00946 Rehabilitation w/o CC/MCC $

Transcription

1 In accordance with section 2718(e) of the Public Health Service Act and and CMS FY19 IPPS Final Rule, Mon Health Medical Center is making available a public listing of their standard charges. To properly estimate the patient responsibility of any procedure, it is recommended that all patients reach out to Patient Financial Services for an individualized estimate regarding services being provided by Mon Health Medical Center. All pricing listed is not reflective of any contractual adjustment, fee schedule or uninsured discount. DRG Average Charges per DRG Rehabilitation w CC/MCC $ Behavioral & developmental dis $ Craniotomy & endovascular intr $ Principal diagnosis invalid as $ OTHER FACTORS INFLUENCING HEAL $ Rehabilitation w/o CC/MCC $ NORMAL NEWBORN $ NO LONGER VALID $ EXTREME IMMATURITY OR RESPIRAT $ NEONATES, DIED OR TRANSFERRED $ NEONATE W OTHER SIGNIFICANT PR $ Hypertensive encephalopathy w $ Aftercare w/o CC/MCC $ PREMATURITY W/O MAJOR PROBLEMS $ Other factors influencing heal $ 1, PREMATURITY W MAJOR PROBLEMS $ 1, Traumatic stupor & coma, coma $ 1, Neonates, died or transferred $ 1, MAJOR SKIN DISORDERS W/O CC $ 1, FULL TERM NEONATE W MAJOR PROB $ 1, FALSE LABOR $ 1, Normal newborn $ 1, OTHER ANTEPARTUM DIAGNOSES W/O $ 1, Neonate w other significant pr $ 1, Prematurity w/o major problems $ 1, False labor $ 1, THREATENED ABORTION $ 2, Cardiac arrest, unexplained w/ $ 2, BONE DISEASES & SPECIFIC ARTHR $ 2, Malignancy, male reproductive $ 2, Extreme immaturity or respirat $ 2, Malignant breast disorders w/o $ 2, OTITIS MEDIA & URI AGE 0-17 $ 2, CELLULITIS AGE 0-17 $ 2, TRAUMA TO THE SKIN, SUBCUT TIS $ 3, OTHER INJURY, POISONING & TOXI $ 3, BRONCHITIS & ASTHMA AGE 0-17 $ 3, Threatened abortion $ 3, NON-SPECIFIC ARTHROPATHIES $ 3,337.53

2 70322 KIDNEY & URINARY TRACT INFECTI $ 3, Menstrual & other female repro $ 3, Other myeloprolif dis or poorl $ 3, SIMPLE PNEUMONIA & PLEURISY AG $ 3, TRAUMATIC INJURY AGE >17 W/O C $ 3, ABORTION W/O D&C $ 3, MOUTH PROCEDURES W/O CC $ 3, Deep vein thrombophlebitis w/o $ 3, MENSTRUAL & OTHER FEMALE REPRO $ 3, NUTRITIONAL & MISC METABOLIC D $ 3, MYRINGOTOMY W TUBE INSERTION A $ 3, BREAST PROC FOR NON-MALIGNANCY $ 3, OTHER INJURY, POISONING & TOXI $ 3, POISONING & TOXIC EFFECTS OF D $ 4, Nasal trauma & deformity w/o C $ 4, Malignancy, female reproductiv $ 4, POSTPARTUM & POST ABORTION DIA $ 4, ALC/DRUG ABUSE OR DEPEND W/O R $ 4, NO DESCRIPTION $ 4, AFTERCARE, MUSCULOSKELETAL SYS $ 4, Inborn errors of metabolism $ 4, VIRAL ILLNESS & FEVER OF UNKNO $ 4, NUTRITIONAL & MISC METABOLIC D $ 4, Dental & Oral Diseases w/o CC/ $ 4, T&A PROC, EXCEPT TONSILLECTOMY $ 4, Non-malignant breast disorders $ 4, Connective tissue disorders w/ $ 4, Concussion w/o CC/MCC $ 4, Other antepartum diagnoses w/o $ 4, OTHER ANTEPARTUM DIAGNOSES W M $ 4, Prematurity w major problems $ 4, Acute major eye infections w/o $ 4, ATHEROSCLEROSIS W/O CC $ 4, UNCOMPLICATED PEPTIC ULCER W/O $ 4, Traumatic injury w/o MCC $ 4, ESOPHAGITIS, GASTROENT & MISC $ 5, CELLULITIS AGE >17 W/O CC $ 5, Other male reproductive system $ 5, Aftercare w CC/MCC $ 5, Endocrine disorders w/o CC/MCC $ 5, Kidney & urinary tract neoplas $ 5, Spinal disorders & injuries w/ $ 5, ALLERGIC REACTIONS AGE >17 $ 5, CARDIAC ARRHYTHMIA & CONDUCTIO $ 5, VAGINAL DELIVERY W/O COMPLICAT $ 5, INFLAMMATION OF THE MALE REPRO $ 5, RESPIRATORY SIGNS & SYMPTOMS W $ 5,441.05

3 00793 Full term neonate w major prob $ 5, OTHER CIRCULATORY SYSTEM DIAGN $ 5, PERIPHERAL VASCULAR DISORDERS $ 5, SPRAINS, STRAINS, & DISLOCATIO $ 5, Epistaxis w/o MCC $ 5, OTITIS MEDIA & URI AGE >17 W/O $ 5, FX, SPRN, STRN & DISL OF UPARM $ 5, KIDNEY & URINARY TRACT INFECTI $ 5, POISONING & TOXIC EFFECTS OF D $ 5, Non-extensive burns $ 5, VAGINAL DELIVERY W O.R. PROC E $ 5, SEIZURE AGE > 17 W/O CC $ 5, TRANSURETHRAL PROSTATECTOMY W/ $ 5, VIRAL ILLNESS AGE >17 $ 5, AMPUTAT OF LOWER LIMB FOR ENDO $ 5, BRONCHITIS & ASTHMA AGE >17 W/ $ 5, Other mental disorder diagnose $ 6, HYPERTENSION $ 6, Other antepartum diagnoses w m $ 6, BENIGN PROSTATIC HYPERTROPHY W $ 6, MOUTH PROCEDURES W CC $ 6, VAGINAL DELIVERY W COMPLICATIN $ 6, CONNECTIVE TISSUE DISORDERS W/ $ 6, BONE DISEASES & SPECIFIC ARTHR $ 6, Minor skin disorders w/o MCC $ 6, ANGINA PECTORIS $ 6, Reticuloendothelial & immunity $ 6, Ear, nose, mouth & throat mali $ 6, TRAUMA TO THE SKIN, SUBCUT TIS $ 6, ALCOHOL/DRUG ABUSE OR DEPENDEN $ 6, VIRAL MENINGITIS $ 6, Bone diseases & arthropathies $ 6, Headaches w/o MCC $ 6, OTHER KIDNEY & URINARY TRACT D $ 6, SIMPLE PNEUMONIA & PLEURISY AG $ 6, Other musculoskeletal sys & co $ 6, HEADACHES AGE >17 $ 6, KIDNEY & URINARY TRACT SIGNS & $ 6, Other disorders of the eye w/o $ 6, OTHER DIGESTIVE SYSTEM DIAGNOS $ 6, MINOR SKIN DISORDERS W CC $ 6, DISORDERS OF THE BILIARY TRACT $ 6, OTHER DIGESTIVE SYSTEM O.R. PR $ 6, ENDOCRINE DISORDERS W CC $ 6, Deep vein thrombophlebitis w C $ 6, TRAUMATIC INJURY AGE >17 W CC $ 6, Trauma to the skin, subcut tis $ 6,971.25

