BERMUDA BERMUDA HOSPITALS BOARD (HOSPITAL FEES) REGULATIONS 2018 BR 110 / 2018

Transcription

1 QUO FA T A F U E R N T BERMUDA BERMUDA HOSPITALS BOARD (HOSPITAL FEES) REGULATIONS 2018 BR 110 / 2018 The Bermuda Hospitals Board, in exercise of the power conferred upon it by section 13 of the Bermuda Hospitals Board Act 1970 and with the approval of the Minister responsible for health, makes the following Regulations: Citation 1 These Regulations may be cited as the Bermuda Hospitals Board (Hospital Fees) Regulations Rates for in-patient treatment of residents in the general hospital 2 (1) The fees payable to the Board by a person who is taken to be ordinarily resident in Bermuda for the purposes of the Health Insurance Act 1970 (in these Regulations referred to as a resident ) for in-patient treatment at the general hospital are (a) (b) in respect of any admission to the hospital with a length of stay of 15 days or less, equal to the amount in Schedule 1 opposite the Diagnosis Related Group to which the patient has been assigned by the attending physician; or in respect of any admission to the hospital with a length of stay of greater than 15 days, equal to the amount referred to in subparagraph (a) plus the product obtained by multiplying the number of days of stay at the hospital greater than 15 days by the per diem rate listed in Part A of Schedule 2. (2) Notwithstanding paragraph (1), the fees payable for in-patient treatment at the general hospital to the Board by residents who are long term care patients or patients requiring hospice care are equal to the product obtained by multiplying the number of days of hospital stay by the applicable per diem rate listed in Part A of Schedule 2. 1

2 Rates for in-patient treatment of non-residents in the general hospital 3 In the case of any person who is not ordinarily resident in Bermuda or who is deemed not to be so resident for the purposes of the Health Insurance Act 1970 (in these Regulations referred to as a non-resident ), the fees payable to the Board for in-patient treatment at the general hospital (a) (b) in respect of any admission to the hospital with a length of stay of 15 days or less, are equal to the amount in Schedule 1 opposite the Diagnosis Related Group to which the patient has been assigned by the attending physician plus a 100% surcharge based on that amount; or in respect of any admission to the hospital with a length of stay of greater than 15 days, are equal to the amount referred to in subparagraph (a) plus the product obtained by multiplying the number of days of stay at the hospital greater than 15 days by the per diem rate listed in Part B of Schedule 2. Rates where patient readmitted with related diagnosis 4 Where a resident referred to in regulation 2 or a non-resident referred to in regulation 3 is readmitted to the general hospital within three days after discharge and is assigned by the attending physician to a Diagnosis Related Group closely related to the one to which he was assigned before discharge, the fees payable to the Board are calculated as provided in regulation 2 or 3, whichever is applicable, as if (a) (b) the length of stay at the hospital for the admission and readmission were one continuous period, not counting the days between discharge and readmission; and the Diagnosis Related Group to which the patient is assigned were the one determined by the attending physician after readmission to be the most appropriate to apply to the entire period referred to in subparagraph (a). Rates for physician charges 5 (1) The fees payable to the Board for in-patient or out-patient treatment of a resident in the general hospital by a physician provided by the Board are as set out in Schedule 3, which (a) (b) in Part A, sets out the fees payable for treatment included in standard health benefit; and in Part B, sets out the fees payable (if any) for treatment excluded from standard health benefit. (2) The fees payable to the Board for in-patient or out-patient treatment of a nonresident in the general hospital by a physician provided by the Board are as set out in Schedule 3 plus a 100% surcharge. 2

3 Rates for treatment of residents in the Mid-Atlantic Wellness Institute 6 (1) The fees payable to the Board by residents for in-patient treatment at the Mid- Atlantic Wellness Institute are equal to the product obtained by multiplying the number of days of stay at the Institute by the applicable per diem rate listed in Part A of Schedule 2. (2) The maximum number of days in any calendar year for which the per diem rate may be charged under paragraph (1) is 40 days. Rates for treatment of residents in hospices 7 The fees payable to the Board for residential hospice care in an establishment under the charge and management of the Board are equal to the product obtained by multiplying the number of days of stay at the hospice by the applicable per diem rate listed in Part A of Schedule 2. Rates for in-patient treatment of non-residents in the Mid-Atlantic Wellness Institute 8 The fees payable to the Board by non-residents for in-patient treatment at the Mid- Atlantic Wellness Institute are equal to the product obtained by multiplying the number of days of stay at the Institute by the applicable per diem rate listed in Part B of Schedule 2. Rates for out-patient treatment 9 (1) The fees payable to the Board by residents for out-patient treatment at the general hospital or in an establishment under the charge and management of the Board are as set out in Schedule 4, which (a) (b) in Part A, sets out the fees payable for treatment included in standard health benefit; and in Part B, sets out the fees payable for treatment excluded from standard health benefit. (2) The fees payable to the Board by non-residents for out-patient treatment at the general hospital or in an establishment under the charge and management of the Board are as set out in Schedule 4 plus a 100% surcharge. Revocation 10 The Bermuda Hospitals Board (Hospital Fees) Regulations 2015 are revoked. 3

