PRINCIPAL ACCOUNTABLE PROVIDER MANUAL

Transcription

1 Health Care Payment Improvement Building a healthier future for all Arkansans Arkansas Payment Improvement Initiative Episodes of Care PRINCIPAL ACCOUNTABLE PROVIDER MANUAL Tonsillectomy/Adenoidectomy Episode Reimbursement Program MPI /17 Arkansas Blue Cross and Blue Shield AHCPII Help Desk APIICustomerSupport@arkbluecross.com Last Update: May 10, 2018 Arkansas Blue Plans in this report refers to Arkansas Blue Cross and Blue Shield, Health Advantage and/or BlueAdvantage Administrators of Arkansas.

2 Tonsillectomy/Adenoidectomy Episode Reimbursement Program The Arkansas Health Care Payment Improvement Initiative (AHCPII) was developed as a joint effort between Arkansas Medicaid, QualChoice and Arkansas Blue Cross and Blue Shield, its affiliates and subsidiaries (Arkansas Blue Cross). More information may be found within this manual or at The Tonsillectomy/Adenoidectomy Episode Program will incentivize better coordination of care, encourage clinical effectiveness, and reward high quality care in order to reduce complications that threaten quality and increase costs. Episode Definition A core component of this program is episodes of care. An episode is the collection of care provided to treat a particular condition over a given length of time. Included in the episode are all related services 90 days prior to (after and including initial consult) and 30 days after tonsillectomy/adenoidectomy procedure, including inpatient and outpatient facility services, professional services, and related medications. Principal Accountable Provider (PAP) For each episode, the provider that holds the main responsibility for ensuring that care is delivered at appropriate cost and quality will be designated as the PAP based on observed patterns of care. The PAP for the episode is the physician performing the tonsillectomy/adenoidectomy procedure. The PAP for each episode is identified retrospectively through claims data. As leaders, however, PAPs will share in the savings and excess costs of episodes. A provider must have five or more eligible cases of an episode to be considered a PAP. For example, a physician must have performed at least five eligible Tonsillectomy/Adenoidectomy episodes. The provider billing for the service on the claim is held responsible in the episode calculations. For this reason accurate coding is essential. Claims Submission Claims filing procedures will be the same as they are today as described in Arkansas Blue Cross Provider Network Agreements and provider manuals. Supplemental Quality Measures In order to participate in upside savings, providers must meet: 1. A quality metric related to the 30-day readmission rate using the same re-admission criteria as CMS. 2. Additionally, PAPs will receive reports highlighting their performance on the percent of episodes with administration of intra-operative steroids, the post-operative primary bleed rate (i.e., post-procedure admissions or unplanned return to OR due to bleeding within 24 hours of surgery), the post-operative secondary bleed rate and the rate of antibiotic prescription post-surgery, if applicable, for each patient must be entered via the AHIN portal in order for the PAP to participate in sharing any applicable savings. Adjustments and Exclusions Reference the Tonsillectomy/Adenoidectomy Algorithm Summary for details.

3 Reports for Principal Accountable Providers (PAPs) Reference the AHCPII Overview Page within this manual for details and instructions on accessing the PAP Reports on the Provider Portal. Financial Settlements in the Episodes of Care Model Reference the AHCPII Overview Page within this manual for details on the Financial Settlement Process. Provider Appeal Process Reference the AHCPII Overview Page within this manual for details on the Provider Appeal Process. This Program document is referenced in the provider agreements and amendments (defined as ("Program") of the Preferred Payment Plan, True Blue PPO, Arkansas' First Source PPO and Health Advantage Network Participating Provider Agreements. Therefore it is considered to be part of these agreements. Tonsillectomy/Adenoidectomy Algorithm Summary

4 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 2 of 12 Triggers PAP assignment Exclusions An episode is triggered when a patient shows a claim with a Tonsillectomy or an Adenoidectomy CPT procedure code. The patient s claims will also be processed by the OptumInsights ETG software, where they must be assigned an Episode Treatment Group (ETG) for Tonsillitis, adenoiditis or pharyngitis with surgery. For specific DRG, ICD-9-CM, and CPT/HCPCS procedure codes, please see dataset. The Principal Accountable Provider (PAP) for an episode is the physician enrolled in an Arkansas Blue Plan provider network who performs the trigger procedure. Episodes meeting one or more of the following criteria will be excluded: A. The patient has claims or enrollment records that indicate coordination of benefits with another payer not associated with the Arkansas Blue Plans within the duration of the episode B. The patient does not have continuous coverage with at least one Arkansas Blue Plan throughout the entire episode C. The overall episode cost for the patient exceeds the outlier criteria. Currently, the outlier threshold is set at three standard deviations above the average episode cost for all patients otherwise included in the reporting period for all PAPs D. Provider terminated prior to report publication E. Episode overlaps with another episode F. Procedure occurred late in the performance period, episode will likely appear on next report G. No outpatient facility claim H. The patient was discharged against medical advice or due to expiration I. Patient less than 3 years old at time of trigger procedure J. Patient older than 21 years at time of trigger procedure K. Concurrent procedure of Uvulopalatopharyngoplasty (UPPP) on the same date as the trigger L. Patient BMI > 50 as indicated on provider portal M. The patient has claims indicating one of the following comorbidities within 365 days before the episode: 1) Suicide and intentional selfinflicted injury, 2) Sickle cell disease, 3) Cystic fibrosis, 4) Coagulopathies, 5) Severe asthma, 6) Down syndrome, 7) Congenital defects of the circulatory system, 8) Post obstructive pulmonary edema, 9) Muscular dystrophy, 10) Myopathies, 11) Degenerative diseases of CNS, 12) Severe mental retardation, 13) Blood disorders, 14) Congenital anomalies, 15) Malignant hypothermia, 16) ESRD (end-stage renal disease), 17) Respiratory distress, 18) Bone cancer, 19) Brain cancer, 20) Bronchial/lung cancer, 21) Colon cancer, 22) Esophageal cancer, 23) GI/peritoneum cancer, 24) Liver cancer, 25) Malignant neoplasm, 26) Neoplasm unspecified, 27) Female genital cancer, 28) Male genital cancer, 29) Ovarian cancer, 30) Pancreas cancer, 31) Rectum/anus cancer, 32) Kidney/renal cancer, 33) Stomach cancer, 34) Urinary organ cancer, 35) Gallbladder cancer, 36) Secondary malignancy, 37) Other respiratory cancer, 38) Other primary cancer, 39) Pneumonia, 40) Fetal disturbances, 41) Forceps or vacuum extractor delivery, 42) Malposition, 43) Other perinatal diagnosis, 44) Umbilical cord complications, 45) Spontaneous abortion N. Patient is an Exchange member O. Patient is an Access Only member P. Non-par self-insured groups: ABB Inc. (ABB/Baldor and Thomas & Betts), Green Bay Packaging, Hytrol Conveyor Co, Inc, Mana, Nabholz Inc, Navistar Inc, NYSC NYS Holding Company (Nucor), Replacement Parts, Riceland Foods Inc, Southern Steel & Wire (effective 1/1/16), and White River Medical Center

