Arkansas Health Care Payment Improvement Initiative Tonsillectomy/Adenoidectomy Algorithm Summary

Transcription

1 Arkansas Health Care Payment Improvement Initiative Tonsillectomy/Adenoidectomy Algorithm Summary

2 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 2 of 12 Triggers PAP assignment s 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, 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/Baldor, Greenbay Packaging, Hytrol, Nabholz, Navistar, Nucor, Replacement Parts, Riceland, Southern Steel and Wire

3 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.

4 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 4 of 12 Trigger Claims with following are considered when triggering an episode: CPT: 42820, 42821, 42825, 42826, 42830, 42831, 42835, 42836, Claims which have any of the following DRG will be excluded: DRG : 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 within 365 days before the trigger procedure will be excluded: CPT : 69424, Patients who have claims including any of the following CPT/HCPCS procedure on the same day as the trigger procedure will be excluded: CPT : 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 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

5 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 5 of 12 Codes (continued) Patients who have claims including any of the following diagnosis within 365 days before the trigger procedure will be excluded: 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, 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, , , , , , , , , ,

6 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 6 of 12 Codes (continued) Patients who have claims including any of the following diagnosis 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 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 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

7 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 7 of 12 Claims included Quality 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. Provided upon request. Utilization Please see the final pages of this document for a list of the corresponding ICD-10 There are no utilization metrics for this episode.

8 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 8 of 12 Patients who have claims including any of the following diagnosis within 365 days before the trigger procedure will be excluded: 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,

9 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 9 of 12 (continued) ICD-10 Diagnosis (continued): G90522, G90523, G90529, G9059, G904, G902, G908, G909, G712, G710, G7111, G7112, G7113, G7114, G7119, G723, G720, G721, G722, G737, M0540, M05411, M05412, M05419, M05421, M05422, M05429, M05431, M05432, M05439, 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,

10 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 10 of 12 (continued) ICD-10 Diagnosis (continued): M61332, M61339, M61341, M61342, M61349, M61351, M61352, M61359, M61361, M61362, M61369, M61371, M61372, M61379, M6138, M6139, M61411, M61412, M61419, M61421, M61422, M61429, M61431, M61432, M61439, M61441, 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,

11 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 11 of 12 (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

12 Tonsillectomy/Adenoidectomy Algorithm Summary v1.6 Page 12 of 12 Quality 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