4 SCHEDULE 1 (Regulations 2, 3 and 4) IN-PATIENT TREATMENT CHARGE BY DIAGNOSIS RELATED GROUP (DRG) DRG CDM Code DRG Title $ ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R. 124, TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. 78, TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W MCC 34, TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W CC 24, TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W/O CC/MCC 16, INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W MCC 70, INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W CC 53, INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W/O CC/MCC 40, CRANIOTOMY W MAJOR DEVICE IMPLANT OR ACUTE CNS PDX W MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY W NEUROSTIMULATOR 38, CRANIO W MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX W/O MCC 27, CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W MCC 30, CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W CC 21, CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W/O CC/MCC 16, SPINAL PROCEDURES W MCC 39, SPINAL PROCEDURES W CC OR SPINAL NEUROSTIMULATORS 23, SPINAL PROCEDURES W/O CC/MCC 15, VENTRICULAR SHUNT PROCEDURES W MCC 28, VENTRICULAR SHUNT PROCEDURES W CC 15, VENTRICULAR SHUNT PROCEDURES W/O CC/MCC 11, CAROTID ARTERY STENT PROCEDURE W MCC 28, CAROTID ARTERY STENT PROCEDURE W CC 15, CAROTID ARTERY STENT PROCEDURE W/O CC/MCC 12, EXTRACRANIAL PROCEDURES W MCC 22,357 4

5 DRG CDM Code DRG Title $ EXTRACRANIAL PROCEDURES W CC 11, EXTRACRANIAL PROCEDURES W/O CC/MCC 7, PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W MCC 26, PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W CC OR PERIPH NEUROSTIM 16, PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W/ O CC/MCC 13, SPINAL DISORDERS & INJURIES W CC/MCC 10, SPINAL DISORDERS & INJURIES W/O CC/MCC 6, NERVOUS SYSTEM NEOPLASMS W MCC 9, NERVOUS SYSTEM NEOPLASMS W/O MCC 7, DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC 13, DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC 8, MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W MCC 11, MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W CC 7, MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W/O CC/ MCC 5, ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA W THROMBOLYTIC AGENT W MCC 19, ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA W THROMBOLYTIC AGENT W CC 13, ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA W THROMBOLYTIC AGENT W/O CC/MCC 11, INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC 12, INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS 7, INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC 5, NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT W MCC 9, NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT W/O MCC 6, TRANSIENT ISCHEMIA W/O THROMBOLYTIC 5, NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC 11, NONSPECIFIC CEREBROVASCULAR DISORDERS W CC 6, NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC/MCC 5,363 5

6 DRG CDM Code DRG Title $ CRANIAL & PERIPHERAL NERVE DISORDERS W MCC 9, CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC 6, VIRAL MENINGITIS W CC/MCC 11, VIRAL MENINGITIS W/O CC/MCC 6, HYPERTENSIVE ENCEPHALOPATHY W MCC 11, HYPERTENSIVE ENCEPHALOPATHY W CC 7, HYPERTENSIVE ENCEPHALOPATHY W/O CC/MCC 5, NONTRAUMATIC STUPOR & COMA W MCC 12, NONTRAUMATIC STUPOR & COMA W/O MCC 5, TRAUMATIC STUPOR & COMA, COMA >1 HR W MCC 15, TRAUMATIC STUPOR & COMA, COMA >1 HR W CC 8, TRAUMATIC STUPOR & COMA, COMA >1 HR W/O CC/ MCC 6, TRAUMATIC STUPOR & COMA, COMA <1 HR W MCC 14, TRAUMATIC STUPOR & COMA, COMA <1 HR W CC 8, TRAUMATIC STUPOR & COMA, COMA <1 HR W/O CC/ MCC 5, CONCUSSION W MCC 9, CONCUSSION W CC 7, CONCUSSION W/O CC/MCC 5, OTHER DISORDERS OF NERVOUS SYSTEM W MCC 10, OTHER DISORDERS OF NERVOUS SYSTEM W CC 6, OTHER DISORDERS OF NERVOUS SYSTEM W/O CC/ MCC 5, BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W MCC 24, BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W CC 16, BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W/O CC/MCC 15, NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W MCC 24, NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W CC 13, NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W/O CC/MCC 8, SEIZURES W MCC 11, SEIZURES W/O MCC 5, HEADACHES W MCC 7, HEADACHES W/O MCC 5, ORBITAL PROCEDURES W CC/MCC 15, ORBITAL PROCEDURES W/O CC/MCC 9,039 6