4 70024 NO LONGER VALID $ 6, Kidney & urinary tract signs & $ 6, ANAL & STOMAL PROCEDURES W/O C $ 6, Major skin disorders w/o MCC $ 7, G.I. OBSTRUCTION W/O CC $ 7, BREAST BIOPSY & LOCAL EXCISION $ 7, SEPTIC ARTHRITIS $ 7, CARDIAC ARREST, UNEXPLAINED $ 7, Skin ulcers w/o CC/MCC $ 7, COMPLICATIONS OF TREATMENT W/O $ 7, KIDNEY & URINARY TRACT SIGNS & $ 7, DYSEQUILIBRIUM $ 7, Diabetes w/o CC/MCC $ 7, Signs & symptoms of musculoske $ 7, ACUTE ADJUSTMENT REACTION & PS $ 7, ABORTION W D&C, ASPIRATION CUR $ 7, Cardiac arrhythmia & conductio $ 7, Fx, sprn, strn & disl except f $ 7, HYPERTENSIVE ENCEPHALOPATHY $ 7, ORGANIC DISTURBANCES & MENTAL $ 7, CARDIAC CONGENITAL & VALVULAR $ 7, ESOPHAGITIS, GASTROENT & MISC $ 7, Otitis media & URI w/o MCC $ 7, OTHER HEART ASSIST SYSTEM IMPL $ 7, ATHEROSCLEROSIS W CC $ 7, Allergic reactions w/o MCC $ 7, NON-MALIGANT BREAST DISORDERS $ 7, DENTAL & ORAL DIS EXCEPT EXTRA $ 7, NONSPECIFIC CVA & PRECEREBRAL $ 7, MINOR BLADDER PROCEDURES W/O C $ 7, EPISTAXIS $ 7, Other circulatory system diagn $ 7, Benign prostatic hypertrophy w $ 7, NEUROLOGICAL EYE DISORDERS $ 7, MAJOR THUMB OR JOINT PROC,OR O $ 7, ENDOCRINE DISORDERS W/O CC $ 7, Bronchitis & asthma w/o CC/MCC $ 7, Other disorders of nervous sys $ 7, OTHER RESPIRATORY SYSTEM DIAGN $ 7, Depressive neuroses $ 7, URINARY STONES W/O CC $ 7, MULTIPLE SCLEROSIS & CEREBELLA $ 7, Septic arthritis w/o CC/MCC $ 7, Neurological eye disorders $ 7, PLEURAL EFFUSION W CC $ 7, CESAREAN SECTION W/O CC $ 7, Penis procedures w/o CC/MCC $ 7,865.71

5 70142 SYNCOPE & COLLAPSE W/O CC $ 7, TENDONITIS, MYOSITIS & BURSITI $ 7, PNEUMOTHORAX W/O CC $ 7, DIABETES AGE 0-35 $ 7, OTHER DISORDERS OF NERVOUS SYS $ 7, CHEST PAIN $ 8, NUTRITIONAL & MISC METABOLIC D $ 8, CARDIAC ARRHYTHMIA & CONDUCTIO $ 8, PANCREAS, LIVER & SHUNT PROCED $ 8, Admit for renal dialysis $ 8, OTHER SKIN, SUBCUT TISS & BREA $ 8, FEVER OF UNKNOWN ORIGIN AGE >1 $ 8, Cardiac congenital & valvular $ 8, Abortion w/o D&C $ 8, SEIZURE AGE > 17 W CC $ 8, NERVOUS SYSTEM NEOPLASMS W CC $ 8, Hypertension w/o MCC $ 8, MAJOR CHEST TRAUMA W CC $ 8, OTITIS MEDIA & URI AGE >17 W C $ 8, KIDNEY & URINARY TRACT INFECTI $ 8, CELLULITIS AGE >17 W CC $ 8, MALIGNANCY, MALE REPRODUCTIVE $ 8, D&C, CONIZATION EXCEPT FOR MAL $ 8, Acute myocardial infarction, e $ 8, FX, SPRN, STRN & DISL OF FOREA $ 8, O.R. proc w diagnoses of other $ 8, LOCAL EXCIS & REMOV OF INT FIX $ 8, SUBTOTAL MASTECTOMY FOR MALIGN $ 8, Sprains, strains, & dislocatio $ 8, BRONCHITIS & ASTHMA AGE >17 W $ 8, Nonspecific cerebrovascular di $ 8, TRANSURETHRAL PROSTATECTOMY W $ 8, Peripheral vascular disorders $ 8, MEDICAL BACK PROBLEMS $ 8, TRANSURETHRAL PROCEDURES W/O C $ 8, SIGNS & SYMPTOMS W/O CC $ 8, SYNCOPE & COLLAPSE W CC $ 8, FEMALE REPRODUCTIVE SYSTEM REC $ 8, SEIZURE & HEADACHE AGE 0-17 $ 8, Aftercare, musculoskeletal sys $ 8, Respiratory signs & symptoms $ 8, Cardiac arrest, unexplained w $ 8, FRACTURES OF HIP & PELVIS $ 8, SKIN GRAFT &/OR DEBRID EXCEPT $ 8, OTHER KIDNEY & URINARY TRACT D $ 8, Wound debridements for injurie $ 8, PENIS PROCEDURES $ 8,866.40

