Dial-In Instructions

Transcription

1 Dial-In Instructions Conference Name: Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment Scheduled Conference Date: Tuesday, July 18, 2006 Scheduled Conference Time: Scheduled Conference Duration: 1:00 p.m. 2:30 p.m. (Eastern), 12:00 p.m. 1:30 p.m. (Central), 11:00 a.m. 12:30 p.m. (Mountain), 10:00 a.m. 11:30 a.m (Pacific) 90 minutes PLEASE NOTE: If the audioconference occurs April through October, the time reflects daylight savings. If your area does NOT observe daylight savings, times will be one hour earlier. Your registration entitles you to ONE telephone connection to the audioconference. Invite as many people as you wish to listen to the audioconference on your speakerphone. Permission is given to make copies of the written materials for anyone else who is listening. In order to avoid delays in connecting to the conference, we recommend that you dial into the audioconference 15 minutes prior to the start time. Dial-In Instructions: 1. Dial 877/ and follow the voice prompts. 2. You will be greeted by an operator 3. Give the operator your pass code and the last name of the person who registered for the audioconference. 4. The operator will then verify the name of your facility. 5. You will then be placed into the conference. Technical Difficulties 1. If you experience any difficulties with the dial-in process, please call the conference center reservation line at 877/ If you should need technical assistance during the audio portion of the program, please press the star (*) key followed by the 0 key on your touch-tone phone and an operator will assist you. If you are disconnected during the conference, dial 877/ Q&A Session 1. To enter the questioning queue during the Q&A session, callers need to push the star (*) key followed by the 1 key on their touch-tone phones. Note: For most programs, this portion generally falls after the first hour of presentation. Please do not try to enter the queue before this portion of the program. 2. If you prefer not to ask your question on the air, you can fax your question to 877/ or 201/ , how ever, you can only fax your question during the program. Prior to the program If you prefer not to ask your question on the air, you can send your questions via to wwalsh@hcpro.com. Cutoff date and time for questions: 5:30 PM ET. Please note that not all questions will be answered. Program Evaluation Survey In your materials on page 2, we have included a program evaluation letter that has the URL link to our program survey. We would appreciate it if when you return to your office you could go to the link provided and complete the survey. Continuing Education documentation If CE s are offered with this program a separate link containing important information will be provided along with the program materials. Please follow the instructions provided in the CE Documentation.

2 P r o g r a m E v a l u a t i o n Dear Program Participant, Thank you for attending the HCPro program today. We hope you found it to be informative and helpful. To ensure a positive experience for our customers and to deliver the best possible products and services, we would like your feedback. Because your time is valuable, we have limited the evaluation to some brief questions found at the link below: We would also ask that you forward the link to others in your facility who attended the program for their input as well. To ensure that your completed form receives our attention, please return to us within six days from the date of this program. PLEASE NOTE: You must complete the Nursing Evaluation available at: and the AAPC Evaluation available at: within 30 days of the program in order to receive your credits. After 30 days, the evaluations for these activities will be closed and the certificates of completion will be sent to you by . If you enjoyed this program, you may purchase a tape or CD at the special attendee price of just $70. Simply call our customer service team at 800/ , and mention your source code: SURVEYAD. Keep the tape or CD handy, and listen again at your convenience--whenever you or your staff might benefit from a refresher, or when your new employees are ready for training. We appreciate your time and suggestions. We hope that you will continue to rely on HCPro programs as an important resource for pertinent and timely information. Sincerely, Frank Morello Director of Multimedia HCPro, Inc. 200 Hoods Lane PO Box 1168 Marblehead MA TEL FAX URL

3 presents... Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment A 90-minute interactive audioconference Tuesday, July 18, p.m. 2:30 p.m. (Eastern) 12 p.m. 1:30 p.m. (Central) 11 a.m. 12:30 p.m. (Mountain) 10 a.m. 11:30 a.m. (Pacific)

4 In our materials, we strive to provide our audience with useful, timely information. The live audioconference will follow the enclosed agenda. Occasionally, our speakers will refer to the materials enclosed. We have noticed that other, non-hcpro audioconference materials follow the speaker s presentation bullet-by-bullet, page-by-page. Because our presentations are less rigid and rely more on speaker interaction, we do not include each speaker s entire presentation. The materials contain helpful forms, crosswalks, policies, charts, and graphs. We hope that you find this information useful in the future. HCPro is not affiliated in any way with the Joint Commission on Accreditation of Healthcare Organizations, which owns the JCAHO trademark. ii Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

5 The Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment audioconference materials package is published by HCPro, 200 Hoods Lane, P.O. Box 1168, Marblehead, MA Copyright 2006, HCPro, Inc. Attendance at the audioconference is restricted to employees, consultants, and members of the medical staff of the Licensee. The audioconference materials are intended solely for use in conjunction with the associated HCPro audioconference. Licensee may make copies of these materials for internal use by attendees of the audioconference only. All such copies must bear this legend. Dissemination of any information in these materials or the audioconference to any party other than the Licensee or its employees is strictly prohibited. Advice given is general, and attendees and readers of the materials should consult professional counsel for specific legal, ethical, or clinical questions. HCPro is not affiliated in any way with the Joint Commission on Accreditation of Healthcare Organizations, which owns the JCAHO trademark. For more information, contact HCPro, Inc. 200 Hoods Lane P.O. Box 1168 Marblehead, MA Phone: 800/ Fax: 781/ customerservice@hcpro.com Web site: Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment iii

6 200 Hoods Lane P.O. Box 1168 Marblehead, MA Tel: 800/ Fax: 800/ Dear colleague, Thank you for participating in our Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment audioconference with Patricia Trela, RHIA, Margaret Cromwell, RHIA, CCS, and Andrea Curry, RN, BS, CCM, moderated by Lisa Eramo. We are excited about the opportunity to interact with you directly and encourage you to take advantage of the opportunity to ask our experts your questions during the audioconference. If you would like to submit a question before the audioconference, please send it to wwalsh@hcpro.com and provide the program date in the subject line. We cannot guarantee that your question will be answered during the program, but we will do our best to take a good cross section of questions. If at any time you have comments, suggestions, or ideas about how we might improve our audioconference, or if you have any questions about the audioconference itself, please do not hesitate to contact me. And if you would like any additional information about other products and services, please contact our Customer Service Department at 800/ Along with these audioconference materials, we have enclosed a fax evaluation. After the audioconference, please take a minute to complete the evaluation to let us know what you think. We value your opinion. Thanks again for working with us. Best regards, Wendy Walsh Associate Producer Fax: 781/ wwalsh@hcpro.com iv Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

7 Contents Agenda vii Speaker profiles viii Exhibit A Presentation by Patricia Trela, RHIA, Margaret Cromwell, RHIA, CCS, and Andrea Curry, RN, BS, CCM Exhibit B Appendix C: Comorbidity Tier Code Lookup Table Source: Program Documentation for DLL Version 2.02 for the CMG Classification System Version 2.00; March 22, 2006; Department of Health and Human Services and the Centers for Medicare & Medicaid Services ( Exhibit C Appendix D: Comorbidities That Were Deleted in V2.00 and V2.02 Source: Program Documentation for DLL Version 2.02 for the CMG Classification System Version 2.00; March 22, 2006; Department of Health and Human Services and the Centers for Medicare & Medicaid Services ( Exhibit D CMS Manual System, Pub Medicare Claims Processing, Transmittal 347; October 29, 2004 Please visit the following Web site to download this Exhibit: Source: Department of Health and Human Services and the Centers for Medicare & Medicaid Services ( Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment v

8 Exhibit E Inpatient Rehabilitation Facility: Patient Assessment Instrument, Form CMS-10036, January 2006 Source: Department of Health and Human Services and the Centers for Medicare & Medicaid Services ( Exhibit F Uniform Bill, Form UB-92 (HCFA-1450) Source: Department of Health and Human Services and the Centers for Medicare & Medicaid Services ( Exhibit G Collection of Articles from JustCoding.com Source: Lisa Eramo, HCPro, Inc. Resources vi Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

9 Agenda I. Overview of PPS: What a hospital has to do to be "excluded" II. III. IV. The 75% rule: A general update a. The rule: What it is and how the FI monitors it b. What the coder can and should do regardless of the size of acute rehab facility c. The "presumptively compliant" list d. How it affects the facility and what one facility did Overview of the IRF-PAI vs. UB-92 a. Review of important coding-related portions of the IRF-PAI b. Etiological versus principal diagnoses c. Comorbidities d. Late effects codes on the UB-92 e. Determining which rules and guidelines apply to each form Coding scenarios on the UB-92 vs. IRF-PAI: The top 13 categories with examples from multitrauma and hip fractures V. Scenario: A real-life example of how it currently works in one facility a. Setting up methods of communication that can work across models b. The benefit of good communication for the coder, the case manager, and patient care VI. Live Q&A Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment vii

10 Speaker profiles Patricia Trela, RHIA Patricia Trela, RHIA is a consultant with PATrela Consulting of Quincy, MA and has over 25 years of experience in health information management. She concentrates principally in the areas of coding, billing, and reimbursement for hospitals and provides both reviews and education on the coding and documentation requirements for facilities reimbursed by the IRF PPS. She was a member of the task force that developed the Functional Independence Measure (FIM) and the Uniform National Data Set for Medical Rehabilitation. She was the 2001 director of education for the AHIMA Society for Clinical Coding and she currently facilitates the AHIMA Community of Practice (COP), Coding for Physical Medicine and Rehabilitation. Margaret Cromwell, RHIA, CCS Margaret Cromwell is an experienced coding professional with more than 20 years of healthcare industry experience. She holds expertise in physician education and health information management, with attention to coding for acute inpatient, acute rehabilitation, and psychiatric and substance abuse treatment facilities. She recently collaborated with HCPro, Inc., on a series of articles for the newsletter JustCoding.com about inpatient rehabilitation coding, and has been a guest speaker for both NJHMA and NJHFMA on coding. Andrea Curry, RN, BS, CCM Andrea M. Curry is a case manager for the JFK Johnson Rehabilitation Institute/Solaris Health System in Edison, NJ, where she works closely with a clinical team and coders reviewing and extracting data, assigning impairment group codes, and coordinating and completing the IRF-PAI. With more than 30 years of experience in the healthcare field, her diversified background includes critical care and acute rehabilitation nursing, risk management, and case management in both an acute-care and acute-rehabilitation setting. She is a member of both the Academy of Certified Case Managers and the New Jersey Case Management Society of America. viii Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

11 Exhibit A Presentation by Patricia Trela, RHIA, Margaret Cromwell, RHIA, CCS, and Andrea Curry, RN, BS, CCM

12 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment Patricia Trela, RHIA Margaret Cromwell, RHIA, CCS Andrea Curry, RN, BS, CCM HCPro Audioconference July 18, Acronyms/Abbreviations CMG CMS DRG FIM TM IGC IRF PAI PPS RIC UDS MR Case Mix Group Center for Medicare & Medicaid Services (formerly HCFA) Diagnosis Related Group Functional Independence Measure Impairment Group Code Inpatient Rehabilitation Facility Patient Assessment Instrument Prospective Payment System Rehabilitation Impairment Category Uniform Data System for Medical Rehabilitation 2 2 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

13 Medicare IRF PPS 1983 DRGs Medicare prospective payment system for acute short stay hospitals implemented One payment for each admission Comorbid conditions can improve the reimbursement Facilities that are exempt continued to receive cost based reimbursement Rehabilitation facilities receive temporary exemption from DRG PPS if they meet certain criteria 3 Medicare IRF PPS Aug 7, 2001 Final rule for Medicare IRF PPS published. Use FIM TM as the measurement instrument. Jan 1, 2002 Start of Program Payment began after start of cost reporting period on or after January 1, 2002 Similar to other Medicare PPS systems Payment based on discharge Discharges assigned to a Case Mix Group (CMG) Single payment for each admission Codes assigned for comorbid conditions can result in additional payment 4 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 3

14 Medicare IRF PPS Covered Services provided to Medicare A fee for service patients All costs of covered inpatient rehabilitation services 5 IRF PPS Exemption Criteria Must have provider agreement Pre-admission screening Patients receive Close medical supervision Rehabilitation nursing PT, OT, ST, social services Orthotic and prosthetic devices Medical Director of Rehabilitation MD or DO Plan of care Patients require and receive 3 hours of therapy 5 days a week 75% of patients must have one of 13 medical conditions 6 4 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

15 That 75% Rule! 7 IRF PPS Exemption Criteria Percentage Required for Compliance Effective for Cost Reporting Periods beginning on or after July 1, 2004 Lowers the percentage of patients required to fall within one of the specified medical conditions 07/01/04 06/30/05 50% 07/01/05 06/30/06 60% 07/01/06 06/30/07 65% 07/01/07 75% Modifies and expands medical conditions listed in the regulatory requirements Conditions reported as comorbidity Provided guidance on verification of the 75% rule 8 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 5

16 IRF PPS Exemption Criteria Percentage Required for Compliance 2006 Congress passed legislation that freezes compliance rate at 60% until 07/01/07 Current Required Percentage 07/01/06 06/30/07: 60% 07/01/07 06/30/08: 65% 07/01/08 : 75% 9 IRF PPS Exemption Criteria Conditions Included in 75% Rule 1. Stroke 2. Spinal Cord Injury 3. Congenital Deformity 4. Amputation 5. Major Multiple Trauma 6. Fracture of Femur (hip fracture) 7. Brain Injury 8. Neurological disorders, including multiple sclerosis, motor neuron disease, polyneuropathy, muscular dystrophy and Parkinson s disease 9. Burns 10 6 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

17 IRF PPS Exemption Criteria Conditions Included in 75% Rule 10. Active Polyarticular Rheumatoid Arthritis, Psoriatic Arthritis, and Seronegative Arthropathies 11. Systemic Vasculidities with joint inflammation Results in significant functional impairment of ambulation and ADLs Not improved, after sustained course of outpatient therapy or in other less intensive rehabilitation setting immediately prior to IRF admission or Results from systemic disease activation immediately before admission Potential to improve with intensive rehabilitation 11 IRF PPS Exemption Criteria Conditions Included in 75% Rule 12. Severe or advanced osteoarthritis (osteoarthrosis or degenerative joint disease) Only joints without joint replacement will be counted as joints with arthritis Osteoarthritis in two major, weight bearing joints (Shoulders, Elbows, Hips, Knees) Severe osteoarthritis manifested by Joint deformity Loss of range of motion Atrophy of surrounding muscles Impairment of ambulation and activities of daily living 12 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 7

18 Conditions Included in 75% Rule 13. Knee or hip joint replacement, or both immediately preceding inpatient rehabilitation stay and one or more of the following Bilateral knee or hip joint replacement during acute hospitalization immediately preceding the IRF admission Extremely obese, Body Mass Index (BMI) at least 50, at time of admission to IRF Age 85 or older, at time of admission to the IRF 13 IGCs Identified as Meeting the Rule RIC 01 Stroke IGC 01.1 Left Body (Right Brain) IGC 01.2 Right Body (Left Brain) IGC 01.3 Bilateral IGC 01.4 No Paresis IGC 01.9 Other Stroke 14 8 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

19 IGCs Identified as Meeting the Rule RIC 02 and 03 Brain Injury IGC 02.1 Non-traumatic Brain Dysfunction Excluded etiologic codes Alzheimer s Disease Senile Degeneration of the brain Benign neoplasm of head, face and neck IGC Traumatic Brain Dysfunction, open IGC Traumatic Brain Dysfunction, closed 15 IGCs Identified as Meeting the Rule RIC 04 and 05 Spinal Cord Injury (SCI) IGCs Non Traumatic SCI Excluded etiologic codes Spinal stenosis, cervical Spinal stenosis, other than cervical IGCs Traumatic SCI Excluded etiologic codes Injury to nerve roots and spinal plexus 16 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 9

20 IGCs Identified as Meeting the Rule RIC 06 Neurological Disorders IGC 03.1 Multiple Sclerosis IGC 03.2 Parkinsonism IGC 03.5 Cerebral Palsy IGC 03.8 Neuromuscular Disorders For all others, use diagnoses 17 IGCs Identified as Meeting the Rule RIC 07 Hip Fracture IGC Unilateral Hip Fracture IGC Bilateral Hip Fracture Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

21 IGCs Identified as Meeting the Rule RIC 08 Bilateral Knee or Bilateral Hip Joint Replacements IGC Bilateral Hip Replacements IGC Bilateral Knee Replacements IGC Knee and Hip Replacements, different sides RIC 08 Joint Replacements, Patient age 85 or more IGC Unilateral Hip Replacement IGC Unilateral Knee Replacement IGC Knee and Hip Replacements, same side 19 IGCs Identified as Meeting the Rule RIC 08 Joint Replacements, Patient Body Mass Index 50 or more Codes not applicable. Determination of matching this medical condition based on medical record review. 20 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 11