7 DRG CDM Code DRG Title $ EXTRAOCULAR PROCEDURES EXCEPT ORBIT 10, INTRAOCULAR PROCEDURES W CC/MCC 10, INTRAOCULAR PROCEDURES W/O CC/MCC 7, ACUTE MAJOR EYE INFECTIONS W CC/MCC 6, ACUTE MAJOR EYE INFECTIONS W/O CC/MCC 5, NEUROLOGICAL EYE DISORDERS 5, OTHER DISORDERS OF THE EYE W MCC 8, OTHER DISORDERS OF THE EYE W/O MCC 5, MAJOR HEAD & NECK PROCEDURES W CC/MCC OR MAJOR DEVICE 16, MAJOR HEAD & NECK PROCEDURES W/O CC/MCC 10, CRANIAL/FACIAL PROCEDURES W CC/MCC 18, CRANIAL/FACIAL PROCEDURES W/O CC/MCC 10, OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W CC/MCC 14, OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W/O CC/MCC 8, SINUS & MASTOID PROCEDURES W CC/MCC 16, SINUS & MASTOID PROCEDURES W/O CC/MCC 9, MOUTH PROCEDURES W CC/MCC 9, MOUTH PROCEDURES W/O CC/MCC 6, SALIVARY GLAND PROCEDURES 7, EAR, NOSE, MOUTH & THROAT MALIGNANCY W MCC 13, EAR, NOSE, MOUTH & THROAT MALIGNANCY W CC 8, EAR, NOSE, MOUTH & THROAT MALIGNANCY W/O CC/ MCC 5, DYSEQUILIBRIUM 4, EPISTAXIS W MCC 9, EPISTAXIS W/O MCC 5, OTITIS MEDIA & URI W MCC 7, OTITIS MEDIA & URI W/O MCC 5, OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W MCC 10, OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W CC 6, OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W/ O CC/MCC 4, DENTAL & ORAL DISEASES W MCC 10, DENTAL & ORAL DISEASES W CC 6, DENTAL & ORAL DISEASES W/O CC/MCC 4, MAJOR CHEST PROCEDURES W MCC 34,867 7

8 DRG CDM Code DRG Title $ MAJOR CHEST PROCEDURES W CC 18, MAJOR CHEST PROCEDURES W/O CC/MCC 13, OTHER RESP SYSTEM O.R. PROCEDURES W MCC 25, OTHER RESP SYSTEM O.R. PROCEDURES W CC 13, OTHER RESP SYSTEM O.R. PROCEDURES W/O CC/MCC 9, PULMONARY EMBOLISM W MCC 10, PULMONARY EMBOLISM W/O MCC 6, RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC 13, RESPIRATORY INFECTIONS & INFLAMMATIONS W CC 9, RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC 6, RESPIRATORY NEOPLASMS W MCC 11, RESPIRATORY NEOPLASMS W CC 8, RESPIRATORY NEOPLASMS W/O CC/MCC 5, MAJOR CHEST TRAUMA W MCC 10, MAJOR CHEST TRAUMA W CC 7, MAJOR CHEST TRAUMA W/O CC/MCC 5, PLEURAL EFFUSION W MCC 10, PLEURAL EFFUSION W CC 7, PLEURAL EFFUSION W/O CC/MCC 5, PULMONARY EDEMA & RESPIRATORY FAILURE 8, CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC 8, CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC 6, CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC 5, SIMPLE PNEUMONIA & PLEURISY W MCC 9, SIMPLE PNEUMONIA & PLEURISY W CC 6, SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC 5, INTERSTITIAL LUNG DISEASE W MCC 11, INTERSTITIAL LUNG DISEASE W CC 7, INTERSTITIAL LUNG DISEASE W/O CC/MCC 5, PNEUMOTHORAX W MCC 12, PNEUMOTHORAX W CC 7, PNEUMOTHORAX W/O CC/MCC 5, BRONCHITIS & ASTHMA W CC/MCC 6, BRONCHITIS & ASTHMA W/O CC/MCC 4, RESPIRATORY SIGNS & SYMPTOMS 5, OTHER RESPIRATORY SYSTEM DIAGNOSES W MCC 10, OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC 6, RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS 38,693 8

9 DRG CDM Code DRG Title $ RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS 16, OTHER HEART ASSIST SYSTEM IMPLANT 90, CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/ SHOCK W MCC 59, CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/ SHOCK W/O MCC 45, CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/ HF/SHOCK W MCC 51, CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/ HF/SHOCK W/O MCC 39, CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W MCC 47, CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W/O MCC 38, OTHER CARDIOTHORACIC PROCEDURES W MCC 46, OTHER CARDIOTHORACIC PROCEDURES W/O MCC 32, AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W MCC 32, AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W CC 18, AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W/O CC/MCC 10, PERMANENT CARDIAC PACEMAKER IMPLANT W MCC 26, PERMANENT CARDIAC PACEMAKER IMPLANT W CC 18, PERMANENT CARDIAC PACEMAKER IMPLANT W/O CC/ MCC 15, AICD GENERATOR PROCEDURES 38, PERCUTANEOUS CARDIOVASCULAR PROCEDURES W DRUG-ELUTING STENT W MCC OR 4+ ARTERIES OR STENTS 22, PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/ O MCC 14, PERCUTANEOUS CARDIOVASCULAR PROCEDURES W NON-DRUG-ELUTING STENT W MCC OR 4+ ARTERIES OR STENTS 21, PERC CARDIOVASC PROC W NON-DRUG-ELUTING STENT W/O MCC 13, PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W MCC 17, PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W/O MCC 11, OTHER VASCULAR PROCEDURES W MCC 22,812 9