6 70035 OTHER DISORDERS OF NERVOUS SYS $ 8, CRANIAL & PERIPHERAL NERVE DIS $ 8, G.I. OBSTRUCTION W CC $ 8, DIABETES AGE >35 $ 8, Poisoning & toxic effects of d $ 8, TRAUMA TO THE SKIN, SUBCUT TIS $ 8, SKIN DEBRIDEMENT W/O CC/MCC $ 8, ESOPHAGITIS, GASTROENT & MISC $ 8, PERIPHERAL VASCULAR DISORDERS $ 8, SIGNS & SYMPTOMS OF MUSCULOSKE $ 8, OTHER EAR, NOSE, MOUTH & THROA $ 9, Chest pain $ 9, Acute adjustment reaction & ps $ 9, PATHOLOGICAL FRACTURES & MUSCU $ 9, SKIN GRAFT &/OR DEBRID FOR SKN $ 9, KNEE PROCEDURES W/O PDX OF INF $ 9, FRACTURES OF FEMUR $ 9, BENIGN PROSTATIC HYPERTROPHY W $ 9, Major chest trauma w/o CC/MCC $ 9, OTHER MALE REPRODUCTIVE SYSTEM $ 9, OTHER DISORDERS OF THE EYE AGE $ 9, Concussion w CC $ 9, DEEP VEIN THROMBOPHLEBITIS $ 9, TRANSIENT ISCHEMIA $ 9, Infections, female reproductiv $ 9, UTERINE & ADNEXA PROC FOR NON- $ 9, OTHER MYELOPROLIF DIS OR POORL $ 9, VAGINAL DELIVERY W STERILIZATI $ 9, INGUINAL & FEMORAL HERNIA PROC $ 9, LOWER EXTREM & HUMER PROC EXCE $ 9, Other disorders of the eye w M $ 9, DEPRESSIVE NEUROSES $ 9, OTHER RESPIRATORY SYSTEM DIAGN $ 9, Chemotherapy w/o acute leukemi $ 9, CESAREAN SECTION W CC $ 9, Nonspecific cva & precerebral $ 9, DISORDERS OF LIVER EXCEPT MALI $ 9, SIGNS & SYMPTOMS W CC $ 9, Other multiple significant tra $ 9, SEPTICEMIA AGE 0-17 $ 9, URINARY STONES W CC, &/OR ESW $ 9, Medical back problems w/o MCC $ 9, Skin graft &/or debrid for skn $ 9, Pathological fractures & muscu $ 9, Dysequilibrium $ 9, SKIN GRAFT &/OR DEBRID EXCEPT $ 9, MALIGNANT BREAST DISORDERS W C $ 9,570.18

7 00745 D&C, conization, laparascopy & $ 9, Hypertensive encephalopathy w/ $ 9, Heart failure & shock w/o CC/M $ 9, KIDNEY AND URETER PROCEDURES F $ 9, KNEE PROCEDURES W PDX OF INFEC $ 9, DEGENERATIVE NERVOUS SYSTEM DI $ 9, PSYCHOSES $ 9, SKIN GRAFT &/OR DEBRID FOR SKN $ 9, RED BLOOD CELL DISORDERS AGE > $ 9, Other ear, nose, mouth & throa $ 9, FEVER OF UNKNOWN ORIGIN AGE >1 $ 9, Interstitial lung disease w/o $ 9, TOTAL MASTECTOMY FOR MALIGNANC $ 9, CIRCULATORY DISORDERS W AMI, E $ 9, TESTES PROCEDURES, FOR MALIGNA $ 9, Major hematol/immun diag exc s $ 9, COMPLICATIONS OF TREATMENT W C $ 9, SKIN, SUBCUTANEOUS TISSUE & BR $ 9, CRANIAL & PERIPHERAL NERVE DIS $ 9, Simple pneumonia & pleurisy w/ $ 9, Angina pectoris $ 9, COMPLICATED PEPTIC ULCER $ 9, CIRCULATORY DISORDERS W AMI W/ $ 9, Seizures w/o MCC $ 9, Nutritional & misc metabolic d $ 9, Cirrhosis & alcoholic hepatiti $ 9, PROSTATECTOMY W CC $ 10, Vaginal delivery w/o complicat $ 10, Intraocular procedures w/o CC/ $ 10, NON-BACTERIAL INFECTIONS OF NE $ 10, ECTOPIC PREGNANCY $ 10, Viral meningitis w/o CC/MCC $ 10, Renal failure w/o CC/MCC $ 10, Connective tissue disorders w $ 10, Back & neck proc exc spinal fu $ 10, URETHRAL STRICTURE AGE >17 W C $ 10, Complications of treatment w/o $ 10, PULMONARY EMBOLISM $ 10, DENTAL EXTRACTIONS & RESTORATI $ 10, Nontraumatic stupor & coma w/o $ 10, SIMPLE PNEUMONIA & PLEURISY AG $ 10, CARDIAC PACEMAKER REVISION EXC $ 10, NONTRAUMATIC STUPOR & COMA $ 10, CONNECTIVE TISSUE DISORDERS W $ 10, POSTOPERATIVE & POST-TRAUMATIC $ 10, RENAL FAILURE $ 10, INFLAMMATORY BOWEL DISEASE $ 10,410.05

8 00284 Acute myocardial infarction, e $ 10, Fractures of hip & pelvis w/o $ 10, Tendonitis, myositis & bursiti $ 10, VAGINA, CERVIX & VULVA PROCEDU $ 10, Spinal procedures w/o CC/MCC $ 10, Esophagitis, gastroent & misc $ 10, Postpartum & post abortion dia $ 10, Hand or wrist proc, except maj $ 10, DISORDERS OF PANCREAS EXCEPT M $ 10, PNEUMOTHORAX W CC $ 10, OTHER DIGESTIVE SYSTEM DIAGNOS $ 10, Inflammatory bowel disease w/o $ 10, Digestive malignancy w/o CC/MC $ 10, FX, SPRN, STRN & DISL OF UPARM $ 10, Psychoses $ 10, Chronic obstructive pulmonary $ 10, CIRCULATORY DISORDERS EXCEPT A $ 10, Atherosclerosis w/o MCC $ 10, APPENDECTOMY W/O COMPLICATED P $ 10, Cellulitis w/o MCC $ 10, Other digestive system diagnos $ 10, Non-malignant breast disorders $ 10, MAJOR GASTROINTESTINAL DISORDE $ 10, Headaches w MCC $ 10, MAJOR ESOPHAGEAL DISORDERS $ 10, Signs & symptoms w/o MCC $ 10, HERNIA PROCEDURES EXCEPT INGUI $ 10, HIV w or w/o other related con $ 10, Viral illness w/o MCC $ 10, Nonspecific cva & precerebral $ 10, INFECTIONS, FEMALE REPRODUCTIV $ 10, INTERSTITIAL LUNG DISEASE W/O $ 10, Pneumothorax w/o CC/MCC $ 10, Other kidney & urinary tract d $ 11, Major esophageal disorders w/o $ 11, Traumatic stupor & coma, coma $ 11, NO DESCRIPTION $ 11, Mouth procedures w/o CC/MCC $ 11, Cardiac arrhythmia & conductio $ 11, NO DESCRIPTION $ 11, Inflammation of the male repro $ 11, RESPIRATORY SIGNS & SYMPTOMS W $ 11, DISORDERS OF LIVER EXCEPT MALI $ 11, G.I. HEMORRHAGE W/O CC $ 11, Other infectious & parasitic d $ 11, G.I. obstruction w/o CC/MCC $ 11, Intraocular procedures w CC/MC $ 11,233.06