5 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 3 of 12 Episode time window Claims included Quality measures Episodes begin with the first service performed by the PAP within 90 days before the trigger procedure and end 30 days after the trigger procedure. Comorbidities are assessed within 365 days before and within 30 days after the trigger procedure. The episode will include all claims identified by the ETG for Tonsillitis, adenoiditis or pharyngitis with surgery. Claims with a DRG on the CMS list of exclusions for other respiratory admissions will not be included in the episode. Quality measures to pass (payment related): A. Intra-operative steroid rate PAP will enter in quality metrics on all required randomly selected prospective episodes. The PAP also has the opportunity to enter in quality metrics for optional episodes, if they so choose. Only included episodes will be considered for the rate calculation. Must meet a minimum threshold of 85% of episodes. Utilization measures Adjustments Quality measures to track (not payment related): A. Post-operative primary bleed rate Calculated based on the percentage of episodes with a diagnosis identified on the Quality Codes list with a service date within 1 day following the trigger procedure. B. Post-operative secondary bleed rate The Calculated based on the percentage of episodes with a diagnosis identified on the Quality Codes list with a service date 2 and 14 days following the trigger procedure. C. Post-operative antibiotic prescription rate Calculated based on the percentage of episodes with a prescription drug claim with an NDC on the Quality Codes list filled within 30 days after the trigger procedure. There are no Utilization measures for this episode. The total reimbursements attributed to the PAP will be adjusted based on the presence complications that resulted in variations in treatment using a multiplier determined by regression. Over time, risk factors may be added or subtracted based on new research and/or empirical evidence.

6 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 4 of 12 Trigger codes Claims with following codes are considered when triggering an episode: CPT: 42820, 42821, 42825, 42826, 42830, 42831, 42835, 42836, Exclusion Claims which have any of the following DRG codes will be excluded: codes DRG codes: 0001, 0002, 0005, 0006, 0007, 0008, 0010, 0011, 0012, 0013, 0014, 0016, 0017, 0020, 0021, 0022, 0023, 0024, 0025, 0026, 0027, 0028, 0029, 0030, 0031, 0032, 0033, 0034, 0035, 0036, 0037, 0038, 0039, 0040, 0041, 0042, 0113, 0114, 0115, 0116, 0117, 0129, 0130, 0131, 0132, 0133, 0134, 0135, 0136, 0137, 0138, 0139, 0216, 0217, 0218, 0219, 0220, 0221, 0222, 0223, 0224, 0225, 0226, 0227, 0228, 0229, 0230, 0231, 0232, 0233, 0234, 0235, 0236, 0237, 0238, 0239, 0240, 0241, 0242, 0243, 0244, 0245, 0246, 0247, 0248, 0249, 0250, 0251, 0255, 0256, 0257, 0258, 0259, 0260, 0261, 0262, 0263, 0264, 0265, 0326, 0327, 0328, 0329, 0330, 0331, 0332, 0333, 0334, 0335, 0336, 0337, 0338, 0339, 0340, 0341, 0342, 0343, 0344, 0345, 0346, 0347, 0348, 0349, 0350, 0351, 0352, 0353, 0354, 0355, 0405, 0406, 0407, 0408, 0409, 0410, 0411, 0412, 0413, 0414, 0415, 0416, 0417, 0418, 0419, 0420, 0421, 0422, 0423, 0424, 0425, 0453, 0454, 0455, 0456, 0457, 0458, 0459, 0460, 0461, 0462, 0463, 0464, 0465, 0466, 0467, 0468, 0469, 0470, 0471, 0472, 0473, 0474, 0475, 0476, 0477, 0478, 0479, 0480, 0481, 0482, 0483, 0484, 0485, 0486, 0487, 0488, 0489, 0490, 0491, 0492, 0493, 0494, 0495, 0496, 0497, 0498, 0499, 0500, 0501, 0502, 0503, 0504, 0505, 0506, 0507, 0508, 0509, 0510, 0511, 0512, 0513, 0514, 0515, 0516, 0517, 0570, 0571, 0572, 0573, 0574, 0575, 0576, 0577, 0578, 0579, 0580, 0581, 0582, 0583, 0584, 0585, 0614, 0615, 0616, 0617, 0618, 0619, 0620, 0621, 0622, 0623, 0624, 0625, 0626, 0627, 0652, 0653, 0654, 0655, 0656, 0657, 0658, 0659, 0660, 0661, 0662, 0663, 0664, 0665, 0666, 0667, 0668, 0669, 0670, 0671, 0672, 0673, 0674, 0675, 0707, 0708, 0709, 0710, 0711, 0712, 0713, 0714, 0715, 0716, 0717, 0718, 0734, 0735, 0736, 0737, 0738, 0739, 0740, 0741, 0742, 0743, 0744, 0745, 0746, 0747, 0748, 0749, 0750, 0765, 0766, 0767, 0768, 0769, 0770, 0799, 0800, 0801, 0820, 0821, 0822, 0823, 0824, 0825, 0826, 0827, 0828, 0829, 0830, 0856, 0857, 0858, 0876, 0901, 0902, 0903, 0904, 0905, 0906, 0907, 0908, 0909, 0927, 0928, 0929, 0955, 0956, 0957, 0958, 0959, 0969, 0970, 0984, 0985, 0986, Patients who have claims including any of the following CPT/HCPCS procedure codes within 365 days before the trigger procedure will be excluded: CPT codes: 69424, Patients who have claims including any of the following CPT/HCPCS procedure codes on the same day as the trigger procedure will be excluded: CPT codes: 30118, 30130, 30140, 30520, 30801, 30802, 30901, 30903, 30905, 30930, 31000, 31020, 31231, 31238, 31525, 31526, 31622, 38510, 41010, 41112, 41115, 42140, 42408, 42960, 42962, 44970, 58558, 58661, Patients who have claims including any of the following diagnosis codes within 365 days before the trigger procedure will be excluded: ICD-9 Diagnosis: , 150.0, 150.1, 150.2, 150.3, 150.4, 150.5, 150.8, 150.9, 151.0, 151.1, 151.2, 151.3, 151.4, 151.5, 151.6, 151.8, 151.9, 152.0, 152.1, 152.2, 152.3, 152.8, 152.9, 153.0, 153.1, 153.2, 153.3, 153.4, 153.5, 153.6, 153.7, 153.8, 153.9, 154.0, 154.1, 154.2, 154.3, 154.8, 155.0, 155.1, 155.2, 156, 156.0, 156.1, 156.2, 156.8, 156.9, 157.0, 157.1, 157.2, 157.3, 157.4, 157.8, 157.9, 158.0, 158.8, 158.9, 159.0, 159.1, 159.8, 159.9, 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 163.0, 163.1, 163.8, 163.9, 164.0, 164.1, 164.2, 164.3, 164.8, 164.9, 165.0, 165.8, 165.9, 170.0, 170.1, 170.2, 170.3, 170.4, 170.5, 170.6, 170.7, 170.8, 170.9, 171.0, 171.2, 171.3, 171.4, 171.5, 171.6, 171.7, 171.8, 171.9, 176.0, Please see the final pages of this document for a list of the corresponding ICD-10 codes