10 DRG CDM Code DRG Title $ OTHER VASCULAR PROCEDURES W CC 17, OTHER VASCULAR PROCEDURES W/O CC/MCC 12, UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W MCC 17, UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W CC 12, UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W/O CC/MCC 7, CARDIAC PACEMAKER DEVICE REPLACEMENT W MCC 21, CARDIAC PACEMAKER DEVICE REPLACEMENT W/O MCC 14, CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W MCC 25, CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W CC 13, CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W/O CC/MCC 11, VEIN LIGATION & STRIPPING 16, OTHER CIRCULATORY SYSTEM O.R. PROCEDURES 22, AICD LEAD PROCEDURES 23, ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC 11, ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC 6, ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC 5, ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC 12, ACUTE MYOCARDIAL INFARCTION, EXPIRED W CC 5, ACUTE MYOCARDIAL INFARCTION, EXPIRED W/O CC/ MCC 3, CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W MCC 15, CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC 8, ACUTE & SUBACUTE ENDOCARDITIS W MCC 19, ACUTE & SUBACUTE ENDOCARDITIS W CC 11, ACUTE & SUBACUTE ENDOCARDITIS W/O CC/MCC 7, HEART FAILURE & SHOCK W MCC 10, HEART FAILURE & SHOCK W CC 6, HEART FAILURE & SHOCK W/O CC/MCC 4, DEEP VEIN THROMBOPHLEBITIS W CC/MCC 7, DEEP VEIN THROMBOPHLEBITIS W/O CC/MCC 5,542 10

11 DRG CDM Code DRG Title $ CARDIAC ARREST, UNEXPLAINED W MCC 10, CARDIAC ARREST, UNEXPLAINED W CC 4, CARDIAC ARREST, UNEXPLAINED W/O CC/MCC 3, PERIPHERAL VASCULAR DISORDERS W MCC 9, PERIPHERAL VASCULAR DISORDERS W CC 7, PERIPHERAL VASCULAR DISORDERS W/O CC/MCC 5, ATHEROSCLEROSIS W MCC 7, ATHEROSCLEROSIS W/O MCC 4, HYPERTENSION W MCC 7, HYPERTENSION W/O MCC 4, CARDIAC CONGENITAL & VALVULAR DISORDERS W MCC 9, CARDIAC CONGENITAL & VALVULAR DISORDERS W/O MCC 5, CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC 8, CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC 5, CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/ O CC/MCC 3, ANGINA PECTORIS 4, SYNCOPE & COLLAPSE 5, CHEST PAIN 4, OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC 13, OTHER CIRCULATORY SYSTEM DIAGNOSES W CC 6, OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC/ MCC 5, STOMACH, ESOPHAGEAL & DUODENAL PROC W MCC 32, STOMACH, ESOPHAGEAL & DUODENAL PROC W CC 14, STOMACH, ESOPHAGEAL & DUODENAL PROC W/O CC/ MCC 10, MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC 34, MAJOR SMALL & LARGE BOWEL PROCEDURES W CC 17, MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC 11, RECTAL RESECTION W MCC 26, RECTAL RESECTION W CC 14, RECTAL RESECTION W/O CC/MCC 9, PERITONEAL ADHESIOLYSIS W MCC 28, PERITONEAL ADHESIOLYSIS W CC 16, PERITONEAL ADHESIOLYSIS W/O CC/MCC 11,416 11

12 DRG CDM Code DRG Title $ APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W MCC 19, APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC 12, APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/ O CC/MCC 8, APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W MCC 17, APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC 10, APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC 7, MINOR SMALL & LARGE BOWEL PROCEDURES W MCC 19, MINOR SMALL & LARGE BOWEL PROCEDURES W CC 11, MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC/ MCC 7, ANAL & STOMAL PROCEDURES W MCC 18, ANAL & STOMAL PROCEDURES W CC 9, ANAL & STOMAL PROCEDURES W/O CC/MCC 7, INGUINAL & FEMORAL HERNIA PROCEDURES W MCC 17, INGUINAL & FEMORAL HERNIA PROCEDURES W CC 10, INGUINAL & FEMORAL HERNIA PROCEDURES W/O CC/ MCC 7, HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W MCC 21, HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W CC 12, HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W/O CC/MCC 9, OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W MCC 26, OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC 14, OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W/O CC/MCC 9, MAJOR ESOPHAGEAL DISORDERS W MCC 12, MAJOR ESOPHAGEAL DISORDERS W CC 7, MAJOR ESOPHAGEAL DISORDERS W/O CC/MCC 5, MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC 12, MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC 7, MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W/O CC/MCC 5,377 12

13 DRG CDM Code DRG Title $ DIGESTIVE MALIGNANCY W MCC 14, DIGESTIVE MALIGNANCY W CC 8, DIGESTIVE MALIGNANCY W/O CC/MCC 6, G.I. HEMORRHAGE W MCC 12, G.I. HEMORRHAGE W CC 6, G.I. HEMORRHAGE W/O CC/MCC 4, COMPLICATED PEPTIC ULCER W MCC 13, COMPLICATED PEPTIC ULCER W CC 7, COMPLICATED PEPTIC ULCER W/O CC/MCC 5, UNCOMPLICATED PEPTIC ULCER W MCC 9, UNCOMPLICATED PEPTIC ULCER W/O MCC 6, INFLAMMATORY BOWEL DISEASE W MCC 11, INFLAMMATORY BOWEL DISEASE W CC 6, INFLAMMATORY BOWEL DISEASE W/O CC/MCC 5, G.I. OBSTRUCTION W MCC 10, G.I. OBSTRUCTION W CC 6, G.I. OBSTRUCTION W/O CC/MCC 4, ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC 8, ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC 5, OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC 11, OTHER DIGESTIVE SYSTEM DIAGNOSES W CC 6, OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC 4, PANCREAS, LIVER & SHUNT PROCEDURES W MCC 37, PANCREAS, LIVER & SHUNT PROCEDURES W CC 19, PANCREAS, LIVER & SHUNT PROCEDURES W/O CC/ MCC 14, BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W MCC 27, BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W CC 16, BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W/O CC/MCC 12, CHOLECYSTECTOMY W C.D.E. W MCC 23, CHOLECYSTECTOMY W C.D.E. W CC 16, CHOLECYSTECTOMY W C.D.E. W/O CC/MCC 11, CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W MCC 25, CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC 14,258 13