22 IGCs Identified as Meeting the Rule RIC 10 Amputation IGC 05.1 Unilateral upper limb above the elbow (AE) IGC 05.2 Unilateral upper limb below the elbow (BE) Excludes etiologic diagnosis codes Traumatic amputation of thumb w/o complication Traumatic amputation of thumb, complicated Traumatic amputation of other fingers w/o complication Traumatic amputation of other fingers, complicated 21 IGCs Identified as Meeting the Rule RIC 10 Amputation IGC 05.3 Unilateral lower limb above knee (AK) IGC 05.4 Unilateral lower limb below the knee (AK) Excludes etiologic diagnosis codes Unilateral Traumatic amputation of foot w/o complication Unilateral Traumatic amputation of foot, complicated Bilateral Traumatic amputation of foot w/o complication Bilateral Traumatic amputation of foot, complicated Traumatic amputation of toes 12 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

23 IGCs Identified as Meeting the Rule RIC 10 Amputation IGC 05.6 Bilateral lower limb above/below knee(ak/bk) IGC 05.7 Bilateral lower limb below the knee (BK/BK) 23 IGCs Identified as Meeting the Rule RIC 12 Osteoarthritis Involving two or more major joints (hips, knees, shoulders, and elbows), not counting any joints with a prosthesis 24 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 13

24 IGCs Identified as Meeting the Rule RIC 13 Rheumatoid Arthritis IGC 06.1 Rheumatoid arthritis* IGC 06.9 Other arthritis* Excludes etiologic diagnoses codes Systemic sclerosis 711.0x Pyogenic arthritis 716.xx Other and unspecified arthropathies *Must meet additional criteria 25 IGCs Identified as Meeting the Rule Systemic Vasculidities IGC 06.9 Other Arthritis* Excludes etiologic diagnosis codes Systemic sclerosis 711.0x Pyogenic arthritis 716.xx Other and unspecified arthropathies *Must meet additional criteria Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

25 IGCs Identified as Meeting the Rule RIC 17 and 18 Major Multiple Trauma (MMT) IGC 14.1 MMT Brain + Spinal Cord IGC 14.2 MMT Brain + Multiple Fractures/Amputation IGC 14.3 MMT Spinal Cord + Mult Fractures/Amputat IGC 14.9 Other Multiple Trauma Excludes etiologic diagnosis codes Pubis, closed Pubis, open Other specified part of pelvis, open Unspecified part of pelvis, closed Unspecified part of pelvis open 27 IGCs Identified as Meeting the Rule RIC 20 Miscellaneous IGC 12.1 Spina Bifida IGC 12.9 Other Congenital Deformities 28 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 15

26 IGCs Identified as Meeting the Rule RIC 21 Burns IGC 11 Burns 29 What s not Included in the Rule RIC 14 Cardiac Conditions RIC 15 Pulmonary Disorders RIC 16 Pain Syndromes RIC 20 Miscellaneous IGC 13 Other Disabling Impairments IGC 15 Developmental Disability IGC 16 Debility IGC 17 Medically Complex Conditions Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

27 Fiscal Intermediary Monitors Compliance with 75% Rule Verification Process Compliance Review Period Data from most recent, consecutive, 12 month time period Begins with data 4 months prior to start of IRF s cost reporting period Types of Data Use IRF-PAI data Compare specific ICD-9-CM and Impairment Group codes (Listed in Transmittal 938) for guidance or by medical judgment 31 Fiscal Intermediary Monitors Compliance with 75% Rule Verification Process FI reports to Regional Office (RO) if facility is compliant FI or RO has discretion to request medical records Facility that does not meet 75% Rule could lose exemption Facility that is not exempt could be paid by DRGs Cases paid by DRG 462 Less than optimal reimbursement 32 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 17

28 How the 75% Rule Affects IRF Patient access to acute inpatient rehabilitation facilities Reduced patient access to acute rehabilitation facilities Full implementation will probably see 25 30% previously admitted turned away IRFs are the only rehab setting that provide medical supervision trained in Rehabilitation IRFs provide a multidisciplinary approach to maximize patient outcomes 33 How the 75% Rule Affects IRF IRFs transition for compliance under the 75% rule It is more important now than ever before to maintain and/or improve length of stay and reduce/control costs Effective case management and preadmission screening are vital to monitor compliance level Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

29 How the 75% Rule Affects IRF How an IRF can cope with the 75% rule Develop a PPS/75% rule task force include Case Managers, Preadmission Coordinators, Directors of Nursing, and Therapy and Medical Director Meet with adjunct departments include Health Information personnel, Information System personnel, billing, and Finance In-service referral sources include Physicians, Social Workers, and Case Managers 35 How the 75% Rule Affects IRF Changes required by the IRF Documentation changes assure all data required for the IRF-PAI and supporting the submitted data is clearly documented on the medical record Data collection and transmission issues select personnel and method of data collection, maintenance of the database, method of collecting and entering the data, and transmission of data to CMS 36 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 19

30 Overview of the IRF-PAI and UB-92 Codes Conditions coded and coding guidelines for the IRF-PAI and UB-92 are different IRF-PAI Official Coding Guidelines do not apply for assignment of a code for the Etiology Official Coding Guidelines are used to report codes for comorbid conditions and complications UB-92 Official Coding Guidelines are used to report codes 37 Overview of the IRF-PAI and UB-92 Codes IRF-PAI and UB-92 Compared IRF-PAI Impairment Group Code Etiology Comorbid conditions Complications Not if identified the day prior to or the day of discharge UB-92 Principal Diagnosis Secondary Diagnoses Comorbid conditions Complications Other conditions affecting the length of stay or outcome Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

31 IRF-PAI 39 IRF-PAI Items that Require Codes Determining which rules and guidelines apply to each form The IRF-PAI #21 - Impairment Group #22 - Etiologic Diagnosis #23 - Date of Onset of Impairment #24 - Comorbid Conditions #46 - Diagnosis for Interruption or Death #47 - Complications During Rehabilitation Stay 40 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 21

32 IRF-PAI Items that Require Codes Item #21 Impairment Group 85 Impairment Group Codes Assigned by facility 21 Rehab Impairment Categories Assigned by computer software 41 IRF-PAI Items that Require Codes Item #21 Impairment Group Admission and Discharge IGC are usually the same When the patient develops a second impairment that requires more resources than the admission impairment, the second impairment is reported as the discharge IGC Note: This will not change the CMG Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

33 IRF-PAI Items that Require Codes Item #21 Impairment Group Code Assignments Impairment Group Code Choose the code that best reflects why the patient was admitted to the Rehab facility In my facility, the code is assigned by the Case Manager In other facilities, the code may be assigned by the coder, etc. Proper selection ensures appropriate Case Mix Group (CMG) assignment for payment 43 IRF-PAI Items that Require Codes Item #22 Etiologic Diagnosis What diagnosis or condition led to the impairment? The acute condition that caused the impairment Diagnosis must be documented in the IRF medical record Impairment previously treated by a completed IRF program report a code for late effect, status post, or history of the acute condition if no additional event has occurred Unclear documentation review the medical record from the acute care hospital for clues as to the etiological diagnosis 44 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 23

34 IRF-PAI Items that Require Codes Item #22 Etiologic Diagnosis Code Assignments Etiologic Diagnosis Choose the code that reflects what caused the impairment i.e., Impairment Amputation, Etiology Gangrene Coding rules do not apply here How to obtain consistency between the impairment group code and etiology when assigned by different people What to do? Query the physician Request the physician to document the etiology 45 Date of Onset of Impairment The date that the event occurred that caused the impairment Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

35 IRF-PAI Items that Require Codes Item #23 Date of Onset of Impairment Code Assignments Date of Onset of Impairment Enter the date of admission to the acute care hospital, the date of injury, or the date of surgery For instructions on coding the date of onset refer to IRF-PAI training manual pages II-15 through II IRF-PAI Items that Require Codes Item #24 Comorbid Conditions A Comorbid condition is a specific medical condition that affects a patient Conditions that co-exist at the time of admission other than the etiology or the impairment that require clinical evaluation, diagnostic procedures, therapeutic treatment, extend the length of stay, or increased nursing care and/or monitoring. 48 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 25

36 IRF-PAI Items that Require Codes Item #24 Comorbid Conditions Conditions that are still under treatment when the patient is admitted to the IRF should be reported on the IRF-PAI Do not report conditions that Resolve in the acute hospital prior to admission Relate to an earlier episode of care 49 IRF-PAI Items that Require Codes Item #24 Comorbid Conditions Code Assignments Comorbid Conditions Enter conditions that affect the patient in addition to the etiologic diagnosis Can include V-codes Enter codes for conditions diagnosed during the Rehab stay Coding rules do apply here Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

37 The Impact of Comorbid Conditions Comorbidities play an important role in providing payment Comorbidities are divided into 3 tiers that affect reimbursement and length of stay Payment will be for the highest ranking comorbidity for that stay 51 IRF-PAI Items that Require Codes Item #46 Diagnosis for Interruption or Death The reason for interruption of stay or death 52 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 27

38 IRF-PAI Items that Require Codes Item #46 Diagnosis for Interruption or Death Diagnosis for Interruption or Death (even if on last day) If more than one interruption, report the most significant diagnosis 53 IRF-PAI Items that Require Codes Item #47 Complications A complication is a condition that develops or is first discovered during the IRF admisssion Complications or Comorbid Conditions that are discovered on the day prior to discharge or the day of discharge are not reported on the IRF- PAI (Report on the UB-92) Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

39 IRF-PAI Items that Require Codes Item #47 Complications Complications Enter the ICD-9-CM code that reflect complications and/or comorbidities that are identified after the admission to the Rehab facility 55 UB Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 29

40 Code Assignment for the UB-92 ICD-9-CM Official Guidelines for Coding and Reporting, effective 12/01/05, apply to codes assigned for the UB-92 Provided by CMS and NCHS Approved by the four Cooperating parties for ICD-9-CM (AHA, AHIMA, CMS, NCHS) apply to coding for the UB-92 Principal Diagnosis: Use one code from V57 V57.89 Other specified rehabilitation procedure (multiple training or therapy) V57.81 Orthotic training (gait training in the use of artificial limbs) 57 Code Assignment for the UB-92 Aftercare codes: Fractures use V54.1x 0- V54.29, V54.89 Joint replacement, V54.81 Other orthopedic aftercare - V54.89 Use late effects codes as applicable Stroke ( ) Burns ( ) Traumatic head injuries (905.0 and 907.0) Spinal cord injuries (907.2), etc. Some require an additional code. Do not use for conditions no longer present Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

41 Code Assignment for the UB-92 Other diagnosis are reported that require clinical evaluation, diagnostic procedures, therapeutic treatment, extend the length of stay, or increased nursing care and/or monitoring. Complications requiring transfer are coded: Pneumonia Cardiac dysrhythmias Respiratory failure 59 Scenario: A real life example of how it currently works in one facility Setting up methods of communication that can work across models Monitoring compliance level Documentation Step by step 60 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 31

42 Scenario: A real life example of how it currently works in one facility Monitoring compliance level Designate one person to monitor the facility s compliance level on a daily basis Compliance: a team approach Preadmission Coordinators and Physician Advisor Case Manager Attending Physicians and Residents Coders 61 Scenario: A real life example of how it currently works in one facility Documentation The IRF-PAI is not a documentation tool, but a data collection tool IRF-PAI ICD-9-CM codes must be substantiated in the medical record Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

43 Scenario: A real life example of how it currently works in one facility Step-by-Step Preadmission Coordinator screens referred patient, establishes need for admission, and assigns the admission diagnosis Rehab attending Physician and Resident performs the admission assessment and completes the H&P 63 Scenario: A real life example of how it currently works in one facility Case Manager reviews the medical record and assigns the Impairment code If questions arise regarding the Impairment Group and/or comorbidites, consult with the physician If necessary, ask the physician for additional supporting documentation 64 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 33

44 Scenario: A real life example of how it currently works in one facility Coder reviews the medical record and transfer record. Enters the Etiologic diagnosis and comorbid conditions If questions arise or additional documentation is needed for tier level comorbidities, query the physician 65 Scenario: A real life example of how it currently works in one facility Multi-disciplinary treatment team team rounds Facilitated by the Case Manager Disseminate the patient s Impairment group, CMG, and its associated average length of stay Set the anticipated discharge date The focus is placed on patient needs and barriers to discharge to the community Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

45 Scenario: A real life example of how it currently works in one facility The benefit of good communication for both the coder and the case manager Case Managers and Coders are now best friends Enhances tier level comorbidity detection and compliance with the 75% rule Interaction heightens awareness Review, compare, and consult on each others work Include the physician in discussions regarding coding and the IRF-PAI 67 CASE STUDIES 68 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 35

46 CASE #1 Stroke (#1) A right-handed 85-year old male has a spontaneous subarachnoid hemorrhage on the left side of his brain resulting in right (dominant) sided hemiplegia, dysarthria (slurred speech) and homonymous hemianopsia. This patient had a cerebral infarction a year ago from which he has dysphagia (difficulty swallowing) as a late effect. He has had a gastrostomy tube since that time and receives tube feedings. 69 CASE #1 Stroke (#1) IRF-PAI Impairment Group 01.2 Stroke with right body involvement Etiology 430 Subarachnoid hemorrhage Comorbid Conditions Hemiparesis, affecting dominant side Dysphagia/slurred speech Homonymous hemianopsia Dysphagia as late effect of prior old stroke (Tier 2) V44.1 Gastrostomy status Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

47 CASE #1 Stroke (#1) UB-92 Principal Diagnosis V57.89 Admission for rehabilitation with multiple therapies Additional Diagnosis Hemiplegia dominant/late effect SAH Dysphasia as late effect of SAH Visual disturbance late effect SAH Homonymous hemianopsia Dysphagia as late effect of prior old stroke V44.1 Gastrostomy status Principal Procedure 96.6 Procedure: Tube feeding 71 CASE #2 Stroke (#2) A 75-year old right-handed female suffers a cerebral infarction on the right side of her brain resulting in left-sided (non-dominant) hemiparesis, dysphagia (difficulty swallowing) and dysarthria (slurred speech). 72 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 37

48 CASE #2 Stroke (#2) IRF-PAI Impairment Group Code 01.1 Stroke with left body involvement Etiology Cerebral infarction Comorbid Conditions Dysphagia Dysarthria 73 CASE #2 Stroke (#2) UB-92 Principal Diagnosis V57.89 Admission for rehabilitation with multiple therapies Additional Diagnosis Hemiplegia affecting nondominant side as late effect of cerebral infarction Dysphagia as late effect of cerebral infarction Dysarthria/slurred speech as late effect of cerebral infarction Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

49 CASE #3 Non-traumatic Brain Dysfunction This 62-year old female was independent until a few weeks prior to admission when she developed difficulty ambulating. CT of the head showed hydrocephalus and she was admitted to the acute care hospital for placement of a ventriculoperitoneal shunt. She is also treated for hypertension and acute renal failure which is resolving. She was transferred to the IRF to regain independence with bed mobility, transfers, ambulation and self care. 75 CASE #3 Non-traumatic Brain Dysfunction IRF-PAI Impairment Group Code 02.1 Non-traumatic brain dysfunction Etiology Communicating hydrocephalus Comorbid Conditions Hypertension Acute renal failure V45.2 Presence of cerebrospinal fluid drainage device 76 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 39

50 CASE #3 Non-traumatic Brain Dysfunction UB-92 Principal Diagnosis V57.89 Admission for rehabilitation with multiple therapies Additional Diagnosis Communicating hydrocephalus Hypertension Acute renal failure V45.2 Presence of cerebrospinal fluid drainage device 77 CASE #4 Non-traumatic Brain Dysfunction This is a 60-year old gentleman who suffered anoxic brain damage as a complication during his coronary artery bypass procedure Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

51 CASE #4 Brain Dysfunction IRF-PAI Impairment Group Code 02.1 Non-traumatic brain dysfunction Etiology Anoxic brain damage Comorbid Conditions Postop central nervous system complication Coronary atherosclerosis of unspecified type of vessel, native, or graft V45.81 Aortocoronary bypass status 79 CASE #4 Brain Dysfunction UB-92 Principal Diagnosis V57.89 Admission for rehabilitation with multiple therapies Additional Diagnosis Postop central nervous system complication Anoxic brain damage Coronary atherosclerosis of unspecified type of vessel, native, or graft V45.81 Aortocoronary bypass status 80 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 41