7 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 5 of 12 Exclusion Patients who have claims including any of the following diagnosis codes within 365 days before the trigger procedure will be excluded: Codes ICD-9 Diagnosis (continued): 176.1, 176.2, 176.3, 176.4, 176.5, 176.8, 176.9, 181, 183.0, 183.2, 183.3, 183.4, 183.5, 183.8, 183.9, 184.0, 184.1, (continued) 184.2, 184.3, 184.4, 184.8, 184.9, 187.1, 187.2, 187.3, 187.4, 187.5, 187.6, 187.7, 187.8, 187.9, 189.0, 189.1, 189.2, 189.3, 189.4, 189.8, 189.9, 190.0, 190.1, 190.2, 190.3, 190.4, 190.5, 190.6, 190.7, 190.8, 190.9, 191.0, 191.1, 191.2, 191.3, 191.4, 191.5, 191.6, 191.7, 191.8, 191.9, 192.0, 192.1, 192.2, 192.3, 192.8, 192.9, 194.0, ,194.4, 194.5, 194.6, 194.8, 194.9, 195.1, 195.2, 195.3, 195.4, 195.5, 195.8, 196.0, 196.1, 196.2, 196.3, 196.5, 196.6, 196.8, 196.9, 197.0, 197.1, 197.2, 197.3, 197.4, 197.5, 197.6, 197.7, 197.8, 198.0, 198.1, 198.2, 198.3, 198.4, 198.5, 198.6, 198.7, , , , 199.0, 199.1, 199.2, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 230.1, 230.2, 230.3, 230.4, 230.5, 230.6, 230.7, 230.8, 230.9, 231.1, 231.2, 231.8, 231.9, 233.3, , , , , 233.5, 233.6, 233.9, 234.0, 234.8, 234.9, 235.0, 235.1, 235.2, 235.3, 235.4, 235.5, 235.6, 235.7, 235.8, 235.9, 236.0, 236.1, 236.2, 236.3, 236.4, 236.5, 236.6, 236.7, , , , 237.0, 237.1, 237.2, 237.3, 237.4, 237.5, 237.6, 237.7, , , , , , 237.9, 238.0, 238.1,238.2, 238.3, 238.4, 238.5, 238.6, 238.7, , , , , , , , , 238.8, 238.9, 239.0, 239.1, 239.2, 239.3, 239.4, 239.5, 239.6, 239.7, 239.8, , , 239.9, , , , , , , , 282.6, , , , , , , , 283.0, , , , 283.2, 283.9, , , 284.1, 284.2, , , 284.9, 286.0, 286.1, , 318.1, 330, 330.0, 330.1, 330.2, 330.3, 330.8, 330.9, 331, 331.0, 331.1, , , 331.2, 331.3, 331.4, 331.5, 331.6, 331.7, 331.8, , , , , 331.9, 332, 332.0, 332.1, 333, 333.0, 333.1, 333.2, 333.3, 333.4, 333.5, 333.6, 333.7, , , , 333.8, , , , , , , 333.9, , , , , , , 334, 334.0, 334.1, 334.2, 334.3, 334.4, 334.8, 334.9, 335, 335.0, 335.1, , , , 335.2, , , , , , , 335.8, 335.9, 336, 336.0, 336.1, 336.2, 336.3, 336.8, 336.9, 337, 337.0, , , , 337.1, 337.2, , , , , 337.3, 337.9, 359.0, 359.1, , , , , , 359.3, 359.4, 359.5, 359.6, 359.7, , , 359.8, , , 359.9, 416, 424.0, 480, 480.0, 480.1, 480.2, 480.3, 480.8, 480.9, 481, 482, 482.0, 482.1, 482.2, 482.3, , , , , 482.4, , , , , 482.8, , , , , , 482.9, 483, 483.0, 483.1, 483.8, 484, 484.1, 484.3, 484.5, 484.6, 484.7, 484.8, 485, 486, , , , , , , , , , , , , , 517.3, 518.4, 585.5, 585.6, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 649.3, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 666.3, , , , , , 728, 728.0, 728.1, , , , , , 728.2, 728.3, 728.4, 728.5, 728.6, 728.7, , , 728.8, , , , , , , , , ,

8 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Exclusion Codes (continued) Page 6 of 12 Patients who have claims including any of the following diagnosis codes within 365 days before the trigger procedure will be excluded: ICD-9 Diagnosis (continued): 728.9, 744, 745, 745.1, , , 745.2, 745.3, 745.4, 745.5, 745.6, 746.1, 746.2, 746.7, 747, 747.1, , 747.3, , 749, 750, 758.0, 760.0, 760.1, 760.2, 760.3, 760.4, 760.5, 760.6, , , , , , , , , , , 760.8, 760.9, 761.0, 761.1, 761.2, 761.3, 761.4, 761.5, 761.6, 761.7, 761.8, 761.9, 762.0, 762.1, 762.2, 762.3, 762.4, 762.5, 762.6, 762.7, 762.8, 762.9, 763.0, 763.1, 763.2, 763.3, 763.4, 763.5, 763.6, 763.7, 763.8, , , , , , 763.9, 766.0, 766.1, 766.2, , ,769, 770.0, 770.1, , , , , , , , , , 770.2, 770.3, 770.4, 770.5, 770.6, 770.7, 770.8, , , , , , , , , 770.9, 771.0, 771.1, 771.2, 771.3, 771.4, 771.5, 771.6, 771.7, 771.8, , , , 772.0, 772.1, , , , , , 772.2, 772.3, 772.4, 772.5, 772.6, 772.8, 772.9, 775.0, 775.1, 775.2, 775.3, 775.4, 775.5, 775.6, 775.7, 775.8, , , 775.9, 776.0, 776.1, 776.2, 776.3, 776.4, 776.5, 776.6, 776.7, 776.8, 776.9, 777.1, 777.2, 777.3, 777.4, 777.5, , , , , 777.6, 777.8, 777.9, 778.0, 778.1, 778.2, 778.3, 778.4, 778.5, 778.6, 778.7, 778.8, 778.9, 779.0, 779.1, 779.2, 779.3, , , , , 779.4, 779.6, 779.7, 779.8, , , , , , 779.9, , , , 789.7, 795.1, , , , , , , , , , , , , , E950, E950.0, E950.1, E950.2, E950.3, E950.4, E950.5, E950.6, E950.7, E950.8, E950.9, E951, E951.0, E951.1, E951.8, E952, E952.0, E952.1, E952.8, E952.9, E953, E953.0, E953.1, E953.8, E953.9, E954, E955, E955.0, E955.1, E955.2, E955.3, E955.4, E955.5, E955.6, E955.7, E955.9, E956, E957, E957.0, E957.1, E957.2, E957.9, E958, E958.0, E958.1, E958.2, E958.3, E958.4, E958.5, E958.6, E958.7, E958.8, E958.9, V10.00, V10.03, V10.04, V10.05, V10.06, V10.07, V10.09, V10.11, V10.12, V10.20, V10.22, V10.29, V10.40, V10.43, V10.44, V10.45, V10.48, V10.49, V10.50, V10.52, V10.53, V10.59, V10.81, V10.84, V10.85, V10.86, V10.88, V10.89, V10.9, V10.90, V10.91, V13.7, V42.0, V45.1,V45.11, V45.12, V50.2, V56.0, V56.1, V56.2, V56.3, V56.31, V56.32, V56.8, V62.84, V71.1 Claims including any of the following procedure codes during the episode window will be excluded: CPT /HCPCS procedure code: 2035F, 3230F, 69405, 69420, 69421, 69433, 69450, 69604, 69610, 69620, 69631, 69632, 69633, 69635, 69636, 69637, 69641, 69642, 69643, 69644, 69645, 69646, 69676, 92550, 92567, 92570, E2120, S2225 Claims including any of the following procedure codes which occur on the same day as the Tonsillectomy/Adenoidectomy will be excluded: CPT /HCPCS procedure code: 30140, 42960, 31525, 31000, 69210, 30930, 30802, 31526, 31231, 42140, 30903, 42962, 31238, 30801, 31622, 41010, 30901, 31020, 30130, 42408, 30520, 38510, 30118, 41112, 41115, ICD-9 Diagnosis code: 19.4, 19.5, 19.52, 19.53, 19.54, 19.55, 19.6, 20, 20.01, 20.09, 20.1, 20.91, Please see the final pages of this document for a list of the corresponding ICD-10 codes