14 DRG CDM Code DRG Title $ CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W/O CC/MCC 9, LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC 16, LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC 11, LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC 9, HEPATOBILIARY DIAGNOSTIC PROCEDURES W MCC 28, HEPATOBILIARY DIAGNOSTIC PROCEDURES W CC 13, HEPATOBILIARY DIAGNOSTIC PROCEDURES W/O CC/ MCC 10, OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W MCC 26, OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W CC 15, OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W/O CC/MCC 11, CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC 12, CIRRHOSIS & ALCOHOLIC HEPATITIS W CC 7, CIRRHOSIS & ALCOHOLIC HEPATITIS W/O CC/MCC 4, MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W MCC 11, MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W CC 8, MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W/O CC/MCC 6, DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC 11, DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC 6, DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC 4, DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W MCC 12, DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC 6, DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W/O CC/MCC 4, DISORDERS OF THE BILIARY TRACT W MCC 11, DISORDERS OF THE BILIARY TRACT W CC 7, DISORDERS OF THE BILIARY TRACT W/O CC/MCC 5, COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W MCC 68,723 14

15 DRG CDM Code DRG Title $ COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W CC 45, COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W/ O CC/MCC 35, SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W MCC 64, SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W CC 48, SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W/O CC/MCC 37, SPINAL FUSION EXCEPT CERVICAL W MCC 42, SPINAL FUSION EXCEPT CERVICAL W/O MCC 28, BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W MCC 34, BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W/O MCC 23, WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO- CONN TISS DIS W MCC 35, WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO- CONN TISS DIS W CC 20, WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO- CONN TISS DIS W/O CC/MCC 13, REVISION OF HIP OR KNEE REPLACEMENT W MCC 35, REVISION OF HIP OR KNEE REPLACEMENT W CC 24, REVISION OF HIP OR KNEE REPLACEMENT W/O CC/ MCC 19, MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC OR TOTAL ANKLE REPLACEMENT 22, MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC 14, CERVICAL SPINAL FUSION W MCC 34, CERVICAL SPINAL FUSION W CC 20, CERVICAL SPINAL FUSION W/O CC/MCC 16, AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W MCC 27, AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W CC 15, AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W/O CC/MCC 8, BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC 22,810 15

16 DRG CDM Code DRG Title $ BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC 15, BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC 12, HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC 21, HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC 14, HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/ O CC/MCC 11, MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES 17, KNEE PROCEDURES W PDX OF INFECTION W MCC 22, KNEE PROCEDURES W PDX OF INFECTION W CC 15, KNEE PROCEDURES W PDX OF INFECTION W/O CC/ MCC 11, KNEE PROCEDURES W/O PDX OF INFECTION W CC/ MCC 14, KNEE PROCEDURES W/O PDX OF INFECTION W/O CC/ MCC 9, LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W MCC 23, LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W CC 15, LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W/O CC/MCC 12, LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W MCC 21, LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W CC 13, LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W/O CC/MCC 9, LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W CC/MCC 17, LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W/O CC/MCC 8, SOFT TISSUE PROCEDURES W MCC 20, SOFT TISSUE PROCEDURES W CC 11, SOFT TISSUE PROCEDURES W/O CC/MCC 8, FOOT PROCEDURES W MCC 17, FOOT PROCEDURES W CC 12, FOOT PROCEDURES W/O CC/MCC 10, MAJOR THUMB OR JOINT PROCEDURES 9,731 16

17 DRG CDM Code DRG Title $ MAJOR SHOULDER OR ELBOW JOINT PROCEDURES W CC/MCC 13, MAJOR SHOULDER OR ELBOW JOINT PROCEDURES W/ O CC/MCC 10, ARTHROSCOPY 12, SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W MCC 17, SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W CC 12, SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W/O CC/MCC 10, HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W CC/MCC 11, HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W/O CC/MCC 7, OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W MCC 20, OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC 13, OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC/MCC 10, BACK & NECK PROC EXC SPINAL FUSION W MCC OR DISC DEVICE/NEUROSTIM 20, BACK & NECK PROC EXC SPINAL FUSION W CC 12, BACK & NECK PROC EXC SPINAL FUSION W/O CC/MCC 9, FRACTURES OF FEMUR W MCC 10, FRACTURES OF FEMUR W/O MCC 5, FRACTURES OF HIP & PELVIS W MCC 8, FRACTURES OF HIP & PELVIS W/O MCC 5, SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH W CC/MCC 6, SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH W/O CC/MCC 4, OSTEOMYELITIS W MCC 13, OSTEOMYELITIS W CC 9, OSTEOMYELITIS W/O CC/MCC 6, PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W MCC 12, PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W CC 7, PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W/O CC/MCC 5,473 17