52 CASE #5 Traumatic Brain Dysfunction This 45-year old male was in a motorcycle crash and was diagnosed with traumatic brain injury and right tibial fracture. He had a tracheostomy placed due to vent-dependent respiratory failure. He was weaned off the vent and transferred to the IRF for rehabilitation of cognitive deficits and ambulation dysfunction. During the IRF stay, the tracheostomy was removed. 81 CASE #5 Traumatic Brain Dysfunction IRF-PAI Impairment Group Code Closed Traumatic Brain Dysfunction Etiology Intracranial injury of other and unspecified nature without mention of open intracranial wound with unspecified loss of consciousness Comorbid Conditions V55.0 Attention to tracheostomy V54.16 Aftercare for healing traumatic fracture of lower leg Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

53 CASE #5 Traumatic Brain Dysfunction UB-92 Principal Diagnosis V57.89 Admission for rehabilitation with multiple therapies Additional Diagnosis Cognitive change due to conditions classified elsewhere Late effect of intracranial injury without mention of skull fracture V55.0 Attention to tracheostomy V54.16 Aftercare for healing traumatic fracture of lower leg Procedure Removal of tracheostomy tube 83 CASE #6 Neurological Disorders This is a 50-year old female who has been diagnosed with Amyotrophic Lateral Sclerosis (a.k.a. Lou Gehrig s Disease) and whose disease has progressed upward to the extent that she now has paralysis of both lower limbs. On admission she has a pulmonary infiltrate diagnosed in the acute hospital for which she is still on antibiotics and a cystostomy that is being attended to by the nursing staff. 84 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 43

54 CASE #6 Neurological Disorders IRF-PAI Impairment Group Code 03.8 Other Neurologic Etiology Amyotrophic Lateral Sclerosis (ALS) a.k.a. Lou Gehrig s disease Comorbid Conditions Paraplegia V55.5 Attention to cystostomy Pulmonary infiltrate (Tier 3) 85 CASE #6 Neurological Disorders UB-92 Principal Diagnosis V57.89 Admission for rehabilitation with multiple therapies Additional Diagnosis Amyotrophic Lateral Sclerosis (ALS) a.k.a. Lou Gehrig s disease Paraplegia V55.5 Attention to cystostomy Pulmonary infiltrate Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

55 CASE #7 Non-traumatic Spinal Cord Dysfunction The 68-year old female was transferred to the IRF from the acute care facility with paraplegia following surgical removal of metastatic disease from the lumbar vertebrae. The patient had a right mastectomy to treat a breast malignancy in December CASE #7 Non-traumatic Spinal Cord Dysfunction IRF-PAI Impairment Group Code Paraplegia, unspecified Etiology Secondary malignant neoplasm of bone Comorbid Conditions V10.3 History of breast malignancy V45.71 Acquired absence of breast 88 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 45

56 CASE #7 Non-traumatic Spinal Cord Dysfunction UB-92 Principal Diagnosis V57.89 Admission for rehabilitation with multiple therapies Additional Diagnosis Paraplegia V58.42 Aftercare following surgery for neoplasm V10.3 History of breast malignancy V45.71 Acquired absence of breast 89 CASE #8 Non-traumatic Spinal Cord Injury This is a 65-year old gentleman who has severe lumbar degenerative disc disease with spinal cord impingement and subsequent paraplegia who is afraid to have surgery due to a poor history of healing due to his advanced type 2 diabetes. His efforts in outpatient rehab have met with limited success. He is admitted now for multiple therapies under medical supervision as well as continued treatment for his diabetic neuropathy to maintain his muscle mass and to attempt to relieve his pain Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

57 CASE #8 Non-traumatic Spinal Cord Injury IRF-PAI Impairment Group Code Non-traumatic spinal cord with paraplegia, incomplete Etiology Lumbar DDD with myelopathy Comorbid Conditions Type 2 diabetes with neurologic manifestation Polyneuropathy and diabetes Gastroparesis 91 CASE #8 Non-traumatic Spinal Cord Injury UB-92 Principal Diagnosis V57.89 Admission for rehabilitation with multiple therapies Additional Diagnosis Lumbar DDD with myelopathy Type 2 diabetes with neurologic manifestation Polyneuropathy and diabetes Gastroparesis 92 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 47

58 CASE #9 Traumatic Spinal Cord Dysfunction This 45-year old male was transferred to the IRF for rehabilitation of T-8 fracture with paraplegia following a fall from a 2 nd story porch. He has a neurogenic bladder and a history of hypoxia due to sleep apnea. 93 CASE #9 Traumatic Spinal Cord Dysfunction IRF-PAI Impairment Group Code Paraplegia, unspecified Etiology T-8 fracture with unspecified spinal cord injury Comorbid Conditions Neurogenic bladder Sleep apnea Sleep related hypoxia Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

59 CASE #9 Traumatic Spinal Cord Dysfunction UB-92 Principal Diagnosis V57.89 Admission for rehabilitation with multiple therapies Additional Diagnosis Paraplegia Late effect of spinal cord injury Neurogenic bladder Sleep apnea Sleep related hypoxia 95 CASE #10 Unilateral Knee Amputation This is a 55-year old with type 2 diabetic arteriosclerotic peripheral vascular disease with gangrene who is admitted following an above the knee amputation. He also suffers from diabetic neuropathy. 96 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 49

60 CASE #10 Unilateral above the knee amputation IRF-PAI Impairment Group Code 05.3 Unilateral above knee amputation (AKA) Etiology Gangrene Comorbid Conditions Type 2 diabetes with peripheral circulatory disorders Arthrosclerosis of the extremities Diabetic Polyneuropathy and diabetes 97 CASE #10 Above the knee amputation UB-92 Principal Diagnosis V57.89 Admission for rehabilitation with multiple therapies Additional Diagnosis V58.49 Other specified aftercare following surgery V49.76 Status above knee amputation (AKA) Type 2 diabetes with peripheral circulatory disorders Arthrosclerosis of the extremities Diabetic Polyneuropathy and diabetes Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

61 CASE #11 Rheumatoid Arthritis This is a 75-year old patient who suffers with rheumatoid arthritis complicated by morbid obesity. She has a history of a total hip replacement in the past. 99 CASE #11 Rheumatoid Arthritis IRF-PAI Impairment Group Code 06.1 Rheumatoid Arthritis Etiology Rheumatoid Arthritis Comorbid Conditions Morbid obesity (Tier 3) V43.64 Status of hip replacement 100 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 51

62 CASE #11 Rheumatoid Arthritis UB-92 Principal Diagnosis V57.89 Admission for rehabilitation with multiple therapies Additional Diagnosis Rheumatoid Arthritis Morbid obesity (Tier 3) V43.64 Status of hip replacement 101 CASE #12 Osteoarthritis This is a 75-year old female who suffers from osteoarthritis of multiple sites (shoulders, hips, knees, fingers) who, due to her arthritis, is losing her mobility. She also suffers from a slow bleeding chronic stomach ulcer from years of taking NSAIDS for her arthritis and as a result also has chronic blood loss anemia. She is admitted now for multiple therapies to increase her mobility and build up her strength while receiving medical supervision of her ulcer and anemia Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

63 CASE #12 Osteoarthritis IRF-PAI Impairment Group Code 06.2 Osteoarthritis Etiology Osteoarthritis involving multiple sites, not specified as generalized Comorbid Conditions Chronic stomach ulcer with hemorrhage (Tier 3) Chronic blood loss anemia 103 CASE #12 Osteoarthritis UB-92 Principal Diagnosis V57.89 Admission for rehabilitation with multiple therapies Additional Diagnosis Osteoarthritis involving multiple sites, not specified as generalized Chronic stomach ulcer with hemorrhage (Tier 3) Chronic blood loss anemia 104 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 53

64 CASE #13 Systemic Vasculidities This is a 45-year old female who has suffered a recent exacerbation of her systemic lupus erythematosus. She also suffers from Raynaud s disease which has also been more of an issue recently due to her increased stress over this recent flare up of her SLE. 105 CASE #13 Systemic Vasculidities IRF-PAI Impairment Group Code 06.9 Other Arthritis Etiology Systemic Lupus Erythematosus Comorbid Conditions Raynaud s phenomenon Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

65 CASE #13 Systemic Vasculidities UB-92 Principal Diagnosis V57.89 Admission for rehabilitation with multiple therapies Additional Diagnosis Systemic Lupus Erythematosus Raynaud s phenomenon 107 CASE #14 Hip Fracture This is a 85-year old gentleman who twisted his leg and fell backwards while carrying out the garbage. He suffered a subcapital hip fracture requiring a hip replacement. His postoperative course was further complicated by a femoral deep vein thrombosis for which he is undergoing treatment as well while in rehab. 108 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 55

66 CASE #14 Hip Fracture IRF-PAI Impairment Group Code Status Post Unilateral Hip Fracture Etiology Subcapital hip fracture Comorbid Conditions V43.64 Status prosthetic hip joint Femoral deep vein thrombosis (DVT) (Tier 3) 109 CASE #14 Hip Fracture UB-92 Principal Diagnosis V57.89 Admission for rehabilitation with multiple therapies Additional Diagnosis V54.81 Aftercare following joint replacement V43.64 Status prosthetic hip joint Postop peripheral vascular complication Femoral deep vein thrombosis (DVT) (Tier 3) Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

67 CASE #15 Multiple Fractures This 76-year old male was an unrestrained driver in an automobile that hit a tree. He sustained closed fractures of the left tibia, left fibula and left humerus. He has a history of hypertension and COPD. 111 CASE #15 Multiple Fractures IRF-PAI Impairment Group Code 08.4 Major multiple fractures Etiology Multiple fractures involving lower with upper limb Comorbid Conditions 496 COPD Hypertension unspecified 112 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 57

68 CASE #15 Multiple Fractures UB-92 Principal Diagnosis V57.89 Admission for rehabilitation with multiple therapies Additional Diagnosis V54.16 Aftercare for healing traumatic fracture of lower leg V54.11 Healing traumatic fracture of upper arm 496 COPD Hypertension 113 CASE #16 Bilateral Knee Replacements This 53-year old female has suffered for years with painful osteoarthritis in both knees. She began to lose her mobility to the point that bilateral knee replacements were her only option. Mary also has a history of combined systolic and diastolic hear failure that flared up after surgery for which she is still receiving treatment Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

69 CASE #16 Bilateral Knee Replacements IRF-PAI Bilateral Knee Replacements Status Post Bilateral Knee Replacements Etiology Osteoarthrosis, localized, not specified whether primary or secondary, lower leg Comorbid Conditions Combined systolic and diastolic heart failure, unspecified (Tier 3) 115 CASE #16 Bilateral Knee Replacements UB-92 Principal Diagnosis V57.89 Admission for rehabilitation with multiple therapies Additional Diagnosis V54.81 Aftercare following joint replacement V43.65 Status prosthetic knee joint(s) Combined systolic and diastolic heart failure, unspecified (Tier 3) 116 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 59

70 CASE #17 Burns This 19-year old college student, sprayed his aerosolized hair spray at a lit cigarette lighter. The ensuing large flame ignited his clothing. He suffered third degree burns on his hair, face, chest, trunk, right arm, and both legs. He suffered smoke inhalation from the subsequent fire in his dorm room and acute pulmonary edema due to the fumes and vapors of the other materials burning in his room. Due to the smoke inhalation and burns he is also suffering from dysphagia. 117 CASE #17 Burns: Impairment Group 11 IRF-PAI Impairment Group Code 11 Burns Etiology Burns over 50% body; 30-39% of which are third degree Comorbid Conditions Third-degree burns of multiple sites Smoke inhalation Dysphagia (Tier 1) Acute Pulmonary Edema due to fumes/vapors (Tier 3 cc) Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

71 CASE #17 Burns UB-92 Principal Diagnosis V57.89 Admission for rehabilitation with multiple therapies Additional Diagnosis Burns over 50% of body surface, 30-39% of which are third-degree burns Third-degree burns of multiple sites Smoke inhalation Dysphagia (Tier 1) Acute Pulmonary Edema due to fumes/vapors (Tier 3) E891.2 Hotel building fire E849.6 Hotel Principal Procedure Surgical debridement Nonexcisional debridement 119 CASE #18 Congenital Deformities This 14-year old was born with congenital hemiplegic cerebral palsy which also resulted in dysphagia. He has acquired contractures of both his lower left leg and left forearm. John also has a urinary tract infection due to pseudomonas for which he is on antibiotic. John is admitted for multiple therapies as well as botox injections for his contractures. 120 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 61

72 CASE #18 Congenital Deformities IRF-PAI Impairment Group Code 12.9 Other Congenital Deformities Etiology Cerebral Palsy hemiplegia Comorbid Conditions Dysphagia (Tier 2) Acquired joint contracture lower leg Acquired joint contracture forearm UTI Due to pseudomonas (Tier 2) 121 CASE #18 Congenital Deformities UB-92 Principal Diagnosis V57.89 Admission for rehabilitation with multiple therapies Additional Diagnosis Cerebral Palsy hemiplegia Dysphagia Acquired joint contracture lower leg Acquired joint contracture forearm UTI Due to pseudomonas (Tier 2) Principal Procedure 04.2 Botox injection Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

73 CASE #19 Major Multiple Trauma This 56-year old was in a 2-car MVA in which he suffered a closed head injury with subarachnoid hemorrhage and prolonged loss of consciousness with eventual return to his pre-existing state. He is on antibiotics for aspiration pneumonia. He has hemiplegia, dysphagia, aphasia, and cognitive deficits due to his head injury and is receiving aftercare for fractures of his hip, tibia and fibula. He has a tracheostomy and, although conscious, is stuporous or drowsy. He is admitted for multiple therapies and extensive acute rehab. 123 CASE #19 Major Multiple Trauma: Brain & multiple fractures Impairment Group: 14.2 IRF-PAI Impairment Group Code 14.2 Major Mult Trauma Brain and Spinal Cord Etiology Closed head injury SAH/prolonged LOC and return to pre-existing state Comorbid Conditions Hemiplegia Dysphagia Aphasia Cognitive deficit Aspiration Pneumonia (Tier 3) V54.13 Aftercare fx hip V54.16 Aftercare fx tibia/fibula 124 V55.0 Attention to tracheostomy (Tier 1) Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 63

74 CASE #19 Major Multiple Trauma UB-92 Principal Diagnosis V57.89 Admission for rehabilitation with multiple therapies Additional Diagnosis Hemiparesis Dysphagia Cognitive deficit Drowsiness, stupor Late effects of closed head injury Aspiration Pneumonia (on meds) V54.13 Aftercare of hip fracture V54.16 Aftercare of fractured tibia/fibula V55.0 Aftercare of tracheostomy E929.0 Late effect of motor vehicle accident Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

75 Exhibit B Appendix C: Comorbidity Tier Code Lookup Table Source: Program documentation for DLL Version 2.02 for the CMG Classification System Version 2.00; March 22, 2006; Department of Health & Human Services and the Centers for Medicare & Medicaid Services (

76 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added Tier Change RIC Exclude Change VOCAL PARAL UNILAT PART VOCAL PARAL UNILAT TOTAL VOCAL PARAL BILAT PART VOCAL PARAL BILAT TOTAL EDEMA OF LARYNX 1 15 V44.0 TRACHEOSTOMY STATUS 1 yes V45.1 RENAL DIALYSIS STATUS 1 yes V55.0 ATTENTION TO TRACHEOSTOMY 1 yes PSEUDOMONAS ENTERITIS INT INF CLSTRDIUM DFCILE PSEUDOMONAS INFECT NOS CANDIDIASIS OF LUNG 2 15 yes DISSEMINATED CANDIDIASIS 2 yes CANDIDAL ENDOCARDITIS 2 14 yes CANDIDAL MENINGITIS 2 03,05 yes CANDIDAL ESOPHAGITIS 2 yes LATE EF CV DIS DYSPHAGIA INTEST POSTOP NONABSORB 2 yes GANGRENE 2 10, DYSPHAGIA SIRS NOS SIRS INF W/O ORG DYS SIRS INF W ORG DYS SIRS NON-INF W/O ORG DYS SIRS NON-INF W ORG DYS PULMONARY TUBERCULOSIS* 3 15 yes TB OF LUNG, INFILTRATIVE* 3 15 yes TB LUNG INFILTR-UNSPEC 3 15 yes TB LUNG INFILTR-NO EXAM 3 15 yes TB LUNG INFILTR-EXM UNKN 3 15 yes TB LUNG INFILTR-MICRO DX 3 15 yes TB LUNG INFILTR-CULT DX 3 15 yes TB LUNG INFILTR-HISTO DX 3 15 yes TB LUNG INFILTR-OTH TEST 3 15 yes TB OF LUNG, NODULAR* 3 15 yes TB LUNG NODULAR-UNSPEC 3 15 yes TB LUNG NODULAR-NO EXAM 3 15 yes TB LUNG NODUL-EXAM UNKN 3 15 yes TB LUNG NODULAR-MICRO DX 3 15 yes TB LUNG NODULAR-CULT DX 3 15 yes TB LUNG NODULAR-HISTO DX 3 15 yes TB LUNG NODULAR-OTH TEST 3 15 yes 1 The only Appendix C change with DLL Version 2.02 was to remove Overweight from this appendix. Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). 66 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