9 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 7 of 12 Claims included codes Quality codes The episode will include all claims classified with an ETG of Tonsillitis, adenoiditis or pharyngitis with surgery. Claims with service dates within 1 day after the trigger procedure qualify the episode for Post-operative primary bleed: CPT Procedure: 42960, 42961, ICD-9 Procedure: 28.7, Claims with service dates within 2 14 days after the trigger procedure qualify the episode for Post-operative secondary bleed CPT Procedure: 42960, 42961, ICD-9 Procedure: 28.7, Pharmacy claims indicating an antibiotic prescription filled within 30 days after the trigger procedure will qualify the episode for Postoperative antibiotic prescription NDC: In excess of 9,000 codes. Provided upon request. Utilization codes Please see the final pages of this document for a list of the corresponding ICD-10 codes There are no utilization metrics for this episode.

10 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 8 of 12 Exclusion Patients who have claims including any of the following diagnosis codes within 365 days before the trigger procedure will be excluded: codes ICD-10 Diagnosis: A4851, C153, C154, C155, C158, C159, C160, C164, C163, C161, C162, C165, C166, C168, C169, C170, C171, C172, C173, C178, C179, C183, C184, C186, C187, C180, C181, C182, C185, C188, C189, C19, C20, C211, C210, C212, C218, C220, C222, C223, C224, C227, C228, C221, C229, C23, C240, C241, C248, C249, C250, C251, C252, C253, C254, C257, C258, C259, C480, C451, C481, C488, C482, C260, C261, C269, C33, C3400, C3401, C3402, C3410, C3411, C3412, C342, C3430, C3431, C3432, C3480, C3481, C3482, C3490, C3491, C3492, C384, C450, C37, C380, C452, C381, C382, C388, C383, C390, C399, C410, C411, C412, C413, C4000, C4001, C4002, C4010, C4011, C4012, C414, C4020, C4021, C4022, C4030, C4031, C4032, C4080, C4081, C4082, C4090, C4091, C4092, C419, C470, C490, C4710, C4711, C4712, C4910, C4911, C4912, C4720, C4721, C4722, C4920, C4921, C4922, C473, C493, C474, C494, C475, C495, C476, C496, C478, C498, C479, C499, C460, C461, C462, C464, C4650, C4651, C4652, C463, C467, C469, C58, C561, C562, C569, C5700, C5701, C5702, C5710, C5711, C5712, C573, C5720, C5721, C5722, C574, C574, C52, C510, C511, C512, C519, C518, C577, C578, C579, C600, C601, C602, C609, C6300, C6301, C6302, C6310, C6311, C6312, C632, C608, C637, C638, C639, C641, C642, C649, C651, C652, C659, C661, C662, C669, C680, C681, C688, C689, C6940, C6941, C6942, C6960, C6961, C6962, C6900, C6901, C6902, C6910, C6911, C6912, C6920, C6921, C6922, C6930, C6931, C6932, C6950, C6951, C6952, C6980, C6981, C6982, C6990, C6991, C6992, C710, C711, C712, C713, C714, C715, C716, C717, C718, C719, C7220, C7221, C7222, C7230, C7231, C7232, C7240, C7241, C7242, C7250, C7259, C700, C709, C720, C721, C701, C729, C7400, C7401, C7402, C7410, C7411, C7412, C7490, C7491, C7492, C750, C751, C752, C753, C754, C755, C758, C759, C761, C762, C763, C7640, C7641, C7642, C7650, C7651, C7652, C457, C768, C770, C771, C772, C773, C774, C775, C778, C779, C7800, C7801, C7802, C781, C782, C7830, C7839, C784, C785, C786, C787, C7880, C7889, C7900, C7901, C7902, C7910, C7911, C7919, C792, C7931, C7932, C7940, C7949, C7951, C7952, C7960, C7961, C7962, C7970, C7971, C7972, C7981, C7982, C7989, C799, C800, C459, C801, C802, C96A, C960, C962, C7A019, C7A010, C7A011, C7A012, C7A029, C7A020, C7A021, C7A022, C7A023, C7A024, C7A025, C7A026, C7A00, C7A090, C7A091, C7A092, C7A093, C7A094, C7A095, C7A096, C7A098, C7A1, C7A8, C7B00, C7B01, C7B02, C7B03, C7B04, C7B1, C7B09, C7B8, D001, D002, D010, D011, D012, D013, D0140, D0149, D015, D017, D019, D021, D0220, D0221, D0222, D023, D024, D0730, D072, D071, D0739, D074, D0760, D0761, D0769, D0910, D0919, D0920, D0921, D0922, D093, D098, D099, D37030, D37031, D37032, D37039, D3701, D3702, D3704, D3705, D3709, D371, D372, D373, D374, D375, D376, D483, D484, D378, D379, D380, D381, D382, D383, D384, D385, D386, D390, D392, D3910, D3911, D3912, D398, D399, D4010, D4011, D4012, D400, D408, D409, D414, D419, D4100, D4101, D4102, D4110, D4111, D4112, D4120, D4121, D4122, D413, D418, D443, D444, D445, D4410, D4411, D4412, D446, D447, D440, D442, D449, D430, D431, D432, D434, D420, D421, D429, Q8500, Q8501, Q8502, Q8503, Q8509, D433, D438, D439, D480, D481, D482, D485, D4860, D4861, D4862, D45, D470, D473, D460, D461, D4620, D4621, D464, D46A, D46B, D4622, D46C, D469, D46Z, D47Z1, C888, C9440, C9441, C9442, C946, D471, D479, D47Z9, D487, D489, D490, D491, D492, D493, D494, D495, D496, D497, D4981, D4989, D499, E849, E8411, E840, E8419, E848, D5740, D57411, D57412, D57419, D571, D5700, D5701, D5702, D5720, D57211, D57212, D57219, D5780, D57811, D57812, D57819, D590, D591, D593, D592, D594, D595, D596, D598, D599, D6101, D6109, D6182, D600, D601, D608, D609, D611, D612, D613, D6189, D619, D66, D67, D5702, D57212, D57412, D57812, F72, E7523, E7525, E7529, E7500, E7501, E7502, E7509, E7510, E7511, E7519, E754, F842, G3181, G3182, G300, G301, G308, G309, G3101, G3109, G311, G910, G911, G913, G918, G919, G912, G3185, G132, G138, G312, G914, G94, G937, G3183, G3184, G3189, G319, G20, G214, G2111, G2119, G212, G213, G218, G219, G230, G231, G232, G238, G239, G903, G250, G251, G252, G253, G2561, G2569, G10, G254, G255, G241, G803, G2402, G2409, G242, G248, G245, G244, G243, G2401, G249, G259, G2582, G210, G2583, G2581, G2570, G2571, G2579, G2589, G26, G114, G110, G112, G111, G3281, G113, G118, G119, G120, G129, G121, G1221, G1222, G128, G1229, G1220, G950, G9511, G9519, G320, G992, G9581, G9589, G9520, G9529, G959, G9009, G9001, G990, G9050, G9059, G90511, G90512, G90513, G90519, G90521,

