Z] 20, BW* 129, BX[0,3,4]Z[X,Z] 20, BX* 129, BY[0,3,4]Z[X,Z] 20, BY* 129, C0[0,3,4]ZZ 12, 17 00C0* 8, 317, C1[0,3,4]ZZ 12, 17, C1* 8, 317, C2[0,3,4]ZZ 12, 17, C2* 8, 317, C3[0,3,4]ZZ 20 00C3* C4[0,3,4]ZZ 12, 17, C4* 8, 317, C5[0,3,4]ZZ 12, 17, C5* 8, 317, C6[0,3,4]ZZ 12, 17 00C6* 8, 317, C7[0,3,4]ZZ 12, 17 00C7* 8, 317, C8[0,3,4]ZZ 12, 17, C8* 8, C9[0,3,4]ZZ 12, 17, C9* 8, 317, CA[0,3,4]ZZ 12, 17, CA* 8, 317, CB[0,3,4]ZZ 12, 17 00CB* 8, 317, CC[0,3,4]ZZ 12, 17 00CC* 8, 317, CD[0,3,4]ZZ 12, 17 00CD* 8, 317, CF* 23 00CG* 23 00CH* 23 00CJ* 23 00CK* 23 00CL* 23 00CM* 23 00CN* 23 00CP* 23 00CQ* 23 00CR* 23 00CS* 24 00CT[0,3,4]ZZ 20 00CT* CW[0,3,4]ZZ 20 00CW* CX[0,3,4]ZZ 20 00CX* CY[0,3,4]ZZ 20 00CY* D1[0,3,4]ZZ 12, 17, D1* 8, D2[0,3,4]ZZ 12, 17, D2* 8, DF[0,3,4]ZZ DF* 24, 50, 150, DG[0,3,4]ZZ DG* 24, 50, 150, DH[0,3,4]ZZ DH* 24, 50, 150, DJ[0,3,4]ZZ DJ* 24, 50, 150, DK[0,3,4]ZZ DK* 24, 50, 150, DL[0,3,4]ZZ DL* 24, 50, 150, DM[0,3,4]ZZ DM* 24, 50, 150, DN[0,3,4]ZZ DN* 24, 50, 150, DP[0,3,4]ZZ DP* 24, 50, 150, DQ[0,3,4]ZZ DQ* 24, 50, 150, DR[0,3,4]ZZ DR* 24, 50, 150, DS[0,3,4]ZZ DS* 24, 50, 150, DT[0,3,4]ZZ 20, 295 Numeric Index to Procedures 2014 OptumInsight, Inc. 841

10 Appendix B Alphabetical and Numeric Lists of CCs and MCCs Alphabetic CC List S42.222P 2-part disp fx of surg nk of l humer, subs for fx w malunion S42.222K 2-part disp fx of surg nk of l humer, subs for fx w nonunion S42.221P 2-part disp fx of surg nk of r humer, subs for fx w malunion S42.221K 2-part disp fx of surg nk of r humer, subs for fx w nonunion S42.223K 2-part disp fx of surg nk of unsp humer, 7thK S42.223P 2-part disp fx of surg nk of unsp humer, 7thP S42.222A 2-part disp fx of surgical neck of left humerus, init S42.221A 2-part disp fx of surgical neck of right humerus, init S42.223A 2-part disp fx of surgical neck of unsp humerus, init S42.225K 2-part nondisp fx of surg nk of l humer, 7thK S42.225P 2-part nondisp fx of surg nk of l humer, 7thP S42.224K 2-part nondisp fx of surg nk of r humer, 7thK S42.224P 2-part nondisp fx of surg nk of r humer, 7thP S42.226K 2-part nondisp fx of surg nk of unsp humer, 7thK S42.226P 2-part nondisp fx of surg nk of unsp humer, 7thP S42.225A 2-part nondisp fx of surgical neck of left humerus, init S42.224A 2-part nondisp fx of surgical neck of right humerus, init S42.226A 2-part nondisp fx of surgical neck of unsp humerus, init E methylglutaconic aciduria S42.232A 3-part fracture of surgical neck of left humerus, init S42.231A 3-part fracture of surgical neck of right humerus, init S42.239A 3-part fracture of surgical neck of unsp humerus, init S42.239P 3-part fx surg neck of unsp humerus, subs for fx w malunion S42.239K 3-part fx surg neck of unsp humerus, subs for fx w nonunion S42.232P 3-part fx surgical neck of l humerus, subs for fx w malunion S42.232K 3-part fx surgical neck of l humerus, subs for fx w nonunion S42.231P 3-part fx surgical neck of r humerus, subs for fx w malunion S42.231K 3-part fx surgical neck of r humerus, subs for fx w nonunion S42.242A 4-part fracture of surgical neck of left humerus, init S42.241A 4-part fracture