77 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added Tier Change TB OF LUNG W CAVITATION* 3 15 yes TB LUNG W CAVITY-UNSPEC 3 15 yes TB LUNG W CAVITY-NO EXAM 3 15 yes TB LUNG CAVITY-EXAM UNKN 3 15 yes TB LUNG W CAVIT-MICRO DX 3 15 yes TB LUNG W CAVITY-CULT DX 3 15 yes TB LUNG W CAVIT-HISTO DX 3 15 yes TB LUNG W CAVIT-OTH TEST 3 15 yes TUBERCULOSIS OF BRONCHUS* 3 15 yes TB OF BRONCHUS-UNSPEC 3 15 yes TB OF BRONCHUS-NO EXAM 3 15 yes TB OF BRONCHUS-EXAM UNKN 3 15 yes TB OF BRONCHUS-MICRO DX 3 15 yes TB OF BRONCHUS-CULT DX 3 15 yes TB OF BRONCHUS-HISTO DX 3 15 yes TB OF BRONCHUS-OTH TEST 3 15 yes TB FIBROSIS OF LUNG* 3 15 yes TB LUNG FIBROSIS-UNSPEC 3 15 yes TB LUNG FIBROSIS-NO EXAM 3 15 yes TB LUNG FIBROS-EXAM UNKN 3 15 yes TB LUNG FIBROS-MICRO DX 3 15 yes TB LUNG FIBROSIS-CULT DX 3 15 yes TB LUNG FIBROS-HISTO DX 3 15 yes TB LUNG FIBROS-OTH TEST 3 15 yes TB BRONCHIECTASIS* 3 15 yes TB BRONCHIECTASIS-UNSPEC 3 15 yes TB BRONCHIECT-NO EXAM 3 15 yes TB BRONCHIECT-EXAM UNKN 3 15 yes TB BRONCHIECT-MICRO DX 3 15 yes TB BRONCHIECT-CULT DX 3 15 yes TB BRONCHIECT-HISTO DX 3 15 yes TB BRONCHIECT-OTH TEST 3 15 yes TUBERCULOUS PNEUMONIA* 3 15 yes TB PNEUMONIA-UNSPEC 3 15 yes TB PNEUMONIA-NO EXAM 3 15 yes TB PNEUMONIA-EXAM UNKN 3 15 yes TB PNEUMONIA-MICRO DX 3 15 yes TB PNEUMONIA-CULT DX 3 15 yes TB PNEUMONIA-HISTO DX 3 15 yes TB PNEUMONIA-OTH TEST 3 15 yes TUBERCULOUS PNEUMOTHORAX* 3 15 yes TB PNEUMOTHORAX-UNSPEC 3 15 yes TB PNEUMOTHORAX-NO EXAM 3 15 yes TB PNEUMOTHORX-EXAM UNKN 3 15 yes RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 67

78 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added Tier Change TB PNEUMOTHORAX-MICRO DX 3 15 yes TB PNEUMOTHORAX-CULT DX 3 15 yes TB PNEUMOTHORAX-HISTO DX 3 15 yes TB PNEUMOTHORAX-OTH TEST 3 15 yes PULMONARY TB NEC* 3 15 yes PULMONARY TB NEC-UNSPEC 3 15 yes PULMONARY TB NEC-NO EXAM 3 15 yes PULMON TB NEC-EXAM UNKN 3 15 yes PULMON TB NEC-MICRO DX 3 15 yes PULMON TB NEC-CULT DX 3 15 yes PULMON TB NEC-HISTO DX 3 15 yes PULMON TB NEC-OTH TEST 3 15 yes PULMONARY TB NOS* 3 15 yes PULMONARY TB NOS-UNSPEC 3 15 yes PULMONARY TB NOS-NO EXAM 3 15 yes PULMON TB NOS-EXAM UNKN 3 15 yes PULMON TB NOS-MICRO DX 3 15 yes PULMON TB NOS-CULT DX 3 15 yes PULMON TB NOS-HISTO DX 3 15 yes PULMON TB NOS-OTH TEST 3 15 yes 012. OTHER RESPIRATORY TB* 3 15 yes TUBERCULOUS PLEURISY* 3 15 yes TB PLEURISY-UNSPEC 3 15 yes TB PLEURISY-NO EXAM 3 15 yes TB PLEURISY-EXAM UNKN 3 15 yes TB PLEURISY-MICRO DX 3 15 yes TB PLEURISY-CULT DX 3 15 yes TB PLEURISY-HISTOLOG DX 3 15 yes TB PLEURISY-OTH TEST 3 15 yes TB THORACIC LYMPH NODES* 3 15 yes TB THORACIC NODES-UNSPEC 3 15 yes TB THORAX NODE-NO EXAM 3 15 yes TB THORAX NODE-EXAM UNKN 3 15 yes TB THORAX NODE-MICRO DX 3 15 yes TB THORAX NODE-CULT DX 3 15 yes TB THORAX NODE-HISTO DX 3 15 yes TB THORAX NODE-OTH TEST 3 15 yes ISOLATED TRACH/BRONCH TB* 3 15 yes ISOL TRACHEAL TB-UNSPEC 3 15 yes ISOL TRACHEAL TB-NO EXAM 3 15 yes ISOL TRACH TB-EXAM UNKN 3 15 yes ISOLAT TRACH TB-MICRO DX 3 15 yes ISOL TRACHEAL TB-CULT DX 3 15 yes ISOLAT TRACH TB-HISTO DX 3 15 yes RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). 68 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

79 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added Tier Change ISOLAT TRACH TB-OTH TEST 3 15 yes TUBERCULOUS LARYNGITIS* 3 15 yes TB LARYNGITIS-UNSPEC 3 15 yes TB LARYNGITIS-NO EXAM 3 15 yes TB LARYNGITIS-EXAM UNKN 3 15 yes TB LARYNGITIS-MICRO DX 3 15 yes TB LARYNGITIS-CULT DX 3 15 yes TB LARYNGITIS-HISTO DX 3 15 yes TB LARYNGITIS-OTH TEST 3 15 yes RESPIRATORY TB NEC* 3 15 yes RESP TB NEC-UNSPEC 3 15 yes RESP TB NEC-NO EXAM 3 15 yes RESP TB NEC-EXAM UNKN 3 15 yes RESP TB NEC-MICRO DX 3 15 yes RESP TB NEC-CULT DX 3 15 yes RESP TB NEC-HISTO DX 3 15 yes RESP TB NEC-OTH TEST 3 15 yes 013. CNS TUBERCULOSIS* 3 03,05 yes TUBERCULOUS MENINGITIS* 3 03,05 yes TB MENINGITIS-UNSPEC 3 03,05 yes TB MENINGITIS-NO EXAM 3 03,05 yes TB MENINGITIS-EXAM UNKN 3 03,05 yes TB MENINGITIS-MICRO DX 3 03,05 yes TB MENINGITIS-CULT DX 3 03,05 yes TB MENINGITIS-HISTO DX 3 03,05 yes TB MENINGITIS-OTH TEST 3 03,05 yes TUBERCULOMA OF MENINGES* 3 03,05 yes TUBRCLMA MENINGES-UNSPEC 3 03,05 yes TUBRCLMA MENING-NO EXAM 3 03,05 yes TUBRCLMA MENIN-EXAM UNKN 3 03,05 yes TUBRCLMA MENING-MICRO DX 3 03,05 yes TUBRCLMA MENING-CULT DX 3 03,05 yes TUBRCLMA MENING-HISTO DX 3 03,05 yes TUBRCLMA MENING-OTH TEST 3 03,05 yes TUBERCULOMA OF BRAIN* 3 03 yes TUBERCULOMA BRAIN-UNSPEC 3 03 yes TUBRCLOMA BRAIN-NO EXAM 3 03 yes TUBRCLMA BRAIN-EXAM UNKN 3 03 yes TUBRCLOMA BRAIN-MICRO DX 3 03 yes TUBRCLOMA BRAIN-CULT DX 3 03 yes TUBRCLOMA BRAIN-HISTO DX 3 03 yes TUBRCLOMA BRAIN-OTH TEST 3 03 yes TB ABSCESS OF BRAIN* 3 03 yes TB BRAIN ABSCESS-UNSPEC 3 03 yes RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 69

80 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added Tier Change TB BRAIN ABSCESS-NO EXAM 3 03 yes TB BRAIN ABSC-EXAM UNKN 3 03 yes TB BRAIN ABSC-MICRO DX 3 03 yes TB BRAIN ABSCESS-CULT DX 3 03 yes TB BRAIN ABSC-HISTO DX 3 03 yes TB BRAIN ABSC-OTH TEST 3 03 yes TUBERCULOMA SPINAL CORD* 3 05 yes TUBRCLMA SP CORD-UNSPEC 3 05 yes TUBRCLMA SP CORD-NO EXAM 3 05 yes TUBRCLMA SP CD-EXAM UNKN 3 05 yes TUBRCLMA SP CRD-MICRO DX 3 05 yes TUBRCLMA SP CORD-CULT DX 3 05 yes TUBRCLMA SP CRD-HISTO DX 3 05 yes TUBRCLMA SP CRD-OTH TEST 3 05 yes TB ABSCESS SPINAL CORD* 3 05 yes TB SP CRD ABSCESS-UNSPEC 3 05 yes TB SP CRD ABSC-NO EXAM 3 05 yes TB SP CRD ABSC-EXAM UNKN 3 05 yes TB SP CRD ABSC-MICRO DX 3 05 yes TB SP CRD ABSC-CULT DX 3 05 yes TB SP CRD ABSC-HISTO DX 3 05 yes TB SP CRD ABSC-OTH TEST 3 05 yes TB ENCEPHALITIS/MYELITIS* 3 03 yes TB ENCEPHALITIS-UNSPEC 3 03 yes TB ENCEPHALITIS-NO EXAM 3 03 yes TB ENCEPHALIT-EXAM UNKN 3 03 yes TB ENCEPHALITIS-MICRO DX 3 03 yes TB ENCEPHALITIS-CULT DX 3 03 yes TB ENCEPHALITIS-HISTO DX 3 03 yes TB ENCEPHALITIS-OTH TEST 3 03 yes CNS TUBERCULOSIS NEC* 3 03,05 yes CNS TB NEC-UNSPEC 3 03,05 yes CNS TB NEC-NO EXAM 3 03,05 yes CNS TB NEC-EXAM UNKN 3 03,05 yes CNS TB NEC-MICRO DX 3 03,05 yes CNS TB NEC-CULT DX 3 03,05 yes CNS TB NEC-HISTO DX 3 03,05 yes CNS TB NEC-OTH TEST 3 03,05 yes CNS TUBERCULOSIS NOS* 3 03,05 yes CNS TB NOS-UNSPEC 3 03,05 yes CNS TB NOS-NO EXAM 3 03,05 yes CNS TB NOS-EXAM UNKN 3 03,05 yes CNS TB NOS-MICRO DX 3 03,05 yes CNS TB NOS-CULT DX 3 03,05 yes RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). 70 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

81 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added Tier Change CNS TB NOS-HISTO DX 3 03,05 yes CNS TB NOS-OTH TEST 3 03,05 yes 014. INTESTINAL TB* 3 yes TUBERCULOUS PERITONITIS* 3 yes TB PERITONITIS-UNSPEC 3 yes TB PERITONITIS-NO EXAM 3 yes TB PERITONITIS-EXAM UNKN 3 yes TB PERITONITIS-MICRO DX 3 yes TB PERITONITIS-CULT DX 3 yes TB PERITONITIS-HISTO DX 3 yes TB PERITONITIS-OTH TEST 3 yes INTESTINAL TB NEC* 3 yes INTESTINAL TB NEC-UNSPEC 3 yes INTESTIN TB NEC-NO EXAM 3 yes INTEST TB NEC-EXAM UNKN 3 yes INTESTIN TB NEC-MICRO DX 3 yes INTESTIN TB NEC-CULT DX 3 yes INTESTIN TB NEC-HISTO DX 3 yes INTESTIN TB NEC-OTH TEST 3 yes 015. TB OF BONE AND JOINT* 3 03,09 yes TB OF VERTEBRAL COLUMN* 3 03,09 yes TB OF VERTEBRA-UNSPEC 3 03,09 yes TB OF VERTEBRA-NO EXAM 3 03,09 yes TB OF VERTEBRA-EXAM UNKN 3 03,09 yes TB OF VERTEBRA-MICRO DX 3 03,09 yes TB OF VERTEBRA-CULT DX 3 03,09 yes TB OF VERTEBRA-HISTO DX 3 03,09 yes TB OF VERTEBRA-OTH TEST 3 03,09 yes TB OF HIP* 3 09 yes TB OF HIP-UNSPEC 3 09 yes TB OF HIP-NO EXAM 3 09 yes TB OF HIP-EXAM UNKN 3 09 yes TB OF HIP-MICRO DX 3 09 yes TB OF HIP-CULT DX 3 09 yes TB OF HIP-HISTO DX 3 09 yes TB OF HIP-OTH TEST 3 09 yes TB OF KNEE* 3 09 yes TB OF KNEE-UNSPEC 3 09 yes TB OF KNEE-NO EXAM 3 09 yes TB OF KNEE-EXAM UNKN 3 09 yes TB OF KNEE-MICRO DX 3 09 yes TB OF KNEE-CULT DX 3 09 yes TB OF KNEE-HISTO DX 3 09 yes TB OF KNEE-OTH TEST 3 09 yes RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 71

82 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added Tier Change TB OF LIMB BONES* 3 09,10,11 yes TB OF LIMB BONES-UNSPEC 3 09,10,11 yes TB LIMB BONES-NO EXAM 3 09,10,11 yes TB LIMB BONES-EXAM UNKN 3 09,10,11 yes TB LIMB BONES-MICRO DX 3 09,10,11 yes TB LIMB BONES-CULT DX 3 09,10,11 yes TB LIMB BONES-HISTO DX 3 09,10,11 yes TB LIMB BONES-OTH TEST 3 yes TB OF MASTOID* 3 yes TB OF MASTOID-UNSPEC 3 yes TB OF MASTOID-NO EXAM 3 yes TB OF MASTOID-EXAM UNKN 3 yes TB OF MASTOID-MICRO DX 3 yes TB OF MASTOID-CULT DX 3 yes TB OF MASTOID-HISTO DX 3 yes TB OF MASTOID-OTH TEST 3 yes TB OF BONE NEC* 3 09 yes TB OF BONE NEC-UNSPEC 3 09 yes TB OF BONE NEC-NO EXAM 3 09 yes TB OF BONE NEC-EXAM UNKN 3 09 yes TB OF BONE NEC-MICRO DX 3 09 yes TB OF BONE NEC-CULT DX 3 09 yes TB OF BONE NEC-HISTO DX 3 09 yes TB OF BONE NEC-OTH TEST 3 09 yes TB OF JOINT NEC* 3 09 yes TB OF JOINT NEC-UNSPEC 3 09 yes TB OF JOINT NEC-NO EXAM 3 09 yes TB JOINT NEC-EXAM UNKN 3 09 yes TB OF JOINT NEC-MICRO DX 3 09 yes TB OF JOINT NEC-CULT DX 3 09 yes TB OF JOINT NEC-HISTO DX 3 09 yes TB OF JOINT NEC-OTH TEST 3 09 yes TB OF BONE & JOINT NOS* 3 09 yes TB BONE/JOINT NOS-UNSPEC 3 09 yes TB BONE/JT NOS-NO EXAM 3 09 yes TB BONE/JT NOS-EXAM UNKN 3 09 yes TB BONE/JT NOS-MICRO DX 3 09 yes TB BONE/JT NOS-CULT DX 3 09 yes TB BONE/JT NOS-HISTO DX 3 09 yes TB BONE/JT NOS-OTH TEST 3 09 yes 016. GENITOURINARY TB* 3 yes TB OF KIDNEY* 3 yes TB OF KIDNEY-UNSPEC 3 yes TB OF KIDNEY-NO EXAM 3 yes RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). 72 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