11 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 9 of 12 Exclusion ICD-10 Diagnosis (continued): G90522, G90523, G90529, G9059, G904, G902, G908, G909, G712, G710, G7111, G7112, G7113, G7114, codes G7119, G723, G720, G721, G722, G737, M0540, M05411, M05412, M05419, M05421, M05422, M05429, M05431, M05432, M05439, (continued) M05441, M05442, M05449, M05451, M05452, M05459, M05461, M05462, M05469, M05471, M05472, M05479, M0549, M3302, M3312, M3322, M3392, M3482, M3503, G7241, G7249, G7281, G713, G718, G7289, G719, G729, I340, I341, I342, I348, I349, J120, J121, J122, J1281, J123, J1289, J129, J13, J181, J150, J151, J14, J154, J153, J154, J1520, J15211, J15212, J1529, J155, J156, A481, J158, J159, J157, J160, J168, B250, A3701, A3711, A3781, A3791, A221, B440, J17, B7781, J180, J188, J189, J4520, J4530, J4540, J4550, J4522, J4532, J4542, J4552, J4521, J4531, J4541, J4551, J45909, J45998, J45902, J45901, J910, D5701, D57211, D57411, D57811, J810, N185, N186, O030, O0337, O035, O0387, O031, O036, O0334, O0384, O0332, O0382, O0333, O0383, O0331, O0381, O037, O032, O0335, O0336, O0338, O0339, O0385, O0386, O0388, O0389, O0330, O0380, O034, O039, O99119, O99111, O99112, O99113, O9912, O9913, O9913, O320XX0, O320XX1, O320XX2, O320XX3, O320XX4, O320XX5, O320XX9, O321XX0, O321XX1, O321XX2, O321XX3, O321XX4, O321XX5, O321XX9, O641XX0, O641XX1, O641XX2, O641XX3, O641XX4, O641XX5, O641XX9, O322XX0, O322XX1, O322XX2, O322XX3, O322XX4, O322XX5, O322XX9, O323XX0, O323XX1, O323XX2, O323XX3, O323XX4, O323XX5, O323XX9, O642XX0, O642XX1, O642XX2, O642XX3, O642XX4, O642XX5, O642XX9, O643XX0, O643XX1, O643XX2, O643XX3, O643XX4, O643XX5, O643XX9, O324XX0, O324XX1, O324XX2, O324XX3, O324XX4, O324XX5, O324XX9, O329XX0, O329XX1, O329XX2, O329XX3, O329XX4, O329XX5, O329XX9, O666, O326XX0, O326XX1, O326XX2, O326XX3, O326XX4, O326XX5, O326XX9, O328XX0, O328XX1, O328XX2, O328XX3, O328XX4, O328XX5, O328XX9, O644XX0, O644XX1, O644XX2, O644XX3, O644XX4, O644XX5, O644XX9, O645XX0, O645XX1, O645XX2, O645XX3, O645XX4, O645XX5, O645XX9, O648XX0, O648XX1, O648XX2, O648XX3, O648XX4, O648XX5, O648XX9, O649XX0, O649XX1, O649XX2, O649XX3, O649XX4, O649XX5, O649XX9, O641XX0, O641XX1, O641XX2, O641XX3, O641XX4, O641XX5, O641XX9, O642XX0, O642XX1, O642XX2, O642XX3, O642XX4, O642XX5, O642XX9, O643XX0, O643XX1, O643XX2, O643XX3, O643XX4, O643XX5, O643XX9, O644XX0, O644XX1, O644XX2, O644XX3, O644XX4, O644XX5, O644XX9, O645XX0, O645XX1, O645XX2, O645XX3, O645XX4, O645XX5, O645XX9, O648XX0, O648XX1, O648XX2, O648XX3, O648XX4, O648XX5, O648XX9, O649XX0, O649XX1, O649XX2, O649XX3, O649XX4, O649XX5, O649XX9, O620, O621, O622, O623, O624, O628, O629, O630, O639, O631, O632, O690XX0, O690XX1, O690XX2, O690XX3, O690XX4, O690XX5, O690XX9, O691XX0, O691XX1, O691XX2, O691XX3, O691XX4, O691XX5, O691XX9, O692XX0, O692XX1, O692XX2, O692XX3, O692XX4, O692XX5, O692XX9, O6981X0, O6981X1, O6981X2, O6981X3, O6981X4, O6981X5, O6981X9, O6982X0, O6982X1, O6982X2, O6982X3, O6982X4, O6982X5, O6982X9, O6989X0, O6989X1, O6989X2, O6989X3, O6989X4, O6989X5, O6989X9, O693XX0, O693XX1, O693XX2, O693XX3, O693XX4, O693XX5, O693XX9, O694XX0, O694XX1, O694XX2, O694XX3, O694XX4, O694XX5, O694XX9, O695XX0, O695XX1, O695XX2, O695XX3, O695XX4, O695XX5, O695XX9, O43129, O43121, O43122, O43123, O699XX0, O699XX1, O699XX2, O699XX3, O699XX4, O699XX5, O699XX9, O723, O665, M60000, M60001, M60002, M60003, M60004, M60005, M60009, M60011, M60012, M60019, M60021, M60022, M60029, M60031, M60032, M60039, M60041, M60042, M60043, M60044, M60045, M60046, M60051, M60052, M60059, M60061, M60062, M60069, M60070, M60071, M60072, M60073, M60074, M60075, M60076, M60077, M60078, M6008, M6009, M6120, M61211, M61212, M61219, M61221, M61222, M61229, M61231, M61232, M61239, M61241, M61242, M61249, M61251, M61252, M61259, M61261, M61262, M61269, M61271, M61272, M61279, M6128, M6129, M619, M6110, M61111, M61112, M61119, M61121, M61122, M61129, M61131, M61132, M61139, M61141, M61142, M61143, M61144, M61145, M61146, M61151, M61152, M61159, M61161, M61162, M61169, M61171, M61172, M61173, M61174, M61175, M61176, M61177, M61178, M61179, M6118, M6119, M6100, M61011, M61012, M61019, M61021, M61022, M61029, M61031, M61032, M61039, M61041, M61042, M61049, M61051, M61052, M61059, M61061, M61062, M61069, M61071, M61072, M61079, M6108, M6109, M6140, M6130, M61311, M61312, M61319, M61321, M61322, M61329, M61331,

