COMMUNITY MEMORIAL HOSPITAL ACUTE INPATIENT CASES BY DRG (diagnosis related group) AVERAGE AVERAGE ALL PAYER CHARGE PAYMENT MSDRG DESCRIPTION PER

Transcription

1 COMMUNITY MEMORIAL HOSPITAL ACUTE INPATIENT CASES BY DRG (diagnosis related group) AVERAGE AVERAGE ALL PAYER CHARGE PAYMENT MSDRG DESCRIPTION PER CASE PER CASE 1 CARDIOMYOPATHY 536, , SEIZURES W MCC 40, , SEIZURES W/O MCC 22, , HEADACHES W MCC 36, , HEADACHES W/O MCC 19, , ACUTE MAJOR EYE INFECTIONS W/O CC/MCC 17, , NEUROLOGICAL EYE DISORDERS 21, , OTHER DISORDERS OF THE EYE W MCC 27, , OTHER DISORDERS OF THE EYE W/O MCC 13, , CRANIAL/FACIAL PROCEDURES W CC/MCC 66, , CRANIAL/FACIAL PROCEDURES W/O CC/MCC 72, , OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W CC/MCC 14, , OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W/O CC/MCC 23, , MOUTH PROCEDURES W CC/MCC 40, , SALIVARY GLAND PROCEDURES 66, , EAR, NOSE, MOUTH & THROAT MALIGNANCY W MCC 18, , EAR, NOSE, MOUTH & THROAT MALIGNANCY W CC 50, , DYSEQUILIBRIUM 10, , EPISTAXIS W MCC 44, , EPISTAXIS W/O MCC 28, , OTITIS MEDIA & URI W MCC 34, , OTITIS MEDIA & URI W/O MCC 18, , OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W CC 19, , OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W/O CC/MCC 12, , DENTAL & ORAL DISEASES W MCC 22, , DENTAL & ORAL DISEASES W CC 27, , DENTAL & ORAL DISEASES W/O CC/MCC 20, , MAJOR CHEST PROCEDURES W MCC 124, , MAJOR CHEST PROCEDURES W CC 96, , MAJOR CHEST PROCEDURES W/O CC/MCC 95, , OTHER RESP SYSTEM O.R. PROCEDURES W MCC 133, , OTHER RESP SYSTEM O.R. PROCEDURES W CC 75, , OTHER RESP SYSTEM O.R. PROCEDURES W/O CC/MCC 62, , PULMONARY EMBOLISM W MCC 38, , PULMONARY EMBOLISM W/O MCC 26, , RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC 54, , RESPIRATORY INFECTIONS & INFLAMMATIONS W CC 38, , RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC 28, , RESPIRATORY NEOPLASMS W MCC 52, , RESPIRATORY NEOPLASMS W CC 29, , RESPIRATORY NEOPLASMS W/O CC/MCC 32, , MAJOR CHEST TRAUMA W MCC 30, , MAJOR CHEST TRAUMA W CC 17, , MAJOR CHEST TRAUMA W/O CC/MCC 27, , PLEURAL EFFUSION W MCC 29, , PLEURAL EFFUSION W CC 26, , PLEURAL EFFUSION W/O CC/MCC 26, , PULMONARY EDEMA & RESPIRATORY FAILURE 52, , CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC 52, , CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC 36, , CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC 28, , SIMPLE PNEUMONIA & PLEURISY W MCC 44, , SIMPLE PNEUMONIA & PLEURISY W CC 29, , SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC 18, , INTERSTITIAL LUNG DISEASE W MCC 71, , INTERSTITIAL LUNG DISEASE W CC 24, , PNEUMOTHORAX W MCC 129, , PNEUMOTHORAX W CC 26, , PNEUMOTHORAX W/O CC/MCC 29, , BRONCHITIS & ASTHMA W CC/MCC 37, , BRONCHITIS & ASTHMA W/O CC/MCC 19, , RESPIRATORY SIGNS & SYMPTOMS 19, , OTHER RESPIRATORY SYSTEM DIAGNOSES W MCC 42, , OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC 32, ,280.41

2 207 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS 365, , RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS 109, , OTHER HEART ASSIST SYSTEM IMPLANT 378, , CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W MCC 255, , CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W CC 286, , CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W/O CC/MCC 207, , CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W MCC 352, , CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W CC 303, , CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W/O CC/MCC 194, , CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W MCC 355, , CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W MCC 235, , CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W/O MCC 223, , OTHER CARDIOTHORACIC PROCEDURES W MCC 344, , OTHER CARDIOTHORACIC PROCEDURES W/O MCC 193, , CRANIO W MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX W MCC OR CHEMO IMPLANT 284, , CORONARY BYPASS W PTCA W MCC 444, , CORONARY BYPASS W PTCA W/O MCC 263, , CORONARY BYPASS W CARDIAC CATH W MCC 340, , CORONARY BYPASS W CARDIAC CATH W/O MCC 250, , CORONARY BYPASS W/O CARDIAC CATH W MCC 286, , CORONARY BYPASS W/O CARDIAC CATH W/O MCC 209, , AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W MCC 94, , CRANIO W MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX W/O MCC 173, , AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W