83 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added Tier Change TB OF KIDNEY-EXAM UNKN 3 yes TB OF KIDNEY-MICRO DX 3 yes TB OF KIDNEY-CULT DX 3 yes TB OF KIDNEY-HISTO DX 3 yes TB OF KIDNEY-OTH TEST 3 yes TB OF BLADDER* 3 yes TB OF BLADDER-UNSPEC 3 yes TB OF BLADDER-NO EXAM 3 yes TB OF BLADDER-EXAM UNKN 3 yes TB OF BLADDER-MICRO DX 3 yes TB OF BLADDER-CULT DX 3 yes TB OF BLADDER-HISTO DX 3 yes TB OF BLADDER-OTH TEST 3 yes TB OF URETER* 3 yes TB OF URETER-UNSPEC 3 yes TB OF URETER-NO EXAM 3 yes TB OF URETER-EXAM UNKN 3 yes TB OF URETER-MICRO DX 3 yes TB OF URETER-CULT DX 3 yes TB OF URETER-HISTO DX 3 yes TB OF URETER-OTH TEST 3 yes TB OF URINARY ORGAN NEC* 3 yes TB URINARY NEC-UNSPEC 3 yes TB URINARY NEC-NO EXAM 3 yes TB URINARY NEC-EXAM UNKN 3 yes TB URINARY NEC-MICRO DX 3 yes TB URINARY NEC-CULT DX 3 yes TB URINARY NEC-HISTO DX 3 yes TB URINARY NEC-OTH TEST 3 yes TB OF EPIDIDYMIS* 3 yes TB EPIDIDYMIS-UNSPEC 3 yes TB EPIDIDYMIS-NO EXAM 3 yes TB EPIDIDYMIS-EXAM UNKN 3 yes TB EPIDIDYMIS-MICRO DX 3 yes TB EPIDIDYMIS-CULT DX 3 yes TB EPIDIDYMIS-HISTO DX 3 yes TB EPIDIDYMIS-OTH TEST 3 yes TB MALE GENITAL ORG NEC* 3 yes TB MALE GENIT NEC-UNSPEC 3 yes TB MALE GEN NEC-NO EXAM 3 yes TB MALE GEN NEC-EX UNKN 3 yes TB MALE GEN NEC-MICRO DX 3 yes TB MALE GEN NEC-CULT DX 3 yes TB MALE GEN NEC-HISTO DX 3 yes RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 73

84 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added Tier Change TB MALE GEN NEC-OTH TEST 3 yes TB OF OVARY AND TUBE* 3 yes TB OVARY & TUBE-UNSPEC 3 yes TB OVARY & TUBE-NO EXAM 3 yes TB OVARY/TUBE-EXAM UNKN 3 yes TB OVARY & TUBE-MICRO DX 3 yes TB OVARY & TUBE-CULT DX 3 yes TB OVARY & TUBE-HISTO DX 3 yes TB OVARY & TUBE-OTH TEST 3 yes TB FEMALE GENIT ORG NEC* 3 yes TB FEMALE GEN NEC-UNSPEC 3 yes TB FEM GEN NEC-NO EXAM 3 yes TB FEM GEN NEC-EXAM UNKN 3 yes TB FEM GEN NEC-MICRO DX 3 yes TB FEM GEN NEC-CULT DX 3 yes TB FEM GEN NEC-HISTO DX 3 yes TB FEM GEN NEC-OTH TEST 3 yes GENITOURINARY TB NOS* 3 yes GU TB NOS-UNSPEC 3 yes GU TB NOS-NO EXAM 3 yes GU TB NOS-EXAM UNKN 3 yes GU TB NOS-MICRO DX 3 yes GU TB NOS-CULT DX 3 yes GU TB NOS-HISTO DX 3 yes GU TB NOS-OTH TEST 3 yes 017. TUBERCULOSIS NEC* 3 yes TB SKIN & SUBCUTANEOUS* 3 yes TB SKIN/SUBCUTAN-UNSPEC 3 yes TB SKIN/SUBCUT-NO EXAM 3 yes TB SKIN/SUBCUT-EXAM UNKN 3 yes TB SKIN/SUBCUT-MICRO DX 3 yes TB SKIN/SUBCUT-CULT DX 3 yes TB SKIN/SUBCUT-HISTO DX 3 yes TB SKIN/SUBCUT-OTH TEST 3 yes ERYTHEMA NODOSUM IN TB* 3 yes ERYTHEMA NODOS TB-UNSPEC 3 yes ERYTHEM NODOS TB-NO EXAM 3 yes ERYTHEM NOD TB-EXAM UNKN 3 yes ERYTHEM NOD TB-MICRO DX 3 yes ERYTHEM NODOS TB-CULT DX 3 yes ERYTHEM NOD TB-HISTO DX 3 yes ERYTHEM NOD TB-OTH TEST 3 yes TB OF PERIPH LYMPH NODE* 3 yes TB PERIPH LYMPH-UNSPEC 3 yes RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). 74 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

85 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added Tier Change TB PERIPH LYMPH-NO EXAM 3 yes TB PERIPH LYMPH-EXAM UNK 3 yes TB PERIPH LYMPH-MICRO DX 3 yes TB PERIPH LYMPH-CULT DX 3 yes TB PERIPH LYMPH-HISTO DX 3 yes TB PERIPH LYMPH-OTH TEST 3 yes TB OF EYE* 3 yes TB OF EYE-UNSPEC 3 yes TB OF EYE-NO EXAM 3 yes TB OF EYE-EXAM UNKN 3 yes TB OF EYE-MICRO DX 3 yes TB OF EYE-CULT DX 3 yes TB OF EYE-HISTO DX 3 yes TB OF EYE-OTH TEST 3 yes TB OF EAR* 3 yes TB OF EAR-UNSPEC 3 yes TB OF EAR-NO EXAM 3 yes TB OF EAR-EXAM UNKN 3 yes TB OF EAR-MICRO DX 3 yes TB OF EAR-CULT DX 3 yes TB OF EAR-HISTO DX 3 yes TB OF EAR-OTH TEST 3 yes TB OF THYROID GLAND* 3 yes TB OF THYROID-UNSPEC 3 yes TB OF THYROID-NO EXAM 3 yes TB OF THYROID-EXAM UNKN 3 yes TB OF THYROID-MICRO DX 3 yes TB OF THYROID-CULT DX 3 yes TB OF THYROID-HISTO DX 3 yes TB OF THYROID-OTH TEST 3 yes TB OF ADRENAL GLAND* 3 yes TB OF ADRENAL-UNSPEC 3 yes TB OF ADRENAL-NO EXAM 3 yes TB OF ADRENAL-EXAM UNKN 3 yes TB OF ADRENAL-MICRO DX 3 yes TB OF ADRENAL-CULT DX 3 yes TB OF ADRENAL-HISTO DX 3 yes TB OF SPLEEN* 3 yes TB OF SPLEEN-UNSPEC 3 yes TB OF SPLEEN-NO EXAM 3 yes TB OF SPLEEN-EXAM UNKN 3 yes TB OF SPLEEN-MICRO DX 3 yes TB OF SPLEEN-CULT DX 3 yes TB OF SPLEEN-HISTO DX 3 yes RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 75

86 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added Tier Change TB OF SPLEEN-OTH TEST 3 yes TB OF ESOPHAGUS* 3 yes TB ESOPHAGUS-UNSPEC 3 yes TB ESOPHAGUS-NO EXAM 3 yes TB ESOPHAGUS-EXAM UNKN 3 yes TB ESOPHAGUS-MICRO DX 3 yes TB ESOPHAGUS-CULT DX 3 yes TB ESOPHAGUS-HISTO DX 3 yes TB ESOPHAGUS-OTH TEST 3 yes TB OF ORGAN NEC* 3 yes TB OF ORGAN NEC-UNSPEC 3 yes TB OF ORGAN NEC-NO EXAM 3 yes TB ORGAN NEC-EXAM UNKN 3 yes TB OF ORGAN NEC-MICRO DX 3 yes TB OF ORGAN NEC-CULT DX 3 yes TB OF ORGAN NEC-HISTO DX 3 yes TB OF ORGAN NEC-OTH TEST 3 yes 018. MILIARY TUBERCULOSIS* 3 yes ACUTE MILIARY TB* 3 yes ACUTE MILIARY TB-UNSPEC 3 yes ACUTE MILIARY TB-NO EXAM 3 yes AC MILIARY TB-EXAM UNKN 3 yes AC MILIARY TB-MICRO DX 3 yes ACUTE MILIARY TB-CULT DX 3 yes AC MILIARY TB-HISTO DX 3 yes AC MILIARY TB-OTH TEST 3 yes MILIARY TB NEC* 3 yes MILIARY TB NEC-UNSPEC 3 yes MILIARY TB NEC-NO EXAM 3 yes MILIARY TB NEC-EXAM UNKN 3 yes MILIARY TB NEC-MICRO DX 3 yes MILIARY TB NEC-CULT DX 3 yes MILIARY TB NEC-HISTO DX 3 yes MILIARY TB NEC-OTH TEST 3 yes MILIARY TUBERCULOSIS NOS* 3 yes MILIARY TB NOS-UNSPEC 3 yes MILIARY TB NOS-NO EXAM 3 yes MILIARY TB NOS-EXAM UNKN 3 yes MILIARY TB NOS-MICRO DX 3 yes MILIARY TB NOS-CULT DX 3 yes MILIARY TB NOS-HISTO DX 3 yes MILIARY TB NOS-OTH TEST 3 yes LISTERIOSIS 3 yes ERYSIPELOTHRIX INFECTION 3 yes RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). 76 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

87 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added Tier Change PASTEURELLOSIS 3 yes ZOONOTIC BACT DIS NEC 3 yes ZOONOTIC BACT DIS NOS 3 yes MENINGOCOCCAL MENINGITIS 3 03,05 yes MENINGOCOCCEMIA 3 03, MENINGOCOCC ADRENAL SYND MENINGOCOCC CARDITIS NOS MENINGOCOCC ENDOCARDITIS MENINGOCOCC MYOCARDITIS TETANUS STREPTOCOCCAL SEPTICEMIA 3 yes STAPHYLOCOCC SEPTICEMIA* 3 yes STAPHYLCOCC SEPTICEM NOS 3 yes STAPH AUREUS SEPTICEMIA 3 yes STAPHYLCOCC SEPTICEM NEC 3 yes PNEUMOCOCCAL SEPTICEMIA 3 yes ANAEROBIC SEPTICEMIA 3 yes GRAM-NEG SEPTICEMIA NEC* 3 yes GRAM-NEG SEPTICEMIA NOS 3 yes H. INFLUENAE SEPTICEMIA 3 yes E COLI SEPTICEMIA 3 yes PSEUDOMONAS SEPTICEMIA 3 yes SERRATIA SEPTICEMIA 3 yes GRAM-NEG SEPTICEMIA NEC 3 yes SEPTICEMIA NEC 3 yes SEPTICEMIA NOS 3 yes 042. HUMAN IMMUNO VIRUS DIS 3 yes VIRAL MENINGITIS NEC 3 03,05 yes VIRAL MENINGITIS NOS 3 03,05 yes 048. OTH ENTEROVIRAL CNS DIS 3 03,05 yes LYMPHOCYTIC CHORIOMENING 3 03,05 yes VIRAL ENCEPHALITIS NOS 3 03 yes POSTVARICELLA ENCEPHALIT 3 03 yes VARICELLA PNEUMONITIS HERPES ZOSTER MENINGITIS 3 03,05 yes POSTHERPES POLYNEUROPATH 3 06 yes HERPETIC ENCEPHALITIS 3 03 yes HERPETIC SEPTICEMIA 3 03 yes H SIMPLEX MENINGITIS 3 03,05 yes H SIMPLEX COMPLICAT NEC POSTMEASLES ENCEPHALITIS 3 03 yes POSTMEASLES PNEUMONIA HPT B ACTE COMA WO DLTA HPT B ACTE COMA W DLTA 3 03 RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 77

88 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added Tier Change HPT B CHRN COMA WO DLTA HPT B CHRN COMA W DLTA HPT C ACUTE W HEPAT COMA HPT DLT WO B W HPT COMA HPT E W HEPAT COMA CHRNC HPT C W HEPAT COMA OTH VRL HEPAT W HPT COMA VIRAL HEPAT NOS W COMA HPT C UNSPEC W HEPAT COMA MUMPS MENINGITIS 3 03,05 yes MUMPS ENCEPHALITIS 3 03 yes MUMPS PANCREATITIS RETROVIRUS-UNSPECIFIED 3 yes HTLV-1 INFECTION OTH DIS 3 06 yes HTLV-II INFECTN OTH DIS 3 06 yes HIV-2 INFECTION OTH DIS 3 yes OTH SPECFIED RETROVIRUS 3 yes CONGEN SYPH MENINGITIS 3 03,05 yes SYPHIL ENDOCARDITIS NOS SYPHILITIC MYOCARDITIS SYPHILITIC MENINGITIS 3 03,05 yes SYPH RUPT CEREB ANEURYSM 3 01, GONOCOCCAL INF SITE NEC 3 yes COCCIDIOIDAL MENINGITIS 3 03,05 yes 115. HISTOPLASMOSIS* 3 15 yes HISTOPLASMA CAPSULATUM* 3 15 yes HISTOPLASMA CAPSULAT NOS 3 15 yes HISTOPLASM CAPSUL MENING 3 03,05 yes HISTOPLASM CAPSUL RETINA 3 yes HISTOPLASM CAPS PERICARD 3 14 yes HISTOPLASM CAPS ENDOCARD 3 14 yes HISTOPLASM CAPS PNEUMON 3 15 yes HISTOPLASMA CAPSULAT NEC 3 15 yes HISTOPLASMA DUBOISII* 3 15 yes HISTOPLASMA DUBOISII NOS 3 yes HISTOPLASM DUBOIS MENING 3 03,05 yes HISTOPLASM DUBOIS RETINA 3 yes HISTOPLASM DUB PERICARD 3 14 yes HISTOPLASM DUB ENDOCARD 3 14 yes HISTOPLASM DUB PNEUMONIA 3 15 yes HISTOPLASMA DUBOISII NEC 3 15 yes HISTOPLASMOSIS UNSPEC* 3 15 yes HISTOPLASMOSIS NOS 3 15 yes HISTOPLASMOSIS MENINGIT 3 03,05 yes RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). 78 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

89 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added Tier Change HISTOPLASMOSIS RETINITIS 3 yes HISTOPLASMOSIS PERICARD 3 14 yes HISTOPLASMOSIS ENDOCARD 3 14 yes HISTOPLASMOSIS PNEUMONIA 3 15 yes HISTOPLASMOSIS NEC 3 15 yes TOXOPLASM MENINGOENCEPH 3 03,05 yes TOXOPLASMA MYOCARDITIS TOXOPLASMA PNEUMONITIS PNEUMOCYSTOSIS LATE EFF VIRAL ENCEPHAL 3 03 yes ACT LYM LEUK W/O RMSION ACT MYL LEUK W/O RMSION ACT MONO LEUK W/O RMSION ACT ERTH/ERYLK W/O RMSON ACT LEUK UNS CL W/O RMSN INSUL DEP DIAB NO COMP NOT 3 yes STATD UNCNTRLD DM II/UNSPC RENL NT STD 3 UNCNTRLD DM I RENL NT STD UNCNTRLD DM II/UNSPC RENL UNCNTRLD DM I RENL UNCNTRLD DM II/UNSPC OPHTH NT ST 3 UNCNTRL DM I OPHTH NT STD UNCNTRLD DM II/UNSPC OPHTH UNCNTRLD DM I OPHTH UNCNTRLD DM II/UNSPC NEURO NT STD 3 06 UNCNTRL DM I NEURO NT STD UNCNTRLD DM II/UNSPC NEURO UNCNTRLD DM I NEURO UNCNTRLD DM II/UNSPC PERIPH CIRC NT STD 3 UNCNTRLD DM I PERIPH CIRC NT STD 3 UNCNTRLD DM II/UNSPC PERIPH CIRC 3 UNCNTRLD DM I PERIPH CIRC UNCNTRLD DM II/UNSPC OTH NT STD 3 UNCNTRLD DM I OTH NT STD UNCNTRLD DM II/UNSPC OTH UNCNTRLD DM I OTH UNCNTRLD 3 RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 79

90 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion DM I/UNSPF UNSPC NT ST 3 UNCNTRLD DM II/UNSPF UNSPC UNCNTRLD CYSTIC FIBROS W/O ILEUS CYSTIC FIBROSIS W ILEUS CYST FIBROS W PULMONARY CYST FIBROS W GASTROINT CYST FIBROS W OTH MANI MORBID OBESITY SICKLE-CELL ANEMIA NOS HB-S DISEASE W/O CRISIS HB-S DISEASE WITH CRISIS SICKLE-CELL/HB-C DISEASE SICKLE-CELL/Hb-C DISEASE W 3 ICD9CM Added Tier Change CRISIS SICKLE-CELL ANEMIA NEC CONGEN APLASTIC ANEMIA APLASTIC ANEMIAS NEC APLASTIC ANEMIA NOS CONG FACTOR VIII DIORD CONG FACTOR IX DISORDER DEFIBRINATION SYNDROME HEMOPHILUS MENINGITIS 3 03,05 yes PNEUMOCOCCAL MENINGITIS 3 03,05 yes STREPTOCOCCAL MENINGITIS 3 03,05 yes STAPHYLOCOCC MENINGITIS 3 03,05 yes MENING IN OTH BACT DIS 3 03,05 yes ANAEROBIC MENINGITIS 3 03,05 yes MNINGTS GRAM-NEG BCT NEC 3 03,05 yes MENINGITIS OTH SPCF BACT 3 03,05 yes BACTERIAL MENINGITIS NOS 3 03,05 yes CRYPTOCOCCAL MENINGITIS 3 03,05 yes MENING IN OTH FUNGAL DIS 3 03,05 yes MENING IN OTH VIRAL DIS 3 03,05 yes TRYPANOSOMIASIS MENINGIT 3 03,05 yes MENINGIT D/T SARCOIDOSIS 3 03,05 yes MENING IN OTH NONBAC DIS 3 03,05 yes NONPYOGENIC MENINGITIS 3 03,05 yes CHRONIC MENINGITIS 3 03,05 yes MENINGITIS NOS 3 03,05 yes POSTINFECT ENCEPHALITIS 3 03 yes ENCEPHALITIS NEC 3 03 yes ENCEPHALITIS NOS 3 03 yes INTRACRANIAL ABSCESS 3 03 RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). 80 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