of surgical neck of right humerus, init S42.249A 4-part fracture of surgical neck of unsp humerus, init S42.249P 4-part fx surg neck of unsp humerus, subs for fx w malunion S42.249K 4-part fx surg neck of unsp humerus, subs for fx w nonunion S42.242P 4-part fx surgical neck of l humerus, subs for fx w malunion S42.242K 4-part fx surgical neck of l humerus, subs for fx w nonunion S42.241P 4-part fx surgical neck of r humerus, subs for fx w malunion S42.241K 4-part fx surgical neck of r humerus, subs for fx w nonunion A42.1 Abdominal actinomycosis O00.0 Abdominal pregnancy T80.30XA ABO incompat react due to tranfs of bld/bld prod, unsp, init T80.310A ABO incompatibility w acute hemolytic transfs react, init T80.311A ABO incompatibility w delayed hemolytic transfs react, init T80.319A ABO incompatibility w hemolytic transfs react, unsp, init N75.1 Abscess of Bartholin s gland O Abscess of breast associated w pregnancy, second trimester O Abscess of breast associated with pregnancy, first trimester O Abscess of breast associated with pregnancy, third trimester O91.12 Abscess of breast associated with the puerperium N45.4 Abscess of epididymis or testis K63.0 Abscess of intestine N41.2 Abscess of prostate K11.3 Abscess of salivary gland E32.1 Abscess of thymus N76.4 Abscess of vulva G40.A11 Absence epileptic syndrome, intractable, w stat epi G40.A19 Absence epileptic syndrome, intractable, w/o stat epi G40.A01 Absence epileptic syndrome, not intractable, w stat epi G40.A09 Absence epileptic syndrome, not intractable, w/o stat epi I82.4Z3 Ac emblsm and thombos unsp deep veins of dist low extrm, bi I82.4Z2 Ac emblsm and thombos unsp deep veins of left dist low extrm I82.4Y2 Ac emblsm and thombos unsp deep veins of left prox low extrm I82.4Y3 Ac emblsm and thombos unsp deep veins of prox low extrm, bi I82.4Z1 Ac emblsm and thombos unsp deep veins of r dist low extrm I82.4Y1 Ac emblsm and thombos unsp deep veins of r prox low extrm B60.10 Acanthamebiasis, unspecified I97.51 Acc pnctr & lac of a circ sys org during a circ sys proc I97.52 Acc pnctr & lac of a circ sys org during oth procedure K91.72 Acc pnctr & lac of a dgstv sys org during oth procedure N99.71 Acc pnctr & lac of a GU sys org during a GU sys procedure M Acc pnctr & lac of a ms structure during a ms sys procedure M Acc pnctr & lac of a ms structure during oth procedure J95.72 Acc pnctr & lac of a resp sys org during oth procedure E36.11 Acc pnctr & lac of an endo sys org during an endo sys proc E36.12 Acc pnctr & lac of an endo sys org during oth procedure H Acc pnctr & lac of eye and adnexa during an opth proc, bi H Acc pnctr & lac of eye and adnexa during oth procedure, bi H Acc pnctr & lac of left eye and adnexa during an opth proc H Acc pnctr & lac of left eye and adnexa during oth procedure G97.48 Acc pnctr & lac of nervous sys org during a nervous sys proc G97.49 Acc pnctr & lac of nervous sys org during oth procedure H Acc pnctr & lac of right eye and adnexa during an opth proc H Acc pnctr & lac of right eye and adnexa during oth procedure L76.11 Acc pnctr & lac of skin, subcu during