18 DRG CDM Code DRG Title $ CONNECTIVE TISSUE DISORDERS W MCC 16, CONNECTIVE TISSUE DISORDERS W CC 7, CONNECTIVE TISSUE DISORDERS W/O CC/MCC 5, SEPTIC ARTHRITIS W MCC 14, SEPTIC ARTHRITIS W CC 8, SEPTIC ARTHRITIS W/O CC/MCC 6, MEDICAL BACK PROBLEMS W MCC 10, MEDICAL BACK PROBLEMS W/O MCC 6, BONE DISEASES & ARTHROPATHIES W MCC 9, BONE DISEASES & ARTHROPATHIES W/O MCC 5, SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W MCC 8, SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W/O MCC 5, TENDONITIS, MYOSITIS & BURSITIS W MCC 10, TENDONITIS, MYOSITIS & BURSITIS W/O MCC 6, AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC 11, AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC 7, AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC 5, FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W MCC 9, FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC 5, OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W MCC 10, OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W CC 6, OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W/O CC/MCC 5, SKIN DEBRIDEMENT W MCC 18, SKIN DEBRIDEMENT W CC 11, SKIN DEBRIDEMENT W/O CC/MCC 8, SKIN GRAFT FOR SKIN ULCER OR CELLULITIS W MCC 28, SKIN GRAFT FOR SKIN ULCER OR CELLULITIS W CC 20, SKIN GRAFT FOR SKIN ULCER OR CELLULITIS W/O CC/ MCC 12, SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W MCC 31, SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W CC 17,232 18

19 DRG CDM Code DRG Title $ SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W/O CC/MCC 10, OTHER SKIN, SUBCUT TISS & BREAST PROC W MCC 18, OTHER SKIN, SUBCUT TISS & BREAST PROC W CC 10, OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/ MCC 8, MASTECTOMY FOR MALIGNANCY W CC/MCC 10, MASTECTOMY FOR MALIGNANCY W/O CC/MCC 9, BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W CC/MCC 13, BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W/O CC/MCC 11, SKIN ULCERS W MCC 10, SKIN ULCERS W CC 7, SKIN ULCERS W/O CC/MCC 5, MAJOR SKIN DISORDERS W MCC 14, MAJOR SKIN DISORDERS W/O MCC 6, MALIGNANT BREAST DISORDERS W MCC 12, MALIGNANT BREAST DISORDERS W CC 7, MALIGNANT BREAST DISORDERS W/O CC/MCC 6, NON-MALIGNANT BREAST DISORDERS W CC/MCC 6, NON-MALIGNANT BREAST DISORDERS W/O CC/MCC 4, CELLULITIS W MCC 10, CELLULITIS W/O MCC 5, TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W MCC 9, TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W/O MCC 5, MINOR SKIN DISORDERS W MCC 9, MINOR SKIN DISORDERS W/O MCC 5, ADRENAL & PITUITARY PROCEDURES W CC/MCC 16, ADRENAL & PITUITARY PROCEDURES W/O CC/MCC 10, AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W MCC 28, AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W CC 14, AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W/O CC/MCC 8, O.R. PROCEDURES FOR OBESITY W MCC 21, O.R. PROCEDURES FOR OBESITY W CC 12, O.R. PROCEDURES FOR OBESITY W/O CC/MCC 11, SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W MCC 25,479 19

20 DRG CDM Code DRG Title $ SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC 13, SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W/O CC/MCC 8, THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W MCC 18, THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W CC 10, THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W/O CC/MCC 7, OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W MCC 25, OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W CC 16, OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W/O CC/MCC 11, DIABETES W MCC 9, DIABETES W CC 6, DIABETES W/O CC/MCC 4, MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W MCC 8, MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC 5, INBORN AND OTHER DISORDERS OF METABOLISM 8, ENDOCRINE DISORDERS W MCC 11, ENDOCRINE DISORDERS W CC 7, ENDOCRINE DISORDERS W/O CC/MCC 5, KIDNEY TRANSPLANT 23, MAJOR BLADDER PROCEDURES W MCC 39, MAJOR BLADDER PROCEDURES W CC 19, MAJOR BLADDER PROCEDURES W/O CC/MCC 14, KIDNEY & URETER PROCEDURES FOR NEOPLASM W MCC 22, KIDNEY & URETER PROCEDURES FOR NEOPLASM W CC 13, KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC 11, KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W MCC 24, KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W CC 12, KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W/O CC/MCC 10, MINOR BLADDER PROCEDURES W MCC 21,487 20