CC 73, , PERMANENT CARDIAC PACEMAKER IMPLANT W MCC 132, , PERMANENT CARDIAC PACEMAKER IMPLANT W CC 124, , PERMANENT CARDIAC PACEMAKER IMPLANT W/O CC/MCC 112, , AICD GENERATOR PROCEDURES 288, , PERC CARDIOVASC PROC W DRUG-ELUTING STENT W MCC OR 4+ VESSELS/STENTS 182, , PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCC 107, , PERC CARDIOVASC PROC W NON-DRUG-ELUTING STENT W MCC OR 4+ VES/STENTS 138, , PERC CARDIOVASC PROC W NON-DRUG-ELUTING STENT W/O MCC 109, , CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W MCC 195, , PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W MCC 101, , PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W/O MCC 83, , OTHER VASCULAR PROCEDURES W MCC 136, , OTHER VASCULAR PROCEDURES W CC 128, , OTHER VASCULAR PROCEDURES W/O CC/MCC 79, , UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W MCC 74, , UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W CC 51, , CARDIAC PACEMAKER DEVICE REPLACEMENT W/O MCC 96, , CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W CC 130, , CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W MCC 63, , CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W CC 108, , VEIN LIGATION & STRIPPING 59, , OTHER CIRCULATORY SYSTEM O.R. PROCEDURES 69, , AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W MCC 271, , AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W/O MCC 187, , CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W/O CC/MCC 111, , OTHER MAJOR CARDIOVASCULAR PROCEDURES W MCC 216, , OTHER MAJOR CARDIOVASCULAR PROCEDURES W CC 159, , OTHER MAJOR CARDIOVASCULAR PROCEDURES W/O CC/MCC 124, , PERCUTANEOUS INTRACARDIAC PROCEDURES W MCC 151, , PERCUTANEOUS INTRACARDIAC PROCEDURES W/O MCC 114, , ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC 53, , ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC 39, , ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC 45, , ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC 36, , CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W MCC 70, , CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC 42, , ACUTE & SUBACUTE ENDOCARDITIS W MCC 98, , ACUTE & SUBACUTE ENDOCARDITIS W CC 48, , SPINAL PROCEDURES W CC OR SPINAL NEUROSTIMULATORS 110, , HEART FAILURE & SHOCK W MCC 40, , HEART FAILURE & SHOCK W CC 29, , HEART FAILURE & SHOCK W/O CC/MCC 19, , PERIPHERAL VASCULAR DISORDERS W MCC 81, , ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R. 812, , SPINAL PROCEDURES W/O CC/MCC 145, , PERIPHERAL VASCULAR DISORDERS W CC 16, ,419.42

3 301 PERIPHERAL VASCULAR DISORDERS W/O CC/MCC 22, , ATHEROSCLEROSIS W/O MCC 24, , HYPERTENSION W MCC 25, , HYPERTENSION W/O MCC 29, , CARDIAC CONGENITAL & VALVULAR DISORDERS W MCC 57, , CARDIAC CONGENITAL & VALVULAR DISORDERS W/O MCC 20, , CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC 34, , CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC 26, , VENTRICULAR SHUNT PROCEDURES W MCC 78, , CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC 17, , ANGINA PECTORIS 12, , SYNCOPE & COLLAPSE 26, , CHEST PAIN 25, , OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC 73, , OTHER CIRCULATORY SYSTEM DIAGNOSES W CC 32, , OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC/MCC 15, , VENTRICULAR SHUNT PROCEDURES W CC 77, STOMACH, ESOPHAGEAL & DUODENAL PROC W MCC 242, , STOMACH, ESOPHAGEAL & DUODENAL PROC W CC 83, , STOMACH, ESOPHAGEAL & DUODENAL PROC W/O CC/MCC 55, , MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC 175, , VENTRICULAR SHUNT PROCEDURES W/O CC/MCC 62, , MAJOR SMALL & LARGE BOWEL PROCEDURES W CC 102, , MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC 72, , RECTAL RESECTION W/O CC/MCC 67, , PERITONEAL ADHESIOLYSIS W MCC 125, , PERITONEAL ADHESIOLYSIS W CC 68, , PERITONEAL ADHESIOLYSIS W/O CC/MCC 54, , APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W MCC 146, , APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC 52, , APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/MCC 51, , APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W MCC 94, , APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC 51, , APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC 46, , MINOR SMALL & LARGE BOWEL PROCEDURES W MCC 37, , MINOR SMALL & LARGE BOWEL PROCEDURES W CC 68, , MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC 60, , ANAL & STOMAL PROCEDURES W MCC 157, , ANAL & STOMAL PROCEDURES W CC 28, , INGUINAL & FEMORAL HERNIA PROCEDURES W CC 57, , HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W MCC 108, , HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W CC 70, , HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W/O CC/MCC 48, , OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W MCC 98, , OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC 72, , OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W/O CC/MCC 101, , MAJOR ESOPHAGEAL DISORDERS W MCC 40, , MAJOR ESOPHAGEAL DISORDERS W CC 31, , EXTRACRANIAL PROCEDURES W MCC 132, , MAJOR ESOPHAGEAL DISORDERS W/O CC/MCC 27, , MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC 47, , MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC 32, , MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W/O CC/MCC 16, , DIGESTIVE MALIGNANCY W MCC 42, , DIGESTIVE MALIGNANCY W CC 40, , G.I. HEMORRHAGE W MCC 53, , G.I. HEMORRHAGE W CC 33, , G.I. HEMORRHAGE W/O CC/MCC 31, , EXTRACRANIAL PROCEDURES W CC 80, , COMPLICATED PEPTIC ULCER W MCC 62, , COMPLICATED PEPTIC ULCER W CC 32, , COMPLICATED PEPTIC ULCER W/O CC/MCC 31, , UNCOMPLICATED PEPTIC ULCER W MCC 45, , UNCOMPLICATED PEPTIC ULCER W/O MCC 21, , INFLAMMATORY BOWEL DISEASE W MCC 65, , INFLAMMATORY BOWEL DISEASE W CC 35, , INFLAMMATORY BOWEL DISEASE W/O CC/MCC 43, , G.I. OBSTRUCTION W MCC 42, , G.I. OBSTRUCTION W CC 22, , EXTRACRANIAL PROCEDURES W/O CC/MCC 63, ,330.79

4 390 G.I. OBSTRUCTION W/O CC/MCC 15, , ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC 30, , ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC 22, , OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC 40, , OTHER DIGESTIVE SYSTEM DIAGNOSES W CC 27, , OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC 16, , TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. 610, , PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W MCC 407, , PANCREAS, LIVER & SHUNT PROCEDURES W MCC 79, , PANCREAS, LIVER & SHUNT PROCEDURES W/O CC/MCC 70, , BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W CC 88, , PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W CC OR PERIPH NEUROSTIM 99, , CHOLECYSTECTOMY W C.D.E. W CC 99, , CHOLECYSTECTOMY W C.D.E. W/O CC/MCC 89, , CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W MCC 116, , CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC 80, , CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W/O CC/MCC 58, , LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC 85, , LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC 70, , LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC 57, , OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W MCC 162, , OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W/O CC/MCC 15, , CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC 61, , CIRRHOSIS & ALCOHOLIC HEPATITIS W CC 25, , CIRRHOSIS & ALCOHOLIC HEPATITIS W/O CC/MCC 15, , MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W MCC 36, , MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W CC 24, , MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W/O CC/MCC 42, , DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC 99, , DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC 25, , DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC 20, , DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W MCC 48, , DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC 28, , DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W/O CC/MCC 16, , DISORDERS OF THE BILIARY TRACT W MCC 60, , DISORDERS OF THE BILIARY TRACT W CC 39, , DISORDERS OF THE BILIARY TRACT W/O CC/MCC 16, , COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W MCC 392, , COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W CC 242, , COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W/O CC/MCC 222, , SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W MCC 523, , SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W CC 156, , SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W/O CC/MCC 223, , SPINAL FUSION EXCEPT CERVICAL W MCC 264, , SPINAL FUSION EXCEPT CERVICAL W/O MCC 194, , BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W/O MCC 120, , WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W MCC 121, , WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W CC 96, , WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W/O CC/MCC 123, , REVISION OF HIP OR KNEE REPLACEMENT W MCC 247, , REVISION OF HIP OR KNEE REPLACEMENT W CC 144, , REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC 131, , MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC 120, , MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC 83, , CERVICAL SPINAL FUSION W MCC 208, , CERVICAL SPINAL FUSION W CC 135, , CERVICAL SPINAL FUSION W/O CC/MCC 125, , AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W MCC 81, , AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W CC 55, , BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC 57, , BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC 60, , BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC 38, , HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC 99, , HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC 75, , HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC 61, , MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES 90, , KNEE PROCEDURES W PDX OF INFECTION W MCC 212, , KNEE PROCEDURES W PDX OF INFECTION W/O CC/MCC 46, , KNEE PROCEDURES W/O PDX OF INFECTION W CC/MCC 56, , KNEE PROCEDURES W/O PDX OF INFECTION W/O CC/MCC 56, ,117.70

5 492 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W MCC 144, , LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W CC 72, , LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W/O CC/MCC 59, , LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W/O CC/MCC 47, , LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W/O CC/MCC 43, , SOFT TISSUE PROCEDURES W MCC 52, , SOFT TISSUE PROCEDURES W CC 41, , SOFT TISSUE PROCEDURES W/O CC/MCC 59, , FOOT PROCEDURES W MCC 58, , FOOT PROCEDURES W CC 70, , FOOT PROCEDURES W/O CC/MCC 65, , MAJOR THUMB OR JOINT PROCEDURES 26, , MAJOR SHOULDER OR ELBOW JOINT PROCEDURES W CC/MCC 55, , SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W MCC 105, , SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W CC 225, , SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W/O CC/MCC 51, , HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W CC/MCC 39, , OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W MCC 117, , OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC 80, , OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC/MCC 66, , BACK & NECK PROC EXC SPINAL FUSION W MCC OR DISC DEVICE/NEUROSTIM 155, , BACK & NECK PROC EXC SPINAL FUSION W CC 84, , BACK & NECK PROC EXC SPINAL FUSION W/O CC/MCC 64, , FRACTURES OF FEMUR W/O MCC 15, , FRACTURES OF HIP & PELVIS W MCC 83, , FRACTURES OF HIP & PELVIS W/O MCC 19, , OSTEOMYELITIS W MCC 36, , NERVOUS SYSTEM NEOPLASMS W MCC 19, , OSTEOMYELITIS W CC 24, , OSTEOMYELITIS W/O CC/MCC 10, , PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W MCC 41, , PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W CC 50, , PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W/O CC/MCC 79, , CONNECTIVE TISSUE DISORDERS W MCC 108, , CONNECTIVE TISSUE DISORDERS W CC 21, , NERVOUS SYSTEM NEOPLASMS W/O MCC 22, , MEDICAL BACK PROBLEMS W MCC 37, , MEDICAL BACK PROBLEMS W/O MCC 24, , BONE DISEASES & ARTHROPATHIES W MCC 10, , BONE DISEASES & ARTHROPATHIES W/O MCC 24, , SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W MCC 25, , SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W/O MCC 36, , TENDONITIS, MYOSITIS & BURSITIS W/O MCC 17, , DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC 162, , AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC 30, , AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC 12, , FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W MCC 37, , FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC 23, , OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W MCC 31, , OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W CC 23, , OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W/O CC/MCC 6, , DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC 45, , SKIN DEBRIDEMENT W MCC 35, , SKIN DEBRIDEMENT W CC 36, , SKIN DEBRIDEMENT W/O CC/MCC 14, , SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W/O CC/MCC 30, , OTHER SKIN, SUBCUT TISS & BREAST PROC W MCC 68, , MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W MCC 27, , OTHER SKIN, SUBCUT TISS & BREAST PROC W CC 45, , OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC 46, , MASTECTOMY FOR MALIGNANCY W CC/MCC 60, , MASTECTOMY FOR MALIGNANCY W/O CC/MCC 33, , BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W CC/MCC 55, , BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W/O CC/MCC 56, , SKIN ULCERS W MCC 28, , SKIN ULCERS W CC 46, , SKIN ULCERS W/O CC/MCC 12, MAJOR SKIN DISORDERS W MCC 27, , MAJOR SKIN DISORDERS W/O MCC 23, , MALIGNANT BREAST DISORDERS W MCC 12, ,510.52