a dermatologic proc H95.31 Acc pnctr & lac of the ear/mastd dur proc on the ear/mastd H Acc pnctr & lac of unsp eye and adnexa during an opth proc H Acc pnctr & lac of unsp eye and adnexa during oth procedure K91.71 Accidental pnctr & lac of a dgstv sys org dur dgstv sys proc N99.72 Accidental pnctr & lac of a GU sys org during oth procedure J95.71 Accidental pnctr & lac of a resp sys org dur resp sys proc L76.12 Accidental pnctr & lac of skin, subcu during oth procedure H95.32 Accidental pnctr & lac of the ear/mastd during oth procedure D78.11 Accidental pnctr & lac of the spleen dur proc on the spleen D78.12 Accidental pnctr & lac of the spleen during oth procedure G97.41 Accidental puncture or laceration of dura during a procedure E87.2 Acidosis D68.4 Acquired coagulation factor deficiency L12.30 Acquired epidermolysis bullosa, unspecified D59.9 Acquired hemolytic anemia, unspecified D Acquired hemophilia B47.1 Actinomycetoma A42.9 Actinomycosis, unspecified A42.82 Actinomycotic encephalitis A42.81 Actinomycotic meningitis D68.51 Activated protein C resistance A06.0 Acute amebic dysentery A24.1 Acute and fulminating melioidosis G36.1 Acute and subacute hemorrhagic leukoencephalitis [Hurst] H Acute angle-closure glaucoma, bilateral H Acute angle-closure glaucoma, left eye H Acute angle-closure glaucoma, right eye H Acute angle-closure glaucoma, unspecified eye K04.4 Acute apical periodontitis of pulpal origin J21.1 Acute bronchiolitis due to human metapneumovirus J21.8 Acute bronchiolitis due to other specified organisms J21.0 Acute bronchiolitis due to respiratory syncytial virus J21.9 Acute bronchiolitis, unspecified I67.81 Acute cerebrovascular insufficiency B57.0 Acute Chagas disease with heart involvement B57.1 Acute Chagas disease without heart involvement K81.0 Acute cholecystitis K81.2 Acute cholecystitis with chronic cholecystitis I24.0 Acute coronary thrombosis not resulting in myocardial infrc N30.01 Acute cystitis with hematuria N30.00 Acute cystitis without hematuria B17.0 Acute delta-(super) infection of hepatitis B carrier K31.0 Acute dilatation of stomach G36.9 Acute disseminated demyelination, unspecified K26.3 Acute duodenal ulcer without hemorrhage or perforation I Acute emblsm and thombos of superfic veins of up extrem, bi I82.4Z9 Acute emblsm and thombos unsp deep vn unsp distal low extrm I82.4Y9 Acute emblsm and thombos unsp deep vn unsp prox low extrm I Acute embolism and thombos of deep vein of low extrm, bi I Acute embolism and thombos of deep veins of up extrem, bi I Acute embolism and thombos of superfic veins of l up extrem I Acute embolism and thombos of superfic veins of r up extrem I Acute embolism and thombos unsp deep veins of l low extrem I Acute embolism and thombos unsp deep veins of low extrm, bi I Acute embolism and thombos unsp deep veins of r low extrem I Acute embolism and thombos unsp deep vn unsp lower extremity I Acute embolism and thombos unsp veins of l up extrem I Acute embolism and thombos unsp veins of r up extrem Appendix B Alphabetical and Numeric Lists of CCs and MCCs 2014 OptumInsight, Inc. 899