9 70202 CIRRHOSIS & ALCOHOLIC HEPATITI $ 11, Major gastrointestinal disorde $ 11, Dental & Oral Diseases w CC $ 11, LAPAROSCOPIC CHOLECYSTECTOMY W $ 11, MINOR SKIN DISORDERS W/O CC $ 11, NONSPECIFIC CEREBROVASCULAR DI $ 11, Arthroscopy $ 11, UTERINE & ADNEXA PROC FOR NON- $ 11, INTRAOCULAR PROCEDURES EXCEPT $ 11, Respiratory neoplasms w/o CC/M $ 11, Alcohol/drug abuse or dependen $ 11, Urinary stones w/o esw lithotr $ 11, Transient ischemia $ 11, FOOT PROCEDURES $ 11, Disorders of pancreas except m $ 11, Kidney & urinary tract infecti $ 11, Degenerative nervous system di $ 11, Disorders of liver except mali $ 11, CHRONIC OBSTRUCTIVE PULMONARY $ 11, G.I. hemorrhage w/o CC/MCC $ 11, DISORDERS OF THE BILIARY TRACT $ 11, Vaginal delivery w complicatin $ 11, Multiple sclerosis & cerebella $ 11, TOTAL MASTECTOMY FOR MALIGNANC $ 11, Syncope & collapse $ 11, RESPIRATORY INFECTIONS & INFLA $ 11, Other injury, poisoning & toxi $ 11, Myeloprolif disord or poorly d $ 11, Disorders of the biliary tract $ 11, OTHER EAR, NOSE, MOUTH & THROA $ 11, Transurethral prostatectomy w/ $ 11, Benign prostatic hypertrophy w $ 11, Prostatic O.R. procedure unrel $ 11, OTHER MUSCULOSKELETAL SYSTEM & $ 11, D&C, CONIZATION & RADIO-IMPLAN $ 11, OSTEOMYELITIS $ 11, CHOLECYSTECTOMY W C.D.E. W/O C $ 11, HEART FAILURE & SHOCK $ 11, Traumatic stupor & coma, coma $ 11, Major chest trauma w CC $ 11, PERITONEAL ADHESIOLYSIS W/O CC $ 11, OTHER MULTIPLE SIGNIFICANT TRA $ 11, Nasal trauma & deformity w CC $ 12, INTRACRANIAL HEMORRHAGE OR CER $ 12, STOMACH, ESOPHAGEAL & DUODENAL $ 12, Complicated peptic ulcer w/o C $ 12, Fractures of femur w/o MCC $ 12,278.49

10 70271 SKIN ULCERS $ 12, Pleural effusion w/o CC/MCC $ 12, ANAL & STOMAL PROCEDURES W CC $ 12, APPENDECTOMY W COMPLICATED PRI $ 12, O.R. PROC W DIAGNOSES OF OTHER $ 12, LOWER EXTREM & HUMER PROC EXCE $ 12, Other respiratory system diagn $ 12, Red blood cell disorders w/o M $ 12, DIGESTIVE MALIGNANCY W/O CC $ 12, Concussion w MCC $ 12, Fever of unknown origin $ 12, Alcohol/drug abuse or dependen $ 12, Skin ulcers w CC $ 12, Other endocrine, nutrit & meta $ 12, MINOR BLADDER PROCEDURES W CC $ 12, Osteomyelitis w/o CC/MCC $ 12, OTHER INFECTIOUS & PARASITIC D $ 12, MALIGNANCY, FEMALE REPRODUCTIV $ 12, Bronchitis & asthma w CC/MCC $ 12, NO LONGER VALID $ 12, Inflammatory bowel disease w C $ 13, Non-bacterial infect of nervou $ 13, NONSPECIFIC CEREBROVASCULAR DI $ 13, EXTRACRANIAL PROCEDURES W/O CC $ 13, Peripheral vascular disorders $ 13, TRANSURETHRAL PROCEDURES W CC $ 13, OTHER MUSCULOSKELET SYS & CONN $ 13, HIP & FEMUR PROCEDURES EXCEPT $ 13, MAJOR HEMATOLOGIC/IMMUNOLOGIC $ 13, MYELOPROLIF DISORD OR POORLY D $ 13, SIALOADENECTOMY $ 13, Non-bacterial infect of nervou $ 13, Acute major eye infections w C $ 13, CIRCULATORY DISORDERS EXCEPT A $ 13, Reticuloendothelial & immunity $ 13, Cirrhosis & alcoholic hepatiti $ 13, Cranial & peripheral nerve dis $ 13, Otitis media & URI w MCC $ 13, Other musculoskeletal sys & co $ 13, NO DESCRIPTION $ 13, OTHER SKIN, SUBCUT TISS & BREA $ 13, UNCOMPLICATED PEPTIC ULCER W C $ 13, Other disorders of nervous sys $ 13, Other male reproductive system $ 13, Nontraumatic stupor & coma w M $ 13, Intracranial hemorrhage or cer $ 13, Disorders of personality & imp $ 13,757.79

11 00965 Other multiple significant tra $ 13, SPINAL PROCEDURES W CC $ 13, NO DESCRIPTION $ 13, OTHER CIRCULATORY SYSTEM DIAGN $ 13, SEPTICEMIA W/O MV96+ HOURS AGE $ 13, NO DESCRIPTION $ 13, Traumatic stupor & coma, coma $ 13, HEPATOBILIARY DIAGNOSTIC PROCE $ 13, Major thumb or joint procedure $ 14, Acute myocardia infarction, di $ 14, CIRCULATORY DISORDERS W AMI & $ 14, G.I. HEMORRHAGE W CC $ 14, Organic disturbances & mental $ 14, SPINAL PROCEDURES W/O CC $ 14, Postoperative & post-traumatic $ 14, Menstrual & other female repro $ 14, Local excision & removal int f $ 14, Anal & stomal procedures w/o C $ 14, OTHER O.R. PROCEDURES FOR INJU $ 14, WOUND DEBRIDEMENTS FOR INJURIE $ 14, Other infectious & parasitic d $ 14, MAJOR MALE PELVIC PROCEDURES W $ 14, LAPAROSCOPY & INCISIONAL TUBAL $ 14, Cesarean section w/o CC/MCC $ 14, SOFT TISSUE PROCEDURES W CC $ 14, INBORN ERRORS OF METABOLISM $ 14, Ear, nose, mouth & throat mali $ 14, Ectopic pregnancy $ 14, Other circulatory system diagn $ 14, Minor bladder procedures w/o C $ 14, Diabetes w CC $ 14, MAJOR MALE PELVIC PROCEDURES W $ 14, Circulatory disorders except A $ 14, MAJOR SKIN DISORDERS W CC $ 14, UPPER LIMB & TOE AMPUTATION FO $ 14, OTHER RESP SYSTEM O.R. PROCEDU $ 14, Other myeloprolif dis or poorl $ 14, Bacterial & tuberculous infect $ 14, NERVOUS SYSTEM NEOPLASMS W/O C $ 14, G.I. obstruction w CC $ 14, Chronic obstructive pulmonary $ 14, Other digestive system diagnos $ 14, Urethral stricture $ 14, Local excision & removal int f $ 14, Disorders of liver except mali $ 14, Kidney & urinary tract signs & $ 14, Transurethral procedures w/o C $ 14,848.40