91 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added Tier Change INTRASPINAL ABSCESS CNS ABSCESS NOS FLCCD HMIPLGA UNSPF SIDE FLCCD HMIPLGA DOMNT SIDE FLCCD HMIPLG NONDMNT SDE SPSTC HMIPLGA UNSPF SIDE SPSTC HMIPLGA DOMNT SIDE SPSTC HMIPLG NONDMNT SDE OT SP HMIPLGA UNSPF SIDE OT SP HMIPLGA DOMNT SIDE OT SP HMIPLG NONDMNT SDE UNSP HEMIPLGA UNSPF SIDE UNSP HEMIPLGA DOMNT SIDE UNSP HMIPLGA NONDMNT SDE GEN CNV EPIL W INTR EPIL 3 02, GRAND MAL STATUS 3 02, ANOXIC BRAIN DAMAGE 3 02, NEUROPATHY IN DIABETES ORBITAL CELLULITIS 3 yes ORBITAL PERIOSTITIS ORBITAL OSTEOMYELITIS RHEUMATIC MYOCARDITIS MAL HYP REN W RENAL FAIL MAL HYPER HRT/REN W CHF MAL HYP HRT/REN W CHF&RF PULMON EMBOLISM/INFARCT* IATROGEN PULM EMB/INFARC PULM EMBOL/INFARCT NEC AC/SUBAC BACT ENDOCARD AC ENDOCARDIT IN OTH DIS AC/SUBAC ENDOCARDIT NOS AC MYOCARDIT IN OTH DIS ACUTE MYOCARDITIS NOS IDIOPATHIC MYOCARDITIS SEPTIC MYOCARDITIS TOXIC MYOCARDITIS ACUTE MYOCARDITIS NEC VENTRICULAR FIBRILLATION CARDIAC ARREST LFT HRT FAIL 3 14 yes SYS HRT FAIL UNSPC 3 14 yes SYS HRT FAIL AC 3 14 yes SYS HRT FAIL CHRO 3 14 yes SYS HRT FAIL AC ON CHRO 3 14 yes RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 81

92 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added Changes in V Tier Change RIC Exclude Change DIA HRT FAIL UNSPC 3 14 yes DIA HRT FAIL AC 3 14 yes DIA HRT FAIL CHRO 3 14 yes DIA HRT FAIL AC ON CHRO 3 14 yes COMB SYS DIA HRT FAIL UNSPC 3 14 yes COMB SYS DIA HRT FAIL AC 3 14 yes COMB SYS DIA HRT FAIL CHRON 3 14 yes COMB SYS DIA HRT FAIL AC ON 3 14 yes CHRON 430. SUBARACHNOID HEMORRHAGE 3 01,02, INTRACEREBRAL HEMORRHAGE 3 01,02, NONTRAUM EXTRADURAL HEM 3 01,02, SUBDURAL HEMORRHAGE 3 01,02, OCL BSLR ART W INFRCT OCL CRTD ART W INFRCT OCL VRTB ART W INFRCT OCL MLT BI ART W INFRCT OCL SPCF ART W INFRCT OCL ART NOS W INFRCT CRBL THRMBS W INFRCT CRBL EMBLSM W INFRCT CRBL ART OCL NOS W INFRC CVA ATH EXT NTV ART ULCRTION 3 10, ATH EXT NTV ART GNGRENE 3 10, DISSECTING ANEURYSM* DSCT OF AORTA UNSP SITE DSCT OF THORACIC AORTA DSCT OF ABDOMINAL AORTA DSCT OF THORACOABD AORTA RUPTUR THORACIC ANEURYSM RUPT ABD AORTIC ANEURYSM RUPT AORTIC ANEURYSM NOS THORACOABD ANEURYSM RUPT LETHAL MIDLINE GRANULOMA PORTAL VEIN THROMBOSIS OTH VENOUS THROMBOSIS* BUDD-CHIARI SYNDROME THROMBOPHLEBITIS MIGRANS VENA CAVA THROMBOSIS RENAL VEIN THROMBOSIS VEN EMBOL THRMBS UNSPEC DP 3 VSLS LWR EXTREM VEN EMBOL THRMBS DP VSLS 3 PROX LWR EXTREM Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). 82 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

93 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V RIC Exclusion ICD9CM Added Tier Change ICD9CM ICD9CM Label Tier VEN EMBOL THRMBS DP VSLS 3 DIST LWR EXTREM AC TRACHEITIS W OBSTRUCT AC LARYNGOTRACH W OBSTR AC EPIGLOTTITIS W OBSTR ACUTE BRONCHIOLITIS* VOCAL CORD PARALYSIS NOS 3 15 yes ADENOVIRAL PNEUMONIA RESP SYNCYT VIRAL PNEUM PARINFLUENZA VIRAL PNEUM VIRAL PNEUMONIA NEC VIRAL PNEUMONIA NOS PNEUMOCOCCAL PNEUMONIA K. PNEUMONIAE PNEUMONIA PSEUDOMONAL PNEUMONIA H.INFLUENZAE PNEUMONIA STREPTOCOCCAL PNEUMN NOS PNEUMONIA STRPTOCOCCUS A PNEUMONIA STRPTOCOCCUS B PNEUMONIA OTH STREP STAPHYLOCOCCAL PNEU NOS STAPH AUREUS PNEUMONIA STAPH PNEUMONIA NEC BACTERIAL PNEUMONIA NEC* PNEUMONIA ANAEROBES PNEUMONIA E COLI PNEUMO OTH GRM-NEG BACT LEGIONNAIRES' DISEASE PNEUMONIA OTH SPCF BACT BACTERIAL PNEUMONIA NOS PNEU MYCPLSM PNEUMONIAE PNEUMONIA D/T CHLAMYDIA PNEUMON OTH SPEC ORGNSM PNEUM W CYTOMEG INCL DIS PNEUMONIA IN WHOOP COUGH PNEUMONIA IN ANTHRAX PNEUM IN ASPERGILLOSIS PNEUM IN OTH SYS MYCOSES PNEUM IN INFECT DIS NEC BRONCHOPNEUMONIA ORG NOS PNEUMONIA, ORGANISM NOS INFLUENZA WITH PNEUMONIA FUM/VAPOR BRONC/PNEUMON FUM/VAPOR AC PULM EDEMA 3 15 RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 83

94 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added Tier Change FOOD/VOMIT PNEUMONITIS OIL/ESSENCE PNEUMONITIS SOLID/LIQ PNEUMONIT NEC EMPYEMA WITH FISTULA EMPYEMA W/O FISTULA BACT PLEUR/EFFUS NOT TB ABSCESS OF LUNG ABSCESS OF MEDIASTINUM PULM CONGEST/HYPOSTASIS POSTINFLAM PULM FIBROSIS SICKLE-CELL/Hb-C DISEASE W AC 3 CHEST SYN PULMONARY EOSINOPHILIA POST TRAUM PULM INSUFFIC ACUTE RESPIRATRY FAILURE MEDIASTINITIS CELLULITIS/ABSCESS MOUTH 3 yes PERFORATION OF ESOPHAGUS ESOPHAGEAL HEMORRHAGE AC STOMACH ULCER W HEM AC STOMAC ULC W HEM-OBST AC STOMACH ULCER W PERF AC STOM ULC W PERF-OBST AC STOMAC ULC W HEM/PERF AC STOM ULC HEM/PERF-OBS CHR STOMACH ULC W HEM CHR STOM ULC W HEM-OBSTR CHR STOMACH ULCER W PERF CHR STOM ULC W PERF-OBST CHR STOMACH ULC HEM/PERF CHR STOM ULC HEM/PERF-OB AC DUODENAL ULCER W HEM AC DUODEN ULC W HEM-OBST AC DUODENAL ULCER W PERF AC DUODEN ULC PERF-OBSTR AC DUODEN ULC W HEM/PERF AC DUOD ULC HEM/PERF-OBS CHR DUODEN ULCER W HEM CHR DUODEN ULC HEM-OBSTR CHR DUODEN ULCER W PERF CHR DUODEN ULC PERF-OBST CHR DUODEN ULC HEM/PERF CHR DUOD ULC HEM/PERF-OB AC PEPTIC ULCER W HEMORR 3 RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). 84 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

95 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V RIC Exclusion ICD9CM Added ICD9CM ICD9CM Label Tier AC PEPTIC ULC W HEM-OBST AC PEPTIC ULCER W PERFOR AC PEPTIC ULC W PERF-OBS AC PEPTIC ULC W HEM/PERF AC PEPT ULC HEM/PERF-OBS CHR PEPTIC ULCER W HEM CHR PEPTIC ULC W HEM-OBS CHR PEPTIC ULCER W PERF CHR PEPTIC ULC PERF-OBST CHR PEPT ULC W HEM/PERF CHR PEPT ULC HEM/PERF-OB AC MARGINAL ULCER W HEM AC MARGIN ULC W HEM-OBST AC MARGINAL ULCER W PERF AC MARGIN ULC W PERF-OBS AC MARGIN ULC W HEM/PERF AC MARG ULC HEM/PERF-OBS CHR MARGINAL ULCER W HEM CHR MARGIN ULC W HEM-OBS CHR MARGINAL ULC W PERF CHR MARGIN ULC PERF-OBST CHR MARGIN ULC HEM/PERF CHR MARG ULC HEM/PERF-OB ACUTE GASTRITIS W HMRHG ATRPH GASTRITIS W HMRHG GSTR MCSL HYPRT W HMRG ALCHL GSTRITIS W HMRHG OTH SPF GASTRT W HMRHG GSTR/DDNTS NOS W HMRHG DUODENITIS W HMRHG GASTRIC/DUODENAL FISTULA ANGIO STM/DUDN W HMRHG DIEU LES(HEMOR)STOM DUOD AC APPEND W PERITONITIS AC VASC INSUFF INTESTINE DVRTCLO SML INT W HMRHG DVRTCLI SML INT W HMRHG DVRTCLO COLON W HMRHG DVRTCLI COLON W HMRHG PERITONITIS IN INFEC DIS PNEUMOCOCCAL PERITONITIS SUPPURAT PERITONITIS NEC PERIT ACUTE GEN 3 yes PERIT ABS 3 yes Tier Change RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 85

96 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added PERIT BACT SPON 3 yes OTR RETPERIT ABS 3 yes OTR RETPERIT INF 3 yes PERITONITIS NEC CHOLEPERITONITIS 3 yes SCLER MESEN 3 yes OTR PERIT SPEC 3 yes PERITONITIS NOS COLSTOMY/ENTER COMP NOS COLOSTY/ENTEROST INFECTN MECH COM COLSTMY/ENTSTMY COLSTMY/ENTEROS COMP NEC PERFORATION OF INTESTINE ANGIO INTES W HMRHG ACUTE NECROSIS OF LIVER ABSCESS OF LIVER HEPATORENAL SYNDROME HEPATIC INFARCTION PERFORATION GALLBLADDER PERFORATION OF BILE DUCT PANCREAT CYST/PSEUDOCYST AC PROLIFERAT NEPHRITIS AC RAPIDLY PROGR NEPHRIT AC NEPHRITIS IN OTH DIS ACUTE NEPHRITIS NEC ACUTE NEPHRITIS NOS RAPIDLY PROG NEPHRIT NOS LOWER NEPHRON NEPHROSIS AC RENAL FAIL, CORT NECR AC REN FAIL, MEDULL NECR AC RENAL FAILURE NEC ACUTE RENAL FAILURE NOS RENAL/PERIRENAL ABSCESS BLADDER RUPT, NONTRAUM SEPTICEMIA IN LABOR-UNSP SEPTICEM IN LABOR-DELIV PRELABOR RUPT UTER-UNSP PRELABOR RUPT UTERUS-DEL PRELAB RUPT UTER-ANTEPAR RUPTURE UTERUS NOS-UNSP RUPTURE UTERUS NOS-DELIV OBSTETRIC SHOCK-UNSPEC OBSTETRIC SHOCK-DELIVER OBSTET SHOCK-DELIV W P/P 3 03 Tier Change RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). 86 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

97 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added Tier Change OBSTETRIC SHOCK-ANTEPAR OBSTETRIC SHOCK-POSTPART AC REN FAIL W DELIV-UNSP AC REN FAIL-DELIV W P/P AC RENAL FAILURE-POSTPAR OB AIR EMBOLISM-UNSPEC OB AIR EMBOLISM-DELIVER OB AIR EMBOL-DELIV W P/P OB AIR EMBOLISM-ANTEPART OB AIR EMBOLISM-POSTPART AMNIOTIC EMBOLISM-UNSPEC AMNIOTIC EMBOLISM-DELIV AMNIOT EMBOL-DELIV W P/P AMNIOTIC EMBOL-ANTEPART AMNIOTIC EMBOL-POSTPART OB PULM EMBOL NOS-UNSPEC PULM EMBOL NOS-DEL W P/P PULM EMBOL NOS-ANTEPART PULM EMBOL NOS-POSTPART OB PYEMIC EMBOL-UNSPEC OB PYEMIC EMBOL-DELIVER OB PYEM EMBOL-DEL W P/P OB PYEMIC EMBOL-ANTEPART OB PYEMIC EMBOL-POSTPART OB PULMON EMBOL NEC-UNSP PULMON EMBOL NEC-DELIVER PULM EMBOL NEC-DEL W P/P PULMON EMBOL NEC-ANTEPAR PULMON EMBOL NEC-POSTPAR PUERP CEREBVASC DIS-UNSP 3 01, OTHER CELLULITIS/ABSCESS* 3 yes CELLULITIS OF FACE 3 yes CELLULITIS OF NECK 3 yes CELLULITIS OF TRUNK 3 yes CELLULITIS OF ARM 3 yes CELLULITIS OF HAND 3 yes CELLULITIS OF BUTTOCK 3 yes CELLULITIS OF LEG 3 10 yes CELLULITIS OF FOOT 3 10 yes CELLULITIS SITE NEC 3 yes EXTREME IMMATUR <500G EXTREME IMMATUR G EXTREME IMMATUR G TETANY 3 06 RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 87

98 EXHIBIT B CMG DLL (version 2.02) Program Documentation Appendix C: Comorbidity Tier Code Lookup Table Changes in V ICD9CM ICD9CM Label Tier RIC Exclusion ICD9CM Added Tier Change CARDIOGENIC SHOCK SEPTIC SHOCK SHOCK W/O TRAUMA NEC ASPHYXIA 3 15 yes HYPOXEMIA 3 15 yes RESPIRATORY ARREST AIR EMBOLISM 3 02, FAT EMBOLISM 3 02, TRAUMATIC ANURIA MALFUNC PROSTH HRT VALVE REACT-CARDIAC DEV/GRAFT REACT-OTH VASC DEV/GRAFT REACT-NERV SYS DEV/GRAFT REACT-INTER JOINT PROST REACT-OTH INT ORTHO DEV REACT-INT PERI DIAL CATH REACT-INT PROS DEVIC NEC INFECTION AMPUTAT STUMP 3 09,10, POSTOPERATIVE SHOCK POSTOP WOUND DISRUPTION DISR INT OPER WOUND DISR EXT OPER WOUND POSTOPERATIVE INFECTION* 3 yes INFECTED POSTOP SEROMA 3 yes OTHER POSTOP INFECTION 3 yes PERSIST POSTOP FISTULA AIR EMBOL COMP MED CARE 3 03 RIC Exclude Change Notes: * Denotes this is a category rather than a code. Last three columns show changes implemented in V2.00 (IDC9CM added to list, tier assignment changed, or RIC exclusions changed). 88 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

99 Exhibit C Appendix D: Comorbidities That Were Deleted in V 2.00 and V 2.02 Source: Program documentation for DLL Version 2.02 for the CMG Classification System Version 2.00; March 22, 2006; Department of Health and Human Services and the Centers for Medicare & Medicaid Services (