21 DRG CDM Code DRG Title $ MINOR BLADDER PROCEDURES W CC 12, MINOR BLADDER PROCEDURES W/O CC/MCC 9, PROSTATECTOMY W MCC 22, PROSTATECTOMY W CC 12, PROSTATECTOMY W/O CC/MCC 6, TRANSURETHRAL PROCEDURES W MCC 18, TRANSURETHRAL PROCEDURES W CC 9, TRANSURETHRAL PROCEDURES W/O CC/MCC 6, URETHRAL PROCEDURES W CC/MCC 10, URETHRAL PROCEDURES W/O CC/MCC 7, OTHER KIDNEY & URINARY TRACT PROCEDURES W MCC 24, OTHER KIDNEY & URINARY TRACT PROCEDURES W CC 16, OTHER KIDNEY & URINARY TRACT PROCEDURES W/O CC/MCC 11, RENAL FAILURE W MCC 10, RENAL FAILURE W CC 6, RENAL FAILURE W/O CC/MCC 4, ADMIT FOR RENAL DIALYSIS 7, KIDNEY & URINARY TRACT NEOPLASMS W MCC 12, KIDNEY & URINARY TRACT NEOPLASMS W CC 7, KIDNEY & URINARY TRACT NEOPLASMS W/O CC/MCC 6, KIDNEY & URINARY TRACT INFECTIONS W MCC 7, KIDNEY & URINARY TRACT INFECTIONS W/O MCC 5, URINARY STONES W ESW LITHOTRIPSY W CC/MCC 11, URINARY STONES W ESW LITHOTRIPSY W/O CC/MCC 8, URINARY STONES W/O ESW LITHOTRIPSY W MCC 10, URINARY STONES W/O ESW LITHOTRIPSY W/O MCC 5, KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W MCC 8, KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W/O MCC 4, URETHRAL STRICTURE 7, OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC 11, OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC 7, OTHER KIDNEY & URINARY TRACT DIAGNOSES W/O CC/MCC 5, MAJOR MALE PELVIC PROCEDURES W CC/MCC 12, MAJOR MALE PELVIC PROCEDURES W/O CC/MCC 9, PENIS PROCEDURES W CC/MCC 16, PENIS PROCEDURES W/O CC/MCC 10, TESTES PROCEDURES W CC/MCC 14,250 21

22 DRG CDM Code DRG Title $ TESTES PROCEDURES W/O CC/MCC 6, TRANSURETHRAL PROSTATECTOMY W CC/MCC 10, TRANSURETHRAL PROSTATECTOMY W/O CC/MCC 6, OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC FOR MALIGNANCY W CC/MCC 15, OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC FOR MALIGNANCY W/O CC/MCC 10, OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY W CC/MCC 13, OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY W/O CC/MCC 8, MALIGNANCY, MALE REPRODUCTIVE SYSTEM W MCC 12, MALIGNANCY, MALE REPRODUCTIVE SYSTEM W CC 7, MALIGNANCY, MALE REPRODUCTIVE SYSTEM W/O CC/ MCC 5, BENIGN PROSTATIC HYPERTROPHY W MCC 8, BENIGN PROSTATIC HYPERTROPHY W/O MCC 5, INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W MCC 10, INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W/O MCC 5, OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES W CC/MCC 7, OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES W/ O CC/MCC 4, PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY W CC/MCC 15, PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY W/O CC/MCC 9, UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W MCC 27, UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W CC 13, UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W/O CC/MCC 9, UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W MCC 24, UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W CC 12, UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W/O CC/MCC 8, UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC 11,562 22

23 DRG CDM Code DRG Title $ UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC 7, D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W CC/MCC 11, D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W/O CC/MCC 7, VAGINA, CERVIX & VULVA PROCEDURES W CC/MCC 11, VAGINA, CERVIX & VULVA PROCEDURES W/O CC/MCC 6, FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES 8, OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES W CC/MCC 18, OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES W/O CC/MCC 9, MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W MCC 12, MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W CC 7, MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC 4, INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W MCC 10, INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W CC 7, INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC 5, MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W CC/MCC 6, MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W/O CC/MCC 4, CESAREAN SECTION W CC/MCC 8, CESAREAN SECTION W/O CC/MCC 5, VAGINAL DELIVERY W STERILIZATION &/OR D&C 6, VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C 7, POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE 12, ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY 5, VAGINAL DELIVERY W COMPLICATING DIAGNOSES 5, VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES 4, POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE 5, ECTOPIC PREGNANCY 6, THREATENED ABORTION 4,294 23

24 DRG CDM Code DRG Title $ ABORTION W/O D&C 4, FALSE LABOR 3, OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS 6, OTHER ANTEPARTUM DIAGNOSES W/O MEDICAL COMPLICATIONS 4, NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY 11, EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE 38, PREMATURITY W MAJOR PROBLEMS 26, PREMATURITY W/O MAJOR PROBLEMS 15, FULL TERM NEONATE W MAJOR PROBLEMS 26, NEONATE W OTHER SIGNIFICANT PROBLEMS 9, NORMAL NEWBORN 1, SPLENECTOMY W MCC 34, SPLENECTOMY W CC 18, SPLENECTOMY W/O CC/MCC 12, OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W MCC 22, OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W CC 13, OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W/O CC/MCC 8, MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W MCC 15, MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC 8, MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W/O CC/MCC 6, RED BLOOD CELL DISORDERS W MCC 9, RED BLOOD CELL DISORDERS W/O MCC 6, COAGULATION DISORDERS 12, RETICULOENDOTHELIAL & IMMUNITY DISORDERS W MCC 12, RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC 7, RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC/MCC 4, LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W MCC 38,221 24