12 70366 MALIGNANCY, FEMALE REPRODUCTIV $ 14, Heart failure & shock w CC $ 14, Testes procedures w/o CC/MCC $ 14, Chemo w acute leukemia as sdx $ 14, Kidney & urinary tract neoplas $ 14, Hand procedures for injuries $ 14, SUBTOTAL MASTECTOMY FOR MALIGN $ 14, Renal failure w CC $ 15, LYMPHOMA & NON-ACUTE LEUKEMIA $ 15, MINOR SMALL & LARGE BOWEL PROC $ 15, MINOR SMALL & LARGE BOWEL PROC $ 15, INGUINAL & FEMORAL HERNIA PROC $ 15, CHEMOTHERAPY W/O ACUTE LEUKEMI $ 15, Abortion w D&C, aspiration cur $ 15, Simple pneumonia & pleurisy w $ 15, Periph/cranial nerve & other n $ 15, Female reproductive system rec $ 15, APPENDECTOMY W/O COMPLICATED P $ 15, Nonspecific cerebrovascular di $ 15, COAGULATION DISORDERS $ 15, MALIGNANCY OF HEPATOBILIARY SY $ 15, Skin grafts & wound debrid for $ 15, PARATHYROID PROCEDURES $ 15, Disorders of pancreas except m $ 15, Sprains, strains, & dislocatio $ 15, Major gastrointestinal disorde $ 15, Complications of treatment w C $ 15, NO LONGER VALID $ 15, THYROID PROCEDURES $ 15, Complicated peptic ulcer w CC $ 15, CHOLECYSTECTOMY EXCEPT BY LAPA $ 15, Signs & symptoms w MCC $ 15, Endocrine disorders w CC $ 15, Other ear, nose, mouth & throa $ 15, RESPIRATORY NEOPLASMS $ 15, INTERSTITIAL LUNG DISEASE W CC $ 16, O.R. PROCEDURES FOR OBESITY $ 16, HERNIA PROCEDURES EXCEPT INGUI $ 16, Esophagitis, gastroent & misc $ 16, Vaginal delivery w sterilizati $ 16, Disorders of the biliary tract $ 16, OTHER ENDOCRINE, NUTRIT & META $ 16, Trauma to the skin, subcut tis $ 16, Septicemia w/o MV 96+ hours w/ $ 16, Interstitial lung disease w CC $ 16, Lymphoma & non-acute leukemia $ 16, Urinary stones w esw lithotrip $ 16,251.69

13 00555 Signs & symptoms of musculoske $ 16, Local excision & removal int f $ 16, Viral meningitis w CC/MCC $ 16, Pneumothorax w CC $ 16, Malignant breast disorders w C $ 16, OTHER O.R. PROCEDURES OF THE B $ 16, POSTPARTUM & POST ABORTION DIA $ 16, Other multiple significant tra $ 16, Extensive burns or full thickn $ 16, LAPAROSCOPIC CHOLECYSTECTOMY W $ 16, Uncomplicated peptic ulcer w/o $ 16, Aftercare, musculoskeletal sys $ 16, KIDNEY AND URETER PROCEDURES F $ 16, KIDNEY AND URETER PROCEDURES F $ 16, Cesarean section w CC/MCC $ 16, Non-extensive O.R. proc unrela $ 16, Multiple sclerosis & cerebella $ 16, Urinary stones w/o esw lithotr $ 16, Major hematol/immun diag exc s $ 16, NON-EXTENSIVE O.R. PROCEDURE U $ 16, Other male reproductive system $ 16, Other kidney & urinary tract d $ 17, Malignancy of hepatobiliary sy $ 17, Respiratory infections & infla $ 17, Acute myocardial infarction, d $ 17, SOFT TISSUE PROCEDURES W/O CC $ 17, Respiratory neoplasms w CC $ 17, Spinal disorders & injuries w $ 17, Pleural effusion w CC $ 17, Knee procedures w/o pdx of inf $ 17, Malignancy, male reproductive $ 17, Malignancy, female reproductiv $ 17, Skin graft &/or debrid for skn $ 17, Penis procedures w CC/MCC $ 17, Kidney & urinary tract infecti $ 17, PERC CARDIO PROC W/O CORONARY $ 17, Atherosclerosis w MCC $ 17, Multiple sclerosis & cerebella $ 17, Cardiac arrhythmia & conductio $ 17, Seizures w MCC $ 17, SINUS & MASTOID PROCEDURES AGE $ 17, Pulmonary embolism w/o MCC $ 17, Cardiac arrest, unexplained w $ 17, Acute leukemia w/o major O.R. $ 17, Nervous system neoplasms w/o M $ 17, Appendectomy w/o complicated p $ 17, Transurethral prostatectomy w $ 17,971.22

14 00543 Pathological fractures & muscu $ 18, PERCUTANEOUS CARDIOVASCULAR PR $ 18, LOCAL EXCIS & REMOV OF INT FIX $ 18, Cholecystectomy w c.d.e. w/o C $ 18, NO DESCRIPTION $ 18, HIV w major related condition $ 18, RESPIRATORY INFECTIONS & INFLA $ 18, Bone diseases & arthropathies $ 18, Postpartum & post abortion dia $ 18, ADRENAL & PITUITARY PROCEDURES $ 18, Major esophageal disorders w C $ 18, Malignancy of hepatobiliary sy $ 18, Red blood cell disorders w MCC $ 18, Soft tissue procedures w/o CC/ $ 18, UTERINE,ADNEXA PROC FOR NON-OV $ 18, Vaginal delivery w O.R. proc e $ 18, Anal & stomal procedures w CC $ 18, Septic arthritis w CC $ 18, Hand or wrist proc, except maj $ 18, Vagina, cervix & vulva procedu $ 18, Prostatectomy w/o CC/MCC $ 18, Nutritional & misc metabolic d $ 18, Digestive malignancy w CC $ 18, PERCUTANEOUS CARDIOVASC PROC W $ 18, Intracranial hemorrhage or cer $ 18, NO DESCRIPTION $ 18, LYMPHOMA & NON-ACUTE LEUKEMIA $ 18, G.I. hemorrhage w CC $ 18, Inflammation of the male repro $ 18, MYELOPROLIF DISORD OR POORLY D $ 19, Infections, female reproductiv $ 19, Thyroid, parathyroid & thyrogl $ 19, Other disorders of nervous sys $ 19, Major skin disorders w MCC $ 19, Laparoscopic cholecystectomy w $ 19, Bacterial & tuberculous infect $ 19, KIDNEY & URINARY TRACT NEOPLAS $ 19, Peripheral vascular disorders $ 19, Inguinal & femoral hernia proc $ 19, Transurethral procedures w CC $ 19, Minor skin disorders w MCC $ 19, Inflammatory bowel disease w M $ 19, Knee procedures w pdx of infec $ 19, Aftercare, musculoskeletal sys $ 19, EXTRACRANIAL PROCEDURES W CC $ 19, Chronic obstructive pulmonary $ 19, Neuroses except depressive $ 19,891.22