100 EXHIBIT C Appendix D: Comorbidities That Were Deleted in V 2.00 and V 2.02 NOTE: Only OVERWEIGHT was deleted with DLL Version All other deletions were made with Version 2.00 ICD9 ICD9CM Label UNC BEHAV NEO ORAL/PHAR DM II/UNSPC UNSPC NT STD UNCNTRL DM I/UNSPF UNSPC UNCNTRLD 260. KWASHIORKOR 261. NUTRITIONAL MARASMUS 262. OTH SEVERE MALNUTRITION OVERWEIGHT IDIO PROG POLYNEUROPATHY AMI ANTEROLATERAL, INIT AMI ANTERIOR WALL, INIT AMI INFEROLATERAL, INIT AMI INFEROPOST, INITIAL AMI INFERIOR WALL, INIT AMI LATERAL NEC, INITIAL TRUE POST INFARCT, INIT SUBENDO INFARCT, INITIAL AMI NEC, INITIAL AMI NOS, INITIAL ACHALASIA & CARDIOSPASM ESOPHAGEAL STRICTURE ACQ ESOPHAG DIVERTICULUM CACHEXIA FOREIGN BODY IN LARYNX FOREIGN BODY BRONCHUS V46.1 DEPENDENCE ON RESPIRATOR V46.11 DEP ON RESP STATUS V46.12 ENC FOR RESP DEP PWR FAIL V49.75 STATUS AMPUT BELOW KNEE V49.76 STATUS AMPUT ABOVE KNEE V49.77 STATUS AMPUT HIP 90 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

101 Exhibit D CMS Manual System, Pub Medicare Claims Processing, Transmittal 347; October 29, 2004 Please visit the following Web site to download this exhibit: Source: Department of Health & Human Services and the Centers for Medicare & Medicaid Services (

102 Exhibit E Inpatient Rehabilitation Facility: Patient Assessment Instrument, Form CMS-10036, January 2006 Source: Department of Health & Human Services and the Centers for Medicare & Medicaid Services (

103 EXHIBIT E DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES Form Approved OMB No INPATIENT REHABILITATION FACILITY PATIENT ASSESSMENT INSTRUMENT Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 93

104 EXHIBIT E DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES INPATIENT REHABILITATION FACILITY PATIENT ASSESSMENT INSTRUMENT 94 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

105 EXHIBIT E DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES INPATIENT REHABILITATION FACILITY PATIENT ASSESSMENT INSTRUMENT Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 95

106 Exhibit F Uniform Bill, Form UB-92 (HCFA-1450) Source: Department of Health and Human Services and the Centers for Medicare & Medicaid Services (

107 EXHIBIT F ST PLY UB-92 APPROVED OMB NO PATIENT CONTROL NO. 4 TYPE OF BILL 5 FED. TAX NO. 6 STATEMENT COVERS PERIOD FROM THROUGH 7 COV D. 8 N-C D. 9 C-I D. 10 L-R D PATIENT NAME 13 PATIENT ADDRESS 14 BIRTHDATE 15 SEX 16 MS 17 DATE ADMISSION 18 HR 19 TYPE 20 SRC 21 D HR 22 STAT 23 MEDICAL RECORD NO. CONDITION CODES a b OCCURRENCE CODE DATE 33 OCCURRENCE CODE DATE 34 OCCURRENCE CODE DATE 35 OCCURRENCE CODE DATE 36 OCCURRENCE SPAN CODE FROM THROUGH 39 VALUE CODES CODE AMOUNT a b c d 37 A B C 40 VALUE CODES CODE AMOUNT 42 REV. CD. 43 DESCRIPTION 44 HCPCS / RATES 45 SERV. DATE 46 SERV. UNITS 47 TOTAL CHARGES 48 NON-COVERED CHARGES REL 53 ASG 50 PAYER 51 PROVIDER NO. INFO BEN 54 PRIOR PAYMENTS 55 EST. AMOUNT DUE A B C 57 DUE FROM PATIENT 58 INSURED S NAME 59 P. REL 60 CERT. - SSN - HIC. - ID NO. 61 GROUP NAME 62 INSURANCE GROUP NO. A B C A B C 63 TREATMENT AUTHORIZATION CODES 64 ESC 65 EMPLOYER NAME 66 EMPLOYER LOCATION 67 PRIN. DIAG. CD. OTHER DIAG. CODES 68 CODE 69 CODE 70 CODE 71 CODE 72 CODE 73 CODE 74 CODE 75 CODE VALUE CODES CODE AMOUNT 76 ADM. DIAG. CD. 77 E-CODE 78 A B C a b c d A B C A B C a b c d 79 P.C. 80 PRINCIPAL PROCEDURE 81 OTHER PROCEDURE OTHER PROCEDURE CODE DATE CODE DATE CODE DATE 84 REMARKS UB-92 HCFA-1450 A OTHER PROCEDURE OTHER PROCEDURE OTHER PROCEDURE CODE DATE CODE DATE CODE DATE C D E OCR/ORIGINAL B 82 ATTENDING PHYS. ID 83 OTHER PHYS. ID x OTHER PHYS. ID A B 85 PROVIDER REPRESENTATIVE 86 DATE I CERTIFY THE CERTIFICATIONS ON THE REVERSE APPLY TO THIS BILL AND ARE MADE A PART HEREOF. a b a b Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 97

108 EXHIBIT F UNIFORM BILL: NOTICE: ANYONE WHO MISREPRESENTS OR FALSIFIES ESSENTIAL INFORMATION REQUESTED BY THIS FORM MAY UPON CONVICTION BE SUBJECT TO FINE AND IMPRISONMENT UNDER FEDERAL AND/OR STATE LAW. Certifications relevant to the Bill and Information Shown on the Face Hereof: Signatures on the face hereof incorporate the following certifications or verifications where pertinent to this Bill: If third party benefits are indicated as being assigned or in participation status, on the face thereof, appropriate assignments by the insured/ beneficiary and signature of patient or parent or legal guardian covering authorization to release information are on file. Determinations as to the release of medical and financial information should be guided by the particular terms of the release forms that were executed by the patient or the patient s legal representative. The hospital agrees to save harmless, indemnify and defend any insurer who makes payment in reliance upon this certification, from and against any claim to the insurance proceeds when in fact no valid assignment of benefits to the hospital was made. If patient occupied a private room or required private nursing for medical necessity, any required certifications are on file. Physician s certifications and re-certifications, if required by contract or Federal regulations, are on file. For Christian Science Sanitoriums, verifications and if necessary reverifications of the patient s need for sanitorium services are on file. Signature of patient or his/her representative on certifications, authorization to release information, and payment request, as required be Federal law and regulations (42 USC 1935f, 42 CFR , 10 USC 1071 thru 1086, 32 CFR 199) and, any other applicable contract regulations, is on file. This claim, to the best of my knowledge, is correct and complete and is in conformance with the Civil Rights Act of 1964 as amended. Records adequately disclosing services will be maintained and necessary information will be furnished to such governmental agencies as required by applicable law. For Medicare purposes: If the patient has indicated that other health insurance or a state medical assistance agency will pay part of his/her medical expenses and he/she wants information about his/her claim released to them upon their request, necessary authorization is on file. The patient s signature on the provider s request to bill Medicare authorizes any holder of medical and non-medical information, including employment status, and whether the person has employer group health insurance, liability, no-fault, workers compensation, or other insurance which is responsible to pay for the services for which this Medicare claim is made. For Medicaid purposes: This is to certify that the foregoing information is true, accurate, and complete. I understand that payment and satisfaction of this claim will be from Federal and State funds, and that any false claims, statements, or documents, or concealment of a material fact, may be prosecuted under applicable Federal or State Laws. 9.For CHAMPUS purposes: This is to certify that: (a) the information submitted as part of this claim is true, accurate and complete, and, the services shown on this form were medically indicated and necessary for the health of the patient; (b) the patient has represented that by a reported residential address outside a military treatment center catchment area he or she does not live within a catchment area of a U.S. military or U.S. Public Health Service medical facility, or if the patient resides within a catchment area of such a facility, a copy of a Non-Availability Statement (DD Form 1251) is on file, or the physician has certified to a medical emergency in any assistance where a copy of a Non-Availability Statement is not on file; (c) the patient or the patient s parent or guardian has responded directly to the provider s request to identify all health insurance coverages, and that all such coverages are identified on the face the claim except those that are exclusively supplemental payments to CHAMPUSdetermined benefits; (d) the amount billed to CHAMPUS has been billed after all such coverages have been billed and paid, excluding Medicaid, and the amount billed to CHAMPUS is that remaining claimed against CHAMPUS benefits; (e) the beneficiary s cost share has not been waived by consent or failure to exercise generally accepted billing and collection efforts; and, (f) any hospital-based physician under contract, the cost of whose services are allocated in the charges included in this bill, is not an employee or member of the Uniformed Services. For purposes of this certification, an employee of the Uniformed Services is an employee, appointed in civil service (refer to 5 USC 2105), including part-time or intermittent but excluding contract surgeons or other personnel employed by the Uniformed Services through personal service contracts. Similarly, member of the Uniformed Services does not apply to reserve members of the Uniformed Services not on active duty. (g) based on the Consolidated Omnibus Budget Reconciliation Act of 1986, all providers participating in Medicare must also participate in CHAMPUS for inpatient hospital services provided pursuant to admissions to hospitals occurring on or after January 1, (h) if CHAMPUS benefits are to be paid in a participating status, I agree to submit this claim to the appropriate CHAMPUS claims processor as a participating provider. I agree to accept the CHAMPUSdetermined reasonable charge as the total charge for the medical services or supplies listed on the claim form. I will accept the CHAMPUS-determined reasonable charge even if it is less than the billed amount, and also agree to accept the amount paid by CHAMPUS, combined with the cost-share amount and deductible amount, if any, paid by or on behalf of the patient as full payment for the listed medical services or supplies. I will make no attempt to collect from the patient (or his or her parent or guardian) amounts over the CHAMPUSdetermined reasonable charge. CHAMPUS will make any benefits payable directly to me, if I submit this claim as a participating provider. ESTIMATED CONTRACT BENEFITS 98 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

109 Exhibit G Collection of Articles from JustCoding.com Source: Lisa Eramo, HCPro, Inc.

110 EXHIBIT G INPATIENT REHAB CODING: AN INTRODUCTION TO THE IRF-PAI First in a three-part series from JustCoding.com. This article is the first in a three-part series about inpatient rehab coding. This week, we'll discuss the inpatient rehab facility patient assessment instrument (IRF-PAI), including what it is and how inpatient rehab facilities (IRF) use it. Next week, we'll look at compliance regulations that IRFs are subject to. The third article in the series will discuss how to choose an etiologic diagnosis code and a late effects code. If you're like most acute hospital inpatient coders, you probably have a daily routine that begins with sifting through a pile of detailed charts on your desk followed by performing physician queries, attending meetings, and fulfilling other non-coding duties as needed. But what if in addition to your to-do list, you also had to accomplish the following tasks within 28 days of discharge or risk your facility losing 25% of its total reimbursement per case: Determine the patient's etiologic diagnosis Help fill out an in-depth reimbursement form during the time of admission and upon discharge Identify comorbidities that impact the tier level of reimbursement Follow up with clinicians to determine the patient's impairment group Welcome to the life of an inpatient rehab coder. "As a rehab coder, your routine is very different from that of an acute hospital inpatient coder," says Margaret J. Cromwell, RHIA, CCS, an industry consultant. "If you're physically located within the HIM department with the other hospital inpatient coders, they may not understand why you keep leaving the office and why it takes you so long when you have to go to the rehab floors, facilities, or units." In fact, Cromwell says inpatient rehab coders might even feel isolated from other coders because of different coding rules and regulations that apply only to the IRF setting. "Coders may feel this way at times. But they will also develop a rapport with the medical staff like they never could as an inpatient hospital coder who might have limited access to physicians," she says. IRF-PAI adds a level of complexity So why do inpatient rehab coders have such a different rhythm to their days? Cromwell says it's because of the IRF-PAI-a reimbursement form specific to IRFs. Visit to view the IRF-PAI form on the CMS Web site. Although IRFs must also submit a UB-92 (and adhere to traditional ICD-9-CM coding guidelines in doing so), the IRF-PAI is unique to rehab settings and plays by its own set of rules. 100 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

111 EXHIBIT G "A lot of people don't even know the IRF-PAI training manual exists," says Paula Archer, RHIA, managing consultant for BKD, LLP. She says many acute care coders who are thrust into coding inpatient rehab services aren't properly trained, so they use basic coding guidelines, she adds. Cromwell says many coders simply aren't provided with access to the Internet, nor are they encouraged to research their questions online, regardless of the subject. Visit to view a copy of the training manual on the CMS Web site. But having two forms to worry about means that inpatient rehab coders must don two coding hats when coding rehab services-one for the UB-92 and one for the IRF-PAI. And when it comes to completing the IRF-PAI, coders aren't the only ones choosing the codes. There are various parts of the form that clinicians-such as physical and occupational therapists, nurses, social workers, and utilization review nurses-must fill out as well. These sections include admission/discharge information and functional independence modifiers (FIM) that range from 0-7. FIM scores indicate a patient's ability to function on his or her own. For example, an FIM score might rate a patient's ability to eat independently, recall information, or interact socially. To view a complete list of FIM scores, visit and view The IRF-PAI Training Manual, section II, pages for the FIM modifiers, and section III, pages 1-54 for FIM scores. IRF-PAI coded on admit CMS requires all inpatient rehab facilities to code the IRF-PAI within three days of the patient's admission to the facility. Just as in an acute hospital setting, when it comes to correct code assignment, documentation is an important factor. Cromwell suggests coders physically go to the patient floor and read the transfer chart as well as the history and physical in the medical record. "I find it essential to read the transfer chart from the sending facility," she says, "because the acute facility has the documentation of the exact injuries or medical conditions of the patient." Cromwell says residents in the acute facility will oftentimes under-document a patient's medical condition, and that it's better to address these documentation problems early-on. For example, a resident may document TIA instead of cerebral infarction or stroke even though the transfer chart history and radiology studies indicate that the patient had a stroke. She says new first-year residents are unaware that a diagnosis of TIA does not justify admission to an acute rehab facility. Another example is a resident who documents intracerebral hemorrhage (ICH) when the patient has a closed head injury with an intracerebral hemorrhage and is still unconscious. "Not only Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 101

112 EXHIBIT G does this impact the coder's selection of the etiologic diagnosis, but it also impacts the selection of the impairment group and the therapy the patient will receive," Cromwell adds. When Cromwell worked in inpatient rehab facilities, she gave documentation guidelines to all of the new residents in the brain trauma unit. "I included the importance of documenting every fracture, coma, respiratory failure, and organ damage," she says. Cromwell also says she worked closely with the attending physicians to address questions when they arose. "This physician education is, in my opinion, the most important contribution the coder makes in the entire process of coding acute rehab," she adds. IRF-PAI coded on discharge, too Upon discharge, inpatient rehab coders must code the IRF-PAI for a second time, as well as the UB-92. Cromwell says to be careful because sometimes the record will contain new information that might impact the original assignment of admission codes. If this is the case, modify the original admission codes. Also be sure that the UB-92 includes any procedures performed, as well as the date the IRF-PAI transmitted to CMS. But what do you do if a patient has a medical condition that requires multiple admissions related to an injury that happened years earlier? Report the etiology and a late effect code on the IRF- PAI. Report the current problem as a comorbid condition. 102 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

113 EXHIBIT G INPATIENT REHAB CODING: THE IRF-PAI AND THE 75% COMPLIANCE RULE Second in a three-part series from JustCoding.com. Last week we discussed the inpatient rehabilitation facility patient assessment instrument (IRF- PAI). This article will detail compliance regulations that IRFs must follow. Compliance should be at the top of any facility's list of priorities and IRFs are no exception. In fact, IRFs must abide by a specific 75% compliance rule, which states that at least 75% of an IRF's patients must have certain diagnoses. But this is all the more reason that inpatient rehab coders need to be on their toes when assigning codes. If an inpatient facility does not maintain a proper case mix containing these diagnoses, CMS will deem it to be noncompliant and the organization could risk losing its status as an acute rehab facility. CMS is slowly phasing this rule in over time. IRFs must currently meet a 60% threshold. On December 19, 2005, the House of Representatives passed a budget reconciliation bill that keeps the threshold at this level for an additional year. However, the bill states that as of July 1, 2007, IRFs must meet 65% compliance, and as of 2008, they must obtain the full 75% compliance. The following is a list of categories/impairment groups that meet the 75% rule: Stroke Spinal cord injury Congenital deformity Amputation Major multiple trauma Fracture of femur (hip fracture) Brain injury Neurological disorders (multiple sclerosis, Parkinson's disease, muscular dystrophy, motor neuron diseases, polyneuropathy) Burns Rheumatoid arthritis Systemic vasculidities Polyarteritis nodosa Osteoarthritis involving two or more major weight bearing joints (excluding joints replaced with a prosthesis) Knee/hip joint replacements (provided the patient meets one of the following requirements: underwent bilateral replacement, is 85 years or older, or has a body mass index of 50 upon admission) Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 103