25 DRG CDM Code DRG Title $ LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W CC 16, LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W/O CC/MCC 8, LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER PROC W MCC 30, LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER PROC W CC 15, LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER PROC W/O CC/MCC 9, MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W MCC 36, MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W CC 16, MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W/O CC/MCC 11, MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS W OTHER PROCEDURE W CC/MCC 22, MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS W OTHER PROCEDURE W/O CC/MCC 9, ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W MCC 38, ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W CC 14, ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W/O CC/MCC 9, CHEMO W ACUTE LEUKEMIA AS SDX OR W HIGH DOSE CHEMO AGENT W MCC 40, CHEMO W ACUTE LEUKEMIA AS SDX W CC OR HIGH DOSE CHEMO AGENT 16, CHEMO W ACUTE LEUKEMIA AS SDX W/O CC/MCC 9, LYMPHOMA & NON-ACUTE LEUKEMIA W MCC 21, LYMPHOMA & NON-ACUTE LEUKEMIA W CC 11, LYMPHOMA & NON-ACUTE LEUKEMIA W/O CC/MCC 7, OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W MCC 12, OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC 8, OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W/O CC/MCC 6, CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W MCC 16,794 25

26 DRG CDM Code DRG Title $ CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W CC 8, CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W/O CC/MCC 6, RADIOTHERAPY 12, INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC 36, INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC 16, INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W/O CC/MCC 10, POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W MCC 31, POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W CC 14, POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W/O CC/MCC 9, POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W MCC 12, POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC 7, FEVER 6, VIRAL ILLNESS W MCC 10, VIRAL ILLNESS W/O MCC 5, OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W MCC 14, OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W CC 7, OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W/O CC/MCC 5, SEPTICEMIA OR SEVERE SEPSIS W MV >96 HOURS 42, SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC 12, SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC 7, O.R. PROCEDURE W PRINCIPAL DIAGNOSES OF MENTAL ILLNESS 24, ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION 5, DEPRESSIVE NEUROSES 5, NEUROSES EXCEPT DEPRESSIVE 5, DISORDERS OF PERSONALITY & IMPULSE CONTROL 8, ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY 8,707 26

27 DRG CDM Code DRG Title $ PSYCHOSES 8, BEHAVIORAL & DEVELOPMENTAL DISORDERS 7, OTHER MENTAL DISORDER DIAGNOSES 7, ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA 3, ALCOHOL/DRUG ABUSE OR DEPENDENCE W REHABILITATION THERAPY 9, ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCC 11, ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC 5, WOUND DEBRIDEMENTS FOR INJURIES W MCC 29, WOUND DEBRIDEMENTS FOR INJURIES W CC 14, WOUND DEBRIDEMENTS FOR INJURIES W/O CC/MCC 8, SKIN GRAFTS FOR INJURIES W CC/MCC 22, SKIN GRAFTS FOR INJURIES W/O CC/MCC 10, HAND PROCEDURES FOR INJURIES 12, OTHER O.R. PROCEDURES FOR INJURIES W MCC 29, OTHER O.R. PROCEDURES FOR INJURIES W CC 14, OTHER O.R. PROCEDURES FOR INJURIES W/O CC/MCC 9, TRAUMATIC INJURY W MCC 9, TRAUMATIC INJURY W/O MCC 5, ALLERGIC REACTIONS W MCC 11, ALLERGIC REACTIONS W/O MCC 4, POISONING & TOXIC EFFECTS OF DRUGS W MCC 9, POISONING & TOXIC EFFECTS OF DRUGS W/O MCC 5, COMPLICATIONS OF TREATMENT W MCC 12, COMPLICATIONS OF TREATMENT W CC 7, COMPLICATIONS OF TREATMENT W/O CC/MCC 5, OTHER INJURY, POISONING & TOXIC EFFECT DIAG W MCC 10, OTHER INJURY, POISONING & TOXIC EFFECT DIAG W/ O MCC 5, EXTENSIVE BURNS OR FULL THICKNESS BURNS W MV >96 HRS W SKIN GRAFT 119, FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W CC/MCC 40, FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W/ O CC/MCC 18, EXTENSIVE BURNS OR FULL THICKNESS BURNS W MV >96 HRS W/O SKIN GRAFT 22, FULL THICKNESS BURN W/O SKIN GRFT OR INHAL INJ 12, NON-EXTENSIVE BURNS 11,908 27

28 DRG CDM Code DRG Title $ O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W MCC 24, O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W CC 16, O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W/O CC/MCC 13, REHABILITATION W CC/MCC 8, REHABILITATION W/O CC/MCC 7, SIGNS & SYMPTOMS W MCC 8, SIGNS & SYMPTOMS W/O MCC 5, AFTERCARE W CC/MCC 8, AFTERCARE W/O CC/MCC 5, OTHER FACTORS INFLUENCING HEALTH STATUS 5, CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA 42, LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA 27, OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W MCC 51, OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W CC 30, OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W/O CC/MCC 19, OTHER MULTIPLE SIGNIFICANT TRAUMA W MCC 18, OTHER MULTIPLE SIGNIFICANT TRAUMA W CC 10, OTHER MULTIPLE SIGNIFICANT TRAUMA W/O CC/MCC 7, HIV W EXTENSIVE O.R. PROCEDURE W MCC 38, HIV W EXTENSIVE O.R. PROCEDURE W/O MCC 18, HIV W MAJOR RELATED CONDITION W MCC 19, HIV W MAJOR RELATED CONDITION W CC 9, HIV W MAJOR RELATED CONDITION W/O CC/MCC 7, HIV W OR W/O OTHER RELATED CONDITION 9, EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC 30, EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC 17, EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC 11, NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W MCC 22, NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W CC 12,067 28