15 00054 Nervous system neoplasms w MCC $ 19, BACK & NECK PROC EXC SPINAL FUSION W CC $ 20, Major chest trauma w MCC $ 20, Cardiac pacemaker revision exc $ 20, O.R. PROCEDURE W PRINCIPAL DIA $ 20, Uterine & adnexa proc for non- $ 20, O.R. procedures for obesity w/ $ 20, Full thickness burn w/o skin g $ 20, Other myeloprolif dis or poorl $ 20, KNEE PROCEDURES W PDX OF INFEC $ 20, HIP & FEMUR PROCEDURES EXCEPT $ 20, Minor bladder procedures w CC $ 20, Skin graft &/or debrid exc for $ 20, Spinal procedures w CC or spin $ 20, Skin grafts & wound debrid for $ 20, DIGESTIVE MALIGNANCY W CC $ 20, Degenerative nervous system di $ 21, Amputation for musculoskeletal $ 21, WND DEBRID & SKN GRFT EXCEPT H $ 21, Foot procedures w/o CC/MCC $ 21, Malignancy, male reproductive $ 21, Cellulitis w MCC $ 21, Osteomyelitis w CC $ 21, Dental & Oral Diseases w MCC $ 21, Chemotherapy w/o acute leukemi $ 21, MAJOR SHOULDER/ELBOW PROC, OR $ 21, Alcohol/drug abuse or dependen $ 21, UTERINE,ADNEXA PROC FOR NON-OV $ 21, Testes procedures w CC/MCC $ 21, Postoperative or post-traumati $ 21, Viral illness w MCC $ 21, FULL THICKNESS BURN W/O SKIN G $ 21, RECTAL RESECTION W/O CC $ 21, OTHER VASCULAR PROCEDURES W/O $ 21, Wound debridements for injurie $ 21, Fractures of hip & pelvis w MC $ 21, Epistaxis w MCC $ 21, Skin ulcers w MCC $ 21, Shoulder,elbow or forearm proc $ 21, Reticuloendothelial & immunity $ 21, NO DESCRIPTION $ 21, Amputation for circ sys disord $ 21, Medical back problems w MCC $ 21, Other musculoskeletal sys & co $ 21, LYMPHOMA & NON-ACUTE LEUKEMIA $ 21, Tendonitis, myositis & bursiti $ 21, Lymphoma & non-acute leukemia $ 21,797.95

16 70170 OTHER DIGESTIVE SYSTEM O.R. PR $ 21, Hypertension w MCC $ 21, Respiratory infections & infla $ 21, MAJOR JOINT REPLACEMENT OR REA $ 21, Appendectomy w complicated pri $ 21, PERIPH & CRANIAL NERVE & OTHER $ 21, Extraocular procedures except $ 22, Disorders of liver except mali $ 22, Prostatic O.R. procedure unrel $ 22, Lymphoma & non-acute leukemia $ 22, Other skin, subcut tiss & brea $ 22, DISORDERS OF PERSONALITY & IMP $ 22, MAJOR SMALL & LARGE BOWEL PROC $ 22, APPENDECTOMY W COMPLICATED PRI $ 22, OTHER VASCULAR PROCEDURES W CC $ 22, O.R. proc w diagnoses of other $ 22, Acute leukemia w/o major O.R. $ 22, Kidney & ureter procedures for $ 22, MYELOPROLIF DISORD OR POORLY D $ 22, Postoperative & post-traumatic $ 22, Poisoning & toxic effects of d $ 22, CARDIAC PACEMAKER DEVICE REPLA $ 22, Intracranial hemorrhage or cer $ 22, PERIPH & CRANIAL NERVE & OTHER $ 22, SKIN DEBRIDEMENT W CC $ 23, Hernia procedures except ingui $ 23, Infectious & parasitic disease $ 23, Nonspecific cerebrovascular di $ 23, Malignancy, female reproductiv $ 23, RETICULOENDOTHELIAL & IMMUNITY $ 23, CHOLECYSTECTOMY EXCEPT BY LAPA $ 23, Disorders of the biliary tract $ 23, Coagulation disorders $ 23, Other digestive system O.R. pr $ 23, Heart failure & shock w MCC $ 23, PULMONARY EDEMA & RESPIRATORY $ 23, Knee procedures w/o pdx of inf $ 23, Hepatobiliary diagnostic proce $ 23, Acute myocardial infarction, e $ 23, Renal failure w MCC $ 23, Other injury, poisoning & toxi $ 23, MAJOR JOINT & LIMB REATTACHMEN $ 23, Other O.R. procedures for inju $ 23, Infections, female reproductiv $ 23, Traumatic injury w MCC $ 23, RETICULOENDOTHELIAL & IMMUNITY $ 24, Kidney & urinary tract neoplas $ 24,066.26

17 00672 Urethral procedures w/o CC/MCC $ 24, Cholecystectomy except by lapa $ 24, Chemo w acute leukemia as sdx $ 24, Endocrine disorders w MCC $ 24, Other respiratory system diagn $ 24, PELVIC EVISCERATION, RADICAL H $ 24, PERCUTANEOUS CARDIOVASCULAR PR $ 24, LOWER EXTREM & HUMER PROC EXCE $ 24, LYMPHOMA & LEUKEMIA W MAJOR OR $ 24, Lower extrem & humer proc exce $ 24, Diabetes w MCC $ 24, Cardiac congenital & valvular $ 24, Spinal procedures w MCC $ 24, Thyroid, parathyroid & thyrogl $ 24, RESPIRATORY SYSTEM DIAGNOSIS W $ 24, Other kidney & urinary tract d $ 24, BACK & NECK PROC EXC SPINAL FUSION W/O CC/MCC $ 24, POSTOPERATIVE OR POST-TRAUMATI $ 24, Malignancy of hepatobiliary sy $ 24, Shoulder,elbow or forearm proc $ 24, Other kidney & urinary tract p $ 25, Upper limb & toe amputation fo $ 25, Respiratory neoplasms w MCC $ 25, Interstitial lung disease w MC $ 25, NO DESCRIPTION $ 25, Splenectomy w/o CC/MCC $ 25, Urinary stones w esw lithotrip $ 25, Cranial & peripheral nerve dis $ 25, Pulmonary edema & respiratory $ 25, Skin grafts & wound debrid for $ 25, OTHER O.R. PROCEDURES FOR INJU $ 25, Pulmonary embolism w MCC $ 25, Biliary tract proc except only $ 25, Other skin, subcut tiss & brea $ 25, Inguinal & femoral hernia proc $ 25, Major esophageal disorders w M $ 25, Soft tissue procedures w CC $ 25, G.I. obstruction w MCC $ 25, Allergic reactions w MCC $ 26, Simple pneumonia & pleurisy w $ 26, Acute myocardial infarction, d $ 26, Adrenal & pituitary procedures $ 26, Other circulatory system diagn $ 26, Laparoscopic cholecystectomy w $ 26, CHOLECYSTECTOMY W C.D.E. W CC $ 26, Major gastrointestinal disorde $ 26, Hip & femur procedures except $ 26,379.81