12 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 10 of 12 Exclusion ICD-10 Diagnosis (continued): M61332, M61339, M61341, M61342, M61349, M61351, M61352, M61359, M61361, M61362, M61369, codes M61371, M61372, M61379, M6138, M6139, M61411, M61412, M61419, M61421, M61422, M61429, M61431, M61432, M61439, M61441, (continued) M61442, M61449, M61451, M61452, M61459, M61461, M61462, M61469, M61471, M61472, M61479, M6148, M6149, M6150, M61511, M61512, M61519, M61521, M61522, M61529, M61531, M61532, M61539, M61541, M61542, M61549, M61551, M61552, M61559, M61561, M61562, M61569, M61571, M61572, M61579, M6158, M6159, M6250, M62511, M62512, M62519, M62521, M62522, M62529, M62531, M62532, M62539, M62541, M62542, M62549, M62551, M62552, M62559, M62561, M62562, M62569, M62571, M62572, M62579, M6258, M6259, M623, M2420, M24211, M24212, M24219, M24221, M24222, M24229, M24231, M24232, M24239, M24241, M24242, M24249, M24251, M24252, M24259, M24271, M24272, M24273, M24274, M24275, M24276, M2428, M357, M720, M722, M721, M724, M6010, M60111, M60112, M60119, M60121, M60122, M60129, M60131, M60132, M60139, M60141, M60142, M60149, M60151, M60152, M60159, M60161, M60162, M60169, M60171, M60172, M60179, M6018, M6019, M6020, M60211, M60212, M60219, M60221, M60222, M60229, M60231, M60232, M60239, M60241, M60242, M60249, M60251, M60252, M60259, M60261, M60262, M60269, M60271, M60272, M60279, M6028, M6210, M62111, M62112, M62119, M62121, M62122, M62129, M62131, M62132, M62139, M62141, M62142, M62149, M62151, M62152, M62159, M62161, M62162, M62169, M62171, M62172, M62179, M6218, M6200, M62011, M62012, M62019, M62021, M62022, M62029, M62031, M62032, M62039, M62041, M62042, M62049, M62051, M62052, M62059, M62061, M62062, M62069, M62071, M62072, M62079, M6208, M6240, M62411, M62412, M62419, M62421, M62422, M62429, M62431, M62432, M62439, M62441, M62442, M62449, M62451, M62452, M62459, M62461, M62462, M62469, M62471, M62472, M62479, M6248, M6249, M62831, M62838, M726, M6281, M6282, M354, M6220, M62211, M62212, M62219, M62221, M62222, M62229, M62231, M62232, M62239, M62241, M62242, M62249, M62251, M62252, M62259, M62261, M62262, M62269, M62271, M62272, M62279, M6228, M6289, M728, M629, M6380, M63811, M63812, M63819, M63821, M63822, M63829, M63831, M63832, M63839, M63841, M63842, M63849, M63851, M63852, M63859, M63861, M63862, M63869, M63871, M63872, M63879, M6388, M6389, Q201, Q205, Q213, Q204, Q210, Q211, Q224, Q226, Q228, Q229, Q225, Q234, Q262, Q900, Q901, Q902, Q909, P000, P001, P002, P003, P004, P005, P007, P006, P041, Q861, P042, P045, P046, P048, P049, Q862, Q868, P0081, P9681, P009, P010, P011, P012, P013, P014, P015, P016, P017, P018, P019, P020, P021, P0220, P0229, P023, P024, P025, P0260, P0269, P027, P028, P029, P030, P031, P032, P033, P034, P040, P035, P036, P03810, P03811, P03819, P0382, P0389, P039, P080, P081, P0821, P0822, P220, P230, P231, P232, P233, P234, P235, P236, P238, P239, P249, P2400, P2401, P2410, P2411, P2420, P2421, P2480, P2481, P250, P251, P252, P253, P258, P260, P261, P268, P269, P280, P2810, P2811, P2819, P221, P270, P271, P278, P279, P283, P284, P282, P285, P2430, P2431, P2881, P228, P229, P2889, P289, P350, P351, P352, P353, P358, P359, P370, P371, P372, P373, P374, P378, P379, A33, P381, P389, P390, P391, P375, P393, P392, P394, P398, P399, P500, P501, P502, P503, P504, P505, P508, P509, P102, P523, P520, P521, P5221, P5222, P103, P525, P510, P518, P519, P541, P542, P543, P544, P545, P540, P546, P548, P549, P700, P701, P702, P940, P721, P710, P711, P712, P713, P714, P718, P719, P741, P742, P743, P744, P703, P704, P740, P84, P708, P720, P722, P728, P745, P746, P748, P709, P729, P749, P53, P610, P60, P616, P611, P613, P614, P612, P615, P618, P619, P760, P762, P782, P761, P779, P771, P772, P773, P780, P768, P769, P781, P783, P7881, P7882, P7883, P7889, P789, P832, P830, P800, P808, P809, P810, P818, P819, P8330, P8339, P835, P834, P831, P836, P838, P839, P90, P918, P919, P910, P911, P913, P914, P915, P921, P922, P923, P924, P925, P928, P929, P9201, P9209, P926, P930, P938, P912, P2912, P2911, P9682, P2981, P290, P292, P294, P2989, P299, P941, P942, P948, P949, P960, P963, P965, P9689, P95, P969, R6812, R6811, R180, R1083, R87620, R87621, R87622, R87623, R87624, R85619, R85610, R85611, R85612, R85613, R85614, T788XXA, T8851XA, T39012A, T39092A, T392X2A, T39312A, T39392A, T394X2A, T398X2A, T3992XA, T400X2A, T401X2A, T403X2A, T411X2A, T41202A, T41292A, T413X2A, T4142XA, T407X2A, T408X2A, T40902A,