6 60 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W/O CC/MCC 25, , NON-MALIGNANT BREAST DISORDERS W CC/MCC 20, , NON-MALIGNANT BREAST DISORDERS W/O CC/MCC 10, , CELLULITIS W MCC 44, , CELLULITIS W/O MCC 19, , TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W MCC 162, , TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W/O MCC 20, , MINOR SKIN DISORDERS W/O MCC 16, , ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W MCC 142, , ADRENAL & PITUITARY PROCEDURES W/O CC/MCC 77, , AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W MCC 67, , AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W CC 58, , ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W CC 91, , O.R. PROCEDURES FOR OBESITY W CC 90, , O.R. PROCEDURES FOR OBESITY W/O CC/MCC 80, , SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W MCC 50, , SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC 42, , THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W CC 35, , OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W MCC 73, , OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W CC 81, , ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W/O CC/MCC 91, , OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W/O CC/MCC 116, , DIABETES W MCC 41, , DIABETES W CC 25, , DIABETES W/O CC/MCC 16, , INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC 70, , MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W MCC 40, , MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W/O MCC 22, , INBORN AND OTHER DISORDERS OF METABOLISM 16, , ENDOCRINE DISORDERS W MCC 50, , ENDOCRINE DISORDERS W CC 31, , ENDOCRINE DISORDERS W/O CC/MCC 19, , INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS 31, , MAJOR BLADDER PROCEDURES W MCC 204, , MAJOR BLADDER PROCEDURES W CC 103, , MAJOR BLADDER PROCEDURES W/O CC/MCC 93, , KIDNEY & URETER PROCEDURES FOR NEOPLASM W MCC 163, , KIDNEY & URETER PROCEDURES FOR NEOPLASM W CC 124, , KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC 113, , KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W MCC 77, , INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC 29, , KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W CC 76, , KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W/O CC/MCC 70, , MINOR BLADDER PROCEDURES W CC 101, , PROSTATECTOMY W CC 44, , PROSTATECTOMY W/O CC/MCC 27, , TRANSURETHRAL PROCEDURES W MCC 158, , TRANSURETHRAL PROCEDURES W CC 61, , OTHER KIDNEY & URINARY TRACT PROCEDURES W MCC 115, , OTHER KIDNEY & URINARY TRACT PROCEDURES W CC 89, , OTHER KIDNEY & URINARY TRACT PROCEDURES W/O CC/MCC 72, , NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT W/O MCC 25, , RENAL FAILURE W MCC 47, , RENAL FAILURE W CC 29, , RENAL FAILURE W/O CC/MCC 16, , KIDNEY & URINARY TRACT NEOPLASMS W MCC 44, , KIDNEY & URINARY TRACT INFECTIONS W MCC 28, , TRANSIENT ISCHEMIA 24, , KIDNEY & URINARY TRACT INFECTIONS W/O MCC 20, , URINARY STONES W/O ESW LITHOTRIPSY W MCC 51, , URINARY STONES W/O ESW LITHOTRIPSY W/O MCC 30, , KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W/O MCC 19, , OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC 55, , OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC 33, , NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC 49, , OTHER KIDNEY & URINARY TRACT DIAGNOSES W/O CC/MCC 33, , MAJOR MALE PELVIC PROCEDURES W CC/MCC 103, , MAJOR MALE PELVIC PROCEDURES W/O CC/MCC 102, , NONSPECIFIC CEREBROVASCULAR DISORDERS W CC 30, , TESTES PROCEDURES W CC/MCC 47, ,858.83