18 00905 Skin grafts for injuries w/o C $ 26, Perc cardiovasc proc w/o coron $ 26, Extracranial procedures w/o CC $ 26, Local excision & removal int f $ 26, Mouth procedures w CC/MCC $ 26, Cirrhosis & alcoholic hepatiti $ 26, Disorders of pancreas except m $ 26, OTHER KIDNEY & URINARY TRACT O $ 26, Connective tissue disorders w $ 26, Digestive malignancy w MCC $ 27, Vagina, cervix & vulva procedu $ 27, OTHER CIRCULATORY SYSTEM O.R. $ 27, Foot procedures w CC $ 27, D&C, conization, laparascopy & $ 27, Mastectomy for malignancy w CC $ 27, Non-extensive O.R. proc unrela $ 27, Nasal trauma & deformity w MCC $ 27, Wnd debrid & skn grft exc hand $ 27, Circulatory disorders except A $ 27, Chemotherapy w/o acute leukemi $ 27, Other O.R. proc of the blood & $ 27, UTERINE & ADNEXA PROC FOR OVAR $ 27, Septicemia w/o MV 96+ hours w $ 27, Uterine,adnexa proc for non-ov $ 27, Postoperative or post-traumati $ 27, G.I. hemorrhage w MCC $ 27, Stomach, esophageal & duodenal $ 27, Pelvic evisceration, rad hyste $ 27, Foot procedures w MCC $ 27, Pneumothorax w MCC $ 28, SKIN GRAFTS & WOUND DEBRID FOR $ 28, Uterine & adnexa proc for non- $ 28, Minor small & large bowel proc $ 28, Malignant breast disorders w M $ 28, Pathological fractures & muscu $ 28, Full thickness burn w skin gra $ 28, Amputation for musculoskeletal $ 28, Mastectomy for malignancy w/o $ 28, PERCUTANEOUS CARDIOVASCULAR PR $ 28, Other resp system O.R. procedu $ 28, OTHER RESP SYSTEM O.R. PROCEDU $ 28, Appendectomy w/o complicated p $ 28, Biopsies of musculoskeletal sy $ 28, Respiratory infections & infla $ 28, Hepatobiliary diagnostic proce $ 29, Other female reproductive syst $ 29, Other digestive system O.R. pr $ 29,441.59

19 00347 Anal & stomal procedures w MCC $ 29, REVISION OF HIP OR KNEE REPLAC $ 29, Kidney & ureter procedures for $ 29, Other digestive system diagnos $ 29, Kidney & ureter procedures for $ 29, OTHER PERMANENT CARDIAC PACEMA $ 29, Peritoneal adhesiolysis w/o CC $ 29, Major male pelvic procedures w $ 29, Perc cardiovasc proc w non-dru $ 29, OTHER VASCULAR PROCEDURES W CC $ 30, PANCREAS, LIVER & SHUNT PROCED $ 30, Appendectomy w complicated pri $ 30, Other male reproductive system $ 30, OTHER FEMALE REPRODUCTIVE SYST $ 30, Pleural effusion w MCC $ 30, Cranial/facial procedures w CC $ 30, Extensive O.R. procedure unrel $ 30, Bacterial & tuberculous infect $ 30, Other musculoskelet sys & conn $ 30, Uncomplicated peptic ulcer w M $ 30, Fractures of femur w MCC $ 30, Fx, sprn, strn & disl except f $ 30, Other kidney & urinary tract p $ 30, Minor small & large bowel proc $ 30, HIV w major related condition $ 30, Upper limb & toe amputation fo $ 30, Shoulder,elbow or forearm proc $ 31, Appendectomy w complicated pri $ 31, Major shoulder or elbow joint $ 31, Major hematol/immun diag exc s $ 31, Thyroid, parathyroid & thyrogl $ 31, Hernia procedures except ingui $ 31, Other endocrine, nutrit & meta $ 31, Biopsies of musculoskeletal sy $ 31, Lower extrem & humer proc exce $ 31, Lymphoma & leukemia w major O. $ 31, Cholecystectomy w c.d.e. w CC $ 31, Complications of treatment w M $ 31, Knee procedures w pdx of infec $ 31, PERITONEAL ADHESIOLYSIS W CC $ 32, Other infectious & parasitic d $ 32, Kidney & ureter procedures for $ 32, Breast biopsy, local excision $ 32, Other O.R. procedures for inju $ 32, Other musculoskelet sys & conn $ 32, TRAUMATIC STUPOR & COMA, COMA $ 32, Acute & subacute endocarditis $ 32,847.35

20 00247 Perc cardiovasc proc w drug-el $ 32, Other vascular procedures w/o $ 33, Inguinal & femoral hernia proc $ 33, Major joint replacement or rea $ 33, Other hepatobiliary or pancrea $ 33, Extracranial procedures w CC $ 33, Osteomyelitis w MCC $ 33, Major shoulder or elbow joint $ 34, NO LONGER VALID $ 34, Amputation for circ sys disord $ 34, Wnd debrid & skn grft exc hand $ 34, Cholecystectomy except by lapa $ 34, Orbital procedures w CC/MCC $ 34, Periph/cranial nerve & other n $ 34, Myeloprolif disord or poorly d $ 34, O.R. procedures for obesity w $ 34, Acute & subacute endocarditis $ 34, Biliary tract proc except only $ 35, RECTAL RESECTION W CC $ 35, Limb reattachment, hip & femur $ 35, Hip & femur procedures except $ 35, Major male pelvic procedures w $ 35, NO LONGER VALID $ 35, STOM, ESOPHL & DUOD PROC PROC $ 35, Complicated peptic ulcer w MCC $ 35, Acute & subacute endocarditis $ 35, Skin graft &/or debrid exc for $ 35, Cardiac pacemaker device repla $ 35, Septic arthritis w MCC $ 36, Infectious & parasitic disease $ 36, MAJOR SMALL & LARGE BOWEL PROC $ 36, Cardiac pacemaker device repla $ 36, Revision of hip or knee replac $ 36, Traumatic stupor & coma, coma $ 36, Breast biopsy, local excision $ 36, MAJOR CHEST PROCEDURES $ 37, O.R. procedure w principal dia $ 37, Transurethral procedures w MCC $ 37, Other musculoskelet sys & conn $ 37, Lower extrem & humer proc exce $ 37, CORONARY BYPASS W/O CARDIAC CA $ 38, AMPUTATION FOR MUSCULOSKELETAL $ 38, Peritoneal adhesiolysis w CC $ 38, EXTENSIVE O.R. PROCEDURE UNREL $ 38, Uterine & adnexa proc for ovar $ 39, Kidney & ureter procedures for $ 39, Minor bladder procedures w MCC $ 40,141.48