13 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 11 of 12 Exclusion codes (continued) ICD-10 Diagnosis (continued): T40992A, T4272XA, T43012A, T43022A, T431X2A, T43202A, T43212A, T43222A, T43292A, T433X2A, T434X2A, T43502A, T43592A, T43602A, T43612A, T43622A, T43632A, T43692A, T438X2A, T4392XA, T360X2A, T361X2A, T362X2A, T363X2A, T364X2A, T365X2A, T366X2A, T367X2A, T368X2A, T3692XA, T370X2A, T371X2A, T372X2A, T373X2A, T374X2A, T375X2A, T378X2A, T3792XA, T380X2A, T381X2A, T382X2A, T383X2A, T384X2A, T385X2A, T386X2A, T387X2A, T38802A, T38812A, T38892A, T38902A, T38992A, T405X2A, T420X2A, T421X2A, T422X2A, T425X2A, T426X2A, T428X2A, T440X2A, T441X2A, T442X2A, T443X2A, T444X2A, T445X2A, T446X2A, T447X2A, T448X2A, T44902A, T44992A, T450X2A, T451X2A, T452X2A, T453X2A, T454X2A, T45512A, T45522A, T45602A, T45612A, T45622A, T45692A, T457X2A, T458X2A, T4592XA, T460X2A, T461X2A, T462X2A, T463X2A, T464X2A, T465X2A, T466X2A, T467X2A, T468X2A, T46902A, T46992A, T470X2A, T471X2A, T472X2A, T473X2A, T474X2A, T475X2A, T476X2A, T477X2A, T478X2A, T4792XA, T480X2A, T481X2A, T48202A, T48292A, T483X2A, T484X2A, T485X2A, T486X2A, T48902A, T48992A, T490X2A, T491X2A, T492X2A, T493X2A, T494X2A, T495X2A, T496X2A, T497X2A, T498X2A, T4992XA, T500X2A, T501X2A, T502X2A, T503X2A, T504X2A, T505X2A, T506X2A, T507X2A, T508X2A, T50902A, T50992A, T50A12A, T50A22A, T50A92A, T50B12A, T50B92A, T50Z12A, T50Z92A, T600X2A, T540X2A, T542X2A, T550X2A, T551X2A, T572X2A, T510X2A, T511X2A, T512X2A, T513X2A, T518X2A, T5192XA, T520X2A, T521X2A, T522X2A, T523X2A, T524X2A, T528X2A, T5292XA, T530X2A, T531X2A, T532X2A, T533X2A, T534X2A, T536X2A, T537X2A, T5392XA, T560X2A, T561X2A, T562X2A, T563X2A, T564X2A, T565X2A, T566X2A, T567X2A, T56812A, T56892A, T5692XA, T578X2A, T5792XA, T6102XA, T6112XA, T61772A, T61782A, T618X2A, T6192XA, T620X2A, T621X2A, T622X2A, T628X2A, T6292XA, T6402XA, T6482XA, T650X2A, T651X2A, T65212A, T65222A, T65292A, T653X2A, T654X2A, T655X2A, T656X2A, T65812A, T65822A, T65832A, T65892A, T6592XA, T410X2A, T415X2A, T535X2A, T573X2A, T590X2A, T591X2A, T593X2A, T59892A, T71162A, T71112A, X710XXA, X710XXD, X711XXA, X711XXD, X712XXA, X712XXD, X713XXA, X713XXD, X718XXA, X718XXD, X719XXA, X719XXD, X72XXXA, X72XXXD, X730XXA, X730XXD, X731XXA, X731XXD, X732XXA, X732XXD, X738XXA, X738XXD, X739XXA, X739XXD, X748XXA, X748XXD, X75XXXA, X75XXXD, X7401XA, X7401XD, X7409XA, X7409XD, X7402XA, X7402XD, X749XXA, X749XXD, X780XXA, X780XXD, X781XXA, X781XXD, X782XXA, X782XXD, X788XXA, X788XXD, X789XXA, X789XXD, X80XXXA, X80XXXD, X810XXA, X810XXD, X811XXA, X811XXD, X818XXA, X818XXD, X76XXXA, X76XXXD, X773XXA, X773XXD, X778XXA, X778XXD, X779XXA, X779XXD, X770XXA, X770XXD, X771XXA, X771XXD, X772XXA, X772XXD, X832XXA, X832XXD, X831XXA, X831XXD, X820XXA, X820XXD, X821XXA, X821XXD, X822XXA, X822XXD, X828XXA, X828XXD, X830XXA, X830XXD, X79XXXA, X79XXXD, X838XXA, X838XXD, T1491, Z8500, Z8501, Z85028, Z85038, Z85048, Z8505, Z85068, Z8507, Z8509, Z85118, Z8512, Z8520, Z8522, Z85238, Z8529, Z8540, Z8543, Z8544, Z8545, Z8548, Z8549, Z8550, Z85528, Z8553, Z8554, Z8559, Z85830, Z85840, Z85841, Z85848, Z85858, Z85831, Z8589, Z859, Z85020, Z85030, Z85040, Z85060, Z85110, Z85230, Z85520, Z85821, Z4822, Z940, Z992, Z9115, Z412, Z4931, Z4901, Z4902, Z4931, Z4932, R45851 ICD-9 Diagnosis code: 19.4, 19.5, 19.52, 19.53, 19.54, 19.55, 19.6, 20, 20.01, 20.09, 20.1, 20.91, ICD-10 Diagnosis code: Z, 09950ZZ, Z, 09960ZZ, Z, 09970ZZ, Z, 09973ZZ, Z, 09974ZZ, Z, 09977ZZ, Z, 09978ZZ, Z, 09980ZZ, Z, 09983ZZ, Z, 09984ZZ, Z, 09987ZZ, Z, 09988ZZ, 09C70ZZ, 09C73ZZ, 09C74ZZ, 09C77ZZ, 09C78ZZ, 09C80ZZ, 09C83ZZ, 09C84ZZ, 09C87ZZ, 09C88ZZ, 09P700Z, 09P770Z, 09P780Z, 09P800Z, 09P870Z, 09P880Z, 09PH30Z, 09PH40Z, 09PH70Z, 09PH80Z, 09PJ30Z, 09PJ40Z, 09PJ70Z, 09PJ80Z, 09Q70ZZ, 09Q73ZZ, 09Q74ZZ, 09Q77ZZ, 09Q78ZZ, 09Q80ZZ, 09Q83ZZ, 09Q84ZZ, 09Q87ZZ, 09Q88ZZ, 09S70ZZ, 09S74ZZ, 09S77ZZ, 09S78ZZ, 09S80ZZ, 09S84ZZ, 09S87ZZ, 09S88ZZ, 09U707Z, 09U70JZ, 09U70KZ, 09U777Z, 09U77JZ, 09U77KZ, 09U787Z, 09U78JZ, 09U78KZ, 09U807Z, 09U80JZ, 09U80KZ, 09U877Z, 09U87JZ, 09U87KZ, 09U887Z, 09U88JZ, 09U88KZ, 09W707Z, 09W70JZ, 09W70KZ, 09W777Z, 09W77JZ, 09W77KZ, 09W787Z, 09W78JZ, 09W78KZ, 09W807Z, 09W80JZ, 09W80KZ, 09W877Z, 09W87JZ, 09W87KZ, 09W887Z, 09W88JZ, 09W88KZ, C762, C763, C7640, C7641, C7642, C7650, C7651, C7652