7 713 TRANSURETHRAL PROSTATECTOMY W CC/MCC 55, , OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC FOR MALIGNANCY W/O CC/MCC 68, , OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY W/O CC/MCC 35, , NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC/MCC 23, , MALIGNANCY, MALE REPRODUCTIVE SYSTEM W MCC 44, , MALIGNANCY, MALE REPRODUCTIVE SYSTEM W CC 76, , BENIGN PROSTATIC HYPERTROPHY W MCC 97, , BENIGN PROSTATIC HYPERTROPHY W/O MCC 15, , INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W MCC 33, , INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W/O MCC 22, , CRANIAL & PERIPHERAL NERVE DISORDERS W MCC 172, , OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES W/O CC/MCC 9, , PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY W CC/MCC 94, , PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY W/O CC/MCC 70, , UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W MCC 192, , UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W CC 87, , UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W/O CC/MCC 71, , UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W MCC 68, , CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC 17, , UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W CC 106, , UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W/O CC/MCC 64, , UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC 68, , UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC 52, , D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W CC/MCC 58, , D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W/O CC/MCC 28, , VAGINA, CERVIX & VULVA PROCEDURES W CC/MCC 62, , VAGINA, CERVIX & VULVA PROCEDURES W/O CC/MCC 44, , FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES 69, , OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES W CC/MCC 125, , VIRAL MENINGITIS W CC/MCC 42, , OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES W/O CC/MCC 10, , MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W MCC 108, , MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W CC 36, , INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W CC 16, , INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC 19, VIRAL MENINGITIS W/O CC/MCC 20, , MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W CC/MCC 14, , MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W/O CC/MCC 13, , CESAREAN SECTION W CC/MCC 41, , CESAREAN SECTION W/O CC/MCC 31, , VAGINAL DELIVERY W STERILIZATION &/OR D&C 25, , VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C 19, , POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE 61, , ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY 22, , VAGINAL DELIVERY W COMPLICATING DIAGNOSES 20, , VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES 16, , POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE 13, , THREATENED ABORTION 18, , ABORTION W/O D&C 9, , HYPERTENSIVE ENCEPHALOPATHY W CC 18, , FALSE LABOR 10, , OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS 26, , OTHER ANTEPARTUM DIAGNOSES W/O MEDICAL COMPLICATIONS 16, , NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY 333, , EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE 340, , PREMATURITY W MAJOR PROBLEMS 77, , PREMATURITY W/O MAJOR PROBLEMS 24, , FULL TERM NEONATE W MAJOR PROBLEMS 31, , NEONATE W OTHER SIGNIFICANT PROBLEMS 6, , NORMAL NEWBORN 3, SPLENECTOMY W/O CC/MCC 135, OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W CC 32, , OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W/O CC/MCC 36, , MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W MCC 38, , MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC 31, , MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W/O CC/MCC 32, , RED BLOOD CELL DISORDERS W MCC 38, , RED BLOOD CELL DISORDERS W/O MCC 27, , COAGULATION DISORDERS 59, , RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC 24, ,796.25