21 00740 Uterine,adnexa proc for non-ov $ 40, Other resp system O.R. procedu $ 40, Other O.R. proc of the blood & $ 40, Amputat of lower limb for endo $ 40, Respiratory system diagnosis w $ 40, LYMPHOMA & NON-ACUTE LEUKEMIA $ 40, Periph/cranial nerve & other n $ 41, AMPUTATION FOR CIRC SYSTEM DIS $ 41, Permanent cardiac pacemaker im $ 41, Other circulatory system O.R. $ 41, Laparoscopic cholecystectomy w $ 41, Perc cardiovasc proc w/o coron $ 41, Tracheostomy for face,mouth & $ 41, MAJOR CARDIOVASCULAR PROCEDURE $ 41, Hernia procedures except ingui $ 41, Major small & large bowel proc $ 41, Upper limb & toe amputation fo $ 41, Stomach, esophageal & duodenal $ 41, Appendectomy w/o complicated p $ 42, Cholecystectomy except by lapa $ 42, Major bladder procedures w/o C $ 42, Adrenal & pituitary procedures $ 42, Splenectomy w CC $ 42, OTHER MALE REPRODUCTIVE SYSTEM $ 42, Myeloprolif disord or poorly d $ 43, Cardiac pacemaker revision exc $ 43, Non-bacterial infect of nervou $ 43, Hepatobiliary diagnostic proce $ 43, BILATERAL OR MULTIPLE MAJOR JO $ 43, Local excision & removal int f $ 43, Revision of hip or knee replac $ 43, Major joint & limb reattachmen $ 43, NO LONGER VALID $ 44, Lymphoma & non-acute leukemia $ 44, SKIN DEBRIDEMENT W MCC $ 44, Other vascular procedures w CC $ 44, PERMANENT CARDIAC PACEMAKER IM $ 44, Hip & femur procedures except $ 44, O.R. proc w diagnoses of other $ 44, Other kidney & urinary tract p $ 44, Extensive O.R. procedure unrel $ 45, Lymphoma & leukemia w major O. $ 45, INFECTIOUS & PARASITIC DISEASE $ 45, NO LONGER VALID $ 45, Lymphoma & non-acute leukemia $ 46, PERCUTANEOUS INTRACARDIAC PROCEDURES W/O MCC $ 47, Extracranial procedures w MCC $ 47,335.81

22 00248 Perc cardiovasc proc w non-dru $ 47, Rectal resection w/o CC/MCC $ 48, Amputation for musculoskeletal $ 48, Bilateral or multiple major jo $ 48, Cervical spinal fusion w CC $ 48, NO DESCRIPTION $ 48, Other skin, subcut tiss & brea $ 48, Knee procedures w pdx of infec $ 48, Pancreas, liver & shunt proced $ 49, Major joint & limb reattachmen $ 49, Permanent cardiac pacemaker im $ 49, Other digestive system O.R. pr $ 49, Other male reproductive system $ 49, Minor small & large bowel proc $ 49, Perc cardiovasc proc w drug-el $ 50, Chemo w acute leukemia as sdx $ 50, Major bladder procedures w CC $ 50, Myeloprolif disord or poorly d $ 51, Pelvic evisceration, rad hyste $ 51, Rectal resection w CC $ 51, Cervical spinal fusion w/o CC/ $ 52, Other female reproductive syst $ 52, CORONARY BYPASS W CARDIAC CATH $ 52, Major joint replacement or rea $ 52, Major chest procedures w/o CC/ $ 52, CHEMOTHERAPY W ACUTE LEUKEMIA $ 52, Kidney & ureter procedures for $ 52, Prostatectomy w CC $ 52, OTHER CARDIOTHORACIC PROCEDURE $ 53, OTHER MAJOR CARDIOVASCULAR PROCEDURES W/O CC/MCC $ 53, Major small & large bowel proc $ 53, Prostatectomy w MCC $ 54, Skin graft &/or debrid for skn $ 55, MAJOR SMALL & LARGE BOWEL PROC $ 55, BILIARY TRACT PROC EXCEPT ONLY $ 55, SPLENECTOMY AGE >17 $ 55, Cardiac pacemaker revision exc $ 55, CORONARY BYPASS W/O CARDIAC CA $ 55, Bilateral or multiple major jo $ 55, Postoperative or post-traumati $ 56, Non-extensive O.R. proc unrela $ 56, Pancreas, liver & shunt proced $ 58, Myeloprolif disord or poorly d $ 58, Amputation for circ sys disord $ 58, Uterine & adnexa proc for ovar $ 59, Soft tissue procedures w MCC $ 59, Lymphoma & non-acute leukemia $ 60,038.76

23 00411 Cholecystectomy w c.d.e. w MCC $ 60, AICD lead & generator procedur $ 60, Other O.R. proc of the blood & $ 60, LYMPHOMA & LEUKEMIA W MAJOR OR $ 61, Major cardiovasc procedures w/ $ 61, Lymphoma & leukemia w major O. $ 62, Revision of hip or knee replac $ 62, Other resp system O.R. procedu $ 63, OTHER MAJOR CARDIOVASCULAR PROCEDURES W CC $ 63, CARDIAC VALVE & OTH MAJOR CARD $ 64, Amputat of lower limb for endo $ 64, Major chest procedures w CC $ 64, CORONARY BYPASS W PTCA $ 65, Other vascular procedures w MC $ 65, Peritoneal adhesiolysis w MCC $ 65, ACUTE LEUKEMIA W/O MAJOR O.R. $ 66, Permanent cardiac pacemaker im $ 66, NO DESCRIPTION $ 68, Rectal resection w MCC $ 69, PERCUTANEOUS INTRACARDIAC PROCEDURES W MCC $ 70, OTHER MAJOR CARDIOVASCULAR PROCEDURES W MCC $ 71, Other O.R. procedures for inju $ 72, Other hepatobiliary or pancrea $ 72, Other cardiothoracic procedure $ 72, Extensive O.R. procedure unrel $ 72, Uterine,adnexa proc for non-ov $ 72, CORONARY BYPASS W CARDIAC CATH $ 72, SEPTICEMIA W MV96+ HOURS AGE $ 73, Biliary tract proc except only $ 75, BACK & NECK PROC EXC SPINAL FUSION W MCC OR DISC D $ 76, Infectious & parasitic disease $ 76, Acute leukemia w/o major O.R. $ 77, Major cardiovasc procedures w $ 79, CARDIAC DEFIBRILLATOR IMPLANT $ 81, Wnd debrid & skn grft exc hand $ 81, Orbital procedures w/o CC/MCC $ 82, Pancreas, liver & shunt proced $ 83, Stomach, esophageal & duodenal $ 84, Other endocrine, nutrit & meta $ 84, Spinal fusion except cervical $ 85, Spinal fusion except cervical $ 85, STOMACH, ESOPHAGEAL & DUODENAL $ 86, Biopsies of musculoskeletal sy $ 86, Uterine & adnexa proc for ovar $ 87, Respiratory system diagnosis w $ 87, Skin grafts for injuries w CC/ $ 88, Major bladder procedures w MCC $ 89,701.79