14 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 12 of 12 Quality codes Claims with service dates within 1 day after the trigger procedure qualify the episode for Post-operative primary bleed: ICD-9 Procedure: 28.7, ICD-10 Procedure: 0W300ZZ, 0W303ZZ, 0W304ZZ, 0W310ZZ, 0W313ZZ, 0W314ZZ, 0W320ZZ, 0W323ZZ, 0W324ZZ, 0W330ZZ, 0W333ZZ, 0W334ZZ, 0W337ZZ, 0W338ZZ, 0W33XZZ, 0W340ZZ, 0W343ZZ, 0W344ZZ, 0W350ZZ, 0W353ZZ, 0W354ZZ, 0W360ZZ, 0W363ZZ, 0W364ZZ, 0W380ZZ, 0W383ZZ, 0W384ZZ, 0W393ZZ, 0W394ZZ, 0W3B3ZZ, 0W3B4ZZ, 0W3D3ZZ, 0W3D4ZZ, 0W3F0ZZ, 0W3F3ZZ, 0W3F4ZZ, 0W3G3ZZ, 0W3G4ZZ, 0W3H3ZZ, 0W3H4ZZ, 0W3J0ZZ, 0W3J3ZZ, 0W3J4ZZ, 0W3K0ZZ, 0W3K3ZZ, 0W3K4ZZ, 0W3L0ZZ, 0W3L3ZZ, 0W3L4ZZ, 0W3M0ZZ, 0W3M3ZZ, 0W3M4ZZ, 0W3N0ZZ, 0W3N3ZZ, 0W3N4ZZ, 0W3P3ZZ, 0W3P4ZZ, 0W3Q3ZZ, 0W3Q4ZZ, 0W3Q7ZZ, 0W3Q8ZZ, 0W3R0ZZ, 0W3R3ZZ, 0W3R4ZZ, 0W3R7ZZ, 0W3R8ZZ, 0X320ZZ, 0X323ZZ, 0X324ZZ, 0X330ZZ, 0X333ZZ, 0X334ZZ, 0X340ZZ, 0X343ZZ, 0X344ZZ, 0X350ZZ, 0X353ZZ, 0X354ZZ, 0X360ZZ, 0X363ZZ, 0X364ZZ, 0X370ZZ, 0X373ZZ, 0X374ZZ, 0X380ZZ, 0X383ZZ, 0X384ZZ, 0X390ZZ, 0X393ZZ, 0X394ZZ, 0X3B0ZZ, 0X3B3ZZ, 0X3B4ZZ, 0X3C0ZZ, 0X3C3ZZ, 0X3C4ZZ, 0X3D0ZZ, 0X3D3ZZ, 0X3D4ZZ, 0X3F0ZZ, 0X3F3ZZ, 0X3F4ZZ, 0X3G0ZZ, 0X3G3ZZ, 0X3G4ZZ, 0X3H0ZZ, 0X3H3ZZ, 0X3H4ZZ, 0X3J0ZZ, 0X3J3ZZ, 0X3J4ZZ, 0X3K0ZZ, 0X3K3ZZ, 0X3K4ZZ, 0Y300ZZ, 0Y303ZZ, 0Y304ZZ, 0Y310ZZ, 0Y313ZZ, 0Y314ZZ, 0Y350ZZ, 0Y353ZZ, 0Y354ZZ, 0Y360ZZ, 0Y363ZZ, 0Y364ZZ, 0Y370ZZ, 0Y373ZZ, 0Y374ZZ, 0Y380ZZ, 0Y383ZZ, 0Y384ZZ, 0Y390ZZ, 0Y393ZZ, 0Y394ZZ, 0Y3B0ZZ, 0Y3B3ZZ, 0Y3B4ZZ, 0Y3C0ZZ, 0Y3C3ZZ, 0Y3C4ZZ, 0Y3D0ZZ, 0Y3D3ZZ, 0Y3D4ZZ, 0Y3F0ZZ, 0Y3F3ZZ, 0Y3F4ZZ, 0Y3G0ZZ, 0Y3G3ZZ, 0Y3G4ZZ, 0Y3H0ZZ, 0Y3H3ZZ, 0Y3H4ZZ, 0Y3J0ZZ, 0Y3J3ZZ, 0Y3J4ZZ, 0Y3K0ZZ, 0Y3K3ZZ, 0Y3K4ZZ, 0Y3L0ZZ, 0Y3L3ZZ, 0Y3L4ZZ, 0Y3M0ZZ, 0Y3M3ZZ, 0Y3M4ZZ, 0Y3N0ZZ, 0Y3N3ZZ, 0Y3N4ZZ Claims with service dates within 2 14 days after the trigger procedure qualify the episode for Post-operative secondary bleed ICD-9 Procedure: 28.7, ICD-10 Procedure: 0W300ZZ, 0W303ZZ, 0W304ZZ, 0W310ZZ, 0W313ZZ, 0W314ZZ, 0W320ZZ, 0W323ZZ, 0W324ZZ, 0W330ZZ, 0W333ZZ, 0W334ZZ, 0W337ZZ, 0W338ZZ, 0W33XZZ, 0W340ZZ, 0W343ZZ, 0W344ZZ, 0W350ZZ, 0W353ZZ, 0W354ZZ, 0W360ZZ, 0W363ZZ, 0W364ZZ, 0W380ZZ, 0W383ZZ, 0W384ZZ, 0W393ZZ, 0W394ZZ, 0W3B3ZZ, 0W3B4ZZ, 0W3D3ZZ, 0W3D4ZZ, 0W3F0ZZ, 0W3F3ZZ, 0W3F4ZZ, 0W3G3ZZ, 0W3G4ZZ, 0W3H3ZZ, 0W3H4ZZ, 0W3J0ZZ, 0W3J3ZZ, 0W3J4ZZ, 0W3K0ZZ, 0W3K3ZZ, 0W3K4ZZ, 0W3L0ZZ, 0W3L3ZZ, 0W3L4ZZ, 0W3M0ZZ, 0W3M3ZZ, 0W3M4ZZ, 0W3N0ZZ, 0W3N3ZZ, 0W3N4ZZ, 0W3P3ZZ, 0W3P4ZZ, 0W3Q3ZZ, 0W3Q4ZZ, 0W3Q7ZZ, 0W3Q8ZZ, 0W3R0ZZ, 0W3R3ZZ, 0W3R4ZZ, 0W3R7ZZ, 0W3R8ZZ, 0X320ZZ, 0X323ZZ, 0X324ZZ, 0X330ZZ, 0X333ZZ, 0X334ZZ, 0X340ZZ, 0X343ZZ, 0X344ZZ, 0X350ZZ, 0X353ZZ, 0X354ZZ, 0X360ZZ, 0X363ZZ, 0X364ZZ, 0X370ZZ, 0X373ZZ, 0X374ZZ, 0X380ZZ, 0X383ZZ, 0X384ZZ, 0X390ZZ, 0X393ZZ, 0X394ZZ, 0X3B0ZZ, 0X3B3ZZ, 0X3B4ZZ, 0X3C0ZZ, 0X3C3ZZ, 0X3C4ZZ, 0X3D0ZZ, 0X3D3ZZ, 0X3D4ZZ, 0X3F0ZZ, 0X3F3ZZ, 0X3F4ZZ, 0X3G0ZZ, 0X3G3ZZ, 0X3G4ZZ, 0X3H0ZZ, 0X3H3ZZ, 0X3H4ZZ, 0X3J0ZZ, 0X3J3ZZ, 0X3J4ZZ, 0X3K0ZZ, 0X3K3ZZ, 0X3K4ZZ, 0Y300ZZ, 0Y303ZZ, 0Y304ZZ, 0Y310ZZ, 0Y313ZZ, 0Y314ZZ, 0Y350ZZ, 0Y353ZZ, 0Y354ZZ, 0Y360ZZ, 0Y363ZZ, 0Y364ZZ, 0Y370ZZ, 0Y373ZZ, 0Y374ZZ, 0Y380ZZ, 0Y383ZZ, 0Y384ZZ, 0Y390ZZ, 0Y393ZZ, 0Y394ZZ, 0Y3B0ZZ, 0Y3B3ZZ, 0Y3B4ZZ, 0Y3C0ZZ, 0Y3C3ZZ, 0Y3C4ZZ, 0Y3D0ZZ, 0Y3D3ZZ, 0Y3D4ZZ, 0Y3F0ZZ, 0Y3F3ZZ, 0Y3F4ZZ, 0Y3G0ZZ, 0Y3G3ZZ, 0Y3G4ZZ, 0Y3H0ZZ, 0Y3H3ZZ, 0Y3H4ZZ, 0Y3J0ZZ, 0Y3J3ZZ, 0Y3J4ZZ, 0Y3K0ZZ, 0Y3K3ZZ, 0Y3K4ZZ, 0Y3L0ZZ, 0Y3L3ZZ, 0Y3L4ZZ, 0Y3M0ZZ, 0Y3M3ZZ, 0Y3M4ZZ, 0Y3N0ZZ, 0Y3N3ZZ, 0Y3N4ZZ