8 816 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC/MCC 9, , TRAUMATIC STUPOR & COMA, COMA >1 HR W MCC 38, , LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W/O CC/MCC 53, , LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W MCC 158, , LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W CC 133, , LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W/O CC/MCC 38, , MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W MCC 168, , MYELOPROLIF DISORD OR POORLY DIFF NEOPL W OTHER O.R. PROC W CC/MCC 54, , TRAUMATIC STUPOR & COMA, COMA >1 HR W CC 46, , MYELOPROLIF DISORD OR POORLY DIFF NEOPL W OTHER O.R. PROC W/O CC/MCC 50, , ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W CC 40, , ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W/O CC/MCC 22, , TRAUMATIC STUPOR & COMA, COMA >1 HR W/O CC/MCC 22, , LYMPHOMA & NON-ACUTE LEUKEMIA W MCC 79, , LYMPHOMA & NON-ACUTE LEUKEMIA W CC 61, , LYMPHOMA & NON-ACUTE LEUKEMIA W/O CC/MCC 70, , OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W MCC 51, , OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC 57, , OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W/O CC/MCC 20, , CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W MCC 96, , CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W CC 87, , TRAUMATIC STUPOR & COMA, COMA <1 HR W MCC 46, , INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC 202, , INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC 82, , POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W MCC 53, , POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W CC 56, , POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W/O CC/MCC 45, , TRAUMATIC STUPOR & COMA, COMA <1 HR W CC 25, , POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W MCC 33, , POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC 22, , FEVER 25, , VIRAL ILLNESS W MCC 44, , VIRAL ILLNESS W/O MCC 17, , OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W MCC 192, , OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W CC 51, , TRAUMATIC STUPOR & COMA, COMA <1 HR W/O CC/MCC 23, , SEPTICEMIA OR SEVERE SEPSIS W MV >96 HOURS 179, , SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC 55, , SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC 26, , ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION 41, , DEPRESSIVE NEUROSES 24, , NEUROSES EXCEPT DEPRESSIVE 3, , DISORDERS OF PERSONALITY & IMPULSE CONTROL 11, , ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY 31, , PSYCHOSES 10, , CONCUSSION W CC 49, , ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA 26, , ALCOHOL/DRUG ABUSE OR DEPENDENCE W REHABILITATION THERAPY 22, , ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCC 101, , ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC 23, , WOUND DEBRIDEMENTS FOR INJURIES W CC 79, , HAND PROCEDURES FOR INJURIES 24, , OTHER O.R. PROCEDURES FOR INJURIES W MCC 185, , OTHER O.R. PROCEDURES FOR INJURIES W CC 60, , OTHER O.R. PROCEDURES FOR INJURIES W/O CC/MCC 28, , OTHER DISORDERS OF NERVOUS SYSTEM W MCC 62, , ALLERGIC REACTIONS W MCC 12, , ALLERGIC REACTIONS W/O MCC 11, , POISONING & TOXIC EFFECTS OF DRUGS W MCC 82, , POISONING & TOXIC EFFECTS OF DRUGS W/O MCC 27, , COMPLICATIONS OF TREATMENT W MCC 40, , OTHER DISORDERS OF NERVOUS SYSTEM W CC 35, , COMPLICATIONS OF TREATMENT W CC 35, , COMPLICATIONS OF TREATMENT W/O CC/MCC 14, , OTHER INJURY, POISONING & TOXIC EFFECT DIAG W MCC 140, , OTHER INJURY, POISONING & TOXIC EFFECT DIAG W/O MCC 41, , OTHER DISORDERS OF NERVOUS SYSTEM W/O CC/MCC 27, , BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W MCC 119, , O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W CC 71, , O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W/O CC/MCC 110, ,906.80

9 947 SIGNS & SYMPTOMS W MCC 20, , SIGNS & SYMPTOMS W/O MCC 26, , AFTERCARE W CC/MCC 5, , BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W CC 100, , OTHER FACTORS INFLUENCING HEALTH STATUS 15, , LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA 108, , BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W/O CC/MCC 101, , OTHER MULTIPLE SIGNIFICANT TRAUMA W MCC 139, , OTHER MULTIPLE SIGNIFICANT TRAUMA W CC 20, , NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W MCC 79, , HIV W MAJOR RELATED CONDITION W MCC 242, , HIV W MAJOR RELATED CONDITION W/O CC/MCC 19, , NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W CC 55, , EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC 129, , EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC 75, , EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC 59, , NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W MCC 269, , NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W CC 45, , NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC 25, , NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W/O CC/MCC 41, ,932.91