114 EXHIBIT G Here's where cooperation comes in: In order for coders to assign the proper impairment group code-a code that goes hand-in-hand with the diagnosis code and that indicates a patient has certain deficits-physicians, nurses, and therapists must provide detailed clinical information. For example, a physician must document that a patient had a stroke with left body involvement (right brain) so a coder can assign the impairment group code If a patient has a nontraumatic brain dysfunction, for example, the nurse must provide coders with this information so they can assign impairment group code Visit to view a complete list of impairment group codes. The codes are listed in Appendix A on pages A1-A3. Oftentimes nurses who work as prospective payment system coordinators (and not coders) actually assign the impairment group code, says Paula Archer, RHIA, managing consultant for BKD, LLP. "This is fine as long as they've been trained," Archer says. "They also need to talk to coders who are applying the etiologic diagnosis code." Splitting the coding duty between nurses who assign the impairment group code and coders who assign the etiologic diagnosis code also opens the door for communication, says Margaret J. Cromwell, RHIA, CCS, an industry consultant. "Had I been the one selecting the impairment group, I am not sure those conversations would have taken place, which would have hindered my subsequent growth in knowledge and understanding of the impact of correct selection of the principal diagnosis and impairment group," says Cromwell, who worked in an IRF for four-and-a-half years. But Archer adds that a coder might be just as qualified as a nurse to assign the impairment group code. "Many times, we see coders who are so well trained and so familiar with the IRF-PAI training manual that we recommend they be the ones to code. It depends on who has been educated and how well they've been educated," Archer says. For more information, including a list of which diagnoses and impairment groups verify the 75% compliance rule, view Appendix A of Transmittal 478 dated February 18, Visit to view this transmittal. Know that IRFs have shorter turn-around time Although acute hospital inpatient coders have the luxury of performing retrospective queries, inpatient rehab coders do not. CMS requires rehab facilities to assign initial admission codes within three days of admission. Cromwell says that inpatient rehab coders should get in the habit of either inserting a written query into the chart or ing a physician on admission because once the patient is discharged, the facility could be subject to a late penalty (25% of the total reimbursement per case) if it submits the completed IRF-PAI late. 104 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

115 EXHIBIT G "Consider the financial loss if the case was a six-month length of stay for a patient in the trauma unit," Cromwell says. CMS references-such as Transmittal A , p. 3-state that a facility must transmit the completed IRF-PAI to its fiscal intermediary within 28 calendar days of discharge, including the date of discharge. However, the Federal Register cites a 10-day window. The Federal Register (d)(2) states the following: In accordance with the regulations, Medicare (Part A fee-for-service) patient assessment data must be transmitted to the CMS National Collection Database by the 17thcalendar day from the date of the patient's discharge. If the actual transmission date is later than 10 calendar days from the mandated transmission date, the patient assessment data is considered late and the inpatient rehab facility receives a payment rate that is 25% less than the payment rate associated with the case-mix group. Therefore, if the inpatient rehab facility transmits the patient assessment data 28 calendar days or more from the date of discharge, with the discharge date itself starting the counting sequence, the penalty is applied. She added that although Transmittal 619 addresses circumstances that CMS has determined to be "extraordinary," there are no guarantees that CMS make allowances. Visit to view this transmittal. Consider IRF-only coder to enhance compliance Hiring a coder to code only IRF claims may be one way to enhance compliance. Both Cromwell and Archer say facilities should base this decision on the individual facility's volume of rehab cases and workload. Cromwell says that if your facility is large enough and has sufficient demand, designate one coder whose job it is to stay on top of inpatient rehab regulations. "Provide the opportunity for that coder to monitor and become thoroughly familiar with the CMS Web site for transmittals concerning acute inpatient rehab," she says. "Provide the opportunity for that coder to receive ongoing training and education in acute rehab." It's also important that the inpatient rehab coder not feel pressured to code acute hospital inpatient discharges as well, Cromwell says. "Putting pressure on the acute rehab coder to rush will lead to costly mistakes, errors, and a failure to stay informed on important ongoing CMS transmittals that impact coding, comorbidities, and the 75% rule." Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 105

116 EXHIBIT G INPATIENT REHAB CODING: THE IRF-PAI AND DIAGNOSIS, LATE-EFFECT CODES Third in a three-part series from JustCoding.com. The first article in this series discussed the inpatient rehabilitation facility patient assessment instrument (IRF-PAI). The second article discussed compliance regulations that (IRFs) are subject to. This week, we'll focus on how to assign an etiologic diagnosis code and late-effects code on the IRF-PAI. Unlike the UB-92 form, coders don't assign a principal diagnosis code from the ICD-9 Manual on the IRF-PAI. Instead, coders fill in what's called an etiologic diagnosis code-a code that represents the reason for the patient's admission to rehab. This is where coders must live in two coding worlds-one for inpatient rehab and the other for acute care, says Margaret J. Cromwell, RHIA, CCS, an industry consultant. For example, consider the following scenario: A 90-year-old patient has a fractured hip and undergoes a hip replacement. During the surgery, however, the patient suffers a stroke, leaving him with hemiparesis and dysarthria. The physician assesses the patient and states that he should be admitted to an IRF due to the hip fracture (820.09). On the UB-92, the principal diagnosis would be V57.xx (admission to rehab). On the IRF-PAI, however, the etiologic diagnosis would be the reason for the admission to rehab-the hip fracture (820.09) with the hip replacement (V43.64) reported as a comorbid condition. This case would meet the criteria for the 75% compliance rule because of the etiologic diagnosis of hip fracture, which would be assigned to impairment group for fractured hip. "The patient could be admitted because of the deficits from the stroke and not necessarily because of the hip replacement. It could be both, but the documentation would have to be very clear," says Paula Archer, RHIA, managing consultant for BKD, LLP. Consider this example: a patient has an acute stroke with hemiparesis. Code the acute stroke (434.91) as the etiologic diagnosis on the IRF-PAI. On the UB-92, report (hemiplegia/hemiparesis) as the principal diagnosis code. Archer suggests your organization have a good query process in place in case the physician's documentation is not clear. But even if the coder correctly assigns the etiologic diagnosis code, this doesn't ensure that diagnosis will meet the 75% compliance rule. "We see people all the time who are admitted to rehab facilities for knee replacements, which don't meet the compliance rule," Archer says. 106 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

117 EXHIBIT G Knee replacements will only meet the 75% compliance rule when one of the following criteria is applicable: The patient is morbidly obese (with a body mass index of 50 or above) The patient has a bilateral knee replacement The patient is 85 years or older Correct code selection is important in any setting, but in the rehab setting, the selection of the etiologic diagnosis is also tied very closely with the 75% compliance rule. "Unlike the acute inpatient setting where two or more diagnoses may meet the definition of principal diagnosis, the negative ramifications of incorrect selection of the etiologic diagnosis are not readily apparent to a coder unfamiliar with the 75% compliance rule," Cromwell says. Archer adds that more facilities are creating skilled nursing facility (SNF) units-which aren't subject to the same kinds of strict rules that IRFs are-to accommodate patients whose diagnoses don't meet the compliance rule. "Rather than put those patients into rehab and risk not being compliant, facilities transfer these patients to an SNF unit," she says. Late-effect codes should indicate prior completed inpatient rehab treatment only Archer says coders often don't know when to assign a late-effects code vs. an acute condition code as the etiologic diagnosis on the IRF-PAI. Base the code assignment on whether the patient has previously completed an inpatient rehab program, Archer says. When choosing which code to assign, keep the following in mind: Use a late-effects code only when the patient has had a previous stroke, for example, and previously completed a course of treatment at an IRF. For example, consider this scenario: A physician admits a patient to an inpatient rehab facility due to a stroke. While in rehab, the patient develops a deep vein thrombosis and the physician transfers him back to the acute care facility. The patient stays in the acute care facility for one week and then returns to the rehab facility for readmission. Because the patient did not complete the program, code the acute condition as the etiologic diagnosis code on the IRF-PAI. If the patient had already completed a course of treatment, meaning the provider discharged the patient from a rehab facility, report the late-effects code as the etiologic diagnosis code on the IRF-PAI. Making a switch between acute care coding and inpatient rehab coding is important, Archer adds. If a patient who was previously admitted to rehab a month ago has a stroke and is admitted to rehab again because of a deficit-such as dysphagia resulting from that stroke-code (late effect of dysphagia) on the UB-92 (because it is a late effect of the stroke), but code the acute Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 107

118 EXHIBIT G condition for the dysphagia (787.2) on the IRF-PAI because the dysphagia is the reason for admission to the rehab facility. It's also necessary for the physician to document the patient's deficits, Archer says. "So many times, we see physicians admit patients to rehab because of a stroke only. They assume that the reader/coder knows that the patient has certain deficits. But they need to document them to support medical necessity," she adds. Comorbid conditions serve a different purpose in IRFs On the acute side, there are several diagnoses-such as congestive heart failure or decubitus ulcers-that drive a higher paying DRG. The case-mix group (CMG) is the equivalent of the DRG on the rehab side, however unlike on the acute side, Archer says comorbidities that drive the CMG also potentially provide additional reimbursement for the inpatient rehab facility by placing the case into one of three different tier levels-either B, C, or D-each of which pays a different amount. Tier level B, for example, could pay $2,500 to $3,000 more than the original CMG, while tier level C could disburse $2,100, and tier level D could grant $1,500 more. Some conditions will be comorbid under both the DRG and CMG systems, such as clostridium difficile enteritis, gangrene, cellulites, septicemia, AIDS, tuberculosis, and diabetic complications. Others, such as morbid obesity or hemiplegia, are only comorbid under CMGs. For a complete list of comorbid conditions under CMGs, visit The conditions are listed in Appendix C (pages ). Note that the following comorbid condition codes were removed from the list for fiscal year 2006, effective October 1, 2005: (Neoplasm of uncertain behavior of digestive and respiratory systems, lip, oral cavity, and pharynx) (Foreign body in pharynx and larynx, larynx) (Foreign body in trachea, bronchus, and lung, main bronchus) (Diseases of esophagus, achalasia, and cardiospasm) (Stricture and stenosis of esophagus) (Diverticulum of esophagus, acquired) V46.11 (Other dependence on machines, dependence on respirator, status) (Other ill-defined and unknown causes of morbidity and mortality, Cachexia) V49.75 (Lower limb amputation status, below knee) V49.76 (Lower limb amputation status, above knee) V49.77 (Lower limb amputation status, hip) (Idiopathic progressive polyneuropathy) (Diabetes with unspecified complication, type II or unspecified type, not stated as uncontrolled) (Diabetes I with unspecified complications, uncontrolled) 261 (Nutritional marasmus) 262 (Other severe protein-calorie malnutrition) (Acute myocardial infarction, unspecified site, initial episode of care) 108 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

119 EXHIBIT G 410.X1 (Specific acute myocardial infarction, initial episode) 260 (Nutritional deficiencies, Kwashiorkor) Archer adds that when looking for comorbid conditions, coders should only use physician documentation even though it is, at times, limited. "Coders will tend to want to go to therapy notes," she says. "If coders see something in the therapy notes, they can query the physician. They should review the entire record when coding, but then they have to confirm anything they see through physician documentation." Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 109

120 Resources

121 From Our Team to Yours! Save 20% on your next order! This is how we say Thanks! Thanks for being an integral part of today s audioconference. Participation, questions, and follow-up comments from you and your peers help HCPro continue to develop quality audioconference programs you can use to train staff, improve internal processes, and meet regulatory demands. This is how we show our thanks Visit us online at and redeem this coupon for 20% off any one item of your choice. You may select today s audioconference sponsor product, any newsletter, book, video, package of handbooks, or perhaps your next audioconference. If you prefer, call our Customer Service Team at 800/ and mention Source Code MAUDIO20, or complete the order form below and fax it to 800/ The choice is yours. The pleasure is ours. While you re at the Marketplace, sign up for any of dozens of free weekly e-zines. It s fast and it s easy! HCPro 200 Hoods Lane P.O. Box 1168 Marblehead, MA Phone 800/ Fax 800/ Product Price Code Quantity Total Order online at Enter your source code at checkout to save 20%! Your order is covered by HCPro s risk-free, money-back guarantee. THIS OFFER EXPIRES IN 30 DAYS. Your source code is: MAUDIO20 Ship to: (Shipments cannot be made to a P.O. Box) Your Name and Title Organization Street Address City/State/Zip *Shipping (see below) **Your state sales $ tax Grand Total $ FOUR EASY WAYS TO PAY! (Please check one) Bill me Charge VISA MasterCard AmEX Check enclosed (pay to HCPro) Bill my facility with P.O. # Account # Expires Signature: Thank you for your order! *Shipping Newsletter shipping $24/year, $27 to AK, HI, PR; Books and Videos $10 on orders under $100, $18 on orders over $100; Handbooks $5 pack, $15 pack to AK, HI, PR **Tax Information States that tax products and shipping and handling: CA, CT, GA, IL, FL, IN, KY, MA, MD, MI, NC, NJ, NY, OH, OK, PA, RI, SC, TN, TX, VA, VT, WA, WI; States that tax products only: AZ

122 RESOURCES Speaker Resources Patricia Trela, RHIA Consultant PATrela Consulting 275 Victory Road Quincy, MA Phone: 617/ Margaret Cromwell, RHIA, CCS Consultant 6105 Hunters Glen Drive Plainsboro, NJ Home: 609/ Fax: 609/ Andrea Curry, RN, BS, CCM Case Manager, Client Services JFK Johnson Rehab Institute 65 James Street Edison, NJ Phone: 732/ , Ext Lisa Eramo (moderator) HCPro sites HCPro: It is HCPro's mission to meet the specialized information, advisory, and education needs of the healthcare industry and to learn from and respond to our customers with services that meet or exceed the quality that they expect. Visit HCPro s Web site at and take advantage of our new Internet resources. At you will find the latest news, advice, and how-to information in the world of healthcare. resourceful FREE newsletters covering everything from survey preparation and JCAHO standards to healthcare credentialing and health information management. Sign up for weekly updates sent right to your computer. your healthcare questions answered by HCPro s experts. weekly tips on how to perform your job at your best. in-depth how-to stories in our premium newsletters, including Briefings on JCAHO, Medical Staff Briefing, and Credentialing Resource Center. (Paid subscriptions or pay-per-view are required to read premium newsletter content.) the most comprehensive products and services (through our online store, HCPro s com) to help you tackle the tough issues that you face on the job every day. all of the information and resources that you need in the following healthcare areas: Accreditation Case management 112 Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment

123 RESOURCES Corporate compliance Credentialing/privileging Executive leadership Finance Health information management Infection control Long-term care Marketing Medical staff Nursing Pharmacy Pharmaceutical Physician practice Quality/patient safety Rehab Residency Safety HCPro continues to offer the expert advice and practical guidance on which you've come to rely to meet your daily challenges. This valuable information will be available to you 24 hours per day, seven days per week via the Internet. The Greeley Company, a division of HCPro: Get connected with leading healthcare consultants and educators on The Greeley Company s Web site at This online service provides the fastest, most convenient, and most up-to-date information on our quality consulting and national training offerings to healthcare leaders. Visitors will find a complete listing of all of our products and services that include consulting services, seminars, and conferences and links to other HCPro offerings. Here s what visitors will find: Detailed descriptions of all of The Greeley Company s consulting services A catalog and calendar of Greeley s national seminars and conferences and available CME s Faculty and consultant biographies learn about our senior-level clinicians, administrators, and faculty who are ready to assist your organization with your consulting needs and seminars Ask-the-Expert Q&A A list of Greeley clients A link to free newsletters HCPro s Healthcare Marketplace: Looking for even more resources? Shop for the healthcare management tools that you need at HCPro s Healthcare Marketplace at Our online store makes it easy for you to find what you need, when you need it, in one secure and user-friendly e-commerce site. At HCPro s Healthcare Marketplace, you ll discover all of the newsletters, books, videos, audioconferences, online learning, special reports, and training handbooks that HCPro has to offer. Shopping is secure and purchasing is easy with a speedy checkout process. Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment 113

124 CERTIFICATE OF ATTENDANCE attended Inpatient Rehabilitation Facility Coding and Billing: A team approach to correct code assignment a 90-minute audioconference on July 18, 2006 Rob Stuart Senior Vice President / Chief Operating Officer